Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.366543
Shaimaa Elsayed Ahmad, H. Obaya, Ahmad Tarek, Abd Algawad, Gehad Ali Abdelhaseeb, Donia M. Elmasry
Background : In intensive care units (ICUs), around one-third of severely sick patients need mechanical ventilation (MV) to maintain their breathing; some require it for just hours, while others need it for months. The diaphragm, abdominal, and intercostal muscles—the three main breathing muscles—may experience atrophy due to lack of usage during this period. Objective: We aimed to determine the effect of transcutaneous electrical co-activation of diaphragm and abdominal muscles on weaning time in MV patients. Patients and Methods : A total of 52 mechanically ventilated patients of both sexes participated in the study with age range from 40 to 55 years old. They were recruited from ICU Department in New Cairo Generalized Hospital; referred by physicians. They were assigned randomly into 2 Groups. Group A consisted of 26 patients; received co-activation of both diaphragmatic electrical stimulation and abdominal functional stimulation in addition to conventional physical program for one session per day for 7 days a week till discharge, 60 minutes per session. Group B consisted of 26 patients; received conventional physical therapy program for 30 minutes per session for one session a day for 7 sessions a week till discharge. Outcome measure weaning time was assessed. Results : Both groups showed significant improvements in the weaning time. However, Group A demonstrated greater improvements compared to Group B. Conclusion: Application of transcutaneous diaphragmatic stimulation and abdominal functional electrical stimulation is safe way for critically ill patients for decreasing length of duration in ICU for mechanically ventilated patient thus improve weaning.
{"title":"Effect of Transcutaneous Electrical Co-Activation of Diaphragm and Abdominal Muscles on Weaning Time in Mechanically Ventilated Patients","authors":"Shaimaa Elsayed Ahmad, H. Obaya, Ahmad Tarek, Abd Algawad, Gehad Ali Abdelhaseeb, Donia M. Elmasry","doi":"10.21608/ejhm.2024.366543","DOIUrl":"https://doi.org/10.21608/ejhm.2024.366543","url":null,"abstract":"Background : In intensive care units (ICUs), around one-third of severely sick patients need mechanical ventilation (MV) to maintain their breathing; some require it for just hours, while others need it for months. The diaphragm, abdominal, and intercostal muscles—the three main breathing muscles—may experience atrophy due to lack of usage during this period. Objective: We aimed to determine the effect of transcutaneous electrical co-activation of diaphragm and abdominal muscles on weaning time in MV patients. Patients and Methods : A total of 52 mechanically ventilated patients of both sexes participated in the study with age range from 40 to 55 years old. They were recruited from ICU Department in New Cairo Generalized Hospital; referred by physicians. They were assigned randomly into 2 Groups. Group A consisted of 26 patients; received co-activation of both diaphragmatic electrical stimulation and abdominal functional stimulation in addition to conventional physical program for one session per day for 7 days a week till discharge, 60 minutes per session. Group B consisted of 26 patients; received conventional physical therapy program for 30 minutes per session for one session a day for 7 sessions a week till discharge. Outcome measure weaning time was assessed. Results : Both groups showed significant improvements in the weaning time. However, Group A demonstrated greater improvements compared to Group B. Conclusion: Application of transcutaneous diaphragmatic stimulation and abdominal functional electrical stimulation is safe way for critically ill patients for decreasing length of duration in ICU for mechanically ventilated patient thus improve weaning.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"36 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363741
Hend Samy, H. Sabry
Background: postpartum depression (PPD) is a serious issue having severe consequences on both the mother and child. Nurses working in family health care centers, play a crucial role in identifying and managing PPD, but they may have inadequate knowledge. Objective: This study aimed to assess the knowledge and attitude of nurses towards PPD, to assess perceived barriers to diagnose and manage PPD, to provide PPD education sessions, then reassess their knowledge and attitude. Materials and method : A pre-and post-test intervention study that was conducted at four family health centers and included 83 nurses. Knowledge and attitude questionnaires were used. Results: after the educational sessions the mean percent knowledge score increased significantly from 13.2 ± 10 to 56.6 ± 11.4, the percentage of agreements in aspects related to nurses’ role in identification and management of PPD increased significantly and the percentage of nurses who perceived barriers decreased significantly. Conclusion: This study highlighted the importance of provision educational programs to maternal health care, which play a vital role in the early detection, treatment, and referral for professional management.
{"title":"Knowledge and Attitude Towards Postpartum Depression among Nurses Working at Family Health Care Centers in Giza Governorate: Impact of Educational Intervention Program","authors":"Hend Samy, H. Sabry","doi":"10.21608/ejhm.2024.363741","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363741","url":null,"abstract":"Background: postpartum depression (PPD) is a serious issue having severe consequences on both the mother and child. Nurses working in family health care centers, play a crucial role in identifying and managing PPD, but they may have inadequate knowledge. Objective: This study aimed to assess the knowledge and attitude of nurses towards PPD, to assess perceived barriers to diagnose and manage PPD, to provide PPD education sessions, then reassess their knowledge and attitude. Materials and method : A pre-and post-test intervention study that was conducted at four family health centers and included 83 nurses. Knowledge and attitude questionnaires were used. Results: after the educational sessions the mean percent knowledge score increased significantly from 13.2 ± 10 to 56.6 ± 11.4, the percentage of agreements in aspects related to nurses’ role in identification and management of PPD increased significantly and the percentage of nurses who perceived barriers decreased significantly. Conclusion: This study highlighted the importance of provision educational programs to maternal health care, which play a vital role in the early detection, treatment, and referral for professional management.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363591
Mohamed A. Shaban, Hisham E. Elareaf, Amr G. Mohamed
Background: One of the most often performed operations and a pillar of a general surgery practice is inguinal hernia repair. Objective: The study aimed to report our experience in tension-free repair of inguinal hernia using Desarda technique. Patients and methods: 179 out of 216 patients with 1ry inguinal hernia repaired with Desarda and who completed at least five years of follow-up and underwent analysis were included. The current retrospective analysis was conducted between December 2013 and December 2023 . Recurrence, chronic pain, abdominal wall stiffness was the main follow up corners. Results: The mean age of the included patients was 44.76 ± 7.88 years. There was a statistically significant decrease in the testicular edema, hematoma, seroma, and surgical site infection after 1-month follow-up when compared to the incidence by the 1 st week (P < 0.001). There was a statistically significant decrease in the incidence of loss of sensation, abdominal wall stiffness and FB sensation by time. The recurrence rate was 1.7% after 5 years follow. Conclusion: Desarda technique is an easy, effective and reliable method in treatment of inguinal hernia repair with favorable long-term outcome.
{"title":"Long-Term Outcome of Desarda Technique in Elective Inguinal Hernia Repair. A 10 Year Multicenter Experience","authors":"Mohamed A. Shaban, Hisham E. Elareaf, Amr G. Mohamed","doi":"10.21608/ejhm.2024.363591","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363591","url":null,"abstract":"Background: One of the most often performed operations and a pillar of a general surgery practice is inguinal hernia repair. Objective: The study aimed to report our experience in tension-free repair of inguinal hernia using Desarda technique. Patients and methods: 179 out of 216 patients with 1ry inguinal hernia repaired with Desarda and who completed at least five years of follow-up and underwent analysis were included. The current retrospective analysis was conducted between December 2013 and December 2023 . Recurrence, chronic pain, abdominal wall stiffness was the main follow up corners. Results: The mean age of the included patients was 44.76 ± 7.88 years. There was a statistically significant decrease in the testicular edema, hematoma, seroma, and surgical site infection after 1-month follow-up when compared to the incidence by the 1 st week (P < 0.001). There was a statistically significant decrease in the incidence of loss of sensation, abdominal wall stiffness and FB sensation by time. The recurrence rate was 1.7% after 5 years follow. Conclusion: Desarda technique is an easy, effective and reliable method in treatment of inguinal hernia repair with favorable long-term outcome.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"18 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363733
Hany Elkholy, Mohamed Ahmed Elnaggar, Osama Saber Shereef
Background: A severe kind of ischemic stroke known as massive hemispheric infarction affects either the entire or most of the middle cerebral artery (MCA) and is distinguished by the emergence of potentially fatal cerebral edema. A death rate of up to 80% has been linked to this type of space-occupying edema. In acute ischemic stroke patients, decompressive craniectomy (DC) is a surgery used to treat brain herniation and deadly progressive edema. Objectives: This work aimed to study the limits and prognostic factors for surgical decompression in managing patients with massive hemispheric infarction. Patients and methods: This prospective study included 17 patients with massive hemispheric infarction who were admitted and treated at the Neurosurgical Departments of Menoufia University Hospital from February 2022 to February 2024. Results: There were no significant differences in the relation between death after treatment and Glasgow Coma Scale (GCS) (Before treatment, after one day and 6 M), MRS (before treatment), and time of surgery after the onset of symptoms/H (P>0.05). Also, NIHSS Score, mRS after 1 M and 6 M were significantly increased among death patients after treatment (P<0.05). Conclusions: Decompressive craniotomy can reduce the mortality rate in patients with massive hemispheric infarction, provided that it is done as early as possible from the onset of symptoms. The higher the GCS the better is the outcome.
{"title":"Limits and Prognostic Factors for Surgical Decompression in The Management of Massive Hemispheric Infarction","authors":"Hany Elkholy, Mohamed Ahmed Elnaggar, Osama Saber Shereef","doi":"10.21608/ejhm.2024.363733","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363733","url":null,"abstract":"Background: A severe kind of ischemic stroke known as massive hemispheric infarction affects either the entire or most of the middle cerebral artery (MCA) and is distinguished by the emergence of potentially fatal cerebral edema. A death rate of up to 80% has been linked to this type of space-occupying edema. In acute ischemic stroke patients, decompressive craniectomy (DC) is a surgery used to treat brain herniation and deadly progressive edema. Objectives: This work aimed to study the limits and prognostic factors for surgical decompression in managing patients with massive hemispheric infarction. Patients and methods: This prospective study included 17 patients with massive hemispheric infarction who were admitted and treated at the Neurosurgical Departments of Menoufia University Hospital from February 2022 to February 2024. Results: There were no significant differences in the relation between death after treatment and Glasgow Coma Scale (GCS) (Before treatment, after one day and 6 M), MRS (before treatment), and time of surgery after the onset of symptoms/H (P>0.05). Also, NIHSS Score, mRS after 1 M and 6 M were significantly increased among death patients after treatment (P<0.05). Conclusions: Decompressive craniotomy can reduce the mortality rate in patients with massive hemispheric infarction, provided that it is done as early as possible from the onset of symptoms. The higher the GCS the better is the outcome.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"89 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.368090
Mohamed Sabry, F. Maklady, Ahmed Tageldein, Fathy A. Nada
Background: A serious medical condition linked to pulmonary hypertension (PH), right ventricular dysfunction (RVD), and cardiovascular consequences is coronavirus (Covid-19) infection. Objective: This study aimed to assess the relation between the rise of cardiac troponin at base line investigation of COVID patients and the development of pulmonary hypertension 3 months after recovery from the infection. Subjects and methods: The study was conducted as a cross-sectional descriptive study and included 104 non-critically ill patients 3 months after recovery from Covid-19 pneumonia. They were divided into 2 groups; mild cases and moderate/severe non-critically ill cases based on the WHO criteria at the time of admission. Troponin at the time of admission was measured. A full echocardiographic assessment of the right ventricle was done, and the pulmonary artery systolic pressure was calculated for every patient. Results: In COVID-19, PH is a common complication encountered after recovery, especially in moderate/severe (non-critically ill) cases. We observed increased incidence of PH in the moderate/severe group 3 months’ post-recovery, significantly correlated with the initial levels of the cardiac troponin at admission ( p ˂ 0.001). Conclusions: There was a statistically significant positive correlation between troponin I levels at baseline admission and the development of pulmonary hypertension (r2 = 0.696, p = < 0.001) 3 months after recovery from the infection.
{"title":"Correlation Between Baseline Troponin Level and The Severity of Pulmonary Hypertension 3 Months After COVID-19 Infection in Subjects without Previous Significant Cardiovascular Pathology","authors":"Mohamed Sabry, F. Maklady, Ahmed Tageldein, Fathy A. Nada","doi":"10.21608/ejhm.2024.368090","DOIUrl":"https://doi.org/10.21608/ejhm.2024.368090","url":null,"abstract":"Background: A serious medical condition linked to pulmonary hypertension (PH), right ventricular dysfunction (RVD), and cardiovascular consequences is coronavirus (Covid-19) infection. Objective: This study aimed to assess the relation between the rise of cardiac troponin at base line investigation of COVID patients and the development of pulmonary hypertension 3 months after recovery from the infection. Subjects and methods: The study was conducted as a cross-sectional descriptive study and included 104 non-critically ill patients 3 months after recovery from Covid-19 pneumonia. They were divided into 2 groups; mild cases and moderate/severe non-critically ill cases based on the WHO criteria at the time of admission. Troponin at the time of admission was measured. A full echocardiographic assessment of the right ventricle was done, and the pulmonary artery systolic pressure was calculated for every patient. Results: In COVID-19, PH is a common complication encountered after recovery, especially in moderate/severe (non-critically ill) cases. We observed increased incidence of PH in the moderate/severe group 3 months’ post-recovery, significantly correlated with the initial levels of the cardiac troponin at admission ( p ˂ 0.001). Conclusions: There was a statistically significant positive correlation between troponin I levels at baseline admission and the development of pulmonary hypertension (r2 = 0.696, p = < 0.001) 3 months after recovery from the infection.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"9 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363736
Mostafa Abdelgalil, Esraa Elmarasy, Ayman Taher, Akmal Elmazny, Ahmed Elzyat
Background: Research from the literature indicates that the likelihood of postpartum hemorrhage (PPH) is one of the most harmful aspects to take into account when preparing for a twin delivery. Objective : Our foremost objective was to compare the effectiveness and adverse effects of carbetocin with oxytocin in preventing postpartum hemorrhage (PPH) in twin pregnant women following elective cesarean section (CS). Study design : In this randomized controlled study, 118 pregnant women with twin pregnancies who were admitted for an elective cesarean section in two equal groups, were given intravenous slow IV boluses of carbetocin (group A) and slow intravenous oxytocin boluses (10 IU) (group B) . Following the delivery of the second fetus, all patients were given the study medications. Results : The need for additional uterotonics was statistically higher in group B than in group A; 5 (24.3%) versus 15 (13.1%) with P-value 0.025. While the estimated blood loss was statistically insignificant between both groups (928.5 ± 146.4 ml in (group A) versus 941.2 ±277.2 ml in (group B), with P-value 0.311. As such, incidence of PPH was statistically insignificantly different between study groups (p value 0.239). Conclusion: The use of carbetocin at elective cesarean section for twin pregnancy is not superior to slow IV oxytocin bolus in reducing the operative blood loss or prevention of PPH but it may reduce the postoperative need for additional uterotonics, especially in IVF twin gestation.
{"title":"Carbetocin versus Oxytocin for Prevention of Postpartum Hemorrhage in Twin Pregnancies Delivered by Cesarean Section: A Randomized Controlled Trial","authors":"Mostafa Abdelgalil, Esraa Elmarasy, Ayman Taher, Akmal Elmazny, Ahmed Elzyat","doi":"10.21608/ejhm.2024.363736","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363736","url":null,"abstract":"Background: Research from the literature indicates that the likelihood of postpartum hemorrhage (PPH) is one of the most harmful aspects to take into account when preparing for a twin delivery. Objective : Our foremost objective was to compare the effectiveness and adverse effects of carbetocin with oxytocin in preventing postpartum hemorrhage (PPH) in twin pregnant women following elective cesarean section (CS). Study design : In this randomized controlled study, 118 pregnant women with twin pregnancies who were admitted for an elective cesarean section in two equal groups, were given intravenous slow IV boluses of carbetocin (group A) and slow intravenous oxytocin boluses (10 IU) (group B) . Following the delivery of the second fetus, all patients were given the study medications. Results : The need for additional uterotonics was statistically higher in group B than in group A; 5 (24.3%) versus 15 (13.1%) with P-value 0.025. While the estimated blood loss was statistically insignificant between both groups (928.5 ± 146.4 ml in (group A) versus 941.2 ±277.2 ml in (group B), with P-value 0.311. As such, incidence of PPH was statistically insignificantly different between study groups (p value 0.239). Conclusion: The use of carbetocin at elective cesarean section for twin pregnancy is not superior to slow IV oxytocin bolus in reducing the operative blood loss or prevention of PPH but it may reduce the postoperative need for additional uterotonics, especially in IVF twin gestation.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"101 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363732
Bassiony Dabian, Sameh Elmahdy, Akmal Elmazny, Bassem Mohammed, Ahmed Elzyat
Background: Numerous studies indicate that difficulties during and after cesarean section may be linked to maternal obesity. Objective: This study aimed to assess the consequences of maternal obesity on intra-operative and post-operative sequelae of elective Cesarean delivery. Patients and methods: Based on maternal BMI at time of delivery, patients were categorized into 3 groups: Normal weight, overweight and obese women. Operative data were documented including operative time, estimated blood loss during CS, etc. Post-operative data included post-operative care timing of catheter removal, return of intestinal sounds, mobilization, initiation of oral feeding, etc. Post-operative complications included postpartum hemorrhage, surgical site infection, DVT, blood transfusion, ICU admission and pulmonary embolism. Fetal outcome was documented including 1 & 5 minute Apgar score, RDS, birth injuries, NICU admission. Results: Operative time was statistically significant longer 40.30 ± 3.28 vs. 33.19 ± 4.42 vs. 27.80 ± 5.16 mins, need insertion of intra-peritoneal drain was higher (7.3%) vs. 0 (0.0%) vs. 0 (0.0%), timing of catheter removal was more delayed 5.48 ± 1.19 vs. 4.06 ± 0.82 vs. 3.00 ± 0.88 hours among obese. Incidence of postpartum hemorrhage was statistically significant higher 16 (14.5%) vs. 12 (10.9%) vs. 6 (5.5%) among obese compared to overweight and normal weight women. Conclusion: Adverse consequences for either mother or baby have been linked to maternal obesity. BMI > 30 kg/m 2 was linked to a higher risk of postpartum hemorrhage, a longer length of stay in the operating room, and delayed urinary catheter removal as maternal outcomes. In terms of fetal outcomes, a greater risk of fetal macrosomia and the newborn's transient tachypnea were linked to higher BMI. [
背景：大量研究表明，剖腹产术中和术后的困难可能与产妇肥胖有关。研究目的本研究旨在评估产妇肥胖对择期剖宫产术中和术后后遗症的影响。患者和方法：根据产妇分娩时的体重指数，将患者分为三组：正常体重、超重和肥胖产妇。记录手术数据，包括手术时间、CS 过程中的估计失血量等。术后数据包括拔除导管、肠鸣音恢复、活动、开始口服喂养等术后护理时间。术后并发症包括产后出血、手术部位感染、深静脉血栓、输血、入住重症监护室和肺栓塞。记录的胎儿结局包括 1 和 5 分钟 Apgar 评分、RDS、产伤、入住新生儿重症监护室。结果据统计，肥胖产妇的手术时间（40.30 ± 3.28 vs. 33.19 ± 4.42 vs. 27.80 ± 5.16 分钟）明显更长，需要插入腹腔引流管的比例更高（7.3%） vs. 0 (0.0%) vs. 0 (0.0%)，移除导管的时间（5.48 ± 1.19 vs. 4.06 ± 0.82 vs. 3.00 ± 0.88 小时）更晚。与超重和正常体重的妇女相比，肥胖妇女产后出血的发生率在统计学上明显较高，分别为 16 (14.5%) vs. 12 (10.9%) vs. 6 (5.5%)。结论母亲或婴儿的不良后果与母亲肥胖有关。体重指数大于 30 kg/m 2 的产妇产后出血的风险较高，在手术室停留的时间较长，导尿管拔除时间较晚。在胎儿结局方面，胎儿巨大儿和新生儿一过性呼吸急促的风险与较高的体重指数有关。[
{"title":"Effect of Maternal Obesity on Operative and Post-Operative Complications of Elective Cesarean Section: An Observational Cross-Sectional Study","authors":"Bassiony Dabian, Sameh Elmahdy, Akmal Elmazny, Bassem Mohammed, Ahmed Elzyat","doi":"10.21608/ejhm.2024.363732","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363732","url":null,"abstract":"Background: Numerous studies indicate that difficulties during and after cesarean section may be linked to maternal obesity. Objective: This study aimed to assess the consequences of maternal obesity on intra-operative and post-operative sequelae of elective Cesarean delivery. Patients and methods: Based on maternal BMI at time of delivery, patients were categorized into 3 groups: Normal weight, overweight and obese women. Operative data were documented including operative time, estimated blood loss during CS, etc. Post-operative data included post-operative care timing of catheter removal, return of intestinal sounds, mobilization, initiation of oral feeding, etc. Post-operative complications included postpartum hemorrhage, surgical site infection, DVT, blood transfusion, ICU admission and pulmonary embolism. Fetal outcome was documented including 1 & 5 minute Apgar score, RDS, birth injuries, NICU admission. Results: Operative time was statistically significant longer 40.30 ± 3.28 vs. 33.19 ± 4.42 vs. 27.80 ± 5.16 mins, need insertion of intra-peritoneal drain was higher (7.3%) vs. 0 (0.0%) vs. 0 (0.0%), timing of catheter removal was more delayed 5.48 ± 1.19 vs. 4.06 ± 0.82 vs. 3.00 ± 0.88 hours among obese. Incidence of postpartum hemorrhage was statistically significant higher 16 (14.5%) vs. 12 (10.9%) vs. 6 (5.5%) among obese compared to overweight and normal weight women. Conclusion: Adverse consequences for either mother or baby have been linked to maternal obesity. BMI > 30 kg/m 2 was linked to a higher risk of postpartum hemorrhage, a longer length of stay in the operating room, and delayed urinary catheter removal as maternal outcomes. In terms of fetal outcomes, a greater risk of fetal macrosomia and the newborn's transient tachypnea were linked to higher BMI. [","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"5 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.366545
M. Mousa, Samia Hussein, Reda M. Khodry, Atef G. Hussain, A. I. Elagrody, A. A. Elfatah
Background: Diabetic nephropathy (DN) is a highly prevalent major chronic complications of DM. DN is diagnosed depending on clinical background with existence of albuminuria and/or declined eGFR and hypertension without any other primary renal disease. Vaspin is an adipokine, which acts as anti-atherogenic. Objective: This study aimed to correlate vaspin levels to the biochemical findings in DM and DN, and to investigate the significance of vaspin in predicting the development of DN among type 2 diabetic patients. Subjects and methods: Our research involved 90 subjects (above 65 years old) who were divided into 3 groups. Group I with 30 elderly healthy individuals, group II with 30 elderly uncomplicated type 2 diabetic patients and group III included 30 elderly type 2 diabetic patients with DN. Results: Statistically significant decreases in vaspin levels among group III compared to groups I and II were detected. Also, group II had a statistically significant rise compared to group I. Statistically significant positive correlations were detected between vaspin levels and each of fasting insulin (r=0.909, P<0.001), HOMA-IR (r=0.902, P<0.001), C-peptide (r=0.721, P<0.001), and GFR (r=0.892, P<0.001). However, statistically significant negative correlations were detected between vaspin levels and each of albumin/creatinine ratio (ACR) (r=-0.600, P=0.002), creatinine (r=-0.551, P=0.002), and blood urea nitrogen (BUN) (r=-0.451, P=0.031) among group III. Receiver operating curve (ROC) showed that vaspin had a significant validity in the prediction of DN among DM cases with sensitivity of 87%, specificity of 78.3% and accuracy of 82.6%. Conclusion: Vaspin could be a potential marker in the prediction of DN development among DM cases. Keyboards
{"title":"Vaspin Levels and Diabetic Nephropathy in Elderly Patients with Type 2 Diabetes Mellitus","authors":"M. Mousa, Samia Hussein, Reda M. Khodry, Atef G. Hussain, A. I. Elagrody, A. A. Elfatah","doi":"10.21608/ejhm.2024.366545","DOIUrl":"https://doi.org/10.21608/ejhm.2024.366545","url":null,"abstract":"Background: Diabetic nephropathy (DN) is a highly prevalent major chronic complications of DM. DN is diagnosed depending on clinical background with existence of albuminuria and/or declined eGFR and hypertension without any other primary renal disease. Vaspin is an adipokine, which acts as anti-atherogenic. Objective: This study aimed to correlate vaspin levels to the biochemical findings in DM and DN, and to investigate the significance of vaspin in predicting the development of DN among type 2 diabetic patients. Subjects and methods: Our research involved 90 subjects (above 65 years old) who were divided into 3 groups. Group I with 30 elderly healthy individuals, group II with 30 elderly uncomplicated type 2 diabetic patients and group III included 30 elderly type 2 diabetic patients with DN. Results: Statistically significant decreases in vaspin levels among group III compared to groups I and II were detected. Also, group II had a statistically significant rise compared to group I. Statistically significant positive correlations were detected between vaspin levels and each of fasting insulin (r=0.909, P<0.001), HOMA-IR (r=0.902, P<0.001), C-peptide (r=0.721, P<0.001), and GFR (r=0.892, P<0.001). However, statistically significant negative correlations were detected between vaspin levels and each of albumin/creatinine ratio (ACR) (r=-0.600, P=0.002), creatinine (r=-0.551, P=0.002), and blood urea nitrogen (BUN) (r=-0.451, P=0.031) among group III. Receiver operating curve (ROC) showed that vaspin had a significant validity in the prediction of DN among DM cases with sensitivity of 87%, specificity of 78.3% and accuracy of 82.6%. Conclusion: Vaspin could be a potential marker in the prediction of DN development among DM cases. Keyboards","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.363728
H. ElSayed, Magdy ElSharkawy, Saeed Abd ElWahab, Ahmed Tawfik, Mahmoud Fayez, Lamis Khedr
Background: Adiponectin and complement factor D are harmful large middle molecules that accumulate in patients with end stage renal disease. High-dose hemodiafiltration (HDF) has recently shown a clear survival benefit. Objective: In this study we aimed to compare the removal of adiponectin and complement factor D in patients on HDF versus high flux hemodialysis (HD) using two different high flux dialysers. Patients and Method: This is a cross over clinical trial. Twenty hemodialysis patients were enrolled. Dialyser and treatment efficacies were examined during a mid-week session with the following treatments HD FX 80, HD H4, HDF FX80, HDF H4. Treatment efficacy was assessed by calculating the reduction ratio (RR) of adiponectin and complement factor D before and after each session. Results: Twenty dialysis patients aged 50.5 ± 10.4 years. During HDF urea reduction ratio (URR) was 70.4 ± 6.8 compared to 65.1 ± 7 during HD. Adiponectin RR using HDF FX80 was 48.1 ± 9.3 compared to 32.2± 9 with HD FX80, p <0. 001. Adiponectin RR using HDF H4 was 46.7 ±12.2 compared to 31.1± 9.4 with HD H4, p<0. 001. Complement factor D RR using HDF FX80 was 48.1 ± 13 compared to 29.8±9.6 with HD FX80, p<0.001. Complement factor D RR using HDF H4 was 46.7±12.2 compared to 26.6 ± 7.5 using HD H4, p<0.001. Conclusion: High-dose HDF offered better removal of adiponectin and complement factor D compared to high flux HD. No difference was observed between the two high flux dialysers used.
背景：脂联素和补体因子 D 是有害的中间大分子，会在终末期肾病患者体内蓄积。大剂量血液滤过（HDF）最近显示出明显的生存益处。研究目的在这项研究中，我们旨在比较使用两种不同的高通量透析器进行 HDF 和高通量血液透析（HD）的患者对脂肪连蛋白和补体因子 D 的清除情况。患者和方法：这是一项交叉临床试验。20 名血液透析患者参加了试验。在周中的一次透析过程中对透析器和治疗效果进行了检查，采用的治疗方法包括 HD FX 80、HD H4、HDF FX80 和 HDF H4。治疗效果通过计算每次治疗前后的脂肪连蛋白和补体因子 D 的降低率 (RR) 进行评估。结果20名透析患者，年龄（50.5±10.4）岁。HDF 期间的尿素还原率 (URR) 为 70.4 ± 6.8，而 HD 期间为 65.1 ± 7。使用 HDF FX80 的脂肪直链肽还原率为 48.1 ± 9.3，而使用 HD FX80 的还原率为 32.2 ± 9，P <0.001。使用 HDF H4 的脂肪直链肽 RR 为 46.7 ± 12.2，而使用 HD H4 时为 31.1±9.4，P<0.001。使用 HDF FX80 的补体因子 D RR 为 48.1 ± 13，而使用 HD FX80 的 RR 为 29.8±9.6，P<0.001。使用HDF H4的补体因子D RR为46.7±12.2，而使用HD H4的补体因子D RR为26.6±7.5，P<0.001。结论：与高通量 HD 相比，高剂量 HDF 能更好地清除脂肪连蛋白和补体因子 D。所使用的两种高通量透析器之间没有差异。
{"title":"Effect of High Dose Hemodiafiltration on Adiponectin and Complement Factor D Removal","authors":"H. ElSayed, Magdy ElSharkawy, Saeed Abd ElWahab, Ahmed Tawfik, Mahmoud Fayez, Lamis Khedr","doi":"10.21608/ejhm.2024.363728","DOIUrl":"https://doi.org/10.21608/ejhm.2024.363728","url":null,"abstract":"Background: Adiponectin and complement factor D are harmful large middle molecules that accumulate in patients with end stage renal disease. High-dose hemodiafiltration (HDF) has recently shown a clear survival benefit. Objective: In this study we aimed to compare the removal of adiponectin and complement factor D in patients on HDF versus high flux hemodialysis (HD) using two different high flux dialysers. Patients and Method: This is a cross over clinical trial. Twenty hemodialysis patients were enrolled. Dialyser and treatment efficacies were examined during a mid-week session with the following treatments HD FX 80, HD H4, HDF FX80, HDF H4. Treatment efficacy was assessed by calculating the reduction ratio (RR) of adiponectin and complement factor D before and after each session. Results: Twenty dialysis patients aged 50.5 ± 10.4 years. During HDF urea reduction ratio (URR) was 70.4 ± 6.8 compared to 65.1 ± 7 during HD. Adiponectin RR using HDF FX80 was 48.1 ± 9.3 compared to 32.2± 9 with HD FX80, p <0. 001. Adiponectin RR using HDF H4 was 46.7 ±12.2 compared to 31.1± 9.4 with HD H4, p<0. 001. Complement factor D RR using HDF FX80 was 48.1 ± 13 compared to 29.8±9.6 with HD FX80, p<0.001. Complement factor D RR using HDF H4 was 46.7±12.2 compared to 26.6 ± 7.5 using HD H4, p<0.001. Conclusion: High-dose HDF offered better removal of adiponectin and complement factor D compared to high flux HD. No difference was observed between the two high flux dialysers used.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"3 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.21608/ejhm.2024.366544
Basant Zahid, Hesham Rashid, Ahmed Osama, Al.Shimaa Sabry
Background: With the increased prevalence of obesity worldwide, even in young adults with a lack of data on its effect on cardiac function in these age groups, the need to detect the possible changes in cardiac function with different degrees of obesity has emerged. Objective: We aimed to use 2-dimensional (2D) deformation imaging to evaluate the potential changes in cardiac function in variable degrees of obesity. Patients and methods: Our study is a single-center observational study. During the study period between September 2022 and September 2023, 323 volunteers without evidence of metabolic syndrome in their first decade of adulthood (18 to 30 years of age) with a BMI more than 25 kg/m 2 were evaluated at the Cardiology Department, Faculty of Medicine, Benha University. 123 cases were excluded due to the presence of significant valvular disease (n=53), atrial fibrillation (n= 36), systolic heart failure (n= 27), and poor image quality (n=7). Finally, the study included 200 patients as follows: Overweight (n=100) and obese (n=100). Forty participants were enrolled (n=40) as a control group. Conventional and speckle-tracking echocardiography evaluated the right (RV) and the left ventricle (LV) function and global longitudinal strain (GLS). Results: No noticeable differences were detected among the groups regarding conventional functional and dimensional echocardiographic parameters. However, significant differences between the groups were noticed regarding 2D speckle tracking of RV global longitudinal strain (GLS), RV free-wall strain, and LV GLS (p<0.001), with worse deformation in obese subjects. Conclusion: Obesity, even in younger ages without metabolic syndrome, is hazardous to LV and RV function, represented by worse myocardial deformation. This finding could be used in risk stratification of obese young individuals.
{"title":"Early Adulthood Obesity Impact on Left and Right Ventricular Function Assessed by Speckle Tracking Echocardiography","authors":"Basant Zahid, Hesham Rashid, Ahmed Osama, Al.Shimaa Sabry","doi":"10.21608/ejhm.2024.366544","DOIUrl":"https://doi.org/10.21608/ejhm.2024.366544","url":null,"abstract":"Background: With the increased prevalence of obesity worldwide, even in young adults with a lack of data on its effect on cardiac function in these age groups, the need to detect the possible changes in cardiac function with different degrees of obesity has emerged. Objective: We aimed to use 2-dimensional (2D) deformation imaging to evaluate the potential changes in cardiac function in variable degrees of obesity. Patients and methods: Our study is a single-center observational study. During the study period between September 2022 and September 2023, 323 volunteers without evidence of metabolic syndrome in their first decade of adulthood (18 to 30 years of age) with a BMI more than 25 kg/m 2 were evaluated at the Cardiology Department, Faculty of Medicine, Benha University. 123 cases were excluded due to the presence of significant valvular disease (n=53), atrial fibrillation (n= 36), systolic heart failure (n= 27), and poor image quality (n=7). Finally, the study included 200 patients as follows: Overweight (n=100) and obese (n=100). Forty participants were enrolled (n=40) as a control group. Conventional and speckle-tracking echocardiography evaluated the right (RV) and the left ventricle (LV) function and global longitudinal strain (GLS). Results: No noticeable differences were detected among the groups regarding conventional functional and dimensional echocardiographic parameters. However, significant differences between the groups were noticed regarding 2D speckle tracking of RV global longitudinal strain (GLS), RV free-wall strain, and LV GLS (p<0.001), with worse deformation in obese subjects. Conclusion: Obesity, even in younger ages without metabolic syndrome, is hazardous to LV and RV function, represented by worse myocardial deformation. This finding could be used in risk stratification of obese young individuals.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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