c:\work\Jor\vol732_1The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 5961- 5969 Role of Magnetic Resonance Urography in Diagnosis of Pediatric Obstructive Uropathy: A Surgeon Perspective 1Sameh AbdelHay AbdelHamid, 2Khaled AbouelFotouh Ahmed, 3Mohamed Soliman ElDebeiky, 3Ahmed Bassiouny Arafa, 3Mohamed AbdelSattar Mohamed, Mostafa Mohamed Abdullah ElGhandour
1Department of Pediatric Surgery and 2Department of Radiology Faculty of Medicine, Ain Shams University,
Cairo, Egypt Corresponding author: Mostafa Mohamed Abdullah ElGhandour, Mobile: 01003703623, E-mail: [email protected] ABSTRACT Background: Obstructive uropathy is a group of different pathologies. Congenital obstructive uropathy represents a major cause of renal failure in infants and children. Urinary tract obstruction is defined as any condition that impairs urinary drainage from the pelvicalyceal system and leads to increased pressure and reduced urine flow rate. Objective: The aim of this study was to assess the role of combined static and dynamic Magnetic Resonance Urography in the management of pediatric obstructive uropathy and to compare it with our basic investigations. Patients and Methods: This study was conducted on the pediatric patients presented to Pediatric Surgery Department in cooperation with Radiology Department, Ain Shams University Hospitals, presented with upper urinary tract dilatation detected by ultrasonograghy. Results: There was a high agreement between MRU and our standard imaging data as regard detection of urinary tract obstruction giving the MRU no superiority to the basic imaging in this field. Combined MRU showed the highest accuracy among other investigations in identification of the level of obstruction. Dynamic MRU and renal scintigraphy in our study yielded similar results for identification of split renal function. Conclusion: This study provides evidence that combined static and dynamic MRU is a promising technique that allows anatomical and functional evaluation of obstructed kidneys to be used as a single modality for the comprehensive evaluation of urinary tract obstruction. Keywords: MRU, obstructive uropathy
rate (2). Clinically, obstruction is usually INTRODUCTION
considered when hydronephrosis is detected
Obstructive uropathy in the pediatric
by ultrasound. But not every patient with
age group is a group of different pathologies.
hydronephrosis has an obstruction, and the
The differential diagnosis of urinary tract
majority of cases of antenatal hydronephrosis
dilatation includes ureteropelvic junction
will improve without surgical intervention or
obstruction,
ureterovesical
junction
renal damage (3).
obstruction, ectopic ureteral insertion with and
The pediatric surgeon asks two
without duplex system, posterior urethral
questions: is there a need to operate, and if so,
valves, urethral atresia, and duplicating
when? Unfortunately, answering these
collecting
system
with
and
without
questions is not straightforward. More than
ureterocele. Congenital obstructive uropathy
half of hydronephrotic kidneys in infants are
represents a major cause of renal failure in
not obstructed and will show resolution or will
infants and children. Together with renal
markedly improve without deterioration of
dysplasia, it leads to almost half of all cases of
renal function. Furthermore, hydronephrosis
chronic kidney diseases in children (1).
may prevent renal damage by keeping the
Urinary tract obstruction is any
pressure inside the renal pelvis low: dilatation
condition that impairs urinary drainage from
does not always indicate obstruction (4).
the pelvicalyceal system and leads to
The well-established methods for
increased pressure and decreased urine flow
investigation still have some defects.
5961
c:\work\Jor\vol732_2 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 5970- 5975 Futures and the outcome of treatment of poisoned children and adolescents admitted to emergency units in different areas of Saudi Arabia Maha Mukhlef R. Alanazi1, Turki Habib AlShammari2,Muhannad Mohammed Alshehri2, Talal Habib AlShammari2, Abdullah Ahmad Alaradi2, Sami Najeeb Alsagre1, Haifa Saeed Alrumeh3, Mohammed Saeed Abdullah Alqahtani4
1Faculty of Medicine, Northern Border University, Arar, 2Faculty of Medicine, Imam Abdulrahman
Bin Faisal University, Riyadh, 3Faculty of Medicine, Taibah University, Madinah, 4 Faculty of
Medicine, King Khaled University, Abha, KSA
, *Corresponding author: Maha Mukhlef R. Alanazi, E-Mail:[email protected]Mobile:
+966535408401 Abstract Background: poisoning is a major problem in the pediatric and adolescents population. Poisoning is a main reason for children's admission to emergency units. Medications are the most common poisonous agent in children. Objective: to describe the, futures, and the outcome of treatment of poisoned children admitted to emergency units in different areas of Saudi Arabia. Patients and Methods: in this study, analysis of a retrospective data was done. Data were collected from mothers from different cities in KSA, during the period from 1st January to 31 March 2018. Cases of childhood or adolescents poisoning that were experienced by those mothers within the period were included. A structured close-ended online questionnaire was distributed to collect the relevant data. Results: the study included 96 cases. More than third (35.4%) of children aged 4-8 years, < 4 years constituted 24.0% and adolescents were 19.8%. Males were more than females (57.3% vs. 42.7%). Mode of poisoning was accidental in 91.8% and intended in 5.2%. As regards mood of administration of poisoned substance, 86. 5% were by ingestion, 7.3% by inhalation and 6.2% by contact of eyes or skin. The type of poison was spoiled food in 55.2%, cleaning compounds, such as chlorine and others in 12.5%, drugs in 7.3%, insecticide in 6.2%, poisonous herbs in 4.2%, narcotic substance in 1% and other substances in13.5%. Symptoms of poisoning was severe diarrhea ,vomiting and excessive sweating by the same percent 31.2%, severe abdominal pain in 14.6%, breathing difficulties in 13.5%, redness of the eyes in 12.5%, fainting in 8.35 and convulsions in 2.1%. As regards outcome of treatment, 93.8% of the cases were improved and cured completely and the overall mortality rate was 3.1%. Conclusion: Accidental childhood and adolescents poisoning in KSA is just like in many other regions. there is thus, the need for public awareness on the proper storage of harmful materials and the need for immediate hospitalization if accidental ingestion occurs. We strongly recommended for regulatory policies on safe keeping drugs to reduce the morbidity and mortality associated with accidental poisoning. Keywords: Accidental poisoning, childhood, adolescents, outcome. Introduction
Medications are the most common poisonous
Injuries represent the leading cause of
agent in children. The prevalence and type of
mortality and morbidity among children. One
substance ingested vary from place to place
category of major importance is poisoning, it
and over time (3). In Sahin's et al. (4) study
constitutes about 2% of all injury deaths in
48.4% of all poisonings were due to drugs.
developed countries and about 5% in
Poisoning is a main reason for children's
developing ones (1).
admission to emergency unit. Presenting
Accidental poisonings involve a person,
features include vomiting and diarrhea,
usually a young child, `accidentally' poisoning
drooling of saliva and difficulty in swallowing,
themselves without wanting to cause harm to
restlessness, weakness, and fever. Respiratory
their body. It is most common in young
features predominated and include cough, fast
children as they are keen to explore their world
and difficulty in breathing as well as abnormal
and often learn about new things by putting
chest findings on examination (5).
them in their mouth (2).
0795
Received: 5/7/2018 Accepted: 14/7/2018
c:\work\Jor\vol732_3The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 5976- 5981
The role of prophylactic radiotherapy in prevention of brain metastasis Jnadi Mohammed Jaber Madkhali, Khalil Ibrahim Ali Kariri, Ammar Abdullah Othman Hakami, Jubran Mohammed Ali Abiri, Alhassan Mahdi Ali Kariri, Ali Mahdi Ali Kariri
Faculty of Medicine, Jazan University, KSA
Corresponding author: Jnadi Mohammed Jaber Madkhali, Email: [email protected] Abstract: Introduction: Despite of these side effects, many studies concluded that the benefits of prophylactic brain radiation in prevention and delaying the spread of cancer overcome its harmful effects. This review aimed to evaluate the literature assessing the role of prophylactic radiotherapy in prevention of metastasis to the brain tissues, measure its incidence and the overall survival rates in patient with lung cancer to provide evidence-based data Methods: Electronic search was performed in Medline using Pubmed resulted in 107 eligible studies. The titles and abstracts of all these articles, was screened and based on this reading studies excluded due to irrelevancy or duplication. Results: Search of the literature identified total of 107 studies, after exclusion of irrelevant, duplicated and review studies, five studies were included in the review as they met the inclusion criteria. The included studies pointed to assess the effect of prophylactic radiotherapy in avoidance of brain metastasis. All included studies were randomized controlled trials. Total numbers of 1399 patients were recruited in the included studies. Age of patients range from 39 up to 84 years old or more. Small-cell lung cancer was the primary cancer in three of the included studies. One of the included studies assessed patients with non-small cell lung cancer and one study included patients with small cell anaplastic bronchogenic carcinoma. Conclusions: The use of prophylactic radiotherapy is effective in reduction of incidence of brain metastasis, but it had no role in rising of the overall survival. Keywords: Brain, tumor, radiation, radiotherapy, prophylaxis Introduction:
of high prevalence of brain metastasis, there is
The incidence of the secondary brain metastasis
an ongoing debate about the importance of
is associated with poor prognosis in most cases
prophylactic radiation of brain, doubts about its
(1, 2). Several studies reported short duration of
toxicity and impact on survival rates (13, 14).
survival after diagnosis of brain metastasis. In
Deterioration of the brain functions and memory
spite of development of treatment procedures in
loss and intelligent deficit are serious side
patients with brain metastasis, the high mortality
effects of radiation when used as a prophylaxis
rates remain a serious barrier to upgrade survival
to prevent brain metastasis (6, 8). Despite of these
rates (3, 4).
side effects, many studies concluded that the
Prophylactic radiotherapy was used to prevent
benefits of prophylactic brain radiation in
metastasis of primary lesions to the brain tissues.
prevention and delaying the spread of cancer
Many randomized control trials were conducted
overcome its harmful effects.
to measure the effect of the prophylactic
This review aimed to evaluate the literature
radiation in prevention of brain metastasis and
assessing the role of prophylactic radiotherapy
improvement of the survival rate (5-9). Small cell
in prevention of metastasis to the brain tissues,
lung cancer is characterized by high metastasis
measure its incidence and the overall survival
rates, especially to the brain (10). It was also
rates in patient with lung cancer to provide
noted that non-small lung cancer metastasis to
evidence-based data. These data can help the
the brain is a common problem that affect the
healthcare providers and improve the quality of
quality of life and the survival rate (11, 12). In spite
treatment benefits of prophylactic brain radiation
5976
Received: 5/7/2018 Accepted: 15/7/2018
c:\work\Jor\vol732_4The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 5982- 5991
Primipara Mothers who delivered vaginally or by cesarean section, is there an impact on the sexual function? 1Mohamed M. Al-Sherbiny, 1Rehab M. Abdelrahman, 1Amr A. Riad, 2Ahmed M. Adel Abdelgawad, 1Mahmoud M. Elsayed
1Department of Obstetrics and Gynecology, 2Department of Psychiatry Faculty of Medicine, Ain Shams University Corresponding author: Mahmoud M. Elsayed; Mobile: 01004992772 Email:[email protected]
ABSTRACT Background: The strength of the muscles of the pelvic floor and other supporting structures of the pelvic organs are affected by various events that occur during a woman's lifetime. Pregnancy and childbirth have a pronounced influence on maternal anatomy and physiology. Aim of the Work: The aim of the study was to investigate the impact of the mode of delivery on the sexual function (arousal-pleasure-orgasm-desire) - among a representative sample of Egyptian primiparae. Subjects and Methods: This cross-sectional observational comparative study was conducted at Ain Shams University Maternity Hospital during the period between November 2017and July 2018 on 260 women who had single uncomplicated delivery within a duration of not less than 6 months and not more than 2 years from recruitment of the study. Results: Pain was significantly positively correlated to the age [r=0.319, p=0.013] and social class [r=0.276, p=0.028]. Both satisfaction and the overall sexual function score was also significantly positively correlated to social class[r=0.275, p=0.032; r=0.237, p=0.048; respectively]. Pelvic floor muscle strength was poorly correlated to sexual function. Conclusions: The study revealed a significant difference in pelvic floor muscle strength between women who delivered vaginally and those who delivered by Cesarean section. However, there was no significant difference in sexual function between women who delivered vaginally and those who delivered by Cesarean section. Pelvic floor muscle strength was poorly correlated to sexual function. Recommendations: Cesarean section on demand should not be considered as prophylaxis against sexual dysfunction. A larger, nation-wide based study should be performed for assessment of sexual dysfunction among women of different age groups and parities. Key words: primipara, vaginal delivery, cesarean section, sexual function
episiotomy could theoretically affect maternal INTRODUCTION
sexual function in a dissimilar way. However, it is
At the beginning of twenty-first century,
unclear whether or how these different obstetrical
efforts were exerted to continue acting on behalf
events influence short- or long-term prognosis for
the health and the safety of both the mother and
maternal sexual function (2).
the child, taking into consideration the mother's
Sexual function was reported to be similar
desire and preference and child's rights. This
among women who delivered vaginally or by
motion raised the concept of prophylactic
cesarean at 6 weeks (3), or at 3 months (4) or at 6
cesarean delivery or as it sometimes referred as
months (5) postpartum.
cesarean on patient's demand(1).
Additionally, there was no reported
During the first 3 months postpartum,
impact of planned mode of delivery (vaginal vs.
many women experience some problems related
cesarean) on satisfaction with sexual relations at 2
to sexual function, such as dyspareunia, decreased
years postpartum (6).
libido, difficulty achieving orgasm, or vaginal dryness (2).
At 6 weeks postpartum, women who had
delivered vaginally without an episiotomy were
Typically, these problems resolve by the
reported to resume sexual activity sooner than
end of first postpartum year. There are three
those with an episiotomy(3).
mechanisms which may contribute to sexual dysfunction after childbirth: dyspareunia, birth
At 6 months postpartum, women who
canal injury (``pudendal neuropathy''), and
sustained anal sphincter lacerations were reported
overall general health of the mother (2).
less likely to return to sexual activity (5).
Thus, various obstetrical events such as
In a wider perspective, postpartum health
cesarean, instrumental or spontaneous delivery or
will be considered in the following time period: immediate postpartum (birth to 6 months), short-
5982
Received: 5/7/2018 Accepted: 15/7/2018
c:\work\Jor\vol732_5The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 5992- 5997
Comparative evaluation of hemodynamic stability and recovery during conscious sedation by dexmedetomidine with fentanyl versus ketamine with fentanyl in dilatation and curettage Gehan Fouad kamel, Rania Magdy Ali, Ali Elsayed Ali Ismail, Beshoy Eshak Aziz Hanna*
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams
University *Corresponding author: Beshoy Eshak Aziz Hanna, Mobile: 01006940037; Email: [email protected] ABSTRACT Background: Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, predictable recovery with minimal post-operative sequels. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and cooperative sedation without respiratory depression. It inhibits the release of norepinephrine via actions on the alpha2A (-2A) adrenoceptors located in the locus ceruleus and the spinal cord, resulting in sedation and analgesia via sympatholysis. Objective: It was to study the effect of dexemdetomidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure. The comparison included the vital data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. Patients and Methods: In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedtomidine loading dose 1 g/kg over 10 min and followed by 0.5 g/kg/hr infusion till completion of surgery and group KF received ketamine 0.5 mg/kg slow intravenous Bolus. Results: Dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines, and propofol. Conclusion: This study demonstrates that dexmedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine better preserved MBP and SpO2. Keywords: Dexmedetomidine, ketamine, fentanyl
easily be awaken, in addition no respiratory INTRODUCTION
depression, make dexmedetomidine one of the
Conscious sedation is a technique of
widely used medication in anesthesia (2).
providing analgesia, sedation and anxiolysis
These properties of dexmedetomidine
while ensuring rapid recovery without side
render it suitable for sedation and analgesia
effects. Conscious sedation is administered
during the whole perioperative period. Its
with the dual goals of rapidly and safely
applications as a premedication, as an
establishing satisfactory procedural condition
anesthetic adjunct for general and regional
for the performance of therapeutic or
anesthesia and as a postoperative sedative and
diagnostic procedures while ensuring rapid,
analgesic are similar to those of the
predictable recovery with minimal post-
benzodiazepines (3).
operative sequels (1).
Dexmedetomidine is selective 2 AIM OF THE WORK
adrenoceptor agonist that has sedative,
The aim of this study is to investigate
sympatholytic, amnestic and analgesic effects;
whether Dexmedetomidine with Fentanyl
it has been placed in a number of clinical trials
combination is an effective alternative
as useful and safe substance. Providing an
modality to ketamine with fentanyl as sedation
excellent analgesia, conscious sedation in
as regard hemodynamics stability and recovery
patients who seem to be asleep, however can
5992
Received: 5/7/2018 Accepted: 15/7/2018
c:\work\Jor\vol732_6 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 5998- 6003
Histologic Features of Uterine Septum Mohamed Ibrahim Mohamed Amer 1, Laila Nabegh Mohammed Nageeb 2, Walid ElBasuony Mohammed 1, Ahmed Hefny Abdo Abdo Hefny 1
1- Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University
2 -Pathology Department, Faculty of Medicine, Ain Shams University Corresponding Author: Ahmed Hefny Abdo Abdo Hefny, E-mail:[email protected], Tel: 01000074984
ABSTRACT Aim of the Work: this study aimed todetect the assessment of the histological features of the uterine
septum as regard the proportion of muscle fibers in relation to fibrous tissue to decide the best
management whether incision or excision.Patients and Methods: this study was carried out on 16
women with uterine septum in childbearing period complaining of either infertility or recurrent miscarriage
fulfilling the inclusion criteria, attending to Ain Shams University Maternity Hospital between May 2017 and
April 2018. The septum was incised or excised by scissors or by resectoscope and then specimen was taken
from the middle of the septum sample (A) and another specimen from the uterine wall sample (B). The
retraction of the septal tissue on both sides was observed. This study included 16 specimens of uterine septum
(A) and 16 specimens from uterine wall (B). Histopathological examination was done. Results: there was a
statistical significant difference between the uterine septum and uterine wall regarding amount of fibrous
tissue, number of cells in the connective tissue, amount of muscle tissue, amount of capillaries and number of
vessels with muscle wall (P < 0.05). Poor retraction of the septal tissue was found in the muscular
septum in contrast to good retraction that found in the fibrous septum. Conclusion: poor retraction of
the septal tissue was found in the muscular septum in contrast to good retraction that found in fibrous
septum. Keywords: histologic features, uterine septum, septal tissue retraction INTRODUCTION
and shape of the septum can vary by width,
Uterine anomalies were described in
length and vascularity (3). Initially, uterine
the 1800s by Cruveilhier and Von Rokitansky
septa were believed to be predominately (1). It is unclear what the exact rate of
fibrous tissue. However, biopsy specimens and
Müllerian abnormalities is in the general
magnetic resonance imaging (MRI) suggest
population, because no good cross-sectional
that septa are composed primarily of muscle
studies of healthy patients have been
fibers and less connective tissue (4).With the
performed. It is believed that the incidence is
development of gynecological endoscopic
in the range of 1% to 6%, with the reported
technology, the diagnostic and treatment
prevalence ranges from 0.16% to 10%. These
techniques of uterine septum are continuously
disorders are associated with various
being improved and perfected. Transcervical
gestational
complications,
including
resection of the septum (TCRS), with
spontaneous abortion, intrauterine growth
advantages such as shorter operating time, less
restriction, abnormal fetal lie, preterm labor,
surgical trauma and fewer complications, has
and preterm birth. Women with recurrent
become increasingly popular in clinical
pregnancy loss (RPL) appear to have a much
application (5). The common methods of TCRS
higher incidence of anomalies relative to the
include electroresection, microscissors, and laser.
general population (2).A uterine septum is
Microscissors do not require cervical dilation or
believed to develop as a result of failure of
cause thermal damage to surrounding tissues and
resorption of the tissue connecting the two
organs, and they can reduce the electrosurgical
paramesonephric (Mullerian) ducts prior to the
risks and occurrence of water intoxication.
20th embryonic week. The true prevalence of
However, their drawbacks include the
the uterine septum is difficult to calculate as
impossibility of synchronized bleeding stop, a
many
uterine
septum
defects
are
relatively long operating time and excessive
asymptomatic, but appear to range between 1
equipment wear and the requirement for regular
to 2 per 1,000 to as high as 15 per 1,000.
replacement of the scissors. Laser surgery has a
Septate uteri have a spectrum of configurations
short operating time, a lower amount of
including
incomplete/partial
septate
to
bleeding, a good haemostatic effect, and no
complete septate uterus. A partial septate
damage to surrounding organs, and it can be
uterus refers to a single fundus and cervix with
used in all types of uterine distention fluids.
a uterine septum extending from the top of the
However, it still has some disadvantages-its high
endometrial cavity toward the cervix. The size
cost, high operation requirements, and increased
risk of gas embolism caused by application of
8995
Received: 5/7/2018 Accepted: 15/7/2018
c:\work\Jor\vol732_7 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6004- 6009 The Effect of Adding Dexmedetomidine or Fentanyl to Levobupivacaine for Ultrasound-guided Supraclavicular brachial plexus block in Upper Extremity Sugeries Eissa R.E, Abo-Elnassr L.M, Amin S.M.and Mohamed R.M
Anesthesiology and Surgical ICU Department, Faculty of Medicine, Tanta University
Abstract Background: Supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. It has gained importance as regional anesthetic technique for surgical, diagnostic and therapeutic purpose in interventional pain management. Aim: We aimed to study the effect of adding dexamedetomidine or fentanyl to levobupivacaine in ultrasound guided supraclavicular brachial plexus block in upper extremity surgeries as regard to onset and duration of sensory and motor block and postoperative pain. Methods and Material: The study was carried out in Tanta University Hospital on 90 patients of 18-60 years old with ASA physical status I/II scheduled for elective surgery of upper hand. Patients were divided into three equal groups. Group A: was given 30 ml of 0.5% levobupivacaine with fentanyl 100 µg. Group B: was given 30 ml of 0.5% levobupivacaine with dexamedetomidine 100 µg. Group C: was given 30 ml of 0.5% levobupivacaine with 1ml normal saline. The following data were measured for each patient: hemodynamic status (HR, MAP), onset of sensory and motor block, and duration of sensory and motor block, visual analogue score (VAS) and incidence of complications. Results: Our results showed that no significant difference between three groups according to hemodynamic changes, while there was significant prolongation in duration of sensory and motor block, significant decrease in VAS score in group B compared to group A and C. Conclusions: We concluded that the addition of dexmedetomidine was better than fentanyl when both used as adjuvants to levobupivacaine in ultrasound guided brachial plexus block as demonstrated by prolongation of duration of sensory block, improved quality of postoperative analgesia and provide of desirable sedation Keywords: Supraclavicular brachial plexusdexmedetomidine-levobupivacaine upper extremity surgeries Introduction
planes and thereby reduce the incidence of
Supraclavicular brachial plexus block is one of the
pneumothorax, arterial puncture and direct nerve
most
effective
anesthetic
procedures
in
damage2.
ndoperations for the upper extremity. The
Levobupivacaine, a new local anesthetic having,
supraclavicular brachial plexus block has gained
similar pharmacological profile, but was shown to
importance as regional anesthetic technique for
possess less cardiotoxicity when compared to
surgical, diagnostic and therapeutic purpose in
bupivacaine3.
interventional pain management. It includes
Dexamedetomidine is Apha-
blocking of the brachial plexus where it is most
2 agonist combined
with local anesthetics to extend the duration of
compactly arranged, with less requirement of
regional anesthesia. There has always been a
anesthetic solution and rapid onset of action1.
search for ideal adjuvants in peripheral nerve
It provides ideal condition for surgery, maintains
blocks that prolong the duration of analgesia with
stable intraoperative hemodynamics and decrease
lesser adverse effects. Dexmedetomidine is
vasospasm, oedema and postoperative pain.
8(eight)
times
more
selective
towards
The use of ultrasound guidance for regional
2adrenoreceptors compared to clonidine4. Clinical
anesthesia became popular owing to detection of
studies have shown opioid sparing effects of
anatomical variants, painless performance and
dexmedetomidine when used intravenously along
more accurate needle placement. The needle tip
with
decrease
in
inhalational
anesthetic
can be guided toward the neurovascular bundle to
requirement5. In addition, it has been reported to
avoid injury to arteries, veins and other adjacent
improve quality of intrathecal and epidural
structure. It also helps to monitor the spread of
anesthesia6. However, very few clinical trials have
local anesthetic solution in the appropriate tissue
4006
Received: 5/7/2018 Accepted: 15/7/2018
c:\work\Jor\vol732_8The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6010- 6020 Lidocaine for Pain Control during Intrauterine Device Insertion: A Randomized Clinical Trial Hassan Awwad Bayoumy, Gihan El Sayed El-Hawwary , Hadeer Abd El-Shafy Fouad*
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University *Corresponding Author: Hadeer Abd El-Shafy Fouad, Telephone No.: (+2) 01098357256, E-mail: [email protected] ABSTRACT Background: Intrauterine contraceptive device (IUCD) is one of the most common contraception methods. In a survey of female Fellows of the American College of Obstetricians and Gynecologists, the prevalence of personal IUCD use was >20-fold higher than among women in the general population. In statistical terms, The IUCD is used by approximately 15% of reproductive-aged women in developing countries and 8% in developed countries. Aim of work: To compare the safety and efficacy of different local lidocaine preparations (spray, cream and injection) for reducing pain associated with IUCD insertion. Patients and Methods: This is a prospective randomized clinical trial. The study was conducted at Ain Shams University Maternity hospital at family planning outpatient clinic during the period between December 2017 and June 2018. Results: Results proved that lidocaine 10% spray application to the cervix during IUCD insertion effectively reduce pain felt during stages of IUCD insertion and is good option for reduction of pain associated with IUCD insertion in compared with lidocaine injection or cream. Conclusion: Our study demonstrated that local lidocaine spray 10% is effective in control of pain associated with IUCD insertion when compared with lidocaine cream or injection because its application is easy and rapid, while lidocaine injection can also reduce pain but injection itself is painful that makes it unfavorable method. Keywords: Lidocaine Intrauterine Contraceptive Device Insertion- Levonorgestrel Intrauterine System
adolescents and young women. In their INTRODUCTION
observational study, Marions et al found that out of 224 nulliparous women, 9% reported no
The intrauterine contraceptive device
pain, 17% reported severe pain and 72%
(IUCD) is the world's most widely used
reported moderate pain during insertion of a
spacing method of reversible birth control,
levonorgestrel intrauterine system (LNG-IUS)
currently used by nearly 120 million women
(3).
(about 10-15% of women in reproductive life(1).
IUCD insertion pain may be felt
during various stages of the procedure,
This popularity of use has been gained
including the vaginal examination, placement
primarily due to high long-term success rates
of the speculum, tenaculum use, and traction
and
reversibility.
Currently,
there
is
of the uterus, hysterometry and insertion of the
established evidence about their safety and
IUCD (4).
efficacy. Additionally, they exhibit superior contraceptive potential 20 times over
Although being difficult to predict,
traditionally used oral contraceptive pills that
factors affecting insertion related pain were
translates to lower rates of unintended
highlighted explicitly in recent literature.
pregnancies (2). Danielsson et al. reported that nulliparity, breastfeeding status and time since last
However, the clinical use of IUCDs is
pregnancy are the most influential predictors
largely limited by the associated pain during
of insertion pain; of these factors, nulliparity is
their insertion, which results in little
the strongest causal factor (4).
preference of use as contraceptive method from the patient perspective, especially for
Prevention and management strategies
of IUCD insertion pain include both non-
6010
Received: 5/7/2018 Accepted: 15/7/2018
ABSTRACTThe Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6021- 6027 Assessment of Pulmonary Artery Pressure in Chronic Obstructive Pulmonary Disease Patients without Resting Hypoxemia Muhammed Ali Mahmoud Farrag1, Mohamed Ali ElSayed1, Ahmed Mohamed El Mahmoudy2, Alaa Gamal Youssef El Mashad1
1Department of Chest Diseases, and 2Department of Cardiology, Faculty of Medicine, Ain
Shams University, Cairo, Egypt Corresponding author: Alaa Gamal Youssef El Mashad, Mobile: 01069999290; Email: [email protected] ABSTRACT Background: Chronic obstructive pulmonary disease (COPD) is a disease state characterized by progressive airflow limitation and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Pulmonary hypertension primarily occurs in COPD patients with severe hypoxemia and fortunately it is typically mild. Hypoxemia increases pulmonary artery pressure (PAP) through hypoxic pulmonary vasoconstriction and vascular remodeling, but there is a correlation between lung function parameters and PAP, suggesting that factors other than airway obstruction and/or loss of alveolar surface may play a role in its etiology. Objective: The aim of the work was to Identify other factors other than resting hypoxemia contributing to pulmonary hypertension in COPD patients. Patients and Methods: This study was a prospective study including 80 cases referred to Ain Shams University Hospitals presented with COPD defined using the standard criteria for chronic bronchitis. All patients underwent spirometry with pre and post bronchodilator treatment and trans-thoracic echocardiography. Results: The results showed that there was significant correlation between right ventricular systolic pressure (RVSP) values and each of the following; age, duration of smoking and degree of airway obstruction which were all contributing to pulmonary hypertension in COPD patients. Among 80 patients, 18 had elevated RVSP value. The mean age of those 18 patients was 58.8 ± 7.78 years while in those with normal RVSP 54.15±10.56 years. Those 18 patients had mean FEV1 percentage of predicted 44.5 ± 12.1% while in those with normal RVSP value 48.72±1.62%. Among those 18 patients 16 had history of smoking for >20 years representing 88.9%. Multivariate analysis showed that among all the studied parameters in our study, degree of obstruction determined by measured FEV1 percentage of predicted is an independent predictor for pulmonary hypertension in stable COPD patients. Conclusion: It could be concluded that pulmonary hypertension occurs frequently in stable COPD outpatients without resting hypoxemia and that age, duration of smoking and low pre- bronchodilator FEV1 are all risk factors for pulmonary hypertension. And that degree of airway obstruction is an independent predictor for pulmonary hypertension in stable COPD patients. Keywords: Pulmonary arterial hypertension, Forced expiratory volume in the first second, Right ventricular systolic pressure
limitation and is associated with an INTRODUCTION
abnormal inflammatory response of the
Chronic obstructive pulmonary
lungs to noxious particles or gases,
disease (COPD) is a disease state
primarily caused by cigarette smoking (1).
characterized by progressive airflow
1206
Received: 5/7/2018
Accepted: 15/7/2018
c:\work\Jor\vol732_10The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6028- 6034
Evaluation of the Effect of Diet Therapy in the Management and Prevention of Acne Vulgaris Sultan Mousa Bakri1, Alshafie Ali Yahya A2, Mohammed Abdulkhaleq Farea3, Bakr Abobakr Albrakati4, Tharaa Waleed Rambo4, Fatimah Mustafa AlShakhs5, Aldhafeer Eman Saad A5, Rawan Adel shafaay6, Mahabbat Nadin Anam A7, Njoud Ibrahim Al-Nodali8, Yara Mahdi BinSaleh9 Prince Mohammad Bin Naser Hospital, 2- National Guard Hospital_ Jeddah, 3- Hadramout University
College of Medicine, 4- Umm Al-Qura University, 5- Imam Abdulrahman Bin Faisal University, 6-
Almareefa College, 7- King Saud Bin Abdulaziz University For Health Sciences, 8- University of Hail, 9-
Alfaisal University Abstract Background: Acne is a widespread and complex skin disease among developed nations, affecting nearly all young adults between the ages of 15 to 17 years. It is a chronic inflammatory skin disorder resulting in psychological stress. Historically, the relationship between diet and acne is controversial. As a result, significant studies have been done to evaluate this relationship. Assessment of these literatures will help to provide better outcomes for the patients. Objective:This study aims to: 1- Measuring effect of diet and nutritional substances in the management and prevention of acne vulgaris. 2- Providing a reference paper analyzing all the clinical studies in this field. 3- Analyzing the last progression has been reached. Methods: PubMed database was used for articles selection. We included all relevant articles to our review with the following topics (("Acne Vulgaris/diet therapy"[Mesh]) AND ("Acne Vulgaris/prevention and control"[Mesh])) AND ("Acne Vulgaris/therapy"[Mesh]). We excluded other articles which are not related to this field. The data will be extracted according to specific form in which it is going to be reviewed by group members to assess the dietary effect of nutritional substance on acne vulgaris. Conclusion: We concluded that there are studies that showed promising results among patients and proved that associations do exist.Nevertheless, further studies with bigger sample and better protocols are needed to establish a concrete evidence-based relationship. Key words: Diet Therapy, Management, Prevention, Acne Vulgaris INTRODUCTION
disease varies markedly from one individual to the other depending upon the interplay of
Acne vulgaris is one of the most common
various factors involved in the development of
chronic skin diseases worldwide (1), with over
acne vulgaris. Grading systems based on the
90% of males and 80% of females affected by
clinical appearance of lesions as well as "lesion
the age of 21 years (2). Acne involves blockage
counting" is useful in assessing the severity of
and/or inflammation of pilosebaceous units (hair
acne vulgaris.
follicles and their accompanying sebaceous gland). Acne can present as non-inflammatory
The influence of nutrition on skin health is a
lesions, inflammatory lesions, or a mixture of
growing research area, a lot of researches done
both, affecting mostly the face but also the back
to assess the effect of various nutrition
and chest. The condition usually starts in
substances on the management and prevention
adolescence, peaks at the ages of 14 to 19 years
of acne. We therefore reviewed the literature
and frequently resolves by mid-twenties. The
done in this filed to assess the effect of diet and
most severe forms of acne vulgaris occur more
nutrition substances in the management and
frequently in males, but the disease tends to be
prevention of acne vulgaris.
more persistent in females (3). Severity of the
6028
Received: 8/7/2018 Accepted: 17/7/2018
c:\work\Jor\vol732_11 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6035- 6041
Risk Factors, Post-operative Complications and outcome of management of Hip Fracture in Arar, Northern Saudi Arabia Saud Rteamy R Alanazi1, Malik Azhar Hussain2, Hamdan Ayed H Albathali1, Fatimah Khalifah A Alshammari1, Zaid Qati F Alshammari1, Adel Turki D ALenezi1, Muaz Bilal Abdulhameed Wali1, Razan Fahad S Alotayfi1, Khalid Nadi M Alanazi1, Bader Arar Shadad Alruwaili1, Abdalla Mohamed Bakr Ali 3
1 Faculty of Medicine, Northern Border University, KSA
2 Assistant professor of surgery, College of Medicine, Northern Border University, Arar, Saudi Arabia.
3 Faculty of Medicine, Sohag University, Egypt Abstract: Background: Hip fractures are defined as any fracture of the femur between the articular cartilages of the hip joint to 5 cm below the distal point of the lesser trochanter. Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals and the elderly. Up to 30 % of the elderly patients with a hip fracture die within the first year. Objective: to show the risk factors and post-operative complications of hip fracture in cases attending orthopedic department of Arar Central Hospital in Arar city. Methods: a cross sectional study conducted during the period from 1 December 2017 to 31 March 2018. A predesigned questionnaire was used for data collection, and included inquiries about sociodemographic data of the studied patients, performing muscular exercise, osteoporosis, diminished vision and disorders in equilibrium, causes of fracture, type and site of fracture, occurrence of complications of surgery, postoperative care and the final outcome of treatment. Results: Most (70.1%) of the studied population aged 22-59 years, males constituted 59.8%. Causes of hip fracture were accident in 66.7% and fall in 25.0%. Among hip fracture cases, 43.9% were obese, 13.1% have osteoporosis, and 17.8% have disorders in equilibrium. Males reported insignificant higher percentage of hip fracture than females (25.0% Vs. 18.6%). Osteoporosis, diminished vision, chronic diseases, continuous use of medications and smoking showed significant relation with hip fracture (P<0.05). While BMI, disorders in equilibrium and performing muscular exercise showed insignificant relation. Complications after surgery was osteomyelitis in 12.6%, early fixation failure in 4.2%, wound infections in 8.4% and hospital acquires pneumonia in 4.2%. Only two thirds of the cases were completely cured. Conclusion: in our study population in Arar city, males reported insignificant higher percentage of hip fracture than females. Osteoporosis, diminished vision, chronic illnesses, continuous use of medications and smoking were significant risk factors of hip fracture. Complications after surgery was included, osteomyelitis, early fixation failure, wound infections and hospital acquire pneumonia. Only two thirds of the cases were completely cured, the rest of cases showed disability and movement limitation. Keywords: hip fractures, risk factors, surgical complications, outcome. Introduction:
Hip fractures are incisive events for senile people and over 90% of hip fracture patients
Hip fractures are defined as any fracture of the
are
older
than
65-year-old.
Overall
femur between the articular cartilage of the hip
complication rates after hip fracture surgery
joint to 5 cm below the distal point of the
may reach 50% [3, 4]. Up to 30 % of the patients
lesser trochanter [1]. Fracture of the femoral
with a hip fracture die within the first year [5]
neck is classified as a type of hip fracture. A
which is an excess mortality of 8-18 % at one
hip fracture is an uncommon fragility fracture
year compared to matching cohorts without a
due to a fall or minor trauma in someone with
hip fracture [6].
weakened osteoporotic bone. Most hip fractures in people with normal bone happens
Gender can play a role as male sex proved to
to individuals with unaccustomed strenuous
be a risk factor as the study of Algarni et al.[7]
activity or changes in activity, such as runners
in Riyadh revealed that the prevalence of hip
or endurance athletes, and as a result of high-
fracture was higher in males than in the
energy trauma such as falling from heights,
females.
sports injuries or car accidents [2] .
Medical complications may affect around 20% of patients with hip fracture. In the study
5306
Received: 8/7/2018 Accepted: 18/7/2018
c:\work\Jor\vol732_12 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6042- 6051
Comparative Study on the Effect of Silver Nanoparticles versus Silver Sulfadiazine in Diabetic Wound Healing in Albino Rat: a Histological Study Heba Mohamed Fawzy, Amany El Shawarby, Nagwa Kostandy Kalleny, Safaa M. Shaker
Histology and Cell Biology Department, Faculty of Medicine, Ain Shams University Corresponding author: Heba Mohamed Fawzy, email:[email protected] Abstract Background: the impairment of wound healing in the diabetic patients is an important clinical problem affecting millions of patients worldwide. This significant health care problem still lacks effective therapy. The ideal wound dressing is resistant to external forces and pathogens. It reduces patient discomfort and achieves good cosmetic results.Aim of the work: this study aimed to compare the effect of silver nanoparticlesversus silver sulfadiazine on diabetic wound healing in the adult albino rat.Material and Methods: twenty adult female albino rats were included in this study. The animals were categorized into four groups, 5 rats each: group I (control).Group II (untreated diabetic wound): diabetic rats that left untreated for 15 days of wound excision. GroupIII: diabetic rats in which silver sulfadiazine cream was applied on the wound daily for 15 days after thin skin excision. GroupIV: diabetic rats in which nanosilver-ointment was applied on the wound daily for 15 days after thin skin excision.At the end of the experiment, the specimens were taken and processed for histologicaland immunohistochemical studies. Morphometric and statistical studies were carried out.Results: examination of thin skin sections of nanosilver treated group revealed continuous epidermis with differentiated keratinocytes with proliferating basal layer .The dermis showed increased collagen deposition ,decreased p53 and increased VEGF expression compared to SSD treated group. Conclusion: silver nanoparticlescould be more effective than silver sulfadiazine in treatment of the diabetic wound. Key words:silver nanoparticles, silver sulfadiazine, diabetes, wound
Introduction
organisms that may delay the healing
Wound healing is a dynamic process
machinery. It is assumed that these excellent
consisting of four continuous, overlapping and
antimicrobial properties are a result of the
precisely programmed phases. The events of
combination of silver and sulfadiazine [3].
each phase must happen in a precise and
Nanoparticles (NPs) defined as particles
regulated
manner.
Interruptions
or
having diameter that range from 1 to 100 nm.
prolongation in the process can lead to delayed
Silver NPs (Ag NPs) have been shown to
wound healing or a non-healing chronic
possess unusual physical, chemical and
wound. In adult humans, optimal wound
biological properties [4].A number of factors
healing involves the following events:
affect
the
antimicrobial
activity
of
(1) rapid hemostasis, (2) appropriate
nanoparticles, such as shape ,size of metal
inflammation, (3) proliferative phase and (4)
particles which influence the surface properties
remodeling phase[1]. Diabetes affects hundreds
of the particles and the stabilizer and the pH of
of millions of people worldwide.Diabetic
the suspension[5] . Wonget al. noticed rapid
individuals exhibit a documented impairment
healing and improved cosmetic appearance
in the healing of acute wounds. Moreover, this
occurred in a dose dependent manner. They
population is prone to develop chronic non-
showed that silver nanoparticles exert positive
healing diabetic foot ulcers (DFUs), which are
effects through their antimicrobial properties,
estimated to occur in 15% of all persons with
reduction in wound inflammation, and
diabetes. Diabetic foot ulcers are a serious
modulation of fibrogenic cytokines [6].
complication of diabetes and precede 84% of Material and Methods: twenty adult female
all diabetes related lower leg amputations
albino rats of average weight 200-250 grams
[2].Topical treatment with silver sulfadiazine
were included. The animals were divided into
cream (SSD) is regarded as the gold standard
four groups: group I (Control group):
for prevention and treatment of burn wound
included 5 rats that received only food and
infection. It has prophylactic and therapeutic
water.
efficacy to control wound colonization by
6042
Received: 5/7/2018 Accepted: 14/7/2018
c:\work\Jor\vol732_13 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6052- 6063
Amniotic Fluid Changes and Doppler Studies in Unexplained Oligohydramnios before and after Intravenous Maternal Hydration
Abd El Moneim M. Zakaria1, Abd El Monsef A. Sedek2, Nader A.Abohassan1* 1Department of Obstetrics and Gynecology,Faculty of Medicine Al-Azhar University 2Department of Obstetrics and Gynecology, Elmenshawy General Hospital *Corresponding author:Nader A.Abohassan; Mobile: 01061010323; Email:[email protected] Abstract Background: role of intravenous hydration is well documented for the treatment of oligohydramnios. The present study concentrated on the efficacy of intravenous hydration in cases of unexplained oligohydramnios.Aim of the study: this study aimed to evaluate the effect of intravenous maternal hydration (hypotonic and isotonic fluid) in pregnancies with third-trimester oligohydramnios on amniotic fluid index and uteroplacental perfusion and fetal blood flow. Patients and Methods: this study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt, during the period from January 2017 to January 2018. A total of 60 pregnant women were included and parameters like age, parity, BMI, amniotic fluid index, urine specific gravity, hematocrit value, umbilical artery pulsatility index and uterine artery pulsatility index before and after maternal hydration were noted and compared. Results: intravenous maternal infusion of (1/2) normal saline (0.45%) at a rate of 1000 ml/hr for two hours has statistically difference in the mean amniotic fluid index ,in mean urine specific gravity, in mean umbilical artery pulsatility index and in mean uterine artery pulsatility index immediately after hydration,72 hr and one week after hydration (p<0.05). Conclusions: maternal intravenous hydration with hypotonic fluid can be used in the treatment of oligohydramnios Key words: amniotic fluid index, maternal hydration, oligohydramnios. Introduction
placental blood flow and isolated placental
Amniotic fluid is important for the
chromosomal mosaicism, associated with
maintenance of fetal well-being (1). It provides
impaired fetal growth, drugs such as
a
supportive
environment
for
fetal
prostaglandin synthetase inhibitors, acute or
development. It protects the fetus from trauma
chronic amniotic fluid leakage (5).In some
and infection through its dampening and
cases, there are no evident fetal or maternal
bacteriostatic properties. It allows for fetal
causes, and the condition is called isolated or
movement and thus fosters the development of
unexplained oligohydramnios (1).Amniotic
the fetal musculoskeletal system. It prevents
fluid volume represents a dynamic state that is
compression of the umbilical cord and
influenced by both fetal and maternal
placenta and thus protects the fetus from
conditions (6).Adequate amniotic fluid volume
vascular and nutritional compromise (2).
is maintained by a balance of fetal fluid
Amniotic
fluid
deficiency,
i.e.,
production (lung liquid and urine) and
oligohydramnios is defined as amniotic fluid
resorption (swallowing and intramembranous
index
(AFI)
5.0
cm
or
less (3).
flow). Even though different hypotheses have
Oligohydramnios can have multiple impacts
been advanced on the mechanisms regulating
on the prognosis of the pregnancy (1).Amniotic
this turnover, the inflow and outflow
fluid is important for the development of fetal
mechanism that keeps amniotic fluid volume
organs, especially the lungs. Too little fluid for
within the normal range is not entirely clear (7).
long periods may cause abnormal or
An additional route of amniotic fluid
incomplete development of the lungs called
absorption is required to balance fluid output
pulmonary
hypoplasia.
At
delivery,
and absorption; this absorption is theorized to
oligohydramnios may increase the risk for
occur across the fetal amnion into the fetal
compression of the umbilical cord and
vasculature, and has been named the
aspiration
of
thick
meconium (4).
intramembranous (IM) pathway. In addition,
Oligohydramnios may be the result of fetal
amniotic fluid volume depends on fetal
renal tract abnormality or damage, placental
hydration. All water in the conception
insufficiency, including impaired maternal-
ultimately derives from the mother; therefore
6052
Received:21/6/2018 accepted:30/6/2018
c:\work\Jor\vol732_14 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6064- 6069
Assessment of Diclofenac Sodium Infusion for Management of Post-Spinal Shivering Sherif Sayed Sultan, Ashraf Elsayed Elagamy, Mayada Ahmed Ibrahim, Mina Magdy Fakhry*
Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine,
Ain Shams University *corresponding author: Mina Magdy Fakhry, E-mail:[email protected] ABSTRACT Background: shivering is a common problem faced by an anesthesiologist during intraoperative as well as in postoperative period. It is a frequent, unpleasant, and undesirable complication occurring after sub- arachnoid block (SAB), secondary to vasodilatation as a result of sympathetic blockade. The incidence of shivering has been reported to be about 36-85% after spinal anesthesia. The present study was designed to compare the efficacy of diclofenac sodium and pethidine on reducing postoperative shivering following sub-arachnoid block. Objectives: the aim of this study was to investigate the ability of intravenous infusion of diclofenac sodium (1mg/kg maximally 75mg) to treat established post-spinal shivering. Patients and Methods: after approval from departmental ethics committee in Ain shams university and written informed consent from the patient, a randomized study was conducted on ninety adult patients with American society of anesthesiologists (ASA) physical status I, II and III aged from 18 to 65 years. The study was conducted from September 2017 to February 2018. The study was a randomized, prospective, double-blind, placebo-controlled study. All patients were informed about the study design and objectives as well as tools and techniques. Informed consent was signed by every patient prior to inclusion in the study. Results: after approval of the department of anesthesiology, intensive care and pain management at Ain Shams University ethical committee, this randomized study was conducted on ninety patients who were scheduled to have surgery with spinal anesthesia. The design of the study included three groups, each constitutes of 30 patients (n= 30). Conclusion: the data showed that pethidine infusion was more effective than diclofenac sodium infusion in management of shivering after spinal anesthesia. However diclofenac sodium was better than placebo in non-significant way. Keywords: Diclofenac Sodium Infusion, Post-Spinal Shivering, pethidine infusion INTRODUCTION
redistribution of warm core blood to cold
Shivering is a frequently occurring
peripheral compartment after peripheral
post-anesthesia complication. It occurs after
vasodilatation that starts immediately after
both general and regional anesthesia. It is
induction of anesthesia. Other factors help
estimated to follow more than 40% of all cases
hypothermia include cold room temperature
receive anesthesia. Shivering is defined as
and intravenous fluids used intraoperatively.
involuntary, spontaneous, oscillatory muscular
Other factors that may lead to shivering
activity. It is one of main cause of patient
include transfusion reactions, bacteremia and
discomfort in the immediate postoperative
sepsis and drug reaction(1).
period. Oxygen consumption increases with
The incidence of shivering has been
the intense of shivering. It may resemble a
reported to be about 36-85% after SAB.
mild exercise but in some severe cases oxygen
Shivering has detrimental effects like
consumption may rise to 600%. Post-
interference in monitoring of pulse rate, blood-
anesthesia shivering may be caused by
pressure (BP), and ECG, increase in oxygen
different factors. It is considered a
consumption, catecholamine secretion, carbon
physiological response to core hypothermia
dioxide production, metabolic rate increase by
that
accompanies
anesthesia.
Core
400%, increase intraocular pressure (IOP),
hypothermia
is
attributed
mainly
to
Intra-cranial pressure (ICP), and lactic acid
0606
Received: 8/7/2018 Accepted: 18/7/2018
c:\work\Jor\vol732_15 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6070- 6074
Values of Chest Ultrasound and Blood Platelet in Diagnosis and Assessment the Severity of Community Acquired Pneumonia Hussein Abd El-Fattah Mohammed1, Mohammed Ali Abboud2, Fareed Shawky Basiony1, Ahmed Younes Younes Younes1*
Departments of 1Chest Diseases and 2Radiodiagnosis, Faculty of Medicine, Al-Azhar University *Corrosponding author: Ahmed Younes Younes Younes, E-mail:[email protected] ABSTRACT Background: over the past 15 to 20 years, lung ultrasound has developed as an important modality for the bedside diagnosis of pneumonia both in the Emergency department and intensive care unit (ICU) settings, Platelets play a crucial role in antimicrobial host defenses and the coagulate system, it is hypothesized that an abnormal platelet count may be an important marker to assess severity of disease in patients with community acquired pneumonia (CAP). Aim of the Work: the aim of this study was to evaluate the role of chest ultrasound and blood platelet in diagnosis and assessment the severity of community acquired pneumonia. Patients and Methods: this was a prospective study carried out at Chest Department and Respiratory ICU at El-Hussein University hospital in the period from September 2017 to June 2018. The study included 50 cases of CAP; 29 cases male and 21 cases female with mean age (48.32+15.62 years) admitted at the Chest Department and Respiratory ICU were enrolled in this study after obtaining informed consent. Results: the results of this study revealed that the transthoracic ultrasound can easily detect signs of consolidation and assess the success of pneumonia correlation with CURB 65 SCOR and blood platelet. Conclusion: thoracic ultrasound is a simple, bedside test used for diagnosis of pneumonia can differentiate between simple pneumonia and post stenotic pneumonia, atelectasis and mass. However, it is operator dependent and needs training. Keywords: Thoracic Ultrasound, CURB 65 Scor, Blood Platelet. INTRODUCTION
diagnosis and assessment the severity of
Community acquired pneumonia is the
community acquired pneumonia.
most common disease recorded worldwide; PATIENTS AND METHODS
pathologically
it
is
characterized
by
This was a prospective study carried
inflammatory process that involve alveolar
out at Chest Department and Respiratory ICU
space or interstitial tissue or both (1).
at El-Hussein University hospital in the period
The diagnosis of pneumonia is based
from September 2017 to June 2018. The study
on clinical presentation, laboratory tests, and
included 50 cases of CAP; 29 cases male and
chest imaging. The utility of chest radiography
21 cases female with mean age (48.32+15.62
is limited compared with chest CT that
years) admitted at the Chest Department and
considers the gold stander for diagnosis of
Respiratory ICU were enrolled in this study
pneumonia (1).
after obtaining informed consent. The study
Chest ultrasound has been shown to be was approved by the Ethics Board of Al-
highly effective in evaluation arrange of Azhar University.
pathogenic pulmonary study and its one of the
All cases were subjected to the
most widely application in evaluation of
following: Full history taking, Full clinical
pneumonia (2).
examination, Vital signs (pulse, blood
Platelets play a crucial role in antimicrobial
pressure,
temperature,
respiratory
rate,
host defenses and the coagulate system; it is
Systemic examination to exclude co existing
hypothesized that an abnormal platelet count
systemic disease, Chest examination for signs
may be an important marker to assess severity
of consolidation e.g. rales and bronchial
of disease in patients with CAP (3).
breathing, Routine laboratory investigations, Complete blood picture was done on the first AIM OF THE WORK
day of admission and on 7th day to assess the
The aim of this study is to evaluate the
response of platelet count to inflammatory
role of chest ultrasound and blood platelet in
process, Hepatic and renal profiles, Blood coagulation profiles, Serum electrolyte (NaK-
0606
Received: 10/7/2018 Accepted: 20/7/2018
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Retrospective Analysis of Clinico-Epidimological Factors in Prostatic Cancer Atef Youssef Reyad, Mai Mohamed Ezz El Din, Nesreen Ahmed Mosalam & Walaa Hatem El Damhogy *
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University *Corresponding Author: Walaa Hatem El Damhogy , Phone No.: (+2) 01003339504,E-mail:[email protected] ABSTRACT Background: Prostate cancer is the second most common cancer in men and the seventh leading cause of male cancer death worldwide. It is a highly heterogenous disease with great variability in its clinical course. Treatment options vary depending on age, stage, and grade of cancer, as well as other medical conditions. Aim of study: In this retrospective study we aimed to provide clinico-epidemiological characteristics of prostate cancer and to present different treatment modalities with respect to OS, DFS and PFS. Patients and Methods: Male patients with localized or metastatic prostate cancer presented to Ain Shams University Hospitals in the period from January 2010, to December 2015. In our study, we reviewed medical records of 101 patients including demographic data and clinic-pathological factors were reported, including age, sex, performance status (ECOG), co-morbidities, personal habits, tumor characteristics, surgery, radical treatment, metastatic treatment, treatment response and survival rates were collected. Results: Our population under study had a median age of 69 years (range: 42-85), majority of our patients (94%) had good ECOG performance status ( 2), (44.6%) of the patients were presented to us with metastatic disease, most common symptoms at presentation were prostatism in 72.8% of patients and bony aches in 18.8%. The mean Gleason score among studied population was mean 7.37. 44.6% of the patients were metastatic at time of presentation. Median overall survival in studied population was 31 months, median PFS of the studied group was 17 months and the median DFS 29 months. Conclusion: We provide an overview of patients with prostate cancer in a single tertiary institution in Cairo and it was found that lack of patient awareness in most patients leads to their late presentation at time of diagnosis. Key word: Prostate cancer; Diagnosis; Enzalutamide; Salvage; Egypt
predictor of cancer than either DRE or trans- INTRODUCTION
rectal ultrasound (TRUS)(4).
Prostate cancer is the second most
common cancer in men and the seventh
MRI is the most valuable modality in
leading cause of male cancer death worldwide;
imaging of prostatic cancer using high-
as there are an estimated 1,600,000 new cases
resolution T2 images. It provides the most
of prostate cancer and 366,000 prostate cancer
accurate demarcation of the extent of the
deaths annually (1).
primary tumor evaluates extra prostatic extension and confirms the presence of
Prostate cancer patients have a good
seminal vesicle invasion. It also provides
survival rate if the cancer is diagnosed at an
information on tumor volume, Gleason grade,
early stage (2).Survival of cancer patients tends
and local and regional stage (5).
to be very poor in developing countries, due to diagnosis at a late stage and inadequate
There are several promising imaging
facilities of treatment (3).
methods that may improve the staging of prostate cancer soon. Prime among these is the
PCa is usually suspected based on DRE
prostate specific membrane antigen (PSMA)
and/or an elevated PSA. Definitive diagnosis
PET-CT. A series of high-affinity gallium-68
depends on histopathological examination.
labeled and fluorine-18 (F- 18)labeled ligands
Abnormal DRE is an indication for biopsy, but
have been developed that bind PSMA, an
as an independent variable, PSA is a better
antigen expressed in prostate cancers and their
6075
Received: 10/7/2018 Accepted: 20/7/2018
c:\work\Jor\vol732_17The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6082- 6089
Effect of Maternal Anemia on Fetal Doppler Indices during the Last Trimester of Pregnancy Abdel-Megeed Ismail Abdel-Megeed, Amr Ahmed Mahmoud Riad, Shaimaa Mahmoud Mohamed Morsi Elsherif
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University Corresponding author: Shaimaa Mahmoud Mohamed Morsi Elsherif, Mobile: 01024035319; Email:[email protected] ABSTRACT Background: Anemia is one of the most commonly encountered medical disorders during pregnancy. In developing countries it is a cause of serious concern as, besides many other adverse effects on the mother and the fetus it contributes significantly to high maternal mortality. According to United Nation declaration 1997, anemia is a major public health problem that needs total elimination. It is estimated that globally two billion people suffer from anemia or iron deficiency.Maternal anemia is frequently associated with premature delivery, reduced neonatal weight, infant iron deficiency, neonatal death, and low APGAR scores at 1 min. It is also suspected to reduce the oxygen supply to the growing fetus, leading to the redistribution of fetal blood flow. Objective: The aim of this study was to evaluate the effect of maternal anemia on fetal Doppler indices namely umbilical artery and middle cerebral artery in the last trimester of pregnancy. Patients and Methods: This study was designed as a prospective case control clinical trial carried out in Obstetric outpatient clinics and inpatient ward, Ain Shams University Maternity Hospital on 200 patients. The patients must follow these criteria, gestational age between 28-40 weeks of singleton pregnancy (calculated by their last menstrual period or by earlier ultrasound), fetus is alive and normal fetal ultrasound parameters. Results: The umbilical artery resistance index show a significant increase in moderate severe anemic patients more than control group, umbilical artery pulsatility index show a significant increase in severe anemic group more than the other 3 groups, umbilical artery systolic/diastolic ratio show a significant increase in severe anemic more than the other groups. Finally the umbilical artery cerebral/umbilical artery resistance ratio show a significant increase in severe anemic more than the other groups. Conclusion: GA at delivery in in different groups was matched. i.e. there was no statistical significant difference between different studied groups regarding GA at delivery (P > 0.05). Neonatal ICU admission were 2(4%), 2(4%), 4(8%) and 9(18%) in different groups respectively. There was statistical significant difference between different studied groups regarding Neonatal ICU admission (P < 0.05). Keywords: Red blood cells, hemoglobin concentration, cerebral/umbilical artery resistance ratio
making of things." So, Erythropoiesis is the INTRODUCTION
process of manufacturing, recycling, and
Anemia in general is characterized by a
regulating the number of red blood cells (2).
decrease in number of red blood cells or less than
Most of the work of erythropoiesis
the normal quantity of hemoglobin. The
occurs in the bone marrow. It takes about 25
condition is determined by the expected normal
days (Fig. 2). In children younger than 5 years
range of hemoglobin in a population, and is
old, the marrow of all the bones of the body is
defined as existing in an individual whose
enlisted for producing red blood cells. As a
hemoglobin concentration (Hb) has fallen below
person ages, red blood cells are eventually
a threshold lying at two standard deviations
produced only in the marrow of the spine, ribs,
below the median for a healthy population of the
and pelvis (3).
same demographic characteristics, including age,
According to the United Nations (UN)
sex and pregnancy status (1).
estimates, approximately half of pregnant
The actual process of making red
women suffer from anemia worldwide.
blood cells is called erythropoiesis. In Greek,
Nutritionally related iron deficiency is the
erythro means "red," and poiesis means "the
main cause of anemia throughout the world. It
6082
Received: 10/7/2018 Accepted: 20/7/2018
c:\work\Jor\vol732_18The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6090- 6096
Role of Diffusion Mri In Differentiation Between The Common Pediatric Posterior Fossa Brain Tumors. HanaaAbdelkader Ahmeda, Eman A. F. Darwisha, Osama Mohamed abo-bakrkhattabb
a. Radiology Department, Faculty of Medicine, Ain Shams University.
b. Radiology Department, Basioun Central Hospital,Basioun, Gharbia. Corresponding author: Osama Mohamed abo-bakrkhattab,Tel: +20 1065448747, E-Mail: [email protected] Abstract Background: Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) map provide information on MRI about the cellularity of the tumor and have an important role in the pre-operative differentiation of different tumor types. Objective: The aim of this work is to assess the role of diffusion MRI in differentiation between the most frequently encountered pediatric posterior fossa brain tumors. Materials and methods: Twenty-four patients were prospectively included in this study. They were referred from the Neurosurgery Department. All of them were suspected to have posterior fossa SOL according to the contrast enhanced CT. All patients were subjected to conventional MRI followed by diffusion MR imaging and calculation of the ADC values. Results: Twenty-four children (15 females) were included in the study. Their ages ranged between one and fifteen years old with a mean age of six years. Low-and high-grade tumors could be differentiated by using both absolute ADC values and ratios. Low-grade tumors showed statistically significantly higher ADC values (1.69±0.15 vs. 0.80±0.23) and ratios for tumor versus normal cerebellum (2.17±0.30 vs. 1.14±0.33) and tumor versus brain stem (1.88±0.35 vs. 1.06±0.24).The probability of error at 0.05 was considered significant, while at 0.01 and 0.001 was considered highly significant. Absolute ADC values and cerebellar and brainstem ratios were significantly higher in low-grade astrocytomas than in MBs. Overlap was found between ADC values of ATRTs and MBs.The sensitivity and specificity of a cutoff ADC value of > 1.083 x 10-3mm2/s for differentiation of pilocytic astrocytomas from MBs and ependymomas were 100%.The sensitivity and specificity of a cutoff ADC value of 0.847 x 10-3mm2/s for differentiation of medulloblastomas from PAs and ependymomas were 100%.The sensitivity and specificity of a cutoff ADC value of 1.083 x 10-3mm2/s and > 0.847 x 10-3mm2/s for ependymomas were 100%. Conclusion: The calculation of ADC value in the solid enhancing portion of a tumor is a simple and reliable technique for preoperative differentiation of the most common posterior fossa tumors. Keywords:DWI,ADC,Posterior fossa tumors. Introduction
Histopathological evaluation of brain biopsies
Brain tumors are the most common solid
is still the gold standard for definitive
tumors in childhood and the second most
diagnosis. However, there are also limitations
common neoplasm in childhood after
to histological diagnosis e.g. sampling errors
hematological malignancies.However, they are
in surgical biopsies due to intrinsic tissue
the leading cause of morbidity and mortality.
heterogeneity where tumors under grading can
Up to 60-70% of brain tumors are infra
occur. Also, due to the complication of being
tentorial, being most common in children from
invasive. So the development of new non-
4 to 11 years[1].Common posterior fossa brain
invasive diagnostic tools is necessary [1].
tumors in children include juvenile pilocytic
Diffusion MR imaging is a technique in
astrocytoma (JPA), medulloblastoma (MB),
which dedicated phase-defocusing and -
ependymoma and brainstem gliomas. Because
refocusing gradients allow evaluation of
these various tumors require very different
microscopic
water
diffusion
within
treatment approaches and have significantly
tissues. It has been considered a means to
different natural histories and outcomes, an
characterize
and
differentiate
accurate and specific diagnosis is mandatory[1].
morphologic features, including edema, necrosis, and tumor tissue, by measuring differences
in
apparent
diffusion
6090
Received: 10/7/2018 Accepted: 20/7/2018
c:\work\Jor\vol732_19The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6097- 6102
Preoperative Prediction of Difficulty of Laparoscopic Cholecystectomy Hanna Habib Hanna, Mohamed Ibrahim Mohamed and Amir Milad Nazier*
Department of General Surgery, Faculty of Medicine, Ain Shams University *Corresponding Author: Amir Milad Nazier, Phone No.: (+2) 01212653453, E-mail: [email protected] ABSTRACT Background: laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures worldwide, is accepted as the gold standard in the treatment of symptomatic gallstones for its minimal invasiveness, less pain and early recovery. Purpose: to predict the difficulty of laparoscopic cholecystectomy in patients according to the recently published scoring system and to add more items to it. Patients and Methods: this is a prospective cohort study. This study took place in Ain Shams University Hospital and Manshiet El Bakry Public Hospital, General Surgery Unit, Surgery Department; the study involved 120 patients admitted with calcular cholecystitis, arranged for laparoscopic cholecystectomy. Results: in our study we found that age, sex and ultrasonographic data were significant predictive factors for assessment preoperatively difficult cases that will be operated upon. We found 14 patients above 50 years who scored to be difficult and very difficult were at outcome difficult, only three patients converted to open surgery over fifty. Conclusion: According to sex males has been described to be associated with difficult LC as in our study that confirmed that as 14 males who participated in our study 10 of them were predicted to have a difficult surgery and 3 expected to be very difficult. Post-surgery 100% of males turned out to have a difficult procedure. Also according to other factors, such as history of acute attacks that increase risk and difficulty due to adhesions at Calot`s triangle and risk of cystic artery and bile spillage, were increased during dissection. Keywords: Laparoscopic Cholecystectomy - Acute Cholecystitis - Pancreatic Duct INTRODUCTION
The degree of difficulties is again impossible
Laparoscopic cholecystectomy, one of
to predict but it is important to know for better
the most commonly performed surgical
preparedness for the surgeon and explanation
procedures worldwide, is accepted as the gold
to patients for possibility of conversion to
standard in the treatment of symptomatic
open (3).
gallstones for its minimal invasiveness, less
Preoperative assessment of complexity
pain and early recovery (1).
factors is needed for frequent procedures such
Although
laparoscopic
as laparoscopic cholecystectomy in order to
cholecystectomy has generally a low incidence
avoid complications and delays and to
of morbidity and mortality and of conversion
guarantee an efficient course of surgery (4).
rate to open surgery, its outcome is particularly
Previous upper abdominal surgery is
affected by the presence and severity of
associated with a higher rate of adhesions, an
inflammation, advancing patients' age, male
increased risk of operative complications, a
sex and greater body mass index (2).
greater conversion to open surgery rate, a
Sometimes
laparoscopic
prolonged operating time and longer hospital
cholecystectomy becomes difficult. It takes
stay. Also, laparoscopic cholecystectomy after
longer time even with bile/stone spillage and
endoscopic
retrograde
occasionally it requires conversion to open
cholangiopancreatography
(ERCP)
with
cholecystectomy (3).
endoscopic sphincterotomy (ES) for combined
It may be difficult to anticipate
choledochocystolithiasis is more difficult with
preoperatively whether this procedure is going
prolonged procedure than in uncomplicated
to be easy or difficult in a particular patient.
6097
Received: 10/7/2018 Accepted: 20/7/2018
c:\work\Jor\vol732_20 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6103- 6108
Timothy Grass Pollen Sensitization in Asthmatic Egyptian Children Elham Mohammad Hossny, Hanan Mohamed Abd El Lateef, Ahmed Abd El-Hamid Abd El-Hamid Youssef
Department of Pediatrics, Faculty of Medicine, Ain Shams University
Corresponding author: Ahmed Abd El-Hamid Abd El-Hamid Youssef, email:[email protected] ABSTRACT Background: Allergic diseases are considered a major problem for healthcare systems in both developed and developing countries. Longitudinal epidemiologic studies have shown an increased prevalence of sensitization to common allergens, and increased prevalence of asthma, atopic dermatitis, food allergy, and allergic rhinitis in children. The increase in allergies is a phenomenon that is being observed in all fast-developing countries. For a long time, science has taken as a starting point that solely a genetic predisposition is a precondition for the development of an allergy. Today, knowledge of environmental factors that can alter genes or the transcription of genes in the cells, has improved. Aim of the Work: We aimed to investigate the rate of sensitization to Timothy grass pollen in a group of asthmatic Egyptian children in relation to other markers of disease expression. Our ultimate objective was to add information to the map of aeroallergen sensitization in our country. Patients and Methods: This analytical cross sectional study was conducted on children with bronchial asthma following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University in the period from September 2017 to March 2018. The sample included 100 asthmatic patients who were enrolled consecutively. Patients were classified into intermittent and persistent Asthma according to the 2009 VA/DoD asthma management guidelines. Results: The current study revealed a high frequency of Timothy grass pollen (TGP) sensitization representing 61% of the studied sample. The diameter of wheal in sensitized children ranged between 3-7 mm with a median (IQR) of 4 (3- 4). None of our subjects had wheal diameter 8 mm, which denotes severe reaction. In our study, Patients with persistent asthma were more prone to be TGP sensitized (80.3%) than those with intermittent asthma (19.7%). Sensitized children with persistent asthma showed larger wheal diameter (median= 4 mm, range: 4-7 mm) than those with intermittent asthma who showed smaller diameter (median= 3.5 mm, range: 3-4 mm). Conclusion: Sensitization to TGP might point a persistent phenotype of pediatric asthma and may be linked to severity and need to step up and/or add on therapeutic options. Keywords: Timothy Grass Pollen Sensitization, Asthmatic Egyptian Children INTRODUCTION
worldwide. About 20 species from five
Allergic diseases are considered a
subfamilies are considered the most frequent
major problem for healthcare systems in both
causes of grass pollen allergy, and the
developed and developing countries (1).
allergenic relationships among them closely
Longitudinal epidemiologic studies have
follow their phylogenetic relationships (4).
shown an increased prevalence of sensitization
The allergic immune response to
to
common
allergens,
and
increased
pollen of several grass species has been
prevalence of asthma, atopic dermatitis, food
studied extensively over more than three
allergy, and allergic rhinitis in children (2).
decades. Eleven groups of allergens have been
The increase in allergies is a
identified and described, in most cases from
phenomenon that is observed in all fast-
more than one species. The allergens range
developing countries for a long time. Science
from 6 to 60 kD in apparent molecular weight
has taken as a starting point that solely a
and display a variety of physicochemical
genetic predisposition is a precondition for the
properties and structures (5). Grass pollens are
development of an allergy. Today, knowledge
amongst the most clinically important allergen
of environmental factors that can alter genes or
sources worldwide and are responsible for
the transcription of genes in the cells has
triggering allergic rhinitis and exacerbating
improved (3). Grass pollens are one of the most
asthma (6). The most complete set of Timothy
important
airborne
allergen
sources
3016
Received: 10/7/2018 Accepted: 20/7/2018
ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6109- 6114 Preoperative Pregabalin Prolongs Duration of Spinal Anesthesia and Reduces Early Postoperative Pain Galal Adel Abd-Elrehim El-Kady, Safaa Ishak Ghaly, Amin Mohammed El-Ansary, Ahmed Mohamed Ismail
Department of Anesthesia, Intensive Care and Pain Management, Ain Shams University Corresponding author: Ahmed Mohamed Ismail, Mobile: 01151552682; Email: [email protected] ABSTRACT Background: Various adjuvants have been used to prolong spinal anesthesia, with the additional advantages of delaying the onset of postoperative pain and reducing postoperative analgesic requirements. Pregabalin is an R-aminobutyric acid analog that binds to the 2- subunit of presynaptic voltage-gated calcium channels. Objective: The aim of this work is to evaluate the efficacy of a single dose of pregabalin in terms of spinal blockade duration and its potential opioid-sparing effect during the first 24 hours postoperatively Patients and Methods: There were limitations to the present study. First, since only 1 dosage of pregabalin was evaluated, we could not determine the most effective dosage. Second, clinically meaningful improvements in recovery were not assessed. Adequate postoperative pain control provides early postsurgical mobilization, shortened hospitalization, and increased patient satisfaction. Third, preoperative pain and anxiety scores were not recorded. Pregabalin might affect the preoperative pain, mood, and anxiety scores, and these factors can be related to the postoperative pain score. Results: The mechanisms by which pregabalin premedication prolongs motor and sensory blocks using local anesthetics in spinal anesthesia are not fully understood. There may be several reasons for the prolongation of spinal anesthesia. Gabapentinoids are an r- aminobutyric acid analog that binds to 2- subunit of presynaptic voltage-gated calcium channels, and this inhibition decreases postsynaptic excitability by reducing potassium- evoked excitatory transmitter release. These medications provide antiepileptic, anxiolytic, and analgesic features by modulating both GABAergic neurotransmission and calcium influx. Gabapentinoid compounds produce a significant and clinically important improvement in preoperative anxiety scores. Since patients may be anxious in the perioperative period, the anxiolytic effects and euphorigenic effects of pregabalin may be beneficial. Keywords: Gabapentin, neuropathic pain, adjuvant antiepileptic drug INTRODUCTION
pregabalin premedication affects sensory
It reduces the depolarization-
and motor blocks using spinal anesthesia
induced calcium influx at nerve terminals,
and its effect upon early postoperative
with a consequent reduction in the release
pain management.
of several excitatory neurotransmitters,
Preemptive analgesia is analgesic
including
glutamate,
noradrenaline,
administration that precedes the painful
substance P, and gastrin-releasing peptide
stimulus, thus improving postoperative (1).
pain control. It is an antinociceptive
The administration of oral
treatment that prevents the establishment
pregabalin preoperatively has been
of altered processing of afferent input,
reported to reduce acute postoperative pain
which amplifies postoperative pain.
and to prolong the duration of anesthesia
This technique is utilized in acute
produced by single-injection peripheral
postsurgical pain management to improve
nerve blockade(2).
the efficacy of analgesics and thereby
However, no clinical study to date
reduce the requirement for opioids(3).
has yet fully investigated whether or not
9016
Received: 12/7/2018 Accepted: 22/7/2018
c:\work\Jor\vol732_22 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6115- 6121
Non-absorbable versus absorbable tacks in transabdominal preperitoneal laparoscopic repair of inguinal hernia Ayman Abd-Allah Abd-Rabu, Mahmoud Saad Farahat, Haitham Mostafa Elmaleh, Dina Hany Ahmed, Ehab Mohammed Ali Fadl*
General Surgery Department, Faculty of Medicine, Ain Shams University
*Corresponding Author: Ehab Mohammed Ali Fadl, E-mail:[email protected] ABSTRACT Background: Groin hernia repair is considered to be one of the most commonly performed operations by general surgeons however, there is no "gold standard" operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, considering patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, and type of anesthesia, occupation, and leisure activities. The laparoscopic revolution has increased the debate about the safest and most effective inguinal hernia repair. This revolution has broadened our understanding of inguinal anatomy and hernia repair. At the least, surgeons should be aware of the current indications and contraindications for laparoscopic inguinal hernia repair, because some hernias should have a laparoscopic repair. To increase versatility, surgeons should consider becoming skilled at both techniques, with the understanding that outcomes are optimal if one is committed to achieving expertise in laparoscopic repair. Objectives: Our objective in this study is to compare the outcome of mesh fixation using non- absorbable tacks versus absorbable tacks in transabdominal preperitoneal (TAPP) laparoscopic repair of inguinal hernia regarding their efficacy and postoperative complications to improve the outcome of patients undergoing surgery for inguinal hernia in Ain Shams University Hospitals. Patients and methods: The present study is a prospective, randomized comparative study that was conducted in Ain Shams University Hospitals in Egypt, and included sixty (60) patients who had inguinal hernia. The patients were divided into two groups each group including 30 patients. In the first group (Group A) titanium non-absorbable tacks were used and in the other group (Group B) absorbable tacks were used. The patients underwent a trans-abdominal preperitoneal (TAPP) laparoscopic repair of inguinal hernia using prolene mesh. The study was conducted from July 2016 to July 2017, with 12 months of follow-up post-operatively until July 2018. Results: The mean age of the patients was 36.93 ± 10.23 (19-55) and the mean BMI was 24.83 ± 2.79 (19-32). There was no significant difference between 2 groups as regard preoperative comorbidities. Patients presented mainly with swelling in the groin region 71.67%. Right sided hernia was 46.7% and bilateral hernia was 15%. There was no difference between 2 groups as regard the operative time (p-value=0.056) and intraoperative complications: bleeding (p-value=0.150) and bladder injury (p- value=0.313). Post-operative complications, postoperative hospital stay, time needed to return to normal activity and the recurrence were all alike between the 2 groups. Pain analysis was done four times, and revealed no significant difference between the 2 groups at any time of follow-up. Conclusion: Both non-absorbable tacks and absorbable tacks used in mesh fixation are similarly effective in terms of operative time, the incidence of recurrence, complications and pain at least in the first year of follow up, but it may be less painful after one year after the complete absorption of the absorbable tacks but this needs further investigations and studies containing more patients and with follow-up for longer time. Keywords: Laparoscopic hernia repair, Transabdominal preperitoneal hernia repair, Non-absorbable tacks, Titanium tacks, Absorbable tacks, Postoperative pain. INTRODUCTION
adequately
trained
surgeons,
produces
Inguinal hernias account for 75% of
excellent results comparable to those of open
all abdominal wall hernias, and with a lifetime
repair (2).
risk of 27% in men and 3% in women. Repair
Studies have listed specific indications
of these hernias is one of the most commonly
for laparoscopy over open repair, including
performed surgical procedures in the world (1).
recurrent hernias, bilateral hernias, and the
Although open, mesh-based, tension-
need for earlier return to full activities (3).
free repair remains the criterion standard,
Several studies have demonstrated
laparoscopic herniorrhaphy, in the hands of
salutary outcomes for laparoscopic repair of
5116
Received: 12/7/2018 Accepted: 22/7/2018
c:\work\Jor\vol732_23 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6122- 6127 Uncomplicated Laparoscopic Cholecystectomy to Drain or not to Drain Selim Said Abdel-Rahman EL-Nemr, Ahmed Mohamed El-Sayed, Abdel-Galeel Kamal Abdel-Galeel Elwany *
General Surgery Department, Faculty of Medicine, Al-Azhar University * Corresponding Author: Abdel-Galeel Kamal Abdel-Galeel Elwany, E-mail: [email protected] ABSTRACT Background: gallstones are present in about 10% to 15% of adult population. Between 1% and 4% of these adults become symptomatic every year.Laparoscopic cholecystectomy first performed by philippe Mouret in Lyon, Francein the late 80s, has gained acceptance at the standard of care for patients requiring cholecystectomy. Laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gall stones. Laparoscopic cholecystectomy for acute cholecystitis is mainly performed after the acute cholecystitis episode subside because of the fear of higher morbidity and need for conversion from laparoscopic to open cholecystectomy. Aim of the Work: the need for routine abdominal drainage in uncomplicated laparoscopic cholecystectomy. Benefits and harms of intra abdominal drains in uncomplicated laparoscopic cholecystectomy. Patients and Methods: the study included 50 patients from Al Azhar University Hospital and with chronic calcular cholecystitis in period from February 2016 to June 2018. They were randomly assigned into one of the two study groups: Group I: with tubal drains; Group II: without drains. The later group wasn't selected except after making sure that a drain is not required by the operating surgeon. Patients were selected on the basis of the following criteria.?? Ethical approval from local ethical committee of surgery department was obtained. Results: data obtained from the present study were selected statistically analysis computed using SPSS. Continuous data were expressed in the form of mean + SD while categorical data were expressed in the form of count and percent. Comparison of continuous data was performed utilizing student t test, while categorical data were done using chi-square test. P value less than 0.05 was considered statistically significant. In group A (with drain) according to the sex is arranged as 7 male patients and 18 female patients, according to the age is arranged between 23-60 years and according to BMI is arranged between 18-30 (kg/m2) in group B (no drain) according to the sex is arranged as 5 male patients and 20 female, according to the age is arranged between 25-60 years and according to the BMI is arranged between 20-35(kg/m2). No statistically significant differences between the two studied groups according to domographic data. Conclusion: use of drain didn't result in reduction of postoperative complications. It was also associated with prolonged operative time, higher pain levels and longer hospital stay. Keywords: Uncomplicated Laparoscopic Cholecystectomy, Pneumoperitoneum. INTRODUCTION
Laparoscopic cholecystectomy for
Gallstones are present in about 10% to
acute cholecystitis is mainly performed after
15% of adult population. Between 1% and 4%
the acute cholecystitis episode subside because
of these adults become symptomatic every
of the fear of higher morbidity and need for
year (1).
conversion from laparoscopic to open cholecystectomy.
Despite
the
many
Laparoscopic cholecystectomy first
advantages of laparoscope over open surgery,
performed byphilippe Mouret in Lyon,
many patients complain about referred pain to Francein the late 80s, has gained acceptance
the shoulder during the postoperative course
at the standard of care for patients requiring (3).High pressure pneumoperitoneum using
cholecystectomy.
Laparoscopic
carbon dioxide gas was accused for those
cholecystectomy provides a safe and effective
complications (4).
treatment for most patients with symptomatic gall stones (2).
A drainage tube is inserted to reduce
pain after laparoscopy (5).Routine drain use
2266
Received: 12/7/2018 Accepted: 22/7/2018
c:\work\Jor\vol732_24 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6128- 6135
Role of diffusion weighted and perfusion weighted imaging in characterization of ovarian tumours Randa Hussein Abdallah, Nermeen Nasry Halim, Eman Ahmed Fouad, Eman Sameh Hussein*
Radiodiagnosis Department, Ain Shams University, Cairo, Egypt *Corresponding Author: Eman Sameh Hussein, Email: [email protected], Tel.: 01003726916 ABSTRACT Background: ovarian cancer is the second most common gynecological cancer and the fifth most common cancer in women. Proper management depends on proper preoperative assessment with the help of clinical examination, laboratory tests and different imaging modalities. Radiological evaluation includes ultrasonography (US), computed tomography (CT) and recently magnetic resonance imaging (MRI). Diffusion weighted imaging (DWI) has been established as a useful functional imaging tool in neurologic applications for a number of years, but recent technical advances now allow its use in abdominal and pelvic applications. Purpose: it was to evaluate the role of diffusion weighted and perfusion weighted MRI imaging in the characterization of ovarian tumours and differentiation between benign and malignant tumours. Patients and Methods: this study was performed on 24 patients. All patients had US finding of solid or complex adnexal lesions. Results: DWI & dynamic MRI are significant promising tool factors for characterization of ovarian tumours and differentiation between benign & malignant lesions with high sensitivity, specificity. The sensitivity, specificity and accuracy of detection of the nature of the lesions. Have been increases after adding of DWI & DCE-MRI to the conventional imaging. Conclusion: Adding of DWI & DCE-MRI to the conventional MRI improves the sensitivity and specificity of diagnosis and allows confident diagnosis and differentiation between benign and malignant lesions. Keywords: Ovarian tumours, MRI, DWI, ADC, DCE, TTP, MRE, SI max. Introduction
diagnosed on the basis of T1- weighted,
Ovarian cancer is a leading cause of death
T2-weighted,
and
fat-saturated
T1-
among women. It is the second most
weighted MR imaging findings (3).
common
gynecological
cancer (1).
Diffusion weighted imaging (DWI) and
Accurate characterization of an adnexal
DCE-MRI have recently been shown to
mass
as
being
benign
can
avoid
be effective in the differentiation of
unnecessary
surgery
especially
in
benign from malignant adnexal masses.
postmenopausal women and can help
DWI provides quantitative information
young women wishing to preserve child
about tissue cellularity that may be used
bearing potential to go for conservative
to
distinguish
benign
and
malignant
surgery (2). MR imaging has shown to be
lesions and distinguish viable tumors
more specific and accurate than US and
from
treatment-related
changes.
DCE-
Doppler
assessment
in
preoperative
MRI is becoming increasingly important
characterization
of
complex
adnexal
in the evaluation of cancer patient in
masses. In addition, it is the best method
initial diagnosis and the assessment of
in delineation of local spread to the pelvic
response to therapy (4).
organs.
The
signal
intensity
characteristics of ovarian masses make
DCE-MRI of ovarian tumors is recommended
possible
a
systematic
approach
to
for accurate characterization of internal
diagnosis. Mature cystic teratomas, cysts,
architecture, especially for delineation of
endometriomas,
leiomyomas,
fibromas,
necrosis,
papillary
projections,
solid
and other lesions can be accurately
8216
Received: 12/7/2018 Accepted: 22/7/2018
ABSTRACT The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6136- 6142 Role of Endovenous Laser Ablation versus Radiofrequency Ablation for Primary Varicose Veins 1Hesham Adel Alaa El-Diin, 1Hesham Mohamed Omraan, 2Amr Nabil Kamel, 1Mohamed Ahmed Abd El-Moniem Hagag
1Department of General Surgery, Faculty of medicine, Ain Shams University
2Department of Vascular Surgery, Faculty of medicine, Ain Shams University *Corresponding author: Mohamed Ahmed Abd El-Moniem Hagag, Mobile: 01126560324, E-mail: [email protected] ABSTRACT Background: varicose veins, a common problem with effects on quality of life, account for a significant cost burden on the health care system. They are enlarged, tortuous, subcutaneous veins that commonly occur in the legs. Varicose veins are caused by faulty valves and decreased elasticity in the vein walls, which allow blood to backflow and pool. This is known as venous reflux. The affected veins enlarge and appear as green, dark blue or purple protrusions just below the skin's surface. Objective: in this study we aimed to compare short term outcomes and postoperative short term complications between EVLA and RFA. Patients and Methods: this is an observational prospective study. It was carried out in General Surgery department and Vascular Surgery unit at Ain Shams Hospitals and in Kahraba hospital for Research and Treatment. Results: there was no significant difference between radiofrequency powered segmental ablation and endovenous laser ablation according to demographic data. Conclusion: there was no significant difference between radiofrequency powered segmental ablation and endovenous laser ablation according to demographic data. Keywords: varicose veins, endovenous laser therapy, radiofrequency
Severe
symptoms
include INTRODUCTION
thrombophlebitis, bleeding and venous
Varicose
veins,
a
common
dermatitis,
which
often
require
problem with effects on quality of life,
intervention(4).
account for a significant cost burden on
A variety of therapies are available
the health care system (1). They are
for treating varicose veins, including
enlarged, tortuous, subcutaneous veins that
conservative therapies, surgical interventions
commonly occur in the legs (2).
and nonsurgical intervention. Conservative
Varicose veins are caused by
therapies are commonly recommended in
faulty valves and decreased elasticity in
asymptomatic patients or those with mild to
the vein walls, which allow blood to
moderate symptoms. Surgical interventions
backflow and pool. This is known as
generally
become
necessary
when
venous reflux. The affected veins enlarge
symptoms of varicose veins significantly
and appear as green, dark blue or purple
impinge on the patient's quality of life (5).
protrusions just below the skin's surface
Junction ligation with or without (3).
vein stripping is generally appropriate when
The
severity
of
symptoms
the GSV and SSV have reflux or
associated with varicose veins varies and
incompetence is demonstrated on duplex
may include pain, heaviness ,pruritis ,
scanning. This intervention is generally
ulceration, skin discoloration and edema.
performed as an inpatient procedure under general anesthetic. Junction ligation involves
6316
Received: 12/7/2018 Accepted: 22/7/2018
c:\work\Jor\vol732_26 The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6143- 6148
A prospective study of the latero-central glandular pedicle technique as an oncoplastic procedure for medial quadrants breast masses:oncological safety and clinical outcomes Ayman Ahmed Talaat, Ahmad Gamal El Din Osman, Niveen Fathy Al Mahmoudy, Mohammed Mostafa Ali
General Surgery Department, Faculty of Medicine, Ain Shams University CORRESPONDING AUTHOR: MOHAMED GLAL, EMAIL:[email protected] Background: breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women. For many women with stage 1 or 2 breast cancer, the combination of partial mastectomy and radiation therapy together referred to as breast- conserving therapy is preferable to total mastectomy because breast conserving surgery survival rates is equivalent to those after mastectomy while preserving the breast. Aim of the work: this study aimed to focus on the latero-central glandular pedicle technique as an oncoplastic procedure for management of medial breast cancer and to assess the technique clinically regarding oncological safety, surgical outcomes and patient satisfaction. Methods: this was a prospective analytical study that included 15 patients aiming to clinically assess the centro-lateral oncoplastic technique for both inner quadrants of breast cancer regarding oncological safety and patient satisfaction. This study was conducted at Ain- Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Results: in our study we were able to conduct an excellent cosmetic outcome for a relatively large tumor excisions with 66% of the cases (10 patients) falling in excellent and very good score groups with mean cosmetic outcome score 4.26. Another 20% (3 cases) which fall in good and fair score groups as those two patients noticed asymmetry of the two breasts in front of the mirror as they refused bilateral breast reduction mastopexy. None of our cases have had a poor or an ugly score. Conclusion: the combination of plastic surgery techniques with breast oncology surgery gives the surgeon a new tool for treatment of breast cancer. This approach has enabled us to increase the number and extend the indications of breast conserving surgery with wider margins offering safer oncologic control with more satisfactory cosmetic outcome. Introduction
performed as delayed procedures by plastic
The breast is the true mirror of
surgeons. Increasingly, breast surgery is being
femininity, and it remains in the mind of every
performed by breast surgeons trained in
one of us as the heart of womanhood, with its
oncoplastic techniques who can offer
role as nourisher, and comforter. These roles
immediate
reconstruction
with
both
evoke the idea of the importance and the
therapeutic and economic option (3).
affection of this delicate organ has in the
The blood supply to the breast skin
minds of women. (1)Breast cancer, according to
depends on the subdermal plexus, which is in
national cancer institute, is the most common
communication with deeper underlying vessels
site of cancer in women in Egypt as it accounts
supplying the breast parenchyma. The blood
for about 38.8% of total malignancies among
supply is derived from the internal mammary
Egyptian females; it is an important cause of
perforators (most notably the second to fifth
mortality
among
women (2).Breast
perforators), the thoracoacromial artery, the
reconstruction is becoming increasingly
vessels to serratus anterior, the lateral thoracic
important due to changes in patient
artery, the terminal branches of the third to
expectations and demand. There is growing
eighth
intercostal
perforators,
the
recognition that immediate reconstruction in
superomedial perforator supply from the
appropriately selected women can combine an
internal mammary vessels is particularly
oncological and aesthetic procedure in one
robust and accounts for some 60% of the total
operation with excellent results. Because most
breast blood supply. This rich blood supply
breast surgery is performed by general
allows for various reduction techniques,
surgeons,
most
reconstructions
were
ensuring the viability of the skin flaps after
3416
Received: 12/7/2018 Accepted: 22/7/2018
c:\work\Jor\vol732_27The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6149- 6156
Correlation between Axial Length and Macular Thickness in Myopia Mahmoud A. Rabea, Sayed M. Al sayed , Mohammad H. Abdel Zaher
Department of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt Corresponding author: Mohammad H. Abdel Zaher; Mobile: 01015048790; Email:[email protected] ABSTRACT Background: Myopia is the most common error of refraction and, in many countries; complications related to high myopia are a major cause of blindness. The prevalence of myopia has been reported as high as 7090% in some Asian countries, 3040% in Europe and the United States, and 1020% in Africa. Myopia, which is measured in diopters, has also been classified by degree. Low myopia usually describes myopia of -3.00 diopters or less. Medium myopia usually describes myopia between -3.00 and -6.00 diopters. High myopia usually describes myopia of -6.00 or more. Roughly 30% of myopes have high myopia. Aim of the Work: To correlate macular thickness in the different degrees of axial myopia. Subjects and Methods: Cross sectional study assessing 40 myopic eyes of 22 subjects. They were subdivided according to axial length into two groups: Group A (low myopes) 20 myopic eyes with their axial length between 24-26.5mm.Group B (high myopes) 20 myopic eyes with their axial length above 26.5mm. Cases were selected from the outpatient clinic of the Al-Azhar University Hospitals. All were above eighteen years of age. Each patient was subjected to a full clinical examination, refraction, axial length assessment by IOL master and macular thickness determined by Swept source OCT. Results: The study revealed a highly significant negative correlation between axial length and macular thickness in all quadrants except foveal thickness which is non-significant positive correlation (an increase in thickness with increasing axial length). Macular thickness was significantly less in high myopes than low myopes except in the fovea. The spherical equivalent was significantly negatively correlated with increasing axial length. Conclusion: In this study macular thickness in myopes was correlated with axial length. A significant negative correlation was found between increasing axial length and macular thickness in all quadrants of the macula except for the fovea. As the degree of myopia increased the average overall thickness of the macula decreased. No significant correlation was found between the foveal thickness and axial length. Keywords: Myopia, axial length, macular thickness, OCT
describes myopia between -3.00 and -6.00 INTRODUCTION:
diopters. High myopia usually describes
Myopia is the most common error of
myopia of -6.00 or more. Roughly 30% of
refraction
and,
in
many
countries;
myopes have high myopia (3).
complications related to high myopia are a
major cause of blindness. The prevalence of
Similarly, myopia has also been
myopia has been reported as high as 7090%
classified according to the axial length (AL)
in some Asian countries, 3040% in Europe
into low to moderate myopia (AL 25.1 ±
and the United States, and 1020% in Africa
1.1mm) and high myopia (AL 27.1±1.1mm) (4) (1). .
It is a refractive defect of the eye in
which collimated light produces an image
This refractive error can also be
which comes into focus in front of the retina
classified
as
pathological
and
non-
when accommodation is completely relaxed.
pathological. Non-pathological myopia is also
Thus the image one sees comes to focus only
commonly referred to as simple myopia. In
on approximation of the object (2).
non-pathologic
myopia
the
refractive
structures of the eye develop within normal
Myopia, which is measured in diopters,
limits, however the refractive power of the eye
has also been classified by degree. Low
does not correlate with the axial length. The
myopia usually describes myopia of -3.00
degree of non-pathological myopia is usually
diopters or less. Medium myopia usually
minimal to moderate (< 6.00 diopters).
6149
Received: 12/7/2018 Accepted: 22/7/2018
c:\work\Jor\vol732_28The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6157- 6164 Tranexamic Acid for Prevention of Postpartum Hemorrhage after Vaginal Delivery Esmail Talaat El-Garhy and Ashraf Hamdy Mohamed ,Ashraf Elshahat ,Ibrahim Abu Elmagd ,Mohamed Awad Allah Hamed*
Department of Obstetrics and Gynaecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
*Corresponding author: Mohamed Awad ALLAH Hamed, E-mail : [email protected] Abstract: Objective: To assess the efficacy of tranexamic acid in reduction of blood loss and pervention of postpartum hemorrhage after vaginal delivary. Methods: This is a multicentric prospective randomized double blind placebo controlled trial. 200 pregnant women were randomized to receive either 60 mg/kg of tranexamic acid (TA) (n=100) or placebo (n=100) intravenously in the second stage of labour.
Postpartum
blood
loss
was
collected
and
measured
accurately
from
placental delivery to 2 hours postpartum and adverse effects of were observed. Results: The mean estimated postpartum blood loss was significantly lower in women treated with tranexamic acid compared to women in the placebo group ( 442.50 ± 128.55 versus 555.75 ± 191.88, respectively; p < 0.001), and the proportion of women in the tranexamic acid group who had an estimated blood loss 500 mL was significantly lower than in the placebo group( 3 [3 %] versus 9
[9%],relative
risk
[RR]=0.30;
97%
confidence
interval
[CI]
0.11
to
0.78;P<0.05).
Maternal
and
neonatal
outcomes
did
not
differ
significantly
between both groups. Conclusion: The addition of tranexamic acid to the active management of third stage of labor after normal vaginal delivery is effective as a prophylaxis
against
post-partum
hemorrhage.
It
can
significantly
reduce
blood
loss during and after delivery. Keywords: Tranexamic acid, postpartum haemorrhage, Blood loss
Introduction
predictable,
underestimated
when
diagnosed
clinically
and
not
Postpartum
haemorrhage
(PPH)
stills
deserving of early specific treatment.
the most common cause of maternal
Accordingly,
detailed
guidelines
mortality
worldwide,
accounting
for
have been issued for optimal use of
about 300,000 deaths every year, and
obstetric
interventions
and
uterotonic
most
of
deaths
occur
in
the
drugs.
immediate postpartum period [1] .PPH
PPH is commonly defined as blood
causes morbidity related to anaemia,
loss of 500ml after vaginal delivery
blood
transfusion
and
haemorrhage
of a baby, or 1000 ml after
related
ischaemic
complications.
caesarean
section.
However,
these
Haemostatic
abnormalities
have
long
thresholds do not take into account
been
considered
consequences
of
pre-existing health status, and blood
uncontrolled
bleeding.
PPH
also
loss of as little as 200 mL can be life-
contributes
to
hospital
morbidity
threatening for a woman with severe
because patients may require a blood
anaemia or cardiac disease and the
transfusion, which can transmit blood
problem is more hazardous in the
borne
viral
infections.
Approximately
developing
countries[4].
Therefore,
1%
of
women
with
spontaneous
measures
aiming
to
reduce
vaginal
deliveries
receive
a
blood
postpartum
blood
loss
have
positive
transfusion, but the rate increases to
effects
in
reducing
bleeding
related
about
5%
for
women
with
maternal
morbidity
and
contributing
instrumental
deliveries
or
caesarean
the
global
commitment
to
the
sections[2] .Direct causes of PPH are
Millennium
Development
Goal
mainly uterine atony, trauma to the
(MDG)
of
reducing
maternal
deaths
birth
canal,
coagulopathy
and
by three-quarters by the year 2015, a
retained placenta [3]. PPH is poorly
commitment that requires a reduction
6157
Received: 12/7/2018 Accepted: 22/7/2018
c:\work\Jor\vol732_29The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6165- 6175 Multifocal Electroretinogram changes after intravitreal injection of Anti VEGF for Diabetic Macular Edema in correlation to visual acuity and optical coherence tomography Magdy E. Tawakol, Hossam Eldin A. Ziada, Amr R. Mahmoud
Department of ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt Corresponding author: Amr R. Mahmoud; Mobile: 01006098955; Email: [email protected] ABSTRACT Back ground: compared to laser photocoagulation, intra vitreal injection of anti-vascular endothelial growth factors (Anti VEGFs) have more desirable results and less complication. Study of this issue by multifocal electroretinogram (mf-ERG) revealed significant improvement in macular function associated with decreased retinal thickness using optical coherence tomography (OCT) and improvement of best corrected visual acuity (BCVA). Aim of the Work: to study the role of multifocal Electroretinogram in the follow up of diabetic macular edema after intravitreal injection of Anti vascular endothelial growth factors (Anti-VEGFs) and study its correlation to visual acuity and optical coherence tomography changes. Patients and Methods: a non-randomized prospective study was carried out from February 2018 to August 2018 on thirty eyes of patients with diffuse or focal DME without macular ischemia. The patients were selected from the outpatient ophthalmology clinic of Al-Hussein University hospital. The patients were injected intravitreally by anti VEGF Ranibizumab 0.5 mg / 0.05 mL at baseline, 1 and 2 months. In this study we assessed pre and post-injection BCVA, IOP measurement by applanation tonometer, OCT and multifocal ERG changes over 3 months. Results: log MAR BCVA improved from (0.88±0.12) preoperatively to (0.53±0.18) at the end of the 3rd month, with P-value <0.001. Central subfield thickness 1 mm improved from (408.73±79.40 µm) preoperatively to (224.33±32.49 µm) at the end of the 3rd month, while para and peri-foveal thickness improved from (402±46.52 µm) preoperatively to (286.30±32.67 µm) at the end of the 3rd month, with P- value <0.001. P1 amplitude in ring 1 using MF-ERG improved from (33.08±10.59 nv/deg2) preoperatively to (58.30±32.67 nv/deg2) at the end of the 3rd month, with P-value<0.001. P1 amplitude in ring 2 using MF-ERG improved from (18.82±5.01 nv/deg2) preoperatively to (26.36±3.006 nv/deg2) at the end of the 3rd month, with P-value in the 1st month <0.05, while in the 3rd month <0.001. P1 implicit time in ring 1 using MF-ERG improved from (78.65±12.37 ms) preoperatively to (63.78±15.73 ms) at the end of the 3rd month, with P-value in the 1st month <0.05, while in the 3rd month <0.001. P1 implicit time in ring 2 using MF-ERG improved from (48.81±6.44 ms) to (44.39±4.06 ms) at the end of the 3rd month, with P-value in the 1st and 3rd months <0.05. Complications during follow up of patients especially 1 week after injection were relatively uncommon, including mild subconjunctival haemorrhage in 1 eye (3.3%) and transient increase of IOP in 4 eyes (13.33%). Conclusion: intravitreal injection of Anti-VEGFs especially Ranibizumab resulted in improvement of macular function in study patients with diabetic macular edema. Postoperative improvement in visual acuity was accompanied by decreased retinal thickness measured by OCT and improvement of P1 amplitude in the central ring measured by MF-ERG. Keywords: Anti-VEGF, Multifocal Electroretinography, Diabetic macular edema INTRODUCTION:
and it has been identified as the gold standard for
Diabetic retinopathy (DR) is one of the
the treatment of DME (2).
leading reasons of blindness throughout the
However, it carries risks in many cases,
world, and diabetic macular edema (DME) is a
and efficient laser treatment may still not prevent
major complication of DR which leads to visual
the progression of diffuse macula edema in the
acuity loss (1).
long term. Vascular endothelial growth factor
The
Early
Treatment
Diabetic
(VEGF) is considered to be the main stimulus
Retinopathy Study (ETDRS) pointed out that
generation of diabetic macular edema, and
laser treatment was a significant therapy in
pharmacologic therapies that inhibit VEGF may
clinically significant macular edema (CSME),
directly target the main cause of the pathology (3).
6165
Received: 12/7/2018 Accepted: 22/7/2018
c:\work\Jor\vol732_30The Egyptian Journal of Hospital Medicine (July 2018) Vol. 73 (2), Page 6176- 6181 Vardenafil versus Tamsulosin as a Medical Expulsive Therapy for Distal Ureteral Stones Amr Fekry Elshorbagy, Karim Omar El Saeed, Mohammed Zaghlol Mohammed Mohammed *
Department of Urology, Faculty of Medicine, Ain Shams University *Corresponding Author: Mohammed Zaghlol Mohammed Mohammed Phone No.: (+2) 01066916213 E-mail: [email protected] ABSTRACT Background:urolithiasis is one of the most common diseases of the urinary tract. The lifetime prevalence of urinary stones is around 1% to 15% and the peak age of incidence is at 30 years. Men are affected 2 to 3 times more often than women. Ureteral stones account for 20% of the calculi in urolithiasis and about 70% of ureteral stones are present in the distal third of the ureter at the time of presentation. Aim of the work: this study aimed to compare the efficacy and safety of vardenafil (5mg twice daily) vs tamsulosin (0.4mg once daily) as a medical expulsive therapy in the management of distal ureteric stones (DUS) in terms of stone expulsion rate, stone expulsion time, number of pain episodes, analgesic use and side effects related to medical therapy. Patients and Methods: this was a prospective randomized comparative study conducted on 50 patients admitted through the outpatient Urology Clinic in Ain shams University Hospitals and Nasser Institute Hospital between February 2018 and August 2018. The patients were randomized using a closed envelope method. The patients were categorized into 2 main groups 25 patients each. Results: this study showed non significant stone expulsion rates and faster expulsion times in favor of vardenafil when compared to tamsulosin. Conclusion: both of the medications demonstrated a good safety and tolerability profile for medical expulsive therapy in patients with lower ureteric stones. Keywords: vardenafil, tamsulosin, distal ureteral stones
Multiple management options for ureteric INTRODUCTION
stones are present, such as conservative,
Urolithiasis is one of the most
medical
expulsive
therapy
(MET),
common diseases of the urinary tract. The
extracorporeal shockwave lithotripsy (ESWL),
lifetime prevalence of urinary stones is around
ureteroscopy and open surgical procedures.
1% to15% and the peak age of incidence is at
MET includes various drugs, such as a-
30 years. Men are affected 2 to 3 times more
adrenergic blockers, PDE5 inhibitors, calcium
often than women. Ureteral stones account for
channel blockers and anti-inflammatory drugs,
20% of the calculi in urolithiasis and about
which have a relaxant effect on the ureteric
70% of ureteral stones are present in the distal
smooth musculature (4).
third of the ureter at the time of presentation (1).
Stone clearance of distal ureteral stones (DUS)
Ureteral stones induce ureteral spasms that
can be affected by several factors such as stone
interfere with stone expulsion. Thus, reducing
size, number, site and also the presence or
these spasms while maintaining normal
absence of ureteric smooth muscle spasm
peristaltic activity can facilitate stone
and/or submucosal oedema (5). The receptors
expulsion. Almost 50% of ureteral stones can
have the subtypes 1 and 2. 1adrenoceptors
pass spontaneously over time and stone size is
were classified into three different subtypes of
the key factor for success. Stones smaller than
-1A, -1B and -1D, of which the
5 mm are expected to pass spontaneously, but
distribution in the ureter was -1D > -1A > -
only 20% of stones larger than 8 mm can pass
1B. The 1A- and 1D-adrenoceptors are the
(2). The management of ureteric stones had
most abundant subtypes in the distal ureter.
changed greatly over the last two decades,
Stimulation of these 1-adrenoceptors leads to
especially after the introduction of shockwave
increases in both the frequency of ureteric
lithotripsy (SWL) and ureteroscopy, as
peristalsis and the force of ureteric
minimally invasive treatments. However, these
contractions. So, blockage of these receptors
treatments are not risk free and are expensive (3).
decreases basal ureteric tone, decreases
6176
Received: 13/7/2018 Accepted: 23/7/2018