c:\work\Jor\vol824_1The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 587-592
Endometrial Thickness Measurement for Detecting Endometrial Cancer in Women with Postmenopausal Bleeding Wael Hussein El Bromboly, Mostafa Abbass Ibrahim, Ramage Magdy Hassan Abd Elhameed*, Amr Ahmed Abd-Elrahman
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, Egypt. *Correspondence: Ramage Magdy Hassan Abd Elhameed, Mobile: (+20)01128134528, E-mail:[email protected]
ABSTRACT Background: Postmenopause is defined as the permanent cessation of menstruation for one year due to failure of the ovarian follicular activity. Objective: This work aimed to study the role of endometrial thickness measured by transvaginal sonography in the detection of endometrial carcinoma in women with postmenopausal bleeding. Patients andMethods: A cross- sectional study was conducted on 120 women with postmenopausal bleeding admitted to the Obstetrics & Gynecology Department at Zagazig University hospitals through the period from September 2018 to September 2019. All cases were subjected to full history, full clinical examination, transvaginal sonography, and diagnostic endometrial biopsy which was taken for histopathological examination. We exclude premenopausal women and postmenopausal patients in HRT. Results: This study showed TVS evaluation of ET of the studied cases ranged from 1 to 20 mm with a mean of 9.65 mm. Also, 48.3% of the cases had endometrial thickness more than 10 mm, 34.2% had less than 5 mm, and 17.5% had from 5 to 10mm.that 34.2% of the studied cases had atrophic endometritis, 26.7% had an endometrial polyp, 17.5% had simple hyperplasia, 7.5% had atypical hyperplasia and 14.2% had endometrial adenocarcinoma. Conclusions: Transvaginal sonography evaluation of endometrial thickness is not sensitive enough to detect cancer of the endometrium and therefore couldn't replace histological evaluation of the endometrial tissue in women with postmenopausal bleeding. Keywords: Endometrial thickness, Endometrial cancer (EC), Abnormal uterine bleeding
INTRODUCTION
Endometrial cancer (EC) is the most common PATIENTS AND METHODS
gynecological cancer and has an increasing incidence
This cross-sectional study included 120 women
in postmenopausal women(1). Endometrial cancer
with postmenopausal bleeding admitted to the
represents 3.6% of all new cancer cases in the United
Obstetrics & Gynecology Department at Zagazig
States with a mortality rate reaches 1.9% of all cancer
University hospitals through the period from
death(2).
September 2018 to September 2019.
Postmenopausal bleeding (PMB) is highly
suspicious of being assigned to the presence of Inclusion criteria:
Female
patients
with
endometrial cancer or premalignant lesions. Nearly
postmenopausal bleeding (permanent cessation of
every endometrial cancer patients report PMB at some
menstruation for 1 year).
point and around 5-12% of PMB results from
endometrial cancer(3). Postmenopausal bleeding is an Exclusion criteria: Asymptomatic postmenopausal
early symptom of endometrial cancer leads to its
women. Postmenopausal ladies on hormone
detection in earlier stages with subsequently better
replacement therapy. Patients with already known
outcomes(4).
malignancies. Patients with thyroid disorders. Patients
Endometrial thickness (ET) is measured by
with a systemic blood disease.
transvaginal ultrasonography as the maximum
Ethical Consideration:
anterior-posterior thickness of the endometrial echo on
Written informed consent was obtained from all
along axis transvaginal view of the uterus(5). Women
participants and the study was accepted by the
with postmenopausal bleeding and endometrial Research Ethics Committee of the Faculty of
thickness <5mm measured with TVS have a low risk Medicine, Zagazig University.
of endometrial cancer(6). While sonographic
The study was carried out on experiments
endometrial thickness >5mm is associated with a high
involving human subjects in compliance with the Code
risk of endometrial cancer in women with
of Ethics of the World Medical Association
postmenopausal bleeding(7). This study aimed to
(Declaration Helsinki).
evaluate the role of TVS in the diagnosis of
endometrial cancer in women with postmenopausal
All cases were subjected to full history, full
bleeding.
clinical examination; general, abdominal, and pelvic
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-SA) license ( http://creativecommons.org/licenses/by/4.0/)
587
Received:17 /7 /2020
c:\work\Jor\vol824_2The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 593-598
Endoscopic Assisted Coblation Tongue Base Reduction in Patients with Obstructive Sleep Apnea Yahia Ali abushab1, Hani Mohamed Elshami1, Abdulghani Eltuhami Albashir2*, Mohamed Hassan Eesa1
1Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt.
2Department of Otorhinolaryngology, Faculty of Medicine, Zawia University, Libya *Corresponding Author: Abdulghani Eltuhami Albashir, Tel.: (+218)915451086, Email: [email protected] ABSTRACT Background: Obstructive Sleep Apnea (OSA) is the most common sleep breathing disorder. In OSA, breathing is interrupted by a blockage of airflow. Objective: This study was aimed to assess the updated technique for endoscope-guided coblator tongue base reduction for the treatment of patients with OSA. Patients and Methods: This clinical trial study included a total of 12 patients with moderate and severe OSA, attending at the Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University Hospital. This study was conducted between April 2018 till August 2019. All the studied patients underwent coblation reduction technique for the treatment of retroglossal obstruction in combination with other palatal and/or nasal surgeries in a multilevel protocol. The tongue base was observed with a 30- degree angled, rigid endoscope (4 mm). Results: Male gender represents 75% of the studied patients. Age of the studied patient ranged from 38 to 54 years old with mean age 44.83 years (± 6.41), Oxygen desaturation index (preop.) was ranged from 30.3 to 56.9, while ODI (postop.) was ranged from 3.8 to 60.9. Conclusions: It could be concluded that tongue base reduction by coblation guided with endoscopy could be safe in management of obstructive sleep apnea without any dangerous complications. Keywords: Obstructive sleep apnea, Coblation, endoscope-guided, Tongue Base Reduction. INTRODUCTION
Sleep apnea is a disorder characterized by PATIENTS AND METHODS
pauses in breathing or periods of shallow breathing
This clinical trial study included a total of 12
during sleep. Each pause can last for a few seconds and
patients with moderate and severe OSA, attending at
they happen many times a night (1). As it disrupts
the Department of Otorhinolaryngology, Faculty of
normal sleep, patients affected are often sleepy or tired
Medicine, Zagazig University Hospital. This study
during the day (2).
was conducted between April 2018 till August 2019.
Obstructive sleep apnea (OSA) is the most Sample size: The study included 9 males and 3
common sleep breathing disorder. In OSA, breathing
females with a mean age of 44.83 years (± 6.41).
is interrupted by a blockage of airflow. People with
Assuming that mean AHI (Apnea-hypopnea Index) in
sleep apnea are often not aware they have it. Often it is
preoperative cases vs postoperative cases is 45.7±25 vs
first observed by a family member (3). Sleep apnea is
12-8±8.5. The sample was calculated to be 12 case by
often diagnosed with an overnight sleep study. For a
using open epi at confidence level 95% and power of
diagnosis of sleep apnea, more than five episodes per
test 80%.
hour must occur (4,5). Inclusion criteria:
OSA results from multilevel collapse of the
Patients diagnosed with moderate to severe OSA
upper airway, with the tongue base being a common
with AHI 15. Patients with lymphatic tongue base
site of obstruction. Multilevel obstructions, including
hypertrophy as diagnosed by nasoendoscopy either
both oropharyngeal and retroglossal obstructions are
isolated or combined with other areas of collapse.
commonly identified in up to 54% of patients (6).
Patients failed or not tolerated CPAP treatment. Age
Approximately 70% of subjects have collapse
between 21 and 70 years. Body mass index (BMI) 35
at the tongue base, which contributes significantly to
(kg/m2). Patients who had a history of previous upper
the obstruction during sleep (7). A number of surgical
airway surgery for the treatment of OSA.
procedures have been developed to address tongue
base obstruction including tissue debulking procedures Exclusion criteria:
(midline glossectomy, radiofrequency ablation) and
Patients with severe medical illness or comorbid
tissue repositioning (tongue suspension, genioglossal
conditions. Patients with significant craniofacial
advancement,
maxillomandibular
advancement
anomalies affecting airway. Unrealistic expectations.
(MMA)), each with varying results (8,9).
Body mass index (BMI) >35 (kg/m2).
This study was aimed to assess the updated
technique for endoscope-guided coblator tongue base
All patients were subjected to full history taking
reduction for the treatment of patients with OSA.
and demographic data, Epworth sleepiness scale (ESS)
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
593
Received:18 /7 /2020
c:\work\Jor\vol824_3The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 599-608 Burnout among Physicians in Egypt during COVID-19 Pandemic Doaa I. Omar1, Basma M. Hani1, Eman E. Abd-Ellatif 2
1 Department of Community Medicine, Faculty of Medicine, Benha University, 2 Department of Community
Medicine, Faculty of Medicine, Mansoura University, Egypt *Corresponding author: Basma M. Hani, Mobile: (+20) 1061821325, Email:[email protected] ABSTRACT Introduction: Physician burnout is considered a great public health problem, and the occurrence of the COVID-19 pandemic made it worse. The pandemic put several physical and emotional stressors on the frontline healthcare providers leading to increased burnout. Aim of work: was to assess the prevalence of burnout and its predictors among frontline physicians in Egypt during COVID 19 pandemic and evaluating the relation between burnout, its subscales, and psychosomatic symptoms. Materials and Methods: This descriptive cross-sectional study assessed 503 Egyptian physicians for burnout between the 26th of March 2020 to the 1st of June 2020, during the COVID-19 pandemic weeks, using the online form of Maslach Burnout Inventory [MBI]. Results: 72.8% of study subjects were classified as having a high burnout level and 26.0% as having an average level. 62.2% and 62.4% of studied physicians had high emotional exhaustion and depersonalization levels, respectively, and 43.5 % had low personal achievement levels. Dealing with critical cases, dealing with suspected cases of COVID 19, the number of shifts per month, and the presence of psychosomatic disorders were the significant positive predictors for total burnout score while dealing with critical cases, the number of shifts per month, and the presence of psychosomatic disorders were the significant positive predictors for emotional exhaustion. Significantly higher scores of psychosomatic disorders were observed among physicians with a high level of burnout, emotional exhaustion, and depersonalization subscales. Conclusion: It could be concluded that dealing with critical cases, suspected and confirmed cases of COVID 19 were significant positive predictors for total burnout score. The high levels of overall burnout and its subscales indicate the need for specific intervention programs to cope with the work-related stressors. Keywords: burnout COVID-19- physicians- Egypt- pandemic. INTRODUCTION
Medical Group Management Association (MGMA),
By the end of 2019, the COVID-19 illness
90% of medical services suppliers have not been
(COVID-19) was distinguished in China, especially in
seeing COVID-19 patients, and for them, they suffered
Whang City, in Hubei territory. In March 2020,
a great drop in their patient volume in a range of 75%
COVID-19 was pronounced as a pandemic of general
to 90%. The surgeons suffered great monetary strain
wellbeing worry because of the quick and overall
as they were forced to postpone all non-emergency
spread of the sickness (1).
operations (4).
Toward the beginning of the SARS-CoV-2
The pressure of expanded working hours,
spread, medical facilities had restricted accessibility
Insufficient eating, no rest, deficient insurance, the
for personal protective equipment (PPE) and
dread of tainting their families, fearing of death and
guidelines or therapy were not evident. Therefore,
seeing COVID-19 patients pass on regardless of what
numerous experts felt befuddled and ill-equipped to
they do, the absence of respect by hospital managers,
treat sufficiently COVID-19 patients (2).
and the dread of being terminated, prompted some
During the pandemic, doctors needed to work
enthusiastic and mental sentiments among physicians
extended periods, which led to a lack of sleep. Large
as an outrage, nervousness, and misery and influenced
numbers of them felt a loss of independence as many
their psychological and passionate prosperity,
doctors needed to sign an agreement that alleged they
prompting burnout indications (5).
could be sent any place, similar to they were in the
Burnout condition (BS) is "a generally
military (3).
common work-related issue which has been viewed as
On account of expanding COVID-19 patients,
a pandemic of present-day culture that requires
clinical doctors who were not worked in the irresistible
expanding consideration and further contemplating
infection field and who didn't have sufficient
around the world " (6).
experience to treat similar conditions assembled to
Burnout is a syndrome defined as "serious
help the frontline physicians, which made them
emotional exhaustion with poor work adaptation
enduring more noteworthy pressing factors and stress
owing to prolonged occupational stress. It has three
when confronting COVID-19 patients (3).
main components: emotional exhaustion (EE),
The monetary strain was another issue all
depersonalization (DP), and diminished professional
through COVID-19 pandemic; as declared by the
achievement (PA)" (7).
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC B Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
599
Received:15 /10 /2020
c:\work\Jor\vol824_4The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 609-614
Corneal Elevation Changes in Normal Population and Keratoconus Patients Using Different Acquisition Diameters with Scheimpflug Imager Sameh Mohamed Elgouhary, Mona Abd Elrahman Abd Elkawi*, Mohamed Samy Abd Elaziz
Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt *Corresponding author: Mona Abd Elrahman, Mobile: +20 106 053 1712, E-mail: [email protected]
ABSTRACT Background: Keratoconus is a bilateral, progressive, noninflammatory disease of the cornea which often leads to high myopia and astigmatism with an estimated prevalence of approximately 1 in 2000. Objective: To detect the changes in corneal elevation values using different acquisition diameters (8, 9 mm) in both normal population and keratoconus patients. Patients and Methods: This is a cross-sectional clinical trial conducted at the Ophthalmology Department, Menoufia University Hospital, and Tiba eye center, Menoufia, Egypt in the period between January 2019 to December 2020. Two hundred corneas of two hundred subjects were involved and categorized into two groups, a control group with normal cornea100 subjects (group A) and a group with keratoconus100 subjects (group B) both confirmed by clinical examination and pentacam readings. Results: Receiver operating curve (ROC) analysis was conducted to identify the optimal elevation front parameters levels for prediction ofkeratoconus. The best cut-off values for front parameters BFS 8mm, BFS 9mm, BFTE 8mm and BFTE 9mm were 6.5, 10.5,2.5,2.5 with (96%,92%,92%,92% sensitivity, and 96%,96%,80%, 72% specificity), respectively. Also, the best cut-off values for back parameters levels for prediction of keratoconus for BFS 8mm, BFS 9mm, BFTE 8mm and BFTE 9mm were 14.0, 25.5, 6.5 and 9.5 mm with (96%, 96%, 80%, 72% sensitivity, and 88%, 96%, 64%, 88% specificity), respectively. Conclusion: We can conclude that there was a significant increase in elevation back parameters in keratoconus patients compared to control. The best cut-off values for front parameters levels as BFS (8, 9mm) and BFTE (8, 9 mm) was 6.5, 10.5, 2.5, and 2.5 mm, respectively. Keywords: Corneal elevation, BFS, BFTE, keratoconus, Pentacam.
INTRODUCTION
Keratoconus is a bilateral, progressive, non-
Various parameters in normal eyes, keratoconus
inflammatory disease of the cornea that often leads to
suspects as well as established keratoconus have been
high myopia and astigmatism with an estimated
measured with Scheimpflug imager. Several studies
prevalence of approximately 1 in 2000 and an
reported that anterior and posterior elevation was the
incidence between 50 and 230 per 100,000. It is a
most effective parameters to diagnose early
multifactorial disease with an unknown exact etiology
keratoconus. Also, alterations in the corneal
that impairs the acuity and quality of vision secondary
thickness, such as a more rapid change from the
to thinning in and protrusion of the cornea that
thinnest point to the periphery, have been reported in
ultimately affects both eyes (1).
early keratoconus even with normal anterior and
Corneal topography is an invaluable screening,
posterior elevation maps, and evaluating the corneal-
diagnostic, and ablation assisting resource. With
thickness (pachymetry) map could help differentiate
several million refractive surgery procedures
normal thin corneas from ectaticizing corneas (4).
performed annually, corneal topography has gained
Elevation-based corneal imaging techniques
importance in determining a candidate's suitability
provide valuable information about the anterior and
for refractive surgery and in monitoring corneal
posterior corneal surface elevation properties which
structural changes postoperatively (2).
were not generated by Placido disk-based topography.
Careful analysis of the preoperative corneal
Knowledge of these indices is important in the
topography is pivotal to avoid postoperative
preoperative examination of refractive surgery
complications, especially corneal ectasia. Iatrogenic
candidates, the diagnosis of early stages and
keratectasia after refractive surgery is of great interest
progression of keratoconus, and keratoconus patients
to refractive surgeons and researchers. Although it is
undergoing
collagen
cross-linking
or
ring
not completely understood, keratectasia is thought to
implantation for treatment (5).
be related to preoperative forme fruste keratoconus or
This study aimed to detect the changes in corneal
preexisting keratoconus (3).
elevation values using different acquisition diameters
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC B Y-SA) license h ( ttp://creativecommons.org/licenses/by/4.0/)
609
Received:16 /10 /2020
IntroductionThe Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 615-625
Urinary TWEAK; Diagnostic and Prognostic Biomarker in Evaluating Lupus Nephritis Case Control Study Nahla M. Gaballah1, Yomna A. Amer1, Lamiaa M. Kamel*2, Salem A. El-Deeb3, Abeer M. El-Shafey1.
Departments of 1Rheumatology and Rehabilitation, 2 Clinical Pathology and
3 Internal Medicine, Faculty of Medicine, Zagazig University, Egypt. *Corresponding author: Lamiaa M. Kamel, Mobile: (+20) 01118631133, Email:[email protected] ABSTRACT Background: Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is a multifunctional cytokine that belongs to the TNF-ligand superfamily. Objective: To evaluate the ability of urinary TWEAK (uTWEAK) to diagnose lupus nephritis (LN) and its correlation with activity and chronicity index. Patients and Methods: This study was carried out on 75 individuals, 50 SLE patients, fulfilling the SLICC revision of the ACR classification criteria for SLEand25 age and sex matched apparently healthy control subjects. Patients were assessed by SLE disease activity index (SLEDAI-2K) score. Renal biopsy were done for SLE patients who have confirmed proteinuria >0.5 g in 24-hour urine samples or active urinary sediment or inexplicable decrease in renal function. UrinaryTWEAK levels were measured by ELISA. Results: uTWEAK level showed a highly statistical significant difference among groups (P<0.001). There was direct highly significant correlations between uTWEAK and total (t)SLEDAI (r=0.58, P< 0.001) and renal (r)SLEDAI (r=0.73, P<0.001). uTWEAK hadsignificant association with the presence of proliferative GN (Class III, IV) (p= 0.003). At cutoff point 9.9 pg/mg Cr, uTWEAK had sensitivity of 76% and a specificity of 60 % to diagnose SLE patients with nephritis. At cutoff point of 14.9 pg/mg Cr, the uTWEAK level had a sensitivity of 88% and a specificity of 76% to predict good response to treatment in LN patients. Conclusion: We concluded that uTWEAK is a candidate biomarker for evaluating LN. It possesses numerous properties that make it suitable for assessment of LN activity and prognosis. Keywords: Diagnostic and Prognostic Biomarker, Lupus Nephritis, Urinary TWEAK. INTRODUCTION
Systemic lupus erythematosus (SLE) is a clinical
lupus nephritis. Thus, novel biomarkers that are able to
syndrome of inflammatory autoimmune disease
discriminate lupus renal activity and its severity, predict
characterized by multisystem involvement and
renal flares, and monitor treatment response and disease
fluctuating disease activity. Symptoms range from
progress are clearly necessary (5).
rather mild manifestations such as rash or arthritis to
A biomarker refers to a biologic,
life-threatening end-organ manifestations such as
biochemical, or molecular event that can be assayed
glomerulonephritis or thrombosis (1). It is an aggressive
qualitatively and quantitatively by laboratory
disease, in which organ damage can't be prevented.
techniques. The levels of biomarkers should correlate
Rheumatologists should try hardly to control disease
with disease pathogenesis or activity in different organ
activity in order to minimize the damage (2).
systems (6). A useful biomarker should be easy to assay,
Lupus nephritis (LN) is one of the commonest
simple to interpret, and readily available in most
manifestations of SLE, occurring in about 5070% of
laboratories with a reasonable cost (7). Sensitive and
patients, and is a major cause of morbidity and mortality
specific clinical markers for the onset or relapse of renal
in these patients. The clinical course of LN is
disease activity in patients with SLE may allow earlier
heterogeneous and varies from mild subclinical disease
institution of treatment and even preventive strategies
to an aggressive course that may rapidly progress to
so that the efficacy of existing therapies can be
end-stage renal disease (ESRD) (3). LN is characterized
enhanced while treatment-related complications can be
by a relapsing-remitting course, requiring constant
minimized (8).
follow-up and surveillance and often entailing changing Xu et al. (9), reported that current laboratory
treatments. Early clinical and histologic diagnosis of LN
markers for LN such as proteinuria, urine protein-to-
is pivotal in order to minimize the risk of progression to
creatinine ratio, creatinine clearance, anti-dsDNA, and
ESRD (4).
complement levels are unsatisfactory. They lack
Renal biopsy is the gold standard for providing
sensitivity and specificity for differentiating renal
information on the histological classes of lupus nephritis
activity and damage in LN. Significant kidney damage
and the relative degree of activity and chronicity in the
can occur before renal function is impaired and first
glomeruli. However, it is invasive and serial biopsies
detected by laboratory parameters. With respect to LN,
are needed which is impractical in the monitoring of
urinary biomarkers may be more specific for kidney
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC B Y-SA) license h ( ttp://creativecommons.org/licenses/by/4.0/)
615
Received:16 /10 /2020
c:\work\Jor\vol824_6The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 626-631
Efficacy and Safety of Fosfomycin Single-Dose Therapy Compared to Nitrofurantoin and Cephalosporin in Pregnant Women with Lower Urinary Tract Infection: A Randomized Controlled Trial Sherif Ramadan El-Mehy1 *, Zakria Fouad Sanad2, Hamed El-Sayed El-Lakwa2
1Obstetrics and Gynecology Department, Shebin El-Kom Teaching Hospital, Menoufia, Egypt.
2Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
*Corresponding author: Sherif Ramadan El-Mehy, Mobile: +201024981618, Email:[email protected] ABSTRACT Background: Fosfomycin is a bactericidal drug that inhibits bacterial cell wall and also reduces the adherence ability of
bacteria to uro-epithelial cells with a broad anti-bacterial activity against both Gram-negative and Gram-positive. Objective: To compare the efficacy and safety of fosfomycin compared to nitrofurantoin and cephalosporin in pregnant women presented with lower urinary tract infection. Patients and Methods: This was a double blinded, randomized controlled trial conducted at Shebin El-Kom Teaching Hospital from Aug 2019 to Aug 2020. Patients experienced uncomplicated lower urinary tract infection either asymptomatic bacteriuria or cystitis were recruited. Patients were randomly allocated via a random table number into three groups, each group comprised 35 patients. Group I received 3 g oral fosfomycin weekly, group II received 100 mg oral nitrofurantoin three times daily, and group III received 500 mg oral cephalosporin three times daily. After 7 days of treatment, all studied groups were subjected to urine sampling and culture analysis and were examined for occurrence of side effects. Results: All patients enrolled in our study had uncomplicated lower urinary tract infection either cystitis (n=85 cases) or asymptomatic bacteriuria (n=20 cases). There was clinical difference in urine pus cells and urine culture in fosfomycin after treatment compared to other groups. The side effects were reported in 7 cases with fosfomycin compared to 14 in other two groups with significant difference. Conclusion: Fosfomycin tromethamine was proved to be more effective, safe, and fewer side effects were reported, which
makes fosfomycin the drug of choice for uncomplicated lower urinary tract infection during pregnancy. Keywords: Asymptomatic Bacteriuria, Cephalosporin, Cystitis, Fosfomycin, Nitrofurantoin, Pregnancy, UTIs.
INTRODUCTION
suggested that fosfomycin inhibits the synthesis of
Urinary tract infections (UTIs) are common bacterial
peptidoglycan earlier than -lactams and glycopeptides (7,
infections among pregnant women as it has been reported 8). Fosfomycin is usually given as a single dose of 3 g
that about half of women will catch at least one of the UTIs
weekly which can result in good tolerance. Moreover, the
during their life time and also about 25% of them will
common side effects that has been reported from taking
experience recurrence (1). Uncomplicated lower urinary
fosfomycin in other clinical trials were mainly affecting the
tract infection (uUTI) and asymptomatic bacteriuria (ASB)
GIT such as diarrhea, nausea, or vaginitis (8, 9). Many
are reported to be the main common types of UTIs in
research on randomized controlled trials showed that
women in which the uUTI is often pointed to acute cystitis
fosfomycin single dose had similar efficacy to 3-7 days of
characterized by symptoms such as dysuria, hematuria,
other antibiotic regimens such as cephalosporin,
and/or suprapubic pain which requires a course of antibiotic
cotrimoxazole, or nitrofurantoin in uncomplicated UTI (8-
therapy. Moreover, ASB is self-limiting and doesn't require 10). In our study, we compared the efficacy and safety
antibiotic therapy in most cases except in pregnancy (2).
measures of single dose 3 g fosfomycin given orally versus
Current guidelines recommend an early use of
100 mg nitrofurantoin given orally three times daily and
antibiotics as main treatments of UTIs (3, 4), despite the
500 mg cephalosporin given also three times daily in non-
frequent use of antibiotic usually leads to bacterial
complicated lower urinary tract infection in pregnant
resistance, which exacerbates the resistant pathogens either
women at Menoufia University Hospital.
multidrug-resistant (MDR) or extensive drug resistant
(XDR), which causes more complicated UTIs (5). This PATIENTS AND METHODS
resistance has affected our management towards such
This was a prospective, double blinded, and
disease which had led us to modify the disease antibiotic
randomized controlled trial conducted at the Department of
protocol (6). Fosfomycin trometamol (Monuril®) was
Obstetrics and Gynecology at Shebin El-Kom Teaching
approved from FDA as category B for the treatment of
Hospital from August 2019 till August 2020.
uncomplicated lower urinary tract infections (UTIs).
One hundred and five pregnant women between 12
However, it has a good antibiotic activity against Gram-
and 36 gestational age were enrolled in our study according
positive and Gram-negative bacteria, the exact mechanism
to the following inclusion criteria: Patients with
for its broad activity is not well-understood; but it was
uncomplicated lower UTIs either asymptomatic or cystitis,
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
626
Received:16 /10 /2020
c:\work\Jor\vol824_7The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 632-636
Effect of Aerobic Exercises in Prevention of Bone Mass Loss Post Bariatric Surgeries Hassan Mohammed Elkholy1, Nessrien Afify Abd Elrashid1, Asem Fayed Moustafa2, Ahmed Mohamed Nagy Saleh1
Departments of 1Physical Therapy for Surgery and 2General Surgery,
Faculty of Physical Therapy, Cairo University, Giza, Egypt *Corresponding author: Hassan Mohammed Elkholy, Mobile: (+20) 01006625259, E-Mail: [email protected] ABSTRACT Background: Patients who have been submitted to bariatric surgery are prone to bone mass abnormalities caused by restriction of calcium intake associated with malabsorption of both calcium and vitamin D. Reduced calcium absorption is secondary to the exclusion of duodenum and proximal jejunum where calcium is maximally absorbed. Aerobic weight bearing exercise is more adapted to improve bone mass over whatever viable physical activity, they assume a double part over stressing the bones as they set both gravitational and muscular stress on bones. Objective: To determine the effect of aerobic exercises in prevention of bone mass loss post bariatric surgeries. Patients and Methods: Thirty female patients with post bariatric surgeries participated in this, their ages were between 25 to 45 years selected from Shebin El-Kom Hospital, Menoufia and randomly distributed into two equal groups: Group A (Study group): included 15 patients who received 30 minutes of aerobic exercise through walking on treadmill, in addition to conventional medical care 3 days per week and group B (Control group): included 15 patients who were on their conventional medical care. Results: There was no significant difference in T score of spine (L2-L4), femoral neck and total femur between both groups pre-treatment (p > 0.05). Comparison between both groups post treatment revealed a significant increase in T score of spine (L2-L4), femoral neck and total femur of the study group compared with that of the control group (p > 0.001). Conclusion: It can be concluded that aerobic exercises had fruitful effects in cases of osteoporosis patients after bariatric surgery as evidenced by the significant increase in BMD and T-score mean, so decrease risk of fractures and enhance physical performance. Keywords: Bariatric Surgeries, Bone density, DEXA, Obesity.
INTRODUCTION
types of aerobic exercise is walking, an exercise
Bariatric surgery has become an increasingly
delicately very well and accepted by the older, as it is
common treatment for severe obesity, as it results in
harmless, self-managed and effortlessly practicable. The
significant, sustained weight loss, reverses many
impacts of walking on BMD have been widely
complications of obesity and decreases mortality (1). It
considered (7). Treadmill exercise stimulates bone
includes a variety of procedures performed on people
formation and suppresses bone resorption, increases the
who have obesity, weight loss is achieved by reducing
serum 1,25-dihydroxyvitamin D3 level, and decreases
the size of the stomach with a gastric band or through
the serum parathyroid hormone level, resulting in an
removal of a portion of the stomach (sleeve gastrectomy
increase in bone mass with stimulation of longitudinal
or biliopancreatic diversion with duodenal switch) or by
bone growth, especially at weight-bearing sites(8).
resecting and re-routing the small intestine to a small
The aim of this work was to evaluate the therapeutic
stomach pouch (gastric bypass surgery) (2). However,
effect of aerobic exercises in reducing bone density loss
these procedures have beneficial effects on many
post bariatric surgeries.
cardiometabolic outcomes, they have negative effects on
bone homeostasis, mineral metabolism, including PATIENTS AND METHODS
vitamin D deficiency, hyperparathyroidism and bone
Thirty female patients with post bariatric surgeries
loss that persist for at least several years(3).
participated in this study. Their ages were between 25 to
The most consistent site for bone loss after all
45 years selected from Shebin El-Kom Hospital,
bariatric procedures is at the hip (4). Exercise is generally
Menoufia and were randomly distributed into two equal
considered to be a safe and efficacious approach to
groups:
restoring physiological function in patients post-surgery Group A (Study group): included 15 patients who (5). Exercise influenced the skeleton by three main
received 30 minutes of aerobic exercise through walking
mechanisms; a direct impact on bone that is translated
on treadmill, in addition to conventional medical care
into biological signals by mechanoreceptors , an indirect
(vitamin D supplements and calcium) 3 days /week.
impact by inducing changes in hormone levels and local Group B (Control group): includes 15 patients who
factors(6). Aerobic weight bearing exercise is more
were only on their conventional medical care (vitamin D
adapted to improve bone mass over whatever viable
supplements and calcium).
physical activity, they assume a double part over Ethical approval:
stressing the bones as they set both gravitational and Research Ethics Committee and quality control
muscular stress on bones(5). One of the most well-known approvals were obtained from Cairo University. The
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c:\work\Jor\vol824_8The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 637-640
Efficacy of Low-Level Laser Therapy on Hand Foot Syndrome Associated with Chemotherapy Hend Ali Mahmoud Ibrahim Badr al-din*1, Amal Mohamed Abd El baky1, Mohammed Abdel Rahman2, Karim Ibrahim Saafan1
1Departments of Physical Therapy for Surgery - Faculty of Physical Therapy, Cairo University,2Department of
Oncology - Faculty of Medicine, Cairo University, Cairo University *Corresponding author: Hend Ali Mahmoud Ibrahim Badr Al-Din, Mobile: (+20) 01117047800, E-Mail: [email protected] ABSTRACT Background: we speculate that low level laser might decrease the inflammatory reactions and pain associated with hand foot syndrome because low-level laser therapy, has proven high efficacy in the management of chemotherapy/radiation-induced oral mucositis and radiation-induced dermatitis that might share some physio- pathological characteristics with hand foot syndrome, Objective: To determine whether low-level laser therapy (LLLT) might be effective for chemotherapy-induced hand foot syndrome (HFS). Patients and methods: This study included thirty patients with hand foot syndrome (grade I -II
- III according to
WHO definition) after treatment with chemotherapy from both sexes. Their ages ranged from 35-60 years. Patients were randomly assigned into two equal groups in number. Group A (the study group) included fifteen patients received low-level laser therapy in addition to the traditional medical treatment. Group B (control group) included fifteen patients received the traditional medical treatment. The participants of both groups were assessed by the following tools to assess the impact of HFS on quality of life by visual analogue scale and HFS-14 questionnaire. Results: There was a significant decrease in VAS and HFS-14 questionnaire score post treatment in the study and control groups compared to that of pretreatment (p > 0.001). The percentages of decrease in VAS and HFS-14 questionnaire score in the study group were 48.29% and 34.22% respectively, while for the control group, they were 28.75% and 18.82% respectively. Conclusion: Based on this study, it could be concluded that LLLT might represent a useful approach for the management of HFS. Keywords: Hand foot syndrome, Low-level laser, Chemotherapy-induced toxicity.
INTRODUCTION
Low-level laser or light therapy (LLLT) has
Hand-foot syndrome (also known as hand-foot
shown significant promise. LLLT refers to light
reaction,
palmar-plantar
erythrodysesthesia,
therapy that may stimulate tissue regeneration, reduce
chemotherapy-associated acral erythema or Burgdorf
inflammation and control pain (5). LLLT mediated
reaction) is a cutaneous toxicity that is most frequently
vascular regulation, increases tissue oxygenation and
linked to cytotoxic drugs (e.g., 5-fluorouracil,
allows for greater traffic of immune cells, which may
capecitabine, cytarabine, docetaxel and pegylated
contribute to the promotion of wound repair and
liposomal doxorubicin) and multikinase-inhibitors (1).
regeneration. Moreover, LLLT when delivered
It usually occurs 212 days after administration of
appropriately reduces pain and improves function (6).
chemotherapy. The initial symptoms are palmoplantar
The present study was designed to investigate
dysesthesia and tingling, which can evolve within a
the effect of low-level laser therapy on the
few days to burning pain and symmetric well-defined
management of the hand-foot syndrome associated
erythema with edematous swelling (2). In severe cases,
with cancer therapy.
blistering, desquamation and subsequent ulceration
can occur. It usually resolves within a few weeks after MATERIALS AND METHODS
withdrawal of the responsible drug (3).
Thirty patients who had HFS participated in this
Histologic features of HFS are non-specific and
study. Their ages ranged from 35 to 60 years. The
based on a small number of patients. They include
participants were selected from Oncology Teaching
vacuolar degeneration of the basal cell layer, mild
Hospital in Ismailia. Patients were randomly assigned
spongiosis, keratinocytes necrosis, papillary dermal
into two equal groups in number. Group A (the study
edema, lymph histiocytic infiltrates and partial
group) included fifteen patients that received low-
separation of the epidermis from the dermis.
level laser therapy in addition to the traditional
Perivascular infiltrates composed of lymphocytes and
medical treatment and group B (control group) that
eosinophils are often seen in the dermis. There may
included fifteen patients who received the traditional
also be evidence of eccrine squamous syringe
medical treatment. Assessment of the impact of hand-
metaplasia or neutrophilic eccrine hidradenitis (4).
foot syndrome (HFS) on quality of life in both groups
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c:\work\Jor\vol824_9The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 641-646
Study of Hyperglycemia as a Prognostic Factor in Acute Ischemic Stroke Samir Mohamed Attia1, Mohamed Said Gomaa2, Hesham Khairy Ismaeil3, Amr Abdel Sattar Elmetwaly*4
Departments of 1Vascular Surgery, 2Neurology, 3Critical Care Medicine and 4Emergency Medicine & Traumatology -
Faculty of Medicine Mansoura University *Corresponding author: Amr Abdel Sattar Elmetwaly, Mobile: (+20) 01095676360, E-Mail: [email protected] ABSTRACT Background: Acute ischemic stroke (AIS) is a grave threat to global healthcare system, which is accompanied by high disability and mortality. Stress hyperglycemia is common in critically ill patients and appears to be a marker of disease severity. Furthermore, both the admission as well as the mean glucose level during the hospital stay is strongly associated with patient outcomes. Objective: To determine the impact of hyperglycemia in AIS on short-term outcome and prognosis. Patients and methods: This was a cross-sectional study, which was carried out on 150 patients arrived to Emergency Department (ED) in Emergency Mansoura University Hospital with clinical presentation and radiological investigations of ischemic stroke over the period from June 2018 to May 2019. Results: There were statistically significant difference as regards both onset and course of symptoms among both groups. Normoglycemic group demonstrated significant increase as regards serum creatinine, while demonstrated significant decrease as regards SBP, DBP, Glasgow coma scale (GCS) and glucose level in comparison with hyperglycemic group. Normoglycemic group demonstrated better outcomes in terms of CT brain and CBC compared to hyperglycemic group. Hyperglycemic group demonstrated abnormal outcomes in terms of ABG. Hyperglycemic group demonstrated marked increase in overall mortality rate compared to normoglycemic one. There were significant increase in ward admission cases as regards onset GCS and significant decrease as regards stay duration more than one week in comparison with ICU admission cases. Conclusion: Stress hyperglycemia is common among acute stroke patients and was associated with less favorable outcomes especially in terms of mortality, hospital stay and functional outcome. Keywords: Acute Ischemic Stroke, Hyperglycemia, Glasgow coma scale.
INTRODUCTION
strokes. Several prior studies have demonstrated that
Stroke is defined as a focal loss of brain
post-stroke hyperglycemia is associated with worse
function lasting more than 24 hours with no
patient outcomes following an acute stroke, including
appearance of cause other than vascular origin
increased post-stroke mortality (5).
resulting in acute neurologic insult that occurs as a
In
the
absence
of
stroke-specific
result of one of brain ischemia or hemorrhage (1).
recommendations, current guidelines advice treating
Worldwide, cerebrovascular accidents (stroke) are the
hyperglycemia in stroke patients as one would treat
second leading cause of death and the third leading
hyperglycemia in any hospitalized patient, including
cause of disability (2).
frequent glucose monitoring and stringent blood
There are two main types of stroke, ischemic
glucose control (6).
and hemorrhagic, while there is a third more minor
The aim of this study was to determine the
stroke called transient ischemic attack (TIA). An
impact of hyperglycemia in acute ischemic stroke on
ischemic stroke can be caused by a blood clot that is
short-term outcome and prognosis.
formed in the heart and travelled to the brain or by
atherothrombosis. Hemorrhagic strokes, conversely PATIENTS AND METHODS
are caused by a rupture in the blood vessels that causes
This was cross-sectional study conducted on
bleeding within the brain. A TIA is a blood clot that
150 patients arrived to Emergency Department (ED)
temporarily interrupts blood flow in the brain and is a
in Emergency Mansoura University Hospital with
major risk factor for future strokes that could cause
clinical presentation and radiological investigations of
more serious damage (3).
ischemic stroke within the period from June 2018 to
Hyperglycemia is common in patients with
May 2019. The patients were classified into two
acute stroke, occurring in up to 60% of patients
groups:
Normoglycemic
group
(86)
and
overall and approximately 1253% of acute stroke
hyperglycemic group (64).
patients without a prior diagnosis of diabetes. It has
been associated with increased stroke severity and Inclusion criteria:
mortality (4). Hyperglycemia is defined as blood
1. Patients with ischemic stroke.
glucose level > 200 mg/dL. It has been observed in two
2. Patients aged more than 16 years old.
thirds of all ischemic stroke subtypes on admission
3. Both genders.
and in at least 50% in each subtype including lacunar Exclusion criteria:
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c:\work\Jor\vol824_10The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 647-654
Study of DNA Damage in Diabetic Mothers and Their Newborn Soheir Sayed Abou El-Ella, Mohamed Abdelsamie Sayed Ahmed Ismaeil*, Naglaa Fathy Barseem
Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt *Corresponding author: Mohamed A.S. Ismaeil, Mobile: (+20)1005815735, E-Mail:[email protected]
ABSTRACT Background: Previous research declares that gestational diabetes mellitus (GDM) affects both mother and infant during pregnancy and in the long term. Objective: To assess the pattern of DNA damage in mothers with gestational diabetes during pregnancy and their possible impact on their offspring. Patients and Methods: A case-control study was designed and conducted on 120 pregnant women and their infants; divided into two groups: 1-Patients group (60 patients had gestational diabetes mellitus during the third trimester of pregnancy and their infants) 2-Control group (60 apparently healthy pregnant women and their infants). Results: DNA damage of mother and their infants was significantly increased among the cases group than controls (p=0.0001). There was a statistically significant increase among infants who had DNA damage group than who hadn't regarding HBA1C, random blood sugar (RBS) 3 hr and RBS 6 hr (p<0.05). Also, infants who had DNA damage had statistically significant decrease regarding Ca, RBS 24 hr, RBS 36 hr and RBS 48 hr (p<0.05). While there was no statistically significant difference between the studied groups regarding Hb, hematocrit, RBS, fasting BS, AST, Hemoglobin (Hb) at 1 hr, hematocrit at 1 hr, Hb 24 hr, hematocrit 24 hr, RBS 1hr, RBS 2 hr and RBS 12 hr (p>0.05). Conclusions: Hyperglycemia affects maternal and fetal DNA integrity and DNA damage response differently, gestational and mild gestational hyperglycemia, were all related to increased oxidative DNA damage and DNA repair may be thus considered an important mechanism to prevent the deleterious effects of hyperglycemia in the genetic material. Keywords: DNA damage, Gestational diabetes mellitus, Hyperglycemia, Newborn, Pregnant. INTRODUCTION
Gestational diabetes is any degree of glucose
predispose the development of GDM as pre-
intolerance with onset or first recognition during
pregnancy, overweight, obesity, family history of
pregnancy. The definition applies whether insulin or
diabetes, advanced maternal age, poor diet, low
only diet modification is used for treatment and
physical activity before or during pregnancy, history of
whether or not the condition persists after pregnancy.
subfertility or infertility, polycystic ovarian syndrome
Studies have reported that women are more than seven
as well as genetic factors (3).
times as likely to develop diabetes after GDM, and that
approximately 50% of mothers with GDM will PATIENTS AND METHODS
develop diabetes within 10 years, making GDM one of All subjects included in this study were divided into
the strongest predictors of type 2 diabetes (1). two groups as: Group I (cases): Included 60 pregnant
The International Association of Diabetes and
mothers with gestational diabetes mellitus; their ages
Pregnancy Study Groups (IADPSG) showed new
ranged between (25 to 38 years) with mean age (31±
criteria for the diagnosis of GDM, based on the
3.5) and their infants and Group II (controls):
Hyperglycemia and Adverse Pregnancy Outcomes
Included 60 pregnant mothers, their ages ranged from
(HAPO) Study. This criteria use a 75-g oral glucose
(21-36 years) with mean age (26 ± 5.5) years and their
tolerance test (OGTT) and diagnose GDM when the
infants.
fasting glucose is 5.1 mmol/L (90 mg/dL) and/or
when the 1 h post load glucose is 10.0 mmol/L (180 Inclusion criteria:
mg/dL) and/or when the 2-h post load glucose is 8.5
All pregnant mothers with gestational diabetes
mmol/L (150 mg/dL) (2).
mellitus (type 1, type 2 and gestational) and their
It is well known that normal pregnancy is
infants.
accompanied by a marked increase in insulin
resistance, which may be the result of both increased Exclusion criteria:
maternal adiposity and the insulin-antagonizing effects
Mothers with chronic diseases as chronic renal
of several placental hormones. Therefore, maternal
diseases, chronic liver diseases and chronic heart
pancreatic beta cell compensation is important for
diseases.
overcoming the insulin resistance provoked by
Gestational diabetes mellitus was diagnosed at any
pregnancy and for maintaining the metabolic balance
time during pregnancy based on any one of the
during pregnancy. There are some risk factors that
following values: (1) Fasting plasma glucose = 5.1-6.9
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c:\work\Jor\vol824_11The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 655-662 The Value of Apparent Diffusion Coefficient Measurement in Assessment and Follow Up of Multiple Sclerosis Patients Samar Ramzy Ragheb*, Mena Elerian Youssef Ekladious
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt *Corresponding author: Samar Ramzy Ragheb, Mobile: (+20)1003568254, E-mail:[email protected] ABSTRACT Background: It is widely accepted that multiple sclerosis effect on white matter extends beyond the demyelinating plaques and that the apparent diffusion coefficient (ADC) measurement can offer an insight on the effect of multiple sclerosis on normal appearing white matter. Objective: The aim of the current work was to evaluate the role of ADC in assessment and follow up of multiple sclerosis patients.Patients and Methods: This retrospective study included a total of 20 healthy volunteers and 50 multiple sclerosis patients in different clinical subtypes, referred from Neurology Department and Outpatient Clinics, and conducted at Department of Radiodiagnosis, Ain Shams University Hospital. A follow up Magnetic resonance imaging (MRI) with ADC measurement was done every 6 months for 3 years. Results: There was significant difference in the ADC of the normal appearing white matter of normal individuals and multiple sclerosis patients (P<0.0001). There was also significant difference in ADC measurement of plaques between relapsing remittent and chronic progressive cases (P<0.0001). The cutoff point in differentiating normal from multiple sclerosis patients was 0.8 ×10-3mm2/sec with sensitivity 93.7%, specifity94.3% and accuracy 85%. The cutoff point in differentiating relapsing remittent cases from progressive cases was 1.3 ×10-3mm2/sec with sensitivity 89.3%, specificity 85% and accuracy 80%. Conclusion: It could be concluded that routine measurement of the ADC value of the normal appearing white matter and multiple sclerosis plaques can help in assessment of the clinical subtype and shows high correlation with the degree of the disease progression. Keywords: Diffusion, ADC, Multiple sclerosis. INTRODUCTION
Multiple sclerosis (MS) is a chronic
The aim of current study was to evaluate the role
demyelinating disease that is characterized by white
and value of ADC in assessment and follow up of
matter plaques that affects the brain and spinal cord (1-
multiple sclerosis patients. 2). Axonal swelling, microglial activation and gliosis
can also be signs of chronic injury of the normal PATIENTS AND METHODS
appearing white matter (3).
This retrospective study included a total of 20
Although conventional MRI can show focal
healthy volunteers and 50 multiple sclerosis patients in
white matter demyelinating plaques yet due to its
different clinical subtypes, referred from Neurology
inability in detecting the damage of the normal
Department and Outpatient Clinics, and conducted at
appearing white matter, it shows week correlation with
Department of Radiodiagnosis, Ain Shams University
the clinical neurological deficit (4,5,6,7).
Hospital. This study was conducted between February
There are several four clinical sub-types of
2016 till January 2019.
multiple sclerosis the most common is relapsing-
Remitting (RRMS), (where the patients suffer from Ethical approval:
periods called relapses and exacerbations) (8) and This study was ethically approved by the
Secondary-Progressive (SPMS), in which symptoms Institutional review board and informed consents
worsen by time (9). were taken from Ain Shams University and
Diffusion
weighted
MRI
with
ADC
an informed written consent was taken from each
measurement plays an important role in assessment of
participant in the study.
early white matter changes. Water diffusion in white
matter is highly directional because of the orientation of
We
excluded
patients
with
MRI
axons and the presence of myelin.
contraindication as those with cardiac pacemaker
In cases of myelin damage and axon disruption
claustrophobia or cochlear implants.
the diffusivity along nerve fibers changes which is
reflected on the ADC values (10, 11, 12). All patients were subjected to the following:
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c:\work\Jor\vol824_12The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 663-667
Surgical Management of High Energy Dorsolumbar Fractures Ahmed Abdel Azez Hassan, Amr Abdel Halem Amr*, Ibrahim Elsayed Abdellatif Abuomira
Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt. *Corresponding Author: Amr Abdel Halem Amr,Mobile:(+20) 01009940553 Email:[email protected] ABSTRACT Background: The management of dorsolumbar fractures has been the subject of much controversy. There are different criteria for the choice of management based on the severity of the kyphotic deformity, canal compromise, vertebral height loss, and neurologic status. Objective:To evaluate the results of surgical management of high energy dorsolumbar fractures in the Trauma Unit at Assiut, and at Al-Azhar University Hospitals. Patients and Methods: From October 2017 to October 2019, 40 patients with thoracolumbar spine (TLS) fractures, all of them were treated by posterior instrumentation with pedicle screws and rod system. 23 petients (57.5%) underwent long-segment fixation and 17 patients (42.5%) underwent short-segment fixation. They were operated upon at the Trauma Unit of Assiut University Hospital and Al-Azhar University Hospital. Results:The clinical outcome according to modified Macnab criteria; in long segment group it was excellent in 8 patients (34.7%), good in 11 patients (47.8%), fair in 3 patients (13% ) and poor in 1 patient (4.3%), while in short segment group; it was excellent in 3 (17.6%), good in 10 (58.8%), fair in 3 (17.6%)andpoor in 1 (5.9%). The kyphosis correction (%), in long segment group was 70 in 16 patients (70%), <70 in 7 patients (30%), while in short segment group, it was 70 in 10 patients (59%) and <70 in 7 patients (41%). Conclusion: Short segment fixation using pedicle screw at the level of fracture, inhigh energy thoracolumbar fractures; provides comparable correction to long segment fixation and the amount of correction loss can be minimized by proper selection of cases suitable for short segment fixation. Keywords: Dorsolumbar, Fractures, High energy, Kyphotic.
INTRODUCTION
Dorsolumbar segment of the spine is an unstable
8 patients (20%) at the lumbar region. We classified
zone between the fixed dorsal and mobile lumbar spine
them by using the AO classification system into 16
and has a higher risk for fracture, but it has also
patients (40%) had type A fractures, 20 patients (50 %)
important anatomic characteristics that allow for a
had type B fractures and 4 patients (10 %) had type C
greater recovery from neurologic injury than more
fractures.
cephaloid cord injuries. More than 50% of thoracic and
lumbar injuries occur between T11 and L1(1), and the Study design: Prospective consecutive study.
majority of these fractures are unstable. Overall, 20 to Inclusion criteria:
40% of these fractures are associated with neurological
1) Adults between 16-60 years old.
deficits(2). The primary goal of treatment of the
2) Patients with high energy dorsolumbar fractures.
thoracolumbar fracture is keeping patients alive, Exclusion criteria:
protecting them from further neural damage, obtaining
1) Patients less than 16 years or more than 60 years.
stability by reconstructing the anatomical alignment of
2) Neglected fractures more than one month
spinal columns and returning patients to the workplace
duration.
through early mobilization and rehabilitation. Surgery
is the treatment of choice in the management of high Method of intervention: They were operated upon at
energy dorsolumbar fractures and the accepted
the Trauma Unit of Assiut University Hospital and Al-
methods of treatment of these fractures include
Azhar University Hospital by posteriorinstrumentation
posterior reduction (with or without decompression)
with pedicle screws and rod system. 23 petients
and instrumentation, and anterior decompression and
(57.5%) underwent long segment fixation and 17
instrumentation(3-5).
patients (42.5%) underwent short segment fixation.
Decompression was done in 3 cases (17.6%) ofshort PATIENTS AND METHODS
segment fixation group and in 6 cases (26%) oflong
A total of 40 patients (23 males and 17 females)
segment fixation group.
and their average age was 28.03±10.95 ranged from 16
to 60 years were included in this study with high energy Postoperative regimen: The mean follow-up period
dorsolumar fractures, 8 patients (20%) at the thoracic
was 6.0±0.85; ranging from 6 months to 1 year. All
region, 24 patients (60%) at the thoracolumbar
patients were followed up and evaluated both clinically
junction,
via ASIA score and modified Macnab criteria and
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c:\work\Jor\vol824_13The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 668-674
Nifedipine versus Nifedipine and Progesterone Therapy in Acute Tocolysis in Preterm Labor and Their Effect on Maternal and Fetal blood flow Mohammad A. El-Sayed, Alaa M. Abdelgaied, Amira A. Fathey, Esraa M. El-Shemy
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt. Corresponding Author: Esraa Mohammad El-Shemy, Mobile: (+20)01061623498, Email: [email protected] ABSTRACT Background: Preterm delivery is labor beginning before completing 37 weeks of gestation with progressive effacement and dilatation of the cervix in the presence of regular painful contractions. Preterm labor as one of the biggest challenges for obstetricians is a world health problem and is responsible for approximately two-thirds of early neonatal morbidity and mortality. Objectives: To compare the effectiveness and safety of nifedipine therapy versus combined use of vaginal progesterone and nifedipine as acute tocolysis and their effect on maternal and fetal blood flow measured at 24 and 72 hours after their use. Patients and Methods: This prospective randomized observational comparative clinical study included 52 pregnant women with symptoms and signs of preterm labor that were randomly allocated into two groups each group consisted of 26 patients. This study was conducted in Obstetrics and Gynecology Department, Menoufia University Hospitals in the period between March 2019 and March 2020. Their gestational ages ranged from 28-34 completed weeks. Result: Time interval between last epilat capsules to tocolytic effect in minutes was significantly shorter in group B than in group A. There was no significant difference between the two groups in Doppler parameters with no long-term effect on fetomaternal circulation as tocolytics in acute preterm labor. Conclusion: This study concluded that oral nifedipine plus vaginal progesterone is associated with more rapid response to tocolysis in threatened preterm labor compared to oral nifedipine alone with nearly the same effect on maternal and fetal blood flow. Keywords: Preterm labor, Tocolytics, Nifedipine, Progesterone, Doppler.
INTRODUCTION
progesterone, magnesium sulfate, oxytocin antagonists
World Health Organization (WHO) defined
and anti-prostaglandins (as indomethacin) (5).
preterm labor as the onset of labor after the age of
Nifedipine was first reported in 1980 in an
viability and before completing 37 weeks of gestation.
observational study to be an effective tocolytic agent
The conditions which determine the onset of labor
with minimal side effects (6). It is an effective tocolytic
include documented uterine contractions (at least 1
agent, with an easy oral route of administration, few
every 10 min), ruptured fetal membrane, documented
side effects and a low neonatal complications rate.
cervical change with cervical length of about 1 cm or
However, it should be used with caution in patients
less and/or cervical dilation of more than 2 cm.
with compromised cardiovascular condition as they
Considering this, threatened preterm labor can be
may be at risk of pulmonary edema and cardiac failure
diagnosed when there are documented uterine (7).
contractions with no cervical changes (1).
Progesterone is an important agent for
Preterm birth is the leading cause of neonatal
maintaining uterine quiescence. It is increasingly used
mortality and morbidity, as well as the most common
in women at high risk for preterm labor and for
reason for antenatal maternal hospitalization, which is
maintenance tocolysis (8). Far too few studies have
associated with socio-economical burdens to the
focused on the possible effects of progesterone on
society (2). In the world, about 15 million preterm
maternal or fetal circulation in late pregnancy,
infants are born every year (3).
especially in high-risk women. Several mechanisms
Tocolytic therapy has a well-defined role in the
were described for the role of progesterone including
management of preterm labor, accomplishing the
anti-inflammatory effect, inhibition of gap-junction
following objectives: permitting transfer of the
formation in the myometrium, and direct effect on the
pregnant woman to a tertiary care center, prolonging
cervix (9).
pregnancy for at least 48 h to optimize the beneficial
The American College of obstetricians and
effect of steroids on fetal lung maturity and prolonging
Gynecologists
(ACOG)
gave
this
general
pregnancy in an attempt to improve perinatal outcome.
recommendation for the use of tocolytic medication in
Tocolysis is currently the principal preterm birth
the clinical management of preterm labor: "if tocolytic
preventive measure and will remain so until the
drugs are used, the choice of drug should be
etiology of preterm labor is better-understood (4). Many
individualized and based on maternal condition,
tocolytic agents are used in clinical practice in an
potential drug side effects, and gestational age" (10).
attempt to prevent preterm delivery such as B2
Aim of the work was to compare the effectiveness,
agonists, calcium channel blockers (as nifedipine),
the safety of nifedipine therapy versus combined use of
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c:\work\Jor\vol824_14The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 675-681
Study of Maternal and Fetal Outcome of Placenta Previa in Zagazig University Maternity Hospital Yousef Abo Elwaan, Mohamed Sabry Mohamed, Ismail Sabry Ismail*, Wael Sabry Nosir
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt. Correspondence to: Ismail Sabry Ismail, Mobile: (+20)01124023200, E-mail:[email protected] Abstract Background: Placenta previa accounts for approximately 0.5% of all deliveries but remains major cause of perinatal mortality and morbidity. Objective: This study aimed to evaluate the outcome (both maternal and fetal) of placenta previa in Zagazig University Maternity Hospital. Patients and Methods: A cross sectional study that was conducted on 160 pregnancies with placenta previa in Obstetric and Gynecology Department of Zagazig University Hospitals from October 2018 until October 2019. The diagnosis of placenta previa was based on ultrasonography and confirmed at cesarean delivery. Results: 160 cases of placenta previa were studied regarding the perinatal and maternal outcome. The maternal ages were high and ranged from 31.9 to 36 years old. Incidence of placenta previa was highest in 60.7% of the multiparous group. Perinatal morbidity was studied as the percentage of babies requiring resuscitation and NICU admission, which was 21.3% of the cases. The percentage of perinatal deaths was 7.5%. Conclusions: The reduced maternal mortality in recent years is mainly due to presence of qualified team of placenta previa and accreta, better diagnosis, blood transfusion, effective antibiotic therapy and better understanding of the management of shock and renal failure. Keywords: Placenta previa, Maternal morbidity, Neonatal mortality.
INTRODUCTION
technology, history of cesarean section(s), and prior
Placenta previa is a major cause of maternal
placenta previa (6, 5, 7).
morbidity and mortality because of the associated
Uncontrolled postpartum hemorrhage from
antepartum and intrapartum hemorrhage. Moreover,
placenta previa or PAS may necessitate a blood
placenta previa is associated with preterm delivery, with
transfusion, hysterectomy and leaving the patient
the neonatal mortality increasing three fold as a result of
infertile, admission to the ICU, or even death (5).
prematurity. The prevalence of placenta previa has been
Tranexamic acid (TXA), an antifibrinolytic agent, could
recently estimated to be approximately 0.5% of all
exert its hemostatic effect via inhibiting the activation of
pregnancies, and this increase correlates to the elevated
plasminogen to plasmin. Its efficacy and safety in
cesarean section rate (1, 2).
reducing hemorrhage and lowering transfusion
Placenta previa should be suspected in any woman
requirements have been well established in various
beyond 20 weeks of gestation who presents with
elective surgeries (8).
painless vaginal bleeding. For women who have not had
During delivery, when the placenta separates from
a second trimester ultrasound examination, antepartum
the uterine wall, physiologic and hemostatic changes
bleeding after 20 weeks of gestation should prompt
occur sequentially to reduce bleeding as strong
sonographic determination of placental location before
myometrial contractions, increased platelet activity,
digital vaginal examination is performed because
massive release of coagulation factors and consequently
palpation of the placenta can cause severe hemorrhage
a parallel increase in fibrinolytic activity. (3).
While oxytocin administration enhances the first
This situation prevents a safe vaginal delivery and
mechanism, TXA administration might be able to
requires the delivery of the neonate to be via cesarean
counteract the latter and thus facilitate the hemostatic
delivery. Most cases are diagnosed early in pregnancy
process. Finally, the association between the extent of
via sonography and others may present to the emergency
the initial decrease in plasma fibrinogen and the
room with painless vaginal bleeding in the second or
subsequent severity of blood loss reported in women
third trimester of pregnancy. The presence of placenta
with early postpartum hemorrhage (PPH) suggests that
previa can also increase a woman's risk for placenta
both the coagulation and fibrinolysis processes are
accreta spectrum (PAS) (4).
implicated in the control of postpartum blood loss. This
The underlying cause of placenta previa is
further supports the hypothesis that TXA might be
unknown. There is, however, an association between
effective in PPH prevention. Accordingly, there is a
endometrial damage and uterine scarring (5). The risk
clear theoretical rationale for the use of antifibrinolytic
factors that correlate with placenta previa are advanced
agents to reduce postpartum blood loss (9). This study
maternal age, multiparity, smoking, cocaine use, prior
aimed to evaluate the outcome (both maternal and fetal)
suction,
curettage,
assisted
reproductive
of placenta previa in Zagazig University Maternity Hospital.
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
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c:\work\Jor\vol824_15The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 682-688
Study of the Determinant Factors in Seizure Following Gastroenteritis in Children Admitted in Aswan University Hospital Hanan Mohammed Abd El-Moneim, Mohamed Baha Eldeen El Amer, Nilly Abdelmoti Abo Baker*
Department of Pediatrics, Faculty of Medicine - Aswan University, Egypt *Corresponding author: Nilly Abdelmoti Abo Baker, Mobile: (+20) 1111568634, E-Mail: [email protected] ABSTRACT Background: Diarrhea is a leading cause of illness and death in children of developing countries, where an estimated 1300 million episodes and 3.2 million deaths occur in under-5 children. About 80% of deaths due to diarrhea occur in the first 2 years of life. Convulsions may occur during a diarrheic illness. Children may develop febrile seizures if fever accompanies the diarrhea. Objective: The aim of the current work was to investigate the prevalence and determinant risk factors of seizure in children with gastroenteritis in children admitted to Aswan University Hospital in Egypt. Patients and Methods: This prospective cross-sectional study included a total of 60 children having gastroenteritis and seizure, attending at Aswan University Hospital. This study was conducted between April 2019 to the end of September 2019. Results: 46.7% of cases had mild fever, 61.7% of cases had gastroenteritis >5 days, vomiting frequency was > 3 times per day in 73%. Mean serum calcium was 5.55 ± 0.614 mg/dl, mean potassium was 4.72 ± 0.632mmol/L, mean sodium was 135.67 ±5.82 mmol/L and mean PH was 7.36 ±0.694. Acidosis and hyponatremia were the most frequent disorder among the patients. High grade fever, gastroenteritis >5 days and vomiting more than 3 times per day were significantly more frequent in patients with convulsion compared to non-convulsion patients. Conclusion: Electrolyte impairment is fairly common in children with acute gastroenteritis. High grade fever, gastroenteritis for > 5 days, vomiting >3 times per day, blood urea nitrogen, potassium and sodium found to be significant predictors of convulsion. Keywords: Gastroenteritis, Diarrhea, Convulsions, Children. INTRODUCTION
gastroenteritis occurs without electrolyte disturbances
The term gastroenteritis denotes infections of
and abnormalities in Electroencephalogram (EEG) (8).
the gastrointestinal tract caused by viral, bacterial, or
In some cases, seizures following gastroenteritis
parasitic pathogens. The most common symptoms are
occurs without fever which is not necessarily febrile
diarrhea and vomiting, which can be accompanied by
seizure due to the gastroenteritis (9).Various spectrums
fever and abdominal pain (1). Diarrhea has a high
of benign convulsions or epileptic syndromes may
contribution to the death of infants (9%), which
develop in infants and pediatrics (10).
accounts for about 71% of deaths per year in the world
Considering
the
high
prevalence
of (2). An average of 166 million deaths occurred in 2014
gastroenteritis in children, the complications caused by
in infants below the age of 5 years old in developing
this disease, which is involved in the morbidity and
countries, of them about 80% were in Africa, South
morbidity of the disease, especially the seizure
Asia, and Middle East (3).
following gastroenteritis, is very important. Vafaei et
Gastroenteritis can be found in healthy infants al. (10) reported that electrolyte impairment is fairly
without any association with diseases such as
common in children with acute gastroenteritis.
meningitis, encephalitis, and encephalopathy (4).
Education about the management of children with
Gastroenteritis occurs mostly in the winter and early
seizure can be an important factor in this regard.
spring, and the most common cause for this is rotavirus Khosroshahi et al. (11) said that benign (5).
convulsion with mild gastroenteritis is a distinct
In children, the daily water exchange rate is
clinical entity that has not been categorized by the
much higher than adults, as well as the incomplete
International League against Epilepsy. It is known as a
renal development in children, which results in more
situation-related seizure. It mostly happens in infants
extracellular fluid. Therefore, water and electrolyte
and has a favorable prognosis and neurologic
disturbances in children are more dangerous than in
evaluations usually turned out to be unnecessary. The
adults (6). The most important complication of
exact path-physiology remains undetermined. Further
gastroenteritis in children is seizure, which is mostly
prospective investigations needed to be performed in
caused by fever, electrolyte disturbances, meningitis
this entity. Increased awareness of pediatricians and
and sometimes toxins (5). Electrolyte disturbances such
pediatric neurologists of this newly recognized clinical
as hyponatremia, hypernatremia and hypocalcaemia
disorder can lead to enhance case detection and avoid
are the major cause of seizures in these children (7).
expensive
and
unnecessary
neuro-diagnostic
However, in many cases, a seizure following
investigations.
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682
Received:18 /10 /2020
c:\work\Jor\vol824_16The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 689-694
The Impact of Acute Kidney Injury on Prognosis and Short-Term Outcome of Acute Ischemic Stroke Samir Mohamed Attia1, Mohamed Said Gomaa2, Hesham Khairy Ismaeil3, Mahmoud Ahmed Mohamed Eita*4
Departments of 1Vascular Surgery, 2Neurology Science, 3Critical Care Medicine and
4Emergency Medicine and Traumatology, Faculty of Medicine, Mansoura University, Egypt. *Corresponding author: Mahmoud Ahmed Mohamed Eita, Mobile: (+20) 01004735491, E-Mail: [email protected] ABSTRACT Background: Stroke is the third leading cause of death and disability globally. After a stroke, neurological deficit leading to dysphagia and physical disability, physiological effects including changes in blood pressure and cerebral salt wasting, as well as investigations and treatments, can all potentially contribute to the development of acute kidney injury (AKI). Furthermore, older, comorbid patients are at greatest risk of AKI. Objective: To investigate the impact of acute kidney injury on prognosis and short-term outcome of patients admitted for acute ischemic stroke. Patients and methods: This was a prospective observational study which was carried out on 100 patients that diagnosed with ischemic stroke and arrived to Emergency Hospital, Mansoura University over a year from June 2019 to June 2020. Results: The average Glasgow coma scale (GCS) among the studied cases was 15. Nearly half of the studied cases developed AKI. The majority of cases were discharged on an Organophosphorus compounds (OPC), while only 29 of which were died. Dead group demonstrated significant increase in serum creatinine after 3 days, AKI development and stay duration more than one week. Demographic characteristics and past history of medical diseases demonstrated insignificant differences among dead and living cases. AKI was demonstrated to be the only significant predator of mortality among the studied cases. AKI was a significant predictor of the survival duration. In contrast, ICU stay and stay duration were not significant predictors of survival. Conclusion: Patients with acute ischemic stroke were at higher possibility for development of AKI, which was accompanied with worse outcomes. Keywords: Acute kidney injury, Acute ischemic stroke.
INTRODUCTION
Stroke represents a continuously evolving
0.3 mg/dL or a rise in the serum creatinine level by 1.5
medical and social problem, being the third leading
times or more within the last 7 days after admission, as
cause of death after heart disease and cancer in
defined by Kidney Disease Improving Global
developed countries (1). The diagnosis of ischemic
Outcomes (KIDGO) (4). AKI has been a frequent
stroke is established by a neurologist based on the
complication after an acute cerebrovascular event,
presence of focal or global signs of cerebral
with an overall prevalence around 11.6%. More
dysfunction lasting more than 24 hours and with no
advanced age, presence of heart failure, diabetes, and
apparent non-vascular cause. In addition, the diagnosis
ischemic heart disease have been associated with a
was confirmed by compatible findings of computed
higher risk of developing AKI after stroke (5) andthe
tomography or magnetic resonance imaging within 24
presence of AKI has been associated to higher
to 72 hours after admission, as defined by the World
mortality risk both in the short-term and long-term
Health Organization criteria(2).
after an ischemic stroke(6).
Several reports have indicated chronic kidney
Patients with reduced renal function are at high
disease (CKD) to be an additional independent and
risk for the subsequent development of cardiovascular
powerful predictor for stroke outcome. In a cohort
disease (CVD) including stroke. Although acute stroke
study of 2042 patients admitted for stroke, renal
is an emergency disease and shares the same
indices (serum urea and creatinine, creatinine
atherosclerotic risk factors with ischemic heart
clearance at admission) remained significant
disease, the association of renal function and stroke is
predictors of mortality even after adjustment for a
poorly investigated(7). MacWalter et al.(3) showed in
variety of `classical' risk factors: age, neurological
a larger group of acute stroke patients that mortality
presentation and comorbidities [congestive heart
was higher among patients with reduced renal function
failure (CHF), ischemic heart disease (IHD),
on admission.
hypertension and smoking] (3).
The aim of our present study was to investigate
AKI was defined by an increase of the serum
the impact of acute kidney injury on prognosis and
creatinine in relation to baseline value at admission This article is an open access article distributed under the terms and conditions of t h e Creative Commons Attribution (CC BY- SA) license (http://creativecommons.org/licenses/by/4.0/)
689
Received:18 /10 /2020
c:\work\Jor\vol824_17The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 695-700
Study of Correlation between Fibroscan and Resistin Level in Non-Alcoholic Fatty Liver Disease Patient Atef Abo El Soud1, Ashraf Dawood2, Sherien Abd El-Aziz Bayoumi El-Kashash*2, Mohsen El Khayat1
Departments of 1Tropical Medicine and 2Biochemistry, Faculty of Medicine, Menoufia University, Menoufia, Egypt *Corresponding Author:Sherien Abd El-Aziz Bayoumi El-Kashash, Mobile: +201006660886, E-mail:[email protected] ABSTRACT Background: Hormone resistin is linked to the development of insulin resistance, but direct evidence of resistin levels in humans with nonalcoholic fatty liver disease (NAFLD) is lacking. Objective: To study the role of fibroscan and resistin level in diagnosis of nonalcoholic fatty liver patients. Methods: This study was conducted on60 NAFLD patients, 27 patients with nonalcoholic steatohepatitis (NASH), and 33 patients with simple steatosis, who were admitted to Tropical Medicine Department in Shebin El-Kom Fever Hospital and 30 healthy subjects as control. Patients were subjected to meticulous history taking, clinical examination, routine laboratory investigations, abdominal ultrasound, fibroscan, and measurement of serum resistin level. Results: Serum resistin can be used to discriminate between simple steatosis group and NASH group at a cutoff level of > 10.5, with 53.3% sensitivity, 83.3% specificity, 76.1% PPV and 64.1% NPV (AUC = 0.73 and p-value = 0.002). Also, there was a significant difference in fibroscan score in comparison between groups, NASH group represented the highest score. There was a significant relation between serum resistin level and fibroscan score in both NASH and simple steatosis groups. Conclusion: Fibroscan and serum resistin level can be used for diagnosis of nonalcoholic fatty liver and for discrimination between simple steatosis and NASH patients. Keywords: Fatty Liver, Fibroscan, Non Alcoholic, Resistin.
INTRODUCTION
resistin levels are associated with metabolic syndrome
Nonalcoholic fatty liver disease (NAFLD) is now
and insulin resistance. In patients with NAFLD, serum
considered the most prevalent chronic liver disease
resistin levels were higher than those in control lean and
(CLD) worldwide. It is expected to become the most
obese patients (6).
common cause of end-stage liver disease (i.e., cirrhosis
The aim of the present study was to study
and hepatocellular carcinoma) in the near future and,
the role of fibroscan and resistin level in diagnosis of
consequently, the most common indication for liver
nonalcoholic fatty liver patients.
transplantation (1). Liver biopsy is the gold standard test
for diagnosis, grading, and histological assessment of PATIENTS AND METHODS
NAFLD, and a four point histopathologic grading
The present study was conducted in Shebin El-
system is used to assess severity of steatosis that ranges
Kom Fever Hospital, including 90 participants. The
from 0 to 3, depending on presence of the percentage of
studied patients were recruited from Tropical Medicine
fat-containing hepatocytes (2).
Department during the period from July 2019 to
But the value of a liver biopsy for the diagnosis of
January 2020. 60 subjects enrolled in this study with
NAFLD in routine clinical practice is controversial,
NAFLD and 30 non obese apparently healthy people.
especially in the presence of a generally good prognosis
Diagnosis based on chronic elevation of transaminases
for most patients with NAFLD, the lack of an
(> 1.5 times the upper normal value for 3 months in
established form of effective therapy, and the risks and
absence of chronic liver disease) and bright liver by U/S
costs associated with the liver biopsy (3). Liver stiffness
and diagnosis confirmed by liver biopsy. Subjects were
(LS) measurement by transient elastography (TE) is a
classified into three groups:
very promising non-invasive method for the diagnosis Group I: include 27 patients with NASH.
of fibrosis in chronic liver diseases. A strong correlation Group II: include 33 patients with simple
between LS measurements and liver fibrosis stages,
steatosis.
assessed by simultaneous liver biopsies, have been Group III: include 30 healthy subjects as control.
reported in nonalcoholic steatohepatitis (NASH) (4). The following patients were excluded:
Resistin, also known as adipose tissue-specific
1- Patients who are known to be alcoholic.
secretory factor (ADSF), is a cysteine-rich polypeptide
2- Patients who are known to be positive for hepatitis
encoded by the RETN gene. It is believed to play a
C or B.
significant role in the development of insulin resistance.
3- Autoimmune hepatitis.
In humans, it is proved to be a 108-amino acid
4- Primary biliary cirrhosis.
polypeptide expressed in adipocytes, pancreatic cells,
5- Obstructive liver disease.
muscle, and mononuclear cells (5). Increased serum
6- Alcohol consumption.
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
695
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c:\work\Jor\vol824_18 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 701-707
Prevalence and Risk Factors for Gestational Diabetes in Aswan, Egypt According to International Association of the Diabetes and Pregnancy Study Groups (IADPSG) Lobna Farag Eltoony1, Salwa Ali Ibrahem2, Mohammed Zain El-dean Hafez1, Omaima Mohamed Ali3, Wael Abd Elgwad Elsewify*3
1Department of Internal Medicine, Internal Medicine Department, Faculty of medicine, Assuit University, Egypt
2 Department of Internal Medicine, Aswan University Hospital, Aswan, Egypt
3 Department of Internal Medicine, Faculty of Medicine, Aswan University, Aswan, Egypt *Corresponding author: Wael Abd Elgwad Elsewify, Mobile: +201001657295, Email: [email protected] ABSTRACT Background: The prevalence of diabetes in Egypt has significantly increased exceeding international rates. Egypt is now ranked ninth highest in the world in terms of the disease according to IDF, 2019. Objective: Estimation of the prevalence of gestational diabetes mellitus (GDM) in Aswan Governorate in Egypt and determination of the risk factors associated with GDM. Patients and methods: Our study was a prospective study, which carried out in the Antenatal Clinic in the Obstetrics and Gynecology Department, Aswan University Hospital from July 2016 to July 2017. The pregnant women were collected form Aswan Governorate as part of a Gestational Diabetes care in Upper Egypt project in collaboration with World Diabetes Foundation. Our study included 1000 pregnant woman. All participants were screened for GDM at 24-28 weeks of gestation. Universal screenings for GDM were performed for the participants using oral glucose tolerance test (OGTT) according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations 2017. Results: According to IADPSG criteria, 17.5% of the screened cases had GDM, 16.8% had fasting blood glucose level 92 mg/dL, 15.5% had 1-hour OGTT 180 mg/dL and 16.7% had 153 mg/dL. It was found that the age 25 years and multiparity were significantly higher in GDM than in Non-GDM. Pregnant women living in rural areas and working women were significantly protected against GDM than those from urban areas. Both family history of diabetes and previous history of GDM represented the major risk factor in our studied group (P < 0.001 & < 0.001 respectively). 40.4 % of studied group exhibited no definite risk factors. There were significant increases in systolic B.P, diastolic B.P in GDM group versus non-GDM (p < 0.001 & p < 0.001 respectively). BMI was significantly higher in GDM than non-GDM (p = 0.024). Conclusion: GDM was highly prevalent in Aswan Governorate with a rate of 17.5%. The major risk factors of GDM were family history of DM and previous history of GDM, increase in age >25 and multiparity and obesity. Keywords: Gestational diabetes, OGTT, Prevalence, Risk factors.
INTRODUCTION AIM OF THE WORK
The rate of diabetes in Egypt have significantly
The objectives of this study were the assessment
increased exceeding international rates. The
of the prevalence of GDM among pregnant females at
International Diabetes Federation (IDF) listed Egypt
24-28 weeks gestation in Aswan Governorate, which is
among the world top 10 countries in the number of
a big governorate in south of Egypt (1.323.215 million
patients with diabetes. Gestational diabetes mellitus
population) (62.726km2). We used the International
(GDM) is a common pregnancy complication, in which
Association of the Diabetes and Pregnancy Study
spontaneous
hyperglycemia
develops
during
Groups (IADPSG) criteria to identify the possible
pregnancy. According to the most recent IDF estimates,
association of GDM with a number of risk factors in a
GDM affects approximately 14% of pregnancies
sample of the Egyptian pregnant population to increase
worldwide, representing approximately 18 million
awareness about GDM and early detection of it among
births annually(1).
pregnant women.
Risk factors of GDM include overweight/obesity,
westernized diet and micronutrient deficiencies, PATIENTS AND METHODS
advanced maternal age and family history of insulin
Our study was a prospective study carried out in the
resistance and/or diabetes. While GDM usually
Antenatal Clinic in the Obstetrics and Gynecology
resolves following delivery, it can have long-lasting
Department at Aswan University Hospital during
health consequences, including increase risk of short-
period from July 2016 to July 2017. The pregnant
and long-term complications for mother and child (2).
women were collected form Aswan as part of a
Gestational Diabetes care in Upper Egypt project in
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
701
Received: 1/10/2020
c:\work\Jor\vol824_19The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 708-713 The Effect of Tranexamic Acid in Patients with Traumatic Brain Injury Samir M Atia1, Mostafa Mahmoud Nabeeh2, Mohamed Elsaid Ahmed3, Ahmed Essam Mohamed Elsokary4
Departments of 1Vascular Surgery, 2Neurosurgery, 3Critical Care Medicine and
4Emergency Medicine, Faculty of Medicine, Mansoura University,Egypt. Corresponding author: Ahmed Essam Mohamed Elsokary, Mobile: (+20) +201112256623, E-Mail: [email protected] ABSTRACT Background: Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage
secondary to TBI is associated with a high risk of coagulopathy, which leads to increasing risk of hemorrhage growth, poor functional outcome and higher mortality rate. The hemostatic drug tranexamic acid with anti-fibrinolytic activity is usually used in patients with trauma. Because of its potential role in reducing hematoma size, which prevents secondary TBI, it has been considered a possible therapy to improve the clinical outcome in patients with TBI. Objective: To evaluate the effect of tranexamic acid on volume changes of intracranial bleeding in patients with TBI
admitted to Emergency Department at Mansoura University Emergency Hospital. Patients and methods: This is prospective interventional study randomized controlled trials carried out on 100
patients with TBI and admitted at Mansoura University Emergency Hospital; a level 1 trauma center with about 250,000 visits and 25000 trauma cases admission per year, through one year from October 2019 to October 2020. Results: The clinical outcome was better in tranexamic group as it was associated significantly with improved motor
GCS and less need for neurosurgical intervention. The secondary outcome was much better in tranexamic acid group which was associated with less hospital LOS, better GOS and less mortality rate. Conclusion: Early administration of tranexamic acid (within 3 hours of injury onset) can limit the extent of bleeding
before the hemorrhagic volume may become dangerous, while late administration can be useless. Keywords: Tranexamic Acid, Traumatic Brain Injury. INTRODUCTION
lysine binding sites on plasminogen molecules and has
Trauma is the first cause of death before 40 years
the potential to enhance the effectiveness of the
of age and is responsible for numerous definitive
patient's own hemostatic mechanisms. Consequently,
handicaps and high costs. Trauma is a time-sensitive
clot breakdown (fibrinolysis) is inhibited and excessive
condition. Especially during the first hour of trauma
or recurrent bleeding is reduced. TXA may be
management, assessment, resuscitation and definitive
commonly used in surgery to reduce blood loss (5). TXA
care are very important. Providing definitive care earlier
also has an excellent safety profile and has been shown
at trauma centers has been shown to decrease mortality
to be cost-effective. Because of the mechanistic (1).
potential for TXA to decrease secondary brain injury it
Traumatic brain injury (TBI) is a major cause of
has been considered as a possible therapy to improve
death and disability worldwide, especially in children
clinically important outcomes in patients with TBI by
and young adults and presents a major social, economic,
reducing systemic blood loss. Hypotension is an
and health problem. TBI is defined as damage to brain
established risk factor for poor outcome after TBI (6).
resulting from external mechanical force, such as rapid
The aim of the work was to evaluate the
acceleration or deceleration, impact, blast waves and
effect of tranexamic acid on volume changes of
penetration by projectile. Brain function is temporarily
intracranial bleeding in patients with TBI admitted to
or permanently impaired with structural damage (2).
Emergency Department at Mansoura University
Head injuries are among the most common types of
Emergency Hospital.
trauma encountered in emergency departments (EDs).
Traumatic brain injury (TBI) is commonly PATIENTS AND METHODS
accompanied by intracranial bleeding, which occurs in
This is prospective interventional study
25% to 45%, 3% to 12% and 0.2% of severe, moderate
(Randomized Controlled Trials (RCT)) carried out on
and mild TBI cases respectively (3). In patients with TBI,
100 patients with TBI and admitted at Mansoura
intracranial bleeding can develop or worsen after
University Emergency Hospital; a level 1 trauma center
hospital admission. Study involving repeated CT
with about 250,000 visits and 25000 trauma cases
scanning have found that intracranial bleeds can
admission per year, through one year from October
develop or expand in the 24 hours after injury (4).
2019 to October 2020. The studied patients were
Tranexamic acid (TXA) is a potent anti-
divided into 2 groups: tranexamic group (50 patients)
fibrinolytic agent that exerts its effect by blocking
who were given tranexamic acid and control group (50
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
708
Received:18 /10 /2020
c:\work\Jor\vol824_20The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 714-718
Role of Cranial Ultrasound in High-Risk Full-Term Neonates Ghada S. Abdelmotaleb, Ahmed M. Soliman*, Neveen T. Abed
Department of Pediatric, Faculty of Medicine, Benha University, Egypt *Corresponding author: Ahmed M. Soliman, Mobile: (+20) 01008139738, E-Mail: [email protected] ABSTRACT Background: Critically ill full-term infants are at risk for brain injury.The improvement of the survival of the "High-Risk Neonate" requires early detection of neurological abnormalities. Cranial ultrasonography (CUS) is the preferred tool to study the neonatal brain. Objective: This study aimed to evaluate the diagnostic role of cranial US in high-risk full-term neonates. Patients and Methods: This observational study was conducted on 60 high-risk full-term neonates randomly selected from the Neonatal Intensive Care Unit, Pediatric Department, Benha University Hospitals. Detailed history, clinical examination, appropriate investigations and cranial ultrasound were done. Results: The cranial ultrasound findings were normal in 58 cases (96.7%) and abnormal only in 2 cases (3.3%). The cranial ultrasound abnormalities found in the first case that was diagnosed as hypoxic ischemic encephalopathy and congenital malformation were hypoplasia of the cerebellar hemispheres, dilated fourth ventricle and prominent cisterna magna with Dandy walker malformation. The second case who was diagnosed as pneumonia and neonatal sepsis, cranial sonography showed cystic leukomalacia and communicating hydrocephalus. Conclusion: Although we found only 2 cases (3.3%) with abnormal CUS among the studied high-risk full-term neonates, cranial ultrasound is considered an important noninvasive method for brain imaging in neonates especially in those presented with neurological manifestations or exposed to hypoxia. It enables screening and follow up of the brain by serial imaging. Keywords: Cranial ultrasound, NICU, High-risk neonates.
INTRODUCTION PATIENTS AND METHODS
Any neonate, regardless of gestational age,
This study was conducted on 60 high-risk full-
who has a greater chance of morbidity and mortality,
term neonates randomly selected from the Neonatal
especially within the first 28 days of life, is classified
Intensive Care Unit (NICU), Pediatric Department at
as high-risk neonate. CUS plays an important role in
Benha University Hospitals, in the a period from
assessing neurological outcome among them (1). CUS
January 2019 to January 2020.
has numerous advantages: it can be performed at the
bedside, it is relatively safe, and can be repeated Ethical approval: Approval of the Research
when needed, helping visualization of ongoing brain Ethics Committee at Faculty of Medicine, Benha
maturation and the evolution of lesions. It detects University Hospital was obtained. A written
most of the hemorrhagic, ischemic, cystic brain
consent was collected from neonates' parents to
lesions,
calcifications,
major
congenital
agree to participate in the study.
abnormalities and cerebral infections (2). It is also
High-risk full-term neonates with any of the
important in the early diagnosis of numerous causes
following diagnosis were included in the study:
of neonatal seizures and encephalopathy in full-term
neonatal convulsions, birth asphyxia, hypoxic
neonates and the subsequent follow up of hypoxic-
ischemic encephalopathy (HIE), respiratory distress,
ischemic brain injury (3). CUS examination should be
neonatal sepsis or metabolic abnormalities.
performed soon after birth and further examinations
depending on clinical symptoms and previous CUS All patients were subjected to the following:
findings in critically ill full-term neonates and full-
Full perinatal history was taken. Thorough
term neonates with congenital anomalies (4).
clinical examination with special emphasis on Benson et al. (5) reported that sonography of the brain
neurological manifestations was done. Routine
is now an integral part of care in the neonate, among
investigations (CBC, CRP) and cranial ultrasound of
unstable premature and high-risk infant. Therefore,
these high-risk neonates were done. Neonates were
this study aimed to evaluate the diagnostic value of
followed up till discharge from NICU.
CUS in high-risk full-term neonates.
The sonograms were performed on a Voluson
630 pro GE machine using a multi frequency high- This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol824_21The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 719-726
Incidence of Vascular Injuries in poly-traumatized Patients Samir M Atia1, Samer Abd El Hamed Regal1, Mohamed Elsaid Ahmed2 , Mohamed Alaa El din Mansour3
Departments of 1Vascular Surgery, 2Critical Care Medicine and 3Emergency Medicine
Faculty of Medicine Mansoura University, Egypt Corresponding author: Mohamed Alaa El din Mansour, Mobile: (+20) 01011271652, E-Mail: [email protected] ABSTRACT Background: Vascular injury resulting from trauma is a leading cause of morbidity and mortality worldwide. Exsanguination is perhaps the most important cause of potentially preventable death after injury. The resulting ischemic tissue damage leads to high rates of amputation in a characteristically young and active population. Objective: To determine the incidence of vascular injuries, modes and mechanisms of trauma and their relations with regional vascular injury distribution and the outcome of vascular injuries in polytrauma patients. Patients and methods: This is a prospective observational analytical (cohort) study that included 520 patients who were presented by multiple causes of trauma to Mansoura University Emergency Hospital, Mansoura, Egypt. A level 1-trauma center with about 250,000 visits and 25000 trauma cases admission per year. This study was conducted over the period of 1 year from January 2019 to December 2019. Results: According to abbreviated injury scale (AIS) 3, patients with vascular injuries had considerable more severe injuries than other patients. The most common regions with vascular injuries were peripheral vascular injuries in 95.8% [52.6% in lower limb and 43.2% in upper limb], followed by central vascular injuries in 4.2% [1.6% in neck, 1.6% in thorax and 1 % in abdomen]. Blunt trauma was considerably more common than penetrating trauma in both groups. Moreover, blunt trauma was more common in all regional vascular injuries (66.7% of neck, 75% of lower limb, and 100% of thoracic and abdominal vascular injuries) except upper limb (in 47.8%). Conclusion: The vascular trauma is associated with more injury severity AIS, injury severity score (ISS) and higher mortality rate than other polytrauma patients. Keywords: Vascular injuries, Poly-traumatized patients,
INTRODUCTION
thrill, pulse deficit" (5). In some instances, vascular
In developed countries, injury is the leading
injury may present without any hard or soft physical
cause of mortality amongst people aged 15-44 years,
examination findings and exist as an occult injury. The
and in developing countries is only exceeded by
physical examination must be augmented with Doppler
infectious disease as a cause of death (1). Motor vehicle
extremity pressure measurements to diagnose vascular
collisions (MVCs) account for the largest number of
injury (6).
traumatic deaths in civilian practice. A strong
It should be emphasized that patients with
correlation has been noted between increasing severity
vascular injuries, like all other trauma patients, should
of injury and incidence of associated vascular injury(2).
be cared for according to the principles described in the
Classically, vascular injury mechanisms are
Advanced Trauma Life Support Program. In addition,
divided into penetrating or blunt. Following blunt
the management of vascular injuries focuses on some
trauma, tissue injury is produced by local compression,
specific goals including early hemorrhage control,
rapid deceleration, and the resulting shear forces. In
minimization of distal ischemia, restoration of
penetrating trauma, the injury is produced by crushing
perfusion, and prevention of compartment syndrome (7).
and separation of tissues along the path of the
The purpose of this study was to determine the
penetrating object along with the resulting concussive
incidence of vascular injuries, modes and mechanisms
shockwave (3). Injury to a vessel can include vasospasm,
of trauma and their relations with regional vascular
which can be limb threatening when severe; intimal
injury distribution and the outcome of vascular injuries
injury including a flap, dissection, or intramural
in polytrauma patients.
hematoma; wall defect leading to pseudoaneurysm or
hemorrhage; arteriovenous fistula (AVF); or partial or PATIENTS AND METHODS
complete transaction (4).
This is a prospective observational analytical
The clinical history combined with knowledge of
(cohort) study that included 520 patients who were
the anatomical target zone and a high index of suspicion
presented by multiple causes of trauma to Mansoura
should alert the experienced trauma practitioner to
University Emergency Hospital (MUEH), Mansoura,
injury complexes most likely to have resulted in major
Egypt. This study was conducted over the period of 1
vascular injury. Clinical signs of vascular injury may be
year from January 2019 to December 2019. The patients
soft signs "history of bleeding, non-pulsatile
were classified into 2 groups according to state of
hematoma" or hard signs "pulsatile hematoma, bruit,
vascular affection: Group 1: with vascular injuries and This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol824_22 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 727-732
Methotrexate Based Regimen versus Post-Transplant Cyclophosphamide in Allogeneic Hematopoietic Stem Cell Transplantation (Clinical Outcome), Egyptian Experience Rasha I. Ibrahim1, George B. Soryal2,Haydi S. Mohamed1 1Department of Internal Medicine and Clinical Hematology, Ain Shams University, Cairo, Egypt 2Department of Clinical Hematology, El Maadi Medical Compound, Cairo, Egypt. *Corresponding author: Haydi Sayed Mohamed, Mobile: (+20)01001357036, Email: [email protected] ABSTRACT Background: Graft-versus-host disease (GVHD) is the major complication after allogeneic hematopoietic stem cell (HSCT) transplantation. GVHD prophylaxis is based on the use of calcineurin inhibitors. With the use of haploidentical HSCT, the use of cyclophosphamide increased after implantation (PT-Cy). Objectives: Compare the clinical outcome of allogeneic HSCT after PT-Cy versus methotrexate (MTX) based regimens Patients and methods: we included 137 patients from Bone Marrow Transplantation Units who received allogeneic HSCT. They were divided into 2 groups according to GVHD prophylaxis protocol: (group 1) included 102 patientsreceived (MTX) and cyclosporine (CSA) and(group 2) included 35 patients who received PT-Cy in combination with (CSA) and mycophenolate-mofetil (MMF). Results: Neutrophil engraftment in group 1 at day 12.91 ± 5.67 vs at day14.69 ± 2.57 in group 2. The mean day of platelet recovery was 14.67 ± 1.89 and 14.69 ± 5.48 in group 1 and 2 respectively. Incidence of acute (a) GVHD at day 100 was 31.4% in group 1 vs 28.6% in group 2. The use of PT-CY reduced the risk of extensive chronic (c) GVHD to 17.1% (group 2) with high statistical significance (p Value <0.001). Overall survival (OS) at 5 years was 40.2%, 53.6% in group1 and 2 respectively (p value = 0.76), while disease free survival (DFS) was (81.3% vs 71.2%, p value 0.32). Conclusion: The use of PT-Cy reduces the risk of extensive cGVHD. Keywords: GVHD, HSCT, PT-CY.
INTRODUCTION
Allogeneic HSCT is considered the main curative
Transplantation Unit who were subjected to
process for hematologic malignancy (1). GVHD is the
allogeneic HSCT from matched related and
leading cause of morbidity and mortality. Acute
haploidentical donor in first or second complete
GVHD occurs in 40% of transplants while chronic
remission (CR) according to disease state and risk
GVHD occurs in 10% up to 80% of cases. The current
stratification. Transplant was held between 2014-2019
preventive systems are striking for developing
with median follow up 60 months.
alternative regimes (2).
The use of calcineurin inhibitors in combination Ethical approval:
with other immunosuppressive (IS) drugs is the
A written informed consent was obtained from all the
standard preventative regimen for GVHD. With
study participants along with the approval of the
increasing use of matched donor in HSCT, high-dose study by the Ethics Committee Board, Faculty of
cyclophosphamide post-transplantation (PT-Cy) has medicine, Ain Shams University. The study
been used in conjunction with other IS drugs such as
conformed to the stipulations of Declaration of
prevention of GVHD and reporting a low incidence of
Helsinki 1964.
acute (a) and chronic (c) GVHD and reduced
The patients were divided into 2 groups according
transplant-related mortality (2).
to GVHD prophylaxis that they had been received:
The main impact of cyclophosphamide on T cells Group 1 (n=102) received MTX and CSA and Group
unlike other immunosuppressive agents is its ability to 2 (n=35) received PT-Cy, MMF and CSA.
induce apoptosis and increase the regulation of Fas
All patients received allogeneic transplant were
(CD95) expression, resulting in activation-induced
subjected to the following pre transplant work up,
cell death within 6 days of activation (3, 4).
which includedCBC, ABO Blood Group test, Kidney
The aim of this study was to compare the clinical
function tests, Liver function and prothrombin
outcome of allogeneic HSCT after PT-Cy versus
activity, HBV DNA by PCR, HCV RNA by PCR,
methotrexate based regimens.
CMV Antibodies (IgM and IgG), Bone marrow
aspiration and radiological investigations in form of PATIENTS AND METHODS
chest X ray, pulmonary function tests, abdominal
The study was conducted on 137 patients aged
ultrasonography and Echocardiography.
from 16-65 years old with benign and malignant
Patients were isolated in HEPA filter cube and
hematological diseases from Bone Marrow
received conditioning regimens in form of fludarabine
This article is an open access article distributed under the terms and conditions of the Creative Commons ttribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
727
Received:19 /10 /2020
c:\work\Jor\vol824_23 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 733-739
Fecal Calprotectin Level in Term and Preterm Babies before and after Starting of Feeding Mohammed Mahmoud Romih1, Eman M. M. El-hindawy1, Naglaa Ali Khalifaa2, Ahmed Mohammed Othman*1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Sharkia, Egypt *Corresponding author: Ahmed Mohammed Othman, Mobile: (+20) 01144959715, E-Mail: [email protected] ABSTRACT Background: Fecal biomarkers (FCP) may be characterized by a superior diagnostic sensitivity as they are highly organ specific. Fecal calprotectin meets the criteria of a laboratory parameter suitable for the assessment of inflammatory bowel disease. Objective: To evaluate FCP levels in both preterm and full-term infants after start feeding and its relationship with the type of feeding, birth weight, and other clinical and laboratory parameters. Patients and Methods: This study was carried out at the outpatient clinic of the Pediatric Department Zagazig University Hospitals on 88 infants during the period from October 2016 to October 2017. Results: FCP levels increased in 100% of infants involved in the study after feeding. FCP levels have a wide range of variation from 82 to 425 µg/g before feeding and from 174 to 692 µg/g after feeding. A significant negative correlation between FCP levels before and after feeding with birth weight especially in the full-term group. A higher percentage of increase was observed in breastfeeding and ranged from 64.76 to 91.31%, while formula-fed feeding ranged from 39.09 to 84.94%. Conclusion: FCP levels increased in all infants after feeding with a wide range of variations with no differences between infants born vaginally or with C-section. The FCP levels increased significantly with breastfeeding than formula-fed feeding. Keywords: Fecal Calprotectin, Term, and Preterm Babies, Feeding. INTRODUCTION
including antimicrobic and immunomodulatory
Initially called leukocyte L1, calprotectin is a 36
activity, and it is released during cell activation (active
kDa calcium and zinc-binding protein that constitutes
release) or cell death (passive release). It has been
about 60% of soluble cytosol protein in human
suggested as a useful indicator to determine the
neutrophil granulocytes, and is found in monocytes,
severity of inflammation in the intestine (6).
macrophages, and epithelial cells (1).
The most significant factors that affect fecal
Calprotectin is a member of the S100 family of
calprotectin (FCP) excretion include ante- and
calcium and zinc-binding proteins; it is the
perinatal antibiotic treatment, the volume of enteral
heterodimer of S100 A8/A9. It is found in neutrophils,
feeding, the occurrence of unplanned interruptions of
monocytes, and some squamous epithelium cells. The
enteral feeding, and the gastrointestinal bacterial
complex accounts for up to 60% of the soluble protein
colonization (1).
content of the neutrophil cytoplasm. It is released by
High fecal calprotectin (f-calprotectin) levels
activation of leucocytes as a consequence of
were shown to correlate with an increased turnover of
inflammatory diseases (2). S100 A8 is also called
leukocytes in the intestinal barrier and granulocyte
calgranulin A and myeloid-related protein 8 (MRP8),
migration towards the intestinal lumen. Hence, f-
and S100A9 is called calgranulin B (MRP14). They
calprotectin has been proposed as a non-invasive
both are linked to the innate immune system (3).
marker of intestinal inflammation in inflammatory
Fecal calprotectin levels ranged from 3.9 µg/g to
bowel disease in adults and children (7). Another review
971.8 µg/g, and there was a significant increase in fecal
points to the relevance and limitations of calprotectin
calprotectin in the study group when compared to the
determination in these clinical settings (8).
control group (334.3 ± 236.6 µg/g vs. 42.0 ± 38.2 µg/g,
Despite these high levels, the putative use of
respectively) with a moderate inverse significant
fecal calprotectin as a marker of gastrointestinal
correlation between fecal calprotectin and birth
disease, particularly necrotizing enterocolitis (NEC),
weight. Furthermore, there was a moderate, significant
has been explored in several cohorts of preterm infants.
correlation between fecal calprotectin and duration of
However, due to the high inter-and intra-individual
breastfeeding range. On the other hand, there was no
variations consistently observed by all authors, the
correlation between fecal calprotectin and post-natal
determination of a cutoff value for f-calprotectin has
age, gestational age, or volume of feeding. A cut-off at
remained an elusive goal, as cut-off values ranging
the 67.0 µg/g level, with 100% sensitivity and 76.9%
from 200 to 2000 µg/g have been proposed (9).
specificity, was considered (4).
Earlier studies suggest f-calprotectin is higher in
Calprotectin has bacteriostatic and fungistatic
infants born by cesarean section, compared with
actions, as it can isolate manganese and zinc in their
vaginal delivery, and correlates positively with
cells (5); it also has several biological properties
postnatal age and volume of enteral feeds, and
This article is an open access article distributed under the terms and conditions of the Creative Commons ttribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
733
Received:18 /7 /2020
c:\work\Jor\vol824_24The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 740-745
Body Mass Index as a Prognostic Factor for the Outcome of Traumatic Proximal Femoral Fractures Hossam AM Sallam1, Samir M Attia2, Ayman MM Ali Hussein3, Hisham KH Ismael*4
Departments of 1Emergency Medicine, 2Vascular Surgery, 3Orthopedic Surgery and
4Critical Care Medicine, Faculty of Medicine, Mansoura University, Egypt *Corresponding author: Hisham KH Ismael, Mobile: (+20) 01095603422, E-Mail: [email protected]
ABSTRACT Background: Fractures of the proximal extremity of the femur are among the commonest traumatic injuries nowadays, not only because of their high incidence in the elderly population but also because of the accompanying morbidity and mortality. A well-documented report has suggested that body mass index (BMI) is a significant prognostic factor for hip fractures. Fractures of the proximal femur may be associated with low BMI, which is considered to be a risk factor. Objective: To evaluate the effect of BMI on the outcome and complications of traumatic proximal femoral fractures in patients who were treated at Mansoura University Emergency Hospital. Patient and method: This was prospective observational non-controlled clinical study was carried out on 134 patients with traumatic proximal femoral fractures selected from Mansoura University Emergency Hospital trauma patients from November 2018 to November 2019. Results: This study demonstrated that the mean duration of hospital and ICU stay were (11.18 ± 8.23) and (0.49 ± 1.26) respectively. The percentage of overall morality was (7.5), (1.5) of which occurred in the first day while the remaining cases occurred in the first month (6%). All demographic data and medical history were comparable among the studied cases except for height, weight and BMI indicating that BMI was the only different factors among cases. Incidence of postoperative complications was not affected by altered BMI. Duration of hospital and ICU admission wasn't affected by alteration in BMI but significantly affected the mortality in the first day. Conclusion: The incidence of proximal femur fracture was higher in cases with higher BMI. Keywords: BMI, Femoral Fracture, Outcome, Trauma.
INTRODUCTION
A well-documented report has suggested that body
Fractures of the proximal extremity of the femur are
mass index (BMI) is a significant prognostic factor for hip
among the commonest traumatic injuries nowadays, not
fractures. In this context, fractures of the proximal femur
only because of their high incidence in the elderly
may be associated with low BMI, which is considered to
population but also because of the accompanying
be a risk factor. Some authors have reported that the ideal
morbidity and mortality. It has been estimated that the
BMI is 2527.4 kg/m2. Lower indices than this are
incidence of hip fractures will increase dramatically over
considered to be important prognostic factors for mortality
the next 20 years. This increase will be most evident
among young and old hospitalized patients (4). It is
among individuals over the age of 85 years (1). Fractures of
suspected that obesity provides protection against
the proximal extremity of the femur involve those of the
fractures, but the mechanisms for such an association still
head, neck, trochanteric region and subtrochanteric region.
remain poorly understood (5). Varying results have been
All of them should be treated surgically, but there is no
reported concerning the effect of body mass index (BMI)
assent regarding the best surgical technique for each of
on polytrauma outcome (6).
them (2).
Although most studies focus on obesity with its
Osteoporosis, sensory deficits caused by a stroke,
associated preexisting medical diseases as a predictor for
dementia, muscular hypotrophy, decreased visual acuity,
increased mortality rates, there is evidence that polytrauma
altered balance and reflexes, muscle weakness,
patients with underweight also face an inferior outcome.
neurological disorders, cardiovascular disorders, and
BMI is an anthropometric index of weight-for-height and
osteomioarticular deformities are predisposing conditions
is defined as the weight in kilograms divided by the square
to falls and, consequently, fractures. Regarding mortality
of the height in meters (kg/m2) (7). Despite some
due to hip fracture, other preoperative factors, identified at
contradictory results, 3 population studies have
the patient's admission, are associated with an increase in
demonstrated U-shaped curves relating BMI to mortality,
study index, namely: being non-white, age, the presence of
suggesting increased mortality at both extremes of body
dementia, male gender, clinical comorbidities, and
weight (8).
delirium (3).
The aim of this study was to evaluate the effect of
BMI on the outcome and complications of traumatic This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol824_25The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 746-754
Biliary Leak After Laparoscopic Cholecystectomy; Incidence and Management Mohammed Maher Mohammed El-Kabeer*, Ahmed Elsaied Abd EL-Rahman, Ahmed M Hassan
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assiut, Egypt *Corresponding author: Mohammed Maher Mohammed El-Kabeer, Mobile: 0201116412599, E-mail:[email protected] ABSTRACT Background: Biliary leak represent an unusual complication of laparoscopic cholecystectomy (LC). The origin of the biliary leak is multifactorial, which may arise from GB bed, cystic, or injuries of a major bile duct. Even with standardization and growing experience, LC still duct, involves the threat of damage of the biliary tree. Patients and Methods: This retrospective study was achieved at the department of general surgery, Al-Azher University, Assiut between October 2015to September 2020. The current study was a case series of 1000 cases who underwent LC. Twenty cases complaining of biliary leakage post-LC had been reported consecutively. The age of Patients was (14 - 65) years and sex was dispensed as 780 females and 220 males. Results: In the current study there were 20 cases out of the 1000 patients that underwent LC complained from biliary leakage, 14 patients of the twenty patients were presented with bile leakage post LC which were attributed to gallbladder Bed, Duct of Luschka, and minor accessory duct, two case due to insecure or slipped ligature of the cystic duct, and a slipped clip and 2cases due to injury to CHD and other two cases due to direct injury to CBD. The definitive treatment of biliary leakage was done. All cases were treated therefore with the use of endoscopy in 4 cases (plus percutaneous techniques in 3 patients) and surgical intervention in 1 patient and one patient died. Conclusion: The endoscopic management proved very effective in cases with simple biliary leakage than patients with complex bile leaks. Keywords: Laparoscopic cholecystectomy; bile duct; Bile leak; Percutaneous.
INTRODUCTION
with blockage of the distal part of the duct from
Laparoscopy comes to be the preferred
residual stone or stricture(9).
technique for the treatment of symptomatic
A minor biliary leak can disappear spontaneously
cholelithiasis and an increasingly more approach
whilst a major leak can result in drastic effects on the
performed for acute cholecystitis(1). Despite the
patient(10). So that the cases presented with internal or
brilliant effect of LC for the treatment of
external bile leak leading to localized or generalized
cholelithiasis, however, surgeons retain to stand
biliary peritonitis(11).
challenges in the utility of LC in surgery(2). Nowadays
About 10% - 24% of bile duct injuries are identified
Laparoscopic cholecystectomy may be a straight
during surgery whist the remaining injuries are
forward surgical procedure, however can also be a
recognized after surgery or after discharge(12). Early
surgical procedure fraught with underlying
treatment in a specialized center is the cornerstone for
complexities. The anatomical variations and the
pleasant outcomes. Improper treatment commonly
severity of underlying pathology make Laparoscopic
leads to critical co-morbidities and repair becomes
cholecystectomy difficult in different situations. Many
more difficult(13).
surgeons continue to be tremendously inexperienced
Surgical intervention is associated with highly
in laparoscopy in regards to the technical nuances that
satisfactory results, however, it is related to severe co-
permit for success and secure completion of a difficult
morbidities and associated with a higher mortality
LC(3).
rate(14). Preoperatively the treatment plan includes
LC remains a secure approach with a mortality rate of
simple drainage and rapid transfer up to Bilio-enteric
0.22-0.4 %(4). Major morbidity takes place in about 5%
anastomosis(15). The minimal invasive endoscopy with
of cases(5). The most dreaded complication of LC is
evidenced outcomes identical to surgical results has
biliary injury and leakage. Biliary leakage is an
become the management of choice(16). In comparison
infrequent disorder but critical. The causes of biliary
to surgical procedures, endoscopy can also
leakage may be due to traumatic causes or most
additionally need multiple sessions and its efficacy is
commonly iatrogenic(6). The tremendous causes occur
not satisfactory in all patients(17). The quality of
following hepatobiliary surgical procedures and the
treatment surgery versus endoscopy of biliary leakage
remarkable causes always following LC or open
remains one of the essential difficulties facing
cholecystectomy(7). Bile ducts injuries takes place in
surgeons (18).
about 0.1% - 0.2% in open cholecystectomy and 0.3%
Furthermore, the prevalence of bile duct injuries
- 0.8% at LC(8). The biliary leak is commonly the end
related to LC does not appear to have diminished in more
result of direct injuries to the bile duct, unsecure or
recent surveys, suggesting that the previously observed
slipped ligature or clip of the stump of the cystic duct,
elevation is not always definitely the end result of a
or bile leak from the liver bed and commonly induced
learning curve related to the laparoscopic approach. This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol824_26 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 755-760
Prevalence of Acute Kidney Injury in Pediatric Patients with Congenital Heart Disease Following Open Heart Surgery Marwa Zakaria1, Ali Mohamed Refat2, Naglaa Ali Khalifa3, Kamal Mohammed Abd El-Hakim*1
Departments of 1Pediatrics, 2Cardiothoracic Surgery and 3Clinical Pathology, Faculty of Medicine Zagazig
University, Egypt *Corresponding Author: Kamal Mohammed Abd El-Hakim, Mobile: (+20)01141145844, Email:[email protected] ABSTRACT Background: Acute kidney injury (AKI) occurs in approximately 40% of children undergoing cardiac surgery and is a risk factor for morbidity and mortality. Such injury leads to several complications, including fluid and electrolyte disturbances. Objective: To determine prevalence of acute kidney injury in pediatric patients with congenital heart disease following open heart surgery. Patients and Methods: We conducted a case control study on 20 patients with congenital heart disease (10 males and 10 females) with mean age of 3.39 ± 1.17 years old, and a range from 1 to 5 years old. They were recruited from Pediatric Cardiothoracic Unit, Zagazig University Hospital and 20 sex and age matched healthy children worked as control group. Results: The mean age of our patients was 3.39 ± 1.17 years old with a range from 1 to 5 years. 50% were males and 50 % were females with no statistically significant difference between both groups regarding age and sex. about 1/3 of the studied group had ASD (30 %), while 1/4 of them had Fallot tetralogy (25 %), and only 15% of them had VSD, subaortic membrane and PM + VSD. The mean serum creatinine level was 0.8 ± 0.15mg/dl, with a range from 0.22 - 0.9 mg/dl. 70% of the patients had no acute kidney injury, 15% developed AKI stage 1 and 15% developed stage 2 AKI. In addition, all patients with AKI needed dialysis. Conclusion: Present study identified that high percentage of pediatric patients with congenital heart disease following open-heart surgery developed acute kidney injury. Keywords: Prevalence, AKI, Congenital heart disease, Cardiac surgery.
INTRODUCTION
iohexol, serum creatinine value. However, there is a
Congenital heart malformations are one of the
need to develop early biomarkers of acute kidney
most prevalent birth defects that accounts for one third
injury following cardiac surgery, where morbidity and
of children with birth defects. Its prevalence is about 8
mortality are increased by its presence (5).
10 cases per 1000 births. Ventral septal defect (VSD)
The study aimed to determine prevalence of acute
is the most important defect with an estimated
kidney injury in pediatric patients with congenital
prevalence rate about 40 % of the congenital heart
heart disease following open-heart surgery.
diseases (CHD). The majority of those defects are
isolated cardiac anomalies while there is still 20 % who PATIENTS AND METHODS
have more than one cardiac defect (1). Surgical A) Site of the study: This study was carried out in
correction of these CHD is the GOLD STANDERED
Pediatric Cardiothoracic Unit, Zagazig University
to avoid the serious unwanted implications of these
Hospital.
lesions on patient-associated morbidity & mortality B) Type of study: Cross sectional comparative study.
and thus improves quality of life and life expectancy C) Sample size: Assuming that the total population
to those patients (2).
size of children under open-heart surgery is 30 patients
Acute kidney injury is a common and serious
in the study period (6 months) and predictive value
complication of cardiothoracic surgery. In cardiac
positive of Cystatin C in detection of AKI is 95 %, so
surgery patients, postoperative increases of serum
the sample size is 20 patients and 20 healthy matched
creatinine of 2025% from preoperative baselines are
controls.
associated with increased morbidity and mortality (3, 4). D) Target population: Patients diagnosed with
The development of acute kidney injury is one of the
congenital heart diseases (CH D) in Pediatric
risk factors for negative hospital outcomes for patients
Department, Zagazig University Hospital (ZUH) who
who undergo cardiac surgery. Intense contemporary
will undergo open heart for correction of the defect at
research has been directed toward validating other
cardiothoracic surgery department.
biomarkers to predict acute kidney injury earlier than
is feasible with acute changes in serum creatinine. The Inclusion Criteria:
best global index for renal function is GFR, which can · Age > 2 years and <18 years old
be estimated using inulin clearance, (51Cr-EDTA), This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol824_27The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 761-766
Nalbuphine Vs Midazolam for Prevention of Shivering in Patients Undergoing Lower Limb Surgery under Spinal Anesthesia; Prospective, Randomized and Double Blinded Controlled Study Mohamed Abdel Raheem Mohamed, Hitham Mohammed Ali, Fawzy Abbas Badawy
Department of Anesthesia and Intensive Care, Faculty of Medicine, Sohag University, Sohag, Egypt *Corresponding author: Fawzy Abbas Badawy, Mobile: (+20) 01004862474, E-Mail: [email protected]
ABSTRACT Background: Shivering is an involuntary, repetitive contractions of skeletal muscles, which commonly occurred after spinal block and it is an uncomfortable problem to the patients and the anesthetists. Shivering is considered as a complication of anesthesia. Shivering has deleterious effects on the cardiac function especially in patients who have limited cardiopulmonary reserve and coronary disease, which could be explained by increased oxygen consumption, production of carbon dioxide and lactic acidosis caused by shivering. Objective: Our study was aiming at evaluating the effect of intrathecal nalbuphine versus intrathecal midazolam in the prevention of shivering during subarachnoid block. Patients and Methods: Ninety patients (ASA physical status I or II) scheduled for lower limb surgeries under spinal anesthesia were randomly allocated into three groups using sealed envelopes technique; Control group receiving mixture of bupivacaine and saline, Nalbuphine (N) group receiving nalbuphine and bupivacaine, and Midazolam group receiving midazolam and bupivacaine. Upon arrival to the operation room basic monitoring was applied and lactated ringer solution at room temperature was infused through peripheral venous catheter. Results: Shivering occurred in 20 patients (66.7%) in control group, 7 patients in nalbuphine group (23.3%), and 10 in midazolam group (33.3%). The incidence of shivering and core temperature differed significantly between group N and the other two groups (P values in saline and midazolam groups > 0.05, while that of nalbuphine < 0.05). Conclusion: Intrathecal nalbuphine is more effective than intrathecal midazolam in prevention of post-spinal shivering for patients undergoing lower limb surgery. Keywords: Nalbuphine, Midazolam, Shivering, Lower limb surgery, Spinal anesthesia.
INTRODUCTION
Unfortunately, a standard guideline for
Shivering is an unprompted, repetitive
management of shivering is deficit because the
contractions of the muscles. Hypothermia may elicit
treatment by drugs have side effects and cannot be
these contractions as a physiologic response to warm
used to all patients. We can treat shivering
the patient by enhancing heat production (1, 2). Also,
pharmacologically or non-pharmacologically or
shivering occurs without hypothermia due to:
combination of both methods. The non-
decreased sympathetic activity, suppression of the
pharmacological method is by providing heat
spinal cord reflex, release of tissue pyrogens, and
externally to the patients by the use of air warmed
suppression of adrenal gland function. Many studies
blankets, and infusion of warm intravenous fluids.
found that the incidence of shivering is high,
The American Society of Anesthesiologists (ASA)
approximately 4050% of patients in their studies
provided
guideline
recommending
forced-air (3). Hypothermia of patients in the theatre is due to
warming devices and administration of meperidine(7).
cold environment of operating rooms, effect of
Other drugs are reported to be effective in
general anesthesia on thermoregulation controlled by
treatment of shivering include clonidine, tramadol,
autonomic nervous system, and infusion of unwarmed
dexmedetomidine and ketamine. Nalbuphine is a
intravenous fluids; this allows shivering to occur(3,4).
semisynthetic opioid and has a mixed agonist
Shivering has deleterious effects on the cardiac
antagonist effect on opioid receptors. It is not only
function especially in patients who have limited
having mu-opioid receptor antagonist effects but also
cardiopulmonary reserve and coronary disease, which
proved to antagonize the kappa-opioid receptor.
could be explained by increased oxygen consumption
Analgesia produced by nalbuphine has the advantage
and production of carbon dioxide caused by shivering.
of being free of opioid receptor agonist related
Furthermore, shivering leads to increased intraocular
adverse effects. As well as, nalbuphine decreases
pressure and intracranial pressure and may stretch the
possibility and severity of the side effects related to
surgical wound leading to more pain, delayed healing
the use of -agonist drugs such as respiratory
and prolonged hospital stay (4,5). Therefore, prevention
depression, urinary retention, nausea, vomiting,
of shivering is essential to avoid these unwanted
sedation and pruritus(7-10). Therefore, the analgesic
effects (6).
effect mediated by and receptors can be achieved with a better side effects profile. This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol824_28The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 761-767
Quick Sequential Organ Failure Assessment Versus Systemic Inflammatory Response System in Early Detection of Sepsis in Emergency Department Khaled MG Embaby1, Samir M Attia2, Amr S El-Saeed3, Hisham KH Ismael4
Departments of 1Emergency Medicine, 2Vascular Surgery, 3General Surgery and 4Critical Care Medicine,
Faculty of Medicine, Mansoura University, Egypt *Corresponding author: Hisham KH Ismael, Mobile: (+20)1095603422, E-Mail: [email protected] Abstract: Background: Sepsis is a life threating medical condition where infection leads to massive inflammatory response and eventually lead to organ dysfunction. It continues to pose a significant health threat despite remarkable developments in critical care medicine and extensive study of septic patients. Early recognition and treatment of sepsis in emergency department (ED) is important to reduce mortality, hospital length of stay and morbidity. Objective: This study was aimed to validate the performance of qSOFA scoring system and SIRS criteria in early sepsis diagnosis in the Emergency Department. Patient and method: This prospective observational clinical study was carried out in Emergency Department (ED) on 100 patients with suspected infection presented and admitted at o Mansoura University Emergency Hospital from February 2019 to February 2020. Patients were divided into two groups: infection group with qSOFA ve criteria and sepsis group with qSOFA +ve group. We compare between qSOFA and SIRS scores in both groups. Results: The study demonstrated that organ dysfunction >2, 2ry to infection (according to sepsis definition by sepsis- 3 task force) was more frequently reported among qSOFA + SIRS + group, compared to qSOFA - SIR group. Moreover, both qSOFA and SIRS had comparable sensitivity (100%) in prediction of mortality within 1 week, while qSOFA demonstrated higher specificity (53.3%) in comparison with SIRS (20%). Both scores had comparable sensitivity for prediction ICU admission and of mechanical ventilation (86.67 and 88.9) whereas qSOFA demonstrated higher specificity than SIRS for ICU admission (94.29 versus 71.43) as well as mechanical ventilation (82.9 versus 63.41). Conclusion: It could be concluded that qSOFA is considered as specific not sensitive tool, while SIRS is more sensitive but not specific score for sepsis detection in emergency room. Keywords: Sepsis, SIRS, qSOFA, Infection, ICU. INTRODUCTION
They defined sepsis as life-threatening organ
Sepsis is a serious medical condition where
dysfunction caused by a dysregulated host response to
infection leads to systemic inflammation and finally
infection (3).
organ dysfunction. The estimated global incidence of
Septic shock was defined as "a subset of sepsis
hospital-treated sepsis and severe sepsis is 437 and 270,
in which particularly profound circulatory, cellular, and
respectively, per 100,000 inhabitants. The incidence of
metabolic abnormalities are associated with a greater
sepsis and severe sepsis has increased in the last few
risk of mortality than with sepsis alone." Septic shock
decades, probably due to better recognition and
was diagnosed by identifying a vasopressor requirement
increasing age. The incidence of sepsis is age-related
to maintain a mean arterial pressure (MAP) 65 mmHg
with an increased incidence in both infants (<1 year)
and serum lactate concentration >2 mmol/L despite
and the elderly (> 65 years). Mortality and long-term
adequate fluid resuscitation (4).
morbidity, especially among elderly patients with
The task force of sepsis-3 developed the more
sepsis, is high (1).
clinical, Quick Sequential Organ Failure Assessment
Since 1991, the Systemic Inflammatory
(qSOFA) screening tool which is based on respiratory
Response Syndrome (SIRS) criteria have been used to
rate, systolic blood pressure and an altered mental state,
classify sepsis. At an International Sepsis Definitions
which is an important part of the sepsis work-up in the
Conference in 2001 it was concluded that the SIRS
Emergency Department (5).
criteria were too non-specific to diagnose systemic
Most patients with sepsis are initially assessed
inflammation caused by an infection. However, due to
in the ED. Because these patients present with a wide
the high sensitivity in predicting systemic
spectrum of disease courses and mortality risks and
inflammation, the SIRS criteria were maintained (2).
early recognition and treatment of them is important to
As a result of growing criticism on the low
reduce mortality, hospital length of stay and morbidity,
specificity of the SIRS criteria, an update of the sepsis
an accurately predictive disease severity score is
definition and criteria was needed. Early 2016; an
important, not only to predict mortality, but also to
international sepsis task force published a new
distribute resources appropriately or make decisions
international consensus for the definition of sepsis.
regarding resuscitation measures (6).
This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol824_29The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 768-772
Hospital Risk Factors Affecting Mortality and Morbidity in Polytraumatized Patients and Their Outcome Mohammed AA Altantawy1, Mohammed S Sharaf2, Hesham KH Ismael*3
Departments of 1Emergency Medicine and 2Anesthesia & ICU, Faculty of Medicine (Damietta), Al-Azhar University, and 3Department of Critical Care Medicine, Faculty of Medicine, Mansoura University, Egypt *Corresponding author: Hisham KH Ismael, Mobile: (+20)1095603422, E-Mail: [email protected] ABSTRACT Background: Trauma is the leading cause of mortality among young individuals worldwide. Brain trauma and massive bleeding are the most severe complications of poly trauma. Another important complication is aspiration pneumonia that requires early detection and management. Objectives: The aim of the work was to assess the intra hospital risk factors namely aspiration pneumonia and hypovolemic shock that affecting mortality and morbidity in polytraumatized patients and their outcome as regards hospital mortality and length of stay. Patient and Method: This study was conducted on 56 polytrauma patients attending at Al-Azhar University Emergency Hospital, Damietta from November 2018 to October 2019. They were divided into two groups: patients with hypovolemic shock group and patients with aspiration pneumonia group. Furthermore, they were divided into survivors and non survivors groups. All patients subjected to resuscitation and stabilization, history taking, examination and laboratory and radiological investigations. Results: Hypovolemic shock and aspiration pneumonia showed statistically significant differences between both groups as regards mode of admission and duration till hospital arrival with a higher percentage of patients admitted after ER resuscitation or arriving early to hospital developing hypovolemic shock. While as, those patients admitted directly to ICU or arriving late to hospital developing aspiration pneumonia. The mortality rate in this study was 23.2% among poly trauma patients. Comparison between survivors and non-survivors revealed that older age had higher incidence of mortality in poly trauma patients. Conclusion: It could be concluded that aspiration pneumonia and hypovolemic shock were good predictors for morbidity and mortality in polytrauma. Keywords: Polytrauma, Hypovolemia, Aspiration pneumonia, Mortality, Morbidity. INTRODUCTION
complications is detrimental to the patient's clinical
Trauma injury is the leading cause of mortality
condition and contributes to an increase in the
and hospitalization worldwide and the leading cause of
consumption of resources, length of stay, hospital
potential years of productive life lost. Severe trauma is
costs, repeat surgery, medical treatment, development
a major global public health issue, contributing to
of legal issues, and costs. Apart from mortality, in-
about 1 in 10 mortalities and resulting in the annual
hospital complications are among the most frequently
worldwide death of more than 5.8 million people (1).
measured and reported outcomes used as an indicator
Before arrival at the hospital, the availability of
of quality, and their continuous evaluation can identify
advanced life support does not greatly improve the
possible flaws in the process of care (5).
outcome for major trauma when compared to the
Several studies have investigated the causes of
administration of basic life support (2).
death in trauma patients. Baker et al found that brain
Hospitals with designated trauma centers have
injury accounted for a majority of deaths, at 50%.
improved outcomes when compared to hospitals
Heart or aortic injury (17%), hemorrhage (12%), sepsis
without them, and outcomes may improve when
(10%), lung injury (6%), burn (3%), and liver injury
persons who have experienced trauma are transferred
(2%) accounted for the remainder. The majority of
directly to a trauma center (3). Management of
patients with major cardiac, vascular, or liver injury
intrahospital polytraumatized patients often requires
died of hemorrhage. Shackford and colleagues also
the help of many healthcare specialists including
found that head injury was the most common cause of
physicians, nurses, respiratory therapists, and social
death, and when combined with spinal cord injury,
workers. Cooperation allows many actions to be
neurologic injuries were responsible for 49% of deaths
completed at once. Generally the first step of managing (1).
trauma is to perform a primary survey that evaluates a
The aim of this study was to assess the intra hospital
person's airway, breathing, circulation, and neurologic
risk factors namely aspiration pneumonia and
status (4).
hypovolemic (hemorrhagic) shock that affecting
In-hospital complications that arise during the
mortality and morbidity in polytraumatized patients
treatment of traumatic injuries are important causes of
and their outcome as regards hospital mortality and
morbidity and mortality. The occurrence of in-hospital
length of stay.
This article is an open access article distributed under the terms and conditions of the Creative Commons ttribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
768
Received:19 /10 /2020
c:\work\Jor\vol824_30The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (4), Page 773-777
Endovaginal Ultrasound versus Hysterosalpingography in Evaluation of Cesarean Scar Mohamed E Anter*, Mohamed S. Gad, Emily M. Fahmy, Alla Aldeen A. Al Halaby
Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt *Corresponding Author: Mohamed Elsibai Anter, Mobile: 01009737067, E-Mail: [email protected] ABSTRACT Background: Cesarean section (CS) is one of the most common surgical procedures in women. A recent study documented that Egypt ranked 3rd among world countries with an estimated rate of CS of 51.8%. Objective: We aimed to evaluate uterine scar after cesarean section (CS) by transvaginal ultrasound (TVS) versus hysterosalpingogram (HSG). Patientandmethods: This cross-sectional study was conducted on 38 patients after obtaining their approval to evaluate CS scar 3 months after delivery using TVS compared to HSG. The study was conducted in Obstetrics and Gynecology Department, Menoufia University in the period between January 2019 and January 2020. Results: Uterine scar defect was identified in 21 cases by HSG (55.3%), while TVS was able to identify it in only 13 cases (34.2%). Compared to HSG, transvaginal ultrasound had sensitivity and specificity of 61.9 and 100% respectively in detecting scar defects, with an accuracy of 78.94%, Conclusion: Along with increased radiological expertise expected with time, TVS will be more comparable to HSG and appears to be a promising tool in evaluation cesarean scar defect as it has significant agreement with HSG. Keywords: Cesarean Section, Cross-Sectional Studies, Hysterosalpingography, Ultrasonography.
INTRODUCTION
Cesarean scar defect (CSD) indicates the
our knowledge, there is a dearth of studies comparing
presence of a hypoechoic region within the
TVS to HSG in uterine scar defects. However, the
myometrium in the isthmus (the lower part of the
existing literature is rich in reports assessing the role
uterus) with the myometrium stopping at the site of
of ultrasound in evaluating the lower part of the
the previous CS scar (1). Patients who had a previous
uterus and its scars (7).
caesarean section should be evaluated for CSD. The
The aim of the current study was to evaluate
best time is after the patient's menstrual cycle, when
TVS versus HSG in the evaluation of uterine scar
the endometrium is at its thinnest and the menstrual
after cesarean section.
blood has recently collected in the defect (this can
highlight imaging) (2). PATIENT AND METHOD
There are several imaging techniques to detect
This cross-sectional study was conducted in
the CSD but there is no universal consensus about
Obstetrics and Gynecology Department Menoufia
which is the gold standard. Moreover, there are no
University in the period from January 2019 to
standardized diagnostic criteria. TVS or saline-
January 2020. The study included 38 participants (all
infusion sonohysterogram serves as a first-line test
were selected from patients attending the
for in-office diagnosis. MRI, 3D US and
departmental outpatient clinic according to sample
hysteroscopy are additional useful imaging
size calculation).
modalities that can aid in the diagnosis (3). HSG is the
radiographic evaluation of the uterus and fallopian Ethical approval:
tubes and is used predominantly in the evaluation of Our study received the approval of the local
infertility. Ultrasonography is currently used for Ethical Committee of Faculty of Medicine,
evaluation of the endometrium and pregnancy, Menoufia University. A written informed consent
whereas MRI is used more in the evaluation of the
was obtained from all participants before starting the
uterine myometrium and the ovaries. In our practice,
procedure after explanations the steps and the
the number of HSG examinations has increased
potential complications of each diagnostic modality.
dramatically over the past few years (4).
Study group was selected regarding the appropriate
TVS is a first level and widely used imaging
inclusion and exclusion criteria. Inclusion criteria:
technique. CSD is described as an anechoic,
age between 20 40 years, with regular menstrual
triangular shape defect with apex pointing anteriorly,
cycles and had previous one cesarean section within
located at the anterior uterine wall (5). Evaluation of
a year. Exclusion criteria: patients with uterine
the CS scar is performed to choose the technique of
pathology observed during TVS examination as
future delivery and prevention of uterine rupture and
endometrial polyp or submucous fibroid and patients
in cases of abnormal bleeding after delivery (6). To
with more than one previous cesarean section.
This article is an open access article distributed under the terms and conditions of the Creative Commons ttribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
773
Received:21 /10 /2020