Pub Date : 2023-10-01DOI: 10.21608/amj.2023.326113
Abd El-Rahman Fathy Shahat, Mohamed Abd El-Hamid Abd El-Rahman, Abd El-Rahman Safwat Yousef
Background: Hemodialysis continues to be the single most prevalent modality of kidney replacement therapy. Longevity on dialysis is directly proportional to the quality of dialysis, and that quality in turn depends on the reliability and integrity of the access to the patient’s vascular system. This crucial connection is known as the hemodialysis vascular access. Objective: To compare between brachiobasilic fistula and superficialization in one stage (basilic v. transposition) or two stages (basilic v. elevation) according to primary failure rate, primary patency rate, complication rate. Patients and Methods: This prospective present study was carried out at Al Azhar university hospitals, El Mokattam health insurance hospital and El Mattaria teaching hospital on 30 patients with ESRD needing vascular access in the period from January 2020 to January 2021. Results: Twelve fistulae were on the right side while eighteen patients had their fistulae on the left side. No significant difference was found. There were no significant differences between both groups in terms of the diameters of basilic vein and brachial artery among the patients. What really differs was the time to cannulate the fistula in both groups. It was earlier in Group A (p 0.007). Seroma had occurred in one patient (6.7%) in each group. Hematoma had occurred in one patient (6.7%) in Group A and two patients (13.3%) in Group B. Wound infection had occurred in one patient (6.7%) in each group. They all responded to conservative treatment. Thrombosis occurred in three patients (20%) in Group A; two patients had early thrombosis ( in the first 30 days) while one patient had thrombosis lately while two patients (13.3%) had thrombosis in Group B; one early and one late. Pseudoaneurysm occurred in only one patient in Group B (6.67%) which was impending rupture. So, it was ligated Mild steal syndrome occurred in one patient (6.67%) in each group which respond to medical treatment with no intervention. Regarding the fate of AVF, primary failure had occurred in four patients in Group A (26.7%) and in two patients in Group B (13.3%). In Group A, eleven patients (73.3%) had patent AVF after 3 months while ten patients (66.7%) had patent AVF after 6 months. In Group B, thirteen patients (86.7%) had patent AVF after 3 months while eleven patients (73.33%) had patent AVF after 6 months Conclusion: The brachiobasilic arteriovenous fistula was a good option as a native access for regular hemodialysis in chronic renal failure patients either done in one stage or in two stages with favoring two stages procedure due to higher primary patency rate and less primary failure rate.
背景：血液透析仍然是唯一最普遍的肾脏替代疗法。透析寿命与透析质量成正比，而透析质量又取决于患者血管系统通路的可靠性和完整性。这一关键连接称为血液透析血管通路。目的根据初次失败率、初次通畅率和并发症发生率，比较一期（基底与转位）或二期（基底与抬高）肱动脉瘘和浅表瘘。患者和方法：这项前瞻性研究于 2020 年 1 月至 2021 年 1 月期间在 Al Azhar 大学医院、El Mokattam 医保医院和 El Mattaria 教学医院进行，对象是 30 名需要血管通路的 ESRD 患者。结果：12名患者的瘘管位于右侧，18名患者的瘘管位于左侧。没有发现明显差异。两组患者的基底静脉和肱动脉直径没有明显差异。真正不同的是两组患者插管的时间。A 组的时间更早（P 0.007）。两组中均有一名患者（6.7%）出现血清肿。A 组有一名患者（6.7%）出现血肿，B 组有两名患者（13.3%）出现血肿。他们均接受了保守治疗。A 组有三名患者（20%）出现血栓形成，其中两名患者血栓形成时间较早（前 30 天内），一名患者血栓形成时间较晚，而 B 组有两名患者（13.3%）出现血栓形成，其中一名患者血栓形成时间较早，一名患者血栓形成时间较晚。B 组仅有一名患者（6.67%）出现假性动脉瘤，即将破裂。因此，每组都有一名患者（6.67%）发生了轻度盗血综合征，接受了药物治疗，没有进行干预。关于动静脉瘘的命运，A 组有 4 名患者（26.7%）和 B 组有 2 名患者（13.3%）发生了原发性失败。在 A 组中，11 名患者（73.3%）在 3 个月后动静脉瘘通畅，10 名患者（66.7%）在 6 个月后动静脉瘘通畅。在 B 组中，13 名患者（86.7%）的动静脉瘘在 3 个月后通畅，11 名患者（73.33%）的动静脉瘘在 6 个月后通畅：肱动脉动静脉内瘘是慢性肾衰竭患者进行常规血液透析的一个很好的本地通路选择，无论是一步法还是两步法，两步法的一次通畅率更高，一次失败率更低。
{"title":"A COMPARISON BETWEEN BRACHIOBASILIC FISTULA AND SUPERFICIALIZATION IN ONE STAGE OR TWO STAGES","authors":"Abd El-Rahman Fathy Shahat, Mohamed Abd El-Hamid Abd El-Rahman, Abd El-Rahman Safwat Yousef","doi":"10.21608/amj.2023.326113","DOIUrl":"https://doi.org/10.21608/amj.2023.326113","url":null,"abstract":"Background: Hemodialysis continues to be the single most prevalent modality of kidney replacement therapy. Longevity on dialysis is directly proportional to the quality of dialysis, and that quality in turn depends on the reliability and integrity of the access to the patient’s vascular system. This crucial connection is known as the hemodialysis vascular access. Objective: To compare between brachiobasilic fistula and superficialization in one stage (basilic v. transposition) or two stages (basilic v. elevation) according to primary failure rate, primary patency rate, complication rate. Patients and Methods: This prospective present study was carried out at Al Azhar university hospitals, El Mokattam health insurance hospital and El Mattaria teaching hospital on 30 patients with ESRD needing vascular access in the period from January 2020 to January 2021. Results: Twelve fistulae were on the right side while eighteen patients had their fistulae on the left side. No significant difference was found. There were no significant differences between both groups in terms of the diameters of basilic vein and brachial artery among the patients. What really differs was the time to cannulate the fistula in both groups. It was earlier in Group A (p 0.007). Seroma had occurred in one patient (6.7%) in each group. Hematoma had occurred in one patient (6.7%) in Group A and two patients (13.3%) in Group B. Wound infection had occurred in one patient (6.7%) in each group. They all responded to conservative treatment. Thrombosis occurred in three patients (20%) in Group A; two patients had early thrombosis ( in the first 30 days) while one patient had thrombosis lately while two patients (13.3%) had thrombosis in Group B; one early and one late. Pseudoaneurysm occurred in only one patient in Group B (6.67%) which was impending rupture. So, it was ligated Mild steal syndrome occurred in one patient (6.67%) in each group which respond to medical treatment with no intervention. Regarding the fate of AVF, primary failure had occurred in four patients in Group A (26.7%) and in two patients in Group B (13.3%). In Group A, eleven patients (73.3%) had patent AVF after 3 months while ten patients (66.7%) had patent AVF after 6 months. In Group B, thirteen patients (86.7%) had patent AVF after 3 months while eleven patients (73.33%) had patent AVF after 6 months Conclusion: The brachiobasilic arteriovenous fistula was a good option as a native access for regular hemodialysis in chronic renal failure patients either done in one stage or in two stages with favoring two stages procedure due to higher primary patency rate and less primary failure rate.","PeriodicalId":7627,"journal":{"name":"Al-Azhar Medical Journal","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139325523","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: The worldwide incidence of placenta accreta spectrum (PAS) is rapidly increasing, following the trend of rising cesarean delivery. PAS is an heterogeneous condition associated with a high maternal morbidity and mortality rate, presenting unique challenges in its diagnosis and management. Objective: This study aims to compare between the role of Transabdominal ultrasound vs Transvaginal ultrasound in assessment of placental invasion in cases of placenta previa anterior wall with previous uterine scar applying the unified descriptors of the "EW-AIP" and also to evaluate the sensitivity and specificity of each criterion by comparing them with the final outcome of pregnancy. Patients and methods: This study was conducted on (50) pregnant women diagnosed as placenta previa by ultrasonography and were candidates for repeated elective CS or elective hysterectomy (if the diagnosis of placenta accreta is confirmed). All of those patients presented during the period of December 2018 till August 2020 to El-sheikh Zayed Specialized Hospital Obstetrics outpatient clinic during their follow up visits in the 3rd trimester. Results: Combined gray-scale ultrasonography and color Doppler increased the accuracy for diagnosis of placenta accreta to 100% as approved intra-operatively and by the histopathological examination. In our study: As regards the analysis of gray-scale ultrasonographic criteria, loss of the hypo-echoic retroplacental sonolucent zone has the highest percentage among the studied group (87.5%), followed by presence of abnormal placental lacunae (79.2%) then thinning or disruption of hyperechoic serosa – bladder interface and the presence of focal exophytic masses invading the urinary bladder (41.7%), (25%) respectively. Conclusion: Combined gray-scale ultrasonography and color Doppler ultrasound are suggested for all patients with placenta previa and pervious CS to find out the features which suggest presence of placenta accreta, and this allows the surgical team to plan ahead of each case individually according to the variable morphological and vascular patterns.
{"title":"ACCURACY OF DOPPLER ULTRASOUND IN PREDICTION AND DIAGNOSIS OF PLACENTA ACCRETE","authors":"Khaled Amine Moustafa Zarea, Assem Anwar Abdo Moussa, Mohamed Aly Mohamed","doi":"10.21608/amj.2023.326884","DOIUrl":"https://doi.org/10.21608/amj.2023.326884","url":null,"abstract":"Background: The worldwide incidence of placenta accreta spectrum (PAS) is rapidly increasing, following the trend of rising cesarean delivery. PAS is an heterogeneous condition associated with a high maternal morbidity and mortality rate, presenting unique challenges in its diagnosis and management. Objective: This study aims to compare between the role of Transabdominal ultrasound vs Transvaginal ultrasound in assessment of placental invasion in cases of placenta previa anterior wall with previous uterine scar applying the unified descriptors of the \"EW-AIP\" and also to evaluate the sensitivity and specificity of each criterion by comparing them with the final outcome of pregnancy. Patients and methods: This study was conducted on (50) pregnant women diagnosed as placenta previa by ultrasonography and were candidates for repeated elective CS or elective hysterectomy (if the diagnosis of placenta accreta is confirmed). All of those patients presented during the period of December 2018 till August 2020 to El-sheikh Zayed Specialized Hospital Obstetrics outpatient clinic during their follow up visits in the 3rd trimester. Results: Combined gray-scale ultrasonography and color Doppler increased the accuracy for diagnosis of placenta accreta to 100% as approved intra-operatively and by the histopathological examination. In our study: As regards the analysis of gray-scale ultrasonographic criteria, loss of the hypo-echoic retroplacental sonolucent zone has the highest percentage among the studied group (87.5%), followed by presence of abnormal placental lacunae (79.2%) then thinning or disruption of hyperechoic serosa – bladder interface and the presence of focal exophytic masses invading the urinary bladder (41.7%), (25%) respectively. Conclusion: Combined gray-scale ultrasonography and color Doppler ultrasound are suggested for all patients with placenta previa and pervious CS to find out the features which suggest presence of placenta accreta, and this allows the surgical team to plan ahead of each case individually according to the variable morphological and vascular patterns.","PeriodicalId":7627,"journal":{"name":"Al-Azhar Medical Journal","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139325762","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 : 2023-10-01DOI: 10.21608/amj.2023.326881
Mahmoud Mohamed El-Misady, Ahmed Saied Abd El-Rahman, Ismail Abd El-Latif Shabayek
Background: Post-laparoscopy analgesia of laparoscopic cholecystectomy is still a challenge. Many studies have been carried out to find the effect of different analgesic techniques in patients undergoing laparoscopic cholecystectomy including ultrasonic guided TAP block &wound infiltration of local anesthetic. Objective: To assess degree of pain control, duration of action, duration of postoperative analgesia, the effect on postoperative analgesic requirements in patients undergoing laparoscopic cholecystectomy and compare between Transversus abdominis plane block and local wound infiltration. Methods: 60 cases were enrolled for laparoscopic cholecystectomy and were divided randomly into two groups: TAP group: (n=30) patients of this group received TAP block performed by ultrasound guidance and LWI group (n=30) patients of this group received local anesthetic (ropivacaine).After surgery, Visual Analogue Score (VAS) was recorded at 1, 2,4,6,12,18 &24 hours. Requirement of rescue analgesia when VAS score ≥4, total dose of morphine received in 24 h were noted in both groups postoperatively. Results: The overall VAS during the first postoperative 24 hours was significantly lower in TAP group (P <0.001at 6, 12, 18 and 24 hours after surgery) and total analgesic consumption (morphine in mg) was lower in TAP group (8.2 mg) compared to LWI (12.2 mg). Conclusion: TAP block provides better postoperative pain control & reduce postoperative opioid requirement in comparison with local wound infiltration in patients undergoing laparoscopic cholecystectomy.
背景：腹腔镜胆囊切除术术后镇痛仍是一项挑战。许多研究都在寻找不同镇痛技术对腹腔镜胆囊切除术患者的影响，包括超声引导下的 TAP 阻滞和伤口浸润局麻药。目的评估腹腔镜胆囊切除术患者的疼痛控制程度、作用持续时间、术后镇痛持续时间、对术后镇痛需求的影响，并比较腹横肌平面阻滞和局部伤口浸润。方法：60 例腹腔镜胆囊切除术患者被随机分为两组：术后 1、2、4、6、12、18 和 24 小时记录视觉模拟评分（VAS）。记录两组患者术后 1、2、4、6、12、18 和 24 小时的视觉模拟评分（VAS）、VAS 评分≥4 时的镇痛抢救需求、24 小时内接受的吗啡总剂量。结果与 LWI（12.2 毫克）相比，TAP 组术后 24 小时内的总体 VAS 显著降低（术后 6、12、18 和 24 小时的 P <0.001），镇痛剂总用量（以毫克为单位的吗啡）也较低（8.2 毫克）。结论与局部伤口浸润相比，TAP阻滞能更好地控制腹腔镜胆囊切除术患者的术后疼痛，并减少术后阿片类药物的用量。
{"title":"COMPARISON BETWEEN ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK AND LOCAL ANESTHETIC INFILTRATION IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY","authors":"Mahmoud Mohamed El-Misady, Ahmed Saied Abd El-Rahman, Ismail Abd El-Latif Shabayek","doi":"10.21608/amj.2023.326881","DOIUrl":"https://doi.org/10.21608/amj.2023.326881","url":null,"abstract":"Background: Post-laparoscopy analgesia of laparoscopic cholecystectomy is still a challenge. Many studies have been carried out to find the effect of different analgesic techniques in patients undergoing laparoscopic cholecystectomy including ultrasonic guided TAP block &wound infiltration of local anesthetic. Objective: To assess degree of pain control, duration of action, duration of postoperative analgesia, the effect on postoperative analgesic requirements in patients undergoing laparoscopic cholecystectomy and compare between Transversus abdominis plane block and local wound infiltration. Methods: 60 cases were enrolled for laparoscopic cholecystectomy and were divided randomly into two groups: TAP group: (n=30) patients of this group received TAP block performed by ultrasound guidance and LWI group (n=30) patients of this group received local anesthetic (ropivacaine).After surgery, Visual Analogue Score (VAS) was recorded at 1, 2,4,6,12,18 &24 hours. Requirement of rescue analgesia when VAS score ≥4, total dose of morphine received in 24 h were noted in both groups postoperatively. Results: The overall VAS during the first postoperative 24 hours was significantly lower in TAP group (P <0.001at 6, 12, 18 and 24 hours after surgery) and total analgesic consumption (morphine in mg) was lower in TAP group (8.2 mg) compared to LWI (12.2 mg). Conclusion: TAP block provides better postoperative pain control & reduce postoperative opioid requirement in comparison with local wound infiltration in patients undergoing laparoscopic cholecystectomy.","PeriodicalId":7627,"journal":{"name":"Al-Azhar Medical Journal","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139325015","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 : 2023-10-01DOI: 10.21608/amj.2023.326882
Tamim Abo El-Naga, A. Harfoush, M. Sallam
Background: Trans-radial approach (TRA) gained sound acceptance as an alternative to trans-femoral approach (TFA), however, still having numerous pitfalls as hematoma, spasm and radial artery occlusion. Objectives: To evaluate the feasibility and safety of TRA for coronary angiography (CAG) and percutaneous coronary intervention (PCI) compared with the TFA in ST segment elevation myocardial infarction (STEMI) patients. Methods: Our study was a prospective analysis enrolled 100 consecutive patients presented with acute STEMI. The patients were randomly assigned to get vascular access either from TFA (Group I, 50 patients) or from TRA (Group II, 50 patients). The clinical, technical, procedural and post-procedural data collected. Results: Group I was younger than Group II (53.0±8.4) versus (55.8±10.9 years), however didn’t reach a statistical significance (p= 0.156). History of prior STEMI was significantly more in group II (6% versus 16%, p=0.032). There was no difference between the two groups regarding the procedural success (98% versus 96%) and number of attempts to fix the femoral or radial sheath. However, the total procedure time, amount of contrast usage and fluoroscopic time were significantly higher in radial group (42.2 ± 16.8 versus 77.4 ± 27.1 minutes), (157.4 ± 10.8 versus 181.2 ± 16.7 milliliter) and 8.74 ± 3.8 versus 18.64 ± 7.1 minute) with p=0.001 respectively. The frequency of acute complications was similar in both groups despite hematoma was less in group II, however, it didn’t reach statistical significance. Conclusions: Our study demonstrated the radial access is a safe and practical approach for coronary angiography or angioplasty in ST segment elevation myocardial infarction patients compared to femoral access, without major complications, however, the procedure time was significantly longer with higher usage of contrast media and fluoroscopic time.
{"title":"COMPARATIVE STUDY BETWEEN RADIAL AND FEMORAL ARTERY APPROACHES IN ACUTE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION; IMMEDIATE AND SHORT-TERM FOLLOW UP","authors":"Tamim Abo El-Naga, A. Harfoush, M. Sallam","doi":"10.21608/amj.2023.326882","DOIUrl":"https://doi.org/10.21608/amj.2023.326882","url":null,"abstract":"Background: Trans-radial approach (TRA) gained sound acceptance as an alternative to trans-femoral approach (TFA), however, still having numerous pitfalls as hematoma, spasm and radial artery occlusion. Objectives: To evaluate the feasibility and safety of TRA for coronary angiography (CAG) and percutaneous coronary intervention (PCI) compared with the TFA in ST segment elevation myocardial infarction (STEMI) patients. Methods: Our study was a prospective analysis enrolled 100 consecutive patients presented with acute STEMI. The patients were randomly assigned to get vascular access either from TFA (Group I, 50 patients) or from TRA (Group II, 50 patients). The clinical, technical, procedural and post-procedural data collected. Results: Group I was younger than Group II (53.0±8.4) versus (55.8±10.9 years), however didn’t reach a statistical significance (p= 0.156). History of prior STEMI was significantly more in group II (6% versus 16%, p=0.032). There was no difference between the two groups regarding the procedural success (98% versus 96%) and number of attempts to fix the femoral or radial sheath. However, the total procedure time, amount of contrast usage and fluoroscopic time were significantly higher in radial group (42.2 ± 16.8 versus 77.4 ± 27.1 minutes), (157.4 ± 10.8 versus 181.2 ± 16.7 milliliter) and 8.74 ± 3.8 versus 18.64 ± 7.1 minute) with p=0.001 respectively. The frequency of acute complications was similar in both groups despite hematoma was less in group II, however, it didn’t reach statistical significance. Conclusions: Our study demonstrated the radial access is a safe and practical approach for coronary angiography or angioplasty in ST segment elevation myocardial infarction patients compared to femoral access, without major complications, however, the procedure time was significantly longer with higher usage of contrast media and fluoroscopic time.","PeriodicalId":7627,"journal":{"name":"Al-Azhar Medical Journal","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139327020","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: Esinophilic esophagitis (EoE) is an atopic inflammatory disease of the esophagus that has become increasingly recognized in children and adults during the last decade. EoE is an atopic inflammatory disease of the esophagus that has become increasingly. Esinophils are typically present throughout the gastrointestinal tract since it is continuously exposed to foods, environmental allergens, toxins, and pathogens. Objective: To evaluate the prevalence of esinophilic esophagitis in atopic patients. Patients and Methods: This was a retrospective single center non randomized, observational study, 120 patients with age ranged from 18-60 years were recruited for this study. They were evaluated for esophageal symptoms using the frequency scale for the symptoms of gastro-esophageal reflux disease (GERD). It was conducted at Dermatology, Ear, Nose, and Throat (ENT), Ophthalmology and allergy clinic of Internal Medicine Departments, Al-Husein University Hospital. The study was done during the periods between July 2017 and September 2018. Results: The mean total immunoglobulin E (IgE) of group II was higher than group I with significant statistical difference between both groups. As regards the mean blood esinophils of group II was higher than group I with significant statistical difference between both groups. Heartburn documented the higher presentations (83%), followed by regurgitation (58.5%), and a combination of other symptoms in patients. Only 6 cases out of 53 examined, endoscopic biopsies have histological features of EoE. The remaining 47 biopsies featured different histological diagnosis which included mild reflux esophagitis in 12 cases, moderate reflux esophagitis in 20 cases, and severe reflux esophagitis in 15 cases. Conclusion: Atopic patients who suffered from esophagitis symptoms were assessed for EoE by endoscopic and histopathological examination especially if there was a high IgE level or increased blood esinophils.
{"title":"PREVALENCE OF ESINOPHILIC ESOPHAGITIS AMONG ATOPIC EGYPTIAN POPULATION","authors":"Ahmed Eid Sadek, Asem Mahmod Al-Sherif, Magdi El-Dahshan, Mohamed Samy Al-Hakim","doi":"10.21608/amj.2023.326106","DOIUrl":"https://doi.org/10.21608/amj.2023.326106","url":null,"abstract":"Background: Esinophilic esophagitis (EoE) is an atopic inflammatory disease of the esophagus that has become increasingly recognized in children and adults during the last decade. EoE is an atopic inflammatory disease of the esophagus that has become increasingly. Esinophils are typically present throughout the gastrointestinal tract since it is continuously exposed to foods, environmental allergens, toxins, and pathogens. Objective: To evaluate the prevalence of esinophilic esophagitis in atopic patients. Patients and Methods: This was a retrospective single center non randomized, observational study, 120 patients with age ranged from 18-60 years were recruited for this study. They were evaluated for esophageal symptoms using the frequency scale for the symptoms of gastro-esophageal reflux disease (GERD). It was conducted at Dermatology, Ear, Nose, and Throat (ENT), Ophthalmology and allergy clinic of Internal Medicine Departments, Al-Husein University Hospital. The study was done during the periods between July 2017 and September 2018. Results: The mean total immunoglobulin E (IgE) of group II was higher than group I with significant statistical difference between both groups. As regards the mean blood esinophils of group II was higher than group I with significant statistical difference between both groups. Heartburn documented the higher presentations (83%), followed by regurgitation (58.5%), and a combination of other symptoms in patients. Only 6 cases out of 53 examined, endoscopic biopsies have histological features of EoE. The remaining 47 biopsies featured different histological diagnosis which included mild reflux esophagitis in 12 cases, moderate reflux esophagitis in 20 cases, and severe reflux esophagitis in 15 cases. Conclusion: Atopic patients who suffered from esophagitis symptoms were assessed for EoE by endoscopic and histopathological examination especially if there was a high IgE level or increased blood esinophils.","PeriodicalId":7627,"journal":{"name":"Al-Azhar Medical Journal","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139328973","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: The increasing number of renal transplantations and the increased survival rate of renal transplantation patients lead to an increase of the number of complications. Complications of renal transplant can be diagnosed and managed with minimally invasive techniques. Radiologists must know about post-renal transplant complications, since it is essential to respond with early treatment, which improves the prognosis of the transplanted kidney. Most complications can be detected by Doppler and ultrasound, although on other occasions it is necessary to resort to other diagnostic techniques such as the CT Angiogram or arteriography. Objective: The aim of work was to highlight the role of ultrasound and duplex study in evaluation of early complications of the transplanted kidney. Patients and methods: This study included 30 renal transplant patients who were referred either for routine assessment of the renal allograft or for investigation of the cause of elevated serum creatinine levels. Patients selected from Ahmed Maher Teaching Hospital and Urology and Nephrology Center Mansoura University, in the period from November 2016 to August 2017. The patients were divided into two major groups: Group I: 20 patients with early complicated renal allografts, and Group II (Control Group): 10 patients with normal renal transplant grafts. Results: The perinephric complications have specific findings on the grey scale ultrasound while the Doppler may not reveal any significant findings. This study revealed that parenchymal complications were the most common early complications to occur after the kidney transplant surgery. The relation between the PSV of either the renal artery or the external iliac artery and the detection of early renal transplant complications in this study was insignificant. Ultrasound and Doppler showed different responses in relation to their specificity and sensitivity in the detection of early renal transplant complications. While Ultrasound was more accurate in detecting urological and perinephric complications showing sensitivity of 100%, Doppler appeared to have the upper hand in the detection of early vascular and parenchymal complications showing sensitivity ranging from 80-100 %. Conclusion: Doppler indices differ in their specificity and sensitivity in detecting the early renal transplant complications. Doppler indices in different arteries differ in the detection of early parenchymal renal transplant complications. In our study, Resistive index of the interlobar artery proved to be more specific in the detection of early cases of parenchymal complications in a renal transplant patient.
{"title":"ROLE OF RENAL ULTRASONOGRAPHY AND DOPPLER IN DETECTION OF COMPLICATIONS OF POST-TRANSPLANTED KIDNEY","authors":"Hassan Shehata, Mokhtar Ragab Ramadan, Mohamad Hassan Tawfik","doi":"10.21608/amj.2023.326112","DOIUrl":"https://doi.org/10.21608/amj.2023.326112","url":null,"abstract":"Background: The increasing number of renal transplantations and the increased survival rate of renal transplantation patients lead to an increase of the number of complications. Complications of renal transplant can be diagnosed and managed with minimally invasive techniques. Radiologists must know about post-renal transplant complications, since it is essential to respond with early treatment, which improves the prognosis of the transplanted kidney. Most complications can be detected by Doppler and ultrasound, although on other occasions it is necessary to resort to other diagnostic techniques such as the CT Angiogram or arteriography. Objective: The aim of work was to highlight the role of ultrasound and duplex study in evaluation of early complications of the transplanted kidney. Patients and methods: This study included 30 renal transplant patients who were referred either for routine assessment of the renal allograft or for investigation of the cause of elevated serum creatinine levels. Patients selected from Ahmed Maher Teaching Hospital and Urology and Nephrology Center Mansoura University, in the period from November 2016 to August 2017. The patients were divided into two major groups: Group I: 20 patients with early complicated renal allografts, and Group II (Control Group): 10 patients with normal renal transplant grafts. Results: The perinephric complications have specific findings on the grey scale ultrasound while the Doppler may not reveal any significant findings. This study revealed that parenchymal complications were the most common early complications to occur after the kidney transplant surgery. The relation between the PSV of either the renal artery or the external iliac artery and the detection of early renal transplant complications in this study was insignificant. Ultrasound and Doppler showed different responses in relation to their specificity and sensitivity in the detection of early renal transplant complications. While Ultrasound was more accurate in detecting urological and perinephric complications showing sensitivity of 100%, Doppler appeared to have the upper hand in the detection of early vascular and parenchymal complications showing sensitivity ranging from 80-100 %. Conclusion: Doppler indices differ in their specificity and sensitivity in detecting the early renal transplant complications. Doppler indices in different arteries differ in the detection of early parenchymal renal transplant complications. In our study, Resistive index of the interlobar artery proved to be more specific in the detection of early cases of parenchymal complications in a renal transplant patient.","PeriodicalId":7627,"journal":{"name":"Al-Azhar Medical Journal","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139329636","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 : 2023-10-01DOI: 10.21608/amj.2023.326110
Ahmed Mohamed Awad Abdalla, Essam Ali Mostafa, Amr Soliman Hamrosh
Background: Laryngoscopy and intubation is a noxious stimulus, which can provoke many untoward responses, particularly in the cardiovascular system in the form of hypertension, tachycardia, and dysrhythmia, which can be detrimental in cardiovascular compromised patients. For decreasing anxiety and the intubation response, use of nonopioid drugs has become a part of the multimodal regimen. Many recent studies show that drugs such as gabapentin and pregabalin are known to decrease stress response due to laryngoscopy and intubation. Objective: To evaluate the effect of different doses of pregabalin as oral premedication to attenuate cardiovascular response during laryngoscopy and endotracheal intubation. Patients and methods: The study included 120 normotensive normoglycemic patients undergoing abdominal hysterectomy who were randomly divided into 4 equal groups: group A received a placebo drug, groups B, C and D received different doses of oral pregabalin (75 mg, 150 mg and 300 mg respectively). The patients were unaware of their group distribution. Patients were carefully selected regarding the demographic data and the medical status. The anesthetic technique included preoperative assessment and preparation, during which the patients were informed about the details of the study, gave their consent, learned how to use VAS, and received the drug
{"title":"EFFECT OF PREOPERATIVE PREGABALIN ON STRESS RESPONE DURING LARYNGOSCOPY AND INTUBATION ON POSTOPERATIVE ANALGESIA IN NORMOTENSIVE NORMOGLYCEMIC PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY","authors":"Ahmed Mohamed Awad Abdalla, Essam Ali Mostafa, Amr Soliman Hamrosh","doi":"10.21608/amj.2023.326110","DOIUrl":"https://doi.org/10.21608/amj.2023.326110","url":null,"abstract":"Background: Laryngoscopy and intubation is a noxious stimulus, which can provoke many untoward responses, particularly in the cardiovascular system in the form of hypertension, tachycardia, and dysrhythmia, which can be detrimental in cardiovascular compromised patients. For decreasing anxiety and the intubation response, use of nonopioid drugs has become a part of the multimodal regimen. Many recent studies show that drugs such as gabapentin and pregabalin are known to decrease stress response due to laryngoscopy and intubation. Objective: To evaluate the effect of different doses of pregabalin as oral premedication to attenuate cardiovascular response during laryngoscopy and endotracheal intubation. Patients and methods: The study included 120 normotensive normoglycemic patients undergoing abdominal hysterectomy who were randomly divided into 4 equal groups: group A received a placebo drug, groups B, C and D received different doses of oral pregabalin (75 mg, 150 mg and 300 mg respectively). The patients were unaware of their group distribution. Patients were carefully selected regarding the demographic data and the medical status. The anesthetic technique included preoperative assessment and preparation, during which the patients were informed about the details of the study, gave their consent, learned how to use VAS, and received the drug","PeriodicalId":7627,"journal":{"name":"Al-Azhar Medical Journal","volume":"133 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139329656","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 : 2023-10-01DOI: 10.21608/amj.2023.326114
Ahmed Sameh Hamed El-Esawy, Magdy AbdAl-Kareem Al-Dahshan, Mohammed Salah Ali, Mohamed Farouk Agag
Background: Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic triglyceride accumulation not due to alcohol consumption (<20 g ethanol per day), resulting in steatosis and hepatic inflammation. NAFLD is currently the most common liver disorder, particularly in Western countries. Worldwide, the prevalence of NAFLD is about 25%. Nonalcoholic fatty pancreas disease (NAFPD) is an excessive lipid accumulation in the pancreas in the absence of significant alcohol intake. Endoscopic ultrasound (EUS) can provide detailed images of the entire pancreas. The use of high-frequency US waves and the ability to simultaneously image adjacent organs like the liver and spleen in real-time. Objective: To determine the possible association between non-alcoholic fatty pancreatic disease (NAFPD) and non-alcoholic fatty liver disease (NAFLD). Patients and methods: This study was conducted on 100 subjects divided into two equal groups: Group I Included individuals with sonographically proven NAFLD, and Group II (control group): Included healthy individuals with no sonographic evidence of NAFLD. All cases were selected from Internal Medicine Department at Al-Hussein Hospital, Al-Azhar University, during the period from April 2019 to April 2020. Results: Based on the severity of fatty pancrease, moderate and severe fatty pancrease was significantly associated with older age with p value 0.0001. Fasting-blood-sugar (FBS), erythrocyte sedimentation rate (ESR), and aspartate-aminotransferase (AST) significantly higher in moderate and severe fatty pancreases too with p value 0.0001, 0.001 and 0.0001 respectively. Serum albumin level was the lowest in severe fatty pancreases with p value 0.001. In addition, low-density lipoprotein (LDL), TG and cholesterol was significantly higher in severe fatty pancreases with p value 0.0001, 0.0001 and 0.0001 respectively. High-density lipoprotein (HDL) was the highest in absent fatty pancreases with p value 0.0001. Patient with severe fatty pancrease was only present in fatty liver group with 24%. Conclusion: Degree of pancreatic steatosis was significantly related to old age, high erythrocyte sedimentation rate, low albumin level, high cholesterol, high triglycerides, and low high-density lipoprotein. Pancreatic steatosis was significantly correlated to presence of fatty liver.
{"title":"STUDYING THE ASSOCIATION BETWEEN NON-ALCOHOLIC FATTY LIVER DISEASE AND NON-ALCOHOLIC FATTY PANCREAS DISEASE USING TRANSABDOMINAL ULTRASOUND AND ENDOSCOPIC ULTRASOUND","authors":"Ahmed Sameh Hamed El-Esawy, Magdy AbdAl-Kareem Al-Dahshan, Mohammed Salah Ali, Mohamed Farouk Agag","doi":"10.21608/amj.2023.326114","DOIUrl":"https://doi.org/10.21608/amj.2023.326114","url":null,"abstract":"Background: Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic triglyceride accumulation not due to alcohol consumption (<20 g ethanol per day), resulting in steatosis and hepatic inflammation. NAFLD is currently the most common liver disorder, particularly in Western countries. Worldwide, the prevalence of NAFLD is about 25%. Nonalcoholic fatty pancreas disease (NAFPD) is an excessive lipid accumulation in the pancreas in the absence of significant alcohol intake. Endoscopic ultrasound (EUS) can provide detailed images of the entire pancreas. The use of high-frequency US waves and the ability to simultaneously image adjacent organs like the liver and spleen in real-time. Objective: To determine the possible association between non-alcoholic fatty pancreatic disease (NAFPD) and non-alcoholic fatty liver disease (NAFLD). Patients and methods: This study was conducted on 100 subjects divided into two equal groups: Group I Included individuals with sonographically proven NAFLD, and Group II (control group): Included healthy individuals with no sonographic evidence of NAFLD. All cases were selected from Internal Medicine Department at Al-Hussein Hospital, Al-Azhar University, during the period from April 2019 to April 2020. Results: Based on the severity of fatty pancrease, moderate and severe fatty pancrease was significantly associated with older age with p value 0.0001. Fasting-blood-sugar (FBS), erythrocyte sedimentation rate (ESR), and aspartate-aminotransferase (AST) significantly higher in moderate and severe fatty pancreases too with p value 0.0001, 0.001 and 0.0001 respectively. Serum albumin level was the lowest in severe fatty pancreases with p value 0.001. In addition, low-density lipoprotein (LDL), TG and cholesterol was significantly higher in severe fatty pancreases with p value 0.0001, 0.0001 and 0.0001 respectively. High-density lipoprotein (HDL) was the highest in absent fatty pancreases with p value 0.0001. Patient with severe fatty pancrease was only present in fatty liver group with 24%. Conclusion: Degree of pancreatic steatosis was significantly related to old age, high erythrocyte sedimentation rate, low albumin level, high cholesterol, high triglycerides, and low high-density lipoprotein. Pancreatic steatosis was significantly correlated to presence of fatty liver.","PeriodicalId":7627,"journal":{"name":"Al-Azhar Medical Journal","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139331036","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 : 2023-10-01DOI: 10.21608/amj.2023.326885
Mohamed Nour El-Din Mohamed, Ibrahim Abd El-Hamid Abou-Sekein, Attia Mohamed Attia
Background: Preeclampsia is a common medical disorder affecting about 2–7% of pregnant women worldwide and can lead to unfavorable pregnancy outcomes such as increased maternal as well as perinatal morbidity and morbidity. The etiology of preeclampsia remains ambiguous, albeit, reports that implicated placental defects and oxidative stress early during pregnancy in affected pregnancies. Micronutrients and trace elements play a pivotal role in metabolism and in the preservation of tissue function. Trace elements are important constituents of a number of antioxidants. Therefore, they are integral part of a robust antioxidant that protects the cell from damage. Objective: To assess association serum levels of calcium, magnesium, uric acid and C-reactive protein in mild preeclampsia ladies and normal pregnant ladies to predict sever preeclampsia. Patients and methods: This was a case control study was conducted at Al-Azhar university hospitals included 100 patients in their third trimester of gestation divided into two groups; The 1st group consisted of 50 pregnant ladies with preeclampsia in the third trimester of pregnancy that was determined by last menstrual period (LMP) or first trimester ultrasound, and the 2nd group consisted of 50 normotensive pregnant ladies in the third trimester of pregnancy that was determined by last menstrual period (LMP) or first trimester ultrasound. Duration of research was
{"title":"ESTIMATION LEVELS OF SERUM CALCIUM, MAGNESIUM, URIC ACID AND C-REACTIVE PROTEIN IN MILD PREECLAMPSIA COMPARED TO LEVEL NORMAL PREGNANT WOMEN TO EARLY PREDICT SEVER PREECLAMPSIA","authors":"Mohamed Nour El-Din Mohamed, Ibrahim Abd El-Hamid Abou-Sekein, Attia Mohamed Attia","doi":"10.21608/amj.2023.326885","DOIUrl":"https://doi.org/10.21608/amj.2023.326885","url":null,"abstract":"Background: Preeclampsia is a common medical disorder affecting about 2–7% of pregnant women worldwide and can lead to unfavorable pregnancy outcomes such as increased maternal as well as perinatal morbidity and morbidity. The etiology of preeclampsia remains ambiguous, albeit, reports that implicated placental defects and oxidative stress early during pregnancy in affected pregnancies. Micronutrients and trace elements play a pivotal role in metabolism and in the preservation of tissue function. Trace elements are important constituents of a number of antioxidants. Therefore, they are integral part of a robust antioxidant that protects the cell from damage. Objective: To assess association serum levels of calcium, magnesium, uric acid and C-reactive protein in mild preeclampsia ladies and normal pregnant ladies to predict sever preeclampsia. Patients and methods: This was a case control study was conducted at Al-Azhar university hospitals included 100 patients in their third trimester of gestation divided into two groups; The 1st group consisted of 50 pregnant ladies with preeclampsia in the third trimester of pregnancy that was determined by last menstrual period (LMP) or first trimester ultrasound, and the 2nd group consisted of 50 normotensive pregnant ladies in the third trimester of pregnancy that was determined by last menstrual period (LMP) or first trimester ultrasound. Duration of research was","PeriodicalId":7627,"journal":{"name":"Al-Azhar Medical Journal","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139330960","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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