c:\work\Jor\vol931_1 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6892-6896

Analgesic Efficacy of Levobupivacaine Injected Intraarticularly
Following Knee Arthroscopy
Ehab M. Mokbel*, Mona A. Hashish, Sherif A. Mousa, Hazem E. M. Weheba, Aalaa M. Qassem
Department of Anesthesia, ICU and Pain Management, Faculty of Medicine Mansoura University, Egypt
*Corresponding author: Ehab M. Mokbel, Mobile: (+20) 01064970209, E-mail: ehabmokbel@yahoo.com

One of the most popular surgeries is arthroscopic knee surgery. The majority of the knee's intraarticular
structures include free nerve endings that may detect painful stimuli and cause excruciating pain. For the rehabilitation
of the knee after surgery, effective pain treatment is crucial. Levobupivacaine is an example of an intraarticular local
anaesthetic that may be used to treat pain because it produces a direct blocking of the nociceptive pain response at the
site of injection with very little systemic absorption.
Objective: To evaluate the analgesic efficacy of levobupivacaine injected intraarticularly following knee arthroscopy.
Patient and method: Eighty patients (ASA I or II) of either sex, aged from 18-70 years undergoing elective arthroscopic
knee surgery were randomly categorized into two groups 40 patients for each. Group C received 20 ml normal saline
0.9%. Group L received levobupivacaine 0.5% (Chirocaine® 5mg/ml from Abbott) intraarticularly at the end of the
surgery and 10 min before tourniquet deflation. Patients were monitored postoperatively by using (VAS) score, (HR)
and (MBP) at 1, 6, 12, 18, 24 hours.
We found that intraarticular levobupivacaine injection after knee arthroscopy provides postoperative analgesia
without causing hemodynamic instability with less postoperative supplemental analgesic requirements. Postoperative
VAS score was statistically significant lower in group L when compared to group C. The time of the first request for
analgesia was longer in group L than group C. However, there was no serious side effects detected in either groups.
Intraarticular levobupivacaine injection after knee arthroscopy provides efficient postoperative analgesia,
less postoperative supplemental analgesic requirements with hemodynamic stability and insignificant complications.
Keywords: Levobupivacaine, Intraarticular, Postoperative pain, Arthroscopy.

surgery patients of either sex, 18­70 years old, with an
Knee arthroscopy has reduced morbidity
American Society of Anesthesiologists (ASA) physical
compared to open operations and protected patients
status I or II were included.
from having huge incisions, but it has not done away

with discomfort (1). The majority of the knee's
Exclusion criteria: Exclusion criteria included patients
intraarticular components, such as the synovial tissue,
under chronic treatment with opioids or NSAIDs,
the anterior fat pad, and the joint capsule, have free
patients with contraindication to spinal anesthesia
nerve endings that may detect unpleasant stimuli and
(infection at site of administration, bleeding disorders),
cause excruciating pain (2). Due to their direct blockage
patients who are allergic to (levobupivacaine or
of the nociceptive pain response at the site of injection
diclofenac Na), patients who had hemorrhagic or
and little systemic absorption, intraarticular local
clotting disorders, or who refused to take part in the
anaesthetics are frequently utilised for pain
management following arthroscopic knee surgery (3).

An amino amide local anaesthetic is
Anesthetic Management:
levobupivacaine. Levobupivacaine and bupivacaine
Preoperative evaluations of all patients included
share a chemical similarity, however research has
obtaining their medical histories, doing physical exams,
demonstrated that levobupivacaine is less harmful to the
ordering electrocardiograms (ECGs), and reviewing
heart and central nervous system (4). Levobupivacaine
their lab results (full blood counts, hepatic and renal
appears to have a greater margin of safety than
function tests, and coagulation profiles). All patients
bupivacaine when it comes to adverse cardiovascular
received instruction on how to evaluate pain using a 10
and central effects when taken at high doses (5).
cm visual analogue scale (VAS) the day before surgery.
The aim of this study was to evaluate the analgesic
The scale is a horizontal 10 cm line that ranges from 0
efficacy of levobupivacaine injected intraarticularly
("no pain") to 10 ("worst imaginable pain") (6).
Patients were instructed to mark a vertical line at a
complications and hemodynamic changes will be also
position that corresponded to their point of discomfort.
Using the closed-envelope approach, the patients were

randomly split into two equal groups, 40 patients each.
The administration of intraarticular medicines was
From March 2014 to April 2016, this
concealed from the patients and the administrator. An
randomised, double-blinded trial was conducted at the
anesthesiologist who was blind to the study created the
knee arthroscopic surgery department of Mansoura
study solutions.
University Hospital. In this study, 80 arthroscopic knees
Received: 02/07/2023
Accepted: 02/09/2023

Full Paper (vol.931 paper# 1)

c:\work\Jor\vol931_2 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6897-6907

Reflected Shadows of Chronic Hepatitis C Virus Infection on its Victims Undergoing
Coronary Artery Bypass Grafting Surgery: 10-Years' Experience
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
3Medical colleague of General Medicine in Department 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) 01225386221,
E-mail: ahmedsaber78@yahoo.com, ORCID ID: https://orcid.org/0000-0003-1243-401X

Due to the improvement of the treatment lines for the victims of chronic hepatitis C viral (HCV) infection,
more survivors elapsed and a larger cohort of patients undergoing coronary artery bypass grafting (CABG) surgery is
frequently operated upon. Their hepatic condition represents a surgical challenge because of the higher risk of
postoperative complications and mortality.
Objective: This study aimed to trace the impact of chronic HCV infection in patients undergoing CABG in the
immediate postoperative period and to identify the predictive risk factors involved in the worse outcomes.
Patients and Methods:
This retrospective comparative study included 421 patients presented with ischemic heart
disease (IHD) and operated upon by CABG. They were divided into group (A) including chronic HCV infection (196)
patients while group (B) including the "free" of HCV infection (225) patients.
Multivariable logistic regression analysis showed that higher model for end-stage liver disease (MELD) score
(OR: 3.140 (95% CI: 1.025-10.964); p= 0.019), lower preoperative platelets count (OR: 3.650 (95% CI: 1.166-12.778);
p= 0.023), higher preoperative total bilirubin (OR: 1.256 (95% CI: 1.035-1.859); p= 0.021), higher preoperative
creatinine (OR: 0.528 (95% CI: 0.345-1.012); p= 0.028) and prolonged cardiopulmonary bypass (CPB) time (OR: 1.145
(95% CI: 0.985-1.925); p= 0.020) were the significant predictors of postoperative morbidity and higher MELD score
(OR: 3.220 (95% CI: 1.198-9.130); p= 0.018) and intraoperative blood transfusion (OR: 3.201 (95% CI: 1.595-6.411);
p= 0.020) were the significant predictors of perioperative mortality.
Conclusion: Identification and careful evaluation of the predictive risk factors may reduce serious post-surgical adverse
outcomes. Greater careful consideration should be offered to patients with preoperative high MELD score, low platelets
count, high total bilirubin and high creatinine. We recommend using the MELD score as a risk model in this subset of
patients in prediction of the postoperative morbidity and mortality along with the currently used ones, which should
involve hepatic dysfunction in its risk scoring system.
Key words: Chronic HCV infection, CABG, HCV.

carotid artery disease and cerebral strokes. It's also
Viral hepatitis represents a serious national and
associated with diabetes mellitus (DM), insulin
international medical dilemma. One of the most
resistance and kidney diseases (8).
prevalent and important etiological agents is HCV. It's
Although there is much controversy among the
a member of the Flaviviridae family (1). Its prevalence is
reported data concerning the risk of chronic HCV
2.5-3 % worldwide. It causes chronic hepatitis C viral
infection as an independent factor initiating the process
infection (chronic HCV infection) with consequent
of atherosclerosis (9, 10), different mechanisms were
hepatic fibrosis, cirrhosis, liver cell failure and lethal
demonstrated explaining its active role. Recent reports
hepatocellular carcinoma and mortality in 175 million
suggest both direct and indirect mechanisms. Direct
people globally (2). Almost 50 % of the deaths assumed
pathway is explained on the basis of vascular wall
to be due to viral hepatitis, which is termed as the
chronic viral infection, inflammation, direct viral
seventh leading cause of death worldwide (3) and is due
invasion and colonization of the wall plaque and
to HCV (4).
endothelial dysfunction. The indirect pathway is
Egypt has HCV infection rates higher than the
claimed to be a metabolic process via chronic HCV
worldwide ones (5). According to Egypt Demographic
infection interference with both lipid and sugar
and Health Surveys (EDHS) in 2009, it was 14.7 % in
metabolism resulting in insulin resistance, DM type 2
15­59 years citizens and 18 % in rural inhabitants (6),
and hepatic steatosis, which are risk factors of
and the rate declined to 10 % in 2015 (7). It isn't only the
atherosclerosis (11).
liver that is affected by the chronic HCV infection but
The proatherogenic effect of chronic HCV
also there are multiple extrahepatic affections. The list
infection of the vascular atherosclerotic plaque on the
includes atherosclerosis and cardiovascular disease
endothelial cells, smooth muscle cells, monocytes,
including coronary (ischemic) heart disease (IHD),
macrophages, and T cells has been proved. Also,
Received: 05/05/2023
Accepted: 04/07/2023

Full Paper (vol.931 paper# 2)

c:\work\Jor\vol931_3 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6908-6913

Effect of Action Observation Physical Training on Quality of Upper Limb and
Functional Independence in Children with Hemiplegia
Heba Essam Abdelfattah, Eman Ibrahim ElHadidy, Alaa Fahmy Al-Nemr
Department of Physical Therapy for Pediatrics Faculty of Physical Therapy, Cairo University, Giza, Egypt
Corresponding author: Heba Essam Abdelfattah,
Email: dr.heba.esam92@gmail.com, Mobile: +20 111 097 3659

The reason for doing this study was to see how action-observation physical training affected the quality of
upper limb functions and functional independence among children who have hemiplegic cerebral palsy (HCP).
Subjects and Methods: Thirty children who have a diagnosis of HCP, aged 6-9 years, have been randomized into 2
groups: the control group got a routinely chosen physiotherapy program, whereas the examined group got action
observation physical training (AOPT) on the upper limb besides a standard selected physiotherapy program for three
successive months. Children who have cerebral palsy (CP) underwent the Quality of Upper Extremity Skills Test
(QUEST) in order to determine the level of quality of their upper limbs' functions, including their movement patterns
and hand functions, while the Wee Functional Independence Measure (Wee FIM) was utilized to assess their functional
According to statistical analysis, there had been no substantial variance between the two groups prior to
therapy. After treatment, the examined group's four QUEST domains (dissociated movement, weight-bearing, grasp,
and protective reaction) and WEE FIM significantly improved (P = 0.0001) when contrasted with the control group.
Conclusions: The addition of action observation physical training to physical therapy resulted in better, more effective
and significant results on upper limb functional abilities in HCP children.
Keywords: Action observation physical training, Upper limb functional abilities, Hemiplegia, Cerebral palsy.


A non-progressive disruption that occurs in the
To the knowledge of the authors, no prior research
growing fetus or infant brain is what is known as CP, a
has investigated the consequence of AOPT on upper
collection of mobility as well as posture deviation that
limb functional abilities in HCP children. Thus, the
result in activity restrictions (1). CP motor disorders
focus of this research was to learn more about how
frequently come along with disturbances in sensory,
AOPT affected children with HCP's quality of upper
communication, cognition, perception, behavior, and
limb functions and functional independence. We
seizures (2).
hypothesized that there is no effect of AOPT on the
There are 1.5 to 3 cases of CP for every 1000 live
quality of upper extremity functions and functional
births (3). It's probable that low-income countries have
independence in HCP children.
more cases of CP compared to high-income ones (4).

Hemiplegic children use their hands for everyday
activities; they face numerous practical obstacles (5).
The investigation is a prospective, controlled,
Impaired hand functions are one of the most disabling
randomised trial. It took place from August 2021 to July
symptoms in children with HCP who, in comparison to
their other hand, use their afflicted hand less frequently

and with lower quality (6).
Sample size: Sample size was determined with
Action observation physical training entails
G*POWER (version; Franz Faul, Universitat
observing actions and repeatedly practicing those
Kiel, Germany) statistical software, whose results
actions through imitation (7). This training, which has
demonstrated that fifteen participants per group would
been developed to effectively induce neuroplasticity by
be required to conduct the study effectively. The
magnifying the impact of task-oriented training, is
calculation was performed utilizing =0.05, power =
closely associated with imitation and observational
80%, and a large effect size of 1.1.
learning (8).

In rehabilitation, positive benefits may be predicted
Participants: Thirty children of both genders were
by letting the patient imagine motions through a
selected from Cairo University's Physical Therapy
combination of action observation and imitation of
Faculty Outpatient Clinic. The inclusion criteria
action, followed by doing motions in line with the
included spastic HCP; their age ranged from 6 to 9
imagination (9).
years; their Manual Ability Classification System
Therefore, considering training via imitation and
(MACS) was at level II or III; their degree of spasticity
observational learning as rehabilitation training
in the affected upper limb ranged between grade 1+ or
approaches may effectively induce improvements in
2 as per the Modified Ashworth Scale (MAS); their
motor abilities (10).
Gross Motor Function Classification System (GMFCS)

has been at level II or III; and they were able to
Received: 10/01/2023
Accepted: 13/03/2023

Full Paper (vol.931 paper# 3)

c:\work\Jor\vol931_4 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6914-6918

Evaluation of Faecal Calprotectin Level in Psoriatic and
Hidradenitis Suppurativa Patients as A Model of An Autoimmune and
Auto-Inflammatory Disease Retrospectively
Medhat M. Elamawy*1, Nader N. Nazmy2, Seham Gouda Ameen3, Hiam Abdallah Eleleimy1
Departments of 1Internal Medicine, 2Dermatology and Venereal Diseases and
3Clinical and Chemical Pathology, Benha Faculty of Medicine, Benha University, Egypt
*Corresponding author: Medhat M. Elamawy, Mobile: (+20) 01024443810, Email: m.elamawy@fmed.bu.edu.eg

: Psoriasis represents an example of an autoimmune disease where adaptive immune system activation, T
helper 17 secretory cytokines secretion such as IL 17 and IL 21, and self­antigen intolerance are the hallmarks of its
pathology. Hidradenitis suppurativa on the contrary, could be described as a neutrophilic dermatosis disease while
recurrent abscess formation and skin fibrosis compose the clinical features. Inflammatory bowel diseases association
with diverse dermatological diseases is well known. Objectives: To evaluate the role of the diagnostic application of
fecal calprotectin (FCP) in patients with either hidradenitis suppurativa or psoriasis.
Patients and Methods
: A lanoitces-nstll study was done on 20 patients with varying severity of plaque psoriasis and
10 patients with hidradenitis suppurativa (HS). Demographic data, duration of illness, area extent affected,
gastrointestinal symptoms, and severity scores were taken such as Psoriasis Assessment and Severity Index (PASI)
score and Hurley staging for psoriasis and HS retrospectively. A fecal calprotectin (FCP) assay was also tested.
: While the psoriasis group demonstrated significantly higher age (median = 51 vs. 25 years, P < 0.001) than
the HS group, hidradenitis suppurativa showed significantly higher FCP levels (median = 215 vs. 83, respectively, P =
0.013). Significant strong positive correlations between FCP and severity were observed in the hidradenitis
suppurativa group (r = 0.921, P < 0.001).
: To our knowledge, our study could be the first comparative study between hidradenitis suppurativa and
psoriasis in relation to fecal calprotectin.
Keywords: Hidradenitis suppurativa, Psoriasis, Fecal calprotectin.

recurrent abscess formation, sinus tracking, and skin
Many dermatological diseases could be classified
fibrosis mostly affecting apocrine glands areas like the
according to their etiology into autoimmune or
axilla and groin (6). HS may go through a severe course
autoinflammatory diseases. Adaptive immune system
over intertriginous areas leading to extensive skin
activation and self­antigen intolerance are the
scarring and mutilation. HS is led mostly by an
hallmark of autoimmune disease pathology. However,
the innate immune system and inflammasome play a
multifactorial elements sharing its pathogenesis like
fundamental role in autoinflammatory disease that is
genetic, bacterial, and environmental factors (7,8).
usually related to genetic links (1).
Hurley classification is mostly used to describe the HS
Psoriasis pathogenesis is linked predominately to
severity for clinical follow-up and surgical decisions in
T helper 17 secretory cytokines such as IL 17 and IL
a single area affection (9). HS might associate
21 that could perpetuate the inflammatory cascade
inflammatory bowel disease with an odd ratio of 2.12
leading to keratinocyte proliferation and subsequently
and 1.51 for Chron's disease and ulcerative colitis
neovascularization development (2,3).
respectively. Also, more than ten percent of IBD cases
Psoriasis encompasses a heterogenous spectrum
of many subtypes that begin from mild localized
manifestation, especially perianal fistula, pyoderma
plaque to the more severe pustular form.
gangrenosum, and hidradenitis suppurativa (10,11).
Extracutaneous features such as psoriatic arthritis
Fecal calprotectin (FCP) is a predominant
sometimes precede the primary skin lesions. Also,
neutrophilic component representing most of the
another autoimmune disease like inflammatory bowel
cytosolic protein in the granulocytes. It is more
disease may accompany its presence (4).
abundant in the stool than other body fluids. It
Many severity scores were utilized to standardize
increases in many intestinal pathologies such as
a stratification of psoriasis intensity that can be used
inflammatory bowel disease, non-steroidal anti-
clinically and in treatment modalities applications
inflammatory drugs (NSAID) regular use, and even
trials. It usually depends on lesion extent,
colorectal cancers (12).
desquamation, and erythema overlying. Psoriasis
Many studies tried to explore the prevalence of
Assessment and Severity Index (PASI) score is the
increased FCP levels and subsequently provisional
most validated and studied psoriasis score in clinical
practice (5).
dermatological diseases (13).
Hidradenitis suppurativa (HS) is a chronic
Our study aimed to evaluate the role of the
debilitating inflammatory disorder that consists of
diagnostic application of FCP in patients with either
Received: 29/01/2023
Accepted: 30/03/2023

Full Paper (vol.931 paper# 4)

c:\work\Jor\vol931_5 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6919-6927

Assessment of Phosphatidyl Serine-Specific Phospholipase A1, and
CH50 in Sera of Systemic Lupus Erythematosus Patients and Its
Correlation with Disease Activity, and Severity
Eman Ramdan*1, Dalia AbdElhassib1, Mayada Khalil2, Abeer E. Abdelmksoud3, Oli Elshemiy1
Departments of 1Clinical Pathology, 2Rheumatology, Rehabilitation and Physical Medicine and 3Community,
Enviromental and Occupational, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mayada Khalil, Mobile: (+20) 01001659940, E-mail: drmayadakhalil@gmail.com

Systemic lupus erythematosus (SLE) is a chronic connective tissue disease with multisystem
inflammation, complement system aid in deposition of immune complexes. Hydrolyzing phosphatidylserine on the
plasma membrane of apoptotic cells and activating neighboring immune cells by producing lysophospholipid,
phospholipase A1 promotes the onset of autoimmunity in SLE patients.
Objective: To determine the levels of Phosphatidyl Serine-Specific Phospholipase A1 (PS-PLA1), and the total
hemolytic complement in the sera of SLE (CH50) patients and to clarify how these levels correspond to the severity and
activity of the disease.
Patients and methods:
80 persons participated in the study (40 SLE patients and 40 healthy as control group). The
disease activity level is evaluated as regards the SLE disease activity score, laboratory tests and enzyme linked immune-
sorbent test for Phosphatidyl Serine-Specific Phospholipase A1 and the total hemolytic complement.
Results: This study revealed a significant difference in PS-PLA1 and CH50 levels in the patient group when compared
to healthy patients. The values of (SLEDAI) and laboratory parameters including antinuclear-antibody, anti-double
stranded, erythrocyte sedimentation rate, CBC, and albumin/creatinine ratio levels were significantly associated with
PS-PLA1, and CH50 in SLE patients (P< 0.05).
Sequential changes of PS-PLA1, and CH50 concentrations in SLE patients and a strong correlation existed
between SLEDAI with both markers, suggesting their putative role in the disease pathophysiology.
Keywords: PS-PLA1, CH50, SLE, SLEDAI.

genetic defect in one or more complement proteins
might result in a CH50 value of extremely low down to
SLE is a chronic autoimmune illness, characterized
zero, moderate CH50 reductions are commonly seen
by B lymphocytes overactivity, immune complexes
particularly in cases with immunological complex
formation that attack several systems causing tissue
formation [9].
damage. SLE patients still have a high risk of morbidity
The study aimed to assess the role of PS- PLA1, and
and mortality despite effective treatment [1]. There are
CH50 in SLE disease activity, and severity.
20 to 70 instances of SLE per 100,000 persons, with a

female predominance (male- to- female ratio, 1:9) [2].
Novel biomarker, are recently studied promoting
A case-control study was conducted at the
early detection of organ outcomes and so management
Rheumatology, Rehabilitation and Physical Medicine
including, lyso phospholipids, which are a group of
Department, Benha University Hospitals on 40 patients
sphingo-phospholipids [3], that are essential for cell
who were diagnosed as systemic lupus erythematous
signaling , inflammatory response, endocytosis, and
according to the European League against
exocytosis [4].
Rheumatism/American College of Rheumatology
An anionic phospholipid called phosphatidylserine
(ACR/EULAR) 2019 criteria [10]. 40 healthy
(PS) is typically confined to the inner leaflet of the cell
participants matched for age and sex were selected to be
membrane. The externalization of PS during apoptosis
in the control group. Laboratory testing was performed
acts as a signal for phagocyte identification. The PS-
by the Clinical and Chemical Pathology Department of
specific phospholipase A1 (PS-PLA1) is one of many
University Hospitals.
phospholipases that have been suggested as the culprits

[5]. LysoPS is created when PS-PLA1 is exposed on
Exclusion criteria: Patients with other autoimmune
apoptotic cells [6]. Complement system components
illnesses, cancer, or chronic infection, metabolic
have been linked to a higher incidence of SLE. It has
disorders and pregnant women.
emerged as a key player in the development of immune

complex deposition associated with SLE [7].
Patients' group:
It has been demonstrated that a lack of classical
40 systemic lupus erythematosus were above the
pathway complement component C1 increases the
age of 16, their disease duration ranged from three
chance of developing the disease in up to 90% of SLE
months to six years. 20 patients (50%) were diagnosed
patients [8]. Interestingly, the total hemolytic
with lupus nephritis based on clinical manifestations,
complement (CH50) has been given varying degrees of
laboratory parameters and renal biopsy findings in some
clinical relevance in measuring disease activity, a
patients 15 out of 40 (38%). No patient showed central
Received: 02/06/2023
Accepted: 01/08/2023

Full Paper (vol.931 paper# 5)

Full Paper (vol.931 paper# 6)

c:\work\Jor\vol931_7 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6935-6940

Non- Segmental Vitiligo Treatment using Narrow Band Ultraviolet B Alone versus
Topical Psoralen- Narrow Band Ultraviolet B
Ghada Fathy Mohamed, Fahmi Shukur Ali, 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: christinekamal81@yahoo.com

With a frequency of 0.5­2% in the general population, vitiligo is a chronic acquired depigmentary
condition that manifests as single or clusters of achromic macules and patches on various body parts.
Objective: This study aimed to evaluate the efficacy of topical psoralen-narrow band ultraviolet B (NB-UVB) treatment
of non-segmental vitiligo patients in comparison with NB-UVB alone.
Patients and Methods:
This prospective interventional study included forty non-segmental vitiligo (NSV) patients,
divided into two equal groups. Group I received only NB-UVB sessions while group II treated with topical psoralen
plus NB-UVB. Vitiligo extent tensity index (VETI) was used for disease severity evaluation. All patients received three
sessions weekly for sixteen weeks. The participants were recruited from the Dermatology Outpatient Clinic of Vitiligo,
Ain- Shams University Hospitals.
Results: Group I and II were statistically matching as regards age, sex, special habits, vitiligo family history, disease
activity or duration and associated diseases. VETI scores showed highly statistically significant post-treatment
improvement in both groups. However, no statistically significant difference could be detected in those receiving
NBUVB alone versus psoralen plus NBUVB.
Conclusion: The combination of topical psoralen and narrow band UVB is a successful treatment option for non-
segmental vitiligo that is well tolerated. Its effectiveness is comparable to narrow band UVB alone, but not better.
Keywords: NB-UVB, VETI, Topical psoralen and vitiligo.


In vitiligo, a chronic, acquired, and
downregulated. The melanocytes are then propelled
progressive illness that affects 0.5­2% of the general
to go to the epidermis and begin producing melanin
population, achromic macules may show up alone or
in groups on various body parts (1, 2). It is
Fructus psoraleae, a popular herb used in
asymptomatic but it can cause significant
traditional Chinese medicine, is the source of
psychosocial distress in patients, ultimately affecting
psoralen, a tiny molecule from the coumarin family
their self-esteem, inter-personal relationships, and
of substances. The US Food and Drug
even employment potentials (3).
Administration has given the PUVA therapy its
The exact etiology of vitiligo has been
blessing for use in clinical settings. Psoralen is a
attributed to many theories, the most prominent are
photosensitive substance that is used to treat vitiligo
autoimmune, oxidative, neural, genetic, viral and
and psoriasis by exposure to sunlight or ultraviolet
psychological theories (4).
radiation. Tyrosinase activity and melanin
According to the convergence theory,
production may be boosted by psoralen treatment in
autoimmune melanocyte loss is caused by an
healthy melanocytes located close to the injured cells
interaction of environmental, genetic, and
(13, 14). This study aimed to evaluate the efficacy of
immunological variables (5).
topical psoralen- NB-UVB treatment of non-
segmental vitiligo patients in comparison with NB-
vitamin D3 analogues, various forms of
UVB alone.
phototherapy (UVB, PUVA and NB-UVB), excimer

lasers, and surgery/transplantation are among the
therapeutic methods utilised for vitiligo (6, 7).
This prospective interventional study included 40 NSV
However, the best course of action has not yet been
patients, recruited from Vitiligo Outpatient Clinic, Ain-
determined (8).
Shams University Hospitals through the period from
The effects of NB-UVB on vitiligo were
January 2018 to December 2018. We included patients
whose ages ranged between 13 and 70 years, who did
Nieuweboer-Krobotova (9). Although it is regarded
not receive any systemic vitiligo treatment for 2 months
the most efficient and risk-free first treatment for
or, topical treatment for 1 month prior to study
moderate and severe disorders, there have been
reports of phototoxicity and probable carcinogenicity

(10, 11). An effect with two steps has been suggested.
Exclusion criteria: Individuals with photosensitive
First, there is immunomodulation, which causes the
conditions such xeroderma pigmentosum, acute lupus
immune response to melanocytes to be
erythematosus, and porphyria. Those exhibiting
Received: 2/06/2023
Accepted: 3/08/2023

Full Paper (vol.931 paper# 7)

c:\work\Jor\vol931_8 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6941-6946

The Diagnostic Value of Lung Ultrasound and Serum Level of Brain Natriuretic
Peptide in Asymptomatic Pulmonary Congestion in Pediatric Hemodialysis Patients
Heba Rasmy Abdelbaset1, Soha Abdel Hady Ibrahiem1, Omima Mohammed Abdel Haie1, Eman Ramadan

Abdel Gawad1, Rehab Elsaied Elsawy2, Osama Mohammady Abd-Alkhalik1*, Eman Abdelbaset Mohamed3
Departments of 1Pediatrics, 2Pulmonology and 3Clinical Pathology, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Osama Mohammady Abd-Alkhalik,
Mobile (+20)01009223659, E-Mail: osamamohamedy11@gmail.com

Background: Optimising the desired dry weight (DW) to reduce volume overflow in hemodialysis (HD) patients,
depending on clinical evaluation, lacks accuracy as signs of hypervolemia are observed only when overhydration is
Objective: To evaluate the diagnostic accuracy of serum level of brain natriuretic peptide (BNP) and its correlation with
lung ultrasound (LUS) in detecting the presence of asymptomatic pulmonary congestion as a sign of residual volume
overload in HD patient.
Patients and Methods:
A prospective observational study was conducted on 20 HD pediatric patients with
asymptomatic pulmonary manifestation who underwent LUS and BNP leveling before and after HD session, LUS was
considered positive when B-line score (BLS) >10. Volume load parameters were also evaluated before and after HD.
Results: the reduction in mean BNP after HD session was significant as BNP levels reduced from (219.5±67.802) pg/ml
to (116.75±50.772) pg/ml, with significant positive correlation between post-dialysis BNP and BLS (p< 0.001, r 0.914).
Conclusion: Many patients who were considered to be at goal DW at the end of the HD session and who were clinically
euvolemic with no clinical indications of overhydration, showed lung congestion at LUS. This suggests that even after
a patient reaches their supposedly goal DW, they may still be experiencing a residual volume overload. If LUS cannot
be used, BNP levelling may be able to help.
Keywords: Pulmonary congestion, LUS, BNP, HD, DW.


congestion as a sign of residual volume overload in HD
Without hypovolemia or hypervolemia, DW is a
volumetric condition. An accurate calculation of
extravascular lung water is a key strategy to prevent
This prospective observational study was carried
these consequences since chronic hypovolemia and
out from July 2021 to January 2023, in the Pediatric
hypervolemia caused by erroneous DW estimation
Nephrology Unit of the Benha University Hospital.
might result in chronic dehydration or long-term
20 chronic hemodialysis children 3-18 years of both
cardiovascular issues (1).
sexes on thrice weekly schedule on HD Unit for at least
As shown by bioimpedance analysis (BIA),
6 months with clinical stability for at least 3 months
several patients who were clinically euvolemic and
with asymptomatic pulmonary manifestation were
thought to be at target DW showed lung congestion at
LUS in the absence of oedema, dyspnea, or

overhydration (2).
Exclusion criteria:
LUS can assess the existence of pulmonary
Patients with unstable clinical conditions.
microcirculation congestion, which is common in HD
Patients with current infections.
patients but frequently asymptomatic and difficult to
Patients with volume or pressure overload due to
detect (3). The air-water interface created by the
other causes than fluid overload as left ventricular
increased pulmonary extravascular volume causes the
dysfunction with EF< 50%, cardiac anomalies,
echo detectable artefact known as the B line, and its
pulmonary hypertension, clinical evident heart
identification enables the calculation of a BLS, which is
used to measure pulmonary congestion (4).
In line with previous study (6), patients with diseases

such as co-existing lung fibrosis, atelectasis,
Additionally, BNP serum levels may be helpful as a
lymphangitis, interstitial lung disease, heart failure,
metric for excessive hydration; although its level is
and acute respiratory distress syndrome may have B
susceptible to a variety of influences, it may be
lines that signify underlying pathology and cloud the
interpreted as a measure of myocardial cell distension
evaluation of fluid overload.
in response to circulating volume overload (5).

The study aimed to evaluate the diagnostic accuracy of
Patients were dialyzed using polysulfone hollow fibre
serum level of BNP and its correlation with LUS in
dialyzers appropriate for their surface area (Fresenius
detecting the presence of asymptomatic pulmonary
F3 = 0.4 m2, F4 = 0.7 m2, F5 = 1.0 m2, and F6 = 1.2 m2)
on Fresenius 4008B and 5008s dialysis machines (Bad
Received: 15/06/2023
Accepted: 15/08/2023

Full Paper (vol.931 paper# 8)

c:\work\Jor\vol931_9 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6947-6953

Study Of Risk Factors Associated With Allergic Fungal Sinusitis
Patients: A Case-Control Study
Tarek Mohamed M. Mansour1, Mahmoud Ibrahim M Elawamry2,
Mohammed Ahmed Hussien2, Amr Embaby El-Sayed2, Mohamed M. El-Baroudy3
Departments of 1Radio-diagnosis and 2Otorhinolaryngology Faculty of Medicine, Al-Azhar University, Assuit, Egypt
Department of 3Radio-diagnosis, South Egypt Cancer Institute, Assuit University, Egypt
*Corresponding author: Tarek Mohamed M. Mansour, Mobile: (+20) 01006237731, E-mail: drtarekrad@gmail.com

A non-invasive sinusitis that often affects young persons is allergic fungal sinusitis.
Objective: This study aimed to explain the potential risk factors that may affect patients suffering from nasal polyps
with allergic fungal sinusitis (AFS)local anatomical variants or general illnesses.
Patients and methods: This case-control study was carried out on 160 patients (80 patients with allergic nasal polyposis
with fungal sinusitis and 80 cases with nasal polyp without superimposed fungal infection). The study was performed
at the ENT Department, Faculty of Medicine, Al-Azhar University, Assuit, from 21st May 2018 to 21st May 2022.
The mean vitamin D level was considerably lower in the case group (27.86 ±5.92 ng/mL) than in the control
group (38.98 ±5.92 ng/mL). The cases had significantly higher anatomical abnormalities (deviated nasal septum and
inferior turbinate hypertrophy) than the control group (P value <0.001). MW-I was lower significantly in the case group
than in the control group while ML-I was significantly longer in the case group than in the control group (P value
<0.001). Deviated nasal septum, vitamin D, MW-I, and ML-I were significant independent predictors for fungal
sinusitis (P value< 0.001)
Conclusions: Features of anatomical abnormalities, such as a notably deviated septum, MW-I, and ML-I may increase
the incidence of fungal sinusitis more than general illness as bronchial asthma and DM. Vitamin D deficiency may have
a role in developing superimposed fungal sinusitis.
Keywords: Allergic fungal sinusitis, Risk factors, vitamin D, Computed tomography.

Although nasal polyposis is a hallmark of AFS, the
Young adults with prior allergy illnesses,
condition is not definitively diagnosed until histology is
unusually high levels of total peripheral eosinophils,
performed post-operatively. Hence, it is crucial to
and immunoglobulin E are frequently affected by
identify the risk factors that might predict the diagnosis
allergic fungal sinusitis (AFS), a non-invasive
of AFS before surgery [5].
pansinusitis [1]. The prevalence and incidence of AFS
As the risk factors for AFS among patients with
nasal polyps have not been adequately quantified, and
sociodemographic variables. Patients who suffer from
due to the possibility of illness complication in
those who have chronic sinusitis are more likely to
instances of AFS, this study was designed to clarify the
acquire AFS [2].
possible risk factors related to patients suffering from
Although the precise pathophysiology of AFS
nasal polyps with fungal sinusitis locally as anatomical
remains unknown, one proposed theory is that fungi
encountered during normal nasal inhalation are the
hypertrophy, and concha bullosa) or general illness
earliest antigenic stimuli in an atopic host. Eosinophils
(DM, Asthma, and Vit D insuffiency) [5].
are involved in a severe inflammatory response after a
This study aimed to explain the potential risk factors
type I (IgE) and type III (immune complex) mediated
that may affect patients suffering from nasal polyps
reaction [2]. Certain anatomical features, such as
with AFS local anatomical variants or general illnesses.
deviated septal cartilage or hypertrophied turbinates,

might promote the inflammation that blocks the ostia.

When the sinus ostium is blocked, the surrounding
This case-control study was carried out on 160
conditions are ideal for the growth of the fungus.
patients (80 patients with allergic nasal polyposis with
Allergenic mucin, produced in response to repeated
fungal sinusitis and 80 cases with nasal polyp without
antigen exposures, eventually fills the affected sinuses
superimposed fungal infection). The study was
of an AFS patient [3].
performed at the ENT Department, Faculty of
AFS is associated with several complications,
Medicine, Al-Azhar University, Assuit, from 21st May
including proptosis, orbital abscesses, and occasionally
2018 to 21st May 2022.
vision loss. The illness and surgical intervention put
Exclusion criteria were cases younger than 18 years,
important neurovascular systems at risk, such as the
invasive fungal sinusitis, nasal malignancies, genetic
cranial nerves, dura mater, internal carotid artery,
disorders accompanied by ciliary dysfunction, and
cerebral lobes, and cavernous sinus [4].
complex sinusitis due to any reason rather than AFS.
Received: 02/07/2023
Accepted: 01/09/2023

Full Paper (vol.931 paper# 9)

c:\work\Jor\vol931_10 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6954- 6961

The Potential Role of Neutrophils in Enhancement of Thrombotic Risk in
Patients with Primary Antiphospholipid Syndrome
1Shereen Abdel Salam Elwan, 2Nema Ali Soliman, 3Marwa Ahmed Abdelwahab, 1Doaa Waseem Nada*
1Department of Rheumatology, Rehabilitation and Physical Medicine, 2Department of Medical Biochemistry,
3Department of Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt
Correspondence: Doaa Waseem Nada, e-mail: doaa.nada@med.tanta.edu.eg / doaa.waseem@yahoo.com,
Mobile: +201069579672, ORCID ID: https://orcid.org/0000-0003-3968-1619.

Antiphospholipid syndrome (APS) is an autoimmune condition characterized by high levels of
antiphospholipid antibodies, which increase the risk of fetal loss, arterial and venous thrombosis. Neutrophils have long
been observed in thrombi, but the specific mechanisms by which they contribute to thrombus development remain
To evaluate the role of neutrophils in enhancement of thrombotic risk in patients with primary
antiphospholipid syndrome.
Material and Methods: 60 patients with primary APS participated in this study, along with 30 age- and sex-matched
healthy volunteers serving as the control group. 30 patients in the patient group had prior thrombotic events, and 30
patients had no prior thrombotic events. The enzyme-linked immunosorbent assay was used to measure the lupus
anticoagulant, anticardiolipin antibodies, anti-B2 glycoprotein, matrix metalloproteinase -2(MMP-2), monocyte
chemoattractant protein-1(McP-1), and citrullinated histone (H3cit). While spectrophotometry was used to assess
myeloperoxidase (MPO) activity.
Result: In groups I and II, the patients' mean ages were (42.93± 7.15) and (42.70± 8.30), respectively. The disease
duration was (5.25 ±2.7 years) in group I and (5.54± 2.9 years) in group II. The recruited patients were distributed
between the two groups, with 39 females and 21 males. Regarding MPO activity, MMP2, McP1, and H3cit, there was
a significant difference between APS patients with prior thrombotic events and APS without such events, as well as
between both groups and control.
Since neutrophil activation pathways are major regulators of both arterial and venous thrombosis, APS
patients may benefit from medications that target these pathways to prevent thrombosis.
Antiphospholipid, Venous thrombosis, Arterial thrombosis, Neutrophils, NETosis.


Antiphospholipid syndrome (APS) is an
7]. Neutrophil extracellular traps (NETs), also produced
autoimmune condition with no known origin that is
by neutrophils, are chromatin-based extracellular
characterized by high levels of antiphospholipid
structures that are primarily made of DNA and histones,
antibodies (aPLs), which increase the risk of fetal loss,
which both originate from the nucleus and have been
arterial and venous thrombosis [1]. There is no known
coated with substances derived from cytoplasm such as
cure for APS, and current treatments focus on
myeloperoxidase and neutrophil elastase granular
suppressing coagulation rather than addressing the
proteins. Recent studies have revealed that NETs may
underlying pathophysiology. Despite being frequently
also play a role in thrombosis by inactivating some
associated with systemic lupus erythematosus (SLE),
anticoagulant factors and activating the intrinsic
APS is now widely acknowledged to exist as a primary
coagulation cascade, even though NETs were first
autoimmune syndrome with thrombosis and pregnancy
identified for their function in host defense against
loss as its cardinal manifestations [2].
pathogens. Moreover, the NET structure acts as a
Vascular beds of different sizes, including arterial
scaffolding for the formation of clots. Recent studies
and venous circuits, may be compromised by
have analyzed the role of neutrophils in APS. These
thrombosis brought on by APS. The most frequent
studies revealed that endothelial cells, neutrophils,
locations for venous and arterial thrombosis,
monocytes, trophoblasts, and platelets are key players
respectively, are the deep veins of the lower extremities
of APS progression. In this regard, evidence has shown
and the cerebral circulation. Thrombosis may also occur
that neutrophils are important leukocytes for the innate
in unusual sites including visceral arteries and veins and
immune response, and they promote pyroptosis-
the cerebral venous sinuses [3].
mediated inflammation and thrombosis in APS patients
As triggers of APS-related thrombosis, platelets,
endothelial cells, and monocytes have previously
Even though neutrophils have long been observed
received the greatest attention [4]. However, recent
in thrombi, their specific roles in the process of
research has focused on the potential role of neutrophils
thrombus formation are not yet fully grasped. Hence,
in APS and their significance in pathologic coagulation,
the current study's objective was to evaluate the role of
particularly venous thrombosis being the first cells
neutrophils in enhancement of thrombotic risk in
present at the site of thrombosis, even before platelets [5-
patients with definite or probable primary
Received: 05/06/2023
Accepted: 02/08/2023

Full Paper (vol.931 paper# 10)

c:\work\Jor\vol931_11 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6962-6969

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: drmohamedali122@gmail.com
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: 02/07/2022
Accepted: 22/09/2022

Full Paper (vol.931 paper# 11)

c:\work\Jor\vol931_12 The Egyptian Journal of Hospital Medicine (October2023) Vol. 93, Page 6970-6979

Clinical Significance of Serum Angiopoietin 2 in Patients with
Hepatocellular Carcinoma
Asmaa Mousa Khater1*, Dina Ibrahim Abdelhai1, Osama El Sayed Negm2, Amal Said El Bendary1
1 Clinical Pathology Medicine Department,
2 Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
*Corresponding Author: Asmaa Mousa Khater, Email: docasmaa94@gmail.com,mobile:+01015030637

Angiopoietin 2 (ANG-2) is essential for blood vessel development, stability, and remodeling.
Objective: We aimed to find out the potential use of serum ANG-2 as a diagnostic indicator for early detection of
hepatocellular carcinoma (HCC).
Patients and Methods:
The present investigation included 80 participants who were categorized as follows: 30
individuals diagnosed with liver cirrhosis, 30 individuals diagnosed with HCC, and 20 healthy individuals serving as
control group. The ages of participants ranged between 35 and 65 years.
ANG-2 levels demonstrated a significant increase within the HCC group compared to the other two study
groups and also in the liver cirrhosis group if compared to the healthy individuals. Age, bilirubin, aspartate
aminotransferase, Child-Pugh score, alanine transaminase, Barcelona Clinic Liver Classification stages, and tumor
characteristics were significantly positively correlated with ANG-2 in the HCC group. A statistically significant
negative connection was observed between the levels of albumin and ANG-2, as well as between ANG-2 and platelets.
Conclusions: ANG-2 has the potential to serve as a diagnostic indicator in HCC and may also play an important function
in controlling the advancement of liver disease. Additionally, it has been demonstrated to be very valuable in identifying
individuals with aggressive tumors.
Serum angiopoietin, Hepatocellular carcinoma.


carcinoma patients as G III, and 20 healthy people as
Hepatocellular carcinoma (HCC) is the most
the control group, all of whom were between the ages
prevalent form of primary liver cancer. Its prevalence is
of 35 and 65.
rising in Egypt as a result of potential increased risk
Our investigation was authorized by the Tanta
factors such as viral hepatitis C and hepatitis B (1). HCC
University Hospitals Ethical Committee in Egypt.
is considered one of the hyper-vascular tumors, and the
Before being included in the research, patients or their
mechanism of its proliferation is mainly associated with
family provided an informed written agreement.
the angiogenesis process. Tumor angiogenesis is

considered the hallmark of cancer that promotes tumor
Exclusion criteria: Mixed HCC­cholangiocellular
growth and metastasis. Factors involved in tumor
carcinoma or other extrahepatic malignancies, previous
angiogenesis are mainly angiopoietins as (Ang 2),
HCC ablation history, and other comorbidities.
vascular endothelial growth factor (VEGF), and
All patients had a full clinical examination, computed
fibroblast growth factor (FGF) (2).
tomography (CT), magnetic resonance imaging (MRI),
Ang 2 has an important marker in the angiogenesis
abdominal ultrasonography, radiological HCC studies,
process during the progression of different human
and real-time abdominal ultrasound (US).
malignancies such as HCC, lung cancer, and breast

cancer (3). Ang 2 contains a total of 478 amino acids. It
Child Pugh scoring of HCC and liver cirrhosis: The
mainly has two domains, one coiled-coil domain (aa
scoring system used bilirubin, serum albumin,
166-248) that is responsible for mediating
neurological disorder, ascites and INR. The severity of
multimerization in addition to a C-terminal fibrinogen-
cirrhosis using the Child-Pugh system: Child-Pugh A
like domain (aa 275-495) that is responsible for
gets from five to six points, child-Pugh B gets about
mediating receptor binding. The gene Ang 2 is
seven to nine points, and child-Pugh C gets from ten to
significantly expressed within HCC. A tyrosine kinase
fifteen points.
receptor family member, who is known as Tie 2, is

responsible for Ang 2 action. HCC neovascularization
Encephalopathy scoring system: None gets one point,
and development are both significantly influenced by
Grades one & two get two points, and Grades three &
the Ang 2-Tie 2 pathway (4).
six get three points. Ascites scoring system: None gets
Through this study, we aimed to find out if serum
one point, slight gets two points, and moderate gets
ANG 2 might be used as a diagnostic tool for early
three points. INR scoring system: below 1.7 gets 1
diagnosis of (HCC).
point, from 1.7 to 2.2 gets two points, INR more than

2.2 gets three points.

The present investigation included about 80
Albumin scoring system: higher than 3.5 mg/ml gets
participants assigned as the following: 30 liver
one point, between 2.8 to 3.5 mg/ml gets two points, and
cirrhosis patients
II, 30
lower than 2.8 mg/ml gets three points. Bilirubin
Received: 25/06/2023
Accepted: 25/08/2023

Full Paper (vol.931 paper# 12)

c:\work\Jor\vol931_13 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page6980-69

Histological And Immunochemical Studies of The Possible Protective
Role of Riboflavin and Urolithin A on Carbon Tetrachloride-Induced
Hepatotoxicity in Albino Rats
Samar Fawzy Gad1, Maged Behery1
1Department of Anatomy and Embryology, Faculty of Medicine, Benha University, Benha 13518, Egypt
*Corresponding author: Samar Fawzy Gad, Mobile: (+20) 01067490565, E-Mail: samar.gad@fmed.bu.edu.eg


Background: Carbon Tetrachloride is used as a dry-cleaning solvent and in lava lamps. Previous research has
demonstrated its harmful potential for several organs. Aim: The objective of the current work is to examine any
hepatoprotection induced by Riboflavin, Urolithin A, and combined Riboflavin and Urolithin A on an animal model of
liver damage brought by CCl4. Histological and immunohistochemical investigations were also used to study the
processes behind such protection. Material and methods: Five equal groups of forty Wistar albino rats were created.
In this study, Wistar rats were given CCl4 intraperitoneally (1 mL/Kg bw) on day 7 as a single dose while given
riboflavin by oral gavage, Urolithin A intraperitoneally and combined Riboflavin and Urolithin A for 14 days. After the
experiment, blood samples were obtained to measure the liver enzymes. Liver samples were prepared using Masson
trichrome as well as Hematoxylin and Eosin staining. Bax and Bcl2 immunoexpression were detected.
Results: Along with disturbed architecture and vacuolization of hepatocytes shown in the H & E results linked with
fibrous propensity in the Masson- trichrome samples, CCl4-exposed animals demonstrated significant disruption of the
biochemical tests. In the group receiving either riboflavin or/and urolithin A, the histology and biochemical markers
were adjusted after therapy.
: Through elevation of anti-apoptotic proteins and suppressing of pro-apoptotic proteins, riboflavin and/or
urolithin A protected against CCl4-induced liver damage. Together, they had a synergistic effect.
Keywords: Carbon tetrachloride, Riboflavin, Urolithin A, Bax, Bcl2.


The liver is the first organ to be affected by the
coenzymatic forms in biological systems. About 100
noxious effects of freshly produced toxic chemicals.
distinct metabolic redox activities, including those
There continues to be evidence that reactive oxygen
related to stress response, body development and DNA
species and free radicals are essential for many
repair, are carried out by these flavin proteins in all
processes that initiate and control the development of
forms of life (4). Riboflavin's antioxidant action (as a
liver diseases (1). Carbon tetrachloride (CCl4) is a
cofactor for enzymes and as a regulator of gene
colourless, non-flammable liquid formed by the
expression) may have positive therapeutic effects. For
reaction of chlorine with chloroform in the presence of
example, enhanced histopathology results in renal
light. It is a widely used chemical solvent in industry, as
toxicity (5), acute lung injury (6) and ulcerative colitis (7).
well as a cleaning agent and degreaser in the household.
Naturally occurring polyphenols known as
It is classified as an environmental contaminant that
urolithins are created by the gut microbiota in response
causes tissue necrosis and cell damage (2). CCl4 caused
to ellagic acid (EA) and ellagitannins (ETs) -rich meals
toxicity by producing the free radical trichloromethyl
(8). Recently, it was shown that Urolithin A promotes
(CCl3*) and other cytochrome P450 metabolites. This
mitophagy in two distinct models of age-related
radical attaches to cellular molecules (nucleic acid,
muscular dystrophy (9). Due to its strong antioxidant
protein, lipid), affecting cellular functions and resulting
activity, urolithin A may play a significant part in
in fatty degeneration, whilst the interaction between
protecting against various clinical disorders caused by
CCl3* and DNA is hypothesised to operate as a liver
oxidative stress on numerous organs, as the heart, liver,
cancer initiator. This radical can also combine with
and kidney (8, 10). This study's objectives were to analyze
the impact of carbon tetrachloride over rats' liver and the
trichloromethylperoxy (CCl3OO*) radical. Finally,
potential protective effects of riboflavin and urolithin A
CCl4 poisoning causes lipid peroxidation in
using biochemical, histological, immunohistochemical,
mitochondrial, endoplasmic reticulum, and other key
and morphometricmethods.
organelle membranes, resulting in inflammation and
cellular death by apoptosis or necrosis (3).
CCl4 poisoning is a complex process in which
Carbon tetrachloride (cat. No.319961, purity
any antioxidant or anti-inflammatory characteristics
>99%) was purchased from Sigma-Aldrich, Chemie
may be beneficial to medical care. Riboflavin (Vitamin
GmbH as liquid solution.
B2) is a water soluble vitamin. It is an important vitamin
Riboflavin (cat. No. 555682, purity >99%) was
because of its function in macromolecule metabolism in
also procured from Sigma-Aldrich, Chemie GmbH. The
all living organisms. Flavin adenine dinucleotide (FAD)
Solution was prepared in saline immediately before the
and flavin adenine mononucleotide (FMN) are its two
experiment by measuring out the desired amount of
Received: 20/7/2023
Accepted: 15/09/2023

Full Paper (vol.931 paper# 13)

c:\work\Jor\vol931_14 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6990-6995

Vaginal Cleansing with Povidone Iodine before Elective Caesarean Section at
Benha University Hospitals
Aziza Ali Elsayed Negm *, Wael Naeem
Obstetrics and Gynecology Department, Faculty of Medicine, Benha University, Benha Egypt
*Corresponding Author: Aziza Ali Elsayed Negm, Email: Aziza.negm@fmed.bu.edu.eg, Phone: +201289176055
With a rate of 51.8%, caesarean section is the most frequent major surgical surgery in Egypt, putting
Egypt in the third place with the highest Caesarean Section (CS) rate, world widely.
Objective: To assess if using povidone iodine in vaginal cleansing during elective caesarean section affect infectious
Methods: This prospective case control study was performed on 140 pregnant women scheduled to deliver with elective
CS aged 20 -35 years old. Women were split equally into 2 groups; group (I): included pregnant women receiving
vaginal cleansing prior to caesarean section and group (II): included pregnant women receiving routine care as a control
group (standard care). All included cases were subjected to full history taking, general, abdominal and local examination.
All patients received preoperative antibiotic according to our department protocol just before skin incision.
Results: Our findings reported that 4 (5.71%) patients in group I and 15 (21.43%) patients in group II had fever, 3
(4.29%) patients in group I and 13 (18.57%) patients in group II had endometritis, and 2 (2.86%) patients in group I and
10 (14.29%) patients in group II had wound infection, revealing significantly higher fever incidence, wound infection
and endometritis in group II compared to group I (P=0.012, 0.014, and 0.03 respectively). Incidence of allergy or
irritation was insignificantly different between the studied groups (P> 0.097).
Conclusions: Using povidone iodine as a vaginal cleansing instantly prior elective CS substantially decreases post-CS
endometritis, wound infection and fever rates.
Keywords: Vaginal cleansing; Povidone iodine; Elective; Caesarean section; Surgical site infection.


The invention describes a povidone iodine
With a rate of 51.8%, caesarean section is the most
containing the following ingredients: 10 to 50 percent
frequent major surgical surgery in Egypt, putting Egypt
polyvinyl pyrrolidone k30, 2.34 to 11.44 % iodine, 1.17
in the third place with the highest CS rate, world widely
to 5.72 % potassium iodide, 5 to 45 % n-propanol as a
[1,2]. Although CS may be a crucial and lifesaving
solvent, 0.01 to 10 % of a stability auxiliary agent, and
procedure, if conducted without medical justifications,
the remainder water. The invention also describes a
it can place mothers and newborns at an undue risk for
technique for preparing povidone iodine [10].
short- and long-term health concerns [3]. Caesarean
There is substantial evidence in the medical
section is one of the main abdominal procedures
literature that preoperative vaginal sterilisation with
associated with medical dangers to the woman's health,
povidone iodine reduces the incidence of postoperative
such as bleeding, need for transfusion, damage to other
infection morbidity during CS delivery. However,
organs, and infections [4,5].
current data on the efficacy of such a measure on post-
Similar to any other surgical operation, CS is
care infectious morbidity are inconclusive, since some
associated with infection-related morbidity, including
researchers have found no significant impact [11]. While
endometritis and surgical site infection (SSI) [6]. It has
previous studies have found a considerable decrease in
been stated that caesarean section is associated with a
post-caesarean infections with the use of povidone-
tenfold greater risk of infection than vaginal birth. In
iodine solution, some other studies did not find such a
addition, increased infection rates have been seen in
decrease [12, 13].
women with ruptured membranes and those who get a
The purpose of this study was to evaluate if vaginal
CS during labour [7].
cleansing with povidone iodine during elective
Infections of this kind impose an extra strain not
caesarean section affect infectious morbidity.
only on the mother, but also on the infant and her family

as a whole. Additionally, it raises the risk of hospital
readmissions and the expense to health care systems
This prospective case control study was performed
worldwide [8]. Diverse antiseptics have been used
on 140 pregnant women scheduled to deliver with
inconsistently for skin preparation and vaginal toileting
elective caesarean section aged 20 -35 years old, at
in an effort to limit the incidence of post-CS infections.
Benha University Hospitals from June 2023 to June
It has been established that vaginal pre-treatment with
2024. A documented informed consent was received
povidone iodine or chlorhexidine solution, as opposed
from the patient or the patient's family.

Exclusion criteria were emergency caesarean section,
to washing with saline or without cleansing before to
premature rupture of membranes, morbidly obese
CS, lowers the incidence of post-CS infection [9].
women and those with pre-existing medical conditions,
Received: 07/08/2023
Accepted: 01/10/2023

Full Paper (vol.931 paper# 14)

c:\work\Jor\vol931_15 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 6996-7001
Maternal Vitamin D deficiency and Intra Uterine Growth Retardation
Waleed M. Khalaf1*, Hisham M. Fathi1, Ahmed M. Ahmed1, Mohamed S. Elsegeny2
1Obstetrics and Gynaecology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt,
2Department of Obstetrics and Gynaecology, El Mahalla General Hospital, El-Gharbiya, Egypt
*Corresponding Author: Waleed M. Khalaf: Email: waleed.khalaf1980@yahoo.com,
Mobile: +201226274935 / +966552165630
Numerous epidemiological research point to a connection between fetal intrauterine growth restriction
(IUGR) and vitamin D deficiency (VDD). Objective: The point of the present examination is to research the vitamin D
status and find if there is a relationship between maternal vitamin D insufficiency and intra uterine growth restriction
(IUGR). Subjects and Methods: From February to August 2019, our case-control study was carried out in the Maternity
Hospital of Ain Shams University, it included 80 pregnant ladies (40 of them with IUGR and the other 40 with normal
fetal growth). Included pregnant ladies were sampled for vitamin D level. Vitamin D test: By using the DRG® 25-OH D
(complete) ELISA (EIA-5396), all samples were examined.
Results: Our investigation indicated significant connection between maternal vitamin D status and IUGR. Results here
uncovered that maternal hypovitaminosis D is related with IUGR. Conclusion: Maternal vitamin D level ought to be
estimated during pregnancy. Pregnant ladies ought to be urged to get normal sources of vitamin D, for example,
satisfactory sun presentation, eating nourishment wealthy in vitamin D. Royal college of obstetricians and gynaecologists
(RCOG) proposals with respect to vitamin D supplementation ought to be satisfied.
Keywords: Vitamin D deficiency; Intra Uterine Growth Retardation.

Vitamin D lack is basic in pregnant ladies and is
Fetal growth restriction (FGR) is a typical and
progressively perceived as a worldwide general medical
complex clinical issue, which is associated with
issue. Expanding proof exhibits that vitamin D
inadequacy during pregnancy is connected with
Notwithstanding irresistible causes and inherent
gestational diabetes mellitus, pre-eclampsia, and
contortions, FGR has been recognized as a significant
bacterial vaginosis (5).
supporter of perinatal mortality (1).
An efficient survey of writing featured the impact
Up to 10% of pregnancies may be affected by
of vitamin D on birth weight. Vitamin D has a key job in
intrauterine growth restriction, which is frequently
fetal development by its association with parathyroid
referred to as small for gestational age (SGA),
hormone and calcium homeostasis (6). High commonness
intrauterine development confinement (IUGR) or fetal
of vitamin D lack (around a billion) has been seen
development limitation (FGR) in a conflicting and
among individuals everywhere throughout the world (7).
befuddling way. Generally, an expected fetal weight
The point of the present examination is to research
(EFW) or abdominal circumference (AC), which is also
the vitamin D status and find if there is a relationship
referred to as stomach perimeter underneath the tenth
between maternal vitamin D insufficiency and intra
centile, raises worries over problematic intrauterine
uterine growth restriction (IUGR).
development. Anyway, the qualification among typical
and pathologic development frequently can't dependably
At the Maternity Hospital of Ain Shams University,
be made at this subjective cut-off. Also, around 70% of
this case control study was carried out between February
embryos beneath the tenth centile will have a typical
2019 till August 2019, it included 80 pregnant ladies
perinatal result (2). The danger of bad outcome is
who were divided into 2 groups (group A which
corresponding to the level of development limitation
included 40 cases with IUGR and group B which
with those underneath the third centile as well as
included 40 pregnant women with normal fetal growth),
abnormal umbilical course Doppler estimations at most
they were recruited for from those women attending
serious danger of horribleness or mortality (3).
outpatient clinic of ASUMH after fulfilling inclusion
What's more, investigation of fetal development
criteria. The study comprised women aged from 20 to 35
directions has been distinguished as a significant factor
years, with singleton pregnancy and gestational age
in the separation between physiological SGA and
between 28 ­ 34 weeks. Pregnant ladies with the
neurotic IUGR (3). Vitamin D, a secosteroid hormone
following criteria were excluded from the study: drug
known for its old style, works in calcium take-up and
misuse (cocaine), chronic kidney illness, hepatic
bone digestion, is currently all around perceived for its
disappointment, multiple pregnancy, congenital fetal
non-traditional activities, including balance of inborn
malformation, antiphospholipid disorder, systemic lupus
resistant reaction and guideline of cell multiplication (4).
Received: 15/03/2023
Accepted: 14/05/2023

Full Paper (vol.931 paper# 15)

c:\work\Jor\vol931_16 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7002-7008

Thyroid Disorders in Juvenile Idiopathic Arthritis Patients and
Its Correlation with Disease Activity: A Cross-Sectional Study
Hend Mehawed Soliman 1, Balsam Sherif Fahmy 2*, Ahmed Mahmoud Nasr1, Eman Shafik Shafie 1
1 Pediatrics Department, Kasr Alainy, Faculty of Medicine, Children`s Hospital, Cairo University, Cairo, Egypt.
2 Clinical and Chemical Pathology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Cairo, Egypt.
* Corresponding author: Balsam Sherif Fahmy Email: balsam.sherif@kasralainy.edu.eg.,
Telephone: +201113151831, ORCID ID: http//orcid.org/0000-0002-5900-5274

The association between juvenile idiopathic arthritis (JIA) and thyroid disorders has been defined in adults
and, less frequently, in children.
Objective: The study's goal was to assess thyroid function and the prevalence of thyroid antibodies in patients with juvenile
idiopathic arthritis, as well as their relationship to disease activity.
Methods: This cross-sectional study included 50 children and adolescents with juvenile idiopathic arthritis. All patients
underwent thyroid function tests (thyroid stimulating hormone, free thyroxine, and free triiodothyronine), anti-thyroglobulin
and anti-peroxidase antibodies by enzyme-linked immunosorbent assays.
Results: The study showed that 52% of the patients were males and 48% were females. Their median age value was 9 years
old. Thyroid abnormalities were detected in 52% of JIA patients. Overt hypothyroidism was the most prevalent disorder [14
patients (28%)], followed by subclinical hypothyroidism [11 patients (22%)], and then subclinical hyperthyroidism [1
patient (2%)], while 24 patients (48%) were euthyroid. Thyroid antibodies showed a normal level in all patients. On
comparing thyroid function tests among patients with active and inactive JIA, no statistically significant difference was
observed in thyroid hormone levels.
Conclusion: To reduce the risk of delayed or undiagnosed thyroid diseases, it is necessary to routinely screen for thyroid
function abnormalities in children with juvenile idiopathic arthritis.
Keywords: Juvenile idiopathic arthritis, Thyroid autoantibodies, Thyroid function, Hypothyroidism.


Juvenile idiopathic arthritis (JIA) is the most
thyroid antibodies in juvenile rheumatoid arthritis
prevalent chronic rheumatic illness in children and can
patients, and their association with disease activity.
trigger chronic pain, joint injury, and disability [1]. It is

defined as an autoimmune inflammatory arthritis that
develops in children less than 16 years old, persists over
Study design and data collection: This cross-sectional
6 weeks, and is of unknown aetiology [2].
study included 50 children and adolescents with juvenile
The existence of other autoimmune diseases in
idiopathic arthritis (JIA) who attended at regular intervals
children with JIA has been reported, and thyroid
for follow-up at the Rheumatology Unit of Specialized
dysfunction is the most frequently involved [3].
Pediatrics Hospital. Cases were recruited from March
Subclinical hyperthyroidism, subclinical hypothyroidism,
2019 to June 2019.
hyperthyroidism, and hypothyroidism are the main forms

of thyroid dysfunction. The most frequent cause of
Inclusion criteria: Patients less than 16 years old of both
different thyroid dysfunctions is autoimmune thyroid
genders diagnosed with JIA according to the International
disease (AITD), which includes Graves' disease and
League of Associations for Rheumatology's (ILAR)
Hashimoto's thyroiditis, as revealed by the generation of
classification of juvenile idiopathic arthritis subtypes (JIA
antithyroid antibodies [4].
include 7 subtypes: systemic arthritis, oligoarthritis,
The presence of autoimmune disorders that co-exist
polyarthritis rheumatoid factor positive, polyarthritis
in JIA patients can be explained by the generalized
rheumatoid factor negative, psoriatic arthritis, enthesitis
dysregulation of the immune system in those patients,
related arthritis and undifferentiated arthritis) [8].
which have been described to decrease life quality and

increase the risk of disability and mortality [5].
Exclusion criteria:
There are limited studies assessing thyroid function and
Patients with thyroid abnormalities caused by other
estimating the prevalence of other autoimmune
conditions or taking medications that can impair thyroid
conditions, including autoimmune thyroid disease, in
function, as well as those with other rheumatological
children and adolescents with JIA [6, 7]. This study was
done to evaluate thyroid function, and the prevalence of
Clinical manifestations of the disease, such as fever

and arthritis along with a high erythrocyte sedimentation
Received: 28/07/2023
Accepted: 30/09/2023

Full Paper (vol.931 paper# 16)

c:\work\Jor\vol931_17 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7009- 7017

A Comparison between Baska Mask and Endotracheal Tube in
Patients Undergoing Gynecological Laparoscopic Surgery
Mostafa Ibrahim Mostafa, Osama Helal Ahmed, Marwa Hamyed Elrasy Murad
Department of Anesthesia, Intensive Care and Pain Management,
Faculty of medicine, Al-Azhar University (Assiut), Egypt
*Corresponding author: Marwa Hamyed Elrasy, Mobile: (+20) 01013255876, E-mail: marwaelrasy@gmail.com

Gynecological laparoscopy is a popular day-case or short-stay surgery. Laryngeal mask airway (LMA)
provides various advantages over tracheal intubation (TI), including less postoperative adverse effects like sore throat,
dysphagia, and dysphonia, faster and easier airway device placement, and less neuromuscular blockade. Correctly
positioned new-generation LMAs prevent stomach insufflation and regurgitation. Laparoscopy, which has high peak
airway pressure, can be anaesthetized with these devices.
Objective: This study aimed to compare the effects of the Baska Mask and endotracheal tube on hemodynamic
parameters (heart rate, mean arterial pressure), airway pressure and EtCO2 values
Patients and methods: This prospective randomized study was conducted on 60 patients through the period from
January 2021 to September 2022 at Al-Azhar University Hospitals (Assiut). They were ASA class I or II, scheduled
for elective gynecological laparoscopic surgery and had mean age of 45.42 ± 8.53 years.
HR was significantly higher in B group regarding measurements at 60 and 90 min. BIS was significantly
higher in B group compared to E group regarding measurements at baseline, after induction/before laryngoscopy, after
laryngoscopy, during intubation/insertion and at 1, 3, 5, 10, 20, 30, 40, 50, 60, 90 and 120 min. Peak airway pressure
was significantly higher in E group regarding measurements at baseline after induction/before laryngoscopy, after
laryngoscopy, during intubation/insertion and at 1, 3, 5, 10, 20, 30, 40, 50, 60, 90 and 120 min. Also, leak pressure
was significantly higher in E group compared to B group at all times of measurements. Between the groups, there was
a considerable difference in insertion time.
The current investigation corroborated the findings of previous studies conducted on individuals having
general surgery. The efficacy of the Baska mask was shown to be comparable to that of endotracheal intubation for
female patients receiving elective laparoscopic gynaecological surgery who were ventilated during general
Keywords: Baska mask, Endotracheal tube, Gynecological.


like laparoscopy, which has a high peak airway
One of the most prevalent types of surgery is
pressure, these devices are a good choice (3).
laparoscopic gynecological surgery, it is usually
The BASKA mask is a new breathing device
performed on a day-case or short-stay basis.
(Logikal Health Products PTY Ltd, Morisset, NSW,
Theoretically, when compared to tracheal intubation
Australia). It has a lot of the same parts as other
(TI), the use of LMA has a number of benefits,
supraglottic airways, as well as a few parts that are
including the avoidance of complications related to TI,
unfamiliar (4). An inlet on the BASKA mask is
quick and simple placement of the airway device itself,
designed to go into the upper oesophagus. In order to
a reduced need for neuromuscular blockade, and a
assist clear this region, suction can be attached to the
lower incidence of postoperative adverse events like
side channels on the dorsal surface of the cuff, which
sore throat, dysphagia, and dysphonia (1). But using the
is intended to drive any oropharyngeal contents away
LMA in laparoscopy is debatable because to concern
from the glottis (5). These traits may make it less likely
regarding a higher risk of regurgitation and lung
that secretions or stomach contents will get into the
aspiration and a decreased ability to breath because of
lungs if they build up in the supraglottic area (6). Due to
the pneumo-peritoneum that comes with it. People
these modifications, the BASKA mask airway is now a
have also questioned whether or not these tools can
desirable, safe, and efficient airway equipment for
give the best ventilation during laparoscopic
low-risk patients undergoing gynecologic laparoscopic
treatments. The seal pressure of the airway is the most
surgery (7).
important factor in making sure that the LMA has
The goal of this study was to find out how the
enough airflow and respiration when it is in a
Baska Mask and endotracheal tube affect the HR and
pneumoperitoneum condition. A good sealing pressure
not only makes sure the patient is getting enough air,

but it also lowers the risk of aspiration because the
The prospective randomized study was
mouth is better sealed (2).
conducted on 60 patients aged 20 to 60 years at Al-
When placed correctly, the new generation of
Azhar University Hospitals (Assiut). They were
LMAs protect against regurgitation and stop gastric
American Society of Anesthesiologists (ASA) class I
insufflation. When giving anesthesia for a treatment
or II and scheduled for elective gynecological
Received: 28/03/2023
Accepted: 24/05/2023

Full Paper (vol.931 paper# 17)

c:\work\Jor\vol931_18 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7018- 7025

Diagnostic Accuracy of HOMA-IR in Detecting and
Grading Nonalcoholic Fatty Liver Disease
Reda Albadawy, Abeer M. El-Bahy*
Department of Hepatology, Gastroenterology and Infectious Diseases, Benha University, Egypt
*Corresponding author: Abeer M. El-Bahy, Mobile: (+20) 01004632465, E-mail: e-mail: ab_elbahy@yahoo.com

The most frequent etiology of chronic liver illnesses globally is non-alcoholic fatty liver disease
(NAFLD). To identify insulin resistance (IR) in NAFLD cases, the homeostasis model assessment estimate of IR
(HOMA-IR) is being studied. Objective: To estimate the role of HOMA-IR in the context of NAFLD diagnosis.
Subjects and methods:
This retrospective cross-sectional study was conducted during the period from 2020 to 2021
in Benha University Hospitals, Egypt. It was conducted on 205 subjects; 102 NAFLD patients and 103 normal
subjects. Entire subjects were assessed by complete history taking and physical examination. Liver function tests and
lipid profile, fasting blood glucose (FBG), fasting insulin (FI) level and HOMA-IR were measured. Abdominal
ultrasound (US) for diagnosis and grading of fatty liver was done for each subject. Results: In NAFLD patients, the
mean age was 45.54 ± 9.56 years, 71.6% were females. Diabetes mellitus, hypertension, weight, and body mass index
(BMI) were higher in NAFLD group. NAFLD cases had significantly higher FBG levels compared to those without
NAFLD (107.40±5.34 mg/dl vs 85.10±0.71 mg/dl, p=0.047). Patients with NAFLD had significantly higher FI
levels in comparison with those without NAFLD (4.62±0.86 U/ml vs 4.39±0.56 U/ml, p=0.026). Patients with
NAFLD had significantly greater HOMA-IR in comparison with those without NAFLD (1.21±0.06 vs 0.92±0.01,
p<0.001), with best cut off (>1.01), sensitivity (Sn) was 64.71% and specificity (Sp) was 82.52%. HOMA-IR showed
ascending level with increased grade of fatty liver. Conclusion: FI, FBG and HOMA-IR are correlated with diagnosis
of NAFLD. HOMA-IR is an biomarker of the degree of hepatic steatosis and can be used to identify individuals for
further testing.
Non-alcoholic fatty liver disease (NAFLD), Body mass index (BMI), Fasting blood glucose (FBG),
Fasting insulin (FI), Homeostasis model assessment estimate of insulin resistance (HOMA-IR).


glycemic clamp in non-diabetic individuals, HOMA-
Nonalcoholic fatty liver disease (NAFLD)
IR, which was developed by Matthews et al. (7), has
represents the commonest cause of chronic liver
been the most often used approach in clinical practice
disease globally. The estimated prevalence of NAFLD
and epidemiological investigations. As a result, it has
is estimated to be 25.2% all over the world (1), and in
lately been used often in clinical investigations of
the Middle East and North Africa (MENA) is found to
NAFLD (8).
be 31.8% of all adults, this is one of the greatest
It has been proven by a previous study that
NAFLD prevalence rates (2).
even in the presence of experienced radiologists,
This condition is recognized as one of the
ultrasound (US) is still not a valid objective method for
leading contributors to liver disorder-related death (3).
grading steatosis, as different grades were given when
It is a liver illness that develops without the use of
same images were assessed by the same radiologist in
large amounts of alcohol or any other secondary
two different settings one month apart. This sheds
causes. It progresses through a range of stages with a
attention to the need for a more objective and
poor prognosis. Steatosis, an excessively elevated fatty
quantitative technique for assessing the degree of fatty
acid accumulation in hepatocytes, non-alcoholic
liver disease (FLD) that is both widely accessible and
steatohepatitis (NASH), fibrosis, cirrhosis, and
relevant for use in normal practice (9). Therefore, we
ultimately hepatocellular carcinoma (HCC) are the
aimed to identify diagnostic accuracy of HOMA-IR in
first stages of the illness spectrum (4). IR, obesity and
detecting and grading NAFLD.
type 2 diabetes mellitus (T2DM) were found to

enhance NAFLD progression (5).
This retrospective cross-sectional study was
According to the definition of IR, this
conducted in the Hepatology, Gastroenterology and
condition is characterized by a diminished biological
Infectious Diseases Department, Benha University
response to the activities of insulin, which has an
Hospitals, Qalyubia Governorate, Egypt. The study
impact that is increased by obesity and leads to
was carried out from 2020 to 2021.
improper metabolism of glucose and fatty acids in
The study included 205 subjects aged between (27
human tissues, particularly fat, muscle, and liver. As it
to 60 years old), who consented to take part in the
is strongly predictive of lipid deposition in the liver,
study. Subjects with history of different hepatic
the evaluation of IR using evaluation model index or
disorders (e.g., viral hepatitis, autoimmune-liver
the HOMA-IR is becoming a more relevant field of
diseases, 1-antitrypsin deficiency, hemochromatosis,
study (6).
Wilson's disease and dugs) or history of alcohol intake
Due to the ease of its measurement and
and steatogenic drugs were ruled out from the study.
computation, as well as its substantial association to

Received: 28/03/2023
Accepted: 24/05/2023

Full Paper (vol.931 paper# 18)

c:\work\Jor\vol931_19 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7025- 7033

Gratification Phenomenon: Clinical Phenotype and Sex Hormones Profile
Hend Abdelmawgood Elafifi*1, Khalid Fathi Megahed1,
Azza Abdelbaky Elbaiomy2, Bothina Mohamed Hasaneen1
Departments of Pediatrics1 and Clinical Pathology2, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Hend Abdelmawgood Elafifi, Mobile: (+20) 01065403636, E-mail: hend_afify1990@yahoo.com


Background: Self-gratification is characterized by self-stimulation of the genitalia habitually. Childhood
masturbation could be described as genital stimulation and touching begins at the age of 2 months, although in certain
cases, it may start as early as in-utero. It is of great difficulty to distinguish attacks of masturbation from different
medical situations, which include fits, dyskinesia, infantile spasm and abdominal pain.
Objective: To demonstrate the clinical and epidemiologic criteria of infant and child with gratification phenomenon
and to assess the level of some sex hormones in such patients.
Methods: This was case control study that conducted on 25 children diagnosed with self-gratification disorder with
control group included 25 children of matched age and gender. Gratification phenomenon diagnosis in our patient was
according to descriptive history and review of videotaped events. Laboratory investigation included level of
dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone (17-OHP) and estradiol.
Results: Regarding serum hormone levels, 17-OHP had comparable levels between the cases and control groups.
However, both DHEAS and estradiol were significantly decreased in the cases in comparison with the control group.
Serum DHEAS had a significant positive correlation with the age of the first attack, while estradiol had a significant
negative correlation with attack frequency.
Conclusion: Hormonal assay showed significant decline in serum DHEAS and estradiol levels in patients with
gratification disorder but with normal levels of 17-OHP, this may indicate the potential role of this hormonal
deficiency in pathogenesis of self-gratification phenomena.
Keywords: Gratification phenomenon, Masturbation, Dehydroepiandrosterone sulfate, 17-hydroxyprogesterone,


Self-gratification (Masturbation) in childhood was
Diseases and Related Health Problems, 10th edition
first described in 1915 by Still, who demonstrated that
[6]. Childhood masturbation isn't comprised in the 5th
such behavior was more common compared to
edition of the Diagnostic and Statistical Manual of
formerly thought [1]. It is featured by self-stimulation
Mental Disorders [7]. The topic of hyperactive sexuality
of the genitalia often accompanied by unusual posture
was suggested but rejected for inclusion in the 5th
and movement, diaphoresis, flushing, tachypnea, and
edition by the American Psychiatric Association as it
classically starts in infancy as well as in early
isn't considered an unhealthy behavior [8].
childhood [2].
Generally, investigators find it is of great difficulty
The prevalence of self-gratification in early
to distinguish attacks of masturbation from different
infancy is not identified as the behavioral features are
medical situations, which include epilepsy [9],
of great difficulty to be interpreted. Parents'
paroxysmal dystonia or dyskinesia, movement
descriptions of the manifestations are sometimes
disorders [10], infantile spasm and abdominal pain [11].
difficult for physicians to interpret as well as for
There are no preceding records on the natural course of
parents to understand. In particular, it is of great
masturbation beginning in early infancy.
difficulty to confirm a diagnosis of masturbation in
children below the age of one year [3].
investigations and use of inappropriate drugs like
Childhood masturbation could be described as
antiepileptic drugs that lead to further parental anxiety
genital stimulation and touching begins at the age of
and stress. Preceding records on infants and early
two months, although in certain cases, it may start in
childhood masturbation are sparse with no trials to
utero [4]. One of the main individual features of
recognize the actual role of sex hormones in such a
childhood masturbation is that the behavior
condition, in spite of the evidence that sex hormones
occasionally stops if the child becomes distracted,
are identified to predispose to adolescent masturbation
helping to differentiate masturbation from different
behavior [12].
simulating conditions [5].
In normal infant with self-gratification, the actual
The World Health Organization (WHO) doesn't
mechanism remains unknown in the majority of
have a special code for childhood masturbation. It is
patients. Despite the documented occurrence of
classified under the coding title "Other specified
gratification in many literatures, there is deficiency of
behavioral and emotional disorders with onset usually
literature depicting its physical characteristics in our
occurring in childhood and adolescence" in the
locality. This is attributed to deficient and ignored
International Statistical Classification System of
Received: 29/03/2023
Accepted: 25/05/2023

Full Paper (vol.931 paper# 19)

c:\work\Jor\vol931_20 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7034- 7036

Effect of Selective Physical Therapy Program on Quality of Life in
Diabetic Polyneuropathy Patient
*Nada M Youssef 1, Abeer Elwishy 2, Islam M Al-Azab 2.3 , Manar Samir Muhamed 4
1. Department of Physical Therapy for Neurology and neurosurgery,
Faculty of Physical Therapy, Deraya University, Elminia, Egypt.
2 Department of Physical Therapy for Neurology and neurosurgery,
Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
3. Department of Physical Therapy for Neurology and Neurosurgery,
Faculty of Physical Therapy, 6th October University, Cairo, Egypt.
4. Department of internal medicine, Faculty of Medicine, Deraya University, Elminia, Egypt.
*Corresponding author: Nada Mohamed Youssef Aldemerdash. Tel: +20 1063613631.
E. Mail: nademerdash93@gmail.com,
Patients with diabetes mellitus commonly experience a diminished quality of life. The adoption of a sedentary
lifestyle is well recognized as a risk factor that can be altered for the development of type 2 diabetes, as well as an
independent indicator that predicts a diminished quality of life. Exercise plays a crucial role in the management of
individuals having diabetes. Purpose: The objective of this investigation was to evaluate the impact of a selected physical
therapy intervention on the quality of life among patients diagnosed with diabetic polyneuropathy. Subjects and methods:
Twenty patients were given selected physical therapy program for a total of 36 sessions spread out over 12 weeks at a rate
of 3 sessions per week for a duration of 40 minutes each. All patients were evaluated with the Quality of Life scale (QoLS).
The study was done in Outpatient Clinics of Faculty of Physical Therapy, Deraya University.
There was a substantial improvement in quality of life after treatment in the study group contrasted with that before
treatment (p > 0.001).
Conclusion: The findings of this study showed improvement of quality of life in patients that were given a selected physical
therapy program (proprioceptive training, stretching as well as strengthening exercises for arm and leg muscles).
Key words: Diabetic polyneuropathy, Selected physical therapy program, Quality of life scale (QoLS).


Neuropathies are the one more common
Given its influence on the long-term prognosis as
complications of diabetes with prevalence of
well as financial burden, QoL is one of the most crucial
approximately 8­45% of the patient with type 2 diabetes.
components of patients' lives influenced by diabetes.
Typical symptoms include sensations of numbness,
Those with painful DPN have a deteriorated QoL,
tingling, pain, as well as/or weakness that originate in the
particularly with regard to their reduced levels of physical
distal regions of the lower limbs. Diabetes has been
activity. Individuals who reported higher pain intensity
widely recognized as the primary metabolic risk factor
had the most significant deterioration in QoL, a finding
accompanying with neuropathy. However, it is
that is consistent with previous studies investigating the
noteworthy that the management of hyperglycemia alone
impact of pain on QoL (5).
is not sufficient in the prevention of neuropathy among
This investigation was conducted to figure out the
individuals diagnosed with type 2 diabetes (1). Diabetic
therapeutic impact of the selected physical therapy
polyneuropathy (DPN) is widely recognized as the
program (proprioceptive training, stretching as well as
prevailing manifestation of diabetic neuropathy,
strengthening exercises for arm and leg muscles), on the
characterized by sensorimotor polyneuropathy that affects
quality of life in people experiencing diabetic
length and is persistent and symmetrical (2).
DPN is a sensory-dominant neuropathy which result

in initial ulcers and foot gangrene, which can cause pain,
poor sleep, an increased risk of falling due to weakness,
Sample size: G POWER was utilized to determine the
as well as an increased risk of extremities amputation (3).
optimal sample size (version; Franz Faul,
Neuropathic pain (PN) occurs in around 67% of people
Universitat Kiel, Germany) based on quality-of-life data
with PN, making it quite prevalent, and varies little
derived from Venkataraman et al. (6) and found that 20
between etiological classifications. It is also widely
participants in the study group would be optimal for
recognized as among the most debilitating neuropathy
carrying out the research.
symptoms, negatively impacting patients' mental health as
Calculation is made with = 0.05, power = 90% and
well as resulting in a low quality of life (QoL) (4).
effect size = 1.1. Study was performed with approval from

the Faculty of Physical Therapy at Cairo University (No.

Full Paper (vol.931 paper# 20)

c:\work\Jor\vol931_21 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7037- 7043

Epidemiology of Ankle Fracture in Mansoura University Emergency Hospital
Ahmed Mohamed Mosad1, Mohamed Elsaid Ahmed1, Samir Mohamed Attia2, Barakat Sayed El-Alfy3
Departments of Emergency Medicine1, Vascular Surgery2 and
Orthopaedic Surgery3, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Mohamed Mosad, Mobile: (+20) 01094363923, E-mail: ahmedmohamedmosad4@gmail.com


Background: Common injuries include ankle fractures, which can happen as a result of low-intensity trauma in young
people or a high-intensity trauma in elderly, weak patients. Both the patient and the treating surgeon must overcome
considerable obstacles while management of fractures of ankle in diabetic patients.
Objective: For determination of the epidemiology of ankle fractures regarding the overall incidence, incidence of each
type, incidence of open fracture, incidence of diabetic patients and associated injuries.
Patients and Methods: In this analytical retrospective analysis, 255 cases of ankle fractures (malleolar fractures) of
any kind and patients older than 18 years were included. The patients underwent radiographic exams, including an
ankle X-ray, a duplex ultrasound on the lower limb, and, if necessary, a CT or MRI.
Results: The mean age was 37 years and male to female ratio was 55/45. Most of the studied cases were Closed
Weber A1 (30%), followed by Closed Weber B2 (20%) and Closed Weber A2 (20%), then Open-Weber B3, Open-
Weber B2 and Closed Weber B1, which represented 10% for each. diabetes mellitus and hypertension and smoking
were recorded in 10%, 40% and 40% of cases respectively. Most of the studied cases (80%) were treated by operation,
and only 20% of cases had cast management.
Conclusion: The majority of ankle fractures occur in middle-aged people, with a higher frequency of men. Ankle
twisting (FTG) is the most frequent type of injury, followed by road traffic accident (RTA). In making decisions for
the patients under study, smoking history is a crucial factor.
Keywords: Epidemiology, Ankle Fracture, Diabetic fractures, Weber classification.

vasculopathy have greater complication rates than both
Common injuries include ankle fractures, which
diabetes patients without these comorbidities and non-
can happen as a result of low-intensity trauma in
diabetic patients. Open reduction and internal fixation
young people or a high-intensity trauma in elderly,
using traditional techniques are advised for diabetic
weak patients. In order to lower the chance of
patients with unstable ankle fractures who do not have
developing post-traumatic ankle arthritis, treatment for
neuropathy or vasculopathy [5].
these fractures tries to reestablish joint stability and
Both the patient and the treating surgeon must
alignment [1]. Open reduction and internal fixation are
overcome considerable obstacles while management of
required for a double break of the ankle mortise ring
ankle fractures in diabetic patients. The well-known
with displacement and tibiofibular disruption.
risk factor for problems after ankle fracture repair is
Whatever method is employed, it should secure the
diabetes. Patients with diabetes who experience ankle
ankle joint mortise and provide perfect congruency,
fractures that need surgical fixation are more likely to
enabling early recuperation. Supine or type C
experience complications [6]. DM patients' ankle
supination-eversion fractures of the Lauge-Hansen
fractures have long been acknowledged as a difficulty
classification have less displacement and fewer
for working clinicians. In this patient population,
sequelae, but Weber ankle fractures and pilon fractures
malunion, delayed union, nonunion, infection,
are linked to a lower result score [2].
decreased wound healing, and Charcot arthropathy are
Open fractures were typically more complex than
common complications [7].
closed fractures and occurred more frequently after
The aim of this study was to determine the
high energy mechanisms. Patients with open fractures
epidemiology of ankle fractures regarding; the overall
frequently had advanced ages, which most likely
incidence, prevalence of each type, incidence of open
contributed to greater complication and secondary
fracture, incidence in diabetic patients and associated
operation rates. Smaller disparities in the foot function
injuries in Mansoura University Emergency Hospital
index's and the brief musculoskeletal function
assessment's activity functions were linked to higher

morbidity following open ankle fractures. Open
injuries were associated with older mean ages (51 vs
Patients who presented to the (MUEH),
45 years, P 0.001), and fractures were more open as
Mansoura, Egypt for one year (August 2022 to August
people aged [3].
2023) with ankle fractures were included in this
At least three of the four major knee ligaments are
analytical retrospective study. The patients were
typically torn after ankle fractures, and serious
analysed with regard to the mode of trauma, types of
capsular, neurovascular, and tendinous injuries are
fractures, presence of diabetes mellitus, presence of
common [4]. Diabetes patients with neuropathy or
vascular injury, and associated injuries. Any adult
Received: 30/03/2023
Accepted: 28/05/2023

Full Paper (vol.931 paper# 21)

c:\work\Jor\vol931_22 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7044- 7052

Egyptian Retrospective Multicenter Study: The Interrelationship between
COVID-19 Infection and Hemodialysis
Enass Sayed Mohammed Elsayed1, Manal Shaker El Hussini*2, Wael Mouhamed Essa3,
Amany A. Salem4, Alaa Elhamzawy1, Hala Mahfouz Abd Elmegeed5, Shereen Youssef5,

Omnia Salaheldin Ali6, Haytham Anis Tolba7, Mostafa Rashed8, Magdy Elsharkawy9
Departments of 1Nephrology, 2Pulmonology, 3Nephrologist, 5Internal Medicine and
6Clinical & Chemical Pathology, Teaching Hospitals and Institutes, Egypt
Department of 4Public Health, Faculty of Medicine, Cairo University, Egypt
Department of 5Internal Medicine & Nephrology, Electricity Hospital, Cairo, Egypt
Department of 7Nephrology, National Institute of Urology and Nephrology, Egypt
Department of 8Urology, General Organization for Teaching Hospitals and Institutes, Egypt
Department of 9Nephrology, Faculty of Medicine, Ain-Shams University, Egypt
*Corresponding author: Manal Shaker El Hussini, Mobile: (+20) 01001165056,
E-mail: drmanalshaker@gmail.com, ORCID No: https://orcid.org/0000-0002-3222-1516

Individuals on dialysis are disproportionately affected by corona virus. It is beneficial to compare the
general population's and dialysis population's hospitalisation trends during the COVID-19 pandemic.
Objective: To study the clinical presentation of SARS-CoV-2 infection in maintenance hemodialysis patients and
identify their clinical sequel and outcomes through comparing the results with non-COVID-19 infection hemodialysis
patients, and non-hemodialysis COVID-19 infection patients.
Material and Methods: In this retrospective multicenter study 734 Egyptian patients were recruited. The clinical course
and outcomes of hemodialysis patients with confirmed COVID, (group I) were compared to non-COVID hemodialysis
patients (group II), and non-hemodialysis COVID-19 patients (group III).
Results: The most common co-morbidities among group I was hypertension (45%), then diabetes mellitus (28.3%).
Fever was the most common symptom (84.4 %) followed by dyspnea (46.9%). The cure rate was 84.4% and mortality
was (15.6%). 5.3% of patients needed mechanical ventilation and majority were treated according to Egyptian protocol
at home (65.3%). Comparison between (group I) and (group II) revealed that body mass index were significantly higher
in group I while comparing investigations of both groups revealed that hemoglobin, hematocrit, leucocytes, platelets,
ferritin & C-reactive protein showed statistically significant difference. Unexpectedly, although the need for intensive
care admission presented more in group III, mortality significantly increased among group I. Comparing investigations
during and after cure there were significant decrease in leucocytes, lymphocytes, and platelets.
Conclusion: Obesity, hypertension and diabetes mellitus are important risk factors among hemodialysis patients with
COVID-19 infection. Hemoglobin, hematocrit, leucocytes, platelets, ferritin & C-reactive protein are significant
investigations for screening of COVID-19 among them, while WBCs, Lymphocytes, and platelets are considerable for
follow-up of cure. Unexpectedly the need for ICU admission presented more in non-hemodialysis patients and mortality
significantly increased among hemodialysis group with COVID-19.
Keywords: COVID-19, Hemodialysis, Obesity, Screening, Hypertension, DM.


general population because of their advanced age and co-
Infection with the SARS-CoV-2 corona virus first
morbid conditions. Unfortunately, not only is the
appeared in Wuhan, China in December 2019, and it has
infection rate higher among them, but the infection is also
since spread quickly around the world [1]. The general
more severe, leading to more fatalities. Mortality rates
public's use of hospitals, and dialysis patients in
were recorded at a startling incidence of nearly 25% prior
particular, has been significantly impacted by the
to the vaccination distribution [5].
COVID-19 pandemic [2].
Although there is adequate information to support
A single-strain RNA virus called SARS-CoV-2
the implementation of preventative measures in
primarily damages the respiratory system, however
hemodialysis centres to stop the spread of the SARS-
severe infections might progress to multisystem diseases.
CoV-2 virus, the specifics of the illness in this group are
The clinical picture varies greatly, ranging from an
yet unknown. There have now only been a few isolated
asymptomatic or moderate course (up to 80%), to severe
reports made regarding the frequency and outcomes of
involvement with bilateral pneumonia (about 15%), to a
COVID-19 in hemodialysis patients [6].
very critical illness requiring mechanical ventilation in
The aim of this work was to study the clinical
the intensive care unit ICU (3%­5%) [3]. The best way to
presentation of SARS-CoV-2 infection in maintenance
handle new COVID-19 is not well understood, and
hemodialysis patients and identify their clinical sequel
patients on maintenance hemodialysis treatment have
and outcomes through comparing the results with non-
even less information than the general public [4]. Patients
COVID-19 infection hemodialysis patients, and non-
receiving dialysis may have greater death rates than the
hemodialysis COVID-19 infection patients.
Received: 30/03/2023
Accepted: 28/05/2023

Full Paper (vol.931 paper# 22)

c:\work\Jor\vol931_23 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7053- 7059

Imaging Findings in Idiopathic Granulomatous Mastitis (IGM) among
Women in Sulaimani, The Kurdistan Region of Iraq
Alla Abdulrahman 1*, Kawa Abdulla Mahmood 2, Lana R. A. Pshtiwan 3, Mahabad Abdalaziz Salih 4
1 Breast Center and Department of Surgery, Shar Teaching Hospital, Sulaimani, Kurdistan Region, Iraq.
2 Radiology, Department of Surgery,Shar Teaching Hospital & College of Medicine,University of Sulaimani,
Sulaimani, Kurdistan Region-Iraq.
3 Breast Imaging Specialist, Arab Board General Radiology, Shar Teaching Hospital-Breast center,
Sulaimani, Kurdistan Region, Iraq.
4 Lecturer at college of Medicine, University of Sulaimani, Sulaimani, Kurdistan Region, Iraq.
*Correspondence: Alla Abdulrahman Ahmed, E-Mail: alla.ahmed@univsul.edu.iq,mobile:+9647717261048

: Idiopathic Granulomatous mastitis (IGM) is known as a rare condition, but it can mimic significant breast
lesions like cancer. Variable nonspecific characteristics are present in IGM imaging. Objectives: The current study
aimed to find the imaging characteristics of IGM among women of Sulaimani City in the Kurdistan Region of Iraq.
Patients and methods: A retro prospective observational study was performed on 80 patients with IGM admitted to the
Breast Center of Shar Hospital, from January 2014 to May 2022. The inclusion criterion was patients diagnosed
histopathologically with IGM. Exclusion criteria were secondary granulomatous processes and incomplete patient data.
We also reviewed ultrasonography (US), mammography, and magnetic resonance imaging (MRI) findings.
Results: Mean ages of patients was 35.8 (SD 5.7) years, and most of them (81.3%) were between 31 and 45 years of
age. Most of participants were married and multiparous. Both breasts were nearly equally affected. Most patients (75%)
presented with pain, followed by mass (70%). The commonest US finding was multiple hypoechoic masses and
collections with tubular extension. Focal asymmetric increased density was the most frequent mammographic finding.
MRI findings were asymmetric signal intensity change 10.0%, non-mass-like enhancement10.0%, type 1 enhancement
12.5%, and BI-RADS 3 in 10.0% of the patients. The BI-RADS score of most women who had MRI was upgraded.
Conclusions: Imaging characteristics of IGM are variable; the US and mammography are helpful as initial exams. MRI
gives more details on the disease and can be used to assess the extent of the disease, especially in complicated cases,
and monitor treatment.
Keywords: BIRADS, Idiopathic granulomatous mastitis, Secondary mastitis, Imaging findings, Radiological findings,
Retrosepctive study, Sulaimani, Ira.


Idiopathic granulomatous mastitis (IGM) is a rare
clinical features. Further, ultrasonography (US),
benign chronic inflammatory disease of the breast.
mammography, and magnetic resonance imaging (MRI)
Kessler and Wolloch first reported the condition in 1972
are helpful imaging modalities (5).
(1). The IGM primarily affects childbearing women,
However, the core-needle biopsy, with or without
especially breastfeeding or postpartum women (2).
the fine needle aspiration (FNA) for cytological
Although its etiology is unclear, studies suggested
examination and culture and sensitivity (C/S), is usually
autoimmune disease or responses to hormonal,
needed to exclude breast infections and malignant
including oral contraceptive drugs, trauma, and
breast tumors (6).
metabolic processes (2,3). By definition, the IGM is a
The IGM can show up with variable nonspecific
diagnosis of exclusion from bacterial infections or
characteristics in imaging which usually looks like the
histopathological biopsy findings of malignancies (1,4).
appearance of breast malignancy or inflammatory
Further, IGM is histopathologically characterized by the
diseases. Besides, these variabilities may be due to
nonnecrotizing granulomatous formation mainly
variable histopathological features like inflammatory
confined to lobules of mammillary glands (1-3).
processes, micro abscess formations, and fibrosis (5).
Besides, it is locally infiltrated by plasma cells,
The imaging techniques required for the diagnosis
multinucleated giant cells, lymphocytes, neutrophils,
of IGM include the US and mammography with other
and epithelioid histiocytes with organized micro abscess
imaging techniques tailored to the imaging findings and
patient characteristics. The US performs the usual initial
The IGM is usually aggressive and frequently
imaging assessment, followed by mammography with
shows properties of inflammatory breast tumors and
mediolateral and craniocaudal views if required (5).
infectious mastitis; thus, its diagnosis is usually
Usually, the patient presents with a palpable mass, focal
delayed. Medical imaging of the breast shows varied
pain, and focal skin changes; therefore, the US with a
features depending on the time the images were taken,
linear high-frequency probe is almost always performed
prior interventions, and the extent of inflammation (2).
(5,6). The limitation of the US and mammography are
The strategy for breast imaging for diagnosing
usually due to pain which limits the patient tolerance to
IGM is based on the patients' ages, risk factors, and
pressure or compression from these techniques, or
Received: 26/07/2022
Accepted: 28/09/2022

Full Paper (vol.931 paper# 23)

c:\work\Jor\vol931_24 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7060- 7065

Interleukin 8 in Children with Obstructive Sleep
Apnea before and after Adenotonsillectomy
Mohamed Tawfik El-Tabbakh1, Alaa Mouhamed Farid1,
Mohamed Salah Rashwan1, Nourhan Ibrahim Abdel Monem*1
1Department of Otorhinolaryngology, Faculty of Medicine, Suez Canal University
Corresponding author: Nourhan Ibrahim Abdel Monem Email: dr.nouribrahim99@gmail.com, Mobile: +201099902761

A reduction in blood oxygen levels and periodic interruptions in breathing during sleep are hallmarks of
obstructive sleep apnea (OSA).
Objectives: to determine the amount of serum IL-8 in children diagnosed with OSA both before & after undergoing
Patients and methods: Prospective randomized single-arm interventional trial. The research was conducted in the ENT
Department of Suez Canal University Hospital, Ismailia City, Egypt. Children experiencing OSA and chronic
intermittent hypoxia (CIH) signs during sleep. T & A was done on children as a matter of choice. Children's ages varied
from three to twelve years old.
Results: We found that there was significant variation among preoperative & postoperative IL-8. There was no
significant distinction among preoperative & postoperative O2 levels (p = 0.069), with the mean preoperative O2 level
being 98.27% and the mean postoperative O2 level being 98.77%. The preoperative oxygen desaturation index (ODI)
was significantly distinct from the postoperative ODI. The preoperative ODI had a mean value of 7.77, whereas the
postoperative ODI had a mean value of 2.90.
Conclusion: The levels of IL-8 in the children who had OSA were elevated. Children who had OSA showed a significant
reduction in their IL-8 levels following adenotonsillectomy.
Keywords: IL-8, Adenotonsillectomy, Obstructive sleep apnea.


The occurrence of recurrent episodes of
Intercellular adhesion molecule 1 (ICAM-1) and
interrupted breathing while sleeping as well as recurrent
IL-8 are examples of proinflammatory mediators that
reductions in blood oxygen saturation are the factors
contribute to this increased adherence by activating
that define OSA (1).
nuclear transcription factor-KB. It has been shown that
Obstructive sleep disordered breathing (SDB) is
systemic ICAM-1 plays a crucial role in leukocyte
extremely prevalent among children. Peak incidence
migration to the inflamed region (9).
occurs among the ages of two and eight, probably due
The study aimed to evaluate serum IL-8 level before and
to the proportional size of lymphoid tissue to airway
after adenotonsillectomy in children with OSA.
diameter. The frequency of primary snoring in

adolescents has been noticed to range among four
percent and twelve percent (2). Severe OSA if left
Study design: Randomized single arm pre-post
untreated can have serious consequences for children's
prospective interventional research.
health and academic performance (3).

As an autocrine growth factor for colon
Study population: Children with obstructive sleep
carcinoma cell lines, or by encouraging cell division and
apnea who were individuals at the ENT Clinic at Suez
may be migration via metalloproteinase cleavage, IL-8
Canal University Hospital.
has also been hypothesized to have a role in colorectal

cancer. It has also been determined that IL-8 induces
Inclusion criteria:
expression of transmembrane transporters, which
Children who displayed signs of OSA and CIH that
contributes to the chemoresistance of malignant pleural
are connected to sleep. Children will be given the option
mesothelioma (4, 5).
to undergo T & A. Age ranged from three to twelve
The pathology of cystic fibrosis has also been
years old.
related to IL-8. Neutrophils can be recruited and steered

toward the lung epithelium thanks to IL-8's role as a
Exclusion criteria:
signaling molecule. A variety of pro-inflammatory
Acute tonsillitis in children defined as a
chemicals and proteases are released by these recruited
temperature above 38.3 degrees Celsius, presence of
neutrophils within the airways as a result of their
cervical lymphadenopathy (tender or swollen > 2
overstimulation and malfunction, further damaging
centimeters lymph nodes), tonsillar or pharyngeal
lung tissue (6, 7). Due to elevated IL-8 serum
effusion, and a positive culture for group A -hemolytic
concentrations in severe COVID-19 people, IL-8 may
streptococcus. Children who had medical history
be a biomarker for illness treatment and prognosis (8).
including cardiovascular, neurological, allergy,

craniofacial and immune system, or genetic
Received: 02/04/2023
Accepted: 29/05/2023

Full Paper (vol.931 paper# 24)

c:\work\Jor\vol931_25 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7066- 7075

Oligometastatic Solid Tumors: Disease Characteristics and Role of Local Therapies
Alshimaa Mahmoud Alhanafy*1, Dalia Ibrahim Aggour2, Osama saber sherif3, Mohamad Kamal Alhanafy4,
Reda Abdel Latif Ibrahem5, Rania Abdallah Hassanin6, Amira Hegazy1
Departments of 1Clinical Oncology and Nuclear Medicine,
2Diagnostic and Interventional Radiology, National Liver Institute, 3Neurosurgery, 4General Surgery,
5Public Health and Community Medicine and 5Pathology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Alshimaa Mahmoud Alhanafy, Mobile: 00201006454574, E-mail: alshimaa_Alhanafy@yahoo.com

Background: Treatment recommendation and benefit of local therapy in oligometastatic disease (OMD) are an era of
interest and debate. However, most of the clinical literature on OMD is cancer site specific.
Objective: To study OMD detailed disease characteristics and outcomes regarding local therapies.
Patients sand methods: This observational prospective cohort study included 234 patients with stage IV solid tumors
who met the criteria of OMD ( 5 metastatic lesions, and or 2 organs) with performance status 0-2; we studied disease
characteristics and outcomes regarding local therapies of OMD.
Results: 126 (53.8%) patients received local therapies; surgery, radiotherapy (RT) and local ablative therapy (group I).
108 (46.2%) patients didn't receive local therapy (group II). Comparing both groups, in group I, patients had
significantly younger age, earlier initial TNM stage, higher rates of metachronous onset, symptomatic disease, soft tissue
disease, single lesion and or single organ involvement and complete response, but lower rates of managed pulmonary
OMD compared to group II. Regarding survival, local therapy of OMD was associated with better PFS and OS. The
mean OS since OMD diagnosis in local therapy group was 64 months vs. 38 months in non-local therapy patients and
the median PFS was not reached in local therapy patients vs. 30 months in no local therapy patients. By multivariate
regression analysis, local therapy for OMD was an independent prognostic factor for both progression-free survival
(PFS) and overall survival (OS).
Conclusions: For selected oligometastatic solid tumor patients, local therapy for OMD could improve PFS and OS.
Keywords: OMD, Solid tumors, Local therapy.

In this work we aimed to study OMD detailed
disease characteristics and outcomes regarding local
The leading cause of cancer mortality is metastases
(1). However, it is known that distant metastases may not

always be multiple and extensive (2). An intermediate
state exists in between localized cancer and extensive
Patients: This observational prospective cohort study
metastatic state, termed oligometastasis, where
included patients of stage IV oligometastatic disease
metastasis targeted therapy has the possibility for cancer
(OMD) of different types of solid tumors through the
cure (3).
period from January 2015 to January 2019.
Oligometastatic state is defined to be a maximum of
Inclusion criteria: Patient with stage IV solid tumors
five metastases at two or three sites (4-5). However, in a
with oligometastatic disease including the following
meta-analysis conducted by Rim et al. (6), the definition
eligibility criteria: 2 organs involved and 5
varies, with some studies included less than or equal to
metastatic lesion with male or female sex of any age but
three metastases. Other studies included less than or
with performance status (PS) 0-2 (12). Staging was done
equal to five, & a few trials chose patients according to
according to AJCC cancer TNM staging manual, eighth
the capability of local consolidative therapies (LCTs) to
edition, 2017 (13).
cover the lesions (4, 7).

The European Organisation for Research and
Exclusion criteria: Patients with incomplete medical
Treatment of Cancer (EORTC) & the European Society
data, patients with decompensated organ functions and
for Radiotherapy and Oncology (ESTRO) OligoCare
polymetastatic disseminated disease at time of
project developed a thorough design for description &
recruitment are excluded but patients with previous
categorization of OMD according to the clinical
history of polymetastatic disease and current induced
scenarios. Criteria for sub-categorization involve: The
OMD are eligible.
timing of OMD, clinical history of previous OMD,
Local therapy done after multidisciplinary team
initial systemic therapy at OMD diagnosis, response to
consultation of Menoufia University Hospital and
systemic therapy and previous clinical history of
Surgical approach aimed for complete surgical excision
polymetastatic cancer state (8). And it was approved by
of metastatic lesion, metastatectomy of brain metastases
a retrospective study that included hundreds of patients
required a careful clinical assessment of individual
with OMD (9). The clinical impact of oligometastatic
state is that local radical treatment could result in long-

term survival or cure (10, 11).
Received: 04/04/2023
Accepted: 01/06/2023

Full Paper (vol.931 paper# 25)

c:\work\Jor\vol931_26 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7076- 7080

Correlation between Anthropometric Measurements and Balance in
Children with Hemiplegic Cerebral Palsy
Ahmed Ibrahim Ali Ibrahim1, Gehan Hassan El Meniawy2,
Hassan Magdy El barbary3, Walaa Abd El-Hakim Abd El-Nabie4
1 Physical therapist, Senbellawein Health Administration, Dakahlia, Egypt
2,4 Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
3 Department of Orthopedic, Faculty of Medicine, Cairo University, Giza, Egypt.
Corresponding author: Ahmed Ibrahim Ali Ibrahim, Email: ptrservices2022@gmail.com, Mobile: 01050366830

Children with cerebral palsy suffer from deficits in balance and multiple nutritional deficiencies.
Purpose: This study aimed to investigate the correlation between anthropometric measurements and balance in children
with hemiplegic cerebral palsy.
Subjects and Methods: Thirty children with spastic hemiplegic cerebral palsy of both sexes with mean age of 8.48 ± 1.47
years participated in this study. Their degree of spasticity ranged from 1 to 2 according to the Modified Ashworth' Scale
and they were on level I or II on the Gross Motor Function Classification System. Their mean body mass index (BMI) was
16.16 ± 2.86. Balance was assessed by the Biodex balance system, which is represented by overall stability index (OASI),
the mediolateral stability index (MLSI) and the anteroposterior stability index (APSI).
Results: The results showed a moderate positive significant correlation between weight and OASI, APSI and MLSI (r =
0.419, r = 0.364, r = 0.434 respectively). Also, there was a moderate positive significant correlation between height and
OASI and MLSI (r = 0.378, r = 0.378 respectively), while there was a moderate positive non-significant correlation with
APSI (r = 0.318). Additionally there was a weak positive non-significant correlation between BMI with OASI, APSI and
MLSI (r = 0.180, r = 0.152, r = 0.207, p = 0.271 respectively).
Conclusion: Weight, height and BMI influence the ability of children with hemiplegic cerebral palsy to maintain balance.
Keywords: Anthropometric measurements, Cerebral palsy, Hemiplegia, Balance.


Brain trauma sustained during fetal development or
significant parameter for determining body composition
soon after birth is the cause of cerebral palsy (CP), a
(5). Anthropometric evaluation is a commonly employed
neurodevelopmental condition. It can seriously affect a
technique to evaluate the nutritional condition of children
child's ability to move, resulting in diminished muscle
with cerebral palsy. Instead of utilizing weight for height,
coordination and motor function. Additionally, children
it is advised to use the body mass index (BMI), which is
with CP have poor balance, which further impairs their
calculated by dividing a person's weight in kilograms by
ability to walk and their level of physical activity (1).
the square of their height in meters (6).
A type of spastic cerebral palsy known as hemiplegia
The fundamental element of the definition of
affects one arm and one leg on either the left or right side
cerebral palsy is impaired control of posture because
of the body (2). Hemiplegic CP constitutes 20­30% of all
dysfunctional regulation of posture interferes with day-to-
forms of CP (3).
day activities. Balance, which can be characterized as the
Weight bearing through the unaffected leg is a
process of preserving, reaching, or reestablishing the
common occurrence in asymmetric alignment, which may
center of mass in relation to the base of support, requires
be an attempt to compensate for muscle paresis in the
control over posture. The intricate integration of several
hemiplegic leg. Despite its functionality, this approach
body systems, including the vestibular, visual, auditory,
might not be the best due to higher energy costs and long-
proprioceptive, and higher-order premotor systems,
term overuse injuries. This uneven weight-bearing pattern
results in balance. One of the balance system's functional
combined with innate spasticity may cause muscle
objectives is to (1) preserve a particular postural stance
atrophy, stunted growth, paretic side weakness, and
(standing or sitting), (2) facilitate voluntary motion,
impaired balance (4).
including the switching between different postures, and
Anthropometric measurements are a methodical
(3) regain balance following outside disruptions, like a
approach that use trustworthy, legitimate, and
push, tumble, or slip (7).
scientifically recognized measurements for classifying
In hemiplegic CP, there are changes in both static and
and sizing the physical characteristics of the human body.
dynamic postural stability parameters. Hemiplegic
Put another way, it's a method for figuring out the
toddlers and adults can walk without the need for
physical dimensions of the human body. These days,
assistance, but their gaits are irregular (8).
anthropometric measurements are thought to be the most
Received: 03/04/2023
Accepted: 30/05/2023

Full Paper (vol.931 paper# 26)

c:\work\Jor\vol931_27 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7081- 7086

Serum Connective Tissue Growth Factor (CTGF) As a
Potential Biomarker for Diagnosis of Rheumatoid Arthritis
Marwa Mohsen Hamed1, Amany Salama Elbahnasawy1, Hosam Abdel Twab2, Amir Abdelrahman Youssef1
Departments of 1Rheumatology, Rehabilitation and Physical Medicine and 2Clinical Pathology (Clinical
Immunology), Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Marwa Mohsen Hamed, Mobile: (+20)01022899042, Email: marwamohsen93@yahoo.com


Background: The most prevalent inflammatory arthropathy in the world is rheumatoid arthritis (RA), a chronic
inflammatory autoimmune (AI) disease. As rheumatoid factor (RF) and anti-CCP are unable to diagnose correctly all
the patients, recent research raised the possibility that serum connective tissue growth factor (CTGF) could function as
a highly sensitive and specific diagnostic biomarker for RA.
Objectives: To evaluation of diagnostic value of serum CTGF in RA patients, investigation of the relationships between
serum CTGF and RF and anti-CCP, and investigation of the relationships between serum CTGF and disease activity.
Subjects and Methods: Four groups were involved in this case-control study: 45 RA cases, 45 OA cases, 45 SLE cases,
and 45 healthy controls. ESR, CRP, RF, and anti-CCP laboratory tests were performed on all RA cases. Physical
examination for painful and swollen joints, the DAS 28 CRP test, and a history-taking procedure were performed. All
subjects underwent testing to determine their serum CTGF levels.
Results: The present study found that serum CTGF levels were higher in RA patients than in SLE patients, OA patients
and healthy control individuals. The correlation between serum CTGF and rheumatoid factor (RF), anti-cyclic
citrullinated peptide (anti-CCP), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and DAS-28-CRP was
positive. Serum CTGF had a high specificity and sensitivity for RA cases.
Conclusion: CTGF could be a possible biomarker for diagnosing RA as well as monitoring disease activity.
Keywords: Rheumatoid arthritis, Connective tissue growth factor, Cellular communication network factor 2, Systemic
lupus erythematosus, Osteoarthritis.

those with other rheumatic disorders. Additionally,
Rheumatoid arthritis (RA) is a chronic systemic
serum CTGF is higher in RA that is active compared to
autoimmune illness that causes synovial membrane
RA that is inert [8].
breakdown in both the small and large joints and is
Objectives of this study were evaluation of
characterized by chronic inflammation. Due to this, life
diagnostic value of serum CTGF in RA patients,
expectancy and quality of life both decline [1].
investigation of the relationship between serum CTGF
Cellular communication network factor 2 (CCN2)
and RF and anti-CCP, and investigation of the
also known as connective tissue growth factor (CTGF),
relationship between serum CTGF and disease activity.
is one of the CCN family members that has been the

most thoroughly researched [2], a group of extracellular
matrix (ECM) regulating proteins with a similar
During their clinical visits from April 2021 to
structural make-up of their functional domains [3].
August 2021, participants in this case-control study
CTGF has been demonstrated to be involved in a
were chosen from the outpatient clinics of the
number of biological processes, which include fibrosis,
Department of Rheumatology, Rehabilitation, and
cancer, angiogenesis, the control of cell growth, tissue
Physical Medicine at Mansura University Hospitals.
modelling, and endochondral ossification [4]. It has been

suggested that the autocrine system may help
The participants in this study were divided into 4
chondrocytes maintain the homeostasis of cartilage
tissue [5].
Group 1 consisted of 45 RA patients who were
According to some earlier investigations, CTGF
diagnosed with the disease using the ACR/EULAR
fuels the inflammatory condition in RA patients. One of
2010 criteria [9], group 2 consisted of 45 SLE cases
the researchers discovered higher levels of CTGF
whom their diagnosis was done using the ACR/EULAR
expression in RA patients' serum as compared to OA
2019 revised classification criteria for SLE, group 3
patients. Additionally, it was determined that CTGF
consisted of 45 OA cases of OA whom diagnosis was
could increase osteoclast activity by activating integrin
done using the ACR criteria, and group 4 consisted of
protein V3 to worsen bone degradation [6].
45 seemingly healthy hospital staff or blood donors. The
Another study found that CTGF, by inhibiting
patients who were included were at least 18 years old.
apoptosis, promotes the growth of fibroblast-like
Patients with other types of arthritis, such as septic
synoviocytes (FLS) in RA, which may lead to synovial
arthritis, any other AI diseases, as well as those with
lining cell hyperplasia and finally joint degeneration [7].
cancer, chronic renal, and liver diseases and those who
According to certain research, people with RA had
refused to participate were not included in the study.
significantly greater serum CTGF concentrations than

Received: 05/04/2023
Accepted: 04/06/2023

Full Paper (vol.931 paper# 27)

c:\work\Jor\vol931_28 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7087- 7092

The Effect of Diabetes Mellitus Type 1 on the Retinal Ganglion Cell Layer
Ali Khalil Awadallah, Mervat El Shabrawy El Gharieb, Mohamed Fawzy Mohamed Abbas*
Department of Ophthalmology, Faculty of Medicine, Suez Canal University, Egypt.
*Corresponding author: Mohamed Fawzy Mohamed Abbas, Mobile: 01006789195
E-mail: mhmdfawzi2512@gmail.com

Retinal ganglion cell layer (RGC) layer has a very significant role in collecting the visual input from the
retina and transmitting the electrical signals to the brain for the creation of a visual image. Unfortunately, that image is
affected by many illnesses and type 1 diabetes mellitus (T1DM) is considered one of the commonest chronic illnesses
in the world and in Egypt specifically.
Aim and objectives:
To assess the impact of diabetes mellitus type 1 on the ganglion cell layer, which may help in
early detection and prevention of diabetic retinal complications and hence improve the quality of vision among diabetic
Subjects and methods: This case-control trial included 100 eyes of 50 cases separated to fifty eyes of diabetic persons
and the same eyes of healthy control. The study was conducted at Department of Ophthalmology, Faculty of Medicine,
Suez Canal University.
Results: There was a statistically significant alteration amongst the studied groups as regard optical coherence
tomography (OCT) of eyes, correlation between duration of DM, (Comparison between ganglion cell layer (GCL)
thickness in OCT and level of DM control) and correlation between severity and duration of diabetes and OCT
Conclusion: Diabetes has an early impact on the organisation of the neuronal retinal layers macular ganglion
cell complex (GCC), which in most of the patients under study even occurred before retinal vascular alterations in
addition to vision impairment. Most of the GCC quadrants were statistically significantly thinner in diabetic type I
patients compared to healthy controls.
Keywords: Retinal Ganglion Cell Layer, Diabetes Mellitus Type 1, OCT


Hyperglycemia and inadequate insulin levels to
since it is noninvasive and may be performed in vivo to
maintain metabolic demand characterize type 1 diabetes
track retinal ganglion cell degeneration in real time (5).
mellitus, an autoimmune disease that affects an ever-
From photoreceptors via bipolar cells to ganglion
increasing number of people around the world (1).
cells is the simplest and most typical route for these
signals to travel from the eye to the brain. Action
hyperglycemia is the hallmark of diabetes with type 1.
potentials from retinal ganglion cells travel along the
Symptoms of diabetes tend to be less severe and the
optic nerve to the brain (6). The dorsal lateral geniculate
period amongst the onset of symptoms and the diagnosis
nucleus is a major destination for RGC axons because it
of diabetes is longer in adolescents and adults who are
serves as a relay station for light information en route to
fifteen and above (2). When the renal threshold for
the visual cortex and further areas convoluted in
glucose excretion is exceeded, the earliest clinical
traditional picture vision. Some retinal ganglion cell
indicators of diabetes in children are polyuria as well as
axons also carry visual data, such as circadian
polydipsia, followed by a slow metabolic breakdown
photoentrainment, from the retina to other parts of the
along with characteristic symptoms (3).
brain (7).
Noninvasive optical coherence tomography (OCT)
The International Diabetes Federation predicts that
was designed to be fast in terms of its hardware besides
by 2030, there will be an estimated 23.9 million African
software qualities, and it displays excellent levels of
people living with diabetes, up from an estimated 12.1
precision and also definition in the identification of
million in 2010. Cataracts along with diabetic
early in addition minute changes in retinal morphology
retinopathy, a degenerative condition of the retina's tiny
blood vessels, are two ways that diabetes can impair
Coherence in Optics: The thickness of the different
vision (8).
retinal layers can be determined by using tomography to
The goal of this work was to estimate the influence
create a cross sectional image of the retina. The axons
of diabetes type one on the ganglion cell layer, which
of the retinal ganglion cells form a layer that may be
may help in early detection and prevention of diabetic
measured in thickness; this layer is known as the retinal
retinal complications and hence improve the quality of
nerve fiber layer (RNFL). Despite the fact that this
vision among diabetic patients.
method does not assess RGC numbers directly, the fact

that axonal loss precedes retinal ganglion cell loss
means that it is expected to be a valid surrogate marker
The trial was performed as a case-control trial. It
of RGC numbers. This technology is advantageous.
was conducted in the ophthalmology outpatient clinic in
Received: 02/04/2023
Accepted: 29/05/2023

Full Paper (vol.931 paper# 28)

References The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7093- 7096
The Accuracy of Abdominal Ultrasound and the Modified Alvarado
Score in the Diagnosis of Acute Appendicitis
Ashraf Ali, Ahmed Habib, Alaa Abd Elrahman
Al-Ahrar Zagazig Teaching Hospital. General Surgery Department, Egypt
Corresponding Author: Ashraf Ali, Phone: 0020 102 423 1360
E-mail: ashrafamer2580@gmail.com, ORCID: 0009-0006-0526-0495

The illness process of appendicitis is defined as dynamic and lasts between 24 and 36 hours. Basically, a
patient's medical history and clinical examination are a cornerstone for acute appendicitis diagnosis.
Objectives: The present study aimed to compare the diagnostic utility of abdominal ultrasound and the Modified
Alvarado scoring approach with a postoperative histological analysis in the diagnosis of acute appendicitis.
Methods: In this study, 193 patients complaining of acute abdomen pain suspected of acute appendicitis were
prospectively recruited. The study population was divided into two groups regarding the Modified Alvarado scoring
7 and > 7.
Results: Our analysis indicated overall specificity, sensitivity and accuracy of diagnosis of the Modified Alvarado score
were 81%, 67.7%, and 72% chronologically. While specificity and sensitivity of pelvic pelvi-abdominal
ultrasonography were 71.4% and 86.2% respectively.
Conclusion: When the Alvarado score is high (> 7), there are strong indicators that the patient is experiencing right
lower quadrant abdomen discomfort. The Alvarado score approach is a low-cost, dependable, and reproducible
diagnostic approach that may be utilised by both primary care physicians and emergency room doctors.
Keywords: Alvarado score, Appendicitis, Ultrasonography, Modified Alvarado score.

compressible peristaltic tubes that emerge from the
A delay in diagnosis or failure to diagnose acute
caecum tip and have a diameter of more than 6 mm. No
appendicitis, which affects one in seven people globally
matter that the appendiceal diameter, visualising an
throughout their lifetime, can result in complications
appendix with an appendicolith is likewise regarded as
that increase the risk of morbidity and fatality 1. The
a successful test 7. Abdominal ultrasonography (USG)
patient's medical history and physical examination are a
significantly improves the diagnostic accuracy of
cornerstone for acute appendicitis diagnosis. Even for
appendicitis in patients with query acute appendicitis,
an experienced practitioner, diagnosis can be difficult
according to a meta-analysis of 18 trials 8.
due to early modest clinical characteristics and atypical
As a result of the muscularis propria's
presentation, which have a significant role in diagnosis
neutrophil infiltration being discovered, which can both
and therapy 2.
confirm and rule out a missed pre-operative diagnosis,
In 1986, Alvarado provided a scoring method
that Kalan et al. later adjusted to change Alvarado's
histopathologically 9. In the current study, we sought to
score. The scoring system consists of nine different
compare the diagnostic utility of the Modified Alvarado
components. A high probability of appendicitis is
scoring approach for acute appendicitis to abdominal
regarded to be a score of 7 or higher 3.
ultrasound, which was then connected to a
Despite the fact that certain research reported
postoperative histological investigation.
that the Modified Alvarado scoring (MAS) approach

gave a greater diagnostic accuracy degree in patients
query having acute appendicitis and lowered the chance
In this study, we prospectively recruited 193
of a successful appendectomy and complication rates 4.
patients complaining of acute abdominal pain (Rt iliac
According to a different study, greater scores were
fossa pain) query having acute appendicitis admitted to
ineffective at detecting and predicting acute
Al-Ahrar Zagazig Teaching Hospital. They fulfilled our
appendicitis before surgery and at preventing
criteria within the study period from Feb 2023 to Aug
unnecessary appendicectomies 5.
Acute appendicitis is still diagnosed clinically,

however abdominal ultrasound (US) is a useful imaging
Inclusion criteria:
modality in patient assessment when the diagnosis is
Appendectomy patients thought they had acute
unsure. The least expensive and least invasive approach,
appendicitis even if the Modified Alvarado score was
graded compression US, has been shown to have an
more than 7, regardless of abdominal ultrasound study
accuracy of 70-95% 6. Features of acute appendicitis in
for appendicitis.
Ultrasonographic study are blind-ended, non-
Exclusion criteria:

Causes of acute abdominal and iliac fossa
Received: 05/04/2023
Accepted: 04/06/2023

Full Paper (vol.931 paper# 29)

c:\work\Jor\vol931_30 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7097- 7100

Diffusion Weighted MRI as a Predictor of Muscle Invasive
Bladder Carcinoma: Review Article
1 Khaled Abdelwahab, 2Tarek A Salem, 3 Hossam M. Abdelrahman, 2Mahmoud Ezzat*, 1 A. M. Zayed
1 Urology Department, 3Radiology Department, Faculty of Medicine, Zagazig University, Egypt
2 Urology Department, Faculty of Medicine, Helwan University, Egypt
*Corresponding author: Mahmoud Ezzat Mahmoud Abd El Halim
Email: drdr8686@gmail.com, Mobile: 01020005862

Bladder cancer is a common genitourinary tumor in Egypt. Muscle invasive bladder cancer can be treated by
bladder preservation protocol (BPP), which include maximum TURT, radiotherapy and chemotherapy. Eventually bladder
preservation treatment could fail.
Objective: To use Diffusion weighted MRI as a non-invasive test to predict response of tumor to BPP before the patient is
exposed to the hazard of this therapy.
Methods: We searched Science Direct, Google Scholar as well as PubMed for relevant articles on Muscle invasive, Bladder
carcinoma and Diffusion weighted MRI. Only the most recent or thorough study was taken into account between 2004 and
2020. 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: Apparent diffusion coefficient (ADC) as an imaging biomarker is not recommended for routine clinical use
due to a lack of standardisation and validation according to (EAU) guidelines, our small group study may be in need of
extension on larger group of patients and the ADC values narrow band could be a curbed point of our work.
Keywords: DWI, Muscle Invasive, Bladder Carcinoma.


Since the introduction of "-omics" technologies a
used in routine MRI capture to create contrast between a
few years ago, It has been suggested to use molecular
subject's clinically significant characteristics (4).
subclassifications of bladder cancer to accurately assess
Fliedner et al. (3) also showed that the ability of
the biologic features of specific cases. Geneomics,
MRI to produce contrast associated with microscopic
proteomics, and metabolomics are a few examples of
tissue structure accounts for its versatile nature. An
extensive methods for analyzing biologic data (1).
applied strong magnetic field excites the molecules of
water in the sample. As a result, several protons in water
classifications based on immunohistochemical profiling
molecules precess concurrently, resulting in signals in
have been proposed, utilizing indicators of the cell cycle
magnetic resonance imaging.
and tumor growth for clinical use. However, tissue
The measurement of the water protons' lack of
collection is required for this classification based on
synchronization or coherence yields contrast. Relaxation
histology, and the information is acquired after surgery.
usually takes longer when water is in an atmosphere
Thus, preoperative quantitative non-invasive testing is
where it can tumble freely. This may result in contrast
preferable (2).
between a pathological area and the surrounding healthy
According to research by Fliedner and
tissue in specific clinical scenarios, such as cancer
colleagues (3), interactions with various barriers,
distinction between benign and malignant (5).
including membranes, fibers, and macromolecules
In clinical practice, contrast-enhanced CT and
influence molecular diffusion in tissues rather than it
MRI are used for the locoregional staging of bladder
being free. Diffusion patterns of water molecules might
cancer. A functional MRI technique called DWI is being
thus provide microscopic information on the architecture
used more and more in the treatment of bladder cancer.
of tissue, whether it is healthy or diseased.
The degree of diffusivity of water molecules is reflected
Diffusion imaging, according to Chen and
in the DWI signal, which is a unique signal that offers
colleagues, is an MRI technique that generates in vivo
non-invasive information on physiologic tissue properties
magnetic resonance pictures of biological tissues
sensitive to the specific characteristics of molecular
DWI can be used as an imaging biomarker to help
transport locally, usually involving water (but MR
characterize the pathophysiology of different kinds of
spectroscopic methods can also be used to explore other
cancers, according to mounting data. The potential use of
moieties). It is possible to make MRI sensitive to
DWI as an imaging biomarker to tailor treatment
molecular motion. The behaviour of protons in water is
Received: 06/04/2023
Accepted: 05/06/2023

Full Paper (vol.931 paper# 30)

The impact of COVID-19 in palliative care or the Collateral damage of COVID-19 in The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7101- 7107

Role of Chest Ultrasound in Diagnosis and Assessment of Patients with
Severe and Critically Ill COVID-19
Fawzy Mohamed Omar, Ahmed Mohamed Abdalla Beshir
Department of Chest, Faculty of Medicine, Al-Azhar University, Egypt
*Corresponding author: Fawzy Mohamed Omar, Mobile: (+20) 01119596656, E-mail: fawzi1984.fo@gmail.com

Due to the extraordinary severity of the 2019 coronavirus pandemic medical establishments must
establish effective and user-friendly ways in the direction of treating patients first and forecast outcomes.
Objective: Our rationale of this work was investigating chest ultrasound's function in the evaluation and diagnosis of
patients with severe and critically ill COVID-19.
Patients and methods: This study was observational study performed at Damanhur chest hospital from April 2021 to
March 2022. The study was carried-out on 200 COVID-19 infected patients with mean age of 60.55 ± 19.50 year.
They were identified as having COVID-19 infection based on a positive Polymerase Chain Reaction test for SARS-
CoV-2 and/or standard CT scan findings. Patients were admitted to the intensive care unit, it was only for really ill
patients with severe and critically ill COVID-19 infection. At time of admission, we examined them by pleuro-
pulmonary ultrasonography.
Results: The results showed elevated scores of lung ultrasonography that had been shown to be significantly related to
hypoxemia and clinical severity. The extent of lung injury and hypoxemia during COVID-19 pneumonia were also
significantly correlated. Confluent B-lines predominate over consolidation in COVID-19-ARDS, indicating that non-
aerated tissue perfusion rather than a true right-to-left shunt is the primary cause of venous mixing. This finding is in
accordance with research that claim this is the case.
Conclusion: The study's findings suggested that, in situations with limited resources, lung ultrasonography might be a
vital instrument for the diagnosis and prognosis of lung damage in seriously sick COVID-19 pneumonia patients. In
such circumstances, this straightforward, easily available, and trustworthy technology has considerable promise. For
our findings to be confirmed, larger multicenter investigations are required.
Chest ultrasound, Diagnosis, Assessment, Sever COVID-19.


Globally, COVID-19 has become widespread
syndrome (SARS-CoV-2), pandemic clinical signs
after the first case was discovered in Wuhan, China, in
range from vague symptoms such as fever, nausea, and
December 2019. Later, more people have diagnosed
dry cough to life-threatening pneumonia. Due to its
positive for COVID-19, which is a result of the virus's
link with a better and quicker recovery, the available
high contagiousness (1).
research has suggested early treatment. This
The government acted swiftly to stop the
emphasises the significance of early screening methods
COVID-19 epidemic from spreading throughout the
in slowing the disease's course (5).
nation by raising public knowledge of the disease,
Real-time polymerase chain reaction (RT-PCR)
encouraging social withdrawal, and promoting the
has drawbacks, regrettably. when the material's viral
widespread usage of masks. Complete nationwide
load is little, it first gives false-negative findings and a
lockdown was proclaimed for the majority of the
low detection. Additionally, it cannot predict the
nations in the world. This was vital to stop the
course of an illness or represent disease occurrence.
COVID-19 outbreak and get hospitals ready for the
Third, there is a dearth of reagent stock, necessitating
influx of COVID-19 patients (2).
extensive research in addition to development for
Patients and their relatives were unhappy in
novel reagents. Fourthly, the process takes a long time.
hospital during the severe acute respiratory diseases'
These drawbacks are the reason why researchers
symptoms because of restrictive rules and stringent
advise utilizing computed tomography (CT) as the
visitor limitations (3).
main technique for diagnosing COVID-19.
Hospitals and other healthcare facilities have

been forced to adjust to the "new normal" by delaying
Additionally, individuals that have positive CT
"non-emergent" procedures, doing extensive COVID-
results but negative PCR results who are clinically
19 investigations, and moving from out-patient clinics
believed to have COVID-19 should be separated and
to telemedicine. However, there has been worried
handled as positive cases as soon as feasible (6).
among medical professionals for patients whose
However, the radiological department's capacity could
procedures were postponed or cancelled because of the
be exceeded by the volume of cases. Additionally,
ongoing COVID-19 epidemic (4).
patients might not be able to be transported because of
A new coronavirus species known as the
their condition or because there might not be enough
coronavirus disease of 2019, which is caused by the
staff or personal protective equipment (PPE).
coronavirus 2 associated with severe acute respiratory.
Additionally, equipment cleaning might delay the
Received: 09/04/2023
Accepted: 06/09/2023

Full Paper (vol.931 paper# 31)

c:\work\Jor\vol931_32 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7108- 7113

In-Situ Anterior Vaginal Wall Flap for Treatment of Stress Urinary
Incontinence due to Urethral Hypermobility (Five Years Follow Up)
Ashraf A Abo Elela1, Haitham A Torky2, Manal A Moussa, Ashraf S Abo-Louz2
Departments of 1Urology, Cairo University, 2Obstetrics and gynecology, October 6th University,
3Obstetrics and Gynecology, Cairo University, Cairo, Egypt
Corresponding author: Ashraf Abo Louz, E-mail: ashraf.abolouz@gmail.com, Tel: +201222376540

Stress urinary incontinence can be attributed to various factors, including the weakening of the supportive
layer resembling a hammock. While tension-free vaginal tape has been employed as a minimally invasive solution, it
has many delayed complications. The objective of this study was to assess a novel minimally invasive approach utilizing
autologous tissue flap to address stress urinary incontinence stemming from urethral hypermobility.
Patients and Methods: A prospective cohort study encompassing fifty patients afflicted by stress urinary incontinence
due to urethral hypermobility. The patients underwent surgical intervention involving the application of an in-situ
anterior vaginal wall flap as a sling. The primary outcome measure was the objective cure rate at the five-year mark.
Secondary outcomes encompassed operative complications, the emergence of voiding problems postoperatively, urge
symptoms, and urinary tract infections.
Results: The study yielded an objective cure rate for stress urinary incontinence of 80%, which slightly declined to 74%
after a five-year follow-up period. Notably, 8% of patients exhibited de novo detrusor over-activity. Urinary tract
infections were observed in 4% of cases, suprapubic wound infections in 2%, recurrent stress urinary incontinence in
4%, and extended time required to initiate voiding in 4% of cases.
Conclusion: The employment of an in-situ anterior vaginal wall flap proved to be an efficacious and cost-effective
modality for addressing stress urinary incontinence linked to urethral hypermobility.
Stress incontinence; Urethral hypermobility; Surgical treatment; Vaginal flap.

which usually presents about 18 months after the
The International Continence Society defines stress
operation, which may be caused by atrophic tissues,
urinary incontinence as "the complaint of any
tape tension and poor vascularity(8). Up to the extent that
involuntary loss of urine on effort or physical exertion
The National Institute of Clinical Excellence in its
(e.g., sports) or on sneezing or coughing" (1). Its
guideline in 2019 recommended autologous rectus
prevalence ranges between 12 and 55% according to the
fascial slings as one of the options of the surgical
patient's age (2).
treatment of stress incontinence (9).
One of the causes of stress urinary incontinence is
The technique of correction of urinary incontinence
the loss of the hammock-like supportive layer that
over the years proved to be adequate and gold-standard
compresses the urethra during the increase in the intra-
treatment (9). However, the materials used may deserve
abdominal pressure such as during cough (3), leading to
innovation, which the focus should be on the patient.
urethral hypermobility and stress incontinence.
Based on that idea, the aim of the current study is to test
Colposuspension consisted of lifting the areas adjacent
a minimally invasive procedure using autologous tissue
to the proximal urethra and bladder neck to the level of
flap for the treatment of stress urinary incontinence due
the retropubic space and is used to treat stress
to urethral hypermobility in a trial to provide another
incontinence. This technique has undergone many
technique, with autologous tissue, reliable and easily
modifications over the years until the development of
reproducible in practice, for correction of stress urinary
Burch colposuspension in 1961(4), which was
considered the gold standard for years with an initial

success rate of 90 %, dropping down to 65% after 10
years (5). However, it is not without complications as
This prospective cohort study was conducted in As-
procedure failure, urinary retention, wound infection,
Salam International Hospital, Al Safwa Hospital, Al
osteitis pubis, suture break, suture erosion, enterocele,
Gabry Hospital, between March 2015 and March 2018.
suprapubic pain, urinary tract infection, hemorrhage,
Fifty patients were prepared in this study for surgical
and detrusor instability (6).
management of stress urinary incontinence (SUI) type 2
This lead to the development of minimally invasive
due to urethral hypermobility.
dynamic slings as the tension-free vaginal tape (TVT)
All the patients performed full medical history,
by Ulmsten et al.(7) as a minimally invasive procedure
clinical examination (general and local), urine analysis,
in order to decrease the risks of complications
Q-tip test (to determine urethral hypermobility), and
associated with colposuspension procedures; however,
stress provocation test with a partially filled bladder
as long-term follow-up data became available, several
(250 cc) in both supine and standing positions to detect
delayed complications started to appear as tape erosion,
stress incontinence. Urodynamic evaluation with
Received: 05/04/2023
Accepted: 04/06/2023

Full Paper (vol.931 paper# 32)

c:\work\Jor\vol931_33 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7114- 7118

Local Vibration Effects on Iliotibial Band Release in Patients with Knee Osteoarthritis
Mariana S Alouis, Amal H Mohamed, Haidy S Roshdy
Department of Physical Therapy, Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Mariana S Alouis, Mobile: (+20) 01202430362, E-Mail: jucyjon@gmail.com


Background: Osteoarthritis is ranked as the 10th largest contributor to global years lived with disabilities, and its
prevalence has more than doubled in the last 10 years. The knee joint is the most frequently afflicted joint in Egyptian
individuals with primary osteoarthritis approximately 8­15% of the general population has been found to have knee joint
Purpose: To evaluate local vibration effects for iliotibial band (ITB) release on pain intensity, pain pressure threshold
(PPT), lower limb (LL) function and knee range of motion (ROM) in patients with knee osteoarthritis (OA).
Subjects and methods: A single-blind randomized controlled trial that included thirty patients who suffered from unilateral
knee OA. They were recruited from the Police Hospital, Nasr city, Egypt. They were assigned randomly into two groups
equal in number, 15 patients each. Control group (A) received a conventional physical therapy program while experimental
group (B) received the same program in addition to ITB release by using local vibration. Treatment sessions were admitted
3 times a week for 4 weeks.
Results: When compared to the pre-treatment condition, the pain intensity decreased, PPT declined, LL functional activity
improved, and increased ROM of knee joint was noted in both groups. There was a statistically significant difference
between the mean value of all dependent variables in control group, and their corresponding variables in experimental group.
Group (A) P-value of pain intensity, PPT, lower limb function, and knee ROM were (p = 0.001), (p= 0.026), (p = 0.001),
and (p= 0.023) respectively in favor to group B.
Conclusion: The local vibration has a great impact on reducing pain intensity, PPT, and improving LL function and knee
ROM by releasing the tension of ITB in patients with knee OA.
Keywords: Iliotibial band release, Local vibrator, Knee osteoarthritis.

indicating inflammation or edema surrounding the ITB,
One of the most prevalent chronic illnesses,
was present in almost 75% of individuals with knee OA
osteoarthritis (OA), is characterized by tight muscles as
(6). It was proved that ITB release by static stretching and
well as degenerative and adaptive changes in the knee's
myofascial release both increase ITB flexibility above
component parts. The tibiofemoral joint contact pattern is
baseline measures significantly (7).
altered as the iliotibial band (ITB) pulls the patella
Previous researchers found that adding vastus
laterally and externally rotates the tibia during knee
lateralis release and ITB stretching to conventional PT
flexion (1). Because life expectancy is consistently rising,
program had better outcomes in treating knee OA (8). ITB
it is anticipated that the prevalence of obesity and OA
release was proved to have an added effect in cases of
would rise sharply in the aging population globally. This
knee OA either when done by using static stretch (1) or
results in disability and decreased joint function. The
myofascial release (9). In addition, pain and function were
disease's prevalence has more than doubled in the past ten
improved significantly.
years, making it the 10th highest contributor to years lived
Vibration is commonly used to relax tension in
with disability worldwide (2). The knee is the most
the limb (10), moreover vibration is a simple, easy applied,
frequently afflicted joint in Egyptian individuals with
time and effort saving technique but unfortunately barely
primary OA approximately 8­15% of the general
studied. This study aimed to detect the effect of using on
population has been found to have knee joint OA (3).
ITB release by using local vibration on pain intensity,
One of the mainstays of the conservative
PPT, LL function and ROM of knee joint in patient with
treatment of knee OA is physical therapy (4). It offers a
unilateral knee OA.
range of therapies, including functional retraining

methods, balance, coordination, and manual therapy
approaches. The suggested methods for treating knee OA
Design of the study: Randomized controlled trial: Pre
include manual treatment and electrotherapy, which
and post-test experimental design used.
physiotherapists are more likely to choose (5).
Sample size calculation: Sample size calculation was
A prior magnetic resonance imaging (MRI)
done using pain, as reported from pilot study, with 80%
investigation examined the frequency of elevated signal
power at = 0.05 level, number of measurements 2, for 2
intensity surrounding ITB. According to the findings,
groups and effective size = 0.53 using F-test repeated
higher signal intensity on the lateral side of the knee joint,
measure MANOVA within and between interaction. The
Received: 06/04/2023
Accepted: 05/06/2023

Full Paper (vol.931 paper# 33)

c:\work\Jor\vol931_34 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7119- 7124

Drain Amylase Level as a Predictor for Postoperative Pancreatic Fistula after
Pancreaticoduodenectomy for Periampullary Carcinoma
Ali Hussein Khedr1*, Hussein Abdelaleem Boushnak2, Hatem Elgohary1, Hossam El Shafey1, Yasser Baz1
1 General Surgery Department, Faculty of Medicine, Helwan University, Egypt
2 General Surgery Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Ali Hussein Khedr, E mail: Ahk413@gmail.com, Mobile phone: +201067182874

Resection of periampullary carcinoma can be performed in fifty to sixty percent of people, although
pancreatic cancer resection is a viable treatment option in ten to twenty percent of cases. Periampullary carcinoma has
a more favorable prognosis after surgical resection. About 0.2% of all gastrointestinal tumors are periampullary
adenocarcinoma (PAAC), which involve adenocarcinoma (AC) of the pancreatic head, the distal common bile duct
(CBD), the second portion of the duodenum, plus the ampulla of Vater. Although relatively uncommon, the incidence
of periampullary tumors has been on the rise in recent years.
Aim of the work: This study aimed to determine the most important predictors of fistula formation after
pancreaticoduodenectomy for periampullary carcinoma.
Methods: This was observational study that included 20 individuals to undergo pancreaticoduodenectomy for
periampullary carcinoma in Helwan University Hospitals.
Results: There was highly significant variation among the two groups concerning drain amylase plus drain lipase.
Comprehensive care to achieve POPF reduction is essential for individuals with greater drain amylase
levels, which were associated with a higher fistula risk grade. Future research must involve a multicenter investigation
to validate as well as to standardize amylase levels.
Keywords: Pancreatoduodenectomy, Pancreatic fistula, Pancreatic cancer, Preoperative inflammatory biomarkers,
Postoperative day 1 drains amylase values.


Resection of periampullary carcinoma can be
This observational research that was conducted in
performed in fifty to sixty percent of people, although
Helwan University hospitals comprised 20 people to
pancreatic cancer resection is a viable treatment option
undergo pancreaticoduodenectomy for periampullary
in ten to twenty percent of cases. Periampullary
carcinoma has a more favorable prognosis after surgical
Inclusion criteria: Periampullary carcinoma & non-
resection, with 5-year relative longevity of 37% to 68%,
metastatic tumors.
compared to ten to twenty percent for resectable
Exclusion criteria: Malignant tumours other than
pancreatic adenocarcinoma & twenty-five percent to
periampullary carcinoma, such as pancreatic ductal
fifty-nine percent for resectable duodenal cancer (1).
adenocarcinoma, malignant intraductal papillary-
The most reliable clinical diagnostic tools available
mucinous neoplasm (IPMN), pancreatic islet cell
today are computed tomography (CT) scans as well as
carcinoma (pancreatic mucinous cystic neoplasms),
magnetic resonance imaging cholangiopancreatography
distal CBD carcinoma (cholangiocarcinoma), as well as
(MRCP) scans. Other diagnostic procedures, such as
cancer of the duodenum treated by potentially curative
endoscopic ultrasonography besides endoscopic
pancreaticoduodenectomy and Metastases.
retrograde cholangiopancreatography (ERCP), both of
Preoperative data: The preparatory procedures that
which enable sample collection also, as a result,
follow variables were investigated: Cancer diagnosis
histological subtyping (2).
based on gender & age, weight, BMI, as well as
Several other prognostic variables, such as TNM
performance status (WHO score) (4).
stage, depth of infiltration (T stage), lymphovascular
The following laboratory & imaging studies results
invasion, regional lymph node involvement (N stage),
were obtained from individuals files: Complete blood
tumor differentiation, & positive surgical margins, have
count, basic metabolic profile, liver function tests,
been postulated for relapse. Nevertheless, the majority
of these prognostic factors are contested, primarily
mainly because the research that mattered were either
inadequately powered or excluded malignancies other
ultrasound, and high-quality computed tomography
than periampullary. 76.5 to 89.4% of periampullary
(CT). Criteria for tumour resectability evaluation
carcinomas are amenable to curative resection. Survival
necessitate thin incisions. Metastatic workup included
at five years was 62.8%. After three years, long-term
chest CT or CXR. Besides, endoscopic ultrasound
survival can be anticipated (3).
(EUS) is performed to assess if there was any vascular
The purpose of the work was to determine which
invasions. Surgical procedure: All Individuals
variables most strongly predicted recurrence after
underwent pancreaticoduodenectomy for periampullary
carcinoma (5).
Received: 03/04/2023
Accepted: 30/05/2023

Full Paper (vol.931 paper# 34)

c:\work\Jor\vol931_35 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7125- 7129
The Role of Serum Procalcitonin in The Diagnosis and Detection of
The Outcome of Acute Bacterial Meningitis in Children
Amr Ahmed Osman 1, Marina Waheeb Shawky 1,
Amany Abbass Abdallah Ahmed 2, Montaser Mohamed Mohamed 1
1 Pediatrics, 2 Clinical Pathology Department, Faculty of Medicine,Sohag University
Corresponding author: Amr Ahmed Osman, Email: ptrservices2022@gmail.com, Mobile: 01003913744

Bacterial meningitis is a pediatric emergency that requires quick diagnosis and treatment due to its high
death and morbidity rates. Clinically, bacterial meningitis and non-bacterial meningitis are frequently difficult to
distinguish from each other. Aim of work: To study the role of serum procalcitonin in the diagnosis and differentiation
of acute bacterial from non-bacterial reasons for meningitis, in addition to its role in the evaluation of the acute bacterial
meningitis outcome.
Patients and Methods: This was a case-control hospital-based prospective study carried out at the Pediatric
Department, Sohag University Hospital, and fever hospitals all over Sohag Governorate for 8 months, after obtaining
ethical approval. Serum procalcitonin level for cases with bacterial meningitis and controls with non-bacterial
meningitis was detected by Ethylenediaminetetraacetic acid (EDTA) and immunoassay device. All participants were
followed clinically and by neuroimaging 2 months after the infection.
Results: There was a significant increase in CRP level among cases in comparison to controls but as regards the PCT
level among cases and controls, there was no significant difference between them and there was a statistically significant
positive correlation between CRP and serum procalcitonin. There was a poor outcome among cases with a significant
difference in comparison to controls with a significant correlation between cases outcome and serum procalcitonin.
Conclusion: Serum procalcitonin levels had no significant associations with acute bacterial meningitis and had an
important role in predicting its outcome but this should be confirmed by larger and more comprehensive studies.
Keywords: Serum procalcitonin, CRP, Acute bacterial meningitis, Outcome.


Meningitis is one of the most typical illnesses
with a more accurate overall diagnosis while
of the central nervous system in newborns and young
offering similar specificity to conventionally utilized
children, which is caused by bacterial, viral, fungal, or
CSF indicators of meningitis (4).
parasitic organisms (1). In children, it is frequently
This work aimed to study the role of serum
challenging to distinguish between bacterial and non-
procalcitonin in the diagnosis and differentiation of
bacterial aetiologies due to comparable clinical
acute bacterial from non-bacterial reasons for
presentation. Bacterial meningitis has a high death and
meningitis, in addition to its role in the detection of the
morbidity rate, so it needs to be quickly diagnosed and
outcome of acute bacterial meningitis in children.
treated (2, 3).

Procalcitonin level is a potentially sensitive
measure of severe bacterial infections, including
This case-control hospital-based study was
meningitis, numerous studies have shown that bacterial
conducted at the Pediatric Department, Sohag
illnesses, such as meningitis, are associated with
University Hospital, and fever hospitals all over Sohag
elevated serum PCT values (5).
Governorate for one year starting from acceptance of
The function of serum procalcitonin in the
protocol from the Ethical Committee at Faculty of
diagnosis and prognosis of acute bacterial meningitis in
Medicine, Sohag University, from July 2021 to July
children has not been extensively studied, procalcitonin
is produced by the thyroid gland's C cells, as a 116-
The study included all patients whose ages ranged
amino-acid peptide that is converted to calcitonin
from 1 month to 14 years and were
through post-translational proteolysis. Peripheral blood
diagnosed as acute bacterial meningitis in the case
leukocytes secrete procalcitonin. When bacterial
group and non-bacterial meningitis in the control group,
lipopolysaccharides and cytokines linked to severe
any patient with cerebral palsy, neurodegenerative
bacterial infections are present, the level of PCT rises,
disease, metabolic disease, and other systemic
without an increase in the level of calcitonin, in
infections were excluded from the study.
contrast, people who are infected with viruses only
The following was applied to all study
experience a little increase in PCT (4, 5).
participants at the time of presentation. Clinical history,
Studies have demonstrated the effectiveness of
focusing on socio-demographic data: age, gender,
PCT as a diagnostic tool for the evaluation of suspected
residence, and developmental history, before and after
meningitis, enabling early diagnosis of bacterial and
the infection. Clinical examination including systemic
non-bacterial aetiologies. According to data, serum
examination, anthropometric measurements, and
PCT provides studied cases with suspected meningitis
complete neurological examination
Received: 09/04/2023
Accepted: 06/06/2023

Full Paper (vol.931 paper# 35)

c:\work\Jor\vol931_36 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7130- 7142

Uterine Artery and Endometrial Doppler Velocimetry before Embryo Transfer in
Intra-cytoplasmic Sperm Injection: Influence on Cycle Success
Hamed Elsayed Ellakwa (1), Zakaria Fouad Sanad (1), Nabih Ibrahim Elkhouly (1),
Nerveen Mohammed Mohammed Harby (2)*, Mohammed Elsibai Anter (1)
(1) Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Egypt.
(2) Resident of Obstetrics and Gynaecology ­ Desouk General Hospital ­ Kafr Elsheikh. Egypt.
*Corresponding author: Nerveen Mohammed Mohammed Harby,
Telephone: +201000267838, Email: nerveenharby1991@gmail.com

: Unfortunately, seeking in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) procedure
is not a guarantee of success or achieving live birth. Recurrent failure of implantation remains a distressing event. There
are strong efforts to assess endometrial receptivity particularly in cases subjected to assisted reproductive technology.
Objective: To assess the role of estimating uterine artery blood flow (UABF) as well as endometrial blood flow via
Doppler ultrasound prior to embryo transfer in IVF/ET cycles in prediction of pregnancy rate.
Subjects and methods: A prospective observational investigation that was carried out on 80 women who were
scheduled for ICSI cycles that was conducted at the private ICSI centers, during the period from October 2021 till
October 2022.
: The mean endometrial thickness was higher in women who got pregnant after ICSI compared to non-pregnant
women after ICSI) [10.24± 1.6mm vs. 9.5±1.89 mm; respectively; P=0.05]. Additionally, the sub endometrial indices ''
PI, RI, and S/D' & uterine artery RI and S/D ratio were all significantly lower in women who get pregnant than in non-
pregnant women after ICSI, (P<0.001). Besides, uterine artery PI was also significantly lower in pregnant cases after
ICSI (P=0.001).
Conclusion: Both uterine artery RI, and uterine artery S/D ratio had significantly the best diagnostic accuracy followed
by sub-endometrial RI and sub-endometrial S/D ratio. So uterine artery and sub endometrial Doppler indices may be
used independently or better combined with the other factors for configuration of a predictive algorithm for ICSI
implantation or pregnancy rates prediction.
intracytoplasmic sperm injection (ICSI), uterine artery Doppler indices, subendometrial Doppler indices,
PI, RI, S/D ratio.


This era witnesses a breakthrough in the art of
effective implantation coupled with consequent normal
assisted reproductive technology (ART) including
placentation (5) .
intracytoplasmic sperm injection (ICSI) which has
It has been estimated that up to 65% of suboptimal
awakened the hope of the infertile couples who were
implantation are triggered by endometrial receptivity
formerly unable to conceive or to get viable
defects. There are strong efforts to assess endometrial
receptivity particularly in cases subjected to assisted
Unfortunately, seeking in vitro fertilization (IVF)
reproductive technology (6).
or ICSI procedure is not a guarantee of success or
Up till now, thanks to its accuracy, repeatability,
achieving live birth(2) . Yet, along days, ICSI are
real-time monitoring, in addition to higher predictability
upgrading along time for the seek of achieving better
as well as non-invasiveness, transvaginal ultrasound has
acceptable pregnancy rates, less multiple births, and
emerged and continued as indispensable modality in the
more healthy offspring (3). Even with these
assisted reproduction specialty, not only for monitoring
achievements and the mounting experiences in this
follicles, but also for assessing endometrial receptivity
field, among the major challenges is implantation
throughout infertility treatment (7).
failure. Recurrent failure of implantation remains a
Endometrial thickness (EMT) acts as one of the
distressing event that faces both the patients and the
most extensively researched markers for numerous
physician and requires a multitude of investigations
years on behalf of evaluating endometrial receptivity for
with its management lines still a debate (4).
revealing its connotation to pregnancy success rates, but
The crucial phase of implantation is now what
results were controversial (3).
prevents ICSI procedures from becoming more
It has been broadly assumed that a thin endometrium
successful. The implantation process necessitates an
is concomitant with lesser conceiving probability
intimate cross-talk bringing together a healthy embryo
following IVF/ICSI, and a cut-off value varying in-
along with a receptive endometrium. This mechanism is
between 7­9mm with triple layered endometrial pattern
orchestrated by physiological, immunological as well as
are the supposed endometrial thickness and pattern
molecular pathways that finally bring about and
markers of endometrial receptivity in prior studies. Yet,
apposition, adhesion of the blastocyst to the
a question has been addressed about the EMT threshold
then trophoblast
value above which implantation is doubtful to occur
endometrial epithelial cells. All of this is mandatory for
with the conflicting results (8).
Received: 18/03/2023
Accepted: 21/05/2023

Full Paper (vol.931 paper# 36)

c:\work\Jor\vol931_37 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7143- 7148

Retracted paper

Received: 10/04/2023
Accepted: 07/06/2023

Full Paper (vol.931 paper# 37)

c:\work\Jor\vol931_38 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7149- 7152

Intrathecal Dexmedetomidine versus Transversus Abdominus Plane Block
(TAP) for Postoperative Analgesia after Cesarean Section: Review article
Dina Mostafa Helmy*, Ahmed Hamody Hassan,
Hamza Abo-Alam Mahmoud, Ahmed Mohamed Abdel Mabood
Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Dina Mostafa Helmy, Mobile: (+20) 01098819616, E-mail: mostafadina99@gmail.com
The quadratus lumborum block (QLB), slow-release local anaesthetics, and non-pharmacological
methods are only a few of the innovative pain-management strategies that have been developed to treat caesarean-
related pain. As a part of the multimodal analgesic strategy, the transversus abdominis plane (TAP) block has been
utilised for post-operative pain reduction following a variety of abdominal procedures. The somatic analgesia it
produces is adequate, and the visceral blockage is minimal or nonexistent. While, less effective than neuraxial
morphine, TAP blocks have less side effects such as nausea and itching. The lateral TAP block approach can result in
post-Caesarean delivery analgesia that lasts for up to 24 to 48 hours after surgery. The 2-agonist dexmedetomidine is
very selective. Objective: To highlight Intrathecal Dexmedetomidine versus TAP block for postoperative analgesia
after Caesarean section (CS).
Methods: Searches in Google, Google scholar, and PubMed were conducted for Dexmedetomidine, QLB, TAP block,
and Caesarean delivery. The authors also reviewed references from pertinent literature, although they only included
the most recent or comprehensive study from July 2000 to May 2022. Documents in languages other than English have
been disqualified due to lack of translation-related sources. Dissertations, oral presentations, unpublished manuscripts,
conference abstracts, and other papers that did not pertain to significant scientific research were excluded.
Conclusion: We came to the conclusion that the addition of dexmedetomidine to bupivacaine in TAP block increased
the length of time before the first dose of rescue analgesia was sought, as well as decreased and lowered postoperative
VAS ratings recorded at all-time points, and it also increased the length of motor block.
Keywords: Dexmedetomidine, QLB, TAP block, Cesarean section.

doses. Although IV opioids are not any more effective in
The QLB, slow-release local anaesthetics, and non-
managing pain than oral opioids are, they do tend to have
pharmacological methods are only a few of the
more side effects (4). Respiratory depression is one of the
innovative pain-management strategies that have
most serious side effects connected to the usage of
recently been developed to treat caesarean-related pain
neuraxial opioids. Obstetric patients who have a high
(1). As a part of the multimodal analgesic strategy, the
BMI, have used opioids in the past, are receiving
TAP block has been utilised for post-operative pain
magnesium sulphate infusions, or have respiratory
reduction following a variety of abdominal procedures.
comorbidities are more likely to have respiratory
It produces a good level of somatic analgesia with little
depression in these circumstances (5).
to no visceral blockage. A posterior abdominal wall

block called a QLB block, which Blanco first described
Neuraxial administration of non-opioid analgesics
in 2007, allows local anaesthetic to spread behind the
When decreasing the amount of the opioid and hence
quadratus lumborum muscle (QLM) into a triangle-
its adverse effects, the use of neuraxial adjuvant non-
shaped area called the lumbar interfascial triangle, which
opioid drugs has been a subject of significant attention.
is next to the middle layer of the thoracolumbar fascia
It has been proven that the analgesic effect can last
(TLF) (2).
longer (6). In the event of epidural administration,

pruritus decreases in addition to the local anaesthetic
Role of opioids in postoperative analgesia after
dose that is needed, and the risk of hypotension,
Caesarean section: Systemic administration is typically
sedation, or negative foetal consequences is not
utilised after general anaesthesia and in locations where
noticeably increased (7).
long-acting preservative-free opioids are unavailable or
Systemic opioid
their use is not well-understood. Intramuscular and
Patient-controlled analgesia (PCA) is a strategy for self-
intravenous delivery of opioids via these routes can be
administration of the drug that avoids the patient nurse-
done sporadically, on demand, or continuously (3).
injection loop, saving important time in the management
Neuraxial opioids:
of acute pain and lowering the peaks and troughs of
Maternal mortality related to anaesthesia has
plasma drug concentrations, leading to increased patient
decreased as a result of the introduction of neuraxial
satisfaction (8). An opioid called morphine is more likely
anaesthetic procedures. The American Society of
than other opioids to enter breast milk in quantities that
Anaesthesia (ASA) recommendations for anaesthesia
might be dangerous for the unborn child. The second
advise against using intermittent parenteral boluses in
drug is oxycodone, whose dosages are dangerously high.
favour of neuraxial opioids, with or without salvage
The drug with the lowest rates of passing is fentanyl (9).
Received: 18/03/2023
Accepted: 21/05/2023

Full Paper (vol.931 paper# 38)

c:\work\Jor\vol931_39 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7153- 7158

Anti-Tumor Effects of Dendronephthya putteri Ethanolic Extract in
DMBA- Induced Breast Cancer in Adult Female Rats
Abeer Z.F. Maued1, Amira El-Tohamy1, Mahmoud Ashry2*
1Zoology Department, Faculty of Science, Al-Azhar University, Girl Branch, Cairo, Egypt
2Zoology Department, Faculty of Science, Al-Azhar University, Assuit, Egypt
*Corresponding author: Mahmoud Ashry, Mobile: (+20) 01009715105, E-Mail: mahmoud_ashry20@yahoo.com
A number of physiological cell signaling pathways can develop aberrations that lead to the complex
breast cancer sickness.
Objective: The effectiveness of Dendronephthya putteri ethanolic extract (DEE) against breast cancer caused by 7,
12-dimethylbenz[a]anthracene (DMBA) in adult female albino rats was examined in this study.
Materials and Methods: Adult female albino rats were divided into five groups of 10, each weighing between 160
and 200 g: group (1) normal rats serving as controls, group (2) normal rats receiving daily injections of DEE at a dose
of 100 g/kg/day, group (3) animals with DMBA-induced breast cancer, group (4) animals modeled with breast cancer,
and group (5) animals modeled for breast cancer receiving reference drug 5-Fluorouracil® (5UR) (10 g/kg/weekly,
ip) treatment for six weeks. Results: DEE injection considerably improved illnesses brought on by breast cancer, as
seen by the sharp decline in serum cancer antigen 15.3 (CA15.3), carcinoembryonic antigen (CEA) and cancer antigen
19.9 (CA19.9) levels. Mammary malondialdehyde (MDA) and nitric oxide (NO), along with mammary superoxide
dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), the activity and appropriateness of reduced
glutathione (GSH) level, were all considerably increased. Other significant elevations were seen in tumor necrosis
factor alpha (TNF-), interleukin-1beta (IL-1), alanine aminotransferase (ALT), aspartate aminotransferase (AST),
urea, creatinine, cholesterol, and triglycerides. Conclusion: By enhancing immune function, lowering inflammation,
and reversing oxidative stress, this study shows that DEE can prevent DMBA-induced breast cancer in rats.
Keywords: Breast cancer, DMBA, Antitumor, Oxidative stress, Dendronephthya putteri

regardless of these treatment choices, cancer still has a
The most prevalent kind of cancer and the main
high mortality rate (7). The fact that the majority of
reason for cancer-related morbidity and death in women
those affected by breast cancer cannot afford the pricey
throughout the world is breast cancer (1). In developing
sort of treatment is one of the largest issues with the
nations, where the illness has historically been rare, the
disease's management (8). Additionally, low- and
incidence and death of breast cancer have lately
middle-income people have been shown to account for
increased (2). Every year, it targets more than 500,000
more than 70% of all cancer-related deaths (9).
women. Enormous cell proliferation, unbalanced cell
Nigeria, one of the tropical countries, is home to
a variety of plants that have been shown to have
characteristics of breast cancer (3). Rats with artificially
medicinal anti-cancer properties (7). The production of
induced breast tumors have been used for some time to
compounds important for drug development depends
simulate the growth of human breast cancer. Single doses
on the various biological effects of marine natural
of carcinogens like DMBA or nitrosomethyl urea can
products (10). A special class of metabolites discovered
cause breast cancer in sensitive rat strains. Rat tumors
in soft corals displays a wide-ranging bioactivities and
are weakly invasive, highly hormone-dependent, have a
structural diversity. Research on marine soft corals will
brief latency, and seldom metastasize. This model's
tumor's shape and histology are similar to estrogen-
physiologically diverse substance that could be used in
dependent actual breast cancer (4).
the pharmaceutical industry as a result (11); the
A high-ranking polycyclic aromatic hydrocarbon
Nephtheidae family, which is made up of 20 species
called dimethylbenz (a) anthracene (DMBA) is a
and is a substantial source of metabolites with
genotoxic and tumor-causing invasive environmental
therapeutic purposes (12). The most high-ranking
pollutant. The DMBA-generated mammary tumor is a
metabolites are terpenes and steroids, which have
crucial preclinical animal model of breast cancer (5).
bacterial, inflammatory, and cancer- preventative
The DNA is harmed by the metabolite of DMBA that
characteristics (13). The Red Sea and Indo-Pacific
results from the addition of adenine and guanine
Oceans are home to the renowned Nephtheidae genus
residues. p53, BRCA, Bcl2, and p63 are only a few of
Dendronephthya putteri. Dendronephthya, a genus of
the biochemical and molecular markers that are
marine soft corals, produces a variety of terpenoids.
expressed in DMBA-induced breast tumors in both rats
These metabolites are commonly considered as
and people (6). Apoptosis, which causes malignancy, as
potential chemotherapeutic agents due to their
is well known, inhibits the development of cancer.
anticancer properties. The genus Dendronephthya
Breast cancer and conditions associated with cancer
putteri is capable of producing up to 250 bioactive
have been treated with surgery, chemotherapy,
compounds, the majority of which are polyhydroxy
radiation therapy, or a combination of these. But
steroids, sesquiterpenes, and diterpenes. These
Received: 18/03/2023
Accepted: 21/05/2023

Full Paper (vol.931 paper# 39)

c:\work\Jor\vol931_40 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7159- 7164

The Role of Neutrophils to HDL-C Ratio in Predicting the
Severity of Coronary Artery Disease
Al-Shimaa Mohamed Sabry, Khaled Emad Al-Rabbat, Eman Saeed El Keshk and Micheal Moris Ishak *
Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt.
*Corresponding Author: Micheal Moris Ishak, Email: mikeibrahim90@gmail.com, Phone: +2 01100013107

Coronary artery disease (CAD) is intricately linked to inflammation and atherosclerosis. Neutrophils, key
contributors to inflammation, have been associated with CAD development and cardiovascular risk.
Objective: To investigate the potential of the neutrophils to HDL-C ratio (NHR) as a predictor for the severity of
coronary artery disease.
Methods: This dual-center, cross-sectional, comparative observational study was conducted at Benha University
Hospitals and Heliopolis Hospital from January 2022 to December 2022. The study included 200 patients scheduled for
coronary angiography due to CAD-related symptoms. Based on coronary angiography results, patients were categorized
into three groups: CAD+ (n=75) with luminal stenosis 50% in at least one major coronary artery, CAD- (n=25) with
luminal stenosis < 50% in one major coronary artery, and a control group (n=100) with normal coronary angiography.
Results: Diabetes, hypertension, and smoking were more prevalent in CAD+ than CAD- and control groups (All P <
0.05). CAD+ had higher BMI (27.99 Kg/m2), systolic (145.69 mmHg), and diastolic blood pressure (96.53 mmHg)
compared to CAD- and control groups (p<0.001). CAD+ had elevated creatinine, triglycerides, uric acid, neutrophils,
eosinophils, and neutrophil to HDL-C ratio (p<0.001). NHR predicted severe CAD with AUC=0.907. NHR correlated
positively with BMI, triglycerides, neutrophils, eosinophils, and Gensini score. Logistic regression showed BMI and
NHR were significant predictors of disease severity.
Conclusions: NHR could serve as a valuable marker in risk stratification and clinical decision-making for CAD patients.
Keywords: Neutrophils, HDL-C Ratio, Severity, Coronary Artery Disease.


Inflammation, the atherosclerotic process, and the

development of coronary artery disease (CAD) are
However, few studies have been found to integrate
closely linked through a variety of complex
these two indicators [6].
pathophysiological pathways. Atherosclerosis plays a
Therefore, the aim of this study is to evaluate the
dominant role in the pathophysiological process of the
role of neutrophils to HDL-C ratio in predicting the
disease, and studies have shown that CAD and
severity of coronary artery disease.

inflammation [1].
Meanwhile, lipid and inflammatory molecules play
Study Design: This dual center, cross sectional,
a key role in the development of inflammation. Studies
comparative observational study was conducted at
have shown that neutrophils contribute critically in the
Benha University Hospitals and Heliopolis Hospital
atherosclerotic process and are markers of persistent
during the period from 1/1/2022 to 30/12/2022.
inflammation as well as predictors of cardiovascular

risk [2,3]. Neutrophil counts increase with metabolic
Patients: This study included 200 patients who were
changes associated with atherosclerosis development
scheduled for coronary angiography due to CAD related
and closely correlate with the extent of early
symptoms. Patients were classified into 3 groups:
atherosclerosis formation under hyperlipidemic
Group (1) (CAD+): included patients with luminal
conditions [4].
stenosis 50% in at least one of the major coronary
Epidemiological data have provided broad evidence
arteries (LM, LAD, LCX and RCA) (n=75). Group (2)
that low concentrations of high-density lipoprotein
(CAD-): included patients with luminal stenosis < 50%
(HDL) cholesterol indicate increased cardiovascular
in one of the major coronary arteries (n=25). Group (3)
risk. Although less consistently, this relationship is even
(control): included patients with normal coronary
apparent in patients treated with statins. Therefore,
angiography (n=100).
raising HDL cholesterol has become a therapeutic target

in CAD [5].
Inclusion criteria: Patients presented with typical chest
Moreover, HDL-C has been found to be closely
pain indicated for coronary angiography, with age older
related to coronary artery stenosis; it has the function of
than 18 years. Patients accepted to be included in the
not only reverse cholesterol transport but also oxidation
resistance and vascular endothelial function protection,

with its concentration being negatively correlated with
Exclusion criteria: Coronary artery bypasses surgery,
the coronary heart disease risk. Neutrophils and HDL-
prior PCI, acute coronary syndrome, liver and kidney
C are both important in the atherosclerotic process.
disease, inflammatory disease, heart failure, blood
Received: 10/04/2023
Accepted: 07/06/2023

Full Paper (vol.931 paper# 40)

c:\work\Jor\vol931_41 https://ejhm.journals.ekb.eg/

Retracted paper

Full Paper (vol.931 paper# 41)

c:\work\Jor\vol931_42 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7171- 7175

Management of Unilateral Fracture Ribs using Ultrasound Guided
Erector Spinae Plane Block versus Paravertebral Block
Mahmoud Yakout Elsayed, Alaa El-Din Mohamed El-Kassaby, Salah Abdel Fattah Ismail,
Emad El-Din Ahmed, Reda Abo El-Magd Ismail
Anesthesia and Intensive Care Department, Faculty of Medicine, Suez Canal University, Egypt
*Corresponding author: Mahmoud Yakout Elsayed, Mobile: (+20) 01298765458, E-mail: mahmoud.yakout@med.suez.edu.eg

For many different purposes, paravertebral plane block (PVB) has been the favoured regional anaesthesia
treatment for postoperative analgesia. The initial definition of erector spinae plane (ESP) block was as a new analgesic
technique for thoracic neuropathic pain.
To improve pain management in patients with fracture ribs through setting regional blocks as a protocol at
Suez Canal University Hospitals.
Patients and methods:
This study included 70 patients with unilateral multiple rib fracture. They were divided into two
groups: Group (E) patients who received ultrasound-guided ESP block with 20 ml of bupivacaine 0.25% as a loading
dose and group (p) patients who received ultrasound-guided PVB block with 20 ml of bupivacaine 0.25% as a loading
Age, sex, weight, and the number of fractured ribs between the two groups did not differ statistically. There
was a significantly lower TLC in the E group at 48 h compared to the P group as well as the baseline value. In both
groups, there was a significantly lower neutrophil count at 24 h and 48 h compared to the respective baseline value. In
group P, there was a significantly higher lymphocyte count at 24 h compared to the baseline value. Moreover, there was
a significantly higher lymphocyte count at 48 h compared to the baseline value in both groups.
Conclusion: Both continuous ESPB and TPVB can be used for pain control of unilateral multiple fracture ribs.
Keywords: Unilateral fracture ribs, ESP, Paravertebral block.

and thoracic surgery are favourites of PVB. It is a
Multiple fractured ribs (MFR) from thoracic
sophisticated method with possible dangers and
trauma are still frequent (1). In contrast to the substantial
problems, while being efficient for delivering
chest discomfort brought on by numerous rib fractures,
appropriate postoperative analgesia. Due to the
which can be difficult to manage and increase hospital
paravertebral spaces' near closeness to the pleura, many
stays, medical costs, and impaired pulmonary function,
medical professionals are hesitant to employ this method
the pain brought on by a single broken rib is often
(7, 8). Due to their simplicity of usage and generally safe
straightforward to manage (2).
block area, ESP blocks are becoming more and more
Various degrees of chest discomfort are a common
popular (9).
first symptom in patients with traumatic rib fractures,
Therefore, this study aimed to determine
which can affect pulmonary mechanics and cause the
analgesic efficacy of continuous infusion ESP block
retention of trachea-bronchial secretions as well as
compared to continuous infusion thoracic paravertebral
atelectasis (3). In addition to substantially impairing
block in patients with rib fracture using post block total
respiratory mechanics, multiple rib fractures also
morphine consumption.
aggravate underlying lung damage and pre-existing

respiratory illness, which increases the risk of respiratory
failure (4).
This study was done on patients with rib fracture
An effective analgesic may aid in enhancing the
at Suez Canal University Hospital. Pre-procedure steps
patient's respiratory mechanics, prevent the need for
included the explanation of the procedure and
tracheal intubation for ventilatory assistance, and so
reassurance of the patient.
significantly modify the course of recovery (4). Early

implementation of a successful pain alleviation is the
Patients were split into two equal groups at random:
cornerstone of managing chest discomfort (5).
1- Group I received ultrasound-guided ESP block with
Systemic opioids, non-steroidal anti-inflammatory
20 ml of bupivacaine 0.25% as a loading dose.
medications, or transcutaneous electrical nerve
Bupivacaine 0.125% was used for continuous
stimulation can all be used to produce analgesia. As an
infusion of local anesthetic. It was titrated for effect,
alternative, effective regional analgesic methods include
at 0.1-0.2 mL/kg/hr.
intercostal nerve block, epidural analgesia, intrathecal
2- Group II received ultrasound-guided PVB with 20
opioids, intra-pleural analgesia, and thoracic epidural
ml of bupivacaine 0.25% as a loading dose.
and thoracic paravertebral block. Regional blocks are
Bupivacaine 0.125% was used for continuous
often more effective than systemic opioids and have
infusion of local anesthetic. It was titrated for effect,
fewer systemic side effects, although being more
at 0.1-0.2 mL/kg/hr.
intrusive (4, 6). Specifically upper abdominal procedures

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

Full Paper (vol.931 paper# 42)

c:\work\Jor\vol931_43 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7176- 7180

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: basmaelbadry@hotmail.com, Mobile: +201001558203
Introduction: The majority of the cells that line the back of Descemet's membrane and the inside of the anterior chamber
of the human eye are hexagonal, non-regenerating cells that make up the endothelium of the cornea. These cells are
found in the cornea. In order to preserve the clarity of the cornea, the metabolically active endothelium pumps water out
of the stroma and into the aqueous humour, maintaining the stroma at a degree of dehydration that is 70% water.
Objective: The purpose of the study is to compare the number and shape of corneal endothelial cells in emmetropic
people of varying ages. 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: Among the five age groups studied, there was a statistically significant variation in endothelial cell density
(ECD). The HEX% varies significantly between the five age groups, and we found that the CV% rises with age.
Conclusion: We identified statistically significant differences in ECD and shape between age groups, suggesting that
age has a major impact on corneal endothelial cells.
Keywords: Cornea, Age Changes, Corneal Endothelial Cell, Emmetropes, Non-Contact Specular Microscope


pathology, glaucoma as well as systemic diseases that
The majority of human corneal endothelial cells are
could affect the eye (e.g., collagen disease, DM) were
hexagonal, non-regenerating cells that line the rear of
excluded. The eighty eyes were classified into 5 age
Descemet's membrane and the interior of the anterior
groups: (1) aged 5-14 years, (2) aged 15-29 years, (3) 30-
chamber of the eye. These cells are found in the cornea
44, (4) 45-60, (5) more than 60 years.
(1). In order to preserve the clarity of the cornea, the
Slit-lamp biomicroscopy with direct and indirect
metabolically active endothelium pumps water out of the
inspection, as well as measurements of visual acuity,
stroma and into the aqueous humour, maintaining the
refraction, external eye, and intraocular pressure, were
stroma at a degree of dehydration that is 70% water (2).
part of the comprehensive ophthalmic examination.
It is possible to examine the number and shape of
A non-contact specular microscope: (NIDEK CEM-
corneal endothelial cells with a specular microscope.
530): To determine the number of corneal endothelial
After proper calibration (3), the specular microscope has
cells and their morphology, a non-contact specular
proven to be dependable and reproducible. The corneal
microscope was used. The apparatus shines light onto the
endothelial cell layer can be analysed morphologically
cornea and records the picture reflected from the
with a slit-lamp specular microscope without causing
endothelium of the cornea and the aqueous humour. A
any damage to the eye (4). Mean cell density (MCD) is
specular photomicrograph is produced by analysing the
calculated, as is the coefficient of variation (CV) in cell
reflected image. Endothelial cell number, cell density,
size and the cell's apparent hexagonal shape. The health
size variation (polymegathism), and form variation
of the endothelium layer of the cornea can be gauged
(pleomorphism) can all be assessed by seeing the cells
from these measurements (5). The corneal endothelium
with specular microscopy. Specular microscopy required
can undergo significant morphological change during
the patient to sit with their chin supported by the chin rest
intra-ocular and refractive surgeries (6) ;therefore,
and their forehead lightly placed on the headband.
assessing the endothelium prior to these procedures is
Automatic focusing and adjusting the head position were
critical for predicting the likelihood of corneal problems.
used to bring the pupil into sharp focus within the
The goal of the study is to examine the differences in
monitor's aiming circle. The centre method was used to
corneal ECD and morphology that occur across age
take the measurements. Specular microscope and corneal
groups in patients who are emmetropic.
thickness measurements were taken when the equipment

was properly focused and aligned.
In this study we used (NIDEK CEM-530) specular
In this prospective, observational study, there
microscope, it is provided with a built-in pachymetry to
were eighty (80) eyes of forty (40) emmetropic
measure central corneal thickness (CCT) at each central,
paracentral and peripheral points. Paracentral imaging is
Ophthalmology Department, Faculty of Medicine, Suez
a special feature of the CEM-530 that complements the
Canal University. In this study, we studied endothelial
standard central and peripheral specular microscopy. As
corneal cell changes by ageing. This study's inclusion
can be seen in figure (1), paracentral images are recorded
criteria were: emmetropes of both sexes aged more than
at eight places, 5o viewing angle, inside a 0.25 mm × 0.55
5 years. Eyes with previous ocular surgeries or trauma,
mm field, allowing for improved assessment in the
previous contact lens wear, corneal diseases, ocular
immediate periphery of the central image.
Received: 04/04/2023
Accepted: 01/06/2023

Full Paper (vol.931 paper# 43)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7181- 7189

Comparison between Airway Block versus Ketofol during Awake Fibroptic
Nasotracheal Intubation in Predicted Difficult Airways
Osama Helal Ahmed, Kareem Abd Elaal Hamed, Randa Asaad Omar Mohammadain
Department of Anesthesia, Intensive Care and Pain Management,
Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
Corresponding author: Randa Asaad Omar Mohammadain, Mobile: 01121498004;
Email: randaasaed94@gmail.com
A skilled practitioner of localized anesthetic of the airway can facilitate intubation of awake individuals
suspected of having difficult intubation due to anatomical variations or airway disease that make direct laryngoscopy of
the glottis difficult or impossible. Aim: Comparing between the influence of ketofol versus the effect of airway block
on intubation conditions during awake fiberoptic nasotracheal intubation regarding; intubation scores, patient tolerance,
intubation time, hemodynamic stability, and satisfaction score.
Patients and Methods: Eighty-four individuals were assigned randomly to double groups: as Ketofol group contained
42 diseased persons received intravenous ketofol inwhich the individuals received a loading infusion dose of ketofol
100 mcg/kg/min over ten min until achieving sedation score.
Airway block group contained 42 diseased persons inwhich superior laryngeal nerve block was done followed by awake
fibroptic intubation without any sedation.
Results: A notable rise was seen statistically in mean arterial blood pressure (MAP) of patients of AB group at
intubation, at 1 minute (min) and at 5 min post-intubation when compared to baseline level. While in the ketofol group,
MAP was more stable at intubation, at 1 min and at 5 min post intubation comparing to baseline.
Conclusion: Administration of ketofol combined with topical anesthesia (Spray-As-You-Go technique lidocaine 2%)
offered better intubation scores, patient tolerance, lesser intubation time, more hemodynamic stability and greater patient
satisfaction than effect of airway block combined with topical anesthesia (Spray-As-You-Go technique lignocaine 2%)
on patients during performing awake nasotracheal fiberoptic intubation technique.
Ketofol, Airway block, Propofol.

Anesthesia during awake fiberoptic intubation
In cases of projected difficulty intubating,
is often provided by nerve blocks. Consequently,
compromised airway, lower airway pathology and in
anesthetizing the upper airway necessitates the use of
cases where neck extension must be avoided, fiberoptic
intubation is an invaluable approach for securing the
(oropharynx), the superior laryngeal (larynx above
airway (1). Patients receiving intravenous sedative for
voice cords), and the translaryngeal (larynx and trachea
awake fiberoptic intubation should be cooperative
below vocal cords) (7).
throughout the procedure, nodding off if not yet
While a nerve block can be used to anesthetize
dispersed, and responsive to verbal directions (2).
a patient for awake intubation, it is more technically
Desirable outcomes of a successful sedation
difficult to do. However, they need blocking more than
procedure include patient comfort, cooperation,
one nerve, which increases the likelihood of problems
amnesia, hemodynamic stability, blunt airway reflexes,
such intravascular injection and nerve injury (7).
and patent airway with spontaneous breathing (3).

Propofol is an antagonist at N-methyl-D-
aspartate receptors in addition to its sedative, hypnotic,
Primary outcome: Comparing the effect of ketofol
and anesthetic properties (4).
versus airway block nerves on patients' acceptance
Ketamine is a neuroleptic anesthetic that acts on
of endotracheal tube placement using a fiberoptic
NMDA receptors in the thalamus, the cortex, and the
limbic system (5). Ketamine and propofol, at varying
Secondary outcomes: Evaluation of hemodynamic
quantities, form the drug ketofol. It's a go-to for a
stability by measuring change in Heart Rate (HR),
variety of medical treatments (4).
Systolic Blood Pressure (SBP),Diastolic Blood
Propofol and ketamine together have several
Pressure (DBP),Mean Arterial Pressure (MAP) and
advantages, including hemodynamic stability, freedom
peripheral capillary oxygen saturation (SPO2)
from rapid recovery, respiratory depression and
percent, evaluation the time during which the
effective after procedural analgesia. Both the dose and
Endotracheal Tube (ETT) will be placed, and
the combination ratio affect the safety and effectiveness
evaluation of complications.
of ketofol as an analgesic agent. Ketofol is a

combination medication, and as such, it should be
ideally suited for procedural sedation (6).

observational study conducted on 84 patients of both

gender at AL-Azhar university hospitals (Assiut) aged
Received: 30/03/2023
Accepted: 28/05/2023

Full Paper (vol.931 paper# 44)

c:\work\Jor\vol931_45 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7190- 7195

Correlation Between Inferior Vena Cava Diameter and
Collapsibility Index with Central Venous Pressure in Assessment of
Septic Shock Patients in Emergency Department
Mahmoud Mohamed Abdo Youssef 1, Samir Mohamed Attia 2,

Mostafa Mahmoud nabeeh 3, Hala Shaban Abdel Azim4
1Department of Cardiovascular Diseases, 2Department of Vascular Surgery,
3Department of Neurosurgery & Faculty of Medicine, Mansoura University
4Department of Emergency and Traumatology Medicine, Emergency Hospital, Mansoura University
*Corresponding author: Hala Shaban Abdel Azim, Mobile: 01012855232
E-mail: tasneemshaban2018@gmail.com

For an early resuscitative response, central venous pressure (CVP) monitoring is an invasive
hemodynamic assessment & useful guidance. In relation to the CVP and the volume of blood in circulation, inferior
vena cava (IVC) is a sizable vein with a certain size and form. Septic shock is defined as sepsis accompanied by
hypotension that does not respond to fluid resuscitation.
Identifying the link between the diameters of IVC, CVP, as well as Inferior Vena Cava Diameter Collapsibility
Index (IVCCI), all while assessing the volume status of critically septic shocked individuals to establish a diagnosis of
septic shock.
Patient and methods:
This prospective observational research involved one hundred individuals who suffered from
septic shock & were hospitalized to emergency department at Mansoura University, Mansoura, Egypt. The research was
carried out over the course of a single calendar year, beginning on May 20, 2022, and ending on May 20, 2023.
There was a considerable disparity among both groups regarding age, sequential organ failure assessment
(SOFA) score, heart rate, platelets count, serum urea and serum creatinine, C-reactive protein, ESR, serum lactate, PH,
serum bicarbonate, inferior vena cava diameter collapsibility index (IVCCI), systolic blood pressure (SBP) & diastolic
blood pressure (DBP). Besides, there was no statistically significant variance between both groups regarding sex, the
change in the CVP, initial SBP, DBP, respiratory rate (RR) and temperature.
The assessment of CVP as well as IVCCI is an excellent prognostic method in sepsis patients.
Collapsibility index, IVC, Septic shock, CVP.


in circulation. Ultrasound, a non-invasive tool for
Individuals admitted to the Emergency
evaluating volume status, can be used to measure the
Department (ED) with hypovolemia can benefit from a
IVC (4). Depending on the phase of respiration, the IVC
CVP assessment since it is both an invasive
diameter (IVCD) fluctuates. During inspiration, the
hemodynamic examination & a valuable guide for an
thorax develops negative pressure, causing the IVC to
early resuscitative response (a CVP less than eight
drain into the right atrium and shrink in diameter. The
cmH2O signals the requirement for IV fluid therapy).
IVC collapsibility index (IVC-CI) is measured by
Invasive hemodynamic monitoring, such as arterial
dividing (IVCD in expiration - IVCD in inspiration) by
puncture, infection, venous thrombosis, etc., is often
IVCD in expiration (5). The goal of this research was to
used to track central venous pressure (CVP) in the
find the relation between IVC diameter, CVP & IVC-CI
emergency department, but it comes with a number of
for the purpose of assessing volume status & making a
drawbacks, including the potential for prolonged
diagnosis of septic shock in critically ill patients.
monitoring times and the need for specialized

equipment and personnel (1). In certain cases, such as
coagulation problems, infection at the insertion site, and
A total of one hundred patients with septic shock in this
so on, the use of a central venous catheter is forbidden.
prospective observational research were admitted to
Infections, inadvertent artery puncture, hematomas,
emboli &
Mansoura, Egypt. The duration of the trial started from
dysrhythmias are all possible complications of a central
May 20, 2022 to May 20, 2023. The patients were
venous catheter (2).
divided into 2 groups; non-survivors (55) and survivors
breathing, optimizing circulatory status, monitoring

oxygen delivery to tissues, and attaining resuscitation
Inclusion criteria: Age from 18 to 70 years old, both
end objectives are all part of the ABCDE strategy for
genders, patients with functioning central venous
resuscitation of patients (3).
catheter and cases suffering from septic shock state.
IVC carries deoxygenated blood to the heart's
Defining sepsis: All patients of septic shock & sepsis
right atrium. IVC is a large vein with a certain size and
are stated in 3rd International Consensus Definitions for
shape that is linked to the CVP and the amount of blood
Sepsis & Septic Shock (Sepsis-3) (6).
Received: 10/04/2023
Accepted: 07/06/2023

Full Paper (vol.931 paper# 45)

c:\work\Jor\vol931_46 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7196- 7206

Modified-FOLFIRINOX-Losartan Followed by Chemoradiotherapy for
Locally Advanced Pancreatic Cancer: A Phase II Study
Alshimaa Mahmoud Alhanafy*1, Naser M. Abd El Bary1, Osama Hegazy2,
Samar H. Soliman1, Reham Ahmed Abdelaziz1, Ashraf E. Abd El Ghany1
1Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Menoufia University, Egypt
2Department of Hepato-Pancreatico-Biliary Surgery, National Liver Institute, Menoufia University, Egypt
*Corresponding author: Alshimaa Mahmoud Alhanafy, Mobile: 00201006454574, E-mail: alshimaa_alhanafy@yahoo.com

: At presentation only 20% of pancreatic cancer patients are defined resectable due to advanced initial
disease stage.
Objective: To study the clinical outcome of patients with unresectable locally advanced pancreatic cancer (LAPC)
after neoadjuvant modified FOLFIRINOX-losartan followed by chemoradiotherapy.
Methods: This phase II clinical trial was carried out on 50 patients with newly diagnosed surgically unresectable
LAPC. Patients had Performance status (PS) 1 and normal organ functions. They arranged to receive 3 cycles of
modified FOLFIRINOX with losartan taken orally every day followed by chemoradiotherapy (CCRT).
Results: Out of the 50 patients, thirteen (26%) patients had surgery; R0 resection achieved in 6 of 13 patients. After
median follow-up duration of 20.25 months (6.0-34.5 months), the median overall survival (OS) was 21 months (95%
CI, (10.200­31.800). Patients who had surgical resection had longer OS of 24 months (95% CI, (16.363 ­ 27.637)
compared to those who didn't have resection the mean OS was 14 months (95% CI, (9.205 ­ 18.795) (P=0.271). The
patients who achieved CR after modified FOLFIRINOX had longer survival of 33 months (95% CI, 19.918 ­ 46.082)
compared to those who had PR and SD. Each has median OS of 13 months (95% CI, 6.768 ­ 19.232), (11.718 ­
14.282) respectively (P=0.040*). The patients who achieved CR after CCRT had longer OS (median not reached)
compared to those who had PR, SD and PD; median OS was 24, 14 and 8 months respectively and 95% CI was (6.761
­ 41.239), (11.022 ­ 16.978), and (4.080 ­ 11.920) respectively (P=0.001*).
Conclusion: Modified-FOLFIRINOX/losartan protocol followed by CCRT had high response, feasible and could
improve patients' outcomes in LAPC.
Keywords: LAPC, Modified-FOLFIRINOX-Losartan, Chemoradiotherapy.

surgically unresectable LAPC during the period from
PDAC or pancreatic ductal adenocarcinoma is a
April 2020 to April 2023.
dismal prognosis malignant neoplasm [1]. Its
Inclusion criteria: histopathological diagnosis of
management continues to be challenging. Surgery is
PDAC, patients age 18-70 years old of both sexes,
the only curative treatment modality but with 5 years
PS 1 [5], with average renal, liver and bone marrow
OS rate of only 10­20% [2]. So, participation in
Exclusion criteria: Stage IV disease [6], previous
chemotherapy followed by chemoradiation and then
irradiation to upper abdominal region, and patients
surgery appears to be optimal option [3]. Also,
have baseline hypotension, defined as systolic blood
combination of intensive chemotherapy and radiation
pressure lower than 100 mm Hg.
with other pharmacological drugs like the blood-
Methods: Included patients underwent baseline
pressure modulating drug losartan may produce
evaluation; physical examination, and staging
remarkable results [2].
imaging; CT or MRI pancreatic protocol, CT chest
Preclinical studies suggested that manipulating
and pelvis with contrast ± PET/CT. LAPC patients
renin angiotensin system (RAS) could have
with unresectable disease by NCCN definition [7].
anticancer effect in patients with PDAC, as it is
Baseline Lab evaluation: CEA, CA19-9, CBC,
possibly mediating cell growth and metabolism.
renal and liver functions. Patients were arranged to
Inhibition of RAS activity achieved by losartan,
receive 3 months of modified FOLFIRINOX prior to
could decrease the oncogenic potential of malignant
CCRT, with losartan taken orally every day 25 mg/
day as a starting dose, if it was tolerable during the
microenvironment and enhance the delivery of
first week. It would be increased to 50 mg/day and
cytotoxic systemic therapy [4].
continued until the completion of the last cycle.
We aimed to study the surgical resectability,
Assessment of blood pressure, K, and Na level were
response and survival of patients with LAPC after
done every cycle. Restaging with CTs with contrast,
CEA and CA 19.9 were requested after 3 cycles of
losartan followed by chemoradiotherapy.
modified FOLFIRINOX-losartan. Toxicity of

treatment protocol were assessed by CTCAE,
Version 5.0 [8].
This phase II prospective clinical study was
Radiological responses to chemotherapy were
carried out on 50 patients with newly diagnosed
evaluated by RECIST criteria version 1.1 [9]. Long-
Received: 10/04/2023
Accepted: 07/06/2023

Full Paper (vol.931 paper# 46)

c:\work\Jor\vol931_47 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7207- 7210

Serum Lactate can predict Short-Term Outcome of Critically-Ill Patient with Liver
Cirrhosis admitted to Medical Intensive Care Unit
Monkez Motieh Yousif, Osama Abdel Aziz, Hend Monsour Mohammed*, Ghada Mohammed Samir
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hend Monsour Mohammed, Mobile: (+20) 010070134765, E-mail: hendmonsour749@gmail.com

Serum lactate level can be used as an important predictor of short-outcomes in critically ill patients with
complicated liver cirrhosis.
To improve risk prediction and better assessment of short-term outcomes of ill critically cirrhotic, through
assessment of serum lactate level on ICU admission and after 24 hours.
Patients and methods:
This observational descriptive cohort study included 151 critically ill patients with
decompensated liver cirrhosis who were admitted into ICU of Zagazig University Hospitals.
Results: Causes of admission to ICU included hepatic encephalopathy (34.4% of cases), bleeding esophageal varices
(33.8%), hepatorenal syndrome (23.2%), SBP (7.3%) and hepatopulmonary syndrome (1.3%). Serum lactate levels were
14.5 ± 8.6 and 14.2 ± 9 mmol/L on admission and 24 h after admission to ICU, respectively. These figures are much
higher than figures in a healthy population and in patients with compensated cirrhosis. Serial measurement of serum
lactate showed a tendency toward elevation in 43.7% of patients, and a drop in 50.3%, 24 h after admission, with the
remaining 6% of cases being unchanged. ICU mortality was encountered in 33.8% of patients.
In critically-ill patients with liver cirrhosis, lactate levels were independently related with short-term
mortality and indicate the severity of the illness and organ failure. Measures that decrease serum lactate toward normal
as early as possible may help improve the chances of survival of these patients in the ICU.
Keywords: Liver cirrhosis, ICU, Serum lactate, Short-term outcome.

Inclusion criteria:
Lactate level is known as an important predictor
Patients with decompensated liver cirrhosis were
of outcome in critically ill patient in the medical
admitted to MICU in the period from January to
intensive care unit (MICU) (1). It is essential to
December 2020 with complications of hepatic
determine the prognosis in patients with cirrhosis in the
MICU in order to direct treatment measures (2, 3).
bacterial peritonitis, hepatorenal syndrome, and other
Normally, glucose is fully oxidized in the cell
decompensated liver-related complications. Age 18
mitochondria to produce efficient energy [adenosine
years old and both sexes were included.
triphosphate (ATP)] under stress condition, glucose is

converted into lactate intracellularly that is secreted as
Exclusion criteria: Patients with incomplete data
lactic acid resulting in metabolic acidosis (4). Under
during follow-up while in ICU, age below 18 years old
normal conditions, lactate is cleared rapidly by the liver,
and patients' relative refusal to participate.
with a small amount by the kidney (5). The liver is the

organ primarily clear the body from lactate, so lactate
clearance may be impaired in the presence of severe
Two hundred thirteen admissions were screened
liver dysfunction (6). Acute decompensation with
during the study period. Only 151 patients were
increasing organ failure is common in patients with liver
available for valid analysis. The remaining patients (62)
cirrhosis. Therefore, they must be hospitalised to the
were excluded because of incomplete data and/or loss
MICU (7). Due to organ failure, acute on-chronic liver
of follow-up.
failure brought on by abrupt decompensation of

cirrhosis has a significant mortality rate (8). The death
All participants were submitted to the following:
rates for cirrhotic patients receiving care in the MICU
I. Thorough history taking: Personal history,
vary from 40 to 60% (7, 9).
presentation problem, past history of the disease,
Therefore, this study aimed to determine the
drugs, operation, and present history of current
impact of elevated serum lactate level on complicated
symptomatology as fever, shortness of breath,
liver cirrhosis outcome. Also, to evaluate the
vomiting, diarrhea, abdominal pain, melena,
demographic, clinical and biochemical variable in
hematemesis, bleeding tendency, anorexia, oliguria,
complicated liver cirrhosis.
abdominal distension and altered conscious level.

II. Full clinical examination including:
This was a prospective cohort study that included
A. General examination: Signs of decompensated
critically-ill patients with decompensated liver cirrhosis
liver cirrhosis including jaundice, pallor, lower
admitted to the medical intensive care unit (MICU) of
limb edema, ascites, gynecomastia, palmar
Zagazig University Hospitals.
erythema, spider nevi, leukonychia, parotid
Received: 04/01/2023
Accepted: 03/03/2023

Full Paper (vol.931 paper# 47)

c:\work\Jor\vol931_48 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7211- 7217

The Role of Shear Wave Elastography in the Assessment of Lateral Epicondylitis
Asmaa Abdullah Abdelsayed*, Ghada Kamal Gouhar, Mohammad Abd AIkhaIik Basha, Riham Amir Kamal
Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Asmaa A. Abdelsayed, Mobile: (+20) 01125135855, E-mail: asmaaabdallah43@gmail.com

Lateral epicondylitis (LE) is the most common cause of lateral elbow pain.
Objective: To evaluate the clinical usefulness of shear-wave elastography as an objective method for the assessment of
the affected tendons in lateral epicondylitis.
Patients and methods:
This cross-sectional study included 35 patients with unilateral lateral epicondylitis for the
evaluation of qualitative and quantitative shear-wave elastography (SWE) parameters.
Mean duration of symptoms among the studied group was 7.17±5.6 months. There was a significant difference
in hypoechogenicity, swelling, cortical irregularities, and calcification among elbows with LE than those without (97.1
vs 8.6%, 42.9 vs 5.7%, 42.9 vs 0%, and 14.3 vs 0% respectively). The mean velocity and stiffness in affected elbows
were (2.3±0.23 and 16.9± 5.7 m/s) compared to the non-affected side (6.1±1.07 kPa and 112.9± 33.4 kPa) (P=0.001).
SWE had the highest sensitivity (97.2% vs 97.1%) and specificity (98% vs 98.5) for velocity and stiffness, respectively.
There was a highly statistically significant decreased pain severity (VAS) scale after treatment than before (P=0.001).
In patients with lateral epicondylitis, SWE can be utilised as a method with excellent repeatability and
appropriate diagnostic accuracy for assessment and monitoring the therapy impact.
Keywords: Shear-Wave Elastography, Lateral Epicondylitis, Grey Scale Ultrasound.


The most typical reason for lateral elbow
formation, and increased Doppler activity; such
discomfort is LE. In the general community, it affects
findings are only based on subjective visual assessment
1-3% of people (1). The recurrent microtrauma
(4-5). However, real-time elastography, was employed to
experienced during supination of the forearm and
assess the mechanical characteristics of tendons, both
dorsiflexion of the wrist that causes tendon
qualitatively and quantitative assessments of tendon
degeneration and collagen fibre rupture that triggers a
elasticity can be achieved (6).
reparative reaction is the pathophysiology of LE. The
One of the two primary elastography techniques
common extensor origin becomes weaker and is at a
is shear wave speed (SWS), which can be produced in
higher risk of rupture in chronic illness due to a cycle of
numerous ways. One such technique calculates the SWS
tendon degeneration and repair (2).
at various depths inside the tissue using numerous
The VAS and clinical examination are the main
focused push beams that produce shear waves and ultra-
sources of information used to make the LE diagnosis.
high frame rate ultrasound imaging of the ensuing shear
The use of diagnostic imaging modalities such as real-
wave propagation(7). This method yields quantitative
time sonoelastography, MRI, and conventional US for
maps of elasticity or shear wave velocity in addition to
confirmation is often saved for cases with unusual
qualitative color-coded elastograms. The SWE of the
presentations or those who don't respond to
CET in LE, however, has hardly ever been studied, and
conservative therapy (3).
the majority of research have only assessed the CET
Imaging methods are crucial for determining the
using real-time strain elastography (8).
severity of LE, measuring the degree of damage,
Therefore, in order to determine whether shear
formulating treatment plans, and directing surgery
elastography can be used to objectively diagnose LE,
because they give pertinent information on the
this study aimed to assess the CET elasticity in patients
physiopathology of the disease process. Although grey
with unilateral LE by quantitative and qualitative
scale ultrasonography and MRI have always been seen
methods and compare findings with the contralateral
as reliable alternatives for assessing LE, the exorbitant
non affected side.
cost of MRI, lengthy examination time, non-dynamic

nature of the examination, need for experienced reader,
and other known contraindications i.e., claustrophobia
This cross-sectional study was conducted over a
and incompatibility with certain metallic prosthesis,
6-month period. A total of 35 patients were referred
greatly limit its feasibility in all cases (3).
from the orthopedic clinic to the Radiodiagnosis
Currently, advanced US techniques are
Department for imaging at the Ultrasonography Unit
increasingly being used in the diagnosis of LE due its
after being evaluated by an orthopedic surgeon with
relatively low cost, non-invasive nature, and added
clinical symptoms suggesting unilateral LE at Zagazig
dynamic features. While grey-scale US findings in LE
University Hospitals.
are characterized by edema and decreased echogenicity

with or without thickening of the common extensor
Inclusion criteria:
tendon (CET), epicondylar cortical irregularity or spur
Patients with unilateral elbow pain were assessed
Received: 04/01/2023
Accepted: 03/03/2023

Full Paper (vol.931 paper# 48)

c:\work\Jor\vol931_49 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7218- 7224

Assessment of Serum Level of High-Molecular-Weight Adiponectin (HMW-APN) in
Rheumatoid arthritis Patients and Its Correlation with the Disease Activity
Eman O. El-shabrawy1*, Nanis O. Neseem2, Yousra Sadeq3, Amany. S. Elbahnasawy4
Departments of 1Physical Medicine, Rheumatology & Rehabilitation and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Correspondig Author: Eman O. El-shabrawy, Mobile: (+20)01092591808, Email: omnoureen2018@gmail.com


Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder, which is associated with joint deformity
and functional impairment. Paradoxically, the pathogenesis of RA adiponectin appears to have proinflammatory
activities in the joints, being able to induce the release of inflammatory mediators and may also be linked to disease
Objective: To assess serum concentration of high-molecular-weight APN (HMW-APN) in RA cases and its association
with disease activity.
Methods: This cross sectional case-control study included 80 persons that were divided into 2 groups; group A (patients'
group) that involved 40 RA cases and group B that included 40 normal persons with matched age and sex. Serum level
of high-molecular-weight adiponectin was assessed using ELISA technique. Plain X-ray on both hands to detect bone
erosion was assessed by Larsen Score.
Results: Serum levels of HMW-APN were significantly higher in RA cases in comparison with controls. A significant
positive correlation existed between HMW APN with number of swollen joints and Disease Activity Score-28 for
Rheumatoid Arthritis with ESR (DAS28-ESR), ESR, Rheumatoid factor, anti-cyclic citrullinated peptides (CCP)
antibodies and Larsen Grading Scale. According to the ROC analysis, the best cutoff point of serum HMW-APN to
identify RA from healthy control was > 77.04 Pg/ml. This point showed high sensitivity (87.5%) with moderate
specificity (70%) and AUC (0.883).
Conclusion: Serum levels of HMW-APN could be used as reliable biomarker in diagnosis of RA in addition to
determination of the disease activity.
Keywords: HMW-APN, RA, DAS-28 with ESR, Rheumatoid factor.


RA is a chronic autoimmune symmetrically
Though, many studies have proven the implications
polyarthritis disease, which is characterized by
of adipokines in the pathophysiology of autoimmune
tenosynovitis, cartilage damage and bony erosions.
disorders, such as RA, their role in the pathomechanism
Until the 1990s, RA has been associated with
of disease progression is unclear [2]. Paradoxically, in
disabilities, inability to work, and high mortalities.
RA, adiponectin appears to possess pro-inflammatory
However, newer treatments have made RA a treatable
effects in the joints since it is able to induce the release
condition. A significant progress has been made in the
of inflammatory mediators and might also be linked to
development of disease-modifying anti-rheumatic
disease activity [6]. Adipokines have been found to have
drugs, which control the inflammatory process and thus
a significant role in RA pathophysiology [7].
prevent further joint destruction [1]. In general, the aim
Hutcheson, points out that knowledge about adiposity
of RA treatment is to improve the quality of life through
has changed and currently it is considered as a
improving the pain, maintaining functional ability, and
significant regulator of many pathophysiologic
thus preventing disability [2].
processes, such as inflammation. Moreover, adipokines
Adiponectin is an anti-inflammatory adipokine
regulate the appetite and glucose metabolism [8].
formed of 244 amino acids and is released
This study aimed at assessing the serum level of
predominantly by adipocytes. Studies suggested that
HMW-adiponectin in RA patient and its relationship
monomeric form of adiponectin seems to occur only in
with disease activity.
adipocytes, however there are 3 circulating forms of

adiponectin in human plasma: trimmer (low molecular
weight, LMW), hexamer (medium molecular weight,
This was a cross sectional case-control study. We
MMW) and multimer (high molecular weight, HMW)
collected the subjects from the Outpatient Clinic and
[3, 4].
Many studies highlighted the important role of
Rehabilitation, Mansoura University Hospitals. Our
adiponectin in obesity, diabetes, atherosclerosis and
study was conducted for one year from November 2021
metabolic syndrome, being the highest levels a
to November 2022. It included 80 subjects that were
protective factor for such conditions [5]. Recently, the
allocated into 2 groups; group A (patients' group)
role of adipokines in the pathomechanism of RA has
involved 40 cases with RA aged 18 years or more and
been investigated however results remain conflicting.
fulfilled the 2010 American College of Rheumatology

European League Against Rheumatism classification
Received: 10/04/2023
Accepted: 07/06/2023

Full Paper (vol.931 paper# 49)

c:\work\Jor\vol931_50 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7225- 7232

Assessment of Right and Left Ventricular Functions in Patient with
Type I Diabetes Mellitus: Strain Imaging Study
Mohamed F. Elnoamany, Aya R. Abo Dief*, Fatma Elzahraa A. Zein
Department of Cardiology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding Author: Aya R. Abodeif, Mobile: (+20) 01015684663, E-mail: drayareda91@gmail.com

Diabetes mellitus type 1 (DM1) is frequently accompanied by increasing risks of cardiovascular diseases.
The prevention of cardiac complications depends on the early diagnosis of myocardial dysfunction.
Objective: Our objective was to assess both right and left ventricular (LV) functioning in DM1 patients depending on
strain imaging by 2D-speckle tracking echocardiography (2D-STE).
Patients and methods: The present prospective, case-controlled study was conducted in the Cardiology Department,
Menoufia Faculty of Medicine, from May 2021 to December 2022. 90 subjects were selected, divided into two groups.
60 patients with type I diabetes mellitus served as cases and 30 healthy subjects age matched served as control.
Results: E wave, E/A value, GLS endo, GLS myo and average global longitudinal strain were lower in patients than
controls (70.43± 13.67 cm/s vs. 84.67 ± 11.97 cm/s, 1.05 ±.25 vs 1.4 ± 0.18, ­20.48 ± 2.81% vs. ­24.08 ± 1.11% , ­
18.71 ± 2.09 % vs. ­21.76 ± 1.01 %, and -18.82 ±1.92 % vs 21.1± .62 % respectively, p < 0.001), meanwhile there was
no difference between both groups regarding ejection fraction and RV strain measurements (68.48 ± 5.96 % vs. 67.39
± 3.55% and ­21.13 ± 1.29 % vs. ­21.06 ± 1.24 % respectively, p =0.357 and p =0.807).
Conclusion: Patients with DM1 and without known heart diseases have diastolic and subclinical systolic dysfunction
with lower LV endocardial and myocardial longitudinal strain demonstrated by multi-layered STE.
Diabetes mellitus, Longitudinal strain, Speckle tracking.


characteristics that have been demonstrated to be more
The International Diabetes Federation anticipated
effective than traditional echocardiography at detecting
that by 2040, there would be 642 million cases of DM,
mild cardiac dysfunction. Furthermore, current
this now has an impact on 8.8% of the world's
software methods enable the measurement of
population. Effective hyperglycemia management has
endocardial, myocardial, and epicardial layers strain
been shown to drastically lower cardiovascular events
individually, offering an even more thorough
in diabetic patients, which are the main cause of
assessment of the heart function (6).
mortality and morbidity in people with diabetes (1,2).
This study aimed to assess the right and LV
Studies revealed that when compared to healthy
functions in patients with DM1 using speckle tracking
persons, DM1 is linked to a 10-fold increased risk for
imaging study.
cardiovascular disease (3).

The term "diabetic cardiomyopathy" (DCM) was
originally used in 1972 by Rubler et al. to characterize
The present prospective, case-controlled study
a non-ischemic form of cardiac dysfunction that results
was conducted in the Cardiology Department, Menoufia
in heart failure. The diagnostic standards for DCM are
Faculty of Medicine, from May 2021 to December
not yet defined. In the absence of CAD, arterial
2022. 90 subjects were selected, divided into two
hypertension, valvular heart disease, or other
groups. 60 patients with type I diabetes mellitus served
myocardial dysfunction-causing conditions, it is
as cases and 30 healthy subjects age matched served as
characterised by the existence of diastolic or systolic
malfunction of the heart (4).
To evaluate the structure and function of the heart,
echocardiograms were both normal, and the recording
of routine echocardiographic and speckle tracking
frequently applied. However, in some circumstances,
measures was possible due to the satisfactory picture
routine assessments may be less sensitive for the
quality of the echocardiograms. But patients who had
diagnosis of moderate and subclinical heart
LV ejection fraction < 55% or any regional wall motion
abnormality, ischemic heart disease, arrhythmia,
echocardiogram appears to be solved by 2D-STE,
valvular, pericardial, congenital heart diseases,
which has proven to be an accurate and reliable method
endocrinal or other system diseases were excluded from
for the detection of mild myocardial dysfunction before
the study.
changes in traditional function measures (5).

The currently established approach for assessing
Both groups underwent:
myocardial function is 2D-STE, which has shown to
A complete history was obtained from the patient,
offer insightful knowledge about the workings of the
with specific focus placed on a history of diabetes
heart. With STE, it is possible to examine myocardial
longitudinal, circumferential, and radial deformation,
arrhythmia, heart failure, valvular heart diseases,
Received: 10/04/2023
Accepted: 07/06/2023

Full Paper (vol.931 paper# 50)

c:\work\Jor\vol931_51 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7233- 7239

Suture-Button versus Syndesmotic Screw in the Treatment of
Distal Tibiofibular Syndesmosis Injury
Khalid Mohamed Hussein*, El-Sayed Abdel-Moaty El-Sherbiny,
Yousef Mohamed Khira, Mohamed Mansour El-Zohairy
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Khalid M. Hussein, Mobile: (+20) 01091122456, E-mail: khalidiab_88@gmail.com

Distal tibiofibular syndesmosis injury is either isolated injury or accompanied with ankle fractures.
Isolated syndesmosis injury occurs in up to 11% of ankle sprains.
Objective: The aim of the current study was to use a custom-made suture button (SB) compared to 4.5 mm syndesmotic
screws (SS).
Patients and methods: This prospective study was carried out in Orthopedic Surgery Department, Zagazig University
Hospital. Forty patients with tibiofibular syndesmotic injury were equally divided to the SB group or the SS group. We
used a custom-made suture button consists of two buttons connected by a fiber wire.
Results: Age and BMI did not significantly differ across groups. Male gender predominated in both groups. There was
no significant difference between groups regarding AOFAS immediately postoperatively, but SB group was
significantly higher than SS group at 6 weeks and 6 months. There was no significant difference between groups
regarding VAS immediately postoperatively, but SB group was significantly lower than SS group at 6 weeks and 6
months. Conclusion: In comparison to the SS approach, the SB technique yields better functional outcomes and reduced
incidence of fractured implants and joint mal-reduction. Therefore, at present moment, the SB approach is advised for
the treatment of syndesmosis injuries.
Keywords: Tibiofibular Syndesmosis Injury, Suture button, Syndesmotic screws.


Inclusion criteria: Patients between the ages of 18 and
A total of 10% to 13% of all ankle fractures result
70 who have an ankle fracture of type 44-C.
in a distal tibiofibular syndesmosis damage (1,2). The
OTA/AO with an acute traumatic damage to the
syndesmosis preserves the tibiofibular connection,
stabilizing the ankle mortise. For many years, the
Exclusion criteria: Multiple injuries, late diagnosis,
syndesmotic screws (SS) has been the preferred way of
open fracture, polytrauma, incapacity to provide
stabilizing syndesmotic injuries (3,4). The objective of an
permission, symptomatic ankle osteoarthritis, lower
early recovery to full range of motion (ROM) and
extremity neurologic impairment, and recent or past
weight-bearing may be hampered by the use of a stiff
injuries to the lower extremities that might hinder
screw to reconstruct the dynamic function of the
rehabilitation were exclusion factors.
syndesmotic ligaments (5,6).
The dynamic suture button (SB), which was first
Operative Assessment:
presented ten years ago, has been recommended as a
Every patient's individual file and secret passcode
way to treat syndesmotic injuries (7-9).
kept all information private. All provided information is
In order to evaluate the clinical and radiological
solely utilized in the present study. The investigation
outcomes following the stabilization of a damaged
was conducted in accordance with the fundamentals of
syndesmosis with SB with those with the use of one or
ethical clinical practice. The used methods of the study
two 4.5-mm quad cortical SS, this study compared the
including methods of diagnosis and preoperative
two approaches. The AOFAS scores of the patients
evaluation, methods of treatment and post-operative
receiving SB treatment will be higher, and their VAS
follow up and methods of post-operative evaluation.
scores for pain while walking and resting will be lower
All studied patients were subjected to complete
history taking. Personal data included age, sex,
The aim of the current study was to use a custom
occupation and special habits, tighter with date and time
made SB compared to 4.5 mm SS.
of trauma, and the risk factors for chronic disease. A

thorough clinical examination was conducted, and
clinical outcomes were assessed using the AOFAS
This prospective study was carried out in
ankle-hind foot scale, VAS, and VAS scores for pain
Orthopedic Surgery Department, Zagazig University
during walking and daily activities. The AOFAS ankle-
Hospital. Forty patients with tibiofibular syndesmotic
hind foot scale is divided into three parts that describe
injury were randomized to the SB group (n= 20) or the
pain, function, and alignment and incorporates both
SS group (n= 20).
subjective and objective factors into a numerical scale

of 0 to 100 points, with 100 being the best result.

Received: 11/04/2023
Accepted: 08/06/2023

Full Paper (vol.931 paper# 51)

c:\work\Jor\vol931_52 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7240- 7247

Inpatient Length of Stay in Femur Fracture Patients in
Emergency Hospital, Mansoura University
Mohammed Ramadan Foudah*1, Mohamed Elsaid Ahmed1, Akram Amin Hammad2, Samir Mohammed Attia3
Departments of 1Emergency Medicine and Traumatology,
2Orthopedic Surgery and 3Vascular Surgery3, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Mohammed Ramadan Foudah, Mobile: (+20) 01098733403, Email: meshfaraah47@gmail.com


Background: One of the most urgent problems facing society nowadays is the rising cost of healthcare. Analysis of
hospitalization periods following femoral fractures is an excellent model to properly evaluate hospital economic
efficiency in their care of trauma cases.
Objective: To ascertain the typical hospital stay following femoral fractures admitted to the emergency department
(ED) of Mansoura University Hospital.
Patients and Methods: This was a prospective observational cross-sectional study that was done at Mansoura
Emergency Hospital. The study included 281 cases older than 18 years with femur fractures. Modified Frailty Index
(MFI) was used for prediction of the occurrence of adverse events after different orthopaedic operations.
Results: The included patients were split into two groups: Group I included 126 patients with hospitalization period
7 days, and group II had 155 patients with longer periods. Patients in group II were significantly older than group I. The
type of trauma had a significant impact on hospitalization period, as penetrating injuries were more common in group
II. Patients in group II had significantly longer time intervals between the fracture and surgery. The need for mechanical
ventilation increased significantly in group II. The presence of injuries was associated with longer hospitalization
Conclusion: We concluded that the average hospitalization period after femur fractures was 10.4 days. Factors that
increased the risk of longer hospitalization (more than one week) included older age, long time interval between injury
and fixation, low GCS, high MFI, associated injuries, penetrating injuries, and need for mechanical ventilation.
Keywords: Femur fracture, Length of stay, Modified Frailty Index.


One of the main load-bearing bones in the lower
should be reduced if signs of neurovascular compromise
limb, the femur is the longest, strongest, and heaviest
are seen [6].
tubular bone in the humans. Adults who sustain femur
Femur fracture complications are generally rare.
fractures may experience life-threatening complications
The most frequent side effects are pain, abnormal
and injuries, such as blood loss, organ damage, wound
fracture healing, and infection. Haemorrhage, NVI,
infections, fat embolisms, and adult respiratory distress
compartment syndrome, repeated fractures, and
syndrome (ARDS) [1].
hardware failure are less frequent complications.
About 100 per 100,000 people experience a femur
Patients with multiple trauma are more likely to
fracture each year [2]. After age of 20 years, the
experience rare but life-threatening complications, such
incidence starts to decline and then increases in the
as death, multiorgan failure, and respiratory issues,
elderly. In those over 75 years, there is a significant
which are typically brought on by ARDS and
increase. Most femur fractures happen in the proximal
pulmonary or fat embolisms [7].
third of the bone [3]. High energy trauma is the most
One of the most urgent problems facing society
frequent etiology of femur fractures in younger adults,
today is the rising cost of healthcare. In particular, many
however low energy traumas are an increasingly
inner-city hospitals are having a difficult time making
significant etiology in older adults [4].
ends meet while trying to treat patients who are
When a femur fracture is suspected, an
uninsured and indigent [8].
anteroposterior (AP) and lateral x-ray of the thigh have
Analysis of the hospitalization period following
to be taken. To rule out any associated injuries, the hip
femoral fractures is an excellent model to evaluate
and knee should also be imaged. If ignored, a fracture
hospital economic efficiency in their care of trauma
neck of the femur that could happen in conjunction with
cases due to the high prevalence of femoral fractures in
a mid-shaft femoral fracture could be associated with
the trauma population [9].
considerable morbimortality [5]. Although there is a
The current study's objective is to ascertain the
paucity of research to back this course of treatment,
typical hospital stay following femoral fractures
many orthopedic surgeons recommend using a skin
admitted to the emergency department (ED) of
traction device to immobilize well-aligned fractures,
Mansoura University Hospital. The length of stay was
whether or not they have neurovascular injury (NVI).
also examined, and any interventions that could hasten
Antibiotics and tetanus prophylaxis are given to cases
hospital discharge and lower both patient and hospital
with open fractures, and all cases have to receive the
costs were examined.
proper analgesia. After giving analgesia, the limb

Received: 13/04/2023
Accepted: 12/06/2023

Full Paper (vol.931 paper# 52)

c:\work\Jor\vol931_53 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7248- 7252

Neutrophil to Lymphocyte Ratio, Cardiac Troponin and D-dimer as
Predictors of Outcome in Patients with Cerebral Venous Thrombosis
Amr Kamel, Hadeer S. Esaa*, A. E. Badawy, Nesma A. M. Ghonimi
Neurology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hadeer Shabaan Abdel-Ati, Mobile: (+20) 01032346796, E-mail: hadsha_47@gmail.com

: Cerebral venous thrombosis (CVT) is a neurovascular disorder with a highly variable presentation and
clinical course. Objective: This study aimed to explore the role of neutrophil to lymphocyte ratio (NLR), cardiac
troponin and D-dimer as predictors of short term outcome in patients with cerebral venous sinus thrombosis.
Patients and methods: Thirty patients diagnosed with CVT were included. They were classified into favorable and
unfavorable outcome groups based on one-month modified Rankin scale scores (mRS) (0-2: good prognosis, 3-6: poor
prognosis). Clinical findings and laboratory markers (NLR, cardiac troponin and d dimer) were compared between the
two groups. The correlation between each marker and mRS was assessed.
Results: This study included 30 patients with diagnosis of CVT, 7 (23.3%) were males and 23 (76.7%) were females
with mean age 31.63 (SD 11.29) years. Headache was the most common symptom (93.3%) followed by blurring of
vision (86.6 %). Left transverse sinus was the most frequent site of sinus thrombosis in 66.66% of patients. A total of
20 (66.7%) patients had favorable outcome and 10 (33.3%) had unfavorable outcome. NLR and D-dimer values were
significant predictors of poor outcome in patients with CVT while cardiac troponin (cTn) was found to be non-
Conclusion: On admission, D-dimer and NLR are separate predictors of short-term functional prognosis in CVT
Keywords: CVT, NLR, D-dimer, Cardiac troponin.


screening tool for deciding how quickly neuroimaging
CVT is a rare type of stroke, accounting for
should be obtained. It might help to foretell the
0.5%­1% of all strokes (1). The pathophysiology of
development of acute or
CVT remains unclear. It is believed that CVT can lead

to both vasogenic and cytotoxic edema due to
subacute CVT (8). However, there is still debate over
increased venous pressure. The blood-brain barrier
whether D-dimer can help to predict outcome and how
may be broken, leading to vasogenic edema, or it may
CVT patients would be managed.
restrict cerebral blood flow, impair cellular
A protein unique to the heart is called cardiac
metabolism, and lead to cytotoxic edema. ICP and
troponin (cTn). It can indicate a bad prognosis since it
parenchymal hemorrhage can result from an increase
is increased in acute ischemic stroke and cerebral
in venous pressure (2).
haemorrhage. Venous stasis brought on by CVT may
There are many CVT risk factors include
cause cardiac stress and increased cTn. Patients with
thrombophilia, infections, inflammation, pregnancy,
arterial ischemic stroke who had elevated plasma cTn
puerperium and usage of oral contraceptives. Women
levels died more frequently, while their role in CVT
are more likely than males to develop CVT (3). Despite
still needs to be elucidated (9).
the wide range of clinical manifestations, CVT
The objective of this study was to investigate
frequently results in one or more of the following four
the function of cardiac troponin, neutrophil to
syndromes: the increased ICP syndrome (headache,
lymphocyte ratio (NLR), and D-dimer as short-term
papilledema, visual disturbance), the focal neurologic
outcome predictors in patients with cerebral venous
syndrome (focal deficits, seizures, or both),
sinus thrombosis.
encephalopathy (impaired cognition, stupor, or coma,

with or without focused signs or symptoms), and the
cavernous sinus syndrome (4).
This study was a prospective cohort study
Inflammation increases the risk of CVT and
conducted in in Neurology Department, Zagazig
causes secondary brain damage (1). Many studies
University Hospitals. All patients diagnosed with CVT
examining the connection between CVT and
during the period from May 2022 to October 2022
inflammation have found increased initial NLR and
were identified.
CRP baseline levels. The severity of the disease, poor

prognosis, and higher inflammatory markers at
Inclusion criteria were age >18 years and patients
admission were all linked in some of these studies (5-7).
with confirmed diagnosis of CVT by MRV or CT
Factor XIIIa acts on the monomers and
polymers of fibrin and produce D-dimer units. In

people who arrive with clinical symptoms that are
Exclusion criteria were patients with: arterial stroke,
thought to be CVT, the D-dimer is an essential
additional causes of optic disc edema, such as ischemic
Received: 05/01/2023
Accepted: 06/03/2023

Full Paper (vol.931 paper# 53)

c:\work\Jor\vol931_54 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7253- 7256

Study of Adding Pheniramine to Midazolam on Sedation during
Colonoscopy in Tanta University Hospital: A Comparative Study
Asmaa Mohammed El-Naggar*, Mohamed El-Sayed Elhendawy, Loai Osama Mansour, Asem Ahmed ElFert
Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
*Corresponding Author: Asmaa Mohammed El-Naggar, Mobile: (+20) 0111 690 8236, Email: sossow68@gmail.com

The whole big bowel may be seen inspected during a colonoscopy. The gold standard for the early
identification of polyps and colorectal cancer, it is safe and reliable. The most often used drugs for moderate sedation
are midazolam and fentanyl, which are benzodiazepines or mixtures of benzodiazepines and opioids.
Objective: The aim of the current study was to assess the safety and viability of midazolam with that of
midazolam/pheniramine in sedation of patients undergoing colonoscopy.
Patients and methods:
This clinical trial was carried out on 90 patients indicated for colonoscopy. Patients were
randomized into 2 equal groups: Group A was sedated using midazolam (Dormicum) 5mg given slowly intravenously
over one minute, and Group B was sedated using phinarimine 25mg (Avil) ampule given slowly intravenously 5 minutes
before the procedure, then midazolam 5mg given slowly intravenously over one minute.
There was a significant delay in time for initiation of sedation, and procedure time in Group A. But there was
a significant delay in the post-procedure time and recovery time in Group B. There was a significant increase in
satisfaction scale, endoscopist's satisfaction in patients of Group B.
Use of intravenous pheniramine maleate given before initiation of midazolam is superior to using
midazolam alone in the decrease of preprocedural's anxiety, quality improvement for moderate sedation during
colonoscopy, high satisfaction score for the patients, high tolerance to the procedure and higher endoscopes' satisfaction
during the procedure.
Keywords: Pheniramine, Midazolam, Sedation, Colonoscopy.


The whole big bowel may be seen inspected during
combination; in these cases, the addition of
a colonoscopy. The gold standard for the early
identification of polyps and colorectal cancer, it is safe
recommendations since it "may allow adequate and safe
and effective. It is also advised for a number of reasons
sedation to be achieved". Furthermore, a number of
studies have demonstrated that administering
Indications of colonoscopy: 1) Colorectal cancer
intravenous diphenhydramine hydrochloride prior to
screening, assessment, and follow-up, screening in
the administration of midazolam significantly improves
individuals with average risk, assessment, and removal
the level of mild sedation experienced during
of polyps, present or prior bowel resection for colon
colonoscopy procedures while reducing sedative-
cancer, and family history of cancer. 2) Management of
related problems [5].
ulcerative colitis or Crohn's disease, follow-up
Therefore, we aimed in this study to assess the
treatment for individuals with these conditions, and
safety and viability of midazolam alone that is usually
management of patients with these conditions. 3)
Locating the location of bleeding, identifying acute
midazolam/pheniramine combination for conscious
bleeding sites, and treating them with endoscopic
sedation of patients undergoing colonoscopy.
therapy that includes epinephrine injection, electro-

cauterization, argon plasma coagulation (APC), band
therapy, and/or clips. 4) Colon decompression. In cases
This clinical trial was carried out on 90 patients
of sigmoid volvulus and for the treatment of individuals
indicated for colonoscopy, at the Tropical Medicine
with Ogilvie syndrome, colonoscopy/sigmoidoscopy
Department, Tanta University Hospital from October
can be utilised to decompress the colon [1].
2020 to September 2021.
As it is a painful invasive procedure, the use of
Patients having allergies to study medicines,
sedation is necessary [2].
neuropsychiatric disorders, advanced cardiac or
Sedation is intended to reduce discomfort and
respiratory conditions, alcohol or drug addiction, and
anxiety in the patient and to induce amnesia, which
severe bleeding were excluded from the study.
creates the ideal conditions for a thorough examination
Patients were randomized into 2 equal groups:
of the patient and the endoscopist [3]. A benzodiazepine
Group A was sedated using midazolam (Dormicum)
or a benzodiazepine and opioid combination is often
5mg given slowly intravenously over one minute, and
used to induce moderate sedation, with midazolam and
Group B was sedated using phinarimine 25mg (Avil)
fentanyl being the most frequently used drugs [4].
ampule given slowly intravenously 5 minutes before the
However, some patients cannot get enough
procedure, then midazolam 5mg given slowly
sedation with the typical benzodiazepine and opioid
intravenously over one minute.
Received: 11/04/2023
Accepted: 08/06/2023

Full Paper (vol.931 paper# 54)

c:\work\Jor\vol931_55 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7257- 7262

Evaluation of Ergonomics in Laparoscopic Appendectomy Technique
Mohamed S. Kharoub1, Emad M. Abdelrahman1, Ehab M. Oraby1,
Yasser H. Metwally and Mohamed O. El-Shaer1
1General Surgery Department, Faculty of Medicine, Benha University, Egypt
2General Surgery Department, Al-Azhar University Hospitals, Egypt
Corresponding Author: Emad M. Abdelrahman Email: emadshan301@gmail.com
Tel: O1226763986, ORCID https://www.orcid.org/0000-0001-6066-2215


Background: Ergonomics in laparoscopy involve some terms as manipulation angle, Azimuth angle, elevation angle, and
eye target axis. These parameters are determined after distribution of ports in relation to target organ. Laparoscopic
appendectomy doesn't have a standard approach. Many variations are available in port placement and mostly dependent on
surgeon's preference. Different port distribution will result in different ergonomics that will positively or negatively affect
the task performance.
Objective: The aim of this study was to evaluate the ergonomics in laparoscopic appendectomy technique in terms of
working angle, elevation angle, Azimuth angle and eye- hand- target axis.
Patients and Methods: This retrospective study included 55 consecutive patients presented with acute appendicitis who
were eligible for laparoscopic appendectomy. Azimuth angle and elevation angles were measured intraoperatively, while
images captured from video records of each operation were used to measure manipulation angles. Surgical team discomfort
or complaint also had been reported.
Results: In this described technique, manipulation angle was 61 ± 8.3°, elevation angles were 38.9 ± 7° and 34 ± 7°, Azimuth
angles were 21.3 ± 5.4° and 63.1 ± 7.3° for right and left surgeon's hand respectively. Operative time was 33.5 ± 9.7 minutes.
Smooth performance was achieved in 94.5%.
Conclusion: Surgeons' orientation of ergonomic rules is a must to accomplish a smooth laparoscopic task performance.
This proposed technique of laparoscopic appendectomy offers a good ergonomics and excellent cosmetic results.
Keywords: Laparoscopic appendectomy, Ergonomics, Manipulation angle, Azimuth angle.


Acute Appendicitis (AA) is the commonest
Manipulation angle is defined as the angle created
emergency in abdominal surgery. Laparoscopic
between the two working ports in a horizontal plain.
appendectomy (LA) is a feasible and safe procedure with
Ideally to be 60° (45-75°). Extremes of this angle below
worldwide acceptance [1]. Laparoscopic appendectomy
30 or above 90 degrees will have a profound drawback on
offers short hospital stay, less wound complications, less
task performance [11].
morbidity, and better cosmetic results [2, 3].
Azimuth angle is defined as the angle between the
Tactile sensation, and binocular vision are missed
telescope and each single working port in a horizontal
items in laparoscopic surgery. The fixed portal of entry
plain. Ideal situation is to put the telescope in a central
restricts surgeon's freedom that often be compensated
position between the two working ports (contralateral port
with musculoskeletal burden [4, 5]. Therefore, optimal
position) to create an equal Azimuth angle for each port
laparoscopic performance is more likely to be achieved
(30°). This ideal arrangement is not usually available as
when a surgeon achieves appropriate triangulation of the
in appendectomy operations in which case the ipsilateral
instrument and camera ports [6].
port position is more suitable [12, 13].
The "ergonomics" is defined as "the concept of
Elevation angle is defined as the angle between each
arranging working environment to fit the worker, instead
single working port and the target tissues in a vertical
of pushing the worker to fit the environment" [7].
plain. In general words, the elevation angle should be
Ergonomics target the human benefits, improve
equal to the manipulation angle i.e., in cases with
workplace efficiency, reduce cost, decrease waste of
manipulation angle is 60 °, the elevation angle should be
materials, and increase work team satisfaction [8].
60° [11, 14].
The port locations in minimally invasive surgery that
Laparoscopic appendectomy doesn't have a standard
can affect the surgical performance, surgical outcomes
approach. Many variations are available in port placement
and affect the surgeon's working positions [9, 10].
and mostly dependent on surgeon's preference. Different
Ergonomics in laparoscopy involve some terms as
port distribution will result in different ergonomics that
manipulation angle, Azimuth angle, elevation angle, and
will affect the task performance either positively or
eye target axis. These parameters are determined after
negatively [9, 15, 16]. And this had motivated the authors to
distribution of ports in relation to target organ.
conduct this study.
Received: 11/05/2023
Accepted: 08/07/2023

Full Paper (vol.931 paper# 55)

c:\work\Jor\vol931_56 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7263- 7267

Role of 18 Fluorine-Fluorodeoxyglucose Positron Emission
Tomography/Computed Tomography Imaging in Assessment of
Neoadjuvant Chemotherapy Response in Breast Cancer Patients
Mohamed Khaled Mohamed Shawky1, Mohamed Refaat Haba2, Tarek Hamed Elkammash2, Walid Mosallam2
1 Radiodiagnosis Department, Faculty of medicine, Zagazig University, Egypt.
2 Radiodiagnosis Department, Faculty of Medicine, Suez Canal University, Egypt.
Corresponding author: Mohamed Khaled Mohamed Shawky, Email: aigmanutd7@gmail.com, Mobile: 01000089680

In cancer, positron emission tomography (PET) using 18 fluorine (18f) fluorodeoxyglucose (FDG) plays
an essential role. Its function in breast cancer management is evolving. In most nuclear medicine departments, combined
PET and computed tomography (CT) equipment have superseded PET alone in recent years.
Aim: To assess the added value of PET/CT scan in evaluation of pathological response to neoadjuvant chemotherapy
in locally advanced or metastatic breast cancer patients before surgery.
Subjects and methods: This study was conducted on forty-four female patients with evidence of proven breast cancer
who were referred to PET/CT Unit at Department of Nuclear Medicine in International Medical Center. All clinical and
histopathological data were extracted from the patients' clinical sheet. This included the pathological data and the current
indication for FDG-PET/CT referral. All patients had a pretreatment PET/CT examination and post chemotherapy
PET/CT follow up examination. Results: 27 patients (61.3%) showed response after non-adjuvant chemotherapy by
pathology. Regarding SUV max, 31 patients (70.4%) showed response (where 6.8% of them revealed complete response
and 63.6% revealed partial response). PET CT SUV max revealed that 31 patients as responders and 13 patients as non-
responders. Among 31 responders, 27 were TP, 4 were FP. Among 13 non-responders, 13 were TN. The sensitivity,
specificity and accuracy were 100%, 76.5% and 90.9% respectively.
Conclusion: PET/CT is a reliable whole body single imaging which can be used in monitoring and evaluation of NAC
response in breast cancer patients showing response, high sensitivity, and accuracy compared to CT alone.
Keywords: PET/CT, Fluorine, Fluorodeoxyglucose, Chemotherapy, Breast.


The primary cause of cancer-related mortality
Finally, the results were compared to the
in women is breast cancer and the most prevalent cancer
histopathological results.
that is extremely dangerous to life. In Western Europe
Ethical approval: Written informed consent was
and the US, the 40­55 age range has the highest
obtained from all patients. The protocol of the study
incidence, and this group is becoming more common. It
was approved by The Ethical Committee of
is the second most frequent cause of cancer-related
Radiology Department, Faculty of Medicine, Suez
mortality among females in the US and the UK,
Canal University (Number RPNC-6). The Helsinki
accounting for 40,000 and 14,000 fatalities, respectively
Declaration was followed throughout the study's
(1-3). This study aimed to assess the added value of PET
CT scan in evaluation of pathological response to
neoadjuvant chemotherapy in locally advanced or
Statistics analysis: The Shapiro test was used to define
metastatic breast cancer patients before surgery.
the normality of the distribution of the data. Data were
analyzed using IBM Statistical Package for Social
Sciences software (SPSS), 21st edition, IBM, United
This is a prospective study in which forty-four
States. The predictive values were calculated by
female patients with evidence of proven breast cancer
obtaining positive predictive values (PPV), negative
were referred to PET/CT unit at Department of Nuclear
predictive values (NPV), sensitivity, specificity and
Medicine in International Medical Center during the
total accuracy of PET/CT. Continuous data were
period from March 2020 to October 2022. Patients with
expressed as mean ± standard deviation and categorical
age between 30 and 70 years old showed different
data as percentage. The t-test was used to compare
locally breast and metastatic breast lesions.
between two groups' quantitative data normally
Exclusion criteria: Patients having tumors with
distributed expressed as mean and standard deviation.
inflammatory changes, concomitant malignancy, renal
For comparisons in between more than 2 groups,
insufficiency or who were pregnant were excluded.
analysis of variance (ANOVA) was used. Chi-squared
All clinical and histopathological data were extracted
or Fisher's Exact tests were used to compare between
from the patients' clinical sheet in agreement with the
the qualitative data expressed as number and
referring physicians. This included the pathological data
and the current indication for FDG-PET/CT referral. All
(Spearman and Pearson) was used to identify relations
patients had a pretreatment PET CT examination and
between data. Any other kind of test was performed
post-chemotherapy PET CT follow up examination.
Received: 11/04/2023
Accepted: 08/06/2023

Full Paper (vol.931 paper# 56)

c:\work\Jor\vol931_57 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7268- 7274

Relationship between Proneurotensin Level and
Cardiovascular Disease among Type 2 Diabetic patients
Nermin Saad Ghanem 1, Abdelmonem Zeid1, Atef Gouda Hussien2,
Hagar Ahmed El-Said*1, Khalid Ahmed Elbanna1
Departments of 1Internal Medicine and 2Biochemistry, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hagar Ahmed El-Said, Mobile: (+20) 01281593099, E-mail: hagoor_2012@gmail.com
Patients who had cardiovascular disease (CVD) events in the past have fewer traditional risk factors to
help them identify their risk. In this regard, measuring circulating biomarkers has been investigated as a potential method
for determining event risk. Objective: To measure of viability of proneurotensin (pro-NT) as a good prediction for CVD
among diabetic patients. Patients and methods: In the Internal Medicine Department's Outpatient Clinic and
Endocrinology Unit at Zagazig University Hospitals, 84 type 2 diabetes mellitus cases were the subject of this case
control research. They were equally subdivided into diabetic patients without coronary artery disease (CAD) and
diabetic patients with established CAD. Results: Regarding the number of WBCs, there was a highly statistically
significant difference between the examined groups. It was shown that diabetic patients with coronary artery disease
had considerably higher cholesterol and LDL levels. In terms of proneurotensin, there was a statistically significant
difference between the study groups. Pro-NT and cholesterol showed a strong positive link in patients with coronary
artery disease, but HDL showed a substantial negative correlation in people without coronary artery disease. Pro-NT
levels greater than or equal to 119.1 can be utilised to forecast when the condition will arise.
Conclusion: To our knowledge, our work is the first to show a relationship between pro-NT levels and insulin resistance
and their ability to predict the occurrence of CVD.
Keywords: Proneurotensin, Type 2 Diabetes, CVD.

translates to a high CV risk profile. Pro-NT is a brand-
In developed nations, coronary artery disease
new CV risk factor prediction marker for adults with
(CAD) is the leading cause of mortality. According to
T1D. Additionally, a high concentration of the peptide
the American Heart Association's 2018 Heart Disease
pro-NT is linked to an increased risk of mortality, CVD,
and Stroke Statistics, 16.5 million persons over the age
and diabetes in women. But not necessary in men, a new
of 20 are thought to have CAD (1). There are many
study suggest this peptide could become a new target for
biological functions that affect the body, including those
drug therapy as well as new marker for risk prediction
that have an impact on the cardiovascular system, such
(6). Therefore, this study aimed to measure of viability
as controlling heart rate, myocardial contractility, and
of proneurotensin as a good prediction for CVD among
vascular tone. Originally derived from intestinal tissue
diabetic patients. Also, to identify the relationship
and then from the bovine hypothalamus, neurotensin
between development of CVD, type 2 DM and level of
(NT) is a 13 a-a peptide. Neurotensin's effects are
predominantly communicated through three receptors:

the G-protein-coupled NTS3 and NT2 receptors, the
non-G-protein coupled NTS3 receptor, and the satilin
In the Internal Medicine Department's Outpatient
receptor 1 (SORT1), which is crucial for the hepatic
Clinic and Endocrinology Unit at Zagazig University
production of VLDL. Coronary artery disease
Hospitals, from January to August, 2022, 84 type 2
development is associated with genetic diversity in the
diabetes mellitus cases were the subject of this case
1p13 region, which contains the SORT1 gene (2).
control research. It was conducted on total number of
The key function of NT, a hormone and
126 subjects with 54.59 mean age ±SD (80 female and
neurotransmitter, in controlling intestinal fatty acid
46 male). There were further classified into:
absorption, body fat buildup, and subsequently raising
1- Control group: composed of 42 healthy individuals
the risk of T2DM and CVD, has been shown in strong
with mean age of 51.8 ±7.4 from 40 to 68 years old;
epidemiological studies (3).
22 female and 20 male
Neurotensin is difficult to measure in blood due
2- Diabetic group: included 84 patients who were
to its unpredictability and quick removal from the
subdivided according to presence or absence of
circulation. The content of proneurotensin was
cardiovascular disease into:
independently predictive for diabetes mellitus and
a- Diabetic with CVD (n 42): mean age 55.3±6.9 from;
CVD, especially in women, hence immunoassays were
28 female and 14 male.
devised to detect the pro-peptide fragment of the peptide
b- Diabetic without CVD (n 42): mean age 54.2±5.4;
released in equivalent levels to native neurotensin (4).
30 female and 12 male.
In a study of Cimini et al. (5) they reported that
Inclusion criteria:
higher pro-NT level in a T1D patient indicates the onset
Patients with type 2 diabetes, both sexes, aged 18 to 65.
of a poor metabolic profile, which, after ten years,
Received: 05/01/2023
Accepted: 06/03/2023

Full Paper (vol.931 paper# 57)

c:\work\Jor\vol931_58 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7275- 7278

Effect of Acitretin on Penile Erection in Psoriatic Male Patients
Aya Abdelghaffar Abdelaziz*, Sara Hamdy Fouad, Samir Mohammad Elhanbly
Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Aya Abdelghaffar Abdelaziz, Mobile: (+20) 01008317310, Email: aya1abdelghaffar@gmail.com


Background: Psoriasis vulgaris (PV), a systemic immune-mediated disease, comprises chronic inflammation stimulated
by psychiatric, genetic, and environmental factors. Acitretin is a systemic retinoid that has been approved for the
treatment of PV. There have been some case reports indicating that retinoids may cause sexual dysfunction.
Objective: To assess the effect of acitretin therapy on penile erection in psoriatic male cases.
Patients and Methods: This study comprised a total number of 31 male patients with psoriasis who were treated with
acitretin for at least 2 months. All cases were asked to complete International Index of Erectile Function (IIEF-5)
questionnaire before and 2 months from treatment with acitretin. Lesions were scored based on psoriasis area and
severity index (PASI) score and Physician Global Assessment (PGA). The dosage of acitretin was 0.5 mg/kg/day, in
form of capsules, route of administration was oral for duration of 2 months.
Results: When IIEF grades were compared before and after two months of therapy, it was observed that the number of
patients with second, third and fourth grades was significantly higher after therapy, while the number of patients with
the first grade was significantly lower after therapy. Erectile dysfunction was detected in 11 patients before treatment,
all of them were grade 2 and in 27 patients after two months of therapy.
Conclusion: Acitretin is associated with a great risk of erectile dysfunction when administrated in treatment of psoriatic
male patients and had showed a significant drop in IIEF scores after two months follow up.
Keywords: International Index of Erectile Function, Acitretin, Penile Erection, Psoriatic Male, Psoriasis Area and
Severity Index.

this side effect should be considered before starting
Psoriasis vulgaris (PV) is a chronic dermatosis of
treatment [7].
unknown etiology with relapsing course. Its worldwide
Aim of the work was to evaluate the effect of acitretin
prevalence is 2% [1]. PV has been recorded to be
treatment on penile erection in psoriatic male cases.
stimulated by several environmental factors [2].

Approximately 85% of patients present with plaque
psoriasis. Other types of PV involve guttate,
This prospective comparative study was conducted
erythrodermic, inverse and pustular psoriasis [3].
in Dermatology and Andrology outpatient clinic of
It is known that there is no a complete cure for PV,
Mansoura University Hospitals (from February 2021 to
on the other hand there are different therapeutic
February 2022) and included thirty-one male psoriatic
modalities that could treat the manifestations including
patients aged from 20 to 55 years in whom acitretin was
topical agents for mild cases, phototherapy for moderate
indicated and included patient took acitretin at least for
cases and systemic drugs for severe cases [4]. Most of
60 days with regular sexual relationship. But we
treatment options have significant side effects, however
excluded patients with psychiatric disorders, diabetes,
hypertension, systemic disorders, penile disorders,
immunosuppressive drugs with relatively less side
hyperlipidemia, history of using other systemic drug for
effects [5].
psoriasis as methotrexate and history of substance
Acitretin is a synthetic retinoid, which is a
pharmacological active metabolite of etretinate. Now

acitretin has been approved by Food and Drug
Administration (FDA) as a promising therapeutic
All cases were subjected to full history taking that
modality in the context of severe PV and also can be
included personal history (name, age, sex, occupation,
used in treatment of generalized pustular psoriasis and
residence), present history (onset, course, duration of
exfoliating erythrodermic psoriasis. Acitretin side
PV, predisposing factors), history of medications
effects including teratogenicity, hyperlipidemia,
(nature, route of administration, dosage, duration,
pruritus and dryness of mucous membranes and erectile
effects and adverse events), family history of PV and
dysfunction have been reported [6].
past history of any medical and surgical conditions as
Erectile dysfunction is defined by difficulty getting
well as any dermal disorder.
and keeping an erection enough to have sexual
Complete general examination was done to rule out
intercourse. It may be due to organic cause,
any systemic disorders and we assessed triglycerides
psychogenic cause or drug use. Recently, acitretin effect
level (TG) and cholesterol level. Full dermatological
on penile erection became an important topic to be
examination was done including skin, hair, nails and
studied as acitretin may cause erectile dysfunction and
mucous membranes to evaluate the type of PV,
distribution and severity and to rule out autoimmune
Received: 13/04/2023
Accepted: 12/06/2023

Full Paper (vol.931 paper# 58)

c:\work\Jor\vol931_59 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7279- 7285

Serum and Ascitic D-Dimer in Cirrhotic Patients with
Spontaneous Bacterial Peritonitis in Minia University Hospital
Eman Hussein Khalil, Fatma Mokhtar Shaaban
Department of Internal Medicine, Faculty of Medicine, Minia University, Egypt
*Corresponding author: Eman Hussein Khalil, Mobile: (+20) 01142741126, E-mail: anjaz3036@gmail.com

The D-dimer (DD) test can detect fibrinolysis with good specificity. Its irregularity is a result of the
coagulation and fibrinolysis systems being overactive in vivo. Since disrupted hemostasis is linked to chronic liver
illness, it's probable that clot lysis as well as coagulation problems are also present. Estimating DD might shed light on
potential disruptions in the fibrinolytic process.
Objective: We aimed to determine the connection between ascites and the hyper fibrinolytic condition in hepatic
cirrhosis. We evaluated serum DD in cirrhotic cases with and without ascites. We also examined how spontaneous
bacterial peritonitis (SBP) affected the DD content in serum and ascitic fluid (AF).
Patients and methods:
This prospective study was conducted on 60 patients from the Department of Internal Medicine
in Minia University Hospital including patients hospitalized due to decompensated liver cirrhosis and ascites. First group
included fifteen cases with hepatic cirrhosis and no ascites. Second group included fifteen cirrhotic cases with ascites.
Third group included fifteen cirrhotic cases with ascites and SBP. Fourth group (Control group) included fifteen matched
healthy individuals with no evidence of hepatic disorder.
There was a diagnostic performance of serum DD in diagnosing of SBP in cutoff point of serum d dimer >
491.5 ng/ml, and ascitic DD in a cutoff point of ascitic d dimer > 380.5 ng/ml predicting cirrhotic ascitic cases with SBP.
Patients with SBP showed a substantial link between serum DD and AF DD, while patients with cirrhotic
ascites without bacterial infection demonstrated no significant correlation. When used to diagnose SBP in cases with
hepatic cirrhosis, DD performed well.
: D-dimer, Liver cirrhosis, AF, SBP.

tumour-related thrombosis, D-dimer has been
It is thought that there is a complex relationship
demonstrated to be a useful diagnostic and predictive
between liver diseases and hemostasis; certain cases
test [8]. We aimed to determine the connection between
with advanced hepatic disorder may develop extensive
ascites and the hyper fibrinolytic condition in hepatic
blood loss, while others could even experience
cirrhosis, we evaluated serum DD in cirrhotic cases with
thrombotic adverse events due to reduced plasma values
and without ascites. We also examined how SBP
of clotting factors produced by the liver [1, 2]. A
affected the D-dimer content in serum and ascitic fluid.
significant coagulopathy that can affect patients with

liver cirrhosis might have many different causes, one of
which is rapid hyperfibrinolysis. However, there is no
This prospective study was conducted on 60
sufficient precise data as regards the prevalence of
patients hospitalized due to decompensated liver
hyperfibrinolysis in cirrhotic individuals, as well as the
cirrhosis and ascites in the Department of Internal
clinical indicators that may help diagnose and treat
Medicine, Minia University Hospital. The patients were
hyperfibrinolysis [3].
divided into 4 groups: First group included fifteen
Since the AF is basically an ultrafiltrate of
cirrhotic cases without ascites. The second group
plasma, it includes proteins that are important for
included fifteen cirrhotic cases with ascites. The third
clotting. Ascites may be a contributing factor to the
group included fifteen cirrhotic cases with both ascites
enhanced fibrinolysis and bleeding tendency commonly
and SBP. The fourth group (Control group) included
present in late hepatic disorder [4]. In individuals with
fifteen age- and sex-matched healthy individuals with
cirrhosis, SBP is a dangerous adverse event. SBP occurs
no evidence of hepatic diseases.

in roughly 20% of decompensated liver cirrhosis
Exclusion criteria: Other causes of ascites. Pregnancy.
patients, and average mortality is 25% [5]. SBP is linked
Cases with previous history of DVT or portal vein
to high resource use and accounts for 2.5% of whole
thrombosis (PVT). Cases on anticoagulation therapies.
hospitalized cirrhotic cases [6].
Hepatorenal syndrome. Hepatocellular carcinoma or any
Since up to 13% of patients might be without
other associated malignancies.
manifestations, a strong index of suspicion is required to
Child-Pugh and MELD scores were measured.
avoid a delay in diagnosis and an escalation of the

prognosis [7]. The D-dimer (DD) test can detect
All patients were subjected to:
fibrinolysis with good specificity. Its irregularity is a
Full clinical history: Subject answered a
result of the coagulation and fibrinolysis system being
questionnaire which comprised: Personal history, which
overactive in vivo. In certain conditions, which include
include name, age, gender, residence, marital status,
deep vein thrombosis (DVT) and some malignant
occupation and special habits as tobacco smoking and
everyday alcohol intake in the last six months. History
Received: 11/06/2022
Accepted: 13/08/2022

Full Paper (vol.931 paper# 59)

c:\work\Jor\vol931_60 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7286- 7290

Identifying Potential Risk Factors and Evaluating the Microbiological
Profile of Infections in Diabetic Feet
Ghada Mohammed Elsagheer1, Hanan Mohamed Elsotouhy2,
Eman Hussein Khalil*1, Mohamed Mamdouh Sedik1, Eman M. Fahmy3
1Department of Internal Medicine, Faculty of Medicine, Minia University, Egypt
2Department of Internal Medicine, Faculty of Medicine, Mansoura University, Egypt
3Department of Endocrinology, Helwan Faculty of Medicine, Helwan University, Egypt
*Corresponding author: Eman M. Fahmy, Mobile: (+20) 01000539149, E-mail: eman.fahmy@helwan.med.edu.eg


Background: Diabetic foot ulcers (DFU) account for about 20% of hospitalisations for diabetes-related reasons.
These wounds may cause patients to develop fatal infections or possibly organ damage. As a result, it is crucial to
have antibiotic therapy to reduce these consequences.
Objective: The current study set out to identify the risk factors for DFU infection, the most typical organism that was
isolated from DFU, and the antibiotics' susceptibility to infection.
Patients and methods: This study was conducted on 74 patients divided into 2 groups: Control group who were not
diabetic and presented with foot ulcers and a diabetic group of 54 Diabetic patients attending the clinic for the first
time with DFU (30 females and 24 males).
Results: Gram-positive organism was isolated from 61.1% of DFU while 33.3% were gram-negative. Isolates were
Staph aureus in 19 (35.2%), 14.8% was coagulase-negative staph, 11.1% for streptococci, pseudomonas, and
klebsiella (MDRO) and 5.6% for klebsiella (ESBL) and E-coli, while negative culture was in 3%. Among non-
diabetics, the isolates were 60% staph aureus, and 10% for each of pseudomonas, klebsiella (ESBL), and E-coli.
While 5.6% of diabetics and 10% of non-diabetics were negative cultures. There was no significant difference
between the two groups. Staph aureus was the most common organism isolated from DFU.
Conclusion: The most typical organism identified from DFU was a gram-positive bacterium. Broad-spectrum action
against both Gram-positive and Gram-negative organisms was seen by vancomycin, imipenem and amikacin.
Keyword: Type2 DM, Foot ulcer, Gram-positive.

chance of getting a foot ulcer in a diabetic patient
Around the world, 425 million people have
reaching up to 25% (5).
diabetes, according to figures from 2017. This
It is not unusual for DFU to receive inadequate
progressive chronic metabolic illness is spreading
care. This is particularly since there are few facilities
quickly across the globe compared to 2013 and 1980,
that specialise in treating DFU. Use of antibiotics
which recorded 382 million ands108 million cases
without sensitivity in culture, the use of medications
respectively (1). Microvascular and macrovascular
that have no effect on the species recovered from the
problems, which are caused by the deposition and
wound site, and improper treatment duration are only a
buildup of glucose and associated metabolites in the
few examples of mistreatments that can result in DFU.
arteries and result in a persistent reduction in blood
At least in Western nations, aerobic Gram-positive
flow and tissue damage, are the main side effects of
cocci, particularly Staphylococcus aureus, are the
this condition (2). Diabetes causes an inadequate blood
major cause of most acute infections in individuals
supply, which leads to diabetic ulcer development. The
who have not received antibiotic treatment. Gram-
foot is where diabetic ulcers occur most frequently.
positive aerobic cocci typically develop in
Neglecting this area of the body, the shape of the arch
polymicrobial infections that are persistent or have a
and toes, and the colonisation of bacteria and fungi
prior history of antibiotic therapy (5).
between the toes due to the sweating of the foot in the

socks are all causes of this complication, which is
primarily in the toes (2). Other areas of the body are
This prospective case-controlled-hospital-based study
susceptible to such ulcers for various reasons,
was carried out on 400 diabetic patients who attended
including neuropathy as the main aetiology (3).
the DF Unit at Mansoura University Hospital in the
The most common kind of classic DFUs are
period between February 2011 and April 2022. A total
tiny, mid-punctured, persistent sores that typically
of 74 patients with foot ulcers were selected and then
develop on the plantar surface of malformed
were divvied into two groups: 54 patients were
metatarsals and Charcot's joints (4).
diabetic, and 20 patients were non-diabetic.
The International Diabetes Federation has
Inclusion criteria: Patients with type 1 or type 2
focused on the prevalence of diabetic foot disease
diabetes who had diabetic foot ulcer attending to the
worldwide as of 2021. A lower limb may be lost due to
Diabetic Clinic.
diabetes worldwide every 30 seconds, with the lifetime
Exclusion criteria: Grade 0 ulcer, pre- or post-
ulcerative lesion that has healed. Patients already on
Received: 16/04/2023
Accepted: 13/06/2023

Full Paper (vol.931 paper# 60)

c:\work\Jor\vol931_61 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7291- 7295

Effect of Adult Congenital Heart Disease in adults on
Psychological Wellbeing and Quality of Life in Egypt
Ayah Tarek Elsayegh1, Ahmed Youssef Omara1, Azza AbdAllah Elfiky1,
Mariam Yehia Mohamed AbouTaleb2, Youssef Mohamed Amin1
1 Department of Cardiology, 2 Department of Neuropsychiatry,
Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author Ayah Tarek Elsayegh, ayahtarek_87@outlook.com
Orcid ID 0000-0002-4670-2388, Mobile: +201001717984

Complex congenital heart disease (CHD) had very poor prognosis just a few decades ago. Nowadays, more
than 90% of them, survive into adulthood, yet the complete "correction" or "repair" of CHD is not the rule and many of
those patients undergo palliative interventions or surgeries. Many psychiatric and mental disorders could be seen in this
group of patients. Furthermore, this could affect quality of life (QOL).
Objectives: Find out how prevalent anxiety and depression are among adult congenital heart disease (ACHD) patients and
understand how it affects their lifestyle quality.
Patients and Methods: Observational case-control, cross-sectional study on 300 Adults with CHD vs 300 controls.
Controls and patients were asked to fill three questionnaires to determine the prevalence of anxiety, depression, and QOL.
Results: Cases had higher anxiety and depression scores than controls and had poorer QOL than controls.
Conclusion: Congenital heart conditions adversely affect the QOL compared to a matched control group. Additionally, this
cohort of patients suffers psychological distress, with more anxiety and depression in comparison to the control group. These
results emphasize the drastic impact of CHD on the overall well-being of affected individuals, stressing upon the importance
of holistic care that addresses both the physical and psychological aspects of their health.
Keywords: Congenital heart disease, Depression, Anxiety, Quality of life, Stress levels.


Complex congenital heart disease (CHD) had high
The QOL of adult CHD patients can also be
rates of mortality in the first few years of life until around
impacted by mental conditions such as anxiety and mood
1940. Nowadays, more than 90% of them reach maturity.
disorders, according to research. The employment and
These significant advancements are mainly due to
social lives of patients may be affected because of these
scientific breakthroughs in congenital cardiology, cardiac
diseases. As a result, psychiatric disorders screening may
surgery, critical care, and pharmacology [1].
help the patient's condition. [5].
One significant study came to the conclusion that the
Quality of life in patients with severe forms of the
age distribution at death is changing from bimodal to
illness is usually more impaired compared to those with
unimodal. In other words, the number of adults with CHD
mild and moderate forms of the illness [6,7].
has surpassed that of children[2] . Despite a sharp decline
Healthcare systems in most countries are challenged
in CHD mortality, a sizable portion of morbidity is still
by a considerable financial strain owing to the growing
underreported. It is important to realize that complete
ACHD population [8,9], this is mainly due to late disease
repair with anatomical and physiological repair that
complications and the necessity of lifetime follow-up. It
results in a normal life expectancy and no need for
is thus crucial to estimate the cost of hospitalization for
additional care, is not the rule [1].Many psychiatric and
ACHD patients [10,11] .
mental disorders can be seen in patients with CHD. For

instance, many studies suggested that adults with CHD
are more prone to depression. Depression in this cohort of
To determine the prevalence of anxiety and depression in
patients could be as high as 30% in some studies.
adult congenital heart disease (ACHD) patients and to
Generally, the co-existence of chronic medical conditions
understand its effect on the QOL.
and depression is well established [3].

physiology are reported to have a lifetime anxiety
We conducted this observational case-control,
diagnosis rate that is five times higher and a lifetime
cross-sectional study on CHD patients presenting for
attention deficient hyperactive disorder (ADHD)
elective assessment in the Demerdash Congenital and
diagnosis rate that is almost six times higher, both of
Structural Heart Disease Unit, Cardiology Department,
which can have an impact on academic performance and
Ain Shams University. We included 300 patients and 300
social functioning. [4].
Received: 13/07/2023
Accepted: 27/09/2023

Full Paper (vol.931 paper# 61)

c:\work\Jor\vol931_62 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7296- 7300

Effects of Isotretinoin on Free Testosterone and DHEAS and Prolactin in
Females with Acne Vulgaris
Manar Sallam1, Elham Shaaban Ibrahim*1, Eman S. Elhennawy2, Ahmed Fawzi Ismael1
Departments of 1Dermatology Andrology and STDs,
2Clinical Pathology, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
*Corresponding author: Elham Shaaban Ibrahim, Mobile: (+20)01015564567, E-Mail: elhamshaaban971@gmail.com

: For mild acne vulgaris that does not respond to conventional therapy modalities and severe nodulocystic
acne vulgaris, oral isotretinoin is known to be the most effective treatment. It is the only form of therapy that affects the
full etiology of acne.
Objective: This study aimed at investigating how isotretinoin affected the levels of prolactin and androgens in the blood
of females with acne vulgaris.
Patients and methods: Fifty adult females with acne vulgaris, between puberty and menopause, who were candidates
for isotretinoin treatment, were included in this study. Patients were chosen from the outpatient dermatology clinics.
Results: After receiving isotretinoin treatment, there was a statistically significant drop in prolactin levels; the mean
difference was 5.33 and the percentage change was 25.4 percent. Following treatment, there was a statistically
significant rise in both DHEAS and free testosterone levels in the cases, with mean differences of 0.58 and -0.22 and
percentage changes of 21.5 percent and 27.2 percent respectively.
Conclusion: According to this study, isotretinoin has been successfully used to treat cases of acne vulgaris. It can lower
prolactin levels while increasing DHEAS and free testosterone; two key factors that contribute to acne etiology.
Keywords: Acne Vulgaris, Isotretinoin, Serum Androgens, Prolactin.


Acne vulgaris is one of the most prevalent
glands, which can change them into more active types.
dermatological illnesses in the world. It is a chronic
Numerous researchers have explored for connections
inflammatory disease of the pilosebaceous unit (1).
between the occurrence of acne, serum androgen levels,
Several factors, including increased sebum production,
altered sebum lipid composition, androgen activity,
dehydroepiandrosterone sulphate (DHEAS) levels are
interaction with neuropeptides, manifestation of pro-
correlated with acne in prepubertal females and sebum
production in both sexes. Even while elevated serum
hyperkeratinization, and Propionibacterium acnes (P.
androgen levels are associated with severe nodular acne
acnes) proliferation, are currently thought to play a role
in women, mild to moderate acne frequently has levels
in the pathogenesis of acne (2).
that are within the normal range. This raises the question
Different acne therapies focus on various stages
of whether patients with acne vulgaris have a localized
in the etiology of acne, from reducing sebum production
increase in androgen production within their sebaceous
and reducing androgens to preventing follicular
glands that causes them to secrete more sebum (6).
occlusion, reducing Propionibacterium acnes growth,
According to this theory, neurohormone
and reducing inflammation (3).
prolactin (PRL) may be a sebotrophic hormone and
Oral isotretinoin, a vitamin A metabolite
represent a unique therapeutic target in human SG
product, is the most effective treatment for mild acne
dermatoses like acne. Additionally, (PRL) might have
that does not respond to conventional therapeutic
an impact on sebaceous gland (SG) biology (7).Although
methods and nodulocystic acne (4). It is the only form of
there is evidence that isotretinoin has therapeutic effects
treatment that has consequences for the overall cause of
that are not mediated by hormones, it is yet unknown
acne, despite the fact that its mode of action is yet
how isotretinoin affects human levels of serum
unknown. It supports the reduction of P. acnes growth,
androgens, precursor androgens, and prolactin (8).
normalization of the pattern of keratinization within the
This work aimed for investigation of the effect
sebaceous gland follicle, suppression of sebaceous
of oral isotretinoin on serum androgens and prolactin
gland activity, and normalization of inflammation.
levels in females of reproductive age with acne vulgaris.
Isotretinoin frequently causes cheilitis, dry skin,

photosensitivity, photophobia, paronychia, arthralgia,
myalgia, and headaches as adverse effects. It is a
Fifty adult females with acne vulgaris between
pregnancy medication of category X. When using
adolescence and menopause, who were prescribed
isotretinoin, women of reproductive age should receive
isotretinoin, were included in this prospective case
appropriate counseling, give their informed consent,
series investigation. They were recruited from the
and undergo regular pregnancy tests (5).
dermatology outpatient clinic.
The secret to acne vulgaris development is

sebum production. Androgens activate the sebaceous
Received: 16/04/2023
Accepted: 13/06/2023

Full Paper (vol.931 paper# 62)

c:\work\Jor\vol931_63 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7301- 7306

Triiodothyronin (T3) as a Parameter in Sepsis Patients Outcome in
The Pediatric Intensive Care Unit (PICU)
Rania Ibrahim Abdel-atty, Eslam Essam Mohamed, Effat Hussein Assar, Yasser Mahmoud Ismail
Pediatrics Department, Faculty of Medicine, Benha University, Egypt
Corresponding author: Eslam Essam Mohamed, Mobile: (+20) 01111134983, E-mail: eslamessam201414@gmail.com
Sepsis can result in systemic multi-organ dysfunction and is brought on by an unbalanced host response
to infection. TSH, T4 and T3 levels are decreased as a result of the changes in thyroid hormones. This hormonal
confluence has been referred to as "Euthyroid Sick Syndrome (ESS)" or "Non-Thyroid Illness Syndrome" since it does
not signify intrinsic thyroid dysfunction. Objective: To determine whether there is a connection between serum T3
levels and sepsis outcomes, particularly mortality in patients hospitalised to the PICU of Benha University Hospitals.
Patients and methods: This study was prospective cohort study. We studied 100 children aged 1 month-18 years who
were diagnosed with sepsis. For each patient, age, gender, mortality and outcome were noted. Study sample included
100 patients were collected from the pediatric intensive care unit at Pediatric Department, Benha University Hospitals
over 6 months. All patients had serum free T3 levels measured, and all data were collected at the time of diagnosis.
Patients were then followed until discharge or death, and they were separated into two groups based on outcome: the
died (70 patients) and survived (30 patients) groups. Results: Serum T3 level was low in 93% of septic patients who
died, while only 25 % did in the survived group. So, low T3 levels are associated with increased mortality in the
paediatric critical care unit. Further investigation found that serum T3 levels of 1ng/dL had a significant relationship
with mortality. Conclusion: Our study found that serum T3 level was low in 93% of septic patients who died, while
only 25 % did in the survived group. So, low T3 levels had significant relationship with mortality in PICU.
Keywords: Pediatric sepsis, Euthyroid sick syndrome, Serum T3 level, PICU.

Sepsis can result in systemic multi-organ
inappropriate levels of thyroxin (T4), free thyroxin
dysfunction and is brought on by an unbalanced host
(fT4), and/or TSH, are characteristics of ESS. The
response to infection. The kind of bacteria, the amount
severity of clinical and biochemical ESS manifestation
of time between the onset of the sickness and the start
varies, and in the more severe instances, decreased fT4
of therapy, the initial illness that existed before the
and TSH values occur after the first decline in fT3
sepsis, and the patient's current immunisation status are
levels [4]. This study aimed to determine whether there
some of the variables that affect the cause of death in
is a connection between serum T3 levels and sepsis
septic patients. Children's life and health are gravely
outcomes, particularly mortality in patients hospitalised
endangered by sepsis. 64% of the 7.6 million kids who
to the PICU of Benha University hospitals.
pass away before turning five years old do so from
sepsis or septic shock brought on by a serious illness [1].
This study was prospective cohort study. We studied
The surviving sepsis campaign, which debuted in 2018,
100 children aged 1 month-18 years who were
clearly established the notion of the "hour-1 bundle,"
diagnosed with sepsis. For each patient, age, gender,
emphasising that sepsis should be viewed as an
mortality and outcome were noted. Study sample
emergency medical event rather than a single sickness.
included 100 patients were collected from the pediatric
Early response is critical, and identifying risk factors
intensive care unit at Pediatric Department, Benha
for sepsis on admission can aid in patient triage,
University Hospitals over 6 months.
individualised therapy, and medical decision making [2].
Inclusion criteria: Patients admitted to PICU one
The control of metabolic homeostasis is greatly
month age until 18 years old age with a diagnosis of
influenced by thyroid hormones. By up-regulating B-
sepsis according to American College of Critical Care
adrenergic receptors and boosting the inotropic
Medicine (ACCM). Exclusion criteria: Patients with
characteristic of the myocardium, they play a crucial
hypothyroid and hyperthyroid diagnosed by a pediatric
role in critical disease. Dopamine's function may be
endocrinologist before admission to PICU, patients
lessened when thyroid hormone levels are low. The
taking drugs that affect thyroid functions, also patient
cardiovascular system is a primary target for the effects
admitted with surgical conditions. For each patient age,
of thyroid hormones, which also control the
gender, mortality and outcome were noted. Study
development and metabolism of different organs [3].
sample included 100 patients who were collected from
Different endocrine alterations occur during
the PICU at Pediatric Department, Benha University
critical illness. TSH, T4 and T3 levels are decreased as
Hospitals over 6 months.
a result of the changes in thyroid hormones. This
All children underwent the following:
collection of hormonal abnormalities, sometimes
A thorough history taking process that included
known as "Euthyroid Sick Syndrome" or "Non-thyroid
their personal history (age and sex), a history of any
Illness Syndrome," does not imply intrinsic thyroid
current illnesses, and a prior history of any significant
disease. Low amounts of triiodothyronine (T3) and free
medical events. All patients underwent thorough
triiodothyronine (fT3), as well as normal, low, or
physical and general examinations as well as
Received: 18/04/2023
Accepted: 15/06/2023

Full Paper (vol.931 paper# 63)

c:\work\Jor\vol931_64 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7307- 7315

Incidence of Acute Vascular Injury Associated with Fracture Distal Radius
Asmaa Hosny Mohamed*1, Mostafa M. Nabeeh2, Barakat El-Alfy3, Samir M. Attia4
Departments of 1Emergency Medicine, 2Neurosurgery, 3Orthopedic Surgery and
4Vascular Surgery, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Asmaa Hosny Mohamed, Mobile: (+20) 01068209026, Email: asmaahosny935@gmail.com


Background: One of the most frequent forms of fractures observed in emergency rooms are distal radius fractures
(DRF). Radial or ulnar artery lacerations caused by distal radius or ulnar fractures are uncommon injuries. Vascular
problems, formerly thought to be uncommon in connection with distal radius fracture, may be more often identified by
volar exposures.
Objective: This study aimed to assess the incidence of acute vascular injury associated with fracture distal radius and
its impact on short term outcomes.
Patients and Methods: This observational study involved 100 patients with distal radius fractures in total. During the
local examination, the kind of fracture--open or closed--was determined as well as the state of the wounded arteries
by vascular evaluation and radiological exams, which included X-rays. The evaluation of the hand's vascular health was
one of the study's primary outcomes.
Results: There was a statistically significant correlation between the injured side and the presence of acute vascular
damage related to distal radius fracture. Regarding the method of trauma and soft symptoms, there was no statistically
significant difference between those with and without acute vascular injury. In cases when a distal radius fracture was
present together with an acute vascular injury, limb salvage was statistically more often than in cases where it wasn't.
Conclusion: There was a significant relation between presence of acute vascular injury and fracture distal radius.
Keywords: Acute Vascular Injury, Fracture Distal Radius, Vascular complications.


Distal radius fractures (DRF) are one of the fracture
Distal radius fractures are among the most frequent
forms that are most frequently seen in emergency
injuries treated in emergency rooms, but when they are
rooms, accounting for as much as eighteen percent of
coupled with radial artery lacerations, they present a
all fractures in people over 65 years old and as much as
particularly special set of challenges for both diagnosis
twenty-five percent of fractures in the pediatric
and management of the patient's care. Despite the fact
population [1]. The majority of instances of
that several reports in the literature describe the vascular
pseudoaneurysms linked with vascular injuries (radial
complications of the radial artery following surgical
or ulnar artery) with distal radius fracture were
therapy of the distal radius fracture. While the protocol
surgically produced and resulted from internal or
of therapy has been elucidated for solitary DRF, it is still
external fixation implants [2,3].
uncertain when the fracture is connected to a radial
Radial or ulnar artery lacerations caused by distal
artery lesion [2].
radius or ulnar fractures are uncommon injuries [4].
This study aimed to assess the incidence of acute
While it is clear how to treat detached radial or ulnar
vascular injury associated with fracture distal radius and
artery injuries with the indication of treating
its impact on short term outcomes.
(conservatively or surgically) an isolated DRF, it is

unclear what the best course of action is when a distal
radius fracture is present along with a lacerated radial
This was an observational study conducted on a
artery. When the hand exhibits normal function prior to
total of 100 patients with fracture distal radius who were
surgery, there is no difference between the two surgical
admitted to Emergency Hospital, Faculty of Medicine,
techniques regarding "cold" sensitivity symptoms. The
Mansoura University within the period from May 2022
two modalities of vascular treatment are reconstruction
to May 2023. We included patients with any age with
of the artery or ligation [2].
fracture distal radius either with or without vascular
Vascular problems, which were long thought to be
affection but we excluded any patient with history of
uncommon in connection with distal radius fractures,
vascular injury in the affected forearm.
may now be recognized more frequently as volar

exposures become more common. Identification of
these injuries is unlikely to have an impact on the
All patients were subjected to primary survey
functional outcome or result since the majority of single
and resuscitation that included airway maintenance and
artery injuries in the wrist and forearm are not linked to
cervical spine immobilisation in cases with cervical
ischemia. Arterial reconstruction may be required in the
injury, endotracheal intubation if needed and
unique patient who has a dysvascular hand following a
mechanical ventilation, control of hemorrhage by
distal radius fracture [5].
intravenous fluids and vasopressors if needed,

management of coma by coma's cocktail (Dextrose,
Received: 17/04/2023
Accepted: 14/06/2023

Full Paper (vol.931 paper# 64)

c:\work\Jor\vol931_65 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7316- 7322

Triglyceride Glucose Index and Related Parameters as Alternative
Indicators of Metabolic Syndrome: Hospital-Based Cross-Section Study
Amira M. Elsayed
Internal Medicine Department, Faculty of Medicine, Benha University, Egypt
Correspondence: Amira M. Elsayed, Mobile: 00201017994486,
E-mail: amiramohamady@gmail.com, ORCID ID: 0000-0002-2863-3120

Insulin resistance (IR) is a main risk factor for metabolic syndrome (MetS), type 2 diabetes, and
cardiovascular disease (CVD). The triglyceride glucose (TyG) index and TyG-related metrics, such as TyG-BMI or
TyG-WC are effective for identifying IR and MetS.
Methods: This cross-sectional study included 120 patients who attended Benha University Hospital Clinics and 60
healthy volunteers. To diagnose MetS, the International Diabetes Federation (IDF) criteria was used. TyG index, TyG-
BMI, and TyG-WC were estimated for every subject.
Results: Patients with Mets showed significantly higher TYG index, TYG-WC, and TYG-BMI compared to controls.
ROC analysis revealed that TYG-WC index and TYG-BMI cut-off values of 422.6 (81.7% sensitivity and 83.3%
specificity) and 111.12 (83.3% sensitivity and 83.3% specificity) could be excellent predictive test of MetS with AUC
of 0.907 & 0.909 respectively. TYG index predicted metabolic syndrome with cut-off value of 4.65 (AUC = 0.819)
(sensitivity and specificity of 75% and 76.7% respectively). Regarding forecasting IR, the TYG index exhibited a
threshold of 4.73, achieving a sensitivity of 77.3% and a specificity of 81.6%. In the case of TYG-WC, the cutoff point
was 465.04, yielding a sensitivity of 84.2% and a specificity of 81.8%. TYG-BMI, on the other hand, displayed a
threshold value of 117.89, accompanied by a sensitivity of 89.5% and a specificity of 77.3%.
Conclusion: Although TYG-BMI and TYG-WC were more effective in evaluating IR and MetS, TYG index is still an
easy way to identify IR and MetS.
Insulin resistance, Metabolic syndrome, TYG index.

which combine TyG index and obesity indices for IR or
Metabolic syndrome (MetS) represents the combined
diabetes and concluded that they are more effective than
presence of risk factors associated with cardiovascular
TyG index alone in evaluating IR and MetS [3]. We
disease (CVD) and diabetes. These include central
intended to assess the relevance of TYG, TYG-WC, and
TYG-BMI concerning their relationship with metabolic
dysglycemia, and low levels of HDL cholesterol [1]. IR
syndrome. Furthermore, we aimed to determine the
is recognised as a key risk factor for metabolic
predictive capability of these parameters for identifying
syndrome, type 2 diabetes, and CVD [2]. Additionally, it
metabolic syndrome and insulin resistance in
has been determined that IR is a defining characteristic
individuals visiting Benha University Hospital Clinic in
and a key underlying mechanism of the metabolic
syndrome [3]. IR is defined as an inadequate

physiological response to the actions of insulin on
peripheral tissues. This results in reduced glucose
This was a cross sectional study involving 120 patients
utilization in muscles and fat, along with heightened
18 years old who attended Benha University Hospital
gluconeogenesis in the liver. These mechanisms
Clinics for checkup or follow up their diabetes,
contribute to metabolic and hemodynamic irregularities
hypertension and dyslipidemia from December 2022 to
commonly associated with metabolic syndrome [4]. In
January 2023.
the past, tests like the pancreatic suppression tests, the

minimal model approximation of glucose metabolism
Exclusion criteria: Subjects with systemic disease,
(MMAMG), and the hyperinsulinemic euglycemic
diabetes complications and cardiovascular diseases or
clamp technique (HIEG clamp) were initially employed
to evaluate insulin resistance [5, 6].
In addition, 60 individuals, age and sex matched, as
However, these procedures are intrusive, intricate,
healthy volunteers. The participants' diagnoses were
pricey, and challenging to apply in clinical settings [7].
made following the criteria outlined by the International
Using insulin concentration and fasting blood glucose,
Diabetes Federation (IDF) for identifying metabolic
indicators that evaluate insulin resistance indirectly
syndrome. This necessitated the existence of at least
have been created in 1985, including the homeostasis
three of the five risk variables, which included elevated
model for IR (HOMA-IR) [8]. It is found that the
triglycerides (with the use of triglyceride-lowering
triglyceride glucose (TyG) index, a straightforward
medication as an alternative indicator) at a level of 150
measurement that combines triglyceride (TG) and
mg/dL (1.7 mmol/L), low levels of high-density
fasting plasma glucose, is effective for identifying
lipoprotein cholesterol (HDL-C) (with the use of HDL-
people with IR and MetS. Numerous studies have
C-lowering medication as an alternative indicator)
examined metrics, including TyG-BMI or TyG-WC,
Received: 16/04/2023
Accepted: 13/06/2023

Full Paper (vol.931 paper# 65)

c:\work\Jor\vol931_66 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7323- 7328

The Association between Serum Adropin Level and
Metabolic Complications of Type 2 Diabetes Mellitus
Marwan Elgohary1, Mohamed Ahmed El Maghawry1,
Dina Mostafa*2, Eman M. Abd el-Sattar3, Fatima El Tahir1
Departments of 1Internal Medicine and Nephrology,
2Clinical Pathology and 3Family Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Dina Mostafa, Mobile: (+20) 01000543757, E-mail: dinamostafa2030@gmail.com

Several recent reports indicated presence of low levels of serum adropin among patients who had type 2
diabetes mellitus (T2DM) when compared with non-diabetic cases. However, more investigations are needed to
determine the clinical importance of this adropin reduction as an early marker for diabetic nephropathy (DN).
Objective: Evaluation of the performance of serum adropin levels as an early biomarker for DN in T2D patients.
Patients and Methods: In a cross-sectional study, sixty cases with T2DM were enrolled in addition to 20 healthy
nondiabetic subjects. The diabetic patients were further subdivided according to albuminuria level into, non albuminuric
group (20 patients), microalbuminuric group (20 patients) and macroalbuminuric group (20 patients). We used enzyme-
linked immunosorbent assay for determination of serum adropin levels among all participants.
Results: Serum adropin levels were much lower among macroalbuminuric diabetic cases compared with non
albuminuric, microalbuminuric cases as well as healthy controls (p < 0.001). Negative correlations were revealed
between serum adropin levels and all of the following: age, estimated glomerular filtration rate (eGFR), serum creatinine
(SCr), blood urea nitrogen (BUN), random blood sugar (RBS), HbA1c, low-density lipoprotein (LDL), cholesterol,
triglycerides (TG), and urine albumin to creatinine (ACR), meanwhile there was a positive correlation with hemoglobin
(HB)%, total protein, high density lipoprotein (HDL) and albumin.
DN is associated with reduced adropin levels, and serum adropin may be a useful diagnostic marker for
early identification of DN among type 2 diabetic cases.
Keywords: Adropin, T2DM, Diabetic nephropathy.


Diabetes mellitus is the highest prevalent
functional abnormalities. Renal injury in diabetes is
endocrinal disorder worldwide and represents a
caused by several interrelated pathophysiological
growing public health concern as about 425 million
mechanisms, including hyperglycemia, hyperlipidemia,
people are already diagnosed as diabetic according to
hypertension, chronic low-grade inflammation,
2017 global statistics of diabetes mellitus, by 2045
oxidative stress and aldosterone-renin-angiotensin
calculations suggest that number will increase to 629
system activation, which leads to glomerulosclerosis
million (1). In Egypt, it is estimated that 15.6% of all
and tubulointerstitial fibrosis and expression of
persons aged 20-79 have type 2 diabetes (2). In addition
profibrotic mediators such as PAI-1 and transforming
to being the major etiology of chronic kidney disease as
growth factor 1 (4). Currently, there is no curative
well as end-stage renal disease (ESRD), which impact
treatment for DN except to delay its progression to
thirty to forty percent of patients who had diabetes, and
ESRD. As a result, developing cutting-edge treatment
the most common complication, which contribute to
strategies for people at high risk and identifying
high morbidity and mortality among these cases is
innovative biomarkers for early identification of DN are
diabetic nephropathy (DN) (3,4).
crucial (3, 4).
Encoded by the Enho gene, the new peptide
Administering adropin to streptozotocin-induced
hormone adropin was detected for the first time in the
type 2 diabetes in rats reduced blood glucose levels and
year of 2008 (5). Adropin helps maintain a steady level
improved insulin resistance, although serum adropin
of energy in the body. Animal researches evaluating the
levels were lower and adropin expression was higher in
various effects of adropin on the metabolic process
these rats' kidney tissue. These findings provide more
revealed its effect on improving insulin resistance and
evidence that adropin may have a part in the etiology of
glucose metabolism by decreasing endogenous hepatic
type 2 diabetes and its complications, particularly
glucose production, and enhancing glucose utilization,
regarding DN (9, 10).
via activation of the insulin signaling pathways as Akt
We aimed at this work to examine the correlations
phosphorylation and glucose transporter 4 receptor.
between serum adropin levels and diabetic metabolic
Adropin decreases levels of low-density lipoprotein
and renal complications.
cholesterol, total cholesterol, and serum triglycerides

while raising levels of HDL cholesterol (6-8).
DN is the most common cause of CKD and ESRD
In a cross-sectional study, sixty patients with
in diabetic patients affecting more than one-third of
T2DM were enrolled in addition to 20 healthy non
patients. DN is characterized by both structural and
diabetic subjects as control group. The American
Received: 14/05/2023
Accepted: 16/07/2023

Full Paper (vol.931 paper# 66)

c:\work\Jor\vol931_67 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7329- 7333

Serum Uric Acid in Patients with Psoriasis Vulgaris and the
Therapeutic Effect of Colchicine
Nadia Fawzy Abdellatif Atta1*, Ahmed Fawzi Ismael1, Abeer Mesbah Abdelhamid2, Hanan Ahmed Salem1
1Departments of 1Dermatology, Andrology and STDs and
2Clinical Pathology, Faculty of Medicine, Mansoura University
*Corresponding author: Nadia Fawzy Abdellatif Atta, Mobile: (+20) 01019124365, Email: nadiafawzy347@yahoo.com

Psoriasis is a chronic, proliferative, and inflammatory skin disorder that manifests as erythematous
plaques coated in silvery scales, most often on the body's extensor surfaces, scalp, and lumbosacral area. Psoriasis
individuals may potentially benefit from the antioxidant properties of SUA. Some evidence of colchicine's
effectiveness in treating psoriasis has been gathered.
To compare the serum uric acid level in psoriasis vulgaris individuals with that of healthy controls and to
evaluate the effect of the addition of colchicine to the ordinary treatment of psoriasis on the level of serum uric acid
and the degree of improvement of psoriasis.
Patients and Methods:
This prospective case-control research included 51 individuals with psoriasis, and conducted
at outpatient clinic of the Dermatology, Andrology, and STDs Department at Mansoura University Hospitals.
There was a statistically significant variance among the patients concerning PASI score after treatment and
uric acid level after treatment, while there was no statistically significant variance regarding PASI score before
treatment and baseline uric acid. Non-smoking and receiving colchicine were associated with a better PASI score in
univariable analysis. However, in multivariable analysis, receiving colchicine was considered a predictor of a better
PASI score.
Hyperuricemia was detected in psoriasis vulgaris cases, which showed improvement after the addition of
colchicine to the treatment of hyperuricemia. Elevated serum uric acid levels didn't affect psoriasis severity. While
receiving colchicine was considered a predictor of a better PASI score.
Psoriasis vulgaris, Serum uric acid, Colchicine, Hyperuricemia.

Some evidence of colchicine's effectiveness in
Psoriasis is a skin, nail, and joint condition that
treating psoriasis has been gathered from case series
causes persistent inflammation. Elbows, knees, scalp,
and cross-over studies. Pustular psoriasis and
and lower back are popular sites for the red, scaly
palmoplantar pustulosis are examples of psoriasis that
plaques that characterize this condition, but any area of
are notoriously difficult to treat, and the medicine may
skin is fair game (1).
be more effective in these cases (8).
Activated T cells infiltrate the skin, where they
The purpose of this research was to compare the
spur the growth of keratinocytes and contribute to the
serum uric acid level in psoriasis vulgaris individuals
disease's pathogenesis. The accumulation of plaques is
with that of healthy controls and to evaluate the effect
a direct outcome of the abnormal turnover of
of the addition of colchicine to the ordinary treatment
keratinocytes. Epidermal hyperplasia and parakeratosis
of psoriasis on the level of serum uric acid and the
are also common symptoms (2).
degree of improvement of psoriasis.
The Psoriasis Area and Severity Index (PASI) is

the gold standard for quantifying the extent of the
disease and gauging the success of therapy (3). The
This was prospective case-control research to
metabolism of adenosine and guanosine, two purines,
compare SUA in patients with that in controls and an
results in the production of uric acid. High uric acid
extended clinical trial to assess the efficacy of adding
levels are strongly correlated with insulin resistance
colchicine to the ordinary treatment of psoriasis. The
and the onset of metabolic syndrome (MetS), which is
study included 51 patients with psoriasis and was
thought to result from insulin resistance (4).
conducted at an outpatient clinic of the Dermatology,
By stimulating the production of inflammatory
Andrology and STDs Department at Mansoura
chemokines, serum uric acid (SUA) mediates the
University Hospitals.
inflammatory response (5). Psoriasis individuals may

potentially benefit from the antioxidant properties of
Sample size: The required sample size was calculated
SUA; as has been suggested (6).
using the IBMŖ SPSSŖ Sample PowerŖ version 3.0.1
Colchicine, a member of the alkaloid family, is
(IBMŖ Corp., Armonk, NY, USA). Based on an
found in plants like Colchicum autumnale that are in
exhaustive literature review, Yilmaz et al. (4) found that
the lily family. Colchicine's cellular effects are
the mean serum uric acid level in psoriasis cases was
principally brought about by blocking microtubule
5.08 mg/dl (SD 1.33) compared to 4.59 mg/dl (SD
polymerization (7).
1.26) in the control group. This distinction among the
categories was used to determine the sample size. At a
Received: 18/04/2023
Accepted: 15/06/2023

Full Paper (vol.931 paper# 67)

c:\work\Jor\vol931_68 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7334- 7338

Effect of Colchicine on Neutrophil to Lymphocyte Ratio and Cardiac Function in
Non-Diabetic Patients Post STEMI Using Speckle Tracking Imaging
Saud M. Elsaughier*, Hosam M. Mansour, Omnia Omer Ahmed, Ramadan Ghaleb
Cardiology Department, Faculty of Medicine, Aswan University, Egypt
*Corresponding author: Saud M. Elsaughier, Mobile: (+20) 01157166779, E-mail: soud_elsoughier_66@yahoo.com

Acute myocardial ischemia is accompanied by myocardial necrosis and endogenous inflammation,
resulting in myocardial injury, ventricular dilation, and dysfunction. Colchicine is a low cost, orally given and potent
anti-inflammatory drug.
Objective: To examine the effect of colchicine on inflammatory markers, such as neutrophil/lymphocyte ratio (NLR)
and cardiac function in non-diabetic ST segment elevation myocardial infarction (STEMI) cases.
Patients and Methods: Our research was done in the Cardiology Department, Aswan University Hospital through the
period from December 2020 to December 2021 on 40 non-diabetic cases who presented with STEMI and underwent
primary percutaneous intervention (PCI). Cases were then randomized into 2 groups: After reperfusion group (A) that
consisted of 20 patients who were given anti-ischemic medication plus colchicine 0.5 mg once/day, while group (B)
consisted of 20 participants who were given anti-ischemic treatment alone. Each participant had tests like NLR and CRP
and an echocardiogram of their hearts performed at the beginning and at the end of the research.
Baseline NLR (P value > 0.05) and 1-month NLR (P value > 0.05) showed no statistically significant variance
among groups. Also, did LVEF (p = 0.5), LVEDD (p = 0.63), LVESD (p = 0.29) and GLS (p = 0.91). Additionally,
there was no statistical noteworthy change among groups in terms of LVEF, LVEDD and LVESD or global longitudinal
strain (GLS) at follow-up.
Conclusion: Adding colchicine to standard anti-ischemic treatment did not significantly enhance inflammatory
indicators (NLR, CRP, and cardiac function) in non-diabetic individuals suffering from STEMI.
Keywords: STEMI, NLR, Colchicine.


and December 2021 participated in a simple double-

Worldwide, coronary artery disease is
blind randomized control experiment. The experiment
responsible for the most deaths (1). The 1-year mortality
was designed to be as objective as possible. Group (A)
rate for patients presenting with STEMI is roughly 10%,
consisted of twenty patients who were given colchicine
with the in-hospital mortality rate ranging from 4% to
(0.5 mg once/day) in addition to the typical anti-
12% (2). Myocardial necrosis and subsequent
ischemic medicine, whereas group (B) consisted of
endogenous inflammation are the results of acute
twenty cases that were not given colchicine. Both
ischemia in acute myocardial infarction (AMI), which
groups received the normal anti-ischemic medication.
also causes ventricular dilatation and dysfunction and
The typical medicine for treating ischaemic conditions
myocardial damage (3). A non-Doppler method known
was given to both groups. Twenty individuals who were
as 2D speckle tracking echocardiography (STE) assists
treated with the conventional anti-ischemic drug alone
in the quantitative evaluation of systolic heart function
served as a control group for this study.
by estimating deformation parameters such as strain and

strain rate (4).
The eligible subjects included in this research were

Colchicine use in gouty patients has been linked
subjected to the following:
to a lower incidence of MI (5). Colchicine is a cheap,
Full history including:
effective anti-inflammatory drug that is administered
- Personal data (age, gender), CV risk factors such as
orally. It may have an impact on the inflammasome,
smoking, hypertension, dyslipidemia, and Family
inflammatory chemokines, and cellular adhesion
history of CAD. Character and onset of the chest
molecules. It inhibits tubulin polymerization and
microtubule formation as reported by various
Physical examination including:
researchers (6).
- Vital signs (temperature, pulse, blood pressure).
The goal of this research was to investigate the
Local cardiac examination and chest auscultation.
influence of colchicine on inflammatory markers like
Anthropometric evaluation included weight (Kg),
NLR and systolic function in non-diabetic instances of
height (cm) and BMI.
STEMI that had primary PCI (PPCI).

Standard 12-lead electrocardiogram (ECG):
before & after medication to look for ischemic

Cases that did not have diabetes and had ST-
elevation myocardial infarction (STEMI) and
As part of the laboratory research, a sample of
underwent PPCI to IRA at the Cardiology Department,
venous blood was obtained from each patient at
Aswan University Hospital between December 2020
admission, prior to the initial PCI procedure. In
Received: 19/04/2023
Accepted: 15/06/2023

Full Paper (vol.931 paper# 68)

c:\work\Jor\vol931_69 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7339- 7348

Impact of Self Care Management Program on Improving Self Efficacy of
Multiple Sclerosis Patients
Baghdad Hussein Mahmoud, Furat Hussein Mahmoud*
Department of Medical Surgical Nursing, Faculty of Nursing, Helwan University, Egypt
*Corresponding author: Furat Hussein, Mobile: (+20) 01061819832, Email: furathu@hotmail.com

Multiple sclerosis (MS) affects more women than males and is a prevalent, persistent, lifelong,
unpredictable, and possibly severely crippling neurologic illness. Although it most frequently begins in young
adulthood, it can also begin in infancy and adolescence.
To determine the impact of self-care management program on improving self-efficacy of multiple sclerosis
patients. Design: a quasi-experimental study design.
The study was conducted at MS outpatient clinic at Ain Shams University Hospitals Cairo, Egypt.
Subjects and Methods: Purposive sample of (65) adult patients from both sexes diagnosed with MS with age ranged
from 20 to more than 50 years old.
Tools: Four tools were used to collect data including: I. Patients' interview questionnaire has two parts; personal
characteristics and knowledge assessment questionnaire, II. Health related needs questionnaire of MS patients, III.
Health problems of MS patients, and IV. Quality of life questionnaire (MSQOL-54).
Better attention to physiological and psychological factors may be important in guaranteeing a better level of
well-being despite the functional limitations caused by the disease. Total health needs have a highly statistically
significant correlation with total health problems and total QOL. Also, total knowledge had a highly statistically
significant correlation with total follow up QOL and had a significant correlation with post QOL.
The findings highlight the need of creating efficient self-care management programmes to minimise
illness effects and enhance patients' self-efficacy and treatment adherence.
MS, Self-Care Management, QOL, Self-Efficacy.

confident, less frustrated, and prevent recurrent
hospitalisations (3).
neurodegeneration are hallmarks of the central nervous
Chronic neurological disorders like MS may require
system condition known as multiple sclerosis (MS). In
a different approach to therapy than other chronic
young adults, it is the most typical non-traumatic
periodic diseases. MS patients have chronic illnesses
impairment cause. According to 2020 epidemiological
that need ongoing observation and management, and
statistics, there are 2.8 million MS sufferers globally.
many healthcare providers frequently offer care in a
Although MS's initial symptoms can manifest at any
variety of settings. Additionally, MS sufferers need to
age, the majority of people are identified between the
comprehend their illnesses in order to properly manage
ages of 20 and 50. The likelihood of having MS rises
them. Due to the fact that there is currently no
with distance from the location and is two to three
treatment for MS, individuals may experience many
times greater in women (1).
difficulties for the rest of their lives. Additionally,
Although MS has little effect on life expectancy,
maintaining circumstances becomes more challenging
people often have the illness for a long time because
and laborious due to the unexpected and complicated
there is presently no treatment. As a result, MS
nature of the disease. Self-management is therefore
patients frequently confront significant obstacles to
crucial in the lives of MS sufferers (4).
their future goals, work chances, and possibilities for a
Self-management, which refers to a person's
fulfilling life. Even when patients are successful in
capacity to manage symptoms, therapies, lifestyle
recovering from prior relapses (or exacerbations or
modifications, and health status as well as social,
attacks), further relapses result in new restrictions,
psychological, and cultural challenges, is a dynamic,
necessitating more adaptation to the unfamiliar
active coping process that is routinely used to manage
conditions. As a result, the ongoing difficulties MS
chronic diseases. The self-management programme is
patients experience have a profoundly detrimental
a collection of regular tasks designed to help people
impact on their QOL (2).
with chronic illnesses. Additionally, a self-
Chronic diseases like MS have a negative impact on
management programme encourages patients to take
QOL. Additionally, the ability of the patient to execute
an active role in managing variables that impact their
self-care is impacted by the direct and indirect costs
health, keeping track of their symptoms, and taking the
that disability, pain, and suffering place on society.
proper actions to manage the intricacies of their
One of the factors contributing to MS patients'
condition. Self-management programmes have been
repeated hospitalisations is a lack of awareness and a
effective in treating a variety of chronic conditions,
weakness in self-care. Therefore, self-care education is
and they have improved patients' health status while
crucial since it will help MS patients feel more
Received: 19/04/2023
Accepted: 15/06/2023

Full Paper (vol.931 paper# 69)

c:\work\Jor\vol931_70 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7349- 7355
Evaluation of The Histological Effects of Aspartame on Testicular Tissue of Albino Mice
Nagla Zaky Ibrahim El -Alfy, Mahmoud Fathy Mahmoud
Mohamed Said Ebied Said, *Sally Ramadan Gabr Eid El-Ashry
Biological and Geological Sciences Department, Faculty of Education, Ain Shams University, Cairo, Egypt
*Corresponding author: Sally Ramadan Gabr Eid El-Ashry,
Email: sallyramadan@edu.asu.edu.eg, Mobile: +201099797341

Background: Aspartame, an artificial sweetener widely used in various food products, has raised concerns regarding its
potential impact on male fertility. Objective: This research aimed to examine the histological effects of aspartame on
testicular tissue in albino mice Mus musculus. Materials and methods: Twenty-five male albino mice (CD-1) of nearly
the same age were individually weighed and randomly assigned to one of five groups: a control group received distilled
water (the aspartame's solvent) orally and four treated groups received oral treatment with one of four doses of aspartame
(250, 500, 750 and 1000 mg/kg body weight) once per day for one month. Results: Histological analysis displayed
noticeable differences within the treated groups when compared to the control group. Mice treated with aspartame
exhibited dose-dependent changes in seminiferous tubules and interstitial spaces. Alterations in seminiferous tubules were
represented by atrophied seminiferous tubules, vacuolation, exfoliated germ cells, hypoplasia of the germinal epithelium
and spermatogenic arrest at various stages of spermatogenesis. However, the intertubular changes included congested
blood vessels and interstitial edema. These findings raise concerns about the potential impact of aspartame consumption
on testicular histology. Conclusion: Current results bring attention to the necessity for additional research on the effects of
aspartame on reproductive health. The observed alterations in testicular tissue of albino mice warrant further investigation
into the implications for human health, especially for individuals regularly exposed to aspartame. Understanding the
underlying mechanisms and long-term consequences of aspartame consumption on male reproductive health is crucial for
informed decision-making regarding its use.
Keywords: Aspartame, Artificial sweetener, Testicular tissue, Testicular histology.

on testicular toxicity are not entirely conclusive, and
With the widespread presence of aspartame in the
further research is needed to establish a definitive link.
modern diet, there is a growing interest in understanding
Some animal studies have suggested possible adverse
the effects of it on various physiological systems,
effects on testicular function after aspartame treatment.
including its influence on testicular tissue fertility (1).
For example, a study conducted on adult male Wistar rats
Aspartame is a food additive employed to enhance the
exposed to aspartame showed alterations in the testicular
sweetness of a wide range of items, including beverages,
morphology, decreased sperm count, and changes in
confections, cakes, chewing gum, yogurt, low-calorie and
hormone levels (9). According to the study of Hozayen et
weight-management products, and even pharmaceuticals
al., aspartame's mode of action appears to involve the
designed for oral consumption. Its inclusion in food
degradation and atrophy of Leydig cells in rats resulting
products can be denoted either by its name or by its code
in reduced testosterone synthesis and secretion due to the
E951 (2).
influence of formaldehyde produced from aspartame (10).
Male fertility is a complex process that relies on the
Seif et al. demonstrated that the treatment of rats with
proper functioning of the male reproductive system,
aspartame (1000 mg/kg body weight (b.wt.)) three times
including the testes, where spermatogenesis takes place.
per week for 12 weeks induced severe testicular toxicity
Any disruption to this delicate process can have
(11). Abu Tfaweel that aspartame consumption led to
significant implications for fertility and reproduction (3).
decreases in red blood cells, white blood cells,
Aspartame, chemically known as N-L--aspartyl-L-
testosterone levels, hemoglobin, platelet counts, and
phenylalanine methyl ester, is a low-calorie artificial
acetylcholinesterase enzyme activity (12).
sweetener commonly used as a sugar substitute in various
In human studies, there is limited research on the
beverages, food products, and medications. Its prevalence
direct impact of aspartame on testicular toxicity.
in the modern diet and its incorporation into numerous
However, a study in humans suggested a potential link
consumables have led to concerns about its safety and
between high consumption of beverages containing
potential health effects (4). While aspartame is approved
artificial sweeteners, including aspartame, and reduced
for consumption by regulatory authorities such as the US
sperm quality (13). However, it is crucial to highlight that
Food and Drug Administration (FDA) and the European
these studies have limitations, and more research is
Food Safety Authority (EFSA) (5), some studies have
required to draw definitive conclusions about the effects
raised concerns about its safety and potential health
of aspartame on testicular toxicity in humans.
effects (6-8). However, the findings on aspartame's effects
Received: 15/12/2022
Accepted: 18/03/2023

Full Paper (vol.931 paper# 70)

c:\work\Jor\vol931_71 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7356- 7365

Serum Endocan Level in Preterm Neonates with
Respiratory Distress Syndrome
Asmaa Salah Abd El-Haleem Saad1, Mohamed Ahmed Rowisha 1,
Nema Ali Soliman 2, Ashraf Mohamed Ibrahim 1
1 Pediatrics Department, Faculty of Medicine, Tanta University, Egypt
2 Medical Biochemistry Department, Faculty of Medicine, Tanta University, Egypt
*Corresponding Author: Asmaa Salah Abd El-Haleem Saad, Email: ma7hmha3425@gmail.com,

In the early newborn period, hyaline membrane disease (HMD) or respiratory distress
syndrome (RDS) is a leading cause of morbidity and mortality. It occurs in 7% - 50% of neonates.
Our objective was to determine serum endocan role in the diagnosis and the prognosis of RDS in
Methods: This prospective controlled study was carried out on 80 preterm neonates 34 weeks
gestation at Neonatal Intensive Care Unit. They were diagnosed with RDS, and were classified into
two groups: Group I consisted of 40 preterm newborns diagnosed with RDS, two blood samples were
withdrawn. 1st at birth (1st day) and 2nd after 4 days. Group II consisted of 40 healthy preterm neonates,
blood samples were withdrawn at day1.
Results: There was a significant high serum endocan level in dead cases in comparison with survived
cases (P=0.001). Serum endocan level in RDS group showed an area under the curve of 0.867, which
gave very good performance (p value was 0.001) at a cut of value > 450 ng/ml. Serum endocan level
had a sensitivity of 88% (was able to identify 88% of cases that had RDS) and a specificity of 83%
(identified 83% of cases that did not have RDS), with positive predictive value of 83%, negative
predictive value of 87%, and accuracy 85%.
Conclusions: Levels of serum endocan are significantly elevated in preterm neonates with RDS.
Serum endocan level had positive correlation with severity of RDS. Serum endocan levels decreased
after 3 days in preterm neonates with RDS.
Keywords: Serum endocan level, Preterm neonates, respiratory distress syndrome.

Preterm male or white newborns are the most
The leading cause of morbidity and
susceptible. Prolonged rupture of membranes,
mortality in the early newborn period is
pregnancies with chronic or pregnancy-
hyaline membrane disease (HMD) or
respiratory distress syndrome (RDS). It affects
corticosteroid prophylaxis, and maternal
between 7 and 50 % of newborns, and
heroin use have a reduced risk of RDS [4].
responsible for 30% - 40% of their hospital
RDS usually occurs during the 1st hours
admission [1]. Depending on gestational age,
of neonatal life, often immediately following
the incidence of NRDS differs from 57% for
birth. Neonates with marked respiratory
newborns born at 30­31 weeks to 92 % for
distress clinically suffer with tachypnea,
newborns delivered at 24­25 weeks [2].
suprasternal, intercostal, and/or subcostal
The anatomical immaturity of the lungs,
retractions, grunting, and nasal flaring [5].
as well as developmental inadequacy of
Surfactant and respiratory support are the
production and function of surfactant, are the
foundation of treatment for cases with RDS
causes of RDS. It can also be caused by a
[i.e. Nasal Continuous Positive Airway
genetic disorders of the surfactant protein [3].
RDS risk rises with numerous births, maternal
Ventilation (MV)] [6]. In complicated cases,
Bronchopulmonary Dysplasia can occur
premature delivery, a maternal history of
leading to asthma, recurrent wheeze, and
previously affected babies, and cold stress.
higher rates of hospitalization later in life [4].
Received: 20/04/2023
Accepted: 18/06/2023

Full Paper (vol.931 paper# 71)

c:\work\Jor\vol931_72 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7366- 7370

True Fecal Incontinence and Its management In Children: Review Article
Wael Mohamed El-Shahat, Amr Ibrahim El-Yasargy, Khaled Sheriff, Amr Mohamed El-Shaer
Pediatric Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Amr Mohamed El-Shaer, Mobile: (+20) 01060004425, Email: amr.elshaer40@gmail.com

Fecal incontinence (FI) resembles a disastrous challenge for those who suffer from it. True faecal
incontinence occurs when a patient's physical restrictions prevent them from having voluntary bowel movements,
necessitating the use of an artificial mechanism to empty the colon. FI frequently makes it more difficult for children
to fit in with society, resulting in serious psychological consequences. More children than previously believed are
affected by this problem, including those who were born with anorectal malformations, Hirschsprung's disease (HD)
and spinal cord disorders, or spinal injuries. Few post-operative complications have a greater impact on patient's
quality of life.
Objective: This article aimed to review true fecal incontinence and possible modalities of management in children.
Methods: We searched Google Scholar, Science Direct, and other online databases for true faecal incontinence and
management. The authors also reviewed references from pertinent literature, however only the most recent or
comprehensive studies from January 2000 to February 2022 were included. Documents in languages other than
English were disqualified due to lack of translation-related sources. Papers such as unpublished manuscripts, oral
presentations, conference abstracts, and dissertations that were not part of larger scientific studies were excluded.
Conclusion: Following surgery for Hirschsprung disease, faecal incontinence may develop. Incontinence is persistent,
severe, and most likely irreversible when the anal canal is injured. This issue might be prevented by maintaining the
anal canal.
Keywords: True fecal incontinence, Management, Children.

anal canal created in patients presenting a congenital
When these muscles are tensed, the anus may
rectourethral fistula is endowed with a high degree of
appear to close in a circular form, but in fact, these
sensibility, content discrimination, and muscular
parasagittal fibres connect one side to the other,
sphincter function. The colon lacks awareness of its
posterior and anterior to the anal orifice. The
contents and all control over faeces if the canal is
parasagittal fibres really follow the muscle complex
diverted to the perineum through the muscular
parallel. The funnel-shaped muscle mechanism's top
diaphragm posterior to the sling (5).
part is called the "levator," while its bottom part is
The surrounding muscles must be taken into
called the "muscle complex" at random. The
account while performing surgeries ranging from low
parasagittal fibres and the muscle complex's junction
anterior excision to anal fistulotomy, which is how the
serves as a representation of the sphincter's borders (1).
anal canal is surgically defined. Digital inspection and
The anorectal sphincters' anatomy is made easy to
ultrasound imaging make it simple to spot the surgical
explain and comprehend by this straightforward
anal canal, which is formed by the puborectalis,
explanation. Traditional anatomy theories are full of
external anal sphincter, and internal anal sphincter (6-7).
details or notions that have no therapeutic use and have
Males often have a longer surgical anal canal than
been handed down from generation to generation.
females do. Men's surgical anal canals are believed to
Medical students are often expected to understand
be 4.4 cm in length on average, compared to women's
some of those principles. Three extremely crucial
4.0 cm, according to intraoperative measurements of
components are required for bowel control: A.
the posterior anal canal. Furthermore, it was
Sensation, B. Sphincter, C. Rectosigmoid motility and
demonstrated that the anal canal constituted a distinct
reservoir function (2).
muscle unit due to its age-invariant length (3).
Magnetic resonance imaging has also been used

Fecal Incontinence in Children:
to characterise the anatomy of the anal canal (3). The
rectum joins the puborectalis muscle at the pelvic
FI is defined as the full ejection of formed faeces
hiatus, where the anal canal develops proximally. The
with a developmental age of at least 4 years or the
muscular anal canal might be conceptualised as a "tube
inadvertent seepage of tiny amounts of liquid faeces
(also known as soiling or leakage) into knickers (7).
within a tube" beginning at this point. The inner tube,
which is innervated by the autonomic nervous system,
Children with FI have considerably worse QOL than
their counterparts who are healthy. Those who look
is the longitudinal layer and visceral smooth muscle of
the internal anal sphincter. Somatic muscles, such as
after children with FI also report experiencing
extremely high levels of parental stress (8).
those of the puborectalis and external anal sphincter,
comprise the outer muscular tube (4).
Bullying, peer rejection, and feelings of
If the new canal is lodged inside the striated
humiliation are common in children with FI, which
muscle complex, which is then its only sphincter, the
negatively impacts their physical and psychological
Received: 20/04/2023
Accepted: 18/06/2023

Full Paper (vol.931 paper# 72)

c:\work\Jor\vol931_73 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7371- 7375

Pathogenesis, Laboratory Diagnosis, Drug Resistance and Treatment of
Pseudomonas Aeruginosa Infections: Review Article
Arwa Mohammed Abd-Alla*, Gehan Ahmed El-Shenawy, Manar Hassan Soliman
Microbiology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Arwa M. Abd-Alla, Mobile: (+20) 01115614754, Email: arwahassan19198@gmail.com

An opportunistic pathogen, Pseudomonas aeruginosa is an aerobic gram-negative bacillus. It is a very
adaptable microbe that can endure low oxygen levels. P aeruginosa can cause bacteremia, pneumonia, and urinary tract
infections. It can also cause significant morbidity and death in cystic fibrosis patients because of persistent infections
that lead to respiratory insufficiency and lung damage over time. P aeruginosa infections still provide a substantial
problem for treatment.
Objective: This article aimed to review the pathogenesis, laboratory diagnosis, drug resistance and treatment of P
Methods: We searched PubMed and Google, for P aeruginosa, diagnostic information, resistance and therapy drugs.
The writers also assessed references from pertinent literature, although they only included the most recent or
comprehensive study from April 2007 to April 2023. Documents in languages other than English have been disqualified
due to lack of translation-related sources. Dissertations, oral presentations, unpublished manuscripts, conference
abstracts, and other papers that did not pertain to significant scientific research were excluded.
Conclusion: One of the most frequent pathogens responsible for nosocomial infections is P aeruginosa. Since this
organism is able to acquire antibiotic resistance, treating these infections is challenging and they have significant death
and morbidity rates.
Keywords: P Aeruginosa, Pathogenesis, Diagnosis, Drug resistance, Treatment.

generate substantial quantities of an extracellular
The complex and diversified bacterial genus
polysaccharide. The polysaccharide is chemically
Pseudomonas inhabits a wide range of environmental
similar to alginic acid, which is a negatively charged
settings. The most recognised species of gram-negative
co-polymer of 1, 4 linked Beta-D-mannuronic acid and
bacteria belong to this genus. With 18 subspecies
Alpha-L-guluronic acid and is generally referred to as
identified, there are now more than 220 species, and the
"alginate" proposed that alginate forms a "glycocalyx"
number of species is continually rising (1).
or loose capsule in which microcolonies are entrapped
Pseudomonas is a genus of aerobic, non-spore-
(4). P aeruginosa alginate is antigenic in both animals and
forming, straight or slightly curved, gram-negative rods
humans. Antigenically, the polymer is conserved across
that use one or more polar flagellae to move about and
all species. This alginate protects the cell from external
measure between 1.5 and 5 meters long and 0.5 to 1
environment, including complement and antibodies (5).
meters broad. With an ideal development temperature of

between 30 and 37 °C, the majority are mesophilic.
Pathogenesis of P aeruginosa:
Based on the 16S rRNA gene sequences, the genus has
P aeruginosa is a gram-negative rod that thrives in
three major lineages, which are represented by the
water, soil, and plants. It can grow and survive in
species P aeruginosa, P fluorescens and P
practically any environment. It can occur in apparently
pertucinogena. Despite the fact that the 16S rRNA gene
healthy patients but is most usually linked to
serves as the fundamental component of the existing
opportunistic infections. It is an opportunistic bacterium
method for classifying bacteria, it is well known that
that preferentially affects immunocompromised and
closely related bacterial species cannot be distinguished
hospitalised individuals, where it produces more or less
on the basis of this gene (2). The entire genome sequences
serious local to systemic infections that can be fatal. The
of the species type strains are required since they serve
dietary requirements of this virus are quite low, and it
as the species representatives when doing a
may adapt to a wide range of environmental factors (6).
phylogenomic study in bacterial taxonomy. For the
Colonisation of altered epithelium by P
genus Pseudomonas, this objective has been nearly
aeruginosa is the initial stage of an infection. Up to 6%
entirely met in a number of papers (3).
of oropharynxes are colonised by the pathogen. On the
Due to a single polar flagellum that is also
other hand, P aeruginosa colonisation represents a
glycosylated, P aeruginosa is able to move. Flagellin,
concern for up to 50% of hospitalised patients (7). P
which has two serotypes (type a and type b) is the main
aeruginosa's adhesion to epithelium is most likely
protein that makes up the flagellar filament. Flagella
mediated by type 4 pili that resemble Neisseria
perform a variety of tasks, including bacterial adhesion
gonorrhea. Flagella, which are principally in charge of
and motility, and they can also activate the inflammatory
motility, can bind to epithelial cells and function as
response in the host via TLR5 (4).
adhesions (8). P aeruginosa generates a number of
On agar culture, P aeruginosa mucoid strains
extracellular substances after colonisation that have the
Received: 20/04/2023
Accepted: 18/06/2023

Full Paper (vol.931 paper# 73)

c:\work\Jor\vol931_74 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7376- 7381

The Effect of Topical Timolol 0.5% Solution on the Healing of
Postoperative Anal and Perianal Wounds; a Randomized Controlled Trial
Hisham Elnaghi, Amir A. Fikry, Ahmed AbdelMawla, Hesham Saad Noor
Department of General Surgery, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Hisham Elnaghi, Mobile: (+20) 101 649 0849, E-Mail: hisham.elnaghi@gmail.com

Wound healing after anal surgery remains a challenging problem. May topical agents have been used to
deal with this problem with variable results? Topical timolol was used successfully in the management of chronic and
refractory wounds.
Aim: This study aimed to assess the effect of topical timolol 0.5% solution on healing of postoperative anal and perianal
Patients and methods: 70 participants with anal and perianal wounds were enrolled in this randomized controlled trial.
Patients were randomized into two equal groups (35 in each): The timolol group where patients were treated with topical
timolol maleate 0.5% solution. The control group wher patients were treated with normal saline solution.
Results: Preoperative patients' characteristics and Quality of life (QoL) were comparable between the two groups.
Regarding the % of healing at postoperative 1 month, outcome data showed that there were no significant results (75.7
± 6 % vs 75.2 ± 10.4 %, P=0.81) and healing time (6.2 ± 2.3 vs 5.9 ± 1.7 weeks, P=0.54) between the timolol and control
groups respectively. Despite the significant improvement in QoL at postoperative 6 months in both groups, non-
statistical significant differences were found between both groups regarding postoperative QoL scores at 1, 3, and 6
months. Pain assessment and complications were comparable between both groups and all complications were managed
Conclusion: Topical timolol 0.5% solution showed no significant advantage over routine postoperative wound care in
the case of anal surgical wounds. Further studies using different forms, doses, and concentrations are required.
Keywords: Timolol solution, Surgical wounds, Healing time, Quality of life.

with hemorrhoidectomy, anal fistula, and anal fissure
One of the most difficult aspects of
surgery wounds compared to the control group (1).
postoperative care following anal surgery is facilitating
Natural therapies, such as Aloe Vera cream
wound healing (1). Surgical wounds in the anal region
applied to the surgical site, have been shown to speed
heal at a considerably slower rate than wounds in other
up recovery time compared to a placebo group (7).
parts of the body due to contamination within the
Many recent studies supported the utilization of
wound. In addition, surgical wound infections are
the topical timolol to manage chronic wounds including
common and can cause discomfort, pruritus, and
leg ulcers (8), refractory wounds (9), and diabetic foot
exudation, all of which slow healing. Therefore, it is
ulcers (10). It has also been observed that topical timolol
crucial to reduce postoperative wound contamination
can speed up the healing of wounds brought on by
and speed up the healing process (2).
chronic diabetes and venous insufficiency (8). But
Many topical agents have been used with
Dabiri et al. (11) looked into how well topical timolol
variable success rates. According to Alvandipour et al.
worked on fresh wounds. Previous studies demonstrated
(3). Individuals who had fistulotomy and were treated
that the application of topical timolol on acute wounds
with sucralfate ointment (10% sucralfate) had
enhanced cosmetic outcomes at the wound site by a
significantly less postoperative pain and faster wound
factor of two. In spite of this, timolol's impact on anal
healing. Also, another study on topical metronidazole
surgical wound healing has not been investigated.
showed that Topical 10% metronidazole reduced

postoperative edema, the overall healing is enhanced in
comparison to the control group(4).
Study design and setting: This study was undertaken
Wound healing was accelerated, postoperative
in the Colorectal Surgery Unit of the General Surgery
pain was greatly reduced, and the need for analgesics
Department, Mansoura University Hospital between
was minimized in the first postoperative week when
May 2021 and May 2022.
topical glyceryl trinitrate (GTN) was used (5).

Postoperative pain following open hemorrhoidectomy
Sample size calculation: With the aid of sample size
was also lessened by topical atorvastatin 2%, which
calculation software (www.clinicalc.com), 64 patients
aided in the recovery process (6). After anal surgery, a
were randomly assigned to one of two groups, with the
silicate-based wound dressing was utilized in another
goal of achieving an 80% power with an alpha of 5%.
study to promote recovery. Research demonstrated that
Assuming a 10% lost to follow-up and 10% dropout
a silicate-based wound dressing was superior at treating
rate, 70 patients were included in the analysis.
the wound following anorectal surgery. The average
Eligibility Criteria: This study included consecutive
healing duration was reduced in the observation group
patients of both genders whose ages ranged between 18-
Received: 23/04/2023
Accepted: 19/06/2023

Full Paper (vol.931 paper# 74)

c:\work\Jor\vol931_75 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7382- 7392

Effect of Time-Management on the Academic Performance of
Medical Students, Benha University: A Cross-Sectional Study

Mai Abdullah Elmahdy*, Mai Magdy Anwer
Departments of Public Health, Community, Environmental and
Occupational Medicine, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mai Abdullah Elmahdy, Mobile: (+20) 01201882742, E-mail: may.yousf@bu.edu.eg

Time management skills are thought to enhance positive students' academic output.
Objective: The aim of the study is to find the impact of time management on the academic performance of students
of Faculty of Medicine, Benha University.
Methods: A cross-sectional study was conducted among undergraduate medical students through using online
questionnaire of 22 questions, which was prepared on the basis of time self-management, awareness, management,
preferences, and performance domains and the question were valued by 5 levels Likert Scale. A stratified random
sample technique was used and data were analyzed by the Pearson chi-square test to find association between the time
management and grade point average (GPA) achieved.
Results: 60.8% of participants strongly agreed (17.1%) or agreed (43.7%) that their academic performance was
degraded due to poor planning, 61.6% of the studied group strongly agreed (20.3%) or agreed (41.3%) that they prefer
to manage their time daily and 45.1% of the studied group strongly agreed (21.8%) or agreed (23.3%) that they often
tend to postpone their tasks, 44.9% of the studied group strongly agreed (21.2%) or agreed (23.7%) that they priorities
between various competing tasks, whereas 39%, 42.2%, 40.3% didn't have a clearly defined plan for each week's,
month's and year's tasks respectively and the majority of them (80.7%) declared that their time management skill
needs more improvement
Conclusions: To improve academic achievements, academic advisors, seminars and workshops, counselors and
psychologists can assist students to improve their time management skills.
Time management, Academic achievement, University students.


Relation between higher academic attainment

Effective and efficient management of time
and efficient time management has been established by
was greatly emphasized through history and was
many previous studies (6). Educational achievement
thought to be essential for success (1). Decreasing time
was effectively predicted by student time management
waste and unproductive work through the concept of
perspective where incorrect time management skills
using of time management for examining employees'
was associated with poor students' planning for their
time and motion studies have been established.
studies and produced stress and worry during the
Performing time management practices in early
evaluation period, particularly near the end of the
student life has been advised. Self-management with a
course (7).
special focus on time in detecting what activities to be

Moreover, prioritization of tasks was reported
done; how to be done more efficiently; in what time it
to improve work and studying and reduce
should be done and what is the correct time for the
inefficiencies, anxiety and stress (8). Whereas, better
specific activity to be done was defined as time
time management skills were established to reduce
management (2).
students' anxiety and tension while increasing their

Time management "behavior" was defined to
output and academic performance (9). Therefore,
do goal directed activities on the basis of efficient use
learning time management skills is essential since
of time. Time attitudes, long-range planning and short-
while some people are excellent at it, others are not.
range planning were three main corners of time
Good time management behaviors to be successful not
management behavior (3). Time attitude, defined as
only in student life but also later in life have to be
one's positive or negative viewpoint on the past,
assured. Time management, as declared by Claessens
present, and future, and it has been found to be
et al. (10), could be achieved through execution,
positively correlated with academic success,
capacity, and drive for oneself. Time management
particularly in the scientific disciplines (4).
abilities have been linked to improved academic
On the other hand, long-term planning was
performance, according to several research. Despite
described as carrying out routine tasks over extended
being aware of how time management affects
periods of time while maintaining the goals established
academic performance, students did not place enough
for important dates. While, preparing daily or weekly
emphasis on this relationship (11).
tasks (day to day activity) was called short-range

Thus, the study's goal is to determine how time
planning. Regarding students, their curricula can be
management affects medical students' academic
managed and learning goals can be achieved through
achievement at Benha University (BU). The study
enhancing their time management skills and improving
objectives also include to assess time management
their academic results (5).
behaviors, self-motivation, planning and prioritization
Received: 02/06/2023
Accepted: 03/08/2023

Full Paper (vol.931 paper# 75)

c:\work\Jor\vol931_76 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7393- 7399

The Role of Matrix Metalloproteinase Inhibitor (Doxycycline) for the
Treatment of Primary Focal Segmental Glomerulosclerosis
M. M. Shahat*, D. A. Younis, A. E. Mansour, M. E. Ibrahim, E. L. Elshaway
Department of Internal Medicine and Nephrology, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mohamed Mahmoud Shahat, Mobile: (+20) 01090412341,
E-mail: Mohamed.shahat21@fmed.bu.edu.eg

Nephrotic range proteinuria, segmental obliteration or collapse of glomerular capillary loops in some
glomeruli, and increased extracellular matrix are the hallmarks of the podocytopathy known as focal and segmental
glomerulosclerosis (FSGS).
Objective: This research set out to determine if the matrix metalloproteinase inhibitor doxycycline (DOX) could be
useful in the management of primary focal segmental glomerulosclerosis.
Patients and Methods: This prospective cohort study was conducted on 100 patients with primary FSGS, who were
recruited from Nephrology Department at Benha University Hospital. Informed consents were signed after getting
approval from the Ethics Committee of Benha University. Inclusion criteria were age >18 years, primary FSGS,
diagnosis is confirmed by renal biopsy, patients with overt albuminuria (A/C ratio>30 mg/g and urinary albumin > 30
mg/day). Results: The hemoglobin level was significantly higher at follow-up compared to baseline level in group 1
(P=0.026) and was insignificantly different between baseline and at follow-up in group 2. Hemoglobin level at baseline
and follow-up was insignificantly different between both groups. C-reactive protein was significantly lower at follow-
up compared to baseline level in group 1 and 2 (P<0.001). C-reactive protein was significantly lower at follow-up in
group 2 compared to group 1 (P<0.001) and was insignificantly different between both groups at baseline. Platelet count
and white blood cells were insignificantly different between baseline and at follow-up in both groups. There was an
insignificant difference between both groups regarding platelet count and white blood cells at baseline and at follow-
up. Conclusions: Patients who received DOX alongside conventional therapy exhibited notable improvements in
clinical and biochemical parameters, including reduced proteinuria and enhanced kidney function, compared to those
receiving conventional therapy alone. These findings suggest that DOX may hold promise as a supplementary treatment
strategy for FS.
Keywords: Matrix Metalloproteinase Inhibitor, Doxycycline, Primary Focal Segmental Glomerulosclerosis.

research[5]. The mechanism by which subantimicrobial
The podocytopathy described as focal and
dosage doxycycline (DOX) (SDD) inhibits MMPs is a
segmental glomerulosclerosis (FSGS) is characterised
direct inhibition of the active form of MMPs by the
by increased extracellular matrix in specific glomeruli,
binding of calcium and zinc ions, as well as a direct
nephrotic-range proteinuria, and segmental obliteration
inhibition of the activation of latent pro-MMPs. Patients
or collapse of glomerular capillary loops. In the United
with diabetic nephropathy (DN) who received DOX for
States, focal segmental glomerulosclerosis (FSGS) is
three months saw a reduction in proteinuria.[6].
the leading cause of kidney failure (ESRD)[1,2].
Doxycycline, an MMP inhibitor, improves
Idiopathic FSGS is distinguished by a poor renal
glomerulosclerosis (GS), but has negative effects on the
prognosis, relapses, and non-responsiveness to
glomeruli. However, there is no data on the effect of
immunosuppressive medications; it recurs in less than
MMP inhibitors or DOX in FSGS.
30-50 percent of patients following kidney
The current study sought to investigate
transplantation, and renal graft failure is common [1].
doxycycline, a matrix metalloproteinase inhibitor, and
its powerful use in focal segmental glomerulosclerosis
endopeptidases that contain zinc and have multiple
domains. Fibrosis and extracellular matrix remodelling

are their respective functions. These entities are found
in numerous organs, including the kidney[3]. MMP-2
One hundred patients with primary focal
and MMP-9 were found in mesangial cells and serum
segmental glomerulosclerosis (FSGS) were enrolled
from patients with chronic renal disease. Podocytes'
from the nephrology clinic at Benha University Hospital
expression was upregulated in response to inflammation
in this prospective cohort research.
[4]. Doxycycline, a well-known tetracycline antibiotic, is

an intriguingly well-tolerated drug with significant
Ethical approval:
MMP inhibitory activity at subantimicrobial dosage
After receiving clearance from the Benha University
levels. Clinical studies are currently being conducted to
Ethics Committee, informed consents were signed by
determine the efficacy of this function as an MMP
the participants. Every participant was given a code
inhibitor in the fields of dermatology, cardiovascular
number and told the study's rationale. The Helsinki
medicine, ophthalmology, and dentistry, all of which
Declaration was followed throughout the study's
were identified in the context of periodontitis
Received: 24/04/2023
Accepted: 20/06/2023

Full Paper (vol.931 paper# 76)

c:\work\Jor\vol931_77 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7400- 7405

Feasibility and Outcomes of Total Mesocolic Excision versus Traditional
Resection in Rt-Sided Colon Cancer: Review Article
Tamer Abd El-Halim Hussein Farag*1, Soliman Hamed El-Kamash1,
Mohamed Kamal El-Din El-Hadary1, Emad Hokam1, Hamdy Mohamed Shaban1
1Department of General Surgery, Faculty of Medicine, Suez Canal University
*Corresponding author: Tamer Abd El-Halim Hussein Farag
Mobile: +201015603529, E-mail: Dr.tamerfarag@gmail.com

As per the GLOBOCAN database of the World Health Organization, colorectal cancer (CRC) ranks 3rd among
males and second among females in terms of frequency of diagnosis. Symptoms of colorectal cancer may not appear
straight away. A decreased red blood cell count can be the earliest indication of colorectal cancer. Surgery, radiation
treatment, and chemotherapy are all viable alternatives. The gold standard of care is surgical resection. Most cases of
colon cancer are treated with potentially curative radical surgery. The fundamental concepts of surgery include detaching
the primary vascular pedicle supplying the tumor and its lymphatics, achieving a tumor-free margin, and resecting the
tumor as a whole along with any associated organs or tissues (end bloc resection). The local recurrence rate of right-
sided cancers does not appear to be affected by ileum length. When a tumor develops in cecum, ascending colon, hepatic
flexure, or proximal transverse colon, blood supply is diverted from the right branch of main colic artery to the right
colic artery and ileocolic artery, respectively. When doing open surgery, doctors typically take a "lateral-to-medial"
technique. First, the lateral peritoneal fold is found; this is an embryonic fusion plane that helps surgeons separate the
mesofascia and retrofascia when treating right-sided colon tumors. "Standard" or "traditional" colon surgery has been
used as a comparison to "complete mesocolic excision" (CME). During "standard" colon surgery, the surgeon's approach
and the presence or absence of radical lymph node dissection are also variables.
Keywords: Total Mesocolic Excision, Traditional Resection, Colon Cancer, Outcomes.


It is anticipated that over 881,000 people would
addition to the presence or absence of drastic lymph
lose their lives to CRC in 2018. With an estimated
node dissection.
551,000 deaths in 2018, globally, colon cancer is
It is becoming increasingly evident that differences
positioned as the fifth most prevalent causes of death
in oncologic results reported among surgeons are
from cancer (1).
directly linked to the differences in the techniques used
Colorectal cancer was estimated to be the second
most commonly diagnosed cancer and the second
In surgery, when the rectum is separated from its
leading cause of cancer death in Europe in 2020, with
surrounding tissues via dissection, a surgical region
nearly 520000 new cases and 245000 deaths (2).
known as the circumferential resection margin (CRM)
The occurrence of colorectal cancer is linked to
is produced. A region of resection that has not been
several potential dangers. Age and genetics are
peritonized. The biggest area is found in the back of the
examples of elements over which an individual has no
body and tapers to a point below the lumbar vertebrae,
say. The development of colorectal cancer may also be
starting at the mesocolon of the sigmoid column. The
influenced by a wide range of environmental and
triangle becomes the circumferential boundary below
lifestyle variables (3).
the peritoneal reflection, and it extends all the way down
Intestinal bleeding is a common complication of
to the skin at the base of the mesorectum (6).
colorectal malignancies. It's possible to detect the blood

in the feces or notice a change in color, but most of the
An attractive mesorectal mass characterized by a
time the stool appears unaffected. But the cumulative
smooth, lipoma-like surface and minimal or negligible
blood loss might cause a decrease in red blood cell count
deficiencies or incisions (no deeper than five mm) is
(anemia) over time. It is not uncommon for a low red
indicative of a successful and comprehensive
blood cell count to be the initial indicator of colorectal
mesorectum excision as seen from the outside in.
cancer (4).
Moderate mesorectum bulk, somewhat uneven surface,
The great majority of CME research done so far
border faults, and likely a little degree of taper
have been retrospective. Comparisons between CME
characterize an excision that is suboptimal or nearly
and "standard" or "traditional" colon surgery have been
complete. There is poor quality mesorectum excision
made in a small number of studies. The difficulty with
when there is a tiny mesorectum mass with a very
"standard" colon surgery lies in the fact that the
uneven surface, significant deficiencies (one cm2), or
procedure relies on the skill of the operating surgeon in
deeper incisions down to muscularis propria and/or a

pronounced taper (7).

Received: 23/04/2023
Accepted: 19/06/2023

Full Paper (vol.931 paper# 77)

c:\work\Jor\vol931_78 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7406- 7412

Predictive Value of R2CHA2DS2-Vasc Score for Short-Term Mortality in
Patients Undergoing Transcatheter Aortic Valve Replacement

Ahmed Bendary Moh
amed Ahmed Elsayed ,

Hisham Mohamed Abou -
l Enein, Yasser Hosny A
Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt
* ardiology Department, Nasr City Health Insurance Hospital, Nasr City, Cairo, Egypt
Corresponding author: Mohamed Ahmed Elsayed, Email: doc.asd2@gmail.com,
mobile: 01095877088, ORCID:0009-0009-4992-7919

Transcatheter aortic valve replacement (TAVR) is a popular method of treating severe symptomatic aortic
valve stenosis in patients who cannot benefit from surgical aortic valve replacement (SAVR).
Objective: We aimed to evaluate how well the modified R2CHA2DS2-VASc score (M-R2CHA2DS2-VASc) predicts
short-term mortality ( 30 days) in TAVR patients.
Methods: This observational multi-center study included 70 patients aged > 55 years with symptomatic severe aortic valve
stenosis who were assigned to undergo transfemoral TAVR. The R2CHA2DS2-VASc score was estimated for all patients,
which comprises persistent kidney disorder and the existence of RBBB or LBBB along with traditional CHA2DS2-VASc
score variables. All patients underwent TAVR using transfemoral access, and the decision to choose a valve was made by
the heart team. Follow-up was conducted for short-term mortality, defined as all-cause mortality within 30 days after TAVR.
Results: The studied patients had a mean age of 76 ± 4 years, with 58.6% males. The median R2CHA2DS2-VASc score
was 4 ranging from 1­9. ROC analysis revealed that the R2CHA2DS2-VASc score had an AUC of 0.911, with a 95% CI
of 0.831 - 0.990 (P < 0.001) for predicting the composite endpoint. The best cut-off point for the R2CHA2DS2-VASc score
was > 4, with 82.40% sensitivity and 84.90% specificity. In multivariable logistic regression analysis, the R2CHA2DS2-
VASc score was a significant predictor of death.
Conclusion: In patients undergoing TAVR, the M-R2CHA2DS2-VASc score is a valuable tool for predicting short-term
Keywords: Aortic valve, Transcatheter aortic valve replacement, R2CHA2DS2-Vasc score, Mortality.


TAVR has emerged as a viable alternative to SAVR
of a cerebrovascular accident (CVA). It has been
to treat patients with symptomatic severe aortic stenosis
suggested that the CHA2DS2-VASc score and its
(AS) who are at high risk for unfavorable postoperative
modified form (R2CHA2DS2-VASc score) can predict
results or those who cannot undergo surgery 1, 2.
mortality within 30 days following TAVR 3, 7.
In the absence of a validated scoring system for
As far as we know, the newly developed
TAVR, the Logistic European System (LES) for Cardiac
R2CHA2DS2-VASc score's ability to predict short-term
Operative Risk Evaluation score, Society of Thoracic
mortality in patients having TAVR has not been well-
Surgeons (STS) Predicted Risk of Mortality (PROM)
studied. Therefore, this study examined the M-
score, and European System for Cardiac Operative Risk
R2CHA2DS2-VASc score ability to predict short-term
Evaluation II (EuroSCORE II) are most frequently used
mortality (30 days) in patients undergoing TAVR.
in the assessment of symptomatic severe AS patients to

determine their mortality risk 3, 4. Although they were
created using a patient group unlike the normal cohort of
Study design: This observational study was carried out at
elderly transcatheter aortic valve implantation (TAVI)
two centers in Egypt; Al-Mokattam and Nasr City Health
patients with comorbidities, these alternatives are
Insurance Hospitals.
primarily employed to assess surgical risk before SAVR

in clinical practice 5. Their applicability to TAVR patients
Inclusion criteria: Patients were eligible if they were
is still debatable. Therefore, numerous new TAVR-
aged >55 years, had symptomatic severe aortic valve
specific risk models have recently been created, including
(AV) stenosis, and were assigned to undergo transfemoral
TAVI. When the mean pressure gradient exceeds 40
transcatheter valve treatment (TVT)-TAVR risk score
mmHg, the jet velocity exceeds 4.0 m/s, and the valvular
(TAVR score). However, the lack of external cohort
orifice area is lower than 1.0 cm2 or 0.6 cm2/m2, severe
validation for many of these scores has prevented their
AS is deemed to exist 8.
widespread use in practice 6.
Exclusion criteria: Patients undergoing concurrent
The CHA2DS2-VASc score is a reliable substitute
percutaneous coronary intervention (PCI) and other
for patients with non-valvular AF to determine their risk
combined procedures, patients with a life expectancy
Received: 24/04/2023
Accepted: 20/06/2023

Full Paper (vol.931 paper# 78)

c:\work\Jor\vol931_79 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7413- 7418

Comparison between Lung Ultrasonography, Plain X-ray, and
Computed Tomography in Acute Bronchiolitis
Mohamed Mahmoud Rashad1, Shaimaa Magdy Hussein2,
Fatma Elzahraa Hamdy Abdelrazek1, Heba Rasmy Abdelbaset1
Departments of 1Pediatrics and 2Pulmonology, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Fatma Elzahraa Hamdy Abdelrazek, Mobile: (+20)01116377136, Email: felzahraa69@gmail.com

A viral upper airway infection usually precedes a viral lower airway infection, which is known as acute
bronchiolitis. When children visit emergency rooms, this respiratory system illness is among the most prevalent ones.
Lung ultrasonography (LUS) has been demonstrated to be a useful diagnostic method for a variety of cardiopulmonary
conditions. Alternative diagnostic methods that do not include the use of ionising radiation should be considered during
the examination of young individuals in order to lower their risk of cancer.
Objective: This study aimed to compare the effectiveness of LUS, plain X-ray, and CT in diagnosing acute bronchiolitis
and the degree of the illness in children. Patients and method: A single-centre comparative study included 53 infants
aged less than 24 months admitted to the Pediatric Department (Benha University Hospital). All children were subjected
to full medical history taking, clinical examination, plain chest X-ray, CT chest (performed prior to admission in infants
experiencing respiratory distress in order to rule out COVID-19 infection), and LUS examination on admission.
Results: In cases of severe bronchiolitis, chest US can accurately predict CT chest subpleural consolidation with a PPV
of 72.22%, NPV of 100%, and accuracy of 90.57%. There was a significant agreement between the prevalence of
subpleural consolidation between chest US and CT chest, with a kappa () of 0.77. Regarding plain chest x-ray, 47
(89%) of the patients had bronchovascular markings (BVM), 23 (43.4%) had hyperinflation, and 3 (5.7%) had minimal
subpleural consolidation. Conclusion: LUS as an initial diagnostic tool could lead to more safe, efficient, and cost-
effective management of acute bronchiolitis in pediatric patients.
Keywords: Bronchiolitis, Lung ultrasound, Chest X-ray.

All studied cases were subjected to the following:
Acute respiratory infections like bronchiolitis are
detailed history taking including personal history
most frequent in children under 24 months of age, with
(name, age, gender, weight, gestational age, type of
1-3 month olds being more susceptible to severe cases.
feeding and age of weaning) and full clinical
Initial symptoms of infection include coryza and
examination including vital signs (pulse, respiratory
occasionally low-grade fever, which develop into
rate, temperature, rhinorrhea and cough).
cough, tachypnea, hyperinflation, chest retraction,

and/or broad crackles and wheezes within a few days.
Laboratory investigations:
Bronchiolitis is a clinical diagnosis. Most of the time,
CBC, CRP, ABG, and Blood culture. Within the
routine laboratory testing provides little useful
first 12 hours following CXR, all patients had a bedside
information. 20% to 96% of chest X-rays (CXRs) show
LUS. The linear probe on a Philips ultrasound machine,
abnormalities (1).
which had frequencies ranging from 7.5 MHz to 12
Ultrasound has just recently been used to analyse
MHz, was used to perform LUS.
the lungs. LUS has shown to be a helpful diagnostic tool
The pulmonologist performing the LUS had
for a wide range of cardiopulmonary disorders (2). LUS
specialized training in LUS and was not aware of the
is particularly useful because it is a quick, portable,
repeatable, and non-ionizing application of echography
information. LUS score can be used to diagnose and
(3). Other diagnostic methods that don't include ionising
manage bronchiolitis in children. A clinical score and a
radiation should be considered in order to lower the risk
sonographic score can be used to describe the severity
of cancer in young individuals (4).
of the condition. LUS could indicate the requirement for

pediatric PICU (PICU) hospitalisation in patients with
bronchiolitis. The severity of the condition was
This single-centre comparative study included 53
determined using five clinical parameters: respiratory
infants aged less than 24 months who were admitted in
rate, inspiratory breath sounds, usage of auxiliary
the Pediatric Department (Benha University Hospitals).
muscles, expiratory wheezing, and PO2 (the partial
Inclusion criteria: All infants aged less than 24 months
pressure of oxygen generally drops owing to airway
(more than 1 month up to 24 months) admitted in the
Pediatric Department with acute bronchiolitis.
After assigning a number between 0 and 2 to each
criterion, the total score was determined. The Lung
Ultrasound Score for Bronchiolitis (LUSBRO) is a tool
used to assess the severity of bronchiolitis. It has four
scores: 0 for A lines and fewer than three B lines, 1 for
Received: 25/04/2023
Accepted: 22/06/2023

Full Paper (vol.931 paper# 79)

c:\work\Jor\vol931_80 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7419- 7424

Predictive Value of Alpha-Fetoprotein Change Rates for
Hepatocellular Carcinoma Recurrence After Liver Transplant
1, 3 *Walid Elmoghazy, 2, 3 Samy Kaskhoush, 3 Toshi Kawahara, 3 Norman Kneteman
1 Department of Surgery, Sohag Faculty of Medicine, Sohag, University of Sohag, Egypt
2 Department of Surgery, National Liver Institute, University of Menofiya, Menofiya, Egypt
3 Department of Surgery, Transplant Division, University of Alberta, AB, Canada
* Corresponding author: Walid Elmoghazy, Tel: +974 44396719,
Email address: moghazyw@gmail.com,https://orcid.org/0000-0001-9590-0930

Liver transplantation offers a conclusive solution for individuals diagnosed with Hepatocellular carcinoma
(HCC). Alterations in alpha-fetoprotein (AFP) levels prior to transplantation could serve as an indicator for the potential
recurrence of HCC.
This study aimed to evaluate the capacity of variations in the pre-transplant AFP levels as a prognostic indicator
for tumor recurrence after transplant.
Patients and methods: 144 HCC patients had liver transplant over a 20-year period at our institute. Their mean age at time
of transplant was 54.8 years, and 124 patients were males. 71 patients (49.3%) received interventions for HCC (group 1),
while 73 patients (50.7%) had no HCC treatment (group 2).
Results: The recurrence-free survival rate was 86.8%. HCC recurrence was reported in 19 patients (13.2%), including 17
males and 2 females. Among these 19 patients, 11 were in group 1 (15.5%), and 8 were in group 2 (11%).
The predictors of recurrence were a tumor volume greater than 115 cc (P = 0.010), and AFP > 400 ng/ml (P = 0.009). While
AFP gradient (AFP-G) did not exhibit a significant correlation with tumor recurrence in the entire cohort, it demonstrated a
notable correlation with recurrence in untreated patients. A specific AFP-G threshold of 60 ng/ml/month was chosen. An
AFP-G of 60 ng/ml/month displayed a sensitivity of 83.3% and a specificity of 94.7% for predicting HCC recurrence.
Conclusion: It was noted that using an AFP-G exceeding 60 ng/ml/month should be regarded as a prognostic tool rather
than a strict selection criterion for transplant candidates.
Keywords: Gradient, Dynamic, Alfa-fetoprotein, Hepatocellular carcinoma, Liver transplant


Liver transplant has emerged as a definitive
such as tumor differentiation, vascular invasion, and
treatment for Hepatocellular carcinoma (HCC). Over the
satellite nodules, are more robust predictors of recurrence
years, numerous studies have sought to optimize
risk (5). Unfortunately, these histological features can only
candidate selection and enhance the outcome of transplant
be determined by examining explanted livers, rendering
for HCC patients (1).
them unsuitable as pre-transplant selection tools (6). High
The criteria used for selecting transplant candidates
AFP levels have been associated with poor histological
have evolved, with the Milan Criteria serving as the gold
features and HCC recurrence after transplant (7).
standard adopted by many centers (2, 3). Despite, their
However, there is no agreement on an AFP cutoff
widespread use, Milan criteria are often limited in
value for selecting transplant candidates. Recent research
predicting patient outcomes accurately. Some patients
has suggested that the rate of AFP increase before liver
with tumors beyond Milan criteria may still have a good
transplant might be a better predictor of tumor recurrence
prognosis after transplantation, while others within Milan
than static AFP values (8). While, pre-transplant
criteria may experience HCC recurrence and poor
therapeutic interventions can reduce AFP levels, they may
outcomes (4). This led to the development of various
not be necessarily associated with a lower recurrence rate
selection criteria, primarily varying in the permissible
(9). This study aimed to study the pre-transplant AFP
tumor morphology, particularly concerning tumor number
dynamics on HCC recurrence after transplant considering
and maximum diameter. Factors such as tumor
patients with and without therapeutic interventions for
progression and pre-transplant HCC management
strategies were found to influence post-transplant

recurrence rates, irrespective of whether patients met the
Milan criteria.
Between 1998 and 2019, patients who had HCC and
This prompted the incorporation of additional
underwent liver transplant at the University of Alberta
parameters into selecting the patients, including Alpha-
were enrolled in this study. At the start of the program,
fetoprotein (AFP) levels and tumor grade (3). This is
selection criteria of HCC patients included those with a
consistent with observations that histological features,
single lesion not larger 7.5 cm, or multiple lesions not
Received: 24/04/2023
Accepted: 20/06/2023

Full Paper (vol.931 paper# 80)

c:\work\Jor\vol931_81 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7425- 7432

Serum Level of Lactoferrin in Patients with Acne Vulgaris and the
Efficacy of Lactoferrin Supplementation
Rokaya Mohsen1*, Hosam Abdel Twab2, Hanan A. Salem1
Departments of 1Dermatology, Andrology and STDs and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Rokaya Mohsen, Mobile: (+20)01096701525, Email: judha_akbar417@yahoo.com

Background: Long-term skin illness known as acne vulgaris (AV) is brought on by clogged hair follicles with oil from
the skin and dead skin cells. Acne is caused by a combination of immunologic, inflammatory, and hormonal pathways.
A protein found in milk that binds iron is called lactoferrin. Lactoferrin is an iron-binding protein involved in innate
defence that has antibacterial and anti-inflammatory properties.
Objective: This study was conducted to evaluate serum level of lactoferrin in patients with acne vulgaris, and the
efficacy of oral lactoferrin supplementation in moderate acne vulgaris.
Patients and Methods: In addition to 42 healthy volunteers who were matched by age and gender who served as the
control group, the trial comprised 42 patients who had acne vulgaris. The cases group was further split into two equal
subgroups: Subgroup (A) consisted of 21 patients who took 100 mg of lactoferrin-enriched tablets twice a day for four
weeks as oral lactoferrin supplementation, and subgroup (B) consisted of 21 patients who did not take oral lactoferrin
supplementation. The Global Acne Grading System was used to evaluate the severity of the illness.
Results: Comparing acne cases to control subjects, there was a statistically significant increase in serum lactoferrin.
Between the two subgroups of the cases group, there was a statistically significant strong positive connection only for
inflammatory lesions and not for non-inflammatory lesions when comparing serum lactoferrin to baseline Global Acne
Grading System (GAGS). On the GAGS score, noninflammatory lesions, and inflammatory lesions, there was a
statistically significant interaction between the treatment arm and time.
Conclusion: Lactoferrin is a potential diagnostic biomarker in acne vulgaris. Utilization of lactoferrin supplementation
is an effective supplementary treatment for acne vulgaris.
Keywords: Acne Vulgaris, Lactoferrin, Using Global Acne Grading System.


destabilisation of the cell wall are two examples of LF's
Seborrhea, the formation of comedones,
antimicrobial properties [6].
erythematous papules, and pustules, as well as, less
In addition, LF has anti-inflammatory properties
frequently, knobs, deep pustules, or pseudocysts, are all
that include neutralising lipopolysaccharide (LPS),
symptoms of acne vulgaris, a chronic inflammatory
complement stimulation of cytokine production and/or
illness of the pilosebaceous units (PSU) that can
binding, and inhibition of hydroxyl radical generation
occasionally be accompanied with scarring [1].
[6]. Products for the skin and food industry have been
Its estimated 9% global prevalence is 0.3% of the
fortified with LF, which is obtained from bovine milk
world's total disease burden. The disease primarily
[7]. As a result, LF consumption may benefit skin health.
affects teenagers, and its causes include hormonal
However, not much research has been done on how LF
imbalances, bacterial infections, stress, and incorrect
supplementation affects acne vulgaris. Accordingly,
use of skin care products or food [2].
there was disagreement between studies that
Multifactorial pathophysiology underlies acne [3].
demonstrated the negative effects of lactoferrin on
Specifically, the sebaceous glands in hair follicles
Candida acnes [8], and those that demonstrated the
harbour Cutibacterium acnes (C. acnes), a Gram +ve
increased levels of serum lactoferrin in patients with
anaerobe that is resident bacteria on the skin's surface
acne vulgaris [5] when compared to healthy individuals
and is essential to the inflammatory lesions associated
with acne. An inflammatory response to acne can be
The aim of this work was for evaluation of serum
brought on by C. acnes growing and reproducing
level of lactoferrin in patients with acne vulgaris, and
excessively in the hair follicles [4].
the oral lactoferrin supplementation efficacy in
One iron-restricting glycoprotein known to help
moderate acne vulgaris.
lessen the severity of microbial illness is lactoferrin

(LF). It is an iron-restricting protein that exhibits non-
iron-subordinate bactericidal action and sequesters iron
In order to assess the effectiveness of oral
that is essential for microbial growth [5]. Particularly at
lactoferrin supplementation in treating mild cases of
mucosal surfaces, it has been implicated in nonspecific
acne vulgaris, a single blinded randomised parallel-
host defence against infections and severe
group clinical trial and a case control study were carried
inflammations. Bacteriostasis by the sequestration of
out. For a year, the study was carried out at the
free iron and bactericidal action through the
Dermatology, Andrology, and STDs Department's
Received: 25/04/2023
Accepted: 22/06/2023

Full Paper (vol.931 paper# 81)

c:\work\Jor\vol931_82 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7433- 7438

Effect of Pericapsular Nerve Group (PENG) Block for
Perioperative Analgesia in Geriatric Patients with Hip Fractures
Samuel H. Daniel, Paula M. Elkomos, Lydia E. Zakhary
Department of anesthesia and intensive care medicine, Faculty of medicine, Ain shams university, Cairo, Egypt.
Corresponding author: Lydia E. Zakhary, email: Lydia_zakhary@med.asu.edu.eg
Mobile: +201222555128

The occurrence of hip fracture is a prevalent orthopedic emergency among older individuals, and it is linked
to substantial morbidity and death. Surgical reduction and fixation are considered the primary therapeutic approach for the
majority of patients. It is crucial to provide perioperative analgesia that is effective in reducing the need for opioids and the
associated side effects, including delirium, in this specific group of patients.
Our research focused on investigating the ultrasound-guided approach for blocking the articular nerve branches
to the hip, namely1 the PENG (PEricapsular Nerve Group) block, which may provide a successful implementation and
approach in individuals with hip fracture.
Methods and patients: The experiment comprised a cohort of sixteen elderly patients, all of whom were above the age of
sixty-five and classified as ASA II or III. These patients suffered from hip fractures and were scheduled to have hip surgery.
All patients had postoperative PENG block after the administration of spinal anesthetic for hip surgery.
Results: postoperative pain assessment both at rest and with movement using visual analogue score (VAS) for twenty-four
hours demonstrated a statistically significant decline compared to preoperative pain.
Conclusion : PENG block provided significant post-operative analgesia after hip surgery.
Keywords : Elderly, Hip fractures, Pain, Regional anethesia , PENG block, VAS scale.

previously documented. This research also identified the
Fractures of the hip are a frequent orthopedic
relevant landmarks for those branches. The high articular
emergency in the elderly and are the most common cause
branches originating from the FN and the accessory
of disability and death 1. In most cases, fixation and
obturator nerve (AON) exhibit a continuous presence in
surgical reduction is the best choice for patients 2. It is
the anatomical region situated between the anterior
important to provide perioperative analgesia that is
inferior iliac spine (AIIS) and the iliopubic eminence
effective in reducing the need for opioids and mitigating
(IPE). In contrast, the ON is positioned in close proximity
associated side effects, including delirium, in this
to the inferomedial aspect of the acetabulum 10.
particular group of patients 3,4.
In this research, we will examine the use of an
Regional analgesic approaches, which involve the
ultrasound-guided approach for the blocking of articular
fascia iliaca block (FIB), femoral nerve (FN) block and 3-
branches to the hip, specifically focusing on the PENG
in-1 FN block, are widely used procedures for pain
block and its successful implementation in individuals
management. These techniques are particularly favored
diagnosed with hip fracture.
owing to their ability to minimize the need of opioids and

reduce the associated adverse outcomes 5-7. The analgesic
effect size resulting from these blocks is found to be only
Design of study: This was observational prospective one
modest, as indicated in the literature. Additionally,
arm clinical trial that studied the PENG block effect in the
existing research reveals that the obturator nerve (ON) is
postoperative pain management following surgery of hip
not well treated by these blocks 8.
Previous anatomical investigations have indicated
ClinicalTrials.gov with the registration number:
that the innervation of the anterior hip capsule includes
NCT05941221. Sixteen elderly patients admitted to our
the FN, the ON and the auxiliary obturator nerve (AON).
institution due to hip fracture were included in our
The anterior capsule of the hip joint has a high density of
innervation, indicating that targeting these nerves would

be a primary approach for achieving analgesia in the hip
Inclusion criteria: Patients with hip fractures,
region. Anatomical research conducted recently by Short
undergoing hip surgery, aging more than sixty years with
et al. (9) confirmed the role of these 3 major nerves in the
ASA II and III with unilateral hip fracture
innervation of the anterior hip, but also discovered a
larger function for the AON and FN than had been
subtrochanteric). Patients who had surgical procedures at

Received: 27/03/2023
Accepted: 24/05/2023

Full Paper (vol.931 paper# 82)

c:\work\Jor\vol931_83 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7439- 7446

Retracted paper
Received: 27/04/2023
Accepted: 25/06/2023

Full Paper (vol.931 paper# 83)

c:\work\Jor\vol931_84 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7447- 7450

Vaginal Application of K-Y Gel During Labor in Nulliparous,
Term Pregnant Women: A Case Control Study.
Elsayed Elshamy¹, Abdelhamid Shaheen¹, Mahmoud Fathy Hassan*2
¹Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt
2Department of Obstetrics and Gynecology, Faculty of Medicine, Ain-Shams University, Egypt
*Corresponding author: Mahmoud F. Hassan, Mobile: (+20) 01289407993,
Email: mahmoudfathy74@yahoo.com, ORCID ID: https://orcid.org/0000-0001-9594-0203

Labor process involves a friction process between fetal head and maternal pelvic floor and perineum
which seems to be inevitable. Repeated vaginal birth with a lengthy second stage is a significant risk factor for pelvic
floor and perineal injuries and related pathological outcomes.
Purpose: This study aimed to assess maternal and fetal outcomes in nulliparous pregnant women after vaginal
application of K-Y gel during the active period of labor as facilitating vaginal delivery can hopefully reduce perineal
and pelvic floor injuries.
Methods: A prospective case-control study including 220 primiparous, term pregnant women hospitalized to the
Obstetrics and Gynecology Department in the first stage of labor. Participants were divided into two groups: Group I
(n =110) got regular antepartum care (Control group) and group II (n =110) received K-Y gel in addition to standard
antepartum care (Study group). Maternal and fetal outcomes were documented and examined.
Results: The length of the second stage and the duration of the active phase were significantly shorter in the study
group (P = 0.001). In the study group, the proportion of deliveries with intact perineum was significantly greater (P =
0.008). The mean Apgar score at one minute was significantly higher in the study group than in the control group (P =
0.029). In the study group, there were fewer perineal lacerations (OR 1.61; 95% CI of 0.95 - 2.75, P = 0.079). Other
data and results were similar across the two groups, with no statistically significant differences.
Conclusion: The administration of K-Y gel vaginally during labor in primiparous women shortens the length of the
active phase and second stage of labor and increases the proportion of women who deliver with an intact perineum.
Keywords: Nulliparous, Active labor, Perineal lacerations, K-Y gel, Episiotomy, Second stage.

Inclusion criteria: 18­40 years of age, primiparous,
Vaginal birth is a significant risk factor for damage
term, singleton pregnancy, vertex presentation, and
to the pelvic floor muscles, which may result in pelvic
estimated fetal weight between 2500 g and 4000 g by
organ prolapse and urine incontinence [1, 2]. Prolonged
obstetric ultrasound.
second stage of labor is the leading cause for that and

for increased fetal morbidity [3].
Exclusion criteria: Women having any obstetric and
In addition, extended second stage heightens the
systemic illness, those who underwent cervical
requirement for operational vaginal delivery and
surgery, BMI 30 kg/m2, induced labors, those with
associated complications [4]. Development and use of
documented fetal anomalies or growth restriction and
obstetric gels with variable structures are reported in
those with documented chorioamnionitis or pre-labor
the literature. Their use aimed for more rapid labors
rupture of membranes.
and less perineal injury through lubricant effect and

decreasing friction between fetal head and birth canal
· Group I: The control group (n = 110) whose labors
[5-7]. So, its use is reported to shorten labor duration but
received standard ante- and intra-partum care without
the effects on perineum are conflicting with lack of
application of K-Y gel.

This study aimed to assess maternal and fetal
· Group II: The study group (n = 110) in whom K-Y
outcomes in nulliparous pregnant women after vaginal
gel (K-Y Jelly Johnson & Johnson 82 gm. Active
application of K-Y gel during the active period of
ingredients) was applied along with the standard care.
labor to facilitate vaginal delivery can hopefully
All interventions including standard intra-partum
reduce perineal and pelvic floor injuries.
care and vaginal application of K-Y gel was carried

out by the attending resident or specialist who was
oriented by the study protocol. Throughout the initial
A prospective case-control study was conducted on
stage of labor, a vaginal examination was conducted
women who were admitted to the Obst. and Gyn. Dep.
every two hours. The frequency of vaginal inspection
at Maternity Hospital of Menoufia University, in the
was modified based on the development of labor. For
period between January and May 2023.
every vaginal examination, sterile gloves were utilized.
After a thorough description of the study's aims, all
The partograph was used to capture maternal and fetal
women who met the inclusion criteria and volunteered
data during labor. The neonatologists who received the
to participate were screened for eligibility.
infant for evaluation, resuscitation, and reporting of the

Apgar score were unaware of the research.
Received: 02/06/2023
Accepted: 02/08/2023

Full Paper (vol.931 paper# 84)

Microsoft Word - New Microsoft Word Document The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7451- 7458

Genotoxic Impacts of Gluten on Chromosomes and DNA of Mice
Nagla, Z. El-Alfy; Mahmoud, F. Mahmoud; Hend, M. Abd-El-Fattah; Asmaa, A. Emam*
Biological and Geological Sciences Department, Faculty of Education, Ain Shams University, Cairo, Egypt.
*Corresponding author: Asmaa Ahmed Emam, Mobile: +201018387665
E-mail: asmaaabdelmohsen@edu.asu.edu.eg, ORCID link: https://orcid.org/0000-0003-4983-3321

Background: Cereal grains contain a group of proteins known as gluten, which is a significant ingredient of the endosperm
of mature cereal grains, making up around 80% of the protein content.
Aim: This study investigated the genotoxic effects of gluten on male albino mice's chromosomes and DNA.
Materials and methods: The study included four groups of mice: a control group, a negative control group given glacial
acetic acid, and two groups given gluten doses of 1.5 and 3 g/kg body weight. These treated groups were given oral injections
3 times/week over 4 weeks. To assess the chromosomal abnormalities of the bone marrow cells, the research utilized C-
banding and G-banding techniques.
Results: The study found that giving mice gluten at both low and high doses caused abnormal changes in bone marrow
chromosomes. The effects were more severe with the higher dose of gluten. These changes involved chromatid
abnormalities such as deletion and fragments, and chromosome abnormalities such as centromeric attenuation, centric
fusion, ring formation, end-to-end association, and chromosomal gap, as well as numerical abnormality like polyploidy.
These changes suggested that gluten treatment may have genotoxic effects. Additionally, the study found that the treated
mice experienced DNA damage, which indicated that gluten can negatively impact DNA integrity.
Conclusion: Limiting gluten intake is important to avoid damage to chromosomes and DNA and prevent potentially harmful
effects on human health. Further research is necessary to understand the genotoxicity mechanisms caused by gluten.
Keywords: C-banding, Chromosomes, DNA, G-banding, Gluten, Mice.


The technological quality of common wheat is
acknowledged as a cancer risk biomarker in humans, as it
significantly determined by the gluten protein
can indicate either the initial biological consequences of
composition of cereal grains (1). When making bread and
genotoxic substances or an individual's predisposition to
pasta, gluten proteins play a crucial role in providing the
cancer (8).
necessary cohesion in the dough. Wheat contains gliadins
Patients with CD who followed a free diet of
(monomers) and glutenins (polymers), while barley
gluten showed a significant decrease in the frequency of
contains hordeins and rye contains secalins. These
chromosomal abnormalities in their PBL (9). The two main
proteins, also known as prolamins, are rich in glutamine
proteins in gluten, gliadins, and glutenins, are known to
and proline amino acids (2). The properties of dough's
be detrimental to individuals with CD. Glutenins form a
viscoelasticity are determined by gluten, a type of storage
mesh of fibers that trap globular gliadins (10). Individuals
protein found in grains. The gluten network in dough
with CD experience DNA damage, pro-apoptotic
provides the necessary cohesion for making bread and
stimulation, and cellular oxidative stress in their cells and
pasta (3). When wheat dough is rinsed, the water-soluble
the mucosa of their duodenum as a result of gliadins (11).
components like starch are removed, leaving behind the

viscoelastic gluten (4).
Wheat allergy, nonceliac gluten sensitivity, and
Chemical used:
celiac disease (CD) are the three primary disorders
For the experiment, gluten powder obtained from
associated with gluten intolerance (5). In individuals with
Sigma-Aldrich Corporation in Cairo was used. The gluten
a genetic predisposition, consuming gluten can lead to
powder had a protein basis assay of 75% and a CAS
celiac disease. The small intestine mucosa is affected by
number of 8002-80-0. The gluten powder was made more
CD, which is a chronic autoimmune disorder that leads to
soluble by dissolving it in glacial acetic acid (0.02 mM)
villi atrophy (6). Gluten intake in individuals with CD
to produce a concentrated solution. This concentrated
results in an immune response that causes damage to the
solution was then given to the animals through an oral
small intestine epithelia. The recommended treatment
feeding tube at doses of 1.5 and 3 g/kg body weight
involves adopting a diet that is free of gluten (7).
(b.wt.). Mice were orally given 3 non-consecutive
Consuming gluten can lead to an increased
days/week for 4 weeks to perform the gluten challenge.
occurrence of chromosomal abnormalities that are
The control group consisted of mice that were not treated
detected through karyotyping of peripheral blood
with gluten or acetic acid, while a negative control group,
lymphocytes (PBL). The identification of this event is
which received only 0.02 mM acetic acid (12, 13).
Received: 27/03/2023
Accepted: 24/05/2023

Full Paper (vol.931 paper# 85)

c:\work\Jor\vol931_86 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7459- 7466

Macrolides and Lincosamides-Resistant Staphylococci Isolated from
Healthcare-Associated Illnesses, Mansoura University Hospitals:
Phenotypic and Genotypic Characterization
Heba Elshahawy1, 2, Alaa Aboelnour1, Mona Sadeq1, Hossam Zaghlol1,
Walaa Othman1, Ehab Badran1, Sara Ghaleb*1
1Microbiology Unit, Clinical Pathology Department, Faculty of Medicine, Mansoura University, Egypt
2Faculty of Medicine, Delta University for Science and Technology, Gamasa, Egypt
*Corresponding author: Sara Ghaleb, Mobile: (+20) 01019338444, E-mail: dr_saraghaleb@yahoo.com

An important public health issue is the rising frequency of infections brought on by
macrolides, lincosamides, and streptogramin-B (MLS-B)-resistant staphylococci. Clindamycin can cause
resistance and therapeutic failure when used to treat infections caused by inducible (iMLS-B) strains.
Objectives: The goal is to identify staphylococcal isolates resistant to MLS-B based on phenotype and
Subjects and Methods:
This study was scheduled to run from September 2021 through August 2022.
Clinical samples were collected from patients admitted to Mansoura University Hospitals with varying
signs and symptoms of infection and cultured on the appropriate culture media. Colony morphology,
Gram stain, biochemical response, and VITEK2 were used to identify isolated colonies. The VITEK2
system was used to test for antibiotic susceptibility.
Bacterial growth was detected in 753 of the 2450 samples analyzed. 350 of them were Gram-
positive bacteria. Of the 350 samples, 200 were staphylococci, and 50 of them were staphylococci with
MLS-B resistance. According to a D-test, 53.2% of MLS-B phenotype had constitutive (cMLS-B), 28.2%
had iMLS-B, and 18.6% had MS. Staphylococcus aureus exhibited a 9.3% MS phenotype, 15.7% iMLS-
B, and 18.7% cMLS-B. ErmA, ermB, ermC, and msrA genes yielded 10%, 32%, 74%, and 4.0%,
respectively. In coagulase-negative staphylococci (CoNS), cMLSB was the most common trait and ermC
gene dominated, followed by the ermB gene. In S. aureus, the ermC gene dominated the iMLSb phenotype
Conclusion: The dominant genes among MLS-B resistant isolates are ermC and ermB, while cMLS-B is
the prevalent phenotype. To prevent therapeutic failure, it is crucial to identify the iMLS-B phenotype by
D-test and find the resistance genes prior to clindamycin administration.
Keywords: Macrolides, Lincosamides, Staphylococci isolated, Healthcare associated illnesses.


Staphylococci are responsible for a variety
which only emerges in response to antibiotics
of diseases, including endocarditis, pneumonia,
that induce methylase production (4).
sepsis, and soft tissue infections (1). Nowadays,
Inducers are macrolides with a 14-member
macrolides, lincosamides, and streptogramin-B
ring (M14, erythromycin, for example) or a 15-
(MLS-B) antibiotics are favored for the treatment
member ring (M15, azithromycin, for example)
(5). Although clindamycin is not an inducer, using
pharmacokinetic qualities. A class of protein
it to treat infections caused by iMLSB strains
synthesis inhibitors are known as macrolides
exhibits broad-spectrum activity (2).
therapeutic failure (2).
Bacterial protein synthesis is stopped when
As a result, the Clinical and Laboratory
macrolides attach to the 50S ribosomal subunit.
Standards Institute (CLSI) recommends utilizing
Once it binds, the medication blocks the enzyme
the double-disk diffusion method (D-test) to
peptidyl-transferase from adding the succeeding
detect Staphylococcus isolates with inducible
amino acid connected to the tRNA, hence
clindamycin resistance (4).
The methylation of adenine in the 23S
specifically, the increasing peptide chain (3).
rRNA ribosomal subunit is carried out by the
methylase, which is encoded by the erm
connected to three key mechanisms: active
(erythromycin ribosome methylation) family of
genes. The presence of active efflux-related
genes, such as the msr genes in Staphylococcus
alterations, and enzymatic inactivation. MLS-B
spp., can also predict the resistance to macrolides
and streptogramins B (MSB phenotype) (6).
This study set out to identify and
resistance to all MLS-B, or inducible (iMLS-B),
characterize the staphylococcal isolates from
Received: 27/03/2023
Accepted: 24/05/2023

Full Paper (vol.931 paper# 86)

c:\work\Jor\vol931_87 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7467- 7472

Intraperitoneal Lidocaine Instillation for
Postoperative Pain Relief after Cesarean Delivery
Mohamed Zakaria Sayer Dayer*, Heba Farag Mohamed Salama, Mohamed El-Sebaaey Antar
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Mohamed Zakaria Sayer Dayer, Mobile: (+20) 01004778794, E-mail: mimo_zsd@yahoo.com

Despite advances in multimodal analgesia, many women still experience inadequate pain control after
cesarean delivery. The intraperitoneal use of local anesthetics has proven effective in postoperative pain reduction
after open or laparoscopic abdominal surgery.
Objectives: We intended to evaluate the efficacy of intraperitoneal lidocaine instillation for relieving postoperative
pain in women underwent elective cesarean sections.
Patients and methods: A randomized, placebo-controlled, triple-blinded trial carried out at Department of Obstetrics
and Gynecology, Menoufia University Hospital. The study comprised 70 term pregnant women underwent elective
cesarean sections through the period from September 2022 to March 2023. They were randomly divided into two
equal groups. Lidocaine group (comprised 35 participants who were administered 50 ml of 2% lidocaine
intraperitoneally). Placebo group (comprised 35 participants who were administered 50 ml of normal saline
intraperitoneally). Primary outcome was postoperative pain scoring (via visual analogue scale) in the first 24 hours
after cesarean delivery. Secondary outcomes were mobilization onset, breastfeeding onset, side effects of
medications, hospital stay duration, and patient satisfaction level in regard to pain control.
Results: Visual analogue pain intensity scores estimated at 4, 6 and 12 hrs after caesarean section were significantly
lower among lidocaine group than placebo (P < 0.001). Lidocaine was significantly superior to placebo in terms of
patient's overall satisfaction score with regards to pain control, the vast majority of candidates in lidocaine group
(94.3%) were satisfied with their pain control versus 57.1% of candidates in placebo group (P<0.001).
Intraperitoneal lidocaine instillation is simple, safe and cost-effective option that can maximize patient's
overall satisfaction with regards to post-cesarean analgesia.
Keywords: Analgesics, Lidocaine, Cesarean section, Patient' satisfaction.

decades, laparoscopic or open abdominal surgery has
Worldwide cesarean delivery is considered the
documented their usage as an efficient adjuvant in
most consistently performed procedure. The cesarean
postoperative multimodal analgesia (4, 5).
delivery rating is about 52% in Egypt that stands out

amongst countries with the highest CS rates
Objective: Evaluation of efficacy of intraperitoneal
worldwide after Dominican republic (56%) and
lidocaine instillation for relieving postoperative pain in
Brazil( 55.6%) (1).
women who had undergone elective cesarean sections.
Postcesarean pain can adversely affects mother­

infant interaction and breastfeeding and its control is
important that mothers can recover early. The best
This randomized, placebo-controlled, triple-
course of action for post-cesarean analgesia should be
blinded trial that was performed at Department of
straightforward, inexpensive, and safe. It should also
Obstetrics and Gynecology, Menoufia University
provide excellent pain relief with a minimal risk of
Hospital through the period from September 2022 to
adverse consequences. Moreover, it should only
March 2023. The aim and steps of the study protocol
involve medications that are very slightly released into
were explained to the participants and written
breast milk and should not interfere with the mother's
informed consents were obtained.
ability to care for the infant or the establishment of
Eighty women were recruited, 10 participants
breastfeeding (2).
were excluded and 70 term pregnant women
Many studies had reported use of local anesthetic
underwent elective cesarean sections were included.
medications during surgeries with beneficial results in
They were randomly divided into two equal groups.
relieving postoperative pain. The mechanism of

analgesic action of local anesthetics applied by
Lidocaine group (comprised 35 candidates who were
intraperitoneal route (IPLA) is mainly via local
administered 50 ml of 2% lidocaine intraperitoneally).
receptors by blocking the afferent peripheral nerve

endings (nociceptors, pain receptors) whose cell
Placebo group (comprised 35 candidates who were
bodies are located in the dorsal root ganglia (3).
administered 50 ml of normal saline intraperitoneally),
The primary benefit of IPLA is that it does not
as shown in consort flow chart (figure 1).
have the significant side effects associated with

systemically injected opioids, despite its well-
Method of randomization: The participants were
established safety and convenience of usage. Since
randomized using statistical package for social science
Received: 30/04/2023
Accepted: 26/06/2023

Full Paper (vol.931 paper# 87)

c:\work\Jor\vol931_88 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7473- 7481

Sexual Functions in Egyptian Females with Vitiligo
Mohammed S. Sultan, Safa Abdulqawi Fetouh*, Youssef Elbayoumy Youssef
Department of Dermatology, Andrology & STDs, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Safa Abdulqawi Fetouh, Mobile: (+20) 01092396301, Email: safaabdulqawi@gmail.com

Background: Vitiligo manifests as depigmented dermal patches developed owing to the loss of melanocytes. It has a
major undesirable effect on sexual activity owing to the deforming skin lesions affecting self-image and self-esteem.
Sexual dysfunction is common and may influence 30­70% of women, leading to individual trouble.
Objective: This study aimed to assess the sexual function and dysfunction in females with vitiligo, and to evaluate the
quality of life (QOL) in relation to disease severity.
Patients and methods: This study was a prospective case-control study, comprising 100 females with vitiligo in the
childbearing period (patient group) and 100 healthy volunteers (control group). Evaluation of vitiligo activity was done
via Vitiligo Disease Activity (VIDA) score & Vitiligo Area Scoring Index (VASI). Patients and controls were asked to
complete the Arabic validated version of Female Sexual Function Index (ArFSFI) questionnaire & Dermatology Life
Quality Index (DLQI).
Results: Total FSFI average score was significantly lower in cases than control with 65% defective pattern in cases,
which was significantly higher than control (22%). Slight difference between patients with VIDA (0 &1) and those with
VIDA (2, 3 & 4), as regards all items and total average scores of FSFI scale. However, the differences were statistically
non-significant. Slight difference between patients with no or slow response to treatment and those with satisfactory
response as regards the total average scores of FSFI scale
Conclusion: According to our study, patients with vitiligo were demonstrated to be at greater risk of sexual dysfunction.
Keywords: Vitiligo, Female sexual dysfunction, Quality of life, Egyptian females, Female sexual function index.


Vitiligo manifests as depigmented patches of the
Sexual dysfunction could be defined as difficulty
epidermis owing to the loss of melanocytes [1].
felt by an individual throughout any stage of a normal
Although a lot of treatment modalities were
sexual activity, such as desire, arousal, lubrication,
prescribed for disease stabilization by stopping the
orgasm, or pain [10]. Management of vitiligo cases must
depigmentation process with a subsequent development
evaluate their emotional effects and comprise tools for
of durable repigmentation, no special cure could be
psychiatric intervention, that might eventually
described till now, and the long-term persistence of
associated with better adaptations with a subsequent
repigmentation could not be predicted [2].
increase of QoL [7].
Vitiligo has been considered as the commonest
Our study aimed to assess the sexual function and
depigmented skin disorder with an estimated prevalence
dysfunction in females with vitiligo, and to evaluate the
of 0.5-2% of the general population. The effects are
QoL in relation to disease severity.
same for both genders, and there are no evident changes

in frequency of occurrence based on photo type or
ethnicity [3]. Obviously, any pathological changes in
The current study was conducted on a total of 100
skin appearance could induce emotional stress, shame,
females with chronic vitiligo in the childbearing period
depression and decrease their self-esteem and hence,
(Patient group) and 100 healthy volunteers (Control
isolate them from the community [4, 5]. Because the skin
group) who meet the inclusion criteria through the
has erogenic functions, skin lesions may negatively
period between October 2021 and June 2022.
affect one's sexual life and interpersonal relations [6].
Patients were recruited from females attending the
It has been demonstrated that the relapsing nature
dermatology, andrology and STDS Out-patients Clinic
of vitiligo impair QoL and the capability for coping with
of Mansoura University Hospital.
society [7].

Development of novel disorders, active diseases,
Inclusion criteria: Females diagnosed with Vitiligo by
and lesion on upper limb had considerable adverse
clinical examination using Woods light, married for at
events on QoL also vitiligo patients being employed and
least 1 year, and had a stable marital relationship and
have new vitiligo patches are of great likelihood for
their husbands had normal sexual function.
depression [8].

FSD is a heterogeneous group of complicated
Exclusion criteria: Pregnant females, females with 2
disorders, which has adverse effects on mental and
months postpartum, females with chronic debilitating
physical health as well as on emotional well-being. It is
and severe medical illnesses, females with history of
a frequent disorder in females whatever the age and
psychiatric disease, females with sexual disorders
negatively affects their QoL and affects also the sexual
before developing vitiligo and females with other
function and QoL of their partners [9].
physical deformities affecting their self-esteem.
Received: 01/05/2023
Accepted: 02/07/2023

Full Paper (vol.931 paper# 88)

c:\work\Jor\vol931_89 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7482- 7487

Value of Coxsackie and Adenovirus Receptor (CAR) Gene
Expression in Colorectal Cancer
Basma Shousha1, Mohammed Elshaer1*, Mohamad Elhemaly2,
Wafaa Elemshaty1, Hosam Zaghloul1, Eman Elsayed1
Departments of 1Clinical Pathology and 2Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*Corresponding author: Mohammed Elshaer, Mobile: (+20) 01020480202,
Email: Melshaer85@mans.edu.eg., ORCID: 0000-0002-0179-2869

The Coxsackie virus and Adenovirus Receptor (CAR) is a cellular protein that has a role in cell adhesion,
signaling, and viral infection. There is much disagreement over the significance of CAR expression in colorectal carcinoma
development, with some research suggesting CAR downregulation and others indicating that CAR enabled complicated
effects during colorectal carcinogenesis.
Objective: This study aimed to elucidate the difference in CAR expression levels in colorectal cancer (CRC) tissue versus
normal colon tissue, and to correlate the expression levels with the disease stage.
Patients and methods: Fifty patients with proven colorectal cancer were enrolled in this study. During surgical excision
treatment, 50 pairs of CRC tissue and normal tissue samples were obtained and examined for CAR expression levels using
reverse transcriptase Real time PCR.
Results: CRC specimens showed significantly downregulated CAR gene expression when compared to nearby safety
margin specimens. No significant differences were found in CAR gene expression levels in CRC tissue based on patients'
gender, tumor site, size, associated LN metastasis and tumor stage (p > 0.05 for each). However, stratifying cases into early
(stages I and II) and advanced (stages III and IV) revealed that lower CAR gene expression was significantly associated
with advanced CRC stages.
Conclusion: Low CAR gene expression may have a potential role in colorectal carcinogenesis and its level is associated
with advanced CRC stages with poorer prognosis.
Keywords: Adenovirus receptor, Colonic neoplasms, Carcinogenesis, Coxsackie virus infections.

to have reduced CAR expression. These include cancers
The fourth most frequent cancer worldwide is
with poor differentiation and late disease stages (9-11).
colon cancer, while rectal cancer is the eighth most
On the contrary, CAR has been hypothesized to
common cancer. In total, colorectal carcinomas (CRCs)
promote the growth of adenocarcinomas due to the
rank the third among cancers diagnosed worldwide (1).
presence of high CAR expression in early-stage breast
CRC often develops when certain epithelial cells undergo
and esophageal cancers (12). Additionally, CAR has been
a number of genetic or epigenetic changes (2). Risk factors
demonstrated to prevent apoptosis in adenocarcinoma
of CRC include older age, excessive alcohol use, limited
cells and is essential for optimal tumor cell proliferation
physical activity, obesity, imbalanced diet, a family
history of polyps, and inflammatory bowel disease (3).
There is a strong controversy in the role of CAR
Metastasis usually occurs in around 30­50% of
expression in colorectal carcinoma, with some studies
individuals after surgical treatment of localized tumor,
demonstrating CAR downregulation (14-15). However,
whereas 25% of patients directly present with metastatic
others suggest that CAR expression, maybe through its
disease (4). The local tumor growth, as well as the
existence of regional and distant metastases, are the most
important factors in determining the prognosis of colon
carcinogenesis (11).
cancer (5).
Therefore, in this study we aimed to elucidate the
On the surface of epithelial cells, the
difference in CAR expression levels in CRC tissue versus
transmembrane glycoprotein known as the CAR was
normal colon tissue, also to correlate the expression levels
initially identified as a location for viral attachment (6).
with the disease stage.
Furthermore, it was recognized as a part of the tight

junction complex (7). It is a member of the
immunoglobulin-like surface molecule subfamily and
Study Design and Participants: This is a cross-sectional
seems to be involved in cell adhesion or intercellular
case-control study, which was carried out in
recognition (8). Numerous solid tumours, such as those of
Gastroenterology Surgical Center and Clinical Pathology
the ovaries, lungs, breast, and bladder, have been shown
Department, Mansoura University through the period
from July 2020 to March 2022 after approval from ethics
Received: 01/05/2023
Accepted: 02/07/2023

Full Paper (vol.931 paper# 89)

c:\work\Jor\vol931_90 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7488- 7501

Production, Properties and Application Trends of Iturin
Biosurfactant Produced from Bacillus altitudinis AHMNAZ2
Alaa Atef1*, Mostafa M. Abo Elsoud2, Heba I. Elkhouly1 and Nagwa M. Sidkey1
1Botany and Microbiology Department, Faculty of Science, Al-Azhar University (Girls Branch), Cairo, Egypt
2Microbial Biotechnology Department, National Research Centre, Dokki, Giza, Egypt
*Corresponding author: Alaa Atef, Tel.: 01069078438; E-mail: alaaatef78@yahoo.com; alaasoliman.el.8.89@azhar.edu.eg.

Biosurfactants are surfactants derived from several types of microorganisms such as bacteria, yeasts and
fungi as membrane components or secondary metabolites.
Objective: To improve the output of biosurfactants as a low-toxic, biocompatible alternative for chemical surfactants
utilized in a wide range of applications in today's industry.
Materials and Methods: Different culture media were used in isolation of the biosurfactant (BS) producers. By using 16S
rRNA, the most effective bacterial isolate was examined. For the optimization circumstances, Plackett Burman and Box-
Behnken designs were employed. Purification and characterization of biosurfactant was done.
Results: Only one isolate (BS) out of 63 isolates was selected for its potential ability of biosurfactant production, which
lowered the surface tension (38.1 mN/m) and exhibited excellent emulsifying index against benzene (60.92 %) as well as
oil spreading activity (9.76 cm), which was analyzed as Bacillus altitudinis AHMNAZ2 with accession number
OP807875.1. The highest biosurfactant production yield was 2570 mg/L. The biosurfactant was lipopeptide in origin,
identified as an iturin. Isolated iturin can be employed as an antibacterial agent against various Gram +ve and Gram -ve
bacteria as well as some fungi. It showed remarkable action against the cell lines of breast cancer (MCV- 7) and colon
cancer (HCT- 116).
Conclusion: The investigation found a cheaper way of synthesis of biosurfactants from industrial wastes, delivering a
twofold benefit of reducing pollution of environment and manufacturing useful biotechnological biosurfactant products, in
addition to biosurfactant synthesis with high potency.
Keywords: Biosurfactant, Bacillus altitudinis, Iturin, Antimicrobial, Antitumor.


Biosurfactants are microbial substances with a
biodegradability is one benefit added by biosurfactants,
unique surface action. They belong to various groups,
among others, environmentally friendly, low toxicity,
including glycolipids, fatty acids, phospholipids,
non-hazardous, higher selectivity, mild production
lipopeptides, neutral lipids, and polysaccharide-protein
conditions using renewable materials and industrial
complexes. These substances can play a variety of
waste/by-products as substrates, capacity to operate in
biological functions in the development and reproduction
harsh conditions with varying pH range and salinity
of microbes. Most biosurfactants are produced
levels, and modification by biotechnology and genetic
extracellularly or on cell surfaces by different
engineering (4). As a result, this current investigation was
microorganisms (bacteria, yeast and fungi) (1).
carried out to generate stable potent biosurfactant using
These are amphiphilic compounds that are
different cost-lowering renewable wastes and to assess
organic and surface-active, including both hydrophobic
the potential of produced iturin for various applications.
and hydrophilic moieties. The non-polar hydrophobic part

has an affinity for non-polar compounds like oils, fats, and
greases, whereas the polar hydrophilic part has a strong
1. Isolation sources and culture media
affinity for polar solvents like water, acetic acid,
A sum of sixteen solid samples were gathered in date
methanol, etc (2). Due to their capacity to aggregate
of 8/2021 from different locations polluted with oil viz.
between fluid phases and lower overhead or interfacial
(Shoubra El Kheima, Nasr City in Cairo, Elbehira, Red
tensions, surfactants are extensively utilized in the food
Sea in El Ein El Sokhna, Egypt) for isolation of the
and beverage, cosmetics, pharmaceutical, textile, and
biosurfactant producers. To isolate, purify, and maintain
improved oil recovery from rocks industries (3).
bacterial isolates, nutrient agar medium and minimal salts
According to Jadhav et al. (4), many commercial
medium (MSM) were utilized. After the isolates were
surfactants in the market today are chemically produced
purified, their capacity to generate biosurfactants was
from hydrocarbon feedstock. These surfactants frequently
assessed, and one especially strong isolate was selected
result in an additional source of pollution to already
for further study. Modified production medium, Bushnell
depleted natural habitat because they are intrinsically
and Hass(6) medium-molasse (BHM-M), which contains
hazardous and non-biodegradable (5). Improved
Received: 26/04/2023
Accepted: 22/06/2023

Full Paper (vol.931 paper# 90)

c:\work\Jor\vol931_91 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7502- 7507

Knowledge and Response of Medical Students at Suez University Regarding
Elective Oocytes Cryopreservation; A Cross-Sectional Study
Ahmed Sewidan1, Hany Mahmoud Abd Elhamid2
1Obstetrics and Gynecology Department, Faculty of Medicine, Suez University,
2Obstetrics and Gynecology Department, ELSahel Teaching Hospital
Corresponding Author: Ahmed Sewidan, Phone No.: (+2) 01205533381
E-mail: Ahmed.Sewidan@med.suezuni.edu.eg, ORCID ID: 0000-0002-6567-9988

With the development of oocyte cryopreservation and the verification process, women who wish to delay
pregnancy can avoid the need for donor oocytes and can use their own eggs at a later age.
Objective: To know the knowledge of female medical students at Faculty of Medicine, Suez University regarding elective
oocytes cryopreservation.
Subjects and Methods: An observational cross-sectional study through a structured online survey about elective oocyte
cryopreservation (egg freezing). The study included 173 Suez University medical students.
Results: Of the total, 50.3% of the studentshad some knowledge about oocyte cryopreservation, 36.4% of them didn't
consider oocyte freezing, 53.2% of them considered oocyte cryopreservation for medical causes (ex. while undergoing
radiation therapy or chemotherapy), 69.4% of them didn't think that this procedure has a negative effect on their future
fertility, 72.8% of them believed that oocytes freezing should be self-paid and 66.5% of them would be more amendable
to freezing their eggs.
Conclusion: Our study revealed an appreciable level of awareness about the oocytes freezing. We found that medical
education has a positive impact on raising awareness regarding the causes of oocytes freezing, the availability, and its
protective efficacy.
Key words: Medical Students; Knowledge; Oocytes Cryopreservation.


Oocyte cryopreservation for nonmedical purposes
The baseline knowledge and attitudes of medical
has become more prevalent in recent years(1).
professionals, including residents in obstetrics and
With the removal of the experimental label from
gynecology, were also evaluated(7).
oocyte cryopreservation by the American Society for
The findings consistently show that adequate
Reproductive Medicine, "elective" use of this technology
awareness of age-related fertility reduction is poor in all
for fertility preservation has gained support in both the
groups, and attitudes toward elective fertility preservation
medical community and mainstream society(2).
differ greatly (8).
The concept of voluntary fertility preservation is not
Medical students are a distinct subset of people when
without dispute, and issues such as the optimal age for
it comes to elective fertility preservation because they are
oocyte cryopreservation, the implications of cost-benefit
both patient advocates and a representation of the young
analysis, and the scarcity of long-term data all merit
professional population who may postpone family
further investigation (3).
formation for the sake of their job and could benefit from
Nonetheless, the focus on age-related fertility
this service. Aside from their medical knowledge, the
decreases and attempts to safeguard future childbearing
interaction between their professional view of elective
potential has certainly been brought to the forefront.
fertility preservation for patients and their notion of
Understanding the baseline knowledge and attitudes
potentially using this technology for their own personal
of individuals involved in the decision-making process,
reasons is an intriguing concern(9).
particularly patients and their health care professionals, is
As a result, the goal of this study was to evaluate
critical to this topic (4).
medical students' general knowledge as well as their
Numerous studies have been conducted to analyze
personal and professional opinions of age-related fertility
the general public's comprehension of age-related fertility
decrease, intentional fertility preservation, and barriers to
decline, attitudes toward ovarian reserve monitoring, and
care. This assessment was conducted after an online
perceptions of elective fertility preservation, particularly
survey on the topic and, to our knowledge, is the first
among young persons pursuing higher education(5).
study at Suez Universityto attempt to assess the impact
Other studies looked at patients' pre-visit
that a brief educational intervention may have on these
information before undergoing medically recommended
fertility preservation (6).

Received: 25/04/2023
Accepted: 21/06/2023

Full Paper (vol.931 paper# 91)

BODY MASS INDEX IN MULTIPLE SCLEROSIS: ASSOCIATION WITH SERUM LEPTIN The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7508- 7514

Assessment of Right Lobe Size/Serum Albumin Ratio as A
Non-Invasive Marker for Esophageal Varices in HCV Patients
Eman Mobarak Kamel, Tarek Maged Elsafty, Ahmed Ali Moenis, Salah Shaarawy Galal
Internal Medicine and Gastroenterology Department, Faculty of Medicine, Ain-Shams University, Egypt
*Corresponding author: Salah Shaarawy Galal, Mobile: (+20) 01099422172, E-mail: salahshaarawy2013@gmail.com

According to current guidelines, all patients with cirrhosis should have a screening endoscopy
performed at the time of diagnosis in order to identify those who would benefit from primary prophylaxis and have
varices that put them at high risk of bleeding. By identifying patients at highest risk for esophageal varices
noninvasively, invasive study would only be necessary for those most likely to benefit.
Our study's objective was to ascertain the predictive efficacy of noninvasive indicators (Right lobe
diameter/serum albumin ratio) in predict esophageal varices.
Patients and Methods:
This is a cross-sectional study carried on 100 patients collected from the Hepatology
Outpatient Clinics and from Hepatology and Gastroenterology Unit, Internal Medicine Department at Ain Shams
University Hospital over 6-months period. All patients were divided into 3 groups: 30 patients with Child-Pugh A, 30
patients with Child-Pugh B, and 40 patients with Child-Pugh C.
Results: Our study showed by regarding platelet count, INR, serum albumin, liver size, liver size/serum albumin ratio
that there was a significant difference among esophageal varices grades. Liver size/serum albumin ratio had non-
significant diagnostic performance in differentiating esophageal varices grade-I from grade-0, and had significant
moderate diagnostic performance in differentiating other esophageal varices grades from each other. Liver size/serum
albumin ratio cutoff points had high specificity and PPV but low sensitivity and NPV in differentiating grade-I from
grade-0, and had high sensitivity and NPV but moderate specificity and PPV in differentiating other grades from each
Our study stresses on the use of some of the non-invasive parameters in predicting the grade of
esophageal varices in cirrhotic patients without submitting them to the invasive, time consuming and expensive
procedure of endoscopy.
Keywords: Right Lobe Size, Serum Albumin Ratio, Esophageal Varices, HCV Patients.


not have esophageal varices and are consequently
Worldwide, Egypt has the highest rate of hepatitis
subjected to endoscopy needlessly (7).
C virus (HCV) infection. Twelve million Egyptians, or
Our study's objective is to ascertain the predictive
13% of the country's population, are thought to be
efficacy of noninvasive indicators (Right lobe
affected with HCV (1). One of the most significant
diameter/serum albumin ratio) in predict esophageal
liver-related comorbidities is esophageal varices,
which eventually result in 20% mortality during the

first attack. Predicting EVs was made easier by using
2D U/S (2). Individuals with long-term HCV infection
Study Population:
run the risk of serious liver problems. Additionally,
This was a cross-sectional study carried on 100
extra-hepatic symptoms were reported by up to two-
patients, collected from the Hepatology Outpatient
thirds of individuals with HCV infection (3).
Clinics and Hepatology and Gastroenterology Unit,
According to extensive research, up to 30% of
Internal Medicine Department at Ain Shams
infected people may develop cirrhosis, which can
University Hospital over a 6-month period, after
result in HCC and end-stage liver failure (4). Patients
acquiring the approval from the Ethical Committee of
with cirrhosis should be screened for varices in order
Ain Shams University.
to start primary prophylaxis and stop variceal bleeding
Patients were divided into 3 groups: 30 patients
with Child-Pugh A. 30 patients with Child-Pugh B,
One of the cirrhosis consequences that characterises
and 40 patients with Child-Pugh C.
the advancement to the stage of decompensated

cirrhosis is variceal haemorrhage, which can have a
The following procedures were performed on all
mortality rate of up to 40% based on the severity of the
liver disease (6). Patients at high risk for variceal
Full medical history and clinical examination.
haemorrhage should get primary prophylaxis. It has
Laboratory investigations: (AST, ALT, Bilirubin,
long been advised to do endoscopic screening for
Albumin, INR, Alpha fetoprotein, CBC).
esophageal varices at the time of cirrhosis diagnosis in
order to identify these individuals. Non-invasive
ultrasonography: these tests were carried out with
techniques for variceal screening have been researched
the patient in a supine position following an
since many patients in the early stages of cirrhosis do
overnight fast. The liver right lobe diameter (cm),
Received: 01/05/2023
Accepted: 02/07/2023

Full Paper (vol.931 paper# 92)

c:\work\Jor\vol931_93 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7515- 7520

Myocardial Strain Analysis by 2-Dimensional Speckle Tracking
Echocardiography in Patients with Suspected Coronary Artery Disease
*Abdelsabour Elsayed , Manar Mostafa Alzaki, Kamal Saad Mansour, and Wael Ali Khalil
Cardiology Department, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Abdelsabour Elsayed, Email: drsaboursherif@gmail.com, Tel: +20 1559010688

segmental and global longitudinal peak systolic strain can detect the presence, severity, and extension of
coronary artery disease (CAD) in suspected CAD patients.
Objective: To evaluate the role of myocardial strain by 2-dimensional speckle tracking echocardiography in patients
with suspected CAD and normal LVEF without rest segmental wall motion abnormalities
segmental and global longitudinal peak systolic strain was done in seventy-four suspected CAD patients with
normal echocardiographic study then correlated to the coronary angiography findings for each patient.
Results: 18.5 was global longitudinal strain (GLS) cut off can detect CAD with AUC of 0.791, sensitivity of 82.4%,
specificity of 70.2%, PPV of 71.2% and NPV of 93%. There was significant relation between CAD presence and GLS
with mean value of 19.94 ± 2.68 and 16.77 ± 2.87 for non-significant and significant CAD respectively. Means of GLS
were 14.88 ± 2.09, 16 ± 2.66, 18.25 ± 2.62 and 19.94 ± 2.68) for 3 CAD, 2 CAD, 1 CAD and normal results respectively
(p value <0.001). GLS discriminated well between LM stenosis and non- LM stenosis (13 ± 0.71 and 16.7 ± 1.91
respectively, p<0.001). Segmental longitudinal systolic strain can localize the affected vessel with p value < 0.001 and
our study showed positive relation between GLS and LVEF and inverse relation between GLS and syntax score
Conclusion: Global and segmental longitudinal strain assessed by 2D-STE at rest in suspected CAD even without
apparent wall motion abnormalities can diagnose CAD earlier and can predict which patient at higher risk. Also, it can
identify how many vessels affected and localize CAD with accepted sensitivity and specificity.
Keywords: CAD, Global & segmental longitudinal strain, Coronary angiography.


longitudinal strain is sensitive for detection of presence
Transthoracic echocardiography is performed for
localization and extension of coronary artery disease (6).
suspected CAD patients. However, a lot of patients with

ischemic heart disease (IHD) do not exhibit rest wall
motion abnormalities especially without structural heart
Our study performed in Zagazig University hospitals
disease or history of myocardial infarction (1).
cardiology department. Patients.
While, stress ECG is widely available but has

limited sensitivity and specificity (2).
Inclusion criteria: seventy four Patients with
suspected CAD and normal LVEF without rest
t e c hni que s have good diagnostic accuracy,
segmental wall motion abnormalities who had high
but radiation, cost, and lack of availability are
clinical likelihood of CAD, patients with symptoms in
considered a major limitation (3).
spite of tolerated maximal medical anti ischemic
It is also possible to do physical/pharmacological
treatment, patients with inconclusive non-invasive
stress echocardiography with good sensitivity and
testing patients with typical angina at minimal effort and
specificity in comparison with myocardial perfusion
high-risk features on non-invasive testing.
imaging, but this method needs great experience with

associated side effects limiting its common use (4).
Exclusion criteria: Patients with ECG changes
The last European Society of Cardiology (ESC)
consistent with transmural MI, LV systolic impairment,
guidelines recommended using cardiac computed
significant valvular heart disease, marked myocardial
tomography (CCT) for younger patients who have chest
hypertrophy, significant ventricular arrhythmia,
pain and low to intermediate clinical likelihood of CAD
pacemaker insertion, BBB and those with poor
due to its greater anatomic information and high
echocardiographic image.

disadvantages are less availability, costs, and a need of
On admission to the hospital, all patients agreed by
a well-trained team (5).
written consent for the research work up that included
Global longitudinal strain (GLS) is non-invasive
the following:
and easy way to detect early signs of myocardial

dysfunction as cause of CAD. Hence selecting patients
1- Meticulous medical histories included the basic
patients' data like age, sex, body mass index, and any
subendocardial fibers are more suffering in case of
cardiovascular risk factors and previous current
CAD. So, studying the global and segmental
management and chest pain analysis
Received: 01/05/2023
Accepted: 02/07/2023

Full Paper (vol.931 paper# 93)

c:\work\Jor\vol931_94 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7521- 7526

Comparison between Breast Feeding and Formula Feeding in
Neonates with Idiopathic Hyperbilirubinemia
Suzan Samir Gad1, Samar ElFiky1, Hamdy Mahmoud SaadElgabery2*
1Pediatrics Department, Faculty of Medicine - Suez Canal University,
2Mansoura general hospital
*Corresponding author: Mahmoud SaadElgabery, Email: drhamdygaberry@gmail.com, Mobile: 01029532975


Background: Breast-feeding had been linked to an increase in newborn jaundice during the first postnatal days.
Unconjugated hyperbilirubinemia prolongation in breastfed infants is a typical and frequently occurrence of a
physiological jaundice extension. Breast feeding and jaundice are strongly linked in healthy newborn newborns.
Aim of the work: This study aimed to improve outcome of neonates with idiopathic hyperbilirubinemia via doing
comparison between breast-fed and artificial-fed infants with idiopathic hyperbilirubinemia.
Patients and methods: Our study included 150 neonates diagnosed with hyperbilirubinemia attending to Suez Canal
University Hospital's Neonatal Intensive Care Unit. They were divided into group one included 50 neonates who
received 75% of their feed as breast milk, group two included 50 neonates who received 75% of their feed as formula
feeding (FF) and group three include 50 neonates who received both formula and breast feeding. Each neonate was
subjected to complete history taking and examination.
Results: The mean serum bilirubin was higher among breast-fed infants than formula-fed infants at admission and after
2 days with statistically significant difference. Feeding frequency showed statistically significant weak negative
correlation with bilirubin among formula-fed infants. Statistically significant negative correlation between bilirubin
change after 2 days of admission in formula-fed infants and weight with bilirubin change among formula-fed infants.
Conclusion: Breastfeeding jaundice should be considered one of the most common causes of pathological jaundice,
making lactational counseling throughout the antenatal and postnatal period to be an essential component of pathological
jaundice care and prevention.
Keywords: Breastfeeding, Idiopathic hyperbilirubinemia, Infants, Jaundice.


Jaundice is a prevalent condition in term and preterm
neonates who are affected during the early neonatal
hyperbilirubinemia in breastfeeding infants. In healthy
period, with up to 60% of term and 80% of preterm
newborn newborns, there is a direct correlation between
infants. Approximately 60% of all term neonates exhibit
breastfeeding and jaundice (6). Thus, this study aimed to
clinical icter within 7 days of delivery, though less have
improve the outcome of neonates with idiopathic
pathogenic etiology (1). Physiologic jaundice is defined
hyperbilirubinemia via doing comparison between
by total serum bilirubin levels of up to 6 mg/dL that
breast-fed and artificial-fed infants with idiopathic
decrease over the first week, whereas pathologic
hyperbilirubinemia and improving the practice of breast
jaundice is defined by developing jaundice within 24
feeding of mothers.
hours of birth, total serum bilirubin levels more than 17

mg/dl, serum conjugated bilirubin levels of more
greater than 2 mg/dL, or greater than 20% of total serum
Our observational cross-sectional study was carried
bilirubin concentration (2).
out in the Neonatal Intensive Care Unit in Suez Canal
Jaundice in breastfed infants often occurs between
University Hospital through the period from December
24 and 72 hours after birth, peaks between 5 and 15 days
2019 to December 2020 on neonates suffering from
later, and goes away by the third week. These infants
have been noted to have higher bilirubin levels. Mild
jaundice in breastfed neonates may appear 10­14 days

after delivery or may return while the infant is still
Inclusion criteria: Neonates diagnosed with
nursing (3). The incidence of hyperbilirubinemia was
hyperbilirubinemia attending to Neonatal Intensive
significantly reduced in neonates who were nursed 8
Care Unit in Suez Canal University Hospital and
times per day than those who were breastfed 8 times per
fulfilling the criteria of idiopathic hyperbilirubinemia.
day, and more frequent breastfeeding is linked to lower

serum bilirubin levels (4).
Exclusion criteria: Newborns who had hemolysis,
Newborns who are breastfed have greater bilirubin
abnormal hemogram, abnormal reticulocyte count,
levels than newborns who had fed formula, frequently
complications such as sepsis or with direct
displaying bilirubin levels >12 mg/dL (5). An expected
hyperbilirubinemia and infection.
and frequent extension of physiological jaundice in

Received: 01/05/2023
Accepted: 02/07/2023

Full Paper (vol.931 paper# 94)

c:\work\Jor\vol931_95 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7527- 7534

Screening for Frequency of Occurrence of Mutations of Exon 28 of ABCC8 Gene in
Egyptian Patients with Congenital Hyperinsulinism
Shereen Abdelghaffar1, Hanan Ali Ahmed Madani 2,
Mohammed Ahmed Mohammed Elsaid Ashour3, Yomna Ahmed Hosni1*, Marise Abdou1
¹The Diabetes Endocrine and Metabolism Pediatric Unit, Abo ElReesh Children's Hospital,
2Department of Clinical and Chemical Pathology, 3Department of Pediatrics, Faculty of Medicine, Cairo University
Corresponding author: *Yomna Ahmed Hosni, Email address: yomnahosni@cu.edu.eg,
ORCID ID: 0000-0003-2174-3535, mobile:Tel.: +20 1115522003

Congenital hyperinsulinism (CHI) is a severe inherited form of hyperinsulinemic hypoglycemia (HH). It can
occur as a result of several gene mutations. The most prevalent are mutations of the ABCC8 gene, which codes for the
sulphonylurea receptor 1 subunit (SUR-1) of the potassium-sensitive ATP channels located on the pancreatic B-cells.
Aim of the study: to identify mutations of exon 28 of the ABCC8 gene in patients with CHI.
Patients and Methods: Thirteen patients diagnosed with CHI, aged from 1 day to 18 years, following up in the Diabetes,
Endocrine and Metabolism Pediatric Unit, Abo ElReesh Children's Hospital, Cairo University were recruited. Clinical and
biochemical data were collected through history taking, physical examination, and revising patients' medical records. Genetic
analysis of exon 28 of the ABCC8 gene was done using DNA sequencing.
Results: The results of the DNA sequencing of exon 28 of the ABCC8 gene and its intronic boundaries detected no
abnormalities in the study group except for one case which revealed an intronic homozygous variant on intron 28
(rs1954399854) of uncertain significance. Conclusion: Mutations of the ABCC8 gene account for around 40-50% of CHI
cases. To our knowledge, there are no sufficient studies in the Egyptian population to detect mutations of the ABCC8 gene,
which necessitated conducting this study. Exon 28 of the ABCC8 gene was the only exon tested due to limited resources and
self-funding. This did not reveal significant mutations. Further research is warranted to detect other ABCC8 gene mutations in
the Egyptian population.
Keywords: CHI, Octreotide, Exon 28 ABCC8 gene.

also lead to life-endangering apnea, status epilepticus, or

Persistent hypoglycemia is a serious illness leading to
coma(3). In older patients, the clinical signs may be less
lifelong neurological sequelae. The most frequent cause of
prominent, but they are typically severe during the first
persistent hypoglycemia is hyperinsulinemic hypoglycemia
month of life. The disease severity may even differ within
(HH). Congenital hyperinsulinism (CHI) is the most severe
the same family(9). Therefore, early detection and prompt
form of HH(1). CHI is a group of heterogeneous diseases
management are necessary to avoid brain insult(10).
characterized by frequent attacks of hypoglycemia due to
In the case of CHI with mutations inherited paternally,
inappropriate insulin production from the B-cells of the
especially in the ABCC8 gene, they have a higher
pancreas. This group of disorders can result in serious
probability of focal lesions occurring in the pancreas.
neurological sequelae in pediatric patients which
Recently, the diagnosis of these patients has been easier due
necessitates prompt diagnosis and management(2).
to recent improvements in molecular genetic analysis and

CHI has an estimated incidence of 1/50,000 newly-
18-fluro L-dihydroxy phenylalanine (18F-DOPA) positron
born and reaches 1/2500 in areas with elevated rates of
emission tomography (PET CT) imaging(11,12).
consanguineous marriage(3,4). Dysregulation of insulin
The first line of treatment is diazoxide, which reverses
production is due to mutations in 12 distinctive genes
the effects of glucose-induced channel closure by activating
intact K-ATP channels. Nevertheless, it is ineffective in
HADH, SLC16A1, HNF1A, UCP2, and HNF4A) (5).
treating patients with focal CHI and diffuse CHI brought on
Recently, mutations in two novel genes forkhead box A2
by recessive inactivation mutations in ABCC8 and
transcription factor (FOXA2) and calcium voltage-gated
KCNJ11(10). A second line therapy is octreotide which is a
channel subunit alpha1 D (CACNA1D) and genes have
long-acting somatostatin analogue that hinders insulin
been associated with CHI(6).
production(13). Surgery is used in the management of patients

Around 40-50% of CHI cases were accounted for by
presenting with focal lesions in the pancreas(14) and when
more than 200 different mutations in ABCC8 (encoding for
medical treatment fails to control hypoglycemia(15,16).
the SUR1 subunit of the K-ATP channel) versus 30 distinct
To our knowledge, there is no sufficient research
KCNJ11 mutations (encoding for the Kir6.2 subunit of the
conducted to detect mutations of the ABCC8 gene, which
K-ATP channel)(7), 5-10% of the cases were accounted for
accounts for around half of the cases of congenital
by other genes. While the remaining 40% remain
hyperinsulinism (CHI). This study aimed to identify
unaccounted for(8).
mutations in the exon 28 ABCC8 and its intronic
The main clinical presentation of CHI is
hypoglycemia. This hypoglycemia may not be symptomatic

(detected as a finding during glucose checking) but it may

Received: 02/05/2023
Accepted: 03/07/2023

Full Paper (vol.931 paper# 95)

c:\work\Jor\vol931_96 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7535- 7540

Venoarterial Carbon Dioxide Gradient and Central Venous Oxygen
Saturation as a Prognostic Value in Severe Intraabdominal Sepsis
Ahmad Maged Abdel Mohsen Abdel Aziz*1, Samir M. Attia2, Mohamed Elsaid Ahmed3, Amr Sameer4
Departments of 1Emergency Medicine, 2Vascular Surgery,
3Emergency Hospital and 4General Surgery, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmad Maged Abdel Mohsen, Mobile: (+20) 1116665156, Email: ahmadmaged802@gmail.com

For physicians, the prognostic value of central venous oxygen saturation (ScvO2) and venoarterial carbon
dioxide difference (PvaCO2) among severe sepsis patients remains unclear.
Objective: The aim of this study was for assessment of the prognostic value of PvaCO2 and ScvO2 among severe
intraabdominal sepsis.
Patients and methods:
This prospective study included 62 patients with intraabdominal sepsis who were presented at
the Emergency Hospital Mansoura University for one year duration. PvaCO2 and ScvO2 values were assessed at
admission and every 6 hours till the end of 48 hours.
Results: The PvaCO2 showed significant high levels among the survivor group compared to with the mortality group at
6-48 Hours. Among the included patients, the non survivors tended to have either above or below normal levels of
ScvO2 at 6-48 hours. Multivariate analysis showed that decreased PvaCO2, increased APACHE-II score, increased
SOFA score and increased qSOFA score at admission were shown as independent risk predictors for mortality.
Conclusion: Elevated PvaCO2, above and below normal ScvO2 levels are associated with poor outcomes and raised risk
of mortality. Thus, they hold promise as prognostic values in severe sepsis patients.
Keywords: Intraabdominal Sepsis, PvaCO2, ScvO2.

Further evidence indicates that raised PvaCO2
In critically ill patients, inadequate tissue
levels may detect septic patients who meet oxygen-
perfusion is a major factor in the onset and course of
related goals but do not receive adequate resuscitation,
MOF. The majority of tissue perfusion monitoring
highlighting the significance of PvaCO2 as an overall
techniques now in use have mostly focused on general
perfusion indicator because it can monitor blood flow
blood circulation and the equilibrium between supply
variations and even identify the production of anaerobic
and demand for oxygen. It has been demonstrated that
CO2 [4]. Moreover, the dynamics of PvaCO2 in the early
early hemodynamic optimization, with an emphasis on
phases of septic shock resuscitation have not been
systemic hemodynamic parameters and central venous
thoroughly studied, and recent research aiming to
oxygen saturation, improves outcomes in severe sepsis
confirm the effectiveness of PvaCO2 as a tool in septic
and septic shock, highlighting the relationship between
patient resuscitation may be biased due to selection bias
tissue perfusion abnormalities and blood flow in the
because not all qualifying patients received goal-
early stages of illness [1]. However, reaching normal
directed therapy and catheter insertion [5-8].
systemic hemodynamic parameters does not ensure
The aim of this study was to assess the prognostic value
sufficient tissue perfusion; in fact, many patients who
of venoarterial CO2 gradient and central venous
meet ScvO2 objectives still have multi-organ
oxygen saturation among severe intraabdominal sepsis.
dysfunction and mortality. Furthermore, some research

has shown that even in the presence of regional and
measures like central venous oxygen saturation (ScvO2)
This was a prospective observational study that
often return to normal upon admission to the ICU, and
was conducted
at the
Emergency Department,
that interventions like urgent intubation can quickly
Mansoura University Hospitals within the period from
restore ScvO2 levels [2].
January 2022 to January 2023.
In the past, scientists have seen that after

cardiac arrest, venous acidosis and elevated venous
Inclusion Criteria: According to the Third
(CO2) levels coexist in both critically ill humans and
International Consensus Definitions for Sepsis and
animals. Consequently, in situations like hypovolemic,
Septic Shock (Sepsis-III) [9], septic patients with severe
cardiogenic, obstructive, and septic shock, an increase
intraabdominal sepsis who were older than 18 years old
in (PvaCO2) has been seen. It's interesting to note that a
and met at least two of the following criteria (disturbed
nonlinear relationship has been found between PvaCO2
consciousness, respiratory rate of 22/min or higher, or
and COP, highlighting the role that blood flow plays in
SBP 100 mmHg were included in the current study.
the buildup of venous CO2. PvaCO2 has attracted

therapeutic interest as a global perfusion indicator
Exclusion Criteria: pregnancy and patients with
during shock states as a result of this [3].
advanced tumors or irreversible organ failure,
Received: 03/05/2023
Accepted: 04/07/2023

Full Paper (vol.931 paper# 96)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7541- 7547

Study of Plasma Cyclic Guanosine Monophosphate as a
New Marker in Patients with Portal Hypertension
Heba Ahmed Faheem1, Nannes Ahmed Adel1, Eslam Safwat Mohamed1,
Omar Galal El Din Moustafa1, Samy Mahmoud Abdo1, Norhan Nagdy Madbouli*2,3
1Department of Internal Medicine, Gastroenterology and
Hepatology Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2Department of Internal Medicine, Armed Forced College of Medicine, Cairo, Egypt
3Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Norhan Nagdy Madbouli, Mobile: (+20)01127911971, E-mail: nono291987@hoatmail.com

Clinically significant portal hypertension (CSPH), causes a number of problems that is linked to
decreased survival. Its diagnosis done by measuring the hepatic venous pressure gradient (HVPG). Although being
invasive but gold standard one. In addition to fibrotic liver tissue remodeling, poor vasotonus control plays a role in
the pathophysiology of portal hypertension (PH) in liver cirrhosis. Research on PH-affected animal models has shown
that hepatic cGMP activity is reduced while systemic and splanchnic cGMP activity are reflectively elevated. These
changes are part of what causes cirrhotic PH, which is characterised by hyperdynamic systemic and splanchnic
circulation as well as profuse hepatic vascular resistance. This pathophysiological context implies that cGMP may
serve as a PH marker. Objective: The aim of the current study was for evaluation of plasma level of cyclic guanosine
monophosphate (cGMP) as a surrogate non-invasive biomarker of portal hypertension.
Patients and methods: This case control study were performed at Ain Shams University Hospitals Inpatients and
Outpatients' settings for one year. It included 40 cirrhotic patients with portal hypertension (Group I), 40 cirrhotic
patients without PH (Group II), and 20 healthy controls (Group III). The following investigations were assessed for all
study subjects: plasma cGMP, and abdominal US with portal vein duplex. Upper endoscopy was performed only for
group I. Results: This study showed high statistically significant difference between the studied groups as regards
plasma cGMP. Also, there was a statistically significant correlation between cGMP and portal vein diameter and
splenic diameter in group I, but there was no statistically significant relation between plasma cGMP and presence of
esophageal varices in group I. ROC curve for plasma cGMP to differentiate between cirrhosis cases with and without
PH showed at cut off point > 53.6 plasma cGMP had a sensitivity of 95%, and specificity of 100% to detect portal
hypertension in patient with liver cirrhosis.
Conclusion: cGMP can be used as a noninvasive biomarker of portal hypertension. Also, cGMP at a cut off value
>53.6 (with 99.4% accuracy) had 95% sensitivity, and 100% specificity. However, cGMP couldn't be used as a
screening for esophageal varices.
Keywords: Plasma cyclic guanosine monophosphate, Clinically significant portal hypertension.

constrict as a result, increasing portal pressure by
Even in the early stages of cirrhosis, no
approximately thirty percent. Conversely, peripheral
specific symptoms are associated with chronic
artery dilatation is more common because of high
hepatitis until the development of clinically significant
levels of cGMP and low PDE-5. The conventional
portal hypertension (1). Ascites and gastric varices are
concept of the pathophysiology of PH is defined by the
the most prevalent presentations for clinically
"NO-paradox" that is defined as increasing NO
significant portal hypertension. Prognostic factors that
synthesis in the peripheral circulatory system and
are associated with the severity of PH include hepatic
decreased NO availability within the liver. However,
encephalopathy (HE), spontaneous bacterial peritonitis
recent studies suggest that rather than concentrating
(SBP), variceal haemorrhage, infections other than
solely on NO availability, cGMP availability may be
SBP, and hepato-renal syndrome (HRS) (2).The
more pertinent in understanding the paradoxical
difference between the portal pressure and the inferior
outcomes of peripheral vasodilation in the body and
cava vein pressure, or portal pressure gradient, is
intrahepatic vasoconstriction (5). The aim of this study
known as PH (3). It can be more than 5 mmHg. In the
was for evaluation of the plasma level of cyclic
majority of cirrhosis aetiologies, the portal pressure
guanosine monophosphate (cGMP) as a new non-
gradient is accurately reflected by the HVPG, or the
invasive biomarker for portal hypertension.
difference between wedged and free hepatic venous

pressure values (4).In cirrhotic liver, there is an
This prospective cross-sectional case control study
phosphodiesterase-5 (PDE-5), soluble guanylate
included a total of one hundred subjects consist of
cyclase (sGC), and endothelial NO synthase (eNOS),
twenty healthy controls and eighty cirrhotic patients
leading to a decrease in cyclic guanosine
from Inpatients or Outpatients at El-Demerdash
monophosphate (cGMP). The hepatic sinusoids
Received: 03/05/2023
Accepted: 04/07/2023

Full Paper (vol.931 paper# 97)

c:\work\Jor\vol931_98 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7548- 7557

Utility of S100 Calcium Binding Protein B and Neuron-Specific Enolase in Meningitis
Reem Mohsen Elkholy1, Gehan Kamal ElSaeed1, Moaz Mohammad Heikal2,
Asmaa Hasan Mansour2, Noran Talaat Aboelkhair1*
1Clinical Pathology Department, Faculty of Medicine, Menoufia University
2Infectious Diseases Department, Clinical Pathology Department, Shebin Elkom Fever Hospital, Ministry of Health
*Corresponding author: Noran Talaat Aboelkhair, Mobile: (+2)01001470343),
E-mail: dr_naboelkhair@yahoo.com, ORCID: 0000-0002-2390-7364

Meningitis represents a critical medical situation that requires appropriate therapy to ensure the patient's
survival and recovery. In such cases, differentiation between viral and bacterial meningitis is crucial to determine the most
effective course of treatment. S100 calcium binding protein B (S100B) functions as a biomarker for the brain inflammatory
process. Neuron-specific enolase (NSE) serves as a biomarker for neuronal stress and neurodegenerative disorders.
The purpose of this research was to assess S100B and NSE in the serum and cerebrospinal fluid (CSF) of patients
with acute meningitis and to assess the diagnostic utility of both markers to identify the cause of meningitis, whether bacterial
or viral.
Patients and methods: This cross-sectional research was conducted on 44 patients, divided into two groups: bacterial
meningitis and viral meningitis. S100B and NSE levels in the serum and CSF were determined by the enzyme-linked
immunosorbent assay. Biochemical and cytological examination and cultures of CSF were performed.
Results: The paraclinical examinations revealed that the bacterial meningitis group exhibited significantly elevated levels
of ESR, CRP, WBC count, neutrophils, and urea compared to the viral meningitis group (p<0.05). Furthermore, as compared
to the viral meningitis group, the bacterial meningitis group exhibited significantly higher levels of CSF protein, CSF
leukocyte count, and neutrophils (p<0.05). Bacterial meningitis was associated with significantly higher serum
concentrations of S100B than viral meningitis (p=0.047).
Conclusion: Serum S100B is a simple, non-invasive biomarker that can be used for the early prediction and diagnosis of
acute bacterial meningitis rather than acute viral meningitis.
Keywords: Neuron-specific enolase, S100 calcium binding protein B, Biomarkers, Viral meningitis, Bacterial meningitis.


results. Prompt and precise identification of the anticipated
Meningitis is defined as inflammation of the
cause of the infection is critical to initiating appropriate
meninges, which wrap and safeguard the brain and spinal
treatment and improving patient prognosis (7). Identification
cord. This condition is typically evolved by bacterial, viral,
of blood biomarkers that most accurately predict the
fungal, or parasitic infection. The causative organism has an
etiology of meningitis (viral or bacterial) can facilitate clues
impact on the severity of meningitis (1). Extremely high
towards neuronal damage and bacterial pathogens that can
mortality rates are associated with acute meningitis;
be neutralized by antimicrobial therapy (8).
therefore, it constitutes a medical emergency. Antibiotic
Astrocytic cells in the central nervous system
treatment requires prompt identification of bacterial
(CNS) contain elevated levels of S100 calcium-binding
meningitis (2). The most prevalent etiological agents of
protein B (S100B); the secretion of S100B by these cells
bacterial meningitis in adults are Neisseria meningitides,
could potentially indicate a glial reaction to metabolic
Streptococcus pneumonia, and Haemophilus influenza.
stress, ischemia, or inflammation. Leucocyte extravasation
However, in infants, other agents, including group B
across the blood-brain barrier (BBB) and into the CNS
parenchyma is more likely to occur in patients with a high
systemic inflammatory burden, such as those who are
administration is critical for the survival and recovery of
critically ill (9). Astrocytes are an essential element of the
patients diagnosed with acute bacterial meningitis (3, 4).
BBB, and the integrity of the barrier is determined by their
Distinguishing between viral and bacterial
interaction with the cerebrovascular endothelium.
meningitis is crucial in order to determine the most effective
Consequently, if the BBB is disrupted due to inflammation,
course of treatment. Antibiotics remain ineffective against
communication may occur between astrocytes and
viral infections (5). Clinical characteristics and standard
leucocytes, it could activate astrocytes and result in the
laboratory investigations succeed in identifying the
release of S100B (10). A variety of neurological disorders can
causative agent in less than 60% of cases (6). Determination
be predicted using NSE, which is a biomarker of neuronal
of the etiologic bacterial organism occurs in less than one-
stress that is firmly established. A number of neurological
third of the instances using conventional culturing
diseases, such as hereditary spastic paraplegia, Friedreich
techniques, however, it can take several days to produce
ataxia, Alzheimer's disease and uncommon types of
Received: 03/05/2023
Accepted: 04/07/2023

Full Paper (vol.931 paper# 98)

c:\work\Jor\vol931_99 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7558- 7566

Study On Antimicrobial Effects of Cerumen, Human Serum, and
Nanoparticles on Microbial Pathogens Isolated from Ear Infections
Samah Mahmoud Eldsouky1* , Naslshah G. Kazem1, Amany K. Shahat2, Doaa Abdallah Shaker2,
A. B. Abeer Mohammed3, Mohamed Sabry Abd Elraheam Elsayed4, Riham Nagah Ragab2
Departments of 1Otolaryngology and Head and Neck Surgery,
2Medical Microbiology and Immunology, Faculty of Medicine, Benha University, Benha, Egypt
Departments of 3Microbial Biotechnology, Genetic Engineering and Biotechnology and 4Bacteriology, Mycology, and
Immunology, Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
*Corresponding author: Samah Mahmoud Eldsouky, Mobile: (+20) 01503548877, E-Mail: samahmahmoed83@yahoo.com

Bacterial infections of ear canal are widely prevalent. Objective: This study was planned to, diagnose
cases of otitis externa then make isolation and identification of the most prevalent bacterial pathogens causing this
infection. Also, to detect the phenotypic antimicrobial susceptibility testing to select the effective antimicrobials.
Subjects and methods:
A prospective clinical study was conducted on 100 cases with acute otitis externa. Patients'
socio-demographic features and clinical history were recorded. Identification of the bacterial pathogens and surveying
of antimicrobial resistance and resistance genes were conducted. The efficacy and minimum inhibitory concentrations
(MIC) of cerumen, human serum, and silver nanoparticles against the pathogens were detected. Results: A total of 100
acute otitis externa patients were investigated, 25% had tonsillectomy. Most of the cases showed discomfort, itching,
otalgia, and edema of the ear canal. Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli were highly
prevalent with rates of 30%, 20%, and 15% respectively. They were highly resistant with multiple antimicrobial
resistance indices of 0.75, 0.7, and 0.95 respectively. S.aureus contained high rates of mecA1, A2, mecA1, mecC, and
BlaZ gene. Most of E. coli harbored class 1 integron, CTX-M, and CTX-M-1. Most of the macrolide-lincosamide­
streptogramin B methylases were present in S.aureus and E.coli. P.aeruginosa contained class 1 integron, while low
rates of CTX-M, msrE, mphE. Silver nanoparticles MIC was 650 µg/mL against E.coli and P.aeruginosa with inhibition
zones of 30 mm and 20 mm, respectively. The cerumen MIC was 1200 µg/mL against S.aureus and E.coli with inhibition
zones of 7 mm and 9 mm respectively. Human serum was effective against E.coli with a MIC of 200 µL/mL and the
inhibition zone was 13 mm. Conclusions: Bacterial pathogens of otitis externa exhibited high antimicrobial resistance
rates. Cerumen, human serum, and silver nanoparticles are promising in controlling these pathogens.
Keywords: Otitis externa, Bacterial pathogens, Antimicrobial resistance, Antimicrobial alternatives.

Strep. pyogenes, Proteus species, and H. influenzae on
The ear infection, in whatever form, has diverse
the other hand, are mostly responsible for infection (7).
microbial causes that determine the effective
The problem of antimicrobial resistance is complex and
antimicrobial medication to be selected. Infections of
its etiology is determined by the individual, bacterial
the external ear and the middle ear are called otitis
strains, and resistance mechanisms. The evolution of
externa and otitis media, respectively, and are
resistance to newly produced antibiotics reinforces the
considered two serious types of ear infections. Bacterial
need for new antimicrobials and lowering the
infection of the ear canal causes otitis, which occurs
uncontrolled antimicrobial utilization (8). Because the
after a rupture in the intact skin or the protective
antimicrobial resistance is growing, particularly in
cerumen layer in the presence of high humidity and
resource-limited nations, current research on the
temperature (1, 2). It is generally referred to as the
antimicrobial susceptibility of isolates from ear
swimmer's ear. However, conditions that cause the
discharge is critical for effective patient management (7).
breaking of this protective lipid barrier can allow germs
The resistance in bacteria is caused by the
to enter and multiply. Cleaning the ears with cotton buds
existence of antimicrobial resistance genes (ARGs).
or fingernails is considered the most common local
Pathogenic bacteria acquire ARGs via plasmid
predisposing factor has been identified as trauma (3, 4).
exchange and develop antimicrobial resistance.
The Gram-positive bacteria constitute 90% of the
Bacterial ARG-carrying plasmids, integrons, and
external auditory canal and live as commensals. When
transposons can undergo horizontal gene transfer
protective barriers such as cerumen, diabetes, canal pH,
among similar and different bacterial strains. The death
and other immune weakened states fail to protect the ear
of the resistant bacteria exposes its DNA to the
canal, the natural flora may become pathogenic (5).
resistance genes, which can stay for a long period in the
Gender, low socioeconomic level, overcrowding,
environment thanks to deoxynucleotide enzymes and
ignorance about the condition, living in a slum area,
being taken by other bacterial agents (9).
poor cleanliness, bathing in pond/river water, smoking,
Cerumen is a hydrophobic ear wax that protects
and foreign bodies in the ear are all conditions that could
the external auditory canal epithelial lining from
predispose to suppurative ear infections (6).
mechanical and microbiological attack (10). It is a natural
Ear infections can be caused by viruses, bacteria,
secretion in the external auditory canal's outer section
or fungi. S. aureus, P. aeruginosa, Strep. pneumoniae,
secreted by "apocrine sweat" and the sebaceous glands
Received: 04/06/2023
Accepted: 05/08/2023

Full Paper (vol.931 paper# 99)

c:\work\Jor\vol931_100 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7567- 7574

Vitamin D And Omega-3 Long Chain Polyunsaturated
Fatty Acids Lowering COVID-19 Cytokines and Anosmia
Samah M. Eldsouky1*, Naslshah G. Kazem1, Amany K. Shahat2, Riham Nagah Ragab2, Marwa Said El-Sayed2,
Dina S. Abdelmotaleb3, Lina Abdelhady Mohammed4, Mohamed S.A. Elraheam Elsayed5
Departments of 1Otolaryngology and Head and Neck Surgery,
2Medical Microbiology and Immunology, 3Clinical and Chemical Pathology and
4Medical Biochemistry and Molecular Biology, Faculty of Medicine, Benha University, Benha, Egypt
5Department of Bacteriology, Mycology, and Immunology,
Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
*Corresponding author: Samah Mahmoud Eldsouky, Mobile: (+20) 01503548877, E-Mail: samahmahmoed83@yahoo.com

Several studies reported the association between olfactory dysfunction and the novel coronavirus
disease in 2019 (COVID-19).
Objective: This study aimed to investigate the effect of vitamin D and omega-3 long-chain polyunsaturated fatty acids
on anosmia and COVID-19-induced proinflammatory cytokines.
Subjects and methods: This is a supervised randomized prospective experiment performed at the Hospital of Faculty
of Medicine, Benha University. It was performed on two groups; 110 cases per group were used; one was considered
healthy control and the other showed anosmia after COVID-19 infection. Evaluation of the vitamin D and omega-3
impacts on decreasing anosmia and COVID-19-induced cytokines was performed using Sniffin' Sticks test and
cytokines' serum tests, respectively.
Results: A number of 110 patients from each group had persistent anosmia; the smell scores with the Sniffin' Sticks
test on the initial assessment were low. The levels of IFN, TNF, IL4, IL6, and IL10 cytokines and CRP were higher
in both groups than in the healthy control group (p < 0.05). On the 10th, 20th, and 30th days, there were improvements
in the smell scores and decrease in the IFN, TNF, IL4, IL6, and IL10 cytokines and CRP in the treatment group than
in the control group (p < 0.05). The duration of recovering the sense of smell was shorter in the treatment group than
in the control group (24.1 ± 1.35 days vs. 28.9 ± 0.93, p < 0.05).
Vitamin D and omega-3 long-chain polyunsaturated fatty acids may decrease the exaggerated cytokines
and improve olfaction after COVID-19 infection.
Keywords: COVID-19, Anosmia, Cytokines, Vitamin D, Omega-3 long chain polyunsaturated fatty acids.

The COVID-19 infection stimulates innate and
In December 2019, an infectious outbreak
acquired immunity, which can recognize pathogen-
started in Wuhan, Hubei, China. The novel etiology for
this outbreak is the severe acute respiratory syndrome
molecular patterns and viral antigens, respectively.
coronavirus 2 (SARS-CoV-2), which is an enveloped
Exaggerated cytokine production by activated
RNA betacoronavirus and is responsible for
immunologic cells leads to cytokine storm, which is an
coronavirus disease 2019 (COVID-19) (1). Globally, as
acute and severe systemic inflammatory response that
of June 16, 2021, there had been 176, 156, 662
can result in tissue injury and an unfavorable
confirmed COVID-19 cases, including 3, 815, 486
prognosis. With cytokine storm, high serum levels of
deaths (2). Within the last two decades, COVID-19 in
TNF, IFN-, IL2, IL4, IL6, IL-10, and CRP are
humans is considered the third pandemic after SARS-
detected (7). COVID-19 is one of many viruses that can
CoV in 2003 and the Middle East respiratory
cause olfactory loss. A proposed explanation is the
syndrome (3,4). According to recent updates from the
viral invasion of the olfactory system by neurotropic
British Association of Otorhinolaryngology-Head and
viruses (8,9).
Neck Surgery and the European Rhinologic Society,
Recently, some nutrients were suggested to
sudden loss of smell might occur after COVID-19
play potential roles in the management of cytokine
infection. Indeed, anosmia is considered one of the
storm; these include vitamins B6, B12, C, D, E, and
COVID-19 symptoms (5).
folate and trace elements, such as copper, iron,
Based on previous reports, anosmia can result
magnesium, selenium, and zinc (10). In addition, long-
from damage in the following three stages: 1)
chain polyunsaturated fatty acids (LC-PUFAs), such as
disturbance of oral or nasal mucosal olfactory
docosahexaenoic acid (DHA) and eicosapentaenoic
receptors, which results in sensorineural loss of
acid (EPA), have been considered noteworthy because
olfaction; 2) disconnection between the brain and
of their direct effect on the host response to viral
afferent nerves from the receptors; and 3) damage to
infectious diseases (10,11). The improvement of
the brain tissue (6).
olfactory function in patients after supplementation of
omega-3 fatty acids was due to neuronal regeneration
Received: 11/05/2023
Accepted: 13/07/2023

Full Paper (vol.931 paper# 100)

c:\work\Jor\vol931_101 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7575- 7579

A Study of The Correlation between Hba1c and Neuropathy Disability
Score in Diabetic Patients
Amina Mohammed Nagah Mohammed*1, Rehab Salah Fathy Zaki 2
Departments of 1 Neurology and 2 Internal Medicine, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Amina Mohammed Nagah Mohammed,
Mobile (+20)01555174671 E-Mail: aminanagah74@gmail.com

: Diabetes mellitus is associated with chronic complications, among which is peripheral neuropathy.
The severity of diabetic peripheral neuropathy (DPN) is evaluated using the Neuropathy Disability Score (NDS).
Hemoglobin A1c (HbA1c) is a measure of glycated hemoglobin utilized to monitor diabetic patients' glucose levels over
the past 2 or 3 months. DPN is linked to glycemic exposure and the duration of diabetes. However, evidence suggests
that only rigorous glycemic control, monitored by HbA1c levels, can alleviate or prevent neuropathy.
Objectives: This study aimed to examine the correlation between HbA1c and the neuropathy disability score in a
specific group of participants. Additionally, the research explored the potential impact of various demographic and
clinical factors on this correlation.
Patients and Methods: This cross-sectional study encompassed 198 adult subjects diagnosed with type 2 DM who
sought medical care at the Neurology and Internal Medicine Departments of Benha University Hospital in Egypt
between July 2021 and July 2022. All participants underwent medical history assessments, general and neurological
examinations, HbA1c tests, lipid profile evaluations, liver function tests, kidney function assessments, and a revised
neuropathy disability score to identify signs of neuropathy.
The Neuropathy Disability Score (NDS) exhibited a significant correlation with HbA1c % and various factors,
including age, BMI, blood pressure (SBP and DBP), fasting blood sugar (FBS), serum creatinine, LDL-C, HDL-C, and
the duration of diabetes. However, it does not display significant correlations with triglyceride levels or total cholesterol.
Conclusion: A strong correlation exists between HbA1c levels and the presence of diabetic neuropathy.
Keywords: Diabetic peripheral neuropathy (DPN), Neuropathy Disability Score (NDS), HbA1c.

glycemic control, potentially predicting diabetic
Diabetes mellitus arises from a metabolic
complications [11, 12]. Therefore, assessing long-term
disorder involving defects in insulin secretion, insulin
glycemic variability through variations in HbA1c over
action, or both [1]. Projections suggest that by 2030,
several months could serve as a reliable risk factor for
approximately 360 million individuals will have
microvascular complications, including diabetic
diabetes [1, 2]. This condition can lead to enduring
neuropathy. Jun et al. [13] have shown a significant
complications, such as retinopathy, nephropathy,
association between HbA1c variability and the presence
neuropathy, and other vascular issues [3].
as well as severity of cardiovascular autonomic
Diabetic peripheral neuropathy (DPN) is among
neuropathy (CAN) in type 2 diabetic patients. However,
the most prevalent microvascular complications in both
the role of HbA1c variability in DPN remains less
type 1 and type 2 diabetes. DPN is defined as "the
understood. Thus, we conducted a study to evaluate the
presence of symptoms and/or signs of peripheral nerve
relationship between long-term glycemic variability,
dysfunction in individuals with diabetes after excluding
assessed by HbA1c fluctuations, and DPN in patients
other causes"[4]. It can predispose individuals to foot
with type 2 diabetes.
ulceration and gangrene, elevating the risk of non-

traumatic amputation [5]. Moreover, DPN is closely
linked to alterations in brain structure, notably a
Study Design: This was a cross-sectional study
decrease in peripheral grey matter volume, potentially
of adult patients who visited the Neurology and Internal
contributing to walking impairments [6, 7].
Medicine Departments, in Benha University Hospital,
Consequently, patients affected by DPN might
Egypt from July 2021 to July 2022. Data Collection: A
experience a diminished quality of life and face
total of 198 adult patients diagnosed with type 2
substantial costs for diabetes care [8]. The fundamental
diabetes mellitus (DM) were included in this study. The
pathogenesis of DPN remains a topic of debate [9].
sample size "n" was determined using the Cochran
Research indicates associations between DPN and
factors such as glycemic exposure, duration of diabetes,
Cochran formula is: n = Z2pq/e2
insulin resistance, visceral adiposity, dyslipidemia, and
Where e is the desired level of precision (i.e., the
hypertension [9]. Microvascular complications of
margin of error). P is the estimated proportion of the
diabetes might be linked to inadequate time-dependent
population, which has the attribute in question is 1-p.
glycemic control [10].

Additionally, glycemic variability is now
Inclusion criteria: Cases with type 2 diabetes mellitus,
acknowledged as an indicator of compromised
adult males and females were included.
Received: 07/05/2023
Accepted: 06/07/2023

Full Paper (vol.931 paper# 101)

c:\work\Jor\vol931_102 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7580- 7586

Association between Myeloperoxidase Enzyme Levels in
Parenchymal Lung Disease and Airway Disease in Paediatrics
Hala Fikry El- Hagrasy1, Asmaa Kamal Kamal Abdelmaogood2,
Ibrahim Emam Emam Mekawy1*, Yasmine G Mohamed1
1Department of Pediatrics and Neonatology, Faculty of Medicine, Suez Canal University, Egypt.
2Department of Clinical and Chemical pathology, Faculty of Medicine, Suez Canal University, Egypt.
*Corresponding author: Ibrahim Emam Emam Mekawy1, Mobile: +201117960485
E-mail: dr.ebrahimped2021@gmail.com

The most prevalent pro-inflammatory biomarker found in neutrophilic granulocytes is myeloperoxidase
enzyme. In order to fight various microbial activities, proinflammatory factors and oxidative stress at the infection site
release it from these cells. Several reactive oxygen and nitrogen species are produced as a result of MPO's antimicrobial
Aim and objectives: This study aimed to assess the diagnostic value of myeloperoxidase elevation in parenchymal lung
disease and airway disease in children.
Subjects and methods: This cross-sectional investigation was carried out at the Pediatrics Department of the Suez
Canal University Hospitals Faculty of Medicine. 99 patients were split into 3 groups: Group A had 33 patients with
pneumonia, group B had 33 patients with bronchiolitis and group C had 33 patients with bronchial asthma in addition
to 33 healthy cases as control group.
Results: Serum and salivary MPO levels were reliable in the diagnosis of pneumonia, but only serum MPO level can
be used to diagnose patients with asthma. However, serum and salivary MPO levels failed to diagnose patients with
bronchiolitis. Also, salivary MPO failed to diagnose patients with asthma. Moreover, serum and salivary MPO levels
failed to predict outcome among pneumonia, bronchiolitis and asthma patients.
Conclusion: Both serum and salivary myeloperoxidase levels were significantly differed between pneumonia,
bronchiolitis, bronchial asthma and control groups, suggesting the potential role of MPO in the diagnosis of
parenchymal lung disease and airway disease in pediatrics.
Keywords: Myeloperoxidase enzyme, Parenchymal lung disease, Airway disease, Paediatrics.


been demonstrated that reactive oxygen species (ROS)
The heme-containing peroxidase enzyme
are linked to the pathophysiology of asthma. This effect
myeloperoxidase (MPO) is widely distributed in
is amplified when the epithelium is damaged or
neutrophils and, to a lesser degree, monocytes. The
removed (3).
powerful oxidant hypochlorous acid, which is produced
One common respiratory infection that causes
by enzymatically active MPO in combination with
bronchiolitis in infants under two years old is the
hydrogen peroxide and chloride, is a major factor in the
respiratory syncytial virus (RSV). When bronchial
oxygen-dependent microbicidal action of phagocytes.
epithelial cells are infected by respiratory viruses, this
Furthermore, tissue damage in a number of disorders,
leads to enhanced neutrophil recruitment and activation
especially those that are marked by acute or chronic
as well as epithelial activation. By releasing their own
inflammation, has been connected to increased MPO-
chemokines, superoxide anion, and granular enzymes,
derived oxidant generation (1). Migrating neutrophils
may release active MPO during inflammatory
inflammation by raising the level of H2O2, destroying
responses. MPO levels have been found to be elevated
extracellular matrix structures, and inducing the release
in a variety of lung diseases, including pneumonia,
of additional inflammatory cytokines (TNF-, IL-8, and
asthma, and bronchiolitis (2).
tumor necrosis factor-) (4). This study aimed to evaluate
Chronic inflammation, mostly caused by the
the diagnostic value of Myeloperoxidase elevation in
overabundance and activation of neutrophils and other
parenchymal lung disease and airway disease in
inflammatory cells, is what defines asthma. Large
volumes of MPO are released by activated neutrophils,

and this causes the Myeloperoxidase-Hydrogen
Peroxide-Chloride system to produce more reactive
This cross sectional research was conducted in the
oxygen species. Because of their direct oxidative
Emergency Department and Inpatient Ward of the
damage to epithelial cells and their cell shedding
Paediatrics Department of Suez Canal University
properties, reactive oxygen species (ROS) may cause
Hospital (Inpatient-PICU). Patients' samples were
lung injury. By inducing bronchial hyperreactivity and
collected throughout an eight months period, starting
directly inducing mast cell histamine release and mucus
from October 2022 to May of 2023.
secretion from airway epithelial cells, which in turn
Clinical cases who presented to the Emergency
causes the preparations of airways to contract, it has
Department with respiratory distress then diagnosed
Received: 07/05/2023
Accepted: 06/07/2023

Full Paper (vol.931 paper# 102)

c:\work\Jor\vol931_103 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 93, Page 7587-7592

Traditional Clomiphene Citrate with Phytoestrogen Versus
Traditional Clomiphene Citrate Versus Stair Step Protocol in
Patients with Polycystic Ovaries: A Randomized Clinical Trial
Ashraf Sobhi Abo-louz1, Mohamed Hussein2,
Ahmed Gamal Badawie1, Heba Hesham Abdelfattah Abdelazim1, Haitham Atef Torky1
1Department of Obstetrics and Gynecology, Faculty of Medicine, October 6th University, Giza, Egypt
2Deparment of Obstetrics and Gynecology, Faculty of Medicine, Al Kasr Alainy, Cairo, Egypt
Corresponding author: Ashraf Sobhi Abo-louz, Email: ashraf.abolouz@gmail.com, Mobile: 01222376540

Polycystic ovary syndrome (PCOS) ranks among the most prevalent endocrine disease affecting women
of reproductive age. Multiple therapeutic approaches have been suggested for the management of PCOS. Anovulation
is responsible for approximately 40% of female infertility cases, and a significant portion of individuals dealing with
infertility are also diagnosed with polycystic ovary syndrome.
Patients and methods: This was a prospective multi-center randomized clinical trial conducted from April 2022 till
March 2023 involving one hundred fifty female patients with PCOS categorized into three categories, category I
(traditional protocol) involved 50 subjects who received traditional clomiphene citrate (CC) 100 mg for 5 days, and
category II stair-step protocol (SS) involved 50 subjects who received clomiphene citrate 50 mg for 5 days followed by
100 mg for another 5 days and phytoestrogen given for the whole 10 days. In addition, group III clomiphene +
phytoestrogen (CCP) included 50 patients who received 100 mg of clomiphene citrate for 5 days and phytoestrogen for
10 days. Results: There was significantly thinner endometrium in the CC group as compared to the other two groups;
the greatest endometrial thickness was in the SS protocol group, followed by the CCP group; a higher pregnancy rate
and ovulation rate were in the SS protocol group, followed by the CCP group; and the lowest pregnancy rate and
ovulation rate were in the CC group.
Conclusions: Clomiphene, when used as an SS regimen, improves pregnancy rates without any side effects compared
to traditional regimens. Adding phytoestrogens to CC is associated with improving endometrial thickness and pregnancy
Polycystic ovary syndrome; Stair-step protocol; Phytoestrogen.


PCOS is the most prevalent endocrine disorder
among women aged 18 to 44, affecting approximately
This study is a multi-center randomized
6% to 20% of this demographic(1). To diagnose PCOS,
clinical trial, conducted on female patients with PCOS.
two out of the following three criteria are required:
This research enrolled 150 female patients with
PCOS who were divided into three groups; Group I
hyperandrogenism, or the presence of PCOS
involved 50 patients who received clomiphene citrate
characteristics on ultrasound scans(2).
100 mg for 5 days, and Group II (Stair-step protocol)
Clomiphene citrate is used to stimulate ovulation
involved 50 patients who received clomiphene citrate
by blocking estrogen receptors in the hypothalamus and
50 mg for 5 days followed by 100 mg for another 5 days
negating the inhibitory effect of estradiol, resulting in
and phytoestrogen given for the whole 10 days. In
increased secretion of endogenous FSH(3).
addition, group III (clomiphene + phytoestrogen)
Combining phytoestrogen with clomiphene citrate
included 50 patients who received 100 mg of
in ovulation induction for females with PCOS aims at
clomiphene citrate for 5 days and phytoestrogen for 10
counteracting the antiestrogenic effect of clomiphene
days. The study setting was on October 6 University
citrate on the endometrium, which may cause
Hospital and Al Kasr Alainy University Hospital from
endometrial hyperplasia and subsequently increase
the period of April 2022 till March 2023.
endometrial thickness(4).

Utilizing a stair-step protocol with a combination
Inclusion criteria
of clomiphene citrate and phytoestrogen in women with
This study included women who met the
PCOS has shown greater effectiveness in terms of
following criteria: aged between 20 and 35 years,
promoting ovulation and improving pregnancy rates
diagnosed with either primary or secondary infertility
compared to the traditional protocol(5).
based on the Rotterdam criteria from 2003 for PCOS,

experienced infertility for a duration of 1 to 5 years, had
Aim: to treat infertile women with polycystic ovary
partners with normal semen analysis, exhibited normal
syndrome by improving endometrial thickness,
uterine conditions as confirmed by transvaginal
pregnancy rate, and fertility rate.
ultrasound, and had normal hysterosalpingography

(HSG) results. Additionally, participants were free from
Received 16/04/2023
Accepted 13/06/2023

Full Paper (vol.931 paper# 103)

c:\work\Jor\vol931_104 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 93, Page 7593-7599
A Randomized Comparison of Intravaginal Boric Acid versus Terconazole in
Treatment of Recurrent Vulvovaginal Candidiasis
Asmaa Mostafa Swidan*, Rafik Ibrahim Barakat, Hatem Ibrahim Abu Hashim, Mahmoud Thabet Mahmoud
Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding authors: Asmaa Mostafa Swidan, Mobile: (+20) 01098705491, Email: aswidan992@yahoo.com


Recurrent vulvovaginal candidiasis (RVVC), is usually defined as three or more episodes of symptomatic
vulvovaginal candidiasis (VVC) in <1 year, with an estimated prevalence of 9% in women. Boric acid (BA) has been
proven to be associated with an antifungal action, so it could be used as a safe, and economic treatment for RVVC.
Terconazole is an anti-fungal drug that is mainly used to treat vaginal candidiasis.
Objective: To compare the effectiveness of intravaginal use of BA versus terconazole in the treatment of RVVC.
Patients and methods:
This was a prospective randomized controlled study conducted on a total 70 females who were
divided into two group; BA group (n=35) who received vaginal suppositories (600 mg/day) for two weeks and
terconazole group (n=35) who received terconazole 80 mg vaginal suppository daily for six days. Mycological cure rate
and improvement rates were evaluated on the 15th day. Any reported adverse effects and recurrence rate were also
assessed at third month follow-up.
Results: Vulval erythema was significantly increased among terconazole group compared to boric acid group.
Treatment response was significantly improved among boric acid compared to terconazole one. No significant relation
was recorded between response to treatment and complaints of the studied cases with mycological recurrence. Higher
median parity was recorded among cases with mycological resistance than cases with mycological cure.
Conclusion: In the context of RVVC, boric acid seemed to be associated with promising outcomes as regards treatment
outcomes with minimal adverse events compared to terconazole.
Keywords: Recurrent vulvovaginal candidiasis, Terconazole, Boric acid.


intravaginal use of BA with terconazole for RVVC. As
Recurrent vulvovaginal candidiasis (RVVC),
a result, the current study is carried out on cases with
which is caused by Candida spp, mainly C. albicans is
RVVC to evaluate this essential issue.
considered a frequent infection of the female genital

tract affecting 75% of females at least once during their
Aim of the work was to compare the effectiveness of
lives. RVVC usually defined as three or more episodes
intravaginal use of BA versus terconazole in the
of symptomatic VVC in <1 year. In addition, it is a
treatment of RVVC.
chronic, difficult to treat vaginal infection that has an

impact on one's quality of life. A lot of factors were
accompanied by RVVC which include long-term use of
Study Design
antibiotics, inadequate treatment of infection,
This was a prospective randomized controlled
uncontrolled diabetes mellitus, immune mechanisms
study conducted on a total of 98 female patients who
(such as human immunodeficiency virus), using oral
were assessed for eligibility. Only 76 female patients
contraceptive pills and the resistance of non-albicans
were included in the study with RVVC at Mansoura
Candida spp to traditional antifungal gents (1).
University Hospital, Obstetrics and Gynecology
Oral administration of fluconazole has been
Department from October 2021 to December 2022 but
considered as the most frequently utilized antifungal
70 female patients were able to complete the study.
agent in the context of cases with RVVC. On the other
Cases were divided into two groups; Boric acid group
hand, throughout the previous years, fluconazole-
(n=35) and Terconazole group (n=35).
resistant Candida albicans is recorded in females with
All women (18-50 years old) with diagnosis of
RVVC. Terconazole is an antifungal agent for C.
RVVC (presence of at least four attacks of VVC which
albicans as well as for non-albicans. Its utilization in a
happened throughout the preceding one year), and
dose of 80 mg vaginal suppository every day for six
complaining of manifestations of VVC such as itching,
days was comparable to the utilization of two dosages
burning sensation, discharges, and erythema and agreed
of oral fluconazole (150 mg) in the management of
to stop the sexual intercourse throughout the treatment
cases with extensive forms of RVVC (2).
course and to stop utilizing different vaginal products
Boric acid (BA) is a weak acid with a confirmed
throughout the study period were comprised in the
antifungal activity. In RVVC in particular in azole-
current study.
resistant strains as well as in non-C. albicans, 600 mg of
Postmenopausal women, pregnant women, cases with
BA vaginal suppository is suggested every 24 hours for
sexually transmitted infection, cases using antifungal
14 days. Such strategy has an average mycologic cure
agents or antibiotics in the last two weeks before the
rate of 70% ranging from 40% to 100% (3). On the other
treatment, patients with gynecological situations
hand, there are no recorded researches comparing
Received: 09/05/2023
Accepted: 10/07/2023

Full Paper (vol.931 paper# 104)

c:\work\Jor\vol931_105 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 93, Page 7600-7609

Polarized Light Therapy for Wounds: A Systematic Review
Taghreed Gomaa Abd-Elhamed1*, Wafaa Hussein Borhan1,
Maya G. Aly2, Marwa Mahdy Abd Elhameed1
Departments of 1Physical Therapy for Surgery and
2Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Taghreed Gomaa Abd-Elhamed, Mobile: (+20) 01017307129,
E-mail: Taghreed.gomaa55@gmail.com

Wounds have a variety of types. Impairment of healing is a common adverse event of wounds. The degree
of tissue injury caused by burn wounds and ulcers can lead to further pain and disability. Polarized light therapy (PLT)
has the ability to penetrate the skin up to 5 cm deep, reaching deeper tissues that are necessary for wound healing.
Objective: This article aimed to systematically review the reported randomized control trials (RCTs) as regards PLT
effects in treatment of wounds.
Methods: An electronic search was conducted in Cochrane library, Physiotherapy evidence database (PEDro) and
PubMed database. The research comprised RCTs published at the period from 2019 to 2023 only on PLT effects in
treatment of wounds of burned and ulcerated patients. In addition, 2 independent reviewers extracted data from the
comprised researches and evaluated its methodological quality by utilizing PEDro scale.
Results: Eight studies matched the inclusion criteria. They provided limited to strong level to support the efficiency of
PLT based on modified Sackett's scale. Meta-analysis was done for four included studies only and showed a significant
difference between the PLT and control groups and revealed significant decrease in ulcer surface area (USA) in PLT
group. As a result, it revealed significant effect of PLT on ulcer healing.
Conclusion: This systematic review revealed limited to strong evidence. It supported the effectiveness of PLT in
treatment of wounds (ulcers, burns and wounds).
Keywords: Wound, Ulcer, Burn, Healing, Polarized light therapy, Bioptron.

themselves following injuries. Essentially, wound
Chronic wounds have an impact on one's
healing is a dynamic process featured by interactions of
quality of life (QoL) and the treatment of wounds has
different cell types, which include lymphocytes,
also considerable economic burdens on healthcare.
monocytes and fibroblasts. Inflammation, granulation
Owing to the geriatric subjects, the persistent threat of
tissue development and proliferation are recognized as
diabetic and overweight patients all over the world and
three major overlapping processes in tissue response to
the persistent problem of infections, it is expected that
injury (5).
chronic wounds could remain to be a considerable
Polarized light has been considered as a system,
clinical, social, and economic challenge. A chronic non-
which generates light with polarization, incoherency,
healing wound (CNHW) is associated with co-
low energy and polychromacy. Polarized light waves
morbidities such as diabetes mellitus, vascular
oscillate on parallel planes. Linear divergence across
insufficiency, hypertension and renal dysfunction. Such
reflection is of great efficacy and has a degree of
predisposing factors make subjects with CNHW at high
polarization of about 95%. The system of PLT covers a
possibility for worse prognosis (1).
wavelength range of 480 nm to 3400 nm, that comprises
Skin ulceration represents a difficult clinical
visible light and some infrared radiation (the polarized
problem and has been considered as a main source of
light electromagnetic spectrum doesn't include UVR).
morbimortality for cases. Pain, swelling and wound
Bioptron is incoherent or "out-of-phase," meaning the
drainage have significant effects on the patient's QoL.
light waves aren't synchronized (6).
PLT had positive biologic actions as regards
manifestations add to the morbidity and have been
improving healing across enhancement of the cell
demonstrated to be accompanied by amputation with a
membrane functions, rising the frequency of
higher death rate (2).
mitochondrial ATP formation. In addition, it decreased
Interestingly, extensive burns could have
inflammation, improved microcirculation, tissue
prolonged impacts on QoL, which include scar
oxygenation, improved new blood vessel formation to
formation, contractures, weakness, pruritus, pain and
the affected area, fibroblast proliferation, composition
psychiatric wellbeing. Moreover, the critical care
of collagen and enhanced epithelialization. Owing to the
management could be associated with cognitive,
improvement of such functions, this approach was
affective or behavioral challenges. Reliably, subjects
talented to improve wound healing process. As a result,
with burns reported a lot of restrictions in their QoL in
it is significantly important to systematically review the
comparison with free normal ones (3, 4).
published RCTs as regards the effects of PLT on wound
Wound healing has been considered as a
healing (7, 8).
complicated process where the skin and organs repair

Received: 08/07/2023
Accepted: 09/09/2023

Full Paper (vol.931 paper# 105)

c:\work\Jor\vol931_106 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 93, Page 7610-7615

The Value of Routine Non-Selective Peripheral Vascular Screening and
Its Potential Impact on Coronary Bypass Surgery Patients
Eslam Elhelw*, Mohamed Elshalkamy, Sara Elbaz, Omar Hussam, Usama Ali Hamza, Rami Ahmed Sabri
Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Eslam Elhelw, Mobile: (+20) 01287813507, E-mail: drislamelhelw@gmail.com

Coronary artery disease and other peripheral vascular diseases often coexist. Therefore, we sought to
determine how frequently routine peripheral vascular screening can influence the surgical decision-making in the
patients undergoing coronary artery bypass graft surgery. Additionally, whether the prospective alteration would be
valuable or necessary.
Objectives: To assess the role of non-selective peripheral vascular screening and its potential impact on coronary bypass
surgery patients.
Patients and Methods: A retrospective analysis for the patients, who underwent coronary bypass grafting surgery with
no prior diagnosis of other vessel diseases, between the years 2021 and 2023. The patients were examined using a routine
sonographic vascular screening strategy that included Doppler sonography on both carotids. Additionally, Doppler scans
of the lower and upper extremities for both the arterial and venous system were done. Results: 216 patients were
conducted for the screening program. 44 patients (20.4%) had their surgical choice changed. The vein harvesting was
compromised in 35 patients (16.2%). Carotid intervention was planned for 6 individuals (2.8%) in total. 3 patients
(1.4%) had their surgical choice impacted in terms of both the saphenous vein and the carotids. Additionally, 34 patients
(15.7%) required additional, specialized investigations.
Non-selective regular peripheral vascular screening can have a substantial impact on the surgical decisions
and maximize the utility of the patients' hospital stay through noninvasive radiological studies.
Coronary artery disease, Peripheral artery disease, Carotid, Endarterectomy, Coronary bypass grafting

The presence of atherosclerosis in one vascular
Design: This is a retrospective observational study,
territory frequently raises the possibility of severe
including analysis of the results of routine peripheral
vascular diseases in other vascular territories, which
vascular screening for all patients underwent coronary
might affect the prognosis of patients(1). The term
artery bypass grafting, who have never developed any
"peripheral artery disease" (PAD) is now used to
signs or symptoms for peripheral artery diseases.
describe any partial or total obstruction of one or more
Study population: coronary artery disease patients
peripheral arteries (2). Patients with concurrent
underwent coronary artery bypass grafting at
peripheral artery disease and coronary artery disease
Cardiothoracic and Vascular Surgery Center (CVSC) at
had higher mortality rates than people without PAD (3),
Mansoura University. Patients were collected from the
which emphasizes the importance of a precise diagnosis
hospital database from 2021 to 2023.
of PAD. Moreover, the existence of coronary artery

disease (CAD) also raises the possibility of other
Inclusion criteria: Age less than 70 years old, patients
important vascular disorders that may be impacted by
presented with ischemic heart disease who underwent
systemic atherosclerosis: compared to the general
coronary artery bypass grafting surgery (CABG).
population, CAD patients have a higher prevalence of
Exclusion Criteria: History of previous CABG or
renal artery or carotid artery stenoses (1).
greater saphenous
After CABG, patients with peripheral artery
vein stripping, vascular angioplasty, amputations etc.
diseases had a 2.4 times higher risk of dying in a
History of DVT. Patients known to have peripheral
hospital than those without PAD (defined as prior
vascular diseases as stroke, transient ischemic attacks,
cerebrovascular accidents, history of transient ischemic
peripheral claudication.
episodes, carotid stenosis, claudication, or prior

vascular surgery)(4). Those with PAD had advanced
cardiac disease, were older, and had more comorbid
Detailed history: A thorough and detailed history was
diseases than people without PAD. The prevalence of
taken, as regards the age, sex, chronic diseases, etc.
PAD continued to be a substantial independent risk
Detailed physical examination: including general
factor for CABG-related death even after controlling for
condition, vital signs, and complete cardiovascular
these comorbidities (5).
examination, etc.
The aim of the current work was to assess the role of

non-selective peripheral vascular screening and its
Routine investigations. In addition to the coronary
potential impact on coronary bypass surgery patients.
angiography that identified the coronary artery disease,

the patients were conducted to a variety of tests. The
Received: 09/05/2023
Accepted: 10/07/2023

Full Paper (vol.931 paper# 106)

c:\work\Jor\vol931_107 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7616-7626

Effectiveness of Self Care program for Patients with Nephrolithiasis on
Their Practices Regarding Nutrition
Sabah Ahmed Amaar, Baghdad Hussein Mahmoud, Furat Hussein Mahmoud*
Department of Medical Surgical Nursing, Faculty of Nursing, Helwan University, Cairo, Egypt
*Corresponding author: Furat Hussein, Mobile: (+20) 01061819832, Email: furathu@hotmail.com

One of the most common disorders of the urinary system and a significant cause of morbidity is
: This study aimed to assess the effects of a self-care programme for patients with nephrolithiasis on dietary
practices. Design: A quasi-experimental study design.
: The study was conducted at the urology department and urology outpatient clinic in Elhussein Hospital
affiliated to Al-Azhar University Hospital Cairo, Egypt.
A sample of (50) patients from both genders with nephrolithiasis ranging in age from 20 to more than 60
years old was collected from the urology out-patient clinic at El Hussein University Hospital.
Three tools were used to collect data include: Patients' interview questionnaire, Self-care knowledge
assessment questionnaire and Self-care dietary practices questionnaire.
36% of the study subjects aged between 30 - > 40 while 4% less than 60 years. There was an improvement in
patient knowledge post the self-care program than the pre-program in all items except the preventive strategies.
The total self-care practices of the research subjects pre- and post-program had a significant relationship,
and the demographic information, total knowledge and practices pre- and post-education, and total practices pre- and
post-self-care programme have a highly statistically significant positive correlation.
Encourage patients with nephrolithiasis for self-care management programs to provide healthy
lifestyle. Patients suffering from nephrolithiasis should participate in ongoing educational programs. More studies
with a bigger sample size are advised in order to attain generalisation.
Keywords: Nephrolithiasis, Nutrition, Self-care program.


Nephrolithiasis is the term used to describe the
influential, painful, and recurrent disorders and chronic
formation of renal stones inside the kidneys. When
diseases. They are caused by a modern lifestyle, poor
these stones leave the renal pelvis and propagate into
nutrition, improper drug use, and bad habits related to
the bladder, urethra, and ureters, the resulting disorder
fluid intake. Sadly, USDs are still a major health
is known as urolithiasis. Many nephrolithiasis patients
concern. Larger stones can cause pain and even
can be treated with analgesics, antiemetic drugs, and
obstruct the urinary system, whereas smaller stones
expectant care. However, more and more intensive
usually move through the body without causing any
therapies are needed to treat stones linked to
discomfort (4).
obstruction, renal failure, and infection (1).
Self-care is giving individuals the tools they need
Although there are many different kinds of kidney
to take care of their health, preserve their health, and,
stones, calcium oxalate or phosphate makes up 80% of
in the event of an illness, take prompt, appropriate
the stones. Other forms of stones are formed of
action to avoid complications and hasten their
calcium oxalate or phosphate (80%) and are far less
recovery. Self-care may frequently also help with
prevalent than uric acid (9%), struvite (10%), and
managing and minimising health issues, cutting down
cystine (1%) stones. Different risk factors, including
on medical expenses, and promoting a quicker
food, past medical history, family and personal history
recovery. In the end, self-care interventions reduce the
of stones, environmental variables, drugs, and the
incidence of disease and its effects, enhance general
patient's medical history, can cause different forms of
health, functional skills, and patient happiness,
stones (2).
increase the use of health services, and lower overall
Genes that may be implicated in the development
health system expenditures (5).
of kidney stones have been discovered, and
The location, makeup, and size of the stone as
nephrolithiasis is known to be highly heritable and
well as patient-specific characteristics including
familial in character. Genes involved in renal tubular
profession, co-morbidities, and single kidney
processing of lithogenic substrates, such as calcium,
determine how the stone should be managed. One can
oxalate, and phosphate, and of inhibitors of
consider all stone care to be acute, final, and
crystallisation, such as citrate and magnesium, have
preventive. Patients are educated as part of
been identified by genome-wide association studies
preventative care to reduce their chance of developing
and candidate gene investigations (3).
stone disease by making dietary and hydration
Urinary tract stones, also known as Urinary Stone
modifications. Since nephrolithiasis has been linked to
Diseases (USDs), are among the most prevalent,
chronic dehydration, maintaining enough water is the
Received: 20/07/2023
Accepted: 20/09/2023

Full Paper (vol.931 paper# 107)

INTRODUCTION & RATIONALE The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7627-7632

Quality of Life among Adolescents with Diabetes Mellitus Type 1 Attending
Pediatric Unit of Diabetes Mellitus, Suez Canal University Hospital
Shaimaa Magdy Abd El-Satar 1, Samar Farag Mohamed, Wael Ahmed Zeid, Mosleh Abdelrahman Ismail,
Hoda Ahmed Atwa2
Family Medicine Department1, Pediatrics Medicine Department2, Faculty of Medicine, Suez Canal University
Corresponding author: Samar Farag Mohamed, Email: sumerahmed2001@yahoo.com, Mobile: 01064684649

Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases during childhood and
adolescence. It threatens the health and endangers life with consequences for the physical and emotional development of
the child and adolescent. Objectives: This study aimed to evaluate the health-related quality of life of adolescents with
type 1 diabetes mellitus, associating it with socio-demographic, clinical and biochemical variables.
Subjects and methods: A cross sectional study included 124 adolescents with T1DM. Sociodemographic information,
metabolic control measures, general and diabetes-related quality of life (QoL), illness profiles, and self-care behaviours
were evaluated. Results: Participants' median age was. Males, single, with higher educational level had significantly
higher level of quality of life than others.
Conclusion: Lower health-related quality of life (HRQoL) was more likely to be experienced by single male adolescents
with lower levels of education and high glycated hemoglobin levels.
Keywords: T1DM, Adolescents, Metabolic control, QOL.

control, low self-efficacy, and inadequate self-care, all
There has been a rise in interest in studying chronic
of which have a detrimental impact on the individuals'
diseases in certain groups in recent years. Type 1
quality of life. Health care professionals need to
diabetic mellitus (T1DM) in teenagers is one example,
understand the challenges posed by the adolescent years
since this illness necessitates intensive care and
and how this demographic deals with illness on a daily
degrades quality of life over time due to specific care
basis in order to promote self-care and help improve
requirements (1).
quality of life (4).
Teenagers with T1DM should receive therapy that
Only a small number of research have looked at the
takes into account their unique characteristics, including
association between socioeconomic, clinical, and
variations in insulin sensitivity brought on by physical
biochemical features and T1DM in children and
and sexual development, their ability to take care of
adolescents, despite the fact that there are numerous
themselves, and their neurological susceptibility to
scientific studies on the subject in both international and
hypo- and possibly hyperglycemia. Thanks to advances
national literature. These factors may have an impact on
in technology, science, the understanding of the
how the condition is treated and managed, which could
psychological aspects of diabetes, the treatment of type
decrease the quality of life for young people with T1DM
1 diabetes is now focused on the triangle of insulin,
(5). In light of the aforementioned, the study question
monitoring, and education about diabetes, which
"Are the HRQoL domains associated with the clinical,
includes a healthy diet, frequent physical activity and
laboratory, and sociodemographic features of teenagers
social issues associated to the condition. In this context,
with T1DM?" was further developed. Based on the
an effective treatment strategy also depends on paying
theory that these variables may have an effect on the
attention to family dynamics. The intricacy of the
HRQoL of adolescents with T1DM, this study aimed to
intensive care plan may degrade quality of life as these
evaluate the HRQoL of adolescents with T1DM and
needs persist throughout life (2).- Teenagers with chronic
connect it with sociodemographic, clinical, and
illnesses may be subjected to pressures that lower their
laboratory characteristics (6).
quality of life. Having a chronic illness like T1DM
According to current diabetes education
throughout this stage of human development has an
recommendations, the results will hopefully advance
effect on the psychosocial environment since it alters
knowledge and contribute to improve quality of life
many aspects of one's social and personal identity and
while taking into account the unique characteristics of
raises the likelihood of developing emotional and
adolescents (Their personal traits and social context).
behavioral disorders. Diabetes distress, which is defined
This study aimed to evaluate the HRQoL of adolescents
as unpleasant feelings brought on by having the
with type 1 diabetes mellitus, associating it with socio-
condition and the responsibility of managing it on one's
demographic, clinical and biochemical variables.
own, might set off these disorders (3).

While research on the prevalence of distress in
adults is well established, it has not been examined in
This cross-sectional study was conducted at
teenagers. A thorough study found that one-third of
Pediatric Unit of Diabetes Mellitus at Suez Canal
teenagers with type 1 diabetes had elevated diabetes
University Hospital and the control group was followed
distress. This condition usually results in poor glucose
up at Ismailia Health Insurance Hospital. Both clinics
Received: 08/05/2023
Accepted: 09/07/2023

Full Paper (vol.931 paper# 108)

introduction The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7633-7638

Prostate Specific Antigen in Different Dermatoses Associated with
Polycystic Ovary: Review Article
Shymaa Mostafa Rezk 1, Hamasat Abdel Hafeez Abdel Khalik* 3, Wagdy Megahed Amer 2,
Alhassan Mohamed Shahrour*1 and Eman Mostafa Sanad 1
1 Dermatology, Venereology and Andrology, 2 Obstetrics and Gynecology, 3 Clinical and Chemical Pathology
Department, Faculty of Medicine, Benha University, Benha, Egypt
Corresponding author: Hamasat Abdel Hafeez Abdel Khalik,
email: Dr.alhasan_shahror@yahoo.com, mobile: +201110799912

Dermatologic signs of hyperandrogenism, such as hirsutism, acne vulgaris, and androgenic alopecia, are
common in women with polycystic ovary syndrome (PCOS). Prostatic Specific Antigen (PSA) is a potential new
measure of hyperandrogenism in both PCOS and hirsute women.
Objectives: The focus of this research is to examine the potential function of prostate specific antigen in different
dermatoses associated with polycystic ovary in females.
Material and methods: We searched Google Scholar, Science Direct, PubMed and other online databases for prostate
specific antigen, different dermatoses and polycystic ovary in females. The authors also reviewed references from
pertinent literature, however only the most recent or comprehensive studies from 2006 to February 2021 were included.
Documents in languages other than English were disqualified due to lack of translation-related sources. Papers such as
unpublished manuscripts, oral presentations, conference abstracts, and dissertations that were not part of larger scientific
studies were excluded.
Conclusion: PSA has the potential to be used as a diagnostic marker for PCO and its accompanying hyperandrogenism,
particularly in the context of acne. More study is needed, however, to corroborate these findings and develop guidelines
for the clinical use of PSA in dermatological practise.
Keywords: Prostatic specific antigen, Polycystic ovary syndrome, Acne vulgaris, Hyperandrogenism.

been found to contain PSA. PSA synthesis appears to be
The most prevalent endocrinopathy in women
regulated by glucocorticoids, progestin, and androgens,
is hyperandrogenism, which can be caused by ovarian
and steroid hormones [2].
or adrenal androgen overproduction, altered peripheral
Our objective was to investigate the potential
metabolism, and/or end-organ hypersensitivity. Clinical
involvement of prostate specific antigen in several
features of polycystic ovary syndrome (PCOS) include
dermatoses that are linked to polycystic ovarian
infrequent or absent ovulation, irregular or absent
syndrome in females (Approval Code: Ms 65-5-2022).
menstrual bleeding, excess androgen production

(including hirsutism and acne), elevated insulin levels,
Dermatoses of hyperandrogenism
and excess body fat [1].
Hyperandrogenism, which refers to the overproduction
Polycystic ovarian syndrome affects about 5-
of androgens, predominantly affects females. There are
10% of reproductive-aged women. But when there is an
a number of diseases in women that have been
excess of testosterone, along with varying degrees of
associated to hyperandrogenism, but PCOS is by far the
gonadotropin and metabolic issues, PCOS may be
most common. Common dermatological manifestations
present. It appears that biochemical markers of
of hyperandrogenism include hirsutism, acne,
hyperandrogenemia have widely varying diagnostic
acanthosis nigricans, and androgenic alopecia [3].
performance, and there is yet no single diagnostic tool

that is sufficient for clinical diagnosis of PCOS. Women
with polycystic ovarian syndrome often exhibit
Hirsutism manifests itself in women when they
hyperandrogenic skin symptoms such as hirsutism, acne
start growing coarse, terminal hairs all over their bodies,
vulgaris, and androgenic alopecia. Hyperandrogenism-
just like men. The prevalence of hirsutism in
related symptoms are present in a subset of patients with
premenopausal women is estimated to be between 5%
PCOS indicating that these people have overt
and 25%. 22,23% PCOS is responsible for between
abnormalities in circulating androgens. People with
70% and 80% of cases of hirsutism. 24 Clinicians
PCOS who don't intend to become pregnant right away,
should approach the issue of hirsutism in women with
the primary therapeutic option is androgen suppression
compassion and understanding [4].
following a diagnosis of hyperandrogenism. The serine
In the past, hirsutism was thought to indicate
protease known as prostate-specific antigen (PSA)
that a woman had an abnormally high amount of the
plays a critical role as a diagnostic marker in the study
male hormone androgen (testosterone). This could have
of prostate cancer. In addition to the prostate gland,
been the result of an overactive adrenal gland or an
certain female tissues, including the ovary,
ovarian disorder. Hair on the top lip, chin, upper back,
endometrium, breast, milk, and amniotic fluid, have
shoulders, sternum, and upper belly tends to grow more
Received: 10/05/2023
Accepted: 11/07/2023

Full Paper (vol.931 paper# 109)

Introduction The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7639-7646
Fingernail versus Toenail Onychomycosis:
A Dermoscopic and Mycological Study
Noha Mahmoud Taha Elsayed*1, Manar Elsayed Sallam2,
Waleed Mahmoud Eldars2, Magdy Abdel-Mageid Elsohafy1
Departments of 1Dermatology, Andrology &STDs and
2Medical Microbiology & Immunology, Faculty of Medicine - Mansoura University, Egypt
*Corresponding author: Noha Mahmoud Taha Elsayed, Mobile: (+20) 01004655771, E-mail: nonodr@yahoo.com

A fungal infection of the nail unit, onychomycosis (OM) is brought on by dermatophytes, yeast, and non-
dermatophyte moulds (NDM). It is the most prevalent nail infection in clinical practice, occurring at 5.5% of the time
Objective: This study aimed to evaluate the role of dermoscopy in diagnosis of finger and toenail onychomycosis
through correlating its finding with mycological study results.
Patients and methods: The current study was carried out on 45 patients with nail abnormality (clinically) suggesting
onychomycosis. They were divided into three equal groups according to site of infection (finger, toe and both).
Dermoscopic examination and taking photographs were taken to detect different clinical and dermoscopic patterns. Nail
scrapings were collected and examined using direct microscopic examination with KOH (20%) and cultured on SDA
media to detect causative organism.
Results: Of all studied groups, female gender showed the highest prevalence in all studied groups representing 80%,
66.7% and 66.7% in group I, II and III respectively. The mean ages of the three groups (I, II and III) were 43.5 ± 12.3,
39.3 ± 12.3 and 47.6 ± 13.1 years respectively. Thumb was the most common affected finger in groups I and III (finger
affection) by 53.3%, while the big toe was the commonest affected toe in groups II and III by 100% and 73.3%
respectively. According to occupation, 51.1% of all cases were housewives.
Onychomycosis had high prevalence in female gender, middle age, housewives and farmers. Thumb and
big toenails were the most common affected nails. According to clinical types of onychomycosis, DLSO was the
commonest clinical type between all groups of onychomycosis except in group III (toe affection) that PSO was the
commonest clinical type. According to dermoscopic patterns, brown and black pigmentation, toe jagged proximal edge
with spikes and Subungual hyperkeratosis was the commonest dermoscopic patterns in groups I, II and III respectively.
Keywords: Onychomychosis, Fingernail, Toe nail, Dermoscopic, Mycological.


Because it can result in localised discomfort,
floccosum. For 90% of toenail onychomycosis and 50%
paresthesia, difficulties carrying out everyday tasks, and
of fingernail onychomycosis, dermatophytes are found.
impairment of social contact, onychomycosis is a
Ten to twenty percent of cases of onychomycosis,
significant issue (1).
particularly in fingernail onychomycosis, are caused by
Onychomycosis can be classified clinically into
Candida species, particularly Candida albicans (4).
distal and lateral subungual onychomycosis (DLSO),
proximal subungual onychomycosis (PSO), superficial
onychomycosis are primarily cultured from toenails e.g.
white onychomycosis (SWO), endonyx onychomycosis
Fusarium, Aspergillus species that account for about
and total dystrophic onychomycosis (TDO). This
8% of nail infection (4).
categorization was expanded to encompass mixed and
Most studies regarding onychomycosis were
2ry infection types (2).
performed on both finger and toenails together,
Weakened immune systems, trauma, advanced age,
however correlation between sites of infection in either
and diabetes mellitus are well-known risk factors for
fingernails or toe nails and clinical pattern, dermoscopic
onychomycosis. Other risk factors include psoriasis,
findings and type of causative fungi does not fully
tenia pedis, and a family history of onychomycosis (1).
investigated (5). Clinicopathological methods, which can
Onychomycosis is more prevalent in certain jobs as
be time-consuming and result in false negative results
housewives, food handlers or food modelling and other
in up to 35% of cases, are being replaced with clinico-
workers that are exposed to excessive water, which
imaging methods in the diagnosis of onychomycosis (6).
increases the risk of onychomycosis. So employees
Dermoscopy has opened a new dimension in the
suffer from employer reluctance to hire individual with
diagnosis of onychopathies. It is a non-invasive
abnormal nail particularly jobs of food handling or
practical imaging method that used to diagnose
where interaction with the public is required (3).
onychomycosis and differentiate onychomycosis from
Trichophyton rubrum is the most common cause of
traumatic onycholysis and other nail disorders (7).
onychomycosis, however it can also be caused by other
Fungal culture still considered the criterion standard of
dermatophytes, such as Trichophyton interdigitale,
onychomycosis and must be shielded against prolonged,
Trichophyton mentagrophytes, and Epidermophyton
needless medical care as well as its negative
Received: 11/05/2023
Accepted: 12/07/2023

Full Paper (vol.931 paper# 110)

c:\work\Jor\vol931_111 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7647-7650

Relationship between Forward Head Posture, Neck Pain, and Disability among
Dentists with Mechanical Neck Pain
Alaa Elsayed Elsayed1, Enas Fawzy Youssef 2, Amal Fathy kaddah3, Marihan Zakaria Aziz Makary 4
1 Physical therapist, Cairo Health Administration, Egypt
2,4 Department of Musculoskeletal Disorder and Its Surgery Faculty of Physical Therapy, Cairo University, Giza, Egypt.
3 Department of Prosthodontic Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt.
*Corresponding author: Alaa Elsayed, Mobile: (+02) 01007606903, E-mail: Alaaelshrief15@gmail.com

Dentistry is a high-risk profession for neck pain due to stressful work positions such as neck flexion, arm
abduction, and inflexible postural positions, which can cause a forward head posture (FHP).
Objective: This study aimed to explore whether there is a relationship between FHP and the severity of neck pain and
disability among dentists with mechanical neck pain. Methods: A cross-sectional study was carried out on twenty-six
dentists with FHP and chronic mechanical neck pain lasting more than 3 months. All participants were assessed for FHP by
photometric measurement of cranio-vertebral angle (CVA), neck pain through the visual analogue scale Arabic version
(VAS-AR), and neck disability through the neck disability index Arabic version (NDI-AR).
Results: The forward head and the neck disability had a weak, inverse, and non-significant correlation (r = -0.250, p =
0.219). While, the forward head and pain had a weak, direct, and non-significant correlation (r = 0.132, p = 0.250).
Forward head posture may contribute to the exacerbation of neck pain and disability among dentists.
Keywords: Dentists, Forward head posture, Neck pain, Neck disability.

Neck pain is the second most common
dentists were selected according to the inclusion criteria
musculoskeletal disorder in population surveys and
facilitated by direct referrals from specialists at Al-Qasr
primary care. It causes a significant health and economic
Al-Aini Dentistry Hospital, the study period extended
burden and is consequently considered the leading cause
from April 2023 and June 2023.
of disability worldwide (1, 2). Neck pain can be classified

into specific to serious conditions such as neurological
Ethical considerations: The study was conducted in
disorders, infections, neoplasms, and cervical spine
compliance with the ethical standards of Declaration of
fractures, or non-specific (neck pain without known cause)
Helsinki. It received approval from the Faculty of
(3). Non-specific neck pain (NSNP) is mechanical neck
Physical Therapy, Cairo University, Egypt's Ethical
pain affecting people, especially in middle age (1, 4).
Committee under the reference number P.T
Dentistry is a profession at high risk of
REC/012/004771. After signing informed consent, all
musculoskeletal disorders with a high prevalence of neck
dentists were enrolled in this study.
pain observed annually at 58.5% (5). Nonspecific neck pain

is commonly associated with disturbed normal mechanical
Sample size calculation: For determining the appropriate
balance of upper quadrants and poor posture (4).
sample size, the statistical software G*POWER (version
Furthermore, the most assumed position by dentists
3.0.10; Franz Faul, Universität Kiel, Germany) was
is the sitting position. Due to the requisite attributes of
utilized. The correlation normal model was selected for
focusing and precision in dental practice, dentists adopt an
this analysis. Based on parameters including a power of
inflexible posture characterized by neck flexion, arm
0.80 (one-tailed), an alpha level of 0.05, and an anticipated
abduction, and fixed postural positions. This posture may
effect size of 0.47, the software recommended a sample
potentially contribute to FHP, neck discomfort, and
size of 26 dentists.
postural abnormalities (6). The prolonged FHP, in which the

head is placed anteriorly to the gravitational axis, puts
Inclusion criteria: Dentists aged 27 to 40 years with a
more strain on the cervical region and leads to neck pain
body mass index (BMI) of 25 to 29.9 kg/m2 and specific
(6). Given the high prevalence of neck pain among dentists,
years of work experience (more than 5 and less than 15
this study aimed to investigate whether FHP is a potential
years). Dentists had FHP with a CVA of less than 50° as a
risk factor that may affect the magnitude of neck pain and
reference angle (7), with chronic mechanical neck pain
disability experienced by dentists.
lasting more than 3 months, a baseline NDI score of at least

10 points (20%) (8, 9), and at least 3 out of 10 pain intensity
on VAS (9).
Study design: A cross-sectional research design was
Exclusion criteria: History of cervical fracture or trauma,
carried out on twenty-six dentists of both genders. The
cervical surgery, temporomandibular surgery or
Received: 01/07/2023
Accepted: 05/09/2023

Full Paper (vol.931 paper# 111)

c:\work\Jor\vol931_112 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7651-7658

The Factors Associated with Variation in Length of Hospital Stay in Covid19 Patients
Mohamed Abd El Hamid Mohamed¹, Marlein Mansour Girgis*², Ghadeer Mohamed Rashad1
¹ Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Benha University and 2
Department of Hepatology, Gastroenterology and Infectious Diseases Benha Fever hospital, Benha, Egypt.
*Corresponding author: Marlein Mansour Girgis , Mobile: (+20) 1220128485,
E-mail: drmarleinmansour@gmail.com , ORCID NO: https://orcid.org/0009-001-9409-1155

The COVID-19 pandemic has significantly burdened healthcare and economic infrastructures. Identifying
indicators linked to hospitalization requirements and duration of stay (LOS) could be crucial for efficiently allocating
resources and prioritizing patient care.
Objectives: The purpose of this study was to investigate, retrospectively, the variables influencing the length of hospital
stay (LoS) for patients with COVID-19.
Patients and Methods: This study included 300 patients with Covid 19 who were admitted to the 23 July Chest Hospital,
El Marg Qaluobia Government, during the period from october 2020 to September 2022. Patients were divided according
to length of hospital stay into 2 groups; Not prolonged group; included 170 patients (56.7%) with LoS < 11 days, and
Prolonged group; included 130 patients (43.3%) with LOS > 11 days. Patients were subjected to complete history taking
and physical examination. Complete blood count (CBC), C- reactive protein, D-dimer, liver function tests, kidney function
tests, radiological examinations and Naso-pharyngeal swab were done.
Results: prolonged group were statistically older (61±11 years) than not prolonged group (48±13 years), p <0.001. Also,
comorbidities and smoking were common in prolonged than the other group. Anemia, leucopenia, lymphopenia,
thrombocytopenia were more common in prolonged group than the other group. Also, all cases in prolonged group showed
elevated d-dimer, CRP, higher frequencies of bilateral pulmonary infiltration and consolidation compared with not
prolonged group.
Conclusion: Old age, comorbidities and smoking are associated with prolonged hospital stay. In addition, O2 saturation <
86%, high levels of blood glucose, D dimer, CRP are significant independent predictors of prolonged hospital stay.
Keywords: Length Of Hospital Stay; LOS: Covid19


A new coronavirus, emerging in December 2019 and
Up to this point, there has been a lack of information
named SARSCoV2, triggered a global outbreak of a
regarding the risk factors for the length of hospital stay
respiratory illness known as COVID (1). The World Health
(LOS) in Egypt. Therefore, we carried out a retrospective
Organization declared COVID-19 a worldwide public
analysis of patients admitted with COVID-19 in a singular
health crisis on January 30, 2020 (2).
hospital setting, with the aim of identifying the elements
Beyond causing death and illness, COVID-19
that influence the duration of hospitalization.
intensifies economic and societal burdens, leading to

lasting and escalating consequences (3). Treating patients
with proven disease requires many physicians, nurses, and
This retrospective cohort study included a total of
hospital beds, which has an impact on the global
300 patients with Covid 19, who were admitted to the
healthcare system by taxing medical resources and
23 July Chest Hospital, El Marg Qaluobia Government.
overcrowding hospitals. In addition, it was shown that the
This study was conducted between october 2020 to
COVID-19 survivors' median length of stay (LOS) was
september 2022.
between 10 and 13 days (4).
Numerous studies have been conducted on COVID-
This study included patients who were admitted to
19. Notably, researchers in China analyzed the factors
ward, both sexes, aged >18 years, after exclusion of
influencing the severity and hospital stay length (LOS) for
patients who were died during admission and patients not
patients with moderate to severe COVID-19. Their
suspected to have COVID as presence of lobar pneumonia
findings indicated that the use of glucocorticoids led to an
or pleural effusion and pneumothorax.
extended duration of hospitalization (5).

A retrospective investigation conducted in Vietnam,
Confirmed Case:
in addition to China, revealed a strong correlation
A patient who has had laboratory confirmation of
between age, place of residence, and sources of
COVID-19 infection by molecular testing (PCR) together
contamination and an extended hospital stay for COVID-
with results indicative of COVID-19 illness on chest
19 patients during the second wave (6).
imaging, regardless of clinical signs and symptoms, and a
Received: 14/05/2023
Accepted: 13/07/2023

Full Paper (vol.931 paper# 112)

c:\work\Jor\vol931_113 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7659-7664

Evaluation of Topical Hydrogen Peroxide 30% versus Topical Zinc Sulphate 10% in
Treatment of Plane Warts: Clinical and Dermoscopic Study
Eman Elsayed Abulnasr Abd Allah*, Mohammed Fawzy EL-Kamel, Abeer Mohamed Abdelaziz Elkholy
Department of Dermatology, Andrology and STDs, Kafr Elsheikh Hospital, Egypt
*Corresponding author: Eman Elsayed Abulnasr Abd Allah, Mobile:(+20) 0109 974 5960, Email: dremansayed9@gmail.com

Plane warts are caused by infection with human papilloma virus (HPV). Lesion usually presented as 2-4
mm flat topped papules, which are slightly erythematous or brown on pale skin and hypopigmented on darker skin.
Many modalities of treatment were used, but none is uniformly effective.
Objectives: To assess the efficacy and safety of topical hydrogen peroxide (HP) 30% versus topical zinc sulphate
(ZnSO4) 10% in plane warts treatment.
Patients and Methods: This is a parallel-group clinical study conducted on 64 patients divided into two groups; H2O2
group (n=32) and ZnSO4 group (n=32). Patients were evaluated clinically and by the dermoscope at the end of two, four
and six weeks.
Results: H2O2 group showed complete response (CR) in 81.3% of cases, while zinc sulphate group revealed CR in
34.4% of cases. There was a statistically significant higher proportion of "disappearance of dotted vessels and reddish
gray / pale background plus appearance of normal skin markings" in H2O2 group vs. zinc sulphate group. There was a
statistically significantly higher ratio of CR among those with facial lesions who received treatment by hydrogen
Conclusion: In the context of plane warts, hydrogen peroxide (30%) seemed to be an effective therapeutic modality
with a higher satisfaction rate compared to 10% ZnSO4 with minimal complications.
Plane warts, Hydrogen peroxide, Zinc sulphate, Dermoscopy.


Warts are benign proliferation of skin, which
There are supportive evidences for the
caused by infection with human papilloma virus (HPV),
efficiency and safety of topical HP 45% as a promising
which are DNA viruses that replicate inside the nucleus.
agent in common warts. The adverse event of such uses
The possibility increases during school years, after that
are minor and mainly include pain on administration
drops significantly until the age of twenty, and more
and irritation to regions of administration (9).
gradually thereafter. HPV infections are classified into
This study aimed to evaluate efficacy of topical
clinical, subclinical, and latent (1).
HP 30% twice weekly versus topical ZnSO4 10% three
Of note, plane warts are caused by HPV type 3
times per day in treatment of plane warts by clinical and
and 10 and mainly affect children and teenagers as well.
dermoscopic signs.
Plane warts could be detected as multiple small flat-

topped skin-colored papules situated most frequently on
the face, hands, and shins. Plane warts are self-limited
This is a parallel-group clinical study conducted
and often resolved within four weeks, in particular when
in outpatient clinic of dermatology, Mansoura
inflammation occurs or they may remain for a
University Hospitals, Mansoura, Egypt on 64 cases with
prolonged period to be resolved (2, 3). Their dermoscopic
plane warts who were haphazardly distributed, based on
distinctive feature is multiple small red dots with regular
the therapeutic plan, into two groups; group 1 (32
distribution on a light brown background, which
cases); received treatment with topical H2O2 30% and
correspond to small vessels in the papillary dermis (4).
group 2 (32 cases); received treatment with topical zinc
A lot of therapeutic options were planned to
sulphate 10%.
manage plane wart management, however, none of them

are equally effective, these involves salicylic acid,
Inclusion criteria
imiquimod, 5-flourouracil, isotretinoin gel (5), and oral
Cooperative cases, with plane warts whose age
zinc sulfate (6). Topical zinc sulphate 10% was
was 8 years old of both genders who had never
confirmed as an efficient and safe therapy in the context
received any previous treatment for plane wart, were
of plane wart management (7). HP is formed in the body
comprised in the current study.
as a shortlived product in a lot of biological processes.

It has been considered as one of the reactive oxygen
Exclusion criteria
species (ROS), and it has been demonstrated to be
The current study excluded pregnant and
associated with antiviral, antifungal antibacterial
lactating females, cases with severe systemic illness or
activities. HP was previously tried successfully as a
malignancy or patients with illusive disorder or
topical agent in the context of molluscum contagiosum
unrealistic expectations.
(MC) (8).

Received: 10/05/2023
Accepted: 11/07/2023

Full Paper (vol.931 paper# 113)

c:\work\Jor\vol931_114 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7665-7670

Prevalence and Prognosis of Spinal Injuries in Pediatrics versus Adults
Ahmed Gamal AbdElsalam*1, Mohamed El-Said Ebrahim1, Mostafa Mahmoud Labib2, Samir Mohamed Attia3
Departments of Emergency Medicine1, Neurosurgery2,
Vascular Surgery3, Faculty of Medicine, Mansoura University, Egypt
Corresponding Author: Ahmed Gamal AbdElsalam, Mobile: (+20) 01023467005, Email: ahmed.gamal99995@gmail.com


Background: Spinal cord injury (SCI) is a devastating neurological lesion, which has been demonstrated to be
accompanied by considerable morbimortality. SCI, which happens in children and teenagers who remain developing
represents a major challenge compared to SCI in adult population.
Objective: The aim of the current work was to compare between the prevalence and prognosis of spinal injuries in
pediatrics versus adults.
Patients and Methods: This was a prospective study conducted on 80 SCI cases coming to Emergency Hospital,
Mansoura University over a period of one year. They were divided into two groups: Group I included 40 SCI cases aged
less than 18 years old and group II included 40 SCI cases aged more than 18 years old.
Results: Most of the studied pediatric cases were living in urban areas, while only 37.5% of which was living in rural
areas. Regarding adults about 50% and 50% of the studied cases were < 40 and 40 respectively. Severe urinary tract
infection (UTI) was significantly increased among adult ones compared to pediatric group, while bowel incontinence
was significantly increased among pediatrics compared to adult group. No significant differences were determined
between both groups as regards pressure ulcers, autonomic dysreflexia, respiratory complications and mortality within
one week. Tetraplegia incomplete was significantly increased among pediatrics, while Paraplegia complete was
significantly increased among adults.
Conclusion: SCI prevalence was demonstrated to be significantly correlated with urban residence in both pediatric and
adults. Incomplete tetraplegia was significantly increased among pediatrics, while complete paraplegia was significantly
increased among adults.
Keywords: Traumatic spinal cord injury, Tetraplegia, Paraplegia, Bowel incontinence.


The incidence rate represents the frequency of a
Trauma (T) is still a main cause of morbimortality
novel disease in certain populations throughout a certain
all over the world, and most early preventable deaths
period. It has been demonstrated that SCI incidence
owing to severe haemorrhage, in spite of recent
increased progressively (except for usual daily
advances in trauma care [1]. TSCI might be accompanied
activities). In the context of developed nation, the
by various grades of paralysis, loss of sensation and
incidence differed from 13 to 163 out of million subjects
urinary dysfunction. Of note, TSCI affects the health
[5]. The rates of non-developed nations differed from 13
and is responsible a major economic burden on the
to 220 per million subjects [6].
families and societies [2]. The World Health
With regard to Egypt at Al-Quseir City, the
Organization (WHO) recorded in 2009 in terms of SCI,
prevalence rate of SCI was 63/100000 for the overall
the percentage of male to female (M/F) ratio in Egypt
population. TSCI had a prevalence of 18/100000, on the
based on the ministry of health records was 71.1/28.9.
other hand non-TSCI was demonstrated in 45/100000.
The record displayed that the main etiologies of injury
Degenerative disc prolapse was the commonest cause of
was motor vehicle collision (MVC) and the greatest
Spinal cord disease (SCD) with a prevalence rate of
distribution happened within the age from 20 to 30 [3].
27/100000 [7].
Also, TSCI which happens in pediatrics and
This study was done to compare between the
teenagers who remain developing represents a major
prevalence and prognosis of spinal injuries in pediatrics
challenge compared to SCI in adult subjects. On the
versus adults.
other hand, data as regards the epidemiology of SCI in

a population-based cohort is missing. As children and
teenagers remains developing, TSCI which happens in
This was a prospective study carried out on SCI
the pediatrics represents various challenges compared
cases coming to Emergency Hospital, Mansoura
to SCI in the adults. Although cause of injury is
University within the period from January 2021 to
demonstrated to vary between pediatric and adult
September 2021. Entire cases were divided into two
populations, data on the incidence and trend of pediatric
groups: Group I comprised SCI cases with age less than
SCI is missing, as the majority of researches focus
18 years old and group II included SCI cases with age
mainly on adults. Understanding the epidemiology of
more than 18 years old but less than 70 years.
pediatric SCI is of great importance to plan the
allocations of resources and to develop prevention
All cases were subjected to primary survey and
strategies [4].
resuscitation that included airway maintenance &
Received: 15/05/2023
Accepted: 16/07/2023

Full Paper (vol.931 paper# 114)

INTRODUCTION The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7671-7678

Mitomycin­C Concentration during Subscleral Trabeculectomy for Treatment of
Primary Open Angle Glaucoma
1 Adel M. Abdul Wahab Khalil, 2Abeer Fouad Ahmed Elbadry, 3Eman ES Moawad
1, 2 Department of Ophthalmology, Faculty of Medicine [For Girls], Al Azhar University,
3 Faculty of Medicine, Al-Menofia University,
Email: 1adel2961959@hotmail.com, 2 abeerelbadry2015@ gmail.com, 3mhamdy12356@gmail.com


Background: Sub-scleral trabeculectomy is the standard surgical procedure for management of uncontrolled primary
open angle glaucoma (OAG). Intraoperative mitomycin­C is frequently used during sub-scleral trabeculectomy to
decrease the risk of recurrence.
Objective: This study aimed to assess the impact of mitomycin-C levels used during subscleral trabeculectomy on
managing intraocular pressure in primary open angle glaucoma cases.
Patients and methods: This study is a prospective comparative interventional and non-randomized study. It was
conducted on 30 eyes of 30 patients with uncontrolled open angle glaucoma. They were operated upon by sub-scleral
trabeculectomy with intraoperative mitomycin­C. Patients were divided into three equal groups according to the
mitomycin­C concentration: Group A [10 patient] received 0.2 mg/ml mitomycin-C. Group B [10 patient] received 0.3
mg/ml mitomycin-C. Group C [10 patient] received 0.4 mg/ml mitomycin-C.
Results: There were statistically non-significant differences between group A, B and C as regards age, sex and
preoperative IOP. Statistically highly significant IOP decrease was detected in all groups one day postoperatively and
continued till the end of follow-up period at 3 months postoperatively as compared to preoperative level. There were
statistically non-significant differences between groups A, B and C as regards the IOP, UCVA and BCVA at the
postoperative follow-up visits.
Conclusion: Different concentrations of mitomycin-C (0.2, 0.3, 0.4 mg/ml) were clinically equaled in controlling IOP
after glaucoma surgery.
Keywords: Mitomycin­C, Glaucoma, Trabeculectomy, Intra ocular pressure, Hypotony.


Glaucoma is a progressive optic neuropathy
leads to bleb failure. Two agents have been
leading to irreversible blindness if left untreated (1).
widely used, the mitomycin C (MMC) and the 5-
Subscleral trabeculectomy is a primary surgical method
fluorouracil. Vascular endothelial growth factors have
for managing glaucoma. While there is often a notable
been investigated to have an important role in the
decrease in intraocular pressure (IOP) following the
healing process in glaucoma surgery. It had been found
surgery, the long-term success can be compromised due
that they induce fibrosis in human tissues (3).
to progressive subconjunctival fibrosis, resulting in a
This study focuses on assessing the impact of
subsequent increase in IOP (2).
mitomycin-C concentration used intraoperatively on
Subscleral trabeculectomy is a surgical
controlling IOP during subscleral trabeculectomy in the
procedure that establishes an alternative pathway for the
treatment of primary open angle glaucoma.
drainage of aqueous humor from the front part of the

eye to the region under the conjunctiva, which is
situated beneath a flap of the white outer layer of the eye
This study is a prospective, comparative,
called the sclera. In order to guarantee the success of
interventional, and non-randomized study. 2023. It was
this treatment, it is imperative that the lower half of the
held at the Ophthalmology Department of Al-Zahraa
somewhat thin scleral flap, the borders of the scleral
University Hospital. It included 30 eyes with primary
incision, and the area between the episclera and
uncontrolled OAG in 30 patients. They were prepared
conjunctiva remain devoid of any healing or scarring
for surgical treatment in the form of subscleral
mechanisms. It is crucial to avoid obstruction of the
trabeculectomy. Patients were classified as follows:
drainage of the aqueous fluid through the surgically
Group A [10 patient]: They were subjected to sub-
established fistula. (3).
scleral trabeculectomy with 0.2 mg/ml mitomycin-C.
Mitomycin C, an antineoplastic agent, is derived
Group B [10 patient]: They were subjected to sub-
from the soil bacterium Streptomyces caespitosus. Its
scleral trabeculectomy with 0.3 mg/ml mitomycin-C.
primary action is as a cross-linker of deoxyribonucleic
Group C [10 patient]: They were subjected to sub-
acid (DNA), which effectively inhibits the proliferation
scleral trabeculectomy with 0.4 mg/ml mitomycin-C.
of fibroblasts (4).

The success rate of the surgical management of
Inclusion Criteria: Primary open angle glaucoma with
glaucoma is related to the healing process to achieve
uncontrolled IOP in patients of either gender and of
long-term results and healthy operating blebs (5).
different age groups.
Antimetabolite agents are used to limit fibrosis that

Received: 16/05/2023
Accepted: 17/07/2023

Full Paper (vol.931 paper# 115)

c:\work\Jor\vol931_116 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7679-7684

Assessment of Knowledge and Practices of University Students of
Pediatrics Basic Life Support
Hesham F. El- Sayed, Ahmed M. Abd El Halim, Yasmine G. Mohamed*
Pediatrics Department, Faculty of Medicine, Suez Canal University, Egypt
*Corresponding author: Yasmine G. Mohamed, Email: yasmine_gabr@hotmail.com, Mobile: +201001127536

Background: Pediatric cardiac arrest in the out-of-hospital setting is a traumatic event for family, friends, classmates,
and school personnel. Children who receive immediate bystander cardiopulmonary resuscitation showed improved
survival dramatically. Aim: to improve the baseline knowledge and practice of pediatric basic life support among
university students who will be responsible for children during their work. Subjects and methods: This is a cross
sectional study of representative sample of students in the first year from the Faculties of Medicine, Nursing, Dentistry
and Education at Suez Canal University. After and before efficacy study of training program assessing knowledge and
practice of Pediatric Basic Life Support (PBLS) was done through online questionnaire to prevent grouping during the
time of COVID19 pandemic. Results: The main outcome of the study was that the overall knowledge score increased
significantly after the workshop 6.07±1.7 comparing with before the workshop 4.67±1.6 (P <0.001) and the overall
practice score increased significantly after the workshop 5.65±1.7 comparing with before the workshop 3.97±1.5
proving that the web-based learning and video-based self-learning are successful in improving the knowledge and practice
of the trainee. Conclusion: Overall, there was a significantly improvement of all participants regarding the knowledge
and practice of the pediatric life support (PBLS).
Keywords: Pediatric cardiac arrest, Cardiopulmonary resuscitation, Automated external defibrillators.

appropriate life support education for kids (e.g., teaching
Children spend a lot of time away from their parents
young kids how to help victims of OHCA, teaching older
and guardians, whether it could be at school, a training
kids CPR, and teaching adolescents CPR and AED use) as
facility, or an amusement center. Even with safety
a part of the curriculum in schools starting in the primary
precautions, medical emergencies can still happen at any
grades. They also favor the installation of an AED that is
time. Numerous medical emergencies necessitate prompt
suitable for treating adults and kids near every school
attention, including respiratory and airway issues,
athletic facility and training school staff and older kids on
disorders connected to trauma, severe allergic responses,
how to use AEDs properly (2). In order to perform BLS
near drowning incidents, and seizures (1). In the context of
successfully, a range of cognitive knowledge and
an out-of-hospital pediatric cardiac arrest, witnesses were
psychomotor retention skills are needed. These actions are
family, friends, and caregivers (2). According to the Central
referred to as the "chain of survival," and they include early
Agency for Public Mobilization and Statistics report from
recognition of cardiac arrest and activation of the
2017, children in Egypt make up to 40% of the total
emergency response system, effective advanced life
population. Consequently, initiatives to improve the health
support, integrated post-cardiac arrest care, early CPR with
of children are extremely important (3).
an emphasis on chest compressions, and early
It is morally required of parents and caregivers to
defibrillation when necessary (5). The implementation of
maintain a copy of the child's vital medical records at
the survival chain phases can increase the survival rate by
home, at school, and at daycare centers. They also need to
10­20% (6). The characteristics of high-quality CPR are
be aware of warning signs of the child's decline and
effective compressions and opening the airway and
understand pediatric basic life support (BLS), which is the
delivering ventilation. Compressions are the most
administration of cardio-pulmonary resuscitation (CPR)
important component of CPR and are necessary to
without the use of any devices or in combination with bag-
maintain circulation to and perfusion of the heart and brain.
mask ventilation or barrier devices until advanced life
Whereas compressions-only CPR is acceptable initially for
support (ALS) can be given (4). The provision of layperson
adults, pediatric basic life support (PBLS) updated
guidelines recommend giving breaths but, if not possible,
demonstrated to increase the rate of survival, with
then effective chest compressions alone can accomplish
favorable neurologic result in OHCA victims of all ages,
bystander CPR (7). According to the 2017 American Heart
despite the dismal survival rates in OHCA for both adults
Association guidelines for Pediatric Basic Life Support,
and children. Consequently, the American Academy of
there is no distinction between CPR that involves chest
Pediatrics (AAP) recently recommended and supported
compressions plus breathing and CPR that simply involves
giving all school employees life support training. Parents,
chest compressions (8).
caregivers, and the general public are also in favor of age-
So, we aimed to improve the baseline knowledge and
Received: 07/05/2023
Accepted :06/07/2023

Full Paper (vol.931 paper# 116)

c:\work\Jor\vol931_117 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7685-7689

Pediatric Patients with Febrile Seizures: The Role of The
Copeptin Assay, at Sohag University Hospital
Amr Ahmed Othman1*, Mahmoud Ali Abd Elrady1,
Abdelrahim Abdrabou Sadek1, Ahmed Ahmed Allam2, Naglaa F. Boraey1
1Department of Pediatrics, 2Department of Clinical Pathology, Sohag University Hospital
*Corresponding Author: Amr Ahmed Othman, Email: amrothman190@gmail.com, Mobile: 01003913744

Recognizing febrile seizures in children might be challenging due to the absence of clear postictal
symptoms. In healthy children, Von Willebrand factor and copeptin levels in the blood are normal but significantly
elevated after febrile seizures in young children.
Objective: To examine copeptin's utility as a serum biomarker for the early detection of febrile seizures in children.
Patients and methods: Quantitative analysis of serum copeptin levels was carried out using a sandwich enzyme-linked
immunosorbent assay. A total of 90 children participated in the study, 30 each in groups 1 (children with febrile
seizures), 2 (children without febrile seizures), and 3 (healthy controls).
Results: Serum copeptin levels were found to differ considerably among the groups investigated, with group I (children
with febrile seizures) showing significantly greater levels than the other groups (P < 0.001). Serum copeptin value of
8.775 pmol/L was the most accurate threshold for predicting febrile convulsion. In a ROC study, the area under the
curve was 0.986, showing good accuracy. The cutoff value was found to have a sensitivity of 93.3% and a specificity
of 91.7%. Overall, the accuracy of the forecast was determined to be 92.2%, with a positive predictive value (PPV) of
84.9%, and a negative predictive value (NPV) of 96.5%.
Conclusion: Discovery of serum copeptin as a biomarker for febrile convulsions is promising. Copeptin is a postictal
biomarker that shows promise for use in the emergency department, particularly in instances with equivocal clinical
histories and presentations, where it might help in diagnosis and management.
Keywords: Copeptin, Febrile seizures, Pediatric fever.


Febrile seizures (FS) are a kind of convulsion
significantly higher in children with febrile seizures
that affects 2%-5% of children aged 6 months to 6 years
(4,5,14). This study set out to ascertain whether copeptin
Febrile seizures may seem like other fever symptoms,
may be used as a biomarker in the blood of children
such as shivering or dizziness, making diagnosis
experiencing febrile seizures.
challenging. Febrile seizure is a major challenge in

pediatric practice because of its high incidence in young
children and its tendency to recur. In recent years, there
This cross-sectional research was conducted at the
has been more awareness about the potential
Pediatric Department at Sohag University Hospital for
complications of febrile seizures and management of
8 months after receiving the necessary ethical clearance
this condition The Japanese Society of Child Neurology
from January 2022 to August 2022. Thirty children in
and the American Academy of Pediatrics (AAP) both
each of the three groups comprised the study's
released revised guidelines for the assessment and
population. Children with febrile seizures (group 1)
treatment of febrile seizures in 2011 and 2015,
ranged in age from 6 months to 6 years old; all were
respectively. Due to the absence of an objective
experiencing seizures. Simple febrile seizures are
biomarker, post-fever diagnosis of FS may be
characterized by their short duration, generalized
challenging (1,15,16).
convulsions, and lack of focal neurological indications.
Some possible biomarkers for use in the
and had an abnormal temperature (38°C). Complex
diagnosis or prognosis of FS have been identified thanks
febrile seizures are characterized by a prolonged
to recent developments in medical technology, most
duration, focal characteristics during the seizure, or
notably in molecular biology. Serum and cerebral fluid
multiple seizures within 24 hours(2). Patients with a
lactic acid levels were considerably raised in children
history of epilepsy, neurological abnormalities, inborn
with FS, as revealed by Imuekemhe et al. (2). Arginine-
metabolic errors, endocrine diseases (such as diabetes
vasopressin (AVP), a hormone produced in the pituitary
mellitus), or gastrointestinal issues (such as diarrhoea)
gland, has a role in the body's thermoregulatory
were not eligible for inclusion in this study.
response to high temperatures and seizures (3,13).
Children aged 6 months to 6 years old who arrived
However, the diagnostic use of AVP is restricted by its
with a fever (>38°C) owing to acute infection
volatility in peripheral blood. Since the AVP precursor's
constituted Group 2. Central nervous system infections,
C-terminal portion is stable in serum and plasma at
preexisting neurological abnormalities, Seizures,
room temperature, quantifying copeptin may be done ex
inherited metabolic problems (such as diabetes
vivo with considerable simplicity. Copeptin is a valid
mellitus), and endocrine diseases (such as diarrhoea)
indicator of AVP secretion since its serum levels are
were all disqualifying conditions for this population.
Received: 10/05/2023
Accepted: 11/07/2023

Full Paper (vol.931 paper# 117)

c:\work\Jor\vol931_118 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7690-7694

The Prevalence of Heterozygous Familial Hypercholesterolemia among
Premarital Couples in Qalubya Governorate in Egypt
Basant Zahid 1, Mutaz Al-Khnifsawi 2 *, Khaled A Al-Rabbat1, Yasser H Abdelrahman1
1 Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt
2 Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding Author*: Mutaz Al-Khnifsawi, Email: dr_mutaz@hotmail.com, Phone number: 0 111 192 5398

Premarital care is a crucial step in preventing unwanted pregnancies, which in turn protects society and
allows people to live their lives to the fullest.
Objective: Our goal was to find married individuals who have heterozygous familial hypercholesterolemia (HeFH).
Subjectives and methods: Six hundred young adults (male and female) with HeFH who were going to get married
participated in this cross-sectional research. The following procedures were performed for all patients: comprehensive
history taking, clinical data collection, review of family history of coronary artery disease, laboratory testing, and
diagnosis of HeFH.
Results: The participants that were studied had an average age of 22 ± 3 years. Of the total, 50% were men and 50%
were women (50.0 %). Among those who participated in the survey, 55.7% lived in rural areas, while 44.3% lived in
metropolitan areas home. At 167 ± 37 mg/dl, the mean total cholesterol was measured. There was an average of 101 ±
37 mg/dl of triglycerides. There was an average of 94.2 ± 31.1 mg/dl for low-density lipoprotein and 52 ± 11 mg/dl for
high-density lipoprotein. There was a prevalence of 0.5% of HeFH observed in three cases.
Conclusions: Among 600 individuals who were contemplating matrimony, 3 (0.5 %) had potential HeFH.
Keywords: Prevalence, Heterozygous familial hypercholesterolemia, Premarital care, coronary artery disease.

development of xanthomas and/or arcus senilis, which
An essential stage in safeguarding society and
are deposits of cholesterol [6].
enabling individuals to enjoy life, premarital care
It is possible to take preventative actions with an
entails enhancing the health and wellness of both the
early diagnosis. When statins are administered to
lady and her spouse prior to conception. It is viewed as
individuals with FH who do not have a history of CAD,
a main preventative strategy for couples preparing to
the risk of CAD is lowered by 79%, to a level
have a family [1].
comparable to the general population. Despite the
Midway through 2001, the first pre-marriage
considerable cardiovascular risk associated with FH,
screening centre opened its doors to the public in Egypt.
most individuals with FH go undetected and untreated,
The % ages reported by Egyptians over the past four
according to numerous current guidelines for the
decades vary between 29 and 39 %. Premarital
therapy of FH [7].
counselling can help identify and avoid hereditary
Primary care physicians often see patients with mild
conditions such as hearing loss, mental retardation,
to moderate FH, but those with severe cases are often
autosomal recessive osteoporosis, and blood problems
referred to lipid clinics or specialists [8]. In addition,
that can occur through interracial marriage [2].
treatment is frequently initiated in the latter phases of
Premature coronary artery disease (CAD) is most
the illness, when atherosclerosis has progressed due to
often caused by familial hypercholesterolemia (FH), an
persistently high levels of LDL-C. Last but not least,
autosomal dominant disorder in which 50% of a
there are insufficient screening programs and health
person's children will be born with the illness. The
care systems do not recognize the problem adequately
LDLR gene is the most common site for the causing
mutations, while the apolipoprotein B and
An effective family-based cascade screening
proproteinsubtilisin/kexintype 9 genes are less common
programme can bridge the gap in FH diagnosis and
(PCSK9) [3]. Also, atherosclerotic coronary disease can
treatment. As part of this procedure, individuals who are
be sped up by 10­40 years with FH [4].
known to have familial hypertension (FH) are tested for
Heterozygous FH (HeFH) is a genetic disorder that
the disease in their immediate family members.
affects around one in three hundred thousand people.
National initiatives for genetic detection using cascade
People with this disorder have total cholesterol levels
screening have been undertaken by only a small number
higher than 500 mg/dL and develop extremely early
of nations [10]. This project's objective was to find
CAD. If left untreated, these people don't make it to
heterozygous FH carriers who intended to enter into
adulthood [5]. Factors that contribute to the diagnosis of
FH include elevated levels of bad cholesterol low-

density lipoprotein-cholesterol (LDL-C), a history of
hypercholesterolemia in the family, the presence of
Six hundred young adults (males and females) who
early coronary artery disease (CAD), and the
are preparing to get married participated in this cross-
sectional research.

Full Paper (vol.931 paper# 118)

c:\work\Jor\vol931_119 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7695-7699

Impact of Covid 19 Among Hemodialysis Patients
Samah Saad Abd El-Hamed*, Mohamed Mahmoud Abd Elnasir,
Abdelhamid Abdelrazik Abdelhafez, Eglal Kenawy
Departments of Internal Medicine, Faculty of Medicine, Al-Azhar University (Assiut), Egypt
*Corresponding author: Samah Saad Abd El-Hamed, Mobile: (+20) 01025375711, E-mail: drsamahsaad146@gmail.com

Global health and life are at risk from COVID-19, particularly for individuals who have several
illnesses, such as renal disease. Hemodialysis (HD) patients make up a sizable subset of kidney failure patients with a
variety of etiologies, most of which are thought to involve immune system impairment.
Objective: To describe the clinical characteristics, laboratory finding, short term outcomes and to estimate the
mortality rate of COVID 19 infection in chronic HD patients in Assiut Governorate.
Patients and Methods: A retrospective study was conducted on 400 patients in upper Egypt (Assiut Governorate)
with end stage renal disease on regular HD was carried out at Quarantine Department of Assiut Feverish Hospital, two
hundred of them were infected with COVID-19 diagnosed by polymerase chain reaction (PCR). Results: Regarding
the two hundred isolated HD patients infected with COVID-19, the mean age was (61.04 ± 14.57 years) older than
those without COVID-19 (49.54 ± 11.78), gender distributed was (48% males and 52.6% females) with an incidence
rate of occurrence about 15.4% of total HD patient in Assiut governorate. The total mortality rate was 31% higher in
males than female. About 41.8% males died while the survivals were 58.2% of total males had COVID 19 infection,
while 17.8% of females died with a total survival 82.2% of females had infected with COVID 19. The most frequent
symptoms were gastritis (0.000), fever (0.001) and cough (0.009) respectively. While the most significant laboratory
findings were elevated s. creatinine, high WBC counts, high absolute neutrophilic counts, and low platelet counts with
Conclusion: At the area of COVID-19 infection, the incidence of COVID-19 infection was relatively low among HD
patients in Assiut Governorate, with good prognosis among infected patients by COVID 19. The predictor factors for
mortality were elderly, male gander, presence of cardiac diseases, elevated serum creatinine, elevated serum
potassium, bilateral GGO in CT scan chest and hypoxemia with need for CAPAP or intensive care admission.
Keywords: HD, COVID-19, Chronic Kidney Failure.


treatment of ESKD on HD patients infected with
The pandemic of COVID 19 head been a life
COVID-19 in Assiut Governorate. In addition, at the
threatening to the whole world. Patients who had heart
same period, Assiut population were around 4447417
illness, chronic liver disease, CKD, or other risk factors
population, while the total number of patients with
were put at risk(1). Fever, cough, and dyspnea were the
ESKD on regular HD were 1299 patients.
most symptoms of COVID -19 infection(2).
Patients were divided into two groups: Group (1):
HD patients were immune compromised and they
included 200 HD patients with COVID-19 infection
had altered immune response to various infections
compared to Group (2): included 200 HD patients not
including virus infection(3). The most common cause of
infected with COVID-19.
immune system dysregulation in HD patients may be
Patients with ESKD on regular dialysis proved as
elevated levels of circulating dialysis membrane-
having COVID 19 infection confirmed by real time
associated inflammatory marker along with uremic
polymerase chain reaction [RT-PCR] test. Patients who
toxins (4). A number of innate and adaptive immune
were <18 years old, patients with chronic lung disease,
patients with major comorbidities or concomitant
aforementioned alterations. HD patients' peripheral
blood has higher levels of inflammatory cytokines (5).
chemotherapy, pregnant and lactating females and non-
This study aimed to describe the clinical
compliant patients were excluded.
characteristics, laboratory finding, short term outcomes
and to estimate the mortality rate of COVID 19
All patients were subjected to the following:
infection in chronic HD patients in Assiut Governorate.
Complete history taking and full clinical examination
include assessment of general condition, vital signs.
Abdominal, chest and heart examination were assessed
In this retrospective study, two hundreds Egyptian
with focus on manifestations of CKD.
patients' lives at Assiut Governorate with end stage
kidney disease (ESKD) on regular HD with a
Laboratory investigations included; CBC by Erma
confirmed diagnosis of COVID 19 was enrolled in this
Automated Blood Count Machine (Tokyo, Japan),
study. Those patients' data were collected from
Latex agglutination slide test was performed for
Quarantine Department, Assault Feverish Hospital in a
qualitative and semi quantitative determination of CRP
period from January 2021 to April 2022.
in non-diluted serum, D-dimer level, Serum ferritin by
Assiut Quarantine Fever Hospital is a large
using (TOSOH AIA-360 Automated Immunoassay
hospital for isolation of cases infected with COVID-19
Anaiyzer, Japan). AST, ALT by using a photometric
and it is considered the only hospital for isolation and
unit of the auto-analyzer the Cobas 6000 analyzer
Received: 16/05/2023
Accepted: 17/07/2023

Full Paper (vol.931 paper# 119)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7700-7706

Role of Sonoelastography in Characterization of Solid Breast Lesions: Review Article
Nany Wahib Aiad Guirguis, Marwa Adel Shaban, Mona Mohamed El-Beheiry, Yousef Ahmed Yousef Sliem
Department of Radio-diagnosis and Nuclear Medicine, Faculty of Medicine - MUST University
Corresponding author: Nany Wahib Aiad Guirguis, Mobile: 01061613871, Email: nany.doss@gmail.com

Breast cancer ranks as the most frequent cancer among women. Detecting it early can lessen the
disease's severe outcomes and death rates. Sonoelastography has proven effective in identifying breast cancer at an
early stage.
Objective: This article aimed to assess how well sonoelastography distinguishes between benign and malignant solid
tumors in the breast.
Material and methods: Medline resources (including PubMed, Medscape, ScienceDirect, EMF-Portal) and all
available online materials up to 2023 for Sonoelastography and Solid breast lesions (Malignant and benign). Studies
not meeting the inclusion criteria were excluded. The quality assessment of studies considered factors like obtaining
ethical approval, specifying eligibility criteria, having appropriate controls, and providing sufficient information and
defined assessment measures.
Conclusion: Ultrasound elastography plays an important complementary role alongside traditional mammograms and
ultrasounds in identifying solid breast lesions. Thus, this technique could aid in planning biopsies for lesions and
preventing unnecessary procedures.
Keywords: Ductal carcinoma in situ, Ultrasound elastography, Strain elastography, Shear wave elastography.


Skin cancers aside, breast cancer stands out as
growths tend to display consistent strain patterns.
the most frequently diagnosed cancer in women within
However, breast malignancies often exhibit a notable
the United States, representing almost one-third of all
absence of strain, both inside the lesions themselves
cancer cases. Furthermore, it ranks as the second most
and in the surrounding tissue. Elastography has been
prevalent cause of cancer-related mortality in women,
acknowledged as a good tool in the discrimination of
following lung cancer (1). The most commonly
shadowing caused by fibrosis and shadowing resulting
occurring cancerous growths were categorized into
from malignancy (5, 6).
three distinct groups: ductal carcinoma in situ (DCIS),
The combination of UE with traditional
invasive ductal carcinoma of the non-scirrhous variety,
sonography and mammography presents a significant
and invasive ductal carcinoma of the scirrhous variety.
advancement in the assessment of two key aspects of a
Likewise, the most frequently observed non-cancerous
lesion: its shape and tissue stiffness. The
growths were segregated into three subcategories:
aforementioned characteristics provide valuable
intraductal papilloma, fibroadenoma, and irregularities
insights into the intrinsic qualities of the disease,
in the normal developmental and involution processes
facilitating the distinction between benign and
(ANDI) (2).
malignant tumors. The implementation of a multi-
Over the last two decades, ultrasound imaging
modal approach improves the sensitivity, specificity,
has seen significant improvements in quality.
accuracy, and positive predictive value, consequently
Nevertheless, diagnosing a breast mass remains a daily
challenge for radiologists using ultrasound (US). This
sonomammography. The effectiveness of UE in the
has led to the need for new diagnostic methods,
detection of breast cancer has been found to be notable
in individuals with lower breast size, surpassing the
Elastography is based on the principle that tissue
compression causes strain (displacement) within the
sonomammography methods. Furthermore, it has been
tissue, with harder tissues exhibiting less strain than
observed that elastography demonstrates increased
softer ones. By measuring the strain induced by
sensitivity in the context of breast lipomatous
compression, UE can effectively "visualize" tissue
involution in comparison with standard B-mode
hardness, display its texture, and reveal the biological
ultrasonography (7, 8).
characteristics of the mass. This approach exhibits
Nevertheless, it is crucial to acknowledge that
promising promise in discerning between benign and
sonoelastography does have notable limits. There exist
aggressive breast cancers (2, 4).
additional factors that contribute to the challenges
Contemporary ultrasound technology, which is
experienced in the field of elastography. Several
readily available via commercial ultrasound machines,
factors contribute to the challenges associated with
encompasses instruments that provide flexible,
elastogram analysis. These factors encompass the
manually directed scanning, offering exceptional
operator's skill level, the subjective interpretation of
spatial resolution and little interference. In the context
elastogram outcomes, and the increased sensitivity to
of tumor detection. It has been shown that benign
even slight adjustments in patient positioning (9).

Full Paper (vol.931 paper# 120)

c:\work\Jor\vol931_121 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7707-7715

The Anticancer Impact of Anthraquinones and Sorafenib on Rat Liver Cancer
Nahla S.A. EL-Shenawe1, Hanaa A. Abd EL-Gawwad1, Amira T. E. Mersal1, Mohammed A. El-Magd*2
1Department of Zoology, Faculty of Science, (Girls), Al-Azhar University, Egypt.
2Department of Anatomy, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
*Corresponding author: Mohammed A. El-Magd: Mobile: (+20) 1068160301, E-Mail: mohamed.abouelmagd@vet.kfs.edu.eg

Hepatocellular carcinoma (HCC) is the primary malignant tumor of the liver and is a deadly and complex
cancer mostly associated with inflammation and oxidative stress in hepatic tissue. An essential first-line treatment for
advanced HCC is sorafenib which can significantly improve overall survival. However, due to acquired resistance against
sorafenib and the heterogeneity of HCC, there is still opportunity for HCC progress. As a result, sorafenib and other
medication combinations may work in concert, offering a novel approach to treating HCC.
Objectives: This study was aimed to investigate the impact of the combinations of sorafenib and free anthraquinones
fraction, containing aloe-emodin, emodin, chrysophanol and physcion, isolated from Rhubarb officinale rhizome on the
chemically induced HCC in rats.
Material and methods: sixty male albino rats (Rattus Albinus) of average body weight 130±20 g were used in this study.
they were divided into 5 groups (n=12/group): normal control group, diethylnitrosamine (DEN)+ carbon tetrachloride
CCL4 induced HCC (HCC group); and 3 treated groups with anthraquinones (Anth group), sorafenib (Sor group), and
both (Anth+Sor).
Results: The HCC group of rats exhibited the most deteriorated effects, including elevated serum alkaline phosphatase
(ALP) and gamma-glutamyl transferase (GGT), declined antioxidant activity of glutathione peroxidase (GPX);
upregulated expression of the genes related anti-apoptosis (survivin), autophagy (beclin 1, Bec1), angiogenesis (vascular
endothelial growth factor, VEGF); and downregulated expression of genes related to apoptosis (p21 and p53). After Anth
and Sor were administered, all the negative effects caused by HCC were reversed, with the combined group (Anth+Sor)
which showed the greatest improvement.
Conclusion: It could be concluded that administration of anthraquinone could improve the therapeutic potential of
sorafenib on HCC.
Keywords: sorafenib, Anthraquinones, Hepatocellular carcinoma, Rhubarb officinale rhizome

inhibitor13 since it can be co-immunoprecipitated with
Hepatocellular carcinoma (HCC) is the most
caspases-3, -7, and -9 and inhibits apoptosis caused by
prevalent primary form of liver cancer and, after
overexpressing these caspases. Moreover, it prevents
stomach and lung cancers, the third most lethal form of
cell death by interfering with the processing of caspase-
cancer worldwide. Hepatocarcinogenesis is mainly
9, the primary inhibitor of the intrinsic route of
dependent on angiogenesis from the beginning.
apoptosis (4).
Vascular endothelial growth factor (VEGF) is a crucial
Two strictly regulated biological processes in cells,
proangiogenic factor that is generated in dysplastic
autophagy, and apoptosis, are essential for preserving
nodules and rises as HCC develops (1). Providing
tissue homeostasis and growth. One possible target for
nutrients and oxygen to neoplastic cells requires
investigating the relationship between autophagy and
forming a new vascular network once the tumor is
apoptosis is the link between the autophagy protein
Beclin 1 and the anti-apoptotic protein Bcl-2. Pro- and
According to Liu Y et al. (2), VEGF binds to its
anti-apoptotic Bcl-2 family proteins are distinguished
receptors, VEGFR1 and VEGFR2, and then transduces
by the presence of the Bcl-2 homology (BH) domain.
its actions by activating many signaling pathways that
Bcl-2 attaches to pro-apoptotic proteins exclusive to
are engaged in the migration, proliferation, and invasion
BH3 and prevents them from becoming pro-apoptotic.
of electric cells. Stresses potentially compromise cell
A BH3 domain has also been discovered in Beclin 1.
division and DNA replication fidelity and trigger the
The BH3 domain of Beclin 1 cannot interact with Bcl-
p53 pathway's reaction. Through post-translational
xl if it is removed or if Bcl-xl's BH3 receptor domain is
changes, the p53 protein receives a stress signal.
Consequently, a program of cell cycle arrest,
One of the most important active ingredients in
cellular senescence, or apoptosis is started by activating
rhubarb is anthraquinones. Nearly all species of
the p53 protein, a transcription factor (3). Many different
Rhubarb contain high concentrations of free
cancer types express survivin, an inhibitor of the
anthraquinones, emodin, chrysophanol, particularly
apoptosis protein. It seems that survivin is also a caspase
rhein, aloe-emodin, and physcion, which have

Full Paper (vol.931 paper# 121)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7716-7722

Primary Vaginal Melanoma: A Rare and Aggressive Entity, A Radical
Hystero-Vaginectomy as a Compromise Treatment Option
Mohamed Ayaty1*, Haitham Abdel Wahab2
1Gyne-oncology Department, National Cancer Institute, Cairo, Egypt
2 Gyne-oncology Department, El-Galaa Maternity Teaching Hospital, Cairo, Egypt
*Corresponding Author: Mohamed Ayaty, Mobile: (+20)01004364499,
Email: mohamedayaty195@gmail.com, ORCID ID: 0000-0002-6230-7345

The greatest outcomes of primary vaginal melanoma have been associated with surgery, either alone or
in combination with adjuvant therapy, making it the preferred course of treatment for primary malignant vaginal
Objectives: We suggest describing the radical hystero-vaginectomy approach as a compromise between pelvic
exenteration operations and conservative excision.
Material and Methods: This study was carried out in National Cancer Institute and El Galaa Maternity Teaching
Hospital through the period from January 2018 and January 2022. The study included 8 cases with different ages and
different complaints, sharing the same diagnosis of primary vaginal melanoma. They had different surgical
approaches; conservative (4 cases) or radical surgeries (4 cases) with different results. The surgical outcomes were
analyzed and determining of surgical technique was described.
Results: The mean age of our patients was 50.6 years. The most common initial complaint was abnormal vaginal
bleeding (6 patients), The most common site of lesion was left lateral wall (5 patients) and posterior wall (5 patients)
of vagina. The depth of invasion was greater than 1 cm in only one patient but unrecorded in 7 patients. The clinical
and surgical staging of the disease according to the international federation of gynecology and obstetrics (FIGO)
varied between two and three. One case staged as PT4 melanoma according to the tumor node and metastases (TMN)
staging due to extra margin related to anterior rectal wall was positive. Recurrence in patients underwent local
excision ranged from 5 months to 15 months after surgical excision. The 2-year DFS (disease free survival) comparing
the radical and the conservative treatment was 75 % versus 0 %. Conclusions: Upon initial diagnosis, surgery
continues to be the primary therapeutic option. For vaginal melanomas, local excision is challenging and frequently
not taken into consideration. We reported a radical hystero-vaginectomy as a compromise treatment option for
primary vaginal melanoma that can take the place of the pelvic exenteration operation.
Keywords: Primary, Vaginal, Melanoma.

vaginectomy or vulvectomy, or pelvic exenteration)
Primary vaginal melanoma is an exceedingly
surgical techniques are used to treat vaginal melanoma
uncommon gynecological cancer that accounts for less
(5, 8, 9). Wide local excision, as opposed to alternative
than 0.2% of all melanomas (1). Despite being
treatment choices like radiation or chemotherapy,
substantially less common, vaginal melanoma is
produced comparable if not superior results in the
considerably more deadly than cutaneous melanoma,
majority of cases with early illness. Given the rarity
with less than 30% of patients surviving five years even
of lymph node involvement, lymphadenectomy is
with treatment (2, 3). Crucially, it is challenging to decide
seldom performed and is dangerous in all other
how to stage and treat this illness due to the paucity of
circumstances (5, 10).
cases seen in clinical practice and documented in the
Eight individuals had V. melanoma between 2018
Memorial Sloan-Kettering reported an updated
and 2022, at the National Cancer Institute and EL-Galaa
cohort with March 2013 at the Annual Society of
Maternity Teaching Hospital. Primary vaginal
Gynecologic Oncology meeting, 75 vulvar and 43
melanoma was determined by biopsies on the patients
vaginal melanomas over 17 years. In a recent cohort
from the lesion. To enable analysis for current
from Memorial Sloan Kettering Cancer Center. The
complaints, stage, initial lesion location and size (in
median age of patients with both vaginal and vulvar
cm), lymph node involvement (inguinal or pelvic), type
melanoma was 62 years. The range for vulvar
of resection (conservative or radical), recurrence, and
melanoma was 24 to 88 years, while the range for
quality of life concerns were investigated.
vaginal melanoma was 38 to 86 years (4).
The best outcomes have been associated with
Description of surgical technique:
surgery, either alone or in combination with adjuvant
Conservative procedure was wide local excision of the
therapy, making it the preferred course of treatment for
melanotic lesion of vagina with or without inguinal
primary malignant vaginal melanoma (2, 5, 6, 7).
lymph node dissection unilaterally or bilaterally
Conservative (broad local excision and partial
according to site of the lesion and clinical presentation
vaginectomy) and radical (hysterectomy, total
(Fig. 1).
Received: 17/05/2023
Accepted: 18/07/2023

Full Paper (vol.931 paper# 122)

c:\work\Jor\vol931_123 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7723-7730

Retracted paper

Full Paper (vol.931 paper# 123)

c:\work\Jor\vol931_124 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7731-7734

Risks and Benefits of Propofol and Midazolam for Sedation during Upper
Gastrointestinal Endoscopy in Egyptian Cirrhotic Patients
1Abdallah H. El-Shahat Soliman, 2*Abdelrhman M. Yusry
1 Departments of Hepatology, Gastroenterology and Infectious Disease,
2Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Abdallah H. Elshahat, Email: drabdallah_soliman@yahoo.com
Mobile: 01112214486
: Upper gastrointestinal (GI) endoscopy, either diagnostic or therapeutic, is frequently performed under
conscious sedation in cirrhotic patients. The standard agent, on the other hand, is not yet well established.
Objective: Comparison between propofol and midazolam for conscious sedation during upper GI endoscopy in patients
with liver cirrhosis in terms of safety and effectiveness. Patients and methods: Sixty cirrhotic (Child-Pugh A or B)
patients, at Al-Azhar University Hospitals' Endoscopy Unit, were included in the study and randomly assigned to either
propofol group (30 patients) or midazolam group (30 patients). Patients aged 18 to 65 years with known chronic liver
disease who presented for upper GI endoscopy for routine variceal screening or banding were eligible. Patients with
advanced or decompensated liver disease (Child score >10) were excluded. Sedation was administered by an
anesthesiologist. Results: Our results observed clearly that the recovery time, patient satisfaction, and the incidences of
hypoxia differ significantly between groups. Conclusions: propofol is safe and effective when compared to midazolam
for sedation during upper GI endoscopy in cirrhotic patients.
Propofol, Midazolam, Cirrhosis, Upper GI Endoscopy.

difference between midazolam and propofol due to small
Upper GI endoscopy is performed regularly in
sample sizes. Other trials ascertained that propofol
patients with chronic liver disease to evaluate for portal
sedation has the potential benefits of shorter recovery
hypertension complications such as esophageal varices
time, shorter discharge time, higher postanesthesia
(1). Patients are routinely sedated to make the procedure
recovery scores, greater sedation, and better patient
simple and more pleasant for them (2).
cooperation, with no raise in side effects (10, 11).
The selection of a sedative agent is critical to
ensuring safe and effective upper GI endoscopy.
Sixty patients with known chronic liver disease
Sedation targets include patient safety, providing
(cirrhosis), at Al-Azhar University Hospitals' Endoscopy
analgesia and amnesia, accomplishing the upper GI
Unit, were enrolled in the study and randomly assigned
endoscopy, and quickly returning the patient to pre-
to either propofol or midazolam for sedation. Patients
sedative levels (3). Because of its amnestic properties,
aged 18 to 65 years with known chronic liver disease
midazolam outclasses older benzodiazepines (4).
(Child-Pugh class A or B) who presented for upper GI
Midazolam alone, with or without opioids, is the most
endoscopy for routine variceal screening or banding was
commonly used sedative regimen in our endoscopy unit
eligible. Patients with advanced or decompensated liver
but the prolonged half-life in patients with liver failure is
disease (CP score >10), GI bleeding within the previous
a red flag (5). Propofol is frequently used as a substitute
month, hepatic encephalopathy, advanced medical
for midazolam in patients with impaired hepatic or renal
disease, known allergy to the sedative, active alcohol or
function because it does not require dose adjustment (6).
illicit drug abuse, or refusal to participate were excluded.
Propofol is a hypnotic agent that influences moderate to
Written informed consent from all patients enrolled in
deep sedation (conscious). It is quickly metabolized in
the study.
the hepatocytes before being excreted by the renal
As shown in table (1), 30 patients were assigned to the
tubules (7). Propofol has several advantages due to its
propofol group (group 1), while the remaining 30
rapid onset, shorter length of action, and rapid recovery
patients were assigned to the midazolam (group 2).
of cognitive abilities (8).
Sedation was administered by an anesthesiologist.
However, whether propofol provides the same
benefits in high-risk groups, such as patients with liver
Table (1): Patient groups
cirrhosis, is mysterious. Deficient protein synthesis,
Propofol group
Midazolam group
disrupted drug metabolism, and affected hepatic blood
30 patients
30 patients
flow in patients with chronic liver disease may affect the
The initial dose of
The initial dose of midazolam
bioavailability of drugs, placing patients undergoing
propofol was 0.5
was 3 -5 mg, and the
endoscopy at a greater likelihood of negative events (8).
mg/kg; the
maintenance dose was 0.5 to
This designed research's main goal was to compare
maintenance dose
1 mg every 2-3 minutes up to
the effectiveness and safety of propofol and midazolam
was 10-20 mg
a maximum cumulative dose
in cirrhotic patients undergoing endoscopy. Numerous
bolus at 60 s
of 10 mg or 0.1 mg/kg of
comparative trials (9) have been carried out to evaluate
body weight.
their effectiveness and tolerability. Some of these
experiments failed to detect a significant statistical

Full Paper (vol.931 paper# 124)

c:\work\Jor\vol931_125 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7735-7739

Extra-nodal Involvement in Adult Lymphomas, Experience, and Outcome
Esraa Mohamed1, Wafaa Abdelhamid1, Waleed Diab2, Mohamed Gaber1
1 Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Sohag University, Egypt.
2 Clinical Oncology Department, Faculty of Medicine, Sohag University Hospital, Egypt.
Corresponding author: Amr Muhammed, Tel: +20-01091512374, Email: dr.esraa.hafez@gmail.com

Roughly 20% of lymphoma patients had extra-nodal involvement. With this study.
Objectives: We aimed to present our experience with extra-nodal lymphoma in terms of presentation and outcome.
Material and methods: This is an observational study that explored the PET/CT scan done to lymphoma patients who have
either primary extra-nodal lymphoma or extra-nodal involvement in their initial staging workup. The study was conducted
between 2019 and 2022. The population were adults who had histological confirmation of lymphoma, no other malignancy,
and were presented with extra-nodal involvement were included in this study. All patients had initial and either interim or
post-therapy scans.
Results: A total of 27 patients with 54 PET/CT scans were included in this study. The median age was 32 (18-69) years,
and 71.7% were males. 26.4% of the scans were done as initial assessment, while 5%, 47%, and 17% were interim
assessment, post-therapy evaluation, and follow-up respectively. Hodgkin lymphoma was reported in 45.3% of the scan.
The distribution of stage I, II, III and IV was 11.3%, 3.8%, 20.8% and 64.2% respectively. Primar extra-nodal lymphoma
were seen in 45.3%. The detection rate of PETCT was higher in the bone marrow (22.6% versus 7.5% for CT, p = 0.008).
There was non-significant trend toward higher detection rate for PET in spleen (32.1% versus 26.4%). PETCT changed the
primary management of the cases in 42.9% of the cases.
Conclusion: PETCT had upper hand compared to CT in detection rate of lesion especially for the spleen.
Keywords: Lymphoma, Non-Hodgkin's lymphoma, Hodgkin's lymphoma, Extra nodal lymphoma.

used to exclude lymphoma when clinical suspicion is
Lymphoma represents diverse disease group that
high, due to the possibility of sampling errors. At this
originate from lymph nodes. Due to diversity of the
instance, repeat core biopsy, or excision of entire lymph
disease and the difficulty in diagnosing and stratification,
node are must (4).
several World Health Organization (WHO) consensus
Currently, the need to perform bone marrow aspirate
statements have been released over the past two decades.
and trephine is diminishing in the era of PET/CT. PET/CT
Many demographic studies tried to link the prevalence of
could be used to evaluate the bone marrow inside the
lymphoma in specific populations. Genomic alteration,
bones. Diffuse uptake is usually linked to suspicion of
infection, and some chronic inflammatory condition
infiltrated bone marrow. The use of PET/CT is also
might increase the risk of lymphomas as well as first-
mandatory for staging of the disease. It should be done
degree relatives of patients suffering from non-Hodgkin
with contrast enhancement computed tomography for the
and Hodgkin lymphomas. The risk was as high as 3.1
neck, chest, abdomen and pelvis (4).
folds the normal population risk (1).
Historically, the staging of lymphoma was based on
Painless adenopathy is most common presentation of
the Ann-Arbor staging that proposed in 1971 in Ann-
lymphoma. The enlarged nodes can grow slowly over
Arbor city in USA (5). The philosophy behind this system
years in an indolent course or evolve aggressively over
proposed the idea of lymph nodes regions or groups. Each
weeks in aggressive subtypes. Usually, Hodgkin
group consists of lymph nodes with specific anatomical
lymphoma presents as supradiaphragmatic adenopathy,
sites. For example, the lymph nodes around the internal
while non-Hodgkin lymphoma can infiltrate any
jugular vein on one side is considered a group. The nodes
lymphatics elsewhere in the body, with specific
around the distal part of axillary vessels is another group,
predilection to central nervous systems, skin, and
while the proximal nodes draining toward the subclavian
gastrointestinal tract in aggressive histologies. Clinically,
vein was another group. Moreover, the entire lymphatic
patients usually complain of unexplained prolonged
within the mediastinal was considered as a group (6).
fever, unplanned weight loss, and night sweats (2, 3).
The major idea behind WHO classification of
The efficient diagnosis of lymphoma mandates a
lymphoma was to divide the disease based on cell linage,
minimum of core biopsy, or excisional lymph node
namely myeloid, lymphoid B and T, natural killer or
biopsy. Fine needle aspiration is unacceptable and
histiocytic/dendritic. The second principle was to
inefficient in the diagnosis of lymphoma and should not
subclassify the disease based on the cells' differentiation
be performed. Although core biopsies are often enough, it
and maturation, starting from precursors-related leukemia
should be clear that negative core biopsy should not be
to mature lymphomas. The final principle was the clinical
Received: 18/05/2023
Accepted: 19/07/2023

Full Paper (vol.931 paper# 125)

Introduction The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7740-7744

Evaluation of Right Ventricular Function in Chronic Renal Failure Patients on
Regular Hemodialysis Therapy (Tissue Doppler Imaging Study)
Ahmed G Abd El Rahman*#, Mohamed M Ahmed**, Mahmoud A Abd El Baset **
Sohage Cardiac center* and Cardiovascular Department, Al-Azhar University, Assiut**
#Corresponding author: Ahmed G Abd El Rahman, E-mail: dr.ahmed.gamal.yossry.889@gmail.com
Phone number: +20 109 601 1018
Major contributors to mortality and disability among patients diagnosed with end-stage renal disease are
cardiovascular disorders. Initial manifestations of cardiovascular function may even be managed while dependent on
dialysis. Those patients are prone to developing severe progressive cardiovascular events and pulmonary artery
hypertension, which occur frequently during prolonged hemodialysis. The overall prevalence of these complications ranges
from 19 to 70%. Objective: To assess right ventricle (RV) functions in chronic renal failure patients on dialysis by
myocardial performance index RV inferred from tissue Doppler imaging (TDI) (MPI-RV).
Patients and methods
: The study involved 100 chronic renal failure patients on dialysis, proved by tissue Doppler
echocardiography, in the cardiovascular Department of the Faculty of Medicine, Al-Azhar University Hospital (Assiut),
and the Cardiac Department of Al Helal Hospital (Sohage), during the period from November 2017 to May 2019.
Results: A noteworthy positive correlation was observed between duration of dialysis and RV diastolic values; however,
no significant negative correlation was found between duration of dialysis and deceleration time (m/s); TV E/E' was not
significantly correlated with duration of dialysis; the correlation between TV E/A and dialysis duration was significant.;
frequency of dialysis was not significantly correlated with IVRT (m/s); and the frequency of dialysis did not exhibit a
statistically significant positive correlation with TV E/A. Conclusions: TDI can detect RV function changes in
hemodialysis patients at an early stage. Early diagnosis facilitates timely interventions, which are presently restricted to
referrals for kidney transplantation or modifications in dialysis modality.
Keywords: Renal hemodialysis, Tissue Doppler echocardiography, RV function.


method for detecting preclinical ventricular abnormalities
Cardiovascular disorders contribute greatly to
through the evaluation of RV function [6].
mortality and disability among end-stage renal disease
RV dysfunction in patients with ESRD has received
(ESRD) patients. Globally, cardiovascular disease has
considerably less attention than LV (left ventricle)
been identified as the cause of approximately 40 % of all
dysfunction in the majority of available studies. This is
documented cases of death in this patient subgroup [1].
crucial, as increased morbidity and mortality have been
Therefore, it appears that the initial manifestations of
linked to RV dysfunction in numerous cardiovascular
cardiovascular function may be managed even in the
diseases [7]. As a validated indicator of LV diastolic or
presence of dialysis. Patients undergoing prolonged
systolic dysfunctions, RV and atrial functions, TDI
hemodialysis are frequently afflicted with pulmonary
measurements are documented in a variety of cardiac
artery hypertension, a severe progressive cardiovascular
conditions [8].
event, in addition to myocardial dysfunction, which
We aimed to evaluate the functionality of the RV in
affects ESRD patients at a prevalence rate ranging from
patients undergoing dialysis for chronic renal failure
19 to 70% [2]. Echocardiography is a stabilised method
using a myocardial performance index of RV (MPI-RV)
utilised to evaluate the function of the ventricles of the
derived from TDI.
heart [3]. It is recommended that ESRD patients who are
candidates for dialysis undergo screening with Doppler
The study included 100 patients with chronic renal
echocardiography as the gold standard for assessing PAH
failure on dialysis, proved by tissue Doppler
[4]. Additionally, tissue Doppler imaging (TDI) can detect
echocardiography, in the Cardiovascular Department of
right ventricle (RV) function changes in hemodialysis
the Faculty of Medicine, Al-Azhar University Hospital
patients at an early stage. Early diagnosis allows for
(Assiut), and the Cardiovascular Department of Al Helal
timely interventions, which are presently restricted to
Hospital (Sohage) (Approval code: Rc 25-5-2017), during
modifications in dialysis modality or patient referrals for
the period from November 2017 to May 2019.
kidney transplantation [5]. The identification of patients
who are at an increased risk of developing heart failure
Inclusion criteria: Chronic renal patients on dialysis.
could potentially be facilitated through the detection of
Exclusion Criteria: Hypertensive patients mainly the
subclinical RV dysfunction in ESRD patients prior to
chronic ones, age younger than 15 years or older than 70
dialysis. TDI has been regarded as a dependable
years, diabetic patients, chronic artery disease, pericardial
prognostic indicator and an precise and reproducible
detectable cardiac compression, significant valvular
Received: 18/05/2023
Accepted: 19/07/2023

Full Paper (vol.931 paper# 126)

c:\work\Jor\vol931_127 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7745-7750

Diagnostic Value of Multi Detector Computed Tomography in Evaluation of
Abdominopelvic Extra-nodal Lymphoma with Assessment of Therapeutic Response
Eman Abdelmonem Abdelmonem Ahmed1*, Radwa A. Noureldin1, Mohamed Refaat Habba1
1Department of Diagnostic Radiology, Faculty of Medicine, Suez Canal University
*Corresponding author: Eman Abdelmonem Abdelmonem Ahmed, Mobile: 01001020293
E-mail: eman.youseif2@gmail.com
Patients with lymphoproliferative diseases frequently develop non-Hodgkin lymphoma or Hodgkin
disease outside of the lymph nodes, a condition known as extra-nodal lymphoma. Non-Hodgkin lymphomas and
Hodgkin disease are best imaged anatomically using Multi Detector Computed Tomography (MDCT).
Aim and Objectives: To evaluate the possible MDCT imaging findings in patients with pelviabdominal extra-nodal
lymphoma before and after therapy. Patients and methods: This quasi-experimental study involved 18 cases, whose
ages ranged from 18 to 81 years (10 males and 8 females), with extra-nodal lymphoma of the abdominal and pelvic
organs. The study was conducted at the Radiology Department, Suez Canal University, and Mansoura Oncology
Hospital, with an assessment of therapy response by MDCT scan. Results: The spleen was found to have the highest
number of diseases among the pelvic and solid organs, followed by the liver and the uterus. Regarding the GIT affection,
in descending order, the stomach, intestine, and esophagus were affected. MDCT scan showed diffuse intestinal wall
thickening with luminal dilation of intestinal loops. The majority of cases were found to be non-Hodgkin lymphoma
(83.3%), with diffuse large B cell lymphoma being the most prevalent subtype (15 individuals). Hodgkin lymphoma
was found in 3 patients (16.6%) with mixed cellularity. Conclusion: MDCT is the most preferred and widely used
imaging modality to evaluate lymphomatous involvement in extra-nodal sites. It provides details about the nature and
extension of the lesion. Also, it can be used to guide needle biopsy into a suspicious area.
Keywords: Abdominopelvic, Extra-nodal Lymphoma, Multi Detector Computed Tomography.

internal bleeding or ischemia may provide that
impression (5). MDCT provides important pretherapeutic
proliferative illnesses that arise outside of the lymph
information about tumor location, morphology and
nodes or other lymphoid tissues where they are normally
extension. As well as about the involvement of lymph
expected to originate from extra-nodal structures, such
nodes and other organs. MDCT staging has important
as solid organs (liver, spleen, kidney, and pancreas) and
therapeutic values because stage and stage disease
hollow gastrointestinal tract organs. They can be found
may be excised, whereas stage and disease must
in the abdomen and pelvis of people with non-Hodgkin
be treated with radiation, chemotherapy, or both. In
lymphomas and Hodgkin's disease (1). Patients with
addition, MDCT allows accurate monitoring of the
recurrent illness or disease associated with
response to therapy. (1).
immunodeficiency are more likely to experience extra-
The purpose of this study was to assess the possible
nodal involvement than those with a first presentation (2).
MDCT imaging findings in patients with pelviabdominal
US, CT, MRI, and scans are all examples of anatomic
extra-nodal lymphoma before and after therapy.
imaging techniques. Because of its superior ability to
identify lesion size, shape, and relationship to
Eighteen individuals, 18 to 81 years age, were
neighboring tissues, MDCT is the modality of choice for
enrolled in our study. Patients with a clinical suspicion
anatomic imaging of non-Hodgkin lymphomas and
of lymphoma are sent from the outpatient clinic to the
Hodgkin disease. Furthermore, MDCT provides
Radiology Department for an ultrasound and MDCT
anatomic imaging examination of nearly all parts of the
scan. Needle biopsy was performed for all cases. The
body, which is not possible with other modalities (3).
study was conducted in the Radiology Departments of
There are three possible patterns of lymphomatous
Suez Canal University and the Mansoura Oncology
involvement of solid organs: localized, multifocal, and
diffuse. Distinct solid nodules can be seen in cases of
focal and multifocal illness, whereas in diffuse disease,
asymptomatic lymphadenopathy, fever, night sweats,
the affected area is infiltrated on a systemic level. Single
weight loss, easily fatigability, and pruritus.
or numerous nodules have the same uniformity in shape
and size. Mild and consistent enhancement is typical
Inclusion criteria: patients with pathologically proven
following intravenous contrast material (3). Central
abdominopelvic extra-nodal lymphoma referred to the
necrosis, however, can cause a patchy appearance on
Radiology Department before and after chemotherapy,
both normal and contrast-enhanced imaging (4).
radiotherapy, or surgical resection for assessment of
Mild to moderate luminal thickening, dilatation,
therapy response.
or cavitation, as well as circumferential thickening of the
Exclusion criteria: patients with contrast allergies and
stomach or intestinal wall, are common CT findings.
pregnancy, and patients refusing to participate in the
Single or numerous lesions are often homogeneous in
appearance, but big lesions that involve regions of
Received: 09/05/2023
Accepted: 10/07/2023

Full Paper (vol.931 paper# 127)

c:\work\Jor\vol931_128 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7751-7758

Comparative Study between Surgical Tracheostomy and
Flexible Fiberoptic Endoscopic Guided Percutaneous
Dilatation Tracheostomy in Intensive Care Unit Patients
Osamah Masoud Salim*1, Gamal Abdelhameed Abdelmaksoud 1,
Tarek Abdelmoaty Ahmed Omran 1, Mohamed El-Sayed El-Shora1, Essamedin Mamdouh Negm2
Departments of 1Otorhinolaryngology and 2Anesthesia and
Surgical Intensive Care, Faculty of Medicine, University of Zagazig, Egypt
*Corresponding author: Osamah Masoud Salim, Mobile: (+20) 01023397105, E-mail: osamamasoud526@gmail.com

In the intensive care unit (ICU), surgical tracheostomy (ST) is a popular procedure and elective technique.
Percutaneous dilatation tracheostomy (PDT) offers numerous advantages compared to operative tracheostomy.
Objective: This study aimed to select the most safe, inexpensive, rapid technique of tracheostomy in intensive care unit
patients through comparing between surgical tracheostomy and flexible fiberoptic endoscopic guided percutaneous
dilatation tracheostomy.
Patients and methods:
This comparative prospective randomized observational study was carried out on 34 cases
admitted to the Intensive Care Unit of Zagazig University Hospital. All of them had either medical causes or surgical
causes for prolonged intubation and ventilation. The patients were randomly divided into two groups: Group A was
assigned for PDT and group B for ST. Each group included 17 patients.
Results: The incision length and duration were significantly longer among surgical group. Surgical group significantly
associated with more ventilator needing. Concerning postoperative complications, such as air leak from a tracheostomy
or infection, there was a statistically significant difference between the two groups in favor of PDT. The cost in surgical
group was significantly cheaper than the percutaneous group.
Conclusion: In intensive care unit patients, PDT can be chosen as the main tracheostomy procedure. It can be performed
faster along with fewer complications compared to ST. ST is more liable to early infections, air leak from tracheostomy
fistula with larger incision length however of low cost than PDT. Because PDT is done at the patient's bedside, there is
no risk of transportation to the operating room, which is one of the advantages.
Keywords: Surgical tracheostomy, Percutaneous dilatation tracheostomy, Intensive care unit.

complications compared to ST (4). When patients require
Tracheostomy is one of the most common
ventilator support for an extended period of time, PDT
procedures and elective techniques performed in the
is being used more and more. By using a bronchoscope,
intensive care unit (ICU) (1). Traditionally, it has been
the surgeon can see exactly where the needle is going,
used to help patients who are having trouble weaning,
make sure the tube is in the right spot, and prevent
to protect airways in patients who are at risk of
damage to the back of the throat during the procedure.
aspiration, to limit the need for sedation, and to assist in
When dealing with an inexperienced operator or
tracheobronchial toileting. Chronic endotracheal (ET)
challenging neck anatomy, it is typically deemed
intubation is the leading cause (2). The use of a
important. Because of its low mortality and
tracheostomy tube to mechanically ventilated patients
complication rates, fiberoptic bronchoscopic guiding
carries many advantages when compared with the use
for PDT is the preferred technique for elective
of an endotracheal tube. The easy replacement of the
tracheostomy in most intensive care patients (5).
tracheostomy tube once the tract has been created, along
Pneumothorax, subcutaneous emphysema, and
with better nursing hand suction and better patient
paratracheal false passage were previously documented
comfort, makes the tracheostomy tube more favorable
using blinded percutaneous procedures. However,
solution with avoidance of the risks of prolonged
elective endoscopic guidance seems to improve
intubation (3).
operation safety and may prevent these problems (1). We
After preparing the area by removing pretracheal
aimed at this work to select the most safe, inexpensive,
tissues and cutting into the tracheal wall, a tracheostomy
rapid technique of tracheostomy in intensive care unit
cannula is inserted under direct visual inspection during
patients through comparing between surgical
a surgical tracheostomy (ST) (4). In Percutaneous
tracheostomy and flexible fiberoptic endoscopic guided
dilatation tracheostomy (PDT), the pretracheal tissues
percutaneous dilatation tracheostomy.
are bluntly dissected, the trachea is dilated over a guide

wire, and a tracheal cannula is inserted (2). PDT offers
numerous advantages compared with operative
tracheostomy. It requires shorter time to perform, less
observational study was carried out on 34 cases
expensive, and can be performed faster (because the
admitted to the intensive care unit of Zagazig University
operative room does not have to be scheduled). In
Hospital during the period from March 2020 to March
Received: 01/03/2023
Accepted: 02/05/2023

Full Paper (vol.931 paper# 128)

Image quality and attenuation values of multidetector CT coronary angiography using high iodine-concentration contrast material: A comparison of the use of iopromide 300 and iopromide 370 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7759-7764

Prediction of Troponin Elevation in Non-ST Acute Coronary Syndrome Patients
Presenting to the Emergency Department Using Neutrophil-Lymphocyte Ratio
Ramy Raymond, Sarah Mohamed Mahmoud, Bassam S. Hennawy*
Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Bassam Sobhy Hennawy, Mobile: (+2) 01227141744, Email: bassam.sobhy@med.asu.edu.eg

: In patients with stable coronary artery disease (SCAD), the neutrophil­lymphocyte ratio (NLR) is
thought to be an independent predictor of death and myocardial infarction (MI). In patients suffering from acute
coronary syndrome (ACS), NLR also has prognostic significance. Nevertheless, further research has to be done on the
diagnostic efficacy of NLR in ACS patients.
Objective: To ascertain if NLR can accurately predict troponin elevation in patients who arrive at the Emergency
Department with NST-ACS.
Patients and Methods: This is a prospective observational study that was carried out on 100 patients who presented
to the Emergency Department at Ain Shams University Specialized Hospital between June 2018 and March 2019 with
angina or angina-equivalent during the first 12 hours of symptom onset.
Results: Two groups were created from the study population: a troponin-positive group (n = 50) and a troponin-
negative group (n = 50). The patients' average age was 55.8 ± 11.3, with 77% of them being males. There was no
discernible difference in the two groups' levels of platelets, WBCs, or hemoglobin. The group that had positive
troponin levels had a considerably higher neutrophil count (p < 0.001). The group that tested positive for troponin had
a considerably greater NLR (2 vs. 3.9, P < 0.001). In terms of predicting follow-up troponin positive, a cutoff value of
3.4 for NLR assessed at admission exhibited 84% sensitivity and 84% specificity. The amount of troponin alteration
and NLR were shown to be extremely significantly correlated (p value <0.01).
Conclusion: NLR is a diagnostic technique that can be used to distinguish between people who have ACS. NLR is an
accessible, affordable, and straightforward metric that may be utilized for NSTEMI diagnosis.
Keywords: MI, NLR, ACS, troponin.


Emergency Department at Ain Shams University
The NLR and total WBC, neutrophil, and
Specialized Hospital between June 2018 and March
lymphocyte counts are regarded as indicators of
2019 with angina or angina-equivalent during the first
systemic inflammation (1). An increased WBC count
12 hours of symptom onset.
has also been linked to a higher risk of heart attacks (2).
Exclusion criteria included patients with;
Particularly in individuals with SCAD and severe
Clinically significant congestive heart failure,
coronary atherosclerosis, the NLR has been
autoimmune disease, cancer, hematological disorders,
demonstrated in earlier studies to be a predictor of
severe liver or renal disease, persistent infection or
cardiac events and death (3-5). Furthermore, a number
of studies have demonstrated the predictive
embolism, peripheral vascular disease, STEMI, and
significance of the NLR, total WBC count, and its
patients with admission troponin values above the
differential count in patients with ACSs (6-8). MI
upper reference.
extension, the onset of post-infarction heart failure,
The patients were divided into 2 groups; patients
compromised epicardial and microvascular perfusion,
who would acquire positive hs- troponin during 12­24-
and post-infarction mortality have all been linked to
hours follow-up and patients with negative hs-troponin
elevated neutrophil counts (9-12).
levels during follow up.
Research on the use of NLR as a diagnostic tool

in patients who arrive at the emergency room
All patients were subjected to;
complaining of chest discomfort is scarce (10). Since the
Full history on age, gender, smoking, hypertension,
diagnosis of acute coronary syndrome can be
diabetes, dyslipidemia, family history of ischemic HD,
challenging, this very cheap and readily available
previous ischemic HD and previous stroke or transient
characteristic can be very important in underdeveloped
ischemic attack.
nations and help establish the accurate diagnosis in
Also, on admission resting 12 leads surface (ECG),
patients experiencing chest discomfort (12).
Aim of our study was to ascertain if NLR can
neutrophil/lymphocyte and highly sensitive troponin
accurately predict troponin elevation in patients who
(hs-troponin) were done. Follow up hs-troponin after 3
arrive at the Emergency Department with NST-ACS.
hours using Architect assay with reference range (0-

35) was used.
0h-3h rule out algorithm for diagnosis of NST-
This is a prospective observational study that was
acute coronary syndrome was used. MI was diagnosed
carried out on 100 patients who presented to the
Received: 21/05/2023
Accepted: 20/07/2023

Full Paper (vol.931 paper# 129)

c:\work\Jor\vol931_130 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7765-7778

Exploring the Potential and Limitations of Medicinal Plants in
COVID-19 Management: Insights from Algeria
Mohammed Messaoudi1*, Yahia Bouslah1, Raouf Zaidi2,
Maroua Merah3, Abdelkader Elouissi4,5, Mustapha TaiebBrahim1, Mounir Sakmeche6
1Department of Biological Sciences, Faculty of Natural and Life Sciences, University of Adrar-Ahmed Draia, Algeria.
2Laboratory of Agriculture and Functioning of Ecosystems, Chadli Benjdid University, EL Tarf, Algeria,3Algerian Center
for Quality Control and Packaging, Algiers, Algeria, 4Department of Agronomic Sciences, Faculty of Natural and Life
Sciences, University Mustapha Stambouli of Mascara, Algeria, 5 Biological Systems and Geomatics Research
Laboratory (LRSBG),6Laboratory of Catalytic Materials and Industrial Processes (LMPCI), Department of
Hydrocarbons and Renewable Energies, Faculty of Science and Technology, University of Adrar-Ahmed Draia,
Adrar, Algeria.
*Corresponding Author: Mohammed Messaoudi, Mobile (+213)661-266-013, E-mail: microbiologistemed@yahoo.fr;

Background: The emergence of COVID-19 in December 2019 marked a global health crisis, originating from China
and swiftly spreading worldwide. This pandemic prompted investigations into traditional medicines' potential in
combating infectious diseases, aiming to alleviate severity, shorten duration, and prevent recurrence. The efficacy of
traditional medicines relies on compounds optimizing immune system functioning and responsiveness.
Objective: The study's objective was to assess the perception and utilization of medicinal plants in alleviating COVID-
19 symptoms among adult individuals in Algeria.
Patients and methods: The study involved 385 participants, predominantly with confirmed COVID-19 cases (88.05%),
centered on Algerians' treatment preferences, juxtaposing traditional and modern medicine. Additionally, it sought to
identify medicinal plants used for preventing and treating COVID-19 in Algeria.
Results: The survey included participants from various regions: 59.22% from Northern Provinces, 27.01% from Internal
Provinces, and 13.76% from Southern Provinces. A median age of 42 years, with 32.46% below 35 years old.
Predominantly educated, with 75.84% having attended university. The respondents were predominantly females
(62.07%). Nearly half (48.31%) reported increased usage of medicinal plants during COVID-19, while 37.40%
maintained usual consumption patterns. Most participants (44.93%) believed their knowledge of medicinal plants had
expanded during the pandemic. Notably, 70.64% highly recommended medicinal plants for COVID-19 prevention,
while 17.92% did not, with 11.42% expressing moderate recommendations. Top cited plants included Syzygium
(344), Citrus limon (315), Verbena officinalis (277), Thymus algeriensis (261), and Zingiber officinalis
Conclusions: While concrete evidence supporting medicinal plants' efficacy against COVID-19 among Algerian
patients remains elusive, their integration alongside prescribed medications showed promise in improving therapy within
this study's parameters. Combining conventional medicine and phytotherapy might offer an alternative strategy in
combatting COVID-19 in the future.
Keywords:COVID-19, Traditional medicines, Modern medicine, Global health, Algeria, Medicinal plants, Pandemic.

ongoing studies aim to assess their efficacy in both
The emergence of COVID-19, acknowledged as a
treatment and prevention [3, 4]. Investigating herbal
21st-century pandemic by the World Health

Organization due to the zoonotic virus SARS-CoV-2 in
remedies entrenched in traditional medicine and
late 2019, led to a global catastrophe with devastating
extracting key compounds from these plants presents an
repercussions. This virus triggers a spectrum of
intriguing strategy to tackle the ongoing pandemic [5].
symptoms categorized by the WHO into common, less
Algeria is incredibly rich in its diverse natural
common and serious manifestations [1].
herbs due to its vast expanses and varied climates:
Throughout history, plants have played a vital role
Maritime, continental and desert, all of which benefit
in sustaining human health, serving as sources of
from warmth, sunshine, beautiful weather, and
medicinal compounds derived from their complex
extremely fertile soil in most areas. Undoubtedly, these
secondary metabolisms and significantly contributing to
climates and soil types have a significant impact not
drug discovery endeavors [2].
only on the richness of plant diversity but also on the
Presently, there is growing interest in the potential
adaptations of the plants, giving them unique
of medicinal plants, utilized in phytotherapy, an
characteristics. There are plant forms that only appear
alternative medicine employing plant extracts and
in limited or very restricted areas in Algeria[6].
natural active principles, in addressing COVID-19.
Moreover, there is still undiscovered plant species
Multiple clinical findings emphasize the favorable
deeply rooted in nature despite the extensive literature
effects of medicinal plants in treating COVID-19, while
on Algerian herbs. The economic value of this botanical
Received: 22/05/2023

Accepted: 23/07/2023

Full Paper (vol.931 paper# 130)

c:\work\Jor\vol931_131 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7779-7782

Impact of Clomiphene Citrate, Tamoxifen and Letrozole in Women with
Unexplained Infertility on Endometrial Thickness
Dina Y. Mansour1, Amr M. El Helaly1, Khaled H. Hassan2
1Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Egypt
2Department of Obstetrics and Gynecology, Qena General Hospital, Egypt
*Corresponding author: Dina Yahia Mansour, Mobile: (+20) 01025375711, E-mail: Dinayahiamansour@hotmail.com

Polycystic ovarian syndrome (PCOS), which is characterized by irregular menstrual cycles, is the most
common diagnosis given to affected women. For these women, ovulation induction is the usual course of therapy.
Objective: To assess the impact of clomiphene citrate, letrozole, and tamoxifen on endometrial thickness in women
with unexplained infertility.
Subjects and Methods: Female patients with unexplained infertility at Ain Shams University Maternity Hospital
participated in the experiment. To stimulate ovulation, they were randomly assigned to receive letrozole, tamoxifen, or
clomiphene citrate.
Results: The results indicate that there was a substantial statistical difference in basic endometrial thickness (ET)
between the three groups, whereas there was not as much of a difference in pre-ovulatory ET.
Conclusion: Letrozole and tamoxifen (TMX) should be seen as optional therapies for women who are CC-resistant. In
addition, letrozole showed fewer side effects than tamoxifen and performed better than TMX in terms of accelerating
the rate of ovulation and pregnancy.
Keywords: Clomiphene Citrate, Endometrial Thickness, Letrozole, Ovulation Induction, Tamoxifen.

stimulate ovulation, they were offered letrozole,
Infertility is described as the inability of a couple to
tamoxifen, or clomiphene citrate.
conceive after six months for women 35 and older and
The age range that was open to consideration was
after twelve months for women under 35 who regularly
20 to 35. Regarding examination of typical semen, The
engage in sexual activity without the use of
World Health Organization (WHO) has published
contraception (1). Inducing ovulation is a very successful
revised lower reference limits for semen analysis (6). A
therapy for such ladies. For a considerable amount of
typical uterine cavity was seen on both HSG and
time, clomiphene citrate--a selective modulator of
transvaginal ultrasonography. Normal tubal patency
estrogen receptors--has been the drug of choice. It
was evaluated using chromotubation laparoscopy
functions primarily on the hypothalamus, releasing the
and/or HSG (7).
hypothalamus from negative feedback by acting
The following are the exclusion criteria: age greater
antagonistically on estrogen receptors. This increases
than 35, low ovarian reserve as indicated by a serum
the release of gonadotrophin (2).
FSH > 10 mIU/ml or a serum AMH < 1 ng/ml, body
Letrozole, an aromatase inhibitor, is a substitute for
mass index of 35 kg/m2 or higher, clomiphene citrate
clomiphene citrate in ovulation induction. It blocks the
(CC), resistance to letrozole or tamoxifen, or a history
enzyme by preventing androgens from being
of serious side effects from clomiphene citrate (CC)
aromatized to estrogen, relieving the hypothalamic-
(blurring of vision, severe OHSS), predicted decreased
pituitary axis of estrogen's negative feedback (3-5).
This study aimed to assess the impact of
abnormalities: adhesions or chronic endometritis).
clomiphene citrate, letrozole, and tamoxifen on

endometrial thickness in women with unexplained
Sampling Method and Randomization
Patients undergoing induction of ovulation with
The first and second outcomes of this study were
tamoxifen, letrozole, or clomiphene citrate were
the number of mature follicles in each group, the
randomly allocated to one of three groups using a
endometrial thickness, unsuccessful induction, cycle
computer-generated sequence of 1: 1: 1. The groups
cancellation, ovarian hyperstimulation syndrome, and
were called the tamoxifen, letrozole, or clomiphene
mid-luteal serum progesterone and clinical pregnancy
citrate group.
rate, respectively.

Allocation and perception
Utilizing opaque, sealed envelopes sent to a nurse--
A double-blind randomized controlled trial was
a third party--who subsequently identified the women's
conducted at the Ain Shams University Maternity
research regions, which were their arms. Every woman
Hospital's outpatient infertility clinic. Female patients
was asked to remove one envelope. Based on the
with unexplained infertility at Ain Shams University
number inside their envelope--which was chosen at
Maternity Hospital participated in the study. To
random by a computer--women were categorized into
either group 1, group 2, or group 3.
Received: 23/05/2023
Accepted: 24/07/2023

Full Paper (vol.931 paper# 131)

c:\work\Jor\vol931_132 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7783-7792

Efficacy of Ultrasound-Guided Deep Perineural Platelet Rich Plasma versus
Corticosteroid Injection in Patients with Ulnar Neuropathy at Elbow,
A Comparative Randomized Trial
Hajar Anwer El Naggar1*, Mervat Abdel Sattar El -Sergany 1, Doaa Shawky Alashkar1, Doaa Waseem Nada1
1 Department of Rheumatology, Rehabilitation & Physical Medicine, Faculty of Medicine, Tanta University, Egypt
*Corresponding author: Hajar Anwer El Naggar, E-mail: hagar160944_pg@med.tanta.edu.eg
Mobile: +201060367657, ORCID ID: https://orcid.org/0009-0000-3130-7716

Ulnar neuropathy at elbow (UNE) is the 2nd most common compressive neuropathy in the upper
extremities, following carpal tunnel syndrome. It occurs when compression and traction are applied to the ulnar nerve
(UN) at the elbow.
Aim: This study aimed to assess and compare the therapeutic effects of ultrasound-guided deep perineural platelet rich
plasma (PRP) against injection of corticosteroid (CS) among individuals with ulnar neuropathy at elbow (UNE).
Subjects and methods: This randomised prospective study was performed on sixty adult participants with mild to
moderate UNE who were categorized into 2 groups. Group I received single US-guided perineural PRP injection, and
group II underwent single US-guided perineural corticosteroid injection.
Results: In comparison with baseline, almost all primary outcome measures in groups II and I significantly improved
after the first- and third-months post-injection, respectively. Almost all participants in the two groups under study had
successful results with ultrasound guided perineural injection of either PRP or corticosteroid with no adverse effects.
Linear regression of tested variables showed that ulnar nerve cross-sectional area (CSA) and nerve conduction velocity
(NCV) slowing across elbow were among the potential predictors for favorable outcomes after corticosteroid and /or PRP
Ultrasound guided deep perineural PRP and corticosteroid injection are a safe and effective tool for mild to
moderate cases of UNE without any difference in outcome measures. Milder cases of UNE were identified to predict better
recovery with regard to nerve healing after PRP more than corticosteroid injection as a long-term therapy.
Keywords: Platelet rich plasma, Corticosteroid injection, Ultrasound guided perineural injection, Ulnar neuropathy at


modification to avoid hazardous elbow postures. These
UNE is the 2nd most common compressive
interventions, meanwhile, are only recommended for a
neuropathy in the upper extremities, following carpal
brief period of time and have not been shown to work for
tunnel syndrome. It occurs when compression and
the majority of patients. Additional therapeutic options,
traction are applied to the ulnar nerve (UN) at the elbow.
such as corticosteroid (CS) and platelet rich plasma (PRP)
The most often compressed areas are the humeroulnar
injections, are required to prevent turning to major
arcade and the retro epicondylar groove. UNE can be
surgical procedures like ulnar nerve decompression if
identified mainly through clinical examination, though
conservative treatment fails (4).
occasionally further testing may be required to confirm
Local PRP improves tissue remodeling, nerve axonal
the diagnosis. The UN compression can result in sensory
regeneration, and local healing. Also, cell signaling
and motor impairments that range from temporary to
molecules such fibronectin, vascular endothelial growth
permanent loss of function (1), and in severe cases, muscle
factor, and nerve growth factor are released in response to
atrophy (2).
PRP (5). These biomarkers have been demonstrated
Axonal degeneration and segmental demyelination
to have a role in modulating the activation of cell-like
are two different types of nerve pathology that can be
myelinating Schwann cell, inflammatory resolutions,
distinguished using electrodiagnostic studies to help with
fibrogenesis, and angiogenesis. As such, they maintain
diagnosis and localization of the compressed area, and
substantial promise as a neurogenic, neuroprotective, and
investigation of the extent of UN harm, which has
neuro-inflammatory therapeutic modulator system as well
occurred (1). While, ultrasonography (US) is particularly
as a booster of motor and sensory functioning nerve-
useful in this regard, there is universal agreement that
muscle unit recovery (6). Additionally, the swelling,
electrodiagnostic testing cannot diagnose a sizable
oedema, and inflammation resulted from local ischemia
fraction of UNEs (3).
brought on by the ulnar nerve's compression that can be
In order to relieve pressure on the ulnar nerve,
treated with local corticosteroids injections (7).
conservative therapy for UNE has primarily relied on
Perineural corticosteroid and PRP ultrasound guided
elbow flexion splints, patient education, and activity
injections has been employed extensively for the
Received: 23/05/2023
Accepted: 24/07/2023

Full Paper (vol.931 paper# 132)

c:\work\Jor\vol931_133 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7793-7796

Childhood Abuse and Depression in Adulthood: Review Article
Ashraf Mohamed Mohamed Ali El-Tantawy1, Haydy Hassan Sayed Ahmed2,
Omnia Youssef Muhammad Ibrahim2, Mohamed Ahmed Gamal Mady Abouelazayem3
1Psychiatry and Neurology department, 2Psychiatry Department, Faculty of Medicine- Suez Canal University
3Misr University for Science and Technology, Suez Canal University
Corresponding author: Mohamed Ahmed Gamal Mady Abouelazayem,
Email: ahmedgamalmady@gmail.com, Mobile:+201098595276


Background: There is widespread agreement that traumatic experiences in early life play a crucial role in setting the
stage for adult depression.
Aim and objectives:
This paper aimed to examine the evidence linking childhood abuse to the development of adult-
onset depression.
For the purpose of quantitatively comparing the magnitude of effect across exposure age groups, we scoured
scholarly papers and databases including PubMed, Google Scholar, and Science Direct for information on the correlation
among both Maltreatment exposure age and Depression. Studies conducted in English were sourced from electronic
databases and grey literature up to April 6th, 2022. Included studies had to provide both: Data on when the abuse
occurred and quantitative measures of the correlation between abuse in childhood and adult depression.
Adults with a record of childhood abuse have a greater likelihood to have depressive disorders with a more
severe clinical presentation during their adulthood than adults without. Exposure to severe, early-onset, chronic, and
treatment-resistant depression throughout childhood is associated with a history of maltreatment, particularly physical
neglect and emotional abuse. Clinical implications include a need for a thorough evaluation of emotional abuse, sexual
abuse, and cumulative exposure to trauma in patients with chronic depression.
Keywords: Depressive disorders, Childhood abuse, Beck score.


Depression is the biggest mental health condition,
risky behaviors like smoking, drinking excessively, or
affecting 300 million individuals globally. Human
using illegal drugs (5).
capital is eroded, and suicide and other causes of early
This article aimed to examine the evidence
death are linked to depression (1). Major depressive
linking childhood abuse to adult-onset depression.
disorder is pervasive and incapacitating, and it
Depressive disorders
frequently recurs and worsens over time. A worldwide
Debilitating mood, interest, and pleasure
12-month prevalence of 10%-17% and a lifetime
alterations, as well as cognitive and vegetative
prevalence of 17%-40% place depression among the
symptoms, are diagnostic criteria for major depressive
most frequent psychiatric diseases (2).
disorder (MDD), and mental illness. Clinical subtyping
The association between early-life stress and
of MDD is now possible with the help of updated
clinical depression is well recognized as a major
diagnostic criteria and specifiers included in the 2013
contributor to adult mental health issues. It's thought of
edition of the Diagnostic and Statistical Manual of
as a bridge between an outside experience and the way
Mental Disorders (DSM-5) (6).
it affects a person's inner world. Early trauma is the
Although major depressive episodes and MDD
leading cause of mental health issues across the board,
share a cluster of symptoms, these symptoms also
including cognitive, behavioral, emotional, and
appear in schizophrenia and bipolar illness. Hence,
physical issues (3).
diagnosis of MDD requires the use of exclusion criteria.
The recorded incidences of child abuse are only
Annually, MDD affects about 6% of the world's adult
the "tip of the iceberg." or the piece that is visible
population, with prevalence being roughly twice as high
"above the surface," of the larger problem. The
in women as in males. When comparing all diseases and
prevalence of maltreatment, the social and demographic
disorders, MDD has the second highest impact on the
elements associated with it, and the impact it has on
chronic disease burden (as defined by 'years lived with
future health are all poorly understood (4).
disability') (7). Moreover, childhood sexual, physical, or
Consequences of child abuse and neglect are
emotional abuse is a significant risk factor for MDD,
frequently discussed in terms of their physiological,
but the complex interplay between environmental
psychological, behavioral, and social effects. But, in
variables and genetic and epigenetic factors is still
practice, it is utterly difficult to disentangle them. Brain
poorly understood (8).
injury in children, for example, can have long-term
Despite advances in our knowledge of the
psychological repercussions like learning and mood
neurobiology of MDD, no one mechanism has been
problems. High-risk actions are frequently A symptom
discovered that accounts for all of the symptoms of the
of underlying mental health issues. Stress and emotional
disorder. However, MDD is related with decreased
distress might increase the likelihood of engaging in
hippocampus sizes and alterations in the activation or

Received: 26/12/2023
Accepted: 26/02/2023

Full Paper (vol.931 paper# 133)

c:\work\Jor\vol931_134 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7797-7802

US Guided Fascia Iliaca Block versus Femoral Nerve Block for Post Operative
Analgesia for Patient Undergoing Total Knee Arthroplasty
Raouf Ramzy Gadalla; Reham Fathy Galal;
Nermeen Shawky Ahmed, Samuel Habachi Daniel
Department of Anaesthesiology, Intensive Care and Pain Management
Faculty of Medicine - Ain Shams University
Corresponding author: Samuel Habachi Daniel; Tel. No.: 01224394897; E-Mail: samuel_habachi@hotmail.com

Pain is the leading cause that drives patients to receive total knee arthroplasty (TKA), it is also performed
to improve joint mobility and quality of life. Peripheral nerve blocks with different modes have shown favorable control
of perioperative pain associated with TKA. The development of new anesthetic medications has given more success in
performing peripheral nerve blocks. Aim of the Study: To study the effect of fascia iliaca compartmental block in
postoperative pain control in patients of TKA and comparing it to femoral nerve block.
Patients and methods: Seventy adults who were undergoing TKA were included in this prospective randomized
clinical trial. Patients receiving spinal anaesthesia were randomly allocated to either have an ultrasound guided fascia
iliaca compartment block (FICB) or femoral nerve block (FNB).
Results: Patients in FICB group had a statistically significant lower visual analogue scale score at PACU arrival than
the FNB group with mean and standard deviation 1.00 ± 0.00 vs. 1.11 ± 0.32 respectively (p= 0.041). This was also seen
after 6, 12 and 24 hours postoperatively. The time interval taken to ask for analgesia postoperatively was significantly
later in FICB group than the other, with mean and standard deviation 9.86 ± 1.31 vs. 6.87 ± 0.92 respectively. There
was also a significant decrease in total pethidine used in FICB patients.
Conclusion: The FICB can significantly decrease pain in the early postoperative period as well as after 6, 12 and 24
hours with a significant decrease in the usage of opioids.
Keywords: Fascia iliaca compartment block, peripheral nerve block, Total knee arthroplasty, Femoral nerve block.


Patients with rheumatoid arthritis and advanced
randomized prospective clinical trial was done to study
osteoarthritis commonly undergo total knee arthroplasty
the effect of fascia iliaca compartment block (FICB) in
(TKA) to treat joint pain, which hinders mobility and
management of pain in patients undergoing TKA, and
worsens quality of life (1). Unfortunately, thirty per cent
to compare it to femoral nerve block (FNB).
of patients experience moderate postoperative pain, and

to a greater extent of sixty percent, experience severe
postoperative pain following total knee arthroplasty(2).
Over the course of six months (this prospective
Early ambulation with regaining full range of
randomised clinical trial was performed in Ain Shams
motion is crucial in the recovery after TKA, and it also
University Hospitals. In this study, seventy adult
decreases thromboembolism. Postoperative pain
patients who were planned to undergo total knee
hinders the previously mentioned ambulation and
arthroplasty (TKA) with spinal anaesthesia were
affects the patient's rehabilitation (3). Consequently, in
randomly assigned, using opaque sealed envelopes and
TKA patients, proper effective pain control is very
computer-generated codes, to one of the following
crucial for early rehabilitation, which improves the
groups: first group of patients (FICB) underwent an
patient's satisfaction (4). Morphine and non-steroidal
ultra-sound-guided fascia iliaca compartment block,
anti-inflammatory drugs (NSAIDs) may help in pain
and the second group of patients (FNB) underwent an
control in these patients. Fortunately, the outstanding
ultra-sound-guided femoral nerve block.
performance of peripheral nerve blocks in decreasing
Patients from both sexes with age range from
pain intensity in the first twenty-four hours
45-65 years, BMI: 28-32, Class- II and III of the
postoperatively and opioid usage has significantly
American Society of Anaesthesiologists Physical Status
decreased the hospital stay duration and improved the
(ASA), who were planned for Total knee arthroplasty
quality of life in TKA patients (2).
(TKA) with spinal anaesthesia with time of surgery: 2-
One analgesic method called the fascia iliaca
3 hours (hrs) were included in this study. Patients who
compartment block (FICB) involves introduction of a
had an allergic history to the drugs employed in the
local anaesthetic under the iliacus muscle's fascia (4).
study, psychiatric illness, and complicated or redo knee
The femoral nerve block which is used to anaesthetize
replacement were excluded from the study. Also, patient
the femoral nerve distribution during surgeries on the
refusal, coagulopathy, and local infection which
anterior thigh and knee, can encourage early hospital
preclude the use of regional anaesthesia were included
discharge and offer efficient pain control with minimal
in the exclusion criteria.
opioid usage, which subsequently lowers the drawbacks
Prior to surgery, each patient was subjected to a
associated with consuming opioids (5). In this study a
complete physical examination, a thorough history
Received: 17/05/2023
Accepted: 18/07/2023

Full Paper (vol.931 paper# 134)

c:\work\Jor\vol931_135 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7803-7809
Detection of cdt and clb Genes in pathogenic E.coli
Zainab Zamel Khalaf and May Talib Flayyih
Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq.
*Corresponding author: Zainab Zamel Khalaf, E-mail: zainab.alnaji@sc.uobaghdad.edu.iq, Mobile: +9647707802415

Many diseases create the cytolethal-distending toxin (CDT), which is representative of an emerging
family of recently identified bacterial compounds.
Objective: This study was performed to detect the antibiotic resistance properties and distribution of cdtB and clbA in
E. coli strains isolated from urine and stool samples.
Materials and Methods: The sensitivity test was evaluated by using different types of antibiotics in the current study,
and the cdtB and clb genes were detected by PCR in all bacterial isolates.
Results: The antibiotics sensitivity test show variable degrees of sensitivity and resistance. The high percentage of
sensitivity was achieved against amikacin at a percentage of 86% and ciprofloxacin, ceftazidime, gentamicin, and
tobramycin at a percentage of 80%, whereas trimethoprim and aztreonam at 64% and 60% respectively. In this study,
most isolates were resistant to amoxicillin (92%); while showing different degrees of resistance against other types of
antibiotics ranging from tetracycline (62%) to amikacin 4%. The frequency of MDR bacteria was about 64 % (32
isolates), 30 from urine, and 2 others from stool. The results showed that the clbA gene was found in 6 bacterial isolates
(12%), whereas the other 44 (88%) isolates don't have this gene, while the cdtB gene wasn't found in any one of the
bacterial isolates.
E.coli was recorded as multidrug resistance (MDR) and the clb gene was found only in 6 bacterial isolates
but it was not the cdtB gene detected in all isolates.
E.coli,cdt,clb, antibiotic sensitivity, genotoxins.


prolonged colonization of the host gut is likewise
Escherichia coli is an opportunistic pathogen that
correlated with the presence of the pks island (9).
is frequently found in the intestinal flora of both humans
The first CDT, a novel form of toxin activity
and animals. Depending on where it dwells, it can be
produced by pathogenic strains of E. coli, was reported
classified as commensal, intestinal, or extraintestinal E.
in 1987 (10). Being able to cause DNA double-strand
coli (1). The expression of a broad spectrum of virulence
breaks in both proliferating and nonproliferating cells
factors contributes to the severity of UTI caused by E.
makes CDT unique among bacterial toxins and results
coli (2) The members of the family of Enterobacteriaceae
in the irreversible cell cycle arrest or death of the
harbor a gene cluster called polyketide synthase (pks)
targeted cells (11). In addition to harmful and disease-
island. This cluster is responsible for the synthesis of the
causing organisms, commensal strains like Escherichia
genotoxin colibactin which might have an important
coli (E. coli), a component of the natural flora in the
role in the induction of double-strand DNA breaks (3).
digestive system of people and warm-blooded animals,
One class of cyclomodulins contains genotoxins
also develop antibiotic resistance (12).
and/or cell cycle-regulating toxins that influence
Although there are many contributing factors, the
cellular differentiation, death, and proliferation, all of
development of antibiotic resistance in E. coli and other
which promote tumorigenesis. These cytotoxins include
bacteria has coincided with the addition of these
Colibactin, Cytolethal Distending Toxin (CTD), and
medications to the treatment toolkit in both human and
Cytotoxic Necrotizing Factors (cnfs) (CIF) (4).
veterinary medicine (13). This study was designed to
Intestinal and extraintestinal infections caused by E.
isolate E. coli from urine and stool samples, study the
coli strains are correlated with virulence factors like
antibiotics susceptibility tests for ten types of antibiotics
CDT and CNF (5).
against E.coli, screen for genotoxins-producing E. coli
In mouse sepsis and meningitis models, the role of
from these samples, and detect the clbA and cdt genes
colibactins in the virulence of E. coli and K.
as genotoxins in E. coli using PCR technique. This
pneumoniae has been established. Isogenic mutants
study was limited by the paucity of molecular studies on
with defective colibactin production show diminished
genotoxic E. coli and multidrug resistance of bacteria.
virulence in comparison to wild-type pks-positive

(pks_) strains. (6). The 54-kb pathogenicity pks Island
contains the clb A-S genes, which code for the
Specimen collection
secondary metabolite known as colibactins (7).
Between January 2021 and March 2021, bacterial
Numerous Enterobacteriaceae strains, including
isolates from urine and stool samples were collected.
particular strains of gut commensal and extraintestinal
One hundred and twenty samples of urine and stool
pathogenic E. coli (ExPEC) and Klebsiella pneumoniae,
were taken in total, and 35 isolates of enteropathogenic
among others, include the clb locus (8). The ability of E.
E. coli and 15 isolates of uropathogenic E. coli were
coli strains from phylogenetic group B2 to establish
acquired and grown on MacConkey and EMB agar
Received: 20/08/2022
Accepted: 02/12/2022

Full Paper (vol.931 paper# 135)

c:\work\Jor\vol931_136 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7810-7813

Cutaneous, Lacrimal and Testicular Lymphomas; Case Series
Esraa Mohamed1, Wafaa Abdelhamid1, Waleed Diab2, Mohamed Gaber1
1Clinical Oncology and Nuclear Medicine Department, and
2Clinical Oncology Department, Faculty of Medicine, Sohag University Hospital, Egypt.
Corresponding author: Esraa Mohamed Tel: +20-01091512374, Email: dr.esraa.hafez@gmail.com

One-fifth of the patients suffering from lymphoma had an extra-nodal presentation.
Objectives: We aimed to provide our experience with three cases of cutaneous, lacrimal, and testicular lymphomas.
Patients and methods: We provided three cases with extra-nodal lymphoma arising from the lacrimal gland, the
subcutaneous tissue, and testis.
Results: The first case was a 42-year-old lady who presented with relapsed diffuse large B-cell lymphoma (DLBCL) in the
form of subcutaneous nodules within both thighs. The second case was 72-year-old lady who presented with an orbital mass.
The mass was proven to be NHL arising from the orbit with regional lymphadenopathy. The third case had advanced NHL
with testicular and renal involvement. Graphical illustrations of their PET-CT scans were included.
Conclusion: Extra-nodal presentation of NHL is a rare but serious condition. We presented three cases with lacrimal,
subcutaneous, and testicular presentation.
Keywords: Lymphoma, Non-Hodgkin's lymphoma, Hodgkin's lymphoma, Extra nodal lymphoma.


Lymphoma is a complex haematological
A 42-year-old female patient with NHL, DLBCL,
malignancy that arises from lymph nodes. These diseases
was diagnosed in 2017. The patient received
are usually present as nodal diseases with supra and infra-
chemotherapy in 2018 and was under follow-up. In 2020
diaphragmatic presentation. In this piece of art, we
she developed subcutaneous nodules at the right thigh. An
present our experience with three cases of extra-nodal
excisional biopsy was done, revealing NHL. 8 mci of
presentation originating from the orbit, testes, and
Fluorine 18 FDG was given IV, and glucose level was
subcutaneous tissue (1,2).
ensured to be less than 90 mg/dl. Multi-detector

tomography examination was done without injection of
IV contrast.
Study design and patients: This is a case series of cases
Images of CT and corresponding functional PET
with a rare form of extra-nodallymphoma.
images are displayed in axial, coronal and sagittal planes.

Reference liver SUV was 3. Reference mediastinal blood
Ethical consent: The Academic and Ethical Committee,
pool SUV was 2.4. The scan showed low-grade FDG avid
Sohag University approved the study. Every patient
sub-centimetric cervical, mediastinal, and pelvic lymph
signed an informed written consent for acceptance of
nodes. There was an increased FDG uptake in the
using his data in the study. This work has been carried out
subcutaneous soft tissue lesion at the right thigh and the
by the Code of Ethics of the World Medical Association
left leg with SUV max 7.5, 7.4 respectively, and Deauville
(Declaration of Helsinki) for studies involving humans.
score was 4 (Figure 1).

Received: 24/05/2023
Accepted: 25/07/2023

Full Paper (vol.931 paper# 136)

c:\work\Jor\vol931_137 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7814-7819

Prevalence of Iron Deficiency Anemia among Pregnant Females Attending
Antenatal Care Unit at Zagazig University Hospitals
Gamal Abas El Sayed, Hoda Sibai Abd Alsalam, Hala Salah Ali Mohamed Seleem, Mostafa Abdo Ahmed
Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Hala Salah Ali Mohamed Seleem, Email: hsalah197861@gmail.com, Tel: 01126078581
Low iron stores were discovered in newborns born to moms who were iron deficient, suggesting that the
fetus's ability to store iron from mothers with low stores is limited. Therefore, determining the risk factors for maternal iron
insufficie.ncy may be useful in creating preventative measures to enhance the health of the kids.
Objective: The aim of the study was to improve the pregnancy outcomes by determining the prevalence of IDA and its risk
factors among the pregnant females attending antenatal care clinic in Zagazig University Hospitals.
Patients and methods:
This cross-sectional study included 354 pregnant females attending the antenatal care clinic in
Zagazig University Hospitals during the period from September 1st, 2019, to the end of April 2020.
There was statistically significant difference regarding age and socio-economic level between studied groups.
Normocytic normochromic anemia was more among women with higher age group as 67.8% of anemic women had age
group more than 28 years versus 53.5% of iron deficiency anemic women had age group less than 28 years. Regarding
socio-economic level, there was statistically significant difference between iron deficiency anemic patients and normal CBC
pregnant females with most of IDA pregnant females (56%) were of low socio-economic level and no one (0.0%) had high
class. While, 47.5% & 52.5% of NNA pregnant females were of low and moderate socio-economic level respectively. All
high class women were with normal CBC. Conclusion: Low socioeconomic standard, multiparity and recurrent pregnancy
are considered high risk factors and should be considered.
Iron deficiency anemia, Anemia, Pregnant.
to Australian guidelines from 2017, a pregnant woman
The WHO defines iron deficiency anemia (IDA) as
should consume an average of 27 mg of iron per day, with
a decreased level of total hemoglobin brought on by
a total requirement of 1000­1200 mg (5, 8).
insufficient iron. Therefore, WHO defines anemia during
The aim of this study was to improve the pregnancy
pregnancy as having a hemoglobin level below 11 g/dl
outcomes by determining the prevalence of IDA and
and 10 g/dl after delivery (1). In order to prevent risks
associated risk factors in women undergoing prenatal
during pregnancy and delivery, IDA, the most frequent
treatment at Zagazig University Hospitals.
nutritional illness in the world, must be detected early and
managed promptly. It is also the most common medical
This cross-sectional study included 354 pregnant
condition during pregnancy (2). Early IDA identification
females attending the Antenatal Care Clinic in Zagazig
and treatment reduces the negative consequences that
University Hospitals during the period from September
pregnancy has on the mother and child, particularly the
1st, 2019 to the end of April 2020.
requirement for blood transfusions and the rates of perinatal
morbidity and death (3, 4). The frequency of IDA is a useful
comprehensive medical, surgical, and obstetric history
tool for assessing the severity of the condition in
taking. There was a general and local examination. For
expectant mothers who visit the clinic, as well as for
patients with microcytic hypochromic anemia and
assessing their general health and eating habits. The
hemoglobin levels less than 10.5 gm/dl, investigations
growing placenta and fetus during pregnancy cause a
were conducted to measure the complete blood count
physiological increase in the mother's need for iron that is
(CBC), which included hemoglobin level, hematocrit
three times greater. Blood volume rises during the third
percent %, RBCs count, mean hemoglobin concentration,
trimester and reaches its peak in the second trimester (5).
mean corpuscular volume (MCV), mean corpuscular
IDA is a type of anemia caused by a sufficient depletion
hemoglobin (MCH), mean corpuscular hemoglobin
of stored iron. It should be distinguished from
concentration (MCHC), and serum ferritin level (9). For
physiological anemia, which is a common condition
estimation of CBC; 2 mL venous blood were collected in
during healthy pregnancy and is caused by an expanded
EDTA tubes in the laboratory of the Outpatient Clinic in
plasma volume but a less significant increase in red cell
Zagazig University Hospitals.
mass (6). In Egypt, 46% of pregnant women had IDA; the
After CBC results patients were divided according
rate was greater in rural regions (63%) compared to urban
to Hb level, HCT %, MCV level, MCH level & MCHC
areas (37%). The World Health Organization established
level into patients with microcytic hypochromic anemia,
four fundamental preventive measures: Dietary and
patients with normocytic normochromic anemia and
nutrition modifications, iron-fortified food fortification,
patients with normal CBC. Serum ferritin was done for
infection control, and iron supplementation (7). According
patients with microcytic hypochromic anemia and Hb
Received: 03/02/2023
Accepted: 07/04/2023

Full Paper (vol.931 paper# 137)

c:\work\Jor\vol931_138 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7820-7824

Elective Induction of Labor at 39 Weeks among Nulliparous Women at
Mansoura University Hospital
Mervat Ali Mohamed*, Osama Mahmoud Warda, Abdelhady Zayed, Alhussein Ahmed Mohamed
Department of Obstetrics & Gynecology, Faculty of Medicine- Mansoura University, Egypt
*Corresponding author: Mervat Ali Mohamed, Mobile: +20) 01116151946, Email: mervatali209@gmail.com

When there are greater hazards to the mother and fetus from continuing the pregnancy than from having
an accelerated delivery, induction of labor (IOL) is advised. Induction of labor without a medical indication is known
as elective induction of labour (eIOL). Objective: This study aimed to assess the impact of eIOL at 39 weeks gestation
in nulliparous women on mother and neonatal outcomes compared with expectant management (EM). Patients and
This prospective study was carried on 120 nulliparous women who were at 39 weeks gestation. The study
population were distributed randomly into 2 groups with 60 participants in each: Group A comprised 60 pregnant women
who underwent eIOL at 39 weeks gestational age and group B who underwent EM and acted as control group. Results:
Incidence of Cesarean section (CS) was higher among group B than in group A. Group B was shown to have a higher
incidence of perineal tears than group A. Both groups demonstrated comparable outcomes as regards postpartum
hemorrhage (PPH) and need for blood transfusion. There was no statistically significant difference between the two
groups regarding fetal problems. Group A exhibited a higher mean APGAR score compared to group B, and group A
required fewer visits to the newborn intensive care unit (NICU) than group B. Conclusion: eIOL at 39 weeks led to
fewer population hazards than EM. In particular, eIOL at 39 weeks gestation that was related to lower rates of CS,
maternal morbidity, stillbirths, and newborn mortality, as well as decreased rates of neonatal morbidity.
Keywords: Elective induction of labour, Cesarean section, Expectant management, Bishop score, Cardiotocography.

consideration of the timing of delivery. There is a rise
This study was a prospective one that was performed
in morbidity and mortality over the entire gestational
at Outpatient Obstetrics Clinics and Emergency
age range at delivery. On the one hand, newborn
Departments at Mansoura University Hospital. A
morbidity and mortality are mostly caused by premature
secondary analysis was conducted on women
birth. However, there is also a risk to the mother, fetus,
randomized at 38th weeks gestation to perform trial of
and newborn associated with late-term and post-term
induction at 39th weeks or EM. Deliveries earlier than
pregnancies. The American College of Obstetricians
39th weeks were not adherent to study protocol. Our
and Gynecologists (ACOG) recommends that due to
study involved 120 nulliparous women with a singleton
these hazards, IOL is advised after 42 0/7 weeks
pregnancy with vertex presentation at 39th weeks
gestational age and may be considered between 41 0/7
and 41 6/7 weeks gestational age [1]. The best time to
Exclusion criteria: Elderly primigravida, being obese
deliver a baby in pregnancies between 39- and 41-
as the mother, having a history of medical problems
weeks' gestation is uncertain. Hazards to the mother and
such as hypertensive disorders, DM, cardiovascular
foetus is reduced with eIOL starting at 39 weeks.
Preeclampsia and stillbirth are two possible dangers of
continuing pregnancies that it helps to prevent.
abnormalities, foetal distress and fetal growth
Furthermore, eIOL lowers the incidence of shoulder
abnormalities. There were 2 study groups with 60
dystocia, which is associated with macrosomia [2, 3].
participants in each one. Group A included eIOL at 39
IOL, however, is not without risk. Fetal heart rate
weeks gestational age, while group B included pregnant
(FHR) tracings that are aberrant and rates of uterine
women underwent EM as a control group.
hyperstimulation are greater in women who undergo
Sampling method: The study was double-blind
IOL. Furthermore, a greater incidence of CS may be
randomized clinical trial. Simple random sampling was
present in nulliparous patients receiving IOL who have
done through sealed envelope technique, every
an unfavorable cervix [4].
participant in the study had the equal chance to be
There are some theoretical concerns about
distributed to either group, group A (Intervention
financial cost, logistics and complications of failed
group) and group B (Control group). Studied groups
trials of induction, which represent the cause of opinion
were matched for confounding variables (age and
against such a policy [5]. The women's predilection and
socioeconomic level).
awareness about IOL is an additional factor, which is
commonly ignored [6].
The purpose of that study was to assess the impact
Clinical evaluation of all participants was done
of eIOL at 39th weeks gestation in nulliparous women
through history taking, abdominal and local
on mother and neonatal outcomes compared to EM.
examinations which had been done according to
Received: 28/05/2023
Accepted: 27/07/2023

Full Paper (vol.931 paper# 138)

c:\work\Jor\vol931_139 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7825-7830

Elective Cesarean Section Induction Delivery Time and Development of
Transient Tachypnea of The Newborn; A Prospective Clinical Study
Mostafa Mahmoud Alkhiary, Alaa Eldein Mohamed Algohary,
Khaled Samir Ismail, Nouran Fouad Mohamed Abu Rashed*
Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University
*Corresponding author: Nouran Fouad Mohamed Abu Rashed, Mobile: 01223586943, E-mail: nouranfoad@hotmail.com

Neonates born via elective cesarean section have a higher risk of respiratory complications such as respiratory
distress syndrome or transient tachypnea of the newborn (TTN).
Objectives: To assess the relation between each of the induction delivery time and the uterine incision delivery time during
Cesarean Section (CS) with the incidence of transient tachypnea of the newborn.
Patients and methods: This was a prospective cohort study conducted on a total of 110 pregnant women at term (completed
37 weeks) scheduled for elective Cesarean Section at Obstetrics and Gynecology Department at El Mansoura University
Hospital. Results: Our results showed that there were no statistically significant relations between all sociodemographic
characteristics (Age, Menstrual history, Parity, Number of abortions, Number of normal vaginal delivery, Number of
Cesarean Section delivery, Duration of pregnancy by date/weeks, Duration of pregnancy by US/weeks, Surgical history,
BMI, PPD, FL, FHR, Placenta, HB, Platelet, INR, blood groups and (RH) of the studied cases and incidence of TTN among
their neonates (P>0.05). There was no statistically significant correlation between induction to delivery interval, uterine
incision to delivery interval, and skin incision to delivery interval in the context of incidence of TTN (P>0.05).
Conclusion: Induction delivery time, skin incision delivery time and the uterine incision delivery time during CS seemed
to have no significant correlation with the incidence of transient tachypnea of the newborn, likewise the Apgar score.
Keywords: Elective cesarean section induction delivery time, Tachypnea of the newborn


Department at El Mansoura University Hospital. From
Cesarean delivery is associated with increased risks for
January 2022 to April 2022.
adverse obstetric and perinatal outcomes in the
Inclusion criteria: Women at term (completed 37-42
subsequent birth as malpresentation, placenta previa,
weeks), women having singleton, non-anomalous fetus
antepartum hemorrhage, placenta accreta, prolonged
and age: 20-39 years old.
labor, uterine rupture, preterm birth, low birth weight, and
stillbirth in their second delivery (1).
Exclusion criteria: Women with maternal medical
Neonates born via elective cesarean section have a
disorders (hypertensive disorders with pregnancy, heart
higher risk of respiratory complications such as
disease, renal disorders, diabetes mellitus, infections, APL
respiratory distress syndrome or transitory tachypnea of
syndrome), Intrauterine growth restriction, Maternal drug
the newborn (2). Transient tachypnea of the newborn; also
affecting respiratory centers intake prior to CS (morphine
known as-type 2 respiratory distress syndrome (RDS),
and related opioid), Premature rupture of membranes,
wet lung syndrome-represents the commonest cause of
Cesarean deliveries due to obstetric emergency; such as,
neonatal respiratory distress, with a prevalence range
between 0.33 to 3.9%. It is a pulmonary disorder that
malpresentation (breech, transverse).
affects lung parenchyma and characterized by pulmonary
edema (3, 4). Despite being a benign and self-limiting
All patients were subjected to the following
disease, still the associated hypoxemia with transient
Thorough history taking, the gestational age from the first
tachypnea of the newborn and respiratory failure may
day of the last menstrual period provided that the patient
increase the morbidity, length of hospital stay, risk of
was sure of date and no recent history of hormonal
chronic pulmonary disease later on and death (5, 6).
contraception, obstetric ultrasonographic study and basic
The aim of this study was to assess the relation
laboratory investigations (Blood grouping, Rh typing,
between each of the induction delivery time and the
uterine incision delivery time during CS with the
incidence of transient tachypnea of the newborn.
Examination: General examination (Vital signs and

At the time of delivery: Complete blood picture (CBC),
This was a prospective cohort study conducted on a total
coagulation profile, (Random blood sugar, preoperative
of 110 pregnant women at term (completed 37 weeks)
ultrasound examination also was done for every
scheduled for elective CS at Obstetrics and Gynecology
participant. All caesarean sections were done by the same
Received: 25/05/2023
Accepted: 26/07/2023

Full Paper (vol.931 paper# 139)

c:\work\Jor\vol931_140 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7831-7839

The Influence of Obesity on Non-Descent Vaginal Hysterectomy (NDVH): A
Retrospective Comparison of Obese and Non-Obese Women Undergoing NDVH
Ahmed Mousad Baioumy Ahmed 1, Ashraf Nassif Mahmoud Elmantwe 1*, Ahmed Kamal Eldin Abbas 1,
Hossam Elbanhawy 2, Ahmed Kasem Mohamed Zain Eldin 1 and Mohamed Anwar Elnory 1
1Obstetrics and Gynecology Department, Benha University Hospital, Benha University, Egypt
2Obstetrics and Gynecology Department, Teaching Hospitals Organization, Egyptian Ministry of Health, Egypt
*Corresponding Author: Ashraf Nassif Mahmoud Elmantwe,
Email: ashrafelmantwe2020@gmail.com, ashrafnassifelmantwe@fmed.bu.edu.eg, Phone: +201001801244

High body mass index (BMI) 30 kg/m2 is associated with non-optimal perioperative consequences in
women undergoing hysterectomy and is deemed a contraindication for non-descent vaginal hysterectomy (NDVH) by
utmost gynecologic surgeons, is this contraindication authentic or assumed?
Objective: To estimate the influence of BMI on perioperative outcomes in patients who underwent NDVH for non-
malignant uterine disorders.
Patients and Methods: This retrospective cohort involves 843 patients; 413 patients were non-obese (BMI < 30 kg/m2)
and 430 patients were obese (BMI 30 kg/m2).
Results: BMI differed significantly between groups (27.4±6.7 vs. 38.6±11.6, P= 0.0001). Both groups also differed
regarding age, parity, preoperative medical comorbidity including hypertension and diabetes mellites, American Society
of Anesthesiologists physical status, and endometrial hyperplasia incidence (P<0.05), but were parallel concerning
nulliparity, menopausal status, number of prior vaginal birth prior cesarean section, and virgin lower abdomen. No
clinically significant alterations were perceived in perioperative consequences as transfusion, ureteral, bladder, or bowel
injuries, fever, systemic infections, fistula, conversion to total abdominal hysterectomy, and total postoperative
complications. Obese group was associated with significant excess operative blood loos, extended total and actual
operative room time, longer postoperative hospital stays, higher rate of deep venous thrombosis (DVT), excess need for
general aesthesia, analgesia and venous thromboembolism (VTE) prophylaxis (P<0.05).
Conclusions: The outcomes regarding intraoperative conversion to TAH and perioperative consequences disclose that
NDVH is safe and feasible for patients with BMI 30 kg/m2 and gynecologist shouldn't consider obesity, even morbid
or super or more, as a contraindication for NDVH.
Keywords: Non-descent vaginal hysterectomy, Obesity, BMI, morbid obesity, Perioperative consequences.

Obesity is associated with numerous health
Non-descent vaginal hysterectomy (NDVH) is the
complications, including cardiovascular disease,
genuine minimally invasive hysterectomy (MIH) in
diabetes, and cancer [5]. Obesity has also been identified
which the real gynecologic surgeon extirpates the non-
as a risk factor for several gynecologic conditions,
prolapsed uterus through the natural vaginal orifice,
including uterine fibroids, endometrial cancer, and
known as natural orifice surgery (NOS) [1] with a recent
abnormal uterine bleeding. Obesity may increase the
modification of utilizing laparoscopy though vaginal
complexity of NDVH surgery due to the increased
orifice known as vaginal natural orifice transluminal
amount of intra-abdominal and pelvic fat, which can
endoscopic surgery (vNOTES) [2], in contrast to other
lead to technical difficulties during surgery, longer
routes for hysterectomy (HR) where a portal to the
operative time, and increased risk of complications [6-9].
uterus is surgically created either as single laparotomy

incision in total abdominal hysterectomy (TAH) and
Despite the potential impact of obesity on NDVH
single port laparoscopic hysterectomy (STLH) or
outcomes, there is a lack of comprehensive studies
multiple abdominal cuts in total laparoscopic
investigating the effect of obesity on NDVH [8]. Existing
hysterectomy (TLH) or robotic assisted laparoscopic
studies didn't concentrate on impact of obesity on
hysterectomy(RALH) [3,4].
consequences of NDVH individually as well as have

reported conflicting results, with some showing that
NDVH is a preferred alternative to TAH, TLH and
obesity is associated with increased surgical
RALH due to its lower morbidity, shorter hospital
complications and prolonged operative time, while
resides, and quicker rescue time. However, the
others have reported no significant differences [6-9].
completion of NDVH may be influenced by several

factors, including patient characteristics, such as obesity
This retrospective study aims to compare the
NDVH outcomes between obese and non-obese
Obesity is a major public health concern worldwide,
women. This study investigated the impact of obesity
with its prevalence increasing at an alarming rate.
on preoperative hospital care, operative time, blood
loss, perioperative complications, length of hospital
Received: 03/02/2023
Accepted: 07/04/2023

Full Paper (vol.931 paper# 140)

c:\work\Jor\vol931_141 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7840-7847

Comparative Analysis of Non-Descent Vaginal Hysterectomy in
Nulliparous and Parous Women: Insights from a Retrospective Study
Ahmed Mousad Baioumy Ahmed 1, Ashraf Nassif Mahmoud Elmantwe 1*,
Ahmed Kasem Mohamed,Zain Eldin 1, Hossam Elbanhawy 2,
Ahmed Sabra Ibrahim Mohammed Sabra 1 , Mohamed Anwar Elnory 1
Obstetrics and Gynecology Department, Benha University Hospital, Benha University, Egypt.
Obstetrics and Gynecology Department, Teaching Hospitals Organization, Egyptian Ministry of Health, Egypt.
*Corresponding Author: Ashraf Nassif Mahmoud Elmantwe.
Email: ashrafelmantwe2020@gmail.com, ashrafnassifelmantwe@fmed.bu.edu.eg, Phone: +201001801244

A lot of alleged contraindications to Non-Descent Vaginal Hysterectomy (NDVH) were cited by lay
gynecologic surgeons: is this true?
Objective: This study aimed to compare NDVH achievement rate and perioperative consequences in nulliparous and
parous women.
Methods: This retrospective cohort study involved 1008 patients who had NDVH between 2010 and 2023 at Benha
University Hospital and private centers.
Results: 203 (20.1%) were nulliparous (reference group), while 805 (79.9%) were parous, out of parous women 202
(20%) were primiparous, while 603 (59.9%) were multiparous (investigational group). Both groups were parallel
regarding most preoperative features and no clinically significant alterations were perceived in perioperative
consequences as transfusion, ureteral and bladder or bowel injuries, fever, systemic infections, fistula, conversion to
total abdominal hysterectomy and total postoperative complications (P>0.05). NDVH was successfully executed in
97.04% (197/203) of the nulliparous and 98.01% (789/805) of the parous women [P = 0.39, relative risk (RR) = 1.48,
95% CI (0.58­3.79), number need treat (NNT), i.e. gynecologist need to operate upon 103 women to meet one case
converted to abdominal hysterectomy]. No difference was noticed in overall intraoperative complications rate [16/203
(7.9%) vs 61/805(7.3%), P = 0.37, RR = 1.03 (0.61­1.76)], but the EBL was less in nulliparous compared to parous
women (295 140 vs.405 160, (95% CI) =110 (85.9 to 134.1), P=0.0001).
Conclusions: The results regarding intraoperative switching to TAH, achievement rate of NDVH and perioperative
consequences revealed that NDVH is secure and viable in nulliparous women and gynecologic surgeon shouldn't deem
nulliparity as a contraindication for NDVH and the maluses of laparoscopy for hysterectomy should be revised.
Keywords: Non- descent vaginal hysterectomy, Nulliparity, Multiparity, Perioperative consequences.


Non-descent vaginal hysterectomy (NDVH) is a
success and outcomes of NDVH, citing the nulliparity
unique surgical procedure for non-prolapse uterine
as a contraindicated route for hysterectomy [3-7].
extirpation through the natural vaginal portal without
In the USA about 600,000 hysterectomies are
the need for an artificial portal through an abdominal
accomplished annually at a charge of more than $5
incision as in total abdominal hysterectomy (TAH),
billion Also, in USA as a consequence to introduction
total laparoscopic hysterectomy (TLH) and robotic
of the LH in 1988, the rate of TAH decreased by 38%
(RH) [1, 2]. It offers several advantages over other
and VH decreased from 24.4% to 21.8% between 1990
hysterectomy approaches, including shorter hospital
and 2003, while LH increased from 0.3% to 11.8%, and
stays, faster recovery, and reduced postoperative
further increased to 30% by 2010. This leads to
complications [1, 2]. However, the success and outcomes
diminished experience to VH during residency training
of NDVH may vary depending on various patient-
[16]. The median number of VH decreased by 35.5%
related factors, including parity [3-7] and various
(from 31% to 20%) in residents graduating in 2017­
gynecologic surgeons (GS)- patient-related factors,
2018, in comparison with 2002­2003. On the other
including skills, residential training, patience, attitude,
hand, the number of LH increased by 115% (from 20%
selfishness, and knowledge-based practices [8-15].
to 43%). This, in turn perpetuates less use of this
Parity, defined as the number of times a woman has
technique [17]. Despite both VH and LH offer
given birth to a fetus of at least 20 weeks gestation, has
comparable pros relative to TAH, VH is less cost,
been shown to influence the pelvic anatomy, tissue
associated with shorter operating times, and may be
characteristics, and surgical outcomes in gynecological
executed in a low resource country [16, 18, 19]. Despite
procedures [3-7]. Previous studies have suggested that
many conditions are looked when choosing the route of
nulliparous women (women who have never given
hysterectomy (including but not limited to presence of
birth) may have anatomical and physiological
prolapse, uterine size, high body mass index (BMI) and
differences compared to parous women (women who
prior abdominal surgery), nulliparity is often used as an
have given birth) that could potentially impact the
alleged contraindication to VH. Most gynecologic

surgeons deferred vaginal route absolutely in
Received: 03/02/2023
Accepted: 07/04/2023

Full Paper (vol.931 paper# 141)

Full Paper (vol.931 paper# 142)

c:\work\Jor\vol931_143 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7857-7861

Predictive Value of sCD93 in The Diagnosis of Bronchial Asthma
Sahar M. Fayed1, Ola S. El-Shimi1, Lubna I. Fathi2, Rana A. Khashaba1,3
1 Clinical and Chemical Pathology Department, Faculty of Medicine, Benha University, Egypt
2 Laboratory Medicine Department, Shebin Alkom Ophthalmology Hospital, MOH, Menofiya, Egypt.
3 Faculty of Medicine, King Salman International University (KSIU), El Tur Branch, Egypt.
Correspondence: Dr. Ola El-Shimi,E mail: ola.samer@fmed.bu.edu.eg,mobille:+201225559623

Studying asthma is no longer focused on symptoms and pulmonary functions but it expands to the
underlying cellular changes. The membrane-associated glycoprotein CD93 is an emerging biomarker for inflammation
in many inflammatory and immune-mediated diseases including asthma.
Objectives: We aimed to evaluate the value of serum sCD93 and its mRNA expression level as a non-invasive
biomarker for bronchial asthma.
Patients and methods: This case control study was conducted to assess serum and mRNA expression levels of sCD93
in 40 bronchial asthma patients and 40 age- and gender-matched healthy controls.
Results: Both serum and mRNA levels of sCD93 were significantly higher in asthmatic patients (18.4 ± 2.4 ng/ml and
1.16 ± 0.57 folds) than healthy controls (11.2 ± 1.3 ng/ml and 0.711 ± 0.35 folds) (P < 0.001 each). Serum sCD93 was
95% sensitive and 80% specific in diagnosing asthma at cut-off value 13.3 ng/ml. While CD93 mRNA expression
was 70% sensitive and 60% specific in diagnosing asthma at cut-off value 0.81 fold.
Conclusion: sCD93 is a valuable non-invasive biomarker for bronchial asthma.
Keywords: Asthma, Non-invasive biomarker, sCD93.


Asthma is a common chronic inflammatory airway
Study design: The current case-control study included
disease that affects between 1 and 29% of the population
40 bronchial asthma patients that were recruited from
in different countries1. It is a heterogenous disease
Chest Department, Benha University Hospitals, Egypt
characterized by wide range of respiratory symptoms
through the period from September 2021 to February
including wheezes, shortness of breath (dyspnea), chest
2022. Asthma was diagnosed according to the published
tightness and/or cough that could vary over time2. The
criteria of the Global Initiative for Asthma 2019 (GINA
diagnosis of bronchial asthma (BA) is based mainly on
2019) 9.
characteristic pattern of respiratory symptoms and

variable expiratory airflow limitation by pulmonary
Exclusion criteria: Any case showed clinical, or
function tests3.
laboratory signs of respiratory tract infection, any active
However, these tests might be inconvenient for
inflammatory disease, adverse drug reaction and other
some patients requiring effort and cooperation of the
lung diseases or under immunotherapy.
patient beside carrying the risk of severe asthma attack4.
A detailed history was taken from all participants to
Therefore, there is always a clinical need to non-
explore their symptoms, medication history especially
invasive reliable biomarkers for asthma diagnosis,
inhaled corticosteroids (ICS) and family history. A
prognosis, and follow-up. These biomarkers are the
clinical examination by a pulmonologist was carried
molecules that undergo cellular, biochemical, or
out. Asthma severity and control level were evaluated
molecular changes in asthmatics rather than healthy
according to Khajotia 10.
subjects and can be measured in various specimens,

such as lung tissue, bronchoalveolar lavage fluid, nasal
Sampling: Five milliliters venous blood were drawn
fluid, or peripheral blood 5.
from each subject and divided into: 2.5 ml in EDTA
CD93 (C1qRp) is a transmembrane glycoprotein
tube for total RNA extraction and 2.5 ml in standard
expressed on different cells, including endothelial cells,
serum separating tube and stored at -80°C for
epithelial cells, stem cells, platelets, and leukocytes 6. It
subsequent testing for serum sCD93 levels.
possess both angiogenic and growth-stimulating effects

7. Inflammatory mediators associated with various
Laboratory investigations: Serum level of sCD93 was
assayed in all studied subjects using a commercial
including asthma, can lead to CD93 shedding in its
double-antibody sandwich ELISA Kit (Cat# EH0089,
measurable soluble form (sCD93) 8. Thus, we aimed to
Fine Test, China) according to the manufacturer
investigate the value of sCD93 as a non-invasive
instructions. The assay sensitivity for sCD93 was 0.188
biomarker in asthma patients' diagnosis, prognosis, and
follow-up for treatment responsiveness.

Received: 01/06/2023
Accepted: 02/08/2023

Full Paper (vol.931 paper# 143)

c:\work\Jor\vol931_144 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7862-7867

Serum Interlukin-22 in Psoriasis Vulgaris
Doaa A. Elshibly1*, Sherif R. Ismail1, Yousra I. Sadeq2, Manar E. Sallam1
Departments of 1Dermatology, Andrology & STDs and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Doaa Abdelfattah Elshibly, Mobile: (+20)0106 931 9738, Email: doaahady24@gmail.com


Background: Psoriasis vulgaris (PV) has been considered as a frequent immune-mediated chronic, inflammatory
dermal disease representing approximately 2% globally. Interleukin-22 (IL-22) is a recently described IL-10 family
cytokine produced by a lot of cellular sources, which include Th17 and Th22 cells, and it plays an essential role in
several autoimmune diseases (AIDs) such as rheumatoid arthritis (RA), and PV.
Objective: To determine the diagnostic value of serum IL-22 level for PV; and to examine the possible correlation
between serum IL-22 and disease severity and activity.
Patients and Methods: This was a case control study conducted on 60 patients complaining from psoriasis; 30 patients
complaining from active psoriasis, 30 patients with stable psoriasis, and 30 age- and sex-matched healthy controls (HC).
Psoriasis area and severity index was used to assess both involved body area and clinical appearance of psoriatic lesions.
Results: IL-22 was significantly increased among cases with active than stable disease and among progressive disease
than intermittent disease. There was a statistically significant higher IL-22 among patients compared to HC. Area under
curve (AUC) of IL-22 in differentiating patients from HC was excellent with sensitivity of 93.3%, specificity of 83.3%
and accuracy of 90%.
Conclusion: Interlukin-22 (IL-22) produces inflammatory signals which induce dermal and systemic manifestations in
PV. IL-22 serum concentration may be an accurate marker of detecting severity of disease progression.
Keywords: Interlukin-22, Psoriasis vulgaris, Psoriasis area and severity index.


Psoriasis vulgaris (PV) has been considered as a
clinic of Dermatology, Andrology and STDs, Mansoura
common immune-mediated chronic, inflammatory
University Hospitals.
dermal disease. The etiology and pathogenetic

mechanisms of PV are still unclear. The cellular innate
Inclusion criteria: the included patients were either
and adaptive immune responses, in particular the
patients with active disease presented with the
simulation of T cells and production of cytokines by T
development of new lesions throughout the preceding
cells, have an essential role in the context of PV
one month or with stable disease with stationary
pathogenesis [1].
existent lesions for more than 3 months, and patients
Interlukin-22 (IL-22) is a cytokine formed by a lot
had no treatment for psoriasis in the past month. We
of cellular sources, which include Th17 and Th22 cells
included patients of both genders with active and stable
[2]. IL-22 can suppress keratinocyte differentiation and
psoriasis, with age ranged from 18 to 60 years, with
could induce PV-like epidermal changes. IL-22 mRNA
body mass index (BMI) between 18.5 to 24.9 kg/m2,
was significantly increased among cases with PV.
before inclusion in the study.
Additionally, IL-22 has the ability to synergize with the

different pro-inflammatory cytokines to elicit several
Exclusion criteria: patients who refused to contribute
pathogenic phenotypes from keratinocytes with a
to the study, pregnant or lactating females, cases treated
subsequent exaggeration of PV progression [3].
with narrowband UVB, irradiations, or systemic
All such results propose that IL-22 has essential
treatment in the past month, and subjects with any
roles in terms of PV pathogenesis. We hypothesized that
concomitant dermatological diseases, or immune-
IL-22 released by keratinocytes could have a main role
mediated comorbidities.
in this AID; as a result, suppressing IL-22 activity could

be a breaking novel therapeutic plan as regards PV
Entire cases were subjected to history taking that
Aim of the work was to determine the diagnostic value
included personal history (name, age, gender,
of serum IL-22 level for PV; and to examine the
occupation, residence), analysis of complain (age at
possible correlation between serum IL-22 and disease
onset, disease duration, progressive, regressive, stable
severity and activity.
over the last 3 months), family history of psoriasis,

medical history (type and duration of previous
treatments) and other diseases and their treatments.
This was a case control study conducted on 60

cases complaining from psoriasis; 30 cases suffering
Clinical Examination
from active psoriasis, 30 cases with stable psoriasis, and
The examination included full general examination
30 age- and sex-matched HC presented to the outpatient
to exclude systemic or autoimmune diseases, full body
Received: 15/06/2023
Accepted: 16/08/2023

Full Paper (vol.931 paper# 144)

c:\work\Jor\vol931_145 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7868-7871

Split Hand Feet Malformation in a Term Newborn with
Involvement of All Limbs: A Case Study
Zenab Yusuf Tambawalaa, Manal Wahba a, Haneena Haneefa a, Maram Hassan b
a Department of Obstetrics and Gynecology/Dubai Hospital /Dubai/UAE
b Medical Education Department/ Alexandria Faculty of Medicine
Corresponding Author: Maram Hassan,
E-mail: maramhassan12@hotmail.com, 0020-122-8184354, Orchid ID 0000-0001-7477-5608

A primigravida in the mid-20s presented with an anomaly scan showing limb deformity in all four limbs with
fused fingers and ventricular septal defect. The patient did not have any other co-morbidities or any drug exposure during
her pregnancy. Ectrodactyly refers to a congenital limb malformation characterized by the absence of one or more central
digits, resulting in a cleft or "lobster claw" appearance.
Objective: Whether isolated or part of a genetic syndrome, the management of this condition often involves a
multidisciplinary team to manage and provide appropriate care including genetic counseling, orthopedic specialists, and
other relevant healthcare professionals.
Patient and methods: A primigravida in the mid-20s presented with an anomaly scan showing limb deformity in all four
limbs with fused fingers and ventricular septal defect.
Results: The delivery of a baby with SHFM is generally managed like that of any other newborn. However, postnatal care
and follow-up involve a collaborative effort between a multidisciplinary team to ensure comprehensive care for the baby
and support for the family.
Conclusion: Surgical interventions may be considered to address limb anomalies and enhance functionality. Early
intervention and support can help improve the individual's quality of life and functionality.
Keywords: Split hand feet malformation, Genotype, Phenotype.


Split Hand Feet Malformation (SHFM), previously
challenging to predict the risk of recurrence in future
known as ectrodactyly, is a rare condition, with 1 in
generations (3).
8,500-25,000 newborns presenting, and can be sporadic,
Single gene mutation, chromosomal rearrangement,
genetic, or non-genetic syndrome (1).
balanced translocations, or inversions can be associated
Second-trimester ultrasound can easily identify the
with this condition and although most cases are sporadic,
condition. Many previously published reports showed
diagnosis and assessment of the risk of recurrence and
women terminating their pregnancy at identification of
management are challenging (1).
ectrodactyly, although it is usually non-lethal with normal

fetal karyotype and most babies do not have other co-
morbidities or development defects (2).
A primigravida in her mid-20s who was in a non-
SHFM can present with significant clinical
consanguineous marriage for a year sought medical care
variability, irregular inheritance patterns, and a wide
from early pregnancy. At 12 weeks of gestation, she
range of molecular genetic alterations, which collectively
underwent a routine nuchal translucency scan, which was
make accurate diagnosis and prognosis assessment
normal. The anomaly scan by the radiologist at 20 weeks
challenging. SHFM can manifest in various ways, ranging
was suggestive of abnormalities in the hands and feet. She
from mild to severe forms. In some cases, only a few
was referred to the Fetal-Maternal Medicine Unit at our
digits may be affected, while in others, entire hands or feet
Tertiary Care Center for additional follow-up and
may be split. This variability in the clinical presentation
can complicate diagnosis, especially when the condition
The patient had a cousin with limb deformity with
is mild or when it presents with atypical features (1).
fused fingers. During the fetal medicine ultrasound scan
SHFM does not follow a simple Mendelian
at 22 weeks, a single active fetus in a variable position
inheritance pattern in many cases. It can be inherited in an
with the presence of an anterior placenta was noted. Fetal
autosomal dominant, autosomal recessive, or even X-
parameters were consistent with the gestational age, and
linked manner, depending on the specific genetic
the amniotic fluid volume was found to be within the
mutations involved. Additionally, some cases may occur
normal range. The hands and feet displayed missing
sporadically without a family history, making it
fingers and toes (the left hand had missing second and

third fingers, the right hand had only two fingers, and both

Full Paper (vol.931 paper# 145)

c:\work\Jor\vol931_146 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7872-7878

Association between Helicobacter Pylori Infection and
Risk of Non-Alcoholic Fatty Liver Disease
Amal Shawky Bakir, Hany Ali Hussein, Mahmoud Mohamed Abdul Azeem Amer, Salah Shaarawy Galal*
Internal Medicine Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Salah Shaarawy Galal, Mobile: (+20) 01099422172, Email: salahshaarawy2013@gmail.com

About 25% of the general population suffers from the epidemic liver condition known as nonalcoholic
fatty liver disease (NAFLD). Clinical phenotyping ranges widely including liver cirrhosis, advanced fibrosis, non-
alcoholic steatohepatitis (NASH), and hepatic steatosis.
Objective: We aimed to find out the link between H. Pylori infection and the risk of NAFLD.
Patients and methods:
This cross-sectional study was conducted on 80 patients presented with H-Pylori in Ain Shams
University Hospitals during the period from September 2020 to June 2021. Patients were divided into 2 groups: Risky
group according to one or more of the following (dyslipidemia, BMI>24.9, SBP>140, DBP>90) and non-risky group
with no metabolic risk factors.
Our findings demonstrated a statistically significant link between H. pylori and the development of NAFLD.
We also discovered that gender has no effect on the prevalence of NAFLD. Furthermore, we discovered that NAFLD is
related with higher TG levels. High SBP and DBP were shown to be related with an elevated risk of NAFLD in our
research. In our investigation, the levels of AST and ALT were considerably higher in the risky group patients than in
the non-risky group patients. In terms of the degree of fibrosis in patients with NAFLD, we discovered that riskier
patients had a higher risk of fibrosis.
Our findings showed that H. pylori infection may play a role in the development of NAFLD. Taking into
account the limitations of the case control research and the limited size of the population covered. Other metabolic risk
variables such as dyslipidemia and obesity may have a substantial role in the development and progression of NAFLD.
Key words:
H. pylori infection, NAFLD, NASH.

NAFLD is a liver disease pandemic that affects
This cross sectional-study was conducted on 80 patients
around 25% of people in general. Clinical phenotyping
presented with H-Pylori in Ain Shams University
ranges widely, encompassing liver cirrhosis, advanced
Hospitals during the period from September 2020 to
fibrosis, NASH, and hepatic steatosis. NAFLD is often
June 2021.
associated with obesity and is a risk factor for several

metabolic illnesses, including type 2 diabetes (T2D).
The patients included in our study were divided into
NAFLD affects up to 90% of people with Type 2 DM.
two groups as follows: Risky Group: According to
It has also been connected to a number of extrahepatic
one or more of (Dyslipidemia, BMI > 24.9, SBP > 140,
conditions, including chronic renal disease and
DBP> 90) included 40 patients. Non-Risky group: (40
cardiovascular problems. The pathophysiology of
patients in number) who had no metabolic risk factors.
NAFLD is intricate and little understood. It involves

inflammation of adipose tissue, insulin resistance, and
Inclusion Criteria: Adult patients (18­60 years old,
gut microbiota, which, in addition to other
both genders) who agreed to participate in our study and
environmental, dietary, and genetic variables, is a key
provided informed consent, patients who were
component in the development of NAFLD. The gold
diagnosed with a positive H pylori infection through
standard for diagnosing NAFLD is a liver biopsy. Its
either an invasive endoscopic gastric biopsy or a non-
invasive nature and associated morbidity concerns, such
invasive stool Ag test, and patients whose ultrasound
as bleeding and infection, restrict its usage, albeit (1).
criteria showed the presence of NAFLD. Hepatic
echoes that are bright, increased hepato-renal
Helicobacter pylori, or H. pylori, is a coloniser of the
echogenicity, and vascular blurring of the portal or
stomach epithelium. Over half of the world's population
hepatic vein. NAFLD is defined as two out of three.
is impacted by it. According to recent research, H.

pylori infection may be linked to increased intestinal
Exclusion Criteria:
permeability and insulin resistance, both of which may
Patients who consumed alcohol, had a history of
hasten the onset of NAFLD (1-3).
gastrectomy, diabetics, infections with HBV and HCV,
This study was designed to find out the link
cirrhotic or other chronic liver illnesses, younger than
between H. Pylori infection and the risk of NAFLD.
18 or older than 60, patients on antihypertensive, on

anti-cholesterol, or on corticosteroid medications.

Received: 04/06/2023
Accepted: 03/08/2023

Full Paper (vol.931 paper# 146)

c:\work\Jor\vol931_147 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7879-7886

Transobturator Four Arms Mesh versus Anterior Colporrhaphy in
Management of Stress Urinary Incontinence with Cystocele
Wagdy M. Ali, Mahmoud R. Fayed, Abd E. Marzouk, Mahmoud, Amira E. El-Shaer * and A. El Sabbahi
Obstetrics and Gynecology Department, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding Author: Amira E. El-Shaer, Email: Amira.El-Shaer@gmail.com , phone: 01068011403

Cysticocele-associated stress urinary incontinence (SUI) is a prevalent condition among women that can
have significant negative impacts on their overall well-being. In order to treat this condition, numerous surgical
procedures have been implemented, such as anterior colporrhaphy (AC) and the transobturator four-arm mesh technique.
Objective: This study aimed to compare AC and four arms mesh for the surgical treatment of anterior vaginal wall
prolapse (AVWP) associated with SUI.
Methods: This cross-sectional study was conducted on 50 women who had cystocele-associated SUI in the Obstetrics
& Gynecology Department of Benha University Hospitals. All patients were allocated into 2 equal groups: group 1
(n=25) who were treated with transobturator four arms mesh and group 2 (n=25) treated with AC.
Results: The findings of the research indicated that age, sex, and comorbidities as well as preoperative SUI grades did
not differ significantly between the two groups. However, significant differences were observed in cystocele stage, total
ICIQ score, general health perception, role limitation, physical limitation, operative time, and hospital stay. No
significant differences were found in postoperative symptoms, postoperative SUI grades, and early complications.
Conclusions: Both surgical procedures are effective methods to manage AVWP in patients with SUI and cystocele. The
selection between the transobturator four arms mesh technique and AC should be based on cystocele stage, general
health perception, and operative time, among other considerations.
Keywords: Stress urinary incontinence, Cystocele, Transobturator four-arm mesh, Anterior colporrhaphy; Surgical

visceral or vascular injury, pelvic pain, and mesh
Pelvic organ prolapse (POP) is a commonly
extrusion have been documented in instances involving
observed pathological condition among women.
the insertion of mesh or needles [5]. This study aimed to
Among adult females, the incidence of female stress
compare AC and four-arm mesh in the surgical
urinary incontinence (SUI) varies between 12.8% and
treatment of AVWP accompanied by SUI.
46.4%, thereby constituting a significant health concern

[1]. POP in women is cystocele, which is also known as
anterior vaginal wall prolapse (AVWP). This condition
Patients: This prospective study included 50 female
is distinguished by the bladder herniating through the
patients who were selected from the outpatient clinic at
anterior vaginal wall. The implantation of mid-urethral
Benha University Hospitals based on specific inclusion
slings by placing polypropylene trans-vaginal or trans-
obturator tapes is a common method for treating SUI.
Inclusion criteria: Female patients experiencing
Since POP and SUI frequently coexist, the simultaneous
symptomatic SUI with cystocele.
treatment of these two conditions has been a source of
Exclusion criteria: Patients with past history of
contention. Typically, a mid-urethral sling is implanted
transvaginal mesh surgeries, with underlying
after cystocele repair when both procedures are
neurological disorders, with detrusor overactivity, and
performed during the same session [2].
those diagnosed with malignancies of the female genital
Anterior colporrhaphy (AC) is the most
system or urinary bladder.
frequently employed technique for the treatment of
AVWP. Conventional approaches to anterior wall
All patients underwent complete history taking
prolapse repair have been found to have a significant
including personal, medical and gynecological data,
recurrence rate when native tissue is utilized [3].
presentation of SUI symptoms, precipitating factors,
Due to the high rate of recurrence and the
and categorization of incontinence severity using
failure of native tissue in the management of SUI and
Stamey's grading of SUI. Physical examination (general,
POP, numerous procedures, such as polypropylene
abdominal, and neurological assessment) and local
mesh, have been utilised on a large scale, resulting in
examination including stress test, was done in the
high success rates [4]. A four-pointed mesh has been
lithotomy position. This test involved assessing urinary
designed to secure the pelvic side wall through the use
leakage while the patient cough. The test was repeated
of four anatomical routes and four arms. For the
with the patient standing and legs separated, and urine
treatment of SUI. A double transobturator four-arm
leakage was clinically noted in all patients.
polypropylene mesh was implemented in addition to
The POP quantification system (POP-Q System)
anterior compartment repair. Complications such as
was used to assess and characterize the degree of
Received: 04/06/2023
Accepted: 03/08/2023

Full Paper (vol.931 paper# 147)

c:\work\Jor\vol931_148 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7887-7891

Investigating the Association between Vape Use and Respiratory
Symptoms in Adults in Riyadh, Saudi Arabia
Saad M Alhaqbani
Riyadh First Health Cluster

Corresponding author: Saad M Alhaqbani, Email: haqbanisaad@gmail.com,Tel: 00966501680727

E-cigarettes, often referred to as vapes, have surged in popularity, especially among younger demographics,
due to misconceptions about their safety compared to traditional tobacco products.
Objective: This study focused on the growing prevalence of vape use in Riyadh, Saudi Arabia, and its associated health
impacts, specifically targeting respiratory symptoms in adult users.
Methods: A cross-sectional study included 100 adults aged 18 to 50 years in Riyadh, all of them had a history of e-cigarette
use. Data were collected through online surveys, focusing on aspects such as income level, money spent on vapes, family
smoking habits, and reported respiratory symptoms. Analysis was conducted using statistical tools to establish correlations
between vaping habits and respiratory health outcomes.
Results: The study revealed that majority of the participants were young adult males mainly from middle and high-income
brackets. A significant portion of the respondents experienced cough (58%) and shortness of breath (68%) during or after
vaping, and 71% reported a rapid heart rate associated with vaping. Despite these symptoms, only a small fraction of the
participants had attempted to quit vaping in the past 30 days, reflecting a lack of awareness or underestimation of the health
risks associated with vaping.
Conclusion: The study underscored a strong association between vape use and adverse respiratory symptoms among adults
in Riyadh. Despite the prevalence of respiratory symptoms, there was a notable gap in awareness or willingness to
acknowledge the health risks associated with vaping.
Keywords: E-cigarette, Vape, Misinformation, Prevalence, Respiratory symptoms, Riyadh.


Wrongly thought that it is safer than other
The rising prevalence of vape use among Saudi adults
tobacco products, e-cigarettes, commonly known as vape,
in Riyadh presents a significant health issue to the region,
have gained popularity among users of different ages. The
considering the respiratory damage caused by e-
Food and Drug Administration (FDA) defined them as
battery-operated products that can deliver nicotine and

other chemicals (1). Misconceptions have promoted its use
Problem Statement:
as an alternative to cigarettes and a means for quitting.
E-cigarette has received advocacy as a safer option
However, the assessment of vape use among American
than conventional cigarette and a path to quitting, leading
young adults demonstrated a prevalence of 5.66 million,
to its prevalence. After interviewing Saudi adults above
with 2.21 million current users, 2.14 million former
18 years, Alfaraj et al. (4) noticed that many users "believe
smokers, and more than 1.30 million who had never
that e-cigarettes help them quit smoking and are less
smoked (2).
harmful than traditional cigarettes". Consequently,
In Saudi Arabia, researchers have discovered a
vaping has gained popularity, with a 27.7% rate among
prevalence rate of 27.7% among university school
university students and 12.2% among the adult population
students, posing a significant threat to future usage among
in Riyadh (3).
adults. Such perturbing trends and fallacies threaten the
According to Figueredo et al. (5) despite the reduction
health and social well-being of the Saudi population and
of nicotine in e-cigarettes, their burning produces other
the economy of the Kingdom of Saudi Arabia. With the
chemicals, such as aluminium, lead, and copper, leading
increased use, researchers have gained interest in the
to the risks of oral cancer and periodontitis. The health
health impacts of e-cigarettes and discovered their
risk, rising prevalence, and misinformation demonstrated
adverse consequences. While users report throat
the urgency for research to educate the masses on healthy
irritations and coughs, the chemicals cause more damage
living and shift of habits.
to the internal organs (3).

In their study of "toxic constituents in e-cigarette
Purpose of the research: The misconception concerning
aerosols, carcinogen biomarkers and the association with
the relationship between vape use and respiratory diseases
bladder cancer, oral health, the impact of e-cigarettes on
is the primary driver for this research. Surveys among
pregnancy, and cardiovascular health", Alqhatani et al.
young adults disclose their little awareness of the health
(2) established that vape use jeopardizes pulmonary health.
risks of e-cigarettes. The research aimed to establish the
Received: 20/12/2023
Accepted: 20/02/2024

Full Paper (vol.931 paper# 148)

c:\work\Jor\vol931_149 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7892-7900

Preoperative Short-Course Radiotherapy with Delayed Surgery Versus
Long-Course Chemoradiotherapy for Locally Advanced Rectal Cancer
Shimaa roshdy Abdelaal1, Asmaa Abdelghany Abdellatef1,
Elsayed Mostafa Ali Hassan1and Mohamed Soliman Gaber1
1Department of Clinical Oncology and Nuclear Medicin, Faculty of Medicine, Sohag University
Corresponding author: Shimaa abdelaal1, shimaa.roshdy@med.sohag.edu.eg
In multiple studies, preoperative long-course radiotherapy (PLRT) in conjunction with concurrent
chemotherapy (PLCRT) and preoperative short-course radiotherapy (PSRT) with immediate surgery have demonstrated
comparable outcomes regarding late morbidity, local control, and prolonged survival. However, long-course RT
demonstrated a more favorable pathological complete response (PCR). The acute radiation toxicities associated with the
short-course program are considerably lower than those observed in standard CRT. Significant benefits are associated
with postponing surgery after neoadjuvant therapy for rectal cancer. As a result, a strategy of short-course RT and then
consolidation chemotherapy prior to surgical resection is developed to achieve these benefits.
Objective: This study aimed to evaluate the treatment outcome, safety, and feasibility of preoperative short-course hypo
fractionated RT (SCRT) followed by chemotherapy versus standard conventional long-course concurrent
chemoradiotherapy (LCRT) for locally advanced rectal cancer (LARC) patients.
Patients and methods: This phase II prospective trial included 59 patients through the period from May 2020 to
February 2021 in Sohag Cancer Center and Sohag University Hospital with a median follow-up of 31 months (range
4:37). Thirty cases were assigned to the experimental group (SCRT) and twenty-nine were assigned to the standard
group (LCRT). The study was performed on locally advanced rectal cancer (LARC) cases and were randomized to
neoadjuvant short-course RT followed by chemotherapy or preoperative conventional long-course CRT. Pathological
response and treatment-related toxicity constituted the main endpoints. EFS, LFFS, DRFS, and OS were the secondary
endpoints. Results: No significant variations were reported between the SCRT and LCRT groups as regards death rate
and locoregional failure rate, or distant recurrence. In subgroup analysis for cases who were subjected to resection, no
significant variations were reported between the SCRT and LCRT groups regarding postoperative (pathological) stages,
pathological complete response rates, and grades of tumors. No significant variation was reported between the two
groups as regards most of treatment-related toxicities, but the SCRT group had significantly lower radiation therapy-
induced toxicities than the LCRT group.
Conclusion: Patients diagnosed with LARC may benefit from SCRT followed by chemotherapy as a substitute for
conventional CRT. SCRT with delayed surgery showed comparable efficacy to conventional LCRT.
Rectal cancer, Neoadjuvant radiotherapy, Long course, Short course.


of radial margin involvement, and higher pathological
With an estimated 6.1% of all cancer cases,
complete response rates (5). These results of multiple
colorectal carcinoma is the third most prevalent
RCTs compared preoperative standard CRT course then
malignancy worldwide in males and females.
surgical resection versus SCRT then consolidation
Additionally, it ranks as the second most frequent
chemotherapy before surgery.
reason for cancer-related death (9.2%). In Egypt,

colorectal cancer constitutes 4.2% and comes at 7th
rank in both sexes (9th in men and 8th in women). The
This randomized phase II prospective comparative
median age is 50 years (1, 2).
study was performed in Sohag University Hospital and
Neoadjuvant radiation treatment decreases local
Sohag Cancer Center. Pathological response and
recurrence rates, preserves sphincter, and reduces
treatment-related toxicity constituted the main
radiation-induced toxicities in stage II and III rectal
endpoints. Secondary endpoints were event-free
cancer cases with no variation within the 5-year overall
survival (EFS), which is the time between the date of
survival (OS) (3). Two preoperative radiotherapy (RT)
randomization to the initial development of
methods are generally used. Firstly, standard long-
locoregional failure (local recurrence, local progression,
course RT (LCRT) includes 45-50.4 Gy in 25-28
or irresectability within 6 months of preoperative
sessions with concurrent chemotherapy followed by
treatment) or distant recurrence. Locoregional failure-
surgical resection after 4-8 weeks. Secondly, short-
free survival (LFFS) is the time between the dates of
course RT (SCRT) that consists of 25 Gy in 5 fractions
randomization to the first occurrence of locoregional
then immediate surgery within one week or delayed
failure. Distant recurrence/relapse-free survival (DRFS)
surgery after more than 8 weeks (4).
that is defined as the time between the dates of
Long course Chemotherapy did not increase OS,
randomization to the first occurrence of distant
late toxicity, or local control compared to SCRT alone
metastasis. OS is the interval of time between the date
with immediate surgery. Cases subjected to long course
of randomization to the last follow-up or death date.
were likely to have lower pathologic stages, lower rates
Disease-free survival (DFS is the interval of time
Received: 09/06/2023
Accepted: 08/08/2024

Full Paper (vol.931 paper# 149)

c:\work\Jor\vol931_150 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7901-7907

Bridge Plating of Humerus Shaft Fractures by Minimally Invasive Plate
Osteosynthesis Technique: A Short-term study
Mohamed Hassan Hashem3, Mohamed Osama Hegazi2, Nagi Zaki Sabet1, Mohamed Ahmed Mohamed Sayed1*
1Department of Orthopedic Surgery, Faculty of Medicine, Misr University for Science and Technology, Cairo, Egypt.
2Department of Orthopedic Surgery, Faculty of Medicine, Banha University, Egypt.
3Department of Orthopedic Surgery, Faculty of Medicine, Helwan University, Egypt.
*Corresponding author: Mohamed Ahmed Mohamed Sayed, E-mail: dr.mohamed_86@hotmail.com,
Mobile: (+20)1204476514

Fractures of humerus shaft account for between one to three percent and 20 percent of all humeral
fractures. Microinvasive Plate Osteosynthesis (MIPO) is a burgeoning therapeutic approach utilized to treat humeral
shaft fractures. One of the primary advantages of MIPO is that it promotes fracture healing by maintaining soft tissue
and periosteal circulation. Objective: The aim of the work was to determine the efficacy of bridge plating for humerus
shaft fractures using the minimally invasive plate osteosynthesis method.
Patients and Methods:
This short-term research study included a total of 15 patients presented with a recent humeral
shaft fracture, chosen from the Department of Emergency, Misr University Hospitals, and received care surgically with
Results: The present study showed that there was one patient had delayed union and no other postoperative
complications. The MEPI scoring system. It is measured at patients' last follow-up. In the MIPO patients, 7 (46.7%)
showed excellent results, 7 (46.7%) showed good results, 1 (6.7%) showed fair, and no case showed a poor outcome.
According to the UCLA scoring system, 6 (40.0%) individuals showed excellent outcomes, 8 (53.3%) individuals
showed good outcomes, 1 (6.7%) patient had a fair outcome, and no patient had a poor outcome.
Conclusion: depending on the result of our research it can be concluded that the MIPO method should be considered
as a good choice for surgical treatment of diaphyseal humerus fractures.
Keywords: MIPO, Humerus shaft fracture, Bridge Plating

infection and radial nerve palsy induced by open
Shaft humerus fractures account for about twenty
plating. In contrast to IM fixation procedures, MIPO
percent of whole humeral fractures and one to three
may offer potential benefits regarding shoulder function
percent of all fractures in grownups (1).
and intraoperative fracture management (8, 9).
Conservative control is still prevailing approach for
The aim of our investigation was to assess the
humeral shaft fractures, (2) despite the unsatisfactory
efficiency of bridge plating during minimally invasive
outcomes associated with this method, such as shoulder
plate osteosynthesis for humerus shaft fractures.
impairment and non-union (3).

A total of fourteen percent of the patients who
underwent this treatment exhibited a restricted range of
This short-term research study included a total of 15
motion, while 12.6 percent demonstrated unification,
patients presented with a recent humeral shaft fracture,
characterized by angulation exceeding 8 degrees(4).
chosen from the Department of Emergency, Misr
Surgical techniques include plate osteosynthesis via
University Hospitals, and received care surgically with
minimally invasive method, internal fixation with
MIPO. This study was conducted between (mention
compressive plate, and interlocking nail. When
period e.g., June 2021 and January 2023).
comparing rigid fixation with a plate to intramedullary

anchoring, discomfort in the shoulder and limitations in
Inclusion criteria: Fractures that were recent (within a
movement are observed (5). Contemporary gold standard
week at most), displaced fracture with an angulation of
for humerus shaft fractures is ultimate stability fixation
more than 20° anterior, 30° varus, valgus, and more than
with a dynamic compression plate via the posterior
3 cm shortening, Patients Patient age ranged between
approach and open method (6).
20-55 years. closed fracture without any neurovascular
But there is a biological cost associated with precise
reduction and absolute stable fixation. In contrast to a
Exclusion criteria: Cases with fractures amenable for
stable mechanical fixation, biological fixation has been
conservative treatment, old fracture, compound
demonstrated to be more effective (6, 7).
fractures and Concomitant other medical disease like
As a consequence, advancements and refinements
malignancy, vascular insufficiency of upper limb, DM.
were made to fissure biological fixation techniques,

alongside the creation of stabilization systems that
All the patients were subjected to the following:
facilitate the attainment of biological fixation. MIPO is
Clinical evaluation (General and Local examination),
designed to achieve a stable fixation, that may increase
Laboratory investigations and X-Rays.
union rate and decrease complications, for example
Method of MIPO
Received: 10/06/2023
Accepted: 11/08/2023

Full Paper (vol.931 paper# 150)

INTRODUCTION The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7908-7918

Left Atrial Volume Assessment in Atrial Fibrillation Patients undergoing Ablation,
using 2-D Echocardiography and Invasive Three-Dimensional CARTO and its
Predictive Value in Recurrence of Atrial Fibrillation after Ablation
Amr El Sayed El Naggar, Muhammad Hassan Ebrahim Muhammad Saleh,
Khaled Emad El Rabbat, Shimaa Ahmad Moustafa
Department of Cardiology, Faculty of Medicine, Benha University
Corresponding author: Muhammad Hassan Ebrahim Muhammad Saleh,
Email: Dr.muhammad.saleh@gmail.com, Phone: 01002800935

The most prevalent cardiac arrhythmia, atrial fibrillation (AF), is expected to affect around 16 million
people worldwide by 2050. Because AF is linked to increased mortality, thromboembolic strokes, myocardial infarction,
and heart failure, it costs the US health care system over $6 billion yearly.
Aim of the Work:
This study aimed to assess left atrial volume (LAV) in atrial fibrillation patients using non-invasive
echocardiography and invasive 3D mapping (CARTO) and to assess its predictive value in recurrence of atrial fibrillation
after ablation.
Patient and methods: The study was conducted on 42 consecutive patients with non-valvular AF who underwent
pulmonary vein isolation and came to follow up in the Outpatient Clinic of the Cardiology Department at El Galaa
Military Hospital and Benha University Hospital.
Results: LAV measured by CARTO was significantly higher compared to LAV measured by Echocardiography.
Recurrence rate after AF ablation was significantly higher in patients with LAVI more than 36 ml/m2 (47.8%) than
patients with LAVI less than 36 ml/m2 (5.3%). LAV by CARTO could significantly predict the AF recurrence with cutoff
value > 98 ml. High BMI related significantly with the recurrence of AF after AF ablation. Recurrence was significantly
lower in patients with ablation catheter type Thermo Cool Smart Touch than patients with EZ steer.
Conclusion: Optimizing the benefits of AF catheter ablation required determining each patient's risk of recurrence as it
assists in identifying individuals who stand to gain the most from AF ablation as well as the technique and approach
employed for ablation.
Keywords: Left atrial volume, Atrial fibrillation, 2-D Echocardiography, Invasive three-dimensional CARTO.

available for determining LA size. LA volume can be
One of the most common arrhythmias, atrial
ascertained during the radiofrequency catheter ablation
fibrillation (AF) is linked to a lower quality of life as
process using electro-anatomic (CARTO) mapping,
well as a higher risk of heart failure, ischemic stroke, and
enabling three-dimensional reconstruction of the LA (4).
all-cause death. In terms of enhancing quality of life,
A three-month blanking interval is theoretically
radiofrequency catheter ablation (RFCA) has
justified by the current understanding that early recurrence
demonstrated its effectiveness in patients with atrial
is associated with temporary local inflammation and tissue
fibrillation (1).
necrosis as a result of catheter ablation. Recent research,
Radiofrequency catheter ablation decreased
however, casts doubt on this, showing that patients who
hard clinical outcomes such as ischemic stroke and
experienced an early recurrence had a markedly higher risk
worsening of heart failure, and all cause death in a
of a late recurrence (5, 6).
subgroup of patients (2). But, radiofrequency catheter
Mujovic et al. (7) found that, at three months
ablation is not a cure for atrial fibrillation (AF),
following the initial radiofrequency catheter ablation,
particularly in cases when the AF is chronic. After
individuals with early recurrence had a considerably
radiofrequency catheter ablation, a considerable number
greater incidence of pulmonary vein reconnection (88.2%
of AF patients have atrial tachycardia (AT) or recurrence
vs. 41.7%) than patients without early recurrence. Patients
of AF. Despite recent improvements in catheter ablation
exhibiting low success rates typically require enlarging
techniques, one-third of AF patients still have
of the ablation lesions in accordance with further
recurrence of AF following ablation, which frequently
modifications to the left atrial (LA) substrate.
necessitates repeat of ablation surgeries. In order to
The aim of this study was to assess left atrial
maximize the benefits of catheter ablation and choose
volume in atrial fibrillation patients using non-invasive
the right patients, it is necessary to evaluate each
echocardiography and invasive 3D mapping (CARTO)
patient's risk of recurrence. This process helps to
and to assess its predictive value in recurrence of atrial
identify the individuals who stand to gain the most from
fibrillation after ablation.
AF ablation. The kind and amount of AF in the left

atrium (LA) are two risk factors linked to recurrence
following radiofrequency catheter ablation (3).
This prospective and retrospective cohort study
Echocardiography is the most popular and
included 42 consecutive patients with non-valvular AF
effective non-invasive imaging method currently
who underwent pulmonary vein isolation and came for
Received: 14/06/2023
Accepted: 14/08/2023

Full Paper (vol.931 paper# 151)

c:\work\Jor\vol931_152 The Egyptian Journal of Hospital Medicine (October 2023) Vol. 93, Page 7919-7928

Effect of Post-Exercise Cold Water Immersion Recovery Protocol on Cardiovascular
Adaptations and Exercise Capacity in Athletes: A Randomized Controlled Trial
AlZahraa Bahy Mohamed1, Zeinab Mohamed Helmy2,
Sherin Hassan Mohamed3, El-Sayed Essam El-Sayed Felaya2
1Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics,
Faculty of Physical Therapy, Ahram Canadian University, Egypt.
2Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics,
Faculty of Physical Therapy, Cairo University, Egypt.
3Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy,
Beni-Suef University, Egypt.
Corresponding author: AlZahraa Bahy Mohamed, Phone: 01021999573, E-mail: zahrabahy@gmail.com

Muscle injuries caused by exercise, including edema, pain, weakness, as well as functional loss of mobility,
greatly affect the capacity to carry out subsequent exercise, which in turn reduces physical activity and sports participation.
Being a cryotherapy tool, cold-water immersion is one of several post-exercise recovery techniques that have grown in
popularity to help in recovery after training and competitions.
Aim of the study: to examine the impact of post exercise cold water immersion on cardiovascular adaptations and exercise
capacity in basketball players.
Subjects and Methods: In total, 60 male basketball players aged from 18­28 years were randomized into two equal groups
(n = 30). The experimental group (A) received both cold water immersion and traditional recovery protocols, whereas the
control group (B) received traditional recovery protocol only. The protocol was applied three times per week for four
consecutive weeks. The dependent variables, namely, heart rate, blood pressure, oxygen saturation, cardiac enzymes, and
exercise capacity were assessed at the beginning and the end of trial.
Results: There was a significant increase in resting O2, immediate after exercise O2, Harvard step test score, and Cooper
test score, while significant decline was found in resting heart rate (HR) immediate following exercise HR, HR recovery
time, resting SBP, immediate after exercise SBP and resting DBP of group A in comparison with that of group B.
Conclusion: Cold-water immersion was an effective post-exercise recovery protocol for cardiovascular adaptations,
exercise capacity enhancement, and reduce risk of injury in subsequent basketball training and competition.
Keywords: Exercise-induced muscle injuries, Basketball players, Exercise capacity, Cold water immersion


It was usual for elite athletes to suffer from post-
adequately after exercise. This includes both
exercise injuries. Despite some variation in the type of
physiological as well as psychological mechanisms. The
lesions seen across sports, most injuries were the result of
complexity of the recovery process following training and
a mixture of factors, making it extremely difficult to
competition was high, and it often varied according on the
identify a single cause (1).
type of exercise and other environmental stresses.
It has been reported that time lost due to illness and
Athletes utilized a variety of well-known strategies to
injuries is an important component in athletic success
speed up the recovery process. Their usage would rely on
when it comes to cardiorespiratory fitness as well as
the type of activity accomplished, the time until the
injury prevention. As a result, reducing in-season injuries
subsequent training session or event and tool and/or
in athletes may be possible through the detection of
personnel accessible. Athletes often utilize aquatic
modifiable risk variables in youth players by aerobic
therapy, active recovery, stretching, compressive
fitness testing conducted either before or during the sports
garments, massage, sleep, as well as nutrition as primary
season. Individuals who aren't as fit are more likely to feel
means of recovery (4).
fatigued quickly from the same amount of work, which
By regulating inflammation as well as cellular stress,
could make them more susceptible to injuries (2).
cold water immersion (CWI) as a recovery approach may
The regulation of the heart rate (HR) throughout
have reduced the long-term adaptive reactions to
exercise and recovery is regulated by a balance of
resistance training. Cryotherapy, which includes icing or
parasympathetic as well as sympathetic activity. Fewer
cold-water immersion, was long thought to lower the
parasympathetic neurons are believed to be the cause of
metabolic rate as well as inflammation in tissues
the diminished heart rate reserve (HRR) following
surrounding an affected skeletal muscle location by
exercises (3). An athlete's ability to compete or train at a
decreasing blood flow and temperature in the muscle. The
high level again depends on their ability to recover
idea was that this prevented surrounding cells from
Received: 06/06/2023
Accepted: 07/08/2023

Full Paper (vol.931 paper# 152)