A study of effect of expremintal pre-eclampsia on plasma lipocalin-2 level in rats The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 518- 527

A Study of Effect of Experimental Pre-Eclampsia on
Plasma Lipocalin-2 Level in Rats
Mohamed S. A. Zamzam, Ahmed B. E. Abd Allah,
Azza A. Y. Megahed and Eman Mahmoud Farg Allah
Department of Physiology, Faculty of Medicine, Zagazig University

preeclampsia (PE) is a pregnancy related complication defined as a disease that begins in
the placenta and ends at the maternal endothelium. It is a multi-stage disease that starts by utero-placental
insufficiency and leads to generalized maternal endothelial dysfunction.Lipocalin2 (LCN2) is a
25kDasecretory glycoprotein implicated in many functions such as apoptosis and innate immunity. Also,
it has been recognized to have potential effects in obesity, inflammation and insulin resistance in mice and
humans. Many controversial studies about the changes in the plasma LCN2 levels in PE are reported.
Aim: The current study was designed to perform an animal model of experimental PE in a trial to
demonstrate the possible relationship between PE and the circulating LCN2 levels.
Design: forty eight healthy adult female albino rats and eight adult male albino rats were used. The male
rats were used for induction of pregnancy. The adult female rats (n=48) were divided into four equal
groups: group I (control non-pregnant group), group II (non-pregnant treated with L-NAME), group III
(normal pregnant group) and group IV (pregnant treated with L-NAME to induce a model of experimental
PE). In all groups, body weight, body mass index (BMI), blood pressure, circulating levels of urea,
creatinine, triglycerides (TGs), IL-6, endothelin-1(ET-1), vitamin D (VD), LCN2 and D-dimers in
addition to total urinary proteins are measured. Histopathological examination of placental sections was
done in group III and group IV.
Results: The results of the present study revealed a significant increase in the body weight, BMI, MAP,
total urinary proteins, circulating levels of urea, creatinine, TGs, IL-6, ET-1, LCN2 and D-dimers in both
group II and IV. In addition to a significant decrease in VD in the same two groups. In group III, there
was a significant increase in body weight, BMI, total urinary proteins and circulating levels of TGS, D-
dimers and LCN2. There was a significant decrease in VD and MAP. Moreover, there was a positive
significant correlation between LCN2 and all measured parameters except VD in group IV together with a
positive significant correlation between LCN2 and MAP, IL-6, ET-1and D-dimers in group II.The results
in group IV are supported by the histopathological examination results.
Conclusion: L-NAME can be used for induction of experimental PE and plasma levels of LCN2 can be
used as an indicator for the renal complications and coagulopathies in PE. Further studies are needed to
ascertain this association.
Keywords: Pre-eclampsia, lipocalin2, L-NAME.


PE is a pregnancy related disorder characterized
by hypertension and proteinuria occurring after
dysfunction and an imbalance of angiogenic
20 weeks of gestation. Several promising
factors [5]. However the placentation differences
biomarkers have been proposed, alone or in
among mammals and the fact that the PE does
combination, that may help in predicting women
not occur naturally in animals other than humans
who are at risk of PE [1].
and two species of higher order primates, the
The exact etiology of PE has not been surly
patas monkey [6] and baboon twins [7] make this
model as a challenge [8].
mechanisms had been suggested. But it is
So, many animal models are suggested including
reported that the placenta is the main key to its
those induced by; reducing the utero-placental
pathogenesis [2, 3].
perfusion [9, 10], inhibition of nitric oxide (NO) [11,
Experimental PE is the induction of PE like state
12, 13], by low dose lipopolysaccharide (LPS) [14,
in animals to facilitate the studying of different
15] and many other models.
pathophysiological mechanisms of PE and
LCN2 is a 25 kilo Daltons (kDa) secretory
investigating its potential preventive and
glycoprotein that belongs to the lipocalin family
therapeutic measures [4]. The ideal animal model
of proteins. It has been implicated in many
of PE was suggested to show all the symptoms
functions such as apoptosis and innate immunity.
seen in women with PE that include
Also, LCN2 has been recognized as an
Received: 10 / 03 /2017 DOI : 10.12816/0037801
Accepted: 20 / 03 /2017


Full Paper (vol.672 paper# 1)

c:\work\Jor\vol672_2 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 528- 535

Anti-Diabetic Effect of Balanites Aegyptiacea Leaves Extract (Heglig) by
Regulation of Erythrocyte Glucose Uptake in Diabetic Patients Type 2 in Vitro
El-Sayed M. El-Sayed Mahdy* Hatem A. El-Mezayen*,
El-Mowafi Abdo Elmowafi** Shaimaa Sabry Mohamed***
*Biochemistry Unit, Chemistry Department Faculty of Science,
Helwan University, ** Medicinal and Aromatic Plants Unit, Horticulture Research
Institute and National Gene Bank, Agricultural Research Center and
***Medicinal Plant Department, Horticulture Institute Agricultural Research Center

in Diabetes, the increase in the oxidative stress and decrease in the antioxidant defense may
elevate he susceptibility of diabetic patients to many pathological complications, oxidative induced cell
damage has been proposed to play an important role in the etiology of numerous pathological conditions.
So, the aim of the present study was to investigate the antioxidant potential of Alcoholic Leaves extract of
Balanites aegyptiacea (Heglig) due to the presence of phenolic and flavonoids compounds on uptake of
glucose in vitro by erythrocytes of diabetic patients.
Results: in hyperglycemic patients, erythrocytes malondialdehyde level was highly significantly increased
(P<0.0001) than that of control. However, the erythrocytes glutathione content was highly significantly
decreased (P< 0.0001) when compared to that of corresponding control values. The glucose uptake by
erythrocytes of diabetic patients was highly significantly decreased (P < 0.0001) with increasing
hyperglycemia (Fasting Blood glucose), while it was highly significantly elevated (P< 0.0001) after addition of
Balanites aegyptiacae leaves extract to the incubation medium. On the other hand, the malondialdehyde
concentration was highly significantly reduced (P < 0.0001) on adding the extract. So, it could be concluded
that , an appreciate support for enhancing Antioxidant supply from natural sources such Balanites aegyptiace
leaves extract may help control blood glucose levels and prevent pathological complications of diabetes
Keywords: Diabetes Mellitus, Balanites Leaves Extract, phenolic and flavonoids cpd., Oxidative Stress,
Human Erythrocytes.

Oxidative stress is defined as either an
Diabetes Mellitus (DM) is a group of metabolic
overproduction of free radicals or a diminution in
disease Characterized by hyperglycemia resulting
antioxidant defenses, the result of either leads to
from defects in insulin secretion, insulin action,
excessive levels of free radicals[7].Oxidative stress
or both[1].Several distinct types of DM caused by
in cell and tissue plays an important role in the
a complex interaction of genetics, environmental
pathogenesis of DM. oxidative stress manifests
factors and life style choices. Pazdro and Burgess
by increased levels of free radicals; it suppresses
[2] reported that; arise in blood glucose
glycolysis, protein and nucleic acids production,
concentration causes increased oxidative stress
and enzyme activities and promotes oxidation ­
which contributes to the development and
phosphorylation uncoupling[8].In living animal's
cells, peroxidized membranes lose their
complications. Diabetic Ketoacidosis (DKA) and
permeability, becoming rigid, reactive and
nonfunctional. Malondialdehyde (MDA) is an
complications of diabetes. Although chronic
end product of cell membrane lipid peroxidation
hyperglycemia is an important etiologic factor
and its concentrations have been widely used as a
measure of cell membrane lipid Peroxidation[9].
mechanism(s) by which it leads to such diverse
Hyperglycemia promotes hyper production of
cellular and organ dysfunction is unknown[3].
active oxygen and nitrogen forms, including
Free radicals are constant products produced from
superoxide radicals, nitrogen monoxide, and
aerobic cell metabolism[4].excessively high levels
peroxinitrite which is to be one of the main
of free radicals cause damage to cellular proteins,
factors in the development of DM complications,
lipids and nucleic acids, and eventually cell
and modifies structural and mechanical
death[5]. A system of nutritional and endogenous
characteristics of erythrocyte membrane and
enzymatic antioxidant defense generally holds the
cytoskeleton and erythrocyte shape[10].
production of free radicals in check[6].
antioxidants as substances that are able, at
Received: 22 / 07 /2016 DOI : 10.12816/0037802
Accepted: 29 / 07 /2016

Full Paper (vol.672 paper# 2)

c:\work\Jor\vol672_3 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 536- 543
Surgical Correction of Alar Collapse with Alar Batten Graft:
Technique and Results
Abdel Aziz Kamal Saad* and Ahmed Taha**
Departments of Otolaryngology* and Plastic & Reconstructive Surgery**
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Abdel Aziz K. Saad, e-mail: aksaad@hotmail.com

: nasal valve collapse has great perception of nasal obstruction. The alar batten graft
technique has proven to be a valid method for treatment of external and internal valve collapse. Aim:
the aim of the present study was to evaluate a two year experience and follow up for external nasal
valve collapse treatment using alar batten graft technique regarding results and complications. Patients
and Methods:
this prospective study was carried out on 18 patients attended the ENT and Plastic
Surgery outpatient clinics of Al-Azhar University hospitals from January, 2014 to January 2016.
Written consent was taken from every patient. All patients were complaining of nasal obstruction of
gradual onset and progressive course with 7 years average. All patients were subjected to detailed
history taking and questionnaire including the NOSE scale. Surgical correction was performed to all
patients using the alar batten graft harvested from the septa cartilage or conchal cartilage. Postoperative
results recorded in relation to subjective sensation of nasal obstruction and aesthetic appearance of the
nose. Results: eleven patients (61.1%) were males and seven (38.9%) were females. Their age ranged
from 18 to 45 years with a mean of 32±2. Bilateral obstruction was found in 33.3% of cases and
unilateral obstruction in 66.7% of cases. There were 22.2%, 27.8%, and 50.0% of the cases had
moderate, fair, and severe obstruction, respectively. Postoperatively, these figures were changed to no
obstruction77.8% (P=0.0), mild 0.0%, moderate 11.1%, fair 11.1%, and sever 0.0%(P=0.0005). The
technique significantly abolishes the severe nasal obstruction. Postoperative complications include 1
case with graft resorption (4.2%) and 1 case of graft displacement (4.2%). Both were improved on
subsequent surgery. Regarding postoperative findings there was tenderness and hypertrophic
postauricular scar in 5.5% of patient and nasal tip edema in 22.2%, all resolved. In the early
postoperative period, 33.3% of patients complained of fullness in the supraalar region. Conclusion:
Successful surgical correction of nasal obstruction requires the precise diagnosis of the anatomic point
of collapse. Alar batten graft improves the rigidity of lower lateral cartilage preventing collapse of the
lateral nasal wall preventing collapse during moderate and deep inspiration. The graft varies according
to the severity of the obstruction and size of the collapsible area of the lateral nasal wall. The septal
cartilage is usually sufficient. The technique significantly improves nasal breathing.
Keywords: Alar Collapse, Alar Batten Graft, Functional rhinoplasty.

contribution of the external valve to nasal
Functional rhinoplasty describes the
obstruction varies considerably depending on
collection of techniques that surgically
the individual anatomy of the nose [1]. External
addresses the airflow by correcting nasal valve
nasal valve collapse is described as collapse of
disturbances [1]. The nasal valves have been
the nostril margin of the nose (alar collapse)
proposed to be a major regulator of nasal
during moderate to deep inspiration through the
airflow from exceeding the capacity to warm
nose [5]. Weakness of the external valve or
and humidify inspired air [2]. It has been
excessive negative airway pressure during
reported that patients with nasal valve collapse
inhalation can result in collapse of the nasal
have greater perception of nasal obstruction
valve with resultant obstruction [6].
than those with septal deviation alone [3].
The internal nasal valve is the area
The external nasal valve refers to the distal
between the caudal border of the upper lateral
most aperture of the nasal airway, serving
cartilages and the dorsal septum. This angle is
essentially as the nostril orifice. It consists
usually 10-15 degrees in the Caucasian nose [7].
mainly of fibrofatty tissue of the nasal valve in
Internal nasal valve collapse is usually
conjunction with the lower lateral cartilages,
observed after previous reductive rhinoplasty in
collumella, medial crural footplates, the caudal
older patients who show weakness of the
septum, and the pyriform aperture [4]. The
supportive structures of the nose (upper and

lower lateral cartilages). Patients typically have
Received: 06 / 03 /2017 DOI : 10.12816/0037803
Accepted: 12 / 03 /2017

Full Paper (vol.672 paper# 3)

c:\work\Jor\vol672_4 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 544- 546

Impact of Kangaroo Position on Serum Nitric Oxide in Preterm Infants
Layla A El Shall*, Afaf A Korraa**, Ragaa A Mohamed***,
Reham B Abo El-Hagag****
Clinical Pathology*, Pediatrics Department**, Pediatrics***,Al-Azhar University

Kangaroo mother care is a standardized protocol-based care for preterm and low birth
weight infants. The core feature is early positioning of the infant, prone and upright on the mother or
father's chest to maximize skin to skin proximity. Kangaroo mother care (KMC) is a safe and
effective method of caring for low birth weight infants and is promoted for its potential to improve
newborn survival.
The aim of this study was to investigate serum nitric oxide (NO) in stable preterm infants before and
after 60 min kangaroo position & to find out a relation between serum NO and neonatal temperature
during that position. Results: showed a statistically significant increase in body temperature,
peripheral oxygen saturation and mean arterial blood pressure immediately after 60 min of KMC
compared to the results before this maneuver. There was significant increase in NO immediately after
60 minutes KMC. Conclusion: Kangaroo position could increase body temperature through NO
dependent mechanisms. KMC is effective in improving all vital signs especially Temperature in
preterm infants avoiding the harmful consequences of hypothermia in those infants.
Key words: nitric oxide, Kangaroo mother care , preterm.


from Neonatal Intensive Care Units of Al-
Premature infants are highly vulnerable
Zhraa and Ain Shams University Hospitals.
group of the population1 .
Inclusion criteria:
Kangaroo mother care (KMC) implies placing
-Late preterm neonates of gestational age
the newborn pre-term baby in intimate skin to
between 34-36weeks
skin contact with the mother's chest and
-All infants are clinically stable preterms.
abdomen where the premature baby is kept
Exclusion criteria:
warm and close to the breast for unlimited
-full term infants
feeding. KMC has emerged as a non-
-preterm on mechanical ventilators
conventional low cost method for new born
-infants of pre-eclamptic mother
care that provides warmth, touch, and security
-sepsis ,hypoxia
to the newborn and is believed to confirm
-hypoxic ­ ischemic encephalopathy
significant survival benefit2 .
-neonatal convulsions
Nitric oxide (NO) is an important cellular
-infants on medication
signaling molecule, having a vital role in many
-congenital heart disease
biological processes. It plays a key role in
signaling the smooth muscles surrounding
All studied cases were subjected to full history
blood vessels to relax thus leading to increased
taking, complete clinical examination and
blood flow and vasodilatation through
anthropometric measurements, their vital signs
contribution to endothelial nitric oxide
(temperature, heart rate, respiratory rate ,blood
synthase (eNOS) that found primarily in
pressure ,oxygen saturation (SpO2) ) were
endothelial cells 3 .
assessed by monitor apparatus Angelus
Heat is a stimulus for the NO pathway which
NoA1010676 and pulse oximeter. Venous
exerts a significant vasodilatory effect .
blood samples (about 2 ml) were withdrawn
And this action resembles skin to skin contact
before and after Kangaroo position and were
during KMC which enables mother's breasts
centrifuged for 15 min at 1000xg.Serum
to generate heat in response to the thermal
samples were stored at -20 C° for assay of
needs of the baby .
serum level of NO by ELISA technique (using

ELISA Plate Reader Das and kit catalog
number kGE001).
A prospective study was carried out on forty-
five healthy clinical stable preterm neonates,
concentrations based on the enzymatic
with gestational age between 34 to 36 weeks
conversion of nitrate to nitrite by nitrate
reductase. The reaction was followed by
Received: 13 / 03 /2017 DOI : 10.12816/0037804
Accepted: 23 / 03 /2017

Full Paper (vol.672 paper# 4)

Hepatitis C virus in peripheral mononuclear cells in patients on regular hemodialysis The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 547- 552

Hepatitis C Virus in Peripheral Mononuclear Cells in Patients on
Regular Hemodialysis
Emad Allam Mohamed, Mostafa Abd Elfattah Elballat,
Mostafa Mostafa Kamel El-Awdy and Ahmed Abo-Elyazid Ali
Internal Medicine Department, Faculty of Medicine ,Al-Azhar University

Occult hepatitis C virus infection (OCI) was identified as Hepatitis C virus (HCV),
characterized by undetectable HCV antibodies and HCV RNA in serum, while HCV RNA is detectable
in liver and peripheral blood mononuclear cells (PBMCs) only. Nosocomial transmission in dialysis
units maintains a higher prevalence of hepatitis C virus (HCV) infection in patients on maintenance
dialysis than in the general population. HCV infection has a detrimental effect on survival in patients on
maintenance dialysis and after renal transplantation. The excess risk for death in HCV-positive patients
was partially attributed to chronic liver disease with its attendant complications, particularly
hepatocellular carcinoma and liver cirrhosis(1).
The aim of this study: was to evaluate the hidden infection of hepatitis C virus among regular
hemodialysis patients in Bab Al Sharia University Hospital with negative ELISA and PCR by using PCR
in mononuclear cells as a marker in the serum of these patients
Patients and methods:in this prospective study, 60 patients with end-stage renal disease on regular
hemodialysis(for at least 6 months duration)were included. For all patients thorough medical history,
clinical examination, kidney function tests, liver function tests, complete blood count, pelvi-abdominal
ultrasound, HCVantibodies, hepatitis C viral RNA, quantitative, HbsAg,. HCV PCR done for all patients
in serum and mononuclear cells.. Patients with acute or chronic HCV infection as marked by positive
hepatitis C antibody,acute or chronic HBV infections marked by hepatitis B surface antigen,other causes
of liver dysfunction ( e.g., primary biliary cirrhosis, autoimmune hepatitis, HIV infection) and patient on
anti HCV treatment.were excluded.
Results: showed detection of HCV-PCR in PBMCs in the absence of HCV-PCR in plasma; was found in
three of the 60 patients (3.3%). All patients had negative HIV, HBsAg, HCV Ab and serum HCV PCR.
Conclusion: it could be concluded that testing for HCV-RNA in PBMCs is more reliable than hepatitis
serological markers in identifying patients with an OCI when a liver biopsy is not available.
Occult hepatitis C virus infection, regular hemodialysis, liver disease, HCV PCR PMNL,
ELISA and serum PCR HCV.


Common problem in HD units is the blood
negative patients with abnormal liver function
tests and it was also found that viral RNA could
infections caused by hepatitis B virus (HBV),
be present in the PBMCs of nearly 70% of these
hepatitis C virus (HCV) and Human
patients. Furthermore, it was demonstrated that
immunodeficiency virus (HIV). Due to the
occult HCV replicates in these cells (4).
nature of the HD procedure, safety concerns
By detecting HCV RNA in liver biopsies or in
exist for limiting their spread among HD
PBMCs, other groups in Japan, Italy, Egypt,
patients and the staff of the unit (1).
Colombia, Pakistan and Iran have confirmed the
Egypt has the highest prevalence rate of hepatitis
existence of occult HCV infection in patients
C virus (HCV) in the world, making it the most
with elevated liver enzymes and without
challenging public health problem facing the
conventional HCV markers. Occult HCV
country. Studies show that 14.7% of the
infection has also been found in hemodialysis
Egyptian population carry HCV antibodies (2)
patients who were persistently anti-HCV and
and 9.8% have an active infection (3).
serum HCV RNA negative but with abnormal
Occult HCV infection was first identified in
values of liver enzymes, in the family setting of
liver of anti-HCV and serum HCV RNA
patients with occult hepatitis C and even in
Received: 13 / 03 /2017 DOI : 10.12816/0037805
Accepted: 23 / 03 /2017

Full Paper (vol.672 paper# 5)

c:\work\Jor\vol672_6 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 553- 563

Subclinical Peripheral Nerve Affection in Hypothyroidism
Mai Abdelazeem, Abeer ElZohiery,Mona Elhussieny,Mohamed Ragaai
Physical Medicine, Rheumatology and Rehabilitation Department
Faculty of Medicine, Ain Shams University,Cairo, Egypt
*Corresponding author: Mai Abd Elazeem Abd Elazeem Rabie,Dr_mai_rabie@yahoo.com/01010999468

Hypothyroidism is most common endocrinal disorder. The existence of hypothyroid
neuropathy is a point of debate and its pathogenesis is incompletely understood.
To detect subclinical motor or sensory peripheral nerve affection among hypothyroid patients.
Methods: The study was conducted on 30 hypothyroid patients without any neurological symptoms and
signs. 10 healthy subjects were included as a control group. All participants were subjected to full medical
history taking thorough clinical examination; full general and neurological examination, laboratory &
radiological investigations and neurophysiologic nerve conduction study.
Results: The study revealed polyneuropathy, mainly sensorimotor, in 86.6% of the patients either axonal
demyelination or axonal affection. Median and peroneal nerves were the dominantly affected nerves. High
incidence of entrapment neuropathy was encountered among the patients especially carpal tunnel CTS
(66.67%).Conclusion: Hypothyroidism is associated with polyneuropathy,mainly of a mixed type (axonal -
demyelinating type).Nerve conduction tests should be performed routinely in hypothyroid patients early in
the course of the disease, even among asymptomatic patients, to minimize structural damage and disability.
Key words: Hypothyroidism, nerve conduction study, neuropathy


Thyroid hormones are involved in many
acquired. Causes of acquired peripheral neuropathy
processes and functions of the nervous system. They
include systemic diseases (the commonest cause),
affect the central and peripheral nervous systems via
trauma from external agents, and infections or
their role in gene expression, production of myelin,
autoimmune disorders affecting nerve tissue.
and their effects on the neurotransmitter system and
Neuropathy affecting just one nerve is called
axonal transportation (1).
"mononeuropathy" and neuropathy involving
Hypothyroidism is a common medical condition in
multiple nerves in roughly the same areas on both
the general population caused by decreased
sides of the body is called "symmetrical
hormone production leading to common systemic
polyneuropathy" or simply "polyneuropathy".
manifestations including fatigue, constipation, cold
When two or more (typically just a few, but
intolerance, weight gain, hair loss, dry skin,
sometimes many) separate nerves in disparate
irregular menstrual periods and hoarseness(2).
areas of the body are affected it is called
Also, a variety of central and peripheral
"mononeuritis multiplex"(7).
nervous system manifestations are common in
The pathogenesis of the hypothyroid neuropathy
patients with hypothyroidism like myxedema
is incompletely understood, with variable
coma, cognitive impairment, cerebellar ataxia,
carpal tunnel syndrome, tarsal tunnel syndrome,
mucopolysaccharide-protein complexes within the
peripheral neuropathy, and mypathy(3,4).
endoneurium and perineurium, reduction in the
Diagnosis of hypothyroidism is based on
number of large myelinated fibers with segmental
demyelination and remyelination, aggregates of
stimulating hormone (TSH) +/- low serum free
glycogen granules, mitochondria, lipid droplets,
thyroxine (FT4) concentration, +/- low serum free
and lamellar bodies and axonal degeneration with
Triiodothyronine (FT3) concentration(5).
shrinkage of axons, and disruption of neurotubules
Peripheral neuropathy describes damage to the
and neurofilaments(1).
peripheral nervous system, which may affect
Nerve conduction studies (NCS) which include
sensation; movement, gland or organ function, and
motor and sensory nerve conduction together with
other aspects of health, depending on the type of
F wave study can play an important role in
nerve affected(6).
diagnosis of peripheral neuropathy because
Peripheral neuropathy may be either inherited or
electrophysiological signs of neuropathy are
Received: 15 / 03 /2017 DOI : 10.12816/0037806
Accepted: 25 / 03 /2017

Full Paper (vol.672 paper# 6)

c:\work\Jor\vol672_7 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 564- 570
The Role of Tonsillectomy in the Treatment of
Obstructive Sleep Apnea
Abdullah Ghafouri 1, Suzan Sulaiman Alzaidi1, Reem Raddah AL-Zayedi 2,
Nihal Khalid N Alsolu 3, Maria Khalifah Alhamed 4, Fetoon Nasser Alsharif 5,
Setah Rashd Alshammari 5, Reem Shadaid Alqahtani 4, Hind Saeed Aseeri 6,
Mohammed Saeed Alghamdi 7, Mohammed Abdullah AL Arim 8, Amany Ali Alghamdi5,
Bayan Khalid Sabb Gul9, Yasser Jamman Ahmad Alzahrani 7, Azizah Aziz Alreshi 5, Amal Talal
Alnakhli5, Ibtisam Shamsu Alam Saleh
King Fahad Armed Forces Hospital, Jeddah1, King Fahd Hospital, Jeddah2,
Arabian Gulf University, Bahrain3, King Faisal University4, Ibn Sina National College5,
6 King Abdulaziz University6, 7 Imam Abdulrahman Bin Fasial University7,
King Khalid University8, Umm Al-Qura University9, KSA

Obstructive Sleep Apnea (OSA) is caused by a partial or complete obstruction of the upper
airway. OSA is a very inconvenient and relatively common disorder with daytime and nocturnal
symptoms. The intervention and management of OSR is dependent on the patients' case severity. The aim
of this study was to evaluate the role and the optimal choice of Tonsillectomy for treatment of OSR.
Methods: a systematic search in the scientific database (Medline, EMBASE, Google Scholer and Ovid)
from 1980 to 2016 was conducted for all relevant retrospective studies including; randomized controlled
trials, cohort studies and case­control studies were analyzed and included based on the preset inclusion
and exclusion criteria. Results: the search has yielded twelve studies to be included in the present SR (n =
206 patients, 34.4 ± 10.0 years and body mass index: 29.3 ± 9.6 kg/m2) met criteria. Tonsils sizes were
hypertrophied, large, enlarged, extremely enlarged, or grades 2 to 4. Apnea-Hypopnea Index decreased by
65.2% (from 43.7± 21.7 /hour to 13.7 ± 12.7 /hour) (n = 198). The AHI mean difference (MD) was -30.2
per hour (95% confidence interval [CI] -39.3, -21.1) (P value < 0.00001). The AHI SMD was -1.37
(-1.65, -1.09) (large effect). Lowest oxygen saturation improved from 77.7 ± 11.9% to 85.5 ± 8.2% (n =
186). Lowest oxygen saturation MD was 8.5% (95% CI 5.2, 11.8) (P value < 0.00001). The Epworth
Sleepiness Scale decreased from 11.6 ± 3.7 to 6.1 ± 3.9 (n = 125). Individual patient outcomes (n = 52)
demonstrated an 85.2% success rate (AHI < 20/hour and 50% reduction) and a 57.4% cure rate.
Conclusion: tonsillectomy is an effective and safe surgical intervention for treatment of OSA in adults,
particularly among carefully selected patients with large tonsils and mild to moderate OSA severity.
Keywords: Tonsillectomy, OSA, sleep apnea syndromes, Tonsillar Hypertrophy.


Obstructive sleep apnea (OSA) is a type of
neuromuscular factors, excess lymphoid tissues
sleep-disordered breathing (SDB) which is a
and airway inflammation are cited as the most
disorder characterized by partial and/or complete
critical components 6. Snoring is one of the most
upper airway obstruction that affects normal
often reported symptoms of SDB in pediatric
ventilation and hypopneas due to repetitive
populations, and its prevalence ranges from 1.5 to
collapse of the upper airway during sleep 1. If left
27.6% for different studies and populations6.
untreated, OSA will be most certainly associated
First-line therapy in most adults, for OSA
with symptoms of excessive daytime sleepiness,
consists of behavioral modification, including
weight loss if appropriate, and positive airway
dysfunction, and an increased risk of
pressure (PAP) therapy 7. For patients who fail or
cardiovascular disease and mortality2 and hence,
do not tolerate PAP therapy, treatment options
Decreased quality of life and behavioral,
include oral appliances and surgical therapy. The
choice among various second-line options
metabolic, endocrine, and growth abnormalities3.
depends on the severity of the OSA and the
Obstructive sleep apnea (OSA) is estimated to
patient's anatomy, risk factors, and preferences.
affect 1 to 5% of all children 4 , and its
Several studies repeatedly showed that tonsillar
incidence peaks are between 3 and 8 years of age
hypertrophy is a major risk factor for OSA in
5. Multiple components are involved in SDB in
Children, and that tonsillectomy is highly
children. Anatomical, craniofacial and
successful in treating those children 8. The
Received: 05 / 03 /2017 DOI : 10.12816/0037807
Accepted: 14 / 03 /2017

Full Paper (vol.672 paper# 7)

c:\work\Jor\vol672_8 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 571- 577

First Line Management of Adult Diabetic Ketoacidosis Patients
Amirah Ali Alshammari1, Louai M Alahdal2, JenanTajuddinJawi3, Hanouf Abdullah
Alnofaie4,Nourah Ali Aldossari5, Hala Mohammad AbdulazizAlassaf1,
Arwa Ibrahim Ramel6, Sajedah Hassan Almshikhess7, Ameenah Saad Felemban8,
Sarah Ali Alanazi9, RawanNashaatJoharji3 , Ali Mohammed B Alzahrani,
Sameer Ayed D Almaghamsi9, Mohammed Saeed M Alalawi11,
Hassan Ibrahim Alasmari10,Abbas Mohammed Abduljabbar12 ,Ahmed fahad alzahrani9
Hail University1, SFH2, Ibn Sina Collge3, Taif University4, King Faisal University5,
East Jeddah General Hospital6, Umm Al Qura University7, PavolJozefSafarik University8,
King Abdulaziz University 9, KingFahad Hospital in Albaha10, Anak General Hospital,
Eastern Province, KSA11, Qatif Central Hospital, Eastern Province12, KSA

Diabetic Ketoacidosis (DKA) is a hyperglycemic crisis that can occur in patients with both
type 1 and 2 diabetes mellitus. It is a medical emergency with a significant morbidity and mortality. It is
however a potentially reversible condition in case an emergency and immediate medical attention, prompt
recognition, diagnosis and treatment were provided.
Aim of the Study:was to leverage the current research data in order to construct a treatment guideline for
diabetic ketoacidosis in the emergency department.
Methods:A literature search was carried out on MEDLINE (including MEDLINE in-process),
CINAHL,Embase and the Cochrane Library. Databases using "diabetic ketoacidosis" as a MeSH heading
and as textword. High yield journals were also hand searched.
Findings:The initial treatment phase aims to restore circulating volume, reduce blood glucose levels, to
correct any electrolyte imbalances and to reduce ketone levels which in turn corrects the acidosis.
Evidence also showed that there is no need for insulin bolus prior to starting an insulin drip in the
treatment of diabetic ketoacidosis. Also, using beta-hydroxybutyrate at presentation can expedite
diagnosis and therefore treatment. Implementing treatment guidelines into the emergency department may
help expedite diagnosis and treatment.
Conclusion:Prompt first line management of DKA is the most critical stage to profoundly reduce
morbidity and mortality rates of this potentially fatal crisis. Its therefore crucial to follow the evidence-
based guidelines and DKA protocol in the emergency department to expedite diagnosis, guide treatment,
and improve continuity of care between the emergency department and the ICU as well as improving the
clinical outcomes of patients with DKA. Initially, this will improve outcomes by decreasing the delay
until treatment is initiated andprovide a continuum of treatment between the emergency department and
the intensive care unit.
Furthermore, the healthcare providersmust ensure that they have the ability to provide support and
education to people at risk of developing DKA and those that have had an episode of DKA by spreading
awareness and education to help reduce both the initial occurrence and recurrence of this often
preventable life-threatening condition.
Keywords:Diabetes complications, DKA, Ketosis, Diagnosis, Pathogenesis Type 1 diabetes Type 2


Diabetic ketoacidosis (DKA) is a serious
Cushings syndrome), and stress of recent
medical emergency resulting from relative or
surgical procedures can contribute to the
absolute insulin deficiency and the unopposed
development of DKA by causing dehydration,
action of counter-regulatory hormones, such as
increase in insulin counter-regulatory hormones,
and worsening of peripheral insulin resistance.
catecholamines1.Omission of insulin is the most
Medications such as diuretics, beta-blockers,
common precipitant of DKA2. Infections, acute
medical illnesses involving the cardiovascular
system (myocardial infarction, stroke) and
metabolism and volume status and, therefore,
gastrointestinal tract (bleeding, pancreatitis),
could precipitate DKA. Other factors that may
diseases of the endocrine axis (acromegaly,
contribute to DKA include psychological
Received: 05 / 03 /2017 DOI : 10.12816/0037808
Accepted: 14 / 03 /2017

Full Paper (vol.672 paper# 8)

c:\work\Jor\vol672_9 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 578- 590

Role of Positron Emission Tomography/Computed Tomography
(PET/CT) in Detection of Bone Metastases
Ahmed Farad, Islam El-Shazley, Ahmed Sherif
Department of Radiology, Faculty of Medicine, Benha University,Egypt


Background and Aim of the Work: Early detection of skeletal metastasis is critical for accurate staging
and optimal treatment. Among the various imaging modalities currently available for imaging skeletal
metastasis, hybrid techniques which fuse morphological and functional data are the most sensitive and
specific, and positron emission tomography (PET)/computed tomography imaging will almost become
increasingly important in this regard. We tried to assess the efficacy of fluorine-18 fluoro-deoxy-glucose
Positron Emission Tomography/Computed Tomography (PET/CT) ((18) F-FDG-PET/CT) scan
detecting bone metastases among various primary malignancies. In order to detect accuracy of fused
PET/CT in the initial detection & characterization of osseous metastases compared to isolated PET and
CT with contrast.
Patients and methods: The study included thirty patients (with a mean age = 27) with various primary
malignancies (pathologically proven) to whom PET/CT was done. In this study population, a detailed
retrograde lesion based analysis was performed for a total of 80 detected bone lesions on PET, CT and
fused PET/CT images. Sensitivity, specificity, PPV and NPV of each modality were calculated. Stastical
analysis of the lesions were performed to study the relationship between the lesion's SUV and its
corresponding morphologic pattern on CT and to set a reliable SUVmax cut-off value that can predict the
presence of malignant lesion.
Results: The calculated fused PET/CT sensitivities and specificities in various malignancies ranged from
95.2% to 99.6% and 75% to 100%, respectively. The combined PET/CT has significantly improved the
low CT sensitivity (especially in lymphoma) as well as both separate CT and PET specificities (using
SUVmax of 3 as a cut off value for malignant osseous lesions).
Conclusion: Detection of early bone marrow infiltration not apparent on CT, resolution of metabolic
activity before definite signs of complete healing on CT, detection of missed sclerotic metastases on PET
due to their relatively low metabolic activity, detection of intra and extra osseous recurrence and
differentiation of benign from malignant bone lesions.


Positron emission tomography (PET) is a
by CT resulting in much more accurate detection
molecular imaging technique most widely
and staging of malignancies (1) .
applied in oncology, using 18F labeled fluoro-
Several studies had illustrated the additional
value of PET/CT scan compared to various
imaging modalities in the accurate initial staging
information about tumor cells depending on
and follow up of malignancies. PET/CT scan
their increased rate of glucose metabolism. 18F-
can identify invisible metastatic lesions not yet
FDG PET is regarded to be effective in the
developing into structural changes. Thereby, a
detection, staging and restaging of malignancies
significant change in the management plan
with a remarkably high sensitivity. The
might be done (2) .
combination of PET and computed tomography
Combined PET/CT is widely applied in the
(CT) represents a unique imaging modality that
evaluation of various malignancies; hence the
scans the whole body in the same session,
importance of evaluating its role in the detection
providing functional and anatomic information
and characterization of skeletal metastases. The
in fused images. It combines the high sensitivity
integration of PET and CT in one modality has
of PET to the superior anatomical localization
improved the diagnostic accuracy of each in the

Received: 08 / 03 /2017 DOI : 10.12816/0037809
Accepted: 17 / 03 /2017

Full Paper (vol.672 paper# 9)

c:\work\Jor\vol672_10 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 591- 598

The Therapeutic Effects of Stem Cell Enhancer on Changes of
Some Physiological Parameters in Male Albino Rats Treated With
Mixture of Food Additives )Food Preservative, Food Coloring Agent,
and Flavor Enhancer)
Eman G.E. Helal*1,Rasha A.A. El-Sayed1, GomaaMostafa-Hedeab2,3, Mariam S. El-Gamal1
1Department of Zoology, Faculty of Science (Girls), Al-AzharUniversity,Cairo, Egypt
2Pharmacology Department, Faculty of Medicine, Beni Suef University, Egypt,
3Pharmacology Department, Faculty of Medicine, Al Jouf University, KSA.
*Corresponding author: Eman Helal, emanhelal@hotmail.com, 00201001025364

food additives are substances intentionally added to food to change its characteristics,
to maintain and improve safety, to improve or maintain the nutrient value and to improve taste,
texture, and appearance. Sodium nitrite is an inorganic salt with widespread applications in the food
industry as a food preservative in meat and fish. However, Annatto is used as a dyeing agent in the
food industry in coloring butter, cheese, and ice-cream whereas Monosodium Glutamate (MSG) is
one of the most used flavorenhancers which is ingested as part of commercially processed foods.
Stem cell enhancer is a natural stem cell mobilizer that can trigger the release of millions of adult
stem cells from bone marrow into the circulation, and its considerable safety allows for a sustained
oral daily intake over long periods of time.
Aim of the work: this study was aimed to determine the therapeutic effects of Stem Cell Enhancer
(SCE) against the hazardous effects of sodium nitrite, annatto and monosodium glutamate on some
physiological parameters in male albino rats. Materials and methods: this study had been done on
thirty male albino rats with an average body weight 120-140 g. The animals were divided into three
groups; Group 1: control (untreated group), Group 2:rats treated with food additives mixture
(sodium nitrite, annatto, and monosodium glutamate); Group 3: rats treated with food additives
mixture, in addition to Stem Cell Enhancer. Blood samples were collected, and the separated sera
were used for estimation of some biochemical parameters (liver enzymes, kidney functions, glucose,
protein profile and lipid profile) and hormonal levels [testosterone,triiodothyronine (T3) and
Results: the biochemical results showed an increase in the activities of liver enzymes [aspartate
aminotransferase (AST) and alanine aminotransferase (ALT)], and the levels of glucose, kidney
functions (urea, and creatinine), lipid profile [total cholesterol, triglycerides, low-density
lipoprotein(LDL-c), high-density lipoprotein(HDL-c)and risk factors 1& 2] and thyroid hormones [T3
and T4]in the mixture accompanied by a significant decrease in protein profile (total protein, albumin
and globulin), HDL-and testosterone hormone levels as compared to the control rats. On the other
hand, these results turned back to nearly to the normal values after receiving the Stem cell Enhancer.
the present study clearly revealed thetherapeutic capability of SCE to fight the grievous
effects of food additives mixture on major physiological parameters.
Keywords: food additives, sodium nitrite, annatto, monosodium glutamate, Stem Cell Enhancer.


Humans are continuously exposed to different
prevent the growthof bacteria, in large
kinds of chemicals such as food additives.
amounts it can be toxic to animals, including
Many of these additives have been
humans. The cytotoxicity and detrimental
effects of nitrite can be attributed to its
hazardous to human health. Sodium nitrite is a
oxidative properties (3).
food additive that is used as a color fixative
Annatto is a shrub native to the South
and preservative for meats and fish (1) as a
American tropics, the natural reddish-yellow
result of itswell-known role in inhibitingthe
color is obtained from the outer coating of its
growth of Clostridium botulinumspores in
seeds. The pigments contain carotenoids,
refrigeratedmeats (2).While sodium nitrite will
including a large amount of cis-bixin and

Received: 10 / 03 /2017 DOI : 10.12816/0037810
Accepted: 19 / 03 /2017

Full Paper (vol.672 paper# 10)

c:\work\Jor\vol672_11 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 599- 604

The Effect of Mehotrexate in the Treatment of Alopecia Areata
Haneen Saud Alsufyani, Wahhaj Abdullah Rawas, Sufyan Saud Alsufyani, Nebras Faisal
Alsaadi, Mohannad Sami Felemban, Mouad Mohammedalqadi, Jameel Abdullah Awadain,
Meshal Mohammed Abdullah Albaqami, Ali Mohammed Alasmari, Mohammed Aiman A
Halawani, Wael Hamed Alsaedi
Umm Al Qura University, Makkah, KSA
Corresponding Author:Haneen saud alsufyani ,email: haneen.saud.ss-123@hotmail.com
Alopecia areata (AA) is one of the most common autoimmune disorders and its severe
types are resistant to almost all conventional therapies. Methotrexate (MTX) has been used as an
adjunctive therapy in some autoimmune disorders and has been proposed to be effective in the
treatment of severe alopecia areata both as a monotherapy and in combination with corticosteroids.
Aim of the study:
was to evaluate the outcome and safety of MTX therapy in patients with severe
forms of AA, whether as monotherapy or in combination with systemic or intralesional corticosteroids;
and to assess therapeutic response according to sex, age, pattern of AA, disease duration and
cumulative MTX dose.
Methods: 28 patients were evaluated in a retrospective, non-controlled study, with alopecia areata in
current or prior treatment with methotrexate to assess the therapeutic response according to sex, age,
pattern of alopecia areata, disease duration, and cumulative dose of methotrexate as well as the use of
systemic corticosteroids or other treatments, and drug safety.
Results: 77.8% % of patients experienced a more than 50% regrowth rate, with the best responses
observed in those with <5 years of disease progression (81%), age over 40 years (84.6%), male patients
(80%), cumulative dose of methotrexate 1000-1500 mg, and multifocal alopecia areata (83.3%),
patients receiving systemic corticosteroids in combination with methotrexate, 78.5% had greater than
50% regrowth, compared with 45.3% in those who used methotrexate alone. The therapeutic dose
ranged from 10-25 mg/week. No patient had serious adverse effects. Relapse was observed in 35.4% of
patients with more than 50% regrowth
Conclusion: methotrexate is a convenient and relatively inexpensive drug that could be used as a safe
and well tolerated adjunctive therapy for severe alopecia areata although careful monitoring of adverse
effect is necessary.
Keywords: alopecia areata, methotrexate, severe alopecia areata.


Alopecia areata is a non-scarring chronic
Potential autoimmune mechanisms involved
inflammatory disease that affects the hair
in the pathogenesis of AA include sensitization
follicle and sometimes the nail. The onset may
of T lymphocytes, particularly CD8+ T cells, to
be at any age and there is no known race or sex
preponderance 1.
lymphocytes that compose the perifollicular
Alopecia areata (AA) is a common cause of
infiltrate characteristic of AA induces release
non scarring alopecia that occurs in a patchy,
of several Th1 cytokines - interleukin (IL)-1
confluent or diffuse pattern. It may involve loss
alpha, IL-1 beta, and tumor necrosis factor
of hair from some or all areas of the body,
(TNF) alpha - capable of inhibiting hair follicle
usually from the scalp 2. In 1­2% of cases, the
growth and arresting hair synthesis, with early
condition can spread to the entire scalp
termination of anagen6.
(Alopecia totalis) or to the entire epidermis
Several treatment options have been
(Alopecia universalis). AA has a reported
suggested for AA, but there is a paucity of
incidence of 0.1­0.2% with a lifetime risk of
randomized, doubleblind, placebo-controlled
1.7% with men and women being affected
trials, and, as noted above, no therapy is able to
equally 3.
modify the course of the disease7.
Depending on the number and distribution of
Treatment of severe AA with conventional
lesions and the extent of involvement, it is
therapies such as topical corticosteroids (CS),
classified clinically into the following patterns:
topical immunotherapy, PUVA or intravenous
(IV) pulse CS is usually disappointing; even
universalis, sisaipho (or ophiasis inversus),
newly introduced biological drugs such as anti-
reticular, and diffuse4.
tumor necrosis factor drugs (infliximab and
Received: 14 / 03 /2017 DOI : 10.12816/0037811
Accepted: 23 / 03 /2017

Full Paper (vol.672 paper# 11)

c:\work\Jor\vol672_12 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 605- 613

Effects of Some Food Additives on Some Biochemical Parameters in
Young Male Albino Rats and the Ameliorative Role of Royal Jelly
Eman G.E. Helal*1,Rasha A.A. El-Sayed1, GomaaMostafa-Hedeab2,3, Mariam S. El-Gamal1
1Department of Zoology, Faculty of Science (Girls), Al-AzharUniversity,Cairo, Egypt
2Pharmacology Department, Faculty of Medicine, Beni Suef University, Egypt,
3Pharmacology Department, Faculty of Medicine, Al Jouf University, KSA.
*Corresponding author: Eman Helal, emanhelal@hotmail.com, 00201001025364

the use of food additives is one of the most important problems in the human health nutrition
field. Food additives are widely used for various purposes; including preservation, coloring, and
sweetening, however, the physiological and biochemical changes may be produced.
Aim of the work:
was to investigate the protective role of royal jelly (RJ) against abnormalities in
metabolic biochemical parameters that induced by these food additives in male albino rats.
Materials and Methods:
thirty young male albino rats with an average body weight 120-140 g were
divided into three groups (10/cage); Group I: served as normal control group, Group II: rats orally
administrated with the mixture which consists of sodium nitrite (NaNO2 0.1 mg/kg b.wt./ day), annatto
(0.065 mg/kg b.wt./day) and monosodium glutamate (MSG 15 mg/kg b.wt./day) and Group III: rats orally
administrated with the previous mixture and then orally administrated with royal jelly (14.28 mg/kg
b.wt./day soluble in maize oil). At the end of the experiment, blood samples were collected for biochemical
estimations which including levels of serum glucose, creatinine, urea, testosterone, thyroid hormones (T3
and T4), activities of AST and ALT, total protein (TP), albumin, total cholesterol, triglycerides, high-
density lipoprotein (HDL-c) and low-density lipoprotein (LDL-c). Results: the present study showed
marked elevation in levels of fasting blood glucose, activities of AST, ALT, levels of serum urea,
creatinine, TC, TG, LDL-c, VLDLand ratios of TC/HDL-c and LDL-c/HDL-c (risk factors) as well as
albumin /globulin ratio and serum thyroid hormones (T3&T4) accompanied with significant reduction in
the body weight, serum total proteins, albumin, globulin, albumin/creatinine, testosterone and HDL-C
concentrations in the group that administrated with the mixture which consists of (NaNO2, MSG and
annatto) as compared to control rats. While administration with royal jelly significantly ameliorated the
disturbed biochemical parameters and showed significant improvement in most of these parameters.
it could be concluded that royal jelly offers a therapeutic advantage that minimizes the
metabolic abnormalities and biochemical changes which induced by these food additives.
Keywords: Royal jelly, Testosterone, Food Additives, Biochemical parameters, Sodium nitrite.


Food additives are organic substances that are

intentionally added to food in small quantities
Synthetic and natural dyes are also used in the
during production or processing to improve the
food industry as additives to intensify,
organoleptic quality (color, flavor, appearance,
compensate or add color to a manufactured
taste and texture) of the food. One of these food
product, thereby maintaining the pleasant and
additives is monosodium glutamate (MSG) which
attractive appearance that resembles the natural
widely used as a flavor enhancing amino acid (1).
product. Annatto pigments one of the natural dyes
It is a common glutamic acid salt (2) that has 78%
that derived from B. Orellana and commonly
glutamic acid, 22% sodium salt and water. The
used as food coloring agent that has great
excessive administration of MSG may lead to
economic and commercial importance(5). Many
liver and kidney damages (3). It is reported that
reports confirmed that B. Orellana is rich in
rats exposed to MSG encounter many problems
flavonoids, tannins, saponins, steroids and
like learning difficulty, gonadaldysfunction, brain
alkaloids. In addition, Bixin and norbixin are the
principle coloring constituents of annatto (6).
neurotransmitters like nor epinephrine, serotonin,
On the other hand, sodium nitrite (NaNO2) is
dopamine and their metabolites in the
used as an antimicrobial agent, a preservative and
hypothalamus region, an increase in the incidence
a color fixative in meats and fish and also
of stomach cancer, oxidative stress in the hepatic
inhibitsthe growth of Clostridium botulinum,
effectively control rancidity by inhibiting lipid
oxidation, the microbiological safety of these
Received: 14 / 03 /2017 DOI : 10.12816/0037812
Accepted: 23 / 03 /2017

Full Paper (vol.672 paper# 12)

c:\work\Jor\vol672_13 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 614- 627

Vaginal Misoprostol versus Bilateral Uterine Artery Ligation in
Decreasing Blood Loss in Trans-Abdominal
Myomectomy: A Randomized Controlled Trial
Ihab Hassan Abdel-Fattah, Ahmed Adel Tharwat, Walid,El Basuony Mohammad,
Mortada El-Sayed Ahmed, Aliaa Mohammad Ali Maaty
Faculty of Medicine ­ Ain Shams University
Uterine leimyomas are tumors of the smooth muscles and the connective tissues of the
uterus. They are considered to be the most common benign pelvic tumor affecting about 20% of women
above the age of 35. The diverse symptomatology of fibroids can be attributed to size, number and location
of the tumors. The common symptoms include menorrhagia, infertility, abdominal mass and pressure
effects. Aim of the Work: The aim of this study is to compare between the effect of medical (preoperative
vaginal misoprostol) and non-medical (bilateral uterine artery ligation) regarding their efficacy to decrease
blood loss in trans- abdominal myomectomy. Patients and Methods: Prospective randomized controlled
interventional clinical trial. The study was conducted in Ain Shams University Maternity Hospital, Cairo,
Egypt in the period between August 2015 till December 2016. It was approved by the Ethical Research
Committee, Obstetrics and Gynecology Department, Ain Shams University, Cairo, Egypt. It included 60
women recruited from those attending the outpatient gynecology clinic, seeking treatment for symptomatic
uterine myomas. Results: The current study revealed that there was no statistically significant difference
between both groups regarding operative time, blood loss and postoperative hospital stay.
Conclusion: A single pre-operative dose of 400 micrograms of vaginal misoprostol is as effective as
uterine artery ligation in decreasing blood loss in transabdominal myomectomy. Misoprostol is a simple,
cheap, fast, available and applicable tool that can be administered even an hour preoperatively.
Recommendations: Preoperative vaginal misoprostol is an effective practical tool in decreasing blood loss
in transabdominal myomectomy. Investigation of misoprostol use in larger population groups and with
different dosages and administration routes, together with comparison of other methods used to reduce
bleeding during myomectomy, is recommended.
Key words:
uterine leimyoma, smooth muscles, connective tissues, vaginal misoprostol, bilateral uterine
artery ligation, blood loss, transabdominal myomectomy.


Uterine leiomyomas are tumors of the
and recurrent pregnancy loss largely occur as a
myometrium that have a prevalence as high as 70%
result of lesions that distort the endometrial
to 80% at the age of 50 (1), the etiology and
cavity that are therefore adjacent to the
prevalence seem to vary with a number of factors
endometrium and consequently referred to as
including age, race, and possibly geographic
submucous leiomyomas(3).
location. Prevalence in the United States is almost
Treatment options for leiomyoma vary;
40% in white patients and more than 60% in
treatment strategies are typically individualized
women of African descent in the same age group (2).
based on the severity of the symptoms, the size
Leiomyomas are listed as the diagnosis for about
and location of the leiomyoma lesions, the
patients age and their chronological proximity to
hysterectomies performed each year in the United
menopause, and the patients desire for future
States (3).
fertility. The usual goal of therapy is the relief of
These benign tumors, are usually
the symptoms. The treatment options range from
asymptomatic, and may be only detectable
the use of acupuncture (ancient Chinese method)
through ultrasound examination, or associated
to the total removal of the uterus and its myoma
with a number of clinical issues including
contents (hysterectomy) (4).
abnormal uterine bleeding (AUB) especially
Treatment of fibroids should be
heavy menstrual bleeding (HMB), infertility,
individualized, and symptomatology may be a
recurrent pregnancy loss, and complaints related
decisive factor in whether or not a fibroid is
to the impact of the enlarged uterus on adjacent
removed. Myomectomy remains the gold
structures in the pelvis, which are often referred
standard for treatment for patients who wish to
to as ,,,,bulk symptoms. It is generally perceived
preserve their uteri and desire future pregnancy.
that the symptoms of HMB, infertility,
The procedure can be accomplished by either
Received: 19 / 03 /2017 DOI : 10.12816/0037813
Accepted: 27 / 03 /2017

Full Paper (vol.672 paper# 13)

c:\work\Jor\vol672_14 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 628- 634

Relationship between Diabetic Retinopathy and Methylenetetrahydrofolate
Reductase Gene Polymorphism
Jihan Abdallah M (1), Seham Mohamed A (2), Hamdia Ezzat A (3), Eman Salah M (4)
(1) Ophthalmology Department, (2,3,4) clinical pathology Department,
(2) Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.

To assess MTHFR rs1801133 (C677T) gene polymorphism in diabetic patients as a risk
factor for diabetic retinopathy and to establish the changes in Platelet indices & count in diabetic
patient as compared to the healthy control group.
Patients and Methods: The study included 40 patients with Type 2 Diabetes Mellitus. They were
divided into 2 equal groups, 20 patients with Diabetic Retinopathy, 20 patients without Diabetic
Retinopathy. Patients were selected from those attending the outpatient Ophthalmology Unit and
Diabetes Clinic of Al-Zahraa University Hospital in the period from June 2014 to June 2015. Their
ages ranged between 34 to 66 years old. They were 14 males and 26 females. Twenty cases apparently
healthy individuals were selected as a control group. All cases were subjected to full history taking
and complete ophthalmological examination. Also laboratory investigations were done including
complete blood picture, kidney and liver function tests, coagulation profile, urine analysis, lipid
profile, fasting and postprandial blood sugar and Genetic study for detection of MTHFR gene C677T
mutation (rs 1801133)by real time PCR.
: In all diabetic patients the mutant homozygous TT showed a highly statistically significant
increase in FBS (p=0.000), PPBS (p=0.000), HbA1C (p=0.000) and cholesterol (p=0.001) as
compared to wild type. Also in all diabetic patients the mutant homozygous TT showed a highly
statistically significant increase in FBS (p=0.002), PPBS (p=0.001), HbA1C (p=0.019) and
cholesterol (p=0.012) as compared to heterozygous mutant type.
Conclusion: The homozygous mutant type (TT) of rs1801133 was detected in 10% of DR patients
group while absent in DWR group and the control group. The heterozygous mutant type (CT) was
increased in DR group (50%) as compared to DWR group (35%) and the control group (25%).
Key words: Diabetic retinopathy, Methylenetetrahydrofolate gene, Platelet indices.


Diabetes mellitus is a group of
with the symbol MTHFR on chromosome 1
location p36.3 in humans (4).
hyperglycemia. It is one of the common non-
Up to 24 numbers of genetic
communicable diseases that are increasing
polymorphisms are associated with this gene.
globally. Type-2 DM is the most common
The most investigated polymorphisms are
C677T (rs1801133) and A1298C (rs1801131)
The chronic hyperglycemia of
single nucleotide polymorphisms (SNP) (5).
diabetes is associated with long-term damage,
A risk factor for vasculopathy in
dysfunction, and failure of different organs,
diabetes is elevated homocysteine level which
isa consequence of decreased activity of
contributes to the structural and functional
MTHFR. It has been reported that
changes in the retina (2).
hyperhomocysteinemia in diabetic patients
Diabetic retinopathy is the most
was associated with the prevalence of
common complication of diabetes mellitus
diabetic retinopathy as it is associated with
and is a leading cause of blindness. It is
slight increase in the risk for arterial and
venous thrombosis (6).
permeability, tissue ischemia, and neo-
The aim of this work is to study
Methylenetetrahydrofolate reductase
(MTHFR) is an enzyme that catalyzes the
polymorphism in diabetic patients as a risk
factor for diabetic retinopathy and to evaluate
methionine. The enzyme is coded by the gene
the changes in platelet indices & count in
Received: 19 / 03 /2017 DOI : 10.12816/0037814
Accepted: 27 / 03 /2017

Full Paper (vol.672 paper# 14)

c:\work\Jor\vol672_15 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 635- 644

Interferon Lambda 4 Gene (IFNL4) Linked to Hepatitis C virus
clearance, treatment
1Saadia Farid, 2Laila Rashed and 3Samya Sweilam
Department of Tropical Medicine, Biochemistry, and Medical Biochemistry
National Hepatology and Tropical Medicine Research Institute and
Faculty of Medicine, Cairo University

A designated IFNL4 gene, encoding the interferon-4 protein (IFNL4), which is
moderately similar to IFNL3, is more strongly associated with HCV clearance in individuals of African
ancestry, whereas it provides comparable information in Europeans and Asians.
Aim of the work: The study was attempted for the identification of interferon Lambda 4 (IFNL4) gene
expression in the liver biopsy and the recombinant IFNL4 protein in the serum of CHCV patients.
Patients and methods: Eighty five patients with chronic hepatitis C virus infection (CHCV), whose age
ranged between 19 and 57 years, were selected from the National Hepatology and Tropical Medicine
Research Institute were included in this study, before chronic HCV therapy, during the preparation of
patients, and ten healthy individuals were included to serve as controls. All the patients and controls were
subjected to the following: history, clinical examination, abdominal ultrasonography and collection of
blood samples for routine laboratory investigations, CBCs. Liver biopsy was done to all patients and
controls. Patients revealed mild fibrosis (Metavir fibrosis from F1 to F3). Using freshly frozen liver
biopsies to identify gene (IFNL4) by real time-PCR and the detection of its serum protein levels by
Results: Patients with CHCV have higher hepatic expression of IFNL4 before treatment and also
recombinant IFNL4 protein expression was detectable in serum with high levels.
Conclusion: An inducible human protein-coding gene IFNL4, which is related to, known IFNs have been
identified in genotype 4 CHCV patients.
Recommendations: The therapeutic inhibition of IFNL4 might represent a novel biological target for the
treatment of HCV and HBV infection and possibly other diseases.
Keywords: HCV, IFNL4, clearance of HCV.


Approximately 130-150 million people are
(HHS), announced in a press release dated
estimated to be infected with HCV. Each year,
1/6/2013 that scientists from the National
an estimated 700 000 people die from HCV-
Cancer Institute (NCI) have discovered a gene
related complications including fatty liver
mutation that affects the treatment of the
(cirrhosis), cancer (hepatocellular carcinoma)
hepatitis C virus (2). The variant in this gene is
and liver failure. Unfortunately, many people
directly responsible for the creation of the
with HCV only learn about their infection when
identified protein (3). The gene belongs to what is
they develop symptoms from cirrhosis or liver
a family of four interferon-lambda protein-
cancer (1). Results from genome-wide association
encoding genes, three of which were discovered
studies (GWAS) identified common inherited
more than ten years ago (IFNL1, IFNL2 and
genetic markers that were associated with
IFNL3). The mechanism by which the IFNL4
response to hepatitis C virus treatment and
protein impairs hepatitis C virus clearance
spontaneous clearance of the infection. Those
remains unknown (2).
markers are located on chromosome 19 near a
Single nucleotide polymorphisms (SNPs) in
known interferon gene, IFNL3. The National
the interferon lambda 4 (IFNL4) - gene are
Institutes of Health (NIH), a division of the U.S.
predictors for treatment success in patients with
Department of Health and Human Services
hepatitis C virus (HCV) infection. For direct

acting antiviral (DAA) combinations only weak
Received: 20 / 03 /2017 DOI : 10.12816/0037815
Accepted: 28 / 03 /2017

Full Paper (vol.672 paper# 15)

c:\work\Jor\vol672_16 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 645-655
Effects of High Flux versus Low Flux on Serum C-Reactive
Protein A as an Inflammatory Biomarker in Hemodialysis Patients
Emad Allam Mohamed, Magdy Elsayed Mohamed
, Haytham Sabry Abdelhamid, Mohammed Al-Arabi Mohammed.
Nephrology Unit, Faculty of Medicine, Al-Alzhar Universit.

: Traditional low-flux dialysis cannot improve micro-inflammatory status, while new high-
flux dialysis can improve the micro-inflammation and lipid metabolism, it helps to improve the quality of
life and survival rate of patients, so how to improve the micro-inflammatory status are a focus for
Objective: was to observe the effect of high flux hemodialysis (HFHD) with Gambro polyflux 170H
dialyser and low flux hemodialysis (LFPD) with polyflux 17L dialyser on high-sensitivity C-reactive
protein in patients with maintenance hemodialysis.
Methods: 60 patients with maintenance hemodialysis were randomly divided into HFHD group and LFHD
group. Another 20 cases for physical examinations served as normal control group. The maintenance
hemodialysis patients were treated with HFHD using 170H dialyser dliahyser and LFHD using 17L
dialyser, three times per week, 4 hours once. After 6 months of the treatment, high-sensitive C-reactive
protein was determined in patients as well as normal controls before and after treatment.
Results and Conclusion: in two groups, the levels of high-sensitive C-reactive protein before the
treatment were higher than normal control (P <0.001). In HFHD group, serum high-sensitive C-reactive
protein markedly decreased (P <0.01). In LFHD group, these indices remained unchanged after the
dialysis for 6 months. HFHD with 170H polysulfone dialyser is effective in improving micro-
inflammation in maintained hemodialysis patients.
Keywords: CRP, ESRD, hemodialysis membrane.


C-reactive protein (CRP) is a large,
understanding of the importance of subclinical
nondialyzable acute phase reactant with putative
chronic inflammation in this cohort. Potential
roles in modulation of the inflammatory
sources of subclinical inflammation include
response[1] ..This protein is produced in the liver
atherosclerotic disease [5] ,chronic infection
under the influence of proinflammatory
(periodontal or arteriovenous graft) [6] , or
cytokines, and its levels rise rapidly to high
uremic metabolic alterations including increased
concentrations. Furthermore, in patients without
oxidative stress[7] and the accumulation of
kidney this protein has a plasma half-life of 19
advanced glycation end products [8] .
hours[2] . This rapid rise to high concentrations
CRP elevations are thought to be clinically
and short half-life has made CRP attractive as a
relevant, as associations have been reported
marker for acute inflammation. In chronic
between elevated levels and cardiovascular
inflammation, however, C-reactive protein levels
disease and mortality in both the general
may remain elevated indefinitely[3] .
population, and in patients with chronic kidney
CRP is a more sensitive and accurate
disease [9] .
reflection of the acute phase response than the
Most of these studies measured a single C-
ESR (Erythrocyte Sedimentation Rate). ESR
reactive protein value.While a number of
may be normal while CRP is elevated. CRP
therapies and technologies have been reported to
returns to normal more quickly than ESR in
increase health-related quality of life in patients
response to therapy [4].
with chronic kidney failure, patients report that
Although there are many clinically evident
they remain substantially burdened by limited
causes of inflammation in patients with chronic
physical functioning and by dialysis-related
kidney disease (CKD), there is an emerging
symptoms [10].
Received: 13 / 03 /2017 DOI : 10.12816/0037816
Accepted: 23 / 03 /2017

Full Paper (vol.672 paper# 16)

c:\work\Jor\vol672_17 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 656-659

Operational Difficulties in Obese Patients
Nawaf AL-Hazmi, Ahmad Al-Zahrani, Abdallah Ali, Hisham Adulbaset
College of Medicine, Taif University, Saudi Arabia

Background and aim of the work:
to give optimal care for obese surgical patients, surgeons and
healthcare personnel should be aware about the surgical problems which may be met in obese patient
and how to overcome a variety of challenges. In this study the awareness of the surgeons about the
obesity as surgical problem would be evaluated from the surgical staff point of view.
Patient and methods: a cross-sectional study was done by interviewing the surgeons to fill the
questionnaire focusing on their awareness about the prevalence of operational difficulties in obese
Results: the study included 82 surgeons most of them practice general surgery. The majority of
surgeons found that the main cause of obesity amongst their patients is dietary factors (91.5%). The
same percent of surgeons (higher percentage in residents) agreed that obesity might modify the surgical
decision. According to the survey, they patients of age between 30-45years represented the majority and
most of them were females. Over 89% of surgeons found that the complications are more in obese
patients than in average weight patients. All specialties (especially general surgeons) agreed that obesity
increases the operative time. Infection was the major problem mentioned by surgeons followed by
anesthetic problems and the size of the instrument used. Over 64.6% of surgeons agreed that some
operations need to reduce patient weight to be performed. Most of surgeons (42.7%) agreed that surgical
error is higher in obese patients; however, 37.8% agreed that surgical errors in obese and average weight
patients are equal. The majority of surgeons (68.3%) agreed that experience of the surgeon will differ in
theatre. 81.7% of surgeons agreed that obese patient needs more evaluation prior to surgery than
average weight patient. 72% agreed that obese patients have prolonged hospital stay.
Conclusion: The study revealed a good to excellent awareness of KSA surgeons about surgical
problems which may be met in obese patient and how to overcome a variety of challenges reflecting the
values of continuous medical education programs applied in their hospitals.
Keywords: KSA surgeons, obesity complications, perioperative care


According to most of surgeons; the operative
surgical problem would be evaluated from the
difficulties in obese patients include, the length of
surgical staff point of view.
surgery increasing the chance of complications (1).

The length of the wound increases the blood loss
(2). The tissue is harder to retract and displace,
In this A cross-sectional prospective study
increasing the difficulties of exposure of the
which was conducted at different tertiary hospitals
target, in addition, poor visibility leads to more
in KSA from June 2016 to January 2017. The
chance for surgical error (3). To operate from a
study included 82 surgeons; 22 consultants
greater distance, surgeons need longer instruments
(26.8%), 25 specialists (30.5%), and 35 residents
and bigger retractors, which add expense and are
(42.7%). The study was approved by the Ethics
harder to handle (4).
Board of Taif University. The study was done by
Postoperatively, in addition to the difficulty in
interviewing the surgeons through the social
transportation, obese patients have a much greater
media to fill the questionnaire focusing on their
chance of surgical site infection with an incidence
awareness about the prevalence of operational
of dehiscence reaching up to 10%(5).They have a
difficulties in obese patients. Statistical analysis:
higher percentage of respiratory problems
Data were gathered, tabulated. SPSS program,
especially with the use of sedation. The intubation
version 20.0(SPSS Inc., Chicago, IL, USA) was
of obese patients will be difficult and may require
used. The data were expressed in number and
video assistance (6). They have also higher liability
percentage (qualitative) whereas, the quantitative
for thromboebolic disease (7). In this study the
data were expressed as means ±SD.
awareness of the surgeons about the obesity as

Received: 20 / 03 /2017 DOI : 10.12816/0037817
Accepted: 28 / 03 /2017

Full Paper (vol.672 paper# 17)

c:\work\Jor\vol672_18 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 660-665

Laparoscopic Appendectomy between the Advantages and Complications:A
Cross Section Study ­Jeddah ­ Saudi Arabia ­ 2016
Asmaa Yaseen Nassir1, Ahmad Mohammad Kashha2, Ali Hassan Altrabolsi1,
Abdullah N Ghannam1, Omar Abdulelah Sindi1, Ahmed Mohammed Alzimaity3
1.Ibn Sina National College ,2.Battarjee Medical College ,3.King Abdulaziz Hospital & oncology center

Appendectomy is the most common surgical procedure performed in emergency surgery.
Laparoscopic appendectomy (LA) for acute appendicitis has several advantages over open appendectomy
(OA). In cases of complicated appendicitis, LA is converted to OA at a constant rate, though converting
appendectomy (CA). In this study, we aimed to assess the LA complication and the prevalence of CA.
A cross Sectional survey conducted among 243 patients with acute appendicitis who were suitable
for the study between April and July 2016. Operative time, length of hospital stay, post-operative
complication return to normal activity has been assessed among the all patients.
Results and Conclusion: Our results showed the advantages of the laparoscopic appendectomy approach
including shorter hospital stay, decreased need for postoperative analgesia, early food tolerance, earlier return
to work, lower rate of wound infection. Furthermore we found a considerable preference (during the
collection of consent) of patients and a high satisfaction after the surgery.
Keywords: appendicitis, appendectomy, laparoscopy, laparotomy.


Appendicitis is the most common cause of
stay, less postoperative pain, faster return to daily
surgical abdomen in all age groups [1, 2].
activities in several settings related with
Approximately 7­10 % of the general population
gastrointestinal surgery [16,17]. In contrast, the rate
develops acute appendicitis with the maximal
of intra-abdominal abscess (IAA), which is one of
incidence being in the second and third decades of
the most concerning abdominal postoperative
life [3].The initial description by Semm in 1983,
complications, occurs almost three times more
laparoscopic appendectomy (LA) has become an
often in LA than after OA [19].
increasingly prevalent intervention [2]. This is in
This study has been done to assess the prevalence
contrast to laparoscopic cholecystectomy, which
of laparoscopic appendectomy with regard to
has promptly become the gold standard for
several post-operative variables.
gallstone disease despite little scientific challenge

[4]. In fact there is more than a century, open
appendectomy (OA) has been the standard surgery
A cross Sectional survey conducted among 243
for acute appendicitis [5], OA is typically
patients with acute appendicitis who were suitable
completed using a small right lower quadrant
for the study between April and July 2016 in the
incision and postoperative recovery is usually
general surgery department-King Abdulaziz
uneventful. It is the second most common general
Hospital & oncology center, Jeddah-Saudi Arabia.
surgical procedure performed in the United States,
Operative time, length of hospital stays, post-
after laparoscopic holecystectomy, and the most
operative complication return to normal activity
common intraabdominal surgical emergency, with
had been assessed among the all patients. Patients
a lifetime risk of 6%. However, several
have been chosen for laparoscopic appendectomy
retrospective studies [3,6,7], several randomized
after evaluation of Included and excluded criteria
trials [8­13] and meta-analyses [14,15] comparing
for the study.
laparoscopic with open appendectomy have

provided conflicting results. There is evidence that
Inclusion Criteria
he use of small incisions to obtain good quality
Retrospective study done for patient (16
visualization and access to the abdominal cavity,
years of age or older) with acute appendicitis upon
minimal surgical trauma through laparoscopic
the following criteria:
approach resulted in significant shorter hospital
Received: 22 / 03 /2017 DOI : 10.12816/0037818
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 18)

c:\work\Jor\vol672_19 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 666-671

The Prophylactic Role of Probiotics for Preterm Infants/Neonates
Abdulrahman Mohammedsaeed Baqasi1, Ali Hussain ALAbdullah2, Fares Ahmed Badghish3,
Jasseer Ahmed Alghamdi3, Maram Mohammed Assiry3, Koloud Ateeq Alharbi4, Anwar
Abdulbasit Hawsawi3, Hussain Yousif Saeedi3, Saeed Salem Saeed Alghamdi3, Fawaz Hasan
Almalki3, Mohammed Hussen Sheikh3
1 Umm Alqura University, 2 Medical University Of Warsaw,3 Al Aziziyah Maternity And Children's
Hospital Jeddah,4 Ibn Sina National Collage

Necrotizing enterocolitis (NEC) is a major morbidity and cause of mortality in preterm neonates.
Probiotics seem to have a beneficial role in preventing NEC, which is confirmed in meta-analyses of
randomized controlled trials (RCTs). We therefore aimed to review and confirm the efficacy of
probiotics in preterm neonates obtained in observational studies. To assess the effects of prophylactic
probiotics in preterm infants.
Keywords: Prophylactic, Probiotics, Preterm Infants.


Necrotizing enterocolitis (NEC) is the most
impact on overall morbidity [4]. Such a
preventive measure could be the enteral
neonates, mostly affecting premature neonates
administration of probiotics. The term
[1]. Advances in neonatology and modern
probiotics is defined as ,,live microorganisms
neonatal intensive care units, the incidence of
which when administered in adequate amounts
NEC has increased, with improved survival of
confer a benefit for the host [5]. The beneficial
smaller and more premature infants [2].
mechanisms of probiotics are unknown but
Premature infants are in the unique situation of
include changes in intestinal permeability,
having an immature digestive system along
enhanced mucosal IgA responses and
with a concurrent need for multiple antibiotics
increased production of anti-inflammatory
and formula feedings, which can all lead to
cytokines [1]. The immature immune system of
feeding intolerances and a predisposition
premature neonates cannot control the
toward necrotizing enterocolitis (NEC). It has
outgrowth of pathogenic bacteria. According
been assumed that probiotics can be used as a
to the benefits of probiotics, feeding premature
treatment for infants with NEC, and early
infants with these bacteria may populate their
clinical studies have shown a certain degree of
intestines with normal flora and prevent an
success. Probiotics are viable non-pathologic
bacteria that colonize the intestine and modify
contributes to the development of NEC [6].
the intestinal microflora with beneficial effects
Several systematic reviews of randomized
for the host that may improve immunity.
controlled trials (RCTs) on prophylactic
Notwithstanding, in spite of an incredible
probiotics for preterm infants have discovered
measure of research several issues are still
beneficial effects on NEC and mortality [1, 7].
hampering our understanding of this disease,
In spite of such convenient results, concerns
and NEC continues to be a major cause of
about the effectiveness of prophylactic
death in preterm infants [3]. It has been
probiotics still remain unevaluated. Thus, we
suggested that pathogenesis must be
needed to investigate any conceivable gainful
multifactorial and may involve an overactive
impacts of probiotics in observational studies
response of the immune system to cause an
beyond the effects previously observed in
insult that might be ischemic, infectious,
RCTs. We therefore aimed to carry out a
related to the introduction of enteric feeds or a
response to translocation of normal enteric
(nonrandomized) studies to evaluate the
bacteria [4]. This overactive inflammatory
efficacy of probiotic supplementation outside
response may lead to harmful effects.
strictly controlled settings.
Accordingly, there is a critical role for both

medical and surgical management in the
Probiotic Use in Neonates
treatment of NEC once it occurs, but
The word probiotic is Greek and means for life
prevention could have the most dramatic
whereas antibiotic means against life. The
Received: 22 / 03 /2017 DOI : 10.12816/0037819
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 19)

c:\work\Jor\vol672_20 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 672-678

Diagnosis and Management of Systematic Lupus Erythematosus
Yousef Taleb Gaafar AL-katheri1, Foad Assad M Bukhari2, Murad Muneer Mawlawi3,
AL NIHAB ALI NAJI A4, Reem Ahmed B Alanazi5, Bayan Saeed A Alghamdi1, Ahdab Abdulmuti
Alkubaydi1, Nada Talal Ibrahem Bima1, Rayan Marzooq F Almutairi6, Abdullah Salem Z
Alghamdi6, Abdurhman Ahmed ALshikhi1, Maram Mutlaq R Altaiary1, Jnadi Mohammed J
Madkhali7, Shaima Mohammed Al-Ghuraybi8, Abdulkareem khaled almotairi1
1ibn Sina College,2King Abdulaziz University,3 King Fahd General Hospital,4 Anak General
Hospital,5 Almaarefa collage ,6Umm Alqura University ,7Jazan University,8Batterje Medical College

Systemic lupus erythematosus (SLE) is the prototypic multisystem autoimmune disorder with
a wide range of clinical presentations impacting almost all organs and tissues, such extreme heterogeneity
suggests that SLE represents a syndrome rather than a single disease. Although the precise etiologic
mechanism is unknown, genetic, hormonal, and environmental factors, as well as immune abnormalities,
have been detected. Associations between lupus onset and age, sex, geography, and race have also been
Aim of the work: This review will focus on advances in the diagnosis and management of SLE.
Conclusion: The diagnosis of SLE must be based on the proper constellation of clinical findings and
laboratory evidence. Management of this disease should be individualized and should include both
pharmacological and non-pharmacological modalities for symptom relief and resolution as well as improved
quality of life.
Keywords: Systematic Lupus Erythematosus, connective tissue disorder SLE, NSAID,

and laboratory markers. Fever, another common
Systemic lupus erythematosus (SLE) is a
yet nonspecific symptom of SLE, may also result
multisystem autoimmune rheumatic disease with

a highly variable course.It is most prevalent in

females of childbearing age with a female: male
from many causes, the most common of which
ratio of 9:1 in this population. The prevalence of
include active SLE, infection, and drug fever2.
SLE is also higher in certain ethnicities, reflected
Careful history taking may help to differentiate
in prevalence rates of 40/100 000 persons in
these. Weight loss may occur in patients with
Northern European cohorts in comparison with
active SLE. Weight gain may also be due to
rates of 200/100 000 persons in studies of
corticosteroid treatment or active disease such as
patients of African-American descent 1.
nephrotic syndrome anasarca 3. These symptoms
Patients with SLE may present with various
can mimic other autoimmune diseases, infectious
systemic manifestations including diverse
diseases, endocrine abnormalities, chronic
abnormalities of the skin, kidney, and
fatigue, and fibromyalgia 4. SLE significantly
haematological, pulmonary, and reproductive and
increases the risk of cardiovascular disease as
musculoskeletal systems. The general symptoms
are not specific. Common manifestations may
include arthralgias and arthritis, malar and other
multisystem inflammatory which can be fatal and
skin rashes, pleuritis or pericarditis, renal or CNS
difficult to diagnose5. The disease has no single
involvement, hematologic cytopenias and weight
diagnostic marker; instead, it is identified
changes are the most common symptoms in new
through a combination of clinical and laboratory
cases or recurrent active SLE flares. Fatigue, the
criteria6. Accurate diagnosis of systemic lupus
most common constitutional symptom associated
erythematosus is important because treatment can
with SLE, can be due to active SLE, medications,
reduce morbidity7 and mortality,12 particularly
lifestyle habits, or concomitant fibromyalgia or
from lupus nephritis. This article reviews
affective disorders. Fatigue due to active SLE
generally occurs in concert with other clinical
diagnosis of systemic lupus erythematosus by
primary care physicians. The 1992 Revised
Received: 22 / 03 /2017 DOI : 10.12816/0037820
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 20)

c:\work\Jor\vol672_21 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 679-682

Cesarean Section among Primigravidae: Cross Section Study ­
Abha Saudi Arabia
Roaa Fahad Alshabanah, Tahani Saeed Almohayya,
Ebtesam Mohammed Alahmari, Sarah Saeed Alshahrani,
Norah Ibraheem Almanie, Reem Ali Almanie, Amal Nasser Alqahtani
King Khalid University
Corresponding Author: Roaa Fahad Alshabanah, Roaa-Alshabanah@hotmail.com

The Primary caesarean section (CS) delivery worldwide rate is increasing due to public
interest to avoid fetal complications and acceptance by most of the couple to complete their family with
one or two children. This study was undertook to study selected cases of primary CSs in primigravid
women, keeping the objectives to study the complications lead to cesarean section, maternal morbidity
and mortality.
Cross sectional survey conducted among Primigravidae in maternity & Pediatrics hospital ­
Abha ­ obstetrics & gynecology department between January 2016 and December 2016. Overall 170
cesarean section has been done out of 1167 births.
Preeclampsia, eclampsia, placenta previa, intrauterine growth restriction, macrosomic fetus,
malpresentation of the fetus, loss of fetal moment, fetal distress and labor dystocia are all indication of
cesarean section. Our study revealed that cesarean section among Primigravidae still low in our area of
the study.
Keywords: Cesarean Section, Primigravidae.

First caesarean section is termed as
accepted that caesarean section delivery carries
Primary Caesarean Section` when it is
somewhere between 5 and 10 times more risk
performed for the first time on pregnant women
than that of vaginal delivery [8]. Based on a
to deliver the baby by doing laparotomy (opening
survey by the World Health Organization (WHO)
the peritoneal cavity by giving incision on
on methods of delivery during the period 2007­
anterior abdominal wall) and hysterectomy
8, the overall rates of CS around the world were
(opening the uterine cavity by giving incision on
27·3% and 27% [9], despite the fact that in 1985,
uterus). This definition does not include removal
WHO recommended that no region should have a
of the baby from the abdominal cavity in case of
CS rate over 10­15% [10,11]. The rate of Caesarean
rupture uterus or in an abdominal pregnancy [1] .
delivery in the United States has steadily
There has been a remarkable increase in the
increased since 1996 when the rate was 21%. In
rate of caesarean section (CS) in both developed
2007, the rate was the highest ever recorded at
and developing countries in the past decades,
32%, representing 1.4 million births and a 53%
increasing from about 5% in developed countries
increase since 1996 [12]. This caesarean delivery
in the early 1970s to more than 50% in some
trend encompasses increases in the caesarean rate
regions of the world in the late 1990s [2-5].
for women of all ages, races, geographic areas
Caesarean delivery one of the most common
and gestational age.
major operation in United States up to 41% of
The real reason for this remarkable increase is
total operation although the rate has been
unknown. Therefore, a widespread debate on the
declined for the last three year in a row to 32.0%
reasons for the progressively increasing rate of
[6-7]. This high incidence of caesarean section
CS is taking place in both the medical and lay
delivery is due to better technique, better
press. In recent years, an increasing number of
anesthetics, different antimicrobial agents, blood
women requested delivery by elective CS without
transfusion facilities etc. However, it must be
a valid medical indication was observed
because of the fear of episiotomies, long and
Received: 22 / 03 /2017 DOI : 10.12816/0037821
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 21)

c:\work\Jor\vol672_22 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 683-691

Depression and Anxiety in Early Pregnancy and Its Risk for
Abdullah Mohammedalsasi A Alawamir1, Nadia Issa Zakaria1, Wafaa Mohammed Alsbhani1,
Arij Mohammed Khalifah2, Asma Abdulkarim Almohamad1, Adhwaa Ahmed M Al Shamrani1,
Afrah Muhaisen Al Lehabi3, Ruya Abdulaziz Althomali3, Alaa Abdullah Alghamdi1, Mada
Salim Al Matrafi1, Tithkar Abdu Othman4, Safa Abdulkhaleq Almomen5, Norah Abdullah

Alhabshan6, Nameer Mohammed A Alshinqeeti1, Ghadir Alwan Abdullah Alnahari1
1Ibn Sina College ­ Jeddah, 26th October University ­ Egypt, 3Taif Collage ­ Taif, 4 Resident-
Coordinator of Breastfeeding Support Program in Jazan Health, 5 King Faisal University, 6Almareefa

Handling depression is one of the greatest challenges facing pregnant women across the globe. The level
of antenatal depression and anxiety has a prevalence rate of above five percent but less than twelve.
Escalated depression has been associated with increasing maternal and infant mortality because of the
development of secondary disorders such as preeclampsia and other obstetric-related conditions. The
objective of this review was to determine the relationship that exists between depression and anxiety and
preeclampsia in early pregnancy.
The present paper draws conclusions on the etiology and potential predisposing factors of preeclampsia
based on the studies consulted which ascertained the existence of a correlation between antenatal anxiety
and depression and preeclampsia which should serve as the baseline for the assessment of the pathogenesis
and future direction, the existing literature has
Keywords: Preeclampsia, Depression, Early Pregnancy.


Depression and anxiety among pregnant
disorder, high hemoglobin, and psychological
women is a common condition that has been
factors (2).
reviewed and examined over the years. Worth
On the other hand, different studies have been
pointing out is that frequent exposure to
carried out to determine the effects emanating to
hypertensive disorders has been associated with
exposure to depression and anxiety during the
different health complications that contribute to
early pregnancy among women. The studies
increasing maternal as well as fetal mortality.
have examined various risk factors and
One of the common disorder is preeclampsia,
correlation to other condition and psychometrics
which is a hypertensive condition among
elements. However, the key concern regarding
pregnant women that is exhibited after the first
depressive tendencies and anxiety among
20 weeks (1). The disorder has been investigated
pregnant women is in line with the prevalence of
in different studies with limited finding
preeclampsia. Most studies have been centered
regarding the etiology. Such outcomes have
on the correlation between stress-based
contributed to the need for extensive analysis of
diagnosis and the onset of preeclampsia (2). The
the risk factors, implication, and prevention
condition has been noted to have a high
measures to ascertain the rate of diagnosis
prevalence and risk factors, which contributes to
among pregnant women. An estimation of about
increasing maternal and infant mortality.
2-7% of pregnancies across the globe is at risk
Nevertheless, the large number of scholarly
of being associated with preeclampsia (2). The
evaluations have been associated with limited
percentage of diagnosis is high as compared to
etiological validity that reveals the reasons why
the general hypertensive tendency in early
preeclampsia is common during early pregnancy
pregnancy, which stands at about 8%. Currently,
(2). The meta-analysis approach that has been
several risk factors have been identified as
undertaken in this review has considered
contributing factors such as lifestyle, sleep
multiple results from the various key studies
Received: 22 / 03 /2017 DOI : 10.12816/0037822
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 22)

c:\work\Jor\vol672_23 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 692-696

Incidence and Risk Factors for Neonatal Jaundice among Neonates
with Urinary Tract Infection in Abha - Saudi Arabia
Tahani Saeed Almohayya, Roaa Fahad Alshabanah, Ebtesam Mohammed Alahmari,
Norah Ibraheem Almanie, Reem Ali Almanie, Amjaad Saleh Saad AlJelban, Salha Ali Ahmad Asery
King Khalid Univerity, Abha, Saudi Arabia
Correspondence author: Tahani Saeed Almohayya -

Hyperbilirubinemia is one of the presenting signs of bacterial infection in newborns, and the
association of neonatal jaundice with urinary tract infection (UTI) has been particularly emphasized. The aim
of this study was to determine the prevalence of UTI in asymptomatic jaundiced neonates younger than 4
weeks old. Method: A cross sectional survey has been conducted at Newborn Unit of Maternity & Pediatrics
Hospital ­ Abha from January 2016 to August 2016. A total of 15 patients have been included in the study,
who were diagnosed with hyperbilirubinemia due to urinary tract infection (UTI) after exclusion of unrelated
criteria. Conclusion: It could be concluded that UTI should be routinely investigated in early (10 days)
idiopathic neonatal jaundice in which all other etiologic factors of neonatal hyperbilirubinemia are ruled out,
and the presence of UTI should be considered in case of a poor phototherapy response in cases receiving
Keywords: neonate, jaundice, urinary tract infection, UTI.


Neonatal jaundice is a benign condition that
mechanism by which hyperbilirubinemia occurs is
often does not require intervention [1]. Most cases
through either increased bilirubin production
(resulting from hemolysis, sepsis, blood
physiological jaundice and do not have serious
extravasation or polycythemia) or increased
consequences. It is a common physiological
occurrence in newborns [2-3]. About 60% of full
prematurity, pyloric stenosis, delayed bacterial gut
term and 80% of premature neonates develop
colonization, gastrointestinal tract immobility or
clinical jaundice in the first week of life [4-5]
obstruction), or decreased bilirubin elimination
showing clinical signs including yellow
which occurs in Crigler-Najjar's and Gilbert's
discoloration of the skin and sclera resulting from
syndromes [11]. Some studies have reported that
high serum levels of bilirubin [6-7]. For the
majority of these infants, hyperbilirubinemia is a
associated with bacterial infections in the
natural transition that resolves within the first
newborn, such as urinary tract infection (UTI) [12].
week of life with maturing of the liver; however,
The clinical manifestations of UTI in neonates
hyperbilirubinemia is also the main reason for
are extremely variable, ranging from severe
hospital readmission during the neonatal period [8-
illnesses to nonspecific signs and symptoms such
as growth failure or jaundice [13]. UTI is thought to
There are many factors implicated in the
be the main reason for prolonged jaundice, thus
development of pathological jaundice, including
urine culture is routinely performed in neonates
perinatal factors (e.g., birth trauma or infections),
with jaundice aged more than 3 weeks [14].
The aims of this study were to determine: (1)
prematurity or polycythemia), and genetic factors
the prevalence of UTI in neonates with
(e.g., Crigler-Najjar's or Gilbert's syndrome) [11].
In addition, the administration of drugs such as
hyperbilirubinemia in the first 4 weeks of life; and
(2) if urine culture should be considered a
dehydrogenase (G6PD) enzyme deficiency has
necessary procedure in these conditions.
been implicated in pathological jaundice [11]. The

Received: 22 / 03 /2017 DOI : 10.12816/0037823
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 23)

c:\work\Jor\vol672_24 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 697-704

The Prophylactic Role of probiotics for Preterm Neonates
Waad Abdullah Saad Aljubairah1, Eman Ahmad Almubarak2, Fatimah Sharif Modawi 3,
Fatimah Mohammed Alhabib2, Sara Abdullah Binsalman4, Nahla Shaker Saati 5, Wasan Usamah
Shehatah 4, Abdullah Yahya Al Dhban3, Areej Ahmad Abulela4, Ammar Yasser Alansari4,
Ahmed Eissa Al Eissa2, Reham Ziyad Yahya 6, Joanne Azmy Filimban7, Hanadi Ali AL-Sadeeq8,
Muneera Yaaqoub Aloudah9, Yara Sami Kassim Felimban4
Maternity & Children Hospital ­ Alhassa1, Imam Abdulrahman Bin Fisal University2, King Khalid
University3, Ibn Sina National College4, Family Medicin/KAAU5, East Jeddah Hospital6, Umm Al-Qura
University7, AL Maarefa College8, King Faisal University9

Probiotics are live microorganisms which when administered in adequate amounts confer
a health benefit on the host. Probiotics have been used for prevention and treatment of various medical
conditions in children and adults. Studies on probiotics in premature infants have focused on
normalizing intestinal flora, improvement in feeding intolerance, prevention of necrotizing enterocolitis
which is the leading causes of death in the neonatal intensive care unit.
Objective of the Study: was to provide an overview of the controversies regarding probiotic use in
preterm infants and to shed light on the practical considerations for implementation of probiotic
Methods: A Systematic search in the scientific database (Medline, Scopus, EMBASE , and Google
Scholer) from 1990 to 2016 was conducted for all relevant retrospective studies including; retrospective ,
prospective and randomized controlled trials and cohort studies were analyzed and included based on the
preset inclusion and exclusion criteria.
Results: The search results yielded 16 studies, 12 of which were RCTs with 2340 premature neonates
and 4 meta-analyses with 10227 neonates which showed a significantly decreased incidence of
Necrotizing Enterocolitis (NEC) (risk ratio, RR = 0.35, 95% confidence interval, 95% CI, 0.23-
0.54; p = 0.0006) and mortality (RR = 0.46, 95% CI, 0.32-0.67; p < 0.0001). Sepsis did not differ
significantly between the two groups (RR = 0.93, 95% CI, 0.76-1.15; p = 0.05).
Conclusion: there is a strong body of evidence supporting that Probiotic supplementation reduces the
risk of NEC and mortality in preterm infants yet there is no sufficient evidence to support the optimal
strain, dose and timing need further investigation.
Keywords: probiotics, Neonates, Lactobacillus reuteri, necrotizing enterocolitis, premature infant


The early bacterial pattern in the first weeks of

life appears to be a crucial step in the
The immature Th2- dominant neonatal response
establishment of the various functions of the gut
undergoes environment-driven maturation via
microbiota. In fact, recognition of self­ and
microbial contact during the early postnatal
non­self­antigens begins early in life, perhaps
period resulting in a gradual inhibition of the
even in utero1.
Th2 response and an increase of the Th1
Maturation of the intestinal immune system
response and prevention of allergic diseases
is thought to be significantly affected by the
which are Th2 linked, a basis of the so-called
sequential bacterial establishment2. Indeed, at
"hygiene hypothesis" 2.
birth, the lymphoid system is not yet mature
Late-onset diseases could be therefore
even though it is developed and the fetus is in a
associated with an impairment of this step, all
Th2 immunological context, and Th1 responses
the more as early impairment in bacterial
are repressed in order to avoid its rejection3
establishment can have long term effects in
.Therefore, after birth, the newborn must
terms of bacterial pattern4.
quickly restore the Th1/Th2 balance. The
Factors known to modify establishment of
existence of a rich microbial environment is
the gut microbiota, e.g. birth through caesarian
thought to be important in this process, the first
section5, prematurity6, and exposure to
bacteria to colonize the infant's gut being the
antibiotics during pregnancy7 have been
first stimuli for post-natal maturation of the T-
associated with a higher risk of atopic disease.
helper balance.
This hygiene hypothesis implicating a
Received: 22 / 03 /2017 DOI : 10.12816/0037824
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 24)

c:\work\Jor\vol672_25 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 705-712

Open Surgery versus Endoscopic Intervention in the
Management of Bile Duct Stones

Bayan Saeed A Alghamdi1, Omar Abdulelah Sindi1, Wahhaj Hani Rajab2, Saeed Hamed Alzahrani3, Hezab
Abdulrahman T Alrayes4, Leena Hatem Moshref5, Nibras Khaled Al Jabri2, Mana abdullah saud Al yami3,

Wafaa Mohammed Alsbhani1, Shaima Mohammed Al-Ghuraybi6, Mohammed Hundur Alasmari3,
Nasser Sauod Nasser AL Hwaymel7, Ahmed Naif Alolaywi4, Othman Rushdy Othman FIlfilan2, Abdullah
Mohammed Aljubairy2, Bayan Mansour AL-Nefaie8
1 Ibn Sina national College, 2 Umm alqura university, 3 Najran University, 4 Aljouf university,5 King
Abdulaziz university ,6 Battarjee medical colleges ,7 Liaquat University of Medical and Health Sciences,
Jamshoro, Pakistan , 8 Taif university

Choledocholithiasis or the presence of common bile duct stones (CBDS) is one of the
medical conditions that requires surgical intervention. The management of choledocholithiasis has
evolved from open common bile duct exploration (OCBDE) to therapeutic endoscopic retrograde
cholangiopancreatography (ERCP) to laparoscopic common bile duct exploration (LCBDE). Each entails
a degree of difficulty. In this review we aim to assess and compare the benefits and pitfalls of open
surgery (OCBDE) versus endoscopic retrograde cholangiopancreatography (ERCP) in management of
common bile duct stones.
Methods: A systematic review of the electronically searched publications of the scientific literature. We
searched the Cochrane HepatoBiliary Group Controlled Trials Register, Cochrane Central Register of
Controlled Trials in The Cochrane Library, MEDLINE (1946 to 2016), EMBASE (1974 to 2016), and
Science Citation Index Expanded (1900 to 2016). Initially all randomized clinical trials which compared
the results from open surgery versus endoscopic clearance for common bile duct stones were included,
articles were selectively screened according to the eligibility criteria.
Results: eight publications were selectively included with 761 participants compared to open surgical
clearance with ERCP. All trials had a high risk of bias. There was no significant difference in the
mortality between open surgery versus ERCP clearance (eight trials; 733 participants; 5/371 (1%) versus
10/358 (3%) OR 0.51;95% CI 0.18 to 1.44). Neither was there a significant difference in the morbidity
between open surgery versus ERCP clearance (eight trials; 733 participants; 76/371 (20%) versus 67/358
(19%) OR 1.12; 95% CI 0.77 to 1.62). Participants in the open surgery group had significantly fewer
retained stones compared with the ERCP group (seven trials; 609 participants; 20/313 (6%) versus 47/296
(16%) OR 0.36; 95% CI 0.21 to 0.62), P = 0.0002. Meta-analysis of the outcomes duration of hospital
stay, quality of life, and cost of the procedures could not be performed due to lack of data.
Conclusion: open surgery intervention in order to remove the gallbladder and trapped gallstones appears
to be as safe as endoscopy and further suggested to be more successful than the endoscopic technique in
clearing the duct stones.
Keywords: CBDS , bile duct stones, gallstones, choledocholithiasis, cholecystectomy , ERCP.

duct. The consequences can include pain,
The prevalence of gall bladder stones in adults is
jaundice, sepsis (cholangitis), acute pancreatitis
approximately 15% 1. Most patients will be

unaware of their presence, but over a 10-year
and, if left untreated, liver cirrhosis. In studies
period, 15-26% of initially asymptomatic
looking at patients who have asymptomatic gall
individuals develop biliary colic 2 .This is
stones at enrolment, the risk of such
important because in most cases, biliary colic
complications occurring over the following
heralds the beginning of recurrent problems. The
decade is approximately 2% 3 .
natural history of stones in the bile duct is not

well understood. Some pass spontaneously into
Common bile duct (CBD) stones are seen in
the duodenum, but others will cause full or
approximately 7%-12% of patients who undergo
partial obstruction of the bile and/or pancreatic
cholecystectomy for symptomatic cholelithiasis
and are a common indication for referral to a
Received: 22 / 03 /2017 DOI : 10.12816/0037825
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 25)

c:\work\Jor\vol672_26 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 713-720

Carotid Endarterectomy versus Medical Therapy in
Stroke Prevention
Yazeed Musaad Alkhuzim1, Hanouf Abdullah Alnofaie2, Abaad Ayed AL Mutairi3,
Muna Darwish Fadhel4, Israa Hassan Alamoudi4, Ahmed Abdullah Jalal5,
Abdulrahman Waleed bagar4, Ibrahim Abdulmajeed Affan4, Salah Ghazi Almatrafi4,
Anas Awad Alsolami3, Adhwaa Ahmed M Al Shamrani4, Nada Talal Bima4,
Lamiaa Saleh Alzahrani4, Nouf Mohammed Abdullah AlMohaimel6,
Nasser Marzouq bin Mohammed Alsharif7, Abdelrahman Ahmed Mohamed Elsadek
1 Postgraduate KSU, MOH ,2 Taif university,3 King Abdulaziz University ,4 Ibn Sina National
College,5 Umm Al-Qura University,6 University of Hail,7 Najran University

Stroke is one of the leading causes of deaths in different parts of the world affecting individuals of
different ages. it is mostly dominant among people having risk factors such drug abuse, having a
background of a mild stroke, and overweight. Various approaches including carotid endarterectomy
(CEA) and medical therapy have been used as mechanisms for preventing stroke particularly
ipsilateral ischemia. However, there are several studies suggesting that even though CEA has the
potential of reducing the risks of stroke, incidences of a high residual risk of stroke after carotid
endarterectomy since Various cases of increased short-term myocardial infarction after CEA are
recorded. Based on the results drawn from randomized trials comparing the effectiveness of CEA and
medical therapy ,CEA provides better protection from ipsilateral strokes than the latter. The efficacy
of CEA is more pronounced in patients presenting symptomatic and asymptomatic carotid artery
disease. The aim of this study was to explore the comparative merits and demerits of using carotid
endarterectomy and medical therapy to determine the most appropriate of the two approaches to be
used in specific cases.
This research concludes that even through both therapeutic methods and carotid
endarterectomy have the ability to reduce the predisposition of patients to different events of stroke,
each of them have inherent limitations that must be addressed effectively to contribute to overall
positive medical outcomes.
Keywords: Carotid Endarterectomy, stroke, medical theray.


Various diseases and defects in organ
multidisciplinary team comprising medical,
functioning threaten public health in virtually
nursing, physiotherapy, occupational therapy,
every society. Irrespective of the nature of
speech therapy, and social workers. It has been
facilities developed to control some of the life-
amply demonstrated that patients treated in
threatening diseases, many of them continue to
stroke units have substantially better outcome
emerge; existing ones mutate and relapse
of acute stroke 2.
hence the need to pursue research into the
This study explores the comparative
most advanced therapeutic responses. one of
merits and demerits of using carotid
the health problems that result in impairment
endarterectomy and medical therapy to
of normal body functioning; attacks both the
determine the most appropriate of the two
endocrine and nervous systems. A stroke is a
approaches to be used in the prevention of
brain defection caused by a cut in the blood
supply to the brain thus depriving its cells of

adequate oxygen. The result of this attack is
Literature Search Strategy
that the brain memory and control of the
An electronic search was conducted in the
muscles are lost. Stroke is the commonest
scientific database PubMed from 1968 to
cause of mortality after coronary artery
January 2015 with the words "stroke",
disease. Also, it is the commonest cause of
"incidence", "prevalence", "case-fatality",
chronic adult disability. The lifetime risk of
"risk factors", "genetics", or "disability-
stroke after 55 years of age is 1 in 5 for
adjusted life year". Relevant articles were also
women and 1 in 6 for men 1. Stroke unit has a
searched in the national journals.

Received: 22 / 03 /2017 DOI : 10.12816/0037826
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 26)

c:\work\Jor\vol672_27 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 721-725

Evaluation of the Relationship between Air Bubbles Depth and
Pregnancy Rate in ICSI Cycles
ElBishrey G, Makled A K, Gomaa I A, Elnashar H.
Department of Obstetrics and Gynecology- Ain Shams University

: to determine the relationship between embryo transfer outcome and the distance between
fundal endometrial surface and air bubbles assessed by trans-abdominal ultrasound
Design: Prospective (cohort) study
Setting: This study was conducted in assisted reproductive technology (ART) unit of Ain Shams
University Hospital from April 2015 to October 2016.
Patient(s): Eighty two women undergoing ICSI were enrolled in and a written informed consent was
obtained from each participant.
Intervention(s): no patient received any additional procedure or intervention.
Outcome measuers: The primary outcome was biochemical pregnancy rate based on serum beta-
hCG level at 14 days after ET. Secondary outcome was clinical pregnancy rate using trans-vaginal
US examination at 6 ­ 8 weeks of amenorrhea to detect the presence of fetal sac & pulsation.
Results: Implantation, biochemical and clinical pregnancy rates were significantly higher in distance
< 10 mm group than 10 mm group.
Conclusion: air bubble used as an identifier of the position of the embryo at ET can be determinative
for pregnancy rates. Clinical PRs were higher in cases with air bubbles < 10 mm from fundal
endometrial surface.
Keywords: embryo transfer, air bubble, ultrasound, ICSI outcome.


One of critical steps during the process
Sample size justifications:
of in vitro fertilization (IVF) is the embryo
Sample size was calculated using
transfer (ET), as all the preparations during IVF
STATA® version 11 program, setting the type-1
can be ruined by a poorly executed ET
error () at 0.05 and the power (1-) at 0.8.
procedure [1]. The aim should be to meticulously
Calculation according to values from previous
and accurately place embryos within the uterus,
studies produced a minimal sample size of 41
to allow for proper implantation and fetal
cases for each group. StataCorp. 2001. Statistical
development [2].
Software: Release 7.0. College Station, TX:
Sonographic visualization of a marker
Stata Corporation.
air bubble loaded alongside the embryos in the
Inclusion criteria included women in
transfer catheter allows visualization of both
reproductive period (age 18-38 years), infertility
initial placement of the embryos and their
due to bilateral tubal block or unexplained
movement just after ET, assuming that the
infertility programmed for ICSI, BMI < 25
bubble represents the location of the embryos [3].
kg/m² and FSH level on cycle day 3 of < 12
mIU/mL. Exclusion criteria included previous
The aim of this work is to assess the effect of air
failed ICSI or IVF attempts. infertility due to
bubbles localization inside the uterus on embryo
male factors, presence of an abnormal uterine
transfer outcome in intracytoplasmic sperm
cavity due to endometrial polyps, myomas
injection (ICSI) cycles.
distorting the uterine cavity, Mullerian

malformations, endometrial synechiae, etc.
This study was a prospective (cohort) study
hysterography), patients with hydrosalpinx or
conducted in assisted reproductive technology
pyosalpinx, patients undergoing ET after
(ART) unit of Ain Shams University Hospital
cryopreservation, patients with blood present on
after approval of the research ethical committee
the catheter during the transfer procedure,
from April 2015 to October 2016. Eighty two
patients with difficult transfer or with suspicion
women undergoing ICSI were enrolled in and a
of touching the fundus and poor responders.
written informed consent was obtained from
All the patients were subjected to counseling
each participant.
about all the steps of the study, full medical
Received: 23 / 03 /2017 DOI : 10.12816/0037827
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 27)

c:\work\Jor\vol672_28 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 726-730

Prediction of Preterm Birth in Women with Short Cervix

Abdullah Mousa M Almadani1, Rasha Ali Ahmed Abuandoos2, Ruya Abdulaziz Althomali3,
Dina Nasser Aldhaban4, Alanoud Abdulrahman Ali Alshamrani4, Ahmed Saeed H. Alqahtani2,
Bshaer Haji A Alrizq5, Eman Najib M Alsafwani6, Alrowathi,Khlood Ibraheem H5, Ayah Ali
Mohammed Mohammed3, Athar Mohammed A Al-Ziyad 5, Njood Obaid Salem Bazhair3,
Tithkar Abdu M Othman7, Roaa Ali M Haemeed8, Salem Abshan M Alshehri2
1 King Abdulaziz University, 2 King Khalid University, 3 Taif University, 4 Alfaisal University
5 Ibn Sina National College, 6 IAU ( Imam Abdulrahman Bin Faisal University )
7 Resident-Coordinator of Breastfeeding Support Program In Jazan Health, 8 Directorate of Health Affairs

Second trimester short cervical length identifies women at increased risk for an early
spontaneous Preterm birth (sPTB), hence raising a compelling needed for Cervical Assessment for
prediction and possible Preventing Preterm Delivery.
Objective of the study: to assess the implications associated with a short cervical length as well as the
use of ultrasonographic-derived cervical length measurement in predicting preterm birth.
Methods: the present review includes relevant randomized controlled trials (RCTs) that investigated the
in Medline (via PubMed), Cochrane Library and Embase. Retrospective and Prospective Cohort studies,
Case-control and Randomised controlled trials. There were no restrictions by outcomes examined,
language or publication status.
Results: The critical search results yielded 6 articles (randomized trials=2, cohort studies=3, case-
control study=1) representing 653 patients . Five of the 6 presented similar pregnancy outcomes
(spontaneous preterm birth or pregnancy loss < 24 weeks' gestation) between the ultrasound-indicated
and the history-indicated cerclage groups. 45­69% of the patients followed with cervical ultrasound
were able to avoid cerclage.
Conclusion: Evidence from randomized trials supports that transvaginal ultrasound is predictive of
preterm birth in women with prior preterm birth and a short cervix. The thresholds proposed vary from
15 mm to 28 mm and cerclage is thus recommended.
Keywords: Preterm birth, labour, ultrasound, cerclage, incompetent cervix, transvaginal, transperineal,


Preterm birth, defined as childbirth occurring
productivity associated with preterm birth were
at less than 37 completed weeks or 259 days of
more than US$ 26.2 billion 6.
gestation 1. In almost all high- and middle-
Worth mentioning that 28% of all the early
income countries of the world, preterm birth is
neonatal deaths all (deaths within the first 7
the leading cause of child death 2. Being born
days of life) that are not interrelated to
preterm also increases a baby's risk of dying
congenital malformations, are due to preterm
due to other causes, especially from neonatal
birth7. Preterm birth rates have been reported to
infections 3.
range from 5% to 7% of live births in some
Preterm birth estimated to be a risk factor in
developed countries, but are estimated to be
at least 50% of all neonatal deaths 4. Children
substantially higher in developing countries8.
who are born prematurely have higher rates of
These figures appeared to be on the rise9.
cerebral palsy, sensory deficits, learning
Events leading to preterm birth are still not
disabilities and respiratory illnesses compared
completely understood, although the etiology is
with children born at term.
thought to be multifactorial. It is, however,
The morbidity associated with preterm birth
unclear whether preterm birth results from the
often extends to later life, resulting in enormous
interaction of several pathways or the
physical, psychological and economic costs 5.
independent effect of each pathway. Causal
Estimates indicate that in 2005 the costs to the
factors linked to preterm birth include medical
United States of America alone in terms of
conditions of the mother or fetus, genetic
medical and educational expenditure and lost
influences, environmental exposure, infertility

Received: 7 / 03 /2017 DOI : 10.12816/0037828
Accepted: 14 / 03 /2017

Full Paper (vol.672 paper# 28)

c:\work\Jor\vol672_29 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 731-741

Evaluation of Antidiabetic and Antioxidant Activity of Aegle
marmelos L. Correa Fruit Extract in Diabetic Rats
Inas Z.A. Abdallah, Ibrahim, S. Salem and Nayrouz A.S. Abd El-Salam
Nutrition and Food Science Department, Faculty of Home Economics, Helwan University

Background: Diabetes mellitus is regarded as a serious chronic disease that carries a high risk for
considerable complications. The use of natural plant products for management of diabetes is increasing
due to their minimal side-effects and economical aspects. Aegle marmelos L. Correa (A. marmelos),
family Rutaceae is highly reputed medicinal plant commonly known as bael. A. marmelos fruit is widely
used in folk medicine for the treatment of diabetes mellitus.
Aim of the work: This study was aimed to evaluate the antidiabetic and antioxidant activity of A.
marmelos fruit ethanolic extract against alloxan-induced diabetes in male rats.
Material and Methods: Twenty five male albino rats with an average body weight 180-195g
were divided into two main groups; first group: control (n=5) and second group: diabetic rats (n=20),
which were divided equally to four subgroups as follows: diabetic untreated rats , diabetic rats treated
with 125 mg/kg/day A. marmelos fruit extract; diabetic rats treated with 250 mg/kg/day A. marmelos fruit
extract and diabetic rats treated with 500 mg/kg/day A. marmelos fruit extract. Diabetes was induced by a
single intraperitonial injection of alloxan (120 mg/kg).
Results: Phytochemical screening of A. marmelos fruit extract revealed the presence of alkaloids,
carbohydrates, glycosides, flavonoids, tannins, coumarins, sterols and triterpenoids. Results of the
biological study reported that alloxan-induced diabetic group exhibited hyperglycemia, hyperlipidemia,
elevation in malondialdehyde (MDA) level accompanied with weight loss and reduction in high density
lipoprotein cholesterol (HDL-C) level, reduced glutathione (GSH) level and superoxide dismutase (SOD)
enzyme activity when compared to control group. Treatment with A. marmelos fruit extract at the three
dose levels reported improvement in the biological evaluation, lipid profile, glucose, insulin, MDA and
GSH levels and SOD enzyme activity when compared to the diabetic group. The improvement was most
pronounced in 500 mg/kg A.marmelos treated group.
Conclusion: It could be concluded that A. marmelos fruit extract had hypoglycemic activity; this
effect may be attributed to its antioxidant activity and its high content of active constituents which was
proved in this study. Therefore, it could be recommended that A.marmelos fruit may be useful as a
healthy food and in the development of antidiabetic drugs.
Keywords: Aegle marmelos fruit extract ­ phytochemichal - Antidiabetic - Antioxidant - Diabetic rats.

Natural products isolated from medicinal plant
Diabetes mellitus (DM) is the most
sources have been used for the prevention and
common metabolic disorder characterized by
treatment of various diseases pathologies,
persistent hyperglycemia, which is due to
including cancers, heart disease, diabetes
carbohydrate, protein and lipid metabolism
mellitus and high blood pressure [7,8]. Up to 2014,
disturbance caused by relative or absolute
More than 800 species have been investigated
deficient in insulin secretion and/or insulin action
and their hypoglycemic effects were reported [9].
in the peripheral tissues [1]. DM has become the
Aegle marmelos L. Correa (A. marmelos),
third greatest "killer"after cancer and cardio-
a medicinal plant of family Rutaceae which is
/cerebro-vascular diseases [2]. It is estimated that
commonly known as Bael, Bengal-quince,
5% of death in the world is caused by diabetes, a
golden apple or wood/stone apple tree. It is a
number which will increase by 50% in the next
medium sized deciduous tree, up to 12-15 m tall
10 years [3]. There are growing evidences that the
with short trunk, thick, soft, flaking bark and
excess generation of reactive oxygen species
spreading, sometimes spiny branches [10]. This
(ROS) in diabetes, which cause oxidative stress,
plant is native to Northern India, but widely
may wholly or in part contribute towards the
found throughout the Indian Peninsula and in
development of complications in a variety of
Ceylon, Burma, Bangladesh, Thailand and
tissues [4,5].
China. It is also grown in some Egyptian
Because DM control without side effects is
gardens, in Surinam and Trinidad [11,12]. A.
a challenge, drugs derived from plants may play
marmelos fruit is globose with smooth, hard and
an important role in the treatment of DM [6].
aromatic shell that is gray green in color when
Received: 22 / 03 /2017 DOI : 10.12816/0037829
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 29)

c:\work\Jor\vol672_30 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 742-748
Comparison of Endoscopic Papillary Large Balloon Dilation and
Endoscopic Sphincterotomy for Retrieval of Choledocholithiasis
Mohamad Amer Afifi*, Shaaban Salah Abd Elmoniem*, Gamal Mohamad Mohamad

Soliman*, Hany Kamal Abd Elhameed** and Ahmad Abd Elkader Elgendy**.
Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University* and
Department of Tropical Medicine, Ahmad Maher Teaching Hospital**

Endoscopic sphincterotomy (EST) combined with balloon catheters and/or baskets are the
routine endoscopic techniques for stone extraction in the great majority of patients. Whereas large
common bile duct (CBD) stones are treated conventionally with mechanical lithotripsy, large balloon
papillary dilation after endoscopic sphincterotomy (ELPBD) represents the onset of an era in large CBD
stone extraction and the management of impaction. That is because it seems effective, inexpensive, less
traumatic, safe and easy method that does not require sophisticated apparatus and can be performed widely
by skillful endoscopists. Studies comparing the efficacy and safety of EPLBD with EST have reported
mixed outcomes. The aim of the study to compare the success and complications rates between endoscopic
papillary balloon dilation and endoscopic sphincterotomy for enlargement of papillary opening during
endoscopic removal of common bile duct stones.
Randomized prospective comparative study was conducted on seventy four patients with CBD
stone(s), subjective to therapeutic ERCP procedures for endoscopic extraction of common CBD(s). The
enrolled patients were randomly divided into two groups according to the maneuver for dilate the papillary
orifice into: Group I: Thirty one patients underwent EPLBD technique combined with balloon catheters
and/or baskets for stone extraction. Group II: Forty three patients underwent EST combined with balloon
catheters and/or baskets, which is considered as conventional endoscopic technique for stone extraction in
the great majority of patients. Results: Complete extraction CBD stones among the patients of group1;
EPLBD was effective for clearance of (92.5%) of CBD stones in patients with the stone sized < 1cm and in
(83%) of patients with stone size > 1cm, (overall clearance rate=87%). Overall adverse effects of patients
of group1 was (29%) as mild self-limiting post ERCP pain occurred in (9.6%) and mild intra- procedure
bleeding occurred in (9.6%), whereas more serious complication as melena which occurred in (3.2%), and
mild pancreatitis occurred in (6.4%). Whereas complete CBD stones clearance among the patients of group
2; EST was effective in (96%) of patients with the stone sized < 1 cm, while stone clearance occurred in
(56%) in patient with stone size> 1cm, (overall clearance rate=79%). Overall adverse effects of patients of
group 2 was (18.5%) as mild self-limiting post ERCP pain occurred in (7%) and mild intra-procedure
bleeding occurred in (4.6%), whereas more serious complications as mild pancreatitis developed in (4.6%),
and post ERCP cholangitis in (2.3%). The comparison between the two groups regarding the extraction of
CBD stones revealed combination of papillary large balloon dilation after EST is not required in patients
whose the CBD stone size < 1 cm. Whereas the clearance rate of CBD stones in the patients with stone
size > 1cm among the group 1 was (83%) which better than among the group 2 which was (56%) with
nearly statistical difference (P value=0.07). Conclusion: Conventional EST is an effective method for
removal of common bile duct stones < 1cm in diameter whereas the use of large papillary balloon dilation
after endoscopic sphincterotomy improve the clearance rate of bile duct stones> 1cm which is difficult to
be extracted by conventional sphincterotomy and extraction devices. Endoscopic papillary large balloon
dilation is an adjunctive tool to endoscopic sphincterotomy for removing large or difficult CBD stones.
Key words: common bile duct (CBD) stones, ERCP, Endoscopic papillary large balloon dilation
(EPLBD) and Endoscopic sphincterotomy (EST).


Bile duct stone management has
ERCP is performed worldwide as the
changed dramatically in the last two decades
firstapproach in the management of extra-
when open surgery has been replaced by per-oral
hepatic bile duct stones and is superior to
endoscopic procedures. Nowadays, therapeutic
Received: 22 / 03 /2017 DOI : 10.12816/0037830
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 30)

c:\work\Jor\vol672_31 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 749-757
Treatment of Iron Deficiency Anaemia in Patients with
Inflammatory Bowel Disease
Abdulilah Ateeq M Alsolami1, Hosam Wahid Wali2, Houssam Nasser S Bajoudah3, Mohammed
Saleh Dumyati2, Basam Zuhaer Sindi2, Abdulaziz Saad M Alshamrani4, Maha Abdullah
Alzubaidi5, Faisal Adnan Alshabrawi6, Othman Rushdy Filfilan2, Khadijah Jaza Aldhafeeri7,
Amani Ambarak Aldgail1, Eslam Ali Hassan Mohammed8, Salma Mashiatullah6, Mohammad Ali
Daghriri9, Abdulghaffar Talal Halawani2, Husain mohammad mashat2
1 King Abdulaziz University,2 Umm Alqura University,3 Medical University of Warsaw,
4 Albaha University, 5 Ibn Sina National College ,6 Battarjee Medical College ,
7 Alexandria University,8University Of Gezira,9 Jazan University

In spite of the fact that anemia is the most widely recognized systemic sign of inflammatory bowel
disease (IBD), among the expansive range of extraintestinal malady complexities experienced in IBD,
including joint inflammation and osteopathy, it has for the most part gotten little thought. In any case,
as far as recurrence, as well as to its potential impact on hospitalization rates and on the personal
satisfaction and work, sickliness is, in fact, a huge and expensive intricacy of IBD.
Frailty is multifactorial in nature, the most predominant etiological structures being iron deficiency
anemia (IDA) and anemia of a chronic disease. In a condition related to irritation, for example, IBD, the
assurance of iron status utilizing normal biochemical parameters alone is insufficient. A more exact
evaluation might be achieved utilizing new iron lists including reticulocyte hemoglobin content, the rate
of hypochromic red cells or zinc protoporphyrin. While oral iron supplementation has generally been a
backbone of IDA treatment, it has likewise been connected to a broad gastrointestinal reactions and
conceivable infection compounding. Be that as it may, numerous doctors are as yet hesitant to
administer iron intravenously, in spite of the wide accessibility of an assortment of new IV
arrangements with enhanced safety profiles, and in spite of the proposals of worldwide master rules.
We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and
therapeutic strategies, efficacy, and safety of iron replacement in IBD.
Keywords: Treatment, Anaemia, Inflammatory Bowel Disease.

critical relationship with "restless legs
Inflammatory bowel disease (IBD) describes
an arrangement of chronic gastrointestinal
This prompts impressive weakening in the
illnesses, including Crohn's disease (CD) and
patient's personal satisfaction, expanded time
ulcerative colitis (UC), of multifactorial
etiology, which continue with times of relapse
hospitalization [2].
and remission. Extraintestinal complications are
regular in IBD, and are accounted for in over
25% of patients. Anemia is one of the most
It relies on the seriousness and chronicity of
common manifestations of IBD [1]. Thirty three
the anemia, in addition to the usual signs of
percent of patients with IBD have hemoglobin
anemia, including fatigue, pallor, and reduced
levels underneath 12 g/dL.
exercise capacity. Cheilosis and koilonychia
The anemic state is firmly corresponded with
indications of cutting edge tissue press
quality of life, and is a vital issue in the
insufficiency which are not much of the time
therapeutic management of patients with
found in the present day world, because of early
chronic disease. Symptoms of a manifest iron
determination and auspicious amendment. Key
symptoms of anemia, such as dyspnea and
tachycardia, are caused by decreased blood
performance, fatigue, headache, dizziness and
oxygen levels and peripheral hypoxia.
tachycardia, in addition exertional and
Compensatory blood shifting from the
notwithstanding resting dyspnea. Moreover,
mesenteric arteries may worsen perfusion of the
latent iron deficiency might be in charge of
intestinal mucosa. Motility disorder, nausea,
non-hematological symptoms such as hair loss,
anorexia, and even malabsorption have been
paresthesia of the hands and feet and reduction
attributed to anemia. Reduced metabolic and
in cognitive function, and furthermore has a
energy efficiency during physical activity also
Received: 10 / 03 /2017 DOI : 10.12816/0037832
Accepted: 18 / 03 /2017

Full Paper (vol.672 paper# 31)

c:\work\Jor\vol672_32 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 758-764

Flexible Ureteroscopy and Laser Lithotripsy Intervention for the
Management of Stone Disease
Daham Abdulmohsen Albdaiwi1, Mohammed Ali Almuanni2, Mohammad Sameer Shobian3,
Sarah Maher Moshref4, Muhannad Basheer Qarah5, Sahar Sameer Al-Jubali6, Ali Radhi
Aldandan7, Maha Ibrahim Alqdairi8, Hanadi Ali Hassan Al-Sadeeq8, Hadeel Hidayahtalla
Saleh9, Faisal Abdullah Alshammari10, Ghali Adel Alhazmi6, Ahmad Abdulhai Alsubahi1, Raed
Mohammed Ibn Ali Almunammis11, Fatimah Nasser M Asiri12
1 Masstricht University,2 King Faisal University ,3 King Abdullaziz University ,4 King Abdulaziz
Hospital & Oncology Center,5 King Faisal Specilaliset Hospital& Researh ,
6 Ibn Sina College,7 Oyun City Hospital, 8 Almaarefa College,9 King Abdul Aziz Hospital
10 Prince Mohammed Hospital,11 Umm Alqura University ,12 King Khalid University

The role of ureteroscopy has dramatically evolved over the past twenty years driven by
profound enhancement in various factors and assisting techniques such as the ureteroscope size,
deflection capabilities, video-imaging, and in lithotripsy (stone breakage) with the advent of holmium
laser, however, the stone size plays a critical role in determining outcomes and operative approach. Aim
of the work:
we conducted a systematic review of the literature to look at the safety and efficacy of
flexible utereroscopy and laser lithotripsy intervention in patients with stone disease; particularly those
with stones larger than 2 cm.
Methods: A systematic search was performed in the scientific database particularly MEDLINE (2000­
2017), EMBASE (2000­ 2017), Cochrane Central Register of Controlled Trials, CINAHL (2000­
Results: The search yielded eight studies involving 392 patients, (390 renal units) were reportedly
treated with FURSL. The mean operative time was 80.7 minutes (26-215 min). The mean stone-free
rate was 91.2% (77%-96.7%), with an average of 1.6 procedures per patient. The mean stone size was
2.5 cm except for one most recent study which reported stones size less than 0.5 cm. An overall
complication rate was 8.1%. Major complications developed in 21 (4.2%) patients and minor
Conclusion: Flexible Ureteroscopy and Laser Lithotripsy intervention has proven to be not only a less
invasive treatment but also a successful with a low complication and stone free rate (SFR) for renal
calci larger than 2 cm. FURSL may represent an alternative therapy to standard percutaneous
nephrolithotomy (PCNL) with satisfactory efficacy and low morbidity.
Keywords: Ureteroscopy, Laser Therapy, Urinary Calculi, Lithotripsy, kidney stone, ureteric stone.


The annual incidence of stone formation in the
nutritional status and inadequate health facilities
industrialized world is generally considered to be
are common in the region. More than half the
1500­2000 cases per million1. The disease most
people live in rural areas and the climate is
commonly presents with pain, usually an episode
moderate to hot 3.Against this background
of renal stone colic, but other types of pain,
urolithiasis constitutes 40­50% of the urological
haematuria and infection might lead to the
workload in hospitals 4.A specific problem of this
diagnosis. The stone needs to be actively removed
region is the neglected asymptomatic large and/or
in approx. 25% of those affected, and hence such
staghorn calculi which present with renal failure 5.
procedures are required in ª500 patients per
The etiology of stone formation in a given
million 2.
population is reflected in the composition of
Countries in the Afro-Asian stone belt (stretching
calculi, metabolic studies, and dietary habits. In
from Egypt and Sudan, through the Middle East,
the region, 60­65% of the patients form calcium
India, Pakistan, Burma, Thailand, Indonesia and
oxalate, 15­30% uric acid and 10­15% struvite
the Philippines) falling within the tropical and
stones. Ammonium hydrogen urate is found in
subtropical regions have consistently reported a
30% of renal calculi in children and in 3% in
high incidence of urolithiasis. Generally in this
adults. Bladder calculi in children are
region the population density is high, the gross
predominantly calcium oxalate, ammonium
national product is low and 30­50% of the
hydrogen urate and uric acid 6.Metabolic studies
population live below the poverty line. Poor
from the region and data from SIUT (Table 2)
Received: 11 / 03 /2017 DOI : 10.12816/0037833
Accepted: 18 / 03 /2017

Full Paper (vol.672 paper# 32)

c:\work\Jor\vol672_33 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 765-770

Evaluation of Knowledge in Hypertensive Saudi Population in
Makkah, KSA
Samah Ali Alharbi, Mohammad Abdulrahman Wedhaya, Maha Fahad Alluqmani,
Sami Samran Alrehaili
Undergraduate students, Ibn Sina College of Medicine, KSA


Background: Hypertension remains a major health problem, causing high mortality and morbidity all over
the world. It is considered a major risk factor for both cerebrovascular accidents (CVAs) and coronary
artery disease (CAD).
Objectives: To assess the level of knowledge of hypertensive patients in Makkah City.
Methods: A cross-sectional analytical questionnaire based study among hypertensive patients of Makkah
Results: The mean age was 45 years, ranged from 35 to 70 and 63.33% were females and 36.67% were
male respondents. The majority of them had college degree and were employed. Most of the respondents
had good knowledge about hypertension, risks and treatments. Neither age nor gender showed association
with the levels of knowledge in included subjects but education was significantly associated with high
levels of knowledge.
Conclusion: The general knowledge score was good with high knowledge about risks and treatments.
Doctors were not informative to patients about hypertension. Also, education significantly impacts the
knowledge of population about hypertension.
Keywords: Knowledge, Hypertension, Makkah, KSA

cardiovascular disease [11]. Other studies showed
Globally, hypertension is considered as a major
varied prevalence of hypertension as in 1995-

2].Uncontrolled high blood pressure could result
2000 and in 2005, the prevalence ranged from
in serious complications affecting human health
26.1% among populatuions 30­70 years [12] to
as kidney disease, coronary artery disease
25.5% in subjects 15­64 years old [13, 14],
(CAD), hypertensive heart disease, stroke,
myocardial infarction and atherosclerosis [3, 4] .
However, being treatable and preventable
The economic impact of hypertension greatly
disease, hypertension is increasing dramatically
affects the loss of human income and
and it is significantly associated with older age
productivity as well as increasing the medical
and if left untreated result in life-threatening
costs [5-7]. Previous study showed that the
diseases [15]. The patient's knowledge, attitude
prevalence of hypertension in adult population
and practice must be clarified to enhance the
was 26.4% (972 million subjects) in 2000 [5].
control of hypertension. Thus, this study aimed to
Other national studies declared a burden increase
understand knowledge of hypertension patients,
in hypertension prevalence in developing
health beliefs perceptions as well as evaluating
countries and lower rates were found in
the possible associations between demographic
developed countries [7-9].
characteristics with hypertension.
In KSA, hypertension was a cofactor resulting in

high mortality rates in Saudi population
according to the study of the Global Burden of
After ethical approval of the committee of Ibn
Disease 2010 (GBD 2010) [10]. Also,
Sina College of Medicine, KSA, a self-
hypertension resulted in about 1.87 of deaths due
administrated questionnaire was distributed
to hypertensive endocrine, blood and urogenital
among hypertensive patients in Makkah region
diseases and 24% of deaths in circulatory and
and their age ranged from 35-70 from Jan. 2017
to March 2017.
Received: 13 / 03 /2017 DOI : 10.12816/0037834
Accepted: 23 / 03 /2017

Full Paper (vol.672 paper# 33)

c:\work\Jor\vol672_34 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 771-783

Role of Bone Marrow Transplantation in Reducing the
Dangerous Effect of Multi-Walled Carbon
Nanotubes or/and Gamma Rays on Male Rats
Mona M. El Tonsy 1, Neamat H. Ahmed 2, Ahkam M. Elgendy 1 and
Amal G. Abo-El Fetouh 3
1 Zoology Department, Faculty of Science, Al-Azhar Univ.2 Radiation Biology Department, National
Center for Radiation Research and Technology, Egyptian Atomic Authority. 3 The Ministry of Manpower.

Aim of the work:
this study evaluated the efficacy of bone marrow (BM) transplantation to protect
male rats from dangerous effect of multi-walled carbon nanotubes (MWCNTs) or/and -irradiation on the
hematopoietic and lung tissues. Materials and methods: experimental animals were divided into 8 groups
each consist of 6 male albino rats. Control group, BM-injected group, MWCNTs-injected group, 5Gy -
irradiated group, 5Gy -irradiated+ MWCNTs-injected group, MWCNTs-injected+ BM-injected group,
5Gy -irradiated+ BM-injected group and 5Gy of -irradiated+ MWCNTs-injected + BM-injected group.
All the treated animal groups were sacrificed after 28 days of the treatments. Blood components, MDA and
GSH levels in the lung tissue were analyzed. The histopathological study in the lung tissue was also
recorded. Results: exposure to MWCNTs or/and -radiation induced a significant decrease in certain blood
components (WBCs, RBCs, Hb content, HCT value and PLT count). Furthermore, a significant elevation in
MDA level and a significant decrease in GSH content were detected in the lung tissue. The
histopathological changes after exposure of rats to MWCNTs recorded perivasculitis, atelectasis and
interstitial pneumonia. Also, -radiation represented more collapsed and thickened walls in the alveoli,
thickened bronchiolar walls with partial epithelial lining and foci of pulmonary hemorrhage in the lung
tissue. The effect of BM transplantation after MWCNTs or/and -radiation ameliorated the values of blood
components, MDA and GSH levels in the lung tissue. The improvement occurred by BM transplantation in
rats treated with MWCNTs or/and exposed to -radiation were also recorded. The lung tissue showed
numerous alveoli with thin interalveolar septa, alveolar sacs and terminal bronchioles with highly folded
mucosa. Conclusion: treatment with BM transplantation improved the most deleterious parameters
obtained in the blood and lung tissue of MWCNTs exposed or/and -irradiated rats.
Keywords: multi-walled carbon nanotubes, - Radiation, bone marrow, male rats.


Carbon nanotubes (CNTs) are of great
dysfunction [7]. One of the recognized delayed
effects of such exposures is lung injury,
characterized by respiratory failure as a result of
important class of engineered nanomaterials.
pneumonitis that may subsequently develop into
Cancer development due to fiber-like straight type
lung fibrosis [8].
of multi-walled carbon nanotubes has raised
Bone marrow is the primary hematopoietic
concerns for human safety because of its shape
tissue in mammals producing all blood cells [9].
similar to asbestos [1]. The exposure to CNTs
Autologous or syngeneic and allogeneic bone
substantially induces harmful effects on the lungs,
marrow transplantation has been increasingly
including inflammatory granulomas and lung
efficacious in the treatment of malignant and
fibrosis in animal models [2]. In a study,
lymph hematopoietic and solid malignancies, as
intracellular ROS production was five times in
well as in non-malignant disorders such as
MWCNTs-treated cells than control levels [3].
thalassemia and immunodeficiency, though it is
Inhalation of MWCNTs during their manufacture
also associated with high treatment-related
or aspirating 25mg of MWCNTs in lung tissues of
morbidity and mortality [10]. Also, the preclinical
mice may cause oxidative stress and GSH
and clinical studies have demonstrated that bone
deficiencies [4].
marrow stromal cells (MSCs) can be used for
Radiation is one of the most important
tissue repair [11]. The pluripotent stem cells play a
environmental factors and has hazardous effects
pivotal role in tissue development and
on health, which include oxidative stress [5],
maintenance by replenishing the depletion of cells
immune dysfunction [6] and hematopoietic system
Received: 22 / 03 /2017 DOI : 10.12816/0037835
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 34)

c:\work\Jor\vol672_35 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 784-788
Vitamin D Deficiency in Orthopedic Patients, Riyadh, Saudi Arabia
Faqih Eman Abdulaziz H, Abdulrahman Ahmed Alrehaili, Ahmed Mohammed Alzahrani,
Nawaf Wael Alolayan, Nessreen Muhammad Algushiry, Hind Mesfer Alghamdi,
Thekra Ali Mureh, Bashayer Ali Mureh, Summer Saeed Almutawa
Medical Students, Almaarefa colleges, Riyadh, Saudi Arabia

Low levels of blood serum vitamin D have been connected to various musculoskeletal and
non musculoskeletal conditions. Vitamin D lack shows up moderately high among different patient
subpopulations, including patients with break non-union. We directed a review study to decide the
pervasiveness of vitamin D lack what's more, inadequacy in an expansive populace of patients with
orthopedic trauma. Methods: The review incorporated all patients who were over age 18 years, had no
hazard components for vitamin D inadequacy and was dealt with for an intense break at a Level 1 injury
focus. Results: Between April 2016 and October 2016, 100 injury patients had recorded serum 25-
hydroxyvitamin D levels. The general commonness of joined vitamin D inadequacy/deficiency was
77%; commonness of vitamin D inadequacy alone was 39%. There were no actually critical (P < .05)
age or sex contrasts among the populace. There did not seem, by all accounts, to be a regular distinction.
Vitamin D inadequacy and deficiency in intense orthopedic injury, patients showed up extremely
normal. Assist examination is expected to completely comprehend the clinical noteworthiness.
Conclusion: The Pervasiveness of low serum levels of vitamin D among patients experiencing
orthopedic trauma is extremely normal. Given the significance of vitamin D in musculoskeletal
wellbeing, such low levels may adversely affect tolerant results.
Keywords: Vitamin D, Orthopedic, Trauma, musculoskeletal, deficiency.


The role of vitamin D in general health
Given this information, a 25-hydroxyvitamin
maintenance is a topic of increasing interest and
D level of 21 to 32 ng/mL (52-72 nmol/L) can
importance in the medical community. Not only
be considered as showing a relative inadequacy
has vitamin D deficiency been linked to a
of vitamin D, and a level of 20 ng/mL or, on the
myriad of nonorthopedic maladies, including
other hand, less can be considered as showing
cancer, diabetes, and cardiovascular disease, but
vitamin D insufficiency [6].
it has demonstrated an adverse effect on
Vitamin D assumes also an indispensable
musculoskeletal health [1]. Authors have found a
part in bone digestion, has been involved in
correlation between vitamin D deficiency and
expanded break hazard what's more, in break
muscle weakness, fragility fractures, and, most
mending capacity [1]. In this manner, reporting
recently, fracture nonunion [2]. Despite the
the pervasiveness of vitamin D inadequacy in
detrimental effects of vitamin D deficiency on
patients with injury is the initial phase in
musculoskeletal and general health, evidence
bringing issues to light among orthopedic
exists that vitamin D deficiency is surprisingly
traumatologists and further building up a
prevalent [3].
screening-and-treatment procedure for vitamin
This deficiency is known to be associated
D insufficiency in these patients. According to
with increasing age, but recent studies have also
studies considered 44 patients with high- and
found alarming rates of deficiency in younger
low-energy fractures and found a practically
populations [4, 5]. In spite of the fact that there
60% pervasiveness of vitamin D deficiency. In
has been some dialog with respect to ideal
the event that vitamin D inadequacy is common,
serum levels of 25-hydroxyvitamin D, most
treatment conventions for patients with cracks
specialists have characterized vitamin D lack as
may require changes that incorporate routine
a 25-hydroxyvitamin D level of 20 ng/mL or
screening and treatment for low vitamin D
less and inadequacy as 21 to 32 ng/mL.5 It was
levels. In the wake of taking note of a normal
event of hypovitaminosis D in our patient
parathyroid hormone and bone resorption and
populace (autonomous of age, sex, or
hindered dietary retention of calcium when 25-
therapeutic comorbidities), we led a review to
hydroxyvitamin D levels were under 32 ng/mL.
decide the pervasiveness of vitamin D

Received: 2 / 03 /2017 DOI : 10.12816/0037836
Accepted: 11 / 03 /2017

Full Paper (vol.672 paper# 35)

Role of Rebamipide and \ or Pantoprazole in Preventing Dexamethasone Induced Gastritis in Adult Male Albino Rats The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol.67 (2), Page 789-805

Role of Rebamipide and \ or Pantoprazole in Preventing Dexamethasone
Induced Gastritis in Senile Male Albino Rats
Amgad Ali El Zahaby, Ahmed Abdel Alim and *Ayman F. El Sharawy
Tropical Medicine Department, *Histology and Cell Biology Department, Faculty of Medicine,
AlAzhar University
Correspondences: Email: aymanelsharawy@hotmail.com,amgad-elzahaby@.edu.eg

Aim of the work: gastritis is the inflammation of the lining of the stomach .It is caused by many factors like
infection by Helicobacter pylori, drug induced such as aspirin, Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs), corticosteroids and alcohol consumption. Pantoprazole prevents HCL formation by blocking
proton pumps in parietal cells of the stomach leading to stoppage of pepsinogen enzyme activation.
Rebamipide stimulates prostaglandins synthesis so the mucous barrier can be build up to protect the gastric
mucosa, so this study aimed to evaluate the efficacy of Pantoprazole and Rebamipide on stomach mucosa
protection from the gastritis that was induced by Dexamethasone in rats.
Material and methods: twenty-five male senile albino rats were included in this study and divided into five
groups: G1 (Control group), G2 (Dexamethasone administrated group), G3 (Pantoprazole administrated
group), G4 (Rebamipide administrated group) and G5 (Pantoprazole and Rebamipide administrated group).
The collected stomach specimens were subjected to hematoxylin and eosin, PAS and alcian blue stains.
Results: the most weight loss was detected in Dexamethasone administrated group, while the least weight
loss was realized in dexamethasone and Rebamipide administrated group. Gastric samples showed
improvement in gastric mucosa in G3 and G4, but the best improvement was demonstrated in G3.
Conclusion: Rebamipide has a better protective effect than the Pantoprazole in prevention of gastric mucosal
Dexamethasone, Pantoprazole, Rebamipide, mucous barrier.


Gastritis is the inflammation of the lining layer
so it prevents the activation of the pepsinogen
of the stomach [1]. It is caused by many factors
enzyme to pepsin [8]. A Pantoprazole use has an
like infection by Helicobacter pylori, drug
important disadvantage which is elevation of the
induced such as aspirin, nonsteroidal anti-
stomach PH, this is known as hypochlorhydria.
inflammatory drugs (NSAIDs) or corticosteroids
Hypochlorhydria may lead to: failure of proper
and alcohol consumption [2]. The complications of
food digestion, failure to absorb important
gastritis may occur over time, especially if
elements like iron and calcium. This will be
gastritis becomes chronic and the underlying
followed by iron deficiency anemia and
causes are not treated. Complications may include
osteoporosis. Failure in sterilization of the
peptic ulcer, bleeding ulcers, anemia and gastric
stomach contents may render the individuals more
cancers [3].
susceptible to gut infections such as gastro-
Corticosteroid like dexamethasone is one of
the important drugs which has many indications in
prostaglandins generation in gastric mucosa and
medicine like cases of rheumatoid arthritis,
improves the speed and quality of ulcers healing,
bronchial asthma and in brain tumors (primary or
in addition it protects the gastric mucosa against
metastatic), as it counteracts the development of
acute injury caused by noxious and ulcerogenic
edema [4,5,6]. Dexamethasone causes gastric
factors. Rebamipide has no effect in changing
erosions by damaging of the surface epithelial
stomach PH so it avoids the disadvantages of
cells and rendering the gastric mucosa susceptible
proton pump inhibitor use [12, 13].
to ulceration by inhibiting prostaglandin synthesis
which is essential for formation of the mucous
This study aimed to evaluate and compare the
barrier layer [7].
protective effect of Pantoprazole and Rebamipide
Many drugs are used for treatment of
as a single drug or in combination on the gastric
gastritis. Proton pump inhibitors like Pantoprazole
decrease HCl secretion by blocking H+/ K+ pump
Received: 22 / 03 /2017 DOI : 10.12816/0037837
Accepted: 30 / 03 /2017

Full Paper (vol.672 paper# 36)