c:\work\Jor\vol911_1The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3771-3778
Early Outcomes of Using Skeletonized Left Internal Mammary Artery (LIMA) for Sequential Grafting of Multiple Left Anterior Descending Artery Lesions Mohamed Elkhouly
Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt *Corresponding authors: Mohamed Elkhouly, Mobile: (+20) 01115551412, E-mail: [email protected] ABSTRACT Background: In comparison to other arterial and venous conduits, the left internal mammary artery (LIMA) conduit showed superior graft patency and outstanding excellent long-term clinical outcomes. In situ LIMA grafting to the left anterior descending artery (LAD) is believed to be the "gold standard" of coronary revascularization for decades. Objective: We aimed to compare between two surgical methods forgrafting diffusely diseased LAD. Patients and Methods: This retrospective clinical trial was carried out on 80 adult cases with diffuse LAD disease in addition to right coronary artery and left circumflex artery involvement or their branches. They were scheduled for coronary artery bypass grafting (CABG) using the cardiopulmonary bypass in Cardiac Surgery Unit of Elkasr Elaini Medical Centre, cardiothoracic Surgery Department, Cairo University, Cairo, Egypt. Patients were equally classified into two groups (A and B). Results: Incidence of post-operative Myocardial infarction (MI), new onset AF, intra-aortic balloon pump, inotropic support and direct-current shock were significantly lower in group B compared to group A. Spontaneous recovery of sinus rhythm was significantly higher in group B compared to group A. Partial clamp time and aortic cross clamp time were insignificantly different between both groups. Total bypass time, hospital stay, and ICU stay were significantly lower in group B compared to group A. Early mediastinitis and mortality was insignificantly different between both groups. Conclusions: It was proven that LIMA with sequential-jump anastomoses should be utilized to operate LAD diffuse coronary artery lesions and that the surgeon should avoid lengthy arteriotomy with or without endarterectomy + onlay SVG patch with a single long anastomosis due to the elevated risk of early graft occlusion. Keywords: Multiple LAD lesions, Skeletonized, Sequential Grafting, LIMA. INTRODUCTION
coronary arteries one can do two or more distal
Usually coronary artery disease (CAD) includes
anastomosis by the same conduit, thus providing only
the proximal section of the major epicardial coronary
one proximal anastomosis for two or more distal
arteries, but not its intramural branches. It is one of the
anastomoses, which is thought to improve the total flow
most widespread groups of chronic diseases worldwide
in the graft by augmentation of the distal run off and
and in developing and developed countries is a primary
improving graft patency [6, 7]. Furthermore, sequential
cause of death [1].
technique provide more preservation of conduits and
The operation of choice for ischemic heart disease
decrease in manipulations of the ascending aorta, as
(IHD) patients is coronary Artery Bypass Grafting
well as a way to provide more anastomoses to small
(CABG) surgery which aims to elevate quality of life
diameter coronary arteries thus improving survival and
with longer living periods [2]. In order to secure
outcomes [8].
complete myocardial revascularization, which is the
As a revascularization technique for a diffusely
primary goal of the surgery, and because of the
diseased LAD, coronary endarterectomy in the LAD
increasing prevalence of severely diffused diseased left
vessel has been utilised. Although, this method still
anterior descending (LAD) coronary arteries
avoided by many surgeons due to the contradictory and
encountered ; CABG surgeries presents a challenge to
disputed comments of numerous authors regarding its
the cardiac surgeon and require more complex
complications and patency [9]. The skeletonized
manoeuvres than simple distal segment arteriotomy
harvesting method of internal mammary artery provides
anastomosis [3].
maximum length and enables easy sequential grafting.
In comparison to other arterial and venous
It has many advantages. Some of many are,
conduits, the left internal mammary artery (LIMA)
skeletonization of LIMA can reduce mediastinitis risk
conduit showed superior graft patency and outstanding
and sternal ischemia and is better quality, longer and
excellent long-term clinical outcomes. LAD In situ
larger than pedicled IMA [10].
LIMA grafting has been believed to be the operation Of
The use of saphenous vein graft as a single
choice " of coronary revascularization for decades [4, 5].
(sequential) graft or multiple venous grafts and in patch
The procedure of sequential anastomosis utilizing the
angioplasty of the LAD (onlay patch) with or without
LIMA conduit to graft more than one major epicardial
LIMA anastomosis, is a common technique for
coronary artery simultaneously was described by prior
achieving complete revascularization of ischemic
research in order to maximise the LIMA conduit
myocardial regions [11]. Sequential SVG has several
benefits. By using the sequential technique in grafting
advantages; first a shorter duration of procedure due to
3771
Received: 19/09/2022 Accepted: 20/11/2022
c:\work\Jor\vol911_2The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3779-3784
Estimation of SLC25A3 Gene Expression in Chronic Myelogenous Leukemia Iraqi Patients Raghda Raisan Al-Omairi, Maha Fakhry Al-Taee
Department of Biotechnology, College of Science, University of Baghdad, Baghdad, Iraq Corresponding author: Raghda Raisan AL-Omairi, E.mail: [email protected] Mobile: +9647714547679 ABSTRACT Background: Chronic myelogenous leukemia is a malignant hematological disease of hematopoietic stem cells. It is difficult to adapt treatment to each patient's risk level because there are currently few clinical tests and no molecular diagnostics that may predict a patient's clock for the advancement of CML at the time of chronic phase diagnosis. Biomarkers that can differentiate people based on the outcome at diagnosis are needed for blast crisis prevention and response improvement. Objective: This study is an effort to exploit the SLC25A3 gene as a potential biomarker for CML. Methods: RT-qPCR was applied to assess the expression levels of the SLC25A3 gene. Results: In comparison to the mean Ct of the control group, which was found to be 0.409±1.69, the mean Ct of CML patients was found to be 0.256±2.7 (p = 0.701). Furthermore, when grouped by gender, there were no significant differences between CML patients and controls, whereas a significant difference was only detected when grouped by age. Additionally, the mean of gene expression folding of the SLC25A3 gene in CML patients was found to be 4.589±8.552 which is >1. Finally, no statistically significant link was discovered when the fold of expression was correlated with the age and gender of CML patients. Conclusions: Gene expression folding (2-Ct) was greater than 1 in CML patients which indicates that the gene could be used as a potential marker for the diagnosis, targeted therapy, and monitoring of prognosis in CML. Keywords: CML (chronic myeloid leukemia), SLC25A3 (solute carrier family 25 member 3). INTRODUCTION
changes in leukemic stem cells that cytogenetic analysis
15-20% of all adult leukemias are chronic
can identify. The stage of the disease can be determined,
myelogenous
leukemia
(CML),
a
malignant
and the best monitoring and therapy can be started by
hematological disease of hematopoietic stem cells. In
comparing laboratory data, including CBC, cytogenic,
CML, cells are only partially developed, and these
and molecular tests, which are used in the diagnosis of
immature cells divide excessively and inefficiently.
CML (5). The solute carrier family 25member 3 gene
They build up in lymphoid tissues and peripheral blood,
(SLC25A3) has a molecular weight of 12,789 bases and
where they can cause anemia, thrombocytopenia, and
is localized at 12q23. SLC25A3 is a gene that codes for
leukopenia (1). With a median age of onset of 55 years,
a protein called Pic, which has a molecular weight of
CML is more prevalent in older individuals. The
40095 Da and a molecular size of 362 amino acids. By
majority of the time, there is no clear cause of CML, and
facilitating the movement of inorganic phosphate (Pi)
there is a lack of information regarding its etiology, but
into the mitochondrial matrix, this protein performs the
exposure to high doses of radiation, whether accidental
dual roles of phosphate and copper transport, By way of
or therapeutic, as well as prolonged exposure to
exchanges with OH or symports with H+ in
industrial chemicals like benzene, seem to be possible
electroneutral transport. The availability of transport of
risk factors (2).
copper can be regulated by phosphate levels, and
Therefore, CML is a sporadic disease with no
SLC25A3 depletion or deletion lowers the overall
evidence of family history among monozygotic
mitochondrial copper levels necessary for cytochrome c
(identical) twins or close relatives of patients (3). In
oxidase production (6).
CML, the bone marrow overproduces immature
Cancer cells have altered sensitivity to the
granulocytes, which then leak into the bloodstream.
mitochondrial and apoptotic pathways. Therefore, it is
Additionally, the myeloblast percentage is less than
not surprising that a large number of mitochondrial
10%, and the proportions of neutrophils, monocytes,
carrier family members are engaged in the development
myelocytes, and eosinophils are higher than usual. The
of cancer. (PiC) controls the mitochondrial permeability
reciprocal chromosomal translocation t (9;22)
transition pore's ability to release cytochrome c, and its
(q34;q11), which results in the Philadelphia
suppression has anti-apoptotic effects (7).
chromosome, a tiny 22q- containing a BCR-ABL fusion
Cancer
cells
have
considerably
higher
gene expressing a BCR-ABL chimeric protein with
transmembrane potential than healthy cells do, and
dysregulated tyrosine kinase activity, is a significant
several of their transporters are changed. Drugs that
cytogenetic feature of CML(4).
target mitochondria have been developed as a result of
The chronic phase, the acceleration phase, and
these variations (8).
the blast crisis phase are the three phases of CML. The
Overexpression of this carrier activates the
acceleration and explosion crisis phases are only
intrinsic apoptosis pathway, which has been shown in
reached by a small percentage of patients in the chronic
studies to have a potential function in mitochondria-
period. This may happen as a result of additional genetic
dependent cell death (9). Furthermore, disruption of ATP
3779
Received: 20/08/2022 Accepted: 21/10/2022
c:\work\Jor\vol911_3The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3785-3789
Relation between Sclerostin and Valvular Calcification in Hemodialysis Patients AbdelRahman Khedr*, Hayam Hebah, Sabry Gohar
Departments of Nephrology, Faculty of Medicine, Ain Shams University, Egypt *Corresponding author: Abdelrahman Khedr, Mobile: (+20) 01005412601, Email: [email protected] ABSTRACT Introduction: Chronic kidney disease (CKD) is prevalent all over the world. Cardiovascular morbidity and mortality are high among CKD patients especially hemodialysis (HD) patients. Vascular calcifications are common among hemodialysis patients and its etiology is related to the derangements in mineral and bone metabolism. Sclerostin is a new glycoprotein that is involved in both vascular calcification and inhibition of bone formation in CKD patients. Objective: The aim of the current study was to investigate the correlation between serum sclerostin level and valvular calcifications in End Stage Renal Disease (ESRD) patients. Patients and methods: Aortic and mitral valve calcifications were assessed by echocardiography and serum sclerostin levels were measured by ELISA method in 80 ESRD patients on regular hemodialysis. Parathyroid hormone, serum phosphorus, serum calcium and serum alkaline phosphatase were also measured. Results: Aortic valvular calcification was present in 58.8% of patients and mitral valvular calcification in 33.8% of patients. The mean level of sclerostin in our patients was 0.63 (SD 0.14) ng/ml. The mean parathyroid hormone was 521 pmol/l, the mean calcium level was 8.39 mg/dl while the mean phosphorus level was 5.5 mg/dl. There was no significant correlation between serum sclerostin levels and aortic valve or mitral valve calcification in our case series. Conclusion: In ESRD patients receiving regular hemodialysis, serum sclerostin levels were not substantially associated with mitral valve or aortic valve calcification. Keywords: Sclerostin, Valvular calcification, ESRD. INTRODUCTION
In some studies, high sclerostin levels were
The prevalence of chronic renal failure is
associated with VC and coronary artery calcification
approaching more than 10%, renal failure has different
(CAC) in CKD patients. It was found to be expressed in
hazardous effects on public health (1).
calcified vascular tissues, also its production by in vitro
Kidneys are involved in activation of vitamin D,
osteocytes was induced by calcifying medium and it
regulation of calcium and phosphorus metabolism and
was expressed in aortic extracts (11-16).
hence affecting parathyroid hormone and bone
Sclerostin expression was discovered using
metabolism, in CKD patients, serum phosphorus
immunohistochemistry in explanted aortic valves from
excretion is impaired while serum calcium is affected
hemodialysis patients (17).
by the derangements in vitamin D and parathyroid
In studies on CKD patients, there was positive
hormone. These changes lead to bone disease and
correlation between sclerostin and vascular calcification
contribute to cardiovascular disease and anemia in (6,8,9), while, other studies did not show this association
chronic kidney disease (CKD) patients (2-4). (4,10).
CKD patients show increased rate of
The aim of this work was to study the correlation
cardiovascular complications, vascular calcifications
between serum sclerostin level and valvular
(VC) secondary to abnormal mineral and bone
calcifications in End Stage Renal Disease (ESRD)
metabolism is an important contributor to
patients.
cardiovascular disease in CKD patients (5.6).
Osteocytes' wingless-related integration site beta- PATIENTS AND METHODS
catenin pathway is crucial for bone development. The
A total of 80 haemodialysis patients in the Dialysis
aberrant mineral metabolism and renal bone disease
Init of Al-Sahel Teaching Hospital were recruited in this
seen in CKD patients are caused by sclerostin, a
study. Patients had four-hour sessions of hemodialysis
recognized inhibitor of Wingless-related integration site
three times per week.
beta-catenin (Wnt-b-catenin). Inhibitors of Wnt may be
Exclusion criteria were age younger than 18 years
targeted with antibodies as a potential therapy for renal
old, overt infection, malignancy, parathyroidectomy,
bone disease (7). Sclerostin (Scl), which connects renal
previous renal transplantation or autoimmune
bone disease to VC, may help patients with chronic
rheumatic diseases.
kidney disease forecast how their cardiovascular illness
A detailed history and thorough clinical
will progress (8,9).
examination were obtained from every patient in this
Osteocytes are the main source of secretion of Scl.
study. Height, weight, waist and mid arm circumference
Sclerostin suppresses osteocyte function and enhances
were registered for all patients.
osteoblast apoptosis; these actions cause inhibition of
Laboratory
investigations
including
serum
bone formation and a decrease in bone mass (9,10).
Sclerostin (by ELISA), serum creatinine, urea, serum
3785
Received: 14/10/2022 Accepted: 15/12/2022
c:\work\Jor\vol911_4The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3790-3796
Outcomes of Neonatal Cardiac Surgery in a Tertiary Neonatal Intensive Care Unit in Cairo, a Retrospective Study Mohamed Hussein Metwally, Ghada Ahmad Saleh
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt. *Corresponding author: Mohamed Hussein Metwally, Mobile: (+20)01003754913, E-mail:[email protected]
ABSTRACT Background: Congenital heart disease (CHD) in neonatal population remains a major health problem that requires more attention. Currently, most of the data came from high income countries which can't represent the situation in low-income countries. Objectives: The aim of the current work was to evaluate in-hospital outcomes of neonates who were admitted to neonatal intensive care unit, Ain Shams University Specialized Hospital (ASUSH) with a cardiac anomaly requiring intervention as their main cause of admission. Methodology: Electronic medical records of enrolled neonates were retrieved, reviewed, and analyzed over a period of 18 months. The outcomes of in-hospital mortality, length of stay, duration of mechanical ventilation, and postoperative complications were evaluated. Results: Twenty-nine patients were identified; 10 females (34.5%) and 19 males (65.5%). 82.8% were full terms, with median admission age of 60 days. 65.5% (19/29) patients had coarctation of the aorta (COA). Twenty-eight patients (96.6%) underwent cardiac surgery. 100% of patients with Fallot tetralogy and double outlet right ventricle (DORV) received palliative surgery, while 94.7% (18/19) of patients with COA had corrective surgery. Overall mortality was 6.9% (2/29). Twenty-four patients required postoperative mechanical ventilation (range 1-41 days). 24/29 (82%) had uncomplicated stay, one patient had pneumothorax and four patients (13.8%) had sepsis. Conclusion: It could be concluded that early outcomes of cardiac surgery in the Intensive Care Unit of Ain Shams University Specialized Hospital (ASUSH) appear to be satisfactory. Key words: Neonatal cardiology- Coarctation- Neonatal surgery- Developing countries- neonatal ventilation
INTRODUCTION
CHD receive appropriate interventions for their life-
Congenital heart disease (CHD) in neonatal
threatening conditions [7].
population remains a major health problem that requires
International humanitarian efforts to improve
more attention. Globally, the gap in the developed and
cardiac care in LMICs have chronically faced
the developing world is strikingly wide. While CHD is
frustration by lack of funding, compromised
the second most common cause of childhood mortality
infrastructure of local healthcare systems, inadequate
in high-income countries (HIC), it is the sixth in Low-
neonatal transport schemes, overwhelming healthcare
and middle-income countries (LMIC) as other problems
priorities and critical shortage of medical professionals
(e.g., infection and malnutrition) still hold a larger share
[8] .Several recent publications and professional
in childhood mortality [1].
associations have started raising awareness about the
Middle-income countries (MICs) from the Latin
high prevalence, the cumulation of yet untreated cases
America, Middle East and South Asia have
and the poor access to cardiac care in developing
impressively augmented their cardiac surgical capacity
countries [9].
in the last twenty years but lagging remarkably behind
The sad fact is that 30% of children with complex
what their populations need [2] and still providing very
CHD either die before being diagnosed or remain
different qualities of cardiac surgical services for their
trapped in a level of care lower than the required and
populations when compared to developed countries [3].
waiting for referral to a highly specialized centre that
Most of the HIC can maintain an excellent
might never happen [10]. Moreover, simple defects (e.g.,
outcome, in spite performing corrective operations early
atrial septal defects (ASDs), ventricular septal defects
- even during the neonatal period [4]. This has become
(VSDs) are the only realistic pathologies to be
possible because of continued improvement of surgical
considered for treatment [11].
techniques, inputs from multidisciplinary teams, and the
As cardiac surgeries are provided more in HIC,
better understanding of the underlying pathophysiology
most of the data presents their outcomes, which can't be
of diseases [5].
replicated to LMIC. Currently, there are databases in
On the other side, and although surgical and
Europe, Asia and North America, but not in Africa [12].
postoperative care for CHD is improving, and early
The aim of the current study was to evaluate the
mortality has markedly dropped in LMICs, the
outcomes of neonates who were admitted to neonatal
management of neonates with CHD there remains
intensive care unit (NICU) of Ain Shams University
challenging [6]. Approximately <1.5% of children with
specialized Hospital (ASUSH), with a cardiac anomaly requiring intervention as their main cause of admission.
3790
Received: 09/01/2023 Accepted: 09/03/2023
c:\work\Jor\vol911_5The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3797-3801
Video Assisted Thoracic Surgery (VATS) Experience in Management of Primary Spontaneous Pneumothorax: Early Results Mohamed Elkhouly*1, Mohamed Hagagg2
1Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
2Department of Cardiothoracic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt *Corresponding authors: Mohamed Elkhouly, Mobile: (+20) 01115551412, E-mail: [email protected] ABSTRACT Background: Pneumothorax without underlying lung disease is the definition of primary spontaneous pneumothorax (PSP). When an interventional technique is required for its treatment, Video Assisted Thoracic Surgery (VATS) is the procedure of choice. It is associated with a marked reduction in operation time, post-operative pain atelectasis, and shorter hospital stay with an accepted recurrence rate of around 3%. Objective: We aimed to evaluate cases with PSP who were treated by VATS at Cairo and Minoufia Universities Methods: This retrospective study was carried out on 19 successive cases with a mean age of 44 years old, both sex who underwent VATS procedure for PSP. Under general anesthesia & double lumen intubation, VATS was conducted. The same surgical team conducted apical pleurectomy or mechanical abrasion and bullectomy on 19 of the patients who had VATS. Results: Regarding the postoperative results, hospital stay ranged from 2-7 days with a mean (±SD) value of 27.05±6.75 years. No case needed ICU admission.Regarding the postoperative complications, ICT removal ranged from 1-3days with a mean (±SD) value of 1.15 ± 0.27 days. Air leaks occurred in 2 (10.53%), Wound infection did not occur in any case. Conclusions: VATS is superior to open thoracotomy as regards cosmetics short operation timeless pain less atelectasis and shorter hospital stay Keywords: VATS, Primary Spontaneous Pneumothorax,PSP.
INTRODUCTION
considerably as the number of SP events increases[6].
Primary spontaneous pneumothorax (PSP) is a
Accepted surgical indications for pneumothorax with
pneumothorax without underlying lung illness, that
the lower morbidity of VATS involve; radiologically
occurs most frequently in young, thin males. The annual
demonstrated large bullae, recurrence, incomplete
incidence of PSP is 9 per 100,000. Males aged 22 to 26
expansion of the lung, tension pneumothorax, persistent
years old are the most susceptible. It affects < 1/5 of
air leak, spontaneous hemopneumothorax, bilateral
females[1].
involvement, SP in a high-risk occupation, and
It is typically the result of ruptured pleural bullae
suspicion of malignancy[7].
or blebs. PSP is accompanied by hyper-resonance
A meta-analysis combining randomized and non-
(tympanic) on percussion, lower chest wall movement
randomized data suggests that VATS is associated with
on inspection, lower breath sounds on auscultation, and
a greater recurrence rate than open thoracotomy[8].
diminished tactile fremitus on palpation of the chest [2].
However, a comprehensive analysis comprising solely
Patients with extensive pneumothorax are more likely
randomized studies indicated that VATS was superior
to exhibit these findings (free air occupies > 15 -20 %
to thoracotomy in terms of hospital stay duration,
area of hemithorax). In response to a respiratory or
atelectasis,
and
pain
alleviation
after
the
circulatory
impairment
or
discomfort,
reflex
treatment[9]. Therefore, we established this research to
tachycardia occurs in the majority of patients[2].
evaluate the cases with PSP who were treated by VATS.
The emergence of video-assisted thoracic surgery
(VATS) was preceded by technological breakthroughs PATIENTS AND METHODS
in digital technologies, lenses, micro-cameras, monitors,
This retrospective research was carried out on 19
and also the use of general anesthesia to provide one-
successive cases with a mean age of 27 years old, both
lung ventilation[3]. VATS is the approach of choice
sex who underwent VATS procedure for PSP in the
when an interventional technique is deemed required for
Cardiac Surgery unit of Elkasr Elaini Medical Centre,
the treatment of pneumothorax, and it is accompanied
Cardiothoracic Surgery Department in Cairo University,
by a significant reduction in recurrence to
and Minoufia University Cairo, Egypt.
approximately 3%[4]. Additionally, VATS enables the
effective and safe utilization of treatments such as Ethical consent:
pleurectomy, bullectomy, and mechanical pleurodesis Informed written consent was obtained from the
that are required for pneumothorax treatment[5]. patient or relatives of the patients. The study was
Conservative care of SP (monitoring, needle done after approval from the Ethical Committee in
aspiration, chest tube, etc.) has shown a significant the Cardiac Surgery Unit of Elkasr Elaini Medical
recurrence rate (16-52%). The recurrence rate increases Centre, Cardiothoracic Surgery Department in
3797
Received: 1/10/2022 Accepted: 2/12/2022
c:\work\Jor\vol911_6The Egyptian Journal of Hospital Medicine (January 2023) Vol. 91, Page 3802-3806
Incidence of Conductive Disorder After Surgical Closure of VSD Mohamed Azzam1, Mahmoud Singer1, Mohamed Amara2
1Department of Cardiothoracic Surgery, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
2Department of Cardiothoracic Surgery, Al Nas Hospital, Cairo, Egypt *Corresponding author: Mohamed Azzam, Mobile: (+20) 01001427368, E-Mail: [email protected] ABSTRACT Background: Ventricular septal defect (VSD), accounts for up to 40% of all cardiac malformations. Defects that are present alone or in conjunction with other congenital cardiac abnormalities can be diagnosed. The conduction system, particularly the bundle of his and its branches, is susceptible to harm when the individual sutures are inserted. A permanent pacemaker is typically needed if a heart block occurs during or after therapy. Objective: we aimed to evaluate the incidence of conductive disorders after surgical VSD closure. Patients and Methods: A prospective observational study was conducted on 100 patients < 18 years with VSD from 2019 to 2021 at the Cardiothoracic Surgery Department of Cairo University Hospitals and Atfal Masr children's hospital. They had a clinical diagnosis of VSD and are referred for elective surgical VSD closure either including isolated VSD or combined with other intracardiac lesions. Results: The peri-membranous defect was the most common type and most VSD lesions were of moderate diameter. The mean ICU stay was 2.91 days. Abnormal rhythm occurred in 12 patients (12%). The most common conductive disturbance that occurred was incomplete right bundle branch block (RBBB) (6%), but complete heart block (CHB) occur in 1% which need a permanent pacemaker, bleeding happened in 2 (2%) patients and one patient died. Regarding the comparison between populations with post-operative normal rhythm and conductive disturbance, there was a significant difference in VSD types and diameter. Conductive disorder in surgical VSD closure was mostly associated with a larger diameter, Peri-membranous, and doubly committed VSD. Conclusion: VSD repair is considered to be a safe procedure with a very low mortality rate. In this study, we found out that large VSD was the most associated risk factor for conductive disturbance occurrence in VSD patients. Keywords: Conductive disorder, VSD, Surgical closure.
INTRODUCTION
One of the most frequent congenital heart
procedure is typically a sign that a permanent
defects, accounting for up to 40% of all cardiac
pacemaker should be inserted (7).
anomalies, is the ventricular septal defect. Since many
This study aimed to evaluate the incidence of
tiny defects present at birth close soon after birth, the
conductive disorders after surgical VSD closure.
frequency of this abnormality varies with age during the
examination. It also depends on how sensitive the PATIENTS AND METHODS
examination technology is (1).
This is a prospective observational study
A highly sensitive color doppler echocardiogram
carried out at the Cardiothoracic Surgery Department of
was used to screen newborn infants, and a prevalence of
Cairo University Hospitals and Atfal Masr children
up to 5% has been recorded (2). The majority are minor
hospital Between January 2019 and October 2021 on
muscle flaws that go away within the first year of life.
100 patients.
Because many individuals can be asymptomatic and
many faults can close over time, the precise prevalence Inclusion criteria: All patients aged less than 18 years
of ventricular septal defects in communities differs
of age with a clinical diagnosis of VSD who are referred
between studies based on the technique of diagnosis and
for elective surgical closure of VSD were included in
the age of the community (3).
the study. It included isolated VSD and patients with
The diagnosis covers a broad range of defects,
coexisting atrial septal defects, patent ductus arteriosus,
both those that are unrelated to other congenital cardiac
patent foramen ovale, vascular rings, coarctation of the
deformities and those that are connected to them (4). The
aorta, or stenotic/regurgitant semilunar valves. This
presentation, symptoms, natural history, and
study included patients who had already had pulmonary
management of ventricular septal defects are all
artery banding.
influenced by the size and anatomical correlates of the
lesion, the patient's age, and the local diagnostic and Exclusion criteria: Atrioventricular canal, right
interventional skills (5).
ventricle with double outlet, and tetralogy of Fallot. The
The conduction system, in particular the bundle
patient's past medical and surgical history, intracardiac
of His and its branches, is frequently connected to a
hemodynamics, ventricular function, and any
portion of the defect's border and is vulnerable to
concomitant cardiac abnormalities. Patient outcomes,
damage during the placement of the individual stitches
postoperative complications, and surgical indications (6). Heart block that develops during or following the
were noted.
3802
Received: 10/09/2022 Accepted: 11/11/2022
c:\work\Jor\vol911_7The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3807-3812
Clinicopathological Study and Management of Primary Malignant Scapular Tumors; 10 Years National Cancer Institute Experience Ibrahim Abdelrahman, Magdy El-Sherbiny, Ihab Fayek, Ibrahim Shaker, Mohammad Taher*
Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt Corresponding author: Mohammad Taher, Mobile: 01001334568 ORCID: 0000-0002-4678-9145, Email:[email protected]
ABSTRACT Introduction: Primary malignant scapular tumors are very rare. Little is written about flat bone sarcomas in the literature, and not much is known about the oncological outcome. Objective: The aim of the current work isreviewing clinicopathological features and surgical management of cases with primary malignant scapular tumors. Patients and methods: Patients with primary malignant scapular tumours who visited the National Cancer Institute (NCI) at Cairo University, Egypt, between January 2009 and December 2019 were subjected to a retrospective descriptive analysis. Results: The study included 25 patients with a mean age of 33.4 years old ranging from 9 to 86 years. Pathology types were chondrosarcoma in 14 patients (56%), Ewing/PNET in 7 patients (28%), osteosarcoma in 2 patients (8%), spindle cell sarcoma in 1 patient (4%), and aneurysmal bone cyst in 1 patient (4%). Twenty patients (80%) had surgery, and 5 patients (20%) had no surgical intervention for being either with a poor general condition or having metastatic disease. Overall survival at 6 months was 92% and was 88%, 75.4%, and 65.4% in the first year, 3rd year, and 5th year respectively. Disease-free survival at 6 months was 90.5%; and was 85.7%, 75.4%, and 42.7% in the first year, 3rd year, and 5th year respectively. Conclusion: Primary malignant scapular tumors are rare. Early diagnosis is very important, as surgical excision with a wide negative margin (limb-sparing surgery) is the main line of treatment in most cases and tends to decrease the recurrence rate, otherwise, palliative treatment and forequarter amputation may be indicated. Keywords: Scapular tumors, Scapulectomy, Limb-sparing surgery, Retrospective descriptive analysis, National Cancer Institute, Cairo University. INTRODUCTION
scapula from another primary, or soft tissue sarcomas
Although the shoulder girdle (proximal humerus,
invading the scapula.We collected patients' files and
scapula, and clavicle) is the third most frequent location
obtained the following data: age, sex, preoperative
for tumours of bone and soft tissues, malignant tumours
pathology,
lines
of
treatment
(neoadjuvant
of the scapula are uncommon (1,2). Children and
chemoradiation, adjuvant chemoradiation, surgery, and
adolescents with Ewing's sarcoma have the most
palliative treatment), surgical management data (types
common malignancies affecting the scapula (2).
of surgical resection, postoperative complications, and
Before being identified, scapular tumours
postoperative pathological data (Disease-free survival
frequently become enormously large. As the disease
(DFS), and overall survival (OS).
progresses, the tumour may also spread to the chest
Malignant tumor staging was according to
wall, the proximal humerus, the rotator cuff, or the
Enneking staging (6). Classification of the type of
neurovascular bundle (3). Limb-sparing resections for
surgical resection was based on what has been described
malignant tumours of the scapula were regarded as
by Malawer and colleagues (7).
high-risk procedures due to the probable danger of local Ethical Approval:
recurrence. So these malignancies frequently required a Patients received all the information they require
full or partial scapulectomy (4). Syme conducted and regarding the research objectives and methodology
documented the first total scapulectomy in 1856 (5). after the study was given the go-ahead by Cairo
Since then, other updates and suggestions have University's Ethics Committee. Each study
appeared in various series (1-3). We aimed to assess participant provided their written consent after
primary malignant scapular tumors regarding receiving full information. The Declaration of
clinicopathological features, surgical management, and Helsinki, the code of ethics of the World Medical
oncological outcome (disease-free survival, and overall Association, was followed when conducting this
survival). research on humans. PATIENTS AND METHODS Statistical Analysis
This is a retrospective descriptive study involving
IBM SPSS advanced statistics (Statistical Package for
all patients with primary malignant or borderline
Social Sciences), version 24, was used to examine the
scapular tumors who received treatment at National
data (SPSS Inc., Chicago, IL). Quantitative data were
Cancer Institute (NCI), Cairo University over 10 years
described as number and percentage, whereas numerical
from January 2009 to December 2019. We excluded
data were described as median and range or mean and
those with benign tumors, metastatic tumors to the
standard deviation (SD), as appropriate. The suitable
3807
Received: 09/11/2023 Accepted: 10/01/2023
c:\work\Jor\vol911_8The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3813-3819
Exploring The Prognostic Significance of Lymphoma in Colon and Rectum, National Cancer Institute Experience, Egypt Mohamed Atef ElKordy1*, Anthony Nozhy Abd ElMesseh1, Ahmed Hussein ElGammal2, Rasha Mahmoud Allam3, Mohammed Fouad Taher1
Surgical Oncology Department1, Pediatric Oncology Department2,
Statistics Department3, National Cancer Institute, Cairo University, Egypt Corresponding author: Mohamed Atef ElKordy, Telephone: 002-01554090340, Email:[email protected] ABSTRACT Background: Colorectal cancer is one of the commonest types of malignancies. Lymphoma is a rare occurrence in this population, with adenocarcinoma constituting the majority of cases. Few publications have analysed the clinico- pathological behaviour of colorectal lymphoma (CL). Both the effect of systemic therapy in these cases and the significance of surgical resection of these tumours remain unclear. Objective: The aim of the current study is to address CL from the perspectives of demographic, clinical characteristics, diagnosis and treatment, as well as studying prognosis. Patients and methods: The current retrospective cohort study included all cases diagnosed with CL and managed at the National Cancer Institute, Cairo University, during the period from 2010 to 2021. The data included demographic, clinical presentation, investigation used and their results, treatment modalities used, and prognosis. Results: Throughout the durationof the study, 49 patients were diagnosed with CL and treated in the National Cancer Institute. Patients' ages ranged between 2 and 70 years, with a median of 5 years. Burkitt lymphoma was the most common type (71%). Most of the cases (63.3%) were aroused in ascending colon. Early stages (Stages I and II) accounted for 81.6% of the cases. Before chemotherapy, 32 cases (65.3%) underwent surgical resection. The absence of B symptoms, Hg 10 gm/dl, and surgically treated cases were associated with a favourable prognosis. Conclusion: The incidence of lymphoma affecting thecolon and rectum is uncommon. Patients' ages upon presentation vary, and it typically originates in the right colon. In combination with systemic therapy, surgical excision of the tumour appears to improve survival in the early stages. Keywords: Colorectal, Lymphoma, Solid organs, Haematological malignancy, Retrospective study, Cairo University. INTRODUCTION
archived medical records obtained from the Cancer
Colorectal cancer is the third most common
Epidemiology and Biostatistics Department of NCI,
cancer in the world. The WHO reported about 1.93
Cairo University. The data included demographic (age,
million new cases in 2020 (1). Most of these cases were
gender), clinical presentation, investigation used and
adenocarcinoma, while lymphoma accounts for about
their results, treatment modalities used, and prognosis
0.2-1% of malignancies that affected the colon and
of these cases in terms of overall survival.
rectum. Extranodal lymphoma, defined as lymphomas Ethical approval: This study was approved by
that originated or infiltrated solid organs (2), occurs in Institutional Review Board (IRB) of National
approximately one-third of cases with Non-Hodgkin Cancer Institute, Cairo University, with approval
Lymphoma (NHL) (3). Even though GIT is the No: 2211-510-023. This work has been carried out in
commonest site of extranodal lymphoma, the colon and accordance with The Code of Ethics of the World
rectum are rarely affected compared to the stomach and Medical Association (Declaration of Helsinki) for
small bowel (4), representing only 10-20% of GIT studies involving humans.
lymphomas (5-7). In literature, the cecum and ascending colon represent the most common sites of CLs, Statistical analysis
accounting for 67-87% of CLs (2).
IBM SPSS® Statistics version 26 was used for the
Due to the rarity of cases, a few published articles
statistical analysis. The median and range were used to
discussed the demographic and clinicopathological
express numerical data. Frequency and percentage were
characteristics of CL. This study aimed to address CL at
used to express qualitative data. A Kaplan-Meier
National Cancer Institute, Cairo University from the
survival analysis was performed, and a log-rank test was
following
perspectives:
demographic,
clinical
used to compare two survival curves. To assess
characteristics, diagnosis and treatment, as well as
independent prognostic factors influencing survival,
determining the effects of systemic therapy and the role
Cox regression analysis was used. All tests were two-
of surgical resection of the tumour in these cases.
tailed. P value <0.05 was considered significant. PATIENTS AND METHODS RESULTS
The current retrospective cohort study included all
During the study period, 49 patients were diagnosed
cases of CL presented and managed at the National
with CL and treated at the NCI. The number of male
Cancer Institute (NCI), Cairo University in the period
patients outperformed females, accounting for 61% of
2010-2021. These cases were diagnosed through either
cases. Patients' ages ranged between 2-70 years, with a
colonoscopic biopsies from the colorectal lesion or
median of 5 years. Patients' characteristics are
definitive specimen pathology for cases that underwent
illustrated in Table 1.
resection. The patients' data were retrieved from
3813
Received: 20/11/2022 Accepted: 15/01/2023
c:\work\Jor\vol911_9The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3820-3824
The Effect of Adding Fentanyl to Peribulbar Block on Muscle Traction during Squint and Buckle Surgeries in Adult Patients: A Randomized Controlled Trial Abeer S. Salem1*, Mohamed Mahmoud Mohamed2, Sara A. Khattab2, Mohamed S. Arafa2
1Anesthesia Department, Research Institute of Ophthalmology, Giza, Egypt
2Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt *Corresponding author: Abeer S. Salem, Email: [email protected], Mobile: (+20)1125666006 ABSTRACT Background: In squint and buckle surgeries, the intraoperative pain of muscle traction might not be completely prevented by local anesthetic (LA) drugs. Adding fentanyl to LA can avoid systemic opioids side effects. Objectives: The aim of the current work was to evaluate the safety and efficacy of adding fentanyl to peribulbar block to abolish or decrease muscle traction pain during squint or buckle operations. Patients and methods: This randomized clinical trial study included a total of 60 adult patients (1865-year-old) of both genders booked for either squint or scleral buckle surgeries, attending at Research Institute of Ophthalmology, Giza, Egypt. Patients were allocated randomly into two groups (30 patients each); fentanyl group and control group. Intraoperative pain was the primary outcome, whereas secondary outcomes included the onset of complete akinesia and patient satisfaction. Results: The median pain score was 1 for both groups. Two patients of the fentanyl group and 5 patients of the control group required general anesthesia. The mean time to achieving complete akinesia was shorter in the fentanyl group with a significant statistical difference (134.2±35.8 vs. 156.3±34.7, p = 0.018). The patient satisfaction was more with fentanyl use but with no statistical significance. Conclusions: It could be concluded that fentanyl added to the local anesthesia mixture of peribulbar block in squint and scleral buckle surgeries shorten the time needed to achieve complete akinesia. However, it does not improve the intraoperative pain resulting from muscle traction. Also, it does not affect the need for general anesthesia or postoperative patient satisfaction. Keywords: Strabismus, squint, scleral buckling, peribulbar block, intraoperative pain, muscle traction, fentanyl.
INTRODUCTION
anesthesia in ophthalmic surgeries has been reported in
Surgical procedures for strabismus include
various studies (7-10). An ideal local anesthetic agent
adjustable
suture
surgery,
minitenotomy,
and
should act rapidly for an adequate duration. It should
miniplication. Scleral buckling is performed to repair
provide suitable analgesia intraoperatively and
rhegmatogenous retinal detachments.
postoperatively. Commonly, a mixture of local
In squint and buckle surgeries, muscle traction
anesthetics is used for peribulbar anesthesia. Frequently,
causes intraoperative discomfort. In addition, the
bupivacaine 0.5% is combined with lidocaine 2% or
postoperative period is marked by significant pain and
mepivacaine 2%, and usually hyaluronidase is added to
postoperative nausea and vomiting (1, 2).
ease the diffusion of the anesthetics in the peribulbar
Selecting the appropriate anesthetic technique and
space (10). However, the pain of muscle traction is not
agents guided by the required level of analgesia and
blocked by only local anesthetic drugs. In addition, one of
akinesia has crucial implications. In ocular surgeries,
the intraoperative drawbacks of these blocks is their
general anesthesia is suitable for patients of all ages
limited duration of action (11).
especially the pediatric group, patients undergoing
Fentanyl is a synthetic opioid, and its action is
bilateral eye surgeries, and in long surgeries (3). Another
characterized by having a rapid onset and a short duration
option is topical anesthesia, but it would not provide (12). The use of intravenous opioids for perioperative
akinesia. When akinesia is required, regional blocks can
analgesia in ophthalmic surgeries decreased recently after
be used. Regional anesthesia shortens hospital stay, helps
variable studies reporting lack of advantage for
patients recover faster with less incidence of
intravenous opioids over other options as intravenous
complications
as
hemodynamic
instability,
nonsteroidal anti-inflammatory drugs (13-18).
cardiorespiratory depression, nausea, vomiting, and
Several adjuvants have been used with regional
emergence agitation (4). Sub-Tenon's, retrobulbar, and
anesthesia to enhance block features. Fentanyl has been
peribulbar blocks are three popular regional procedures
added to local anesthetics used for regional anesthesia to (2).
improve analgesia (19-24). This practice has been taken to
Compared to retrobulbar blocks, the peribulbar
reduce complications of systemic opioids, for example
technique is rarely associated with serious complications
cardiorespiratory
depression,
drowsiness,
and
like ocular perforation (5, 6). The efficacy of peribulbar
postoperative nausea and vomiting (11, 25-27).
3820
Received: 12/12/2022 Accepted: 15/02/2023
c:\work\Jor\vol911_10The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3825-3831
Evaluation of Chemokine CCL18 Level in Cord and Peripheral Blood as a Predictor of Intraventricular Hemorrhage in Preterm Infants Suzan Abd El Razek Mohamed Abd El Razek1, Nehal M ElRaggal1, Rania I H Ismail1, Shaimaa A Yousry2, Hanaa A H Amer3, Mohamed O. Abdel Dawoud1
1Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
3Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
2Ministry of Health and Population, Cairo, Egypt. Corresponding author: Mohamed O. Abdel Dawoud, ORCID: https://orcid.org/0000-0001-8583-7026. Mobile: 002 01113434349, email:[email protected] ABSTRACT Background: Intraventricular hemorrhage (IVH) is a serious complication of prematurity. While early diagnosis is crucial for appropriate management, determining high-risk neonates might prompt extra preventive measures. Low levels of Chemokine (C-C motif) ligand 18 (CCL18) may predict the development of IVH in preterms. Aim of the study: to evaluate the association between CCL18 level in cord and peripheral blood and the incidence of IVH in preterm neonates. Patients and methods: This prospective cohort study included, 51 preterm neonates aged (29-32 weeks). Neonates with perinatal hypoxia, brain malformations, or major congenital malformations were excluded. CCL18 was analyzed in cord blood at birth and in the peripheral blood on day 2 of life. Cranial ultrasound scans were done on day 3 and day 7. Results: Out of the studied neonates, only 44 were enrolled,18 males (40.9%) and 26 females (59.1%). The incidence of IVH was 52.3% (23/44). No statistical differences were observed in gestational age (p=0.59), weight (p=0.192), gender (p=0.139), maternal illness (p=0.355), and Apgar score (p=0.961) in both groups. Cord and blood CCL18 were comparable in patients with and without IVH (p=0.518 & p=0.70 respectively). Impaired neurological examination and low platelet count were significantly associated with IVH (p<0.05). Conclusion: The current work suggests that the CCL18 level in the cord or peripheral blood can't indicate preterm neonates at a higher risk of developing IVH. Through neurological examination, sequential cranial ultrasounds and platelet counts might be a more convenient tool for early detection of IVH in preterm babies. Keywords: CCL18, Intraventricular hemorrhage, prematurity, Neonatal, Neurodevelopment.
INTRODUCTION
Intraventricular hemorrhage (IVH) is a common,
vessels, fragile germinal matrix, impaired cerebral
and rather a serious complication of prematurity, whose
autoregulation, fluctuations in the carbon dioxide level,
incidence is inversely proportional to the gestational
and other medical conditions, either maternal (e.g.,
age. Despite all advances in neonatal medicine, the
sepsis) or neonatal (e.g patent ductus arteriosus PDA,
prevalence of IVH remains relatively stationary (1).
coagulopathy) (5).
Hydrocephalus, blindness, cerebral palsy (CP),
As the risk of preterm IVH increases with some
and even mortality are direct sequala of IVH,
inflammatory
conditions
(e.g.,
maternal
particularly the most severe grades (grades 3 and 4) (2).
chorioamnionitis), but decreases with antenatal steroids,
Staggering reports suggest that even milder grades of
the role of inflammatory mediators in the pathogenesis
IVH aren't benign as previously thought. Recent long-
of IVH has been studied (6). Thus, the discovery of
term follow-up studies suggest that -compared to
biomarkers that can highlight infants at risk for injury,
normal neonates- those with mild IVH might be at
quantify its progression, and audit the efficacy of
higher risk of suffering behavioral problems, impaired
neuroprotective interventions is much needed (7).
cerebellar growth, white matter microstructure
Chemokine (C-C motif) ligand 18 (CCL18) -also
immaturity and dysfunction, and overall neurological
referred to as Pulmonary and Activation Regulated
impairment later in life (3).
Chemokine (PARC) is a member of the C-C chemokine
In preterm babies, almost 90% of IVH occurs in
family, whose main biologic role is mediating
the first week of life. For that reason, regular cranial
chemotaxis of leukocytes, mainly as a part of innate
ultrasound scans (up to three in the first week) are
immunity (8). It is present at high levels in human plasma
considered standard of care in most neonatal units.
and is located on chromosome 17q1, aside from other
However, this detects the IVH after it already happened.
macrophage inflammatory proteins (9). CCL18 receptors
While early diagnosis is crucial for the appropriate
can be detected in the germinal matrix, choroid plexus,
management and closer monitoring, determining high-
endothelium of periventricular capillaries, as well as
risk neonates might prompt extra preventive measures,
ependymal cells (10).
like deferring unnecessary procedures or applying IVH
In preterm babies, CCL18 chemokine levels in
prevention care bundles (4).
cord blood are low but notable increase from 32 weeks
The pathophysiology of IVH in preterms is
gestation onwards. It is well known that the incidence
complex and multifactorial. This includes frail blood
of IVH drops massively after 32 weeks gestation, which
3825
Received: 01/09/2022 Accepted: 02/11/2022
c:\work\Jor\vol911_11 The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3832-3840
Targeted Metabolic Profiling of Preterm Neonates with Intraventricular Hemorrhage Noha M. Ashour1, Sara M. Abd Elghany1, Marwa L. Helal2, Marwa Ali Tahoon3, Sameh A. Abd El-Naby1
1Pediatric department, Faculty of Medicine, Menoufia University, Egypt
2Clinical Biochemistry and Molecular Diagnostics Department, National Liver Institute - Menoufia University, Egypt
3Epidemiology and Preventive Medicine Department, National Liver Institute - Menoufia University, Egypt *Corresponding author: Marwa Helal, Mobile: 01003224451, Email:[email protected] ABSTRACT Background: Intraventricular hemorrhage (IVH) is a major cause of morbidity and mortality in preterm neonates. It is essential to obtain new biomarkers for its early diagnosis. This can mainly occur by understanding its pathophysiology and mechanism of occurrence. Objective: To investigate the metabolic changes (blood amino acids and carnitine concentrations) associated with IVH in preterm neonates, and the ability to discover new biomarkers for early diagnosis of such disease that enable early intervention. Patients and Methods: This study was conducted on twenty preterm infants with IVH in the period from July 2019 to July 2020. Preterm infants were evaluated for IVH according to Velisavljev-Fillpoviewith head US scans performed within 24 h after birth, on the 3rd day of life and thereafter weekly till discharge in survivors (Cases). Twenty preterm infants were chosen as a control group matching with the case group in gestational age, gender, and birth weight. Results: There was significant rise of alanine, aspartate, glutamate, and ornithine amino acids in IVH group than control in day 1 (P value < 0.05) in addition to glycine, valine, and proline in day 3. Alanine amino acid > 112.5mol/L showed the highest accuracy 80%, sensitivity 70% and specificity 90% for diagnosis of IVH in premature neonates among all tested amino acids in day 1with significant rise in C3:C2 at cut off point 0.095 (p= 0.001) and C6 cut off point 0.08 (P=0.001) and acylcarnitine cut off point >0.045 mol/L (P=0.002) for diagnosis of IVH. Conclusion: Preterm neonates with IVH showed significant changes in amino acids and carnitines that might guide us to new biomarkers for early diagnosis and intervention. Keywords: IVH, Amino acids, Carnitine, Acylcarnitine, UPLC-MS/MS.
INTRODUCTION
and excremental models of hypoxia-induced asphyxia
IVH is major cause of morbidity and mortality in [8].
preterm neonates. 20-25% of infants with birth weight
Some amino acids may rise in urine of premature
less than 1500 gram, 45% of infants with birth weight
infant having IVH as: Arginine, asparagine, glutamine,
500-750 g have IVH. 60% in very low birth weight
lysine, valine, proline, taurine, threonine, also elevation
newborn with hypoxic ischemic encephalopathy (HIE)
of acylcarnitine level in urine of preterm infant having
also develop IVH [1].
IVH [5, 7].
IVH usually develop spontaneously in premature
Muscles are where carnitine is mostly kept.
infant that may be due to trauma or asphyxia. It may
Medium- and long-chain fatty acids are transported
occur from primary hemorrhagic disorder or congenital
from the cytosol into the mitochondria for oxidation and
vascular anomaly. IVH may be associated with
energy production with the help of carnitine.
disseminated
intravascular
coagulation
(DIC),
Additionally, carnitine promotes the Krebs cycle and
isoimmune thrombocytopenia, neonatal vitamin k
the pyruvate dehydrogenase complex, enhancing the
deficiency, inborn error of metabolism and infant born
oxidation of branched-chain amino acids in muscles [9].
to mother receiving Phenobarbital or phenytoin [2-3].
The important metabolites differed between strata
The high prevalence of IVH and its effects in
regardless of IVH status. The acylcarnitine C-5OH and
preterm newborns highlight the need for more research
C-14:1 in particular were crucial to the survival of
into the underlying processes of IVH as well as the
newborns with IVH, suggesting they may be a good
creation of biomarkers for early diagnosis in high-risk
indicator of the severity of the condition and supporting
neonates [4].
additional research [10].
For the prediction of outcomes, metabolomics can
Several experimental and clinical studies have
offer useful information. Metabolites provide a
been demonstrated some amino acids and certain
distinctive profile that may be used to predict newborn
acylcarnitine in blood level abnormality in IVH
illnesses, assess disease progression, and determine the
conditions [1, 5, 6].
impact of interventions [5-7].
The aim of the present study was to study the
There isn't a lot of metabolomics-based research
predictive ability of blood amino acids and acylcarnitine
on newborn brain damage that focus on term neonates
levels as potential biomarkers for early detection of IVH in premature neonates.
3832
Received: 20/10/2022 Accepted: 20/12/2022
c:\work\Jor\vol911_12The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3841-3845
Office Hysteroscopy and Pain Management by Adding Lignocaine with Distension Media Versus Paracervical Block: A Randomized Controlled Clinical Trial Amina N. Elasy*, Ahmed I. Heraiz, Ahmed M. Farag
Faculty of Medicine, Zagazig University, Egypt Corresponding Author: Amina N. Elasy, Mobile: 00201277530006, ORCID: 0000-0002-8609-8955, Email:[email protected] ABSTRACT Background: Office hysteroscopy is an excellent tool for assessing the uterine cavity, with a very low rate of complication. Oral medicines, local anesthetics, or inhalation-conscious sedation could be used for pain management. Local anesthetics, lignocaine, and use during the office procedure are evident to improve patient satisfaction and increase pain tolerance levels. Objectives: The current study aims to compare the effectiveness of adding lignocaine 2% to the distension media versus paracervical block during office hysteroscopy in pain reduction, and also to compare the need for rescue analgesia, complications rate, and satisfaction of both patients and gynecologists. Patients and methods: A randomized controlled clinical trial was conducted at the Laparoscopy and Cytogenetic Unit of Zagazig University Hospital, between January 2020 and September 2022. A total of 240 women who were eligible for diagnostic hysteroscopy were randomly assigned either to Group 1 (lignocaine 2% mixed with saline distention media) or Group 2 (lignocaine 2% through the paracervical block). We compared pain scores before and after the procedure, patient satisfaction, and surgeons' satisfaction in each group. Results: Paracervical pain during cervical canal passage was greater in Group 2 than in Group 1. However, there was no significant difference in pain levels between the 2 studied groups during the examination of the cavity and for the following 10 minutes. Group 1 had higher satisfied patients and surgeons compared to Group 2. Conclusion: When compared to a paracervical block, the use of lignocaine 2% with saline distension medium was more effective in managing pain without making the patients feel uncomfortable. Keywords: Office hysteroscopy, Pain, Distention media, Lignocaine, Clinical trial, Zagazig University.
INTRODUCTION
office hysteroscopy relays on; the non-touch technique
Office hysteroscopy is a well-acknowledged
through vaginoscopy, the right selection of patient, the
minimal-invasive tool in gynecology practice for the
right time for the procedure, and the preparation of the
assessment of the endometrial cavity (1).
cervical region for those who are most likely to
By avoiding unnecessary operational procedures,
experience cervical stenosis or pain with dilation,
office hysteroscopy procedures have the potential to
individualized pain-management
techniques,
enhance both patient care and satisfaction. Additionally,
the distension media usage, and video monitoring to
it facilitates faster diagnostic and treatment planning
engage the patients involved in the procedure (6).
while lowering the financial and logistical constraints (2).
The current study compares the efficiency of
However, severe pain and discomfort remain
including 2% lignocaine to the saline distension media
concerning to the patient and limiting steps to the
during office hysteroscopy versus paracervical block
gynecologists. In this regard, pain management during
injection to reduce patient pain and improve
the office hysteroscopy involves nonpharmacological
satisfaction.
methods like engaging the patient all through the
procedure, and music. Pharmacological methods PATIENTS AND METHODS.
usually include oral non-steroidal anti-inflammatory
This prospective randomized controlled clinical
medication, local anesthetic agents, or oral or inhaled
trial was approved by the ethical committee of Zagazig
conscious sedation. (3).
University.
Meanwhile, local anesthetics and lignocaine use
We included all patients indicated for office
during the office procedure are evident to improve
hysteroscopy either for cavity assessment, investigation
patient satisfaction and increase pain tolerance. Several
of abnormal uterine bleeding, or removal of an
factors related to the technique can cause pain initiation
intrauterine device at Zagazig University Laparoscopy
during the process. The Ergonomic of the hysteroscopy
and Cytogenetic Unit, during the period from January
instruments includes the tenaculum, speculum,
2020 to September 2022.
hysteroscope diameter, the procedure duration, and Exclusion criteria were a pelvic inflammatory disease,
experience of the operator (4).
endometriosis,
need
for
prolonged
operative
Patient-related factors include cervical stenosis
hysteroscopy,
previously
failed
diagnostic
and patient anxiety. All these factors may make it
hysteroscopy, lignocaine allergy, and patients with
difficult to accurately assess the pain that results from
psychiatric disorders or neurological disorders affecting
the hysteroscope entering the uterus (5). The best
their pain perception.
evidence practices limiting the patient discomfort in
3841
Received: 05/11/2022 Accepted: 08/01/2023
c:\work\Jor\vol911_13The Egyptian Journal of Hospital Medicine (april 2023) Vol. 91, Page 3846-3849
Comparative Study between Effects of Kinesio Taping and Contractubex Phonophoresis on Post-Burn Hypertrophic Scar Characteristics Ahmed M A Abdalla1, Heba S Mohamed2, Karim I Saafan1, Nancy H Abo Elnour1
1Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt
2Department of Dermatology and Venereology, Mataria Teaching Hospital, Egypt Correspondence: Ahmed Mohamed Ahmed Abdalla, E-mail: [email protected], ORCID: 0000-0001-7350-0872,
Telephone: (+20)1010008051 ABSTRACT Background: Post-burn hypertrophic scar (HTS) is common and leads to physical, cosmetic, and psychological problems. Kinesio taping (KT) and contractubex phonophoresis (CP) were proven effective but no studies were found to compare between their effects on improving scar characteristics in post-burn HTS. Objective: The aim of the current work was to compare between effects of KT and CP on improving scar characteristics in HTS after burn injuries. Patients and methods: This study included 40 patients with HTS from burn injuries and aged 20 to 45 years who were selected from Om El Masryeen Hospital. They were randomly and equally allocated into group A (treated with KT) and Group B (received CP). Both groups received traditional physiotherapy. Treatment lasted for six weeks with three sessions weekly. They were assessed with Modified Vancouver burn Scar assessment Scale (MVSS) and A Schiotz tonometer device for scar characteristics. Results: There was a significant improvement in HTS characteristics after both interventions (P- value 0.001). Significant difference was detected between groups in the improvement of HTS characteristics at post-treatment (P- value<0.01), in favor of group A. Conclusion: It could be concluded that KT is better than CP in improving HTS characteristics. Keywords: Contractubex phonophoresis, Kinesio taping, Post-burn hypertrophic scar. INTRODUCTION
Giza, Egypt. This study was conducted between October
Hypertrophic scar (HTS) is abnormal excessive
2022 and December 2022).
healing response as a common consequence of burn
The included subjects were randomly divided into two
injury1. The patients with post-burn HTS had cosmetic,
groups; Group A (KT) consisted of 20 patients underwent
physical (pain, pruritus, contracture, and dysfunction),
KT, and Group B (CP) consisted of 20 patients underwent
psychological and social consequences2,3 The incidence
CP. Both groups underwent traditional physiotherapy.
rate of HTS is 91% following burn injuries4. So, the good
Treatment lasted for six weeks, three sessions weekly.
treatment of HTS is crucial for patients. Kineso taping is
effective for improving HTS pliability and cosmetics and Inclusion criteria: Patients aged 20 to 45 years, post-
decreasing its thickness and need for surgery, via
burn HTS, and scar size ranged from 5 to 7 cm2.
decreasing tensile forces of post-burn HTS and increasing Exclusion criteria: Patients with open wound at
laminin and collagen production4,5.
treatment site, implanted electronic devices, any marked
Phonophoresis is a transdermal drug distribution
health problem that affects assessment or treatment, skin
with help of therapeutic ultrasound to overcome
tumor, been un-cooperative patients, or deep venous
resistance of stratum corneum to the entry of medical
thrombosis.
drugs into skin. Contractubex gel is one of the topical
drugs described for HTS treatment after burn. It can Instrumentations:
control inflammatory, bacteria and fibroblast proliferation Measurement tools:
during healing. It has a positive effect on painful HTS6,7. Modified Vancouver Scar Scale (MVSS): assesses 4
There are no studies that compared between the
characteristics of HTS; vascularity (1=Pink, 2=Red,
effect of kinesio taping and contractubex phonophoresis
3=Purple),
pigmentation
(1=Hypopigmentation,
on post-burn HTS based on researchers knowledge.
2=Mixed, 3=Hyperpigmentation), pliability (1=Supple,
So, this study was aimed to compare between the
2=Yielding, 3=Firm, 4=Ropes, 5=Contracture) and
therapeutic effects of kinesio taping and contractubex
height (1=< 2 mm, 2= 2 to 5 mm, 3=> 5 mm). The larger
phonophoresis on HTS after burn.
the total score, the worse the HTS. Normal skin (zero
score)8. PATIENTS AND METHODS A Schiotz tonometer device: This device (Riester,
This study included a total of 40 patients with HTS from
Germany, 0124) was used as an objective tool to assess
burn injuries, attending at Om El Masryeen Hospital,
the hypertrophic scar elasticity. It has a plunger with
c:\work\Jor\vol911_14The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3850-3854
Predictors of Success of Noninvasive Ventilation in Patients with COPD Exacerbations (Role of Clinical Parameters and Arterial Blood Gases) Rasha A. Abdelfattah1, Ysora M. Ali1, Mohammed O. Abdel Aziz2, Ali O. Abdelaziz1*, Bahaa Ibrahim Mohamed1
Departments 1Chest and 2Internal Medicine, Faculty of Medicine, Minia University, Egypt *Corresponding author: Ali Omar Abdelaziz, Mobile: (+20) 01142741126, E-Mail: [email protected] ABSTRACT Background: Noninvasive mechanical ventilation (NIV) decreases the need for endotracheal intubation (ETI) and also decreases mortality in severe acute exacerbation of COPD (AECOPD). Objective: The aim of the current study is to assess determinants of NIV effectiveness in patients with COPD exacerbation. Patients and methods: Our study was a cross-sectional comparative study. A total 100 patients with AECOPD were included in this study. Patients were admitted to the Respiratory Intensive Care Unit (RICU) in Minia Cardiothoracic University Hospital. All patients were evaluated at the time of admission, at the start of NIV, after 1 hour (hr) of NIV and at the end of NIV. This evaluation included heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, and arterial blood gases (ABG) which include PaO2, PaCO2, PH, HCO3, as well as PaO2 /FiO2 ratio. Results: Patients were divided into 2 groups; 85 (85%) patients improved with NIV (success group, Group I) and 15 (15%) patients failed NIV and were intubated (Group II). PH, PO2, as well as PCO2 revealed significant improvement after 1 hr, which persisted till the end of the study in the success group. Clinical data including heart rate, respiratory rate, systolic blood pressure, and diastolic blood pressure showed significant difference between the two groups at time of hospital admission and the initiation of NIV. After 1 hr, these variables showed significant improvement in the success group that continued till the and at the end of the study. Also, PaO2/FiO2 ratio showed a significant improvement in the success group after 1 hr of NIV. Multivariate analysis showed PH <7.26 and RR35 (at hospital admission) are predictors of failure of NIV. Conclusion: Clinical parameters including HR, RR and blood pressure, as well as ABG, could predict success of NIV in patients with AECOPD. Improvement in these parameters within 1 hr of NIV could be a good predictor of success. Keywords: COPD exacerbation, Clinical parameters, NIV, ABG.
INTRODUCTION
They were admitted to Respiratory Intensive Care Unit
Chronic obstructive pulmonary disease (COPD) is
(RICU) in Minia Cardiothoracic University Hospital,
a substantial contributor to chronic morbidity and death
during the period from June 2021 to December 2021.
globally and is one of the top three killers in the globe (1). AECOPD is a well-known, typical COPD Inclusion criteria: Patients with AECOPD who
consequence with a high mortality and morbidity rate
required NIV according to gold criteria (2).
that might result in hospitalization (1). Exclusion criteria:
Bronchodilators, corticosteroids, antibiotics, and
- Patients who did not tolerate NIV or in whom NIV was
regulated oxygen therapy are common treatments for
contraindicated (2).
AECOPD (2).
- All patients were evaluated at the time of admission,
Patients with acute respiratory failure and
at the start of NIV, 1 hour after start of NIV and at the
hypercapnia will require less endotracheal intubation
end of NIV.
(ETI) and experience lower mortality when non-
invasive ventilation (NIV) is added to this therapy (3). The evaluation of patients included:
Inappropriate patient selection increases mortality by A) Clinical evaluation; including monitoring of heart
delaying ETI, with documented failure rates ranging
rate, respiratory rate, systolic blood pressure (SBP),
from 9 to 50%, whether at the time of admission or by
diastolic blood pressure (DBP) and temperature.
under-recognition of NIV failure (4). B) ABG; includes PaO2, PaCO2, PH, and HCO3.
Lack of qualified workers, concomitant conditions, C) PaO2 /FiO2 ratio.
and a lack of clear recommendations for the ideal NIV
The patients were divided into 2 groups; 85 patients
settings and timing are the main contributors to NIV
showed clinical improvement (successes NIV Group,
failure (5). Group I) and 15 patients failed NIV and needed
The aim of the current study is to assess determinants of
intubation (Group II).
NIV effectiveness in patients with COPD exacerbation.
Ethical approval: PATIENTS AND METHODS This study was ethically approved by the
Our study was a cross-sectional comparative study. A Institutional Review Board of the Faculty of
total of 100 patients with AECOPD were included in Medicine, Minia University. Written informed
this study. consent was obtained from all participants. This study was executed according to the code of ethics of
3850
Received: 20/11/2022 Accepted: 20/01/2023
c:\work\Jor\vol911_15The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3855-3861
Antifungal Activity of Clove (Syzygium aromaticum) Essential Oil Extract against Induced Topical Skin Infection by Candida albicans in Mice in vivo Ban M. Ali , and Ooroba M.S .Ibrahim
Department of Physiology, Biochemistry and Pharmacology, College of Veterinary Medicine,
University of Baghdad, Baghdad, Iraq
*Corresponding Author: Ban Manaf Ali, E-mail:[email protected] ORCID ID1: 0000-0003-0189-9874 ABSTRACT Introduction: Fungal infection is a serious health problem, involved with the life threatening mycosis and mortality. Emerging of resistance and limited antifungal drugs against most antifungal agents lead to the requirement for development of effective and alternate strategies to fight fungal infections, like herbal medicine such as clove oil which is used as antifungal agent against different strains like Candida albicans. Objective: In vivo investigation of antifungal activity of clove oil extract against topical induced infection by Candida albicans in mice. Methods: Forty mice were used to induce skin infection by making a scratch until the skin injuries was formed then inoculate 1×106 C.albicans suspension on scratched skin. Then observe the gross lesion, measure the level of IL-6 and histopathological changes. Result: The development of lesions in mice after induced infection with C.albicans required a period of 5 days in all infected groups. Group treated with clove oil 5 mg/ml showed absence of lesion at day 4 and return to normal thickness and regrowth of hair at day 7 of treatment with significant decrease in level of IL-6 compared to group treated with clotrimazole 2%, which showed presence of dark patch on infected area at day 4 and return to normal but without regrowth of hair at day 7 with decrease in IL-6 but still high compared to negative control. Conclusion: Eugenol has a strong activity against C. albicansin vivo. So, has potential therapeutic effect. Keywords: C. albicans, Clove oil, Eugenol, Gross examination, Interleukin-6, Histophathological changes.
INTRODUCTION
important for keeping fungal cell membranes flexible
There are many different types of fungi,
and stable (7) .
including yeasts, molds, and some that can be both a
A new clinical issue in antifungal therapy is
mold and a yeast, Candida albicans is the most
that fungal pathogens are becoming resistant to the
common fungus that give individuals fungal
drugs that are available to treat them (8).
infections, especially oral or vaginal thrush, which
One alternative to synthetic drugs for treating
often happens after they take antibiotics (1) .
fungal infections is to use medicinal plants and herbal
Fungi are classified according to the virulence
products. These are safe, don't have any harmful side
into two kindes: Primary and opportunistic, Primary
effects, are cheaper, and are often easy to find. Clove
pathogens can cause infections in immune-competent
is one of the spices that can be used instead of chemical
hosts, such as Cryptococcosis, Blastomycosis and
preservatives in many foods, especially when making Histoplasmosis(2).
meat because it has antioxidant and antimicrobial While, Aspergillosis, candidiasis and
characteristics. In the commercial world, they are used
cryptococcosis are examples of opportunistic fungal
for making medicines and in the fragrance industry (9).
infections that are mostly characterized in immune-
Analysis of the structures of eugenol suggests that its
compromised hosts (3).
ability to eradicate fungi may depend on the existence
A kind of infection called superficial mycosis
of an aromatic ring and the fact that it is still there (10).
only affects the top layers of skin and its appendages,
such as the nails and hair and the main agents of these MATERIALS AND METHODS
infections are dermatophytes, non-dermatophytes Experimental Animals
moulds, yeast-like fungi and yeast (4). In addition,
For each test, 40 Albino Swiss female mice (Mus
subcutaneous mycoses, are implantation of fungal
musculus) were used. They were put in a plastic cage
infections that form beneath skin and typically spread
by themselves. The animals were kept in a room with
from the initial infected location to impact muscle,
a temperature between 23 and 25 °C. They had free
deep fascia, and sometimes bone such as
access to standard pellets and water (ad Librium). Chromomycosis, sporotrichosis and Lobomycosis(5). Inducing Skin Infection
There are five major groups of antifungal
Female mice were anesthetized by using chloroform,
drugs, including azoles, polyenes, echinocandins,
their back hair have been clipped and shaved, and the
allylamines, and pyrimidine analogues, that can be
cleansing iodine was applied on their exposed skin. 25
used for both systemic and topical antifungal
mm diameter scratching until the skin injuries was
treatments (6). Azoles like clotrimazole stop an enzyme
formed. Directly following the injury, C. albicans was
called sterol 14-demethylase from making sterol. They
inoculated on the scratched skin by using a 1× 106 cell
also change lanosterol into ergosterol, which is
3855
Received: 20/10/2022 Accepted: 25/12/2022
c:\work\Jor\vol911_16The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3862-3869
Antidiarrheal Effect of Capparis Spinosa Fruits Extract Reham N. Abdulridha, Ali H. Saliem
Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Baghdad, Iraq *Corresponding author: Reham Najem Abdulridha, Mobile: (00964) 7737001711, E-Mail: [email protected] ABSTRACT Introduction: This research was conducted for the purpose of evaluating the antidiarrheal effect of Capparis spinosa fruits methanolic extract and ciprofloxacin against resistant E. Coli. O157:H7. Objective: This research aimed to know the antidiarrheal effect of Capparis spinosa fruits extract against resistant E. Coli. O157:H7. Patients and methods: The extract dose that used in this study was 400 mg/kg of rat weight and 7.14 mg/kg of ciprofloxacin twice daily for seven days. A one ml containing concentration of 1.0 × 109cfu/ml of the activated cells from E. Coli. O157:H7 was obtained to be administrated orally to experimental animals. Results: This extract showed antidiarrheal activity leading to return of electrolytes to nearly normal value and caused reduction in the number of stools and bacterial count. The results of this study suggest that using C. Spinosa fruit extract may have the perfect to be choice in treatment of diarrhea a result of E. coli O157:H7. The findings indicated the alcoholic C. spinosa fruit extract contained some biologically active compounds that may be effective against diarrhea. This finding may explain why the substance has traditionally been used to treat gastrointestinal diseases. Conclusion: There was evidence that the methanolic extract of C. spinosa fruits had antidiarrheal activity against E. coli O157:H7. Keywords: Anti-diarrheal, C. spinose, Fruits, Methanolic, Ciprofloxacin. INTRODUCTION
grows furiously in open, arid wilds throughout the parched
The passing of loose stools and an increase in
and semi-arid zones of various regions of the world (9).
bowel frequency, weight, or volume are considered signals
Caper fruits were distinguished by having a green
of diarrhea, or increase in bowel movement frequency,
exocarp throughout all phases of growth, a decline in
fluidity, or volume, and is associated with increased bowel
protein content as the fruit grew, and high levels of total
sound frequency, wet stools, abdominal pain and reduced
phenols, flavonoids, and flavanols (10).
fluid absorption and loss of electrolytes (particularly
The nutritional value of Capparis species is well
sodium) as well as water in the small and/or large intestine
known, and it also has a wide range of antimicrobial
resulting in abundant watery stool output. Diarrhea is
properties, such as antifungal and antibacterial activity, or
either chronic, or acute. As for acute diarrhea normally
as antioxidant, hepatoprotective, anticancer, antiallergic,
caused by infection with bacteria, parasites and viruses. It
anthelmintic, antidiabetic, anti-inflammatory, cytotoxic,
continues for one to two days (1).
antiarthritic,
anti-oxidant,
cardiovascular,
Cattle are the main reservoir for E. coli O157:H7, a
chondroprotective, hypolipidemic, antiallergic, anti-
potential bacterial foodborne zoonotic pathogen that is
histaminic, immune modulatory. The fruits are used in the
significant globally (2, 3). It results in infections that can be
treatment of fever, diabetes, rheumatism, and headaches,
fatal, including renal failure, hemolytic uremic syndrome,
while leaves, buds and roots are used to treat
bloody diarrhea, and abdominal pain (4). Antimicrobial
gastrointestinal, earache, dermatological, liver, and renal
medications are frequently used to treat calf diarrhea. The
diseases (11,12).
development of microbial tolerance to many antimicrobial
There have suggested that the aerial portions of C.
drugs has nonetheless become a well-known phenomenon spinosa could be a source of antibacterial substances and
due to their broad spectrum activity, which is a major
extracts from C. spinosa components have been shown to
worry (5, 6). Synthetic medications are known to have a
effectively prevent the growth of a variety of bacterial
variety of harmful adverse effects on human health (7).
strains, particularly those that have developed antibiotic
Synthetic drugs are known to have a range of
resistance (13). Also,it hasantibacterial effectagainst E.
harmful adverse effects. Using herbal products is one of coli and different type of bacteria (14) whereit is taken
the promising solutions if it is supported by scientific
internally to treat diarrhea and gastrointestinal illnesses (15).
studies. In regards to the ongoing rise in bacterial
The fruits of capersare traditionally used for treating
resistance to antibiotics, the development of strains that are
resistant E. coli and may have the perfect to be choice in
multi resistant, and the therapeutic issues that result.
clinical control (16). methanolic, ethanolic, ethyl acetate
Recently, a number of data have been published in this
extracts were used successfully against growth of
area, allowing for the valuation and justification of
pathogenic bacteria. Capparis spinose extracts produced
medicinal plants' positive effects on health (7, 8). C. spinosa
good results with respect toinhibiting pathogenic
L(Caper) is a Capparidaceae perennial thorny shrubs Escherichia coli growth andincreasing its sensitivity to
3862
Received: 20/10/2022 Accepted: 26/12/2023
c:\work\Jor\vol911_17The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3870-3876
Vitamin E versus Evening Primrose Oil versus Placebo for the Treatment of Cyclic Mastalgia: A Double-Blind Randomized Controlled Trial Mohamed Elsayed Seifalyazal, Sherif Albalkiny, Gamal Fawzy, Ahmed Elnabil-Mortada
Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt *Corresponding author: Mohamed Elsayed Seifalyazal, Mobile: (+20) 01157327366, E-mail:[email protected], [email protected] ABSTRACT Background: Reassurance is important because it influences lifestyle choices or fears of breast cancer in 70% of women of reproductive age who have breast discomfort and seek medical attention. Either cyclic or noncyclic mastalgia exists. Breast discomfort needs to be carefully evaluated and should be looked into the same way as any other breast symptom. Natural remedies like evening primrose oil and vitamin E are now being used as therapeutic options because of the undesirable side effects of other treatment approaches. Objective: In order to treat cyclic mastalgia, we compared the efficacy and adverse effects of vitamin E and evening primrose oil. Patients and Methods: We conducted a double-blind randomized controlled trial between February 2018 and February 2019 at Al-Jedaani Hospitals, KSA. A total of 160 women of reproductive age with a chief complaint of cyclic mastalgia were enrolled into this study. They were randomly assigned into 3 groups: group A of 55 patients (34.4%) received vitamin E, group B of 45 patients (28.1%) received evening primrose oil and group C of 60 patients (37.5%) received placebo. Overall pain severity and the effect of pain on patients' lifestyle were assessed at 1-month and 3-month follow-up visits. Results The mean age of the patients was 31.23 ± 6.82 years. Highest respondents were aged between 30 and 38 years (34.5%). The median pain score and the effect of pain on patients' lifestyle were significantly decreased on successive follow-up visits. Although this decrease was significant in each individual group, it was not statistically significant compared to one another (P value = 0.619 and 0.621 respectively). Conclusion Vitamin E and evening primrose oil have a good impact on cyclic breast pain but their effect is not much different than placebo effect Keywords: Cyclic Mastalgia, Evening primrose oil, Vitamin E.
INTRODUCTION
Evening primrose oil (EPO) is native plant of North
Mastalgia may affect up to 70% of females during
America. The seed contains a variety of amino acids as
their reproductive age. It ranges from tension or
lysine, tyrosine, phenylalanine, etc., while the seeds' oil
discomfort to real pain. It is typically classified as cyclic,
contains the omega 6 fatty acid gamma-linolenic acid
non-cyclic and extra-mammary pain [1]. Although benign
(GLA), which is thought to be deficient in patients with
factors are more frequently to blame for this disease,
mastalgia [6]. Lack of GLA renders the epithelium of
breast cancer should be ruled out since it is the most
breast cells more susceptible to circulating hormones. In
common source of concern for patients. It is important to
addition, GLA plays a critical role in the production of
rule out extra-mammary sources of pain such Tietze
anti-inflammatory eicosanoids via the lipoxygenase and
syndrome or transferred pain. Severe mastalgia has a
cyclooxygenase pathways [6].
major impact on women's daily activities [2]. Numerous
Vitamin E is an antioxidant that acts by preventing the
illnesses, including stress, anxiety, depression, irritable
formation of and scavenging reactive oxygen species
bowel syndrome, and various mental disorders, have been
(ROS), eventually stabilizing the epithelium of breast
linked to mastalgia, which may indicate a psychosomatic
cells while lowering the amount of oxidative stress
basis or multifactorial aetiology [3].
indicators and shielding them from harmful free radicals
Increased serum prolactin levels, oestrogen
[7]. In order to treat cyclic mastalgia, we compared the
sensitivity, reduced serum progesterone, an antioxidant or
efficacy and adverse effects of vitamin E and evening
gamma linoleic acid deficit, or a systemic condition of salt
primrose oil.
and water retention are only a few of the causes of cyclic
MATERIALS & METHODS
mastalgia that have been suggested [4]. The most crucial Population
management move once cancer has been ruled out is
We included one hundred sixty eligible women who
reassurance [5]. Various treatment modalities have been
were presented to the Breast Clinic at AL-Jedaani
used like Tamoxifen, Danazol, Bromocriptine but their
Hospitals between February 2018 and February 2019,
side effects preclude their use except for resistant cases
complaining of cyclic mastalgia for at least 3 months.
only. This makes the use of natural supplements like Oenothera biennis (Evening primrose oil) and vitamin E We excluded women with suspected breast lesion,
an attractive treatment option [1].
diagnosed breast cancer, pregnant, lactating, non-cyclic
3870
Received: 5/10/2022 Accepted: 5/12/2022
c:\work\Jor\vol911_18The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3877-3884
Evaluation of Salivary Osteoprotegerin in Hypothyroidism and Periodontitis Patients Case-Control Study Ghada Ghalib Hussien*, Omar Hisham Ali
Periodontics Department, College of Dentistry, University of Baghdad, Baghdad. Iraq Corresponding author: Ghada Ghalib Hussien, E-mail:[email protected], phone: 009647725478147
ABSTRACT Introduction: The immune system has been used to mediate the link between periodontal disease and the endocrine system, particularly thyroid dysfunction. Osteoprotegerin, a dimeric glycoprotein, its structure similar to receptor activator of nuclear factor kappa-b is generated and secreted by osteoblasts and considered as a member of the TNF family. To prevent RANK from contacting RANKL, OPG functions as a "false target." OPG is necessary for preventing osteoclast activation and development; as a result, bone resorption will stop. Objective: To demonstrate the salivary level of OPG in hypothyroidism and periodontitis patients in comparison to healthy controls. Patients and Method: Saliva samples were taken from 90 subjects ranging in age from (22-65) years, 50 of whom were hypothyroid patients (25 participants with periodontitis and systemically healthy; 25 participants with hypothyroidism and a healthy periodontium, 25 participants with hypothyroidism and periodontitis, and 15 individuals systemically healthy with healthy periodontium, which serve as the control group. OPG in saliva was discovered using ELISA. Result: According to the current findings, the levels of salivary OPG were significantly low in the disease group (periodontitis group, hypothyroid patient group with and without periodontitis) than in the control group. In addition, salivary levels of OPG were significantly lower in hypothyroidism with the periodontitis group in comparison to the periodontitis group. Conclusion: OPG has a protective role in disease processes, in which the level of OPG decreased in all diseases group and increase in health. Hypothyroidism affects the level of salivary OPG. Keywords: Periodontal disease, Osteoprotegerin, Hypothyroidism, Saliva.
INTRODUCTION
activity of these hormones can cause hypothyroidism, a
The potential link between periodontitis and
common endocrine disorder with a variety of adverse
hypothyroidism has only been investigated in a limited
effects on the body (8). Hypothyroidism is a chronic illness
number of high-quality studies (1). The metabolic activity
marked by decreased levels of T4 and T3 (9). The primary
of fibroblasts decreases as a result of hypothyroidism,
function of thyroid follicular cells is the production of
delaying the healing of wounds (2). Due to the long-term
thyroid hormones, which are essential for many
exposure of the injured tissue to pathogenic organisms, a
physiological processes, including regulation of the basal
delay in the healing process may be associated with a
metabolic rate (BMR), growth, and development (10).
greater risk for infection, which shows clinically as higher
Cytokines are soluble proteins that initiate intracellular
gingival bleeding (3). The cytokines produced by thyroid
signaling cascades by binding to specific receptors on
dysfunction increase inflammatoryn cascade easily (4).
target cells, which modify how genes are controlled and
Periodontitis defined as a severe, chronic disease
result in changes in the phenotype of the cell (11).
of the periodontium brought on by an abnormal immune
Immune cell activation, death, proliferation, and
response in susceptible individuals and characterized by
inhibition are just a few of the basic processes that
the predominance of Gram-negative bacteria in the
cytokines can regulate (12). Osteoprotegerin (OPG), a
subgingival niches (5). Periodontitis considered as one of
dimeric glycoprotein produced and secreted by
the most prevalent non-communicable chronic
osteoblasts and consider as TNF family member, shares
inflammatory illnesses, and affects 50% of adults and is
structural similarities with receptor activator of nuclear
the sixth most widespread disease worldwide. About 11%
factor kappa-B (13). OPG serves as a "false target" to keep
of individuals have periodontitis in its more aggressive
RANK from making contact with RANKL. Formation
form (6). In people who are vulnerable, the dental plaque
and activation of the Osteoclast must be prevented by
biofilm is thought to be the main etiological factor;
OPG to stop bone resorption (14).
however, smoking and diabetes also play a role in the
A variety of tissues produce the OPG, including
progression of the disease (7). thyroid hormones are two
the heart, placenta, kidney, vasculature, lung, and bone
type Thyroxine (T4) and Triiodothyronine (T3) that (15). Saliva is a complex, diluted, colorless, and opalescent
secreted by the thyroid gland and needed by all
aqueous solution that contains both inorganic and organic
metabolically active cells. As a result, a lack of or reduced
components (16). Saliva collection lowers the likelihood of
3877
Received: 06/11/2022 Accepted: 07/01/2023
c:\work\Jor\vol911_19The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3885-3895
Gold Nanoparticle Biosynthesis-Mediated Acinetobacter umannii as a Cytotoxic and Apoptosis Inducer in Prostate Cancer Cell Lines Intesar H. Al-Abdeli*, Esam J. Al-kalifawi
Department of Biology, College of Education for Pure Science,
Ibn-Al-Haitham University of Baghdad, Baghdad, Iraq *Corresponding author: IntesarH. Al-Abdeli,Mobile: (+20) 01140292959, Email: [email protected]
ABSTRACT Background: Gold nanoparticles (AuNPs), unlike chemotherapy, may destroy cancer cells without harming normal cells. Objective: For the first time, Acinetobacter (A.) baumannii-biosynthesized AuNPs (Ab-AuNPs) were evaluated for anticancer properties. Materials and methods: The Ab-AuNPs were characterized by UV-visible spectroscopy, TEM, FE-SEM, AFM, XRD analysis, and FTIR. The MTT assay was used to determine the antiproliferative efficacy of the Ab-AuNPs at different concentrations against prostate cancer (PC3) and human breast normal cell line (MCF-10). Potential apoptotic- mediated cell death was investigated using acridine orange and propidium iodide staining and mitochondrial membrane potential (MMP). Results: Biosynthesized Ab-AuNP had a zeta potential below 30 mV at -22 mV, suggesting particles stability with no aggregation. The average size was estimated at 66 nm (range 20-90 nm). Ab-AuNPs inhibited PC3 cell proliferation dose-dependently, with no adverse effect on MCF-10 cells. The mean lethal dose (IC50) was 13.72 µg/mL, and the maximal inhibitory concentration was 25.50 mg/mL (57.33% and 80.67%, respectively). Examining PC3 cancer cells treated with Ab-AuNPs at IC50 for 24 hours by flow cytometry revealed an increase in apoptosis that resulted in the disruption of the membrane and vacuoles of the lysosomes, which corresponded with the depletion of MMP. This was in contrast to MCF-10 AuNPs-treated cells, which showed no adverse effects. Conclusions: Producing gold nanoparticles in an A. baumannii broth culture is simple, inexpensive, and non-toxic to healthy cells. They showed anticancer effects by inducing apoptosis, making them a potential effective anticancer agent. Keywords: Gold nanoparticles, Acinetobacterbaumannii, Anti-cancer activity, Apoptosis activity.
INTRODUCTION
decrease and stability of metallic nanoparticles (9).
The use of biological systems in nanoscience
has given birth to the name nanobiotechnology, which
There are several uses for AuNPs in cancer
modulates entities in the 1100 nm range using
diagnostics and therapy, drug delivery, and gene
biological systems or for the benefit of natural systems
therapy (10). AuNPs are the most commonly used metal (1). It is a field Bio sourced synthesis of nanomaterials
nanoparticles due to their morphology, dimensions,
mediated by microorganisms and plants. Bio-sourced
excellent optical and electronic properties, high
synthesis of nanomaterials through microorganisms and
biocompatibility, and stability (11). Cancer is one of the
plant-based mediators is a growing field (2). Many
leading causes of death worldwide, affecting over 11
bacteria, the most prevalent species in the biosphere,
million people annually (12).
have been shown to create extracellular and
Including prostate cancer is a tumor that forms
intracellular metallic nanoparticles (3).Acinetobacter
in the male prostate (a little gland with a walnut-like
(A. aumannii) has been suggested because it is
form) that produces semen, which supplies nutrients
widespread in the surrounding environment.
and transports sperm, and the most common cancer in
Acinetobacter is a diverse group of organisms
men is prostate cancer (13). After AuNPs enter most
ubiquitous in nature (4). Its high forming capacity allows
cancer cells, a series of processes evolve from the loss
it to form biofilms and withstand extreme conditions (5).
of migration stability, the onset of unstable oxidation
This group is known to resist various metal ions and
states, and waves of free radicals that disrupt and
antibiotics (6).
expand the nuclear membrane of the nucleus. Initially,
The biosynthesis of gold nanoparticles
mitochondria unfold to increase oxidative stress within
(AuNPs) would benefit from developing clean, non-
the cell (14).
toxic, and environmentally friendly procedures for
The aim of current study was to demonstrate the
microorganisms from bacteria to fungi (7).
biosynthesis of AuNPs using A. aumannii broth
The simplest way to produce nanoparticles is to
cultures and measuring its in vitro cytotoxic effects on
reduce the respective salts (8). Bacteria have always
tumor cell lines prostate cancer (PC3) and comparing
been organisms of choice due to their unique property
them with the normal human cell line MCF-10, to
of creating various enzymes for chemical detoxification
evaluate its potential therapeutic anticancer activity and
and energy-dependent ion efflux, involved in the
its apoptosis induction in prostate cancer cell lines.
3885
Received: 04/08/2022 Accepted: 05/10/2022
c:\work\Jor\vol911_20The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3896-3901
Effect of Aminophylline on Incidence of Apnea and Recovery Time during Propofol Sedation for Gastrointestinal Endoscopy Mohammed M. Maarouf*, Mostafa M. Hussein, Rania G. El Sayed
Department of Anesthesiology, Intensive Care and Pain Management, Ain Shams University Faculty of
Medicine, Cairo, Egypt *Corresponding author: Mohammed M. Maarouf, Mobile: (+20) 01006469268, E-mail:[email protected] ABSTRACT Background: Apnea may occur during propofol sedation for endoscopy, which can be harmful to the patient and disruptive to the procedure. Objective: To test the hypothesis that a small dose of aminophylline before propofol sedation may result in a lower incidence of apnea, as well as faster emergence from sedation. Patients and Methods: The researchers conducted a single-center, prospective randomized controlled study on 76 adult ASA I or II patients with age ranged from 20 to 65 years old. They were admitted for upper gastrointestinal or colonoscopic endoscopies. All patients were sedated with 25µg fentanyl, 1mg/kg propofol bolus over 30 seconds, then propofol boluses (0.5 mg/kg) according to need. Patients were divided into two groups: Control group [Group C (n=38)], and a study group [Group Am (n=38)] who received 0.5 mg/kg aminophylline preoperatively. Apneas were counted during each procedure, and emergence from sedation was assessed with modified Aldrete score. Results: There was a statistically significant decrease in the overall incidence of apneas with aminophylline premedication (P = 0.025), as well as a reduction in the number of apneas per bolus of propofol (P = 0.006). However, there was no statistically significant difference regarding the average time to modified Aldrete score both when tested after 5 minutes or after 10 minutes after discharge from the endoscopy room. Conclusion: Premedication with a small dose of intravenous aminophylline significantly reduces the incidence of apnea during propofol sedation for gastrointestinal endoscopies, while its effect on emergence from sedation is not significant. Keywords: Propofol sedation, Aminophylline, Gastrointestinal endoscopy. INTRODUCTION
Propofol is a potent anesthetic with dose-dependent
residents, regardless of patient risk, type of procedure or
respiratory depression (1).
planned depth of sedation, or specialty of the operator
After intravenous injection of propofol, apnea
(surgical, internal medicine, and pediatric). This is
occurs; the incidence and duration of apnea depend on
consistent with the increasing involvement of
the dose, rate of injection, and other premedications (2).
anesthesiologists in endoscopy services around the
An anesthetic dose of propofol results in a 25% to 30%
world (7).
incidence of apnea in the absence of surgical or painful
While a sedative dose of propofol (0.5 - 1 mg/kg)
stimuli. Metabolic depression also decreases the PaCO2
administered for a patient undergoing gastrointestinal
elevation. The duration of apnea with propofol may be
endoscopy is significantly lower than an induction dose
prolonged to more than 30 seconds with the addition of
(1-2.5 mg/kg) (8), still, respiratory depression happens
opioids as premedication (3).
and apneic episodes are encountered, albeit less
As with other sedative and anesthetic drugs,
frequently and less severely. Nonetheless, even those
spontaneous ventilation for a patient under propofol
less-encountered respiratory depression and episodes of
sedation is dependent on a balance between the drug's
apnea, which invariably result in hypoxia and a decrease
respiratory depressant effects and decrease in carbon
in SpO2, are potentially harmful to the patient and
dioxide production (due to metabolic depression) versus
disruptive of the anesthetic practice and the endoscopic
the stimulatory effects of increased PaCO2 resulting
procedure.
from apnea and stimulation from nociception. Propofol
The attending anesthesiologist has to ensure that the
also depresses the respiratory response to hypoxia by
patient's airway is clear and patent, and at times, resort
acting on the carotid body chemoreceptors (4).
to stimulating or improving ventilation with painful
Endoscopy is the most common medical procedure
techniques like jaw thrust. These maneuvers frequently
performed under sedation. A safe and competent
decrease the level of sedation, and may lead to the
anesthetic service has to ensure rapid patient turnover
patient's discomfort, awakening, and movement,
and discharge, in addition to a high operator
disrupting the endoscopic procedure. Not infrequently,
(endoscopist) and patient satisfaction. Medical
the anesthesiologist needs to give an additional dose of
practitioners from across the medical spectrum, ranging
propofol, risking repeating the same unfavorable
from operators to nurses to anesthesiologists, have been
sequence of events. Aminophylline acts centrally as an
providing sedation for endoscopies, and the safety of
adenosine antagonist (9). Several clinical trials have
some of these practices has been assessed (5,6). In Ain
shown that aminophylline decreases the depth and
Shams University Hospitals, nearly all endoscopy
duration of propofol sedation (10). Other studies have
patients are managed by anesthesiologists, staff and
shown that aminophylline may be used to decrease the
3896
Received: 2/11/2022 Accepted: 2/01/2023
Type of article: OriginalThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3902-3906
Serum Neprilysin Is a Significant Predictor of Metabolic Syndrome in Psoriasis Patients Essam Mohamed Akl1, Nehad A. Fouad2, Marwa Bashir Amir Alamin1, Karem Taha Khalil*1
Departments of 1Dermatology, Venereology and Andrology and
2Medical Microbiology and Immunology, Faculty of Medicine Benha University, Egypt *Corresponding author: Karem Taha Khalil, Mobile: (+20) 01282559828, Email:[email protected] ABSTRACT Background: There is a lot of disagreement on the connection between metabolic syndrome and psoriasis. A membrane- bound metallopeptidase with a wide variety of physiological uses is neprilysin (NEP). New information suggests that NEP may contribute to the aetiology of the metabolic syndrome. Objective: To evaluate serum NEP levels and their significance in the metabolic features of psoriasis patients. Patients and Methods: A total of fifty psoriasis patients and thirty healthy volunteers of matched age and sex participated in this case-control research. Every participant underwent clinical examination with focus on measuring the PASI score, blood pressure (systolic, SBP and diastolic, DBP), and abdominal circumference. Additionally, lipid profile, NEP, and fasting blood sugar (FBS) assays were performed. Results: In comparison to controls, psoriasis patients had significantly higher SBP, DBP, FBS, and triglycerides (p=0.01, 0.04, 0.04, and 0.01, respectively). Median level of NEP was 225.35pg/mL with range of 45.4-540.2pg/mL in psoriasis patients compared with controls (51.65, 41.6-368.9) (p <0.001). NEP showed significant positive correlation with PASI score (r=0.462, p=0.001). NEP was found to be the only predictor of the probability of metabolic syndrome in psoriasis patients (p<0.001). Conclusion: NEP concentrations can be used as a marker to check for metabolic syndrome in psoriasis patients. Keywords: Psoriasis, Neprilysin, PASI, Metabolic syndrome.
INTRODUCTION
Additionally, patients who were nursing or pregnant
Psoriasis is considered a complex and multisystemic
were not permitted to take part.
disease (1). It is linked to the increased possibility of
Methods
coronary artery disease (2-6). Metabolic syndrome
Each participant underwent a thorough general
(MetS) includes abdominal obesity, high blood
examination,
including
assessment
of
waist
pressure, disturbed lipids, and glucose intolerance (7).
circumference, body mass index (BMI), and blood
Neprilysin (NEP) is a plasma membrane protein that
pressure, as well as a detailed history taking (age, sex,
is produced by fibroblasts, endothelial, and smooth
duration of psoriasis, and family history of psoriasis).
muscle cells in the mesenteric adipose tissue and
The psoriasis severity was calculated with the aid of
pancreatic islet cells (8).
psoriasis area and severity index (PASI) score.
Endothelin, bradykinin, atrial, and brain natriuretic
Diagnosis of MetS requires the existence of any three of
peptides are small vasoactive peptides, and angiotensin
the next five factors: waist circumference greater than
I and II are degraded and inhibited by NEP (9).
90
cm
(males)
and
80
cm
(females),
Glucagon-like peptide 1 (GLP-1) activity is destroyed
hypertriglyceridaemia (150 mg/dl); decreased HDL
by NEP, which prevents GLP-1 from binding to its
(<40 mg/dl) for males and (<50 mg/dl) for females;
receptor. Additionally, NEP inhibition improved
blood pressure 130/85 mm Hg or use of
glycemia (10).
antihypertensive drugs); fasting blood sugar 5.6
Obesity and type 2 diabetes are metabolically altered
conditions that increase NEP (11). As a consequence, in
mmol/L (100 mg/dL) (12).
order to assess circulating NEP levels in psoriasis Laboratory investigations were done for fasting blood
patients and their clinical correlations with metabolic
sugar (FBS), lipid profile and serum NEP using ELISA
syndrome, the current study was carried out.
(Baoshan District, Shanghai, China).
PATIENTS AND METHODS
Study population Ethics statement:
This was a cross-sectional study at the Dermatology The Benha Faculty of Medicine's ethics
department, Benha University hospitals from February committee for research involving human beings
2022 to August 2022. Fifty patients with psoriasis over authorised the study (MS.5-2-2022). Everyone who
the age of 18 years were enrolled, while control group took part provided their signed, informed
comprised of thirty normal individuals who were of permission. The Declaration of Helsinki for human
matching age and sex. Exclusion criteria for the study beings, which is the international medical
included those with pustular or erythrodermic psoriasis, association's code of ethics, was followed during the
other skin disorders, or those who had recently conduct of this study.
undergone systemic or topical psoriasis treatment. Statistical analysis
c:\work\Jor\vol911_22The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3907-3912
Dental Plaque and Gingivitis in Relation to Knowledge and Attitude among Osteoporotic Menopausal Women in Baghdad City, Iraq Zainab Abdulkareem Hameed (1), Nada Jafer MH Radhi (2) (1) Master student. Department of Pedodontics and Preventive Dentistry,
College of Dentistry, University of Baghdad, Iraq (2) Department of Pedodontics and Preventive Dentistry. College of Dentistry. University of Baghdad, Iraq Corresponding Author: Zainab Abdulkareem Hameed, Phone number: 009647805616519, E-mail:[email protected] ABSTRACT Background: Dental plaque is complex biofilm. Gingivitis is first stage of body responses towards dental plaque present in the oral cavity; it characterized by gum redness, swelling and bleeding without periodontal attachment loss. Osteoporosis occurs when new bone formation and old bone resorption are not equal. During menopause, women experience an increased rate of bone loss. Objective: The current study aimed to evaluate dental plaque and gingivitis in relation to knowledge and attitude among osteoporotic menopausal women in Baghdad, Iraq. Patients and methods: A cross sectional study was conducted on women attending Medical city teaching hospital in Baghdad city. The total sample composed of 90 menopausal women, and their age ranged from 45 to 65 years old. First (study) group consisted of 45 menopausal women with osteoporotic disease as appeared in dual energy X-ray absorptiometry (DEXA) scan. The second (control) group consisted of 45 menopausal women without osteoporosis as appeared in DEXA. Plaque and gingival indices were examined. Women's knowledge and attitude about osteoporosis, vitamin D and oral health were assessed. Results: Mean value of plaque and gingival indices were higher in study group than control with no statistical significant difference. Knowledge and attitude of studied women toward osteoporosis, vitamin D and oral health findings showed no statistical significant differences. Conclusion:Dental plaque and gingivitis are high among menopausal women with osteoporotic disease.Therefore, old women with osteoporosis need more oral health educational and preventive programs. Keyword: Osteoporosis, Menopause, Dental plaque,Gingivitis, Cross sectional study, University of Baghdad.
INTRODUCTION
are the intermediary colonizers between primary and
Osteoporosis is a condition that causes
secondary colonizers (8). Gingivitis is the first stage of
disturbance of bone microarchitecture, low bone mass,
the body's reaction to local factors present in the oral
and degeneration of bone tissue. It can weaken bone
cavity, which is characterized by gum redness, swelling
strength and increase the chance of fractures (1).
and bleeding, without periodontal attachment loss (AL)
It happens when the amount of new bone (9). Many patients are unable to recognize the disease or
formation and old bone resorption are not in balance.
ignorant of it, as it is frequently painless and seldom
Not enough new bone is produced by the body, too
results in spontaneous bleeding (10) and there is no bone
much old bone is reabsorbed, or both are occurring. As
or periodontal support being lost, so it is reversible.
a result, the bones could deteriorate, making them more
According to histopathology, collagen fibers
brittle and prone to breaking. The incidence of
within the lamina propriety are damaged, which causes
osteoporosis and bone loss increases with age; in
ulcerations in the sulcular epithelium (8).
addition, lack of certain hormones, mainly estrogen in
Numerous epidemiological researches used the
women and androgen in men, is the main contributor to
gingival index (GI) or Community Periodontal Index
osteoporosis (2-3). The dual energy X-ray absorptiometry
(CPI) of Treatment Needs (CPITN) for assessing gum
(DEXA) scan is a device use for osteoporosis diagnosis
inflammation to determine the prevalence of
and screening makes the Bone Mineral Density (BMD)
periodontal diseases(11).
test available for many patients (4). Vitamin D
Plaque biofilm is more harmful to gingival tissue and
supplementation and calcium are recommended as a
inflammation of the gingiva is linked to circulating sex
complementary treatment even if dietary supply is
hormone levels (9).
appropriate (5).
Although raised ovarian hormone levels, as
Menopause is characterized as the cessation of
observed in puberty, menstruation, and pregnancy can
menstruation brought on by the decline in ovarian
cause a rise in gingival
follicular activity (6).
inflammation and microbial alterations in dental plaque
Dental plaque is thought to be a varied colony of (12).
bacteria that live on the surface of teeth as a biofilm and
Contrarily, a lack of hormones during menopause
are trapped in an extracellular matrix of polymers of
might also result in poor periodontal health. It is
both microbial and host origins (7). Dental plaque builds
hypothesized that hormonal changes and a decline in
up gradually layer-by-layer, causing the environment to
bone mineral density (BMD) increase postmenopausal
become oxygen-deprived and finally allowing
women's tendency for alveolar bone loss (13). Gender (14),
anaerobic bacteria to colonize. Fusobacterium species
dental calculus, oral hygiene, socioeconomic variables
3907
Received: 03/01/2022 Accepted: 01/03/2022
Can passive leg raising predict fluid responsiveness in intra-abdominal hypertension mechanically ventilated Surgical critically ill patientsThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3913-3919
Can Passive Leg Raising Predict Fluid Responsiveness in Intra-Abdominal Hypertension Mechanically Ventilated Surgical Critically Ill Patients Mohammed Abdel Monem Saeed1, Tarek Osman AbdelAzim2, Deyaa Mohamed Ibrahim3, Alaa Mohamed Hussein4
Departments of 1Critical Care Medicine and 2General surgery, Faculty of Medicine, Helwan University, Egypt
Department of 3Critical Care Nursing, Faculty of Nursing, Helwan University, Egypt Department of 4Clinical Pharmacist, Faculty of Pharmacy, Helwan University, Egypt *Corresponding author: Mohammed Abdel Monem Saeed, Mobile: (+20) 01099292999, E-Mail: [email protected] ABSTRACT Background: The fluid responsiveness of patients who are mechanically ventilated is evaluated using the reversible fluid loading technique known as passive leg raising. Objective: This study purpose to determine if intra-abdominal hypertension, which reduces venous return, affected the ability of passive leg raising to detect fluid responsiveness in critically ill patients. Patient and methods: Our study is a prospective study done at the critical care Medicine Department of Helwan University Faculty of Medicine on 400 mechanically ventilated patients with a pulse pressure variation greater than 12%. The esophageal Doppler was used to continually monitor the stroke volume. The bladder pressure was used to calculate intra-abdominal pressure. Fluid loading with 500 ml of saline was conducted after a passive leg-raising exercise and a return to baseline, with hemodynamic parameters recorded at each stage. Results: Four hundred patients were divided into two groups based on their response to passive leg raising: responders (at least a 12% increase in stroke volume) and non-responders (all patients in both groups were responders to volume loading). Two hundred patients responded to passive leg raising (50%), whereas the non-responders (i.e. false negatives) were similarly 50%. At baseline, the non-responders to passive leg raising had considerably greater median intra- abdominal pressure than the responders to passive leg raising (20 [5.5]- vs 10 [4.5], respectively, with a p-value < 0.001). Conclusion: Passive leg raising has false negatives are caused by intra-abdominal pressures more than 12 mmHg. In severely sick ventilated patients, intra-abdominal pressure (IAP) should be assessed before doing passive leg raising. Keywords Intra-abdominal pressure, Passive leg raising, Mechanical Ventilation.
INTRODUCTION
Fluid treatment is the first-line therapy in critically
We included patients in our trial with circulatory
sick hypotensive patients because insufficient fluid
failure, were receiving mechanical ventilation while
supply is harmful (1). Passive leg raising increased
sedated, and had a pulse pressure variation (pp) of
stroke volume was used to forecast fluid response in
greater than 12%. We also chose to track intra-
individuals who are extremely ill (2). Although multiple
abdominal hypertension.
studies (2, 3), indicated that passive leg raising had good
Blood pressure during systole of less than 90 mmHg
sensitivity in septic and postoperative patients, the IAP
indicates circulatory failure, chronic lactic acidosis, or
levels of the patients who were included in these studies
a requirement for vasoactive medications.
were not disclosed.
The tidal volume for each trial subject was kept to
Intra-abdominal hypertension (IAH) lowered
a minimum of 8 ml/kg. These were the specific criteria
venous return, which reduced cardiac output (4-6); this is
we used to exclude people: Exclusions include those
due to constriction induced by increased IAP of the
who are under the age of 18, women who are pregnant,
inferior vena cava (4). The foundation of the passive leg
those who have a known mitral or aortic valve disease,
raising movement is the recruitment of splanchnic and
those who have deep vein thrombosis or are wearing
leg blood (7). The ICU common pathophysiology of
elastic compression stockings, and those who have
intra-abdominal hypertension affects this maneuver's
severe acute respiratory distress syndrome that prevents
capacity to identify fluid responsiveness (8).
them from finishing the PLR.
This study purpose to determine if intra-abdominal
hypertension, which reduces venous return, affected the Measurements:
ability of passive leg raising to detect fluid
At baseline, demographic information and
responsiveness in critically ill patients.
ventilator parameters (tidal volume, plateau pressure
(Pplat), and end expiratory pressure) were collected (such PATIENT AND METHODS
as age, gender, weight, height, body mass index, and the
Our study was performed on four hundred patients
simplified Acute Physiology Score II).
who were responders to volume expansion in the period
A trained researcher who was uninformed of the
from April 2020 till October 2022 in the Critical Care
clinical data orally implanted an esophageal Doppler
Department Faculty of Medicine Helwan University, in
probe into each patient (Cardio Q: Gamida Eaubonne,
the general intensive care unit after approval of the
France).
ethical committee.
3913
Received: 05/11/2022 Accepted: 06/01/2022
c:\work\Jor\vol911_24The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3920-3924
Association between The Cytokine IL-23 in Saliva with Periodontal Health and Disease Tiba Faiz Kamil 1, Omar Husham Ali 2
College of Dentistry, University of Baghdad, Periodontics department, Iraq. College of Dentistry, University of Baghdad, Periodontics department, Iraq.
*Corresponding author: Tiba Faiz Kamil, E-mail:[email protected], phone: 009647714429433 ABSTRACT Background: In the term of the prevalence of chronic inflammatory conditions manipulating human beings, periodontal diseases were the predominant. Cytokines are proteins of low molecular weight responsible for the inception of inflammatory response and further stages of it in which they coordinate the extent and the duration of the response. IL- 23 is a member of a heterodimeric IL-12 cytokine family, generated from macrophages and dendritic cells after the exposure to bacterial pathogens. Saliva is a hypotonic solution formed by the salivary glands, gingival crevicular fluid, and oral mucosal exudate. Objective: this study aimed to find the association of salivary concentration of IL-23 with periodontal health and disease by examining its' level in individuals with healthy periodontium, with dental biofilm-induced gingivitis and periodontitis (localized and generalized). Patient and method: Saliva were collected from 90 participants with age ranged from 20-60 years. All of them were systemically healthy. 25 cases enrolled under the dental biofilm-induced gingivitis group, 25 cases under the localized periodontitis group and 25 cases under the generalized periodontitis group, with 15 subjects under healthy periodontium (control) group. Detection of IL-23 in saliva was done by Enzyme Linked Immunosorbent Assay (ELISA). Results: Our data revealed that the salivary IL-23 level was significantly (P<0.05) reduced in disease groups in comparison to healthy (control) group with a significant difference between dental biofilm-induced gingivitis and localized periodontitis groups. Conclusion: Salivary IL-23 has a significant and negative relationship with all disease groups as compared to healthy subjects. Keywords: Cytokine IL-23, Saliva, Periodontal health, Disease. INTRODUCTION
cemento-enamel junction (4). By the extent, periodontitis
In the term of the prevalence of chronic
can be divided into three categories (5):
inflammatory conditions manipulating human beings,
If the bone loss due to periodontitis is limited to
periodontal diseases were the predominant. Usually
molars/incisors named "Molar/incisor pattern'.
caused by a combination of factors include bacterial
If the bone loss due to periodontitis affect
factors, environmental factors and compelling host
number of teeth less than or equal 30% the
involvement that is accountable for greater soft and hard
pattern is "Localized periodontitis".
tissue devastation. This could sacrifice the tooth in
If the bone loss due to periodontitis affect
severe illness (1).
number of teeth more than 30% the pattern is
Two variety of periodontal diseases affecting the
"Generalized periodontitis".
periodontium. The first is dental biofilm-induced
gingivitis that is an inflammatory condition that is
For the purpose of quality and quantity of pertinent
restricted only to the gingiva and doesn't involve the
clinical information objectively, efforts have been made
rest of the supporting attachment (cementum,
to shift the periodontal investigation from the
periodontal ligament and alveolar bone). Commonly
conventional ways into using biomarkers (6). Biomarker
caused by an interplay between dental plaque biofilm
is a property used to indicate normal biological and
and the host immune response. Such disease doesn't go
pathological processes that can be calculated and
beyond the muco-gingival line and the tissue can return
estimated objectively. Also, it is considered to monitor
back to the clinically healthy condition by the removal
pharmacological feedback to therapeutic interference"
of bacterial deposit at and apical to the gingival line (2).
declared by the National Institutes of Health
This disease entity could lead to periodontitis if left
Biomarkers Definitions Working Group (7).
untreated, therefore early diagnosis is efficient in
Cytokines are proteins of low molecular weight
reducing the risk of periodontitis development (3).
responsible for the inception of inflammatory response The second one is periodontitis, which is
and further stages of it in which they coordinate the
represented by periodontal attachment loss caused by
extent and the duration of the response (8).IL-23 is a
microbial and host mediation of inflammation. A
member of a heterodimeric IL-12 cytokine family (9).
circumferential assessment of the whole erupted
Within few hours after the introduction of
dentition by a special standard periodontal probe, which
lipopolysaccharide and other bacterial products to
can detect that clinical attachment loss in relation to the
dendritic cells (DCs) and macrophages, they produce
3920
Received: 06/11/2022 Accepted: 07/01/2022
c:\work\Jor\vol911_25 The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3925-3931
A Case of Cardiac Pellet Embolism Unmasked the Current Status of Radiological Modalities in Egyptian Mortuaries Walaa Abdelhady Abdelhalim1, Riham F. Hussein1, Pansee Mohamed2, Asmaa Mohammad Moawad1*
1 Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Egypt
2 Forensic Legal Authority, Zeinhom Morgue, Cairo, Egypt Corresponding author: Asmaa Mohammad Moawad, Mobile: 01114665109, ORCID: 0000-0002-8448-0034, Email:[email protected] ABSTRACT Background: A rare, but well-known consequence of penetrating trauma is the migration of bullets and other foreign bodies inside the blood vessels. Only, few cases of pulmonary or arterial emboli reported in literature. These injuries have a significantly high mortality rate. Therefore, they can pose a diagnostic problem. A shotgun pellet embolism to the heart requires rapid detection and careful radiological testing. Case study: This case report presents the death of a 19-year-old male following head shotgun injury. Investigating the current case highlights the importance of radiology in firearm injuries. Conclusion: It is crucial to use every practical and available approach during the autopsy and examination to reach proper diagnosis and hence adequate management. The use of virtual autopsies in Egypt faces several challenges that need to be overcome. Keywords: Embolism, Shotgun, Craniocerebral, Pellets, Virtual autopsy, Radiology, Case report, Cairo University.
INTRODUCTION
Violent crime - including firearms - is a serious
victims. We aimed to present a case of intravascular
social and legal issue. Shotgun wounds can occur
embolism of a pellet to the right ventricle following a
accidently or in homicide/suicide incidents [1]. Shotguns
shotgun injury, diagnosed during autopsy.
are the most common type of weapons frequently used
by criminals. Its unique modifications, such as sawn-off Ethical Consideration:
barrels, make the weapon easier to use [2].
This study was ethically approved by the
In recent decades, many homicides have been
Institutional Review Board of the Faculty of Medicine,
committed using the so-called pump action shotguns
Cairo University (IRB code: N-2-2023). This study was
especially in developed countries [2,3]. A shotgun is a
executed according to the code of ethics of the World
weapon that fires by employing an explosive power of
Medical Association (Declaration of Helsinki) for
a fixed shotgun shell to discharge either one projectile
studies on humans.
pellet or a number of pellets, often known as ball shots,
where rifles and handguns discharge a single bullet. The CASE PRESENTATION
mechanism of gunshot-related injuries varies according
A 19-year-old male worker presented to the
to the type of firearm and projectile used [4].
emergency department with a shotgun wound of the
The distance between the target and firearm
head during an incident. He was comatose with rapidly
influences the severity of the injury. Intravascular
deteriorating vital signs. Few minutes later, the patient
missile migration is one of the most devastating
was arrested with unsuccessful resuscitation efforts.
consequences that can be life-threatening [5,6]. Migration
According to the Egyptian law, the deceased victim
episodes might occur immediately following the injury
transferred for a postmortem legal examination at the
or afterwards whereas extravascular migration occurs in
Zeinhom morgue (the official referral governmental
some cases [7]. Only few cases of bullet-related
morgue). A standard x-ray was performed before the
embolism have been documented in literature,
autopsy showed no significant findings except a faint
particularly, wounds related to the lower back [8], chest
radiopaque shadow in the cardiac area.
[9], neck [10], and abdomen [11].
Postmortem external examination of the firearm
Therefore, radiological assessment is essential for
wound revealed an ovoid 1x 0.5 cm purple fresh inlet
evaluating tissue damage and detecting potential
wound with inverted edges at the right lower forehead,
complications, and it should not be delayed either in
0.3 cm just above the right eyebrow without soot
firearm living victims or autopsy of firearm dead
deposition (Figure 1).
c:\work\Jor\vol911_26The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3932-3937
Evaluation of the Outcomes of Anti-Reflux Surgery in the Management of Extraoesophageal Symptoms of Gastro-oesophageal Reflux Disease Sherif Albalkiny, Ahmed Elnabil-Mortada*, Mohamed Elsayed Seifalyazal
General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt Corresponding Author: Ahmed Elnabil-Mortada, Mobile: (+20) 01140509696, Email:[email protected] ABSTRACT Background About one third of gastro-oesophageal reflux disease (GORD) patients were found to have atypical or extra-oesophageal symptoms (EOS), which represent a diagnostic and therapeutic challenge. The efficacy of the current treatment strategy used to control these symptoms is still controversial. Anti-reflux surgery has been shown to significantly improve respiratory symptoms associated with GORD. Objective: The aim of the current study was to evaluate the outcomes of laparoscopic fundoplication to control GORD- related EOS. Patient and methods: A prospective cohort study was conducted and included patients diagnosed with GORD with or without EOS or predominant EOS who were referred from Respiratory or ENT Departments. All participants underwent laparoscopic fundoplication surgery. Data about patients' demographics, body mass index (BMI), GORD/EOS presenting symptoms, 24 pH/manometry results, oesphagogastroduodenscopy findings, perioperative outcomes, quality of life using gastrointestinal quality of life Index (GIQOLI)questionnaire, patient's satisfaction using modified Visick score, and EOS severity using reflux symptom index (RSI) preoperatively, and 6 months postoperatively were collected and statistically analyzed. Results: A total number of 103 were included withmean age of 45.6 (SD 8.7) years, and 60% of the study's population was female. Mean BMI was 27.25 (SD 3.6). Heart burn was the main symptoms in all patients (71.9%), while chronic cough was the main EOS (27%). The mean operative time was 96 (SD 19.21) minutes, and mean hospital stay was 1.21 (SD 0.42) day. There was significant improvement in quality of life [65.7 (SD 11.6) and 118 (SD 12.8)] and reflux score [93.76 (SD 0.8) and 1.7 (SD 0.6)], RSI score for EOS [19.89 (SD 14.7) and 4.3 (SD5.3)] preoperatively and 6 month postoperatively respectively. Conclusion Laparoscopic fundoplication is a feasible option to control EOS associated with GORD with significant improvement of quality of life and reflux symptom index. Further larger studies are still warranted to evaluate the benefits on the long term. Keywords: Chronic cough, Reflux, Fundoplication, Laryngopharyngeal reflux, Extraoesophageal symptoms.
INTRODUCTION
In the western world, gastro-oesophageal reflux
to rule out other causes, the diagnosis of GORD-related
disease (GORD) is a common gastrointestinal
EOS necessitates close coordination amongst experts
pathology with a high prevalence. According to the (6,7).
Montreal Consensus, GORD is a disorder that appears
There is no conclusive test to demonstrate GORD-
when the stomach's contents reflux into the oesophagus
related EOS. Even though non-acidic and moderately
and
generate
bothersome
symptoms
and/or
acidic reflux episodes may now be measured using
consequences (1).
impedance reflux technology, this still does not
The troublesome symptoms can be oesophageal
sufficiently indicate reflux into the pharynx or the
symptoms as heartburn, regurgitation, dyspepsia with
airway (8).
related complications ranging from oesophagitis,
Although the presence of pepsin in the
strictures, Barrett's esophagus and up to oesophageal
bronchoalveolar lavage fluid is thought to be irrefutable
adenocarcinoma (2).Extraesophageal symptoms (EOS)
evidence of aspiration of stomach contents, this method
associated with large-scale GORD provide diagnostic
of diagnosis may not be practical or practicable in many
and therapeutic challenges since they can affect the
underdeveloped nations (9,10).
mouth, upper airways, and lungs and manifest as
Currently, empirical double dose of proton pump
asthma, laryngitis, persistent cough, dental erosions,
inhibitors (PPI), modifying one's diet and way of life are
and non-cardiac chest pain (2).
the standard treatment strategy used for management of
In a large prospective European study, GORD is
GORD related EOS, although the efficacy of PPI to
associated in about 13% of patients with variety of
control these symptoms was still controversial. It has
atypical EOS as chronic cough, hoarseness of voice,
been demonstrated that anti-reflux surgery considerably
asthma, sore throat, painful swallowing, and lump
reduces the requirement for medication and improves
sensation in the throat (3-5).
respiratory symptoms related to GORD (11).
It has been estimated that about 20-60% of patients
The aim of the current study was to evaluate the
with GORD will present with atypical symptoms
outcomes of laparoscopic fundoplication to control
without having typical symptoms of GORD. Therefore,
EOS associated with GORD.
Spontaneous bacterial peritonitis in Critically ill hepatic patients adverse outcomes detected Echo cardiographically Electro cardiographicallyThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3938-3944
Spontaneous Bacterial Peritonitis in Critically Ill Hepatic Patients Adverse Outcomes Detected Echocardiographically and Electro Cardiographically Mohammed Abdel Monem Saeed*1, Amr El Fouly2, Deyaa Mohamed Ibrahim3, Alaa Mohamed Hussein4
Departments 1Critical Care Medicine and 2Endemic and Hepatology, Faculty of Medicine, Helwan University, Egypt
Department of 3Critical Care Nursing, Faculty of Nursing, Helwan University, Egypt Department of 4Clinical Pharmacist, Faculty of Pharmacy, Helwan University, Egypt *Corresponding author: Mohammed Abdel Monem Saeed, Mobile: (+20) 01099292999, E-Mail: [email protected] ABSTRACT Background: Cirrhotic patients who develop Spontaneous Bacterial Peritonitis (SBP), they most likely have cirrhotic cardiomyopathy, which is characterized by diminished contractility in response to stress despite a generally normal resting cardiac output. Objective: Patients who developed SBP can be assessed prognosticaly by electrocardiography and echocardiography together with scoring systems this was proposed in our study. Patients and Methods: Four hundred cirrhotic patients were included in our study admitted to our general ICU in Critical Care Medicine Department, Faculty of Medicine, Helwan University in the period from May 2020 to September 2022, all patients did not undergo transplant within the study duration and if any patients underwent liver transplant within one year of the last SBP episode were excluded. Patients were classified according to electrocardiographic parameters into low and high QTC and echo cardiographically with tissue Doppler into low and high E/E Ratio with a cut off values > 480 ms for QTc and > 10 for E/E ratio. Results: Four hundred cirrhotic patients were classified into two groups according to the QTC and E/E into low QTc and low E/E group included 200 patients and high QTC and high E/E group included the other 200 patients. Higher QTC and higher E/E were associated with increased in hospital acute kidney' injury, ICU mortality and 1 year mortality. Conclusion: Cirrhotic patients with SBP associated with high QTC and high E/E are at high risk for acute kidney injury, ICU mortality and 1 year mortality, also, high QTC duration > 480 ms and high E/E ratio of > 10 together with diabetes mellitus, left atrial diameter and left atrial volume, were independent parameters associated with increased mortality at 1-year followup. Keywords: SBP, Cirrhotic cardiomyopathy, QTc duration > 480, E/E >10, 1-year mortality.
INTRODUCTION
In order to describe the phenomenon of altered
Chronic liver disease, of which cirrhosis is the
diastolic relaxation, suboptimal response of the heart's
primary cause, is the ninth largest cause of mortality in
contractile function to physiological or pathological
the United States (1). Spontaneous bacterial peritonitis
stressors, and electro-physiological abnormalities in
(SBP) linked with liver is connected to a significant
the absence of known cardiac disease, Ma and Lee
mortality rate of roughly 4070% at one year. Patients
coined the term "cirrhotic cardiomyopathy" (7).
with cirrhosis and this particular group in particular
No matter the underlying etiology of liver
constitute a high-risk demographic.
disease, cirrhotic cardiomyopathy might still exist.
After the resolution of the infection by
Heart dysfunction was present in almost 50% of
spontaneous bacterial peritonitis, all patients became
cirrhotic patients having liver transplants, and seven to
candidates for liver transplant (2). For the purpose of
twenty one percent of mortality following orthotopic
analyzing and estimating the prognosis of cirrhotic
liver transplantation are attributable to frank heart
patients, the Child-Pugh Score (CPS) and the Model
failure (8).
for End Stage Liver Disease (MELD) score are
When echocardiography is performed on patients
utilized. The 3-month mortality in patients with liver
with liver cirrhosis, the ratio of relatively normal to
disease has been found to be well predicted by the
enhanced ejection fraction might lead to a false sense
MELD score. In order to classify patients prior to liver
of normality. In order to identify patients who are
transplantation, liver transplant hospitals in the United
more likely to have difficulties or have a poorer
States have used MELD Scores since 2002 (3).
prognosis, it is essential to measure cardiac function in
Patients with cirrhosis typically have significant
more detail in liver transplant candidates (9).
vasodilatation of the splanchnic artery system, It
In order to better understand cirrhotic patients
stimulates the sympathetic nervous system, the renin-
with SBP, we concentrated on this demographic
angiotensin system, and causes the release of anti-
because it is a significant stressor on the
diuretic hormone. The overactive sympathetic state,
cardiovascular system and may mask or exacerbate
hyperdynamic circulation, high normal to augmented
underlying heart disease.
cardiac output, and low degree of systemic vascular
Patients who developed SBP can be assessed
resistance are all symptoms of decompensated liver
prognosticaly
by
electrocardiography
and
cirrhosis (4-5). Nearly 50 years ago, structural anomalies
echocardiography together with scoring systems this
on postmortem investigation by Lunseth et al. (6)
was proposed in our study.
cirrhotic patients have heart problems.
c:\work\Jor\vol911_28The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3945-3954
Platelet Function Abnormalities in Patients with Liver Cirrhosis and Esophageal Varices Olfat M. Hendy1, Gamal Yousef Abo-Raia1, Esraa Reda Mohamed Soph1, Osama Desouky Elbahr2, Hanan M. Bedair1
Departments of ¹Clinical Pathology and
²Hepatology & Gastroenterology, National Liver Institute- Menoufia University, Egypt *Corresponding author: Esraa Reda Mohamed Soph, Mobile: (+20)01012963205, E-mail: [email protected] ABSTRACT Background: Severe thrombocytopenia and platelet dysfunctions are common amongst patients with cirrhosis and can contributeto increase risk of bleeding in patient with cirrhosis and portal hypertension (PH).Many studies confirmed the close association between thrombocytopenia and accordance of variceal bleeding. But the relationship of platelet function disorder and risk of variceal bleeding is still a matter of debate. Objectives: This study aimed to evaluate effect of platelet count, platelets indices and platelet functions in cirrhotic patients with different grade of oesophageal varices (OV) and identifying potential risk factors associated with variceal bleeding. Patients and methods: 60 cirrhotic patients with different grades of OV were included in the study, 30 of them had a history of variceal bleeding and 30 patients never bled as well as 30 apparently healthy control subjects. They were subjected to laboratory investigations including: liver function tests, coagulation tests, platelet count, platelet indices and platelet function assessment using light transmission aggregometry. Results: Thecollagen corrected area at cut off point 0.76 (AUC=0.832), with a sensitivity of 70% and a specificity of 96.7%. Ristocetin corrected area at cut off point 0.76 (AUC=0.832) with a sensitivity of 66.7% and a specificity of 93.3% but ADP had a poor diagnostic performance as ADP corrected area at cut off point 0.51 (AUC=0.646) sensitivity is 53.3% and specificity 90%. Conclusion: The corrected areas of ADP, collagen, and ristocetin were significantly associated with risk of OV bleeding, in which the corrected area of collagen and ristocetin were good diagnostic markers and superior to ADP for prediction of bleeders OV group. Keywords: Oesophageal varices, platelet function tests, ADP, collagen, ristocetin, light transmission aggregometry.
INTRODUCTION
with liver cirrhosis. For evaluating platelet function,
The last stage of any chronic liver damage, liver
impedance aggregometry (IE) is now regarded as the
cirrhosis, is characterised by vascular fibrosis and
"gold standard." Thrombin, adenosine diphosphate
distortion, which increases hepatic resistance and may
(ADP), collagen, and ristocetin are used as platelet
result in portal hypertension [1]. Oesophageal varices
receptor agonists to assess the capacity of platelets to
(OV) are a frequent and dangerous cirrhosis
aggregate [8]. This study aimed to evaluate effect of
consequence that are linked to higher mortality and
platelet count, platelets indices and platelet functions in
morbidity rates [2]. In Egypt, the incidence of large
cirrhotic patients with different grades of oesophageal
varices is 47% and the incidence of OV in hepatitis C
varices (OV) and identifying potential risk factors
virus (HCV) patients with liver cirrhosis is around 62%
associated with variceal bleeding. [3]. Low platelet counts might increase bleeding risk and
make it more severe. However, there is proof that people PATIENTS AND METHODS
with thrombocytopenia and cirrhosis still have
This case control study, was conducted on 90
relatively high levels of functional platelet capacity [4].
subjects, 60 of them were collected from inpatient,
The most important portosystemic collaterals are the
outpatient
clinic
and
endoscopic
unit
of
OV because variceal haemorrhage, the most common
Gastroenterology and Hepatology department of
and deadly cirrhosis consequence, is caused when they
National Liver Institute of Menoufia University from
rupture [5]. Seventy percent of all instances of upper
August 2020 to September 2021, as well as 30 age and
gastrointestinal haemorrhage in people with PH are due
sex-matched apparently healthy subjects were enrolled
to variceal bleeding, a serious consequence of liver
as controls. After a complete clinical history, clinical
cirrhosis [6]. Platelet dysfunctions are present in patients
examination, abdominal ultra-sonography and upper
with cirrhosis, so the laboratory investigations for
endoscopy. The cirrhotic patients were divided into 2
platelet disorders may include: platelet count, mean
groups: Group I, 30 patients with cirrhosis and
platelet volume (MPV), platelet morphology in the
oesophageal varices, who had never bled and Group II,
blood smear, and platelet function tests, such as
30 patients with cirrhosis with a history of variceal
activated clotting time (ACT), bleeding time (BT),
bleeding. They were 42 male and 18 female patients and
platelet
aggregation,
flowcytometry-measuring
their ages ranged from 40 to 72 years with mean of age
precense of platelet membrane glycoproteins, and the
51.97 ± 7.46 and 54.40 ± 8.24 years for GI and GII,
platelet aggregation metabolites may be detected by
respectively.
ELISA technique[7]. It might be challenging to choose
the best platelet function testing technique for patients Sampling: Nine mL of venous blood sample were taken
3945
Received: 15/12/2022 Accepted: 01/02/2023
c:\work\Jor\vol911_29The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3955-3959
Serum Interleukin 17 as a Marker for Alopecia Areata Severity: A Case-Control Study Samah Ibrahim1, Nehal Zuelfakkar1, Hadeel Asar1, Ahmed Elhawatky2
1Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain-Shams University, Egypt
2Department of Dermatology, Venereology and Andrology, National Research Centre, Egypt *Corresponding author: Ahmed Elhawatky, Mobile: (+20)1065226628, E-Mail:[email protected] ABSTRACT Background: Alopecia areata )AA
( is a non-scarring skin disease affecting the scalp or other body parts. The etiology
of AA is still controversial and various pathogenic causes are under investigations. It is characterized by infiltration of T helper 17 cells the hair follicles and chemokine secretion. Objectives: The aim of the current work was to measure serum level of IL-17A in patients with AA and healthy controls to demonstrate if it has a role in the pathogenesis of A.A. and to correlate disease severity with its level. Patients and methods: This case control study included a total of 26 A.A. patients, and 26 age and gender matched healthy controls, attending at Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain- Shams University Hospitals, and Department of Dermatology, Venereology and Andrology, National Research Centre, Egypt. Serum level of interleukin-17 was measured. Clinical type, and the severity of the disease were determined for each A.A. patient. Results: Serum level of interleukin-17 was significantly higher in A.A. cases compared to unaffected controls. The interleukin-17 level among A.A. patient was ranged from 133 to 326 (med. 195) pg /ml, while among controls, the level was ranged from 14 to 226 (med. 48) pg /ml. Also, no statistically significant differences were found between interleukin-17 levels regarding the clinical types, age, gender, disease duration, and severity. Conclusion: The significantly high concentration of serum interleukin 17 in A.A. patients supports the theory of its contribution in the process of the hair follicular destruction. It could also be concluded how beneficial its inhibitors can be especially in resistant cases of A.A. Keywords: Alopecia areata, Hair follicle, Interleukin 17. INTRODUCTION
C.D 8+ T cells. Recently, the interest of finding the role
Alopecia areata is the most prevalent
of T cells in the development of autoimmune disorders
autoimmune disorder and the second most frequent
increased and new targeted drugs on T cell show very
disease-causing hair loss after androgenetic alopecia
promising efficacy in many auto-immune diseases like
(AGA) (1). Alopecia Areata (A.A.) is an auto-immune
psoriatic patients(9). Various dermoscopic features
disease where T-cell infiltration and secretion of
detected in AA are black dots (cadaverous hairs),
chemokines surrounding the hair follicles at their
yellow dots, exclamation mark hairs and broken
Anagen stage (2). A.A. shows no gender or ethnic
hairs(10). Folliscope usage offers significant diagnostic
predilection (3).
tool in assessing grade of alopecia and grade of response
Many theories for the pathogenesis developed,
to treatment. Folliscope allows accurate assessment of
such as infection, a trophoneurotic hypothesis (based on
hair and skin changes in different types and phases in
emotional or physical stress and/or trauma), thyroid
alopecia patients (11).
diseases and other hormonal imbalance (as in pregnant
We measured interleukin-17 in serum of A.A.
women or menopause) (4). AA is an autoimmune disease
cases and healthy controls and compared these levels to
where the CD+8 cells attack the hair follicles as they
demonstrate if it has a role in the pathogenesis of A.A.
already lost their immune privilege (5).
and also to correlate disease severity with its level.
Exclamation point hair (A type of dystrophic
hair), is a key characteristic of AA. Peri-bulbar PATIENTS AND METHODS
inflammation is noticed surrounding the anagen follicles
This case control study included a total of 26 A.A.
nearby the focal lesion (6). Alteration of one of the
patients, and 26 age and gender matched healthy
follicular growth phases could be the cause of A.A., a
controls, attending at Department of Dermatology,
pre-mature transition of the anagen hair to the catagen
Venereology and Andrology, Faculty of Medicine, Ain-
one, or the anagen to telogen phase may happen, but it
Shams University Hospitals, and Department of
needs predisposing environmental, genetic, and
Dermatology, Venereology and Andrology, National
immunologic factors to develop(7). There is increase in
Research Centre, Egypt.
clonality in A.A. patients, which may suggest a Inclusion criteria: Patients with various degrees of
common antigen epitope like trichohyalin peptides in
alopecia areata who had not received systemic or topical
cases of A.A(8). Interleukin 17 (IL 17) is an
treatment in at least 1 month. Both sexes were included.
inflammatory chemokine secreted mainly by Th17 cells Exclusion criteria: Patients with other dermatological,
and other cells like neutrophils, natural killer cells and
autoimmune, or systemic diseases like rheumatoid
3955
Received: 20/11/2022 Accepted: 19/01/2023
c:\work\Jor\vol911_30The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3960-3967
Potential Use of Synovial Fluid Peptidase Activity as A Biomarker to Anticipate How Egyptian Patients with Knee Osteoarthritis Will Fare Clinically: A Cross-Sectional Study Alaa M. Elsalawy1, Shreen A. Elwan1, Asmaa H. Okasha2, Amira Oraiby3, Doaa W. Nada1
1 Departments of Rheumatology, Rehabilitation and Physical Medicine, 2 Medical Biochemistry,
3 Clinical Pathology, Faculty of Medicine, Tanta University, Egypt. Corresponding author: Doaa Waseem Nada, Mobile: +201069579672, ORCID: 0000-0003-3968-1619, E-mail: [email protected] ABSTRACT Background: Osteoarthritis (OA) is a chronic protracted inflammatory joint disorder that frequently coexists with other comorbidities. Previous studies analyzed peptidase activity in synovial fluid in knee OA (KOA) patients, but they did not investigate whether type of therapy influences enzyme activity. Moreover, it is yet unknown if the activity of any particular enzyme can be taken into account as a reliable prognostic marker for the severity and progression of KOA. Objective: The aim of the current study is toassess synovial fluid peptidase's potential role as a biomarker for KOA in Egyptian patients as well as to determine whether it can predict the clinical progression of such disease. Patients and methods: A cross-sectional study was estimated on 75 KOA patients (Ahlback grade 3 or higher and indicated for arthrocentesis), who were subjected to sociodemographic and clinical characteristics, as well as Functional and Physical Health Status assessed every month. Puromycin sensitive aminopeptidase (PSA), neutral aminopeptidase (NAP), prolyl endopeptidase (PEP), aminopeptidase B (APB) glutamyl aminopeptidase (GLU), aspartate aminopeptidase (ASP), and pyro glutamyl aminopeptidase (PGAP) are among the peptidases shortlisted for their activity as biomarkers in synovial fluid. Results: Asignificant association between NAP (P=0.038) and APB (P=0.05) peptidases and pain generation on movement in patients with KOA was noticed. Only ASP peptidase showed significant correlation with range of motion (P=0.049). Another clinical condition of knee failure significantly influenced by the presence of ABP (P=0.013) and PEP (P=0.033) peptidase presence. When diagnosing knee effusion, PEP (P=0.050) and PGAP (P=0.018) differ significantly depending on the clinical symptom. PSA was protective (P=0.003), whereas GLU and PEP were risk factors, according to a binary logistic regression (P values 0.001 and 0.019, respectively). Conclusion: Peptidase activity is considered an important synovial fluid biomarker to determine disease progression in osteoarthritic patients, which could aid in early disease detection and the development of better treatment protocols. Keywords: Synovial fluid peptidase, Knee osteoarthritis, Osteoarthritis progression, Peptidase enzymes activity, Cross sectional study, Tanta University.
INTRODUCTION
biomarkers that could be used to determine clinical
Osteoarthritis (OA) is a chronic protracted
progression of such disease (5).
inflammatory joint disorder that frequently coexists with
Additionally, one of local renin-angiotensin
other comorbidities. It restricts joint motion, causes
systems has been previously characterized and is found in
discomfort and pain, with functional limitations,
the synovial fluid and synovium. It seems to contribute to
that places a heavy financial burden on patients (1,2).
knee osteoarthritis (KOA) and worsens periarticular
Although the presence of a variety of moderately effective
osteopenia in animal models by boosting bone resorption
strategies (3), it is well recognized that medications do not
and reducing bone formation (6). Also, some studies on
totally halt the disease's progression, which is related to
humans suggest that the development of rheumatoid
joint inflammation and cartilage breakdown causing
arthritis may be influenced by intra-articular injection of
severe impairment and disability (1).
renin and angiotensin-converting enzyme. Hence, the use
There are numerous OA phenotypes, including
of renin inhibitor or Angiotensin receptor blockers have
metabolic, biochemical, inflammatory, and osteoporotic
been demonstrated to help rats with OA and osteoporosis
aspects of the disease. MRI and biochemical indicators
resulting in reducing the inflammation in arthritic animal
are used to further characterize these phenotypes (3). New
models (7,8).
aberrant gene expression mediators and prospective
Furthermore, Peptidases may break down
therapeutic targets for OA have been identified as JUN,
bioactive peptides, altering their physiological functions,
JUND, MYC, RELA, EGR-1, and other dysregulated
and so controlling signal transmission, cell proliferation,
transcription factors (4). Additionally, Leptin, IL-1, IK-6,
and differentiation (8).
and IL-18 levels as well as changes in messenger RNA, De Silveira et al. (9) demonstrated in an animal
circular RNA, and long non-coding RNA in OA-affected
model of arthritis that activation of the angiotensin-
cartilages are considered post-traumatic osteoarthritis
converting enzyme-2/Ang-(1-7)/Mas receptor pathway reduced joint inflammation whereas stimulation of the
3960
Received: 2/12/2022
Accepted: 5/2/2023
c:\work\Jor\vol911_31The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3968-3973
Effect of Bacterial Infections of The Respiratory Tract System on The Activity of Rheumatoid Arthritis Ahmed R. Oleiwi*, Ayaid Khadem Zgair
Baghdad University, College of Science, Department of Biology, Baghdad, Iraqi. *Corresponding author: Ahmed R. Oleiwi, Mobile: (+964)7719438146, E-mail: [email protected], ORCID ID: http://orcid.org/0000-0002-8105-8188. ABSTRACT Background: Several infectious lung diseases often develop in patients with Rheumatoid arthritis (RA), especially during immunosuppressive medication, including disease-modifying anti-rheumatic drugs (DMARDs). The present study aimed to determine the role of respiratory tract bacterial infection in RA activity. Methods: Blood and sputum samples were collected from 31 patients with RA and 12 healthy subjects as control. The bacterial isolates were isolated and identified in collected sputum by biochemical tests and Vitec 2 system. Results: In the present study, thirty-one patients with RA were compared with 12 healthy subjects. Eight patients with RA were not infected with pathogenic bacteria (RA-NIPB) (25.8%). Twenty-three RA patients were infected with pathogenic bacteria (RA-IPB) (74.19%). From 23 RA-IPB, 10 RA patients were infected with Staphylococcus aureus, 6 RA patients were infected with Klebsiella pneumonia, 4 RA patients were infected with Streptococcus pneumoniae, and 3 RA patients were infected with Pseudomonas aeruginosa. No pathogenic bacteria were isolated from the sputum of a healthy subjects. There was no significant difference between RA-NIPB and RA-IPB in terms of the level of disease activity score DAS28. Conclusion: The current study showed that patients with RA have a higher incidence of being infected with pathogenic bacteria than the healthy control group. No significant effect of bacterial species infection on the level of DAS28. The present study is the pioneer study that showed no effect of bacterial respiratory infections and different RA treatments on RA disease activity. Keywords: Rheumatoid Arthritis, DAS28, MTX, ETC, Pathogenic Bacteria. INTRODUCTION
Serious infections in RA patients were
inflammatory
and
anti-inflammatory
cytokines
frequently caused by bacterial infections (1,2). The lung,
followed
by
systematic
inflammations
(16,17).
urinary tract, and skin are the sites that are most often
Alternatively, bacteria through the activation of the
affected (36). Compared to the general population, there
innate immune response such as the toll-like receptors
were no major differences in the types of isolated
may induce the release of inflammatory cytokines as
pathogens, may be with the exception of intracellular
Interleukin (IL-8) and TNF- that could stimulate
bacteria in patients using anti-tumor necrosis factor-
neutrophilic inflammation (18). Taken together the
alpha (anti TNF-alpha)(7). Pulmonary diseases are most
above, the study aimed to highlight the role of RA in the
popular causes of extra-articular morbidity and
incidence of bacterial respiratory tract infection and role
mortality in a percentage of 60-80 % of patients with
of this and type of treatment on the RA disease activity
rheumatoid arthritis (RA) and the second cause of death
in terms of score DAS28.
by infection (8).Although pulmonary infection and
therapy toxicity were frequent complications of lung PATIENTS AND METHODS
disease associated with RA(911). When treating RA
The samples were collected from 31 patients
patients with respiratory comorbidities, Physicians
with RA and 12 healthy subjects as control group. The
frequently need to decide how best to treat them and
average of age of patients with RA was 46.4 ± 12.03 and
establish plans for their long-term care.
the control subjects was 41.06 ± 7.8 years. The disease
Although there was no conclusive evidence or
duration was more or equal to one year, and the subjects
general agreement and there was conflicting data,
were successively recruited between November 2021
conventional and biological disease modifying
and March 2022 during routine visits to the
antirheumatic medications (DMARD) have been linked
rheumatology outpatient clinic of Baghdad Teaching
to the progress of treatment related pulmonary
Hospital. The 2010 ACR/EULAR criteria (19) were used
damage(12,13). Moreover, due to there is an increased
in diagnosis of the patients. All patients underwent a
incidence of smoking in RA patient (14), RA is linked
baseline of disease activity score (DAS28) to assess RA
with an increased prevalence of lung cancer compared
activity (19) and tested for erythrocyte sedimentation rate
to the healthy subject (15).
(ESR); the C-reactive protein (CRP); Rheumatoid factor
The paucity of controlled studies on the effect
(RF); Anticitrullinated protein antibody (ACPA). Based
of treatment on bacterial infections in the lung are
on DAS28, subjects were divided into four groups:
scanty in literature unclear the role of pathogenic
remission, low, moderate, and severe.
bacteria in RA patients. The exposure to bacterial
The sputum samples were taken into sterile
lipopolysaccharide causing an imbalance between pro-
screw cap containers (aseptically) in the early morning.
3968
Received: 19/11/2022 Accepted: 23/01/2023
c:\work\Jor\vol911_32The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3974-3979
Serum Adiponectin and Insulin Resistance in Systemic Lupus Erythematosus and Rheumatoid Arthritis Patients Doaa Salah Elgendy1, Maha Mohamed Abdelraof Salman*2
Departments of 1Internal Medicine, Endocrinology Unit, and
2Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Menofia University, Menofia, Egypt *Corresponding author: Maha Mohamed Abdelraof Salman, Mobile: (+20)01096897968, Email:[email protected], ORCID: 0000-0002-8102-4228 ABSTRACT Background: Insulin sensitivity, blood sugar, lipids, and cardiovascular disease (CVD) are all affected by adiponectin. Adiponectin's involvement in the aetiology of autoimmune illness is still debatable. Objective: To assess the blood level of adiponectin in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), as well as the probable relationship with insulin resistance and disease activity ratings. Patients and methods: A total of 100 SLE, 100 RA, and 100 matched controls were examined. Both the disease activity score (DAS28) and the SLE disease activity index (SLEDAI) were evaluated. Serum adiponectin, C-peptide, and lipid profile were all measured. Both the homeostasis assessment model of insulin resistance (HOMA-IR) and HOMA-B homeostasis model evaluation indices for beta cell function were evaluated. Results: In SLE and RA patients, adiponectin (12.27±1.45, 12.05±0.94 vs 4.12±2.03), C peptide (3.97±2.85, 5.66±3.69 vs 1.8±0.9), fasting insulin levels (37.6±13.2, 35.85±13.68 vs 6.55±2.04), HOMR-IR (7.9±3.03, 7.1±3.09 vs 1.33±0.67) were significantly higher compared to control group (p<0.001). In patients with SLE and RA, adiponectin had significant positive correlation with ESR and disease activity (p<0.001, p=0.042 and p<0.001, p=0.015 respectively) but negative correlation with platelet count (p=0.003, p=0.004), while C-peptide had significant positive correlation with HOMA-B (p= 0.019, 0.041), ESR (p=0.004, p<0.001), and BMI (p=0.020, p<0.001) Conclusion: Adiponectin level, C-peptide and indices of IR are elevated in patients with SLE and RA. Adiponectin positively correlated with disease activity and ESR and C-peptide positively correlated with HOMA-B in SLE and RA patients. Keywords: Adiponectin, Insulin resistance, Systemic lupus erythematosus, Rheumatoid arthritis.
INTRODUCTION
Connecting peptide (C-peptide), the cleavage
Obesity is a low-grade inflammatory condition that
product of proinsulin, is a small linear molecule
is characterised by altered adipokine expression and
composed of 31 amino-acids. Its stability and ability to
increased production of pro-inflammatory mediators
escapes first-pass metabolism by the liver, allow the use
including interleukin 6 (IL-6) and tumour necrosis
of C-peptide as a reliable marker of beta cell function in
factor alpha (TNF-). Due to the immunomodulatory
clinical practice. Many studies had proved that C-
qualities of adipose tissue and the connection between
peptide is a biologically active molecule acting as an
inflammation and autoimmunity, obesity may raise the
endogenous antioxidant, preventing, in adjunction with
risk of developing autoimmune diseases including
insulin,
hyperglycemia-induced
microvascular
rheumatoid arthritis (RA) and other immune-mediated
dysfunction and nervous damage (4).
illnesses (1).
A
complex
medley
of
immunological,
Due to its inflammatory, fibrotic, and antioxidant
environmental, hormonal, and genetic predisposing
effects, the adipokine adiponectin plays a critical role in
factors contributes to the development of both SLE and
controlling insulin sensitivity, lipid metabolism, and
RA. Potential involvement of autoantibodies, immune
blood sugar levels. Three molecular weights of
complexes, and soluble mediators in tissue injury is a
circulating adiponectin low, medium, and high, each
common characteristic (2).
have unique biological characteristics and tissue targets.
A particular insulin concentration is associated
Anti-proliferation, anti-atherosclerotic, and inhibition
with a suboptimal glucose response in the clinical
of carcinogenesis are further protective properties (2).
condition known as insulin resistance (IR). IR, which is
However, adiponectin, may have a pro-inflammatory
most likely the most significant predictor of type 2
impact. It is prevalent in the fluid and synovium that are
diabetes, may be connected to the inflammatory
swollen in RA and causes inflammatory reactions.
proteins leptin, adiponectin, TNF-alpha, and resistin
Additionally, it has been linked to the emergence of
released by adipocytes (5). Low-grade inflammatory
bone erosions (1). It's important to note that these
states have been linked to IR, which may assist to
variations in adiponectin activity are related to its
understand how it arises. Inflammation may worsen IR
degree of oligomerization, and contrasting effects have
and affect the function of pancreatic cells (6).
been reported for both low and high molecular isoforms
Additionally, IR has been linked to inflammatory (3). Hence, adiponectin role in autoimmune disease is
diseases as RA (7), and SLE (5).
still a matter of controversy.
The aim of this work was to compare the level of
adiponectin in patients with SLE and RA and to
3974
Received: 19/11/2022 Accepted: 23/01/2023
c:\work\Jor\vol911_33The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3980-3985
Dental Implant Status in Relation to Caries Experience and The Functional Tooth Unit (Cross-Sectional Study) Modar AbdulAbbas Fedik, Ban Sahib Daib
Department of Pediatric and Preventive Dentistry, College of Dentistry, University of Baghdad Corresponding author: Modar AbdulAbbas Fedik E-mail address: [email protected]. Mobile Phone: +96477376786 ABSTRACT Background: Many factors affect how stable an implant is, including number of the teeth and dental tissue condition. This study aimed to investigate the relation between the implant stability over number of remaining functional teeth and caries experience. Patients and Method: The sample consisted of 103 healthy individuals with dental implants and in function for at least six months. Decay, missing and filled index according to the criteria of WHO in 2013 were used to evaluate the caries experience. Based on pain evaluation and clinical mobility the dental implant was considered as failed, the dental implant's subclinical movement was assessed utilizing Periotest M® device. Results: 13.29% of the total number of implants failed according to the clinical parameters, females showed a higher percentage of failure. Percentage of the decayed surfaces was documented to be higher at the lower level of stability, and the percentage for the filled surface showed a decrease as increase in the mobility of dental implants. The results showed that the percentage of patients with >5 functional tooth unit decreased with increase of mobility, in addition the result revealed a positive relation between increase in the number of implants and the Periotest value. Conclusion: This study concluded that implant stabilityis significantly affected by the number of implants inserted in a patient and increase of decayed surfaces was reported in the worst level of stability. Also, patients with >5 functional tooth units had a better dental implants stability than other even though the result were not significanti. Keywords: Dental Implants, Failure, Periotest®, DMF index, Cluster behaviour.
INTRODUCTION
mandible, the failure rate in the edentulous maxilla was
Dental implants alloplastic are materials that are
around three times higher (6).
inserted into the jaw bone to replace missing orofacial
Dental implants like natural teeth can be affected by
tissues brought on by trauma, neoplasia, and congenital
microorganisms (7).
abnormalities as well as to control tooth loss. The most
They have shown that flora associated with healthy
common form of dental implant is endosseous, which
implants is similar to the flora in natural teeth, however
consists of a discrete, single implant unit (typically
the most prevalent dental diseases in the world is dental
screw- or cylinder-shaped) inserted into the
caries, which is caused by various bacteria in the oral
dentoalveolar or basal bone. Dental implants typically
cavity(8). In dental caries, dental hard tissues are
use commercially pure titanium, titanium alloy (1),
destroyed by this infectious illness, which has a
ceramics or polymers (significant increase in impact
complex etiology and a sluggish evolution (9). One study
strength when zirconium oxide nano fillers were added
reported microbial colonization of stable dental
to high impact heat cured poly methyl methacrylate
implants and found that supragingival plaque in stable
polymer (2).
implants predominantly consists of gram-positive cocci
Osseointegration is a term used to describe "a direct,
(similar to that of dental caries) and subgingival plaque
structural and functional connection between organized
is dominated by Haemophilus spp and Veillonella
living bone and the surface of an implant, capable of
parvula (10).
carrying the functional load" (3).
Studies reported that no differences were found in
Implants are highly successful treatment option
microbiological analysis of subgingival plaque from
although it can fail at many times similar to any other
dental implants and teeth(11). Other longitudinal study
type of treatment, implants can be described as
found that the flora was established shortly after
successful, failing or failed. A failing implant
installation of the dental implant(12). From other point of
demonstrates a progressive loss of supporting bone but
view, it has been seen that after dental implant
is clinically immobile, whereas a failed implant is
placement, open contact between implant restorations
clinically mobile. When an implant has failed, removal
and natural teeth has been considered as a potential
is recommended while a failing implant may be
causative factor for dental caries(13,14).
salvaged if it is diagnosed early and treated
Because the diameter of the implant is often less
appropriately (4).
than that of the tooth being replaced, and the circular
Implant failure, which is described as "the
shape of the implant does not mirror the architecture of
insufficiency of the host tissue to initiate or maintain
the tooth, a wide gingival embrasure region commonly
osseointegration", can happen even with high success
arises between the implant platform and neighboring
rates. Interestingly, failure rates within edentulous
tooth. An analysis of radiographs of molar implants
patients were almost double those for partially dentate
implanted in one private practice over an 11-year period
patients (5). Additionally, compared to the edentulous
revealed an exceptionally high prevalence of proximal,
3980
Received: 05/11/2022 Accepted: 08/01/2023
c:\work\Jor\vol911_34The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3986-3994
Omitting Chest Tube Drainage after Video Assisted Thoracoscopic Surgery Mohamed Alanwar, Mamdouh El-Sharawy, Alaa Brik, Islam Ahmady *, Dina Said Shemais
Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Islam Ahmady Mobile: (+20)01125229521, E-mail:[email protected] ABSTRACT Background: Drainless minimally invasive video-assisted thoracoscopic surgery (VATS) has improved perioperative outcomes and has become the standard of care for many thoracic procedures. Objectives: This study aimed to assess safety and perioperative outcomes of omitting chest tube drainage after VATS among eligible selected patients Methods: This study included 48 patients eligible for VATS and fulfilling the inclusion and exclusion criteria of omitting chest tube drain where, they were randomly allocated into two groups: GroupI (Drainless group) included 24 patients undergoing VATS with intra operative omitting of chest tube drains after an air leakage test and group-II (Drainage group) that included 24 patients undergoing VATS with conventional treatment using standard chest tube drainage. Results: Omitting chest tube drainage improved the median of operation time (116.0 minutes), average post-operative pain score per day (1.66) and shortened median of postoperative duration of hospital stay (1.0 days) among patients in drainless group-I compared to 139 minutes, 4.8 and 3.5 days among patient in drainage group-II (P<0.001) respectively. Uniportal VATS procedure, VATS sympathectomy, male sex, younger age and non-smoking habits in eligible selected patients with omitting chest tube drainage among them expressed significantly the lowest postoperative pain score, shortest postoperative duration of hospital stay and the least operation time with minimal risk of perioperative complications compared to drainage group-II (P<0.01). Conclusions: Omitting chest tube drainage after VATS is feasible in eligible selected patients and improved its efficacy, safety and perioperative outcomes (postoperative pain, hospital stay length, and the risk of perioperative complications). Keywords: Omitting, Chest tube drainage, VATS.
INTRODUCTION
assisted thoracoscopic surgery (VATS) among eligible
Minimally invasive surgical techniques, in
selected patients.
particular, Video-assisted thoracoscopic (VATS) has
advanced quickly over the past two decades, replacing the PATIENTS AND METHODS
standard open thoracotomy procedure in simple thoracic
This randomized-controlled-clinical trial was
surgeries. It also grown up as a choice for a
conducted on 48 randomly selected patients from those
complementary procedure in other more complex
admitted to Cardiothoracic Surgery Department, Zagazig
surgeries (1, 2).
University Hospitals eligible for Video-assisted thoracic
Conventionally, following VATS, a chest tube is
surgery (VATS) during the period, from the first of July
routinely inserted into the pleural cavity even in absence
2022 to the end of February 2023.
of air leak in the middle of operation. When there is no
sign of an air leak and the daily pleural effusion has Inclusion criteria:
dropped to as little as 300 ml per day or less, the tubes are
Absence of cardiopulmonary insufficiency as
removed (3). Chest drains are linked to discomfort,
coronary artery abnormalities, no associated co morbid
decreased pulmonary function, infectious complications,
diseases such as diabetes, coagulation issues, or cirrhosis
and an extended hospital stay (4). Additionally, they may
of the liver, clearly unfavourable surgical indications, no
affect the postoperative course in a negative way and
metastatic tumors in any other organs by computed
diminish the possible benefits of (VATS) (5).
tomography (CT), no air leakage after VATS, no purulent Leaving chest drains in the pleural cavity following
pleural effusion, patient without lung atelectasis (with
the VATS procedure is controversial. With the enormous
complete lung expansion), and absence of prolonged
development of (VATS) in recent decades, some surgeons
pleural effusion requiring postoperative chest drainage.
are starting to apply a protocol of drainless VATS,
especially in thoracic surgeries, in which the lung is left Exclusion criteria:
untouched (6, 7, 8) drainless techniques following VATS Changing surgical procedure during operation,
lung resection have been attempted, however the safety
existence of total pleural adhesion at time of the
and feasibility are still controversial.
procedure, patients with cancerous tumors that have
This study was to assess safety and perioperative
spread to the nearby organs, patients with high bleeding
outcomes of omitting chest tube drainage after video
tendency and patient with underlying lung disease or traumatic pneumothorax).
3986
Received: 16/10/2022 Accepted: 19/12/2022
c:\work\Jor\vol911_35The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 3995-4000
Prevalence of Sleep Disorders Among Diabetic Patients with Systemic Lupus Erythematosus in Menoufia University Hospital Asmaa Metwally Abdel Tawab1, Doaa Salah Elgendy2, Maha Mohamed Abd El Raof Salman*3, Marwa Mohammad Sharaf1
Departments of 1Chest Diseases, 2Internal Medicine, Endocrinology Unit, and
3Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Menoufia University, Menoufia, Egypt *Corresponding author: Doaa Salah Elgendy, Mobile: (+20) 01019965366, Email:[email protected], ORCID Number: 0000-0003-0954-6838 ABSTRACT Background: Patients with diabetes and systemic lupus erythematosus (SLE) frequently have sleep disruption. Unfortunately, there is still a lack of knowledge about the relationship between the incidence of sleep disorders in SLE and the causes of these disorders. Objectives: To study the sleep breathing disorders among diabetic patients with systemic lupus erythematosus (SLE) and associated relationship with both disease severity and activity. Patients and Methods: Thirty diabetic patients with SLE and thirty apparent healthy control subjects were enrolled in this work. For all patients, full medical histories, in-depth clinical exams, Epworth sleepiness ratings (ESS), laboratory evaluations, and complete overnight polysomnography were done. Results:Diabetic patients with SLE have a lower significant total sleep time (TST), sleep onset, sleep efficiency (%), percent of sleep in supine than controls (p < 0.001 for all). However, diabetic patients with SLE have a higher significant Spon Arousal index, number of awaking/hour, low limitation index and apnea/hypopnea index in supine than controls (p < 0.001 for all). Diabetic patients with SLE have a higher significant periodic leg movements during sleep (PLMS) sequence, apnea/hypopnea index (AHI), oxygen desaturation events (OD), percent of snoring time in TST, percent of rapid eye movement sleep (REM) in TST, total AHI in non-rapid eye movement sleep (NREM), total AHI in REM, ESR, CRP, uric acid and FBS, HBA1c% than controls (p < 0.001 for all). However, diabetic patients with SLE have a lower significant average oxygen saturation % and lowest oxygen saturation (%) than controls (p < 0.001 for all). Conclusion: Sleep breathing problems are frequently seen in people with systemic lupus erythematosus and diabetes. These patients' disease activity and poor glycemic management may be significant contributors to their sleep disruption. Keywords: Sleep disorders, Systemic lupus erythematosus, Diabetes mellitus. INTRODUCTION
Menoufia University Hospitals in the period from June
Many rheumatic illnesses, such as SLE,
2018 to July 2021 to evaluate their sleep pattern
rheumatoid arthritis, sarcoidosis, and Behcet's
changes and 30 healthy individuals as a control.
syndrome, have been linked to sleep difficulties [1].
SLE was diagnosed according to the 2019
Both Type 2 diabetes mellitus (T2DM) and sleep
European League Against Rheumatism/American
disorders are frequent health issues that are mutually
College
of
Rheumatology
(EULAR/ACR)
destructive. Diabetes patients frequently experience
classification criteria [4].
sleep difficulties. Diabetes patients take more sleeping
A through history and clinical examination
pills and report greater rates of insomnia, poor sleep
including general and rheumatological examination
quality, and excessive daytime drowsiness [2].
were done. Laboratory investigations as fasting blood
Due to restrictions in physiological gas exchange,
sugar and HBA1c for diagnosis of diabetes,
SLE patients run the risk of developing sleep disordered
erythrocyte sedimentation rate (ESR), antinuclear
breathing. Muscle weakness and weariness throughout
antibodies (ANA) and antidouble stranded antibodies
the daytime may lead to hypoventilation. The
(Anti-DNA) were done. Plain chest X-ray, ECG,
assessment of SLE activity and responsiveness to
echocardiography and high-resolution CT chest were
treatment may be hampered by sleep apnea being
done when needed.
present as a comorbidity [3].
Epworth sleepiness score (ESS) and SELDAI
It is still unclear how often sleep impairment is and
score for activity of SLE were calculated [5]. Also,
what are the factors contributing to sleep quality in
resting arterial blood gases and post exercise arterial
patients with SLE and diabetes.
blood gases (After six minutes' walk) was measured.
We aimed to study the sleep breathing disorders among
Pulmonary function tests were done using (Quark,
diabetic patients with SLE and associated relationship
PFT, Italy). The following measurements were done
with both disease activity and severity.
to all patients in the sitting position: Forced vital capacity (FVC), forced expiratory volume in the first PATIENTS AND METHODS
This comparative case-control study included 30
second (FEV1), FEV1/FVC ratio and maximum
SLE diabetic patients admitted to Chest Department,
voluntary ventilation (MMV).
3995
Received: 20/12/2022 Accepted: 20/02/2023
c:\work\Jor\vol911_36The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91 (2), Page 4001-4010
The Impact of Alpha-lipoic acid on the Monosodium Glutamate Induced Motor Coordination Dysfunction in Rats Safaa M. Saleh, Gerges S. Yousef, Suzan A. Khodir, Amany F. Elziat*, Ghana S. Amer
Department of Clinical Physiology, Faculty of Medicine - Menoufia University, Egypt *Corresponding author: Amany Fared Elziat, Mobile: (+20) 01007285789, E-Mail: amanifareid7@gmailcom ABSTRACT Background: Monosodium Glutamate (MSG) is one of the most commonly used flavors that may lend to motor incoordination. Alpha-lipoic acid (ALA) has antioxidant and anti-inflammatory effects with neuro-protective effects. Objectives: Present work aimed to elucidate possible protective potential of ALA on the motor incoordination induced by MSG and the possible underlying mechanisms. Materials and Methods: Seventy male Wister albino rats were randomized into five groups: 1-Control group (10 rats). 2-MSG group (20 rats): MSG 3 wks and MSG 6 wks ten rats each. 3-ALA pretreated group (10 rats). 4-ALA cotreated group (20 rats): ALA cotreated 3 wks and ALA cotreated 6 wks ten rats each. 5-Alpha-Lipoic acid-post- group.Thereafter, motor coordination assessed using Rotarod and
Footprint analysis were assessed in addition to serum Malondialdehyde (MDA), total antioxidant capacity (TAC), Tumor necrosis factor- alpha (TNF- ), cerebellar brain derived neurotrophic factor (BDNF) and Oxidative DNA damage were measured. Also, histo-pathological examination of cerebellar tissue was performed and number of purkinjie cells was assessed.Results: ALA resulted in better improvement for MSG-induced motor incoordination,
oxidative impairment and microscopic alterations of cerebellar architecture in cotreated group than that of post-treated group, with insignificant change in pretreated group. Conclusion: ALA exhibit protective effect against motor
incoordination, oxidative stress and cerebellar damage induced by MSG toxicity best as cotreatment, less when used as post-treatment but this effect useless as pretreatment. Keywords: Alpha-lipoic acid, BDNF and oxidative DNA damage, motor incoordination, MSG.
INTRODUCTION
known as the "universal antioxidant" because of its
Over the world, people's health issues are directly
special property of being both fat- and water-soluble (5).
related to unnecessary dietary modifications and
Due to its crucial involvement in the operation of
delicious food. The majority of them consume fast food
several enzymes involved in oxidative metabolism, it
from nearby restaurants that contains flavor-enhancing
has an antioxidant effect. It is thought that ALA, or its
additives such monosodium glutamate (MSG). Changes
reduced form, dihydrolipoic acid, performs a variety of
in eating habits and the body's production of reactive
biochemical tasks, including functioning as metal
oxygen species (ROS) brought on by MSG ultimately
chelators, lowering the oxidized forms of other
result in systemic abnormalities (1).
antioxidant agents like vitamin C and E, and
According to several studies using animal models,
glutathione, and acting as biological antioxidants.
MSG alters the development, metabolism, and activities
Moreover, ALA has been demonstrated to lessen
of many different organs, including the liver, thymus,
oxidative stress during exercise training and to
ovaries, kidney, and several areas of the brain, including
ameliorate endothelial dysfunction (6).
the cerebellum. According to investigations, adult rats'
Due to these advantages, ALA has been proposed
Purkinje cells experienced cellular deaths and Purkinje
as a potential therapeutic agent for a number of chronic
cell degeneration after receiving MSG orally at doses of
diseases with significant economic, social, and
3 g/kg BW every day for 14 days straight. Also, young
epidemiological consequences, including diabetes
rats given a subcutaneous injection of MSG at a dosage
mellitus and its complications, hypertension,
of 4 mg/g BW every other day for ten days had brief
Alzheimer's disease, Down syndrome, cognitive
impairments in their ability to coordinate their
impairment, and some types of cancer. In the medical
movements (2).
and nutritional care of patients, ALA is suggested as a
In addition to increasing oxidative stress, MSG also
dietary supplement (7).
lowers the activity of enzyme antioxidants. Free radical
It was discovered that ALA dramatically improved
generation or elimination in cells that is either too high
muscular coordination and strength, and that its
or too low, with the bulk of these free radicals being
capacity to lower induced lipid peroxidation by
oxygen radicals and other reactive oxygen species
scavenging ROS was responsible for its protective
(ROS) (3). Oxidative stress is caused by the metabolism
impact against tardive dyskinesia (7).
of food and a number of extracellular and intracellular
In light of this, the current study aimed to
components, including hormones, cytokines, and
investigate the protective potential of alph-alipoic acid
detoxification procedures. Hence, prolonged MSG
in different manners, as pretreatment, cotreatment and
consumption and excessive renal glutamate metabolism
post treatment, on MSG induced motor coordination
can both be sources of ROS (4). Thioctic acid, also
deficits in male Wister albino rats and the underling
known as alpha-lipoic acid (ALA), has emerged as one
mechanism involved.
of the most widely utilized antioxidants for protection.
A vitamin-like antioxidant called alpha lipoic acid is
c:\work\Jor\vol911_37The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4011-4018
Assessment of Local Freestyle Perforator Flaps for Face Defects Reconstruction Mohamed Mohamed Salah Awad, Mohamed Abbas Hegazy Wahsh, Mostafa Hussien Mohamed Hussien*, Mohamed Adel Saqr
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Mostafa Hussien Mohamed Hussien, Mobile: (+20)1151126159, E-Mail: [email protected] ABSTRACT Background: Freestyle perforator-flap surgery allows for more versatility in selecting a donor location by basing flap selection on the specific quality and quantity of soft tissue needed at the recipient site. Objective: The aim of the current work was to evaluate the role of freestyle perforator flaps in reconstruction of small to medium-sized facial defects in plastic and reconstructive surgery. Subjects and methods: This interventional study included a total of 18 patients with small to medium-sized facial defects reconstructed with freestyle local perforator flaps, attending at Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Zagazig University Hospitals. Preoperative perforator detection and its markings was done by hand-held Doppler and was confirmed by intraoperative exploration before raising a suitable flap. Patients were followed up 6 months or more postoperatively after discharge from the hospital. Results: Postoperative histopathology indicated that all the margins of the resected tissue were free of cancerous cells. Most cases had defects on the nose (33.3%), cheek (22.2%) and Lower lip (11.1%). 6 Flaps were based on facial artery perforators to cover nasal, cheek, and upper lip defects. 2 flaps were based on infraorbital artery perforators. Also, Superficial temporal artery and supra-trochlear artery represented a good donor of perforator flaps in our work. Congestion occurred in 4 patients. In only two patients, flaps showed ischemia. Regarding patient satisfaction with the aesthetic result, 6 of them were excellent, 6 were good, four were fair and two were poor. Conclusion: Because of their adaptability, wide range of motion, similar texture, and color match, the freestyle local perforator flaps could be used successfully to rebuild complex face deformities for cosmetic purposes. Keywords: Local Freestyle Perforator Flaps, Face Defects.
INTRODUCTION
Reconstructive outcomes in the face are more
perforator found intraoperatively and considerably
heavily influenced by aesthetic and functional
detected by a portable Doppler equipment, regardless of
considerations than in any other body part. The color
the course of the parent vessel (4).
and texture matching of local face flaps makes them a
Local flaps based on freestyle principles offer more
great choice. Facial skin has great vascularity, therefore
versatility than conventional local alternatives,
pedicled or islanded local flaps don't have to worry
permitting single-stage restorations using more similar
about getting enough blood. Some disadvantages of
tissue and reducing donor-site morbidity (5).
local pedicled flaps include restricted motion and
The flaps of a freestyle perforator can be collected
increased bulk at the pedicle site, both of which may
according on the strength of Doppler signals in a given
necessitate additional surgery (1).
area. The narrow pedicle permits the flaps to rotate
Single-stage surgery that involves harvesting tissue
widely, allowing them to access a variety of defect
that is the same color and texture as the face is necessary
locations on the face. The extent of the defect that can
for successful repair of facial deformities (2).
be repaired with these flaps is limited by the need for
Taylor's thorough description of human angiosomes
primary closure of the harvesting site and pedicle
led to the development of a fundamental anatomical
position (1).
concept that paves the way for novel methods of
Even though perforator arteries were researched by
elevating soft tissue flaps that rely on a single terminal
Taylor and Palmer on cadavers in 1987 and perforator
vessel for skin nutrition. The "new generation" of skin
vessels in the face were studied more recently (6).
flaps only have a single little artery entering the dermal
However, there is a lack of research on the clinical
anastomotic vascular plexus for blood supply. The
applications of local perforator flaps for facial
vascular region of these tiny terminal arteries is
reconstruction. In contrast to its cosmetic modification
unexpectedly enormous and is always sufficient to
or problems, the surgical benefits of local perforator
cover any gap in the oral cavity because of the opening
flaps have been thoroughly characterized (1).
of choke vessels. If the perforators are large enough,
This study was aimed to evaluate the role of
these flaps might theoretically be raised anywhere in the
freestyle perforator flaps in reconstruction of small to
body (3).
medium-sized facial defects in plastic and
In 2004, Hofer's free-form approach to face
reconstructive surgery.
reconstruction was popularized by Mardini and Wei.,
The freestyle idea allows for the harvesting of a skin
flap from any location on the body based on a single
4011
Received: 28/10/2022 Accepted: 31/12/2022
ReferencesThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4019-4028
Survivin Gene Polymorphism in Association with Plasma Survivin Level as Potential Risk Factors for Acne Severity and Post-Acne Scaring Ahmed Fathy State1, Magdy Abdelmageed El-Sohafy1, Dalia Shaalan Abdel Salam2, Yasmin Tarek Abdulraouf Elbashir*1
Departments of 1Dermatology, Andrology and STDs, and
2Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Egypt *Corresponding author: Yasmin Tarek Abdulraouf Elbashir, Mobile: (+20)1000205414, E-Mail: [email protected] ABSTRACT Background: Acne vulgaris is the most common cutaneous ailment in the world, affecting up to 80% of teenagers and up to 50% of adults. It is a chronic inflammatory disease of the pilosebaceous unit. The development of acne lesions is heavily influenced by keratinocyte proliferative and inflammatory states, which have been observed to elevate survivin levels. Objective: This study was conducted to assess survivin gene polymorphism and its plasma level in patients with active acne vulgaris and patients with post acne scars with varying severity. Patients and methods: The study included 60 acne patients divided into two groups: 30 patients with active acne lesions and 30 patients with post acne scars; in addition to 30 healthy volunteers who were served as control group selected from Outpatient Clinic, Department of Dermatology, Andrology and STD, Mansoura University Hospitals, Mansoura, for 1 year duration. Results: The levels of serum survivin in both group of patients with active acne and group of patients with post acne scars are significantly higher than that of the control group. There was no statistically significant difference in the serum survivin levels among the patients with different grades of acne. There was a significant increase in the serum survivin level with increased severity of post-acne scars. The distribution of the survivin rs-9904341 & rs-1042489 genotypes among the study's groups did not differ significantly (P > 0.05) for each. Conclusion: It could be concluded that survivin may be used as a diagnostic biomarker in acne vulgaris and as a prognostic tool for post acne scarring severity. Survivin is involved in the pathogenesis of active acne vulgaris and more importantly, the pathogenesis of the development of fibrotic tissue in acne scars. Keywords: Acne, Survivin gene polymorphism, Plasma Survivin level. INTRODUCTION
sebum production, which can result in comedones and
The most typical time for the development of
acne [6]. According to El-Tahlawi et al. [7] study on the
acne vulgaris, a pilosebaceous unit illness, is during
Egyptian population, there were statistically significant
adolescence. The severity of the condition varies from
differences in the levels of survivin and IGF-I in the
person to person. Over 650 million individuals, or 9.4%
control and sick groups. In light of this, Survivin and
of the world's population, are impacted. While acne
IGF-I could contribute to the pathogenesis of both
vulgaris is the most prevalent illness in adolescents,
active acne and the formation of postinflammatory acne
little has been published regarding its complex
scars [8].
pathogenesis [1]. Acne vulgaris is caused by a variety of
This study was conducted to assess survivin
variables, including genetics, food, hormones, stress,
gene polymorphisms and its level in plasma of patients
and environment [2]. According to its intensity, acne
with acne vulgaris of varying severity with and without
may be split into three groups: mild, moderate, and
post-acne scarring.
severe. Papules, pustules, nodules, and cysts are
examples of classifications for both inflammatory and SUBJECTS AND METHODS
non-inflammatory disorders [3].
This case-control study included a total of 60 acne
The family of genes known as apoptotic
patients, attending at Outpatient Clinic, Department of
inhibitors includes the human survivin gene. The roles
Dermatology, Andrology and STD, Mansoura
of transcription factors are reportedly impacted by
University Hospitals, Mansoura.
single nucleotide polymorphism of the survivin
The patients were divided into two groups
promoters, which changes how proteins are expressed
where group (A) included 30 patients with acne [4]. Survivin is expressed at relatively high levels in a
vulgaris without post acne scars, group (B) included 30
range of malignant tissues, embryonic and fetal tissues,
patients with acne and post acne scars. In addition to
as well as a small number of normal adult tissues, control group that included 30 healthy persons who
including skin. Normal tissues either do not express
were age and gender matched with the patients.
survivin or do so at extremely low levels [5].
Atypical apoptosis and increased sebocyte Inclusion criteria: Patients with acne vulgaris of
survival mediated by survivin may both have an impact
varying severity with or without post acne scar who
on infundibular keratinocyte differentiation and altered
were aged from 13 to 35 years, and did not receive any
4019
Received: 28/10/2022 Accepted: 31/12/2022
c:\work\Jor\vol911_39The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4029-4034
Study of Diagnostic Accuracy of Cone Beam Computed Tomography for Detection of Pathological and Anatomical Variations in Chronic Sinusitis Patients Abdel Zaher Elsayed Tantawy, Tarek Abdelmoaty Omran, Fatma Mahmoud Abdulla Emara*, Mohamed Salah Ibrahim
Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Fatma Mahmoud Abdulla Emara, Mobile: (+20)1029439382, E-Mail: [email protected] ABSTRACT Background: Cone-beam computed tomography (CBCT) was developed because of studies demonstrating its value in enhancing vision of the nasal cavity, lateral nasal wall, osteomeatal complex, and sinuses prior to functional endoscopic sinus surgery (FESS). Objective: The aim of the current work was to detect paranasal sinus diseases and anatomical variants in patients with chronic sinusitis identified prior to sinus surgery by CBCT and intraoperative during FESS. Patients and Methods: This study included a total of 30 patients with chronic sinusitis scheduled for FESS, attending at Department of Otolaryngology, Head and Neck Surgery, Zagazig University Hospitals. Results: The current research demonstrated consistent findings between CBCT and FESS in patients with chronic rhinosinusitis. Statistically significant (P<0.001) agreement was found between CBCT and FESS in the diagnosis of nasal deviation and concha bullosa. For nasal polyp and OMC blockage, the correlation between CBCT and FESS was statistically significant (P<0.001). The sensitivity and NPV of CBCT with respect to FSSS were both 100%, and the agreement between the two methods for detecting infundibulum thickening was statistically significant (P<0.001). Exceptions include nasal deviation and a thickened infundibulum, but otherwise, specificity is very good (67 percent and 70 percent respectively). Additionally, PPV was quite high except for nasal deviation, which was just 70%. Conclusion: It could be concluded that CBCT and FESS yield similar results when examining the paranasal sinuses. Diagnostic sinus endoscopy for the evaluation of chronic rhinosinusitis syndrome (CRS) is not always appropriate, but CBCT would be a suitable option due to its high accuracy, reduced costs, and lower radiation doses. Keywords: Cone Beam Computed Tomography, Chronic Sinusitis INTRODUCTION
they are isotropic, unlike in medical CT. Reconstructed
Worldwide, millions of people suffer from
CBCT images have the same resolution and quality in
chronic rhinosinusitis. Objective and subjective criteria
the axial, sagittal, and coronal planes. CBCT's higher
are included in the consensus recommendations used
resolution and lower radiation exposure to patients
to clinically characterize chronic rhinosinusitis. After
make it the method of choice for maxillofacial imaging
12 weeks of nasal obstruction, drainage, facial (3).
pain/pressure, and hyposmia/anosmia, as well as
In the oral and maxillofacial area, CBCT can be
objective evidence of sinusitis on nasal endoscopy or
used for a wide variety of procedures it is usually
sinus computed tomography, the American Academy
utilized for evaluation of lesions of mandibular
of Otolaryngology--Head and Neck Surgery
condyle among cases who had or maxillofacial trauma
recommends a diagnosis of chronic rhinosinusitis
or disorders of temporomandibular joint; for
syndrome (CRS) (1).
individuals undergoing orthodontic treatment and
Chronic rhinosinusitis can be diagnosed with the
implant planning; olfactory and airway examination;
help of a thorough patient history, a standard
for the evaluation of nasal mucosal thickness; the
otolaryngoscopic examination, and radiographic
diagnosis of sinusitis; the finding of nasal septal
imaging. The most reliable method for seeing this area
deviation, concha hypertrophy; prior to functional
is computerized tomography (CT). Before functional
endoscopic sinus surgery (FESS) to assess sinus
endoscopic sinus surgery, CT can be used to see the
diseases and anatomical variances (1).
sinuses, nasal cavity, and lateral nasal wall in detail.
It was demonstrated that CBCT may be
While CT has many potential benefits, its widespread
preferred to CT for detecting anomalies in the
use is limited by concerns over cost and radiation
mandibular region and paranasal sinuses due to its
exposure. Because of these benefits, using CBCT in
lower patient radiation dosage and higher resolution.
dentistry is highly recommended. Furthermore, the
CT remains the optimum imaging modality for this
precise function of CBCT in the field of
purpose. Few studies have, to the authors' knowledge,
otolaryngology is still up for debate. Compared to
compared the results of CBCT and FESS to determine
conventional CT, cone beam (CBCT) has fewer
whether there is concordance between the two (4).
drawbacks (2).
This study was aimed to evaluate if CBCT is an
Cone-beam computed tomography emerged
effective approach for assessing the paranasal sinuses
from studies with this aim (CBCT). In CBCT, the
in individuals with chronic rhinosinusitis by
voxels can be utilized to precisely quantify
comparing its findings to those of functional
maxillofacial features from a variety of angles because
endoscopic sinus surgery (FESS).
4029
Received: 28/10/2022 Accepted: 31/12/2022
c:\work\Jor\vol911_41The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4045-4051
Study of Feasibility of Simultaneous Laparoscopic Sleeve Gastrectomy and Cholecystectomy in Patients with Asymptomatic Cholelithiasis Gamal Mohammed Osman, Khaled Safwat EL Sayed Fahmy, Muhamad Mahmoud Abdelfattah Muhamad*, Ehab Shehata Abd Allah
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Muhamad Mahmoud Abdelfattah, Mobile: (+20) 01000607972, E-Mail: [email protected] ABSTRACT Background: Morbidity increases for obese patients when laparoscopic cholecystectomy is performed at the same time as bariatric surgery. Objective: The aim of the current study was to evaluate the safety, efficacy, and clinical outcome of simultaneous cholecystectomy (CC) during laparoscopic sleeve gastrectomy (LSG) obese patients with asymptomatic cholelithiasis. Patients and methods: A case series was carried out on 18 morbidly obese patients in the Department of General Surgery, Hepatopancreatico and Biliary Surgery Unit at Zagazig University Hospital for surgical management. During the period study, all patients with LSG and CC were postoperatively followed-up with for 6 months. Results: The mean duration of surgery for both LSG and CC was 108.50 (SD 9.364) min (range, 90-125 min). There were 2 (11.1%) females complicated with gall stone spillage, while, there were 2 (11.1%) male and female complicated with gall bladder bed bleeding. All cases completed the procedure laparoscopically without conversion to open, visual analogue scale (VAS) revealed a mean score of 5.28 (SD 1.708). According to patient's satisfaction, there were 10 (55.6%) patients with good satisfaction and 8 (44.4%) patients with excellent satisfaction. Only 5.6% discharged in the 1st day, 33.3% of patients at the 2nd day, 44.4% at the 3rd day and 16.7% patients discharged at the 4th postoperative day. Conclusion: CC is safe and practical during LSG and is appropriate for all patients with established gall bladder. CC can be done during LSG without increasing morbidity or duration of hospital stay. Keywords: Laparoscopic sleeve gastrectomy, Concomitant cholecystectomy, Bariatric surgery.
INTRODUCTION
linked with the dramatic weight loss and the correlation
Until the gallstones cause symptoms, no therapy is
between
bariatric
surgery
and
changes
in
necessary. Twenty percent of those with asymptomatic
gastrointestinal structure (5).
gallstones will experience symptoms within 15 years
However, there are risks involved when a
after diagnosis. Further consequences from gallstones
laparoscopic cholecystectomy is performed at the same
include cholecystitis, cholangitis, choledocholithiasis,
time as bariatric surgery. These risks include a higher
gallstone pancreatitis, and, in extremely rare cases,
incidence of conversion to open surgery and bile duct
cholangiocarcinoma (1).
injuries, as well as excess intra-abdominal fat and a
Acute cholecystitis symptoms include pain in the
potential difference in port placement between the two
upper right abdominal region, fever, and an increase in
procedures (6).
white blood cells (leukocytosis). Supportive care and
The aim of the current study was to evaluate the
cholecystectomy are both part of the treatment plan.
safety, efficacy, and clinical outcome of simultaneous
Choledocholithiasis patients should have their common
cholecystectomy (CC) during laparoscopic sleeve
bile duct stones removed as part of their treatment.
gastrectomy (LSG) obese patients with asymptomatic
Involving severe inflammation and infection of the
cholelithiasis.
common bile duct, acute ascending cholangitis can be
fatal if left untreated (2). PATIENTS AND METHODS
Biliary drainage, decompression, intravenous
A total of 18 patients with the diagnosis of morbid
antibiotics, and analgesics are all part of the treatment
obesity (BMI >40) were admitted to the Department of
plan. In the absence of gallstones, biliary dyskinesia can
General Surgery, Zagazig University Hospitals for
cause biliary colic due to motility issues (3).
surgical management.
Gall bladder (GB) disease is strongly linked to both Inclusion criteria:
obesity and significant weight loss following bariatric
1. Who aged >18 years.
surgery. There is still some uncertainty in the medical
2. Both sexes with BMI >40 or >35 with at least one
community about how and when laparoscopic
obesity-related co-morbidity.
cholecystectomy (LC) should be performed in
3. Ultrasound (US) documented GB stones (simple
conjunction with bariatric surgery (BS) (4).
chronic calcular cholecystitis).
It is debatable whether the best time would be to
have a laparoscopic cholecystectomy after bariatric Exclusion Criteria:
surgery because of the increased risk of GB diseases
1. Patients aged <18 years.
4045
Received: 30/10/2022 Accepted: 02/01/2023
c:\work\Jor\vol911_42 The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4052-4057
CHA2DS2VASc Score as A Risk Stratification in Patients with Heart Failure with Preserved Ejection Fraction: Review article Ragab Abdelsalam Mahfouz, Radwa Muhammad Abdullah, Muhammad Elsayed Sideq Elsayed, Ahmed Mohamed Hassan Salem
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Muhammad Elsayed Sideq Elsayed, Mobile: (+20) 01554663454, E-mail:[email protected] ABSTRACT Background: Age, heart failure, and hypertension are a few clinical characteristics that are separately linked to structural and electrical remodeling of the left atrium and make up the CHA2DS2-VASc index. In patients without atrial fibrillation (AF), remodeling and dysfunction are those of the left atrium (LA). The likelihood of stroke risk factors including atrial fibrillation. Objective: This review's objective was to assess the prognosis and thromboembolic risk that patients with HFpEF are predicted by the CHA2DS2-VASc score. Methods: We looked for data on Heart Failure, Hypertension, Atrial Fibrillation and Left Atrium in medical journals and databases like PubMed, Google Scholar, and Science Direct. However, only the most recent or extensive study was taken into account between February 2004 and September 2022. References from related works were also evaluated by the writers. There are not enough resources to translate documents into languages other than English, hence those documents have been ignored. It was generally agreed that documents such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations did not qualify as legitimate scientific study. Conclusion: CHA2DS2-VASc scores are simple to calculate, easy to remember, and reductionist. Utilizing the score in people with sinus rhythm can speed up clinical evaluation and help identify people who are particularly at risk of stroke. Keywords: Heart failure, Hypertension, Atrial fibrillation, Left atrium.
INTRODUCTION
maximum age score is 2, not 10, as would be projected if
The CHADS2 score has been supplemented with the
the columns were added together (4, 5).
"stroke risk modifier" risk variables to create score on the
CHA2DS2-VASc (1). The CHA2DS2-VASc score has Table (2): Annual stroke risk (3).
taken the place of the CHADS2 score in clinical settings. Enabling the classification of low-risk patients with greater accuracy. In a number of patient populations, including AF patients undergoing outpatient elective electrical cardioversion, CHA2DS2-VASc has exceeded CHADS2 in terms of score (2). Table (1): CHADS2 Score: Evaluation of stroke risk in atrial fibrillation (3) Table (3): Matching yearly stroke risk and CHADS2 score (3).
The CHA2DS2-VASc score augments the CHADS2 score by three additional usual stroke risk factors: age 65- 74, gender, and vascular disease. The score for the
CHA2DS2-VASc in those over 75 assigns an additional 2
Based on data for hospitalised patients with AF, Gage
points of weight (1). CHADS2's maximum score is 6, et al. (3) originally published the adjusted stroke rates
while CHA2DS2-VASc's highest score is 9. The
described above in 2001. In recent non-hospitalized
4052
Received: 29/10/2022 Accepted: 01/01/2022
IntroductionThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4058-4065
Prognostic Value of Global Longitudinal Speckle-Tracking Strain after Coronary Revascularization in Patients with Non-ST Elevation Myocardial Infarction Ahmed Said Eldamanhory, Mahmoud Hassan Shah, Ahmed Abdelshafie Hassan Soliman*, Islam Ghanem
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ahmed Abdelshafie Hassan Soliman, Mobile: (+20) 01155539351, E-mail [email protected] ABSTRACT Background: Acute myocardial ischemia is a hallmark of myocardial infarction without ST-segment elevation (NSTEMI). Using wall motion analysis and left ventricular ejection fraction, conventional echocardiography is frequently used to assess cardiac function. However, this technique may not be sufficient to explore all the complex features of NSTEMI. Speckle tracking echocardiography has been used in the context of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) multiple times in recent years. Objective: The aim of the current study was to ascertain whether there is a global longitudinal speckle tracking strain in NSTEMI patients following coronary revascularization could be a prognostic indicator of LV remodeling. Patients and methods: A cross-sectional study was conducted at Echocardiography and Catheterization Lab Unit of Zagazig University Hospital, on 82 patients presenting with moderate risk NSTEMI and who were candidates for early invasive coronary angiography. All patients were subjected to speckle tracking echocardiography.The patients were divided into 2 groups based on the percentage changes in LVED volume at the time of admission and the six-month follow-up. Those who experienced a minimum 15% increase in LV end-diastolic volume but no improvement in LV function were said to have LV remodeling. Results: For the variables EF, WMSI, LVEDV, LVESV, declaration time, and GLS upon admission, between the 2 groups, there were observable differences. At six months, there was a substantial difference in the EF, WMSI, LVEDV, and LVESV between the 2 groups. GLS's cut-off value for predicting LV remodeling was -14.65%. Conclusion: Individuals with NSTEMI who underwent PCI or CABG treatment showed signs of remodeling of the LV in 48.8% of these patients. GLS at a cut-off value -14.65 %, EF at a cut-off value 50.5%, and Least vessel diameter at a cut-off value 2mm were distinct indicators of LV remodeling in patients with NSTEMI revascularized by PCI or CABG. Keywords: Generalized longitudinal strain, Revascularization, Speckle-tracking, NSTEMI, Cross sectional study, Zagazig University.
INTRODUCTION
Acute coronary syndrome (ACS) can be divided
because of its capacity to identify time, contractility,
into subgroups of ST-segment elevation myocardial
and myocardial deformation in individuals with
infarction (STEMI), non-ST-segment elevation
various heart illnesses. Doppler angle of incidence,
myocardial infarction (NSTEMI), and unstable
however,
severely
restricts
Doppler
strain
angina. Cardiomyocyte necrosis, which is non-ST-
measurements (5).
segment elevation myocardial infarction (NSTEMI) or,
Speckle
tracking
two-dimensional
strain
less frequently, myocardial ischemia without cell loss,
echocardiography (2DSE), a novel technique,
is the pathological correlate at the myocardial level
quantifies regional LV function from standard gray-
(unstable angina) (1).
scale 2D echocardiographic images by estimating
Studies have indicated that when the period
myocardial strain using an Automated Imaging
between angiography and revascularization rises in
Function (AFI), independent of angle of incidence. It
NSTEMI patients. Myocardial function diminishes and
has recently been validated against sonomicrometry
the damage becomes permanent, particularly in those
and tagged magnetic resonance imaging (6).
who have coronaries occlusion on angiography (2).
Analyzing specific to assess LV function,
Also, it is well recognized that injured myocardial
myocardial wall portions appear to be more useful than
segments can evolve in multiple ways following acute
the total myocardium. The new indicator, ventricular
coronary
syndrome
revascularization
therapy,
function's global longitudinal strain (GLS) that
including functional recovery or irreversible negative
outperforms traditional ejection fraction (EF)
remodeling, both of which have different prognostic
measurements, is likely a result of the assessment's
consequences (3).
high degree of automation. (7). Moreover, studies have
Several studies have demonstrated that one of the
shown showed Global longitudinal strain is present in
most significant indicators of left ventricular (LV)
ischemic heart disease both acutely and chronically
systolic functional recovery following myocardial
(GLS), as assessed by 2DSE, is a very reliable
infarction is the amount of viable myocardial tissue (4).
indicator of the size of myocardial infarcts (8).
Strain
Rate
imaging,
one
of
many
The aim of the current study was to ascertain
echocardiographic techniques, has become popular
whether there is a global longitudinal speckle tracking
strain in NSTEMI patients following coronary
4058
Received:29/10/2022 Accepted:01/01/2023
c:\work\Jor\vol911_44The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4066-4071
Management of Subacute Monteggia Fracture Dislocation in Children Mahmoud El-Badawy Thabet*, Mohamed Abdel Aziz Aly, Ibrahim Abdellatif Algohiny
Department of Orthopedics, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Mahmoud El-Badawy Thabet, Mobile: (+20) 01125286540, E-mail: [email protected] ABSTRACT Background: Although Monteggia fracture dislocation is a rare injury, representing less than 1% of pediatric forearm fractures, missed Monteggia injuries are common, representing up to 50% of the acute injury. Both the acute and the chronic Monteggia injuries have different treatment protocols. There is a gray zone between the acute and the chronic Monteggia fracture dislocation, which represents the period after 2 weeks of injury until the ulnar fracture union. Objective: This study aimed to identify the treatment protocol for this gray zone between the acute and the chronic Monteggia fracture dislocation. Patients and Methods: Sixteen subacute Monteggia fracture dislocation patients (10 boys and 6 girls) underwent either closed or open reduction of the ulnar fracture with internal fixation. The patient's mean age was 9 years. Inclusion criteria conditioned a patient with Monteggia fracture dislocation after two weeks of the injury and before the ulnar fracture union. Results: By the end of the follow-up, all patients resumed full elbow range of motion with no elbow pain or deformity. All radiological parameters, including the radiocapitellar line and the ulnar bow lines, were normal at the end of the follow-up, with no redislocation of the radial head. Conclusions: Unlike the acute injury, there is no role for conservative treatment in the subacute Monteggia fracture dislocation. And contrary to chronic Monteggia, all patients didn't need open reduction of the radial head. Level of evidence: level IV. Keywords: Monteggia fracture dislocation, Missed Monteggia, Treatment of Monteggia fracture.
INTRODUCTION
By definition, the Monteggia fracture dislocation is
girls) underwent either closed or open reduction of the
a fracture of the proximal or middle ulna associated with
ulnar fracture with internal fixation. The patient's mean
dislocation of the radius head and proximal radioulnar
age was 9 (ranging from 6 to 12) years. According to
dissociation. It is an uncommon injury, representing less
the Bado classification system [10], nine fractures were
than 1% of all pediatric forearm fractures [1, 2].
Bado type I, two were Bado type II, and five were Bado
Missed Monteggia fracture is not uncommon, it
type III. The mean follow-up period was 13 (ranging
complicates up to 50% of acute injuries [3]. It can be
from 9 to 24) months.
missed by even a skilled radiologist, orthopedic
surgeon, or emergency room physician particularly if Inclusion criteria: Patient with Monteggia fracture
the ulnar injury is in the form of plastic deformation.
dislocation after two weeks of the injury and before the
Prompt management of the acute Monteggia fracture
ulnar fracture union.
dislocation gives excellent results and avoids the
possible complications of the chronic Monteggia Surgical technique: With the patient in a supine
fracture dislocation. Even a few weeks delay in the
position and under general anesthesia, sterilization and
management of acute injury can complicate the
draping of the affected upper extremity were done.
situation compared to early management [4].
According to the ulnar fracture pattern, we faced one of
Many authors agreed that Monteggia fracture
two situations. The first was a length stable ulnar
dislocation is considered chronic if the ulnar fracture is
fracture (short oblique or transverse fracture) mostly in
united, mostly after 4-6 weeks from the onset of the
the middle part of the ulna. The second was a length
injury [5-9]. The period from two weeks after the onset of
unstable ulnar fracture (long oblique or comminuted
the acute injury to before the union of the ulnar fracture
metaphyseal fracture).
is considered a gray zone between acute and chronic
In the length stable ulnar fractures (10 cases),
Monteggia injuries and could be called "subacute
reduction of the ulnar fracture was performed by
Monteggia fracture dislocation".
traction and counter-traction and by fracture
This study aimed to define the subacute Monteggia
manipulation. A suitable sized K-wire (or even 2 K-
injury and to propose a suitable treatment protocol for
wires) was then introduced from the ulnar metaphysis
this injury.
through the fracture site to the distal ulna for fixation.
The accuracy of reduction of the head radius was finally PATIENTS AND METHODS
checked under the image intensifier (Figure 1). In four
We conducted this study in the period between
cases, there was slight subluxation of the radial head
January 2019 and October 2022. Sixteen subacute
after adequate ulnar fracture reduction and fixation. We
Monteggia fracture dislocation patients (10 boys and 6
had to overcorrect the ulnar fracture angulation by
slightly bending the fracture and the K-wire opposite to
the direction of the radial head dislocation.
4066
Received: 29/10/2022 Accepted: 01/01/2023
c:\work\Jor\vol911_45The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4072-4077
Serum Osteoprotegerin (OPG) as a Potential Biomarker for Disease Activity in Ulcerative Colitis Ahmed Ahmed Al-said Ibrahim1, Gasser Ibrahim El-Azab1, Naglaa Allam Ahmed Allam1, Mona Mahmoud Hassouna1, Ahmed Mohamed Edrees2
Departments of 1Gastroenterology and Hepatology and
2Clinical Pathology, Laboratory Medicine, National Liver Institute, Menoufia University, Egypt *Corresponding author: Ahmed Ahmed Al-Said Ibrahim, Mobile: (+20) 01555509567, Email:[email protected] ABSTRACT Background: Inflammation and ulceration of the intestinal mucosa occur repeatedly in patients with ulcerative colitis (UC), leading to numerous bouts of bleeding per rectum. Objective: To evaluate serum osteoprotegerin (OPG) level in cases who had ulcerative colitis and its correlation with disease activity. Patients and Methods: This case control was conducted at the National Liver Institute, Menoufia University on 89 patients. They were divided into two groups and were matched in age and gender: Group I: 50 patients with ulcerative colitis diagnosed utilizing colonoscopy and histopathological examination. Group II: 39 individuals who had normal colonoscopic findings (grossly and histopathologically) as a control group. Results: Differences in OPG readings between the control group and UC subgroups were statistically significant. The mean OPG level in patients with extraintestinal manifestations (EIM) was 596 ± 365 pg/ml, while the mean OPG level in patients without EIM was 384 ± 333 pg/ml. OPG levels were not significantly linked to the prevalence of extraintestinal symptoms. The concentration of OPG was positively correlated with disease severity. Conclusion: The present study suggested that serum osteoprotegerin can be considered as a novel biomarker for assessing ulcerative colitis activity. Keywords: Osteoprotegerin (OPG), Biomarker, Ulcerative Colitis.
INTRODUCTION
(RANKL).Inflammatory pathways are also affected by
Inflammation and ulceration of the intestinal
the interactions between OPG, RANKL, and RANK.
mucosa occur repeatedly in patients with ulcerative
Several pathways are involved in T-lymphocyte and
colitis (UC), leading to numerous bouts of bleeding per
dendritic cell (DC) survival are activated after RANKL-
rectum [1]. Normal progression involves the entire colon
RANK binding [6].
and begins in the rectum. The development of ulcerative
Recent research has linked OPG, specifically in
colitis is typically the result of a combination of
the setting of inflammatory bowel disorders, to pro-
hereditary and environmental factors [2].
inflammatory processes, contradicting earlier assertions
Endoscopy along with mucosal biopsy for
that OPG plays a significant role in bone metabolism
histopathology is the gold standard for diagnosing UC.
and is critical for accurate identification of the
Diagnostic imaging and laboratory testing can narrow
inflammatory bowel diseases (IBD) [7, 8].
down a patient's potential conditions [3]. Patients with
Aim of present work was evaluation of serum
severe ulcerative colitis are less likely to die if their
osteoprotegerin (OPG) level in ulcerative colitis
disease activity is detected at an early stage [4].
patients and correlate it to disease activity.
Commonly used noninvasive diagnostics for
primary diagnosis and reliable monitoring of disease PATIENTS AND METHODS
activity in UC include erythrocyte sedimentation rate
A case control study was conducted at the National
(ESR), C-reactive protein (CRP), white blood cells
Liver Institute, Menoufia University on 89 subjects
(WBC), fecal calprotectin, as well as PMN-elastase.
divided into two groups and were matched in age and
Nevertheless, a perfect test has not yet been created. So,
gender: Group I: 50 patients with ulcerative colitis
using a second serum marker is helpful in both
diagnosed grossly on colonoscopy as well as
anticipating the severity of a disease and making an
histopathological examination. Group II: 39
accurate diagnosis [2].
individuals who had normal colonoscopic findings
Osteoprotegerin (OPG), or tumor necrosis factor
grossly and histopathologically as a control group.
receptor superfamily member 11B (TNFRSF11B),
These 39 normal individuals had undergone
plays a crucial function in many NF-kappa B signaling
colonoscopy for colorectal cancer screening, bleeding
pathways. OPG participates in a wide variety of
per rectum and anemia with unknown cause and were
biological processes, including those that regulate cell
found to have normal colonoscopic findings. Exclusion
differentiation, survival, and apoptosis [5]. It plays a
criteria included pregnancy, malignancy, collagen
pivotal role in bone metabolism, inflammation, cancer,
diseases as rheumatoid arthritis and systemic lupus
and other areas. Osteoclastogenesis is triggered by a
erythematosus, Crohn's disease and bone disease.
complex composed of receptor activator of NF-kappa B
Detailed history was noted and the patients were
(RANK) and receptor activator of NF-kappa B ligand
4072
Received: 30/10/2022 Accepted: 02/01/2023
c:\work\Jor\vol911_46The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4078-4083
Biological Role of Chemerinin Inflammatory Skin Disease: Review Article Soheir Mohammed Ghonemy1, Hanaa Hosny Elsaid2, Zeinab Osama AbdelHameed Ibrahim1*,Mona El Radi1
Departments of 1Dermatology, Venereology and Andrology and
2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Zeinab Osama AbdelHameed Ibrahim, Mobile: (+20) 01013064070, E-Mail:[email protected]
ABSTRACT Background: Chemerin is a novel adipokine that has been found to function in both autocrine and paracrine pathways. It draws in both innate and adaptive immune cells as a chemoattractant. There are several roles for this pro-inflammatory chemokine. Also called retinoic acid receptor responder 2 (RAR2) and tazarotene-induced gene 2 (TIG2). The protein chemerin is involved in a variety of processes, including metabolism, inflammation, and adipogenesis, as well as vascular dysregulation. Chemerin was evaluated among different inflammatory skin diseases and showed significant correlations. Objective: Review of the biological role of chemerin in inflammatory skin disease. Methods: We looked for data on Chemerin, Biological role and Inflammatory skin disease in medical journals and databases like PubMed, Google Scholar, and Science Direct. However, only the most recent or extensive study was taken into account between February 2015 and January 2023. References from related works were also evaluated by the authors. There are not enough resources to translate documents into languages other than English, hence those documents have been ignored. It was generally agreed that documents such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations did not qualify as legitimate scientific study. Conclusion: Psoriatic individuals had increased chemerin levels in their skin biopsies. Also serum chemerin levels were found to increase with acne vulgaris disease severity. Recent research has found a correlation between obesity and atopic dermatitis, an inflammatory skin condition. Adipokines can be used as a marker for the degree to which eczema is present. Keywords: Chemerin, Inflammatory skin diseases.
INTRODUCTION
estimated that between 7 and 20% of children and 7 to
Psoriasis is a genetically and environmentally
14% of adults are affected by this globally. 80% of
influenced multisystemic inflammatory skin disorder.
individuals develop symptoms within the first five
Like other erythematous-squamous illnesses, it can
years of life, and 60% of them suffer a recurrence in
affect the skin and the joints. There is mounting
maturity (4).
evidence linking it to metabolic syndrome,
Itching is the most prominent sign of AD. Initial
cardiovascular illness, and other psychological
symptoms of the condition include scratching, followed
disorders that contribute significantly to morbidity and
by the appearance of excoriation marks. Weeping,
mortality, hence the condition is being labelled a
eczematous, and erythematous lesions covered the
"global burden" (1).
flexural areas of the skin. Persistent scratching leads to
Over the past 30 years, psoriasis has become
a chronic phase characterized by lichenification and
increasingly common over the world. Psoriasis is
prurigo nodules (5).
estimated to affect 34% of the population. There are
One of the most prevalent chronic inflammatory
about 100 million people throughout the world who are
skin illnesses affecting humans is acne vulgaris. Acne
affected. Its prevalence is highest in industrialised
is one of the most common medical conditions treated
nations, where 5.32% of the population, split fairly
by dermatologists. The hair follicles and sebaceous
evenly between sexes and age groups, is affected by it
glands are both impacted. Acne vulgaris had the (2). Reports of the frequency among Egypt's Caucasian
second-highest incidence of disability-adjusted life
population vary from 0.19 to 3% (3).
years (DALYs) among all skin disorders included in
Atopic dermatitis (AD) is a chronic recurrent
2013 Global Burden of Disease (GBD) Study, behind
inflammatory skin illness. Asthma of the bronchi and
only dermatitis. The quality of life for both patients and
allergic rhinitis/conjunctivitis may coexist in what is
their relatives suffers as a result (6). Over 85% of young
known as an allergic triad. Atopic eczema is another
people globally suffer from acne vulgaris, with the
name for it. It can first be seen in newborns or children
prevalence being higher in industrialised countries than
and persists throughout maturity. The development of
in developing ones. The onset of puberty and the
the illness is influenced by genetic and immunological
subsequent increase in BMI are both factors in the
abnormalities. Infected people have a lower quality of
earlier onset of acne in developed-world females (7).
life because of their illness. It has not been totally
About 9% and a half of all people have acne.
healed, and future efforts to rein it in will be fraught
Puberty, when sex hormones are at their peak, is when
with difficulty. As a result of its rapid expansion into a
it first manifests in teenagers and young people. The
major public health issue, atopic dermatitis has recently
incidence of this, however, declines with age. Infants
experienced a dramatic increase in its prevalence. It is
are hardly ever impacted. Acne affects 40% of
4078
Received: 01/11/2022 Accepted: 03/01/2023
c:\work\Jor\vol911_47The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4084-4091
Study of Nuclear Factor Erythroid Related Factor 2 Gene Polymorphism in Patients with Type 2 Diabetes Mellitus Nader Mahmoud Mohamed Aly1, Tasnem Mohamed Younes*1, Ehab Shehata AbdAllah Ahmed2, Basma S. Elsayed1
Departments of 1Medical Biochemistry and Molecular Biology and
2General Surgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Tasnem Mohamed Younes, Mobile: (+20) 01144979879, E-Mail: [email protected] ABSTRACT Background: The molecular mechanisms that downregulate the nuclear factor erythroid related factor 2 (NRF2) expression in addition to gene polymorphism among type 2 diabetes mellitus (T2DM) patients. Objective: To investigating possible association between NRF2 gene polymorphism with T2DM development. Patients and Methods: This case-control study included 81 persons who were categorized into three groups; The first group, made up of 27 healthy people, served as a control, group 2 consisted of twenty-seven type 2 diabetics without foot ulcers, and group 3 consisted of twenty-seven patients with diabetic foot ulcer who had type 2 diabetes. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was utilized to do genotyping of NRF2 (rs35652124) single nucleotide gene polymorphism. Results: Concerning NRF2 genotyping in the investigated groups, 18 (67%) of controls possessed the CC genotype, while 7 (26%) possessed the CT genotype, and 2 (7%) possessed the TT genotype. Eight (30%) of cases in the cases group had the CC genotype, while 13% had CT genotype and 48% had TT genotype. Cases had a far higher frequency of the CT and TT genotypes than controls did. In terms of NRF2 allele distribution, we found that although 43 (80%) of controls and 11 (20%) of controls carried the C allele, 29 (54%) of patients carried the C allele and 25 (46%) of cases carried the T allele. T2DM patients had a significantly greater frequency of T alleles than control subjects. Conclusion: Regarding NRF2 genotyping, our study revealed that TT genotypes and T alleles were statistically significantly higher among patients' group (diabetic with and without diabetic foot) compared to controls. NRF2 gene has a proper value in prediction of T2DM. Keywords: Nuclear Factor Erythroid Related Factor 2, Gene Polymorphism, Type 2 Diabetes Mellitus.
INTRODUCTION
High rates of morbidity and mortality associated
related disorders, providing strong evidence for a
with type 2 diabetes mellitus (T2DM) and its
relationship between NRF2 polymorphisms and disease
consequences make this disease a global public health
risk (8). Therefore, we set out to see if there was any
crisis (1). Retinopathy, nephropathy, and neuropathy are
connection between a variation in the NRF2 gene and
examples of microvascular problems, while ischemic
the onset of type 2 diabetes.
heart disease, peripheral vascular disease, and stroke are
examples of macrovascular complications strongly SUBJECTS AND METHODS
linked to T2DM (2). The prevalence of diabetic foot
In a case control study at Medical Biochemistry
ulcers (DFUs) is increasing, and they are a leading
and Molecular Biology, Medicine and Surgery
cause of death among people with diabetes (3).
Departments, Faculty of Medicine, Zagazig University,
Gene NRF2 encodes nuclear factor erythroid 2-
81 subjects were included. The first group, made up of
related factor 2, also known as NRF2. This protein
27 healthy people, served as a control, group 2 consisted
interacts as an important part for keeping homeostasis.
of twenty-seven type 2 diabetics without foot ulcers,
NRF2 activates a plethora of proteins like, UDP-
and group 3 consisted of twenty-seven patients with
glucuronosyltransferase
(UGT),
glutathione-S-
diabetic foot ulcer who had type 2 diabetes.
transferase (GST), glutathione peroxidase (GPx) as well
as nicotinamide adenine dinucleotide phosphate Inclusion criteria:
NAD(P), which play a role in detoxification and cellular
The World Health Organization's (WHO) criteria
protection (4). NRF2 has been shown to be
was used to diagnose persons with type 2 diabetes (9):
downregulated in a variety of inflammatory illnesses,
Over 126 mg/dL in the blood while fasting.
according to studies (5). Previous research has found that
more than 200 mg/dL in the blood within two hours
genetic variables like single-nucleotide polymorphisms
after eating
(SNPs) control NRF2 expression (6).
Patients with HbA1c levels greater than 6.5% who
In T2DM and DFU, the molecular processes that
are experiencing hyperglycemic symptoms or a
reduce NRF2 expression are unclear. SNPs are among
hyperglycemic crisis.
the most common types of genetic changes that put a
Cases who had abnormal oral glucose tolerance test
person at risk for diabetes and its consequences (7).
(OGTT).
Genetic and epidemiological research have connected
WBC 4000-12000 cells /µL and wound size (2 cm)
variations in the NRF2 promoter to oxidative stress-
were used to determine which DFU would be used.
4084
Received: 30/10/2022 Accepted: 02/01/2023
c:\work\Jor\vol911_48The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4092-4095
Effect of Breather on Multidimensional Outcomes in Post-Stroke Survivors Lamiaa Z.Salama1*, Nesreen G. Elnahas1, Sandra Ahmed2, Rana Elbanna1
1Physical Therapy Department for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy
and 2Neurology Department, Faculty of Medicine, Cairo University, Egypt
* Corresponding author: Lamiaa Z. Salama, Mobile: (+20) 0109 979 3264, E-mail:[email protected] ABSTRACT Background: Strokes are the second-most frequent reason of dementia and the most frequent reason of physical impairment. In addition, most survivors develop motor impairments that affect their quality of life and capability to perform activities of daily living. Objective: This study aims to show if respiratory muscle training by the breather could enhance the quality of life in post-stroke patients. Material and methods: Fifty stroke patients were assigned into two groups. Both groups were engaged in conventional rehabilitation three times per week for six weeks. The experimental group performed respiratory muscle training (RMT) by the breather at a rate of five breaths per set, five sets/session, twice daily. The intensity was approximately 60% of the maximum effort. Data about quality of life assessed through the stroke impact scale were taken before and after six weeks. Results: Both groups achieved significant improvement in physical, emotional, and social memory, communication, and stroke recovery of SIS, but there was no significant difference between the two groups. Conclusions: Adding a breather to conventional rehabilitation of stroke patients produces a non-significant effect on the quality of post-stroke life. Keywords: Stroke,Quality of life,Rehabilitation.
INTRODUCTION
conventional rehabilitation three times weekly for six
Stroke was the second most common reason of
weeks. The
mortality worldwide in 2019. Behind cancer, stroke
claimed 6.55 million lives. Stroke is linked to a
experimental group performed respiratory muscle
significant morbidity rate, accounting for 143 million
training (RMT) by the breather at a rate of five breaths
with a disability [1].
per set, five sets/session, twice daily. The intensity was
Stroke is an abrupt onset of several daily life
approximately 60% of the maximum effort. They were
difficulties for survivors and their families. Stroke
enrolled in the outpatient clinic of Faculty of Physical
survivors experience problems that include speech
Therapy at Cairo University. Data about quality of life
damage, brain injury, and physical or cognitive
assessed through the stroke impact scale were taken
impairment. A stroke survivor's dependence on others
before and after six weeks.
increases by 30%50% if they have a significant
disability [2]. Procedure:
Reduced quality of life (QoL) and concurrent
The device used in this study to strengthen
reductions in daily physical activity are also frequently
inspiratory and expiratory musclesisBreather (PN
noted. Stroke-related burden is considerable in low- and
Medical Cocoa Beach, FL32931, made in the United
middle-income countries where medical care and social
States of America). Each patient in both groups was
support resources are scarce [3].
engaged in a conventional rehabilitation program for 30
Stroke patients' diaphragm, intercostal muscles, and
min three times per week for six weeks.
abdominal muscles are all weakened, limiting their
Each patient in the breather group (group A) was
ability to breathe and reducing their capacity for
asked to breathe in for 3 s, slight pause, then breathe out
physical activity and independent walking. The studies
for 3 s for ten repetitions/set and repeat this rhythm ten
found that breathing exercises can help stroke patients'
times /two sets, two sessions per day, three times per
physical function and increase their stamina and quality
week. The resistance was about 60%80% of the
of life [4].
maximum effort. The resistance was gradually
The breather is respiratory equipment that trains
increased according to patient tolerance.
both inspiratory and expiratory muscles. Hence, we
hypothesized that it could help post-stroke patients and Outcome measures:
improve their pulmonary functions and quality of life. Stroke Impact Scale: (SIS 3.0) is frequently utilized to
assess the quality of life of stroke survivors [5]. MATERIAL AND METHODS
The Stroke Impact Scale (SIS 3.0), created by Participants Duncan et al. [6], is one of the unique measures for
Fifty stroke patients of both sexes were allocated
evaluating health-related quality of life (HRQoL) that
to two groups. Both groups were engaged in
enables a thorough multidimensional assessment of the effects of a stroke on ADLs and Instrumental ADLs
4092
Received: 02/11/2022 Accepted: 04/01/2023
Diagnostic Value of Endoscopic Ultrasonography (EUS) in Unexplained Common Bile Duct DilatationThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4096-4101
Diagnostic Value of Endoscopic Ultrasonography (EUS) in the Unexplained Common Bile Duct Dilatation 1 Ahmed I lotfy, 2 Mohamed M Refaey, 2 Mostafa HA Elshamy, 2 Ramy El Hendawy, 2Kamal Amer 1 GIT Department AlAhrar Teaching Hospital, Zagazig, Egypt 2 Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Ahmed Lotfy Email: Ahmedlotfygit106 @gmail.com Mobile: +20 100 655 3263 ABSTRACT Background: Many etiologies can be behind common bile duct dilatation that is undiagnosed, such as pancreatic and periampullary tumors, choledocholithiasis, or an inflammatory condition as stenosis. Endoscopic ultrasound (EUS) may have a major diagnostic value in detecting etiologies of dilated CBD undetected by other non-invasive modalities. Objectives: This study aimed to determine whether endoscopic ultrasonography is helpful in detecting a common bile duct dilatation that isn't clear. Methods: This study was conducted on 67 participants who had unexplained CBD dilatation at Tropical Medicine Department, Zagazig University. Every patient underwent TUS, CT, MRCP and EUS. Findings of EUS were seen and verified by ERCP, surgery, or a biopsy that revealed cancer. Those who had normal results underwent three months of clinical monitoring. Results: 77.6% and 59.7% of patients underwent US and CT respectively prior to MRCP and EUS. By MRCP, 82.1% of patients were normal, 11.9% had stone, while 3% had CBD mass and 3% had stricture. While by using EUS, 50.7% were normal, 22.4% had stone, while 8.9% had ampullary lesion. Post EUS outcome 37 (55.2%) of patients had only medical follow up while 22.4% had stone extracted by ERCP, 6 patients (8.9%) had sphincterotomy and biopsy from lesions, 4 cases of them had adenocarcinoma, the other 2 cases had adenoma and 2 cases had CBD stricture treated by sphincterotomy and stent dilatation. 2 cases of pancreatic cancer underwent Whipple operation. EUS denied results of MRCP in 25 cases. Conclusion: EUS has a very useful role in the diagnostic work up for patients with unexplained CBD dilatation with or without symptoms. Keywords:Diagnostic, Endoscopic ultrasound, Common bile duct, Dilatation.
INTRODUCTION
opportunity for histological tissue/lesion sampling and
Common bile duct (CBD) dilatation that is
staging (5). However, this study aimed to assess the role
undiagnosed with unidentified cause by imaging might
of EUS in identifying the precise cause of unexplained
be attributed to many pathological causes like
common bile duct dilatation because there is limited
periampullary
and
pancreatic
neoplasms,
information regarding the yield of such EUS in
choledocholithiasis and/or inflammatory strictures. Also,
individuals with unexplained CBD dilation.
CBD can be dilated in non-pathological conditions such
as old age and prior cholecystectomy (1). PATIENTS AND METHODS
There are many investigational modalities of biliary
This prospective cohort study was conducted at
system
abnormalities
incorporating
endoscopic
Tropical Medicine, Zagazig University Hospitals between
ultrasonography (EUS), transabdominal ultrasound (US),
January 2020 and January 2022. The study comprised 67
magnetic resonance imaging (MRI), endoscopic
participants with enlarged common bile ducts (internal
retrograde cholangiopancreatography (ERCP), and
diameter of CBD 7 mm (6)) proved by any other
computed tomography (CT) (2). Transabdominal
diagnostic imaging (US, CT, MRCP) irrespective to
ultrasonography (US) lacks accuracy since the imaging
clinical data either symptomatic or not.
quality varies depending on the tissues and is operator- Exclusion criteria:
dependent in between, in determining the cause of biliary
Patients with history of cholecystectomy or previous
dilatation. Additionally, CT imaging lacks sensitivity in
biliary surgery, patients having platelet count
the diagnosis of biliary diseases and exposes users to
<50,000/cmm, patients with severe liver or kidney
radiation and contrast material (3). Despite being while
dysfunction, and patients having contraindication to
being the gold standard for biliary tract evaluation, ERCP
sedation by Propofol.
has a number of disadvantages, including the possibility
Patients were categorized according to findings of EUS
of life-threatening consequences including post-ERCP
after MRCP modality into: Group (A) included patients
pancreatitis, hemorrhage, perforation, and even mortality
who had no new findings in EUS with agreement with (4). Magnetic resonant cholangiopancreatography
MRCP and group (B) contained patients who had new
(MRCP) is the preferred imaging method for evaluating
findings in EUS with disagreement with MRCP.
biliary tract abnormalities due to its high accuracy
All patients underwent rigorous history taking,
unfortunately it has limitations also like the inability to
comprehensive clinical examinations, and the subsequent
attain a histological diagnosis and the complications of
laboratory tests: liver enzymes (ALT, AST, and serum
contrast usage (3).
alkaline phosphatase), albumin, total and direct bilirubin,
In the last decades the development of EUS as a
complete blood count, serum creatinine, coagulation
cutting-edge technique for biliary abnormalities not only
profile PT and INR.
the highly sensitive diagnostic yield but also offers
4096
Received: 30/10/2022 Accepted: 02/01/2023
c:\work\Jor\vol911_50The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4102-4109
Diagnostic Dermoscopic Feature Patterns of the Parasitic Skin Diseases Khalid Gharib1, Samia Ibrahim1, Marwa M. Abdelhameed2, Sohaila E. Ahmed2, Ayat N. Ali2, Yasmin A. Atif2, Youstina G. Farahat2, Mahmoud M. Mohammed2, Rabab S. Abdelmohsen2*
1Dermatology, Venereology, and Andrology Department, Faculty of Medicine,Zagazig University, Zagazig, Egypt 2Dermatology, Venereology, and Andrology Department, Al-Ahrar Teaching Hospital, Zagazig, Egypt
* Corresponding author: Rabab S. Abdelmohsen, Mobile: (+20) 01100352255, E-mail: [email protected] ABSTRACT Background: Epidermal parasitic skin diseases (EPSD) are a diverse group of neglected parasitic diseases that affect the outermost layer of skin. Diagnosing Scabies, Pediculosis, and Leishmaniasis is a problematic issue. Dermoscopy is regarded in vivo as a highly sensitive and efficient diagnostic approach for EPSD. Objective: The current study aimed to assess and describe typical dermoscopic characteristics utilized for diagnosis of the most prevalent parasite skin disorders in Egypt, including Scabies, Pediculosis, and Leishmaniasis. Patients and methods: The present study included 110 EPSD patients, especially Scabies, Pediculosis, and cutaneous leishmaniasis. All patients underwent a comprehensive history, physical, dermatological examination, and photography of suspicious lesions. Dermoscopes investigated these lesions. Results: Of the included 110 patients, 50 had scabies, 50 had pediculosis, and 10 had cutaneous leishmaniasis. Dermoscopy of 50 scabies patients revealed a darkening triangle in 84% and a burrow in 86%. Among 50 pediculosis patients, 72% exhibited ovoid brownish nits with a nymph, 52% had empty nits, and approximately 16% had both empty and full nits, while 16% had mobile lice. Phthirius crab louse was only identified in 2% of patients. Leishmania dermoscopy exhibited widespread erythema throughout all lesions, hyperkeratosis in eight cases, and central erosion/ulceration in eight cases. Conclusion: Conventional dermoscopy with a handheld Dermatoscope is an effective method for diagnosing scabies, pediculosis, and cutaneous leishmaniosis with a high degree of sensitivity. It significantly improves clinical decision- making and diagnosing skills. Keywords: Scabies, Pediculosis, Cutaneous Leishmaniasia, Dermoscopy, Parasitic Infestation, Skin.
INTRODUCTION
Dermoscopy is a noninvasive approach that
There are numerous dermoscopy case reports to
improves the clinical evaluation of pigmented skin
diagnose scabies. This evidence supports dermoscopy's
lesions by visualizing subsurface skin structures and
usefulness, particularly among specific cases. Dupuy et
invisible vascular structures. Dermoscopy was al. [4] and Walter et al. [5] assessed dermoscopy's
consequently utilized to diagnose non-pigmented skin
diagnostic properties. There have been few if any, well-
problems, including malignancies and inflammatory
designed clinical investigations evaluating skin
and infectious disorders [1].
scraping with and without dermoscopy to determine
Since dermoscopy enhances cutaneous clinical
diagnostic accuracy.
examination by identifying invisible morphologic
Infestation
with
blood-feeding ectoparasitic
structures, it is gaining increasing popularity across the
insects of Phthiraptera is known as pediculosis. Any
general dermatology field. Recent findings suggest that
mammal or bird, including humans, is at risk for
it may also be useful in assessing treatment outcomes
developing this illness [6].
and side effects. The development of handheld
Dermoscopy also serves as a potential diagnostic
polarized light dermatoscopes has contributed to
and monitoring tool for pediculosiscapitis. Newer
dermoscopy spread because of their portability,
models of handheld dermoscopy eliminate the need for
avoidance of skin contact or immersion fluid, and rapid
physical contact., hence reducing parasite transmission
screening of multiple lesions [2].
potentiality [7]. For pediculosiscapitis diagnosis, an
Epidermal parasitic skin disorders (EPSD) are a
adhesive tape with a portable contact dermoscopy is
diverse collection of infectious diseases that include
proposed. Digital dermoscopy revealed the presence of
parasite-host interactions on the skin's surface. Scabies,
a living, moving lice on Pthirus pubis [8].
pediculosis (capitis, corporis, and pubis), tungiasis,
Leishmaniasis is spread by sandflies that transmit
cutaneous leishmaniasis, and hookworm-related
protozoan
parasites
of
genus
Leishmania.
cutaneous larva migrans are prominent EPSD. EPSD is
Leishmaniasis can manifest in 3 primary forms:
prevalent and causes significant main and secondary
cutaneous, mucocutaneous, and visceral. Ulcers on the
morbidity, according to current knowledge. Poverty
mouth, skin, and nose are the hallmark of cutaneous
promotes animal reservoirs, transmission, atypical
form; fever and anemia, along with enlarged spleen and
infectious agent distribution, and exposure. Very high
liver, characterize mucocutaneous and visceral types,
prevalence and intensity of EPSD infestations are a
respectively [9]. The microscopical examination of
direct outcome of a population's lack of resources [3].
parasites enables the diagnosis of all three types.
RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKEThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4110-4116
Lidocaine Spray 10% versus Oral Ibuprofen Tablets in Pain Control during Copper Intrauterine Device Insertion (A Randomized Controlled Trial) Noha A. Sakna, Mohammed Ahmed Elkadi, Marina Ramsis Aziz Ghaly, Al Hassan Mohammad Khedr*
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University *Corresponding author: Marina Ramsis Aziz Ghaly, Mobile: (+20) 01271869711, E-Mail: [email protected] ABSTRACT Background: The intrauterine contraceptive device (IUCD), which is a plastic T-shaped device with copper attached to it, is the most widely used type of reversible contraception in the world. It was developed more than 30 years ago and has since become the industry standard due to its long-term effectiveness, safety, and affordability. Objective: To compare the effectiveness of oral ibuprofen versus 10% lidocaine spray as pain killers during the installation of copper intrauterine devices. Patients and Methods: This prospective, randomized clinical study comprised 140 women who sought out the Family Planning Clinic at Ain Shams Maternity Hospital between December 2021 and June 2022 in order to have an IUCD inserted for the purposes of contraception. Two groups were created from the participants. Those in Group 1 were given four sprays (40 mg) of 10% lidocaine spray to be administered topically on the cervix uteri 3-5 minutes before to IUCD implantation, whereas those in Group 2 were given 400 mg of ibuprofen tablets orally to be taken at least 45 minutes before IUCD implantation. Results: Failure of insertion statistically was non-significantly different among lidocaine spray and ibuprofen tablet groups. Vasovagal reactions statistically were non-significantly less frequent among lidocaine spray. Patients' pain perception statistically was significantly lower among lidocaine spray group. Moderate pain statistically was significantly less frequent among lidocaine spray. Need to analgesics statistically was significantly less frequent among lidocaine spray. Conclusion: Pain from IUCD insertion may be effectively managed with 10% local lidocaine spray, which is more convenient than ibuprofen pills and takes action quickly. When deciding between ibuprofen pills and lidocaine spray for pain management following IUCD implantation, many women choose the latter. Keywords: Lidocaine Spray 10%, Ibuprofen, Copper Intrauterine Device Insertion.
INTRODUCTION
despite the fact that the devices have been shown to be
A tiny, usually T-shaped contraceptive device
safe and effective. To lessen discomfort, non-steroidal
that is put into the uterus, an intrauterine device (IUD)
anti-inflammatory medicines (NSAIDs) are often used
is also known as an intrauterine contraceptive device
before having an IUCD inserted. Ibuprofen 400 mg was
(IUCD) (1). IUCDs are a kind of reversible, long-acting
the dose tested in the biggest NSAIDs study before
contraception (LARC). According to research, female
IUCD implantation. Colposcopy and endometrial
family planning professionals are more likely to use
biopsies are not the only gynecologic procedures
LARC techniques (41.7% vs. 12.1% of the total
performed in an outpatient setting where NSAIDs are
population) (2).
often prescribed as a pretreatment. Increasing IUCD
The intrauterine contraceptive device (IUCD) is
uptake is possible after an effective strategy for
a plastic T-shaped framework that is implanted into the
minimizing insertion-related discomfort has been
uterus. The copper variety is a coiled wire made of
developed (5).
copper, which triggers an inflammatory response that is
Researchers have looked at a variety of pain
poisonous to sperm and eggs (ova), therefore inhibiting
relief strategies for IUCD insertion. Non-steroidal anti-
conception (3).
inflammatory medicines (NSAIDs) and medications
The copper intrauterine contraceptive device
that numb the cervix with local anesthetics are examples
(IUCD) is very effective in preventing conception and
of these. Besides medication, other non-drug
contains no hormones. This makes it a viable choice for
interventions, such as pre-insertion counselling, the
those who choose non-hormonal birth control or who
procedure's location, or the provider's assurance, may
cannot use hormonal methods due to medical conditions
change a woman's degree of anxiety, which in turn may
such as a history of blood clots (Deep venous
affect her perception of pain and her experience (6).
thrombosis (DVT), pulmonary embolism (PE), stroke,
Lidocaine spray, a local anesthetic often used in
or myocardial infarction (MI). To allay concerns
dentistry for oral mucosal anesthesia during small
concerning fertility, it has been proven that fertility
surgical operations, is a straightforward and practical
returns to normal within a short time after the device is
option with few unwanted effects. It's possible that the
removed (3). Women who used the Copper T IUCD (Cu-
spray version of lidocaine will be more user-friendly
T380A) had a median delay to conception of three
and well-received by patients than alternative delivery
months from the time of removal(4).
methods. Lidocaine produces local anesthetic effects by
Concerns about discomfort and difficulties with
stabilizing neuronal membranes by blocking ionic
insertion are now the greatest obstacle to IUCD usage,
4110
Received: 02/11/2022 Accepted: 04/01/2023
c:\work\Jor\vol911_52The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4117-4123
Clinical Diagnosis and Management of Traumatic Acute Intracranial Subdural Hematoma: Review Article Omar Mohammed Omar Darah*, Mustafa Abd-Elsalam Mustafa El-Zohiery, Magdy El-Sayed Hassan Rashed, Wael Abd-Elrahman El-Mesallamy
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Omar Mohammed Omar Darah, Mobile: (+20) 01021825006, E-mail:[email protected] ABSTRACT Traumatic brain injury (TBI) is the leading cause of death and disabling conditions in persons. The frequency and severity of head injuries have both decreased as a result of numerous industrial safety improvements, the installation of airbags in automobiles, and the enforcement of speed restrictions. TBI survivorship has increased due to advancements in emergency response times and acute care, but this has also increased the need for accurate ways to detect individuals at risk of subsequent diseases. Pupil reactivity, the Glasgow Coma Scale, and head computed tomography are currently the main clinical signs indicating the existence of brain damage. The current review will cover the clinical presentation, diagnosis, and treatment of TBI, Keywords: Traumatic brain injury, Glasgow Coma Scale, Head injuries, Review, Zagazig University.
INTRODUCTION
Scale (GCS), the most popular tool for classifying
Brain damage caused by an external mechanical
TBI severity, rates a subject's level of awareness on a
force, such as impact, rapid acceleration or deceleration,
range
blast waves, or projectile penetration, is known as
from 3 to 15 based on how they react to verbal, motor,
traumatic brain injury (TBI). With current technology,
and eye-opening stimuli (5).
brain structural damage may or may not be detectable, and
The Glasgow Coma Scale is a neurological tool
brain function may be temporarily or permanently
designed to record a person's level of consciousness in a
impaired (1).
reliable, impartial manner for both initial and follow-up
Based on severity, anatomical aspects of the
examination.
damage, and the mechanism, TBI is often categorized into
A patient's score is determined by comparing their
closed and piercing head injuries (the causative factors).
condition to the requirements of the scale, and the results
When there is a closed injury, also known as a non-
range from 3, which denotes profound unconsciousness,
penetrating or blunt injury, the brain is not exposed. A
to either the old scale of 14 or the new scale of 15 (The
penetrating, or open, head injury happens when
more widely used modified or revised scale). The GCS is
something pierces the skull and pierces the dura mater, the
now used by clinicians and first responders to assess all
outermost membrane enclosing the brain (2).
acute medical and trauma patients. It was originally used
to gauge a patient's level of consciousness after suffering DIAGNOSIS
a head injury.
TBI patients are often treated and initially diagnosed
In hospitals, it is also utilized to keep track of
in the emergency room of a hospital. The process of
chronic patients receiving critical care. Professors of
determining the severity of brain injury starts after vital
neurosurgery at the University of Glasgow, Graham
signs are evaluated, stabilized and other life-threatening
Teasdale and Bryan Jennet, published the scale in 1974.
injuries are discovered and treated (3).
Three tests make up the scale: verbal, motor, and eye
responses. CLINICAL DIAGNOSIS
Both the individual three values and their aggregate Initial Clinical Evaluation:
are taken into account. Death or a deep coma is Since its invention in 1974 by Teasdale and Jennet,
represented by a GCS of 3, while 15 is the maximum (a
the Glasgow Coma Scale (GCS) has served as the
fully conscious individual) (5).
benchmark for impartially evaluating patients with
catastrophic brain injuries. The GCS offers a reliable, Best eye response (E):
tracking a patient's neurological condition over time is a
The four ratings are, from most severe to least:
relatively simple and objective way to evaluate
1. No eye movement.
neurological health, which are its two key benefits (4).
2. If there is pressure on the patient's fingernail bed, the
With brain injuries, there are three degrees of
eye may open in response to pain fails to elicit a response,
severity: mild, moderate, and severe. The Glasgow Coma
pressure or rub may be applied to the supraorbital and
c:\work\Jor\vol911_53The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4124-4129
Predictive Value of Monocyte/ HDL-Cholesterol Ratio for Coronary Artery Disease Severity in Patients Presenting with Non-ST Elevation Acute Coronary Syndrome Islam Ghanem*, Ayman Tantawy, Ahmed Shaker
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Islam Ghanem Ahmed Ghanem, Mobile: (+20) 01062829880, E-Mail:[email protected], ORCID ID: 0000-0001-5512-2978 ABSTRACT Background: Despite the fact that the monocyte count/HDL-C ratio (MHR) has been studied extensively in patients with chronic kidney disease as an independent predictor of both fatal and composite cardiovascular events. Only a few studies have looked at the MHR in patients with non-ST elevation acute coronary syndrome (NST-ACS). Objective: Using the SYNTAX score (SX score) in patients with non-NST-ACS, we will undertake this study to examine MHR as an independent predictor of the complexity and severity of coronary atherosclerosis. Subjects and methods: This study was a cohort analytical retrospective study conducted on 156 patients presented with NST-ACS admitted for coronary angiography, collected from Zagazig Catheterization Laboratory Database. All patients had the following: Cardiac enzymes, complete blood count, lipid profile and serum creatinine. The SX score was determined with baseline coronary angiography Results: Patients were divided into two groups based on their Syntax score: Group 1 (score < 23) and group 2 (Score > 23). There was significant positive correlation between monocyte/HDL-C ratio and SYNTAX score (p=0.001) with correlation coefficient 0.768. Receiver operating characteristic (ROC) curve showed that the best cutoff value for monocyte/HDL-C ratio for prediction of the severity of coronary artery disease assessed by SYNTAX score in the studied population was 22.25 with area under the curve (AUC): 0.975, sensitivity of 95% and specificity of 75%, (p value 0.0001). In-hospital non-fatal MI was higher among patients with high MHR (P: 0.029), but no statistically significant difference between both groups of MHR regarding in-hospital, 3 months CV mortality and 3 months non- fatal MI was revealed. Conclusion: MHR as a novel inflammatory marker is indicated to be an independent predictor of severity of coronary artery disease among patients presenting with NST-ACS. Keywords: MHR, NST-ACS, SYNTAX score. INTRODUCTION
protective function of serum HDL cholesterol (HDL-
Innate immunity, which swiftly and effectively
C) levels in the general population. The HDL
begins defence against pathogens, is mostly influenced
molecule's function in reverse cholesterol transport has
by monocytes. In atherosclerotic plaques, these cells
been primarily identified as the cause of its anti-
play a key role in the inflammatory process. In the
atherosclerotic capabilities. In individuals with chronic
initial phase of acute myocardial infarction (AMI),
renal disease, a recent study showed that both fatal and
plaque growth has been associated with an increase in
composite cardiovascular events may be accurately
monocyte count [1], and monocytosis has been
predicted by the monocyte count/HDL-C ratio
recognised as a distinct marker for both coronary
(MHR)[8].
artery disease (CAD) and AMI [2].
Finding a correlation between MHR value and
Although it has been demonstrated that a high
coronary atherosclerosis severity as measured by
monocyte count in healthy, middle-aged males might
SYNTAX score in patients with ACS and follow-up
predict coronary events, a greater monocyte count may
after three months for significant adverse cardiac
also hasten the onset of atherosclerosis [3]. It has been
events was the goal of the study.
shown that large amounts of low density lipoprotein
(LDL) that contains triglycerides and cholesterol PATIENTS AND METHODS
encourage primary human monocyte adhesion to artery
This Cohort analytical retrospective study had
endothelial cells [4].
been conducted in Cardiology Department; Zagazig
Atherogenesis is the process through which
University during the period from April 2022 to
monocytes enter the subendothelial region, take up
December 2022. The study included 156 patients
lipoproteins, and develop into macrophages or foam
suffering from NST-ACS admitted to Cath. Lab. for
cells. The formation of atherosclerotic lesions depends
coronary angiography.
on monocytes' capacity to move through the
endothelium. The results demonstrate that circulating Inclusion criteria: All patients with NST-ACS and
monocytes behave differently under conditions of
admitted to Zagazig University Catheterization
elevated blood cholesterol, and it appears that
Laboratory for coronary angiography and possible
monocytes
move
significantly
better
under
revascularization from April 2022 to December 2022.
hypercholesterolemic settings [5].
c:\work\Jor\vol911_54The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4130-4136
Studying The Expression of RNA-Binding Proteins RBM-Hur, and Lysophosphatidylcholine Acyltransferase 1 (LPCAT1) in Urothelial Carcinoma; Immunohistochemical Study Emad M Abdelrahman1, Mona A. Abo Elkheir 2, Kareem Ali ElAttar3 , Eman A. Saad2
1General Surgery Department, 2 Pathology Department and
3Urology Department, Faculty of Medicine, Benha University, Egypt Corresponding Author: Emad M. Abdelrahman, Email: [email protected] and [email protected] ,Tel: O1226763986, ORCID https://www.orcid.org/0000-0001-6066-2215 ABSTRACT Background: In developed nations, bladder cancer is a main cause of mortality. Urothelial bladder cancer (UBC) makes up the bulk of cases up to (90%) . An important lipid metabolism enzyme called LPCAT1 has been linked to the development of various cancers. HuR is an RNA-binding protein involved in tumor growth, regulates normal cell proliferation and inflammatory responses associated with cancer (13). that regulates the healthy cell proliferation and inflammatory responses associated with cancer. The study aimed to evaluate the significance expression of RBM-HuR and LPCAT1 in UBC. Methods: The current retrospective study included 50 formalin-fixed, paraffin-embedded blocks for UBC. to examine the expression of both RBM-HuR and LPCAT in UBC was performed using Immunohistochemistry where. anti RBM-HuR and anti LPCAT1 immunostaining were performed using Avidin-Biotin complex technique and correlated to clinicopathological parameters including pT stage and grade of the tumor, lymph node (LN) metastasis, distant metastasis, lympho-vascular invasion, and associated CIS Results: LPCAT1 expression was negatively correlated with the ( pT stage and grade of the tumor, lymph node (LN) metastasis, distant metastasis, lympho-vascular invasion, and associated CIS) (P < 0.05). However, RBM-HuR expression was positively correlated to the same clinicopathological criteria. (P< 0.05). Conclusions: RBM-HuR and LPCAT1 could both be used as potential prognostic indicators in UBC. Keyword: Urothelial carcinomas, RBM-HuR, LPCAT1. INTRODUCTION
AYTL2 gene produces the LPCAT1 enzyme, which is
Bladder cancer is among the top 10 prevalent
widely present in healthy tissues (8). This enzyme can
malignancies. It was anticipated that there were 213,000
move from its primary location at the endoplasmic
fatalities in 2020 (1). Men: Women ratio is 3-4:1, but
reticulum in the cytoplasm to the nucleus (9). According to
females are already in advanced stages of the disease
several studies, LPCAT1 when overexpressed can initiate
when they are discovered, which results in a worse
the development of malignancies (10).
prognosis (2).
Several RNA-binding proteins are involved in the
According to the National Cancer Institute, bladder
regulation and expression of genes (11). Moreover, they
cancer ranks third among all malignancies in Egypt for
have the ability to attach to RNA, which allows them to
both sexes, accounting for 6.9% of all cancer cases (3).
influence cell growth, invasion, and metastases (12).
More than 90% of bladder cancers are urothelial cell
HuR is an RNA-binding protein involved in tumor
carcinomas (UBC) (1). Smoking cigarettes and
growth. HuR regulates normal cell proliferation and
occupational exposures are well-established risk factors
inflammatory responses associated with cancer (13).
in the development of UBC (4). The TNM staging and
The pathogenic functions, predictive and prognostic
tumor grading, which serve as indicators of a patient's
utility of both RBM-HuR and LPCAT1expression in
likelihood of having a favorable or bad prognosis, are
UBC patients, however, are still unknown despite having
clinicopathological factors that affect bladder cancer care
previously been investigated in several malignancies (6). (5). Many clinic-pathological markers are proposed for the
Hence, the purpose of the study was to evaluate the
prediction of an recurrence and outcome in patients with
importance of expression of RBM-HuR and LPCAT1 in
UBC(6).
UBC.
According to reports, UBC has a number of
metabolic anomalies, and numerous altered metabolic MATERIAL AND METHODS
pathways
that
can
contribute
tumorogenesis.
The current retrospective study was conducted after
Phospholipid levels in UC have been reported to be higher
approval of the ethical and research committee, Benha (7).
university (RC 25-3-2023) the study included 50
Lysophosphatidylcholine
acyltransferase
1
formalin-fixed, paraffin embedded blocks for UBC that
(LPCAT1), a crucial enzyme in lipid metabolism, has
were assessed at the Pathology Department of faculty of
received a lot of interest recently from academics. The
4130
Received: 02/11/2022 Accepted: 04/01/2023
c:\work\Jor\vol911_55The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4137-4144
Intraoperative and Postoperative Opioid-Sparing Effect of Ultrasound Guided Quadratus lumborum Block versus Erector Spinae Plane Block in Renal Surgeries under General Anesthesia Ekram Fawzy Sayouh, Mona Abd El Razik Shahin, Hesham Mohamed Osman Ahmed*, Mohamed Gaber Mohamed EL-Sayed
Department of Anesthesia, Intensive Care and Pain Management Department,
Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Hesham Mohamed Osman Ahmed, Mobile: (+20) 01153304380, E-Mail:[email protected] ABSTRACT Background: Erector spinae plane block (ESPB) and Quadratus lumborum block (QLB) III are great interfacial plane blocks that have been providing a lot as regard perioperative pain relief in various surgeries. Objective: To compare the effect of both block on opioid consumption. Patients and methods: In a prospective randomized double blinded controlled trial, 102 (ASA 1 & II), aged 21- 64 y of both genders were scheduled to undergo open renal surgeries. They were separated into three groups at random (34 each). Control group where cases received general anesthesia alone, QLB group in which patients received unilateral QLB (III) before general anesthesia, with 20 ml of bupivacaine 0.25% and ESPB group in which patients received unilateral ESPB before general anesthesia, with 20 ml of bupivacaine 0.25%. Data collection included calculating amount of opioids given intra-operatively and 24h postoperatively, calculating time till end of block and evaluating patient satisfaction. Results: The current results demonstrated a non-significant recording in the two block groups as regard amount of analgesics given (intra-operative fentanyl being 125.15 ± 17.17 and 121.18 ± 16.1 in QLB and ESPB respectively), (postoperative morphine being11.09 ± 2.53 and 10.85 ± 2.34 in QLB and ESPB respectively), satisfaction score (being 5.71 ± 0.87 and 6.06 ± 0.69 in QLB and ESPB respectively), hemodynamics and VAS score recordings, while being significant when comparing the block groups to the non-block ones. Conclusion: ESPB and QLB provide relatively comparable analgesic effect with reduction of total intra-operative and post-operative opiate consumption in patients undergoing open renal surgery under general anesthesia. Keywords: Postoperative opioid-sparing, Effect of ultrasound guided Quadratus lumborum block, Erector Spinae plane block, Renal surgeries under general anesthesia.
INTRODUCTION
Renal surgeries e.g., nephrectomy and pyeloplasty
The aimed of this study was to compare the effect of
are common surgical procedures in urologic surgeries.
both block on opioid consumption.
The open approach provides a major tissue trauma to
the patient, which results in a severe pain and SUBJECTS AND METHODS
discomfort in the convalescence period. Postoperative Population
pain is a major clinical issue because it slows down
At Zagazig University Hospitals we conducted a
patients' recoveries and can even cause long-term pain
prospective randomized double-blind controlled trial.
conditions (1).
In order to alleviate pain and reduce opioid-related Inclusion criteria: age between 21 and 64 years, had
side effects, multimodal analgesia is increasingly being
BMI 30 kg/m2, from both genders, ASA I & II ready
used (2). It represents combining of different
for general anesthesia and a planned open nephrectomy.
mechanisms of analgesics, which helps to improve
efficacy and decrease dose, which result in minimizing Exclusion criteria: Patients with history of allergy to
side effects of these drugs. It includes combining
the studied drugs, those with chronic use of analgesics
systemic drugs (e.g., acetaminophen, opioids,
or drug dependence, patients with mental health issues,
medication, such as NSAIDs or neuraxial analgesia e.g.
those with anatomical abnormalities, neuropathic
combined spinal/epidural or epidural either spinal
disease, abnormal bleeding profile and infection at site
alone) for pain relief, interfascial plane block, local
of injection or liver diseases.
anesthetics infiltration as well as peripheral nerve block
(3). Sample size calculation: Assuming the VAS at 2 hours
Both ESP block and QL block had emerged as a
postoperative was 4.2+2 vs 3.1+1.5 in control vs QL
relatively novel interfacial plane blocks modalities for
group (5). The estimated sample was 102 cases, divided
the management of post-surgical pain. Multiple
into 34 cases in each group. Taking into account a
publications prove its efficacy for managing acute,
nonresponse rate of 10%, the sample size was computed
chronic, visceral and somatic pain that can add benefits
using the open EPI program at a confidence level of
to multimodal approach (4).
95% and a power of 80%.
4137
Received: 02/11/2022 Accepted: 04/01/2023
c:\work\Jor\vol911_56The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4145-4151
Surgical Outcome of Minimally Invasive U-Shaped Rod Strategy in Cases of L5 Pars Articularis Fracture Ahmed Kamal Abdelhameid, Bahaa Ghareeb Hassanin, Karam Kenawy*
Department of Neurosurgery, Faculty of Medicine, Sohag University, Sohag, Egypt Corresponding author: Karam Kenawy, E-mail:[email protected],mobile:+201007005639 ABSTRACT Background: Isthmic spondylolysis commonly occurs at L5 with causing low back pain in younger adults. Pars interarticularis fracture produced by repeated cumulative stress of the pars interarticularis resulting in pars microfracture, leading to bony defect. Persistent back pain and sometimes-radicular pain are common complaint. Objective: The aim of the current study was to evaluate the clinical results and complications after minimally invasive surgical approach of bilateral L5 pars interarticularis fracture by U shaped rod strategy technique. Patients and methods: A total 12 consecutive patients were reviewed retrospectively during the period from February 2019 to February 2022 with bilateral L5 pars interarticularis fracture. Preoperative symptoms, and postoperative results for those patients who underwent minimally invasive surgical approach for treatment of bilateral L5 pars interarticularis fracture, are all recorded. Results: Ten males and 2 females whose age ranged from 16 to 24 years. Clinical symptoms were: persistent low back pain in all patients (100%), radicular pain in 33% of patients (4 cases). The mean operative time was 82.5 (SD 11.8) minutes and the average blood loss was 206.5 (SD 47.8) ml. Post-operative assessments using the Oswestry scale showed improvement in 8 (66.6%). Three cases (25%) complain from mild back pain in exercise or during playing sport however the radiology showed good fusion. Failure of fusion with persistent of the complaint occurred only one case (0.08%) and re-surgery was done with the classic interbody fusion. Conclusion: Direct pars repair using U shaped road technique in bilateral fracture pars articularis in the lumbar spine should be the procedure of choice in the indicated cases with short hospital stay and early recovery to normal life. Keywords: Pars articularis fracture, U shaped rode, Fusion, Retrospective study, Sohag University. INTRODUCTION
Isthmic spondylolysis commonly occurs at L5 with
instrumentation then thinking about wiring fixation of the
distinguishable low back pain in younger adults. Pars
graft with Scout (6-8).
interarticularis fracture produced by repeated cumulative
Buck in 1970 introduced lag screw 3.5 mm across the
stress of the pars interarticularis resulting in pars
fracture line. Morscheret in 1984 advocated the use of
microfracture, leading to bony defect. Up to 25% of cases
laminar fixation with a hook screw device. More recently,
may develop Spondylolisthesis. Persistent back pain and
authors advised the use of U shaped rod pars repair
sometimes-radicular pain are the most common complaint
surgical technique (below the spinous process), as the best
(1,2).
minimally invasive strategy (9-13).
The plan of management is conservative in most cases
The aim of the current study was to evaluate the
for at least three months with analgesics, anti-
clinical results and complications after minimally
inflammatory, and muscle relaxant. Physiotherapy plays
invasive surgical approach of bilateral L5 pars
a role when deep abdominal strengthening exercises are
interarticularis fracture by U shaped rod strategy
indicated. Also, restriction of the flexion extension
technique.
exercise is necessary (3).
Conservative treatment may last for maximum six PATIENTS AND METHODS
months, if the conservative management failed and there
From February 2019 to February 2022, at the
is no evidence of fracture healing; surgical management
Neurosurgery Department at Sohag University Hospitals,
will be the choice of management (4,5).
12 patients with bilateral L5 pars interarticularis fracture
Decompression with lumbar fusion is the classic
were recruited and studied.
operative management for most cases especially with
radicular pain is the main complaint. In young adult with Inclusion criteria:
no evidence of spondylolisthesis and healthy
1. Age less than 24 years,
intervertebral disc material in MRI, minimally invasive
2. Average body built not over weight not more than 80
surgery for pars repair will be of great value. Pars repair
kg,
surgeries updated since 1968 when kimura advised to put
3. Persistent low back pain with failure of medical
a bone graft in the fracture site without any
treatment for 6 months,
4145
Received 20/01/2023 Accepted 23/03/2023
c:\work\Jor\vol911_57The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4152-4157
New Management Lines of Acne Vulgaris: Review Article Amany Abd El Rahman Nassar, Alshimaa Mohamed Ibrahim, Arwa Gamal Youssef*
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Arwa Gamal Youssef, Mobile: (+20) 01142593063, E-Mail:[email protected] ABSTRACT Background: The pilosebaceous unit is affected by acne vulgaris (AV), which manifests as open and closed comedones, papules, pustules, and nodules, and variable degrees of scarring. Adolescent onset is the norm for AV, which is otherwise a very rare disorder. Reevaluation of pharmaceutical treatments is suggested after 8 weeks for mostly comedonal or moderate inflammatory acne and 12 weeks for severe disease. Objective: Review of new management lines of acne vulgaris. Methods: We scoured scholarly papers and databases including PubMed, Google Scholar, and Science Direct for information on acne vulgaris and management lines. Between January 2001 and November 2022, however, only the latest or most comprehensive study was considered. The authors also assessed the usefulness of references taken from similar books. Documents written in languages other than English have been overlooked because of a lack of funding to translate them. Unpublished articles, oral talks, conference abstracts, and dissertations were all generally agreed upon to not constitute valid scientific investigation. Conclusion: New therapy approaches and numerous permutations and combinations have been developed as a result of a deeper comprehension of the aetiology of acne. Benzoyl peroxide, antibiotics, retinoids, and other topical medications are the backbone of treatment. They can be administered in any combination. Oral antibiotics, hormone therapy, and isotretinoin are considered examples of systemic options of treatment, although the best option will vary from patient to patient. Keywords: Acne vulgaris, Management.
INTRODUCTION Management of Acne:
More than eighty-five percent of adolescents
New therapy approaches and numerous
around the world suffer with acne vulgaris (AV), a skin
permutations and combinations have been developed as
condition. Although it typically appears and worsens
a result of a deeper comprehension of the aetiology of
throughout adolescence, research has shown that this
acne (Figure 1).
most prevalent skin disease can appear at any age (1).
Benzoyl peroxide, antibiotics, retinoids, and other
Although acne is not fatal, it does cause severe
topical medications are the backbone of treatment; they
emotional distress and has many co-occurring
can be administered in any combination. Patients' needs
conditions that must be addressed in order to restore the
will dictate which systemic therapeutic options, such as
patient's confidence and appearance (2).
oral antibiotics, hormone therapy, or isotretinoin, are
used. Lesion excision is one method of physical
The majority of people with active acne put off getting
therapy, and phototherapy is effective for some cases
treatment, which increases their risk of developing acne (1). Reevaluation of pharmaceutical treatments is
scars. Different types of acne scars have been identified,
suggested after 8 weeks for mostly comedonal or
including those with increased tissue production (3).
moderate inflammatory acne and 12 weeks for severe
disease (4).
c:\work\Jor\vol911_58The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4158-4163
Routine Placement of Drains versus Drainless in Uncomplicated Total Thyroidectomy Abeer Ahmed Ismail*, Weal Ibrahim El Shelfa, Ahmed Raafat Abd El fatah, Ahmed Kamal EL Taher
General Surgery Department, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Abeer Ahmed Ismail, Mobile: 01015796517, Email: [email protected] ABSTRACT Background: One of the most frequent surgeries a general surgeon performs is thyroid surgery. Nearly all surgeons utilize a closed vacuum drain at the conclusion of the intervention in an effort to avoid the deadliest complication, a smothering hemorrhage, which several studies suggest may not be essential. Thus, it may be necessary to evaluate the benefit of drainless following thyroidectomy by looking at factors like length of hospital stay, post-operative pain, and wound sepsis. Objective: The aim of the current study was to evaluate the advantages of drain-free surgery following thyroidectomy, postoperative pain, wound sepsis, seroma formation andhematoma. Patients and methods: A randomized controlled clinical trial was conducted at the General Surgery Department, Zagazig University Hospital in Sharkia, Egypt. A total of 30 enlarged thyroid patients were included in the study; 15 patients underwent a thyroidectomy without drain (Group A) and 15 patients underwent thyroidectomy with a drain (Group B). Results: Regarding post-operative complications including hematoma, infection, dehiscence, and seroma, there was no statistically significant difference between the studied groups. Group B had a higher infection rate. Group A had a longer postoperative hospital stay and a higher postoperative pain score (VAS), with statistical significant differences. Conclusion: Without drains, thyroidectomy is possible, less uncomfortable, results in an earlier discharge and hence lower costs, and doesn't raise the risk of postoperative complications. Keywords: Thyroid surgery, Drains, Complications, Postoperative, Clinical trial, Zagazig University.
INTRODUCTION
One of the most essential components of general
All types of thyroid surgeries, from lobectomies to
surgical practice is thyroid surgery. The majority of
subtotal thyroidectomies to complete thyroidectomies,
surgeons still employ drains, despite the continued
were detailed in the studies that made up this meta-
controversy around their usage in routine thyroid surgery.
analysis (6).
Numerous publications have claimed that after a
After reviewing the published data, it is still
thyroidectomy, the drains are unsuccessful at avoiding the
unknown whether drainless complete thyroidectomy is
development of a potentially fatal hematoma (1).
safe for people of different ages, how big the thyroid
In addition to causing discomfort, drains have the
lesion is, how diseases affect it, and how neck dissection
potential to worsen the cosmetic outcome, increase the
affects it (7). Thus, it is necessary to designate an
risk of surgical site infections, lengthen hospital stays and
acceptable target demographic for its performance.
hence raise costs (2).
The aim of the current study was to evaluate the
In situations where there is significant bleeding, the
advantages
of
drain-free
surgery
following
drain's tiny lumen frequently becomes blocked by clots.
thyroidectomy, postoperative pain, wound sepsis, seroma
The necessity of drains during thyroid surgery has been
formation andhematoma.
questioned in light of the fact that procedures like
cholecystectomy and colon anastomosis, which have PATIENTS AND METHODS
significantly bigger potential dead zones, are carried out
A randomized controlled clinical trial was conducted
without drains (3).
at the General Surgery Department, Zagazig University
The idea behind using drains during thyroid surgery
Hospital in Sharkia, Egypt. A total of 30 enlarged thyroid
is to avoid issues like seroma and hematoma formation
patients were included in the study; 15 patients underwent
after the procedure, although there isn't any real evidence
a thyroidectomy without drain (Group A) and 15 patients
to back up this theory in the literature. According to
underwent thyroidectomy with a drain (Group B).
reports, the incidence rates of hematomas requiring
surgical intervention range from 0-1.5% (4). Inclusion criteria:
A meta-analysis of 25 randomized trials comprising
All Patients undergoing Thyroidectomy.
2,939 patients indicated no difference in seroma
Patients in euthyroid and benign thyroid lesions
formation between the groups who had the procedures
All age group and small size legion.
with and without a drain. Several studies have been done to assess the necessity of installing drains in thyroid Exclusion criteria
surgery (5).
o People who have been given a thyroid cancer
c:\work\Jor\vol911_59The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4164-4169
Iron Bisglycinate versus Sucrosomal Iron in Prevention of Iron Deficiency Anemia in Pregnancy: A Randomized Controlled Clinical Trial Khaled Fathy Helal, Tarek Mohamed El Behiedy, Randa Farag Mustafa Mohamed*, Mohamed Ahmed Mahmoud Wasfy
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Randa Farag Mustafa Mohamed, Mobile: (+20) 01026219018, Email:[email protected] ABSTRACT Background: Pregnant women with anemia, especially those with severe anemia, run the risk of having poor physical activity levels, higher maternal morbidity, and increased death. Also, their newborns experience adverse effects such as perinatal mortality, intrauterine growth restriction, premature delivery, low birth weight, and fetal anemia. Objective: The aim of the current study was to compare the bioavailability, safety, efficacy and hematological responses to oral ferrous bisglycinate supplementation and sucrosomal iron in the treatment of iron deficiency anemia (IDA) in pregnant women. Patients and methods: A clinical trial was conducted at Antenatal Care Outpatient Clinic of Zagazig University Hospitals. The clinical trial included 66 oregnant women in their second and third trimester with IDA (hemoglobin level 10 g/dl). Participants were divided two groups; Group 1included cases who received ferrous bisglycinate supplementation and Group 2 included cases who received sucrosomal iron therapy. All Pregnant women were subjected to a full medical history, physical examination, and laboratory testing, including CBC, iron, ferritin, and total iron binding capacity (TIBC). Results: In groups I and II, there was significant increase of RBCs, hemoglobin, HCT%, MCV, MCHC and ferritin, iron and TIBC at final values compared to the corresponding basal value. The improvement of CBC findings, ferritin, iron and TIBC was more significant in group 2 cases who received sucrosomal iron therapy. Conclusion: Oral sucrosomal iron therapy is more effective and acceptable than oral iron salts for the treatment of IDA. Keywords: Iron Bisglycinate, Sucrosomal Iron, Iron Deficiency, Anemia, Clinical trial, Zagazig University.
INTRODUCTION
Pregnant women with anemia, especially those with
high iron bioavailability and great gastrointestinal
severe anemia, run the risk of being inactive and having
tolerance, SI has unique structural, physicochemical,
higher rates of maternal morbidity and mortality. Also,
and pharmacokinetic properties (4). The examination of
their newborns experience adverse effects such as
the existing evidence suggests that oral SI iron, which
perinatal mortality, intrauterine growth restriction,
is more effective and acceptable than oral iron salts, is
premature delivery, low birth weight (LBW), and fetal
a viable alternative for treating iron deficiency anemia
anemia (1). The most frequent causes of anemia in
(IDA). As a result, oral SI becomes a good first
pregnant women are iron and folate deficits (2).
treatment choice for IDA, especially for patients who
If caught early enough, anemia is mostly treatable
are intolerant to iron salts or for whom iron salts are
and easily curable. Treatment of the underlying causes,
ineffective (5) .
return of hemoglobin concentration to normal ranges,
Moreover, SI should be taken into account as a
and prevention and management of consequences all
substitute for IV iron for initial and/or ongoing
contribute to effective management of anemia (3).
treatment in anemic pregnant individuals (6). In order to
Iron supplements, such as ferrous bis-glycinate, are
treat pregnant women with iron deficiency anemia, this
typically started in the second trimester of pregnancy.
study compares the bioavailability, safety, efficacy, and
Unfortunately,
traditional
iron's
therapeutic
hematological responses to sucrosomal iron and oral
effectiveness is constrained by inadequate absorption.
ferrous bisglycinate supplementation.
Moreover, a higher prevalence of anemia in the second
The aim of the current study was to compare the
part of pregnancy is linked to unfavorable side effects
bioavailability, safety, efficacy and hematological
such gastrointestinal (GI) intolerance, dietary
responses to oral ferrous bisglycinate supplementation
interactions, and non-compliance with iron therapy (1).
and sucrosomal iron in the treatment of IDA in pregnant
Even though intravenous (IV) iron formulations are
women.
getting safer, venous access and infusion monitoring are
still necessary and there is a risk of infusion and PATIENTS AND METHODS
hypersensitivity reactions (1).
A randomized controlled clinical trial was
An novel oral iron formulation called
conducted at Antenatal Care Outpatient Clinic of
Sucrosomial® Iron (SI) protects ferric pyrophosphate
Zagazig University Hospitals. The clinical trial
with a phospholipid bilayer and a sucrester matrix
included 66 oregnant women in their second and third
(sucrosome), which is then absorbed via para-cellular
trimester with IDA (hemoglobin level 10 g/dl), from
and trans-cellular pathways (M cells). Because to its
April 2022 to October 2022.
c:\work\Jor\vol911_60The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4170-4176
Comparative Study between Caudal Epidural Block and Ultrasound Guided Transversus Abdominis Plane Block for Post-Operative Analgesia in Children Undergoing Infraumblical Surgeries Fouad Ibrahim Soliman*, Ahmed Hamody Hassan, Haytham Mohammed Esmail, Hala Mahmoud Hashem
Department of Anesthesia and ICU, Faculty of Medicine, Sohag University, Egypt *Corresponding author: Fouad Ibrahim Soliman, Mobile: (+20)1113815186, E-Mail:[email protected] ABSTRACT Background: Regional anesthesia techniques as a caudal epidural block (CEB) are commonly used to help with pain control during pediatric surgeries, decrease parenteral analgesics requirement, and improve the quality of postoperative pain control and general satisfaction of patient parents. Transversus abdominis plane (TAP) block is an evolving modality of regional anesthetic techniques for the abdominal wall. Objective: The aim of the current study was to compare the analgesic effect of CEB versus TAP block in pediatrics undergoing infraumblical surgeries. Patients and methods: A total of120 kids between the ages of 4 and 7 years old who needed infraumbilical procedures were divided into two groups of 60 patients. Group (1) received caudal epidural block using Plain bupivacaine 0.25 % 1 ml/kg, and Group (2) received ultrasound-guided TAP block using plain bupivacaine 0.25% 1 ml/kg. Follow up postoperative pain using Faces Pain Scale-Revised, vital signs, first rescue analgesia, the total dose of paracetamol needed, and complications. Results: At 8 and 18 hours postoperatively, Group (1) had substantially lower pain scores on the Faces pain scale-revised, reduced heart rate and mean arterial pressure compared to Group (2). Group (1) had a considerably later time to first rescue analgesia with less paracetamol use than Group (2). There was no discernible difference in postoperative complications between groups (1) and (2). Conclusion: At 6-24 hours after block placement, caudal block provides superior analgesia compared to TAP block in children undergoing lower abdominal surgeries. Caudal block is an effective, feasible, and safe option for postoperative analgesia, especially when compared to TAP block. Keywords: Caudal epidural block, Transversus abdominis plane, Children, Infraumbilical surgeries.
INTRODUCTION
the injected local anesthetic solution, and observe
Children, who undergo surgery, as well as their
anatomical features in real-time (4).
parents and medical experts, are quite concerned about
Transversus abdominis plane (TAP) block, a type
pain. Children can be managed for postoperative pain
of regional anesthesia that relieves abdominal wall
in a variety of ways using a variety of medications
pain after abdominal surgeries, was created in response
(Opioid or non-opioid). In some types of procedures,
to growing understanding of the anatomy of the
effective postoperative analgesia reduces perioperative
abdominal wall. Its goal is to block the transversus
movement, attenuates the surgical stress response, and
abdominis and internal oblique muscles' segmental
enhances the prognosis (1). In a variety of surgical
nerves T9T12 and L1. TAP block issues are rare,
procedures, regional anesthesia, including peripheral
especially when done with ultrasound assistance, and
and central neuro-axial blocking, can be utilized to
they seldom have lasting effects. Clinical trials have
reduce discomfort. Regional anesthetic is superior
not fully compared TAP block to CEB, which is now
because it can lessen the harmful stress reaction to
the standard method for treating regional analgesia in
pain, which is three to five times more pronounced in
pediatric patients. The goal of the current study was to
children than in adults. Moreover, it can improve
evaluate the analgesic effectiveness of ultrasound-
postoperative analgesia, reducing the requirement for
guided TAP block versus CEB in pediatric patients
systemic analgesics and their negative side effects (2).
undergoing infra umbilical surgery (5). The aim of the
Because it effectively manages somatic and
current study was to compare the analgesic effect of
visceral pain with a low complication rate, as well as a
CEB versus TAP block in pediatrics undergoing
significant reduction in intraoperative analgesic
infraumblical surgeries.
requirements and upper airway complications, caudal
epidural block (CEB) is the most frequently used PATIENTS AND METHODS
regional anesthesia technique in pediatric lower
A randomized controlled clinical trial carried out in
abdominal procedures (3).
Sohag University Hospital on about 120 kids between
Nevertheless, because to its lower incidence of
the ages of 4 and 7 years old, who needed
problems than neuron-axial approaches and ability to
infraumbilical procedures. Patients of both sexes were
circumvent some particular contraindications that
chosen according to their ASA Physical Status Class I
forbid the use of CEB, peripheral nerve blockade is
to II at Sohag University Hospitals.
increasingly being used wherever it is practical (i.e., Inclusion criteria: Children ranging in age from 4 to
impaired hemostasis, bacteremia, and anatomic neuro-
7 years old. Patients subjected to infraumbilical
axial abnormalities). Ultrasonography was also used to
operations as inguinal hernia and orchiopexy. Patients
guide the blocking technique, see the distribution of
with American Society of Anesthesiologists (ASA) class I or II.
4071
Received: 08/11/2022 Accepted: 10/01/2023
c:\work\Jor\vol911_61The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4177-4184
Overview about motor Sparing articular nerves Intervention in Chronic Shoulder Pain: Review Article Howaydah Ahmed Mohamed Othman, Sanaa Ahmed El-Tohamy, Mohamed Muftah Ben Naji*, Ashraf Elsayed Ahmed Elsayed
Department of Anesthesia, Intensive Care and Pain Management Department,
Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Mohamed Muftah Ben Naji, Mobile: (+20) 01128601089, E-Mail:[email protected]
ABSTRACT Background: Shoulder pain is one of the most often reported musculoskeletal symptoms. Shoulder pain can be caused by a number of different issues, including damage to the rotator cuff, subacromial impingement, osteoarthritis, adhesive capsulitis and pain after surgery, as well as bursitis. Motor-sparing nerve interventions are one of many treatments offered for chronic shoulder pain. Objective: The goal of these interventions was to alleviate shoulder pain by blocking certain nerves without significant motor deficits. Methods: In this review, we conducted a thorough search for relevant literature on the topic of chronic shoulder pain and its management. Our search included medical journals and databases such as PubMed, Google Scholar, and Science Direct, and we limited our inclusion criteria to studies published between 1994 and 2022. Additionally, we reviewed references from related works. To ensure consistency and accuracy, only documents published in English were considered for this review, and unpublished manuscripts, oral presentations, conference abstracts, and dissertations were excluded. Conclusion: Articular nerve interventions that spare motor function have shown great potential in managing chronic shoulder pain. These interventions have a primary goal of improving shoulder function and reducing pain while minimizing the risk of any motor deficit. Keywords: Articular nerve, Interventions, Chronic shoulder pain, Glenohumeral joint.
INTRODUCTION
Pain of shoulder is common among the elderly,
challenging due to the various potential causes. To
with a reported percentage of 6.9% to 26.0%.
address this, a scoping review was conducted to
Therefore, alleviating shoulder pain is a socially
provide information on shoulder pain risk factors, its
significant activity because it can significantly enhance
differential diagnosis, and shoulder pain management.
individuals' quality of life. Physical therapy is a
The review focused on (A) glenohumeral and/or
common treatment, however other methods such as
acromioclavicular joint articular innervation. (B) the
steroid injection and nerve block are also performed (1).
distribution of each articular branch within the capsule
Chronic shoulder pain is a multifactorial condition,
as well as the various techniques available for blocking
with several underlying pathologies such as arthritis,
these branches (3).
degeneration, trauma, frozen shoulder, nerve
entrapment, and complex regional pain syndromes. Risk factors of chronic shoulder pain:
Transcutaneous electrical nerve stimulation and
Shoulder pain is more likely in women and those
physical therapy are two non-pharmacological
who are overweight or elderly or who have a
interventions that may be effective in treating chronic
preexisting medical condition like diabetes mellitus,
shoulder pain. A combination of these treatments may
multiple
sclerosis,
fibromyalgia,
inflammatory
be used to manage shoulder discomfort, although it is
arthritis, as well as polymyalgia rheumatica. Shoulder
rare to identify a singular etiology for intractable
pain may also be caused by emotional issues, and
shoulder pain (2).
depression as well as distress.The chance of reporting
The etiology of chronic shoulder pain is often
pain was shown to rise by a factor of two when
multifactorial, and nociception-motor interaction plays
correlated with psychological pain (4).
a significant role in pain which is chronic or persistent
due to the complexity of the shoulder joint's range of Anatomical consideration (Figure 1):
motion, pain relief must be achieved without causing
The shoulder is a multifaceted joint that
motor block if an early rehabilitation programme is to
encompasses the and clavicle bones, humerus, scapula,
be provided following surgery and persistent
as well compromise individual joints - the AC joint as
nociceptive activation related to pain-induced
well as the glenohumeral joint. A ring of fibrous tissue
movement is to be controlled (3). However, choosing an
called the glenoid labrum encircles the glenoid fossa
effective treatment option for shoulder pain can be
and connects to the articular cartilage at the glenoid
rim (5).
4177
Received: 05/11/2022 Accepted: 07/01/2023
c:\work\Jor\vol911_62The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4185-4198
Role of Ultrasound and Computed Tomography in Evaluation of Salivary Glands Lesions Hayam Abdelmonsif Abdellatif, Ahmed Sameh Mohamed Ibrahim*, Basma Abdelmoneim Dessuky
Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Menoufia, Egypt *Corresponding author: Ahmed S. M. Ibrahim, Mobile: (+20)1092241288, E-mail:[email protected] ABSRACT Background: The most typical reason for salivary gland swellings is mumps, one of the viral diseases of the salivary gland. Another reason for swelling is a tumor. The parotid glands are the primary source of around 70% of salivary gland tumors. The initial imaging technique for swollen salivary glands is ultrasound. Examining the deep lobe of the parotid with ultrasound (U/S) is challenging. Objective: The aim of the current work was to evaluate the role of ultrasound and computed tomography (CT) in the differentiation between benign and malignant salivary glands lesions. Patients and Methods: A cross sectional analytic study was conducted on 46 patients with swellings in the head and neck of either gender referred from the outpatient clinics of ENT, head and neck surgery and dentists to Radiology Department, Faculty of Medicine, Menoufia university, Sheikh Zayed Specialized Hospital, and some private center during the period from November 2021 to November 2022. Results: showed that, primary and final diagnoses of salivary gland lesions by ultrasound and computed tomography were the same, that (39.1%) of patients suffered from sialadenitis, followed by both of sialolithiasis and benign tumor (21.7%), followed by malignant tumors (8.7%), and abscess and cystic lesion (4.3%). Inflammatory lymph nodes was significantly higher in ultrasound than computed tomography versus pathological lymph nodes, it was significantly higher in CT than U/S (p=0.032). Conclusions: It could be concluded that CT and ultrasonography can be used to diagnose abnormalities of the salivary glands accurately. It is a helpful imaging technique for evaluating salivary gland masses. It could assist in distinguishing between benign and malignant tumors and reduce the range of possible diagnosis. Keywords: Computed tomography, Salivary glands lesions, Parotid gland, US. INTRODUCTION
are the most frequent clinical indicators of salivary
Saliva is produced, modified, and secreted into
gland imaging [3].
the oral cavity by the salivary glands, which are
Pathology of the salivary glands is separated
exocrine glands. Salivary glands are divided into two
into neoplastic and nonneoplastic illness. Sialolithiasis
main
types:
the major
salivary
glands,
and inflammatory or infectious diseases are other
which include the parotid, submandibular and sublingu
categories of neoplastic illness. Nonneoplastic
al glands, and the minor salivary gland tissue, which is
disorders of the salivary glands most usually occur in
made up of 800-1000 tiny salivary glands, and are
the main salivary glands (i.e., parotid, submandibular,
morphologically split into two basic categories.
sublingual) [4].
Although minor salivary gland tissue may be found
The pathology most frequently affecting the
throughout the aerodigestive tract, it is most abundant
salivary glands is inflammation. The most common
around the soft/hard palate, the floor of the mouth, the
ailment affecting the salivary glands in the past was
labial mucosa, and the buccal mucosa [1].
mumps. Sialolithiasis and obstructive sialadenitis,
The biggest of the three primary salivary glands
infectious sialadenitis, granulomatous disorders,
is the parotid gland (PG). It runs from the tip of the
Sjögren's
syndrome,
sialosis,
human
mastoid to just below the angle of the mandible, and it
immunodeficiency virus (HIV) sialopathy, recurrent
is situated between the masseter and the
sialadenitis of childhood, and radiation-induced
sternocleidomastoid muscle. The second-largest gland,
sialadenitis are among the inflammatory conditions of
the submandibular gland (SMG), is located between
the salivary glands [5]. The neoplasms of the salivary
the anterior and posterior bellies of the digastric
glands are uncommon and comprise a diverse set of
muscle, inferior to the jaw, and weighs around half as
benign and malignant tumors with a range of
much as the parotid. The mylohyoid muscle and the
behavioral traits. As the aggressivity grade of these
sublingual gland (SLG) are located above the mucosa
lesions relies on their histological kinds, a proper
of the mouth's floor (between the mandible and
pathologic diagnosis is essential [6].
genioglossus muscles). In the middle, between the
Imaging is helpful in distinguishing salivary
sublingual gland and the base of the tongue [2].The
gland masses from masses or diseases in nearby
three principal pairs of salivary glands in the body that
cervical spaces, particularly in the parapharyngeal,
contribute to the first stage of digestion are the parotid,
masticator, and submental spaces and mandibular
submandibular, and sublingual glands. Pain and edema
lesions [7].
4185
Received: 06/11/2022 Accepted: 08/01/2023
c:\work\Jor\vol911_63The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4199-4203
A Prospective Study of the Benefits of Simulators in Improving Beginners Obstetric Vaginal Examination Skills Shaimaa Mostafa Elshemy*, Ahmed M. El Minawi, Nadine A. Sherif, Mohamed Ezzat Yousef Abd El Rasoul
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt. *Corresponding author: Shaimaa Mostafa Elshemy, Email: [email protected]
mobile: (+20)1220632263, ORCID: 0000-0002-7470-2692
ABSTRACT Background: Vaginal examination is a procedure used frequently during the management of labor, especially to assess its beginning and to evaluate its progress. Objective: The aim of the current work was to assess the benefits of the use of simulators in improving obstetric vaginal examination to house officers. Subjects and methods: A single-center, prospective study was performed at the Department of Obstetrics and Gynecology, Cairo University Hospitals, between June 2020 and March 2021. It enrolled 39 house officers spending their internship program and 70 women admitted for an uncomplicated delivery. All house officers attended orientation lectures and each student performed vaginal examinations for different conditions of the simulator followed by examination of different patients within emergency department. The overall accuracy score for simulators examination was calculated out of 90 for each participant and compared with the score of patient's examination. Results: There was no statistically significant difference between simulator and patient's examination accuracy score concerning cervical dilatation, presenting part, fetal station, and moulding. Participants were more accurate in assessing effacement after simulator examination compared to their accuracy after real patient's examination. On the other hand, cervical position assessment accuracy was significantly higher after real patient's examination compared to that shown after simulator examination. Overall, students' examination accuracy was not significantly different when comparing both simulators versus real patients. Conclusion: Simulation training has achieved great results using one that is anatomically typical to human female pelvic structure. However, it did not show similarity with real patients when assessing the cervical effacement and position. Keywords: Simulator, Vaginal examination, Labor.
INTRODUCTION
confidence, knowledge, skills, workplace behaviors,
Teaching technical skills during medical
and translation to patient care (6).
training can present many ethical and medico-legal
The idea of the present study was that initial
issues (1). Vaginal examination is a procedure used
training by simulators could be beneficial for non-
frequently during the management of labor, especially
experienced house officers, allowing them to improve
to assess its beginning and to evaluate its progress (2).
their vaginal examination skills.
However, being able to perform vaginal
examination correctly is considered as an essential skill SUBJECTS AND METHODS
in the labor management (3).
This prospective study enrolled a total of 39 house
It is the most accepted way to assess progress during
officers spending their internship program and 70
childbirth (4).
women admitted for an uncomplicated delivery, and
Many studies have reported low levels of
performed at VESELKA Unit, Department of
accuracy in vaginal examinations performed by
Obstetrics and Gynecology, Kasr Al_Ainy Hospital,
residents in gynecology and obstetrics departments (5).
Cairo university, during the period from June 2020 to
This is due to these technical skills in examination
March 2021. Clinical trial registration: NCT05190692.
cannot be learnt by observation only, but house officers
need to perform multiple vaginal examinations on real Study population:
different pregnant women (1).
For the 39 house officers, clinical demonstration
Vaginal examination Simulators play an
sessions were performed first for three successive
important role in the education of house officers and
sessions: 1 hour duration for each.
have important effects on learner outcomes such as
They were oriented about the six parameters of
examination in case of both simulators and real patients.
c:\work\Jor\vol911_64The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4204-4209
Management of Post-Penetrating Keratoplasty Astigmatism by Photorefractive Keratectomy Asaad Nooreldin
Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Assiut Branch, Egypt Email:[email protected], Mobile: 01026366024 ABSTRACT Background: Astigmatism after keratoplasty continues to be a difficult case for corneal refractive surgeons. Astigmatism is a barrier to visual recovery after a successful corneal transplant, even though graft viability is the primary concern in keratoplasty. Aim and objectives: The aim of the study was to assess the management of postoperative penetrating keratoplasty astigmatism by photorefractive keratectomy. Subject and methods: Study was done between March 2021 and March 2022 at Al-Nahar eye center (Assiut). 30 eyes of 30 patient underwent PTK-PRK (phototherapeutic keratectomy and photorefractive keratectomy), all were done by the same surgeon.
Results: The BCVA (Best Corrected Visual Acuity) of the studied eyes ranged from 0.01 to 0.2 with a median value of 0.1 and IQR between (0.1 and 0.2) preoperatively, which was significantly improved after 1 month to have a median value of 0.5 and IQR between (0.4 and 0.58, P=0.003) and kept improving significantly after 2 and 3 months by comparison to preoperative to have a median of 0.7 with IQR (0.7: 0.8) after 2 months and all eyes had a BCVA of 0.8 after 3 months (P<0.001). Conclusion: Clear graft penetrating keratoplasty (PK) improves eyesight. Significant postoperative astigmatism, however, may impair visual acuity to some degree. After keratoconus, patients with astigmatism have more than one treatment option available. Keywords: Topography-guided photorefractive keratectomy, Post keratoplasty astigmatism, Irregular astigmatism, Laser refractive surgery, Keratoplasty.
INTRODUCTION THE AIM OF THE STUDY
For patients who have undergone penetrating
Discuss the efficacy of photorefractive
keratoplasty, postoperative astigmatism, which can be
keratectomy to improve visual acuity by correction of
anywhere between 15 and 20 diopters (D) and result in
astigmatism after penterating keratoplasty procedure.
severe anisometropia, is the main barrier to adequate
visual rehabilitation (PKP)(1). PATIENTS AND METHODS
Too much astigmatism can be caused by a number
This study was done between March 2021 and
of things, such as preexisting corneal thinning, eccentric
March 2022 at Al-Nahar eye center (Assiut). 30 eyes of
trephination of the host, vascularization, preoperative
30 patient underwent PTK-PRK (phototherapeutic
keratoconus, big grafts, and astigmatism of the donor
keratectomy and photorefractive keratectomy), all were
eye, and the length, depth, tension, and arrangement of
done by same surgeon.
corneal sutures(2).
Sadly, utilising glasses for vision rehabilitation Inclusion criteria:
often yields unsatisfactory visual results(3).
Patient 2 years after PKP, PKP after complete
Contact lenses are the go-to in cases like these, but
suture removal, astigmatism up to ± 6 diopter, myopia
they may be tricky to install. In addition, contact lenses
or hypermetropia up to ± 2, age of the patient 21-35
have been shown to enhance the likelihood of transplant
year, no ocular surface disorder, normal IOP, no
rejection by inducing peripheral neovascularization(4).
dryness, BCVA up to 0.8.
The need for surgical intervention in vision
rehabilitation arises when conventional optical Exclusion criteria: Ocular surface disorder as dry eye,
approaches fail to provide satisfactory results.
high astigmatism more than ± 6 diopter, myopia or
Astigmatism after PKP may be surgically corrected in a
hypermetropia more than ± 2 diopter and systemic
number of ways. They include: relaxing incisions,
disease as DM and autoimmune disease.
wedge resection, astigmatic keratotomy, and selective
Complete ocular examination was done. Pentacam and
suture removal(5).
Z-wave Aberrometry were used.
Myopia and astigmatism after PKP have been
reported to respond well to laser refractive surgeries Operative details:
including photorefractive keratectomy (PRK) and laser
After explaining the procedure's purpose and
in situ keratomileusis (LASIK)(6).
potential hazards, we got all patients' informed
Nevertheless, most of the investigations are part of
permission. Patients were included in the trial if their
much smaller series with brief follow-ups(7).
visual acuity improved with phoropter correction,
4204
Received: 29/10/2022 Accepted: 01/01/2023
c:\work\Jor\vol911_65The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4210-4214
Plasma Biomarker Dickkopf-3 and its Association with Chronic Kidney Disease:Review Article Ezzat Mostafa Mohamed, Amal Ahmed Zidan, Reham Mohamed Said Ahmed Mohamed Khttab*, Hala Mohamed Allam
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Reham Mohamed Said Ahmed Mohamed Khttab, Mobile: (+20) 01097627315, E-mail:[email protected]
ABSTRACT
A secreted glycoprotein known as Dickkopf-related protein 3 (DKK3) has been linked to the pathophysiology of
numerous illnesses. According to recent research, urine DKK3 may be used as a possible biomarker to track the onset of renal disease and assess the efficacy of treatments.
INTRODUCTION
prognosis of kidney failure, risk equations have been
A major public health issue on a global scale,
created. These are heavily dependent on albuminuria and
significant morbidity, a shortened life expectancy, and an
e-GFR, but they also take other clinical and biochemical
excessive use of medical resources are all symptoms of
factors into account. (4).
chronic kidney disease (CKD). Around 800 million
Although further expanding these equations and
people, or up to 15% of the world's population, have
adding more progression indicators can boost their
CKD, and the prevalence of the condition increases
accuracy at the large population level to predict the 2- or
substantially with advancing age in the general
5-year likelihood for ESKD, the individual CKD course
population. (1).
(i.e., dialysis or transplantation) is varied and difficult to
Diabetic and/or hypertensive kidney damage are the
predict by general equations. Indeed, research has
main acute kidney injury (AKI), which occurs repeatedly,
demonstrated that both linear and non-linear GFR
is one of the emerging causes of progressive chronic
trajectories are associated with the advancement of CKD (5)
kidney disease (CKD) and kidney failure in the West. The
.
progression of CKD is marked by a reduction in kidney
Additionally, some people's kidney function might
function, and renal replacement therapy is necessary
hold steady for years without their renal disease
when end-stage kidney disease (ESKD) is reached (2).
progressing. For instance, in 1.7 million people from 35
The early stages of CKD are non-renal issues,
cohorts with 12 344 ESKD incidences, a widely variable
together with a host of co-morbidities, contribute to the
individual CKD development was seen, even within
abnormally high rates of, for instance, cardiovascular
subjects classified in the same KDIGO risk category.
mortality in CKD patients. This makes severe uremic
Individuals with a baseline e-GFR of 35 mL/min/1.73 m2
complications caused by progressive CKD a "systemic"
whose e-GFR remained stable within the first two years
disease that has a significant effect on almost all organ
of the subsequent monitoring period had an 18% chance
systems. Therefore, accurate detection of individuals with
of having ESKD after ten years (6).
continuing CKD progression has wide-ranging effects on
Patients with the same e-GFR at baseline (35
their health as well as healthcare resource conservation (3).
mL/min/1.73 m2), however, who saw a mean e-GFR
Currently, the glomerular filtration rate (GFR) and
reduction of 57% in the first two years, had a 99% chance
albuminuria are acknowledged indicators of the long-term
of developing ESKD in the ensuing ten years.
progression of CKD. Patients with CKD of diverse
Consequently, it is difficult to identify people who are at
etiologies are categorised in the kidney disease based on
risk for rapid advancement, regardless of the etiology, but
their estimated GFR (e-GFR) and albuminuria: kidney
it is crucial for each patient (7).
disease progression is classified according to Improving
Recent investigations conducted in the general
Global Outcomes (KDIGO) standards as low, moderate,
population and in patients at high risk found that a
high, or extremely high (4).
considerable GFR loss could occur even in the absence of
Even within a given risk category, it can be
higher-grade albuminuria for developing CKD (termed
challenging to predict an individual's course of CKD,
non-proteinuric CKD pathway). Consequently, the
especially
when
using
disease-modifying
requirement for biomarkers that enable the identification
pharmacological therapies. Thus, in order to improve the
of patients with CKD progression is so important (3).
4210
Received: 10/11/2022 Accepted: 12/01/2023
c:\work\Jor\vol911_66The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4215-4222
Comparing the Diagnostic Value of Sonomammography and MRI with Diffusion Techniques in Detection and Characterization of Lesions in Mammographically Dense Breast Hassan Magdy Abd Elrazek*1, Eman Abd elaziz Elnaghy1, Omar Farouk2, Sieza Samir Abdallah1
Departments of 1Diagnostic Radiology and 2Surgical Oncology, Faculty of Medicine, Mansoura University, Egypt *Corresponding author: Hassan Magdy Abd Elrazek, Mobile: (+20) 01063074147, E-Mail: [email protected] ABSTRACT Background: Sonography has been used as adjunct to mammography to increase the accuracy during screening. Breast MRI is the most sensitive tool in imaging of breast cancer. Diffusion weighted imaging (DWI) does not depend on intra-venous contrast injection and is currently investigated to be added to screening of females with dense beast. Diffusion tensor imaging is a rising technique that can be of value in breast imaging. Objective: The aim of the current study was to evaluate the diagnostic accuracy of MRI and MRI with diffusion techniques and compare it with sonomammography which is the routine exam for dense breasts. Patient and methods: A diagnostic study was carried out and included 88 patients (age range 40-67 years) referred to Radiology Department of Mansoura University Hospital. All patients were subjected to proper history taking, sonomammography, conventional, contrast enhanced, diffusion weighted MRI and DTI. This study was using a 7-11 MHz hand held ultrasound, full field digital mammography and 1.5 T MRI scanner. Results: The sensitivity of sonomammography was found to be 71%, with a specificity of 90%, a Positive Predicative Value (PPV) of 89%, a Negative Predictive Value (NPV) of 93%, and an overall accuracy of 91%. However, the sensitivity and specificity of sonomammography were significantly lower than those of MRI with DWI and MRI with DTI, as indicated by the lower values of these parameters (P<0.001) for sonomammography compared to MRI with DWI and DTI. Specifically, MRI with DWI had a sensitivity of 82% and a specificity of 85%, with a PPV of 91.4% and a NPV of 89.5%, resulting in an overall accuracy of 90.7%. Similarly, MRI with DTI had a sensitivity of 82% and a specificity of 90%, with a PPV of 94.3% and an NPV of 94.7%, resulting in an overall accuracy of 94.4%. Conclusion: MRI with diffusion techniques is a more reliable imaging modality in mammographically dense breasts, with higher sensitivity and specificity. Keywords: Dense Breast, Sonomammography, Diffusion weighted imaging, Fractional Anisotropy.
screening (6). It has the advantage of absence of INTRODUCTION
radiation hazards. However, it shows high operator-
Cancer is second cause of deaths between the age
dependence and a lower specificity compared to
zero and sixty nine years as reported by the global
mammography (7). Breast MRI is the most accurate
cancer estimates (GLOBOCAN-2018) in Egypt (1).
imaging method for finding breast cancer and is
According to the results of the national population-
superior to other methods for finding malignancy in
based cancer registry program, breast cancer ranked as
dense breast tissue (8). However, it has low specificity.
the leading cause of death in females (2). As a result,
Another disadvantage of conventional MRI is the
breast cancer screening has become essential for early
lengthy exam duration of about 40 minutes (9).
identification and management to lessen the burden of
DWI is a quick (between 2 and 3 minutes)
the illness since the odds of survival are quite high
unenhanced MRI method that has demonstrated
when breast cancer is discovered and treated early (3).
potential for the identification and characterization of
The primary breast imaging modality for the early
breast cancer (8).Diffusion Tensor Imaging (DTI) is a
identification and diagnosis of breast cancer has always
fresh MRI breast scanning method that has recently
been advised to be sonomammography (4).The thicker
been developed. This DWI-based technique tracks
breast tissue shown on mammography is one of the
water molecule diffusion in the tissue and reveals
biggest barriers to screening. In the most recent edition
information on the strength of the cell membrane (10).
of the Breast Imaging Reporting and Data System (BI-
Based on their biological characteristics, DTI
RADS) from the American College of Radiology, there
with several quantitative parameters was able to
are four labels for breast density, ranging from "A" to
identify benign lesions from breast malignancies (11).
"D," where A indicates that the tissue is almost entirely
The aim of the current study was to evaluate the
fatty and D indicates that the breasts are extremely
diagnostic accuracy of MRI and MRI with diffusion
dense. Breast density in mammography has been shown
techniques and compare it with sonomammography
to be a powerful independent predictor of breast cancer
which is the routine exam for dense breasts.
and a direct cause of mammography's decreased PATIENT AND METHODS
sensitivity. 3 According to reports, women with high
A prospective diagnostic study was carried out in the
breast densities are 4 to 6 times more likely to get
period between August 2020 and September 2022 in the
breast cancer than those with low breast densities (5).
Diagnostic
Radiology
Department,
Mansoura
To solve the problem of mammographically
University Hospital. A total of 88 female patients were
dense breast, ultrasound has been used as adjunct in
included in the study and were referred from the
c:\work\Jor\vol911_67The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4223-4229
Assessment of Tpeak-Tend/QT Ratio for Predicting Malignant Arrhythmias among ST Segment Elevation Myocardial Infarction Cases Undergoing Primary Coronary Intervention Ahmed Mahmoud Yousof Amin*, Mahmoud Hassan Shah, Abdel-Salam El-Sayed Hussein Sherif, Ahmed Shawky Shereef
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ahmed Mahmoud Yousof Amin, Mobile: (+20) 01097486744, Email : [email protected] ABSTRACT Background: In individuals with ST-segment elevation myocardial infarction, the most telling sign of arrhythmogenesis was a lengthening of the Tpeak-Tend (Tp-e) interval. Objective: To evaluate the Tpeak-Tend/ QT ratio in predicting malignant arrhythmias among cases who had myocardial infarction (elevated ST segment) and underwent primary percutaneous coronary intervention. Subjects and methods: In a prospective cohort study; we classified the selected cases into 2 groups: Group A: included 78 cases with complete-ST segment resolution (CSTR), which meant they got a successful complete reperfusion. Group B: included 42 patients with incomplete-STR (ISTR), meant they got an unsuccessful complete reperfusion. Results: Significant lower values of ST elevation, ventricular rate, and QT interval were found among CSTR group than ISTR group, significant lower corrected QT was found among CSTR group than ISTR group. Significant lower Tp-Tec, and Tp-e/QT ratio were found among CSTR group than ISTR group. AUC of ROC curve of Tp-e/QT and Tp- Tec were 0.746, 0.838. At cutoff 0.305 and 133.5, the sensitivity was 55.0% and 85.7% and specificity was 62.8% and 64.1% respectively. Conclusion: The electrophysiologic feature that represents transmural dispersion of cellular repolarization (TDR) in STEMI was similar in nature for both an elevated ST-segment and an elevated Tp-ec. Patients with STEMI after PPCI had an increased STR and Tp-e/QT ratio, both of which predicted arrhythmia and had predictive value for malignant arrhythmia. Keywords: ST Segment Elevation Myocardial Infarction, Primary Coronary Intervention (PCI). INTRODUCTION
to the fact that acute transmural myocardial infarction is
Coronary artery diseases, that contribute to
characterized by an elevated ST segment. The degree to
myocardial infarction (MI), is a major etiology for death
which STR resolves after reperfusion therapy among
as well as disability in modern civilization.
cases with ST-segment elevation myocardial infarction
Arrhythmogenic substrates, such as extended QT
(STEMI) has been demonstrated in numerous studies to
intervals and T wave alternans, have been the focus of
be predictive of left malignant arrythmia, ventricular
electrophysiological characterization investigations in
function preservation, and sudden cardiac death (4).
patients with myocardial infarction (1).
Recent research has demonstrated that STR is
Several ion channel illnesses have been linked to
incomplete in ECG leads even when significant
an increase in the time it takes for the T wave to
epicardial vascular recanalization has been achieved,
complete its cycle from peak to end (Tpeak-Tend
indicating that even if myocardial microcirculation
interval [Tp-e]). Malignant arrhythmia and sudden
disruption is present, myocardial tissue perfusion may
cardiac death (SCD) are thought to be more likely as a
not be adequate. Brugada syndrome (Brs) and ST-
result of this rise. The Tp-e interval, calculated from an
elevation myocardial infarction (STEMI) are
electrogram taken across the wedge, has been shown to
characterized by an elevated Tpeak-Tend (Tp-e)
correlate well with the transmural dispersion of cellular
interval in electrocardiogram (ECG) leads, which
repolarization in experiments using rabbit as well as
represents phase 2 reentry in ischemic cellular models
canine left ventricular wedge models (2).
and is the fundamental cause of arrhythmogenesis in
Cases who had congenital long QT syndrome
these patients (5).
(LQTS) or short QT syndrome (SQTS) frequently
We aimed at this work to assess the Tpeak-Tend/
exhibit a prolonged Tp-e interval, which plays a role in
QT ratio in prediction of malignant arrhythmias among
the arrhythmogenesis of these conditions. This evidence
cases who had ST segment elevation myocardial
lends credence to the hypothesis that the Tp-e/QT ratio
infarction and underwent primary percutaneous
is a reliable biomarker of ventricular repolarization
coronary intervention.
variability that is independent of HR. Recent researches
have revealed that Tp-e/QT ratios, rather than only QT, PATIENTS AND METHODS
QTc, or Tp-e intervals, are the best predictors of
This is prospective cohort study that was done at
ventricular arrhythmias (3). Patients reporting chest pain
Coronary Intensive Care Unit and of Cardiology
should have urgent coronary revascularization if they
Department at Zagazig University Hospital and
have an elevated ST segment on the ECG, the most
continued for follow up for 6 months.
important clinical criterion for this decision. This is due
c:\work\Jor\vol911_68The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4230-4235
An Overview of Thymectomy Approaches among Myasthenia Graves Patients: Review Article Mahmoud Ahmed Abdelsamed Desoky*, Elrady Kamal Emam, Ehab Sobhy Ragab, Ahmed Mahmoud Ahmed Shafeek
Department of Cardiothoracic surgery, Faculty of Medicine, Zagazig University, Egypt. *Corresponding author: Mahmoud Ahmed Abdelsamed Desoky, Mobile: (+20) 01029439382, E-Mail:[email protected] ABSTRACT Background: Myasthenia gravis (MG) is a syndrome characterized by fatigue- and activity-induced improvements in skeletal muscular weakening. There is a wide range of possible involvement, including but not limited to the muscles of the eyes, face, oropharynx, trunk, and limbs. Once the patient's level of weakness has been managed to the point that surgery is possible, thymectomy is recommended. Preoperatively, patients are typically treated with mild doses of intravenous immunoglobulins as well as glucocorticoids. Objective: Review of the literature on thymectomy approaches among myasthenia graves' patients. Methods: We scoured medical journals and databases including PubMed, Google Scholar, and Science Direct for information on thymectomy and myasthenia graves. Between September 2006 and August 2022, however, only the latest or most comprehensive study was considered. The authors also assessed the usefulness of references drawn from similar books. Documents written in languages other than English have been overlooked because of lack of funding to translate them. Unpublished articles, oral talks, conference abstracts, and dissertations were all generally agreed upon not to constitute valid scientific investigation. Conclusion: It has been argued that a maximum thymectomy, in which both the transsternal and transcervical techniques are used on the same MG patient, yields superior results. After extensive transsternal thymectomy or video-assisted thoracoscopic thymectomy, half of patients with non-thymomatous MG had complete stable remissions at 6 years of follow-up. Keywords: Thymectomy, Myasthenia graves.
INTRODUCTION
chronic long-term immunomodulating treatment, and (iv)
Myasthenia graves (MG) is a syndrome
surgical intervention [1].
characterized
by
fatigue-
and
activity-induced
improvements in skeletal muscular weakening. Variable Surgical Management:
involvement of ocular, facial, oropharyngeal, axial, and Thymectomy:
limb muscles is possible [1].
Once the patient's level of weakness has been
The global population as a whole, and the MG
managed to the point that surgery is possible,
population specifically, have both had longer life spans in
thymectomy is recommended. Low-dose glucocorticoids
recent decades. In spite of the decade-weighted mean MG
and intravenous immunoglobulin (IVIg) are common
prevalence of 60 per million, The prevalence of MG in
preoperative treatments for surgical patients. Because
the United States is estimated to be around 200 per
anti-MuSK antibody-positive patients' thyme lacks the
million people, based on recent studies from a variety of
germinal centres and infiltrates of lymphocytes that
European nations and the United States, with point
characterize thyme in patients who have anti-
prevalence rates ranging from 100 to 150 per million
acetylcholine receptor (AchR) antibodies, thymectomy
population [2]. In spite of the prevalence of complaints of
may not be a viable therapeutic option for these
weakness and fatigue, the diagnosis of MG is frequently
individuals. This provides evidence that MG with an anti-
missed in people whose weakness is modest or limited to
MuSK Ab but not an anti- Ab has a distinct pathogenic
a small number of muscles. It is important to verify a
mechanism [5].
clinical diagnosis [3].
Patients diagnosed with thymoma are highly
Patients with MG should have their treatment
encouraged to undergo surgical therapy. Thymectomy
tailored to their specific needs and disease severity. The
has been shown to be effective in some clinical settings,
pathogenesis of MG dictates one of two treatment
while its utility in others has been questioned due to
modalities. Immunosuppressive drugs reduce antibody
insufficient evidence for its utility. Long-term
binding to cholinergic receptors, and acetylcholinesterase
thymectomy benefits become clearer as time passes [6].
inhibitors increase the amount of acetylcholine available
Thymectomy is considered a treatment option for anti-
to engage with the postsynaptic receptor [4]. MG is treated
AchR Ab-positive gMG in patients less than 50 years old
with
four
primary
approaches
include:
(i) [7]. Patients with AChR antibody-positive MG benefit
acetylcholinesterase inhibitors for symptom relief, (ii)
clinically from thymectomy. Non-thymomatous and
plasmapheresis and intravenous immunoglobulin for
thymomatous MG patients may both benefit from
rapid short-term immunomodulating treatment, (iii)
minimally invasive thymectomy [8].
glucocorticoids and other immunosuppressive drugs for
c:\work\Jor\vol911_69The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4236-4241
Computerized Axial Tomography Role in Detection of Complications of Laparoscopic Sleeve Gastrectomy: Review Article Ibrahim Abdel-Aziz Libda1, Christina Soliman Goda1 , Hany Maurice Sabry2, Ahmed Mohamed El Maghraby1
Departments of 1 Radiodiagnosis and 2 General Surgery, Faculty of Medicine Zagazig University. Egypt. *Corresponding author: Christina Soliman Goda, Mobile: (+20), -Mail:[email protected] ABSTRACT Background: Obesity usually refers to, very fat accumulation. On the other hand, overweight refers to moderate fat accumulation. Abdominal Computerized Axial Tomography (CAT) ideally completed by using oral and intravenous contrast agents. This CT study aimed to learn about and identify the normal anatomy following laparoscopic sleeve gastrectomy (LSG), as well as to identify any issues that may have developed as a result of this procedure. Objective: Review of the computerized axial tomography role in detection of complications of laparoscopic sleeve gastrectomy. Methods: We scoured scholarly journals and databases including PubMed, Google Scholar, and Science Direct for reports on laparoscopic sleeve gastrectomy and computerized axial tomography. Between November 2005 and April 2022, however, only the latest or most comprehensive study was considered. The authors also assessed the usefulness of references drawn from similar books. As a result, non-English documents have been overlooked due to a lack of resources to translate them. It was commonly recognized that scientific research did not include things like unpublished publications, oral presentations, conference abstracts, or dissertations. Conclusion: CT is very important in the diagnosis of early complications after LSG. Splenic infarction was clearly observed with CT angiography, after dividing the short stomach vasculature, the ischemic patches were visible on inspection of the laparoscopic pictures, and it helped for differentiation and diagnosis of several early complications as hemorrhage, stricture, fistula, splenic infarction as well as other wound complications. Keywords: Computerized axial tomography, Laparoscopic sleeve gastrectomy.
INTRODUCTION
Obesity usually refers to, very fat accumulation,
females, so generally more males are overweight than
while overweight refers to moderate fat accumulation.
female. However, females are obese than male
Overweight refers to increase in weight of human body
worldwide (3). This epidemic is affected by the changes
in comparison with typical standard values. Obesity
of countries social state, education and cultural state, as
implies exactly having unusually elevated fat
well as economic status of these countries. These are
percentage. Both terms have definitions that state the
some factors that specify exact quantity of energy and
degree of excessive fat for health researchers (1).
the exact quality of this energy taken and energy
Body fat is found in storage and essential forms.
spending like special types of nutrition intake and
Essential fat is vital for body normal functions and
exercise. In 1996, about ten to twenty percent males and
exists in all organs including the intestines and central
fifteen to twenty-five percent female were obese in
nervous system. Storage fat is considered energy source
European society, with expanding rate by about ten to
and is found under the skin as (sub-cutaneous adipose
forty percent in the following 10 years (4).
tissue). Storage fat is influenced by food intake and
More than fifteen percent of the 693 million
workout, while quantity of essential fat stays fixed.
obese patients in the earth present within ten governates
WHO suggested a description of obesity depending on
named United States of America, Mexico from North
the person weight to height equation called body mass
America. Arab republic of Egypt from Africa. Russia
index (BMI), this equation is directly proportionate to
and Germany from Europe, Brazil from South America.
indices of both morbidity occurrences and mortality
India, Indonesia China and Pakistan from Asia (5).
rates (2).
Bariatric operations became one of the most
BMI is calculated by weight of the person by
famous and popular operation in the previous 10 years,
kilograms divided by person tall by meters squared (a
about 1/2 million operations performed every year
man weighing 100 kg and measuring1.6 m, BMI=100/
worldwide. Different surgical operations and
(1.6×1.6) =39.06 kg/m2). This BMI has no relation
techniques such as LSG represents about 58.5%, Roux-
either to persons' age or sex. Obesity, considered when
en-Y gastric bypass (RYGB) represents about 37%,
patient' BMI reaching about thirteen or more, and is
Laparoscopic adjustable gastric banding (LAGB) (3%),
directly proportionate to increasing rates of disease
and biliopancreatic diversion with duodenal switch
appearance and death rates (1).
(1%). RYBG is considered as the operation that
Measuring BMI as an indicator for overweight
facilitate excess loss of weight rather than other
peoples as well as obese people, despite being not the
operations and documented during serial follow up. At
ideal measures, but it represents usual values used.
4-year follow-up previous study conducted for about
Usually males having excess BMI in contrast to
2410 persons with loss of weight the percentage
4236
Received: 07/11/2022 Accepted: 09/01/2023
c:\work\Jor\vol911_70The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4242-4245
Overview on Acquired Partial Lipodystrophy: Review Article Raghad Awad Alraddadi
Internal Medicine Specialist, Endocrinology and Diabetes Fellowship, KSA
Email: [email protected],mobile: 0096655272988
ABSTRACT Background: Acquired partial lipodystrophy (APL), an uncommon form of the disease, is characterised by a gradual onset of bilaterally symmetrical subcutaneous fat loss from the face, neck, upper extremities, thorax, and abdomen while sparing the lower limbs. About 20% of those with APL also have autoimmune disorders, especially membranoproliferative glomerulonephritis (MPGN). Additionally, the majority of patients have low levels of serum complement 3 (C3), and some of them also have C3 nephritic factor. Metabolic issues are uncommon. Objective: This review aimed to provide an overview of acquired partial lipodystrophy's prevalence, pathophysiology, diagnosis, and treatment. Methods: We scoured medical journals and databases including PubMed, Google Scholar, and Science Direct for information on: Acquired partial lipodystrophy, Pathophysiology, Diagnosis and Treatment. Between 2003 and 2022, however, only the latest or most comprehensive study was considered. The authors also assessed the usefulness of references drawn from similar books. Documents written in languages other than English have been overlooked because of lack of funding to translate them. Unpublished articles, oral talks, conference abstracts, and dissertations were all generally agreed upon not to constitute valid scientific investigation. Conclusion: Hyperglycemia and hypertriglyceridemia that do not improve with medication or excessively high insulin dosages may be important signs of lipodystrophy in the clinical environment. It is important to emphasise that these criteria have not been prospectively tested, despite the fact that efforts to introduce these criteria to various treatment contexts (private, academic, government, and others) may be significant for figuring out the true incidence of these diseases. By enhancing lipodystrophy identification and increasing public awareness of the ailment, it will be simpler to ensure that patients with the condition receive the proper care. Acquiring metabolic control and treating aesthetic issues brought on by fat loss are the main goals of therapeutic care for patients with acquired lipodystrophy. Keywords: lipodystrophy, acquired, glomerulonephritis, metabolic disease.
INTRODUCTION
symptoms (Due to severe hypertriglyceridemia) 2, 4.
The term "lipodystrophy" is used to describe a
Additionally, the loss of adipose tissue frequently causes
variety of metabolic disorders marked by either a total or
a decline in leptin levels, which inhibits the transmission
partial loss of fat (lipoatrophy), which may coexist with
of hunger-satiety signals and frequently results in
abnormal fat accumulation in other parts of the body 1.
hyperphagia 5.
Additionally, it was shown to be a group of uncommon
There are various subtypes of lipodystrophy, each
heterogeneous illnesses that are all characterised by a lack
with a unique pattern of fat loss and the potential to be
of adipose tissue without signs of malnutrition or a
either congenital or acquired. Although all acquired
catabolic condition 2. These conditions can be thought of
variants are generally uncommon, they have grown in
as lipid-partitioning disorders because their primary flaw
popularity as a side effect of specific drugs and iatrogenic
is the destruction of functional adipocytes, which results
processes. However, depending on the subtype, decreases
in ectopic steatosis, severe dyslipidemia, and insulin
in overall adipose burden could lead to metabolic issues,
resistance 3. However, regardless the etiology, what
which would increase morbidity and mortality in people
disrupts insulin sensitivity and lipid metabolism is the
with lipodystrophy 6, 7.
selective absence of adipose tissue and the diminished
Based on the aetiology (genetic or acquired) and
capacity to store long-term energy 3.
distribution of lost adipose tissue, which may affect the
Lipodystrophic patients frequently have metabolic
entire body (generalized) or only specific parts,
issues, highlighting the significance of adipose tissue as
lipodystrophies are categorised (partial). These results in
an active endocrine organ. Diabetes mellitus,
the creation of four main categories: familial partial
hypertriglyceridemia, and hepatic steatosis, which can
lipodystrophy
(FPLD),
acquired
generalised
progress to steatohepatitis, are only a few of the metabolic
lipodystrophy
(AGL),
and
congenital
partial
abnormalities that frequently accompany significant
lipodystrophy (CGL) 8. All acquired variants are rare,
insulin resistance in lipodystrophy syndromes.
although as a side effect of some pharmaceuticals as a
Acanthosis nigricans, polycystic ovarian syndrome
result of iatrogenic causes, they have increased in
(PCOS), and eruptive xanthomas are further public
popularity 9.
2442
Received: 07/11/2022 Accepted: 08/01/2023
c:\work\Jor\vol911_71The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4246-4250
An Insight about Possible Role of Imiquimod in Dermatology and Possible Benefit on Plane Warts: Review Article Fatma Ali Elmabrok Omran*, Ahmad Nofal, Hagar Nofal
Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt. *Corresponding author: Fatma Ali Elmabrok Omran, Mobile: (+20) 01002327771, E-Mail: [email protected] ABSTRACT Background: Plane warts are smooth, flesh-colored papules that might be flat or raised slightly. Lesions can range in size from 1 mm to greater than 5 mm, and can number anywhere from a handful to the hundreds. The face, hands, and lower legs are frequent places for them to manifest. Scratching, shaving, and trauma can cause them to emerge in a linear pattern. Imiquimod enhances the immune system's reaction. Injecting imiquimod into a skin wound or ulcer triggers cytokine synthesis and activation of the innate and adaptive immune systems. This makes it an accessible alternative for the treatment of a wide range of dermatologic diseases, both benign and malignant. Objective: Assessment of the possible role ofimiquimod in dermatology and possible benefit on plane warts. Methods: Research on Imiquimod, Skin cancer, and Genital warts was scoured through the databases PubMed, Google Scholar, and Science Direct. The authors also analysed references from related works, but only included the latest or most comprehensive study between October 2000 and January 2021. Documents written in languages other than English have been disqualified due to a lack of translation resources. Dissertations, conference abstracts, and oral presentations were not included since they do not constitute "important scientific discoveries". Conclusion: Dermatologists have taken notice of imiquimod's recent rise to prominence as a useful immunomodulatory topical medication. However, the appropriate use and utilization of imiquimod in dermatology have been impeded by a lack of randomized controlled studies in the assessment of this potentially crucial medicine, as well as anecdotal evidence combined with varying treatment regimens. Keywords: Imiquimod, Dermatology, Plane warts.
INTRODUCTION
you've shaven. In this case, HPV testing is of no use. A
Plane warts are smooth, flesh-colored papules that
shave biopsy can be used to confirm the diagnosis, but is
may be flat or slightly raised. They can be anywhere from
typically unnecessary [9].
1 mm to greater than 5 mm in diameter, and there can be
Because of their resistance to treatment, extended
anywhere from a handful to hundreds of lesions.
duration, and prevalence in aesthetically prominent
Common areas for their appearance are the face, hands,
regions, plane warts present a difficult therapeutic
and lower legs. Scratching, shaving, or trauma can cause
challenge [10]. Since severe treatments for plane warts
them to appear in a linear pattern [1].
might cause scarring, it's important to strike a balance
Plane warts are a typical problem for young people.
between the benefits and risks of doing so. Although
About 4.7% of elementary school students have warts,
there are currently no controlled studies on the efficacy
and the rate is slightly greater among students who live
of this strategy, topical tretinoin is the therapy of choice
in rural areas and commute to school. [2, 3]. Despite being
in this situation. It's the same with light-based or laser-
the rarest type of wart, 10% of the population or more is
based treatments [11].
affected with plane warts [4], and tend to cluster together
on a single person. Human papillomavirus types 3, 10, Non-pharmacologic:
28, and 29 commonly produce plane warts [5].
Inflammation often precedes the regression of these
It is believed that 18% of all non-genital cases
lesions. Currently, there are no virus-specific treatments
requiring medical attention are caused by verruca plana
available for HPV [11]. [6]. Frustration and discomfort are experienced by 51.7%
of patients due to the lesions of verruca plana, which are Pharmacologic:
resistant to therapy and frequently recur. About 38% of
Based on results from five randomised, placebo-
people with verruca plana report difficulties in social
controlled studies, topical salicylic acid is among the
situations as a result of their condition [7]. Patients seeking
most effective treatments for warts of all sorts. Legs are
therapy for verruca plana of the face often report
a more appropriate application area for salicylic acid than
significant cosmetic and social issues related to the
the face. Topical salicylic acid 17% is commonly used
condition [8].
overnight, every night, until the warts disappear [12].
Another standard treatment is using a retinoic acid cream Clinical Features:
(0.025%, 0.05%, or 0.1%) to the affected areas before
In the clinic, plane warts look like slightly raised papules
night. Applying it less frequently will result with a
of pink, light brown, or light yellow-shaped like a
milder, finer scaling and erythema. We must take care to
polygon. Appear on the face, especially the forehead, the
shield ourselves from the sun. Sometimes treatment takes
mouth, the backs of the hands, and the places where
a long time, even if it doesn't work [13].
4246
Received: 08/11/2022 Accepted: 10/01/2023
c:\work\Jor\vol911_72The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4251-4258
The Diagnostic Value of Platelet/Lymphocyte Ratio and Neutrophil/Lymphocyte Ratio in Preterm Premature Rupture of Membranes Mahy Nabil Mahmoud Egiz, Sayed Abdel-Moneim Mahmoud, Samar Rashad Mohammed Abdel-Samea*, Ragab Mohammed Dawood
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt *Corresponding author: Samar Rashad, Mobile: (+20) 01092194253, Email:[email protected] ABSTRACT Background: Preterm Premature rupture of membranes (PPROM) is the rupture of the membranes that encapsulate the amniotic fluid and the fetus before delivery, resulting in the amniotic fluid draining through the vagina. PPROM affects between 20% and 36% of all pregnancies. Objective: The aim of the current study was to assess the significance of the platelet/lymphocyte ratio (PLR) and the neutrophil/lymphocyte ratio (NLR) in PPROM. Patients and methods: A case control study was conducted on 70 women between 2020 and 2022 at the Obstetrics and Gynecology Department of Menufia University in Shebin Elkom, Egypt, and the Ministry of Health Hospital in Ashmoun, Egypt. Results: According to our findings, the optimal cutoff value for detecting PPROM for NLR was 4.658, with a sensitivity of 97% and a specificity of 29% at an AUC of 0.955. PLR's cutoff value was 133.415, with a sensitivity of 95% and a specificity of 98% at an AUC of 0.663. Conclusion: NLR and PLR values in the PPROM group are considerably greater than in healthy controls. Keywords: Chorioamnionitis, Neonatal hypoxia, Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio. INTRODUCTION
Moreover, preeclampsia has elevated NLR levels [6].
Preterm Premature rupture of membranes
Several
pregnancy-related
disorders
were
(PPROM), or spontaneous rupture of the fetal
identified to affect NLR. Similar conditions include
membranes before 37 weeks of gestation, affects 3% of
gestational
diabetes,
intrahepatic
cholestasis,
all pregnancies. It is linked to severe maternal and fetal
hyperemesis gravidarum, and pregnancy-related acute
morbidity and mortality. One of the most frequent
appendicitis. The authors came to the conclusion that
causes of premature birth, PPROM is linked to both
NLR was a helpful marker for PPROM prediction. In the
maternal and newborn infections. The risk of
literature, there are few details about the relationship
chorioamnionitis is roughly 610%, and if it persists for
between PLR, NLR, and the presence of PPROM. The
more than 24 hours, it rises to 40% [1].
present study evaluated how PLR and NLR can be used
Furthermore, a neonatal infection is also twice as
to predict PPROM [4]. The aim of the study was to
likely to affect those who do not have chorioamnionitis.
evaluate the diagnostic value of PLR and NLR in
During PPROM, the risk of infection rises, and jaundice
PPROM. Early diagnosis of these cases will improve the
and newborn hypoxia are also more prevalent. Because
pregnancy outcome and limit the morbidity and
of these critical problems, to ensure the health of both
mortality rates significantly.
the mother and the fetus, early diagnosis is essential [2]. PATIENTS AND METHODS
A substantial correlation between several
A case control study was conducted on 70 women
inflammatory indicators and PPROM has been
between 2020 and 2022 at the Obstetrics and
documented, and inflammation is a key factor in
Gynecology Department of Menufia University in
membrane rupture. Although many etiological factors
Shebin Elkom, Egypt, and the Ministry of Health
may be taken into consideration with Prior preterm birth,
Hospital in Ashmoun, Egypt.
sexually transmitted infections, cervical surgery (past or Study population: Group A included 35 women who
present), low socioeconomic level, low maternal body
were carrying singletons between 24+0 and 36+6 weeks
mass index, amniocentesis, etc. are all forms of PPROM,
who had PPROM and Group B included 35 women who
and membrane rupture is heavily influenced by
were carrying singletons between 24+0 and 36+6 weeks
inflammation [3].Megakaryocytic series multiply more
without PPROM.
often and lymphocyte numbers typically decline because exhibiting extreme apoptosis in settings of ongoing Inclusion criteria:
inflammation. As a result, severe chronic inflammatory
Women who are 24+0 to 36+6 weeks along in a
illnesses might impact markers determined from total
singleton pregnancy. The gestational age was
blood counts such as the platelet-to-lymphocyte ratio
determined by the previous menstrual period and, if
(PLR) [4]. PLR is a popular, trustworthy, and simple
necessary, corrected by ultrasound. We included both
marker. It has been associated to preeclampsia, acute
women with and without PPROM symptoms and signs.
appendicitis, recurrent miscarriages, gestational Exclusion criteria: Preeclampsia or eclampsia in the
diabetes mellitus, and premature labor in pregnant
past, pregnancy with twins or triplets, >30 mm of
women [5]. Increased neutrophil/lymphocyte ratio (NLR)
cervical dilatation, significant vaginal hemorrhage
has been shown to have prognostic and predictive
previa placenta, diseases of the blood, hepatic disease,
significance in a number of cancers such as lung cancer,
history of autoimmune disease, calatori any acute or
colorectal cancer, and hepatocellular carcinoma.
chronic viral or inflammatory disorders, such as
4251
Received: 12/11/2022 Accepted: 14/01/2023
c:\work\Jor\vol911_73The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4255-4264
Outcome of Ultrasound-guided Insertion of Internal Jugular Vein Permanent Hemodialysis Catheters Ehab M. Abdo1*, Amal H. Ibrahim2, Samar Ahmed Kasem2, Lobna Kh. Sakr3, Hassan Ismail Mohamed4 1Vascular Surgery Department, 2Nephrology Unit. 3Department of Radio-Diagnosis, Faculty of Medicine (for Girls),
Al-Azhar University, Cairo, Egypt. 4Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt Corresponding author: Ehab M. Abdo, Email:[email protected] ABSTRACT Background: Vascular access is critical for hemodialysis (HD) patients. Traditional catheter insertion techniques rely on anatomical landmarks, which correlated with higher failures and increased rates of complications. The procedure's efficacy and safety could be optimized by utilizing real-time ultrasound guidance during HD central venous catheter placement. Objective: The aim of the current study was to evaluate the effectiveness and safety of ultrasound-guided permanent internal jugular vein (IJV) catheterization in serving hemodialysis patients. Patients and methods: A total of 150 patients suffering from end-stage renal disease (ESRD) who had ultrasonography (US)-guided IJV permanent HD catheters implanted in our university hospital, from March 2015 to March 2016 were recruited. Patients were examined for their catheter insertion site, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered high-operative risks. Results: All patients experienced the technical success of the 150 catheters, and 62 (41.3%) were placed in high-risk patients. The first-attempt success ratewas 89.8% for the normal-risk group and 72.5% for the high-risk group (P=0.006). IJV cannulation took less time in the normal-risk group compared to the high-risk group (21.2±0.09 minutes vs 35.4±0.11 minutes, P<0.001). No serious complications were reported. Only 4 (6.4%) patients experienced arterial puncture in the high-risk group. Conclusion: A low complication rate and ahigh success rate are associated with the US-guided placement of a catheter into the IJV, even in the high-risk group. Keywords: Hemodialysis, Permanent HD catheters, Real-time ultrasound guidance, Retrospective study, Al-Azhar University.
INTRODUCTION
catheters should be used10. According to a recent report,
Approximately two-thirds of end-stage renal
approximately 80% of those with ESRD will require a
disease (ESRD) patients receive hemodialysis (HD), one-
hemodialysis catheter during their long-term treatment11.
quarter have kidney transplants, and one-tenth require
Anatomical landmarks are used in traditional
peritoneal dialysis1. For HD, three access procedures are
hemodialysis catheter insertion methods. The absence of
commonly used: an autogenous arteriovenous fistula
a pulsatile flow pattern and the dark color of venous blood
(AVF), a prosthetic bridging graft (BG), and an
indicate successful cannulation. Based on landmarks,
indwelling central venous catheter.The ideal access
success rates ranged from 60% to more than 90%, with
should be durable, easily punctured, provideasufficient
the reported risk of complications ranging from 5% to
flow rate for efficient dialysis, and have a low
20%12. Anatomical landmark methods have a higher
complication rate2. The autogenous AVF was approved
failure rate, require more attempts, and have a higher
by the Kidney Disease Outcome Quality Initiative
complication rate13. Long-term problems such as
(KDOQI) recommendations as to the first-line technique
thrombosis, infections, and central venous stricture, as
for vascular access since it tends to get closer and closer
well as early complications like pneumothorax, arterial
to meeting these standards3. Although AVF is the first
puncture, and puncture site hematoma, have been
option for permanent vascular access, it is required at least
attributed to HD catheters14.
6- 8 weeks pass after its construction before using it4,5.
In 1973, the first description of catheter
Furthermore, persistent
respiratory
implantation into the IJVs using US guidance was
failure, ischemia steal syndrome, and patients with severe
published15. To lower the arterial puncture risk, US
cardiac failure may not be suitable for AVF6,7. The BGs
guidance has been followed16. As a result, the National
should not be punctured before 14 days and are not
Kidney Foundation suggested using real-time ultrasound
recommended as primary vascular access. As a result,
to guide the central venous catheters' insertion, to
both permanent and temporary cuffed tunneled catheters
improve insertion success and reduce placement-related
are used in these cases and in those with acute HD8,9. If
complications as well as fluoroscopic screening for
the patient needs access for longer than a month, tunneled
proper catheter tip localization after tunneled catheter
4259
Received: 08/11/2022 Accepted: 10/01/2023
c:\work\Jor\vol911_74The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4265-4271
Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block versus Transversus Abdominis Plane Block for Post-cesarean Delivery Pain under Spinal Anesthesia Ahmed Abdelhakim Abdelaziz Balata,Lobna Taha El-Dorgham, Hossam Abdelbaqy Mahmoud Ismail, Mohammed Ahmed Mohammed Salama*
Department of Anesthesia, Intensive Care and Pain Management,
Faculty of Medicine, Zagazig University, Sharqiyah, Egypt *Corresponding author: Mohammed Ahmed Mohammed Salama, Email:[email protected]
ABSTRACT Background: Post cesarean delivery pain is a great problem that need approaches to enhance early recovery, activity, and encourages breastfeeding without any side effects. The perfect method for minimizing post-operative pain following cesarean delivery while under spinal anesthesia remains unknown. Although spinal or systemic opioids have been used to achieve effective painkillers, they are often accompanied by numerous adverse effects. The plane of the transversus abdominis (TAP) block's post-operative analgesic impact has already been applied to caesarean delivery women as a part of a multimodal analgesic strategy. Objective: The aim of the current study was to minimize post cesarean delivery pain using either erector spinae plane (ESP) or TAP blocks after spinal anesthesia. Patients and methods: A randomized controlled clinical trial was conducted in the Departments for Anesthesia, Intensive Care, and Pain Treatment at Zagazig University Hospitals, from September 2022 to March, 2023. The study was conducted on 36 women scheduled for category IV cesarean delivery and they were divided into 3 groups: Control group [group C]: n=12 patients underwent spinal anesthesia with (12.5mg hyperbaric bupivacaine) before cesarean delivery, ESP blocks group [group E]: n=12 patients were put under spinal anesthesia using (12.5mg hyperbaric bupivacaine) then they received an ultrasound-guided bilateral ESP block using (15 ml bupivacaine 0.25%) after finishing and dressing the cesarean delivery incision on each side, and TAP blocks group [group T]: n =12 patients underwent spinal anesthesia with (12.5mg hyperbaric bupivacaine) then they received an ultrasound-guided bilateral TAP blocks using (15 ml bupivacaine 0.25%) after completing and dressing the cesarean delivery wound on both sides. Result: There were noticeable variations across the studied groups in terms of VAS on rest and movement in different follow-up periods, time to 1st analgesic request, total amount of pethidine iv and complications, with better outcomes in ESP blocks group. Conclusion: ESP block provided extended analgesia with appreciably lower analgesic requirements compared to TAP block and also associated with lower complications and higher patient satisfaction. Keywords; Post cesarean delivery pain, Ultrasound, Erector spinae plane, Transversus abdominis plane, Clinical trial, Zagazig University. INTRODUCTION
patients as a part of a multimodal analgesic strategy (7).
Cesarean deliveries are the most frequent obstetric
The thoracolumbar nerves T10 to L1 are blocked,
surgeries performed and managing post-cesarean delivery
providing sufficient somatic analgesia with little to no
pain is important for both patient satisfaction and quick
inhibition of visceral pain (8).
recovery. In addition to uterine cramping, somatic
The aim of the current study was to minimize post
discomfort during a cesarean delivery is also caused by
cesarean delivery pain using either ESP or TAP blocks
skin incisions and visceral pain (1,2). After a cesarean
after spinal anesthesia.
delivery, a number of patients experience moderate-to-
severe pain that negatively affects their quality of life as a PATIENTS AND METHODS
whole. As a result, an ideal analgesic approach that
A randomized controlled clinical trial was conducted
combines effectiveness and safety is essential (3).
in the Departments for Anesthesia, Intensive Care, and
Erector spinae plane (ESP) block is a method of
Pain Treatment at Zagazig University Hospitals, from
anesthesia that enables local anesthetic dispersion into the
September 2022 to March, 2023. The study was
space between the transverse process and the erector
conducted on 36 women scheduled for category IV
spinae muscles, resulting in a para-vertebral spread of
cesarean delivery and they were divided into 3 groups. A
three vertebral levels cranially and caudally, respectively.
computer-generated database was used to assign these Chin et al. (4) covering the dorsal and ventral rami inhibits
patients at random to one of the three trial groups (12 in
somatic and visceral pain (5, 6).
each) as follows:
Transversus abdominis plane (TAP) block post- - Group (C): n=12 patients underwent spinal anesthesia
operative analgesia has already been utilized by caesarean
before cesarean delivery.
4265
Received:11/11/2022 Accepted:13/01/2023
c:\work\Jor\vol911_75The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4272-4282
Hepatic Expression of Transforming Growth Factor Beta 1 (TGF1) in Infants with Biliary Atresia Mohamad Abd El-Salam El-Guindi1,Magdy Anwar Saber1, Mervat Mahmoud Ismail Soltan2, Muhammad Adel Eliwa*1, Samira Abdel-Wahab Abdel-Aziz1
Departments of 1Pediatric Hepatology, Gastroenterology and Nutrition, and
2Pathology, National Liver Institute, Menoufia University, Egypt *Corresponding author: Muhammad Adel Eliwa, Mobile: (+20) 01004834586, E-Mail: [email protected] ABSTRACT Background: In advanced biliary atresia, the majority of TGF-hepatic expression is restricted to hepatocytes. These results imply paracrine fibrogenesis-driven by TGF-1 in advanced biliary atresia. Objective: To study the hepatic expression of TGF-1 in biliary atresia (BA) as well as other causes of neonatal cholestasis. Patients and Methods: This study included sixty infants from those who attended to the Pediatric Hepatology Gastroenterology and Nutrition Department, National Liver Institute, Menoufia University from September 2019 to May 2021. They were divided into two groups: Group 1 (biliary atresia group): included 30 infants diagnosed as biliary atresia patients that was subdivided into 2 sub-groups, successful Kasai group (14) and failed Kasai group (16). Group 2 (non-biliary atresia cholestatic group): included 30 infants with other causes of neonatal cholestasis as control group. Results: Patients with BA were easily distinguished from those with other infantile cholestatic liver disorders using the BA scoring system (98.83 percent). There was significant difference between the successful and failed Kasai groups regarding postoperative complication, recurrent cholangitis, surgical outcome at (three months, six months, one year, two years postoperatively), (P <0.05). Hepatic TGF Beta1 expression (in both biliary epithelial cells and liver cells) differed significantly between the non-atresia cholestatic group and both BA subgroups (P <0.01). Conclusions: Intraoperative cholangiography (IOC) verified the diagnosis of BA in surgical patients who were promptly referred for treatment. Hepatic expression of TGF Beta1 (biliary epithelial cells and liver cell expression) was significantly different between the non-atresia cholestatic group and biliary atresia subgroups. Keywords: Transforming Growth Factor Beta 1 (TGF1), Infants, Biliary atresia. INTRODUCTION
to maintain tissue homeostasis, and an abnormal
The extra-hepatic biliary ducts (EHBDs) and the
expression of TGF- is connected to several liver
intra-hepatic biliary system (IHBDs) are both damaged
disease processes (3).In advanced biliary atresia, the
by biliary atresia (BA), a pediatrics idiopathic
majority of TGF-hepatic expression is restricted to
obstructive cholangiopathy, but the former is more
hepatocytes. In advanced biliary atresia, findings point
seriously harmed. Hepatosplenomegaly, chronic
to paracrine pathways of TGF-1-driven fibrogenesis. As
jaundice, clay-colored stools, and dark urine are typical
a result, some researchers advise using its blood level
signs that will eventually appear soon after birth. In
assessment as a diagnostic tool for biliary atresia, while
most cases, it is characterized by increasing
others suggest using new developments in cell biology
inflammation and fibrosis that results in secondary
to target TGF- activity or production inhibition as a
biliary cirrhosis (1). Although the precise cause of BA is
major target for the development of antifibrotic
unknown, it is generally accepted that the BA
therapies (2). The purpose of this research was to study
phenotype can be caused by a variety of different causes
the hepatic expression of TGF-1 in biliary atresia and
of liver damage, eliciting a stereotypical response that
other causes of neonatal cholestasis.
includes inflammation, bile duct growth, apoptosis, and PATIENTS AND METHODS
fibrogenesis (2).- Most researchers have concentrated
The study was carried out at Menoufia University's
their study on a small number of inflammatory factors,
National Liver Institute in the Pediatric Hepatology,
such as tumour necrosis factor (TNF), interleukin (IL)-
Gastroenterology, and Nutrition Department. The
2, IL-8, IL-12, and IL-18. As well as transforming
research took place from September 2019 to May 2021.
growth factor beta1 (TGF-1) (2).
An accelerated portoenterostomy procedure and Type of the study: Our study was retrospective study.
prompt diagnosis are essential components of managing Subjects: Subjects included in the study were 2 groups:
biliary atresia (BA). Surgeries like these may seem Group 1 (biliary atresia group): included 30 infants
promising at first, but only about 20% of seriously ill
diagnosed as biliary atresia patients by intraoperative
children actually benefit from them in the long run.
cholangiogram.
Because of complications from cirrhosis, such as portal Group 2 (non-biliary atresia cholestatic group):
hypertension and stunted growth, the majority of
included 30 infants with other causes of neonatal
affected children need to undergo liver transplantation
cholestasis as control group.
(LT) to increase their chances of survival (3). Inclusion criteria: Infants diagnosed as biliary atresia.
The profibrogenic, anti-inflammatory, and
Age matched other causes of neonatal cholestasis.
immunosuppressive actions of TGF- protein are many. Exclusion criteria
The proper coordination of these activities is necessary
Neglected biliary atresia.
4272
Received: 12/11/2022 Accepted: 14/01/2023
c:\work\Jor\vol911_76The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4283-4287
Three-port versus Four-port Laparoscopic Cholecystectomy Mohammed Ali Abd El Fattah Faraag1, Abdullah Badway Abdullah1 , Ramy Abdulrahim Hassan1, Ahmed Ali Abdulmutallab1
1 Department of General Surgery, Faculty of Medicine - Assiut University Corresponding authors: Mohammed Ali Abd El Fattah Faraag, E-mail: [email protected] Mobile number: +201020832073 ABSTRACT Background: The preferred course of treatment for symptomatic gallstone disease includes cholecystectomy due to both therapeutic reasons and secondary prevention of recurring gallstone-related problems. Objectives: This study examined the effectiveness, safety, and practicability of three- and four-port lap cholecystectomy: The intraoperative and postoperative complications of 3 port and 4 port lap cholecystectomies are compared: Days spent in the hospital, or operational time. Intraoperative and postoperative complications, as well as postoperative pain {by VAS visual analog scale}. Patients and methods: At Assiut University Hospitals' Department of General Surgery, a randomized controlled study was done. Results: Both groups had significant difference (p> 0.001) as regard patient's satisfaction where good, average and poor satisfaction present in 47 (94%), 2 (4%) and 1 (2%) patients of 3-port Laparoscopic Cholecystectomy (LC) group and present in 27 (54%), 21 (42%) and 2 (4%) patients of 4-port LC group. Conclusion: Three in terms of procedure and morbidity outcomes, the one-port laparoscopic cholecystectomy is comparable to the four-port approach. Additionally, it might lead to less postoperative discomfort, a shorter stay in the hospital, and a quicker return to normal activities. Keywords: Cholecystectomy, laparoscopic, gall stones, conventional. INTRODUCTION
cholecystectomy, and the patient's refusal are all factors
When treating acute calculus cholecystitis and
that should be taken into consideration.
biliary colic, as well as for secondary prevention of
recurrent gallstone-related problems, the recommended Ethical Approval:
course of treatment for symptomatic gallstone disease The Assuit University Ethics Board approved
was cholecystectomy (1).During a standard laparoscopic the study, and the patients received all the
cholecystectomy, four ports are inserted: sub-umbilical, information they require on the trial. Each study
sub-xiphoid, right subcostal, and right lumbar (2). participant provided their signed consent after
With more experienced surgeons, laparoscopic receiving full information. The Declaration of
cholecystectomy has seen substantial advances, Helsinki, the code of ethics of the World Medical
including a decrease in port size and number. In order Association, was followed when conducting this
to reveal the Calot's triangle, the fourth port is either research on humans. Identifier: NCT04107909
utilised to retract the liver (French technique) or to grip
the gallbladder fundus and drag it upward and outward Sample size and randomization: Based on identifying
(American technique) (3). Many surgeons realized that
the primary outcome variable, it is expected that a
the most lateral port in laparoscopic cholecystectomy
sample size of at least 100 patients is needed (50 in each
had a minimal impact as their familiarity with using four
group). Using G*power software 3.1.9.2, the sample
ports increased. The result was, they decided to perform
size was determined under the following presumptions:
the treatment with just three ports, which was simple to
Operating time is a key factor in the outcome.
execute, and remove the one that was the most lateral
According to a prior study, the operating time for (4).If a fourth port is required, this three-port approach
patients having a 3 port cholecystectomy was 47.3 29.8
is deemed to have failed (5).
minutes, whereas the time for patients having a 4 port
procedure was 60.8 32.3 minutes. The primary PATIENTS AND METHODS
statistical test used to identify operation time
At Assiut University Hospitals' Department of General
differences between the two groups was the t-test.
Surgery, a randomized controlled experiment was
Alpha error is 0.05, power is 0.80, effect size is 0,43,
carried out.
and allocation ratio is 1. Inclusion criteria: Any patient with clinical, laboratory
But secondary to low frequency of LC in our
and/or radiological evidence that candidate for
setting, it was expected that a total of 100 cases would
cholecystectomy operation were enrolled in the study
be operated during the study period. Hence, the total
with age between 25 and 65 years' old
expected ample size is about 100 cases: 50 cases in each Exclusion criteria: Choledocholithiasis, severe acute
group. The patients are divided into treatment groups in
calculus pancreatitis, severe co-morbid diseases
a 1:1 ratio using a computer-generated table of random
(uncontrolled diabetes, hypertension, and severe direct
numbers. Patients were allocated to the appropriate
hyperbilirubinemia), prior surgery or adhesion, radical
therapy group in numerical order after providing their
4283
Received: 28/09/2022 Accepted: 01/12/2022
c:\work\Jor\vol911_77The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4288-4293
Degree of Orbital Affections in Cases of Nasal Mucormycosis Associated with COVID-19 Ezzeddin Mohamed El Sheikh, Hani Mohamed Ali El Shamy, Manar Muhammad Abdel Rehim*, Mohammed Elsayed Elmaghawry, Tarek Gamal Ahmed El Naggar
Department of Oto-Rhino-Laryngology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Manar Muhammad Abdel Rehim, Mobile: (+20) 01122828262, E-mail: [email protected] ABSTRACT Background: The incidence of acute invasive fungal sinusitis (AIFS) increased without obvious cause in the COVID-19 era subsequently there is a burden on the health care system. Objective: In our study, we attend to find the best assessment for orbital affections in patients with AIFS and decrease morbidity rates. Therefore, the present study aimed to assess the functional outcome of endoscopic debridement and medical treatment in cases of orbital affection. Patients and methods: A one-arm interventional study was conducted in Orhinolaryngology, Head and Neck Surgery Department, Zagazig University Hospitals. The study included 19 patients, aged between 31 and 65 years, who had orbital symptoms associated with nasal mucormycosis with history of COVID-19 infection. Patients have undergone endoscopic debridement surgery, under general anesthesia. Results: The endoscopic assessment performed intraoperatively revealed that a significant percentage of cases had septal necrosis (31.6%), superior turbinate necrosis (10.5%) and inferior turbinate necrosis (47.4%). Furthermore, all cases showed middle turbinate necrosis which is considered to be the classical sign of nasal mucormycosis by endoscopic examination. Regarding prognosis and mortality, most cases (78.9%) showed improvement while 21.1% of cases died. Conclusion: Early combined medical and surgical treatment of AIFS can save the lives and salvage the eyes. Keywords: Mucormycosis, Head and Neck, COVID-19, Rhinosinusitis, Intervention study, Zagazig University. INTRODUCTION
Mucormycosis is an invasive, potentially lethal
Diagnostic work-up is frequently put off due to the
fungus belonging to the Mucorales order, including the
rarity of the occurrence and the possibility of vague initial
species Rhizopus species, Mucor species, and
symptoms. But for a curative therapy involving rigorous
Rhizomucor species belong (1).
surgical debridement and high-dose antimycotic
Nasal mucormycosis in immunocompromised hosts
medication to be possible, a prompt, early and accurate
begins with sporangiospore inhalation, direct extension to
diagnosis is necessary (5). Thus, the present study aimed
the paranasal sinuses, and hyphae angioinvasion. This
to assess the functional outcome of endoscopic
leads to necrotizing vasculitis, fungal thrombi, and tissue
debridement and medical treatment in cases of orbital
infarctions later on (2). Vascular invasion, occurs by
affection.
occluding ophthalmic vessels, while direct invasion
through the superior orbital fissure, or cribriform plate. PATIENTS AND METHODS
Perineural invasion or the carotid artery can potentially
A one-arm interventional study was conducted in
induce intracranial involvement (3).
Orhinolaryngology, Head and Neck Surgery Department,
There are four types of mucormycosis involvement
Zagazig University Hospitals, in the period from July
in the head and neck: isolated nasal, Sino-nasal, rhino-
2022 to December 2022.
orbital, and rhino-orbital-cerebral (4). When spores are
The study included 19 patients, aged between 31 and
inhaled or come into direct contact with wounds,
65 years, who had orbital symptoms associated with nasal
mucormycosis can result in invasive infections that
mucormycosis with history of COVID-19 infection.
advance rapidly, especially in immunocompromised
We excluded patients with positive polymerase
people. The diagnosis of this condition is dependent on
chain reaction (PCR) for COVID-19, chronic
the clinical symptoms, pathological criteria, and imaging
granulomatous fungal sinusitis, MRI incompatible
findings (5). Broad-spectrum antibiotics, monoclonal
devices.
antibodies, and frequent use of steroids might cause a
Patients included in study were subjected to full
preexisting fungal illness to develop or worsen.
clinical history taking, detailed ophthalmological
Physicians should be aware that patients with COVID-19
examination fundus examination, visual acuity (VA),
infection may develop secondary, invasive fungal
assess EOM (extra ocular movement), diagnostic nasal
infections (6).
endoscopy under local anesthesia, CT scan and MRI (T1
with gadollinum, T2 with fat suppression, diffusion
4288
Received: 13/11/2022 Accepted: 15/01/2023
c:\work\Jor\vol911_78The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4294-4297
Brief overview about Updated Management Lines of Post Acne Erythema: Review Article Dina Mohamed Khamis El-Sayed*, Amany Abdelrahman Nassar, Shrook Abd Elshafy Khashaba
Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Dina Mohamed Khamis El-Sayed, Mobile: (+20) 01114099430 E-Mail:[email protected] ABSTRACT Background: Post Acne Erythema (PAE) is a common sequelae of acne inflammation. Time may help some acne erythema lesions clear up. Although the inflammation caused by acne has subsided, the cosmetic fallout of treatment for these visible red markings, remains a therapeutic issue. Objective: Review of the literature on updated management lines of post acne erythema. Methods: We scoured medical papers and databases including PubMed, Google Scholar, and Science Direct for information on: Post acne erythema, its management, and its treatment. However, only the most recent or comprehensive study conducted between September 2013 and March 2022 was considered. The authors also analyzed references from similar literature. Documents written in languages other than English have been overlooked because of a lack of funding to translate them. It was commonly recognized that scientific research did not include things like unpublished publications, oral presentations, conference abstracts, or dissertations. Conclusion: PAE has been treated with a variety of approaches, from topical therapies to surgical interventions. In the same way as treating acne lesions is essential, so is attending to post-acne effects (PAE) and scarring. Different forms of vitamin C and topical treatments such 0.025% retinoic acid, 12.5% glycolic acid, 0.2% brimonidine tartrate, and 5% tranexamic acid solution have all been explored. Vascular lasers have been used to treat PAE, although most studies have only looked at their effectiveness in treating active inflammatory acne. Keywords: Post acne erythema, Vitamin C, Interleukin-1.
INTRODUCTION
Acne is a skin condition that is quite widespread. It
is characterized by the presence of comedones (both open and closed), nodules, pustules as well as papules (all inflammatory lesions), and variable degrees of scarring. Early and late stage inflammation were crucial to the idea of acne aetiology. At every stage, from onset to clearing up, acne is predominantly an inflammatory illness. Therefore, reducing inflammation should be a primary goal of acne therapies (1).
More people in urban areas suffer from acne than
those living in rural areas. A significant percentage of those affected (20%) suffers from severe acne that can leave scars. It seems that some racial groups are disproportionately impacted. Acne is more common in Caucasian groups, but is typically milder in Asians and
Africans (2). Figure (1) (a & b): Acne lesions in the form of
inflamed papules and pustules (3)
Acne lesions develop due to four main pathogenic
processes: comedone formation due to follicular keratinization changes, complex inflammatory pathways combining innate and acquired immunity, androgen- regulated increased and altered sebum production, and follicular colonization by Propionibacterium acnes all contribute to the development of acne (4).
Adult female acne has a highly convoluted
aetiology. Women with normal androgen levels may experience unwanted side effects from hormone-based therapy such as oral contraceptives and anti-androgen medicines when treating hyperandrogenism diseases a
such polycystic ovarian syndrome (PC bO S). The
effectiveness of hormone therapies for adult female acne
reveals the significance of androgens. Sebaceous glands
4294
Received: 11/11/2022 Accepted: 13/01/2023
c:\work\Jor\vol911_79The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4298-4304
Functional Outcome of Internal Fixation of Extra-Articular Scapular Fracture: A Systematic Review/ Meta-Analysis Abdelsalam Eid Abdelsalam, Tarek AbdElsamad Elhewala , Ahmed Elsayed IbrahimAli Elgendy*, Mohamed Ismail Abd El Rhman Kotb
Orthopedic Department, Faculty of Medicine, Zagazig University, Egypt. Corresponding Author: Ahmed Elsayed Ibrahim Ali Elgendy, Mobile: (+20)01061177789, E-mail: [email protected] ABSTRACT Background: Scapular fractures are a rare upper extremity injury brought on mostly by high-energy trauma. The bulk of these fractures are extra-articular. Un-displaced fractures can be successfully treated with conservative measures. However, displaced fractures do not produce excellent outcomes and require surgical intervention. Objective: The aim of the current study was to perform a review of literatures and meta-analysis on the function results of treating extra-articular scapular fractures. Material and methods: A meta-analysis study was conducted in the Orthopedics Surgery Department, Faculty of Medicine, Zagazig University. To find relevant literatures published between 2004 until 2019, a computerized search was conducted in the PubMed, MedLine, Cochrane Library (Cochrane Systematic Reviews and Cochrane Bone, Joint and Muscle Trauma Group), Embase, Science Direct, Scopus, CNKI, and Google Scholar are just a few of the databases that are available. A search included the single keyword or in combination: "extra-articular scapula fracture internal fixation". We searched for non-randomized clinical trials (CTs), as well as prospective and retrospective investigations, randomized CTs, and studies reviewing the functional results of extra-articular scapula fracture fixation. Results: The results indicated that man DASH prior to procedure was 17.9, which decreased to 9.3 post operation, mean constant score was 77.6 pre-operation and increased to 89.1 post operation. As regard ROM mean for forward flexion was 151.4, mean abduction was 123.4, mean external rotation was 60.1 and mean internal rotation was 23.2. Conclusion: Scapular body fractures treated with internal fixation have a high rate of success for union and shoulder function. Keyword; Extra-articular scapular fracture, Internal fixation, Systematic review, Meta-analysis, Zagazeg University.
INTRODUCTION
Cochrane Bone, Joint and Muscle Trauma Group),
About 0.5% of fractures are scapular fractures, and
Embase, Science Direct, Scopus, CNKI, and Google
62% to 98% of all scapular fractures are extra articular
Scholar are just a few of the databases that are available.
fractures (1,2). Extra-articular scapular fractures
A search included the single keyword or in
frequently accompany both local and systemic injuries,
combination: "extra-articular scapula fracture internal
and they typically result from high-energy trauma. The
fixation". We searched for non-randomized clinical
scapula is anatomically protected by the rib cage and the
trials (CTs), as well as prospective and retrospective
surrounding muscles, which explains why this
investigations, randomized CTs, and studies reviewing
phenomenon has an anatomical explanation and why
the functional results of extra-articular scapula fracture
extra-articular scapular fractures typically have a minor
fixation. Studies that fulfilled the next criteria were
displacement (3).
included in our systematic review:Extra-articular
It is debatable whether extra-articular scapular
scapular fracture, skeletally mature patients, both sexes,
fractures should be operated on when anatomical
minimum follow up period one year and radiological
deformity criteria are used. The signs are only more
evaluation by X-RAY and CT scan. Exclusion criteria
obvious in the presence potential problems, such as an
were intraarticular scapular fractures, brain trauma with
open fracture or injury to the neurovasculature (3).
a dismal prognosis, damage to the ipsilateral brachial
Extra-articular
scapular
fractures
have
plexus and follow up period <1 year.
traditionally not required surgery, however since Robert
Clinical outcomes data was operative time and
Judet's work (4), the methods and indications for internal
post-operative data like DASH, ROM and constant
fixation of these fractures have drawn growing interest
score. The assessment was done using Cochrane
(5). Therefore, the purpose of this meta-analysis was to
Handbook Tool 5.1.0; the researchers were in charge to
analyze earlier research on surgical treatment of extra-
assess the methodological quality for each included
articular scapula fractures and assess its implications on
study, in which the quality criteria were assessed.
patients' functional outcomes. Ethical Consideration: MATAERIAL AND METHODS The protocol for this study was approved and
A meta-analysis study was conducted in the registered by both the Institutional Review Board
Orthopedics Surgery Department, Faculty of Medicine, [IRB] and the Local Ethics Committee at Zagazig
Zagazig University. To find relevant literatures University's Faculty of Medicine.
published between 2004 until 2019, a computerized Statistical Analysis: Review Manager (RevMan5.4)
search was conducted in the PubMed, MedLine,
software provided by Cochrane collaboration was used
Cochrane Library (Cochrane Systematic Reviews and
4298
Received: 13/11/2022 Accepted: 15/01/2023
c:\work\Jor\vol911_80The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4305-4310
Intravenous Tranexamic Acid Possible Effects on Ovarian Reserve during Laparoscopic Cystectomy of Endometrioma: Double Blind Randomized Controlled Trial Mohamed El-Hussieny ElKoddosy, Anwar Ezzat Ismail, Howaida Hussieny Abo-Zaid Salem*, Ahmed Ismail Mohamed
Department of Obstetrics & Gynecology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Howaida Hussieny Abo-Zaid Salem, Mobile: (02)1550804010, E-Mail:[email protected] ABSTRACT Background: Numerous gynecologists look for ways to protect ovarian health. To lessen the risk of blood loss, surgeons sometimes prescribe tranexamic acid (TXA). Objective: The aim of the current work was to examine the potential benefit of tranexamic acid on ovarian reserve and intraoperative blood loss, by comparing the mean differences in anti-müllerian hormone (AMH) levels before and after laparoscopic ovarian cystectomy. Subjects and Methods: A total of 30 women had ovarian endometriomas were included in the study, the laparoscopic cystectomy was done for ovarian endometriomas in the Endoscopic Unit in Zagazig University Hospitals. They were categorized randomly into two groups; Group I (control): consisted of 15 patients who were subjected to intravenous administration of 110 ml of normal saline preceding the incision of the skin. Group II: consisted of 15 patients who were subjected to intravenous administration of 1 g tranexamic acid (2 kapron 500 mg 5 ml ampoules) preceding the incision of the skin. Results: There was a substantial difference between the study group and the control group regarding intraoperative, postoperative, and total blood loss. Postoperative serum AMH at one and six months later after the operation showed significant reported differences, that were higher in Group II. There was a highly statistically significant difference between the studied groups regarding operative time, hospital stay being higher among control group. Conclusion: The current study's findings lend credence to the hypothesis that reducing the risk of ovarian reserve loss after laparoscopic cystectomy for endometrioma is facilitated by intravenous TXA administration. Keywords: Tranexamic Acid, Laparoscopic Cystectomy, Endometrioma. INTRODUCTION
Up to 10% of reproductive women and 20%-50%
This hormone indicates how many oocytes are
of infertile women suffer from ovarian endometriosis, also
ready to fertilize. In reproductively aged females,
known as endometriomas (1). Pelvic pain, worsening
granulosa cells release AMH. Endometrioma cystectomy
dysmenorrhea, dyspareunia, and infertility are some of the
by laparoscopy has been shown in multiple studies to
clinical symptoms. Due to their potential to damage
reduce circulating levels of the male hormone AMH (5).
healthy ovarian tissues, endometriomas have been
Numerous gynecologists look for ways to protect
associated to decreased ovarian function, ovulation
ovarian health. We postulated that if surgical blood loss
problems, and primary ovarian insufficiency (1).
could be reduced, the surgeon would have better visibility
There is some debate on what the best treatment
of the operational field and would require less bipolar
for endometriotic cysts is. Any endometriotic cyst greater
coagulation to complete the procedure. Damage to blood
than 3 cm in diameter should be treated with a laparoscopic
vessels and normal ovarian tissue would be mitigated. In
ovarian cystectomy as an initial course of action. Since
the current investigation, tranexamic acid (TXA) is used as
ovarian cystectomy can alleviate pelvic pain and make the
a pharmaceutical technique to lessen surgical blood loss.
egg retrieval process easier to carry out, it is recommended
When given intraoperatively, TXA has been shown to
for women with infertility to have one before undergoing
significantly reduce bleeding and wound complications (6).
assisted reproductive technologies (2).
1 gram every 6 to 8 hours is the typical dose that's
While laparoscopic ovarian cystectomy has the
suggested (7). There is no recommended daily dosage,
lowest recurrence rate and the highest rate of spontaneous
however in cases of severe bleeding, the amount may be
conception, it also carries the risk of severe ovarian
increased to 4 grams (8).
damage. It is theorized that the primary causes of ovarian
The goal of our study was to examine the potential benefit
injury are inflammation brought on by surgical trauma or
of tranexamic acid on ovarian reserve and intraoperative
vascular injury and the loss of viable ovarian follicles after
blood loss, by comparing the mean differences in anti-
surgery. Surgery for endometriotic cysts, according to a
müllerian hormone (AMH) levels before and after
few recent studies, can diminish ovarian reserve (3).
laparoscopic ovarian cystectomy.
Ovarian reserve is diminished when healthy
ovarian tissue is lost unintentionally during cystectomy. To SUBJECTS AND METHODS
evaluate ovarian potential, serum anti-Müllerian hormone
This prospective interventional trial study included a
(AMH) is the gold standard (4).
total of 30 women who had ovarian endometriomas,
4305
Received: 14/11/2022 Accepted: 16/01/2023
c:\work\Jor\vol911_81The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4311-4316
Ovarian Masses from Anatomy to Its Complications: Review Article Tarek Mohamed El Behiedy, Ahmed Mahmoud Abdou Mohamed, Ayiman Ahmed Mohammed Al Zanati, Mohamoud Abubakr Nasr Negm
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ayiman Ahmed Mohammed Al Zanati, Mobile: (+20) 01158152465, E-mail:[email protected] ABSTRACT Ovarian mass represents a common problem in clinical practice. Of all gynecologic carcinoma, ovarian carcinoma represents the greatest clinical challenge. The majority of ovarian masses are benign (80%) with cystic, solid, and mixed characteristics and a favorable diagnosis. The other 20% masses are malignant.
INTRODUCTION
An adnexal mass (mass of the ovary, fallopian
suspensory ligament of the ovary), through which the
tube, or surrounding connective tissues) is a common
ovarian vessels travel, that attaches the ovary to the pelvic
gynecologic problem. It is estimated that there is a 5 to 10
sidewall; and the broad ligament, which condenses to
percent lifetime risk for women undergoing surgery for a
form the mesovarium. It is also attached to the broad
suspected ovarian neoplasm (1).
ligament through the mesovarium. The ovary consists of an outer cortex, where the ova and follicles are located, Clinical approach:
A mass in the adnexa may be symptomatic or
and a medulla, where the blood vessels and connective
discovered incidentally on pelvic examination or
tissue compose a fibromuscular tissue layer. The fallopian
imaging. There are many different types of adnexal
tubes arise from the uterine corpus posterior and superior
masses. The type of mass is identified with pelvic
to the round ligaments. The broad ligaments support the
imaging, use of biomarkers, and/or surgical exploration
tubes with a condensation of connective tissue called the
and pathologic evaluation. Most adnexal masses arise
mesosalpinx (4).
from the ovary or fallopian tube. However, other Histology:
gynecologic structures may give rise to an adnexal mass,
The ovary includes several different tissue types.
including the mesovarium or mesosalpinx (e.g., paratubal
The most common neoplasms are epithelial. These derive
cysts). Uterine leiomyomas may protrude toward the
from the stem cells that would typically give rise to
adnexa and be palpated or visualized as an adnexal mass
fallopian tube epithelium (most high-grade serous (2). In addition, adnexal masses may arise from other
carcinomas), or ovarian surface epithelium and inclusions
proximal structures, including the urinary tract (e.g.,
(e.g., cystadenomas). Ovarian germ cell tumors are
bladder diverticulum), bowel (e.g., appendiceal abscess,
derived from primordial germ cells of the ovary. Ovarian
diverticular abscess, bowel neoplasm), or pelvic
sex cord-stromal tumors derive from stem cells that would
connective tissue (e.g., peritoneal cyst) or nerves (nerve
normally give rise to supporting epithelial cells, including
sheath tumor). Some adnexal masses require immediate
ovarian stroma (e.g., fibromas) and follicles (e.g.,
attention; these include ectopic pregnancy, adnexal
granulosa cell tumors, Sertoli-Leydig cell tumors).
torsion, a ruptured ovarian cyst with hemorrhage, or a
The fallopian tubes consist of an outer
tubo-ovarian abscess. A serious concern when an adnexal
muscularis layer of the tube with longitudinal smooth
mass is discovered is the possibility that it is malignant. A
muscle fibers and an inner layer with circular fibers. The
consensus paper from the Society of Radiologists in
fallopian tube mucosa is composed of numerous delicate
Ultrasound in 2010 indicated that transvaginal ultrasound,
papillary folds (plica) consisting of three cell types:
supplemented by transabdominal ultrasound, was the best
ciliated columnar cells; nonciliated, columnar secretory
technique for imaging and characterizing an adnexal cyst
cells; and intercalated cells, which may simply represent (3).
inactive secretory cells (5). Anatomy and Histology: Gynecologic tract masses: a) Gross anatomy:
There are many different types of adnexal
The uterine adnexa consist of the ovaries,
masses. The likely etiology of an adnexal mass differs by
fallopian tubes, and surround vascular, lymphatic, and
age and reproductive status. This is because some masses
connective tissues. The ovaries are suspended
are stimulated by reproductive hormones (6).
lateral and/or posterior to the uterus. The supporting Premenopausal women:
structures of the ovaries include the utero-ovarian
There is a broad differential diagnosis of an
ligament that attaches the ovary to the uterus; the
adnexal mass in women of reproductive age. Adnexal
infundibulopelvic ligament (also referred to as the
masses stimulated by reproductive hormones are found
4311
Received: 13/11/2022 Accepted: 15/01/2023
c:\work\Jor\vol911_82The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4317-4322
An Overview about Vitamin-D in Children with Bronchial Asthma and its Relation to Severity of the Disease: Review Article Amr Elsayed Monir, Alaa Zedan Ibrahim, Ahmed Galal Seiam
Department Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt *Corresponding author: Amr Elsayed Monir, Mobile: (+20) 0 112 849 9975, E-Mail: [email protected] ABSTRACT Background: Bronchial asthma is a prevalent health problem. Asthma is characterized by chronic airway inflammation that is thought to have both genetic and environmental roots. Low vitamin D levels have been suspected for a long time as a possible cause of asthma. Lack of vitamin D has been connected to the rising incidence of asthma seen in recent decades. Objective: Assessment of vitamin D in children with bronchial asthma and its relation to severity of the disease. Methods: Vitamin D and bronchial asthma were searched for on Science Direct, Google Scholar, and PubMed. The authors also reviewed the relevant literature, however only the most recent or comprehensive study from April 2004 to August 2021 was included. There are no translation resources available, thus non-English documents are out. Unpublished articles, oral presentations, conference abstracts, and dissertations were not included because they were not considered to be part of major scientific projects. Conclusion: Whether or not vitamin D is associated with asthma and allergies is still up for debate. A higher risk of vitamin D deficiency has been associated with asthma, according to certain studies, Vitamin D supplements may increase allergy risk, according to several studies. Keywords: Vitamin-D, Bronchial Asthma, Disease severity.
INTRODUCTION
effects of asthma on children and their caretakers are
Variable reversible and recurrent symptoms due to
significant. Physical, emotional, and academic outcomes
airflow restriction, bronchial hyper reactivity, and
for asthmatic children have all been proven to be lower
underlying inflammation characterize asthma, a common
than for children without the condition. Direct costs to the
chronic condition of the airways. Patients, their families,
health care system, such as those associated with
and the community as a whole feel its effects through
hospitalizations, doctor visits, and medication, and indirect
things like missed days of work or school, lower quality of
costs to society, such as lost productivity, make asthma a
life, increased likelihood of hospitalization or even death.
major economic burden. About $56 billion is anticipated to
As a result, the best available information has been used to
be spent in the United States, with the majority of that
produce international guidelines to aid clinicians in their
going toward health care expenses. Factors that increase
management of asthma (1).
the risk of death from asthma include having a history of
Asthma is a worldwide epidemic that affects people
severe asthma requiring intubation and mechanical
of all ages. The number of countries where it is a problem
ventilation, being recently hospitalized or visiting an
is growing. Although asthma-related deaths and
emergency room for asthma, using or discontinuing oral
hospitalizations have decreased in certain nations, the
corticosteroids (a marker of event severity), not using
disease continues to cost economies and families dearly
inhaled corticosteroids, having a history of psychiatric
due to missed work and school days (particularly in the
disease or psychosocial problems, and not taking asthma
case of children) and asthma-related disruptions in the
medications as prescribed. Asthma is diagnosed by looking
home (2).
for a specific set of symptoms in addition to the known
One of the most prevalent lifelong diseases in kids is
limitation in expiratory airflow. Asthma diagnosis is best
asthma. The effects of asthma on a child and his family, as
recorded at the time of initial presentation, since
well as the cost of medical treatment, make asthma a major
confirmation can be challenging after controller
public health issue that places a heavy financial burden on
medication has begun (5).
society (3).
Children's health and development rely heavily on
Asthma affects over 6 million American children, or
vitamin D because it is necessary for strong bones and
8.3% of the total, disease rates in 2018 were quite low, per
may also contribute to other aspects of overall health (6).
CDC statistics. Males exhibited a slightly higher frequency
Vitamin D ensured adequate intestinal calcium
than females did among both children and adults. The rate
absorption from food sources. Consequently, it plays a
was higher in low-income communities and among black
pivotal role in the maturation and upkeep of a calcified
children (4).
mammalian skeleton. Vitamin D, which can be gotten
A thorough research found that about 7.5% of
from diet or the sun, is still necessary for most people to
Middle Eastern youngsters suffer from asthma. Prevalence
have strong bones (7).
ranged greatly, from 1% to 22%, among nations. The
4317
Received: 13/11/2022 Accepted: 15/01/2023
c:\work\Jor\vol911_83The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4323-4326
Topical Insulin and Fractional Laser in Management of Acne Scars: Review Article Amin Mohamed Amer, Al-Shimaa Al-Tohamy Goda*, Fathia Mohamed Khattab
Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Al-Shimaa Al-Tohamy Goda, Mobile: (+20) 01151462960, E-Mail: [email protected] ABSTRACT Background: Eighty percent or more of teenagers will experience acne. The acne scars left behind by acne vulgaris are irreversible. Up to 95% of people with acne vulgaris may experience scarring, yet this issue has received little attention from researchers. Depending on the study, acne scars affect between 1% and 11% of the population. Lasers have great potential as a therapeutic tool, but it has been difficult to get desirable clinical results because of the inherent trade-off between efficiency and safety, especially with the first generation of ablative lasers. Current research suggests that topical insulin may be effective in reducing the appearance of acne scars. Increased VEGF is produced after topical insulin activates PI3K/AKT pathways. Unlike the crisscross pattern typical of scar tissue, the collagen fibres generated and developed in normal skin more closely resemble a "basket weave. ". Objective: Assessment of possible role oftopical insulin and fractional laser in the treatment of acne scars. Methods: PubMed, Google Scholar, and Science Direct were scoured for information about: Acne scars, fractional laser therapy and topical insulin. The authors also reviewed additional sources, but only the most up-to-date or comprehensive study between April 2004 and April 2021 was included. There are no translation resources available, thus non-English documents are out. Dissertations, conference papers, and oral presentations were not included since they do not constitute "important scientific discoveries." Conclusion: It's possible that post-acne scars can be effectively treated with either topical insulin or fractional laser. Larger controlled studies are needed to confirm the effectiveness of insulin as a novel anti-scarring medication. Keywords: Topical insulin, Fractional laser, Acne scars.
INTRODUCTION
subcutaneous fat, and genetics all play a role, the exact
To a greater or lesser extent, up to 80% of the
origins of atrophic acne scars remain unknown (3).
adolescent population suffers from acne. Scarring that
Eighty percent of teenagers have acne, with 10 to
doesn't fade with time is an undesirable side effect of
20% having severe cases. According to 1996 study,
acne vulgaris. Although acne scarring has not been
acne affects between 40 and 50 million Americans, with
thoroughly investigated, it may affect up to 95% of
a peak incidence (85%) among those aged 12 to 24 (4).
patients with acne vulgaris. Scarring from acne appears
Insulin is an endogenous peptide and growth factor
to affect between 1% and 11% of the population,
that has multiple functions in the body. Past research has
according to studies(1-3). The emotional and
established the existence of insulin receptors in the
psychological toll of acne scarring can be significant.
epidermis' keratinocytes and fibroblasts, so the topic of
Like acne, acne scars are linked to low self-esteem,
insulin's function in the skin is not new. Increasing
sadness, anxiety, impaired social interactions, altered
numbers of human keratinocytes require insulin.
body image, shame, rage, poor academic achievement,
Moreover, insulin can recruit healing-related cells and
and unemployment. Scars don't typically fade with time
stimulate their proliferation. Insulin has been
and, due to ageing or sun damage, may even stand out
demonstrated to have a significant role in the creation
more (2). There are three basic types of acne scars:
of granulation tissue by boosting protein synthesis in the
Atrophic, hypertrophic, and keloidal. Atrophic acne scars
skin and encouraging the growth and development of
are the most common kind. Though inflammatory
various cell types, including keratinocytes, endothelial
mediators, enzymes that tear down collagen fibres and
cells, and fibroblasts (5). Figure (1): Acne scar classification (5)
4323
Received: 11/11/2022 Accepted: 13/01/2023
c:\work\Jor\vol911_84The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4327-4332
On Postoperative Problems Following Mastectomy and Their Impact on Immediate Breast Reconstruction, Early Neoadjuvant and Adjuvant Chemotherapy Hassan A Saad¹, Kamal Rabie Eid², Ashraf Abdelmonem Elsayed¹, Mohamed E Eraky¹, Rasha S Elsayed¹, Mohamed Riad¹
Surgical Department, Faculty of Medicine, ¹Zagagic University, ²Alazhar University, Egypt. Corresponding author: Hassan A. Saad, Telephone: (+20)01221025689, ORCID: 0000-0002-6242-7823. E-mail:[email protected] ABSTRACT Background: Chemotherapy plays a significant part in the management of breast cancer. In the current study, mastectomy with prompt breast reconstruction, the effects of neoadjuvant and adjuvant chemotherapy were investigated. Objective: The effect of neoadjuvant and adjuvant were given systemically to breast cancer patients to investigate their effect on breast reconstruction following mastectomy. Methods: Two-year postoperative follow-up at Zagazig University Surgical Department for 82 patients who received assistance systemic neoadjuvant (NAC) and (ACT) adjuvant chemotherapy for breast cancer between January 2021 and December 2022, together with mastectomy and rapid reconstructive surgery of the breast. Results: During the trial, 82 patients received fast breast remodeling after mastectomy. 34 patients did not receive any systemic therapy, whereas 28 patients had preoperative chemotherapy and 20 patients received postoperative chemotherapy. Conclusion: There were no differences in unscheduled reoperation, donor-site complications, or expander loss across the groups although the adjuvant chemotherapy group had a substantial number of wounds that were infected. Keywords: Breast cancer, Mastectomy, Chemotherapy, Early reconstruction.
INTRODUCTION
axillary lymphatics. Long-term survival is anticipated by
To prevent the spread of the disease after surgical
treatment response, but failing to adapt to the treatment
removal of breast cancer and to enhance cosmetic results,
can impact further chemotherapy options (9, 10).
breast reconstruction (BR) is emerging as a novel
The timing of reconstruction may be impacted by
treatment option. More than 18,000 women took part in
the use of neoadjuvant chemotherapy (11). Irradiation after
the National Mastectomy and Breast Cancer
mastectomy has been the subject of numerous studies, and
Reconstruction Audit (NMBRA), which recently came to
sizable studies have revealed increased wound affection
an end and examined a wide range of clinical and personal
and cosmesis outcomes following mammary remodeling
results, including death and survival. The evaluation also
in patients receiving NACT (12-13). Neoadjuvant and
took into account important factors including information
adjuvant chemotherapy is effective in enhancing breast
and access to reconstructive treatments, as well as the
cancer oncologic outcomes and survival rates, but its
degree of pain, problems, living quality, and well-being
impact on breast aesthetic results is less clear (14-15). Post-
suffering by women following different surgeries (1).
mastectomy reconstruction is now increasingly popular
Although women with breast cancer are now less
among patients as a result of the rise in the number of
likely to undergo a radical mastectomy, oncoplastic
mastectomy procedures (16-17).
surgery is still a crucial component of breast cancer Inclusion criteria:
treatment, particularly for aggressive tumors that are more
1- Patients fit for adjuvant and neoadjuvant therapy. 2-
progressed or localized (3). Following tumor elimination,
Patients fit for operation. 3-Operated non-metastatic
patients' psychosocial and aesthetically pleasing
cases.
outcomes are enhanced, according to many studies (2). Immediate repair is safe from an oncological and surgical Exclusions criteria: 1- Advanced metastatic cancer.
standpoint (3), with no difference in complications when
2- Unfit cases for surgery or any therapy.
versus delayed reconstruction (4). To find wounds and METHODS
other negative effects, we completed the research
We had 82 female patients who regularly took
collected with subjects of women who undergo this
prescription medications between January 2021 and
operation and the process of chemotherapy.
December 2022. The age ranged from 25 to 72 years old.
Modern breast cancer treatment strategies heavily
They underwent the procedures of mastectomy and
rely on neoadjuvant chemotherapy (6). Females can be
reorganization over a 6-7 week period at Zagazig
successfully operated with less extensive destructive
University Surgical Department. They were divided into
surgeries with ACT and NAC therapy that have
three groups, group (20 cases) received adjuvant
substantial benefits for both description and prognosis
chemotherapy, group (34 cases) received chemotherapy,
effect on breast malignancy (7, 8). It further decreases the
and group (28 affected cases) received neoadjuvant
amount of recurrence in both the breast mass and the
4327
Received: 09/11/2022 Accepted: 11/01/2023
c:\work\Jor\vol911_85The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4333-4339
Evaluation of Circulating Serum Meteorin-like Protein Levels in Obesity and Type 2 Diabetes Mellitus Islam Maher Wahid 1, Amira Shoukry Ahmed Soliman 1, Naday Faez Yousuf*1, Ahmed Abdulsaboor Mohammed2
1Department of Internal Medicine and Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Naday Faez Yousuf, Mobile: (+20) 01284990809, E-mail:[email protected] ABSTRACT Background: Given the burden that diabetes and obesity place on patients' quality of life and healthcare systems, elucidating the relationships between diabetes, insulin resistance, and meteorin-like protein may be useful in improving understanding of the pathological processes underlying those clinical conditions. Therefore, this study aimed to evaluate the circulating serum meteorin-like protein levels in patients with obesity and type 2 diabetes mellitus (T2DM) in an attempt to elucidate possible relationships between serum meteorin levels with anthropometric and metabolic parameters of T2DM and obesity. Subjects and methods: The study was cross-sectional case-control observational study, carried out in outpatient clinic of Internal Medicine Department, Endocrinology and Metabolism Unit, and Department of Clinical Pathology, Faculty of Medicine, Zagazig University Hospitals from August 2022 to February 2023. This study was carried out on 104 subjects divided into two groups: non-diabetic subjects group and newly diagnosed type 2 diabetic patient group, with futher subdivision according to BMI to obese and non obese subgroup. Results: Serum meteorin-like protein levels in newly diagnosed T2DM patients were statistically substantially higher than in nondiabetic controls. Furthermore, when these groups were separated into nonobese and obese subgroups, we discovered that serum meteorin levels were considerably greater in obese nondiabetic controls and obese diabetic patients, than in nonobese nondiabetic controls and nonobese diabetic patients, respectively. Obese T2DM patients had the highest serum meteorin levels. Conclusion: Circulating serum meteorin-like protein levels were increased in newly diagnosed T2DM and obesity. Keywords: Meteorin-like protein, Type 2 Diabetes Mellitus, Obesity.
INTRODUCTION
Impairment of insulin production and varying
T2DM development is at risk due to insulin
levels of peripheral insulin resistance (IR) are symptoms
resistance (IR). As novel insulin-sensitizing medications
of diabetes mellitus (DM), which results in
are required, improving IR is still a crucial field of study
hyperglycemia (1). It is classified as a lipid, protein, and
for the treatment of T2DM and metabolic syndrome (7).
carbohydrate metabolic disease. The frequency of DM
Adipokines and myokines are examples of
has significantly increased in recent years, posing a
secreted proteins that have been demonstrated to be
serious hazard to public health (2).
strongly related to the emergence of IR and may one day
Type 2 diabetes affects more than 90% of persons
be used as therapeutic targets for the treatment of T2DM
with the condition. The disease is very common among
and obesity (8,9).
ethnic groups and in family members of those who have
The purpose of this study was to look at
the condition are both indications that there are obvious
circulating serum meteorin-like protein levels in
genetic drivers. Although a number of genetic variants
individuals with obesity and type 2 diabetes mellitus
have been discovered during the past several years, the
(T2DM) to see if there were any links between serum
most prevalent forms of T2DM are not caused by a single
meteorin levels and anthropometric and metabolic
gene (3).
parameters associated with T2DM and obesity.
In the world, type 2 diabetes mellitus (T2DM) is
one of the most common co-morbidities, and its incidence PATIENTS AND METHODS
is rapidly rising. The most prevalent kind of
The
study
was
cross-sectional
case-control
hyperglycemia, insulin resistance, and a relative shortage
observational study, carried out in outpatient clinic of
of insulin are signs of diabetes (4).
Internal Medicine Department Endocrinology and
Additionally, the epidemic of obesity worldwide
Metabolism Unit, and Department of Clinical Pathology,
is responsible for the concurrently rising prevalence of
Faculty of Medicine, Zagazig University Hospitals from
cardiometabolic illnesses, such as T2DM (5). It is
August 2022 to February 2023.
commonly known that insulin resistance (IR), obesity,
and prediabetes are all closely related (6).
c:\work\Jor\vol911_86The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4340-4348
Preemptive Nebulization of Dexmedetomidine versus Ketamine for Postoperative Analgesia in Nasal Surgeries Zainab Abd Alkhader Mabrouk Alshame*, Maha Ebrahem Eldesouky, Mohammed Saad Ahmed Mousa, Doaa Mohammed Farid
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Zainab Abd Alkhader Mabrouk Alshame, Mobile: (+20) 01008864059, E-mail:[email protected] ABSTRACT Background: Nasal backing and the actual surgical trauma are responsible for mild to severe postoperative pain following nose operations. Aim: To evaluate analgesic effectiveness of nebulized ketamine against nebulized dexmedetomidine for patients undergoing nose operations. Patients and methods: 105 adult patients for elective nose operations were divided into three groups. Patients in each group were given the drug via nebulization 15 minutes before to surgery; in the case of group D, patients received 50 g of dexmedetomidine (0.5 ml + normal saline 0.9% up to 3 ml), group K, 50 mg of ketamine (1 ml + normal saline 0.9% up to 3 ml), and group C, 0.9% (3 ml) of normal saline. Hemodynamics, intraoperative opioids, the first-time analgesia was requested, the total amount of postoperative rescue analgesia administered, and side effects were all included in the outcome measures. Version 20 of SPSS was used to code and analyses the data that had been gathered. Results: There was statistically significant (p< 0.05) reduction in intraoperative fentanyl needs in D group < K group < C group and also significant decrease in postoperative ketoprofen needs. The first time to rescue analgesia was delayed (p< 0.05) in D group > K group > C group. Postoperative complications were lower in D and K groups < C group (p< 0.05). Conclusion: Preemptive nebulization of dexmedetomidine produces extremely good analgesia in nasal surgeries, when compared with other groups it can effectively reduce the intra- and postoperative opioid consumption. Keywords: Preemptive Analgesia, Dexmedetomidine, Ketamine, Nasal nebulization
INTRODUCTION
Nasal surgeries are usually associated with mild
This study aimed to assess the efficacy of good
to severe postoperative discomfort, due to both nasal
postoperative pain management with a less rescue
backing and surgical damage. The administration of
analgesia
by
using
either
nebulization
of
opiates to treat this pain may result in respiratory
dexmedetomidine or ketamine in patients undergoing
depression, hypoxia, decreased alertness, nausea, and
nasal surgeries.
vomiting (1).
Nebulization of analgesics across the nasal PATIENTS AND METHODS
mucosa plays a major role in pain control and is
The Zagazig University Hospitals conducted this
generally favored because it is safe and simple for the
prospective, randomly, controlled clinical trial between
patient to receive, with delivering the medication to the
September 2022 and March 2023. 105 cases were
lower airway with less risk of aspiration (2).
separated into three groups with 35 cases in each
Dexmedetomidine is a selective -2 adrenergic
category, according to the open Epi program's
agonist action. As it is highly lipid soluble agent, it has
calculation of the sample size. A prior study found that
good systemic absorption on trans mucosal
the test has an 80 percent power at 95% confidence
administration (3). It induces hypotension, bradycardia,
interval. Depending on heart rate (HR) measurement it
sedation, and analgesia by activating spinal cord and
was assumed that mean HR was 83.3911 vs
brain receptors (4). Dexmedetomidine has a distribution
77.767.88 beat/min in ketamine vs dexmedetomidine
half-life of about 6 min and a terminal elimination half-
group (7).
life of about 2 h (2-compartment model). It has a quick
In this study, elective nasal operations on adult
onset and short duration of action. Dexmedetomidine is
patients between the ages of 21 and 60, of either sex,
extremely lipophilic and about 94% protein bound. It is
who were ASA I and ASA II patients, BMI 1830
nearly completely biotransformed, and is excreted in
kg/m² and scheduled for these procedures, were
feces (4%) and urine (95%) (5).
included. Exclusion criteria for this study included
Ketamine is an N-methyl D-aspartate (NMDA)
patients with advanced respiratory, renal, hepatic,
receptors antagonist, it acts on the limbic system and the
neurological, or psychiatric disease, pregnant or nursing
central nervous system to cause drowsiness and
women, patients with a history of allergies to any study
analgesia (6). It has various routes of administration
drugs, patients who had used central nervous system
including intramuscular, intravenous, oral, nasal,
depressants or analgesics within the previous 24 hours,
intrathecal subcutaneous, intraosseous and rectal
and patients with hypertension, hypotension, or
gargles (7). Nebulized ketamine has anti nociceptive
bradycardia.
anti-inflammatory properties (8).
4340
Received: 13/11/2022 Accepted: 15/01/2023
ProtocolThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4349-4356
Impact of an Educational Program on Physicians' and Nurses' Knowledge and Performance in Management of Sepsis in the Intensive Care Unit Samia Mohammed Masood, Mohammed Almowafy Khattab, Essamedin Mamdouh Negm, Mahmoud Mustafa Alsayed Alfakharany*
Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Mahmoud Mustafa Alsayed Alfakharany, Tel.: +2 01117054060, Email:[email protected] ABSTRACT Background: Sepsis is defined as a life threatening organ dysfunction caused by a dysregulated host response to infection, and it is one of the most deadly and costly conditions at hospitals. Objective: The aim of the current study was to decrease the incidence of sepsis and mortality related to it among ICU patients through applying educational programs and assessment of physicians' and nurses' knowledge and performance. Patients and methods: A quasi-experimental study was carried out on physicians and nurses in Zagazig University Hospitals during the period between September 1, 2021 and February 28, 2022. The investigated units were the Emergency ICU (EICU) and the Surgical ICU (SICU) at Zagazig University Hospitals. Results: There was significant difference in sepsis and infection control scores pre and post educational program among physicians and nurses, in relation to department where total sepsis and infection control score was statistically higher among Surgical ICU physicians and nurses than Emergency ICU physicians and nurses. Conclusion: Implementation of an educational program has a positive effect on knowledge and performance of ICU physicians and nurses in management of sepsis. Therefore, this may help proper management of cases and reducing mortality rates. Education workshops should be based on the most recent guidelines. Keywords: Educational Program, Knowledge, Performance, Management, Sepsis, Intensive Care Unit, Quasi- experimental Study, Zagazig University. INTRODUCTION
and assessment of physicians' and nurses' knowledge
Sepsis is defined as a life threatening organ
and performance.
dysfunction caused by a dysregulated host response to
infection and it is one of the most deadly and costly PATIENTS AND METHODS
conditions at hospitals (1).
A quasi-experimental study was carried out on
Sepsis occurs in 1-2% of all hospitalizations and
physicians and nurses in Zagazig University Hospitals
accounts for as much as 25% of ICU bed utilization.
during the period between September 1, 2021 and
Due to it rarely being reported as a primary diagnosis
February 28, 2022. The investigated units were the
(often being a complication of cancer or other illness),
Emergency ICU (EICU) and the Surgical ICU (SICU)
the incidence, morbidity and mortality rates of sepsis
at Zagazig University Hospitals.
are likely underestimated (2).
EICU had 22 beds including two isolated beds and
National Institute for Health and Care Excellence
SICU had 33 beds including 3 isolated beds at time of
(NICE) guidelines recommend ensuring that all
the study. Distance between beds was found to be 1.5
healthcare staff involved in assessing people's clinical
meter and there was physical separation in between.
condition are given regular, appropriate training in
There were available sinks allocated for hand washing
identifying people who might have sepsis. This includes
in addition to alcohol hand rub dispensers which were
primary, community care and hospital staffs. All
distributed between the beds.
healthcare professionals involved in triage or early
The EICU admits all types of patients with critical
management should be given regular appropriate
illness from the emergency room, ward and the
training in identifying, assessing and managing sepsis.
operating room. The SICU is more dedicated to patients
This training should include risk stratification
in perioperative state who are arranged to be managed
strategies, local protocols for early treatments,
in ICU before and after elective operations.
including antibiotics and intravenous fluids and criteria
There was one ICU resident and one ICU specialist
and pathways for escalation, in line with their health
continuously in each ICU. The nurse - patient ratio
care setting (3).
ranged mostly from 1:2 to 1:3 but only reached 1:4 in
A good knowledge of sepsis guidelines among
the EICU.
physicians and nurses is essential to correct
A quasi-experimental study that was divided into
management of this condition and could be improved
three phases: A pre-interventional phase, an
through educational training (4).
interventional phase, and a post-interventional phase.
The aim of the current study was to decrease the Study population: Physicians and nurses from the
incidence of sepsis and mortality related to it among
EICU and the SICU, Zagazig University Hospitals.
ICU patients through applying educational programs
They were arranged into two separated groups along the study, physicians group and nurses group.
4349
Received: 24/10/2022 Accepted: 27/12/2023
c:\work\Jor\vol911_88The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4357-4360
Recent Updates of Clinical Guidelines in Diagnosis of Meniere's Disease: Review Article
1 Mohammad Ramadan Hassaan, 2 Ahmed Abdelhamid Mohammed,
1 Nadia Mohamed Elnabtity, 1 Amal Salah Mohamed Hussien
1 Audio-Vestibular Medicine, ENT Department, Faculty of Medicine, Zagazig University, Egypt
2 Radiology Department,Faculty of Medicine, Zagazig University, Egypt Corresponding author: Amal Salah Mohamed Hussien Email: [email protected] Mobile: 01092783388 ABSTRACT Background: Meniere's disease (MD) is a peripheral vestibular disorder presented presented with fluctuating aural symptoms (fullness, tinnitus and hearing loss). In addition to recurrent spontaneous vertigo lasting between few minutes to several hours. Based on these symptoms, there are two categories of MD: definite and probable. Objective: The objective of this review article is to present an overview about recent methods for diagnosis of MD. Methods: We looked for data on Meniere's disease, Tinnitus, Vertigo, and Electrocochleography in medical journals and databases like PubMed, Google Scholar, and Science Direct. However, only the most recent or extensive study was taken into account between February 2015 and January 2023. References from related works were also evaluated by the authors. There are not enough resources to translate documents into languages other than English, hence those documents have been ignored. It was generally agreed that documents such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations did not qualify as legitimate scientific study. Conclusion: MD is diagnosed clinically since it typically manifests as unilateral ear problems that might remain for decades. Attacks from MD are sporadic and episodic, with remissions in between. As there is no definitive vestibular testing for MD, these tests are typically carried out to rule out disorders with similar symptoms. Keywords: Meniere's disease, Tinnitus, Vertigo, Electrocochleography.
INTODUCTION
Meniere's disease (MD) is an idiopathic peripheral
Strict diagnostic criteria based on symptom
audiovestibular disorder characterized by episodic vertigo
categories were developed by the American Academy of
that lasts between minutes to hours, unilateral fluctuating
Otolaryngology--Head & Neck Surgery (AAO-HNS)
or permanent loss of hearing, tinnitus, and blocking of ear.
2015 to facilitate the diagnosis and management of MD.
In 1861, Prosper Meniere recognized that an insult within
MD can be categorized as either defined or probable. For
the inner ear could result in symptoms of vertigo and
the diagnosis of MD, there is no definitive test (5).
hearing loss (1).
The pathophysiology of MD is not fully A) Definite MD
understood, and over the years, several theories have been
The AAO-HNS stated that this condition is
developed to explain the disease's well-known symptoms.
associated with two or more spells of vertigo lasting
Based on investigations on human temporal bones, it is
between twenty minutes and twelve hours, audiometric
clear that all MD subjects exhibit endolymphatic hydrops
confirmation of low- to mid-frequency hearing loss
(EH), which is used to describe an accumulation of
concomitant with vertigo, and fluctuating aural symptoms
endolymph in the membranous labyrinth, frequently in
in the affected ear. It's critical to discriminate MD from
cochlear duct, saccule before utricle, and semi-circular
other prevalent causes of vertigo that may also be
canals (2).
accompanied by hearing loss, tinnitus, or auditory
Increased endolymph production or impaired
fullness (5).
endolymph reabsorption are two mechanisms suggested
to cause hydrops. Genetic, viral, traumatic, mechanical, B) Probable MD
autoimmune, allergy, hormonal, and vascular etiologies
At least two attacks of dizziness or vertigo lasting
all predispose them. All of the clinical and pathological
for twenty minutes to several hours, varying aural
findings in MD cannot be explained by any of them (3).
symptoms (such as hearing loss, tinnitus, or fullness), and
According to theory of Schuknecht's rupture, the
other reasons that have been ruled out by further testing.
endolymphatic space enlarges and leading to rupture of
Although the condition often manifests as unilateral ear
Reissner's membrane. After being exposed to toxic and K-
symptoms, they may last for many years. Around six to
rich endolymph the hair cells of cochlea and the
eleven attacks of MD occur episodically and randomly on
audiovestibular nerve experience episodic spinning
average every year. Remission intervals can range from
vertigo and hearing abnormalities (4).
months to years. Hence, the diagnosis of MD is not
usually made entirely at once. It could take a long time to
4357
Received: 05/11/2022 Accepted: 07/01/2023
c:\work\Jor\vol911_89The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4361-4367
Laparoscopic Splenectomy as A Result of Morbid Consequences in The Treatment of Benign Splenic Disorders and Malignant Splenic Diseases Hassan A Saad¹, Mohamed Riad¹, Kamal Rabie Eid², Ashraf Abdelmonem Elsayed¹, Mohamed E Eraky¹, Rasha S Elsayed¹
1Surgical Department, Faculty of Medicine, Zagazig University and 2 Al-Azhar University, Egypt Corresponding author: Hassan A. Saad, Telephone: (+20)01221025689,
E-mail: [email protected], ORCID:0000-0002-6242-7823 ABSTRACT Background: Both benign and malignant diseases now have more and more justifications for laparoscopic splenectomy, which is currently considered a standard technique for handling practically all disorders necessitating splenectomy. Objective: We aimed to contrast the consequences of benign versus malignant hematological diseases following laparoscopic splenectomy. Patients and Methods: We carried out seventy-six laparoscopic splenectomies between 2019 and 2022. 38 patients were handled with the use of a unique method, an anterior approach, but 38 patients have been positioned in a semi-lateral position for laparoscopic intervention. Result: Malignant disorder patients had older ages (60.1), whereas benign disorder sufferers had younger ages (35.6), P = 0.001. Laparoscopy was used in 72 of 76 cases (94.7%). Four situations (5.2%) have been modified to open cases. Operative time used to be 2.51 h/min for malignant in distinction to 2.30 h/min for benign tumors (P > 0.05). Conclusions: laparoscopic splenectomy is logically appropriate as a less invasive technique for benign splenomegaly, hematological tumors, or both. Keywords: Splenectomy, Laparoscopic, Malignant, Benign.
INTRODUCTION
situations of lymphoma, hilar lymphadenopathy, or peri
History points: Delaitre(1). carried out the first
splenitis, splenectomy may be worthwhile with size
laparoscopic splenectomies in France in 1991,
adjustment with the aid of an X-ray (11). So, we have
accompanied by Carroll(2) in the United States in 1992,
restricted our indications in such cases.
and Poulin(3) in Canada three months later that same year Objective: The current study's objectives included
(1992) . Following that, several research studies were
analysing results of 76 consecutive patients (adults and
meant to be drastically used in many countries with the
children) who had either benign or malignant diseases and
skill of specialists(4). Laparoscopic splenectomy (LS
assessing the advantages of laparoscopy for those with
splenectomy) has the following benefits: The main
lymphomas and other hematological malignancies.
advantages of LS in adults encompass less bleeding,
The study's goals were to determine the benefits of
shorter hospitalization, rapid recovery to everyday
laparoscopy with innocuous splenic tumors and
activities, and first-rate beauty results for the treatment of
hematological malignancies in patients with splenic mass.
benign diseases, particularly in healthy patients with a
small spleen, such as those with hereditary PATIENTS and METHODS
thrombocytopenic purpura, laparoscopic splenectomy
Our database used to be as unexpectedly reviewed
(LS) is an extremely common operation. However, there
for patients who had extended, prolonged preceding with
is little experience with LS for hematological
the resource of laparoscopic splenectomy. Between April
malignancies, and there are no trials that compare it to the
2019 and November 2022, seventy-six sufferers were
surgical approach(5).
subjected to LS for hematological malignant and benign
The process is further complicated by the unique
diseases in the Zagazig University Surgical Department.
clinical characteristics of malignant hematological
The preoperative activities included blood investigations,
illnesses, such as splenomegaly, developed patient-years,
coagulation profiles, chest X-rays, ultrasounds, and
and more severe symptoms. More challenging could
electrocardiography. Before the operation, ultrasound for
affect the direct results after LS (6).
the everyday pole diameter, dimension of the spleen, and
Immune thrombocytopenia is the most an alliance
CT for peritonitis, splenic consolidation, or hilar nodes
of splenectomy (ITP), followed by systemic hemolytic
were necessary. In addition, MRI was necessary to help
anemia caused by inherited spherocytosis (7-8). Massive
the CT provide a suited prognosis and a dimension of all
splenomegaly (average pole diameter > 20 cm, spleen
suspected hematological malignancies in the abdomen
weight > 1000 g) has been successfully cured
(Fig. 1).
laparoscopically in several studies. LS has been effective
Patients who had received laparoscopic splenectomy
at treating individuals with hematological malignancies,
were searched for in our database. We dealt with 76
but (9-10), although there are technical challenges in the
4361
Received: 05/11/2022 Accepted: 07/01/2023
c:\work\Jor\vol911_90The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4368-4372
Role of Oral Lactoferrin in Prevention of Recurrent Bacterial Vaginosis in Third Trimester of Pregnancy Amal Mohamed Alanwar, Rania S. Ezzat , Marian Asaad Gerges, Khoulh Al Mahdi Anbeeh Al Barhami, Safaa Abd El salam Ibrahim
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Khoulh Al Mahdi Anbeeh Al Barhami, Mobile: (+20) 01029728338 , E-mail:[email protected] ABSTRACT Background: One of the most common conditions affecting women's health throughout the childbearing years is bacterial vaginosis (BV), which have a negative impact on pregnancy. Nutraceutical proteins and probiotics (such as lactoferrin) can help restore the equilibrium of the vaginal microbiome, which can be of significant use in avoiding unfavorable pregnancy outcomes. Aim of Study: This study aimed to evaluate the efficacy of lactoferrin in prevention of recurrent bacterial vaginosis in third trimester singleton pregnancy. Patients and method: This was randomized controlled clinical trial conducted at Obstetrics and Gynecology Department, Zagazig University, Outpatient Clinic. The study included 66 cases with history of receurent bacterial vaginosis divided into two groups: Study group that received lactoferrin oral consumption of 2 capsules/day for 5 days, then 10 consecutive days at the dosage of 1 capsule/day (pravotinR). Control group, which did not receive lactoferrin. All of the ladies took 1 capsule of lactoferrin or a placebo daily for 10 days straight each month during the follow-up period. Results: There was significant differences in microbiological cure rate as detected by Nugent scores in studied groups at T1 and T2 where the study group had microbiological cure rate than control one (57.6% and 9.1%) versus (72.7% and 18%) respectively. Low APGAR1, preterm, CS delivery type, LBW and PROM were significantly higher with control group. Conclusion: Repeated sessions of orally delivered probiotics in conjunction with lactoferrin are beneficial in preventing BV recurrences, as evidenced by much greater clinical and microbiological cure rates, as well as a favourable safety profile. Keywords: Bacterial vaginosis, Prevention, Lactoferrin. INTRODUCTION
vaginal microbiota, probiotics may reduce the recurrence
One of the most prevalent illnesses affecting
rate of the infection (5).
women of reproductive age is bacterial vaginosis (BV).
A milk glycoprotein called lactoferrin (LF), which
From 5% in Asia and Australia to 59% in Southern and
binds to iron and is involved in a wide range of biological
Eastern Africa, BV is prevalent. Prevalence rates range
processes, including an antibacterial impact, helps certain
from 8% to 51%, making pregnant women one of the
probiotic strains proliferate (6). In ferrokinetics, lactoferrin
populations most susceptible to the negative effects of BV
is crucial. As a result of its strong affinity for binding free
(1). There are BV-related consequences include pelvic
iron, LF restricts the amount of ions available for
inflammatory disease (PID), which can lead to
microbial metabolism (7). Because of its bacteriostatic and
miscarriage, premature birth, and preterm premature
bactericidal properties, LF plays a part in the host's
rupture of the membranes (PPROM). Moreover,
defence mechanisms. Moreover, it prevents the growth of
regardless of symptoms, BV is linked to a number of
other bacteria including fungi and viruses. The immune
sexually transmitted diseases (STIs), including
system is also modulated by lactoferrin, and new research
Chlamydia trachomatis, Neisseria gonorrhoeae, HSV-2,
suggests that lactoferrin directly affects the generation
and an increased risk of HIV-1 acquisition (2). After 4
and operation of neutrophils and monocytes (8).
weeks of treatment, patients with BV treated with
The transporter of iron in the serum, serum
metronidazole or clindamycin can see an 80% reduction
transferrin, is physically and chemically identical to the
in symptoms. Nonetheless, recurrence has been seen in
iron-binding, non-haem protein known as LF. It is created
40% to 50% of instances after stopping treatment for a
by mucosal epithelial cells, widely present in bodily
year (3). Known gastrointestinal side effects of
fluids, and abundantly secreted in milk (9). Thus the aim
clindamycin and metronidazole include nausea and
of this study was to evaluate the effectiveness of LF as a
vomiting, and stomach discomfort, despite the fact that
new strategy for prevention of recurrent bacterial
both medicines have the potential to cause a number of
vaginosis in third trimester singleton pregnancies.
side effects. Another issue with common BV treatment
approaches is that they do not take into account the effects PATIENT AND METHODS
of disrupting vaginal ecosystems and the subsequent risk
This randomized controlled clinical trial was
of disease recurrence (4). Because BV treatment should put
conducted at Obstetrics and Gynecology Department,
an emphasis on getting rid of patients' clinical symptoms
Zagazig University Outpatient Clinic through the period
and lowering the recurrence rate, and replenishing the
4368
Received: 17/10/2022 Accepted: 20/12/2022
c:\work\Jor\vol911_91The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4373-4379
Serum suPAR and Urinary Nephrin as Novel Sensitive and Specific Markers for Diabetic Nephropathy in Patients with Type 2 DM Amr M. Elhammady1*, Hend S. ELShafie1, Asmaa A. El Fallah2, Medhat A. Khalil1
Departments of 1Internal Medicine and 2 Clinical Pathology, Faculty of Medicine, Benha University, Benha, Egypt *Corresponding Author: Hend Saad Eissa ELShafie, Mobile: (02) 01017012201, Email:[email protected] ABSTRACT Background: The most frequent reason of end-stage kidney disease (ESKD) is diabetic nephropathy (DN), highlighting the need of early detection, treatment, and prevention. Objective: To assess the sensitivity and specificity of serum (soluble urokinase-type plasminogen activator receptor (suPAR) and urinary nephrin in cases with type 2 diabetes mellitus (T2DM) with and without nephropathy. Methods: This prospective study was conducted on 70 patients of T2DM and 15 healthy control group of age and sex matched persons. All patients and control group were subjected to pelviabdominal U/S, laboratory investigations (CBC, ESR, liver and kidney function test, fasting and 2 hours post prandial blood sugar, urine analysis, (urine albumin creatinine ratio (UACR), nephrin, and serum suPAR levels). Results: ROC analysis was done for suPAR to predict DN. It showed a significant AUC of 0.869, with a 95% CI ranging from 0.785 0.953 (P < 0.001). The best cutoff was > 82.3, at which sensitivity and specificity were 97.1% and 68.6%, respectively. ROC analysis was done for urinary nephrin to predict DN. It showed a significant AUC of 0.760, with a 95% CI ranging from 0.642 0.877 (P < 0.001). The best cutoff was > 10.8, at which sensitivity and specificity were 80% and 68.6%, respectively. Conclusions: In T2DM patients, serum suPAR and urinary nephrin were more specific and sensitive markers than microalbuminuria in early detection of DN. Keywords: Serum suPAR, Urinary Nephrin, Diabetic Nephropathy, Type 2 DM. INTRODUCTION
in experimental models of the illness (7). According to a
Type II diabetes mellitus (T2DM) is a
study by Jim et al. all T2DM cases with
complicated metabolic disorder brought on by the
microalbuminuria
and
macroalbuminuria
had
combination of hereditary and environmental variables,
nephronuria (8). Moreover, 54% of T2DM individuals
which change the activity of insulin to varying degrees
with normoalbuminuria had nephronuria (9).
in pancreatic cells as well as peripheral organs.
The 3-domain membrane-bound receptor has a
Overweight and obesity, especially of the android type,
circulating variant called suPAR. It is expressed on a
are the primary diseases that encourage the
number of cells, comprising endothelial cells,
development of DM2 (1). It has been demonstrated that;
podocytes, and immunocompetent cells (10).
the main single reason of ESKD is diabetic nephropathy
SuPAR could act as a biomarker for renal
(DN), highlighting the need of early detection,
illness, as well as inflammatory and immunological
treatment, and prevention. The most prevalent early
disorders, according to prior research. Evidence also
clinical sign of DN, microalbuminuria, has been
suggested widespread usage in systemic lupus
identified as a predictor of the development of ESKD in
erythematosus, hyperglycemia, and sepsis (11, 12).
the context of type 1 DM (T1DM) and T2DM (2, 3).
SuPAR may be a predictor of CKD and
In certain circumstances, diabetic individuals
cardiovascular outcomes in individuals with mild to
have a gradual drop in renal functions prior to the onset
moderate CKD and ESKD, according to a number of
of microalbuminuria (4). When evaluated at a later
studies (13, 14).
period, microalbuminuria may no longer be present in
The development of DN biomarkers, which
some individuals, and it is a poor indicator of the
enable the early DN diagnosis and the degree of renal
development
of
macroalbuminuria (5).
dysfunction among cases with DM has attracted
Microalbuminuria can occur in diabetic individuals
enormous interest over the last 20 years (15).
without present or future DN and also in non-diabetic
In cases with T2DM who had nephropathy or
people with progressing chronic kidney disease (CKD),
not, we sought to assess the sensitivity and specificity
hence it is not always indicative of the existence of
of blood suPAR and urine nephrin.
diabetic kidney disease (DKD) (6).
In order to detect DKD early and forecast the PATIENTS AND METHODS
development of ESKD, it is vital to find more sensitive
This prospective study was conducted on 85
and specific indicators than microalbuminuria.
cases. Seventy diabetic cases aged from 40 years to 60
A significant molecular composition of the
years with 15 healthy volunteers serving as control
glomerular
filtration
slit
diaphragm
between
group. The patients were recruited from Internal
neighbouring podocytes is the transmembrane protein
Medicine Department Benha University Hospital, in the
nephrin, which belongs to the immunoglobulin
period of July 2022 to November 2022.
superfamily. Its expression is identified to be changed
Diabetic patients were categorized into 2
in human proteinuric disorders, including diabetes, and
groups: Group 1 which comprised 35 cases with DN
4373
Received: 15/11/2022 Accepted: 17/01/2023
c:\work\Jor\vol911_92The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4380-4386
Predictive Value of Neutrophil to Lymphocyte Ratio Combined with C-Reactive Protein for Diagnosis of Spontaneous Bacterial Peritonitis among Cirrhotic Patients Ramy I. Elhendawy, Salama M. Elghoneimy, Sahar A. Elnemr, Aya A. Salem*, Abeer H. Abdelkader
Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Aya Abdelreheem El-Sayed Salem, Mobile: (+20)1211604129, Email:[email protected] ABSTRACT Background: A serious problem for cirrhotic individuals is spontaneous bacterial peritonitis (SBP). Clinical significance of SBP's C-reactive protein (CRP) as well as neutrophil-to-lymphocyte ratio (NLR) have been discovered using varying threshold levels. Objective: The aim of the current work was to assess the validity of diagnostic paracentesis with the use of combined blood NLR and CRP as a non-invasive predictor for early diagnosis of SBP. Patients and Methods: This case control study included a total of 60 cirrhotic decompensated patients, admitted at Department of Tropical Medicine, Zagazig University Hospitals. Patients were categorized into two groups (30 each) according to neutrophil count in Ascitic fluid; Group I with SBP and Group II free from SBP. Both NLR and CRP were assessed among all subjects. Results: NLR was statistically significant higher in SBP group. A cut-off value of blood NLR >2.9 on ROC curve had a specificity of 88% as well as sensitivity of 95% for SBP diagnosis in cirrhotic patients. CRP level differed significantly among cirrhotic patients diagnosed with SBP. A cut-off >15 mg/L had a sensitivity and specificity of 85% and 90 % respectively in diagnosing SBP in cirrhotic patients. Combination NLR and CRP had a cut-off >22.6 mg/L, had a sensitivity and specificity of 86%, 91 % respectively in SBP diagnosis among cirrhotic patients. Conclusions: Combined NLR and CRP with cut of >2.9, and >15 mg/dl respectively could be used as a novel, non- invasive predictor for SBP diagnosis. Keywords: Spontaneous Bacterial Peritonitis, NLR, CRP.
INTRODUCTION
systemic inflammation you may be experiencing (6). As
In severe cases of liver disease, ascites may
an indicator of the interplay between these two arms of
develop. It's the leading reason why people with
the immune system, the neutrophil-to-lymphocyte ratio
cirrhosis end up in the hospital. Ascites infections
(NLR) was proposed as a diagnostic marker for
caused by bacteria can increase mortality in cirrhotic
bacterial peritonitis that develops on its own. The
individuals by a factor of four or more. The chances of
presence of neutrophils indicates the presence of active
acquiring a bacterial infection among people with
inflammation, while lymphocytes are indicative of the
cirrhosis is four to five times higher than among the
immunological regulation mechanism. Patients with
general population. Cirrhotic patients usually
peritonitis caused by bacteria on their own have had
deteriorate because of infections (1). In patients with
their outcomes predicted using the NLR (7). It has been
decompensated liver cirrhosis, hepatorenal syndrome or
shown that platelet indices, C-reactive protein, and total
systemic sepsis can precipitate the development of life-
white blood cell counts can foretell infection in ascites
threatening spontaneous bacterial peritonitis (SBP),
fluid. Clinically useful diagnostic criteria for SBP were
which has a high recurrent incidence of over 70%
postulated by Janum and coworkers using NLR alone
throughout one year of follow up. While in the hospital,
and in combination with CRP (8).
10%-30% of those people have it. About 50% of
This study objective was to assess the validity
patients admitted have SBP, and another 50% will
of diagnostic paracentesis with the use of combined
develop it while they are hospitalized )2). Ascites with
blood NLR and CRP as a non-invasive predictor for
more than 250 polymorphonuclear neutrophils
early diagnosing of SBP.
(PMN)/mm3 and no other obvious cause of intra-
abdominal infection are diagnostic of SBP (3). SUBJECTS AND METHODS
Risks of Diagnostic paracentesis involves,
This case control study included a total of 60
peritonitis, hemoperitoneum, persistent leak abdominal
cirrhotic decompensated patients, admitted at
wall hematoma as well as visceral perforation, which is
Department of Tropical Medicine, Zagazig University
the most common complication (4).
Hospitals.
When inflammation occurs in a living
Patients were categorized into two groups
organism, C reactive protein (CRP) levels rise in the
according to Neutrophil count in Ascitic fluid; Group I
blood. In response to a bacterial infection, macrophages
included 30 patients with SBP (neutrophil more than
secrete cytokines such interleukin-1, interleukin-6, and
250 /ml), and Group II included 30 patients free from
tumor necrosis factor, which stimulate the liver to
SBP (neutrophil less than 250 cells / ml).
produce serum CRP (5).
.Inclusion criteria:All patients diagnosed with
The neutrophil-to-lymphocyte ratio (NLR) in
cirrhosis and ascites by clinical, laboratory and
the blood is a simple and inexpensive way to gauge how
radiological criteria who were free of other infections
well your immune system is functioning and how much
(chest, skin, urinary ...etc.)
4380
Received: 14/11/2022 Accepted: 16/01/2023
c:\work\Jor\vol911_93The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4387-4392
Effect of Touch Screen Devices Use on Fine Motor Skills of Preschool Children Nehad Mamdouh Mohamed, Hebatallah Mohammed Kamal, Rami Mahmoud Gharib
Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt *Corresponding author: Nehad Mamdouh Mohamed, Mobile: (+20)1279584360, E-Mail: [email protected] ABSTRACT Background: The development of preschoolers' hand skills may be impacted by touch screen technology. Objective: The purpose of this study was to investigate the effect of touch screen devices use on fine motor skills of preschool children. Subjects and Methods: The study sample included 50 children aged 4-5 years who had frequently used interactive tablet media (group A) and 50 children matched for age who hadn't used interactive tablet media (group B). Fine motor skills were evaluated using Peabody Developmental Motor Scale-2 (PDMS-2). Both groups' socioeconomic position was similar and assessed by the Socioeconomic Status Scale (SES). Results: There was a significant decrease in raw score of grasping and visual motor integration of group A compared with that of group B (p < 0.05). There was a significant decrease in age equivalent of grasping and visual motor integration of group A compared with that of group B (p < 0.01). There was a significant decrease in standard score of grasping and visual motor integration of group A compared with that of group B (p < 0.01). There was a significant decrease in percentile rank of grasping and visual motor integration of group A compared with that of group B (p < 0.01). Fine motor skills of group B were better than those of group A. Conclusion: The fine motor skills of preschool children who do not use touch screens are better than those of children using a touch screen. Keywords: Fine motor skills, Tablet use, Child development, Peabody scale. INTRODUCTION
unable to execute everyday duties. Interactive media
The ability to move and coordinate one's
have recently been included in the library of teaching
muscles and body is referred to as having motor
tools. Unfortunately, little is known about how these
abilities [1]. Gross and fine motor skills are the two
interactive toys affect young children's development,
main categories of motor skills. For motions like
including their fine motor skills [8].
sprinting, jumping, and throwing, an individual has to
The widespread use of electronic technology in
be able to coordinate their arms, legs, and other big
recent years has significantly impacted people's daily
body components [2].
lives. The incidence of device ownership among
The capacity to regulate movement through the
adolescents has reached very high levels and is rising
coordinated use of the nerve system, fibres, and
among younger children as these technological usages
muscles such as those in the fingers and hands is
become more essential in daily life [9].
known as fine motor skill [3]. The development of fine
Families now own a lot more modern
motor skills involves the physical manipulation of
technology, like tablets and smartphones, and young
items including writing, weaving ropes, arranging
kids are using it more often [10].
beams, tying shoelaces, turning pages of books, using
Young children find touchscreens to be an
scissors, playing with playdough, and folding paper to
intuitive and alluring source of sensory and cognitive
create shapes [4]. Activities that require fine motor
stimulation [11], and the effect of such gadgets on
skills include cutting with scissors, colouring, and
children's development is a major issue that worries
sketching with pencils and crayons [5].
parents, researchers, and policy officials. Children are
Early childhood, defined as the age range from
more independent in their interactions with the gadget
three to six years old, is a time of rapid growth and skill
and consequently the material thanks to the simplicity
development for children [6]. Environmental,
of a touch screen [12].
biochemical, and genetic variables all have an impact on
Despite warnings against newborns and early
a child's development [7].
toddlers using touch screens independently, the
Both academic and everyday tasks require fine
majority of families said they often allow their kid to
motor abilities to be completed. Without the capacity to
use a gadget. As toddlers improve their cognitive
carry out these regular duties, a child's self-esteem may
executive abilities and are able to comprehend what is
suffer, their academic performance may suffer, and they
being done on the screen, the displays become easier to
may have very few play alternatives. Also, they are
operate and offer sensory sensations [13]. By using touch
unable to acquire the necessary independence in daily
displays, learning is improved through haptic
skills (such dressing and eating oneself), which has
engagement [14].
social and peer interaction repercussions. Fine motor
The purpose of this study was to investigate the
abilities are crucial for carrying both daily tasks and
effect of touch screen devices use on the fine motor
academic tasks. Children's self-esteem will be poor and
skills of preschool children.
their academic performance will be impacted if they are
4387
Received: 14/11/2022 Accepted: 16/01/2023
c:\work\Jor\vol911_94The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4393-4398
Burnout in Stroke Patients Pre-and Post-COVID-19 Pandemic Habiba Mohamed Ahmed1, Hoda Mohamed Zakaria1, Ebtesam Mohamed Fahmy2, Abdelaziz Abdelaziz Elsherif1
1Department of Physical Therapy for Neurology, Faculty of Physical Therapy, Cairo University, Egypt,
2Department of Neurology, Faculty of Medicine, Cairo University, Egypt Corresponding author: Habiba Mohamed Ahmed, Tel. +20109 0708377, E-mail: [email protected] ABSTRACT Background: Since the first appearance of COVID-19 numerous complications have been reported particularly within 1.48% of the population suffering from stroke. Maintaining positive mental health is crucial to modulate COVID-19 impacts involving burnout, depression, and anxiety. Objective: The aim of the current study was to investigate the consequences of the COVID-19 pandemic in Egypt on the level of burnout in stroke cases. Patients and methods: A total of 100 Egyptian stroke male and female cases participated in the study. Participants aged between 34 and 70 years old and their cognition score was >26 according to Montreal Cognitive Assessment (MOCA) scale. The Malach-Pines tool was used to measure burnout. Results: The mean scores of all items of the burnout scale increased significantly post COVID-19 in comparison with that of pre COVID-19 (P<0.001). The highest score was for "I've had it" with a mean score of 4.17 (SD 1.08) pre COVID-19, which increased significantly post COVID-19 to 5.98 (SD 0.97). The score of "I've had it" also increased significantly post COVID-19 in both age classes, duration of illness classes, and in females and males (P<0.001), also increase significantly post COVID-19 compared with that pre COVID-19 in subjects with high, medium, and low educational levels (P<0.001). Conclusion: Lockdown procedures related to the COVID-19 pandemic had a major impact on stroke cases whose post COVID-19 burnout levels had increased and led to worse management outcomes. Keywords: Post COVID-19, Burnout, Stroke, Cross sectional study, Cairo University, Egypt.
INTRODUCTION
anxiety, or depression symptoms, as well as
Since the first appearance of COVID-19, there
loneliness (8). There was a marked shift in
are new insights into various clinical presentations
rehabilitation resources during the COVID-19
beyond the acute respiratory illness, including
epidemic without taking into account the
cardiovascular and cerebrovascular complications in
fundamental need for stroke cases who were released
particular stroke (1).
with little to no rehabilitation (9).
Stroke has been defined as a non-traumatic,
focal vascular-induced injury with rapid onset of
Low motivation and productivity, as well as
symptoms of focal neurological dysfunction that
mental and behavioural issues, are all associated
affects nearly 13.7 million new strokes reported
with burnout (10). Burnout and stress recently
every three years (2). It typically results in permanent
displayed a strong beneficial association during the
damage and is reported as the third largest cause of
COVID-19 epidemic (11). Therefore, the aim of the
disability and dementia (3).
current study was to investigate the consequences of
Worldwide recorded stroke hospital visits
the COVID-19 pandemic in Egypt on the level of
incidence during the COVID-19 pandemic has
burnout in stroke cases.
decreased (4), which represents around 3.3% of all
stroke admissions, which declined by 11.5% PATIENTS AND METHODS
compared to immediately before (5).
A cross sectional study was conducted
The COVID-19 pandemic has had a
between October 2022 and January 2023. A total of
substantial impact on stroke patients who exhibit
100 Egyptian stroke male and female cases
extreme anxiety and possible infection anxieties
participated in the study. They were diagnosed
while visiting hospitals, as well as phobia,
following a thorough clinical examination, brain
somatization, and despair (6). Additionally,
MRI and computed tomography (CT), and sent to a
neurological abnormalities slow the healing process
physical therapy outpatient clinic.
and lower mental quality of life (QOL), especially in
individuals with a history of stroke (7). Recent reports Inclusion criteria were medically stable stroke
have linked certain behaviours to detrimental effects
patients living in Egypt within the time frame of pre-
on mental health and well-being, including stress,
and post-COVID-19, both genders, ages ranged
4393
Received: 15/11/2022 Accepted: 17/01/2022
c:\work\Jor\vol911_95The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4399-4404
Significance of Adequate Upper Gastrointestinal Bleeding Management Planning on Healthcare Outcomes: A Review of Current Literature Naseralla J E Suliman 1, Marei O Ali Jahany 2 1Consultant General Surgeon, Benghazi Medical Center, Benghazi-Libya - Libyan Council of Medical Specialties/General
Surgery, 2Consultant General Surgeon, Hawarii General Hospital, Benghazi-Libya Corresponding Author:Naseralla J E Suliman, e-mail: elsaadidawn @ gmail.com. Mobile: + 218925101190 / +218915101190, ORCID identifier: 0000-0002-4481-1986 ABSTRACT Background: Gastrointestinal bleeding is a frequent medical emergency with a steady 10% mortality rate for 20 years. Upper gastrointestinal bleeding is an increasing global health issue requiring quick evaluation, resuscitation, coagulation correction, and interventions. Objectives: The study aimed to evaluate if a comprehensive approach involving quick evaluation, resuscitation, coagulation correction, and timely diagnostic or therapeutic intervention can improve outcomes of upper gastrointestinal bleeding patients. Patients and Methods: The retrospective analysis examined hospital records of 224 patients with upper gastrointestinal bleeding proximal to the Treitz ligament admitted to Al-Jalla Hospital from January to December 2021. The study collected clinical presentation, investigation, and outcome data through a specialized form. Results: The study analyzed 224 patients with upper gastrointestinal bleeding, with 65% male preponderance and almost half being over 60 years old. The majority (79.5%) were admitted to general surgical wards, and melena was the most common symptom (72%). Endoscopic findings revealed duodenal ulcer, gastric ulcer, and erosive gastritis in 21% of cases each, and erosive esophagitis in 9%. The mortality rate was 16%, with higher rates observed in patients over 60 years. Conclusion: The study found a mortality rate of 16% in the patient population, indicating a need for more resources and a more comprehensive approach to patient management. Keywords: Emergency admission, Endoscopy, Hematemesis, Melaena. GI bleeding.
INTRODUCTION
the UK (1). Clinical aids include a systolic blood pressure
Upper gastrointestinal bleeding (UGIB) is a
of less than 90 mmHg or a heart rate of more than 110
medical emergency requiring fluid replacement and blood
beats per minute (4, 5). Recent landmark UK publications
transfusion. Endoscopy should be performed within 24
on the topic include the 2015 NCEPOD Massive GI
hours, and bleeding can be stopped using various
Haemorrhage Report and the 2018 UK Lower GI
techniques (1). Gastrointestinal bleeding can occur
Bleeding Collaborative audit (1, 2, 6). Comorbidities and
anywhere along the gastrointestinal tract and is classified
lack of fitness for treatment are significant contributors to
as upper or lower depending on its origin. UGIB refers to
the risk of mortality following severe UGIB, as reported
bleeding from the esophagus, stomach, or duodenum,
by NCEPOD (1, 6).
which can be accessed with a standard fiberoptic
In Western nations, UGIB has an annual incidence
endoscope. This type of hemorrhage is subclassified as
of approximately 100 cases per 100,000 people and is four
non-variceal (89%) or variceal (associated with liver
times more common than LGIB. Despite the high
disease) (11%). Mortality rates for UGIB have remained
incidence, more than 75% of UGIB cases are resolved
unchanged since the 1990s (1, 2), at approximately 10%.
with supportive treatments. Symptoms may include
Lower gastrointestinal bleeding (LGIB), on the other
abdominal pain, lightheadedness, dizziness, syncope,
hand, occurs distal to the ligament of Treitz and includes
hematemesis, and melena. Gastroenterologists, surgeons,
bleeding of jejunal, ileal, colonic, rectal, or anal origin.
and interventional radiologists may collaborate in the
Although less common than UGIB, in-hospital mortality
treatment of UGIB cases that require further intervention
rates for LGIB can be as high as 3.4%.While classifying (7, 8).
hemorrhage as upper or lower gastrointestinal can aid in
UGIB is characterized by symptoms such as melena
diagnosis and management, guidelines recommend that
or hematemesis. Misdiagnosis of LGIB is common when
both groups be regarded as one clinical entity for the
brisk upper GI bleeding presents with hematochezia.
delivery of care and structured accordingly (3).
Conversely, patients with bleeding from the caecum or
Massive UGIB can be defined as the transfusion of
distal small bowel may present with melaena (7, 34).
at least four units of packed red blood cells, or as the loss
Mortality rates have remained constant despite
of one blood volume in 24 hours, 50% of total blood
advancements in endoscopic and minimally invasive
volume within 3 hours, or blood loss of more than 150
treatments (9). A full gastrointestinal examination is
ml/minute, according to the NHS transfusion service in
necessary to localize the source of bleeding and identify
4399
Received:15/11/2022 Accepted:17/01/2023
c:\work\Jor\vol911_96The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4405-4408
Outcome of Internal Fixation of Pott's Fractures of the Ankle Joint in Diabetic Patients Omar Abdelwahab Kelany, Waleed Mohammed Nafea, Eslam Mohammed Elnaggar*, Mohamed Hussien Elsayed
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Eslam Mohammed Elnaggar, Mobile: (+20) 01027443022, Email:[email protected] ABSTRACT Background: One of the most frequent injuries that orthopedic surgeons treat is an ankle fracture. There are more ankle fractures today prevalent in this patient population as the frequency of diabetes mellitus (DM) has increased. Objective: The current study was to look at how well for Pott's fractures, open reduction internal fixation with plates and screws were successful of the ankle joint in diabetic patients. Patients and methods: A descriptive follow up study was conducted on 30 patients with ankle Pott's fractures visiting the orthopedic outpatient clinic of Zagazig University Hospital. Internal fixation and open reduction were used to treat all patients. Operative fixation was done through ORIF by plate and screws according to AO principles of periarticular fracture fixation. Results: The high union rate occurs mainly at week 10 at higher percent (74%) in controlled diabetic patients, while union rate in uncontrolled diabetic patients was delayed till 6 months. Patients with DM experience higher complication rates with both open and closed methods for ankle fractures. People with poorly controlled diabetes who have high HbA1c levels experience more complications than those with well-controlled diabetes. Conclusion: Bimalleolar ankle fractures respond well to surgical treatment in controlled diabetic patients, providing good functional outcome. Keywords: Ankle, Pott's fractures, Diabetes mellitus, Follow up study, Zagazig University.
INTRODUCTION
One of the most frequent injuries that orthopedic PATIENTS AND METHODS
surgeons treat is an ankle fracture. With a rise in diabetes
A descriptive follow up study was conducted on 30
mellitus prevalence and ankle fractures are becoming
diabetic patients with ankle Pott's fractures visiting the
more common in this patient population. Compared to
orthopedic outpatient clinic of Zagazig University
any other risk factor, diabetes mellitus had the highest
Hospital. Internal fixation and open reduction were used
prevalence of postoperative complications and
to treat surgically all patients.
amputation after ankle fracture repair. Despite having the
The most frequent form of injury was twisting, and
proper surgical care, diabetics are also more likely to need
the most frequent fracture type was supination-external
additional treatments and have worse scores for activity
rotation type. The average age was 50 years.
limitation. Despite this, sustained results are still
uncertain because researchers frequently report Inclusion criteria: Recent isolated or bimalleolar Pott's
inconsistent findings (1).
fracture. Adults Patients aged more than 18 years old.
Diabetics make up about 1 in 8 patients who have Exclusion criteria: Poly trauma patient. Open fractures.
rotational ankle fractures need surgical treatment.
Patients who are older than 70 or younger than 18 years
Diabetes patients have been found to have between 26%
old. Old Trauma. Non-Diabetic Patients. Bone deformity
to 47% more problems following ankle fracture surgery
or diseases. Pathological fractures. If death occurred
than non-diabetic patients in comparable control groups
during the review period. Patient's ability to effectively
(2).
fill out surveys was compromised by dementia or other
According to a recent large-scale investigation,
mental health conditions.
diabetes mellitus had the highest likelihood of amputation Pre-operative: Anteroposterior, lateral, mortise, and
following the treatment of ankle fractures. Due to the
other optional views such as manual stress and gravity
higher risk of infection and other major surgical
stress views were used to evaluate ankle fractures.
complications, diabetics are also more likely to require
HbA1C and blood glucose levels were measured
secondary operations and have worse results in terms of
randomly and after fasting in the lab. In addition, blood
the activity limitation score (3).
count, liver function tests, kidney function tests, HIV,
The current study was to look at how well for Pott's
HBV, and HCV screening were done before surgery.
fractures, open reduction internal fixation with plates and Operative Technique: With both spinal and epidural
screws were successful of the ankle joint in diabetic
anesthesia, the patient was lying on his back. To enhance
patients.
lateral side exposure, the contralateral buttock was lifted
4405
Received: 09/11/2022 Accepted:11/01/2023
c:\work\Jor\vol911_97The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4409-4413
Diagnostic Accuracy of Lung Ultrasound in Determining the Position of the Endotracheal Tube in Mechanically Ventilated Children Eman Mohammed Mohammed El-Hindawy1, Hanan Saqr Sherbini1, Mona Mohammad Alshafei Abdel all1, Mohamed Ibrahim Amin Ibrahim2, Ebtisam Ali Khalifa Ramadan1*
Department of Pediatrics1, Radiodiagnosis2, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Ebtisam Ali khalifa Ramadan, Mobile: (+20) 01557467899, E-mail:[email protected] ABSTRACT Introduction: Due to their short and narrow airways, endotracheal intubation in children is difficult and demands a high degree of precision. Chest X-rays (CXR) are the current gold standard for endotracheal tube (ETT) verification. Objective: The aim of the current study was to evaluate the role of lung ultrasonography in confirming ETT installation in children receiving mechanical ventilation. Patients and methods: A cross-sectional study was carried out at pediatric intensive care unit (PICU), Faculty of Medicine, Zagazig University Children Hospitals. A total of 30 patients, aged between 28 days and 16 years were enrolled in the study. History taking and general clinical examination were performed on all patients. The ETT was inserted and the position is adjusted by the guide of ultrasonography (Alpinion E Cube i7). Thereafter, all patients were subjected to CXR. Results: Incidence of correct ETT position with CXR was 53.3% compared to 86.7% with ultrasound (P=0.002). Agreement between ETT position detected by CXR and ETT position detected by ultrasound had a fair level. Only 17 (56.7%) children were survived after endotracheal intubation and 13 (43.3%) died among the 30 studied children. Percent of children's death among children of once intubation was 10%, while percent of children's death among repeated intubation was 33.3%. Conclusion: Lung ultrasonography can be used as a fast, safe and effective tool for confirming the correct placement of ETT in mechanically ventilated children, especially in conditions where CXR and capnography are not reliable or inaccessible. Keywords: Endotracheal intubation, Chest X-ray, Ultrasound, Cross sectional study, Zagazig University.
INTRODUCTION
anatomy can interfere with LUS evaluation for the ETT
Due to their short and narrow airways, endotracheal
position.
intubation (ETT) in children is difficult and demands a
History taking and general clinical examination
high degree of precision. It is imperative to confirm the
were performed on all patients. The ETT was inserted and
proper placement of the ETT because it is frequently
the position is adjusted by the guide of ultrasonography
mispositioned (1). This could lead to atelectasis or air leak
(Alpinion E Cube i7). Thereafter, all patients were
syndromes such as esophageal insertion, unintentional
subjected to CXR. By analysing lung parenchymal
extubations, and inappropriate mainstem bronchial
movement during the breathing cycle (sliding along the
intubations (2).
parietal pleural line), the probe position was verified.
Pediatric intensive care unit (PICU) requires
When a bilateral sliding lung was clearly visible on a LUS
multiple X-rays to position the ETT because chest x-ray
and the tip of the ETT could not be detected in the
(CXR) is the typical method for doing so. Lung
extrathoracic trachea in longitudinal view, the insertion
ultrasonography (LUS) can be utilized to evaluate ETT
depth of the ETT was deemed to be accurate. Each
location in the trachea, according to a modest number of
procedure's duration was noted. Each patient's required
feasibility studies (3). Therefore, the aim of the current
number of modifications was noted.
study was to evaluate the role of lung ultrasonography in
confirming ETT installation in children receiving Ethical Consideration:
mechanical ventilation. This study was ethically approved by the Institutional Review Board of the Faculty of Medicine, PATIENTS AND METHODS Zagazig University. Written informed consent was
A cross-sectional study was carried out at pediatric obtained from parents of all participants. This study
intensive care unit (PICU), Faculty of Medicine, Zagazig was executed according to the code of ethics of the
University Children Hospitals. A total of 30 patients, aged World Medical Association (Declaration of Helsinki)
between 28 days and 16 years were enrolled in the study. for studies on humans. Inclusion criteria: Mechanically ventilated children
needing endotracheal intubation. Statistical Analysis Exclusion Criteria: Patients with congenital airway
The collected data were introduced and statistically
anomalies or anticipated difficult intubation were
analyzed by utilizing the Statistical Package for Social
excluded. Also, patients with anatomical neck problems
Sciences (SPSS IBM Corp., Armonk, New York) version
were not accepted distortion, as the neck distorted
23.0 for windows. Qualitative data were defined as
4409
Received: 14/10/2022 Accepted: 07/12/2022
c:\work\Jor\vol911_98The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4414-4417
Role of Tongue Fat in The Pathogenesis of Obstructive Sleep Apnea: Review Article Ali Abdullah Amer Elfeires1, Tarek Abdel Zaher Emara1, Ashraf Elsayed El-Malt1, Mohamad Gamal nada2, Alsayed Abdulmageed Alsayed1
1Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
1Department of Radiology, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Ali Abdullah Amer Elfeires, Mobile: 01032911676, Email: [email protected] ABSTRACT
Humans are fortunate to have sleep. A happy, fulfilling life depends on getting a restful night of sleep. Obstructive
sleep apnea is a widespread sleep disorder is characterized by snoring loudly, difficulty breathing, and partial or complete lack of sleep. Systemic side effects from chronic obstructive sleep apnea may affect the cardiovascular system and other important body organs. Although the exact cause is unknown, a number of factors may contribute to this condition. Increased intramuscular fat may impair the tongue's capacity to act as a pharyngeal dilator muscle by changing its shape and decreasing its contractile force. More fat was found in apneic person at the base of the tongue, where the tongue's extrinsic muscles attach to the bone. Each extrinsic muscle's ability to position the tongue correctly away from the airway may be impacted by the increased fat.
INTRODUCTION
is related to obesity (5). It has not yet been determined
An important upper airway soft tissue risk factor
whether it is possible to pass on fat deposits in the tongue's
for OSA is the tongue, which has a high fat content
upper airway muscles. Despite the fact that it has been
according to previous autopsy (1) and fast spin echo
shown OSA patients appear to preferentially deposit fat in
imaging (2) studies. However, these studies didn't focus
both the tongue and the cheeks and soft palate, despite the
specifically on OSA sufferers. They have demonstrated
fact that tongue size is inherited (6). Significant OSA
that the intramuscular fat content of the tongues of obese
intermediate phenotypes may include increased
apneic person is extremely high (32.6%).
intramuscular tongue fat and fat percentage, especially at
The average percentage of tongue fat in controls
the base of the tongue (7).
was found to be slightly higher (27.7%) than in the earlier Tongue Fat's Role in the Pathogenesis of OSA
autopsy (1) and imaging (2) studies, according to Kim et al.
People think that the tongue is the biggest and most (3). However, Kim et al. found that the masseter muscle
important muscle that opens up the throat (8). Four muscles
had a low percentage of fat, suggesting that fat is not
outside the body (external bony origin and insertion into
uniformly deposited in the muscles of the upper airway
the base of the tongue) are the only muscles that anchor it
and that the tongue may be a unique reservoir for fat
to bone, unlike other muscles, other than that at the base.
deposition(3). They also found that compared to control
It is a distinct muscle that moves unhindered
tongues, the apneic tongue is bigger and contains more
(genioglossus, hyoglossus, styloglossus, palatoglossus).
intramuscular fat. Although the differences in the overall
longitudinal, verticalis, and transversus superior and
percentage of tongue fat between cases and controls were
inferior, the four muscles near the top of the tongue that
not statistically significant after covariate adjustment
start and end inside the tongue control how the tongue
(32.6% vs. 27.7%, P = 0.089), they did find statistically
changes shape while these extrinsic muscles control
significant differences between apneic person and
tongue positioning. The tongue's useful abilities to
controls in the RG region of the tongue, particularly near
maintain the patency of the airways are facilitated by the
the base. Both apneic person and controls had the same
specific fiber compositions of its muscles (9). Increased
masseter muscle volume and masseter fat composition.
tongue fat, according to Kim et al., may impair muscle
These findings prompt significant queries about the
function in addition to increasing The size and
causes of the significant intramuscular fat percentage
collapsibility are influenced by the tongue's size of the
differences between a person's upper airway muscles and
airways(3). Increased intramuscular fat, in particular, may
the reasons why fat is preferentially deposited in the
change the tongue's contractile force and shape, making it
tongue. The apneic tongue's increased fat content may
less effective as a muscle that dilates the pharynx. At the
have genetic roots claim (3). Fat distribution phenotypes
base of the tongue, where the tongue is attached to the
have been shown to be genetically heritable, and it has
bone by extrinsic muscles, they discovered a higher
been shown that the increased fat content of the apneic
proportion of fat in apneic person. Each extrinsic muscle's
tongue, as well as lower body fat deposition, are under
ability to the tongue should be properly positioned away
genetic control (4).
from the airway may be impacted by the increased fat.
In the past, it has been shown that fat has built up
The upper airway's size and shape are significantly
in men's bellies and women's necks an effect on OSA that
influenced by the tongue. Increased fat at the tongue's
4414
Received: 14/09/2022 Accepted: 17/11/2022
c:\work\Jor\vol911_99The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4418-4421
Different Types and Importance of Negative Pressure Drain:Review Article Mohamed Abdel-moniem Ibrahem, Hanan Atef Ghaly, Hibah Hamad Abraheem, Abd Elrazik Elsayed Abd Elrazik
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Hibah Hamad Abraheem, Mobile: (+02) 01007513429), E-mail:[email protected] ABSTRACT Postoperative unimpeded drainage is crucial for preventing hematoma and fluid collection formation as well as postoperative consequences. Aim: To discuss the characteristics and key points of clinical management of types of commonly used negative pressure drainage systems. Keywords: Negative pressure, Drainage, Complications.
INTRODUCTION
subcutaneous plane. The drain output is subsequently
Surgical site infections (SSIs) are a significant
carefully observed. One method to combat seroma may
postoperative complication. These infections happen
be to use these drains behind flaps. After that, it can be
within 30 days of surgery for the deep layers, and 30 to
removed sterilely and covered with pressure dressing. The
90 days for the superficial layers, when microorganisms
seroma if gathers once more, the incision should be
penetrate the tissues. Two more categories of SSIs are
opened to remove it. Seroma should be evacuated if it
organ/space and incision. There are two types of
returns after two aspirations by releasing the stitch and
incisional SSIs: superficial and deep. SSIs even though
applying saline gauze to the wound to promote secondary
they are only allowed at surgical sites. The epidermis and
healing (1). By resolving the issues with the clotting
superficial fascia are affected by superficial SSIs, whereas
factors, hemostasis can be avoided (4). Interrupted sutures
the fascial and muscle layers are infected by deep SSIs.
or synthetic mesh are the most secure options for high-
Within 30 or 90 days following surgery, Any tissue below
risk patients. This has shown to be quite helpful coupled
the fascial layer that was engaged in the procedure gets
with wet surgical gauze, an iodophor dressing, and
infected by organ/space SSIs (1).
continual suctioning. In 7 to 10 days, the wound can be
The incidence of SSI varies between 0.5 and 15%
stitched up. If the wound cannot be stitched shut, it is
globally. Increased dead space, hematoma, or tissue that
instead allowed to granulate before being stitched shut
has lost vitality are all consequences of poor surgical
with a skin graft. According to several research, using
methods--increase the risk of infection. It also applied to
subcutaneous catheter covered in an antibiotic solution
any other foreign object, such as stitches or drains.
and irrigated with saline works best for filthy wounds (1).
Additionally, it has been reported that individuals with
high body mass indexes (BMIs), documented histories of Types of surgical drain:
drinking, chronic heart conditions, and diabetes are key 1. Open or closed
risk factors for developing SSI(2).
Fluid is drained from open drains (such as
Due to the general reduction in immunological
corrugated rubber or plastic sheets) into a stoma
activity they produce, delayed wound healing occur. The
bag or a gauze pad. They probably make becoming
kind of wound and operations also played a significant
sick more likely.
influence; for example, a contaminated wound receiving
Tubes draining into a bottle or bag provide closed
an urgent procedure (such as an emergency caesarean
drains. Drains for the chest, abdomen, and joints are
section) is more likely to develop SSI following the
a few examples. Infection risk is generally
procedure than a clean wound experiencing a similar
decreased.
procedure (elective caesarean section) (1). 2. Active or passive
These infections manifest as erythema,
Suction is used to sustain active drains (which could
discomfort, fever, pus discharge from wounds, and
be high or low pressure).
dehiscence. Several strategies have been used to decrease
Passive drains work by using the difference in
them, including shaving, using chlorhexidine to wash
pressure between bodily cavities and the outside
hands, and receiving antibiotics before surgery (3).
environment rather than suction (5).
In surgical wounds following surgery, the use of 3. Silastic or rubber
subcutaneous drains has appeared to be really hopeful,
Silastic drains cause little tissue reactivity and are
especially in emergency laparotomies. The idea behind it
largely inert.
was to eliminate any accumulated in order to reduce the
Red rubber drains may cause a strong tissue
risk of infection and wound complications, remove any
reaction and occasionally cause a tract to form (this
fluid or debris and fill in any dead areas in the
4418
Received: 27/09/2022 Accepted: 30/11/2023
c:\work\Jor\vol911_100The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4422-4426
Effectiveness of Antimuscarinics and Beta-3 Adrenoceptor in Adult Female with Overactive Bladder 1 Mohamed Moustafa Zaitoun, 1 Ahmed Ismail Heraiz, 2 Eslam Elshafey, 1 Mahmoud Abubakr Negm 1 Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University 2 Clinical Pathology Department, Al-Ahrar Zagazig Teaching Hospital Corresponding author: Ahmed Ismail Heraiz, Email: [email protected]Mobile: 00201006759210 ABSTRACT Background: Overactive bladder (OAB), a clinical condition with chronic, complex symptoms that negatively affect quality of life (QoL) and affects a large section of the population. Beta-3 adrenergic agonists that provides a different mode of action and are still in the early stages of development, are being used more frequently than antimuscarinics to treat OAB.Aim: To compare between antimuscarinics and a beta-adrenergic agonist (mirabegron) regarding efficacy and side effects in treatment of adult female with overactive bladder. Patients and methods: This prospective trial was carried out in the Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University on 82 female patients with OAB. Patient groups were divided into two groups (mirabegron 50 mg n = 41 and tolterodine 4 mg n = 41). Results: There was a significant difference between each group's baseline and final assessment in terms of post-void residual urine, number of micturitions, urgency episodes, incontinence episodes, and urgency incontinence episodes/24 h, volume voided/micturition, number of nocturia episodes, and number of incontinences. The only significant difference between the two groups was a lower number of nocturia episodes in mirabegron than tolterodine. Conclusion: In the Egyptian population, with a low incidence of side effects, mirabegron 50 mg and tolterodine 4 mg are efficient therapies for OAB symptoms. Keywords: Antimuscarinics, Beta-3 adrenoceptor, Overactive Bladder.
INTRODUCTION
incontinence after antimuscarinic therapy (9). Although
An overactive bladder (OAB) is defined as the
nasopharyngitis (3.4%), urinary tract infections (3%),
presence of urine urgency, typically accompanied by
and hypertension (7.3%) are among the most frequently
frequency and nocturia, with or without urgent urinary
reported side effects of mirabegron therapy, mirabegron
incontinence, in the absence of a urinary tract infection
nevertheless has a higher drug adherence and
or other obvious pathology (1). The two primary current
persistence tolerability rate than antimuscarinics.
ideas for its multifactorial pathogenesis are enhanced
Selective agents and various administration methods
afferent signaling (the urothelium-based theory) and
have the potential to improve adherence, but these
aberrant detrusor excitability (myogenic hypothesis) (2).
advantages have not been demonstrated in clinical
OAB impairs sexual function, mental health, sleep
settings, preventing many patients from accessing
quality, and quality of life (QoL) while being regarded
appropriate treatment (6, 10).
as a benign illness (3).
So, we aimed to compare between antimuscarinics
Due to disappointed expectations or unacceptable
and a beta-adrenergic agonist (mirabegron) regarding
side effects, many patients choose to stop receiving
efficacy and side effects in treatment of adult female
OAB treatment despite many advancements. Even
with overactive bladder.
though antimuscarinic medications were effective as the
first line of treatment for OAB, unfavorable side effects PATIENTS AND METHODS
continue to prevent patients from complying with their
This prospective trial was carried out in the
prescriptions as recommended (4).
Obstetrics and Gynecology Department, Faculty of
The management of OAB symptoms and
Medicine, Zagazig University on 82 female patients
enhancement
of
health
outcomes
require
with OAB. Patient groups were divided into two groups
pharmacotherapy (5). Despite the effectiveness of
(mirabegron 50 mg n = 41 and tolterodine 4 mg n = 41).
antimuscarinic medications in controlling OAB,
The study comprised patients who had overactive
compliance and adherence to antimuscarinic therapy are
bladders (OAB), were female only, and were older than
negatively impacted by negative symptoms such
18 years old. Patients with claims for two or more OAB
constipation, fatigue, blurry vision, dry mouth, and
products on the same day (data for combinations of
cognitive impairment (4, 6). According to numerous
mirabegron with antimuscarinics or the use of two or
studies, low effectiveness and a significant incidence of
more different antimuscarinics were not captured),
unfavorable events cause antimuscarinic therapy
diabetic patients, people with congenital renal diseases,
adherence to be low and to decline over time (7, 8).
people with neurogenic bladders, and people with all
Mirabegron, an alternative to antimuscarinic
cases of genitourinary tract cancer were excluded from
drugs, has been shown to reduce overactive bladder
the study.
symptoms such frequency, urgency, and urgency
c:\work\Jor\vol911_101The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4427-4433
An Overview about Left atrial Strain and its Imaging: Review Article Marwa Abdullah Abdulkarim, Mahmoud Hasan Abdalqader Shah, Hala Gouda Abomandour, Moataz Hassan Ali
Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt *Corresponding author: Marwa Abdullah Abdulkarim, Mobile: (+20) 0 102 420 0845, E-Mail: [email protected] ABSTRACT Background: Strain is a metric that analyses the extent to which the segment under study has been deformed in comparison with its original dimensions. A percentage represents this value here. Strain and strain-rate imaging is better to conventional echocardiography for evaluating Left atrial (LA) function because it can distinguish between active and passive cardiac tissue movement. Objective: Review of literature andassessment of left atrial strain as well as its imaging. Methods: Left atrial strain and imaging were searched for on Science Direct, Google Scholar, and PubMed. The authors also reviewed the relevant literature, nonetheless, only the most recent or exhaustive analysis was included, covering the time span from May 2002 to January 2023. There are no translation resources available, thus non-English documents are out. Unpublished articles, oral presentations, conference abstracts, and dissertations were not included because they were not considered to be part of major scientific projects. Conclusion: When compared to more conventional parameters of LA function, the strain parameter is less load dependent and more resistant to tethering effects. It is also possible to assess phasic atrial function throughout the cardiac cycle by measuring strain and strain rate. Keywords: Left atrial strain, Imaging.
INTRODUCTION
component is immediately confluent with the body and
In the middle of the chest, behind the right atrium, is
features venous orifices at each corner [1]. The five layers
where the left atrium (LA) resides (RA). Located
of the left atrial wall are the roof, the infero-posterior, the
posteriorly and superiorly, the pulmonary venous
left lateral, the septum, and the anterior (Figure 1).
Figure (1): Segmentation of the left atrium using a five-segment model in transthoracic 2D echocardiography [2].
c:\work\Jor\vol911_102The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4434-4439
Options of Treatment of Post Acne Scar: Review Article Amin Mohamed Mohamed Amer, Alaa Mohamed Abdallah Zakzouk, Mai Samir
Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Alaa Mohamed Abdallah Zakzouk, Mobile: 0 101 627 9216 ABSTRACT Background: Despite improvements in acne treatment, post-acne scarring is still a widespread issue. Scarring is difficult to treat and difficult to avoid. Inflammatory mediators and enzymatic breakdown of collagen fibres and subcutaneous fat are likely involved in the aetiology of atrophic acne scarring. Objective: Review of the literature on options of treatment of post acne scar. Methods: PubMed, Google Scholar, and Science Direct were some of the places we explored for information about post-acne scarring and its treatment. Between January 2000 and May 2021, however, only the latest or most comprehensive study was considered. The authors also assessed the usefulness of references taken from similar books. We haven't paid attention to non-English documents because we don't have the time or money to translate them. Unpublished articles, oral presentations, conference abstracts, and doctoral dissertations were all widely acknowledged to not constitute valid scientific research. Conclusion: Facial resurfacing procedures like dermabrasion and microdermabrasion mechanically ablate damaged skin and stimulate re-epithelialization. When performed properly, dermabrasion can remove the epidermis and reach the reticular or papillary dermis underneath. Both invasive and noninvasive treatments have been tried with varied degrees of success to cure atrophic scars, but it is still difficult to reach the aim of complete improvement, even with the most expensive approaches. Consequently, there is a growing need for therapeutic approaches that are both highly successful and very inexpensive in the treatment of acne scars. Keywords: Post acne scars, Matrix metalloproteinases (MMPs).
INTRODUCTION
scars are a potential outcome at any stage of the disease.
Up to 95% of acne sufferers have some degree of
Existing acne scars are frequently irreversible, but can
acne scarring, with 30% reporting severe acne scarring
be avoided if inflammatory and nodulocystic acne are (1). Scarring from acne is common when medical care is
treated early (5).
delayed or is not sufficient, although it can also occur
Scarring from acne can occur regardless of
even when treatment is adequate. Acne inflammation
whether or not the condition is properly treated with
causes collagen and other tissues to break down,
medication. Acne inflammation causes collagen and
resulting in long-term changes in skin texture and
other tissues to break down, resulting in long-term
fibrosis. Common wound healing stages include
changes in skin texture and fibrosis. Common wound
inflammation, granulation, and remodeling, which all
healing stages include inflammation, granulation, and
contribute to the formation of a scar. Scarring from acne
remodeling, which all contribute to the formation of a
is difficult to treat, and many methods may only be
scar (6).
partially successful, which can lead to dissatisfaction
The intricate process of wound healing involves
and frustration among patients (2). Acne scarring's
many different types of cells. Parenchymal resident
consequences are not restricted to its visual
cells such as infiltrating blood cells like lymphocytes,
manifestations. Acne scarring, on the other hand, has
monocytes, and neutrophils are all examples of these
been linked to mental health issues including depression
(collectively referred to as immunoinflammatory cells)
and suicide ideation as well as emotional and social (7). Inflammation, granulation tissue development, and
impairments like shame and low self-esteem (3).
matrix remodeling are the three phases of the wound-
About 90% of acne scars are related with collagen
healing process (8).
loss (atrophic scars), whereas the remaining 10- 20%
The
coagulation
cascade,
which
causes
show collagen gain (keloidal or hypertrophic scars).
inflammation, is triggered shortly after an injury. When
Resulting from the contraction of fibrous tissue,
a wound is made, platelets are the first cells to appear
atrophic scars appear as depressions. We can divide (9). Furthermore, melanogenesis may be prompted. Post-
atrophic acne scars into three distinct types: boxcar,
acne erythema and hyperpigmentation are greatly aided
icepick, and rolling (4).
by this process. Scarred cases showed a more severe and
longer-lasting
inflammatory
reaction
at
the Pathogenesis of atrophic acne scar:
pilosebaceous gland (10). The high correlation between
Atrophic acne scars have a complex aetiology that
inflammation severity and duration and scar formation
likely involves inflammatory mediators, as well as the
shown by Holland et al. (11) suggests that reducing
enzymatic breakdown of collagen fibres and
inflammation in acne lesions early may be the most
subcutaneous fat. It may seem like there's a direct
effective way to avoid scarring. More scar tissue forms
proportion between how bad your acne is and how bad
when inflammation levels are high throughout the
your scars will be, but that's not always the case. Acne
healing process. Acne scarring is accompanied by an
4434
Received: 16/11/2022 Accepted: 18/01/2023
c:\work\Jor\vol911_103The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4440-4444
Overview about Correlation between Heart Failure and Diabetes Mellitus: Review Article Azeezah Rabeea Raghib Mabrouk, Laila Mohamad Elmaghawry, Ahmed Shawky Shereef, Mohamed Saad El-Shetry
Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt *Corresponding author: Azeezah Rabeea Raghib Mabrouk, Mobile: (+20) 01228385454, E-Mail: [email protected] ABSTRACT Background: Myocardial shape and function can be altered by diabetes alone, without the presence of other risk factors like hypertension, ischemic heart disease and a condition known as diabetic cardiomyopathy (DCM). Diabetes is associated with a wide range of metabolic disturbances, some of which have been linked to the emergence of DCM. Some examples are elevated blood sugar levels, abnormal lipid profiles, an increase in the release of free fatty acids (FFAs), and insulin resistance. Objective: Review of literature about correlation between heart failure and diabetes mellitus. Methods: Heart failure and diabetes mellitus were searched for on Science Direct, Google Scholar, and PubMed. The authors also reviewed the relevant literature, nonetheless, only the most recent or exhaustive analysis was included, covering the time span from September 2010 to November 2022. There are no translation resources available, thus non- English documents are out. Unpublished articles, oral presentations, conference abstracts, and dissertations were not included because they were not considered to be part of major scientific projects. Conclusion: There is a lack of understanding of the molecular underpinnings and pathophysiology of heart failure in diabetic people. The incidence, prevalence, and outlook for heart failure in diabetic individuals have been proven by certain clinical and epidemiologic data. In recent decades, diabetic heart disease has emerged as a major contributor to the mortality rate among diabetics. Keywords: Heart failure, Diabetic cardiomyopathy, Diabetes mellitus.
INTRODUCTION
and cellular damage. Protein kinase C is activated,
"Diabetic cardiomyopathy" is utilized despite its
protein glycation is permanent, and the hexosamine and
fuzziness when cardiac dysfunction is apparent in
polyol pathways also experience enhanced flux (3).
diabetic persons who do not suffer from heart disease,
As a result, mitochondrial reactive oxygen
valve disease, or other related complications (1). The term
species (ROS) production, glutathione reductase (GR)
"diabetic cardiomyopathy" was coined in 1972 to
activity decrease, and advanced glycation end-product
describe myocardial dysfunction in diabetic individuals
creation follow from these metabolic alterations. The
who did not also have valvular heart disease, hypertrophy
increased oxidative stress causes a disruption in the
or coronary artery disease. Diabetes-related heart failure
oxidative equilibrium, which in turn damages
is a poorly understood aetiology and molecular
deoxyribonucleic acid (DNA) and hastens the death of
processes. Diabetes-related heart failure has been studied
cardiomyocytes. Diastolic dysfunction can also result
clinically and epidemiologically, and its incidence,
from hyperglycemia's direct effects on calcium (Ca2+)
prevalence, and prognosis have been documented. In
homeostasis components. Diabetic hearts have reduced
recent decades, diabetic heart disease has emerged as a
glucose uptake via insulin-dependent glucose transporter,
major contributor to the mortality rate among diabetics.
resulting in decreased glucose availability in the
Diabetic cardiomyopathy (DCM) refers to alterations in
myocardium (4).
myocardial shape and function caused by diabetes alone,
Increased glycation of several circulating
rather than by additional risk factors such as ischemic
proteins, including haemoglobin, is another consequence
heart disease or hypertension. Heart energy metabolism,
of prolonged hyperglycemia. Several studies have shown
cardiac remodeling, and hypertrophy, and diastolic
that cardiovascular illness such as heart attack, stroke,
dysfunction are all symptoms (2).
and heart failure are associated with elevated levels of
Diabetes is associated with a wide range of
glycosylated hemoglobin. Perumal and colleagues(5)
metabolic disturbances, some of which have been linked
found that diastolic dysfunction was significantly
to the emergence of DCM. There is an increase in the
correlated with the level of HBA1c of diabetic cases.
release of free fatty acids (FFAs), hyperglycemia, and
Chronic dyslipidemia, defined as both quantitative and
insulin resistance. Hyperglycemia is a consequence of
qualitative abnormalities of lipoproteins, has been
both impaired glucose utilization and elevated hepatic
recently identified as a substantial contributor to the
glucose synthesis in diabetes mellitus. Animal models of
aetiology of cardiovascular disease among diabetics.
diabetes have provided mounting evidence that Al-Rasheed et al. (6) has demonstrated a strong
hyperglycemia is a key pathogenic mechanism in DCM.
correlation between elevated blood levels of triglycerides
Persistently elevated blood sugar levels, however, cause
(TG), total cholesterol (TC), and low-density lipoprotein
metabolic and molecular alterations in cardiac cells that
(LDL-C), and lower HDL-C in diabetic rats.The
ultimately lead to the production of various mediators
myocardium's structure and function are drastically
4440
Received: 16/11/2022 Accepted: 18/01/2023
c:\work\Jor\vol911_104The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4445-4449
Insight about Possible Consequences of Tracheostomy on Swallowing and Voice: Review Article Salma Saeed Mohamed Aldaker, Amal Saeed Quriba, Elham Magdy Hassan, Nasser Labeb Alnakeb
Phoniatrics and E.N.T Department, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Salma Saeed Mohamed Aldaker, Mobile: (+20), 0 111 841 8140 E-Mail: [email protected] ABSTRACT Background: About 10% of patients requiring more than 3 days of artificial breathing are expected to require tracheostomy, making it one of the most common procedures performed in the ICU. Many tracheostomized patients have difficulty swallowing, despite the fact that tracheostomy does not necessarily imply dysphagia. The patient's capacity for expressive speech is diminished once a tracheostomy is performed. Objective: Review of the literature on possible consequences of tracheostomy on swallowing and voice. Methods: PubMed, Google Scholar, and Science Direct were some of the places we explored for information about Tracheostomy, Swallowing and Voice. Between July 1992 and January 2022, however, only the latest or most comprehensive study was considered. The authors also assessed the usefulness of references taken from similar books. We haven't paid attention to non-English documents because we don't have the time or money to translate them. Unpublished articles, oral presentations, conference abstracts, and doctoral dissertations were all widely acknowledged to not constitute valid scientific research. Conclusion: Reduced laryngeal elevation is another main cause of swallowing impairment has been reported, especially with an inflated cuff, The long-held belief that tracheostomies make swallowing more difficult and increase the danger of aspiration has been disproven by a number of studies. The patient's ability to speak clearly is impaired after a tracheostomy tube is placed. Patients with tracheostomies who are otherwise healthy (i.e., have no laryngeal or pharyngeal issues) often regain their ability to speak. Keywords: Tracheostomy, Swallowing, Voice.
INTRODUCTION
Infections of the soft tissues of the neck or other
Around 10% of patients requiring more than 3
anatomical anomalies are rare but possible
days of artificial breathing are expected to require
contraindications
to
tracheostomy.
Extreme
tracheostomy, making it one of the most common
respiratory distress accompanied by hypoxemia and
procedures performed in the ICU. In addition, the rise
hypercapnia that refuse to resolve may be viewed as a
in the number of patients requiring difficult or delayed
relative
contraindication.
Hematologic
and
weaning from endotracheal tube (ETT) as a result of
coagulation
problems
are
often
seen
as
ageing and severe comorbidities has led to the
contraindications for tracheostomy, despite the fact
development of less invasive surgical techniques that
that prior research has shown that this treatment can
have made tracheostomy safe to conduct at the
be safely carried out in patients with severe
patient's bedside (1).
neutropenia or thrombocytopenia (4).
The smooth muscle segments of the
oesophagus are controlled by the brain stem, major pathways of the cortex, and the enteric nervous system. It requires the coordinated actions of many muscles, each of which is innervated by a different set of nerves. The oral phase, the pharyngeal phase, and the esophageal phase make up the physiological mechanism of swallowing in a healthy individual. Blending, mashing, and swallowing are the three steps involved in getting a bolus of food from the mouth to
the stomach (5). Figure (1): Tracheostomy tube low pressure cuffed
with an above-cuff suction facility (2). Effect of tracheostomy on swallowing:
A tracheostomy is a regular operation for patients
Acute respiratory failure with the expectation
in serious condition. It helps keep the airway
of extended continuous support, inability to wean
protected, reduces the need for mechanical ventilation,
from mechanical ventilation, occlusion of the upper
and streamlines pulmonary defecation. It also
airway, difficulty in maintaining an adequate airway,
improves patient comfort, eases breathing, and
and copious secretions are all common reasons to
protects the larynx as compared to an endotracheal
perform a tracheostomy (3).
tube (6).
4445
Received: 16/11/2022 Accepted: 18/01/2023
c:\work\Jor\vol911_105The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4450-4455
Ambulatory Blood Pressure Monitoring in Normotensive Patients with Type 2 Diabetes Mellitus Mohamed Hossam El dein El shaaer, Elsayed Mohamed Farag, Saleh Mohamed Ahmed Mohamed Wahdan, Islam Ghanem Ahmed Cardiology department, Faculty of Medicine Zagazig University Corresponding author: Saleh Mohamed Ahmed Mohamed Wahdan, Email:[email protected], Mob: 01099299151 ABSTRACT Background: One of the primary risk factors for the beginning and development of chronic problems in type 2 diabetes mellitus is hypertension (DM). Aim and objectives: The aim of this study was early detection of BP abnormalities in people with type 2 diabetes mellitus over the course of 24 hours. Subjects and methods: The present study was carried out on 135 patients who presented to Cardiology Department at Zagazig University Hospitals and Cardiology Department at Matrtouh Cardiac Center in the duration between Janurary 2021 and Augest 2022. The patients were classified into three groups according to blood pressure dipping. Group 1 (Non-dippers): (n= 65), group 2 (dippers) included 53 cases and group 3 reversed dippers (n= 17). Results: Significant positive correlation was detected between ratio of BP dipping and height (r=0.209, p-value =0.015) as well as night BP (r=0.287, p-value =0.001) while there was significant negative correlation between ratio of BP dipping and TG (r=-0.217, p-value =0.011) as well as day BP (r=-0.363, p-value <0.001), Conclusion: Insightful information is provided by the study on the prevalence of aberrant ABP patterns and the limits of office blood pressure readings for either diagnosing hypertension or evaluating blood pressure control in people with type 2 diabetes. Keywords: Ambulatory, Blood pressure, Monitoring, Normotensive, Type 2 Diabetes mellitus. INTRODUCTION
One of the major risk factors for the beginning and
over the course of 24 hours was the goal of this
development of chronic problems in type 2 diabetes
investigation (ABPM).
mellitus (DM) is hypertension (1).
Compared to office-based blood pressure data, SUBJECTS AND METHODS
ambulatory blood pressure monitoring (ABPM) has a
This cross-sectional study was carried out between
better correlation with abnormalities of the target organ.
January 2021 and August 2022 at Cardiology
The ability to check a variety of blood pressure
Departments, Zagazig University Hospitals and
parameters, including the 24-hour, daytime, and
Matrtouh Cardiac Center.
overnight systolic and diastolic BP means, BP loads,
and the absence of a nocturnal decrease in blood Inclusion Criteria
pressure, as well as the detection of white-coat and Age > 18, both sexes and patients with type-2
masked hypertension, is also provided (2).
diabetes mellitus not known to be hypertensive.
Compared to non-DM patients, DM patients had
higher daytime and nocturnal BP means. Additionally, Exclusion Criteria
one-third of type 2 DM patients with normotensive Heart failure, coronary heart disease, stroke
blood pressure have concealed hypertension, which is
history, renal dysfunction (serum creatinine > 2 mg/dl
linked to an increase in albuminuria and a thickening of
or macroalbuminuria > 300 mg/24 h), significant
the left ventricular wall. We still don't know how
valvular or pericardial disease, rhythm disturbances that
common or dangerous white-coat hypertension is in
make it challenging to interpret echocardiographic
people with type 2 diabetes. In the absence of nocturnal
findings (like right or left bundle-branch block and
declines in blood pressure, the 24-hour, daytime, and
atrial fibrillation), patients who work at night, and
overnight blood pressure measurements do not provide
individuals with already low left ventricular ejection
further information, but the midnight blood pressure
fraction are all risk factors (LVEF).
readings seem to be significant in DM retinopathy (3).
All patients were subjected to the following:
In pre-hypertensive stages, white-coat settings, or
Complete physical examination, thorough history
lone clinics, ambulatory blood pressure monitoring has
taking (clinical symptoms, related diseases, drug use,
emerged as a critical method for the diagnosis of
past medical history, and family history), and regular
hypertension. Nowadays, those with high blood
laboratory tests including tests for kidney function, an
pressure (BP) when checked in a medical facility but
ambulatory
blood
pressure
monitor,
an
normal readings elsewhere are referred to as having
echocardiogram, and a complete blood count.
hypertension, such as at home or with a 24-hour
All patients were classified according to the results.
ambulatory BP monitor (4). Early detection of BP
abnormalities in people with type 2 diabetes mellitus
c:\work\Jor\vol911_106The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4456-4461
Prevalence of Dysmenorrhea and Its Psychological Impact on Adolescent Girls Rania El-Sayed Moustafa1, Waleed Ali Sayed Ahmed2, Mariam Lotfy Mohammed2,Rasha El-Sayed Abd El-Fatah2
1 Resident of Obstetrics and Gynecology, Port-Said General Hospital, Faculty of Medicine, Cairo University, Egypt
2Obstetrics and Gynecology Department, Faculty of Medicine, Suez Canal University, Egypt Corresponding author: Rania El-Sayed Moustafa, Tel: +2 01271464115, E-mail:[email protected] ABSTRACT Background: A severe, excruciatingly painful cramping sensation in the lower abdomen is known as dysmenorrhea, or painful menstruation. It is the most typical gynecological condition among teenagers. Objective: The aim of the current study is to assess the prevalence of dysmenorrhea among adolescent girls, to determine the psychological impact of dysmenorrhea on adolescent girls and to detect the differences between adolescent girls with and without dysmenorrhea regarding the frequency and severity of psychosomatic manifestations. Patients and methods: A cross-sectional study was conducted on 520 adolescent girls from 4 Port-Fouad and Port-Said Secondary schools. The enrolled girls were evaluated for the presence of the characteristic symptoms of primary dysmenorrhea to assess the prevalence of dysmenorrhea among them. The participants were subdivided into two groups according to the presence or absence of dysmenorrhea to compare between girls with and without dysmenorrhea regarding the frequency of psychosomatic manifestations. General characteristics, gynecological data and family history were assessed and compared with presence or absence of dysmenorrhea. Results: Prevalence of dysmenorrhea was high (74.6%); younger and obese girls were more prevalent to dysmenorrhea. Dysmenorrhea does lead to important school absenteeism. Conclusion: Female teenagers at Port-Fouad and Port-Said Secondary Schools had a high prevalence of dysmenorrhea. Abdominal pain was the most common type of pain, with most girls reporting a moderate level of discomfort. Keywords: Menstrual Pain, General Health Questionnaire, Dysmenorrhea, School absenteeism, Cross sectional study, Suez Canal University. INTRODUCTION
Teenagers between the ages of 13 and 19 are
comparable Egyptian research has been done to
regarded to be in adolescence, which can be thought of
investigate this theory. In order to better understand the
as a transitional stage in their physical and
connection between dysmenorrhea and adolescent girls'
psychological growth as they approach maturity (1).
psychological health, this study will be started.
Menarche, or the beginning of menstruation, is a
The aim of the current study is to assess the
sign of female pubertal maturation. The onset of
prevalence of dysmenorrhea among adolescent girls, to
menarche is frequently accompanied by issues such as
determine the psychological impact of dysmenorrhea on
dysmenorrhea, heavy bleeding, and irregular
adolescent girls and to detect the differences between
menstruation. One of these that many adolescent
adolescent girls with and without dysmenorrhea
females commonly deal with is dysmenorrhea (2).
regarding the frequency and severity of psychosomatic
Several discomforts, including backaches,
manifestations.
constipation, cramping in the abdomen, nausea, and
vomiting, may occur during the menstrual cycle. PATIENTS AND METHODS
Adolescent girls frequently experience dysmenorrhea,
Adolescent girl students from Port-Fouad and Port-Said
which lowers their quality of life (QOL). The most
secondary schools were chosen by simple random
prevalent gynecologic issue in women of all ages and
sampling for a cross-sectional study. To determine the
races is dysmenorrhea, which is described as unpleasant
prevalence of dysmenorrhea among the enrolled girls,
cramps that accompany menstruation. Dysmenorrhea is
the girls were asked for the presence of the typical
also one of the most common causes of pelvic pain (3).
symptoms of primary dysmenorrhea. To compare the
Teenage girls who experience dysmenorrhea
frequency of psychosomatic symptoms in females with
typically have primary symptoms, regular ovulatory
and without dysmenorrhea, the participants were
cycles, and no pelvic pathology. Additionally, it has
divided into 2 groups based on the presence or absence
been observed that between 5 and 10 percent of females
of dysmenorrhea.
in their late teens experience severe spasmodic
dysmenorrhea, which interferes with their social and Inclusion criteria: Adolescent girls of 13-19 years
academic lives (4).
(girls after onset of menarche).
Numerous studies support the value of Exclusion criteria: Patients who have been diagnosed
psychological evaluation, but more research is needed
with a psychiatric condition or who have previously had
to determine how psychological problems and
one, or who have declined to participate.
dysmenorrhea are related. To our knowledge, no
4456
Received: 16/11/2022 Accepted: 18/01/2023
c:\work\Jor\vol911_107The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4462-4467
Kinesio Taping Versus Oromotor Training on Drooling in Children with Spastic Cerebral Palsy: Comparative Study Hagar Mohamed Awaad*, Maya G. Aly, Hebatallah Mohamed Kamal
Department of Pediatrics Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt *Corresponding author: Hagar Mohamed, Mobile: (+20)1030773968, E-mail: [email protected] ABSTRACT Background: Children with cerebral palsy (CP) frequently have sustained drooling, which leads to feeding difficulties and social affection. Oral motor (OM) exercises and kinesio taping (KT) are treatment options described for management of drooling. Objective: The aim of the current work was to compare between the effectiveness of KT versus OM training for improving drooling in children with spastic CP. Patients and Methods: This study included 24 children of both gender with spastic CP, aged 4 to 8 years. They were selected according to specific eligibility criteria and were randomly allocated into Kinesio taping (KT) group (n=12) and oromotor (OM) group (n=12). The KT group received Kinesio taping application on orbicularis oris muscle, while the OM group received oral motor exercise program. Both groups received intervention 3 times/week for successive 2 months. Assessment of drooling severity and frequency by using the 5-minute drooling quotient (DQ) and drooling severity and frequency scale (DSFS). Data were collected at the baseline and the end of intervention. Data were statistically analyzed and compared. Results: Comparison of pre- and post-treatment mean values of all measured variables showed significant improvement for children of both KT and OM groups.The post treatment results showed that OM training is more effective than KT in decreasing drooling severity and frequency. Conclusion: Although both OM exercises and KT application are effective in improving drooling in children with spastic CP; OM training is proven to be more effective than KT when used as a standalone treatment. Keywords: CP, Drooling, Kinesio Taping, Oro motor, Oral motor Exercises.
INTRODUCTION
The most prevalent physical impairment in
children with disabilities. Botulinum neurotoxin A,
children is cerebral palsy (CP). It is described as a
surgery, and the use of drugs are intrusive treatments;
collection of movement impairments brought on by an
behavioural, oral motor therapies, and the use of
anomaly or non-progressive lesion in the developing
equipment are less invasive ones (5).
brain (1). Oral motor disorders as feeding delays, oral
The goal of oral motor therapy is to influence
secretion management, and phonological and
the physiological support of the oral-pharyngeal process
articulation delayed development are all common. This
and thereby enhance its functions. This is accomplished
occurs as a result of sensory, neuromuscular, and
by innervating sensory nerves for precise movement of
postural control deficits (2).
the mouth contents (lips, jaw, tongue, soft palate, and
Sialorrhea, another name for drooling, is the
larynx) and respiratory muscles. Examples of oral-motor
unintended loss of saliva from the mouth. Children older
exercises include stretching, active exercises, passive
than four are deemed to have pathologic chronic
workouts, and sensory nerve stimulation (6, 7).
drooling or excessive salivation. The documented
Drooling is linked to lip position in children
prevalence of persistent drooling in children is 0.5%, but
with CP, hence KT treatment to the orbicularis oris
in individuals with neurological diseases, especially
muscle was shown to lower the interlabial gap, which in
those with cerebral palsy, the rate jumps to 60%. Many
turn reduced drooling. KT is said to elevate the skin,
physically and psychologically debilitating problems,
enhancing blood flow and lymphatic drainage, which
such as social isolation and low self-esteem, can be
relieves pain (8).
brought on by severe sialorrhea (3, 4).
The present literature lacks the evidence about
Children with neurodisabilities are more likely
the best intervention for treatment of drooling in
to drool for a variety of reasons, including lower
children with CP. This study was aimed to find which
awareness of drooling, less frequent and ineffective
intervention is more effective for these cases by
swallowing, and oral sensory abnormalities, which can
comparing between the effectiveness of KT versus OM
be made worse by posture disorders or reflux. This
training on drooling.
intricacy is further increased by the existence of
contributory variables, such as the frequent use of PATIENTS AND METHODS
drooling-inducing drugs by children with disabilities.
This randomized clinical trial study included a
Drooling is a multifaceted habit with many underlying
total of 24 children of both gender with spastic CP,
causes, demanding the knowledge of a multidisciplinary
aged 4 to 8 years, selected from children referred to
team. While there is disagreement on the efficacy of
Pediatric Outpatient Clinic, Department of Pediatrics
various therapies, they can be used to treat drooling in
4462
Received: 16/11/2022 Accepted: 18/01/2023
c:\work\Jor\vol911_108The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4468-4471
Evaluation of Immediate Post-placental Insertion of the Copper Intrauterine Contraceptive Device during Caesarean Delivery Mohamed Zakaria Sayer Dayer1*,Mohammad Ali Abdelkader2, Medhat Essam El Din Helmy1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt
2Department of Obstetrics and Gynecology, Kafr El-dawar General Hospital, Egypt *Corresponding author: Mohamed Zakaria Sayer Dayer, Mobile: (+20)1004778794, E-Mail: [email protected]
ABSTRACT Background: The second most popular type of contraception is an intrauterine contraceptive device (IUCD). Immediate post-placental placement of IUCD provides women with immediate, safe, effective, long-acting reversible contraception that prevents unintended pregnancies. Objective: The aim of the current work was to evaluate efficacy, safety, and complications (displacement, expulsion, perforation, and infection) of immediate post placental insertion of copper T380 IUCD during cesarean section. Patients and methods: This prospective study included a total of 164 full term pregnant women delivered through cesarean section, attending at Department of Obstetrics and Gynecology, Menoufia University Hospital and Department of Obstetrics and Gynecology, Kafr El-dawar General Hospital. Post-placental copper T380 IUCD was offered after admission and inserted during cesarean section. Rates of IUCD displacement, expulsion, removal, uterine perforation, pregnancy and infection (endometritis/PID) were estimated at 1 week, 4 weeks, 3 months and 6 months after discharge. The absence of all these complications was considered a satisfactory outcome. Results: Mean age among study population was 28.45± 5.14 years. Rates of displacement, expulsion and satisfactory outcome at the fourth week post-insertion were 2.5%, 0.6 % and 96.9% respectively. Cumulative rates of displacement and expulsion at the end of 6-months follow-up were 4.3% and 0.6% respectively. No cases complicated by perforation, infection (endometritis/ PID) or pregnancy on top of post placental IUCD. Follow-up rate at the end of 6-months was 94.5%. Continuation rate with intrauterine contraception at the end of 6-months follow-up was 93.9%. Cumulative rate of intrauterine device removal was 6.1%. Conclusion: It could be concluded that immediate post placental IUCD insertion is a suitable option with high satisfactory outcome, contraceptive efficacy, safety, and convenience. Complications (displacement, expulsion, perforation and infection) are very low. Keywords: Caesarean delivery, Immediate, IUCD, Post-placental. INTRODUCTION
perforation, and infection) of immediate post placental
The most extensively used kind of reversible long
insertion of copper T380 IUCD during cesarean section.
lasting contraception in the world is the intrauterine PATIENTS AND METHODS
device (IUD). It is estimated that approximately 128
This prospective study included a total of 164 full
million women in the world use it for contraception [1].
term pregnant women delivered through cesarean
IUCD is regarded as the second most popular
section, attending at Department of Obstetrics and
contemporary form of contraception since it is
Gynecology, Menoufia University Hospital and
affordable, secure, long-acting, and reversible with the
Department of Obstetrics and Gynecology, Kafr El-
advantages over hormonal contraception of being
dawar General Hospital. This study was conducted
independent of women's compliance and not affecting
between January 1st, 2021, to April 1st, 2022.
the coagulation or lactation [2].
Interval placement of IUCD is usually performed 6 Inclusion criteria:
weeks after delivery. However, women experience
Age: 1840 years.
difficulties to return for a separate postpartum visit, and
Singleton full term pregnancy.
it was reported that significant proportion of the
Voluntarily requesting IUD placement for
postpartum women who decided to use IUCD for
postpartum contraception.
contraception had turned out not to have an IUCD
No uterine anomalies.
inserted. In order to overcome these limitations of interval IUCD placement, an additional postpartum visit Exclusion criteria:
is not necessary if the instant implantation occurs within
Uterine anomalies or pathological uterine lesions
10 minutes of placenta delivery. IUCD implantation
preventing IUCD placement e.g. leiomyoma.
during caesarean birth has shown good rates of device
An 18-hour or longer prolonged membrane
retention and low rates of complications in prior studies
rupture. [3]. No studies have shown that insertion of an IUCD
An intrapartum fever that exceeds 38oC.
immediately post-placental increased the risk of
Chorioamnionitis, a genital tract infection that is
infection or any other problems [4].
active yet untreated.
The aim of the current work was to evaluate efficacy,
Disorders with hemorrhage.
safety, and complications (displacement, expulsion,
Previous ectopic pregnancies.
Multiple pregnancy.
4468
Received: 17/11/2022 Accepted: 19/01/2023
c:\work\Jor\vol911_109The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4472-4476
Comparison Between the Effects of Primary Angioplasty and Pharmaco-Invasive Strategy on Left Ventricular Functions in ST- Elevation Myocardial Infarction Patients Mohamed Ibrahim Amin, Mohammad Mahmoud Elshwadfy*, Ahmad Shafie Ammar, Ahmed Mohamed Elzayat, Islam Ghanem Ahmed Ghanem
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Mohammad Mahmoud Attia Ibrahim Elshwadfy, Mobile: (+20)1001835678, E-Mail:[email protected] ABSTRACT Background: The preferred therapy for people with ST-elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (PPCI). Pharmaco-invasive therapy, which can be described as the combination of fibrinolytic therapy followed by angiography with or without PCI, either immediately when there is failed fibrinolysis or within 24 hours in case of successful fibrinolysis, is another technique for treating STEMI patients. Objective: The aim of this study was to compare the effects of pharmaco-invasive strategy on infarct-related artery (IRA) patency and on left ventricular systolic and diastolic functions with those of primary angioplasty in STEMI patients assessed in-hospital before patient discharge. Subjects and methods: This prospective cohort cross-sectional nonrandomized study included a total of 100 patients with 1st attack of acute STEMI who had symptom onset within 12 h, attending at Department of Cardiology, Zagazig University Hospital, Zagazig, Egypt. The patients were randomized into 2 groups (50 patients each), First group underwent PPCI, and the second group underwent pharmaco-invasive PCI. Assessment of myocardial blush grade, global longitudinal strain, and E/e` ratio was done for both groups. Results: The mean age of the study population was 52.95 ± 8.41 with 54 % of the whole population being males. There was a statistically significant difference between the two groups regarding pain to ECG time with a P value of 0.03. The Myocardial blush grade was significantly higher in the Pharmaco-invasive arm with a statistically significant difference between the two groups with P value 0.03. After revascularization there was a better improvement in the diastolic function in the PHINV arm as assessed by E/e` with a P value of 0.004. Conclusion: It could be concluded that pharmaco-invasive strategy could offer a superior outcome regarding the recovery of the diastolic function and a higher myocardial blush grade (which indicates a better microvascular circulation) in STEMI patients compared to those who underwent PPCI. Keywords: Primary PCI, Pharmaco-invasive PCI, diastolic function. INTRODUCTION
The preferred therapy for people with STEMI is
The aim of this study was to compare the effects
PPCI. Benefits of PPCI are attributable to the rapid
of pharmaco-invasive strategy on IRA patency and on
restoration of infarct-related artery (IRA) blood flow
left ventricular systolic and diastolic functions with
patency (1). An important factor in determining clinical
those of primary angioplasty in STEMI patients
outcomes is the interval between the start of symptoms
assessed in-hospital before patient discharge.
and myocardial reperfusion (2).
Pharmaco-invasive therapy, which can be PATIENTS AND METHODS
described as the combination of fibrinolytic therapy
This
prospective
cohort
cross-sectional
followed by angiography with or without PCI, either
nonrandomized study included a total of 100 patients
immediately when fibrinolysis fails or within 24 hours
with 1st attack of acute STEMI who had symptom onset
in case of successful fibrinolysis, is another technique
within 12 h, attending at Department of Cardiology,
for treating STEMI patients (3). Better outcomes and
Zagazig University Hospital, Zagazig, Egypt. This
increased survival have been linked to infarct related
study was conducted between June 2020 to June 2022.
arterial patency at first angiography (measured as TIMI
3 coronary blood flow grade) (4). Inclusion criteria:
In the event of acute myocardial infarction 1. Patients having acute STEMI.
microvascular blockage may occur due to disintegration 2. Patients who came within two hours of the start of
of thrombus with subsequent distal embolization. This
chest discomfort and a Left Bundle Branch block
might occur during performing primary angioplasty due
(LBBB) pattern of new onset (1).
to pushing the thrombus by wires, balloons or stents.
Blockage of microcirculation might impair left Exclusion criteria:
ventricular functions (5). We hypothesized that using 1. Those who had pain or non-ischemic chest
thrombolytic therapy before angioplasty (pharmaco-
discomfort.
invasive strategy) might lyse the thrombus and prevent 2. Patients with established Qwave acute myocardial
distal embolization.
infarction on presentation.
c:\work\Jor\vol911_110The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4477-4486
Does Echocardiographic Epicardial Fat Thickness Associate with The Severity of Coronary Artery Disease? Hany Mohamed Fakhry*, Muhammad Ibrahim Muhammad Abdel Aziz, Zeinab Abdelsalam Fahmy
Cardiology Department, Faculty of Medicine, Ain Shams University, Egypt *Corresponding author: Hany Fakhry, Mobile: (+20) 01002554916, Email:[email protected] ABSTRACT Background: One of the main health issues in the world is coronary artery disease (CAD). It frequently causes morbidity and death. From 28.9% in the 1990s to a predicted 36.3% in the 2020s, the global death rate for CAD is anticipated to increase. Objective: The aim of the current study was to confirm the relationship between the epicardial adipose tissue thickness on echocardiography and CAD severity. Patients and Methods: Epicardial adipose tissue thickness (EATT) was measured by echo in 200 patients referred for coronary angio in Ain Shams University between May 2013and October 2014. Results: In our study, diabetic, hypertensive and smoker patients had more significant EATT when compared to non-diabetic, non-hypertensive and non-smoker ones. EATT measured during both systole and diastole was found to be significant in patients with BMI 30 and abnormal waist hip ratio when compared to corresponding values of normal BMI and waist hip ratio. On measuring EATT during both systole and diastole, it was found that P-value was significant in high levels of LDL and TGs patients compared to corresponding values in normal levels of LDL and TGs subjects. EATT was highly significant in patients with coronary affection with mean EATT(s) in CAD patients was 6.07 (SD 1.16) compared to 4.22 (SD 0.9) in patients with normal coronaries and mean EATT(d) in CAD patients was 5.77 (SD 1.13) compared to 4.02 (SD 0.9) in patients with normal coronaries. Also, there was a significant correlation between measurements of both systolic and diastolic EATT and the number of diseased coronary artery in CAD patients. Our study showed no significant correlation between gender and EATT measurements during both systole and diastole. Conclusion: A significant correlation exists between EAT and the existence and severity of CAD. It supports the idea that epicardial fat may contribute to the development of CAD, presumably through paracrine or vasocrine pathways. EAT may be evaluated safely and non-invasively by echocardiography, as it may be a component of the normal evaluation of individuals suspected of being at risk for cardiovascular or metabolic disorders. Keywords: Coronary artery disease, Echocardiographic Epicardial Fat Thickness.
INTRODUCTION
challenging since modest plaque load often does not
Cardiovascular diseases (CVDs) are the main
generate symptoms, even while exercising (3).
killers on a global scale. Each year, more people die
According to recent research, epicardial adipose
from CVDs than from any other cause. An estimated
tissue (EAT) mediates the development of arterial
17.5 million deaths globally in 2012, or 31% of all
plaque and is linked to both catastrophic and nonfatal
fatalities, were caused by CVDs. Of these fatalities,
coronary events (4).The coronary artery may be
7.4 million were thought to be caused by coronary
immediately impacted by inflammatory cytokines that
heart disease and 6.7 million by strokes. Most CVD
are produced from peri-coronary EAT because EAT is
mortalities happen in low- and middle-income
located within the pericardial sac (1). Abdominal
countries. 82% of the 16 million deaths under 70
visceral adipose tissue (VAT) is associated with plaque
caused by non-communicable illnesses occur in low-
shape, and increased levels of inflammatory cytokines
and middle-income nations, and 37% of those deaths
and reactive oxygen species may hasten the
are attributable to CVDs (1).
progression of this disease (5). The development of
The majority of cardiovascular disorders may be
CAD may be influenced differently by various kinds
averted by implementing population-wide measures
of adipose tissue depot, but this problem is not yet
that focus on behavioral risk factors such as cigarette
completely known (6).
smoking, poor diet, obesity, inactivity, and
There are several ways to measure visceral fat
problematic
alcohol
drinking.
Those
with
tissue, including direct methods using cost-prohibitive
cardiovascular illness or at high cardiovascular risk
computed tomography and magnetic resonance
require early identification, treatment, and medication,
imaging, as well as indirect methods using physical
due to the existence of one or more risk factors like
measurements, such as waist girth and body mass
hypertension, diabetes, hyperlipidemia, or an existing
index (BMI) (7).
disease (2).
The most reliable method to assess visceral
Despite the advancement of prophylactic
adiposity is magnetic resonance imaging, but the
medicine, CAD continues to be a leading global cause
reliability of results based on single slice sampling has
of mortality. Because early and stringent treatment of
raised some questions (i.e., whole body magnetic
coronary risk factors can halt the advancement of
resonance imaging scan is the true gold standard). In
coronary plaque instability in those individuals,
elderly people, the reliability of the waist measurement
detecting the presence of coronary arteriosclerosis is
as a marker of visceral obesity may be reduced.
critical for primary CAD prevention. Nevertheless,
Additionally, waist circumference rather than visceral
identifying the early stages of coronary plaque can be
obesity may be a stronger indicator of subcutaneous
4477
Received: 19/11/2022 Accepted: 21/01/2023
c:\work\Jor\vol911_111The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4487-4491
Diagnosis of Infertility: What Is New?: Review Article Ashraf Mohamed Naser, Reda Abdel Aziz Ahmed, Wafa Khalid Ali Aeboudah, Mohamed Ahmed Helmy
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Wafa Khalid Ali Aeboudah, Mobile: (+20) 01095360339, E-mail:[email protected] ABSTRACT Background: One of the most common chronic health conditions affecting young adults is infertility, which is defined as a year of unsuccessful attempts at conception. The diagnosis has made progress of reproductive problems over the past ten years. Objective: The standard testing used to identify infertility is included in this review. We also go into other tests, such as ovarian reserve evaluation, and the prospective application of laparoscopy in the evaluation of infertility that cannot be explained. Methods: PubMed, Google Scholar, and Science Direct were some of the places we explored for information about Infertility, Standard tests and New tests for Diagnosis. Between July 1992 and January 2022, however, only the latest or most comprehensive study was considered. The authors also assessed the usefulness of references taken from similar books. We haven't paid attention to non-English documents because we don't have the time or money to translate them. Unpublished articles, oral presentations, conference abstracts, and doctoral dissertations were all widely acknowledged to not constitute valid scientific research. Conclusion: A thorough but time-efficient investigation of the infertile couple is required prior to a diagnosis of unexplained infertility. Couples should undergo a semen analysis, ovulation testing, assessment of ovarian reserve, and imaging to assess for tubal and uterine factors before a diagnosis of unexplained infertility is made. This workup can be completed within 1 menstrual cycle. INTRODUCTION
possible. The sample can be collected at home and
Because it affects a pair rather than just one person,
brought to the lab within an hour if it is not practical
infertility is a rare medical illness. For women under the
of being taken. At least two samples should be taken
age of 35, it is defined as the couple's failure to conceive
at least one week apart due to the significant intrinsic
after 12 months of regular sexual activity without the use
fluctuation of sperm concentrations in semen samples.
of contraception, and after 6 months for women 35 and
The World Health To carry out the recommended
older. To characterize this inability to conceive until the
standard procedures for World Health Organization
pair has been shown to be sterile, some professionals use
(WHO) Laboratory Manual for the Examination and
the term subfertility. Fecundability, which measures the
Processing of Human Semen should be utilized while
likelihood of becoming pregnant within one menstrual
analyzing human sperm (3).
cycle, is a more appropriate term because it takes into
Lower reference levels for semen analysis have
account different levels of infertility (1).
been published by the WHO. The traits listed below were discovered from a research of more than 1900 guys whose Prevalence of Infertility: From 2006 to 2010, the prevalence of infertility decreased
partners had a time to conception of less than 12 months,
from 8.5% to 6.0%. This number is lower than the
and they represent the frequently accepted 5th percentile
incidence of infertility, which is estimated from
(lower reference limits and 95% CIs are in parenthesis) (4).
prospective research and ranges from 12 to 18% in the
United States. Additionally, it is lower than the primary Volume: 1.5 mL (95% CI 1.4-1.7)
infertility rate for married nulliparous women. Between
· Spermconcentration: 15 million spermatozoa per
7.3 and 9.1% of married women aged 15 to 34, 25% of
milliliter (95% CI: 1216)
those aged 35 to 39, and 30% of those aged 40 to 44
· Total sperm number: 95% confidence interval: 33
experienced primary infertility. (2).
46; 39 million spermatozoa per ejaculate
· Morphology: employing the "strict" Tygerberg Investigations:
technique, 4% of the normal forms (95% CI 3-4).
· Semen analysis: The main laboratory evaluation of a
· Vitality: 95% confidence interval: 55-63)
male partner in an infertile pair is a semen analysis.
· Progressive motility: (99% confidence interval: 31-
The typical semen assay comprises measurements of
34)
volume, pH, sperm motility, count, morphology,
· Total (progressive+ non-progressive) motility: 40%
debris, and agglutination as well as leukocyte count
(95% CI: 38-42)
and immature germ cells. After two to seven days have
· Additional evaluation: Men with infertility should go
elapsed with no ejaculatory activity, the semen sample
through the following evaluations following the
should be taken. The patient should obtain the sample while masturbating in the doctor's office, if at all
4487
Received: 18/11/2022 Accepted: 20/01/2023
c:\work\Jor\vol911_112The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4492-4498
The Role of Intraoperative Sodium Fluorescein-Guidance in Maximizing The Resection of Contrast-Enhancing Brain Gliomas Mansour Abd El-Magid Makia, Ahmed Mohammed Ragab, Mohamed Khaled El-Badawy, Magdy Omar El-Sheikh*
Neurosurgery Departments, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Magdy Omar El-Sheikh, Mobile: (+20)01221235929, E-Mail: [email protected] ABSTRACT Background: Glioma is the most common primary brain neoplasm. Surgical excision is the primary management modality for high-grade glioma. The aim of surgery is maximum safe resection for improving survival. Objective: The aim of the current study was to evaluate the value of intra-operative sodium fluorescein in detecting boundaries and maximizing surgical resection of glioma. Patients and methods: The study included 40 patients with pre-operative MRI showing contrast-enhanced lesions suspected to be high-grade glioma. Patients were operated on after IV injection of sodium fluorescein (5-8mg/kg) after induction of anesthesia. With the help of FL560 filters integrated into the Leica Provido microscope, all fluorescent areas could be resected. Volumetric assessment of the resected tumor tissue was calculated from pre-operative and early post-operative MRI with contrast. Results: Gross total resection was achieved in most patients (95%), while in 5% of patients we just did near-total resection. The extent of resection ranged from 96 to 99% with a mean of 98.08%. The sensitivity and specificity of fluorescein for the high-grade glioma (contrast-enhanced areas) is 95% and 100% respectively. Conclusion: The integration of intra-operative IV sodium fluorescein provided a safe, easy, and effective utility for differentiating tumorous from normal tissue thus maximizing the extent of resection of high-grade gliomas. Keywords: Fluorescein, Intra-operative dyes, Glioma, Maximum resection, Glioblastoma. INTRODUCTION
High-grade gliomas are malignant tumors of the
and accumulation of fluorescent porphyrins in different
central nervous system (CNS) that have a poor
lesions (10).
prognosis regardless of treatment plan (either
As a replacement for 5-ALA, we can use sodium
chemotherapy, radiotherapy, or surgery) (1). For patients
fluorescein (FL). FL, when given intravenously, can
with high-grade glioma, the degree of resection is a
selectively concentrate in regions of the brain where the
good predictor of increased survival (2). Therefore, the
blood-brain barrier (BBB) has been compromised; these
first step in treatment should be maximal safe resection
regions match to those that show contrast enhancement (3). Only few lesions could be completely resected (4) as
on pre-operative MRI scans(11). FL has been found to
a result of glioma expansion into eloquent cortical and
enhance tumor visibility under either standard white
subcortical areas (2).
light or a surgical microscope equipped with a
And even in non-eloquent areas, there is difficulty
specialized filter (12). The primary emission wavelength
in differentiating the tumor tissue from the adjacent
of FL is in the green spectrum, between 540 and 690
edematous brain at the margins of the resection area (5).
nm, and it is triggered by a blue excitation wavelength
Therefore, many techniques were used for improving
peak between 460 and 500 nm. Using excitation and
intra-operative glioma visualization and maximizing
emission filters, it is straightforward to identify tumor
the extent of resection, such as neuronavigation (6),
parts (11).
intra-operative Magnetic Resonance Imaging (iMRI) (7),
In this study, we assessed the value and accuracy
and intra-operative ultrasound (8).
of using intra-operative sodium fluorescein injection in
The most recent facility for eliciting brain region
maximizing the resection of glioma, aiming to improve
functions and defining and personalizing safe bounds of
the surgical excision and make more benefit from
tumor removal is intra-operative electrophysiological
surgery.
monitoring and cortical and subcortical mapping
conducted in awake-craniotomy operations(9). Complete PATIENTS AND METHODS
resection rates and 6-month progression-free survival Study population: Our study included patients in
rates (PFS) for patients with high-grade gliomas have
which pre-operative brain MRI with contrast showed
been demonstrated to improve with the use of
enhanced lesions, which were suspected to be glioma,
photodynamic detection, in which a dye or
either for the first time or recurrent lesions. All patients
photosensitive drug is used to improve tumor
were candidates for surgery.
localization and delineation by fluorescence. For
We excluded patients with lesions starting from
example, the biological precursor of hemoglobin known
basal ganglion or brain stem, patients with reasons
as 5-aminolevulinic acid (5-ALA) causes the formation
preventing the use of IV sodium fluorescein as previous
hypersensitivity or renal insufficiency, patients with
4492
Received: 19/11/2022 Accepted: 21/01/2023
c:\work\Jor\vol911_113The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4499-4504
Comparison between Tranexamic acid and Doxycycline Pleurodesis in Malignant Pleural effusion by Medical Thoracoscopy Hytham Abdalla*1, Ibraim Shalan1, Kamal Darwish1, Kahalid Haleima2, Montaser AbdElrahman1
1Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
2Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt *Corresponding author: Hytham Abdalla, Mobile: (+20) 01007323393, E-Mail: [email protected] ABSTRACT Background: Malignant pleural effusion (MPE) is a morbid disability that places a major strain on the healthcare system. For MPE, pleurodesis and indwelling pleural catheters continue to be standard treatments. Objective: The aim of the current study was to compare thoracoscopic pleurodesis with tranexamic acid and doxycycline powder as palliative preventative therapies for recurring malignant pleural effusions in terms of effectiveness, safety, and prognosis. Patients and methods: A randomized controlled clinical trial included 100 patients with MPE who were divided into 2 groups: Group (I) included 50 patients with thoracoscopic pleurodesis of tranexamic acid and Group (II) included 50 patients with thoracoscopic pleurodesis of doxycycline powder. All patients had their history checked, clinical assessment, pleural fluid laboratory investigations (total proteins, LDH, Differential cell count, cytology for malignant cells, PH, Glucose level, culture and sensitivity, and Adenosine Deaminase (ADA)), chest radiograph, chest ultrasound, computed tomography (CT) scan of the chest, and thoracoscopic pleurodesis. Results: There was no significant difference between the groups in terms of Light's criteria and lymphocytes (%) in the pleural fluid. However, there was a significant difference between groups regarding Chest x ray at 3rd month and Chest ultrasound at 3rd month. Success of pleurodesis was higher in the Tranexamic acid group (95.5%) compared to the Doxycycline group (81%) with statistically significant difference (P=0.047). Conclusion: Medical thoracoscopy is a safe, easy and efficient way to diagnose the malignant pleural effusion as well as performing pleurodesis. Tranexamic acid has a great benefit in pleurodesis with no chest pain during and after pleurodesis and has a higher success rate than doxycycline for pleurodesis. Keywords: Malignant pleural effusion, Thoracoscopy, Pleurodesis, Tranexamic acid, Doxycycline. INTRODUCTION PATIENTS AND METHODS
Malignant pleural effusion (MPE) renders people
A randomized controlled clinical trial was
morbidly disabled and places major strain on the
conducted at Al-Hussein University Hospital, Sayed
healthcare system. More than 500,000 new instances of
Galal University Hospital, and Kafr El-Sheikh Chest
malignant pleural effusion are anticipated to occur each
Hospital between August 2017 and August 2019.
year in affluent nations [1]. Approximately 4477% of all
The study enrolled 100 patients known to have
exudative pleural effusions are malignant. Nearly half
MPE either primary or secondary and diagnosed by
of individuals with disseminated malignancies develop
pleural fluid cytology, via pleural biopsy taken through
it [2]. The presence of MPE indicates a 4 to 6
Abram's needle or medical thoracoscopy. Patients were
months average overall survival rate [3].
divided into 2 groups; Group (I) had 50 patients with
All available treatments for MPE are palliative, as
thoracoscopic pleurodesis of tranexamic acid, while
there is no cure. The standard treatments for MPE
Group (II) had 50 patients with thoracoscopic
continue to be pleurodesis and indwelling pleural
pleurodesis of doxycycline powder.
catheters, both of which have recently been
We excluded patients without MPE, encysted,
demonstrated to be equally successful [4].
multiloculated malignant pleural effusion or those with
If the pleura seem aberrant upon visual
extensive pleural adhesions, central obstruction causing
observation, pleurodesis using thoracoscopy may be
total lung collapse trapped in the lung, uncorrectable
performed, providing both diagnostic and therapeutic
bleeding tendency disorder, previous failed trial of
treatments in a single sitting [5].
pleurodesis, inability to lie in the lateral decubitus
When it comes to causing pleurodesis, the oral
position, known subjective hypersensitivity to
forms of doxycycline are just as accessible, affordable,
constituents, respiratory insufficiency requiring
and effective as the parenteral forms [6].
ventilatory support, very poor general condition, or
Meanwhile tranexamic acid is an effective, safe,
those with uncontrolled cardiac disease.
cheap and available sclerosing agent as a chemical agent
All patients were subjected to history taking,
for pleurodesis [7].
clinical assessment, serum laboratory investigation
The aim of the current study was to compare
(Complete Blood Count, Liver functions, kidney
thoracoscopic pleurodesis with tranexamic acid and
functions, and INR), pleural fluid laboratory
doxycycline powder as palliative preventative therapies
investigations (total proteins, LDH, Differential cell
for recurring MPE in terms of effectiveness, safety, and
count, cytology for malignant cells, PH, Glucose level,
prognosis.
culture and sensitivity, and Adenosine Deaminase
4499
Received: 19/11/2022 Accepted: 21/01/2023
c:\work\Jor\vol911_114The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4505-4510
Angiotensin Converting Enzyme Insertion/Deletion Gene Polymorphism in Egyptian Population with Type 2 Diabetes and Its Relation to Diabetic Nephropathy Amira M. El Sayed, Walaa M. Ibrahim, Ayman M. El Badawy, Marwa M El. Araby, Rasha O. Abd Elmoniem
Internal Medicine Department, Endocrinology Unit, Faculty of Medicine, Benha University, Egypt *Corresponding author: Marwa M. El Araby, Mobile: (+20) 01559993906, Email: [email protected] ABSTRACT Background: Angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism has been linked to diabetes and the progression of diabetic comorbidities. Objectives: Study the correlation between the ACE I/D gene polymorphism and: a) Risk of development of type 2 diabetes mellitus (T2DM) in Egyptian population. b) Development of diabetic nephropathy. Patients and methods: we studied80 participants: including 20 healthy participants, and 60 patients with diabetes. The following laboratory tests were performed: HA1C, lipid profile, estimated glomerular filteration rate (eGFR), serum creatinine, urine analysis, urine albumin creatinine ratio,DNA Isolation and Determination of ACE Genotype (GT) were performed to all patients and control subjects. Results: In diabetic patients about 81 % had Genotypes II and 18.3% had Genotype ID, while in control group 95 % had genotype II. In diabetics without chronic kidney disease (CKD) 96 % had genotype II and about 3 % had genotype ID. In diabetics with CKD about 66 % had genotypes II while 33 % had genotype ID. There was a significant difference found in the studied groups, p was 0.033. the mean HbA1c, GFR and creatinine in diabetics with chronic kidney disease with genotype II was 7.81,22.57 and 4.08 respectively, while the mean HbA1c, GFR and creatinine in diabetic chronic kidney with genotype ID was 8.92, 13.44 and 5.02 respectively. There was significant difference found in the studied groups according to GFR, p was 0.005. Conclusion The current study demonstrated that; ACE gene I/D polymorphism has potential link to DM and progression to diabetic nephropathy. Keywords: Diabetic chronic kidney, ACE, Insertion/deletion polymorphism.
INTRODUCTION
Disturbances in the metabolism of carbohydrates,
old and 20 subjects with age and sex matched appear
fats, and proteins are a hallmark of diabetes mellitus, a
healthy volunteers serving as control (group B).
metabolic illness with numerous aetiologies caused by
Diabetic patients were recruited from those
a complex interplay between hereditary and
attended Endocrinology Unit in Banha University
environmental
variables.
Long-term
harm,
Hospital. The period of the study was from April 2020
malfunction, and organ failure are among the
to November 2021.
consequences of DM (1, 2).
All patients were informed about their
With regard to both T2DM cases and non-diabetic
participations in the study and a signed a consent that
ones, several earlier research found that those with the
was reviewed by the local ethical committee of Banha
ACE gene DD genotype were more insulin sensitive
University.
and with a reduction in insulin response to oral glucose
Patients with T2DM sub groups: group A1 was 30
loading in comparison with cases with the ID/II
diabetics with diabetic nephropathy and the second
genotype. Many investigations demonstrated that the
group A2 was 30 patients with T2DM without diabetic
DD genotype is substantially related with elevated
nephropathy.
plasma or serum ACE levels despite the fact that the I/D
Diagnosis of diabetic nephropathy is based on eGFR
polymorphism resides in the intronic area of the ACE
less than 60 ml/hour \1.73 m2 or urine albumin
gene (3-10).
creatinine ratio more than 30mg/gm creatinine.
The study's objective is to assess the correlation
Microalbuminuria (A2) was defined as 30-300 mg/gm
between
the
ACE
insertion/deletion
gene
creatinine
in
aspot
urine
collection
and
polymorphism and: a) T2DM risk in the Egyptian
macroalbuminuria (A3) as more or equal 300mg per g
population; and b) the onset of diabetic nephropathy
cr.
(diabetic chronic kidney disease).
Exclusion criteria were: patients with type 1 diabetes, SUBJECTS AND METHODS
Presence of other systemic disease which might cause
This was a case control cross-sectional prospective
chronic kidney disease and infection within the
study which is carried on 60 Egyptian cases with T2DM
previous month.
(group A) their age ranges from (41to 84) years
Entire cases were subjected to a thorough history taking
c:\work\Jor\vol911_115The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4511-4516
Prognostic Value of Ascitic Neutrophil Gelatinase-Associated Lipocalin in Decompensated Liver Cirrhosis with Spontaneous Bacterial Peritonitis Patients Rashed Mohamed Hassan1, Ghada Abd Elghafar Salem1, Bassem Mohamed ALsayed Refaat Mohamed1, Amal Ahmed Zidan2, Ahmed M. El-Gebaly1
1Tropical Medicine, Faculty of Medicine Zagazig University
2Clinical Pathology, Faculty of Medicine, Zagazig University Corresponding author: Bassem Mohamed ALsayed Refaat Mohamed, Phone: 01117587994, Email:[email protected] ABSTRACT Background: In cirrhotic individuals, spontaneous bacterial peritonitis (SBP) is a relatively frequent complication. NGAL, or lipocalin linked with neutrophil gelatinase, is a trustworthy indicator of inflammation. Objective: The aim of this work was to evaluate the prognostic value of ascitic neutrophil gelatinase associated lipocalin in decompensated liver cirrhosis with SBP patients. Patients and Methods: The study comprised 72 patients with cirrhotic liver and ascites, they were categorized into two groups SBP group and non SBP group, each group had 36 patients. Each patient had a thorough history-taking process, physical examination, pelvic-abdominal ultrasonography, laboratory tests, and chemical and bacterial analysis of ascitic fluid samples and specific assay of NGAL levels using ELISA technique. Results: We found thatthe optimum cutoff value of NGAL was 230.05 ng/ml with (AUC) 0.989, 89.5% positive predictive value, 94.4% specificity, 88.9%, and -94.4% negative predictive value 94.1% and overall accuracy 91.7%. The optimum cutoff of ascitic fluid NGAL in prediction of mortality is 401 ng/ml with (AUC) 1, 94.4% overall accuracy, 85.7% of positive predictive value, 100% of negative predictive value, 100% of sensitivity. Conclusion: Ascitic fluid NGAL can be used not only for SBP diagnosis but also for prediction of SBP patients' short- term prognosis. Keywords: Neutrophil gelatinase associated lipocalin (NGAL), Ascites, Spontaneous bacterial peritonitis (SBP), Cirrhosis. INTRODUCTION
In cirrhotic individuals with ascites, spontaneous
Hospitals, during the period from July 2022 to
bacterial peritonitis (SBP) is a common and devastating
December 2022. Approval was obtained from the
consequence with very high mortality rate up to 70%
institutional Review Board (IRB). A written consent
(1,2). Diagnosis of SBP up till now is based on ascitic
obtained from all patients. The study comprised 72
fluid (AF) polymorph neutrophil leucocyte (PMNL)
patients with cirrhotic liver with ascites. 72 individuals
count 250/mm3 or positive AF culture which
with liver cirrhosis and ascites were divided into two
consumes a lot of time for detection of the causative
groups; group I contained 36 individuals with SBP,
pathogen and unfortunately, it is negative in about 60%
while group II contained 36 individuals who did not
of patients (3). Neutrophil gelatinase-associated lipocalin
have SBP.
(NGAL), a member of the lipocalin family, is a low
molecular weight secretory protein that was first Inclusion criteria:
discovered in active neutrophils that in cirrhotic patients
All patients in this study diagnosed as cirrhotic
with acute renal injury, urine NGAL can indicate kidney
patient based on clinical and laboratory tests,(clinical
function loss (4). Although NGAL and acute kidney
presence of ascities, hepatic encephalopathy,jaundice or
damage (AKI) have been the subject of numerous
hematemesis and melena )(laborartory CBC platelet
research (5,6,7) relation between ascitic NGAL and SBP,
<150000 , liver function test albumin<3.5 ,INR >1.1
have received very less attention. According to earlier
and coagulation profile) with ascites caused by chronic
investigations, ascitic NGAL may be helpful for
liver illness and ultrasound criteria, after that they were
monitoring bacterial peritonitis in developing non-
divided into two groups, the first one with SBP and the
malignant ascites (8). According to a recent study, when
other one without SBP as a control group.
it comes to decompensated cirrhosis-related SBP, Exclusion criteria:
ascitic NGAL may not only be a biomarker for SBP
Cirrhotic patient with hepatocellular carcinoma,
monitoring but also a predictor of worse outcomes (4).
peritonitis due to any cause other than SBP, patients
We aimed to evaluate the prognostic Patients with
with portal hypertension and ascites from any cause
decompensated liver cirrhosis and spontaneous
other than cirrhosis, patients with liver transplantation
bacterial peritonitis should be tested for ascitic
or any organ transplantation and patients with renal
neutrophil gelatinase associated lipocalin.
diseases.
To identify spontaneous bacterial peritonitis, all PATIENTS AND METHODS
cases underwent a detailed history taking, thorough
This was a case-control study that was carried out
physical examination, laboratory tests (abdominal
in Tropical Medicine Department, Zagazig University
paracentesis and SBP was diagnosed by PMNL count
4511
Received: 17/11/2022 Accepted: 19/01/2023
c:\work\Jor\vol911_116The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4517-4523
Stress Echocardiography and Risk Stratification in Patients with Suspected Ischemic Heart Disease: Review Article Ahmed Shawky Shereef, Kamal Saad Mansour, Reda Ali E. Naji*, Shimaa Gamal ZeinElabdeen
Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt *Corresponding author: Reda Ali E. Naji, Mobile: (+20) 01067113071, E-Mail: [email protected] ABSTRACT Background: In addition to atherosclerosis, non-atherosclerotic occlusive disease and vasospasms all contribute to coronary artery disease (CAD). The leading cause of CAD, atherosclerosis, continues to be a leading contributor to mortality as well as disability globally. Several possible indicators and imaging techniques exist with the potential to enhance diagnosis accuracy in stable CAD. Stress echocardiography and computed tomography coronary angiogram are two of the most prominent imaging techniques. Objective: Review of literature about Stress echocardiography and Risk stratification in patients with suspected ischemic heart disease. Methods: Ischemic heart disease and Stress Echocardiography were searched for on Science Direct, Google Scholar, and PubMed. The authors also reviewed the relevant literature, Nonetheless, only the most recent or exhaustive analysis was included, covering the time span from January 1997 to August 2021.There are no translation resources available, thus non-English documents are out. Unpublished articles, oral presentations, conference abstracts, and dissertations were not included because they were not considered to be part of major scientific projects. Conclusion: The use of stress echocardiography has expanded greatly in recent years as a diagnostic and prognostic tool for patients suspected of having coronary artery disease (CAD). Keywords: Ischemic heart disease, Coronary artery disease, Stress echocardiography.
INTRODUCTION
imaging is after the fact. This raises the prospect of a false-
In addition to atherosclerosis, non-atherosclerotic
negative study due to the quick resolution of WMA. This
occlusive disease and vasospasms all contribute to
is especially true in mild or single-vessel stenosis. The
coronary artery disease (CAD). Risk factor reduction,
heart can be imaged at peak exercise intensity when
screening and early identification, and early and effective
cycling. Theoretically, this could lead to a higher degree of
treatment are just some of the methods available for
sensitivity, allowing for earlier identification of ischemia.
reducing the incidence of atherosclerosis and the deaths it
To prevent the resolution of stress-induced WMA, imaging
causes. The diagnosis of vasospasm typically involves
after the treadmill must be conducted within 45 to 60
ruling out obstructive coronary artery disease because it is
seconds (5).
so common (1).
For patients who are unable to participate in sufficient
When it comes to people who are at a high absolute
physical activity, pharmacologic stress may be an
risk of developing CAD, aggressive therapy typically
alternative. The most common medications are
renders extra non-invasive testing unnecessary. Similarly,
dobutamine and dipyridamole (or adenosine). Due to its
additional non-invasive testing is unnecessary in low-risk
low cost and wide availability, dobutamine has become the
patients. Many people, however, fall somewhere in the
drug of choice in the United States. Myocardial oxygen
middle and could benefit from further non-invasive risk
demand and flow disparity are both raised when
stratification in order to "subclassify" risk/prognosis and
dobutamine and dipyridamole are administered together.
guide future therapy (2).
Heart arrhythmias can be treated in non-exercise ways,
Therefore, the preferred modality would be one that is
such as with stress pacing by transvenous catheter,
easily accessible, has sufficient knowledge, is cost-
permanent pacemaker, or transesophageal atrial pacing.
effective, uses a low dose of radiation, and accurately
When evaluating dyspnoea and tiredness, as well as the
diagnoses and predicts outcomes. The aforementioned
presence or absence of coronary artery disease in exercise-
requirements
can
be
satisfied
through
stress
capable patients, exercise is preferred over pharmacologic
echocardiography. However, CT angiography is
testing. Although the tricuspid regurgitation jet has been
recommended as a primary investigation according to the
shown to accurately reflect the response of the pulmonary
NICE guidelines. CT angiography's limited specificity and
artery pressure to exercise, this does not hold true when
lack of ability to diagnose ischemia result in more frequent
pharmacologic stress is applied (4).
follow-up exams, although the findings of the most recent
SCOT-Heart study may help to justify this choice (3, 4). Stress echocardiograms Analysis:
Stress echocardiogram analysis is a complex part of Stress echocardiography:
echocardiography, and only individuals with the
Stress can come in the form of either exercise or
appropriate knowledge and experience should attempt it.
medication. Exercise equipment (Treadmill vs. bicycle) is
Multiple scales are available for analysing wall motion.
now a question of personal preference and lab protocol.
The basic qualitative assessment of normal versus
When working out on a treadmill, the only option for
pathological regional wall motion using adjectives like
4517
Received: 19/11/2022 Accepted: 21/01/2023
c:\work\Jor\vol911_117The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4524-4530 Assessment of Serum Level of N-Terminal Pro B-Type Natriuretic Peptide as A Predictor of Cardiovascular Disease in Patients with Psoriasis Vulgaris Salma Elsayed Abdo Ebrahim, Elshahat Farag Ahmed Sharaf, Hamdy Foaad Ali Marzouk, Shreif Refaat Esmail
Dermatology, Andrology and STDs Department, Faculty of Medicine, Mansoura University, Egypt Corresponding author: Salma Elsayed Abdo Ebrahim, Mobile: (+20) 01091108162, E-Mail: [email protected] ABSTRACT Background: Psoriasis is a chronic immune-mediated inflammatory illness that impacts two to three percent of the global population. Cardiovascular (CV) comorbidities in cases with psoriasis may be asymptomatic and may even result in sudden mortality. Despite its widespread recognition, the N-terminal pro B-type natriuretic peptide (NT-proBNP) is not yet a standard tool for predicting (CV) outcomes in patients. Objective: The research's goal was to estimate NT-proBNP, as a predictor of CVD, in psoriasis cases and compare it with healthy non psoriatic controls and searching for any correlation among the level of serum NT-proBNP and severity of psoriasis, as defined by PASI ( Psoraisis Area and Severity Index). Patients and Methods: 50 participants with psoriasis and 40 matched healthy controls underwent laboratory test for serum level of NT-proBNP: Each participant had 3 ml of venous blood drawn, centrifuged at 3000 g for five minutes. The serum was stored at -70 degrees Celsius for further biochemical examination. Serum paraoxonase-1 concentrations were measured utilizing ELISA kits Cat. No E3041Hu. Results: In cases who had psoriasis, NT-proBNP levels were considerably greater than in the control group (median=148.5 against 53; p<0.01). Psoriasis severity was inversely related to NT-proBNP rise. Among psoriasis cases, those with hyperlipidemia had significantly higher NT-proBNP level when compared to those with non-hyperlipidemia. Conclusion: Increased levels of NT-proBNP were seen in the studied psoriatic individuals, supporting the possibility of utilizing this biomarker to predict CV hazard in people with psoriasis. Keywords: Psoriasis, NT-proBNP, Cardiovascular (CV).
INTRODUCTION
incipient cardiac risk (9). It has gained credibility as a
The chronic immune-mediated inflammatory
helpful biomarker in HF diagnosis and prognosis (10).
illness psoriasis affects two to three percent of the world's
To our knowledge, only two studies investigated
population (1). Immune system, heredity, keratinocytes, and
serum level of (NT-proBNP) in psoriasis. The two studies
environmental factors interact in a complex manner in the
reported higher NT-proBNP concentrations in psoriatic
pathogenesis of psoriasis (2, 3).
cases related to healthy controls (11, 12).
The fact that psoriasis is linked to other major hazards such
hypertension, diabetes, dyslipidemia, obesity and smoking AIM OF THE WORK
does not explain why those with severe psoriasis have a
This study's objective was to determine the serum
higher hazard of heart attack. Those with more severe
level of NT-proBNP, a predictor of CVD, in psoriasis cases
psoriasis appear to be at greatest risk for developing CVD
and contrast it with healthy non-psoriatic controls. Also, to (4). Psoriatic inflammation may raise CVD risk as well as
search for any correlation among the level of serum NT-
other risk factors and treatments (5).
proBNP and severity of psoriasis, as defined by PASI.
High levels of proinflammatory cytokines in the
blood of psoriatic patients may also encourage the PATIENTS AND METHODS
migration of inflammatory cells across the endothelium of
Fifty people with psoriasis and forty people
blood vessels, which can result in endothelial dysfunction
without the skin condition were studied. The controls were
and plaque formation (1, 6). It is important to identify
of a similar age and gender to the participants. They were
reliable biomarker(s), which may be beneficial for early
randomly selected from the outpatient clinic of the
diagnosis,
prognosis and
prevention
of
certain
Dermatology Department at Mansoura University
cardiovascular problems.
Hospital. Patients were diagnosed on the basis of typical
Brain natriuretic peptide (BNP) is a 32-amino acid
clinical manifestations. Age, gender, SBP, DBP, and heart
peptide produced by the ventricles, Prepro-BNP is
rate were all determined for both patients and controls. The
synthesized first, then pro-BNP is cleaved off and finally
PASI score was also utilized to determine the severity of
BNP is produced (7). BNP is predominantly produced and
the psoriasis. All patients underwent laboratory test for
stored in the cardiac ventricles from membrane granules
lipid profile, FBS, ESR and CRP.
and BNP release is continuous because of ventricular
Serum NT-proBNP levels were measured in all cases. Each
volume expansion and pressure overload (8).
participant had 3 ml of venous blood drawn, centrifuged at
N-terminal pro-brain natriuretic peptide (B-type
3000 g for five minutes, the resulting serum was
natriuretic peptides) has been recognized as a marker for
maintained at -70 degrees Celsius for biochemical testing.
4524
Received: 17/11/2022 Accepted: 19/01/2023
c:\work\Jor\vol911_118The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4531-4534
Prevalence of Non-Alcoholic Fatty Liver Disease and Its Association with Severity in Patients with Irritable Bowel Syndrome 1 Mahmoud labib Mahmoud Salim, 1 Amr Mohamed Fathy Youssef, 2 Eslam Elshafey 1 Hepatology and Gastroenterology and Infectious Diseases Department, 2 Clinical Pathology Department, Al-Ahrar Zagazig Teaching Hospital, Zagazig, Egypt Corresponding author: Eslam Elshafey, Email: [email protected], Mobile: 00201281494169 ABSTRACT Background: In Egypt, irritable bowel syndrome (IBS) and non-alcoholic fatty liver disease (NAFLD) are both common conditions. There has been increased interest in the apparent co-incidence of NAFLD in individuals with IBS as we gain a better understanding of their overlapping risk factors and pathophysiology. The aim: to ascertain the prevalence of NAFLD among IBS patients, as well as the relationship between NAFLD and IBS severity. Patients and methods: A cross-sectional study was conducted on 150 IBS patients who were older than 18 years old at the Hepatology, Gastroenterology, Infectious Diseases Outpatient Clinic and Clinical Pathology Department of Al-Ahrar Zagazig Teaching Hospital. All patients underwent a history taking, general clinical examination, and clinical assessment, imaging studies and laboratory analysis. Results: There were 70.7% people who had NAFLD. 30.2% of patients had severe NAFLD, 19.8% had mild NAFLD, and 50% of patients had intermediate NAFLD. Conclusion: IBS patients have a significant prevalence of NAFLD. In the study participants, moderate/severe NAFLD was a predictor of moderate/severe IBS. Keywords: NAFLD, IBS. INTRODUCTION
consequences. Obesity and insulin resistance are both
A condition of the gut-brain connection known as
problems key components in the pathophysiology of
irritable bowel syndrome (IBS) causes recurring stomach
NAFLD (5).
pain linked to faeces and a change in bowel habits.
The goal of research has been to better understand
Individuals who meet the Rome IV IBS diagnostic
the pathophysiology of NAFLD, which is known to be
criteria, which include a disturbed bowel habit
caused by a combination of genetic, nutritional, and
(constipation, diarrhoea, or a combination of the two),
immunoregulatory variables. It is typically associated
frequent stomach pain, and abdominal bloating or
with obesity and is regarded as the primary outward
distension for at least 6 months prior to diagnosis, are
manifestation of metabolic syndrome (6). However, liver
deemed to have the condition (1). In a recent
steatosis can also occur in people who are normal weight
comprehensive review and meta-analysis, IBS prevalence
or underweight or in people who have a normal metabolic
was found to be 9.2% globally, with significant regional
profile (7), indicating that there may be additional factors
variation (2).
besides obesity and insulin resistance that contribute to
Depending on how it affects one's way of life, IBS
the aetiology of NAFLD.
can range in severity. There are no research demonstrating
According to some studies, irritable bowel syndrome
a connection between NAFLD and IBS, despite several
(IBS) patients are more likely to have NAFLD, and
studies linking obesity and IBS (3).
several explanations for this association have been
As a clinicopathological syndrome, the severity of
proposed, including the co-existence of metabolic
non-alcoholic fatty liver disease (NAFLD) can range
syndrome, small bowel surgery, malnutrition, the effects
from benign steatosis to non-alcoholic steatohepatitis
of medications, intestinal inflammation, and dysbiosis (8).
(NASH) with cirrhosis and associated consequences
developing later in some of these people. NAFLD is PATIENTS AND METHODS
becoming more prevalent in the western population, and
Hospital-based cross-sectional research was carried out at
studies have revealed that it is particularly prevalent in the
the Hepatology, Gastroenterology and Infectious
US (around 30%), where it has replaced cirrhosis as the
Diseases Outpatient Clinic and Clinical Pathology
most prevalent chronic liver disease (4).
Department on 150 IBS patients who were older than 18
When there is excessive fat buildup in hepatocytes
years old.
without any known nonalcoholic fatty liver disease is Exclusion criteria: Individuals under the age of 18 and
caused by factors such as alcohol consumption, and it can
women who were pregnant were not included in the study.
occur with or without necroinflammation and its
Those who displayed serious symptoms such
4531
Received: 21/11/2022 Accepted: 23/01/2023
c:\work\Jor\vol911_119The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4535-4542
Place of Emicizumab in the Management of Hemophilia A: Review Article Tamer Hassan, Marwa Zakaria, Ahmed Farag Mohamed*
Pediatrics Department, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Ahmed Farag Mohamed, Mobile: 01028116702, Email: [email protected] ABSTRACT Emicizumab (Hemlibra®), By connecting FIXa and FX, In hemophilia A patients, a recombinant, humanized, Absent activated factor VIII (FVIII) is successfully functionally restored by a bispecific monoclonal antibody. Subcutaneous emicizumab has been approved in a number of countries for the routine prevention of bleeding episodes in patients with moderate to severe hemophilia A, with or without the use of FVIII inhibitors. In phase III clinical investigations, emicizumab prophylaxis significantly decreased annualized bleeding rates in adults and adolescents with hemophilia A with or without inhibitors and avoided or significantly reduced bleeding in children with hemophilia A with or without inhibitors. Regular use of emicizumab improved health-related quality of life with no discomfort. Emicizumab, regardless of the presence or absence of inhibitors, provides a consistent and frequently well-tolerated alternative to conventional FVIII replacement medications for the prevention of bleeding episodes in people with hemophilia A. This is because of the delivery method's practicality and the flexible dosage schedules (maintenance doses every 1, 2, or 4 weeks).
INTRODUCTION
Emicizumab (Hemlibra®), the first non-factor
It has been demonstrated that emicizumab can
replacement drug to reach the market is a subcutaneously
resemble active FVIII phase I/II early trials are phase I.
injected, recombinant, humanized, bispecific monoclonal
Emicizumab reduced the activated partial thromboplastin
antibody designed to imitate the cofactor effect of
time and increased the peak height of thrombin generation
activated FVIII. Emicizumab has received approval from
(aPTT) in a first-in-human study including 64 healthy
some countries, most notably the USA and Japan, for the
adult males (5).
regular prevention of bleeding events in people with
Emicizumab
showed
mental
focus
hemophilia A. regardless of whether they are also taking
pharmacodynamically reliant impact on the production of
FVIII inhibitors. Moreover, the EU has authorized routine
thrombin and the activity of FVIII in male hemophilia (n
bleeding episode prevention in those with severe or
= 103 evaluable) Patients in the pivotal HAVEN 1 trial.
inhibitor-dependent haemophilia A (2).
After taking the first dose of emicizumab, the aPTT
returned to normal (i.e., 40 s), and stayed there the entire Emicizumab Pharmacodynamics Properties
time. A human-based FVIII chromogenic activity test
Both FIX/FIXa and FX/FXa contain domains that are
showed that emicizumab treatment boosted mean FVIII
similar to epidermal growth factor are highly responsive
activity from 1% at baseline to 30%. Prothrombin time,
to the humanized bispecific IgG1 antibody emicizumab
D-dimer, FIX and FX antigen concentrations, von (3). Emicizumab reconnects To restore the function of
Willebrand factor, or prothrombin fragment levels may
absent activated FVIII, which is essential for effective
change during emicizumab treatment 1.2 did not change
hemostasis, activated FIX and FX in a way similar to that
appreciably (6, 7).
of active FVIII. The plasma concentration of the ternary
complex and the cofactor activity of emicizumab are Pharmacokinetic Properties of Emicizumab
correlated that bridges antigens (FIX-emicizumab-FX).
The
pharmacokinetics of
emicizumab
after
Emicizumab does not promote the synthesis of FVIII
subcutaneous injection are dose-proportional at weekly
inhibitors since there is no sequence homology or
dosages of 0.3-6 mg/kg. After giving hemophilia A
structural similarity to FVIII (1).
patients emicizumab at a loading dose of 1 or 3 mg/kg,
In animal models of hemophilia A, emicizumab
steady state plasma concentrations were discovered after
showed hemostatic action. For instance, In a long-term
around 12 weeks. When given once a week, emicizumab
monkey model of acquired hemophilia, emicizumab
3 mg/kg produced average trough plasma levels of 52.6
prophylaxis decreased the occurrence of the spontaneous
g/mL after 4 weeks of treatment. Absolute bioavailability
bleeding indications that were observed in the control
of emicizumab after a dose of 1 mg/kg varies its median
group. A. In a model of hemophilia A blood, emicizumab
half-life of absorption is 1.6 days, ranging from 80.4 to
increased clot stability in the presence of activated
93.1%. (1,6).
prothrombin complex concentrate (aPCC), which may
Emicizumab's average apparent distribution volume is
assist to partially explain the elevated risk of thrombotic
10.4L. Emicizumab typically has an apparent half-life of
events when emicizumab is used and aPCC are
around 27 days, and its average apparent clearance is 0.27
administered together (4).
L/day. Proteolytic catabolism is the main process by
4535
Received: 21/11/2022 Accepted: 23/01/2023
c:\work\Jor\vol911_120The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4543-4545
Use of Gonadotropin-Releasing Hormone Agonists in Induction of Ovulation: Review Article Walid Mohamed Sayed Ahmed El-Nagar, Zakiya Abdulsalam Miftah Alsahli, Asmaa Mohamed Abdelhady
Department of Obstetrics & Gynecology, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Zakiya Abdulsalam Miftah Alsahli, Phone: 01030434212, Email:[email protected] ABSTRACT Gonadotropin-Releasing Hormone Agonists (GnRH -a) are now frequently used in addition to ovulation induction. With the help of these analogues, a variety of regimens can be utilized to increase the quantity and/or quality of follicles that can be stimulated, lower rates of early luteinization, lower cancellation rates, and eventually increase the likelihood of pregnancy. The current review summarizes the mode of action of GnRH a, and the three types of superovulation protocols; the ultrashort, short, and long protocols. Keywords: Gonadotropin-Releasing Hormone Agonists, Ovulation, Luteinization, Review, Zagazig University.
INTRODUCTION
It has been demonstrated that the presence of an
About 15 to 20 percent of stimulated cycles were lost
elevated basal level of luteinizing hormone (LH) has little
before the development of GnRH agonists as a result of
to do with the effectiveness of an IVF cycle. Premature
an early LH surge. Pretreatment by down-regulation
LH surges, which led to premature luteinization and were
caused this rate to drop to under 2% (6).
causes for discontinuing the treatment cycle, were
brought on by the positive feedback of growing estradiol GNRh Protocols for Controlled Ovarian
levels brought on by the gonadotropins (1). Stimulation:
The initial clinical trials of GnRH analogues have
Three types of superovulation protocols--the
shown their efficacy in lowering the incidence of low
ultrashort, short, and long protocols--combine the use of
responders and removing the basal levels of LH. Cycle
GNRH agonists and hMG, originally and now
cancellations became much less common, and GnRH
recombinant FSH (r-FSH) (7). Both the short and
analogs quickly became widely used (2).
ultrashort protocols attempt to stimulate follicles by
utilizing the initial flare-up in gonadotropin release (7). Mode of Action:
Agonists were first created to have a more potent and The Short Protocol:
pervasive effect on the pituitary; as a result, they boost the
From the first day of the cycle until the induction of
initial release of FSH and LH reserves and temporarily
ovulation with HCG, GnRH agonist is administered
upregulate the membrane-based gonadotropic cell
subcutaneously or intranasally. To prolong follicular
receptors (3).
growth when the pituitary gonadotropins become
A longer duration of administration of agonists
desensitized, exogenous gonadotropins such as hMG or
simulates a chronic infusion of GnRH, neutralizing the
r.FSH must be administered by day 2 of menstruation, or
pulsatile impact. The number of receptors decreases as the
even better, day 3 (5).
agonist receptor complexes are integrated, commonly
referred to as downregulation (4). The Ultra Short Protocols:
The biological activity of FSH and LH is reduced,
Only days 2 through 4 of the cycle are used in the
their serum levels fall, and postmenopausal levels of
ultrashort protocol to administer GnRH agonist
estradiol are reached. By giving GnRH agonists daily
subcutaneously or intranasally, and days 2 mark the
intranasally, subcutaneously, or monthly as part of a
beginning of hMG stimulation (3).
Depot regimen, follicular maturation can be persistently
Starting on day 5 of the cycle, the patient is assessed
suppressed (4).
every day by evaluating serum levels of estradiol and LH
together with vaginal ultrasonography to gauge follicular The Flare up Effect:
growth up to the HCG day, both agonist and hMG are
The GnRH agonists always have an initial stimulatory
sustained for an average of 13 to 14 days (8).
impact before having an inhibitory effect. After 12 hours,
this flare-up results in a five-fold spike in FSH Induction of Ovulation:
concentration and a roughly ten-fold increase in serum
When the leading follicle measures 17 mm in
LH levels. Estradiol levels briefly increase to around four
diameter ovulation induction begins by giving 5000
times the baseline at the same time (5).
4543
Received: 20/11/2022 Accepted: 22/01/2023
c:\work\Jor\vol911_121The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4546-4553
Pre-Contrast Hemogram-Derived Indices as Predictors for Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention Al-Sayed Ahmed Hassan Al-Nahal1, Medhat Ibrahim Mahmoud1, Mohamed Ibrahim Amin2, Mostafa Abd-Elwahab Naguib1, Niveen Shafeek Shokry Sakla1*.
1Internal Medicine and Nephrology Department, Faculty of Medicine, Zagazig University, Egypt.
2Cardiology Department, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Niveen Shafeek Shokry Sakla, Email: [email protected] ABSTRACT Background: Percutaneous coronary intervention (PCI) may be complicated by contrast-induced acute kidney injury (CI- AKI). The current study aimed to evaluate the pre-contrast hemogram-derived indices as early predictors for CI-AKI after PCI. Methods: A case-control study involved 54 patients who underwent PCI, divided into Group I (27 patients with no CI-AKI), and Group II (27 patients with CI-AKI). After the history taking, examination and routine laboratory investigations, the pre-contrast hemogram-derived indices were calculated; neutrophil / lymphocyte ratio (NLR), platelet / lymphocyte ratio (PLR), neutrophil / platelet ratio (NPR), monocyte / lymphocyte ratio (MLR), eosinophil / lymphocyte ratio (ELR), and systemic immune-inflammation (SII) index (platelet count × (neutrophil count / lymphocyte count). Results: There were significantly higher pre-contrast leucocytes, neutrophils, NLR (p0.001) (HS), MLR, PLR, NPR, ELR, and SII in group II than in group I (p0.05). The ROC analysis showed a significant predictive value for pre-contrast NLR (92.8% sensitivity & 51.3% specificity), NPR (42.8% & 86.4%), and SII (53.5% & 81.1%), MLR (85.7% & 43.2%), and ELR (50% & 78.3%). The odds ratios (OR) for pre-contrast hemogram-induced indices as predictors for CI-AKI, with confidence interval (CI) 95% were as follows; NLR OR (2.12), CI (0.71-6.31); PLR OR (2.11), CI (0.71-6.26); SII OR (2.96), CI (0.96-9.11); MLR OR (2.89), CI (0.95-8.72); ELR OR (3.4), CI (1.11-10.4); NPR OR (2.5), CI (0.82-7.53); RDW OR (2.12), CI (0.71-6.31). Conclusion: Hemogram-derived indices including pre-contrast SII, NLR, NPR, and MLR may be useful early predictors for CI-AKI after PCI. Keywords: CI-AKI; NLR; NPR; SII; MLR; PLR; ELR.
INTRODUCTION
count × platelet count / lymphocyte count and reflects the
Acute kidney injury (AKI) is a sudden, and often
inflammatory and immune status of patients (9).
reversible reduction in kidney function (1). AKI is defined
Preoperative high SII index was found to be an
as a rise in serum creatinine (Cr) levels by 0.3 mg/dl or
independent risk factor of CI-AKI following PCI (10). The
more within 48 hours, or its increase 1.5 times the
study was conducted to evaluate the role of pre-contrast
baseline levels within the prior 7 days, or urine volume
hemogram-derived indices as predictors for CI-AKI after
<0.5 ml / kg /h for 6 hours (2). When percutaneous
PCI.
coronary intervention (PCI) for acute coronary syndrome
is complicated with AKI, this predicts worse outcomes, METHODS
and the athero-embolic renal disease has a higher
A case-control study that was conducted from July
likelihood of long-term renal replacement therapy (3). A
2022 to December 2022, at the Intensive Care Unit,
post-PCI increase of 0.3 mg/dL or more in serum Cr
Zagazig University Hospitals, Egypt, and included 54
within 48 hours predicts mortality and major adverse
patients who had PCI; divided into; Group 1: (27 patients
cardiovascular events most accurately (4). Contrast-
with no CI-AKI), and Group 2: (27 patients with CI-AKI).
associated AKI (CA-AKI) may result from ischemia of Inclusion Criteria:
the renal medulla or tubules, vasoconstriction, or from
Patients >18 years, who underwent diagnostic or
cholesterol embolism (5). Serum Cr is a delayed marker for
therapeutic PCI, using iso-ionic iodinated contrast-media
contrast-induced AKI (CI-AKI), so newer biomarkers are
200-250 ml. They were well-hydrated with intravenous
used for early diagnosis (6). Platelets and leucocytes play a
saline 0.9% for 12 hours after the PCI. Patients with CI-
role in thrombogenesis, and inflammation, thus
AKI were diagnosed according to the KDIGO criteria as
hemogram-derived ratios such as the neutrophil /
a rise in serum Cr 0.3 mg/dl or more within 48 hours, or
lymphocyte ratio (NLR), neutrophil / platelet ratio (NPR),
its rise 1.5 times or more the baseline level within the
platelets / lymphocyte ratio (PLR), in addition to systemic
prior 7 days, or urine volume <0.5 ml/kg/h for 6 hours [2].
immune inflammation index (SII) could help as predictors Exclusion Criteria:
for patients at risk for Intensive Care Unit (ICU)
Patients 18 years, AKI before PCI, hypovolemia,
admission (7). The NLR is easily calculated from the
congestive heart failure, kidney transplantation,
differential white blood cell (WBC) count and is an early
hemodialysis, nephrotoxic agents, exposure to contrast
biomarker for AKI (8). The SII is calculated as neutrophil
agent 30 days before the PCI, use of nephrotoxic
4546
Received: 19/11/2022 Accepted: 21/01/2023
c:\work\Jor\vol911_122The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4554-4559
Overview about Complications of Central Venous Catheters of Hemodialysis and Their Prevention in Adults: Review Article Mohamed Fouad Ahmed1, Medhat Ibrahim Mahmoud1, Aya Elsaied Rezk Eljaafary*1, Mahmoud A. Elsabbagh2, Mohamed Gomaa Abdelrahim1
Departments of 1Internal Medicine and 2Vascular Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt *Corresponding author: Aya Elsaied Rezk Eljaafary, Mobile: (+20) 0 100 128 0284, E-Mail: [email protected] ABSTRACT Background: Nontunneled hemodialysis catheters and tunneled hemodialysis catheters, often known as tunneled dialysis catheters, are the two catheter types utilised for vascular access during hemodialysis. Short-term (1 week) consequences include catheter malfunction, central vein stenosis or thrombosis, and catheter-related infection. Long-term (>1 week) complications include those occurring during catheter placement and immediate access-related injuries. Objective: Review of literature about complications of central venous catheters of hemodialysis and their prevention in adults. Methods: Central venous catheters and complications were searched for on Science Direct, Google Scholar, and PubMed. The authors also reviewed the relevant literature. Nonetheless, only the most recent or exhaustive analysis was included, covering the time span from January 2005 to December 2022.There are no translation resources available, thus non-English documents are out. Unpublished articles, oral presentations, conference abstracts, and dissertations were not included because they were not considered to be part of major scientific projects. Conclusion: Infection in the bloodstream is a potentially fatal consequence of a central venous catheter (CVC). The best methods for preserving a catheter have been the subject of numerous scientific investigations. This included delaying replacement, exchanging catheters via a wire, or preserving a new catheter with antibiotic locks and systemic antibiotic therapy, but it was clear that removing the contaminated catheter was the best approach to get rid of the organism. Keywords: Central venous catheters, Hemodialysis, Complications.
INTRODUCTION
withdrawn from the patient through the red port, which
Nontunneled hemodialysis catheters and tunneled
indicates the "arterial lumen," and returned to the patient
hemodialysis catheters, often known as tunneled dialysis
through the blue port after being processed by the dialysis
catheters, are the two catheter types utilised for vascular
machine. Dialysis requires a higher blood flow rate than
access during hemodialysis. The doctor can choose the
normal central venous access catheters can handle (300-
most suitable catheter from among many different
375 mL/min). Hemodialysis catheters come in sizes
models. Polyurethane, poly (carbonate) urethane, and
ranging from 8 to 14 Fr for those that aren't tunneled, and
silicone are the materials used to make hemodialysis
from 10 to 16 Fr for those that are tunneled.
catheters. Both tunneled and non-tunneled catheters are
Catheters come in a wide range of shapes and styles,
formed from polyurethane, while the latter is made to be
with a number of different configurations and tip designs
softer in chronic hemodialysis catheters due to the longer
to choose from. Catheter tip separation can be achieved
dwell durations, while the former is made to be slightly
via a staggered tip design, a septum that protrudes beyond
stiffer at the time of insertion but softens when exposed
the perforations, or lumens that separate distally. The
to normal temperature of the body (1).
catheter tip can be pushed away from the vessel wall by Nontunneled hemodialysis catheters: Catheters that
built-in curvature in another version for self-centering.
aren't tunneled feature a conical point at the end and often
The goal of these layouts is improved circulation and, for
have two or three lumens (2).
some patients, less recirculation (3).
Tunneled hemodialysis catheters: Surface-coated catheters:
A tunnel is constructed subcutaneously through the
Silver, chlorhexidine, rifampin, and minocycline are only
chest wall in the case of the internal jugular site, and
some of the antimicrobials that have been tried and tested
through the thigh in the case of the femoral site, before
as surface coatings forwarding against infection.
the catheter is placed into the vein. The catheter is
Antimicrobial-coated hemodialysis catheters were found
secured and infection risk is decreased with the help of
to be useful in avoiding intravascular catheter infections
an ingrowing tissue point created by the polyester cuff
in early research. Heparin-coated catheters reduce the
inside the ensuing subcutaneous tunnel. It is possible to
risk of blood clots caused by the device (4).
create a fixation point that aids in prevention by sealing the cuff into the intravascular section of the catheter from Indications:
the skin. Infection rates can be lowered by ting migration Nontunneled hemodialysis catheters: Acute kidney
or unintentional dislodging (2).
injury, hemodialysis AV fistula thrombosis, and poisoning all call for the immediate insertion of a catheter Catheter design:
that does not require tunneling. Critically ill individuals
The dialysis circuit consists of two lumens and two
who are bedridden can have femoral catheters placed
ports, one blue and one red. Conventionally, blood is
4554
Received: 21/11/2022 Accepted: 23/01/2023
c:\work\Jor\vol911_123The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4560-4568
Re-Biopsy for Proliferative Lupus Nephritis in Egyptian Female Patients: A Single-Center Study Al-Sayed A. Al-Nahal1, Mohamad A. Fouda2, Amina Mohamed Hosseny3, Eman M. El-Desoki2, Niveen S. S. Sakla*1
Departments 1Internal Medicine and Nephrology and 3Rheumatology and Rehabilitation, Faculty of Medicine,
Zagazig University, Egypt
2Urology and Nephrology Center, Mansoura University, Egypt *Corresponding author: Niveen Shafeek Shokry Sakla, Mobile: (+20) 01285031953, Email:[email protected] ABSTRACT Background: Renal biopsy is the golden tool for the diagnosis of proliferative lupus nephritis (LN), the level of histological activity, and the risk of end-stage renal disease (ESRD). Objective: This study aimed to investigate the value of repeated renal biopsy in the follow-up of proliferative LN patients and to determine the predictors for re-biopsy and re-induction. Methods: A retrospective study made on 184 LN Egyptian females, data from 2002 to 2020 included history, examination, laboratory investigations, and results of repeated biopsies. Results: Remission was achieved in 46.7% of patients versus 53.3% with non-remission. The non-remission was significantly higher with higher chronicity index (CI), CYC 1ry induction, and AZA 1ry maintenance than with lower CI, MMF 1ry induction, or maintenance (S). About 41.8% of patients had a 2nd biopsy, and 30.9% received re- induction therapy. Significant predictors for non-responding included type of 1ry induction and activity index (AI). In the CYC 1ry induction group, the AI mean±SD in 2nd biopsy (6.83 ±4.02) was significantly lower than in 1st biopsy (10.6 ±4.08) (S), while the CI mean±SD in 2nd biopsy (3.4 ±1.4) was significantly higher than in 1st biopsy (2.5 ±1.2) (S), with no significant difference in the MMF group. Out of the 184 LN patients who had their 1st biopsy, 77 patients (41.8%) had a 2nd biopsy, with no difference as regards the class of LN, but the AI mean±SD was significantly lower in the 2nd biopsy (7.4±4.2) compared to 1st biopsy (10.0±4.4) (S), while the CI mean±SD was higher in the 2nd biopsy (3.0±2.3) compared to the 1st biopsy (2.4±1.6) (S). Conclusions: Repeated renal biopsies are important in the follow-up of Egyptian female patients with proliferative LN, after 1ry induction therapy or an event-based biopsy. The use of MMF reduces the risk for non-remission, and the need for re-biopsy, or re-induction. Keywords: Lupus nephritis (LN), Re-induction; Re-biopsy, Cyclophosphamide (CYC), Mycophenolate Mofetil (MMF).
mofetil (MMF), are commonly used for this purpose[6], INTRODUCTION
but new strategies include multitarget therapy with
The development of lupus nephritis (LN) in
calcineurin inhibitors and B-cell depletion therapy [7].
patients with systemic lupus erythematosus (SLE)
Response to current therapy may be delayed and
occurs due to several factors including apoptosis,
less than 50% of LN patients achieve complete
autoantibodies, complement activation, and immune
remission and proteinuria <0.5 g/24 hours after 12
complex formation [1].
months [8], and complete remission was associated with
For the diagnosis of LN and guidance for therapy,
chronicity index on renal biopsy, disease duration, and
renal biopsies play a crucial role [2]. The risk of end-
early hydroxychloroquine use [9]. Moreover, the
stage renal disease (ESRD) is high in patients with
severity of LN and the response to various types of
biopsy-proven class III and IV (proliferative) lupus
therapy vary according to ethnicity and race [10].
nephritis (LN) [3].
This study aimed to investigate the value of
Although most patients with proliferative LN
repeated renal biopsy in the follow-up of proliferative
remain proliferative in repeated renal biopsy, it is still
LN patients and to determine the predictors for re-
recommended to identify the ones that switch to a non-
biopsy and re-induction.
proliferative class as they make up 20% of cases.
Repeated biopsy can also assist in identifying cases PATIENTS AND METHODS
with proliferative LN with progression and the need to Study Design:
intensify, reduce, or replace immunosuppression [4].
This retrospective cohort study had been carried
Short and intensive induction therapy with
out on a total of 184 Egyptian females diagnosed with
immunosuppression is typically the approach for
lupus nephritis (LN), class III and class IV
managing proliferative LN (3-6 months) followed by
(proliferative), with their mean age±SD (36.33±7.82)
maintenance therapy [5]. Corticosteroids, intravenous
years. Data were reviewed for patients attending
and oral cyclophosphamide, as well as mycophenolate
Urology and Nephrology Center, at Mansoura
4560
Received: 20/11/2022 Accepted: 22/01/2023
c:\work\Jor\vol911_1247The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4569-4573
Assessment of Brain Natriuretic Peptide in Contrast-induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Coronary Artery Intervention Mahmoud Hassan Shah, Tamer Mohamed Mostafa, Ahmed Shaker Mousa, Mohammed Rashed Mohammed Hassan*, Shaimaa Wageeh
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt Corresponding Author: Mohammed Rashed Mohammed Hassan, Phone Number: 01030107414, Email:[email protected]
ABSTRACT Background: Acute coronary syndrome (ACS), which encompasses unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI), is frequently caused by atherosclerotic plaque rupture or superficial plaque erosion. One of the leading causes of death worldwide is ACS. Notwithstanding considerable progress in therapy over the previous couple decades. Objective: The current study aimed to evaluate the brain natriuretic peptide's diagnostic value for identifying contrast- induced nephropathy (CIN) after intervention with the coronary artery. Patients and methods: A total of 150 patients participated in this cohort study, which was conducted at the Cardiology Department of Zagazig University and El-Ahrar Teaching Hospital in the Sharkia Governorate. Participants were divided into 2 groups: Group I included CIN sufferers and Group II included those who lack a CIN. Results: A total of 104 patients were followed up and fulfilled our inclusion criteria; the CIN group included 16 (15.4%) patients and he No-CIN group had 88 (84.6%) patients. Male gender was (62.5%) in our research. Patients who had CIN were noticeably older than those who did not. The analysis at hand found that baseline and NT-pro BNP levels varied statistically significantly in comparison to the study groups (both were considerably greater in the CIN group). Conclusion: NT-proBNP or BNP may be reliable predictors of CIN Keywords: Brain natriuretic peptide, Contrast-induced nephropathy, Coronary artery intervention, Acute coronary syndrome, Cohort study, Zagazig University.
INTRODUCTION
Acute coronary syndrome (ACS), which
In reaction to pressure overload, ventricular
encompasses unstable angina (UA), non-ST elevation
dilatation, or myocardial ischemia, the blood is filled
myocardial infarction (NSTEMI), and ST-elevation
with brain natriuretic peptides that are released. There
myocardial infarction (STEMI), is frequently caused by
have been reports of B-type natriuretic peptide (BNP)
atherosclerotic plaque rupture or superficial plaque
or N-terminal pro-B-type natriuretic peptide (NT-
erosion. Although ACS treatment has made great
proBNP) concentrations to be increased in individuals
progress in recent decades, ACS remains a leading
with ACS and have predictive significance.
cause of death globally (1). Coronary angiography is
Additionally, several studies have discovered that
crucial for ACS patients. For UA and NSTEMI, when
Patients with AKI had increased BNP or NT-proBNP
complicating comorbidities are absent, urgent the first
levels, especially those who have ACS and get PCI or
course of treatment for STEMI is advised to be
coronary angiography (5).
percutaneous coronary intervention (PCI). Still
The current study aimed to evaluate the brain
recommended is early invasive treatment involving
natriuretic peptide's diagnostic value for identifying
heart catheterization and revascularization. These
contrast-induced nephropathy (CIN) after intervention
treatments can increase prognosis and lower death in
with the coronary artery.
ACS patients (2).
A frequent and serious consequence that affects PATIENTS AND METHODS
inpatients is acute kidney injury (AKI) and is Type of study: Cohort study.
responsible for a considerable amount of mortality as Study setting: El-Ahrar Teaching Hospital and the
well as other major consequences. Due to exposure to
Cardiology Department of Zagazig University are both
contrast agents, patients with ACS, AKI is more likely
in the Sharkia Governorate.
to develop in those who are having PCI or coronary
angiography, in particular (3). Inclusion criteria: More than 18 middle aged patients
Poor clinical outcomes, such as death, unfavorable
getting coronary intervention for ACS Patients having a
cardiac events, and stent restenosis, are substantially
history of drug use that has an impact were included.
linked with the emergence of CI-AKI stands for
BNP level such as B-blockers, ACES, ARBs and
coronary angiography-induced acute kidney damage.
spironolactone are advised to stop these drugs at least
Early detection of those at risk for CI-AKI is crucial so
48 hours before the procedure.
that the treating physician can take preventative
measures the appropriate preventative measures (4). Exclusion criteria: Patients who are unsuitable for
coronary intervention, hypertensive emergencies and
4569
Received: 21/11/2022 Accepted: 23/01/2023
c:\work\Jor\vol911_125The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4574-4582
Significance of Glucose Transporter Isoform-1(GLUT-1) and Progesterone Receptor Immunohistochemical Expression in Uterine Leiomyomas Associated with Endometrial Hyperplasia or Carcinoma Raafat A. Hegazy, Youssef A. Bayomi, Sabreen M. Abdelnaby, Doaa I. Abdelrahman
Pathology Department, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Sabreen Mohamed Mohamed Abdelnaby, Email: [email protected] Mobile: 01020007663 ABSTRACT Background: The most typical solid benign uterine tumors are called uterine leiomyomas. The most prevalent gynecologic malignancy worldwide is endometrial cancer. It is mandatory to search for new markers that could facilitate early diagnosis and prognosis of endometrial cancer biopsy specimens; among these are Glut-1, and progesteron receptor (PR). Aim: To investigate if there is relation between uterine leiomyoma and the associated benign or malignant endometrial lesions. Materials and methods: This study included 109 patients who underwent a total abdominal hysterectomy, the specimens were fixed in 10% formalin solution and sent to Pathology Department, Faculty of Medicin, Zagazig University and processed for histological routine H&E investigation. Patients were divided into: GI (control group) and included 24 patients diagnosed with uterine leiomyomas with normal endometrium, GII included 60 patients diagnosed with uterine leiomyoma associated with endometrial carcinoma, and GIII included 25 patients diagnosed with uterine leiomyoma associated with atypical endometrial hyperplasia. Results: Patients with leiomyoma associated with endometrial cancer and coupled negative PR expression were substantially linked with high GLUT-1 expression 26. Conclusion: High GLUT-1 and low PR expression in leiomyomas could serve as useful additional marker in predicting the increased future risk of hyperplastic atypia and malignancy and differentiate benign endometrium from atypically hyperplastic endometrium. Keywords: GLUT-1, PR, immunohistochemical, leiomyoma, endometrial carcinoma. INTRODUCTION
Endometrioid and mucinous carcinoma are under Type
The most typical solid benign uterine tumors are called
(1) of endometrial cancer, while serous, clear cell,
uterine leiomyomas, likewise called uterine fibroids.
undifferentiated carcinoma, and carcinosarcoma go under
Hysterectomy is most frequently performed due to uterine
Type (2). A pathological disease known as endometrial
leiomyomas. Uterine leiomyomas affect one in every four
hyperplasia (EH) is marked by hyperplastic alterations in
women. By age 50, the incidence is greater than 70% (1).
the endometrial glandular and stromal tissues lining the
Uterine leiomyomas can be divided into common
uterine cavity. Endometrioid intraepithelial neoplasia
leiomyomas and a few relatively uncommon subtypes,
(EIN), also known as atypical endometrial hyperplasia, is
including cellular, atypical, mitotically active, epithelioid,
thought to be the precursor lesion of endometrial cancer
and myxoid leiomyomas, based on histology. Many (5).
pelvic illnesses, such as endometrial hyperplasia and
The major fuel used to keep the human metabolism
endometrial cancer, frequently coexist with fibroid uterus,
running is glucose. Glucose transport proteins (GLUT)
indicating the presence of shared etiological causes (2).
are the main transport proteins controlling glucose
Uterine leiomyomas may put women at risk for
entrance into cells in humans. These stages are
developing uterine cancer. Numerous studies found that
interdependent and govern glucose hemostasis. There are
women with uterine leiomyomas had a 2- to 3-fold higher
14 different kinds of GLUT, each with a unique tissue
risk of uterine malignancies and that there was a
distribution pattern, sensitivity to the insulin stimulus, and
correlation between uterine leiomyoma and risk of uterine
glucose affinity (6).
cancer. Uterine leiomyomas have been shown in case
The most popular transport protein, known as GLUT-1, is
series to be more frequent among women having
mostly present in erythrocytes, the blood-brain barrier,
hysterectomy for endometrial carcinoma (3).
the liver, and capillary endothelium. Due to their elevated
Uterine cancer is the tenth most prevalent type of cancer
metabolic rates and glucose needs, malignant cells require
among women in Egypt. Endometrial cancer incidence is
a greater expression of the glucose transporter gene.
rising worldwide, according to the Middle East Cancer
Numerous human malignancies, including bladder, lung,
Consortium (MECC), with 382,069 new cases recorded
gallbladder, gastric, head and neck, colorectal, ovarian,
in 2018 (4).
pancreatic, esophageal, breast, and gallbladder
4574
Received: 17/11/2022 Accepted: 19/01/2023
c:\work\Jor\vol911_126The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4583-4589
Usefulness of Platelet to Lymphocyte Ratio as a marker of Erythropoietin Resistance in Hemodialysis Patients Haitham ELSheikh1, Ayman Fathy1, Mona Khaled Azab2*, Ahmed Embaby1
1Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
2Department of Internal Medicine, Al-Ahrar Hospital, Zagazig, Egypt *Corresponding author: Mona Khaled Azab, Mobile: (+20)1018646141, E-Mail: [email protected] ABSTRACT Background: Chronic inflammation was associated with the hyporesponsiveness to erythropoiesis stimulating agents (ESA) in hemodialysis (HD) patients. A rising indicator of inflammation is the platelet-to-lymphocyte ratio (PLR). Objective: The aim of the current work was to assess the role of the PLR in detection of the response to ESA in HD cases. Patients and methods: This cross-sectional study included a total of 80 patients who underwent regular HD at the Department of Internal Medicine, Zagazig University Hospitals. Patients were classified according to median value of erythropoietin hyperresponsiveness index (EHRI) into two groups: Group1; included (41 patients) with low resistance EHRI < 0.167, and Group 2: included (39 patients) with high resistance 0.167. PLR was assessed in both groups. Results: PLR best cutoff value derived from ROC curve to predict EPO resistance was 87.5, with specificity, and sensitivity, were 51.3%, and 56.1%, respectively. PLR had significant positive linear correlation with MCH, MCHC, PLR platelet count, serum sodium and creatinine clearance. PLR was negatively correlated with ALC, AMC, serum creatinine, potassium, and LDL cholesterol, serum iron and TIBC. However, in multivariate linear regression analysis only ALC, platelet count, TIBC and MHCH were found to be independent determents of PLR in HD case. Conclusion: Despite being a simple widely available marker of inflammation, PLR did not appear to be useful in reflecting the EHRI in CKD patients. Thus, we recommend further future multicenter and nationwide studies to stand on the suitable marker for EHRI in CKD population in Egypt. Keywords: Erythropoietin Resistance, Platelet to Lymphocyte Ratio, Hemodialysis INTRODUCTION
assessment of PLR role for detection of the ESA
Patients who had chronic kidney disease (CKD)
hyporesponsiveness in HD cases.
often experience anemia, a condition that is linked to PATIENTS AND METHODS
higher rates of hospitalization and mortality. Anemia
This cross-sectional study included a total of 80
and erythropoietin (EPO) resistance may result from
patients who underwent regular HD at the Department
iron deficiency, occult blood loss, vitamin B12 and
of Internal Medicine, Zagazig University Hospitals.
folate deficiencies, hemoglobinopathies, insufficient dialysis,
hyperparathyroidism,
and
chronic Inclusion criteria: all patients aged 18 years of both
inflammation. However, the relative lack of EPO
sexes, who underwent HD treatment three times/ week,
secretion from the damaged kidney is the primary
each at least about four hours for three months
cause of anemia in CKD. Subsequently, anemia with
employing high permeability polyether sulfone
CKD is typically treated with EPO therapy (1).
hemodialysis filters with a surface area higher than 1.7
About 10% of patients had inadequate response
m2 and an ultrafiltration rate greater than 74
to erythropoiesis stimulating drugs (ESA), a
ml/h/mmHg; blood flow rates of 300-400 mL/min;
phenomenon known as ESA resistance. When an
standard bicarbonate dialysis solution; arterial blood
increased dose of an ESA is not sufficient to attain or
pressures of greater than 74 mmHg (5), using the
maintain the desired hemoglobin (Hb) or hematocrit
erythropoiesis-stimulating agent; Epoetin Beta.
levels, this phenomenon is known as ESA resistance Exclusion criteria: pregnant females or patients with (2).
iron deficiency (who had serum ferritin equals or less
The weekly dose of EPO divided by per kilogram
than ng\ml that indicated the presence of iron
of body weight divided by Hb level (g/dL) has been
deficiency anemia with reference to KDIGO
found to be an effective index of EPO resistance; this
guidelines), who had previously undergone kidney
index is known as the ESA hyporesponsiveness index
transplantation, or recent infection, or receiving
(EHRI). The EHRI has a direct correlation to
immunosuppressive drugs or had history of
comorbidity and mortality in HD patients and may be
malignancy or recently received blood transfusion.
easily measured in the clinic (3).
Patients were classified according to median
It has been suggested that inflammation plays a
value of erythropoietin hyperresponsiveness index
significant role in ESA hyperresponsiveness along
(EHRI) into two groups: Group1; included (41
with oxidative stress commonly occurring in uremic
patients) with low resistance EHRI < 0.167, and
patients (2). In HD patients, inflammation was linked Group 2: included (39 patients) with high resistance
to a low platelet-to-lymphocyte ratio (PLR) (4). Thus,
0.167.
within the scope of these findings we aimed for
All patients were subjected to full history taking,
4583
Received: 22/11/2022 Accepted: 24/01/2023
c:\work\Jor\vol911_127The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4590-4596
Evaluation of the Presence and Risk Factors for Pediatric Metabolic Syndrome in Obese School-Aged Children Ghada Mohammed Abdellatef1, Hend Mohammed Ahmed Ibrahim1*, Weaam Ibrahim Ismail2, Nahed Mahmoud Helmy Khater1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Hend Mohammed Ahmed Ibrahim, Mobile: (+20)1014058918, E-Mail: [email protected] ABSTRACT Background: There is a clear association between metabolic syndrome (MetS) in children with high risk of type 2 diabetes and cardiovascular disease later in life. Objective: The aim of the current work was to detect prevalence of MetS and risk factors of pediatric metabolic syndrome (PMS) in obese children. Subject and Methods: This cross-sectional study was performed at the Departments of Pediatrics and Clinical Pathology, Zagazig University Hospitals. It included 136 primary school-age children having obesity. High-density lipoprotein-cholesterol (HDL-C), fasting plasma glucose (FPG), triacylglycerols (TGs), total cholesterol (TC) and low- density lipoprotein-cholesterol (LDL-C) were assayed. Modified adult treatment panel (ATP-III) classification and cook et al definition were used for assessment of MetS in children involved in the study. Results: A high prevalence of MetS was found in the obese children population (35.3% according to cook et al. definition of MetS and 26.5% according to modified ATP classification). Waist circumference was the major contributor to a metabolic syndrome where each 1 cm increase in circumference increased the risk factor of metabolic syndrome by 1.59 (P<0.0001), followed by systolic blood pressure (SBP) where each 1 mmHg increase in blood pressure led to increased risk of metabolic syndrome by 1.06 (P=0.015). Finally, total cholesterol was the third contributor where each one mg/dl increase in total cholesterol level led to increased risk of metabolic syndrome by 1.02 (P=0.035). Conclusion: It could be concluded that childhood obesity is strongly linked to the occurrence of metabolic syndrome. Keywords: Metabolic Syndrome, Obesity, Pediatrics.
INTRODUCTION
One of the most critical public health challenges Gupta et al. (2) stated that children in Indian
of the 21st century is the epidemic of childhood obesity.
schools had a prevalence of PMS of 3.3%. In Egypt,
An excess of 3 standard deviations (SD) above the Soliman et al. (4) found that 13.12% of children and
median of the World Health Organization's child growth
adolescents were estimated to have MetS.
criteria is considered to be obese. Overweight is defined
Overall, 17.7 percent and 13.5 percent of Port
as a BMI greater than 2 standard deviations above the
Said city's public school students in the 6-12 age range
median, as established by the World Health
were overweight or obese (5, 6).
Organization's growth criteria for children. In 2006, the
Studying the prevalence of the pediatric
rate of childhood obesity was 27.5% in the USA, 25.5%
metabolic syndrome and its related risk factors in obese
in Europe, and 12.5% in Egypt and North Africa. The
children was the focus of this study.
rising rates of overweight and obesity in children and
adults have been linked to dietary patterns that SUBJECTS AND METHODS
emphasize saturated fats, added sugars, and refined
This cross-sectional study included a total of 136
starches (1).
school-age children having obesity with BMI 97%,
Two adult health risks related with pediatric
performed at the Departments of Pediatrics and Clinical
metabolic syndrome (PMS) are early onset diabetes
Pathology, Faculty of Medicine, Zagazig University
mellitus and cardiovascular diseases. School-aged
Hospitals.
children are diagnosed with PMS when three or more of
the following metabolic and clinical problems coexist: Inclusion criteria: School-aged obese children, aged
insulin resistance (IR), abdominal obesity, low high-
510 years, both sexes.
density lipoprotein (HDL), high triglycerides, high
fasting blood glucose (FPG), and high blood pressure Exclusion criteria: Children with secondary causes of
(BP) (2).
obesity, e.g.:
Eighty-five percent of overweight children go on
1- Genetic
syndromes
(e.g.
Bardet-Biedl
to be overweight adults, making childhood obesity a
syndrome,
Alstrom
syndrome,
Cohen
leading cause of preventable illness and death in the
syndrome,
Borjeson-Forssman-Lehmann
adult population. Detecting MetS in young children and
syndrome, Frohlich syndrome, as well as
teenagers is crucial for reducing the global monetary
Prader-Willi syndrome).
and human cost of cardiovascular disease and type 2
2- Endocrinal causes: hypothyroidism, growth
diabetes. For the first time in human history, today's
hormone deficiency, cushing Syndrome and
youth may not live as long as their parents did (3).
insulinoma
4590
Received: 22/11/2022 Accepted: 24/01/2023
c:\work\Jor\vol911_128The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4597-4600
Skin Only Versus Skin and Orbicularis Oculi Muscle Resection in Upper Blepharoplasty Mohammed Salah Awad1, Mohamed Ali Nasr1, Nesma Ahmed Mohamed Abd El-Khalik Rabie2*
1Plastic and Reconstructive Surgery, Faculty of Medicine, Zagazig University, Egypt
2Plastic and reconstructive surgery Resident, Elhelmeya Armed Forces Hospital, Egypt
*Corresponding author: Nesma Ahmed Mohamed Abd El-Khalik Rabie, Mobile: +201069163845, Email: [email protected]
ABSTRACT Background: The actual benefit of resecting of the orbicularis oculi muscle (OOM) in standard blepharoplasty has been questioned in several studies. A significant concern about strip resection of OOM is the addition of more morbidity to the patient's recovery period with potentially equivalent aesthetic outcomes. Objective: The current study aimed to identify patients need upper eyelid blepharoplasty, determine the procedure of choice for patients with changes in periocular region, demonstrate the technique of skin excision only versus skin and OOM excision in blepharoplasty and compare between two techniques as procedures for facial aesthetic surgery. Patients and methods: A randomized controlled clinical trial was conducted at the Plastic and Reconstructive Surgery Department in Zagazig University Hospitals. During the study period (6 months) a total of 24 cases were subjected to upper blepharoplasty. Participants were divided into 2 groups; skin excision only (12 cases) versus skin and OOM excision (12 cases). Results: Edema, hematoma, itching, and pain scores were significantly higher among skin and OOM group compared to skin group. There was a significant difference between the two studied groups regarding 7 days postoperative VAS. Moreover, there were no significant differences regarding 3 months and 6-months postoperatively. Conclusion: Patients who undergone OOM excision had higher satisfaction, less surgical adverse effects, higher VAS score and higher postoperative symptoms than patients who undergone skin only excision. Keywords: Blepharoplasty, Periocular region, Facial aesthetic, Clinical trial, Zagazig University.
INTRODUCTION
The human face is composed of small functional and
(father of Albrecht von Graefe, Ophthalmologist) first
cosmetic units, of which the eyes and periocular region
coined the term "blepharoplasty" while reporting an
constitute the main point of focus in routine face-to-face
eyelid reconstruction (4). Since then, blepharoplasty has
interactions. This dynamic region plays a pivotal role in
evolved and becomes the most commonly performed
the expression of mood, emotion, and character, thus
facial esthetic surgery. Besides being performed for
making it the most relevant component of the facial
esthetic concern, UEB is considered to be the procedure
esthetic and functional unit (1).
of choice for correcting dermatochalasis for functional
Any change in the periocular unit leads to facial
indication (1).
imbalance and functional disharmony, leading both the
The current study aimed to identify patients need upper
young and the elderly to seek consultation, thus making
eyelid blepharoplasty, determine the procedure of choice
blepharoplasty the surgical procedure of choice for both
for patients with changes in periocular region,
cosmetic and functional amelioration (1).
demonstrate the technique of skin excision only versus
Blepharoplasty is a surgical procedure in which the
skin and OOM excision in blepharoplasty and compare
eyelid skin, orbicularis oculi muscle, and orbital fat are
between two techniques as procedures for facial aesthetic
excised, redraped, or sculpted to rejuvenate the esthetic
surgery.
look of the patient along with correction of any functional
abnormality (2). PATIENTS AND METHODS
The word "blepharon" means eyelids and "plastikos"
A randomized controlled clinical trial was conducted at
means to mold. In general, the upper eyelid
the Plastic and Reconstructive Surgery Department in
blepharoplasty (UEB) is done for both esthetic and
Zagazig University Hospitals. During the study period (6
functional indications while the lower eyelid
months; 4 cases/ month) a total of 24 cases were subjected
blepharoplasty is commonly performed for esthetic
to upper blepharoplasty. Participants were divided into 2
rationales(3).
groups; skin excision only (12 cases) versus skin and
Arabian surgeons, Avicenna and Ibn Rashid, described
OOM excision (12 cases).
the significance of excess skin folds in impairing eyesight
way back in the 10th and 11th century. They excised this Inclusion criteria: Confirmed diagnosis with periocular
skin to improve vision, thus giving the first example of a
changes or disharmony as dermatochalasis, Age 18
surgical approach toward the management of
years, intention for surgery at admission, patients with
dermatochalasis. In 1818, Karl Ferdinand Von Graefe
adequate physiological function to undergo anesthesia
4597
Received: 17/11/2022 Accepted: 19/01/2023
c:\work\Jor\vol911_129The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4601-4605
Assessment of Serum Syndecan-1 and its Relation to Renal Involvement in Patients with Systemic Lupus Erythematosus Doaa Ebrahim Ahmed Shreif 1*, Nagat Mohamed ElGazzar 1, Rasha Adel El kholy 2, Doaa Shawky Alashkar 1 1 Rheumatology, Rehabilitation &Physical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
2 Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt *Corresponding author: Doaa Ebrahim Ahmed Shreif., Mobile: +201099823372, E-Mail: [email protected] ABSTRACT Background: Systemic lupus erythematosus (SLE) is an autoimmune illness with variable clinical symptoms and disease course. We aimed to identify the Syndecan-1(SDC-1) role in SLE patients with renal involvement, and to determine its correlation with the disease activity & severity. Patients and Methods: This case control research was performed on 30 SLE patients with renal involvement; they fulfilled the 2019 EULAR/ACR SLE Classification Criteria and were collected from outpatient and inpatient clinics of Department of Rheumatology, Rehabilitation, and Physical Medicine at Tanta University Hospitals. Twenty apparently healthy volunteers of matched age and sex were included as controls.Results: Serum level of SDC1 was significantly increased in SLE patients compared to controls. There was a significant negative correlation between SDC1 & C3 level, a significant positive correlation between SDC1 & WBCs, ESR, CRP, blood urea, serum creatinine, 24 h urinary protein, A/C ratio, Anti-dsDNA, SLEDI & illness duration. Conclusions: The SDC1 serum level was significantly higher than controls, and positively correlated with disease activity In SLE patients with LN. Keywords: Serum Syndecan-1, Renal Involvement, SLE. INTRODUCTION
involvement, & to research its correlation with the
Systemic lupus erythematosus (SLE) is an
disease severity & activity.
autoimmune disorder characterized by variant clinical SUBJECTS AND METHODS
manifestations. Genetic, hormonal, environmental and
This case control research was performed on 30
viral factors are likely to play a role in SLE etiology;
SLE patients with renal involvement; they fulfilled the
yet, the exact SLE pathoetiology remains unknown but
2019 EULAR/ACR SLE Classification Criteria for SLE
it is believed to be multifactorial (1).Lupus nephritis (10). They were selected from the inpatient and outpatient
(LN) involves about 50% of SLE patients and is
clinics of Tanta University Hospitals' Department of
associated with substantial morbidity and mortality (2).
Rheumatology, Rehabilitation, and Physical Medicine.
It has been shown that standard serological
Twenty sex and age- matched volunteers in an apparent
biomarkers, like anti-dsDNA antibodies & complement
good health were included as controls in this research.
levels, are neither predictors of disease flares nor accurate indicators of disease activity (3). Ethical considerations:
Absence of effective SLE biomarkers impedes the Informed written consent was obtained from each
disease activity and treatment response assessment. As eligible patient who participated in the research. The
a result, new biomarkers development to utilize as current research was approved by Local Research
surrogate measures of disease activity and/or to predict Ethics Committee of Faculty of Medicine Tanta
illness flare-ups is of an increasing interest (3). Early University at 2/10/2021 approved code 34951/10/21.
identification of renal impairment can enhance clinical All patients were given an explanation of each test,
outcomes & reduce the end-stage renal disease risk (4). before obtaining their signed informed consent to
Therefore, for the effective management, an easily participate in the research, Patients with stroke,
accessible, noninvasive & reproducible biomarker to transient ischemic attack, vasculitis, & pre-existing
anticipate the nephritis onset & measure its activity overt coronary artery disease (myocardial
would be important (5). Syndecan, a heparin -sulphate infarction, typical angina) and pregnant females
proteoglycan, participates in a variety of biological were excluded from the research. This work has
pathways, as inflammation, development and wound been carried out in accordance with The Code of
healing. (6). Four SDC proteins are found in mammals Ethics of the World Medical Association
encoded by 4 separate genes (7).Of the 4 SDC subtypes; (Declaration of Helsinki) for studies involving
SDC-1 (CD138) is widely expressed on epithelial, humans.
endothelial, and plasma cell surfaces (6).In active SLE, All patients underwent the following assessments:
serum SDC-1 was significantly higher than in inactive Full medical history taking:
SLE, and its level was linked with SLE disease activity
Name, age, gender, residence, occupation, and
index & CD138-positive plasma cells ratio (8).Under
special habits), Complaint in the patient's own words,
certain pathological situations, It is feasible to release
current history: onset, course, illness duration, family
the SDC-1 extracellular domain into extracellular fluids
history of comparable condition or other rheumatologic
by removing it from the cell surface (9). We aimed to
disorders and past history of previous medications or
identify the SDC-1 role in SLE patients with renal
operation, and Complete clinical examination:
4601
Received: 19/11/2022 Accepted: 22/01/2023
RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKEThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4606-4613
Neutrophil-to-Lymphocyte Ratio and Mean Platelet Volume in Predicting Coronary No-Reflow in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention *Hany Mohamed Fakhry, Ahmed Eltelawy, Khaled Said Othman, Shehab Adel El Etriby
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt *Corresponding author: Hany Mohammed Fakhry Mahmoud, Mobile: (+20)1002554916, Email:[email protected] ABSTRACT Background: Primary percutaneous coronary intervention (PPCI) is the recommended treatment for acute ST-elevation myocardial infarction (STEMI). However, 40% of patients receiving initial PCI may experience the no-reflow phenomenon (NRP), which can enlarge the myocardial infarction region and increase death rate. Objectives: The aim of the current work was to ascertain the role of the mean platelet volume (MPV) and neutrophil-to- lymphocyte ratio in predicting coronary no-reflow in STEMI cases undergoing PPCI. Patients and Methods: This prospective study included a total of 100 patients with ST segment elevation myocardial infarction (STEMI) treated with primary PCI at Nasser Institute Hospital and Ain Shams University Hospitals. The patients were divided into 2 groups according to TIMI flow grades after primary PCI. 50 patients with TIMI flow grade 3 formed (reflow group) and 50 patients with TIMI flow grades 0-2 formed (no-reflow group). Results: Cases which manipulated with post stent dilatation in no-reflow group were significantly higher than in the reflow group (P = 0.028). Ejection fraction (EF) by M mode was significantly lower in the no-reflow group cases compared to those of reflow group (P = 0.040). Absolute lymphocytes were significantly higher in the no-reflow group cases compared to those of reflow group (P = 0.001). When compared to cases in the reflow group, the neutrophils to lymphocytes ratio was significantly higher in the no-reflow group cases (P = 0.011). When compared to the reflow group cases, MPV was significantly higher in the no-reflow group cases (P = 0.001). Hb level was significantly higher in the no-reflow group cases compared to those of reflow group (P = 0.005). Mean platelet volume and Neutrophil to lymphocyte ratio are considered a promising positive predictor of no-reflow phenomenon after primary PCI. Conclusion: It could be concluded that mean platelet volume is thought to be a potentially favorable predictor of the no- reflow phenomenon. New independent variables for forecasting no-reflow phenomenon in patients having PPCI include post- stent dilatation and EF by M mode. In patients having PPCI, the neutrophils to lymphocytes ratio plays a part in forecasting the no-reflow occurrence. Keywords: Mean platelet volume, Neutrophil-to-lymphocyte ratio, no-reflow phenomenon, PPCI, STEMI.
INTRODUCTION
atherosclerotic plaque, as well as artery blockage, can
Despite the complete removal of the artery-
all be caused by inflammation (7). Techniques like
related infarction-related obstruction, no-reflow
angiography, electrocardiography (ECG), contrast
phenomenon (NRP) refers to the failure of myocardial
ultrasound, scintigraphy, and magnetic resonance imaging
perfusion. Mojno came up with the word "no-reflow" in
(MRI) can be used to identify it (5).
1967 (1).
A severe slowing or lack of distal coronary flow
Myocardial infarction (MI), higher mortality,
(TIMI 0-1-2) without any dissection, vasospasm,
impaired left ventricular ejection fraction, malignant
thrombosis, or remnant stenosis is what it is known
rhythms, and occurrence of cardiac rupture are all
angiographically as no-reflow phenomenon (5). The
associated with the formation of the NRP (1).
frequency during primary PCI is approximately 11%-
Macroscopic symptoms of NRP include
41%, despite the fact that it was 0.6-2.0% in all PCIs (1).
extensive tissue hemorrhage and myocardial necrosis,
MBG and TIMI flow scores are commonly used
while microscopic symptoms include endothelial
to evaluate coronary perfusion. The term "TIMI flow"
injury, inflammation, and intracellular swelling (2,3).
describes both the rate of dye flow and intensity of
Leukocyte-erythrocyte plugs, microcirculatory
visualization of infarct related epicardial artery.
vasospasm,
platelet
agglutination,
neutrophil
TIMI ranges from 0 to 3. The myocardial
infiltration, free radical damage, and severe myocardial
perfusion refill and clearing are assessed using MPG.
capillary damage brought on by distal microthrombus
MBG receives a score of 0-3. Upon filling, cardiac color
embolization all contributed to the development of these
is visible (or ground glass appearance of the myocardium)
symptoms (2,4, 5). (9).
The etiology of myocardial reperfusion and
As a result, TIMI flow grading measure the
inflammation, which are both important contributors to
epicardial flow, whereas MBG analyze the capillary
the development of coronary artery disease and its
flow. Angiographical no-reflow is defined by TIMI
consequences, are closely related (6).
flow classification and MBG as TIMI flow <3 (with any
The growth of NRP and the creation of thrombi
MBG grade) or TIMI flow 3 with MBG 0-1 whereas
are actively influenced by systemic and local
effective reperfusion is attained when MBG is (2-3) and
inflammation. The development and rupture of
TIMI flow is 3 (10).
4606
Received: 22/11/2022 Accepted: 24/01/2023
c:\work\Jor\vol911_131The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4614-4618
Interleukin-29 in Autoimmune Diseases: Review Article Amal Bakry Abdelsattar, Merna Mohamed Hazem Mohamed*
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Egypt *Corresponding author Merna Mohamed Hazem Mohamed, Mobile: (+20) 01098600191, E-Mail:[email protected] ABSTRACT Background: A number of cytokines are produced when interleukin-29 (IL-29) is introduced to monocytes. High creation of IL-6, IL-8, and IL-10 was seen after stimulating human monocytes with IL-29. The cytokine Interlukin-19 belongs to the interleukin-10 family. When interleukin-29 was added to monocytes, IL-19 production was increased. In response to IL-29, monocytes exhibited rapid morphological changes. Objective: To study and focus on role of Interleukin-29 in autoimmune diseases. Methods: We scoured medical papers and databases including PubMed, Google Scholar, and Science Direct for information on IL-29 and autoimmune illnesses. Only the most recent or comprehensive study conducted between April 2002 and December 2020 was included in the analysis. The authors also assessed the usefulness of references drawn from similar books. Documents written in languages other than English have been neglected because of a lack of funding to translate them. Unpublished articles, oral talks, conference abstracts, and dissertations were all generally agreed upon not to constitute valid scientific investigation. Conclusion: As a newly found type III interferon, interleukin-29 (IL-29) is an exciting discovery. It mediates signal transmission and results in the generation of inflammatory components via interactions with its receptor complex that initiate further signal transduction. Recent studies have linked dysregulated IL-29 expression to a wide variety of inflammatory autoimmune diseases, involving osteoarthritis, systemic sclerosis, rheumatoid arthritis, psoriasis, systemic lupus erythematosus as well as Sjögren's syndrome. Furthermore, functional investigation suggested that IL-29 may contribute to the onset of autoimmune inflammatory disorders. Keywords: Autoimmune diseases, Interleukin-29. INTRODUCTION
arthritis (RA), Sjögren's syndrome, systemic sclerosis,
The interleukin-29 receptor is expressed on some
psoriasis, as well as systemic lupus erythematosus (1).
cell types such as dendritic cells, T cells, leukaemia
cells, and intestinal epithelial cells. There has been a lot Structure:
of talk about how interleukin-29 plays a crucial function
In spite of its structural similarities to other members
in tumours and how it could be used in clinical therapy.
of the IFN- family, interleukin-29's core amino acid
In addition to its role as an antiviral and
sequence (and, by extension, its activity) is more like to
immunoregulatory cytokine, research has shown that
that of type I interferons. It interacts with a
interleukin-29 plays a crucial role in inflammatory
heterodimeric receptor consisting of the IFN-specific
autoimmune illnesses (1).
IFNL1R subunit and the IL-10 family-wide IL10RB
In the recently identified type III IFN family,
subunit (3).
interleukin-29 plays a pivotal role. Due of the
considerable link between it among inflammatory Signaling and mechanism of action of IL-29:
autoimmune disorders, we thoroughly examined the
Interleukin-29 is the most abundant type III
most recent literature on this topic. More people are
interferon (IFN) protein subtype, and it acts as a signal
paying attention to these researches because of the
transducer through stimulation of the Akt/protein kinase
potential role of IL-29 as a regulator in inflammatory
B (PKB) and mitogen-activated protein kinase (MAPK)
autoimmune disorders. The data gathered are expected
signaling pathways in response to cytokines. Mediating
to aid in the study of interleukin-29 in the future, and
interleukin-29 signaling are the IL-28R alpha and IL-
may yield insights into the role of this cytokine in
10R beta 2 receptor complexes (4).
inflammatory autoimmune disorders. Important
It's worth noting that interleukin-29 may have a
implications for its potential in clinical therapy may also
limited effect on signaling pathways outside of certain
be gleaned from our review (2).
cells. After being stimulated with interleukin-29,
There has been a lot of interest in interleukin-29 as
fibroblast-like synovial cells (FLS) from people with
of late. Some tissues were found to be the only ones that
osteoarthritis (OA) phosphorylated proteins in the
produced interleukin-29. There has been a lot of talk
mitogen-activated protein kinase (MAPK) and Akt
about how interleukin-29 plays a crucial function in
signaling pathways. The IL29-treated mast cell line
tumours and how it could be used in clinical therapy. In
P815 increased its production of IL-4 and IL-13 via the
addition to its role as an antiviral and immunoregulatory
phosphatidylinositol
3kinase
(PI3K)/Akt
and
cytokine, research has shown that interleukin-29
JAKSTAT3
signaling
pathways.
Macrophages
(interleukin-29) plays a crucial role in inflammatory
generated from monocytes react to interleukin-29
autoimmune illnesses like osteoarthritis, rheumatoid
treatment by being phosphorylated at the signal transducer and activator of transcription (5).
4614
Received: 23/11/2022 Accepted: 25/01/2023
c:\work\Jor\vol911_132The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4619-4623
Aerobic Exercises versus Laser Puncture Therapy on Immune Response Following Neck Lymph Node Dissection Zakaria M.Emam ¹, Eva S. Kamel1*, Ahmed R. Abd EL-Fatah ²,Aya Gamal Fawzy El-Sayed1
1 Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt
2 Department of Surgical Oncology, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Eva S. Kamel, E-mail: [email protected],Telephone: +201224372237 Abstract Background: The treatment of head and neck cancers is still difficult and calls for a multidisciplinary strategy that includes surgery, radiation, chemotherapy, and systemic therapy. Purpose: In the current academic work, the effects of aerobic exercise and laser puncture on immunological responses following neck lymph node removal were assessed and compared. Subjects and Methods: After dissection of the neck lymph nodes, forty male cases with decreased total leukocyte counts and differential lymphocyte counts. They were sub-categorized into two equal groups randomly. Group (A) had two months treatment plan of 15 minutes per day, every other day, of aerobic exercise. Group (B) had a two-month treatment plan of 15 minutes per day, every other day, of laser puncture in the depression beneath the spinous process of C7 at Governor Vessel (GV - 14 Dazhui). Leukocyte total count and a differential lymphocyte count were utilized in the current work as evaluation techniques. Results: The results demonstrated the effectiveness of both aerobic exercise training and laser puncture in the depression beneath the spinous process of C7 at Governor Vessel (GV - 14 Dazhui). However, aerobic exercise training was more successful and helpful in boosting the decreased immune response than the laser puncture. Conclusion: The outcomes of the current academic work highlighted the fact that aerobic exercise is preferable, and low-level laser puncture is also crucial in boosting the immune response. Keywords: Aerobic exercises; Laser puncture; Leukocytes; Differential count of lymphocytes; Immune response. INTRODUCTION
This study aimed to trace and shed light on the
Often, medical treatment consists of several different
influence of aerobic exercise and laser puncture on the
interventions (3).
immune response after neck lymph node dissection.The
Neck dissection, or the excision of the neck's
incidence of neck cancer is substantially higher in
lymph nodes, was the surgical procedure followed to
several regions of the world. 90% of cases with a history
treat neck cancer. There are three main categories of
of smoking report that smoking, alcohol, nicotine,
neck dissection procedures: radical neck dissection,
viruses, and heredity were major contributing factors to
modified radical neck dissection, and selective neck
the development of their neck cancer (1).
dissection (4).
Squamous cell carcinoma accounts for about 90%
A spectrum of academic research papers has
of neck cancer cases. Cancer suppressor genes are
demonstrated that host cellular immunity is both
rendered
inactive
and
proto-oncogenes
are
qualitatively and quantitatively compromised when
overexpressed in epithelial cells, which lead to the
malignancies advance. According to recent research,
growth of tumor cells and distant metastasis. Cases with
immune deficiencies are linked to both cancer and its
head and neck squamous cell carcinoma (HNSCC)have
therapy, and blood immune function is positively
decreased dendritic cell (DC) and natural killer (NK)
correlated with cancer progression
cell functions, elevated levels of immune-suppressive
Exercise is increasingly popular as an intervention
molecules, a loss of regulatory T cells, co-stimulatory
for symptoms brought on by cancer treatment.
molecules, and major histocompatibility complex
Preliminary evidence suggests that exercise can
(MHC) class I molecules, fewer lymphocyte subsets,
enhance cancer survivors' blood immunological
and suboptimal response to antigen-presenting cells (1).
function, according to a new systematic review.
A deeper comprehension of the interplay between
Increased monocyte function, circulating granulocyte
the immune system and HNSCC is needed in order to
percentage, and natural killer (NK) cell cytotoxic
create successful immunotherapies, and innovative
activity are a few of the improvements that have been
therapeutic alternatives should be developed in
observed i.e., neutrophils, eosinophils, and basophils (5).
particular. An individual's white blood cell count can be
There has been a lot of attention lately on the
impacted by certain cancer treatments, which can cause
connection between exercise and the immune system.
leukopenia. Chemotherapy and radiation therapy are
By hemodynamic changes, exercise is thought to affect
two treatment plans that might have this impact (2).
innate immunity, T and B cell activities, and cytokine
The medication plan for individuals with
responses. Exercises that are aerobic or "with oxygen"
squamous cell carcinoma (SCC) of the neck
improve cardiovascular fitness (6).
encompasses the treatment of the local lymph nodes.
The results of current randomized controlled trials
on the benefits of moderate-intensity exercise are,
4619
Received: 22/11/2022 Accepted: 24/01/2023
c:\work\Jor\vol911_133 The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4624-4631
Antibiotic Susceptibility Pattern of Bacterial Isolated from Lower Respiratory Tract Infections at Respiratory Intensive Care Unit Sara Ibrahem Amin*1, Howida Mohamed Abdelsalam1, Adel Attia Ahmed1, Doaa Mostafa Gad1, Rehab Hosny El Sokkary2
Departments of 1Chest and 2Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Sara Ibrahem Amin, Mobile: (+20) 01223403477, E-Mail: [email protected] ABSTRACT Background: The control of infections in intensive care units (ICUs) is becoming more difficult.Antibiotics utilization Recent antibiotic overuse has prompted the emergence resistance to antibiotics, which poses a threat to healthcare, especially in developing nations without access to antibiogram in most ICUs. Objectives: This study aimed to present antibiotic susceptibility pattern of microbial infections and describe some antibiotic use features. Patients and method: This is a cross sectional study included 53 patients with lower respiratory tract infections admitted in respiratory ICU chest department, University Hospitals of Zagazig in the period from September 2018 to September 2019, we collected the following data: past history, length of hospital stay and comorbidities. The following parameters were assessed: clinical pulmonary infection score (CPIS), general and local examination, radiological and routine laboratory investigation, arterial blood gases (ABG) and microbiological results of isolated microbes and their susceptibility pattern using (blood and sputum culture). Result: Among studied patients one patient died during the study and excluded, mean age was 56.4815.73, 53.8% were males and 46.2% were females. 36 (69.23%) were improved,16 (30.77%) were complicated. Blood and sputum culture were done for all patients most organism detected in sputum culture was Klebsiella pneumonie, in blood culture was Staphylococcus aures. According to culture towards Klebsiella, highest sensitivity was levofloxacin (93.33%), Streptococcus pneumoniae highest sensitivity was levofloxacin (83.33%), Staphylococcus aureus highest sensitivity was linezolid (85%), Pseudomonas aeruginosa. highest sensitivity was meropenem (83.33%), Acinetobacter highest sensitivity was imepenem (58%). Conclusion: Combined clinical, laboratory, radiological and microbiological findings help in diagnosis and treatment of LRTI. Keywords: LRTI, Antibiogram, Antibiotic, Utilization.
INTRODUCTION
The importance of identifying risk factors in clinical
Significant morbidity, death, and healthcare-related
settings for multi-drug resistance bacteria (MDRB),
costs are attributable to respiratory infections in patients
before the results of the culture are available, the
hospitalised to the ICU. Worldwide, respiratory
(MDRB) infection is to guide empirical therapy, or the
infections are responsible for 3.5 million fatalities and
pathogen identification and testing for antibiotic
79 million years of lost productivity due to disability (1).
susceptibility. The intricate interactions between the
The most common cause of pneumonia is a bacterial
host, environment, and pathogen preclude the use of a
infection, which is treated with an antibiotic
single algorithm to forecast an MDRB infection,
prescription. Antibiotic overprescribing carries a
necessitating the adoption of an individualised
number of concerns, including exposing patients to side
probabilistic method for the selection of empirical
effects needlessly while failing to speed up their
medications. It is not necessary to consider documented
recovery, raising the chance of contracting an infection
carriage as a specific need when selecting an empirical
with an antibiotic-resistant bacterium, and lengthening
therapy. Patients who have experienced prior antibiotic
the time, expense, and workload associated with patient
exposure, protracted hospital stays, invasive surgeries,
recovery. On the other hand, under prescribing
and advanced co-morbid conditions are at an elevated
antibiotics can raise the chance of developing a serious
risk of MDRB infections(4).
pneumonia(2).
Antibiotic resistance has lately evolved as a
The majority of currently known biomarkers target
result of antibiotic abuse and poses a threat to the
the host inflammatory response and are therefore
healthcare system, particularly in developing nations
notoriously less accurate for making a diagnosis in
where the majority of ICUs lack antimicrobial
critically sick patients with several additional causes of
stewardship programmes (5).
inflammation or compromised immune function.
Therapeutic Drug Monitoring (TDM) is defined by
Biomarkers can help with antibiotic monitoring as well.
the World Health Organisation (WHO) as ensuring that
Nevertheless, in critically sick patients with a range of
patients receive the right drugs for their clinical needs,
infections, a consistent pattern of safely reducing the
for the shortest time possible, and at the least expensive
length of antibiotic treatments based on a noticeable
possible price for them and their community. Since
improvement or normalisation of biomarkers, such as
many factors that are crucial for the best possible
procalcitonin and C-reactive protein, has been shown(3).
antimicrobial therapy have previously been identified,
4624
Received: 24/11/2022 Accepted: 26/01/2023
c:\work\Jor\vol911_134The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4632-4638
Interleukin 17 gene in Bronchial Asthma: Review Article Heba Abdel Hameed Attia Mohamed*1,Yousri Mostafa Hussein1, Azza Ali Khalil2, Abdallah Salem El Deeb1
Departments of 1Medical Biochemistry & Immunology and
2Pediatrics, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Heba Abdel Hameed Attia Mohamed, Mobile: (+20) 01091633601, E-Mail:[email protected] ABSTRACT Background: Asthma patients from all walks of life share a common symptom: persistent airway inflammation. A history of wheezing, chest tightness, shortness of breath, and cough, along with these symptoms, are diagnostic of this condition. Serum levels of interleukin-17 (IL-17) were considerably higher in patients with uncontrolled asthma compared to those with managed asthma and healthy people. Objective: To study and focus on role of IL-17 among bronchial asthma patients. Methods: We scoured medical papers and databases including PubMed, Google Scholar, and Science Direct for information on IL-17 and bronchial asthma. Only the most recent or comprehensive studies conducted between November 2006 and December 2022 were included in the analysis. The authors also assessed the usefulness of references drawn from similar books. Documents written in languages other than English have been neglected because of a lack of funding to translate them. Unpublished articles, oral talks, conference abstracts, and dissertations were all generally agreed upon not to constitute valid scientific investigation. Conclusion: Genetic research, clinical correlations, in vitro investigations, and animal models all point to IL-17 dysregulation as a possible cause of asthma. Asthma is linked to variations in the IL-17 gene in humans. Based on in vitro studies revealing that IL-17 A caused IL-17 receptor alpha expression in human bronchial epithelial cells, the notion was initially proposed that IL-17 A caused airway neutrophilia, a trait of the neutrophilic phenotype. Keywords: Bronchial asthma, IL-17.
INTRODUCTION Epidemiology and Incidence:
Asthma patients from all walks of life share a
More than 300 million individuals around the world,
common symptom: persistent airway inflammation,
including 25 million Americans, suffer from asthma.
wheezing, chest tightness, shortness of breath, and
Youngsters all throughout the world, including an
cough, which are hallmarks of this condition, as are
estimated 6.4 million children in the United States,
histories of these and other respiratory symptoms (1).
suffer from it. Asthma varies in incidence, severity, and
fatality rates among regions. Asthma prevalence has Description of Asthma:
been on the rise in some affluent countries, but seems to
Worldwide, 1-18% of the population has asthma,
have levelled off in others, and the rate of increase
making it the most prevalent chronic respiratory
varies widely depending on where you look. Asthma is
condition. Asthma is characterised by fluctuating
more prevalent in males than females in both childhood
wheezing, shortness of breath, chest tightness, and/or
and adulthood, suggesting that sex hormones may
coughing symptoms and fluctuating expiratory airflow
contribute to the development of various forms of the
limitation. Exercising, being exposed to allergens or
disease (2).
irritants, a shift in the weather, or a viral respiratory
Exposure to exogenous factors, such as cigarette
illness are all common triggers for these shifts.
smoke, a decrease in host resistance, an increase in the
Sometimes, weeks or months will go by without any
incidence of viral respiratory infection, allergens,
signs of the condition at all, and sometimes, symptoms
cockroach allergy, and dietary changes, may explain the
and airflow limitation will disappear on their own or in
rise in the prevalence of paediatric asthma. These
response to medicine. On the other hand, persons with
factors may reduce natural antioxidant defences,
asthma might have episodes of worsening symptoms
making the respiratory system more vulnerable to the
(exacerbations) that pose a serious risk to their health
oxidant injurious effects of free radicals (3).
and the health of their community. Asthma is
More than a third of youngsters in some developed
characterized by airway hyperresponsiveness to both
nations suffer from asthma or allergies, which has
direct and indirect stimuli and by persistent airway
reached an alarming level. Whether this is attributable
inflammation. These characteristics typically continue
to a truly rising asthmatic and allergic population or just
even in the absence of symptoms or abnormal lung
due to improved detection and diagnosis is unclear (4).
function, however they may return to normal with
c:\work\Jor\vol911_135The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4639-4643
The Impact of Forkhead Box Protein P3 (FOXP3) on Allergic Asthma: Review Article Ahmed Roshdy Mohammed Hassan1, Nagwan Adel Ismail2, Yasmin Ahmed Fahmy1, Amira Gamal Mohammed Abdallah*1
Departments of 1Medical Microbiology and Immunology and
2Chest diseases, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Amira Gamal Mohammed Abdallah, Mobile: (+20) 01154938361, E-Mail: [email protected] ABSTRACT Background: Asthma is a major health problem. Increases the price tag as well as the number of people affected by it. The pathogenesis of allergic asthma has been linked to a number of genes. The FOXP3 gene have recently been studied for their potential relevance in the protection against development of allergic asthma. Objective: Assessment of possible importance of Forkhead Box Protein P3 (FOXP3) among Allergic Asthma. Methods: PubMed, Google Scholar, and Science Direct were scoured for information on FOXP3, polymorphism, and allergic asthma. The authors also reviewed the relevant literature, however only the most recent or comprehensive studies from December 2005 to January 2022 were included. Documents written in languages other than English have been disregarded because translation resources are inadequate. Unpublished articles, oral presentations, conference abstracts, and dissertations were not included because they were not considered to be part of major scientific projects. Conclusion: The FOXP3 gene located on Xp11.23 has a great importance in immune hemostasis and prevention of a wide variety of diseases, including a number of allergy-related conditions. Therefore, it appears to prevent allergic disease, however, additional research is needed to determine how it affects asthma. Keywords: Forkhead Box Protein P3, Allergic asthma.
INTRODUCTION
and 18% of the world's population suffers from asthma,
Asthma is a wide-ranging condition characterized
with the condition affecting both young and old (1).
by a history of wheezing, shortness of breath, chest
Adjusted prevalence estimates for asthma in the Middle
tightness, and cough in addition to a history of variable
East ranged from 4.4% to 7.6%, lower than those
expiratory air flow limitation (1). The most prevalent form
reported for Europe and North America (3).
of asthma is allergic asthma, which is defined by the
The most common form of asthma, known as
development of characteristic asthmatic symptoms
allergic asthma, typically manifests in early childhood
following exposure to airborne allergens due to the IgE's
and is associated with a personal or family history of
sensitivity to these allergens. Inflammation of the
other allergic disorders. Sputum analysis before
airways of type 2 (T2) is the etiology of allergic asthma
treatment often demonstrates eosinophilic airway (2). It is estimated that 300 million individuals around the
irritation in these patients. Patients with this subtype of
world suffer from asthma. Using consistent methods,
asthma typically benefit from inhaled corticosteroids
researchers have been able to determine that between 1
(ICS) (Figure 1) (1). Figure (1): Pathophysiology of development of Asthma (3)
4638
Received: 24/11/2022 Accepted: 26/01/2023
c:\work\Jor\vol911_136The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4644-4647
Athletes Trunk Proprioceptive Ability Versus Non athletes Dina M. A. Al hamaky1, Aya A. Khalil2*, Mohamed Nabil Elbahrawy3, Ahmed Ebrahim Elerian4, Dina S. Abd Allah1
Departments of 1Physical Therapy for Musculoskeletal Disorders and its Surgery, 2Biomechanics,
3Physical Therapy for Neurological Disorders and its Surgery,
4Basic Science, Faculty of Physical Therapy, Cairo University, Egypt *Corresponding author: Aya A. Khalil, Mobile: (+20) 01112204944, E-Mail: [email protected] ABSTRACT Background: Intact proprioception is required to maintain motor trunk control and lumbopelvic stability. Impaired proprioception has an adverse effect on trunk motor control that increases the risk of injury particularly low back pain. Objective comparison between athletic and non-athletic population in trunk proprioception is needed. Objective: The current study was to investigate whether a significant variance in trunk proprioception can be observed between athletic and non-athletic subjects. Patients and methods: A cross sectional study conducted on 70 male and female volunteer subjects with age ranged from 18-37 years old. Participants were assigned into two groups; Group (A) with 35 athletic football players, and Group (B) control group with 35 age matched healthy non-athletic volunteers. Subjects in both groups were assessed for active repositioning error in the Army Rehabilitation Centre's Isokinetic Laboratory, Cairo. Results: Both groups did not differ significantly in terms of mean age, height, weight, and BMI (P<0.05), while a considerable difference in active repositioning error was found in Group (A) compared with Group (B) (P=0.006). Conclusions: The trunk proprioception differs significantly in athletes when compared to non-athletes. Athletes have better trunk proprioception than non-athletes. Keywords: Trunk proprioception, Active repositioning error, Athletes.
INTRODUCTION
In order to investigate or assess proprioception
Trunk control and stability is strongly related to
wide varieties of tests have been developed. Specific
proprioception. Proprioception means literally to
tests of proprioception regarding both joint position
receive (-ception) one's own (propio-). It could be
sense (JPS) and movement sense are either passive or
defined as sense of joint static position & sense of
active (2,5). JPS tests are used to assess the accuracy to
movement (kinesthesia) either acceleration or
reposition the joint to the predetermined angle (10),
deceleration (1), it also includes sense of muscle force,
while threshold to detection of passive motion
tension, length and sense of pain as well (2).
(TTDPM) is utilized to assess an individual's capacity
Receptors that contribute to deep sensation are
to perceive joint movement (11), task tracking that
termed proprioceptors (3). Those are found in various
measure
movement
acuity,
or
movement
connective tissues throughout the body as skin,
discrimination tests (12). Force sense tests are used to
ligaments, joint capsules, tendons, fascia& muscle
assess the ability to detect and generate the previously
tissue (muscle spindle and golgi tendon organ). It is
pre-determined sub-maximal force (13).
believed that the initial proprioceptive input comes
It is thought that all types of exercise could
from muscle spindles (4), as they are highly sensitive to
stimulate proprioceptors and in turn can affect
detect minor changes in muscle length (5), while other
proprioception (14), regular daily exercise routine of a
proprioceptors provide additional sensory information
football player usually includes exercises that are
about both position and movement senses (1). Joint
specific to improve proprioception commonly involve
proprioceptors provide proprioceptive input throughout
JPS (15), kinesthesia or sense of force & exercises to
the entire joint's range of motion (ROM) and at the
train balance, co-ordination and dynamic stability (16).
extremes or end ROM, those proprioceptors are
Such exercise training may lead to morphological
essential in joints' stability (6).
changes in proprioceptors either (joint or muscle)
Musculoskeletal disorders as ligamentous or
making them more sensitive to detect changes in
tendon or muscular sprain, muscle weakness also
length, tension or position. That in turn could lead to
chronic pain could result in impaired or altered
improve joints stability, balance, dynamic postural
proprioception (7). Impaired proprioception has an
control and minimize risk of injuries (17).
adverse effect on trunk motor control that could in turn
The current study was to investigate whether a
lead to balance disturbance, increasing risk of injury
significant variance in trunk proprioception can be
and falling (8). These dysfunctions in motor control
observed among athletic and non-athletic individuals.
encompass decreased input to alpha motor neurons,
disturbed reflex joint stability, The dysfunctions in PATIENTS AND METHODS
motor control include reduced input to alpha motor
A cross sectional study conducted on 70 male
neurons, disrupted reflexive joint stability, heightened
and female volunteer subjects with age ranged from
postural instability, and greater inaccuracy in tasks
18-37 years old. Participants were assigned into two
related to visual movement acuity (9).
4644
Received: 23/11/2022 Accepted: 25/01/2023
Effect of Heart Rate at Admission on Outcome of Patients Undergoing Primary Percutaneous Coronary InterventionThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4648-4653
Study of Role of Maternal Serum Ferritin in the Prediction of Asymmetric Intrauterine Growth Restriction Amr Kamel El-Fayomy, Walid Abdallah Abdelsalam, Ahmed Ismail Mohamed, Mostafa Ahmed Mostafa*
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Mostafa Ahmed Mostafa, Mobile: (+20) 01093016946, E-mail: [email protected] ABSTRACT Background: Late-onset asymmetric Intrauterine Growth Restriction (IUGR) is associated with an increase in the maternal serum ferritin level, which is thought to be caused by a decrease in placental extraction ferritin from the systemic circulation. Objective: The aim of the current study was to predict asymmetric IUGR by measuring maternal serum ferritin at 30-32 weeks of gestation. Patients and methods: A cross sectional study was conducted on a total of 550 women. At 30-32 weeks of gestation, maternal serum ferritins were assessed. Of the studied women, 84 women were selected and divided into two groups; 42 cases of elevated serum ferritin level taken as a case group and the first included 42 cases with normal serum ferritin level served as a control group. At 30-32 weeks of gestation, we assessed maternal serum ferritin. Results: Serum ferritin is good marker for detecting cases of IUGR at cut off 12.45 with a sensitivity of 85.7%, a specificity of 35.7%, a positive predictive value of 57.1% and a negative predictive value of 71.4%., while serum ferritin is good marker for excluding cases of IUGR at cut off 20.5 with a sensitivity of 33.3%, a specificity of 85.7%, a positive predictive value of 70% and a negative predictive value of 56.3%. Conclusion: Serum ferritin level with a cut off level 12.45 ng/dl in addition to ultrasonography has as a predictive value of asymmetric IUGR Keywords: Serum Ferritin, Ultrasonography, Asymmetric Intrauterine Growth Restriction.
INTRODUCTION
Due to its low cost and widespread availability, the
Asymmetric, late-onset (type II), intrauterine
primary iron storage protein ferritin has been proposed
growth restriction (IUGR) is characterized by
as a suitable replacement for the current screening test.
pathologically delayed fetal growth beginning in late
Its concentration increases in response to low oxygen
pregnancy due to uteroplacental insufficiency. For
levels or during the acute phase of an infection (6).
comparison, the phrase "Small for Gestational Age"
Maternal serum ferritin levels are elevated because
(SGA) refers to a newborn whose birthweight is below
placental extraction of ferritin from the systemic
the 10th centile for its gestational age, even if the infant
circulation is diminished in late-onset asymmetric
is otherwise healthy but just small (1). Fetal growth
IUGR pregnancies. Its predictive value has been looked
restriction has multiple root reasons that can be broken
into before, but only in a few short studies with a limited
down into these three groups: complications can arise
sample size (5). In the current study, we aimed to predict
on all levels, from the mother (maternal diabetes,
asymmetric IUGR by measuring maternal serum ferritin
hypertension, connective tissue illnesses or heart
at 30-32 weeks of gestation.
diseases) to the developing baby (fetal exposure to
teratogens, fetal virus infection, fetal abnormalities) to PATIENTS AND METHODS
the placenta) (2). Maternal serum ferritin has been shown
A cross sectional study was conducted on women
to distinguish between normal small group and small
attended at the Zagazig University Department of
fetuses with pathological growth limitation in a few
Obstetrics and Gynecology's Obstetric Outpatient
studies (3). Fetuses with IUGR have a higher risk of
Clinic and Maternity Hospital.
experiencing fetal distress, dying in utero, developing
Assuming the mean ferritin level was 19.3 (SD 6.83) vs
neurological abnormalities, and having meconium
14 (SD 5.18) in IUGR versus normal growth, about 550
aspiration after birth (4).
pregnant women at 30-32 weeks were recruited for our
Seventy-eight percent of IUGR cases are
study. Cases were chosen based on either a known first
asymmetric, and this is associated with factors such as
day of the last menstrual cycle or a first trimester
decreased umbilical blood flow, a brain-sparing impact,
ultrasound report.
oligohydramnios, and a low ponderal index (5).
Fasting blood samples were taken to detect serum
The identification of suitable prediction diagnostics
ferritin level to obtain 42 women with elevated serum
for IUGR remains one of the top priorities in obstetrics
ferritin forming the case group. Another 42 women with
despite the lack of a direct causal therapy and the fact
normal serum ferritin level and firstly recruited
that the majority of IUGR patients are idiopathic (5).
delivering adequate for gestational age neonates at term
Many biomarkers, including, adiponectin, lactate
were selected to form the control group.
dehydrogenase, metastin s-endoglin, pregnancy Inclusion criteria: All included women had singleton
associated plasma protein, endothelin-1, as well as
at 30-32 weeks of pregnancy with reliable date.
leptin, have been proposed as potential early indicators Exclusion criteria: Women with many pregnancies or
of IUGR. Most of these tests either have low sensitivity,
those under the age of 20 Pregnancy-related diabetes,
are difficult to come by, require invasive procedures
maternal smoking, low body mass index, and anemia all
like amniocentesis, or all three (5).
increase the risk of needing a blood transfusion. Disease
4648
Received: 23/11/2022 Accepted: 25/01/2023
c:\work\Jor\vol911_138The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4654-4662
Value of Forkhead Box A1 (FOX A1) Immunohistochemical Expression in Epithelial Ovarian Carcinoma Asmaa Hussein Mohamed, Naeimah Abdullah Mohammed Mustafa*, Ola Abdelraouf Harb, Anan Fathi Mohamed
Pathology Department, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Naeimah Abdullah Mohammed Mustafa, Email: [email protected], Mobile: 01507428022 ABSTRACT Background: Ovarian cancer is with the greatest fatality rate in the gynecological malignancy, with about two-thirds of patients receiving an advanced diagnosis because of late presentation. Additionally, 90% of patients experience recurrence and eventually develop chemo resistance. Finding new prognostic indicators and treatment targets tailored to that cancer is therefore highly desirable. It was discovered that FOX A1 plays a part in the growth and development of numerous tumours, including gliomas, breast, stomach, lung, and esophageal cancers, although its function in ovarian cancer has not been fully characterised. Aim: To assess the value of FOX A1 immunohistochemical expression in epithelial ovarian cancer and its relationship with clinicopathologic features. Materials and methods: This is a retrospective cohort study that was carried out in the Pathology department, Faculty of Medicine, Zagazig University, in the period from November 2021 to November 2022. All cases of epithelial ovarian cancer of different; grades, stages and histopathological subtypes with complete clinical data were included in the study. Specimens of paraffin blocks were obtained by total abdominal hysterectomy with bilateral salpingoophorectomy (TAH+BSO) with omentectomy and lymph node dissection. They were examined by two independent pathologist for evaluation grade and stage. FOX A1 immunohistochemical staining was done for all specimens. Results: There was a statistically significant association betweenFOX A1 expression and patients' age, menopause, patients with bilateral lesions, ruptured capsule, positive peritoneal cytology, lymph node metastasis, omental depositspathological grade and FIGO stage.- Conclusion: FOX A1 expression was related to poor prognostic predictors in EOC. Keywords: FOX A1, Immunohistochemical, Epithelial Ovarian Carcinoma. INTRODUCTION
development of various types of human tissue for the
Ovarian cancer is one of the most common
growth of various tissues, including the liver, lungs,
gynecological cancers. After cervical and uterine
midbrain, and mammary glands. It can promote
carcinoma, it comes in third place (1), 1,2% of all cancers
transcription by chromatin to allow for the binding of
in the world (2). Ovarian cancer accounts for 21% of
additional transcriptional factors and interacting with DNA
malignant genital system tumors and 2.7% of all female
through its forkhead binding domain (9), it takes part in a
cancers in Egypt(3). The majority of ovarian tumors
variety of human disorders and may contribute to the
(approximately 90%) are epithelial ovarian cancers
development and spread of a number of tumors, including
(EOCs) (4). Serous ovarian carcinoma, which comprises
those that cause prostate, glioma, breast, stomach, lung,
high-grade serous carcinoma (HGSC) (70%) and low-
ovarian, and esophageal cancers (10).
grade serous carcinoma (LGSC) (5%), mucinous ovarian
Poor prognosis in hepatocellular carcinoma and
cancer, endometrioid ovarian carcinoma, clear cell
the development of metastatic prostatic cancer are linked
carcinoma, Brenner tumors, and other carcinomas are the
to high levels of FOX A1 expression (11), and in cervical
categories into which EOCs fall (5). The majority of people
carcinoma is linked to treatment resistance (12).
who are affected by EOC are asymptomatic or have
nonspecific symptoms, and silent metastatic spread occurs MATERIAL AND METHODS
in 60% of cases before diagnosis. EOC has a dismal
A retrospective cohort study was conducted in the
prognosis and a deadly outcome (6). Less than 29% of
faculty of medicine's pathology department at Zagazig
patients with advanced EOC survive five years (7). There is
University, in the period from November 2021 to
a need to identify innovative prognostic markers to assess
November 2022 after taking an approval (ZU-IRP#9758)
prognosis and enhance outcome due to the high rate of
by the local ethics committee Institutional review board
chemotherapy resistance, the prevalence of EOC, and the
(IRB), faculty of medicine, Zagazig University.
dearth of adequate screening tests (1).
The present study includes formalin, paraffin
Hepatocyte nuclear factor 3 (/HNF3), also
embedded tissue blocks from 46 cases of EOC including:
known as forkhead box A1, is a gene that is encoded by
32 cases of serous ovarian carcinoma, 12 cases of
FOX on human chromosome 14q21.1 (8). The transcription
mucinous ovarian carcinoma and 2 cases of endometroid
factor FOX A1, which is widely expressed and involved in
ovarian carcinoma. They were gathered from the
the expression of multiple crucial genes during the
pathology department's archive at faculty of medicine,
4654
Received: 25/11/2022 Accepted: 27/01/2023
c:\work\Jor\vol911_139The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4663-4666
Femtosecond Laser Assisted Cataract Surgery versus Phacoemulsification Effects on the Corneal Integrity. Wael R. Aboumostafa, Ahmed M. Abdelsalam, Ibraheam M. Taher, Osama M. Alnahrawy, Roberto Bellucci.
National Institute of Laser Enhanced Sciences, Cairo University, Egypt. Corresponding authors: Wael Aboumostafa Mobile :00201005104688 Email: [email protected] ABSTRACT Background: Femtosecond Laser Assisted Cataract Surgery has benefits and drawbacks, our work was to study its effects on the corneal integrity. Objectives: To study the effect of femtosecond laser assisted cataract surgery on the corneal integrity in comparison with phacoemulsification. Patients and methods; This prospective comparative randomized controlled study was done at Cortoba eye center, Cairo. It was conducted on 40 eyes suffering from cataract graded from 2 to 4. They were divided into 2 equal groups. Group (A) femtosecond laser assisted cataract surgery was done using Victus Femtosecond Laser Platform (Bausch and Lomb). Group (B) conventional phacoemulsification was done using Alcon Infiniti Phaco Machine. Full preoperative ophthalmological examination, best corrected visual acuity (BCVA), corneal thickness and endothelial cell count were done and repeated postoperatively. Main outcome measures included visual acuity, corneal oedema, corneal thickness, and endothelial cell count. Data was collected and statistically analyzed. Results: Regarding corneal thickness; there was no significant difference between groups and it significantly increased in both groups. Corneal endothelial cell count in Group B was significantly lower after one month and it significantly decreased in both groups but more in group B. Conclusion: Femtosecond laser assisted cataract has a transient corneal edema and loss of endothelial cell count with less effects on the corneal integrity than phacoemulsification. Keywords: Femtosecond laser, phacoemulsification, cataract, corneal integrity.
INTRODUCTION PATIENTS AND METHODS
The cornea is a complex structure that requires all its
Our prospective randomized study was done at
layers to work together to maintain corneal integrity. Any
Cortoba Eye Center, Cairo, (Private Sector). Forty eyes of
disruption to any one of its layers can lead to corneal
forty patients suffering from cataract were included in this
injury or disease]1,2[.
study. They were randomly divided into two groups, each
Phacoemulsification and femtosecond laser-assisted
group containing twenty eyes. Group (A) for them
cataract surgery (FLACS) are surgical techniques for
Femtosecond laser assisted cataract surgery were
cataract extraction]3,4[. (FLACS) is a technique that
performed.
Group
(B)
for
them
traditional
utilizes a femtosecond laser to perform key steps of the
phacoemulsification was done.
procedure.]5,6[.
The use of the femtosecond laser has been shown to Inclusion criteria:
improve the precision, reproducibility, and safety of
Patients subtending forward cataract extraction
certain steps of cataract surgery, including the creation of
without any complications either with femtosecond or
the corneal incision, capsulorhexis, and lens
phacoemulsification, having matching age group and
fragmentation]7[.
hardness of the nucleus. Their age ranged between 45 and
Recent studies have suggested that FLACS has
60 years old, without any systemic diseases except
several advantages over traditional cataract surgery ]8,9[,
diabetes and or hypertension, cataract grading ranged
such as enhanced visual outcomes, reduced surgical time,
from grade 2 to grade 4 according to Lens Opacity
and reduced risk of complications]10[.
Classification System (LOCS). Their preoperative visual
Although both methods have proven to be effective
acuity ranged between 0.1 and 0.2, their average central
]11[, there is ongoing debate regarding their impact on
corneal thickness ranged from 490 to 590 micron, with
corneal integrity.
their endothelial cell count not less than 2000 /mm2.
AIM OF THE STUDY Exclusion criteria
To report the effects of femtosecond laser user in Any uneventful cataract extraction with any
Femtosecond Laser Assisted Cataract Surgery on the
complication during the procedures were excluded.
corneal integrity in comparison with Phacoemulsification.
c:\work\Jor\vol911_140The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4667-4671
Measurement of the Thickness of the Lower Part of the Uterine Wall before Childbirth Using 2D and 3D Ultrasound across the Abdomen after Previous Cesarean Section Tamer Salah Elsayed*, Abdelrahman Ragab Rashed, Elsayed Mohammed Ibrahim
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University of Boys, Cairo, Egypt Corresponding Author: Tamer Salah Elsayed, Mobile phone: 01061273610, Email:[email protected]
ABSTRACT Background: The most frequent gynecological procedure, caesarean section (CS), is linked to the advantages and disadvantages of elective repeat caesarean (ERC) and vaginal birth after cesarean (VBAC). Recent research has revealed that VBAC is less safe than previously thought due to an elevated risk of problems that may be associated to lower uterine segment (LUS) thickness. The LUS has been measured with ultrasound (US) using a variety of methods, including transabdominal (TA) and transvaginal procedures. The LUS thickness may be measured more precisely using 3D US than 2D US. Objective: The aim of the current study was to use 2D and 3D ultrasonography across the abdomen following previous CS to gauge the lower uterine wall's thickness before childbirth. Patients and methods: A cross sectional study was carried out at the Obstetrics and Gynecology Department of the Faculty of Medicine, Al-Azhar University of Boys, from November 2021 to November 2022. The study included pregnant women, aged more than 18 years old, with gestational age between 37 and 39 weeks, with past history of one CS. Multiparous women, pregnant women with polyhydramnios or placenta previa were excluded. All participants were subjected to full history taking and thorough complete clinical examination. Ultrasound exams were carried out using a device with a 4-8 MHz transducer for 2D and 3D volume scanning. Results: The best cutoff value for 2D US was 3.91 mm with an AUC of 0.742, and this resulted in significant diagnostic accuracy with sensitivity 82.5%, specificity 69.3%, PPV 77.8%, and NPV 75%. The mean LUS thickness by 2D transabdominal US was 6.74 1.52 mm, while by 3D transabdominal US it was 5.86 1.43 mm. Conclusion: Thickness of the lower portion of the uterine wall may be precisely measured before delivery using both 2D and 3D ultrasonography, with 3D ultrasound having a better degree of accuracy. Obstetricians can still use 2D ultrasound in locations without 3D technology. Keywords: Caesarean section, Lower uterine segment thickness, 2D ultrasound, 3D ultrasound, Cross sectional study, Al-Azhar University. INTRODUCTION
two risks: Stillbirth and hypoxic ischemic
One of the most common abdominal surgical
encephalopathy (3).
procedures performed in Egypt is a caesarean section
The greatest risk of a VBAC trial is uterine
(CS). Between 1990 and 2018, the CS rate rose from
rupture caused by the previous CS scar dehiscing;
12% to 29% in the UK and from 21.2% to 30.1% in the
Uterine rupture despite being a rare side effect (4).
USA. Interest in the behavior of CS scars and their
There is no accurate method to forecast if uterine
potential morbidity has been sparked by the rising CS
rupture will occur in women attempting VBAC. Some
rate and its related problems (1).
authors have suggested that identifying women with the
Two birth alternatives are available to women
lowest risk of uterine rupture during delivery may be
who have previously undergone a CS: an elective repeat
aided by sonographic measurement of the lower uterine
caesarean (ERC) or vaginal birth after cesarean
segment (LUS) (5).
(VBAC). The use of caesarean sections has been
With 2D ultrasonography, the LUS can be seen
associated with complications such as uterine rupture,
in late pregnancy as a 2-layered structure made up of the
placenta previa, placenta accreta, increta or percreta1
myometrium, which is relatively hypoechoic, and the
dehiscence, or increta or percreta1 dehiscence in
muscularis and mucosa of the bladder wall, which are
subsequent pregnancies.
echogenic and contain a portion of the visceral-parietal
Along with the surgical maternal morbidity, the
peritoneum. The myometrium often covers the
risk of bowel and bladder damage has also increased (2).
chorioamniotic membrane and the decidualized
Recent research has shown that vaginal birth
endometrial layer. There might not be any amniotic
after CS VBAC is less safe than previously thought.
fluid between the presenting area and the LUS in fetuses
This situation led to fewer VBACs being performed by
with vertex presentation. The LUS has been measured
obstetricians, and fewer patients asking for them. The
using a variety of methods, such as transabdominal
declining usage of VBAC and the rising rates of ERC
(TA) and transvaginal procedures (6).
are two of the major factors contributing to the global
Multiplanar projection of 3D images of the LUS
increase in CS rates. According to the information now
is now possible thanks to the advent of 3D volume
available, VBAC is linked to a higher risk of uterine
sonography, potentially improving the LUS's
rupture, maternal hemorrhage, blood transfusion, and
measurement accuracy. One of the fundamental
peripartum hysterectomy. VBAC for the fetus carries
advantages of 3D ultrasound is its ability to reconstruct and display any arbitrarily chosen segment within the
4667
Received: 25/11/2022 Accepted: 27/01/2023
c:\work\Jor\vol911_141The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4672-4678
Assessment of Ocular Manifestations in Children with Nephrotic Syndrome during steroid Treatment 1 Mona Mohammed ELsharkawy,1 Hadeel Mohammad Abd Elrahman, 1 Khadija Alforjani Abdulhadi Omar, 2 Yasmine A. Deiaeldin 1 Pediatrics Department, Faculty of Medicine, Zagazig university, Egypt 2 Ophthalmology Department, Faculty of Medicine, Zagazig university, Egypt Corresponding author: Khadija Alforjani Abdulhadi Omar, Mobile: (+20)01206146575, Email:[email protected] ABSTRACT Background: Ocular problems are related to patients with nephrotic syndrome (NS) who use corticosteroids for long-term. They consist of ptosis, atrophy of the eyelid skin, keratitis, changes in the pigmentation of the macular area, and exacerbations of bacterial and viral infections. The precise prevalence, severity, and timing of the onset of these problems in the pediatric patient population have not yet been thoroughly investigated. Aim: This study aimed to estimate the burden of youngsters with nephrotic syndrome's eye problems on steroid therapy or after cessation of treatment. Patients and methods: This cross-sectional study was conducted at the Paediatrc Nephrology Clinic in association with the Department of Ophthalmology Clinic, Zagazig University Children Hospital for ocular examination. We studied 48 children with primary nephrotic syndrome received corticosteroids either alone or with other treatment modalities for more than three months. Clinical signs, lab test findings, and a kidney biopsy were used to make the diagnosis of nephrotic syndrome. Results: The most frequent ocular manifestations were refractive errors in 38 patients (79.2%) followed by blepharitis in 26 patients (54.2%), then hypertrichosis in 25 (52.1%) of patients, and 12 (25%) of patients had repeated eye infection in the form of mucopurulent conjunctivitis. While,the least frequent manifestations were epiblepharon in 4 patients (8.30%) and ptosis in 3 patients (6.3%). Conclusion: A sizable percentage of kids with nephrotic syndrome receiving long-term steroids experienced eye problems. Keywords: Nephrotic syndrome, Ocular, Errors, Ptosis, Blepharitis, Glomerulosclerosis, Children. INTRODUCTION
The most prevalent form of glomerular disease in
Pediatric Nephrology Unit of the Pediatrics Children
children is nephrotic syndrome (NS), which is also one of
Hospital from September 2022 to March 2023, Faculty of
the main causes of systemic glucocorticoid exposure in
Medicine, Zagazig University. Cases were referred to the
young children. Estimates of the annual incidence of NS
Outpatient Clinic of Ophthalmology Department, Zagazig
to be 2-7 per 100 000 children (1).
University to complete their ocular examination. Nephrotic syndrome is characterized by having
proteinuria > 40 mg/m2/h, serum albumin < 2.5 g/dl, Inclusion criteria: Patients with NS between the ages of
hyperlipidemia and oedema. Pediatricians frequently
4 and 16 years. Antinuclear antibody (ANA), anti-double
utilize large doses of steroids for a prolonged period of
stranded DNA (anti dsDNA), antineutrophil cytoplasmic
time in patients with nephrotic syndrome, where there is
antibody (ANCA), hepatitis B surface antigen (HBsAg),
a high risk of relapse and a markedly increased risk of
hepatitis C virus (HCV), human immunodeficiency virus
developing steroid dependency and toxicity. During
(HIV), and normal complement (C3, C4) level serology
relapses, patients receive extended and repeated steroid
results that are negative. Consumption of corticosteroids
courses (2).
as the primary or supplemental component of treatment
Evaluation of steroid side effects is therefore
for longer than three months. Patient's companions who
essential in NS. Ptosis, atrophy of the eyelid skin,
signed the consent form and agreed to participate in the
keratitis, changes in the pigmentation of the macular area,
survey.
and exacerbations of bacterial and viral infections are Exclusion criteria: Children under the age of 4 (because
among the common adverse effects of steroids on the
to their poor cooperation) and those who had co-morbid
eyes. (3, 4). Our aim was to determine the prevalence of
ocular problems such as trauma and infection, or
ocular problems in kids with nephrotic syndrome who
inflammation. Children with ocular congenital defects
were receiving steroid therapy or stopped the medication.
such as congenital cataracts, NS patients who are
uncooperative for ophthalmologic examinations, and PATIENTS AND METHODS
patients who have any systemic diseases other than NS.
48 children with primary NS were involved in this
cross-sectional study, which was carried out at the
4672
Received: 27/11/2022 Accepted: 29/01/2023
c:\work\Jor\vol911_142The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4679-4685
Assessment of Fungal Blood Stream Infection in Patients with Liver Cirrhosis Admitted to The Intensive Care Unit Enas Faried Abd-ELlatief*1, Hala Ismail Mohammed Hussein1, Takwa E. Meawed2, Heba A. Mohammed2, Shimaa Abd-Elfattah Awwaad1, Ahmed Said Mohammed1
Departments of 1Tropical Medicine and 2Medical Microbiology and Immunology,
Faculty of Medicine - Zagazig University, Egypt *Corresponding author: Enas Faried Abd-ELlatief, Mobile: (+20)01028767219, Email:[email protected] ABSTRACT Background: Liver cirrhosis (LC) patients are at increased risk for infection due to weakened immune systems and gastrointestinal dysfunction. Therefore, it is crucial to do fungal cultures in LC patients and to keep a high index of suspicion. Objective: To detect fungal blood stream infection in patients with liver cirrhosis admitted to the intensive care unit. Methods: In a prospective cross-sectional study that was conducted on 124 subjects were admitted to Zagazig University Tropical department with symptoms and signs suggestive of fungal infections. Using light microscope 40X and 40X for visualization of fungal structures of blood culture. Results: Our study couldn't detect any case with fungal blood stream infection. Nearly all our patients had leucocytic and inflammatory reaction. Fifty-one patients had HCC, 4 patients had malignant masses: 2 gastric and 2 duodenal masses with no other malignancy. Our patients had mean MELD score of 14.0 ± 3.55. Immune compromising drugs among our patients were completely absent and medical condition that may affect the immunity such as DM were relatively few in our patients. Conclusions: Liver cirrhosis frequently results in infections. Patients with cirrhosis who are hospitalized to the intensive care unit often get fungal infections, which exacerbate their overall state and can be fatal. Keywords: Fungal, Liver Cirrhosis. INTRODUCTION
emergence of infections in cirrhosis, it warrants special
Liver cirrhosis is an irreversible, systemic condition
attention (4).
characterized by the replacement of normal liver cells
About 25% of patients with liver cirrhosis reported
by regenerating nodules and fibrous septa between
an infection, and the mortality rate was roughly four
them. In response to liver injury, hepatic stellate cells
times greater than in the general population. Blood
(HSC) are activated and converted into myofibroblasts,
stream infections (BSIs) are a serious problem for
a process that is part of the wound healing pathway.
people with liver cirrhosis because they lead to more
Liver cirrhosis is the terminal stage of any liver disease
hospitalizations and a higher risk of death (5).
that has persisted over time (1).
Infections caused by bacteria tend to be more
When cirrhosis progresses to the decompensated
common. Spontaneous bacterial peritonitis (SBP)
stage, survival rates drop from 12 years in the
accounts for 25% of all bacterial infections, followed by
compensated stage to 2 years. The presence of any of
UTIs (20%), pneumonia (15%), bacteremia (12%), and
the following problems is diagnostic of decompensated
cellulitis (2%-11%) (6).
cirrhosis: Hepatic failure manifested by ascites,
Cirrhosis patients with fungal bloodstream
encephalopathy,
jaundice,
and/or
hepatorenal
infections are at an extremely low survival risk. Due to
syndrome. Several factors can lead to the
its low prevalence, non-specific clinical symptoms, and
decompensation stage being reached, such as: problems
the time required for an accurate diagnosis, it is often
with alcohol consumption, infections, and bleeding in
misdiagnosed or detected late (7).
the stomach (2).
Cirrhosis of the liver is associated with a 10-13%
Cirrhosis infections significantly exacerbate the
incidence of fungal BSI. Bacterial infections are
disease's overall course. Cirrhosis problems are another
sometimes present as well. Risk factors for fungal BSI
risk factor for getting sick. In cirrhotic individuals,
include renal insufficiency, antibiotic overuse, and
infections can be caused by a number of causes,
invasive procedures (8).
including immunological failure, bacterial and fungal
About 10% of BSI is caused by Candida species,
translocation due to small intestinal bacterial and fungus
which are frequently isolated from cirrhotic patients in
overgrowth with increased intestinal permeability, and
the intensive care unit. Therefore, the most common
hereditary factors (3).
fungal BSI in such individuals is candidemia (9).
Syndrome of immune dysfunction due to cirrhosis
This study objective was Detection of fungal blood
and systemic inflammation is known as cirrhosis
stream infection in patients with liver cirrhosis admitted
associated immune dysfunction (CAIDS). As the
to the intensive care unit and its relation to morbidity in
primary pathophysiological mechanism behind the
those patients.
c:\work\Jor\vol911_143The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4686-4691
Different Routes for Misoprostol Usage Before Intra Uterine Contraceptive Device Insertion in Women with Previous Cesarean Section Mohamed A. Emara1, Basma M. Abdel Fattah*2, Heba F. Salama1, Amira A. Fathey1 1Department of Gynecology and Obstetrics, Faculty of Medicine,
Menoufia University, Shebin Elkom, Menoufia, Egypt 2Department of Gynecology and Obstetrics, Quesna Central Hospital, Quesna, Menoufia, Egypt *Corresponding author: Basma Abdel Fattah,Mobile: (+20)1050469914, E-mail:[email protected] ABSTRACT Background: Intrauterine device (IUD) is one of the most efficient contraceptive techniques, despite its low use rate due to the user's fear of discomfort and the provider's insertion issues. Misoprostol is a drug that softens and facilitates dilatation of the cervix. Objectives: The aim of the current work was to evaluate the usage of different routes of misoprostol before insertion of IUD in women with previous caesarean delivery. Patients and methods: This prospective randomized comparative study included a total of 249 women eligible for IUD insertion, attending at Outpatient Clinics, Departments of obstetrics and gynecology of both the Menoufia university and Quesna Central Hospitals. The included women were randomly divided into three equal groups, and 4 hours before IUD insertion, each woman received 400 ug misoprostol, vaginally (Group A), rectally (group B), and sublingually (group C). Full history taking, clinical examination, and ultrasound (US) examination were done. Results: In the 1st attempt, group A showed a significant higher success rate (n=80, 96.4%) than group B (n=78, 94%) and group C (n=66, 79.5%), (p<0.001). While in the 2nd attempt, the success rate did not show any significant difference among the studied groups (p=0.904). Pain during insertion was significantly higher frequent among group C (n=20, 24.1%) than group A (n=5, 6%) and group B (n=7, 8.4%), (p<0.001). Regarding 6 weeks follow-up after intrauterine device insertion did not show any significant different among the studied groups (p>0.05), except, first menstruation after insertion was significantly differed among the studied groups (p=0.04). Conclusion: It could be concluded that misoprostol is best administered vaginally rather than sublingually or rectally since it has a higher chance of causing cervical ripening. Repeated attempts in the next cycle may be beneficial when a previous insertion attempt has failed. Keywords: Caesarean section, Insertion complications, intrauterine device, Misoprostol routes, Success rate, Uterine axis. INTRODUCTION
There are more and more effective contraceptive
The low prevalence of IUD use is brought on by
options available nowadays. Even though they all have
the user's anxiety over discomfort and the provider's
negative effects, they all present a lesser risk than
difficulties with insertion. In 41% of women and 86%
pregnancy [1].
of women, insertion was associated with anxiety [6].
50% of pregnancies in the USA are unplanned,
Insertion failure happens in as many as 14% and 20%
and 50% of them result in abortions [2]. This may
of porous and nonporous women, respectively.
indicate a gap in the market for quality contraceptive
Insertion-related pain is linked to the insertion of the
consultation [3].
scope, tenaculum traction on the cervix, uterine
Various forms of contraception are categorized
sonography, transit of the insertion tube through the
based on their efficacy. The top tier meets the
cervix, and implantation of the device inside the
requirements for ease of use, extended duration of
uterine cavity [7].
action, low need for follow-up clinic visits, and low
Misoprostol is a synthetic and affordable estrone
user motivation or intervention and provides the
counterpart of prostaglandin. It may be supplied orally
greatest degree of efficacy (measured as two
or vaginally the night before minimally invasive
pregnancies per 100 women/year). These procedures
gynecological procedures such as hysteroscopy, and if
include male and female sterilization, subdermal
necessary, again in the morning. It may cause adverse
contraceptive implants, and intrauterine devices [1].
consequences including stomach pain, chills, uterine
Even though the failure rate for intrauterine
hemorrhage, diarrhea, nausea, and vomiting [1].
contraception is extremely low (0.20.6 per 100
Misoprostol usage prior to IUD placement has
women per year), it is only used by 7.6% and 14.5% of
had mixed outcomes in the research. While some users
contraceptive users in industrialized and developing
have experienced a more comfortable insertion with no
nations, respectively [4].
change in discomfort, others have seen no
About 17% of Asian women who used
improvement at all. Benefits in terms of both insertion
contraception in 2015 used an intrauterine device
difficulty and discomfort were noted in one trial [7].
(IUD), and more than 20% of women in 12 Asian nations [5].
4686
Received: 24/11/2022 Accepted: 26/01/2023
c:\work\Jor\vol911_144The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4692-4696
Clinical and Neurophysiological Evaluation of Recovery after Ipsilesional High- Frequency Repetitive Transcranial Magnetic Stimulation in Patients with Acute Ischemic Stroke: Experience in Minia University Hospital Muhammad M. Ismail*, Wael T. Soliman, Mohamed M. Abdelkader, Hadeer K. Mohamed, Rasha N. Saleh
Department of Neurology, Faculty of Medicine, Minia University, Egypt *Corresponding author: Muhammad Mamdouh Ismail, Mobile: (+20)1010648246, Email:[email protected] ABSTRACT Background: The role of repetitive transcranial magnetic stimulation (rTMS) in improving post-stroke recovery has been suggested due to its known modulatory effect on the cortical excitability. It might be therapeutically used either by high-frequency stimulation (>1 Hz) to the motor cortex of the affected cerebral hemisphere, or by low-frequency stimulation (1 Hz) to the motor cortex of the nonlesional hemisphere. Objective: This study was aimed to evaluate the clinical and neurophysiological improvement after ipsilesional high- frequency rTMS in patients with acute ischemic stroke. Patients and methods: Fifty patients of both sexes were included in this randomized double-blind sham-controlled study in the period between July, 2021 and March, 2022. Patients included were admitted to the Stroke Unit, Department of Neurology, Minia University Hospital. TMS sessions were delivered for 7 consecutive days. All patients were both clinically and neurophysiologically evaluated just before the beginning of the 1st rTMS session and after the end of the 7th session. Patients were clinically evaluated by Medical Research Council (MRC) scale, National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin scale (mRS). Neurophysiologically, patients were evaluated by measuring the resting motor threshold (RMT) to ipsilesional and contralesional abductor pollicis brevis (APB) muscles and the central motor conduction time (CMCT) in lesion side. Results: Twenty-five patients were subjected to real rTMS and twenty-five to sham stimulation. After the end of sessions, there was significant clinical and neurophysiological improvement in outcome in the favor of real rTMS group. Conclusion: It could be concluded thatipsilesional high-frequency rTMS improves recovery in patients with acute ischemic stroke. Keywords: Stroke, Recovery,Ipsilesional high-frequency, rTMS.
INTRODUCTION
high-frequency rTMS in patients with acute ischemic
Worldwide, stroke represents the second
stroke.
most common cause of death and disability. PATIENTS AND METHODS
Burden increases in low- and middle-income
Fifty patients of both sexes were included
countries (1). Traditional methods, such as physical
in this randomized double-blind sham-controlled
therapy and occupational therapy usually applied
study in the period between July, 2021 and March,
to facilitate recovery after stroke. Repetitive
2022. Patients included were admitted to the
transcranial magnetic stimulation (rTMS) has
stroke unit of the Neurology Department in Minia
been increasingly used for the treatment of post-
University Hospital, presented with acute stroke
stroke motor weakness, aphasia and depression (2).
(within 72 hours from onset) with motor deficit,
The role of rTMS in improving post-stroke
due to subcortical ischemia in the territory of
motor recovery and rehabilitation has been
middle cerebral artery (MCA) as diagnosed by
suggested due to its known modulatory effect on
brain diffusion weighted magnetic resonance
the cortical excitability. Stroke affects the balance
imaging (DW-MRI).
of inhibitory transcallosal pathways between both
We excluded patients younger than 18
primary motor areas. The affected hemisphere
years old, patients with hemorrhagic strokes, brain
disrupts by the infarction itself and also by
tumors, dementia, aphasia, mental retardation,
inhibitory impulses from the contralateral
history of seizures and patients with magnetic
hemisphere. So, rTMS might be therapeutically
sensitive metal implants in head, neck or close to
used either by high-frequency stimulation (>1 Hz)
the TMS coil field. We also excluded patients
to the motor cortex of the affected cerebral
with residual weakness from previous strokes,
hemisphere, or by low-frequency stimulation (1
pregnant patients and patients with severe
Hz) to the motor cortex of the nonlesional
systemic illness and organ failure. All patients
hemisphere (3).
were subjected to complete history taking
This study aims at studying the clinical and
including stroke risk factors, general examination
neurophysiological improvement after ipsilesional
and neurological examination.
4692
Received: 27/11/2022 Accepted: 29/01/2023
c:\work\Jor\vol911_145The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4697-4700
Ultrasound in Neonatal and Childhood Hydronephrosis: Is It Reliable Pediatric Tool to Guide the Management? Maged Elsayed Affifi*, Khaled Kamal Ahmed
Departments of Pediatricand Radiology, Faculty of Medicine, Ain Shams University, Egypt *Corresponding author: Maged Elsayed Afifi, Mobile: (+20)1277128984, E-Mail: [email protected] ABSTRACT Background: The pelvicalyceal system distension and dilatation are referred to as hydronephrosis. Objective: The goal of the current study was to use ultrasonography to identify newborns and young children at risk for renal scarring and assess whether they would require additional surgical intervention. Subjects and Methods: This retrospective study was conducted from January 2008 to February 2012 and comprised 320 infants and newborns, who were diagnosed with hydronephrosis by US standards (200 boys, 62.5%; 120 girls, 37.5%), unilateral or bilateral. 130 of them were newborns, and 190 were kids. An algorithm for managing and treating hydronephrosis based on the Society of Fetal Urology (SFU) grading system for US can be created. Further imaging tests such as voiding cystourethrogram and isotope scanning were applied. Results: Using the SFU grading system, 150 patients (46.8%) were classified as I and II-degree hydronephrosis and 170 cases (53.2%), as III- and IV-degree hydronephrosis. Without any risk of UTI, Grade I and II spontaneously cleared (P <0.001). With a significant risk of recurrent UTI, all 170 instances of hydronephrosis in grades III and IV required isotope scanning and a voiding cystourethrogram (P <0.001). Conclusions: It could be concluded that the SFU grading system developed by the US is a helpful diagnostic tool for hydronephrosis. Keywords: Ultrasound, Neonatal and childhood, Hydronephrosis.
INTRODUCTION
own, patients are typically monitored with further US
The pelvicalyceal system distension and
scans when the initial postnatal sonograms reveal
dilatation are referred to as hydronephrosis. Only a
modest dilation (6).
percentage of newborns with hydronephrosis later
98% of patients with moderate hydronephrosis
demonstrate actual restriction of urine flow from the
(SFU grade 1 or 2) had spontaneous remission,
kidney due to anatomical or functional problems, and
improvement, or stability at follow-up, according to a
this disease is not the same as obstruction of the
systematic study (7).
urinary tract (1,2). While infants or early children with
However, it has been observed that by 12 to 14
hydronephrosis may rarely appear with a palpable
months of age, more than 90% of instances of mild
abdominal mass or obstruction-related problems such
dilatation of the renal pelvis (anteroposterior diameter,
urinary tract infection or hematuria, hydronephrosis is
10 to 15 mm) resolve on their own (8).
often identified on prenatal ultrasonography (US) (3).
Further testing is often advised if the postnatal
For verifying hydronephrosis and assessing the
ultrasonography
reveals
moderate
to
severe
degree of dilatation and amount of blockage in
hydronephrosis or dilated ureter(s) (6, 9).
newborns and early children, ultrasound (US)
To find vesicoureteral reflux and lower urinary
continues to be the primary imaging modality (2).
tract blockage, voiding cystourethrography is advised.
The Society for Fetal Urology (SFU) grading
A diuretic renal scan can be useful to diagnose the
method for hydronephrosis should be used, and it
kind of blockage and establish whether surgery is
should be rated as follows: Grade 1: Little renal pelvic
necessary by evaluating renal perfusion, differential
dilatation; Grade 2: Mild renal pelvic dilation with
renal function, and excretion if there is no
some but not all calices dilated; Grade 3: Almost all
vesicoureteral reflux or lower urinary tract obstruction.
calices dilated; Grade 4: Parenchymal thinning. Good
Surgery is often only advised when the hydronephrosis
intra-observer reliability and limited inter-observer
is getting worse or when there is a sizable disparity in
dependability characterize this grading method (4, 5).
kidney function. Vesicoureteric reflux, pelviureteric
The categorization of hydronephrosis by the
junction blockage, and vesicoureteric junction
Society of Fetal Urology is seen on a postnatal
obstruction are among the causes of newborn
ultrasonography: Grade 1: Mildly dilated renal pelvis
hydronephrosis. Many cysts in the kidney, neurogenic
without calyceal dilatation. Renal pelvis is more
bladder, ureterocele, prune-belly syndrome, ureteral
dilated in, Grade 2; some calyces may be seen. Grade
atresia, posterior urethral, obstructive, and non-
3: Although the renal parenchyma is normal in
obstructive megaureter (10).
thickness, the renal pelvis and minor calyces are
Our goal was to use US to identify newborns and
diffusely dilated. Grade 4 is the same as Grade 3,
young children at risk for renal scarring and assess
except the renal parenchyma has thinned over the
whether they would require additional surgical
dilated calyces. Because isolated dilatation of the renal
intervention.
pelvis in the neonatal period frequently resolves on its
7964
Received: 26/11/2022 Accepted: 28/01/2023
c:\work\Jor\vol911_146The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4701-4706
Assessment of Fungal Blood Stream Infection in Patients with Liver Cirrhosis Admitted to The Intensive Care Unit Enas Faried Abd-ELlatief*1, Hala Ismail Mohammed Hussein1, Takwa E. Meawed2, Heba A. Mohammed2, Shimaa Abd-Elfattah Awwaad1, Ahmed Said Mohammed1
Departments of 1Tropical Medicine and
2Medical Microbiology and Immunology, Faculty of Medicine - Zagazig University, Egypt *Corresponding author: Enas Faried Abd-ELlatief, Mobile: (+20)01028767219, Email:[email protected] ABSTRACT Background: Liver cirrhosis (LC) patients are at increased risk for infection due to weakened immune systems and gastrointestinal dysfunction. Therefore, it is crucial to do fungal cultures in LC patients and to keep a high index of suspicion. Objective: To detect fungal blood stream infection in patients with liver cirrhosis admitted to the intensive care unit. Methods: In a prospective cross-sectional study that was conducted on 124 subjects were admitted to Zagazig University Tropical department with symptoms and signs suggestive of fungal infections. Using light microscope 40X and 40X for visualization of fungal structures of blood culture. Results: Our study couldn't detect any case with fungal blood stream infection. Nearly all our patients had leucocytic and inflammatory reaction. Fifty-one patients had HCC, 4 patients had malignant masses; 2 gastric and 2 duodenal masses with no other malignancy. Our patients had mean MELD score of 14.0 ± 3.55. Immune compromising drugs among our patients were completely absent and medical condition that may affect the immunity such as DM were relatively few in our patients. Conclusions: Liver cirrhosis frequently results in infections. Patients with cirrhosis who are hospitalized to the intensive care unit often get fungal infections, which exacerbate their overall state and can be fatal. Keywords: Fungal, Liver Cirrhosis. INTRODUCTION
emergence of infections in cirrhosis, it warrants special
Liver cirrhosis is an irreversible, systemic
attention (4).
condition characterized by the replacement of normal
About 25% of patients with liver cirrhosis
liver cells by regenerating nodules and fibrous septa
reported an infection, and the mortality rate was roughly
between them. In response to liver injury, hepatic
four times greater than in the general population. Blood
stellate cells (HSC) are activated and converted into
stream infections (BSIs) are a serious problem for
myofibroblasts, a process that is part of the wound
people with liver cirrhosis because they lead to more
healing pathway. Liver cirrhosis is the terminal stage of
hospitalizations and a higher risk of death (5).
any liver disease that has persisted over time (1).
Infections caused by bacteria tend to be more
When cirrhosis progresses to the decompensated
common. Spontaneous bacterial peritonitis (SBP)
stage, survival rates drop from 12 years in the
accounts for 25% of all bacterial infections, followed by
compensated stage to 2 years. The presence of any of
UTIs (20%), pneumonia (15%), bacteremia (12%), and
the following problems is diagnostic of decompensated
cellulitis (2%-11%) (6).
cirrhosis: Hepatic failure manifested by ascites,
Cirrhosis patients with fungal bloodstream
encephalopathy,
jaundice,
and/or
hepatorenal
infections are at an extremely low survival risk. Due to
syndrome. Several factors can lead to the
its low prevalence, non-specific clinical symptoms, and
decompensation stage being reached, such as: problems
the time required for an accurate diagnosis, it is often
with alcohol consumption, infections, and bleeding in
misdiagnosed or detected late (7).
the stomach (2).
Cirrhosis of the liver is associated with a 10-13%
Cirrhosis infections significantly exacerbate the
incidence of fungal BSI. Bacterial infections are
disease's overall course. Cirrhosis problems are another
sometimes present as well. Risk factors for fungal BSI
risk factor for getting sick. In cirrhotic individuals,
include renal insufficiency, antibiotic overuse, and
infections can be caused by a number of causes,
invasive procedures (8).
including immunological failure, bacterial and fungal
About 10% of BSI is caused by Candida species,
translocation due to small intestinal bacterial and fungus
which are frequently isolated from cirrhotic patients in
overgrowth with increased intestinal permeability, and
the intensive care unit. Therefore, the most common
hereditary factors (3).
fungal BSI in such individuals is candidemia (9).
Syndrome of immune dysfunction due to
This study objective was Detection of fungal
cirrhosis and systemic inflammation is known as
blood stream infection in patients with liver cirrhosis
cirrhosis associated immune dysfunction (CAIDS). As
admitted to the intensive care unit and its relation to
the primary pathophysiological mechanism behind the
morbidity in those patients.
c:\work\Jor\vol911_147The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4707-4711
The Prevalence of Osteoporosis in Chronic Liver Disease Patients Seen in Basrah Gastroenterology and Hepatology Hospital Kamal Breesam Lafta1, Muntadher Abdulkareem Abdullah1, Fatih A. Al Khaqani1, Akeel M. Jaber2
1 Gastroenterologist and Hepatologist, Basrah Gastroenterology and Hepatology hospital, Basrah, Iraq
1 Department of Medicine, Basrah College of Medicine, Basrah Gastroenterology and Hepatology Hospital, Basrah, Iraq
1 Consultant of Internal Medicine, Department of Medicine, Basrah College of Medicine, Basrah, Iraq
2 CABM, Internist, ALFaiyha teaching hospital, Basrah, Iraq Corresponding author's name: Muntadher Abdulkareem Abdullah, Email: muntaderaltememy [email protected],
Tel:+964781398007, ORCID: 0000-0002-8893-1920 ABSTRACT Background: Osteoporosis (OP) has become an increasingly recognized complication among patients with chronic liver disease (CLD). Objective: This study aimedto determine the prevalence of osteoporosis among patients with CLD and to identify the risk factors associated with osteoporosis in these patients. Materials and Methods: One hundred patients who visited Basrah Gastroenterology and Hepatology Hospital between February 2020 and December 2021 with assessed osteoporosis. Using dual energy X-ray absorptiometry (DEXA), bone density was evaluated. The severity of liver disease, smoking, alcohol use, demographic, biochemical characteristics were all taken while assessing the risk factors for osteoporosis. Results: Of the 100 patients (male/female: 44%/56%, mean age (46 ± 11.5), 50% had CLD diagnoses, 50% did not. Of the 50 patients with CLD,20 patients had OP(40%),while four patients (8%) of the 50 patients without CLD had OP. Twenty- four (24%) of the total patients who undertook the DEXA study showed OP, while seventy-six (76%) did not. Twenty of the twenty-four individuals with OP had CLD (84%) while just four (16%) did not. Child-Pugh A made up 26% of CLD patients, Child-Pugh B 30%, while Child-Pugh C 44%. In this study, osteoporosis and osteopenia were present at rates of 24% and 31% respectively. OP and CLD appeared to be related in a very substantial way (p 0.001). CLD was identified as an independent predictor of OP by multivariate logistic regression analysis (OR (95% CI):9.09(2.18-37.93), p=0.0 Conclusion: It was determined that OP and CLD are significantly correlated. People with CLD were more likely to develop OP. As a result, routine follow-up of these individuals may require biochemical and bone mineral density (BMD) monitoring. Keywords: Osteoporosis, Chronic liver disease, CLD, DEXA scan
INTRODUCTION
growth factors (IGF) might influence osteoblast and/or
A common metabolic bone illness called
osteoclast function [4].
osteoporosis (OP) causes the bone tissue to deteriorate
The metabolism of bones may be impacted by toxic
structurally, increasing the risk of fracture. It is
chemicals, such as aluminium and copper, which build up
anticipated that as lifespans expand, this significant public
in liver failure. Increased iron burden in hemochromatosis
health issue will worsen for the elderly [1]. Osteoporosis
may reduce osteoblastic activity [5, 6]. It has also been
in chronic liver illness has a complicated and poorly
demonstrated that bilirubin inhibits osteoblast growth [7].
understood etiology, although the primary causes are
Calcium (Ca) malabsorption and low levels of serum
increased bone resorption and decreased bone production
vitamin D3 metabolites were discovered in CLD [811].
[2, 3].
Patients with CLD have been described as having
There are many mechanisms that contribute to
hyperparathyroidism [12].
unstable bone remodeling, some of which are still unclear.
Osteoporosis and fractures in CLD have also been
However, a number of chemicals, such as parathyroid
linked to chronic corticosteroid therapy [13]. Although they
hormone (PTH), vitamin D, and calcitonin, affect how
have not been identified as independent risk factors for
quickly normal bone remodeling occurs. PTH levels that
osteoporosis, typical CLD patient characteristics
are higher encourage bone remodeling by raising
including alcohol use, low body weight, and inactivity can
resorption. The active metabolite of vitamin D,
be presumed to be significant [14].
1,25(OH)2D3, is a powerful bone resorption agent and is
also necessary for the mineralization of new bone. Growth Aim of the study: To determine the prevalence of
hormone (GH), thyroid hormone, and sex steroids are
osteoporosis among patients with chronic liver disease
other key hormones in bone metabolism. Additionally,
and to identify the risk factors associated with
some systemic and local variables as interleukin-1 and -6,
osteoporosis in these patients.
transforming growth factor (TGF-), and insulin-like
c:\work\Jor\vol911_148The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4712-4717
Management of Female Sexual Dysfunction: Review Article Abdalla Hassan Kandil, Amany Abd Elrahman Nasar, Dalia Elsayed Mohamed
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Dalia Elsayed Mohamed, Mobile: (+20) 01222411044, E-mail:[email protected] ABSTRACT Background: Female sexual dysfunction (FSD) comprises genitopelvic pain and issues with female arousal and sexual interest include penetration disorder, preceding hypoactive sexual desire problem, female orgasmic disorder, and sexual dysfunction brought on by drugs or alcohol. With an estimated 2040% frequency among women, these illnesses are very prevalent. Objective: As obstetricians and gynecologists, it is our duty to recognize conduct examinations for female sexual dysfunction and identify risk factors. It is possible to investigate sexual function and dysfunction further with appropriate screening, which finally leads to the identification of any associated suffering. The underlying problem is frequently addressed during treatment through therapy or medicinal control. Methods: PubMed, Google Scholar, and Science Direct were scoured for information on Female sexual dysfunction (drugs or alcohol), Sexual desire problem, and Management. The authors also reviewed the relevant literature, however only the most recent or comprehensive studies from December 2003 to January 2020 were included. Documents written in languages other than English have been disregarded because translation resources are inadequate. Unpublished articles, oral presentations, conference abstracts, and dissertations were not included because they were not considered to be part of major scientific projects. Conclusion: The most common forms of treatment include cognitive behavioral therapy, sometimes with a mindfulness component, and consideration of medication management are effective treatments for female sexual desire and arousal issue. Counseling, instruction, and public awareness campaigns are all part of the female orgasmic dysfunction therapy. For the treatment of penetration and genito-pelvic discomfort dysfunction, it is crucial to evaluate the underlying causes of these conditions. Last but not least, the best way to treat sexual dysfunction brought on by drugs or alcohol is to stop using the substance in question and, if the disorder is brought on by antidepressants, to think about supplementary therapy. In clinical practice, female sexual dysfunction is frequently disregarded, yet effective medical and psychosocial treatments are available. Keywords: Female sexual dysfunction (drugs or alcohol), Sexual desire problem, Management.
INTRODUCTION
might be to speak to a couple's counselor therapy plan. It
Non-pharmacologic approaches, because all
is essential that the HCP creates a treatment strategy
currently available pharmacologic treatments for female
because there are numerous variables that could affect
sexual dysfunction have a limited efficacy, are
low sexual desire that addresses any potential causes (2).
accompanied by side effects, and may even be dangerous,
should be the first line of treatment for the majority of Non-pharmacologic and behavioral recommendations
women. Physical and mental health, as well as the quality
In particular for patients who are reluctant to
of the relationship with the partner, are the main
pursue pharmacological choices, non-pharmacologic and
predictors of sexual satisfaction, thus therapies that
behavioral advice are a crucial stage in a patient's healing
enhance health, wellbeing, and the partner relationship
process to take into account. Assessing non-
should be the focus of treatment (1).
pharmacologic options that could potentially enhance low
There is a need for a variety of patient assistance
sexual desire is one of an HCP's objectives. For instance,
strategies because FSD and low sexual desire are complex
if relationship problems are found, recommending
conditions. Health care professionals (HCPs) should take
couples therapy may be useful. Additionally,
into account potential causes, if any, using low sexual
nonpharmacologic alternatives are being looked into.
desire in a patient is diagnosed via a patient assessment
Recent research in terms of desire, orgasm, lubrication,
instrument or by broad open-ended questions during a
and satisfaction, using a sacral nerve stimulator to treat
visit in order to best target and tailor treatment choices,
the symptoms of FSD shows statistically significant
whether nonpharmacologic or pharmacologic, to help the
benefits (3). In addition, Oakley et al. (4) In a small patient
patient. Consider looking for replacement medications
sample of premenopausal women, the effectiveness of
that are for instance, if the cause is medication-related, it
twice-weekly acupuncture for five weeks in treating
is not known to raise the incidence of sexual dysfunction.
reduced sexual desire was assessed. There were gains in
If the patient has mentioned relationship or stress
the female sexual function index (FSFI) desire and overall
concerns, a referral the first step in the overall process
scores despite the absence of blinding and the minimal
4712
Received: 29/11/2022 Accepted: 01/02/2023
c:\work\Jor\vol911_149The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4718-4724
Comparative Study of Swallowed Foreign Body Extraction between Oesophagoscope and Conservative Management
1 1 2 Mahmoud Abo Amra Mahmoud , Gamal Galal Shemy A , 2 , Ahmed Mohamed Taha hmed Yamany Hussien*
1General Surgery Department, Faculty of Medicine, Al-Azhar University-Assiut
2Cardiothoracic Surgery Department, Faculty of Medicine, Assiut University Corresponding author:Ahmed Yamany Hussien, Email: [email protected], Tel.: +20 101 419 2048
ABSTRACT Background: Bolus impaction of food or other foreign bodies is common. Most foreign bodies that are accidentally swallowed will be expelled without medical intervention. Evidence from pre-endoscopic series suggests that eighty percent or more of foreign bodies will pass naturally. Aim of the study: The aim of this study was to compare between the outcome of management of foreign body in esophagus by oesophagoscopy and by conservative management. Patients and Methods: This was prospective research involving 40 patients with foreign body ingestion. In Cardiothoracic Unit at Al-Azhar University, Assiut Hospital and Cardiothoracic Department Assiut University Hospital, 20 patients underwent extract foreign body by oesophagoscope and 20 patients underwent conservative management. Results: highly statistically significant (p-value < 0.001) increased percentage of infection in conservative group (15 patients, 75%) when compared with endoscopic group (1 patient, 5%). No statistically significant (p-value > 0.05) difference between endoscopic and conservative treatment as regard laceration of mucosa, esophageal perforation, retropharyngeal abscess, esophageal obstruction, esophageal necrosis, esophageal stricture and tracheoesophageal fistula, Conclusion: Children under the age of three are disproportionately affected by the common occurrence of foreign body (FB) ingestion. Eighty to ninety percent of gastrointestinal (GI) FBs are expelled normally without intervention (i.e., without problems), ten to twenty percent are removed endoscopically, and one percent necessitate open surgery. Thus, FB swallowing is a major clinical challenge for pediatric gastroenterologists. Keywords: Foreign bodies, Endoscopy, Gastrointestinal emergency, Medical management, Dysphagia. INTRODUCTION
a few hours when the right instruments and personnel
Foreign body swallowing and aspiration are
have been assembled. This permits a thorough
common occurrences in children. Although airway
evaluation of the airway with ample preparation for the
aspiration is generally considered more dangerous,
best possible instrumentation and planning for alternate
delayed diagnosis of esophageal foreign bodies leads to
techniques, such as the ability to do an emergency
complications that are also life-threatening. Children
surgical airway if necessary (5).
with esophageal foreign bodies routinely present to their
Managing EFBs might be difficult because of a
primary care physicians or emergency department staff
lack of trained medical professionals and adequate
with a variety of symptoms of the respiratory and/or
esophagoscopy resources in some poor nations. One
gastrointestinal systems consistent with multiple
study also attempted to determine what characteristics
disease processes (1).
are linked to a negative esophagoscopy and what
Although swallowing of a foreign body (FB) is
radiologic signals are useful in locating EFBs(6).
prevalent among children, esophageal FB impaction is
Most of foreign body swallowed can be passed to
common in adults. Among children, the type of FB
GIT (gastrointestinal tract) without complication
varies according to the feeding habits and sociocultural
(conservative management). In some patient cases,
features of the community. By far the most reported
foreign bodies passed spontaneously. It means, hospital
esophageal FB (EFB) in children is the coin, whereas in
stay was 2-8 days. Some patients were hospitalized for
adult's fish bones rank among the most common
16 additional days for psychiatric treatment. The foreign
impacted EFBs (2).
bodies passed through the GI tract and were absent on
Although many EFBs are retrieved without event,
subsequent radiographic examination, though seldom
FBs can lead to devastating complications such as
recovered (7).
esophageal perforation, tracheoesophageal fistula,
The purpose of this research was to assess the
respiratory distress, and even death (3).
effectiveness between the outcome of management of
Otolaryngologists, gastroenterologists, pediatric
foreign body in oesophagus by oesophagoscopy and by
surgeons, cardiothoracic surgeons, and pediatric
conservative management.
pulmonologists are the specialists who deal with foreign
bodies that get stuck in the aerodigestive system. PATIENTS AND METHODS
Depending on the patient's age, the severity of their
This was a prospective study that included 40 patients
condition, the nature of the foreign body, and whether
suffering from foreign body ingestion in Cardiothoracic
or not it was aspirated, there are a variety of possible
Unit at Al-Azhar University, Assiut Hospital and
treatments (4).
Cardiothoracic Department, Assiut University Hospital,
In most cases, the operation doesn't need to be
20 patients underwent extract foreign body by
performed immediately but should be completed within
4718
Received: 25/11/2022 Accepted: 27/01/2023
c:\work\Jor\vol911_150The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4725-4730 Proadrenomedullin as a Cardiac Biomarker in Prediction in Pediatric Heart Failure: Review article Mohamed El Sayed Amer1, Besheir Abd Alla Hassan1, Mohamed Milad Abdul Hamid Enbaya 2, Hanan Samir Ahmad 1
Department of Pediatrics1, Medical Biochemistry 2, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Mohamed Milad Abdul Hamid Enbaya, Mobile: (+20) 01288023029, E-mail:[email protected] ABSTRACT Background: Children's morbidity and death from heart failure continue to be major contributing factor. The evaluation of several biomarkers may serve as a valuable diagnostic aid. Objective: To evaluate the role of Proadrenomedullin in detection of heart failure. Conclusion: There is a high diagnostic value of measuring plasma level of proADM at admission, regarding the diagnosis in the setting of pediatric congestive heart failure, and can be used as prognostic value after treatment. Keywords: Proadrenomedullin, Heart Failure, Pediatric.
INTRODUCTION
During the screening of a panel of peptides taken
amino acid sequences of adrenomedullin from several
from a pheochromocytoma by a research team in Japan,
species are compared in figure (1). Additionally, the
they came across the regulatory peptide. They were
canine and bovine adrenomedullin sequences have been
examining the biological activity of the peptides to see if
clarified (3).
they may raise platelet cAMP levels. It originated from
Pre-proadrenomedullin, a more substantial
the adrenal medulla, the researchers named the peptide
precursor molecule, is used in the synthesis of
they discovered with this activity "adrenomedullin" after
adrenomedullin. A 21-amino acid N-terminal signal
purifying and sequencing it. The rat gene was sequenced
peptide immediately follows the proadrenomedullin N-
after the gene encoding human adrenomedullin. The first
terminal 20 peptide, or PAMP found in pre-
putative adrenomedullin receptor had been discovered, a
proadrenomedullin.
Additionally,
it
has
been
new field of endocrine research had begun, and plasma
hypothesized that the adrenomedullin gene may produce
adrenomedullin levels had been measured in a variety of
another biologically active peptide known as
clinical settings (1).
adrenotensin, but this has not yet been proven (4).
Adrenomedullin is the name of the gene that Synthesis and secretion of adrenomedullin:
produces pre-proadrenomedullin, and it has been
One disulfide link exists between residues 16 and
identified as being on chromosome 11 at a single locus.
21 of the 52-amino acid peptide known as human
Three introns and four exons make up the human
adrenomedullin, and the carboxy terminus contains an
adrenomedullin gene. The TATA, CAAT, and GC boxes
amidated tyrosine. Due to some similarities to calcitonin
can be found in the gene's 5-flanking region (figure ).
gene-related peptide, it has been added to the
Both the cAMP-regulated enhancer element and the
calcitonin/CGRP/amylin peptide family (CGRP). 50
activator protein-2 (AP-2) contain a lot of binding sites.
amino acids make up rat adrenomedullin, which has the
Furthermore, Nuclear Factor-B (NF-B) sites have been
human peptide has 6 alterations and 2 deletions (2). Only
found in the promoter of the adrenomedullin gene. The
one difference separating pig adrenomedullin from the
structure and chromosomal location of the mouse
human peptide occurs at position 40 (Gly for Asn). The
adrenomedullin gene location have also been determined
c:\work\Jor\vol911_151The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4731-4735
Effectiveness and Safety of High Dose Oral Ibuprofen versus Standard Dose for Treatment of Preterm Infants with Patent Ductus Arteriosus Dahlia El Sebaie 1, Shaimaa Mohamed Hassan Ali 2*, Yasmeen Mansi 1, Rodina Sobhy 1, and Amira M. Sabry 1
1Pediatric Department, Cairo University, 2Neonatology Department, El Sahel Teaching Hospital, Cairo, Egypt *Corresponding author: Shaimaa Mohamed Hassan, E-mail: [email protected], Phone: +201010761933. Orcid:0000-0003-0871-2021 ABSTRACT Background: One of the most significant changes needed for the transition to extrauterine life is the ductus arteriosus (DA) closure, which is located in the fetal circulatory system between both the aortic arch and the pulmonary artery. The extended length of patent DA (PDA), that further raises premature mortality and morbidity, impairs hemodynamics. The effectiveness and tolerability of oral ibuprofen administered at regular and high doses to treat PDA were examined in this research. Patients and Methods: The newborn Critical Care Unit at Cairo University Pediatric Hospitals received 60 preterm neonates (Gestational age<36 weeks) with clinically severe PDA during the course of 2.5 years. A randomized controlled trial was used in the investigation. They were divided into two groups at random, with the first receiving oral ibuprofen at a standard dose (10, 5, 5 mg/kg/day) and the second receiving oral ibuprofen at a high dose (20, 10, 10 mg/kg/day) for three days straight. Results: The neonates in our experiment exhibited a considerable reduction in PDA size both before and after taking it, and no statistical considerable difference between two regimens of ibuprofen was existent. Despite the fact they stayed within the scope of normal range for age in the high-dose group, serum creatinine level rose by two to three times following ibuprofen treatment. To completely comprehend this conclusion, further study is needed. Conclusions: Our results show that regular-dose ibuprofen for PDA closure is just as effective as high-dose ibuprofen with fewer side effects. Keywords:Preterm Neonate; High Dose Oral Ibuprofen; Ductus Arteriosus.
INTRODUCTION PATIENTS AND METHODS
Normal term delivery causes the ductus
The newborn intensive care unit of Cairo
arteriosus to spontaneously shut; in preterm neonates, it
University Pediatric Hospitals admitted 60 preterm
often doesn't. A left-to-right shunt triggered by the
neonates (Gestational age<36 weeks) with clinically
disease known as patent ductus arteriosus (PDA) can
severe PDA between March 2016 and December 2018.
potentially lead to hemodynamic abnormalities such
This research was a randomized controlled trial
pulmonary fluid overload as well as a decrease in
investigation. Neonatal patients were admitted upon
systemic circulation. This has been linked to chronic
parental signed informed permission.
lung illness, necrotizing entero-colitis (NEC), and
Preterm newborns (Gestational age<36 weeks)
extended ventilation. PDA may be managed medically
within the first week of life must meet the inclusion
or surgically by ligation. There is now a global
criteria, as well as a pediatric cardiologist must find
discussion on the ideal PDA drug management
clinical or echocardiographic evidence of a
approach (1).
hemodynamically severe PDA.
It is crucial to identify between such a clinically
Significant congenital defects, a serum creatinine
significant or non-significant PDA before deciding on a
level of less than 1.5 mg/dl,a platelet count of less than
course of treatment. The preterm newborns' respiratory
50,000/mm3, and a history of bleeding tendencies are all
state is made worse by the hemodynamically severe
considered exclusion factors (for example; hematuria,
PDA by increasing the infants' previously manageable
bloody endotracheal aspirate, bloody gastric aspirate,
ventilator support and oxygen requirements (2).
blood in stools, or blood oozing from puncture sites).
Ibuprofen, a non-steroidal anti-inflammatory
A comprehensive clinical examination was done
medication, causes the PDA to close by blocking cyclo-
both before and throughout treatment throughout the
oxygenase. When administered during the first three
intervention, daily measurements of rate of heart, blood
postnatal days, ibuprofen proved particularly effective
pressure, capillary refill time, and output of urine was
in closing the ductus arteriosus (3). Additionally,
taken. Blood samples for the full blood count, CRP,
different research discovered that using high doses of
serum creatinine, urea, liver enzymes, bilirubin, blood
ibuprofen (20-10-10 mg/kg/day for three days straight)
cultures, chest X-ray, cranial ultrasound, and
is more efficient than using conventional doses (10-5-5
echocardiography were also included. Additionally,
mg/kg/day for three days straight) while reducing the
these tests were done before the patient began taking the
incidence of side effects (4).
medicine, every other day while it was being taken, at
the conclusion of the ibuprofen administration, or as
soon as a doctor deemed it necessary.
4731
Received: 22/07/2022 Accepted: 24/09/2023
c:\work\Jor\vol911_152The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4736-4741 Role of Irisin in Physiological and Pathological Conditions: Review Article Talal Altahir Ammarah Aldeeb*, Sherif Wagih Mansour, Mai Mohammed Hasan, Nanees Fouad Elmalky
Physiology Department, Faculty of Medicine, Zagazig University, Egypt Corresponding author: Talal Altahir Ammarah Aldeeb, Mobile: 0155 0420202, Email: [email protected]
ABSTRACT The chance of developing several illnesses, such as obesity, diabetes, heart disease, some types of cancer, and some neurological conditions, is increased by a sedentary lifestyle or a lack of exercise. Exercise lowers the risk of numerous diseases and helps to enhance quality of life. Irisin, a hormone released during exercise that connects muscles to other tissues, is a fragment of the cell membrane protein FNDC5. Over the past ten years, it has become abundantly clear that irisin is a molecular mimic of exercise and has a variety of advantageous effects, such as browning of adipocytes, alteration of metabolic processes, control of bone metabolism, and nervous system function. Irisin plays a part in the development of cancer; various studies have demonstrated how it affects the invasion, migration, and growth of cancer cells. Irisin's receptor is not fully understood, however, it probably works through a specific family of integrin receptors in some tissues. In this article, we examine recent studies, which suggest that irisin may be a useful therapeutic agent for the treatment or prevention of a number of disorders with a metabolic component. This paper describes the irisin's biochemical and structural characteristics and offers information on how irisin functions in various clinical circumstances.
INTRODUCTION (1)
mice and humans have 100% identity .
Irisin is a hormone that was identified in 2012
After being secreted by working skeletal
and is mostly produced by muscles and adipose
muscle, irisin binds to white adipose tissue (WAT)
tissue. It regulates many physiological and metabolic (1)
pathways. When the PPAR co-activator-1 (PGC-1)
cells through an unknown receptor . Schumacher
is stimulated by an event like physical activity, it (6) et al. showed that irisin is a premade dimer that
cleaves the fibronectin type III domain-containing
may be crucial for ligand receptor binding. The
protein 5 (FNDC5) into a 112 amino acid peptide (1).
protein N-terminal is a potential candidate for
PGC-1 is a multifunctional transcriptional co-
interaction with an undiscovered receptor because
factor that affects fatty acid and glucose metabolism
irisin has two loop sections made up of residues
as well as mitochondrial biogenesis and function.
55-58 and 106-108 (Figure 1).
It can be activated by a variety of dietary and
physiological inputs. The transmembrane FNDC5
protein's expression and production are both
(2)
stimulated by PGC-1 .
A glycosylated type I membrane protein called
FNDC5 has a transmembrane domain (171-209
amino acids), a fibronectin III domain (33-124
amino acids), and a N terminal signal peptide (1-28
(3) (4)
amino acids) . Moreover, Mahajan and Patra
reported that the type I membrane protein, whose
proteolytic breakdown produced the release of the
protein's N-terminal portion into extracellular space,
(5)
is the source of FNDC5. In addition, Seifi et al.
reported that the mouse chromosome 4 and human
chromosome 1 both contain the FNDC5 gene.
(6)
Schumacher et al. reported that irisin is
released following the proteolytic cleavage, (6)
glycosylation, and likely dimerization of FNDC5, Figure (1): Structure of the irisin dimer
which contains the majority of the fibronectin III
domain and has a same amino acid sequence in
There are two types of receptor activated
both humans and mice. FNDC5 has a molecular
dimerization, including binding of a single ligand
weight of between 12-32 kDa. All mammalian
that causes dimerization of two receptors or binding
species have well maintained irisin hormone, and
of two monomeric ligands that encourage dimer interactions between monomeric receptors. The irisin
4736
Received: 27/11/2022 Accepted: 29/01/2023
c:\work\Jor\vol911_153The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4742-4748
Assessment of Left Ventricular Function by Layered Strain in Hypertensive Patients with and without Left Ventricular Strain Mahmoud Kamel Ahmed, Emad Mahmoud Elokda*, Fatma Elzahraa Abd Almonem Zein
Department of Cardiology, Faculty of Medicine, Menoufia University, Egypt *Corresponding author: Emad Mahmoud Elokda, Mobile: (+20)1020439253, E-Mail: [email protected] ABSTRACT Background: ST depression and T-wave inversion (TWI) are classic ECG strain patterns that indicate left ventricular hypertrophy (LVH) and a poor prognosis. The relationship between strain and increased left ventricular (LV) mass and its relationship to ischemic heart disease (IHD), however, hasn't been thoroughly studied. Objectives: The aim of the current work was to assess if hypertensive cases with a strain pattern on ECG have more ischemic changes at the level of the myocardium or if it is just an electrical phenomenon associated with hypertension (HTN). Patients and methods: The current study comprised 100 hypertensive cases who were undergone coronary angiography for suspected angina pectoris and revealed normal coronaries, and 15 age and sex-matched normotensive health volunteers (control group). Patients were further divided into 2 groups; Group I: included 50 hypertensive patients with strain criteria by ECG, and Group II: included 50 hypertensive patients without strain criteria. A conventional echocardiogram was performed using M-mode, 2D, Doppler, and Tissue Doppler, and then myocardial strain measured by 2D speckle tracking echocardiography (STE) was used to evaluate the layers of the myocardium. Results: The layer-specific strain (LSS) was significantly lower in both hypertensive groups compared to the controls in all three layers (endocardium, myocardium, and epicardium). The LSS was significantly decreased in GI cases with strain ST-T changes than in GII cases with no strain ST-T changes. The endocardial layer was much more affected than the mid-myocardial and epicardial layers; in GI, the endocardial layer's P-value was <0.001, while in the mid- myocardial layer the P-value was <0.05), and in the epicardial layer P-value was <0.05. Conclusion: It could be concluded that hypertensive patients with LVH and strain pattern have more ischemic changes than hypertensive patients without strain and the ischemic changes are more profound at the level of the endocardium. Keywords: Hypertension, left ventricular strain, speckle tracking, layer-specific strain INTRODUCTION
gradually impairs the function of the mid-myocardium
Stroke, atherosclerosis, and ischemic heart
and epicardium as well (4, 5).
disease are only a few cardiovascular disorders for
As a result, different hypertension stages may
which HTN are a significant risk factor. A typical side
cause layer-specific dysfunction that is difficult to
effect of HTN is LVH, which has its own set of risks
identify with a single-layer evaluation. LSS is a novel
for cardiovascular morbidity and death (1).
technique that has the ability overcome such
A well-known indicator of anatomical LVH is
limitations; it permits an exhaustive evaluation of the
the characteristic pattern of ST depression and TWI on
three myocardial layers and, as a result, can determine
the resting electrocardiogram (ECG) (2).
the origins and evolution of myocardial mechanical
When ECG LVH criteria are employed for
dysfunction (6).
stratification, this anomaly of repolarization is the best
As a result, we aimed to assess if hypertensive
predictor of poor outcomes. It has been linked to a
cases with a strain pattern on ECG have more ischemic
poor prognosis in several clinical groups. Furthermore,
changes at the level of the myocardium or if it is just
in addition to the clinical effects directly linked to high
an
electrical
phenomenon
associated
with
left ventricular (LV) mass, the strain pattern could be a
hypertension.
reflection of underlying coronary artery disease
(CAD). This correlation may help to partially explain PATIENTS AND METHODS
the clinical effects of this ECG finding (3).
This study included a total of 100 hypertensive
A measurement of tissue deformation is strain.
patients who underwent coronary angiography for
When the ventricles contract, the muscles undergo
suspected angina pectoris and revealed normal
negative strain in the longitudinal and circumferential
coronaries, attending at Department of Cardiology,
dimensions and positive strain in the radial direction.
Menoufia University Hospital.
However, because global strain only evaluates global
function rather than myocardial layer-specific activity,
The included patients were recruited for the
it cannot provide a thorough analysis of LV
investigation of the effect of HTN on different layers
mechanics. The layer of the heart most susceptible to
of the myocardium using 2D speckle-tracking
early injury from hypertension is the endocardium, but
echocardiography.
as the situation progresses, the pathology spreads and
7474
Received: 29/11/2022 Accepted: 01/02/2023
c:\work\Jor\vol911_154The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4749-4755
Prevalence of Thyroiditis Following Either COVID -19 Infection or Vaccination in a Group of Egyptian (Hashimoto and Normal) Cases Khaled Mahmoud Makboul, Laila Mahmoud Ali Hendawy, Hany Khairy Mansour*, Menna Allah Adel Mohammed, Rana Hashem Ibrahim
Department of Internal Medicine & Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, Egypt *Corresponding author: Hany Khairy Mansour, Mobile: (+20)12295455922, E-Mail: [email protected] ABSTRACT Background: Hashimoto's thyroiditis (HT), one of the most common autoimmune thyroid diseases (AITDs), is the major cause of hypothyroidism in the world's iodine-sufficient regions. The Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) causes COVID-19 illness, belong to the family of beta-coronaviruses which rapidly spread leading to COVID-19 pandemic on March 11, 2020. Since follicular thyroid cells express the angiotensin converting enzyme 2 (ACE2), the virus's receptor for cellular entry, they may serve as a direct target for SARS-CoV-2 infection. Objective: The aim of the current work was to evaluate the thyroid function consequences following either (COVID- 19) infection or vaccination in group of Hashimoto thyroiditis and normal subjects in relation to their clinical features, biochemical, immunological, and inflammatory markers. Patients and Methods: This study was conducted on 80 subjects attending the COVID Vaccination Center and Emergency Isolation at Ain Shams University Hospital during the period from August to October 2022, 14 males, and 66 females, their age ranged from 18 to 70 years. They were divided according to thyroid Abs into Hashimoto's thyroiditis group and normal group, each of them divided into 2 subgroups (exposed to COVID 19 infection & got COVID 19 vaccine). Results: This study showed significant increase in the level of TSH and decrease in the level of free T3, Free T4 in Hashimoto's patients who exposed to COVID19 infection (P-value <0,01). Significant decrease in the level of TSH and increase in the level of free T3, Free T4 in Hashimoto's subjects' group after their exposure to COVID19 vaccine (AstraZeneca) (P-value <0,01), normal subjects group after exposure to COVID19 infection (P-value .02 and <0,01) and normal subjects group after being exposed to COVID19 vaccine (AstraZeneca) (P-value .02 and .04). Conclusion: COVID19 infection and vaccination against COVID might be followed by an attack of thyroiditis in Hashimoto patients and even in normal persons. Keywords: Thyroiditis, COVID-19, Egyptian Hashimoto Cases. INTRODUCTION
In regions of the world where iodine is
As follicular thyroid cells express the
abundant, Hashimoto's thyroiditis (HT), the most
angiotensin converting enzyme 2 (ACE2), the virus's
common autoimmune thyroid disease (AITD), is the
receptor for cellular entry, they may in fact be a direct
main cause of hypothyroidism. Approximately 2030%
target for SARS-CoV-2 infection. Additionally, thyroid
of patients have HT, which is thought to be caused by a
peroxidase has been shown to cross-react with
confluence of genetic predisposition and environmental
antibodies against the SARS-CoV-2 spike protein,
factors that results in the loss of immunological
indicating that molecular mimicry mechanisms may be
tolerance, an autoimmune attack on the thyroid tissue,
to blame for thyroid auto-inflammatory damage (4).
and the development of the disease (1).
Furthermore, COVID-19 is linked to a widespread
The global COVID-19 pandemic, which was
inflammatory response that includes innate immune
brought on by the brand-new SARS-CoV-2
cells, T helper (h)1/17, and Th2 lymphocytes and may
coronavirus, first appeared in Wuhan in December
affect the thyroid. As a result, a broad range of thyroid
2019. As a result of direct or indirect consequences of
illnesses caused by SARS-CoV-2 have been identified,
SARS-CoV-2 infection, thyroid gland dysfunction was
from subacute thyroiditis to autoimmune thyroid
a very prevalent endocrine complication during the
diseases
with
accompanying
symptoms
of
COVID-19 pandemic (2).
thyrotoxicosis and/or hypothyroidism (4).
The original SARS-CoV and the novel SARS-
Numerous vaccines, including mRNA-based
CoV-2 both enter target cells through the ACE2
vaccines, viral vector vaccines, and inactivated viruses,
receptor, which causes these receptors to be
have been developed to combat the pandemic. An
downregulated. The luminal surface of alveolar
increasing number of case reports have suggested a
epithelial type II cells expresses over 83% of the ACE2
potential link between SARS-CoV-2 vaccines and
receptors, making these cells the main sites of viral
thyroid disorders in the past year, replicating the range
invasion. Additionally, the widespread distribution of
of thyroid dysfunction that has already been described
ACE2 receptors in extra-pulmonary tissues can be
to occur during SARS-CoV-2 infection. This is due to
linked to the multi-organ dysfunction seen in these
the widespread administration of SARS-CoV-2
patients (3).
vaccines (5).
c:\work\Jor\vol911_155The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4756-4764 Changes in Vitamin D Level After Sun Exposure in Egyptian School Children Youmna M. El Moataz*1, Sahar S. Ganeb1, Refaat El Tanawy1, Waleed Hassan1, Yasmin Marei2
Departments 1Rheumatology, Rehabilitation and Physical Medicine, and
2Medical Biochemistry, Faculty of Medicine, Benha University, Egypt *Corresponding author: Youmna M. El. Moataz, Mobile: (+20)1222887373, E-Mail:[email protected] ABSTRACT Background: Vitamin D is a fat-soluble vitamin found in blood, muscle, liver, fat, and other tissues. The regulation of calcium phosphorus balance and bone health are two of vitamin D's main roles. However, studies on both humans and animals suggest that vitamin D may play a part in the emergence of a number of endocrine disorders. Objective: The aim of the current work was to determine the baseline state of 25-hydroxyvitamin D levels in a sample of Egyptian schoolchildren and to assess how sun exposure affects vitamin D status. Subjects and methods: This cross-sectional study included a total of 50 apparently healthy schoolchildren, aged from 6 to 11 years, and performed at swimming pool center, in Benha, Egypt, between May 2018 and the end of September 2018 Vitamin D was measured twice, the first time in May, and the second time in September with good exposure to the sun three times/per week one hour before swimming. Results: Pre exposure mean vitamin D level was 26.9, while it was 27.1 after exposure, with no statistically significant difference between pre and post exposure levels. Vitamin D was sufficient in 40%, insufficient in 44%, deficient in 16%. No change was found in vitamin D status post exposure. Pre and post exposure vitamin D levels showed significant positive correlation with total calcium, ionized calcium, and significant negative correlation with body mass index (BMI). Darker skin, fast food, higher centile, BMI, formula feeding, lower sun exposure, activity level, total, ionized calcium was associated with risk of lower vitamin D status. Conclusion: It could be concluded that vitamin D deficiency and insufficiency are highly prevalent in sunny Egypt. To increase vitamin D status and reduce the risk of its deficiency, vitamin D supplementation, consumption of vitamin D- rich food, and the encouraging of outdoor activities should be considered. Our findings indicate that, despite receiving a lot of sun exposure, some children exhibit varied responses to ultraviolet Blight (UVB) light, which results in poor vitamin D status. Keywords: Vitamin D, Cholecalciferol, Egyptian children, Sun exposure.
INTRODUCTION
Vitamin D is a fat-soluble vitamin, it comes in a
adults up to the age of 70. In contrast to the IOM's
variety of shapes. Ergocalciferol (Vit.D2) and
recommendation of 800 IU/day for people over 70, the
cholecalciferol (Vit.D3) are regarded as the two main
Endocrine Society did not distinguish between
forms of vitamin D (1).
adults' vitamin D needs depending on age. According to
1,25-Dihydroxyvitamin D, a form of vitamin D
the Endocrine Society, persons with a high body mass
that is hormonally active, affects the expression of
index (BMI >30) need two to three times as much
numerous genes whose byproducts are not only
vitamin D as healthy, normal-weight people (5).
involved in calcium and bone metabolism but also have
Vitamin D deficiency, according to the Endocrine
the ability to interact with a variety of non-traditional
Society, is defined as levels below 20 ng/mL (50
organs and target tissues, such as the heart, liver, and
nmol/L), and vitamin D insufficiency as levels between
pancreas (2). It has been shown that vitamin D plays a
21 and 29 ng/mL (52.5-72.5 nmol/L). The biological
crucial role in cell division, differentiation, and
indication of vitamin D status is serum 25 hydroxy
immunomodulation (3).
vitamin D, which measures vitamin D insufficiency.
More studies have revealed a direct link between
The current permissible level of vitamin D, which is 30
vitamin D deficiency and a number of diseases,
ng/mL (75 nmol/L), is indicative of vitamin D
including cancer, infections, autoimmune disorders,
insufficiency, whereas vitamin D deficiency is indicated
metabolic syndrome, insulin resistance, cardiovascular
by a blood 25 hydroxyvitamin D level of 20 ng/mL (50
disease (CVD), and non-alcoholic fatty liver disease (4).
nmol/L) (6).
The Institute of Medicine's (IOM) and the Endocrine
Along with the typical rickets symptoms and
Society's guidelines for vitamin D consumption in the
growth delay, children with vitamin D deficiency also
diet can be used to support that conclusion. Infants and
experience these conditions (7). Adults who don't get
kids alike need at least 400 IU each day. Both
enough vitamin D are more likely to develop
organizations recommend giving kids at least 600 IU
osteomalacia, osteoporosis, and fractures (8).
per day. The Endocrine Society indicated that all adults
The key factor affecting vitamin D level in infancy
require 15002000 IUs of vitamin D per day for the
is the maternal vitamin D status. Even though it is
health of their musculoskeletal systems, however the
technically difficult, all pregnant women should have
IOM did not make a distinction between children and
their 25(OH)D levels checked throughout the first
trimester of pregnancy. If they are inadequate, they
4756
Received: 30/11/2022 Accepted: 02/02/2023
Lidocaine versus midazolam for prevention of post-extubation laryngospam in children undergoing tonsillectomy with or without adenoidectomy: A randomized controlled clinical trialThe Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4765-4771
Study of Dexmedetomidine versus Fentanyl as Adjuvants to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block for Postoperative Analgesia after Cesarean Delivery Abdullah Abobakr Ali*, Neveen Mahmoud El-Aaser, Kamelia Ahmed Abaza, Abdalla Mohamed Goda Mohamed
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Abdullah Abobakr Ali, Mobile: (+20) 01096199607, E-Mail: [email protected] ABSTRACT Background: Dexmedetomidine's potential to increase blockade duration has piqued the interest of researchers as a local anaesthetic adjuvant in recent years. As an opioid analgesic, fentanyl is highly effective. Objective: Improving postoperative analgesia after Cesarean delivery using dexmedetomidine or fentanyl as additives to bupivacaine for transversus abdominis plane block with ultrasonography guidance. Patients and Methods: One hundred and twenty cases were randomly divided into two equal groups each included 60 cases. Group D received ultrasound guidedtransversus abdominis plane (TAP) block using dexmedetomidine 1 microgram/kg + 40 ml bupivacaine 0.25%, and the volume was divided equally and given bilaterally. Group F received ultrasound guided TAP block using fentanyl 1 microgram/kg + 40 ml bupivacaine 0.25%, and the volume was divided equally and given bilaterally. Results: Group D had lower mean arterial pressure as well as heart rate than group F at 4, 8, 12, 18, and 24 hours post-operative. Group D had a significantly longer time to first analgesia compared to group F. Group D had significantly reduced total analgesic intake compared to group F over a 24-hour period. Rescue analgesics were needed by a greater percentage of patients in group F than in group D after 6, 12, and 24 hours. A statistically significant difference was seen between the two groups after 20 and 24 hours on the VAS, with group D scoring lower than group F. Conclusion: Dexmedetomidine was more effective than fentanyl in providing postoperative analgesia with bupivacaine for transversus abdominis plane block with ultrasonography guidance following caesarean section. Keywords: Dexmedetomidine, Fentanyl, Bupivacaine, Cesarean delivery. INTRODUCTION
systemically has calming, pain-relieving, sympathetic-
Opioid medications given via the systemic
nerve-calming, and anesthetic-saving properties.
and/or neuraxial pathways are the standard of care in
Dexmedetomidine's potential to increase blockade
analgesia. Neuraxial techniques are efficient and risk-
duration as a local anaesthetic adjuvant has garnered a
free, but they require a skilled practitioner and close
lot of attention as of late. After abdominal surgery, it
observation to ensure success. Patient-controlled
may be best to combine a local anaesthetic with
analgesia (PCA), such as intravenous or epidural
dexmedetomidine administered via TAP block, as the
morphine, is another method of administering opioids.
latter primarily affects peripheral nociceptive receptors
Patients report higher levels of therapeutic satisfaction (4).
when they are given agency for their pain
With the discovery of opioid receptors in
management. Opioids can have serious negative
peripheral nerves, efforts have been made to improve
effects on a person's body, including drowsiness,
the efficacy and safety of peripheral nerve blocks by
vomiting, itching, or nausea as well as respiratory
combining local anaesthetics with opioids. There are
depression in very rare circumstances. Breast milk
numerous opioids that have been discovered to have
secretion is a further concern with this group.
local anaesthetic effects, including fentanyl and
Paracetamol and other NSAIDs don't do the trick when
sufentanil (5).
they come to relieving pain by themselves (1).
As an opioid analgesic, fentanyl is highly
The transversus abdominis plane (TAP) block is
effective. It's an opioid agonist having analgesic and
a targeted treatment for pain in the area where the
sedative characteristics, and it's a synthetic
anterior division of the thoracic spinal cord (T6) meets
phenylpiperidine. Fentanyl acts on the central nervous
the lumbar spinal cord (L1). The TAP block is used to
system by binding selectively to the mu-receptor
lessen pain after numerous abdominal procedures (2).
(CNS). Fentanyl exerts its analgesic effects by
The TAP block, used for postoperative
stimulating the opening of potassium channels and
analgesia after a Caesarean section, is easily performed
blocking the opening of N-type voltage-gated calcium
with ultrasound technology. Several adjuvants have
channels. So, the neuronal excitability drops and
been used to lengthen the effect and improve the
hyperpolarization happens (6).
quality of the local anaesthetic action, with promising
results, but TAP block only lasts as long as the local
This study aimed to improving postoperative
anaesthetic does (3).
analgesia
after
Cesarean
delivery
using
Dexmedetomidine is a highly selective alpha 2-
dexmedetomidine or fentanyl as additives to
adrenoceptor agonist that, when administered
4765
Received: 01/12/2022 Accepted: 03/02/2023
c:\work\Jor\vol911_157 The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4772-4779
Euthyroid Sick Syndrome Is Predictive of Illness Severity in Pediatric Sepsis Muhammad Said El-Mekkawy*, Al-Shimaa Zakaria El-Demerdash, Naglaa Fathy Barseem
Department of Pediatrics, Faculty of Medicine, Menoufia University, Egypt *Corresponding author: Muhammad Said El-Mekkawy, Mobile: (+20) 01015359228, E-mail:[email protected], ORCID ID: 0000-0003-1755-431X ABSTRACT Background: Thyroid dysfunction, termed "euthyroid sick syndrome", was described in critically ill patients, but data in pediatric sepsis is limited. Objective: Our objective was to evaluate prevalence and prognostic value of this syndrome among children with sepsis. Patients and Methods: Prospective observational study including 81 children admitted into Pediatric Intensive Care Unit (PICU) with sepsis. Patients were classified on admission into "sepsis", "severe sepsis", and "septic shock" groups. Pediatric Index of Mortality2 (PIM2) was calculated. Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured upon PICU admission. Results: Hormonal abnormalities were detected in 57 (70.4%) patients. 52 patients had FT3 deficiency; 7 had FT4 deficiency; 23 had TSH deficiency; and two had TSH elevation. The predominant pattern was isolated FT3 deficiency (32.1%) then combined FT3 and TSH deficiency (23.4%). Mean FT4 was lower among "septic shock" compared with "sepsis" and "severe sepsis" groups (p=0.001). TSH was lower among severe sepsis than sepsis (p=0.033). FT3, FT4, and TSH were lower among patients needing vasoactive medications (p=0.046, 0.037, and 0.022 respectively). TSH was lower among patients requiring mechanical ventilation (p=0.003). FT3, FT4, and TSH inversely correlated with vasoactive infusion days. TSH inversely correlated with mechanical ventilation duration and PIM2. No specific hormone was associated with mortality, but TSH predicted "unfavorable course" i.e., the composite outcome of mortality or presence of one illness severity indicator (area under receiver operating characteristic curve=0.70). Conclusion: Euthyroid sick syndromeis common in pediatric sepsis. TSH and FT4 are particularly associated with illness severity. Keywords: Euthyroid sick syndrome; Low T3 syndrome; Non-thyroidal illness syndrome; Prognosis; Pediatrics; Sepsis.
INTRODUCTION
Cytokines can also directly suppress TRH and TSH
In the setting of critical illness, abnormalities
secretion. At the level of thyroid, cytokines affect
in thyroid function take place without prior intrinsic
different steps of thyroid hormone synthesis like iodide
thyroid disease. Decreased serum triiodothyronine (T3)
uptake and thyroid peroxidase expression, with
level is the most frequent alteration. Thyroxine (T4)
consequent downregulation of T4 and T3 secretion. In
level may also fall. Despite lowering of T3 and T4
peripheral tissues, deiodinase 3 expression is
levels, serum thyroid stimulating hormone (TSH) is
upregulated by cytokines and hypoxia, leading to
normal or decreased. This constellation of
conversion of T4 to the biologically inactive reverse
abnormalities is termed "euthyroid sick syndrome" or
T3 (rT3), while hepatic expression of the T3-producing
"non-thyroidal illness syndrome" (NTIS)."Low T3
enzyme deiodinase 1 is decreased. Furthermore,
syndrome" is an alternative term, given the observation
decreased thyroxine-binding globulin levels, altered
that low T3 level is the most striking and consistent
thyroid hormone transporters, and altered thyroid
finding. Euthyroid sick syndrome is thought to
hormone receptor expression may have a role in
represent adaptive response, aiming at decreasing
euthyroid sick syndrome(8, 9).
energy expenditure in sick patients(1).
Interest in euthyroid sick syndrome has been
Euthyroid sick syndrome has been reported in
growing, not only because of its ability to mislead
in acute conditions like pneumonia(2), sepsis(3), surgery,
doctors but also owing to its potential to predict
burn, and trauma(4-6).Chronic illnesses, like collagen
prognosis in different clinical conditions (2,5). However,
diseases, can also be associated with euthyroid sick
available data on this condition in pediatric sepsis is
syndrome(7).
very limited. Therefore, the aim of the present study
How euthyroid sick syndrome develops in
was to determine the prevalence of euthyroid sick
sepsis is not fully understood. It was suggested that
syndrome among pediatric patients with sepsis, and to
pro-inflammatory cytokines (like interleukin-1,
evaluate its association with disease outcome.
interleukin-6, interleukin-12, interleukin-18, and tumor
SUBJECTS AND METHODS
necrosis factor-) induce expression of deiodinase 1 in
This was a prospective observational study
the pituitary and, possibly, induce expression of
conducted on 81 patients with sepsis who were
deiodinase 2 in both the hypothalamus and pituitary,
admitted to a tertiary Pediatric Intensive Care Unit
that might be responsible for increased local
(PICU) belonging to Menoufia University Hospital
availability of T3, which suppresses thyrotropin
from October 2019 to April 2021.
releasing hormone (TRH) and TSH secretion.
4772
Received: 02/12/2022 Accepted: 04/02/2023
c:\work\Jor\vol911_158The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4780-4785
Study of Micro RNA 181 a3p As a Biomarker for Diagnosis of Acute Myeloid Leukemia DaliaM. Abd El-Hassib1, Magda Abdel-Aziz Zidan1, Yomna Mohammed Marei2, Nancy El Sayed Nabih Abo El Gheit3, Hamasat A Alnoury1
1Clinical and Chemical Pathology Department, 2Internal Medicine Department,
Faculty of Medicine, Benha University, Benha, Egypt
3 Clinical and Chemical Pathology Department, Faculty of Medicine, Tanta Cancer Center, Ministry of Health, Egypt Corresponding author: Nancy El Sayed Nabih Abo El Gheit, Email:[email protected], Mobile no.: +201211951373 ABSTRACT Background: Tiny non-coding RNAs called microRNAs (miRNAs) are crucial for cell survival and differentiation. Numerous cancer varieties, including acute myeloid leukemia, have been linked to abnormal miRNA expression (AML). Objective: The objective of this study is to assess the prognostic importance of miRNA-181a-3p and its participation in the diagnosis of acute myeloid leukemia. Subjects and methods: Forty-five subjects were recruited from Benha University Hospital and Tanta Cancer Center. They were divided into 30 newly diagnosed adult patients with AML as patient's group and 15 apparently healthy individuals matching age and sex with patients as control group. At the beginning, blood samples (2 ml) were taken from the patients and control for complete blood picture and RT-PCR, and after 28 days of medication, more blood samples (1 ml) from the patient's group were taken in order to quantify the relative gene expression of miRNA-181a-3p. Results: The present study demonstrated a significant overexpression of miRNA -181a-3p gene as opposed to the control group in the AML group. Moreover, miRNA-181a-3p gene expression level decreased significantly after treatment when compared to its pretreatment level. Comparing post treatment level to control group, revealed that miRNA-181a-3p gene expression level decreased, but did not reach the control level. Non remission cases were significantly associated with higher baseline miRNA-181a-3p gene expression when compared to remitted cases. Conclusion: The current study revealed that miRNA-181a-3p expression level had a role in AML diagnosis and in prediction of prognosis. Keywords: Acute myeloid leukemia, Polymorphism, Complete remission. INTRODUCTION
interact with their target genes. Exosomes are one type
The most prevalent form of leukemia in adults is
of vesicle that miRNAs may be released into and used
acute myeloid leukemia (AML), which makes up
to reach target cells; another methodology includes
around 80% of all cases. Ineffective erythropoiesis and
miRNAs attaching to proteins (5).
bone marrow failure are generated via clonal growth of
AML genesis and advancement may be strongly
immature "blast cells" in the peripheral blood and bone
influenced by miRNAs, which have important
marrow (1). Myeloid precursor cells' failure to
biological implications in hematopoietic cell
accomplish terminal differentiation from proliferative
differentiation and proliferation (6).
precursor cells into mature blood cells distinguishes
Four members of the MicroRNA-181 (miRNA-
AML as a highly diverse illness. AML has been linked
181) family--miRNA-181a, miRNA-181b, miRNA-
to alterations in post-transcriptional control by miRNAs
181c, and miRNA-181d--have undergone extensive
in addition to genetic and genomic aberrations, such as
evolutionary conservation in nearly all vertebrate
chromosomal translocations and inversions, gene
species. The genes for human miRNA-181a and
deletions, and mutations (2). AML is characterised by
miRNA-181b are situated on chromosomes 1 and 2 (7).
mutations in hematopoiesis-related genes. Even though
It is yet unsure how miR-181a, a member of the
the precise source of genetic problems is obscure, a few
miR-181 family, impacts growth of cancer cells;
risk factors include smoking, chemotherapy, and
depending on the kind of neoplasm, it may either
radiation exposure. Aplastic anemia, paroxysmal
promote or repress expansion (8).
nocturnal hemoglobinuria, myelodysplastic syndrome
The clinical application of miR-181a-3p in AML
(MDS), and myeloproliferative maladies (MPD) can all
patients has not been thoroughly researched. In order to
develop into AML. Genetic alterations caused by family
assess miR-181a-3p's diagnostic validity and forecast
history should also be taken into account (3).
function in the prognosis and outcomes of AML
Certain RNAs regulate cells as a controlling factor,
patients, the current researchers focused at the
whereas others provide physiological roles. Long non-
expression of miR-181a-3p in AML patients.
coding RNAs (lncRNAs) and short non-coding RNAs
(miRNAs), which make up the largest class of non- SUBJECTS AND METHODS
coding RNAs (ncRNAs), are among the ncRNAs in
From March 2021 to February 2022, we carried
cancer that have been the subject of the most concerned
out a case-control experiment for our work. 45
research (4). Many genes' transcription can be controlled
individuals in all were recruited for this study from the
or activated by microRNAs. MiRNA abundance,
Internal Medicine Department at Benha University
subcellular localization, target messenger RNAs
Hospital and Tanta Cancer Center and they were
(mRNAs), and miRNA-mRNA interactions' affinities
divided into: Group I (patient group): contained 30
are only a few of the variables that affect how miRNAs
adults newly diagnosed AML and Group II (control
4780
Received: 30/11/2022 Accepted: 02/02/2023
ABSTRACT The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4786-4792
Role of CXCL-10 as a Biomarker for Rheumatoid Arthritis Sherihan Mahdy Salama*, Mervat Mohamed Abdulhakim, Soha El-Dessouki Ibrahim, Ahmed Saeed Saad Zaghloul
Department of Physical Medicine, Rheumatology & Rehabilitation Faculty of medicine Ain Sham University, Egypt *Corresponding author: Sherihan Mahdy Salama, Mobile: (+20) 01090604024, E-Mail: [email protected] ABSTRACT Background: CXCL-10 has been discovered as a pro-inflammatory chemokine that mediates leukocyte trafficking and modulates innate and adaptive immune responses after being demonstrated in the sera, synovial fluid (SF), and synovial tissue (ST) of cases with rheumatoid arthritis (RA). It contributes to several biologic processes and is essential to the inflammatory response. Objective: This study aimed to evaluate the predicative significance of chemokine CXCL10 in RA and to identify its relation to disease activity. Patients and Methods: 30 cases with RA and 30 healthy controls made up a case-control study. For each patient, a clinical examination was conducted. ELISA was utilized to measure the amount of CXCL10 in the blood, and the Disease Activity Score (DAS-28) that was utilized to assess the disease activity in the patients. Results: In terms of the blood level of CXCL-10, it was watched a high significant difference between the patients and controls with a high sensitivity and specificity in regard to RA diagnosis. According to the DAS-28, there was a significant difference between the different activity groups when CXCL-10 levels in patients with various grades of disease activity were compared. Conclusion: Our research confirmed the pivotal function of CXCL10 in the RA inflammatory cascade and shown its importance as a biomarker for RA disease prediction. Additionally, it is essential for RA inflammation and might be a marker of disease activity in RA. Keywords: Rheumatoid arthritis, CXCL10, Chemokine receptor, Disease activity.
INTRODUCTION
The CXCL10 gene in humans produces the 8.7
Rheumatoid arthritis (RA) is a chronic systemic
kDa protein known as C-X-C motif chemokine ligand
inflammatory disease that is characterized by synovial
10 (CXCL10), also known as small-inducible cytokine
inflammation with gradual deterioration of bone and
B10. Small cytokine C-X-C motif chemokine 10 is a
cartilage in the joints (1). Different leukocytes,
member of the CXC chemokine family. The CXCL10
comprising T cells, B cells, monocytes, neutrophils,
gene is part of a cluster with numerous additional CXC
eosinophils, dendritic cells (DC), and natural killer
chemokine genes on human chromosome 4 (7-9). The
(NK) cells are proposed to be comprised in RA
important function of CXCL10 in chronic
pathogenesis although its etiopathogenesis isn't totally
inflammatory disorders has been thoroughly described.
identified (2).
CXCL10 increases the production of CXCL10 in
According to many studies, RA represents a
numerous cell types, leading to positive feedback that
"window of opportunity" within which effective
amplifies CXCL10 and Th1 responses in inflamed
treatment may stop the irreparable destruction and stop
tissues where IFN- is released by Th1 cells via
the transition from acute, reversible inflammation to
CXCR3 (10). Human RA patients have been
chronic persistent inflammation. Up till now, only a
demonstrated to have higher blood and SF levels of
little is known about the pathological mechanisms
CXCL10 (11).
underlying early and pre-clinical RA than is the case
Several cell types can secrete CXCL10 under
with established RA (3).
the effects of IFN. Many immune and non-immune
T helper (Th) 1 and Th17 cells are primarily
cells can produce it when stimulated by interferons.
defined as participating factors in the context of RA
Monocytes, endothelial cells, and fibroblasts are some
pathogenesis in the current paradigm of the T-cell
of these cell types. Numerous functions of CXCL10
subsets (4). The synovial fluid (SF) cytokines in RA,
have been identified, comprising chemoattraction of
however, has been demonstrated to differ from that in
monocytes/macrophages, T cells, NK cells, and DC,
confirmed RA and to have a Th2 and Th17 bias
promotions of T-cell adhesion to endothelial cells,
(demonstrates increased level of interleukins; IL-2, IL-
antitumor activity, and suppression of angiogenesis
4, IL-13, IL-17, IL-15, BFGF, and EGF in comparison
and BM colony formation (12). Myositis and
with confirmed RA) (5). Additionally, it was
rheumatoid arthritis are two autoimmune disorders in
demonstrated that, when compared to healthy controls,
which CXCL10 has been identified as a biomarker (13).
patients with RA who are not receiving treatment have
In the context of animal models of RA, block
higher serum levels of cytokines linked to Th17
of the CXCL10-CXCR3 axis is demonstrated to lessen
polarisation, neutrophil recruitment, and stimulation (6).
the severity of arthritis and bone and cartilage damage
while also preventing the influx of inflammatory cells, such as T cells and macrophages, into inflamed joints.
4786
Received: 02/12/2022 Accepted: 04/02/2023
c:\work\Jor\vol911_160The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4793-4801
Study of Outcome of Early Breast Cancer Patients Treated with Different Chemotherapy Protocols Ola M. Elfarargy, Mahmoud Ahmed Mohammed Hassan*, Adel Bakry, Heba F. Taha
Department of Medical Oncology, Faculty of Medicine Zagazig University, Egypt *Corresponding author: Mahmoud Ahmed Mohammed Hassan, Mobile: (+20) 01094471107, E-Mail: [email protected] ABSTRACT Background: If detected and treated early, breast cancer has a chance of being cured. Therapy has progressed utilizing multiple chemotherapeutic regimens with great efficacy and minimal toxicity. Objective: To improve the outcome of patients with early breast cancer by clarifying the most effective adjuvant therapy regimen. Subjects and methods: In a clinicopathological retrospective study, we included 854 patients with non-metastatic breast cancer patients treated at Medical Oncology Department, Maadi Armed Forces Medical Complex and Medical Oncology Department, Zagazig University; from January 2015 to December 2018. Results: Most of our study population 505 patients (59.1%) received adjuvant chemotherapy protocol of (4 AC (Adriamycin and Cytoxan) + 4 taxanes), while the 2nd most common used protocol was 6FAC (Fluorouracil, Adriamycin, and Cytoxan), which was received by 17.7% of patients, on the other hand some patients received 4AC, 3AC+3 taxanes and 4TC protocols. Percentage of our patients who were still alive after 4 years of diagnosis were 86.5% (739 patients). Disease recurrence or metastasis occurred in 317 patients (37.1%) during follow up period ranged from 13-84 months, while 537 patients (62.9%) didn't experience either recurrence or metastasis to time of study. Conclusion: Early breast cancer is considered potentially curable disease. Disease recurrence or metastasis occurred in 37.1% of our patients. Survival rate after 4 years of diagnosis was 86.5%. The FAC protocol has been used in just 17.7% of our patients, but DFS rate of those patients who received FAC was the highest (73.5%), even superior to AC+Taxanes. Keywords: Chemotherapy, Breast cancer, Chemotherapy protocols. INTRODUCTION
With an estimated 1.9 million new cases in 2017,
Chemotherapeutic regimens comprising anthracyclines
breast cancer (BC) is the most frequent cancer in
and taxanes are effective against breast cancer (4).
women and the fifth greatest cause of death in women
Numerous adjuvant chemotherapy regimens are
worldwide. In the same year, breast cancer accounted
detailed in the National Comprehensive Cancer
for 601,000 deaths among women (1).
Network (NCCN) recommendations for the treatment
Breast cancer is the most frequent type of cancer
of breast cancer, involving; concurrent anthracycline-
in women in Egypt. It's the third most common form of
cyclophosphamide and taxane (ACT); sequential
cancer among females (2).
anthracycline-cyclophosphamide and taxane (AC-T),
Epidemiologic studies have established a number
cyclophosphamide, methotrexate, and fluorouracil
of risk factors for breast cancer, some of which are
(CMF);
anthracycline-cyclophosphamide
without
unavoidable (such as race and ethnicity) and others that
taxane
(AC);
as
well
as
docetaxel
and
are modifiable (such as increased alcohol use, physical
cyclophosphamide (TC)(5).
inactivity, exogenous hormones, and specific female
To provide more effective treatment with reduced
reproductive variables). Potential long-term impacts on
side effects, it is vital to tailor medicines to each
sex hormone levels or other biological mechanisms link
individual patient and their tumor's unique molecular
an earlier age at menarche, higher parity, and later age
and clinical profile (6).
at first full-term pregnancy to an increased risk of breast
This study aim was to estimate disease outcome in
cancer (3).
each chemotherapy regimen and also to correlate this If detected and treated early, breast cancer has a
outcome with clinical and pathological characteristics.
chance of being cured. Over the past few years,
significant strides have been made in the field of cancer SUBJECTS AND METHODS
treatment, with a corresponding decrease in the severity
This
clinicopathological
and
of therapy for both locoregional and systemic therapy
immunohistochemical retrospective study included 854 (4). Patient age and menopausal status, hormone
patients with non-metastatic breast cancer patients
receptor status, HER2/neu overexpression, and the
treated at Medical Oncology Department, Maadi Armed
presence of lymph node involvement; all are factors into
Forces Medical Complex and Medical Oncology
the decision to use adjuvant systemic therapy. Systemic
Department, Zagazig University from January 2015 to
chemotherapy, endocrine therapy, and radiation are the
December 2018.
standard treatments for node-positive breast cancer (for
hormone receptor-positive cancer), both HER2/neu
overexpressing cancers and trastuzumab.
4793
Received: 02/12/2022 Accepted: 04/02/2023
c:\work\Jor\vol911_161The Egyptian Journal of Hospital Medicine (April 2023) Vol. 91, Page 4802-4807
Role of Choline and Inositol Treatment for Patients with Polycystic Ovarian Syndrome: A Clinical Study Nadia Saddam Fahad1*, Izdihar Nsaif Ali2 and Noor Wali Aiad3
1,2College of Medicine, University of Thi-Qar, Thi-Qar, 64001, Iraq 3Bint Al-Huda teaching hospital, Thi-Qar health department, Thi- Qar, Iraq *Corresponding author: Nadia Saddam Fahad, Phone: 009647800438143, E-mail:[email protected] ABSTRACT Background: The most frequent cause of infertility, hyperandrogenism, and ovulatory problems is polycystic ovarian <br