Pub Date : 2024-04-01DOI: 10.21608/ejhm.2024.349083
N. Adawy, Magdy Anwer Saber, Mohammed Shawky Al Warraky, G. A. Sobhy, Shaimaa Samy Goda, Muhammad Ahmed Magdy
Background: The early diagnosis of elevated intracranial pressure (ICP) improves the prognosis of acute liver failure (ALF). Invasive monitoring (intracranial bolts) is the gold standard approach for measuring ICP, however it comes with problems. Objective: This study aimed to evaluate the role of bedside, ultrasound (US) guided measurement of optic nerve sheath diameter (ONSD) in ALF children. Methods: 36 ALF and 21 healthy children (0 ‐ 18 years) were enrolled. All patients had undergone full history taking, thorough clinical examination, and routine investigations. ONSD was measured for each on admission, with any change of consciousness and at recovery in ALF, and once in controls. Results: Both groups were age-and sex-matched. The ALF group showed significant increase in ONSD than in healthy controls (P 0.008). On admission, the mean of ONSD in resolved group (4.13 ± 0.573 mm) was lower than that of died group (4.57 ± 0.64 mm) but without statistical significance (P = 0.082). ONSD before discharge significantly increased in died group 5.07 ± 0.44 mm than in living group (3.98 ± 0.354 mm, P<0.0001). ONSD was significantly higher in ALF patients with disturbed conscious level (5.16 ± 0.45 mm) than in conscious patients (4.007 ± 0.34 mm, P <0.0001). ONSD at a cut-off value of > 4.82 mm showed accuracy of 88.7% in discriminating between resolving and vanishing ALF patients (P =<0.0001) . Conclusions: ONSD is a safe bedside method that may be used to serially monitor children with ALF. It is an excellent predictor of patient outcomes.
{"title":"Optic Nerve Sheath Diameter Measured by Trans-Cranial Ultrasound in Children with Acute Liver Failure","authors":"N. Adawy, Magdy Anwer Saber, Mohammed Shawky Al Warraky, G. A. Sobhy, Shaimaa Samy Goda, Muhammad Ahmed Magdy","doi":"10.21608/ejhm.2024.349083","DOIUrl":"https://doi.org/10.21608/ejhm.2024.349083","url":null,"abstract":"Background: The early diagnosis of elevated intracranial pressure (ICP) improves the prognosis of acute liver failure (ALF). Invasive monitoring (intracranial bolts) is the gold standard approach for measuring ICP, however it comes with problems. Objective: This study aimed to evaluate the role of bedside, ultrasound (US) guided measurement of optic nerve sheath diameter (ONSD) in ALF children. Methods: 36 ALF and 21 healthy children (0 ‐ 18 years) were enrolled. All patients had undergone full history taking, thorough clinical examination, and routine investigations. ONSD was measured for each on admission, with any change of consciousness and at recovery in ALF, and once in controls. Results: Both groups were age-and sex-matched. The ALF group showed significant increase in ONSD than in healthy controls (P 0.008). On admission, the mean of ONSD in resolved group (4.13 ± 0.573 mm) was lower than that of died group (4.57 ± 0.64 mm) but without statistical significance (P = 0.082). ONSD before discharge significantly increased in died group 5.07 ± 0.44 mm than in living group (3.98 ± 0.354 mm, P<0.0001). ONSD was significantly higher in ALF patients with disturbed conscious level (5.16 ± 0.45 mm) than in conscious patients (4.007 ± 0.34 mm, P <0.0001). ONSD at a cut-off value of > 4.82 mm showed accuracy of 88.7% in discriminating between resolving and vanishing ALF patients (P =<0.0001) . Conclusions: ONSD is a safe bedside method that may be used to serially monitor children with ALF. It is an excellent predictor of patient outcomes.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"388 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140758179","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 : 2024-04-01DOI: 10.21608/ejhm.2024.348719
F. Ahmed, Mikhaiel Gerges Boshra, Heba Wahid, Mohamed El Said, Ahmed Mohamed Tawfik, Fatma Abdelrahman, Ahmed
Introduction: The majority of dialysis patients have chronic low-grade inflammation linked to protein energy waste, early CVD, osteoporosis, and overall weakness. To minimize the risk of infections and complications, guidelines advocate for the use of arteriovenous fistulas (AVFs) whenever possible, as central venous catheters (CVCs) pose a greater risk for these issues. Objective: This study aimed to assess the impact of various hemodialysis vascular access types on the occurrence and characteristics of infections experienced by hemodialysis patients. Patients and Methods: This prospective cohort study was conducted in Ain Shams University Hospitals, Hemodialysis Units over 6 months duration. Results: We found that the average age of the patients was 49.5 ± 8.4 years and the average duration of hemodialysis (HD) was 3.2 ± 1.9 years. The proportion of males and females was nearly equal (46.0% and 54.0% respectively). Patients from El-Demerdash and ASHUSH accounted for 60.3% and 39.7% of the cases, respectively. Catheter types included temporary catheters (49.2%), AVFs (31.7%), and AVGs (19.0%). We noticed that less than one-fifth of cases had leucocytosis and elevated procalcitonin in months 2 and 3. Leucocytosis and elevated procalcitonin in months 2 and 3 were most frequent in temporary catheters, followed by AVGs, and least frequent in AVFs. Conclusion: The use of temporary catheters was linked to a higher incidence of infections. Infection episodes were accompanied by elevated inflammatory markers, a higher likelihood of catheter removal, an increased risk of thrombosis, and more frequent hospital admissions.
{"title":"Impact of Vascular Access Type on Inflammatory Biomarkers and Clinical Outcomes in Haemodialysis Patients","authors":"F. Ahmed, Mikhaiel Gerges Boshra, Heba Wahid, Mohamed El Said, Ahmed Mohamed Tawfik, Fatma Abdelrahman, Ahmed","doi":"10.21608/ejhm.2024.348719","DOIUrl":"https://doi.org/10.21608/ejhm.2024.348719","url":null,"abstract":"Introduction: The majority of dialysis patients have chronic low-grade inflammation linked to protein energy waste, early CVD, osteoporosis, and overall weakness. To minimize the risk of infections and complications, guidelines advocate for the use of arteriovenous fistulas (AVFs) whenever possible, as central venous catheters (CVCs) pose a greater risk for these issues. Objective: This study aimed to assess the impact of various hemodialysis vascular access types on the occurrence and characteristics of infections experienced by hemodialysis patients. Patients and Methods: This prospective cohort study was conducted in Ain Shams University Hospitals, Hemodialysis Units over 6 months duration. Results: We found that the average age of the patients was 49.5 ± 8.4 years and the average duration of hemodialysis (HD) was 3.2 ± 1.9 years. The proportion of males and females was nearly equal (46.0% and 54.0% respectively). Patients from El-Demerdash and ASHUSH accounted for 60.3% and 39.7% of the cases, respectively. Catheter types included temporary catheters (49.2%), AVFs (31.7%), and AVGs (19.0%). We noticed that less than one-fifth of cases had leucocytosis and elevated procalcitonin in months 2 and 3. Leucocytosis and elevated procalcitonin in months 2 and 3 were most frequent in temporary catheters, followed by AVGs, and least frequent in AVFs. Conclusion: The use of temporary catheters was linked to a higher incidence of infections. Infection episodes were accompanied by elevated inflammatory markers, a higher likelihood of catheter removal, an increased risk of thrombosis, and more frequent hospital admissions.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"139 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140759672","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 : 2024-04-01DOI: 10.21608/ejhm.2024.349087
Maha A. Elgyyar, Heba A. Abdelazeem, Doaa S. Mohammed, Doaa T. Masallat
Background: Onychomycosis is a chronic fungal infection of the nail unit. The therapeutic options include oral antifungals as terbinafine, pulse itraconazole, fluconazole and voriconazole. Various laser systems have been tried for resistant cases to improve the results of treatment as carbon dioxide (CO 2 ) and Nd:YAG lasers. Objective: Compare between two treatment methods; combined therapy of fractional CO 2 laser (FCO 2 L) plus topical tioconazole 28% nail solution versus topical tioconazole 28% nail solution alone in the same patient with fingernails onychomycosis. Methods: This was prospective comparative interventional study conducted on 20 patients with two or more affected fingernails. The degree of affection of the studied nails was assessed clinically by onychomycosis severity index (OSI) and was confirmed by KOH and mycological culture. The studied nails were categorized into two corresponding groups; group (A), fingernails were treated with combined therapy in the form of 4-6 fractional CO 2 laser sessions four weeks apart plus topical tioconazole 28% twice daily for six months, group (B), fingernails were treated with topical tioconazole 28% alone twice daily for six months. Results: A high statistically significant improvement was reported among patients treated with combined therapy than those who treated with antifungal only. The CO 2 laser plus topical tioconazole solution yielded significantly higher percentage of improvement for onychomycosis. Conclusion: Both combined therapy and local therapy reported safe and promising outcomes. However combined therapy was associated with better improvement and local therapy was associated with minimal adverse events.
{"title":"Fractional CO2 Laser Plus Topical Tioconazole 28% versus Topical Tioconazole 28% Alone in the Treatment of Onychomycosis","authors":"Maha A. Elgyyar, Heba A. Abdelazeem, Doaa S. Mohammed, Doaa T. Masallat","doi":"10.21608/ejhm.2024.349087","DOIUrl":"https://doi.org/10.21608/ejhm.2024.349087","url":null,"abstract":"Background: Onychomycosis is a chronic fungal infection of the nail unit. The therapeutic options include oral antifungals as terbinafine, pulse itraconazole, fluconazole and voriconazole. Various laser systems have been tried for resistant cases to improve the results of treatment as carbon dioxide (CO 2 ) and Nd:YAG lasers. Objective: Compare between two treatment methods; combined therapy of fractional CO 2 laser (FCO 2 L) plus topical tioconazole 28% nail solution versus topical tioconazole 28% nail solution alone in the same patient with fingernails onychomycosis. Methods: This was prospective comparative interventional study conducted on 20 patients with two or more affected fingernails. The degree of affection of the studied nails was assessed clinically by onychomycosis severity index (OSI) and was confirmed by KOH and mycological culture. The studied nails were categorized into two corresponding groups; group (A), fingernails were treated with combined therapy in the form of 4-6 fractional CO 2 laser sessions four weeks apart plus topical tioconazole 28% twice daily for six months, group (B), fingernails were treated with topical tioconazole 28% alone twice daily for six months. Results: A high statistically significant improvement was reported among patients treated with combined therapy than those who treated with antifungal only. The CO 2 laser plus topical tioconazole solution yielded significantly higher percentage of improvement for onychomycosis. Conclusion: Both combined therapy and local therapy reported safe and promising outcomes. However combined therapy was associated with better improvement and local therapy was associated with minimal adverse events.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"90 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140758970","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}
Background: Postoperative pain is defined as acute pain present at the surgical site or related to it after procedure. Objective: This work was aimed at performing a comparison between the erector spinae plane block (ESPB) impact in comparison with Intravenous morphine for postoperative analgesia following spine surgeries. Patients and Methods: This prospective randomized double-blind research included sixty individuals with ASA physical status class I and class II going through an uncomplicated spine surgery with general anesthesia. All participants went through a categorization into two equal groups; 30 in each. The first group patients were administered bilateral ultrasound guided ESPB utilizing plain bupivacaine at a dosage of 100 mg diluted to volume with saline, thus obtaining 50% concentration (50 mg plain bupivacaine in each side), The second group: received a dosage of 0.1 mg /kg of IV morphine diluted with saline to 10 ml volume when the surgical procedure is completed. Results: Postoperative heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), and visual analogue measurements (VAS) were significantly lower at 6h,12h and 24h within the first group as opposed to the second one (P value<0.05). Duration till the first analgesic need was significantly longer within group 1. Total paracetamol dosages within initial twenty-four hours postoperatively were significantly lower in group 1. PONV, hypotension and bradycardia were insignificantly varied among both groups. Conclusions: Using ESPB in spine surgeries is associated with better analgesic outcomes through pain score, duration till the first analgesia need and total paracetamol administration with no difference regarding complications compared to intravenous morphine.
背景：术后疼痛是指手术后出现在手术部位或与之相关的急性疼痛。研究目的本研究旨在比较竖脊肌平面阻滞（ESPB）与静脉注射吗啡对脊柱手术后镇痛的影响。患者和方法：这项前瞻性随机双盲研究纳入了 60 名 ASA 体力状态 I 级和 II 级的患者，他们都是在全身麻醉的情况下接受了不复杂的脊柱手术。所有参与者被分为两组，每组 30 人。第一组患者在超声引导下使用双侧ESPB，使用剂量为100毫克普通布比卡因，用生理盐水稀释至50%浓度（每侧50毫克普通布比卡因）；第二组：手术完成后，使用剂量为0.1毫克/千克的静脉注射吗啡，用生理盐水稀释至10毫升。结果术后 6 小时、12 小时和 24 小时，第一组的心率（HR）、平均动脉压（MAP）、呼吸频率（RR）和视觉模拟测量值（VAS）均显著低于第二组（P 值<0.05）。第一组患者首次需要镇痛药的时间明显更长，第一组患者术后最初 24 小时内的扑热息痛总用量明显更少，两组患者的 PONV、低血压和心动过缓差异不大。结论：与静脉注射吗啡相比，在脊柱手术中使用ESPB可通过疼痛评分、首次镇痛需求前的持续时间和扑热息痛的总用量获得更好的镇痛效果，而并发症方面则没有差异。
{"title":"Comparative Study between Erector Spinae Plane Block versus Intravenous Morphine as Postoperative Analgesia after Spine Surgeries","authors":"Khaled Mohamed, Hamza Hassan, Abo Alam, Mahmoud Mohamed Abo, Elhamd Abd, Elrahman, Khaled Abdelfattah, Mohamed Abdelfattah, Mohamed Abo Elhamd, Abd Elrahman","doi":"10.21608/ejhm.2024.348925","DOIUrl":"https://doi.org/10.21608/ejhm.2024.348925","url":null,"abstract":"Background: Postoperative pain is defined as acute pain present at the surgical site or related to it after procedure. Objective: This work was aimed at performing a comparison between the erector spinae plane block (ESPB) impact in comparison with Intravenous morphine for postoperative analgesia following spine surgeries. Patients and Methods: This prospective randomized double-blind research included sixty individuals with ASA physical status class I and class II going through an uncomplicated spine surgery with general anesthesia. All participants went through a categorization into two equal groups; 30 in each. The first group patients were administered bilateral ultrasound guided ESPB utilizing plain bupivacaine at a dosage of 100 mg diluted to volume with saline, thus obtaining 50% concentration (50 mg plain bupivacaine in each side), The second group: received a dosage of 0.1 mg /kg of IV morphine diluted with saline to 10 ml volume when the surgical procedure is completed. Results: Postoperative heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), and visual analogue measurements (VAS) were significantly lower at 6h,12h and 24h within the first group as opposed to the second one (P value<0.05). Duration till the first analgesic need was significantly longer within group 1. Total paracetamol dosages within initial twenty-four hours postoperatively were significantly lower in group 1. PONV, hypotension and bradycardia were insignificantly varied among both groups. Conclusions: Using ESPB in spine surgeries is associated with better analgesic outcomes through pain score, duration till the first analgesia need and total paracetamol administration with no difference regarding complications compared to intravenous morphine.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"132 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766892","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 : 2024-04-01DOI: 10.21608/ejhm.2024.348927
Omnia Ameen, Safaa M. Saleh, Gerges S. Yousef, R. Yassien, Nasra D. Raslan, Essam O. Hendya
Background : Neurocognitive impairment is recognized as the fourth microvascular complications of type 2 diabetes mellitus (T2DM). Objectives: To compare the effect of glycemic control on cognitive functions in diabetic rats by using different anti-diabetic drugs. Materials and Methods: Fifty male albino rats were equally categorized into: Control group, Janumet group, Diabetic non-treated group, Diabetic+Insulin group and Diabetic+Janumet group. At the end of 4 weeks, neurocognitive assessment was done by using Morris water maze (MWM) and Y-maze tests. Blood samples were collected to estimate glycemic state, lipid profile and total antioxidant capacity level (TAC). Rats' brains were extracted. The right half of the brain was utilized for lipid peroxidation marker (MDA), tumor necrosis factor alpha (TNF-α), superoxide dismutase (SOD), and interleukin 1B (IL-B) measurement. The left half was utilized for histopathological study of the hippocampal tissue. Results : Diabetic group showed significant increase in FBG, HBA1C, HOMA-IR, total cholesterol, triglyceride, MDA, TNF-alpha and IL-1B, and decrease in serum insulin, HDL, TAC and SOD. Neurocognitive impairment and hippocampal degenerative changes were also obvious in diabetic rats. Diabetic+ Janumet group demonstrated significant improvement in the measured biomarkers and neurobehavioral tests with restoration of the hippocampal tissue structure in comparison with Diabetic+ Insulin group. However, there was an insignificant difference in lipid profile markers between Diabetic+ Janumet group and Diabetic+ Insulin group. Insignificant difference between Control and Janumet groups regarding all measured parameters was detected. Conclusion: Both insulin and Janumet drugs alleviates the metabolic, neurocognitive impairment and hippocampal changes associated with T2DM. However, the improvement was more pronounced with Janumet treatment than insulin treatment. The synergistic hypoglycemic, anti-oxidant and anti-inflammatory effects of Janumet's components may account for this improvement.
{"title":"Effect of Glycemic Control Using Different Antidiabetic Drugs on Cognitive Functions in Experimentally-Induced Type 2DM: A Comparative Study","authors":"Omnia Ameen, Safaa M. Saleh, Gerges S. Yousef, R. Yassien, Nasra D. Raslan, Essam O. Hendya","doi":"10.21608/ejhm.2024.348927","DOIUrl":"https://doi.org/10.21608/ejhm.2024.348927","url":null,"abstract":"Background : Neurocognitive impairment is recognized as the fourth microvascular complications of type 2 diabetes mellitus (T2DM). Objectives: To compare the effect of glycemic control on cognitive functions in diabetic rats by using different anti-diabetic drugs. Materials and Methods: Fifty male albino rats were equally categorized into: Control group, Janumet group, Diabetic non-treated group, Diabetic+Insulin group and Diabetic+Janumet group. At the end of 4 weeks, neurocognitive assessment was done by using Morris water maze (MWM) and Y-maze tests. Blood samples were collected to estimate glycemic state, lipid profile and total antioxidant capacity level (TAC). Rats' brains were extracted. The right half of the brain was utilized for lipid peroxidation marker (MDA), tumor necrosis factor alpha (TNF-α), superoxide dismutase (SOD), and interleukin 1B (IL-B) measurement. The left half was utilized for histopathological study of the hippocampal tissue. Results : Diabetic group showed significant increase in FBG, HBA1C, HOMA-IR, total cholesterol, triglyceride, MDA, TNF-alpha and IL-1B, and decrease in serum insulin, HDL, TAC and SOD. Neurocognitive impairment and hippocampal degenerative changes were also obvious in diabetic rats. Diabetic+ Janumet group demonstrated significant improvement in the measured biomarkers and neurobehavioral tests with restoration of the hippocampal tissue structure in comparison with Diabetic+ Insulin group. However, there was an insignificant difference in lipid profile markers between Diabetic+ Janumet group and Diabetic+ Insulin group. Insignificant difference between Control and Janumet groups regarding all measured parameters was detected. Conclusion: Both insulin and Janumet drugs alleviates the metabolic, neurocognitive impairment and hippocampal changes associated with T2DM. However, the improvement was more pronounced with Janumet treatment than insulin treatment. The synergistic hypoglycemic, anti-oxidant and anti-inflammatory effects of Janumet's components may account for this improvement.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"284 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775496","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}
Background: Over 80% of patients receiving hemodialysis have hyperparathyroidism, a common complication of chronic kidney disease (CKD) that is a major concern; given the increased cardiovascular risk and declining quality of life associated with CKD. Early stages of CKD are when the pathophysiologic mechanisms causing secondary hyperparathyroidism begin, and they intensify in direct proportion to the loss of renal function. Objective: Investigate the association between hyperparathyroidism and intradialytic hypertension in prevalent hemodialysis patients. Patients and Methods: We conducted a multicenter cross-sectional study at a total of 70 prevalent hemodialysis patients with hyperparathyroidism (iPTH>300), aged more than 18 years old and less than 60 years at El-Dakahlia Governorate hospitals. They have been recruited to our study design and assigned according to developing intradialytic hypertension into group 1: patients with intradialytic hypertension (n=10) and group 2: patients without intradialytic hypertension (n=60) and they were subjected to detailed medical history, examinations, and laboratory investigations. Results: The patients with intradialytic hypertension had higher mean of weight gain (1.9 ± 0.9 kg) than patients without (0.9 ± 0.3 kg) with statistically significant differences between them as p=0.025. We also noted a statistically significant difference between both groups as regards the intradialytic blood pressure measurements (p<0.05) with a difference between post versus pre dialytic systolic blood pressure monitoring in the patients within each group (p<0.001). Lower mean of hemoglobin level has been detected in the patients with intradialytic hypertension with statistically significant differences between both groups as p=0.011. Conclusion: Our study demonstrated that no statistically significant correlation noted between the prevalence of intradialytic hypertension and hyperparathyroidism among prevalent hemodialysis patients.
{"title":"Association between Hyperparathyroidism and Intradialytic Hypertension in Prevalent Hemodialysis Patients","authors":"Khaled Gouda, Saeed Abdelwahaab Saeed, Amira Mahmoud Mahmoud, Mohamed Ali Ezzat","doi":"10.21608/ejhm.2024.349394","DOIUrl":"https://doi.org/10.21608/ejhm.2024.349394","url":null,"abstract":"Background: Over 80% of patients receiving hemodialysis have hyperparathyroidism, a common complication of chronic kidney disease (CKD) that is a major concern; given the increased cardiovascular risk and declining quality of life associated with CKD. Early stages of CKD are when the pathophysiologic mechanisms causing secondary hyperparathyroidism begin, and they intensify in direct proportion to the loss of renal function. Objective: Investigate the association between hyperparathyroidism and intradialytic hypertension in prevalent hemodialysis patients. Patients and Methods: We conducted a multicenter cross-sectional study at a total of 70 prevalent hemodialysis patients with hyperparathyroidism (iPTH>300), aged more than 18 years old and less than 60 years at El-Dakahlia Governorate hospitals. They have been recruited to our study design and assigned according to developing intradialytic hypertension into group 1: patients with intradialytic hypertension (n=10) and group 2: patients without intradialytic hypertension (n=60) and they were subjected to detailed medical history, examinations, and laboratory investigations. Results: The patients with intradialytic hypertension had higher mean of weight gain (1.9 ± 0.9 kg) than patients without (0.9 ± 0.3 kg) with statistically significant differences between them as p=0.025. We also noted a statistically significant difference between both groups as regards the intradialytic blood pressure measurements (p<0.05) with a difference between post versus pre dialytic systolic blood pressure monitoring in the patients within each group (p<0.001). Lower mean of hemoglobin level has been detected in the patients with intradialytic hypertension with statistically significant differences between both groups as p=0.011. Conclusion: Our study demonstrated that no statistically significant correlation noted between the prevalence of intradialytic hypertension and hyperparathyroidism among prevalent hemodialysis patients.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"229 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776029","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 : 2024-04-01DOI: 10.21608/ejhm.2024.349389
Haitham AboAli Hamza, Said Abd, Al-Aty Saleh, Mohamed Ismail Sabry, Shokry Abd, Al Azeem Elshershaby, Mohamed Tawfik, Khalaf Allah
Background: Repeated implantation failure has been one of the concerns in ICSI in recent years. It's linked to maternal or embryonic influences. One of the maternal factors is chronic endometritis (CE) which may affect the outcome of ICSI and so, its treatment may improve the results of ICSI. Objectives: To evaluate the effect of chronic endometritis treatment on the outcome of ICSI in repeated implantation failure (RIF). Methods: This is a prospective study conducted at the International Islamic Center for Population Studies and Research, Al-Azhar University on 120 patients with RIF. Patients were scheduled for hysteroscopic endometrial biopsy with histopathological examination. If there was no evidence of CE, the patients were scheduled for ICSI directly (Group A). Patients with CE received antibiotics and endometrial biopsy was done in the next cycle. According to the result of the second biopsy, patients were divided into 2 groups: - Patients with cured CE (Group B) and patients with persistent CE (Group C). We compared the chemical pregnancy rate, clinical pregnancy rate, and the miscarriage rate in study groups. Results: Patients with cured chronic endometritis had a significant higher chemical and clinical pregnancy rate compared with patients with persistent chronic endometritis (43.5% vs. 17.9% and 39.1% vs. 10.7% respectively). The miscarriage rate was higher in patients with persistent CE than other groups but with no significant difference. Conclusion: Treatment of chronic endometritis improved the outcome of ICSI regarding the chemical and clinical pregnancy rate.
背景：近年来，反复植入失败一直是卵胞浆内单精子显微注射关注的问题之一。这与母体或胚胎的影响有关。母体因素之一是慢性子宫内膜炎（CE），它可能会影响卵胞浆内单精子显微注射的结果，因此，治疗慢性子宫内膜炎可改善卵胞浆内单精子显微注射的结果。研究目的评估慢性子宫内膜炎治疗对反复着床失败（RIF）的 ICSI 结果的影响。方法：这是一项前瞻性研究：这是一项前瞻性研究，在爱资哈尔大学（Al-Azhar University）的国际伊斯兰人口研究中心（International Islamic Center for Population Studies and Research）进行，对象是 120 名反复种植失败（RIF）患者。患者被安排接受宫腔镜子宫内膜活检和组织病理学检查。如果没有 CE 的证据，患者将直接安排 ICSI（A 组）。有 CE 的患者接受抗生素治疗，并在下一个周期进行子宫内膜活检。根据第二次活组织检查的结果，患者被分为两组：- 已治愈的 CE 患者（B 组）和 CE 持续存在的患者（C 组）。我们比较了研究组的化学妊娠率、临床妊娠率和流产率。结果治愈的慢性子宫内膜炎患者的化学妊娠率和临床妊娠率明显高于持续性慢性子宫内膜炎患者（分别为 43.5% 对 17.9% 和 39.1% 对 10.7%）。持续性慢性子宫内膜炎患者的流产率高于其他组别，但无显著差异。结论慢性子宫内膜炎的治疗提高了卵胞浆内单精子显微注射的化学妊娠率和临床妊娠率。
{"title":"Effect of Chronic Endometritis Treatment on The Outcome of ICSI in Patients with Repeated Implantation Failure","authors":"Haitham AboAli Hamza, Said Abd, Al-Aty Saleh, Mohamed Ismail Sabry, Shokry Abd, Al Azeem Elshershaby, Mohamed Tawfik, Khalaf Allah","doi":"10.21608/ejhm.2024.349389","DOIUrl":"https://doi.org/10.21608/ejhm.2024.349389","url":null,"abstract":"Background: Repeated implantation failure has been one of the concerns in ICSI in recent years. It's linked to maternal or embryonic influences. One of the maternal factors is chronic endometritis (CE) which may affect the outcome of ICSI and so, its treatment may improve the results of ICSI. Objectives: To evaluate the effect of chronic endometritis treatment on the outcome of ICSI in repeated implantation failure (RIF). Methods: This is a prospective study conducted at the International Islamic Center for Population Studies and Research, Al-Azhar University on 120 patients with RIF. Patients were scheduled for hysteroscopic endometrial biopsy with histopathological examination. If there was no evidence of CE, the patients were scheduled for ICSI directly (Group A). Patients with CE received antibiotics and endometrial biopsy was done in the next cycle. According to the result of the second biopsy, patients were divided into 2 groups: - Patients with cured CE (Group B) and patients with persistent CE (Group C). We compared the chemical pregnancy rate, clinical pregnancy rate, and the miscarriage rate in study groups. Results: Patients with cured chronic endometritis had a significant higher chemical and clinical pregnancy rate compared with patients with persistent chronic endometritis (43.5% vs. 17.9% and 39.1% vs. 10.7% respectively). The miscarriage rate was higher in patients with persistent CE than other groups but with no significant difference. Conclusion: Treatment of chronic endometritis improved the outcome of ICSI regarding the chemical and clinical pregnancy rate.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"93 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770020","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 : 2024-04-01DOI: 10.21608/ejhm.2024.348390
Ahmed H. Lamloum, Ihab Mohamed Salah, Eldin Elsharkawy, Hassan Alsisi, M. ElZayadi, Mahmoud A. Wkeel, Ahmed M. Elwakeel
Background: Postoperative broncho-pleural fistula (BPF) is a major surgical complication that may be life-threatening in some cases. Many prophylactic surgical techniques were claimed. However, the best method to be used is not yet settled. Objective: In this study, we investigated the efficacy and safety of an autologous reflected pericardial flap in protecting against such a serious condition in the pediatric population. Patients and Methods: Between January 2018 and June 2023, 202 patients who underwent lung resection surgery for congenital and/or infective causes at Kasr Al-Ainy and Fayoum University Hospitals were divided into two groups: group A (104 patients with no coverage techniques) and group B (98 patients with pericardial flap coverage). Results: Over the mean follow-up duration (21.02+9.76 months), postoperative air leakage occurred in 10 patients. 9 (8.82%) of which belonged to group A, and only 1 diabetic patient (1.02%) was among the coverage method group that denoted a statistically significant difference (P value = 0.0116). Postoperative hospital stays and need for reintervention were also significantly lower in group B (2.02 + 0.60) vs. group A (6.13 + 1.65) and 8 patients needed intervention in group A vs. 1 patient in group B, with a p value< 0.05). Conclusion: In-hospital results of bronchial stump covering with pericardium were favourable in terms of postoperative morbidity and mortality, indicating its efficacy and safety in preventing postresection bronchial stump dehiscence.
{"title":"Autologous Reflected Pericardial Flap Coverage of Post-Resection Bronchial Stump; Was it Effective in Preventing Broncho-Pleural Fistula in Children?","authors":"Ahmed H. Lamloum, Ihab Mohamed Salah, Eldin Elsharkawy, Hassan Alsisi, M. ElZayadi, Mahmoud A. Wkeel, Ahmed M. Elwakeel","doi":"10.21608/ejhm.2024.348390","DOIUrl":"https://doi.org/10.21608/ejhm.2024.348390","url":null,"abstract":"Background: Postoperative broncho-pleural fistula (BPF) is a major surgical complication that may be life-threatening in some cases. Many prophylactic surgical techniques were claimed. However, the best method to be used is not yet settled. Objective: In this study, we investigated the efficacy and safety of an autologous reflected pericardial flap in protecting against such a serious condition in the pediatric population. Patients and Methods: Between January 2018 and June 2023, 202 patients who underwent lung resection surgery for congenital and/or infective causes at Kasr Al-Ainy and Fayoum University Hospitals were divided into two groups: group A (104 patients with no coverage techniques) and group B (98 patients with pericardial flap coverage). Results: Over the mean follow-up duration (21.02+9.76 months), postoperative air leakage occurred in 10 patients. 9 (8.82%) of which belonged to group A, and only 1 diabetic patient (1.02%) was among the coverage method group that denoted a statistically significant difference (P value = 0.0116). Postoperative hospital stays and need for reintervention were also significantly lower in group B (2.02 + 0.60) vs. group A (6.13 + 1.65) and 8 patients needed intervention in group A vs. 1 patient in group B, with a p value< 0.05). Conclusion: In-hospital results of bronchial stump covering with pericardium were favourable in terms of postoperative morbidity and mortality, indicating its efficacy and safety in preventing postresection bronchial stump dehiscence.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"165 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756984","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 : 2024-04-01DOI: 10.21608/ejhm.2024.348919
Ahmed Sohaib, R. Abdelaziz, Faten Younis, Amira Hegazy
Background: Gemcitabine and 5 FU+folinic acid have both proved efficacy in treating patients with advanced pancreatic cancer. Objective: In our study, we combined the two most active agents against pancreatic cancer; gemcitabine and 5FU that were given every 2 weeks to gain the maximum benefit of both drugs and avoid the toxicity that occurs very frequently with FOLFIRINOX. Patients and Methods: This prospective phase II study included 42 patients of metastatic cancer pancreas who met the inclusion criteria Results: The median age at diagnosis was 55 years. Males were more common (59.5%) than females. The most common site of metastasis was the liver (57.1%). Toxicity profile showed that neutropenia and thrombocytopenia were the most common forms of toxicity being high grade in 11.9% of patients. Other forms of toxicity were minimal not exceeding 5%. The overall response rate (ORR) was 33.3% with no reported complete responses. There was a significant correlation between the change of tumor markers levels (CEA, and CA 19.9) and both response and quality of life (QOL). The changes of CEA and CA19.9 levels were found to be independent predictors of progression free survival (PFS). One year OS rate was 49%. The median OS was 11.3 months, while the median PFS was 8.8 months. Response was also found to be a surrogate marker for survival. Conclusions: Gemcitabine-5
{"title":"A Phase II Trial of Flouro-Gem as a First Line Treatment of Metastatic Adenocarcinoma of the Pancreas (GEFLUPAN trial)","authors":"Ahmed Sohaib, R. Abdelaziz, Faten Younis, Amira Hegazy","doi":"10.21608/ejhm.2024.348919","DOIUrl":"https://doi.org/10.21608/ejhm.2024.348919","url":null,"abstract":"Background: Gemcitabine and 5 FU+folinic acid have both proved efficacy in treating patients with advanced pancreatic cancer. Objective: In our study, we combined the two most active agents against pancreatic cancer; gemcitabine and 5FU that were given every 2 weeks to gain the maximum benefit of both drugs and avoid the toxicity that occurs very frequently with FOLFIRINOX. Patients and Methods: This prospective phase II study included 42 patients of metastatic cancer pancreas who met the inclusion criteria Results: The median age at diagnosis was 55 years. Males were more common (59.5%) than females. The most common site of metastasis was the liver (57.1%). Toxicity profile showed that neutropenia and thrombocytopenia were the most common forms of toxicity being high grade in 11.9% of patients. Other forms of toxicity were minimal not exceeding 5%. The overall response rate (ORR) was 33.3% with no reported complete responses. There was a significant correlation between the change of tumor markers levels (CEA, and CA 19.9) and both response and quality of life (QOL). The changes of CEA and CA19.9 levels were found to be independent predictors of progression free survival (PFS). One year OS rate was 49%. The median OS was 11.3 months, while the median PFS was 8.8 months. Response was also found to be a surrogate marker for survival. Conclusions: Gemcitabine-5","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"260 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140779884","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 : 2024-04-01DOI: 10.21608/ejhm.2024.348920
E. Abdelkhalik, El Darky, Hazem Abdelraouf, Mohamed Khadra, A. Atia, Mahmoud Saeed Abdalnaby
Background: Over 15 million people died globally from acute coronary syndrome (ACS) in 2019, with individuals under 70 years old accounting for 40% of these untimely fatalities. Objective: To investigate the prognostic value of systemic inflammatory response index (SIRI) in ACS patients as an independent risk factor for adverse events, and assessment severity of coronary artery disease. Patients and Methods: A prospective cohort study was conducted on 130 patients with ACS patients (ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), Unstable Angina). In addition to evaluation of SIRI, comprehensive clinical evaluations, lab tests, and subsequent appointments were conducted for thorough analysis. Results: The mean SIRI was 1.042 ± 0.4, the mean Syntax Score was 18.77 ± 3.54. There was non-significant difference in between the two groups as regard to sex, age, SBP, DBP, and HR. There was a significant difference in between survived and died cases as regard to family history, Killip class and number of vessels affected, and also, in between SYNTAX score more than 22 and below 22 as regard to troponin, creat, cholesterol, neutrophils, and monocytes. The Sensitivity of SIRI and SYNTAX score as a predictor of outcome of ACS was 90% and 84.85%, the specificity was 94% and 82.69% and the cut-off point was >0.744 and >22 respectively. There was a significant positive correlation in between SIRI and Age, Killip class, cholesterol, lymphocytes, number of vessels affected, Syntax score, number of dead cases, number of non-fatal MI, and number of strokes. According to the SIRI, univariate analysis showed that the most prevalent unfavourable outcome was death, non-fatal myocardial infarction, and stroke. Conclusions: SIRI could be used as an inflammatory biomarker for the prognosis of patients with ACS.
{"title":"Value of Systemic Inflammatory Response Index as a Novel Prognostic Biomarker and Severity Assessment in Patients with Acute Coronary Syndrome","authors":"E. Abdelkhalik, El Darky, Hazem Abdelraouf, Mohamed Khadra, A. Atia, Mahmoud Saeed Abdalnaby","doi":"10.21608/ejhm.2024.348920","DOIUrl":"https://doi.org/10.21608/ejhm.2024.348920","url":null,"abstract":"Background: Over 15 million people died globally from acute coronary syndrome (ACS) in 2019, with individuals under 70 years old accounting for 40% of these untimely fatalities. Objective: To investigate the prognostic value of systemic inflammatory response index (SIRI) in ACS patients as an independent risk factor for adverse events, and assessment severity of coronary artery disease. Patients and Methods: A prospective cohort study was conducted on 130 patients with ACS patients (ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), Unstable Angina). In addition to evaluation of SIRI, comprehensive clinical evaluations, lab tests, and subsequent appointments were conducted for thorough analysis. Results: The mean SIRI was 1.042 ± 0.4, the mean Syntax Score was 18.77 ± 3.54. There was non-significant difference in between the two groups as regard to sex, age, SBP, DBP, and HR. There was a significant difference in between survived and died cases as regard to family history, Killip class and number of vessels affected, and also, in between SYNTAX score more than 22 and below 22 as regard to troponin, creat, cholesterol, neutrophils, and monocytes. The Sensitivity of SIRI and SYNTAX score as a predictor of outcome of ACS was 90% and 84.85%, the specificity was 94% and 82.69% and the cut-off point was >0.744 and >22 respectively. There was a significant positive correlation in between SIRI and Age, Killip class, cholesterol, lymphocytes, number of vessels affected, Syntax score, number of dead cases, number of non-fatal MI, and number of strokes. According to the SIRI, univariate analysis showed that the most prevalent unfavourable outcome was death, non-fatal myocardial infarction, and stroke. Conclusions: SIRI could be used as an inflammatory biomarker for the prognosis of patients with ACS.","PeriodicalId":22467,"journal":{"name":"The Egyptian Journal of Hospital Medicine","volume":"219 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786853","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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