c:\work\Jor\vol852_1The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3491-3497
Screening of Dyslipidemia and Obesity among Children in Zagazig University Hospitals Amira El-Sayed Ali*1, Ehab Abd El-Hamid Abd El-Salam1, Mohamed Ahmed Arafa1, Noha Abd El-Halim Mohamed2
Departments of 1Pediatrics and 2Medical Biochemistry, Faculty of Medicine, Zagazig University, Egypt. *Corresponding Author: Amira El-Sayed Ali, Email: [email protected] ABSTRACT Background: Westerners are well aware of plasma lipid problems, which are becoming increasingly important in the Middle East. The European Expert Panel has advocated universal screening as a preferable approach of hypercholesterolemia screening as a part of the primary preventive effort. Objective: To assess the relation between dyslipidemia and its risk factors; age and body mass index. Patients and Methods: A cross-sectional study that included 357 of children who visited the Pediatrics General Outpatient Clinic at Zagazig University Hospitals. All subjects were subjected to full history taking, general examination, anthropometric measurements, blood pressure, and laboratory investigations including: non-fasting and fasting lipid profiles. Results: Non-fasting total cholesterol (TC) of 200 was (14.3%) and < 200 was (85.7%). Non-fasting (LDL) of 130 was (16.8%) and <130 was (83.2%). HDL category of < 40 was (61.3%) and 40 was (38.7%). There was no statistically significant difference between age, sex and lipid profiles. There was statistically significant positive correlation between non-fasting triglycerides (TG) and non-fasting HDL and non-fasting non-HDL-C. Conclusion: Obesity was associated with the prevalence of at least one abnormal lipid level. This highlights the importance of paying greater attention to the prevention of cardiovascular disease and obesity in children from an early age. Keywords: Dyslipidemia, Obesity, Children.
INTRODUCTION
increased BMI may not always reflect an increase in
Unhealthy levels of either lipids (cholesterol
body fat (5).
and/or fatty acids) or lipoproteins in the blood are known
The risk of developing atherosclerosis and
as dyslipidemia (1). Increased triglycerides (TG) and low
cardiovascular disease in early adulthood is up to 100
high density lipoprotein cholesterol (HDL-C) both reflect
times greater in those with familial hypercholesterolemia
dyslipidemia. Besides, disturbance in lipid metabolism,
(FH) who do not receive treatment. In order to prevent
as do high total cholesterol (TC), high low density
hypercholesterolemia from causing other health
lipoprotein cholesterol (LDL-C), high non-HDL-C, and
problems, the National Heart Lung and Blood Institute,
raised LDL-C (2). It is a well-known Western medical
the National Lipid Association Expert Panel, and the
issue that plasma lipid problems are also becoming
European Expert Panel recommended universal
increasingly important in the Middle East. Lack of
screening as the best strategy for doing so (6).
clinical investigations and inconsistent definitions and
We aimed at this study to assess the relation
criteria employed by those studies limit estimates. yet the
between dyslipidemia and its risk factors; age and body
prevalence of plasma lipid abnormalities is high there
mass index.
despite this (3).
Atherogenesis, the pathophysiology of most SUBJECTS AND METHODS
cardiovascular disorders such as coronary, peripheral
A cross-sectional study that was conducted on 357
cerebrovascular and vascular diseases, has been linked to
children who visited the Pediatrics General Outpatient
high plasma lipid concentrations in particular cholesterol
Clinic at Zagazig University Hospitals.
(2). In children and adolescents, the onset of Ethical approval:
atherosclerosis can proceed slowly and gradually All Parents of participants signed informed consent
throughout life. One of the most effective ways to avoid forms for participation in the study. The study was
atherosclerosis is to detect dyslipidemia early (4). approved by Zagazig University's Research Ethics
Reduced mortality from cardiovascular disease can be Committee (ZU-IRB#6195/12-8-2020). We followed
achieved by managing hypercholesterolemia and other the World Medical Association's Ethical Code for
risk factors (2). human experimentation (Helsinki Declaration).
Many studies show that obesity is a significant risk
factor for the development of dyslipidemia in children. In Inclusion criteria: Children visiting the Pediatrics
order to assess a person's nutritional state and the
General Outpatient Clinic, Zagazig University Hospitals,
likelihood of developing cardiometabolic illnesses, such
and aged from 2 to 11 years old.
as dyslipidemia, the body mass index (BMI) is often
utilized (4). However, BMI is unable to distinguish Exclusion criteria: Children whose parents unwilling to
between fat and lean mass by definition. As a result, an
participate, post-surgical patients, patients with
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/)
3491
Received: 17/8/2021
Accepted: 27/9/2021
c:\work\Jor\vol852_2The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3498-3502
Role of Creatine Kinase MB in Diagnosis of Myocardial Injury after Neonatal Hypoxia-Ischemia Heba AbouZied*1 , Naglaa Ali Khalifa2, Miftah Heeblu Loudeeni1, Sahar Abdel-Raouf El-Shaarawy1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Heba AbouZied, Mobile: (+20)1017001301, Email:[email protected] ABSTRACT Background: Creatine kinase MB (CK-MB), which exists mainly in the cytoplasm of myocardial cells, is currently accepted as an indicator and has high sensitivity and specificity for the diagnosis of myocardial injury. Objective: This study was aimed to estimate serum creatine kinase MB (CK-MB) levels after asphyxia-induced myocardial injury in neonates. Patients and methods: 40 neonates were included in this study and divided into 20 cases with the diagnosis of perinatal hypoxia ischemia and 20 controls admitted to Neonatology Unit of Pediatric Department at Zagazig University. Serum CK-MB levels were estimated in all studied neonates. Results: In the present study serum CK-MB levels in cases were significantly higher than controls. A significant area under curve with cutoff >14.5 (units /L) with sensitivity 99%and specificity 97.5% for CK-MB. Encephalopathy cases were significantly associated with higher HR and CKMB. Cases with organ failure were significantly associated with higher HR and CKMB. Cases with metabolic acidosis were significantly associated with higher HR and CKMB. Conclusion: It could be concluded that cases with hypoxic ischemic encephalopathy (HIE) and those with multiple organ failure had a more pronounced elevation of serum CK-MB compared with cases of hypoxia-ischemia with no organ failure. Similarly, patients with HIE had significant elevation of cardiac enzymes. Collectively, these findings indicate more myocardial systolic dysfunction and damage in neonates with HIE and organ failure. Keywords: Neonatal Hypoxia-Ischemia,Myocardial Injury, Creatine kinase -MB. INTRODUCTION
Hypoxic ischemic encephalopathy (HIE) is the
less than 5; need for delivery room intubation or CPR;
most important reason for morbidity and mortality of
umbilical cord arterial pH less than 7.00; and abnormal
newborns in all over the world although antenatal and
neurological signs, such as hypotonic muscles or lack of
neonatal cares have been improved in recent years.
sucking reflex (5).
Neonatal HIE is not a rare condition, and its incidence
Creatine kinase-muscle-brain isoenzyme (CK-
is between 1 and 8 per 1000 live births in developed
MB) is one of the three isoenzymes of creatine Kinase
countries with rates as high as 26 per 1000 live births in
and is expressed in myocardial muscle and in very small
the developing world (1).
amounts in skeletal muscle. There is some evidence that
Amongst those who survive the initial injury,
CK-MB levels are significantly elevated in asphyxiated
rates of disability remain high throughout life. Of
infants compared with controls. Levels of CKMB in
patients surviving neonatal HI, 510% of infants
asphyxiated infants rose to a significant peak at 12 h of
demonstrate persistent motor deficits, and 20 50%
life before returning to a low level at 48 h of life (6).
display sensory or cognitive abnormalities that persist
Other studies found that CK-MB was not helpful
to adolescence (2).
in predicting myocardial injury in a group of infants
A meta-analysis of seven studies including 386
with neonatal hypoxic ischemia, and levels of CK-MB
infant patients investigated the average incidence of
do not help distinguish between asphyxiated newborns
mortality and morbidity: 5.9% of all patients across all
and normal infants. Therefore, CK-MB may not be
studies died, 16.3% suffered neonatal seizures, and
helpful in identifying infants with neonatal hypoxic
17.2% experienced neurological deficits, with 14.2%
ischemia who have cardiovascular compromise but may
qualifying for a diagnosis of cerebral palsy (3). Because
be more useful as part of a predictive model for poor
of these high rates of morbidities caused by HIE,
outcome following neonatal hypoxic ischemia (7, 8).
development of new treatment strategies has come into
The current study was aimed to estimate serum
consideration. HI can develop acutely or chronically
creatine kinase MB (CK-MB) levels after asphyxia-
during the prenatal (hypotension, severe hypoxia, or
induced myocardial injury in neonates.
infection), perinatal (cord occlusion or prolapse,
abruption or placental insufficiency, uterine rupture), or PATIENTS AND METHODS
postnatal periods (shock, respiratory, or cardiac arrest)
This study included a total of forty neonates divided (4).
into 20 cases diagnosed as perinatal hypoxia ischemia
The diagnostic criteria for neonatal HI are based
and 20 controls, attending at Neonatology Unit,
on a set of markers demonstrated to correlate with
Departments of Pediatric, Faculty of Medicine, Zagazig
clinical outcome. These include: 5-min Apgar score of
University Hospitals.
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/)
3498
Received: 20 /6 /2021
Accepted: 16 /8 /2021
c:\work\Jor\vol852_3The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3503-3508
Assessment of 25 (OH) Vitamin D in Neonates with Hypoxic Ischemic Encephalopathy Mohammed Elsayed Hamed 1, Dina Gamal Abd Elhamed 2, Ansam Mohamed Alshtewi 1*, Nahed Mahmoud Khater 1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding authors: Ansam Mohamed Alshtewi, Mobile: (+20)01095325445, Email: [email protected] ABSTRACT Background: Vitamin D is a hormone that affects a wide range of functions within the body. Neonatal hypoxic ischemic encephalopathy (HIE) is a serious disease that may lead to permanent brain injury. Objective: The present study aimed to study vitamin D status in hypoxic ischemic in encephalopathy. Patients and methods: A case control study carried out in newborn intensive care unit (NICU) of Zagazig University Children Hospitals. Total number of cases that met the inclusion and exclusion criteria was 49 full term neonates with HIE divided according to Sarnat stages: stage I; 20 full term neonates, stage II; 15 full term neonates and stage III; 14 full term neonates. Cases were compared to 16 healthy controls. Results: There was a statistical significant increase in Apgar score 1, 5, 10 in control group compared to all cases groups. There were no statistical significant differences between the studied groups in relation to CBC results. There was a statistical significant difference between the different stages of HIE in CRP and pH.There was a statistical significant increase in frequency of hypoxic change in stage III compared to stage II and I. All stages of HIE showed statistical significant increase in frequency of vitamin D deficiency compared to control group. Stage III had statistical significant increase in frequency of vitamin D deficiency compared to stage I and II. Conclusion: Serum 25(OH) vitamin D insufficiency is present in the majority of term HIE neonates. 25 (OH) vitamin D was significantly deficient in stage III more than stage I and II. Keywords: CBC, CRP, HIE, Neonates, Serum 25(OH).
INTRODUCTION
vitamin D status and immunomodulatory function in
Hypoxic ischemic encephalopathy (HIE) is a
neonatal hypoxic-ischemic encephalopathy (HIE) (5).
potentially devastating neonatal brain injury with long-
The current study aimed to seek for reducing risk of HIE
term neurologic effects that affect between 1 and
in neonate.
8/1,000 live birth with the highest rates in developing
countries. Hypoxic-ischemic encephalopathy (HIE) is PATIENT AND METHODS
an important cause of acquired neonatal brain injury in
This study was case control study carried out in
term newborn infants and it may lead to neonatal death
NICU unit of Zagazig University Children Hospitals.
and long-term disability (1).
Total number of cases that met the inclusion and
Vitamin D is an important neuro-steroid during
exclusion criteria was 49 full term neonates with HIE
development and after CNS injury. Deficiency of
divided according to Sarnat stages: stage I; 20 full term
vitamin D contributes to many diseases that involve
neonates, stage II; 15 full term neonates and stage III; 14
systemic or CNS inflammation, and vitamin D deficient
full term neonates and cases were compared to 16
adults have worse outcomes after stroke (2). The
healthy controls.
significance of vitamin D as an immune-modulator and
regulator of pro-inflammatory Th17 lymphocytes has Inclusion criteria for studied cases:
been well established in adult stroke. Adult patients
Full term neonate's 37weeks of gestation of any
have demonstrated an increased proportion of Th17
mode of delivery. Both gender who were born with
lymphocytes within 24 hours and one week after stroke
perinatal asphyxia or asphyxia required resuscitation as (3).
follow: fetal distress, passage of meconium, metabolic
Circulating concentrations of prohormone
acidosis, and failure to establish spontaneous respiration,
25(OH)D are important for the maintenance of CNS
depression of Apgar scores, hypoxic ischemic
concentrations of active 1,25(OH)2 vitamin D
encephalopathy and multiorgan involvement. Neonatal
(1,25(OH)2D), which is synthesized in many extra-
neurologic sequelae (e.g. seizures, hypotonia, coma).
renal cells, including neuronal and glial cells that
contain 1--hydroxylase. Thus, serum concentrations of Inclusion criteria for control group: Full term 37
25(OH)D may be crucial for vitamin D's
weeks of gestation neonate who did not require
neuroprotective and immune functions after HI injury,
resuscitation, Apgar score on the first and the fifth
in addition to endocrine roles in calcium and
minutes of life >8 and no neonatal disease.
phosphorus homeostasis (4).
Most vitamin D studies in neonates have focused Exclusion criteria: Premature infants (gestational age
on its role in mineral metabolism. Little is known about
<37 weeks) or post term 42 weeks. Infants with
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/)
3503
Received: 18 /6 /2021
Accepted: 14 / 8/2021
c:\work\Jor\vol852_4The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3509-3513
Effect of Sildenafil Citrate on Success Rate of Ovulation Induction by Clomiphene Citrate Taha Abdel Fattah Ahmed, Ahmed Mohammed El-Husseiny, Sherif Mohammed Ali Abdel Hamid*, Ahmed Mahmoud Farag
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt *Correspondence to: Sherif Mohammed Ali Abdel Hamid, Mobile: (+20)1068288865, E-mail:[email protected] ABSTRACT Background: Disorders of ovulation are common causes of infertility, and polycystic ovary syndrome (PCOS) is by far the most frequent condition. Objetive: The aim of this work was to evaluate the effect of adding vaginal sildenafil citrate to clomophine citrate used as ovarian stimulant drug on both endometrial thickness and pregnancy rate in patient with polycystic ovary syndrome (PCO). Patients and Methods: This prospective Comparative study included a total of 58 patients with primary and secondary infertility aged between18 years to 35 years, attending at Outpatient Clinics, Obstetrics and Gynecology Department, Zagazig University Hospitals. Patients were divided into two equal groups; each were 29. 1st Group was given clomiphene, and 2nd group was given Clomophine citrate and Sildenafil. A transvaginal Scan for imaging the uterus and adnexa for any pathology and measuring the basic endometrial thickness was also done on Day 3. Results: This study shows that there was an increase in endometrial thickness in sildenafil group (13.4±1.814 mm) comparable with clomiphene citrate group only (8.52±2.081 mm) (P=0.01). The result was statistically significant with increase threshold regard for implantation with statistically significant in group B (P=0.018). Conclusions: It could be concluded that addition of sildenafil citrate to clomiphene citrate therapy for induction of ovulation in patients with PCOS resulted in significant increase of endometrial thickness and non-significant increase of pregnancy Rates. Keywords: Sildenafil, Clomiphene, Polycystic ovary syndrome.
INTRODUCTION
Clomophine citrate is the first-line treatment for
Infertility is defined as the inability to conceive
anovulation (7). It is an antiestrogen agonist Clomiphene
after one year of unprotected intercourse. The causative
citrate antagonist that interacts with hypothalamic
factors of infertility are diverse and at times
estrogen receptors. The hypothalamus interprets this
unexplained. Despite extensive diagnostic workup,
signal falsely with a rise in circulating luteinizing
etiology in 10 25% of the couples remains
hormone (LH) and follicle stimulating hormone (FSH)
unexplained (1) and this has bought implantation and (8).
endometrial receptivity into focus (2).
Although CC is easy to use and results in
One of the strongest predictors of implantation is
ovulation in most patients (57-91%), the pregnancy
endometrial thickness (ET) (3). A number of studies have
rates are disappointing (27-40%) (9). It is because of the
put forth that embryo implantation and clinical
adverse effects of CC mainly on quality of the cervical
pregnancy rates are significantly higher in patients with
mucus and the endometrial development during the
an Endometrial Thickness more than 9 mm (4).
stimulation (10).
Endometrial thickness less than 7 mm is thought to be
It has been reported that vaginal Sildenafil
less able to support implantation and pregnancy (5).
significantly reduced peripheral natural killer cell (NK-
The available option for treating thin
cell) activity and improved successful pregnancy rates
endometrium is deal up with largely empiric or
in women with histories of recurrent miscarriages.
experimental by the use of estrogens, hCG, piroxicam,
Although the mechanism of influence by Sildenafil on
Granulocyte Colony Stimulating Factor (G-CSF) and
natural killer cell activity is unclear, it seems that
Acetylsalicylic acid (3). Most of these treatments are
enhancement of uterine artery flow has an effective
based on the fact that an increase in blood flow to the
influence on the local endometrial NK-cell population
endometrium causes endometrial development and (11).
thickening. The importance of endometrial appearance
The aim of the current work was to investigate
as a predictor of outcome in patients undergoing
whether sildenafil vaginal tablet plus clomiphene
induction of ovulation is well established. However,
citrate would improve endometrial thickness, ovulation
treatment with estrogens alone does not appear to
rates and pregnancy rates compared with clomiphene
improve pregnancy rates significantly in patients with
citrate alone.
an inadequate endometrial response (6). PATIENTS AND METHODS
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/)
3509
Received: 21 /6 /2021
Accepted: 17 /8 /2021
c:\work\Jor\vol852_5The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (1), Page 3514-3518
Intraoperative Hemodynamic Changes in Dexamethasone and Magnesium Sulphate as an Adjunct to Bupivacaine for Caudal Blockade Anesthesia and Analgesia in Children Undergoing Lower Abdominal Surgeries Zeinab Ebrahim Ahmed Elhossary, Ghada Mohammed Ibrahim Abdelrazek, Abdalla Mohamed Goda, Hesham Hassan Shahadah*
Department of Anesthesia & Surgical Intensive Care, Zagazig University, Zagazig, Egypt *Corresponding author: Hesham Hassan Shahadah, E-mail: [email protected] ABSTRACT Background: It is possible to achieve caudal analgesia by administering a little amount of local anesthetic into the caudal canal. There have been good analgesic effects reported for Dexamethasone with Magnesium Sulfate. Objective: The aim of the work was to evaluate and compare between dexamethasone and magnesium sulphate regarding duration and first time of rescue analgesic requirement intraoperative and to measure intraoperative hemodynamic changes (MAP, HR, SPO2) sedation and the amount of sedative and analgesic required. Patients and Methods: Pediatric patients aged 2 to 6 years of both genders were included in this Randomized double blind clinical study. They were all scheduled for Lower Abdominal Surgeries. Before surgery, a computer-generated randomization table randomly assigned patients into two dexamethasone (D) and magnesium (M) groups, each were 20. Caudal block was administered to patients in Group D using dexamethasone 0.1mg/kg in conjunction with bupivacaine 0.25% at 2mg/kg. Group M: patients received a 0.25 percent bupivacaine/magnesium sulphate caudal block of 5mg kg. The patients were submitted to clinical evaluation, laboratory investigations and monitoring pre and intraoperative hemodynamic changes. Results: Regarding demographic data, there was no significant difference between both groups (P > 0.05). Regarding HR distribution at different times pre and intraoperatively, there was no significant difference between both groups (p value >0.05). Regarding mean arterial blood pressure (MAP) at different times pre and intraoperatively, there was no significant difference between both groups (p value >0.05). Regarding the arterial oxygen saturation at different times, there was no statistical significant difference between both groups (p value >0.05). Conclusion: The analgesic profile of bupivacaine-induced caudal blocking children undergoing lower abdominal surgery was improved with magnesium (5 mg/kg) and Dexamethasone (0.1mg/kg). Keywords: Lower Abdominal Surgeries, Caudal Blockade Anesthesia and Analgesia, Dexamethasone, Magnesium Sulphate.
INTRODUCTION
Intravenous dexamethasone (8-10mg) has been
A local anesthetic is injected into the caudal canal
shown to extend IV regional anaesthesia when used in
to create caudal analgesia. The sacral and lumbar nerve
conjunction with regional analgesia (4).
roots are thus blocked as a result. It is beneficial in the
Previous studies have indicated that intravenous
administration of analgesia following surgical
dexamethasone can improve postoperative nausea and
procedures. This method is well-liked by young
vomiting while preserving opioids in the early
patients. Continuous caudal block can be treated with
postoperative phase, between 24 and 48 hours after it is
catheter insertion (1).
administered (5).
When it comes to anesthetics, bupivacaine is
Magnesium sulphate (MgSO4) by virtue of N-
classified as a pipecoloxylidide because it comes from
methyl-d-aspartate (NMDA) receptors antagonist
the amide family. Bupivacaine is formed when a butyl
property has been evaluated as an adjuvant to local
group is attached to mepivacaine's piperidine nitrogen
anesthetics in the neuraxial blocks and peripheral nerve
atom. Chiral drugs, like bupivacaine, have an
blocks (6).
asymmetric carbon atom (2).
NMDA receptor blockage and a reduction in
A
powerful
synthetic
glucocorticoid,
catecholamine release are responsible for some of
dexamethasone has just a little amount of
magnesium's analgesic effects. Volatile anesthetics
mineralocorticoid action. It has 25-50 times the anti-
have the ability to lower their MAC (minimum alveolar
inflammatory and immunosuppressive effectiveness of
concentration) by as much as 60% in laboratory
hydrocortisone and can be up to 16 times more potent
investigations using rat models (7).
than prednisolone. A list of essential medicines for
The aim of the current work was to evaluate and
adults compiled by the World Health Organization
compare between dexamethasone and magnesium
includes this drug. This list encompasses both
sulphate regarding duration and first time of rescue
prescription and over-the-counter medications (3).
analgesic requirement intraoperative and to measure intraoperative hemodynamic changes (MAP, HR,
This article is an open access article distributed under the terms and conditions of the Creative Commons
c:\work\Jor\vol852_6The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3519-3523
Post-Thoracotomy Pain: Review Article Fawzy Abbas Badawy, Abd El-Rahman Hasan Abd El-Rahman, Salah Ahmed Mohamed, Asmaa Saad-Eldeen Farghaly Gad-Allah*, Khaled Abdelfattah Mohamed Abdelfattah
Department of Anaesthesiology, ICU and Pain Management, Faculty of medicine, Sohag University, Egypt. *Corresponding author: Asmaa Saad-Eldeen Farghaly Gad-Allah, Mobile: (+20) 01020283823, E-mail:[email protected]
ABSTRACT Background: Thoracotomy is a very painful surgical procedure that is used to get access into the pleural space, to the lungs, to the heart, to the esophagus or to get access to the thoracic aorta or anterior mediastinum. Objective: To study different modalities of treatment used for post thoracotomy pain control. Recent Findings: Inadequate post-thoracotomy analgesia enhances the postoperative stress response with deleterious effects on respiratory, cardiovascular, gastrointestinal, urinary, immune and coagulation systems. In addition to anxiety and increased risk of Post Thoracotomy Pain Syndrome (PTPS), which can interfere with normal life and may persist for years or even for life? Conclusion: Providing adequate post-thoracotomy analgesia can be challenging, as patients are often elderly or having multiple comorbidities. A multimodal approach is considered in managing post-thoracotomy pain starting with preemptive analgesia and cognitive behavioral modalities in addition to conventional multimodal systemic regimens as opioids, acetaminophen, NSAID, cyclooxygenase (COX)-2-specific inhibitors, gabapentin and pregabalin, steroids, IV lidocaine infusion, ketamine, and many regional analgesic modalities to avoid or decrease adverse effects of systemic regimens. These regional analgesic modalities include thoracic epidural blocks, thoracic paravertebral blocks, intrathecal opioid analgesia, serratus anterior plane blocks, intercostal nerve blocks, interscalene block, erector spinae block and interpleural block. Keywords: Post-thoracotomy pain, Systemic analgesic treatment, Regional analgesic modalities.
INTRODUCTION
Thoracotomy is a surgical procedure to get access
(splinting). Thus, minimizing the stretch on the incision
into the pleural space, to the lungs, to the heart, to the
during inspiration and reducing forced expiratory
esophagus or to get access to the thoracic aorta or
volume in 1st second (FEV1) [5].
anterior mediastinum. Thoracotomy is the first step in
Diaphragmatic contraction is also impaired by
thoracic
surgeries
including
pneumonectomy,
reflex mediated increase in abdominal muscles tone
lobectomy, lung segment resection, biopsies, and
during expiration that results in reduction in pulmonary
decortication or to get access for thoracic exploration in
compliance and inability to breathe deeply or to cough
major trauma [1]. Acute postoperative pain is intense,
forcefully resulting in possible hypoxemia and
universal and interfering with the recovery of respiratory
hypercarbia, retention of secretions, atelectasis or
function requiring the use of opioid analgesics. Later,
pneumonia [6]. Postoperative neuroendocrine and
chronic postoperative pain may develop that may last for
metabolic
stress
response
includes
increased
years or even for life. Moderate quality evidence was
catecholamine and catabolic hormone secretion and
concluded by a Cochrane review that regional analgesia
decreased secretion of anabolic hormones. The effects of
may decrease the risk of chronic postoperative pain
this process include increased oxygen consumption,
persisting at 3 to 18 months after thoracotomy [2].
mobilization of metabolic substrates from storage
depots, sodium and water retention and increased blood Acute post-thoracotomy pain:
glucose, free fatty acids, ketone bodies and lactate. A
Thoracotomy is a very painful incision, with
catabolic state with negative nitrogen balance occurs if
significant trauma and distraction forces involving
the process continued. There is current interest in
several muscles and fascial layers, ribs, neurovascular
inhibition of such stress response and its possible
bundles and pleura that are exaggerated with continuous
consequences by various anesthetic and analgesic
movement during patient breathing [3].
methods [7].
Severe acute post-thoracotomy pain may be due to
Stress response also causes immunological
retraction, resection, or fracture of ribs, dislocation of
changes as epinephrine and cortisol that induce
costovertebral joints, injury of intercostal nerves, and
suppression of the adaptive immune system. It also
further irritation of the pleura by chest tubes [4].
produces leukocytosis
with lymphopenia and
Inadequate post-thoracotomy analgesia has major
reticuloendothelial system depression that predispose
respiratory effects, as breathing requires stretching of the
patients to infection. Postoperative epidural analgesia
incision, which is extremely painful. Patients without
has shown valuable effects in decreasing these
adequate analgesia try to prevent stretching of the
immunological alterations [7, 8]. On cardiovascular
incision by contracting their expiratory muscles
system, sympathetic stimulation by pain causes
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c:\work\Jor\vol852_7The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3524-3529 Wound Surface Area and Colony Count of Various Modes of Phototherapy Zakaria Mowafy Emam Mowafy1, Ismail Shehata Mostafa Ibrahim2, Mohamed Bayoumi Ibrahim1, Amr Mohamed Mohamed Mokhtar Elshahawy1
1Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
2Plastic & Reconstructive Surgery, El- Mataria Teaching Hospital, Cairo University, Giza, Egypt. *Corresponding author: Amr Mohamed Mohamed Mokhtar Elshahawy, Mobile: (+20)01156621095,
E-Mail: [email protected] ABSTRACT Background: The degree of tissue damage caused by related inflammatory and immunological sequelae poses a major therapeutic treatment problem in burn wounds. Chronic wounds frequently have a significant bioburden and pathogens that are resistant to antibiotics. This review article discusses present research on phototherapy, which is believed to be useful in managing wound bioburden and promoting healing. Objective: To evaluate the wound healing efficacy of polarized light therapy (BLT) against low-level laser therapy (Ga- As laser) in order to determine which is more efficient and successful at speeding burn healing. Subject and methods: The current study enrolled thirty patients having partial thickness thermal burn on the forearm (dermal burn). They were selected from Burn Unit at Legislation Association Hospital for Burns & Oncology. They were randomly assigned into two equal groups: Group (A) that included fifteen patients who received the BLT with mean age of 28.8 ± 2.51 years old and group (B) that enrolled fifteen patients who received LLLT with mean age of 29.6 ± 2.79 years old. Both groups also received traditional physical therapy and conservative treatment for the burn site three times weekly for four weeks. Results: Group A and B showed a significant reduction in colony count and wound surface area after treatment in comparison to that before treatment (p > 0.001). In group A, the colony count and wound surface area decreased by 38.63% and 55.1% respectively, but in group B, by 15.6% and 37.92% respectively. Conclusion: Both polarized light therapy and low-level laser therapy had a therapeutic efficiency on wound healing, but BLT is more efficient and more successful in the acceleration of the burned wounds healing. Keywords: Burn, Wound healing, Colony count, Low-level laser, Polarized light therapy.
INTRODUCTION
through increased scavenger cell creation, increasing
Burns are typically described as skin wounds due
neutrophil stimulation, increasing neutrophil number
to thermal exposure (e.g., fire, hot liquids, solids, or
and phagocytosis activity (5). Low-level laser therapy
gases), electricity, radiation exposure (e.g., ultraviolet
(LLLT)
is
progressively
being
utilized to
light, ionizing radiations such as X-ray, microwaves,
minimize complications of burn because it promotes
etc.), or chemical compounds (e.g., strong acids or
tissue regeneration and wound healing, while also
bases). The main treatment objective is prevention and
reducing pain and edema via anti-inflammatory
management of infection while promoting adequate
mechanisms that
increase adenosine
triphosphate
healing and function preservation (1). Patients who have
(ATP) synthesis, decrease oxidative stress and stimulate
sustained severe burns covering a large part of their
natural biological processes (6). Additionally, numerous
body surface require rapid skilled emergency treatment
in vitro investigations have demonstrated that LLLT
to reduce death and frequently require long-term
stimulates human gingival fibroblasts proliferation and
rehabilitation and recovery to avoid disabling scars and
decreases inflammatory conditions (7).
other morbidities (2). Certain conventional therapies
The objective of the present study was to evaluate
depend on the use of topical antibiotics, mafenide
the wound healing efficacy of polarized light therapy
acetate, chlorhexidine, povidone-iodine, or silver-
(BLT) against low-level laser therapy (Ga-As laser) in
sulfadiazine (3). Recently, light therapy, such as low-
order to determine which is more efficient and
level laser therapy as a coherent source of light and
successful at speeding burn healing.
polarized polychromatic noncoherent light (Bioptron)
therapy as a polychromatic and non-coherent light PATIENTS AND METHODS
source, has been suggested as a non-aggressive
The study enrolled thirty patients who had partial
treatment choice in case of slow-to-heal or non-healing
thickness thermal burn on the forearm (dermal burn).
wounds in soft tissues, tendons, and bones, owing to
They were selected from Burn Unit, Legislation
enhanced tissue nutrition and oxygenation (4). Bioptron
Association Hospital for Burns & Oncology. They
light treatment promotes endogenous purification
ranged in age from 25 to 35 years and were randomly
through cellular debris and infectious pathogens
assigned into two equal groups:
removal
by: boosting
macrophage
stimulation, Group (A): Included 15 male patients who underwent
improving bacterial phagocytosis activity and capacity
BLT plus traditional physical therapy routine and
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ReviewThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3530-3534
Role of Cerebro-Placental Ratio in Prediction of Perinatal Outcome in Preeclamptic Patients with Intrauterine Growth Restriction Ali El-Shabrawy Ali, Walid Abdalla Mohamed, Basem Mohamed Hamed, Ruwaydah Meeloud Khalleefah Alrandi*
Obstetrics and Gynecology Department, Faculty of medicine, Zagazig University, Egypt * Corresponding author: Ruwaydah Meeloud Khalleefah Alrandi, Mobile: (+20) 01559441022, E-Mail:[email protected] ABSTRACT Background: The assessment of fetal hemodynamic status via Doppler flow is increasingly regarded as likely to aid in the detection of pregnancies at risk of developing adverse fetal outcomes. Doppler flow provides useful information beyond the ultrasound-based assessment of fetal growth alone. Objective: This study aimed to evaluate the role of cerebro-placental ratio (CPR) in prediction of perinatal outcome in preeclamptic patients with intrauterine growth restriction (IUGR). Patients and methods: This case-control study was conducted at Obstetrics and Gynecology Department, Zagazig University, on 50 pregnant women divided in to two groups: Group I (study group) that included 25 high risk pregnant women with IUGR. Group II (control group) included 25 high risk pregnant women without IUGR. The study was conducted during the period from December 2020 till July 2021. Results: The current study showed that CPR had 90.9% sensitivity, 78.6% specificity and 84 % diagnostic accuracy to predict newborns with low Apgar score, with statistically significant positive correlation. CPR also had 100% sensitivity, 100% specificity and 100 % diagnostic accuracy to predict stillbirth, with highly statistically significant positive correlation. The CPR had 100% sensitivity, 83.3% specificity and 92 % diagnostic accuracy to predict newborns with NICU admission, with statistically significant positive correlation. Other complications as meconium aspiration and neonatal death had no statistically significant to be predicted by low CPR. Conclusion: This study concluded that the Cerebro-Placental Ratio had high predictive value of perinatal out come in preeclamptic patients. Keywords: Cerebro-placental ratio, Intrauterine growth restriction, Perinatal outcome.
INTRODUCTION
The use of cerebro-placental ratio (CPR)
Intrauterine growth restriction (IUGR) is an
allows the assessment of blood flow disorders in the
indicator of the increased risk of perinatal and long-
placenta, umbilical cord, and fetal-cerebral circulation.
term mortality and morbidity when compared to those
CPR reflects fetal adaptation to placental chronic
born with normal growth. There is a considerable
hypoxia and appears to be more sensitive than the
difference in the incidence of IUGR across different
Doppler ultrasound of the umbilical and middle
populations (1). Current challenges in the clinical
cerebral artery by detecting clinically unrecognized
management of IUGR include accurate diagnosis of
fetal compromise (5).
the truly growth restricted fetus, selection of
The current study aimed to evaluate the role of
appropriate fetal surveillance, and optimizing the
cerebro-placental ratio in prediction of perinatal
timing of delivery. Despite the potential for a
outcome in preeclamptic patients with intrauterine
complicated course, antenatal detection of IUGR and
growth restriction.
its antepartum surveillance can improve outcomes (2).
Pre-eclampsia (PE) is inconsistently associated PATIENT AND METHODS
with intrauterine growth restriction, but PE and
This case-control study was conducted at
gestational hypertension causes IUGR to occur in 30-
Obstetrics and Gynecology Department, Zagazig
40% of cases. Intrauterine growth restriction can be a
University, on 50 pregnant women during the period
serious problem in newborns because it is associated
from December 2020 till July 2021.
with increased morbidity and mortality and long-term
neurological sequelae (3). Ethical approval:
Current theories show that the primary cause Written informed consent was obtained from every
of IUGR in preeclampsia is abnormal invasion of participant and the study was approved by the
placental trophoblast. If this theory is correct, we can Research Ethical Committee of Faculty of
expect that women with severe PE to have the highest Medicine, Zagazig University International review
IUGR risk. Also, according to the same theory, we board. The work has been carried out in
expected that women with mild PE would be less accordance with The Code of Ethics of the World
likely to have IUGR fetuses(4). Medical Association (Declaration of Helsinki) for studies involving humans.
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The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3535-3539
Management Of Subtrochanteric Femoral Fractures Using Proximal Femoral Nail Riad Mansour Megahed, Mohamed Abdalla M. Abdelsalam, Ahmed Mohammed Abdelwahab, Yousuf Ali Ahmed Farhat*
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Yousuf Ali Ahmed Farhat, Mobile : (+20)01559441022, Email : [email protected] ABSTRACT Background: Fractures of the proximal femur are a big challenge in traumatology. Rapid strides in implant and instrumentations in quest of ideal fixation of subtrochanteric femoral fractures have made various options available. Objective: The present study aims to study the role of standard proximal femoral nail (PFN) in the management of these fractures. This study aimed to evaluate the results of treatment of subtrochanteric femoral fractures using PFN. Patients and methods: This prospective study conducted at Orthopedic Department, Zagazig University Hospital, from November 2020 to July 2021. It included 24 patients, complaining of closed subtrochanteric fractures treated with PFN (Gamma intramedullary nail). The age ranged from 23 to 87 years (with mean 54.21 years), 13 of them were males and 11 females. Road traffic accident (RTA) represented the most common mechanism of injury in 10 patients (41.7%) while fall down represented (37.5%) in 9 patients, and fall from height in 5 patients (20.8%). Results: there was statistically significant difference in HHS among patients with different age groups, mechanism of injury and presence of diabetes mellitus (DM) as associated condition. Statistically there was significant correlation between type of reduction and diabetes mellitus with Harris hip score. Conclusion: This study concluded that the Gamma nail is an excellent choice in treatment of subtrochanteric fractures as it has many advantages as allowing for early functional exercise and full weight-bearing of the affected limb, shortening the duration of operation, high rotation stability, small wounds and minimizing blood loss along with risk of infection Keywords: Proximal femoral nail, subtrochanteric fractures, trochanteric fractures.
INTRODUCTION
subtrochanteric femoral fractures using proximal
The subtrochanteric region is usually exposed to
femoral nail.
high stresses during routine activities. Axial loading
forces through the hip joint create a large moment arm, PATIENTS AND METHODS
with significant lateral tensile stresses and medial
A prospective study conducted at Zagazig
compressive loads. In addition to the bending forces,
University Hospital, from November 2020 to August
muscle forces at the hip also create torsional effects
2021; included 24 patients, complaining of closed
that lead to significant rotational shear forces(1). High
subtrochanteric fractures treated with proximal femoral
compressive and tensile forces of muscles separate the
nail (gamma intramedullary nail). The age ranged from
fracture fragments and cause instability of the fracture.
23 to 87 years (with mean 54.21 years), 13 of them
Hence this fracture is difficult to manage and is
were males and 11 females. Road traffic accident
associated with many complications including
(RTA) represented the most common mechanism of
malunion, delayed union, non-union and implant
injury in 10 patients (41.7%) while fall down was
failure(2). Due to these anatomical features
present in 9 patients (37.5%) and fall from height in 5
conservative treatment is not preferred, and if there are
patients (20.8%).
no absolute contraindications and the patient can Inclusion criteria: Any patient after skeletal maturity
tolerate surgery, surgery is the treatment of choice.
presenting with subtrochanteric femoral fractures
The goal of operative treatment is restoration of
included in the study.
normal length, anatomical alignment and angulation to Exclusion criteria: Any patient with unstable pelvic
restore adequate tension to the abductors (3). Early
fractures and open fractures, severe medical
mobilization and weight bearing are possible with
comorbidity.
advances in implants and fixation technology. The two Preoperative assessment:
primary options for treatment of subtrochanteric History Taking: Name, age, sex, special habits,
fractures are intramedullary fixation and surface
causes and the time of injury, any previous injuries and
fixation (4).
previous surgical interventions, any medical
Primary nail is placed in the intramedullary
comorbidity and medications.
cavity, creating central fixation(5). Several advantages General examination: Blood
pressure,
pulse,
of the proximal femoral nail have been proposed, such
temperature, respiration, examination of the spine,
as its application to the femoral head and neck and
knee, pelvis and calcaneus was very important for
femoral shaft to increase stability at fracture sites and
associated injury.
to promote healing (6). The aim of the current study Local examination: Inspection: deformity, skin
was to evaluate the results of treatment of
condition and associated injuries. Palpation: skin
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MicrobialThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3540-3544
Role of Elastic Stable Intramedullary Nailing in Diaphyseal Fractures in Children Mohammed Hazem Mahmoud, Adel Mohammed Salama, Mohamed Abd El-Fatah Sebai, Eslam Ahmed Elsayed Hassan*
Orthopaedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Eslam A. Hassan, Mobile: (+2)01200089970, Email:[email protected] ABSTRACT Background: All femoral or tibial fractures regardless of associated injuries, intramedullary nailing (IMN) has its more advantages in rapid rehabilitation, good effects on the child and his family and strong fixation. Objective: To assess the role of elastic stable IMN in union of diaphyseal fractures of long bones in children. Patients and Methods: A prospective and retrospective analytical study on ten children with isolated femoral or tibial fractures who were admitted to Orthopedic Department, Zagazig University Hospitals. They were divided equally into group I that included 5 patients with femoral shaft fracture managed with IMN and group II, which included 5 patients with tibial shaft fracture managed with IMN. Their mean age was 4.7 years old. Results: When the groups compared, the spica cast group was found to have a shorter duration of hospital stay compared to elastic nail group. The knee range of motion of the spica cast group was found to be better compared to the elastic nailing group. The elastic nailing group was found to have started walking earlier both with and without support. Patients with intramedullary nailing started to walk with aid after one month and independently after 2 weeks. Patients with spica cast started to walk with aid after 2 months and independently after 12 weeks. Conclusion: None of the available treatment tools to fix diaphyseal long bones fractures in preschool children is perfect because each method has its own set of complications. However, constitute the motive for developing new techniques or changing the design of currently available devices. Keywords: Elastic stable intramedullary, Nailing, Diaphyseal fractures, Children.
INTRODUCTION
Diaphyseal long bones fractures are the most
could impart excellent axial and lateral stability to
common major pediatric injuries treated by the
diaphyseal fractures in long bones. Rotational stability
orthopedic surgeons (1, 2). The cause of these injuries
was also better than had previously been experienced,
varies with age; in preschool children the most
although this was to remain the weakest point of the
common mechanism is a fall from a height of less than
technique (9).
1 m. In children aged 412 years accidental injury
To correct angulation and to avoid plaster
during sport is the predominant cause (3).
immobilization in diaphyseal fractures in childhood,
A vast majority of diaphyseal fractures in
intramedullary nailing with flexible titanium pins is an
children heal without any long-term sequelae
easy and safe method. Under radiographic control,
irrespective of the treatment method (4). However,
fractures of femur and tibia are stabilized with two
excessive shortening and angular deformity has been
crossing pins. This method is safe in elective trauma
reported in 43 % of patients treated by an early cast (5).
surgery
and
will
especially
be useful
in
The greatest problems of immediate spica casting on
polytraumatized children in whom multiple fractures
patients and families following femoral shaft fractures
should be stabilized with minimal x-ray exposure in a
in children were transportation, cast intolerance by the
short time (10).
child, and keeping the child clean (6). With better
In this study we assessed the role of elastic
understanding of biology of fracture healing and with
stable intramedullary nailing in union of isolated
advances in fixation methods and operative techniques,
diaphyseal fractures of femur or tibia in children
there has been a general trend toward operative
compared to casts to assess the best method of
stabilization of shaft fractures in children (7). Operative
management of femoral fractures in this age.
treatment options for fractures in children include
plating, rigid intramedullary nailing, flexible PATIENTS AND METHODS
intramedullary nailing, and external fixation.
A prospective and retrospective analytical study on
Previous experience had suggested that elasticity
children with isolated femoral or tibial fractures who
and stability were not easily combined in one construct.
were admitted to Orthopedic Department. Children
However, working from the concept of three-point
aged 414 years who sustained a non-pathological
fixation used with a single Rush nail, surgeons were
femoral and tibial shaft fracture were divided equally)
able to improve stability significantly by using two pre-
as follow: Group I included 5 patients with femoral
tensioned nails inserted from opposite sides of the
shaft fracture managed with IMN. Group II included 5
bone(8). Titanium nails, which were accurately
patients with tibial shaft fracture managed with IMN.
contoured and properly inserted greatest problems
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c:\work\Jor\vol852_12The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3551-3556
Efficacy of Hyaluronic Acid Injections versus Steroid Injections on Painful Tendinopathies Marina Saif Azmy, Ibtesam K. Ali, Ahmed R. Radwan*, Mohammed Ali Ismail
Department of Physical medicine, Rheumatology and Rehabilitation - Faculty of Medicine- Sohag University, Egypt. *Corresponding author: Ahmed R. Radwan, Mobile: (+20) 1092914019, Email:[email protected] ABSTRACT Background: Tendinopathies are manifested by pain, swelling, and limited mobility functions.Corticosteroid injections have been a mainstay in the treatment of tendinopathy, and are widely used despite the controversy regarding their usefulness and safety.The peri-tendinous administration of hyaluronic acid (HA) has shown promising results in the management of tendinopathy. Objectives: The aim of the current study was to evaluate the efficacy of peri-tendinous injections of hyaluronic acid versus steroid injections on pain reduction in patients with painful tendinopathies. Patients and methods: A prospective study, including a total of 90 patients with tendinopathy who were recruited from the Rheumatology and Rehabilitation Outpatient Clinic at Sohag University Hospital. Demographic data including age, disease duration, and tendon affected were evaluated. Patients were divided into three groups, each group contained 30 patients. First group received peritendinous steroid injection, second group received peritendinous hyaluronic acid injection, and the third group received both peritendinous hyaluronic acid and steroid injections. Groups were compared using in visual analogue scale, tenderness and range of motion after one week, one month and after 3 months from injection. Results: Best improvement was seen in the group of combined hyaluronic acid and steroid; followed by the group of steroid injection alone, which showed early response better than hyaluronic acid alone. Conclusion: Local injection for tendinopathies by combined hyaluronic acid and steroid gives significantly better and more long standing effect compared to either hyaluronic acid or steroid alone. On the other hand, monotherapy showed non-significant difference between steroid and hyaluronic acid. Keywords: Tendinopathy, Steroid, Hyaluronic acid.
INTRODUCTION
Tendinopathies comprise a group of tendon
Platelet-rich plasma (PRP) is achieving growing
disorders manifested by pain, swelling, and limited
evidence regarding its usefulness in many fields of
mobility functions. Typically, pain is worse with
medicine owing to its possibilities in enhancing tissue
movement and improved by rest. The most commonly
regeneration (9).
involved tendons include those around the shoulder
The anti-inflammatory and lubrication properties of
(rotator cuff tendinitis, biceps tendinitis), elbow (tennis
HA have been drew the scientific community's interest
elbow, golfer's elbow), wrist, hip, knee (jumper's knee)
to treat tendinopathies. HA is a polysaccharide present
and ankle (Achilles tendinitis) (1). Causes may include
in the extra cellular matrix of many mature tissues.
an injury or repetitive activities such as tennis. Less
Many chronic injuries could change the concentration
common causes include infection, arthritis, gout,
of HA in the synovial fluid (10).
thyroid disease, and diabetes (2).
Experiments conducted on human macrophages
Oral and local non-steroidal anti-inflammatory
have shown its ability to interfere with the expression of
drugs (NSAIDs) appear effective in the treatment of
PGE2 and of the cyclooxygenase 2. Further
acute shoulder bursitis/tendonitis (3, 4).
mechanisms contributing to the anti-nociceptive effect
Stretching and strengthening exercise programs are
are the inhibition of arachidonic acid release from
common physiotherapeutic modalities in most
fibroblasts and the activation of opioid receptors (11).
programs planned for management of tendinopathy.
Actually, there are many studies about HA
Other modalities may include therapeutic ultrasound,
injections in the management of tendons disorders (12).
iontophoresis, deep transverse friction massage, laser
The peritendinous administration of HA has shown
therapy and hyperthermia (5).
promising results in the management of tennis elbow
Also, extracorporeal shock wave therapy (ESWT) (13), patellar tendinopathy (14), Achilles tendinopathy (15,
is a rapidly growing option, with good outcome 16), and tendons in the rotator cuff (17, 18). Although the
evidence in the treatment of calcific tendinopathy (6).
mechanisms of action in the treatment of tendinopathies
Corticosteroid injections have been a mainstay in
are not well understood, peritendinous injection of HA
the treatment of tendinopathy, and are widely used
may reduce tendon adhesion, provide mechanical
globally, despite the controversy regarding their
protection, and upregulate the vascular endothelial
usefulness and safety in these cases (7, 8).
growth factor and type IV collagen, leading to
acceleration of tendon healing (19).
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c:\work\Jor\vol852_13The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3557-3560
Methotrexate in the Treatment of Non-Melanoma Skin Cancers Manal Mohamed El-Sayed, Basma Magdy Elkholy, Maryam Abo-Abdullah Ahmed*
Departments Dermatology, Venereology and Andrology and 2 Clinical Pathology,
Faculty of Medicine, Zagazig University, Egypt. *Corresponding author: Maryam Abo-Abdullah Ahmed, Email: Sola65417@gmail .com ABSTRACT Background: There are three types of non-melanoma skin cancer (NMSC): basal (BCC), keratoacanathoma (KA), and cutaneous squamous cell carcinoma (cSCC). These three malignancies account for 99 percent of all tumors in this category. Because it slows DNA synthesis in quickly proliferating cells, methotrexate (MTX) is an effective treatment for tumors that are fast developing. To prevent the production of the purine nucleotide thymidine, it inhibits the development of tetrahydrofolate by binding to the dihydrofolate reductase. Objective: To assess the efficacy and safety of MTX in the treatment of NMSCs. Conclusion: When used as a less intrusive and less expensive treatment for NMSCs, MTX has the potential to be a very effective and safe alternative treatment, especially in patients who are elderly or have other medical conditions. Keywords: Non-melanoma skin cancers (NMSCs),Methotrexate (MTX).
INTRODUCTION Clinical presentation:
By far the most common malignancies are those that
In terms of aggression, BCC is the least aggressive
do not spread to the lymph nodes or bones. NMSCs with
NMSCs because it contains cells that are similar in
basal cell carcinoma (BCC) and squamous cell carcinoma
appearance to epidermal basal cells. Despite the ability to
(SCC) as their primary tumours account for 70% and 25%
locally infiltrate, tissue damage, recurrence, and a limited
of all NMSCs, respectively. Skin cancer, on the other
capability for metastasis, the cancer has spread
hand, can develop from any of the cells in the skin, and
throughout the body. BCC displays a modest level of
both basal cell carcinoma and squamous cell carcinoma
malignancy. Age, sex, hereditary history like Fitzpatrick
have excellent prognosis when detected in their early
skin types I and II, GorlinGoltz syndrome, and immune
stages, despite the fact that their behaviour, development,
status are all individual risk factors for BCC (1).
and metastatic capabilities differ from each other (1).
Squamous cell carcinoma is an abnormal
proliferation of invasive squamous cells and can progress. Epidemiology:
SCC also has a high risk of recurrence, which is
BCC had a negligible impact on the mortality rate
determined by the size of the tumor, the degree of
of NMSCs. According to the American Cancer Society, 1
histological differentiation, the depth of the lesion, the
in 14,000,000 people will develop metastatic BCC, and 2
presence of perineural invasion, and the patient's immune
in 14,000,000 people will die from locally advanced
system (3).
BCC. It's safe to assume, then, that the mortality rate will
be 0.02 per 10,000. Pathogenesis of NMSCs:
In contrast, SCC has a variable metastatic rate of
Different factors, including UV radiation, human
0.19.9 percent and is responsible for roughly 75 percent
papillomavirus (HPV), arsenic compounds, X-rays and
of all NMSC-related fatalities (1, 2).
other chemical products all play an important role in the
development of NMSCs and actinic keratosis (AKs)
(figure 1) (2)
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c:\work\Jor\vol852_14The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3561-3564
Limited Invasive Techniques in Management of Sander's Type II, III Calcaneal Fractures Ahmad Atef Abou Elsoud*, Adel Mohammad Salama, Amr Mohammad Al Adawy
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ahmad A. Abou Elsoud, Mobile: (+2)0111631931, Email:[email protected] ABSTRACT Background: A thorough understanding of the clinical and radiographic anatomy of the calcaneus and its articulations is crucial when attempting less invasive procedures for intraarticular calcaneus fractures. Objective: The aim of this work is to evaluate the functional outcome and to assess the anatomical restoration of the calcaneus with radiographic measurements after percutaneous fixation of Sanders type II and type III calcaneal fractures by K-wires and cannulated screws. Patients and methods: This was a prospective study that is conducted on 23 patients whom were classified as Sanders type II, III Calcaneal fractures. This study was done at Alexandria Police Hospital and Zagazig University Hospital. These patients were followed up for at least 6 months postoperatively. All patients in the study were evaluated including history taking and clinical examination. All patients had preoperative lab investigations and were evaluated radiologically with X-ray calcaneus and CT scan, and were followed up at outpatient clinic twice in the first week then once a week for the next two months. Results: The final results at the end of this study were satisfactory in 91.3% of patients and unsatisfactory in 8.7% of patients. About (81.3%) of the excellent results were obtained in Sanders type II fractures, while 18.7 % of the excellent results were obtained in Sanders type III fractures. Conclusion: Less invasive surgical techniques for treating displaced intraarticular calcaneus fractures have been undertaken in an attempt to reduce complications and improve recovery when surgery is indicated. These emerging techniques may be beneficial in patients with soft-tissue compromise, multiple comorbidities, and displaced intraarticular fractures with minimal comminution. Keywords: Calcaneal fractures, Cannulated screws, K- wires, Percutaneous fixation.
INTRODUCTION
further 9.2 % soft tissue problem like peroneal
Fractures of the calcaneus account for
tendinitis, sinus tarsi syndrome, and even
approximately 60% of tarsal injuries and usually are
compartment syndrome (6).
the result of a fall from a height (1). More than 70% of
To avoid the feared soft tissue complications,
calcaneal fractures are intraarticular involving the
several minimally invasive and percutaneous
subtalar joint, mostly caused by a fall from a height
approaches have been proposed throughout the history
with the heel directly hitting the ground (2).
of calcaneal fracture treatment and recently gained
Over 80% of calcaneal fractures involve the
popularity for selected injury patterns (7). After the first
posterior articular surface (PAS) of the bone resulting
percutaneous operation by the German surgeon
in incongruence of the subtalar joint. This leads to
Westhues, a considerable number of percutaneous and
arthritis of the joint with painful limitation of motion
minimally invasive open techniques have been used to
and intolerance of uneven surfaces. Increasing
treat calcaneal fractures (8).
difficulty in dorsiflexion of the foot impedes gait
Therefore, this study aimed to evaluate the
leading to a limp. Reduction of the height of the
functional outcome and to assess the anatomical
calcaneal tuberosity leads to impingement of malleoli
restoration of the calcaneus with radiographic
on the shoe sole and disorders of Achilles tendon
measurements after percutaneous fixation of Sanders
mechanics, while compression of the peroneal tendons
type II and type III calcaneal fractures by K- wires and
causes tendinopathy. Widening of the flattened heel
cannulated screws.
increases compression and makes fitting standard
shoes even more difficult (3, 4). PATIENTS AND METHODS
Infection rates after using the extended lateral
This study was done at Alexandria Police
approach vary between 1.3- 7%. Several smaller direct
Hospital and Zagazig University Hospital. These
approaches to the lateral calcaneal wall, resembling the
patients were followed up for at least 6 months
classical palmar approach, have been carried out
postoperatively. Open, extra-articular of Sander's,
without significantly reducing the soft tissue problems
type I and type IV fractures and patients with
as they cut throw the lateral calcaneal artery(5). A direct
ipsilateral vascular injury or peripheral neuropathy
approach over the sinus tarsi requiring retraction of the
were excluded from this study.
peroneal tendons and sural nerve with minimal
All patients in the study were evaluated
fixation resulted in an infection rate of 8.5 % and
including history taking and clinical examination. All
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c:\work\Jor\vol852_15The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3565-3572
Practical Needs in Assessing Response to Therapy in Operated Brain High Grade Glioma According to Response Assessment in Neuro-Oncology Criteria Rania M. Almolla1, Hazim I. Tantawy 1, Mohamed Mahmoud*1, Ahmed A. Morsy 2, Ahmed A. Bessar1
Departments 1Radiodiagnosis and 2Neurosurgery, Faculty of Medicine, Zagazig University, Egypt. *Corresponding Author: Mohamed Mahmoud, Email: [email protected] ABSTRACT Background: Tumors known as gliomas begin in the brain or spine's glial cells and might spread throughout the body. An effort was made to improve tumor response evaluation and end point selection through the Response Assessment in Neuro-Oncology (RANO) working group. Objective: To standardize the assessment method and results reporting by applying MRI-RANO criteria in detecting glioma response to surgical treatment. Patients and Methods: This was a prospective cohort study included 12 patients (4 males and 8 females) whose mean age was 53.6 ± 15.1years. Included patients are those who were operated and pathologically proved as brain glioma grade IV (GBM). They underwent post-operative MRI within 48 hours and are available for follow up MRI after 3 months. Imaging modalities applied in both MRI exams were conventional magnetic resonance imaging, MRI diffusion weighted images, and contrast imaging.RANO criteria were applied. Results: According to RANO criteria, none of the lesions had pseudo response or pseudo progression. However, two thirds (66.7%) had progressive disease and one third (33.3%) had complete response. There was statistically significant association between MRI findings 3 months postoperative and RANO criteria as patients with compete response had statistically significant decrease on measurable solid components, diffusion restriction, post contrast enhancement and all lesions had grade I edema with no mass effect or midline shift compared to patients with progressive disease. 4 cases that showed complete response category had fulfilled all the RANO criteria, while 8 cases with category progressive disease had fulfilled more than one of the described RANO criteria. Conclusion: RANO criteria are an effective tool to be used in interpretation of MRI for follow-up of surgically operated glioma patients to detect their response. Keywords: Therapy response, Brain high grade glioma, Neuro-oncology criteria.
INTRODUCTION
enhancing disease progression (6). It was found that the
Brain or spinal cord tumors known as gliomas arise
Macdonald criteria had three key flaws that were
from the glial cells that surround and support the brain or
corrected by the RANO guidelines: Standardizing
spine, respectively. Gliomas account for around thirty
imaging definitions, such as the size and number of
percent of all brain tumors and almost eighty percent of
enhanced T1 lesions that are measurable and non-
all malignant brain tumors (1). Gliomas are the most
measurable, pseudo-progression and pseudo-response
frequent type of brain cancer, and new treatment
interpretation for changes in T2 and FLAIR signal
modalities have necessitated the development of accurate
abnormalities to be taken into consideration when
tools for evaluating the disease's response. Surgery,
evaluating the impact of antiangiogenic treatments, and
radiation, and/or new chemotherapy drugs are currently
widening the radiographic response (7). Shorter trial
used to treat high-grade gliomas, however there are
durations and lower drug development costs can be
additional options (2).
achieved with endpoints based on imaging that include
It was decided to create the Response Evaluation in
tumor evaluation and measurement. By distinguishing
Neuro-Oncology (RANO) working group in order to
between therapy response and tumor development,
enhance tumor response assessment and end goal
radiologists can help patients avoid harmful treatment
selection. Endpoints and criteria for determining therapy
changes (2).
response have evolved due to advancements in imaging
We aimed at this study to standardize the
technologies, in particular (3). In patients with high-grade
assessment method and results reporting by applying
glioma, the MacDonald criteria were proposed in 1990 as
MRI-RANO criteria in assessment of glioma response to
the gold standard for evaluating response and
surgical treatment.
progression. Failure to provide guidance on pseudo-
PATIENTS AND METHODS
progression, pseudo-response, and tumor progression
A Prospective cohort study was carried out at the
while using this response criterion posed a challenge. The
Radiodiagnosis
Department-Zagazig
University
MacDonald criteria only included illness progression that
Hospitals. All the patients were referred from
enhanced contrast and ignored disease progression that
Neurosurgery Department of Zagazig University
did not enhance contrast (4, 5). For the RANO criteria,
Hospitals from January 2021 to June 2021.
progression is defined as an increasing level of non- Ethical approval:
enhancing illness. The RANO criteria argue that any The study was approved by Zagazig University'
qualitative increase in non-enhancing disease represents Research Ethics Committee, (ZU-IRB#6210/25-9-
progression as it could be difficult to quantify non- 2020). This work has been carried out in accordance
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c:\work\Jor\vol852_16The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3573-3577
Role of Corticosteroids versus Hyaluronic Acid in Healing of Sciatic Nerve Injury in Male Albino Rats Alaa Nabel El Sadek1, Mohamed Ali Nasr1, Osama El Sayed Ibrahem Abdo*1, Mostafa Mohamed El Aidy2
Departments of 1Plastic and Microscopic Surgery and 2General Surgery, Faculty of Medicine, Zagazig, Egypt *Correspondence author: Osama El Sayed Ibrahem Abdo, Mobile: (+20)01007246633, E-mail:[email protected] ABSTRACT Background: Peripheral nerve lesions are common and severe injuries that impact about 2.8% of traumatic patients annually, and result in lifetime disability if untreated. Objective: This study aimed to investigate the effect of corticosteroids vs hyaluronic acid in peripheral nerve healing in rats. Patients and methods: This was experimental and histopathological study that had included (18) Sprague-Dawley rats with an average weight of 300350 gm. All rats were divided into three groups (n=6 per group). Group 1; Corticosteroids was injected under epineurium after primary repair. Group 2; Hyaluronic acid group: the site of anastomosis was coated by hyaluronic acid after primary repair. Group 3; Primary repair only was done. Results: 100% of cases in group 1 and group 2 showed satisfactory wound healing and 83.3% in group3 showed satisfactory wound healing with no significant difference between them. Conclusion: There was an increase in the number of regenerated nerve fibers in the corticosteroids and hyaluronic acid especially on the distal end in comparison to the control group. Keywords: Corticosteroids, Hyaluronic acid, Peripheral nerve, Rats. INTRODUCTION
Peripheral nerve lesions are common and severe
The aim of the current study was to investigate
injuries that impact about 2.8% of traumatic patients
the effect of corticosteroids vs hyaluronic acid in
annually, and result in lifetime disability if untreated(1).
peripheral nerve healing in rats.
Nowadays, various methods are used to guide
regenerating nerve fibers into the correct distal MATERIALS AND METHODS
endoneurial tubes during surgical repair. The most used
This is an experimental study on 21 rats, it was
strategies developed for nerve repair include end-to-end
done at Zagazig University Hospital at October, 2018.
anastomosis of nerve stumps or bridging by
There was animal loss of 3 rats died in the postoperative
autografts(2). However, a major problem for nerve repair
period. On final assessment, 18 rats were available.
is the formation of fibroblastic scars at the site of
anastomosis(3). Ethical approval:
Even with well repaired nerve, half of the We confirm that a high standard of ethics was
regenerating axons may grow into scar tissue, which applied in carrying out all aspects of the current
may lead to local neuroma and impedes axonal investigation. All experimental procedures and
regeneration to the target. Consequently, regenerating protocols for animals approved to the Institutional
nerve function is generally far from satisfactory thus, Animal Care and Use Committee Zagazig University
production of fibroblastic scars during nerve ZU-IACUC.
anastomosis impedes the regeneration of repaired
In our study we used (18) Sprague-Dawley rats
nerves(4). Scar tissue prevents nerve regeneration
with an average weight of 300350 gm. Sciatic nerve of
primarily by increasing nerve adhesion, which provides
18 rats were cut on left sides and repaired by nylon 10/0
a direct physical block to the nerve, and by inhibiting
under microscope and divided into three group 6 rats in
angiogenesis(5). The scar grows into the site of the
every group. Group (1); Corticosteroids group:
lesion, and hinders extension of the regenerating nerve
Corticosteroids was injected under epineurium after
fibers(6).
primary repair. Group (2); Hyaluronic acid group: The
The prevention of scar hyperplasia has become
site of anastomosis was coated by hyaluronic acid after
a hot topic in neural regeneration research. However,
primary repair. Group (3); Control group: Primary
outcomes have not been satisfactory in both basic and
repair only was done.
clinical studies(7). There have been many strategies for
reducing the impact of scar on nerve regeneration. The Surgical Procedure:
first approach has been to separate the nerve ends from
The rats were anaesthetized by intraperitoneal
the surrounding tissue to prevent tissue adhesions by
and/or intramuscular injection of 0.005 mg/gm ketamine.
nerve conduit and The second approach has been the
Hair was shaved from left hind limb and the mid-back.
application of topical pharmacological agents at the site
The rats were placed in a prone position on a rodent
of anastomosis like corticosteroids or hyaluronic acid(8).
operating board. A 12 cm skin incision began 0.5 cm
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/)
3573
Received: 24 /6 /2021
Accepted: 20 /8 /2021
c:\work\Jor\vol852_17The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3578-3582
Correlation between Coronary Artery Diseases and Dyslipidemia in Type 2 Diabetic Patients Muhammed Hossam Al-Shaer, Manar Mostafa Elzaky, El Sayed Mohamed Farag, Mostafa Osama Mohamed Saad*
Department of Cardiovascular Medicine, Faculty of Medicine, Zagazig University Zagazig, Egypt *Corresponding author: Mostafa Osama Mohamed Saad, Email:[email protected] ABSTRACT Background: Premature atherosclerotic cardiovascular disease (CVD) has a significant association with diabetes
mellitus. There are numerous studies showing that decreasing cholesterol is effective in improving cardiovascular outcomes in people with diabetes. Objective: This study aimed to identify the correlation between coronary artery diseases (CADs) and dyslipidemia in diabetic patients. Patients and methods: In the Cardiology Department of Zagazig University Hospitals we conducted this case-control
study. 140 patients with type 2 DM were divided into two groups: Group 1 included 70 people with type 2 diabetes who had CADs and group 2 that included 70 patients with type 2 DM who had no signs of CADs (admitted complaining of symptoms of angina or CA showing no significant stenotic lesions). Angiographic examination and fasting and 2-hour postprandial blood glucose levels were performed for all patients. Moreover, comprehensive history was taken, cardiovascular risk profiles and laboratory investigations such as glycosylated hemoglobin (HbA1c) were done. Results: CAD group were significantly higher regarding BMI as it was distributed as 28.77 ± 2.3 and 30.04 ± 3.03
between No-CAD and CAD respectively. There was no significant difference or association between smoking or hypertension and CAD. SBP and DBP were significantly higher among CAD. Fasting blood glucose and HbA1c were significantly higher among CAD group than in No-CAD group. CAD group showed significantly higher TG and LDL- c distribution than No-CAD group. Conclusion: Increased triglycerides and decreased HDL levels were associated with CVD among diabetic patients. Keywords: Coronary artery diseases, Dyslipidemia, Diabetes mellitus.
INTRODUCTION
LDL cholesterol is greater than 3.4 mmol/L (130 mg/dl),
A prominent public health issue in the world is
high-density lipoprotein cholesterol is less than 0.9
cardiovascular disease (CVD). Research shows that
mmol/L (35 mg/dl), or a mix of these levels is present (5).
diabetics are twice to four folds as likely to develop
We aimed in this work to identify the correlation
coronary artery disease or have a myocardial infarction
between coronary artery diseases and dyslipidemia in
(MI), verifying the hypothesis that type 2 diabetes is a
diabetic patients.
risk factor for both stroke and heart disease (1).
Atheromatous alteration in coronary vessels causes a PATIENTS AND METHODS
wide spectrum of disorders, including coronary artery
Case-control research was conducted at Cardiology
disease (CAD). In the past, CAD was assumed to be only
Department, Zagazig University Hospitals. 140 patients
a straightforward, inexorable process of artery
with diabetes mellitus type 2 were the only considered.
narrowing, eventually causing a full blockage of the
They were divided into two categories: 70 patients in
vessels. It was discovered that there are several types of
group 1 who had diabetes type 2 and CADs and 70
coronary plaques, with some being stable (lipid-poor)
patients with type 2 diabetes who don't have any signs of
while others are more unstable (lipid rich), which shifted
coronary artery disease (only complaining of symptoms
the explanatory paradigm in recent years (2).
of angina or CA showing no significant stenotic lesions)
A tight relationship exists between diabetes
and worked as group 2 (No-CAD group).
mellitus (DM) and coronary artery disease (CAD), with Inclusion criteria: Those with diabetes mellitus type 2
DM serving as a significant risk factor for CAD and even
(NIDDM) were included if they had a history of
being regarded as being equal to existing CAD (3).
coronary artery disease (CAD) and had chest pain that
Diabetes increases the risk of early atherosclerosis and
was not related to their blood sugar levels (glycemic
cardiovascular disease in diabetics. Clinical research has
variability). The femoral or radial technique was used for
shown that strict glycemic management has no effect on
coronary angiography, with the Gensini score being used
cardiovascular health. When a person has diabetes, they
to determine the degree of coronary artery disease.
are more likely to have dyslipidemia, and research Exclusion criteria: The study excluded diabetics with
shows that decreasing cholesterol can improve
any of the following risk factors: smoking, drinking,
cardiovascular outcomes even in those with otherwise
high blood pressure, liver illness, kidney disease, and
normal lipid profiles (4).
those who had not undergone coronary angiography.
The American Heart Association classifies
dyslipidemia as being in the 95th percentile or higher in All patients were subjected to the following
the general population of the United States as there is a procedures:
high level of total cholesterol > 5.2 mmol/L (200 mg/dl),
Clinical evaluation and full history taking were
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c:\work\Jor\vol852_18 The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3583-3588
A Comparative Study of Pedicled Versus Skeletonized Left Internal Mammary Artery Harvesting Techniques Regarding Rate of Mediastinitis Post CABG in Diabetic Patients Waleed Abbas Kamel*, Sherif Ahmed Kamal Elhendawy
Department of Cardiac Surgery, National Heart Institute, Egypt * Correspondence author: Waleed Abbas Kamel, Mobile: (+20)01000251414, Email:[email protected] ABSTRACT Background: For grafting the left anterior descending (LAD) coronary artery, the left internal mammary artery (LIMA) has become the gold standard. Pedicled and skeletonized methods are the two most common harvesting procedures. Objective: In this study we compared between both techniques regarding incidence of postoperative mediastinitis in diabetic patients. Patients and methods: 80 diabetic patients with controlled diabetes i.e. HbA1c below 7 underwent on-pump coronary artery bypass grafting (CABG) surgery were included in this study. The patients were divided into two groups, according to the procedure applied to harvest the LIMA: Group 1: 40 patients underwent pedicled LIMA and Group 2: 40 patients underwent skeletonized LIMA. After CABG surgery, the cases had a 3-month follow-up time. Results: In the pedicled LIMA group, the frequency of excessive intraoperative usage of bone wax was significantly increased. A significant increase was found regarding the occurrence of sternal wound infections (SWI) in the pedicled LIMA group (22.5%) versus (12.5%) within the skeletonized one, (P-value = 0.003). The univariate analysis of the factors related to SWI in all of the studied CABG patients were obesity [OR (95% CI): 15.61 (5.78-42.12), P <0.001], pedicled ITA [OR (95% CI): 4.3(1.4-12.9), P 0.004], intraoperative excessive use of bone wax [OR (95% CI): 14.53(6.48-32.56), P <0.001], and intraoperative excessive use of diathermy [OR (95% CI): 17.31(7.55-39.4), P <0.001]. Conclusion: In comparison to pedicled LIMA, skeletonized LIMA in CABG was correlated to reduced occurrence of superficial as well as deep SWI among diabetic patients. Keywords: Internal mammary artery mediastinitis, Pedicled, Skeletonized, Sternal wound infection, CABG.
INTRODUCTION
has been disputed on a regular basis, as each technique
In coronary artery disease (CAD), the
has its own set of benefits and drawbacks (4).
procedure of coronary artery bypass grafting (CABG) is
The complication profile of the harvesting
a commonly acknowledged surgical therapy option. For
approach must be taken into account, with a particular
grafting the left anterior descending (LAD) coronary
focus on the risk of mediastinitis. The diminished
artery, the left internal mammary artery (LIMA) has
sternal vascularization associated with the pedicled
become the gold standard, despite the fact that other
method has been linked to increased mediastinitis (6).
conduits have been employed in CABG (1). This is
Skeletonization, on the other hand, preserves sternal
owing to the fact that it has a higher ten-year patency
microcirculation better, which may be a preventative
rate with minimal or no atherosclerotic alterations (2).
factor against mediastinitis (7).
The IMA's impact in clinical application can
Cardiac surgery through median sternotomy
vary, with different harvesting techniques introducing
can be complicated by mediastinitis, which is a rare but
variation. There are two widely used harvesting
dangerous complication. It has a large socioeconomic
methods: pedicled and skeletonized methods. The
impact as well as a high morbidity rate (8, 9). A major
pedicled technique involves dissecting the artery along
problem of coronary artery bypass graft (CABG)
with its veins, fascia, adipose tissue, and lymphatics
surgery is mediastinitis, especially when left internal
away from the chest wall, while skeletonization
mammary artery (LIMA) are harvested. The actual
involves dissecting the LIMA only far from the wall of
mechanism that causes mediastinitis is multifactorial
the chest (3). (10). Post-cardiac surgery mediastinitis remains a
The preferential harvesting technique has
significant surgical site infections (SSI), particularly in
indeed been questioned on several occasions, as each
CABG surgeries with the internal mammary artery graft
technique has its own set of advantages and (11).
disadvantages. Skeletonization has some advantages
According to reports from throughout the
over pedicled LIMA, as skeletonized LIMA is lengthier
world, the incidence of mediastinitis following coronary
with superior free flow and lower chest wall ache (4).
artery bypass surgery (CABG) is minimal. It is,
Skeletonization, on the other hand, is more technically
however, linked to a large rise in postoperative
demanding, and hypothetically, gathering the vessel
mortality and treatment expenses. Diabetes mellitus and
with no adjacent fat might result in a reduction in its
harvesting of the internal mammary artery are the two
long-term resistance because it is exposed to more
major risk factors mentioned (12).
direct surgical damage (5). The best harvesting technique
The aim of this study was to compare between
pedicled and skeletonized LIMA harvesting techniques
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c:\work\Jor\vol852_19The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page -3589-3595
Significance of Left Atrial Electromechanical Function for Atrial Fibrillation Prediction after Cardiac Surgery Mohamed Saleh Abdel Fattah*, Mohamed Wafaie Aboleineen, Islam Abd El Moniem El Sherbiny, Hala Gouda Abomandour
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt. *Corresponding Author: Mohamed Saleh Abdel Fattah, Email: [email protected]
ABSTRACT Background: Postoperative atrial fibrillation (POAF) is the most important type of secondary AF. POAF is a complication in approximately one-third of patients undergoing cardiac surgery. The duration from P-wave onset on ECG to the peak of the A' lateral wave on tissue Doppler imaging (PA-TDI) provides a reliable estimation of total atrial conduction time. Objective: To evaluate the efficacy of the PA-TDI duration for predicting post-operative atrial fibrillation in patients undergoing cardiac surgery. Patients and methods: This prospective study was conducted at national heart institute for 70 patients who were eligible and planned for undergoing cardiac surgery. Patients were divided into 2 groups according to the presence of post- operative AF. Accordingly, patients in the study were divided into group (I) that included patients who developed POAF and group (II), which included patients who remained in sinus rhythm and did not develop POAF. Results: PA-TDI duration in group I was longer than in group II with highly significant difference between the two groups with P-value < 0.001. It was found that PA-TDI duration ( 171.5 ms) has sensitivity equal to 91 and specificity 95%. Conclusion: PA interval measured by TDI preoperatively seems to be a simple method to predict incidence of POAF in patients undergoing cardiac surgery and it may be part of preoperative cardiovascular examination. The current study suggests that longer PA-TDI duration to be additive to conventional risk factors and biomarkers in predicting POAF and that PA-TDI duration is a predictor of POAF, and the best cut off value of PA-TDI duration for POAF is 171.5 ms. Keywords: Left atrial electromechanical function, Atrial fibrillation prediction, Cardiac surgery.
INTRODUCTION
grafting (CABG) or surgery. Clearly, postoperative
An important type of secondary atrial fibrillation,
POAF should be avoided and managed (4). In order to
known as new-onset atrial fibrillation (AF), is
identify high-risk patients before surgery and provide
postoperative atrial fibrillation (POAF), which is defined
them with appropriate preventive regimens, several
as the emergence of AF shortly after surgery. Patients
approaches have been evaluated for calculating the risk
who experience POAF, which increases hospital costs,
of developing POAF (5). Several studies have found that
time in the intensive care unit (ICU), and length of stay
measuring LA characteristics such the left atrium volume
all as a result of their cardiac surgery, are in the minority.
index (LAVI), total atrial conduction time (TACT), left
The research has covered a wide range of mechanisms.
atrial strain, and total atrial conduction time improves
In addition, numerous therapy options for prevention
prediction of POAF significantly. Even while
have been floated. Despite this, POAF is still common,
electrocardiography (ECG) theoretically has the ability to
and it's a problem (1). There is a lack of knowledge about
measure TACT, there are various other methods for
the exact causes, predictors, and risk factors for POAF,
doing so. TACT can be accurately estimated using the
however old age and various heart disorders that alter
time elapsed between the start of the P-wave on the ECG
structural alterations and promote inflammation have
and the peak of the A' lateral wave on tissue Doppler
been related to POAF repeatedly (2).
imaging (TDI; PA-TDI duration). The length of the PA-
Patient's with POAF require an average hospital
TDI has been linked to several types of AF and the
stay and additional treatment costs of between ten
frequency with which they reoccur (4).
thousand to twenty thousand dollars, roughly a day of
longer ICU time, and an extra two to five days as PATIENTS AND METHODS
inpatient. POAF has been linked to a higher risk of
This prospective cohort study was conducted at
stroke, bleeding, cardiac death, renal or respiratory
Cardiology Department, National Heart Institute for 70
failure, infection, and a variety of neurological
patients who underwent open heart surgery. Patients were
complications including the need for a permanent
divided into 2 groups according to the presence of POAF.
pacemaker. It has also been linked to an increased risk of
Accordingly, patients in the study were divided into:
death from any cause within the first month and six
Group I that included patients who developed POAF and
months, according to several studies (3).
group II, which included patients who remained in sinus
After mitral valve surgery (MVS), the probability of
rhythm and did not develop POAF.
POAF was greater than after coronary artery bypass
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c:\work\Jor\vol852_20The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3596-3603
Recent Modalities in Treatment of Atopic Dermatitis: Review Article Nada Saad Elkady, Ayman Elsayed Youssef, Fathia Mohamed Khattab
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University Corresponding Author: Nada Saad Elkady, Email:[email protected] ABSTRACT Background: Inflammation of the skin marked by itchy, pigmented, dry areas is known as Atopic Dermatitis (AD), also known as Atopic Eczema (AE) or Eczema. Symptoms include red, itchy pimples that leak fluid and crust, scaly or raw skin, or raw or scaly skin. Dermatitis can come in many different forms, such as atopic, contact, or seborrheic. In children, atopic dermatitis is the most prevalent kind of eczema and often occurs in association with other allergic or asthmatic conditions. Eczema is most commonly found on the face, neck, elbows, knees, and toes, among other places. In terms of phototherapy, ultraviolet B phototherapy (280320 nm) is the "oldest" method that is used in treatment of atopic dermatitis. Platelet rich plasma (PRP) injection utilizes the body's own regenerative mechanisms to help treat disease in the patient. Objective: Determination of the updated treatment modalities in Atopic Dermatitis management. Conclusion: Clearly there remains a need to find more potent topical agents with fewer side effects. The most gratifying advances in AD therapy have come from better understanding of immune and inflammatory mechanisms. Keywords: Atopic dermatitis, Ultraviolet B phototherapy, Platelet rich plasma.
INTRODUCTION
industrialized nations. About 2% to 3% of people in
Atopic dermatitis is an autoinflammatory skin disease.
China and Iran are affected. In individuals who come
It has been linked to skin barrier abnormalities in both
from less developed nations and move to the developed
clinical and molecular studies. Early infancy is usually
world, the incidence is higher (5).
when it begins although an adult-onset form has been Clinical Presentation:
identified (1). AD is the first sign of an allergic illness such 1. Symptoms: As the most common and debilitating
as asthma, food allergy, or allergic rhinitis developing in
symptom of AD, incessant pruritus causes children to
succession. Early or severe AD and skin sensitization to
scratch themselves excessively and relentlessly (6).
environmental allergens may contribute to later allergy 2. Physical Examination: A routine skin examination
illness at different epithelial barrier surfaces, leading to
for symptoms of AD is done to rule out acute urticaria
the "atopic march" notion of an allergic illness developing
and look for dermographism in younger patients who
in succession (e.g. gastrointestinal or respiratory tract).
have the disease (7). Eczematous lesions, xerosis, and
This claim is supported by both cross-sectional and long-
lichenification are all common AD symptoms.
term research (2).
Excoriations and crusting are prevalent, and prurigo Epidemiology:
nodularis-like lesions can be seen in certain patients.
Incidence of AD: Since the 1970s, the prevalence
When it comes to finding the eczematous alterations, the
of AD has increased two to three times in developed
patient's age plays a role (8). The following characteristics
countries, affecting 15 to 20 percent of children and 1 to
are crucial (and help with the diagnosis): Early onset of
3 percent of adults globally. In the United States,
xerosis, atopy, and other related traits can be
population-based research shows that prevalence is
characterized
as
follows:
hyperlinear
approximately 10.7% in children and 7.2% in adults. The
palms/ichthyosis/keratosis pilaris changes in the
condition usually begins to manifest around the age of
ocular/periorbital region and other regional results
five, with the maximum occurrence occurring between
including unusual vascular responses (9).
the ages of three and six months, but it can strike anyone, Atopic Dermatitis Treatment & Management:
regardless of their age (3). In the first year of life, 60 1. General considerations: Most of the treatment for
percent of patients get disease, and 90 percent of patients
AD is based on keeping your skin healthy by using
develop disease within the first five years of their
moisturizer every day, as well as using anti-
existence. The condition will persist in 20% of children
inflammatory medication as necessary. Topical
who are diagnosed with AD before the age of 2 and will
calcineurin inhibitors (TCIs) and or topical
have sporadic symptoms in the remaining 17% by the
corticosteroids (TCSs) should be used appropriately
age of 7. Among individuals with AD, only 16.8% get
based on the disease activity when selecting anti-
the disease after adolescence. However, among 10% to
inflammatory therapy (10).
30% of patients will continue to have illness symptoms 2. Contributing factors: When obtaining a medical
even after AD has resolved in most cases by the time a
history, it's crucial to look for anything that could be
kid reaches maturity (4). Prevalence: An increasing
aggravating. Allergens in the air, foods, climate, stress,
percentage of children and adults are affected by AD,
hormone levels, cigarettes, irritants, and bacteria are the
with AD affecting 15-30% of children and 2-10% of
most common causes of AD. All of the aforementioned
adults. This number is an estimate of the prevalence in
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c:\work\Jor\vol852_21The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3604-3608 Predictors of Long Covid 19 Syndrome Ahmed F. Mady1, Rash A. Abdelfattah1, Fatma M.M. Kamel*2, Al Shaimaa Mamdouh Abdel Naiem3, Wael M. AbdelGhany4, Ali Omar Abdelaziz1
Departments of 1Chest Diseases, 2Internal Medicine, 3Rhumatological and Rehabilitation and
Tropical Medicine4, Faculty of Medicine, Minya University, Egypt *Corresponding author: Fatma Mohamed Mohamed Kamel, Mobile: (+20)1007407599, E-mail:[email protected] ABSTRACT Background: Symptoms of covid persist in most cases with development of a multisystem syndrome called long covid syndrome. Objective: The aim of the work was to evaluate symptoms that persist after the acute stage of the disease in a cohort of patients with confirmed or suspected COVID 19 and to define the predictors for long COVID syndrome. Patients and method: This retrospective study involved 164 patients with previously confirmed or highly suspected COVID 19 and still attending to the post covid outpatient clinic in El-Minia University Chest Hospital complaining from persistence of symptoms or for regular follow up. Their data was obtained from their previous medical reports. Results: Post Covid 19 symptoms were found in about 86 % of the studied patients with 42.7% reported neuropsychiatric symptoms and 26.8% reported respiratory symptoms. The most common reported symptoms in non- severe cases were the anxiety disorders (18.9%), followed by chronic fatigue and neuropathy (15.2%), while chronic dyspnea in 9.8% mostly in severe cases, while vertigo and headache in 9.1%, musculoskeletal symptoms in 6.1% and skin lesions in 3.7%. Conclusion: It could be concluded that persistence of symptoms is very common after acute Covid 19 infection. Chronic dyspnea was reported more frequently in severe cases while anxiety reported mostly by patients with mild disease. Keywords: Long covid syndrome, Post covid syndrome, Persistent symptoms, chronic fatigue syndrome. INTRODUCTION
complaining of persistence of symptoms or for regular
A novel coronavirus (nCoV) disease (COVID-19)
follow up.
has been defined as a pandemic health problem caused
Their data was obtained from their previous
by a newly discovered SARS COV-2 virus. Post covid-
medical reports. Demographic data, comorbidities, the
19 ("long covid") is a multisystem syndrome, occurring
initial presenting symptoms, and laboratory finding
even after a mild acute illness. The patients remain
were recorded.
suffering from multiple neuropsychiatric and
respiratory symptoms as chronic dyspnea `lung burn', The severity of the cases was defined based on the
tachycardia and loss of smell or taste accompanied by criteria established by China's National Health
chronic fatigue but not always (1). The symptoms may Commission (4): 1- Mild: minor symptoms only,
be constantly persistent or fluctuate. It may take days
without evidence of pneumonia by chest X-ray. 2-
till feeling well but may recur sometimes following
Moderate: Fever and respiratory symptoms are present,
exertion and sometimes for no apparent reason (2).
and there is evidence for pneumonia by chest X-ray, Greenhalgh et al. (3) define the post-acute covid-
(both groups classified also as non-severe cases). 3-
19 symptoms that extending beyond three weeks from
Severe: Defined by any of the following conditions. 1)
the onset of first symptoms and chronic covid-19 which
Dyspnea, respiratory rate 30 /min, 2) resting hypoxia
extend beyond 12 weeks.
SaO2 93%, 3) PaO2/FiO2 300 mmHg. 4. Critical: the
The aim of the present study was to evaluate
presence of any of the following conditions. 1)
symptoms that persist after the acute stage of the disease
Respiratory failure, require mechanical ventilation, 2)
in a cohort of patients with confirmed or suspected
shock, 3) other acute organ failure. (Both groups
COVID 19 and to define the predictors for long COVID
classified also as a severe cases).
syndrome. Ethical consent: PATIENTS AND METHODS
An approval of the study was obtained from Minya
For the purpose of this study, we used the
University Academic and Ethical Committee. Every
definition of post COVID 19 syndrome as symptoms
patient signed an informed written consent for
that persist for beyond 3 months from the start of the
acceptance of the operation. This work has been carried
disease.
out in accordance with The Code of Ethics of the World
This retrospective study included a total of 164
Medical Association (Declaration of Helsinki) for
patients with previously confirmed or highly suspected
studies involving humans.
COVID 19 attending at the Post Covid Outpatient
Clinic,
El-Minia
University
Chest
Hospital,
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c:\work\Jor\vol852_22The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3609-3615
Relation between Lymphopenia and Internal Organ Involvement in Systemic Lupus Erythematosus Patients Amal S. Abd El Hamed1, Ahmed R. Radwan*1, Mohammed A. Ismail1, Abd Elhady Ragab2, Ashraf A. Abdelwahab3, Ibtesam K. Ali1
Departments of 1Physical Medicine, Rheumatology & Rehabilitation, 2Clinical Pathology and 3Dermatology,
Venereology & Andrology, Faculty of Medicine, Sohag University, Egypt *Corresponding author: Ahmed R. Radwan, Mobile: (+20)1092914019, Email: [email protected] ABSTRACT Background: Systemic lupus erythematosus (SLE) is an autoimmune disease, characterized by autoantibody production and immunocomplex formation, leading to widespread inflammatory damage involving multi-organ systems. Lymphopenia is a common laboratory involvement seen in patients with SLE and the mechanism of it is still unclear. Objectives: The aim of the current study was to investigate the relation between lymphopenia and clinical manifestations, laboratory findings, and disease activity in systemic lupus erythematosus (SLE) patients. Patients and Methods: It was a cross sectional study; with a total of 60 patients with SLE recruited from the Rheumatology and Rehabilitation outpatient clinic at Sohag University Hospital. Demographic data, personal history, detailed history of general health condition and chronic or current diseases were reported. All the participants were subjected to detection of erythrocyte sedimentation rate, liver function tests, renal function tests, complete blood count (CBC), renal biopsy, protein/creatinine ratio and/or 24hr protein in urine, urine analysis, ANA profile, and Complement 3 and 4. Results: Two thirds of the study population had normal lymphocytic count, and one third had lymphopenia. Lymphopenia group showed significantly more hypochromic anemia with significant lower hemoglobin level and lower MCV. The mean creatinine level was significantly higher among lymphopenic cases. Lymphopenic cases had higher proteinuria. Conclusions: It could be concluded that lymphopenia in patients with SLE may be used as indicator of renal involvement in these patients. Keywords: Systemic lupus erythematosus, Lymphopenia, Renal involvement.
INTRODUCTION
Systemic lupus erythematosus (SLE) is an
The aim of this study was to investigate the
autoimmune disease, which is characterized by excess
relation
between
lymphopenia
and
clinical
autoantibody
production
and
immunocomplex
manifestations, laboratory findings, disease activity in
formation, leading to widespread inflammatory damage
SLE patients.
involving multi-organ systems. It may affect any organ
and produce a broad spectrum of clinical manifestations PATIENTS AND METHODS (1). Lymphopenia is a common laboratory involvement
This cross-sectional study included 60 patients
seen in patients with SLE and the mechanism of it is
classified as SLE according to either the 2012 SLICC
still unclear (2).
criteria or the new 2019 ACR/EULAR SLE
The clinical usefulness of lymphopenia has been
classification criteria. Patients were recruited from the
limited mainly to aid in lupus diagnosis because
Rheumatology and Rehabilitation outpatient clinic at
lymphopenia is one of the hematologic criteria
Sohag University Hospital.
according to the American College of Rheumatology
(ACR). Lymphopenia was found in the majority of SLE Inclusion criteria:
patients (over 60%) on initial diagnosis and this rises to
1- Patients diagnosed as SLE according to SLICC
over 90% during the disease course of SLE (3).
2012 or ACR/EULAR 2017 classification
Lymphopenia was seen to be correlated with
criteria.
disease activity in adults with SLE. However, it may be
2- Age (18-60) years
caused by multi-factors other than SLE itself (4).
3- Patient with disease duration more than 6 months
Medications
including
corticosteroids,
cytotoxic agents (e.g. cyclophosphamide) and many Exclusion criteria:
infections may contribute to the reduction in
1- Other autoimmune disease including rheumatoid
lymphocyte count (5). Some studies have shown
arthritis, scleroderma, mixed connective tissue
lymphopenia to be associated with particular clinical
disease and polymyositis.
manifestations of SLE, disease activity and organ
2- Patients who had active infections, malignancies,
damage (1, 6).
hematologic diseases, hepatosplenic diseases.
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c:\work\Jor\vol852_23The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3616-3620
The Relationship between Serum Procalcitonin and Dialysis Adequacy in Hemodialysis Patients Khaled Gouda*, Saeed Abdelwahab Saeed, Ahmed Yehia Mohamed
Division of Nephrology Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt *Corresponding author: Khaled Gouda, Mobile: (+20)1111990962, E-Mail: [email protected]@gmail.com ABSTRACT Introduction: In hemodialysis (HD) patients procalcitonin (PCT) considered as an early predictor of acute infection. It represents a new and potential marker of inflammation and may correlate with dialysis adequacy. This makes procalcitonin a potential biomarker for obesity-related low-grade inflammation. Objective: The aim of the work was to assess procalcitonin level in obese prevalent hemodialysis patients and its relation to hemodialysis adequacy. Patients and Methods: A cross sectional study was conducted on 90 patients divided into 3 groups, 40 obese (BMI 30 Kg/m2) ESRD patients on regular hemodialysis (group A), 40 non obese (BMI < 25Kg/m2) ESRD patients on regular hemodialysis (group B) attending at Dialysis Unit, El-Sahel Teaching Hospital and 10 healthy individuals with BMI < 25Kg/m2 as a control group (group C). All patients were subjected to detailed history taking and general examination. All patients were laboratory investigated for CBC, serum urea, creatinine, CRP, urea reduction ratio (URR), equilibrated Kt/v. All controls were subjected to written informed consent, full history, examination and CRP level. Procalcitonin level was done by ELISA technique for all patients and controls. Results: In our study, we found that there was a higher level of procalcitonin (PCT) in obese hemodialysis patient than non-obese. We also found that there was no correlation between PCT and hemodialysis adequacy in our study population. Conclusion: It could be concluded that procalcitonin is a potential biomarker for obesity-related low-grade inflammation, but not related to hemodialysis adequacy. Keywords: Hemodialysis, Procalcitonin, Obesity.
INTRODUCTION
Procalcitonin (PCT) is an innovative and highly
Herget-Rosenthal and his colleagues reported that
specific marker for the diagnosis of clinically relevant
the PCT level gradually increased according to the
bacterial infections and sepsis. It is a marker of
degree of deterioration in renal function and was
inflammatory response stimulated by production of
influenced by the type of the renal replacement therapy
bacterial endotoxins and cytokines (IL-1, IL-6, and (5).
TNF) (1).
Uremia has various influences on the general
Large number of publications, primarily clinical
condition of patients with ESRD (6). Inflammatory
studies, demonstrated the increasing use of
cytokines produced and released by uremia cause
Procalcitonin (PCT) in modern clinical practice. It is a
chronic inflammation in the whole body. The
propeptide of calcitonin induced by a variety of stimuli
activation of TNF-alpha, an inflammatory cytokine, is
including bacterial endotoxins, pro-inflammatory
well known to promote PCT production (7).
cytokines and triggering events such as trauma or
A significant number of patients who undergo
cardiogenic shock. PCT is not induced by viral
hemodialysis are overweight or obese (8). The presence
infections, autoimmune disorders, neoplastic diseases,
of excess weight, especially visceral obesity
and organs transplantation (2).
contributes to the increased risk of metabolic and
In healthy people, PCT Level is very low, usually
cardiovascular complications in patients with chronic
0.1~0.5 ng/L. In the case of infection, PCT appeared
kidney disease (CKD). The relationship between
and increased earlier than CRP, IL-6 and other acute
weight and outcome is complex among dialysis
proteins and inflammatory factors, and the half-life was
patients. The extra weight is usually associated with
shorter, so PCT had higher sensitivity and specificity.
improved survival in this patient group (9).
Animal studies have found that injection of IL-6 and
Some studies showed that adipose tissue is
TNF- in a rat model of sepsis can cause large-scale
capable of expressing and secreting procalcitonin (10).
release and increase of PCT, and PCT itself has no
Despite constant efforts to improve the survival of
significant effect on the increase of cytokines, PCT can
hemodialysis (HD) patients, which have produced
be a secondary inflammatory factor and amplify the
tangible results, their mortality rate remains high
inflammatory effect (3).
Several factors affect survival in HD patients, with
The serum PCT level of non-infected patients
dialysis adequacy representing one of the most
with chronic kidney disease (CKD), including dialysis,
important and modifiable factors (11). Procalcitonin
is significantly higher than that of healthy people (4).
(PCT) represents a new and potential marker of
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c:\work\Jor\vol852_24The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3621-3623
Relation between Interleukin 8 and Bronchial Asthma in Children: Review Article Sahbaa Fehr Mohamed1, Fathy Mohamed Abd-Elwahab*1, Dina Mohamed Shokry1, Walaa Mohamed-Samy2
Departments 1Pediatrics and 2Medical Biochemistry, Faculty of Medicine, Zagazig University, Egypt. *Corresponding Author: Fathy Mohamed Abd-elwahab, Email: [email protected] ABSTRACT Background: Asthma is a frequent respiratory condition to treat. A persistent airway inflammation characterizes this frequent form of pulmonary disease. Immune responses are triggered by cytokines and chemokines produced by airway epithelial cells. Human bronchial epithelial cells secrete IL-8 in response to the presence of interleukin-4 (IL-4) and interleukin-13, both of which are increased in asthmatics. There are two receptors for IL-8, the IL-8 receptor alpha (also known as CXCR1) and beta (also known as the IL-8 RB, CXCR2). IL8 is a potent chemotactic cytokine that activates inflammatory cells by recruiting mast cells, mononuclear phagocytes T lymphocytes, and neutrophils to the site of inflammation. Objective: To determine the relationship between IL8 and bronchial asthma in children. Conclusion: The assessment of IL8 levels in pediatric asthmatic patients is a useful biomarker reflecting the status of asthma and also to glucocorticoids and treatment responses. Keywords: Bronchial asthma, Interleukin 8. Bronchial asthma in pediatrics:
nonspecific stimuli, a rise in Immunoglobulin E (IgE)
Asthma is a diverse disease that is often accompanied
levels in the bloodstream, and increased mucus
with persistent inflammation of the respiratory tracts.
production. As a result of the chronic inflammation,
Chest tightness, shortness of breath and cough, and
structural changes (airway remodeling) occur, including
wheezes, which change in time and intensity over time,
collagen deposition, hyperplasia, and thickening of the
and variable expiratory airflow limitation are used to
airway wall. The bronchoalveolar infiltration of
identify the disease (1).
numerous
immune
cell
types,
predominantly Pathogenesis of asthma:
eosinophils, mast cells and activated CD4+ T-cells, is
Individuals with allergic asthma, who are predisposed
triggered in asthmatic patients by allergic episodes. To
genetically, respond to allergens by mounting an
coordinate the immune response to allergens, effector T-
incorrect T-cell immune response, resulting in chronic
helper 2 (Th2) cells release cytokines that set off the
airway narrowing. Airway hyper-responsiveness to a
hallmarks of asthma. There are several factors that
wide range of particular and non-specific stimuli
contribute to the formation of IgE, including the
characterizes allergic asthma, which is defined by the
secretion of interleukin 4 and interleukin 13, as well as
formation of inflammatory infiltrates in the lungs and
the activation of mast cells by interleukin 5 and 9 (2).
airway hyper-responsiveness to a variety of specific and
Figure (1): Factors limiting airflow in acute and persistent asthma (2).
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c:\work\Jor\vol852_25The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3624-3627
Recent Guidelines in Bronchial Asthma Management in Children: Review Article Marwa Osama Ali1, Mohammed Elsayed Hamed1, Mohamed Hassan Sarhan2, Yousif Mohamed Yousif1
Departments of 1Pediatrics and 2Medical Parasitology, Faculty of Medicine, Zagazig University, Egypt. Corresponding Author: Marwa Osama Ali, Email:[email protected] ABSTRACT Background: A common childhood and adolescent illness, asthma is a chronic inflammatory condition marked by episodes of wheezing, dyspnea, tightness in the chest, and coughing. A mix of genetic and environmental factors is likely to be responsible for its occurrence. A short-acting beta-2 agonist (such as salbutamol) breathed into the lungs is mainly used to treat acute symptoms. Inhaling corticosteroids and avoiding triggers like allergens and irritants can help prevent symptoms. Objective: to determine the recent treatment modalities in bronchial asthma management in children. Conclusion: many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Keywords: Bronchial asthma, Corticosteroids, Short-acting beta-2 agonist.
Bronchial Asthma:
early life, making a diagnosis challenging. Coughing,
Inflammation of the airways is a characteristic of
wheezing, and shortness of breath are all frequent
asthma, which is a long-term, diverse disease. Wheeze,
symptoms, especially at night. Asthma diagnosis relies
shortness of breath, tightness in the chest, and cough are
heavily on whether or not bronchodilators have improved
all respiratory symptoms that can change with time and
symptoms in children of this age range. Allergens tend to
intensity, along with a fluctuating expiratory airflow
be the primary cause of these intermittent symptoms (6).
restriction that may become permanent later on in the
While the symptoms commonly present in late
disease process (1).
childhood include wheezing, chest tightness, and non- Epidemiology:
localized chest pain, which are usually intermittent and
Asthma is a clinical ailment that affects millions of
primarily linked to allergen and exercise-induced
children throughout the world every year. In the United
symptoms, this results in decreased activity and a refusal
States alone, asthma affects about 25 million individuals.
to perform any exercise; however, severe attacks are more
6.4 million of these are children living in the United
common when exposed to triggers (7).
States. It is indicated that the global incidence of asthma Physical examinations:
has plateaued in some wealthy countries but continues to
Asthma symptoms can vary from person to person,
climb in low and middle-income countries (1).
and most individuals only have a history of asthma Diagnosis of asthma:
symptoms when they first visit the doctor. Acute attack
Making an asthma diagnosis relies heavily on finding
symptoms are most often detected through auscultation,
both a distinctive pattern of respiratory symptoms as well
which reveals a wheezy chest and a prolonged expiration
as a changeable restriction in expiratory airflow. Because
time. Respiratory distress may also take the form of
it is difficult to establish a diagnosis of asthma once the
tachypnea, retraction, grunting or even cyanosis, which
controller is started based on the pattern of respiratory
necessitates the use of supplemental oxygen (8).
symptoms and data supporting the diagnosis, asthma Investigations:
should be diagnosed as soon as a patient first presents (2).
When asthma is suspected, a pulmonary function test History:
must be performed. Asthma is mostly clinically
The presence of asthma or atopic condition in either
diagnosed. In order to reduce overdiagnosis or
mother or father is highly associated with asthma;
underdiagnosis, several algorisms were developed to link
diagnosis is based primarily on family history (3). Atopic
clinical history and symptoms to specific tests (9).
march, a pattern of clinically described atopic disorders, Treatment of Asthma (Fig. 1):
is present in the patient's medical history. Asthma first
Asthma treatment's goal is to regulate symptoms while
developed in childhood when the atopic march first
preserving children's regular activities and reducing
showed up as eczema or allergic rhinitis in infancy (4).
airway inflammation (10). Another goal is to lessen flare-
There has also been a link shown between asthma risk and
ups, keep lung function and development intact, and
early exposure to allergens like house dust mites (5).
reduce drug side effects to a minimum. Presentation of asthma symptoms: Asthma symptoms present itself in a non-specific and varied manner during
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RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKEThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3628-3634
Endovenous Laser Ablation, Radiofrequency Ablation and Flebogrif versus Conventional Surgery in Treatment of Primary Varicose Vein of the Lower Limb: Prospective Randomized Controlled Study Ahmed M. El Mahdi1, Sherif Omar El Kerdawi1, Ali Mahmoud M. Galal*2
1Vascular Surgery Department, Faculty of Medicine, Helwan University, Egypt.
2Vascular Surgery Department, Faculty of Medicine, Aswan University, Egypt. *Corresponding Author: Ali Mahmoud M. Galal, Mobile: (+20)1001816078, E-mail:[email protected] ABSTRACT Background: Endovenous laser ablation (EVLA), radiofrequency ablation (RFA) and mechanochemical ablation (MOCA) of primary varicose vein are thought to minimise postoperative morbidity and reduce work loss compared with the conventional surgical procedure. Objective: To determine, whether endovenous ablation methods (radiofrequency, laser and mechanochemical) have any advantages or disadvantages in comparison with conventional surgery, in the treatment of primary varicose vein. Patients and Methods: This was a prospective randomized study,conductedonforty patients presented at Vascular Outpatient Clinic for management of chronic venous insufficiency. All patients underwent clinical examination and duplex ultrasonography. Ten (10) patients were treated with ligation and stripping of the great saphenous vein (GSV). Ten (10) patients were treated with radiofrequency ablation. Ten (10) patients were treated with endovenous laser ablation. Ten (10) patients were treated with Flebogrif. Results: Compared with conventional surgery, endovenous ablation methods reduced postoperative discomfort and pain, with a lower complication rate after treatment for avoidance of a groin incision and dissection at the saphenofemoral confluence. Cosmetic demands were also better satisfied. Non-controlled clinical trials have shown that the ablation rate of GSV after EVLA is over 90%. However, risks of EVLA, RFA and Flebogrif remain in terms of recanalization and neoreflux via junctional tributaries. Conclusion: RFA, EVLA, and Flebogrif are minimally invasive procedures. Their potential early benefits, by avoiding groin dissection and GSV stripping, have been confirmed by the findings from this trial. Current evidence based on randomized trials consistently demonstrates significant early benefits after RFA, EVLA and Flebogrif in suitable patients with varicose veins. Keywords: Endovenous Laser Ablation, Flebogrif Lower Limb, Radiofrequency Ablation, Varicose Vein.
INTRODUCTION
Interventional treatment of superficial venous
Chronic venous disorders encompass a
incompetence can be accomplished by techniques that
spectrum
of
venous
diseases
from
simple
result in removal, ablation, or ligation of the refluxing
telangiectasia and reticular veins, varicose veins, leg
venous segment. Current options include high ligation,
edema
to
more
severe
forms,
including
ligation and stripping, endovascular ablation,
hyperpigmented skin changes, dermal sclerosis, and
sclerotherapy, and phlebotomy (2).
ulcer formation (1).
The aim of this study was to determine,
Chronic venous disorders with manifestations
whether
endovenous
ablation
methods
specific to abnormal venous function are termed chronic
(radiofrequency, laser and mechanochemical) have any
venous insufficiency (CVI). A distinguishing feature of
advantages or disadvantages in comparison with
chronic venous disease (CVD) and (CVI) is that (CVI)
conventional surgery, in the treatment of primary
indicates more advanced form of chronic venous
varicose vein.
disorders (2).
Varicose veins have been recognized since the PATIENTS AND METHODS
advent of recorded history, and manifestations of CVI,
This was a prospective randomized study,
including edema and ulceration, since biblical times.
conducted on forty patients presented at Vascular
The use of compression therapy dates back to roman
Outpatient Clinic for management of chronic venous
times, with foot soldiers using tight wraps to reduce
insufficiency. The study was conducted at Ain Shams
discomfort induced by prolonged standing. Modern
University Hospitals and Helwan University Hospitals.
understanding of CVI pathophysiology arouse with the
The study took place from September 2017 to June
work of Brodie and Trendelenburg in the 1850s and
2018. All patients underwent clinical examination and
1890s describing superficial and deep venous reflux.
duplex ultrasonography.
Trendelenburg was the first to introduce surgery for
The
patients
with
saphenofemoral
or
varicose veins marking the beginning of modern
saphenopopliteal
junction
incompetence
were
vascular surgery for this problem (1).
randomized. Ten (10) patients were treated with ligation and stripping of the GSV. This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_27The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3635-3638
Bronchial Asthma and Salivary Surfactant Protein D: Review Article Ahmed Hassan Hanafee*, Rabab Mohamed Elbehedy, Yousef Mohamed Yousef
Pediatrics Department, Faculty of Medicine, Zagazig University, Egypt. * Corresponding Author: Ahmed Hassan Hanafee, Email: [email protected] ABSTRACT Background: Chronic bronchial inflammation underlies asthma, which is a complex disease with varied and largely reversible blockage of the respiratory route. Asthma is a major public health issue that affects people of all ages around the world. Many countries are seeing an increase in the prevalence of this disease, particularly among children. Among children, asthma is the most frequent long-term condition, accounting for more than half of all missed school days, emergency room consultations, and hospitalizations. Surfactant Protein D, a pattern-recognition molecule, dampens elevated levels of particular antibodies, alveolar macrophage accumulation, eosinophilia, and subepithelial fibrosis and mucous metaplasia, as well as airway hyper-reactivity in allergic asthma in vivo. Objective: In order to discover the connection between children's bronchial asthma and surfactant protein D. Conclusion: Salivary SP-D is a simple, low-cost, quick, and noninvasive way to collect saliva from children. Salivary SP-D levels may be linked to asthma exacerbation severity and peripheral airway resistance. Keywords: Bronchial asthma, Surfactant protein D, Pediatrics.
Bronchial asthma in pediatrics:
hypothesized that SP-D also plays a role in
Asthma incidence has increased significantly
phospholipid homeostasis beyond the lungs (3).
over recent decades, and geographic variation is evident
in both the baseline prevalence rate and the extent of the Effects of SP-D:
increase. These findings lend credence to the idea that
Researchers have found that SP-D can attach to a
current asthma epidemics may be linked to
wide range of microbes, including bacteria, viruses,
environmental factors. Studies on asthma risk factors
fungi, and most recently, helminthic parasites, allowing
must take into account genetic, environmental, and host
them to be removed via opsonization and phagocyte
factors. Having an asthmatic parent or sibling is not a
recognition (4).
guarantee that kid will develop asthma (1). Nayak et al. (5) conducted a comprehensive
assessment of SP-various D's interactions with Salivary Surfactant Protein D:
pathogenic microorganisms.
In the collectin family of C-type lectins, the
Other biological or abiotic particles can also be
pattern-recognition molecule surfactant protein D.
attracted to SP-D, allowing it to aid in their removal
Surfactant protein A (SP-A) is a human collectin with a
from the airways and other possible locations for
tissue distribution and activities that largely coincide
exposure. There is evidence to support the claim that
with those of surfactant protein D (SP-D). It increases
SP-D can help to clear allergens and apoptotic material
phagocytosis of microorganisms and dying host cells by
from the body, as well as aggregate and remove particle
aggregating and enhancing phagocytosis. Mannan-
detritus. It has also been shown to impact the intestinal
binding lectin (MBL), another member of the collectin
microbiota of mice in several experiments (6).
family of proteins that activates complement via the
Antimicrobial properties of SP-D include
lectin route in association with MBL-associated serine
opsonization for phagocytosis as well as aggregation. It
proteases, is another example of a typical member of the
is possible that this will increase the effectiveness of
collectin family (2).
neutrophil extracellular traps, neutralization of
It has been found that SP-D is found in both
infectiousness, bacterial and fungal cell membrane
pulmonary as well as non-pulmonary tissue. These
destruction, and suppression of innate signals caused by
epithelia and glands have the protein attached to their
pathogens (7). The increased phagocytosis and
luminal or outer surfaces in order to function properly.
antibacterial activity of SP-D are advantageous to the
Since most of the places where it is expressed are at the
host. An increase in the burden of pathogens and the
interfaces with blood, tears, cerebrospinal fluid,
progression of disease may be facilitated by SP-D
amniotic fluid, and urine. SP-D participation in pattern
binding to the pathogen (8).
recognition would explain this. Non-pulmonary SP-D
expression locations may create materials that resemble Determinants of SP-D Levels:
surfactant, and phospholipid lubrication can be found in
Variations in BAL or circulatory SP-D levels are
a variety of different places throughout the human body.
linked to lung disease, according to a number of studies
Because it controls the amount of pulmonary surfactant
employing disease-selected cohorts (9). Furthermore, in
lipids, SP-D has a critical function in the lungs, and
a homogenous Caucasian population, factors such as
although this has not been studied, it has been
gender, smoking, body mass index, and age were found
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c:\work\Jor\vol852_28The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3639-3644
Value of Serum Growth Differentiation Factor 15 in diagnosis of Colorectal Cancer Ibraam F. Kamel*1, Hany M. Elsadek1, Ahmad Mokhtar Ahmad2, Ahmed I. Elagrody1
Departments 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ibraam Fakhry Kamel, Email:[email protected] ABSTRACT Background: Colorectal Cancer (CRC) is considered the third most deadly and fourth most commonly diagnosed cancer in the world. Objective: The aim of the present study was to compare serum levels ofgrowth differentiation factor-15(GDF-15) in patients with CRC and in those healthy control subjects. Patients and methods: The study included 60 subjects that were divided in two groups: Group included 30 patients diagnosed with colorectal cancer and group that included 30 healthy volunteers as control group. They didn`t have any acute or chronic diseases. All subjects of this study were subjected to full history taking, clinical examination and laboratory investigations. The study was conducted at Internal Medicine Department (gastroenterology and endoscopy unit), Faculty of Medicine, Zagazig University. Results: The study comprised 35 males (58.3%) and 25 females (41.7%), with a mean age of 61 ± 9 years. Twenty-six participants were from urban areas (43.3%) and 34 from rural areas (56.7%). Thirteen participants had a suspicious occupational exposure (21.7%) and 27 were smokers (45%). Mean BMI of all participants was 31 ± 6 kg/m2 with no statistically significant differences between the studied groups. Regarding Hb level and GDF-15, there were statistically significant differences between CRC group and control group where Hb was higher in the control group, while GDF- 15 was higher in CRC group. Conclusion: Growth differentiation factor 15 (GDF-15) could be used as a valuable independent biomarker for screening CRC. Keywords: Colorectal Cancer, GDF-15, CRP, CT scan.
INTRODUCTION
technical part was performed at Clinical Pathology
Colorectal cancer is the third most common
Department, Faculty of Medicine, Zagazig University.
malignancy in men (10%) and the second most common
The study included 60 subjects that were divided
cancer in women (9.2%) worldwide (1). Early detection
in two groups: Group included 30 patients diagnosed
and diagnosis improve outcomes and give chance for
with colorectal cancer and group , which included 30
effective and successful management. Early detection
healthy volunteers as control group. They didn`t have
of hepatic metastasis is an indication for surgical
any acute or chronic diseases.
intervention. Therefore, novel biomarkers for prompt
detection of cancer and screening of metastatic disease Inclusion criteria: Adult patients in age above 18 years
are strongly needed (2). It has been reported that the level
old, both male and female who were diagnosed with
of GDF-15 is markedly elevated in malignant tissues
colorectal carcinoma.
and cancer lesions as compared to non-malignant
normal tissues, and with basal GDF-15 serum level. Exclusion criteria: Patient with other primary
Many studies show the important role of GDF-15 in
malignant tumors, patient with inflammatory bowel
CRC (3).
disease and patient refusal.
GDF-15 dysregulation is involved in the
progression of colon cancer, and the serum level of Operative Assessment: All subjects of this study were
GDF-15 is gradually elevated with progression of
subjected to full history taking and complete clinical
adenomatous polyps to colorectal carcinoma. A
examination.
significant correlation was observed between serum
GDF-15 level and each of tumor stage and progression Routine laboratory investigations including:
of CRC to metastatic disease (4).
1) Complete blood count (CBC): by automated cell
Therefore, this study aimed to compare serum
counter "Sysmex XS" (Sysmex Corporation,
levels of GDF-15 in patients with CRC and those
Japan).
healthy control subjects.
2) Liver function tests: serum bilirubin (total and
direct), serum albumin, serum alanine transferase PATIENTS AND METHODS
and aspartate transferase measured by kinetic
The study was conducted at Internal Medicine
method.
Department (Gastroenterology and Endoscopy unit),
3) Kidney function test: serum creatinine and serum
Faculty of Medicine, Zagazig University, and the
urea.
4) Coagulation Profile.
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c:\work\Jor\vol852_29The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3645-3648
Evaluation of Retinal Nerve Fiber Layer Thickness in Patients with Multiple Sclerosis Rasha M. Fahmi, Amr E. Kamel, Mourad A. Salem*, Enas E. Mohammed
Department of Neurology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Mourad A. Salem, Mobile: (+2) 01068069208, Email:[email protected] ABSTRACT Background: Multiple sclerosis (MS) is a neurodegenerative disease, and is considered a chronic inflammatory disease. Retinal nerve fiber layer (RNFL) thickness as a structural biomarker for axonal loss in MS. Objective: The aim of the present study was to assess the role of optical coherence tomography (OCT) in detecting RNFL in MS patients without history of optic neuritis and to correlate with disease duration and disease disability. Patients and methods: Case-control study included 34 patients with clinically definite relapsing remitting multiple sclerosis (RRMS) and 34 age- and sex-matched individuals (other than MS) served as the controls. They were selected from the inpatients wards and Outpatients Clinic of Neurology Department, Zagazig University Hospitals. All patients were subjected to full history taking, clinical examination as well as laboratory and specific investigations. Results: The mean age was 34.56 ± 8.79 years in MS patients and 34.03 ± 8.79 years in controls. VEP 42.9% is with delay of p100 wave in bilateral eyes, and prolongal p100 laterary in bilateral eyes in 54.3%. There was a highly statistical significant difference between groups as regard RNFL average thickness and RNFL symmetry. Expanded disability status scale (EDSS) showed independently associated with RNFL. Conclusion: The thickness of the RNFL observed by OCT in MS patients is dramatically reduced when compared to controls, according to the current study. OCT is a valuable tool for determining the thickness of the RNFL in MS patients. Keywords: Multiple sclerosis, Optical coherence tomography, Retinal nerve.
INTRODUCTION
ON. Optical coherence tomography used image distinct
Multiple sclerosis is a journey from being at risk,
strata of the retina histologically in real time with
through the asymptomatic, prodromal and symptomatic
sensitivity enables micron-scale resolution imaging and
phases of the disease. MS is typically suspected when a
quantification of RNFL and macular thickness (6).
person presents with a clinically isolated syndrome
The present study aimed to evaluate the role of
(CIS). The most commonly seen presentations are optic
OCT in detecting the thickness of RNFL in MS patients
neuritis and brainstem and spinal cord syndromes.
without history of optic neuritis.
Gross clinical recovery from relapses often appears
A case control study included 34 patients with
complete in early MS; however, most relapses leave
relapsing remitting multiple sclerosis (RRMS) and 34
behind some damage (1).
age- and sex-matched control subjects were selected
Acute optic neuritis (ON) results in rapid and
from Outpatients Clinic of Neurology Department,
prominent peripapillary retinal nerve fiber layer
Zagazig University Hospitals.
(RNFL) as measured with optical coherence
tomography (OCT). However, the degree of thinning Inclusion criteria: Patients aged 18 years of both
within these layers following ON is heterogeneous,
sexes and with clinically definite RRMS. Control group
varying across patients, even within the same disease
with visual acuity (VA) of 20/30 or better and without
state. Optic neuritis is practically ubiquitous in MS, with
ophthalmic or neurologic diseases.
up to 94%99% of patients demonstrating
demyelinating plaques within their optic nerves (2). Exclusion criteria: cases with a refractive error of ±
Spectral-domain optical coherence tomography
5.0 D, history of optic neuritis (ON), other diseases as
(SD-OCT) has matured from a research instrument to a
hypertension or diabetes mellitus, glaucoma, anterior
tool used in clinical routine. SD-OCT permits the
ischemic optic neuropathy, congenital abnormalities of
visualization of neurodegeneration in vivo at a hitherto
the optic nerves, history of ocular surgery or penetrating
unparalleled structural resolution (3).
trauma.
The ability to quantify RNFL could provide a
diagnostic opportunity for assessing neuronal or axonal Clinical assessment:
damage (4). The optimal interval to capture RNFL
All patients were subjected to full history taking,
thinning is estimated to be approximately 6 months
clinical
examination
including
neurological
following acute ON.
examination at neurology department, Zagazig Gabilondo et al. (5) reported thinning from
University.
baseline of the RNFL by 45.3 m at 6 months following
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c:\work\Jor\vol852_30The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3649-3653
Estimated Brain Volume at Term Age in Very Preterm Infants with Uncomplicated Grade II And III Intraventricular Haemorrhage Ehab Sorour¹, Hossam Ibrahim ² ¹Pediatric Department, ² Radiology Department, Faculty of Medicine, Alazhar University
Corresponding author: Ehab Ibrahim Sorour, Mobile (+20)01013309288, E-mail: [email protected]
ABSTRACT Background and aims: In very pre-term new-borns, cerebral lesions are usually complicated with neuro-developmental issues. But un-complicated intra-ventricular haemorrhage (IVH) has no reliable associations with poor outcomes. Objective: In the current work we aimed to assess the impact of un-complicated brain haemorrhage on assessed brain size at term-equivalent ages (TEA), through standard indices made from cranial ultrasound (cUS). Methods: This study included 87 very pre-term babies [< 32 weeks' gestational age (GA)] up to and at TEA which were divided into two groups; group one included infants with uncomplicated grades II or III IVH, and group two included infants with normal cUS. A previously described standards based on linear measurements were used to calculate the estimated brain volumes at TEA and to compare between the two groups using independent groups t-test; p-value 0.05 was considered significant. Results: 19 very pre-term babies with un-complicated IVH and 68 with normal images have been studied. Bi-parietal diameter at TEA was shorter in the IVH new-borns (72 vs 87 mm, p-value < 0.05) while thalamo-occipital distance was longer in IVH infants (23.7/21.4 mm, p-value < 0.05)). But, there were non-significant changes at TEA for bi-frontal diameter (69.3 vs 70.1 mm), transverse cerebellar diameter (51.1 vs 49.9 mm), valued cranial size (384/414cc3), valued cerebral size (338/341cc3) and Levene's ventricular index (1.38/1.23 cm). Conclusions: There is no difference in assessed cerebral size at TEA, built on measures performed at the bedside via cranial US among very pre-term new-borns with dependably ordinary images and those with un-complicated grade II and grade III IVH. Keywords: Cranial ultrasound, Pre-term, Intraventricular haemorrhage.
INTRODUCTION
sorting). Well-established tri-dimensional standards
Parents and health workers dealing with very pre-
based on cUS charts for assessing brain sizes and
term newborns are highly concerned for the significant
diameters revealed a considerable change in brain sizes
danger of neuro-developmental difficulties. The dangers
among very pre-term babies with no brain pathology
of this problem differ inversely with gestational ages
investigated at TEA and term-delivered controls are
(GA), but other clinical variables and biomarkers are as
accessible, signifying a pattern of slower brain growth in
well very significant ¹.
very pre-term babies by TEA. Brain MRI was used in
The danger of long-term neuro-developmental
different studies for comparing with these US results
impairments connected to perinatal brain injuries and
supported that smaller brains on neuroimaging are
changed brain maturations in pre-term babies is
usually connected to risk of neuro-developmental issues.
considerably high ². The best method and timing of
In the current work, we utilized our cUS standards
neuroimaging for recognising elevated-risk babies is
for comparison of estimated brain dimensions among
under argument ³. Early and consecutive cUS may be
very pre-term babies with un-complicated IVH and a
satisfactory utilized to diagnose main brain injuries;
preceding group of very pre-term babies with no normal
however, it is not sensitive as MRI for the more common
cUS, to study influence of un-complicated IVH on brain
diffuse white matter injuries complicating pre-term
growth at TEA.
delivery. cUS still the commonest utilized neuro-
imaging method for pre-term babies as it is readily PATIENTS AND METHODS
accessible, simply repeated, and sufficiently sensitive for
The study was performed at a tertiary NICU of Al-
detection of most main pathologies.
Emadi hospital, Doha, Qatar. The study was explained
to parents of each baby and written consents were Factors affecting Long-Term Neurodevelopment:
signed.
A variety of perinatal factors are proven to be
associated with brain injuries and long-term neuro- Ethical approval:
developmental outcomes in pre-term delivery. These Al-Emadi hospital, Ethical Committee Board
involved GA at delivery, birth weight, multiple approved the study. Each patient enrolled in the
gestations, chorioamnionitis, antenatal corticosteroids, study signed an informed consent form. This work
broncho-pulmonary dysplasia, established sepsis and/or has been carried out in accordance with The Code of
necrotizing
enterocolitis,
and
intra-ventricular Ethics of the World Medical Association (Declaration
haemorrhage, detected on cUS (defined by Volpe of Helsinki) for studies involving humans.
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c:\work\Jor\vol852_31The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3654-3658
Evaluation of Adding Desmopressin to Alpha Blockers in Treatment of Nocturia in Cases of Benign Prostatic Hyperplasia: A Prospective Randomized Clinical Study Khaled Mohammed Abdelwahab, AbdEllatif Mohammed AbdEllatif, Ibrahim Ali Ibrahim Jaedah*, Maged Mohammed Ali
Department of Urology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ibrahim A. Jaedah, Email:[email protected] ABSTRACT Background: Nocturia is one of the most bothersome symptom of lower urinary tract symptoms in males with Benign Prostatic Hyperplasia (BPH). Alpha blockers has good effect in relieving bladder outlet obstruction. Objective: The aim of the present study was to provide best available medical treatment for nocturia in patients of BPH. Patients and methods: This prospective study was carried out on 44 male patients complaining of lower urinary tract symptoms (LUTS) of BPH with nocturia, were enrolled in this prospective randomized study for 12 weeks. They were divided randomly into 2 groups, each group included 22 patients. Group A: the patient received oral desmopressin added to tamsulosin once daily. Group B, the patient received oral tamsulosin daily. Results: The mean serum Na of patients at group A was 142.35. No significant difference regarding in-between groups before treatment but at after 12 week of treatment; group A was (mean of Na=137.68±2.033) significantly lower than group B and significantly decreased from before to after treatment. There was no significant difference between groups in both nocturnal void and nocturnal volume before treatment and after treatment as group A was significantly lower and both groups significantly changed and improved from before to after treatment. No significant difference was found at before treatment regarding total International Prostate Symptom Score (IPSS) but group A was significantly lower regarding total IPSS after treatment and both groups significantly decreased after treatment (6.36±2.59 in group A and 10.55±4.13 in group B). Conclusion: Addition of desmopressin to -blockers is an active therapy for men with BPH and suffering nocturia and is preferred than -blockers therapy alone. Keywords: Alpha Blockers, BPH, Desmopressin, Nocturia.
INTRODUCTION
desmopressin in treatment of nocturia in patients with
Polyuria is defined as a 24-h urine volume of >40
BPH.
mL/kg body weight, with nocturnal polyuria (NP)
defined as a proportion of the 24-h urine voided at night PATIENTS AND METHODS
being >2033%. NP is the most likely cause of
This prospective study was carried out at the
persistent nocturia in most patients who are treated for
Department of Urology, Zagazig University Hospital on
benign prostatic hyperplasia (BPH) (1). In men with
44 male patients complaining of lower urinary tract
benign prostatic hyperplasia (BPH), nocturia is
symptoms (LUTS) of BPH with nocturia, were enrolled
considered to be one of the most bothersome lower
in this prospective randomized study for 12 weeks.
urinary tract symptoms (LUTS), with a positive
correlation between degree of severity and increased Inclusion criteria: Males with BPH and nocturia 2
bother (2).
times or more/night.
Vasopressin also plays a minor role in increasing Exclusion criteria: Cases with the following conditions
systemic vascular resistance and increasing urea
were excluded from the study: diabetes insipidus,
reabsorption in the medullary collecting tubule. It is the
diabetes mellitus (uncontrolled), polydipsia, congestive
most frequently tested medication for the specific
heart failure, treatment with diuretics, impaired renal
treatment of nocturia, but has traditionally been used to
function.
treat central diabetes insipidus, bleeding disorders such
as Von Willebrand disease, and primary nocturnal Methods:
enuresis (3). Desmopressin, a synthetic analogue of
Patients were divided randomly by using computer
arginine vasopressin, has antidiuretic effects and leads
randomization program (Random-allocation software)
to a significant decrease in nocturnal urine output as
into 2 parallel groups; 1st group (Group A) patients took
well as the number of nocturia episodes in nocturnal
alpha blockers (oral tamsulosin 0.4 mg at bedtime) with
polyuria (4). The routine addition of oral desmopressin
desmopressin for 12 weeks. 2nd group (Group B)
to alpha blocker therapy to improve patients' bother
patients took alpha blockers (oral tamsulosin 0.4 mg at
symptoms is questionable (5).
bedtime for 12 weeks) only.
The aim of this study is to provide best available Dose of the drug:
medical treatment for nocturia in patients of BPH by
Desmopressin is administered orally at bedtime
evaluating the outcome (safety and efficacy) of oral
for 12 weeks usually beginning with 0.1 mg. Dose increase or decrease was permitted upon patient
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c:\work\Jor\vol852_32The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3659-3662
MISA (Minimally Invasive Surfactant Administration) Versus Insure (Intubation, Surfactant, Extubation) In Preterms Less Than 34 Weeks With RDS Mohamed I. Garib*, Wafaa Moustafa M. Abo El-Fotoh, Mohamad A. Ramadan
Department of Pediatrics, Faculty of Medicine, Menoufia University, Egypt *Corresponding author: Mohamed Garib, Mobile: (+20) 01010688218, E-Mail: [email protected] ABSTRACT Background: Newborn Respiratory Distress Syndrome (RDS) or what is known as surfactant deficiency disorder is a syndrome that affects premature infants who are born prematurely and is caused by a developmental deficiency in the production of pulmonary surfactant or as it is called immature formation of the lungs, or as a result of a defect in the protein gene that forms pulmonary surfactant. Non-invasive positive pressure ventilation (NIPPV) is the first technique for respiratory therapy while MISA and InSurE are both the most commonly used in RDS. Objective: To compare the use of the MISA method and the InSurE method in the treatment of premature infants less than 34 weeks of gestational age with respiratory distress syndrome (RDS). Patients and methods: The sample size was 70 infants with gestational age less than 34 weeks with RDS. 35 newborn were enrolled in each group. First group received surfactant via MIST technique and the other 35 newborn received it via InSurE technique. Infants in the InSurE group required intubation, according to previous collected data from the neonatal intensive care unit (NICU) center. Results: After the injection of surfactant, the 13 (37%) infants needed another dose in the MIST group, while only 3 (8.57%) infants in the InSurE group needed a second dose of the same substance. Accordingly, the response of the MIST group was shown to be a less improvement than the InSurE group in the child's breathing methods. Conclusion: The MIST method was the most successful with a rate of 96.5% in terms of time and the child's response to treatment, and the researcher recommended that the reasons for the effectiveness of MISA in treating RDS should be studied. However duration of invasive mechanical ventilation were higher in MIST group than InSurE group. Keywords: ICU, InSurE, MIST, RDS.
INTRODUCTION Nasal continuous positive airway pressure
The respiratory Distress Syndrome (RDS) is a
(NCPAP) is a common treatment for neonatal, which
common syndrome between premature who are 34
helps maintain the airways open by forcing air into the
weeks gestation or younger. RDS symptoms almost
nose. It can be administered by a ventilator (while the
appear within minutes of birth. However, they may not
baby is breathing on his or her own) or a separate
be observed for several hours. Newborn respiratory
CPAP device, which is monitored by InSurE. Nasal
distress syndrome has surfactant deficiency lung
intermittent positive pressure ventilation (NIPPV) is
disease. This surfactant is made by the cells in the
considered as a better alternative for the primary
airways of lung and its structure content is
respiratory support because its rate of respiratory failure
phospholipids and protein (1).
is lower and also it can deliver time-cycled positive
Surfactant is discovered in the amniotic fluid.
pressure ventilation more than positive end expiratory
Most babies will have acquired appropriate quantities
pressure (PEEP) level in the endotracheal tube absence
of surfactant by the time they reach 35 weeks of (4).
pregnancy. Surfactant deficiency causes breathing
In our research we wanted to compare between
complications in which less oxygen is provided and
two techniques to give surfactant for the new born. The
more carbon dioxide accumulates in the blood. There
first technique is minimal invasive surfactant
are several techniques and medication that used for RD
administration (MISA) which can be done by tube
syndrome treatment. Treatment will depend on how ill
inserting without intubation and other technique is
the newborn is (2).
InSurE, which is intubation then giving surfactant then Non-invasive positive pressure ventilation
extubation. This research aims to discover the effects of
(NIPPV) is considered as the first technique in
MISA versus InSurE in preterm less than 34 weeks
respiratory treatment, minimally-invasive surfactant
with RDS.
administration (MISA) and the Intubation Surfactant
PATIENTS AND METHODS
Extubating (InSurE) techniques are the most common
The number of preterm infants at the beginning of the
treatment for improving the oxygenation function of the
study was 89, 19 preterm infants were excluded due to
lung. Non-invasive ventilation is needed for surfactant
the lack of study conditions such as: 6 infants were not
administration. Surfactant is administered as a liquid
in need for surfactant, 5 infants were intubated at birth,
phase by tube that is an endotracheal tube in a suitable
4 infants had congenital anomaly, and 4 infants were
dose. Strategies that are used in minimally invasive
given surfactant after 6 hours of birth. The study was
technique for surfactant therapy (MIST) show good helpful results in preterm infants' treatment (3).
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c:\work\Jor\vol852_33The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3663-3667
Role of Prostaglandin E2 in Cirrhotic Patients with Spontaneous Bacterial Peritonitis Ahmed Ibraheem Aboghiaty1, Ihab Barsoum Fahim1, Hanan Samir Ahmed2, Ahmed Fathy Gomaa1
Departments of 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ahmed Ibraheem Aboghiaty, Mobile: (+2)01003567334, Email: [email protected] ABSTRACT Background: Spontaneous bacterial peritonitis (SBP) is the most frequent bacterial infection in patients who suffer from liver cirrhosis and ascites. Prostaglandin E2 (PGDE2) is considered a simple and accurate tool for diagnosing systemic inflammation and has a relevant impact on prognosis in cirrhotic patients. Objective: We tried to detect the role of PGDE2 in serum and ascitic fluid as a diagnostic marker for eradication of SBP. Patients and methods: This clinical-based prospective cohort study involved patients with liver cirrhosis, ascites and spontaneous bacterial peritonitis referred to the Internal Medicine Department, Faculty of Medicine, Zagazig University during the period from June 2020 to March2021. Patients with ascites were divided equally into: (a) case group included cirrhotic patients with SBP); and (b) control group included cirrhotic patients without SBP. All patients were subjected to complete clinical and laboratory examination. Serum and ascitic PGDE2 were estimated before and after five days of treatment. Results: There was statistically significant difference between the studied groups regarding Child score and presence of HCC. Serum and ascitic PGDE2 was elevated in all cirrhotic groups; both of case and control had more than normal. However, PGDE2 level was lower in case group before treatment in comparison with control group, and after treatment PGDE2 levels was elevated. Conclusion: Serum and ascitic fluid PGDE2 can be used as a diagnostic marker for SBP diagnosis and eradication. Serum PGDE2 is preferred due to its less invasiveness and minimal risk of complications. Keywords: Liver Cirrhosis, PGDE2, SBP.
INTRODUCTION
and bacterial translocation (BT), are potentially able to
Spontaneous bacterial peritonitis (SBP) is the
induce the synthesis of these markers (7).
most frequent bacterial infection in patients who suffer
Therefore, the aim of the present study was to
from liver cirrhosis and ascites (1).
detect the role of Prostaglandin E2 (PGDE2) in serum
Patients at greatest risk for spontaneous bacterial
and ascitic fluid as a diagnostic marker for eradication
peritonitis have decreased hepatic synthetic function
of SBP.
with associated low total protein level or prolonged
prothrombin time (PT) (45%) (2). PATIENTS AND METHODS
With respect to compromised host defenses,
This clinical-based prospective cohort study
patients with severe acute or chronic liver disease are
involved 52 patients with liver cirrhosis and ascites
often deficient in complement and may also have
referred to the Internal Medicine Department, Faculty
malfunctioning
of
the
neutrophils
and
of Medicine, Zagazig University during the period from
reticuloendothelial systems (3). In cirrhosis with portal
June 2020 to March 2021. Patients with ascites were
hypertension, the microcirculation in the intestinal
divided equally into: (a) case group included cirrhotic
mucosa is disturbed, resulting in a reduction of mucosal
patients with SBP and (b) control group included
blood flow that leads to congestion, edema, ischemia,
cirrhotic patients without SBP.
and potentially to erosions, intestinal bacterial
overgrowth and impaired mucosal integrity (4). Inclusion criteria: Cirrhotic patients with ascites
PGD E2 is promoted by IL-6, a proinflammatory
and diagnosed as SBP of both genders
IL upregulated in advanced liver disease (5). Its value Exclusion criteria: Patient with Collagen vascular
reflects the degree of systemic inflammation, regardless
disorders, patient with any form of acute arthritis,
of the underlying cause. Patients with decompensated
patient with acute infections and septicemia and patient
cirrhosis. PGDE2 as a surrogate marker of systemic
with other causes of elevated PGDE2.
inflammatory response and PGDE2 levels were higher
in patients who developed systemic inflammatory Methodology:
response syndrome, infection, and alcoholic hepatitis
Liver cirrhosis diagnosis done by clinical signs, (6). In cirrhosis, several factors independent of infection,
laboratory and ultrasound findings and severity of the
such as hepatocellular carcinoma (HCC), necrosis or
liver disease was scored according to ChildPugh's
the ongoing local inflammatory reaction in liver tissue
classification; Child-Pugh A=5-6 points, Child-Pugh B=7-9 points, Child-Pugh C=10 or more points.
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c:\work\Jor\vol852_34The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3668-3672
Assessment of Neurocognitive Functions in Children Treated for Cancer Mervat Atfy Mohammed, Mohamed Refaat Beshir, Mohammed Salim Hamad Alsuweediq, Rehab Saeed Mahdy
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt. *Corresponding Author: Mohammed Salim Hamad Alsuweediq, Email:[email protected]
ABSTRACT Background: About eight percent of adults and children who receive a cancer diagnosis today are projected to live at
least 5 years thanks to advancements in pediatric cancer therapy over the last several decades. More than half a million people will have survived childhood cancer by 2020, according to current estimates. Objective: To evaluate the association between childhood cancer, antineoplastic treatment and neurocognitive
dysfunction. Patients and Methods: In the Pediatrics Department of the Faculty of Medicine at Zagazig University, a case control
study was undertaken on 25 cancer patients who had completed their treatment and on 25 healthy children between August 2020 and July 2021. Children of both sexes, aged 5-15, were enrolled in the study. Results: In terms of full and performance intelligence quotient (IQ) scale, there was statistically significant difference
between the groups (much higher in the control group), but the verbal scale did not differ statistically between the groups. Regarding verbal IQ, there was no statistically significant difference between the groups examined. However, there were no significant differences in IQ subtests for information, vocabulary, arithmetic, comprehension, picture completion, mazes or block design between groups. Control group was significantly higher as regard similarity and geometric design. Conclusions: Neurocognitive function is affected in cancer survivors of children as there is statistically significant
difference between the studied groups regarding full, and performance IQ scale (significantly higher in control group) but verbal scale was not statistically different between the groups. Keywords: Cancer, Neurocognitive functions, Survivors,
INTRODUCTION
Neurocognitive impairments are common among
There are many different types of childhood
childhood cancer survivors. It's possible that cancer
cancer, and each one has its own etiology, treatment,
and/or therapy led to these problems. Children with
prognosis, and treatment options. There is also a risk of
cancer who have received neurotoxic therapies such
long-term hazardous side effects from chemotherapy,
neurosurgery, cranial radiation therapy (CRT), high
radiation, and other treatments. In the last 50 years,
dosage methotrexate, intrathecal chemotherapy, and
significant progress has been made in diagnostics,
corticosteroids have been shown to have significant
pharmacology, therapy combinations, and methods for
declines in their cognitive abilities (2).
children cancer, resulting in increased survival and
Childhood cancer survivors' brain development
decreased mortality rates for this disease. The five-year
may be influenced by a variety of sociodemographic,
survival rate for children with cancer has increased from
environmental, and biological factors. They can have a
30% in the 1960s to over 80% in most high-income
major impact on survivors' eventual functional
nations. It's important to note, however, that these
outcomes, such as schooling, work, income, and marital
advancements do not benefit all children equally, and
status because of these neurocognitive difficulties (3).
the prognosis varies depending on the type of cancer,
We aimed at this study to evaluate the association
age at which it first manifests itself clinically,
between childhood cancer, antineoplastic treatment and
anatomical site, and stage of the disease (in solid
neurocognitive dysfunction.
tumours).
Furthermore,
survival
rates
differ
significantly based on geographic region and even PATIENTS AND METHODS
within regions. The percentage of pediatric cancer
In the Pediatrics Department of the Faculty of
patients who survive into adulthood is rising. Increased
Medicine at Zagazig University, a case control study
attention and worries regarding cancer treatment
was undertaken on 25 cancer patients who had
exposures at a young age resulting in late effects have
completed their treatment and on 25 healthy children
accompanied this rising population, which has
between August 2020 and July 2021. Children of both
prompted a surge in interest in survivorship research.
sexes, aged 5-15, were enrolled in the study. The
Surviving children's cancer puts survivors at risk for a
research examined individuals with all types of cancer,
wide range of physical and mental health issues,
including children cancers, who had gone into remission
including depression, anxiety, suicidality, and suicidal
after treatment.
ideation, as well as other social and economic effects (1).
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c:\work\Jor\vol852_35The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3673-3677
Serum Soluble CD93 as a Biomarker of Asthma Exacerbation in Children Mohamed Osman Hafez1, Sanaa Mahmoud Abdelsalam2, Hanan Samir Ahmed1, Thuraya Rafea Goda Rafea*1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine Zagazig University, Egypt. *Corresponding author: Thuraya Rafea Goda Rafea, Mobile: (20)01129172494, Email: [email protected] ABSTRACT Background: Asthma is considered one of the most prevalent diseases affecting over than 300 million individuals worldwide. Soluble CD93 was normally detected in human plasma and induced by the inflammatory mediators TNF- and LPS, suggesting that physiologic pathways trigger the cleavage event. Objective: To evaluate the diagnostic value of serum soluble CD93 level in acute asthma exacerbation in children and to find if there is a relation between serum level of soluble CD93 and acute exacerbations of asthma among children. Patients and Methods: Our study included 30 patients who were diagnosed as acute asthmatics with acute exacerbation (diagnosed and classified according to GINA 2018) as group I. Group , which included the same 30 patients after receiving treatment and relieve of symptoms by clinical examination as well as routine laboratory investigations that confirmed their healthy state. Plasma sCD93 concentration using ELISA (at the time of exacerbation and repeated on the follow up day) and spirometry were done. Results: Regarding severity (after classification of cases into intermittent, mild and moderate), there was no statistical significance difference in severity either pre- or post-treatment. Regarding sCD93, there was statistical significance reduction in sCD 93 level post-treatment compared to pre-treatment in all cases. There were no statistical significance relation between gender, residence and family history and sCD 93 levels among the studied group. There were no statistical significance relation between WBCs and x-ray and sCD 93 levels among the studied group. Conclusion: sCD93 was not affected by gender or age and did not affect by reliever or controller medications. sCD93 showed a modest decrease in the controlled stage of asthma, which allowed to interpret its role as inflammatory biomarker. Keywords: Serum soluble CD93, Biomarker, Asthma exacerbation.
INTRODUCTION
is 120 kD and consists of a c-type carbohydrate-
Asthma is considered one of the most prevalent
recognition domain, a fine rationale epidermal growth
diseases affecting over than 300 million individuals
factor-like domain, a single transmembrane domain, a
worldwide (1). It is defined as a chronic immunological
main domain, and an intracellular domain (5). CD93 has
lung disorder causing reversible obstruction,
been implicated in regulating adhesion and expression
inflammation of air ways and increases its hyper-
on the endothelial and circulating cells and cellular
responsiveness to various provocations (2).
homing to the sites of inflammation. Also, CD93 could
The diagnosis and management of asthma is
be involved in endothelial cell migration, angiogenesis,
generally based on symptoms together with pulmonary
leukocytes extravasation, removal of immune
function tests results. But these criteria may not reflect
complexes and pathogenic factors via the process of
the underlying airway inflammation so asthma research
phagocytosis (6). Soluble CD93 was normally detected
is shifting to the narrow-focus cellular profiles, protein
in human plasma and induced by the inflammatory
analysis, biomarkers, and genetic markers. Asthma
mediators TNF- and LPS, which suggest physiologic
biomarkers include biomolecules that undergo cellular,
pathways that trigger the cleavage event (7).
biochemical, or molecular alterations in asthmatic
The aim of this work was to evaluate diagnostic
patients versus healthy subjects that can be measured in
value of serum soluble CD93 level in acute asthma
biological samples, such as lung tissue, bronchoalveolar
exacerbation in children.
lavage fluid, nasal fluid, or blood, but being these
currently unavailable in asthma, reliable and PATIENTS AND METHODS
noninvasive biomarkers would ideally be standard in
This study was carried out over 18 months from
the daily clinical routine (3).
February 2017 to August 2018 in the Outpatient Clinic
Type 1 transmembraneglycoproteine CD93
of Pediatric Department, Faculty of Medicine, Zagazig
(C1qRP) is encoded by the CD93 gene found on
University Hospitals on 30 asthmatic patients
chromosome 20. It is expressed early on the surface of
( according to GINA guidelines 2018 (8)). The patients
myeloid cells during B-cell differentiation in the bone
were classified into group (patients group before
marrow and on the surface of hematopoietic stem cells,
treatment), which included 30 asthmatic patients with
natural killer cells, endothelial cells, platelets, and
acute exacerbation (17 females and 13 males). Their
microglia (4). The predicted molecular weight of CD93
ages ranged from 5-14 years with a mean of 9.7 ± 3.24
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c:\work\Jor\vol852_36The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3678-3681
Trace Element's Role in Male Infertility; Review Article Mohamed Sobhy Abd Elhady*, Abdalla Hasan Kandil, Waleed Mohamed Albalat
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Mohamed Sobhy Abd Elhady, Email: [email protected] ABSTRACT Background: Trace elements are the basic components of biological enzyme system or the structural components of very low concentration bioactive components. There are a number of trace elements in foods, such as iron, iodine, fluorine, copper and zinc, as well as chromium and cobalt. Other trace elements include tin and vanadium. Nickel and silicon are two examples of metals. Some of the trace elements are toxic to reproductive health at high doses. Trace amounts of these substances are rarely used for various physiological functions of the body. Many metal ions (copper, arsenic, cadmium, chromium, nickel, lithium vanadium, lead, and mercury) have many adverse effects on reproduction and development, fertility of men and women, abortion, and deformity. Exposure timing and duration, metal ions' distribution and accumulation in various organs, and interference with specific developmental processes; all have an impact on the consequences of metal ions. Objective: To assess the trace element's role in male infertility especially the role of zinc. Conclusion: Trace elements are very important for the sperm production and quality and could affect the male fertility by one way or another. Keywords: Male Infertility, Trace Elements.
INTRODUCTION
The components of the human body come in a variety
Environmental, dietary, lifestyle, and work-related
of shapes and sizes. Essential elements must not only
factors all have a significant impact on a wide range of
exist, but must also be present in the correct quantities and
health issues, such as cancer, cardiovascular diseases,
oxidation states, as well as paired with the appropriate
reproductive and developmental defects. In the past few
chemical partners, in order to preserve optimal health (3).
decades, many aspects of our diet, lifestyle, and
For this reason, morphological analysis is critical in the
environment have changed gradually. In lifestyle,
quest to find the cause of and treat physical ailments. This
consumption of tobacco, drinking alcohol or using illegal
will reveal the presence of specific chemicals and explain
drugs or any combination of these has a significant
the internal balance (constant excretion and
negative influence on one's overall health. Numerous
rearrangement) and trace element intake and metabolism
medical conditions including high blood pressure,
mechanism (4).
diabetes, lipids that are out of control, and obesity,
According to its concentration in nature, elements can
cardiovascular disease, and even some types of cancer are
be divided into primary, secondary, trace, or ultra-trace
related to nutrition and lifestyle factors to a certain extent.
elements. In human body, primary /there are a number of
These factors may also be the reasons for increasing
secondary elements as well as a number of ultra-
reproductive disorders in men and women. Reproduction
trace/trace elements. The secondary elements include: H,
is an important biological activity of all organisms.
C, N, O, Na, Mg, P, S, Cl, K, and Ca, while the ultra-trace
Cancer of the testicles, congenital defects such
elements include: F, Si, V, Cr, Mn, Fe, Co, Ni, Cu, Zn,
cryptorchidism and urethral malformation, and a scrotum
As, Se, Mo, Sn, and I (3).
all affect the quality of the male reproductive fluid
(semen) (1). Role of trace elements in human health:
Abnormal concentrations of certain elements are
As well as reducing and oxidizing reactions,
linked to certain clinical conditions. For example, a lack
membrane permeability, the function of subcellular
of balance in at least 19 components might cause issues
organs (such mitochondria), and the production and
during human reproduction, embryogenesis, and
stability of proteins and nucleic acids, trace elements are
pregnancy. Mercury, lithium, boron, aluminium, lead,
engaged in other biological functions (5).
chromium, manganese, and iron, as well as, selenium,
nickel, copper, zinc, arsenic, cadmium, cobalt, tellurium, Seminal plasma:
molybdenum, indium, and iodine are among these
Testes and the male reproductive organs combine
elements (2).
to generate semen, which is a chemical solution. Sperm suspended in seminal plasma make up this substance. It is
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c:\work\Jor\vol852_37The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3682-3686
Insulin Growth Factor-1 in Egyptian Children with Juvenile Idiopathic Arthritis: Correlation with Growth Pattern and Disease Activity Nermin H. El-Gharbawy*1, Rasha M. Hammoda2, Mona Mohamed El-Bably1
Departments of 1Physical Medicine, Rheumatology and Rehabilitation and
2Internal Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Egypt. *Corresponding author: Nermin Hassan El-Gharbawy, Mobile: (+20) 01066099955, Email: [email protected] ABSTRACT Background: Juvenile idiopathic arthritis (JIA) is a systemic, chronic, inflammatory disease that affects patients under 18 years. Interactions between growth hormone (GH), insulin-like growth factor-1 (IGF-1), and the immune system are complex. Many studies found that chronic inflammation suppresses GH/IGF-1 axis. Objective: To assess if there is correlation between the serum level of IGF-1 and the growth pattern in children with JIA in Egypt, and to evaluate the correlation between the serum level of IGF-1 and disease activity among these patients. Patients and Method: The study was a case control study which included 80 patients with JIA and 40 normal children as a control. Their ages ranged from 5-15 years. All patients were subjected to full history taking from their care givers, clinical examination, growth assessment, and laboratory measurement of serum IGF-1 level, CRP, ESR, and CBC. Results: There was a statistically significant decrease in serum level of IGF-1 among patients with JIA. There was a statistically significant positive correlation between serum level of IGF-1 with height, weight and BMI. There was a statistically significant difference between patients and controls regarding Height-for-Age-Z-Score (HAZ), 35% of patients had short stature. There was a statistically significant decrease in weight and BMI, 90% of patients were underweight. There was no statistically significant correlation between serum level of IGF-1 and the disease activity. Conclusion: There was a statistically significant positive correlation between IGF-1 with height, weight and BMI. Short stature and underweight were common among JIA patients. There was no significant correlation between serum level of IGF-1 and the disease activity among JIA patients. Keywords: Body mass index (BMI), Growth hormone (GH), Insulin-like growth factor-1(IGF-1), Juvenile idiopathic arthritis (JIA), Height-for-Age-Z-score (HAZ).
INTRODUCTION
Against Rheumatism) defined the current classification
Juvenile idiopathic arthritis (JIA) unifies all
of JIA categories (8).
forms of chronic arthritis during childhood, affecting
Impaired
linear
growth
is
commonly
joints and extra-articular structures (including eyes,
encountered in children with chronic inflammatory
skin, and internal organs) and is leading to disability. It
diseases such as JIA (9). Growth retardation may lead to
is defined as the presence of arthritis of unknown
short stature and a reduction in adult height despite the
etiology that starts before the age of 18 and persists for
medical therapy (10). Suboptimal nutrition, prolonged
at least 6 weeks (1). The prevalence of JIA in Europe was
use of glucocorticoid, and chronic inflammation itself
reported as 0.07 - 4.01 per 1000 children and the annual
contribute to the underlying pathophysiology of growth
incidence is 0.008 to 0.226 per 1000 children (2).
retardation (11, 12). This may be through effects on the
Although epidemiological studies are limited in Egypt,
growth hormone (GH) axis that regulates linear growth
few data was reported to a similar range (3).
or through direct effects on the level of the growth plate
The pathogenesis of JIA is currently unknown, (13). Chronic inflammation may lead to a continuum of
but it is a complex multifactorial origin due to a
abnormalities in the systemic GH/IGF-1 axis, including
combination of environmental factors and specific
relative GH insufficiency, GH/IGF-1 resistance due to
immunogenic factors (4). Genetic variants underlying
impairment of IGF binding proteins (IGFBPs), down-
JIA susceptibility have been reported (5).
regulation of GH/IGF receptors and/or impairment of
The diagnosis of JIA requires the persistence of
local GH and IGF-1 signaling pathways (14).
arthritis of at least one joint in a child less than 18 years
The aim of the studywas to assess the
old for more than 6 weeks after exclusion of other
correlation between the serum level of IGF-1 and the
causes of arthritis (6). Joint inflammation manifests with
growth pattern in children with JIA in Egypt, and to
joint pain, effusion, decreased range of motion, or
evaluate the correlation between the serum level of IGF-
warmth over the joint (7).
1 and disease activity among these patients.
Based on the predominant clinical and PATIENTS AND METHODS
laboratory features presented during the first 6 months
A case control study of 80 children diagnosed as
of the disease, the ILAR (the International League
JIA were recruited from pediatric outpatient clinic of Ain Shams University Hospitals during the period from
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CLAUDIN-3 Protein Expression Relation with Dermatological Diseases: Review Article Shorouk Hegazy Abdel Hamid*, Ayman ElSayed, Hagar Awad
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University. *Corresponding Author: Shorouk Hegazy Abdel Hamid, Email: [email protected] ABSTRACT Background: When it comes to barrier and pore creation in metazoans, especially vertebrates and tunicates. Claudins are an important family of transmembrane proteins. In epithelia and endothelia's apical junctional complex, chordate claudins are crucial architectural proteins for tight junction strands. Psoriasis patients often have some degree of subclinical intestinal irritation. In gastrointestinal mucosal biopsies, lymphocytic infiltration is found in about 60% of patients. Intestinal absorption is hampered by structural and functional changes in the colon caused by inflammatory cells. Those who have psoriasis have abnormalities in fecal fat excretion, decreased D-xylose absorption, and impaired lactase activity.Objective: To assess the relation between CLAUDIN-3 protein with dermatological diseases. Conclusion: Claudin-3 is a key component of tight junctions, which may serve as marker of gut barrier integrity. Claudin-3 level may be altered in patients with psoriasis. Keywords: CLAUDIN-3 protein, Psoriasis.
INTRODUCTION
homeostasis maintenance. Cells' protective barriers are
Claudins are a group of transmembrane proteins
made up of three types of structures: desmosomes,
found in metazoans, particularly in vertebrates and
adhesion junction (AJ) cells, and tight junction (TJ)
tunicates that help build barriers and pores. Chordate
cells (4). Occluding junctions, also called TJs, are
claudins are critical structural proteins in epithelial and
multiprotein complexes that help cells keep their
endothelial cells' apical junctional complexes where
barriers intact while simultaneously allowing for
they form tight junction threads (1). In tissues, the
intercellular communication and movement. TJs are
claudin protein complexes found in junctional strands
most frequently seen in the epithelial cell's apical
serve primarily as paracellular seals for big molecules
region. TJs have three key transmembrane proteins:
and as an ion semipermeable barrier. To provide tissue-
junction adhesion molecule (JAM), occludin and
specific permeability and barrier properties, different
claudin (5).
claudin members are overexpressed in a given tissue (2).
These tiny proteins, which have four
For the assembly of cell-to-cell signals, claudins act
transmembrane domains and N- and C-terminal ends in
as scaffold proteins. Understanding the expression,
the cytoplasm as well as two extracellular loops, are
organization, and regulation of the claudin family of
called claudins. They range in size from 2034 kDa
proteins in the cell at a temporal and geographical
(Figure 1) (6). Paracellular charge and ion selectivity are
resolution is crucial for uncovering processes that affect
regulated by the first extracellular loop, which is located
paracellular barrier function, tissue integrity, and
outside the cell. Second extracellular loop is involved in
stability (3).
adhesion of claudinclaudin interaction and functions as a receptor for the toxin produced by bacterial Claudins Structure:
The primary role of epithelial and endothelial
infection (7).
cells in most living organisms is organ protection and
Figure (1): Claudins have a specific structure and function as a component of a tight junction (7)
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Updated Management of Atrophic Post Acne Scars: Review Article Sohier Mohammed Ghonemy, Ayat Saleh Mohammed*, Waleed Mohammed AlBalat
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Egypt. *Corresponding Author: Ayat Saleh Mohammed, Email:[email protected] ABSTRACT Background: Hair follicle and sebaceous gland inflammation causes acne, which is a long-term, chronic skin condition. The androgen-induced sebum overproduction leads to first acne appearance. It is caused by altered and aberrant keratinization, inflammation and the colonization of facial hair follicles by the bacteria Propionibacterium acnes. Acne also has a delayed immune response, as well as influences from the environment and genetics. Treatments for post-acne scarring have included topical preparations such as chemical peels, dermabrasion, laser resurfacing and punch excision and punch elevation, as well as fat transfer, implantation of autologous collagen and cultured and expanded autologous fibroblasts. Other treatments have included trichloroacetic acid focal treatment and skin microneedling to improve the dermal extracellular matrix (ECM) proteins. Objective: To determine the updated treatment modalities in atrophic post-acne scars. Conclusion: In most types of atrophic acne scars combination therapies typically provide superior outcomes than solo treatments. Keywords: Management, Atrophic post-acne scars.
Acne Scars: 1. Laser resurfacing:
Eczema, often known as acne, is an inflammatory Ablative (traditional and fractional):
skin condition that affects the pilosebaceous units. It is Non-ablative (traditional and fractional):
characterized by seborrhea and the development of
In order to give heat energy, they use a
comedones, erythematous papules and pustules. Acne
monochromatic light source, which then stimulates skin
affects 90 percent of people between puberty and 30
fibroblasts to produce new collagen and elastin (5).
years of age, both males and females (1).
Physicians now have more alternatives as new
Because of permanent and unsightly consequence
technologies emerge, giving them a better balance
of inflammatory acne, acne scars are formed. Severity,
between efficacy and tolerance, as well as adverse
duration of acne, and time since therapy has been, all
effects for each patient. Discomfort during the
are linked to it (2).
procedure, considerable recovery time and a high risk
of adverse effects are all connected with traditional Mechanisms inducing acne scarring:
ablative lasers. While non-ablative lasers are less
Inflammatory processes, follicular rupture, and
painful and require fewer treatments, the results aren't
perifollicular abscess formation are all caused by acne
as impressive clinically as ablative lasers (6).
pathogens, and these wound-healing processes involve
soluble
chemomediators,
ECM
components, Acne scar removal using lasers:
parenchymal resident cells like keratinocytes, and Traditional CO2 laser at a wavelength of 10,600
infiltrating blood cells like lymphocytes, which are
nm. Far infrared light is emitted by the ablative CO2
collectively referred to as immunoinflammatory cells.
laser. 2,940 nm Er: YAG lasers are a less-damaging
There are three stages to the wound healing process:
alternative to the more common CO2 lasers (7).
inflammation, scarring, and closure. Thus, formation of
Fractional ablation lasers with ablation at a distance. As
granulation tissue and renovation of the matrix (3).
a result of the development of ablative fractional lasers,
which have fewer side effects than fractional Treatment of Acne Scarring:
technology but are just as effective, ablative lasers were
If erythema is present, treatment should begin with
created (8).
managing it. Treatment should target atrophic scarring,
The CO2 laser has a peak wavelength of 10,600
with the strategy decided by the types of scars present
nm and is a fractional laser. Studies show that fractional
and whether they are generalized or individual in nature.
CO2 lasers are effective in treating acne scars; however
Patients who receive early treatment and a combination
the improvements are not as dramatic as with regular
of treatments tailored to their unique needs are most
ablative lasers (9). Collagen remodeling is induced by
likely to see substantial changes (4).
non-ablative lasers that use water as their principal
chromophore of light. They also show that hemoglobin Generalized atrophic scars:
and melanin absorb different amounts of the substance.
Dermabrasion, lasers, chemical peels, microneedling,
They transmit photothermal energy to the dermis
and radiofrequency are all used in treatment.
without ablating the surrounding epidermis, resulting in
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c:\work\Jor\vol852_40The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3695-3699
Necrotizing Pneumonia: A Case Report on a Rare Complication of Respiratory Syncytial Virus Pneumonia Rotana Hammad 1, Khourshed Tewfik 1, Shahinaz Munshi2, Mohammed Felemban3
Departments of 1Pediatric Pulmonary Medicine and 2Pediatric Allergy/Immunology,
King Fahd Armed Forces Hospital, Jeddah, KSA
3Jeddah Health Surveillance Centers, Ministry of Health, Jeddah, KSA ABSTRACT Background: Necrotizing pneumonia is uncommon in children compared to adults. It is characterized by progressive pneumonic illness in a previously well child despite appropriate antibiotic treatment. This further leads to areas of necrosis and liquefaction of the consolidated lung tissue, which may be complicated by solitary, multiple, or multiloculated radiolucent foci, bronchopleural fistulas, and intrapulmonary abscess formation. Necrotizing pneumonia is usually secondary to Pneumococcus, Staphylococcus aureus, or, less commonly, Pseudomonas aeruginosa infections, and is rarely seen secondary to viruses. Although cavitary necrosis manifests as a severe disease, most children exhibit complete recovery even without surgical treatment and have normal chest radiographs in the long term. Case report: In this report, a 3-year-old immunocompetent patient developed pleural effusion and empyema and underwent ultrasound-guided drainage without clinical improvement, leading to necrotizing pneumonia secondary to a respiratory syncytial virus and requiring video-assisted thoracoscopic surgery. We initiated conservative treatment with prolonged antibiotics, ventilator support, and analgesics. Conclusion: Early surgical intervention in cases of necrotizing pneumonia is challenging, and it is unknown whether it is superior to medical management. Repeating chest radiographs should be considered in cases of changes in the patient's status or whenever there is a delay in recovery. Keywords: Necrotizing pneumonia, Respiratory syncytial virus, Video-assisted thoracoscopic surgery INTRODUCTION
who are immunocompromised. The typical histological
Necrotizing pneumonia is a potentially fatal
finding of RSV pneumonia is the interstitial infiltration of
complication of pulmonary infection with high
mononuclear cells, which is mainly manifested as
morbidity. Staphylococcus aureus strains that produce
widening of the alveolar space and the predominant
Panton-Valentine leucocidin, as well as Streptococcus
exudate interstitial monocyte (2). pneumonia and Klebsiella pneumonia, are reportedly the
Here, we report a case of RSV pneumonia presenting
most frequent cause of rapidly progressive necrosis of the
as rapidly progressive necrotizing pneumonia in an
lung
tissue
in
young
immunocompetent
immunocompetent patient.
patients. Moreover, necrotizing pneumonia is less
frequently secondary to fungi and viruses among Case presentation:
immunocompetent patients. Fungi are more common in
A previously healthy 3-year-old Saudi male
patients who are immunocompromised, causing
presented to our Emergency Department, King Fahd
cavitation and fibrotic changes in the lungs. Respiratory
Armed Forces Hospital, with fever, nasal congestion, and
syncytial virus (RSV) is the most common cause of acute
shortness of breath for 2 days. The patient had a history
lower respiratory tract infections in infants and young
of coughing and had contact with his mother who has an
children and has caused approximately 66,000 to 199,000
upper respiratory tract infection. He was in respiratory
deaths among children worldwide in 2005 (1).
distress, was tachypneic, had a respiratory rate of 44 bpm,
It is a single-stranded negative-sense RNA virus that
was febrile with a temperature of 39°C, had a desaturation
belongs to the family of paramyxoviruses that is
of up to 88% on room air, and exhibited a fussiness with
transmitted
through
respiratory
droplets
and
no cyanosis.
contact. While the majority of infants display only mild
The initial laboratory findings revealed mild
upper respiratory tract infection, the virus can lead to
leukocytosis with a white blood cell count (WBC) of 10.3
bronchiolitis and severe lower respiratory tract infection
x109/L, neutrophil count of 57%, lymphocyte count of
in young children, and it is responsible for serious
30%, platelet count of 204 x109/L, and a C-reactive
complications, respiratory failure, prolonged hospital
protein level of 166 mg/L. The patient exhibited
stay, and even high mortality, especially in individuals
combined metabolic and respiratory alkalosis on blood
gas and his blood culture showed no organism.
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c:\work\Jor\vol852_41The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3700-3705
Hypophosphatemia and Hyponatremia in Systemic Lupus Erythematosus Patients and Its Relation to Clinical Characteristic and Disease Activity Alyaa A. Mohamed*, Esam M. Abu AlFadl, Osama S. Daifallah, Rabab H. Ali
Department of Physical Medicine, Rheumatology & Rehabilitation, Faculty of Medicine, Sohag University, Egypt *Corresponding author: Alyaa A. Mohamed, Mobile: (+20)1007218644, E-mail: [email protected]
ABSTRACT Background: Systemic Lupus Erythematosus (SLE) is a chronic auto-immune disease with diverse manifestations, ranging from mild rash or arthritis to severe organ-threatening involvement. Objective: The aim of the work was to find-out the possible association of hypophosphatemia and hyponatremia with disease activity in SLE patients. Patients and methods: A total of 100 patients with SLE were involved in this study and the serum level of sodium and phosphorus, erythrocyte sedimentation rate (ESR), leucocytic and platelet counts, and 24 hr. protein were measured. SLE disease activity index (SLEDAI) score was assessed, Results: The majority of patients were females; 94 (94%) and 6 males (6%) (F:M 15.7:1). The age of the patient ranged from 17 to 63 years with a mean age of 34.23 ±11.19 years. The disease duration was 48±55.7 months. 7. 41% of SLE patients were hyponatremic and 49% showed normonatremic. There was a significant correlation between Na level, SLEDAI score, vasculitis and arthritis and insignificant correlation with ESR. 47 patients were hypophosphatemic (47%) and 53 (53%) were normophophatemic. There was a significant correlation between phosphate level and SLEDAI, oral ulcers p=0.001 and arthritis p<0.0004 but negatively related with ESR. Conclusion: It could be concluded that hyponatremia and hypophosphatemia are significantly related to SLEDAI, so it could be used as indicators of SLE activity and sever inflammation. Keywords: Systemic lupus erythematosus, Hypophosphatemia, Hyponatremia, SLEDAI score.
INTRODUCTION
Lupus activity can be measured by many
Systemic lupus erythematosus (SLE) is a
laboratory markers as aberrant production and
chronic
auto-immune
disease
with
diverse
imbalance of T-helper (Th1/Th2) cell cytokines which
manifestations, ranging from mild rash or arthritis to
have been implicated in the pathogenesis of
severe organ-threatening involvement (1).
autoimmunity. Also Increased RDW is connected with
SLE in Egypt shares many similarities with
active disease status of SLE patients. RDW could be
that in other nations. At the same time, several different
used as a surrogate marker of the inflammation and
clinical and immunologic characteristics are displayed
correlated with the SLEDAI score (8).
even within the same country. Autoantibodies are
Hypophosphatemia is observed not only in
present in a comparable number of patients as shown
genetic diseases such as Xlinked hypophosphatemia
worldwide. Genetic and/or climatic factors may lead to (9), autosomal dominant hypophosphatemia, and
different presentations of lupus and subsequent
McCuneAlbright syndrome (10), but also in acquired
different therapeutic regimens (2).
states including tumorinduced osteomalacia and
Systemic lupus Erythematosus (SLE) is a
malnutrition. Studies have revealed that fibroblast
typical autoimmune disease which adversely affects
growth factor 23 seems to play a key role in phosphate
multiple end-organs, including heart, joints, liver, and
metabolism (11).
Although
mechanisms
of
kidneys. Hyper activation of autoantibodies against cell
hypophosphatemia in these conditions are not fully
nucleic antigens leads to the deposition of immune
understood. A recent report showed that serum
complex in end organs (3, 4).
phosphate concentrations were decreased in early
Common manifestations may include
sepsis, and tumor necrosis factor (TNF) and
arthralgia and arthritis, malar and other skin rashes,
interleukin 6 (IL6) were suggested to be causes of
pleuritis or pericarditis, renal or CNS involvement,
hypophosphatemia in this pathologic condition (12). In
hematologic cytopenia and weight changes are the most
SLE, those cytokines have been shown to be involved
common symptoms in new cases or recurrent active
in the disease activity, which led us to speculate about
SLE flares (5), with abnormal laboratory data, such as
whether Phosphate metabolism in SLE might be
pancytopenia, low serum complement concentrations
aberrant, especially in patients with active disease (9).
and positive autoantibodies against nucleus and DNA.
Hyponatremia is defined as a serum sodium
Abnormalities of phosphorus (P) have never been
level that is less than 135 mEq/L. It is a common water
described (6, 7).
balance disorder, with multiple causes including,
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Demographic Aspects of Human Hydatidosis in Egypt Elham Adel Ahmed Elgabaly Heikal, Fatma Mohamad Ibrahem El-Lessy,
Department of Parasitology, Faculty of Medicine for Girls, Al-Azhar University, Egypt *Corresponding author: Elham Adel Heikal, Mobile: (+20)1016868799, E-Mail: [email protected] ABSTRACT Background: Cystic echinococcosis or hydatidosis is caused by the larval stage of the tapeworm Echinococcus granulosus. It is one of the most important parasitic zoonoses. Objective: The aim of the work wasto determine the prevalence of the disease in humans and its clinical presentation, also targeted to identify risk factors predisposing infections. Subjects and Methods:Thirty-one cystic echinococcosis cases were collected to determine the presence of hydatid cysts in human.Confirmation of hydatid cyst infection was done by radiological assessment and direct parasitological detection of hydatid cyst through PAIR technique or pathological confirmation of surgical removal cyst. A questionnaire survey to identify risk factors of transmission was also carried out. Results:The highest percent of infection with hydatid cyst was in age group 21-30 years (29.04%), followed by age group 31-40 years and 41-50 years that attained (25.81%) for each. Females attained the higher percent of infection (58.06%) in comparison to males (41.94 %).The highest percent of cystic echinococcosis was recorded for farmers (32.26 %) followed by housewives (29.03%). 67.75 % of cystic echinococcosiswas for rural resident and (32.25%) was for urban resident. Conclusion: It could be concluded that hydatid disease is still an endemic problem and is a course of challenge to all the medical practitioners. The study has established that hydatidosis is prevalent in humans in Egypt and that the risk factors for its transmission exist. Keywords: Cystic echinococcosis, hydatid cyst, prevalence, Egypt. INTRODUCTION
Accidental discovery of asymptomatic CE in liver is
Hydatid disease or cystic echinococcosis (CE) is a
frequent in uncomplicated cases (8). Many patients
major zoonotic disease of significant public health and
present first by complications which occur in about
worldwide distribution caused by the larval stage of the
(40%) of cases as infection, rupture to the biliary tree,
dog tapeworm belonging to the family Taeniidae;
rupture to the peritoneal cavity and rupture to the pleural
genus Echinococcus(1, 2).
cavity (9).
The most common species to cause the human CE
Transmission and maintenance of echinococcosis
is Echinococcus granulosus. Echinococcus
is dependent on complex interactions of several factors, multilocularis causes alveolar echinococcosis although
including environmental, host and pathogen factors. A
it is rare. Echinococcus vogeli and Echinococcus
number of such factors are of local epidemiological oligarthrus cause polycystic echinococcosis (3).
significance and the identification of such factors is
Two mammalian hosts are involved in the life
important in the effective implementation of control
cycle of Echinococcus granulosus. The adult worm
strategies (10).
lives in the small intestine of carnivores (definitive
The aim of this study was to determine the
hosts) (1) and the larval stage (Hydatid cyst) develops in
prevalence of the disease in humans and its clinical
the internal organs of a wide range of mammalian
presentation. The study also is targeted to identify risk
species such as goats, sheep and cattle, including
factors predisposing infections.
humans, which acquire the infection through accidental
ingestion of the tapeworm eggs (4). MATERIAL AND METHOD
Cystic echinococcosis affects various organs of the Samples collection:
human body (5). Hydatid cyst primarily affects the liver Hydatid fluid collection: Samples were collected into
in (5277%) of cases. However, the most common
caped plastic tubes during the period of April 2016 till the
location for hydatid cysts in children is the lung (6).
end of September 2016, from Interventional Radiology,
Other rare locations of hydatid cyst include spleen,
Internal Medicine Surgery Departments in Kasr El Eieni
thyroid, gall bladder, central nervous system, kidney,
Cairo University, Ain Shams University Hospital, Zagazig
psoas sheath, retroperitoneal region and orbit (7). The
University Hospital, Benha University Hospital and from
clinical features of hydatid cysts disease depend on the
Theodore Bilharz Research Institute (TBRI) Hospital,
size and site of the cyst and the presence of
Giza, Egypt.
complications (1). Theinitial phase of CE is
asymptomatic withsmall well encapsulated cysts.
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c:\work\Jor\vol852_43The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3712-3717
Ceramide 24 Level in Hepatitis C Virus- Patients and Healthy Persons Rashed Mohammed Hassen1, Talaat Fathy Aly1, Mona Ahmed Abdelmaksoud1, Ahmad Mokhtar Ahmad2, Rehab Mohamed Abd-Elmonem1
Departments of 1Tropical Medicine and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt. *Corresponding author: Rashed Mohammed Hassen, Email:[email protected] ABSTRACT Background: There are 170 million people in the globe living with hepatitis C virus (HCV) infection, which causes inflammation and hepatic fibrosis in various degrees. A portion of these patients will develop cirrhosis and other end-stage liver disease problems over the course of twenty to forty years. Low levels of serum ceramide 24 (Cer24) are linked to severe liver fibrosis and poor response to antiviral therapy in those with chronic HCV infection. Objective: This study was designed to assess level of ceramide 24 in chronic HCV and normal individuals. Subjects and Methods: The study was carried out as a case control study at Tropical Medicine Department, Clinical Pathology Department in Zagazig University Hospitals and at Viral Hepatitis Treatment Unit in Al-Ahrar Teaching Hospital. The study included 60 individuals who were divided into 2 groups. Group 1 included 30 case and group 2 was 30 healthy subjects as control. All patients were clinically evaluated, had routine laboratory investigations and measurements of circulating levels of ceramide 24. Abdominal ultrasonography was done. Results: Serum ceramide 24 level in HCV patients (cases) is 15.16 ± 6.93 while its level in normal individuals (control) is 65.01 ± 65.84. Conclusion: It was found that serum ceramide 24 level was significantly reduced in case group. Keywords: HCV, Serum ceramide 24 INTRODUCTION
indicators in insulin resistance, diabetes mellitus, the
170 million people around the world are infected
metabolic syndrome, Alzheimer's disease, and acute
with the hepatitis C virus (HCV), which causes
phase responses, according to recent studies (7).
inflammation and hepatic fibrosis in various degrees.
Membrane organisation and the development of
Patients with chronic infection are more likely to develop
lipid microdomains are both aided by ceramide, which
cirrhosis and other end-stage liver disease complications
plays a key role. In order for HCV entry factors to be
over the next 20 to 40 years, depending on their age (1).
properly located, sphingolipids may be crucial.
HCV incidence in Egypt was the highest in the world,
Sphingomyelin hydrolysis enriched plasma membranes
with the majority of cases being caused by genotype 4,
in ceramide, which inhibited HCV penetration (8).
which has been shown to be highly related with severe
It's vital to know that the hepatitis C virus has lipid
fibrosis and cirrhosis. This has led to a rise in
components since they affect the virus' infectiousness
hepatocellular carcinoma as the most common cancer
and virion-building ability (9). Reservoirs of HCV
diagnosis in the country (2, 3).
replication complexes are seen in fatty tissue (10).
The current HCV treatment includes a cocktail of
Cholesterol and glycosphingolipids make up the
antivirals known as direct acting antivirals (DAAS) that
majority of lipid raft composition.
work together. Non-nucleoside NS3/4A Protease
Hepatitis C virus replication complex formation
Inhibitors (PIs), nucleoside and nucleotide NS5B and
and localization as well as HCV RNA-dependent RNA
NS5A polymerase inhibitors (4).
polymerase activity are both dependent on
A group of lipid compounds known as the
sphingomyelin, according to research (11). Chronic HCV
ceramides includes both ceramides and ceramides-
infection reduces blood Cer24 concentrations markedly,
related substances (5). Signal transduction involves the
and low serum Cer24 levels are linked to advanced liver
production of quickly and transiently degradable lipid
fibrosis, poor antiviral medication response, ascites, and
second messengers, such as ceramides, in response to
a bad prognosis in cirrhotic HCV patients with
certain stimuli. They may also influence the membrane
decompensated liver cirrhosis (2).
characteristics to govern cellular functions (6).
This study was designed to assess level of ceramide
Ceramide influences cellular and molecular
24 in chronic HCV and normal individuals.
physiology in both cell autonomous systems and
complex organisms, and it is both a structural and SUBJECTS AND METHODS
functional unit of sphingolipid metabolism. The effects
Between March 2019 and March 2020,
of Cer on cell destiny have been demonstrated to be
researchers at Zagazig University Hospitals' Tropical
largely dependent on the subcellular compartment of
Medicine Department, Clinical Pathology Department,
synthesis and metabolism, as well as the chain length of
and the Viral Hepatitis Treatment Unit at Al-Ahrar
the fatty acid attached to the sphingosine backbone,
Teaching Hospital conducted this case control study.
despite its initial role as an antiproliferative and
The attendance rate of hepatitis C patients at Al-Ahrar
proapoptotic mediator. Serum Cer levels may be used as
viral hepatitis treatment unit was 10 patients/month. The
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INTRODUCTIONThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3718-3723
Serum Osteopontin and its Relation to Colorectal Carcinoma in Egyptian Patient Ahmed Samir Allam*, Mohamed Abd Elmoghny Mostafa, Hany Haron Kayser, Abanoub Refaat Hakim
Internal Medicine and Gastroenterology and Hepatology Unit Department,
Faculty of Medicine, Ain Shams University, Egypt. *Corresponding author: Ahmed Samir Allam, Mobile: (+20) 01001701223, E-Mail: [email protected] ABSTRACT Background: Colorectal cancer (CRC) incidence has increased worldwide recently, and the death rate from it has increased to reach 10% of cancer-related deaths. Many risk factors are expected to play a role in this high incidence such as the higher age, change in dietary habits, cigarettesmoking, low physical exercise, and the increased prevalence of obesity of the populations worldwide. Objectives: To evaluate the role of serum level of osteopontin in prediction of colorectal carcinoma in correlation with tissue histopathology, which is the gold standard test. Patients and Methods: This study was conducted on 80 subjects referred for colonoscopy at the Endoscopic Unit of Ain Shams University Hospitals. Patients were divided into 2 groups: Group A included 40 patients diagnosed as colorectal carcinoma as a patient group and group B that included 40 individuals with age- and sex-matched who had normal colonoscopy and was used as control group. Results: The level of osteopontin was statistically significant higher in CRC patients than in subjects with normal colonoscopy. Also, the ROC curve for osteopontin in prediction of CRC showed the best cut of value of > 12 ng/ml with area under the curve (AUC) = 0.889, sensitivity = 85% and specificity = 77.5%. Conclusion: Serum Osteopontin (OPN) level was detected in our study to be high in patients with CRC in comparison to patients with normal colonoscopy. Therefore, it can be used as a biomarker in the diagnosis of CRC. Also, serum osteopontin level is significantly higher in cancer patients with metastasis according to TNM staging, thus it can be used in prognosis. Keywords: Colorectal carcinoma, Serum osteopontin, Colonoscopy, Histopathology. INTRODUCTION
and brain. Local relapse and distant metastasis are two
Colorectal cancer (CRC) is one of the commonest
main intractable problems in managing CRC in spite of
GIT malignancies and one of the causes of morbidity
the presence of many new chemotherapeutic agents.
and mortality among different types of neoplasms,
Many tumor markers-such as CEA and CA19.9- are
despite improvement in diagnosis and treatment (1). The
used in clinical practice to detect and follow-up CRC
survival rate of patients with CRC remains poor due to
patients. However, the exact value of these markers is
distant metastasis in most cases upon discovery. Thus,
still unclear (4).
early diagnostic and treatment modalities during the
Osteopontin (OPN), a phosphorylated glycoprotein,
early stages will help to improve the prognosis,
plays a role in many processes including cell adhesion,
survival, and disease-free time for patients with CRC (2).
cell migratory activity, bone metabolism, and stone
Common symptoms such as hematochezia and
formation (5). Additionally, OPN is found in many
abdominal discomfort, and tests such as digital rectal
tumor cells, as in the stomach, large intestine, mammary
examination and abdominal palpation will help to
gland, and lungs (6). OPN is involved in
diagnose patients with CRC in the early stages (3). The
neovascularization of tumor cells through an interaction
most common histological type accounting for almost
with VEGF, as it triggers VEFG expression in tumor
95% of CRCs is adenocarcinoma, whether papillary
cells that stimulates neovascularization (7).
adenocarcinoma, tubular adenocarcinoma, mucinous
The aim of this study was to evaluate the role of
adenocarcinoma, and signet-ring cell carcinoma. The
serum level of osteopontin in prediction of presence of
exact etiology contributing to the CRC is still unclear.
colorectal carcinoma in correlation with tissue
Many genes, microstructures and the microenvironment
histopathology, which is considered the gold standard
participate in tumor formation, proliferation, invasion
test.
and spread. Other factors, such as sex, age,
environment, also have a role (3). PATIENTS AND METHODS
Treatment options for CRC include surgical
This was a randomized-controlled prospective
removal in addition to chemotherapeutic medications
clinical trial conducted at the Endoscopic Unit of Ain
such as fluorouracil, oxaliplatin, and cetuximab. These
Shams University Hospitals. It was conducted on 80
medications can be used to either shrink the tumor
Egyptian subjects that were divided into 2 groups as
diameter pre-operation or serve as a post-surgical
follows: Group A included 40 patients diagnosed with
adjuvant for the treatment of patients with CRC (3).
colorectal carcinoma-by colonoscopy and confirmed by
Colorectal cancer can spread to the liver, bone, lung,
histopathology, and group B, which included 40
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Evaluation Of QT Interval In Diabetic Ketoacidosis In Medical Intensive Care UnitThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3724-3729
Evaluation of Antioxidants Status at Diagnosis in Childhood Acute Lymphoblastic Leukemia Elhamy Rifky Abdelkhalek1, Yosry El-Sayed Abo-Elmagd2, Adel Sherif Ahmed1, Mohamed Mostafa Arafa*1
Departments of 1Pediatrics, 2Biochemistry, Faculty of Medicine, Zagazig University, Egypt. *Corresponding Author: Mohamed M. Arafa, Mobile: (+20)01140006686, Email: [email protected] ABSTRACT Background: Acute lymphoblastic leukemia (ALL) is a neoplastic disease of immature lymphocytes or lymphocyte progenitor cells either the B- or T-cell lineage. It is the most common malignancy diagnosed in patients younger than 15 years, and account for approximately 25-30% of adult acute leukemia. Objective: To evaluate some antioxidants as zinc, selenium, vitamin A (retinol) and vitamin E (tocopherol) status at diagnosis of childhood acute lymphoblastic leukemia and to compare it to that of a control population. Patients and methods: This case-control study was carried out at Oncology Unit of Pediatrics Department and Medical Biochemistry Department, Faculty of Medicine, Zagazig University Hospitals. This study consisted of two groups: Patients' group (30 children patients with newly diagnosed ALL). As regard control group, it included 30 healthy children who were matched well with patients' age and sex. Fasting levels of serum zinc, selenium, retinol and tocopherol were measured. Results: There was a high statistically significant decrease of vitamin E, selenium and zinc among all cases than their controls. While, there was a significant increase of vitamin A among all cases. Zinc level was statistically significantly increased with increased risk of disease, while no statistically significant relation between disease risk and other levels of serum antioxidant. Conclusion: Some antioxidants as zinc, selenium and vitamin E (tocopherol) status at diagnosis of childhood acute lymphoblastic leukemia are lower compared to that of a control population. Key words: Selenium, Retinol, Tocopherol, Antioxidants, Acute lymphoblastic leukemia. INTRODUCTION
Zinc also has been shown to have
Every year more than 175 300 children are
immunomodulatory effects both directly by acting on
diagnosed with malignancy in the world. Of this total,
the immune system and indirectly by acting on the
80 percent of children with malignancy, live in
respiratory, gastrointestinal and epithelial linings.
developing countries including Egypt and contribute
Several studies have shown benefits of long-term zinc
significantly to the estimated 96 400 childhood cancer
supplementation on the incidence, severity, and
deaths annually. Thus childhood malignancies are
duration of diarrhea and respiratory infections.
considered an important global public health problem
Prolonged zinc supplementation also improves cell- [1]. Acute lymphoblastic Leukemia (ALL) is the most
mediated immunity in severely malnourished children
common cancer found in children under 15 years of [5]. Zinc may also reduce the duration and severity of
age and it accounts for more than 50% of the
febrile neutropenia and associated complications [6].
hematopoietic malignancies in this age group. ALL is
Patients who suffer from malnutrition have been
a disorder caused by an abnormal expression of genes,
shown to tolerate treatment with chemotherapeutic
which is usually a result of chromosomal translocation.
drugs poorly. Most studies focusing on nutrition and
The disease can be originated from lymphoid cells of
outcome in pediatric cancer have focused on the
different lineages giving rise to B or T cell Leukemia
clinical nutritional status of the patient and few have
or sometimes mixed-lineage leukemia [2].
looked at the serum micronutrient levels at diagnosis
Selenium (Se) is a trace element that share in the [7].
antioxidant system by saving the cells from reactive
Cancer patients have been noted to have low
oxygen species. The possibility that increased
antioxidant levels even at initial diagnosis [8]. Oxidant
supplementation of selenium and vitamin E can protect
damage with free radicals leads not only to cancers but
against the development of cancer has generated great
also is implicated in chemotherapy-related adverse
interest. Low serum selenium levels appear in children
effects [9]. Children with normal dietary intake of
with malignancies [3].
antioxidants while on treatment for cancers have fewer
Vitamin A (Retinol) and Vitamin E
complications and better quality of life [7]. Some argue
(Tocopherol) have been studied in relation to cancer
that since many chemotherapeutic drugs act by
chemotherapy and toxicity reduction. In a study,
producing reactive oxygen species, antioxidants may
supplementation of tocopherol has shown reduced
be counter-productive in that they may decrease the
hematological complications and need for transfusion
efficacy of chemotherapy [10]. However other studies
support in the first 2 months of treatment [4].
find that it is helpful in reducing the side effects of chemotherapy. Patients on antioxidants tolerate
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Zagazig UniversityThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3730-3736
Comparison Study between Opioid Free and Opioid Based General Anesthesia in Functional Endoscopic Sinus Surgeries Abdalsalam Faraj Rafa Ali*, Mahmoud Adel Omar Al-Arnous, Mohammed El-Mowafy Elsaid Khattab, Sherif Mohammed Said Mowafy
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine Zagazig University, Egypt *Corresponding author: Abdalsalam Faraj Rafa Ali, Mobile: (+20)01026336069, E-mail:[email protected] ABSTRACT Background: Functional endoscopic sinus surgery is a standard procedure for the treatment of chronic sinusitis. This surgery is usually conducted under general anesthesia and it is better to be performed under controlled hypotensive technique to improve surgical field and to decrease the operation time. Routine analgesic treatment is usually based on non-opioid analgesics with rescue opioids. Objective: The aim of this study was to compare opioid free versus opioid based general anesthesia in functional endoscopic sinus surgeries regarding hypotension, surgical field, operation time and postoperative pain. Patients and methods: Patients were divided into 2 equal groups: Group 1: Opioid free group: (Group OFA) 22 participants, Group 2: Opioid based group: (Group OBA) 22 participants. All participants were subjected to medical history taking, complete clinical examination and premedication and routine laboratory investigations. Results: There was no statistical significant difference between the studied groups regarding the mean arterial pressure, oxygen saturation and need for analgesia. Duration of stay in post anesthesia care unit was significantly shorter in OFA group than OBA group. OBA Group was significantly associated with higher VAS score at 6-, 10- and 12-hours postoperatively. Conclusion: OFA provided satisfactory intraoperative analgesia and control of surgery-induced pressor reflexes. Also, the perioperative safety and efficacy of the opioid-free anesthesia techniques provided for functional endoscopic sinus surgeries had good postoperative analgesia and other postrecovery criteria. There is a need for wider-scale comparative studies with large number of patients with long period in multi-center studies to confirm our finding. Keywords: Endoscopic, Opioid Based Anesthesia, Opioid Free Anesthesia, Sinus surgery.
INTRODUCTION
about the routine systemic administration of opioids
Endoscopic sinus surgery is the most
during general anesthesia and the development of
commonly performed otolaryngological procedures.
recent non-opioid strategies (3). Literature supporting
Moreover, functional endoscopic sinus surgery (FESS)
restraint in opioid prescription practices following
could be considered the gold standard surgical
FESS surgery are increasing. Opioid free anesthesia
treatment of chronic rhinosinusitis (CRS). This surgery
(OFA) which has been applied mainly in bariatric
is usually conducted under general anesthesia and it is
surgery has begun to receive more attention as an
better to be performed under controlled hypotensive
alternative anesthetic strategy (4).
technique where mean arterial pressure (MAP) is
Several OFA protocols have been published.
between 55 and 65 mmHg to improve surgical field
The most commonly used non-opioid agents are
and to decrease the operation time. Mild to moderate
lidocaine, dexamethasone and magnesium sulfate.
postoperative pain is commonly encountered with
Lidocaine has demonstrated analgesic and opioid-
these types of surgeries owing to both nasal packing
sparing effects in cardiac and non-cardiac surgery.
and surgical trauma itself (1).
Additionally, the use of lidocaine has been associated
Opioids are the most commonly used
with a decrease in arrhythmias and a non-constant
analgesics perioperatively and it is considered one of
improvement in postoperative cognitive functions.
the main pillars of anesthesia. The use of synthetic
Also magnesium were shown to have analgesic effects
(fentanyl and remifentanil) or natural (morphine)
and opioid-sparing effects, both drugs provide
opioids during the perioperative period provides an
effective postoperative analgesia as well as a reduction
important component of balanced anesthesia. Timely
in opioid consumption (5).
administered opioid during surgery is well known to
The aim of this study was to reduce
reduce the dose of general anesthetic needed, enable
complications of opioid in patients undergoing
faster recovery and provide good postoperative
endoscopic sinus surgeries.
analgesia. Consequently, improves patients comfort
and satisfaction (2). However, opioids administration is PATIENTS AND METHODS
not devoid of adverse effects that limit their
This prospective randomized comparative
effectiveness in perioperative care, the most relevant
clinical study was conducted at Zagazig University
adverse effects include respiratory depression,
Hospitals, on 44 ASA I and II patients undergoing
gastrointestinal alterations, hyperalgesia, inflammation
elective bilateral FESS during the period from January
and immunologic modulation which raise questions
2021 to July 2021.
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c:\work\Jor\vol852_47The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3737-3741
The Predictive Value of Vanin-1 in Pediatric Immune Thrombocytopenia Mohamed Eissa1, Amal Zidan2, Alaa A. Omran2
1Pathology Department, College of Medicine, King Khalid University, Abha, KSA and Clinical Pathology
Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
2Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt *Corresponding author: Mohamed Eissa, Mobile: 00966599151626, E-Mail: [email protected] ABSTRACT Background: Immune thrombocytopenia (ITP) has oxidative stress-related pathway as one of its possible mechanisms. Vanin-1 (VNN1) is an oxidative stress sensitive sensor. Objective: The present study was conducted to assess the clinical significance of VNN1 in pediatric ITP patients. Patients and Methods: A total of 50 kids with ITP have been involved in this work; 25 newly diagnosed, 25 chronic patients with ITP more than 12 months (15 responders and 10 non responders to treatment) and 25 apparently healthy children. All groups had their serum VNN-1 levels checked using a two-antibody sandwich enzyme-linked immunosorbent test. Results: The serum VNN1 level was significantly higher in ITP group than control group (p0.001). The level of serum VNN1 was significantly very high in newly diagnosed ITP group (p0.001) in comparison to chronic responders and chronic non responders ITP groups. Moreover, there was a significant increase in serum VNN1 level in chronic non responders ITP group (p0.001) compared to chronic responders group. In newly diagnosed ITP group, both age (r=-0.62, p=0.006) and the platelet count (r=-0.46, p=0.01) had a significant negative connection with serum VNN1 level. A cut-off value lower than 0.6 ng/ml for serum VNN1 could be used to distinguish the chronic non-responders ITP from chronic responders patients with 100 percent specificity and 90 percent sensitivity. Conclusion: From our current results, it is hypothesized that high VNN1 level plays a role in the pathogenesis and progress of pediatric ITP. Keywords: Oxidative stress, Pathogenesis, Pediatric ITP, Responders, Vanin-1. INTRODUCTION
pantetheine's amide bonds specifically. Treatment for
When a child has thrombocytopenia, their count of
cystinosis may benefit from cysteamine's antioxidant
platelets is lower than 100 x 109/L, which is indicative
properties (11). In addition, because pantothenic acid is a
of a hematological condition called ITP. A decrease in
structural component of CoA, its creation allows for
platelet synthesis, high platelets sequestration by
continued manufacture of CoA. The profibrotic actions
spleen, or destruction due to immune reactions can all
of pantothenic acid, on the other hand, appear to be due
induce thrombocytopenia (1).
to its involvement in the encouragement of dermal
In 80% of cases, ITP is a disorder that causes
fibroblast migration and proliferation (12-14).
spontaneous bleeding from the skin and mucous
The restoration of mitochondrial CoA levels is
membranes, primary ITP is commonly considered an
another benefit of pantothenic acid, resulting in
autoimmune disorder. However, the majority of these
increased mitochondrial function (15). Many metabolic
cases are classified as idiopathic, while a small number
pathways are regulated by vanin1, which has been
occur secondary to other health issues (2). It's been
demonstrated. Mouse liver PPAR- discovered to
reported in numerous studies that oxidative damage
interact with the vnn1 gene, making it an excellent
may be crucial (3-6).
target for drug development. The liver's reaction to
There were early discoveries of the vascular non-
fasting is heavily regulated by PPAR- (16-18).
inflammatory molecules (VNN), such as the murine
Vanin1 is overexpressed in some disorders, which
Vnn1 gene (mVnn1), human Vnn1 and hVnn2, as well
aids in the progression and aggravation of the disease.
as human Vnn3 (7,8). Ectoenzyme VNN1 has the
Oxidative stress role in in ITP etiology or progression
pantetheinase action. As a matter of fact, the liver, gut,
has not been studied widely. A number of contradictory
and kidneys are all high-CoA turnover tissues where
investigations have found that oxidative indicators
vanin1 is abundantly expressed (9).
involving, reduced or oxidized glutathione, and serum
Pantothenic acid (vitamin B5) is a critical
malondialdehyde, the total antioxidant status, and the
precursor in the production of Coenzyme A (CoA), and
activity of specific antioxidant enzymes fluctuate in
vanin1 plays a vital role in recycling it. When it comes
blood levels. In peripheral leukocytes, there has been
to fatty acid synthesizing and oxidizing processes, CoA
confirmed upregulation of vanin-1 (VNN1), which is a
is important since it is a heat-stable cofactor necessary
sensitive oxidative stress sensor (19, 20).
for several enzyme-catalysis acetylation reactions (10).
Aim of the present study was conducted to assess
Pantothenic acid and cysteamine are both powerful
the clinical significance of VNN1 in pediatric ITP
antioxidants produced by vanin1 during CoA
patients.
catabolism, when it hydrolyzes one of the substrates
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c:\work\Jor\vol852_48The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3742-3752
Mortality Predictors in Patients with Infective Endocarditis Undergoing Surgery Ahmed Sobhy Emara1, Tamer Eid Fouda2, Mostafa Mohammad Abdalraouf Yousof3, Mohamed Saied Darwish4, Abullah Osama Mahfouz*5
1Department of Cardiothoracic Surgery, 4Department of Cardiology, Faculty of Medicine, Banha University, Egypt
2Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
3Department of Cardiothoracic Surgery, Sheikh Zayed Specialized Hospital, Egypt
5Department of Cardiothoracic Surgery, Faculty of Medicine, Fayoum University, Egypt *Corresponding author: Ahmed Sobhy Emara, Mobile: (+20) 01092362217, E-Mail: [email protected] ABSTRACT Background: Infective endocarditis (IE) is considered a series disorder with high in-hospital mortality, so early detection and therapy can improve outcomes. Diagnosis relies upon consistent history and manifestations like persistent bacteremia, fungemia or active valvulitis. Surgical treatment in infective endocarditis is considered as a part of management rather than a consequence of medical treatment failure. Objectives: To assess the risk factors influencing the early outcome of surgical intervention in patients with IE. Patients and methods: This prospective cohort study was conducted on sixty patients diagnosed with infective endocarditis and underwent cardiac surgery. We tested preoperative, intraoperative and postoperative factors that may act as prospective predictors of mortality. Results: Rheumatic heart was found to be the most common underlying fundamental issue among most of the cases. Mitral valve regurgitation was the frequent lesion found (61.7%). The mean EuroScore II in non-survivor group was 25.69 ± 8.13. The hospital mortality was 21.7% (13 patient), while the 6-month mortality was 12.8% (6 patients). Congestive heart failure, embolization, and periannular extension of infection are the most significant predictors of hospital mortality and 6 month mortality also. Conclusion: Surgery for IE keeps on being challenging. EuroScore II was found to have a very good capability to anticipate mortality in IE surgery. Also favorable outcomes could be acquired with valve repair techniques even in cases of IE. Keywords: Infective endocarditis, Predictors, Mortality, Risk factors, Surgery.
INTRODUCTION
Infective endocarditis (IE) is characterized by being
selected during the study period from December 2017
an infection of the endocardial surface of the heart,
to December 2019.
which may incorporate at least one heart valve, the
endocardium or a septal defect (1). It has an annual Ethical consent:
incidence of 310/100,000 of the population with 30 An approval of the study was obtained from
days mortality reaches up to 30% (2). The modified Duke Benha University Academic and Ethical committee.
criteria can be utilized to help diagnose IE. These Every patient signed an informed written consent
criteria have 80% sensitivity. However, this is for acceptance of the study. This work has been
altogether lower in instances of prosthetic valve carried out in accordance with The Code of Ethics of
endocarditis or implantable electronic device infections. the World Medical Association (Declaration of
In this case clinical doubt, microbiological correlation Helsinki) for studies involving humans.
and additional imaging may be required (3). Heart failure
as a consequence to valvular insufficiency, uncontrolled Case definition:
resistant infection, persistent bacteremia regardless
Case definition depended on definitive items
proper antimicrobial treatment, infection with a fungus
meeting the modified Duke's criteria with assistance of
and presence of a risk of systemic embolization are the
special endocarditis team, which included demographic
main surgical indication (4).
criteria, pathological criteria (presence of micro-
The aim of this work was to assess the risk factors
organism in a vegetation), major clinical criteria (blood
affecting the early outcome of surgical intervention in
culture positive for endocarditis, echocardiographic
patients with IE.
evidence of endocardial involvement) and minor
clinical criteria (predisposing heart disease, intravenous PATIENTS AND METHODS
drug abuse, fever, vascular phenomena as major arterial
This prospective cohort study was conducted on 60
emboli and mycotic aneurysm, immunologic
patients who were admitted at Sheikh Zayed
phenomena as rheumatoid factor and microbiological
Specialized Hospital. They were diagnosed with
evidence as serological evidence of active infection) (5).
definite IE and required cardiac surgery. Cases were
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c:\work\Jor\vol852_49The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3753-3757
Risk Factors of Hypocalcemic Patients at Surgical Intensive Care Unit of Zagazig University Hospitals Zeinab Ibrahim El hossary, Sahar Mohammed Saad Eldin, Heba Helmy Matar, Ibrahim Abdel-Halim Askar
Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ibrahim A. Askar, Mobile: (+2)01064377460, Email:[email protected] ABSTRACT Background: Hypocalcemia may be present as an asymptomatic laboratory finding or as a severe life-threatening condition. Objective: The study aimed to estimate incidence rate of hypocalcemia and to identify risk factors associated with hypocalcemia in patients of Surgical Intensive Care Unit of Zagazig University Hospitals. Patients and methods: This study involved 310 patients who enrolled to Surgical Intensive Care Unit, Zagazig University Hospitals over a period of six months. Total serum calcium concentration and ionized calcium concentration were measured. Results: The distribution of the studied cases according to admission diagnosis, 40% of the studied cases were admitted to ICU due to sepsis and septic shock, 16% polytrauma, 10% respiratory failure, 10% post-operative monitoring, 6% with ICH, 6% with uncontrolled HTN, 4% with ischemic stroke, 2% pancreatitis, 2% dehydration and electrolyte imbalance, 2% DKA and one case due to organophosphorus poisoning and 1% rhabdomyolysis. There was statistically significant negative correlation between GCS score and Ca total and ionized at 3rd day. However, a statistically significant positive correlation was detected between Ph and Ca total at 3rd day.Only sepsis, septic shock, hypertensive crisis, aminoglycosides, respiratory failure and APACHE score were significant risk factors for hypocalcemia. Conclusion: Hypocalcemia is more common in cases with sepsis and septic shock, hypertensive crisis, respiratory failure and cases with electrolyte disturbance. Keywords: Hypocalcemia, Ill patients, ICU, APACHE score.
INTRODUCTION
to lack an adequate PTH response to decreasing serum
Hypocalcemia may be present as an
calcium levels (5).
asymptomatic laboratory finding or as a severe life-
Hypocalcemia and osteomalacia have been
threatening condition. Distinguishing acute from
described with prolonged therapy with anticonvulsants
chronic hypocalcemia and asymptomatic from severely
(e.g. phenytoin, phenobarbital). The mechanisms differ
symptomatic
hypocalcemia
is
important
for
according to the class of anticonvulsants; for example,
determining appropriate therapy. In case of acute
phenytoin induces cytochrome P450 enzymes and
hypocalcemia, rapid treatment may be required. In
enhances vitamin D catabolism (6).
contrast, chronic hypocalcemia may be well tolerated,
Some studies used corrected calcium values
but treatment is necessary to avoid long-term
while others measured ionized calcium. It is also not
complications (1, 2). In extreme cases of hypocalcemia,
clear if calcium measurements were made for
bronchospasm and laryngospasm with stridor may
diagnostic, screening, homeostatic or daily routine
occur. Muscle symptoms can be so severe as to present
purposes. The only thing that is evident at present is that
with a polymyositis-like picture with elevated muscle
some 50% of critically ill patients in an ICU will have
isoenzymes. These symptoms are corrected by calcium
hypocalcemia at some moment at some day during their
replacement (3).
stay (7).
Hypocalcemia can also occur in patients treated
The aim of the study was to estimate incidence
with some chemotherapeutic drugs. For example,
rate of hypocalcemia and to identify risk factors
cisplatin can induce hypocalcemia by causing
associated with hypocalcemia in patients of Surgical
hypomagnesemia, and combination therapy with 5-
Intensive Care Unit of Zagazig University Hospitals.
fluorouracil and leucovorin can cause mild
hypocalcemia, possibly by decreasing calcitriol PATIENTS AND METHODS
production. In addition, acute kidney injury and
This study involved 310 patients who enrolled to
hypocalcemia have been reported as adverse effects in
Surgical Intensive Care Unit, Zagazig University
patients receiving the programmed cell death protein 1
Hospitals over a period of six month.
(PD-1) inhibitors nivolumab and pembrolizumab (4). Inclusion criteria: Patients in age above 18 years old
Hypocalcemia may result from the treatment of
who admitted to Surgical Intensive Care Unit of
hypercalcemia with bisphosphonates, particularly
Zagazig University Hospitals with normal calcium level
zoledronic acid, which is significantly more potent than
over period of 6 months.
other bisphosphonates in suppressing the formation and function of osteoclasts. Patients who are affected appear Exclusion criteria: Patients with previous history of hospital admission within 2 weeks before presentation,
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c:\work\Jor\vol852_50The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3758-3761
Tranexamic Acid Intravenous Overdose Administration in Primary Total Knee Arthroplasty: Case Report Saeed Hamed Alzahrani*, Atif Ahmed Labban
Department of Orthopedic, King Faisal Hospital, Mecca, Saudi Arabia *Corresponding author: Saeed Hamed Alzahrani, Mobile: 966564560633, E-Mail: [email protected]
ABSTRACT Background: Topical application of tranexamic acid (TXA) to bleeding wound surfaces reduces blood loss in patients undergoing some major surgeries, without systemic complications. TXA decreases blood loss and, therefore, may minimize pain. Objective: To know the efficacy and safety of tranexamic acid intravenous overdose administration in primary total knee arthroplasty. Case study: We reported a 53 years old Saudi female ambulatory with no assisting aid and was not known to have any medical illnesses, presented to the orthopedic clinic complaining of bilateral knee pain and difficulty to ambulate for long distances for the last 5 years. This complain gradually worsened since last 2 years with no history of trauma prior to presentation or even after the follow up. The pain was localized at the knee joints and it was sharp in nature. The pain used to improve with rest and paracetamol intake and aggravated while standing or walking for long period of time. She was treated surgically by total knee arthroplasty, however during the operation by mistake she was given 4000 mg of tranexamic acid through IV route instead of topical application. Conclusion: Administration of 4000 mg of tranexamic acid through IV route is unusual but it seems to be safe without side effect on the patient in the early postoperative period. Keywords: Intravenous overdose administration, Total knee arthroplasty, Tranexamic acid
pulmonary embolism in this high-risk patient INTRODUCTION
population have hindered the wide adoption of this
Tranexamic acid (TXA) is a synthetic lysine
medication in the sitting of total knee arthroplasty (3, 4).
derivative that exerts its action by competitively occupying the lysine binding site of plasminogen,
In view of these safety concerns, topical
thereby blocking interaction with fibrin and subsequent
application of the tranexamic acid to the knee joint
clot breakdown. TXA has a molecular weight of 157.2
before closure of total knee arthroplasty remains a safer
g/mol, and its injectable formulation is marketed under
route of administration that reduces postoperative
the name cyklokapron (1).
bleeding without increasing the hypercoagulable state associated with total knee arthroplasty. In fact, topical
The pharmacokinetics of TXA in healthy
application of tranexamic acid in the surgical filed is a
individuals after administration of a 10 mg/kg dose
cost-effective and simple route of administration that
demonstrate peak concentrations at 60 minutes post
has been shown to reduce bleeding associated with
administration, with a half-life of approximately 2 hours
dental cardiac and spine procedures (5).
for the terminal elimination phase, and 90% excretion at 24 hours. An antifibrinolytic dose remains in tissues for
This case report aimed to know the efficacy and
up to 17 hours and in serum for up to eight hours. It has
safety of tranexamic acid intravenous overdose
also been shown to cross the placental barrier, is
administration in primary total knee arthroplasty.
excreted in breast milk, and rapidly appears in synovial CASE STUDY
fluid. The overdose complications of TXA
We reported a 53 years old Saudi female,
administration is mainly having seizure. The
ambulatory with no assisting aid and was not known to
mechanisms of seizure are still poorly understood.
have any medical illnesses, presented to the Orthopedic
Other side effects are nausea and vomiting, blurred or
Clinic at King Faisal Hospital complaining of bilateral
loss of vision (2).
knee pain and difficulty to ambulate for long distances
Several
meta-analyses
have
shown
that
for the last 5 years. This complain started to worsen
interventions administration of the antifibrinolytic agent
since last 2 years with no history of trauma prior to
tranexamic acid reduced postoperative bleeding and the
presentation or even after the follow up. The pain was
need for transfusion.
localized at the knee joints and was sharp in nature. The
However, concerns about the safety of systemic
pain used to improve with rest and paracetamol intake.
administration of tranexamic acid and the risk of
There were no other complaints.
thromboembolic events such as deep vein thrombosis or
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c:\work\Jor\vol852_51The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3762-3766
Treatment of Bronchiolitis Using Nebulized Hypertonic Saline in Asthma-Prone and Non-Asthma-Prone Patients Yomna Osama Taha, Osama Taha Amer, Hadeel Mohamed Abd Elrahman, Heba Gamal Anany*
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Yomna Osama Taha, Email: [email protected]
ABSTRACT Background: In bronchiolitis, children under the age of two experience cough, dyspnea and wheezing, following a viral upper respiratory infection. Frequently recurrent bronchiolitis in infants with atopic background is the best example of asthma-prone viral-induced wheeze. In bronchiolitis management, inhaled hypertonic saline is the subject of debate among pediatricians and researchers. Nebulized hypertonic saline acts by increasing fluidity of airway surface liquid. Bronchospasm is a theoretical risk for inhaled hypertonic saline when used without adjunctive bronchodilators. Objective: To compare the response to nebulized hypertonic saline plus B 2 agonists, with nebulized isotonic saline plus B 2 agonists, in asthma-prone and non-asthma-prone bronchiolitis patients. Patients and methods: This study was a randomized double blind controlled trial, which was carried out at Pulmonology Unit, Pediatric Department, Zagazig University Children Hospital. The study was conducted on 104 infants with acute viral bronchiolitis of mild to moderate severity. They were divided into two groups 52 in each group. Group 1: Asthma-prone patients and group 2, which included non-asthma-prone patients. Patients were randomly assigned to receive inhalation of 0.3 mg/kg salbutamol added to 5 ml of either normal saline 0.9% or hypertonic saline 3%. Within each group the number of patients receiving hypertonic or isotonic saline inhalation was equal to 26. Results: Nebulized hypertonic saline salbutamol mixture resulted in better improvement of the studied asthma- prone and non-asthma prone bronchiolitis patients. Hypertonic saline decreased case severity and days of hospital stay. Conclusion: Nebulized hypertonic saline shortened the days of hospital admission and improved the respiratory distress in mild to moderate bronchiolitis. Nebulized hypertonic saline is equally effective in asthma- prone and non-asthma-prone patients and its beneficial effect outweighs its theoretical broncho-constrictive effect. Keywords: Treatment of bronchiolitis, Nebulized hypertonic saline, Asthma. INTRODUCTION
hypertonic saline, we expected different response in
The American Academy of Pediatrics (AAP)
asthma-prone and non-asthma prone patients with
guidelines 2014 defined bronchiolitis as wheeze cough
bronchiolitis. The aim of our study was to compare the
following viral upper respiratory infection in children
therapeutic response to nebulized hypertonic saline plus
less than two years old (1). Recurrent early bronchiolitis
B 2 agonists, with nebulized isotonic saline plus B 2
may predispose to childhood asthma (2). TheGlobal
agonists, in asthma-prone and non-asthma-prone
Initiative for Asthma (GINA) developed diagnostic
bronchiolitis patients.
criteria for diagnosing asthma in children under 5 years
SUBJECTS AND METHODS
old with recurrent virus caused wheezing (3).
This study was a randomized double blind-
The updated AAP (American Academy of
controlled trial, which was carried out at Pulmonology
Pediatrics) guidelines 2014 recommended nebulized
Unit, Pediatric Department, Zagazig University
hypertonic saline as a treatment option for bronchiolitis
Children Hospital. The study was conducted on 104 (4). In bronchiolitis management, inhaled hypertonic
infants with acute viral bronchiolitis of mild to
saline is the subject of debate among pediatricians and
moderate severity dividing them into two groups 52 in
researchers. Hypertonic saline creates high osmotic
each group. Group 1: Asthma-prone patients and group
pressure in the lumen of bronchioles withdrawing water
2 that included non-asthma-prone patients. Patients
from submucosa to hydrate airway surface liquid. This
were randomly assigned to receive inhalation of 0.3
results in substantial reduction of edema in the
mg/kg salbutamol added to 5 ml of either normal saline
submucosa and increased fluidity of the mucus layer (4).
0.9% or hypertonic saline 3%. Within each group the
Since Hypertonic saline is used as a challenge test
number of patients receiving hypertonic or isotonic
for diagnosis of bronchial asthma by inducing
saline inhalation was equal to 26.
bronchospasm (5), bronchoconstriction is a possible theoretical side effect of inhaled hypertonic saline when Ethical approval: All Parents of participants signed
used without bronchodilators (6). During treatment of
informed consent forms and submitted them to Zagazig
bronchiolitis, nebulized hypertonic saline is usually
University's Research Ethics Committee, which
mixed with either terbutaline (7) or epinephrine (8) to
approved the study (ZU-IRB#6192/20-9-2020). The
guard against bronchoconstriction. Considering the
study followed the World Medical Association's
aforementioned facts about the action of nebulized
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c:\work\Jor\vol852_52The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3767-3771
Effect of Modifying Mechanical Ventilator Trigger Sensitivity on Arterial Blood Gases in ICU Patients Omnia A.K. Ismail*1, Nessrin G. El-Nahass1, Heba A.A. Abdeen1, Youssef M.A. Soliman2
1Departments of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics,
Faculty of Physical Therapy, Cairo University, Egypt.
2Department of Pulmonology, Faculty of Medicine, Cairo University, Egypt *Corresponding author: Omnia A.K. Ismail, Mobile: (+20) 01127000721, E-Mail:[email protected] ABSTRACT Background: Despite the fact that mechanical ventilation is an essential part in management of critically ill patients, mechanically ventilated patients have a higher risk of complications, which can lead to increased morbidity and mortality. Objective: This study aimed to study the effect of training inspiratory muscle through modifying mechanical ventilator (MV) trigger sensitivity on arterial blood gases in mechanically ventilated patients. Patients and Methods: Sixty adult patients diagnosed with acute respiratory failure, needed to be intubated and connected to mechanical ventilated. They were from both gender and their ages ranged from 50 to 70 years. The patient were chosen from Intensive Care Unit (ICU), Department of Chest Diseases, Cairo University Hospitals. They were randomly assigned into two equal groups. Group (A): included thirty patients who received training for inspiratory muscle through modifying MV trigger sensitivity plus usual physical therapy. Group (B): included thirty patients who received usual physical therapy only. Results: The results showed a significant increase in partial arterial pressure (PaO2) in both groups, this increasing was significantly higher in patients who received training for the inspiratory muscle plus the usual chest physical therapy than patients who only received usual chest physical therapy (P-value < 0.001). The results showed no significant change in neither power of hydrogen (pH) nor partial pressure of carbon dioxide (PaCO2). Conclusion: Training to inspiratory muscles in mechanically ventilated patient through modifying mechanical ventilator trigger sensitivity can produce a significant increase in partial arterial pressure (PaO2). Although it has no effect in pH nor PaCO2. Keywords: Arterial blood gases, Inspiratory muscle training, Intensive care unit, Mechanical Ventilation INTRODUCTION
Intensive care unit (ICU), often known as critical
Most ICU patients are required to receive chest
care unit, is dedicated to the comprehensive management
physiotherapy procedures such as manual chest
of patients with acute, life-threatening organ dysfunction
manipulation, chest vibrations, chest percussions, manual
or who are at risk of developing it. Intensive care employs
hyperinflation, posture drainage and various coughing
a variety of technology to help failing organ systems,
techniques in combination or individually to prevent
especially the lungs, cardiovascular system, and kidneys
pulmonary complications (5). In mechanically ventilated (1).
patients, chest physical therapy applied aiming to
In intensive care units (ICU), mechanical ventilation
improve airway clearance, thus helping to decrease work
(MV) is a very crucial medicine. It used clinically to
of breathing, promote the lungs expansion, and prevent
preserve gas exchange in patients who need assistance in
complication (6).
maintaining adequate alveolar ventilation. Although MV
Inspiratory muscle training (IMT) is a technique
can be a life-saving intervention for patients suffering
used to increase the strength and endurance of the
from respiratory failure, MV has been associated with
diaphragm and other accessory inspiratory muscles (7).
both short- and long-term deleterious consequences (2). In
Inspiratory muscle training applies a load to the
majority of cases, mechanical ventilation is used
diaphragm and accessory inspiratory muscles to increase
temporarily, lasting several hours, days, or weeks. The
their strength and endurance. Training to inspiratory
patients should weaned from mechanical ventilation as
muscle in the ICU have typically applied this load either
soon as they can breathe effectively on their own.
via external devices that impose resistance or load to
However, some patients with permanent problems may
inspiratory muscles, or via modification of the
need to be whole life mechanical ventilation dependent
mechanical ventilator trigger sensitivity so that patients (3).
can only initiate inspiratory flow by generating more
Physiotherapy has shown to be a crucial component
negative intrathoracic pressure (8).
in the management of ICU patients, with both short- and
Arterial blood gas (ABG) analysis and continuous
long-term advantages. Physiotherapy for the chest
monitoring is a vital process in identifying and
produces physiological changes such as changes in
controlling high-risk patients. In arterial blood gases
hemodynamic, respiratory, and intracranial parameters (4).
analysis, acid-base balance (pH), partial arterial oxygen
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Zagazig UniversityThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3772-3777
Health Related Quality of Life in Egyptian Children and Adolescents with Epilepsy Safaa Hamdy Ahmad Saleh, Mohammed Elsayed Hamed Mohammed, Osamah Abdullah Abounaji*
Department of Pediatrics,Faculty of Medicine Zagazig University, Egypt *Corresponding author: Osamah Abdullah Abounaji, Mobile: (+20)01020496850, E-mail:[email protected] ABSTRACT Background: Childhood epilepsy is one of the most significant and prevalent neurological condition in the developing years. The aim of the study was to explore the current status of health related quality of life (HR-QOL) in Egyptian children and adolescents with epilepsy using (WHOQOL-BREF) questionnaire. Patients and Methods: This case control study was carried out in Pediatric Neurology Unit and Outpatient Clinic in Department of Pediatrics at Zagazig University Children's Hospital on 110 children, divided into 2 groups, case group included 55 children with epilepsy and control group included 55 apparently healthy children without epilepsy of matched age, sex and social class. All the children were subjected to history taking, clinical examination and assessment of QOL. Results: There was a significant decrease in all domains and total score of WHOQOL-Bref questionnaire in the case group. There was a significant ve correlation between age and psychological domain score, also between number of school failure and both psychological and environmental domain. Disease duration and treatment duration were negatively significantly correlated with all QOL domains. A significant +ve correlation was found between social class score and both general and environmental domain. There was a significant decrease in general and environmental domain score between cases with generalized and partial seizers compared to cases with absent seizers. Conclusion: Diminished QOL is common in children with epilepsy than other children. Patients with epilepsy had lower mean scores of all domains of QOL, especially those with frequent fits, those with long duration, and in patients with generalized fits. Keywords: Childhood, Epilepsy, Health, Quality of life.
INTRODUCTION PATIENTS AND METHODS
Epilepsy is one of the most common chronic
This case control study was carried out in
neurologic conditions in children, and it is associated
Pediatric Neurology Unit and Outpatient Clinic in
with increased risk for poor health-related quality of life
Department of Pediatrics at Zagazig University
(HR-QOL) (1). Childhood epilepsy is an elevated hazard
Children's Hospital on 110 subjects, divided into two
for poor psychological outcomes and impacts on quality
groups, case group included 55 children with epilepsy
of life of children but also has a great sway on family
and control group included 55 apparently healthy
functioning. Children being the high-risk group and in
children without epilepsy of matched age, sex and
crucial development period during which many
social class during the period from February 2021 to
cognitive and social skills have to be learned. QOL is a
September 2021, to explore the current status of health
significant health outcome to assess children with
related quality of life (HR-QOL) in Egyptian children
epilepsy (2). Epilepsy also has a significant emotional
and adolescents with epilepsy by using (WHOQOL-
impact on parents of affected children, and parental
BREF) questionnaire and the socioeconomic position
emotional stability has been found to be a major
(SEP) scale (6).
predictor of the quality of life (QOL) of the epileptic Ethical approval:
child. It has been associated with significant Written informed consent was obtained
psychosocial maladjustment in both the affected from all children' parents or their relatives and the
children and their families (3). Children with epilepsy study were approved by the Research Ethical
experience difficulty in aspects of functioning, Committee of Faculty of Medicine, Zagazig
including emotional and behavioral problems, social University. The work has been carried out in
competence, academic achievement, and family life, accordance with The Code of Ethics of the World
with effects extending into adulthood. The management Medical Association (Declaration of Helsinki) for
of epilepsy requires recognition of potential effects of studies involving humans.
epilepsy and all aspects of life (4).
Quality of life (QOL) is affected by age, Inclusion Criteria: Aged between 9 and 16 years, both
seizure frequency, parent's education, type of epilepsy,
sexes, ability to answer the questions by
and type of anti epileptic in children with epilepsy.
himself/herself, and medical diagnosis of epilepsy for
Cognition, energy levels and concentration are most
more than 2 years.
commonly affected due to epilepsy (5). Exclusion criteria: Children < 9 and > 16 years,
The aim of the study was to explore the current
previous brain surgery, and use of a concomitant
status of health related quality of life (HR-QOL) in
medication with central nervous system effects, or
Egyptian children and adolescents with epilepsy by
presence of another progressive neurological,
using (WHOQOL-BREF) questionnaire.
psychiatric illness or other chronic disease.
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c:\work\Jor\vol852_54The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3778-3782
Assessment of The Diagnostic Value of TOX Versus CD3 Immunohistochemical Markers in Detection of Early Mycosis Fungoides Cases Mai Ahmed Gobran1, Ahmed Embaby2, Abeer Hafeez1
Departments of 1Pathology and 2Internal Medicine, Faculty of Medicine, Zagazig university, Egypt *Corresponding Author: Mai Ahmed Gobran, Email: [email protected] ABSTRACT Background: Primary cutaneous lymphoma (PCL) with clonal proliferation of atypical CD4+ skin-homing T lymphocyte cells is called Mycosis Fungoides (MF). TOX staining is observed in subtypes of PCL, as MF & Sézary Syndrome (SS) in comparison to controls. Early MF is difficult to diagnose, & its distinction from inflammatory diseases may be impossible. Objective: This study aimed to evaluate the expression of the TOX versus CD3 as a diagnostic marker for early MF. Patients and methods: retrospective-cross sectional study includes 30 MF and 30 benign cutaneous inflammatory diseases (BCID) cases. All were evaluated using H & E and immunohistochemical staining for TOX & CD3. Results: There was statistically significant increase of TOX & CD3 expression in MF than BCID & ability of TOX to detect all true positive cases (100.0%) compared to (76.7%) for CD3, (P < 0.001). Conclusion: TOX had the highest sensitivity (100.0%) & accuracy (88.3%). TOX is useful marker in the diagnosis of early MF & differentiating it from BCID. Keywords: TOX, CD3, Mycosis Fungoides, Benign cutaneous inflammatory diseases (BCIDs), Immunohistochemistry.
INTRODUCTION
controlled before exiting the CD4+ T-cells from the
Atypical T-lymphocytes were found in patients
thymus. The proteins of TOX-mRNA were
with Mycosis Fungoides (MF), which is a primary
inadequately expressed in peripheral lymphoid tissue
cutaneous lymphoma (PCL). MF had the lengthy (5).
clinical progression, beginning with splatters and
The stanning of TOX is expressed in several
progressing through plaques to malignancies. In
CTCLs-subtypes, i.e., peripheral T-cell lymphoma,
primary phases, MF mostly affects the skin, and
MF, and sézary syndrome (SS) and others, which were
among advanced MF cases, malignant lymphocytes
not detailed (PTCL-NOS) (6). In CTCL, miR-223
can extend to the peripheral blood, lymph nodes, and
targeted a gene called TOX (7). Furthermore, studies
visceral organs. The MF survival rate varies greatly
have shown that the TOX gene is highly expressed in
depending on the stage of the disease.
the initial MF lesion as compared to controls (8). A
Diagnosing MF is mostly depending on the
number of malignancies, including breast, leukemia,
combined algorithm of clinical and histological norms
and lungs have been shown to have aberrant (1, 2). The MF-histology shows a strip-like intervene of
expression of the TOX-gene (9).
mononuclear cells within the papillary dermis with
Meanwhile, MF is not easy to diagnose,
superimposing
epidermotropism
(intraepidermal
particularly at the initial lesions, where the uniqueness
lymphocytes with a spongiosis' paucity). These
between inflammatory diseases and MF is occasionally
lymphocytes may be collectively or singly acquired
unattainable. It was found that the infiltrating
within the epidermis, which were often enclosed by an
lymphocytes in MF are mostly CD4, with a marginal
obvious halo (Pautrier microabscesses). The high-
of CD8 T-cells. The CD4 is also expressed by
power test of mononuclear cells shows hyperchromatic
histiocytes, which could be abundant herein (10). The
& unequal nuclear features. The epidermis normally
high ratio of CD4:CD8 is noted in typical initial phase
displays an outline of psoriasiform epidermal
of MF, where this ratio was furtherly declined.
hyperplasia with hyperkeratosis & focal parakeratosis.
Nevertheless, there are uncommon MF-variants with
Hematoxylin & eosin-stained sections persist the
the declines of CD4:CD8 proportion. The CD3 is the
diagnostic gold typical, but the diagnosis in the initial
key reliably positive indicator for T-cells. The declined
phase may be a challenge since it primarily may
expression of CD7 could be improper but not definite
resemble the other chronic inflammatory dermatoses
for MF-diagnosis (11). (3).
However, it should be noticed that the CD7-loss
Thymocytes assortment equated HMG-box
could happen in harmless processes and other kinds of
(TOX), is unfettered gene in the MF-skin biopsies,
cutaneous T-Cell lymphoma (CTCL) (12). The
which encodes an extreme-motion group family
diagnostic measures of MF contain CD3-expression
(HMG) domain DNA-binding nuclear protein. This
with < 50% of T-cells, CD7-expression with < 10% of
gene governs the developing T-cells differentiation (4).
T-cells, and epidermal disagreement from CD3- or
TOX is initially expressed in the thymus and down-
CD7-expression on the dermal T-cells (13).
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c:\work\Jor\vol852_55The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3783-3789
Fecal Lactoferrin As A Diagnostic and Prognostic Marker in Egyptian IBD Patients Mohamed M. Makhlouf1, Wael A. Yousry1, Shereen Abou Bakr Saleh1, Ahmed Mohamed Naguib1, Christina Alphonse Anwar*2
1Internal Medicine Department, Hepatology and Gastroenterology Unit, Faculty of Medicine, Ain Shams University, Egypt.
2Internal Medicine Department, Hepatology and Gastroenterology Unit, Faculty of Medicine, Ain Shams University and AFCM. *Corresponding author: Christina Alphonse Anwar, Mobile: (+20)01201276220, Email:[email protected] ABSTRACT Background: Inflammatory bowel diseases (IBD) are organic chronic inflammation of the gastrointestinal tract characterized by variable disease activity with repeated periods of remission and exacerbation. Irritable bowel syndrome (IBS) is prevalent in up to fifth of population; diarrhea type has the broadest differential diagnosis. To distinguish inflammatory versus functional disorder fecal biomarkers as fecal lactoferrin (FL), being non-invasive acute phase proteins produced by inflamed mucosa, can help to avoid invasive procedures. Objective: The aim of this study was to assess sensitivity and specificity of fecal lactoferrin as a non-invasive biomarker in Egyptian patients with IBD and to detect its role in assessment of disease severity. Patients and methods: This comparative case control study was held through one year duration. Patients were recruited from Internal Medicine and Hepatology Department at a University Hospital. 50 subjects were classified into 3 groups: Group I included 30 patients with inflammatory bowel disease, Group II included 10 patients with irritable bowel syndrome, Group III included 10 healthy subjects as control group. Results: fecal lactoferrin assay (FLA) levels were highest in patients with IBD in comparison with IBS patients and healthy group. Moreover FLA levels also correlated significantly with disease severity in patients with IBD as higher levels of FLA were found in patients with severe ulcerative colitis (UC) or Crohn`s disease. Conclusion: Fecal lactoferrin can be used to differentiate IBD from IBS with 96.7% sensitivity and 100% specificity at cutoff value of 37 ug/ml while at cutoff value 7.2 ug/ml FLA has 100% sensitivity and specificity in differentiating IBD patients from healthy subjects in Egyptian population. Yet it can't differentiate ulcerative colitis versus Crohn's disease. Keywords: Inflammatory bowel diseases, Irritable bowel syndrome, Lactoferrin.
INTRODUCTION
Data suggests that IBD is of low prevalence
Inflammatory bowel disease (IBD) is a chronic
among patients with IBS symptoms and no alarm
inflammatory condition of the gastrointestinal tract
features(9,10), yet there is significant symptom overlap
comprising two forms; Crohn's disease (CD) and
between both conditions(11-13) with some IBD patients
ulcerative colitis (UC). It is a lifelong relapsing and
with symptoms meeting symptom-based criteria for the
remitting disease in random unpredictable patterns(1),
diagnosis of IBS(13).
caused through molecular mimicry in genetically
Colonoscopy and biopsy are corner stone in IBD
predisposed patients to unknown initiator resulting in
diagnosis, yet it is invasive, expensive, embarrassing
macroscopic inflammation of the GIT with recurrent
and time consuming with severe complications in some
episodes of relapse and remission(2).
conditions(14), therefore, non-invasive, simple and
IBS is a functional disorder, which may result from
accurate tests were needed to differentiate IBD from
alterations in the gut microbiome, maldigestion of
IBS patients and to assess severity of IBD. Erythrocyte
carbohydrates, psychologically mediated effects, and
sedimentation rate (ESR), C-reactive protein (CRP),
dysregulation of immunity (3-4). Patients with IBD and
and leukocytes are serum biomarkers influenced by
irritable bowel syndrome (IBS) share many clinical
multiple systemic host responses which make them
symptoms, including abdominal pain, diarrhea and
nonspecific for intestinal inflammation(14). Fecal
generalized malaise(5).
biomarkers are increasingly used to assess activity in
IBS should be diagnosed based on ROME IV
IBD due to direct correlations with intestinal
criteria(6), in the absence of alarm features with no need
inflammation(1). Neutrophil granular proteins as
for extensive investigations other than routine serologic
lactoferrin, lysozymes, calprotectin are of fecal markers
screening for celiac disease in patients with diarrhea-
of intestinal inflammation(15).
predominant IBS or mixed IBS and colonic mucosal
Lactoferrin (FL) is an 80kDa glycoprotein with
biopsies for microscopic colitis when performing
iron-binding capacity. Being a part of innate immunity,
colonoscopy in patients with diarrhea-predominant IBS
lactoferrin is present in various secretory fluids, (7). Yet, a lot of doctors consider IBS as a "diagnosis of
including milk and nasal secretions(16) with
exclusion" ordering multiple diagnostic tests to rule out
antimicrobial activity but it is not affected by
various organic diseases before confidently diagnosing
age
variation,
or
extraintestinal
causes
of
IBS(8).
inflammation(17,18).
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c:\work\Jor\vol852_56The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3790-3797
Mccleery's Syndrome the Overlooked Cause of Swollen Upper Limb, Completion Venoplasty is The Key Word for Successful Surgical Decompression Ahmed K. Allam1,3,4*, Mohamed Ismail Mohamed Ismail2,3,4, Mohamed Abd El-Monem Abd El-Salam Rizk2,3
1General Surgery Department, Benha University Hospitals, Benha, Egypt.
2Vascular Surgery Department, Ain Shams University Hospitals, Egypt.
3Vascular Surgery Department, Wadi El-Neel Hospital, Egypt.
4General Surgery Department, Vascular Surgery Unit, Police Academy Hospital, Egypt. *Corresponding author: Mohamed Abd El-Monem Abd El-Salam, Mobile: (+20) 01222310844, Email:[email protected] ABSTRACT Background: Venous thoracic outlet syndrome (VTOS) is the second most presenting pattern of thoracic outlet syndrome (TOS). Non thrombotic VTOS swollen upper limb is usually overlooked by many surgeons. When there is chronic intermittent arm swelling that is associated with discoloration that worsen with overhead arm movement, McCleery's syndrome is more likely. Objective: We present the results of our treatment strategy of McCleery's syndrome consisting of para-clavicular approach for thoracic outlet decompression (PCA-TOD), external venolysis, and combined surgical decompression with or without routine completion venoplasty. Patients and methods: A retrospective analysis of the data of twenty-three patients who presented from January 2016 to February 2021 with chronic intermittent arm swelling, we divided the patients into two groups, group (A): 13 patients who underwent surgical decompression alone and follow up. Group (B): 10 patients who underwent surgical decompression associated with Intraoperative venography and balloon angioplasty. Results: In group (A) complete symptomatic resolution was achieved in 6/13 (46.2%) patients, secondary endovenous intervention was required in 7 (53.8%) patients due to residual symptoms, postoperative average residual arm circumference difference was 0.92 ± 0.86 cm with a statistically significant difference in favor to group (B) (P value = 0.0274). In group (B) complete symptomatic cure achieved in 10/10 (100%) patients with statistically highly significant difference favoring to group (B) (P value = 0.0075). Conclusion: From our results, completion angioplasty of surgically decompressed axillo-subclavian venous segment added a significant cure and symptoms improvement for patients with McCleery's syndrome and could be considered as a primary therapy in conjunction with surgical decompression. Keywords: McCleery's syndrome, Para-clavicular approach, Venoplasty.
INTRODUCTION
Pain, numbness and tingling are common symptoms to
Venous thoracic outlet syndrome (VTOS) term is
both syndromes (4).
dedicated to the group of symptoms caused by squeezing
Patients who have VTOS are thought to be at risk
of the subclavian vein between the clavicle and the first
for developing upper limb deep venous thrombosis
rib at the costoclavicular space (nutcracker like effect) in
because there is compression of subclavian vein between
the thoracic outlet (1). Mostly this squeeze is augmented
the clavicle and the first rib, which acts as a permissive
by an abnormaly inserted costoclavicular ligament
lesion and should undergo definitive treatment with first
and/or hypertrophy of the scaleneus anterior muscle
rib resection and scalenectomy (1). The lack of much
and/or subclavius muscle that narrow(s) the thoracic
published articles concerned with McCleery syndrome
inlet (2). There is some confusion about the nomenclature
could be explained by the unpopularity of its symptoms
describing this condition. This confusion arises from
due to its intermittent behavior. So, the aim of our study
variation of patients' symptoms and their associated
was to describe the peculiar characteristics of patients
pathology classifying VTOS into two main patterns.
presenting with McCleery syndrome and to evaluate the
Compression and thrombosis of the axillo-subclavian
outcomes of those underwent first rib resection and
venous segment are quite frequently referred to as effort
scalenectomy with/without axillo-subclavian venous
thrombosis or PagetSchroetter syndrome. There is a
segment angioplasty.
subset of patientscomplaining of symptoms that worsen
with the arm being in overhead position, but without PATIENTS AND METHODS
thrombosis, which is termed intermittent obstruction or
We conducted our retrospective analysis of
McCleery syndrome (3).
prospectively collected data of 23 patients who were
It is essential to differentiate patients presenting
operated upon for first rib resection and complete
with McCleery syndrome from those with neurogenic
surgical decompression, we analysed all patients
TOS. Arm swelling is a frequent component of
admitted to Vascular Surgery Units/Departments of
McCleery syndrome and is absent from neurogenic TOS.
included centres from January 2016 to February 2021 at Benha University Hospital, Ain Shams University This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_57The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3798-3804
Detection of Bacteria Causing Early Onset Pneumonia among Neonates Admitted to NICU In Children Hospital, Zagazig University Tarek Hamed Atteyah1, Wessam Abd El monem Mokhtar1, Mai Mohammed Malek2, Ahmed Badawi Mohammed1
Departments of 1Pediatrics and 2Immunology and Microbiology, Faculty of Medicine Zagazig University, Egypt *Corresponding Author: Ahmed Badawi Mohammed, Mobile: (+20)01111159254, Email:[email protected] ABSTRACT Background: Early onset pneumonia could be caused by bacteria, virus or fungi. Early identification and treatment with antibiotics is vital in reducing mortality and morbidity. Objectives: The current study aimed for detection of organisms that cause early onset pneumonia guided by nasopharyngeal aspirate culturing, in addition to blood culturing. Patients and methods: This study was applied on 36 neonates admitted to NICU in Zagazig University Children Hospital, during the period from October 2018 to April 2019. Results: There was no relation between gestational age and birth weight with neonatal pneumonia (NP) incidence rates. The prevalence of confirmed early onset NP with positive blood culture was 88.9%. The hospital stays of studied subjects were 7.2 ± 3.5 days. Neonatal pneumonia caused by Gram negative bacteria (53.1%) was more common than Gram positive bacteria (46.9%). K. pneumonia (37.5%) was the most common microorganism isolated from the blood cultures. S. saprophyticus (21.8%) was the most frequently recovered CONS isolate from blood cultures, followed by S. cohnii (9.4%) and S. haemolyticus (6.3%). The most prevalent organism isolated from BAL fluid was Klebsiella (38.5%). Conclusion: Neonatal sepsis remains a major problem in neonates. Gram-negative bacteria were the most common cause of early onset NP in Zagazig University Hospital with K. pneumonia being the most common pathogen. Regular periodic surveillance of the causative organisms of neonatal pneumonia is needed to implement the rational empirical choice of antibiotic prescription while waiting for blood culture result to come out. Keywords: Bacteria, Early onset pneumonia, Neonates, NICU.
INTRODUCTION
infants, there may be a latent period of a few hours or
Respiratory conditions are the most common cause
an interval of 1-2 days before respiratory distress or
for admission to a neonatal unit in both term and
shock develops. In some infants, the early signs and
preterm infants. Early onset pneumonia "also known as
symptoms may be nonspecific, presenting with poor
congenital pneumonia" is associated with trans-
feeding, lethargy, irritability, cyanosis, temperature
placental infection and presents within 48 hours of age.
instability or with an overall impression that just not
Chorioamnionitis is a major contributory factor for
doing well baby (3).
sepsis, with infected uterine fluid being inhaled by the
Early identification and treatment with antibiotics
fetus, potentially resulting in congenital pneumonia (1).
is vital in reducing mortality and morbidity. This is
Early onset pneumonia is defined as an inflammatory
reflected in the guidance that antibiotics must be
condition of the lungs affecting primarily the alveoli
commenced within 1 h of decision to treat. The
with clinical and radiological evidence present at birth.
prognosis of neonates with congenital pneumonia varies
Some authors defined this condition as pneumonia that
greatly and is dependent upon the organism and its
is present at birth with a positive tracheal aspirate
virulence. However, early identification and treatment
culture obtained within 4 hours of delivery (2).
of neonates at risk of infection or with symptoms of
Early onset "congenital" pneumonia could be
infection reduces both morbidity and mortality. A worse
caused by bacteria, virus or fungi. Bacteriological study
prognosis is seen in infants with low birth weights and
of lung tissues showed that both Gram-negative and
for those with intrauterine compared to those with later
positive bacteria could cause congenital pneumonia.
onset disease (4).
Since the 1970s, Group B Streptococcus has been
A definitive diagnosis can be made in the presence
recognized as an important cause of early onset
of clinical manifestation of pneumonia shortly after
"congenital" pneumonia. Due to increased risk of
birth with associated chest radiograph changes, and the
resistance of organisms to antibiotics due to disuse of
causative organisms cultured or isolated from
different antibiotics, early detection of organisms
nasopharyngeal aspirates or tracheal aspirates obtained
causing congenital pneumonia by culturing is a must (1).
aseptically within the first 8 hours of life (1).
Clinical manifestation of early onset "congenital"
The current study aimed for detection of organisms
pneumonia may be apparent before delivery in the form
that cause early onset pneumonia guided by
of fetal distress or tachycardia, or at delivery as a low
nasopharyngeal aspirate culturing, in addition to blood
Apgar score or severe respiratory distress. In some
culturing. Also, the antibiotic resistance profiles of
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c:\work\Jor\vol852_58
The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3805-3809
An Overview of QT Dispersion Finding in Cardiac Patients,Review Article Ahmed Mohamed Sanad 1, Kamel Hasan Ghazal 2, Mohammad Abdalla Eltahlawi 2, and Ahmed Taha Abdelwahed 2
1 Kobri El-Kobba Military Hospital, Cairo, Egypt, 2 Zagazig University, Zagazig, Egypt *Corresponding Author: Ahmed Mohamed Sanad, E-Mail: [email protected]
ABSTRACT Background: QT duration represents the time of the whole summated electric cardiac ventricular activity involving stepwise depolarization followed by repolarization. There has been a long history of using the surface electrocardiogram (ECG) to identify ventricular repolarization problems. The 1960s were a turning point for precise mathematical methodologies. It has been customary in clinical practice to use only the QT interval and the polarity and shape of the T wave when evaluating cardiac repolarization using an electrocardiogram (ECG). This terminology, such as "non-specific ST segment and T wave variations are widely used. An earlier theory on interlead disparities in QTI length was resurrected in a 1990 report by the group led by Professor John Campbell. The "QT dispersion" range of durations was proposed as a measure of ventricular recovery time spatial dispersion. Objective: Determine the relevance of QTd in prediction of myocardial and its severity. Conclusion: For cardiac patients, QTd is an easy-to-use, rapid, affordable, and helpful tool for helping with study interpretation, clinical management, and therapeutic orientation. Keywords: QTd Dispersion Finding, Cardiac Patients QT dispersion Definition: Pathophysiology of QT dispersion:
The difference between 12-lead ECG's longest and shortest
Increased QTd has a complex pathophysiology that
QT intervals can be described as QT Dispersion. These two
is still being studied. Regional changes in ventricular wall
extreme indices are calculated by measuring each one of 12
stress (contraction-excitation feedback or mechano-
QT intervals separately (1). This technique has a good
electric) generated by ventricular dilatation and fibrosis
correlation with the QT interval standard deviation across
may increase the refractoriness' dispersion. This theory is
whole 12 leads. Instead of just two leads, the QT interval
backed up by research showing elevated QTd in patients
standard deviation could provide a more trustworthy
with acquired long QT interval, such as those with
dispersion measurement because it incorporates all of 12
hypertension,
hypertrophic
cardiomyopathy,
left
lead values, lowering reliance on each lead's ability to
ventricular hypertrophy, and acute MI (7).
detect the QT interval (2).
On top of that, it's unclear what causes the QTd seen
over surface of the body to appear so long. Because action Long QT syndromes (LQTS):
potential duration and activation time vary regionally,
Despite the fact that most experts believe that LQTS
which causes repolarization heterogeneity. Repolarization
patients have more QT dispersion, no connection was
dispersion can be caused by changes in the action potential
found between QT dispersion and symptoms according to
duration between cell groups coming from different levels Linker et al. (3). Before and after beta blocker usage, QT
of the ventricular myocardium, as evidenced by research in
dispersion did not differ significantly across the groups,
this subject. In comparison to endocardial or epicardial cell
according to this research. Priori et al. (4), on the other hand,
layers, the presence of M-cells (in the mid-myocardial
discovered that poor beta blocker treatment in LQTS
layer) has been shown to be accompanied by repolarization
patients was linked to persistently high QT dispersion
prolongation (1).
values, as opposed to lower values found in individuals
It was discovered by Gokhan et al. (8) that
who reacted successfully by use of this medication. QTc
prolongation of QT over ECG indicates a non-uniform and
dispersion was found to decrease both before and during
delayed repolarization recovery in regions of infarction or
beta blockage in normal subjects but increased abnormally
ischemia.
Ischemia
elevates
potassium
level
in LQTS subjects due to exercise. This abnormal rise was
extracellularly, causing anoxia and acidosis, these are the
avoided by beta blockers usage. Beta blocking medications
fundamental mechanisms. This also reduces membrane
have been shown to protect against LQTS arrhythmias,
excitability, shortens action potentials, and extends the time
which are usually caused by stress, according to the authors
it takes for excitability to recover once an action potential (5).
has occurred. Myocardial no-reflow syndrome is thought to
After beta blockers were used in LQT1 group, the
be caused in part by embolization of thrombotic material.
mean Tpe values were no longer prolonged in the same way
The epicardiac layer's action potential ended at the T-
as they were in the control group without beta blockers
wave peak in the body surface ECG, while the mid-
utilization. In LQT1 patients, our findings show that the use
myocardial layer's repolarization ended at the T-wave
of BBs reduces the risk of ventricular repolarization
offset (containing M-cells). T-wave peak (Tp) to T-wave
arrhythmia. Sudden cardiac arrest and syncope risks can be
end (Te) time difference signifies the repolarization
reduced in this population by BBs taking (6).
transmural dispersion from this perspective (9).
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c:\work\Jor\vol852_59The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3810-3815
Predicting Adverse Pregnancy Outcomes During the Late First Trimester and Early Second Trimester Using the Uterine Artery Doppler Dina Hassan Abdel Wahid, Mohammed Sabry Mahdy,Hala Elsayed Mowafy, Walid Abdullah Abdelsalam
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt Corresponding Author: Dina Hassan Abdel Wahid, Email:[email protected]
ABSTRACT Background: The high resistance occurring in vessels of placenta pathologically can be assessed by impaired blood
flow of uterine arteries of pregnant women. It has been proven that measuring of blood flow in the uterine artery in 1st trimester is useful. Results from the second trimester, on the other hand, have proven to be more predictable. Objective: The aim of the work was to predict fetal and maternal morbidity and mortality as a result of low placental
blood flow. Subjects and Methods: This prospective study included a total of 127 pregnant women, attending for routine first trimester U/S scan at Department of Obstetrics and Gynecology, Zagazig University Hospitals. This study was conducted between April 2020 till December 2020. Results: The mean Doppler Uterine artery resistance index (RI) was 0.587±0.22 ranged from 0.31 to 1.21 and for
pulsatility index (PI) 1.56±0.29 ranged from 0.39 to 2.45. The incidence rate of Fetal maternal adverse outcome was 22.8%, distributed as 11.8% Maternal adverse outcome (most prevailing preeclampsia) and 15.7% Fetal adverse outcome (IUGR and preterm). There was statistically significant higher value of Doppler Uterine artery RI and Doppler Uterine artery PI of Adverse outcome compared to Favorable outcome women. Uterine artery PI was good marker to discriminate maternal fetal adverse outcome at late first to second trimester. While uterine artery RI was fair marker to discriminate maternal fetal adverse outcome at late first to second trimester. Conclusions: It could be concluded that uterine artery PI was good marker while uterine artery RI was fair marker to
discriminate maternal fetal adverse outcome at late first to second trimester. Keywords: Adverse Outcome, Uterine Artery Doppler, Pregnancy.
INTRODUCTION
cutoff to study PI of uterine artery in 1st trimester, they
To ensure that the fetus receives the maximum
reported that 30.8 percent had major sequalae (5). This
amount of oxygen and nutrients during pregnancy, the
has resulted in the absence of any set guidelines for the
trophoblasts of placenta go via the innermost third of the
gestational age at which testing should be performed, as
myometrium and the whole depth of the spiral arteries
well as the absence of any established criteria for
of the mother. In Preeclampsia women, no invasion
abnormal uterine artery Doppler investigations. If the
occurs of trophoblasts through the muscle layer of
clinician has had sufficient training in this method,
uterus; hence, the spiral arteries and their cover of
using a U/S being capable of both continuous and
elastic muscles make the flow still to be difficult (1).
pulsed wave operation. Doppler tests on the uterine,
The high resistance occurring in vessels of
arcuate, and sub placental arteries would be an
placenta pathologically can be assessed by impaired
acceptable strategy (6).
blood flow of uterine arteries of pregnant women,
The reports appear to be useful in determining the
hence, helping clinicians identify pregnant women with
flow rate of the uterine artery during the first trimester.
preeclampsia. Doppler examinations in the first and
The second trimester, on the other hand, has produced
second trimesters that showed atypical uterine arteries
outcomes that are more consistent. It is acceptable to
have also been connected to complications in perinatal
expect performance during 18-20 weeks of pregnancy.
life according to the recent studies (2).
Evidence suggests that repeating the tests at 24-26
During systole, uterine artery flow velocity rises
weeks may be beneficial in terms of gaining additional
and falls rapidly in the non-pregnant condition, and the
information (7).
descending waveform has a notch in early diastole.
The aim of the current work was to predict fetal
Between 8 and 16 weeks of pregnancy, the uterine
and maternal morbidity and mortality as a result of low
artery compliance increases significantly, and this trend
placental blood flow.
maintained until 26 weeks of pregnancy, but to a lower
level (3).To identify existence of high resistance in utero- SUBJECTS AND METHODS
placental vessels, many studies showed high parameters This prospective study included a total of 127
of PI or RI or diastolic notch persistence in uterine
pregnant women, attending for routine first trimester
artery. Some studies have used only one cutoff number
U/S scan at Department of Obstetrics and Gynecology,
(e.g., RI > 0.58), whereas others have used percentage
Zagazig University Hospitals. This study was
cutoff values to identify aberrant RI (e.g., 75th, 90th, 95th)
conducted between April 2020 till December 2020. (4).
Major Complications of pregnancy were detected Ethical Consideration:
by Gomez et al. w Thi
hen s ta
h rt
eyicle
is
use d an
t
h o
e pen
95thacce
perss
ce anrt
ti icle
le distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_60The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3816-3820
Comparison Between Combined Sensory Index Test and Diagnostic Ultrasonography (Inlet Outlet Ratio) in Suspected or Early Cases of Carpal Tunnel Syndrome Mennatallah M. Mustafa, Nagwa M. Nassar, Iren R. Amin, Hossam S. Labib*
Department of Physical Medicine, Rheumatology and Rehabilitation, Ain Shams University Hospital, Cairo, Egypt *Corresponding author: Hossam Salaheldin Abdelmohsen Labib, Mobile: (+20)1002058687, Email: [email protected] ABSTRACT Background: The combined sensory index (CSI) test is more precise in diagnosing carpal tunnel syndrome (CTS) early cases. Another useful tool for early detection of CTS is the diagnostic ultrasonography. Objective: The present study was conducted to compare between the CSI test and its sensitivity with diagnostic ultrasonography IOR (inlet outlet ratio) in suspected or early cases of carpal tunnel syndrome (CTS). Patients and methods: The presentcase-control study involved 20 subjects with signs and symptoms suggestive of early cases of CTS with duration less than 6 months, in addition to 20 apparently healthy subjects who were clinically examined and underwent EDX and US evaluation. We excluded patients with severe CTS, proximal cervical lesion, or other neurological diseases. Results: By comparison, CSI shows a higher sensitivity than IOR. Combining both tests induced elevated substantial differences between patients as well as controls (P <0.01), besides elevating the sensitivity to 100%. Conclusion: It could be concluded that the sensitivity and accuracy of CSI is higher than diagnostic ultrasonography IOR on the median nerve. On the contrary, diagnostic ultrasonographycan detect the anatomical abnormalities of the median nerve while the physiological abnormalities of the median nerve and their level can be examined by nerve conduction studies (NCS). They are complementary tests for CTS diagnosis Keywords: Combined sensory index, Carpal tunnel syndrome, Diagnostic ultrasonography IOR (inlet outlet ratio) INTRODUCTION
The aim of the current work was to compare
Carpal tunnel syndrome (CTS) is a prevalent
between the CSI test and its sensitivity with diagnostic
form of nerve compression syndromes. It is induced by
ultrasonography IOR (inlet outlet ratio) in suspected or
entrapment of the median nerve at the wrist and occurs
early cases of carpal tunnel syndrome (CTS).
in approximately 3.8% of people (1). According to the
guidelines, the diagnose of CTS includes clinical PATIENTS AND METHODS
finding and electro diagnostic test (2).
This case-control study included a total of 20
In early stages, clinical finding is insufficient for
participants who developed signs and symptoms
CTS diagnosis as the history and topographic
suggestive of early cases of CTS with duration less than
distribution of symptoms are nearly normal. In these
6 months, in addition to 20 apparently healthy subjects
suspected cases, combined sensory index (CSI) which
as controls, attending at Outpatient Clinics, Department
is the aggregate of average ulnar peak sensory latency
of
Physical
Medicine,
Rheumatology
and
difference (Ring difference), average radial peak
Rehabilitation, Ain Shams University Hospitals, Cairo,
sensory latency difference (Thumb difference), as well
Egypt.
as average ulnar mid palmer peak sensory latency
difference (Palm difference) are considered more Ethical Consideration:
sensitive (3). An approval of the study was obtained from Ain
Another useful tool for early detection of CTS is Shams University academic and ethical committee.
diagnostic ultrasonography which is utilized to evaluate Every patient signed an informed written consent
median nerve anatomical abnormalities that NCS for acceptance of the operation. This work has been
cannot evaluate. The importance of ultrasonography is carried out in accordance with The Code of Ethics of
manifested in its vast availability, noninvasiveness, the World Medical Association (Declaration of
reduced cost as well as decreased time of examination Helsinki) for studies involving humans. (4). The most widely method used to diagnosis CTS by
ultrasonography is measuring the median curve cross- Inclusion Criteria: Cases which developed signs and
sectional area (CSA) at the wrist on two regions (outlet
suggestive CTS symptoms (4) Nocturnal paresthesia in
as well as inlet of the tunnel). The proportion between
lateral three and half fingers, hand shaking (the flick
these two regions namely, Inlet _outlet ratio (IOR) has
sign) alleviates numbness sensation and tingling,
recently been used to compensate for the individual
burning pain in the in lateral three and half fingers,
inter variability in the median nerve CSA and to give a
positive Phalen's test, positive Hoffman-tinel sign and
more precise CTS diagnosis (5).
positive compression test.
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c:\work\Jor\vol852_61The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3821-3826
Hypovitaminosis D and Systemic Lupus Erythematous Activity and Related Neuropathy: Clinical Correlation Mohamed Abd Ellatif Afifi*1, Mahmoud Rizk1, Walid Abdel Halim2, Mayada Khalil3, Wael Gabr4, Mohamed Kamal5, Ahmed Mohamed Hussein1
Departments of 1Internal Medicine, 2Clinical and Chemical Pathology and
3Rheumatology Rehabilitation and Physical Medicine, Faculty of Medicine, Benha University, Egypt
Department of 4Neurology, Faculty of Medicine, Mansoura University, Egypt
Department of 5Rheumatology, Al-Azhar University, Faculty of Medicine, Egypt *Corresponding Author: Mohamed Abd Ellatif Afifi, Mobile: (+20)01001588752, Email:[email protected] ABSTRACT Background: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. Vitamin D has a modulating effect on immune responses. Hypovitaminosis D is highly prevalent in SLE patients, and it may lead to SLE activity and SLE-related neuropathy. Aim of the study: To recognize the role of serum vitamin D levels in SLE activity and also to investigate its relation to SLE-related neuropathy. Patients and Methods: the current study was a cross-sectional study performed on 100 SLE patients, who were divided into two groups, Group 1: included 50 patients with disease activity. Group II: included 50 patients without disease activity. They were tested for serum vitamin D levels, serum electrolytes, complement levels and nerve conduction. Results: Vitamin D was significantly low in group1 (median = 9.0 ng/ml) compared to the group 2 (median = 19.3 ng/ml and P-value of<0.001). Hypovitaminosis D was statistically significantly correlated with lower levels of complement (both C3 and C4) in the activity group but not in the non-activity group. Vitamin D levels were significantly associated with delayed nerve conduction in both groups, suggesting that neuropathy was linked to vitamin D level rather than SLE activity Conclusion: Hypovitaminosis D is statistically significantly correlated with SLE activity and SLE-related neuropathy. Keywords: SLEDAI-2k, Systemic Lupus Erythematous, Vitamin D. INTRODUCTION
Vitamin D is considered a multifunctional steroid
Systemic lupus erythematosus (SLE) is a chronic
hormone with many actions. Little about its function is
multisystem autoimmune disease characterized by
understood. It is becoming more clear that vitamin D is
autoantibody attacks and the deposition of
not only engaged in calcium homeostasis and bone
complement-fixing immune complexes (ICs), which
metabolism, but also has multiple biological actions
causes inflammation and can lead to systemic injuries
mediated by vitamin D receptors (VDR) (1), present in (6). Hypovitaminosis D is common in SLE patients,
even more than thirty tissues including the kidneys(2),
likely due to photoprotection, renal insufficiency,
brain, intestine, pituitary, parathyroid gland, prostate,
glucocorticoid usage (7), and the presence of
breast, heart muscle, skeletal muscles, hepatic cells,
antivitamin D antibody (8). SLE activity has been
immune system and the endothelial cells (3).
linked to hypovitaminosis D (9) and the development of
Vitamin D is obtained from certain food staffs and
peripheral neuropathies (10).
from exposure to ultraviolet light. Activation of
Vitamin D has a modulating effect on immune
vitamin D is done through two steps; the first is
responses (11). Both the innate and adaptive immune
activating vitamin D through hydroxylation of
systems rely on vitamin D for immune stability, as it
cholecalciferol into the 25-hydroxyvitamin D (25-
stimulates the innate immune response while inhibiting
OHD) metabolite that occurs in the liver (4).
the adaptive immune response (12), this role is mediated
This is the major circulating metabolic form of
by VDR, which is expressed on immune cells (13).
vitamin D. It circulates bound to the vitamin D-
Vitamin D enhances regulatory T cells and macrophage
binding protein carrier protein (DBP) with a 15-21 day
antimicrobial effects, while decreases Th1 CD4 T cells
half-life. Second activation process for 1, 25 dihydroxy
and cytokines including IL-2, interferon, and tumor
vitamin D occurs mainly in the kidney and to a lesser
necrosis factor, it also inhibits dendritic cell
extent in a range of all other tissues such as bone,
differentiation and prevents activated B cells from
mammary gland, brain tissue, monocytes, parathyroid
proliferating (11).
gland and placenta. This active metabolite has a shorter
As a consequence, vitamin D would be more anti-
1020 hour half-life. Accordingly, the level of vitamin
inflammatory and immune-regulatory. Additionally, it
D is commonly assessed by measuring circulating 25-
is essential for calcium homeostasis and its deficiency
OHD (4, 5).
may leads to calcium metabolism disorders and
autoimmune diseases (14).
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Zagazig UniversityThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3827-3830
Intralesional Injection of Botulinum Toxin for Post-Herpetic Neuralgia: A Pilot Study Wafaa S. Mohamed1, Soheir Mohammed Ghonem2, Hanan Muftah Ahmed Emsheri*2, Eman Salah2
Departments 1Neurology and 2Dermatology, Venereology & Andrology,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hanan Muftah Ahmed Emsheri, E-mail:[email protected] ABSTRACT Background: When someone has herpes zoster and the rash goes away in spite of persistence of pain, they are defined to have post-herpetic neuralgia (PHN). Herpes zoster is frequently accompanied by post-herpetic neuralgia. Clostridium botulinum produces botulinum toxin (BTX-A), a neurotoxic protein that is used to treat various ailments. Objective: Intralesional botulinum toxin injections were tested for their efficacy in the treatment of post herpetic neuralgia. Patients and methods: An intralesional BTX-A injections pilot trial including 19 patients with PHN was carried out. Quality of life scale (QLS), neuropathy pains scale (NPS), and pain analyses by visual analogue scale (VAS) were used for all patients after comprehensive history-taking process. Results: After a six-months therapy follow-up period, we found significant differences comparing before and after treatment in the neuropathy pain scale, VAS score, and the QLS (SF-36). Pain at site of injection was found in all patients while redness or erythema was found in 13 patients. Conclusion: Treatment with botulinum toxin via local injection is beneficial for post-herpetic neuralgia (PHN). BTX could be alternative therapeutic modality in treating PHN in the future. Keywords: Post-herpetic neuralgia, Botulinum toxin A. INTRODUCTION
Most people who get herpes zoster develop post- PATIENTS AND METHODS
herpetic neuralgia (PHN), which is neuropathic pain
Pilot research including 19 people with PHN
caused by the virus. The standard definition of herpes
was carried out in the Dermatology and Neurology
zoster pain is dermatomal discomfort that lasts at
departments.
least 90 days after the rash appears. PHN leads in Ethical approval:
significant pain and suffering for those affected, as Patients signed a valid written agreement to
well as a financial and social cost on society as a participate in the study, and it was authorized by
whole (1). the Zagazig University Faculty of Medicine's
PHN is characterized by a stabbing sensation, Research Ethical Council (ZU-IRB). The study
burning, or pain induced by light touch with non- complied with the World Medical Association's
painful stimuli and affects nerve fibers and skin. Code of Ethics for Human Research (Declaration
Post-herpetic neuralgia pain is notoriously difficult to of Helsinki).
cure and can last for years, making several negative
impacts on patient social life (2). Inclusion criteria: Cases with post herpes zoster
Central neurons sodium channels are inactivated
persistent dermatomal pain 90 days, patients with
through action of a neurotoxin made by the bacterium
variable degree of PHN, males or females, and age
Clostridium botulinum that is called Botulinum toxin
18 years.
(BTX-A), which also can suppress peripheral
Exclusion criteria:
neurotransmitters as well as inflammatory mediators
Individuals suffering from motor neuron disease, (3). BTX's effectiveness in PHN has been the subject
myasthenia gravis, severe organ failure, Eaton-
of several studies. On 60 PHN patients Xiao et al. (4)
Lambert syndrome, mental disorders, cognitive
conducted a double-blind randomized placebo-
impairment and a history of infectious diseases,
controlled study with the following groups: BTX, 0.5
recent fever or having asthma.Patients taking
percent lidocaine, and 0.9 percent saline groups.
medication for aggravated transmission disorders of
When compared to the other two groups, the BTX-
neuromuscular junction, one week prior to the study.
treated patients showed the largest improvement on
History of allergy to the same used materials.
VAS and in terms of sleep quality.
Pregnant and lactating women. Coagulation
Intralesional botulinum toxin injections were
abnormality, including use of coumarin or
tested for their efficacy in the treatment of post
anticoagulants. The affected dermatome is infected
herpetic neuralgia in this research.
with bacteria on the skin, and immunocompromised
patients.
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c:\work\Jor\vol852_63The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3831-3837 Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving SurgeryDetects Occult Multifocal Cancer, A Prospective Study Mohamed Mahmoud Ali*1, Emad Gomaa1, Ashraf Mohammad El-Badry1
1Department of Surgery, Sohag University Hospital, Faculty of Medicine, Sohag University, Sohag, Egypt *Corresponding author: Mohamed Mahmoud Ali, Mobile: (+20) 01004564240, E-mail:[email protected] ABSTRACT Background: Cavity shaving (CS) entails circumferential tissue removal from residual lumpectomy cavity following tumor resection during breast conserving surgery (BCS). It could allow detection of occult multifocal breast cancer (OMFBC). Objectives: This study aimed to highlight the impact of unidentified OMFBC as essential risk factor for local recurrence after BCS. Patients and Methods: Eligible breast cancer patients for BCS and CS were prospectively enrolled. Patients with negative margins of "resected tumor specimens" were designated as group A whereas group B comprised those with positive margins. OMFBC, diagnosed in the additionally shaved margins of the "residual lumpectomy cavity" as malignant breast tissues with intervening normal areas, was investigated in both groups. The study was conducted through the period from November, 2017 to March, 2021. Results: Forty-two patients with median age of 43 years were studied. Group A included 32 patients (76.2%) compared with 10 (23.8%) in group B. Overall, OMFBC was confirmed in the additionally shaved margins in 6 (14.3%) patients. OMFBC rate was less in group A (4/32 patients, 12.5%) compared to B (2/10 patient, 20%), however the difference did not reach statistical significance. In group B, another 1 patient showed persistent positive margins without evidence of OMFBC. All 7 patients with positive CS margins (6 with OMFBC and 1 with persistent positive margin without evidence of OMFBC) had their treatment strategy switched to modified radical mastectomy. Local recurrence occurred in only one among the remaing 35 patients (2.9%) who were treated by BCS with CS. Conclusions: CS improves outcome of BCS by reducing the rate of positive margins, enabling diagnosis of occult multifocal breast cancer and reducing local recurrence. Keywords: Breast cancer, Conservative surgery, Cavity shave margin. INTRODUCTION
Nonetheless, ductal carcinoma in situ (DCIS) requires
Breast conserving surgery (BCS) comprises
at least 2 mm width of cancer-free breast tissue from
partial mastectomy (lumpectomy, tumor resection)
the edge of resected lump to conclude a negative
followed by adjuvant treatment including radiation and
margin (911).
possibly systemic therapy (1). Currently, BCS is the
The second objective was accomplished by
standard treatment for early-stage breast cancer. BCS
several techniques, among which cavity shaving (CS),
provides not only superior cosmesis, but also
which denotes circumferential resection of additional
equivalent survival benefit compared to the
tissues from the walls of the lumpectomy cavity, has
conventional procedures, which involve total
achieved evident attention(12, 13). Multicenter study
mastectomy (2). Safety of BCS relies on achieving
showed that CS significantly reduced the incidence of
negative margins of the resected tumor specimen and
positive margins from 36% to less that 10%, which
avoidance of missing occult multifocal breast cancer
correlated with remarkable decrease of re-operation
(OMFBC) in the walls of the residual lumpectomy
rates from 24% to 9% (14).
cavity. Positive margins and overlooked OMFBC raise However, the efficacy of CS might be
the incidence of local recurrence and increase the
challenged by missing OMFBC in the shaved margins
percentage of reoperations to 20-60% (35).
of the residual lumpectomy cavity (12). This could
Given the unacceptably high re-excision rates,
occur even in patients who had negative margins of
refinements to optimise the outcome of BCS have
their resected tumor specimens leading to failure of
focused on fulfilment of two objectives including
BCS (15, 16). For instance, OMFBC was confirmed in
proper description of negative margin and avoidance
CS margins of 8-23% of patients who initially had
of missing OMFBC (6). To implement the first, a
negative margins of lumpectomy (resected tumor)
consensus on precise definition of negative margin
specimens (12, 17, 18).
based on the types of primary cancer was established
In this study, we will highlight the impact of (7).In the setting of invasive ductal adenocarcinoma,
unidentified OMFBC as essential risk factor for local
negative margin was described as absence of
recurrence after BCS.
malignancy at the border of lumpectomy specimen (8).
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IntoductionThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3838-3844
Correlation between Serum Uric Acid and Atherosclerotic Cardiovascular Complications in Patients with Systemic Lupus Erythematosus in Sohag University Hospital Eman Ahmad Sabet, Sharaf Eldeen Shazly, Emad Ahmad Mohamad Yousef, Ahmad Mamdouh Taha
Department of Internal Medicine, Faculty of Medicine - Sohag University, Egypt *Corresponding author: Ahmad Mamdouh Taha, Mobile: (+20) 01140140347, E-Mail: [email protected] ABSTRACT Background: Systemic lupus erythematosus (SLE) has been associated with excess cardiovascular morbidity and mortality. The underlying causes of this phenomenon are still relatively unknown, but it is believed that a combination of classic and new cardiovascular risk factors including chronic low-grade inflammation may be involved. Objective: This study was designed to assess the relationship between serum uric acid level and the CVD complications in SLE patients. Patients and methods: This clinical-based prospective study was carried out on 60 patients. This study was conducted in Sohag University Hospital. The patients in the study were divided into two equal groups: Group (A) included patients with normal S.UA in between (2.4-6.0 mg/dl) for females and (3.4-7.0) for males and group (B) that included patients with elevated S.UA higher than the upper limit. Results: Serum uric acid was significantly increased in patients with pulmonary hypertension than those who didn't develop pulmonary hypertension (P = 0.02). serum uric acid level was insignificantly different as regards ECG and ECH findings except for segmental wall motion abnormality (SWMA) and pulmonary hypertension. There was a positive mild significant correlation between serum uric acid and cholesterol level (r = 0.35 and P = 0.01) and duration of treatment (r = 0.29 and P = 0.03), but insignificant with triglyceride level (r = 0.22 and P = 0.08) and EULAR\ACR2019 score (r = 0.01 and P = 093). Conclusion: Higher serum uric acid levels are associated with global damage in patients with SLE. Serum uric acid was associated with arterial stiffness. Nevertheless, serum uric acid might be an ancillary indicator of subclinical atherosclerosis in SLE women with clinically evident atherosclerotic cardiovascular disease. Keywords: Systemic Lupus Erythematosus, Serum Uric Acid, Atherosclerotic Cardiovascular.
INTRODUCTION
cardiomyopathy
and
arrhythmia,
hypertension,
Systemic lupus erythematosus (SLE) is a
diabetes, insulin resistance, metabolic syndrome, and so
complex autoimmune disease of unknown etiology,
on (3). Furthermore, it has been found that although 29%
characterized by chronic immune activation and
of SLE patients were hyperuricemic, gout has rarely
multiple immunologic phenotypes (1). SLE can involve
been reported in SLE patients (6). On the other hand,
various organ systems, of which kidney involvement is
some cases of coincidental SLE and gout had been
a major concern, affecting about 50% of patients and
reported associated with nephropathy, but the detailed
accounting for significant morbidity and mortality in
association between elevated serum uric acid level and
western countries, and the 5-years survival in SLE
the development of lupus nephritis in SLE patients
patients with renal involvement is very low even with
without gout remained unclear (7).
treatment (2). However, it has been reported that early
Serum uric acid assays are clinically available
diagnosis and prompt treatment may dramatically
and inexpensive. Clarification regarding whether SLE
modify the course of renal disease and improve the
patients may benefit from uric acid being measured
long-term survival (3). Therefore, early detection and
because of its possible role as a cardiovascular predictor
diagnosis of lupus nephritis (LN) appear to be of great
is necessary. As far as we know, the potential link
importance (4).
between serum uric acid and subclinical atherosclerosis
Uric acid (UA) is a breakdown product of
it has not been explored in SLE. On the other hand,
ingested and endogenously synthesized purines, which
arterial stiffness is a marker for vascular dysfunction
undergoes no further metabolism in humans and is
and an independent risk factor for cardiovascular
excreted by the kidneys and the intestinal tract. It is well
diseases and this has been well validated in studies (8).
known that uric acid crystals are the causative agents of
This study was designed to assess the
gout (5).UA is capable of activating inflammasome,
relationship between serum uric acid level and the CVD
which plays an important role in some inflammatory
complications in SLE patients.
responses including gout. However, a number of
epidemiologic studies have reported that high uric acid PATIENTS AND METHODS
levels in serum are associated with a wide variety of
This clinical based prospective study was carried out
disorders, such as ischemic heart disease (IHD),
on 60 patients in Sohag University Hospital.
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c:\work\Jor\vol852_65The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3845-3850
Accuracy of Unenhanced Breast MRI Compared to Dynamic Contrast Enhanced MRI in Detection and Characterization of Breast Masses Arwa Ashraf Ahmed Mansour, Fatma Zaitoun, Maged Abdelglil Hamed, Mohamed Zaitoun
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Alsharquia, Egypt *Corresponding author: Arwa Ashraf Ahmed, Mobile: (+20)01063403763, Email:[email protected] ABSTRACT Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females worldwide. Obtaining an accurate diagnosis is of considerable importance as it informs the choice of treatment and the prognostic outcomes of the disease. Magnetic resonance imaging (MRI) has a higher sensitivity for the diagnosis of breast cancer than mammography and ultrasound. Objective: We aimed to assess the diagnostic efficacy and efficiency of unenhanced MRI sequences for detection and characterization of breast lesions. Accordingly, we evaluated the breast unenhanced- MRI (UE-MRI) protocol as a reliable alternative for dynamic contrast-enhanced MRI (DCE-MRI). Patients and Methods: 90 female patients underwent MR examination with a diagnostic protocol including UE-MRI sequences (T1WI, T2WI, short TI inversion recovery (STIR) and diffusion weighted imaging (DWI)) and CE-MRI. UE-MRI results were compared with DCE-MRI and the gold standard results having the latter as the reference standard. Results: UE-MRI results obtained sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 90%, 80%, 90%, 80%, and 86.7% respectively. On the other hand, those for the DCE-MRI were 95%, 90%, 95%, 90%, and 93.3% respectively. It was revealed that there was no significant difference between the two methods. Conclusion: UE-MRI could be considered as a reliable diagnostic tool and an effective substitute for DCE- MRI when contrast administration is not feasible or contraindicated. Keywords: ADC, Breast lesions, Diffusion weighted imaging, STIR, T2WI, Unenhanced MRI.
INTRODUCTION
We aimed to evaluate the diagnostic efficacy and
Breast cancer is now a significant cause of
efficiency of unenhanced MRI sequences for detection
worldwide morbidity and mortality. Further, the
and characterization of breast lesions.
increasing rate of breast cancer continues to be a major
area of concern for both clinicians and researchers. PATIENTS AND METHODS
Increased awareness in the affected population leads to
A total number of 90 female patients with suspected
more frequent physical examinations and diagnostic
breast lesions diagnosed by mammography or
imaging procedures, which results in earlier diagnosis
ultrasonography were scheduled for MRI at
and hence improved prognosis (1). Breast magnetic
Radiodiagnosis Department, Zagazig University
resonance imaging (MRI) has gained a major role in the
Hospitals. They were referred from General Surgery
detection and characterization of primary and recurrent
and Oncology Departments.
breast cancer, and in the evaluation of the response to
therapy (2). Inclusion criteria: Patients with suspected breast
Dynamic contrast-enhanced MRI (DCE-MRI)
lesions diagnosed by mammography or ultrasonography
had been introduced and has become an important tool
of any age group.
in the workup of breast lesions (3). However, two major Exclusion criteria: Patients with previous breast
limitations are represented by its specificity which
surgery or who received chemotherapy, any
ranges from 37% to 97% (4) and by the injection of
contraindications for MRI (Implanted electric and
contrast material, which increases examination time and
electronic devices, heart pacemakers, implanted hearing
costs and may lead to various reactions as well as
aids), patients with renal impairment (GFR less than 30)
nephrogenic systemic fibrosis syndrome in patients with
unless the examination was followed by renal dialysis.
impaired renal function (5).
These limitations have been overcome by the Ethical considerations:
introduction of diffusion weighted imaging (DWI) in We explained our study to our patients and a
the field of breast imaging. It provides important written informed consent was obtained. The study
functional information without the need for contrast was approved by the Research Ethical Committee of
material (6). The biologic information provided by DWI Faculty of Medicine, Zagazig University. The study
and DWIBS images combined with morphological and was done according to The Code of Ethics of the
signal intensity data of STIR (Short TI Inversion World Medical Association (Declaration of Helsinki)
Recovery), T1 weighted and T2 weighted TSE can be for studies involving humans.
used to characterize breast lesions without the injection Patients' preparations:
of contrast material (7,8).
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c:\work\Jor\vol852_66The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3851-3856
Correlation between Gene Polymorphisms of Prostaglandin D Receptor and Severity of Asthma in Children Hayam Zakaria Abd Allah*1, Hassan El Banna Khidr1, Khalid Mohamed Salah1, Nermin Abd El Fattah Raafat2
Departments of 1Pediatrics and 2Medical Biochemistry, Faculty of Medicine, Zagazig University, Egypt. *Corresponding Author: Hayam Zakaria Abd Allah, Email: [email protected] ABSTRACT Background: Patients, their families and the community suffer a heavy burden when it comes to asthma because it is both common and possibly life-threatening. It has been postulated that arachidonic acid's most prevalent cyclooxygenase metabolite, prostaglandin D2 (PGD2), is a mast cell activation marker in asthma. Objective: To evaluate association between PGDR-441 polymorphism with risk factors, laboratory characteristics, and severity of asthma in children. Methods: In this cross-sectional study, Forty Egyptian children were genotyped using allele specific polymerase chain reaction (AS-PCR) to assess single nucleotide polymorphism of PTGDR2 receptors. Selected cases were classified according to GINA guidelines and spirometrically assessed to evaluate pulmonary functions. Results: There is significant difference between mild, moderate and severe asthma regarding total IgE level(P1<0.001). 68.0% of the studied patients had Homogenous PGDR2(TT) and 32% had Heterozygous PGDR2(TC). There were no statistically significant associations between PGDR2 Polymorphisms and both of asthma risk factors and laboratory characteristics. There was a statistically significant difference between PGDR2 Polymorphisms and bronchial asthma severity of the studied patients. Heterozygous PGDR2 was associated with more severe bronchial asthma. Conclusion: Our study showed a strong relationship between polymorphism of PTGDR2 receptor and severity of bronchial asthma. Keywords: Bronchial asthma, Prostaglandin D Receptor, gene polymorphism.
INTRODUCTION
People who suffer from asthma are burdened by the
disease, as are their families and the community at large.
laboratory characteristics, and severity of asthma in
Shortness of breath, tightness in the chest, and cough are
children.
common symptoms, which appear and disappear at
varying intervals over time (1). Environmental allergens PATIENTS AND METHODS
such mites or house dust mites as well as smoking
A cross-sectional study of children who visited the
cigarettes and eating habits all play a role in asthma
pediatrics general outpatient clinic at Zagazig University
development. Social and economic factors have an
Hospitals was conducted on forty asthmatic patients (18
impact on exposure to allergens and the availability of
males and 22 females), their ages ranged from 5 to 12
health care services, therefore they should not be
years. With a mean value of (8.5± 2.4) years. This group
neglected (2).
was classified into 4 subgroups mild intermittent, mild
Activation of mast cells in asthma is suspected to be
persistent, moderate persistent and severe persistent.
marked by the prostaglandin D2 (PGD2) metabolite of
As long as all parents of participants signed informed
arachidonic acid, the most common cyclooxygenase
consent forms and submitted them to Zagazig
enzyme metabolite.Genome 14q22.1 contains a gene for
University's research ethics committee, the study was
the Prostaglandin D2 Receptor in humans and the gene's
allowed (ZU-IRB#6167/15-7-2020). We followed the
protein sequence is codified by 359 amino acids, 40.276
World Medical Association's ethical code for human
kDa G protein-coupled receptor. Exposure to allergens
experimentation, the Helsinki Declaration.
increases PGD2 levels in asthma sufferers, which is
known to cause bronchoconstriction in the airways, Inclusion criteria:
according to research (2). Asthma patients' PGDR2 levels
Children aged from 5 to 12 years, having typical
rise in response to allergen challenge, as do those with the
asthma symptoms in accordance with the Global Asthma
most severe forms of the condition (3).
Management and Prevention Initiative recommendations
There have been numerous PGDR2 receptor
in 2016 (1), Variable expiratory airflow obstruction was
polymorphisms discovered, a study of the American and
validated and demonstrated by an increase in pre-
African American populations found that the PGDR2
administered leukotriene receptor antagonist FEV1 of
gene's 549T/C and 441C/T polymorphisms were linked
>15 percent anticipated following montelukast (5mg per
to asthma (4).
day) administration, in the last six weeks, had no history
We aimed at this study to evaluate association
of corticosteroid treatment, Oral beta-adrenergic agonists
between PGDR-441 polymorphism with risk factors,
should be taken within 1 week, inhaled beta-adrenergic
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c:\work\Jor\vol852_67The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3857-3864
Role of MRI Diffusion Weighted Imaging in Evaluation of Gynecological Pelvic Masses Mohamed Kamel Abd-Elmageed, Rehab Abdelnasser Mohamed*, Mohamed A. Elaziz Maaly
Radiodiagnosis and Interventional Radiology Department, Faculty of Medicine, Menoufia University, Egypt *Corresponding Author: Rehab Abdelnasser Mohamed, Mobile: (+20)01030675599, Email: [email protected] ABSTRACT Background: Gynecological Pelvic masses are common problem that are commonly discovered during routine gynecologic or physical examinations. Radiologists routinely evaluate a wide range of pelvic masses during daily practice. Proper management depends on proper preoperative assessment with the help of clinical examination, laboratory tests and different imaging modalities. Radiological evaluation includes ultrasonography (US), computed tomography (CT) and recently magnetic resonance imaging (MRI). Diffusion weighted imaging (DWI) is widely used in protocols for magnetic resonance imaging (MRI) of the female pelvis. It provides functional and structural information about biological tissues, without the use of ionizing radiation or intravenous administration of contrast medium. Objective: This study aimed to evaluate the role of diffusion weighted imaging in the characterization of gynecological pelvic masses and differentiation between benign and malignant tumors. Patients and Methods: This study was performed on 63 patients. All patients had US findings of uterine and adnexal lesions then they underwent conventional MRI with contrast & DWI. Results: DWI is significant promising tool factors for characterization of gynecological tumors and differentiation between benign & malignant lesions with high sensitivity 95% (81%:99% with 95% CI). The sensitivity, specificity and accuracy of detection of the nature of the lesions have been increased after adding of DWI to the conventional imaging. Conclusions: Adding of DWI to the conventional MRI improves the sensitivity and specificity of diagnosis and allows confident diagnosis and differentiation between benign and malignant lesions. Keywords: Gynecological masses, MRI, DWI, ADC.
INTRODUCTION
clinical and surgical history, and using MRI to identify
Gynecological pelvic masses are common
the anatomic origin, shape, composition, and
problem that are commonly discovered during routine
enhancement pattern of the mass, a short meaningful
gynecologic or physical examinations. Radiologists
differential diagnosis, and often a definitive diagnosis,
routinely evaluate a wide range of pelvic masses during
can be made (3).
daily practice (1). Accuracy in diagnosis and early
Diffusion-weighted imaging (DWI) is widely
diagnosis is extremely important because it improves
used in protocols for magnetic resonance imaging
the prognosis and decreases the morbidity and
(MRI) of the female pelvis. It provides functional and
mortality. The evaluation of a pelvic mass begins with
structural information about biological tissues, without
clinical history and physical examination then different
the use of ionizing radiation or intravenous
imaging modalities starts with ultrasound, CT and
administration of contrast medium DWI is a valuable
finally proceeds to MRI. Each of these modalities has
problem-solving tool in gynecologic malignancies with
advantages and disadvantages (2).
other wise equivocal features. It may be more useful in
Ultrasound is relatively cheap, assesses for
post-therapy. DWI is more sensitive for infection and
ascites, delineates cystic versus solid lesions and often
inflammation in pregnant patients when avoiding
the first-line imaging modality for the evaluation of
gadolinium and CT. It May be a useful for other patients
pelvic masses, especially in women, in whom the
in whom gadolinium is contraindicated, such as patients
ovaries are a potential source. However, ultra-sound
with renal failure. DWI Improves not only the detection
may be limited by poor acoustic windows and poor
and potentially the characterization of small uterine
depth of penetration, preventing characterization of
tumors and complex ovarian cancer, but also the
some masses (3).
visualization of small implants of peritoneal
CT is excellent for retro peritoneum and assesses
carcinomatosis, which could significantly impact
for other organs. However, limited in the pelvis by a
patient management (4).
lack of soft-tissue contrast, which becomes problematic
This study aimed to evaluate the role of diffusion
when, for example, trying to differentiate decompressed
weighted MRI imaging in the characterization of
bowel from adnexal structures. MRI, on the other hand,
gynecological pelvic masses and differentiation
provides excellent contrast resolution, resulting in
between benign and malignant tumors.
accurate tissue characterization and improved anatomic
delineation. As a result, MRI has been shown to be more PATIENTS AND METHODS
specific and accurate than ultrasound for characterizing
This is an observational analytical comparative cross-
adnexal masses by using a systematic approach to
sectional, retrospective study done at MRI Unit,
complex pelvic masses, incorporating the patient's
Department of Radio-diagnosis and Interventional
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c:\work\Jor\vol852_68The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3865-3871
Anti-ficolin-2 Antibody: Could it be a Predictor of Proliferative Lupus Nephritis in Lupus Patients? Sylvia Talaat Kamal*1, Mohamed Nazmy Farres1, Rehab Ali Ibrahim2, Ibrahim Sami Ibrahim1, Fatma Abdelrahman Ahmed3.
Departments of 1Allergy and Clinical Immunology, Internal Medicine, 2Physical Medicine Rheumatology and
Rehabilitation, and 3Nephrology, Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt *Correspondence author: Sylvia Talaat Kamal, Email: [email protected], ORCID: Sylvia Talaat 0000-0003-3235-2644 ABSTRACT Background: Nephritis is a challenging domain of systemic lupus erythematosus (SLE). There is a growing need for identification of a non-invasive marker for diagnosing and monitoring nephritis. Objective: To explore the relevance of using anti-ficolin-2 antibody (Anti-FCN2) as a biomarker for detecting lupus nephritis (LN), and its relation to renal biopsy histopathology and disease activity. Patients and Methods: Sixty SLE patients were compared to 30 apparently healthy individuals. Thirty of the patients were LN patients (documented by a recent renal biopsy). Full history, examination and laboratory investigations were done. Activity was assessed by SLE disease activity index (SLEDAI) score, and Anti-FCN2 titer was measured by enzyme-linked immunosorbent assay technique (ELISA). Results: Forty-four of our SLE patients were in disease activity by SLEDAI score. Anti-FCN2 titer was significantly higher among SLE patients compared to control group (p value <0.001). It was also higher among patients with high disease activity compared to those with low disease activity and cutoff value was at 37 ng/ml (p value is <0.001). Anti- FCN2 titer was significantly higher among patients with LN compared to those without LN (p value is <0.001) with best cutoff value at 72.50 ng/ml. Regarding LN patients, it was significantly higher among patients with proliferative changes than LN patients with non-proliferative changes (p value is 0.05) with best cutoff value at 155 ng/ml. Conclusion: Anti-FCN2 shows promising results as a biomarker for lupus disease activity, especially regarding LN and proliferative changes. Further longitudinal studies on larger samples are needed to confirm. Keywords: Anti-ficolin-2 antibody, Biomarker, Lupus activity, Lupus nephritis, Systemic lupus erythematosus.
INTRODUCTION
be one of the possible mechanisms of autoimmunity in
Systemic lupus erythematosus (SLE) is a
lupus (3,5,6).
multisystem autoimmune illness that has various
Ficolins are multimeric proteins that possess
clinical presentations, including cardiac, renal,
collagen and fibrinogen-like domains. They are part of
dermatological, and neurological signs. It is a
innate immunity, as they are structurally similar to MBL
multifactorial disease in which both adaptive and innate (7). They bind to MBL-associated serine proteases and
immunity are involved (1, 2).
trigger bacterial lysis by activating the complement
One of the life-threatening domains of SLE is
pathway via LP. They also play an important function
lupus nephritis (LN). Rheumatologists encounter a
in the clearance of apoptotic cells, which helps to
significant challenge in determining the extent of renal
maintain tissue homeostasis. In humans, there are three
damage and monitoring it. Clinical indicators may not
varieties of ficolins: 1, 2, and 3. Ficolin-1 is located on
necessarily reflect the specific renal pathophysiology,
monocytes, granulocytes, and pulmonary cells'
therefore finding new meaningful non-invasive
surfaces, however ficolins-2 and 3 are circulating
biomarkers is critical nowadays. Furthermore, this may
proteins (3, 8).
aid in the development of new therapeutic options (3, 4).
Ficolin -2 (also called L-ficolin) is a triple helical
One of the key mechanisms of LN is the
protein which is produced in liver and secreted in the
formation
of
immune
complexes
(antigen,
circulation. It is considered one of the main recognition
autoantibody, and complement), and their deposition in
proteins (9).
renal tissue causes glomerular damage. The classic,
Low ficolin-2 plasma levels have been linked to
alternative, and lectin pathway (LP) all activate the
an increased risk of LN in patients with SLE, according
complement system. Normally apoptotic and necrotic
to previous studies (10, 11).
cells are cleared to avoid liberation of intracellular
Our study aimed to explore the relevance of
autoantigens. This clearance is promoted by some
using antificolin-2 antibody (Anti-FCN2) as a
protective molecules such as C1q, mannose-binding
biomarker for lupus disease activity. Also, to elucidate
lectin (MBL), ficolins-1 and 2. So, the presence of
its relationship to various clinical manifestations
autoantibodies against those protective molecules might
especially LN and renal biopsy histopathology.
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c:\work\Jor\vol852_69The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3872-3877
Neuron Specific Enolase in Children with Diabetic Ketoacidosis: Does it Correlate with Impaired Consciousness and Disease Severity? Eman Gamal Baz1, Saffaa M. Elalawi2, Mervat Atfy1, Tarek A. Abdelaziz1
Departments of 1Pediatric Medicine and 2Clinical Pathology, Faculty of Medicine,
Zagazig University, Zagazig, Egypt *Corresponding author: Saffaa M. Elalawi, Mobile: (+20) 01212849069, E-Mail: [email protected] ABSTRACT Background: Diabetes ketoacidosis (DKA) is the leading cause of death in children with diabetes, especially when it is complicated by cerebral edema. The predictors of CNS dysfunction/injury are largely unknown. In many neurological disorders, neuron-specific enolase (NSE) is a marker of neuronal damage. Objective: This study aimed to investigate the role of serum neuron-specific enolase as a marker of neuronal damage in patients with DKA. Patients and methods: A cross-sectional study with 90 DKA patients (aged 9.58 ± 2.89 years) presenting to Pediatric Intensive Care Unit (PICU), Children Hospital Zagazig University. Patients subjected to clinical history and examination including Glasco coma scale (GCS), blood glucose, serum electrolytes, blood PH and computed tomography of the brain for children with disturbed consciousness. Blood NSE at admission (baseline point) and after 24 hours of starting treatment of DKA (2-time points). Results: There was a significant difference between NSE level on admission and NSE level 24 hours after start of treatment. Patients with low GCS scores had higher serum NSE at baseline and 2-time points than those with normal CGS (P=0.001; P=0.053). Patients with moderate and severe DKA had higher NSE at baseline and 2-time points in comparison with those with mild DKA (P=0.001; P=0.098). Conclusions: Children with moderate to severe DKA and impaired consciousness had higher serum NSE. The high levels of NSE in patients with abnormal GCS, in the absence of cerebral edema on brain imaging indicate that NSE is a reliable marker of neuronal injury. Keywords: Diabetic ketoacidosis, Neuron-specific enolase, Impaired consciousness.
INTRODUCTION
the cytoplasmic glycolytic pathway that is found in
Diabetic ketoacidosis (DKA) occurs in 30% of
neurons and neuroendocrine tissue and is elevated in the
children with Type-I Diabetes Mellitus (T1DM) at
blood after these cells die. In several studies, it has been
diagnosis, while many children develop DKA as the
established that higher serum or cerebrospinal fluid
disease progresses (1). DKA occurs due to a lack of
levels of NSE represent a higher vulnerability to
adequate insulin in the body. In the absence of insulin,
traumatic injury, hypoxic-ischemic injury, and
the glucagon levels rise, releasing free fatty acids from
neurodegeneration (5).
adipose tissue and amino acids from muscle cells (2).
As a result, an early marker that can be easily
DKA causes several abnormal processes within the
measured in the blood and coincides with clinical
body, including fluid shifts, decreased perfusion, and
decompensation for diabetic children could be useful
deranged pH, all of which affect many functions and
for adjusting treatment strategies to minimize
cause electrolyte imbalances. Consequently, many
neurologic injury during DKA presentation. NSE has
organs and body systems are affected (3).Brain injury
been studied as a brain injury biomarker in traumatic
has been shown to result from DKA, although its exact
brain injury, but studies assessing its value in pediatric
pathogenesis is not known. Subclinical cerebral edema
DKA are very few (5, 6, 7, 8). This study investigated
is prevalent in children with DKA, and frank cerebral
serum concentration of NSE in children presenting
edema occurs in 0.5 to 1% of children. In the past,
with DKA upon PICU admission and after 24 hours of
cerebral edema resulting from DKA was believed to be
the start of treatment, as well as exploring the
the result of overaggressive fluid resuscitation and loss
association between NSE and both impaired
of brain osmotic homeostasis. Recently, this theory has
consciousness and severity of DKA.
been challenged. It is now thought that cerebral
hypoperfusion followed by reperfusion injury may SUBJECTS AND METHODS
cause the cytotoxic and vasogenic edema seen in
This cross-sectional study was conducted at
patients with cerebral edema from DKA (4).
the Pediatrics and Clinical Pathology Departments of
Neuronal-derived proteins (such as neuron-
Zagazig University Hospital. Ninety pediatric patients
specific enolase) have been quantified in peripheral
presenting to the PICU of the University Children
samples (blood and cerebrospinal fluid) as measures of
Hospital with a diagnosis of DKA. They were enrolled
brain damage/injury at the clinical and experimental
in the study over a 2-year-period. 90 patients (32
levels. Neuron-specific enolase (NSE) is an enzyme of This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_70The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3878-3882
Platelet-rich Fibrin for Chronic Wounds Management Mena Zarif Helmy1, Mohammed Hussein Khalifa2, Asser AbdElhamed Goda2, Kamal A. A. M. Hasanein*1
Departments of 1General Surgery and 2Vascular Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt *Corresponding author: Mohammed Hussein Khalifa, Mobile: (+20) 01019174312, Email:[email protected] ABSTRACT Background: A chronic wound can be defined as any wound that fails to heal within a reasonable period. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate. It is safe, simple, affordable and less expensive procedure in treatment of chronic wounds. Objective: This study aimed to assess safety and effectiveness of platelet-rich fibrin for treatment of chronic wounds. Patients and methods: This prospective study included 50 patients with chronic ulcer not responding to conventional therapy for at least 6 weeks, normal values blood tests especially platelet count, red blood cell count and serum albumin level. Debridement of the necrotic tissues was done using surgical and chemical debridement. The fibrin clot membrane was applied to the ulcer followed by paraffin gauze and secondary sterile dry dressing. Results: Complete wound healing occurred in 18 of 50 patients before 8th week of therapy (36%). A decrease in the mean area was observed from 7.22 ± 5.80 cm2 before treatment to 0.98 ± 1.52 cm2 after 8 weeks of therapy, which was highly significant. Conclusions: The use of PRF is effective, simple, affordable and inexpensive method allowing acceleration of healing of chronic wounds. Keywords: Platelet-rich Fibrin, Chronic Wounds, Diabetic foot ulcer, Critical limb ischemia.
INTRODUCTION
Chronic wounds exhibit such a disrupted repair
factors is a feasible, safe, simple and inexpensive
process where a sustained anatomical and functional
method (6).
result is not reached within an appropriate length of time
This study aims to assess the safety and efficacy
usually taken to be three months. They fail to progress
of platelet rich fibrin for treatment of chronic wounds.
through the orderly phases of healing where
interruptions in the inflammatory phase during the PATIENTS AND METHODS
normal wound healing process occurs(1). Different
This was a prospective study that was conducted
factors can delay wound healing including chronic
on patients with chronic wounds who were presented to
diseases, vascular insufficiency, diabetes, malnutrition,
our Outpatient Clinics of Vascular Surgery and General
ageing and local factors such as pressure, infection, and
Surgery Departments, Faculty of Medicine, Sohag
edema (2).
University.
Chronic wounds have been associated with high
costs and increased anxiety, both of which can Inclusion criteria:
negatively impact patients' quality of life (3). The use of
Cases having an open wound for more than four
blood derivatives was often suggested in the last 50
weeks described as a chronic wound by a clinical
years for the treatment of chronic skin wounds and the
professional, with no active bacterial, viral or fungal
use of platelet-fibrin concentrates is one of approaches
infection in the wound, wound area less than 50 cm2,
of regenerative medicine in modern therapy (4). Fibrin
not taking any anticoagulants or equivalent functional
matrix and platelet components (particularly growth
drugs for one month before enrolment and number of
factors) offer interesting healing properties as surgical
platelets in the range of 150,000 to 450,000/UL and
adjuvants. Leukocyte- and platelet-rich fibrin (L-PRF)
coagulation index determined as normal [prothrombin
is an autologous blood-derived product, which can be
time (PT value) ranging from 11 to 16 seconds].
obtained quickly and at low cost (4).
Hemoglobin concentration > 9 mg/dl, serum protein
The PRF, described by Choukroun(5), is a new
concentrations > 6 gram/dl and serum albumin > 3
therapeutic approach using blood derivatives, with a
gm/dl.
simplified design and requiring minor artificial Exclusion criteria:
biochemical changes. This technique does not require
Cases with wound area more than 50 cm2, ulcers
anticoagulants, thrombin, or any other gelling agent,
with exposed bones, ligament or tendon, patients with
which renders it different from natural blood,
peripheral arterial disease, characterized by ankle
centrifuged without additives (5). PRF is useful in wound
brachial index (ABI) less than 1, patients with systemic
healing and skin regeneration as a primary and a
infection and/or clinical manifestations compatible with
supplemental technique owing to its fibrin matrix,
active infection of ulcer, irradiation, chemotherapy,
cellular components, and prolonged release of growth
malignant ulcers, terminal disease e.g. terminal stages
of malignancy, uncontrolled systemic disease e.g.
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c:\work\Jor\vol852_71The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3883-3888
COVID-19: The Potential Difference in High Resolution Computed Tomography Findings between Vaccinated and Unvaccinated Cases among The Adult Egyptian Population Dena M Serag, Eman R Selima
Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Egypt
Corresponding author: Dena M Serag, Phone number: (01000205159), E-mail :[email protected]
ABSTRACT Background: As the world experiences successive waves of corona virus disease (COVID-19) pandemic, global efforts to develop and distribute an effective vaccine produced several promising options. The aim of our study was to assess the difference in pulmonary involvement between vaccinated and unvaccinated patients among Egyptians. Patients and methods: Our study involved 234 patients who were tested positive for COVID-19 and had classic symptoms. They were split into 2 groups: group 1 (131 unvaccinated patients), and group 2 (103 fully vaccinated patients). Patients underwent high resolution computed tomography (HRCT) of the chest. All scans were evaluated, and CT severity score (CT-SS) was calculated. Results: For group 1 the patients' ages ranged from 19 to 84, mean = 44.5 years (+ 16.2 SD), 76 (58%) males and 55 (42%) females, while group 2 age ranged from 18 to 85, mean (+SD)= 42.2 years (+ 16.6 ), 59 (57.3%) males and 44 (42.7%) females". The presence of ground glass opacities and white lung sign varied significantly between both groups (P=0.001 and 0.002 respectively). For other recorded signs no significant difference was detected. The mean computed tomography severity score (CT-SS) for group 1 was 11.25 (± 6.6 SD). While for group 2 it was 6.32 (± 4.33 SD). The difference between studied groups was highly significant (P<0.001). Conclusion: Our results showed that COVID vaccine could effectively reduce the extent and severity of lung involvement in vaccinated patients compared with unvaccinated patients. Further wide-ranging clinical studies are needed to support our results. Keywords: Computed tomography, Coronavirus, COVID-19, Vaccine. BACKGROUND PATIENTS AND METHODS
Coronaviruses consist of a large group of viruses Cases:
which often lead to upper respiratory mild to moderate
The current prospective case-control study was
illnesses, as common cold. Unfortunately, the multiple new
carried out in the period from 15th April 2021 to 15th July 2021
coronaviruses that developed from animals during the last
with enrollment of 234 cases.
twenty years caused severe critical health problems[1]. Inclusion criteria:All enrolled participants had positive
In December 2019, a newly identified strain appeared
reverse transcription polymerase chain reaction (RT-PCR) or
leading to a pandemic that began in China. The incriminated
rapid test. All cases underwent HRCT chest during the 5th to the
virus is known as severe acute respiratory syndrome
10th day from the onset of the symptoms. The cases were split
coronavirus 2 (SARS-CoV-2). The resulting morbidity is known as (COVID-19) disease [2].
into two groups; group 1 unvaccinated patients and group 2 fully vaccinated patients (who had their second dose more than
This current pandemic has caused a violent respiratory
two weeks before developing symptoms). Most of group 2
affection in more than one hundred and sixty million people
participants were of medical personnel.
worldwide and caused more than 2% deaths [3]. Since the Exclusion criteria: the vaccinated cases who had confirmed
commencement of the outbreak, the suspected or the confirmed cases underwent HRCT of the chest to assess the degree of
previous infection or confirmed symptoms since the commencement of the outbreak. Cases less than 18 years old.
pulmonary involvement [4]. On HRCT, ground glass opacities are the commonest pattern in COVID-19 pneumonia which Ethical approval:
means increased attenuation of the lung parenchyma without
The study was approved by the Research Ethical
obscuring the vasculature and the bronchial markings. Bilateral
Committee of Menoufia Faculty of Medicine. An informed
sub-pleural lesions with lower lobar predominance are still the
consent was taken from every patient in this research. Every
most popular pattern in many of the scanned cases [5].
patient got an explanation for the purpose of the study.
Reaching a rightful vaccine being effective and
All given data were used for the current medical research
offering safety is crucial to abort COVID-19 outbreak.
only. This work was performed in accordance with The Code
Continuous efforts are made to provide and develop many kinds
of Ethics of the World Medical Association (Declaration of
of vaccines. For this foreseeable future, the populations must
Helsinki) for studies involving humans.
continue keeping their masks, washing their hands, maintain proper ventilation, social distancing, and stay away from Image acquisition and analysis:
crowds as possible [6].
Chest HRCT was performed on a 160- MDCT scanner
The aim of this work was to assess the difference in
(Aquilion Prime, Canon medical systems, Japan). Patients were
severity of lung involvement between vaccinated and
examined in supine position, headfirst. Using single breath hold
unvaccinated patients.
whenever possible and tolerable.
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Prevalence Rate of Congenital Fetal Malformations in Second Trimester by Ultrasound Scanning in Zagazig University Outpatient ClinicThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3889-3992
Prevalence Rate of Congenital Fetal Malformations in Second Trimester by Ultrasound Scanning in Zagazig University Outpatient Clinic
Ali El-Shabrawy Ali, Gamal Abbas El-Sayed, Basem Mohamed Hamed, Mabruka Ali Omran Tumi*
Department of Obstetrics & Gynecology, Faculty of Medicine Zagazig University, Egypt *Corresponding author: Mabruka Ali Omran Tumi, Mobile: (+20)01147026222, Email: [email protected]
ABSTRACT Background: All pregnancies are at a risk of producing congenital malformations, though only some of them are at a greater risk. Congenital anomalies its problem in which abnormalities of structure, function or body metabolism resulting in physical or mental disability or it may be fatal. Objective: This study aimed for early detection of major fetal anomalies to improve fetal and maternal outcome. Patients and methods: This cross-sectional study that include 422 pregnant females was carried out at the Ultrasound Unit and Obstetrics & Gynecology Department, Faculty of Medicine, Zagazig University during the period from December 2018 to July 2019. Results: Ultrasonography can identify at least 35-50% of major fetal malformations with a specificity of 90-100%. Though other methods of screening like biochemical markers and karyotyping are available, ultrasonography has the advantage of being non- invasive, safe, fast, accurate and reproducible with real time display, causing no discomfort to the patient at any time of gestation. Conclusions: The Prevalence of congenital fetal malformations (CFMF) among the study participants using ultrasonography scanning was 3.6%. The most prevalent anomalies were Hydrops fetalis and CVS anomalies. Therefore screening for congenital anomalies in obstetric sonography is an important component of primary healthcare for maternal and child health. Keywords: Fetal malformations, Second trimester, Ultrasound scanning.
INTRODUCTION
The Prevalence of abnormalities also depends
All pregnancies are at a risk of producing
upon the population being scanned. At the end an early
congenital malformations, though only some of them
detection of fetal anomalies has become an important
are at a greater risk. There is a need for routine and
part of antenatal care, by helping in identifying the
thorough screening for fetal congenital anomalies. The
severity of disease and in providing on opportunity for
priority goal in screening is the early detection of
fetal therapy (9, 10). This study aimed to help early
major fetal anomalies (1, 2). Congenital anomalies are
detection of major fetal anomalies to improve fetal and
defined
as
structural
defects,
chromosomal
maternal outcome.
abnormalities, inborn errors of metabolism and
hereditary diseases diagnosed before, at, or after birth. PATIENTS AND METHODS
Any deviation from the normal range during
A Cross-Sectional study include 422 pregnant
morphogenesis constitutes an anomaly (3, 4). Each year,
women was carried out at the Ultrasound Unit and
eight million children are born worldwide
with
Obstetrics and Gynecology Department, Faculty of
congenital anomalies, of which 3.3 million die before
Medicine, Zagazig University during the period from
the age of five, 3.2 million of the survivors may be
December 2018 to July 2019.
mentally and/or physically disabled. The prevalence of
birth defects is comparable all over the world; about Inclusion Criteria: Gestational age (GA) from 16-24
3% in the United States, 2.5% in India and 2% to 3%
weeks. All singleton pregnant women who were
in the United Kingdom (5, 6, and 7).
referred to the Department for a second trimester
Ultrasonography has emerged as one of the most
complete antenatal ultrasound examination.
powerful tools for prenatal diagnosis of congenital
malformations. A second trimester anomaly scan has Exclusion Criteria: GA before 16 weeks or after 24
been suggested in routine antenatal care to increase the
week. Multiple gestations. Women known to have a
prenatal
detection
rate
of
fetal
defects.
fetus with congenital malformation and sent for follow
Ultrasonography can identify at least 35 - 50% of
up.
major fetal malformations with a specificity of 90-
100%. Though other methods of screening like All patients were subjected to the following :
biochemical markers and karyotyping are available,
Consent to be involved in the study. Complete history
ultrasonography has the advantage of being non-
taking including (age of pregnant lady, parity, date of
invasive, safe, fast, accurate and reproducible with real
last menstual period (LMP), positive consanguinity,
time display, causing no discomfort to the patient at
history of previous baby with anomaliy, IUGR, IUFD,
any time of gestation (2, 8).
neonatal death, history of teratogenic drug intake or
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MicrobialThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3893-4897
Outcome of Dome-Shaped Proximal Tibial Osteotomy in Infantile Genu Varum El Sayed El-Etewy Soudy, Mohamed El Sadek Atia, Mohamed Nagy El Alfy, Ahmed Alaa El-Deen Ali Basiony*
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ahmed A. Basiony, Mobile: (+20)1004914458, Email: [email protected] ABSTRACT Background: The goals of the proximal tibial osteotomy are correcting the deformity, Hip-knee-ankle angle, and preventing the progress of the destruction of the medial compartment of the knee joint. Objectives: The aim of the work was to evaluate the outcome of children with genu varum after proximal tibial dome shaped osteotomy. Patients and Methods: These randomized clinical trials study included a total of 10 patients with 12 affected knees confirmed with persistent physiologic genu varum, attending at Orthopedic Department, Zagazig University Hospitals, Zagazig, Egypt. All cases were evaluated pre and post-operatively according to Modified Hospital for Special Surgery Knee Scoring System (HSSKS) as shown in appendix I. cases were assessed for functional improvement after surgery at 2, 4 months and detection of malunion or delayed union after 3 months. Results: The mean (±SD) pre-operative tibio-femoral angle was 21.7 (±5.6) versus 3.18 (±1.97) post-operatively, pre- operative femoral condyle-tibial shaft angle (FTA) was 16.3 (± 2.8) versus 3.2 (±1.1) post-operatively and pre- operative metaphyseal diaphyseal angle was 15.8 (±2.6) versus 3.6 (±1.2) post-operatively with a statistically significant difference in between (p < 0.05). The mean pre-operative HSSKS scores were 70.16±11.3 while the mean post-operative HSSKS scores were 91.4±2.1. Conclusion: It could be concluded thatproximal tibial osteotomy using dome-shaped procedure to correct Infantile Genu varum deformity, has favorable treatment outcomes, does not involve any dangerous complications, and can be used as a safe and effective treatment method for the correction of infantile genu varum deformity. In the current study, angles significantly improved, most of legs got full correction and little complications occurred. Keywords: Proximal Tibial Osteotomy; Tibio-femoral angle; Genu Varum.
INTRODUCTION
a varus deformity of the knees. Paley et al modified this
Genu varum is a type of deformity of knee joints
concept by describing a focal dome osteotomy through
marked by a change in the center of the knee joint that
the CORA to allow for deformity correction with
lies outside the mechanical axis of the limb. In this
minimum translation (2,3).
deformity the patient's knees are distanced from each
Dome shaped proximal tibial osteotomy is a
other in standing position giving the limbs the
conventional and traditional method for genu varum
appearance of parentheses. The existence of the
deformity (4).
deformity puts the patient at risk of many complications
Dome-shaped osteotomy is performed when a large
such as the increased risk of the injury of
degree of correction is needed (18-20 mm open or
patellofemoral joint, osteoarthritis of tibiofemoral joint,
closed, or more than 20° of angular correction). In
also compensatory deformities in leg and ankle joints,
severe varus deformity cases or Blount's disease, this
and increased risk of stress fracture of the tibia.
method is used. The control of the correction of the
Proximal tibial osteotomy is a useful method to relieve
tibiofemoral alignment during surgery is performed
pain and restore knee function. It may be performed by
using radiography and smaller or larger than the
a wide range of techniques including opening wedge,
required correction is one of the complications that may
closing wedge and dome shaped surgery methods (1).
occur due to inaccuracies of intraoperative
It was felt that a suitable osteotomy should be near
radiographies (4).
the center of rotation of angulation (CORA) with little
The aim of the current work was to evaluate the
translation, primarily in cancellous bone to allow rapid
outcome of children with genu varum after proximal
healing, and safe the epiphyseal plate and tibial length.
tibial dome shaped osteotomy.
In addition to these, the osteotomy site should be stable
without the use of internal fixation devices to be able to PATIENTS AND METHODS
change the amount of correction obtained on table
These randomized clinical trials study included a
during postoperative period. To fulfill these
total of 10 patients with 12 affected knees confirmed
requirements and at the same time provide 3-plane
with persistent physiologic genu varum, attending at
correction of the deformity dome shaped tibial
Orthopedic Department, Zagazig University Hospitals,
osteotomy has been described for realignment of the
Zagazig, Egypt. This study was conducted between
knee by many authors. Ponseti et al discussed a bilateral
March 2019 and May 2020.
dome-shaped osteotomy of the proximal tibia to correct
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c:\work\Jor\vol852_74The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3898-3902
Assessment of the Relation between Serum Carcinoembryonic Antigen and Tumor Node Metastasis Staging of Colorectal Cancer Nouralddeen Ahmed Kareemeed*, Alaa Mohamed Ibrahim Khalil, Wael Elsayed Lotfy Mokhtar, Hassan Rabea Galal Ashour
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Nouralddeen Ahmed Kareemeed, Mobile: (+20)1110918916, Email: [email protected] ABSTRACT Background: Although awareness via cancer screenings and the knowledge of therapy modalities has increased, the burden of colorectal cancer (CRC) is much more pronounced in developing countries. Objective: This study was aimed to estimate serum carcinoembryonic antigen (CEA) levels in preoperative CRC patients and to determine the associations between serum CEA levels and tumor node metastasis (TNM) stage. Patients and methods: This cross-sectional study included 36 patients with CRC (stages IV) attending at Department of General Surgery, Zagazig University Hospitals. Patients scheduled preoperatively for sigmoidoscopy were prepared by an enema and examined by using standard video endoscopes. The CEA levels were estimated preoperatively for all patients. Results: CEA level among the studied cases ranged from 0 to 23 ng/dl with mean 6.39 ng/dl and median 4.5ng/ml. Also 58.3% had CEA level 5 ng/ml. There were no statistical significance relations between the CEA and age or sex distribution. But there was a statistical significance increase in frequency of smoking among cases had CEA level >5 ng/ml. There was no statistical significance relation between site and diameter of lesions and CEA level among the studied cases. Conclusions: It could be concluded that there is a meaningful link between TNM stage and CEA level. However, normal levels of CEA will not rule out CRC diagnosis, and these patients should be investigated in detail. Keywords: Carcinoembryonic Antigen, Colorectal Cancer, TNM Stage. INTRODUCTION
Cancer is a dreadful disease caused to an
patients with CRC, to guide adjuvant therapy after
anomalous growth of cells, which leads to an irregular
potentially curative surgery, and to classify patients for
balance of cell proliferation and death. Cell death is a
participation in clinical trials. The ideal prognostic
physiological process where normal cells are regulated
system should provide homogeneity within the same
by "touch contact-inhibition". However, proliferating
stage, good discrimination between different stages, and
tumor cells metastasize to distant sites and invade other
monotonicity of gradients that predicts survival
tissues, often causing morbidity (1). In recent years,
outcomes that are consistent with the severity of
colorectal carcinogenesis (CRC) has imposed a major
cancer staging (6).
health burden in developing countries (2).
Carcinoembryonic antigen (CEA) is a classic
Common symptoms of CRC are rectal bleeding,
tumor marker for CRC and has been used to monitor
significant changes in the color of stool (especially dark
CRC recurrence and as a prognostic factor for CRC
or black-colored stools), irregular bowel habits, pain or
patients. However, the effectiveness of CEA as a
discomfort in the lower abdomen, weakness or fatigue,
preoperative and postoperative marker for CRC remains
and certain types of anemias (3).
to be evaluated. It remains unclear how accurate a
Several risk factors are thought to cause CRC.
negative CEA value is for excluding primary and
Age is a major risk factor. About 90% of CRC patients
recurrent CRC, and under what conditions CEA values
are above the age of 50. The median age of CRC
are inaccurate (7).
diagnosis is 68 in men and 72 in women. CRC risk also
The aim of the current study was to estimate
increases due to environmental factors, which include
serum carcinoembryonic antigen (CEA) levels in
consuming a diet rich in red meat and fat, poor intake of
preoperative CRC patients and to determine the
dietary fiber, sedimentary lifestyle, obesity, diabetes
associations between serum CEA levels and tumor node
mellitus, smoking and consumption of alcohol (4).
metastasis (TNM) stage.
Malignancy risk has been linked to the site, size, and
histological characteristics of polyps. Polyps < 5 mm in PATIENTS AND METHODS
diameter are harmless and pose an insignificant risk of
This cross-sectional study included a total of 36
malignancy, whereas those with a diameter > 25 mm
cases with CRC, attending at Surgical Oncology Unit,
pose a significant risk (5).
Department of General surgery, Zagazig university
The tumor node metastases (TNM) staging
hospitals.
system established by the American Joint Committee on
Cancer is widely used to predict the prognosis for
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Evaluation Of QT Interval In Diabetic Ketoacidosis In Medical Intensive Care UnitThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3903-3908 Prevalence of Prediabetes in Patients with Acute Coronary Syndrome and Its Relation to In-Hospital Clinical Outcome Eman Abdullah Al-Shorbagy, Gehan Abdel Kader Ibrahim, Mohamed S.S. Saad, Khaled Bashir Salem Harsha*
Internal Medicine Department, Faculty of Medicine Zagazig University, Egypt *Corresponding author: Khaled Bashir Salem Harsha, Mobile: (+20)01147023222, E-mail:[email protected] ABSTRACT Background: Diabetes mellitus is one of the leading causes of vascular disease. The caseload is expected to reach 350 million by the year 2030, and it is estimated that up to 30% of patients are undiagnosed. Objective: The aim of the study was to explore the prevalence of prediabetes in patients admitted with acute coronary syndromes (ACS) who were not known to have diabetes and to determine the impact of prediabetes on in-hospital clinical outcomes versus non-diabetic patients. Patients and methods: This prospective study was conducted on 60 patients with acute coronary syndrome who were admitted to the intensive care unit (ICU), Internal Medicine Department, Faculty of Medicine, Zagazig University during the period from September 2019 to March 2020. All studied subjects were subjected to full history taking complete clinical examination, complete blood count, glycosylated haemoglobin (HbA1c), lipid profile, serum creatinine and oral glucose tolerance test (OGTT), ECG and ECHO. Results: There was a statistical significant difference between the studied groups regardingacute coronary syndrome types, glycated haemoglobin (HbA1c), serum creatinine, and high-density lipoproteins cholesterol. There was statistically significant difference between the studied patients grouped according to the clinical outcome regarding ACS types. Conclusion: Prediabetes is common in patients presenting with acute coronary syndrome who are not previously known to have diabetes. Pre-diabetic patients had worse in-hospital clinical outcomes compared with patients without diabetes. Pre-diabetic patients with ACS have greater prevalence of cardio-metabolic risk factors (abdominal obesity, and hypertension) as compared to non-diabetic patients. Keywords: Acute coronary syndrome, Coronary complications, Prediabetes. INTRODUCTION
Prediabetes is a serious condition that is
Although it is well established that Asian Indians
associated with an increase in cardiovascular
have a higher risk for type 2 diabetes and coronary
morbidity and mortality, and necessitates early and
heart disease, there are only sparse data on the
adequate intervention to prevent the development of
occurrence of hyperglycemia at ACS and its
complications and progression to overt diabetes.
association with the outcome in ACS (5). The
Higher fasting glucose levels in patients with ACS
association of insulin resistance and elevated
were associated with worse clinical outcomes
proinsulin-to-insulin ratio with cardiovascular diseases
irrespective of the presence of diabetes mellitus.
has also been demonstrated in both the white
Similarly, in patients without diabetes presenting with
population and the Asian-Indian populations (6).
acute ST-segment elevation myocardial infarction
The aim of this study was to explore the
(STEMI), higher fasting glucose was a marker of
prevalence of prediabetes in patients admitted with
adverse outcome (1).
acute coronary syndromes who were not known to
Individuals with diabetes are at higher risk of
have diabetes and to determine the impact of
myocardial infarction than non-diabetics. However,
prediabetes on in-hospital clinical outcomes versus
much less is known about the incidence of
non-diabetic patients.
development of diabetes and impaired fasting glucose
in patients who had myocardial infarction (2). Diabetes PATIENTS AND METHODS
is a major risk factor for coronary heart diseases.
This prospective study was conducted on 60
Impaired glucose metabolism is also frequently
patients with (ACS) who were admitted to the ICU,
observed subsequent to an acute coronary event in
Internal Medicine Department, Faculty of Medicine,
non-diabetic subjects. The glycemic metabolic status
Zagazig University during the period from September
indicated by the blood glucose and glycosylated
2019 to March 2020.
hemoglobin (HbA1c) concentrations (3). At the time of
acute myocardial infarction in diabetic subjects, and Ethical approval:
even in the case of non-diabetic subjects, are Written informed consents were obtained from all
determinants of future cardiovascular events and the participants. The study was approved by The
increased risk of death (4). Research Ethical Committee of Faculty of This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_76The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3909-3911
Use of Oral Mini Pulse Dexamethasone in Vitiligo Patients: Review Article Ghada Mahmoud El Ghazaly*, Waleed Mohammed AlBalat, Mohamed Ibrahim El Ghareeb
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Ghada Mahmoud El ghazaly, Email:[email protected] ABSTRACT Background: One to two percent of the population globally suffers from vitiligo, an acquired depigmentation condition of multifactorial etiology. Macules and patches of depigmentation characterize vitiligo. People's moods are affected greatly and depressingly by it. As a result, prompt and effective therapy is necessary. Many individuals are able to slow the advancement of the disease, acquire repigmentation, and achieve cosmetically appealing results with proper therapy. There is a wide range of treatments for vitiligo, including topical corticosteroids (TCS) as monotherapy (as for vitiligo local therapy) or in conjunction with phototherapy or other topical medications in generalized vitiligo. Intermittent administration of large (pharmacological) dosages to maximize therapeutic benefit and prevent side effects is known as dexamethasone oral mini pulse (OMP) treatment. Objective: to determine the success of oral dexamethasone in vitiligo management. Conclusion: In vitiligo patients, when corticosteroids are provided at the onset or at early stages of disease, they can reduce disease progression and promote repigmentation and in some cases total repigmentation. Keywords: Oral Mini Pulse Dexamethasone, Vitiligo.
Vitiligo:
Oral corticosteroids can cause weight gain,
A condition known as vitiligo is defined by the lack
hyperglycemia, and infection, among other side effects.
of pigmentary cells in the epidermis, which causes
Additionally, hypothalamic pituitary adrenal (HPA)
white patches and macules to appear on the skin (1).
axis suppression, growth retardation, bone density loss,
Segmental vitiligo (SV) and non-segmental vitiligo
hypertension, and cataracts are some of the most typical
(NSV) are the two main types of vitiligo based on
side effects. Corticosteroid discontinuation causes
clinical presentation. Generalized, mucosal and
behavioral alterations as well (7). Monitoring of, glucose
acrofacial NSV are all types of NSV. Other clinical
levels, weight, blood pressure, waist circumference and
forms of vitiligo, such as, inflammatory, confetti-like
infections as well as an ocular examination every 6-12
(punctate), localized and trichrome, have been recorded
months is recommended for patients on systemic
in the literature (2).
corticosteroids (8).
To treat vitiligo, 8 mg/kg methylprednisolone Oral Mini Pulse Dexamethasone:
High numbers of cytotoxic CD8+ T cells are
was given for three consecutive days in a month in prior
found in the blood of patients with vitiligo compared
research. Vitiligo individuals were given intravenous
with healthy controls. It is hoped that oral
500 mg of methylprednisolone (a half-dose of pulse
corticosteroids will arrest the progression of lesions in
steroids) for three consecutive days three times each
patients with active illness, and that repigmentation will
month (9). A spectrophotometer was used to examine the
occur as a result of their immunosuppressive properties
patients. Three out of the five patients who completed (3)
three such monthly cycles saw a decrease in white .
Instability of disease is indicated by a number of
contrast on spectrophotometric examinations, which
indicators (koebnerization and confetti-like macules).
halted illness development.
In making the decision to begin oral corticosteroid
When administering systemic corticosteroid
medication, physicians may consider these markers (4).
therapy, the most commonly used method is to
Corticosteroids in vitiligo act by reducing
administer
supra-pharmacological
doses
and
complement-mediated
cytotoxicity.
Levels
of
intermittently
administer
betamethasone
or
antibodies against the melanocyte surface have been
dexamethasone via oral minipulses. This is done in
found in patients with unstable vitiligo who showed
order to minimize the side effects that occurs when
good results using systemic corticosteroids (5).
steroids are used in daily basis (10). There are several
High-dose pulsed therapy, daily oral low dosage
different types of OMP therapy, but they all include
corticosteroids and mini pulse regimen have all been
using low doses of cyclical pulsed corticosteroids (11).
utilized as systemic corticosteroids. In more than 85%
Only one 5 mg dose is given twice per week, on
of cases, low-dose oral prednisolone (0.3 mg/kg) given
two consecutive days of the week, for the OMP. Vitiligo
daily for two months and a high dosage of intravenous
progression can be halted at this dosage with little
methylprednisolone (8 mg/kg) given three times in a
adverse effects. In patients who do not respond to the
row stopped disease progression and produced some
initial dose, the dosage can be increased to 7.5 mg.
repigmentation in more than 70% of cases, according to
When used for two days in a row, a dose of 2.53.5 mg
research studies (6).
per day can be safely administered to youngsters (12).
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c:\work\Jor\vol852_77The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3912-3914
Role of Immunoglobulin E in the Pathogenesis of Psoriasis: Review Article Amany Abdelrahman Nassar1, Noha M. Bakr2, Manal Mohamed Fawzy1, Enas Hussien Issa Elyousefi*1
1Department of Dermatology, Venereology and Andrology Department,
Faculty of Medicine, Zagazig University, Egypt
2Department of Biochemistry, National Research Centre, Dokki, Giza, Egypt *Corresponding Author: Enas Hussien Issa Elyousefi, Email:[email protected] ABSTRACT Background: In the general population, psoriasis affects two to three percent of people and is characterized by aberrant epidermal proliferation and inflammation. Several clinical subtypes exist for it. The most prevalent form of this disorder is chronic plaque psoriasis (CPP) that is characterized by well-defined, erythematous plaques with silvery scales on knees, scalp, and elbows. There is a chance that any part of the skin could be affected. High IgE levels are frequently linked to parasite infections and atopic dermatitis, allergic contact dermatitis and bullous pemphigoid. Research suggests that psoriasis pathogenesis could be correlated with an increase in IgE expression, which could be a prospective therapy target. Objective: Study the relation to immunoglobulin E in the pathogenesis of psoriasis. Methods: The databases were searched for articles published in English in 4 data bases [PubMed Google scholar- science direct] and Boolean operators (and, or, not) had been used such as [Immunoglobulin E and pathogenesis of Psoriasis OR IgE] and in peer-reviewed articles between January 2001 and October 2020. Conclusion: Overexpression of Immunoglobulin E may have a role in the pathogenesis of psoriasis through several mechanisms. Hence, it could be a viable target to assess severity of psoriasis and follow up of treatment goals. Keywords: Psoriasis, Pathogenesis, Immunoglobulin E. INTRODUCTION
E, and pathogenesis of psoriasis, more synonymous key
Psoriasis is a common chronic skin disorder
words had been used.
characterized by inflammation and abnormal epidermal
These databases were searched for articles
proliferation. The worldwide prevalence is about 2%, but
published in English in 4 data bases [PubMed Google
varies according the regions (1). Chronic plaque psoriasis
scholar- science direct] and Boolean operators (AND,
(CPP), the most common form of the condition is usually
OR, NOT) had been used such as [Immunoglobulin E
manifested as well-demarcated erythematous, scaly
and pathogenesis of Psoriasis OR IgE] and in peer-
plaques on elbows, knees, scalp, but any skin surface
reviewed articles between January 2001 and October
may be affected as well. Psoriatic erythroderma (PE)
2020; a 19-year date range was selected, and no language
represents the generalized form of the disease that affects
limitations, and filtered in selected data basis for the last
all body sites. The specific pathogenesis of psoriasis is
19 years, however, the range of time interval for
not completely understood, but the underlying
researches is wide as there's scarcity of data on the
mechanisms involve a complex interplay between
particular reviewed, accurate and depth in the retrieved
epidermal keratinocytes, T limphocytes as well as other
literature. Documents in a language apart from English
leukocytes, and vascular endothelium (2). The T-helper
have been excluded as sources for interpretation was not
(Th) 1 and Th17 cells are responsible for the
found. Papers apart from main scientific studies had been
inflammation of psoriasis. Inflammation is not limited to
excluded: documents unavailable as total written text,
the psoriatic skin, and has been shown to affect different
conversation,
conference
abstract
papers
and
organ systems. Thus, it has been postulated that psoriasis
dissertations.
is a systemic entity rather than a solely dermatological Psoriasis:
disease (3). Epidemiology:
The discovery of immunoglobulin E (IgE) was
Psoriasis is a widespread, chronic inflammatory skin
major stimuli to the investigation of allergic diseases (4).
disease that is characterized by well delineated, scaly,
Within a decade of its discovery, reports began to
erythematous plaques. As a result, the patient's quality of
incriminate IgE as a possible contributor to the
life may be significantly affected. It is difficult to
pathogenesis of several chronic inflammatory disorders
pinpoint a single cause for the development of psoriasis. (5). Although serum IgE concentrations are low in normal
Hence, psoriasis could result from the interaction
health condition, they are high in atopy, parasitic
between
several
factors
including;
genetic,
infestation, human immunodeficiency virus (HIV)
environmental, and immunologic factors (7).
infection, and certain types of cancer(6).
The onset of psoriasis can occur at any time, regardless Methods:
of the patient's age. It seems that the onset of disease has
A search strategy has been performed to determine
a bimodal distribution, peaking in young adults, in the
the related literature. Initially, the objective of review
20-30-year-old range and then again in the 5060-year-
was identified: Immunoglobulin E in the pathogenesis of
old range (early-onset psoriasis and late-onset psoriasis,
Psoriasis. Relevant keywords included: Immunoglobulin
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c:\work\Jor\vol852_78The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3915-3920
Comparison between Preterm versus Full Term Septic Neonates Whose Feeding Is Powdered Milk Formula Regarding Cronabacter Sakazakii Abdelrazek Hefny Elsheikh 1, Ehab Abdelmoneim Elbanaa 1, Ahmed Shahin 2, Ahmed Alaa Eldein Gameel*1
Departments of 1Pediatrics and 2Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Ahmed Alaa Eldein Gameel, Email: [email protected]
ABSTRACT Background: Foodborne pathogen Cronobacter sakazakii (CS) has been detected around the world. When it comes to foodborne bacteria, C. difficile (CS) is one of the most prevalent diseases, particularly among infants with low birth weight and preterm neonates. Objective: To compare between the incidence of Cronobacter Sakazakii infection among preterm versus full term septic neonates whose feeding is powdered milk formula. Patients and Methods: Our study was a comparative cross-sectional study and included 50 neonates: 25 full term and 25 premature. It was conducted at Pediatrics Department, Zagazig University Hospital and the patients' status fulfilled the inclusion and exclusion criteria. Medical history, clinical examination, and laboratory tests were performed on all patients. Collection of specimens and culture and sensitivity tests for the isolates were also done. Results: There was significant increase of prevalence of Cronobacter sakazakii in preterm more than full term. The sepsis score and its associated characteristics varied significantly between the two groups. With time, increasing temperature led to reduce number of C. sakazakii in reconstituted infant powdered milk Conclusion: Powdered infant formula (PIF) can be contaminated with C. sakazakii, which can cause sickness in infants who are fed PIF rather than breast milk, and in preterm infants rather than full-term ones. Keywords: Cronobacter sakazakii, Powdered Milk Formula, Preterm.
INTRODUCTION
One of the members of the Enterobacteraceae
birth weight (LBW), are the most often known groups
family, Cronobacter is also known as Enterobacter
at risk because the bacteria cause necrotizing
sakazakii. Non-spore, rod-shaped, and peritrichous
enterocolitis (NEC), meningitis and sepsis in
flagella producing bacteria are the characteristics of
hospitalized neonates (4).
Cronobacter. It is Gram-negative bacterium.
Listeria
monocytogenes
and
Clostridium
Citrobacter and Enterobacter are closely related to this
botulinum are two of the most frequent bacterial
bacterium. A wide range of food products, including
diseases and CS has been put in this group. As with
powdered infant formula (PFI), have been shown to
Salmonella, CS is becoming more and more of a cause
contain Cronobacter spp., including spices, wheat,
for concern when it comes to foodborne bacteria. PIF
herbs and rice (1).
reconstituted under favorable conditions could allow
Foodborne pathogen Cronobacter sakazakii has
this bacterium to multiply and pose a major threat, as
been detected around the world. Plant-based beverages
researchers have discovered (5).
and foods, vegetables, PIF, fruits, cereals and other
We aimed at this study to compare between the
plant-based foodstuffs all include it. Because PIF is a
incidence of Cronobacter sakazakii infection among
non-sterilized product, contamination is more likely to
preterm versus full term septic neonates whose feeding
occur (2).
is powdered milk formula.
Cronobacter's epidemiology and virulence are
both poorly understood at this time. However, because PATIENTS AND METHODS
reconstituted PIF is commonly provided to neonates
The study was a comparative cross-sectional trial that
(particularly those in neonatal critical care units), this
included 50 neonates: 25 full term and 25 premature
product has drawn attention for its ability to reduce
and was carried out at the Newborn Intensive Care Unit
infection risk in newborns due to the limited number of
(NICU) of the Pediatrics Department, Zagazig
exposure pathways (3).
University Hospital.
There are many ways in which the opportunistic
pathogen CS might infect a host. Adults are more likely Ethical considerations:
than children to contract Cronobacter infections, which
As long as all parents of participants signed informed
affect
all
age
groups.
Preterm
infants,
consent forms and submitted them to Zagazig
immunocompromised newborns and neonates with low
University's research ethics committee, the study was
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c:\work\Jor\vol852_79The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3921-3926
Cervical Length as a Predictor of Success of Induction of Labor in Term Pregnancy Ibrahim Mohiy El-Maghraby
Obstetrics and Gynecology Department, Shebin El-Kom Teaching Hospital, Egypt *Corresponding author: Ibrahim Mohiy El-Maghraby, Mobile: (+2)0100035 7896, E-mail:[email protected] ABSTRACT Background: Vaginal delivery is the most important event occurring in women's life. It carries many risks of significant concerns to the physicians. Predicting the chances of vaginal delivery is of paramount concern for the pregnant woman. Antenatal cervical length measurement has paramount importance in the prediction of labor. Objective: This study aimed to study the role of cervical length in prediction of success of induction of labor in term pregnancy. Patients and Methods: A prospective study where 140 pregnant women undergoing induction of labor for various indications were included, the cases were recruited from Obstetric Department of Shebin El-Kom Teaching Hospital in the period from October 2019 to December 2020. Results: Methods of induction was misoprostol in (75) females and amniotomy with oxytocin in (65) females. 97 Females were delivered by simple vaginal delivery, 79 females were delivered within 24 hours of induction, 18 females were delivered after 24 hours, and 43 females were delivered by caesarian section (C.S.). Indications of C.S. were mainly due to failed induction and fetal distress. Conclusions: We concluded that successful induction of labor was correlated significantly with detection of insulin- like growth factor-binding protein 1 (iGFBP-1) in cervical secretions and measurement of cervical length by transvaginal ultrasound (TVUS), IGFBP-1 detection by Actim Partus test is simple, easy bed side test that can predict successful induction of labor and measurement of cervical length by TVUS is a good predictor factor for successful induction of labor. Keywords: Cervical, Induction of labor, Oxytocin, Transvaginal, Ultrasound, Uterine.
INTRODUCTION
Induction of labor is defined as an intervention
Transvaginal
ultrasonographic
imaging
designed to artificially initiate uterine contractions
measuring the cervical length is a good method for
leading to progressive dilatation and effacement of the
cervical assessment i.e., if the cervical length>30 mm
cervix and birth of the baby. Induction of labor is
and funneling (wedging) is > 30 percent of total cervical
indicated when benefits to the mother or the fetus
length this indicates an unripe cervix. Also, it might lead
outweigh those of continuing the pregnancy such as
to a reduction in cesarean delivery and thereby its
post-dated pregnancy, premature rupture of the
complications (5). Rupture of membrane, separation
membranes before onset of labor, maternal diseases
(stripping) of membranes by fore fingers, massage of
such as diabetes mellitus, hypertension with pregnancy,
breasts, extra amniotic injection of prostaglandin
or fetal growth restriction, these are the most common
solution and gel, introduction of catheter and
indications for induction of labor (1). Successful
administration of prostaglandins analogue; misoprostol
induction is reported to be related to cervical
(cytotec),
misotac,
vagiprost,
antiprogestin;
characteristics, "readiness or `ripeness'. The traditional
mifepristone (RU 486), oxytocin (6). Today, Bishop
method of assessment of cervical ripeness is based on
score remains the standard method to predict the
digital examination of the cervix. This scoring system
duration and outcome of induced labor. However, the
described by Bishop in 1964 (2).
preinduction `favorability' of the cervix as assessed by
The uterine cervix undergoes considerable
the Bishop score is very subjective and several studies
physiological, biochemical and anatomical changes
have demonstrated a poor predictive value for the
during transition between the antenatal and intrapartum
outcome of induction especially in women with a low
period. In primiparous women, cervical dilation and
Bishop score (7).
effacement were related to the time of gestation at
Therefore, this study aimed to study the role of
which labor started(3). The uterine cervix has been used
transvaginal ultrasound measurement of cervical length
as a predictor of the probability of vaginal delivery.
in prediction of success of induction of labor after 37
Traditionally, the Bishop score has been used to assess.
weeks of pregnancy.
Bishop score consist of dilation, effacement, position,
consistency of the cervix, and station of presenting part. PATIENTS AND METHODS
Digital examination of the cervix is subjective and has
This is prospective cohort study. 140 pregnant
considerable interobserver variability. Furthermore
women undergoing induction of labor for various
only that portion of the cervix below the anterior vaginal
indications were included, the cases were recruited from
wall is assessed (4).
Obstetric Department of Menoufia University Hospital
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c:\work\Jor\vol852_80The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3927-3935
The Diagnostic Role of Normalized and Mean Apparent Diffusion Coefficient in Differentiation between Pancreatic Lesions Mai M. K. Barakat*, Laila Ahmad Abdurrahman, Doaa Anany, Nivan Hany Khater
Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt *Correspondence author: Mai Mokhtar Kamal Barakat, Mobile: (+20)01006294780, E-mail: [email protected] ABSTRACT Background: Diffusion-weighted magnetic resonance imaging (DWI) with quantification ofapparent diffusion coefficient (ADC) values is well established in the diagnosis of a variety of abdominal abnormalities. Regarding pancreatic disease, several investigators have shown that DWI with ADC measurement helps detect and characterize focal pancreatic lesions, as well as assess the severity of other pancreatic conditions. Objective: The study aimed to evaluate the diagnostic role of both normalized and mean apparent diffusion coefficient in discrimination between pancreatic lesions. Patients and Methods: Thirty-one participants presented with pancreatic lesions using clinical examination and ultrasound. Dynamic contrast MRI abdomen with diffusion-weighted MR imaging (DWI) on a 1.5-Tesla MRI machine was done. Mean ADC and normalized ADC (as the ratio of ADC of the lesion to the adjacent normal pancreas) were measured and compared. Results: Our study reported a mean ADC cut value of 1.47 while the cut-off value for normalized ADC was 0.96. Normalized ADC revealed a higher sensitivity 92.31%, specificity 88.89%, PPV 85.71, NPV 94.12%, accuracy 90.32%, positive likelihood ratio 8.31 and negative likelihood ratio 0.09 as compared to mean ADC, which revealed sensitivity 84.62%, specificity 77.78%, PPV 73.33%, NPV 87.5%, accuracy 80.65%, positive likelihood ratio 3.81 and negative likelihood ratio 0.2 respectively. Conclusion: Measuring the mean and normalized ADC value in pancreatic focal lesions can significantly differentiate between benign and malignant pancreatic lesions. However, normalized ADC has a higher sensitivity, specificity, PPV, and NPV than mean ADC value and could be used to differentiate between pancreatic lesions with higher accuracy than mean ADC. Keywords: Diffusion-weighted MR imaging, Apparent diffusion coefficient, MRI, Normalized ADC, Pancreatic lesions.
INTRODUCTION
high b value DWIs, with accompanying low ADC in
MRI is a known imaging modality for the
comparison to normal tissue. However, the ADC values
evaluation and characterization of pancreatic masses. It
in the normal pancreas could vary between different
is used for adequate analysis of the changes in the
scanners, protocols, and different parameters.
morphology of pancreatic parenchyma. However, there
Moreover, there is interobserver high variability due to
are many contraindications to the infusion of contrast
the difficulty in the region of interest (ROIs) placement
agents due to its many adverse effects. Subsequently a
in the small glands. Therefore, normalized ADC has
need for another modality such as DWI to give the same
been introduced for more accurate differentiation of
diagnostic information (1).
lesions (2). Normalized ADC value might decrease the
Diffusion-weighted imaging is an important
effects of many factors on calculating ADC, for
sequence that could be used complementary to the main
example, the different strengths of field, b values, and
MRI protocol in pancreatic imaging. It could help in
variability of patients (3).
pancreatic focal lesions characterization and for diffuse
The aim of the study was to evaluate the
parenchymal diseases evaluation. It is not time
diagnostic value of measuring the normalized and
consuming and with no need for contrast media
mean ADC as a quantitative tool in differentiation
administration. Also, it could give us information about
between pancreatic masses.
the cellularity of tissues and cell membranes status (2).
The water molecules' random motion is measured from PATIENTS AND METHODS
DWI acquisitions in biologic tissues. The high
Our prospective study was performed in our
cellularity and integrity of cell membranes suppress the
institution from April 2018 till January 2020. Thirty-
motion-free water in both extracellular and intracellular
one patients (16 females and 15 males) were included in
compartments. So, tumors with high cellularity act as
this study. Their ages ranged from 29 to 76 years with a
barriers to this free diffusion in both extra and
mean age of 51.7 ± 11.88 years. They were diagnosed
intracellular compartments (3).
with pancreatic mass 1st clinically followed by
ADC is a quantitative value calculated from
ultrasound. All were subjected to proper history taking.
DWI acquisitions. Malignant focal lesions have
Patients were told to fast for 4 hours before the MRI
increased cellularity and show restricted diffusion on
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c:\work\Jor\vol852_81The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3936-3939
Cataract Surgery Techniques and Effects in Mature Senile Cataract: Review Article Nora Ahmed Mahmoud, Gamal Naguib Elmoteey, Alaa Mohamed Hamdy, Ahmed Mahmoud Alyan
Ophthalmology Department, Faculty of Medicine, Zagazig University, Egypt Corresponding Author: Nora Ahmed Mahmoud, E-mail: [email protected] ABSTRACT Background: One of our most cherished belongings is our ability to see well. The ability to see clearly is a fundamental human right. People fear losing their sight the most according to surveys. As we age, we are more likely to suffer from vision issues. The typical age of cataract onset in the West is around 60 years old, however in poorer countries it is more common around the age of 45 or even earlier. Since cataracts are responsible for 47.8 percent of the world's total blindness, they are a major cause of concern and a significant public health issue in developing countries. Objective: This study aimed to study the corneal endothelial changes in both procedures for extraction of mature senile cataract. Conclusion: Corneal endothelial cells are sensitive to trauma, which affects cell density and cell morphology. Endothelial cell loss during surgery affects the ability of the cornea to preserve transparency with subsequent visual affection. Keywords: Cataract surgery techniques, Mature senile cataract.
INTRODUCTION
viewed, regardless of its cause. Phacoemulsification has Cataract surgery: Cataract surgery is the most
become the standard treatment for white cataracts in
commonly done surgical technique on these patients for
affluent countries with the introduction of capsule dye.
the purpose of visual rehabilitation. There has been a
Most underdeveloped countries, including India, are
massive increase in surgeries due to enhanced safety and
unable to use phacoemulsification due to the expensive
results of surgical and lens technology. Manual Small
expense of disposable supplies, and phaco-machines as
Incision
Cataract
Surgery
(MSICS),
and
well as necessity for more advanced surgical training (2).
Phacoemulsification have made significant breakthroughs
The aim of the present review was to study the
in cataract surgery throughout the years. Basically,
corneal endothelial changes in both procedures for
current cataract operations are divided into two categories:
extraction of mature senile cataract.
machine-independent Manual Small Incision Cataract Phacoemulsification and corneal Affection:
Surgery, and machine-dependent Phacoemulsification. A
Phacoemulsification has become the most
massive and ever-increasing backlog of cataract blindness
common surgery to treat cataract. It possesses many
continues to be the primary obstacle in the treatment of
benefits more than alternative type of cataract removal
cataracts despite substantial technological breakthroughs
surgeries as regard terms of safety, acceptance and rapid (1).
visual rehabilitation. Despite the wide advantages of phacoemulsification, it still has a known negative impact on corneal endothelium. With the recent advances in the technology of the phacoemulsification machine and surgeons skills, surgeons expand the use of phacoemulsification to operate on mature senile cataracts with hard lens. This is associated with high damage to endothelium (3).
Damage to the corneal endothelium layer causes
corneal edema, which can lead to permanent bullous keratopathy. Because corneal endothelial cells are unable to renew, corneal tissue transplantation is the only effective treatment. Cataract surgery was found to be the most common cause of penetrating keratoplasty in a recent Japanese national survey of bullous keratopathy
(24.2 percent) (4). After Fuchs endothelial dystrophy, Figure (1): Showing mature senile cataract (1).
cataract surgery was ranked second in a recent study in the
There are an estimated 19 million persons worldwide
United Kingdom as an indication for endothelial
who are blind because of bilateral cataracts. Intumescent,
keratoplasty (5).
mature, and super mature lenses (white cataracts) make up a considerable component of the backlog of cataract Damage to the corneal endothelium during
procedures in underdeveloped countries. What is a white phacoemulsification: causes and consequences:
cataract? It is described as complete opacification of the
Damage to the corneal endothelium during
crystallized lens that prevents any red reflex from being
phacoemulsification has been reported to be caused by an
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c:\work\Jor\vol852_82The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3940-3944
Assessment of Antibody Titer to Pneumococcal Vaccine in Nephrotic Syndrome Children post Vaccination Isam Makhlouf Eanoga1, Hanaa Abdel Fattah Mohammed1, Mayy Abd Alfattah Neemat Allah1, Mai Mahmoud Sami Ibrahim2
Departments of 1 Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Isam Makhlouf Eanoga, Email: [email protected] ABSTRACT Background: The most common glomerular condition in children is idiopathic nephrotic syndrome (INS). Pneumococcal infections are one of the most serious consequences for children with nephrotic syndrome. Objective: Assessment of antibody titer in children with renal impairment 1- and 3-months after immunization with pneumococcal conjugate vaccine 13 (PCV13). Patients and Methods: Cross-sectional research including 24 nephrotic children was carried out at Pediatric Nephrology Unit and Outpatient Nephrology Clinics of Children Hospital at Zagazig University over a period of one year from April 2020 to March 2021. Results: At 1- and 3-months following vaccination, level of antibody titer was significantly higher among patients within group II. There was statistically significant difference between the studied groups regarding trend of antibody at three months. Steroid dosage at time of immunization was strongly associated with antibody titer one month (M) after vaccination in both groups. While there was statistically significant negative correlation between steroid dose at time and 3 months after vaccination with antibody titer at 3 months post vaccination in both groups. Conclusion: Nephrotic children in both groups can mount adequate antibody production to pneumococcal vaccine post vaccination, which is equal or higher than 0.35 g/ml. On low doses of oral steroids and immunosuppressive medications, PCV-infected nephrotic youngsters developed strong protective antibody titers. Keywords: Nephrotic syndrome, Pneumococcal Vaccine, Post Vaccination.
INTRODUCTION
The prevalence of bacterial infections in children PATIENTS AND METHODS
with nephrotic syndrome (NS) has reduced in
Cross-sectional research including 24 nephrotic
industrialized nations, but they remain a substantial issue
children was carried out at Pediatric Nephrology Unit
in poor countries. Sepsis is still a leading cause of death
and Outpatient Nephrology Clinics of Children Hospital
in children with NS, whereas peritonitis is a major source
at Zagazig University over a period of one year from
of morbidity and mortality in NS patients, and
April 2020 to March 2021.
Streptococcus pneumoniae is the most common bacteria
responsible for primary peritoneal peritonitis (1, 2). Ethical considerations:
Resistance to conventional antibiotics by S. pneumoniae As long as all parents of participants signed
highlights the urgent need to employ vaccinations in the informed consent forms and the study was agreed
fight against pneumococcal illness (3). from Zagazig University's Research Ethics
To combat pneumococcal illness, vaccinations are Committee, with number (ZU-IRB#6227). We
urgently needed since S. pneumoniae is becoming more followed the World Medical Association's ethical
and more resistant to treatments (4). Many medical experts code for human experimentation, the Helsinki
are baffled by the technique for administering the NS Declaration.
pneumococcal vaccine to youngsters, resulting in many
of these children not receiving an adequate vaccination Inclusion criteria: (5).
1. Diagnosed children with NS of both sexes and their
While on high dose prednisolone for more than two
age between 2 to 15 years were included.
years, Ulinski et al. (6) found that patients who received
2. Acute NS cases (newly cases after 1 month of daily
PPV23 during active disease were able to mount an
steroid either early responder or late responder or
antibody response of 10-fold increase on day 30 post
steroid resistant NS (SRNS)).
vaccination, similar to that of NS patients who received
3. Treated NS cases along 1 to 1.6 year (frequent,
vaccine in remission while on low dose prednisolone.
infrequent or resistant cases) and they were treated
One year after immunization, antibody levels in both
by relatively low doses of both corticosteroid and
groups were strong and no individuals developed
other immunotherapy.
invasive pneumococcal illness (7).
4. All children of NS included in study were not
We aimed in this study to assess antibody titer to
vaccinated previously (either at the time of
pneumococcal conjugate vaccine 13 in children with
obligatory vaccines or later on).
nephrotic disease 1- and 3-months post vaccination.
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c:\work\Jor\vol852_83The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3945-3948
Novel Guidelines for Immunotherapeutic Treatment Options of Genital Warts: Review article Shimaa Mohamed Abd Elfatah, Eman Abd Elgawad Nofal, Soheir Mohamed Ghonemy
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Egypt. Corresponding Author: Shimaa Mohamed Abd Elfatah, Email: [email protected] ABSTRACT Background: The appearance of genital warts varies. Flat or resembling raspberries or cauliflower, they can be found in a variety of shapes. They begin as little red or pink growths and can reach a diameter of four inches or more before interfering with sexual activity or delivery (in certain circumstances) (in some cases). The warts thrive in the vaginal area's moist tissues. On the external genitals and the walls of the cervix and urethra, in women, as well as on the shaft of the penis in males, they are found. Despite the availability of different therapeutic modalities, treating warts with immunotherapy is a tremendous benefit. HPV vaccination has shown promising efficacy in the treatment of genital warts. Objective: To hallmark the new guidelines of immunotherapeutic options for treatment of genital warts. Conclusion: Immunotherapy with HPV vaccines is an effective and safe treatment modality of anogenital warts. Keyword: Genital warts, Immunotherapy, HPV vaccination.
INTRODUCTION Immunotherapy:
Anogenital wart, most sexually transmitted
Genital warts can be treated in two ways:
infections are caused by the anogenital human papilloma
Aggressively and destructively using traditional methods
virus (HPV), which can cause cancerous or
such as, cryotherapy, electrocauterization, chemical
noncancerous skin and mucosal tumors, including
cautery, laser ablation and surgical excision, or using
anogenital warts (AGWs) to occur. To qualify as an
immunotherapy to stimulate the immune system to fight
anogenital HPV infection, AGWs must have visible
the virus and reduce its activity. Intralesional, topically,
lesions on the perianal area, vulva, urethra, perianal area
or systemically, immunotherapy can be administered (5).
and urethra. These lesions include single or numerous
Because of the availability of various therapeutic
papules (1).
lines and the immune status of the patients, the selection
Condylomata
acuminata
(pointed
warts),
of the most appropriate means of immunotherapy is
flat/macular lesions, papular lesions, and keratotic
usually difficult. Many factors should be considered
lesions are all subtypes of AGWs that have been
before the treatment of the patients, such as age, sex, past
documented. The first two varieties are often seen on wet,
medical history, and the clinical characteristics of warts.
non-keratinized epithelia, whereas the latter two are more
People who suffer from many warts or warts that are
commonly found on keratinized epidermis. However,
resistant to treatment are more likely to have a faulty cell-
genital warts (GWs) and genital verruca are really
mediated immune response (6). Due to immunotherapy's
subclasses of the AGW group (2).
ability to treat warts that are far from where they were
The majority of AGW cases are caused by HPV 6
injected, a large proportion of patients are cured of
or 11. Infection with AGWs is extremely contagious,
remote warts as a result of the treatment (7). In genital wart
with roughly 65 percent of those infected developing
treatment, immunomodulating drugs such as skin test
AGWs within three weeks and eight months. Buschke
antigens, interferon- 2b (IFN- 2b), and topical
Lowenstein tumours (BLTs) have been linked to AGWs
imiquimod agents have been widely used (8). Interleukin
in a small number of instances (3).
6 (IL6), IL-1 , tumor necrosis factor - - and IFN- are
Giant condyloma acuminatum, a fungating variety
some of the cytokines that are elevated when imiquimod
of condyloma, was first described by Buschke in 1896
is applied topically. Other immunotherapy approaches
and is extremely uncommon. One of condyloma's most
that induce robust tissue cytokine responses should be
virulent strains is this one. Depending on the
investigated in light of the response of genital warts to
aggressiveness of the lesion, several sinuses or fistula
them. Genital warts can be successfully treated with
tracts can be formed, which can penetrate deep into the
intralesional immunotherapy utilizing various antigens
fascia, muscle, and rectum. Inflammation, infection, or
as MMR vaccination, trichophyton skin test antigens and
bleeding may result from this. This benign lesion has a
candidal extract, mycobacterium W vaccine (MWV) and
high recurrence rate and is difficult to treat because of its
bacillus Calmette-Guérin (BCG) (9) as shown in table (1).
large size, local invasion, and recurrence potential (4).
A very promising immunotherapeutic option is
vaccination with any of the HPV vaccines available for
Aim of the study was to hallmark the new guidelines of
the prevention of cervical cancer. Vaccination seems to
immunotherapeutic options for treatment of genital
induce immunity to those HPV types that cause genital
warts.
and extragenital cutaneous warts because of cross-
reactivity (10).
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c:\work\Jor\vol852_84 The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3949-3952
Novel Overview of Seasonal Blood Pressure Variation: Review Article Mahmoud Mohamed Hamed Abo El Sadat*, Tarek Ahmed Naguib, El Sayed Mohamed Farag, Marwa Mohamed Gad
Cardiology Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Mahmoud Mohamed Hamed Abo El Sadat, E-Mail:[email protected]
ABSTRACT Background: One of the world's most common health issues is high blood pressure. Hypertension's dangers are well- documented and have been shown in numerous large-scale investigations. Seasonal variation in blood pressure is largely due to changes in the temperature of the surrounding environment. Several studies have found a negative correlation between the temperature outside and blood pressure. No observational study has been done in Egypt so far using either healthy people or patients to examine the effect of weather on blood pressure. Evidence suggests that seasonal fluctuations in ambient temperature have an impact on cardiovascular events and blood pressure levels. Objective: Study the blood pressure levels in the winter and summer to see whether they differ. Conclusion: In both men and women, young and elderly, the seasonal change in BP appears to be a global phenomenon that has been documented in regions with varying climate conditions. Keywords: Seasonal Blood Pressure Variation, Systemic Hypertension.
Systemic Hypertension: Mortality and blood pressure patterns in relation to
It is estimated that one third of the world's population the seasons:
would be affected by hypertension by 2025 because of
Globally, seasonal temperature change is linked to
increased obesity and population ageing. Hypertension is
seasonal variations in BP and cardiovascular mortality,
rapidly increasing in developing countries (80% of the
according to accumulating research. Many major studies
world), a situation where insufficient treatment and
of various designs have proven the relationship between
control of hypertension contributes to the burgeoning
season and temperature and mortality (5). In both
epidemic of cardiovascular disease (CVD). Globally,
temperate and frigid areas in the Southern and Northern
high blood pressure (BP) is the leading cause of strokes
Hemispheres, winter is the highest season for mortality.
and ischemic heart disease, accounting for two-thirds of
Near the equator, winter mortality is at its lowest, whereas
all cerebrovascular accidents (strokes) (1).
in the Mediterranean region, it is at its highest (6). Seasonal blood pressure variation: Pathophysiological mechanisms:
Temperature-dependent oscillations in blood
Increasing
peripheral
resistance
and
pressure have been seen in numerous investigations,
vasoconstriction in cold, together with vasodilation and
warmer temperatures result in lower blood pressure, while
decreased resistance in warmer temperatures, are thought
cooler temperatures result in higher blood pressure. All
to be responsible for the observed link between blood
age groups, people with and without high blood pressure,
pressure (BP) and temperature in epidemiological studies
those who are neither hypertensive nor those who are (7). Prolonged exposure to cold air may activate additional
being treated for it have seen seasonal changes in their
regulating systems, as blood pressure remained elevated
blood pressure. This suggests that seasonal variations in
even when measured indoors in a room with a constant
blood pressure are a worldwide phenomenon (2).
temperature. Seasonal changes in temperature affect the
Hypertensive individuals who are well-managed in the
activity of the sympathetic nervous system. During cold
winter may experience an unexpected decline in BP over
exposure, norepinephrine excretion increases and the
the summer, which may necessitate a reduction in the
maximum outside temperature has a negative link with
dosage of their medication (3, 4).
norepinephrine (8).
Hypertensive patients who manage their BP in the
In the winter season, less sweating, which reduces
summer may need to increase their medication dosages in
salt loss, may contribute to a rise in blood pressure (7).
the winter because of an increased risk of their BP rising
Increased parathyroid hormone production as a result of
above the acceptable level. The same can happen when
decreased ultraviolet (UV) light exposure may boost the
people go from cold to hot climates, or the other way
development of vascular smooth muscle and improve its
around. It's imperative for a practitioner to verify the
contractility via adrenaline reactivity, endothelial
change in blood pressure and adjust antihypertensive drug
function, and changes in intracellular calcium (9). There
therapy in order to maintain a safe and effective BP level
may be a correlation between the amount of sunshine
without symptoms. 13.5 percent of the 667 patients in a
exposure and changes in corticosterone, adrenaline, and
recent study who sought treatment for high blood pressure
prolactin release (10).
throughout the summer had their prescription decreased,
People with untreated mild essential hypertension
with diuretics having the highest rate of reduction (4).
who received repeated full-body UVB radiation treatment
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c:\work\Jor\vol852_85 The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3953-3959
Dry Weight Assessment in Children on Regular Hemodialysis with Special Relation Between Acute and Chronic Renal Failure Doaa Youssef Mohammed Youssef, Al-Shaymaa Ahmed Ali, Huda Al sayed Mohammed Saadoon*, Mayy Abd Alfattah Neemat-Allah
Department of Pediatric, Faculty of Medicine Zagazig University, Egypt *Corresponding Author: Huda Al sayed Mohammed Saadoon, Mobile: (+20) 01008128477, E-mail: [email protected] ABSTRACT Background: Adequate assessment of fluid status is an imperative objective in the management of HD patients. An inaccurate assessment of dry weight leads to many complications. Objective: The aim was to assess applicability of clinical using inferior vena cava (IVC) and lung ultrasonography to assess dry weight and the adequacy of fluid removal in hemodialysis children with special relation between acute and chronic renal failure. Patients and methods: 75 children were classified into two groups: Group (1): Chronic renal failure and group (2): Acute renal failure. Results: A statistically positive significant correlation between percent of weight loss after dialysis among the studied patients and all of serum ferritin, creatinine, phosphorus and iron. There was statistically negative significant correlation between percent of weight loss after dialysis among the studied patients and serum creatinine. There was statistically significant negative correlation between percent of weight loss after dialysis among the studied patients and SPAP. There was statistically non-significant correlation between percent of weight loss after dialysis among the studied patients and percent change in IVC inspiratory diameter, expiratory diameter, collapse index and B lines. There was statistically significant difference between the studied groups and expiratory IVCD, collapse index before and after dialysis, difference in B lines. Conclusion: Lung ultrasound is an accurate and sensitive method of quantifying subclinical fluid overload in children on dialysis before its clinical manifestation. IVC measurement is reliable to assess intravascular fluid overload in children on HD and was not correlated with extracellular fluid volume as need more time (2-3h) after dialysis and maneuver difficult with young age. Keywords: Dry weight, Hemodialysis, Renal failure, Evaluation. INTRODUCTION PATIENTS AND METHODS
Adequate assessment of fluid status is an
This study was performed at Pediatric Nephrology
imperative objective in the management of HD patients.
Unit and Echo Cardiology Unit of Children Hospital,
Fluid overload is one of the most common modifiable
Zagazig University. It was carried out over a period of
risk factors directly associated with hypertension, heart
one and half years from June 2019 to December 2020.
failure, left ventricular hypertrophy, and eventually,
higher morbidity and mortality risk in these categories Ethical approval:
of patients (1). An inaccurate assessment of dry weight This study was approved by Ethics Review
leads to hypertension /hypotension, cardiac and Committee of Faculty of Medicine, Zagazig
vascular dysfunction, omission of small changes in University. Written informed consents from all
nutritional status and intradialytic morbidity and parents of children were obtained. This work has
mortality (2). been carried out in accordance with The Code of
Different methods are commonly used to Ethics of the World Medical Association
determine fluid status (eg, clinical assessment, (Declaration of Helsinki) for studies involving
natriuretic peptide concentrations, cardiothoracic index humans.
based on chest X-ray, echocardiography, inferior vena
cava measurements, or bioimpedance analysis. In recent
Seventy five children were classified into two groups.
years, lung ultrasonography, through the assessment of Group 1: (Chronic renal failure): They comprised 60
extravascular lung water, has received growing
children on regular HD [33 male (55%) and 27 female
attention in clinical research in infant and children of
(45%)]. Their ages ranged from 3 to 18 years.
HD (1). Group 2 (Acute renal failure): They comprised 15
So, our cross-sectional study was conducted to
children of newly diagnosed acute kidney injury on HD
assess applicability of clinical using IVC and lung
during period of admission in PICU to maximum period
ultrasonography to assess dry weight and the adequacy
one month later at hemodialysis unit. Nearly fifty
of fluid removal in hemodialysis children.
percent of this group became on regular HD later on.
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c:\work\Jor\vol852_86The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3960-3966
The Effect Of Culture System On Embryonic Development and Aneuploidy Rate For Icsi Cases Yasmine Sayed Azouz1 ,Mohamed Abbas Eid2, Mohamed Refaat Shehata3,Heba Ali Abd EL-Rahman 4
1.Ganin Fertility Center, Cairo, Egypt ,2.Andrology and Sexology - Faculty of Medicine
Cairo University,3. Inorganic Chemistry , 4. Zoology Department ,Faculty of Science - Cairo University
Corresponding author:Yasmine Sayed Azouz,email:[email protected],mobile:00201154682010 ABSTRACT Background: Patients undergoing intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF)cycles often suffer from recurrent implantation failure (RIF). To ensure live birth and embryonic viability, culture systems should be optimized in all ICSI and IVF cycles. The success of IVF can be affected by the culture systems employed for embryonic development. It has been argued that covering micro drops with oil in culture systems can prevent microbial infection, ensure suitable osmotic and pH conditions, and prevent the evaporation of the medium. Objectives: Comparing the embryonic development, euploidy rate ,and clinical outcome of using GPS Dishes covered with paraffine oil and SPL Dishes with mineral oil for patients with previous RIF. Patients and methods: the study was a prospective randomized controlled trial and the sample size consisted of 174 patients undergoing ICSI cycles at a private fertility center during the period between April 2017 and March 2020. Patients' embryos were randomly assigned into one of the two of the aforementioned groups. Results: The two groups weren't statistically significantly different in male age, female age, collected oocyte number, number of mature oocytes, and number of blastocysts undergoing preimplantation genetic diagnosis (PGD-A). For the pre- implantation parameters of the embryos, fertilization, cleavage, and high-quality blastocyst rates were statistically significantly higher in the GPS Dishes with paraffin oil group than in the SPL Dishes covered with mineral oil group (77.5, 80.1, and 79.45%) (p = 0.012, and 0.001). Conclusion: we conclude that embryonic development can be enhanced by using GPS Dishes with paraffin oil overlying. Keywords: ICSI; RIF; Culture systems; IVF media; Embryo development.
INTRODUCTION
media during embryonic development. Oils can help to
Couples suffering from infertility problems caused
slow down the processes of variations in pH and
by a severe male factor or those who underwent a
temperature as well as evaporation. Embryonic
previous in vitro fertilization (IVF) without successful
development can be adversely affected by increased
fertilization are recommended to seek intracytoplasmic
media osmolality which can result from the absence of an
sperm injection (ICSI) treatments. ICSI can be helpful to
oil overlay(3).
patients who have low chances of conceiving as it
For optimum ART and embryo development
bypasses various fertilization barriers (1) .
outcomes, IVF laboratories should concentrate on
To ensure the delivery of healthy babies and the
reducing stressors with detrimental effects on cells in IVF
viability of embryos, the culture systems in IVF
laboratories. This is of crucial importance due to the
laboratories should be ideal. The success of IVF can be
sensitivity of the oocytes, spermatozoa, and embryos(4).
affected by the culture systems employed for embryonic
Several elements within IVF laboratories can act as
development(2). Typically, media used in IVF are covered
negative stressors on cells including different chemical
with paraffin or mineral oils to ensure the stability of the
and mechanical factors (FIGURE 1).
This article is an open access article distributed under the terms and conditions of the Creative
Computerized tomographic study of the normal dimensions of the anterior horn of lateral ventricle in adultsThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3967-3974
Role of Ultrasonic Elastography in the Evaluation of Fibrosis in Children with Chronic Liver Disease in Comparison to Liver Biopsy Soumaya E. Hadhod*1, Mohamed Z.A. Mourad2, Ashraf M. Radwan1, Omar A.A. Ahmed1
Departments of 1Pediatrics and 2Diagnostic Radiology, Faculty of Medicine, Sohag University, Egypt *Corresponding author: Soumaya E. Hadhod, Mobile: (+20)1064463697, E-Mail: [email protected] ABSTRACT Background: Chronic liver illnesses can be caused by a variety of factors, including metabolic, genetic, drug-induced, inflammatory, structural, dietary, and immunological factors. Even with Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI), liver fibrosis makes diagnostic imaging difficult in chronic liver injury. Percutaneous liver biopsy is the gold standard for diagnosing, grading, and monitoring liver fibrosis in children, but it is painful, invasive, requires heavy sedation, and has numerous complications such as bleeding. Objectives: The aim of the current work was to assess and measure liver stiffness in children with chronic liver disease using real-time elastography (RTE), compare the results to histopathological findings obtained after performing a percutaneous liver biopsy, and investigate the availability of noninvasive safe liver elastography as a future replacement for this invasive tool in the evaluation and grading of liver fibrosis. Patients and methods: This hospital-based cross-sectional comparative study included a total of 30 individuals with chronic liver disease of various etiologies with age ranged from 4-16 years, attending at Department of Pediatric, Sohag University Hospitals. This study was conducted between January 2017 to December 2019. A control group of ten healthy people was also included in the investigation. Results: The degree of liver stiffness measured by the last ultrasonic elastography was greater in the patient group than in the control group, with a statistically significant difference between the two groups. Except for F0-F1 and F3- F4, there was a substantial relationship between fibrosis stage and liver stiffness assessment by sonoelastography, where the difference was significant between every two individual groups. There was a strong link between biopsy diagnosis and liver stiffness measurement. Conclusion: It could be concluded that in adults, ultrasonic elastography is a well-established approach for assessing liver fibrosis. The utility of elastography in the follow-up of children with chronic liver disease might be increased. Keywords: Fibrosis, Liver biopsy, Ultrasonic elastography, Chronic liver disease INTRODUCTION
being studied, causing strain (displacement) inside the
Chronic liver illnesses are defined by six months
tissue, and then calculating the strain profile along the
of clinical or biochemical evidence of hepatic
compression axis. The comparison of signals obtained
dysfunction. In Egypt, liver problems are a significant
before and after tissue movement is the basis of
source of illness and mortality. When there are clinical
ultrasonic elastography. There have been several
and biochemical signs of liver failure, chronic liver
ultrasonic elastographic methods developed (4).
disease can be compensated or decompensated (1).
In 34 children, Schenk et al. (5) compared the
Fibrosis is a complicated condition that involves
usefulness of ultrasonic elastography to liver biopsy in
both parenchymal and non-parenchymal liver cells, as
pediatric liver disorders. They concluded that RTE
well as invading immune cells. The activated hepatic
characteristics can help differentiate between high and
stellate cell is the most important fibrogenic effector
low fibrosis, however, their link with the fibrosis stage
cell type in the liver (HSC). The characteristics of HSC
is only mild. RTE appears to be a viable approach for
activation
and
phenotypic
transition
into
assessing liver fibrosis in youngsters.
myofibroblasts, as well as their pro-fibrogenic activity,
The aim of the current work was to assess and
have been widely defined, and they serve as a critical
measure liver stiffness in children with chronic liver
foundation for understanding hepatic fibrogenesis (2).
disease using real-time elastography (RTE), compare
The criteria standard for determining the genesis
the results to histopathological findings obtained after
and degree of liver disease is still liver biopsy.
performing a percutaneous liver biopsy, and
Although liver biopsy is typically safe and is now
investigate the availability of noninvasive safe liver
regarded as the gold standard for assessing hepatic
elastography as a future replacement for this invasive
inflammation and fibrosis, it is not without risk.
tool in the evaluation and grading of liver fibrosis.
Sampling errors, uncommon complications, and
substantial patient anxiety have all been reported. PATIENTS AND METHODS
These variables have sparked a great deal of interest in
This hospital-based cross-sectional comparative study
the development of noninvasive hepatic fibrosis
included a total of 30 individuals with chronic liver
diagnostics (3).
disease of various etiologies with age ranged from 4-
The elastography technique works by applying
16 years, attending at Department of Pediatric, Sohag
small external tissue compression to the structures
University Hospitals. This study was conducted
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c:\work\Jor\vol852_88The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3975-3979
Surgical Management of Split Depression Fracture of The Lateral Tibial Plateau Seleem Hamed Almosalamy, Mohsen Mohamed Abdo Mar'ei, Ahmed Mostafa El Naggar, Ayhaab Abuzayd Salim Mohammed*
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ayhaab Abuzayd Salim, Mobile: (+20)1023768824, E-Mail: [email protected] ABSTRACT Background: Tibial plateau fractures are one of the commonest intra-articular fractures resulting from indirect coronal or direct axial compressive forces. Fractures of tibial plateau constitute 1% of all fractures and 8% of fractures in the elderly. Objective: In the present study, we aimed to prevent the development of osteoarthritis and to correlate the radiological findings with this type of tibial plateau fracture. Patients and methods: This study was an interventional study, where 18 patients were conducted with tibial plateau fracture Schatzker type 2 and were operated in the Department of Orthopedics, Faculty of Medicine, at Zagazig University Hospital. Results: Most of cases (55.6%) were operated upon 2 days after occurrence of fracture, followed by 27.8%, 16.6% were operated upon after 7 days and 10 days respectively. Seventeen (94.4%) cases were fixed by buttress plate while 1 case (5.6%) was fixed by proximal tibial plate and 16 cases (88.9%) needed bone graft. Significant improvement in time regard function score (knee society score) and radiological score (Rasmussen Assessment score) were found. No complication was found in 66.7% of studied group; 16.7% had infection, 11.1% had valgus deformity and only one case 5.6% had stiffness. Conclusion: It could be concluded that the surgical management of tibial plateau fractures is challenging and gives excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early knee motion by reducing post-traumatic osteoarthritis and thus achieving optimal knee function. Keywords: Surgical Management, Split Depression Fracture, Lateral Tibial Plateau INTRODUCTION
In the surgical treatment of split depression
Tibial plateau fractures are one of the
fractures (Schatzker type II) of the lateral tibial plateau
commonest intra-articular fractures resulting from
(which constitute more than 25% of all tibial plateau
indirect coronal or direct axial compressive forces.
fractures) the goal is reduction of the articular surface
Fractures of tibial plateau constitute 1% of all fractures
and stable fixation. The subchondral defect in the
and 8% of fractures in the elderly (1).
metaphysis is usually grafted with bone from the iliac
These fractures encompass many and varied
crest to support the elevated articular surface (6).
fracture configurations that involve the medial condyle
The advantages of surgical treatment include
(10-23%), lateral condyle (55-70%) or both (11-30%)
early mobilization of the knee, rapid bone union, and
with differing degrees of articular depression and
better quality of reduction (7).
displacement (2).
Disadvantages are pain symptoms (8) and other
In case of improper restoration of the plateau
donor site complications (9) as well as resorption of the
surface and the axis of the leg, these fractures could
graft with subsequent loss of reduction. Non-
lead to development of premature osteoarthritis, injury
resorbable, osteoconductive bone substitutes may
in ligaments, as well lifelong pain and disability (3).
therefore be an advantage over autogenous bone grafts
Tibial plateau fractures may be accompanied by (10).
meniscal and ligamentous injuries to the knee too (4).
In the present study, we aimed to prevent the
For assessment of the initial injury, planning
development of osteoarthritis and to correlate the
management and prediction of prognosis, orthopedic
radiological findings with this type of tibial plateau
surgeons widely use the Schatzker classification
fracture.
system, which divides tibial plateau fractures into six
types. Each increasing numeric category specifies PATIENTS AND METHODS
increased level of energy imparted to bone thereby
This interventional study included a total of 18
increasing severity of fracture (4).
patients presented with tibial plateau fracture
First four are unicondylar and type V and VI
Schatzker type 2 and were operated upon in the
are bicondylar. Each fracture's pattern in Schatzker
Department of Orthopedics, Faculty of Medicine,
classification helps to direct orthopedic surgeons to
Zagazig University Hospital.
adopt appropriate treatment modality (5). This article is an open access article distribute d under the terms and conditions of the Creative
c:\work\Jor\vol852_89The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3980-3984
Impact of Total Salpingectomy Versus Tubal Conservation During Abdominal Hysterectomy on Ovarian Function Mahmoud Ahmed Gareeb,Mohamed Lotfy Mohamed El-sayed, Heba Alsayed Lashin, Mohamed Abdallah El-Bakry
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt *Correspondence author: Heba Alsayed Lashin, Mobile: (+20)1093356130, E-mail:[email protected] ABSTRACT Background: Hysterectomy is one of the most common surgeries in women worldwide. It is applied for the treatment of various problems, such as pelvic pain, menstrual problems, tumors, and other related diseases. Objective: The aim of this work was to preservation of ovarian function as long as possible to decrease manifestation of menopause in hysterectomized patients. Patients and Methods: The study was case control study included 58 patients attendant in outpatient clinic of Obstetrics and Gynecology department, Zagazig University Hospital, and Banha Teaching Hospital during the period from April 2017 to October 2018. All patients were scheduled to total abdominal hysterectomy without oophorectomy due to benign uterine disease. Patients was classified into two groups randomly: Group 1: included odd number of patients 29 was subjected to total abdominal hysterectomy with bilateral complete excision of the tubes. Group II: included an even numbers of patients (n =29) for whom the classical approach of hysterectomy was performed. Results: There was no significant difference between groups regarding Operation, time Hospital stay and Bleeding. Also regarding number of antral follicle post operatively. While these are significant differences between Ovary size distributions between studied groups at different times. Conclusions: It could be concluded that salpingostomy with abdominal hysterectomy is a safe and convenient treatment that does not have a deleterious effect on ovarian reserve. Keywords: Ovarian conservation, Salpingectomy, Hysterectomy
INTRODUCTION
occurrence of post-hysterectomy carcinoma in the
Ovarian
conservation
during
abdominal
preserved fallopian tube has been reported (8).
hysterectomy in a premenopausal woman with
The aim of this study was to preservation of
sufficient ovarian reserve is a subject to be considered,
ovarian function as long as possible to decrease
since oophorectomy may cause sudden hormonal
manifestation of menopause in hysterectomized
imbalance, aggravation of menopausal symptoms and
patients.
decrease of libido (1).
Hysterectomy alters intraovarian blood flow and PATIENTS AND METHODS
may impair ovarian function (2). However it is not clear
This case control study included a total of 58
whether tubal conservation at time of hysterectomy has
patients scheduled to total abdominal hysterectomy
any impact on ovarian blood flow; which has dual blood
without oophorectomy due to benign uterine disease,
supply from terminal ascending branch of the uterine
attending at Outpatient Clinic, Department of
and corresponding ovarian artery(3).
Obstetrics and Gynecology, Zagazig University Strandell et al. (4) studied the effect of prophylactic
Hospital, and Banha Teaching Hospital. This study
salpingectomy on ovarian response in IVF treatment
was conducted between April 2017 to October 2018.
and found no impairment of ovarian response after
prophylactic salpingectomy moreover; Sezik et al. (5)
Patients were classified into two groups randomly:
suggested that complete removal of fallopian tubes has
Group 1: included odd number of patients (n =29).
no advantageous effect on ovarian blood supply during
They were subjected to total abdominal hysterectomy
abdominal hysterectomy.
with bilateral complete excision of the tubes. Group II: Xiangying et al. (6) found that the total blood
included an even number of patients (n =29) They
supply to the ovary was reduced after hysterectomy due
were subjected to the classical approach of
to loss of blood supply coming from uterine arteries and
hysterectomy.
advised not to remove the uterus in patients for whom
other conservative measures can be performed, Ethical Consideration:
otherwise new technique must be followed to keep an Informed written consent was taken from all
intact artery network as possible between fallopian participants, and the study approved by the local
tubes and ovary for patients requiring hysterectomy. Hospital Ethics Committee, Zagazig University and
Furthermore Repasy et al. (7) found that 35% of the Banha Teaching Hospital and performed as per the
patients without tubal excision developed hydrosalpinx ethical standards laid down in 1964 (Declaration of
or tubo-ovarian cysts causing symptoms that led to Helsinki and its later amendments).
additional surgery. Although rarely encountered, the
This article is an open access article distributed under the terms and conditions of the Creative
Diabetes and coronary artery disease The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3985-3988
Awareness of Chronic Kidney Disease Evaluated Using Validated Questionnaire in Minia Governorate Public Basma Fathy1, Hussien Se'eda2, Tarek Mohamed Fayez2, Mahmoud Ali Elshinawy2, Arwa Ashraf2, Asmaa Yasser2, Elham Mohamed2, Esraa Mohamed, Sara Adel2
1Internal medicine Department, Nephrology Unit, Faculty of Medicine, Minia University, Egypt
2Student in 6th grade, Faculty of Medicine, Minia University, Egypt *Corresponding author: Basma Fathy, Mobile: (+20) 01003746052, E-Mail: [email protected] ABSTRACT Background: Awareness and education of kidney disease has an impact on its effective management and will reduce the economic and public health burden. Objective: We conducted a cross-sectional descriptive study to assess the level of awareness, knowledge and common risk factors of CKD in the community to plan to preventive modalities. Patients and methods: We used a pretested validated questionnaire to gather information about sociodemographic knowledge and risk factors of CKD from 464 residents aged >18 years. Results: A total of 464 residents completed this study with a median age of 30 years, 50.5% of them were females. The mean knowledge score of chronic kidney disease (CKD) was relatively poor as it was 13.12% ± 3.95. Only 48.6% could mention at least one function of the kidneys with 66.4% agreeing with that certain medications can help to slow-down the worsening of chronic kidney disease. A laboratory test for kidney function was known by 75.9%. 92.9% and 17.2% believe that CKD can be cured by spiritual means and herbal concoctions respectively. Abdominal obesity and excessive stress were seen in 64.7% and 45.5% respectively. Hypertension was seen in 56.5% while diabetes mellitus was found in 57.1% as risk factors for chronic kidney disease. Conclusion: Efforts should be made to increase the public knowledge of CKD in Minia, Egypt as it was relatively poor that may be achieved by increasing awareness, education of people about CKD and how to prevent or regress its risk factors. Keywords: Chronic kidney disease, Cross-sectional study, Public knowledge.
INTRODUCTION
Chronic kidney disease (CKD) is defined as
organize preventive modalities using the information
abnormalities of kidney structure or function for more
gathered from our population.
than 3 months, with inferences on health (1). The rapidity
of climbing CKD the ladder in the lists of causes of PATIENTS AND METHODS
global death was alarming (2). The prevalence of CKD
This is a cross-sectional descriptive study
is increasing in Egypt and is likely to continue to rise as
conducted in Minia community; it was conducted
risk factor such as diabetes mellitus and hypertension
between January and February 2020. Our medical
are increasing in the coming years (3, 4). Also, the
students run outpatient clinics in Minia University
increasing incidence of infectious diseases leading to
Hospital and other areas in our community on regular
nephropathies may be another cause. The major
intervals. A pretested validated questionnaire was used
challenge of CKD patients in developing countries is the
to draw information on sociodemographic awareness,
presentation of most patients in an advanced stage
knowledge and beliefs about CKD from 464
which might be returned to a poor level of awareness
participants aged >18 years.
and knowledge of the disease (5, 6).
Interviewers were trained, and questionnaires
In developed countries epidemiological studies
were administered in the local language. The pretested
have also shown a low level of awareness, knowledge
validated questionnaire was divided into 5 sections and
and risk factors of CKD as in the United States (US),
included a total of 24 evidence-based questions on the
the awareness of CKD among people with glomerular
physiology of the kidneys, `Kidney Health Check'(11),
filtration rate (GFR) 1560 ml/min was 24.3% (7). While
risk factors for CKD (12) and signs & symptoms of
in Australia was only 2.8% (8). In a study among African
advanced CKD or kidney failure. With the multiple-
Americans, only 23.7% knew at least one laboratory test
choice options `True', `False' and `I don't know'.
for kidney disease and < 3% agreed that CKD is an
Correct responses were given a score of 1 and
important health condition (9). Improving quality of life
incorrect responses including the option `I don't know'
and increasing productivity will be the inevitable result
were given a score of 0. Reliability of validated
of early identification and creation of awareness of risk
questionnaire was measured by calculating the
factors (10). Information on awareness of CKD in Egypt
Cronbach's alpha. Permission to enter the hospital was
is scanty; this study was conducted to determine the
taken from the hospital leader.
level of CKD awareness and knowledge in order to This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_91The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3989-3996 Serum and Circulatory Omentin mRNA Gene Expression as Predictive Markers of Systemic Lupus Erythematosus Disease Activity and Lupus Nephritis Nearmeen M. Rashad*1, Usama Khalil1,Mahmoud A. Sharafeddin1, Rehab M. Atef2, Marwa H.S. Hussien3, Magda M. Sherif1
Departments of 1Internal Medicine, 2Clinical Pathology and 3Medical Biochemistry & Molecular Biology,
Faculty of Medicine, Zagazig University, Zagazig, Egypt *Corresponding author: Nearmeen M. Rashad, Mobile: (+20) 01224248642, E-mail: nrashad78@ yahoo.com; [email protected]
ABSTRACT Background: Lupus nephritis (LN) affects 50% of systemic lupus erythematosus (SLE). LN often leads to renal failure. Thus, early diagnosis of LN is mandatory for the prevention of complications. Objective: We aimed to evaluate serum and relative omentin mRNA gene expression levels as a noninvasive diagnostic test of LN and to assess their correlations with disease activity, clinical and laboratory features of SLE. Patients and Methods: Case-control study included 104 subjects, 60 patients with SLE were stratified into two subgroups LN group (n=25) and the non-LN group (n=35). Disease activity was assessed by the SLE disease activity index (SLEDAI). Measurement of serum omentin was done by ELISA and investigation of omentin mRNA relative expression was done by real-time PCR. Results: Our results detected that serum omentin levels were significantly lower in the LN group and non-LN group compared to controls. Intriguingly, omentin mRNA relative expression levels were significantly lower in the LN group and non-LN group compared to controls. Among the LN group, there were significant negative correlations between serum and relative omentin mRNA expression with SLEDAI, clinical, and laboratory features of LN. Moreover, SLEDAI, proteinuria, and serum creatinine were independently correlated with them. The sensitivities and the specificities of serum omentin were 91% and 65.5% respectively. While the relative omentin mRNA expression diagnostic power showed sensitivities and specificities of 93% and 68.8% respectively. Conclusion: LN group had significantly lower values of serum and relative omentin mRNA expression compared to non-LN and control groups. Additionally, it was negatively correlated with SLEDAI, clinical and laboratory features of LN. Thus, they could be used as non-invasive predictive markers of LN. Keywords: SLE, Lupus nephritis, Omentin mRNA expression, SLEDAI, Real-time PCR.
INTRODUCTION
A preponderance of evidence confirmed that
It has been postulated that autoantibodies,
systemic lupus erythematosus (SLE) is an
cytokines, and immune complex deposition are the
autoimmune disease that mainly affects females more
main pathological causes of SLE. In addition,
than males, in particular females during the
cytokines and autoantibodies levels were strongly
childbearing
period.
Intriguing
reports
are
related to renal diseases and can be used for the
investigating the etiological factors of SLE and
prediction of patients with LN (3). However,
detected that the etiology is complex including
antibodies to dsDNA and the decrease of
genetic predisposition and immunological as well as
complements were also present in non-LN patients
hormonal influences (1).
and clinically non-active SLE patients. It may be
There is a lot of evidence that raised the
assumed that this lack of specificity of anti-dsDNA
issue that SLE may affect all the organs and tissues of
antibodies for renal activity was also detected in other
the body such as the skin, joints, lungs, heart, and
biomarkers. Thus, there is a need to explore more
central nervous system, as well as the kidneys (2).
specific and sensitive predictor biomarkers of LN and
A preponderance of evidence suggests that
SLE severity (4).
lupus nephritis (LN) is one of the most severe
Omentin is a novel hydrophilic adipokine of
complications of SLE and is present in about 60% of
313 amino acids (35 kDa). Mounting evidence
patients (3). It has been suggested that the pathological
indicates that omentin suppresses NFB activity,
classification of LN focused on the degree of
TNF-, and CRP (5).
glomerular
involvement.
However,
recent
Even more importantly, omentin genes
publications have addressed the value of vascular and
encoding is proximal to the 1q22q23 chromosomal
tubulointerstitial changes, as well as the role of
region associated with type-2 diabetes mellitus
activity and chronicity indices in the prognosis of
(T2DM). Omentin-1 has an anti-inflammatory role in
kidney outcomes (4).
obesity and exerts its effects probably by inducing an This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_92The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 3997-4002
Last Guidelines Overview of Consecutive Esotropia Management: Review Article Riham Salah Attia, Omar El-Shabrawy Basyoni, Mohammad Ahmad El-Marakby, Sahar Hemeda Elsayed
Department of Ophthalmology, Faculty of Medicine, Zagazig University, Egypt Corresponding Author: Riham Salah Attia, Email: [email protected] ABSTRACT Background: Consecutive esotropia (ET) is persistent esodeviation for 24 weeks afterward bilateral lateral rectus recession (BLRR) for correcting exotropia (XT) with or without diplopia. Some patients may have limited eye movement; amblyopia and loss of binocularity can result. Early postoperative overcorrection has been recommended in surgical treatment of intermittent XT due to tendency towards postoperative exotropic drift. ET with small angles (within 15 PD) vanishes naturally over time, whereas bigger angles are more likely to be present at the start. Patients who have ET that has persisted for at least 24 weeks after BLRR and has been present for more than 15 postoperative days should have surgery. Objective: Hallmark the updated lines of management of consecutive esotropia. Conclusion: For the purpose of maintaining one MR muscle for a future intervention, several research have shown that ET can be performed consecutively after BLR recession by advancement of LR muscle previously recessed and MR muscle recession in the more deviating eye. Studies in recent years have sought to determine the effectiveness of the use of lateral rectus advancement in the treatment of consecutive ET. Keywords: Consecutive esotropia, Extraocular muscles. Anatomy of Rectus Muscles: Origin of rectus muscles: Insertions of rectus muscles:
Rectus muscles come from an oval band of
Preceding the equator, the rectus muscles attach to the
connective tissue called the annulus of Zinn, which is
surface of the globe (Figure 2). The spiral of Tillaux is
found in front of the optic foramen and in the medial
a line that connects the muscle insertions. This spiral
portion of superior orbital fissure, just anterior to the
starts at the medial rectus insertion that is closest to the
optic foramen and medial section of superior orbital
limbus and proceeds to the inferior, the lateral and
fissure in the periorbita (Figure 1).
finally the superior rectus insertion that is farthest from the limbus (2). Variations were found from person to
The dural sheath of the optic nerve is also linked to
person in specific measurements, but the spiral of
the medial and superior rectus muscles. Once the rectus
Tillaux was always observed. The tendons of insertion
muscles have travelled anteriorly, they attach to the
pierce Tenon's capsule and merge with scleral fibers. A
globe's anterior surface (1).
sleeve of the capsule covers the tendon for a short
distance, and the muscle can slide freely within this
sleeve (1). Figure (1): Origin of extra-ocular muscles (1).
This article is an open access article distributed under the terms and conditions of the Creative
Computerized tomographic study of the normal dimensions of the anterior horn of lateral ventricle in adultsThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4003-4006
Epidemiology and Laboratory Investigations in Children with Chronic Liver Diseases in Sohag University Hospital Soumaya E. Hadhod*1, Mohamed Z.A. Mourad2, Ashraf M. Radwan1, Omar A.A. Ahmed1
Departments of 1Pediatrics and 2Diagnostic Radiology, Faculty of Medicine, Sohag University, Egypt *Corresponding author: Soumaya E. Hadhod, Mobile: (+20)1064463697, E-Mail:[email protected] ABSTRACT Background: Chronic liver diseases encompasse metabolic, genetic, drug-induced and inflammatory diseases. The causes of liver disease in children vary with age. In countries where HBV is endemic, perinatal transmission remains the most important cause of chronic infection. The prevalence of hepatitis C infection was much higher in individuals receiving blood products for conditions such as thalassemia or haemophilia. Glycogen storage disorders may present with chronic liver disease. Objectives: To study epidemiological features and laboratory investigations that may affect the incidence in children with chronic liver disease. Patients and methods: Our study included 30 treatment-naïve patients with chronic liver disease of different aetiologies referred to the Department of Pediatrics, Sohag University Hospital. All patients were subjected to history taking, general and local examinations, laboratory investigations and measurement of serum ceruloplasmin. Results: The mean age of children was 10.23 years in case group and 10.75 years in control group, ranging between 5.5 to 15 years. The majority of patients were females (53.3%) and the remained patients were males (46.7%). There was significant difference between patient and control groups as regard total leucocytic count. Also, there were significant differences between the two groups regarding ALT, AST, total bilirubin, direct bilirubin and concentration and high significant differences regarding serum albumin and prothrombin time. Conclusion: Total leucocytic count, AST, ALT, bilirubin, and serum albumin concentration, and prothrombin time are significant investigations to rule out diagnosis and anticipate complications in patients with chronic liver diseases. ALT and PT are early sensitive markers that anticipate liver decompensation. Keywords: Children, Chronic liver diseases, Epidemiology, Laboratory.
INTRODUCTION
test became available and routine screening of the blood
Chronicity of liver disease is determined either by
supply began) to as late as 1992 (when the second-
duration of liver disease (typically >36 months) or by
generation
ELISA
test
was
introduced) (5).
evidence of either severe liver disease or physical
Seroprevalence rates of 1020% have been reported
stigmata of chronic liver disease (clubbing, spider
among children with a variety of other potential
telangiectasia and hepatosplenomegaly) (1).
exposures such as malignancy, haemodialysis,
The severity is variable; the affected child may
extracorporeal membrane oxygenation, or surgery for
have only biochemical evidence of liver dysfunction,
congenital heart disease (6).
may have stigmata of chronic liver disease, or may
Glycogen storage disorders may present with
present in hepatic failure. Chronic liver disease may be
chronic liver disease. Patients with the autosomal
caused commonly by persistent viral infections,
recessive liver-specific type may develop cirrhosis (7).
metabolic diseases, drugs, autoimmune hepatitis, or
The hepatic injury in Wilson disease is believed to be
unknown factors (2).
caused by excess copper, which acts as a pro-oxidant and
The causes of liver disease in paediatric patients
promotes the generation of free radicals (8).
vary with age. Some are associated with certain age
The aim of this work was to study epidemiological
groups, such as biliary atresia and idiopathic neonatal
features like age, gender and anthropometric measures
hepatitis, which are observed only at birth or shortly
that may affect incidence or prevalence in children with
thereafter. Conversely, acetaminophen intoxication and
chronic liver disease and to laboratorily investigate
Wilson disease are typical of older children, especially
children suspected to have chronic liver disease, which
adolescents (3). In countries where HBV is endemic,
helps to diagnose and clarify aetiology, anticipate
perinatal transmission remains the most important cause
complications and compare it in cases and control.
of chronic infection. Perinatal transmission also occurs in
non-endemic countries, including the United States, PATIENTS AND METHODS
mostly in children of HBV infected mothers who do not
This hospital-based cross-sectional comparative
receive appropriate HBV immunoprophylaxis at birth (4).
study included 30 patients with chronic liver disease of
The prevalence of Hepatitis C infection was much
different aetiologies, aged from 4 to 16 years.
higher (5095%) in individuals who received blood
In addition, 10 healthy subjects were included in
products for conditions such as thalassemia or
the study as a control group.
haemophilia before 1990 (when a first-generation ELISA This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_94The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4007-4012
Value of Atrial Fibrillation Prophylaxis after Coronary Artery Bypass Graft Surgery Ahmed Samy Alsadeq, Montaser Mostafa Alcekelly, Ahmed Shawky Shereef, Hala Gouda Abomandour
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt Corresponding Author: Ahmed Samy Alsadeq, Email: [email protected]
ABSTRACT Background: Heart surgery patients who develop acute and new-onset AF (postoperative atrial fibrillation, POAF) are among the most common postoperative complications, affecting around 35 percent of those who undergo the procedure. Objective: To assess the effectiveness of amiodarone in prophylaxis of AF post coronary artery bypass surgery (CABG). Patients and Methods: Our work represents a randomized clinical trial, which was carried out at National Heart Institute and Zagazig University from the period of August 2020 to June 2021. 68 patients, admitted for CABG and had high risk score according to POAF score, were included in our study. Results: Regarding mean left ventricular ejection fraction (LVEF), in group I was 47.52±5.85 while in group II it was 49.85±6.25. There was a statistically non-significant difference between the groups with a P value of 0.414. Mean Intensive Care Unit (ICU) period was 4.42±1.35 in group I, and group II was 2.73±0.95. The difference between the groups was statistically significantly shorter among group II (prophylaxis group) (P <0.01). Regarding development of POAF, in group I, the incidence of POAF was 85.3% while in group II, it was 38.2%. Difference among the two studied groups was statistically significantly lower in the group II (prophylaxis group). Conclusion: A prophylactic amiodarone strategy dramatically decreased incidence of POAF risk. All previous estimations of POAF risk reduction using prophylactic amiodarone were found to be accurate. Amiodarone was more effective in preventing postoperative atrial fibrillation with no serious side effects and it decreased postoperative ICU stay. Keywords: Amiodarone. Coronary Artery Bypass Graft, Postoperative Atrial fibrillation.
INTRODUCTION
Heart surgery patients who develop postoperative
The POAF has been linked to a higher death rate
atrial fibrillation (POAF) face the greatest risk of death. It
and longer hospitalizations. In addition, patients who
is most common on the second postoperative day for
acquired POAF had a worse long-term prognosis than
POAF to occur. About one-third of patients who undergo
those who did not. An additional 2 to 4 times the risk of
heart surgery develop POAF, according to prior studies
stroke, infection, reoperation, cerebral problems, and
resulting in higher intensive care unit admissions with
cardiac arrest, renal or respiratory failure are borne by
more costs as well as increasing hospital stay (1).
patients with POAF who develop additional hospital
Tachyarrhythmia is the most common symptom
treatment costs. They may also require an intervention as
of POAF, which has a wide range of repercussions on the
permanent pacemaker (5). After surgery, there is no
cardiovascular system. Myocardial ischemia can occur as
established treatment for AF. During the last few decades,
a result of insufficient coronary flow compensating for the
the majority of research has concentrated on ways to
high myocardial oxygen demand caused by an irregularly
avoid its occurrence. AF following surgery can be
rapid ventricular rhythm. As a result of tachyarrhythmias,
effectively treated with amiodarone. After heart surgery,
diastolic filling time and cardiac output can be
there have been few studies that have proven its
significantly lowered (2). A bradyarrhythmia in sequence
therapeutic effects, thus the investigations concentrated
of atrial fibrillation (AF) can reduce cardiac output in
on its preventative effects (6).
patients who have a fixed stroke volume. The absence of
A Class III Vaughan-Williams antiarrhythmic
atrial contraction, especially in patients who had diastolic
medicine, amiodarone also has some of the effects of
dysfunction and hypertension, results in an increase in
Class I and II antiarrhythmic drugs as well. The drug
pressure of pulmonary arteries (3).
slows the repolarization of myocardial cells by inhibiting
POAF is a common complication following heart
potassium channels, resulting in a reduction in membrane
surgery, although its specific cause remains a mystery.
potential. Blood vessels in the limbs and coronary arteries
Patients, surgeons, anesthesiologists, and postoperative
can be dilated with amiodarone. Amiodarone can be used
circumstances were thought to play a role in its
orally or intravenously. When amiodarone is
emergence. Excessive catecholamine release, systemic
administered as a vascular injection at doses of 2.510
inflammation, vasoplegia, alterations in sympathetic and
mg/kg, it has been shown to be safe and effective, a
parasympathetic tone, neurohumoral activation, and
decrease in heart rate, the persistence of peripheral
significant fluid shifts are all possible stimuli for
arteries, and a boost to the left ventricle's contractile force
arrhythmia following cardiac surgery, which makes it a
are all possible outcomes. Even in patients with low
risk factor for the procedure (4).
ejection fraction (EF), oral doses are sufficient to treat
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c:\work\Jor\vol852_95The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4013-4017
An Overview for Concomitant Exotropia Management: Review Article Ahmed Gamal Mahmoud El-Kial, Mohamed Ahmed EL-Marakby, Yasser Mohamed EL-Sayed, Sahar Hemeda Elsayed
Ophthalmology Department, Faculty of Medicine, Zagazig University, Egypt Corresponding Author: Ahmed Gamal Mahmoud El-Kial, Email: [email protected] ABSTRACT Background: A common type of strabismus known as concomitant exotropia (XT) occurs when mismatched eyes deviate outward and the angle of deviation is the same regardless of which eye is fixed. Among ophthalmologists, there is no agreement on non-surgical treatment options for XT. For those who suffer from strabismus, surgery is an option for correcting their visual axis and restoring their ability to see in both eyes simultaneously. Instead, then severing the muscle, muscle plication involves folding the muscle around itself and stitching it in place, essentially shortening and tightening the muscle. Muscle plication has been found to reduce the risk of anterior segment ischemia by protecting the anterior ciliary arteries. Objective: To hallmark the new guidelines options of concomitant exotropia management. Conclusion: Muscle-tightening techniques such as excision, plication, advancement, and transposition have been documented in the literature. Technical simplicity, the ability to reverse it, shorter operating times, reduced surgical trauma, and the preservation of anterior ciliary arteries are only a few of the many advantages of plication. Keyword: Concomitant Exotropia, Strabismus.
INTRODUCTION Treatment of Concomitant Exotropia:
As the visual axes of the eyes deviate outward, the A-Non-surgical treatment:
condition known as exotropia occurs, which may manifest
Among ophthalmologists, there is no agreement on
constantly or intermittently. It may be acquired or
non-surgical treatment options for XT (5).
congenital, most often its etiology is unknown (primary 1-Correction of refractive error:
forms of exotropia) but may be secondary to other
Corrective lenses should be provided in the case of
underlying causes. Only 1% of people have it, with
a clinically severe refractive defect that causes impaired
intermittent exotropia being the most common form (1).
vision in one or both eyes. Exophoria compensation in
The risk of strabismus is increased in families with a
myopia or absolute hypermetropia can be achieved with
history of strabismus, in women, astigmatism, myopia,
the help of refractive correction.Maintaining active
and anisometropia, and in children with a mother who uses
accommodation necessitates prescribing full correction
drugs or smokes during pregnancy (2).
for myopia. Avoid correcting mild to moderate degrees
of hyperopia to keep the accommodative convergence Exotropia types:
that controls the exodeviation in check (6). A- Primary exotropia: 2-Overcorrecting minus lens therapy (-2.00 to -4.00 1- Intermittent exotropia: At distance fixation, non- D over the habitual distance prescription):
constant exotropia is more prevalent than at close
By promoting accommodative convergence, it can
fixation. It accounts for nearly half of all children's
help minimize an exodeformation. Patients with a high
exotropia (1).
accommodative-convergence/accommodation (AC/A) 2. Infantile exotropia:
ratio benefit from this treatment. It can be utilised in a
It is very rare condition among the different types (3).
variety of ways, including enhancing myopia correction B-Secondary XT: Oculomotor palsy, Duane's
in myopes, reducing hyperopia correction in hyperopes,
syndrome,
craniofacial
disorders,
internuclear
or prescribing corrective action of myopia in ametropes (7)
ophthalmoplegia (INO) (4).
. However, when this treatment is withdrawn, the
occasional exotropia returns to its prior level of control. C-consecutive XT: It occurs after surgery for esotropia
If there is an increase in the frequency of deviations with
or it even develops spontaneously in patients who had
lower power, the amount of the lens diopters is again
infantile esotropia (4).
raised. Two successive visits without an improvement D-Sensory Exotropia:
in six months led to the termination of overminus It is common for the eye to become exotropic in
therapy (5).
older children aged from two to 4 years and adults with 3-Treatment of amblyopia: Patching improves the
a blindness or poor vision (4).
sensory and motor fusion by an elimination of the
The aim of the review was to hallmark the new
suppression scotoma.Intermittent exotropia is rare, but
guidelines
options
of
concomitant
exotropia
if a patient's vision is impaired without an obvious cause
management.
(such as anisometropia or an ocular anatomical defect),
it should prompt an ophthalmologist to look into the
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c:\work\Jor\vol852_96 The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4018-4022
Single Balloon Enteroscopy Versus Push Enteroscopy for Small Bowel Bleeding Assessment: A Systematic Review and Meta-Analysis AlAmri Turki Abdullah, Alrezuk Abdulaziz
Division of Gastroenterology, Department of Medicine, King Fahad University Hospital, Imam Abdulrahman Bin
Faisal University, Dammam 31441, Saudi Arabia Corresponding author: AlAmri Turki Abdullah, Mobile: +966557521347, E-mail:[email protected] ABSTRACT Background: Until recently, the small bowel was considered to be inaccessible using conventional endoscopy techniques. In 2001, the balloon enteroscopy system to examine the small bowel was introduced. Single balloon enteroscopy versus push enteroscopy for small bowel diagnostics are 2 types of commonly used balloon-assisted enteroscopic techniques for "deep enteroscopy. Objective: To perform a systematic review and meta-analysis to assess the efficacy and safety of single balloon enteroscopy versus push enteroscopy for small bowel bleeding assessment. Methods: A systematic search strategy was performed to determine the related literature. Initially, the objectives of review were identified: specifically, impact of single balloon enteroscopy vs push enteroscopy for small bowel diseases. These databases were searched for articles published in English in data bases [Pubmed Google Scholar- Science direct] and Boolean operators (AND, OR, NOT) had been used such as [Impact AND Single Balloon AND Push AND Small Bowel OR GIT] and in peer-reviewed articles between 2000 and 2021. Conclusion: Our meta-analysis indicated that both single balloon technique and push enteroscopy techniques are safe procedures with rare complications, with the single balloon technique having higher diagnostic and therapeutic yields compared with the push technique. Keywords: Push enteroscopy, Single balloon enteroscopy, Small bowel.
INTRODUCTION
instances as well as in many CE positive cases,
Gastrointestinal (GI) bleeding is among the most
subsequently it's possibly better to start with PE in the
typical issues faced by digestive system specialists.
initial place. Additionally, capsule endoscopy must
Bleeding origin is frequently identified using
simply be utilized as a first line exploration for OGIB,
endoscopy, though these techniques don't determine the
so that present recommendations on obscure GI
bleeding origin in 3%-5 % of patients (1).
bleeding realize the lack of evidenced based details on
In latest years, push enteroscopy (PE) was
the option in between the two methods and also the
regarded as the best effective analysis technique of
order where they ought to be achieved (7,8).
obscure GI bleeding (OGIB), determining bleeding
The double balloon enteroscopy platform was
origin in 30%-50 % of individuals. Nevertheless, PE is
created to analyze the small intestine. Double balloon
an invasive technique, involves heavy anesthesia, and
enteroscopy (DBE) offers deep enteroscopy by
seldom explores much more than one 1/3 of the entire
performing an adaptable overtube as well as 2 balloons,
small intestine length (2).
1 on the tip of the endoscope along with 1 on the
Capsule endoscopy (CE) has quickly acquired a
overtube; however, DBE is discovered to possess some
recognized part in small intestine investigation. This
specialized problems, which includes complex,
particular video endoscope unit is tiny adequate being
cumbersome preparing as well as handling (9,10).
swallowed, and also sends pictures throughout its road
In conducted study (2008), a new, program of
toward the needed part within intestinal tract (3). Most
single balloon enteroscopy (SBE) was created, using 1
potential relative scientific studies but one have
rather than 2 balloons, rather than the endoscope
revealed that capsule endoscopy is better than PE for
suggestion balloon in DBE. SBE has been
identifying possible bleeding origin. Nevertheless, the
recommended for much less preparing as well as
actual analysis yield of capsule endoscopy, its clinical
evaluation time; however, there are actually issues that
relevance, and its location in the obscure GI bleeding
it might additionally be much less effective compared to
management algorithm continue to be controversial (4, 5).
DBE for serious intubation of the little bowel (11).
Push enteroscopy had become the identified
Consequently, in this particular research, we
endoscopic technique of looking at the proximal portion
conducted an extensive literature review as well as
of the small intestine in the 1980s, and also with its
quantitative meta-analysis of several experiments done
facilities for biopsy process in taking samples as well as
on SBE and drive enteroscopy strategies. This particular
therapy, it went on to keep its location. Nevertheless,
study was done based on the PRISMA standards for
the insertion level is frequently restricted to the
systematic reviews and meta-analyses (12).
proximal jejunum (6). It's often argued that, if push
The objective of our study was to perform a
enteroscopy has to be completed in capsule endoscopy
systematic review and meta-analysis to assess the
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c:\work\Jor\vol852_97The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4023-4027
Assessment of Serum Level of Paraoxonase-1 in Patients with Psoriasis Vulgaris Ahmed Abd-Elkhabir Ahmed, Nancy Mahsoub Saeed, HebaAhmed Abd-ElAzim, Karima Hussein Mohamed Abo-Elsood*
Department Dermatology, Andrology & STDs, Faculty of Medicine, Mansoura University, Egypt *Corresponding author: Karima Hussein Mohamed, Mobile: (+20) 01015596641, E-Mail: [email protected] ABSTRACT Background: Psoriasis is a chronic inflammatory dermatological disease with a strong genetic predisposition and autoimmune pathogenic traits. The hallmark of psoriasis is sustained inflammation that leads to uncontrolled keratinocyte proliferation and dysfunctional differentiation. Objective: The aim of this study was to evaluate serum level of paraoxonase-1 in psoriasis patients compared to control group. Patients and methods: This research included 50 psoriasis patients and 40 healthy controls that were comparable in age and sex to the cases category. They were chosen at random from the Outpatient Clinic of Dermatology Department, Mansoura University Hospitals. Results: Psoriasis group showed significantly lower level of paraoxonase-1 when compared to control group (median=35.6 versus 54.5; p < 0.001). Additionally, median paraoxonase-1 level decreased gradually with increased psoriasis grades (p < 0.001). No significant associations were found regarding paraoxonase-1 level according to gender, smoking, and FH in psoriasis group (p > 0.05 for each). Paraoxonase-1 level showed significant negative correlation with PASI score (p < 0.001), but not with age, onset, or duration (p > 0.05 for each). Lower paraoxonase-1 level was considered as independent predictor of psoriasis development. Lower paraoxonase-1 level was considered as independent predictor of psoriasis severity (p < 0.001). Conclusion: Paraoxonase-1 level in psoriasis patients had substantially lower levels than healthy controls. Paraoxonase- 1 level showed significant negative correlations with PASI score. Lower baseline paraoxonase-1 level was suggested to be independent risk predictor for psoriasis occurrence and severity. Keywords: Paraoxonase-1 level, PASI score, Psoriasis vulgaris.
INTRODUCTION
activity was also reported (5, 6). The aims of this study was
Psoriasis is a multifactorial disease in which certain
to compare the serum levels of paraoxonase-1 in
environmental variables acting on those who have a
psoriasis patients to a control group and correlation
genetic predisposition leading to immunologic
between paraoxonase-1 level and disease severity based
dysregulation and disordered keratinization, resulting in
on Psoriasis Area and Severity Index (PASI) score.
development of characteristic skin lesions (1). Psoriasis is PATIENTS AND METHODS
a genetically based chronic inflammatory disease
Ninety persons were included in this study. They
affecting the skin. It is characterized by epidermal hyper
were chosen from the Outpatient Clinic of Dermatology,
proliferation, aberrant differentiation of keratinocytes,
Andrology & STDs department, Mansoura University
T-cell infiltration, and enhanced cytokine production
Hospitals from January, 2020 to January, 2021. Patients'
resulting in appearance of inflamed plaques (2).
group included 50 patients with psoriasis vulgaris and 40
Histologically, psoriasis is characterized by epidermal
healthy individuals of cross matched age and sex were
hyper-proliferation,
abnormal
differentiation
of
included as a control group.
keratinocytes, dermal infiltration by inflammatory cells, as well as enhanced vascularity (3). Several studies have Inclusion criteria: Fifty Patients with psoriasis vulgaris
shown that
pharmacological therapies reduce
and forty apparently healthy people acted as control
inflammatory process, lipid peroxidation, along with
group underwent evaluation of their serum level of
recovery of high density lipoprotein (HDL) activities in
paraoxonase-1.
adults with psoriasis. This reveals an association Exclusion criteria: Patients receiving systemic therapy
between psoriasis, oxidative stress, inflammatory
for psoriasis during last month, patients receiving topical
response, and altered lipoprotein functions (4).
therapy for psoriasis during last two weeks, pregnant or
PON1 (paraoxonase-1) is a multifunctional
lactating mothers, patients with any systemic disease
protein found on the surface of HDL that has been found
such as hepatic and renal impairment, patients with
to protect against oxidative stress-associated illnesses (5).
chronic skin diseases such as vitiligo, alopecia areata,
In fact, PON1 protects biological membranes, HDL, and
children < 18 years old, and erythrodermic or pustular
low density lipoprotein (LDL) from lipid peroxidation.
psoriasis.
This suggests that when PON1 activity is reduced, it The following procedures were performed for all
becomes unable to protect against oxidation of patients:
membranes and LDL, and thus is involved in the
enhancement of oxidative stress in psoriatic cases (5). The
Detailed history taking regarding age, sex,
activity of PON1 is considerably decreased among adult
occupation, marital status, special habits, dietary
psoriasis patients, and an association with disease
intake, associated psychological disturbance,
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Early Cerebrovascular Silent Changes in Long-Standing End-Stage Renal Disease Patients on Hemodialysis Value of Adding Advanced Unenhanced MRI Sequences to Imaging Protocols Marwa Hassan Madboly, Mohamed Fathy Khater, Hosam N. Almassry, Fatma Zaiton, Ali M. Hassanin Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Marwa Hassan Madboly, Mobile: (+20) 01017219552, E-Mail: [email protected] ABSTRACT Background: End-Stage Renal Disease (ESRD) patients on hemodialysis suffered from many central and peripheral neurological insults. Aim of the work:This study aimed to assess the value of using MRA, MRV, and SWAN sequences in early visualization of the silent cerebrovascular complications in those patients. Patients and Methods: Our study was conducted on forty-five patients with well-documented ESRD on regular hemodialysis for more than 5 years with no neurological manifestation, all undergone unenhanced MRI, DWI with ADC and measuring the ADC value, SWAN, MRA, and MRV. Results: we found that 11% of cases have acute infarction at the basal ganglia region. 36.7% of patients are diagnosed with intracerebral hemorrhage, only 26.7% of them are seen by the conventional MRI, and 16.7% of cases showed microbleeds on SWAN with normal conventional MRI. The sensitivity and specificity of SWAN with ADC value to detect brain hemorrhage are 100% and 88.8% respectively. Conclusion: Visualization of cerebrovascular complications such as infarction, hemorrhage, atherosclerosis, and arterial and venous occlusion using DWI with ADC, MRA, MRV, and SWAN and is very useful in early management and better prognosis of ESRD patients even with silent complications that don't give up symptoms with high sensitivity and specificity of SWAN in early detection of hemorrhage and microbleeds. Keywords: Cerebrovascular, Hemodialysis, DWI, MRI.
INTRODUCTION
Department of Radiodiagnosis, Faculty of Medicine,
Uremic encephalopathy (UE) is a metabolic disease
Zagazig University, during the period from July 2019 to
occurring in patients with end-stage renal disease
April 2021.
(ESRD) and resulting from the accumulation of uremic
Inclusion criteria were (1) ESRD patients of both
toxins such as creatinine and BUN, it may have acute or
genders on regular hemodialysis more than 5 years, (2)
subacute onset of reversible neurological symptoms (1).
age group 20-40 years. Patients with the following
These neurologic complications can affect negatively
criteria were excluded (1) history of any neurological
the ESRD prognosis. Early diagnosis of these
disease, diabetes, and hypertension (2) patients below 20
complications may carry the hope for optimum care and
years or exceeding 40 years, and (3) Contraindication to
re-evaluation of treatment strategic plans for ESRD
MRI like pacemaker, cochlear implant.
patients (2). Cerebrovascular complications of ESRD
patients are infarction, hemorrhage (3), venous, arterial Ethical considerations
occlusion, atherosclerosis, and posterior reversible This prospective cross-sectional study was
encephalopathy syndrome PRES (4). conducted after approved by the Ethics Board of
The white matter and basal ganglia are the most Zagazig University.Informed consent was obtained
affected areas as well as the cerebral cortices (5). The from all patients before the study. We followed the
vascular complications are detected easily by using MRI ethical principles of the Declaration of Helsinki
even without the presence of neurovascular symptoms during the preparation of this study.
and using MRI series like diffusion-weighted imaging MRI examination: MR imaging was performed using
DWI with apparent diffusion coefficient ADC, magnetic
1.5 Telsa MR Scanner (GE MR Signa Medical system)
resonance angiography MRA, magnetic resonance
using the head coil.
venography
MRV,
and
susceptibility-weighted MR Protocol (Scan protocol and parameters):
Angiography SWAN help in the detection of some brain
The examination protocol started with Conventional
insults that can't be visualized on the usual conventional
Magnetic Resonance Imaging, at first Sagittal T1WI
MRI (6).In this study, we aim to early detection of silent
used as a localizer (TE=10-15m/sec & TR=400-600
cerebrovascular changes of ESRD patients using a new
m/sec), axial spin echo sequences, short TR/TE (T1-
MRI series adding to the value of the usual conventional
Weighted Images): (TE=10-15 M/sec, TR=400-600
MRI.
m/sec), Axial and coronal fast spin echo, long TR/TE
(T2- Weighted Images): (TE=70-110 m/sec, TR=2400- PATIENTS AND METHODS
3500 m/sec) and Axial Fluid.
Our study included 45 patients with end-stage renal
Attenuated Inversion-Recovery sequences (FLAIR):
disease on regular hemodialysis, conducted at the
(TE=119-150 m/sec, TI=2470-2800 m/sec, TR=6000-
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Risk Factors of Epistaxis in Primary School Children in Dakahlia Governorate, Egypt Huda M. EL-Baz*1, Khalid A. Mohammed2, Hanaa S. Said3
Department of 1Family Medicine in Sanafa Family Health Center Mit-Ghamr City Dakahlia Governorate, Egypt
Departments of 2Ear, Nose and Throat and 3Family Medicine, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Huda Mohamed EL-Baz, Mobile: (+20) 01115163402, Email:[email protected] ABSTRACT Background: Epistaxis is a common pediatric complaint, so we study its risk factors trying to control and decrease it among primary school children. Objectives: To determine frequency of epistaxis and to assess the risk factors of epistaxis in primary school children (8-12 years old). Patients and Methods: A cross-sectional study that was conducted on 312 children. Sample was collected by systematic random technique from the children attending to Family Health Center, Sanafa, Mit-Ghamr city, Dakahlia Governorate, Egypt. Participants' data regarding socio-demographic characteristics, and risk factors were collected via predesigned questionnaire. Results: The study revealed that prevalence of epistaxis among the studied group was 32.4% and the most common risk factors among the studied group were smoking, head trauma, factory gases, chronic cough and upper respiratory tract infection (URTI) (56.7%, 45.8%, 35.6%, 32.7% & 30.1% respectively). Conclusion: Recurrent epistaxis can be troublesome and alarming for parents and children. so special attention must be given for it. Keywords: Epistaxis, Risk factors, Primary school children.
INTRODUCTION
location. Traumatic epistaxis is more common in younger
Hemorrhages from the nasal cavity are called
individuals and is most often due to digital trauma, facial
epistaxis or nose bleeds. Epistaxis is not a disease; it is a
injury, or a foreign body in the nasal cavity. Non-
symptom. It is a highly common ear, nose and throat
traumatic epistaxis is rare in children and may be due to
emergency. Yet its exact prevalence is not known, and
systemic
diseases
and
environmental
factors
studies report a wide range about 60% cases in the
(temperature, humidity, altitude). Epistaxis that occurs in
population, with only 6% of those seeing a physician.
children younger than 10 years usually is mild and
Epistaxis is rarely life threatening but may cause
originates in the anterior nose (5).
significant concern, especially among parents of young
children (1). Research question:
Children may be more prone to nose bleeds due to
What about the frequency of epistaxis among
the extensive vascular supply and increased frequency of
primary school children (between 6 and 12 years old)?
upper respiratory tract infection. The natural history of the
And what are its risk factors?
problem is one of intermittent, recurrent and usually
minor nose bleeds that mostly nonspontaneous, but which
The aim of the present study was to determine
can cause alarm (2).
frequency of epistaxis and to assess its risk factors in
Epistaxis is affecting up to 56% aged 6-10 years and
primary school children (8-12 years old).
around 9% of teenaged population (3).
Severe and recurrent forms of epistaxis are PATIENTS AND METHODS
considered a major trouble to the parents and treating
A cross-sectional study that was conducted on 312
doctors. Causes of recurrent epistaxis look different
children. As the total attendance rate of the target aged
between adult and children regarding frequency and
children at Sanafa, Mit-Ghamr Family Health Center was
distribution of such causes (4).
1740 in six months and the prevalence of epistaxis was
The etiology of epistaxis can be divided into local
56% (3),thepower of the study was 80% and CI was 95%
or systemic causes, although this distinction is difficult to
by open epi program version 3.
make and the term "Idiopathic Epistaxis" represents about
Sample was collected by systematic random
80-90% of the cases. The etiological profile of epistaxis
technique from the children attending the previously
has been reported to vary with age and anatomical
mentioned health unit asking for any medical service.
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c:\work\Jor\vol852_100The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4042-4045
Macular Thickness Variations with Axial Length in Healthy Individuals: Review Article Amena Abdullah Mohammed*, Kamal Abdelmoniem Solaiman, Medhat Mohammed Shawky, Mostafa Abdullah Abdulaziz
Ophthalmology Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Amena Abdullah Mohammed, E-Mail:[email protected]
ABSTRACT Background: In the diagnosis and evaluation of many visual illnesses, such as macular edema, macular thickness is an important metric. Gender, age, ethnicity, refraction, and axial length all have an effect on the retinal macular thickness. Preoperative calculations of intraocular lens power during cataract surgery and myopia research necessitate precise and accurate measurements of axial eye length. Objective: To assess the macular thickness in eyes with no ocular pathology, which is important because it serves as a reference for the consequent diagnosis, and to assess the effectiveness of treatment for various macula-related illnesses. Conclusion: Thickness of macula is not the same in all eyes, as it expected to vary with change of eye axial length, which can guide and help in various ocular diseases.
INTRODUCTION
Ophthalmic illnesses that affect the retina, such as
is estimated that the diameter of the macula in humans
macular degeneration, can be accurately diagnosed and
is around 5.5 mm, and it is split into the foveola, foveal
treated by measuring the thickness of the retinal
avascular zone, fovea, parafovea, and perifovea regions
pigment epithelium (RPE). Thus, understanding the
(Figure 1).
typical thickness and distribution is critical in
When compared to the clinical macula, the
diagnosing macular thickening in various ocular
anatomical macula is substantially larger. Because the
illnesses (1).
macula is crucial for central high-resolution and color
Noninvasive optical coherence tomography
vision, if the macula is diseased, such as in macular
(OCT) allows doctors to quantify and consistently track
degeneration, the vision is much affected (2).
the progression of macular thickness. There is a wide
range of thicknesses in the macular region determined
By the ophthalmoscopy or retinal imaging, the
by OCT, with values ranging from 190 to 387
clinical macula can be viewed through the pupil. Its
micrometers. The retinal thickness decreases with age
name macula lutea derived from the Latin macula
in both the macular and other retinal areas, according to
meaning "spot," and lutea meaning "yellow" (2).
research (1).
Due to presences of xanthophyll pigments, lutein
and zeaxanthin, the macula appears darker and
The aim of the present review was to assess the
yellowish in color (3, 4).
macular thickness in eyes with no ocular pathology,
They can be found all over the retina, but the
which is is important because it serves as a reference for
macula has the highest concentration (5).
the consequent diagnosis, and to assess the effectiveness
of treatment for various macula-related illnesses. These pigments are scanty in the newborn, but
they build up during time through dietary sources. Macula:
These pigments have a role of reducing chromatic
Human eyes have an oval-shaped pigmented area
aberration, as they absorb short wavelength visible light,
known as the macula lutea, in the center of the retina. It
they may also have an antioxidant action, and protect
against UVR (4).
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Study of MicroRNA192 as an Early Marker of Nephropathy in Type 2 Diabetic Patients Esam Eldin Mahmoud Lotfy1, Mohammed Fouad Ahmed Ayoub1, Lamiaa Abd Elwahab Mohamed2, Hesham Mohamed Mitwally Elsayed3
Departments of 1Internal Medicine and Nephrology and 2Clinical Pathology,
Faculty of Medicine Zagazig University, Egypt
Department of 3Internal Medicine and Nephrology, Suis Canal Authority Hospital, Egypt *Corresponding Author: Hesham Mohamed Mitwally Elsayed, Mobile: 01222192645 Email: [email protected] ABSTRACT Background: MicroRNAs (miRNAs) are endogenous ubiquitous non-coding single-stranded (ss) RNA transcripts, frequently of 1925 nucleotides in length. They alter the differentiation, growth, apoptosis and proliferation of cells by interfering with protein synthesis by either inducing mRNA degradation or repressing translation. miRNAs are expressed in many diseases and different cancers such as diabetes and have the potential to become new kinds of diagnostic markers. miRNA-192 is highly expressed in kidney especially in renal cortex. Many studies have confirmed that miRNA-192 played important roles in the fibrosis of kidney and liver. Objective: This study aimed to evaluate the use of microRNA-192 as early predictor in cases of diabetic nephropathy. Patients and methods: This study was conducted on volunteers from Internal Medicine Department - Suez Canal Authority Hospitals. 80 subjects were divided into: 60 patients with type 2 diabetes mellitus (T2DM) who were further subdivided into (normal albuminuria group (n= 20), microalbuminuria group (n= 20), and macroalbuminuria group (n=20)), and 20 healthy control group. MicroRNA-192 was quantified in blood using Reverse Transcription TaqMan MicroRNA Assay. Results: There was a statistical significance decrease in micro RNA-192 level in macro-albuminuria group compared to other groups and also in microalbuminuria group compared to normal albuminuria group and healthy control group. Conclusions: We concluded that there is a possible role of miRNA-192 in the pathogenesis and progression of diabetic kidney disease in humans. Also, blood miRNA-192 may be a useful biomarker for predicting the development and the stage of diabetic kidney disease. Keywords: T2DM, MicroRNAs, Nephropathy, Diabetes. INTRODUCTION
extracellular matrix, apoptosis and necrosis, endothelial
The incidence of type 2 diabetes mellitus (T2DM)
permeability and oxidative stress, which cause the
has increased significantly, especially in developed
development of microvascular diabetic complications
countries. Many studies have speculated that diabetes
as neuropathy, retinopathy, and nephropathy. IL-18 is a
mellitus causing microvascular and macrovascular
member of the IL-1 family and was primarily described
pathological conditions could result in various
as an interferon gamma inducing factor. It has been
complications leading to a sever morbidity in T2DM
associated with obesity, insulin resistance, and
subjects. Approximately, 40% of T2DM patients
dyslipidemia. Circulating levels of IL-18 have
develop diabetic nephropathy. Diabetic nephropathy
consistently been reported to be elevated in patients
(DN) is a progressive kidney disease caused capillaries
with T2DM in different studies, and have also been
damage of the kidneys' glomeruli (1).
suggested to participate in microangiopathy such as
Microalbuminuria is widely-used as an early
nephropathy in T2DM(3).
marker for nephropathy in diabetic patients. TGF-
MicroRNAs (miRNAs) are endogenous ubiquitous
families are essential for regulation of cellular growth,
non-coding single-stranded (ss) RNA transcripts,
differentiation and apoptosis, as well as immune
frequently of 1925 nucleotides in length that alter the
suppression. TGF-1 has been known as a key mediator
differentiation, growth, apoptosis and proliferation of
in extracellular matrix formation. In fibrosis and in
cells by interfering with protein synthesis by either
tissue remodeling during disease progression in
inducing mRNA degradation or repressing translation
different organs, up-regulation of TGF-1 is informed (4). Specifically, miRNAs are expressed in many
to be necessary, in which glomerular fibrosis in the
diseases and different cancers such as diabetes, hepatic
kidney is included (2).
cancer, prostatic cancer, breast cancer, gastric cancer,
Inflammatory cytokines implicated in the
squamous cell carcinoma, lymphoma, colon cancer, and
pathogenesis of diabetes play a significant role in
lung cancer. Serum miRNAs phenotypes have the
several renal disorders development and progression,
potential to become new kinds of diagnostic markers.
including diabetic nephropathy. Effects of them on
MiRNA-192 is highly expressed in kidney especially in
renal disease involved the expression of different
renal cortex. Many studies have confirmed that
molecules, intraglomerular abnormalities, alteration of
miRNA-192 played important roles in the fibrosis of
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Extraction, Isolation and Identification of Some Natural Bioactive Marine Products from Squilla mantis (Stomatopoda-Squillidae) with Special Reference to Seasonal Variation of Marine Algae diversity Amr M. Nasef
Marine Biology Section, Zoology Department, Faculty of Science, Al-Azhar University,
Nasr City Cairo Egypt.
E.mail: [email protected] , Mobile:00201009324339 ABSTRACT Background: Marine algae important in food chain, productivity and marine ecosystem, Also Squilla mantis is healthy human food. Aim of the work: To identify some biologically active natural marine products, and screening its bioactivity, as well as discover the seasonal variation diversity of associated marine algae, for its role in the marine food chain. Materials and methods: The squills were collected and marine macroalgae associated with it. Also, some biologically active marine natural products were extracted and identified from shell extract to examine its effect on some microbs and laryngeal cancer. Results: The results showed a seasonal variation in diversity of marine algae, which indicated the effect of seasonal change food availability and environmental yield. The results of antimicrobial activity of Squilla mantis shell extract indicated an important effect differences between the groups treated with shell extract (1.5, 2.5, and 5 mg/mL) compared to the control . Also, evaluation of viability of Hep-2 cell line post treatment with shell extract of Squilla mantis using sufranin uptake assay as (MTT) uptake and microscopic examination indicated a significant difference between the groups treated with shell extract compared to the control group. Cell viability decreased depending on dose or concentration. The shell extract inhibited the proliferation of a larynx cancer cell line in a dose dependent manner. Conclusion: The present study showed that, there are seasonal variation in marine algae diversity , which affect on productivity and food availability. Also, there are importance natural bioactive marine products from Squilla mantis shell extract. Key words: Benthos, Extract, Marine Macroalgae, Mediterranean Sea, Shell, Squilla mantis
INTRODUCTION
changing fields of inquiry". The photosynthetic
Although the impact of seasonal changes on
activity of aquatic flora, temperature, salinity, and the
the environment and marine organisms has been
amount of organic components all have a significant
explored in multiple papers, the area is still vast and
impact (6).
requires more new research from various perspectives,
The findings of Velasco et al. (7) showed that
especially in light of the rise of climate change.
abiotic stressors (temperature, pH, etc.) have an impact
According to Whiteley (1), who researched the
on marine creatures (fauna or flora) in many of the
physiological and ecological responses of crustaceans,
physiological aspects that influence the performance
the species most at danger are entirely marine and have
and composition of the aquatic organism.
limited physiological capacities to adapt to
Understanding and anticipating the consequences of
environmental change. As a result of these changes,
numerous stressors in the face of change is one of the
species survival, range, and abundance may be
most important concerns in conservation and applied
impacted.
ecology which we require and should increase in order
According to Akram Ullah et al.(2), the
to improve the state of marine ecosystems (8-10). These
biochemical composition of different species vary.
alterations at the organism level are the primary and
Despite the fact that no data on the elements that may
most sensitive stress reactions, but they may eventually
influence it is collected. The environment is unstable
alter community composition and interfere with
along the Mediterranean Sea's south coast, (3).
ecosystem processes and services that support human
Ecological variables have influenced the physiology
wellbeing (11).
and distribution of marine creatures through physical
Invertebrates from the sea are an important part of
and chemical stress, according to Davenport et al. (4).
our diet since they contribute to our health intake,
suitable source for bioactive chemical production, the Bridget et al.(5) investigated the effects of the
occurrence of these chemicals is influenced not only
environment on fished lobsters and crabs, and found
by species, but also by environmental and seasonal
that: "Climate change's consequences, such as ocean
conditions(12).
warming and acidity, are fast-growing and rapidly This article is an open access article distributed under the terms and conditions of the Creative
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Inventory of Associated Marine Macro Algae Species to Rissoides Desmaresti (Crustacea - Stomatopoda), with screening of Bioactivity of shell extract Amr M. Nasef
Marine Biology Section, Zoology Department, Faculty of Science, Al-Azhar University,
Nasr City Cairo Egypt.
Email: [email protected], Mobile:00201009324339 ABSTRACT Background: Shrimp, Rissoides desmaresti, making a healthy choice for human consumption. Objective: This study aimed to isolate, and identify some natural bioactive marine products from its shell extract, as well as to investigate the biological activity of the seashell extract and the degree of its influence on various microbiological species and laryngeal cancer,, as well as to discover the distribution and relationship between itand marine algae, as the marine food chain.Materials and methods: Squills were gathered, and the varieties of marine algae connected with the organism in the maritime environment were tallied, since they are a major contributor in the marine environment's productivity. Several biologically active marine natural components were extracted, separated, and identified from the organism under research. Results: The findings revealed a seasonal variation in the percentage of marine algae present, which was reflected on diversity in the environment from one season to the next, and indicated the magnitude of the effect of seasonal change on productivity, food availability, and environmental yield. Antimicrobial activity of Rissoides desmaresti shell extract revealed significant differences between groups treated with shell extract (1.5, 2.5, and 5 mg/mL) in comparison with the control group. In addition, the viability of the Hep -2 cell line after treatment with Rissoides desmaresti shell extract was assessed and microscopic examination revealed a significant difference between the shell extract-treated groups and the control group. Depending on the dosage or concentration, cell viability decreased in a dose dependent way. The shell extract suppressed the growth of cancer cell line of larynx. Conclusion: The current study revealed that there was seasonal variation in the percentage of marine algae present, which is reflected in the observed species numbers of marine macro algae in the environment of the organism under study and had an impact on marine productivity, food availability, and eco-physiology of Rissoides desmaresti. Shell extract can be employed as an antibacterial, antifungal, and anticancer agent because of several natural bioactive marine compounds from Rissoides desmaresti shell extract. Keywords: Mediterranean sea, Rissoides desmaresti, Benthos, Marine, Macro algae.
INTRODUCTION
stressors such as (temperature, pH...etc.) have an
Although the effect of seasonal changes on the
impact on marine creatures (fauna or flora) in several
environment and marine organisms has been
physiological aspects that define the performance and
previously studied in several articles, the field is still
composition of the aquatic organism. Understanding
large and needs more innovative studies, and from
and anticipating the impacts of numerous stressors in
different angles, especially after the emergence of the
the face of global change is one of the most important
phenomenon of climate change. Whiteley (1) studied
concerns in conservation and applied ecology (7, 8).
physiological and ecological responses of crustaceans
Various compounds can be present in the
and stated that the species most at risk are exclusively
environment and organisms; the occurrence of these
marine that have limited physiological capacities to
chemicals is influenced not only by species, but also
adjust to environmental changes. These changes could
by
environmental
and
seasonal
conditions.
affect species survival, distribution and abundance.
According to Trung and Phuong (9), shrimp (Penaeus
Numerous interconnected environmental variables are
monodon) heads can be an excellent source of
expected to have an impact on community makeup and
bioactive chemicals. Abouzeed et al. (10) looked on the
organisation. Ecological variables have influenced the
synthesis and physicochemical features of several
physiology and distribution of marine creatures
beneficial
substances
derived
from
squilla
through physical and chemical stress, according to
(Oratosquilla massavensis) shells. Benedetta and Davenport et al. (2, 3). The consequences of climate Paul (11) stated that we are in need for scientific
change, particularly ocean warming and acidification
information about mantis shrimp (Squilla mantis), to
are fast-growing and rapidly changing fields of
improve the state of marine ecosystems.
inquiry.
Anticancer chemicals, antibiotics, and enzyme
The photosynthetic activity of aquatic flora,
inhibitors have all been found in marine natural
temperature, salinity, and the quantity of organic
products. Despite the present interest in bioactive
components all have a significant impact (4, 5). The
marine chemicals, our understanding is restricted due
findings of Velasco et al. (6) showed that abiotic
to the field's recent history (12). Crustaceans and marine
algae play a significant part in the ecosystem's
evaluation and production. It is well recognised that it This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_104The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4075-4084
Role of Assistive Devices on Gait in Patients with Incomplete Spinal Cord Injury:Systematic Review Wessam A. Alrefaie*1, Nahed A. Salem2, Mahmoud S. El fakharany3,Mahmoud Y. El Zanaty2
1Department Physiotherapist at Police Hospital Authority, Cairo, Egypt
2Department of Physical Therapy for Neuromuscular Disorder, 3Department of Physical Therapy for Pediatrics,
Faculty of Physical Therapy, Cairo University, Cairo, Egypt *Corresponding author: Wessam A. Alrefaie, Mobile: (+20)01063045651, E-Mail:[email protected] ABSTRACT Background: People with incomplete spinal cord injury disabilities can be able to live a healthy, productive, and dignified life by using Assistive devices as their role in improving gait. Facilitate locomotion rehabilitation. And enable people with incomplete SCI to ambulate in an upright position. Objective:This systematic review aimed to examine the effectiveness of the role of using assistive devices in gait rehabilitation in patients with incomplete SCI. Material and Methods: Studies were identified from 2000 to 2020 by electronic search using PubMed, Cochrane Database of Systematic Reviews, Google Scholar, and Physiotherapy Evidence Database (Pedro). They were reviewed if they were randomized control trials focused on the effectiveness of Assistive Devices on Gait in Patients in age more than 18 years with incomplete Spinal Cord Injury being published in English. Eight studies were selected according to inclusive and exclusive criteria and descriptive analysis was conducted due to heterogeneity. Results:Eight trials were identified with good quality methodology. Descriptive analysis was applied for three studies that supported the use of assistive devices for those patients and meta-analysis was applied for five studies. The mean difference across all the five studies is -0.69 (95% CI -0.93, -0.45). According to AACPDM, there is level II evidence that supports the use of the assistive device as a method to be able to live a healthy, productive, and dignified life. Conclusion: The current level of evidence supports the effectiveness of assistive devices in improving gait in patients with incomplete spinal cord injury. Keywords: Incomplete Spinal cord injury, Types of incomplete SCI, Orthoses, Lower limbs disabilities, Types of orthoses.
INTRODUCTION (4). The proportion of patients with SCI who walked at
Spinal cord injury is any damage to the spinal cord
inpatient discharge with devices/braces and without
which blocks communication between the brain and the
physical assistance: ASIA A (motor and sensory
body. A person's motor, sensory, and reflex messages
complete): 6.4%. ASIA B (motor complete, sensory
are affected and may be unable to get past the damage in
incomplete): 23.5%. ASIA C (motor and sensory
the spinal cord (1). Incomplete Lesion: nerves slightly
incomplete, generally weaker legs): 51.4%. ASIA D
damaged. Recovery is possible, but never to pre-injury
(motor and sensory incomplete, generally stronger legs):
level (1). The clinical outcomes of incomplete SCI depend
88.9%(5, 6, 7).
on the severity and location of the lesion (2). According
Devices have been developed to assist patients
to the National Spinal Cord Injury Statistical Center,
suffering from SCI with mobility and to facilitate
_282,000 persons are living with spinal cord injury (SCI)
locomotion rehabilitation (8). There has been an evolution
in the United States, and 17,000 new SCI cases occur
in gait rehabilitation programs for people with ISCI in
each year. More than 90% of SCI cases are traumatic and
recent decades, from manually assisted over-ground
caused by incidences such as traffic accidents, violence,
training; body-weight-supported treadmill training
sports, or falls. The Male: female ratio of 2:1 for SCI,
(BWSTT) to robotic-assisted gait training (RAGT) (9, 10),
which occurs frequently in adults compared to children.
which is a powered exoskeleton. Powered exoskeletons
Demographically, men are mostly affected during their
are motorized orthoses placed over a person's limb with
early and late adulthood (3rd and 8th decades of life)
joint parts corresponding to those of the human body.
Difficulty walking is very common following a spinal
Their purpose is to facilitate standing and walking, as
cord injury (SCI)(1).
well as assist in rehabilitation (11).
People with an "incomplete" SCI have more
The RAGT focuses on the correct performance of
potential to regain walking than those with a
gait movements. Therapy is performed at low speed and
"complete" SCI which depends on many factors
the level of assistance by the system can be adjusted
including Level of injury, severity of the injury, level of
based on the patient´s ability to step (12). Body weight-
sensation, level of pain, time since injury, age, and level
supported treadmill training (BWSTT) can enhance
of fitness(3). Other Related Problems such as Spasticity
locomotor activity after a spinal cord injury. In this
and Joint Problems e.g., Contractures It is difficult to
approach, partial body weight support is provided by an
predict if a person with SCI will regain walking abilities
overhead harness while leg movements are assisted by
therapists and a moving treadmill belt (13, 14). There are
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c:\work\Jor\vol852_105The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4085-4091
Surgical Outcome of Three-Dimensional Correction of Adolescent Idiopathic Scoliosis Hanee Ali Awad Ali*1, Samer Mohamed Nabil Serag El-deen1, Mohamed Safwat Ibrahim1, Yasser Mahmoud Elbanna2, Allan D. Levi3, Ashraf Shaker Zidan1
Department of 1Neurosurgery, Faculty of Medicine, Mansoura University, Egypt
Department of 2Neurosurgery, Faculty of Medicine, Alexandria University, Egypt
Department of 3Neurosurgery, Faculty of Medicine, University of Miami, USA *Corresponding author: Hanee Ali Awad Ali, Mobile: (+20) 01007072482, E-Mail: [email protected] ABSTRACT Background: Adolescent idiopathic scoliosis is an abnormal curvature of the spine that appears in late childhood or adolescence. Instead of growing straight, the spine develops a side-to-side curvature, usually in an elongated "S" or "C" shape; the bones of the spine are also slightly twisted or rotated. To prevent further curve progression and obtain a balanced spine, surgery remains the mainstay of treatment for idiopathic scoliosis (IS). Objective: This study aimed to discuss three dimensional surgical techniques used for correction of adolescent idiopathic scoliosis, evaluating their feasibility, efficacy and safety. Patients and methods: This study was conducted in Mansoura University Hospital and Alexandria University Hospitals between September 2018 and April 2021. 3D surgical correction was performed for 91 patients complaining of idiopathic scoliosis, and not responding to conservative measures and not associated with neurological affection. Results: According to Lenke classification, there were 56 patients (61.5%) with type 1 curve type , 9 patients (9.9%) with type 2, 7 patients (7.7%) with type 3, 7 patients (7.7%) with type 5 and 12 patients (13.2%) with type 6. Mean preoperative height was 1.60 m while mean postoperative height was 1.66 m. with significant increase in height postoperatively (p < 0.001). Mean percentage height gain was 3.91%. Conclusion: We do believe that the posterior only approach 3D correction is an effective method in management of AIS concerning correction of Cobb angle, shoulder balance and spinopelvic parameters and recommend it as the best way nowadays to treat this disease. Keywords: Three dimensional surgical techniques, adolescent idiopathic scoliosis.
INTRODUCTION
x-rays should include pelvis to assess the ossification of
Scoliosis comes from the Greek Word
iliac crest in order to evaluate the Risser's sign (growth
"skoliosis" meaning crooked. It is a complex three
status). Obtain bending films to assess the flexibility of
dimensional deformity of the spine characterized by a
the curve (1).
lateral deviation of at least 10 degrees with a rotation of
The main treatment options for scoliosis can be
the vertebra and usually associated with reduction of
summarized by the three Os: Observation, Orthosis
normal kyphotic curvature of the spine (1). The overall
(bracing), and Operative treatment. The selection of the
prevalence of AIS is 0.47% to 5.2% in the current
best treatment is based on the maturity of the patient
literature (2, 3). AIS commonly affect girls with a female
(age, menarchal status and Risser grading of iliac
to male ratio of 1.5:1 to 3:1. This ratio increases
epiphysis), location, severity and risk of progression of
substantially with increasing age, 90% of the
the curvature (6). A common protocol used to guide
presentation will show a right-sided thoracic curve (3, 4).
treatment is: to observe patients with curves of less than
There are several classifications for scoliosis
25 degrees, to brace patients between 25-45 degrees,
used by professionals to help in management and to
and to consider surgery on patients with curves of
predict outcomes for patients. The one that is currently
greater than 45 degrees (6).
used for surgical planning is the Lenke classification (1).
Over the past years, several articles have been
The Lenke classification has three components: (1)
published on the evaluation and potential classification
Curve patterns (2) Lumbar spine modifiers (3) Sagittal
of adolescent idiopathic scoliosis (AIS) using three-
thoracic modifier (5). This classification was introduced
dimensional (3D) terminology and techniques. CT scan
to help surgeons in determining the extent of spinal
and MRI could be used to assess the spine in 3D (7).
instrumentation. The vast majority of patients initially
The aim of the present study was to discuss three
present due to a deformity. This may be a perception of
dimensional surgical techniques used for correction of
asymmetry about the shoulders, waist, or rib cage
adolescent idiopathic scoliosis, evaluating their
noticed by the patient, a family member, the primary
feasibility, efficacy and safety.
care physician or a school nurse. Asymmetry of breasts PATIENTS AND METHODS
might be the first thing noticed by female patients (5).
This study was conducted in Mansoura
X-ray imaging includes standing posterior-
University Hospital and Alexandria University
anterior to measure the degree of the curve using the
Hospitals between September 2018 and April 2021.
Cobb method. Standardized lateral radiograph
3D surgical correction was performed for 91 patients
appreciates any sagittal abnormality. These whole spine
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Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4092-4095
Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging Omar Ashraf Kadry*, Ahmed Mohamed Algebally, Hosam Nabil Almassry, Ahmed Fekry Salem
Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Omar Ashraf Kadry, Email: [email protected]
ABSTRACT Background: Triangular fibrocartilage complex (TFCC) may be assessed using ultrasound (US) because of its wide availability, mobility, low cost, and lack of radiation. When it comes to TFCC imaging, MRI is the gold standard, although US can provide a more detailed picture of the disease. Objective: Comparing and contrasting the use of ultrasound (US) and magnetic resonance imaging (MRI) in the detection of triangular fibrocartilaginous complex injuries of the wrist. Patients and Methods: The study was conducted at the Radiodiagnosis Department, Zagazig University Hospital, Egypt. Wrist discomfort or reduced wrist mobility was reported by 35 individuals with a mean age of 39 ± 13.18 years old. Both radiologists who performed the ultrasound and the MRI were blinded to each other's results in order to minimize bias. Results: 82.9 % of patients showed normal ulnar variance while 11.4 % of patients showed positive variance and 5.7% with negative variance. The ultrasound detected 18 positive cases with TFCC injury with a percentage of 51.4%. The MRI detected 24 positive cases with TFCC injury with a percentage of 68.6%. The ultrasound detected TFCC cases with a sensitivity of 75%, specificity 100%, PPV 100 and NPV 64.7. Conclusion: It is very suggested that tendons and inflammation of the wrist could be examined by ultrasonography. In recent investigations, it was shown that US had the ability to identify injuries in the TFCC and intrinsic ligaments. Keywords: Triangular fibro-cartilaginous complex injuries, High resolution ultrasound, Magnetic resonance imaging. INTRODUCTION
order to get a clear picture of the TFCC, a systematic
Diagnosing wrist pain on the ulnar side might be
approach is necessary. US can display the various
difficult. To a large extent, this is owing to the region's tiny
components of the TFCC as well as detail the lesions of the
size and complexity. To make things easier, the anatomical
articular disc and meniscus homologue (6).
structures implicated in ulnar-sided wrist discomfort can
Regarding MRI of the wrist, proton density,
be categorized. Joint, cartilage, tendon, nerve, and, bone
gradient-echoes, or T2-weighted sequences can detect a
ligament are all examples of these structures (1).
TFCC rupture in the disc or ligament with fluid signal
An ultrasound test may be performed at a fraction of
intensity extending through it. If the tear is horizontal or
the cost, is easy to transport, and does not emit radiation.
parallel to the distal radius rim, it is called a radial tear and
Aside from the soft tissues, ultrasound may also reveal
is sometimes called a "slit-like" radial or "vertical look."
cortical information about the bone. Ultrasound was made
It's fairly unusual for a tear to include two components,
possible by its imaging, practicality, capabilities and
such as a complicated tear (3).
dynamic component. Therefore, it is increasingly used as a
We aimed at this study to highlight the role of US in
first-line investigation for wrist soft-tissue abnormalities
detecting different triangular fibrocartilage complex (2). The distal radioulnar joint (DRUJ) is stabilized by the
injuries of the wrist in comparison with MRI as a gold
triangular fibrocartilage complex (TFCC), which acts as a
standard.
cushion for the ulnar head and lunate during wrist axial
SUBJECTS AND METHODS
stress and ulnar deviation, and also restricts carpus ulnar
At Radiodiagnosis Department, Zagazig University
deviation (3).
Hospital, Egypt, this study was conducted. This research As the principal stabilizers of the distal radioulnar
included 35 patients, ranging in age from 17 to 70, who
joint, the articular disc is encircled by the dorsal and palmar
reported either wrist discomfort or restricted wrist
radioulnar ligaments. Meniscus homologue, ulnar
movement. There were 21 male patients (60%) and 14
collateral ligament and ECU subsheath are all part of the
female patients (40%) in the study. Trauma history was
complex, which all contribute to the stability of TFCC
present in 86.6 percent of the patients. In 18 (51.4%) of the
stability. In addition, the ulnotriquetral ligaments, and
patients, the right wrist was examined, whereas the left
ulnolunate, which both come from the palmar radioulnar
wrist was also examined in 17 (48.6 percent).
ligament, support the TFCC on the palmar side of the wrist (3, 4). Ethical approval:
When diagnosing musculoskeletal tissues, the best An approval of the study was obtained from
equipment and transducers must be used, as well as Zagazig University Academic and Ethical Committee
comprehensive software choices to enhance the picture (ZU-IRB#6210).
quality. In other words, the finest feasible artefact removal, Every patient signed an informed written consent for
as well as the best possible resolution. Ultrasound acceptance of the operation. This work has been
equipment should provide the most sensitive color Doppler carried out in accordance with The Code of Ethics of
choices as well as high-quality grayscale pictures (5). In
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c:\work\Jor\vol852_107The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4096-4101
Assessment of Outcomes of Ileostomy Closure versus Colostomy Closure Ali Helmy El-Shewy, Amr Ahmed Ibrahim, Yasser Ali Orban, Bassem Saeed Elgabry
Department of General and GIT Surgery, Faculty of Medicine, Zagazig University, Egypt Corresponding Author: Bassem Saeed Elgabry, Mail: [email protected]
ABSTRACT Background: Small-bowel ostomies and large-bowel ostomies are two subtypes of intestinal ostomies based on the portion of the intestine that is exposed above the skin. Protecting the anastomosis from infection and keeping the peritoneum clean are critical functions of ileostomy and colostomy. Objective: to evaluate short term outcome of ileostomy and colostomy closures to recognize which procedure is better for diversion based on the outcomes of the stoma reversal. Methods: Two groups of 32 patients having a colostomy or an ileostomy in Zagazig University Hospitals underwent a clinical comparison of the outcomes of stoma closure. 16 patients in Group 1 had an ileostomy for reversal. Those in Group 2 who had a temporary colostomy for reversal included 10 patients with Hartmann procedure and 6 patients with simple loop stoma. During the first month, patients were seen at the outpatient clinic once a week, then once a month for the next five months. Results: As regard intraoperative complications: Amount of blood loss was higher among Hartmann's group (112 ±18 ml) due to severe adhesions during laparotomy compared to ileostomy group (89 ± 16 ml) and loop colostomy group (98 ± 16 ml). In terms of intraoperative blood loss, there was no statistically significant difference between ileostomy and loop colostomy, although there was a statistically significant difference between ileostomy and the Hartman procedure. In the ileostomy group, postoperative problems such as wound infection, anastomotic leakage, ileus, and intraabdominal collection were less common and more easily controlled. Conclusion: Ileostomy closure is superior to colostomy closure as simple closure with small circumferential incision was easier than colostomy which need exploration in most cases. Keywords: Colostomy, Ileostomy, Intestinal ostomies
INTRODUCTION
it removed as soon as possible. As a result, the stoma is
Distal bowel anastomosis healing and blockage
eagerly anticipated by both surgeons and patients (6, 7).
relief can be achieved by diverting the fecal stream
As long as the underlying problem has been treated,
away from the anastomosis via a stoma (1). An intestine
recovery has taken place and adhesions have softened,
stoma is a hole in the abdominal wall that allows the
the ostomy reversal can be delayed for up to three
intestines to pass through. Depending on the pathology
months. A functional end-to-end anastomosis can be
and the requirement for construction, the stoma can be
created by first releasing the stoma from the abdominal
either a loop or an end (2).
wall circumferentially, and then performing an ostomy
There are two main types of intestinal ostomies:
closure along this side of the wall (8).
small- and large-gut ostomies, which are divided into
Several clinical reviews have described parameters
loop ostomies and end ostomies, respectively, based on
that could influence the outcome of intestinal stoma
the number of openings found in the bowel. Ileostomies
closure as the surgeon's experience, type of the stoma,
are more commonly performed on the right side of the
the timing of the operation, the patient's age, etiology of
abdomen, while colostomies are more commonly
the disease and coexistent medical conditions (9).
performed on the left (3).
We aimed in this work to evaluate short term
Preoperative education, counselling, and ostomy
outcome of ileostomy and colostomy closures to
site selection should be performed whenever possible
recognize which procedure is better for diversion based
by the surgeon and skilled ostomy nurse specialist in
on the outcomes of the stoma reversal.
order to allay these fears in patients who require an
ostomy due to misconceptions and fears about social SUBJECTS AND METHODS
acceptance, sexuality, and financial burden (4). By
From February 2020 to February 2021, at Zagazig
helping patients adjust to the considerable lifestyle
University Hospitals we compared the outcomes of 32
adjustments that come with a stoma, preoperative
ileostomy and colostomy patients who had been
counselling enhances their quality of life after the
admitted for stoma closure in a clinical comparative
procedure. Additionally, it has been linked to a shorter
study.
hospital stay and fewer stoma-related postoperative
problems (5). Ethical considerations:
For stoma closure, there were no established All participants signed informed consent forms
guidelines. The idea of having to wear a stoma is and the study was approved from Zagazig
distressing to many patients, and many are eager to get University's Research Ethics Committee, the study
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ABSTRACTThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4102-4107
Role of Lung Ultrasound and Inferior Vena Cava Diameter in Assessment of Patients with Heart Failure Hussein Abd El-Fattah Mohammed 1, Mohamed Salah El-Feshawy2, Fareed Shawky Basiony1 and Mustafa Maged Abd Alla *
1Chest diseases department, 2Diagnostic Radiology department, Faculty of Medicine, Al-Azhar University, Egypt *Corresponding Author: Dr. Mustafa Maged Abd Alla, Mobile.:01110005021,
E-mail: [email protected] ABSTRACT Background: Congestive heart failure (CHF) is a multifaceted clinical condition marked by recurrent episodes of acute decompensation, needing repetitive hospital stays, and re-admissions. The CHF management is still a clinical challenge; choices are built on clinical evaluations of volume status, which are utilized for cardiac filling pressure estimation. Aims: This study aimed to investigate the role of lung US and Inferior Vena Cava Diameter (IVCD) in assessment of HF-cases. Patients and Methods: The current work has been performed on 50 HF (heart failure) cases diagnosed in the Chest Department of Al- Azhar University Hospitals from April 2019 to June 2021. Chest radiograph, as a reference for the presence of pulmonary congestion, echocardiography for both systolic and diastolic function assessment and lung U/S. US examinations of the anterolateral chest were done. Results: A highly significant association was found among inferior Vena Cava-Collapsibility Index (IVC-CI) and Dyspnea Class.A highly significant association was found among IVC-CI and echocardiography.A highly significant association was found among IVC-CI and B lines. Conclusion: Ultrasound can be utilized as an alternative technique for estimating the intra-vascular volume such as measuring the IVCD and so the caval index. The utilization of pulmonary ultrasound (PU) to evaluate dyspneic cases and those with HF in dissimilar clinical settings raises the sensitivity, specificity, and accuracy of pulmonary congestion diagnosing and prognosis in HF cases. Keywords: Lung ultrasound, Inferior vena cava, B lines, Heart failure.
INTRODUCTION
notice the existence of interstitial edema. Each of these
Congestive heart failure (CHF) is a main public
modalities was utilized lonely in assessment of
health problem. About 5.7 million cases in the U.S.A
diagnosing power. However, when utilized lonely,
diagnosed with CHF with a lifetime frequency of 1 in 5
everyone wants the accuracy desired to finally perform
for persons greater than 40-yrs old. HF is the commonest
the diagnosing between acutely dyspneic cases in ED.
hospital discharge diagnosing, and more Medi-care cash
A depressed left ventricular EF existing in chronic
is paid for CHF management than for any other
HF doesn't specify whether there was an acute decrease
management. Acutely decompensated HF (ADHF) is as
in systolic functions, and neither a plethoric IVC nor the
well the commonest reason for acute dyspnea between
existence of interstitial edema is definite to acute
aging cases in the emergency department. While earlier
decompensated HF [4]
suitable diagnosing and treatment are accompanying
Correspondingly, bedside US was utilized to
reduced mortalities, ADHF is as well the commonest
determine IVCD to discriminate AHF from other reasons
reason of mortality between dyspneic cases admitted to
of dyspnea. Some previous researches have concluded
the emergency department (ED) [1].
that BNP and IVCD were associated, proposing that
Variation among cardiac dyspnea and pulmonary
IVCD can be utilized in the discrimination of dyspnea [5].
dyspnea is conservatively accomplished via blood tests,
physical examinations, and x-ray of the chest. But, these AIM OF THE WORK
examinations have moderate accuracies [2].
This study was designed to investigate the role of
Echo-cardiography assessment aids clinicians to
lung US and IVC Diameter in assessment of HF cases.
perform the demarcation, but it needs advanced skills
and training. Therefore, many other laboratory PATIENTS AND METHODS
investigations were advanced to make a precise
The current work included 50 HF cases diagnosed in
demarcation of dyspnea. Brain natriuretic peptide (BNP)
the Chest Department of Al- Azhar University Hospitals
was settled and presented into clinical practices for this
from April 2019 to June 2021.
aim [3].There are 3 points of care US modalities that have
possible efficacy in ADHF diagnosing: cardiac US Inclusion criteria: An acute decompensation due to
[which gives straight visualizations of ejection fraction
clinically evident pulmonary congestion not requiring
(EF)], IVC-US (a non-invasive method of assessing
emergency treatment.Age between 18 & 65-year-
intra-vascular volume status), and lung US (that may
old.
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c:\work\Jor\vol852_109The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4108-4114
Intramedullary Elastic Nailing Management for Fracture of Forearm Bones in Pediatric Patients Ashraf Salim Ibrahim, Khaled Edris Abdelrahman, Mohamed Abdelfattah Sebaei, Yamen Safwat Abdeldayem
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt. *Corresponding Author: Ashraf Salim Ibrahim, Mail: [email protected] ABSTRACT Background: Forearm fractures are the third most prevalent in children, accounting for 40% of all fractures in children. Using titanium elastic nailing techniques to fix both fractures of the forearm revealed a lot of benefits. Objective: This study aimed to determine if elastic nail fracture treatment improves the radiological and clinical outcomes in children. Patients andmethods: 18 patients with fracture shafts of both bones forearm treated with intramedullary elastic nails were studied in Zagazig University Hospital and Sebha medical centre, Sebha, Libya for this prospective clinical trial. Patients returned for follow up visits nearly every 2 weeks following fixation for removal of suture. Then Serial radiographs were made after 2 weeks, 4 weeks, 6 weeks and 12 weeks after surgery. They were evaluated for callus formation and assessment of range of motion and any complications till complete bone healing. Results: Between 8 and 14 weeks, the average time for union was 10.38 ±1.72 weeks. According to the Price score majority were excellent 77.8%, then good 16.7% and finally fair 5.6%, Only 2 cases 11.1% had complication (Surgical site infection, superficial radial nerve injury, and re-displacement). Complicated cases were significantly associated with road traffic accident and Fair price score. Excellent cases were significantly associated with younger age and shorter union time. Conclusion: For the treatment of displaced forearm fractures, Elastic Stable Intramedullary Nailing (ESIN) is a safe and effective option for young patients. Effective and definitive therapy of these fractures is still achievable with this less invasive approach. A functional outcome was attained without the need for corrective treatments, angulations, or repeated reductions. Keywords: Elastic stable intramedullary nailing, Forearm fractures, Pediatric. INTRODUCTION
problem was prevented implant failure , non-union,
Forearm fractures are the third most prevalent in
malunion, or osteomyelitis, may also lead to problems
children and account for 40% of all children fractures (1).
such compartment syndrome (7).
Due to the unique growing potential of young bones,
Elastic nails were used to treat children with fractures
closed reduction and plaster cast application has been the
of both bones in the forearm, and this study was designed
gold standard in treating these fractures. However, in
to examine the radiological and clinical outcomes.
older children, re-displacement is more likely to lead to
angulation, rotation and shortening (2). SUBJECTS AND METHODS
Treatment of distal radius and forearm fractures aimed
This prospective clinical trial was conducted on 18
at facilitating the union of the fracture at a position that
patients. Intramedullary elastic nailing was used to heal
restores elbow and forearm function (3). For angulation,
fractures of the forearm bone shafts in Zagazig University
malrotation, and displacement, surgical surgery has been
Hospital & Sebha medical center in Sebha, Libya.
indicated in earlier studies (4). Open reduction and plate Inclusion criteria: Compound forearm fracture (grade
osteosynthesis and closed reduction and internal fixation
one or two) or displaced diaphyseal fracture in children
with titanium elastic nails are the most prevalent surgical
aged 5 to 15 years.
procedures. Both bone forearm fractures in children were Exclusion criteria: Patients more than 15 years or less
first described by Metaizeau and Ligier (5) who used
than 5 years of age, with pathological fractures,
elastic intramedullary nails.
malunion, nonunion or unfit for surgery all have been
Proponents of using flexible nails to treat forearm
excluded from the trial.
fractures argue that doing so reduces surgical dissection Ethical approval:
and keeps biologic components in place where the
All participants signed informed consent forms and
fracture occurs (6). Smaller incision, minimum soft tissue
the study was approved by Zagazig University' Research
interference, rapid osseous healing and maximal range of
Ethics Committee (ZU-IRB#6235). We followed the
motion were just some of the advantages of titanium
World Medical Association's ethical code for human
elastic nailing methods for the repair of both forearm
experimentation, the Helsinki Declaration.
fractures. Also, complication rate was reduced. When both bones of the forearm are fractured, intramedullary All participants in this research were subjected to the
titanium elastic nailing is a viable treatment option in the following:
pediatric population. When the implant protrudes out of History and clinical examination: The patient's age,
the skin, oral antibiotics can be used to treat the infection.
gender and mechanism and time of injury were all
By burying the implant a little deeper under the skin, this
recorded in a thorough medical history. Medical history,
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c:\work\Jor\vol852_110The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 41154119
P-Wave Dispersion and Its Relationship with the Severity of the Coronary Artery Disease in Patients with Stable Angina Ahmed Kamal Metawea, Wael Mohamed Attia, Ahmed Abd Elraouf Mahdy*, Mohamed Gamal Salama
Cardiology Department, Al-Azhar University, Faculty of Medicine, Egypt *Corresponding author: Ahmed Abd Elraouf Mahdy, Mobile: (+20) 01063635890, E-Mail: [email protected] ABSTRACT Background: In Electrocardiography (ECG), the term "P-wave dispersion" (PWD) refers to variation between maximum and minimum P-waves recorded from various Electrocardiography leads. P-wave analysis in ECG may become more widely used marker in many clinical contexts as a result of improved methods for capturing and analyzing this ECG. The link between (PD) and severity of coronary artery disease (CAD) was established among personnel who had stable form of CAD. Objective: We wanted to determine if there was an association between P wave dispersion and CAD severity in patients who had stable CAD. Patients and methods: At Al-Hussein University Hospital Cath Lab, 51 consecutive patients were referred for diagnostic coronary angiography in a cross-sectional trial. They were classified into group A (control group, n=8), who were found to have normal coronary angiography and group B (n = 43), who were found to have coronary artery disease. Results: P wave dispersion was significantly different across cases, with 95.3 percent of patients having abnormal P wave dispersion compared to 100 percent of control cases. P wave dispersion and Gensini score were statistically significantly different between cases and controls where cases had significantly higher scores than controls. Dispersion of P waves was statistically linked to number of vessels affected as well as Gensini scores. The P wave dispersion and the Gensini score showed a strong positive association. Conclusion: Stable coronary artery disease (CAD) patients had aberrant PWD, according to the findings of this study, in patients with stable coronary artery disease, severity of the CAD is correlated with P wave dispersion. Keywords: CAD, Stable Angina, P-wave dispersion.
INTRODUCTION
were found to have normal coronary angiography and
Coronary artery disease, often known as
group B (n = 43), who were found to have CAD. At Al
atherosclerotic coronary heart disease or ischemic heart
Hussein University Hospital's Cath lab, the patients
disease (IHD), is a group of conditions that includes
underwent coronary angiography as part of this study to
stable and unstable angina, sudden coronary death, and
determine if they had coronary artery disease.
myocardial infarction (MI). Mortality and morbidity are
more likely to occur as a result of these conditions (1). Inclusion criteria: Stable coronary artery disease
In Electrocardiography (ECG), the term "P-wave
patients with chest discomfort or other symptoms that
dispersion" (PD) refers to variation between maximum
warranted coronary angiography.
and minimum P-waves recorded from various Exclusion criteria:
Electrocardiography leads. P-wave analysis in ECG
Atrial fibrillation with an invisible P wave.
may become more widely used marker in many clinical
Acute coronary syndromes (ACS).
contexts as a result of improved methods for capturing
Cardiomyopathy.
and analyzing this ECG specially for determination of
Antiarrhythmic medications use.
Atrial Fibrillation (AF) risks (2). Many researches were
Patient that has a history of past heart attacks and
done to study P- wave dispersion among conditions of
heart surgery.
cardiac patients like dilated cardiomyopathy, coronary
P-wave analysis might be hindered by any
angioplasty or angina pectoris, hypertension, diabetes
irregularities in the heartbeat (frequent atrial and
mellitus, obesity and myocardial infarction (3).
ventricular ectopic, pacemaker rhythm). Akin et al.(4) studied people who had stable
Altered functions of thyroid.
coronary artery disease and found that the illness's
Disturbance in serum electrolytes
severity was linked to an elevated PD level.
We aimed at this trial to study if personnel who had Ethical consent:
stable coronary artery disease were found to have a An approval of the study was obtained from Al-
correlation among P wave dispersion and CAD severity. Azhar University Academic and Ethical Committee.
Every patient signed an informed written consent PATIENTS AND METHODS At Al-Hussein University Hospital Cath Lab, 51 for acceptance of the study. This work has been carried out in accordance with The Code of Ethics of
consecutive patients were referred for diagnostic the World Medical Association (Declaration of
coronary angiography in a cross-sectional trial. They Helsinki) for studies involving humans.
were classified into group A (control group, n=8), who All patients were subjected the followings:
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c:\work\Jor\vol852_111The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4120-4125
Surgical Management and Outcome of Patients with Thyroid Diseases during the COVID-19 Pandemic Wael Mohamed Abdelgawad Hamed*, Said Abd Elmaksoud Hewidy
Damanhur Medical National Institute, Egypt *Corresponding author: Wael Mohamed Abdelgawad Hamed,E mail: [email protected] ,phone:01223004249
ABSTRACT Background: Globally, healthcare authorities have reacted by restricting medical care to emergency cases and postponing elective surgical procedures of all types. Elective surgeries have been almost totally postponed keeping to a minimum the risk of transmission of SARS-CoV-2 and to allow a better allocation of resources. Since thyroid surgery usually does not cover immediate surgical interventions, during this pandemic nearly all the patients who require thyroid surgery care are experiencing delays in the operation planning procedure. Objective: The aim of the work was to investigate the impact of COVID-19 pandemic on thyroid surgery. Subjects and methods: We conducted prospective study from August 2020 to February 2021 among all patients who attended to Damanhur Medical National Institute Hospital. Total sample size was 60 patients and patients with positive COVID-19 were enrolled in group 1 (cases) and those who were negative COVID-19 were enrolled in group 2 (controls). Results: A total of 60 patients were seen during the study period. Males were 35 (58.3%) while females were 25 (41.7%). The mean age 39.5± 9.5 years. There is no statistically significant difference between patients with COVID-19 and patients without COVID-19 regarding developing complications from thyroid surgeries. Conclusion: The COVID-19 pandemic has created a complicated set of issues for patients with endocrine-related cancers. Most thyroid cancers are indolent and so postponement of surgery in the era of COVID-19. There is no significant association between COVID-19 and complications of surgery. Key words: Thyroid diseases, COVID-19, Thyroid surgery, endocrine cancers INTRODUCTION
As the number of cases continued to rise, a rapidly
timely delivery of surgical care during COVID-19 and
increasing number of hospitals were designated by
applied it institutionally (7,8).
Governments for the exclusive admission of patients
The expected effect of the constraint on surgical
with SARS-CoV-2 (Covid19) to contain cross-infection
planning due to the need to limit hospital access was to (1). The 2019 novel coronavirus and the disease it causes
preserve only essential surgical procedures, freezing
(COVID-19) is a public health crisis that has profoundly
waiting times for surgeries for conditions without
modified the way medical and surgical care is delivered.
developmental risk and freeing professionals and
Countries around the globe had a variable initial
patient care facilities for SARS-CoV-2 patients (9,10).
response to the COVID-19 pandemic from imposing
Elective surgeries have been almost totally
massive lock downs and quarantine to surrendering to
postponed to keep a minimum the risk of transmission
herd immunity (2).
of SARS-CoV-2 and also to allow a better allocation of
Globally, healthcare authorities have reacted by
resources (11). Since thyroid surgery usually does not
restricting medical care to emergency cases and
cover immediate surgical interventions, during the
postponing elective surgical procedures of all types. The
COVID-19 pandemic nearly all of the patients who
priority was made for the treatment of COVID-19
require thyroid surgery care are experiencing delays in
patients and emergency cases, in anticipation of a
the operation planning procedure (12).
possible need for hospital beds and resources (3,4).
The impact of the SARS-CoV-2 pandemic on
The American College of Surgeons (ACS) called
thyroid surgery, is yet to be investigated (1,13).
to prioritize appropriate resource allocation as it relates
The aim of the current work was to investigate the
to elective procedures and minimize the use of essential
impact of COVID-19 pandemic on thyroid surgery.
items required to care for patients (5).
Nevertheless, the unpredictability of the timeline PATIENTS AND METHODS
of COVID-19 in the absence of effective drug
This study was conducted prospectively from
treatments and vaccination, suggests that patients may
August 2020 to February 2021 among all patients
be deprived of access to needed surgical care, likely for
having thyroid nodules and or cancer and fulfilling one
many months (6). The potential outcome of delay in
of the inclusion criteria, attended at Damanhur Medical
necessary elective surgical procedures may have a more
National Institute Hospital. Enrolled patients aged from
detrimental impact on patients' health compared to that
25- 60 (39.5± 9.5) years.
of COVID-19 itself. Therefore, we have proposed a
Follow up period was one month to detect
comprehensive strategy that allows for the safe and
complications after surgery. Any patient with
unexplained fever or any symptoms related to COVID-
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c:\work\Jor\vol852_112The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4126-4130
Postoperative Outcomes after Laparoscopic Cholecystectomy in Elderly Patients Wael Mohamed Abdelgawad Hamed *, Said Abd Elmaksoud Hewidy
Damanhur Medical National Institute, Damanhur, Egypt * Corresponding author: Wael Mohamed Abdelgawad Hamed
E mail: [email protected], Mobile phone: 01223004249 ABSTRACT Background: Age is a critical factor influencing the death and morbidities afterward cholecystectomy. It was revealed that laparoscopic cholecystectomy (LC) in the elderly has similar security and effectiveness to those in young people. The gold-standard in the management of cholelithiasis is LC. Objectives: This work was aimed to assess post-operative outcomes of LC between elderly cases and for comparing the post-operative outcome of LC among ages groups >60yrs and <60yrs. Patients and Methods: This prospective study conducted among 68 cases who experienced LC at Damanhur Medical National Institute Hospital. Cases were allocated into 2 groups according to ages: elderly (60yrs, n= 38) and young (<60 yrs, n= 35). Results: 68 cases divided into two groups. The mean age is 68.4± 5.7 and 49.1± 10.5 among elderly and younger groups. There is significant difference between groups regarding age and comorbidities. The mean operative time was 62.8± 21.2 and 59.5± 18.7 among elderly and young groups. There is no statistically significant difference between two groups regarding intraoperative data. There is nonsignificant change regarding post- operative outcomes after LC. Conclusion: It could be concluded that laparoscopic cholecystectomy in elderly cases is similar with young cases. Consequently, LC is secure even in the elderly. Keywords: LC, Elderly, Geriatric, Post-operative outcomes INTRODUCTION
global populations. Globally, population aged 60-yrs is
The occurrence of gallstone disorder in the aged
rising at a rate of around 3 % yearly, faster than all
people ranges between 14- 27% as stated by several
younger groups. With the increasing of the population
reports. LC is known as the gold-standard for the
longevity, acute and chronic cholecystitis has become a
operative managing of gallstone disorders. Operation for
frequent problem in this group (6). Currently,
cholelithiasis is more frequent in elderly cases as the
cholecystectomy for calculous cholecystitis is the
frequency of gallstones rises with age (13 to 50 %) (1).
commonest abdomen operation in the ageing. The
Age is a critical factor influencing the death and
natural history of symptomatic biliary lithiasis in the
morbidities afterward cholecystectomy. The usage of
elderly is more severe than in younger cases and needs
laparoscopic procedures in aged cases can result in issues
special considerations. The frequency of acute
as co-morbid disorders are very mutual with advanced
cholecystitis and its complications is elevated in the
aged cases and can rise the post-operative side-effects
elderly. In addition, the surgical risk is increased due to
and the incidence of conversions to open operations. It
comorbidities and reduced physiological reserve.
was stated that LC in the old aged cases has similar
Complications of surgical treatment of chronic
security and effectiveness to those in young aged cases
cholecystitis and acute cholecystitis are worse in the (2). Though, no reports were stated in developing nations
elderly (79).
on the aged people yet.
This work was aimed to assess the outcomes of LC
Cholelithiasis is measured to be the commonest
in the elderly cases in comparison with young cases in
gallbladder disorder. Its prevalence is <5% between
developing states as Egypt with limited resources.
cases of <40-yrs, while the prevalence rises up to 30 %
between people aged >80-yrs (3,4). PATIENTS AND METHODS
The gold-standard in the treating the cholelithiasis
This prospective study included a total of 68 cases
is LC. LC is more beneficial since it gives lesser pains,
underwent LC, attending at Damanhur Medical
earlier discharging, early recover the normal activity,
National Institute Hospital. This study was conducted
better cosmetic outcome, and it is economic. Because of
between . October 2019 till October 2020.
a rise in the QoL, the aged cases progressively rise and
Cases were allocated into 2 groups according to
henceforth, the prevalence of cholecystitis in the people
ages: elderly (60-yrs, n= 38) and young (<60-yrs, n=
as well rises. The age-depending co-morbidities that may
35). Cases demographic data and operative data were
rise are the most significant parameter growing the
investigated. All cases were assessed with abdominally
opportunity of post-operative death and morbidities
US and baseline examinations needed for operation.
Although gallstones occur in cases of any age, from
Magnetic
resonance
cholangio-pancreatography
newborn to the elderly, its prevalence increases
(MRCP) has been done only in particular cases with
markedly with age (5). Cholelithiasis influences 25-40%
assumed gallstones or with expanded biliary duct in US.
of the population in the seventh decade of life and
Pre-operative
endoscopic
retrograde
cholangio-
approximately 50% of the persons of ages >80-yrs. In
pancreatography (ERCP) has been employed in cases
2017, the United Nations estimated the world population
with common bile duct stones. The timing of LC in cases
aged 60 -yrs to be one billion, comprising 13% of the
presented with acute stage was after the resolutions of
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c:\work\Jor\vol852_113 The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4131-4137
Effect of Body Weight on Pattern of Coronary Lesions in Patients Undergoing Coronary Angiography at Sohag University Hospital Usama Ahmed Arafa, Hamdy Saad Mohamed, Mohamed Abdel Wahab Ezzat, Ali Badawy Khalaf*
Department of Internal Medicine, Faculty of Medicine, Sohag University, Egypt *Corresponding author: Ali Badawy Khalaf Mobile: (+20) 01118380846, E-Mail: [email protected] ABSTRACT Background: Obesity is related to multiple risk factors of cardiovascular disease (CVD) including hypertension, diabetes mellitus (DM), metabolic syndrome, and dyslipidemia, while also likely being an independent risk factor for CVD. Through multiple pathways including increased angiotensin, circulating blood volume, and total peripheral resistance, excess weight increases hypertension (HTN) risk. Objective: This study aimed to reveal the relationship between body weight and the severity of coronary artery disease (CAD) in patients referred for coronary angiography at Sohag University Hospital. Patients and methods: This was a cross-sectional hospital-based study performed on 200 patients, at Sohag University Hospital. Mean age was 56.94 ± 10.30 years. Among them, there were 175 patients (87.5%) who were overweight or obese with higher prevalence of HTN, hyperlipidemia, and diabetes. Normal weight patients were 25 (12.5%) with lower prevalence of HTN, hyperlipidemia, and diabetes. Results: According to BMI in our study, 175 patients (87.5 %) were overweight or obese, 162 patients (92.57%) of the overweight had significant coronary artery disease. 162 patients (81%) had significant coronary angiography findings (> 70% stenosis in any of the coronary arteries). They were classified to 63 patients (31.5%) had single vessel diseased, 53 patients (26.5%) had two vessels diseased, and 46 patients (23%) had three vessels diseased. Conclusion: Obesity, diabetes, hypertension, hyperlipidemia, aging and male gender were correlated with severity of CAD. Thus, reduction of weight, stoppage of smoking and control of diabetes, hypertension and hyperlipidemia will improve outcome of coronary artery disease. Keywords: Body weight, Coronary lesions, Coronary angiography, Obesity.
INTRODUCTION
overweight (25.029.9 kg/m2), and obese class (> 30
Obesity is an independent risk factor for
kg/m2) (6).
cardiovascular disease (CVD), and is associated with
The pathogenesis of obesity and atherosclerosis
advanced CVD that is associated with percutaneous
has several common factors. In both cases, lipids,
coronary intervention (PCI), reduction in life
oxidized LDL particles, and free fatty acids activate the
expectancy, and a higher mortality rate. Weight loss has
inflammatory process and trigger the disease.
been associated with improvement in pre-existing
Inflammation is responsible for all the steps towards
cardiovascular risk factors including hypertension
atherosclerosis, from early endothelial dysfunction to
(HTN), diabetes, and dyslipidemia and mortality (1).
the atherosclerotic plaques causing complications, and
Obesity is an accepted risk factor for CAD. Therefore,
is related to obesity, insulin resistance, and type 2
it may be assumed that obese patients have poorer
diabetes. The fatty tissue releases adipocytokines,
outcomes than non-obese patients (2).
which
induce
insulin
resistance,
endothelial
Some studies have reported improved clinical
dysfunction,
hypercoagulability,
and
systemic
outcomes in overweight and obese patients treated for
inflammation, thereby facilitating the atherosclerotic
CVDs compared to normal weight patients, suggesting
process (7).
a paradoxical survival benefit. This effect has been
A 10kg rise in body weight increases the risk of
reported in patients with diabetes, end-stage renal
coronary artery disease by 12% and at the same time,
disease, HTN, and other conditions traditionally
systolic blood pressure rises by 3mmHg and diastolic
associated with poorer outcomes. Obesity was primarily
by 2.3mmHg as a consequence (8).
measured using BMI. The mechanisms leading to this
This study was conducted to reveal the
phenomenon, termed "obesity paradox," are unclear (3,
relationship between body weight and the severity of 4).The quantification of coronary artery disease (CAD)
coronary artery disease in patients referred for coronary
severity can be captured using coronary angiography
angiography at Sohag University Hospital.
(CA). Historically CAD has been categorized as single,
double, and triple vessel and left main disease, with PATIENTS AND METHODS
luminal stenosis of either 50% (left main) or 70%
This was a cross-sectional hospital-based study
(other major epicardial vessels) used to define
performed on 200 patients, at Sohag University
significance (5).
Hospital-Catheter Lab. Unit.
Patients are classified into three categories Inclusion criteria: All patients with coronary artery
according to BMI using the World Health Organization
disease undergoing coronary angiography.
classification system: normal (18.524.9 kg/m2), Exclusion criteria: All patients with history of CABG
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c:\work\Jor\vol852_114The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4138-4142
Role of Proangiogenic Tyrosine Kinase with Immunoglobulin and Endothelial Growth Factor Homology Domains 2 Expressing Monocytes in Chronic Lymphocytic Leukemia Amira Raafat Elsheikh1, Gehan Abd Elkader2, Ahmad Sallam Soliman1, Noran Salah Eldin Elsabbagh1
Departments of 1Clinical Pathology and 2Internal Medicine, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Noran Salah Eldin Elsabbagh, Email: [email protected]
ABSTRACT Background: Globally, highest hematologic malignancy in prevalence is considered chronic lymphocytic leukemia (CLL). The expression of angiopoietin-2 (Ang2) and tyrosine kinase with immunoglobulin and endothelial growth factor homology domains (Tie1), two critical components of the Ang-Tie2 pro-angiogenic pathway, in CLL cells has been demonstrated. Objective: Clarification of Tie2-expressing monocytes' (TEMs) involvement in the pathophysiology of CLL is the goal of this study. Patients and Methods: The study was case control, which was performed on 21 CLL patients; their age ranged from 46 to 71 with a mean of 58.2 ± 6.9, in addition to 21 age and sex matched healthy control subjects. Full medical histories, clinical examinations, and laboratory tests were conducted on all individuals. The percentage of TEMs in peripheral blood was determined by flow cytometry and their phenotypic characteristics defined as CD14+/CD16+/Tie-2+ cells. Results: Compared to the control group, there was a statistically significant increase in TEMs in the cases group. Among the cases group there was a statistical significant increase in LDH, uric acid, WBCs, reticulocyte, CD 38 2 microglobulin and TEMS and statistical significant decrease in Hb with increase Binet stage. There was a statistical significant +ve correlation between TEMs and LDH, WBCs, reticulocytes, CD38 and 2 microglobulin. Also, there was a statistical significant negative correlation between TEMs and Hb and platelets count among the cases group. TEMs percentage had sensitivity, specificity and accuracy (100%) in diagnosis of leukemia at cut off > 20.95%. Conclusion: TEMs could be a part of CLL pathogenesis which can be a predictor of disease progression alongside with other prognostic indicators. Keywords: Chronic lymphocytic leukemia, Tyrosine kinase with immunoglobulin and endothelial growth factor. INTRODUCTION
angiogenesis, this process occurs in some circumstances
The most frequent hematologic cancer in Western
like hypoxia (6). Ang-2 and Tie1 are two key components
countries is chronic lymphocytic leukaemia. CLL is an
of the Ang-Tie2 pro-angiogenic pathway in CLL cells.
incurable disease, despite recent breakthroughs in
However, the role of the Ang-Tie2 pathway in CLL
treatment. Increased risk of infection, an increased
pathogenesis remains a mystery at this time (7).
prevalence of autoimmune illnesses, as well as
By examining Tie2-expressing monocytes (TEMs)
hypogammaglobulinemia are all symptoms of CLL's
in CLL patients, we hoped to better understand their
altered immune system (1).
function in the development of the disease.
Clonal proliferation and accumulation of mature
monomorphic B lymphocytes (B lymphocytes) in the PATIENTS AND METHODS
blood, bone marrow, and the surrounding lymphatic
In the Clinical Pathology Department, this case control
tissues are hallmarks of CLL. They appear to be small,
trial carried out, at Zagazig University Hospitals,
mature lymphocytes that may be combined with large or
between February 2021 and August 2021.
atypical lymphocytes, or prolymphocytes, in some cases Ethical considerations: (2). As long as all participants signed informed consent
The majority of circulating human monocytes (90 forms and submitted them to Zagazig University's
percent) have strong CD14 but no CD16 expression Research Ethics Committee, the study was allowed
(CD14++CD16-), while the minor population is separated (ZU-IRB#6237). We followed the World Medical
into the intermediate subsets (CD14++CD16+), and the Association's ethical code for human
non-classical subgroup, with high CD16 and low CD14 experimentation, the Helsinki Declaration.
expression (CD14+CD16++) are the two groups (3).
Furthermore, among circulating monocytes, those that Inclusion criteria: Patients suffering from CLL
express Tie-2 (angiopoietin receptor tyrosine kinase with
attending the Oncology Department at Zagazig
immunoglobulin and endothelial growth factor
University Hospital during the study period, and patients
homology domains 2) have tumour-promoting features
were diagnosed as CLL by: Blood tests (CBC and LDH). (4). It was formerly thought that angiopoietin-2 (Ang-2)
Bone marrow aspiration and biopsy, and flow cytometry.
was a particular ligand for Tie-2 (5). Exclusion criteria: Patient refusal, and patients with
Ang-2 from Weibel-Palade bodies activates
other types of malignancies.
endothelial cells, which in turn attracts Tie-2-expressing The studied patients were subjected to the following:
monocytes (TEMs) to the tumour site and stimulates
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c:\work\Jor\vol852_115The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4143-4148
Clinico-Pathological Measures and Management of Mucinous Ovarian Cancer: Single Institutional Study Mohamed Ayaty, Islam A Mansour
Department of Gynecological Surgery, National Cancer Institute, Cairo University, Egypt
Corresponding author: Mohamed Ayaty, E-Mail address: [email protected], Telephone: 01004364499 ABSTRACT Background: Mucinous ovarian cancer is less common and less aggressive epithelial ovarian cancer, which represents 3% of epithelial ovarian cancer. Patient and methods: A retrospective descriptive analysis involving all patients with mucinous ovarian cancer who underwent surgical management or referred to National Cancer Institute (NCI), Cairo University (CU), from January 2010 to January 2020. Of 46 cases reviewed. 16 cases were excluded (10 cases had metastatic and 6 cases had incomplete data). Results: forty-six cases reviewed with median age of 48.3±18.1 years. Half of patients were in premenopausal status. Patients presented with distention with or without pain were 70% of cases, 10% of patients with abdominal mass and 6.7% of patients with bleeding. Most of cases 63.30% were diagnosed at late stages (1C and beyond). Patients had unilateral disease were 70% of cases and had elevated tumor markers were 53.3 % of cases. The most commonly elevated tumor marker was CA 125 (26.7%). Patients had comorbidities were 30% of cases. Surgery was the main line of management. Total abdominal hysterectomy and bilateral salpingo-oophorectomy plus infracolic omentectomy were done in 73.3% of patients, 6.7% underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, 3.3% underwent cytoreductive surgery and 3.3% underwent cytoreductive surgery and 13% of patients underwent fertility sparing surgery. The role of pelvic lymphadenectomy was limited (13.3% underwent pelvic lymphadenectomy and only one patient had positive lymph node metastasis). Conclusion: The most important prognostic factors were disease stage, laterality, tumor markers and performance status. Key words: Mucinous ovarian cancer (mEOC), Surgery. INTRODUCTION
advanced or recurring responds poorly to current
Epithelial ovarian cancer (EOC) is the most
cytotoxic therapies, and the prognosis is unfavorable (6).
lethal gynecological malignancy. Epithelial ovarian
cancer is not a single disease but is composed of a diverse PATIENTS AND METHODS
group of tumors which includes serous, mucinous,
A retrospective descriptive analysis involving
endometrioid and clear cell tumor (1).
all patients with mucinous ovarian cancer who
Mucinous ovarian cancer is a less common
underwent surgical management or referred to National
epithelial
ovarian
cancer
which
represents
Cancer Institute (NCI), Cairo University (CU) in
approximately 3% of epithelial ovarian cancers.
Department of Surgery from January 2010 to January
Mucinous ovarian cancer (mEOC) seems less aggressive
2020. Patient of all age groups and all stages who
than other histologic types and require more
underwent surgical management for primary mucinous
conservative treatment (2). Mucinous EOC most
ovarian cancer were included. They were excluded if
commonly presents in women between 39 and 50 years'
they met the following criteria:
old which is younger age range than other histological
1- Primary mEOC, tumors that had metastasized to the
types. Almost 83% of mEOCs are stage I at the time of
ovaries were excluded
diagnosis (3).
2- Insufficient data and medical records. Patients were
Many patients are premenopausal, and most
excluded when data on pathological review were not
mucinous tumors are unilateral, allowing for fertility
available
preservation. In early-stage illness, preservation of the Medical records and data:
normal-appearing uterus and contralateral ovary is A. Medical records:
possible (4).
Data from National Cancer Institute Hospital-
Because lymphatic dissemination is uncommon
based registry were used to generate a list of all patients
in primary mucinous ovarian cancer, pelvic and/or para-
diagnosed with mucinous ovarian cancer at the period
aortic lymphadenectomy as part of the staging method is
from January 2010 to January 2020. Records were
not required in patients with primary mEOC that is
scrutinized at archives of biostatistics and Surgery and
grossly confined to the ovary (5).
Pathology Departments.
Early stage mEOC has a better overall prognosis B. Data:
than non-mucinous forms. The majority of tumors are
A pre-determined sheet was used to fulfill
detected at an early stage, and the prognosis after surgery
objectives of the study. All patients' files were reviewed
is favorable. Mucinous carcinoma of the ovary that is
to obtain all available data as follows:
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c:\work\Jor\vol852_116The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4149-4153
The Efficacy of Ringer lactate and Sublingual Nitrates vs Indomethacin to Reduce Post-ERCP Pancreatitis: A Review Article AlAmri Turki Abdullah
Division of Gastroenterology, Department of Internal Medicine, King Fahad Hospital University, Imam Abdulrahman
Bin Faisal University, Dammam 31441, Saudi Arabia Corresponding author: AlAmri Turki Abdullah, Mobile: +966557521347, E-mail:[email protected] ABSTRACT Background: Inflammation in pancreas usually happens as a complication after endoscopic retrograde cholangiopancreatography (ERCP) in 16% from patients. Many studies confirmed this incidence rate of pancreatitis. Some special intervention pre-, post-operative and also during may decrease the incidence rate of pancreatitis after cholangiopancreatography, as well as mortality rate. Proper history taking and physical examination about risk factors of procedure related risks may help in determining the proper patients. Most post-endoscopy pancreatitis (PEP) complications are mild to moderate inflammation only. The defined pathophysiology of PEP is initially damaged activation of drainage of duct of pancreas which secrets phospholipase A2, then prostaglandin, and prostacyclin then finally, ischemic attack for pancreatic cells. Objectives: This study aimed to compare between the efficacy of Ringer lactate and sublingual nitrates vs indomethacin to reduce post-ERCP pancreatitis Methods: The databases were searched for articles published in English in 3 data bases [PubMed, Google scholar and science direct]. Post-ERCP Pancreatitis (and, or, not) had been used such as [Ringer lactate and sublingual nitrates vs indomethacin] and in peer-reviewed articles between January 2008 and October 2020. Results: There're some pharmaceutical actions using pharmacological agents that may help in preventing post-operative or after endoscope inflammation of pancreas. Latest information suggested ringer lactate and sublingual nitrates to decrease the danger of post-endoscopic retrograde cholangiopancreatography pancreatitis (post-ERCP) in vulnerable group. Another data added that pancreatic stents may benefit in preventing this problem. Conclusion: A blend of ringer lactate with sublingual nitrate is substantially more effective compared to indomethacin without help from anyone else in view of the assurance against pancreatitis following ERCP. Keywords: ERCP, Post-ERCP pancreatitis, Endoscopic retrograde cholangio-pancreatography, Ringer lactate, Sublingual nitrates, Indomethacin.
INTRODUCTION
The practical usage of non-steroidal anti-
Inflammation in pancreas usually happens as a
inflammation drugs rectally as prophylactic for PEP has
complication after endoscopic retrograde cholangio-
similarly been confirmed in conducted studies. Today,
pancreatography, in 16% of patients. Many studies
healthcare information confirmed significantly that the
confirmed this incidence rate pf pancreatitis. Some
usage of non-steroidal anti-inflammatory medications
special intervention pre-, post-operative and also during
to solve/prevent PEP may be beneficial. The NSAIDs
may decrease the incidence rate of pancreatitis after
stop a number of inflammatory mediators of cascade,
cholangiopancreatography, as well as mortality rate.
which are considered to possess role in the disease
There is .4 to .6% of patients may complicated with
process of acute pancreas inflammation, particularly,
severe pancreatitis. Most complication that occurs after
prostaglandins in addition to phospholipase A2. For an
PEP is mild to moderate inflammation only. The
end result, 100 mg of indomethacin rectally instantly
defined pathophysiology after PEP is initially damaged
before or perhaps post ERCP is recommended for
activation of drainage of duct of pancreas which secrets
proper protection and to reduce the possibility of
phospholipase A2, then prostaglandin, and prostacyclin
inflammation for vulnerable groups of PEP. Nitrates
then finally, ischemic attack for pancreatic cells. A great
may possess considerable impact in prevention of post-
deal of methods is recommended for halting post-ERCP
ERCP pancreatitis as well (2).
pancreatitis, and also might be classified to stenting of
The impact of adequate IV administration of
pancreatic duct together with pharmacological
lactated Ringer's solution has similarly been established
prophylaxis. Pancreatic duct stenting occurs due to
in probably the latest scientific tests to decrease PEP.
damaged drainage of pancreas via its duct that may
Most trials, which happen to examine the convenience
occur due to papillary edema or perhaps stenosis of the
of PD stenosis in vulnerable groups, which at too much
oddi sphincter all through ERCP. Affected by previous
risk of PEP are created just before these
scientific tests, the great bulk of endoscopists invest a
pharmacological measures began being available (3, 4).
"fall out" stent in the pancreatic duct in vulnerable
Nitrates protect from post-ERCP pancreatitis. The
groups (1).
impact of sublingual nitrates to decline post-ERCP
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c:\work\Jor\vol852_117The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4154-4158
Different Methods to Decrease Seroma Formation Post Hernioplasty of Ventral Hernias Osama Hassan Gharieb, Hatem Mohamed Abdelmonem, Mohamed Abdallah Elsayed Mohamed*, Ashraf Abdel Monem Elsayed
General Surgery Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Mohamed Abdallah Elsayed Mohamed, Mail: [email protected]
ABSTRACT Background: Wounds can become infected associated with serous collection in the wound dead space in a condition known as seroma. After abdominal wall hernias correction, a variety of treatments have been tried to decrease seroma formation. Objective: To assess the rule of different modalities used in prevention of seroma formation post abdominal wall hernias repair. Patients and Methods: At Zagazig University Faculty of Medicine's General Surgery Department we carried out a clinical trial investigation. Transverse incisions and suction drains have been inserted in all patients undergoing hernioplasty and onlay mesh repair. The patients were divided into 4 groups: Group A: Classic hernioplasty for ventral hernia. Group B: Applying of histoacryl intraoperative after onlay mesh fixation. Group C: Applying of fibrin glue intraoperative after onlay mesh fixation. Group D: block closure of dead space after onlay mesh fixation. The patients were followed up in inpatients wards for 24 hours then discharged to continue their care and follow up in outpatient clinic at 1, 2, and 4 weeks. Results: When it came to the reduction of seroma production or other postoperative outcomes, there was no statistically significant difference between the groups. Conclusion: Fluid buildup can be avoided with the use of sclerotherapy, a minimally-invasive procedure that eliminates empty space. Chemical agents, tetracyclines, and talc were used satisfactorily with minimal complication rates. Keywords: Hernioplasty, Seroma Formation, Ventral Hernias. INTRODUCTION:
These hernias are frequently repaired by utilizing
Wounds can become infected with a condition
subcutaneous drains. Despite the fact that drains have
known as seroma. An investigation into the source of this
been found to minimize the frequency of postoperative
sludge is still ongoing. The inflammatory foreign body
seroma, infection risk may be increased if foreign
reaction with monocytes and macrophages at the
material is present (5).
connective tissue-implant contact can lead to seroma
Techniques aimed at reducing seroma production
development. To control the wound healing, immune
following herniation correction have been tested. Serous
response, and scar formation at the site, these cells secrete
drainage volume following surgery can be reduced by
cytokines. The presence of seroma in a patient might lead
using harmonic scalpel tissue dissection rather than
to higher rates of pain, infection at the surgical site, need
electrocautery (6).
for additional procedures, and an extended hospital stay Other methods to reduce seroma risk in abdominal (1).
wall hernia repair include the use of tetracycline, talc,
Dead space closure may lower the chance of seroma
histoacryl, and fibrin glue, however the results have been
formation during open surgical procedures because
inconsistent. No single treatment has been found to
seroma is a common consequence, particularly when big
totally eliminate the risk of postoperative seromas despite
skin flaps are created during surgery. Seromas are more
past efforts. There has been a recent increase in interest
likely to occur when mesh is used for repair, although
in the use of fibrin sealant to reduce postoperative seroma
little is known about how they form. Tissue reactions to
development, however the supporting data are few (7).
alloplastic mesh prostheses are many, including the
We aimed at this study to assess the rule of different
release of cytokines following surgery (2).
modalities used in prevention of seroma formation post
It is likely that the true frequency of seroma
abdominal wall hernias repair.
following hernia repair is underreported, as clinical signs
may not always be visible and intervention might not be PATIENTS AND METHODS
required. Discomfort, persistent pain, or an infection may
At Zagazig University Faculty of Medicine's General
necessitate percutaneous aspiration, drainage, or
Surgery Department we carried out a clinical trial
reoperation in other circumstances (3).
investigation. Transverse incisions and suction drains
In contrast to minor seromas, large symptomatic or
were inserted in all patients undergoing hernioplasty and
chronic seromas may necessitate several aspirations,
onlay mesh repair. We divided patients into 4 groups:
which may raise the risk of secondary infection, but this
Group A: Classic hernioplasty for ventral hernia. Group
is rare. One study found that 20% of open ventral hernia
B: Applying of histoacryl intraoperative after onlay mesh
surgeries necessitated intervention due to seromas (4).
fixation. Group C: Applying of fibrin glue intraoperative
This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_118 The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4159-4166 Role of Histological Investigation in The Protective Evaluation of Ginger Mai Abd El Hady Mousa1, Hemmat Mansour1, Fatma Eid1, AlyaMashaal2
1Cytochemistry and Histology, 2Immunology, Zoology and Entomology Department, Faculty of Science (for Girls),
Al-Azhar University, Cairo, Egypt *Correspondence: Alya Mohammad Aly Mohammad Mashaal, Email: [email protected], ORCID ID: https://orcid.org/0000-0002-5369-243X,mobile:00201021623414 ABSTRACT: Background: Monosodium glutamate (MSG) usage has been increased in the industry year after year reflecting its crescent use in the food industry. MSG toxicity is specific to the tissue in the body. Herbal drugs provide a managing role for several hepatic disorders so it is critical to find an effective and preventive agent to manage various hepatic insults. Objective: This experimental study aimed to examine the possible protective effect of ginger extract against injury induced by MSG as a therapeutic agent in pharmaceutical therapies. Materials and methods: Four groups of rats were divided and obtained treatment periods, after that they conducted serial histological and histochemical changes in control, MSG- and ginger-treated rats, focusing particularly on liver pathology. Results: MSG exhibited histological and histochemical changes in the liver. Such alterations induced hepatopathology, involving a return to a somewhat normal condition-ginger treatment. Conclusions: Ginger as herbal supplementations speed up the healing progression of hepatotoxicity. This study reports the effect of ginger exerts anti-toxicity and anti-fibrotic potentials. Keywords: Monosodium glutamate, Ginger, Histology, Histochemistry.
INTRODUCTION
possible antioxidants has been successful in reversing
Monosodium glutamate (MSG) is trusted by
the effects of MSG (7).
some people as a food flavoring that improves the
The liver is the primary organ of the
delicacy of cuisine as a nonessential amino acid, L-
metabolism
and
the
breakdown
of
many
glutamic acid. It can affect major brain functions
anticonvulsants, so it is at risk for drug damage and
including synapses formation and stabilization,
hepatotoxic reactions. The use of spices in the
memory, cognition, learning, and cell metabolism (1).
treatment of health problems has been a tradition in the
MSG possesses a certain dose limit because
world since early ages. Su et al. (8) stated that dried
intake is safely recommended by the World Health
ginger has therapeutic effects by regulating multiple
Organization (WHO) with the Food and Agriculture
metabolic pathways. During stressful times, ginger
Organization of United Nations (FAO) for adults in
boosts the unique defensive systems of living
daily intake of less than 2 g sodium (safely one-tenth
organisms by increasing their resistance to infections
of a tablespoon) per day (2). (9). Ginger is used traditionally worldwide for its health
The Food and Drug Administrations declared
endorsing properties such as reducing cardiovascular
that limited usage of MSG is safe and increased MSG
disease, cancer, diabetes, allergic response, aging, and
consumption is linked to several potential side effects
cancer. It exhibits beneficial effects due to the
such as circulatory, cardiac, muscular, neurological,
presence of gingerol and shogaol. They target multiple
and gastrointestinal disorders. Clinical trials of human
pathways, inclusive of the cell cycle, apoptotic cell
and animal subjects also suggested various potential
death, and angiogenic pathway (10).
health hazards. The extrapolation of animal model
However, according to experiments, studies,
results to humans is more demanding and strenuous (3).
and applications of traditional medicine and
Monosodium glutamate use is still considered a
physiotherapy, it is possible to get more benefits for
controversial source (4). Free radicals are oxidizing
ginger, whether by eating boiled or oil or powder use
agents, and an imbalance in the production/elimination
or in other ways (11). The avoidance of oxidative stress
of free radicals (oxygen radicals and other reactive
and liver toxicity by ginger can be linked to its
oxygen species (ROS) in cells result in oxidative
antioxidants (12).
stress, which destroys macromolecules and essential
By inhibiting the activity of enzymes involved
structures in biological systems(5). Oxidative stress
in carbohydrate and lipid metabolism, ginger or its
occurs in glutamate excitotoxicity due to increase ROS
active compounds reduced serum lipid and glucose
production and a decrease in the antioxidant defense
levels, increased lipolysis in the liver and adipose
mechanisms (6). Antioxidants act as free radical
tissue, decreased oxidative stress in white adipose
scavengers that help to overcome the deteriorating
tissue, increased energy metabolism capacity in
effects of ROS. In this regard, it appears that the use of
skeletal muscle, and decreased the expression of This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_119The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4167-4172
Modalities in Acne Vulgaris Treatment: Review Article Muhammed Abd El Qader Toama, Mai A. Samir, Hend Hisham Omar*
Dermatology, Venereology and Andrology Department, Faculty of Medicine,
Zagazig University, Sharkia, Egypt *Corresponding Author: Hend Hisham Omar, Email:[email protected] ABSTRACT Background: Acne Vulgaris is a complex illness linked to the pilosebaceous unit. Almost 85% of adolescents suffer from this disease, which results in a higher incidence of low self-esteem since it affects primarily the face. Inflammatory and non-inflammatory lesions are common in acne vulgaris. There are different lines of treatment that can be tailored to the patient's condition. New modalities emerge every day to combat the possible side effects of the traditional lines. Objective: To determine the updated treatment modalities in acne vulgaris management. Conclusion: Several modalities have been introduced to treat acne vulgaris including topical, systemic, light assisted, and novel topical agents like Triafortene and Nitric oxide gels. Keywords: Acne vulgaris, Novel, Treatment.
INTRODUCTION
pathogenic events implicated in the pathogenesis of
Acne Vulgaris is a complex illness of the
acne vulgaris (6).
pilosebaceous unit. It appears as comedones, papules,
pustules, and less frequently as nodules and cysts (1). Inflammatory changes:
Although it doesn't shorten the patients' life
Acne lesions are now known to be primarily driven
expectancy, it is thought to have a negative impact on
by inflammatory changes mediated by the host's innate
their quality of life, much like diabetes and coronary
and adaptive immunity, and inflammation is required
heart disease do. Low self-esteem and increased
for the emergence of acne lesions and is not a
incidence of social isolation, unemployment, and
coincidental occurrence (7).
depression were seen in adolescents with acne
compared to those who had not had acne (2). Clinical presentation:
The word acne is derived from " acme "; a Greek
Acne's primary lesion is microcomedone. It makes
word meaning any pointed thing that comes out of the
up histological changes that aren't visible clinically. The
surface. The earliest documentation of the disease was
follicle is damaged by sebum buildup, and so
in the Roman literature as "Akmas" meaning the prime
comedones are formed, which are closed lesions also
of life in the roman language, referring to the most
known as "white heads," or open, also known as "black
commonly affected pubertal age group (1).
heads." The dark color is a result of sebum oxidation,
Acne is mostly a self-limiting disease that usually
which is why it is black. Papules, pustules, nodules, and
resolves after adolescence however in some cases it can
cysts are inflammatory lesions. Papules are raised red
take many years and persist till adulthood (2).
spots on the skin, whereas pustules are the same but
This review aimed to determine the updated
include a little amount of pus in the center. Nodules are
treatment modalities in acne vulgaris management.
large, hard lesions that are more than 5 cm in diameter
and have become firmly indurated as a result of the Acne Vulgaris:
inflammation (8). Typically, the lesion is painless and
Acne presently affects 9.38 percent of the world's
itchless, however, itchiness or pain may accompany it
population (3). It is estimated that almost 85% of
in some situations (9).
teenagers will experience acne at some point in their
There are two outcomes to acne: either it goes away
lives. According to recent epidemiological research,
on its own with no sequelae, or it leaves erythema, post-
developed countries face a greater danger than
inflammatory hypo-or hyperpigmentation, or scarring
developing countries (4).
which can be either atrophic or hypertrophic but more
usually is atrophic (10). Course:
In most situations, acne is a self-limiting illness that Treatment:
goes away after puberty, but it can last for many years
General lifestyle changes such as reducing high
and even into adulthood in certain people (5).
glycemic diets, avoiding oil-based cleansers that clog
pores, and using cleansers no more than twice daily are Pathogenesis:
critical to the effectiveness of medical treatment (11).
Hyperkeratinization of the follicular epithelium,
Alkaline soap (9-10 PH) with various surfactants is
excessive sebum, Cutibacterium acnes colonization,
recommended for acne patients as well (12).
and finally inflammatory changes are the four main
This article is an open access article distributed under the terms and conditions of the Creative
ReThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4173-4178
Fractional Carbon Dioxide Laser versus Glycolic Acid Peel in Treatment of Pseudo-Acanthosis Nigricans Ahmed Fathy State,Ghada Elsayed Mohamed Elsayed*, Shaymaa ElMongy ElMongy Mohammed
Department of Dermatology, Andrology & STDs, Faculty of Medicine - Mansoura University, Egypt *Corresponding author: Ghada Elsayed Mohamed Elsayed, Mobile: (+20) 01013101269, E-Mail: [email protected] ABSTRACT Background: Acanthosis nigricans (AN) is a common cutaneous condition that can be a manifestation of systemic disease. AN is characterized by hyperpigmented and hyperkeratotic velvety skin lesions that presents mainly on the flexural sites, for example, the neck, the axillae, and groin. Objective: The aim of this study was to evaluate the clinical efficacy of fractional carbon dioxide laser versus glycolic acid peel 70% in treatment of pseudo-acanthosis nigricans through assessing changes in degree of area index, severity and texture of lesion. Patients and methods: Twenty patients with pseudo-acanthosis nigricans were included in this study. They were chosen from the Outpatient Clinic of Dermatology, Andrology & STDs department, Mansoura University Hospitals. All cases were subjected to fractional CO2 laser on the right side of the neck and glycolic acid peel 70% on the left side of the neck. Each patient was followed up for 3 and half months. Results: There was statistically significant difference regarding improvement in area index, severity and texture across time subjected to glycolic acid (GA) peeling 70%. There was statistically significant difference regarding improvement in area index, severity and texture across time subjected to fractional CO2 laser. There was no statistically significant difference when comparing effect of laser and peeling on adult and children. There was no statistically significant difference when comparing effect of laser and peeling on rural and urban cases. Conclusion: Acanthosis nigricans is a difficult dermatosis to treat, although there are many methods of treatment. Glycolic acid peeling 70% and fractional CO2 laser are considered effective modalities for AN treatment. However, GA peeling was more effective but statically insignificant. Keywords: Fractional carbon dioxide laser, Glycolic acid peel, Pseudo-acanthosis nigricans.
INTRODUCTION
lesions due to their keratolytic effects. Triple-
Acanthosis nigricans (AN) is a common cutaneous
combination
depigmentation
cream
(Kligman's
condition that can be a manifestation of systemic disease
bleaching formula; tretinoin 0.05%, hydroquinone 4%
that is associated with insulin resistance, diabetes
and fluocinolone acetonide 0.01%) nightly with daily
mellitus, obesity, internal malignancy, endocrine
sunscreen can also be used safely (1).
disorders, and drug reactions (1). Acanthosis nigricans is
Fractional laser improves both the pigmentary and
characterized by symmetrical, hyperpigmented, velvety
textural changes by removing thin layers of skin with
lesions, which can occur especially in the axilla, groin,
minimal thermal damage leading to dermal wound and
neck, antecubital, popliteal fossae, and umbilical region
new collagen formation, which is the primary (2). These lesions may be skin-colored or brownish and
mechanism behind the improvement seen after laser
may vary in thickness between 0.1-1 cm (3).
resurfacing and the undamaged normal surrounding skin,
Pseudo-acanthosis nigricans is the most frequent
is a reservoir allowing rapid epidermal repair (9).
form, the term pseudo-acanthosis nigricans was referred
Glycolic acid (GA) peels have anti-inflammatory,
to obese individuals who have AN with no underlying
keratolytic, and antioxidant effects. GA targets the
endocrinopathies. In these cases, the etiology was
corneosome by enhancing breakdown and decreasing
attributed to obesity, excessive local friction, and sweat
cohesiveness, causing desquamation. The intensity of
(4). The severity of AN has a positive correlation with
peel is determined by the concentration of the acid, the
fasting insulin levels (5). AN is likely the result of high
vehicle used to carry it, the amount of acid applied, and
levels of insulin binding to insulin-like growth factor 1
the technique used (10).
receptors (IGF-1Rs) on keratinocytes and fibroblasts.
The aim of this study was to evaluate the clinical
This leads to a proliferation of both cell types and
efficacy of fractional carbon dioxide laser versus
clinically apparent plaques and papillomatosis (6).
glycolic acid peel 70% in treatment of pseudo-acanthosis
The treatment of acanthosis nigricans is carried out
nigricans through assessing changes in degree of area
in particular for cosmetic reasons (7). For most cases of
index, severity and texture of lesion.
obesity associated with benign AN; weight loss and
lifestyle changes may lead to clinical improvements (8). PATIENTS AND METHODS
Topical medications, such as tretinoin 0.05% and
Twenty patients with pseudo-acanthosis
ammonium lactate 12%, are useful in hyperkeratotic
nigricans were included in this study. They were chosen
This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_121The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4179-4181
Indications, Creation, and Complications of Colostomy in Neonates: Single Tertiary Center Experience Over Three Years Mohamed M. Shalaby
Pediatric Surgery Department, Tanta University, Egypt *Corresponding Author: Mohamed Mahmoud Shalaby, Mobil: 00201064665637, Email:[email protected] ABSTRACT Background: The congenital anomalies that indicate colostomies in neonates at any tertiary paediatric surgery centre are Hirschsprung's disease, anorectal anomalies, and colonic atresia and they constitute the main bulk of colostomy workloads. Objective: In this study, we aimed to evaluate the indications, site of creation, type of colostomy, and complications of colostomy in new-born in the last three years in a single tertiary center. Patients and Methods: This study was a retrospective cohort study that was carried out in the Paediatric Surgery Department, Tanta University Hospital, Egypt to evaluate the indications, site of creation, types of colostomies, and complications of colostomy in new-born over three years from March 2018 to March 2021. Results: High anorectal malformations (90%) and Hirschsprung's disease (5%) were the most common causes of creation of neonatal colostomy. Out of 120 neonates, 71 (59 %) patients were males, and 49 (41 %) patients were females. The gestational age ranged between 35 and 40 weeks with a mean of 37.55 ± 1.43 weeks (mean ± SD). Complications of colostomy were seen in 38 (31.6%) neonates. Most common complications were skin excoriation in 22 (18 %) patients, stomal prolapse in 5 (4%) patients, bleeding from stoma site in 4 (3%) cases, wound infection in 3 (2.5%) cases, parastomal hernia in 2 (1.6%) patients, and dehiscence and stomal stenosis in one (0.8%) patient for each. Conclusions: Expert paediatric surgeons should perform or assist in colostomy creation operations in neonates and should pay close attention to proper choice of the site of colostomy with early management of complications and early closure of the colostomy. Keywords: Anorectal malformation, Colostomy, Hirschsprung's disease, neonates. INTRODUCTION
We excluded the neonates with extreme low birth
A stoma is defined as surgical procedure made in
weight or with congenital severe medical illness, which
the intestine to convert faeces and flatus to outside. The
were incompatible with life. Patients' medical records
congenital indications for colostomies in neonates at
including the detailed demographic and clinical data,
any tertiary paediatric surgery center are Hirschsprung's
the physical examination, and the relevant
disease, anorectal anomalies, and colonic atresia and
investigations for the studied patients were recorded.
this constitutes the main bulk of colostomy workloads(1-
Preoperative management were done based on the 3).
congenital anomalies; invertogram film was done after
The primary goal of colostomy surgery is to divert
24-48 hours of birth for high anorectal malformations,
stool until the time for the specific definitive treatment.
colostomy was performed only in obstructed
The site and the type of the least troublesome stoma
Hirschsprung cases as trans-anal pull through was the
have been major subjects for discussion amongst
main method for Hirschsprung disease. The type of
podiatric surgeons. Clinical studies have established the
colostomy,
site
of
colostomy
creation,
its
high morbidity associated with neonatal colostomy and
complications, and the operative time were recorded for
that transverse colostomy has a higher rate of
each patient.
complications than sigmoid colostomy (4,5).
All the studied patients started feeding once
However, debate continues regarding the type of the
colostomy was functioning except with any
diverting colostomy and despite being the most
contraindication for feeding and according to the
performed procedure in children; few research has been
general condition of the patients. All patients started
reviewed this subject. In this study, we aimed to
intravenous antibiotics for 24-48 hours post colostomy
evaluate the indications, site of creation, type of
creation. All the colostomies' new-born babies with
colostomy, and complications of colostomy in new-
failure to thrive were admitted for nutritional
borns in the last three years in a single tertiary center.
rehabilitation by supplementary feeding under care of
paediatric nutritionist. Follow up for colostomies PATIENTS AND METHODS
patients after hospital discharge was achieved at the out-
This study is a retrospective cohort study that was
patient clinic every 2 weeks till closure of colostomy.
carried out in the Paediatric Surgery Department, Tanta
University Hospital, Egypt. The study included all the Ethical consent:
neonates who underwent colostomy that were done by An approval of the study was obtained from
well-trained paediatric surgeons in that period over the Tanta University Academic and Ethical Committee.
last three years from March 2018 to March 2021. Every parent of every patient signed an informed This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_122The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4182-4193
The Potential Protective Impact of Spirulina on Cisplatin Induced-Renal Toxicity in Adult Male Albino Rats: Histological, Immunohistochemical and Biochemical Study Hala Taha Shalan and Yasmin Ramadan Abd El Fattah
Anatomy and Embryology department, Ain Shams University, Faculty of medicine, Cairo, Egypt Corresponding author: Hala Taha Shalan,Email: [email protected], Orcid id:0000-0002-0067-4764,
Mobile:00201001970159 ABSTRACT Introduction: Cisplatin (CP) is regarded as a prevalent anticancer medication utilized against several cancer types. Spirulina (SP), a bluegreen alga, has been utilized as a nutritional supplementation, in addition to other therapeutic enforcement. Spirulina includes lipids, proteins, carbohydrates, and vitamins including a pigmented protein and b-carotene besides some vital minerals. Objectives: The present study was carried out to verify the toxic impacts of cisplatin on kidney of the rat and the probable protective role of spirulina platensis supplementation. Material and methods: The twenty-four rats were randomly categorized into three equal groups (eight rats/each). Group I (Control Group): Eight rats were subdivided into two subgroups, four rats each: Group I-a: Four rats did not undergo any experiments and received only food and water for 8 days. Group I-b: Four rats received Spirulina (500 mg/kg) body weight orally by using a gastric tube for 8 days. Group II: The animals were administrated a single dose of cisplatin 6 mg/kg body weight intra-peritoneal. Group III: Each rat received Spirulina (500 mg/kg) body weight orally for 8 days and cisplatin 6 mg/kg body weight intraperitoneal on day 4. Results: cisplatinshowed extensive tubular damage as wide vacuolations in tubular epithelium, pyknotic nuclei and distortion of renal corpuscles showing widening of Bowman's space with adherence of glomerular capillary tuft to the parietal layer of Bowman's capsule. Administration of spirulina showed regeneration of tubular epithelium and presence of tubular brush border and apparently normal lumen. Conclusion: Cisplatin resulted in histological as well as biochemical changes in the kidney of adult male rats. Administration of spirulina with cisplatin attenuated these negative impacts which can be attributed to the antioxidant activity. Keywords: Cisplatin, Spirulina, Renal tissue, Caspase 3.
INTRODUCTION
Nephrotoxicity triggered by cisplatin is because of
Cisplatin (CP) is regarded as a prevalent anticancer
reactive oxygen species (ROS) formation. Cisplatin also
medication utilized against several cancer types as
leads to the inhabitation of several antioxidant enzymes
cervical, uterine, ovarian, and testicular malignancies.
like glutathione-S-transferase (GST), glutathione
Furthermore, it is believed to be toxic to the kidney, ear,
peroxidase (GPX), as well as superoxide dismutase
gastrointestinal tract, and nervous system. This drug is
(SOD). This leads to mitochondrial lysis and generation
believed to be biologically active to a nephrotoxic
of ROS in cells (7). Generation of ROS induces cascades
substance (1, 2). After cisplatin treatment about 20-30% of
of signal transduction, which leads to necrosis and
cases, experience acute kidney injury (AKI) in spite of the
apoptosis. To date, the mechanism of cisplatin-induced
therapeutic improvements. Cases that experience AKI
ROS signaling pathways remains undetermined, as there
have an elevated mortality risk and probably encounter
is no treatment until now to retrain cisplatin side effects.
chronic kidney injury (CKI) (3, 4).
Multiple agents have demonstrated a nephroprotective
Nephrotoxicity mainly occurs in the epithelial cells
impact in renal damage models caused by cisplatin and it
of proximal renal tubule. The concentration of cisplatin in
is clearly evident that most of them are antioxidants (8).
the cells of epithelial tubular is five times more elevated
Spirulina (SP), a bluegreen alga, was utilized as a
compared to its concentration in the blood. Renal
nutritional supplementation in addition to some
dysfunction happens after days from administrating
therapeutic enforcement. Spirulina includes lipids,
cisplatin (50120 mg/m2) in therapy. Proximal as well as
carbohydrates, proteins, vital minerals, vitamins like a
distal convoluted tubules are the main target for cisplatin
pigmented protein and b-carotene. The antioxidant effect
impacts in the kidney, where it induces oxidative stress,
of spirulina has been proven in vitro as well as in vivo
cellular damage, DNA damage, nephritis, and apoptosis
studies. Spirulina is recognized due to its broad biological (5, 6).
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c:\work\Jor\vol852_123The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4194-4203
Elective Division Versus Preservation of The Ilioinguinal Nerve to Reduce Postoperative Pain in Hernioplasty for Inguinal Hernia Atef Mohamed Abdel Latif, Ahmed Elsayed Lotfy, Mohamed Abdallah AbdElhady, Mohamed Abdelrahim Mohamed*
Endocrine Surgery Unit, Faculty of Medicine, Mansoura University, Dakahlia, Egypt *Corresponding author: Mohamed Abdelrahim Mohamed Abdelmoghith, Mobile: (+20) 01005109057, E-mail:[email protected] ABSTRACT Background: Lichtenstein tension-free mesh hernioplasty is the gold standard and the method of choice for the repair of inguinal hernia in developed countries. Chronic post-operative inguinal pain (CPIP), which is defined as pain lasting at least 23 months after surgery, is a major problem that affects about 8-16 % of inguinal hernia patients and affects their daily lives. Pain can be caused by perioperative injury to nerves or nerves that are being trapped and impaired by sutures or perforated by fixation devices such as tacks. Ilioinguinal nerve trauma throughout dissection, inflammation or fibrosis, and nerve entrapment by the mesh have all been involved in the pathogenesis of inguinodynia. Objective: To evaluate the effect of ilioinguinal neurectomy versus nerve preservation on the incidence and severity of chronic groin pain following Lichtenstein tension-free mesh hernioplasty for inguinal hernia. Patients and Methods: This prospective study was conducted on 100 patients with inguinal hernias who underwent Lichtenstein tension-free mesh hernioplasty. They were divided randomly into 2 equal groups; ilioinguinal neurectomy group (A) and nerve preservation group (B). There was no significant difference in patients of both groups regarding age, type of the hernia, precipitating factors, or type of anesthesia. Follow-up of postoperative groin pain was done at1st and 7th POD and after 1, 3, and 6 months during rest as well as after minor exercises using NRS. Results: The Incidence of postoperative groin pain was significantly lower in the neurectomy group than the preservation group in all follow-up periods. Conclusion: Resection of ilioinguinal nerve during inguinal hernia repair reduces significantly the incidence of post- operative chronic pain. Keywords: Inguinal hernia, Ilioinguinal nerve, Chronic groin pain, Elective division
INTRODUCTION
entrapment by the mesh have all been involved in the
Lichtenstein tension-free mesh hernioplasty is
pathogenesis of inguinodynia. The ilioinguinal nerve is
the gold standard and the method of choice for the repair
of inguinal hernia in developed countries (1). Chronic
a peripheral branch of the lumbar plexus. It goes
post-operative inguinal pain (CPIP), which is defined as
through the lateral abdominal muscles, then into the
pain lasting at least 23 months after surgery, is a major
inguinal canal, before innervating the superomedial part
problem that affects about 8-16 % of inguinal hernia
of the thigh, the teguments of the pubis, the scrotum in
patients and affects their daily lives (2).
men, and the labia majora in women. The ilioinguinal
Many factors are attributed to the incidence of
nerve is usually faced during open inguinal hernia repair
chronic pain after inguinal hernia surgery but it is not
and has been involved in the pathogenesis of
possible to point to a special reason for the pain in a
postoperative chronic groin pain (4).
specific patient. Pain can be caused by perioperative
Elective detachment of the ilioinguinal nerve
injury to nerves or nerves that are being trapped and
has been recommended in an attempt to reduce the
impaired by sutures or perforated by fixation devices
frequency of chronic groin pain following open mesh
such as tacks (2).
hernia repair. The importance of elective nerve
Many regimens for the management of CPIP
detachment to decrease postoperative pain was
have been experienced including non-surgical and
highlighted by some authors, considering the
surgical routes. Surgical treatment consists of resection
ilioinguinal neurectomy to be a part of the regular
of the inguinal nerves, either by selective or triple
surgical step. Good planning preoperatively for
neurectomy including all inguinal nerves which is the
ilioinguinal nerve resection has been observed to
most performed surgical procedure for neuropathic
decrease the incidence of postoperative pain. A major
CPIP. Removal of the mesh (meshectomy), either
source of morbidity is reduced using this simple
complete or partial can be considered when the mesh is
procedure (5).
the origin of non-neuropathic post-operative pain (3).
The present study aimed to evaluate the effect
Ilioinguinal
nerve
trauma
throughout
of ilioinguinal neurectomy versus nerve preservation
dissection, inflammation or fibrosis, and nerve
on the incidence and severity of chronic groin pain
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c:\work\Jor\vol852_124The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4204-4207
Contemporary Onlay Incisional Hernia Repair: Review Article Mohamed Kamal Almasri*, AbdElhafez Mohammad Elshewail, Gamal Osman, Ibrahim Ali Heggi
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Mohamed Kamal Almasri, Email: [email protected] ABSTRACT Background: Abdominal procedures, whether open or laparoscopic are often complicated with an incisional abdominal hernia (IH). Approximately 15% - 20 % of all laparotomies and 1% to 5% of all laparoscopic surgeries are complicated by IHs. IH is a really bad situation for doctors and patients. Dissatisfaction, long-term malfunction, and limitations of activities and unsatisfying cosmetic appearance are just a few of the side effects that patients endure as a result of IH. For doctors; it is a challenging surgical issue associated with multiple risk factors, unclear etiology and different pathological changes, affecting different patients. Management of such a variable surgical issue necessitates a good understanding of the anatomical and physiological features of the abdominal wall by the hernia surgeon beside a wide armamentarium of surgical options to deal with complex variants to repair and restore abdominal wall integrity and function, many procedures have been utilized to repair IH and to restore abdominal wall integrity. Objective: To review the feasibility and safety of the abdominal wall component release with contemporary onlay mesh fixation procedure in the treatment of incisional abdominal hernias. Conclusion: Large incisional hernias that are difficult to close in the midline might benefit from the component separation approach. Repair of incisional hernias by abdominal wall component separation with contemporary onlay mesh fixation results in favorable outcomes and lower recurrence rates. It gives a more durable abdominal wall repair, a more physiological repair in cases of loss of domain, an affordable financial outlay, and a low incidence of complications. Keywords: Abdominal Wall, Complications, Incisional Hernia Repair.
INTRODUCTION
many specialties, IH poses a significant surgical
Incisional hernia is referred to as protrusion of an
challenge (9).
intra-abdominal organ or tissue through a defect or
Recurrence rates for open and laparoscopic
defects on the musculofascial layers of the abdominal
procedures are practically identical (10).
wall in the region of a postoperative scar. This may be
a laparotomy or laparoscopic trocar site incisions or Incisional Hernia Repair Operative Approaches:
parastomal hernia (1-3).
Identifying a single, ideal surgical strategy for
It was decided to use the definition put forward by
incisional hernia repair is difficult and in some cases, Korenkov et al.(4): "IH is any abdominal wall gap with
unachievable because of the wide variety of operative
or without a bulge in the area of a postoperative scar
procedures and the wide variety of patients and hernias
perceptible or palpable by clinical examination or
that can be treated. For patients having incisional hernia
imaging". It is the most frequent postabdominal surgery
repair; surgeon choice and technical competence play
complication. In spite of the vast improvement in the
the most significant roles in identifying the most
procedures and suture materials used to close
effective surgical method (3).
abdominal wall incisions, its incidence continues to
Laparoscopic incisional hernia repairs are preferred
rise. Approximately 15% - 20 % of all laparotomies and
by some surgeons who have had adequate minimally
1% to 5% of all laparoscopic surgeries are complicated
invasive training, while open incisional hernia surgeries
by IHs (5). Comorbid problems include persistent
are preferred by others. Mesh placement in a sublay,
cough, urethral stricture, obesity, benign prostatic
onlay, underlay, or bridge complicates the decision-
hyperplasia, ascites, and constipation all of them
making process. If fascial releases are considered, the
influence the result of IH repair (6).
reconstructive surgeon has a plethora of layers of the
Suture repair, prosthetic repair, laparoscopy, and a
abdominal wall to release. It is still debatable whether
variety of other procedures and techniques have been
or not a component separation should be undertaken (11).
documented for preventing and correcting IH (7).
Even small symptomatic hernias should be repaired
Reconstruction of the abdominal wall with the release
early. In asymptomatic hernias the risks of intestinal
of external oblique or transversus abdominis muscles
obstruction, strangulation and skin ulceration are such
allow repair of IH with a defect or defects greater than
that repair, even in older patients, is often also
15 cm or more deficit (8).
recommended (12).
Because most IH treatments are followed by
complications, despite all the work done to reduce its Contemporary Onlay Incisional Hernia Repair:
frequency, no one has yet come up with the optimal
Onlay incisional hernia repair relies heavily on
strategy for preventing and healing it. For surgeons of
patient selection. Prior aortobifemoral bypasses, abdominal aortic aneurysm [AAA] procedures, and
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c:\work\Jor\vol852_125The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4208-4217
Evaluation of Laparoscopic Sphincter Saving Surgery in Management of Rectal Cancer Mohamed W. Arafa*, Ayman M.A. Ali, Hosam F. Abdelhameed, Abd-El Hafiz Hosny Mohammed
Department of General Surgery, Faculty of Medicine, Sohag University, Egypt *Corresponding author: Mohamed W. Arafa, Mobile: (+20) 01020036846, E-Mail: [email protected] ABSTRACT Background: Sphincter-saving surgery for rectal carcinoma (RC) has been classically performed by open surgery. Laparoscopic restorative proctectomy (LRP) has been evolved for the same purpose, but its benefits are controversial representing an enigma in the choice of management of RC. Objective: The aim of this study was to evaluate the feasibility, adequacy, safety, short- and long-term outcomes of LRP. Patients and methods: This was a prospective observational study included 35 patients suffering from middle and distal third RC admitted electively to Sohag University Hospital and Colorectal Unit in Ain Shams University. Patients were evaluated and analysed regarding efficacy of LRP, length of stay and different risk factors for post-operative complications. Results: Regarding operative outcomes the mean operative time was 189 minutes, and mean operative blood loss was 95.4 mL, while operative complications happened in 8.5%. Post-operatively, complications happened in 22.9%. The mean post-operative hospital stay was 4.2 ± 1.4 days. Higher American Society of Anesthesiologists (ASA) risk scoring and advanced pathological stage proved to be independent risk factors responsible for complications. During follow-up, local recurrence was evident in 5.7% and distant recurrence developed in further 5.7%. Disease-free survival rate was 80.02 %, and overall survival rate was 91.3% for stage II and 83.3% for stage III. Conclusion: LRP can be done safely reflecting adequacy of the procedure with a comparable complication rate and long-term outcomes to conventional surgery, which makes it a good alternative to conventional technique. Keywords: Rectal cancer, Laparoscopic surgery, Total mesorectal excision.
INTRODUCTION
proctectomy
in
treatment
of
RC
is
still
RC constitutes more than one third of
controversial.
colorectal cancers and 6% of all body cancers (1).
Laparoscopy
has
changed
lower
rectal
It represents a challenge due to its unique
surgery from being in a hidden area to be a
anatomy viz; difficult exposure in a narrow
visible one providing a magnified view of the
pelvis, low intestinal transection, total mesorectal
pelvis with better visualization than conventional
excision (TME), and challenging nerve-sparing
surgery which makes preservation of autonomic
maneuvers (2).
nerves easier with better preservation of the
TME in RC resection provides reduction in
urinary and sexual functions (8). Not only it has a
local recurrence rate from 25% to 10%, and when
similar
efficacy
compared
to
conventional
combined with neoadjuvant radiation therapy, an
surgery in mid and distal RC, but also achieved
additional 50% reduction in local recurrence is
better short-term outcomes (9) including less
achieved (3). TME with its hallmarks of less blood
tissue trauma, better cosmesis, less analgesics,
loss and saving of autonomic nerves has
less intra-operative blood loss, less wound
encouraged many surgeons for its standardization
complications, less post-operative pain, earlier
in radical rectal cancer resection. In the same
recovery of bowel movement and return to
time the introduction of staplers made very low
normal activities, faster return to work and
anastomosis in the distal rectum a possible issue
shorter hospital stay.
increasing the scope of sphincter saving surgery
LRP
has
its
own
limitations
and
is
in RC (4).
technically difficult, with a long learning curve, Jacobs et al. (5) reported
their
first
particularly due to the narrow and deep pelvic
laparoscopic colorectal resection in 1991. Since
cavity and anatomical complexity especially in
then laparoscopic colectomy for colon cancer has
lower RC, which is associated with more
become the standard worldwide, in 2004, the first
comorbidity (6, 10).
Another
challenge
for
laparoscopic TME for rectal cancer was done and
laparoscopic instruments is that they are straight
becomes widely adopted (6) proved to be safe and
and may have difficulty at the pelvic inlet to
effective with oncological outcomes comparable
navigate around the sacral promontory and reach
to conventional surgery (7), but laparoscopic
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c:\work\Jor\vol852_126The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4218-4222
Alpha 1 Acid Glycoprotein as a Marker for Diagnosis of Early-Onset Neonatal Sepsis in Full-term Neonates Azza Ali Khalil1, Safaa Hamdy Ahmad1, Naglaa Ali KHalifa2, Gameel Hassan Mansor*1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Sharkia, Egypt *Corresponding Author: Gameel Hassan Mansor, Mobile: (+20)01064381557, Email: [email protected] ABSTRACT Background: Neonatal sepsis is defined as a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first 4 weeks of life. Alpha-1 acid glycoprotein is one of the lipocalin family and members of acute- phase protein; it appears to function in modulating the activity of the immune system during the acute phase reaction. Objective: This study aimed to assess -1AGP as a marker in the diagnosis of EOS. Patients and Methods: This study was a prospective case-control study conducted on full-term neonates up to 7 days of life, admitted to the neonatal intensive care unit of Zagazig University Hospitals. The studied neonates were divided into 3 groups first confirmed cases (20) of early-onset sepsis, confirmed clinically and with a positive blood culture. Second suspected cases (20), with clinical features of sepsis and non-specific lab markers. Third group control (20), are apparently healthy term newborns, delivered in the Zagazig University Hospital. Alpha-1 acid glycoprotein was measured for all neonates. Results: There was a statistically significant difference among the studied groups as regard alpha one acid glycoprotein. It is a good diagnostic marker detection of cases. Conclusion: Alpha-1-acid glycoprotein appeared to be a useful marker for the early detection and diagnosis of early- onset neonatal sepsis. Keywords: Alpha 1 Acid Glycoprotein, Early Onset Neonatal Sepsis, Fullterm Neonates Diagnosis. INTRODUCTION
first month of life. Almost one million deaths occur on
A case definition for neonatal sepsis is lacking and
the day of birth and close to two million die in the first
neonatal sepsis is variably defined. However, specific
week of life. Incidence of neonatal sepsis varies from 1-
criteria that classify sepsis into culture-proven, possible
4/1000 live births in developed countries to 10-50/1000
and probable sepsis have been developed using clinical
live births in developing countries. Incidence in Egypt
and laboratory findings. Moreover, the term `clinical
was found to be 21.5% of neonates admitted to NICU
sepsis' is commonly used by neonatologists and (3). Similar studies in Egypt reported a higher rate around
clinicians in the presence of negative blood culture, and
33% among neonates admitted to NICU (4, 5).
clinical symptoms and signs of sepsis. However, this
Accurate and timely diagnosis of early-onset
term also lacks consensus and no clear criteria exist for
neonatal sepsis remains challenging to the clinicians
its use in research and clinical practice. Neonatal sepsis
and the laboratory (6). Various strategies to reduce
is classified by the time and onset of the disease into
morbidity and mortality involve the use of clinical signs
early and late-onset (1).
with hematological and serological markers (7). Alpha-1
Early-onset neonatal sepsis (EONS) is the one that
acid glycoprotein is one of the lipocalin family and
occurs in the first 3 days of an infant's life and is often
members of acute-phase proteins, it appears to have a
due to vertical transmission of organisms from the
function in modulating the activity of the immune
maternal genitourinary tract, while late-onset neonatal
system during the acute phase reaction (8).
sepsis (LONS) is defined as sepsis occurring in infants
This study aimed to assess -1AGP as a diagnostic
older than 72 hours and is commonly due to horizontal
biomarker in EOS in full-term.
transmission. However, the time limits for defining
early and late-onset sepsis lack consensus too, and many PATIENTS AND METHODS
authors extend the duration of EONS for up to 7 days
This study was a prospective case-control study
following birth. Historically, blood culture is
conducted on full-term neonates up to 7 days of life,
considered the "gold standard" test for the diagnosis of
admitted to the neonatal intensive care unit of Zagazig
sepsis. However, the low yield of blood culture often
University Hospitals.
leads to more reliance on clinical judgment in treating
The studied neonates were divided into 3 groups
infants with suspected sepsis (1).
first confirmed cases (20) of early-onset sepsis,
When pathogenic bacteria gain access into the
confirmed clinically and with a positive blood culture.
blood stream, they may cause overwhelming infection
Second suspected cases (20), with clinical features of
(septicemia) or may get predominantly localized to the
sepsis and non-specific lab markers. Third group
lung (pneumonia) or the meninges (meningitis) (2).
control (20), are apparently healthy term newborns,
The World Health Organization (WHO) estimates
delivered in the Zagazig University Hospital.
that 45% of deaths in under-five years occur during their
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Vitamin D Receptor Gene (Fok-I) Polymorphisms in Type 1 Diabetic Children; Case Study in Zagazig University Hospitals Mohamed Eissa1, Lamia A Mohammed2, Hany Abdel Malik2, Azza Ali Khalil3, Nahla Ibrahim4, Abdallah Salem Abdelazem5, Nora M. Said2
1Pathology Department, College of Medicine, King Khalid University, KSA and
Clinical Pathology Department, Faculty of Medicine, Zagazig University, Egypt
2 Clinical Pathology Department, 3Pediatrics Department, Faculty of Medicine, Zagazig University, 4El-Ahrar Zagazig
Teaching Hospital, Egypt
5Medical Biochemistry Department, Faculty of Human Medicine, Suez University, Suez, Egypt *Corresponding author: Mohamed Eissa, Mobile: 00966599151626, E-Mail: [email protected] ABSTRACT Background: Many meta-analyses studied the association between vitamin D receptor (VDR) gene polymorphism and type 1 diabetes (T1DM) susceptibility. Objective: This study was designed to assess the role of VDR gene (FOK-I) polymorphisms in type 1 diabetic children from Zagazig University Hospitals in Egypt. Patients and Method: In this case-control study, the genotypes of VDR gene (FOK-I) polymorphisms were assessed in 180 type 1 diabetic children and 120 healthy matched age controls by PCR-RFLP analysis. Results: Ahigh statistical difference between patient and control regarding VDR gene (FOK-I) polymorphisms, where 44% of the patient group had heterozygous genotype (AG) compared to 8.3% in the control group. AG genotype has almost a higher risk nine times odds ratio (OR) = 8.8 than AA genotype in diabetic patients. There was a significant increase in the G allele in the patient group. Moreover, a significant association between (FOK-I) polymorphisms and T1DM complications was also observed. Conclusion: (AG) genotype of VDR gene (FOK-I) polymorphisms could be a risk factor for T1DM complications. So, VDR gene (FOK-I) polymorphisms should be performed with other genetic studies for early prediction, detection and prevention of microvascular complications of T1DM that adversely affect health-related quality of life of Egyptian children and burden the primary care units. Keywords: FOK-I, Genotype, Polymorphisms, T1DM, VDR gene. INTRODUCTION
history of chronic infection or inflammation. Patients
Type 1 diabetes (T1DM) is the most frequent form
were subjected to the following: history taking
of diabetes in children and young adults and is one of
regarding age, together with the onset and duration of
the most common chronic diseases in children(1). The
the disease, complete clinical examination. Routine
worldwide incidence of T1DM is increasing by 2-5%
investigations as fasting and 2 hours postprandial blood
annually(2). Egypt represents the highest incidence of
glucose, hemoglobin A1C levels, liver, and kidney
childhood T1DM in the Middle East(3). Approximately
function tests, and albumin/creatinine ratio (ACR) and
96,000 children are anticipated to develop T1DM
lipid profile.
annually worldwide(4).
All laboratory investigations were done using Cobas
HLA haplotypes are related to 50% of disease
Hitachi,
Roche
diagnostics
(Japan).
Specific
heritability(5). Vitamin D plays a possible role in
investigations: genotyping of vitamin D receptor gene
immune regulation(6). VDR gene provides instructions
(FOK 1) using DNA sequencing Genetic analyzer 3500
for making a protein that allows the body to respond to
was done for patients and control groups. Polymerase
vitamin D(7). Four common single nucleotide
chain reaction amplicons were generated using the
polymorphisms for vitamin D receptor gene have been
following primer pairs: for FOK 1:
investigated(8). VDR polymorphisms are associated
Forward 5'-
with T-cell mediated autoimmune diseases (9).
AGCTGGCCCTGGCACTGACTCTGCTCT-3' and
This study was designed to assess the role of VDR
reverse 5'-
gene (FOK-I) polymorphisms in type 1 diabetic
ATGGAAACACCTTGCTTCTTCTTCTCCCTC-3'
children from Zagazig University Hospitals in Egypt.
Ethical approval:
PATIENTS AND METHODS This study was carried out in the Clinical and
The study included two groups; 180 patients of type Chemical Pathology Department and Pediatric
1 diabetes mellitus and 120 non-diabetic completely Department in Zagazig University Hospitals in
healthy. Patient inclusion criteria were: age 1-16 Egypt. The study was approved by the Ethical
years, gender male and female and blood glucose Committee of Zagazig Faculty of Medicine (hospital
levelfasting >126 mg/dl, 2 hours postprandial >200 IRB approval number 4813). An informed consent
mg/dl.While patient exclusion criteria: age > 16 years, was obtained from all patients and their parents in
patient with a history of chronic renal disease, patient this research. Every patient and parent received an
with a history of chronic liver disease, patient with a explanation for the purpose of the study. All given
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c:\work\Jor\vol852_128The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4227-4230
Osteopontin as a Marker of Lower Extremity Arterial Disease in Type 2 Diabetic Patients in Zagazig University Jehan Saeed1, Sally Mahmoud Saeed2, Ali Irhoumah Mohamed*1, Mohamed Gaber Hamed1
Departments of 1Internal Medicine and 2Biochemistry and Molecular Biology,
Faculty of Medicine, Zagazig University. *Corresponding author: Ali Irhoumah Mohamed, Email: [email protected] ABSTRACT Background: Diabetic individuals often have lower extremity arterial disease (LEAD), which is a prevalent symptom of macrovascular disease with both a high prevalence and significantly worse outcomes. There are numerous biological activities for osteopontin (OPN) in health and illness. Objective: This study aimed to investigate whether serum OPN levels differ between type 2 diabetic subjects with and without LEAD and to examine the differences in serum OPN levels between subjects with and without type 2 diabetes mellitus (T2DM). Patients and Methods: Zagazig University Hospitals' Departments of Internal Medicine, Endocrinology Unit, and Biochemistry Department collaborated in this case-control study. Sixty people were divided into three groups: a control group of 30 people, 15 type 2 diabetics without LEAD, and 15 type 2 diabetics who had LEAD. ELISA kits were used to measure levels of osteopontin in the blood. LEAD was assessed using ankle brachial index (ABI) measurements made with a hand Doppler. Results: Diabetics had higher serum OPN levels than non-diabetics (111.53±35.6 ng/ml, 35.91±10.50 ng/ml) respectively. OPN values in diabetics with LEAD group were substantially higher (147.35±25.59 ng/ml) compared to diabetics without LEAD group (75.70±16.96 ng/ml) (p<0.001). Conclusion: Individuals with type 2 diabetes mellitus and have LEAD was found to have higher levels of serum osteopontin than in diabetics without LEAD, this concludes that OPN can be a marker for vascular disease of the lower extremities in diabetic patients. Keywords: Lower extremity arterial disease, Osteopontin, Type 2 Diabetes Mellitus.
INTRODUCTION
OPN appears to have a wide range of biological
It is estimated that 9095 percent of people with
roles in both normal and pathological states, which is
diabetes have type 2 diabetes (T2D), which is a
not surprising given its chemical structure. It regulates
developing epidemic that's linked to a variety of health
bone mineralization and has a powerful effect on the
problems, including coronary artery disease, diabetic
prevention of ectopic calcium deposition, which
retinopathy, peripheral neuropathy, and kidney disease.
includes the hardening of blood vessel walls.
This means that understanding the risk factors for type
Inflammation, immune cell migration into tissues, and
2 diabetes will be more useful in developing T2D
wound healing have all been linked to this protein (6).
prevention strategies (1).
The study's goal was to see if serum OPN levels
Another important manifestation of atherosclerosis
differed between diabetics with and without LEAD, and
is a condition known as lower extremity arterial disease
if they did, whether they differed between people with
(LEAD), which affects an estimated 200 million people
and without T2DM.
globally. The fact is that (LEAD) is a prevalent
symptom of diabetes-related macrovascular disease, PATIENTS AND METHODS
with a high prevalence and even worse prognosis in
Zagazig University Hospital's Internal Medicine,
diabetic patients (2).
Endocrinology Unit, and Biochemistry Departments
LEAD was discovered to coexist with the
conducted this case-control study between January
microvascular consequences of diabetes mellitus,
2021 and July 2021. Three groups were formed from the
according to the previous research (3). LEAD is typically
participants: sixty people were divided into three
found in diabetic patients who have poorer outcomes,
groups: a control group of 30 people, 15 type 2 diabetics
such as a four- to five-fold increased risk of lower limb
without LEAD, and 15 type 2 diabetics who had LEAD.
amputation compared to healthy controls (4).
One of the many names for osteopontin (OPN) is Inclusion criteria: Both sexes and those who were at
"early
T-lymphocyte
activation,"
"secreted
least 18 years old were included in the study, and longer
phosphoprotein 1", or "uropontin". Osteopontin was
than five years of diabetes duration among type 2
first discovered in the bone matrix as an osteoblast
diabetics.
secretory product. Some of the tissues and cell types
where it is found include the osteocyte, fibroblast and Exclusion criteria: Age under 18, type 1 diabetes,
endothelium as well as vascular smooth muscle cells. It
diabetes duration under 5 years, pregnancy, major
is also found in dendritic, macrophage and T-
hepatic or cardiorespiratory disease, cancer, acute
lymphocyte cells in the immune system (5).
sickness, history of lower limb revascularization, foot ulceration, and acute limb ischemia are all exclusions.
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c:\work\Jor\vol852_129The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4231-4239
Evaluation of Effectiveness between Two Different Facilities for Drinking Water Having Different Water Sources for Removal of Free-Living Amoeba in Qalyubia Governorate, Egypt Lamiaa A. Shawkey*1, Faten A. Elfeky2, Basma M. Abou-Elnour2, Eman S. El-Wakil3
Reference Laboratory for Drinking Water1, Holding Company of Water and Waste Water, Shopra Elkhiema,
Qalyubia, Department of Zoology2, Faculty of Science for Girls, Al-Azhar University, Cairo,
Department of Parasitology3, Theodor Bilharz Research Institute, Warrak El-Hadar, Imbaba, Giza, Egypt *Corresponding author: Lamiaa A. Shawkey, Email:[email protected] ABSTRACT Background: Conventional drinking water treatment plants (CDWTPs) and Ground water (GWTP) are the main 2 types of drinking water treatment using freshwater as a source for drinking water in Egypt. Objective: The Egyptian standards for drinking water denied the presence of any type of living protozoa in drinking water produced for human use. Martials and methods: 48 water bodies were selected from Benha and Kaha districts in Qalyubia Governorate, Egypt. Mean turbidity, pH, conductivity, temperature, ammonia, nitrite, iron, manganese, magnesium and residual chlorine were recorded in each water body from two sites. Centrifuged samples were cultured on non-nutrient agar plates with Escherichia coli. Positive sample isolates were subjected to DNA extraction and polymerase chain reaction using genus and species- specific primers targeting the internal transcribed spacer region (ITS) and Mp2CL5 gene. Results: The prevalence of Naegleria species, N. fowleri and Acanthamoeba in the study area were 54.1% and 0% (N. fowleri and Acanthamoeba) of all sample examined. The removal of free-living amoebae from drinking water, it was shown that conventional DWTP (Benha) could get rid of 91% of FLAs present in the raw untreated water, while ground DWTP removed only 55.6% of these organisms. Conclusions: The conventional drinking water treatment system for surface water was better than that of only chlorine disinfection for ground water in removing free-living amoeba (FLAs). In general, the persistence of FLAs in drinking tap water unfortunately exerts public health hazards. Keywords: Amoebae, Microscopy, PCR, Drinking water treatment plant, Groundwater.
INTRODUCTION
amoeba varies from 23% to 89%, depending on the
"Water is life"; actually, water is the most plentiful
geographic location (5).
compound on Earth and is vital natural resource for human
Several studies have identified the prevalence of living
health and essential to life. It is most important that water
amoeba in Asia, including Thailand, China, and India (6).
that people drink and use for other purposes must be clean
The Acanthamoeba spp. incriminated in human infections
water. The presence of microbial pathogens in source
can cause rare, but severe infections. They cause amoebic
waters, drinking water and recreational water bodies is a
keratitis, granulomatous amoebic encephalitis, and
global problem. Microbial contamination of drinking water
disseminated granulomatous amoebic diseases (e.g., skin,
contributes to disease outbreaks and background rates of
sinus,
and
pulmonary
infections) (7).
The
disease in developed and developing countries worldwide
genus Naegleria was originally grouped with the (1). Control of waterborne disease is an important element
Amoebozoa because of having an amoeboid stage.
of public health policy and an objective of water suppliers.
However, based on molecular phylogenetics, it is currently
Waterborne diseases caused by the consumption of
classed as part of the Excavata (8).
contaminated water can affect a large number of people in
Despite the fact that there are over thirty Naegleria
a short time (2). spp, only N. fowleri can infect humans (9). This species is
According to the World Health Organization (WHO),
most often found in warm freshwater and soil
two million people die each year because of such illnesses,
environments. It infects individuals when contaminated
the majority of whom are children under the age of five.
water containing N. fowleri enters the body by the nose and
Furthermore, roughly 663 million people still do not have
then migrates to the brain, where it causes primary amoebic
access to safe drinking water (3).Free-living amoeba, which
meningoencephalitis (PAM), which is generally deadly in
include
the
genera Acanthamoeba, Naegleria,
healthy people (10). The epidemiology studies on free-living Vahlkampfia and Vermamoeba/Hartmannella, are found
pathogenic amoebae from both fresh and ground water
all over the world. Some FLA species are potentially
have been conducted all over the world but their spreading
harmful to humans and flourish in a variety of
in the environment in Egypt is still poorly understood.
environments, including freshwater and marine Therefore, the aim of the present study was to assess the
environments (4). The global distribution of free-living
prevalence of potentially pathogenic free-living amoebae
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Open Reduction and Internal Fixation with a Small T-plate for Volar Barton Fracture Management Elsayed El Etewy Soudy, Waleed Mohamed Nafea, Ahmed Hatem Farhan, Ahmed Magdy Mohamed Ibrahim*, Nagi Mohamed Fouda
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Ahmed Magdy Mohamed Ibrahim, E-Mail: [email protected]
ABSTRACT Background: One-sixth of all fractures in the emergency room are distal radius fractures. It is very important to recognize and adequately treat volar Barton fractures to avoid complication of malunion and its adverse effects. Although various fixation techniques have been described, with the plate, the patient can begin early active wrist workouts performing stable reduction. Objective: Open reduction and small T-plate internal fixation of a distal radius volar Barton fracture were used to evaluate the functional outcomes for the fracture treatment. Patients and Methods: At Zagazig University Hospital, 30 patients with a volar Barton fracture were studied in prospective interventional research, the study was carried out through six months. Preoperative X-ray and CT were done and the patient was prepared for surgery. By adopting an FCR technique (flexor carpi radialis approach), the fracture was reduced, the plate was fixed, and the image intensification was utilized for confirming the results. Results: Mean operative time was 54.1±8.47 and of 30 patients operated upon, 16 patients were discharged one day after operation while the mean time lapse before surgery was 1.3±0.53. The mean time of bone union was 6.5±0.89 weeks (range 5-8 weeks). There was a significant improvement in wrist range of motion in all directions postoperatively. 2 patients (6.7%) had superficial infection, 1 patient (3.3%) had tourniquet paralysis, 1 patient had stiffness (3.3%) and another had mal-united fracture (3.3%). Conclusion: Volar distal buttressing with the Ellis T plate is easy and inexpensive, and it delivers good functional benefits. Simplistic and low-complication procedure provides precise anatomical reduction of the fracture and restoration of the wrist's shape and function. Keywords: Open Reduction and Internal Fixation, Small T-plate, Volar Barton Fracture.
INTRODUCTION
reduction under direct vision, reliable internal fixation, a
One-sixth of all fractures in the emergency room are
shorter period of immobility, and a faster return to normal
distal radius fractures. It is typical among the older
exercise. There are several ways to treat fractures of this
population to suffer from this type of injury (1). As far as
type, but the T-plate is a simple and successful one (9).
distal radius fractures issue, they can only occur between
This study was designed to evaluate the functional
the radiocarpal joint and up to 3 cm away from that point.
outcomes of volar Barton distal radius fractures treated
In most cases, they're closed and the skin that covers them
with open reduction and tiny T-plate internal fixation.
is intact. They're called complicated since they frequently
include injuries to the nearby ligaments and cartilage (2). PATIENTS AND METHODS
There are a variety of therapy options out there,
At Zagazig University Hospital, 30 patients with volar
including closed reduction and plaster application as well
Barton fractures were studied for six months in prospective
as external fixation and open reduction and internal
interventional research. All cases with volar Barton
fixation (ORIF) (3). To prevent long-term dysfunction, the
fracture that fulfill the inclusion criteria were included in
best therapy is important to give optimal anatomical
one study as a comprehensive sample.
reduction and repair of fracture fragments (4).
Operative intervention should only be considered if the Ethical considerations:
fracture is unusually complex or if the surgeon has As long as all participants signed informed consent
extensive experience with the various treatment options forms and submitted them to Zagazig University's (5,6). John Rhea Barton's fracture is a distal end of the radius Research Ethics Committee, the study was allowed
fracture that includes the dorsal or volar rim and extends (ZU-IRB#6228). We followed the World Medical
into the intraarticular region. It is named after Barton. Rare Association's ethical code for human experimentation,
as they are, intra-articular fractures usually occur as the the Helsinki Declaration.
result of either low or high-energy trauma. Their Inclusion criteria: Adult patients from both genders with
percentage of distal radius fractures is just 1.3 percent (7).
volar Barton fracture and the Fracture not more than 14
In the early 1950s, James Ellis from England began
days ago.
employing a specifically designed T plate to support the Exclusion criteria: Patients who had associated forearm
little marginal fragment in volar Barton's fractures. The
fractures, open fractures, extra-articular fractures, and
AO group developed plates for distal radius fractures in the
patient whose follow-up was lost had been omitted from
1970s (8). Open reduction and internal fixation are
the trial.
preferable over conservative treatment because it allows
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c:\work\Jor\vol852_131The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4246-4252
Prevalence of Musculoskeletal Disorders among Kasr-Alainy Hospital Medical Students Hend S. Mohamed
Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
Email: [email protected], Mobile:00201118513537
ABSTRACT Background :Musculoskeletal disorders (MSDs) are significant health issues affecting a great majority of individuals and highly prevalent among medical university students. It has various modifiable risk factors.Objectives: To assess the prevalence of musculoskeletal disorders among Medical University students and determine their associated factors. Methods: A cross-sectional study was conducted from October 2018 until September 2019. It included 370 students selected by stratified random sample. A structured questionnaire was used consisting of socio-demographic characteristics, Nordic Musculoskeletal Questionnaire, and Global Physical Activity Questionnaire. Results:Eighty-two percent of the students had musculoskeletal disorders during the past 12 months. These disorders were significantly higher among students with positive family history, practice low level of physical activity or inactive, sitting a long time in stretch position and long study hoursp<0.01.Conclusion :The prevalence of MSDs among the students was high interfering with their work and attending lectures. It can lead to long-term complications and negatively compromise their quality of life and academic achievement. Authorities have to be aware of this health issue so they can set control measures, cost-effective national interventions, and programs. Keywords: Low back pain, Medical University Students, Musculoskeletal disorders.
INTRODUCTION
interactions, and lowers the overall health status (6). Not
Musculoskeletal disorders (MSDs) are significant
only MSDs have the quality of life compromising effect
health issues affecting a great majority of individuals. The
but also have a negative economic impact on society and
recent analysis of the Global Burden of Disease data
at the individual level (7).
revealed that the worldwide prevalence of MSDs is 21.9%
The high prevalence of MSDs among Medical
affecting all ages with continuous increase. It contributes
University students is of high concern and its impact is
to 17% of all years lived with disability (YLDs) worldwide
extensive. Medical students are the future doctors and will (1). The prevalence of MSDs among university students is
promote the health of the community. Despite the
increasing with alarming figures. Various researches have
significant burden of MSD and having modifiable, highly
reported the prevalence range was between 32.9% and
preventable risk factors (8). It has been underestimated or
89.3% in several countries (2). The highest prevalence was
even ignored. No sufficient studies have investigated MSD
among medical university students. They suffer from neck,
in the scientific literature. It hasn't been a focus of health
shoulder, and lower back MSDs in the form of chronic
programs, especially in low-income and middle-income
aches, pain, discomfort, or numbness. This high prevalence
countries. In the Eastern Mediterranean Region (EMR), the
can be attributed to the various modifiable risk factors (3).
epidemiological data on MSD are sparse and are not easily
Medical students are exposed to physical stress from
comparable (9). The current study aimed to assess the
the prolonged time of attending lectures, prolonged bad
prevalence of MSD among medical students and determine
posture, and long clinical training hours. Students spend a
its associated factors. This can support policymakers and
long time studying and on computer usage. They have no
program planners in planning supportive and preventive
time to practice physical activity leading to increased BMI
measures for enhancing the quality of life for future
and obesity. Students carry heavy backpacks which
physicians.
increase the risk of developing low back pain (4). Moreover,
it was shown that trauma, positive family history of MSD, MATERIALS AND METHODS
and excessive caffeine intake were among the risk factors leading to adverse consequences (5). Study design and study setting
Musculoskeletal disorders are major causes of
This descriptive cross-sectional was conducted at the
chronic pain, illness, impaired educational attainment,
Faculty of Medicine, kasr Alainy from October 2018 until
reduction of quality productivity, and increased
September 2019.
absenteeism which will compromise students' future Study population and sampling
careers. It negatively affects the mood leading to
The total number of students in all six grades was
irritability, anxiety, depression, disability, poor social
approximately 12000 students. The sample size was
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c:\work\Jor\vol852_132The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4253-4256
Correlation between Metabolic Syndrome and Psoriasis Amin Mohamed Amer,Somaia Gamal Mohamed*, Waleed M. Albalat
Dermatology, Venereology and Andrology Department, Faculty of Medicine Zagazig University *Corresponding author: Somaia Gamal, Email:[email protected] ABSTRACT Background: Psoriasis is a chronic inflammatory disease that is mediated by the immune system. It was thought to be a specific skin condition, but numerous studies have shown that it is a systemic disorder, as well as psychological difficulties like shyness, low self-esteem, and anxiety are related with it. Resistin is considered to be an important modulator of chronic inflammation. Objective: Todetermine serum level of resistin and C-reactive protien (CRP) in psoriasis vulgaris patients with metabolic syndrome (MetS). Patients and Methods: Clinical examinations were performed on 40 patients ranging in age from 28 to 53, and venous blood samples were collected. Tests were performed on the blood samples to identify levels of, resistin, and C-reactive protein (CRP). Results: levels of resistin were elevated with increased severity of psoriasis as measured by Psoriasis Area/Severity Index (PASI) score with statistically significant relation; p value (0.04), PASI score also was positively associated with elevated CRP levels; p value (0.001) . Conclusion We conclude that resistin levels provide important value to optimize medical treatment and improve clinical outcomes in patients with psoriasis . Keywords: CRP, Diabetes mellitus, Hyperlipidemia, Hypertension, Obesity, Psoriasis, Resistin.
INTRODUCTION
Psoriasis and psoriatic arthritis appear to benefit
Itchy or painful lesions at various parts of the
from weight loss in patients who are overweight or
body, as well as psychological negative effects can be
obese, particularly when combined with other drugs.
caused by psoriasis, which is a chronic,
Psoriasis may benefit from calorie restriction in
hyperproliferative, inflammatory, immune-mediated
obese patients, which has been proven to reduce
skin condition of varying severity. In addition, it is
levels of circulating inflammatory cytokines (6).
linked to a number of other health conditions, including,
As a marker of low-grade inflammation and a
diabetes mellitus, cardiovascular disease, hypertension,
risk factor for cardiovascular disease, CRP is highly
depression as well as obesity (1).
sensitive one. Obese children had higher levels of
When the Th-1, Th-17, and Th-22 cells expand
systemic CRP has been linked to an increased risk of
and become activated in the skin of psoriasis patients, this
developing the metabolic syndrome in early adulthood(7).
results in the local overproduction of various pro-
Compared to healthy controls, psoriasis patients have
inflammatory
mediators
by
lymphocytes
and
higher levels of CRP and a substantial drop in CRP as
keratinocytes in the skin of psoriatic patients as an T-cell
the PASI score lowers. Psoriasis has been linked to
mediated inflammatory reaction, such as IL-6,
CRP, according to Coban et al. higher CRP levels were
interleukin 1, interleukin 17, interleukin 22 and
detected in psoriasis patients; the PASI score and CRP
interleukin 23, tumour necrosis factor (TNF)-alpha,
levels had a substantial connection (8).
interferon-alpha as well as vascular endothelial growth
psoriasis, obesity, and cardiovascular disease are
factor (VEGF) (2).
all linked to the proinflammatory adipokine resistin.
Pro- or anti-inflammatory adipokines may play
Adipose tissue-derived macrophages and monocytes are
a role in psoriasis patients' systemic inflammation,
the primary sources of this protein, Proof exists of a
depending on how they are expressed in the body.
correlation between resistin levels in the plasma and the
Psoriasis pathogenesis is influenced by the activation of
Psoriasis Area/Severity Index (PASI) score (9). Insulin
mature and inflammatory dendritic cells (DCs) in the
resistance is the result of decreased glucose uptake and
skin (3).
insulin sensitivity caused by resistin, a protein that
Studies have found metabolic syndrome
interferes with glucose tolerance. Proinflammatory
(MetS), and its individual parts to be more common
cytokines such as resistin also play a role in resistin's
among patients with than without psoriasis in both adult
development of a link between inflammation and
and pediatric patients (4).
metabolic symptoms, unlike other adipokines (10).
Endothelial dysfunction as well as insulin
Resistin, which is linked to obesity, inflammation, insulin
resistance have been linked to atherosclerosis, hence it is
resistance, and comorbidities of cardiovascular disease,
likely that there is a pathogenetic link between psoriasis
was found to be elevated in patients with MetS compared
and cardiovascular disease comorbidity, Because of this,
to their healthy counterparts (11).
there is a lot of interest in identifying risk factors for
The aim of the present study was todetermine serum
atherosclerosis in people with psoriasis (5).
level of resistin and C-reactive protien (CRP) in
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Hematological Indices in Chronic Kidney Disease Patients and The Effect of Hemodialysis on These Indices Alshabrawy.M.Abdelnabi, Emam Mohamed Mohamed Ismaeyl, Ahmed Mohamed Mohamed Abdellatif*
Internal Medicine Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt. *Corresponding Author: Ahmed Mohamed Mohamed Abdellatif, Email: [email protected] ABSTRACT Background: Chronic kidney disease (CKD) is a major health issue that affects people all over the globe. Hematological problems are connected to varying grades of CKD. Objective: To study the relationship between chronic kidney disease and hematological indices, and to study the effect of hemodialysis on these parameters. Subjects and Methods: At Internal Medicine, Faculty of Medicine, Zagazig University, Sharkia, Egypt. we conducted this cross-sectional study in addition to the Nephrology Unit of El-Sahel teaching hospital from May 2019 to February 2020 on 165 subjects categorized into three groups with each group of 55 subjects. Group I included normal healthy persons. Group II involved chronic kidney disease patients not on hemodialysis (NDD-CKD) while Group III included patients on maintenance hemodialysis (DD-CKD). All participants' histories were gathered, with particular attention paid to demographic data and the co-morbid medical conditions as diabetes mellitus and hypertension. Full clinical examination was done including local and systemic examinations. In addition, a complete blood count, urea, and creatinine levels were measured. Results: There is a significant association between CKD and changes in RBCs indices with a significant effect of hemodialysis on these changes. A decrease in the mean platelet count in diseased groups compared with normal ones was revealed. We also found differences between the 3 groups according to WBCs indices with significant changes between the 3 groups in TLC. Conclusion: CKD impacts all hematological parameters and hemodialysis also influence all these parameters. Keywords: CKD, Anemia, Hemodialysis, Hematology.
INTRODUCTION
indices and to study the effect of hemodialysis on these
ManyPeople from all around the world are
parameters.
affected by chronic kidney disease. Patients with ESRD
use a significant number of healthcare services and have SUBJECTS AND METHODS
a higher rate of death, morbidity, and a lower standard
Technical design: Internal medicine and nephrology
of living than the general population. CKD is a term that
units at Zagazig University and the El-Sahel Teaching
refers
to
a
group
of
primary
disease
Hospital were used in this cross-sectional study from
pathologies resulting
in
functional
or
May 2019 to February 2020 on 165 subjects categorized
morphological renal defects, or even both, that lasts at
into three groups with each group of 55 subjects. Group
least three months (1).
I included normal healthy persons. Group II involved
Hematological problems are connected to
chronic kidney disease patients not on hemodialysis
varying grades of CKD. CKD patients are prone to
(NDD-CKD) while Group III included patients on
anemia. Serious grades of anemia can impair
maintenance hemodialysis (DD-CKD).
the cardiac health in CKD patients, in addition to
causing debilitating symptoms. Patients with lower Hb Inclusion criteria: included patients of both sexes, aged
levels had a higher risk of cardiovascular complications
more than 18 years, and known to have chronic kidney
and mortality and it can hasten the advancement of non-
disease with documented increased renal profile more
dialysis CKD patients to end-stage renal disease
than 3 months ago.
(ESRD) (2). There are also great changes in the Exclusion criteria: We excluded patients with a
hematological parameters in those patients as Hb%,
previous
long-term
systemic
treatment
with
RBC count, HCT, MCHC, RDW, MCV, or MCH. Total
immunosuppressive drugs, major bleeding in the past
and differential white blood cell (WBC) counts are two
three months, recent infection, primary known
other commonly impaired blood parameters in CKD
hematological disease, HIV infection, life-threatening
that have yet to be completely characterized concerning
malignancy, or current multiple myeloma. Pregnant or
CKD (3). Platelet disorders have been discovered to be
lactating women or patients who had a blood transfusion
an important method for grading severity in CKD
in the past 3 months were also excluded from the study.
patients. MPV is a clear indicator for platelet activation
due to inflammation, which is elevated in patients with Methods: A full history was taken from all participants
CKD. When platelets are activated, they get bigger (4).
with stress on the demographic data and the co-morbid
The present study aimed to study the relationship
medical conditions as diabetes mellitus and
between chronic kidney disease and hematological
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c:\work\Jor\vol852_134The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4263-4267
Role of Inflammatory Markers in the Differential Diagnosis of Bleeding in Early Pregnancy Nehad M. Hosni*, Iman A. Ahmedy, Ayman Elsayed Solyman
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt *Corresponding author: Nehad M. Hosni, Mobile: (+20)01063035400, Email: nehadm. [email protected] ABSTRACT Background: Defective placentation as a cause of many pregnancy-related conditions including abortion and ectopic pregnancy will involve abnormal inflammatory response. Assessment of different inflammatory markers as neutrophil- lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) may aid in the differentiation of causes of bleeding in early pregnancy. Objective: To verify the ability of NLR, PLR, and LMR to differentiate cases of miscarriage or ectopic pregnancy from normal pregnancy in patients presenting with bleeding in the first trimester. Patients and Method: A prospective observational study of 150 patients presenting with bleeding in the first trimester were enrolled in the study. After history taking, clinical examination, ultrasound, quantitative beta-human chorionic gonadotropin (B-hCG), or laparoscopy, patients were allocated into three groups: miscarriage group (60 patients), ectopic pregnancy group (30 patients), and control group (60 patients) who continued their pregnancy beyond 20 weeks. For all patients NLR, PLR, and LMR were calculated. Results: NLR was significantly higher and LMR was significantly lower in ectopic pregnancy group when compared to the miscarriage group or the normal pregnancy group. A cutoff level of > 2.7 for NLR and < 3.7 for LMR has a sensitivity of 80% and 70%, and a specificity of 60 % and 80 %, respectively. Conclusion: Utilization of both NLR and LMR will aid in the differentiation of cases of ectopic pregnancy from normal pregnancy or miscarriage with an acceptable sensitivity and specificity. Keywords: Ectopic, Inflammatory markers, LMR, Miscarriage, NLR.
INTRODUCTION
mortality in young women. The world-wide prevalence
Implantation which is a flawless dialogue between
of ectopic pregnancy is around 1-2% per number of
the blastocyst and endometrium/decidua involves a
pregnancies (8). UK Confidential Enquiry into Maternal
local inflammatory response that allows cell clearance,
and Child Health (CEMACH) reported a maternal
cell growth, angiogenesis, and tolerance (1). Disruption
mortality rate due to ectopic pregnancy of 0.3 per
of this process will result in defective placentation
100000 maternities (9).
which is responsible for many pregnancy-related
Despite the great advances in ultrasound machines
conditions (2,3).
and the administration of sensitive assay of B-subunit
It entails abnormal inflammatory response, hence,
of human chorionic gonadotrophins (B-hCG), the
the idea of employing different inflammatory markers
differentiation between intrauterine pregnancy and
as prognostic and/or diagnostic indicators.
ectopic pregnancy remains problematic in some cases.
Bleeding in early pregnancy is one of such
CBC which is a simple and routine investigation in such
conditions that is relatively common. Approximately
cases may be utilized to give a clue for the diagnosis.
one fourth of pregnant women will experience bleeding
NLR, PLR, and LMR have been proposed to
in the first trimester (4). It does not always mean there is
differentiate between causes of bleeding in the first
a problem. However, it may signal grave complications
trimester (15).
as miscarriage and ectopic pregnancy. Miscarriage
The aim of this study is to verify the ability of
affects woman not only physically but psychologically
NLR, PLR, and LMR to differentiate cases of
as well. The American College of Obstetricians and
miscarriage or ectopic pregnancy from normal
Gynecologists (ACOG) estimated that as many as 26%
pregnancy in patients presenting with bleeding in the
of all pregnancies end in miscarriage (5).
first trimester.
The frequency of clinically recognized early
pregnancy loss for women aged 20-30 years is 9-17%, PATIENTS AND METHOD
and this rate increases sharply from 20% at the age of A prospective observational study was conducted
35 years to 40% at the age of 40 years (6). Approximately
at the Obstetrics and Gynecology Department,
80% of all cases of pregnancy loss occur within the first
Menoufia University Hospital from March 2020 to
trimester (7).
September 2021 including 150 patients who were
On the other hand, ectopic pregnancy is a major
presenting by bleeding in early pregnancy.
health problem that may cause serious morbidity and
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c:\work\Jor\vol852_135The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4268-4274
Video Assisted Laryngoscope versus Conventional Macintosh for Pediatric Intubation by Beginner Anesthesiologists Nada Mostafa Ibrahim El-Komy*, Kamelia Ahmed Gamal Eldin Abaza, Farahat Ibrahim Ahmed, Ashraf Elsayed Ahmed
Anesthesia, Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Nada Mostafa Ibrahim El-Komy, E-mail: [email protected] ABSTRACT Background: Tracheal intubation is most usually facilitated by the use of a conventional Macintosh laryngoscope. Video and indirect laryngoscopes are becoming more significant tools in the management of the airways in children. Objective: To compare the time of intubation, the number of tries, and the success rate of pediatric intubation by beginner anesthesiologists using a video laryngoscope versus conventional Macintosh laryngoscope.
Patients and Methods: Thisprospective randomized, single-blind clinical was conducted atZagazig University Hospitals on 52 children aged from 2-6 years who were undergoing elective surgeries. VL Group: (n; 26 patients) intubation using video assisted laryngoscopy (Hugemed type). ML Group: (n; 26 patients) intubation using conventional Macintosh laryngoscope. Duration of intubation, number of trial, hemodynamic response as well as oxygen saturation were recorded at different intervals (base line, after induction, during intubation, after intubation) with assessment of complications.
Results: As regard the efficacy and the safety of intubation those patients in ML group had lower intubation time than VL group. There was statistical difference as regard complications of endotracheal intubation as trauma, which was higher in ML group.
Conclusion: With the use of a video-aided laryngoscope, it is possible to safely and under supervision to insert an airway into a patient with a difficult airway.
Keywords: Conventional Macintosh, Pediatric Intubation, Video Assisted Laryngoscope.
INTRODUCTION
challenging, however it is estimated that 47 intubation
In order for anesthesia and cardiac resuscitation to
attempts yield a success rate of 90% (6).
be successful, airway management must take place,
"Can't intubate can't ventilate" was the most
whether or not tracheal intubation is used. As a result,
common primary airway difficulty reported by patients
it may pose a difficulty to less-experienced
who had complicated, delayed or unsuccessful
anesthesiologists, airway obstruction causes fast
intubation (7). Indirect laryngoscopes come in a variety
desaturation in infants and children because their
of shapes and sizes. Prototypes and examples of
airways are very different from adult ones (1).
pediatric products are available from a number of
Patients requiring neuromuscular paralysis and
companies. On the market now are the new McGrath
positive pressure ventilation often have tracheal
pediatric size 2 video laryngoscope, Truview, Storz
intubation performed in the operating room after
video laryngoscope (Glide Scope), Airtraq, Pentax
anesthesia has been initiated (2). Anesthesiologists face
AWS (8).
unique challenges while managing an infant or child's
Video laryngoscopes, as well as indirect
airway (3).
laryngoscopes are becoming increasingly significant in
A wide range of factors influence upper airway
the management of airways in children. Attaching a
space, causing difficulties with mask breathing,
camera to the blade's tip may provide a better view of
obstructing spontaneous ventilation, and making
the glottis in both normal and troublesome pediatric
laryngoscope use become harder. It is also possible for
airways (9).
upper airway obstruction to occur because of hypnotic,
Laryngoscopes that use a magnifying mirror, a
sedative, and anesthetic medication use (4).
light source, and a guide are known as video
Tracheal intubation is most usually facilitated by
laryngoscopes/indirect
laryngoscopes.
Pediatric
the use of a conventional Macintosh laryngoscope (5).
anesthesia is more challenging for the teacher and
Inexperienced medical workers may find it
learner to see eye-to-eye using a conventional
Macintosh laryngoscope. As a result, an indirect
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c:\work\Jor\vol852_136The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4275-4278
Treatment of Multiple Common Warts by Intralesional Immunotherapy: Review Article Aya Elsayed Elaraby*, Ahmad Abd Elgawad Nofal, Basma Magdy Elkholy
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Aya Elsayed Elaraby, E-Mail:[email protected] ABSTRACT Background: Human papillomavirus (HPV) is the most prevalent cause of warts on the skin and mucous membranes of the human body. With the aid of a variety of destructive and immunotherapeutic methods, wart therapy remains a major difficulty. Antigen immunotherapy by intralesional technique uses the immune system's ability to recognize viral, bacterial, and fungal antigens that elicit a delayed-type hypersensitivity reaction, not only to the antigen but also to the wart virus, which in turn boosts the immune system's ability to recognize and remove HPV. All lesions on the body, not just the injected one, could be destroyed by this boosted immune response. Different antigens, including Candida and pure protein derivative (PPD), have been shown to be useful in the treatment of various wart forms. Objective: Intralesional immunotherapy for numerous common warts is to be evaluated for its effectiveness. Conclusion: There has been substantial research into the use of intralesional vaccinations and organic antigens to treat warts, with good results of effectiveness. Keywords: Intralesional immunotherapy, Multiple common warts.
INTRODUCTION
Children are more likely to have them. Sexually active
The human papillomavirus (HPV) causes warts,
women are estimated to have 12 percent of genital warts
which are frequent, benign proliferations of the epidermis. (2). There are more than 150 different varieties of this non-
However, despite the fact that they can be seen allover, it
enveloped DNA virus. Sexual contact can spread some
is more typical to observe them on face, genitalia, feet and
HPV strains. Towels and washcloths, for example, are
hands. Around seven percent to ten percent of patients
common objects that most diseases are conveyed through
seeking medical advice in dermatology departments
skin-touch. Breaks in the skin, like a hangnail or a scrape,
worldwide are affected by warts. The most prevalent
are the most common ways the virus spreads to new cases.
sexually transmitted disease is genital warts. Infection
Warts on the fingertips and in the vicinity of the nails can
with HPV causes the formation of verrucae, which are
also spread as a result of nail biting. HPV causes warts in
typically 1- to 20-mm-diameter epithelial proliferations on
some people, however not all people who come into touch
mucus membranes and the skin (1).
with the virus develop warts (3).
Medically, warts are frequent, especially among white
The aim of this review of intralesional
people. 11.7 percent of the world's population is expected
immunotherapy for numerous common warts is to be
to have HPV, Eastern Europe (21.4 percent), Eastern
evaluated for its effectiveness.
Africa (33.6 percent), and the Caribbean (35.4 percent).
Types of warts (Figure 1): Figure (1): Different types of warts (4).
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c:\work\Jor\vol852_137The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4279-4283 Chemerin Level in the Serum of Knee Osteoarthritis Patients and its Relation to Disease Severity Fadia A. Abd Elghany1,Eman S. Algharabawy2,Aziza B. Shehatah*1,Ibrahim T. Abd Elal1
Departments of 1Rheumatology and Rehabilitation, 2 Medical Microbiology and
Immunology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Aziza B. Shehatah, E-mail:[email protected] ABSTRACT Background: Chemerin is a new adipokine that has been linked to joint inflammation and degeneration. It has a pro- inflammatory effect and modulates immune system activity. Objective: The aim of the work was to assess the chemerin role in diagnosis as well as monitoring of severity of the disease in knee osteoarthritis (KOA) patients. Patients and Methods: This case-control study included a total of 60 subjects, 30 of them had knee osteoarthritis (KOA) and 30 served as controls, attending at Department of Rheumatology, Rehabilitation, and Physical Medicine, Zagazig University Hospitals. Chemerin level was measured for all the subjects by ELISA technique. In osteoarthritis group, knee osteoarthritis was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: Statistically insignificant differences in age, BMI, as well as sex were found among the 2 studied groups.Serum chemerin levels in patients with KOA were statistically significantly higher than in controls, with a p-value of 0.001. Serum chemerin had no statistically significant correlations to age, BMI, or length of illness, while WOMAC scores, CRP, as well as ESR were strongly associated with serum chemerin levels. Conclusion: It could be concluded that serum chemerin can be utilized as an inflammatory marker in KOA patients and it can be considered as a therapeutic target. Further studies are recommended to assess its levels in other types of OA, and other rheumatic diseases. Keywords: Chemerin, Knee osteoarthritis, Disease severity INTRODUCTION
For the first time, it has been discovered that the
As a systemic, chronic, and debilitating illness of the
receptor 23 (Chem23) of the chemerin molecule has
joints, osteoarthritis (OA) affects many people all over
powerful chemotherapeutic activity, which is
the world (1).
accompanied with enhanced production of inflammatory
A progressive degradation of the articular cartilage,
mediators (8, 9).
as well as alterations in the subchondral bone, and to a
Serum chemerin levels in OA patients have been
lesser extent, the synovium are hallmarks of primary and
studied, however the results were diverse. In those
secondary osteoarthritis (2).
patients chemerin levels have been linked to tumor
As a rule, knee pain is the most prevalent site of
necrosis alpha (TNF-), C-reactive protein, as well as
injury, followed by hand and hip pain (3). Osteoarthritis
interleukin-6 (IL-6) levels implying an inflammatory
affects around eighteen percent of women and ten
component (10).
percent of men aged more than sixty and is the 10th
The aim of the current work was to assess the
major cause of disability (4). Metabolic variables, gender,
chemerin role in the diagnosis as well as monitoring of
age, trauma as well as obesity are all risk factors for
severity of the disease in knee osteoarthritis (KOA)
osteoarthritis. OA's pathophysiology hasn't been
patients,
outlined in any detail (5).
Chondrocytes, endothelial cells, synoviocytes, and SUBJECTS AND METHODS
other cells of the connective tissue release Chemerin
This case-control study included a total of 60
(163 amino acids in length), a protein that acts as a
subjects, 30 of them had knee osteoarthritis (KOA) and
chemoattractant (6), insulin resistance, adipolipidemia,
30 served as controls, attending at Department of
hypertension, as well as low-grade inflammation may all
Rheumatology, Rehabilitation, and Physical Medicine,
be linked to increased levels of this molecule. There are
Zagazig University Hospitals. This study was
two primary receptors for its biological activity, G
conducted between June 2020 and June 2021. This study
protein-coupled protein 1 (GPR1), and chemokine-like
was approved by Institutional Review Board of Zagazig
receptor 1 (CMKLR1) (7).
University.
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Study Of Interleukin-8-251 A/T (Rs4073) Polymorphism in Paediatric Bronchial AsthmaThe Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4284- 4289 Microalbuminuria as a Predictor of Outcome in Non-Diabetic Patients Undergo Percutaneous Coronary Intervention for Acute Coronary Syndrome Ayman Osama Khalil*, Abd El-Fattah Hassan Frere, Magdy Mohammad Abd El-Samei and Mohammad Mustafa Al-Daydamony
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt *Correspondence: Ayman Osama Khalil, Mobile: (+20)01007195995, Email: [email protected] ABSTRACT Background: Acute coronary syndrome (ACS) is a medical emergency requiring prompt diagnosis and care. Percutaneous coronary intervention (PCI) has become integral part of management of coronary artery disease (CAD) and become lifesaving in acute STEMI patients. Microalbuminuria (MA) is a common phenomenon in patients with cardiovascular disease. Objective: To assess importance of microalbuminuria as a predictor of outcome in non-diabetic patients undergoing PCI for ACS. Subjects and methods: This study was conducted on 123 patients admitted with ACS and were divided equally into three groups [unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI) and STEMI). The patients were then divided into patients with negative and positive microalbuminuria (MA). Echocardiography, coronary angiography and estimation of microalbuminuria level were done to all patients. Results: Mean age of patients 54.94 ± 9.86 years. There were 28 females (22.8%) and 95 males (77.2%). MA was more common in smokers than non-smokers were. There was statistically significant decrease in EF% and increase in WMSI in patients with positive MA than those with negative MA. There was statistically significant increase in the complications and mortality rate in patients with positive MA than those with negative MA. The univariate logistic regression analysis showed statistically significant association between presence of MA and wall motion score index (WMSI) >1.25, amount of dye > 160 ml, no reflow, occurrence of complications, EF pre 55%, and EF post 59%. Conclusion: Albuminuria was a strong predictor of outcome in non-diabetic patients underwent PCI for ACS. Keywords: Acute coronary syndrome, Percutaneous coronary intervention, Microalbuminuria. INTRODUCTION
Acute coronary syndrome (ACS) is a term used to
urine sample instead of traditionally 24-hour
describe a range of conditions associated with
collections (4).
sudden, reduced blood flow to the heart. It often Schrader et al. (5) showed that patients with
causes severe chest pain or discomfort. A medical
higher proteinuria are at risk of developing higher
emergency requires prompt diagnosis and care. The
degrees of ACS with adverse outcomes. Deveci et al.
goals of treatment include improving blood flow, (6) found MA to be an independent predictor for the
treating complications and preventing future
presence and severity of CAD. They concluded a
problems (1).
strong relationship between MA and the severity of
Percutaneous coronary intervention (PCI) is a
CAD. Paudel et al. (7) concluded that there is
nonsurgical technique for treating obstructive
increased prevalence of microalbuminuria in ACS
coronary artery disease, including unstable angina,
patents. MA was associated with statistically higher
acute myocardial infarction (MI), and multivessel
number of cases with history of smoking and
coronary artery disease (CAD) (2).
hypertension and presence of increasing number of
Albuminuria is the most widely evaluated marker
risk factors.
of renal damage. Microalbuminuria (MA) is a known
The aim of this work was to assess importance of
marker of vascular permeability and endothelial
microalbuminuria as a predictor of outcome in non-
dysfunction and has been found to be predictive of
diabetic patients who underwent PCI for ACS.
outcome in a wide variety of chronic and acute
conditions, such as neoplastic disease, surgery, acute PATIENTS AND METHODS
pancreatitis and trauma (3).
This prospective cohort study was conducted on 123
Microalbuminuria is a predictor of kidney
patients of acute coronary syndrome, at Cardiology
dysfunction mainly in diabetic and hypertensive
Department, Faculty of Medicine, Zagazig University
patients. In addition, there was a correlation between
and in Cardiology Department, Air Force Military
high levels of microalbuminuria and the poor
Hospitals through the period from March 2020 till
outcomes seen in patients with ACS. MA can be
April 2021 to measure levels of microalbuminuria in
estimated easily nowadays through the dosage of the
non-diabetic patients with ACS. The patients were
albumin-to-creatinine ratio (ACR) through a simple
divided into 3 groups (41 patients in each group).
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/)
4284
Received: 04/08/2021 Accepted: 30/09/2021
c:\work\Jor\vol852_139The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4290- 4294
Comparison of Closure Versus Non-Closure of Buccal Mucosal Graft Harvest Site Outcomes in Urethroplasty Mohamed Mahmoud Hassan Abdallah, Aref Mohamed Maarouf, Islam Elsayed Mohamed Kesba*,Kareem Mahmoud Taha
Department of Urology, Faculty of Medicine, Zagazig University, Sharkia, Egypt *Corresponding author: Islam Elsayed Mohamed Kesba, Mobile: (+20)01097997150, Email: [email protected] ABSTRACT Background: Urethroplasty is open surgical reconstruction of urethral stricture disease and it depends on the site of stricture and the used technique either by excision and primary anastomosis, on-lay repair, stricture excision and augmented anastomosis, flap-based repair, and staged repair. Objective: This study aimed to improve postoperative outcomes of the buccal mucosal graft harvest site by comparing closure versus non-closure of the harvest site. Patient and Methods: This prospective comparative study was conducted on 34 patients with urethral stricture planned to be managed by buccal mucosal graft (BMG) urethroplasty. Those 34 patients attended to urology outpatient clinic at Zagazig university hospital from September 2019 to December 2020. Results: Intraoperatively, two patients were found to have short stricture (approximately 1 cm) with dense spongiofibrosis and they were managed by anastomotic urethroplasty. Post-operative pain was maximal on the first day in both groups but it was more significant in the closure group by the second day. Conclusions: Buccal mucosal graft harvesting is well tolerated by all patients. The pain appears to be worse in the immediate postoperative period after suturing the harvest site. Keywords: Buccal mucosal graft (BMG),Urethroplasty,Urethral stricture INTRODUCTION
Urethral stricture is a urological disease that
characters of stricture and the surgeon preference, one
affects up to 0.6% of the male population and its
of these techniques is used(6).
surgical repair can represent a challenge(1).
This study aimed to improve postoperative
Endoscopic management of urethral stricture
outcomes of the buccal mucosal graft harvest site by
disease is more common than open surgical
comparing closure versus non-closure of the harvest
reconstruction and it is achieved by direct visual
site.
internal urethrotomy (DVIU) which has the advantages
of being a simple transurethral approach with low PATIENTS AND METHODS
morbidity and minimal invasiveness compared to open Study design: Thirty-four patients underwent BMG
urethral reconstruction(2).
urethroplasty and were randomized into two groups
Urethroplasty is open surgical reconstruction of
depending upon whether the graft harvest site was
urethral stricture disease and it depends on the site of
closed (group 1) or left open (group 2). The method of
stricture and the used technique either by excision and
randomization was every alternate patient (1:1 ratio)
primary anastomosis, on-lay repair, stricture excision
undergoing buccal mucosal harvesting assigned to
and augmented anastomosis, flap-based repair, and
group 1 or 2. Four patients lost to follow-up. Only 30
staged repair(3).
patients completed the study.
In cases where the simple excision and primary
anastomosis of the stricture cannot be achieved, a Inclusion criteria: Patients with urethral stricture
urethral substitute is a must in these cases to maintain
disease undergoing urethroplasty using buccal mucosal
the continuity of urethral passage. The process of using
graft attending urology department during the study
a urethral substitute is called substitution or
period from September 2019 till December 2020.
augmentation
urethroplasty
which
involves Exclusion criteria: Bleeding tendency, oral pathology,
augmentation or replacing the circumference of the
and constraints of harvesting buccal mucosa.
diseased urethra using a patch or tube respectively of
suitable material derived from genital or extra-genital Ethical Consideration:
tissue flaps or grafts(4). Written Informal consent was obtained from Barbagli et al.(5) described the dorsal onlay free the patient and relative to participate in the study.
graft urethroplasty which is subsequently used Informed consent from each patient after being
worldwide for the treatment of bulbar and pendulous informed in detail about the procedure. The
urethral strictures. approval for the study was obtained from the
After that, some modifications for this technique Urology Departments of Zagazig University
have been used including dorsal inlay, dorsolateral and Hospitals after the approval of the Institutional
ventral onlay graft urethroplasty and according to the Review Board (IRB). The work was carried out
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c:\work\Jor\vol852_140The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4295-4302
Analgesic Effect of Intra-Articular Dexamethasone versus Fentanyl added as an adjuvant to Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery Hazem El Sayed Moawad Weheba*, Mohamed Ahmed Sultan, Tawfik Abouhalawa Tawfik Hassan, Hosam I. El Said Saber
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt *Corresponding author: Hazem El Sayed Moawad Weheba, Mobile: +201121516041 - +201012805817, E-mail: [email protected] - [email protected] ABSTRACT Background: Knee arthroscopy is usually associated with a variable degree of pain ranging from moderate-to-severe pain in about 70% of patients. Objective: This trial was designed to assess the efficacy of intra-articular administration of dexamethasone versus fentanyl as adjuncts to bupivacaine in patients undergoing arthroscopic knee surgery. Patients and methods: Eighty-nine patients of either sex were enrolled in this study. The patients were randomly divided into three equal groups. Group F that received intra-articular (IA) injection of 1 g/kg fentanyl (In 2 ml saline) added to 18 ml of 0.25% bupivacaine, group D, which received IA injection of 8 mg (2 ml) dexamethasone added to 18 mL of 0.25% bupivacaine and group S that received IA injection of 2 ml normal saline added to 18 mL of 0.25% bupivacaine. Results: The time required for the first request of analgesia in group F, group D, and group S was 5.7 ± 0.7 vs 4.5 ± 0.5 vs 3.3 ± 0.5 hours respectively. There were significant differences between both treatment groups and the control group (p< 0.001) and in between both treatment groups (p< 0.001) in favor of group F. There was a significantly lower median visual analogue score in group F when compared to group D and S at 6 hours (p = 0.006 & 0.01, respectively), 12 hours (p< 0.001 & < 0.001, respectively), and 18 hours (p = 0.003 & 0.007, respectively) postoperatively. Conclusion: The addition of fentanyl or dexamethasone to IA bupivacaine in knee arthroscopic surgery provided a better quality of analgesia with less consumption of systemic analgesics without significant adverse effects. Keywords: Knee arthroscopy, Fentanyl, Dexamethasone INTRODUCTION
provide long-lasting postoperative analgesia (8). The use
Knee arthroscopy is a minimally invasive
of bupivacaine and opioids in conjunction was proved
surgical procedure commonly performed on a day-case
to act through different mechanisms. They have a
basis. However, knee arthroscopy is usually associated
synergistic action, thus providing longer analgesia.
with a variable degree of pain ranging from moderate-
Fentanyl is a lipophilic opioid with a rapid onset, can
to-severe pain in about 70% of patients following
prolong the duration of postoperative analgesia, and has
surgery (1). Inadequately treated postoperative pain
less side effects in comparison with morphine when
following knee arthroscopy results in delayed recovery,
combined with bupivacaine (9).
prolonged hospitalization, and increased medical care
Dexamethasone is a potent, highly selective
costs (2). Several studies have been conducted in an
glucocorticoid that can inhibit the nociceptive
attempt to find out an ideal analgesic technique that
transmission along the myelinated C fibers and when
could be safe and satisfactory (1, 3). Intrathecal opioids,
combined with local analgesics, it prolongs the duration
such as fentanyl or morphine, provide excellent
of regional blocks (10).
postoperative analgesia but may cause side effects such
This randomized-controlled trial was designed to
as urinary retention, pruritus, nausea, and vomiting (4).
assess the efficacy and safety of intra-articular
Anti-inflammatory drugs can provide good analgesia in
administration of dexamethasone versus fentanyl as
the immediate postoperative period, and usually have
adjuncts to the local anesthetic bupivacaine in patients
more serious side effects (5).
undergoing arthroscopic knee surgery.
An intra-articular (IA) injection of local
anesthetics and analgesics is a simple, effective, safe, PATIENTS AND METHODS
and practical method in decreasing patients'
This randomized double-blind study was conducted in
postoperative pain in addition to avoiding the need for
the Knee Arthroscopic Surgery Unit, Mansoura
additional analgesics (6). Bupivacaine is a local
University Hospital, from March 2019 to January 2020.
anesthetic that blocks peripheral afferent through
Eighty-nine patients of either sex with ASA (American
blocking sodium ion channels. High lipid-solubility and
Society of Anesthesiologists) physical status I or II,
large molecular size of bupivacaine result in slow
aged from 20-65 years undergoing arthroscopic knee
absorption and longer duration of action (7). However, to
surgery were enrolled in this study.
be an ideal analgesic, the drug must cover the Ethical approval:
completely postoperative period ( 24 hours), therefore, The study was approved by the Institutional
bupivacaine is usually combined with many adjuncts to Review Board (code number MS.18.09.306), Faculty This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_141The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4303-4307
A Decade of Experience with Radical Abdominal Trachelectomy after Supracervical Hysterectomy Mohamed Ayaty, Samir S. Ahmed, Eman D. El Desouky
Department of Gynecological Surgery, National Cancer Institute, Cairo University, Egypt
Corresponding author: Mohamed Ayaty, E-Mail address: [email protected], Telephone: 01004364499.
ABSTRACT Background: The supracervical hysterectomy is no longer indicated for the treatment of female genital disease. Patient and Methods: All women who had trachelectomy after supracervical hysterectomy between 2010 and 2020 had their records reviewed at Cairo University's National Cancer Institute (NCI) Hospital. Results: A total of 34 trachelectomy surgeries were performed during a ten-year period. The patients were 42 to 72 years old, with a mean +SD of 55+7.5. Recurrent vaginal bleeding was the reason for trachelectomy in 67.6% of cases due to residual disease found in hysterectomy specimens, with pathologic evidence of uterine malignancy in 47.2%, and 11.7 percent of patients had cervical malignancy. Uterine stromal sarcoma was found in 5.9% of the cases. There were 11.8% of cases with uterine fibroids, 7.8% with endometrial hyperplasia, and 2.9 % with uterine adenomyosis who had true benign lesions. There were no pathology reports available in 8.8% of the cases. The pathology of the trachelectomy revealed that 26.5% of patients had no residual disease, while 73.5% had the residual disease in the cervical stump, with 32.4% having cervical squamous cell carcinoma, 20.6% having uterine adenocarcinoma, 8.8% having cervical adenocarcinoma, and 2.9% having cervical adenosquamous. Mullerian carcinoma was found in 2.9% of the cases, whereas undifferentiated carcinoma was found in 2.9%. In 61.8% of cases, bilateral pelvic lymphadenectomy was coupled with trachelectomy for radical excision of gross malignancy. Conclusions: A significant number of patients who had a subtotal hysterectomy for apparent benign illness required trachelectomy within a few months. Keywords: Cervical stump, Trachelectomy.
INTRODUCTION
Cervical stump excision (trachelectomy) is the
Problems with retention of the cervical stump have
removal of the cervix following supracervical
been reported in 5%22% of patients undergoing
hysterectomy (SCH). Subtotal or supracervical
supracervical hysterectomy, including persistent vaginal
hysterectomy is an alternative to total hysterectomy in
bleeding, prolapse, cervical dysplasia or cancer, and less
women undergoing hysterectomy for many benign
frequent pathological surprise of cervical or endometrial
indications, advocates of this procedure hypothesized that
cancer not detected preoperatively. After a supracervical
removing the entire cervix may diminish sexual response,
hysterectomy, new cervical symptoms will develop in up
urinary function, and pelvic support while increasing
to one-quarter of women (4).
operative time and complications (1).
The American College of Obstetrics and Gynecology
Subsequent studies failed to find benefits from
reported that 1.5% of patients required a second surgery
retention of the cervix at hysterectomy. Moreover,
to remove the cervix in less than 3 months from the time
persistent symptoms in some women, mainly pelvic pain
of their original subtotal hysterectomy, and 23% of
and vaginal bleeding were the cause of subsequent force
women were required to return to the operating room for
removal of the cervical stump .The reported incidence of
excision of the cervical stump at a mean of 14 months
trachelectomy following SCH for benign gynecologic
from their first surgery (5).
disease ranges between 2% and almost 23% (2).
The subtotal hysterectomy is no longer indicated for PATIENTS AND METHODS
the treatment of female genital disease with rare
A retrospective chart review was conducted at Cairo
exceptions. It has been known for a long time that the
University's National Cancer Institute Hospital for all
remaining cervical stump has very few advantages but
women who had trachelectomy after supracervical
many potential risks. Among those who had cervical
hysterectomy between January 2010 and October 2020.
stumps removed about half of the cases had malignant
34 patients with residual cervical stumps after
changes in the cervical stump (3).
supracervical hysterectomy were included due to
pathological surprise in the final pathological report as
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c:\work\Jor\vol852_142The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4308-4313
Comparison of Post-Operative Analgesic Effects of Peritonsillar Infiltration of Dexmedetomidine, Lidocaine or Both in Children Following Tonsillectomy Hazem El Sayed Moawad Weheba*, Mohamed Mahmoud El Madany, Mohamed Aly Eloraby
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Dakahlia, Egypt *Corresponding author: Hazem El Sayed Moawad Weheba, Mobile: +201121516041 - +201012805817, E-mail: [email protected] - [email protected] ABSTRACT Background: Peritonsillar infiltration of local anesthetics has efficient pain relief in children undergoing tonsillectomy.
We hypothesize that lidocaine plus dexmedetomidine will potentiate the analgesic effect of each other rather than. Objectives: This study aimed to compare the analgesic effect of peritonsillar infiltration of lidocaine, dexmedetomidine,
or lidocaine/dexmedetomidine on post-tonsillectomy pain. The primary outcome is the time of analgesia. The secondary outcomes are postoperative pain score, the effect of study medications on postoperative hemodynamic, and complications. Patients and Methods: Ninety patients were randomly allocated to three groups, 30 patients each. L group, patients
received 2mg/kg lidocaine. D group, patients received 1 g/kg of dexmedetomidine. LD group, patients received 1 g/kg of dexmedetomidine plus 2 mg/kg lidocaine. Results: The time of the first analgesia request (h.) was longer in the LD group (13.70 ± 2.91) when compared with the
L and D groups. Postoperative pain score was significantly lower in LD and D groups compared with the L group (P <0.05) On the other hand, there was a significantly lower median VAS score in the LD group when compared with the D group (P1 <0.05) Postoperative paracetamol consumption was significantly lower in LD group (0.55 ± 0.51 gm/24h) when compared with D and L groups (0.65 ± 0.59, 2.25 ± 0.44 gm/24h respectively). Conclusion: the use of lidocaine with dexmedetomidine is better than using each drug alone in decreasing post-
tonsillectomy pain and increasing the time to first request for analgesia with no significant postoperative side effects. Keywords: Posttonsillectomy pain, Lidocaine, Dexmedetomidine. INTRODUCTION
Tonsillectomy with or without adenoidectomy
The study aimed to compare the analgesic effect
remains one of the most commonly performed surgical
of
peritonsillar
infiltration
of
lidocaine,
procedures in pediatrics. The main complications of this
dexmedetomidine, or lidocaine/dexmedetomidine on
surgery are hemorrhage, pain, nausea, vomiting, and
post-tonsillectomy pain. The primary outcome is
dehydration (1). In an attempt to decrease complications,
comparing between the studied groups regarding the
a wide spectrum of surgical techniques for
time of analgesia. The secondary outcomes are
tonsillectomy has been developed. Additionally,
postoperative pain score, the effect of study medications
various perioperative adjuvant therapies such as local
on heart rate, mean arterial pressure, and postoperative
anesthetic, steroids, analgesics, antibiotics, and
nausea and vomiting (PONV).
antiemetics have been implemented to improve
outcomes (2). PATIENTS AND METHODS
The oropharynx and the tonsillar fossae are Ethical Considerations:
exquisitely sensitive. They are well innervated locally This randomized double-blind study was
by the branches of the trigeminal and glossopharyngeal performed at Mansoura University Hospitals,
nerves and are well represented in the somatic cerebral Dakahlia, Egypt after being approved by the
cortex (3). A local anesthetic agent administered at the Institutional Review Board (IRB) with a code
peritonsillar space that provides analgesia with minimal number; MS/17.03.36. The study was presented
adverse effects is an attractive solution to the problem following the Consolidated Standards of Reporting
of post-tonsillectomy pain (4). Trials (CONSORT) guidelines. Written informed
Dexmedetomidine is a highly selective 2- consent was taken from the child's parents after
adrenoceptor agonist that produces dose-dependent explanation of the procedure and purpose of the
sedation, anxiolysis, and analgesia without respiratory study. This work has been carried out in accordance
depression (5, 6). The present study has been planned to with The Code of Ethics of the World Medical
assess the post-tonsillectomy analgesic efficacy of Association (Declaration of Helsinki) for studies
peritonsillar
lidocaine
infiltration
with involving humans.
dexmedetomidine rather than each drug alone and
possible postoperative complications in children
Nighty children of either sex with American
undergoing tonsillectomy.
Society of Anesthesiologists (ASA) physical status I or
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/)
4308
Received: 10/8/2021 Accepted: 2/10/2021
c:\work\Jor\vol852_143The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4314-4316
Investigating Alopecia Areata and its Connection to The High-Mobility Group Box 1: Review Article Asmaa Abd El-Hameed El-Sayed*, Afaf Helmy Ghanem, Mohamed Ibrahim El Ghareeb
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Asmaa Abd El-Hameed El-Sayed, E-Mail:[email protected]
ABSTRACT Background: It is a common and reversible hair loss illness known as alopecia areata (AA). Hair loss on the scalp and other regions of the body can begin as a patchy area of full hair loss which may develop to the entire loss of all hair on the body. It is uncertain what causes AA but it is characterized by hair cycle disruption and the presence of mononuclear cell infiltrates in the perifollicular, as well as peribulbar areas. There have been numerous studies that have shown that AA has been linked to various autoimmune illnesses, including vitiligo. Autoimmune disease is becoming more prevalent, and researchers have found a link between chronic inflammation and HMGB1 (high-mobility group box 1). Objective: To evaluate the role of (HMGB1) protein in pathogenesis of AA. Conclusion: HMGB1 is a promising predictor of prognosis and treatment responsiveness in the pathophysiology of alopecia areata. Keywords: Alopecia Areata, High-Mobility Group Box 1.
INTRODUCTION
The aim of the present review was to detect the role
Autoimmune, and inflammatory disease alopecia
of (HMGB1) protein level in pathogenesis of AA.
areata is characterized by non-scarring hair loss. There Epidemiology:
are numerous clinical symptoms of alopecia areata. If you
About 0.1-0.2 percent of the population suffers from
have hair, your scalp is the most likely area to be affected.
alopecia areata. Children, men, and women of all hair
Alopecia areata is a condition that results in the whole or
colours are affected by the disease. Although the disease
partial loss of hair on a specific area of the body or on the
is rare in children before the age of three, most patients
entire body. Most hair loss is circumscribed patches, but
are between the ages of two and six. Between the ages of
it can also progress to include the entire scalp (alopecia
30 and 40, the greatest number of people suffer from the
totalis) or involve the entire body (alopecia universalis).
disease. Only 20% of patients are over the age of 40,
Hair loss can manifest in any of these ways (1).
while 66% are under the age of 30 (4). AA appears to
Most patients with alopecia areata are
impact both sexes equally. According to certain surveys,
asymptomatic; however, it can cause significant
the adult age group is dominated by men, while others
psychosocial stress in those with severe or chronic forms
report different findings (5).
of the illness. Localized, well-defined patches of hair loss are the most common symptoms. The condition can Etiopathogenesis:
manifest in various ways: as a single patch of hair loss or
Alopecia's etiopathogenesis is uncertain. People
as multiple patches of hair loss, including alopecia totalis,
with a history of alopecia areata are suffering from an
alopecia reticularis, alopecia sisaipho (inverse ophiasis),
illness that is both a symptom and a sickness in and of
as well as alopecia universalis, all of which cause
itself, caused by a variety of complex etiological reasons
complete hair loss on the scalp or even the entire body, (6). People who are genetically susceptible to AA are
as well as ophiasis, which affects only the sides (2).
thought to suffer from T-cell-mediated autoimmunity.
The protein HMGB1 is highly conserved in the
Predisposition genetic and environmental variables, in
nucleus. Cell nuclei use it to control recombination,
addition to immunological dysfunction, have a
transcription, repair, and replication of DNA. It is also
significant role in the progression of the disease. Trace
possible for cells to secrete HMGB1 into the extracellular
element changes, viruses, thyroid dysfunction, as well as
matrix to serve as a signaling molecule in response to
endocrine abnormalities, have also been postulated to
stimuli. Cells that have died, are dying, or have been
play a role in perifollicular nerves and vasculature. A lack
wounded emit HMGB1 passively into the environment.
of trace elements may lead to the start of AA, according
Extracellular HMGB1 is therefore seen as being an ideal
to some theories (7).
"necrosis marker" released by the immune system to Classification of alopecia areata (Figure 1):
detect tissue destruction (3).
This article is an open access article distributed under the terms and conditions of the Creative
c:\work\Jor\vol852_144The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4317-4322 Ipsilateral Retrograde Balloon Angioplasty of Flush Lesions of Superficial Femoral Artery Occlusion Hany Abd El Momen Abd El Fatah, Ahmed Abd El Raouf Mahdy
Departments of Vascular Surgery and Cardiovascular Medicine, Faculty of Medicine, Al-azhar University Corresponding author Hany Abd El Momen Abd Elfatah , Email:[email protected] ABSTRACT Background: For almost 50 years, endovascular treatment has been used to treat chronic limb ischemia. The retrograde contralateral "crossover," antegrade ipsilateral, or retrograde popliteal techniques may be used to treat superficial femoral artery occlusions. There were early drawbacks to the retrograde technique, thus it was used as an emergency alternative. Objective: This study aimed to investigate efficacy and safety of ipsilateral retrograde balloon angioplasty for flush lesions of superficial arterial blockage. Patients and methods: This prospective cohort study was carried out at Sayed Galal Hospital and Al-Hussein Hospital through the period from August 2018 to August 2021. This study included 50 individuals with peripheral arterial disease (PAD). Interventional study was conducted on flush lesions of superficial femoral artery occlusion. Results: A significant difference between patients who achieved patency and who did not achieve patency )regarding BMI, dyslipidemia, cardiac diseases and postoperative ABI). Conclusion: Retrograde balloon angioplasty of flush lesions is a reliable procedure for superficial femoral artery occlusion handling with relatively low rate of complications. Key words: Popliteal approach, retrograde superficial femoral artery revascularization, superficial femoral artery flush occlusion.
INTRODUCTION
obstruction with endovascular means is a tough endeavor.
Since atherosclerosis is a systemic disease, a
Numerous projections are required to pinpoint the SFA's
substantial percentage of patients with chronic coronary
origin, since the wire is prone to being trapped in the deep
artery disease (CAD) have associated cerebrovascular
femoral vein (5, 6). The groin-to-diaphragm stent might
disease, lower extremity artery disease (LEAD), or both.
become obstructed or fractured as a result of this kind of
The term peripheral artery disease (PAD) is used to include
treatment. A proper degree of compression may reduce the
all vascular sites, including carotid, vertebral, upper
diameter of veins in both the superficial and deep
extremity, mesenteric, renal, and lower extremity vessels
networks, although this does not occur in all people (7). (1). PAD is the third leading cause of cardiovascular
In the majority of cases, the SFA occlusions are
morbidity after myocardial infarction and stroke. Both
recanalized intraluminally or subintimally using an
knowledge and treatment of PAD have improved
antegrade or retrograde femoral approach. In the case of
dramatically in recent years. The superficial femoral
failure, a retrograde popliteal access (RPA) is an
arteries (SFA) and its complex lesions and occlusions are
alternative. As a last option, the retrograde popliteal
two of the most common arteries in the lower extremities
procedure has its own set of limitations (8, 9). However,
affected by atherosclerotic symptoms (2, 3). The main
recent developments have made this strategy more
advantages of endovascular revascularization are the low
enticing. It was indicated as a first alternative for patients
complication rates, ranging from 0.5% to 4.0% and high
with common and/or SFA stenosis, excessive obesity,
technical success rates (even in long occlusions)
tandem iliac and/or SFA lesions, or RPA lesions, rather
approaching 90% and an acceptable short-term clinical
than as a last resort surgery (10, 11). When the retrograde
outcome (4).
popliteal technique was first introduced, it was considered
In the SFA and popliteal artery (PA), therapy may
a "back-up" choice because of the risk of arteriovenous
be hindered by the long lesions, high calcium content, and
fistulas, dissections, pseudoaneurysms, haemorrhage and
unique dynamic stresses. Treatment of a flush SFA
hematoma (12).
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c:\work\Jor\vol852_145The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4323-4327
Treatment of Atrophic Acne Scars with Platelet Rich Plasma Gel and Micro-needling Enas Tarek Shafik*, Amany Abd El-Rahman Nassar, Amira Amin Salem Tawoos, Nashwa Kamal Radwan, Doaa Hosny Abd EL-Fattah
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt *Corresponding author: Enas Tarek Shafik, E-Mail: [email protected]
ABSTRACT Background: Following the advancements in the treatment of acne, post-acne scarring is still a widespread problem. Platelet-rich plasma (PRP) gel is one formulation with beneficial biological or medicinal qualities that aid in the management of post-acne scarring. Objective: It was the goal of this work to evaluate the utilization of treatment of post-acne scars with micro-needling and plasma gel. Patients and Methods: Patients with post-acne scars were recruited from the university hospital's dermatology and venereology outpatient clinic. Our study was based on 23 patients (8 males= 34.8%, 15 females= 68.2%) having 3 skin types (II, III, IV); skin type III patients representing 56.2% of total patients, most of these patients have scars for less than 10 years. Dermapen has been done to the face then the PRP gel has been applied combined with micro- needling to the post-acne scars. We performed four sessions of the previous treatment with two weeks intervals then one month's follow-up. Results: The baron, as well as Goodman scale improvement significantly post-treated with Platelet Rich Plasma Gel Combined with micro-needling, where 69.6% of cases become grade1 post-treatment, drop grade 3 to be (8.7%) post-treatment compared to (47.8%) pre-treatment the difference statistically significant p=0.022. Furthermore, all grade4 fade out post-treatment p=0.008. Conclusion: Dermapen combined with plasma gel is a promising effective therapeutic modality for atrophic acne scars. Keywords: Platelet Rich Plasma Gel, Post Acne Scars. INTRODUCTION
designed to increase the availability of the various
Inflammatory skin disease of the pilosebaceous
proteins at the damage site (4). An original blood
glands, acne often begins during adolescence and may
composition that contains proteins in a gelled condition
continue throughout adulthood, with flares often
as the result of thermal heating and cooling treatment
occurring when testosterone levels rise. More than forty
yields plasma gel, one of the PRP formulations with
percent of adults, as well as eighty-five percent of
beneficial biological or medicinal features (6).
teenagers, are affected by late-onset acne. Environment,
Because it is injected into the subcutaneous fat
as well as genetics both, play a role in its prevalence and
layer, and dermis in a manner that is both gentle and
severity, making it one of the most common
natural, plasma gel is an excellent filler (7). The possible
dermatological conditions globally (1). It's still a
benefit of employing a self-derived product is the
widespread condition even though acne therapy has
prevention of problems and undesirable consequences
improved greatly. The prevention and management of
from the immune response (8).
scarring is a continuing concern (2).
Because it creates hundreds of microclefts in the
Due to decreased or increased collagen deposition
epidermis, micro-needling allows growth factors to
in the skin, acne scars may be caused by the impaired
penetrate deeper into the dermis (9).
breakdown of subcutaneous fat, collagen fibers as well
It was the goal of this work to evaluate the utilization of
as, inflammatory mediators (3).
treatment of post-acne scars with micro-needling and
The "healing cascade" refers to the body's
plasma gel.
inherent ability to repair damaged tissue at the location
of an injury. Platelets, white blood cells, and plasma PATIENTS AND METHODS
include proteins that influence clot formation,
Outpatient clinic admissions at the Dermatology,
inflammation, and cell proliferation in the early stages of
Venereology, and Andrology Department included 23
this cycle. Multiple plasma proteins and activated
subjects with post-acne scars. Patients from Zagazig
platelet membranes work together to generate a clot (4).
University Hospitals' Faculty of Medicine, Sharka,
For many years, the idea of using a patient's blood or
Egypt were randomized to participate in this randomized
components to assist the healing process has been widely
crossover design-controlled study. As long as all
used (5).
participants signed informed consent forms and
There are many ways to employ platelet-rich
submitted them to Zagazig University's research ethics
plasma (PRP) to promote wound healing. Platelet
committee, the study was allowed (ZU-IRB#6260). We
concentrates and platelet gels for local application are
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Assessment of Oxytocin Level in Patients with Manic Depressive Disorders Nihad Shokry Mohamed, Laila Mahmoud Ali, Bassem Murad Mostafa*
Department of Internal medicine, Endocrinology and Metabolism,
Ain Shams University Hospital, Cairo11566, Egypt. *Corresponding author: Bassem M. Mostafa, Mobile: (+20)01144322070, E-Mail: [email protected] ABSTRACT Background: Major depressive disorder (MDD) is a major health concern, with lifetime prevalence. In the United States estimated to be as high as 16.2%. Although, a number of pharmacological agents are available to treat, approximately 3040% of patients do not respond to treatment. Therefore, a major emphasis in modern psychiatric research is to uncover the underlying etiology of mood disorders, and to develop novel efficacious antidepressant treatments. Oxytocin may be of therapeutic benefit in these patients. Objective: To assess the level of oxytocin in patients with major depressive disorders. Patients and methods: A case-control study was conducted on sixty subjects above eighteen years old. They were classified into: 20 naïve patients during the manic attack of bipolar manic depressive disorder (group I), 20 naïve patients during the depressive attack of bipolar manic depressive disorder (group II) and 20 normal control subjects (group ). All participants were subjected to full history, clinical examination and laboratory measurement of oxytocin, AST, ALT, serum albumin, BUN & creatinine. Results: On comparing group I (bipolar patients with recent attack of mania) and group 3 (control) regarding serum oxytocin level, there was a significant difference in serum oxytocin being higher in patients with manic symptoms (p < 0.001) but with no significant difference between group 2 (bipolar patients with recent attack of depression) and group 3 (control). Conclusion: The significant difference in the level of oxytocin among the studied groups may suggest a possible role of oxytocin in management of patients with such psychiatric disorder. Keywords: Oxytocin, Major depression, Mania. INTRODUCTION
involved in this study were collected from the
Oxytocin is present in most bony vertebrate species.
Psychiatry Outpatient Clinic and Ward at Ain Shams
It is a neuropeptide which has a major role in delivery
University Hospital.
and lactation, above that it acts as neuromodulator
within the brain and interacting with the central Ethical approval:
oxytocin receptors (1). This study was approved by the Local Ethical
Oxytocin is present in amygdala and the tegmental Committee and a written consent was taken from
area, such brain areas are involved in social emotion. every subject to be included in our study. This work
Oxytocin is a key go between of complex passionate and has been carried out in accordance with The Code of
social practices, for example, connection, social Ethics of the World Medical Association
acknowledgment, and hostility in people. Many reviews (Declaration of Helsinki) for studies involving
discovered relationship amongst oxytocin and humans.
neuropsychiatric issue, such as autism and depression (2). Affective disorders are the most widely recognized
All participants were subjected to full medical history
psychiatric issues. In the United States and Europe, 8-
with special stress on psychiatric assessment of criteria
11 % of male adults and about 18-23% of female adults
of depression or mania and thorough clinical
have a depressive syndrome. Hospitalization is required
examination (5).
in 6% of the females and 3% of the males who had
severe depression (3). Exclusion criteria:
There is hypothesis that many of the manifestation
Other psychiatric disorders e.g. schizophrenia.
usually reported in depression (i.e. social withdrawal,
Pregnancy or lactation. Neurological disorders, which
decreased appetite, cognitive impairment) may be due
may affect mood e.g. DS. Endocrinal diseases as
to changes in central oxytocin function (4(.
hypopituitarism, hyperprolactinemia and thyroid
The aim of the present study was to assess the level
disorders. Patients with major illnesses as cancer, IHD,
of oxytocin in patients with major depressive disorders.
renal failure or liver cell failure. Drugs, which might
affect mood e.g. corticosteroids and history of substance PATIENTS AND METHODS
abuse.
Our case-control study was conducted through the
Subjects enrolled in this study were divided into 3
period from 1/5/2016 to 30/7/2016 in Cairo on 60
groups, group : 20 naïve patients during the manic
subjects (males and females) above 18 years old. Cases
attack of bipolar manic depressive disorder, group :
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c:\work\Jor\vol852_147The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4331-4337
Mycosis Fungoides Diagnosis Using TOX Versus Old Panel Immunohistochemical Markers Mai Ahmed Gobran, Abeer Hafeez*, Mohamed Ali Alabiad, Sabah Mohamed Hanafy, Amira Salem
Departments of Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Mai Ahmed Gobran, Mail:[email protected] ABSTRACT Background: For primary cutaneous lymphoma, mycosis fungoides (MF) is the most prevalent form with skin-homing T cells plus clonal proliferation of CD4. In many CTCLs, thymocyte selection associated with the HMG-box (TOX) is an uncontrolled gene, together with MF in comparison with controls. Early mycosis fungoides is difficult to diagnose, and, its distinction from inflammatory diseases is sometimes impossible. Objective: In this study, we compared the TOX vs C7 and CD4 expression as an early mycosis fungoides diagnostic markers & to assess their ability to differentiate Mycosis fungoides from benign cutaneous inflammatory diseases (BCID). Materials and methods: 60 patients who had been previously diagnosed as MF (30 cases) and BCID (30 cases). All were evaluated histopathologically using H & E and immunohistochemically staining for TOX, CD7 & CD 4. Results: There was statistically significant difference between MF and BCID with increased TOX, CD7 & CD4 expression among MF than among BCID and ability of TOX to detect all true positive cases (100.0%) compared to 83.3% for CD4 and 13.3% for CD7. TOX had the highest sensitivity (100.0%) and accuracy (88.3%) followed by CD4 with sensitivity of 88.3% and accuracy of 66.7%, (P < 0.001). Conclusion: TOX had the highest sensitivity (100.0%) & accuracy (88.3%) followed by CD4 with sensitivity of 88.3% and accuracy of 66.7%. Our results suggest that TOX is a useful marker in diagnosis of MF & differentiating it from BCID. Keywords: TOX, CD7, CD4, Mycosis fungoides (MF), Benign cutaneous inflammatory diseases (BCID), Immunohistochemistry.
INTRODUCTION
interacting nuclear protein, which governs the developing
Skin diseases are not only affecting the overall look of
differentiation of T-cells (4). Prior to the evacuation of
the patient but also could cause serious health
CD4+ T cells from the thymus, TOX is down regulated in
complications. Mycosis fungoides (MF) is initially
the thymus. Peripheral lymphoid tissue expresses proteins
affecting the skin and is considered as a widespread type
and TOX mRNA at a very low level (5). At a higher
of primary cutaneous lymphoma (PCL) (1). Atypical CD4+
frequency, TOX staining was observed in several vaired
skin-homing T cells are the hallmark of MF, which is a
subtypes of CTCLs such as Peripheral T-cell lymphoma,
low-grade lymphoma. It is possible that MF grows into
not otherwise required (PTCL-NOS), Sézary Syndrome
tumors over its lengthy clinical history, which begins with
(SS), and MF (6). It was found that TOX was the target
MF-infiltrated plaques. MF mainly affect the skin in the
gene of miR-223 in CTCL (7). Moreover, a study
early stage, but could disseminate to visceral organs,
confirmed the high expression of TOX gene in early MF
peripheral blood, and lymph nodes in the advanced stages.
lesions compared to controls (8). In another study, rare
In MF patients, the prognosis is heavily influenced by the
expression of TOX gene was obtained in numerous
disease's stage. Clinical and histological criteria was used
tumors, such as leukemia, breast cancer and lung cancer
for MF diagnosis through an integrated algorithm (2). (9).
Histology of MF shows a lichenoid infiltrate or band-
However, MF is difficult to be diagnosed, especially in
like mononuclear cells within the papillose dermis with
early stages, distinction between MF and inflammatory
covering epidermotropism. In many cases, these
diseases can be impossible. It was discovered that the
lymphocytes are bordered by a clear halo (Pautrier
permeating lymphocytes in MF were mostly CD4, with a
microabscesses), but they could be produced in groups or
section of CD8 T-cells, but CD4 was also conveyed by
individually within the epidermis. Irregular and
histiocytes, which can be abundant in this situation (10). A
hyperchromatic nuclear contours are shown after high-
quantitative assessment of CD4:CD8 ratio (normal value
power analysis of mononuclear cells. Focal parakeratosis
of 2:1) was performed beside evaluation of CD marker
and hyperkeratosis-associated psoriasiform epidermal
expression in terms of quality (negative, decreased, and
hyperplasia pattern are commonly shown from the
positive). In classic patch stage MF/CTCL, a higher
epidermis. Hematoxylin and eosin-stained sections
CD4:CD8 ratio is common, but lowers as the disease
remain the diagnostic gold requirement, but the early
progresses. T-cells can be identified by a reduced
stages diagnosis may be challenging as it is like other
CD4:CD8 ratio with unique CTCL mutations. CD7, which
chronic inflammatory dermatoses (3).
is generally the first CD marker to lose expression in
Thymocytes election-related high-mobility set family
CTCL, can be used to diagnose the disease (11).
(HMG) box (TOX), is an unfettered gene in MF-skin
However, it has been discovered that CD7 depletion
biopsies, which encodes an HMG-domain DNA
can occur in BCID processes as well. CTCL patients also
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c:\work\Jor\vol852_148The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4338-4343
Evaluation of Neonatal Sepsis Based on Measurement of Red Cell Distribution Width Aya Sami Essayed*1, Mohamed Mamdouh Gaafar1, Manal Mohammed Elamin2, Sherief Mohamed El Gebaly1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding Author: Aya Sami Essayed, E-Mail: [email protected]
ABSTRACT Background: Infant morbidity as well as mortality are frequently caused by neonatal sepsis. Neonatal sepsis can be predicted using the red cell distribution width (RDW), according to several researches. Objective: To determine if RDW can be employed as a marker for the evaluation of newborn sepsis and the assessment of its severity. Patients and Methods: 40 newborns, 20 of whom were infected and the other 20 of whom were non infected, participated in this case-control research. Patients and controls were collected from neonatal intensive care unit (NICU), Zagazig University Hospitals. Full history was taken from all participants parent, with clinical and laboratory examination were done; complete blood picture, and creatinine, blood culture, and serum level of C-reactive protein (CRP). Results: We revealed significant link between RDW and all of total leukocyte count (TLC), immature to total neutrophil ratio (I/T ratio), absolute neutrophil count (ANC), CRP, procalcitonin, severity of sepsis, and mortality. RDW and platelet count, on the other hand, have a strong negative association. With a sensitivity of 83.3 percent, specificity of 50 percent, a positive predictive value (PPV) of 71.4 percent, and a negative predictive value (NPV) of 66.7 percent, accuracy of 70 percent (p>0.05), the best RDW cutoff for diagnosing newborn sepsis severity was 17.9. Conclusion: Predictors of illness severity and death in newborn sepsis may be accurately predicted using baseline RDW measurements, which is critical for treatment of neonates who are at great risk of sepsis. Keywords: Neonatal Sepsis, Red Cell Distribution Width.
INTRODUCTION
the whole blood count, predicting the outcomes of infant
As a result of a malfunction in the body's response to
sepsis is still a challenge. There are a number of
infection, sepsis is a life-threatening illness (1). Sepsis is
traditional screening tests that may be useful in
one of the most prevalent causes of newborn death and
determining the severity of sepsis; however these tests are
illness (2). Neonatal sepsis is more common than at any
not able to reliably predict the severity of sepsis (6).
time in a person's life. In underdeveloped nations, Severe
Prognostic indicators for newborn sepsis have been
neonatal sepsis is the main cause of death among
examined using a variety of substances, procalcitonin,
newborns; As many as five newborn sepsis infections per
soluble E-selectin, C-reactive protein (CRP), CD64, IL-
thousand live births are common in wealthier nations,
6, IL-8 and are all examples of these biomarkers (7).
however, other population-based research from poor
The variance in red blood cell volume within a blood
nations have shown rates of 49-170 per 1,000 live births
sample is described by the red cell distribution width
in these countries (3).
(RDW). All normal complete blood cell counts include
Predominantly mild, nonspecific symptoms and
RDW as an indicator of anisocytosis of the red blood cells
indications of newborn sepsis are often followed by (8). Pathological diseases linked with infection as well as
septic shock, a condition known as dispersed
inflammation have been observed to alter the width of the
intravascular coagulation (DIC), and death. In this
red blood cell dispersion considerably in recent
regard, determining which neonates are most likely to
researches (9). Many studies have found that RDW can
have a negative clinical outcome is of critical importance,
accurately predict all-cause death in ICU as well as
and more intensive treatment should be given to those
critically ill patients (10). In inflammatory or viral settings,
who need it the most (4).
the RDW may rise due to a lack of red blood cell
Traditional methods for detecting sepsis include
formation or an increase in the breakdown of red blood
blood cultures. Blood cultures, on the other hand, take a
cells (11). The traditional screening index for iron
long time to perform; typically, to detect the organism in
deficiency anemia is the width of the red cell distribution.
the blood, it takes between two and five days. A decrease
It's been shown to play a role in the prediction of poor
in blood culture sensitivity occurs when antibiotic
outcomes in sepsis and other clinical circumstances,
therapy is initiated or when a slow-growing or fastidious
involving critically ill children in general, infective
organism is being cultured (5).
endocarditis, heart failure, coronary artery disease,
A complete blood count (CBC) is utilized in
malignancy, acute pancreatitis as well as peritoneal
conjunction to a blood culture to determine sepsis. Even
dialysis (12).
with current severity levels and indicators derived from
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The Effect of Peri-Radial Injection of Papaverine Versus Nitroglycerine on Radial Artery Diameter Prior to Cannulation Ahmed Said *1, Mohammed Maher1, Wael Fathy2
Departments of Anesthesia, Critical Care and Pain Management,
1Cairo University Hospitals and Beni-Swuif University Hospitals2, Egypt. *Corresponding Author: Ahmed Said, Email:[email protected],mobile:00201005287692 ABSTRACT Objective:The present study aimed to compare the effect of periradial injection of Papaverine versus Nitroglycerine on radial artery diameter prior to cannulation in cardiac surgery patients. We hoped that periradial injection will facilitate the radial artery cannulation and decrease its spasm. Design:This is a prospective randomized controlled trial that included ninety patients scheduled for elective cardiac surgery. Interventions:Patients were randomly assigned into one of three groups: One group received a peri-radial subcutaneous injection of Papaverine and Lignocaine 2% (30 participants); the second group received a peri-radial subcutaneous injection of Nitroglycerine and Lignocaine 2% (30 participants) and a control group that received a peri-radial subcutaneous injection of Lignocaine 2% (30 participants). Measurements and Main Results:Theradial artery diameter was measured by ultrasound before the injection and 20 minutes following injection, and the radial pulse palpability score was measured on a score of 1 (being weak) to 3 (being strongly palpable) before the injection and 20 minutes after.We observed a significant increase in radial artery diameter after injection of Papaverine (p< 0.001) and Nitroglycerine (p< 0.001), compared to baseline values, while there was no significant change in the control group. The changes in the Papaverine group were significantly higher (p= 0.003) than that observed in the Nitroglycerine group.The palpatory score of the radial artery was significantly higher in the Papaverine group than the Nitroglycerine group and both are significantly higher than the control group. Conclusions:Papaverine achieved significant increases in radial artery diameter and palpability score. Keywords: Radial artery, Papaverine, Nitroglycerine.
INTRODUCTION
Arterial cannulation is a routine pre-operative
Nitroglycerine is a vasodilator of low cost, short
procedure, performed in cardiac surgery for continuous
half-life, and few adverse effects [10]. Administration of
monitoring of blood pressure and repeated arterial blood
nitroglycerin by different routes (intravenous [11], topical
sampling [1-3]. In cardiac surgery, the radial artery is the [12], and intra-arterial [13]) has been proven to cause
best site for cannulation, compared to other vessels
vasodilatation of the radial artery. Further, recent data
because it is easy to find and its cannulation is usually
indicate that subcutaneous injection of nitroglycerin
smooth without complications[1]. However, cannulation
dilates the radial artery [14]. Therefore, we performed this
of the radial artery is sometimes difficult because it is
study to assess the effect of periradial injection of
susceptible to arterial spam that may occur in the
papaverine versus nitroglycerine on radial artery diameter
traumatic puncture. Moreover, the radial artery has a large
prior to cannulation.
muscular layer with a small diameter and marked
receptor-mediated vasomotion [4]. Methodology:
To decrease the radial spasm, various vasodilators
This was a prospective randomized controlled trial
are used like nitrates [5] and calcium channel blockers[6].
that enrolled 90 patients scheduled for elective cardiac
In addition, papaverine, an alkaloid obtained from opium
surgery.
or prepared synthetically, is a vasodilator that is used to
Patients were randomly assigned into one of three
resolve the radial artery spasm during coronary
groups: One group received a peri-radial subcutaneous
angiography [7].
injection of papaverine and lignocaine 2% (30
During coronary artery bypass surgery, papaverine
participants); the second group received a peri-radial
increases the internal mammary artery blood flow [8]. In
subcutaneous injection of nitroglycerine (1mg/ml) and
addition, recent data showed that radial artery diameter
lignocaine 2% (30 participants) and a control group that
and pulse palpability are significantly increased after
received a peri-radial subcutaneous injection of
subcutaneous papaverine injection, which would facilitate
lignocaine 2% (30 participants). Randomization and
the cannulation procedure [9].
blinding were performed using a closed opaque envelope.
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c:\work\Jor\vol852_150The Egyptian Journal of Hospital Medicine (October 2021) Vol. 85 (2), Page 4348-4352
Assessment of Interleukin 1- in Controlled and Uncontrolled Type 2 Diabetic Patients Mohamad S. Hamed, Enas M. Sabry, Bassem M. Mostafa
Department of Internal Medicine, Endocrinology and Metabolism,
Ain Shams University Hospital, Cairo 11566, Egypt *Corresponding author: Bassem M. Mostafa, Mobile: (+20)01144322070, E-Mail: [email protected] ABSTRACT Background: Type 2 diabetes has been identified as an immune-mediated disease characterised by poor insulin signaling and selective death of insulin-producing cells, with cytokines playing a key role. Disturbance of the anti- inflammatory response could be a key component of the type 2 diabetes-causing chronic inflammation. The cytokine family interleukin 1 (IL-1) plays a key function in endocrinology and the regulation of inflammatory stress responses. Objective: The aim of this work is to assess the role of interleukin 1, in patients with type 2 diabetes mellitus (controlled and uncontrolled) compared to healthy individuals. Patients and Methods: A case control study was conducted on 80 adults, ranging from 25-60 year old, attending the endocrine or internal medicine clinic in Ain Shams University Hospital. They were divided into 3 groups :Group (1): 30 controlled type 2 diabetic patients on oral hypoglycemic. Group (2): 30 recently uncontrolled type 2 diabetic patients over the last 6 months, on oral hypoglycemic. Group (3): 20 healthy individuals. Results: Serum IL-1 was significantly increased in recently uncontrolled diabetics than controlled diabetics and normal subjects. Serum IL-1 was positively correlated with fasting blood sugar (FBS), 2 hours post prandial (2 hrs PP), glycosylated Hemoglobin (HBA1C), triglycerides (TG) and HOMA IR and there was a negative correlation with high density lipoproteins (HDL). Conclusion: The significant difference in the level of interleukin 1 among the studied groups highlights an implication of interleukin 1 in the pathogenesis of type 2 diabetic patients. Keywords: Cytokines, Diabetes mellitus, Inteleukin1 .
INTRODUCTION
Interleukin 1 beta (IL-1) has been a known
Cytokines are a broad and diversified family of tiny
mediator of beta-cell dysfunction and death and is
cell signaling protein molecules. Interleukins and
potentiated by Tumor Necrosis Factor (TNF-) and
interferons, for example, are immunomodulating agents.
Interferon Gamma (IFN-g), both of which are present at
Interleukin 1 (IL-1), Interleukin 6 (IL-6) and Tumor
high levels under conditions of insulin resistance. Indeed,
Necrosis Factor (TNF- ) are produced by virtually all
beta-cells are uniquely susceptible to interleukin 1 beta's
nucleated cells, particularly endothelial, epithelial, and
effects as they express higher levels of interleukin 1
macrophage cells (1).
receptors (IL-1R1) than any other cell type in the body (5).
The interleukin 1 (IL-1) family plays a critical role
And their subsequent activation resulting in direct
in immunological and inflammatory response control. It
promotion of apoptosis, as well as the inhibition of insulin
controls the fundamental metabolic rate, blood glucose
signaling, which is critical for optimal beta-cell function
levels, and blood pressure, among other things. It also (6). In addition, interleukin 1 beta (IL-1) signaling results
reduces insulin release and causes apoptosis in cells,
in the production of pro-inflammatory mediators that act
resulting in type 2 diabetes. Polymorphisms in the
in a feed-forward autocrine/paracrine manner in beta-cells
interleukin 1 (IL-1) gene are type 2 diabetes susceptibility
and local innate immune cells to amplify these effects (7).
indicators in several populations (2).
Interleukin 1 (IL-1) is a family of pro-inflammatory AIM OF THE WORK
cytokines that includes interleukin 1 alpha (IL-1) and
The aim of this work is to assess the role of interleukin
interleukin 1 beta (IL-1), as well as an anti-inflammatory
1, in patients with type 2 diabetes mellitus (controlled
drug called interleukin 1 receptor antagonist (IL-1Ra or
and uncontrolled) compared to healthy individuals.
IL-1RN) (3).
Interleukin 1 beta (IL-1 ) is an inflammatory PATIENTS AND METHODS
response regulator that is produced in response to
A case control study was conducted on patients
infection, damage, and antigenic exposure. It's involved
attending the endocrine clinic at Ain-Shams University
in autoimmune disorders including rheumatoid arthritis,
Hospital from November 2014 till November 2016 on
inflammatory bowel disease, and type 1 diabetes, as well
eighty (80) subjects; their age ranged from 40 to 60 years.
as diseases like atherosclerosis, chronic heart failure, and
The subjects were divided into 3 groups: Group (1) 30
type 2 diabetes that are linked to the metabolic syndrome
recently uncontrolled type 2 diabetic patients on (4).
sulphonylureas over last 6 months their FBS>130, 2 hrs pp>180, HBA1C 7, Group (2): 30 controlled type 2
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