c:\work\Jor\vol941_1 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 1-8

Internet Addiction among Zagazig University Students and Its Association with
Mental Health Using Arabic Version of Depression Anxiety Stress Scale
Eman Elshahat Elsayed Orabi
Community Medicine and Public Health Department, Faculty of Medicine, Zagazig University
ORCID number: 0009-0001-6861-4389- Telephone: -01008048, Email: dr.eman.elshahat1@gmail.com

One of the public health concerns today is the increasing use of the internet especially among adolescents
and the appearance of internet addiction problems. Although using the internet to students represents great benefits, it
has despised consequences on their mental health such as depression, anxiety, and stress.
Objectives: To estimate the prevalence of internet addiction among Zagazig University students and to identify its
association with mental health using DASS-21 scales.
Methodology: Across sectional study was done on 246 randomly selected students at Zagazig University during 1st term
of the academic year 2023/2024 representing both males and females using a cluster sampling technique. A self-
administered questionnaire was used. It consisted of three components: the first component comprised
sociodemographic data, which included age, gender, and collage, the second part represented a young scale for the
detection of internet addiction, and the third part was an Arabic version of Depression Anxiety Stress Scale-21 (DASS
-21) to evaluate mental health of studied participants.
Results: Prevalence of internet addiction was 73.2% among the studied group. There were statistically significant
associations between internet addiction, gender, degree of academic achievement, place of living, students-parents
relationship, income, depression, anxiety, and stress. Also, they were the predictors of internet addiction with odds ratios
(14.16, 27.72, 24.55, 24.61, 3.32, 1.94, 2.51, 2.55) respectively.
Conclusion: Prevalence of internet addiction was 73.2% among students. Female, bad degree of academic achievement,
living away from family, bad students-parents relationship, enough or more family income, depression, anxiety and
stress were predictors of internet addiction.
Keywords: Internet addiction, Mental health, DASS-21 scales, Zagazig University Students.


Fifty percent of all mental illnesses start before
One of the public health concerns today was the
fourteen years old, most of them are missed and not
increasing uses of computers, smartphones, and other
treated and unfortunately can lead to long-term
electronic devices, as well as the internet (1). Internet
complications such as impairment of physical, and
addiction is an impulse control disorder affecting people
mental health and ability to survive normal productive
who spend weekly more than thirty-eight hours online
lives as adults (7).
and cannot control their own life activities. It is like
There is a two-way relationship between
pathological gambling but does not include misuse of
adolescents' depression, anxiety, and stress due to
intoxicating drugs (2). Internet addiction is prevalent
internet addiction (8). Internet addiction and depression
among adolescents and young adults (12-29 years) and
relationship could begin by anxiety/stress alteration or
they are at high risk of misuse (3).
stimulation of internet addiction by the stress-and-
There is rapid growth of Egyptian users of the
anxiety shortcut also, internet addiction can affect the
internet from 34.1 million to 77.66 million between
emotional condition, which over the long run would
2013 and 2022 respectively, representing a twenty-two
promote depression (9). The aim of our study was to
percent increase in internet usage from 2019 to 2020 and
measure the prevalence of internet addiction among
a 1.9 percent growth from 2021 to 2022. The internet
Zagazig University students and to recognize its
penetration rate in Egypt in 2022 was 71.9 % (4).
association with mental health using DASS-21 scales to
The internet offers numerous educational
help in the future reduction of the prevalence of internet
advantages; however, overuse can lead to despised
addiction and promotion of mental health of University
consequences like neurological and medical issues,
depression, anxiety, social isolation and mental
instability, unhappiness, decrease self-esteem, and poor
Research design: A cross-sectional study design was
academic performance among students (5).

Mental health is a state of mental well-being,
Site and time of study: The study was completed in Zagazig
which allows enabling people to cope with the stresses
University throughout the first term of the academic year
of life, realize their abilities, learn well and work well,
2023/2024 among university students of both sexes.
and participate in their community. Depression, anxiety,
and stress are considered as fundamentally negative
Sample size calculation was done using (open Epi-Info
indices of mental health (6).

7.0). Based on the statistical letter of Zagazig

University, the overall numbers of registered students at
Received: 31/10/2023
Accepted: 31/12/2023

Full Paper (vol.941 paper# 1)

c:\work\Jor\vol941_2 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 9- 13

Risk Factors of Prolonged Air Leak Following Thoracic Surgery:
A Single-Center Observational Study
Marwa Ramadan Mohamed*, Wasiem Atteya Mohammed, Ehab Mohamed Farag
Cardiothoracic Surgery Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
*Corresponding Author: Marwa Ramadan Mohamed, Email: marwaramadan.el20@azhar.edu.eg, Mobile: (+20)1003090067

Prolonged air leak (PAL) is a significant complication following thoracic surgery, leading to increased
morbidity and prolonged hospital stays.
Objective: This study aimed to investigate the predictors of prolonged air leak PAL following thoracic surgery.
Patients and Methods:
This prospective clinical study enrolled 42 patients who underwent thoracic surgery. They were
divided into a PAL group (n=5) and a non-PAL group (n=37). Data collection included patient demographics, surgical
details, and postoperative outcomes. PAL was defined as an air leak lasting more than 4 days. Statistical analysis was
performed to compare variables between PAL and non-PAL groups.
Obesity (P = 0.002), diabetes mellitus (P = 0.005), chronic obstructive pulmonary disease (P < 0.001), low vital
capacity (P < 0.001), low forced vital capacity (P < 0.001), low diffusing lung capacity (P < 0.001), steroid use (P < 0.001),
and emphysematous lung (P < 0.001) were significantly associated with PAL. Pleural adhesion (P < 0.001), location of
lobectomy (P = 0.026), and operative time (P < 0.001) were also significantly associated with PAL. However, smoking
status, cardiovascular disease, previous chest surgery, lobectomy, and number and size of chest tubes, did not significantly
correlate with PAL. The duration of hospital stay was significantly prolonged in the PAL group (P < 0.001).
Our study identified several factors associated with PAL following thoracic surgery. These findings contribute
to our understanding of PAL risk factors and can guide preventive strategies to improve patient outcomes after thoracic
Keywords: Prolonged air leak, Thoracic surgery, Pleural adhesion, Risk factors.


improved tissue approximation and sealing, thereby
Thoracic surgery is a highly specialized medical field
decreasing the risk of PAL (9,10).
focused on treating conditions and diseases that affect the

organs within the chest, including the lungs, heart, and
In addition, intraoperative factors, such as high tidal
esophagus (1,2). Despite significant advancements in
volumes during mechanical ventilation and prolonged
surgical techniques and postoperative care, there are still
surgical duration, have been identified as contributing to
instances where complications arise, resulting in longer
an increased risk of PAL (11,12). The underlying
hospital stays and higher morbidity rates. Among these
mechanism behind these associations is multifaceted and
complications, prolonged air leak (PAL) is particularly
involves increased tension on suture lines, impaired tissue
concerning. PAL refers to air leakage from the lung into
healing, and reduced lymphatic drainage (13). By
the chest cavity, which persists longer than expected. This
understanding and addressing these intraoperative factors,
complication can cause delays in the patient's recovery,
the risk of PAL can be further minimized.
increase healthcare expenses, and potentially lead to
Preventing PAL is crucial for improving outcomes
further complications (3­5).
after thoracic surgery. Strategies to minimize PAL risk
Several factors have been recognized as predictors of
include preoperative optimization through thorough
PAL after thoracic surgery. These factors are patient-
assessment, pulmonary function testing, and addressing
related, including advanced age, suboptimal pulmonary
factors like smoking and underlying lung disease (14,15).
function, pre-existing lung conditions like chronic
Our study aims to investigate the predictors of PAL
obstructive pulmonary disease (COPD) or interstitial lung
following thoracic surgery and to identify effective
disease, and obesity. These patient-related factors can
strategies to prevent its occurrence. By examining patient-
adversely affect lung tissue's healing and sealing process,
related factors, surgical factors, and intraoperative
elevating the risk of a persistent air leak (6­8).
variables, we aim to identify the significant predictors
Surgical factors also have a significant impact on the
associated with PAL.
development of PAL. The complexity and nature of the

surgical procedure, particularly when involving lung
tissue resection, can influence the likelihood of air leaks.
This randomized prospective clinical study was
Implementing techniques such as stapler line
conducted at Al Zahraa University Hospital from May
reinforcement effectively reduces air leaks by promoting
2023 to August 2023. A total of 42 patients who
Received: 26/09/2023
Accepted: 23/12/2023

Full Paper (vol.941 paper# 2)

c:\work\Jor\vol941_3 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 14- 17

Darier Disease: Case Report
Heba Abd El Sabour Ali Abd El Rahiem
Dermatology Department, Al-Badari hospital, Egypt.
Corresponding author: Heba Abd El sabour Ali Abd El Rahiem, E-mail: abdelsabour_heba@yahoo.com, Mobile: +201158216731
Background: A change in a gene called Ca2+-ATPase type 2, which controls the movement of calcium in the endoplasmic
reticulum, causes Darier disease. Darier disease is a rare skin condition that affects how cells stick together. Also, this illness
gets worse with heat and exposure to the sun, sweating, and rubbing, and it is characterized by many bumpy, greasy spots
with an oily skin distribution. Sometimes, it can also harm the mucosa (the lining inside our body) and cause our nails to
grow strangely. There is a special type of Darier disease called unilateral segmental Darier disease. It causes red, scaly
bumps to appear on one side of the body and they are not related to any other illnesses.
Objective: To show an example of a person with Darier's disease. Also, to talks about the main characteristics and the
treatments that are available. Subject and methods: A case report. Results: 51 years old male patient presented with
multiple red to brown hyperkeratotic papules coalesce into plaque and led to thickened skin affecting the face,
trunk, axilla and dorsa of both upper and lower extremities. Histopathology, there was hyperkeratosis, acanthosis,
and papillomatosis. Supra basal acantholytic blister containing acantholytic cells, some of them showed Evidence of
dyskeratosis. Corps ronds are present in the uppermost layer, especially the granular layer. Grains are present within the
horney layer. No signs of malignancy or granuloma. Conclusion: Because there are no confirmed ways to cure DD, it is
hard to treat. There are many different ways to treat this problem, like using special creams or medications, having surgery,
or using lasers. But these treatments don't work very well and only help a little bit. It is important to ensure a
multidisciplinary approach in the management of patients with Darier's disease because systemic retinoids have shown to
be more effective in achieving some reduction of symptoms in 90% of patients. Isotretinoin was used in our patient with a
good outcome because it reduces hyperkeratosis, smoothens papules, and reduces odour.
Male, Face, Papules, Darier disease.

the study. The study was conducted in accordance
The rare genetic skin condition called Darier disease
with the Declaration of Helsinki, and the protocol was
(DD), also known as keratosis follicularis, which passes
approved by the Ethics Committee of Al-Badari
down in families and can be inherited from just one
hospital, Egypt.
parent. It can appear differently in different people.
Acantholysis happens when there is a change in a gene
51 years old male patient presented with multiple
called ATP2A2 in skin cells. This change makes the skin
pruritic papules on the face, trunk, axilla, and both upper
cells not stick together as well. It affects both boys and
and lower extremities of 20 years duration (Figure1). On
girls equally and is found in about 1 in every 30,000 to 1
examination we found multiple red to brown
in every 100,000 people in the general population. It often
hyperkeratotic papules coalesce into plaque and led to
starts to appear when a person is in their 20s or 30s. The
thickened skin affecting the face, trunk, axilla, dorsa of
most common symptoms of DD are itchy, widespread
the hand and both upper and lower extremities ( Figures
bumps and raised areas on the body, especially in areas
2-5). Histopathology showed hyperkeratosis, acanthosis,
with more oil and moisture [1].
and papillomatosis. Supra basal acantholytic blister
Darier's disease can appear as lighter patches of skin
containing acantholytic cells, some of them showed
with a pattern around the hair follicles in people with
Evidence of dyskeratosis. Corps ronds are present in the
darker skin. Also, a few DD patients who have the
uppermost layer, especially the granular layer. Grains are
segmental subtype have specific areas of damage. In
present within the horney layer. No signs of malignancy
histology, DD often shows splitting in the layers above
or granuloma (figure 6). Treatment options were:
the base, abnormal skin cells, round bodies, and small
General treatment that included light clothes and
particles along with loss of skin cell connections.
sunscreen. Daily skin care antibiotics, antifungal agents
Infections like herpes simplex virus can make treating DD
and keratolytic emollients.
harder and cause serious harm. Damaging one's self-
Topical treatment: topical retinoids and 5-fluorouracil,
esteem and relationships, DD can greatly impact a
patient's overall happiness and well-being. Moreover,
Systemic treatment: oral retinoids (isotretinoin and
studies have indicated that developmental disabilities
acitretin). Cyclosporine in severe cases that do not
(DD) and neuropsychiatric issues might exist together [2].
respond to retinoids.
Ethical approval: written consent to publish was
obtained from the patient, before they participated in
Dermabrasion and Laser removal.
Received: 05/08/2023
Accepted: 04/10/2023

Full Paper (vol.941 paper# 3)

c:\work\Jor\vol941_4 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 18-22

Low-Dose Aspirin in Combination with Transarterial Chemoembolization in
Treatment of Unresectable Hepatocellular Carcinoma
Alshimaa Mahmoud Alhanafy1, Naser M. Abd Elbary1,
Mohammed S. Elwarkky2, Eman G. Esmail1, Ashraf E Abd Elghani 1
1Departments of Clinical Oncology and Nuclear Medicine, Faculty of Medicine and 2Medical Imaging and
Interventional Radiology, National Liver Institute, Menoufia University, Egypt
*Corresponding author: Alshimaa Mahmoud Alhanafy, Mobile: (+20)01006454574,
E-mail: Alshimaa_Alhanafy@yahoo.com, ORCID Number: 0000-0002-5452-5967

Various strategies under investigation aim to improve the outcome of transarterial chemoembolization
(TACE). Aspirin demonstrated chemopreventive, antithrombotic and anti- inflammatory properties. Moreover, it has
been reported that aspirin may reverse apoptosis resistance in hepatocellular carcinoma (HCC) cell lines.
Objective: To explore the clinical impact of adding aspirin with TACE in management of unresectable HCC patients.
Patients and Methods: This prospective randomized trial included 60 cases diagnosed as HCC indicated for TACE;
who were simply randomized into two arms with ratio 1:1; to control arm and aspirin arm. Aspirin arm patients received
75 mg of aspirin daily for 3 months; we assessed aspirin toxicity and disease outcome.
: In this study most of side effects of aspirin were of grade I gastrointestinal side effect. 10% of patients in aspirin
arm had complete response versus 6.7 % in control arm and 30% had partial response in aspirin arm versus 23% in
control arm, 30% of patients in aspirin arm had disease progression versus 40% in control arm. The median progression
free survival and Overall survival were not reached for aspirin arm versus 11 and 22 months for control arm (P=0.035
and P=0.036 respectively).
Conclusions: Low dose aspirin use in selected unresectable intermediate stage HCC undergoing TACE is tolerable and
could be associated with survival benefit.
Keywords: Aspirin, Transarterial Chemoembolization, Hepatocellular carcinoma.

Although hepatocellular carcinoma (HCC) is the 5th
In this randomized prospective trial, we included
most frequent cancer, it has the 3rd leading cause of
HCC cases of intermediate stage, BCLC; Barcelona
clinic liver cancer B stage.
chemoembolization (TACE) is associated with

improvement of median overall survival (OS) of cases
Inclusion criteria: HCC patients diagnosed by biopsy
from sixteen to twenty months for intermediate disease
or specific imaging patterns in triphasic computed
stage of HCC (2).
tomography (arterial enhancement and wash out in
Patients who responded initially to TACE could
portal venous phases) or dynamic magnetic resonance
progress if they developed TACE refractoriness (3).
imaging. We included HCC cases of intermediate stage
There are several factors affecting treatment response as
(10) eligible to TACE, with hemoglobin level more than
patient's general condition, liver functions, initial tumor
10 gm/dl, platelet count above 100,000, normal serum
stage, and the technique used. TACE refractoriness has
creatinine, prothrombin time, and compensated cellular
recently drawn much attention as regard TACE failure
and vascular liver functions. Previous local treatment of
that will affect disease outcome (4).
HCC was allowed.
TACE and sorafenib combination in SOCRATES

study was feasible and showed an improvement in
Exclusion criteria:
overall survival and response (5). There is less valuable
Patients who had gastrointestinal tract (GIT)
combination regimens, which had lack of a clear benefit
ulcers or any cause of bleeding, patients with portal
like thalidomide with TACE, which had no survival
hypertension and/or esophageal varices, and patients
improvement, so there is a need for other agents
with allergy to aspirin or had any contraindication for
combined with TACE (6).
HCC carcinogenesis had high levels of COX-2 and
All patients were initially had complete clinical
aspirin have inhibitory action of COX-2 (7). Aspirin
could prevent transarterial embolization induced
investigation; CBC, alpha fetoprotein (AFP), complete
ischemia from initiating angiogenesis and proliferation
liver and kidney functions, imaging: triphasic CT with
of the viable cancer cells (8). Moreover, aspirin could
contrast, metastatic work up and upper endoscopy.
overcome apoptosis resistance in all HCC cell lines (9).
Total of 60 patients were randomized with ratio
In this trial, we aimed to explore the clinical impact
1:1 into two groups: Control arm: TACE only and
of adding aspirin with TACE in management of
aspirin arm: TACE with combination of 75 mg oral
unresectable HCC patients.
Received: 26/04/2023
Accepted: 22/06/2023

Full Paper (vol.941 paper# 4)

c:\work\Jor\vol941_5 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 23 - 26

Assessment of Mesh Fixation by Dual Use of Trans-Fascial Sutures and Tacks in
The Outcome of Laparoscopic Ventral Hernia Repair "Case-Series"
Mahmoud Elsayed Nagaty Elsayed
General Surgery Department, Al-Hussein Hospital, Faculty of Medicine, Cairo, Al-Azhar University
Corresponding author: Mahmoud Elsayed Nagaty Elsayed, Email: dr_nagaty84@yahoo.com,
Telephone number: +966549423244 - +201277033012, ORCID number: 0000-0001-8096-3111
Background: In laparoscopic ventral hernia repair (LVHR) there are many modifications related to the methods of
mesh fixation. Using trans-fascial sutures decrease the chance of mesh shrinkage and migration and subsequent hernia
recurrence but it is still controversial in comparison with tackers alone. Objective: The study goal was to assess the
effect of adding four corners trans-fascial sutures to double crown tackers for mesh fixation. Patients and Methods: A
total of 50 patients with different types of abdominal wall hernias were subjected to LVHR. Patients were randomized
into two groups: Group A where mesh was fixed using double crown of tackers only and group B where mesh was fixed
using both tackers and four corners trans-fascial sutures. Mesh fixation duration, postoperative pain score and recurrence
rate were recorded. Results: Males and females were 21 and 29, respectively. The mean age was 48 years. Types of
hernias were 29 para umbilical hernias (PUH), 17 incisional hernias and 4 epigastric hernias. In Group A, the median
operative time for mesh fixation was 15 mins. In group B, the duration was 24 minutes. The median Visual Analogue
Scale (VAS) for pain was 1 at 24 hours post-operative. The average hospital stay post-surgery was between 1 to 3 days.
Within 12 months, three patients from group A experienced a recurrence of their hernia. Conclusions: LVHR with
tackers was an easy and time saving procedure. However, adding trans-fascial sutures decreased the chance of mesh
shrinkage/migration and gave less recurrence rate.
Keywords: Laparoscopic ventral hernia repair, Mesh fixation, Trans-fascial sutures, Sutures versus tacks.
Laparoscopic ventral hernia repair (LVHR) is
Between January 2017 and December 2019, this
comparative study was conducted. It included 50
complications can arise. Literature suggests that LVHR
consecutive patients undergoing LVHR. The patients
recurrence rates vary between 4.7% and 29% [1, 2]. A
were randomly divided into two comparable groups:
significant reduction in recurrence rates is theoretically
Group A included 25 patients who were scheduled for
possible by adhering to core surgical principles, such as
mesh fixation using double crowns of tacks only. Group
ensuring ample mesh overlap and robust mesh fixation.
B included 25 patients who were scheduled for mesh
Recurrences most commonly occur due to overlooked
fixation using both tacks and four corners trans-fascial
hernial defects, insufficient mesh size or improper mesh
sutures. All patients who enrolled in this study were
fixation, leading to inadequate defect coverage or mesh
followed up to 3 years.
shrinkage/migration. While some surgeons argue
Inclusion criteria: Uncomplicated ventral hernia.
against the need for trans-fascial sutures in mesh
Hernia defect away from bony prominence. Hernial
fixation, there have been reports of mesh migration and
defect size of 10 cm or less at its greatest dimension.
contraction or shrinkage with various mesh types [3].
Exclusion criteria: BMI more than 45 kg/m2. Hernial
Post-LVHR complications can increase the risk of
defect size more than 10 cm. Recurrent hernia.
hernia recurrence. An ideal mesh should prevent
Preoperative assessment: Every patient underwent
adhesion on one side while promoting fibrous
clinical examination, abdominal and pelvic ultrasound,
integration on the other. Double face meshes are crafted
routine blood tests, and pre-anesthesia evaluation.
to allow tissue growth on the parietal surface and
Surgical technique:
prevent visceral adhesions [4, 5]. Trans-fascial sutures are
General anesthesia with endotracheal intubation was
believed to heighten post-operative pain, as they pierce
employed in all cases. Patients were positioned supine
through various muscle and fascia layers [6], and may
and securely fastened to the operating table, enabling
potentially cause muscle fiber ischemia [5] or entrap the
adjustments to Trendelenburg, reverse Trendelenburg,
intercostal nerve, leading to chronic neuropathic pain [7].
or side positions for dissection of adhesions. The video
However, they offer the benefit of increased tensile
monitor's placement was determined by the hernia's
strength, significantly reducing recurrence rates [8].
Tack fixation, on the other hand, is associated with a
Pneumoperitoneum insufflation commenced using a
notable reduction in surgery time [9], but can lead to
Veress needle inserted in the left hypochondrium, under
severe post-operative issues such as bowel obstruction
the subcostal margin, as illustrated in figure (1). The
and perforation [10, 11], chronic neuropathic pain [12], and
first 10 mm trocar for the optical system was introduced
complications from tack displacement [13]. Recent
from the right lateral side at the anterior axillary line's
evaluations of both trans-fascial sutures and tack
intersection with the umbilical level. Two or three
fixation in laparoscopic ventral hernia repairs regarding
additional 5 mm trocars were then inserted under direct
postoperative pain have shown no significant
vision in the right iliac, suprapubic, and left iliac
differences between the two methods [10].
regions, as depicted in figure (2).
Received: 08/05/2023
Accepted: 09/07/2023

Full Paper (vol.941 paper# 5)

c:\work\Jor\vol941_6 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 27- 33

Clinical Significance of NPM1 A and Non A Mutations and Its Relation to
The ARF/P53 Pathway in Egyptian Acute Myeloid Leukemia Patients
Samar S. Elshazly, Asmaa Abobakr, Hend A. Nooh
Clinical pathology Department, National Cancer Institute, Cairo University.
Corresponding author: Samar S. Elshazly, E-mail: samar.sami@nci.cu.edu.eg,
Tel: +2-010-019-151-97, ORCID: 0000-0003-3243-4623
Nucleophosmin 1 (NPM1) gene is known for its regulatory role of the ARF-p53-tumor suppressor pathway.
Its mutations are known to be the most common gene mutations in AML.
Aim: To detect the type of NPM1 gene mutation (NPM-A mut and non-A mut) in AML patients and correlating it with
changes in molecular gene expression level of p53 and ARF genes also to study their relation to clinical, laboratory data
and response to treatment. Methods: Absolute quantification of the NPM1 mutation type and the expression level of p53
and ARF genes were assessed using quantitative reverse-transcription PCR (RT-qPCR).
Results: We studied 41 newly diagnosed AML patients, all of them had NPM1 gene mutation, out of them 25/41 had non-
A mutation (61%) and 16/41 (39%) had mutation A. A statistically significant difference between AML patients with NPM1
mutation-A and non-A mutation was found in bone marrow blasts count (p-value=0.032). A trend statistical significance
was observed in patients with NPM1 mutation-A and P53 gene overexpression than in patients with non-A mutation as well
as ARF gene expression for patients with NPM1 mutation-A is higher than patients with non-A mutation (p-value=0.063).
Median follow up of patients' cohort was 1.81 (0.03-47.1) months. Median survival duration for patients carrying NPM1
mutation-A compared to those with other NPM1 mutations was 1.09 months versus 1.05 months, and this variation lacked
statistical significance (p-value of 0.634). Conclusion: We can conclude that there is a trend statistically association
between p53 and ARF genes high expression level and NPM1 mut-A type. It is important to detect the type of NPM1
mutation with examination of P53 and ARF genes expression to help in therapeutic strategies.
Keywords: AML, NPM1, P53, ARF.

protein with disarrangement at the cellular level. This can
result in promoting leukemogenesis due to defect in DNA
Acute myeloid leukemia (AML) is resulted from
repair, unlimited centrosome duplication and repression of
clonal proliferation of hematopoietic progenitor cells,
tumor suppressor genes [9]. Till now, different mutations
resulting in selective growth enhancement and suppression
affecting NPM1 gene have been verified. Most of them
of normal hematopoiesis. Nearly 80% of acute leukemia
consist of frame shift mutation as a result of four base pair
cases in adults are AML [1]. The Nucleophosmin (NPM1)
(bp) insertion at position 863 and 864 nucleotides. There
gene is situated on chromosome 5q35, responsible for
are three main types of NPM1 mutation including A, B,
encoding a phosphoprotein which localized predominantly
and D, the type A mutation represents about 70­80% and
in the nucleolus, and it migrates continuously through the
is marked by insertion of the four nucleotides with
nucleus and the cytoplasm. This protein is responsible for
lengthening of the NPM protein while mutations B and D
various cellular functions as maintaining the genomic
together represents about 15­20% [10,11] .AML with NPM1
stability, DNA repair, centrosome duplication and
gene mutation is now identified as a particular entity
molecular chaperoning [2,3]. NPM1 has a main regulatory
according to World Health Organization (WHO)
role in the ARF-p53-tumor suppressor pathway[4]. Upon
classification of myeloid neoplasms, based on this unique
exposure of cells to distinct genotoxic agents that disturb
genetic and molecular abnormalities, regardless of blast
nucleolar integrity, the nucleolar proteins NPM and
counts. AML patients with mutated NPM1 have a
alternative reading frame (ARF) are released from nucleoli
favorable prognosis in absence of FLT3 mutation [12]. As
to the nucleoplasm and engaged to activate p53 which
accompanying mutations with NPM1 mutations such as
required for apoptosis of damaged cells [5]. NPM is
FLT3, MLL or double-mutated CEBPA would ultimately
important for ARF stability as it sets side by side with ARF
have different molecular and genetic behaviors and can
and keep it safe from degradation [6]. NPM1 gene mutations
affect the prognosis [13, 14].
are considered the most prevailing genetic insult in acute
The core of our study is to focus on the relation of
myeloid leukemia. In adults, it has been found in about
different types of NPM1 gene mutation (NPM-A mut and
one-third of de novo cases of AML and in the major part
non-A mut) with the changes in molecular gene expression
of the cytogenetic normal -AML patients [7,8]. For example,
level of p53 and ARF genes and their association with
In adults, this mutation is found in approximately one-third
clinical, laboratory findings and the response to treatment.
of de novo AML cases and is prevalent in the majority of
cytogenetically normal AML patients. Mutations of NPM1
Study population
gene leads to atypical cytoplasmic disruption of NPM1mut
In our research, 41 individuals newly diagnosed
Received: 01/10/2023
Accepted: 09/12/2023

Full Paper (vol.941 paper# 6)

c:\work\Jor\vol941_7 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 34- 41

Liver Involvement in Children with COVID-19 and
Multisystem Inflammatory Syndrome
Manal Sadek El Defrawy 1, Asmaa Mohamed Ahmed Emara 1*,
Amira Osama Abd El-Ghafar 2, Heba Rasmy Abdelbaset 1
1 Pediatrics Department, Faculty of Medicine, Benha University, Benha, Egypt.
2 Clinical and chemical pathology Department, Faculty of Medicine, Benha University, Benha, Egypt.
*Corresponding Author: Asmaa Mohamed Ahmed Emara, Email: asmaa.emara2024@gmail.com, Phone: +201010695713

At the beginning of the pandemic, the SARS-CoV-2 was perceived as a lower respiratory tract infection,
affecting the lung parenchyma predominantly and potentially leading to acute respiratory distress syndrome (ARDS)
Objective: This study aimed to demonstrate the laboratory outcomes of liver involvement and clinical manifestation in
multisystem inflammatory syndrome (MIS) and Covid-19 in children.
Subjects and methods: This cross-sectional case-control study was conducted at the Pediatric Department of Al
Mabarra-Tanta Hospital, Health Insurance Authority Hospital. This study included 40 children who divided into two
groups: Group I included 20 children affected with COVID-19 who met the Centers for Disease Control and Prevention
(CDC) definition of MIS-C condition associated with COVID-19. Group II included 20 of sex- and age-matched
children with alternative diseases of MIS due to causes other than COVID-19 (autoimmune disease and other types of
Results: Alkaline phosphatase levels were significantly higher in group I compared to group II (325.6 ± 98.6 vs 271.9
± 45.2 U/L). Total bilirubin and direct bilirubin levels were significantly higher in group I compared to group II. Albumin
was significantly lower in group I (p=0.01). According to CT result, the percentage of positive findings was significantly
higher in group I (100%) compared to group II (30%) (p < 0.001). Among the specific CO-RAD categories, there were
significant differences in the distribution between the groups.
Conclusions: The findings emphasized the importance of early recognition of MIS-C by investigation and clinical
manifestation. These insights could guide improved diagnosis, management, and treatment strategies for children
affected by COVID-19-associated liver complications.
Keywords: Liver involvement, COVID-19, Multisystem inflammatory syndrome, Laboratory outcomes.


At the beginning of the pandemic, the SARS-CoV-
2 was perceived as a lower respiratory tract infection,
inflammatory multisystem syndrome (PIMS), also
affecting the lung parenchyma predominantly and
classified as a multisystem inflammatory syndrome in
potentially leading to acute respiratory distress
children (MIS-C) [6]. This information further
syndrome (ARDS) [1]. However, with time, it became
complicates the understanding of the course of COVID-
evident that COVID-19 can present with wide
19 infection in children and post-infectious immune
variability of symptoms, including gastrointestinal,
transformation (alteration or readjustment) in children
neurologic, cardiovascular, and even multiorgan failure,
[7]. In children, the first reports of MIS-C changed the
as part of a severe inflammatory response syndrome
reputation of SARS-CoV-2 as an infection that mostly
(SIRS) [2].
spares children with moderate or even asymptomatic
Furthermore, research showed that the wide range
presentation to a potentially fatal one with multiorgan
of clinical manifestations is linked to the viral tropism
involvement and uncertain outcome [8].
to the angiotensin-converting enzyme 2 (ACE2)
Lately, liver involvement has been included in
receptor found on many different cells, including liver
assessing COVID-19 severity infection or MIS-C
and bile-duct epithelial cells [3]. The distribution of
presentation and the possibility of using liver enzymes
ACE2 receptors in the liver is unusual. The receptor is
as a prognostic sign for the expected outcome [9]. There
abundant in the endothelial layer of small blood vessels
is a lack of reports and studies on COVID-19 infection
but not in sinusoidal endothelial cells. Velikova et al. [4]
in children with pre-existing chronic liver disease.
reported more robust surface expression of ACE2 in
However, in the non-pediatric population, infections are
cholangiocytes (59.7%) than in hepatocytes (2.6%). The
associated with decompensation of cirrhosis and the
level of ACE2 expression in cholangiocytes was
onset of acute or chronic liver failure. This by itself is a
comparable to that of type 2 alveolar cells in the lungs,
risk factor for a severe course of COVID-19 [10]. Among
implying that the liver may be a possible target for
other organs involved in MIS-C, such as the heart,
SARS-CoV-2 as well. However, Kupffer cells, T and B
kidneys, lungs, gastrointestinal, skin, nervous system,
lymphocytes tested negative for ACE2 on
and blood, the liver can also be damaged during
immunohistochemistry staining [5].
COVID-19 infection and MIS-C particularly [11].
Reports to date indicate that SARS-CoV-2 infection
Therefore, we aimed to observe the clinical presentation
precedes the onset of various autoimmune and
and laboratory investigations in children with MIS-C
Received: 18/05/2023
Accepted: 19/07/2023

Full Paper (vol.941 paper# 7)

c:\work\Jor\vol941_8 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 42- 46

Early Extrusion of Grommet Tubes and its Impact on Eustachian Tubes of Children
Hany Amin Riad, Eslam Farid Abu Shady*, Mohamed Goda Elnems,
Radwa Mahmoud Ahmed, Samah M. Eldsouky
Department of Otorhinolaryngology, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Eslam Farid Abu Shady, Mobile: (+20)1207835481, E-mail: eslam.farid@fmed.bu.edu.eg

Otitis media with effusion (OME) which also called glue ear is famous in children. Most of children
under four years could have OME, but decline beyond six years of age, medical and surgical treatments are present for
OME. Objective: The aim of the current work was to evaluate the impact of early extrusion of grommet tubes on the
eustachian tubes of children and whether this necessitates another intervention or not.
Subjects and methods
This retrospective cohort study included a total of 191 pediatric patients (aged 3 to 14 years
old) who suffered from bilateral otitis media with effusion (OME), not responding to medicinal treatment, and
undergone myringotomy with Shepard grommet tubes insertion. It was performed at Department of
Otorhinolaryngology, Faculty of Medicine, Benha University, Benha, Egypt. The included subjects were divided into
two groups; Group (A) included 318 ears with standard extrusion time of grommets (6 to 12 months), Group (B)
included 64 ears with early extrusion time (before 3 months from grommet tube insertion). Both groups were followed
for 6 months after extrusion of the grommet's tubes.
Results: At the insertion time the mean ages for group A and B were 5.3 years and 5.1 years, respectively, without
statistical differences for age and sex. Adenoidectomy performed in 52.9 % of patients, without statistical difference
between groups. Cure rate was 84.9% in group A and 84.4 % in group B, which was comparable.
: Early extrusion for grommets tube has similar fate to standard extrusion time. No further treatment in early
extrusion time grommets until 6 months with treatment and follow up is elapsed.
Keywords: Otitis media with effusion, Recurrence, Tympanostomy, Ventilation tubes, Extrusion.


ventilation or tympanostomy tubes, are 2 mm in
Otitis media with effusion (OME), is particularly
diameter and constructed of inert plastic. They can be
frequent among children, from one to three years of age.
employed in patients of various ages, although the bulk
The frequency of this problem ranges from10% to 30%
of the time they are used in children. When exudate of
and reaches an incidence of 80% with four years aged
the middle ear happens three or more times in a six-
children and the signs of acute infection could be absent
month period, grommets are frequently recommended
in OME(1).
(5). A grommet's goal is to make ventilation of the middle
The OME has a functional impact of 25 to 30 dB of
ear rather than draining it. Grommets therefore mimic
conductive hearing threshold with effusion in the middle
the role of the glue ear's closed eustachian tube and
ear (1). Hearing loss is a significant clinical characteristic
increase hearing (6).
of OME, produced by diminished tympanic membrane
The grommet sometimes protrudes into the ear canal
movement and consequent decline in sound
and becomes entangled in wax. The return of glue ear or
transmission. If hearing loss persists, it can have an
middle ear infection can take place in 15% of cases.
impact on speech and language development, as well as
When the grommets are extruded, additional sets of
contribute to behavioral issues in some children (2).
grommets may be required till children develop without
OME symptoms include problems with balance
Eustachian tube difficulties (7). Except for those intended
(vestibular) and ear discomfort. Whenever symptoms
for long-term placement, the tubes tend to move
continue, they might influence a child's everyday
naturally. OME is more likely to return if a tube is
activities, social relationships, and emotions, perhaps
removed too soon, but problems are more likely if it is
resulting in an inferior standard of life for the child (2).
left in too long (8,9).
Antibiotics, decongestants, antihistamines, mucolytics,
The recurrence rate of otitis media with exudate is
and steroids are the most commonly used medicinal
high after myringotomy with tympanostomy tube
treatments for OME. These treatments' efficacy has yet
insertion, ranging from 19.9 to 53.2%. The duration of
to be shown. Ventilation or tympanostomy tube
tympanostomy tube extrusion is an essential factor in
installation, adenoidectomy, or both are surgical
determining the frequency of recurrences of OME, with
options. The risks and benefits of tympanostomy tube
a longer extrusion period being associated with a lower
placement are fiercely discussed. As a result, OME
recurrence rate. Several factors have been described in
control remains a source of contention (3).
studies to influence tympanostomy tube extrusion. From
The majority of OME cases in children recover
these factors are; sex and age of patient, tube shape, size,
and concurrent surgery, added to that size of adenoid,
nonetheless, roughly 35% of children will have more
characters of effusions, postoperative reoccurrence of
than one episode of OME, and 5% to 10% of cases
infections, and findings of tympanometry (10). Within 6-
continue for over one year (4). Grommets, also known as
24 months, tympanostomy tubes normally extrude from
Received: 01/09/2023
Accepted: 02/11/2023

Full Paper (vol.941 paper# 8)

ABSTRACT The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 47- 54

Subfoveal Choroidal Thickness in Diabetic Patients without Retinopathy versus
Normal Individuals Using Optical Coherence Tomography
Eman Shawky Abd El Haleim El Sanhoury, Ragaa Ahmed Mohmmed,
Abeer Foad El Badry

Ophthalmology Department ,Faculty of Medicine for Girls ­Al-Azhar University,Egypt
Corresponding author:Eman Shawky Abd El Haleim El Sanhoury,

Diabetes mellitus (DM) is a prevalent systemic ailment. The incidence of this condition varies from
8.3% to 11.6% among different ethnic groups in the general population. Objective: The objective is to compare the
subfoveal choroidal thickness between diabetic patients without retinopathy and healthy individuals, utilizing Optical
Coherence Tomography (OCT) as the primary diagnostic tool.
Individuals and Methods: This study was conducted on 40 individuals who attended the Ophthalmology outpatient
Clinic at Al-Zahraa University Hospital.
Results: The mean age of the cases ranged between 18 and 53 year (mean ± SD was 37.65 ± 6.91 years. Twenty-five
were females (62.5%) and 15 were males (37.5%). The mean subfoveal choroidal thickness (SFCT) in healthy
individual was 272±13.79 (m), while in diabetic patients without retinopathy it was 269±12.1 (m). In our study
there was non-statistically significant difference in right, left and average SFCT found between the patients group and
the normal group (p-values were 0.428, 0.805 and 0.529 (m) respectively).
Conclusion: Diabetes mellitus is a microvascular systemic disease, so it affects choroidal circulation lately with
development of diabetic retinopathy. Diabetic patients without retinopathy had no significant changes in the subfoveal
choroidal thickness. Spectral domain optical coherence tomography with enhanced depth imaging is an objective, fast,
reliable, high sensitive, and a non-invasive technique used for measurement of subfoveal choroidal thickness.
Diabetes mellitus, optical coherence tomography.

evaluating choroidal alterations can aid in making more
Diabetes mellitus, a widespread condition,
informed therapy decisions and enhancing treatment
impacts an estimated 8.3% to 11.6% of people across
monitoring (7).
diverse ethnic backgrounds (1). Diabetes mellitus (DM) is
Initial studies on the pathology of diabetic
a persistent medical condition that impacts 415 million
choroids have shown various changes, including twisted
individuals globally, and it is projected to increase in
blood vessels, the loss of choriocapillaris, drusenoid
prevalence to around 642 million by the year 2040 (2). It is
deposits on Bruch's membrane, microaneurysms, and
defined by long-term high blood sugar levels and a
choroidal neovascularization. Additionally, both the
disrupted balance among cells, potentially resulting in
choroidal vascularity index (CVI) and subfoveal
malfunction of many organs. Diabetes mellitus (DM)
choroidal thickness (SFCT) are dynamic factors
leads to the development and buildup of advanced
influenced by diabetic macular edema (DME) (8).
glycosylation end products (AGEs) due to high blood
The choroidal layer provides oxygen and
sugar levels. These AGEs are closely linked to many
nutrients to the outermost layer of the retina. Any
clinical consequences of DM (3).
alteration or harm to this tissue's thinning can impact the
The choroidal layer in the eye, responsible for
retina above it, resulting in hypoxia and contributing to
supplying blood to the outer portion of the retina, could
the emergence of diabetic retinopathy, lesions, or the
have a significant role in the onset of diabetic retinopathy
advancement of pre-existing retinal disease. It remains
(DR). The primary alterations observed in the choroid are
uncertain if the reduction in choroidal thickness is a
predominantly seen in the choriocapillaris layer, and
precursor to diabetic retinopathy (DR) lesions or if these
these changes can extend to the larger vessels found in
lesions contribute to the thinning of the choroid.
the choroid's outer layers (4).
Therefore, deepening our knowledge of the pathological
Diabetic choroidopathy is the term used to describe
processes involved in DR, especially those affecting the
choroidal abnormalities in individuals with diabetes.
choroid, is crucial. This understanding could aid doctors
Lutty (2017) outlined the risk factors linked to diabetic
in better grasping how the disease evolves and in refining
choroidopathy, which include severe diabetic retinopathy,
DR treatment through tailored approaches (7).
inadequate management of blood sugar levels, and the
Choroidal blood flow deficit may occur as an
specific treatment plan being followed (5).
initial pathological alteration in diabetic retinopathy
Recent research into neo-vascular age-related
(DR). The luminal to choroidal area ratio (L/C ratio) can
macular degeneration and diabetes suggests that the
serve as a predictive indicator for the development of
choroid thickness could be a useful marker for assessing
diabetic retinopathy (DR) before to its clinical
the efficacy of antiangiogenic medications (6). Therefore,
manifestation. The primary occurrence in diabetes, even
Received: 20/09/2023
Accepted: 25/11/2023

Full Paper (vol.941 paper# 9)

c:\work\Jor\vol941_10 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 55- 60

Helicobacter Pylori Infection as A Risk Factor for Colorectal Cancer
Mohamed Abd Ellatif Afifi, Ahmed R. Mohamed, Mohamed A. ElAssal, Ahmed M. Hussein Dabour, Raof M.
Rashed, Basem M. Abdelghafar Meghawary*, Amira K. El-Alfy
Department of Internal Medicine, Faculty of Medicine, Benha University, Egypt.
*Corresponding Author: Basem M. Abdelghafar, Mobile: (+20) 01018842042, Email: Basemmeghawarybasem@yahoo.com

Helicobacter pylori (HP) infection, traditionally associated with gastric disorders, has increasingly
drawn attention for its potential role in extra-gastric pathologies. Colorectal cancer (CRC) is among the diseases under
scrutiny, with emerging evidence suggesting a possible link between HP infection and CRC risk.
Objective: This study aimed to assess the correlations between H. pylori infection and colorectal cancer.
Subjects and methods: A total of 85 individuals were recruited from the Internal Medicine Department of Benha
University Hospital through the period from January 2023 to July 2023 and categorized into two groups. Group 1
consisted of 50 patients with confirmed CRC following colonoscopy and histopathological examination. Group 2, the
control group, included 35 individuals without CRC. Both inpatients and outpatients aged 18-70 years of both sexes.
Results: patients with CRC were older and had lower hemoglobin levels, higher leukocyte counts, and elevated urea,
creatinine, and international normalized ratio (INR) compared to controls. However, there were no significant gender
differences. When categorized by H. pylori stool antigen presence, no age, gender, or laboratory parameter differences
emerged between those with positive and negative antigen status. Notably, multivariate analysis revealed a substantial
association between H. pylori stool antigen positivity and a nearly tenfold increased risk of CRC, even after adjusting
for age and gender, highlighting the potential link between H. pylori infection and CRC in this study population.
Conclusions: The present study confirmed the predictor value of positive stool antigen for H. pylori infection for
development of colorectal cancer.
Keywords: Helicobacter pylori, Colorectal cancer, INR.

(like gastrin) that could promote the growth of
Human stomach mucosa is infected with HP, a
gram-negative bacterium that can lead to gastric
Therefore, our aim was to detect the relationship
adenocarcinoma, peptic ulcers, and chronic gastritis [1].
between HP Infection and colorectal cancer risk.
With an estimated 4.4 billion persons affected, HP

infection has become a global issue [2]. HP infection
has been recognised as a significant risk factor for
A case-control study was conducted at Internal
gastric cancer by the International Agency for
Medicine Department, Benha University Hospital
Research on Cancer since 1994 [3]. HP infection has
through the period from January 2023 to July 2023
been extensively researched in relation to stomach-
including both inpatients and outpatient care. 85
related illnesses. Notably, HP infection can have a
individuals were classified into 2 groups: Group 1
systemic impact on other organs due to its protracted
included 50 patients diagnosed with colorectal
stomach inflammation. Studies on HP's involvement in
carcinoma (after colonoscopy and histopathology).
the pathophysiology of extragastric lesions have been
Group 2 "control group": 35 individuals without
extensively publicised, particularly in the last several
colorectal carcinoma and both groups were evaluated
years [4].
for H.Pylori infection.
It has been shown that people who test positive for

HP have a higher chance of developing a number of
Inclusion criteria: Patients aged 18-70 years and both
illnesses, such as autoimmune disorders, digestive,
genders were included.
neurological, extra-gastroduodenal, cardiovascular,

and pulmonary conditions. For instance, new research
Exclusion criteria: Patients with inflammatory bowel
indicates that HP may have a direct connection to
disease, gastric malignancies, other solid organ
tumours of the digestive tract, namely CRC [5].
malignancies, patient receiving proton pump inhibitors
Although the risk is low, HP-related gastritis is linked
or H2 blockers or patient with recent use of antibiotic.
to a higher risk of colorectal adenomas and CRC [6].

Furthermore, it was discovered that the CRC's
All participants were subjected to the following:
malignant tissues had HP infection. The idea that HP is
History taking and complete clinical examination,
a direct CRC activator is still only a theory, though [7].
laboratory investigations including CBC, AST, ALT,
However, experimental data suggest that these bacteria
Urea, Creatinine, INR, Total and direct bilirubin and
may interact with the colonic mucosa in a number of
H.Pylori stool antigen by ELISA. Colonoscopy was
ways that could lead to cancer, such as inducing and
performed using (OLYMPUS GIF-CF 140 videoscope,
maintaining inflammatory responses, altering intestinal
Japan) and multiple colonic biopsies were taken for
flora, and releasing toxins and/or hormonal mediators
histopathological examination.
Received: 05/09/2023
Accepted: 06/11/2023

Full Paper (vol.941 paper# 10)

c:\work\Jor\vol941_11 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 61- 67

Study of Interleukin 21 Gene Polymorphism in Egyptian Patients with
Allergic Rhinitis and Sinonasal Polyps
Kassem Mohamed Kassem1, Awad Mohamed El Abd2, Samer Badie Kamel1,
Dalia Mamdouh Elsayed Salem*1, Inas A. Ahmed2, Alaa Mohamed Abdelsamie1
Departments of 1Otorhinolaryngology, and 2Medical Biochemistry and Molecular Biology,

Central Laboratory for Research, Faculty of Medicine,Benha University, Egypt
*Corresponding author: Dalia Mamdouh Elsayed Salem, Mobile: (+20)01015730321,Email: daliamamdouh908@gmail.com

Sinonasal polyps and allergic rhinitis are prevalent disorders that significantly diminish the standard of
living for those who suffer from them. Variants in the interleukin 21 (IL-21) gene have been linked to an increased
risk of developing several immune-related diseases. Objective: To examine the correlation between IL-21 gene
polymorphisms and the likelihood of developing allergic rhinitis and sinonasal polyps.
Patients and Methods:
Patients with sinonasal polyps and allergic rhinitis, in addition to a control group, participated
in this cross-sectional study. Controls (Group A), patients with AR (Group B), and patients with SNP (Group C)
comprised the patient population. TaqMan SNP Genotyping assays were utilised to genotype the IL-21 gene SNP
(rs6822844). To identify associations, clinical and genetic data were evaluated.
: A notable disparity in the distribution of genotypes was identified in the case-control comparison (p < 0.006).
In particular, individuals diagnosed with AR had 32 %GG genotypes, 56 %GT genotypes, and 12% TT genotypes. In
contrast, the control group demonstrated a mere 4% TT genotypes, 12% GG genotypes, and 84% GT genotypes. The
genotype distribution of the SNP patients differed significantly (p < 0.002), with 16% carrying the GG genotype, 60%
carrying the GT genotype, and 24% carrying the TT genotype. The distribution of genotypes in the control group
comprised 4% TT genotypes, 84% GT genotypes, and 12% GG genotypes.
It is possible that Egyptians with certain IL-21 gene variants are more likely to suffer from allergic
rhinitis and sinonasal polyps.
Keywords: Interleukin 21, Gene polymorphism, Allergic rhinitis, Sinonasal polyps, Susceptibility.

immune cells, including lymphocytes, natural killer
In the family of type I cytokines, interleukin (IL)-21
cells, dendritic cells, macrophages, and epithelial cells.
is one that CD4+ T cells, such as T follicular helper
It is produced by activated cluster of differentiation
(Tfh) cells, Th17 cells, and natural killer (NK) T cells,
(CD)4+ Th cells and natural killer cells [5].
are able to secrete. In addition to regulating CD4+ T
Some research has also found that polyp tissues are
cell activation, proliferation, and survival, IL-21 also
rich in B cells and immunoglobulins (Ig), suggesting
increases CD8+ T cell and NK cell cytotoxic activity
that local B cell immunity might be a major factor in
and helps differentiate Tfh and Th17 cells [1].
keeping the nasal inflammatory response going in
An IL-21 receptor, a member of the class I cytokine
CRSwNP patients. The results of this study provide
receptor family, binds to a cell surface heterodimeric
more evidence that interleukin-21 (IL-21) plays a
receptor comprised of a common-chain component
harmful function in a variety of inflammatory
(CD134) and a unique receptor (IL-21R). This receptor
disorders that affect humans [6].
is shared with receptors for IL-2, IL-4, IL-7, IL-9, IL-
Airway remodeling, hyperresponsiveness, and
13, and IL-15 [2]. Studies have demonstrated that
strong eosinophil infiltration are hallmarks of allergic
inflammatory diseases, such as cancer, allergies, and
disorders, such as allergic rhinitis (AR). Augmented
autoimmune disorders, are influenced by the binding
reality's global ubiquity has been on the rise[7,8].
of IL-21 to its receptor. In addition, IL-21 has the
The connection between IL-21 gene polymorphisms
ability to positively influence B cells and enhance their
and susceptibility to allergic rhinitis and sinonasal
immunity. Plasma cells are generated in humans by
polyps was the objective of this investigation.
memory B cells that are stimulated with IL-21. This

process also induces class switch recombination and
transforms insensitive naive cord blood B cells into
plasma cells that secrete IgG [3].
Patients with allergic rhinitis and sinonasal polyps
The persistence and function of germinal centers
are the subjects of this case-control study that
(GCs), which impact their proliferation, transition into
examines IL-21. From June 2022 to June 2023,
memory B cells, and affinity maturation, are severely
participants were selected from the outpatient clinic at
impacted by the absence of IL-21 signaling [4]. Other
Benha University Hospital.
cytokines might play a role in chronic rhinosinusitis
Inclusion criteria were 1) Age ranging from 15 to 40
(CRS) as well. IL-21 may influence the immune
years 2) Individuals identified as having allergic
system's innate and adaptive mechanisms. It is a
rhinitis. 3) Individuals who have been identified as
cytokine that performs multiple roles in diverse
having sinonasal polyps.
Received: 01/10/2023
Accepted: 01/12/2023

Full Paper (vol.941 paper# 11)

c:\work\Jor\vol941_12 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 68- 73

Does Intramuscular Injection of Human Chorionic Gonadotropin before Frozen
Embryo Transfer Improve Intracytoplasmic Sperm Injection Outcomes?
Mohamed Zakaria Sayer Dayer*, Mohamed Elsibai Anter, Heba Farag Salama
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University
*Corresponding author: Mohamed Zakaria Sayer Dayer, Mobile: (+20) 01004778794, E-mail: mimo_zsd@yahoo.com

Evidences reported the advantageous impact of human chorionic gonadotropin (hCG) in process of
embryo implantation via activation of LH/hCG receptors expressed in endometrium.
Objective: The current context investigated whether intramuscular (IM) administration of hCG on the frozen embryo
transfer (ET) day would improve the pregnancy outcomes of intracytoplasmic sperm injection (ICSI) cycles.
Methods: A total of 176 artificially prepared frozen-thawed embryo transfer (FET) cycles were randomly categorized
into two equal groups: (A) hCG -treated group (in which intramuscular administration of 10,000 IU hCG on the
morning of frozen embryo transfer day was done) and (B) control group (underwent routine FET protocol without
hCG intramuscular administration. Our primary outcome was clinical pregnancy rate (CPR) that compared between
the two groups, secondary outcomes were ongoing pregnancy and first trimester miscarriage rates.
Results: Basic and clinical patient characteristics were matched between groups. In terms of CPR, it was significantly
superior in patients received IM hCG prior to frozen embryo transfer (FET) compared to control group (70.5% versus
52.3%, P value = 0.013). Regarding ongoing pregnancy rate (OPR), it was improved significantly in hCG group
compared to control group (50% versus 28.4%, P value = 0.003). Miscarriage rates were similar among study groups.
Univariate analysis revealed that age at the index ICSI cycle, serum progesterone on pregnancy test day (15 days after
FET), number/quality of embryos transferred and hCG injection on the embryo transfer day were significant
predictors of clinical pregnancy in frozen-thawed cycles. In the multivariate analysis, the intramuscular administration
of hCG remained a significant predictor of clinical pregnancy after FET (adjusted odds ratio (AOR) 2.22; P = 0.014).
Conclusions: Intramuscular hCG administration on the frozen embryo transfer day significantly raise the rates of both
clinical & ongoing pregnancy.
Keywords: Human chorionic gonadotropin, FET, Pregnancy rate.

clinical & ongoing pregnancy outcomes in the
Successful embryo implantation requires a
artificially prepared FET cycles.
synchronized embryo-decidua cross-talking through

biochemical messages between the blastocyst and the
decidua [1]. HCG produced by blastocyst before
A randomized controlled trial comprised 176 FET
implantation is one of such molecules [2]. Evidences
cycles that was conducted at a specialized fertility and
documented a favorable impact of hCG on embryo
gynecology center through the period from January
implantation (acting via LH/hCG receptors, which are
2021 to January 2023.
expressed and functionally active in human

endometrium) [3, 4].
Inclusion criteria: Women aged 23-43 years (at the
Human chorionic gonadotropin enhances micro-
index stimulated ICSI cycle), underwent hormone
vascularization and angiogenesis needed in preparing a
replacement FET, endometrial thickness more than 8
mm at the day of progesterone initiation in frozen
intrauterine macrophage colony stimulating factor,
cycle and one top-quality embryo transferred were
stimulation of vascular endothelial growth factor
comprised in our study.
(VEGF) [5], and amplification of endometrial response

to interleukin [6].
Exclusion criteria: Cases were ruled out when they
Human chorionic gonadotropin has important roles in
were diagnosed with endometriosis, fresh ET cycles,
prolonging the implantation window by suppression of
FET cycles other than hormonal replacement therapy
insulin-like growth factor binding protein-1 (IGFBP-1)
and refusal to engage in the study.
in the endometrium [7]. Additionally, hCG induces

trophoblast proliferation and invasiveness [8], regulates
the immunologic tolerance at maternal-foetal interface
One hundred seventy-six candidates fulfilled the
and suppress myometrial contractile activity [9].
inclusion criteria and randomly categorized into two
Several controlled trials confirmed the clinical potency
equal groups. Group allocation was concealed by
of intrauterine hCG administration before ET in the
preparing one hundred seventy-six sealed opaque
improvement of clinical outcomes of ART strategies
identical serially numbered envelopes (88 envelopes
for hCG-treated group and the other 88 for control
Objective: The current study investigated whether the
group) using computer generated randomization sheet
intramuscular administration of hCG would improve
Received: 14/08/2023
Accepted: 16/10/2023

Full Paper (vol.941 paper# 12)

c:\work\Jor\vol941_13 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 74-81

The Impact of Mitral Valve Replacement in Treating Moderate-to-Severe Ischemic
Mitral Regurgitation on Preservation of the Left Ventricular Function
Ahmed Saber*1, Mohamed H. Abdallah1, Abdallah Nosair1, Eman Salah Eldin Elsakaan2, Mahmoud
Abdeltawab Mahmoud Atia Gbre3, Ahmed Elsharkawy1, Eman Mahmoud4, Sherif Nasr5
Departments of 1Cardiothoracic Surgery and 3Anesthesiology & ICU, Faculty of Medicine, Cairo University, Egypt
2Medical colleague of General Medicine in Department of Cardiothoracic Surgery,
Mansoura University Hospital, Mansoura University, Egypt.
Departments of 4Cardiology and 5Cardiothoracic Surgery, Faculty of Medicine, Fayoum University, Egypt
*Corresponding author: Ahmed Saber Ibrahim Elsayed, Mobile: (+2) 01225386221,
Email: ahmedsaber78@yahoo.com, ORCID ID: https://orcid.org/0000-0003-1243-401X

Moderate-to-severe ischemic mitral regurgitation (IMR) accounts for 10-20% of ischemic heart disease
(IHD) cases. Although the widespread recommendations by the guidelines for dealing with it surgically, they don't
clearly address mitral valve (MV) repair to be of choice over MV replacement (MVR) due to the numerous
contradictory and un-conclusive results reported about both techniques.
Objective: This study aimed to evaluate the impact of MVR in treating moderate-to-severe IMR on one-year
outcomes [left ventricular (LV) function, mortality, major cardiac problems, cerebrovascular adverse events,
functional status, and quality of life].
Patients and methods: This retrospective study included twenty-three patients presented with IHD complicated with
moderate-to-severe IMR and operated upon by coronary artery bypass grafting (CABG) and MVR. All relevant data
were evaluated in the preoperative, intraoperative, and over one-year postoperative periods.
Results: The mean age was 58.22 ± 3.58 years. They were all in Canadian Cardiovascular Society (CCS) grade III.
The mean preoperative left ventricular ejection fraction per cent (LVEF %) was 40.75 ± 1.35. Intraoperative mortality
was nil. Early (immediate) postoperative mortality was 4.34%. Late mortality was nil. The overall hospital
complications rate was 21.73%. The overall one-year survival rate was 95.65% with statistically significant
improvement of LVEF% with a mean of 52.86 ± 1.59 (p<0.001), CCS grade and New York Heart Association
(NYHA) class whereas 90.91% were in CCS grade I and NYHA class I while 9.09% in CCS grade II and NYHA class
II (p<0.001).
Conclusion: Although conjoint MVR with CABG resembles an aggressive approach for treating moderate-to-severe
IMR, its performance is safe and beneficial. Even hazardous in the early postoperative period, it showed lower rates of
intraoperative, early and late mortality and morbidities particularly the newly developed postoperative atrial
fibrillation (AF) and low cardiac output syndrome. At one-year follow-up period, it resulted in preserving and
augmenting the LV systolic function improving significantly the impaired preoperative LVEF% and the functional
clinical status of the patients.
Keywords: IHD, Moderate-to-severe IMR, CABG and MVR.

established by different diagnostic tools including
Ischemic mitral regurgitation (IMR), which can be
echocardiography, only the quantitative parameters
expressed as a regurgitation of the mitral valve (MV)
(amongst the others namely structural, qualitative and
following myocardial infarction (MI) due to coronary
semiquantitative parameters) can help subclassify the
artery disease (CAD) of the circumflex or the right
moderate group and clearly outline the moderate-to-
coronary branches resulting in significant segmental
severe subgroup (5). This is agreed upon according to
wall motion abnormalities (SWMAs). Yet, unaffected
the 2020 ACC/AHA Joint Committee and the 2021
MV leaflets is the commonest complication of
European Society of Cardiology (ESC) and the
ischemic heart disease (IHD) accounting for 20-50%
European Association for Cardio-Thoracic Surgery
of the cases (1). The grade of IMR depends on the
(EACTS) guidelines (6, 7).
severity of the underlying pathology that causes
Although the widespread recommendations by the
distortion of the LV and evident remodeling with
guidelines for dealing with moderate-to-severe IMR
resultant apico-lateral papillary muscle tethering and
surgically, they don't clearly address MV repair to be
consequently MV annular disfigurement preventing
of choice over MV replacement (MVR) due to the
proper coaptation of the MV leaflets during systole (2).
numerous contradictory and un-conclusive results
Even the mild grade of the disease is associated with
reported about both techniques (8). Reported evidence
morbid adverse complications and mortality. The
doesn't conclude any difference in mortality,
moderate-to-severe IMR grade, which accounts for 10-
cerebrovascular adverse complications, and heart
20% of IHD cases, reports doubled-incidence of
failure condition between MV repair or MVR used to
congestive heart failure and mortality (3, 4). Whilst, the
treat moderate-to-severe IMR. However, MVR cases
cut point of differentiating moderate or severe IMR is
shows better preservation of the LV function and
Received: 20/08/2023
Accepted: 22/10/2023

Full Paper (vol.941 paper# 13)

c:\work\Jor\vol941_14 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 82-90

Pursuit of the Changes of the Descending Aortic False Lumen after
Surgical Repair of Acute DeBakey Type 1 Aortic Dissection
Ahmed Saber*1, Abdallah Nosair1, Eman Salah Eldin Elsakaan2,
Ali Saad Ali Mohamed1, Eman Mahmoud3, Sherif Nasr4, Ahmed Elsharkawy1
1Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
2Medical Colleague of General Medicine in Department of Cardiothoracic Surgery,
Mansoura University Hospital, Mansoura University, Egypt
Departments of 3Cardiology and 4Cardiothoracic Surgery, Faculty of Medicine, Fayoum University, Egypt
*Corresponding author: Ahmed Saber Ibrahim Elsayed, Mobile: (+20)1225386221,
Email: ahmedsaber78@yahoo.com, ORCID ID: https://orcid.org/0000-0003-1243-401X

After surgical repair of acute DeBakey type 1 aortic dissection (AIAD), most survivors suffer from
persistent false lumen in the descending aorta that adversely affects the long-term prognosis, and the need for secondary
intervention is prompted. Objective: This study was aimed at providing control data to determine the actual benefits of
more aggressive or newer approaches by investigating the changes in the descending aortic false lumen over 1-year
follow-up. Patients and Methods: This retrospective study included 83 patients with AIAD ± significant aortic
incompetence (AI). On emergency basis, all the patients had undergone aggressive resection of the intimal tear and
replacement of the ascending aorta ± proximal or total aortic arch replacement, and aortic valve (AV) repair,
replacement, valve sparing re-implantation of the AV or composite replacement of the aortic root (depending on the
encountered pathology). Multi-slice CT aortography (MSCT) at 6-months and 1-year was done for segmental analysis
of the distal aortic diameter at fixed levels and false lumen status evaluation. Results: The mean age was 47.18±4.87
years. Mortality was 8(9.64%) intraoperatively, 10(12.05%) operative mortality, no late mortality and the overall 1-year
survival rate was 65(78.31%). The overall hospital complications rate was 17(22.67%). The descending aortic false
lumen remained patent in most [56(86.15%)] survivors. There was no dilatation of the descending aorta at 6-months. At
1-year, there was statistically significant (p<0.001) dilatation of the descending aorta of >10 mm in 24(42.86%) and <10
mm in 32(57.14%) in patients with persistent false lumen. Patients <40 years expressed statistically significant (p<0.001)
total resolution of the false lumen and >10 mm dilatation of the descending aorta. Multivariable logistic regression
analysis showed that the significant predictive risk factors for persistence of the false lumen in the descending aorta
were age <50 year (OR: 3.10 (95% CI: 0.846-19.320); p= 0.041), Bentall operation (OR: 0.35 (95% CI: 0.026-2.087);
p= 0.021) and long-term anticoagulation (OR: 0.19 (95% CI: 0.025-1.289); p= 0.043), and those for thrombosis of the
false lumen were age >60 years (OR: 6.13 (95% CI: 5.123-34.162); p= 0.031) and valve-sparing aortic root
reconstruction (OR: 4.23 (95% CI: 1.480-14.053); p= 0.007). Conclusion: Residual intimal tear in the distal descending
aorta is the major cause of continued false lumen patency. More extensive aortic replacement and avoidance of surgical
reconstruction procedures needing long-term anticoagulation could diminish the prevalence of patent false lumen and
its adverse sequelae.
Dilated descending aorta, Patent false lumen, Persistent false lumen, MSCT, Aortic dissection, Marfan


Thus, we lack sufficient control data to establish
Markedly obvious and steady improvements have
the real value of more aggressive or novel treatments,
occurred over the last two decades in the postoperative
such as regular aortic arch replacement or insertion of a
surgical outcomes for repair of acute DeBakey type 1
frozen elephant trunk, which are believed to enhance
aortic dissection (AIAD) (1).
long-term prognosis.
Persistent false lumen post-conventional surgery
This study was aimed at providing such control
in the downstream aorta has affected most AIAD
data by investigating the changes in the descending
candidates, which may have a negative impact on their
aorta false lumen and its differences over one-year
long-term prognosis (2).
While several previous research investigated the

descending aortic false lumen and risk factors for
aneurysmal dilatation, very few focused on differences
This retrospective observational non-randomized
or changes that began with immediate postoperative
study included a total of 83 patients with AIAD with or
features and extended to subsequent, longer-term
without significant aortic incompetence (AI), attending
alterations. Furthermore, most earlier research used
at Department of Cardiothoracic Surgery, Cairo
antiquated methods such as limited replacement of the
University Hospitals. This study was conducted
ascending aorta solely and anastomosis under aortic
between June 2018 to May 2023.
cross-clamping without complete circulatory arrest
The patients mean age was 47.18±4.87 years
(TCA), even when an aortic arch rupture was present(3).
(range: 34-62). On emergency basis surgery, all the
Received: 01/10/2023
Accepted: 01/12/2023

Full Paper (vol.941 paper# 14)

c:\work\Jor\vol941_15 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 91-96

Outcome of Bilateral Video-Assisted Thoracoscopic Sympathectomy (BVATS)
Thoracic Sympathectomy in Treatment of Hyperhydrosis
Abdelhamid F Sherif 1*, Sherine Elsharkawy 2, Dina A Saad 1
1 Cardiothoracic surgery department, Faculty of Medicine, Benha University, Egypt
2 Physiology Department, Faculty of medicine, Banha University, Egypt,
Corresponding author: Abdelhamid F Sherif, E-mail: abdelhamidfathi6@gmail.com
Phone: +966509499912
Primary hyperhydrosis (PH) is a pathological condition that impacts the quality of life by inducing
excessive, uncontrollable sweating in the palmar, axillary, and/or plantar regions.
Objective: We aimed to evaluate the effectiveness of undergoing B-VATS in the treatment of patients with
hyperhidrosis. Methods: This prospective cohort trial was carried out on 60 patients who were subjected to B-VATS
for primary palmar hyperhydrosis (HH). All patients were subjected for grading of palmar HH on the hyperhidrosis
disease severity scale, full history taking, preoperative scores level of participants activity, associated axillary/plantar
HH, and family history. Results: Regarding the outcome, the average hospital stay was 35.1 ± 6.84 days, the average
follow-up period was 8.98 ± 1.74 months, the incidence of compensatory sweating (CS) was 17 (28.33%), the cure rate
was 54 (90%) and no recurrence or mortality was detected. Concerning the patients' satisfaction, the majority of the
studied patients were satisfied [35 (58.33%)], 5 patients (8.33%) were very satisfied, 5 patients (8.33%) were neutral,
and 6 patients (10%) were very dissatisfied.
Conclusions: BVTS was an effective therapeutic method in treatment of hyperhidrosis had a higher cure rate, no
recurrence or mortality with high patients' satisfaction. Early after VATS, CS was a significant health concern that
impacted a considerable proportion of patients.
Keywords: Bilateral video-assisted thoracoscopic sympathectomy, Thoracic sympathectomy, Hyperhidrosis, Palmar
hyperhydrosis, Compensatory sweating.

Primary hyperhidrosis (PH) is a pathological
This a prospective cohort study was carried out on
condition that impacts the quality of life by inducing
60 patients who underwent B-VATS for primary palmar
excessive and uncontrollable sweating in the axillary,
HH. The study was conducted through the period from
facial, palmar, and/or plantar areas [1]. Approximately
March 2022 to March 2023.
2.8% of the population is afflicted with PH, and a
Exclusion criteria: Patients with previous thoracic
positive family history is present in 12.5% to 56.5% of
surgery, effect on intimate relationship, inefficacy of
the patients. [2]. Palmar hyperhidrosis (PmH) is the most
medical treatment, repercussions on social life,
significant form owing to the profound emotional,
repercussions on professional activity, VATS for
social, and occupational consequences it entails.
recurrent HH severe and debilitating primary PmH, and
Sympathectomy was the standard treatment for PH
patient motivation and determination.
patients till 2010 [3]. Following that, oxybutynin
All patients were subjected to full history taking
chloride was administered as the initial treatment option
including smoking, gender, age, body mass index
(BMI), grade of palmar HH by the hyperhidrosis disease
sympathectomy (B-VATS) is the gold standard and
severity scale associated axillary/plantar HH, [8],
most frequently carried out procedure for the treatment
activity level, family history, and preoperative
of PmH. The observed favorable outcomes can be
hyperhidrosis quality of life questionnaire (HQLQ)
attributed, in part, to variables known to impact the
scores [9].
hyperhidrosis, including body mass index, resection
level, preoperative life quality, and the ganglia quantity
experienced general anesthesia via double-lumen
that are resected [5]. In addition, VATS was discovered
endotracheal tubes and the single-lung isolation
to be associated with significant elevations in heart rate
technique. The participants were placed in a semi-
variability, bronchomotor tone disturbances, and
sitting position while maintaining abducted arms.
sympathovagal imbalance. Although these
During the procedure, participants were positioned in a
semi-prone position on both sides, with the ipsilateral
insufficient research has been conducted on their long-
arm abducted and in a mild anti-Trendelenburg
term effects on extremely active individuals [6]. As
position. During monitoring, electrocardiogram,
indicated by a prior randomized investigation, it is
saturation, and blood pressure were measured. Those
probable that these modifications were associated with
patients who were undergoing general anesthesia were
the degree of denervation [7]. We aimed to evaluate the
connected to a double-lumen endotracheal tube for one-
undergoing B-VATS effectiveness in the patient's
lung ventilation. Two-minute incisions, each measuring
treatment with hyperhidrosis.
around 1.0 cm in length, were created in every
Received: 01/10/2023
Accepted: 01/12/2023

Full Paper (vol.941 paper# 15)

c:\work\Jor\vol941_16 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 97-107

Survival Outcomes and Prognostic Factors of
Thymic Epithelial Tumors a Single Center Experience
Hadeer Saber Abd El Rasoul*, Nawal Mohamed El Sayed El Kholy,
Mohamed Saad El-deen El-zahi, Fatma Mohamed Farouk Akl
Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Hadeer Saber Abd El Rasoul, Mobile: (+20)1141404031, E-Mail: hadersaber07@gmail.com

Thymic epithelial tumors (TET) constitute the most common neoplasia in the anterior mediastinum,
although they account for less than 1% of all neoplasms.
Objective: This is a retrospective study conducted to analyze clinic-epidemiological characteristics, prognostic factors,
treatment modality and survival outcomes of patients with thymic epithelial tumors.
Patients and Methods:
All patients diagnosed with Thymic epithelial tumors (TETs) over a period of 10 years (from
2010 to 2019) were reviewed. A clinical sheet was designed for 34 cases, and all clinicopathological data were collected.
Data analysis was performed using both the Kaplan-Meier method and Cox proportional hazards modeling.
Results: seventy-six (76%) of patients presented with thymoma (N: 26) while only 8 patients had thymic carcinoma.
By Masoaka staging system 35.3% of the patients were stage III. Myasthenia gravis presented in 11 patients (32.4%).
Multiple treatment modalities were needed for 22 patients (64.7%) while single modality was used in 12 patients (35.3
%). Twenty-three of the patients (67.6%) underwent surgical resection. Twenty-nine (29%) of the patients received
adjuvant RT.
Conclusion: For patients with TETs, surgery is statistically significant for Overall survival (OAS) prognostic factors
and the Masoaka staging system is the only statistically significant factor of the progression-free survival (PFS)
prognostic factors.
Keywords: Thymoma, Multi-modality treatment, Prognostic factors.

Favorable characteristics like younger age,
Thymic epithelial tumors (TETs) make up less
thymoma histologic type, earlier stage, and higher rate
than 1% of all tumors. The most prevalent kind of TETs
of complete resection status are linked to
are thymomas (1). TETs are the most common neoplasia
paraneoplastic/autoimmune (PN/AI) syndromes (7).
in the anterior mediastinum, despite being rare. They
In 10% of myasthenic cases, thymoma coexists
sporadically develop ectopically, primarily in the neck.
with myasthenia gravis. This is a common combination.
Reaching its height in the fourth and sixth decades (2).
Up until now, there has been no connection between
Thymomas may behave like malignant tumors,
thymic carcinoma and myasthenia gravis (8).
but histologically, they seem to be benign tumors.
Imaging is essential to the treatment of patients
Thymic carcinoma, on the other hand, has more
with thymic carcinoma and thymoma. Imaging plays a
aggressive tumor cells and a propensity to spread (3).
key role in the initial diagnosis, patient staging,
Types A and AB of thymomas are typically
especially for identifying locally invasive disease
regarded as benign tumors, while type B1 is a low-grade
distant and metastases (9).
malignant tumor with a 90% 10-year survival rate; type
For the most part, thymomas can be surgically
B2 exhibits a higher degree of malignancy; and type B3,
resected without a prior diagnosis (10). The standard
which resembles thymic carcinoma in that it has a poor
therapy for TET is still resection, with the desired
outcome being total excise of the tumor and any
Over the past few decades, at least fifteen
affected organs (11).
distinct stage classification schemes for thymic
PORT is advised for thymomas that have not
malignancies have been put up and put into practice.
been fully excised, if stage II or above. Every stage of
The Masaoka-Koga classification is still the most often
thymic carcinoma that shows positive surgical margins
used clinical staging system, nevertheless. A new
should be considered for PORT treatment (12).
categorization for thymic malignancies has been
Neoadjuvant therapy, such as radiotherapy and
proposed by the International Thymic Malignancy
possibly chemotherapy, may be beneficial for patients
Interest Group (ITMIG) and the International
who had locally advanced TET to facilitate complete
Association for the Study of Lung Cancer (IASLC) (5).
excision, enhance local control, and improve survival
One-third to one-half of thymoma patients
(13). Radiotherapy plays an important role in the
exhibit no symptoms, while the remaining third show
management of unresectable locally advanced TET (14).
localized symptoms because of the tumor's
This work was aimed to assess progression free
encroachment on nearby structures. A third of cases are
survival and overall survival and to determine the
unintentionally discovered during radiographic exams
prognostic factors that could influence survival of
done as part of a myasthenia gravis (MG) workup (6).
thymic tumors.

Received: 15/10/2023
Accepted: 15/12/2023

Full Paper (vol.941 paper# 16)

c:\work\Jor\vol941_17 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 108-114

Pneumatic Compression versus Local High-Frequency Vibration Impact on
Nerve Conduction and Balance Performance in Diabetic Polyneuropathy
Mohamed Shawky Eliraqi*1, Hany Ezzat Obaya1, Hussein Ahmed Abo Saleh2,
Hend Abd El-Monaem Abd El-Monaem1
1Department of Physical Therapy for Cardiovascular/ Respiratory Disorder and Geriatrics,
Faculty of Physical Therapy, Cairo University, Egypt
2Department of Endocrinology and Diabetes, El Obour General Hospital, Kafr El Sheikh, Egypt
*Corresponding author: Mohamed Shawky Eliraqi, Mobile: (+20) 01090936189, E-mail: mohamad.shawky1993@gmail.com
One of the most common microvascular complications of diabetes is neuropathy. Objective: This study
aimed to compare the impact of intermittent pneumatic compression (IPC), high-frequency vibration (HFV), and
balance program on nerve conduction velocity (NCV) as well as balance performance in patients with diabetic
polyneuropathy. Patients and methods: Sixty female patients had lower limb diabetic polyneuropathy (DPN). Their
ages ranged from 50 to 60 years. They were randomized into 3 groups of the same number (n=20). The vibration
group received plantar, ankle, and cuff HFV. The compression group received lower limbs IPC, and the exercise
group received the balance exercise program. The trial was for 12 weeks (3 sessions/week). NCV, Toronto clinical
scoring (TCS), and Berg Balance Scale (BBS) were assessed at baseline and after treatment. Result: The study
demonstrated that all the three groups (HFV, IPC, and exercise) had significant improvement from pre- to post-
treatment, with no significant differences among them. The TCS decreased by 17.8%, 11.2%, and 14.8% respectively,
in favor of the HFV group. The percentage of improvement of the BBS was 10.8%, 13.04 and 10.6 % respectively for
the IPC group. The HFV and IPC groups showed better motor and sensory NCV improvement than the exercise
group. Conclusions: The local HVF and IPC have almost the same positive impact on NCV and different quality-of-
life issues for DPN as relieving pain and paresthesia, improving proprioception, and promoting functional balance
better than the exercise group.
Keywords: Functional balance, Intermittent pneumatic compression, Diabetic neuropathy, Motor conduction study,
Sensory conduction study, Local vibration therapy.
this study aimed to compare the impact of lower limb
HFV and IPC therapy on DPN symptoms and patient's
Diabetic polyneuropathy (DPN) is the most widely
quality of life.
prevalent form of neuropathy. DPN in patients with type 2
diabetes affected more than 25%. High blood pressure,
cardiovascular diseases, and depression were found to be
related with longer periods of diabetes and bad glycemic
randomized controlled trial (RCT) was conducted at
control [1]. DPN causes pain and somatosensory nervous
Kafr El-Sheikh General Hospital, Egypt, between May
system lesions. It primarily affects the feet and hands,
and August 2023. Sixty eligible female patients were
reducing Schwann cells, axons, and sensory neurons,
selected after clinical assessment. They were diagnosed
leading to chronic degenerative diseases [2]. DPN is caused
as bilateral lower limb DPN for at least three months,
by endo-neural metabolism changes, poor neurotrophic
aged from 50 to 60 years. Their HbA1c ranged between
support, and decreased nerve blood flow, potentially due
7% and 9%, and all the patients had significant
to oxidative stress [3]. DPN is characterized by severe pain,
decreases in the sensory (sural & superficial peroneal)
loss of ambulation, and balance problems. It is a risk of
and motor (tibial & deep peroneal) lower limb nerve
falling as well as raising the risk of foot ulceration as well
conduction velocity (from 20 to 30 m/s). All the
as amputation [4]. DPN patients often have anxiety,
depression, and other mental comorbidities, which can
patients had scored more than twenty on Norfolk QOL-
worsen pain and treatment response. Sleep disorders and
DN and more than eight on the TCS.
chronic pain are also common, impacting 50% of DPN
Exclusion criteria: Patients with chest diseases,
patients [5]. Vibration therapy has been shown to improve
clinical signs of a severe cardiac event, smoking,
muscle strength, power, proprioception, as well as blood
flow beneath the skin. Studies have indicated that
polyneuropathies (like, alcoholic, hereditary). Patients
vibrating insoles placed on planter feet can improve
with lower limb pathology that may interfere with the
sensation and balance among patients with DPN [6].
results like cellulitis, diabetic ulcer, atherosclerosis, or
Additionally, vibration therapy can accelerate diabetic
deep venous thrombosis. Using a computer-based
foot ulcer recovery [7]. Intermittent pneumatic
randomization program the patients were randomized
compression (IPC) is a therapy strategy using whole-leg
into three groups (n=20) shown in figure (1). The first
sleeves to boost blood flow and improve lower limb artery
group underwent IPC, while the second group received
hemodynamics. It boosts arteriovenous pressure gradient
plantar, ankle, and calf HFV. The control group
and endothelial function [8]. IPC is a common method for
enhancing lower extremity peripheral circulation, with
calf/hamstring stretches. The rehabilitation program
efficient dosages ranging from 90 to 120 mmHg in healthy
was performed by the same physiotherapist for all three
individuals and 120 mmHg for type 2 diabetics [9]. Thus
groups, with blinded evaluation.
Received: 14/09/2023
Accepted: 16/11/2023

Full Paper (vol.941 paper# 17)

c:\work\Jor\vol941_18 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 115-123

Knowledge, Attitude, and Practice of Breast Self-Examination among
Women Attending Primary Health Care Facility in Sharkia Governorate, Egypt
Eman Elshahat Elsayed Orabi
Community Medicine and Public Health Department, Faculty of Medicine, Zagazig University
ORCID number: 0009-0001-6861-4389- Telephone: 01008048, Email: dr.eman.elshahat1@gmail.com

Breast cancer (BC) is the most common cancer among females worldwide. Breast self-examination (BSE)
is accepted, cheap, simple, accessible, non-invasive screening methods for early detection, helping in reducing morbidity
and mortality and improving prognosis of breast cancer.
Aim: Assessments of the knowledge, attitude and practice of women toward breast self-examination to help in the future
reduction of prevalence of breast cancer and promote women health.
Subjects and methods:
A cross sectional study was done on 420 females 20 years old attending primary health care
services in Zagazig district of Sharkia Governorate. Data were collected through structured questionnaire to assess the
sociodemographic data, knowledge, attitude, and practice of women toward breast self-examination (BSE).
The level of satisfactory knowledge, attitude, and practice towards BSE; 24.3%, 27.4% and 22.9% respectively
and it was high among highly educated, professionally working and those with positive family history of BC with
statistically significant association. Most common source of information of women about BSE was mass media (49%) and
(63%) were practicing BSE irregularly. There were statistically significant association between knowledge, attitude, and
Conclusion and recommendation: There was low level of satisfactory knowledge, attitude and practice towards BSE
among participants, and (63%) of those practicing BSE did it irregularly. So, we recommend regular health education
program to all females 20 about BC and importance of BSE in early detection and training them on how to perform it
properly and regularly in simple and clear way.
Keywords: Breast self-examination, Knowledge, Attitude, Practice, Primary Health Care, Sharkia Governorate.

how to correctly do BSE , screening more than 34.7
Breast cancer (BC) is the most common cancer
million women through 3,588 health units and 102
and most commonly diagnosed malignancy in women

worldwide and the leading cause of cancer-related deaths.
hospitals nationwide and suspected cases were provided
In 2020, more than two million women were diagnosed
with proper management freely (5).
with BC, and 685,000 deaths were sick globally. Nearly,
Assessment of women knowledge, attitude and
7.8 million women had been living with BC for the past 5
practice toward breast self-examination can indirectly
years, making it the world's most widespread form of
lead to raise awareness and knowledge and improving
cancer (1). Two important strategies for early detection of
attitude and practice toward breast self-examination
BC include early diagnosis and screening. A key step in
especially among females attending primary healthcare
early detection includes raising awareness of the early
centers as it is the first basic level of contact between them
signs of cancer among health care professionals, and the
and the health care system leading to early detection,
general public (2).
proper management and good prognosis of breast cancer
Breast self-examination (BSE), mammography
(6). Therefore, our study aims to assess the knowledge,
and clinical breast examination (CBE) are accepted
attitude, and practice of women toward breast self-
screening methods for breast cancer. BSE is a process
examination to help in the future reduction of prevalence
whereby women examine their breasts regularly to detect
of breast cancer and promote women health.
any abnormal swelling or lumps to seek prompt medical

attention. It is recommended for females in their 20s to
know how healthy breasts look and feel. It is cheap,
Study design: -A cross sectional study was done.
simple, accessible and non-invasive (3-4).
Target population, site and time: Women were
Egypt has high incidence of breast cancer which
attending the primary health care services in Zagazig
represents thirty-five percent from all cancers affecting
district of Sharkia Governorate during the period from
females. In 2019 the Egyptian Ministry of Health started
June 2023 to October 2023.
initiatives to improve women health through increasing
awareness of women about breast cancer and importance
Sample size calculation was done using (open Epi-Info
of breast self-examination (BSE), training the women on
7.0). Based on data obtained from Central Agency for
Public Mobilization and Statistics, 2017 the overall
Received: 29/10/2023
Accepted: 29/12/2023

Full Paper (vol.941 paper# 18)

c:\work\Jor\vol941_19 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 124-129

Allergic Rhinitis Symptoms, Causes and Treatment among
Medical Students in Basra City
Zainab Najim Abdul-Nabi
Department of Pharmacology ­ College of Pharmacy ­ University of Basrah, Iraq
Phone no.: 00964 7712578885, mail: zainab.abdulnabi@uobasrah.edu.iq, Orcid: https://orcid.org/0000-0002-3520-4201

Allergic rhinitis (AR) is a chronic upper respiratory disorder that has an impact on performance, attendance
at work, and education, and is a growing global health concern.
Objective: The aim of the present investigation was to study the allergic rhinitis in Iraqi medical students and treatment
schedules. Patients and methods: A cross-sectional study obtained through a web-based structured questionnaire was
used to collect both qualitative and quantitative data. 359 peoples with AR have taken part in this study.
Results: The most prevalent bothersome symptoms in AR patients were 72% sneezing, and it's important to note that
females experienced these symptoms with more severity than males. 82% of those observed had allergy to dust, 60%
took loratadine for therapy. 78% preferred tablets as a dosage form and 60% of both males and females used vitamin C
as adjuvant.
Conclusion: It has been determined that medical university students frequently experience allergic rhinitis, with a
slightly higher incidence among females. Sneezing is the common symptom, dust appeared as major allergen and
loratadine was the most used drug by the patients.
Keywords: Allergic rhinitis, Treatment, Causes, Medical students.


Allergic rhinitis is an atopic disorder that causes
Study Design: This cross-sectional population survey
nasal pruritus, clear rhinorrhea, postnasal drip, and nasal
was carried out through the period from December 9 to
congestion as symptoms [1]. One of the most common
December 26, 2022. A web-based structured
chronic diseases globally, it is brought on by immune
questionnaire was utilized to collect both qualitative and
system reactions to inhaled allergens through the
quantitative data for this investigation.
immunoglobulin E (IgE) receptor [2]. Seasonal AR
Participants and eligibility Criteria: Based on earlier
accounts for 20% of cases, perennial AR for 40%, and
investigations, a screening questionnaire form was
mixed AR accounts for 40% of cases. AR can be
created for this aim. In this study, only respondents who
classified as seasonal (intermittent) or perennial
were willing to provide information and were
(chronic) [3].
conveniently available for data collection were included.
There are several risk factors for developing AR,
The study eliminated those who did not feel comfortable
including atopy in the family, male, the presence of
providing information.
allergen-specific IgE, serum IgE levels greater than 100
IU/mL before age 6, and higher socioeconomic class [4].
Data collection, sampling and recruitment:
The cornerstones of managing AR continue to be anti-
All of the respondents were asked to complete this
inflammatory therapies, symptomatic medication, and
survey, which had both closed-ended and open-ended
avoiding allergens [5].
questions. Only the responses to these questionnaires
were employed as the study's data source, and it was
distributed online across telegram groups and other
corticosteroids, leukotriene receptor antagonists, oral
social media. This Arabic-language survey asked for
and topical antihistamines, intranasal anticholinergics,
information like demographic information of the
decongestants, and intranasal cromolyn (Nasalcrom) [6,
participants, allergic rhinitis symptoms, triggers and
7], other treatment option is allergen immunotherapy
medications and their dosage form.
which usually need to be saved for individuals whose
Data analysis: The data were collected, then
best avoidance practices and medication are either
using statistical analysis and using descriptive T-
poorly tolerated or ineffective in controlling their
test, tables and diagrams to display the outcomes
of Microsoft Excel programs for Windows.
Approximately 67% of AR patients have sneezing,
63% have dust allergies, 51% take the second-
generation antihistamine loratadine as a therapy, and
Demographic data: A total of 359 volunteers
41% prefer tablet dosage forms, according to a study
participated in the study; 294 were females (mean age
conducted in Iraq [9].
was 21.94 ± 2.39 years) and 65 were males (mean age
The aim of this work was to study the allergic
was 23.68 ± 3.78 years). According to the results showed
rhinitis symptoms, triggering agents and treatment
at both table (1) and figure (1), there was no significant
schedules in Iraq medical students.
differences in age between males and females.

Received: 20/10/2023
Accepted: 24/12/2024

Full Paper (vol.941 paper# 19)

Maher The Egyptian Journal of Hospital Medicine (January 2024) Vol. 93, Page 130-140
MicroRNA-372 and Long Non-Coding RNA-HULC as Diagnostic
Biomarkers of Colorectal Carcinoma in Egyptian Patients
Laila Mahdi1*. Shaker O2. Nermien E. Waly3. Amal H. Eissa4. Wael Omar5.
Tarik A. A. Hassan6. Nelly Hegazy7. Amel E. Salem8. Marwa Kamel9
1-9 Department of Medical Biochemistry & Molecular Biology, 3 Department of Physiology, 4 Clinical pathology
department (immunology), 5-6 General Surgery department, 7 Public Health and Community Medicine Department,
Faculty of Medicine, Helwan University, Ain-Helwan, Cairo, Egypt.
2 Department of Medical Biochemistry & Molecular Biology,
8 Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
*Corresponding author: Laila Mahdi, Email address: Laila.mahdi@med.helwan.edu.eg, Mobile: +201066615134


Background: Colorectal cancer (CRC) is a significant health issue albeit limited reports from Egypt. Long non-coding
RNAs (lncRNAs) and circulating microRNAs (miRNAs/miRs) have been found to have dysregulated expression in CRC.
Objective: This study aimed to investigate the use of miR-372 and lncRNA-HULC as noninvasive diagnostic biomarkers
for CRC as well as to study the interaction between their expression levels in CRC.
Methods: Using quantitative real-time PCR, the relative expression levels of miR-372 and lncRNA-HULC in serum were
assessed in all study subjects (40 CRC patients and 30 healthy controls).
When compared to controls, serum expression levels of miR-372 and lncRNA-HULC were found to be
significantly higher among CRC patients. According to receiver operating characteristic (ROC) analysis, which is the
most popular approach of reporting the diagnostic accuracy of dysregulated ncRNAs, miR-372 had an AUC (an area
under the curve) value of 0.76, sensitivity of 74.2%, and specificity of 96.4% at 7.8 cutoff point. Concerning lncRNA-
HULC in the current study, AUC was 0.71 with sensitivity of 71.50% and specificity of 83.7% at 8.35 cutoff point.
Conclusions: This study provided evidence that miR-372 and lncRNA-HULC are possible noninvasive diagnostic
biomarkers for CRC. This work is the first that, as far as we know, to demonstrate the correlation between serum relative
expression levels of miR-372 and lncRNA-HULC in CRC. Results of our study showed that high expression levels of
miR-372 and lncRNA-HULC in serum could predict CRC and could distinguish CRC patients from healthy controls.
Keywords: CRC, Noncoding RNAs, MiRNA-372, LncRNA-HULC.


noncoding RNAs (lncRNAs) with a length over 200
One of the most common malignancies of the
nucleotides, are two categories into which these non-
digestive system in the globe is colorectal cancer (CRC).
coding RNAs are divided (5).
The second-leading cause of death in America, after lung
MicroRNAs are small, non-coding RNAs that have
cancer, is colon cancer, which has the fourth highest
an average length of 22 nucleotides (miRNAs/miRs) (6,
incidence (1). Despite the paucity of data, it was
7). Several studies have indicated that miRNAs are either
discovered that CRC is significantly more common in
tumour suppressors or oncogenes in human cancers (8).
Egypt (2).
According to Bartley et al. (9) the miRNA was a
The majority of colorectal cancers are regular type
potential ideal biomarker in CRC and 230 miRNAs were
adenocarcinomas, which can be graded as either tumors
expressed differently in adenoma and CRC (9).
that are weakly differentiated, moderately differentiated,
Additionally, it was discovered that 31 miRNAs were
or well-differentiated 1, 2, or 3. Histologically, it is
either elevated or downregulated in the CRC cases'
further divided into low-grade (50­100% gland
serum (10). Considering its diminutive size, stability, and
development for adenocarcinomas that are well-and
resistance to RNase destruction, miRNA performs better
moderately differentiated), and high-grade for those that
as a molecular marker than mRNA (6, 7). Colorectal
are poorly differentiated (0-49% gland development) (3).
cancer (CRC) and other cancers have been shown to
Since the mechanisms behind the formation of CRC
have dysregulated levels of microRNA-372 (miR-372);
are still unknown, understanding the molecular
nevertheless, its specific function in cancer is yet
underpinnings of colon oncogenesis is vital (1). The
unknown (10- 12).
development of colorectal cancer can be caused by
LncRNAs control the stability & pattern of
mutations in specific genes. Genes involved in repairing
expression of the genome (13, 14).
DNA pathways may exhibit such mutations (4).
A number of malignancies, including CRC, are
There are several non-coding RNAs in the human
prone to carcinogenesis due to nonfunctional lncRNAs (1,
transcriptome. Small noncoding RNAs (sncRNAs),
15). The most increased lncRNA in hepatocellular
which range in size from 18 to 200 nucleotides, and long
carcinoma (HCC) and other cancers is highly
Received: 03/09/2023
Accepted: 07/11/2024

Full Paper (vol.941 paper# 20)

The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 141-147

Empowering Communities: Guillain­Barre Syndrome (GBS)
Awareness and Education in Qassim, Saudi Arabia
Mona Alromaihi1
1Department of Pediatrics, College of medicine, Qassim university, Buraydah 51452, Saudi Arabia
Correspondence: Mona.Alromaihi@qu.edu.sa, ORCID ID: https://orcid.org/0000-0002-0735-9628

Guillain­Barre syndrome (GBS) is the most common acute autoimmune disease of peripheral nervous
system. GBS has received little attention in Saudi Arabia. GBS causes an acute flaccid paralysis that may lead to
respiratory failure. So, it requires early diagnosis and management. GBS is a clinical diagnosis which has no
international criteria and needs a high index of suspension for diagnosis. It is characterized by a heterogeneous group
of clinical presentations that may delay the diagnosis. Objective: this study aimed to conduct an analytical, cross-
sectional study based on the data obtained from the online self-administrated questionnaire about the level of awareness
of GBS presentation in Qassim region. Materials and methods: This study follows an analytical, cross-sectional design,
focusing on data collected through an online self-administered questionnaire to assess awareness of GBS presentation
in Qassim region. The study comprised a randomly selected sample of at least 926 participants.
Results: The study revealed among 926 participants, 112 were familiar with GBS. Younger participants showed greater
awareness. Notably, 62.5% without medical backgrounds knew about GBS. About 75% had personal contact with GBS
patients, possibly influencing their awareness. Misconceptions persisted, with only 19.6% recognizing GBS's typical
onset duration. Urgency was recognized by 61.6%, but only 29.5% identified the ER as the right care setting.
Conclusion: The results unveiled a mix of awareness and misconceptions about GBS. Strengthening education is crucial
for better understanding and management.
Keywords: GBS, Immune-mediated disease, Flaccid paralysis, Respiratory failures, Immunomodulation therapy.

although a complete list of these factors is not yet
Guillain­Barre syndrome (GBS) is a group of
accessible 11. Patients with GBS have been found to be
clinical syndromes that appear as an acute inflammatory
infected with a wide variety of micro-organisms in the
polyradiculoneuropathy with paralysis and decreased
past, but only a select number had a relationship
reflexes 1. It is brought on by the autoimmune
demonstrated in case-control studies. 25-50% of adult
destruction of peripheral nervous system nerves, which
GBS patients, with a higher prevalence in Asia, tested
causes symptoms including numbness, tingling, and
positive for Campylobacter jejuni 8, Cytomegalovirus
weakness that can develop into paralysis 2. GBS is a
(CMV), Ep-stein-Barr virus (EBV), influenza A virus
cause of acute ascending flaccid paralysis in adults and
(IAV), Mycoplasma pneumoniae (M. pneumoniae), and
pediatrics. The incidence rates showed an exponential
Haemophilus influenzae (H. influenzae) 11, 12.
increase, ranging from 0.62 to 2.66 cases per 100,000
Several illnesses have been reported to be
persons across different age groups worldwide.
associated with GBS. GBS has been linked to hepatitis
Variations in GBS prevalence are highly sensitive to
E in patients hailing from the Netherlands and
case detection, case definitions, and sample size 3. There
Bangladesh 4. The initial suspicion of GBS is based
are multiple recognized subtypes of GBS, each with
upon the clinical presentation (Table 1).
unique clinical and pathological characteristics. Twenty
Although there are many different clinical
to thirty percent of cases with GBS have the severe,
manifestations of the disease, the typical sensorimotor
widespread presentation with respiratory failure 4.
type of GBS typically manifests as symmetrical distal
Fewer studies have been conducted and
paraesthesias or sensory loss. This is followed by a
published about GBS in Saudi Arabia and this may be
gradual weakness that starts in the legs and moves up
attributed to regional differences in the availability of
the body to the arms and eventually the cranial nerves 4,
incidence data due to differences in healthcare systems
9. Reduced or absent reflexes are common at the time of
and reporting practices and underdiagnosis as GBS
diagnosis. Most people with GBS reach their maximal
diagnosis may be challenging in mild cases 5-8.
impairment within 2 weeks. Alternative diagnoses
According to prior study, men are substantially more
should be considered in patients who have reached the
likely to develop GBS 3. It can be manifested at any age,
maximum disability within 24 hours of the disease's
but it is more common in adults 9. Children under the
start or after 4 weeks, as the disease can progress
age of five have a higher incidence of the disease 1.
quickly. About 20% of people with GBS require
It is classified as a postinfectious disease because
mechanical ventilation due to respiratory failure. The
roughly two-thirds of patient's report had an upper
involvement of the autonomic nervous system can lead
respiratory tract infection or gastroenteritis before
to cardiac arrhythmias and unstable blood pressure 4, 9.
developing the condition. Immune response against
The weakness can vary from mild difficulty with
peripheral nerve antigens may be triggered by these
walking to nearly complete paralysis of all extremity,
illnesses 4, 10. The causes of GBS have been linked to
facial, respiratory, and bulbar muscles, or sphincter
numerous diseases, immunizations, and other factors,
control problems. Atypical manifestations of GBS may
Received: 01/10/2023
Accepted: 12/12/2024

Full Paper (vol.941 paper# 21)

The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 148-153

Serum Visfatin levels in Ankylosing Spondylitis: Correlation with Disease Activity
Asmaa Hassan El-Meshad*1, Ibrahim Abdallah Elboghdady1, Abeer Abdelhamid Fikry1, Sherin Abdel-Aziz2
Departments of 1Physical Medicine, Rheumatology & Rehabilitation and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Asmaa Hassan El-Meshad, Mobile: (+20)01011135269, Email: asmaahassan181@gmail.com
Ankylosing spondylitis (AS) is a form of spondyloarthropathy (SPA) that is featured by sacroiliac joints
(SIJ), axial skeleton, entheses and peripheral joints inflammation. Non-radiographic axial spondyloarthropathy or nr-
axSPA is a common early sign of AS before developing radiographic sacroiliitis. Visfatin is an adipokine produced in
fat tissue mainly, as well as in skeletal muscle, brain, and hepatocytes. Visfatin has been demonstrated to contribute to
bone homeostasis and it can induce pro-inflammatory responses in different cell types.
Objective: This study aimed to investigate serum visfatin level among AS, nr-axSPA patients and controls and to
elucidate its possible relationship with disease activity.
Patients and methods: This was a case-control study, which comprised 26 AS cases, 26 nr-axSPA cases and 27 healthy
volunteers age- and sex-matched with the patient groups. ELISA was used in measuring visfatin concentration in the
serum of studied subjects. Results: Serum visfatin level was significantly higher in AS and nr-axSPA cases groups in
comparison with control group (p<0.001). There was positive correlation between visfatin with Bath AS Disease
Activity Index (BASDI) (P= 0.032) and (P=0.001), and Bath AS Functional Index (BASFI) (p=0.004) and (p=0.001) in
AS and nr-axSPA groups respectively. There were significant positive correlations between modified Stoke AS Spinal
Score (mSASSS) and visfatin values in AS group (p<0.001). Visfatin concentrations didn't correlate with age, BMI,
disease duration, ESR, CRP and ASDAS-CRP.
Conclusion: Serum visfatin concentration was elevated in cases with AS and nr-axSPA, and it was accompanied by
disease activity, functional impairment and radiographic damage.
Keywords: AS, nr-axSPA, Visfatin, BASDAI, mSASSS.

activity. Of note, the present study is the first to measure
AS has been considered as a chronic immune-
AS Disease Activity Score with CRP (ASDAS-CRP)
mediated arthritis that causes inflammation in the
and to illustrate its correlation to serum visfatin levels
entheses, peripheral joints, and axial skeleton (1). In
in AS and nr-axSpA cases.
more severe situations, inflammation can develop into
calcification and fibrosis, which cause the spine to fuse
This was a case-control study comprised 79
together and lose its flexibility, giving it a "bamboo"
subjects divided into three groups: AS group (26
look and static posture (2). Visfatin is a beneficial protein
patients), nr-axSPA group (26 patients) and control
group (27 healthy volunteers age- and sex-matched with
(NAMPT) enzyme activity and has the capacity to
the patients). The AS cases met the modified New York
enhance the differentiation of B cell (3). Adipokines are
criteria for AS (10), while nr-axSPA cases met the
released mainly by fat cells, they considered as an
Assessment of Spondyloarthritis International Society
important element of the complicated network of
(ASAS) criteria (11). Entire cases were 18 years old or
soluble mediators comprised in the pathogenesis of
chronic immune related and inflammatory disorders as
rheumatic diseases (4).
Exclusion criteria: Patients suffering from diabetes
Adipose tissue, along with other tissues like the
mellitus, osteoarthritis, obesity, cardiac diseases,
liver, bone marrow, and muscles, produces visfatin (5).
malignant tumours or other autoimmune rheumatic
Visfatin promotes the formation of proinflammatory
and anti-inflammatory cytokines in human monocytes,
The following data was gathered: detailed history
including intrelukin-1(IL-1), IL-1Ra, IL-6, IL-8, IL-10,
taking, general and systemic examination, locomotor
and or TNF- (6). It was discovered to be involved in
examination of axial and peripheral joints, laboratory
bone homeostasis via promotion of the osteoblastic
disease activity determinants including ESR and CRP,
proliferation of osteoblasts (7), and hindering
disease activity measures such as the Bath AS Disease
osteoclastogenesis (8). The modified Stoke AS Spinal
Activity Index (BASDAI) (12), the ASDAS (13) and Bath
Score (mSASSS) is one of several scoring techniques
AS Functional Index (BASFI) (14), and imaging
accessible for assessing radiographic spinal destruction
including MRI of SIJ as well as X-ray of SIJ, cervical
in AS (9). This work aimed to evaluate serum visfatin
and lumbar spines were obtained.
level among patients with Magnetic Resonance Imaging
(MRI) and plain x-ray of sacroiliitis (AS group),
Measurement of visfatin serum levels: Blood samples
patients with MRI but without plain x-ray evidence of
were obtained from all participants then centrifuged and
sacroiliitis (nr-axSPA group) and control individuals
serum was frozen at -80 till analysis. ELISA (The kit
and to evaluate their possible correlation with disease
was Sunred Biological Technology Co, Catalog No.
Received: 14/08/2023
Accepted: 16/10/2023

Full Paper (vol.941 paper# 22)

c:\work\Jor\vol941_23 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 154-160

A Comparative Study between Intrathecal Dexmedetomidine vs Ketamine with
Intrathecal Bupivacaine in Orthopedic Lower Limb Surgeries
Ahmed Elsaied Abd Elrahman, Ahmed Talaat Mohammed, Ziyad Ahmed Ali*, Khaled Abdelfattah Mohamed
Department of Anesthesiology, Surgical Intensive Care and Pain Medicine,
Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Ziyad Ahmed Ali, Mobile: (+20)1159596946, E-mail: ziadali467@yahoo.com

Many adjuvants have been used to increase the analgesic duration of intrathecal bupivacaine.
Objective: This work was aimed at comparing intrathecal ketamine vs dexmedetomidine for patients with lower limb
surgery regarding advantages, efficacies, and hemodynamic stability.
Patients and methods: This prospective randomized double-blind study involved 100 individuals whose ages ranged
from eighteen to fifty years, both sexes, who underwent orthopedic lower limb surgeries. All participants went through
an even categorization into two groups: Group D: administering calculated dosage of intrathecal hyperbaric bupivacaine
0.5 % according to body weight and 5g dexmedetomidine and Group K: administering calculated dosage of intrathecal
hyperbaric bupivacaine 0.5 % according to body weight and 0.1 mg/kg of ketamine.
Results: Intraoperative HR as well as MAP measurements were significantly higher during 15 min, 30min, 45min and
end of surgery within group K as opposed to group D (P value <0.05). Postoperative HR, MAP, SaO2 as well as VAS
measurements were significantly less during 30 min, 2h, 4h and 6h within group K as opposed to group D (P value
<0.05). Time to first analgesic request was significantly delayed within group K as opposed to group D (P value<0.001).
Complications (bradycardia as well as hypotension) were insignificantly varied among two groups. Respiratory
depression occurrence was not present in both groups.
Conclusions: Ketamine produces better analgesic outcomes compared to dexmedetomidine in patients with lower limb
surgery. However, it is associated with higher intraoperative HR and MAP and lower postoperative HR and MAP
compared to dexmedetomidine with no difference in complications among them.
Keywords: Intrathecal Dexmedetomidine, Ketamine, Intrathecal Bupivacaine, Orthopedic Lower Limb Surgeries


Proper pain management is of the highest value to
Continuous nerve block methods have become
anyone caring for patients going through surgeries.
more popular recently for treating postoperative pain.
Monitoring pain relief has become a vital essential
Regional procedures are frequently a component of a
measure of postoperative quality, as it offers substantial
multimodal pain management strategy that also
includes pharmacological and nonpharmacological
management is aimed at minimizing or alleviating pain
methods [6].
as well as discomfort while avoiding adverse events [1].
This work was aimed at comparing intrathecal
Numerous medications, involving opioid vs.
ketamine vs dexmedetomidine for those undergoing
nonopioid, with various administration routes such as
lower limb surgery regarding advantages, efficacies,
oral, intravenous, neuraxial, as well as regional were
and hemodynamic stability.
introduced along with patient control approaches

(patient controlled vs." as needed"). Pain alleviation is
proved to be a human right by both the WHO as well as
This prospective randomized double-blind study
the International Association for the study of pain [2].
included a total of 100 patients who underwent
Chronic pain that lowers quality of life is linked to
orthopedic lower limb surgeries under intrathecal
uncontrolled acute pan development [3].
anesthesia and ASA class I and II, attending at
Managing pain properly exhibits benefits,
Department of Anesthesiology, Surgical Intensive Care
involving reduced hospitalization, decreased expenses,
and Pain Medicine, Sohag University Hospitals. This
as well as improving satisfaction. Therefore,
study was conducted between March 2023 to September
postoperative pain control remains a more essential
quality measure [4] .

The need for greater effectiveness and shorter
The patients were of both sexes, whose ages ranged
hospital stay has made anesthesia as well as acute post-
between eighteen and fifty years.
surgical pain control more important for orthopedic

surgeries. Orthopedic anesthesia as well as acute post-
Exclusion criteria: Patients having drug abuse,
surgical control, two anesthesiology subspecialties,
neurological, psychiatric, or neuromuscular disorders,
have got more credit for reducing hospital stays,
chronic pain as well as prior allergies to study
promoting functional recovery and improving patient
satisfaction [5].

Received: 15/09/2023
Accepted: 17/11/2023

Full Paper (vol.941 paper# 23)

c:\work\Jor\vol941_24 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 161-171

Study of the Predictive Value of Neutrophil/Lymphocyte Ratio in
Diagnosis of COVID-19 Infection
Ayman Mohammed Ellehleh1, Mohsen Mohamed Elkhayat1, Reham Salah EL Zaiat2,
Mervat Hussein Kamel Habib1, Ahmed Ragab El-Gazzarah1
Departments of 1Tropical Medicine and 2Clinical Pathology,
Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Mervat Hussein Kamel, Mobile: (+20) 01010096261, E-mail: waleedkhedr1991@gmail.com

Early diagnosis of COVID-19 infection can prevent the lethal clinical course of the disease and
result -instead- in a better outcome. Thus, there was an urging need for rapid and simple laboratory tests for early
prediction of infection that will eventually improve morbidity and mortality of the disease.
The study aimed to assess the predictive value of neutrophil/lymphocyte ratio in the diagnosis of
COVID-19 infection in terms of sensitivity and specificity.
Patients and methods: In this retrospective study, we analyzed the clinical data of 150 participants divided into
three equal groups; 50 patients with a positive reverse transcription polymerase chain reaction (RT-PCR)
oronasopharyngeal swab for SARS-CoV-2 (Group I), 50 patients with non-COVID-19-related fevers and/or
respiratory illness (negative swab and CT chest) (Group II) and 50 healthy controls (Group III).
Results: There was a high statistically significant difference between the studied groups regarding absolute
neutrophil count, absolute lymphocyte count, NLR, CRP and serum ferritin. In this study there was a significant
correlation between NLR and CRP while, there were no significant correlations between NLR and other parameters
like BMI, heart rate, Hb, platelet count and serum ferritin. Thus, the NLR can be considered as a dependable
predictor of COVID-19 infection at a cutoff point of more than 3.06 with sensitivity 61% and specificity 86%
Conclusion: NLR could be a useful, cheap, simple marker for early prediction of patients infected with COVID-19
with cutoff point more than 3.06. NLR could be used as a dependable risk predictor in the diagnosis of COVID-19
infections apart from its cut-off point.
Keywords: COVID-19, Lymphocyte, Neutrophil, NLR, Cutoff point.

well correlated with disease severity and
COVID-19 caused catastrophic effects on the
world's demographics as the disease has a high rate
Several prior research on neutrophils,
of infection and mortality. It was first discovered in
lymphocytes, CRP, serum ferritin, and other reactive
Wuhan, China, in December 2019 as an infectious
proteins in COVID-19 patients have been conducted
disease in which patients suffered from ARDS of
[5-8]. However, nothing is known regarding their
unknown cause [1]. The disease, which was found to
relationship with early illness prediction in Egypt.
be caused by one of beta-corona viruses was
Because of the low cost and ease of access to
considered as a pandemic in March 2020 [2], as the
the neutrophil-to-lymphocyte ratio (NLR), many
virus was of a highly infectious deadly strain [3]. This
researches declared that it could be used as a
new coronavirus can spread from person to person
prognostic factor in different diseases like solid
mainly by aerosol and contact routes [4]. The main
cancer, cardiovascular diseases, chronic obstructive
target for COVID-19 infection was to bind to
pulmonary diseases, rheumatic diseases, traumatic
angiotensin-converting enzyme 2 (ACE2) receptor in
brain injury and hepatic and pancreatic diseases. So,
the host cell membrane so, it can enter the host cell.
it can also be used as a diagnostic factor in COVID -
COVID 19 disease has been rapidly distributed
19 infection [9-12].
around the world and caused a lot of deaths so, many
The aim of the present study was to assess the
countries had to impose quarantine in different places
predictive value of the NLR in the diagnosis of
[5]. The clinical presentation of this disease ranged
COVID-19 infection in terms of sensitivity and
from asymptomatic infection to severe symptomatic
cases with acute respiratory failure, which was lethal

in some cases [6].
COVID -19 affects many systems and organs
Study Design: In this retrospective study we
in the body leading to their failure. It can also cause
analyzed the clinical data of 100 patients. Fifty of
endothelial damage and cytokine storm. The early
them were COVID-19 patients [diagnosed with a
detection of COVID-19 infection has a great effect
positive reverse transcription polymerase chain
on clinical outcome of the patients so there was a
reaction (RT-PCR) oronasopharyngeal swab for
need for rapid available laboratory tests for early
SARS-CoV-2] (Group I; COVID group).
detection of infection. Multiple hematological
Another 50 patients with non-COVID-19-related
abnormalities and acute phase reactants have been
fevers and/or respiratory illness (negative swab and
Received: 17/08/2023
Accepted: 19/10/2023

Full Paper (vol.941 paper# 24)

c:\work\Jor\vol941_25 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 172-179

Imaging of Developmental Malformations Affecting Craniocervical Junction
Ahmed Elghaieb, Ahmed M. Abd El-Kahlik, Ashraf M. Abd-ElRahman, Jehan A. Mazrou
Department of Radiodiagnosis, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*Corresponding author: Ahmed H. Elghaieb, Mobile: (+20)1141491999, E-Mail: ahmedelghaieb@gmail.com

Craniovertebral anomalies assessment is challenging and reaching the accurate diagnosis is the corner
stone for appropriate management.
Objective: The aim of the study was to demonstrate various imaging features of the developmental anomalies
affecting cranio-cervical junction (CCJ) by using CT scan and MRI scans.
Patients and methods: In the Radiology Departments in Mansoura University and Mansoura University Children's
Hospital, 30 patients (16 males and 14 females) participated in this study at different ages with history of CCJ
abnormalities by at least one imaging modality. Those patients underwent careful examination of the previous imaging
scan. Some of the patients were fully diagnosed using MRI only or CT scan. Analysis was performed on the MDCT
and MRI examination.
Results: Arnold Chiari malformation (ACM) type 1 was the most common diagnosis followed by ACM type 2,
tonsillar herniation in 3 cases, MPS, achondroplasia in 2 cases while split atlas, platypesia, Down syndrome and Os
odenoottidum in 1 case each.
Conclusion: Careful radiological examination of the CCJ and understanding of its complicated anatomy is required in
order to reach the proper diagnosis of its lesions.
Keywords: Craniovertebral junction, Developmental anomalies, CT, MRI, Mansoura University.

Inclusion criteria: Both sexes. Patients with
The craniocervical (craniovertebral) junction
accidentally discovered lesion in cranio-cervical
represents the complex transitional zone between the
junction region by at least one imaging modality.
cranium and the spine and comprises a complex

balance of different elements including osseous
Exclusion criteria: 1) Patients with contraindication
structures articulated with synovial joints, intrinsic
for CT scan (Patients with known allergy to sedation.
ligaments and membranes and muscles [1].
Patients with movement disorder that cannot be
Evaluation and assessment of craniocervical anomalies
controlled by sedation). 2) General contraindication for
is challenging and coming to accurate diagnosis plays
MRI scan [(General contraindications as previously
a crucial role in the management. Congenital,
mentioned in CT scan, patients with significant
developmental and acquired anomalies cause atlanto-
deformity not fit for MRI machine (un fit for
axial instability or it can affect the vertebrobasilar
examination by head coil and the gantry),
vascular system [2].
claustrophobic patients and patients who had artificial
Computed tomography scan (CT) and magnetic
implants (cardiac implants, cochlear implants, etc.)].

resonance imaging (MRI) have improved their
Techniques and methods:
technological capability, offering a high quality 3-
Computed tomography:
dimensional visualization of the craniovertebral
MDCT is the primary modality used for screening
junction. CT evaluates bones Very well, but MRI is
patients with suspected carnio-cervical bony
absolute necessary in joint, ligament, vascular and soft
anomalies. All scans are performed on a 128
tissue evaluation [3]. This study aimed to demonstrate
multi-detector, 128 channel CT scanner GE
various imaging features of the developmental
systems). Cervical spine scan is obtained at 0.625
anomalies affecting craniocervical junction by using
mm slice thickness with axial, coronal, sagittal
CT scan and MRI examination.
reformats and 3D reconstruction.

Magnetic resonance image:
This retrospective study was carried out
Images are acquired using a 1.5 T magnet Philips
through the period from July 2020 till August 2023 in
system with 16 channels. The Cervical spine
Mansoura University Hospital and Mansoura
protocol includes sagittal T1WI, T2WI, STIR and
axial T1WI, T2WI and 3D GRE sequences.
Department. 30 Patients were enrolled in this study (16
Sagittal images were obtained using FOV 20cm,
males and 14 females). The patients' age ranged from
slice thickness 3mm with 0.3mm slice gap, while
the first day of life up to the age of 18 years. They
axial images were obtained using 18cm FOV, slice
were referred to Radiology Department from Genetics
thickness 3mm with slice gap 1mm. Sedation [
Clinic in Children's Hospital, Mansoura University
chloral hydrate 5% was used (0.5mg/kg single
and Neurosurgery Department, Mansoura University
All patients underwent the following:

(1) Thorough history taking [The main complaint with
Received: 06/09/2023
Accepted: 07/11/2023

Full Paper (vol.941 paper# 25)

INTRODUCTION The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 180-185

The Role of Lung Ultrasonography as a Diagnostic Tool in
Different Pediatric Lung Diseases in Benha University Hospital
Soha Abdelhady Elgendy 1, Hamada Mohamed Khater 2, Hend Nabil Iraky Hassan 1, Hanaa Ramadan Omar 1
1 Pediatric Department, and 2 Radiology Department, Faculty of Medicine, Benha University
Corresponding Author: Hend Nabil Iraky Hassan, E-Mail: hendn550@gmail.com, Tel.: (020)1032457059

Lung illnesses account for the majority of problems that affect newborns and children, as well as the
main cause of death for children under the age of five. Thus, prompt and precise diagnosis is critical to effective
therapy and better patient outcomes for those suffering from lung conditions. This study aimed to assess the role of
lung ultrasonography as a diagnostic tool in different pediatric lung diseases.
Patients and Methods: This case-control study was conducted at Pediatric Department, Benha University Hospital
during the period from December 2022 to December 2023. It included 120 participants presenting with symptoms and
signs suggesting lung diseases, the average age of the participants was 5.27 years with a standard deviation of 2.21.
Results: Chest X-ray was (100%) diagnostic in different studied lung diseases, except for bronchitis where it was
diagnostic in 69.7% of cases. Chest ultrasound was diagnostic in 84.8% of patients with bronchitis and (75%) of
patients with pneumonia, while it was 100% diagnostic in cases with pneumonia complicated with effusion, collapse,
and pneumothorax. In diagnosis of bronchitis, based on chest radiography (CXR), as a reference standard, US had
overall sensitivity, specificity, and diagnostic accuracy of 100%, 50% and 84.8% respectively. Kappa statistics
revealed significant moderate agreement between LUS and X-ray (kappa =0.582, p<0.001). In diagnosis of
pneumonia, US had overall sensitivity, and diagnostic accuracy of 75% and 75% respectively.
Conclusion: LUS has good sensitivity and specificity in diagnosing and following up common pediatric lung diseases
at least as accurate as chest X-ray.
Keywords: Lung Ultrasonography, Pediatrics, Lung Diseases, Benha.

Pediatricians still face a global issue in the form
The aim of our study was to assess the role of
of lung disorders. Not only in developing nations but
lung ultrasonography as a diagnostic tool in different
also in the West, pulmonary infections are a leading
pediatrics lung diseases.
cause of illness and mortality (1).

The mainstay of pediatric chest imaging remains
to be plain chest X-rays. For the imaging diagnosis of
This cross-sectional study included 120
all disorders, a chest computed tomography scan is
participants presenting with symptoms and signs
regarded as the gold standard. It is neither cheap nor
suggesting lung diseases, collected from Pediatric
accessible in the critical care unit, therefore it must be
Department, Benha University Hospital during the
transported to the radiology department, which could
period from December 2022 to December 2023.
be hazardous. Furthermore, it subjected the patient to

significant ionizing radiation doses (2).
Ethical approval
When it comes to diagnosing some diseases,
Before participating in the study, all
most notably pneumothorax, where ultrasound has a
patients' guardians gave their written informed
sensitivity of 92% compared to computed tomography,
consent. This consent was approved from the
it compares favorably with the scan. Furthermore, it is
Institutional Review Board (IRB), Faculty of
easier and faster than a chest X-ray or CT because it is
Medicine, Benha University. The work has been
easily accessible at the bedside and reasonably priced
completed in compliance with the Declaration of
Helsinki, the World Medical Association's code of
When it comes to the diagnosis and
ethics for human subjects' research.

particularly respiratory distress syndrome and transient
Both sexes, ages between two and twelve,
tachypnea, lung ultrasonography seems to be a more
suggestive histories (fever, cough, sputum production,
successful method. Additionally, lung ultrasonography
dyspnea, and/or pleuritic chest discomfort), and
can distinguish between the causes of premature
general and local physical symptoms suggestive of
newborns who have long-term oxygen requirement,
lung illnesses were the inclusion criteria. Exclusion
which is a useful practical feature. Lung
criteria were; patients or their guardian refused to share
ultrasonography examinations on a regular basis are
in the study, comorbidities other than lung diseases,
crucial for managing pulmonary illness in the NICU (3).
obese patients with thick chest wall, patients with

subcutaneous emphysema.

All patients were subjected to:
Received: 09/06/2023
Accepted: 08/08/2023

Full Paper (vol.941 paper# 26)

c:\work\Jor\vol941_27 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 186-193

A Study on Some Factors Affecting the Preparation of Piroxicam
Nanosuspension Using Hydroxypropyl Methyl Cellulose (HPMC E5)
Rabab Mohammed Noori Hameed, Shaimaa Nazar Abd Alhammid
Department of Pharmaceutics, College of Pharmacy, University of Baghdad, Baghdad, Iraq
Corresponding author: Rabab Mohammed Noori Hameed. E-mail: nrabab37@gmail.com
Piroxicam is nonsteroidal anti-inflammatory drug used for the treatment of inflammatory conditions such as
arthritis. Piroxicam belongs to Biopharmaceutical Classification System (BCS) class II, by its low solubility and high
permeability through the biological membrane. Objectives: This study aimed to improve the water solubility of piroxicam
by formulating it as nanosuspension using hydroxy propyl methyl cellulose (HPMC E5) as a main stabilizer by the mean of
solvent-antisolvent precipitation method. Methods: Different factors were studied and evaluated in an attempt to obtain a
monodispersed nanosuspension formula with lower particle size and optimum stability. Seventeen formulas were prepared
and characterized for particle size, polydispersity index and drug entrapment efficiency percentage.
Results: The results showed that the best formula (F13) has a particle size of (197) nm due to Dynamic Light Scattering
Technique measurements. F13 stabilized by the synergistic effect of hydroxy propyl methyl cellulose (HPMC E5) and
sodium lauryl sulphate (SLS). Conclusion:The poorly water-soluble piroxicam was successfully formulated as
nanosuspension preparation by using an aqueous vehicle, that improved the drug water solubility.
Keywords: Nanosuspension, Piroxicam, Hydroxypropyl methyl cellulose.

Piroxicam powder was purchased from Al Safa
Nanosuspension drug delivery system (NS) represents
Pharmaceutical Industries (SPI), HPMC E5 (Qingdao
Sinocmc Chemicals), poly vinyl alcohol (PVA), sodium
Nanosuspensions are colloidal dispersions of nanosized
lauryl sulphate (SLS), sodium lauryl ether sulphate (SLES)
drug particles stabilized by surfactants and polymers, in
and tween 80 from Alpha Chemika.
which the diameter of the suspended particles is < 1 micron
(1). Nanosuspension is the unique technique for a drug
Determination of piroxicam melting point
molecule with some properties like, a large molecular
The melting point of piroxicam was measured by by
weight and dose, high log P and melting point and also for
DSC. Pure PRX powder wrapped in a flat-bottomed
drugs that have low solubility in both of aqueous and lipid
aluminum pan of the differential scanning calorimeter
media (2).
(Shimadzu DSC-60 plus, Japan). Data collection was
The benefits of nanosuspension is that it is a simple
attained at a heating rate of 10°C/min under nitrogen gas
technique and scale up, that can be used to formulate most
at a flow rate of 40 ml/min (11).
drugs by handling a large dose in a small volume, can be
Determination and Calibration curves of
administered by many routes as an oral, ocular, parenteral
piroxicam: The stock solutions of piroxicam were
and transdermal route with low incidence of side effects
prepared by dissolving 10 mg of piroxicam in 100 mL
and better tolerance by the patients. On the other hand a
deionized water. Serial dilutions were constructed from
stability problems at storage due to an elevation of the
the stock solution of concentration 100 µg/ml.
settling rate of the dispersed nanoparticles. This may arise
Spectrophotometric analysis of samples was done at the
as a major problem with nanosuspension, although this
wavelength of maximum absorbance of piroxicam. The
problem can be avoided by the use of suitable polymers
measured absorbances were recorded and plotted versus
(3). Hydroxy propyl methyl cellulose (HPMC), is the
the respective concentrations (12).
propylene glycol ether of methylcellulose. It is a nonionic,
Preparation of piroxicam nanosuspension (NS):
water-soluble stabilizer, present in various grades such as
The nanosuspension formulas of piroxicam were
E5 and E15, that vary in viscosity and degree of
formulated by solvent anti-solvent precipitation method. The
substitution. Various grades of HPMC are branded by an
organic phase was formed by dissolving10 mg of piroxicam
attached number (4).
powder in (1 ml) of acetone at room temperature with
Piroxicam (PRX) is a non-steroidal anti-inflammatory
sonication for 5 minutes (13). The stabilizers were dissolved in
drug, used in arthritis, gout and other inflammatory joint
(10 ml) of deionized water, also at room temperature with
diseases (5). It showed polymorphism with melting point is
continuous stirring using a magnetic stirrer. The organic
198°C to 201°C (6).
phase dispensed into the aqueous phase in a slow rate (1
Piroxicam belongs to class II with low solubility and
ml/min), by a plastic syringe positioned directly into the
high permeability based on the BCS parameters (7).
aqueous phase with continuous stirring 2in sufficient time to
Arthritis means inflammation of the joints, tissues
evaporate the organic solvent and to precipitate the drug with
surrounding it and other connective tissues (8,9,10)
stabilizers (14). The composition of NS formulas are shown
in Table 1.
Received: 07/10/2022
Accepted: 10/12/2022

Full Paper (vol.941 paper# 27)

c:\work\Jor\vol941_28 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 194-200

Effect of Selected Physical Therapy Program on Heart Rate Variability and
Cervical Angle in Violent Video Game Addict Children
Rowayda R. Rashad*, Naglaa Ahmed Zaky, Mohamed Ismail Attia Elassal
Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Rowayda R. Rashad, Mobile: (+20) 01010042242, E-mail: roudywhite9@hotmail.com

Playing violent games puts the body in a state of stress because of the situation you face. Children neglect
the body reaction, which is severe and, in some cases may leads to death, due to the impairment that happens in vagal
nerve activity, leading to dysregulation of inflammatory processes and cardiovascular disease, also addicting playing
violent video games can affect children's musculoskeletal health especially at the cervical region due to staying in a
fixed position for long times focusing on the screen.
Objective: To determine the effect of selected physical therapy program on heart rate variability and cervical angle in
violent video game addicted children.
Subjects and Methods:
Forty children from both sexes were selected randomly from Cairo schools and were classified
into two equal groups: group A (control group) consisted of 20 school aged children who were also addicted to play
violent video games and group B (study group) consisted of 20 school aged children who were addicted to play violent
video games, and they received selected physical therapy program.
Results: This study found a significant increase in heart rate variability (HRV) of group A compared with that of group
B post treatment (p = 0.001), there was no significant difference in flexion angle between groups pretreatment (p =
0.59), there was a significant increase in extension angle of group A compared with that of group B post treatment (p =
Selected physical therapy program in the form of aerobic exercise combined with relaxation technique
improved the cardiac rhythm and improved neck extension range of motion (ROM).
Keywords: Physical exercise, Aerobic exercise, Diaphragmatic breathing, Heart rate variability, Violent video games,
Cervical spine angle.


Video games, like any other media medium, are
Breathing has a crucial role in the regulation of
classified into many kinds. Around the world, many
many bodily processes. Breathing techniques through
different sorts of video games are played, including
targeted exercises can help avoid cardiac events,
manage anxiety, stress, depression, and post-traumatic
roleplaying, shooter, simulation, sports, and strategy(1).
stress disorder, as well as treat asthma (2). When certain
Violent video games are defined by their main goal
workout approaches are used, HRV and vagal activity
which usually boils down to kill or be killed(2).
improve state-specifically and can eventually result in
Because digital media is becoming more and more
persistent increases in HRV(7).
common, people are becoming more concerned about
This study aimed to determine the effect of selected
its possible negative impacts, such as the chance that
physical therapy program on HRV and cervical angle in
playing video games might become "addictive." (3). An
violent video game addicted children.
assessment of stress levels has been made using heart

rate variability (HRV). Since the autonomic nerve
system (ANS) is impacted by stress, HRV, which is
Study design:
regulated by the ANS, is frequently used as a stress
A prospective randomized controlled trial was
indicator (4).
undertaken at Cairo University Hospitals for three
There have been reports of possible concerns for
successive months from August to October in 2022.
musculoskeletal issues associated with the increased

usage of smart gadgets. The majority of actions on smart
Sampling procedure and recruitment:
gadgets demand the user to extend their arms out in
Inclusion and exclusions:
front of them or to look down sharply, which forces the
Initially, a sample of forty-two children from both
head to go forward. Chronic musculoskeletal
sexes were selected randomly from Cairo schools who
discomfort has been linked to incorrect head and neck
were addict to play violent video games. An
posture. Addiction to smart gadget use might result in
independent person randomly selected numbers from a
neck disability(5).
sealed envelope to divide the 42 participants into two
Maintaining physical fitness can be achieved
groups: group A (control group), which consisted of 20
through aerobic exercise. Physical activity is well
school aged children who were classified as addict to
recognised as being vital to children's growth and
violent video games playing, they did not receive any
development. Children's physical, mental, and social
therapeutic intervention, and group B (study group),
wellbeing can all benefit from regular physical activity
which consisted of 22 school aged children who were
addict to play violent video games, participants in this
Received: 20/08/2023
Accepted: 21/10/2023

Full Paper (vol.941 paper# 28)

c:\work\Jor\vol941_29 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 201-207

Endoscopic Underlay Tympanoplasty Type 1: Ring-Shaped Versus
Wheel-Shaped Composite Cartilage-Perichondrium Graft
Alaa Mohamed Abdelsamie, Mohammed Hussiny Hassan Soliman*, Hossam Eldin Mohammed Abd El Azim
Department of Otolaryngology, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mohammed Hussiny Hassan Soliman, Mobile: (+20)01004085448, Email: dr.elhussiny@gmail.com

Previously a techniques variety have been described and are currently utilized in tympanoplasty type 1,
involving sandwich, underlay, overlay, plugging, rosette and pegging. The operative material and technique choice for
tympanoplasty persists controversial.
Aim: We aimed to evaluate the wheel-shaped cartilage-perichondrium composite graft and functional and anatomical
outcomes of ring in endoscopic tympanoplasty type I for repairing of large and subtotal perforation.
Methods: This prospective comparative study was carried out on fifty chronic suppurative otitis media patients
tubotympaic type with large and subtotal tympanic membrane (TM) perforation. The participants were assigned
randomly into two groups: Group A included 25 patients who were subjected to endoscopic tympanoplasty type 1 ring-
shaped composite cartilage perichondrium graft. Group B contained 25 patients who were subjected to endoscopic
tympanoplasty wheel-shaped composite cartilage-perichondrium graft.
Results: Post-operative pure tone audiometry (PTA) test in ring-shaped graft group was 20.2 ± 2.5, while in wheel-
shaped graft group was 19.36 ± 2.53 with no statistically significant difference (p= 0.244) between the two groups.
Our study found that while both ring and wheel-shaped cartilage-perichondrium composite grafts can
achieve successful graft acceptance, the wheel-shaped graft showed a significantly greater postoperative improvement
in hearing outcomes, a higher rate of TM regeneration, and comparable graft success rates. Additionally, the choice of
graft shape played a pivotal role in optimizing surgical outcomes, particularly in cases with significant perforation size.
Our study highlighted the potential advantages of wheel-shaped grafts in enhancing hearing improvement and TM
regeneration for patients with CSOM.
Endoscopic tympanoplasty, Perichondrium, Perforation, Transcanal.


Tympanoplasty type 1 presently employs a number
shaped cartilage piece positioned peripherally and a
of techniques that were previously described as
perichondrium sheet adhered to it. This particular graft
sandwich, rosette, underlay, pegging, overlay, and
variant possesses the benefits associated with
plugging (1). Material and surgical technique selection
perichondrial grafts, TF grafts, and cartilage­
for tympanoplasty continue to be controversial (2).
perichondrium composite grafts, while excluding their
Furthermore, an extensive grafting materials variety has
drawbacks (8).
been implemented, including allografts, homografts,
We aimed to compare the functional and
and autografts (3). Currently, the most frequently utilised
anatomical outcomes of ring- and wheel-shaped
autografts consist of veins, temporalis fascia
cartilage-perichondrium composite graft in endoscopic
(TF), areolar tissue, periosteum, and perichondrium.
tympanoplasty type I for repairing a large and subtotal
These autografts are applied using either the underlay or
overlay technique (4).

The cartilage application to reconstruct the
posteriosuperior quadrant of the TM has demonstrated
This prospective comparative study included 50
a reduction in the occurrence of recurrent retraction
patients presented in Outpatient Clinic of Benha
pockets due to the rigid nature of cartilage (5). Well
University Hospitals with chronic suppurative otitis
tolerated in the middle ear, the graft is straightforward
media (CSOM) tubotympaic type with large and
to extract from the tragus or conchal bowl.
subtotal TM perforation. The patients were randomly
Nevertheless, the thickness of cartilage has prompted
allocated by sealed envelopes into two groups: Group
criticism regarding its potential impact on hearing
A included 25 patients who were subjected to
outcomes (6).
endoscopic underlay tympanoplasty type 1 ring-shaped
In previous research, endoscopic tympanoplasty
composite cartilage perichondrium graft. Group B
demonstrated superior outcomes in terms of
included 25 patients who were subjected to endoscopic
postoperative recovery and morbidity. Therefore, it may
wheel-shaped composite cartilage-perichondrium graft.
serve as a viable substitute for microscopic
The study duration was 6 Months.
tympanoplasty. Endoscopes may one day be employed

in all ear procedures, including cholesteatoma,
Inclusion criteria: Patients aged above 12 years and
stapedotomy, and cochlear implant procedures (7).
below 60 years old. Patients who had CSOM
A modified cartilage­perichondrium composite
tubotympaic type with subtotal and large sized TM
graft, referred to as a "ring" graft, is comprised of a ring-
Received: 02/09/2023
Accepted: 03/11/2023

Full Paper (vol.941 paper# 29)

ABSTRACT The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 208-214

Ultrasound Versus Conventional Methods (Mallampati Score and
Thyromental Distance) for Prediction of Difficult Airway in
Adult Patient without Anticipated Difficult Airway
Osama Helal Ahmed, Hayam Shaaban Soliman, Sara Yousry Abd Alhameid Zaki*
Department of Anesthesia, Intensive Care and Pain Management,
Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
*Corresponding author: Sara Yousry Abd Alhameid Zaki, Mobile: 01068365114, Email: Sarayousry18@yahoo.com

Unpredictable difficult intubation continues to be a primary reason for morbidity and mortality, and it is
regarded as the greatest obstacle to standard care. Therefore, any tool can enhance airway assessment should be
considered complementary to the conventional clinical assessment.
Aim of the study: Was to determine if the distance from the skin to the epiglottis, estimated by Ultrasound (US), is
useful for predicting laryngoscopy difficulty.
Patients and Methods: This was a prospective, randomized, single-blind clinical study involving sixty patients
undergoing elective surgery while under general anesthesia. Three parameters were utilized to assess the airway prior
to the operation: the thyrohyoid membrane-level ultrasound-measured distance from skin to epiglottis (DSE), the
thyromental distance, and the Mallampati score. The Cormack-Lehane grading system was also used.
Results: Of the 60 included patients, 13 were considered to have difficult laryngoscopy because they showed an
increased thickness in the US-measured distance from the skin to the epiglottis. We established that skin to epiglottis
distance 2.15±0.489 cm could predict a difficult laryngoscopy with sensitivity of 80.85%, specificity of 69.23% and
area under the receiver operating characteristic curve was 0.764. Slight correlation was found between difficult
laryngoscopy and Mallampati score and among thyromental distance and easy laryngoscopy. Mallampati score and
thyromental distance had poor area under the curve = (0.728 and 0.530 respectively).
Conclusion: Our research found a strong link among the skin-to-epiglottis distance and the Cormack-Lehane grade in
the Egyptian population, suggesting that airway US might be utilized to predict laryngoscopy difficulties.
Keywords: Difficult intubation, Mallampati score, Thyromental distance.

patient is in class I. If only the soft palate and the uvula
Unpredictable and difficult intubation is a key
are visible, then the patient is in class III. If only the soft
component to mortality and morbidity, and airway

control is a primary concern for anesthesiologists (1).
palate and the base of the uvula are visible, then the
When administering anesthesia in a clinical setting, it is
patient is in class IV (6).
essential to secure the airway. Complications
New research has demonstrated an association
throughout difficult intubation (DI) might vary from
among difficult laryngoscopy and several US
mild airway edema to potentially fatal occurrences (2).
characteristics, and it additionally utilized the thickness
The American Society of Anesthesiologists (ASA)
of the anterior soft neck tissue to forecast intubation
guidelines describe a difficult airway as a clinical
difficulties (7).
condition when an anesthesiologist with traditional
The persistent misunderstanding of TMD has
training has trouble with either endotracheal intubation
added to the current state of bewilderment and
or face mask ventilation of the upper airway (3).
aggravation around the prediction and comprehension
The structures of the neck and the airway may be
of challenging intubations. Take El-Ganzouri et al.'s (8)
easily seen and assessed with the utilization of US, a
multivariate risk index research as an example, it didn't
non-invasive and fast bedside technology. A number of
include TMD by name, but its data revealed that TMD
US-related measures can be utilized in predicting
accurately predicted 7% of difficult intubation cases
airway difficulty, including tongue thickness, mandible
(93% inaccurate). There was no distinction in TMD
condylar mobility, the thickness of the soft tissues in the
among simple and difficult (problematic) intubations in
anterior neck from the skin to the thyrohyoid membrane
an investigation on morbid obesity and tracheal
and the thickness of the hyoid bone, which is
intubation (9).
undetectable (4).

A straightforward scoring system, the modified
Mallampati classification estimates the available space
Primary outcome: Find out how well US-DSE
for oral intubation by direct laryngoscopy by correlating
can predict which adult cases will have a difficult
the proportion of tongue size to oral aperture (5).
laryngoscopy. Secondary outcomes: Find out how well
If all four parts of the Mallampati scale--the soft
US-DSE predicts difficult laryngoscopy contrasted with
palate, the uvula and the pillars--are visible, then the
clinical airway screening tests like the Mallmpati score
and thyromental distance.

Received: 11/06/2023
Accepted: 10/08/2023

Full Paper (vol.941 paper# 30)

c:\work\Jor\vol941_31 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 215-223

Serum YKL-40 as a Potential Diagnostic and Prognostic Biomarker in Asthma:
Correlations with Exacerbation, Inflammatory Markers, and Disease Severity
Asmaa A.A. Alsharkawy1, Asmaa Ali 2*, Rasha N. Yousef3, Dina Y.Mostafa4,
Dina A. Zaki4, Rasha Monir5, Mai S. Elsheikh5
1Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt, 2Department of Pulmonary
Medicine, Abbassia Chest Hospital, MOH, Cairo, Egypt, 3Clinical and chemical pathology department,
Research institute of medicine and clinical studies, Giza, Egypt, 4Child Health Department,Medical Research and
Clinical Institute, National Research Center, Giza, Egypt, 5Department of complementary medicine
Research institute of medicine and clinical studies, Giza, Egypt
*Corresponding author: AsmaaAli; Phone: 00201003054849;
Email: Asmaa.ali81@yahoo.com, ORCID ID: 0000-0002-7421-5085
YKL-40 is a new marker that plays a role in tissue remodeling and airway inflammatory processes.
Objective: The objective wasevaluatingYKL-40 serum levels in children with bronchial asthma, its predictive value for
asthma exacerbation, and its correlation with other inflammatory parameters.Patients and Methods: 84 patients with
bronchial asthma (34 acute, 50 stable) and 60 healthy children as controls were recruited. YKL-40 levels were measured
using an ELISA kit, analyzing correlations with inflammatory parameters. Results:Serum YKL-40 levels in asthmatic
patients were significantly higher than in non-asthmatic individuals (p < 0.001), demonstrating excellent diagnostic
accuracy; the area under the curve (AUC) was 1. At a cutoff of 11.9 ng/mL, YKL-40 exhibited 100% sensitivity and
98% specificity. Higher levels were observed in patients with exacerbations (p < 0.001) and a history of hospitalizations
or intensive care unit (ICU) admissions (p = 0.03, p < 0.001 respectively). Positive correlations were found with ICU
admissions (r = 0.34, p < 0.001) and inverse correlations with asthma control test (ACT) score (r = -0.62, p < 0.001).
YKL-40 was also associated with inflammatory markers and predicted exacerbations (AUC = 0.73, p < 0.001) at a cutoff
of 20.2 ng/mL (sensitivity 79%, specificity 65%).Conclusion:YKL-40 could serve as a potential biomarker for asthma
exacerbation prediction and may provide valuable insights into disease severity and inflammation.
YKL-40, Severe Bronchial Asthma, Asthma exacerbation, ICU admission.

with specialist care (7). Clinical scientists have observed
Asthma is a complex condition caused by multiple
that improving disease outcomes in asthma involves
factors, characterized by reversible obstruction of the
diagnosing the condition earlier and monitoring it more
airways due to chronic inflammation affecting the
closely with greater sensitivity. It is crucial to find new
bronchi. Bronchial asthma can cause recurring cough
and specific biomarkers that can be used to evaluate and
episodes, wheezing with rhonchi, and difficulty
keep track of lung inflammation in patients with different
breathing, especially during exhalation. These symptoms
levels of asthma control(6-7).
are common across all age groups and are often
Lately, there has been an increasing interest in
accompanied by increased bronchial responsiveness (1).
researching the distinct function of chitinase and
Asthma affects a significant portion of the world's
chitinase-like proteins in the inflammation and alteration
population, with estimates ranging from 1% to 18%. In
of tissues in different human illnesses (8). Gaining
Egypt, the reported prevalence of asthma in school-aged
knowledge about these roles could provide valuable
children is approximately 9%, while 23.2% of infants
perspectives in managing asthma.YKL-40 is a
with wheezy chests are suspected to have airway
glycoprotein that weighs 40 kDa and can bind to heparin.
diseases such as asthma (2). Studies show that bronchial
It is known to attach to chitin, which is a polysaccharide
asthma is the most prevalent chronic illness affecting the
consisting of N-acetylglucosamine, particularly in cells
airways of infants and school-aged children (3). A
that are experiencing inflammation. It is secreted from
multifaceted interplay between genetic factors and
macrophages, smooth muscle cells of blood vessels,
environmental exposures influences the development of
neutrophils, chondrocytes, and cancer cells (9). Previous
asthma in infants. Research indicates that asthma
research has shown its dual role in inflammation and
prevalence is higher in urban areas than in rural areas,
tissue remodeling in human diseases like liver fibrosis,
and environmental tobacco smoke and air pollution are
joint injury, and type II diabetes (10).
believed to be the main contributing factors to the
This study aimed to evaluate the serum levels of
disease (4).Asthma is characterized by bronchial
YKL-40 in children with bronchial asthma, its predictive
inflammation, which significantly impacts its prognosis.
value for asthma exacerbation, and its correlation with
Additionally, structural changes in the epithelium and
other inflammatory parameters.
remodeling, can cause a decline in spirometry
Study design and patient's selection: The current study
parameters (5). However, the pathophysiology of asthma
included 84 patients with bronchial asthma.All data
is multifactorial and complex (6). Despite updated
werecollected from files during routine patient's visits,
guidelines for asthma control, many subgroups and
Pediatrics Pulmonary Follow-up Clinic, Ain Shams
caregivers still struggle with poor asthma control, even

Full Paper (vol.941 paper# 31)

INTRODUCTION The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 224-230

Evaluation of a Clinical Outcome of Resistant Gastroesophageal Reflux
Disease after Treatment with Full Thickness Endoscopic Device
Emam Gamal Abd El Aziz Emam, Ahmed Ali Monis, Ayman Gamil Anwar, Salah Shaarawy Galal*
Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Salah Shaarawy Galal, Mobile: (+20) 01099422172, Email: salahshaarawy2013@gmail.com

The widespread chronic illness known as gastroesophageal reflux disease (GERD) significantly lowers
quality of life (QOL). Additionally, reflux esophagitis and occasionally serious side effects including ulceration,
strictures, Barrett's mucosa, and esophageal cancer can be brought on by gastroesophageal reflux disease (GERD).
Objective: To determine the clinical effectiveness of endosural suturing using a gastroscope in patients with refractory
Patients and methods: This is prospective research that was conducted at Ain Shams University Hospitals'
Gastroenterology Outpatient Clinic and Endoscopic Centre. The research was carried out between September 2019
and December 2020 on 25 adult patients with Hiatus hernia or recalcitrant GERD.
After the procedure, 2 (8%) had heart burn, 1 (4%) had regurgitation, 0 (0%) had asthma, 0 (0%) had chronic cough,
0 (0%) had laryngitis, and 0 (0%) had hoarseness. Regarding the severity of symptoms, there was a highly statistically
significant difference between the pre- and post-treatment periods. In our investigation, we determined that the mean
Hb was 12.89 (± 0.80 SD), the mean RDW was 13.40 (± 0.95 SD), the mean number of platelets (*1000) was 239.76
(± 59.92 SD), and the mean RBCs was 5.19 (± 0.51 SD) based on CBC data. The Gastrointestinal QOL Index showed
a very statistically significant difference between the pre- and post-procedure states. Based on our own research, we
discovered that the difference in Hill's grade before and after treatment was extremely statistically significant.
Conclusion: According to our study, endoscopic suturing of the gastroesophageal junction significantly improves
QOL following the treatment, significantly lessens the intensity of symptoms following the procedure, and
significantly improves reflux management for up to six months.
GERD, QOL, Full Thickness Endoscopic Device.


One of the most common stomach problems is
patients not responding to PPIs, however large
GERD, which is characterised by the reflux of stomach
percentage of patients restart PPI on long term and
and duodenal contents into the esophagus, resulting in
require reintervention (9).
uncomfortable symptoms and consequences that lower
Other adverse effect may occur with antireflux
QOL (1).
surgery such as gas bloating, dysphagia. When treating
Clinical symptoms can include common ones
refractory GERD, endoscopic plication is a less
like heartburn and regurgitation (2), as well as unusual
invasive alternative to laparoscopic fundoplication that
ones including asthma, persistent cough, laryngitis,
has been shown to be an effective and practical method
hoarseness, and otitis media when stomach contents
pass across the upper esophageal sphincter (3). In
The goal of this study was to determine the
addition to impairing the patient's QOL, GERD
clinical effectiveness of endosural suturing using a
increases the chance of developing Barret's esophagus
gastroscope in patients with refractory GERD.
and esophageal cancer (4).

A complicated pathophysiology including
altered reflux exposure, visceral sensitivity, and
This is prospective research that was conducted at
epithelial resistance underlies GERD. Acid reflux
Ain Shams University Hospitals' Gastroenterology
produces symptoms and damages the esophagus (5).
Outpatient Clinic and Endoscopic Centre. The research
The diagnosis of GERD is a challenging
was carried out between September 2019 and
process that involves combining upper endoscopy,
December 2020 on 25 adult patients with Hiatus hernia
esophageal pH monitoring, and clinical symptoms (6).
or recalcitrant GERD.
The management of GERD includes life style

modification such as weight loss, changes in diet and
Inclusion criteria:
sleeping posture (7).
1. Adults (18-75) years old patients from both
Long-term Proton Pump Inhibitors (PPIs)
therapy is one aspect of pharmacological treatment;
2. Patients with typical reflux symptoms despite
nevertheless, it is linked with adverse effects,
treatment with PPI for more than 6 months.
including osteoporosis, small intestine bacterial
3. Resistant GERD.
overgrowth, and renal failure (8).
4. Hiatus hernia of size less than 2 cm.
Antireflux surgery (open or laparoscopic
5. Patients not fit for prolonged use of PPs.
fundoplication) has been suggested for management of
6. Patients not fit for a surgery.
Received: 18/06/2023
Accepted: 17/08/2023

Full Paper (vol.941 paper# 32)

c:\work\Jor\vol941_33 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 231-238

Predictors of Relapse among Inflammatory Bowel Disease Patients on
Biological Treatment in Upper Egypt
Hossam Mahmoud Abdelwahab*, Ashraf Mohamed Elsaghier, Rania S. Gendy, Hussein Elamin
Department of Internal Medicine, Gastroenterology and Hepatology Unit and
Department of Pediatrics, Faculty of Medicine, Assiut University
Department of Gastroenterology and Tropical Medicine, Elmabara Hospital, Health Insurance, Assiut branch
*Corresponding author: Hossam Mahmoud abdelwahab, Mobile :(+2)1146539976,
E-Mail: h.mahmoud@aun.edu.eg, ORCID ID: https://orcid.org/ 0000-0002-8504-527X

Prevalence of inflammatory bowel disease (IBD) is increasing in Egypt. Multiple lines of biological
treatment have been but still there is failure of treatment to these medications and because of high cost it is of great
importance to personalize treatment options.
Aim of the study: This study aimed to assess the factors that can predict the response to biological treatment.
Subjects and methods: This study included 133 patients with IBD who were indicated to biological treatment (Anti-
TNF), and followed up for 2 years. All demographic, clinical laboratory data and disease activity were recorded at 1st
presentation. Patient were classified into 2 groups one group who showed nonresponse to treatment and the other one
who responded well to treatment. All factors were analyzed as predictors of nonresponse using univariate and multiple
Results: Out of 133 patients of IBD, 77 patient showed non-response. Younger age, family history of IBD, long duration
of disease, previous surgical resection and presence of extraintestinal manifestation could be predictors of non-response.
Increased levels of inflammatory markers of ESR, CRP and fecal calprotectin were associated with poor response to
therapy (p value < 0.001, < 0.001 and 0.001 respectively). Moreover, increased activity and colonic extent in UC
associated with nonresponse also marked activity and behavior of CD patients could be predictive factors of relapse. In
multivariable analysis the factors independently associated with non-response were younger age, long duration of
disease, presence of extraintestinal manifestations, elevated ESR and fecal calprotectin.
Conclusions: Multiple disease related factors can be associated and could predict the response to anti-TNF treatment.
Keywords: Inflammatory bowel disease, biological treatment, Anti-TNF, non-response to treatment.

response and are expensive, so it seems to be important
The chronic gastrointestinal illness known as
to study the various predictive factors of reaction to the
inflammatory bowel disease (IBD) is typified by
subset of people with IBD who will also respond to
remission and exacerbations including ulcerative colitis
several targeted medicines with the characterization of
(UC) and Crohn's disease (CD) manifested usually by
individual phenotype and genotype may affect the
bleeding per rectum abdominal pain, fecal urgency and
choice of treatment as old concept of "one drug suits all"
chronic diarrhea and is associated with extraintestinal
should be replaced by the strategy of personalized
manifestation affecting joints, eye, skin and liver (1).
IBD has relapsing and progressive course affecting
So, the aim of this research was to present the
quality of life and contribute to high cost to the health
predictive factors of non-response to biological
care system, so there is a great need for a quick and
treatment as the current data suggest that there are
consistent response from a safe and efficient treatment
multiple factors affecting this, which may be disease
related or clinical and laboratory features. Moreover,
The new biological therapies act upon the molecular
microbiological, metabolic, and pharmacogenomics
pathways included in the pathogenesis of IBD, as it act
elements in addition to local mucosal features could
selectively to inhibit mediators in these inflammatory
have a great influence on response to different
processes (3). Anti tumour necrosis factor agents are
biological treatment.
usually the 1st line biological treatment in IBD include

different agents as infliximab, which is chimeric
monoclonal antibody, adalimumab as human
This was a prospective observational research
monoclonal antibody and golimumab, which is fully
carried out through the period from April 2021 to May
human monoclonal antibody. It improves quality of life
2023 in Assiut University Hospital (IBD Clinic and
by enhancement of mucosal healing and decreases need
Pediatric Clinic). Data collected from 133 patients
for repeated courses of steroid and need for surgeries.
either UC or CD with confirmed diagnosis via
However treatment failure for these agents is not
histopathological analysis and colonoscopy, who were
uncommon. Among IBD patients on anti-TNF therapy,
eligible to 1st line biological treatment by anti-TNF
two thirds showed good first reaction to treatment and
according the guidelines and local protocols (choice of
up to 50% of cases had secondary failure to treatment
the type of anti-TNF guided by nature of the disease,
and may need switch to other class of biology (4). Since
recent protocols, availability of the drug and preference
these different agents of biologics do not have universal
of patients after counseling).
Received: 18/06/2023
Accepted: 17/08/2023

Full Paper (vol.941 paper# 33)

Full Paper (vol.941 paper# 34)

c:\work\Jor\vol941_35 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 247-254
Serum Protein C and D-Dimer as Predictors of Portal Vein Thrombosis in
Cirrhotic Patients without Hepatocellular Carcinoma
Alaa Kandil*1, Samir Kabil1, Seham Gouda Ameen2, Ahmed Mahmoud Mohammed Fouda1
Departments of 1Hepatology, Gastroenterology and Infectious Diseases and
2Clinical and Chemical Pathology, Faculty of Medicine, University of Benha, Egypt,
*Corresponding author: Alaa Kandil, Mobile: (+20) 1062066936, E-mail: alaakandeel104@yahoo.com

Although the exact origin of portal vein thrombosis (PVT) is unknown, many studies have linked it to
systemic factors like protein C, protein S as well as antithrombin III deficiencies. Other studies have linked it to the
elevation of D-dimer and international normalized ratio (INR).
Aim: To evaluate the role of serum protein C, D-dimer and INR as predictors of portal vein thrombosis among
cirrhotic patients without hepatocellular carcinoma (HCC).
Patients and methods
: This cross-sectional study was conducted on 60 cirrhotic patients, 30 cirrhotic patients without
PVT (Group I) and 30 cirrhotic patients with PVT (Group II), who were collected from patients who attended at the
outpatient clinic and inpatient of The Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of
Medicine, University of Benha. Levels of protein C, D dimer and INR were assessed among all participants.
Results: This present study showed that protein C level was lower in group II than in group I. In contrast D-dimer and
INR levels were higher in group II than in group I. Positive correlation was found between D-dimer, INR, alanine
transaminase (ALT), aspartate transaminase (AST), serum creatinine and total bilirubin with severity of liver disease
(Child score) especially with cirrhotic patients with PVT. Negative correlation was found between protein C, platelets
and serum albumin with severity of liver disease (Child score) especially with cirrhotic patients with PVT.
Conclusion: Decreased protein C, increased D-dimer and increased INR were considered risk factors for formation of
PVT among cases with liver cirrhosis. So, it is important to conduct specific imaging techniques in order to confirm
the diagnosis and start treatment early.
: Protein C, D-dimer, International Normalized Ratio, Portal Vein Thrombosis, Hepatocellular Carcinoma.


K-dependent serine protease enzyme protein C,
There are many different types of chronic liver
requiring the cofactor thrombomodulin and the
illnesses, but they all end in cirrhosis. Histologically
endothelium protein C receptor, the risk of thrombosis
speaking, it is a widespread hepatic process that
is already elevated in people with liver cirrhosis, and
transforms normally structured nodules in the liver into
vitamin K antagonist medication may further decrease
fibrous scar tissue. Liver damage can lead to cirrhosis
the level of this naturally occurring anticoagulant (5).
in a matter of weeks or years (1).
D-dimer, which is generated when factor XIII
About 6-8 cm in length, the portal vein branches
cross-links fibrin monomer and plasmin hydrolyzes it,
off from the superior mesenteric vein and the splenic
is a sensitive sign of aberrant coagulation and
vein at the base of the pancreas. It supplies the liver
fibrinolysis and a useful early diagnostic marker for
with roughly 75% of its blood. The portal vein
thrombosis (6).
bifurcates in the porta hepatis, with branches going to
The international normalized ratio (INR) is a
the right and left lobes of the liver to drain into the
time-tested way to evaluate blood coagulation
sinusoids there (2).
When thrombosis develops in the extrahepatic
proaccelerin (V), proconvertin (VI), and X are the
portal venous system, it can spread upstream to the
specific names of these components (Stuart-Prower
superior mesenteric and splenic veins or downstream
factor). In order to achieve hemostasis, the
to the intrahepatic portal vein branches. Five to
aforementioned components work together as part of
twenty-seven percent of cirrhotic patients develop
the extrinsic coagulation pathway. This metric is
portal vein thrombosis. An increased risk of PVT was
frequently utilized in clinical practice by doctors to
revealed in patients with advanced liver cirrhosis, and
assess the risk of potentially fatal hemorrhage. This is
its occurrence may be linked to sclerotherapy and
particularly the case for those on warfarin, have
abdominal surgery, or hepatocellular cancer. Even
vitamin K insufficiency, or have liver disease (7).
though protein C, protein S, as well as antithrombin III
We aimed at this work to evaluate the role of
deficiency conditions have all been linked to portal
protein C, D-dimer and INR as predictors of portal
vein thrombosis, its exact etiology is still unclear (3).
vein thrombosis among cirrhotic patients without
Protein C (PC) is a crucial component of a
hepatocellular carcinoma.
significant natural anticoagulant pathway. It is

generated in the liver and circulates in the plasma (4).
Activated protein C (APC) is formed when the
In this cross-sectional study, total 60 cirrhotic
trypsin-like protease thrombin reacts with the vitamin
patients were included, 30 cirrhotic patients without
Received: 01/09/2023
Accepted: 01/11/2023

Full Paper (vol.941 paper# 35)

c:\work\Jor\vol941_36 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 255-262

Serum Amyloid-A in Behçet's Disease: Relation to
Clinical Manifestations and Disease Activity
Arwa S. Amer*1, Ali Ibrahim Fouda1, Abdel Wahab Shams Eldin Elbrashy1,
Nashwa E. Ahmed2, Hadeel Mohamed Mahmoud1
Departments of 1Rheumatology, Rehabilitation, and Physical Medicine and
2Medical Biochemistry and Molecular Biology, Faculty of Medicine-Benha University, Egypt
*Corresponding author: Arwa S. Amer, Mobile: (+20) 01003611562,
E-mail: arwa.amer@fmed.bu.edu.eg, ORCID ID: 0000-0003-2642-0575
Behcet's disease (BD) is an autoimmune systemic vasculitis with an unknown origin. Recent
discoveries have proven the essential role of Serum Amyloid A (SAA) in the pathophysiology of inflammatory
rheumatic illnesses, including its involvement in the activation of the inflammasome cascade and the recruitment of
interleukin 17-producing T helper cells.
Aim of the work: This study aimed to measure the level of SAA in Behçet's disease and to examine the relation of
SAA levels with disease activity and different organ involvement.
Patients and Methods: This case-control research was done on 30 Behcets' cases which were subjected to history
taking, full clinical examination, and assessment of disease activity by Behcet Disease Current Activity Form
(BDCAF). Investigation in the form of CBC, ESR, CRP, and SAA were assessed.
Results: Serum amyloid-A level was significantly greater in BD cases when contrasted to controls (P<0.001). Higher
SAA was significantly related to the existence of oral ulcers, genital ulcers (P=0.041), eye involvement (P=0.005), and
musculoskeletal manifestations (P=0.049). Skin manifestations, neurologic and large vessel involvements were not
associated with SAA levels (P=0.948, P=0.077, and P=0.198 respectively). Lower SAA was significantly associated
with those who received biologic therapy (P=0.045). Serum amyloid-A levels revealed significant positive
relationships with disease activity (P<0.05) and higher SAA was considered a risk predictor for BD susceptibility
(P=0.002), OR 1.156.
Conclusion: Serum amyloid-A would be a predictor for BD susceptibility and activity. SAA levels are associated
with ocular manifestations and could be a predictor of eye involvement.
Serum amyloid-A, Behçet's disease, Behçet's disease activity form (BDCAF).


been shown to produce extrahepatic SAA by a variety of
Genital ulcers, Oral aphthosis, and sight-threatening
tissues and cell types [5]. This research aimed to measure
ophthalmologic symptoms are the clinical hallmarks of
the level of SAA in BD and to examine the relation of
BD. Repeated attacks of posterior uveitis, pan uveitis,
SAA levels with disease activity and different organ
and/or retinal vasculitis can cause significant impairment
to vision and need for cautious diagnosis and therapeutic

therapy [1]. Moreover, major vessel disease and CNS
problems may further complicate the clinical scenario of
This case-control research was done on Behcet's
these individuals [2]. Skin involvement, such as
cases attending the Inpatient and outpatient clinic of
pseudofolliculitis and erythema nodosum, may also be
the Rheumatology, Rehabilitation, and Physical
present. The assessment of disease activity is presently
Medicine Department of Benha University Hospitals.
dependent on BDCAF, one of the most utilized
Our study population was divided into two groups;
clinimetric scores due to its high dependability amongst
Group I included 30 BD cases and Group II (control
observers [3].
group) included 30 subjects healthy with comparable
age, sex, and social level to the patient group.

apolipoprotein implicated in the acute phase response,
Inclusion criteria: According to the international
and its levels are commonly elevated in several
criteria of Behçet's Disease (ICBD) [6].
autoinflammatory illnesses, both throughout acute
inflammatory episodes and the inter-critical periods [4].
Exclusion criteria: Concomitant inflammatory
Interleukin-6 (IL-6), IL-1, tumor necrosis factor,
disorders, chronic diseases, positive history of
interferon-, and transforming growth factor- (TGF-) are
malignancies, ongoing infections, pregnancy, and
examples of proinflammatory cytokines that induce the
individuals who are obese (demarcated as a body
production of acute-phase SAA. In situations of injury
mass index > 30 kg/m2).

or acute inflammation, the levels of SAA may elevate
Data collection: In this research, patients' data were
dramatically to 1000-fold greater than normal in as little
mostly retrieved through paper-based patient files.
as 5 or 6 hours. Similar to other acute-phase reactants,
Information from patient records was recorded for the
the liver is the primary supplier of circulating SAA.
following factors: disease duration, different organ
Nevertheless, individuals with chronic disorders
involvements (mucocutaneous, eye, gastrointestinal,
including Alzheimer's, cancer, obesity, insulin resistance,
diabetes, metabolic syndrome, and atherosclerosis have
Received: 12/09/2023
Accepted: 11/11/2023

Full Paper (vol.941 paper# 36)

c:\work\Jor\vol941_37 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 263-268

The FASILA Score versus Shock Index and ABC Score to Predict Need for
Massive Blood Transfusion in Patients with Abdominal Trauma
Reem M. Rizk*1, Samir M. Attia2, Ahmed M. Abd-Elmodaber3, Mohamed Elsaid Ahmed1
Departments of 1Emergency Medicine, 2Vascular Surgery and
3General Surgery, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Reem M. Rizk, Mobile: (+20) 01115949597, Email: reem.mamdoh6@gmail.com


Background: Trauma has been demonstrated to be responsible for a considerable number of emergency visits
worldwide. Abdominal trauma participates significantly in the morbimortality of trauma cases. Of note, there were
several studies that evaluated the role of Shock Index (SI) in the context of abdominal traumas. However, fewer
researches only that emphasized on the role of FASILA score.
Objective: To compare these three scoring systems (FASILA Score versus Shock Index (SI) and Assessment of Blood
Consumption (ABC Score)) to detect which is a better predictor for MTP activation in cases with abdominal traumas.
Patients and Methods: This was an observational prospective study conducted on a total of 54 patients admitted to the
Emergency Department (ED) with abdominal trauma. The FASILA score was evaluated in terms of cases with
abdominal injuries, for the initial prediction of massive blood transfusion (MBT) together with being an acronym for
Results: The median SI, ABC and FASILA score were 1.4, 3 and 6 respectively. Cases with MBT were accompanied
by a considerable increase in FASILA score compared to MBT free ones, while SI and ABC demonstrated insignificant
differences between both groups (P>0.05). ABC could be used as a predictor for MBT with a higher sensitivity (Sn) and
lower specificity (Sp). FASILA could be used as a significant predictor for MBT with higher Sn and Sp.
Conclusion: The FASILA score may be used as a promising feasible and simple modality, which predicts the need for
BT and MTP activation, in patients with abdominal trauma.
Keywords: Abdominal Trauma, Massive Transfusion Protocols, Shock Index, FASILA Score.

and the requirement for BT. The incorporations of
Uncontrolled hemorrhage has been considered as
FAST, SI, and serum lactate into a single score (in other
the main preventable etiology of death from trauma all
words FASILA score) could offer a precise, easy
over the world. About 50% of all deaths within the
system, providing better results in comparison with
initial twenty four hours following traumas are owing to
different prediction scoring systems. FAST is a
both exsanguination and coagulopathy [1]. Massive
traditional test, which is conducted to determine free
transfusion (MT) could be described as the BT of at
fluid in the peritoneum in the context of cases with
least ten units of packed red blood cells (PRBCs) in 24
abdominal traumas. According to its results physician
h, is needed in three percent of traumatized cases. MT
could determine the needs for MT [5]. On the other hand,
is often unintentional and needs huge amounts of BT;
no study has compared such preceding scoring systems
on the other hand, it is frequently the distinguishing
in a direct manner to detect which is a better indicator
factor between life and death. Delay in stimulating MT
in the context of MTP stimulation.
protocols (MTP) could negatively interfere with
Aim of work was to compare those three scoring
patients' outcomes; on the other hand, improper
systems (FASILA Score vs SI and ABC Score) to
stimulation could waste resources and incur charges to
determine which was a better predictor for MTP
the organizations. Sustained and proper MTP activation
activation in cases with abdominal traumas.
is still a challenge to whole trauma centers [2].

MTP activation mainly depends on the subjective
evaluation of initial vital signs and the results of
This study was an observational cohort prospective
resuscitative measure. Different scores are suggested to
study on patients who attended and were admitted to the
recognize cases in need of MT. Till now; no general
ED at Mansoura University with abdominal trauma
score has been broadly utilized and well-established [3].
during the period from July 2022 to July 2023. This
A lot of scores utilize several laboratory tests
study included patients aged between 18 to 60 years old
besides physiological and anatomic parameters; on the
from both genders with abdominal trauma, but it
other hand, other scores utilize physiological
excluded any patient younger than 18 years old or older
parameters besides point of care (POC) tests. They
than 60 years old, or pregnant females, or patients with
involve the Assessment of Blood Consumption (ABC)
brain trauma.
score, generally for penetrating traumas, the SI (heart

rate (HR)/systolic blood pressure (SBP)), and the
FASILA score [4].
Every patient was subjected to primary survey
FASILA score is the sum of several variables that
(ABCDE) that included airway maintenance, breathing
involves clinical, physiologic, and laboratory items,
and ventilation, circulation assessment, disability
which are independently valid indicators of mortality
detection, neurologic condition, exposure and
Received: 10/08/2023
Accepted: 09/10/2023

Full Paper (vol.941 paper# 37)

c:\work\Jor\vol941_38 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 269-274

A Study of Comorbid Sexual Addiction in Male Patients with
Substance Use Disorder: Review Article
Ibrahim S. Nayel *, Shorouk F. Abd-Elmaksoud, Waleed E. Elazab, Mohamed M. El-Hamady
Psychiatry Department, Faculty of Medicine, Benha University, Benha, Egypt.
*Corresponding Author: Ibrahim S. Nayel, Email: ibrahimnayel005@gmail.com, Phone: +201228818083

Sexual addiction involves the inability to control one's sexual behaviour. The classification of excessive
sexual behavior as an addiction, compulsion, or impulse control disorder remains debatable due to distinct etiological
models and treatment approaches. Despite, causing significant emotional and behavioral issues, sexual addiction
disorder has received limited attention from clinicians. Recent research highlights a bidirectional relationship between
substance use disorder (SUD) and sexual addiction.
Objective: This review article aimed to examine the occurrence of sexual addiction in patients with substance use
disorder. We hypothesized that patients with substance use disorder have a higher level of sexual addiction when
compared to individuals not suffering from substance use disorder.
Methods: We searched Google Scholar, Science Direct, PubMed and other online databases for Comorbid sexual
addiction, Male patients and substance use disorder. The authors also reviewed references from pertinent literature,
however only the most recent or comprehensive studies from 2010 to February 2023 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
Conclusion: Controversies persist regarding the definition, diagnosis, and treatment of sexual addiction, despite its
substantial impact on affected individuals. Although, limited current data support a correlation between SUD and sexual
addiction, emphasizing the need for further comprehensive research to elucidate this relationship.
Keywords: Comorbid sexual addiction, Male patients, substance use disorder.


Sexual addictive behaviours may include
most recent edition of the diagnostic and statistical
manual of mental disorders (Fifth edition), sexual
pornography use, masturbation, sexual video/chat use
addiction disorder or hypersexuality disorder was
and engagement in sexual fantasy or sexual intercourse.
ultimately excluded [4]. According to Odlaug et al. [5]
Nearly 31% of men suffering from substance use
prevalence of sexual addiction among young adults is
disorder (SUD) are at risk of sexual addiction disorder
2%, and is associated with symptoms of anxiety,
[1]. SUD is defined as having significant psychological,
depression, and a range of psychosocial impairments.
biological, or sociological problems and while
This review aimed to examine the occurrence
persistently contributing to the use of the substance
of sexual addiction in patients with substance use
responsible for these problems. By this model, the
disorder. We hypothesized that patients with substance
patient does not have problems in all three areas, or even
use disorder have a higher level of sexual addiction
two, to be considered substance dependent [2].
when compared to individuals not suffering from
The American Society of Addiction Medicine
substance use disorder.
(ASAM) changed their concept about definition of

addiction to include both substances and behaviors.
Substance Use Disorder:
Many evidences come to uncover the overlap between
Substance use disorder is characterized by the
both behavioral and substance addictions in terms of
excessive use of illicit substances, resulting in negative
clinical expression (e.g. craving, tolerance, and
impacts on one's social, occupational, and academic
withdrawal symptoms), neuro-biological profile,
functioning. Illicit substances that are frequently found
comorbidity, heritability, and treatment. Furthermore,
include sedatives, cannabis, hypnotics, inhalants,
both behavioral and substance addictions share several
anxiolytics, opioids, stimulants and hallucinogens.
characteristics in natural history, phenomenology, and
Substance use disorders are characterized by the
adverse consequences. Such addictive behaviors may
following specific elements: intoxication, abuse and
include gambling, Internet use, video game playing,
psychological/physical dependence [6].
shopping, kleptomania, and sexual addiction [3].
Various substances may be categorized
Sexual addiction is a condition distinguished by
according to their impact on the central nervous
intrusive and repetitive sexual thoughts and fantasies,
system. The effects of these substances vary depending
excessive sexual behaviours, and a lack of control over
on the specific substance, and might range from
one's own sexual desire. This leads to distress and
profound sedation to euphoria and elevated energy.
impairment in one's relationships and social life.
Typically, during the early phases of drug use disorders,
Despite, being proposed as a distinct condition in the
people undergo positive reinforcement, which is
Received: 04/07/2023
Accepted: 05/09/2023

Full Paper (vol.941 paper# 38)

c:\work\Jor\vol941_39 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 275-279

Electroretinography Findings in Patients Treated with Hydroxychloroquine
Amal Khaled Abd Elhamed*, Walid Samir Abousaif, Mohamed Ali Abdrabbo, and Essam El Matbouly Saber
Department of Ophthalmology, Faculty of Medicine, Benha University
*Corresponding Author: Amal Khaled Abd Elhamed, Email: amalkhaled22887@gmail.com, Phone: 0 111 581 9348

Hydroxychloroquine (HCQ) is frequently prescribed for managing rheumatic diseases such as systemic
lupus erythematosus and rheumatoid arthritis. However, prolonged use of HCQ has been linked to retinal toxicity.
Objective: To assess retinal changes in patients receiving HCQ treatment using multifocal electroretinogram (mfERG).
Methods: This cross-sectional study included forty Egyptian patients with a history of one year or more of HCQ intake
for conditions like systemic lupus erythematosus or rheumatoid arthritis. Patients underwent complete ophthalmic
examinations and were subsequently evaluated using multifocal electroretinogram.
Results: There was no statistically significant difference in multifocal ERG abnormalities concerning the age
distribution among the studied patients (P>0.05). However, a statistically significant difference was observed between
mfERG abnormalities and the duration of HCQ treatment (P<0.05). Notably, patients with paracentral depression had
the longest treatment duration.
Conclusions: The study findings indicate that multifocal ERG serves as a valuable screening tool for early detection of
HCQ retinopathy, detecting signal depression, primarily in the paracentral region, in patients treated with HCQ for over
5 years. Importantly, even visually asymptomatic patients with no fundus abnormalities may exhibit abnormal results
on mfERG.
Keywords: Electroretinography, Hydroxychloroquine, Multifocal Electroretinogram.


Hydroxychloroquine (HCQ) is a derivative of
abnormal results of mf ERG in patients treated with
chloroquine used primarily for rheumatologic
HCQ. The study was performed over one-year period
conditions like lupus and arthritis [1]. Its expanding use
January 2022 to January 2023.
includes dermatological disorders and pediatric

inflammatory conditions. HCQ has shown benefits in
Ethical considerations:
reducing diabetes, thrombosis risk, and preserving renal
The study was done after being accepted by the
function in lupus patients [2].
Research Ethics Committee, Benha University
Administered orally as a 200 mg sulfate tablet,
(Approval code: MS-98-10-2021). All patients
HCQ reaches peak concentrations within 3­5 hours. Its
included in this study provided written informed
retinal toxicity mechanism involves inhibiting retinol
consent prior to their enrolment. The consent form
uptake, leading to potential visual cycle disruption and
explicitly outlined their agreement to participate in
RPE permeability [3].
the study and for the publication of data, ensuring
Long-term use can cause HCQ retinopathy due to
that their confidentiality and privacy would be
accumulation in ocular tissues, affecting retinal and
protected. This work has been carried out in
photoreceptor cells. Screening for retinal toxicity is
accordance with The Code of Ethics of the World
recommended after 5 years of therapy or earlier if
Medical Association (Declaration of Helsinki) for
additional risk factors are present, as per American
studies involving humans.
Academy of Ophthalmology guidelines [4, 5].
The patients included in the study were adult
Multifocal electroretinography (mfERG) stands out
patients over 18 years. Both sexes were included.
as a sensitive test for detecting early HCQ-related
Patients with rheumatic disease as rheumatoid arthritis
retinal changes, surpassing other tests like visual field
and systemic lupus erythematosus. Patients treated with
analysis, autofluorescence, and Optical Coherence
HCQ for 1 year duration or more.
Patients with refractive error spherical equivalent >
electrophysiological alterations preceding visible
4.00 diopter, patients with elevated intraocular pressure,
retinopathy, making it crucial for early detection [6-8].
previous eye surgery, previous ocular inflammations or
The goal of this study is to evaluate retinal changes
trauma, systemic vascular diseases, patients with renal
in patients treated with HCQ using mfERG.
disease, patients with diabetes mellitus, patients who

refused to participate in the study and uncooperative
patients were excluded.
This cross-sectional study involved forty Egyptian
individuals with a history of one year or more of
All patients were allocated to history taking
hydroxychloroquine intake due to rheumatic diseases
involving: Personal history: Name, age, sex, residence
like systemic lupus erythematous or rheumatoid
and occupation. Past history: history of previous
arthritis selected from Department of Ophthalmology at
medical illness, history of wearing glasses, history of
Benha University Hospital. This study evaluates the
previous ocular investigations. Present history:
Received: 03/07/2023
Accepted: 04/09/2023

Full Paper (vol.941 paper# 39)

c:\work\Jor\vol941_40 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 280-284

A Study of Plasma Neurotrophin 4/5 Level as a Biomarker in
Bipolar Disorder Patients during Manic Episode
Hussien E. El Sheikh, Mohamed M. El-Hamady, Hisham M. Al Sayed,
Nehal M. Barhoma * and Marwa M. Dahroug
Department of Psychiatry, Faculty of Medicine, Benha University, Benha, Egypt.
*Corresponding Author: Nehal Mohamed Abdel Hamid Barhouma, Email: nehalbarhoma@gmail.com Phone: 01026505539

Bipolar disorder (BD) is characterized by mood swings involving both manic and depressive symptoms.
The absence of confirmed biomarkers for BD results in its diagnosis and management being primarily empirical.
Neurotrophin 4/5 (NT-4/5) has garnered attention in mood disorder research due to its involvement in neuronal processes
and association with antidepressant effects.
Objective: To compare NT 4/5 levels between bipolar disorder cases during manic episodes and a control group, while
also exploring correlations between NT4/5 levels and various clinical parameters.
Subjects and Methods: The study examined thirty (30) bipolar patients and thirty (30) healthy controls matched for
age and sex. Structured Clinical Interview for DSM (SCIDI) confirmed the diagnosis of bipolar disorder, supplemented
by assessments using the Young Mania Scale. Plasma NT4/5 levels were measured in both groups.
Results: Bipolar patients experiencing manic episodes, whether mild, moderate, or severe, exhibited significantly lower
plasma NT-4/5 levels compared to healthy controls (p<0.001). Moreover, moderate and severe cases showed notably
lower NT 4/5 levels compared to remitted cases (p=0.014, p=0.001 respectively). No significant differences were
observed between remitted bipolar cases and controls.
Conclusions: Lower NT 4/5 levels were suggested as an independent risk predictor for bipolar disorder development,
while higher NT 4/5 levels were suggested as an independent predictor for bipolar disorder remission.
Conclusions: Plasma Neurotrophin 4/5, Biomarker, Bipolar Manic Episode.

Bipolar disorder is estimated to affect
This is a comparative cross-sectional study
approximately 3% of the general population [1]. The
conducted on thirty (30) bipolar patients during manic
disorder is characterized by successive periods of
episodes and thirty (30) healthy controls, matched for
elation (mania) and depression interspersed with
age, sex, residency, marital status, and occupational
periods of euthymia, an asymptomatic phase in which
status. Patients were recruited from Benha Mental
patients are in clinical remission [1].
Hospital. Recruitment and data collection took place
Shorter periods of euthymia between relapses are
from November 2016 to November 2018 until the
associated with poorer functioning, increased odds of
required sample size was achieved. SCIDI was utilized
for confirming the diagnosis of bipolar disorder,
hospitalization [2]. A major research goal is thus to
excluding comorbidities, and ruling out any psychiatric
identify predictors of upcoming relapse in order to
disorders in both cases and control groups. Further
facilitate timely treatment [3]. Yet, predicting relapse
assessment involved the use of the Young Mania Scale.
using existing clinical diagnostic tools or demographic
Additionally, blood samples were collected from all
information has proven largely ineffective in bipolar
participants to assess the plasma level of NT 4/5.
disorder [4].
Participants were informed about the potential
The etiopathogenesis of BD is multi-faceted with
academic use of the obtained data. The study included
genetic, environmental and psychosocial factors
both genders aged between 18 and 50 years. Patients on
playing a role; also the diagnosis and management of
psychotropic medications were included if the dosage
BD are purely on empirical grounds as we lack
had not been adjusted in the past week. Exclusion
confirmed biomarkers for this condition [5]. NT-3 and
criteria involved individuals under 18 or over 50 years
NT-4/5 have also become a focus of investigation in
old, currently pregnant or lactating females, patients
mood disorders because of their role in neuronal
with severe cognitive impairments hindering brief
processes and association with antidepressant actions
psychiatric interviews, those with comorbid psychiatric
disorders or experiencing a current depressive episode,
Thus, the aim of the current study was to evaluate
individuals with comorbid medical disorders (such as
the levels of neurotrophin 4/5 in bipolar disorder during
seizures, major head trauma), major illnesses (like
manic episodes and to assess the relation between its
cancer, IHD, renal or liver failure), endocrine diseases
level and severity of bipolar disorder measured by
Young Mania Rating Scale. Moreover, to try to find if
disorders), and neurological conditions that could
neurotrophin 4/5 has a predictive or prognostic value.
impact mood.

Received: 02/07/2023
Accepted: 03/09/2023

Full Paper (vol.941 paper# 40)

c:\work\Jor\vol941_41 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 285-290

The Additive Value of Cardiac MRI in Cases of Cardiomyopathy
Shaimaa Abdelhamid Hassanein, Ahmed Hussein Shehata Elsobky*,
Elsayed Elmekkawy Elsayed, Yasmin Hosney Hemeda
Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Ahmed Hussein Shehata Elsobky, Mobile: (+20) 01000104072, E-mail: ahmedelsobky10@yahoo.com

Worldwide, myocardial diseases are major contributors to patient morbidity and death. Cardiovascular
Magnetic Resonance (CMR) has gained recognition as a useful clinical technique that may evaluate ventricular function
and volumes, myocardial fibrosis, iron loading, flow measurement, tissue characterisation, and myocardial perfusion
imaging all in a single scan scenario.
Objective: This study aimed to identify the role and diagnostic potential of cardiac magnetic resonance imaging to
diagnose cardiomyopathy.
Patients and methods: A cross-sectional study that was conducted through the period from October 2020 to May 2022
at Radio Diagnosis Department, National Heart Institute. The study involved 50 patients who had clinical suspicion of
cardiomyopathy. They were referred from Cardiology Department. The mean age of patients was 57.42 ± 6.45 years.
Results: There was a significant difference between Echo and Cardiac MRI regarding ejection fraction and end diastolic
volume among the studied patients. Also, EF% was significantly higher with cardiac MRI (45.60 ± 8.12%) compared
to Echo (43.00 ± 7.49%), with a mean difference of 2.60 ± 2.42%. Furthermore, EDV/ml was significantly higher with
cardiac MRI (161.54 ± 48.14 ml) compared to Echo (158.50 ± 46.38 ml), with a mean difference of 3.04 ± 5.26 ml.
Cardiac magnetic resonance technique was more accurate for diagnosis among patients suspicioned of
cardiomyopathy compared to echocardiography.
Keywords: Echocardiography, Cardiomyopathy, Hypertrophic cardiomyopathy, Magnetic resonance imaging.


With an incidence of 1:500 in the general
A cross-sectional study that was conducted
population, hypertrophic cardiomyopathy (HCM) is the
through the period from October 2020 to May 2022 at
most prevalent hereditary cardiomyopathy (1, 2). The
Radio Diagnosis Department, National Heart Institute.
symptoms of HCM include myocardial fibrosis,
The study involved 50 patients who had clinical
coronary microvascular dysfunction, myocardial fibre
suspicion of cardiomyopathy. They were referred from
disarray, and unexplained, typically asymmetric left
Cardiology Department. The age of patients ranged
ventricular (LV) enlargement (3).
from 39 to 84 years.
Even with an autosomal dominant mode of

transmission, penetrance is age-dependent and
Inclusion criteria: Patients of both sexes who had
imperfect, and phenotypic manifestation is very varied
clinical suspicion of cardiomyopathy on basis of
echocardiography, ECG changes, ages of patients
Currently, over 1400 mutations are affecting
ranged from 39 to 84 years.
different sarcomere components have been shown to be

the cause of this cardiac condition (5). Most HCM
Exclusion criteria: Congenital heart disease, patients
patients have a lifetime that is almost normal, and the
presenting with myocardial masses not related to
condition's natural history is often benign (6, 7). However,
cardiomyopathy, pericardial diseases and masses,
a number of individuals suffer with limited symptoms
patients with allergy to gadolinium contrast media and
and unfavourable outcomes as a result of ventricular and
history of renal disease, individuals with pacemakers or
supraventricular arrhythmias, myocardial ischemia,
systolic and/or diastolic heart failure, and sudden
cardiac death (8).
fibrillation, contraindications for MR imaging, patients
In HCM, cardiac imaging continues to be the
who had one or more of absolute or relative MRI
mainstay for clinical diagnosis and treatment
contraindication such as electronic, magnetic,
recommendations (9).
mechanically activated implants and cochlear implants
Due to its broad availability and inexpensive
and examinations markedly compromised by motion
cost, traditional 2-D transthoracic echocardiography
(TTE) has been the primary imaging modality for

evaluation of patients with HCM for decades (10).
All study participants were subjected to the
Nonetheless, CMR has demonstrated more penetration
following procedures:
in clinical practice in recent years (11). So, the aim of the
Thorough history taking, which included personal
current study was to identify the role and diagnostic
history (Age, sex and past history included chest pain
potential of CMR imaging to diagnose cardiomyopathy.
and other cardiac related symptoms). Physical and

general examinations were carried out by our colleague.
Received: 05/07/2023
Accepted: 06/09/2023

Full Paper (vol.941 paper# 41)

c:\work\Jor\vol941_42 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 291-299

Systemic Review of Community-Based Interventions for Preventing
Chronic Diseases in Preventive Medicine Practice: Review Article
Saud Alhuwayfi1 , Abdulrahman Alwakeel1 , Ahmad Saud Alhuwayfi 2, Aram Alhuwayfi3
1 Department of Preventive Medicine, Ministry of Health, Tabuk, Saudi Arabia.
2 King Salman Medical City, Al Madina, Saudi Arabia.
3 Al Rayan Medical College
Email: Saud.alhuwayfi@gmail.com Phone: 00966539535590
Community-based interventions are methodical endeavors carried out at the community level to elevate
health status and mitigate risk factors. These interventions entail the collaboration of community members, local
organizations, and medical professionals to foster awareness of health, facilitate modifications in behavior, and create
conducive conditions. They frequently encompass a wide array of tactics, including educational programs, modifications in
lifestyle, and alterations in the environment. Community-based interventions have a vital role in preventing chronic diseases
in the realm of preventive medicine.
Objective: This review article aimed to through the light on the importance of the community-based interventions for
prevention of chronic diseases.
Methods: The search was performed on scientific databases including the Cochrane Central Register of Controlled Trials
(CENTRAL) of the Cochrane Library, Elsevier, National Library of Medicine (Pubmed), Frontiers, Research Gate, Scopus,
Pubmed Central (PMC), and Google Scholar. The search for this article utilised many medical subject headings such as
"prevention," "community-based intervention," "chronic diseases and mortality," "prevention of morbidity," "education
intervention and diabetes," and "education in young adults," among others. The main strategies encompass health education
and awareness campaigns, initiatives to promote physical activity, programs focused on nutrition, efforts to help individuals
quit smoking, programs for screening and early detection, collaborations between communities, advocacy for policy changes
and environmental modifications, social support programs, telehealth services and technology-based interventions, and
customization based on cultural factors. English-language peer-reviewed research ensures the maintenance of academic
rigor and comprehensive incorporation of intellectual contributions. The analysis incorporated research conducted between
2010 and 2023. Research conducted in languages other than English, for which translations are not available, was excluded.
Conclusion: Evidence has shown that community-based therapies are successful in improving metabolic control, reducing
diabetic secondary complications, and optimizing glycemic control in persons with Type 2 diabetes mellitus. Research has
shown that peer support was successful in improving diabetes management and dietary behaviors, especially in
geographically isolated regions. Research demonstrated that interventions implemented within communities proved to be
efficacious in diminishing the prevalence of cardiovascular illnesses and managing hypertension. Nevertheless, these
interventions encountered obstacles such as logistical, socio-cultural, sustainability and measurement and evaluation of
difficulties that must be resolved to ensure their long-term viability and effectiveness.
Keywords: Community-based interventions, Prevention of chronic diseases, Prevention, Community intervention, Risk


Community-based interventions for avoiding
appropriate, pertinent, and customized interventions,
chronic diseases are systematic initiatives implemented at
which promote a sense of collective responsibility and
the community level to enhance health and reduce risk
empowerment amongst members of the community (3).
factors. These interventions entail the cooperation of
Community-based interventions are a crucial
community people, local organizations, and medical
component in the prevention of chronic diseases within
personnel to promote health consciousness, enable
the field of preventive medicine. These treatments
changes in behavior, and establish settings that provide
prioritize the mitigation of risk factors, the
support (1).
encouragement of health-promoting behaviors, and the
Their method frequently involves the utilization of a
diverse range of strategies, such as educational initiatives,
communities. Primary approaches encompass health
adjustments to one's lifestyle, and alterations to the
education and awareness campaigns, physical activity
surrounding environment. These treatments primarily aim
initiatives, nutrition programs, smoking cessation efforts,
to enhance knowledge and understanding of beneficial
screening and early detection programs, collaborations
habits, advocate for a healthy lifestyle, and enact
modifications to the existing systems (2). Community
environmental modifications, social support programs,
engagement is essential for implementing culturally
Received: 28/6/2023
Accepted: 29/8/2023

Full Paper (vol.941 paper# 42)

c:\work\Jor\vol941_43 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 300-304

Single Versus Double Dose Tamsulosin for Patients with Moderate or
Severe Lower Urinary Tract Symptoms due to
Benign Prostatic Hyperplasia: Prospective Randomized Study
Ahmed Mohamed El-Sayed Ahmed Hassaan*, Baher Mohamed Abdel Raouf Salman,
Mohamed Abdelgaber El Sayed Selim, Osama Abdel Wahab Abdel Gawad, Mohamed Sayed Ahmed Aziz
Department of Urology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Ahmed Mohamed El-Sayed Ahmed Hassaan,
Mobile: (+20) 01099323264, E-mail: ahmedhassane166@gmail.com

As men age, the prevalence of lower urinary tract symptoms (LUTS) linked with benign prostatic
hyperplasia (BPH) rises. By the time they are 70 years old, almost 80% of men have been found to have BPH-related
LUTS. LUTS, such as incomplete urination, frequency, urgency, nocturia, and reduced urine flow, appear in patients
with BPH.
Objective: We aimed to evaluate the efficacy and safety of single versus double dose of tamsulosin 0.4 mg for treatments
Patients and methods: A double-blinded randomized controlled trial was conducted in the Outpatients Clinics for BPH-
associated moderate and severe LUTS. Patients were randomized to receive single dose tamsulosin 0.4 mg capsule (1st
group n = 33), and double dose tamsulosin 0.4 mg capsule (2nd group n= 32). The primary endpoints were the changes
in International Prostate Symptom Score (IPSS), Uroflowmetry and PVR urine volume before starting the study, after
one month and after 3 months of the treatment.
Results: Total IPSS was more decreased (improved) in double dose tamsulosin 0.4 mg group than single dose tamsulosin
0.4 mg group, with P-value = 0.005 at one month follow up and 0.007 at three months follow up, which was statistically
significant. However, dizziness was more frequent in double dose tamsulosin 0.4 mg group than in single dose
tamsulosin 0.4 mg group (with P = 0.03 at one month follow up and P= 0.01 at three months follow up), which was
statistically significant.
Conclusion: Tamsulosin single and double doses had equal effects, safe, and well tolerated in the target BPH population.
However, tamsulosin double doses was statistically superior to single dose in improving IPSS scoring. On the other
hand, tamsulosin double doses had statistically significant adverse effect in the form of dizziness.
Keywords: Benign prostatic hyperplasia, Tamsulosin, Lower urinary tract symptoms.


Men's LUTS is frequently caused by BPH. The
Between March 2022 and December 2022, a
pathophysiology of BPH involves both active and
double-blinded randomized controlled trial was
passive pressures in the prostatic tissue. Although the
conducted in the Outpatients Clinics of Menoufia
adrenergic nerve system has been shown to govern
University Hospitals.
active smooth muscle tone, it is unknown what elements
A total of 65 patients suffering from BPH-
ultimately decide the prostate's passive tone (1).
associated moderate and severe LUTS, were
randomized to receive single dose tamsulosin 0.4 mg
endogenously generated noradrenaline from acting on
capsule (1st group = 33), and double dose tamsulosin 0.4
the prostate's smooth muscle cells, which lowers BOO
mg capsule (2nd group = 32). Three and two patients
and prostate tone (2).
from the first and second group respectively, lost follow
Alpha1-blockers usually result in a 30­40%
reduction in IPSS and a 20­25% rise in Qmax. Alpha1-

blockers showed up to a 50% improvement in IPSS and
Inclusion criteria: Patients suffering from BPH-
a 40% rise in Qmax in another experiment (3).
associated moderate and severe LUTS (IPSS ranging
Nonetheless, the preferred medication for
from 8 to 35) and had normal PSA ( 4 ng/dl).
LUTS related to BPH (LUTS/BPH) is an -blocker.

Three subtypes of the alpha 1-adrenoceptor exist: 1a,
Exclusion criteria: Patients with congenital or acquired
1b, and 1d. Of these, 1a is the most common in
urethral stricture and neurogenic bladder or bladder
patients with BPH, accounting for up to 85% of cases.
cancer. Also, patients with elevated PSA ( < 4 ng/dl ),
Alpha-blockers relieve LUTS/BPH by relaxing the
history of previous prostate surgery, complicated BPH
smooth muscles of the prostate (4).
either with hematuria, stones, diverticulum, refractory
In this trial, we aimed to evaluate the efficacy
urinary retention and patients with upper urinary tract
and safety of single versus double dose of tamsulosin
pathology were excluded in this trial.
0.4 mg for treatments of LUTS/BPH.

Received: 16/07/2023
Accepted: 17/09/2023

Full Paper (vol.941 paper# 43)

c:\work\Jor\vol941_44 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 305-310

Serum Levels of Interleukins 6 And 8 In Malnourished Children with
Acute Diarrhea: A Case-Control Study
Ashraf Abou-Taleb1, Rania Bakry2, Moataz M. Hassan1, John S. Shaker1,
Elsayed Abdelkreem*1, Mohamed Kassem1
1Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
2Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
*Corresponding author: Elsayed Abdelkreem, Mobile: (+20) 1114232126,
Email: d.elsayedmohammed@med.sohag.edu.eg, ORCID ID: 0000-0002-8976-2989


Background: Acute gastroenteritis continues to be a prevalent global health issue among children. The release of
interleukin-6 (IL-6) and interleukin-8 (IL-8) from the gastrointestinal tract's epithelial cells is essential for protection
against mucosal infections because it triggers the body's inflammatory reactions to infectious pathogens both locally
and systemically.
Objectives: To investigate serum levels of IL-6 and IL-8 in malnourished children with acute diarrhea.
Patients and Methods: A case-control study that included three groups of 30 children each: children with severe acute
malnutrition (SAM) and acute diarrhea (SAM-AD), well-nourished children with acute diarrhea (AD), and healthy
controls (HC). Participants underwent clinical evaluation and routine laboratory investigations. Serum levels of IL-6
and IL-8 were measured within 72 hours of diarrheal onset using Luminex Human Premixed Multi-Analyte kit.
Results: Serum level of IL-6 in the SAM-AD group (median 1.0 [IQR 1-4.3] pg/ml) was comparable to the HC group
(2.2 [1-4.6] pg/ml) but significantly lower than the AD group (12 [3.9-175.6] pg/ml). The SAM-AD group had
significantly lower IL-8 levels (16.2 [11-39] pg/ml) than the AD (612 [84.8-800] pg/ml) and HC (157.5 [23.8-298.7]
pg/ml) group. IL-6, IL-8, and CRP showed significantly strong correlation with one another (r > 0.67; p <0.001). The
presence of fever was significantly associated with higher levels of IL-6, IL-8, and CRP.
Conclusion Our study found significantly lower serum levels of IL-6, IL-8, and CRP in malnourished children with
acute diarrhea compared to well-nourished children with acute diarrhea, which indicates that malnutrition may impede
the acute phase inflammatory response during acute diarrhea.
Keywords: Acute diarrhea, SAM, Cytokines, IL-6, IL-8.


Around the world, children still frequently suffer
of IL-6(9,10). But malnourished youngsters were not
from acute gastroenteritis, which has a high morbidity,
included in any of these investigations.
mortality, and financial cost. Each year, more than
A major public health issue is severe acute
500,000 children under the age of five die as a result of
malnutrition (SAM), especially in poorer nations, and
diarrheal infections, with the majority of these deaths
up to two-thirds of children with SAM present with
occurring in low- and middle-income countries.
diarrhea. SAM is associated with increased severity and
Additionally, diarrheal illnesses are a major reason for
risk of mortality from acute diarrhea(11,12). This could be
hospital stays and emergency room visits (1­4).
attributed to multiple vulnerabilities associated with
The majority of cases of acute diarrhea in children
SAM, including impaired immunity, disruption of
(70­90%) are caused by viral infections (rotavirus,
gastrointestinal barrier, reduced exocrine protective
norovirus, adenovirus, etc.); the remaining cases are
secretions, altered intestinal microbiota, and deficit of
essential nutrients(11-14).
Campylobacter, enterotoxigenic E. coli, etc.) and
SAM has a significant role in immune system
parasites (Cryptosporidium, Giardia, and E. histolytica)
impairment in children, resulting in abnormalities
related to opsonization, complement system and
In the defence system during severe diarrhea,
phagocytosis, chemotactic activity of neutrophils and
cytokines are crucial. IL-6 and IL-8, in particular, are
monocytes, and antigen-presenting cell function(14).
essential for immunisation against mucosal infections;
SAM has a detrimental effect on the immune system
they are generated by the gastrointestinal tract's
and may hinder cytokines and the acute phase
epithelial cells to elicit an inflammatory response to
inflammatory response (15,16). Studies on the levels of
infectious pathogens both locally and systemically (7,8).
IL-6 and IL-8 in malnourished children experiencing
A number of research looked at the function of
severe diarrhea have not been conducted, as far as we
cytokines, namely IL-6 and IL-8, as biomarkers for
are aware.
acute diarrhea in children who were fed well. The blood
In this study, we aimed to evaluate serum levels
levels of IL-6 and IL-8 in children with acute diarrhea
of IL-6 and IL-8 in children with SAM and acute
have often been shown to be considerably greater than
diarrhea compared to well-nourished children with
those in healthy individuals. Furthermore, compared to
acute diarrhea as well as healthy controls.
viral diarrhea, bacterial diarrhea has much higher levels

Received: 19/07/2023
Accepted: 20/09/2023

Full Paper (vol.941 paper# 44)

c:\work\Jor\vol941_45 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 311-314

Oral Vitamin D versus Injectable Vitamin D in
Treating Obese Women with Vitamin D Deficiency
1* Shereen Mohammed Bahgat Awad, 2 Hosnia Mohammed Ragab, 3 Tarek ElHewala,
1 Nada Abbas Hassan, 1 Eman Mohamed Abd El-Sattar
1 Family Medicine Department, 2 Public Health and Community Medicine Department,
3 Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Shereen Mohammed Bahgat Awad,
Email: drshereenbahgat@yahoo.com, Tel:002 01000088816

Vitamin D deficiency is a widespread problem especially in females. The presence of different vitamin D
preparations (oral, parenteral) with no definite evidence about the most appropriate method for vitamin D deficiency
treatment aroused the need for more studies about the most effective route. Aim: To evaluate the oral vitamin D preparation
compared to intramuscular (IM) vitamin D preparation in correcting vitamin D deficiency in affected women. Subjects and
This is an interventional research performed on obese female patients diagnosed with vitamin D deficiency in the
2019­2022 timeframe for outpatient clinics at Zagazig University Hospitals. Eighty females were included in the study.
They were allocated randomly into 2 equal groups (40 females per group); oral group and injection groups, based on their
preference. Pre and post intervention assessment was done by assessing the level of serum vitamin D.
Results: There was statistically insignificant difference among studied groups concerning vitamin D level before therapy,
while there was significant difference between them after therapy, where oral group had significantly higher level. Within
each group, there was significant increase in vitamin D level after therapy. There was statistically significant positive
correlation between percent of increase in vitamin D and both age and body mass index (BMI) of patients in the oral group,
but no significant correlation was detected in injectable group between age and percent of change.
Conclusion: Treatment for vitamin D insufficiency works well when administered intramuscularly and orally but oral group
showed more improvement.
Keywords: Vitamin D deficiency, Oral preparations, Injectable preparations.

The Endocrine Society advises treating all
Vitamin D is a lipophilic vitamin essential for
vitamin D deficient adult populations with 50,000 IU of
bone mineralization process. The most important factor
vitamin D3 once a week for two months in order to boost
as a primary contributor to vitamin D formation is
the level of vitamin D above (30 ng/mL). A maintenance
sunlight exposure (1).
therapy of 1500­2000 IU/d should be given after this
Vitamin D deficiency is a widespread problem
treatment (7). There are various vitamin D preparations;
that affects many people around the world. Vitamin D
oral and injectable. There is no sufficient evidence about
deficiency represents a common problem for Egyptian
the effectiveness of one of them over the other type. This
people. This problem is commonly detected in people
debate aroused the need for more studies about the most
who are not exposed to adequate sun exposure and those
effective route especially in obese women. This
with sedentary kind of life, unhealthy eating patterns and
intervention study was conducted to evaluate the
inadequate calcium consumption in their diets (2). In
outcomes of oral vitamin D preparation versus
addition, there are many risk factors for vitamin D
intramuscular (IM) vitamin D preparations in correcting
deficiency such as variances in the seasons, aging,
vitamin D deficiency in affected obese women.
increase weight, dark skin pigmentation and morbidities

of malabsorption (3,4).
For all-cause mortality, vitamin D deficiency and
Study design: Interventional study
insufficiency are frequently risk factors. Most evidence
Study Setting: The investigation was carried out in
indicates that they are connected to conditions affecting
2021 at outpatient clinics of Zagazig University
other organ systems, muscle health, and bones (5).
Many cross-sectional studies have illustrated that
Population: Women visiting the outpatient clinics of
low serum 25(OH) D levels are inversely correlated with
the University Hospitals in Zagazig.
obesity. Most parameters of obesity specially (BMI) are

assumed to be inversely correlated with plasma 25(OH)
Inclusion criteria:
D and 1,25(OH)2D levels. A previous study stated that
Adult females in childbearing period (18-50 years old)
obese people had lower levels of plasma 25(OH)D and
with a body mass index greater than 30 kg/m2 and a serum
1,25(OH)2D than people with normal weight (6).
25 OH D level less than 10 ng/ml.
Received: 28/6/2023
Accepted: 29/8/2023

Full Paper (vol.941 paper# 45)

c:\work\Jor\vol941_46 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 315-321

Clonazepam as a Treatment of Excessive Infantile and Childhood Masturbation
Asmaa Ali Abdelaal Mohamed, Khalid Fathi Megahed, Bothina Mohamed Mohamed Hasaneen
Department of Pediatric, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Asmaa Ali Abdelaal Mohamed, Mobile: (+20) 01024847932, Email: drasmaa736@gmail.com

Masturbation is a self-stimulating pleasurable behavior of the child, which occurs between the ages of 3
months and 5 years. Clonazepam was recorded to reduce the frequency of sexual behavior during sleep.
Objective: This study aimed to investigate the benefits of adding clonazepam to the general behavioral treatment of
infantile and childhood masturbation.
Patients and methods:
This was randomized controlled trails (RCTs) conducted on a total number of 52 infants and
pre-adolescent children with masturbation attending the Neurology Outpatient Clinic in Mansoura University Children
Hospital (MUCH). Patients were classified into 2 groups: Group on behavioral therapy and clonazepam and group on
behavioral therapy only. The response was observed in both groups as regards the frequency after treatment and duration
till complete response
Results: Masturbation was common among females, and cases with moderate socioeconomic level. Combined therapy
was associated with a significant improvement in response compared to behavioral therapy only.
Conclusion: Combined behavioral therapy and clonazepam is more effective and superior to behavioral therapy alone
in ameliorating masturbation phenomena in infants and children.
Keywords: Masturbation, Clonazepam, Behavioral therapy, Gratification.

clonazepam to the general behavioral treatment of
Masturbation could be described as self-
infantile and childhood masturbation.
stimulating pleasurable behaviors of the child. It occurs

between the ages of three months and five years. It could
be noticed in both genders, but is very common in girls.
This was randomized controlled trails (RCTs)
Children press their legs by stretching them while sitting
conducted over a period of one year on a total number
or lying, their breathing speeds up, flushing happens,
of 52 infants and pre-adolescent children with
and the hands aren't frequently on the genital area
masturbation attending the Neurology Outpatient Clinic
contrasting to what is expected. The events last for a few
in MUCH.
minutes and could be affected by intervention (1).

Epilepsy has been considered as the most
Inclusion criteria: Boys and girls aged 0.5 year up to 7
essential differential diagnosis. Video recording of the
years who were diagnosed with masturbation that was
event, EEG and history taking are of great importance
confirmed by videotape of the attacks obtained by
to rule out the diagnosis of epilepsy in the suspected
parents. Also, patients doing masturbation as a daily
children. It is noticed more frequently among children
habit that interfere with daily activity.
with lack of love and interest and with mental
Exclusion criteria: Cases with any serious medical
condition that would interfere with the study, cases with
A few researches have assessed the underlying
any current neurological or psychiatric disorder,
factors, or its course. Certain studies have pointed out to
children with chronic drug treatment and cases with
the higher serum levels of hormones and some different
infection of genitalia.
studies have recorded therapy with medication, which

includes risperidone, or its formation, after the
consumption of olanzapine. In general, there is no need
Patients were classified into 2 groups (each
for medications in childhood masturbation unless it is
group includes 26 participants): Group on behavioral
very frequent and it interferes with their daily
therapy and clonazepam on dose according to FDA
functionality. The therapeutic plan is composed of
approval, (0.03 ­ 0.07 mg/kg/day).
behavioral therapy and/or drug therapy. The drug
Clonazepam was started based on child's body
therapy includes mainly atypical antipsychotic drugs.
weight and continued for four weeks. A form was given
There uses are increasing owing to their low drug
to the parents to fill out the frequency and duration of
interactions and adverse events (3).
masturbation daily by observation at home, during the 4
Clonazepam affects serotonin transmission and
weeks period of the study. The children were assessed
is the only benzodiazepine in the market for which
once a week for the drug adverse events. The data was
additional serotogenic activity has been shown, an
collected and analysed to measure the drug efficiency.
action that may contribute to its anxiolytic effects.
Group on behavioral therapy, which contained
Research shows that treatment with clonazepam may
spending more time with the children at home for more
reduce the frequency of sexual behavior during sleep (4).
emotional support, distracting them from masturbation
So, the aim was to test the benefits of adding
indirectly and a form is given to parents to fill out the
Received: 17/07/2023
Accepted: 18/09/2023

Full Paper (vol.941 paper# 46)

c:\work\Jor\vol941_47 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 322-330

Non-Invasive Prediction of Gastric Varices in HCV Related Cirrhosis
Hany Shabana, Ahmed Saad Ahmed*, Nader A. Yousef
Department of Internal Medicine, Hepatology & Gastroenterology Unit, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Saad Ahmed, Mobile: (+20) 01012307898, Email: audaiahmed159 @gmail.com
Gastric varices may bleed severely and are often associated with poor outcomes. The Baveno VII
consensus encouraged non-invasive tests (NITs) to identify patients at risk of acute upper GI bleeding (AUGIB) due to
ruptured varices and to avoid unnecessary screening upper GI endoscopic examination (UGIE). Recently, various NITs
have been demonstrated as simple and non-invasive predictors of the presence of esophageal varices (EVs) and gastric
varices (GVs) in patients with liver cirrhosis. Objectives: The current work aimed to evaluate the NITs that could predict
the presence of GVs in patients with HCV related liver cirrhosis. Patients and Methods: 260 adult patients with HCV-
related cirrhosis who were admitted for UGIE for either screening for varices or management of AUGIB were enrolled.
Various NITs were calculated. Results: Liaoning score at a cutoff value > - 0.1635 was a statistically significant
predictor of GVs with sensitivity=78.6%, specificity = 60.1%, positive predictive value (PPV) = 27.5 %, false discovery
rate (FDR) = 72.5%, negative predictive value (NPV) = 93.6 %, false omission rate (FOR) = 6.4% & accuracy= 63.1%.
RLLD at a cutoff 9.75 cm was a statistically significant predictor of GVs with sensitivity=73.8%, specificity= 54.1%,
PPV= 22.3%, FDR= 77.7%, NPV= 90.9 %, FOR= 9.1% & accuracy= 54.2%. On multivariate regression analysis,
Liaoning score & RLLD were significant predictors of GVs in patients with HCV related cirrhosis.
Conclusion: Liaoning score & RLLD are significant predictors of GVs in HCV Egyptian cirrhotic patients with very
high negative predictive value & very low false omission rate.
Keywords: Liver cirrhosis, Chronic hepatitis C, Gastric varices, Esophageal varices, Non-invasive tests.


In Egypt, liver cirrhosis (LC) has been considered as
This was two centers, cross-sectional study
a main etiology of morbimortality (0.727/1000) (1). It has
included a total of 260 cirrhotic patients, attending at the
a mortality of 18% in males aged 45­54 years (2). There
Department of Internal Medicine, Hepatology &
are a lot of adverse events of LC which ultimately ends
Gastroenterology Unit, Specialized Medical Hospital,
in a decrease in life expectancy such as ascites,
Faculty of Medicine, Mansoura University and the
spontaneous bacterial peritonitis (SBP), bleeding owing
Department of Internal Medicine at Mansoura New
to ruptured varices, hepatorenal syndrome (HRS),
General Hospital, Mansoura, Ministry of Health, from
hepatic encephalopathy (HE), hepatic failure and
December 2021 to December 2022.
hepatocellular carcinoma (HCC) (3).
Sample size: Based on a previous study, total sample
AUGIB due to ruptured EVs accounts for a mortality
size of 260 cirrhotic patients achieves a 90% confidence
of 30% within six weeks of the attack, ranging from zero
level for expected prevalence of 60% and an acceptable
percent for cases with CTP class A to 30% for cases with
margin of error of ± 5 and to achieve the rule of thumb
CTP class C. The possibility of AUGIB is associated
of 15 to 50 participants for each predictor variable.
with the size of varices, existence of red signs and
Inclusion criteria: Adult cases whose age more than or
decompensated cirrhosis (4). Compared to EVs, GVs
equal to 18 years old with HCV related LC who were
aren't common, occurring in approximately 20% of
admitted for UGIE for either screening for varices or for
cirrhotic cases. On the other hand, GVs have more
management of AUGIB.
liability for severe bleeding and are occasionally
Exclusion criteria: Cases who underwent preceding
accompanied by bad prognosis (5). GVs were displayed
endoscopic treatment for EVs, GVs or portal
to bleed at minimal portal pressures compared to EVs,
hypertensive gastropathy (PHG), cases who underwent
mainly owing to the greater prevalence of gastro-renal
previous surgical interference for portal hypertension
shunts which decompress the portal system (6).
(PH), patients who underwent splenectomy, patients who
In recent years, different noninvasive tests (NITs),
were on nonselective beta blockers (NSBB), patients
which include model for MELD, aspartate transferase
with non-portal hypertensive source of bleeding, patients
(AST) to alanine transferase (ALT) ratio (AAR), AST to
with combined chronic hepatitis B & C infections,
platelet ratio index (APRI), PLC to spleen diameter
patient with Bilharzial hepatic diseases, patient with
(PLC/SD) ratio,fibrosis-4-index (FIB-4),fibrosis index
other causes of chronic liver disease, patients with
(FI) and King's score are revealed as a simple,
malignancy, cases with portal or splenic vein
noninvasive and simple predictors of EVs in cirrhotic
thrombosis, patients with bleeding disorder, patients
patients (7).
with organ failure other than the liver, patients who
However, their clinical utility is indefinite.
underwent preceding endoscopic or surgical intervention
Their accuracy varies in various populations and in
for gastro-esophageal reflux disease and patients who
various causes of LC (8). The present study aimed to
did not provide informed consent, were excluded.
evaluate the NITs that could predict the presence of GVs
Out of 400 HCV cirrhotic patients, 260 patients were
in cases with HCV related LC.
enrolled and 140 patients were excluded (figure 1).
Received: 06/07/2023
Accepted: 07/09/2023

Full Paper (vol.941 paper# 47)

c:\work\Jor\vol941_48 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 331-333

Evaluation of Adipocyte Fatty acid Binding Protein (A-FABP) Serum
Level in Male Androgenetic Alopecia Patients
Mohamed S Hussein1, Khaled M Monib1, Walaa A Halawa*1, Hamasat A Abd Elkhalik2
1 Dermatology, Venereology and Andrology Department, Faculty of Medicine, Benha University., Benha, Egypt
2 Clinical and Chemical Pathology Department, Faculty of Medicine, Benha University, Benha, Egypt
Corresponding Author: Walaa A Halawa Phone number: +20 100 121 6052
E-mail: walaa.h.84@gmail.com
Male androgenetic alopecia (AGA) is the utmost frequent kind of male baldness.
Objective: This study aimed to determine serum levels of A-FABP in individuals with AGA and their putative link to
the severity of AGA and other metabolic diseases. Methods: This case-control research comprised 60 male patients
with AGA and twenty healthy volunteers of the same age and gender. Medical history, clinical examination, and
laboratory testing were performed for all individuals. A-FABP serum levels were determined for all subjects. Human
A-FABP ELISA kit was used to assess A-FABP in the serum. Participants' A-FABP serum levels were analysed.
Results: AFABP levels in AGA patients were substantially higher than in controls.
Conclusion: The pathogenesis of AGA may be aided by the presence of serum A-FABP. With its high sensitivity,
specificity, and accuracy rate, it might be regarded a biomarker for early illness detection.
Keywords: Adipocyte, Fatty acid binding protein, Androgenetic alopecia, AFABP.

had a systemic disease (such as cardiovascular disease,
Patients who are genetically susceptible to
diabetes mellitus and hypertension) and
androgenetic alopecia have a non-scarring, gradual hair
chronic liver or renal disease, or who were receiving
follicles shrinkage of. A genetic susceptibility and the
anti-hyperlipidemic drugs.
androgens presence are both critical etiological
All participants were divided into two groups:
variables for AGA, according to Brockschmidt et al.
Group A: Sixty male patients with AGA.
[1] research. Testosterone levels may contribute to the
Group B: Twenty age- and gender-matched
development of thrombosis and atherosclerosis and
volunteers as control group.
hypercholesterolemia [2].Adipose tissue produces and
secretes a range of peptides known as adipokines that
All participants were undergoing complete clinical
affect weight gain, insulin sensitivity, fat metabolism,
examination, detailed history taking, and laboratory
and vascular functSion. Adipose fatty acid binding
measurement. All cases were tested for adipocyte fatty
protein (A-FABP) has been proposed as another
acid binding serum level determination. Serum A-
adipokine that is generated and released by adipose
FABP was measured using "Human adipocyte fatty
tissue [3].Data from both rats and humans reveal that A-
acid binding protein (A-FABP) ELISA Kit".
FABP is produced into the circulation by adipose

tissue, which has been demonstrated to influence the
Ethical Consideration: The study was done after
inflammatory cytokines production [4]. The obesity
approval from the Ethical Committee Faculty of
development, insulin resistance, diabetes mellitus,
Medicine, Benha University Hospitals (approval
atherosclerosis, and hypertension are all associated to
code: RC 12-5-2019). All cases provided written
elevated levels of A-FABP [5].
informed consents prior to blood sample collection
Serum level of A-FABP in individuals with AGA
(patients and normal volunteers in the control
and its putative link to the severity of AGA and other
group). This study was conducted in accordance
metabolic diseases were the focus of this investigation.
with the Helsinki declaration.

Statistical methods
The statistical analysis and management of data
For this case-control study, twenty age-matched
were conducted utilising SPSS version 28 (Armonk,
healthy volunteers of the same gender and sixty male
New York, United States of America: IBM). The
patients who presented with AGA participated in this
normality of quantitative data was evaluated by
study. They were chosen from patients attending the
employing the Shapiro-Wilk test for controls and the
Outpatient Clinic of Benha University Hospitals,
Kolmogorov­Smirnov test for cases in addition to
Department of Dermatology, Venereology, and
utilising direct data visualisation techniques (for both).
Andrology. The research was conducted between May
In accordance with the results of tests for normality,
2019 and October 2021.
numerical data were condensed into medians and
Inclusion criteria: The study included male patients
ranges or means and standard deviations. Numerical
with AGA over 18 years old.
and percentage summaries were compiled for the
categorical data. Comparing quantitative data between
Exclusion criteria: Patients who had medical history
study groups required the use of the Mann-Whitney U
of smoking, who had active malignancy, who
test for non-normally distributed numerical variables

Received: 06/07/2023
Accepted: 07/09/2023

Full Paper (vol.941 paper# 48)

c:\work\Jor\vol941_49 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 334-337
Serum Endocan and Carotid Intima Media Thickness Evaluation in Vitiligo Patients
Khaled M Monib1, Mohamed S Hussein1, Amira M Abdelrahman2, Mohamed S Darwish3, Rania M Elhady4*
1 Dermatology, Venereology and Andrology Department,
2 Clinical and Chemical Pathology Department,
3 Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt
4 Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Rania M Elhady, Phone number: 01554464636,
E-Mail: dr.raniaelhady@gmail.com

Vitiligo is an acquired pigmentary disorder of the skin characterised by patches and circumscribed
depigmented macules caused by epidermal melanocyte loss. A vasculoprotective molecule, endocan is an indicator of
endothelial function.
Objective: We aimed to evaluate carotid intima media thickness (CIMT) and serum endocan level in vitiligo patients
and to compare their levels with healthy controls.
Methods: This case-control study involved sixty male vitiligo patients aged 18 years or older, in addition to twenty
healthy controls of the same age. A comprehensive evaluation of each patient included general and clinical examination,
the Vitiligo Extent Tensity Index (VETI) score that was used to quantify the severity of vitiligo, a laboratory analysis to
determine the serum endocan level, and Doppler ultrasound imaging of the CIMT.
Results: No statistically significant differences were observed between the patient and control groups with respect to
the age, gender, and body mass index. Patients had a significantly higher mean CIMT than the control group.
Conclusion: Serum endocan and CIMT levels were significantly higher in vitiligo patients than in the control group
and were significantly correlated with the severity of the disease, according to the study.
Keywords: Serum endocan, Carotid intima media thickness, Vitiligo patients, Epidermal melanocyte.

marker associated with cardiovascular disease. Endocan
plays a crucial role in the prognosis and prediction of
melanocytes are selectively lost, is the most prevalent
cardiovascular disease progression [5].
The intima-media thickness is characterised by a
approximately 0.5 % of the global populace. No
double-line interface between the lumen, intima, and
discernible disparities in incidence rates are observed
media-adventitia. Its configuration can be observed
based on phototype or race and both sexes are equally
longitudinally on both walls of the common carotid
impacted [1].
artery using two-dimensional ultrasound. The
The involvement of genetic, immunological,
effectiveness of carotid intima-media thickness in
cytotoxic, neuronal, and inflammatory factors in the
detecting early non-calcified subclinical atherosclerotic
complex pathogenesis of vitiligo may account for a
changes was established. The European Society of
broad spectrum of its systemic manifestations.
Hypertension and European Society of Cardiology have
Proinflammatory cytokines such as interleukin-6 (IL-6),
reaffirmed carotid intima-media thickness (> 0.9 mm)
tumour necrosis factor (TNF), and IL-1 are recognised
as an indicator of asymptomatic atherosclerotic changes
for their role in inducing insulin resistance, metabolic
in their hypertension guidelines [6]. Age and gender are
complications, and atherosclerosis, all of which are
determinants of normal CIMT values, as age increases,
associated with vitiligo [2]
CIMT rises significantly and steadily, with men having
Endocan is a molecule specific to human
significantly higher values than women [7].
endothelial cells that promotes angiogenesis and
The purpose of the study was to assess serum
inhibits leukocyte binding to vascular endothelium.
endocan level and carotid intima media thickness in
Endocan might play a role in the development of a
vitiligo patients and to compare their levels with healthy
number of inflammatory diseases [3].
Globally, cardiovascular disease is characterised

by significant morbidity and mortality. There is some
evidence that a high level of endocan may be closely
This case-control study encompassed sixty
associated with the development and progression of
individuals diagnosed with vitiligo and twenty healthy
cardiovascular disease. The fact that serum endocan
volunteers who were matched in age and gender. They
levels were higher in patients with cardiovascular
were recruited from Benha University Hospitals'
disease initially suggested that endocan levels and
Outpatient Clinics of Dermatology, Venereology, and
cardiovascular disease are related [4].
Enhanced concentrations of endocan in the plasma

may indicate endothelial dysfunction and activation. It
Inclusion criteria: All participants were willing to
is also regarded as a possible immuno-inflammatory
participate in the study and were at least 18 years old.
Received: 06/07/2023
Accepted: 07/09/2023

Full Paper (vol.941 paper# 49)

c:\work\Jor\vol941_50 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 338-342

Effect of Mode of Anesthesia on Fetal Acid-Base Status at Cesarean Section
Doaa W Sadek 1*, Raghdaa M Ali 2, Rashaad A Elsayed 1, Nazih M Elnady1
1 Pediatrics Department, Faculty of Medicine, Banha University, Banha, Egypt
2 Pediatrics Department, Ahmed Maher Teaching Hospital, Egypt
*Corresponding Author: Doaa W Sadek, Email: doaawaheedsadek@gmail.com
Phone number: (+20)1276863264

It is well-known that there's more risk of neonatal respiratory distress with babies born by cesarean
delivery than vaginal delivery, regardless of fetal gestational age.
Objectives: The aim of this work was to evaluate if different modes of anesthesia affect fetal acid-base for cesarean
Patients and methods: This cross-sectional study was conducted on newborns of 150 pregnant women of full-term
babies aged 20 to 35 years with no previous maternal medical condition, undergoing elective caesarean section.
Patients were allocated into two equal groups; SA group where cesarean sections were done under spinal anesthesia
and GA group where cesarean sections were done under general anesthesia. All neonates underwent history taking,
and postnatal history including general neonatal examination, Apgar score, neurological examination [Mental status,
sensory perception, and reflexes] and systemic examination. Cord blood samples were taken from participant
newborns, and immediately after birth and the taken samples were sent for blood gas analysis.
Results: There was a significant strong positive correlation between the outcomes and PH, PO2, and PCO2. Regarding
univariate correlations and multivariate correlations, there was a significant strong positive correlation between the
outcomes and PH, PO2 and PCO2 (P value= <0.0001).
Conclusions: It could be concluded that umbilical cord arterial blood gas values, Apgar score (at 1, 5 and 10 min after
birth) and neonatal asphyxia are comparable between the two different modes of anesthesia (spinal and general).
Moreover, there are significant strong positive correlations between the outcomes and PH, PO2, and PCO2, and they also
are strong predictors of the neonatal outcome.
Keywords: Mode of Anesthesia, Fetal Acid-Base Status, Cesarean Section, Gestational Age, Neonatal.


A caesarean section is usually described as elective
vomiting, headache in the mother due to cerebrospinal
(when it's planned) or emergency (when there is risk on
fluid (CSF) leakage following lumbar puncture, and a
either mother or fetus or both). It's well-known that
restricted effect duration. In addition, fetal acidemia is
there's more risk of neonatal respiratory distress with
caused by hypotension resulting from the reduction in
babies born by cesarean delivery than vaginal delivery,
uteroplacental perfusion and intervillous blood flow
regardless of fetal gestational age [1].
caused by the sympathetic blockage induced by RA.
Both general and spinal anesthesia are frequently
Apgar scoring is frequently employed as a rapid method
utilized during cesarean sections, and each has its own
of evaluating the clinical condition of neonates. It is
set of benefits and drawbacks [2].
generally accepted that umbilical cord blood gas values
Spinal anesthesia is the preferred method for
are a more dependable indicator of fetal oxygenation and
cesarean delivery not only because it circumvents the
neonatal clinical status [4].
potential hazards associated with general anesthesia,
There are much research investigating the relation
such as failed intubation and its repercussions, but also
between mode of anesthesia and fetal outcome regarding
because it offers more efficient pain management, early
either Apgar score of the newborn or fetal acid-base
ambulation, and thus facilitates the resumption of daily
balance. Some have noted no difference in Apgar score
activities for postpartum women [3].
between spinal or general anesthesia groups. Some have
Each method of anesthesia has benefits and
shown that Apgar score is lower in general than in spinal
drawbacks. Rapid induction, reduced hypotension,
anesthesia; they suggested this difference due to
improved respiratory tract and ventilation control, and
transient sedation during general anesthesia [2]
preserved cardiovascular balance are all advantages of
The aim of this work was to evaluate if different
GA. Conversely, aspiration of stomach contents,
modes of anesthesia affect fetal acid-base for cesarean
intubation difficulties, and respiratory depression in the
neonate are all disadvantages. Regional anesthesia
significant benefits include the mother remaining
This cross-sectional study was conducted on
conscious during the delivery process, observing the
newborns of 150 pregnant women of full-term babies
newborn at birth, facilitating early breastfeeding, and
aged 20 to 35 years with no previous maternal medical
preventing respiratory depression in the neonate.
condition, undergoing elective caesarean section, at
Drawbacks include the potential for nausea and
Ahmed Maher Teaching Hospital and Banha University

Hospital from January 2022 till February 2023
Received: 06/07/2023
Accepted: 07/09/2023

Full Paper (vol.941 paper# 50)

c:\work\Jor\vol941_51 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 343-351

Evaluation of Adjunctive Subconjunctival Injection of
Bevacizumab before Pterygium Surgery
Mahmoud Abdelbadie Mohamed*, Hasan Shams El Din Youssef Amer*, Ahmed Khalaf Amin*
* Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Egypt
Correspondence: Ahmed Khalaf Amin, E-Mail: akhalafzedan@yahoo.com
Mobile: 01101863111, Orchid No: 0009-0006-6262-8591

Pterygium is a common ocular surface lesion involves the bulbar conjunctiva's fibrovascular expansion
onto the cornea. The exact cause of pterygium remains unclear, however exposure to ultraviolet radiation is recognized
as a significant contributing element. The development of pterygium is believed to involve vascular endothelial growth
factor (VEGF). Bevacizumab, a monoclonal antibody, functions by attaching to and blocking VEGF.
Aim of study:
This study aimed to assess the effectiveness and safety of preoperative subconjunctival bevacizumab for
primary pterygium excision.
Patients and methods:
This prospective study included 30 patients with primary pterygium attending the
Ophthalmology Outpatient Clinic, Al-Azhar University Hospital, Assiut, Egypt. Patients were divided into two groups:
Group "A" (15 patients) received subconjunctival injection of 2.5 mg bevacizumab 1 week before surgical excision of
the pterygium with conjunctival autograft transplantation. Group "B" (15 patients) underwent pterygium excision with
conjunctival autograft transplantation without injection of bevacizumab. Patients were followed up for 6 months.
In group "A", 14 out of 15 patients (93.3%) showed no recurrence after bevacizumab injection and pterygium
surgery. One patient (6.7%) had recurrence. In group "B", 6 out of 15 patients (40%) had recurrence after pterygium
surgery without bevacizumab injection. The recurrence rate was significantly lower in the bevacizumab injection group
compared to control group (p=0.031). No complications were observed with subconjunctival bevacizumab injection.
Conclusion: Subconjunctival injection of bevacizumab before surgical excision of primary pterygium is safe and
effective in reducing the recurrence rate.
Pterygium, Bevacizumab, Vascular endothelial growth factor, Recurrence.

Pterygium refers to a wing-shaped encroachment of
aimed to assess the effectiveness and safety profile of
fibrovascular tissue from the bulbar conjunctiva onto the
bevacizumab administered subconjunctivally before
cornea (1). This common ocular surface lesion can lead to
surgically removing primary pterygium.
chronic irritation, induced astigmatism, and visual

deterioration (2). Pterygium is estimated to affect over

200 million people worldwide, with prevalence varying
This prospective comparative study was conducted
based on geographic location and ultraviolet light
at the Ophthalmology Clinic, Al-Azhar University
exposure (3, 4). Histologically, pterygium demonstrates
Hospital in Assiut, Egypt. The study enrolled 30 patients
elastotic degeneration of collagen and fibrovascular
with primary pterygium affecting the nasal limbus.
proliferation covered by conjunctival epithelium (5, 6).

Although the pathogenesis is not fully understood,
Inclusion criteria: Adults over 18 years old with
ultraviolet radiation appears to be a major environmental
primary nasal pterygium causing ocular irritation,
trigger. Excessive UV exposure induces limbal stem cell
induced astigmatism, or documented progression over 6
damage and pro-inflammatory cytokine release leading
to conjunctival overgrowth (4). Hereditary factors also
Exclusion criteria: Patients with current ocular
play a role, as pterygia demonstrate familial clustering in
infections, prior pterygium surgery, pregnancy,
some populations (7).
hypertension and cardiac issues, or coagulopathy.
Recent studies have provided evidence of viral

infections and immunologic mechanisms to be
Patients were randomized into two equal groups:
contributing as well (8).
Group "A" (n=15) received subconjunctival injection of
bevacizumab 1 week prior to pterygium excision with
bevacizumab, a recombinant humanized monoclonal
conjunctival autografting. Group "B" (n=15) underwent
antibody that binds and inhibits all VEGF isoforms (12).
pterygium excision with conjunctival autografting alone
By blocking VEGF from binding receptors on vascular
without bevacizumab injection.
endothelium, bevacizumab can potentially inhibit
The subconjunctival injections were performed by
neovascularization (13). Studies have shown decreased
an ophthalmologist using aseptic technique. Following
VEGF levels and reduced proliferation after
the application of 0.5% proparacaine for local numbing,
subconjunctival bevacizumab administration (14).
a 30 gauge needle was used to administer 0.1 mL (2.5
Given the role of VEGF in pterygium pathogenesis
mg) of bevacizumab (Avastin) into the pterygium mass.
and the anti-VEGF properties of bevacizumab (15), we
One week later, pterygium surgeries on all patients were
Received: 20/09/2023
Accepted: 25/12/2023

Full Paper (vol.941 paper# 51)

c:\work\Jor\vol941_52 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 352-357

Open Anterior Component Separation Reconstruction Technique for
Large Ventral Incisional Abdominal Wall Hernias
Wael Mohamed Abdelgawad*, Hassan Mohamed Khalaf, Mohamed Ali Agwa
Department of General Surgery, Damanhur Medical National Institute, Elbehiera, Egypt.
*Corresponding author: Wael Mohamed Abdelgawad , E-mail: waeldoc80@gmail.com ,Tel.: +201223004249

Eleven percent of all abdominal laparotomies are complicated with ventral abdominal wall hernias, which
is an increasing problem.
To assess complication rates as well as outcomes of the open anterior component separation (ACS) technique for
large ventral and incisional abdominal wall repair.
Patients and Methods:
This prospective research was conducted on twenty cases who underwent open ACS procedure
for large incisional hernia. Clinical and routine studies including investigations of blood and radiological investigations,
as abdominal US, were performed for all cases.
Results: Regarding operative data, the duration of the operation varied from 123 to 167 min with a mean of 142.6 ±
14.5 min, and blood loss varied from 318 to 712 ml with a mean of 495.7 ± 130.41 ml. Regarding prevalence of 30-day
readmission, 4 (20%) individuals were readmitted to the hospital within a month after operation. Regarding wound
complications, 5 (25%) patients had infection, 3 (15%) patients had seroma, 2 (10%) patients had hematoma, and 1 (5%)
patient had skin necrosis. Regarding GIT complications, 3 (15%) patients had paralytic ileus and 1 (5%) patient had
fistula. No cases had systemic complications.
The open anterior components separation technique still a good option for detecting primary fascial
closure in treating giant ventral hernias. Preserving perforator vessels and retromuscular mesh placement are to be
installed to original method to reduce wound problems and rather high recurrence rate.
Keywords: Large Ventral and Incisional Abdominal Wall Reconstruction, Open Anterior Component Separation
Technique, Hernia repair, Incisional hernia.

the anterior release of aponeurosis of external oblique
Eleven to twenty three percent of all abdominal
muscle. A differentiation must be established among the
laparotomies are becoming increasingly complicated by
release executed through an anterior or posterior
ventral abdominal wall hernias. In contemporary
approach, with respect to the separation of components.
general surgery, the execution of dependable and long-
Additionally, there have been developments of
lasting ventral hernia repairs accompanied by minimal
endoscopic variations of the anterior and posterior CST.
morbidity and recurrence has emerged as a substantial
Utilizing open, laparoscopic, and robotic surgical
challenge (1).
armamentarium; every technique has been documented
For instance, open mesh repair encounters a failure
to date (8).
rate of as much as thirty-two percent, whereas primary
Therefore, we aimed to evaluate open ACS
suture repair encounters twenty-five to fifty four
method for large ventral and incisional abdominal wall
percent (2-4).
reconstructionon regarding complications as well as
Open suture methods for the repair of incisional
hernias produced unacceptably high recurrence rates;

these methods were abandoned in the early 2000s in
favor of mesh restorations, which could be performed
Patient selection:
laparoscopically or openly (5).
This prospective research was performed on
Despite mesh repair, however, large and recurrent
twenty cases who underwent open anterior component
incisional hernias remained a significant clinical
separation method for large incisional hernia at the
concern because sac's size, contents, and compromised
Department of Surgery, Damanhur Medical National
abdominal wall functions (6).
Institute, Elbehiera, Egypt, throughout duration from
The method of ACS was initially established in
January 2021 to June 2023.
1990 by Ramirez et al. (7) to assist with medial fascial

advancement and final repair. According to them, the
Inclusion criteria were hernia following a midline
posterior rectus sheath was released first in their
incision, a reducible hernia, a primary hernia that is
component separation procedure. Then, a wide skin flap
either recurrent or primary, a horizontal defect
exposure was created, and the external oblique was
exceeding twelve cm in length, or numerous
deficiencies with a combined transverse dimension
Since its inception, the components separation
surpassing 12 cm. Patients with BMI > 40 and with
technique (CST) has evolved to include a number of
hernias smaller in diameter were excluded.
distinct CSTs in addition to the open method involving

Received: 20/09/2023
Accepted: 25/12/2023

Full Paper (vol.941 paper# 52)

c:\work\Jor\vol941_53 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 358-362

Modified Hanley Procedure for Management of
Complex Posterior Horseshoe Anal Fistula
Wael Mohamed Abdelgawad*, Hassan Mohamed khalaf, Mohamed Ali Agwa
Department of General Surgery, Damanhur Medical National Institute, Elbehiera, Egypt.
*Corresponding author: Wael Mohamed Abdelgawad , E-mail: waeldoc80@gmail.com,Tel: +201223004249

An anorectal fistula is a connection that is not normal among the epithelialized surface of the anal canal
and most commonly the skin of the perianal region or the perineum. Surgery is the mainstay therapy aiming to drain
local infection, to eliminate the fistulous tract and to avoid its recurrence while maintaining the function of the sphincter.
Aim: This study aimed to evaluate the treated patients with horseshoe fistula of cryptoglandular origin utilizing a
modified Hanley method involving a hybrid cutting one-stage approach.
This prospective trial was done on twenty cases with chronic horseshoe fistula. All patients were subjected
to preoperative PR examination to check for sphincter tone, preoperative MRI to demonstrate the extent of fistula and
the deep post-anal space affection.
Results: Regarding type of fistula, 3 (15%) persons had high trans-sphincteric fistula & 17 (85%) patients had low
trans-sphincteric fistula. Seven (35%) patients had external opening from the anal verge within three centimetres and 13
(65%) patients had external opening from the anal verge beyond 3 cm. Out of the total number of individuals, three
individuals (15%) had an internal opening located at the dentate line, while the remaining 17 individuals (85%) had an
internal opening situated above the dentate line. Four (20%) patients had recurrence. Complete healing was achieved in
all cases at 12 weeks post-operative period.
Conclusions: The modified Hanley operation is effective and conservative surgical procedure that eliminates the
disadvantage of keeping the seton for a long period and preserve the sphincter function.
Keywords: Modified Hanley procedure, Complex posterior horseshoe anal fistula, Anorectal abscess.


Anorectal fistula refers to an inflammatory pathway

or improper link that connects the epithelialized surface
It often evolves from a spontaneously draining
of the anal canal and typically, the perianal skin or
anorectal abscess. The presence of perianal fistula
perineum (1).
illness greatly affects the patient's quality of life, as it
The paths and scope of the fistulas and the
can lead to various complications for instance mild pain,
accompanying acute infections are determined by their
social embarrassment because of hygiene issues, as well
origin in the cryptoglandular complex and the
as severe sepsis (3).
involvement of the anatomically defined perirectal
The therapy of anorectal fistula is a complex &
areas. Both structures establish communication with the
contentious issue in the field of colorectal surgery (4).
ischioanal fossa, so creating a pathway for the
Surgery is the mainstay of therapy with the aim of
development of a horseshoe abscess. Operation may
draining local infection eradicating the fistulous tract
result in several consequences for example urine
and prevention of recurrence while preserving native
sphincter function (5). The surgical approach is
incontinence, faecal impaction, anal stenosis, as well as
influenced by several factors such as the aetiology,
delayed wound healing. The use of fecal diversion as
location, type & duration of the fistula besides
the sole treatment for horseshoe fistula did not
previously performed procedure and preoperative
successfully resolve the condition (2).
sphincter function (6).
Hanley, 1965 reported his original procedure for
Thus, the usual horseshoe fistula consists of paired
horseshoe fistula which involved complete division of
exterior apertures connected by a deep post-anal
the posterior 12 o'clock sphincter mechanism down to
connection in the posterior midline, resulting in a U or
the deep post-anal space. Counter drains were placed
horseshoe-shaped arrangement (7). Individuals suffering
through each lateral extension and were removed
from horseshoe fistula typically undergo several
several weeks after wards. Note surprisingly this
drainage procedures as well as unsuccessful surgeries
aggressive procedure obliterated the source of the
before receiving a proper diagnosis and therapy (8).
fistula but at the inevitable price of high incidence of
Persons with horseshoe fistula are typically
anorectal incontinence. This was followed by the
recommended an operation for their condition. Several
modified Hanley procedure 1990, in which the posterior
surgical procedures are available for the treatment of
sphincter was divided gradually by using a cutting
fistulas, including fistulotomy, cutting seton placement,
hybrid seton placed around the 6 o'clock sphincter
fibrin glue injection, fistula plug insertion, as well as
mechanism, this seton was serially tightened until the
endorectal advancement flap (9). Our hypothesis is that
posterior sphincter was divided and it was tethered by
the modified Hanley approach remains an effective &
resulting scar tissue (2).
Received: 20/06/2023
Accepted: 21/08/2023

Full Paper (vol.941 paper# 53)

c:\work\Jor\vol941_54 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 363-368

The Validity of the American Diabetes Association's Diabetes Risk Test in
A Sample of Egyptian Population
Rasha O. Abdelmoniem, Amira M. Elsayed, Mohamed Shawki El Sayed, Ayman M .
Elbadawy, Eman Mahmoud*, Walaa M. Ibrahim
Department of Internal Medicine, Faculty of Medicine, Benha University, Kalubia, Egypt.
*Corresponding author: Eman Mahmoud, Mobile: +201026553145, Email: dremanmahmoud324@gmail.com

In order to identify community members at high risk for developing diabetes and to bring attention to the
importance of good lifestyle choices and reducing risk factors. The American Diabetes Association created the diabetes
risk test.
Objectives: This study aimed to determine whether the American Diabetes Association (ADA) risk test is accurate in
predicting who among Egyptian population would develop pre-diabetes or diabetes & how sensitive & specific it is in
doing it.
Patients and Methods: This cross-sectional study performed on 580 cases aged 18 years or older attending different
hospitals in Benha City, Egypt,
According toADA risk test subjects of score <4have no risk to develop prediabetes or type2DM,those of score=4 risky
t.o develop prediabetes and those of score>=5 are risky to be diabetic
T h
. e persons in this study are divided into 2 groups:euglycemic and diabetic group that complete the score
Results: T . his study found that in the euglycemic group, 184 people (51.1%) had no risk of developing either
prediabetes or diabetes, 44 people (12.2%) had a risk of developing prediabetes, and 132 people (36.7%) had a potential
for progressing type 2 DM. Between our studied population, ADA 4 was found in 93.6% of DM subjects, and ADA
5 was found in 88.2% of DM subjects, suggesting significant agreement of the ADA score to predict DM. Older age
> 50 years, obesity, gestational diabetes mellitus (GDM), hypertension, and poor physical activity were significantly
correlated with an enhanced probability of DM. at scores 4, ADA had 93.6% sensitivity and 63.3% specificity to
detect DM. At scores 5, ADA had 88.2% sensitivity and 62.3% specificity to detect DM.
Conclusion: Screening for prediabetes & type 2 DM risk factors in Egyptian population sample using the American
Diabetes Association's prediabetic risk assessment test was valid, reliable, & authentic.
Key words: Diabetes risk test, American diabetes association, Egyptian population, Diabetes mellitus.


The cardiovascular mortality rate increases due to
with a group that is exposed to risk factors as age,
the microvascular & macrovascular problems caused by
stress, & unhealthy eating habits (9). The researchers in
type 2 diabetes mellitus, a condition that worsens over
this study set out to determine how well the ADA risk
time (1). Thus, DM2 poses a significant threat to global
test could detect cases of prediabetes & diabetes in a
public health. The incidence of DM2 is approximately
population sample from Egypt, considering the test's
11.6% in countries like China & USA. The prevalence
sensitivity, specificity, & validity.
of type 2 diabetes is 9.7% in Egypt (2). This is why pre-

diabetes & diabetes detection should be the primary
goals of public health initiatives (3). So, Having a
This was a cross-sectional study conducted on 580
primary care facilities don't necessarily have access to
cases over the age of eighteen who visited different
laboratory tests (4). This is why it is critical to develop a
hospitals in Benha City, Egypt through the period from
quick, easy, & lab-free detection approach immediately
December 2022 to June 2023, using the American
(5). One of the tools available is the ADA (Risk
Diabetes Association Risk Test questionnaire.
TestADA TestADA Test Risk Score) (6).

The ADA test has seven questions and a possible
The inclusion criteria: Any patient over the age of
score between zero and eleven. The original intent was
eighteen who visited different hospitals in Benha City,
to identify people who were at high risk of developing
type 2 diabetes. Patients have indicated a rejected DM2

test (6) if their score was higher than five. Although the
The exclusion criteria: Pregnant and lactating women,
cut-off points for prediabetes screening vary per study,
patients below 18 years of age, and patients who did not
this test has demonstrated good screening values in
need follow-up tests have Type 1DM.
previous research (7). For the sake of making the best

possible clinical decisions, it is not advised to apply
The sample size: A power of eighty-five percent & a
these findings to the Egyptian population (8).
sampling error of five percent were used to generate the
So, this study intended to assess the ADA test's
estimated sample size. The screening tool was estimated
diagnostic validity as a screening tool for prediabetes &
to have a sensitivity of seventy-two percent & an
diabetes in a group of Egyptian employees, beginning
estimated diabetes prevalence of 14.4%. 4 patients were
Received: 20/09/2023
Accepted: 25/12/2023

Full Paper (vol.941 paper# 54)

c:\work\Jor\vol941_55 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 369-374

Evaluation of Serum Zinc Level in Patients with
Pattern Hair Loss (A Case-Controlled Study)
Noura Hussein Abbas Mahmoud Moussa*, Amal Wagdy Abdelaziz Hawas, Mohammed Fawzy El-Kamel
Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Noura Hussein Abbas Mahmoud Moussa,
Mobile: (+20) 01551667945, E-mail: Nourahussein1110@gmail.com

Although androgenetic alopecia affects both males and females, trace elements may play as crucial impact.
To evaluate serum zinc in patients with pattern hair loss (PHL) and to compare the findings with normal
Patients and Methods:
This study is a cross sectional observational case control study conducted at outpatient clinic of
Dermatology, Andrology and STDs Department, Mansoura University hospital in the period between May 2022 and May
2023. The study included 100 subjects, divided into two groups: the first consisted of 50 patients (Male and female) with
pattern hair loss and the second was 50 subjects (control group). The serum zinc assay was done for all participants.
Results: The mean serum zinc level in the cases group was 75.36±19.29 and 71.73±20.19 in the control group, with no
statistically significant difference between the two groups (p= 0.360). Low zinc levels were found in 56% of cases and 60%
of controls, with no significant difference between the two groups (p= 0.685). There was no significant variation in serum
zinc levels across the different degrees of hair loss in either male or female patients. The best cutoff point of serum zinc
level to identify patients with PHL was less than 68.85. This value showed mild sensitivity and specificity with no significant
value (p= 0.261). Conclusion: Zinc deficiency cannot be viewed as a direct etiologic component in the development of
androgenic alopecia and not all androgenic alopecia patients may benefit from obtaining nutritional supplements. There is
disagreement on the function of supplementing with zinc.
Androgenetic alopecia, Zinc.

of adverse effects of these treatments significantly affect
how well patients comply with their treatment [9].
miniaturisation to vellus hair fibres on the scalp and a
Zinc is a crucial trace element that is involved in
progressive loss of terminal hair are the hallmarks of
many biological processes, such as the creation of DNA,
PHL, a nonscarring type of hair loss [1]. About 30 million
the expression of genes, the regulation of hormones,
women and 50 million men in the US suffer from female
enzymatic activities, and cell division [10]. Zinc has a
pattern hair loss (FPHL) and male pattern hair loss
strong anti-regression effect on hair follicles and speeds
(MPHL) accordingly [2]. There is a 50% probability of
up their recovery in relation to hair loss. More precisely,
development of MPHL in males over 50, while around
acrodermatitis enteropathica, which causes hair loss, is
40% of women acquire FPHL by the age of 50 [3].
mostly caused by temporary zinc insufficiency [11].
The three primary phases of the hair follicle cycle
The purpose of this study was to compare blood
are traditionally referred to as anagen, which is active hair
zinc levels in individuals with PHL to normal controls.
growth, catagen, which is hair growth halt, and telogen,

which is follicular rest [4].
But in MPHL and FPHL, this cycle's anagen
This study is a cross sectional observational case
phase gets smaller with each cycle, while the telogen
control study conducted at outpatient clinic of
phase stays the same or even gets longer. This results in
Dermatology, Andrology and STDs Department, Mansoura
smaller follicles and less hair growth [5]. Hair eventually
University Hospital in the period between May 2022 and
thins and becomes too short to successfully project
May 2023. The study included 100 subjects into two
through the scalp's surface, leaving an empty follicular
groups: the first consisted of 50 patients (Male and female)
pore as a result of the gradual reduction in the anagen
with PHL and the second was 50 subjects (control group).
phase and the early transition from the anagen to the
The required sample size was calculated using the
catagen phase [6].
IBMª SPSSª Sample Powerª version 3.0.1 (IBMª Corp.,
The only recognised therapies for MPHL and
Armonk, NY, USA). With considering serum zinc level as
FPHL approved by the Food and Drug Administration are
the main outcome, based on intensive literature review, the
topical minoxidil and oral finasteride [7]. Other treatment
mean serum zinc level in the control group was 128.4 µg/dl
options may include low-dose oral minoxidil, low-level
(SD 41.4) in the study conducted by Dhaher et al. [12]
laser therapy and PRP therapy [8]. Nevertheless, a variety
versus 56.6 µg/dl (SD 14.2) in the AGA group. This
difference between the groups was taken for calculating the
Received: 02/08/2023
Accepted: 01/10/2023

Full Paper (vol.941 paper# 55)

c:\work\Jor\vol941_56 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 375-378

Pruritus in Psoriatic Patients: A Review Article
Sally Y. Abo-Algood 1*, Essam M. Akl 1, Shymaa M. Rezk 1 and Yasmin M. Marei 2
1 Dermatology, Venerology and Andrology Department,
2 Medical Biochemistry Department, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding Author: Sally Y. Abo-Algood, Email: sa.raafat.y@gmail.com, Phone: +201012007687

Psoriasis, a chronic skin condition, often accompanies distressing pruritus, impacting patients' quality of
life. Understanding the pathogenesis of pruritus in psoriasis offers promising avenues in psoriasis treatment.
This review aimed to comprehensively explore the epidemiology, pathogenesis, clinical characteristics,
impact on patients' quality of life, and treatment options associated with pruritus in psoriasis.
Methods: We searched Google Scholar, Science Direct, PubMed and other online databases for Psoriasis, Pruritus and
Quality of life. The authors also reviewed references from pertinent literature, however only the most recent or
comprehensive studies from 2012 to 2023 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.
Conclusions: Pruritus is a prevalent and distressing symptom in psoriasis, affecting a majority of individuals with the
Keywords: Psoriasis, Pruritus, Therapeutic interventions, Neuroinflammatory pathways.


regarding the epidemiology, pathogenesis, clinical
Psoriasis, a condition characterized by
characteristics, impact on patients' quality of life, and
heightened keratinocyte growth, is a complex
treatment options associated with pruritus in psoriasis.
inflammatory skin ailment with both genetic and non-

genetic roots. Factors contributing to its onset range
from medications and smoking to stress, trauma, and
Psoriasis, a prevalent chronic skin disease affecting
various infections. This condition exhibits diverse
individuals globally and spanning all ages, imposes a
forms, with plaque psoriasis being the most common. It
significant societal and personal burden. Linked to
results in raised, dry and red skin patches covered by
conditions like depression, psoriatic arthritis, and
silvery scales. Additional variations include nail
psoriasis, guttate psoriasis, inverse psoriasis, pustular
erythematous papules and plaques with silver scales,
psoriasis, erythrodermic psoriasis, and psoriatic arthritis
often manageable in outpatient settings for most cases.
However, rare life-threatening presentations may
For individuals grappling with psoriasis,
necessitate intensive inpatient care. While, its precise
pruritus, or itching, is a prevalent issue, affecting a
cause remains elusive, genetic predisposition is evident,
substantial 70-90% of patients. This symptom
and ongoing research investigates the immune system's
significantly impacts their overall quality of life and
role. Though potentially autoimmune, the absence of a
often correlates with depressive symptoms, making it a
defined autoantigen adds complexity. Triggers like
particularly distressing aspect of the condition [2].
trauma, sunburn, infections, medications, and stress can
The underlying mechanisms of psoriasis
provoke psoriasis, contributing to its complex etiology
involve a cascade of factors including excessive skin
cell growth, heightened display of antigens, the

production of specific T helper 1 cytokines, expansion
Epidemiology of psoriasis
of T-cells, and the formation of new blood vessels.
Psoriasis exhibits a gender-neutral impact but
Pruritus, commonly associated with dry skin or eczema,
often manifests earlier in females and individuals with
can also emerge from diverse conditions such as
a familial predisposition. The age of onset demonstrates
cirrhosis, blood disorders, infections, reactions to
distinct peaks, notably between 30­39 and 60­69 years
medications, and malignancies [3].
in men, occurring roughly a decade earlier in women.
Pruritus in autoimmune and inflammatory
Globally, psoriasis prevalence varies markedly across
dermatoses, is a common symptom that can be severe
regions, being more prevalent in high-income nations
and affects patient's lifestyle. In some diseases, pruritus
and affecting white populations disproportionately. Its
is related to disease activity and severity or may occur
prevalence spans from 0.1% in East Asia to 1.5% in
independently of the disease condition [4].
Western Europe, while Egypt showcases a prevalence
Pruritus has been linked to reduce quality of life and
ranging from 0.19% to 3%. The condition's genetic
accompanies several skin disorders including burns,
underpinnings are evident in around 30% of affected
insect bites, xerosis, and dermatitis [5].
patients, with identified genes potentially contributing
The purpose of this review was to provide a
to susceptibility. Moreover, the high concordance
comprehensive overview of the current knowledge
observed in monozygotic twins supports the genetic

Full Paper (vol.941 paper# 56)

c:\work\Jor\vol941_57 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 379-389

Assessment of Nurses' Knowledge, Attitude and Practice Regarding
Nutritional Care Management of Diabetic Patients in Benha University Hospital
Mai Abdullah Elmahdy*, Mai Magdy Anwer
Department 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
Diabetes mellitus (DM) is a major public health issue in Egypt and is regarded as a pandemic of modern
times. Most medical professionals that help diabetic people manage their difficulties are nurses. Nutrition is a key
element of diabetes control. Objective: This study aimed to evaluate nurses' knowledge, attitudes, and practices
(KAP) on the dietary treatment of diabetes. Subjects and methods: A cross-sectional based survey was carried out on
nurses working in medical and surgical departments, Benha University Hospital through the period from 1 June 2023
to 30 July 2023. To evaluate nurses' KAP, a verified self-administered questionnaire was utilized. The data were
analyzed using descriptive statistics and multiple linear regression to detect predictors for nurses' knowledge, attitude
and practice scores. Results: Age and awareness of national diabetes guidelines were revealed to be statistically
significant determinants of participants' knowledge of dietary treatment for diabetes. Higher knowledge scores was
significantly reported by nurses who were > 41 years (B = 7.68, P=0.03) and those who were aware of National
Diabetes Guidelines (B = -5.39, P=0.02). Only 44% of nurses expressed satisfaction with the nutrition education
received during their training in nursing universities and institutes. 86% never attended a refresher course on
managing diabetes. Most nurses (68%) felt they had a responsibility and were qualified to educate patients about
diabetes nutrition. It was shown that 60.6% of Benha University Hospitals' nurses had knowledge levels that were
below average. Participants generally showed a moderate degree of understanding of the dietary treatment of diabetes.
Although nurses' attitudes towards nutritional management of diabetic patients were good. In this study,
the nurses declared a modest level of knowledge and practices in relation to the dietary care of diabetes mellitus.
Keywords: Nurses, Knowledge, Nutritional care management, Diabetes mellitus.

according to their dietary needs. It has been
Numerous researches had examined the effect
determined that a significant obstacle to diabetic self-
of nutrition on the incidence and prevalence of
management regimens is this lack of comprehension
diabetes during the past few decades (1). The research
(8). People seeking comprehensive services, such as
emphasizes not just the pervasive impacts of diet on
prevention, diagnosis, treatment, and referrals from the
the development and consequences of diabetes, but
medical system should first consult primary health care
also the part nurses play in empowering diabetic
(PHC). Many people believe that nurses working in
patients (2). One of the primary duties of professional
PHC are essential to the efficient delivery of primary
nurses is assisting chronically ill patients in acquiring
care services for chronically ill patients. However,
self-management abilities. Education and counseling
relatively few researches have examined nurses
are frequently used to accomplish this. The main
working in PHC settings. The bulk of earlier studies
person in charge of giving diabetes patients the
that looked at nurses' awareness of diabetes-related
knowledge they need to improve their quality of life is
nutrition concentrated on nurses in acute care settings
a nurse (3). Patient education improves patient
(9). Additionally, past research has shown that patients
outcomes, according to earlier research (4). Therefore,
with chronic diseases like diabetes benefit the most
nurses should be adequately knowledgeable to give
from basic healthcare services (10).
patients the information they need. Diabetes patients
As the frequency of hospital admissions
tend to stay in hospitals longer than non-diabetic
related to diabetes increases, patients with diabetes are
patients and have higher hospitalization rates (5).
more likely to be encountered by nurses. Given the
Glycemic control, which may be attained through
time they worked with patients, they are additionally in
efficient management, is a cost-effective method of
an exceptional position to enhance results for diabetes
lowering the risk of complications of DM (6). The
patients. Nurses must ensure that the hospital' patients
ability of nutritional treatment of diabetes to enhance
are fed adequately and function as informal nutrition
insulin sensitivity, decrease the frequency of
counselors due to the nursing profession's broad scope.
hypoglycemia and hyperglycemic episodes, and
They support patients during mealtimes when patients
regulate glycated hemoglobin (HbA1c) levels has been
could ask for nutritional guidance (11).
well documented (7). Nutritional solutions that improve
As a result, nurses need to be familiar with the
diabetes management and prevention that are
dietary management of diabetes recommendations.
inexpensive and simple to apply are extremely
However, earlier research findings indicated a sizable
important. Consequently, diabetic individuals find it
knowledge gap among nurses regarding the dietary
difficult to choose appropriate meal options and
treatment of diabetic patients (12). Lack of knowledge
determine if a food item is suitable for eating
of the dietary requirements for individuals with
Received: 03/09/2023
Accepted: 02/11/2023

Full Paper (vol.941 paper# 57)

c:\work\Jor\vol941_58 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 390-399

The Role of Single Anastomosis Duodeno-Ileal Bypass with
Sleeve Gastrectomy in Treatment of Type-2-Diabetes Mellitus with
Morbid Obesity in Comparison with Mini-Gastric-Bypass
Mohamed E. Zayed, Mohamed M. Abd El-Wahab, Gamal E. Saleh, Mohamed H. Eid *, Ahmed Khairy Allam
Department of General Surgery, Faculty of Medicine, Benha University
*Corresponding Author: Mohamed H. Eid,email: mostafa.sa.madboly@gmail.com,mobile:+201554464636

The surge in obesity globally has paralleled an alarming rise in type 2 diabetes mellitus (T2DM), prompting
a search for effective treatment modalities. Bariatric surgery, evolving as a viable intervention for obesity-associated T2DM,
encompasses various procedures like the Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S)
and the Mini-Gastric Bypass (MGB). This study aimed to compare the efficacy of SADI-S versus MGB in managing
T2DM in obese patients.
Methods: This study was conducted at Banha University Hospitals between September 2021 and September 2022. 50 obese
patients with T2DM were enrolled and split equally into SADI-S and MGB groups. Preoperative assessments included
comprehensive clinical, laboratory, and radiological evaluations, delineated inclusion and exclusion criteria. Patients
underwent meticulous preoperative preparation and received detailed postoperative care, including staged diet regimens and
follow-up assessments.
Results: There was statistically significant difference between groups according to treatment, in Triglycerides and
cholesterol after 3, 6, and 12 months.
Conclusion: Surgical treatment of T2DM is gaining increasing attention due to the significant influence that weight loss
procedures have on glucose metabolism. Carefully selected patients with metabolic syndrome may undergo metabolic
surgery without risk. A therapeutic focus is necessary for individuals at high risk due to the heightened susceptibility to type
2 diabetes and cardiovascular disease. According to the findings of our research, SADIS and MGB exhibit comparable
efficacy in managing hypertension, diabetes mellitus, and hyperlipidemia.
Keywords: Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy; Type-2-Diabetes Mellitus; Morbid
Obesity; Mini-Gastric-Bypass


Obesity arises from a combination of inadequate
which is commonly attributed to a rise in the proportion of
energy expenditure and subsequent energy storage, which
overweight people worldwide (1). Recently, T2D has
culminate in weight gain. In recent decades, it has emerged
evolved into a worldwide pandemic; it is a chronic
as a significant healthcare concern in both developed and
metabolic disorder characterised by multiple factors and
developing nations (1).
affecting numerous organs. The disease in question is
The body mass index (BMI) of an obese person is at
widely recognised and largely attributed to the sedentary
least 30 kg/m2, while those whose BMI is between 25 and
lifestyle and the ongoing obesity epidemic. It is also
30 are considered overweight. The incidence of obesity
becoming more prevalent on a global scale (2,3). Weight
and overweight has increased by over twofold since 1980,
management and support for healthy lifestyles are central
according to the WHO. As a result, there are now over 2.1
to public health initiatives aimed at averting type 2 diabetes
billion people worldwide with a BMI of 25 or higher.
(2). T2DM constitutes at least 90% of all cases of diabetes
There exists a correlation between obesity and a
and is the most prevalent form (4).
heightened susceptibility to developing musculoskeletal
Bariatric surgery is defined as gastrointestinal surgery
disorders (including osteoarthritis), cardiovascular
performed to assist patients who are morbidly obese in
diseases, premature mortality, and hypertension. The
losing weight. It affords the greatest practical opportunity
relationship between BMI and postprandial and fasting
for the resolution or improvement of co-morbidities and
insulin levels is firmly established as being generally
sustained weight loss for the majority of these patients,
proportional. There is an analogous relationship between
including those with diabetes mellitus. During the early
BMI and the extent of insulin resistance. The elevation in
1980s, surgeons observed that a considerable number of
insulin levels linked to increasing BMI is essential to
type 2 diabetes patients who had undergone gastric bypass
counteract insulin resistance and sustain normal blood
surgery to address morbid obesity had achieved a full
glucose levels (1).
remission of their condition [1, 2]. Currently, metabolic
Diabetes is diagnosed in less than 25 percent of the
surgery is characterized as any procedure that reroutes the
2.1 billion individuals who are overweight or obese. The
food passage through the gastrointestinal tract in an effort
incidence of T2D has risen steadily in recent decades,
to alleviate diabetes through a mechanism unrelated to
Received: 02/08/2023
Accepted: 01/10/2023

Full Paper (vol.941 paper# 58)

c:\work\Jor\vol941_59 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 400-405

Role of Trabecular Metal Augments in
Revision Total Hip Arthroplasty with Acetabular Bone Defects
Emad Sanad *, Samir M Monib, Mohamed A. Abd Elbaky
Department of Orthopedic Surgery Faculty of Medicine, Benha University, Egypt
Corresponding author*: Emad Sanad, Phone Number: 01011891025, E-mail: dr_emadsanad85@fmed.bu.edu.eg

Annually, a growing number of total hip arthroplasties (THA) are being conducted, and a comparable
upward trend has been noted in revision hip procedures.
Objective: The objective of this research endeavour is to assess the initial functional and radiological results in patients
who are undergoing revision THA and have acetabular defects; trabecular metal augments (TMA) are utilised for
acetabular reconstruction.
Patients and Methods: A prospective cohort study was conducted on 40 patients undergoing rTHA with loose
acetabular component with acetabular defects. The study was done in the period between April 2021 and December
2022 in Benha University Hospital, including forty patients undergoing revision total hip arthroplasty with acetabular
defects that necessitate reconstruction. All the patients were followed up for one year. All patients were evaluated with
anteroposterior and cross table lateral plain X-ray, immediately postoperatively then at two, six, twelve weeks, six
months then annually. Functional outcomes were measured with Oxford Hip Score (OHS).
Results: There was no significant difference between Paprosky II and Paprosky III as regard OHS improvement. 2(5%)
of patients had fair OHS grade, 16(40%) had good OHS grade, 22(55%) had excellent OHS grade.
Conclusions: The promising early results of using THA for acetabular reconstruction convinced more surgeons to start
using this system in revision surgeries.
Keywords: Acetabular bone defects, Revision total hip replacement, Hip arthroplasty, Bone reconstruction.


Similar trends have been observed in revision hip
Custom triflange acetabular components (CTACs;
procedures and the annual increase in the number of
Zimmer Biomet, Warsaw, Indiana) present an
total hip arthroplasties (THAs) performed. In revision
alternative option, particularly in cases where chronic
total hip arthroplasty and specific primary total hip
pelvic discontinuity is present, in contrast to the
arthroplasty, acetabular bone stock deficiency is one of
unsatisfactory midterm and long-term outcomes
the most significant obstacle factors. The objectives of
observed with antiprotrusio devices and cages, as well
a successful revision surgery are the following:
as cemented acetabular components. Nonetheless, this
achieving press-fit of the implant, bridging bony
construct is costly, its fabrication takes about six weeks,
defects, and restoring the hip's centre of rotation [1].
and iatrogenic bone loss during removal of the existing
Regarding revision total hip arthroplasty, the
component often prevents it from matching the
management of acetabular bone defects is difficult.
preoperatively mapped defect [6].
Porous-coated hemispheric cups have the capability to
In recent times, augments made of tantalum, a
effectively reconstruct small, contained defects,
modular porous trabecular metal, have been devised to
whether additional allografts are utilised or not. In the
accomplish biological fixation while also furnishing
presence of sizable uncontained defects, even with the
mechanical support and coverage for an uncemented
addition of screws, a cementless cup will fail to
hemispheric acetabular component. A variety of sizes
interlock adequately with the host bone to offer primary
and shapes are utilised in the production of these cups
stability. Surgical options consist of bilobed oblong
and augments to accommodate bony defects [7].
cups, reconstruction cages, extra-large hemispheric
The objective of this research endeavour is to assess
cups, high hip centre placement, cement impaction
the initial functional and radiological results in
grafting, and structural allografts [2,3].
individuals who are undergoing revision total hip
To accomplish these objectives, various strategies
arthroplasty (rTHA) and have acetabular defects.
have been implemented. Alternative approaches
Trabecular metal augments (TMA) were utilised to
encompass the utilisation of cup-cage configurations,
reconstruct the acetabulum.
elliptical shells, rings or cages composed of cemented

shells, and shells featuring a high centre of rotation. But
osseous fixation can be impeded and early failure can
A prospective cohort study was conducted on 40
result from inadequate primary stability and host-bone
patients undergoing rTHA with loose acetabular
contact of less than 50% [4]. Failure by breakage or
component with acetabular defects. The study was done
loosening, as in the case of cages and reinforcement
in Benha University Hospital including forty patients
rings, and graft resorption and late failure, as in the case
undergoing revision total hip arthroplasty with
of allograft bone utilised with earlier acetabular
acetabular defects that necessitate reconstruction. The
component designs, are disadvantages of their use [5].
research was conducted between April 2021 and
Received: 02/08/2023
Accepted: 01/10/2023

Full Paper (vol.941 paper# 59)

c:\work\Jor\vol941_60 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 406-412

Efficacy of DJ Stenting versus Silodosin after Ureteroscopic Lithotripsy for
Lower Ureteric Stones: A Prospective Randomized Clinical Trial
Ahmed A Abdel Fattah*, Tamer Diab, Ahmed Hashem, Hosam Abu El-Nasr, Salah A El Hamshary
Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding Author: Ahmed A Abdel Fattah, Phone number: (+20)1228555403,
E-mail: ahmed.aboelezz@fmed.bu.edu.eg

A Double J (DJ) stent utilizing following ureteroscopy facilitates the residual fragments passage and
provides pain alleviation produced by mucosal swelling & obstruction, despite several complaints of stent related pain
The current work aimed to compare DJ stenting and Silodosin following ureteroscopy lithotripsy for lower
ureteric stones.
Patients and methods: This prospective randomized open label parallel clinical trial was carried out on 70 cases
diagnosed with lower ureteric stone 5-18 mm in size and scheduled for ureteroscopic lithotripsy. Cases were randomly
allocated into 2 equal groups; group A had a 5 Fr DJ stent to be removed after 3 weeks and group B who get 1
silodosin capsule 8 mg at night preoperatively and for 3 weeks postoperatively. All cases underwent plain X-ray of the
kidneys, ureters, and bladder (KUB), ultrasonography, and non-contrast CT of abdomen and pelvis before operation.
Results: Group B had a significantly shorter operative time than group A (21.7 ± 4.65 min vs. 38.6 ± 4.82 min, P <0.001
respectively). Postoperative follow-up of symptoms at days 3, 7, and 15 were insignificantly different between both
groups. Group B had a significantly higher stone free rate 24 hours than group A (91.43% vs 68.57%, P =0.034). Group
A had a significantly higher need for secondary procedure & residual fragmentation than group B (P <0.001)
Conclusion: Compared to the DJ Stent group, operative time is significantly shorter in cases received silodosin after
ureteroscopic laser lithotripsy.
Keywords: DJ Stenting, Silodosin, Ureteroscopic Lithotripsy, Lower Ureteric Stones.

determining the appropriate therapy for ureteric calculi,
10 - 15 % of whole population is affected by
stone factors (composition, location & burden) and both
ureteral calculi, and the urolithiasis incidence is
patient factors (medical comorbidities, coagulation
elevating over time [1]. It is known that most of these
status & body habitus) will be put in consideration [7].
stones pass on their own, with or without expulsive
A Double J (DJ) stent utilizing following
medical treatment and calculus is expelled based on the
ureteroscopy facilitates the residual fragments passage
calculus's size and placement within the ureter. In
and provides pain alleviation produced by mucosal
accordance with these variables, the expulsion rate for
swelling & obstruction, despite several complaints of
calculi < 5 mm ranges from 40 - 98 %, whereas that of
stent related pain postoperatively. Stent removal is an
calculi the calculi of 6 mm is between 35 - 50 % [2].
additional surgical procedure that increases the expense
In the presence of stones, and because of presence
of treatment. Stent related morbidity has been deemed a
of -adrenergic receptors (a-ARs) within ureteral
potential health risk despite their utility [8].
smooth muscles, therefore their contraction results in
There have been numerous attempts to alleviate
ureteral colic. The reactive inflammation generated by
these symptoms, but pharmaceutical treatment is the
calculus irritation of the ureteric mucosa creates
most noninvasive & straightforward alternative.
mucosal swelling, hence enhancing stasis causing
Interestingly, the lower ureter contains an a-ARs
obstruction. The lower ureter section involves greatest
abundance, that are responsible for phenylephrine-
density of the receptors compared to upper one [3].
induced ureteric smooth muscle contraction. While
70 % of these stones are distal ureteric stones, that
sustaining tonic propulsive contractions, muscle
are predominantly symptomatic. The ideal choice for
relaxation is provided by the application of a -blocker
distal ureteral stone therapy is determined by stone
that dilates the ureter. Therefore, -blocker
composition, location, size, clinical variables, surgeon
administration reduces intra-ureteric pressure, allowing
experience & equipment availability [4].
Several studies have demonstrated that semirigid
ureteroscopy (URS) lithotripsy is of high success rate
(PDE5Is), -blocker & analgesics had been tested to
for distal ureteric stones treatment despite having
alleviate these symptoms [9, 10].
various disadvantages that might be hazardous and
Silodosin is a highly selective a1-ARs antagonist
sometimes problematic [5, 6].
utilized for lower urinary tract symptoms (LUTS)
The ureteric calculi therapy is tailored to the
treatment. The lower urinary tract smooth muscle cells
patient depending on the need for additional procedures,
are densely populated with a1-ARs, and silodosin
success rates of various treatment approaches, and the
induce their relaxation, other investigations have
morbidity associated with treatment modality. When
Received: 02/08/2023
Accepted: 01/10/2023

Full Paper (vol.941 paper# 60)

c:\work\Jor\vol941_61 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 413-418

Otologic Changes in Tracheostomized, Mechanically Ventilated Patients
Eslam Farid Abu Shady*1, Diaa Bakry Eldib2, Taha Mohamed Abdelaal1
Departments of 1Otorhinolaryngology, 2Radiodiagnosis, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Eslam Farid Abu Shady, Mobile: (+20) 01207835481,
E-mail: eslam.farid@fmed.bu.edu.eg, ORCID: 0000-0002-9161-3149
One of the most often used procedures in intensive care units for patients on mechanical ventilation is
tracheostomy. In order to provide a safe and secure airway for individuals with traumatic brain damage, it is done.
Patients with tracheostomies exhibit both transient and permanent alterations. Numerous investigations indicated that
tracheostomies had an increased incidence of middle ear illness. Tympanostomy is necessary for about 20% of children
who have had tracheostomies. Objective: To evaluate the otologic changes based on clinical, audiological, and
radiological findings in tracheostomized, mechanically ventilated patients.
Patients and Methods:
This retrospective study of 43 tracheostomized, mechanically ventilated selected from intensive
and long-term care units from January 2020 to January 2023. Fifty individuals with unilateral sensorineural hearing loss
or tinnitus, with no previous history of ear surgery or other complaints were selected as a control group.
The study included a total of 86 ears and 100 ears as controls. The studied groups were comparable regarding
age, gender, and laterality. Patients' ears showed significantly higher middle ear effusion (62.8% vs. 0%, P < 0.001) and
tympanic membrane retraction (14% vs. 0%, P < 0.001). Tympanometry results significantly differed between the
studied groups (P < 0.001). Type B was the most frequent type in the patients' group (62.8%), followed by types A
(22.1%), C (11.6%), Ad (2.3%), and As (1.2%). Radiologically, patients' ears showed significantly higher eustachian
tube obliteration (68.6% vs. 0%, P < 0.001), middle ear cavity effusion (62.8% vs. 0%, P < 0.001), mastoid air cells
effusion (55.8% vs. 0%, p < 0.001), and petrous apex effusion (5.8% vs. 0%, P = 0.02).
Conclusion: Prolonged tracheostomized and mechanically ventilated patients exhibit a significant incidence of middle
ear changes as determined by clinical, audiological, and radiological assessments.
Keywords: Tracheostomized, Mechanically ventilated patients, Otologic changes, Middle ear effusion.

intensive care unit, resulting in better utilization of ICU
Tracheostomy is one of the ancient surgical
resources, and lowering the cost [4].
procedures performed three thousand years ago in
Egypt and India. The epidemics of diphtheria in the
incidence of ventilator-associated pneumonia, which is
middle 19th century increased the performance of
more prevalent with longer mechanical ventilation
tracheostomy, which improved the outcome of patients
duration. This complication carries a significant risk of
with upper airway obstruction [1].
morbidity and even mortality [5].
About 10% of mechanically ventilated patients are
Tracheostomy is frequently recommended in post-
tracheostomized. The prevalence of tracheostomy is
traumatic brain injury patients. Many studies suggest
increasing with the higher performance of percutaneous
early tracheostomy to avoid the above-mentioned
bedside tracheostomy. However, the indication and
possible complications. However, few studies were
timing of decannulation are still controversial [2].
conducted to evaluate the importance and post-
Tracheostomy is one of the most common
procedure sequelae in this group of patients [6].
procedures performed for mechanically ventilated
The timing and selection of patients who might
patients in intensive care units. It is primarily indicated
benefit from tracheostomy is still a challenging and
for patients with respiratory failure who require
complex medical decision. It depends on the medical
mechanical ventilation. It is performed for post-
condition and variable comorbidities of the patient.
traumatic brain injury patients aiming for a safe and
Patients with a single organ failure, such as head injury
secure airway. The main goals for tracheostomy include
or respiratory failure, have different management from
airway protection and access to suction the lower airway
those having multiple organ injuries [7].
secretions. Tracheostomy decreases the incidence of
Tracheostomized patients show evidence of short
and long-term changes. One of these changes is an
endotracheal intubation, including injury to the
alteration of nasal physiological function due to the
oropharynx, larynx, and trachea and patient discomfort.
discontinuity of inhaled air and its connection with the
In addition, systemic sedation is administrated mainly
nasal mucosal lining [8]. Generally speaking, functional
for all patients with endotracheal intubation, with its
changes mirror structural changes and vice versa. The
possible adverse effects [3].
nasal airflow is essential to maintain normal nasal
In long-term dependent ventilated patients,
mucosal epithelium. Subsequently, the absence of nasal
tracheostomy facilitates the early weaning process from
airflow may result in pathological changes in the nasal
mechanical ventilation by reducing the dead space of
mucosal lining and alter nasal function [9]. Patients who
upper airway passage, shortening mechanical
have had a complete laryngectomy are not allowed to
ventilation duration and the length of stay in the
breathe via their noses. As a result, the nose stops
functioning physiologically. Furthermore, nasal
Received: 06/08/2023
Accepted: 04/10/2023

Full Paper (vol.941 paper# 61)

c:\work\Jor\vol941_62 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 419-426

Intermittent Versus Regular Daily Regimen of Antenatal Oral Iron
Supplementation for Preventing Iron Deficiency Anemia During Pregnancy
Essam A. Amin1, Nabieh Ibrahim El Khouly1,
Azza Mokhtar Ahmed El Kayal*2, Mohamed Zakaria Sayer Dayer1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt
2Department of Obstetrics and Gynecology, El Sahel Teaching Hospital, Egypt
*Corresponding Author: Azza Mokhtar Ahmed El Kayal, Mobile: (+20) 01068180118, E-Mail: azza.mokhtar_91@yahoo.com

Anaemia is a medical condition that is quite frequent during pregnancy and the postpartum period
globally. It poses several health hazards to both the mother and the child.
Objectives: This study aimed to evaluate the efficacy and adverse effects of intermittent versus regular daily regimen
of antenatal oral iron supplementation for preventing iron deficiency anemia (IDA) during pregnancy.
Patients and methods:
A prospective randomized controlled study was conducted at Departments of Obstetrics and
Gynecology, Menoufia University Hospital and El Sahel Teaching Hospital through the period from February 2020 to
December 2022. During this study, two hundred sixteen non-anemic pregnant women were enrolled and divided into 3
equal groups (each group included 72 patients): Group A (daily) received 60 mg of elemental iron + 1000 ug folic acid
daily, group B (every 3 days) received 60 mg of elemental iron + 1000 ug folic acid twice weekly and group C (once
received 120 mg of elemental iron + 2000 ug folic acid once weekly. Complete blood picture and serum ferritin
were done at the start of the study and compared with follow up levels at 28 and 36 weeks.
Result: Demographic data were matched between groups. hemoglobin, hematocrit and ferritin levels before and after
iron supplementation were comparable in the three groups regardless iron supplementation regimen. Iron side effects
were more frequently encountered in group A than in groups B and C (27.8% vs 15.3% and 9.7% respectively).
Regression analysis revealed that regimen of iron supplementation was not predictive of final hemoglobin concentration
and the only significant predictor for final hemoglobin concentration was the initial hemoglobin level.
Conclusion: Intermittent (once or twice weekly) iron supplementation is advisable to non-anemic pregnant women as
it is not associated with increased risk for developing anemia or ID when compared to daily regimen with fewer side
Keywords: ID, Anemia, Iron Supplementation.


fulfil the increased iron requirements throughout
Anaemia during pregnancy is characterised by
pregnancy and the postpartum period, and around 40%
a drop in hemoglobin < 11gm/dl or total RBCs, which
of women have low or no iron stores at the beginning of
results in a loss in the blood's ability to carry oxygen.
their pregnancy (4).
Worldwide, anaemia is a very prevalent illness during
pregnancy that has several health hazards for both the
communities where the prevalence of anaemia is less
mother and the unborn child (1).
than 20%, the WHO suggests an intermittent regimen
Generally non-specific, maternal signs and
(e.g., weekly 120 mg of elemental iron and 2.8 mg
symptoms might include pallor, tiredness, dyspnea,
folate) as an effective substitute for a daily regimen for
palpitations, and dizziness. Anaemia has several well-
the prevention of anaemia during pregnancy. Oral
known effects on mothers, such as increased risk of
supplements given once a week would expose new
maternal death, decreased physical and mental function,
intestinal epithelial cells to each subsequent dose,
decreased peripartum blood reserves, and higher risk of
improving iron absorption. It is believed that an oral
peripartum blood product transfusion (2).
dose of iron can become saturated in an intestinal
Reduced red blood cell synthesis, increased red
epithelial cell, leading to decreased iron absorption
blood cell oxidation, or blood loss can all lead to
because intestinal cell turnover happens every five to six
anaemia. IDA is the most common cause of anaemia
days. Studies on weekly supplements have
during pregnancy globally. Offspring of IDA-afflicted
demonstrated comparable effects on mothers as those
mothers are at a higher risk of low birth weight, preterm
on daily supplements (5). Moreover, intermittent oral
birth, infections, and even death during pregnancy.
iron supplementation may lessen the oxidative stress
Studies based on observation reveal that iron shortage
caused by free radicals, which harms the intestinal
during pregnancy may cause distinct problems in the
mucosa and causes the unfavourable gastrointestinal
child's behaviour or cognitive development (3).
side effects linked to daily oral iron supplements.
For a 55 kg woman, the average daily need for
Consequently, weekly schedules could be more
elemental iron during pregnancy is between 30 and 60
palatable to women, leading to higher levels of
mg. Foetal development, placental requirements, and
compliance (6).
the rise in red cell mass are all supported by this iron.
However, it has been demonstrated that
Up to 90% of women have iron reserves insufficient to
occasional supplementing programs raise the risk of
Received: 05/09/2023
Accepted: 04/11/2023

Full Paper (vol.941 paper# 62)

c:\work\Jor\vol941_63 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 427-435

Whole Pelvis versus Bladder Only Radiotherapy in Trimodality Therapy for
Negative Lymph Node Muscle Invasive Bladder Cancer
Aya Mahmoud Ebraheem, Mohamed Soliman Gaber, Asmaa Abdelghany Abdellatef, Rafaat Abdelaal Bakheet
Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Sohag University, Egypt.
Corresponding author: Aya Mahmoud , Tel: +20-01002558777 , Email: ayamahmoud581989@gmail.com

Trimodality therapy has been recommended as a valid treatment option for well-selected patients of muscle
invasive bladder cancer (MIBC). The benefit of elective nodal irradiation during bladder radiotherapy (RT) remains a
controversial topic.
Objectives: Our study comparing bladder only (BO) versus whole pelvis (WP) radiotherapy, concurrent with cisplatin to
evaluate BO radiotherapy outcome and toxicity.
Patients and methods: A randomized prospective study comparing BO versus WP radiotherapy using 3D conformal
radiotherapy concurrent with cisplatin followed by 4 cycles gemcitabine/cisplatin in nonmetastatic negative lymph node
: Our cohort included 28 and 30 patients in BO and WP group, respectively. No statistically significant difference
(P =0.59) was detected between 2 groups as regard disease free survival (DFS)rate at 3 years, which was 81% and 85 % in
BO and WP group, respectively. At 3 years the reported bladder cancer specific survival and overall survival(OS) rate in
BO group was 83% and 75 %, respectively while for WP group the results were 80 % and 73%, respectively with no
statistically significant difference between the 2 groups. Regarding RT toxicity, acute small bowel (P=0.03) and acute rectal
toxicity (P=0.007) showed statistically significant difference favouring BO radiotherapy while acute genitourinary toxicity
(P=0.91), late genitourinary (P =0.33) and late GIT toxicity (P=0.4) showed no statistically significant difference between
the 2 groups.
Conclusion: BO radiotherapy concurrent with chemotherapy is an effective treatment option in patients with lymph node-
negative MIBC with comparable oncologic outcomes and less RT toxicity when compared with WP radiotherapy.
Keywords: Bladder only radiotherapy, Whole pelvis radiotherapy, Bladder radiotherapy.


In 2020, an estimated 573,000 new cases
However, data from matched comparisons and
diagnosed with bladder cancer and 213,000 deaths.
meta-analysis demonstrate that trimodality therapy yield
Therefore, bladder cancer ranked as the 10th most
similar long-term survival rates and comparable clinical
commonly cancer worldwide. In Egypt, bladder cancer
oncologic outcomes when compared to radical
remains as a serious health concern as it is the 3rd most
cystectomy. Based on these data, the current NCCN
prevalent cancer according to GLOBACAN 2020 (1).
Guidelines and the American Society of Clinical
Management of MIBC, which constitute
Oncology have recommended trimodality therapy as a
25% of bladder cancer diagnosis is challenging
valid treatment option for appropriate-selected patients
with neoadjuvant chemotherapy followed by
of MIBC who refuse to undergo radical cystectomy, as
well as those who are not candidates for neoadjuvant
lymphadenectomy, is considered the standard of
chemotherapy and surgery (4,5).
care for treatment by international guidelines.
Trimodality therapy consists of maximum
Although there is progress in surgical techniques and
transurethral resection of bladder tumor (TURBT)
perioperative care, radical cystectomy causes significant
followed by chemotherapy concurrently with
postoperative morbidity and complication even in the
radiotherapy. The radiation volume in trimodality
most experienced hands at high volume centers.
therapy needs further investigations particularly the
Additionally, the majority of bladder cancer patients are
unresolved issue of benefit of elective pelvic lymph node
elderly, and many of them may not be good candidates
(LN) irradiation in negative lymph node MIBC.
for surgery because of co-morbidities that could raise the
Consequently, for bladder preservation, elective nodal
risk of complications after surgery (2,3).
irradiation is a matter of debate in practice worldwide (6).
So, trimodality therapy has emerged as an
RTOG protocols include irradiation to WP then
alternative treatment of MIBC that would provide non-
the bladder and gross tumor received radiotherapy (RT)
inferior oncological outcomes to radical cystectomy and
boost while the UK BC 2001 trial using whole bladder
maintain quality of life. Unfortunately, there are no
radiotherapy showed that regional nodal failure was
completed head-to-head randomized comparisons
similar to that reported in the studies utilizing WP
between the trimodality therapy and radical cystectomy.
Received: 02/08/2023
Accepted: 01/10/2023

Full Paper (vol.941 paper# 63)

c:\work\Jor\vol941_64 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 436-438

Short-Course Radiotherapy with Delayed Surgery for
Locally Advanced Rectal Cancer: Review Article
Shimaa Roshdy Abdelaal*, Asmaa Abdelghany Abdellatef, Elsayed Mostafa Ali, Mohamed Soliman Gaber
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Sohag University
Corresponding author: Shimaa Abdelaal*, Mobile:(+2)01061552011,

Multiple studies have found that neoadjuvant long-course concurrent chemoradiotherapy and neoadjuvant short-course
radiation therapy with immediate surgical resection have equal efficacy as regards local and distant control. However, PCR
was better in long-course radiotherapy. The short-course strategy has decreased the incidence of acute radiation toxicities
more than conventional chemoradiotherapy. Short-course radiotherapy is also less expensive plus more practical,
particularly in busy oncology centers. There are significant benefits to postponing surgery after preoperative rectal cancer
treatment. This concern progresses to the short-course radiotherapy approach with subsequent chemotherapy prior to
surgical resection aiming to improve complete pathological response rates with less radiation toxicities. Whether
neoadjuvant short-course irradiation with delayed resection or neoadjuvant conventional concurrent chemoradiotherapy is
the best strategy is still being debated.
Keywords: Rectal, Preoperative, Radiotherapy, Short course.

make surgery easier plus raise sphincter-preserving
Colorectal carcinoma is the 2nd most prevalent
surgery rates. Secondly, exposing non-surgical tissue,
reason for cancer death and the third most prevalent tumor
which has a higher concentration of oxygen, to radiation
in both sexes worldwide. Within Egypt, colorectal cancer
might make it more sensitive to radiation therapy.
ranks seventh among both genders, accounting for 4.2%
Thirdly, radiation therapy administered before surgery
of the population (9th in men and 8th in women). The
can shield the small bowel that has been held captive by
median age is 50 years (1,2).
adhesions in the pelvic region from radiation-induced
Preoperative concurrent chemoradiotherapy with
damage. Preoperative radiation encompassing structures
subsequent complete mesorectal excision (TME) within
planned for resection enhances the probability of
four to eight weeks and preoperative short-course
conducting an anastomosis with normal tissue (4).
radiation therapy followed by immediate surgical
For locally advanced rectal tumors, two neoadjuvant
resection after one week were the standard treatments for
regimens recognized as the neoadjuvant standard therapy
stages III and II locally advanced rectal cancer. These two
were preoperative standard concurrent chemoradiation
approaches demonstrated comparable local and distant
then operation, and neoadjuvant short-course radiation
control rates, but the long-course approach exhibited
therapy then subsequent operation after one week (4). In
higher pathological complete response rates (3). These
numerous studies, both techniques demonstrated
results led to the development of modern treatment
comparable long-term survival, late morbidity, and local
regimens that included a short course of radiotherapy then
control. However, long-course RT exhibited higher
chemotherapy and
pathological complete response rates. The acute radiation
postponed for longer than eight weeks.
toxicities associated with the short-course schedule are

significantly lower than those associated with
Standard of neoadjuvant therapy
conventional CRT. Additionally, in overcrowded
Due to the high locoregional recurrence risk,
oncology centers, short-course irradiation is more
neoadjuvant therapy for stage two or stage three rectal
practical and financially advantageous (3).
cancer should include locoregional treatment. The
Approximately 50% to sixty percent of cases
rectum's proximity to pelvic structures, the serosa absence
undergo downstaging following preoperative treatment,
encircling, and the technical challenges of achieving wide
while twenty percent exhibit a pathologic complete
surgical margins during resection all contribute to this
response (4). Recently trials established a correlation
risk. Sphincter preservation, local recurrence rate, and
between the efficacy of preoperative therapy and the
radiation-induced toxicities were all improved by
prolonged prognosis in cases diagnosed with rectal
neoadjuvant therapy, but regarding 5-year OS, an
tumors. A multivariate analysis of MERCURY trial
insignificant difference was found (4)
showed a significant relationship between OS and DFS
Preoperative radiation may have advantages over
and the cancer regression level assessed with MRI. Cases
postoperative radiation in preserving healthy tissue and
with inadequate cancer regression grades showed five-
tumor response. First, decreasing tumor volume may
year survival rates of twenty-seven percent compared to
Received: 07/08/2023
Accepted: 04/10/2023

Full Paper (vol.941 paper# 64)

c:\work\Jor\vol941_65 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 439-444

Parents' Satisfaction About Quality of Physical Therapy Services for
Children with Spastic Cerebral Palsy
Kholoud Ahmad Reyad*, Khaled Ahmed Mamdouh, Amira Mahmoud Abd-Elmonem
1Physical Therapy for Pediatrics departement, Faculty of Physical Therapy, Cairo University,Egypt
Corresponding author: Kholoud Ahmad Reyad Email: Drkholoudreyad@gamil.com, Mobile: +201111322809

In healthcare, particularly in physical therapy, patient satisfaction is a vital quality care indicator. It mirrors
patient perceptions about service quality. Parents' satisfaction, especially in pediatric rehabilitation, is crucial for child-
focused healthcare organization. It encompasses elements like access, service availability, appropriateness, facility quality,
staff competence and respectful care. Parental satisfaction levels serve as a reliable proxy for assessing overall healthcare
Aim of study: This study aimed to determine substantial factors that are important for parents satisfaction at both
governmental and private clinics.
Methods: Fifty-five spastic crerbral palsy children from both sex were enrolled in a cross-sectional qualitative study. The
parents' satisfaction was assessed through direct documentation by utilizing the MedRisk-Instrument Questionnaire for
measuring patient satisfaction with physical therapy care (MRPS).
Results: When comparing mean value of total score of MRPSQ between place of survey categories (private rehabilitation
centers and governmental hospitals), there was a notably substantial difference among both groups in favor to private
rehabilitation centers category (P<0.05). Significant positive correlations were observed between individual items of
medrisk as well as current patient state, in addition to the two global items of same questionnaire. The mean value of
GMFM in unilateral CP category was 64.88 ± 5.08, while in the bilateral CP category was 38.69 ± 8.75. There was a
highly significant difference among both categories in favor to unilateral CP category as P < 0.05.
Conclusion: Services of physical therapy sessions are better at private rehabilitation centers than those, which served at
governmental rehabilitation centers, the less the disability the more the parent satisfaction.
Keywords: Parents satisfaction, Quality, Services, Spastic cerebral palsy, Medrisk.


Satisfaction has been employed as an index to
Cerebral palsy influences around 2.6 children in
assess the quality of service provided in the healthcare
each 1000 and is one of the most widely recognized
industry, including the field of physical therapy (1).
reasons of disability in children (5). It is classified to five
According to the prevailing agreement, satisfaction is a
types including spasticity, dyskinesia, ataxia, hypotonic
measure of how patients perceive the quality of the
and mixed; with spastic type being 75% of all the cases
treatment they have received (2). As a conceptual
(6). Children with spastic CP experience challenges with
framework, it encompasses a wide range of influences,
motor movement, which lead to communication
including the interactions between therapist and patient,
impairments (7).
socio-cultural values, and the environmental context of
Patient satisfaction is progressively used to
the service. In the field of physical therapy, the
screen patient opinions of the quality of healthcare
connection between therapists and patients is typically
facilities (8). At first glance, it would appear surprising
more intense compared to other healthcare professions.
that a questionnaire utilized at an outpatient pediatric
This is because physiotherapeutic treatment is divided
practice only interviewed parents (9). Nevertheless,
into numerous scheduled sessions, therefore the
research that compares self-assessments of children with
satisfaction of patients can be directly influenced during
assessments conducted by their parents reveals a strong
these sessions (3).
correlation among these two measures (10).
Cerebral palsy (CP) refers to a number of
The involvement of parents is a vital source of
disorders marked by impaired motor function resulting
information required for the organization of child-
from non-progressive brain injury that occurs in early
oriented healthcare. Total quality management is based
childhood. Typically, there are concurrent disabilities
on the idea that both customer satisfaction and
along with emotional and social challenges within the
attainment of organizational objectives are closely
family. The severity can vary from complete dependence
related. This matter can be achieved by developing
and immobility to the ability to do self-care tasks
excellence and continuous improvement of organization
independently and engage in activities such as walking,
processes involved in providing services (11).
running in addition to other skills, but there is some
Presently, quality management as well as
clumsy actions (4).
certification procedures in healthcare facilities, which
Received: 14/08/2023
Accepted: 12/10/2023

Full Paper (vol.941 paper# 65)

c:\work\Jor\vol941_66 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 445-448

Relationship of Exclusive Breastfeeding with History of Acute
Respiratory Infection (ARI) in Children in Benha University
Ahmad Ata Sobeih 1, Tarek Mahmoud Arafa Khattab 1, Nouran Ramzy Badr Mohammed 1,
Mai Abdullah Elmahdy 2, Abeer Elsayed Elaraby Herzalla 1 and Marwa Elsayed Ahmed 1
1 Pediatrics Department, 2 Public Health, Community, Environmental and Occupational Medicine,
Faculty of Medicine, Benha University, Egypt
* Corresponding author: Abeer Elsayed Elaraby Herzalla, Email: abeeromar499@gmail.com, Phone: +201061663529

Acute respiratory infections (ARIs) represent a significant public health concern in young children, with
potential long-term consequences for their health and well-being. Exclusive breastfeeding has been postulated to have
a protective effect against ARIs, but the extent of this association requires further investigations.
Objective: This research aimed to determine whether or not exclusive breastfeeding was associated with upper and
lower respiratory tract infections during infancy. Methods: This cross-sectional observational study was carried out in
November and December 2022 at Benha University Hospital. Children with acute respiratory tract infections between
1 and 24 months were included. Children with immunocompromised states or chronic inflammatory disorders were
excluded. Comprehensive medical, obstetric, maternal, familial, and perinatal records were compiled.
Results: Of the children in the study, 58% received exclusive breastfeeding, and 48% experienced acute respiratory
infections. Those with acute respiratory infections had significantly lower exclusive breastfeeding rates (20.8%)
compared to those without respiratory infections (92.3%). Univariate analysis indicated that higher gestational age and
exclusive breastfeeding were correlated with a lower risk of acute respiratory infection. In the multivariate analysis,
exclusive breastfeeding was associated with a substantial 97.6% risk reduction in acute respiratory infections.
Conclusions: The results showed a statistically significant correlation between the occurrence of ARIs and lower
gestational age. It has been shown that exclusive breastfeeding significantly reduces the risk of developing ARIs.
Keywords: Exclusive breastfeeding, Acute respiratory infection, Maternal history, Child health.

lowering infant mortality because it can lower the
Acute respiratory infection (ARI) is one of the
incidence of illnesses that frequently affect babies, such
major public health issues in both developed and
as diarrhoea, ARI, otitis media, and urinary tract
developing nations because it can result in a high infant
infections. Lactoferrin, a protein found in breast milk, is
and toddler mortality rate, roughly 1 in 4 fatalities [1].
an immunological component that works to shield
ARI is a condition in which both the upper and
against bacterial infections brought on by viruses,
lower respiratory tracts are affected. A virus or bacteria
fungus, bacteria, and other agents. Apart from
is the cause of ARI. WHO states that ARI is the primary
lactoferrin, other immune-boosting compounds found
infectious disease-related killer worldwide, particularly
in breast milk include antibodies, immunoglobulin A,
in underdeveloped nations. The primary reason for
and oligosaccharides [1].
treating children in hospitals or health facilities is ARI
The current study aimed to investigate the
relationship between upper and lower respiratory tract
Risk factors that can lead to ARI in children include
infections and exclusive breastfeeding during infancy.
unfavourable environmental conditions (such as poor

ventilation and exposure to cigarette smoke), partial
immunizations, low birth weight, inadequate nutrition,
which can compromise an underdeveloped immune
This observational cross-sectional study was
system, low parental education, gender, and non-
carried out on a total of 100 children from November to
exclusive breastfeeding. In the first few months after
December 2022 in Banha University Hospital's
delivery, breast milk has a protective impact that tends
Pediatric and Neonatology Department. All children
to assist lower morbidity. According to the research,
between the ages of 1 and 24 months who were
infants who did not receive exclusive breastfeeding had
hospitalised for acute respiratory tract infections,
a 4.96-fold higher incidence of ARI than children who
including lower and upper infections, were included in
did receive it [3].
the study population. The study was conducted with the
Mother's milk is a food that provides nutrients that
utmost ethical considerations; all parents provided
kids need to strengthen their immune systems against
informed consent and the study was approved by Benha
different diseases. Giving breast milk to infants between
Faculty of Medicine ethical committee for research
the ages of 0 and 6 months without any additional food
involving human beings, along with administrative
is a unique way to provide neonates with nourishment
[4]. The benefits of breastfeeding extend to women,
Inclusion criteria: Children diagnosed with acute
newborns, and the socioeconomic sphere. Research
respiratory tract infections (including lower and upper
indicates that breastfeeding plays a critical role in
respiratory tract infections), those aged from 1 to 24

Full Paper (vol.941 paper# 66)

c:\work\Jor\vol941_67 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 449-455

Bladder Only Radiotherapy Concurrent with Chemotherapy Outcomes in Muscle
Invasive Bladder Cancer Management: Our Institute Experience
Aya Mahmoud Ebraheem*, Mohamed Soliman Gaber, Asmaa Abdelghany Abdellatef, Rafaat Abdelaal Bakheet
Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Aya Mahmoud Tel: +20-01002558777 Email: ayamahmoud581989@gmail.com


Background: Bladder only radiotherapy (RT) concurrent with chemotherapy emerged as a valid treatment option for
patients with muscle invasive bladder cancer (MIIBC) with complete response to chemoradiotherapy, has been associated
with better survival outcomes.
Our study evaluates bladder only RT outcomes as regard locoregional and distant metastasis in negative lymph
node MIBC and evaluates associations between patients, tumor characteristics, and treatment and complete response to
Patients and methods: This prospective study was conducted in Sohag University Hospital and Sohag Cancer Institute.
This study was a part of study comparing bladder only RT versus whole pelvis RT. The study included 28 patients diagnosed
as nonmetastatic negative lymph node MIBC. Patients underwent maximum transurethral resection of bladder tumor
(TURBT) then received bladder only RT, concurrent with cisplatin then 4 cycles gemcitabine/cisplatin.
Results: Complete response was achieved in 75% of patients on cystoscopy assessment at 3 months post
chemoradiotherapy. With median follow up of 3 years, locoregional recurrence free survival rate and distant metastasis free
survival rate at 3 years were 85 % and 82 %, respectively. Complete TURBT, absence of carcinoma in situ (CIS) and
concurrent chemotherapy were related to achieving complete response following bladder only RT concurrent with cisplatin
but with no statistical significance, maybe due to small sample size.
Conclusion: Bladder only radiotherapy is an effective treatment option as a part of trimodality therapy for negative lymph
node MIBC with complete TURBT, absence of CIS and concurrent chemotherapy is associated with complete response.
Keywords: Bladder only radiotherapy, Trimodality therapy, Complete response.


Bladder cancer is the 10th most common cancer
Optimizing radiation treatment volumes for
globally, with an estimated 573,000 new cases and
trimodality therapy is still subject for further studies. The
213,000 deaths in 2020. Bladder cancer is a significant
whole bladder irradiation without pelvic lymph node
burden on healthcare systems due to its high rate of
(LN) irradiation evolved as a feasible treatment option for
morbidity and mortality. Over time, the incidence has not
patients with negative lymph node MIBC with favourable
remained stable worldwide, and it is not expected to do so
RT toxicity as shown in BC2001 trial (5).
in near future (1).
Achieving treatment response is a serious issue during
Bladder cancer is still a serious health issue in Egypt.
trimodality therapy. Studies showed that patients
Despite evidence of schistosomiasis control, bladder
responding to trimodality therapy have better survival
cancer ranks third as most common cancer and cause of
outcomes in comparison with non-responders. Factors
cancer death in 2020. According to GLOBACAN 2020, it
affecting response include tumor size, tumor stage,
is the second most frequent cancer among men in Egypt
multiplicity of tumor, the presence of hydronephrosis
and/or CIS and maximum TURBT (6).
At presentation, approximately 70% of bladder cancer
Our study evaluates outcomes of bladder only RT
cases are non-muscle invasive and the remaining 25% are
concurrent with cisplatin at our institute as regard
muscle-invasive. Although radical cystectomy with
locoregional and distant metastasis rates. Also, we
neoadjuvant chemotherapy is considered the standard
evaluate patients, tumor characteristics and, treatment
treatment for MIBC, the associated morbidity and
associated with complete response.
mortality remain substantial concerns result in growing

interest in bladder preservation treatment. Trimodality
therapy, which consists of maximum TURBT followed by
Study design
concurrent chemoradiotherapy, now included in major
This study is a prospective study, this study was a part
guidelines. Trimodality therapy has comparable
of another study comparing bladder only versus whole
oncologic outcomes to radical cystectomy in carefully
pelvis RT, conducted in Sohag University Hospital and
selected patients as demonstrated by meta-analysis and
Sohag Cancer Institute. The study included 28 patients
matched comparisons (3,4).
with non-metastatic negative lymph node MIBC enrolled
Received: 14/08/2023
Accepted: 12/10/2023

Full Paper (vol.941 paper# 67)

c:\work\Jor\vol941_68 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 456-464

Vitamin D Level in Graves' Disease and Effect of
Vitamin D Supplements on Associated Autoimmunity
Mayson M. Ghanam1, Megahed Abouelmagd1, Abeer Mesbah2, Ahmed N. Shaaban3, Nagy M. Shaaban1*
Departments of 1Internal Medicine, Endocrinology and Diabetes Unit and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
3General Practitioner, Ministry of Health, Egypt
*Corresponding author: Nagy M. Shaaban, Mobile: (+20) 01220042003, E-mail: nagyshaaban@hotmail.com

Graves' disease (GD) is the most frequent cause of hyperthyroidism. There is debate about the role of
vitamin D deficiency (VDD) in thyroid autoimmunity and the effect of vitamin D (VD) administration on thyroid
Objective: This work aimed to study if vitamin D insufficiency (VDI) in patients with GD was linked to elevated thyroid
autoantibody titer levels and how vitamin D supplementation affects Thyrotropin receptor antibody (TRAb), anti-
thyroid peroxidase antibody (TPO Ab), and Anti-thyroglobulin antibody (anti Tg) titers in patients who have both VDI
or VDD and GD.
Patients and Methods: A total of 30 patients with GD and 30 matched control individuals were involved in our study.
Serum from these patients and controls was tested for vitamin D (25[OH]D) and thyroid profile. Following evaluation,
patients (n=16) with GD and insufficient or deficient vitamin D were given cholecalciferol. An evaluation was conducted
six months after the vitamin D treatment.
Results: Cases with GD were associated with a higher prevalence of VDI than the control group (P<0.001). VD values
in Graves cases revealed a negative association with both TRAb (P<0.001) and age (P<0.001). The results of
multivariate regression analysis indicated that the most significant predictors of Graves were TRAb (P=0.002), anti-
TPO (P=0.006) and VDD (P=0.013).
Low VD level is linked to elevated TRAb titers in GD, and the level of thyroid autoantibodies were
decreased after Vitamin D administration, pointing to a potential connection between elevated thyroid autoimmunity in
GD patients and their vitamin D levels.
Keywords: Vitamin D deficiency, Graves' disease, TRAb.


The most common etiology of hyperthyroidism
Vitamin D deficiency (VDD) is considered as a
is GD. It is an autoimmune disease (AID) that affects
significant problem for public health globally. There is
only certain organs and causes excess thyroid hormone
growing evidence relating low vitamin D values to
production (1). Antibodies against thyroid hormone
increased risks of several non-skeletal illnesses, such as
receptors are frequently seen in GD patients (2). Clinical
autoimmune, heart disease, cancer, and infections.
symptoms are linked to both the autoimmune and
However, the fundamental mechanisms are still
unknown (5).
physiological systems are impacted by excess thyroid
The majority of the literatures reported a link
hormones. Thus, warning indications including the
between VDD and a higher propensity for development
severity of GD symptoms can vary widely and have a
and/or greater titers of antibodies related to GD.
big impact on general health (3).
However, there have been several studies that contradict
Fat-soluble vitamin D is important for
such links, making it difficult to come to a consensus (6).
maintaining Ca+2 homeostasis and bone metabolism.
The efficacy of VD intake in VDD Graves cases is
The nuclear vitamin D receptor (VDR), found in most
debatable. Certain researches have recorded that
tissues and cells, including immune cells, attaches to the
vitamin D supplementation decreases thyroid
active form of vitamin D and controls the expression of
autoantibody titers, while others have shown no effect
approximately 200 genes comprised in cell division,
proliferation, and death. Numerous studies on vitamin
Information about the connection between GD
D's non-skeletal effects have been conducted in recent
and vitamin D is less abundant. Misharin et al. (8) used
years, and evidence supports a connection between VD
immunization of two BALB/c and C57BL/6 mouse
insufficiency (VDI) and a number of illnesses, including
strains fed either a vitamin D-sufficient or -depleted diet
cancer, metabolic syndromes, and autoimmune diseases
to study the response to TRABs induction. Compared to
C57BL/6 strains, BALB/c strains showed a decreased
capability for conversion of 25(OH)D to 1,25(OH)2D
physiologically active form of vitamin D exerts strong
and a greater susceptibility to disease induction.
immunomodulatory actions on the immunity. By
Depending on the diet given, the immunological
triggering VDR, which reduces CD4+, Th1, Th2, and
response of BALB/c mice varied marginally, according
Th17 cell over activity and cytokine formation, vitamin
to the authors' findings, the primary difference was the
D inhibits pro-inflammatory pathways (5).
increased risk of chronic hyperthyroidism (8).
Received: 02/09/2023
Accepted: 01/11/2023

Full Paper (vol.941 paper# 68)

c:\work\Jor\vol941_69 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 465-472

In Vitro Assessment of Antineoplastic Potential of The Venom
Extracted from Dysdera Sp. Inhabiting The Egyptian Environment
Nehad Ali 1; Mona Eltonsy 1; Walaa Tantawy 1; Hamdy Aly 2 and Waleed B. Suleiman 3*
1 Zoology Dept., Faculty of Science (Girls), Al-Azhar University, Cairo-Egypt.
2 Zoology Dept., Faculty of Science, Al-Azhar University, Assiut Branch, Assiut-Egypt.
3 Botany and Microbiology Department, Faculty of Science (Boys), AlAzhar University,
The Permanent Camp St., 6th Ward, Nasr City,11884 Cairo, Egypt.
* Corresponding author: Waleed B. Suleiman, Email: dr_wbs@azhar.edu.eg, Phone: +20 109 424 7999

Cancer is a leading cause of mortality, challenges in conventional nonsurgical cancer treatments, such as
chemotherapy and radiation and include poor prognosis, recurrence, and low survival rates.
Objective: The primary objective of this study was to investigate the potential antitumor activity of the venom extracted
from an Egyptian spider, preliminarily identified as Dysdera sp. The focus is on exploring the cytotoxicity of the spider
venom against various tumor cell lines, including lung (A549), hepatocellular (HEPG-2), colon (HTC-116), and breast
(MCF-7) cells, in comparison with non-tumorigenic WI-38 cells.
Material and methods: The Egyptian spider was hunted from Fayoum governorate, and its venom was extracted in
PBS for further investigation. MTT assay was employed to assess the potential cytotoxicity of the venom against the
specified tumor cell lines. The study aims to determine the IC50 values, representing the concentration of the venom at
which 50% inhibition of cell growth occurs.
Results: The results of the MTT assay revealed varying IC50 values, ranging from 163 to more than 1000 µg/ml, against
the different tumor cell lines. Notably, the spider venom exhibited promising antitumor activity against HEPG-2 and
A549 cells, with IC50 values of 163 and 432 µg/ml, respectively. These findings suggest that the crude venom may
contain elements that could be explored for their potential as anticancer medications.
Conclusion: This study demonstrated the potential antitumor activity of the Dysdera spider venom, particularly against
HEPG-2 and A549 cells. The varying IC50 values indicated the specificity of the venom's cytotoxic effects on different
tumor cell lines.
Keywords: Egyptian spider, Dysdera, Antineoplastic, MTT assay, Spider venom.


Spiders, belonging to the order Araneae, are eight-
Dysdera spiders are notable among the limited
legged arthropods that breathe air. They possess
arthropods known for hunting and consuming woodlice,
chelicerae, commonly known as fangs, capable of
constituting their primary food source. Equipped with
injecting poison, and spinnerets for extruding silk [1].
large fangs and robust jaws, these spiders adeptly
Dimitar et al. [2] note that spiders constitute the largest
penetrate the tough shells resembling armor that encase
order of arachnids, ranking seventh in total species
woodlice. This ability enables Dysdera spiders to
diversity across all organism orders. Except for
outcompete or even eliminate other spiders and
Antarctica, spiders are found on all continents, thriving
centipedes, establishing them as formidable predators
in nearly every land habitat. In 2023, the World Spider
relative to their size. The Dysderidae family of
Catalogue [3] reported the identification of 51,673 spider
araneomorph spiders, originally described by Carl
species from 136 families by taxonomists. A spider's
Ludwig Koch in 1837, predominantly inhabits Eurasia,
lifestyle dictates its habitat and influences its adaptive
extending into North Africa, with only a few species
behavior for prey capture and food acquisition.
found in South America [6].
While spiders are widespread, they are particularly
Five Dysdera species, namely D. crocata, D.
abundant in areas with dense vegetation. Conversely,
ninnii, D. dubrovninnii, D. hungarica, and D.
arid environments such as sand dunes, tidal zones, or
longirostris, persist in Central Europe following the last
mountain tops also serve as habitats for spiders. Spiders
glacial epoch [7]. These spiders also thrive in Ethiopia,
have successfully colonized almost every ecological
the Iberian Peninsula, Australia, and North African
niche on land, displaying adaptability to various
nations such as Morocco and Egypt.
physical and biological extremes.
Among Egyptian spiders, adult Dysdera sp. exhibit
Despite predominantly being terrestrial, spiders
a shiny pale beige to yellow-brown abdomen,
include aquatic species, tidal zone residents, and those
occasionally dark grey, along with a reddish-brown
venturing into the water for hunting purposes [4]. In
cephalothorax and legs. With a maximum length of 2
Egypt, there are 405 spider species distributed among
centimeters (0.79 in), females grow slightly larger than
204 genera and 41 families [5]. Notably, the Salticidae
males, reaching lengths of 1.1 to 1.5 cm, while males
family leads with 33 genera and 74 species, followed by
attain lengths of 0.9 to 1 cm. Possessing six closely
the Gnaphosidae with 20 genera and 47 species [4].
spaced oval eyes. Dysdera spiders are characterized by

their large fangs and wide jaws, causing potentially
Received: 20/08/2023
Accepted: 18/10/2023

Full Paper (vol.941 paper# 69)

c:\work\Jor\vol941_70 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 473-479

The Yolk Sac Abnormalities, Maternal Serum Level of Cancer Antigen 125 (CA-125)
and Beta Human Chorionic Gonadotropin (B-HCG) as an Early Predictors of First
Trimester Pregnancy Loss in Patients with Threatened Miscarriage: Review Article
Eman Adel Bastawi*1, Mohamed M. Shaaban2, Eman Ahmed Keshk 1,2, Asmaa M. Elgedawy1
1Department of Obstetrics and Gynecology, Faculty of medicine, Suez Canal University, Suez, Egypt
2 Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Suez, Egypt
*Corresponding Author: Eman Adel Bastawi, Mobile: 01024455657,
Email: pgs.000934406@med.suez.edu.eg

Miscarriage is defined as the loss of a pregnancy before to the twenty-week mark or of a foetus weighing
fewer than five hundred grams prior to viability. In between 15­25% of pregnancies, the mother has a threatened
miscarriage. It is associated with anxiety in the mother, family, and the physicians. More than 50% of pregnancies with
threatened abortions end in pregnancy loss. Its fate can be predicted using a plethora of biological markers. However,
there is currently no convincing biochemical marker utilized before sonographic diagnosis is confirmed, which may
take several weeks to distinct between normal and abnormal pregnancy.
Objective: This article aimed to determine how accurately cancer antigen 125 (CA-125) as well as beta HCG levels in
the mother's blood may predict a miscarriage.
Methods: We searched Science Direct, Google Scholar as well as PubMed for relevant articles on Cancer Antigen 125
(CA-125), Beta Human Chorionic Gonadotropin (B-HCG), First Trimester Pregnancy Loss and Threatened Miscarriage.
Only the most recent study was taken into account between 1988 and 2022. Documents written in languages other than
English have been ignored due to a lack of translation funds. Unpublished works, oral presentations, conference
abstracts, and dissertations were generally agreed upon not to qualify as scientific research.
Conclusion: Blood CA 125 levels are a sensitive as well as specific predictor of loss of pregnancy in cases of threatened
abortion because of their low cost, ease of availability, as well as lack of inconvenience
CA-125, B-HCG, Yolk Sac, Threatened Miscarriage.


Spontaneous abortions are among the most prevalent
frank bleeding during the 1st half of her pregnancy with
complications during pregnancy. Currently, 9 hormonal
no experiencing cervical dilatation (4).
techniques [estradiol (E2), estriol, serum human

chorionic gonadotropin, estrone urine human chorionic
gonadotropin, progesterone, cortisol, human placental
According to data published by the American
lactogen, as well as urine estrogen & progesterone] are
College of Obstetricians & Gynecologists (ACOG), it is
used to diagnose a spontaneous abortion. Several
the type of miscarriage that occurs the most frequently.
sonographic characteristics have been suggested as
Nearly one in four pregnant women will experience
potential miscarriage predictors. These involve the
some level of vaginal bleeding at some point throughout
presence & characteristics of the yolk sac (1), fetal heart
the first two trimesters of their pregnancies. Of the
rate, gestational sac size (2), and decreased embryonic
women who experience vaginal bleeding, around half
will end up miscarrying their babies. Any pregnancy,
Our research was set out to determine how accurately
regardless of the mother's age, lifestyle, comorbidities,
cancer antigen 125 (CA-125) as well as beta HCG levels
or socioeconomic standing, is at risk of being threatened
in the mother's blood may predict a miscarriage.
with abortion (5). A woman's advanced age, a history of

miscarriage, her father's advanced age, uncontrolled
Threatened Abortion
hyperglycemia, TORCH infections, uncontrolled
In medical terms, an abortion is defined as the
thyroid disease, obesity, major stressors, the use of
termination of a pregnancy before to the twentieth week
teratogenic medications & the chance of a subchorionic
of pregnancy. Abortions that don't end up being
hemorrhage can all make it more likely that she will
performed are classified as either missed or induced (3).
have an abortion (16).

Definition: If a urine or blood pregnancy test is positive
Symptoms and signs: It is possible for an individual to
& the cervical os is closed, there is also prohibited
have pelvic pain, cramping in the abdomen, pelvic
transfer of fetuses & no symptoms of fetal or embryonic
pressure, &/or back pain. In most cases, blood loss from
mortality, then vaginal bleeding prior to twenty weeks
the vaginal tract comes first, followed by cramping and
of gestational age is regarded as a threatened abortion.
abdominal pain several hours to days later. The greatest
According to the WHO, a threatening abortion occurs
indicator of a future miscarriage is bleeding during
when a female experiences bloody vaginal discharge or
pregnancy. Abortions will occur in more than fifty

percent of cases where they are threatened. When a
Received: 23/08/2023
Accepted: 23/10/2023

Full Paper (vol.941 paper# 70)

c:\work\Jor\vol941_71 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 480-485

Effect of Reflexology on Pain and Disability in Patients with
Diabetic Adhesive Capsulitis
Osama Salah Abdil Karim Ali1*, Zahra Mohamed Serri1,
Mohamed Amr Gamal El Dein2, Shymaa Mohamed Ali1
1Department of Physical Therapy, Cardiovascular/Respiratory Disorder and Geriatrics,
Faculty of Physical Therapy, Cairo University, Egypt
2Department of Internal Medicine, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Osama Salah Abdil Karim, Mobile: (+20) 01002941642, E-mail: osamayoussif4@gmail.com

Worldwide attention for diabetic adhesive capsulitis is due to its growing negative impact either economic
or reported physical dysfunction. Potential evidence regarding reflexology as an alternative therapy, and well-known
manipulation with movement for their therapeutic benefits on diabetic adhesive capsulitis.
To distinguish effect of reflexology on disability and pain in diabetic adhesive capsulitis patients.
Patients and Method:
Fifty diabetic participants with adhesive capsulitis from Out-patient Clinic of Physical Therapy
in Al-Kasr Al-Ainy Hospital, Cairo, Egypt, with age ranged 45-60 years old; were randomly divided into equal two
groups; Group A received foot reflexology, and mobilization with movement, three session/week for four weeks; and
Group B received mobilization with movement, only three session/week for four weeks. Baseline evaluation involving
shoulder mobility using smartphone inclinometer and shoulder pain and disability using shoulder pain and disability
index, as well as shoulder muscular strength using hand-held dynamometer.
No significant difference was revealed at baseline analysis. Both groups had revealed a significant raise in
shoulder mobility posttreatment with favor for group A, also a significant decrease in shoulder pain and disability post
treatment was found with no superiority for any group. While there were significant differences in shoulder rotators
strength of group A post treatment.
Foot reflexology and mobilization with movement are effective with favor for foot reflexology in terms of
shoulder mobility and muscular strength. Therefore, foot reflexology could be recommended in diabetic adhesive
capsulitis management.
Keywords: Diabetic adhesive capsulitis, Foot reflexology, Handheld dynamometer, Smartphone inclinometer

triggered by growth factors release (7).
Moderate evidence suggested that poorly
Current guidelines stated that early AC mobilization
understood painful diabetic adhesive capsulitis with 10-
beyond painful limits is advised, unless therapeutic
36% incidence, is defined as a disability leading issue
program parameters remain controversial (8). Numerous
with remarkable socioeconomic impacts that consumed
complementary therapeutic modalities have been
huge healthcare costs (1,2).
addressed i.e., acupuncture, dry needling, and
Current estimated prevalence of diabetic adhesive
reflexology since earlier centuries. Reflexology
capsulitis of 10.3% in type I diabetes mellitus (DM),
involves gentle manipulation or application of pressure
and 22.4% in type II DM, which have worse functional
to specific points on the feet and hands, that addressed
outcomes compared to their nondiabetic counterparts,
to relieve the body from any stress in daily living
particular among poorly controlled glycemic status
activities (9).
along an extended duration (3).
As well, mobilization with movement reveals
multiple therapeutic benefits could be explained the
pathophysiological process with well-defined four
analysis and correction of any minor positional fault.
distinctive stages `inflammatory, freezing, frozen, and
Also, mobilization with movement realign joints
thawing'; as well AC is classified into primary
positional faults by applying a manually specific
idiopathic sort that occur spontaneously without any
oriented glide while adjusting force intensity, and also
particular inciting event, or secondary adhesive
restoration of the interstitial fluid to near normal levels,
capsulitis that may represented with severe
while patient actively performs joint movement, so
manifestations (4). Recent identified evidence estimated
immediately relieved and the makeovers improve pain
that 70% of AC sufferers were females, despite males
and movement (10).
did not respond well in the same manner as women (5).
In addition, multimodal interventions provide a
Almost diabetic populations have a repeated complains
practical view of care have potential benefits such as
recognized clinically as D-AC, which overload those
relieving pain and improving associated disabilities
who were exhausted with multiple co-morbidities (6).
mainly among diabetic adhesive capsulitis sufferers.
The exact etiology for AC remains unknown, unless
Furthermore, conservative treatments including oral
AC dense intraarticular adhesions, capsular thickness
medications, corticosteroid injections, electrotherapy
addressed for progressive mobility restrictions may
modalities, and also various manual approaches
Received: 27/08/2023
Accepted: 25/10/2023

Full Paper (vol.941 paper# 71)

c:\work\Jor\vol941_72 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 486-490

Effect of Weighted Vest on Gross Motor Function and Balance in
Children with Spastic Cerebral Palsy
Rehab Ali1; Eman Ibrahim Elhadidy2; Silvia Hanna2
1Department of physical therapy for pediatrics, Faculty of Physical Therapy, Deraya University, Egypt.
2Department of physical therapy for pediatrics, Faculty of Physical Therapy, Cairo University, Egypt.
Corresponding author: Rehab Ali, Email: rehabalnashar93@gmail.com, Mobile: +20 115 606 2040
High muscle tension in children with CP causes unstable posture and mobility. The weighted vest was used
as an intervention tool that provides weight resistance while applying the exercise program to children with disabilities.
The study was conducted to examine the impact of the weighted vest on gross motor functions as well as balance
abilities in children suffering from spastic diplegia. Patients and Methods: Thirty children, ranging in age from four to
seven, suffering from spastic diplegia were involved in this study. They were divided into two equal groups utilizing random
assignment. The participated children in both groups were given designed physiotherapy program. The study group was
given the same physiotherapy program while wearing the weighted vest. The treatment program for the two groups was
conducted for 3 times a week for 3 consecutive months. The gross motor function and balance of all participated children
in both groups were measured by gross motor function measure (GMFM) as well as pediatric balance scale (PBS)
respectively. Results: There was significant improvement in both groups in the gross motor function as well as balance
abilities post-treatment. When comparing post-treatment for both groups, the results showed a significant improvement
favoring the study group. Conclusion: This prospective study demonstrated beneficial effects of three months of physical
therapy exercises, while wearing the weighted vest on gross motor abilities and balance in children with diplegia.
Balance, Diplegia, Motor function, Weighted vest.

pelvis, as well as hip joints, and exhibit asymmetrical
Cerebral palsy (CP) is chronic non-progressive
pelvic movement throughout walking (6).
encephalopathy that is the most prevalent reason of motor
Wearing weighted vest with sandbags was utilized
impairment in childhood. It also refers to a heterogeneous
to enhance strength, stability and mobility in children
group of neurological conditions that progress with
with developmental disabilities (7). Weighted vest
central motor dysfunction affecting movements and
provides deep compression sensation and resistance.
posture. The fundamental pathophysiological mechanism
Also, it improves concentration, and promotes changes in
involves the occurrence of brain injury during the prenatal
daily life movements in children with autism and CP (8).
and neonatal stages of development (1). Diplegia
Limited studies are available on the effectiveness
represents the most commonly observed form of spastic
of using weighted vests in patients with CP, but these
CP. The condition is distinguished by a prominent
studies are insufficient to provide an effective basis for
pyramidal motor syndrome primarily affecting the lower
use as an effective intervention method in clinical practice
extremities. Perinatal hypoxic-ischemic insult often leads
(9, 10). Therefore, the effect of wearing weighted vest
to the development of injuries in the white matter located
equivalent to 10% of a child's body weight, on the gross
around the lateral ventricles of the brain, a condition
motor functions as well as balance of children with
known as periventricular leukomalacia (2).
spastic diplegia was studied.
Children with spastic diplegic CP often exhibit a

greater degree of impairment in the lower extremities
compared to other regions of the body. This typically
Study design: This prospective randomized clinical trial
manifests as challenges in maintaining an upright posture
was done at the Outpatient Clinic of the Faculty of
of the trunk due to the inherent instability caused by a
Physical Therapy, Deraya University from November
high center of mass and a limited base of support (3). It
2022 to September 2023.
was demonstrated that children with spastic diplegic CP
Sample size: The sample size was computed using
had worse trunk control and maintaining balance than
G*POWER statistical (G*power version 3.1), with a
typically developing children. Impaired trunk control
power of 80%, an -level of 0.05, as well as an effective
directly causes problems with functional tasks, such as
size of 1.1. In order to conduct this study, we needed 15
activities of daily living (4). Abnormal gait patterns are
participants in each group.
common in children with spastic diplegia due to problems
30 children, from both genders, with spastic diplegic CP
with balance, muscle weakness, spasticity, as well as
were involved in the study. They were selected from the
skeletal deformities (5). The observed patterns are
Physiotherapy Outpatient Clinic, Faculty of Physical
distinguished by restricted movement in the lumbar spine,
Therapy, Deraya University. They were aged from four to
Received: 28/08/2023
Accepted: 26/10/2023

Full Paper (vol.941 paper# 72)

c:\work\Jor\vol941_73 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 491-499

Clinical Significance of HLA DPB1 (SNPrs3116996 & SNPRs2071025)
Gene Polymorphism in Liver Cirrhosis Development among
Egyptian Patients with Chronic HCV Infection
Elsayed Ibrahim Abdelrhman Ali1, Samia Ali Abdo Gamie1, Enas Mahmoud Foda2,
Samah Ahmed Bastawy3, Heba Ahmed Osman*4, Abeer Mohamed Mahmoud Sabry1
Departments of 1Internal Medicine and 3Clinical Pathology, Faculty of Medicine, Helwan University, Egypt
2Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Egypt
4Department of Tropical Medicine and Gastroenterology, Qena Faculty of Medicine, South Valley University, Egypt
*Corresponding author: Heba Ahmed Osman, Mobile: (+20) 01000816547,
E-mail: drheba.saleh@med.svu.edu.eg ; hebaahmed198098@yahoo.com

Chronic liver disease, which can lead to cirrhosis and hepatocellular carcinoma (HCC), is mostly caused
by hepatitis C. Objective: We aimed to clarify the association between HLADPB1 expression and chronic HCV
infection in Egyptian patients.
Patients and methods: 85 adult participants were enrolled in this study. They were divided into three groups: Group
included 20 cirrhotic patients with HCV, group 2 included 20 chronic HCV patients and group 3 included 45 healthy
controls. HLADPB1SNPrs3116996 and HLADPB1 SNPRs2071025 polymorphism were assessed.
Results: There was significant higher frequency of HLADPB1SNPrs3116996 genotype TA in cirrhotic HCV patients
in comparison with chronic HCV patients and healthy controls (40%, 15% and 4.4 % respectively; p=0.002). Also,
cirrhotic HCV group had significantly higher frequency of A allele when compared to chronic HCV group and healthy
controls (20.0%, 7.5% and 2.2% respectively; p0.001). HLADPB1 (SNPRs2071025) genotypes AG in patients with
cirrhotic HCV, chronic HCV patients and healthy control were 45%, 25% and 8.9% respectively with significant P-
value (0.001). In addition, there was significantly higher allele G frequency among the cirrhotic HCV patients (22.5%)
followed by chronic HCV patients (17.5%) compared to controls (4.4%) with significant p-value (0.002).
Conclusion: HLADPB1SNPrs3116996 genotype TA and HLADPB1 SNPRs2071025 genotype AG carry risk of liver
cirrhosis development in patients with chronic HCV infection and deterioration of clinical and biochemical parameters.
Keywords: Hepatitis C virus, Liver cirrhosis, HLA-DPB1 SNP, Genotype, Polymorphism.

determinant of vulnerability to autoimmune disorders is
The illness hepatitis C has a major worldwide
HLA [6].
effect [1]. The prevalence is more than 10% in Egypt.
The six main genes A, B, C, DR, DQ, and DP
One of the main causes of chronic liver disease, which
make up the HLA cluster. The first three genes in class
progresses to progressive hepatic fibrosis and
I control how endogenous antigens are presented, but
eventually cirrhosis and HCC, is chronic HCV infection
the remaining three genes in class II affect how
[2]. The development of oral Direct-Acting Antivirals
exogenous antigens are presented, which in turn affects
(DAAs), which directly block the HCV replication
how different infectious diseases turn out. Due to the
cycle and target three key HCV genome regions
great polymorphism of HLA alleles between groups,
(NS3/4A protease, NS5A, and NS5B RNA-dependent
there is variance in the immunological response [7].
polymerase) led to a significant advancement in HCV
Shaker et al. [8] showed a correlation between HLA
therapy [3]. Raouf et al. [4] have documented the impact
alleles and the outcome of HCV infection. However, the
of numerous variables on the onset and course of
correlation between the related alleles varies greatly
disease, including genetic variants, host factors (age,
throughout populations.
sex, environment, and related medical conditions) and
The purpose of this study was to determine whether
viral factors like viral genotype and viral load.
HLA DPB1 expression and the severity of chronic
The host's immunity can have a major effect on
hepatitis C infection in Egyptian patients are related.
the outcome of an HCV infection. The primary factors

influencing viral clearance or persistence are the potent
and long-lasting immune responses facilitated by the
Study design and participants: This case-control
activation of CD4+ and CD8+ cytotoxic T cells. By
study was conducted at the Gastroenterology and
binding their T-cell receptors to human leukocyte
Hepatology Outpatient Clinic at the Internal Medicine
antigen (HLA) molecules, which transfer the viral
Department in Helwan University Hospitals, Ain Shams
antigens' peptide fragments, both T cells are able to
University Hospitals and Tropical Medicine and
recognise the viral antigens expressed on the surface of
Gastroenterology Outpatient Clinic, Qena Faculty of
infected hepatocytes [5]. A cluster of genes on
Medicine, South Valley University through the period
from September 2019 to August 2020. Eighty-five
histocompatibility complex region, which codes for the
adult participants were enrolled into this study. They
HLA glycoprotein. It is acknowledged that a significant
were divided into three groups: group 1 (Cirrhotic
Received: 29/08/2023
Accepted: 29/10/2024

Full Paper (vol.941 paper# 73)

c:\work\Jor\vol941_74 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 500-505

Hepatocellular Carcinoma Recurrence Post Direct-Acting Antiviral and
Its Relation to Time of Treating Chronic HCV Infection
Ali F. Soliman*1, Mohamed F. Elgazzar2, Mahmoud Elsakhawy3,
Hassan Zaghla2, Eman Rewisha2, Imam Waked2
Department of 1Internal Medicine, Ministry of Health, Dakahlia, Egypt
Departments of 2Hepatology and Gastroenterology and
3Radiology, National Liver Institute, Menofia University, Shebin Elkom, Egypt
*Corresponding author: Ali F. Soliman, Mobile: (+20) 01096204162, E-mail: alisoliman198411@gmail.com

There is a documented relationship between Hepatocellular Carcinoma (HCC) recurrence and Direct
Acting Antiviral (DAAs).
Objective: This study's overarching goal was to determine whether there is a correlation between the length of time
between HCV treatments and the frequency of recurrence of HCC following successful ablation of HCC.
Patients and Methods:
This retrospective study included 400 cases with chronic HCV infection and HCC who had a
complete response to treatment. The patients also had to have attended the clinic for HCC recurrence during this time.
A total of 200 cases with recurrent HCC were randomly assigned to one of four categories and then exposed to DAA
(case group). Fifty patients in each of Groups 1, 2, and 3 began treatment 3, 6, 9, and 12 months following their
curative HCC therapy, while 200 patients with recurrent HCC who were not exposed to DAAs served as the control
Results: The case group's recurrence rate increased significantly throughout the first six months, then decreased
during the second half of the study.
Conclusion: It appears that the recurrence of HCC in individuals exposed to DAAs is more rapid and aggressive than
in those who are not exposed to DAAs. We advise waiting at least one year after an ablative treatment's complete
response before beginning DAA treatment.
Keywords: Hepatocellular carcinoma, Direct-acting antivirals, Hepatitis C virus infection.


About 20 to 30% of persons who get chronic
hepatitis C, which is caused by an infection with the
In retrospective analysis at the Outpatient
hepatitis C virus (HCV), end up with cirrhosis of the
Clinic at National Liver institute (NLI) at Menoufia
liver. Each year, an estimated 3.5% of people with
University, 400 hepatocellular carcinoma cases who
advanced liver cirrhosis may develop liver cancer [1].
were infected with HCV and responded fully to
In terms of cancer incidence and cancer-related
ablative treatment for HCC (resection, thermal
deaths, hepatocellular carcinoma (HCC) is the second
ablation, or ethanol injection) in accordance with
most common cancer in the world. New treatment
EASL and AASLD recommendations for HCC
options have improved the 5-year survival rate for
management were included in this study in the
HCC, but it is still quite low (15% in the US and 5% in
duration between August 2017 and August 2018.
developing countries) [2].

Due to their superior tolerability and SVR rates
Inclusion criteria:
(over 90%) for most HCV genotypes, DAAs have
Age 18 years or older. Patients who had HCV
lately supplanted previous treatment regimens [3].
related HCC. Patients who exposed to DAAs and
Retrospective evaluations of HCC recurrence in
achieved SVR. Patients who have successfully
studies have shown contradictory findings. Two
undergone ablative therapy for HCC (assessed by
studies, one in Italy involving 59 patients and the other
triphasic CT abdomen or dynamic MRI) before
a multicentre trial in Spain involving 58 patients,
undergoing DAA therapy, in line with EASL and
found that patients given DAAs had an unusually high
AASLD protocols for the management of HCC, are
recurrence rate after curative treatment (28% and 29%
eligible to receive this treatment. HCC criteria: single
respectively) [4]. On the other hand, observational study
focal lesion and size 5 cm before ablative therapy.
data suggest that persons with chronic hepatitis C and
Prior to DAA treatment, all patients included had a
a history of HCC therapy are more likely to experience
Child Pugh score of A and a performance status of 0.
a recurrence of the cancer when using DAA

medication [4, 5].
Exclusion criteria:
We aimed at this research to determine whether
HCC patients secondary to other causes than
there was a correlation between the length of time
hepatitis C or combined HCV and HBV infection.
between HCV treatments and the frequency of HCC
Incomplete response to HCC ablative treatment.
recurrence following successful ablation of HCC.
Patients who did not achieve SVR to DAAs therapy

(non SVR).
Received: 01/10/2023
Accepted: 01/12/2023

Full Paper (vol.941 paper# 74)

c:\work\Jor\vol941_75 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 506-511

The Safety and Effectiveness of Corticosteroids in Twin Pregnancy
Ashraf Sobhi Abo-louz*, Ahmed Gamal Badawie, Rania Hamdy,
Moemen Nagah Abdalsalam, Haitham Atef Torky
Department of Obstetrics and Gynecology, Faculty of Medicine, October 6th University, Giza, Egypt
*Corresponding author: Ashraf Sobhi Abo-louz, Mobile: (+20) 01222376540, E-mail: ashraf.abolouz@gmail.com

Preterm deliveries are disproportionately caused by multiple pregnancies. All things considered, 10.7%
of multiple births occur before 32 weeks and 52.2% before 37 weeks. Prematurity represents the largest cause of global
perinatal death.
Objective: To evaluate the effectiveness of steroids in twins' pregnancy between 28 and 36 weeks.
Patient and methods: This cross-sectional multi-center research enrolled 150 pregnant women with twin pregnancies
at Obstetrics and Gynecology Department, October 6th University Hospital, and Al Galaa Teaching Hospital from June
2022 to February 2023. These patients delivered within 48 hours of receiving antenatal corticosteroids and were
followed up for 24 to 72 hours after delivery for the outcome.
Results: There was highly significant variation between those who received steroid than those didn't receive steroid as
regard gestational age at birth while there was statistically insignificant difference as regard maternal age, body mass
index, gravidity, parity, blood pressure, fetal FL, rate of periventricular leukomalacia (PVL), retinopathy of premature
(ROP), birth weight, sex and type of labor. There was statistically significant lower rate of NICU admission, neonatal
death, bronchopulmonary dysplasia, respiratory distress syndrome, and intraventricular hemorrhage in those who
received steroid than those not received steroid.
Conclusion: Antenatal corticosteroids administration is a crucial antenatal intervention in twin early and late preterm
deliveries and must be considered especially in developing countries because of lack of facilities. Further studies are
required to recognize the efficacy of steroids therapy in twin pregnancies and postnatal long-term effects and to assess
in establishing proper guidelines to this unique risk category.
Antenatal corticosteroids, Prematurity of newborn, Twin pregnancy, Multifetal gestations.

that produce surfactant. Even though the corticosteroids
Over the past few decades, there has been a
cause the alveolization to happen quickly (6).
considerable rise in the occurrence of twin pregnancies,

as a result of increased assisted reproductive approach
Due to rapid lung maturation and its impact on the
and older mothers (1). Compared to singleton
vascular structure, prenatal corticosteroid therapy may
pregnancies, twin pregnancies are linked to higher rates
boost the generation of surfactant in the fetal lungs,
of unfavorable neonatal outcomes. This is primarily
which may rise the flow of blood in the pulmonary
because of preterm delivery, that represents a major
arteries (7).
concern in the management of such cases and is present
The Society for Maternal-Fetal Medicine (SMFM)
in 59% of US pregnancies, with the majority of births
and the American College of Obstetricians and
taking place in the late-preterm period (2,3).
Gynecologists (ACOG) revised the guidelines and
Late preterm has been linked to poor neonatal
extended the use of ACS to the late-preterm in cases of
outcomes, specifically respiratory morbidity, as well as
potentially preterm birth in singleton pregnancies as a
a long-term detrimental impact on cognitive abilities
result of this and other supporting evidence. While the
and developmental outcomes as compared to term
likelihood of respiratory morbidity appears to be same
neonates (4).
in late-preterm twins and singletons (8-10).
It is important to investigate methods for
The aim of this research was to investigate the
enhancing the newborn outcomes of late-preterm twins.
efficacy of steroids in twins' pregnancy between 28 and
Neonatal morbidity and mortality, including respiratory
36 weeks.
distress syndrome, intraventricular hemorrhages, and

necrotizing enterocolitis, are decreased when pregnant
female with an elevated risk of preterm delivery are
This cross-sectional multi-center research included
administered antenatal corticosteroids (ACS) before 34
150 pregnant women with twin pregnancies with 300
weeks of gestation. This effective therapy has been
live births neonates at Obstetrics and Gynecology
proved (5).
Department, October 6th University Hospital, and Al
Galaa Teaching Hospital from June 2022 to February
corticosteroids are administered during pregnancy. Fast
2023. These patients delivered within 48 hours of
alveolization is the result of an acceleration of the
receiving antenatal corticosteroids and followed for 24
double capillary loops' typical thinning, which forms
to 72 hours for the outcome.
the thin gas-exchanging walls of alveoli. Additionally,

there is a faster development of type II pneumocytes
Received: 30/08/2023
Accepted: 30/10/2023

Full Paper (vol.941 paper# 75)

c:\work\Jor\vol941_76 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 512-520

Functional Brain MRI as a Diagnostic Tool for Detecting Neurological
Changes in Children with Wilson's Disease
Sameh Abokoura1, Ahmed Elkholy1, Enas Mohammed Korayem1, Nermin M. Adawy2, Hazem Omar*1
Departments of 1Diagnostic and Intervention Radiology,
2Pediatric Hepatology, Gastroenterology, Nutrition, National Liver Institute, Menoufia University, Egypt
*Corresponding author: Hazem Omar, Mobile: (+20) 01228229522, E-mail: hazemomar2020@gmail.com
Wilson's disease (WD) is a rare genetic disorder marked by copper buildup, causing hepatic and
neurological issues. Objective: This study aimed to thoroughly evaluate clinical, biochemical, and neuroimaging
aspects of WD, highlighting the diagnostic potential of magnetic resonance spectroscopy (MRS) and diffusion-
weighted imaging (DWI) for detecting neurological involvement.
Patients and methods: The study included 40 children divided into two groups: 20 healthy children (group 1) and 20
with Wilson's disease (group 2). Various MRI techniques, including T1, T2, FLAIR, diffusion imaging, and MRS,
were used. For WD patients, comprehensive clinical examinations, lab tests, and MRS were performed to understand
their neurochemical profile. The analysis involved assessing clinical features (hepatomegaly prevalence) and lab
parameters (24-hour urine copper excretion, albumin, alkaline phosphatase, bilirubin, and ceruloplasmin). MRS
provided insights into metabolites like N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr). The diagnostic
accuracy of neurochemical ratios (NAA/Cr, NAA/Cho, Cho/Cr) for predicting neurological manifestations was
evaluated, alongside conventional brain MRI and diffusion MRI for neurological status assessment.
Results: The study found hepatomegaly in 70% of WD patients, a significant range of 24-hour urine copper excretion
was from 10 to 4699 µg/24h and a median of 122.5 µg/24h (IQR=27.5-309) and distinct neurochemical shifts in NAA,
Cho, and Cr. Brain MRI detected neurological abnormalities in 80% of patients. Cho showed promise (P-value: 0.038)
in predicting neurological issues, while caution was urged against relying solely on Cr due to lower specificity (p-
value: 0.777). The NAA/Cr ratio proved a robust predictor (P-value: 0.006), surpassing NAA/Cho (P-value: 0.925).
Conclusion: Our study underscored the clinical significance of hepatomegaly, elevated 24-hour urine copper
excretion, and distinctive neurochemical shifts in WD. Neuroimaging findings, especially using diffusion-weighted
imaging, contributed valuable insights into neurological manifestations. The diagnostic potential of MRS-derived
ratios, notably the NAA/Cr ratio, hold promise for predicting neurological involvement in Wilson's disease.
Keywords: Wilson's disease, Magnetic resonance spectroscopy, Neurological manifestations, Diffusion MRI.


Wilson's disease (WD) is a rare autosomal
choline-containing compounds (Cho), creatine (Cr),
recessive disorder characterized by abnormal copper
and lactate are key resonances in MRS, reflecting
metabolism, leading to copper accumulation in various
neuronal dysfunction and membrane turnover.
organs, including the liver, brain, and kidneys. The
Reduced Cho signifies decreased cell membrane
global incidence of WD is approximately 1 in 50,000
synthesis and/or cell number (5).
live births (1). Clinically, WD manifests with hepatic
Diffusion MRI, particularly apparent diffusion
and Neurological features, ranging from biochemical
coefficient (ADC) maps, provides detailed information
abnormalities to acute hepatic failure and neurological
about tissue integrity. It reflects molecular water
symptoms such as tremors, motor disturbances, and
motion, with low ADC values indicating restricted
psychiatric manifestations like depression and
diffusion in conditions like cytotoxic edema, and high
psychosis (2). Diagnostic criteria for WD include
ADC values suggesting increased water mobility in
increased urinary copper excretion, reduced serum
vasogenic edema (6). Our study investigated WD by
ceruloplasmin, the presence of the Kayser-Fleischer
incorporating conventional magnetic resonance
ring in the cornea, and liver biopsy findings.
imaging (MRI) sequences, including T1, T2, and
Conventional magnetic resonance imaging (MRI)
advanced functional MRI
reveals diverse findings, from T1-hypointensity in
techniques such as magnetic resonance spectroscopy
basal ganglia and other regions to T2-hyperintensity.
(MRS) and diffusion-weighted imaging (DWI) with
Additionally, subcortical white matter and cortical gray
apparent diffusion coefficient (ADC) mapping. By
matter abnormalities may occur (3). In contrast to
integrating these comprehensive imaging modalities,
conventional MRI, functional MRI techniques,
we aimed to enhance the characterization of early
specifically magnetic resonance spectroscopy (MRS)
metabolite abnormalities in children with WD.
and diffusion-weighted imaging (DWI), offer insights
into early neurological changes before clinical
Study design and participants: This prospective
symptoms manifest. MRS provides information on
cohort study was conducted at the Diagnostic Medical
neuronal viability, cellular membrane status, and
Imaging and Interventional Radiology Department of
energetics, making it a valuable tool for monitoring
the National Liver Institute Hospital, Menoufia
metabolic variations and treatment response (4). NAA,
University.The study included two groups: Group I
Received: 01/10/2023
Accepted: 01/12/2024

Full Paper (vol.941 paper# 76)

c:\work\Jor\vol941_77 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 521-528

Long Noncoding RNA H19 rs3741219 Polymorphism and
Risk of Hepatocellular Carcinoma in Egyptian Population
Amr Ragab*1, Hamdy ELsobky1, Mona Gamal El-Abd2, Eman Abdelsameea1, Mohsen Salama1
Departments of 1Hepatology and Gastroenterology,
2Laboratory Medicine, National Liver Institute, Menoufia University, Egypt
*Corresponding author: Amr Ragab, Mobile: (+20) 01000407600, E-mail: amr.ragab124@yahoo.com

RNA molecules which are longer of 200 nucleotides that are unable for protein coding are known as
long non-coding RNAs or LncRNAs. They play a vital role in different biological activities and cancer biology.
Numerous long non-coding RNAs with tumor-suppressive and carcinogenic functions have been found in human
Objective: Exploring the role if lncRNA H19 (rs3741219) gene polymorphism plays in raising the hepatocellular
carcinoma (HCC) risk in Egyptian patients.
Patients and Methods
: We performed this case-control study upon95 participants, 40 HCC patients diagnosed by
Computed Topography (according to EASL guidelines), 35 cirrhotic patients, and 20 healthy subjects as control.
A significant statistical difference between the three groups under study was found regarding child score (p =
0.028). The results of a univariate and multivariate analysis on the risk variables for HCC showed that liver size and
child score were linked to a higher risk of HCC when compared with the cirrhosis group (P<0.05 and P=0.024,
respectively). Comparing the HCC group versus the cirrhotic group, variant genotypes of rs3741219 were not
significantly associated with the risk of HCC when compared with the wild genotype (AA) (P=0.230). Non-significant
correlations were found between the variant genotypes AG/GG of rs3741229 (adjusted OR = 608, 95%CIs = 0.162­
2.28, P = 0.679) and the risk of HCC.
Conclusion: Our research showed a non-significant correlation between the risk of HCC and the H19 (rs3741219)
genotype variants.
Keywords: Hepatocellular carcinoma, long non-coding RNA, H19, Real-time PCR.

LncRNA subtypes have been identified as having both
Hepatocellular carcinoma (HCC) is one of the
tumor-suppressive and carcinogenic functions in
major causes of cancer related deaths among many
human hepatocarcinogenesis [6].
countries as it ranks fourth worldwide [1]. Factors that
Of the several LncRNAs that have been linked to
raise the risk of HCC include being exposed to
HCC, the most studied ones are H19, MALAT1,
aflatoxin, having persistent infections of HBV and
TUC338 HULC, and HOTAIR. H19 is a lengthy
HCV, drinking alcohol, and having non-alcoholic fatty
noncoding RNA that is highly expressed before birth,
liver disease (NAFLD) [2]. The two main risk factors
silenced in the majority of tissues upon birth, and then
for HCC in Egypt are chronic hepatitis brought on by
re-expressed in some cancers [7].
HBV and HCV infection [3]. Early detection of HCC
Recent studies reported that lncRNA-H19
greatly predicts the course of the illness and the death
polymorphisms play roles in HCC development, much
rate. Individuals who receive a diagnosis at an early
research revealed a tumor-suppressive function
stage can receive curative treatments, such as liver
whereas others revealed its oncogenic role. It might be
transplantation, ablative therapies, and resection;
a valuable biomarker in determining the risk and
patients who receive a late-stage diagnosis can only
prognosis of HCC and a potential target for HCC
receive palliative treatments, which have a greater
chemotherapeutics [8].
death rate. Patients whose cancer is detected early have

a 5-year survival rate of over 70%, whereas those
whose cancer is detected later have a rate of less than
Subjects: This case-control research was
5% [4].
performed during the period from January to
One of the RNA molecules that do not code for
September 2023, 95 participants were incorporated in
functional proteins, is long non-coding RNAs, are
the study, divided into three groups: 20 healthy
more than 200 nucleotides long. It has been established
individuals served as the control group, 35 patients
that long noncoding RNAs (lncRNAs) are essential for
with cirrhosis, and 40 patients with proven HCC. The
a wide range of biological activities, for example, cell
National Liver Institute, Menoufia University, and
differentiation, apoptosis, cell division, and regulation
inpatient and outpatient clinics were the sources of the
of gene expression [5]. Researchers have discovered
patients. Patients with HCC were diagnosed according
that LncRNAs affect gene expression both during
to EASL practice guidelines for HCC diagnosis [9],
transcription and after transcription has taken place.
Cirrhotic patients were diagnosed based on clinical
More and more data suggests that LncRNAs play an
pictures, radiological findings, and laboratory evidence
important regulatory role in cancer biology. Numerous
of liver cell damage. All HCC patients and cirrhotic
Received: 01/10/2023
Accepted: 01/12/2023

Full Paper (vol.941 paper# 77)

ABSTRACT The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 529-539

Association of Mean Platelet Volume with Angiographic Thrombus Burden and
Short-term Outcome in Patients with ST-segment Elevation Myocardial Infarction
Undergoing Primary Percutaneous Coronary Intervention
Araquib AK, Suwailem SM, Elhammady WA, Elserafy AS, Fakhry HM, and Zahran ME
Department of Cardiology, Faculty of Medicine, Ain shams University
Corresponding author: Zahran ME, Mobile: 01111377796; Email: zahran@med.asu.edu.eg

Mean platelet volume (MPV), is an indicator of platelet reactivity and could be a biomarker of the risk and
prognosis of patients with ST-segment elevation myocardial infarction (STEMI).
Objectives: Testing the predictive value of MPV for angiographic thrombus burden and short-term outcomes in
patients with STEMI undergoing primary percutaneous coronary intervention (PPCI).
Patients and Methods: Seventy-two patients presented with acute STEMI to the Cardiology Department of Ain Shams
University Hospitals for PPCI. MPV was measured on admission. Angiographic thrombus burden and post-interventional
thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded. Patients
were followed up for 3 to 6 months. Results: The patients' ages ranged between 33 and 73 (mean age 53.22 ± 9.96 years).
This study included 62 males and 10 females. The MPV of the studied cases was 9.97 ± 1.31 fl. MPV was higher among
patients with high thrombus burden (HTB) (11.42±1.007 vs. 9.53±1.039. p< 0.001) and patients with MBG (0-1) and
TIMI flow>3 (10.59±1.839 vs 9.81±1.092, p 0.04 and 11.77±0.74 vs 9.87±1.26, p 0.004 respectively). The primary
composite endpoint occurred in 12 patients with a higher MPV (10.95 ± 1.14 vs. 9.73 ± 1.29, p 0.01). In univariate
regression analysis for the predictors of MBG (0/1), the MPV was an independent predictor of MBG (odds ratio 0.487,
and p <0.006), CI (0.292- 0.811).
MPV may be a useful biomarker to help identify higher-risk patients with large intracoronary thrombus
burden, who might require more potent antiplatelet therapy.
Mean platelet volume; Coronary artery disease; Angiographic thrombus burden; Thrombolysis in myocardial
infarction flow; Myocardial blush grade; ST-elevation myocardial infarction; Percutaneous coronary intervention.


Atherosclerotic CAD is a leading cause of death
MPV is considered a useful prognostic marker of
worldwide, is on the rise, and has become a true
cardiovascular risk(2).
pandemic that respects no borders. Results from recent
In the general population, a higher MPV value is
reports do suggest that mortality and morbidity from
associated with an increased occurrence of MI. MPV was
CAD are leveling, especially in younger adults. Because
found to be a useful hematological marker allowing the
it offers prompt and complete recanalization of an
identification of patients with stable CAD who are at
occluded infarct-related artery (IRA), primary
higher risk of post-PCI low-reflow(3). Elevated mean
percutaneous coronary intervention (PCI) is the preferred
platelet volume (MPV) has been recently discussed as a
reperfusion strategy for STEMI at PCI-capable hospitals.
predictor of death in patients with acute coronary
However, in a significant proportion of patients,
syndrome (ACS), but the cut-off point of MPV in relation
microvascular and myocardial reperfusion cannot be
to poor prognosis has not been estimated so far(4). In some
regained despite successfully restoring TIMI grade 3
studies, conducted in AMI, elevated MPV was associated
epicardial blood flow. This occurrence, better known as
with a higher risk of death and recurrent infarction not
the `no-reflow phenomenon', is associated with
only in the hospital but also during the 2-year observation
progressive left ventricular dysfunction and increased risk
after ACS. The baseline mean MPV in patients who
of congestive heart failure, myocardial infarction (MI),
developed restenosis or stent thrombosis was significantly
and mortality(1). Platelets play a significant role during the
higher than in those who did not develop such a
occlusion and reperfusion period of myocardial infarction
and they also strongly contribute to the microvascular
obstruction, tissue level perfusion, and
To investigate the association of mean platelet
maintenance of vessel patency. Their reactivity is a
volume with angiographic thrombus burden and its
key pathophysiological issue and it has been shown that
prognostic value in patients with ST-segment
platelet size, simply measured by mean platelet volume
(MPV) is correlated with platelet activity. It is known that
undergoing primary percutaneous
larger platelets are more reactive due to higher
concentration of active substances in micro granules (e.g.
thromboxane A2, platelet factor 4, P-selectin, platelet-
derived growth factor) and expression of adhesive
This study was carried out on 72 patients,
receptors (glycoprotein IIb/IIIa). Furthermore, increased
presented with acute STEMI to the Cardiology
MPV values are associated with shortened bleeding time.
Department of Ain Shams University Hospital, in
Received: 22/08/2023
Accepted: 22/10/2024

Full Paper (vol.941 paper# 78)

c:\work\Jor\vol941_79 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 540-544

Accuracy of FNAC in Thyroid Nodules in Comparison with
Surgical Specimen: Qena Oncology Center Experience
Mohamed A. Orabi, Amr M. Makky, Remon E. Lukas, Mohamed Taha,
Abdullah Atyah, Mohamed A. Salem, Mohamed Ayaty*
Department of Surgery, Qena Oncology Center, Egypt
*Corresponding author: Mohamed Ayaty, Mobile: (+20)01004364499,
E-Mail: mohamed.ayati@nci.cu.edu.eg.com, ORCID ID: 0000-0002-6230-7345

Thyroid diseases are very common. Preoperative thyroid FNAC is now routine for most of thyroid
Objective: We aimed to compare preoperative FNAC of thyroid enlargement with postoperative histopathology to
obtain a consensus methodology as a straightforward technique for diagnosing and optimally managing thyroid
Patient and methods: A retrospective study that was conducted at Qena Oncology Center at Department of Surgery
including all patients underwent thyroid surgery during the period from January 2021 to June 2022. All FNAC were
obtained under sonography guiding. The data of age, gender, complaint, unilateral or bilateral, U/S TIRADS &
nodularity, type of operation and the result of pathology of FNAC and post-operative specimens were retrieved.
The study included 98 cases of thyroid nodules (TN) diagnosed clinically where 85 patients (86.7%) females
and 13 patients (13.3%) males. The main complaint of these patients was neck swelling in 65 patients (66.33%).
FNAC results of 98 cases were 17 cases (17.4%) were malignant thyroid tumor (all of them were papillary) and 81
cases (82.6%) were benign, hemorrhagic smears or suspicious lesions. After surgical excision, histopathology 73 cases
(74.5%) were benign lesions and 25 cases (25.6%) were malignant thyroid lesions, 24 cases (24.6%) were papillary
carcinoma variants and only one case (1%) follicular carcinoma. The sensitivity of FNAC in determining malignant
thyroid disease in our study is 68%. Specificity was 100% as no cases were reported as false positive by FNAC for
malignancy in our study. So, the accuracy of the FNAC in TN for detecting cancer was 91.8% and the positive and
negative predictive values were 100% and 90.1%, respectively.
Conclusion: Our study's findings are consistent with the data already available in publications, showing that FNA
cytology is a sensitive, specific, and accurate first diagnostic test.
Keywords: FNAC, Thyroid nodules.


six categories: (1) Insufficient or non-identifiable, (2)
After diabetes mellitus, thyroid gland disorders
Non-cancerous and benign, (3) Atypical or
rank as the second most prevalent endocrine
unidentified follicular lesion, (4) Follicular neoplasm
disorders(1). TN are extremely frequent illnesses, with
or suspicious for follicular neoplasm, (5) Suspicious
a percentage ranging from 4 to 10% in the adult
for, but not diagnostic of, malignancy and (6)
population, and 5% to 30% of them are malignant (2).
Malignant. Bethesda facilitates more accurate thyroid
FNAC is a well-established method for
nodule research and diagnosis and enhances the
preoperative evaluation of thyroid nodule today. It is a
interpretation of FNAC data (1).
simple, economical test for the diagnosis of
However, FNAC is unable to distinguish between
malignancy, and its usage has significantly reduced the
benign and malignant follicular neoplasms. Only after
incidence of needless thyroid operations. When
a thyroid lobectomy can follicular adenoma and
assessing TN, it is regarded as the gold standard
follicular cancer be distinguished from one another (2,
diagnostic test (3).
When weighing the benefits of preoperative
Numerous FNAC investigations revealed that a
FNAC of thyroid swelling against postoperative
significant overlap existed between benign and
histopathology, FNAC is becoming an increasingly
malignant neoplasms, with around 68% of patients
important tool for helping with preoperative decision-
identified by FNAC as follicular neoplasms turning out
making regarding thyroid swelling and for reaching
to be the follicular form of papillary carcinoma (6).
consensus protocols as a straightforward process for
Several worldwide scientific associations have
diagnosis and optimal management of thyroid diseases
developed clinico-radiological recommendations for
(4). The frequency of accidentally detected nodules has
the detection and treatment of TN (2, 7). Sonographic
grown over the past several decades due to a
features that favour a malignant nodule hat include
considerable increase in imaging utilisation, with this
picture being used to guide FNAC (5).
heterogeneity, absence of halo, absence of elasticity,
Thyroid FNAC specimens are now reported using
presence of microcalcifications: almost always
the Bethesda system of reporting thyroid cytology
warrants biopsy, local invasion of surrounding
(TBSRTC). Cabs and Ali (1) stated that this method
structures, taller than wider, large size: the cutoff is
was created in 2007 and is divided into the following
often taken as 10 mm to warrant biopsy, suspicious
Received: 15/09/2023
Accepted: 14/11/2023

Full Paper (vol.941 paper# 79)

c:\work\Jor\vol941_80 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 545-549

Prevalence of Mechanical Low Back Pain among Field Farmers in Giza-Egypt
Manar Ahmed Wahba(1)*, Omaima MA Kattabei(2), Magda Gaid Sedhom(2)
(1) Physiotherapy Department, Al-Hwamdia Hospitalm,
(2) Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Manar Ahmed Wahba,Email: mohamedfathyyy50@gmail.com, Mobile: +201021019665

: Low back pain (LBP) is prevalent among people's musculoskeletal systems, particularly among farmers.
Furthermore, it frequently results in missed pay and significant medical bills. Aim: The purpose of this research was
to find out how prevalent mechanical LBP among Egyptian farmers during transplanting process in Giza and to
determine the association between number of working years and mechanical LBP in farmers of Giza, Egypt.
Subjects and Methods: A cross-sectional survey of 270 farmers was undertaken. Their ages ranged from 18 to 60.
Face-to-face interviews were used to gather data. The intensity of pain, degree of functional impairment, and lumbar
range of motion were assessed via the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and lumbar
flexibility test. In addition to measuring scales, anthropometry, personal and vocational history were gathered.
Results: The prevalence of mechanical LBP in farmers was 65.6% among the 270 farmers studied and there was a
substantial association between mechanical LBP and working years (P0.001) as with increasing the farming years
there was an increase in incidence of mechanical LBP. Conclusions: Farmers exhibit a substantially elevated
occurrence of mechanical low back pain and experience functional limitations as a consequence of this condition.
Keywords: Farmers, Prevalence, Low back pain, Flexibility, Oswestry Disability Index, and Visual Analogue Scale.


Agriculture is an essential sector of every
occurrence of LBP has been found to be most prevalent
country's economy and export. Farming is a significant
in the farming transplantation technique due to the
employment. Because of technical advancements,
physically demanding and exhausting nature of manual
agricultural production in wealthy countries is now
easier than in the past. However, agricultural
There is a lot of complexity to the transplanting
technology application is restricted in poor nations. As
process. From a chronological standpoint, it is closely
a result, farmers in developing nations, such as
connected to plowing, harrowing, and gathering
Myanmar, Laos, as well as Thailand, depend on
saplings in the primary field. Transplanting requires the
conventional techniques including physical labor.
act of standing upright in a flooded field as well as
Many physical chores, as transplanting and seeding, are
bending over to carefully plant the seedlings in the soil
involved in farming. Consequently, it is unsurprising
at regular intervals over a prolonged duration. As a
that farmers experience a high prevalence of work-
result, the transplantation procedure requires hazardous
related musculoskeletal problems (1).
postures for example extended stooping as well as
LBP is a prevalent health issue caused by manual
repetitive twisting. As a result, it usually affects the low
labor (2,3), particularly in farmers (4,5). The literature
back region, causing pain. Working postures while
indicates that LBP is common among farmers,
transplanting is widely recognized to be associated to
particularly in underdeveloped nations. Multiple
LBP; regardless, every farmer has their unique
requirements, which might be seen as elements beyond
of LBP among those engaged in farming activities. In
of their control. Factors that have been associated to
Thailand, for example, statistics indicate that the
LBP include hours worked per week, intensity of work,
frequency of LBP in farmers ranges between 56% and
stress levels, as well as prior work experience (13,14).
73.1% (6).
Because episodes of LBP are often short,
The causes of LBP can be categorized into three
numerous farmers might decide against seeking
categories. Personal characteristics including their age,
healthcare services. LBP is generally alleviated after
body mass index (BMI), exercise, alcohol intake, as
one month, according to research. However, recent
well as smoking are included in the first category (7,8).
studies have indicated that LBP can last for a duration
of six months or more and often reoccurs within a span
dissatisfaction with work, poor body perception, as
of one year (15).
well as low self-esteem are all psychosocial variables

(9,10). Physical occupational variables, activities such as
This study was conducted:
repetitive movement, strenuous lifting, unfavorable
To investigate the prevalence of mechanical LBP in
body positions, and vibration belong to the third
Egyptian farmers during transplanting process in
category (11).
The current evidence simply suggests that
To determine the association between number of
occupational variables, particularly working postures,
working years and mechanical LBP in farmers of
are the primary causes of LBP (12). Consequently, the
Giza, Egypt.

Full Paper (vol.941 paper# 80)

c:\work\Jor\vol941_81 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 550-556

Phenotypic Detection and Molecular Characterization of Metalo-Beta-lactamases in
Carbapenem Resistant Pseudomonas Aeruginosa in Zagazig University Hospitals
Arwa Mohammed Abd-Alla*, Gehan Ahmed El-Shenawy, Manar Hassan Soliman
Department of Microbiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Arwa M. Abd-Alla, Mobile: (+20) 01115614754, Email: arwahassan19198@gmail.com
Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic nosocomial pathogen that acquires
resistance to conventional anti-pseudomonal antibiotics especially carbapenems. Due to the existing lack of choices,
treating individuals infected with MBL-resistant pseudomonas is difficult.
Objective: The aim of the present study was to evaluate the performance of different phenotypic methods for the
detection of metallo-beta-lactamase (MBL) producing P. areuginosa in comparison with polymerase chain reaction
(PCR) for MBLs genes. Patients and methods: This study was conducted two hundred and twenty-five (225) samples
obtained in ICUs in Zagazig University Hospitals, 80 samples were P. aeruginosa positive of age group between 39-70
years, including 50 males and 30 females.
Results: The antimicrobial resistant pattern of P. aeruginosa isolates by disc diffusion method. Among the 80 P.
isolates, all isolates were resistant to CAZ and CTX. While 75 isolates (93.8%) were resistant to IPM, MEM
and TBZ. All cases were negative regarding the presence of IMP gene. VIM gene was positive in 48% of cases. While
NDM-1 gene was positive in 60% of cases. Both VIM and NDM-1 genes were positive in 29.3% of cases. CDST is more
sensitive, while DDST with both concentration of EDTA is less sensitive but more specific. Sensitivity, specificity, PPV
and NPV of DDST (taking the presence of any MBL gene as a reference test were 96.6%, 94.1%, 98.2% and 88.9%
respectively. Conclusion: The ICU was a highly dispersed location for MBL-producing P. aeruginosa, which is one of
the main sources of resistance to carbapenem and other antimicrobial drugs.
Keywords: Carbapenem Resistant, Ps. Aeruginosa; Metalo-Beta-lactamases.

different phenotypic methods for the detection of MBL
As an opportunistic infection, Pseudomonas
producing P. aeruginosa in comparison with PCR for
aeruginosa frequently exhibits multiple drug resistance.
MBLs genes.
Because there are few effective treatments for this
disease, carbapenem-resistant Pseudomonas aeruginosa
This cross-sectional study was carried out in the
poses a serious threat to public health (1). Hospital isolates
Medical Microbiology and Immunology Department, and
often have multidrug resistance mechanisms because they
ICUs, Zagazig University Hospitals. This study was
survive in the hospital environment as a means of
conducted on 80 hospitalized patients of all age groups;
survival. As a result, the number of antibiotics available
they were 50 males and 30 females of age group between
for therapy is restricted. When treating severe
39-70 years.
recommended antibiotic (2).
Inclusion criteria: Hospitalized patients admitted in
There are several reasons why carbapenems are
ICUs were included for study criteria.
resistant to them, but the primary one is the synthesis of
Exclusion criteria: Apparently healthy individuals
MBL enzymes, which are broad-spectrum enzymes that
admitted to ICU under observation without clinical
can hydrolyze the majority of beta-lactam antibiotics
manifestations of infections like fever etc.
without being inhibited by sulbactam or clavulanic acid,
the two common beta-lactamase inhibitors (3). There are
Samples collection: Full history including name, age, sex
two groups of enzymes that hydrolyze carbapenem that
and cause of admission were taken from ICU staff
have been identified: MBLs and serine enzymes with
doctors. In addition, history of antimicrobial
SBLs. It was known that there were three different kinds
administration, underlying disease and any previous
of MBL genes: NDM-1 (New Delhi MBLs), VIM
medical history. Sputum samples were collected from
inpatients with lower respiratory tract infections early in
(Imipenemase). The majority of the genes producing
the morning in clear dry container after requesting the
MBLs are found on integrons and plasmids, which
patients to rinse the mouth with water and then
facilitates the genetic elements' broad distribution (4).
expectorate deep cough sputum. Urine samples were
Other non-molecular based approaches have been
sterilely aspirated via the catheter lumen.
developed, but all rely on chelating chemicals such as
The new catheter was placed for a maximum of 30
minutes, it was clamped off above the port to enable the
ethylenediaminetetraaccetic acid (EDTA) to limit
collection of an adequate volume of new urine. The
carbapenemase activity. PCR is regarded the gold
catheter port was disinfected with 70% alcohol. A sterile
standard for detecting carbapenemase genes (5). The aim
10 ml syringe was attached to the sampling port to
of the present study was to evaluate the performance of
aspirate urine. Then urine was collected and transported
Received: 24/07/2023
Accepted: 25/09/2023

Full Paper (vol.941 paper# 81)

c:\work\Jor\vol941_82 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 557-565

Urinary Orosomucoid as a Potential Marker of Inflammation in Psoriasis Vulgaris
Asmaa Shaban Hasan*1, Mohamed Khaled Selim2, Mayada A. Ghannam1, Amal Wagdy1
Departments of 1Dermatology, Andrology and STDs and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Asmaa Shaban Hasan, Mobile: (+20) 01097072071, E-mail: asmaashaban458@gmail.com

Psoriasis vulgaris (PV) is a chronic proliferative inflammatory dermal disease. Orosomucoid (ORM) is
an acute phase protein (APP) primarily formed in the liver. Novel research revealed urinary orosomucoid (uORM) as a
more sensitive, noninvasive biomarker of inflammatory activation compared to serum ORM (se-ORM).
Objective: To investigate the role of uORM as a surrogate marker for psoriasis and to correlate its urinary values with
the PV severity. Patients and Methods: This was a case-control study, comprised 50 cases with confirmed diagnosis
of psoriasis and control group included 50 healthy controls. The included cases were classified based on PASI score
into; mild PV (10), moderate PV (>10 -<20) and severe PV (20). Morning urine samples were acquired from all cases
and controls to measure urinary ORM.
Results: The AUC for uORM A in differentiating cases from control was fair with the best detected cutoff point was
53.18 yielding sensitivity of 74% and specificity 58%, and for uORM A/creatinine in differentiating cases from control
was fair with the best detected cutoff point was 0.293 yielding sensitivity of 70% and specificity 52%. There was a
statistically significant higher median uORM A, uORM A/ creatinine among severe cases than mild and, moderate cases.
Conclusions: A highly sensitive, inexpensive, and easily available noninvasive biomarker, uORM demonstrates itself
ability to become a new inflammatory marker in PV offering further data on disease severity and progression.
Keywords: Psoriasis, Urinary Orosomucoid, Erythematous Plaques, Psoriasis Area and Severity Index.

hand, increased uORM levels are described in particular
Psoriasis vulgaris (PV) is a chronic proliferative and
disorders (14,15). The increased uORM appears to be
inflammatory dermal disease skin (1,2). It has been
accompanied by systemic inflammatory processes and
demonstrated that two percent of populations suffer
impaired endothelial functions, which are reported also
from different forms of PV (3). Although PV is a benign
to play essential roles in the PV pathomechanism (12,16).
dermal disease, it is a chronic disease with remission
Based on the previous concept and due to the lack of
and exacerbation, it has been associated with poor
relevant studies regarding this perspective, this study
quality of life (QoL) (4). Of note, the median age of the
was conducted aiming to assess uORM role as a
initial presentation of PV ranges from 15 to 20 years of
surrogate marker for psoriasis, and to correlate its
age, while the second presentation happening within the
urinary levels with the disease severity.
fifth decade (5,6).

The pathophysiology of PV includes dermal
infiltration by stimulated T cells with subsequent
This was a prospective case-control study that was
activation of keratinocytes proliferation. Such
conducted at Dermatology, Andrology and STDs
dysregulation in keratinocyte turnover has been
Department in Mansoura University.
demonstrated to be associated with thick plaques
Inclusion criteria: This study included a total of 100
formation. Other accompanying characteristics involve
subjects, who were divided into two equal groups; cases
epidermal hyperplasia and parakeratosis. Additionally,
group included 50 cases aged between 18 and 60 years
the epidermal cells could not form lipids resulting in
with confirmed diagnosis of psoriasis based on the
scaly skin (characteristic feature of PV) (7,8).
typical clinical and dermoscopic examination and
C-reactive protein (CRP) is a broadly utilized
control group included 50 healthy controls.
inflammatory marker. Earlier researches demonstrated
Exclusion criteria: we excluded patients who had
an increase in CRP values in cases complaining from
systemic treatments, pregnant females, patients with
PV; some of which recommended that CRP may be
impaired kidney functions (eGFR < 60 ml/min/1.73m2),
utilized as a marker of PV severity (9,10).
patients with acute inflammation and patients with
Orosomucoid (ORM) has been considered as a major
autoimmune diseases (AIDs).
APP primarily formed by the liver, representing about
0.5-1.2 g/L of serum proteins (11).
Even though novel researches have demonstrated
All of the included cases were subjected to complete
uORM as a sensitive, noninvasive marker of
history taking that comprised personal history (name,
inflammatory stimulation, the clinical value of the
age, sex, occupation and residence), history of the
urinary marker is poorly evaluated in the current
current illness (onset, course and duration of PV and
literature (12,13). Under normal physiological conditions,
predisposing factors), history of drugs (nature, route,
uORM excretion is low and its urinary concentrations
dosage, duration, effects and adverse events), family
represent a few mg/L (0.01-0.3 mg/mmol), on the other
history of PV or different dermatologic diseases and
Received: 07/09/2023
Accepted: 07/11/2023

Full Paper (vol.941 paper# 82)

c:\work\Jor\vol941_83 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 566-570

Effect of Genital Tract Infection on Fructose Level in Semen of Infertile Men
Yousra Ahmed Mohamed Mashaly, Amal Wagdy Abdel Aziz Hawas, Samir Mohamed Elhanbly
Dermatology and Andrology Department, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Yousra Ahmed Mohamed Mashaly,
Mobile: (+20) 01024753358, E-mail: malekramy.4848@gmail.com

Infertility is the inability to conceive after one year of unprotected, sexual intercourse. Most of infertility
cases with signs of genital tract infections (GTI) are without manifestions. Fructose is the main sugar related to
metabolism and sperm motility.
Objectives: This study aimed to evaluate the effect of GTI on the level of fructose in semen of infertile men.
Patients and methods:
This study was conducted on 31 infertile male cases with pyospermia who were confirmed by
semen analysis. Fructose level was measured before and after standard period of treatment of two weeks and after
disappearance of infection by 3 weeks.
Results: There were highly statistically significant reductions in both serum fructose and pus cells before and after the
treatment (P<0.001). It was concluded that fructose level was significantly reduced after pyospermia treatment, but still
within the average normal value. Conclusion: The current study revealed that, fructose level was significantly reduced
after pyospermia treatment, but still within the average normal value. However, no significant correlation was detected
between both fructose level and GTI.
Keywords: Genital tract infection, Fructose, Infertile.


Infertility is the inability to conceive after one
Human fructose is the primary carbohydrate
year of unprotected sexual intercourse (1).
source in seminal plasma, which plays an important role
The male factor (MF) infertility has been
in terms of sperm motility (10).
considered a primary cause of infertility in twenty
It has been demonstrated that there was a
percent of cases and participates in about 50% in the
significant positive association between body mass
remaining causes. There are a lot of causes for MF
index (BMI) and fructose levels. BMI and basal
infertility; infections participate in about fifteen percent
metabolic rate have a positive association with reactive
of such cases (2).
oxygen species. Sperm count, morphology, and motility
Male GTI are difficult to be detected as they are
have negative association with reactive oxygen species
without manifestations in the majority of cases (3).
(11). Pearson correlation revealed significant negative
The number of cases searching for infertility
association of sperm count, vitality and sperm
management are increasing, as a result, the diagnosis of
progressive motility with fructose level (12).
non-manifested GTI must gain more attention as the
This study aimed to assess the GTI effects on the
infectious process could be associated with
fructose level in semen of infertile males.
asthenozoospermia (4).

Of note, GTI is a curable etiology of male
infertility, but the resistance to the traditional antibiotics
This study was conducted on 31 infertile male
could interfere with their efficiency in management of
patients with pyospermia before and after treatment.
complicated GTI or restoring fertility (5).
Cases were enrolled from the Andrology Unit of
Bacteriospermia has been demonstrated to be
Mansoura University Hospital for one year. The age of
associated with infertility by deteriorating the process of
participants ranged from 21 to 45 years.
spermatogenesis, decreasing sperm motility, altering

acrosome reactions, altering the shape, generation of
Exclusion criteria: Patients with criteria of inability to
free radicals, which ultimately ends in increased DNA
conceive less than 12 months, varicocele, cigarette
fragmentations, development of antibodies against the
smoking and drug abuser, systemic diseases and taking
sperms, and obstruction owing to inflammation and
anti-microbial within last 3 months.
fibrosis (6). The polymorphonuclear leukocytes is the

best identified inflammatory marker in the male genital
tract and has been considered as a traditional diagnostic
All cases were subjected to complete history taking
indicator (7).
including personal, sexual, martial history and
Seminal vesicle fluid represents 65% of the
preceding drugs. In addition, complete general and
seminal fluid and the fructose in their secretions is an
andrological examination were conducted.
indispensable nutrient for sperm maturation (8). In
Collection of semen specimens from cases was done by
addition, it plays an essential role with regard semen
masturbation after 72 hours of abstinence. Prior to
coagulation, sperm motility, and inhibition of the
sampling, the cases were instructed to urinate and after
immunological activities in the female genital tract (9).
that wash their glans with soapy water before drying it.
Received: 17/09/2023
Accepted: 18/11/2023

Full Paper (vol.941 paper# 83)

c:\work\Jor\vol941_84 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 571-577

Efficacy of Endoscopic Ultrasound in Preoperative Assessment of Pancreatic Head
Tumors from A Surgical Perspective: A Prospective Study
Mohamed Elshobari1, Youssif Elmahdy1, Hosam Hamed1, Mohamed Medhat1*
1Department of General Surgery, Mansoura Gastroenterology Surgical Center, Egypt
*Corresponding author: Mohamed Medhat Saleh El_Sayed, E-mail: Midomedhat20.mm@gmail.com, Mobile : +201006959083

Cancer of the pancreatic ducts, often known as pancreatic ductal carcinoma, is the most common type of
pancreatic cancer.
This study aimed to assess the accuracy, specificity, and sensitivity of endoscopic ultrasound in diagnosis of
pancreatic head tumors and detection of lymph node metastasis, tumor size, vascular invasion and local infiltration of
surrounding organs based on surgical assessment.
Patients and methods: This prospective study of forty consecutive patient who presented to the Gastrointestinal Surgical
Center during the period from 2020 to 2023.
Results: There was statistical significance difference between the Endoscopic Ultrasound (EUS) results and CT vascular
results only in the studied patients. There was high statistically significant difference between the EUS results and
operational LNs results in the studied patients. There was high statistical significance difference between the EUS results
and operational vascular results in the studied patients.
Conclusion: The use of EUS to confirm a pancreatic cancer diagnosis is highly encouraging. Lymph node metastases as
well as vascular invasion can be effectively detected using this method. Removing the tumor entirely also improves the
chances of a successful recovery after operation.
Endoscopic ultrasound, Preoperative assessment, Pancreatic head tumors.


Cancer of the pancreatic ducts, often known as
cancer is a mass inside the pancreas (2). The sensitivity of
pancreatic ductal carcinoma, is the most common type of
computed tomography (CT) in detecting pancreatic
pancreatic cancer. It ranks as the eighth most common
cancer ranges from 89 to 97% when using a helical
cancer killer globally. The only treatment option available
multidetector row computed tomography scan that is
at the moment is surgical removal of the affected
augmented with contrast in multiple phases (6).
pancreatic cancer cells. However, only 20% of cases are
Based on surgical evaluation, the present research
amenable to this approach when diagnosed (1,2). Forecasts
targeted to determine if endoscopic ultrasonography was
indicate that the number of pancreatic cancer cases in
more specific, accurate & sensitive than surgical
Egypt would rise from 2,226 in 2013 to 2,836 in 2020 as
examination in diagnosing pancreatic head cancers as
well as 6,883 in 2050 (3).
well as detecting tumor size, vascular invasion, lymph
Although cystadenocarcinoma & acinar cell
node metastasis, & local infiltration of adjacent organs.
carcinoma are also present, duct cell adenocarcinomas

account for about 90% of pancreatic adenocarcinomas.
While one-third originates in the pancreatic tail & body,
This was a prospective study of forty consecutive
two-thirds occur in the pancreatic head. A comprehensive
patient who presented to the Gastrointestinal Surgical
genetic profile of pancreatic cancer has been compiled
Center during the period from 2020 to 2023.
from a number of studies that have assessed the

heritability of the disease's subtypes. Potentially
Inclusion criteria: Patients with pancreatic head cancer
increasing survival rates for pancreatic cancer patients,
eligible for palliative or radical surgical intervention.
these genetic features may one day inform the

development of targeted treatments (4).
Exclusion criteria: Patients with tumors arise from the
Pain is a commonly reported symptom, especially
distal common bile duct, proximal-mid-duodenum & the
in cases of tiny pancreatic tumors (under 2 cm).
ampulla of Vater. Patients who were unfit for surgery and
Pancreatic cancer pain typically develops slowly and has
refusing surgery or their ASA score IV.
been going on for at least a month or two before the
patient presents with symptoms. Epigastric, spreading to
the sides and/or straight through to the back, it typically
has a gnawing visceral aspect (5).
Although pancreatic enlargement is occasionally
observed, the most common CT result of pancreatic
Sample size: Andrew Fisher's Formula, a sample

Full Paper (vol.941 paper# 84)

c:\work\Jor\vol941_85 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 578-583

Inferior Vena Cava Collapsibility Index versus Central Venous
Catheter for Early Detection of Hypovolemia in abdominal Trauma
Rabab Mohamed Lashin*1, Mohamed El-Said Ahmed1, Medhat Mekhail Messeha2, Samir Mohamed Attia3
Departments of 1Emergency & Trauma Medicine, Anesthesia, 2Surgical ICU & Pain and
3Vascular Surgery, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Rabab Mohamed Lashin, Mobile: (+20) 01032895818,
Email: rabablashin93@gmail.com

Background: Abdominal trauma has been considered as a significant cause of morbidity and mortality, necessitating
prompt and accurate assessment of fluid status and hypovolemia. The inferior vena cava (IVC) collapsibility index and
central venous catheter (CVC) have emerged as potential tools for fluid assessment in trauma patients.
Objective: This study aimed to evaluate the utility of the IVC collapsibility index (IVC-CI) in assessing fluid status
and hypovolemia in patients with abdominal trauma.
Patients and Methods: A cross-sectional study that is conducted on 67 trauma patients attended to the Emergency
Department (ED) with hypovolemia state to compare IVC-CI with central venous pressure (CVP) as early indicator of
hypovolemia in abdominal trauma patients. The diameter of the IVC, the central venous pressure, and the IVC-CI were
recorded before and after fluid resuscitation. Results: IVC-CI has decreased from base line to follow up after fluid from
54.55 ± 15.23 to 45.06 ± 13.81. IVC-CI has negative association with central venous pressure at base line (P<0.001).
IVC-CI has a negative association with urine output (UOP) at baseline (P<0.001). IVC-CI has negative association with
central venous pressure and urine output at follow-up (P<0.001). Conclusion: IVC-CI had a strong statistically
significant inverse association with central venous pressure. IVC-CI was found to be more predictive of fluid
responsiveness and early hypovolemic state when compared to central venous pressure. So, the study supported the use
of the IVC-CI and CVC as reliable markers for assessing fluid status and hypovolemia in abdominal trauma patients.
Keywords: IVC-CI, CVC, Hypovolemia, Abdominal trauma.

expiratory IVCD by the inspiration IVCD to get the IVC-
When patients present to the ED with hypovolemia
CI [5]. The intravascular collapsibility index (IVC-CI) is
(CVP less than 8 cm H2O), measuring their CVP is an
a non-invasive approach of estimating intravascular
invasive haemodynamic assessment and a helpful guide
volume that is gaining in popularity. Hemodynamic
for an initial resuscitative response with the goal of
evaluation is best performed with point-of-care
reducing morbidity and mortality rates. On the other
ultrasound due to its non-invasiveness, low charge, ease
hand, invasive hemodynamic monitoring can have
of repeatability, increased availability, and portability [6].
unfavorable effects when used for CVP monitoring in the
The potential value of the IVC-CI as a non- invasive
ED (arterial puncture, infection, venous thrombosis, and
technique for intravascular volume evaluation is
so on), as well as time and practical limitations, such as
growing. Because of its non-invasive nature, cheap cost,
the need for specialized monitoring equipment and
easy repeatability, improved availability, and portability,
accompanying resources [1].
point-of-care ultrasound is the hemodynamic evaluation
A central venous catheter shouldn't be used if the
modality of choice [7]. The IVC diameter (IVCD)
patient has certain conditions, such as bleeding or
alterations are mainly based on the respiratory stage.
infection at the insertion site. Infections, accidental
Throughout inspiration, the negative pressure is
artery puncture, hematoma, hemothorax, pneumothorax,
developed in the thorax, causing the IVC to drain into the
air embolism, and arrhythmias are all possible
right atrium, with subsequent reduction in its diameter
complications of a central venous catheter [2]. Because of
(IVCD) [8].
its safety, non-invasiveness, speed, and convenience as a
This work aimed to assess the utility of the IVC
bedside test, ultrasound has gained popularity in the
collapsibility index in assessing fluid status and
emergency room. One of the most frequently performed
hypovolemia in patients with abdominal trauma.
ultrasonography is not a routine radiological
This cross-sectional observational study was done
investigation but rather is performed to assess a targeted
over a period of one year from May 2022 to May 2023
medical issue [3]. Deoxygenated blood is transported to
on trauma patients attended to the Emergency Hospital,
the right atrium of the heart via the IVC. The IVC is a
Mansoura University. They were presented by clinical
large vein whose dimensions and shape are related to the
signs and symptoms suggestive of hypovolemia (systolic
CVP and blood volume [4].
blood pressure below 90 mmHg, heart rate (HR) over
The internal thoracic artery (IVA) diameter (IVCD)
100 beat/minutes, and capillary refill more than 2
changes size throughout the breathing cycle. When the
thorax experiences negative pressure, the IVC narrows
Inclusion criteria: Patients with age from 18 to 60 years
as blood is drained into the right atrium. Divide the
old, from both genders, with accessible central venous
Received: 25/09/2023
Accepted: 23/11/2023

Full Paper (vol.941 paper# 85)

c:\work\Jor\vol941_86 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 584-592

Is Vitamin D Deficiency a Risk Factor for Spontaneous Bacterial Peritonitis?
Mostafa Gamal El Helbawy1, Amany Wasef Abdel Salam1*, El-Sayed Shaaban Tharwa1,
El-Sayed Ibraheem Zalabia1, Ahmed Salah Abd EL Gawad2, Hassan Ahmed Elshenawy1
Departments of 1Hepatology and Gastroenterology and
2Clinical Pathology, National Liver Institute, Menoufia University, Menoufia, Egypt
*Corresponding Author: Amany Wasef Abdel Salam, Mobile: (+20) 01065291252, Email: amanywasef6@gmail.com

Spontaneous bacterial peritonitis (SBP) is a severe worldwide liver condition.
Objective: The aim of this study was investigating the association between serum 25(OH)D deficiency and the
complications of hepatitis c virus (HCV) related cirrhosis, notably, SBP.
Patients and Methods: This prospective case control study was carried out on 100 patients, with cirrhosis and ascites.
The patients were divided into two groups: Group I cirrhotic patients with ascites and SBP, which were divided into two
equal subgroups according to addition of 25(OH)D to treatment of SBP: group Ia did not receive vitamin D and group
Ib received vitamin D. Group II: cirrhotic patients with simple ascites and without SBP. Group Ib of patients were
receiving a dose of 2.000 I. U of 25 hydroxycholecalciferol per day for at least 1 week.
Results: There was a significant correlation between serum vitamin D and end-stage liver disease (MELD) score (r = -
0.51, P= 0.012; r = -0.37, P= 0.016, respectively) in subgroup (GI a) not receiving vitamin D and control group. Serum
level of vitamin D was also significantly correlated with ascitic polymorphonuclear neutrophils (PMN) count (cell/µL)
in both SBP subgroups (GI a and b) (r = -0.61, P= 0.002; r = -0.61, P= 0.002, respectively). The receiver operating
characteristic (ROC) curve analysis estimated a sensitivity of 78.3%, a specificity of 69.0%, a positive predictive value
(PPV) of 58%, a negative predictive value (NPV) of 85.3% and an accuracy of 73.7% at the best cutoff value of 13.96
(ng/mL). The AUC was 0.76 with a highly significant P-value < 0.001. A positive highly significant correlation between
serum vitamin D and serum albumin was observed in both subgroups and control (r = 0.67, P = 0.001 and r =0.50,
P=0.014, r = 0.44, P=0.004, respectively).
Conclusions: MELD scores >15 were related with an increased risk of SBP. It was also shown that Escherichia coli
and Staph aureus were the most frequent bacteria among SBP patients.
Keywords: Vitamin D Deficiency, SBP, MELD score, Cirrhosis.


As a monomicrobial infection of ascitic fluid
possible that a Vit-D shortage raises infection rates,
without a communicable source of infection, SBP is a
which in turn raises death rates in cirrhosis patients. It
major morbidity worldwide hepatic condition. SBP is
is true that Vit-D controls the immune system and that
related with a higher risk of infection and mortality and
bacterial infections shorten the longevity of cirrhosis
can arise from a variety of aetiologies due to immune
patients [7].
system abnormalities, which are frequent in patients
The aim of this study was investigating the
with MELD [1].
association between serum 25(OH)D deficiency and the
Low ascitic fluid protein content and advanced
complications of HCV-related cirrhosis, notably, SBP
liver disease have been found to be risk factors for SBP.
and impact of addition of 25(OH)D to treatment
Research indicates that the most potent predictor of SBP
regimen on outcomes of patients with SBP and Vit-D
is an ascitic fluid total protein (TP) level 1 gm /dL,
which indicates a reduced opsonization capability and

low complement concentration [2].
Polymorphonuclear (PMN) cell count in ascitic
This prospective case control study was carried
fluid (AF) more than or equal to 250 cells/mm3, where
out on 100 patients aged up to 59 years old, of both
60­70% of cases show the isolation of the infectious
genders, with cirrhosis and ascites.
organism, is the diagnostic tool for SBP [3].
Exclusion criteria were patients with malignant or
Up to 92% of individuals with chronic liver
tuberculous ascites; patients with alcoholic liver
disease have some form of insufficiency or deficit in
cirrhosis; patients with Wilson disease; patients with
Vit-D, and the severity of the shortage is correlated with
hemochromatosis and glycogen storage disease;
the severity of liver dysfunction. This correlation
patients with renal disease; patients with DM; patients
between the degree of liver malfunction and Vit-D
with collagen diseases; patients with sepsis; patients
insufficiency was thought to be caused by deterioration
with infection other than SBP; patients who received
of the synthetic liver [4-6].
vit-D supplementation within the last six months; and
Patients with cirrhosis and alcoholic liver
patients who are not available for follow-up
disease have been linked to higher death rates when
Patients were grouped based on the presence of
deficient in Vit-D; however, the source of this
ascites as follows: Group I included cirrhotic patients
correlation and its causal linkage remain unclear. It is
with ascites and SBP, patients were diagnosed to have
Received: 29/09/2023
Accepted: 29/11/2023

Full Paper (vol.941 paper# 86)

c:\work\Jor\vol941_87 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 593-599

Serum Copeptin as a Cardiomyopathy Predictor in
Thalassemic Children: Relation to Tei Index
Nesma Ahmed Safwat1, Omneya Ibrahim Youssef 2, Hend Attia3, Mahmoud Adel Kenny2
Departments of 1Clinical Pathology, 2Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of 3Clinical and Chemical Pathology, School of Medicine, Newgiza University, Giza, Egypt
*Corresponding author: Nesma Ahmed Safwat, Mobile: (+20)01228609860, E-mail: drnesma@windowslive.com

: Among the most dangerous side effects for persons with beta thalassemia major (B-TM) are cardiac
problems. Early recognition of cardiomyopathy guides early management and therefore minimize mortality and
: This study aimed to assess copeptin levels as an early predictor of myocardial dysfunction in children with
B-TM and to determine its relationship to tissue doppler derived Tei index in those patients.
Subjects and methods:
The study was conducted on 42 children with B-TM without known heart disease and 40 age
-and sex-matched healthy controls. Serum copeptin was assayed by a commercial ELISA kit and left ventricular Tei
index was measured using tissue Doppler imaging.
Results: Copeptin levels were significantly higher in thalassemic patients compared with controls (P=0.014).
Copeptin was correlated positively with age, disease duration, transfusion index, lactate dehydrogenase, indirect
bilirubin, serum ferritin, end systolic and diastolic diameters and tricuspid regurgitant jet velocity. Copeptin, on the
other hand, showed a negative correlation with fractional shortening and ejection percent. Copeptin and Tei index
showed a substantial link in the investigation of correlation (p=0.001).
Copeptin in B-TM may be regarded as an early indicator of cardiomyopathy. It ought to be included in
thalassemic follow-up in order to detect and treat subclinical problems correctly, lowering the risk of detrimental heart
failure (HF).
Copeptin, Tei index, B-TM.


echocardiographic abnormalities typically appear later
The future of thalassemic patients is bright,
in the course of the illness [9]. The use of tissue-derived
since scientific research in the past several years has
doppler myocardial performance (Tei index), which
concentrated on cardiac biology and imaging
has distinct benefits over more traditional established
indicators in TM patients. These indicators are helping
indices, has shown to be a dependable technique for
to clarify how early cardiac involvement occurs and
assessing global cardiac performance and emerges as a
how patients who are at risk might receive intense
marker utilised for early identification of myocardial
chelation quickly, which increases the likelihood of
functions [10].Ideally , for a precise cardiovascular
preventing HF, which is the primary cause of mortality
in this population [1].
biomarkers is important to assist in precise functional
Copeptin is a relatively novel and promising
evaluation and risk stratification in addition to
marker of many cardiovascular events, including HF,
echocardiography cardiac imaging methods and to
since it indicates the arginine vasopressin (AVP)
guide therapeutic decisions that may prevent cardiac
system. The AVP complex is critical for maintaining
remodeling and progressive dysfunction [11].
cardiovascular homeostasis [2]. Copeptin is part of the
Therefore, this study was performed to assess
uncleaved pro-AVP, which is co-secreted with AVP,
copeptin levels as an early predictor of myocardial
mirroring its levels[3]. Copeptin is therefore employed
dysfunction in children with B-TM and to determine
as a stand-in marker for AVP release [4].
its relationship to Tei index in those patients.
Copeptin's significance has mostly been

demonstrated in acute life-threatening illnesses
mediated by the stress response system and
Study population:
hemodynamic instability, as copeptin is released in
The study comprised 42 Egyptian children and
response to several stressors [5,6]. Nonetheless, the
adolescents with B-TM who were frequent attendees at the
cardiovascular system is highlighted as the primary
Pediatric Hematology Clinic, Pediatric Hospital, Ain
location of copeptin formation and the significance of
Shams University. As a control group, forty healthy
copeptin measurement [7]. Besides the established
individuals of similar age and gender were enlisted.
biomarkers for cardiac injury, copeptin has
Hemoglobin analysis information was obtained from
demonstrated the ability to offer corrective diagnostic
patient records. All patients had their medical history
data for early discriminating and risk stratification in
taken, with particular attention paid to their demographics,
cardiac diseases [8]. In the context of B-thalassemia
the length of their illness, the frequency of their
cardiomyopathy, copeptin has not yet been studied.
transfusions, and their iron chelation treatment. An
From an imaging standpoint, it is challenging
extensive clinical examination was performed on the
to identify early cardiac abnormalities, and traditional
patients, which included anthropometric measurements
Received: 24/09/2023
Accepted: 22/11/2023

Full Paper (vol.941 paper# 87)

c:\work\Jor\vol941_88 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 600-606

Knowledge of Cervical Cancer and Human Papilloma Virus among
Medical Students in Suez, Egypt
Ahmed Sewidan1*, Ahmed Yasser Shokry2, Mohamed Ramadan2, Hany Mahmoud Abd Elhamid3
1Obstetrics and Gynecology Department, Faculty of Medicine, Suez University.
2Medical student at Faculty of Medicine, Suez University.
3Obstetrics 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

Healthcare professionals, particularly the younger medical students, can be very helpful in advising patients
on how to prevent or treat human papilloma virus (HPV)-related cervical cancer (CC). However, it is frequently noted that
medical students, who provide first-line support for managing patients, have a poor awareness of CC and HPV.
Objective: To evaluate medical students' awareness and knowledge on cervical cancer by testing their understanding of
clinical diagnosis and screening, risk factors, human papilloma virus, and other related topics in Suez, Egypt. The purpose
of the study is to shed light on how this information might improve community awareness of cervical cancer.
Subjects and Methods: An organized online survey was used to conduct an observational cross-sectional study on
people's knowledge of HPV and cervical cancer. 92 medical students from Suez University participated in the study.
Results: Of the total, 81.5% of the students were aware of the connection between the human papilloma virus and its role
in cervical cancer; 93.5% knew it is sexually transmitted; 87.0% knew an HPV infection may not cause any symptom;
87.0% had heard of an HPV vaccine; and 41.3% believed that girls as young as 15 years old could receive it.
Conclusion: An acceptable degree of awareness and understanding regarding HPV, cervical cancer, and HPV vaccine
was found in our study. We discovered that increasing knowledge of the etiology of cervical neoplasia, the availability of
the HPV vaccine, and its preventive efficacy is positively impacted by medical education.
Keywords: Medical Students; Knowledge; Cervical Cancer; Human Papilloma.


A serious health concern is cervical cancer. With an

anticipated 604,000 new cases and 342,000 deaths
countries, there have only been a few studies done in
worldwide in 2020, it is the fourth most common cancer
Egypt among medical students, and none of them
identified globally and the fourth greatest cause of
included postgraduate medical students (10­11).
cancer-related deaths among women (1).
Our study aims to close this gap by focusing on
99.7% of cervical cancer specimens have been
medical students in Suez, Egypt, who play a crucial role
confirmed to include HPV, a sexually transmitted virus.
in providing healthcare. Their thorough knowledge of
It is particularly prevalent in younger people, with the
HPV and cancer cervix offers promise for better patient
highest incidence among those in the 20­30 age range,
education, early identification, and prevention. Our goal
which includes many college students (2­3). Between 50%
was to evaluate their awareness and knowledge on HPV
and 80% of women who are sexually active are thought
and cervical cancer.
to have contracted the virus at least once in their lifetime.

About 70% of all cases are of the most prevalent strains,
HPV16 and HPV18 (4-5).
Study area and subjects
There are known risk factors for HPV infection and
The investigation was carried out at Suez University.
how it progresses to cervical cancer. These include long-
Medical students at Suez University were the target
term oral contraceptive pills (OCP) usage, cigarette use,
multiple sexual partners, early initiation of sexual
This observational cross-sectional study evaluated the
activity, immunosuppression, and diet (6-7).
knowledge, response, and attitude regarding cervical
Over the years, screening for cancer cervix has been
cancer, HPV, and HPV vaccination using a structured
made possible by the length of time that separates HPV
online electronic survey. The survey assessed
infection from cancer cervix (8).As of right now, the
participants' knowledge of risk factors, clinical diagnosis,
World Health Organization recommends cervical
and screening of human papilloma virus to offer insights
screening, HPV vaccination, and broad education as part
into the potential impact of such knowledge on raising
of a complete cancer prevention strategy (9).
cervical cancer awareness within the community.
Although medical students' knowledge of cervical
It should take approximately ten minutes for each
cancer and HPV has been assessed in many different
participant to complete the 26 questions on the online
Received: 12/09/2023
Accepted: 12/11/2023

Full Paper (vol.941 paper# 88)


Fatty Liver Disease and Its Impaction on Insulin Resistance
Bishoy Malak Salib Hens, Hatem Abdel Latif, Christina Alfons, Sonya Ahmed El-Gaaly
Department of Gastroenterology and Hepatology Management, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding Author: Bishoy Malak Salib Hens, Mobile: (+20) 01211077845, E-mail: bishoymalak6@gmail.com
Non-alcoholic fatty liver disease (NAFLD) involves excess liver fat accumulation without specific causes
like alcohol or viral infections, categorized into simple steatosis and nonalcoholic steatohepatitis (NASH). While simple
steatosis is generally stable, NASH is linked to progressive liver disease. Diagnosis excludes secondary causes, and
NAFLD, marked by hepatocyte changes, inflammation, and fibrosis, may lead to severe complications. Strongly
correlated with adipose and hepatic tissue insulin resistance (IR). NAFLD disrupts glucose-insulin interplay,
compromising insulin's regulatory functions and contributing to metabolic disorders and disease progression.
Objective: This study aimed to investigate fatty liver disease and evaluate its impact on IR.
Patients and Methods: This cross-sectional study, conducted at Ain Shams University, included 98 adult patients with
NAFLD patients who had liver disease and impaired glucose tolerance to assess IR. We recorded demographic and
anthropometric data, metabolic syndrome assessment, ultrasound grading of steatosis, and laboratory tests for liver
function, FIB-4 index, and IR using HOMA-IR. Results: In this study, IR was prevalent in 63.3%. The cases,
predominantly females (52%), had mean age of 43 years, 50% were hypertensive, and 48% were diabetic. IR was
directly related to age, and its prevalence was significantly higher in patients with diabetes and hypertension. IR
correlated positively with body weight, BMI, ALT, AST, FIB-4, TG, and cholesterol. Fatty liver grading showed a
significant association with IR, particularly in grade 2 cases. The optimal HOMA-IR cutoff for distinguishing between
grade I and II fatty liver was >2.56, with high sensitivity (100%) and specificity (88.73%). These findings emphasize
the intricate relationship between NAFLD, IR, and associated metabolic factors.
Conclusion: The study established a robust link between IR and NAFLD, noting a 63.3% prevalence of IR in the
subjects. Employing HOMA-IR, a cutoff point >2.56 effectively differentiated between NAFLD grades I and II,
demonstrating 100% sensitivity, 88.73% specificity, and a remarkable AUC of 98. This underscored HOMA-IR's
valuable role in identifying and stratifying NAFLD, especially in individuals with diabetes.
Keywords: NAFLD, NASH, Insulin resistance.

glycogen synthesis, lipogenesis and cell proliferation.
When there is no major alcohol consumption,
On the other hand this cascade leads to down regulation
viral infection, or any identifiable aetiology of liver
of gluconeogenesis and lipolysis (6).
disease, NAFLD is defined as liver fat accumulation
Insulin sensitivity is decreased in insulin-
that exceeds 5% of hepatocytes (1). NAFLD is classified
resistant people with NAFLD, not just in muscle but
into two groups: simple steatosis and NASH. The latter
also in liver and adipose tissue. Adipose tissue becomes
is differentiated from the former by the presence of
resistant to insulin's antilipolytic function in insulin-
hepatocellular damage, either with or without fibrosis.
resistant situations, leading to an increase in fatty acid
While NASH is linked to liver disease that progresses
release. Increased insulin levels associated with IR lead
over time, uncomplicated steatosis patients often have
to an increase in hepatic triglyceride production when
stable liver histology (2). When there are no other
combined with increased lipolysis and/or fat
secondary causes of hepatic steatosis, such as severe
consumption (7). This study aimed to investigate fatty
alcohol intake, medicines, Wilson's disease, starvation
liver disease and evaluate its impact on IR.
or parenteral nutrition, among other disorders linked to

microvesicular steatosis, NAFLD is identified either by
histology or imaging (3). Hepatocyte ballooning, lobular
This cross-sectional study, conducted at Internal
inflammation, and/or fibrosis are characteristics of
Medicine Department, Ain Shams University, focused
NAFLD, which can result in cirrhosis, hepatocellular
on adults with NAFLD to assess IR.
carcinoma, and metabolic disorders such IR and DM (4).
Inclusion criteria: Adult patients above the age of 18
Reduced whole-body insulin sensitivity and IR in
years, patients with fatty liver disease based upon the
adipose and liver tissue are also substantially correlated with
results of pelvic abdominal ultrasound, patients with
NAFLD. The human body has intricate metabolic pathways
impaired glucose intolerance as evaluated by a 75-g
that involve molecular interactions between insulin and
OGTT (i.e., a fasting plasma glucose concentration >7
glucose. IR results from a malfunction in this interaction.
mmol/l and a 2-hour postglucose plasma glucose
Insulin's incapacity to stimulate muscle's absorption of
concentration >7.8 mmol/l), and patients who are able
glucose and the liver's inhibition of gluconeogenesis result
to provide informed consent.
in a gradual decline in beta cell activity and, eventually, IR
Exclusion criteria: Alcohol intake, either viral or chronic
(5). Insulin binds to its receptor, which contains 2 alpha
hepatitis, liver damage brought on by drugs, obstructive
and 2 beta chains on the cell surface, and this activates
disorders of the liver, complete parenteral nourishment,
signaling cascade leading to glucose influx into cells,
inflammatory hepatitis, Wilson's disease, patients with a
Received: 27/09/2023
Accepted: 27/11/2023

Full Paper (vol.941 paper# 89)

c:\work\Jor\vol941_90 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 614-620

Association of Gastrointestinal Problems and Behavioral Disorders in
Children with Autism Spectrum Disorders in Pediatrics and
Psychiatry Outpatient Clinics in Suez Canal University Hospital
Mohamed Ahmed Shawky Eissa *1, Hesham Fathey El-Sayed 2,
Omneya Youssef Muhamed Ibrahim2, Ahmed Mohamed Kotb Abdelrahman1
1Department of Pediatrics, Faculty of Medicine, Suez Canal University, Suez, Egypt.
2Department of Pediatrics at Suez Canal Authority Hospital, Suez, Egypt
*Corresponding author: Mohamed Ahmed Shawky Eissa, Email: mas_spy@yahoo.com, Mobile: +201156221446

: Dysfunction of gastrointestinal tract (GIT) is one of the most frequent problems in children with autism
spectrum disorder (ASD). Objectives: To assess the propagation of GIT problems in autism spectrum disorder kids and
its correlation with their behavioral problems. Patients and Methods: This case-control study included 50 children with
ASD matched with 50 healthy kids with the same age and gender. Parents of children with autism spectrum disorder
and typically developed children, were interviewed to fill out the checklists about their behavior and GIT symptoms,
then the collected data were tabulated and analyzed using SPSS version 26 software.
Results: All autism spectrum disorder group had significantly greater produce of the following symptoms: vomiting,
constipation, soiling, reflux, and abdominal pain than typically developed group, with statistically significant
differences. Also, autism spectrum disorder group had significantly longer duration of constipation, soiling, reflux, and
abdominal pain than typically developed group. Medication used showed statistically significant difference among study
groups as more than half autism spectrum disorder group used laxatives. Autism spectrum disorder had significantly
greater mean values than typically developed group on the following CBCL scales: withdrawn, somatic complaints,
anxious, social, thought, attention, aggressive behavior, internalizing problem, externalizing problem, and total problem,
while delinquent behavior was significantly higher among typically developed than autism spectrum disorder group.
Conclusions: Children with autism spectrum disorder are at greater risk of some behavioral and GIT problems which
need a special care as compared to typical development (TD) children.
Keywords: Gastrointestinal Problems, Behavioral Disorders, Autism Spectrum, Pediatrics.

diagnosed with ASD. Furthermore, for some ASD
Persistent impairment in reciprocal social
patients, short-term antibiotic therapy that modifies the
communication and relationships and confined,
gut's bacteria may result in a transient improvement in
repetitive patterns of behaviors or interests are
behavioral symptoms (5, 6).
hallmarks of autism spectrum disorder, a complex
The objective of the present research was to look at
neurodevelopmental disease (1). Many children with
the frequency of gastrointestinal symptoms in kids with
ASD often have co-occurring medical disorders that
ASD as well as their association with behavioral issues.
impact various areas of their bodies. One of the most
common issues in children with autism spectrum
This case control study was performed in Pediatrics
disorder is dysfunction of the GIT. A recent meta-
and Psychiatry Clinics in Suez Canal University
analysis found that compared to typically developing
Hospital and included 100 children distributed as 50
children, children with autism spectrum disorder are
children with autism spectrum disorder and 50 typical
four times more likely to have general gastrointestinal
development controls with the following inclusion and
(GI) difficulties, more than three times more likely to
exclusion criteria:
suffer diarrhea and constipation, and twice as likely to
experience stomach discomfort (2, 3).
Inclusion Criteria for the cases: Age 4 to 14 years, no
A lot of research has been done on the types
usage of any type of antifungal or antibiotic drugs
and prevalence of GIT problems in kids with ASD.
within the last month, diagnosis of autism, or Asperger's
Children with autism spectrum disorder have a reported
by a psychiatrist by using the CARS evaluation method.
prevalence of nine percent to 91 percent for abdominal
Exclusion criteria for the cases: Children with any
pain or discomfort ranges between two percent to forty-
one percent for stomach pain or discomfort, six percent
tracheoesophageal fistula, and children with attention
to forty-five percent for constipation, three percent to 77
deficit disorders (ADD/ADHD).
percent for diarrhea, and eight percent to nineteenth
percent for chronic diarrhea (4).
Inclusion criteria for the control group: Age 4 to 14
A substantial amount of new research has
years, no usage of any type of antifungal or antibiotic
demonstrated the significance of the gut as an autism
drugs within the last month, and in good physical and
trigger in recent years. Gastrointestinal dysfunction is
mental health.
often linked to increased tantrums, irritability,
aggressive behavior, and sleep difficulties in children
Received: 03/09/2023
Accepted: 01/11/2023

Full Paper (vol.941 paper# 90)

c:\work\Jor\vol941_91 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 621-629

The sodium glucose transporter 2 inhibitor Dapagliflozin Regulates
kisspeptin and GABA receptors mRNA expression in hypothalamic arcuate
nucleus in polycystic ovary rat model , Can it be a therapeutic target ?
Abeer Albiomy Khalefa, Reham Hassan Ebrahim*
Department of Physiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author Reham Hassan Ebrahim, Mobile: (+20) 01144963609,
Email: phisiology_lover_4@yahoo.com, Orchid ID: 0000-0001-8038-4144

Polycystic ovary syndrome (PCOS) is a reproductive disease that causes metabolic, endocrine and
cardiovascular effects. Dapagliflozin (DAPA) is a sodium glucose transporter 2 (SGLT-2) inhibitors that control
glucose level, and improve insulin sensitivity, DAPA improved sex hormones profile and ovulation rate in obese
mouse model.
Objective: The study aimed to detect if there is a role of DAPA on ovarian function in estradiol-induced PCOS rats.
Material and methods: Thirty rats were divided into 2 groups. Group (control) were given 0.5 ml saline
intramuscular (IM) once, after 60 days, they were given. 0.9% saline by gastric gavage. Group II (PCOS-induced
group) where rats were administered 4 mg/kg of estradiol valerate by single IM injection, 60 days later. PCO group
was subdivided into subgroup IIa where rats were given 0.9% saline. Subgroup IIb included rats that were given
DAPA 5 mg/kg/day. Both subgroups were administered by gastric gavage for 4 weeks. At end of experiment, serum
sex hormones profile, insulin, glucose, ovarian oxidative stress and inflammatory markers, ovarian histopathology,
transforming growth factor B1 (TGF-1) immunohistochemistry, hypothalamic kisspeptin and GABA B receptor gene
expression were estimated.
Results: In PCO group IIa, value of kisspeptin expression was increased significantly (p <0.01), value of GABA B
receptor expression was decreased significantly (P < 0.01), compared to Dapagliflozin-treated PCO group IIb. The
same opposing results when both compared to normal control group I (P< 0.001). Moreover, there was a significant
increase in kisspeptin expression (P<0.05) and significant decrease in GABA B receptor expression (P< 0.01) in
Dapagliflozin-treated PCO group IIa compared to normal control group I.
Conclusion: DAPA improved inflammatory status, oxidative stress markers, hormonal profile, ovarian histological
structure and decreased TGF-1 immunoreactivity and kisspeptin and increased GABA B receptor gene expression.
DAPA can be used as a therapeutic target for PCOS.
Keywords: Polycystic ovary syndrome, Estradiol, Dapagliflozin, Glucose transporter 2 inhibitors.

This study aimed to assess if DAPA has a
PCOS is characterized by ovarian polycystic
therapeutic role in polycystic ovary syndrome.
changes, it can cause female infertility, menstrual
Experimental animals: 30 adolescent virgin female
disturbance, which is caused by increased ovarian
albino rats of local strain weighing 180-200 gram were
granulosa cells (GC) apoptosis [1].
obtained from Veterinary Medicine Faculty, Zagazig
In addition, disturbance in pulsatile manner of
University. The animals were housed in steel wire
gonadotrophin releasing hormone (GnRH) release
cages. They received food and water ad libitum and
under the effect of hypothalamic kisspeptin, which is
were left for two weeks for acclimatization before start
considered the master regulator of GnRH neurons. In
of the experiment.
addition to metabolic disorders involving insulin
resistance (IR), chronic inflammation and oxidative
Grouping of animals: Group (control) (n = 10
stress [1, 2]. SGLT-2 inhibitors are drugs that lower
rats): Rats were given 0.5 ml saline IM once. Then
blood glucose levels by preventing glucose
after 60 days, they were given .0.9% saline by gastric
reabsorption in renal proximal tubules [3].
gavage every day for 4 weeks.
DAPA is highly selective SGLT-2i that give
glycaemic control, weight loss, improved insulin
Group II (PCOS-induced group) (n= 20 rats): Rats
sensitivity, reduced oxidative stress and inflammation.
were administered 4 mg/kg of estradiol valerate by
It was the first SGLT-2 inhibitors to be approved for
single IM injection [7], 60 days later, PCO group was
managing diabetes mellitus type 2 [3, 4].
subdivided into two subgroups (n = 10 rats/group).
In addition, DAPA improved sex hormones
Subgroup II a: rats were given 0.9% saline by gastric
profile and ovulation rate in obese mouse model [5].
gavage every day for 4 weeks. Subgroup II b: rats
SGLT-2 inhibitors may be effective for many
were given DAPA (5 mg/kg/day) by gastric gavage
characters related to PCOS, including insulin
every day for 4 weeks [8].
resistance (IR), oxidative stress, and inflammation [6].
Induction of PCOS: Single dose of estradiol valerate
(EV) causes irregularity in reproductive cycles with
Received: 02/10/2023
Accepted: 02/12/2023

Full Paper (vol.941 paper# 91)

c:\work\Jor\vol941_92 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 630-636

Role of Multidetector CT in Preoperative Evaluation of Periampullary Neoplasms
Dalia Ibrahim Aggour1, Ahmed Nabil Sallam2,
Muhamed Ahmed Magdy Abdelhamid1, Heba Ahmed Abdehalim1
Departments of 1Diagnostic Medical Imaging and Interventional Radiology and 2Hepatobiliary and Pancreatic
Surgery, National Liver Institute, Menoufia University, Egypt
*Corresponding author: Dalia Ibrahim Aggour, Mobile: (+20) 01005166447, E-mail: daliaibrahim296@gmail.com

The phrase "periampullary tumours" refers to tumours that arise in the periampullary area, which is 2
cm around the ampulla of Vater and comprises the pancreas, duodenum, common bile duct distal section and ampulla
of Vater. Using the proper staging procedures is critical for properly identifying patients who may benefit from major
surgical interventions. One useful test is Multi-Detector Computed Tomography (MDCT), which provides precise
diagnosis, staging, operability evaluation and postoperative follow-up. The most significant surgical step is the first
assessment of tumours to identify resectable masses from those with growing vascular encasement.
This study aimed to evaluate the preoperative resectability of periampullary tumors using MDCT accuracy
in comparison to operative data.
Materials and Methods:
A cross sectional study comprised 40 individuals with suspected periampullary
malignancies (27 men and 13 women). Using a contrast-enhanced pancreatic protocol, we performed 128-slice
MDCT of abdomen on the patients. The intraoperative results and the preoperative CT were evaluated for diagnostic
accuracy regarding the vascular involvement of the tumor and the resectability of masses.
Forty individuals with periampullary cancer were enrolled in the research between January 2022 and June
2023. Five of them were deemed incurable as follows three cases of substantial vascular invasion shown on the CT
scans, one case of invasion of surrounding organs and hepatic metastasis, and one case of hepatic metastasis.
Following the surgical procedure, 70% of the cases were resectable overall. With a 75% diagnostic accuracy, the
sensitivity and specificity of MDCT for tumor resectability were 90% and 22% respectively. By using MDCT,
vascular invasion could be identified with a sensitivity of 56% and specificity of 100%.
Conclusion: When evaluating periampullary carcinomas preoperatively, MDCT has a high sensitivity but a low
specificity. The low precision of the CT scan in identifying vascular invasion is the cause of the poor specificity.
Preoperative evaluation, Multidetector computed CT, Periampullary cancer.

growing vascular encasement [11, 12]. A CT scan is
Tumours arising from the periampullary area,
commonly used as the first preoperative assessment
encompassing the pancreas, duodenum, distal common
procedure in individuals suspected of having
bile duct, and the ampulla of Vater itself, and
pancreatic cancer. It assesses vascular involvement in
measuring 2 centimeters around the latter, are referred
a single session while also providing comprehensive
to as "periampullary tumours" [1]. Periampullary
anatomic coverage at a decent resolution [13].
tumours account for 5% of malignancies of the
In this study, the accuracy of MDCT in
gastrointestinal tract [2, 3]. When there are no distinct
assessing the resectability of periampullary tumors
clinical signs, it takes longer to diagnose a patient.
prior to surgery was evaluated.
Jaundice, discomfort, and weight loss help to rule out

periampullary tumors [4]. Surgical resection is the most
effective curative treatment for periampullary
A cross-sectional analysis that included 40
neoplasms; however, only 10% to 20% of patients
patients (27males and 13 females) with periampullary
diagnosed with periampullary adenocarcinoma are
tumours who underwent pre-operative CT assessment
candidates for resection at presentation [5-7]. The most
over 18-month period from January 2022 to June
serious kinds of malignancy are regarded to be
periampullary neoplasms. As a result, employing the
Participants' ages ranged from 35 to 77 years old.
appropriate staging approaches is critical for properly
Prior to imaging, each subject was given a neutral oral
identifying patients who may benefit from extensive
contrast. The patients received an intravenous
surgical intervention [8].
injection of 100 milliliters of nonionic iodinated

One of the helpful diagnostics is MDCT,
contrast solution. Following the contrast injection, CT
which offers accurate diagnosis, staging, operability
scanning was initiated. In this investigation, patients
assessment, and postoperative follow-up [9]. For
underwent a contrast-enhanced pancreatic procedure
to obtain a 128-slice multidetector abdominal CT scan
pancreaticoduodenectomy is the sole curative option
(MDCT). Two radiologists collected images of the
and the cornerstone of treatment [10]. The most
periampullary/peripancreatic region and classified the
important surgical approach is to initially examine
masses as either resectable or non-resectable. The
tumours to identify resectable masses from those with
resectable CT criteria for periampullary tumours
Received: 08/10/2023
Accepted: 06/12/2023

Full Paper (vol.941 paper# 92)

c:\work\Jor\vol941_93 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 637-643

Early Outcome after Mitral Valve Replacement in
Adult Patients with Infective Endocarditis
Hany Salman Faisal*, Marwan Mohamed Elkasas,
Morsi Mohamed Amin, Mohamed Ahmed Lotfi, Hassan Salah Hassan
Department of Cardio Thoracic Surgery, Faculty of Medicine, Suez Canal University, Egypt
*Corresponding author: Hany Salman Faisal, Mobile: (+20) 01019222723, Email: hanyfaisal42@yahoo.com

The mitral valve is frequently affected by the complicated illness known as active infective endocarditis
(IE), which has significant rates of mortality and morbidity.
Objective: To evaluate early outcome after mitral valve replacement in adult patients with IE.
Patients and methods: This descriptive prospective study was carried out at cardio thoracic Department at Suez Canal
University Hospitals, where 30 patients who have infective endocarditis and underwent operative mitral valve
replacement were included and were followed up for 3 months after surgery. Patients were clinically assessed and
managed as per the ABC protocol, after stabilizing the patient. Postoperative evaluation was performed during their
intensive care unit stay, hospital stay, and through first 3 months postoperatively.
Results: A native infective endocarditis was present in 19 cases and a prosthetic infective endocarditis was in 11 cases.
There were 9 cases with heart failure, 7 cases had risk of embolization, 9 cases had uncontrolled infection, and 5 cases
had severe MR. There were 17 cases who needed inotropes for weaning from bypass. There was 1 case that had
intraoperative mortality. Mean aortic cross clamp was 1.66 ±0.37. Mean intraoperative blood transfusion was 2.43±0.72.
The mean hours of weaning from ventilator was 6.00 ±1.4 and of weaning from cardiac support was 25.84±16.5. Mean
days of removal of med. drain was 3.46±0.50.
Conclusion: There was increasing risk of 3 months mortality with prosthetic IE and staphylococcus infection. There
was increasing risk of 3 months recurrence and CONS with staphylococcus infection. There was increasing risk of
operative mortality with prosthetic IF and large valve vegetation.
Infective Endocarditis; Mitral Valve Replacement; Early Outcome.

Multiple presentation patterns are possible in patients
Infectious endocarditis (IE) was fatal in the days
with infective endocarditis. These can include evidence
before antibiotics. The early mortality rate of IE remains
of hemodynamic compromise, heart failure, shortness
rather high (14-31%) even after more than fifty years
of breath, chills, fever, and night sweats, among other
since the first successful valve replacement and more
symptoms of systemic bacteremia (6).
than thirty years since the introduction of antibiotic
Echocardiography and blood culture should be
therapy. The use of CT-guided stereotactic surgery to
performed on a patient suspected of suffering from
treat deep-seated brain lesions (1,2).
infective endocarditis in order to confirm the diagnosis.
The prevalence of mortality and morbidity is still
Medical care was initially provided with an empirical
high: one in five patients pass away during their initial
broad-spectrum antibiotic, but as the culture result was
hospital stay, even with improvements in therapeutic
acquired, the primary treatment shifted to sensitivity
diagnosis and antibiotic choice. The type and virulence
antibiotics (7). To identify any septic foci that need to be
of the infecting organisms have advanced, as has the
treated before surgery, a CT scan of the brain and spleen
population at risk of developing IE, which are some of
is crucial. In order to minimise the risk of heart surgery,
possible explanations for this increased mortality (3).
the patient should ideally get intravenous antibiotics for
Patients with ESRD on HD who abuse
at least one week (8).
intravenous drugs may develop native valve
The following are the indications for valve
endocarditis. There are potential abnormalities with the
endocarditis surgery: 1) Heart failure along with
tricuspid, mitral, and aortic valves. The predominant
hemodynamic impairment. This usually manifests as a
organism among intravenous drug abusers is usually
sudden and severe cardiac regurgitation, either of the
Staphylococcus aureus. Usually, this is an indication of
aortic or mitral. 2) A resistant organism or persistent
acute bacterial endocarditis. Infections from dental
bacteremia following at least one week of appropriate
abscesses, tooth extractions, or oral surgery can cause
antibiotic therapy. 3) Prosthetic valve malfunction or
valvular endocarditis in non-drug-abusing patients.
massive valve destruction due to an annular abscess or
Often streptococcal, the organism is indicative of
atrioventricular obstruction. 4) The vegetation's
subacute bacterial endocarditis (4).
embolisation occurring repeatedly or continuously, with
A post-surgical infection of the heart valve results
the potential to embolise at any time. 5) Fungal or
in prosthetic valve endocarditis. Gram-negative
brucella-induced infectious endocarditis. 6) Late-onset
organisms and Staph epidermidis are the most prevalent
prosthetic endocarditis caused by S. aureus (9,10).
in the early stages of the perioperative period and even
Surgery is a considerable survival improvement
up to one year. Streptococcal bacteria are mostly
over medical therapy for prosthetic valve endocarditis.
responsible for late prosthetic valve endocarditis (5).
A periprosthetic leak is typically present in cases of
Received: 24/07/2023
Accepted: 25/09/2023

Full Paper (vol.941 paper# 93)


Assessment of Pro Collagen III as Non-Invasive Biomarker for
Diagnosis of Non-Alcoholic Steatohepatitis
Esam Abdel-aty Ahmed Ashoush, Hanan Mahmoud Badawy, Ahmed Samir Allam, Salah Sharawy Galal
Department of Gastroenterology and Hepatoloy, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Salah Sharawy Galal, Mobile: (+20) 01099422172, E-mail: salahshaarawy2013@gmail.com

One of the most frequent causes of chronic liver disease globally is non-alcoholic fatty liver disease
(NAFLD). It is believed that NAFLD is the hepatic expression of metabolic syndrome. Historically, NAFLD was
thought to be a rather benign liver condition. Hepatocellular carcinoma, cirrhosis, and liver fibrosis can develop in
some NAFLD patients. Consequently, it is crucial from a clinical standpoint to accurately diagnose and stage NAFLD
Objective: This study aimed to evaluate the performance of pro collagen III as a NASH-Fibrosis biomarker within the
optimum diagnostic context of usage in comparison with FIB-4.
Patients and Methods: This study was a case-control study that was conducted at Gastroenterology and Hepatology
Outpatient Clinic at Damas Centre for Liver and GIT. This study was performed on 56 Egyptian patients who were
18 years of age and are overweight with Body Mass Index 25 and diagnosed with NAFLD by US. They were
divided into 2 groups: Group 1 included 28 healthy individuals diagnosed with NAFLD by US without any evidence
of hepatitis and group II that included 28 patients with NASH diagnosed by elevated liver enzymes.
Results: Patients with non-alcoholic steatohepatitis (NASH) have relatively low platelet count in comparison with
NAFLD patients. Patients with NASH had Higher AST & ALT levels than NAFLD patients. FIB-4 was higher in
NASH group than NAFLD group. Pro collagen III level was higher in patients with NASH than patients with
NAFLD. Pro collagen III was a significant discriminator of NAFLD & NASH. Pro collagen III correlates with the
grades of histological steatohepatitis, and stage of fibrosis. Pro collagen III can diagnose steatohepatitis at cut-off 9.57
with sensitivity & specificity was 92.9% & 92.9% respectively.
Conclusion: Pro collagen III is a sensitive biomarker to discriminate between NAFLD & NASH. Pro collagen III
level correlate positively with BMI, AST & ALT. Pro collagen III level correlate with grades of histological
steatohepatitis and grades of fibrosis.
Keywords: Pro collagen III, Steatohepatitis, NAFLD, NASH.

biomarker within the optimum diagnostic context of
NAFLD is a spectrum of liver disease that
usage in comparison with FIB-4.
includes cirrhosis, fatty liver with inflammation and
hepatocyte ballooning non-alcoholic steatohepatitis (-
This study was a case-control study that was
NASH-), with or without fibrosis, and steatosis
conducted at Gastroenterology and Hepatology
affecting more than 5% of hepatocytes (1).
Outpatient Clinic at Damas Centre for Liver and GIT.
The current gold standard for diagnosis and
The study included 56 Egyptian patients who were
prognosis is a liver biopsy. However, this invasive
18 years of age and are overweight with Body Mass
costly technique has a significant risk of sample
Index 25 and diagnosed with NAFLD by US.
mistake and consequences, such as bleeding,

discomfort, and in rare cases, death. Furthermore,
The study was conducted through the period from
underestimating the severity of the illness and
August 2022 to January 2023. The patients were
sampling bias are typical because a biopsy specimen
divided into 2 groups: Group I included 28 healthy
only represents 1/50000 of the liver volume (2).Finding
individuals diagnosed with NAFLD by US without any
more effective non-invasive methods to evaluate
evidence of hepatitis and group II that included 28
NASH as pro collagen III patients is urgently needed.
patients with NASH diagnosed by elevated liver
Levels of pro collagen III (Pro-C3) indicate
extracellular matrix turnover (ECM). Pro collagen III's

Exclusion Criteria:
terminal peptide and, indirectly, active fibrogenesis are
Pregnancy, peoples with liver aetiology other than
measured using a non-epitope-specific antibody that
viral liver disease (HCV and HBV), autoimmune
can attach to the protease-specific cleavage point of
hepatitis, primary biliary cholangitis, primary
collagen fragments. It is possible to distinguish
sclerosing cholangitis, metabolic liver disease, and
between NASH and plain fatty liver, and it is
drug-induced liver disease (Individuals who are on
correlated with the degree of steatohepatitis and the
long-term steatosis-inducing medications such as
stage of fibrosis (3).
amiodarone, tamoxifen, and corticosteroids and
The study's objective was to evaluate the
injectable drug abusers, as well as those who have
performance of pro collagen III as a NASH-fibrosis
previously or currently consumed large amounts of
Received: 10/10/2023
Accepted: 10/12/2023

Full Paper (vol.941 paper# 94)

c:\work\Jor\vol941_95 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 650-655

The Impact of Arteriovenous Access Placement on Estimated Glomerular Filtration
Rate in Diabetic, Non-Diabetic Chronic Kidney Diseases Pre-Dialysis Stage 5
Shaimaa Mostafa Mohamed, ELMetwally L. ELShahawy,
Mohamed E. Ibrahim, Salma Essam Eldin Abdelaziz and Ahmed E. Mansour
Internal Medicine and Nephrology Department, Faculty of Medicine, Benha University, Egypt.
* Corresponding author: Salma Essam Eldin Abdelaziz, Email: salmaessameldinomar@gmail.com Phone: +20 01011947943

Chronic kidney disease (CKD) represents a significant and often deteriorating condition that can lead to
the ultimate need for hemodialysis due to end-stage renal disease. In patients with CKD, creating arteriovenous access
(AVA) is a routine surgical procedure.
Objective: This study aimed to explore how AVA surgery affects the estimated glomerular filtration rate (eGFR) in
both diabetic and non-diabetic CKD patients at pre-dialysis stage 5, emphasizing the timing and impact on renal
Patients and Methods: A prospective cohort study was conducted on 100 CKD patients who underwent AVA surgery.
These patients were divided into diabetic and non-diabetic groups for comparison. Comprehensive clinical evaluations,
lab tests, and subsequent appointments were conducted for thorough analysis.
Results: In the diabetic cohort (Group 1), there was a notable reduction in eGFR, decreasing from 11.05 ± 0.81
mL/min/1.73 m² one month prior to AVA formation to 10.00 ± 0.43 mL/min/1.73 m² three months afterward (p < 0.001).
There was also an increase in serum creatinine from 6.03 ± 0.96 mg/dL to 6.80 ± 0.99 mg/dL (p < 0.001), and urea
levels escalated from 211.15 ± 33.6 mg/dL to 237.85 ± 34.78 mg/dL (p < 0.001). Conversely, in the non-diabetic cohort
(Group 2), a meaningful reduction in eGFR was observed, from 12.07 ± 0.87 mL/min/1.73 m² before AVA formation
to 11.84 ± 0.52 mL/min/1.73 m² after three months (p = 0.004).
Conclusions: The findings indicated that the insertion of AVA in patients with stage 5 CKD pre-dialysis, especially
those with diabetes, significantly decreased eGFR, accompanied by rises in serum creatinine and urea levels.
Keywords: Chronic kidney disease, Arteriovenous access, Estimated glomerular filtration rate, Diabetes, Renal
function, Hemodialysis.

remote ischemic preconditioning (RIPC) and changes in
Chronic kidney disease (CKD) poses a significant
subcutaneous dermal capillaries [5, 6].
challenge to global health, with an increasing trend in
Our study investigated the impact of AVA
end-stage kidney disease (ESKD) cases, especially
placement on eGFR in diabetic and non-diabetic CKD
noted in the United States and Canada. In 2014, the
patients in pre-dialysis stage 5, aiming to understand its
initiation of hemodialysis accounted for nearly 90% of
timing and effects on kidney function.
new ESKD cases in the U.S., while Canada experienced

a twofold increase in ESKD rates between 1994 and
2014 [1].
Patients: This prospective cohort study involved 100
CKD is characterized by either kidney damage or
patients diagnosed with stage 5 pre-dialysis chronic
a consistent GFR below 60 mL/min/1.73 m² over a
kidney disease, all of whom received arteriovenous
period of at least three months. The progression of
fistula surgery. Participants were enlisted from the
nephron damage leads to irreversible sclerosis and a
Internal Medicine Department, Benha University
consequent decrease in GFR [2].
Hospitals through the period from December 1, 2022, to
The strategic timing for arteriovenous access
November 30, 2023.
(AVA) construction is crucial for enhancing patient

survival rates and facilitating the onset of dialysis
Inclusion criteria: Patients over 18 years of age with
treatment. Effective pre-dialysis AVA planning
chronic kidney disease stage 5 prior to the initiation of
significantly improves patient outcomes. Yet,
hemodialysis, including both diabetic and non-diabetic
identifying the optimal timing for AVA creation is
complex due to the potential for delayed AVA
maturation, which heightens the necessity of initiating
arteriovascular diseases, congestive heart failure with
dialysis via a central venous catheter (CVC). On the
EF less than 30, amputation of extremities, pregnancy,
other hand, premature AVA construction might lead to
its underuse [3, 4].
malignancy, and patients with any other hemodialysis
AVA creation impacts various factors, including
vascular access (central venous catheter, arteriovenous
hormonal, hemodynamic changes, and potential
graft) 6 months before or during or after arteriovenous
ischemic pre-conditioning. It improves oxygenation,
fistula creation.
reduces arterial stiffness, blood pressure, and enhances
Patients were randomly divided into 2 groups:
cardiac function. Mechanisms for these benefits include
Group (1) included fifty diabetic patients with chronic
kidney diseases predialysis stage 5 (CKD -5) who
Received: 05/10/2023
Accepted: 05/12/2023

Full Paper (vol.941 paper# 95)

c:\work\Jor\vol941_96 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 656-662

Prevalence and Risk Factor of Patellofemoral Pain and
Knee Pain in Great Cairo Obese Population
1 Mohamed Abdelalim Aboelhassan, 2 Omaima M. Ali Kattabei,
3 Mohamed Abdelhalim Khaddah, 2 Sabah Mohamed Elkady
1Basic Science Department, Faculty of Physical Therapy, Suez University, Egypt
2Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt
3Orthopedic Department, Faculty of Medicine, Cairo University, Egypt
Corresponding author: Mohamed Abdelalim Aboelhassan, Email: Malim5701@gmail.com, Mobile: +20 114 164 4884

The gradual development of diffuse anterior knee pain is characteristic of patellofemoral pain (PFP), which
is made worse by activities that put stress on the patellofemoral joint, such as running, stair climbing, and squatting. While
23% of the overall population has PFP, athletes can have a prevalence of 35%.
To identify the prevalence and potential risk factors of patellofemoral pain as well as knee pain in the heavily
obese people living in Cairo.
Subjects and methods: This study was carried out in Great Cairo, Egypt. The SNAPPS questionnaire was utilized. 910
participants were male and female young adults, ranging in age from 18 to 40.
Results: The prevalence of PFP was shown to be 42.4%. Males had a prevalence of 42.2% for PFP and females 42.6%.
With 127 individuals reporting knee pain, the overall prevalence of the condition was determined to be 14%. In males,
17.3% of the population experienced knee pain, while in women, it was 11.9%. Chi-squared test revealed that all risk factors
(body mass index, job, marital state and age) were significantly linked with prevalence of patellofemoral (p-value<0.05)
and knee pain (p-value<0.05) except gender that was insignificantly associated with patellofemoral pain (p-value=0.46).
Conclusions: Obese people living in Cairo, Egypt, had a relatively significant incidence of PFP and knee pain. People under
the age of 40 had a greater incidence of PFP and knee pain in comparison with those in older age groups.
Keywords: Patellofemoral pain, Knee, Obesity, SNAPPS.


The gradual development of diffuse anterior knee pain
information about the health effects of overweight and
is characteristic of patellofemoral pain (PFP), which is
obesity than BMI alone (10).
made worse by activities that put stress on the
The knee constitutes one of the biggest joints in the
patellofemoral joint, such as running, stair climbing, and
body and a highly complex joint overall (11).
squatting (1). While 23% of the overall population has PFP,
Knee pain can have many causes, but one of the most
athletes can have a prevalence of 35% (2).
prevalent is PFPS (12).
In addition to a low quality of life, PFP is associated
When the patellofemoral joint is subjected to a
with poor physical and mental health (3).
particular type of weight-bearing motion, such as when the
Some people think that PFP is a sign of patellofemoral
knee is bent, the result is pain behind the patella (13). In
osteoarthritis (OA) (4).
addition to affecting adolescents, athletes, as well as active
Many aspects related to biomechanics, anatomy, and
adults, it is more common in females (13).
psychology have been associated with PFP (5).
Unfortunately, individuals with the disease may find it
One risk factor for PFP is weak knee strength (6), and
difficult to continue going about their regular lives as they
one predictor of poor rehabilitation results for anterior
attempt to avoid things that make their pain worse (14).
knee pain patients is decreased functional ability (7).
So, we aimed to identify the prevalence and potential
A higher body mass index (BMI) (8) was found in young
risk factors of patellofemoral pain as well as knee pain in
individuals with PFP compared to pain-free controls,
the heavily obese people living in Cairo.
according to a systematic study. People with PFP are more

likely to have bad long-term consequences if their BMI is
higher (9).
The study took place in Great Cairo, Egypt, from
Never before has the effect of BMI on functional ability
May 2023 to October 2023, and used a descriptive cross-
and strength been investigated in the PFP population,
sectional questionnaire. Particularly targeted were the
although strong evidence suggesting that this condition is
young people of Cairo who were obese. A self-
deleterious to those with PFP. Furthermore, no research has
administered questionnaire was used to collect the data.
yet been conducted in this population using alternative
utilizing Google Forms, the survey could be sent out
measurements of body composition, such as lean mass and
body fat, which appear to offer more precise and additional

Received: 03/10/2023
Accepted: 03/12/2023

Full Paper (vol.941 paper# 96)

c:\work\Jor\vol941_97 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 663-668

Corneal Endothelial Changes among High Myopic Patients of Different Age Groups
Dina Roshdy Mohamed Abdelnaby Ramadan*, Hussein Salah El-Dien El-Nahas, Mervat Elshabrawy Elgharieb
Department of Ophthalmology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
*Corresponding authors: Dina Roshdy Mohamed Abdelnaby Ramadan
Email: dinaroshdy2016@gmail.com, Mobile: +201010877096

Background: Myopia a refractive error that is a major contributor to visual disability across combined age groups all over
the world.
Aim of the work:
To detect changes in the corneal endothelial cells parameters among high myopic patients versus
emmetropic individuals in different age groups aiming at proper identification of the endothelial cells behavior; hence we
can predict more precise results after phaco refractive surgeries and implantable collamer lens (Icl) implantation.
Patients and methods:
This case-control research, performed on 168 eyes of 84 participants allocated into two groups:
Group I (42 cases, 84 eyes): individuals with high myopic eyes, and Group II (42 cases, 84 eyes): individuals with healthy
emmetropic eyes as a control group at Outpatient Clinic, Ophthalmology Department, Suez Canal University Hospital,
Ismailia, Egypt for a period of six months from February 2021 to July 2021. (NIDEK CEM-530) specular microscope was
utilized to determine the central corneal thickness (CCT) of the participants.
Results: The study observed no significant variance in CoV% among high myopic and emmetropic eyes, but there was a
significant variation in ECD (Endothelial Cell Density) and HEX% (Hexagonality) among the two groups. The mean ECD
in high myopic eyes was 2533.79±315.37 cells/mm2, while in emmetropic individuals, it was 2706.65±313.50 cells/mm2.
Conclusion: The research found that corneal endothelial cell density and morphology significantly vary among different
age groups, indicating a significant effect of age on corneal endothelial function.
Keywords: Cornea, Endothelial Changes, Myopia, Icl implantation.

from the stroma to the aqueous, hence maintaining a
Myopia a refractive error that is a prominent factor
partly dehydrated condition with 70% water content (6,7).
contributing to visual disability across combined age
Non-contact specular microscope is a non-invasive
groups all over the world. The condition has variable
method used to analyze the corneal endothelial cells
prevalence according to geographical region, age and
quantitatively and qualitatively, with accurate and reliable
race, with particularly high prevalence in East Asian
measurements of mean cell density, coefficient of
countries, but affects both the developed and the
variation in the cell size, in addition to hexagonality
developing world (1,2).
index. These parameters provide a reflection of the
The cornea is a transparent structure that constitutes
anatomical and functional status of the corneal
the anterior 1/6 of the outer coat of the eye globe and has
endothelium (8-10).
the dual function of protection and refraction as it
This research was designed to detect changes in the
represents two third of the refractive power of the eye.
corneal endothelial cells' parameters among high myopic
The human cornea is typically described in five layers: an
patients versus emmetropic individuals in different age
overlying epithelium, a fibrous network underneath the
groups aiming at proper identification of the endothelial
epithelium called Bowman's layer, the majority of the
cells' behavior.
thickness (90%) constituted by the stroma which is

composed of regularly arranged collaged fibers in an
extracellular matrix and scarce cells, and a Descemet's
This was case-control research, done at Outpatient
membrane which acts as the basement membrane of the
Clinic, Ophthalmology Department, Suez Canal
single-layered corneal endothelial cells - the final layer of
University Hospital, Ismailia, Egypt for a period of six
the cornea (3, 4). The discovery of Dua's layer, which is an
months from February 2021 to July 2021. A total of 168
acellular pre-Descemet's space has led to the revision of
eyes of 84 individuals were enrolled, they were allocated
corneal layers and their re-arrangement into six layers
into two groups: Group I (42 cases, 84 eyes): individuals
instead of five (5).
with high myopic eyes, with mean age of 39.02 ± 11.75
The corneal endothelial cell layer involves a single
included (Group A (Age 18 - 35), Group B (Age 35 - 55)
layer of non-regenerating hexagonal cells that covers the
and Group C (Age > 55) and Group II (42 cases, 84
posterior surface of Decrement's membrane in direct
eyes): individuals with healthy emmetropic eyes as a
contact with the anterior chamber of the eye. The cells
control group, with mean age of 35.31 ± 18.17 included
exhibit metabolic activity and have a crucial function in
(Group A (Age 18 - 35), Group B (Age 35 - 55) and Group
preserving transparency by actively transporting water
C (Age > 55))
Received: 24/08/2023

Full Paper (vol.941 paper# 97)

c:\work\Jor\vol941_98 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 669-671

Challenging Case: A Case Report on Crohn's Disease Emerging after
The Initiation of Capecitabine for Colorectal Cancer
Anas Zaher1, Hassan Elsaygh2
New York-Presbyterian Brooklyn Methodist Hospital, Internal Medicine Department, Brooklyn, NY,11215, USA 1
University of Debrecen, Internal Medicine Department, Egytem Sugarut 1, Debrecen, Hungary, 2
Corresponding author: Anas Zaher, email:qks9002@nyp.org,mobile:001 646 705 2347, ORCID: 0009-0004-6949-4384

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory condition that affects the gastrointestinal tract.
This group of disorders includes Crohn's disease and ulcerative colitis. Diagnosis of IBD involves a comprehensive approach
that combines medical history, physical examination, laboratory tests, endoscopy, imaging, and occasionally biopsy of
intestinal tissue. Patients with IBD have an increased risk of developing colorectal adenocarcinoma, a type of colorectal
cancer. However, IBD induced by surgical resections of the intestines or chemotherapy drugs is extremely rare.
Objective: This study aimed to throw the light on the importance of careful evaluation and accurate diagnosis in patients
presenting with symptoms suggestive of both types of IBD.
Subject and methods: This abstract presents a challenging case in which a patient was initially suspected to have
chemotherapy-induced colitis but was ultimately diagnosed with IBD-associated colorectal cancer.
Results: The case highlighted the importance of careful evaluation and accurate diagnosis in patients presenting with
symptoms suggestive of both IBD, as the treatment approaches and prognoses can significantly differ between the two
Conclusion: Capecitabine, commonly used in cancer treatment, can induce colitis with symptoms that overlap with those
of inflammatory bowel disease (IBD). Distinguishing between capecitabine-induced colitis and IBD is challenging due to
similar clinical presentations. Discontinuation of capecitabine often leads to symptom improvement, but in IBD cases,
additional therapies like steroids and biologics may be necessary. Close monitoring and further evaluation are crucial for
accurate diagnosis and appropriate treatment strategies in patients experiencing gastrointestinal toxicity from capecitabine-
based chemotherapy.
Keywords: Inflammatory bowel disease, Colorectal cancer, Capecitabine, Chemotherapy-induced colitis.

The intricacies of distinguishing between
A 61-years-old male with a past medical history of
inflammatory bowel disease (IBD) and chemotherapy-
diabetes mellitus type II and hyperlipidemia recently went
induced colitis are exemplified in a compelling case
for his first screening colonoscopy and was found to have
study. A 61-year-old male, initially suspected of
sigmoidal adenocarcinoma. The patient was referred by
chemotherapy-related colitis, presented with persistent
his primary care physician for a colorectal cancer routine
screening; at that time, he had no abdominal pain, bloody
evaluation uncovered the unexpected: Crohn's disease.
stool, or further signs of disease. His labs were
This underscores the challenges of differentiation, where
unremarkable, with no anemia. The patient was compliant
chemotherapy-induced symptoms often resolve upon
with taking his medications, which included metformin,
cessation, while IBD demands sustained intervention.
pioglitazone, empagliflozin, sitagliptin, omega 3, and
pathogenesis contrasts with IBD's complexity,
He had a mild allergy only to Penicillin. Family
spotlighting the critical need for precise diagnosis. This
history was significant only for diabetes mellitus type II
case also unveils the potential link between surgical
on his father's side and denied any smoking or alcohol
interventions, chemotherapy, and the emergence of
intake history in the past. His colonoscopy showed a non-
chronic inflammatory conditions. The narrative
obstructing, 2 cm size mass in the sigmoid with multiple
emphasizes accurate diagnosis's paramount importance,
polyps. Biopsy was obtained from different regions,
steering clinicians to tailored treatments through
revealing well-differentiated adenocarcinoma with no
acute changes on the pathology report. He underwent
collaboration. In the interplay of chemotherapy and
computed tomography (CT) chest, abdomen, and pelvis
inflammation, this case illuminates the necessity of
with contrast, which revealed no metastatic disease. The
unraveling underlying conditions to guide effective
surgery team was consulted, and he underwent a
therapeutic choices.
laparoscopic left hemicolectomy.

Received: 10/10/2023
Accepted: 10/12/2023

Full Paper (vol.941 paper# 98)

c:\work\Jor\vol941_99 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 672-681

Hang-up Technique versus Non-fixation Technique for
Immediate Post-placental IUD Insertion during Cesarean Section:
A Randomized Controlled Trial
Hisham A. Abotaleb, Abdelrahman M. Mohammed, Alzahraa M.
Ali, Mohamed S. Abdellah, Dina M. Habib
Department of Obstetrics and Gynecology, Women Health Hospital, Assiut University, Egypt
*Corresponding author: Hisham A. Abotaleb, Mobile: (+20) 01003332139, Email: hishamaboutaleb1@aun.edu.eg

Background: Postpartum intrauterine device (IUD) insertion provides safe and extremely effective contraception,
while women are receiving medical treatment.
Objective: To evaluate the expulsion rate of IUD implantation during caesarean section (CS) using the hang-up and
non-fixation techniques.
Patients and Methods: This is a randomized controlled trial from the Women's Health Hospital, Assiut University,
Egypt. Eligible women for inclusion were the pregnant women after age of viability (28 weeks) who were undergoing
elective or emergency cesarean section (n = 118). Participants were divided into two groups; 59 participants in each
study group. IUD was inserted using the hang-up technique in one group and using non-fixation technique in the other
Results: No cases of IUD expulsion were reported in the 1st group; however, the expulsion rate was high in the non-
fixation group (0% Vs 12.5%, p = 0.013). Moreover, hang up technique showed higher continuation rate after 6 months
of delivery than non-fixation technique (96.4 %, Vs 78.8 % P = 0.003). No significant differences were detected between
both study groups regarding postpartum endometritis, heavy menstrual bleeding, pelvic infection, and dysmenorrhea.
Conclusion: The hang-up technique resulted in better IUD fixation with higher continuation rate and less expulsion
rate than on ­fixation technique. IUD fixation during cesarean section was safe easy and rapid learning curve.
Keywords: Intrauterine device, CS, Hang-up technique.

method for IUD insertion after CS, and no expulsions
Breastfeeding while pregnant increases the risk of
were noted (10).
an untimely, unexpected, and occasionally undesirable
Till now there is no randomized controlled trial
delivery. Unwanted pregnancies are a global issue. Up
comparing IUD insertion using hang up technique
to 30% of pregnancies that result in births in the UK are
versus non-fixation technique.
thought to be unplanned (1).
This study aimed to evaluate the expulsion rate of
Unintentional pregnancy is thought to be riskier
IUD implantation during caesarean section (CS) using
throughout the postpartum period. In women who are
the hang-up and non-fixation techniques.
not nursing, ovulation can restart as early as 2-4 weeks

after giving birth, which increases the possibility of an
unwanted pregnancy (2).
This is a single-blinded randomized controlled trial
Postpartum family planning is advised by the WHO
conducted in the Department of Obstetrics and
to promote appropriate birth spacing (3).
Gynecology, Assiut University Hospital, Assiut, Egypt.

All pregnant women after the age of viability (28
IUDs are incredibly successful in spacing out
weeks), who were willing for immediate postpartum
pregnancies, particularly in underdeveloped nations
contraception, and were counseled during antenatal
where women lack frequent access to medical facilities
care; they were included in this study after signing
(2). In less than ten minutes, an intra-cesarean post-
written consents; either undergoing elective or
placental IUD insertion offers a strong chance to
emergency CS.
provide reversible, long-term, safe, and affordable
The exclusion criteria were intrauterine infection,
contraception with little to no discomfort for the patient
intrauterine lesions such as submucous fibroid or
(4). The CDC and ACOG endorsed this strategy (5).
uterine septum, bleeding disorders, genital tract

malignancy, uterine atony, sexually-transmitted
The immediate CU T 380A IUD insertion during
diseases, extensive adhesions that prevent uterus
CS without fixation has been the subject of several
exteriorization, hypersensitivity to copper, bad general
trials. The high risk of expulsion that occurs when an
conditions such as cardiac diseases or diabetes with
IUD is implanted after placental birth without fixation
was the primary issue with immediate postpartum IUDs

(6­9). In 2014 was the first description of the hang-up
Received: 11/10/2023
Accepted: 11/12/2023

Full Paper (vol.941 paper# 99)

c:\work\Jor\vol941_100 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 682-688

Adiponectin Decreased Aquaporin 4 MRNA Expression in Rat Model of
Type 1 Diabetic Retinopathy, Can It Prevent Retinal Edema?
Mohamed Hussein Mohamed, Huda Galal Mohamed, Reham Hassan Ebrahim
Department of Physiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author Reham Hassan Ebrahim, Mobile: (+20) 01144963609,
Email: phisiology_lover_4@yahoo.com, Orchid ID: 0000-0001-8038-4144

Diabetic retinopathy is a great ocular diabetic disorder and may cause blindness. It is linked with
hyperglycemia, inflammation and oxidative stress. Adiponectin is an adipokine that has antioxidant, anti-inflammatory
and anti-angiogenic effects. Objective: to detect possible role of adiponectin as a therapy in experimentally induced
diabetic retinopathy in male adult rats.
Material and Methods: Thirty male adult rats were divided into 2 groups: group (control 10 rats) and group II
(diabetic type 1 induced by streptozotocin, 20 rats). Diabetic rats were divided four weeks later into 2 subgroups:
Subgroup IIA (diabetic retinopathy), Subgroup IIB (adiponectin-treated diabetic retinopathy), in all groups, serum
glucose, insulin, lipid profile, superoxide dismutase (SOD), malonaldehyde (MDA), interleukin 6 (IL-6) and vascular
endothelial growth factor (VEGF) and aquaporin-4 (AQP4) gene expression were estimated. Retinal histopathology
and immunohistochemistry of retinal VEGF and tumor necrosis factor (TNF) alpha were also estimated.
Results: Subgroup IIB showed significant decrease in serum levels of glucose, cholesterol, triglyceride, low density
lipoprotein (LDL), MDA, VEGF and IL-6, and AQP4 gene expression, with significant increase in insulin, SOD and
high-density lipoprotein (HDL) levels. Retinal histopathology showed partial restoration of retinal layers organization
and immunohistochemistry showed downregulation of TNF- and VEGF.
Conclusion: Adiponectin may improve diabetic retinopathy via antioxidant, anti-inflammatory, antidiabetic and anti-
angiogenic effect.
Keywords: Adiponectin, Aquaporin 4 MRNA Expression, Diabetic Retinopathy, Retinal Edema.

Faculty of Veterinary Medicine. The rats were present
Diabetes mellitus (DM) is a major disorder that has
in stainless steel cages (5 / cage) in the Physiology
many complications and high mortality [1]. Many
Department. They were allowed for acclimatization for
complications occur in diabetic patients, as corneal
two weeks before the experiment. The rats were fed
abnormalities, cataract, glaucoma and diabetic
commercial rodent chow.
retinopathy (DR). DR is a common vascular disease

that threatens all diabetic patients, leading to blindness
Drugs and chemicals:
if left untreated [2].
DR occurs with a higher incidence in T1DM than
recombinant protein: MyBioSource, USA.
T2DM patients, and this different incidence is due to
Grouping of animals:
longer duration and worse metabolic control of
Group I [control group (n=10)]: healthy adult
diabetes in patients with T1DM than in T2DM [3].
male albino rats treated with 0.5 ml saline/day
Diabetic retinopathy development is strongly linked
intraperitoneally (I.P) 1 week
with hyperglycemia, dyslipidemia, oxidative stress,
Group II [diabetic, type 1 group (n=20)]: type 1
inflammation and pathological angiogenesis [3, 4].
diabetic rats by streptozotocin[9] were subdivided to
Adiponectin (APN) is an adipokine, it regulates
2 subgroups 4 weeks after induction of diabetes:
glucose and lipid metabolism with anti-inflammatory,
o Subgroup II A [diabetic retinopathy group:
diabetic rats treated with 0.5 ml saline/day I.P
hypertensive effects [5,6]. Adiponectin has two
for 1 week
receptors (AdipoR), they are AdipoR1 and AdipoR2
o Subgroup II B [adiponectin-treated diabetic
retinopathy group: diabetic rats treated by
Both APN receptors are expressed in the retinas of
globular adiponectin (3.5 ug/day) I.P for 1
humans and rats, it was stated that diabetic retinopathy
week [10].
patients have low levels of plasma APN [5], in contrast,

Li et al.[7] found high plasma APN level in patients
Experimental design:
with diabetic retinopathy, so APN may have a role in
Induction of diabetes type 1:
diabetic retinopathy [8].
Single I.P injection of STZ 60 mg/kg was given.
Aim of the work was to clarify possible therapeutic
STZ was freshly diluted in 0.1 M sodium citrate buffer
effects of adiponectin on rat model of diabetic
with pH 4.5. After 2 days we measured blood glucose
levels, rats used in the study had glucose levels of 250

mg/dl or more [9]. Rats were injected by 0.1- 0.2
units/kg of insulin subcutaneously daily to prevent
Animals: Thirty adult male albino rats, weighing 180-
ketosis and maintain rats alive, without normalizing
220 gm and aged 12 weeks old, were obtained from
blood glucose level [11]. 4 weeks after induction of
Received: 11/10/2023
Accepted: 11/12/2023

Full Paper (vol.941 paper# 100)

c:\work\Jor\vol941_101 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 689-694

Serum Markers of Intestinal Barrier Integrity in Patients with
Plaque Psoriasis and Their Association with Disease Severity
Amira Abdelrahman Alghareeb*, Elshahat Farag Ahmed Sharaf,
Hamdy Foaad Ali Marzouk, Shreif Refaat Esmail
Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Amira Abdelrahman Alghareeb, Mobile: (+20) 01097622828, E-Mail: dramira148@gmail.com

An inflammatory chronic illness is psoriasis. The body of research on the gut microbiota and its function in
homeostasis has expanded recently. Psoriasis pathogenesis is significantly influenced by changes in the gut microbiota.
Objective: Our study aimed to determine the link between non-invasive measures of intestinal barrier integrity in
psoriasis patients and disease severity. Patients and methods: This is a case-control study that was conducted to
investigate the relationship between claudin-3 and I-FABP levels and psoriasis vulgaris. The subjects were divided into
two groups: Group A (patients group) included 50 patients with chronic plaque psoriasis, and group B (control group)
included 40 non-psoriatic healthy volunteers who matched the patient group as regard age, sex and BMI. They were
chosen because they did not have any autoimmune, inflammatory, or systemic infections, and they were not taking any
medication. Results: Serum claudin-3 level was higher in patients with psoriasis compared to healthy control (mean,
41.84 ± 9.13 vs 33.77 ± 7.45 ng/mL, P < 0.001) and the mean claudin-3 of mild, moderate and severe patients subgroups
were 36.08 ± 7.87, 42.30 ± 5.66 and 50.20 ± 5.52 ng/mL respectively (P <0.001). Patients with psoriasis also had
elevated level of serum I-FABP (307.2 ± 143.1 vs 222.5 ± 40.14 pg/mL, P 0.004) and I-FABP was statistically higher
in severe subgroup (419.81 ± 147.23) and moderate subgroup (340.05 ± 164.28) as compared to mild subgroup (218.43
± 37.80) (P < 0.001).
Conclusion: Claudin-3 and I-FABP (non-invasive indicators of intestinal integrity) were elevated in psoriasis and
correlated with disease severity. More research is needed to evaluate whether strengthening the intestinal barrier can be
a novel treatment target in psoriasis.
Keywords: Psoriasis, Claudin-3, I-FABP.

Inclusion criteria: The clinically diagnosed long-term
plaque psoriasis, defined as more than two months.
1-3% of people have psoriasis, a prevalent chronic
Subjects were older than 18 years (cases and controls).
immune-mediated illness (1). The link between the immune
system, intestinal barrier, and gut microbiota has received
Exclusion criteria: Patients who had systemic
a lot of attention recently. The gut microbiota is a varied
antipsoriatic treatment in the last three months.
group of bacteria, viruses, fungi, and eukaryotes that live
Individuals who exhibited a past or clinical indication
in the human gastrointestinal tract (2).
Tight connections interconnect the extensive network
If under the age of eighteen.
of epithelial cells that comprise the gastrointestinal
Acute gastrointestinal illness history during the three
epithelial barrier (3). Enterocytes and the intestinal
months previous to the research.
microbiota are always interacting through metabolite
During the previous three months, consumption of
release and direct adhesion (4).
probiotics, prebiotics, or antibiotics.
Nevertheless, it is yet unknown, whether psoriasis-
Acute or chronic infection,
related inflammatory processes and changes in the gut
A history of gastrointestinal surgery during the prior
flora have an impact on the intestinal barrier. Thus, our
six months.
study's objective was to evaluate the plasma
Dietary restrictions or eating problems within the last
concentrations of markers associated with intestinal
three months
epithelial tight junction structure and enterocyte injury.
Long-term digestive disorders (such as food
allergies, irritable bowel syndrome, inflammatory
Study design: This is a case-control study that was
bowel disease, and celiac disease),
conducted to investigate the relationship between
Chronic renal or liver disease, or Cardiac failure,
claudin-3 and I-FABP levels and psoriasis vulgaris. The
Pregnancy and breastfeeding.
subjects were divided into two groups: Group A
Heavy smokers.
(patients group) included 50 patients with chronic
Other inflammatory or immune-mediated skin
plaque psoriasis. Group B (control group) included 40
non-psoriatic healthy volunteers who matched the
patient group as regards age, sex and BMI. They were
chosen because they did not have any autoimmune,
All participants in the research were subjected to the
inflammatory, or systemic infections, and they were not
taking any drugs that interfered.
Complete history taking including name, age, sex,
profession, place of residence, unique habits, and
Received: 15/10/2023
Accepted: 13/12/2023

Full Paper (vol.941 paper# 101)

c:\work\Jor\vol941_102 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 695-702

Role of Neutrophil Lymphocyte Ratio and Platelet Indices as
Inflammatory Indicators and Its Association with Preeclampsia
Mohamed Ismail Sabry, Maram Atef Mahmoud Gomaa*, Wael Gaber El-Damaty, Sherif Sobhy Menshawy
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Maram Atef Mahmoud Gomaa, Mobile: (+20) 01010986357, E-mail: maraaam.atef@gmail.com

Preeclampsia (PE) is a pregnancy-specific illness that can manifest as late as 4-6 weeks after delivery
and often develops after 20 weeks of gestation due to extensive endothelial dysfunction and vasospasm. PE affects
between six and eight percent of pregnancies globally and is an intractable obstetric condition with substantial
mortality and morbidity.
Objectives: Neutrophil to lymphocyte ratio and platelet to lymphocytic ratio measurements in pre-eclamptic women
and gestationally-matched healthy controls are used to measure the systemic inflammatory markers.
Methods: In this cross-sectional study, pregnant patients with pre-eclampsia between the ages of 18 and 40 who were
admitted to Department of Obstetrics and Gynaecology, Menoufia University Hospital. Two equal groups of pregnant
women were created: Group (A) included 84 preeclampsia pregnant women, and group (B) included age- and
gestational age-matched healthy 84 pregnant women.
Results: When comparing pre-eclamptic pregnant women to normal pregnant women, there was a statistical
significant increase in both neutrophil to lymphocytic ratio (NLR) and platelet to lymphocytic ratio (PLR) (mean 4.3
vs 2.9 for NLR and 141.2 vs 113.4 for PLR, p < 0.001). In addition, women with severe pre-eclampsia had much
higher NLR and PLR than those with mild pre-eclampsia. There were the most effective predictors of pre-eclampsia,
as demonstrated by neutrophil to lymphocytic ratio and platelet to lymphocytic ratio. NLR was positively correlated
with neutrophil counts, diastolic and systolic blood pressure, and gestational age at birth. The relationship between
NLR and platelets was inverse. There was a positive connection between platelet to lymphocytic ratio and GA at
delivery as well as platelets.
Conclusion: NLR and platelet to lymphocytic ratio were significantly higher in pre-eclampsia women, which could be
used as clinical predictors of preeclampsia and its severity.
Keywords: Preeclampsia, NLR, PLR.

A novel trustworthy inflammatory marker of
After the 20th week of pregnancy, proteinuria and
systemic inflammation is NLR. Neutrophils might be
raised blood pressure greater than or equal to 140/90
crucial to the pathophysiology of PE (7).
mm Hg are used to diagnose preeclampsia (PE), a
Autoantibodies, endothelial dysfunction, and the
dangerous condition. It accounts for between six and
release of inflammatory cytokines are caused by the
eight percent of all pregnancies worldwide (1).
hyperactivation of neutrophils and lymphocytes. NLR
Many researchers are working to develop a
has so been investigated as a PE marker. (8).
screening test that can predict the likelihood of PE and
While, some studies (6) found a statistical
its severity because PE can lead to serious difficulties
significance rise in NLR in PE patients, particularly in
for both the mother and the fetus. In PE, variations in
those with severe cases, others found no significant
platelet count (PC), NLR, and platelet to lymphocytic
increase in NLR in patients with severe PE when
ratio have been studied (2). According to certain
compared to healthy non-pregnant individuals. (9).
theories, platelets are crucial to the pathophysiology of
Prior research on platelet to lymphocytic ratio as a
PE. By calculating platelet indices, one can indirectly
novel inflammatory marker for PE prediction and
investigate platelet functioning (3).
severity assessment yielded conflicting findings (10). In
Changes to platelet parameters, such as platelet
this study, women with PE and GA-matched healthy
count, mean platelet volume (MPV) and platelet
controls were asked to rate their levels of the systemic
distribution width (PDW) have been evaluated and
inflammatory markers NLR and platelet to
researched in PE. Numerous studies have shown that
lymphocytic ratio.
PE causes a sharp decline in platelet count (4).

However, no relationship has been found by any
researches between the platelet count and the pre-
In this cross-sectional study included 84 pregnant
eclamptic state presence and severity (5).
patients with pre-eclampsia between the ages of
In healthy pregnancies, systemic inflammation
eighteen and forty who were admitted to the Menoufia
happens. Pregnancy and PE both cause the activation
University Hospital's Department of Obstetrics and
of maternal circulating leukocytes. Studies on PE have
Gynaecology to be compared to 84 healthy gestational
revealed variations in the number of leukocytes,
age-matched pregnant women.
primarily neutrophils and lymphocytes (6).

Received: 15/10/2023
Accepted: 15/12/2023

Full Paper (vol.941 paper# 102)

c:\work\Jor\vol941_103 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 703-709

Neuromuscular Electrical Stimulation on Shoulder Dysfunction Post Mastectomy
Hussein Gamal Hussein, Mahmoud Abdel Ghany Moustafa*,
Ahmed Mohamed Kenawy, Amany Refaat Abdel Wahid
Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding Author: Mahmoud Abdel Ghany Moustafa,
Mobile: (+20) 01274589620, E-Mail: mahmoudbadawey45@yahoo.com

Background: Neuromuscular electrical stimulation (NMES) is a therapy approach that has been utilised to speed the
rehabilitation of individuals with neurological injury. NMES stimulation has been shown to be an effective adjunct in
the enhancement of muscle recruitment.
Objective: To investigate the effect NMES on shoulder dysfunction after mastectomy operation.
Patients and Methods: Sixty-eight female patients with age ranged from 40-55 years, with shoulder dysfunction after
mastectomy were participated in this study. They were assigned randomly and equally in two groups. Shoulder range
of motion "ROM" was measured pre, after 3 weeks (post 1) and after 6 weeks (post 2) by electronic goniometer.
Shoulder dysfunction was assessed by disability of Arm, Shoulder and Hand (DASH) scale; Group A received NMES
and exercise program (stretching, strengthening and active ROM exercises) 3 sessions per week for 6 weeks. Group B
received exercise program.
Results: There was a significant difference in shoulder ROM and dysfunction between pre, post1, and post 2 in group A
as P value was (0.001). but there was no significant difference in pre, post1 and post 2 measurements in group B as P value
was <0.05. Conclusion: Neuromuscular electrical stimulation is an effective method for treatment of shoulder dysfunction
post mastectomy.
Keywords: Shoulder dysfunction - NMES - Exercise program.


Due to the prevalence of persistent post-
tissue fibrosis, limited ROM, and restricted shoulder
mastectomy pain (PPMP) and its potential severity,
mobility following the procedure. Although decreased
research on the condition has increased, underscoring
ROM and function following breast cancer surgery has
the significance of improving the quality of life (QOL)
long been acknowledged as an issue, few studies have
for post-surgical breast cancer patients. Breast cancer is
compared these findings with preoperative measures to
the most common cancer among women. The sensation
ascertain the occurrence of these changes in this clinical
of dull burning and aching in the chest, axilla, and
group. Twelve months following an axillary dissection
ipsilateral upper limb after a mastectomy has been
for breast cancer, twelve percent of the women did not
identified as a significant post-surgical consequence.
restore complete ROM in their shoulders based on
This pain is ascribed to injury caused to the intercostal-
preoperative comparisons for flexion, abduction,
brachial nerve during surgical dissection (1).
internal rotation, and external rotation motions. Within
6 months after surgery, up to 50% of patients
the first two years following surgery, rates of shoulder
experience chronic pain. Compared to patients without
mobility loss have been reported to be 17% and 32%.
persistent breast pain or women without a history of
Despite the fact that less invasive surgical
cancer, those with persistent breast pain exhibit
techniques are being used with adjuvant treatments, it is
significantly higher levels of depressive symptoms,
still suggested that impaired shoulder ROM
increased anxiety, and increased fear of pain.
postoperatively may remain a potential problem for
Unmanaged pain following surgery is a significant risk
some women undergoing breast cancer treatment
factor for chronic pain syndrome (2).
despite this current surgical practice and the avoidance
It is believed that between 25% and 60% of breast
of radiotherapy to the axillary region when possible (4).
cancer survivors endure post-surgical chronic pain,
Using an electrical stimulator to send electrical
which is linked to a worse QOL and motor dysfunction,
impulses through the skin and into the muscles and
despite an 83% survival rate. A generalised
nerves is known as NMES. NMES increases the
hypersensitivity of the somatosensory system, which is
shoulder muscle fibers recruitment, promoting their
described as an amplification of the neural signal at the
physiological contraction and prevent the post
level of the central nervous system, is one of the
incisional atrophy, therefor help maintain shoulder
characteristics that some patients with chronic pain
muscles strength and prevent incision-induced atrophy.
exhibit, which may indicate central pain sensitization (3).
NMES can include Transcutaneous Electrical Nerve
In individuals who have had mastectomy surgery,
Stimulation (TENS) that help decrease incisional site
one of the most frequent musculoskeletal complications
pain and improve overall shoulder function )5,6).
is shoulder dysfunction because of pain, connective
This study aimed to investigate the effect NMES

on shoulder dysfunction after mastectomy operation.

Received: 12/10/2023
Accepted: 12/12/2023

Full Paper (vol.941 paper# 103)

c:\work\Jor\vol941_104 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 710-718

Behavioral Readjustment Therapy versus Vocal Fold Injection in the
Management of Swallowing Disorders in Cases of Unilateral Vocal Fold Paralysis
Mai M. El Alawy*1, Mahmoud F. Abdel Aziz2, Mohammed E. Darweesh1, Shimaa M. Serag El Deen1
1 Department of Phoniatrics, Faculty of Medicine, Tanta University, Tanta, Egypt.
2 Department of Otorhinolaryngology, Faculty of Medicine, Tanta University, Tanta, Egypt
Corresponding Author: Mai Mohamed El Alawy, Email: mai.mohammed@med.tanta.edu.eg , Mobile: +20 106 587 8604.

Unilateral vocal fold immobility (UVFI) is the most prevalent neurological disease affecting the larynx.
Objective: This work aimed to evaluate management of oropharyngeal dysphagia in cases of unilateral vocal fold
paralysis (UVFP) by either behavioral readjustment therapy (BRAT) or vocal fold injection (VFI) to provide the best
management technique regarding safety and effectiveness in these patients.
Methods: This study was carried out on 20 consecutive candidates of both sexes with vocal fold immobility and
dysphagia for BRAT or VFI. They were aged from 20 to 60 years old, both sexes. Patients were divided randomly into
two equal groups: Group I included odd numbers received BRAT with mean age of 42.3 ± 15.21 years and group II that
included even numbers received VFI with mean age of 45.1 ± 12.56.
Results: The glottic gap was significantly better in one week and three months follow-up for injection group than
behavioral group. The presence of the residue one week post intervention showed non-significant difference between
both groups. Penetration aspiration scale (PAS) after one week and 3 months of intervention for fluids showed a
significant difference between both groups but PAS for semisolids and solids showed no significant difference between
them. Food consistency was affected and choking of fluid showed a significant difference in both groups.
Conclusions: Injection laryngoplasty (IL) and BRAT could improve oropharyngeal dysphagia in patients with unilateral
VFP. IL improved the glottal closure, therefore it improved airway protection and increased cough power, so it helps to
prevent aspiration. BRAT improved motor power and motor control of swallowing in oropharyngeal phase, improved
impaired sensation, improved bolus flow, and decreased the patient's symptoms.
Keywords: Behavioral readjustment therapy, Vocal fold injection, Swallowing, Unilateral vocal fold paralysis.


Vocal fold paralysis (VFP) refers to the condition
The objective of this study was to assess the
when the actual vocal fold becomes immobile due to
treatment of oropharyngeal dysphagia in instances of
damage to the neurological pathways, specifically the
UVFP by either behavioral readjustment therapy
ipsilateral vagus or recurrent laryngeal nerve. Unilateral
(BRAT) or vocal fold injection (VFI), in order to
vocal fold paralysis (UVFP) is the most common
determine the most optimal approach in terms of safety
neurological disease observed in the larynx [1].
and efficacy for these patients.
UVFP is a frequent underlying factor for

insufficient closure of the vocal folds [2].
Glottal insufficiency hampers the ability to
This research was conducted on a sample of 20
swallow, breathe, and produce sounds. Glottal
consecutive individuals, both males and females, aged
insufficiency is characterized by a voice that is breathy
between 20 and 60 years old, who were diagnosed with
and weak, diminished strength in coughing, difficulty
vocal fold immobility and dysphagia and were
swallowing (dysphagia), and difficulty breathing
candidates for BRAT or VFI. Patients were divided
(dyspnea) [2]. Bilateral VFP generally presents with
randomly into two equal groups (10 patients each):
difficulty breathing and a two-phase high-pitched sound
Group I included odd numbers and received BRAT and
during respiration, with voice changes and difficulty
group II included even numbers and received VFI.
swallowing happening less often [3].

When a patient is identified with a swallowing
Exclusion criteria: Previous injection, previous history
issue, therapies are implemented to enhance the
of neck irradiation, cervical spine problems or difficult
movement of food and improve the physiological
exposure of the neck, impaired conscious level, affected
process of swallowing. This allows the patient to get
intellectual functions, refusing to participate in the
sufficient oral nutrition and water necessary for their
survival [4].

The process of dysphagia rehabilitation involves
Oropharyngeal dysphagia assessment:
the use of both compensatory and rehabilitative
Primary diagnostic procedures: Patient's interview
strategies. Compensatory tactics are used to mitigate
and auditory perceptual assessment (APA) of voice,
symptoms of dysphagia without modifying the
speech, and language. Clinical examination comprised
underlying physiology, while rehabilitative treatments
general examination, oropharyngeal tract examination,
aim to enhance swallowing physiology and enhance the
neck examination, and neurological examination, as
safety and tolerance of a less restricted diet [2].
well as observations during trial feeding. Diagnostic
Received: 15/10/2024
Accepted: 13/12/2024

Full Paper (vol.941 paper# 104)

c:\work\Jor\vol941_105 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 719-724

Abbreviated MRI Protocols: Efficacy in Improving
Acquisition and Interpretation Time in Breast Cancer
Sara El Garwany , Azza Abdelhamid Gad , Sahar Mahmoud Mansour ,
Mohamed Ahmed Al-Shatouri , Taghreed Alshafeiy , Ahmed Fathy AlSerafi
1 Radiology Department, Suez Canal University, Ismailia, Egypt,
2 Radiology Department, Cairo University, Cairo, Egypt
Corresponding author: Sara El Garwany, Email: Saramohammed2017@yahoo.com
To be cost-effective, the abbreviated magnetic resonance imaging (MRI) protocols have to be proved to
reduce examination and reading times, while being clinically effective.
Objective: To investigate the efficacy of these protocols in enhancing the efficiency of exams and reducing
interpretation time. The study reviews the rationale behind abbreviated protocols and why they are an essential evolving
tool in breast screening programs. Patients and methods: This was a prospective randomized study. 60 female patients
were examined. They were presented to Kasr Al-Ainy Medical School Breast Unit for screening. Patients were stratified
using a risk assessment model. Different risk categories were included. Results: Abbreviated MRI is proved to be a
cost-effective method of screening for breast cancer. It has found to be faster to be performed compared with traditional
mammogram, as given all the preparation required and proper position needed in mammograms, MRI would be a better
modality. Average time for completing abbreviated MRI (AB-MRI) was 5.1 minutes, while mammograms took 10 min.
Reading AB-MR took an average of 4.7 minutes, while traditional mammograms 5.7minutes. Regarding efficacy, when
compared to traditional screening methods, AB-MR showed the following: 100% negative predictive value (NPV),
85.7% specificity, 50% positive predictive value (PPV), and 100% sensitivity in breast cancer. Conclusion: Abbreviated
MRI was found to be an efficient method to identify breast cancer, with shorter imaging and reading times.
Keywords: Time-efficacy, abbreviated MRI, AB-MR, breast cancer.

screening tests, this could be used instead of
Different tools are currently used to assess patent's
morphological characteristics of the lesions.
risk of breast cancer (1).

As it is essential for all women to have a screening
test, we are continuously looking for affordable and
This is a prospective randomized study. 60 female
efficient ways to achieve that (2). MRI has been proved
patients were examined. They were presented to Kasr
to be an excellent modality for this purpose. However,
Al-Ainy Medical School Breast Unit for screening
it is a costly method, due to the long protocol used and
between November 2019 and September 2020. Patients
the expertise needed for interpreting these scans (3). The
were stratified using a risk assessment model. Different
most cost-effective technique for screening for breast
risk categories were included.
cancer is mammography (4). However, MRI has been

proved to be a better modality, especially in women
Data collection: Mammography and tomosynthesis
with dense breast composition (5). Mammograms of
(Amulet Innovality, Fujifilm global, Bellus black and
women with dense breasts are more likely to miss
white workstation, 5 megapixels) were used for initial
malignancies (6). Furthermore, screening women who
patient's assessment. In a few patients, ultrasound could
are at high risk of breast cancer with mammography
have been used as an additional assessment. MRI
alone is inadequate (7). Hence, abbreviated protocols
machine used was (1.5 Tesla Philips MRI scanner,
were developed, in an attempt to develop a less
phased-array breast coil).
expensive and more efficient tool for assessing breast
Acquisition times were recorded for both modalities.
cancer (8). Breast MRI screening has best results in
Both modalities were then read by a senior registrar and
women with a family or personal history of breast
a consultant breast radiologist, with 10 years of
cancer, particularly in those who have had breast
experience in breast imaging. Reading times for both
conservation surgery (9, 10). While there are many
modalities were also collected.
advantages to magnetic resonance imaging (MRI) for
MR protocol: MRI machine used was (1.5 Tesla
screening and surveillance, its use is limited because of
Philips MRI scanners, with an 8- channel dedicated
its high cost, restricted availability, requirement for
phased-array breast coil).
injecting contrast media for sufficient imaging, and lack
of standardisation in terms of technique and
MRI protocols used comprise the following:
interpretation criteria for breast MRIs (11).
Unenhanced non-fat-saturated T1- weighted images,
In this study, the time of acquisition as well as
first contrast enhanced fat saturated T1 weighted
interpretation of one of the formulated abbreviated
images, subtracted first contrast enhanced fat saturated
protocols has been assessed and calculated. If proved
T1 weighted images, MIP images. Contrast was injected
efficient and less time consuming than traditional
using a high-pressure syringe. Data were processed.
Received: 02/10/2023
Accepted: 30/11/2023

Full Paper (vol.941 paper# 105)

c:\work\Jor\vol941_106 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 725-732
The Effect of Vitamin D Deficiency on the Frozen-Thawed Embryo Transfer Outcome
Shoroq Saber Ahmed1, Abdel-Wahab El Ghareeb1,
Tamer El- Nahas2, Mohamed Sobhy3, Eman Anwar Hassan4, Heba Ali Abd El Rahman*1
1 Department of Zoology, Faculty of Science, Cairo University, Egypt
2 Department of Reproductive Health, National Research Center, Egypt
3 Department of Histology, Faculty of Medicine, Al-Azhar University, Egypt
4 International Islamic Center for Population Studies and Research,
Al-Azhar University, Egypt, Wald and Bent IVF Center
*Corresponding author: Heba Ali Abd El Rahman, Tel: (+20)1127070059, E-mail: hebaabdelrahmana15@cu.edu.eg

Vitamin D (vit D) regulates the female reproductive system and inflammation reduction. Vit D deficiency
has been reported to be related to various diseases, such as infertility in females.
Objective: This work aimed to study the effect of vitamin D deficiency and vaginal inflammation on the pregnancy rate
following frozen embryo transfer.
Subjects and Methods: This prospective study included 188 infertile females who underwent ICSI protocol between
February 2021 and January 2022. The individuals were categorized into two groups: Group I (Vit D deficiency, vit D <
30 ng/mL), and group II (Normal vit D 30 ng/mL). Vitamin D levels in serum and vaginal inflammation were detected,
and pregnancy outcomes were compared between the groups. The impact of vitamin D deficiency and vaginal
inflammation on the pregnancy rates was investigated.
Results: Among participants, 74.3% had vitamin D deficiency, and 25.5% had normal vit D levels. 37.23% of patients
had a positive -hCG, while 62.77% had negative -hCG. 14.9% of cases had no vaginal infection, while 85.1% had a
vaginal infection. There was a statistically significant correlation between lower pregnancy rates in Egyptian females
and vit D deficiency (p<0.001). However, there was no correlation association between vaginal inflammation and
pregnancy rates (p > 0.05). Logistic regression analysis showed that reduced pregnancy outcome could be due to vit D
(P<0.001). Conclusion: Lower pregnancy rates following ICSI among Egyptian women may be related to vitamin D
deficiency, while vaginal inflammation has no impact on pregnancy rates.
Keywords: Frozen embryo transfer (FET), Intracytoplasmic sperm injection (ICSI), Infertility, Pregnancy rates,
Vitamin D.

According to the American Association of Clinical
Infertility is considered a serious health issue that
Endocrinologists guidelines (AACE), vit D deficiency
affects over 70 million women globally. According to
refers to a serum level of vit D < 30 ng/mL, which is
the World Health Organisation, between 10 and 25 %
common in 30­81% of adults worldwide while 30
of couples (48 to 180 million) are thought to suffer from
ng/mL or above refer to Vit D sufficient [7]. Vit D
infertility [1]. Assisted reproductive technology (ART)
deficiency can result from impaired vit D 1-
is widely used to treat infertility. The most effective
hydroxylation, impaired vit D 25-hydroxylation,
assisted reproductive technique currently available is
inadequate exposure to sunlight, inadequate vit D intake
frozen-thawed embryo transfer (FET), which has
from food, malabsorption, and vit D resistance
overcome many of the fresh embryo transfer technique
resulting from mutations in the VDR gene [8].
drawbacks such as superfluous embryos following
Low vit D has been revealed to be related to numerous
oocyte retrieval and Intracytoplasmic sperm injection
non-skeletal diseases including cardiovascular disease,
(ICSI) to improve pregnancy rates [2].
autoimmune, cancer, obesity and diabetes, and
Vit D is an essential hormone that is not only
infertility in both males and females [9]. Vit D is
responsible for phosphate and calcium homeostasis [3],
essential for maintaining a healthy pregnancy and for
but also vitamin D exhibits many other biological
several reproductive processes that occur throughout
effects, such as regulating hormone synthesis, immune
pregnancy, such as fertilization and implantation.
system response, and reduction of inflammation [4].
Miscarriage, recurrent implantation failure, and some
Vit D has a crucial role in the reproductive process. It
binds to the vitamin D receptor (VDR) that is found in
preeclampsia are also associated with low vitamin D [10].
most female reproductive systems and tissues such as
The vaginal microecosystem, immune response, and
the placenta, fallopian tubes, uterus, endometrium, and
biological metabolism are significantly influenced by
ovaries. Additionally, it stimulates the production of
the vaginal flora. Flora protects the vagina against
progesterone, estrogen, placental prolactin, and FSH,
harmful microorganisms, including those responsible
and controls human chorionic gonadotropin secretion
for urinary tract infections, vaginosis, candidiasis, and
[5]. This implies that vitamin D is essential for mediating
sexually transmitted diseases (STDs) [11]. Vaginal
its biological effects in female reproductive tissues [6].
inflammation (VI) is inflammation of both the vagina
and vulva, characterized by the disruption of the natural

Full Paper (vol.941 paper# 106)

c:\work\Jor\vol941_107 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 733-739

Factors Associated with Sleep Disturbances in SLE Patients:
A Descriptive Cross-Sectional Study
Esraa Elsayed Mahmoud Elsayed, Yasser Abdelaziz Abdelhameed, Noha Hosni Ibrahim
Department of Rheumatology, Rehabilitation & Physical Medicine, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Esraa Elsayed Mahmoud, Mobile: (+20) 01032492527, E-mail: esraelsayed249@gmail.com

Systemic lupus erythematosus (SLE), a diverse autoimmune inflammatory condition, affects various
organs and systems. Determining the origin of sleep disturbances in systemic lupus erythematosus patients is essential
to create specific and focused measures to enhance sleep quality.
Objective: This study aimed to evaluate the sleep quality of a group of patients with systemic lupus erythematosus
and investigate the correlation between sleep quality and disease activity, severity, and different disease parameters.
Patients and methods: The present cross-sectional study included 73 systemic lupus erythematosus patients. Disease
activity was assessed by means of the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K).
SLE severity was assessed by the SLICC/ACR damage index. Life quality was assessed by the short form quality of
life (SF-36 QoL) scale. Assessment of sleep disturbances was conducted using the Pittsburgh Sleep Quality Index
Patients with lower PSQI (21) scores showed significantly higher SLEDAI scores, indicating a more active
disease compared to those with higher scores (p=0.001). Lower scores were associated with significantly greater
SLICCs scores, indicating a more severe disease state (p=0.008). Patients with good PSQI 21 scores had slightly
higher SF36 scores (mean=60.58) than those with poor scores (mean=54.11), nevertheless, the disparity did not
exhibit statistical significance (p=0.071). Conclusion: Systemic lupus erythematosus patients often suffer from poor
sleep quality. Disease features and sleep variables impact sleep quality. Poor sleep may negatively impact systemic
lupus erythematosus patients' disease activity, damage, as well as well-being.
Keywords: Systemic lupus erythematosus, Sleep disturbances, PSQI 21.

the general populace (4). Between 56.0% and 80.5% of
SLE is a health issue characterised by an
individuals diagnosed with SLE experienced sleep
abnormal immune response that targets multiple organ
disturbances together with decline in sleep quality.
systems. The disease displays a diverse array of
Prior research has indicated that sleep disruptions can
observable characteristics, with clinical manifestations
exacerbate cardiovascular morbidity in individuals
ranging from mild symptoms affecting the skin and
with SLE (5).
mucous membranes to severe impairment of multiple
Sleeplessness worsens disease activity. Thus,
organs and the central nervous system. The course is
detecting the causes of poor sleep in SLE patients is
marked by repetitive occurrences of relapse and
essential for targeted interventions towards improving
remission (1).
sleep quality. Sleep disorders have unknown causes (6).
Notwithstanding recent progress in knowledge of
Psychological/social factors, especially depression, are
the clinical basis and risk factors linked to SLE, the
the most common causes of SLE sleep disorders. It is
precise cause of the disease remains unknown. SLE
worth to mention that depression affects 35.0% of SLE
can be difficult to diagnose, and despite the fact that
patients (7).
numerous classification criteria have been proposed,
Some studies linked sleep disturbances to SLE
their clinical utility remains debatable. Involvement of
disease activity, pain, and steroid use. Notably, sleep
organ systems dictates SLE management. Although,
disruptions symptoms like pain and fatigue overlay
numerous medications have exhibited efficacy in the
with constitutional inflammatory symptoms of SLE
and may resemble disease-related relapse (8).
remains a substantial contributor to morbidity and
The objective of this study was to assess the sleep
mortality among individuals with SLE (2).
quality of a cohort of patients with systemic lupus
The persistent and intense nature of SLE, along
erythematosus and to examine the relationship between
with its underlying physiological processes, are
sleep quality and disease activity, severity, and various
associated with a heightened susceptibility to
disease parameters in these patients.
psychiatric and neurological complications, including

mood disorders, anxiety disorders, and sleep
This descriptive cross-sectional study included 73
disruptions. Sleep is a dynamic and intricate state
patients diagnosed with SLE. They were enrolled from
marked by significant physiological alterations in body
Inpatient and Outpatient settings at the Rheumatology,
temperature, muscle tone, the endocrine system,
Rehabilitation, and Physical Medicine Department of
Benha University Hospitals, Egypt. The recruitment
functions (3). A 2020 meta-analysis revealed that the
period spanned from June 2022 to June 2023.
sleep quality of patients with SLE is inferior to that of

Received: 16/10/2023
Accepted: 14/12/2023

Full Paper (vol.941 paper# 107)

c:\work\Jor\vol941_108 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 740-746

Ultrasound Assessment of Post Placental Insertion of (Cupper T380A)
Intrauterine Device at Cesarean Section; Two Different Techniques
Ayman Elsayed Solyman, Ayman Abd ElKader Shabana,
Reham Salah Ahmed Elsotohy*, Ahmed Mohamed Tharwat
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Reham Salah Ahmed Elsotohy, Mobile: (+20) 01275508346, E-Mail: Amirmo777amed@gmail.com

post placental intrauterine device (IUD) insertion is effective, convenient strategy to reduce the risk of
rapid repeated pregnancy.
Objectives: To evaluate abnormal uterine bleeding (AUB), infection, loss of threads, displacement, expulsion, and
pregnancy on top, regarding two post placental IUD insertion techniques.
Patients and Methods: Cohort prospective comparative study was conducted on 164 women in the Obstetrics and
Gynecology Department, Menoufia University Hospital, during a period time from September 2022 to December 2022.
Significant differences among the studied two groups regarding IUD displacement (p=0.029), AUB (p=0.001),
loss of threads (p=0.036) and IUD expulsion (p<0.001) after 6 weeks of IUD insertion, and a significant difference
regarding IUD displacement and loss of threads after 3 months of IUD insertion (P<0.05).
Conclusions: Because the new approach is linked to a decreased frequency of IUD displacement and non-visibility of
IUD threads, it may become the standard procedure for intra-cesarean section IUD insertion.
Keywords: Cesarean section, Contraceptive device, Copper-T380A, Insertion, Post placental, Ultrasound.


Higher rates of morbidity and death in children and
The aim of the study was to record the complications
mothers are associated with shorter gestational periods
after insertion of IUD by the two different techniques
[1]. The avoidance of unwanted and closely spaced
regarding, AUB, infection, loss of threads,
pregnancies during the first year after childbirth is
displacement, expulsion, and pregnancy.
known as postpartum family planning. A variety of

efficient contraception techniques are necessary for
postpartum women to be able to avoid an unintended
Cohort prospective comparative study was
pregnancy in a short amount of time [2].
conducted on 164 women to evaluate patient
Among the various alternatives, the Copper
satisfaction of post-placental insertion of contraceptive
T380A IUD is one of the most economical and long-
device who attended to the Obstetrics and Gynecology
acting solutions due to its multi-year cost. Regardless of
Department, Faculty of Medicine, Menoufia University
whether a woman is nursing during this time, she can
Hospital, during a period time from September 2022 to
safely utilise the highly effective, non-hormonal Copper
December 2022.
T 380A intrauterine contraceptive device (IUCD) [1].

The rate of ejection and adverse effects, such pain and
The study's patients were split into the following two
bleeding, are the primary drawbacks of IUDs as
groups: Group A: The IUD was placed by traditional
contraceptive devices and may need an early removal
method, and Group B: The IUD was placed by A
modified method.
Since the 60s, the idea of early postpartum IUD

implantation has been studied and is now well
Method of randomization:
recognised [4, 5]. When it comes to contraception, early
Using opaque envelopes, participants were
postpartum IUD implantation offers a number of
divided into the two groups at random. Then, in order to
benefits over alternative options. It offers contraceptive
preserve secrecy, the envelopes were opened one after
the other right before the IUD was inserted. After then,
Furthermore, putting in an IUD early can help prevent
a statistician who was not involved in this study created
insertion-related pain. IUD implantation during birth is
the randomization list using "computer software".
linked to increased expulsion rates, despite these
The 1:1 ratio was the basis for the participant's
benefits [4].
allocation. Subsequently, the researchers recruited
According to some publications, women who
individuals and allocated them to various therapies. In
deliver by caesarean section and put their IUD
order to support analyses based on the intention to treat
immediately after the birth (within 10 minutes) through
by protocol, a record of the intervention type and
a hysterotomy may experience a lower expulsion rate
insertion technique was maintained. Ultimately, the
than women who deliver vaginally and insert their IUD
group assignment was concealed from the participants.
immediately [5].

Received: 15/10/2023
Accepted: 15/12/2023

Full Paper (vol.941 paper# 108)

c:\work\Jor\vol941_109 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 747-754

Awareness of Emergency Department Physicians toward Management of
Medicolegal Cases in Egypt
Rabab Abdulmoez Amin Eltokhy, Shimaa Ahmed Alsaeed, Amal Salama Mahmoud Mahmoud*
Department of Forensic Medicine and Clinical Toxicology, Cairo University
*Corresponding author: Amal Salama Mahmoud Mahmoud, E-mail address: amalsalamabadawy@cu.edu.eg.
Phone: 0201091341431, ORCID no.: 0000-0002-1979-0650
Other authors' E-mail addresses: drrabababdulmoez@gmail.com, shimo999shimo@yahoo.com

The emergency department physicians' awareness of situations that could have medical-legal repercussions
is critical. The patient's right to justice will be infringed if it is not implemented and medical professionals cannot recognize
medicolegal cases or neglect to gather forensic evidence.
Aim: The aim of the current study is to assess the awareness of Egyptian emergency department physicians in managing
medicolegal cases they encountered in the emergency department.
Subjects and methods: A self-administered structured questionnaire was created and filled out online by 404 physicians
working in emergency departments all over Egyptian private, Ministry of Health, and, university hospitals to assess
physicians' way of handling cases that had medicolegal depths.
Results: The score of knowledge of documentation, and knowledge of reporting authority were 63% and 36% respectively,
the majority of respondents said that they require training programs, particularly during the residency time. Unfortunately,
there was a lack of awareness of the availability of a standardized methodology for the handling of medicolegal cases, tools
and kits for recording and evidence collecting. Even while several teaching hospitals in Egypt have standardized protocols
for the administration of medicolegal matters, doctors were still not fully aware of these standards.
Conclusion: The majority of emergency physicians had a passable understanding of the significance of medical records for
legal purposes and there was a lack of practice, inadequate training, and a lack of tools and kits for gathering evidence.
Keywords: Awareness, Medicolegal, Emergency, Egypt

The most frequent mistakes reported in
Medical cases vary widely in terms of type,
medicolegal reporting of cases were incomplete patient
nature, and approach. A team of professionals is needed
cooperation status recording and poorly defined exterior
in certain instances, while a single department can handle
lesions in the majority of instances [2]. Another factor
others. This variability highlights the need for physicians
inhibiting doctors from organizing medicolegal reports
to acquire specific knowledge and abilities in order to
was their need for more expertise and reluctance to
manage routine medicolegal concerns. As the first point
assume responsibilities [6,7].
of contact for patients seeking medical attention, the
This situation emphasizes the necessity of
Emergency Department ED (also known as the ER `
treating every trauma patient in the emergency room as a
Emergency Room') is crucial to the early assessment and
medicolegal case until otherwise demonstrated. The
management of patients. Additionally, being aware of
patient's right to justice will be infringed if it is not
situations that could have medical-legal repercussions is
implemented and medical professionals cannot recognize
critical. In order to establish a suitable approach to the
medicolegal cases or neglect to gather forensic evidence
reporting of medicolegal cases, such as road traffic
accidents, burns, physical, sexual, or battery abuse,
As a first step towards proposing a unified set of
poisoning, drowning, alleged suicide, and homicide,
guidelines on how to handle these cases in order to
specific protocols are adopted [1].
preserve both patient rights and physicians' rights, the
It is possible to describe a medicolegal case as "a
current study, conducted in Egypt, aimed to assess the
case of injury or illness that requires investigation by law-
awareness of Egyptian emergency department physicians
enforcing agencies to fix the responsibility regarding the
in managing medicolegal cases they encountered in the
causation of the injury or illness" [2-4].
emergency department and compared the results to
The first line of administration in emergency
current international guidelines.
departments is doctors, and one of the most frequent

problems they encounter is obtaining forensic evidence.
Doctors working in the emergency room can overlook
This descriptive cross-sectional exploratory study
such occurrences. When patients are afraid or
was conducted from November 2021 to January 2023, on
embarrassed to explain the facts about their injuries, they
404 physicians working in Egyptian private, university
often present an incomplete or hazy history [5].
and Ministry of Health hospitals engaged in the
Received: 15/10/2023
Accepted: 13/12/2023

Full Paper (vol.941 paper# 109)

c:\work\Jor\vol941_110 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 755-760

Role of Endoscopic Ultrasound in Diagnosis of
Unexplained Distal Common Bile Duct Stricture
Reda Badr, Ahmed Samir*, Mohammed Abbasy, Talaat Zakaria, Mahmoud Allam, Hassan Zaghla
National Liver Institute, Hepatology and Gastroenterology Department, Menofia University,
Shebin El-Koom, Menofia, Egypt
*Corresponding author: Ahmed Samir, Mobile: (+20) 01014819796,
E-mail: ahmed.atwa@liver.menofia.edu.eg, ORCHID ID: 0009-0005-2293-8950

Determining the etiology of distal biliary strictures lacking a recognizable cause on imaging is crucial for
appropriate therapy. Objective: This study aimed to evaluate the efficacy of endoscopic ultrasound (EUS) in diagnosing
distal biliary strictures that were not diagnosed by cross-sectional imaging modalities like computed tomography or
magnetic resonance imaging. Patients and Methods: Prospective study included 80 patients with unexplained distal
biliary strictures diagnosed using Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde
Cholangiopancreatography (ERCP), CT, or MRI done EUS.
Results: 80 patients (50 males mean age 57.9 ± 9.8 years) were studied. Based on EUS findings, 51 patients were
diagnosed with malignant strictures (63.75%) (21 distal cholangiocarcinomas, 17 pancreatic head masses, 11 ampullary
mass lesions, and 2 intraductal papillary mucinous neoplasms), and the remaining patients were diagnosed as benign
strictures (36.25%). Receiver Operating Characteristic (ROC) analysis between malignant and benign strictures for
distal Common Bile Duct (CBD) wall thickness showed a cut-off value of > 3.2 (Sensitivity of 80.39%, specificity of
89.66%, positive predictive value (PPV) of 93.2% negative predictive value (NPV) of 72.2% and accuracy of 85.7%).
Conclusion: EUS is a promising investigational procedure for patients with challenging distal CBD strictures, and can
predict the nature of the strictures whether benign or malignant.
Keywords: Common bile duct, Distal biliary stricture, Endoscopic retrograde cholangiopancreatography, Endoscopic


Endoscopic Ultrasound (EUS) has progressed
(MRI) cannot detect a causative mass or bile duct
since its introduction and is now a widely accepted
irreplaceable assessment tool that makes previously

unreachable anatomical areas visible and has the ability
to acquire tissue for diagnosis [1]. Over the past ten
A prospective study was conducted on 80 patients
years, significant developments in imaging techniques
who underwent EUS at the National Liver Institute,
and the emergence of new ways for tissue
Menoufia University for the evaluation of distal biliary
differentiation based on vascular structure and tissue
strictures. Patients with distal biliary strictures were
stiffness have led to enhancements in diagnostic EUS
diagnosed using other imaging modalities, such as
[2]. EUS has grown to be a key tool in assessing biliary
disorders. In addition to offering vital diagnostic data on
biliary anatomy, it also gives a chance to take a sample
cholangiopancreatography (ERCP) and CT, or MRI,
of the tissue or lesion for histological diagnosis [3].
were included in the study.
Diagnostic challenges frequently arise from

intrahepatic and/or extrahepatic biliary strictures in
Exclusion criteria: Patients under 18 years of age, unfit
those with a cholestatic clinical scenario. Proper
for EUS due to other severe comorbidities, refusal to
diagnosis is crucial to prevent missing cancer in
participate in this study, identifiable mass lesions
strictures that seem benign or performing needless
causing biliary strictures, and proximal bile duct
surgery to investigate benign conditions that resemble
malignancy [4].
The patients were studied for their full history,
With its excellent sensitivity and accuracy in
physical examination, and laboratory and imaging
identifying the malignant origin of distal biliary
obstruction, endoscopic ultrasonography has emerged
EUS was performed to evaluate the presence of
as the preferred imaging modality for those patients [5].
masses that could result in disintegration of the typical
Sensitivities ranging from 40% to 90% have been
2-3 layers and extrinsic pressure at the CBD stricture
recorded in many trials, with the majority displaying a
site [7]. The EUS procedure was performed in the same
sensitivity >70% [6].
manner as the standard endoscopic examinations. Most
This study aimed to assess the ability of EUS to
procedures were performed on an outpatient basis under
diagnose distal biliary strictures in which cross-
intravenous sedation [8].
sectional imaging modalities such as computed
In the present study, EUS images were evaluated
tomography (CT) and magnetic resonance imaging
to detect extrinsic pressure at the stricture location
Received: 16/10/2023
Accepted: 14/12/2023

Full Paper (vol.941 paper# 110)

c:\work\Jor\vol941_111 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 761-764

Audiological Evaluation and Cochlear Reserve in
Posterior Canal Benign Paroxysmal Positional Vertigo
Alaa Hady Abass, Wessam Ibrahim El-Shawaf, Mohamed Moustafa Abd-Eltawwab
Audiology Unit, ORL Department1, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Alaa Hady Abass, Mobile: (+20) 01098246865, Email: aha700009@gmail.com


Background: Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular disorder affecting the
semicircular canal (SCC). It is important to determine the potential contribution of posterior canal BPPV (PC-BPPV) to
function of cochlear outer hair cells, by application of Otoacoustic emission (DPOAE and TEOAE) and to investigate
changes of pure tone audiometry (PTA) thresholds in patients suffering from PC-BPPV.
Objective: This study aimed to assess the audiological and cochlear reserve in PC-BPPV.
Patients and Methods: This prospective study involved twenty patients with PC-BPPV. All patients in this study were
evaluated by the Dix Hallpike test. Basic audiological evaluations included pure tone audiometry (PTA),
immittancemetry and otoacoustic emissions audiometry (OEA), which included transient-evoked otoacoustic emissions
(TEOAE) and distortion product otoacoustic emissions (DPOAE).
Results: There was a significant positive correlation between age and pure tone audiometry (PTA), which increased by
increase of the age in the studied PC-BPPV patients. Also, there was a significant negative relationship only between
DPOAE (1 KHz) and PTA (1 KHz) but DPOA at 2, 4, and 8 KHz revealed statistically non-significant difference at all
other OAE PTA.
Conclusion: We concluded that as the age increased, a statistically significant threshold increased at high frequencies
(4000 to 8000 Hz) suggestive of presbycusis. Considering the correlation between PTA and DPOAE, we concluded that
otoacoustic emissions could be a complementary modality for the detection and control of hearing abilities.
Keywords: BPPV, Posterior semicircular canal, Vertebrobasilar insufficiency, Immitancemetry, Otoacoustic emissions.


Benign paroxysmal positional vertigo (BPPV) is a
whether there exists a true contributing effect or there is
peripheral vestibular disorder affecting the semicircular
an accidental relationship. In the majority of cases with
canal (SCC) commonly but not solely the posterior
BPPV, a direct correlation with an ipsilateral disease
canal SCC (PC-SCC). Affection of the lateral SCC
process affecting the labyrinth cannot be recognized and
(LSCC) and superior SCC (SSCC) frequently occurs
idiopathic BPPV is still the commonest diagnosis [2].
too. BPPV, with its distinctive, short-duration vertigo
With regard to the cause of BPPV, it could be
and associated nystagmus is elicited by provocative
classified into primary BPPV that happens in a
head motion in relation to gravity, occasionally lying
spontaneous manner. Of note, there are certain
down. In fact, when the patient gives a previous history
predisposing factors which could increase its incidence
of the word "bed", the examiner has to take into
including old age, osteoporosis, vitamin D
consideration BPPV. It is of great significance to note
insufficiency, and vertebrobasilar insufficiency.
that up to 1/3 of cases could be presented with an
Secondary BPPV occurs in addition to ear diseases,
unusual history; as a result entire vague cases must
which include Meniere's disease, vestibular neuritis,
undergo provocative positioning. Despite the site of
vascular and otosclerosis, chronic suppurative otitis
lesion being in the end-organ, BPPV isn't accompanied
media, or after ear surgeries. Post-traumatic BPPV
by impaired hearing or tinnitus; nor are there disturbing
occurs when the symptoms develop within three days
neurologic manifestations [1].
after traumatic head injury. Of note, trivial head
The mechanism of detached otoconia isn't totally
traumas, which include domestic traumas and could
identified. It appears that inner ear diseases which
stimulate otoconial detachment, which ultimately ends
detaches otoconia and yet doesn't affect SCC functions
in BPPV development [3].
could be accompanied by secondary BPPV. It has been
Till now, fewer research emphasized on secondary
demonstrated that the most common diseases
BPPV, that might be considered as an underdiagnosed
accompanied by secondary BPPV are head traumas,
entity. In spite of the clear similarities, changes between
the clinical features and the outcomes of repositioning
postoperative. The remaining disorders which affect the
approaches between the numerous forms of secondary
inner ear and are included in the pathogenesis of
and idiopathic BPPV appear to dictate various
secondary BPPV are sensorineural hearing loss and
diagnostic, counseling, management, and follow-up
migraine. Preferably, for an etiological correlation to be
planes. Ibekwe and Rogers [1] highlighted the co-
evident, BPPV has to be on the same side to the
existence of BPPV with several pathological conditions,
accompanying condition and manifestations have to
which also are known to be accompanied by dizziness.
develop simultaneously or following the development
In such patients, BPPV is frequently underdiagnosed, as
of the original disease. In certain cases, it isn't obvious
Received: 17/10/2023
Accepted: 17/12/2023

Full Paper (vol.941 paper# 111)

c:\work\Jor\vol941_112 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 765-772

Serum Immunoglobulin G and M as Predictors for
Outcome of Childhood Nephrotic Syndrome
Abdelhamed Salah El-Hamshary1, Alaa Tarek Abdelwahab*1, Asmaa Adel El-Fallah2, Hanaa Ramadan Omar1
Departments of 1Pediatrics and 2Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Alaa Tarek Abdelwahab, Mobile: (+20) 01011744594, Email: alaatarik484@gmail.com

Nephrotic syndrome (NS) is characterised by a loss of albumin, proteins, and other plasma components
with comparable bulk. Symptoms include decreasing serum albumin levels, increased blood lipid levels, lipids in urine,
and edema. Objective: To estimate serum levels of IgG, IgM, in nephrotic syndrome cases in addition to detect the
relationship between IgG/IgM ratio and response to treatment with steroids.
Patients and Methods:
The present study was carried out in Benha University Hospital, it comprised 60 children
admitted to Nephrology Unit of Pediatric Department of Benha University Hospitals. The cases were divided into four
groups: Group A included 15 cases of frequent relapse N.S. (FRNS), Group B comprised 15 cases of steroid-resistant
nephrotic syndrome (SRNS), and Group C consisted of 15 cases with infrequent relapses. Additionally, a control group
of 15 cases.
In our study, serum IgM showed a significant difference between the studied groups (P < 0.001). Pairwise
analysis revealed that it was significantly lower in the control group (median = 0.71 mg/ml) than in groups A (median
= 1.48 mg/ml), B (median = 1.27 mg/ml), and C (median = 1.62 mg/ml). ROC analyses were conducted to assess the
discriminatory potential of serum IgG and IgM levels among the different study groups (Group A, Group B, and Group
C) compared to controls. For serum IgG, the analysis for all groups demonstrated significant AUC values, ranging from
0.938 to 0.958, with confidence intervals indicating excellent discrimination.
Our findings highlight the potential of serum IgG and IgM levels as diagnostic markers for differentiating
nephrotic syndrome cases and provide valuable insights into the pathophysiology and treatment response in these
Keywords: Serum Immunoglobulin G - Serum Immunoglobulin M ­ Nephrotic Syndrome.


The term "NS" describes a collection of clinical
have been noted from the outset of the disease, prior to
symptoms that are brought on by several glomerular
the administration of any immunosuppressive
illnesses. These symptoms include severe edema,
hyperlipidemia, hypoproteinemia (<30 g/L), excessive
immunosuppression given in severe forms of the
proteinuria (>3.5 g/day), and edema. The loss of
disease may potentially contribute to the decrease of
immunoglobulins and complement proteins causes a
protective antibodies seen in INS patients, raising the
reduction in immunological function. The best
possibility that these patients may have serious
medications for treating NS are corticosteroids and
infections (2).
Patients are treated with a standardised regimen of
medications exacerbate immune system suppression.
oral prednisone medication from the outset of the
As a result, among the most frequent side effects among
condition; most react to this treatment within 4-6 weeks
NS patients is infection. According to a prior study, at
(referred to as "steroid-sensitive NS" patients, or
least 20% of patients with NS had serious infections at
SSNS). The majority of pediatric SSNS patients have
some point during the illness, including invasive fungal
highly variable clinical evolutions, ranging from non-
infections and even meningitis caused by cryptococcal
relapsing to severely steroid-dependent forms that
bacteria (1).
necessitate repeated cycles of steroid therapy and
The most common glomerular condition in children
additional immunosuppression with one or more
is idiopathic nephrotic syndrome (INS). Its occurrence
steroid-sparing medications, such as B-cell depleting
is uncommon, though 1­17 instances per 100,000
medications, calcineurin inhibitors, and anti-
children annually. The hallmark of INS is glomerular
proliferative medications (2).
permeability barrier impairment, which results in a
The pathogenesis of idiopathic NS is caused by a
significant leakage of proteins into the urine and is
number of variables, including structural abnormalities,
linked to edema and hypoalbuminemia. During the
systemic characteristics, and immunology. Idiopathic
active period of the illness and occasionally even during
NS contained MCNS, MesPGN, and FSGS in its
remission, there is often a significant decrease in blood
histology. Serum IgM levels rise in NS, whereas IgG
IgG levels accompanied by elevated serum IgM levels.
and IgA levels fall. IgM and IgG syntheses can be
It's debatable if the severe proteinuria alone or a
reversed by T-cell malfunction (3).
compromised immune system is to blame. A number of
The aim of this study was to estimate serum levels
T cell dysregulations have been reported in both relapse
of IgG, IgM, in nephrotic syndrome cases in addition to
and remission, and changes in memory B cell counts
Received: 16/10/2023
Accepted: 14/12/2023

Full Paper (vol.941 paper# 112)

c:\work\Jor\vol941_113 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 773-776

Patterns of Relapse in Patients with Locally Advanced
Cervical Cancer after Image Guided Brachytherapy
Fatma Ahmed Abdelfatah1*, Mohamed Soliman Gaber2, Ali Mohamed Ali2, Mohamed Mahmoud Abdelhakem 3
1Clinical oncology department, faculty of medicine, Luxor university, Egypt.
2Clinical oncology department, faculty of medicine, Sohag university, Egypt.
3Radiation Oncology Department, NCI, Cairo University, Egypt.
*Corresponding Author: Fatma Ahmed Abdelfatah, Email: Fatma.rekabi@med.sohag.edu.eg , Phone: +201002155832

In the treatment of locally advanced cervical cancer (LACC), brachytherapy (BT) is a pivotal treatment
modality, used in conjunction with external beam radiotherapy (EBRT). However, even with advancements in EBRT and
BT techniques, the occurrence of local relapse continues to pose significant challenges.
Objective: This research aimed to examine the recurrence patterns following the administration of concomitant
chemoradiotherapy (CCRT) and subsequent enhancement with image-guided brachytherapy (IGBT).
Subjects and methods: The research involved 40 patients diagnosed with locally advanced cervical cancer. These
individuals underwent CCRT, subsequently enhanced by IGBT, as part of a phase 2 prospective study.
Results: Among the 40 patients studied, 4 (10%) experienced local recurrence, and among these, 2 also had simultaneous
distant relapses. Node recurrence was identified in 2 patients (5%), and 4 patients (10%) had distant failures. Local
recurrence within the radiation treatment area was noted in 2 patients (5%), while 2 others experienced recurrence outside
the treatment area. Treatments administered included stereotactic body radiotherapy (SBRT) for one patient, salvage surgery
for another, and palliative care for the two patients with concurrent distant metastases. The median survival time after
recurrence was 12.1 months, with an interquartile range (IQR) of 10 to 14.1 months.
Conclusion: Although the application of IGBT in the treatment of cervical cancer led to commendable local control and
disease-free survival rates, the most common failure mode observed was distant relapse.
Keyword: Cervical cancer, Relapse, Image-guided brachytherapy.

Globally, cervical cancer ranks as the second most
Study design and participants: The research was
prevalent cancer among women, posing a significant
designed as a prospective study carried out at a single
health risk. The essential cause of cervical cancer has
institution, spanning from January 2021 to December
been identified as a continuous infection with high-risk
strains of the human papillomavirus (HPV) [1].

Nearly 90% of cases of cervical tumor happen in low-
Inclusion criteria: Patients with a pathological diagnosis
and middle-income nations without systematic screening
of adenocarcinoma, squamous cell carcinoma, or
or HPV immunization initiatives [1].
adenosquamous carcinoma of the cervix. To be eligible,
The development of an all-encompassing approach in
individuals had to be diagnosed with cervical cancer
order to avoid and manage cervical cancer was expedited
stages IB3 to IVA according to the International
by the apparent etiology. When the World Health
Federation of Gynecology and Obstetrics (FIGO)
Organization (WHO) prompted for worldwide cervical
standards, be aged 18 or above, and to have an Eastern
cancer eradication in May 2018, over 70 countries as well
Cooperative Oncology Group (ECOG) performance
as worldwide academic bodies complied right away [2].
status of 0 or 1.

The standard of care for locally advanced cervical
Exclusion criteria: Barred individuals with any other
tumor incorporates concurrent chemoradiotherapy
types of cancer (with the exception of cervical carcinoma
succeeded by BT either intracavitary alone or hybrid
in situ and basal cell carcinoma of the skin), those with
intracavitary/interstitial brachytherapy. Advances in
metastasis extending beyond the para-aortic lymph nodes,
radiation therapy technology, such as MRI based image
those who had previously undergone pelvic radiotherapy,
guided brachytherapy have led to a decrease in toxicity
and those with contraindications for undergoing magnetic
associated with therapy as well as excellent local control
resonance imaging (MRI).

This study aimed to describe the patterns of relapse
after concomitant chemoradiotherapy (CCRT) followed
by an image-guided brachytherapy (IGBT) boost.
brachytherapy treatment. The external beam radiotherapy

protocol included 25 sessions of pelvic radiotherapy, with

each session delivering 1.8 Gy for a cumulative dose of
Received: 15/10/2023
Accepted: 15/12/2023

Full Paper (vol.941 paper# 113)

c:\work\Jor\vol941_114 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 777-784

Evaluation of Baveno VII Criteria in Ruling out High Risk Varices in
Cirrhotic Egyptian Patients
Badawy A. Abdulaziz1, Magdy AbdelMawgoud Gad1,
Ahmed Mohamed Edrees2, Ahmed Esmat ElAshry*1, Ahmed S. Elgazar1
1Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Benha University, Egypt
2Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Egypt
*Corresponding author: Ahmed Esmat El Ashry, Mobile: (+20) 1000199299, E-Mail: drahmadesmat@gmail.com

Most serious complications of liver cirrhosis, including ascites, esophageal varices (EV), and variceal
hemorrhage, are brought on by portal hypertension. It has been suggested that screening with a gastroscopy be used to
evaluate EV and bleeding risk in patients with cirrhosis. Gastroscopy, however, is a costly and intrusive surgery that
carries some risk. Esophageal varices and high-risk varices have been identified or ruled out using noninvasive
screening techniques such as liver and spleen stiffness.
Objective: Our goal was to confirm that, in Egyptian cirrhotic individuals, spleen stiffness, liver stiffness, and platelet
count (PLT) can be used to rule out high-risk varices.
Subjects and Methods: A total of 155 individuals with liver cirrhosis were included in cross-sectional study based on
whether they had esophageal varices or not using esophagogastroduodenoscopy. The patients were sorted into three
distinct groups according to the degree of varices: Those without varices, those with low-risk varices, and those with
high-risk varices.
It was observed that the high-risk varices group had greater liver and spleen stiffness measurements than the
no varices and low risk varices groups. Spleen stiffness at a cut-off level of < 45 kpa is optimum in ruling out high
risk varices (HRV) with 93.85% sensitivity, 96.67% specificity 95.3% PPV and 95.6% NPV with P value <0.001 and
AUC of 0.981, while liver stiffness for ruling out HRV, the optimum cut-off level was < 29.1 kpa with 71.11%
sensitivity, 95.38% specificity, 95.52% PPV and 70.45% NPV with P value <0.001 and AUC of 0.886. Platelets at a
cut-off level <93 can rule out HRV with 84.44% sensitivity, 96.92% specificity, 97.44% PPV and 81.82% NPV with
P value <0.001 and AUC=0.898.
Conclusions: In Egyptian cirrhotic individuals, spleen stiffness in addition to liver stiffness and PLT may be helpful
in ruling out high-risk varices, which is consistent with the Baveno VII criteria.
Baveno VII criteria, Cirrhotic, Egyptian, High-risk varices, Spleen stiffness.

(HVPG) evaluation; readings more than 10 mmHg are
Cirrhosis stands as one of the predominant
associated with a higher risk of high-risk GEV.
causes of mortality worldwide, particularly in
Varices are highly connected with the HVPG in terms
developing nations, where the 1-year mortality rate
of both frequency and magnitude, but measuring it
varies between 1 to 57% based on the stage (1).
requires an intrusive process, hence it is not used
Individuals with cirrhosis necessitate frequent medical
frequently (4).
assistance, leading to a substantial healthcare burden.
Esophageal varices, which indicate stage 2 in
Cirrhosis, beyond being a chronic and progressive liver
the illness's natural history, occur in patients with
compensated cirrhosis at a yearly rate of 7% to 8%. A
dysfunction. This dysfunction involves uncontrolled
transition to decompensated cirrhosis (state 3 in the
cytokine secretion, reduced phagocytosis by the innate
typical course of cirrhosis) is indicated by bleeding in
immune system, and aberrant responses from T and B
5%­15% of patients' year after they first appear (5).
cells during pathogen stimulation (2). Gastroesophageal
There is a 20% higher risk of death for those who
varices (GEV) and variceal hemorrhage (VH) serve as
bleed. Esophageal varices should be examined in
significant clinical milestones in the natural course of
patients with cirrhosis to avoid bleeding, and primary
cirrhosis, potentially indicating various stages of
prophylaxis against rupture should be administered to
disease progression and a substantial correlation
those who are more vulnerable (6).
between portal hypertension severities. Variceal
The Baveno VI criteria, incorporating a liver
hemorrhage (VH), in particular, stands out as a clinical
stiffness measurement (LSM) of 20 kPa through
consequence characterizing cirrhosis decompensation,
transient elastography (TE) and a platelet count (PLT)
representing a potentially fatal complication of the
of 150 × 10^9/L, has been thoroughly validated as a
condition (3).
reliable non-invasive tool for anticipating a low
The incidence of esophageal varices (up to 62%)
and big varices (up to 47%) was considerably greater
Consequently, this obviates the necessity for invasive
in Egyptian patients with HCV who also had liver
endoscopic investigation concerning esophageal
cirrhosis. The conventional technique for assessing
varices (OV). The updated Baveno VII consensus
portal pressure is the hepatic venous pressure gradient
extends its scope to encompass the diagnosis of
Received: 16/10/2023
Accepted: 17/12/2023

Full Paper (vol.941 paper# 114)

c:\work\Jor\vol941_115 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 785-792

Cardiac Dysfunction as an Early Outcome Predictor in Severe Sepsis
Asmaa Elsaeed Ebrahim*1, Mohamed El-Said Ahmed2, Samir Mohammed Attia3,
Afaf Abdel-Hafez Abdel-Mageed4
Departments of 1Emergency Medicine and 2Membership of Critical Care Medicine,
Emergency Hospital, Mansoura University, Egypt
Departments of 3Vascular Surgery and 4Internal Medicine and Critical Care Medicine,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Asmaa Elsaeed Ebrahim, Mobile: (+20) 01033969279, E-mail: asmaaelsaeed510@gmail.com

Background: Sepsis has been considered as a major cause of morbimortality worldwide. The mortality rate of severe
sepsis is 25%, representing about 40% of hospital mortality. Sepsis-induced cardiac dysfunction (SICD) is
encountered in the intensive care unit (ICU), and its prevalence in septic cases ranges from 10 to 70%. Such
discrepancies among researches are mainly owing to the absence of well-established diagnostic criteria.
Objective: To investigate if cardiac dysfunction as evidenced by positive troponin (cTnI) and left ventricular systolic
and diastolic functions can predict bad outcome in non-cardiac patients with severe sepsis and/or septic shock.
Patients and Methods: This was a prospective observational cohort study carried out in Emergency Department
(ED), Mansoura University on 100 patients, adults, non-cardiac, non-surgical patients, who were presented with
severe sepsis over a period of 1 year from July 2022 to July 2023.
Results: 55% of the included patients were positive troponin. Troponin was a statistically significant independent
predictor of mortality, bad outcome and need for vasopressor among studied cases. Possible predictors of mortality
showed that lower albumin, lower ejection fraction and positive troponin were statistically significant predictors of
mortality among studied cases.
Conclusion: High troponin levels may be detected in non-cardiac patients with sepsis and this group according to new
guidelines are considered stage-B pre heart failure patients. Troponin is a statistically significant independent predictor
of mortality, bad outcome and need for vasopressor among studied cases.
Keywords: Positive troponin, Sepsis-induced cardiac dysfunction.

Sepsis has been considered as a primary cause of
morbimortality all over the world. The mortality rate
Study design:
of severe sepsis is 25%, representing about 40% of
This was a prospective observational clinical
hospital mortality. SICD is a gradually identified type
study (cohort) carried out in ED on 100 patients, who
of transient cardiac dysfunction in the septic cases. In
were presented with severe sepsis to Mansoura
spite of implications for patient outcomes, the critical
University Emergency Hospital (MUEH) and admitted
healthcare communities haven't given considerable
at Mansoura University Hospital (MUH). This study
focus on such disease (1).
was conducted over the period of 1 year (from July
In addition, SICD is encountered in the ICU,
2022 to July 2023).
and its incidence among septic cases ranges from 10 to

70% (2). These discrepancies among studies are mostly
Study population:
owing to the absence of well-established diagnostic
Inclusion criteria included: Patients with age more
criteria. In addition, the epidemiological alteration
than 18 years old; non-cardiac patients with severe
highlights the complicated factors in sepsis: source and
sepsis, which is defined as "life-threatening organ
degree, onset of resuscitation, and therapeutic
dysfunction due to a dysregulated host response to
modalities. Low systolic, diastolic blood pressure and
lower ejection fraction were predictors of SICD.

Additionally, it was demonstrated that; SICD was
Exclusion criteria included:
accompanied by a higher possibility of hospital mortality.
Age <18 years old; patients who didn't match the
Hypoalbuminemia, higher creatinine levels and positive
sepsis criteria; surgical patients; patients with
bacterial culture could be considered as independent
pulmonary embolism; patients with history of cardiac
predictors of SICD (3).
diseases or previous cardiac surgeries such as
Of note, SICD often develops in critically ill
myocardial infarction, angina pectoris, coronary
cases; on the other hand, the clinical manifestations
angioplasty, coronary artery bypass graft (CABG),
and prognostic impact of SICD on sepsis outcomes are
positive stress test for ischemia; admission ECG of
still a matter of debate (4). So, our study aims to
ACS or typical changes of IHD; echo Doppler
investigate if cardiac dysfunction, as evidenced by
revealing cardiac disease as cardiomyopathies, EF >
positive troponin (cTnI) and left ventricular systolic
0.50, significant valvular regurgitant or stenotic lesions
(LVSF) and diastolic (LVDF) functions, can predict
or pericardial disease; and clinical evidence of
bad outcome in non-cardiac cases with severe sepsis
congestive heart Failure.
and/or septic shock.

Received: 16/10/2023
Accepted: 14/12/2023

Full Paper (vol.941 paper# 115)

c:\work\Jor\vol941_116 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 793-798

Executive Function Impairment in Correlation with EEG Finding in
Children with Type 1 DM at School Age
Wesam E. Affia 1, Ashraf Shaheen 1, Asmaa S.M. Said 2, Basma Adel E. Abo Elasaad 3 * and Hanaa Ramadan
Omar 1
1 Pediatrics Department, Faculty of Medicine Benha University, Benha, Egypt
2 Psychiatry Department, Faculty of Medicine Benha University, Benha, Egypt
3 Public Health Ministry, Qutor Hospital Gharbia Governorate, Egypt.
*Corresponding author: Basma Adel E. Abo Elasaad, Email: badel5634@gmail.com, Phone: +201119977616
The age of onset is an important characteristic of type 1 diabetes mellitus, influencing cognitive functions.
Typically, earlier onset is associated with poorer cognitive performance.
Objective: This study aimed to investigate the relationship between type 1 diabetes mellitus and cognitive dysfunction.
Methods: This study included 100 children with type 1 diabetes mellitus (DM) and 20 apparently healthy children.
They were divided as follows: The patient group (Group I) comprised 100 children with type 1 DM and the control
group (Group II) consisted of twenty apparently healthy children. All participants underwent a comprehensive
assessment including history-taking, sociodemographic data collection, general and local examination, and laboratory
investigations. Results: A statistically significant association was found between "start the task" function and gender,
with significantly higher mean scores observed in females (p = 0.003). Participants' weight and height showed
statistically significant negative correlations with the "organized" function (p = 0.043 and 0.009, respectively).
Moreover, the scores of "Block response" and "Working memory" were found to exhibit statistically significant positive
correlations with TLC, RBCs, and Hb levels, while they showed significant negative correlations with HbA1c levels (p
< 0.05). Conclusions: Children with type 1 diabetes mellitus demonstrated notable impairments in various executive
functions, indicating a potential association between glycemic control, EEG findings, and cognitive dysfunction.
Monitoring cognitive function alongside medical parameters could be crucial in managing type 1 diabetes mellitus in
Keywords: Executive function impairment, EEG finding, Children, Type 1 DM, School age.

attention, flexibility, spatial ability and speed of
Type 1 DM is a major subtype of diabetes, once
information processing. Early visual information and
known as juvenile diabetes or insulin dependent
contrast sensitivity are also impaired. In addition,
diabetes, is a chronic condition in which the pancreas
psychomotor speed and reaction speed [4]. Diabetic
produce little or no insulin. Different factors, including
ketoacidosis (DKA) is a very serious complication.
genetics and some viruses, may contribute to type 1
Type 1 DM with DKA performs worse on spatial
diabetes. Type 1 diabetes mellitus account for about 5%
response task [5].
of all diabetic cases and the main feature is insulin
This work aimed to study the relationship between
deficiency and the patients treated with different types
type 1 DM and cognitive dysfunction.
of exogenous insulin (rapid, short, intermediate and
long-acting insulin). Thus it is called insulin-dependent
Study Design and patients: This study was conducted
diabetes mellitus [1].
at the Faculty of Medicine, Benha University Hospital.
Compared with non-diabetic controls, patient with
100 children with type 1 DM patients for this study were
type 1 DM will typically have reduced effectiveness in
recruited from the Pediatric Endocrinology Unit and
the following cognitive area: Intelligence, psychomotor
Clinic of Benha University Hospitals and Tanta
efficiency, information processing speed, visual and
University Hospital. 20 apparently healthy control
constant attention, cognitive flexibility and visual
children were selected from Outpatient Clinic. The
perception. In some patient cognitive dysfunction was
study was conducted through the period from February
characterized by slowing mental speed and flexibility
2023 to July 2023. The children were divided into two
but hearing and memory were spared [2].
groups: Patient group (Group I): 100 children with type
The age at onset is important characteristic of type
1 diabetes and control group (Group II): twenty children
1 for influencing cognitive functions. A worse cognitive
apparently healthy. Current study included both sexes
performance is usually associated with earlier age at
children diagnosed with type 1 diabetes mellitus at age
onset. Example: hearing and memory skills are more
range from 6 to 18 years who were on conservative
affected in pediatric type 1 DM patient with early onset
therapy, while children below 6 years or above 18 years,
than those with late onset. Pathologically, more atrophic
with acute or chronic infections and psychiatric or
cerebral structural changes are found in early onset than
neurological diseases were excluded. All the patients
in late onset. Chronic hyperglycemia is shown to be
were subjected to: Full history taking including the
associated with low executive function and memory,
onset of diagnosis of type 1 diabetes mellitus,
slow fine motor speed and low receptive language
sociodemographic data, general and local examination,
functions [3]. Hypoglycemia is associated with impaired
and laboratory investigations.
Received: 16/10/2023
Accepted: 17/12/2023

Full Paper (vol.941 paper# 116)

c:\work\Jor\vol941_117 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 799-804

Anti-Thyroid Peroxidase Antibody and Segmental Vitiligo
Sara Hamdy Fouad*, Eman El Shashaey Taha El Shahawy,
Nora Mohamed Mostafa Darwish, Khadiga M. El-Hamaky
Department of Dermatology and Andrology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Sara Hamdy Fouad, Mobile: (+20) 01119639034, Email: elshahawy.eman55@yahoo.com

Background: Vitiligo is an autoimmune disease (AID) of the skin, which affects pigment-producing melanocytes and
results in depigmented patches. It has been demonstrated that; anti-thyroid hormones autoantibodies may have a role in
the process of depigmentation among cases with vitiligo.
Objective: To evaluate auto-immunity role in segmental vitiligo (SV) by comparing anti-thyroid peroxidase (anti-TPO)
antibody (Ab) in vitiligo and healthy subjects. To compare anti-TPO Ab in segmental vitiligo and non-segmental vitiligo
(NSV) patients. Patients and Methods: This was a case-control study that comprised 3 groups, 20 patients with SV,
20 patients with NSV and 40 healthy individuals with age and sex-matched controls. Thyroid stimulating hormone
(TSH) and thyroid peroxidase antibody (antiTPO) were measured by enzyme linked immunosorbent assay (ELISA)
technique in each group.
Results: Anti-TPO positivity was demonstrated to be significantly more common in non-segmental vitiligo (NSV) than
segmental vitiligo patients. While TSH level did not differ significantly between groups.
Conclusions: This result suggests that AIDs are more common among cases with NSV than SV. Anti-TPO Ab positivity
is more common among females and among cases with a long duration of vitiligo.
Keywords: Segmental vitiligo, Non-segmental, Thyroid stimulating hormone, Thyroid peroxidase antibody.


Vitiligo is a depigmented dermal lesion developed
This case-control study enrolled 20 patients with NSV,
owing to the extensive loss of melanocytes (1). The
20 patients with SV. Additionally, forty healthy subjects
distinctive lesion is a totally amelanotic, nonscaly,
were comprised as a control group. Cases with
chalky-white macule with well-circumscribed outlines
manifestations of thyroid dysfunctions were excluded.
(2). In recent years, it is classified, based on the
manifestations of macules, into 3 main types, called
All patients were subjected to history taking and general
NSV, SV, and undetermined/unclassified vitiligo (3).
and dermatological examination. Vitiligo lesions were
Vitiligo is now classified as an AID, accompanied
described according to site, symmetry, type, activity and
by genetic and environmental factors in association with
stability. Then, venous samples were withdrawn from
metabolic, free radicals generations and cell detachment
all subjects to measure thyroid stimulating hormone
alterations (2). The degrees of AID are greater in NSV in
(TSH) and thyroid peroxidase antibody (antiTPO) were
comparison with SV, especially concerning thyroid
measured by enzyme linked immunosorbent Assay
disease (4). Different thyroid autoantibodies such as
(ELISA) technique in each group.
thyroid stimulating Ab, anti-thyroglobulin (Tg) Ab and
antiTPO were noticeable in autoimmune thyroid
Ethical approval:
diseases (AITD) (5).
The Mansoura Medical Ethics Committee of the
Till now, the actual mechanism of anti-thyroid
Mansoura Faculty of Medicine gave its approval to
hormone autoantibodies-mediated depigmentation
this study. All participants gave written consent
remains controversial. These comprised the reactions of
after receiving all information. The Helsinki
anti-thyroid hormone autoantibodies with melanogenic
Declaration was followed throughout the study's
enzymes or enzymes comprised in regulation of free
radical generation, which ultimately ends in inhibition
Statistical analysis: Data were analysed by IBM SPSS
of their activity and consequent affection of melanin
Corp, V22.0. Armonk, NY. Qualitative data were
production (6).
represented as numbers and percent. Quantitative data
Cases with NSV were demonstrated to be
were represented as medians and range for non-normal
accompanied by increased anti-TPO Ab, which is of
distribution of data and means ±standard deviation
great sensitivity in terms of AITD diagnosis and
(SD), for normally distributed data after testing
supervision. Moreover, AIDs are frequently associated
normality by Kolmogrov-Smirnov test. P value was
with NSV cases, while cases with SV are not. Such
considered significant when its value was less than 0.05.
outcomes are reinforcing the hypotheses of SV

pathogenesis and NSV is different (7).
This study carried out to evaluate auto-immunity
There was no significant difference among the 3
role in SV by comparing anti-TPO Ab in vitiligo and
groups, regarding gender. Regarding age and body mass
healthy subjects. Also, comparing anti-TPO Ab in SV
index (BMI), there was a statistically significant
and NSV patients was conducted.
difference between SV group and NSV group (Table 1).
Received: 17/10/2023
Accepted: 17/12/2023

Full Paper (vol.941 paper# 117)

c:\work\Jor\vol941_118 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 805-810

Original versus Accelerated Ponseti Techniques in
Treatment of Congenital Talipes Equinovarus
Ahmed A. Moneim Abdel Fatah *, Haitham S. Aboqamr and Elsayed M. Mohamady
Orthopedic Surgery Department, Faculty of Medicine, Benha University, Benha, Egypt
* Corresponding author: Ahmed A. Moneim Abdel Fatah, Email: ahmed.salama@fmed.bu.edu.eg, Phone: +2 01014070377

Clubfoot, a prevalent congenital orthopedic anomaly, demands extensive treatment. Ignacio Ponseti
introduced a non-invasive approach for its management.
Objective: This study aimed to compare the accelerated and traditional Ponseti therapy methods for congenital talipes
equinovarus (clubfoot). Patients and Methods: Sixty infants diagnosed with idiopathic congenital talipes equinovarus
were enrolled in an RCT. Patients were divided into two groups, each comprising thirty individuals. One group
underwent modified accelerated Ponseti therapy with casts applied every three days, while the other followed the
traditional Ponseti method with casts applied weekly. The severity of clubfoot was assessed using the Pirani grading
system, and the Ponseti procedure was employed for casting. Tendo-Achilles tendonitis and tenotomy (TAT) were
monitored, with a six-month follow-up period.
Results: The duration of treatment was significantly shorter in the modified accelerated group (Group II) compared to
the traditional group (Group I) (P<0.001). Group II exhibited greater improvement at six months and one-year post-
tenotomy compared to Group I. Complication and recurrence rates were similar between the groups. The modified
accelerated Ponseti method not only reduced treatment duration but also facilitated in-hospital supervision, alleviating
parental burden. Early identification of issues is possible with this approach. Conclusions: Besides expediting treatment,
the modified method offers the advantage of hospital supervision, reducing parental stress associated with frequent
travel for plaster changes. Complication rates and recurrence were comparable between the two methods.
Keywords: Original Ponseti Techniques, Accelerated Ponseti Techniques, Congenital Talipes Equinovarus, Pirani
scoring system.


There are few congenital orthopaedic disorders as
time. The right foot is somewhat more likely to get
common as clubfoot, a deformity that affects 1-2
clubfoot than the left [5].
percent of live babies and requires substantial therapy.
The exact cause of clubfoot, which can be either
French lexicographer Nicolas Andry defined "Pedis
unilateral or bilateral, remains a mystery. Incorporating
Equinal" as "foot of the horse" in his "Orthopaedicia"
data from both unilateral and bilateral clubfoot patients
(1743). Ankle, pes, equinus, and varus are the Latin
is common in trials, although it is unclear if these
roots of the English term "talips equinovarus," which
examples represent a new condition or two separate
means horselike, plantarflexed, adducted, or inverted [1].
unilateral cases on the same individual [4].
Ancient Egyptian tomb paintings were the first to
Postural clubfoot is not considered a "real"
depict clubfoot, and by 1000 B.C., the condition had
clubfoot deformity because it just impacts the range of
made its way to India, where it was treated. The earliest
motion of the foot and does not hinder normal foot
known written account of the disease dates back to
movement [6]. The difference between idiopathic
Hippocrates, who lived approximately 400 B.C. He
clubfoot and syndromal clubfoot is that the latter
went on to say that strapping and repeated manipulation
usually occurs in conjunction with other abnormalities
are effective therapies, adding that it's important to
rather than alone. Atypical clubfoot, a more severe type
address the disease early on before the deformities
of the deformity, can occur independently or as a sign
become permanent [2].
of another, more systemic disorder [7].
This disease, clubfoot, "the source of which is not
The degree of clubfoot might vary. To evaluate
known, the pathological anatomy of which is equivocal,
the seriousness of clubfoot, researchers employ a
the behaviour of which is uncertain and the therapy of
variety of instruments, including the Pirani and
which remains controversial," as Gartland famously
Dimeglio Scales [8].
stated in 1964. It holds current relevance [3].
In the early 1940s, Ignacio Ponseti developed a
Clubfoot is an umbrella term for a group of
non-operative approach of treating clubfeet [9].
related congenital foot deformities. Idiopathic, atypical,
The current research set out to evaluate the
syndromal, and postural clubfoot abnormalities are all
effectiveness of both the accelerated and traditional
included under this umbrella category. The degree,
Ponseti procedures--one that had been tweaked and one
kind, presence of co-morbidities, and laterality of a
that had been originally developed--in the treatment of
clubfoot are all affected by many factors [4].
congenital talipes equinovarus (club foot).
The term "clubfoot" describes the four different

foot positions: equinus, adductus, varus, and cavus. It
manifests as a bilateral issue approximately 50% of the
This randomised controlled clinical trial took

place at Benha University Hospital outpatient clinic
Received: 16/10/2023
Accepted: 17/12/2023

Full Paper (vol.941 paper# 118)

c:\work\Jor\vol941_119 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 811-814

Serum IL-6/ IL-10 Ratio As A Biomarker for Primary
Open Angle Glaucoma Assessment
Fatma El-Zahraa Mohamed Emad El-Din1*, Enas Sebaey Ahmad 2,
Tamer Ibrahim Mahmoud 1, Osama Mohamed Kamal 1, Ahmed Mohamed Saeed1
1Department of Ophthalmology, Faculty of Medicine- Benha University, Benha, Egypt
2Department of Clinical and Chemical Pathology, Faculty of Medicine- Benha University, Benha, Egypt
*Corresponding author: Fatma El-Zahraa Mohamed Emad El-Din,
Email: zahraemad706@gmail.com, Phone: (+20) 1008700372

Substantial studies have been conducted on the function of interleukin-6 (IL-6) in various eye problems.
While the versatile nature of IL-6 is well-documented, its primary role is to induce inflammation through its cytokine
Objectives: The current work aimed to use serum IL-6 and IL-6/IL-10 ratio as potential biomarkers for primary open
angle glaucoma (POAG) assessment.
Patients and Methods: 40 individuals were enrolled in this case-control study at Benha University hospitals'
Ophthalmology, and Clinical and Chemical Pathology Departments. The participants were divided into two distinct
groups: the case group consisted of twenty patients diagnosed with POAG and the control group included twenty healthy
individuals who did not have glaucoma or any other ocular disorders. The cytokines levels of each participant were
assessed using ELISA kits for serum IL-6 and IL-10.
Results: POAG and control groups showed no significant difference in age and sex. Regarding serum cytokines levels
as diagnostic markers, POAG patients had a higher level of IL-6 and a lower level of IL-10 than control subjects. The
IL-6 /IL-10 ratio displayed significantly higher values in POAG cases than controls. Regarding serum cytokines levels
as prognostic markers, a significantly higher IL-6 level, and IL-6/IL-10 ratio were observed in the severe stage relative
to the mild-moderate stages with no significant difference in the serum IL-10 levels.
Conclusions: It could be concluded that the serum IL-6 and IL-6/IL-10 ratio is potentially useful as biomarkers for
diagnosis and evaluation of the severity of POAG. Consistently monitoring serum concentrations of IL-6 and IL-10
may be used as supplementary laboratory methods in the POAG assessment.
Keywords: Cytokines; Serum Il-6/Il-10 Ratio; Biomarker; Primary Open Angle Glaucoma


Considerable research has been devoted to
Glaucoma is distinguished by the gradual
examining the involvement of IL-6 in a variety of
deterioration of optic nerve head (ONH) retinal
ocular disorders. Despite the well-known versatility of
ganglion cells (RGCs) and axons. Significantly,
IL-6, its principal function remains as an inflammatory
intraocular pressure (IOP) contributes to the disease's
cytokine [6,7]. Glaucoma-associated fibrosis of the
progression.[1] Open-angle glaucoma (OAG) and angle-
human trabecular meshwork (HTM) is predominantly
closure glaucoma are both the two broad categories of
governed by the interplay between transforming
glaucoma which can be primary or secondary diseases.
growth factor beta (TGF- ) and IL-6. Furthermore, IL-
Although OAG accounts for more than 80% of cases
6 has the potential to function as an indicator of
diagnosed in the United States, angle-closure glaucoma
impaired axonal transport in experimental glaucoma.
contributes to a disproportionately high proportion of
Most research has been devoted to IL-6 production in
cases characterized by severe visual impairment.[2]
the eye, although it remains unknown how systemic IL-
OAG is an irreversible, chronic, and progressive
6 contributes to the pathogenic mechanism of
optic neuropathy that is brought on by a confluence of
glaucoma. Anti-inflammatory response as opposed to
numerous contributing factors. Characteristics of this
IL-6 is where IL-10 truly excels [8]. IL-10 promoter
condition include an open anterior chamber, typical
polymorphisms have been linked with POAG
changes of ONH, and corresponding visual field (VF)
susceptibility in numerous ethnic group investigations.
loss. With time, it ends with blindness. The disease is
IL-10 production has been observed to decrease in
usually bilateral but asymmetrical and IOP is a main
glaucomatous individuals carrying the IL-10
modifiable threat element [3]. POAG is the most
haplotypes -1082, -819, or -592. In summary, these
common type. Patients diagnosed with POAG have
results provide support for the idea that the aberrant
been seen to demonstrate dysregulation of systemic
systemic immune environment of individuals with
inflammatory cytokines, including TNF- , IL-1 , IL-4,
glaucoma shows a substantial part in the formation and
IL-6 and IL-12 [4]. These results support the notion that
progress of neurodegeneration [8, 9].
aberrant systemic immunological conditions have a
Glaucoma frequently manifests with a gradual
significant effect on the neurodegenerative process of
onset, and the alterations in both structure and function
glaucoma patients [5].
may remain imperceptible for several years. Despite the
potential for visual abnormalities to be recognized prior
Received: 16/10/2023
Accepted: 17/12/2023

Full Paper (vol.941 paper# 119)

The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 815-825

Assessment of Knowledge, Attitude and Barriers to Practice
Regarding Evidence Based Medicine among Doctors in
National Liver Institute, Menoufia University, Egypt
Menna Allah Saber 1*, Laila Sh. Dorgham 1, Mohamed Ahmed Khedr 2, Sally Waheed Elkhadry 1.
1 Epidemiology and Preventive Medicine Department, and 2 Pediatric Hepatology, Gastroenterology and Nutrition
Department, National Liver Institute, Menoufia University, Egypt.
*Corresponding author: Menna Allah Saber,Email: mennasaber@liver.edu.eg, Mobile:01098937630

Evidence based medicine (EBM) helps physicians to provide patients with the best possible clinical care
through systemically reviewing, critically appraising, and using findings of the clinical research. The essence of EBM
lies in its ability to bridge the gap among scientific knowledge and clinical practice, fostering a patient-centered approach
that ensures informed decision-making and improved health outcomes. Objective: This study aims to assess EBM
knowledge, attitude, and barriers to practice among doctors in National Liver Institute (NLI), Menoufia University,
Egypt. Subjects and Methods: This is a cross sectional questionnaire-based study, included 150 medical staff personnel
from different specialties in National Liver Institute. Data were analyzed utilizing descriptive statistics. Chi-square test,
Fischer's exact test and logistic regression model were used to study factors affecting knowledge scores among the
studied medical staff participants. Results: About one third of the studied participants (37.3%) attended previous
evidence based medicine training. About one third of the participants (36.7%) had good knowledge. Regarding attitude
toward EBM, majority of the participants (91.3%) had positive attitude. The most prevalent obstacles that the
participants in this study agreed upon, were lack of time (62%), lack of clinic facilities (64.7%) and patient preferences
(71.4%) and beliefs (69.3%). Conclusions: Variations in EBM knowledge and attitudes among healthcare professionals
underscore the need for a strict understanding of individual, educational, and contextual factors that shape the adoption
of evidence-based approaches.
Keywords: Evidence based medicine, Knowledge, Attitude, Egypt.

health care. It also increases the quality of health care
Evidence-based medicine has been defined as "the
by preventing major mistakes in the course of treatment,
conscientious, explicit, and judicious use of current best
so generally it can save lives of patients. For healthcare
evidence in making decisions about the care of
providers when they properly use EBM; this will save
individual patients" as reported by Dr. David Sackett (1).
time, increase level and quality of provided medical
Lately, EBM was defined as "The integration of the best
services and increase health professional satisfaction (6).
available research evidence with clinical expertise
Assessment of physicians' knowledge, attitudes,
and patient values" (2).
and practice (KAP) concerning Evidence based
Evidence-based practice refers to providing
medicine may be valuable in determining the extent to
quality care for the patients taking into consideration
which physicians use evidence based medicine in their
patient's choices and behaviors, accessible clinical
day-to-day practice (7). Many studies are carried out to
resources, and relevant and up-to-date scientific
assess (KAP) of healthcare workers towards evidence-
evidence under the supervision and clinical training of
based medicine especially in developed countries (8). In
a healthcare provider (3). Consequently, it provides the
Egypt, relatively few investigations have been
best treatment plan for the specific cases. It was found
performed to explore knowledge of health care
that patients who received treatment based on current
providers toward evidence-based medicine, the ability
research evidence have been shown to have better
to get to and critically appraise evidence and the
clinical results than those who did not (4).
obstacles hindering the development from opinion-
EBM has been a core component of medicine from
based to evidence-based practice (9-13).
both academic and professional perspectives since the
So, this research was conducted to assess
term first emerged officially in 1992(5). This includes
knowledge, attitude of doctors in Menoufia National
EBP, evidence-based health, evidence-based nursing,
Liver Institute in Egypt regarding EBM and the barriers
evidence-based health policy, in study methods, in
hindering its practice. Assessing the knowledge,
medical education and training, and during
attitude, and barriers to practice of doctors at the
internship/residency (5).
Menoufia National Liver Institute in Egypt regarding
EBP is important for improving cases care,
EBM is pivotal for ensuring evidence-based, high-
reducing costs and length of stay in hospital, enhancing
quality patient care, fostering a positive and supportive
cases satisfaction and elimination of unnecessary
culture of EBM, and addressing barriers that may hinder
practices. Its good application provides better health
the integration of evidence-based practices into routine
care with low cost, the clinician reaches the best
clinical care. It ultimately contributes to the continuous
possible solution for his patient by using the best
improvement of healthcare practices and outcomes
available evidence providing the patient with optimum
within the institute. The specificity in specialize health
Received: 12/10/2023
Accepted: 12/12/2023

Full Paper (vol.941 paper# 120)

Type of article: Original The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 826-831

Intratympanic Steroid Treatment in Otitis Media with
Effusion Resistant to Conventional Therapy in Children
Hossam Eldin Mohammed Abdelazeem, Khaled Elhusseiny Mohammed Khdr*, Mohammed Goda Elnems
Department of Otorhinolaryngology, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Khaled Elhusseiny Mohammed Khdr, Mobile: (+20) 01027228290, E-mail: khaledkhedr7@gmail.com

Children's hearing impairment is primarily caused by otitis media with effusion (OME). OME may be
linked to developmental delays, thus early and appropriate therapy of OME avoids hearing and speech impairment in
children. Treatment is still a contentious topic, though.
Objectives: We aimed to assess the efficacy of Intratympanic (IT) steroids for the management of OME resistant to
traditional medical Therapy.
Patients and methods: The study was conducted on 40 patients who had complaints of hearing loss and bilateral
OME that resisted medical treatment lasting at least three months. Under general anesthesia, we performed
myringotomy and ventilation tube (VT) was inserted bilaterally on each patient Then we injected steroid (.5 ml
methylprednisolone 40 mg/mL) into the right middle ear. During the operation and in follow-up visits, once a week
for three weeks in a row.
Results: Resolved OME was 32 (80%) ears with ventilation tube (VT) alone and 38 (95%) ears with ventilation tube
(VT) and steroid injection. This difference was significant (p = 0.043). As regard postoperative complication,
tympanosclerosis was noted in 6 (15%) non-injected ears and one injected ear (2.5%) and the difference was
statistically significant (p<0.05). Also, permanent perforation occurred in two (5%) non-injected ears and one (2.5%)
injected ears, with statistically non-significant difference (p =1.000). While Otorrhea occurred in 4 (10%) non-injected
ears and 5 (12.5%) injected ears, with statistically non-significant difference (p =1.000).
Conclusion: IT steroid injections have been shown to be effective in treating OME resistant to pharmaceutical and
surgical interventions, with a little risk of recurrence and surgical side effects. The best well-known therapeutic
method combines IT steroid injection with ventilation tubes.
Keywords: OME, Glue ear, Secretory otitis media, Tympanometry, VT, IT steroids.

ear infections, which may not respond well to
Considering how much hearing influences our
medicinal or local therapy [7,8].
capacity for communication, hearing may be the most
It is known that systemic steroids can improve
important sense for humans. After all, what sets
hearing in people with inner ear illnesses, Menière's
humans apart from other animals is this amazing
disease, and SSNHL. Higher steroid concentrations in
ability to communicate. According to reports, hearing
the inner ear may be achieved by IT steroid injection,
impairment is becoming the most frequent sensory
all the while preventing systemic adverse effects [9,10].
deficiency in humans and is rising quickly on a global
We aimed to assess the efficacy of IT steroids
scale [1]. The most common ear condition in children
for the management of OME resistant to traditional
and the main factor contributing to hearing loss at this
medical therapy.
time is OME. By the time they are ten years old,

around 80% of kids have had at least one OME
The study was conducted on forty patients aged
episode. The malfunction of the Eustachian tube is
5 to 15 years presented in the outpatient clinic of
essential to the development of OME [2].
Benha University Hospitals during the period of
OME is the main cause of childhood hearing
October 2022 and October 2023. The individuals who
impairment. Because OME may be linked to
were part of the study had to have complained of
developmental delays, early and appropriate care of
bilateral OME and hearing loss, which required
OME avoids hearing and speech damage in children.
medical attention for a minimum of three months. We
OME therapy is still a contentious topic, though [3].
excluded patients with mixed hearing loss, familial
Oral antibiotics, nasal or oral corticosteroids,
muco-ciliary diseases (like Kartagener's syndrome),
antihistamines, decongestants, and mucolytics do not
craniofacial anomalies, and patients with chronic
enhance medium- or long-term hearing and have
medical diseases (DM).
minimal effect on retrotympanic effusion [4].
Tympanometry was used to verify OME, and
Since the healing of myringotomy usually takes
pure tone audiometry was used to ascertain the hearing
only one or two days, myringotomy and fluid
threshold. Preoperatively, the kids had this process
aspiration alone have shown to be ineffectual [5,6].
done over the course of one to four days.
However, the ventilation tube has a somewhat lengthy
The surgeon performed a myringotomy on
4-to 6-month lifespan [6,7].
the anteroinferior quadrant of the tympanic membrane
Additionally, it is frequently associated with a
(TM) while the patient was under general anaesthesia
high incidence of otorrhea and postoperative middle
using a sickle knife. After aspirating the middle ear
Received: 01/11/2023
Accepted: 31/12/2023

Full Paper (vol.941 paper# 121)

c:\work\Jor\vol941_122 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 832-835

Correlation between Thoracic Kyphosis and Shoulder Joint
Position Sense among Health Care Workers
Eman Saad Nabih*, Enas Fawzy Youssef, Dina S. Abd Allah
Department of Physical Therapy for Musculoskeletal Disorders and its Surgery,
Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Eman Saad Nabih, Mobile: (+20) 01019262991, Email: emansaad1228@gmail.com

Healthcare workers especially those dealing with the patient and involved in physical demanding,
intense and repetitive tasks in their practice are more predisposed to work-related musculoskeletal disorders
(WMSDs). These WMSDs lead to prolonged postural abnormality and pain, which negatively affect productivity and
quality of life.
This study aimed to identify the correlation between thoracic kyphosis and shoulder joint position sense
among healthcare workers.
Patients and methods:
A cross-sectional observational study include forty-five participants of both gender with
thoracic kyphosis detected by screening measurements at the start. Their ages ranged from 30-49 years old and their
thoracic kyphotic angle (TKA) ranged according to age into 2 groups: (Group A) their ages ranged from 30 to 39 years
old and (group B) their ages ranged from 40 to 49 years old. All subjects were right-handed. A bubble inclinometer is
used to measure both TKA and joint position sense (JPS) of dominant arm among healthcare workers.
Results: There was a moderate correlation between thoracic kyphosis angle and shoulder flexion and abduction joint
position error (JPE) at r = 0.469 & p = 0.001 and r = 0.462 & p = 0.001 respectively.
Conclusion: Thoracic kyphosis directly affects shoulder joint proprioception. Therefore, dorsal spine assessment
should be considered during evaluation of shoulder joint and vice versa. So better control of the symptoms and better
plan of treatment for preventing the potential disabling condition.
Keywords: Thoracic kyphosis, Thoracic mobility, Shoulder proprioception, Shoulder stability.

acromial impingement syndrome) it was found that
JPS markedly diminished (8, 9).
(WMSDs) have become common between healthcare
workers especially those with high intensity work load
association between increasing thoracic kyphosis and
(1), and those who adapting improper posture during
shoulder range of movements, muscular strength, sub-
the day such as physiotherapist, dentist, surgeon and
acromial distance, and upper extremity function, and
nurses which increase the likelihood postural
reported that there is an inverse relationship between
deformities and dysfunction (2, 3, 4). One of these
thoracic hyper kyphosis and shoulder disorders (5, 10-12).
postural disorders is thoracic hyper kyphosis, which is
Regardless of the strong relationship between
an excessive posterior curve of the thoracic spine (4).
increased thoracic kyphosis and the shoulder complex,
There is an anatomical relation between scapula and
there are few high-quality studies required to fully
thoracic spine as scapula is resting on rib cage
explore the relation between thoracic kyphosis and
posteriorly. Therefore, any change of the thoracic
shoulder joint position sense as it has vital importance
curve beyond its normal ranges alters the scapular
in daily activities.
kinematics, the scapula will be in protraction, anterior

tilting and downward rotation causing shoulder
problems like subacromial impingement syndrome,
This study was a cross-sectional observational
which affects shoulder mobility and stability causing
study. Participants were collected from El Andalusia
activity limitation and impede the quality of life (5, 6).
Hospital in Alexandria, Egypt. The research was held
Most activities of daily living and recreational
between February 2023 to September 2023.
activities rely on joint position sense (JPS) to complete

the task as it gives the majority of shoulder mobility.
Subjects: forty-five participants of both genders with
Proprioceptive deficit can lead to instability, pain and
thoracic kyphosis detected by screening measurements
furthermore injury to the joint so it is important to
at the start. The calculation of the sample size was
assess JPS of shoulder joint as it affects quality of
done by G*Power statistical software (version;
movement which hinders the working tasks and
Franz Faul, Universitat Kiel, Germany).
activity of daily livings (7). As JPS has a substantial
The minimum required sample size for this study
role in the maintenance of shoulder joint stability and
is N=45. Calculation was made using = 0.05, power=
upper extremity function. Numerous studies reported
890%, and moderate effect size = 0.5 (21). Participants
that there is a strong relationship between shoulder
were divided according to age into two groups as their
dysfunction and JPS as in case of shoulder instability
thoracic kyphotic angle varies according to age (13, 14):
and shoulder disorders (e.g. frozen shoulder, sub-
Group A ranged from 30 to 39 years old, and group B
Received: 20/10/2023
Accepted: 20/12/2023

Full Paper (vol.941 paper# 122)

c:\work\Jor\vol941_123 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 836-839

Innovations in Sacral Fracture Management:
A Comparative Study of Open vs Closed Reduction Outcomes
Mohamed Osama Hegazy 1, Hisham ElAshry Hussien 2,
Mahmoud Ahmed Anwar 3*, El tayb Mahmoud Nasser 4
1 Orthopaedic Surgery Department, Faculty of Medicine, Benha University, Benha, Egypt
2 Orthopaedic Surgery Department, Military Medical Academy, Egypt
3Orthopaedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
4Orthopaedic Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
*Corresponding Author: Mahmoud Ahmed Anwar, Email: mhmodzayat31@gmail.com, Phone: +201154054134

Sacral fractures represent a significant challenge in orthopedic trauma care, particularly given their
occurrence in both high-energy traumas in young individuals and low-energy falls in the elderly. The choice between
conservative treatment and surgical intervention, including open reduction and internal fixation (ORIF) versus closed
reduction and percutaneous fixation (CRIF), remains contentious due to varying outcomes reported in the literature.
Objective: This study aimed to compare the clinical outcomes, radiologic healing, functional recovery, and
complications associated with ORIF and CRIF techniques in the treatment of sacral fractures.
Methods: A prospective study that was conducted on 20 patients with sacral fractures who were divided into two groups:
10 patients underwent CRIF, and the other 10 underwent ORIF. Clinical evaluation, radiological assessments, and
functional outcomes were meticulously recorded.
Results: The AO classification showed a statistical significance in fracture types between the groups (p=0.015).
However, operative time and time to operation were not significantly different (p=0.130 and p=0.587 respectively).
Functional outcomes, including sitting, standing ability, and sexual function, which showed no significant differences
(p>0.05). The incidence of complications was low, with no significant differences in outcomes between the two
treatment modalities.
Conclusion: Both ORIF and CRIF were viable options for the treatment of sacral fractures, with no significant
differences in clinical outcomes, functional recovery, or complication rates.
Keywords: Sacral fractures, Open reduction and internal fixation, Closed reduction and percutaneous fixation, Clinical
outcomes, Functional recovery.


Sacral fractures encompass a diverse range of
closed reduction with percutaneous iliosacral screw
injuries that typically occur in younger individuals due
(CRIF) [5].
to vehicular accidents and high falls, or in older,
Papakostidis and colleagues [6], after reviewing
osteoporotic patients as a result of minor incidents [1].
English literature from the past three decades,
Statistics show that sacral fractures are not
determined that there is a lack of definitive evidence to
associated with osteoporosis occur at a rate of 2.1 per
guide clinical decisions for the best treatment approach
100,000 individuals. Meanwhile, fractures related to
for unstable pelvic ring injuries.
osteoporosis are observed in 1­5% of the elderly
This study aimed to evaluate and compare the outcomes
population at risk. Such fractures are common in young
between open and closed reduction techniques in the
adults following incidents involving significant force,
treatment of sacral fractures.
or in older adults and those with osteoporosis after falls

from less significant heights [2].
A majority of research advocates for non-surgical
This prospective study involved 20 individuals with
treatment of sacral fractures, given the ambiguity
sacral fractures that was conducted at Helwan
surrounding the surgical intervention for these injuries.
University Hospital and El-Helmia Military Hospital
Nonetheless, there are studies suggesting that surgical
over a one-year timeframe.
fixation may be necessary for patients with multiple

traumas to avoid systemic complications and issues
Inclusion criteria: Patients without osteoporotic sacral
related to prolonged bed rest [3].
stress fractures, unstable anterior pelvic ring disruptions
Methods for stabilizing such fractures, including
and sacral dysmorphism, or pathological metastatic
open lumbopelvic fixation with traditional iliac screws
sacral fractures.
(LPF), local plate osteosynthesis, trans-iliac bars, and

iliosacral screw fixation (ISF), have been examined
Exclusion criteria: Individuals who declined
extensively [4].
participation, those with osteoporotic sacral stress
The debate continues whether injuries to the
fractures, patients with sacral fractures and unstable
posterior pelvic ring are more effectively managed
anterior pelvic ring disruptions, those with sacral
through open reduction and internal fixation (ORIF) or
dysmorphism from the group receiving percutaneous

Full Paper (vol.941 paper# 123)

c:\work\Jor\vol941_124 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 840-845

Assessment of Parental Knowledge, Attitudes and Practice Towards Antibiotic
Use in Egyptian Pediatric Community, Qalyubia
Mohammad Amin Aly El-Din
Clinical research department, Abou Al Monagga Central Hospital, Qalyubia, Egypt
ORCID number: 0000-0003-1298-7482- Telephone: (+20)01143022043, Email: Mohamed.ali2@pharma.asu.edu.eg

Wrong and too much use of antibiotics are key causes of the worldwide issue of resistance to them.
In Egypt, the number of parents not knowing the correct way to use antibiotics for kids is growing. This mistake
can cause an increase in infections resistant to antibiotics.
Aim: The purpose of this study is to measure what Egyptian parents know and think about antibiotics for kids, and
what they do about it. This can help find misunderstandings and things missed. These findings can then be used to
teach parents. Subjects and Method: This cross-sectional observational study was conducted at Abou Al Monagga
Central Hospital, Qalyubia, Egypt, in December 2023. We gathered this info from 240 parents at Hospital's Pediatric
Clinics. Results: Initial research shows a big hole in what parents know about when and how long to give antibiotics
for kids' infections. Lots of parents like to decide for themselves when to use antibiotics or use ones they have left
over, without asking a doctor. Parents' feelings about antibiotics are different. Some think they're a fast fix for colds
and the flu, even though these are caused by viruses. Behavior shows a worrisome amount of not sticking with the
antibiotics schedule. This leads to unfinished treatments and possible resistance.
Conclusion: There's a big need for special educational plans. They should better parent understanding and thinking
related to kids' antibiotics use. By fixing wrong ideas and increasing obedience to given treatments, we can lessen
incorrect antibiotic use.
Keywords: Parental Knowledge, Antibiotic Stewardship, Qalyubia, Egypt, Antibiotic Misuse.

Numerous studies have looked at parents' attitudes,
A serious concern to Egypt's public health is
knowledge, and behaviors regarding the use of
antimicrobial resistance. Numerous children under the
antibiotics for common pediatric ailments (7). According
age of five were among the 1.27 million fatalities
to a Saudi Arabia (KSA) poll of parents, there are a lot
globally in 2019 that the Global Burden of Disease
of common misconceptions, one of which is that
research estimated were caused by antibiotic resistant
antibiotics work well for viral infections (8). Qualitative
illnesses (1,2). Antimicrobial resistance was common
studies conducted in several low- and middle-income
among Gram-positive, Gram-negative, and candida
nations revealed that parents frequently put pressure on
species in certain Egyptian hospitals. The high rate of
medical professionals to prescribe antibiotics because
resistance to most antibiotics employed, particularly in
they lacked knowledge on the proper use of antibiotics
secondary microbial infections in COVID-19 patients,
(9-11). Few research, meanwhile, have specifically
is concerning, foreshadows a disaster, and necessitates
evaluated the connection between pediatric antibiotic
constant observation to prevent the emergence of new
resistance and parental understanding. Antibiotic use at
strains. An important factor contributing to AMR
the population level and resistance patterns have been
(Antimicrobial Resistance) in Egypt is the overuse and
found to be correlated by ecological analysis (12,13). It is
misuse of antibiotics in both human care and
believed that around 50% of pediatric antibiotic
agriculture. Egypt needs better surveillance systems,
prescriptions are influenced by parents (14). With
public education campaigns about responsible
increased parental information, modeling research
antibiotic use, and better antimicrobial stewardship to
projected a 45% decrease in pediatric antibiotic courses
address this expanding issue (3). Responding to AMR
(15). This shows that by prescribing amounts, parental
requires a multifaceted "One Health" approach
information could have a significant impact on
encompassing human, animal, and environmental
health sectors (4).
One study indicated that there may be a connection
As infections develop more resistant to widely used
between resistance and self-medication with antibiotics
medicines, antibiotic resistance poses an increasing
among juvenile populations, as seen by the carriage of
hazard to public health (5). Developing successful
resistant bacteria in these populations (16). Few
interventions requires an understanding of the factors
research, meanwhile, have examined the relationships
that contribute to resistance. The over prescription and
at the individual level between parental education,
abuse of antibiotics, particularly in pediatric
antibiotic use in children, and resistance transmission.
populations, is one factor that may be involved (6).
Lack of studies measuring these three elements
Pediatric antibiotic use decisions are largely influenced
together represents a significant knowledge gap (17). To
by parents, but little is known regarding the relationship
summarize, while it has been proposed that parental
between parental understanding and community-level
knowledge contributes to pediatric antibiotic resistance
pediatric resistance patterns.
through suboptimal dosing, there is currently little

Full Paper (vol.941 paper# 124)


Comparison between Intubated Video Assisted Thoracoscopic
Surgery and Awake Video Assisted Thoracoscopic Surgery in
Management of Recurrent Pleural Effusion in Suez Canal University Hospitals
Ahmed Fouad Heussein1*, Morsy Amin1, Mohamed Ahmed Amr1, Ramy M. Samir1, El-Sayed Ahmed Fayad1
*Department of Cardiothoracic Surgery, Faculty of Medicine, Suez Canal University, Suez, Egypt
Corresponding Author: Ahmed Fouad Heussein, E-mail: ahmed.Foo24@gmail.com,
Mobile: 01029906329

Pleural effusion is a common clinical disease characterized by pathological fluid accumulation in the pleural
cavity. There are many possible causes of pleural effusion, with congestive heart failure, pneumonia, and malignancy being
the most prevalent in adults. Aim of the work: This research aimed to study the effect of enhancing the accuracy of
diagnosis and decreasing post-operative complications on patients with recurrent pleural effusion.
Patients and methods: This randomized controlled clinical trial study was conducted at Suez Canal University
Hospitals, Cardiothoracic Surgery Department through the period from August 2021 to March 2023. The study included
100 cases who presented with recurrent pleural effusion of unknown origin. Patients were allocated into two groups.
Patients who underwent intubated VATS were in group (A), and those who underwent awake VATS were in group (B).
Results: The intraoperative complications of cardiac arrhythmia and self-limiting subcutaneous emphysema were
insignificantly less frequent in awake VATS group. The postoperative complications including loculated effusion,
prolonged air leakage and expansion defect, empyema and long pleural drainage were non-significantly less frequent in
awake VATS group.
Conclusion: In terms of operative complications and pain after surgery, awake video-assisted thoracoscopic operation
was safer, more accurate, and more effective than video-assisted thoracoscopic operation conducted under general
anesthesia. Additionally, the duration of the operation was shorter. Consequently, it may be the treatment of choice for
all cases, not just those with comorbidities.
Keywords: Intubated and awake Video, Thoracoscopic surgery, Recurrent pleural effusion.

the outcomes & complications of the two procedures to
Pleural effusion is a prevalent clinical condition
determine if there is a clinically significant difference
characterized by abnormal fluid accumulation in the
between them.
pleural cavity. It can develop in various conditions, with

congestive heart failure, pneumonia, and malignancy
being the most common causes in adults (1, 2).
This randomized controlled clinical trial study was
To determine the cause of pleural fluid,
conducted at Suez Canal University Hospitals,
thoracocentesis is performed, which involves analyzing
Cardiothoracic Surgery Department from August 2021
to March 2023 and performed on a total 100 patients
microbiologically. However, this diagnostic procedure
who presented with recurrent pleural effusion of
only results in approximately 60-75% of cases.
unknown origin.
Unfortunately, 25-40% of cases with exudative pleural
Inclusion criteria: Age <18 years. Both genders were
effusion remain undiagnosed even after repeated
included in the study.
thoracocentesis attempts (3, 4).
The underlying causes of exudative effusions differ
Exclusion criteria: Patient with chronic illnesses
across populations, with malignancy & tuberculosis
(Uncontrolled diabetes mellitus, liver cell failure, end
being the most common undiagnosed causes. Hence, it
stage renal diseases & heart failure). Patients with
is crucial to accurately identify the exudative effusions.
coagulation disorders (INR > 1.5) and bleeding diathesis,
A definitive diagnosis is typically achieved through
or anticoagulant therapy. Presence of bronchopleural
targeted biopsy of the pleura (5, 6).
fistula. History of immunodeficiency. History
Video-assisted thoracic surgery (VATS) conducted
tuberculosis. History of intrathoracic malignancy.
under general anesthesia has traditionally been the
Autoimmune disease.
standard approach for these patients. However, in recent
Sample Size justification:
years, the use of local anesthesia with sedation in video-
Sample size was estimated according to the
assisted thoracic surgery operations has been proposed
following equation: 7, 8
to minimize operative risks & allow patients to breathe
n = [(Z/2 + Z)2 × {(p1 (1-p1) + (p2 (1-p2))}]/ (p1 -
spontaneously. This technique enables the treatment of
cases with compromised lung function who cannot
n = [(1.95+ 0.83)2 × {(0.95(0.05) + (0.75(0.25))}] / 0.04
tolerate endotracheal intubation, as well as those with
n = [7.7284 × {0.0475 + 0.1875] / 0.04
poor general health (2, 6). This research aimed to compare
n= 1.816174 /0.04 = 45.4043


Full Paper (vol.941 paper# 125)

c:\work\Jor\vol941_126 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 852-857

The Efficacy of Bleomycin for Treating Keloid and Hypertrophic Scar
Bothaina Mahrous Ghanem, Laila Ahmed Sharaf, Mai Shams El-din Attwa*, Sara Hamdy Fouad
Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Mai Shams El-din Attwa, Mobile: (+20) 01113326277, Email: rosem5078@gmail.com


Background: Keloids are benign fibroproliferative lesions characterized by abnormal collagen deposition within a skin
injury. Keloid occurs as a result of an exaggerated tissue response to skin injury in a genetically-predisposed individual.
Bleomycin is an anti-cancer agent that has been utilized for treating keloids and hypertrophic scars. It inhibits collagen
synthesis and activates apoptosis of fibroblasts.
Objective: To assess the effectiveness and the safety of bleomycin for treating keloids and hypertrophic scar.
Patients and Methods: This was a prospective randomized experimental study, carried out on forty patients with keloid
or hypertrophic scars. Dermatological examination included complete clinical assessment of lesions to determine the
distribution, clinical variants and the extent of lesions. Assessment of keloid was done by Vancouver scar scale (VSS).
The Patient and Observer Scar Assessment Scale (POSAS) were utilized to evaluate the efficacy of treatments. No
recurrence was observed after six months follow up.
Results: Sixty% of the patients were females. The commonest cause for lesions was surgery, there was a significant
improvement in POSAS and VSS after treatment, 52.5% of the patients showed improvement percentage >75% and
other 40% showed improvement percentage 50-75%, 50% of the patients had excellent satisfaction while 42.5% had
good satisfaction, the most frequently reported adverse effect was hyperpigmentation.
Conclusion: Bleomycin is a safe and effective method for treating keloids and hypertrophic scars.
Keywords: Keloid, Bleomycin, Hypertrophic Scar, Vancouver Scar Scale, Patient and Observer Scar Assessment Scale.


Keloids are benign fibroproliferative lesions
This was a prospective randomized experimental
characterized by abnormal collagen deposition within a
study that enrolled forty patients with keloid or
skin injury. Keloid occurs as a result of an exaggerated

tissue response to skin injury in a genetically-
hypertrophic scars attending the Outpatient Clinic
predisposed individual [1].
(OPC) of Dermatology, Andrology and STDs

Department, Mansoura University Hospital.
These lesions are more common in dark-skinned

people and are mainly found in those of African, Asian,
We included patients with keloid or hypertrophic
and Hispanic descent [2]. Keloids can occur at all ages
scars aged between 10 to 50 years. But we excluded
however it is more common in those aged 10 and 30
pregnant or lactating females, patients with previously-
years. Keloids are commonly formed over the sternum,
treated keloid scars (in the previous six months),
earlobes, shoulders, ankles, and/or face [3].
previous allergy from bleomycin injection and with

hepatic, renal or peripheral vascular diseases. Y
There are many available treatments for keloids

including pressure therapy, topical applications, intra-
lesional corticosteroid injection and surgical excision.
Each patient was subjected to personal history
These therapeutic options can be utilized either as
(name, age and gender), complaint analysis, present
monotherapy or in combination [4].
history (Onset, Course, Percentage of body surface area

involved, and Duration of the disease), past history
The treatment of keloid using traditional therapeutic
(autoimmune skin diseases, malignancy, previous
options is challenging. Novel therapeutic options, such
operations), medical history (Drug history, diabetes or
as bleomycin, are gaining great interest and extensive
hypertension), and family history of similar conditions.
use [5]. Bleomycin is an anti-cancer agent that has been

utilized for treating keloid and hypertrophic scars. It
A thorough general examination was done to detect
suppresses collagen synthesis, activates apoptosis of
predisposing factors, co-morbid conditions and to
fibroblasts, and inhibits DNA synthesis [6,7], few studies
have showed that keloids and hypertrophic scars are
examination included complete clinical assessment of
improved by intra-lesional injection of bleomycin [8,9].
lesions to determine the distribution, clinical variants
This study aimed at evaluating the effectiveness and
and the extend of lesions, assessment of keloid by VSS
safety of bleomycin for treating keloids and
hypertrophic scars.


Full Paper (vol.941 paper# 126)

Cover letter The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 858-866

The Effect of Stem Cells Exosomes on Circumvallate Papillae of Albino-Rats
Subjected to Cyclophosphamide Chemotherapy
Radwa S. Megahed*, Dina M. Abd Elkhalik, Medhat A. Elzainy
Oral Biology Department, Faculty of Dentistry, Ain Shams University, Egypt
*Corresponding author: Radwa S. Megahed, Email: Radwadent@gmail.com, Mobile: (+20) 01019044320

: There is an increasing attention towards stem cells exosomes and their regenerative potential, bone-
marrow derived stem cells exosomes was shown to enhance tissue regeneration. Objective: To explore the effect of
bone-marrow derived stem cells exosomes on circumvallate papillae subjected to cyclophosphamide chemotherapy.
Methods: Forty-four adult male albino-rats, weighing between 180 and 200grams were used. Two rats were used as a
source of bone-marrow stem cells exosomes and the rest were divided equally into 3 groups; 14 rats each as follows:
Group I: Control; Group II: Cyclophosphamide group, this group received a single dose (150mg/kg) of
cyclophosphamide intraperitoneal; Group III: exosomes group, this group received a single dose (150mg/kg) of
cyclophosphamide intraperitoneal then after two days, they received single dose of bone-marrow mesenchymal-stem
cells (BM-MSCs)-derived exosomes (100g) suspended in 1ml phosphate buffered saline intraperitoneal. All groups
were sacrificed on day 9 of the experiment. Circumvallate papillae were examined histologically and ultra-structurally.
The inflammatory cell counts and percentage of cytoplasmic vacuolation were statistically analyzed.
Results: A significant improvement in the shape and size of cells of circumvallate papillae was noticed in both epithelium
and connective tissue compared to the samples subjected to cyclophosphamide only, the ultrastructural examination of
the tissues showed significant improvement in all cellular organelles especially nuclei shapes, endoplasmic reticulum
and mitochondria. A statistically significant decrease in inflammatory cells and vacuolation percentage was also revealed.
Bone-marrow derived stem cells exosomes could be considered an effective regenerative treatment for
cyclophosphamide induced circumvallate papillae damage.
Keywords: Bone-marrow stem cells exosomes; Cyclophosphamide; Circumvallate papilla.
budding of the endosomal membranes during the
Mesenchymal Stem cells (MSCs) are immature cells
maturation of multivesicular endosome. They have role in
isolated from various tissues with apparent regeneration
a wide range of physiological and pathological processes.
capacity which makes them useful in the treatment of
Because exosomes have the capability to carry molecular
several diseases in various parts of the body such as bone,
cargos and transfer bioactive components, more studies
blood and neurological diseases. Bone-marrow (BM)
are published recently on exosome-based disease
derived stem cells(1). BM-MSCs are a type of
diagnosis and therapeutics (3).
mesenchymal stem cells that are isolated from bone-
Mesenchymal stem cells or their derivative exosomes
marrow. Its abundance and relatively easy extraction make
could increase Brain-Derived Neurotrophic Factor
them included in many treatments to induce regeneration(2).
(BDNF) expression which is an important growth factor

Stem cell exosomes were first discovered in the early
for the proliferation and differentiation of epithelial basal
1980s. they were defined as nano scale extracellular lipid
progenitor cells into taste bud cells(4). Cyclophosphamide
bilayer vesicles that are secreted normally by many cells.
(CTX) is an important antineoplastic drug with
They are intraluminal vesicles formed by the inward
immunosuppressive action used for treatment of many

Full Paper (vol.941 paper# 127)

c:\work\Jor\vol941_128 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 867-871

Serum YKL-40 Levels in Patients with Rheumatoid Arthritis and
Its Relationship with Disease Activity
Marwa Elbassiouny*1, Basma Elkady1, Zakaria F. Lotfy2, Yasmin Adel1
Departments of 1Rheumatology and 2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Marwa Elbassiouny, Mobile: (+20) 01025565592, Email: dr.marwa.elbassiouny@gmail.com

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune synovitis. The etiopathogenesis of RA
remains unidentified. Nonetheless, autoimmune mechanisms have a role in its pathomechanism. It was reported that the
chronic inflammatory process in RA is associated with synovial proliferation, which is linked to cartilage and bone
resorption. YKL-40 is a primary protein produced from arthritic joints by chondrocytes in vitro and in vivo. It has been
demonstrated that its value is markedly increased in the context of joint disorders such as RA and osteoarthritis (OA).
Objective: This study aimed to evaluate serum YKL-40 concentrations in RA patients compared to healthy individuals
and to investigate the association between serum YKL-40 levels with disease activity in RA.
Patients and Methods:
This study included 35 RA patients with mean age of 42.23 ± 9.94 years, 6 (17.1%) males & 29
(82.9%) females. 35 apparently healthy individuals with mean age of 39.46 ± 8.28 years, 10 (28.6%) males & 25 (71.4%)
females. Laboratory investigations were done. Serum YKL-40 was analyzed and DAS28 was evaluated.
RA cases were linked to a significant increase in YKL-40 levels compared to controls. Serum YKL-40 level
was significantly correlated with RA activity (P=0.001) (DAS28). There were statistically significant increases in Anti-
CCP, rheumatoid factor (RF), CRP, ESR, WBCs and platelet in RA cases than in the controls.
Conclusion: Serum YKL-40 was significantly increased with RA as well as with its activity. It could be used as a valid
marker in the context of RA diagnosis.
Rheumatoid Arthritis, YKL-40, autoimmune, DAS 28.


We aimed to evaluate serum YKL-40 concentrations
Rheumatoid arthritis (RA) is a chronic
in RA patients compared to healthy individuals and to
inflammatory autoimmune synovitis, which influences
assess the association between serum YKL-40 levels
about one percent of population and leads to functional
with disease activity in RA.
disability (1, 2). The etiopathogenesis of RA remains

unidentified. On the other hand, autoimmune
mechanisms have a role in its pathomechanism (3).
The present study was case-control study. Patients
It was suggested that the chronic inflammatory process
were enrolled from the Outpatient Clinics of the
in RA is associated with synovial proliferation which is
Physical Medicine, Rheumatology and Rehabilitation
linked to cartilage and bone resorption (4).
Department, Mansoura University Hospitals during
It has been described that biomarkers of joint
their clinical visits from September 2021 to March 2022.
metabolism and disease activities are important for
The participants of this study were classified into 2
proper follow-up of the disease course in RA cases (5).
groups, 35 RA patients diagnosed according to criteria
It is noted that a lot of biochemical markers of joint
proposed by 2010 EULAR/ACR for classification of RA
disease metabolism in RA patients are evaluated. The
(9), and 35 apparently healthy volunteers of matching
most commonly utilized markers for long-term
ages and sexes were included as control group.
supervision of disease activity have been the erythrocyte
Inclusion criteria: Cooperative patients and established
sedimentation rate (ESR) and the serum C-reactive
RA patients with various disease activity.
protein (CRP) up to now. Novel biomarkers are essential
to predict the course and prognosis of disease and also
Exclusion criteria: Patients with any other autoimmune
to follow the response to treatment (6).
diseases (AID) e.g., SLE, Psoriatic arthritis, Behcet's
YKL-40 is a heparin-binding glycoprotein-39 having a
disease, Ulcerative colitis, primary osteoarthritis,
molecular weight of 40 kDa. It is secreted in the arthritic
pregnancy, malignant tumours, HTN, DM and Cardiac
joint by different cell types. Its name is derived from its
3 terminal amino acids i.e. tyrosine (Y), lysine (K) and
History taking and examination including personal
leucine (L) (7).
history, complaint of the patient, multisystem affection,
It is formed in arthritic joints by chondrocytes in
medication, past history of medical or surgical
humans as well as in experimental studies. Serum and
SF YKL-40 concentrations are increased in joint
disorders, which include RA and OA, signifying that
Laboratory investigations: Complete blood count
YKL-40 could be considered as an inflammatory marker
(CBC), ESR was measured in mm/hr, CRP, was
and also a marker of tissue remodeling, while YKL-40
measured in mg/dl, rheumatoid factor, anti-CCP, serum
isn't detected in the healthy joint (8).
YKL-40 and DAS28 was evaluated.
Serum YKL-40 assessment: 5 ml blood were collected

Full Paper (vol.941 paper# 128)

c:\work\Jor\vol941_129 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 872-880

Role of MR Enterography in Assessment of Small Bowels Diseases: A Review Article
Mohamed Sayed Soliman *, Enas Mohamed Korayem,
Mohamed Mohamed Houseni and Manal Ebrahim Gomaa
Diagnostic and Interventional Medical Imaging Department,
National Liver Institute, Menoufia University, Menoufia, Egypt.
*Corresponding Author: Mohamed Sayed Soliman, Email: dr.mohamedrad90@gmail.com, Phone: (+201001126139)
Magnetic Resonance Enterography (MRE) has evolved as a fundamental imaging modality in the
assessment of small bowel diseases, thanks to its non-invasive nature and the absence of radiation exposure. It offers
detailed visualization of the small bowel's morphology and function, overcoming challenges presented by the bowel's
complex anatomy and physiology. MRE's ability to provide comprehensive insights into various small bowel
pathologies, including inflammatory bowel diseases, tumors, and vascular disorders, underscores its significance in
clinical practice. Objective: This review aims to elucidate the role of MRE in the diagnosis and management of
common small bowel diseases, highlighting its advantages over other diagnostic methods, and discussing the
indications, contraindications, and techniques employed in MRE.
Methods: A comprehensive review of scientific and medical journals was conducted using reputable search engines to
get scientific data on the anatomy and histopathology of the small bowels and MR Enterography indications and
contraindications, and its role in common small bowel diseases compared to other diagnostic methods such as CT and
endoscopy. Only recent, relevant scientific papers were included. Conclusion: MRE has emerged as an essential tool
in the assessment of small bowel diseases and is expected to continue playing a significant role in the future.
Keywords: Crohn's Disease, Inflammatory Bowels Diseases, Post-Chemotherapy Assessment, Small Bowels

MR Enterography: Indications, Contraindications,
MR Enterography (MRE) has become an
and Techniques
indispensable tool in the diagnosis and monitoring of
MRE Indications; MRE is acclaimed for its diagnostic
small bowel diseases. It offers a non-invasive and
precision, especially for conditions such as Crohn's
radiation-free approach to visualize the small bowel,
disease and other inflammatory bowel diseases,
providing comprehensive details about its morphology
marking it as the preferred diagnostic tool. It plays a
and function despite the imaging challenges posed by
crucial role in assessing unexplained small bowel wall
its lengthy and convoluted structure, constant peristaltic
thickening and identifying sources of gastrointestinal
movement, and complex histology [1]. MRE is
bleeding. MRE is instrumental in detecting small bowel
performed using a surface coil and requires both oral
masses, strictures, fistulas, and intestinal abscesses. It
and intravenous contrast, along with bowel preparation
also assesses small bowel obstruction and evaluates
and an antispasmodic agent. It can be conducted
acute abdominal pain in pregnant females. Additionally,
through a wide array of sequences, enhancing its
MRE is used to investigate intestinal wall tears
diagnostic capabilities.
resulting from trauma or injury [1].
Therefore, this research aimed to examine the
MRE role in the diagnosis and ongoing management of
MRE Contraindications; The contraindications for
common small bowel diseases.
MRE are consistent with those for MRI devices,
divided into absolute and relative categories. This
classification ensures patient safety and the
Extensive scientific research was conducted
effectiveness of the diagnostic process [3].
across various scientific and medical journals, websites,
MRE Techniques; In MRE, various methods are
and book publishers using the Google search engine to
utilized to improve the precision of diagnoses:
get scientific data on the anatomy of the small bowels
Coils: Employing an array of multi-coil surface
and and MR Enterography indications and
receivers is a widely adopted practice.
contraindications, and its effectiveness in diagnosing
Oral Contrast Agents: The preference for biphasic
and managing common small bowel diseases compared
oral contrast agents stems from their efficacy in
to other diagnostic methods such as CT and endoscopy.
generating distinct visuals in both T2-weighted (bright)
Anatomy of the Small Intestine: The small intestine,
and T1-weighted (dark) scans, which assist in
which constitutes the most extensive segment of the
evaluating mucosal enhancement and the thickening of
digestive system, spans from the stomach's pyloric
the bowel wall. Commonly, agents such as 0.1% low-
opening to the ileocecal valve. Its length ranges around
density barium suspension (NeuLumEX) and mannitol
6 to 7 meters, while its diameter remains relatively
are used. Recent studies have identified pineapple juice
slim. Small Intestine contain three parts: the duodenum,
as a potent medium for bowel expansion and enhancing
jejunum, and ileum. [ 3].
image clarity, offering the advantage of minimal
artefacts and lacking adverse reactions (Figure 1) [4].

Full Paper (vol.941 paper# 129)

c:\work\Jor\vol941_130 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 881-884

Total Knee Arthroplasty for Treatment of Osteoarthritis of
The Knee with Fixed Flexion Deformity
Mohamed A Khalil*, Elsayed M. Ibrahim, Elsayed M Bayomy
Orthopedic surgery of the Department, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding Author: Mohamed A Khalil, Phone number: +20 120 335 6213, Email: m.abdelghany88@yahoo.com

Fixed flexion deformity (FFD) caused by osteoarthritis is primarily caused by the rigidity and tethering
of posterior soft tissues, particularly the posterior capsule. This results in functional, biomechanical, and gait limitations,
affecting patients' ability to perform daily activities and satisfaction after total knee replacement (TKR). Correcting FFD
is crucial during TKR to improve postoperative outcomes. Knee surgeons use various surgical corrective measures, but
there is no universally accepted approach.
Objective: This study aimed to assess and achieve an effective repair as a sequential stepwise strategy focusing on soft
tissue incisions is recommended over bone cuts.
Methods: The study involved 21 patients with 23 knees, treated at Benha University Hospitals.
Results: The postoperative knee clinical score ranged from 66-93, with a mean of 78.87, and the mean functional knee
score was 78.70. The total knee score, including both clinical and functional scores, was 157.22, ranging from 121-173.
Conclusion: The stepwise approach for addressing fixed flexion contracture in osteoarthritic knees during total knee
replacement has shown significant efficacy in correcting deformity, enhancing postoperative patient satisfaction, and
achieving superior clinical outcomes.
Keywords: FFD, Osteoarthritis deformity, Correction, TKR.

coefficient (r) was used for detection of correlation
Knee flexion deformity is a condition where the
between two quantitative variables in one group.
knee cannot fully extend to 0°, resulting from factors

like ligament contracture, bone impingement, and
posterior capsular contracture [1]. It is caused by
There was a statistical relationship between
synovial inflammation in osteoarthritis, leading to fluid
preoperative and postoperative KSS scores (P value =
accumulation and chronic conditions. Persistent flexion
0.001). Meaning that in all cases included in the study,
deformity evolves as the posterior capsule expands and
the postoperative clinical and functional KSS score was
contracts. A comprehensive physiotherapy regimen is
better. (Table 1).
essential to address this condition. Total knee

replacement is a successful therapeutic approach for
Table 1: Statistical analysis of interpretation
end-stage osteoarthritis [2].
preoperative and postoperative KSS score.

Patients and methods

Mean ± S. D
Inclusion Criteria: The study involved 35 patients
21.39 ± 16.82
aged 60-80 years with knee osteoarthritis, presenting
Knee score
78.87 ±5.79
with fixed flexion deformity exceeding 15 degrees.
36.48 ± 14.39

78.70 ±9.20
Exclusion Criteria: Participants with neoplastic lesion,
58.30 ±25.42
osteomyelitis, infective knee disease, and previous knee
Total score
157.22± 13.19
surgeries were excluded.

Ethical considerations: An informed written consent
was obtained from every patient. The study was
done after approval from The Ethical Committee
Benha University Hospitals (approval code: Ms 9-3-
2022) between March 2022 and December 2022. The
Helsinki Declaration was followed throughout the
study's conduct.

Statistical analysis

Statistical analysis was done by SPSS v28 (IBM Inc.,
Data are presented as mean ± SD and number (%)
Armonk, NY, USA). Quantitative variables were
Out of twenty-one patients, nine patients (39.1%)
presented as mean and standard deviation (SD).
needed blood transfusion of one unit of packed RBCs.
Qualitative variables were presented as frequency and
One knee only needed one step (4.3%), fourteen knees
percentage (%). Pearson or spearman correlation
needed two steps (60.9%), four knees needed three steps
(17,4%), and four knees needed four steps (17.4%).

Full Paper (vol.941 paper# 130)

c:\work\Jor\vol941_131 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 885-888

Anogenital Distance for Detection of Fetal Sex in First Trimester
Tarek Ibrahim Edris 1, Mohammed Abdelsalam Mohamed 1,
Lobna Ahmed Mohamady 2* and Mohammed Anwar El-Noury1
1Obstetrics and Gynecology Department, Faculty of Medicine, Benha University, Benha, Egypt.
2Obstetrics and Gynecology Department, Al-Ahrar Teaching Hospital, Zagazig, Al-Sharqia Governorate, Egypt
*Corresponding author: Lobna Ahmed Mohamady, Email: Lobna.mohamady22@gmail.com, Phone: (+20) 1033663060

The determination of fetal sex in the first trimester has significant implications, not only for familial
curiosity but more critically in sex-linked genetic disorders. Traditional methods range from invasive procedures with
associated risks to non-invasive techniques that may lack universal accessibility or come with high costs.
Ultrasonography in the second trimester, though effective, offers a delayed resolution that may not be ideal for early
intervention in cases of sex-linked diseases. Objective: This study aimed to assess the utility of anogenital distance
(AGD) measurements in the first trimester as a reliable, non-invasive predictor of fetal sex, thereby facilitating earlier
diagnosis and management of sex-linked conditions. Methods: This prospective cohort study was conducted at Benha
University Hospitals' Feto-maternal Unit, 245 pregnant women within 11-13 weeks +6 days of gestation were included.
The AGD was measured via ultrasound, avoiding positional bias, to predict fetal sex.
Results: The study delineated a clear distinction in AGD measurements between male and female fetuses, with males
presenting significantly longer AGD. Optimal AGD cut-offs were established at 4.5 mm for weeks 11 to 12+6 days with
an AUC of 0.967-0.988, indicating high diagnostic accuracy. At 13 weeks to 13 weeks +6 days, a cut-off of 4.9 mm was
identified, with an (Area under the Curve) AUC of 0.928. The predictive accuracy of fetal sex using AGD was
substantiated by a 100% confirmation rate of sex determination in the second trimester and post-delivery.
Conclusions: AGD measurement in the first trimester presents a highly accurate, non-invasive method for early fetal
sex determination.
Keywords: Anogenital distance; Fetal sex determination; First trimester; Ultrasound; Sex-linked genetic diseases;
Prenatal diagnosis.


The determination of fetal sex in the early stages of
challenges in measuring AGD accurately during the
pregnancy has long been a subject of medical interest
early stages of pregnancy and the need for standardized
and research. This interest is not merely academic; it has
practical implications for the clinical management of
considerations surrounding early sex determination
sex-linked genetic disorders and for families with a
necessitate careful consideration, particularly in terms
history of such conditions [1]. Traditional methods of
of consent and the use of this information [6].
fetal sex determination, such as ultrasound, typically
The feasibility and reliability of AGD measurement
become reliable only in the second trimester, around the
for this purpose also require empirical validation.
18th to 22nd week of pregnancy. However,
Previous studies have primarily focused on the
advancements in medical imaging and diagnostic
anatomical and physiological significance of AGD in
techniques have opened the door to earlier
animals and humans, with less emphasis on its prenatal
determination, potentially revolutionizing prenatal care
diagnostic potential. Establishing a clear, evidence-
and the management of pregnancy [2].
based understanding of AGD's applicability in early
The concept of using anogenital distance (AGD) as
fetal sex determination could significantly impact
a biomarker for early fetal sex determination presents
clinical practice and patient care [7-9].
an innovative approach in the field of obstetrics and
In light of these considerations, this study aims to
gynecology. AGD--the measure between the anus and
investigate the use of AGD as a reliable marker for
the genitalia--is a parameter that has been shown to
determining fetal sex in the first trimester of pregnancy.
differ between males and females postnatally, with
implications for reproductive health [3,4]. Extending this
This prospective cohort study has been conducted
metric to prenatal development could provide a non-
on 245 pregnant women admitted at the Department of
invasive, early, and reliable method for gender
Obstetrics and Gynecology, at Benha University
identification. Such a method would be particularly
Hospitals (Feto-maternal Unit) From August 2021 to
valuable for expecting parents and clinicians dealing
December 2022.
with pregnancies at risk of sex-linked diseases, where
early diagnosis can significantly influence treatment
Inclusion criteria were women between the ages of 18
decisions and outcomes [5].
and 35, women who were pregnant with a single fetus,
Despite the potential benefits, the application of
gestational age was 11-13 weeks +6 days.
AGD for fetal sex determination during the first
Exclusion criteria were patients who refused to provide
trimester remains underexplored. Several factors
consent and multifetal gestation.
contribute to this gap in research, including technical


Full Paper (vol.941 paper# 131)

c:\work\Jor\vol941_132 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 889-895

Impact of Sodium Bicarbonate Supplementation on
Serum Alpha Klotho in Chronic Kidney Disease Patients
Howayda A. Elshinnawy, Lina Essam Khedr, Mahmoud Rabie Ibrahim, Marwa Shaban Abdel Samea*
Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Marwa Shaaban Abdel Samea, Mobile: (+20) 01278064363, Email: marwashaaban@med.asu.edu.eg

The course of chronic kidney disease (CKD) is highly connected with the Klotho gene through multiple
pathways, including renal fibrosis, vascular calcification, inflammation, and mineral bone abnormalities.
This study aimed to assess the impact of oral sodium bicarbonate supplementation on blood levels of soluble
-Klotho in patients suffering from chronic renal disease (stage 3b:4) at Ain Shams Specialized Hospital in Cairo, Egypt,
using the CKD-EPI formula.
Patients and Methods:
45 CKD patients were recruited for this interventional, prospective, open-label clinical trial
from the Inpatient and Outpatient Clinics at Ain Shams Specialized Hospital in Cairo, Egypt.
Results: The cohort study had an average age of 48.13 ± 6.96 years. Serum bicarbonate (HCO3) improved from mean
19.74 ± 1.43 mmol/L pre-study to 23.63 ± 3.23 mmol/L post-study, with a p-value of 0.000. Additionally, eGFR
significantly improved with a p-value of 0.000 following the study. Serum alpha Klotho level was 596.30 ± 148.58
pg/mL before the study and 696.16 ± 172.99 pg/mL after the study, with a statistically significant difference of 0.006.
Serum alpha Klotho after the study did not show a statistically significant link with serum creatinine, eGFR, potassium
and phosphorus, or parathyroid. However, serum bicarbonate level and serum Klotho after the study showed a
statistically significant positive correlation.
Serum soluble klotho level was significantly higher post-study compared to pre-study after oral sodium
bicarbonate supplementation and improved acidosis.
Keywords: Sodium bicarbonate supplementation, Serum alpha klotho, chronic kidney disease.


Implication for health policy /practice /research
alpha Klotho. The extracellular domain of TM-Klotho
/medical education:
sheds, resulting in the circulating protein known as
Over 800 million people worldwide suffer from
soluble -Klotho (s-Klotho) (3).
chronic renal disease, a condition that affects over ten
The pathophysiology of CKD MBD involves
percent of the population. Both the proximal and distal
vascular calcification with reduced renal klotho,
kidney tubules' cell surface membranes express the anti-
hyperphosphatemia, vitamin D insufficiency, elevated
aging gene klotho. Even in the initial stages of chronic
renal disease, serum klotho dropped and was
osteodystrophy. Reduced klotho levels in CKD patients
associated with the pathogenic mechanism of CKD.
restrict FGF23 control, leaving hyperphosphatemia as
Recently, variables of circulating klotho modulation
the primary regulator of FGF23 synthesis (4).
have been found, including metabolic acidosis and
When plasma level of bicarbonate concentrations
proteinuria. Thus, using the CKD-EPI formula, we
becomes < 21­23 mmol/L in CKD patients with GFR <
sought to assess the impact of oral sodium bicarbonate
40 mL/min/1.73 m2, the rate of death and the course of
supplementation on blood levels of soluble -Klotho in
the disease increase. The effects of metabolic acidosis
chronic renal disease (stage 3b: 4).
include decreased sensitivity to calcium receptors,
Over 16 million Americans suffer from chronic
mobilization of bases from bones, stimulation of
kidney disease (CKD), a serious health issue that
osteoblasts to create prostaglandins, stimulation of
increases mortality and morbidity. Chronic metabolic
osteoclasts, and decreased osteoblast activity. Alkali
acidosis, which accelerates the course of CKD, is one of
therapy is an attempt to reduce the function of CKD
its consequences. Even in the absence of overt
progression by protecting klotho levels (5).
metabolic acidosis, acid retention can have detrimental
Our study aimed to evaluate the effect of oral
effects (1).
sodium bicarbonate supplementation on soluble -
In 1997, the Klotho gene was discovered to be an
Klotho serum levels in patients with chronic kidney
"aging suppressor" gene. If the Klotho disturbance is
disease (stages 3b and 4) according to the CKD-EPI
overexpressed, it prolongs life and accelerates aging.
formula at Ain Shams Specialized Hospital, Cairo,
Although the control of circulating Klotho is mainly
understood, one of its confounders has recently been

discovered as metabolic acidosis and proteinuria (2).
Renal distal tubule cells express a transmembrane
Study design: 45 patients with chronic kidney disease
(TM) Alpha-Klotho. Fibroblast growth factor-23
(CKD) were recruited for an interventional,
(FGF23), which is in charge of the kidneys' phosphate
nonrandomized, open-label clinical trial from the
management and calcitriol synthesis, is a coreceptor for

Full Paper (vol.941 paper# 132)

c:\work\Jor\vol941_133 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 896-898

Assessment of Hand Hygiene compliance among
Health Care Workers at National Liver Institute, Menoufia University
Amira Mohammed Ahmed Yousef*1, Inas Maged Moaz1,
Azza Mohammed Abd-ElAziz2, Laila Shehata Dorgham1

1Epidemiology and Preventive Medicine Department and 2Clinical Microbiology and Immunology Department,
National Liver Institute, Menoufia University, Menoufia, Egypt
*Corresponding author: Amira Mohammed Ahmed Youse, Mobile: (+20) 01125599029, Email: amirayousef20200@gmail.com

The hands of health care workers (HCWs) are more often the carriers of the germs that cause HAIs.
Therefore, among HCWs, illnesses are frequently linked to poor hand hygiene habits.
Objective: This study aimed to assess hand hygiene compliance among HCWs at Inpatient Departments National
Liver Institute (NLI), Menoufia University.
Patients and Methods:
In this cross-sectional study, hand hygiene compliance of HCWs in NLI at inpatients was
assessed using standardized world health organization hand hygiene (WHO HH) observation check list.
Results: Regarding hand hygiene compliance at different NLI inpatients, HH compliance was the highest among
HCWs of Hepatobiliary surgery inpatient (37.5%) compared to Hepatobiliary pediatric (31.25%) and Hepatobiliary
Internal Medicine inpatient (28.1%).
Conclusion: HH compliance of HCWs at different inpatient departments was low. Education is a major aspect
influencing the practice of HH. Further studies with large numbers of participants need to be conducted for better
Keywords: Hand hygiene, Health care workers, Compliance.


Health care-associated infections (HAIs) impact
hundreds of millions of people globally and pose a
This cross-sectional study was conducted in
serious threat to patient safety. HAIs lead to higher
different departments' outpatients of NLI, including
rates of morbidity and death, length of hospital stay,
Surgery, Pediatrics, and Internal medicine departments.
antibiotic-resistant bacteria, new infectious disorders,
Data were collected from May to the July 2023.
and increased health care expenses (1).
On the day of the observation, the observer chose
Compared to high-income countries, the
the HCWs and the observation time at random.
frequency of HAIs is greater in low- and middle-
Utilised was an observational WHO checklist designed
income nations. The frequency of HAIs in hospitals is
to look for HH compliance. It was divided into two
estimated to be 15.5%, according to studies done in
portions. The first part listed the sociodemographic
low-income settings. This is significantly higher than
details of the HCWs, including department, ward, age,
findings from the United States and Europe (2).
and sex.
Hand hygiene (HH) among HCWs is regarded as
one of the most crucial tactics to lower the frequency
Utilising an observational checklist of a "HH
of HAIs, and consistent HH compliance improvement
opportunity" comprised the second part of the
has been shown to lower HAIs while also being
checklist. This involved practicing HH prior to
economically advantageous. The "my five moments
touching a patient, prior to the aseptic procedure,
for hand hygiene" approach developed by the WHO
following the risk of body fluid exposure, following
outlines the critical times when healthcare
the touching of objects in the patient's surroundings,
professionals should practise HH. These times include
and following the touching of a patient.
before touching a patient, before clean/aseptic
The number of HH actions and opportunities were
procedures, after body fluid exposure/risk, after
documented. Throughout the observation time, the
touching a patient, and after touching the patient's
observer remained in the wardroom or attended the
surroundings (3).
major round, counting all HH acts and HH chances in
Multidisciplinary HH improvement programs
accordance with the WHO's "five moments for hand
must include the gold standard of HH compliance
monitoring. As a result, researching HH behaviour
among HCWs is crucial for managing HAIs and
When the observation began, the observer
organising future HH campaigns (4).
introduced herself to the attending health-care workers
This study aimed to assess HH compliance among
who were in charge of patient care, acquired consent,
HCWs at inpatient departments NLI, Menoufia
and collected data.


Full Paper (vol.941 paper# 133)

c:\work\Jor\vol941_134 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 899-905

Effect of Bundled Interventions to Reduce Surgical Site Infection after
Gynecologic Cancer Surgery: A Randomized Clinical Trial
Hisham A. Abou-Taleb1*, Rabab M Farghaly2, Aya M. Abdelhafez3, Nabila Taha3,
Amal F. Aref3, Ahmed O. Twaisy4, Ahmed F. Abdel-Kawi1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
2Department of Medical Oncology and Hematological Malignancy,
South Egypt Cancer Institute, Assiut University, Assiut, Egypt
3Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt
4Department of Anaesthesia and Intensive Care, Faculty of Medicine, New Valley University, New Valley, Egypt
*Corresponding Author: Hisham A. Abou-Taleb, Mobile: (+20)01003332139, E-mail: hishamaboutaleb1@aun.edu.eg

: Patients can avoid surgical site infections (SSIs), which are a known cause of morbidity and death.
They follow between 10 and 35 percent of gynecologic oncology operations performed globally.
Objective: To assess how bundled therapies affect the reduction of SSI following gynecologic cancer surgery.
Patients and methods:
Between January and December 2019, a tertiary university hospital conducted a single-center
open-labeled randomised clinical study. Fifty women with gynecological cancer procedures were recruited in the trial
and were randomly assigned in a 1:1 ratio to either bundled care (group I) or normal hospital care (group II). Overall
surgery site infection was the main result, while duration of hospital stays and readmissions were the secondary
results, etc. Results: The overall infection rate was 20% in group I and 64% in group II (p= 0.002). The length of
hospital stays; was 4.68 ± 3.437 days in group I and 8.48 ±7.171 days in group II (P= .021).
Significant decreases in SSIs and length of hospital stays following major gynecologic cancer surgery
were linked to the SSI reduction bundle.
Implementation of the bundled interventions in gynecologic oncology patients as a routine care
and further studies are needed to generalize the results of the current study.
Keywords: Bundled interventions, SSIs, Gynecologic cancer, Gynecological surgery.

Study population
SSIs are one of the surgical complications;
Women who had undergone surgery for
defined as infection occurring after surgical
gynecologic cancer were invited to take part in the
procedures. Between 10 and 35 percent of gynecologic
research. Women with immunocompromised illnesses,
oncologic procedures result in SSI (1). The removal of
severe chronic disabling diseases, or septic focus
hair, normothermia, glycemic management, and
infections, were not allowed to participate in the study.
perioperative antibiotic administration protocols are all
In addition, ladies who were sensitive to chlorhexidine
well adhered to, yet they have not been shown to
gluconate and those who declined to take part in the
reduce the incidence of SSIs. This suggests the need
research were not included.
for further evidence-based therapies to improve SSI

Sample size
The impact of bundled efforts on SSI rates
Using the Open Epi software programme, version 2.3.1
after surgery for gynecologic cancer is still poorly
(Epi-infoTM, CDC, and USA. 2016), the sample size
understood, and the results of the individual studies on
was determined. According to earlier research, 35% of
the impact of care bundles on SSIs are inconsistent (3,4).
infections occur with routine treatment. With a two-
The application of bundled care was not reported to be
sided 2-test with of 0.05, it was estimated that a
applied on oncologic surgery in the setting of the
50% difference with the use of bundled care would be
current study; so, this would be implemented to assess
clinically significant. To detect a 50% difference in the
the effect of the bundled intervention on reducing SSI
infection rate with bundled intervention, a minimum
among gynecologic oncologic surgery.
sample size of 50 women was required, and 80%
The study's objective was to assess how
power was needed [Odds Ratio=0.02].
bundled therapies affected the risk of SSI following

gynecologic cancer surgery.

After evaluation and disclosure of the trial, the
participating women were randomised in a 1:1 ratio to
Between January and December 2019, a
either bundled care (group I) or normal hospital
tertiary university hospital conducted a single-center
treatment (group II) for evaluating surgical site
open-labeled randomised clinical study.
infection within the 30-day postoperative period. A

computer-generated table of random integers with


Full Paper (vol.941 paper# 134)

c:\work\Jor\vol941_135 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 906-914

Omentopexy versus Non-Omentopexy after Sleeve Gastrectomy:
A Randomized Controlled Trial
Mohamed E Abd El-latif, Mohamd A Sehsaha *, Gamal El E Saleh, Haytham S Afify
General Surgery Department, Faculty of Medicine, Banha University, Banha, Egypt
*Corresponding Author: Mohamd A. Sehsaha, Phone number: + 20 128 303 2929,
Email: mohamedsehsaha25@gmail.com

Laparoscopic sleeve gastrectomy has been a common method performed exclusively for morbidly obese
cases as an achieving weight loss means.
Objective: We aimed to compare outcome of omentopexy versus non-omentopexy in reducing of bleeding after sleeve
Patients and Methods: This prospective randomized controlled trial was conducted on 64 morbid obese patients aged
from 30 to 55 years old, both sexes, with body mass index (BMI) above 40 and were fit for general anesthesia and
accepting participation in the research. Participants were randomly allocated into two equal groups; group A were
morbid obese participants underwent omentopexy after sleeve gastrectomy and group B were morbid obese participants
underwent non-omentopexy after sleeve gastrectomy.
Results: Sex was significantly different between both groups with more prevalence of females in group A. The operative
time was significantly prolonged in group A in contrast to group B. Regarding the postoperative weight, and BMI
change, the cases body weight in both group A and B was significantly reduced during follow up (P<0.001). When
comparing between both groups, the weight, and BMI at 1, 3, 6 and 12 months was significantly decreased in group A
in contrast to group B (P<0.05).
Conclusions: The results detected that although the procedure in group A was more time-consuming, it may have
yielded superior long-term control overweight and BMI while maintaining comparable safety profiles.
Keywords: Omentopexy: Non-Omentopexy: Sleeve Gastrectomy; Operative Time.


Laparoscopic sleeve gastrectomy (LSG) has been a
Several approaches have been proposed to mitigate
common method done exclusively for morbidly obese
the occurrence of leakage and bleeding during staple
patients as an achieving weight loss means. In recent
line reinforcement (SLR), including buttressing the
years, its ascendancy as the preeminent bariatric
staple line or oversewing it with biological and
procedure has been attributed to its ability to preserve
synthetic materials. Its potential benefit was
gastrointestinal continuity and its comparatively
demonstrated by studies that evaluated its efficacy [5].
straightforward nature [1].
SLR is the subject of considerable debate and is
Leakage and hemorrhage are two significant
strongly advised by the majority of surgeons as a means
complications that are specifically linked to LSG.
to minimize postoperative complications [6]. Primarily,
Gastric leakage is the most dreaded complication
the greater curvature dissection of the staple line or
following SG; it occurs most frequently at the upper
stomach can induce bleeding. In an effort to reduce
staple line in close proximity to the gastroesophageal
SLB, numerous techniques have been applied, such as
junction. Failure to promptly and aggressively identify
suturing and buttressing material [7].
and treat this complication may result in the
We aimed to assess outcome of omentopexy versus
development of severe abdominal sepsis, potentially
non-omentopexy in bleeding decreasing of after sleeve
escalating into chronic gastric fistula or multiorgan
failure, ultimately culminating in the patient's demise [1].

Over the past decade, LSG has been refined to be
safer and more effective than alternative bariatric
This prospective randomized controlled trial was
surgeries; numerous procedures have been identified to
carried out on 64 morbid obese participants admitted to
reduce postoperative complications like leakage and
the General Surgery Department, Benha University
bleeding [2].
Hospitals of both sexes, aged from 30 to 55 years old,
Several complications are frequently observed
with body mass index (BMI) above 40 and were fit for
following LSG, including leakage (with an incidence of
general anesthesia. The study lasted from November
2.2 %) and bleeding (with an incidence range of 0--
2022 to November 2023.
4.4 %) [3]. Although surgical intervention may be
Exclusion criteria were all patients < 30 or > 55
required in certain severe cases--for instance, to avoid
years old, with BMI < 40, and with previous gastric
a severe hemorrhage or to block a persistent leakage site
surgeries history, cases demanding concomitant method
following stent insertion--these complications are
(hiatal repair, or cholecystectomy) or with severe
typically manageable conservatively, without the need
gastroesophageal reflux disease (GERD) symptoms
for revision surgery [4].

Full Paper (vol.941 paper# 135)

c:\work\Jor\vol941_136 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 915-922

A Comparative Study between Postoperative Arrhythmia Between Bilateral
Trans-Septal Approach and Left Atriotomy in Mitral Valve Surgery
Ahmed Ibrahim Mohamed Ali Wardy*, Morsy Amin Mohamed, Mohamed Ahmed Amr, El-Sayed Ahmed Fayad
Department of Cardio-Thoracic surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
*Corresponding authors: Ahmed Ibrahim Mohamed Ali Wardy
Email: dr.ahmedwardy@gmail.com, Mobile: +201117633345

Although the intra-septal method offers better access to the mitral valve, there are concerns over the increased
likelihood of postoperative atrial fibrillation and full heart block.
Aim: To compare incidence of postoperative arrhythmia between bi-atrial trans-septal approach and left atrial approach in
mitral valve surgery, to improve outcome and quality of life to reduce morbidity and mortality.
Patients and methods: This comparative prospective clinical trial was done in Cardio-Thoracic Surgery Department and
Clinic in Faculty of Medicine in Suez Canal University Hospital for Health Insurance and Ismailia Medical Complex. This
study included 100 participants who were separated into 2 groups: group A: 50 patients who were going to have trans-septal
approach and group B: 50 patients who were going to have left atriotomy.
Operative details of the studied groups found that the mean cross-clamp time in trans-septal group was statistically
significantly higher than in left atriotomy group (p=0.020). The mean CPB time in trans-septal group was statistically
significantly higher than in left atriotomy group (p=0.022). Postoperative assessment of the studied groups found that the
mean EF in trans-septal group was statistically significantly higher than in left atriotomy group (p=0.015).
Conclusion: The findings of our trial demonstrate that compared to left atriotomy, the TS approach was linked to longer
pump as well as cross-clamp times, as well as an increased risk of postoperative atrial fibrillation, pleural effusion,
postoperative mean EF, and mean duration of inotropic use.
Keywords: Mitral Valve diseases, Postoperative Arrhythmia, Bilateral Trans-Septal Approach, Left Atriotomy.

stress who develop hemodynamically severe arrhythmias
An irregular or aberrant heartbeat is known as
require medication in order to return to a stable clinical
dysrhythmia or arrhythmia. Bradycardia is when the
position. The highly specialized cells known as cardiac
heartbeat is too slow, whereas tachycardia is when it is
myocytes are in charge of both mechanical contraction
too rapid. While palpitations and dizziness are common
and electrical impulse conduction. Some myocytes
symptoms of arrhythmias, many of them can have more
exhibit automaticity, which is characterized by the cardiac
dangerous outcomes, such as unexpected death. One of
cells' capacity to spontaneously depolarize during diastole
the main causes of morbidity following heart surgery is
and to generate an electrical impulse in the absence of an
arrhythmias, which are a recognized complication. In the
external electrical stimulus (3).
One of the most common valvular heart conditions
tachyarrhythmias can both manifest (1).
is mitral valve disease, which requires surgery to replace
The most prevalent abnormality of the heart rhythm
or repair the mitral valve. When removing a previously
is atrial fibrillation. Although postoperative atrial
implanted synthetic valve prosthesis or calcifying the
fibrillation frequently resolves on its own, it may need to
original valve, good exposure is definitely necessary for
be managed with anticoagulant medication and either
mitral valve operation (4).
rhythm or rate control. Ventricular arrhythmias and
The tiny size of the left atrium and the substantial
conduction abnormalities, however, are also possible. If
enlargement of the right ventricle may make mitral
there are no reversible reasons, sustained ventricular
visualization insufficient. Previous heart surgery may also
arrhythmias during the recovery phase following heart
make mitral valve exposure more difficult because of the
surgery may require immediate care as well as a long-term
likelihood of adhesions and decreased movement in the
preventative approach (2).
surrounding tissues (5).
Arrhythmia management involves targeted therapy
For the majority of surgeons, the typical procedure
for the arrhythmia itself in addition to addressing
is conventional left atriotomy. However, when there are
temporary and modifiable underlying factors. The clinical
simultaneous surgeries requiring right atriotomy, when
appearance of the arrhythmia determines the type and
the left atrium is small, or when adhesions from prior
urgency of the necessary therapy. When self-terminating
procedures exist, the trans-septal [TS] method may
arrhythmias occur after a brief stressful episode and there
provide greater exposure to the mitral valve. However,
is no obvious heart illness, they frequently require no
despite all of the benefits that the TS method provides,
treatment at all. Conversely, individuals under critical
there is still debate over its results (6).

Full Paper (vol.941 paper# 136)

c:\work\Jor\vol941_137 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 923-928

Serum Lipocalin-2 in Patients with Psoriasis Vulgaris in
Relation to Itching and Psoriasis Severity
Sara Hamdy Fouad1, Mona Antar Areda1, Khadiga M. Hasanin2, Mohamed Khaled Selim1
Departments of 1Dermatology, Andrology and STDS,
2Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*Corresponding author: Mona A. Areda, Mobile: (+20) 01069132580, Email: aredamona@gmail.com

Psoriasis vulgaris (PV) is a chronic immune-mediated inflammatory skin lesion, which affects
approximately 2.5% of the populations. It is featured by erythematous plaques covered with silvery scales, in
particular over the extensor surfaces, scalp, and lumbosacral region. Lipocalin-2 (LCN2) is a secreted protein
belonging to the lipocalins superfamily. LCN2 stimulates neutrophils to release pro-inflammatory cytokines; IL-6, IL-
8, TNF- , and IL-1 , via activating the 24p3R receptor on the cell surfaces.
Objective: To assess the possible relation between serum lipocalin-2 levels and the degree of itch in psoriatic cases in
relation to psoriasis severity.
Patients and Methods: The current study was a case-control study that included 60 patients with PV and 60 healthy
controls (HC) of matched age and sex. The dermatological examination included examinations of site, size,
distribution of lesion, assessment of disease severity by Psoriasis Area and Severity Index score. Serum LCN2
concentrations were measured by specific ELISA kits.
Results: The median Psoriasis Area and Severity Index (PASI) score among patients was 25.2 ranging from 5.7 to
56.4. All cases experienced itching. LCN2 was significantly increased among cases compared to the controls. No
significant correlation was detected between LCN 2 and body mass index or PASI score. Higher levels of LCN2 were
detected in patients experiencing severe itching than those with mild to moderate itching.
Conclusion: The current study concluded that lipocalin-2 was markedly increased among psoriatic cases compared to
psoriatic free ones. Also, lipocalin-2 seemed to have a positive correlation with psoriasis degree of itch in cases with
PV but not with disease severity by measured PASI score.
Keywords: Psoriasis, Lipocalin-2, Erythematous Plaques, Psoriasis Area and Severity Index.

levels and the itch degrees among psoriatic cases in
Psoriasis vulgaris (PV) is considered as a chronic
relation to psoriasis severity.
proliferative and inflammatory skin lesion which has

incompletely understood etiology (1). It is featured by
itching sensation in about 75% of cases (2). Itch has
The current study was a case-control study that
been associated with major distress in psoriatic cases,
included 60 psoriatic cases and 60 healthy controls of
not only by interfering with life quality but also by
matched age and sex. The study was conducted on
worsening exanthema owing to scratching (3).
Egyptian patients attending the outpatient clinic of
Itching in cases of PV is frequently neglected and
Dermatology Department, Mansoura University
isn't considered in disease management. Potential
Hospitals, between January 2022 and December 2022.
mediators of itch in PV involve histamine, opioids and
This study included patients with uncomplicated
chronic plaque psoriasis from both genders and aged
LCN2, a protein secreted primarily by triggered
between 18 to 60 years with or without previous
neutrophils, is accompanied by neurodegeneration,
treatment, while the control group included subjects
without any prior history of psoriasis lesions and
Additionally, LCN2 is a secreted glycoprotein member
matching with patient group in age and sex. But we
belonging to lipocalins superfamily. (6).
excluded cases with associated conditions such as
LCN2 could participate in PV pathogenesis by
diabetes mellitus (DM), asthma, malignant tumour, or
modulation of neutrophil activities, such as neutrophil
any other diseases were ruled out from the study.
infiltration, migrations, and stimulation, inducing
neutrophils to produce pro-inflammatory mediators (7).
All cases were subjected to full history taking
In addition, LCN2 has been demonstrated to be
comprising personal history (name, age, Sex, address),
accompanied by a higher possibility of metabolic
history of current illness (onset, course, duration and
syndrome development among cases with PV (8).
predisposing factor for the disease), past history (other
Moreover, cases with PV were associated with a
autoimmune diseases as thyroiditis), medical history
significant increase in LCN2 value compared to PV
(drugs as corticosteroids and immunosuppressives),
free ones (9). As a result, LCN2 could be a possible
and family history of similar skin conditions. All
target in the context of PV management (10). So, our
patients were subjected to general examination to rule
study was done to correlate between serum lipocalin-2
out any chronic diseases, which could interfere with
the results. Dermatologic assessment included
Received: 18/10/2023
Accepted: 18/12/2023

Full Paper (vol.941 paper# 137)

c:\work\Jor\vol941_138 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 929-931

Visual Outcomes of Glaucomatous Patients after Phacoemulsification
Mohamed Salah Hamed Mohamed1*, Amr Mounir Mohamed1,
Mahmoud Mohamed Farouk1, Ahmad Mostafa Ahmad1
1Department of Ophthalmology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding Author: Mohamed Salah Hamed Mohamed
Email: Mohsalah513@gmail.com, Mobile: (+20) 01005473113
Angle closure glaucoma represent one of main causes of irreversible visual loss due to optic atrophy
caused by too high intra ocular pressure.
Objectives: The current study aimed to assess visual outcomes of glaucomatous patients after phacoemulsification.
Patients and methods: Twenty individuals with primary angle closure glaucoma (PACG) and cataract grade II or
higher were included in this investigation. Every participant had a thorough eye examination and had their visual
acuity measured either before or after surgery. Uncorrected visual acuity (UCVA) and best corrected visual acuity
(BCVA), presented as a logarithm of the minimum angle of resolution (logMAR), were the primary research outcome
Results: Regarding mean baseline and follow up values of UCVA of the phaco group, the mean baseline was (1.03 ±
0.187), at 1 week was (0.66 ± 0.187), at 1 month was (0.63 ± 0.192), at 3 months and 6 months was (0.60 ± 0.145).
Regarding mean baseline and follow up values of BCVA of the phaco group, the mean baseline was (0.86 ± 0.252), at
1 week was (0.50 ± 0.182), at 1 month was (0.46 ± 0.154), at 3 months and 6 months was (0.45 ± 0.147).
Conclusions: Phacoemulsification in cases with primary angle closure glaucoma is connected to improved UCVA and
BCVA up to 6 months follow-up.
Keywords: UCVA, BCVA, glaucoma, Phacoemulsification


2021 and December 2022. A single surgeon (M.S.)
Angle closure glaucoma represent one of main
carried out every surgery.
causes of irreversible visual loss due to optic atrophy

caused by too high intra ocular pressure (1,2).
Exclusion criteria included patients with previous
In its current form, cataract extraction has been a
glaucoma and cataract surgery, ocular or intraocular
safe and successful procedure for many years.
Numerous studies have shown that the removal of
pathology, patients who lost follow-up, and patients
cataracts may potentially have a clinically important
with advanced glaucoma (30-2 Humphery visual field
role in the management of glaucoma. The only known
analysis yields a mean deviation score >12 on the visual
effective way to manage the risk factor for glaucoma is
field score).
to lower intraocular pressure, which is achieved by lens
Every research participant had a thorough eye
extraction (3).
examination and had their visual acuity measured either
Surgery for glaucoma may hasten the evolution of
before or after surgery.
cataracts, and combining the two procedures may raise
Uncorrected visual acuity (UCVA) and BCVA,
the incidence of structural alterations and problems after
presented as logMAR, were the primary research
surgery (4). It might be difficult to decide whether to get
outcome measurements.
cataract surgery alone or combine glaucoma with

surgery (4,5). Pentacam may be used for safe, noncontact
Ethical Considerations: This study was ethically
glaucoma screening, except for eyes with plateau iris
approved by Department of Ophthalmology, Sohag
configurations. Postoperative corneal biomechanics
University, and the Faculty of Medicine's
results may be affected by variations in surgical method
Institutional Review Board (IRB) and registered in
The Pan African Clinical Trial Registry
Pentacam offers both qualitative and quantitative
evaluation of anterior segment structures relevant to the
consent of all the participants was obtained. The
pathophysiology and structural variations of glaucoma,
study protocol conformed to the Helsinki
as well as the effectiveness of various therapeutic
Declaration, the ethical norm of the World Medical
strategies (8).
Association for human testing.
The purpose of the present research was to assess

Statistical analysis
STATA version 17.0 (Stata Statistical Software:

Release 17.0 College Station, TX: StataCorp LP.) was
utilized to analyze the data. The terms mean, standard
This study included a total of 20 cases with primary
deviation, median, and range were utilized to describe
angle closure glaucoma and cataract grade II or higher,
quantitative data. Student t-test data analysis was
attending at Department of Ophthalmology, Sohag
utilized to compare the means of the two groups. The
University Hospital, during the period from January
Mann-Whitney test was used to compare both groups

Full Paper (vol.941 paper# 138)

c:\work\Jor\vol941_139 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 932-939

Correlation between the Degree of Forward Head Posture and
Hamstring Muscles Tightness in Non-Specific Neck Pain
Holy Shaker Iskander Naroz*, Nadia Abd El Azeem Fayaz,
Salwa Fadl Abdelmegeed and Dina Mohamed Ali Al Hamaky
Department of Physical Therapy for Musculoskeletal Disorders and Its Surgeries,
Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
*Corresponding author Holy Shaker Iskander, Mobile: (+2)01275020045,
Email:holynaroz3@Gmail.com, Orchid ID 0009-0006-3365-9129.
Anterior translation, also recognized as Forward Head Posture (FHP), is a pathology that happens when the
head moves forward from the vertical line of gravity. FHP can cause significant problems, such as fascial stretching at the
lower cervical level, shortening of the upper cervical segment, hamstring tightness, and back fascial limitation at the
hamstring and calf muscles levels.
Aim of this study: This study aimed to determine the correlation between forward head posture and hamstring, calf muscles
Methods: The study involved 84 university students of both sexes, with a mean age of 21.96 ± 2.25 years for males and a
mean age of 22.05 ± 2 years for females, and a mean BMI of 22.32 ± 1.68 kg/m2 for males and a mean of 22 ± 1.7 kg/m2 for
females. The sample size included only those with a craniovertebral angle (CVA) measurement of less than 490, which was
determined using the photogrammetry method. The study was conducted to establish the degree of correlation among FHP
and hamstring-calf muscles by using the active knee extension test (AKE test), as well as the passive straight leg raise test
(PSLR) for hamstring muscles tightness using the ankle dorsiflexion with the knee extended (ADFKE), in addition to ankle
dorsiflexion with the knee flexed (ADFKF) for calf muscles tightness.
Results: There was a weak significant direct correlation (r=0.300, p=0.034) between CVA and right hamstring tightness as
measured by PSLR in males with a normal BMI.
Conclusion: Forward head posture (FHP) weakly correlates with hamstring tightness in males with normal BMI, therefore
treatment program should include hamstring muscles stretching.
Keywords: Craniovertebral angle (CVA), Forward head posture (FHP), Hamstring muscle tightness, Flexibility, Calf
muscles tightness.

balance control because of the overall activity of posture
maintenance muscles 6. FHP negatively impacts
The spinal deformity most commonly observed is

FHP, occurring when the head is translated in front of the
the autonomic nervous system's functions and disrupts
vertical line of gravity in the sagittal plane by 5 cm1. It is
cervical sensorimotor control 7. Chronic tension
known that the prevalence of FHP in computer-based
headaches (CTTH), which can be extremely
workers is 66%, and an increasing number of teenagers
incapacitating, are a common symptom of FHP, inducing
worldwide are using electronic devices for extended
postural abnormalities. The degree of FHP affects the
periods, which can cause musculoskeletal pathologies such
severity of both CTTH, muscle shortening and increases
as reduced postural control, forward translation of the
myofascial trigger point activity (MTrPs). Addressing
body's center of gravity (COG), and impaired balance 2.
FHP is essential for preventing these long-term effects 8.
Continuous usage of smartphones and laptops can also lead
The hamstring muscles are a group of three muscles,
to malalignment of the head and neck 3.
semimembranosus, semi-tendinosis, along with biceps
The cervical lordotic curve is mandatory for efficient
femoris. The hamstring muscles are two-joint muscles
mastication, breathing, vocalization, eye movement, gaze,
located at the posterior thigh that cross both the hip and
tolerating compressive loads, mimicking stress on the
knee joints, allowing for hip extension and knee flexion 9.
vertebral end plate, and absorbing shocks during walking
However, studies have shown that there is a high
and running. Loss of normal cervical curvature affects all
prevalence of 68% among college students who have a
of these functions 4.
hamstring score of 300 to 450 on the AKET test, which is
Young adults with FHP may experience chronic neck
considered a moderate tightness, who are between the ages
pain, a reduction in the normal curve of the neck, and
of 18 to 25 years 10. Extended periods of sitting during
radicular symptoms for the upper limb due to anterior
work can cause tightness in the hamstrings for 90% of the
translation of COG, flexion, stretching of the lower
population, and 85.75% of office workers who work for 6-
cervical spine, and disc pathology 5. Static balance control
8 hours a day experience hamstring tightness. This can
is affected more significantly by FHP than dynamic
greatly decrease flexibility in the hamstring muscles as
time goes on 11.
Received: 18/10/2023
Accepted: 18/12/2023

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c:\work\Jor\vol941_140 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 940-949

Cardiac MRI Findings in Symptomatic Post Covid Patients with Suspected Myocarditis
Hager I Allam, Mohamed H Sabra *, Khaled E Elrabbat, Mahmoud S Abd El-Moneum
Cardiovascular Medicine Department, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding Author name: Mohamed H Sabra,
Phone number: +20 101 754 9995, Email: Msabra@ymail.com
Cardiovascular magnetic resonance (CMR) imaging, considered the gold standard for myocarditis
diagnosis, presented conflicting results on the prevalence of COVID-19-associated myocarditis.
Objective: This study aimed to describe CMR findings in patients with active COVID-19 infection within three months
of infection and who had suspected acute myocarditis. Patients and Methods: This was a multi-center cross-sectional
study that comprised adult patients with COVID-19 and clinical suspicion of associated myocarditis. Evaluation
encompassed history, clinical examination, laboratory investigations, ECG, echocardiography, and CMR using the
revised Lake Louise Criteria 2018 for myocarditis diagnosis. Participants (n=100) were divided into three groups based
on CMR findings (Group I (n = 6); no myocarditis, Group II (n = 63); suspected myocarditis, and Group III; proved
myocarditis. Notably, Group III (n = 31) exhibited distinct characteristics.
Results: A multivariate analysis showed that chest pain, ferritin levels, and LAVI significantly predicted proved
myocarditis after adjusting the other confounding factors.
Conclusions: Active COVID-19 infection within three months showed a high prevalence of suspected and proved
myocarditis, with specific characteristics in the proved myocarditis group.
Keywords: Cardiac MRI Findings, Symptomatic Post Covid Patients, Suspected Myocarditis.


The pathophysiology of COVID-19 related
According to the 2021 American Heart
myocarditis is thought to be a combination of direct
Association/American College of
viral injury and cardiac damage due to the host's
Cardiology/American Society of Echocardiography/
immune response. COVID-19 myocarditis diagnosis
American College of Chest Physicians/Society for
should be guided by insights from previous coronavirus
and other myocarditis experience. The clinical findings
Cardiovascular Computed Tomography/Society for
include changes in magnetic resonance imaging,
Cardiovascular Magnetic Resonance Guideline for the
electrocardiogram, cardiac biomarkers, and impaired
Evaluation and Diagnosis of Chest Pain, cardiac MRI is
cardiac function [1]. Cardiovascular complications of
useful in distinguishing myocarditis from other causes
COVID-19 have received less medical attention;
of acute chest pain in patients with myocardial injury
nevertheless, the first case of myocarditis in COVID-19
who have non-obstructive coronary arteries at anatomic
patients have been reported and myocarditis has been
testing [5]. Cardiac MRI is also useful in patients with
recognized as the cause of death in some of them.
suspected myocarditis or myopericarditis if there is a
Pathology is usually focal within the myocardium, but
diagnostic uncertainty or to determine the presence and
there is a risk of arrhythmia as well as progression to
extent of myocardial or pericardial inflammation and
fulminant heart failure and cardiogenic shock [2].
fibrosis [6]. The aim of this study is to describe cardiac
According to the U.S. Centers for Disease Control
MRI findings in participants with active COVID-19
and Prevention, the risk of myocarditis after infection
infection within three months of infection and had
with COVID-19 is much higher, at 146 cases per
suspected acute myocarditis.
100,000. The risk is higher for males, older adults (ages
50+) and children under 16 years old. Over 80% of
myocarditis cases not related to COVID-19 or COVID-
This multi-centre cross-sectional study was carried
19 vaccination resolve spontaneously, while 5% of
out on 100 adult COVID-19 patients within 3 months of
patients die or require a heart transplant within 1 year of
infection, of both sexes with clinical suspicion of
diagnosis [3].
Adults who develop myocarditis from COVID-19
consequently from the Cardiovascular Medicine
have poorer outcomes than non-myocarditis COVID-19
Department, Benha University Hospital and Kobry El
cases, including a higher risk of death. It should be
Kobba Military Complex in the duration between
noted that myocarditis associated with SARS-CoV-2
January 2021 to December 2021. Exclusion criteria
infection is just one of several heart conditions linked to
were patients with acute coronary syndrome, structural
COVID-19 with outcomes that are worse than non-
heart disease (valvular or congenital heart disease) and
COVID-19 cases [4]. Cardiac MRI is the most important
those who needed mechanical ventilator.
non-invasive cardiac modality for the diagnosis, follow-
Participants (n=100) were subdivided into three
up, and risk stratification of patients with non-ischemic
groups based on cardiovascular magnetic resonance
myocardial inflammation, with unparalleled ability to
(CMR) findings (Group I (n= 6); no myocarditis, Group
characterize myocardial tissue.
II (n= 63); suspected myocarditis, and Group III (n=
31); proved myocarditis. All patients were subjected to:
Received: 22/9/2023
Accepted: 20/11/2023

Full Paper (vol.941 paper# 140)

c:\work\Jor\vol941_141 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 950-956

Evaluation of A Novel Index That Incorporates Both Neutrophil-Lymphocyte
Ratio and C-Reactive Protein for The Detection of Spontaneous Bacterial Peritonitis
Ahmed Kamal1, Islam Moheb1, Ehab M Hassouna1,
Eman E El-Gohary1, Reham AH Abo Elwafa2
1Internal Medicine Department, 2Clinical Pathology Department,
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
*Corresponding author: Islam Moheb, Mobile: (+20) 01069203940,
E-mail: islam.moheb@alexmed.edu.eg, ORCID Number: 0000-0001-7246-7679

Diagnosing spontaneous bacterial peritonitis (SBP) requires a high clinical index of suspicion because the
clinical presentation varies widely. Early detection and treatment of SBP are crucial for improving survival rates. Minimally
invasive markers such as blood neutrophil-lymphocyte ratio (NLR) and serum C-reactive protein (CRP) could be helpful to
clinicians in identifying SBP patients.
This study aimed to assess the diagnostic efficacy of integrating measurements of NLR and CRP as a minimally
invasive approach for detecting SBP.
Patients and methods: This was a cross-sectional study that included 124 cirrhosis-related ascites patients admitted to the
Alexandria Main University Hospital in the Department of Internal Medicine. Participants with 250 neutrophil cells/mm3
in ascitic fluid were defined as the SBP group (50 patients). In contrast, those with less than 250 neutrophil cells/mm3 in
ascitic fluid and negative ascitic cultures were the non-SBP group (74 participants).
Results: There was a substantially elevated blood NLR and CRP in SBP patients (p<0.001). Analyzed separately, NLR
exceeding 3.16 offered a sensitivity of 76% and specificity of 97.3%, whereas CRP above 45.6 mg/L yielded a sensitivity
of 84% and specificity of 91.8%. Our new index "NLR x CRP" at a cutoff > 18.28 significantly improved diagnostic
precision, with a better sensitivity of 94.0% and specificity of 94.59%.
Conclusions: The use of "NLR x CRP index" at a cutoff > 18.28 introduces an innovative, efficient, economical, and
minimally invasive strategy for the diagnosis of SBP.
Spontaneous bacterial peritonitis, Inflammatory markers, C-Reactive protein, Neutrophil-Lymphocyte ratio.

abdominal wall hematoma, and persistent leakage, which
Ascites is a substantial complication of advanced
is the one that happens most often (7).
liver dysfunction, which ranks as the principal reason for
Elevations in C-reactive protein (CRP) levels
hospital admissions among patients with cirrhosis.
within the bloodstream indicate inflammatory or necrotic
Infections of ascitic fluid in individuals with cirrhosis
lesions within the body (8). It is posited that during
escalate the risk of mortality by up to four times (1).
bacterial infections, macrophages secrete cytokines (such
Spontaneous Bacterial Peritonitis (SBP), a prevalent and
as tumor necrosis factor, interleukin-1, and interleukin-6)
severe infection in this demographic, occurs in 10% to
that stimulate hepatocytes for CRP production (8). The
30% of these patients upon hospitalization (2).
neutrophil-lymphocyte ratio (NLR), which shows how
Around 50% of patients are diagnosed with SBP
the body's immune and inflammatory systems work
upon admission, whereas it develops in the remaining
together, is a key indicator for figuring out how balanced
patients during their hospitalization (3).The etiology of
they are (9). Furthermore, platelet indices, CRP levels, and
SBP is linked to alterations in the gut microbiota, bacterial
total leukocyte counts were found to be good markers to
translocation, and increased intestinal permeability (4).
tell if ascitic fluid is infected (10). Consequently, we
Furthermore, compromised immune function
propose that NLR offers a valuable diagnostic method for
among patients who have advanced cirrhosis significantly
detecting SBP when integrated with CRP levels.
contributes to the disease's progression (5). Given the

nonspecific clinical manifestations of SBP and its
variability across different stages of liver disease, the
This was a cross-sectional study. The software
diagnosis primarily relies on laboratory and
MedCalc 18.2.1 was utilized to calculate the required
microbiological evaluations. Diagnostic paracentesis and
sample size for the study. This calculation was based on
subsequent analysis of ascitic fluid are deemed the
the areas under the ROC curves (AUC) of the combined
definitive methods for confirming or excluding SBP in
NLR and CRP in predicting SBP of 0.89, with an alpha
cirrhotic patients (6). However, this diagnostic procedure
error of 5% and a statistical power of 80%. The calculated
comes with some risks, such as visceral perforation,
sample size was rounded to 114 patients, but the study
hemoperitoneum, secondary peritonitis, site of infection,
ultimately included a total of 124 patients.
Received: 18/10/2023
Accepted: 18/12/2023

Full Paper (vol.941 paper# 141)

c:\work\Jor\vol941_142 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 957-962

Epicardial Adipose Tissue Thickness in Hypertensive
Patients with or without Left Ventricular Hypertrophy
Mostafa Momtaz Olimy *, Mahmoud Ali Soliman and Neveen Ibrahim Samy
Cardiology Department, Faculty of Medicine, Menofia University, Menofia, Egypt
*Corresponding Author: Mostafa Momtaz Olimy, Email: melelamy@gmail.com, Phone: +201028170406

Epicardial adipose tissue (EAT) is a type of visceral fat located between the heart and pericardium,
affecting vascular smooth muscle activity through chemical secretion. It is a risk factor for cardiovascular metabolic
issues and may relate to hypertension (HT).
Objective: To assess the correlation between EAT thickness and HT in individuals with and without left ventricular
hypertrophy (LVH).Patients and Methods: This observational study included 105 individuals with HT, defined as
having a systolic blood pressure of 140 mm Hg, a diastolic pressure of 90 mm Hg, or being on antihypertensive
medication, and 30 healthy controls. Participants underwent transthoracic echocardiography to measure left ventricle
dimensions and EAT thickness. Results: Positive correlations were found between EAT thickness and several cardiac
structural and functional parameters (Left ventricular mass index (LVMI), the ratio of early mitral inflow velocity to
mitral annular early diastolic velocity (E/'e ratio), etc.), with a significant correlation between EAT thickness and both
LVMI and E/'e ratio. EAT thickness above 5.25 mm predicted LVH in HT patients with 85.7% sensitivity, 82.1%
specificity, and 83.9% accuracy. Conclusions: Compared to hypertensive patients without hypertrophy and healthy
individuals, hypertensive patients with LVH had a much thicker EAT. Based on the findings, EAT may be a useful
marker for HT ventricular remodeling and hypertrophy.
Keywords: Epicardial Adipose Tissue; Thickness, Hypertension; Left ventricular hypertrophy.

The accumulation of fat surrounding internal
echocardiography is being widely used for evaluating
organs is only one aspect of visceral adipose tissue.
EAT because to its several benefits, including
Among its many metabolic and endocrine roles, it is a
accessibility, affordability, lack of radiation, speed, and
rich source of a small number of bioactive compounds
consistency [13].
with far-reaching effects on energy metabolism,
The objective of this research was to assess the
vascular health, immunology, and inflammation [1].
relationship between EAT thickness and the occurrence
EAT is a kind of visceral fat that accumulates in
of LVH in individuals with HT.
certain areas surrounding the coronary arteries, the right

ventricle's lateral wall, the atrioventricular and
interventricular sulcus, and the pericardium [2].
An observational study was carried out on 105
It is believed that its physiological functions
individuals with hypertension, characterized by a
relate to lipid storage and these processes; it is
systolic blood pressure of 140 mmHg or higher and/or
associated with metabolic syndrome [3], insulin
diastolic blood pressure of 90 mmHg or higher [14], or
resistance [4], coronary artery disease (CAD) [5],
using an antihypertensive medicine. Additionally, 30
hypertension (HT) [6], and the production of hormones,
non-hypertensive healthy adults were included as a
cytokines, and chemokines [7,8]. The pathophysiology of
control group. The study was conducted at
CAD is thought to be heavily influenced by EAT. It
Cardiovascular Medicine Department, Faculty of
modulates the contraction of vascular smooth muscles
Medicine, Menoufia University Hospitals from August
by releasing a variety of physiologically active
2022 to september 2023.
chemicals [9]. Their proximity to the adventitia and
extravascular bed may explain their paracrine actions
echocardiographic images, patient history of coronary
[12]. New research suggests that HT may be associated
artery disease (CAD), significant valvular disease on
with increased EAT thickness, which might be a new
echocardiography, heart failure with reduced or mildly
cardio-metabolic risk factor [10, 11].
reduced ejection fraction, chronic obstructive
Echo-cardiography is a common tool for
pulmonary disease (COPD), and regional wall-motion
diagnosing LVH, a symptom of HT-induced
abnormalities on resting echocardiography.
compensatory cardiac mechanisms carried on by an
All patients underwent history taking, physical
elevated chronic workload. LVH is a significant
examination, and echocardiographic testing.
indicator of death and illness in individuals with HT. It
Echocardiographic assessment
may cause diastolic dysfunction, decrease coronary
flow reserve, and promote ventricular arrhythmias [12].
evaluations were part of a comprehensive transthoracic
Additionally, LVH serves as an indicator of
two-dimensional echocardiographic examination that
underlying cardiovascular illness that may not yet be
all patients underwent. Patients were positioned in the
showing symptoms. The relationship between EAT and
left lateral decubitus position for the acquisition of
Received: 18/10/2023
Accepted: 18/12/2023

Full Paper (vol.941 paper# 142)

ABSTRACT The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 963-967

Endoscopic Ultrasonography versus Submucosal Enhancing Strip as
Contrast Material Enhanced MRI in Rectal Lesions
1Mohamed E. El-Shewi, 1Fatma M. Abdelsalm, 2Amr I. Abo-ELmagd,
3Mohamed A. Elsedik Mohamed, 1*Ahmed A. Aiad
1Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Banha University
2Department of Gastroentrology and Hepatology, Armed Force Collage of Medicine
3Departemnt of Radiology, Armed Force Collage of Medicine
*Corresponding author: Ahmed Abo Elfotouh Moussa Aiad, Email: folded1991@gmail.com, Mobile: 01228530625

The incidence of rectal cancer has risen. In addition, about 60% of rectal cancer cases are in the advanced
stages of diagnosis. The goals of colorectal cancer (CRC) screening are early diagnosis of cancer in the preclinical state
and increasing survival.
Objective: To evaluate endoscopic ultrasonography versus submucosal enhancing strip as contrast material enhanced
MRI in colorectal lesions. Patients and Methods: Thirty-three patients with colorectal lesions who were admitted to
Kobry Elkoba Military Hospital were included, diagnosed by colonoscopy followed by histopathological examination.
Submucosal enhanced stripe MRI and endoscopic ultrasound were done for all patients.
Results: Nineteen patients who underwent either endoscopic submucosal dissection or surgical intervention with T1
and T4 were confirmed by pathological examination. Submucosal enhancing stripe (SES) MRI accuracy in T staging
was 89.47% while in N staging was 94.74%. EUS accuracy in T staging was 100% while in N staging was 94.74%. The
difference in accuracy in T staging was in T3 and T4 only because the main target of SES MRI is differentiating T1
from T2. In T1 and T2 no significant difference was reported between SES MRI and EUS. Regarding lymph node
infiltration no significant difference was reported. Conclusion: SES MRI and EUS are comparable imaging techniques
for the local and lymph node staging of rectal cancer.
Colorectal cancer, Rectal cancer, Endoscopic ultrasound.

and T2 tumors is limited. Independent imaging
The occurrence of rectal cancer has seen an
characteristics such as the presence of a submucosal
increase, and notably, approximately 60% of these cases
enhancing stripe (SES) in contrast-enhanced MRI, the
are identified at an advanced stage [1]. It is essential to
status of the muscularis propria (SMP) in T2-weighted
precisely determine the stage of rectal cancer (RC) to
images, and the shape of the tumor, are critical for
select the most effective combination of treatments [2].
identifying differences between stage T0-T1 and stage
The selection of treatment and the outlook for the
T2 rectal tumors [7].
patient are influenced by the T and N stages of the
Contrast-enhanced MRI with SES provides a
disease at diagnosis [3]. Endoscopic ultrasound (EUS)
superior visualization of the rectal wall's intricate layers
and magnetic resonance imaging (MRI) have become
compared to non-contrast MRI, due to the varied MRI
the leading methods for assessing the stage of rectal
signal characteristics of the mucosa, submucosa, and
adenocarcinoma [4]. Initially introduced in 1980 for
muscularis propria. This enhancement facilitates the
assessing pancreatic cancer, endoscopic ultrasound
assessment of the tumor's invasion depth into the rectal
wall and aids in distinguishing between the early T
technology. This innovation allows for detailed imaging
stages of the tumor [8].
of the gastrointestinal mucosa and provides insights into
The literature has yet to thoroughly examine the
the depth and adjacent structures of the tract wall [3].
comparison between SES MRI and EUS for rectal
EUS proves valuable for evaluating the impact on
cancer staging, which this study aims to address.
anal sphincters by lower rectal tumors and for staging
This study aims to compare the effectiveness of
anal squamous-cell carcinomas. The approach to
endoscopic ultrasonography with that of submucosal
treating anal cancer is significantly influenced by
enhancing stripe MRI, which uses contrast material for
whether the sphincter is affected [5]. MRI is commonly
the evaluation of rectal lesions.
employed for the pre-surgical assessment of rectal

cancer, offering precise evaluations of the tumor and the
nearby mesorectal fascia. Its reliability extends to
Study Type: This research was a comparative,
determining the scope of local and regional disease,
prospective study carried out at Kobry Elkoba Military
devising radiation therapy plans, monitoring changes
Hospital from January 2023 to December 2023.
after surgery, and detecting recurrences in the pelvic
Inclusion Criteria: Participants aged 18 and above
area [6].
(including adults and seniors) of any sex were eligible.
Precisely distinguishing between stage T0-T1 and
Eligible participants were those newly diagnosed with
stage T2 rectal tumors is key for choosing the correct
rectal cancer through lower GI endoscopy, with their
surgical approach. Although MRI is favored for local
diagnosis confirmed by histopathology, prior to being
staging, its effectiveness in differentiating between T1
Received: 19/10/2023
Accepted: 19/12/2023

Full Paper (vol.941 paper# 143)

c:\work\Jor\vol941_144 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 968-974
Assessment of the Thyroid Hormones in Patient with Chronic Renal Failure
Undergoing Maintenance Haemodialysis in Hospital Cross Section Study
Amira M. El Sayed, Ayman M. Elbadawy, Mohamed S. Saleh, Ghada Z. Rady* and Walaa M. Ibrahim
Internal Medicine Department, Faculty of Medicine, Banha University, Banha, Egypt
*Corresponding Author: Ghada Z. Rady, Email: ghadazaki626@gmail.com, Phone: +201009798017


Background: A significant alteration in thyroid hormone function tests occurred in chronic kidney disease (CKD)
patients especially if they are on dialysis.
Objective: The purpose of our study was to determine the prevalence of thyroid hormone abnormalities among chronic
renal failure patients undergoing maintenance haemodialysis, and to assess the connection between thyroid hormones
dysfunction, duration of dialysis, complication of chronic renal failure and other comorbidities.
Patients and Methods: This cross-section study was executed on 200 patients exceeding the age of 18, with confirmed
end-stage renal disease (ESRD. Patients were split into 4 groups based on status of thyroid dysfunction into
hypothyroidism group, hyperthyroidism group, normal thyroid or sick euthyroid group.
Results: There was overt hypothyroidism in 20 (64.51%) patients and subclinical hypothyroidism in 11(5.5 %)
patients. However, overt hyperthyroidism was in 9 (4.5%) patients and subclinical hyperthyroidism was in 10 (5 %)
patients. Sick euthyroid was found in 83 (41.50%) patients and finally, euthyroid patients was in 67 (33.50%)
Thyroid hormone dysfunction is common in chronic renal failure patients undergoing maintenance
hemodialysis, even in those who are clinically euthyroid.
Keywords: Thyroid dysfunction, Chronic Renal Failure, Hemodialysis.

thyroxine (FT4). Uremic toxins, metabolic acidosis,
Chronic kidney disease (CKD) symbolizes
malnutrition, heparin (as used in hemodialysis), chronic
problems and in public health and kidney disease
inflammation, hepatitis C virus (HCV) infection,
outcome quality initiative (NKF/DOQI) defines it as
advanced age and specific drugs including amiodarone,
renal injury that persists for a duration beyond three
steroids, and beta-blockers have also been linked to
months, accompanied by structural or functional
thyroid dysfunction in CKD [6].
problems, and may or may not involve a reduction in
Hyperthyroidism or hypothyroidism can impact the
GFR characterized by indications of kidney injury or
function of the renal tubules, the GFR, and induce
pathological abnormalities, or by a GFR of < 60
proteinuria. Thyroid hormone function tests are
mL/min/1.73 m2. In light of GFR value, CKD is
significantly altered in CKD patients, particularly those
separated into five stages [1]. Kidney Disease Improving
who are on dialysis. Thyroid replacement therapy has the
Global Outcomes (KDIGO) guidelines define CKD
potential to preserve renal function in CKD patients [7,8].
through the utilization of kidney damage markers
The objective of this work was to evaluate the
(proteinuria and glomerular filtration rate). Kidney
prevalence of thyroid hormone dysfunction in chronic
disease (CKD) is characterized by the coexistence of two
renal failure patients undergoing maintenance
indicators: a GFR of less than 60 mL/min (1.73 m2) and
hemodialysis, as well as the connection between thyroid
albumin levels over 30 mg/g of creatinine; additionally,
hormones dysfunction, duration of dialysis, complication
the presence of structural or functional abnormalities in
of chronic renal failure and other comorbidities.
the kidneys for a duration beyond three months is

required [2]. A GFR < 15 mL/min/min1.73m2 or CKD
stage 5 indicates end-stage renal disease (ESRD).
This cross-section research was conducted on 200
Continuous organ support can be administered using a
patients over the age of 18, with confirmed ESRD, with
diverse range of methodologies to aid renal function.
the following features: undergoing hemodialysis (three
Rigorous extracorporeal methods, paracorporeal or
times a week, four hours/session), clinically stable
hemodialysis techniques, and peritoneal dialysis
patients, free of active infections and no previous history
comprise renal replacement therapy (RRT) [3]. A range of
of thyroid disease. The study was performed in a period
endocrine diseases, including insulin resistance and
from February 2022 to January 2023.
secondary hyperparathyroidism, have been identified as
Exclusion criteria; age of patients < 18 years,
extra-renal consequences of CKD and as possible
history of thyroid disease, thyroid and parathyroid
indicators of morbidity and death in this demographic [4].
surgeries, patients treated with interferon therapy,
Diverse factors contribute to thyroid problems in
patients received or exposed to radiation and patients
patients with CKD. CKD patients have a greater
using antithyroid drugs or thyroid replacement therapy.
prevalence of hypothyroidism than the overall population
Patients were categorized into four groups based on
[5]. Through the action of isoform D1 of the enzyme T4-
status of thyroid dysfunction into hypothyroidism group,
5-deiodinase, the kidney contributes to the synthesis of
hyperthyroidism group, normal thyroid or sick euthyroid
serum free triiodothyronine (FT3) by deiodinating free
group. Each patient underwent history taking, examining

Full Paper (vol.941 paper# 144)

c:\work\Jor\vol941_145 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 975-981

Knee Alignment-Oriented Balance Exercises Versus Conventional
Balance Exercises in Treating Patellofemoral Pain Syndrome
Ammar M. Abd Elhady(1), Salwa Fadl Abd Elmajeed (2), Wafaa Atef Abd Allah(1), Huda Badr Abd Elhamed(2)
1Department of Musculoskeletal Disorders and Its Surgery, Faculty of Physical Therapy, MUST University,
2Department of Musculoskeletal Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University
Corresponding author: Ammar M. Abd Elhady, Email: ammar.abdelhakiem@must.edu.eg, Mobile: 01032325653
: Patellofemoral pain syndrome (PFPS) is the most prevalent musculoskeletal disorder encountered by
orthopedic physical therapists and one of the primary reasons for pain in the anterior part of the knee. Balance and
Function of the knee may be affected in patients with PFPS due to pain and abnormal lower limb alignment.
Aim: to investigate and compare the effects of knee-alignment-oriented balance exercises and conventional balance
exercises in patellofemoral pain syndrome patients with dynamic knee valgus.
Patients and Methods: Thirty-four patients were diagnosed with PFPS with dynamic knee valgus and were divided
into group A: received knee alignment-oriented balance exercises while the other group B received conventional
balance exercises. Dynamic knee-valgus throughout a Single-Legged Drop Jump test was measured via two-dimensional
video analysis with the Kinovea software. Pain severity was assessed via a visual analog scale. Proprioception was assessed
via dynamic postural stability with the Biodex Stability System (Biodex balance system).
Results: there was no statistically substantial difference among both groups concerning VAS as well as dynamic
postural stability with (p-value>0.05) but for each group, there was a substantial decline in VAS (p=0.0001), as well
as for dynamic posture stability, there was no substantial difference except the significant decrease in
Anterior/Posterior Index (p=0.014) of the knee alignment-oriented balance group.
Conclusion: There was no significant difference between the knee alignment-oriented balance group and the
conventional balance group regarding pain intensity and dynamic postural stability. However, both exercises were
helpful in improving pain, and only knee alignment-oriented balance improved proprioception.
Keywords: Knee alignment, Oriented balance exercises, Conventional balance exercises, Patellofemoral pain
syndrome, Proprioception.

diminished proprioceptive function and neuromuscular
Patellofemoral pain syndrome (PFPS) is the most
control, both of which are associated with alterations in
prevalent musculoskeletal condition encountered by
the lower extremity biomechanics (dynamic knee valgus)
orthopedic physical therapists as well as one of the most
(8). Dynamic knee valgus is believed to be strongly
prevalent causes of anterior knee pain due to multiple
associated with PFPS due to its impact on reducing the
factors (1). Some of these factors are movement-related
contact area between the patella and the trochlea, leading
factors that can be identified by executing tasks that
to increased pressure on the patellofemoral joint. This
require knee flexion exceeding 60° and knee movement
increased pressure can induce overloading on the
preceding toes (2). Additional contributors to PFPS
subchondral bone and nearby soft tissues (9).
include bone malalignment, imbalances in the muscles of
Erdoganoglu et al. (10) Found that balance and
the knee, instability in the quadriceps or gluteal muscles,
functionality were affected in patients with PFPS due to
loss of proprioception, impaired neuromuscular control,
pain and abnormal lower limb alignment. Another study
and altered biomechanical processes of the lower
by Motealleh et al. (11) discovered that balance is affected
extremity (3-5). In contrast with the population as a whole,
in those with PFPS and other muscular-skeletal disorders
which experiences an incidence of 22.7% per year,
in addition to its importance in daily activities Thus,
current systematic reviews have identified a prevalence of
patellofemoral joint rehabilitation programs must include
PFP among adolescents at 28.9% per 1,000 person-years.
it. Also, many previous studies have found that PFPS
Although this review incorporated studies that
patients have impaired postural stability, as a result,
predominantly focused on highly active populations, such
treatment options for these patients have included
as military recruits along with athletes, the participants
balancing exercise therapy (12-14). A knee alignment-
encompassed a range of ages (6). Engaging in physical
oriented balance exercise would involve keeping the knee
activities such as running, jumping, squatting, or
from moving laterally or medially while standing on one
prolonged periods of sitting with the knees bent can
leg, and keeping the pelvis as well as shoulders level to
exacerbate the excruciating pain experienced in the
avoid patellar mal tracing (15).
peripatellar region, which is an outcome of overuse injury
This study intended to compare alterations
(7). A critical aspect of patient care for individuals with
regarding proprioception (dynamic postural stability), as
PFPS involves the assessment and management of
well as pain intensity (VAS) among PFPS patients having
Received: 22/10/2023
Accepted: 20/12/2023

Full Paper (vol.941 paper# 145)

c:\work\Jor\vol941_146 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 982-987

Preliminary Results of Neonatal Screening of 19 Genetic and
Metabolic Disorders in Qalyubia Governorate
Mostafa A. Mostafa1, Doaa A. Soliman1, Ola G. Behairy1, Nadia M. Abdelgwad2, Asmaa M. Ghanem*1
1Department of Pediatric, Faculty of Medicine - Benha University, Benha, Egypt
2Department of Pediatric and Neonatology, Benha Children Hospital, Qalyubia Governorate, Egypt
*Corresponding author: Asmaa M. Ghanem, Mobile: (+20) 01140069451, E-mail: mamdouhasmaa112@gmail.com

Tandem mass spectrometry (MS/MS) expanded neonatal screening for inborn errors of metabolisms
(IEMs) and it is an effective method for early diagnosis and presymptomatic therapy to avoid serious long-term
consequences and mortality.
Objective: To detect the prevalence of the preventable 19 IEM screened among neonates in NICUs of our community
and identify types of IEM most commonly found in Qalyubia Governorate. Screening obstacles were also addressed to
be resolved appropriately with provision of purposeful family counseling.
This cross-sectional study was performed on neonates admitted to NICU of Benha Children Hospital in
Qalyubia Governorate for early detection of 19 neonatal genetic diseases and early treatment of positive ones for
duration of one year from June 2022 to June 2023. This study included 700 neonates. All neonates were subjected to
detailed history taking, detailed examination and assessment of 19 genetic and metabolic disorders.
Results: Regarding the screening test for 19 genetic and metabolic disorders of the studied group, 19 (2.71%) patients
were true positive, 51 (7.29%) patients were false positive, and 630 (90%) patients were negative. Congenital adrenal
hyperplasia was confirmed in 1 (0.14%) patient, G6PD enzyme deficiency was confirmed in 16 (2.29%), and urea cycle
defect was confirmed in 1 (0.14%) patient and elevated TSH and confirmatory free T4 recommended was found in 1
(0.14%) patient. Regarding the outcome of the positive cases, 18 (94.74%) patients survived, and 1 (5.26%) patient did
not survive (urea cycle defect). The diagnostic accuracy of the screening test was 92.7%, with 100% sensitivity, 92.5%
specificity, 27.1% PPV and 100% NPV. This test was proven to be an effective and good negative test.
This test was proven to be an effective and good negative test. Even before they showed symptoms, infants
who were tested positive for illnesses were treated promptly. Thus, it might lower health care expenses and prevent or
reverse serious disability.
Keywords: Newborn screening, IEMs, Incidence of IEMs.


neonates in NICUs of our community and identify types
It has long been acknowledged that newborn
of IEM most commonly found in Qalyubia
screening, which looks for inborn errors of metabolism
Governorate. Screening obstacles were also addressed
(IEM), is a crucial, life-saving, and efficient
to be resolved appropriately with provision of
preventative public health service. With the
purposeful family counseling.
introduction of this new screening technique, neonates

may be tested for and treated for many more problems
than was previously feasible. In other cases, diagnosing
This cross-sectional study was performed on
newborns with a condition implies that they can be
neonates admitted to NICU of Benha Children Hospital
treated and therefore not face lifelong handicap or
in Qalyubia Governorate from June 2022 to June 2023.
cognitive impairment(1).
This study included 700 neonates.
IEMs are a broad category of monogenic disorders

that cause defects in neurological and physical
Inclusion Criteria
development at practically every stage of life, as well as
Both males and females preterm and full-term
mortality. IEMs are always brought on by an enzyme,
neonates admitted to NICU Department of Benha
coenzyme, or transporter flaw that causes the substrate
Children Hospital in Qalyubia Governorate.
to build up or the downstream products to become

insufficient. With the advent of tandem mass
All neonates were subjected to the following:
spectrometry (TMS), screening for over 50 IEMs
1. Detailed history taking and general and local
throughout the newborn period is now possible utilising
examination were performed.
dried blood spots (2).
2. Assessment of 19 genetic and metabolic disorder
Neonatal screening started worldwide in the early
The newborn blood sample was obtained usually at
1960s (3). In the early 1990s there was a revolution in
24 to 48 hours of life, and screening results were
NBS programmes which aimed mainly at the detection
generally available within 24 hours. The test was
of amino acid organic acid, mitochondrial and fatty
performed by pricking the baby's heel to collect a few
acid-oxidation disorders (4).
drops of blood. The blood was placed on a special type
So, the aim of this study was to detect the
of paper and sent to a laboratory for analysis (5). These
prevalence of the preventable 19 IEM screened among
19 genetic and metabolic disorder were congenital
Received: 22/10/2023
Accepted: 20/12/2023

Full Paper (vol.941 paper# 146)

c:\work\Jor\vol941_147 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 988-993

Validity and Reliability of an iPhone® Clinometer Application for Assessment of Joint
Repositioning Error in Patients with Non-Specific Chronic Low Back Pain
Nada Elsayed Ahmed Mohamed*1, Salwa Fadl Abdelmegeed2,
Aya A. Khalil1, Dina S. Abd Allah2, Mohamed Abdelmegeed2
Departments of 1Biomechanics and 2Physical Therapy for Musculoskeletal System Disorders and Its Surgery,
Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Nada Elsayed Ahmed Mohamed, Mobile: (+20) 01007800902, E-mail: nadaelsayed95@gmail.com

Non-specific chronic low back pain (NSCLBP) is a complex issue that impacts an individual's quality
of life and functionality, leading to impairments in somatosensory and proprioception. Errors in proprioception are
evaluated using specific tests such as joint reposition sense.
This study aimed to validate and determine the reliability of the iPhone inclinometer application
(Clinometer) in measuring the error in lumbar joint repositioning in patients suffering from NSCLBP.
Materials and methods:
In this cross-sectional study, 55 male and female patients diagnosed with NSCLBP were
involved, with an average age of 25.51 ± 6 years. All patients underwent an active lumbar repositioning test using the
Clinometer application and an isokinetic dynamometer to calculate the absolute angular error for a target angle of 30°
lumbar flexion. This was done over two assessment sessions on different days, with each patient being evaluated by
two examiners at each session. The intra-rater and inter-rater reliability were determined using the Intraclass
Correlation Coefficient (ICC), and the concurrent validity was tested using Spearman's correlation.
Results: The Clinometer application demonstrated excellent concurrent validity with the isokinetic measurements at
the same target angle (r= 0.83, p< 0.01), and exhibited excellent intra and inter-rater reliability (ICC values ranged
from 0.88 to 0.93 for intra-rater reliability and from 0.82 to 0.88 for inter-rater reliability).
Conclusion: The Clinometer app is a viable and reliable alternative to the isokinetic dynamometer for evaluating
active lumbar reposition sensation in persons with NSCLBP at 30° of flexion.
Joint reposition sense, LBP, Proprioception, Reliability, Validity.


NSCLBP is described as chronic pain in the back
acuity and proprioception, which impair motor
and sacrum lasting more than 12 wks. It has emerged
function, upset segmental spinal stability, and
as a leading cause of disability among adults,
eventually cause greater pain and articular injury (10).
impacting their functionality and quality of life (1, 2).
Gaining an understanding of these mechanisms in
It affects approximately 12-33% of the adult
individuals with LBD may be essential to enhance
population, with 85% of chronic LBP cases being non-
back pain care, particularly with regard to making
specific, meaning they lack identifiable physiological,
correct diagnoses, delivering a believable explanation
neural, or orthopaedic disorders in the spine (3).
for the issue, providing pertinent information, and
Joint position sense (JPS) is one test used to
recommending efficient rehabilitation techniques (11).
measure proprioception, which is the awareness of
This study was therefore conducted to aid in the
joint and body movement as well as the location of the
development of a smartphone-based measurement of
body or its parts in space (4, 5).
JPS of lumbar flexion, using a portable and simple tool
The JPS test is frequently used to assess a
to measure proprioceptive deficits in patients with
participant's accuracy in reproducing a lumbar spine
NSCLBP conveniently and cost-effectively.
"target position" that is provided via verbal, physical,

or visual cues. The subject is taken out of the position
and asked to actively recreate the goal position once it
Participants: A cross-sectional study that was
is given (6). Prior studies have utilized complex,
conducted through the period from April to September
expensive, and non-portable equipment like video
2023. A calculation was carried out to determine the
analysis systems and isokinetic dynamometers, which
necessary sample size for the study, which was
are challenging to use in clinical settings (7).
conducted at the Outpatient Clinic of the Faculty of
According to recent comprehensive reviews,
Physical Therapy at Cairo University, Egypt.
patients with NSLBP have much worse lumbopelvic

proprioceptive acuity than people without symptoms (4,
Inclusion criteria: Age between 18 and 45 years, had
8). Individuals with NSCLBP have been shown to have
NSCLBP for more than three months, had pain that
both functional (e.g., disrupted neuromuscular
was either referred to the leg or between the costal
coordination between the deep and superficial back
margins and the inferior gluteal folds, and had scored
muscles) and structural (e.g., muscle atrophy and fat
at least three on the numerical pain rating scale
infiltration) alterations in the trunk muscles (9). These
(NPRS), which goes from zero for no pain to ten for
modifications cause impairments in tactile selective
the worst possible pain.
Received: 23/10/2023
Accepted: 20/12/2023

Full Paper (vol.941 paper# 147)

c:\work\Jor\vol941_148 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 994-999

Effect of Trunk Muscles Strengthening on Hip Abductors Strength and
Endurance in Young Adults
Ahmed S. Abdel latif 1*, Neveen A. Abdel Raoof 2, Olfat A. Diab 1
1 Department of Biomechanics, Faculty of Physical Therapy, October University for Modern Sciences and Arts, Egypt
2 Department of Basic Sciences and Vice Dean of Student Affairs and Education, Faculty of Physical Therapy, Cairo University,
Corresponding author: Ahmed S. Abdel Latif, Email: ahmedsamir9430@gmail.com, Mobile: 01222832888

Hip abductors muscles are extremely important during several activities and its weakness can affect our daily
life activities. Objective: This study aimed to investigate the effect of strengthening trunk muscles on Hip abductors
strength and endurance in young adults.
Patients and methods: This study was conducted on 58 patients. They were assigned into 2 equal groups: Group A
(Control group) consisted of 29 subjects received conventional hip abduction exercises from standing position against a
theraband and group B (Study group) consisted of 29 subjects received the same hip abduction exercises plus a curl up
exercise performed 3 days a week at October University for Modern Sciences and Art (MSA). Results: There was
statistically significant differences in the mean values of maximum abductor isometric strength post-study between both
groups (p= 0.038) in favor of group B, in the mean values of time of unilateral bridging test post-study between both groups
(p= 0.046) in favor of group B and in the mean values of time of hip abductor endurance post-study between both groups
(p= 0.005) in favor to group B.
Curl up exercise combined with hip abduction resisted exercise against an elastic band did a significant
improvement regarding the maximum hip abductors isometric strength, and there was a significant difference in Hip
abductors endurance compared to doing just hip abductors resisted exercise only. It's recommended to add curl up exercise
in programs aimed to improve Hip abductors strength and endurance.
Keywords: Hip abductors strength, Trunk muscles, Curl up exercise.


less durable hip abductor muscles (8). Furthermore, a
The primary hip abductor, gluteus medius, is one of
greater risk of injury is linked to decreased prone-bridge
the muscles that stabilizes the pelvis while walking (1). Hip
hold duration and abductor torque in soccer players (9).
abductors were observed to be engaged during walking,
Using a hand-held dynamometer to measure hip
particularly on the stance limb (2). There is an anatomical
abduction strength is reliable (10). Exercises like single-leg
relationship between the hip abductors and rectus
bridge, side-lying hip abduction with internal rotation,
abdominis, oblique abdominis and quadratus lumborum.
and isometric standing hip abduction are suggested to
Gluteus medius and gluteus minimus both take an origin
enhance hip abductor strength (11).
from the pelvis while rectus abdominis, oblique
This aim of this study was to investigate the effect
abdominis and quadratus lumborum insert into it (3). There
of rectus abdominis, quadratus lumborum, and oblique
is also an electromyographic relationship between gluteus
abdominis strengthening on hip abductors strength.
medius, oblique internus and quadratus lumborum (4).
This shows a connection between trunk muscles and the
This study was conducted on 58 patients. They were
hip abductors.
assigned into 2 equal groups: Group A (Control group)
The isokinetic hip muscle strength was the subject
that consisted of 29 subjects received conventional hip
of a systematic review in 2018, and the muscular torque
abduction exercises from standing position against a
was evaluated as a measure of this strength (5).
theraband and group B (Study group) consisted of 29
Researchers studied the impact of exercise on hip muscle
subjects received the same hip abduction exercises plus a
strength and other factors in individuals with total hip
curl up exercise performed 3 days a week at October
arthroplasty, using hip abduction torque as a measure (6).
University for Modern Sciences and Art (MSA).
So, using the terms "torque" and "strength"
Sample size calculation: The sample size was calculated
interchangeably is reliable and valid.
using the G*Power software (version 3.0.10). F-test
Moderate-to-severe hip osteoarthritis may be
MANOVA using within and between interaction effects
detected by bilateral impairments in lower limb maximum
was selected. Power is 0.80, level of 0.05 and effect size
strength, notably decreased knee extensor endurance, and
of 0.42; two groups and number of measures 2, a
poor functional performance (7). Also, individuals that
generated sample size of at least 52 subjects. Adding 6
suffer more intense and chronic pain, have weaker and
Received: 22/10/2023
Accepted: 20/12/2023

Full Paper (vol.941 paper# 148)

c:\work\Jor\vol941_149 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 1000-1002

Comparative Study between Different Agents Used in Chemical Pleurodesis
Hatem. M. Aboalazayem; Mohammad Sharaf Elfeky
Cardiothoracic Surgery Department, Faculty of Medicine, Al-Azhar University
ORCID number:0009-0008-3709-1512, Telephone: 01005577483. Email: h.m.aboalazayem@gmail.com.

: Pleurodesis is a medical technique used to eliminate the gap among the parietal and visceral pleura in
order to avoid the reoccurrence of pleural effusion or pneumothorax.
This method involves the introduction of a chemical substance into the pleural space, which leads to the scarring and
adhesion of the membranes.
Objective: The objective of this research was to evaluate the outcomes of medical pleurodesis utilizing three distinct
agents and two delivery routes.
Patients and methods:
Our university hospital treated 135 individuals who had recurrent malignant and benign pleural
effusions with pleurodesis by employing three distinct chemical agents: povidone-iodine solution, bleomycin ampoules,
and fresh frozen plasma (FFP), administered by two different methods, namely chest tube and small-bore pigtail catheter.
: All patients were dyspneic. Seventy were men; their ages varied from 45 to 76. Chest tubes were used for
effusion drainage and sclerosing agent instillation in eighty-seven individuals (64.45 percent), whereas pigtail catheters
were used in forty-eight individuals (35.55). With 83 cases of malignant effusion and 52 cases of non-malignant
effusion, 60 cases were treated with bleomycin, 30 with fresh frozen plasma (FFP), and 45 with povidone-iodine.
Sclerosing agent type was associated with a change in overall success rate.
Conclusion: FFP is a good alternative sclerosing agent to bleomycin and it is safe, available and less costy.
Keywords: pleurodesis, pleural effusion, sclerosing agents and chest tube.

recurrent pleural effusion (PE) and recurrent
Pleural effusions are anomalous accumulations of
spontaneous pneumothorax (5).
fluid found within the pleural space. They frequently
Exposure of pleural mesothelial cells to a
arise due to increased fluid production beyond what the
sclerosing agent leads to the secretion of various
body needs and/or impaired lymphatic absorption. It is
mediators, involving chemokines as interleukin 8 (IL-8)
the most prevalent sign of pleural disease, and its causes
and monocyte chemoattractant protein (MCP-1), in
vary from systemic inflammatory conditions
addition to growth factors like vascular endothelial
and cardiopulmonary disorders to cancer (1).
growth factor (VEGF), platelet-derived growth factor
The typical pleural space holds approximately ten
(PDGF), basic fibroblast growth factor (bFGF), and
mL of fluid, which is the result of the equilibrium
transforming growth factor- (TGF-). Mesothelial
between hydrostatic and oncotic pressures in the
cells and their cytokines are crucial in initiating
capillaries of the visceral and parietal pleura, as well as
and sustaining
continuous drainage through the sulcal lymphatic
inflammation and pleural space obliteration (5).
system. Pleural effusions can occur due to disturbance
The objective of the present investigation was to
of this inherent equilibrium(2).
evaluate the outcomes of medical pleurodesis by
The presence of a pleural effusion indicates an
utilizing three distinct chemical agents: povidone-
underlying illness process, which can originate from
iodine solution, bleomycin ampoules, andfresh frozen
either the lungs or other parts of the body. Additionally,
plasma, administered through two different methods,
this condition can be either acute or chronic (16). While
namely chest tube and small-bore pigtail catheter.
the causes of pleural effusion can vary greatly, the

majority of cases are attributed to congestive heart
failure, pneumonia, malignancy, or pulmonary
Site and time of research: Our prospective research
embolism(3). According to the mechanism of formation
started at February 2021 till June 2023 in our
of pleural fluid and chemical analysis of it, the pleural
Cardiothoracic Department in Al-Azhar University
effusion can be classified into two types transudate
which is formed as a result of imbalance between

oncotic and hydrostatic pressure, and exudates type
Ethical considerations:
which is formed by inflammatory process in the
Approval of institutional Research Board of Al-
Azhar University was obtained. We followed the
Chemical pleurodesis is a therapeutic process that
declaration of Helsinki as regards trial on humans.
is used to build a connection between the parietal and
Patients were informed and they signed written
visceral pleura by introducing different chemical agents
consent for participation in our study, operation,
into the pleural space (13). Chemical pleurodesisis
and publishing of clinical data.
primarily used to treat two primary clinical conditions:

Received: 23/10/2023
Accepted: 20/12/2023

Full Paper (vol.941 paper# 149)

c:\work\Jor\vol941_150 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 1003-1010

ECG Changes in Children with Convulsions at Sohag University Hospital
Montaser M. Mohamed1, Eman Aimn Sadek Hassan2,
Mostafa Ashry Mohamed1, Omar A. A. Ahmed1, Shaimaa Mohamed Mahmoud1*
1Department of Paediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
2Department of Paediatric, Sohag General Hospital, Sohag, Egypt
*Corresponding author: Shaimaa Mohamed Mahmoud, Mobile: (+20) 01026682473, E-mail: shaymaa_sayed@med.sohag.edu.eg

Background: Convulsion is a common problem encountered in the emergency department and represent a major source of
morbidity, many children are admitted to emergency department and PICU with different clinical types of convulsions due
to different etiologies. Frequent electrocardiographic (ECG) alterations are commonly observed during and following
convulsions, indicating that individuals experiencing convulsions often possess significant risk factors for cardiac strain,
which in turn typically correlates with elevated morbidity and mortality rates.
Objective: To identify electrocardiogram (ECG) abnormalities in pediatric patients with various etiologies of convulsions.
Patients and Methods: This cross-sectional hospital-based research was carried out at Pediatric Emergency Department
and PICU at Sohag University Hospital during the period from January 2022 to September 2023. 12 leads ECG had been
done to all children aged one month to eighteen years old who presented to the Pediatric Emergency Department with
Results: 200 children were included in the study, 104 (52%) males and 96 (48%) females with male to female ratio was
1.08:1. The age of children ranged between 1 month to 12 years with mean age was 3.75± 3.19 years. More than half of
children (58%) were between 2-10 years and the least group represented was between 11-18 years (3%). Consanguinity was
reported in more than half of children (57%). Encephalopathy was the most common cause of convulsions in children (34%),
generalized tonic-clonic convulsions was the most frequent type of convulsions (89%). A statistically significant distinction
was discovered among types of convulsions related to PR interval (p<0.001) as it was highest in epilepsy. However, no
significant variance was found among types of convulsions related to QTc interval (p=0.220).
Conclusion: QTc interval was not significantly varied amongst the various seizure sources. There was significant variance
among various causes of convulsions as regard heart rate and PR interval.
Keywords: Paediatric, ECG, PR interval, Convulsions.

A significant proportion of patients saw a rise in
This cross-sectional hospital-based research was
cardiac necrosis and dysfunction indicators after
carried out at Pediatric Emergency Department and PICU
protracted convulsions, which might signal the beginning
at Sohag University Hospital during the period from
of myocardial damage (1). While seizures impact several
January 2022 to September 2023.
autonomic parameters, the most significant expression is
Children with convulsions as young as one month
seen in cardiovascular symptoms. During maximal
old to as old as eighteen years old were enrolled in this
seizures, sympathetic reactions are more common and can
study. Children with preexisting heart disorders or known
result in tachycardia, tachypnea, elevated blood pressure,
cardiac arrhythmias were excluded.
pupillary dilatation, diaphoresis, and face flushing (2).

They might also lead to dysregulation of the functioning
All children subjected to:
ANS (3).
Complete history taking, physical examination,
Changes in cardiac characteristics like heart rate
cardiac examination, neurological examination (including
result from autonomic dysfunction (4). Seizures have also
Glasgow coma scale), laboratory investigation (complete
been related to cardiovascular alterations (5). Especially
blood count, renal function, and serum electrolytes) and
QT prolongation that has the danger of serious
12-lead electrocardiogram were done to all patients.
dysrhythmia (6). Relevant abnormalities like prolonged
ECG was done within 24 hours of admission
QTc interval or cardiac block can be detected by a 12-lead
utilizing a Fukuda Denshi CardiMax FCP 7101 (UK).
ECG, which is an inexpensive test. Hypocalcemia as a
Analysis of ECG included heart rate, rhythm, PR interval
cause of convulsions can be identified on an
and QT interval. The QT interval was calculated by the
electrocardiogram (ECG) by a QTc prolongation due to a
time it took for the terminal T wave to return to the
ST segment elongation, the severity of which is inversely
isoelectric T-P baseline from the beginning of the QRS
related to the serum calcium level (7).
complex. Bazett's method used to make adjustments of
Our study aim was to detect cardiac ECG abnormalities
the QT interval for changes in HR.
in children with different causes of convulsions.
Received: 23/10/2023
Accepted: 22/12/2023

Full Paper (vol.941 paper# 150)

c:\work\Jor\vol941_151 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 1011-1013

Case Report: Angioleiomyoma in a 12-Year-Old Boy
Solafa Salih Mohamed, Anas Mahmoud Fatani, Afzal Siddique, Nizar Musawa
Surgery Department, King Salman Armed Forces Hospital Tabuk, KSA
Corresponding author: Solafa Salih Mohamed, Email: solafa.salih@gmail.com
OCRID: https://ocrid.org/0009.0005.8482-2953

This was a unique case of solid subtype angioleiomyoma located in the right posterior neck triangle of a
12-year-old boy, emphasizing the differential diagnoses and the diagnostic journey.
Objective: This report aimed to study the importance of differential diagnosis of pediatric neck lumps.
Clinical examination, imaging (ultrasound and CT scan), and histological evaluations were employed.
Results: Despite initial assumptions surrounding the nature of the lump, histological examination following an excisional
biopsy confirmed it as a solid subtype angioleiomyoma.
Conclusion: The report stressed on the importance of including angioleiomyoma in the differential diagnosis for pediatric
neck lumps and the significance of histological examination in achieving a definitive diagnosis.
Keywords: Angioleiomyomas, pediatrics, neck lump

Angioleiomyomas are benign tumors that originate
A 12-year-old boy presented with right lateral neck
from smooth muscles. There are four recognized
lump of 5 months duration, painless, increased gradually
subtypes: leiomyoma, angioleiomyoma, epithelioid
in size over the first few months then became static last
leiomyoma, and mesectodermal leiomyoma. The World
month, with no other associated symptoms and no lumps
Health Organization (WHO) defines a vascular
elsewhere in his neck or body. No significant past
leiomyoma, or angioleiomyoma, as a benign dermal or
medical history.
subcutaneous tumor. This tumor is characterized by well-
On examination, there was 3 X 2 cm lump in the right
differentiated smooth muscle cells organized around a
posterior triangle, oval in shape, with normal overlying
network of vascular channels 1.
and surrounding skin, non-tender, normal temperature,
Histologically, angioleiomyomas can be divided into
smooth surface, firm, well defined edges, relatively
three distinct subtypes:
mobile, not attached to skin or sternocleidomastoid

muscle, not pulsatile or compressible and not fluctuant
Venous: Featured as venous lamina of varying sizes with
but was transilluminant. No enlarged lymph nodes or
a pronounced muscular wall. This wall is interspersed
other lumps in the neck.
with loosely arranged intervascular smooth muscle
Routine blood tests showed no abnormality and
thorough ear, nose, and throat examination was normal.

A neck ultrasound scan revealed that the lump was an
Cavernous: Comprised of either thick or thin-walled,
enlarged lymph node about 1.5 X 0.9 cm with few
dilated vascular channels. These channels are set
internal calcifications in addition to multiple enlarged
between a limited numbers of smooth muscle bundles.
cervical lymph nodes, the largest measured 2.8 X 0.7 cm
Solid: Dominated by tightly compacted smooth muscle
(Figure 1).
cells that are arranged in variably intersecting bundles,

interspersed with slit-like vascular channels.

Mostly individuals commonly diagnosed with
angioleiomyomas are aged between 40 and 60 years.
These tumors typically manifest as firm, small, and slow-
growing lumps. Notably, cavernous and venous subtypes
appear more frequently in males, while the solid variant
is predominant in females. A primary symptom is a
painful lump, the discomfort from which may intensify
due to factors such as cold, wind exposure, pregnancy
and pressure, or menstruation.
In terms of prevalence, angioleiomyomas account
for about 4-5% of all benign soft tissue tumors. A
significant 89% of these are located in the extremities,
particularly below the knee. Those occurring in the head
and neck regions are comparatively rare, constituting
approximately 8.5% of all angioleiomyomas 2.

Figure (1): An ultrasound scan of the neck.

Received: 23/10/2023
Accepted: 22/12/2023

Full Paper (vol.941 paper# 151)

c:\work\Jor\vol941_152 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 1014-1026

The Importance of Intraoperative Culture Swabs for The Management of Patients
With Complicated Appendicitis Who Undergoing Laparoscopic Appendectomy
Heba E. Hashem 1, Zakaria H. Ibrahim2, Wafaa O. Ahmed3 & Safeya H. Hassan1
1 Clinical Pathology department - Faculty of Medicine -Ain Shams University, Egypt.
2 General Surgery department - faculty of Medicine ­ Al-Azhar University, Egypt.
3 Pediatrics department - Faculty of Medicine- Ain Shams University, Egypt
Corresponding Author: Heba Ezzat Hashem, Phone number: +966564407961
Email: hebaezzat@med.asu.edu.eg, ORCID ID: https://orcid.org/0000-0002-2996-7309

: There is a controversy about the benefits of intraoperative culture swabs (IOCS) in appendectomy
patients, some studies show no efficacy of such procedures while others support its use.
Aim of the work: This study aimed to determine the epidemiological, clinical data, isolated microorganisms, and
antibiotic resistance patterns in patients who underwent Laparoscopic appendectomy (LA) and evaluation of whether
IOCS can modify the rate or management of post-appendectomy complications.
Methods: the study was conducted on 292 patients who underwent laparoscopic appendectomy and intraoperative
culture and sensitivity were done. Patients' electronic medical records were reviewed for the relevant demographic,
perioperative, and postoperative data.
Results: The most common isolated microorganisms were E coli 36.6%, and Klebsiella species 21.25% followed by
Pseudomonas 8.33% which represents (21.27% and 5.18 % in complicated and non-complicated cases, respectively).
Isolated Pseudomonas spp. and extended-spectrum beta-lactamase (ESBL) resistant Enterobacteriaceae were less
frequently encountered (8.35%) but were resistant to most beta-lactam groups.
Conclusion: 2nd generation cephalosporins and metronidazole were used as a first-line postoperative treatment in most
uncomplicated cases. This treatment regimen was not effective against Pseudomonas spp and most ESBL-resistant
strains. Quinolones were added to the regimen in complicated and severe cases, its use was reserved for complicated
cases. A lower rate of complications was documented among studied patients in whom IOCS were used comparable to
other studies' results. The treatment protocols were adjusted in a significant number of patients according to the result
of IOCS, this reflects that its clinical implementation in routine surgical workup is clinically justified.
Keywords: Microbiology, Bacteria, Swab, Laparoscopy, Appendicitis, Antibiotic resistance.


Appendicitis remains the most common cause of
should include agents effective against facultative,
acute abdomen and surgical emergencies (1). It affects
aerobic Gram-negative, and anaerobic organisms and
96.5 to 100 people per 100,000 adults per year
should be based on knowledge of microbial testing (7).
worldwide with a range from 7 to 14% (2, 3). Over the
Microbiological culture during appendicectomy is
last decades, there have been several trials suggested
a routine medical practice. This practice was established
that antibiotics usage as the first approach without
after Altemeier. 1938 who showed that polymicrobial
surgery is relatively safe (4, 5).
flora was present in the peritoneal cavity in cases of
However, a systematic review with meta-analysis
perforated appendicitis. Although many surgeons tend
showed that surgical resection remains the treatment of
to rely on the proven efficacy of empirical antibiotic
choice for acute appendicitis (AA), although antibiotic
therapy rather than microbiological swab results (10-12).
therapy alone may be considered in some selected
Obtaining intraoperative culture swabs (IOCS) in
patients (6). Furthermore, relatively broad-spectrum
appendectomy patients is important to identify the
antibiotics and combinations of multiple antibiotics
pathogen and adjust the antibiotic regimen. Peña et al.
were used in antibiotics alone-treated groups in most
(13) and Felber et al. (14) reported that IOCS can help in
studies (7). Although, such treatment may be effective
knowing antibiotic resistance patterns in a specific
for major microorganisms that cause AA, it leads to
population or institution, and therefore guide the most
multidrug resistance emerging and in fact, antibiotic
effective empiric antibiotic regimen in patients
resistance is a resurging problem worldwide with
undergoing LA rather than being blindly treated. In a
multiple major medical sequels (8).
cohort study conducted by Coccolini et al. (15) on 1431
Concerning the preoperative antibiotic treatment
AA patients, they reported that antimicrobial resistance
protocol, it is recommended to be given to all patients
was strictly linked to the clinical outcome of the patients
with acute appendicitis, whereas postoperative
and adequate empirical antimicrobial therapy being
antibiotics are only prescribed in cases of complication
guided by microbiological swab results is fundamental
(9). In the treatment of acute appendicitis, appropriate
to counteract bacterial resistance and cutting down
antibiotics have a major role in patients with infectious
postoperative complications.
complications after surgery or in those receiving
Vanhatalo et al. (16) declared that the application
nonsurgical treatment. Appropriate choice of antibiotics
of traditional culturing methods combined with new
Received: 12/10/2023
Accepted: 15/12/2023

Full Paper (vol.941 paper# 152)

c:\work\Jor\vol941_153 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 1027-1034

Prevalence of Forward Head Posture among Cleaning Workers and
Its Correlation to Physical Workload
Heba Mohamed Ibrahim*1, Neveen Abdel Latif Abdel Raoof2,
Olfat Abdelrahman Diab1, Aya Abdelhamid Khalil3
Department of 1Biomechanics, Faculty of Physical Therapy, October University for Modern Science and Arts, Egypt
Departments of 2Basic Science and 3Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Heba Mohamed Ibrahim, Mobile: (+20) 01155425325,
E-mail: hmabdu@msa.edu.eg, ORCID ID: 0009-0000-7731-3003

Cleaning workers often perform repeated activities in awkward postures, exposing them to postural
malalignment and musculoskeletal disorders.
Objective: This study aimed to investigate the prevalence of forward head posture (FHP) among cleaning workers
and to determine its associated risk factors with a correlational analysis to physical workload.
Methods: This cross-sectional observational research was conducted using Photogrammetry to determine the
craniovertebral angle and a Rapid Upper Limb Assessment (RULA) working sheet to evaluate the physical workload
and the risk level for developing musculoskeletal disorders (MSDs) in 104 cleaning workers.
Results: The prevalence of forward head posture among cleaning workers was 61.54% with 95% CI (51.94- 70.32%).
FHP was significantly associated with higher weight status and working years (p<0.05). A Binary logistic regression
determined that overweight and obese participants were 0.11 times more likely to have FHP compared to normal
weight participants (Odds Ratio = 0.11, 95% CI 0.04-0.34). Participants with working 5-30 years were 0.23 times
more likely to have FHP than participants with 1- 4 working years (Odds Ratio = 0.23, 95% CI 20.09-0.53). RULA
score among them was 6.33 ± 0.73. There is a significant moderate positive correlation between the FHP and RULA
score (rpb = 0.49 p < 0.05).
Conclusion: 61.54% of cleaning workers exhibited forward head posture. High BMI and long working years were the
associated risk factors. High RULA scores emphasized the need for preventive actions to lower the risk of developing
FHP and other MSDs.
Keywords: Musculoskeletal Disorders, Photogrammetry, Posture, Workload.

frequently used observational ergonomic tool. It
Assuming healthy postures is thought to be
evaluates deviations in joint angles in the shoulder,
essential for overall health on both a musculoskeletal
elbow, wrist, neck, and trunk regions relative to their
and psychological level (1). Forward head posture
neutral positions across a range of occupational
(FHP) is a common abnormal posture in the sagittal
situations (10).
plane that is described as a position whereby the head
Posture assessment is significantly important for
is anteriorly displaced from a vertical reference line
clinicians and researchers investigating the impact of
that passes through the ear lobe to the tip of the
chronic incorrect postures on musculoskeletal
shoulder (2). Lower cervical spine flexion and
disorders progression (11). Therefore, this research was
hyperextension of the upper cervical spine are the
conducted to determine the prevalence of FHP in
defining characteristics of this particular postural
cleaning workers and to investigate its correlation to
abnormality (3, 4).
physical workload related to the musculoskeletal
After handling or lifting large objects, individuals
with improper postures are more likely to develop

musculoskeletal disorders (MSDs) compared to those
who maintain a proper posture (5). Housekeeping
Design: The study was conducted from April to
involves frequent manual material handling tasks,
November 2023 using a cross-sectional observational
including lifting, bending, pushing, carrying, and
research design.
pulling, often in awkward positions (6). As a result of

performing lots of hazardous duties, cleaning workers
Participants: Participants were recruited from the
are definitely among those most susceptible for
Housekeeping Department in 3 Universities in Cairo,
developing work-related musculoskeletal disorders
Egypt. Sample size calculation was done by the
(WRMSDs) (7).
G*power program 3.1.9 (version 3.1, Heinrich-Heine-
Photogrammetry is a method of quantifying body
University, Düsseldorf, Germany) for two-tailed tests
posture through the utilization of software specifically
( balancing: /2 on each side) based on ² tests -
designed to measure angles and linear distances
Variance: Difference from constant (one sample case),
(formed between lines produced by body markers
Ratio var1/var0 =1.5434598623, Type I error () =
and horizontal or vertical lines) on digital photographs
0.05, power (1- error probability) = 0.80.
(8,9). The Rapid Upper Limb Assessment (RULA) is a
Received: 23/10/2023
Accepted: 22/12/2023

Full Paper (vol.941 paper# 153)

c:\work\Jor\vol941_154 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 1035-1039

Assessment of Anterior Chamber Depth and Angle width among Patients undergoing
Cataract Surgery in Suez Canal University Hospital in Ismailia City
1 Hussein Salah Eldin ElNahas, 1 Mohamed Mounir Mohamed, *2Shereen Mohamed Mahmoud Abu-Eleneen
1 Ophthalmology Department, Faculty of Medicine, Suez Canal University.
2 Ophthalmology Department, El-Manzala General Hospital.
*Corresponding author: Shereen Mohamed Mahmoud Abu-Eleneen, Email: editor.j.official@gmail.com, Mobile: 01277311827

Cataract causes half of all cases of blindness and 33% of visual impairment worldwide. The sole viable
treatment for cataracts is surgery including phacoemulsification and posterior chamber intraocular lens (IOL)
implantation. Cataract surgery lowers intraocular pressure (IOP) in both glaucomatous and non-glaucomatous eyes via
altering the anterior chamber (AC) architecture.
Objective: This study aimed to assess anterior chamber depth (ACD) and angle width (ACAW) using Pentacam before
and after cataract surgery.
Patients and Methods:
This study involved 20 eyes of 20 patients having cataract surgery. About 55% were males
and 45% were females with mean age of 58.25 ± 8.83 years. Pentacam was used to measure ACD and ACAW before
and after cataract surgery.
The study showed significant increase in anterior chamber depth and in angle width after cataract surgery
(2.72 ± 0.42 before vs. 3.36 ± 0.77 after, p=0.001). ACD showed significant negative moderate correlation with age
before surgery (r=-0.521, p=0.018). Also, there was a significant increase in ACAW after surgery (35.11 ± 10.55 before
vs. 45.4 ± 12.01 after, p<0.001). Angle width showed significant direct strong correlation before and after surgery
(r=0.785, p<0.001).
Pentacam is a good method for obtaining quantitative data regarding anterior chamber configuration.
ACD and angle width significantly increased after cataract surgery.
Keywords: Cataract surgery, Anterior chamber depth, Angle width.


Cataract causes half of all cases of blindness and
assessment of its opacity at a selected location, yielding
33% of visual impairment worldwide (1).
a figure associated with its average opacity (4).
The sole viable treatment for cataracts is
Several techniques have been employed in
surgery including phacoemulsification and posterior
earlier research to assess ACD and ACA alterations
chamber intraocular lens (IOL) implantation. In
prior to and following cataract surgery. This study uses
phacoemulsification, the lens nucleus is emulsified
Pentacam to examine changes in the ACD and angle
into smaller pieces and aspirated by the surgeon using
an ultrasonic probe that is placed into the incision. The
phacoemulsification in healthy eyes.
benefits of the more recent method include a smaller

incision than with traditional ECCE, the need for fewer
or no stitches to close the incision, and a quicker
This prospective clinical case series trial was
recuperation period for the patient. Its drawbacks
conducted through the period from January 2023 to
include the surgeon's high learning curve and the
December 2023 at the Ophthalmology Department,
requirement for specialized equipment. A number of
Suez Canal University Hospital, Ismailia governorate.
early looks at clinical trials demonstrated that cataract
It involved 20 eyes of 20 cataractous patients of both
surgery lowers intraocular pressure (IOP) in both
sexes. The included patients were eligible for cataract
glaucomatous and non-glaucomatous eyes via altering
surgery with age more than 40 years. Patients had
the anterior chamber (AC) architecture (2).
intact clear cornea and intact AC.
The AC is the aqueous filled space inside the

eye between the iris and the corneal endothelium.
Exclusion criteria: Patients with increased intraocular
Several methods available for measuring changes in
pressure (IOP), corneal conditions (such as pterygium,
AC (3).
ulcer, opacity, dystrophy, etc.), symblepharon or
A medical tool called Pentacam is used to
conjunctival scar, history of trauma or surgery, and
measure the crystalline lens's morphological and
disorders of the posterior segment.
functional properties as well as the primary anterior

segment features. The Pentacam rotates around the eye
Methodology: Clinical ophthalmic examination,
from 0° to 180° while taking 25,000 single-slit
history, and visual acuity assessment using Landolt C
photographs in 2 seconds using a blue light-emitting
chart, refraction, AC slit-lamp biomicroscopy (SL-D7
diode to image the anterior eye segment. It offers a
slit-lamp Topcon Co, Tokyo, Japan, with Galilean
partially finished picture of the lens and an objective
magnification changer with converging binocular

tubes), IOP measurement (Haag Streit Applanation),

Full Paper (vol.941 paper# 154)

c:\work\Jor\vol941_155 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 1040-1045

Assessment of Serum Level of Vitamin B12 and Homocysteine in
Vitiligo Patients and Their Correlation with Disease Activity and Severity
Rana Ansary Hassan*1, Ahmad Shawki Hasan2, Sherif Refaat Ismail1, Ahmed Fathy State1
Departments of 1Dermatology, Andrology & STDs and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Rana Ansary Hassan, Mobile: (+20) 01000380708, Email: rana.ansary92@gmail.com
Background: Vitiligo is a common idiopathic disorder featured by depigmented epidermis and hair follicles. It has been
demonstrated that cases with vitiligo are often associated with vitamin B12 (cobalamin) deficiency. Vitamin B12 is a
main determinant of homocysteine (Hcy) level. High values of Hcy are reported to be associated with toxic effects on
melanocytes, which ultimately end in vitiligo. Objective: This study aimed to assess serum level of Hcy and vitamin
B12 in vitiligo patients and to detect their correlation with disease activity and severity.
Patients and Methods: This was a case-controlled study conducted on 50 vitiligo patients and 50 healthy controls.
General and dermatological examinations were made. Serum levels of vitamin B12 and Hcy were assessed. The severity
of the disease was assessed by Vitiligo Area Scoring Index (VASI) score.
Results: There was a highly statistically significant increase in serum Hcy and a highly statistically significant decrease
in vitamin B12 in the case group compared to the control group. There was a statistically significant relationship between
serum Hcy and both VASI, duration of the studied cases, both sexes, and vitiligo type.
Conclusion: Our study revealed a significant correlation between serum Hcy and both disease activity and severity
(VASI). This might indicate that Hcy can be utilized as a useful marker for activity and severity of vitiligo. There was
a statistically significant negative correlation between vitamin B12 and severity of vitiligo (VASI score). This might
indicate that vitamin B12 can be utilized as a useful marker for severity of vitiligo.
Keywords: Vitiligo, Vitamin B12, Homocysteine, Vitiligo area scoring index.

and vitamin B12 in vitiligo patients as biomarkers of
Vitiligo is a common cutaneous lesion featured by
activity and severity of vitiligo.
depigmented epidermis and hair follicles. Its prevalence
represents about 1% of the population globally. Loss of
This was a prospective case-controlled study
the pigment cells could be induced by intracellular and
conducted on a total of 50 vitiligo patients attending the
extracellular factors and there are a lot of possible
Outpatient Clinics of Dermatology Department of
systems, which could be comprised. Vitiligo has
Mansoura University Hospital over a period of one year.
psychological devastation and negative impact on
They were divided into two groups: Group (A) included
quality of life (QoL) [1]. It has been demonstrated that
50 patients with vitiligo and group B (control group)
vitiligo cases are more susceptible to pernicious anemia
comprised 50 age- and sex-matched normal persons.
and vitamin B12 deficiency [2]. Vitamin B12 is
Exclusion criteria:
important in melanin synthesis via the stimulation of a
Patients with age younger than 20 and older than 50
lot of enzymatic pathways. Vitamin B12 has been
years, smokers, treated by systemic or topical
considered as a primary determinant of homocysteine
modalities within the 4 weeks preceding examination,
(Hcy) level, as it acts as cofactor of the enzyme
patients took folic acid, vitamin B6, vitamin B12 or
methyltransferase for the regeneration of methionine
hormonal therapy 4 weeks preceding examination and
from Hcy, so nutritional deficiency in this vitamin
who had diseases known to affect the Hcy levels.
results in hyper homocysteinemia [3]. Increased Hcy
values are supposed to have toxic actions on
melanocytes which ultimately end in vitiligo. On the
All cases and the controls were subjected to history
other hand, the actual reason of melanocytes destruction
taking, which included personal history (age, smoking),
is complicated and not totally identified till now [4].
present history, family history of vitiligo, medical
It has been recommended that Hcy exerts a
history and past history of any medications or surgeries.
suppressive action on histidase as well as on tyrosinase
Complete general and dermatological examination
activity. Hcy has been demonstrated to be accompanied
such as the degree of vitiligo, which was estimated by
by suppression of tyrosinase enzyme by binding with
the rule of nines, lesion distribution, types of vitiligo,
copper, resulting in transient hypopigmentation [5]. As a
and bilaterality of lesions. The severity of the disease
result, it has been reported that increased Hcy could
was evaluated by VASI score [8]. The disease activity
interfere with the process of melanogenesis with
was evaluated as following: stable disease­ no change
subsequent stimulation of vitiligo development [6].
in the lesion throughout the previous 60 days based on
Elevation in serum Hcy is accompanied by a broad
the patient's observation and progressive lesion­
spectrum of medical disorders, which include psoriasis
enlarged lesions and/or the development of new lesions
[7]. Therefore, we aimed to assess the serum level,
within the 60 days before the study based on the
possible relation and the validity of utilization of Hcy
patient's observation [9]. Investigations included
Received: 23/10/2023
Accepted: 22/12/2023

Full Paper (vol.941 paper# 155)

c:\work\Jor\vol941_156 The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 1046-1049

Effectiveness of Percutaneous Radiofrequency Cervical Zygapophyseal
Neurotomy in Improving Chronic Cervicogenic Headache
Mohamed A. Matter*, Mohamed Mohamed Al Aswad, Amr Azmi Al-Eraqi, Aly Salah Eldin Khedr
Department of Neurourgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
*Corresponding Author: Mohamed A. Matter,Phone number: +201003908044,
E-mail address: mohamed_matter@med.psu.edu.eg

A variety of modalities have been developed to relieve cervicogenic headache. From these, percutaneous
radiofrequency neurotomy is the most commonly investigated treatment option in the literature and has been reported
to give satisfactory results.
Objective: The present research evaluated radiofrequency neurotomy's effectiveness in reliving cervicogenic
headaches, originating from the zygapophysial joint.
Subjects and Methods: The current investigation was carried out at the Neurosurgery Department of Hospital of
University of Suez Canal, Egypt, Ismailia. Twenty-four patients with chronic headache meeting the diagnostic criteria
of cervicogenic headache were enrolled and underwent radiofrequency neurotomy. Afterwards, their pain intensity was
assessed by Visual Analogue Scale (VAS) at one month, one week, twelve months, and at six months and compared to
their baseline scores.
Results: VAS scores improved by over 75% in 62.5% of patients 1 week following the treatment. This percentage
increased to 87.5% after 1 month; however, it declined again to 70.8% in patients after 12 months. After the course of
therapy, patients saw a sixty-five percent reduction in their weekly average analgesic administration and an average of
5.8 fewer headache days per week (down from 5.8 to 1.9). There were no significant post-procedural problems.
Conclusion: Reducing the need for analgesics and alleviating chronic cervicogenic headaches are two major benefits
of radiofrequency neurotomy.
Keywords: Cervicogenic headache, Radiofrequency neurotomy, Visual analogue scale.


Cervicogenic headache may arise not only from
Several studies have supported its efficacy in improving
the upper, but also from the middle and even from the
pain in the cervical Z-joint, both acute and chronic, when
lower cervical area (1). A headache originating from the
instances are effectively checked and selected for such
upper cervical spine is known as a cervicogenic
procedure (5, 8).
The present research aimed at evaluating the
headache. 4.1 percent of people have it, making it a
effectiveness of alleviating cervicogenic headache arising
rather common ailment (2).
from the zygapophysial joint through percutaneous
The atlanto-axial (A-A) joint is thought to be the
radiofrequency neurotomy.
second most frequent origin, whereas the C2-C3
zygapophysial joint (Z-joint) accounts for the bulk of
From May 2020 to October 2020, the research was carried out
cases (3). The atlanto-occipital (A-O) joint, the C2-C3
at the Neurosurgery Department of Hospital of Suez Canal
intervertebral disk, and the C3-C4 Z-joint have been
University in Ismailia, Egypt. Twenty-four patients who
less frequently reported as sources for such a condition
presented to SCU neurosurgery outpatient clinic with chronic
headache (>6 months of duration) fulfilling the requirements