Al-Hussein University Hospital Research Articles

Comparison between oxytocin intravenous bolus, oxytocin intravenous bolus and infusion, rectal misoprostol and carbetocin infusion for the control of blood loss at elective cesarean section

Background: Uterine atony is the greatest typical etiology of primary PPH. Developed nations' atonic PPH rates are rising despite regular active control of the third stage of work. Primary PPH continues to be the greatest cause of maternal mortality in less developed nations. Aim and objectives: to assess the effectiveness of rectal misoprostol, oxytocin infusion, and oxytocin intravenous bolus and infusion in reducing blood loss during and after elective caesarean delivery. Subjects and methods: This prospective research included 200 pregnant patients who were hospitalized to the labor ward at the Al-Hussein University Hospital's Department of Obstetrics and Gynecology. Result: There was a substantial variation among included groups regarding Additional uterotonic use Intraoperatively as it was used in 17, 12, 13 and 5 respectively in groups 1,2,3 and 4. Conclusion: Compared to the Oxytocin and Misoprostol groups, Carbetocin is only effective in reducing postpartum bleeding and is related with a reduced requirement for further uterotonic medicines or surgical hemostatic treatments.

Prediction of Fetal Macrosomia in Patients with Gestational Diabetes Mellitus through measuring the umbilical cord thickness and glycated hemoglobin (HbA1c) levels

Background: One of the most prevalent medical issues, diabetes mellitus, has emerged as a serious concern to pregnant women. It is linked to a number of maternal and fetal issues, including delivery traumas, perinatal death, shoulder dystocia, macrosomia, and operating room interference. Early prediction of fatal complications will improve outcome and reduce perinatal mortality. Aim and objectives; to determine if pregnant diabetes women's use of HbA1c and umbilical cord thickness may accurately predict fetus's macrosomia. Subjects and methods; At Al-Hussein University Hospital, six-month prospective observational research on 100 pregnant women with gestational diabetes who were 28 to 29 weeks along was conducted. Patients had a thorough medical history review, an ultrasound assessment, and an ultrasonography examination. Result: HbA1c and UCA at 27-28 weeks and 36-37 weeks of gestation are substantially different across the three groups that were examined. Conclusion: The severe obstetric problems, including shoulder dystocia and postpartum hemorrhage, are caused by macrosomia. There are times when it is difficult to foresee shoulder dystocia. The group most at risk for these issues may be found, however, using macrosomia prediction. There have been documented studies using sonographic measurement for predicting fetal macrosomia. Fetal macrosomia is well predicted by the thickness of the umbilical cord and the fetal fat layer.

Role of different imaging modalities and FNAC correlation in diagnosing thyroid gland pathologies

Background: Thyroid nodule, goiter, thyroiditis, and thyroid cancer are all common conditions that may have a negative impact on normal thyroid function. Objective: Determine how FNAC correlation and various imaging modalities contribute to the diagnosis of thyroid gland diseases. Patients and Methods: Al-Hussein University Hospital's outpatient departments (OPD) for thyroid problems saw 100 participants for the research. All patients were screened with ultrasound, and based on the results of that exam, some were sent for further radiological testing. Results: Out of the 100 patients included in the study, US was able to classify the thyroid diseases as focal (69 cases) diffuse (30 cases) and others (11 cases). 48 thyroid nodules underwent FNAC and distributed based on Bethesda score as 3 (6.2%) in category I, 30 (62.5%) in category II, 5 (10.4%) in category III, 1 (2%) in category IV, 3 (6.2%) in category V and 6 (12.5%) in category VI; the sensitivity, specificity, positive and negative predictive values, accuracy, and likelihood ratios of US, and pathology were determined. about 22 patients (22 %) underwent a CT scan mainly to evaluate retrosternal extension and for pre-operative staging; 22 patients (22%) underwent a radionuclide scan. Conclusion: Patients with normal thyroid function (euthyroid) should first have an ultrasonography. In the same way, ultrasonography is the first line of diagnosis for a goiter's size and extent. CT without contrast is appropriate if there is any worry about effect on the trachea or if it is necessary to determine how deep the goiter sits.

Evaluation of Pattern of Relapse in Luminal Breast Cancer

Background: The most common molecular subtype of breast cancer worldwide is luminal breast cancer. It has shown a good prognostic profile compared to other types. Despite the immense development of adjuvant treatment in the past years, around 20% of patients with early-stage disease relapse. Aim of the study: To evaluate the relapse pattern in luminal breast cancer and the correlation between luminal types and (AJCC 8th edition). Subject and Methods: A total of 230 luminal breast cancer patients treated at Al-Hussein University Hospital between 2013 and 2018 were analyzed. Patients have been divided into the following groups: luminal A (31%) and B (32.6%), luminal B HER2+ve (18.6%), and luminal UC (17.3%). Results: The median follow-up was 66.7 months, and the relapse rate of luminal breast cancer was 27.8%. Although statistically not significant, luminal A had the lowest relapse rate (19.4%), while luminal B (36%), HER2 positive luminal B (23.2%), and luminal UC (32.5%) (p=0.117). The predominant organ relapse was bone (29.6%) mainly observed in luminal A and B, 35.7% and 32.3% of patients respectively (p=0.048). Luminal Correlation with the AJCC staging system was significant, luminal A was most often observed in early stages with 81.9% presented in Stages I to II (p=0.008). Conclusions: Luminal breast cancer has a wide discrepancy in relapse rate and pattern. Luminal A seems to have the best prognosis for DFS. Ki-67 % and HER2 testing would give a prognostic factor in luminal subcategorization and could be beneficial in the intensification of adjuvant therapy.

Medical archives management systems in Al-Azhar University hospitals: Al-Hussein University Hospital as a model A study of reality and a vision for development

Medical archives management systems in Al-Azhar University hospitals: Al-Hussein University Hospital as a model A study of reality and a vision for development

Fetal hemoglobin as a predictor in cases of pre-eclampsia

Background and Aim Fetal hemoglobin (Hb) has been described as a new predictive biomarker for pre-eclampsia and has also been hypothesized to be a causative factor. Interestingly, the heme scavenger and antioxidant α-microglobulin increases in parallel with fetal Hb. The aim was to measure the level of fetal Hb in the serum of pregnant women with pre-eclampsia. Patients and methods This a prospective study that was conducted on 100 pregnant women selected from the Obstetrics and Gynecology Department of Al-Hussein University Hospital. Results There was a significant increase in fetal Hb in the patient group more than the control group. The fetal Hb shows a high sensitivity, specificity, and accuracy in prediction of pre-eclampsia and eclampsia. Conclusion Fetal Hb was significantly higher in patients with eclampisa and pre-eclampsia. Moreover, it can be used as a predictive marker for both eclampisa and pre-eclampsia.

Role of cerebro-placental ratio in prediction of perinatal outcome in high-risk Pregnancies with intrauterine growth restriction

Background: Antenatal surveillance using Doppler ultrasound velocimetry of the uteroplacental umbilical and fetus arteries has been commonplace. The cerebroplacental ratio has been investigated as a way to predict newborn outcomes. Aim and objectives: In this research, we wanted to see whether the cerebro-placental ratio may help predict perinatal outcomes in high-risk gestation with intrauterine growth restriction. Subjects and methods: This was case-control research done at Al-Hussein University Hospital's Department of Obstetrics and Gynecology; The obstetric color Doppler investigation might be examined in two groups of 100 high-risk pregnant wome: Group Ⅰ - study group: 50 high risk pregnant women with IUGR and Group Ⅱ - control group: 50 high risk pregnant women without IUGR. Results: CPR achieved significance at cutoff point of 1.03 for predicting IUGR with sensitivity of 87.2% and specificity of 71.6% with PPV 83% and NPV 79%. Conclusion: Intrauterine growth restriction in high-risk gestations, the cerebral-placental ratio has a significant prognostic value for perinatal outcome.

COMPARISON OF R WAVE AMPLITUDE CHANGES VERSUS ST-SEGMENT DEPRESSION IN STRESS TESTING ELECTROCARDIOGRAM AMONG ISCHEMIC HEART DISEASE PATIENTS

Background: R-wave changes might be helpful in accurate diagnosis of coronary artery disease with exercise testing in combination with ST segment changes as ∆RST index and might be superior to the traditional ST segment depression only. Objective: To further clarify R-wave amplitude (RWA) changes during exercise stress test (EST) among established IHD patients. Patients and methods: The study enrolled 50 subjects - aged from above 35 to below 65 years old of both sexes, known to be ischemic by a previous angiography, divided into two main groups: Group I (control group): 15 subjects with normal coronaries (lesion 70 % stenosis).The study was conducted at the Department of Cardiovascular Medicine and its Out-patient Clinic, Al-Hussein University Hospital during the period from September 2019 to March 2021. ∆RST index was formed from algebraic summation of RWA difference between (rest and immediate recovery) plus ST segment depression in mile meters. Results: ∆RST index was more useful in detection of coronary artery disease with higher sensitivity and specify among chronic ischemic patients than RWA difference or ST segment depression alone. When cutoff ≥ -1.65 cardiac ischemia could be predicted with a sensitivity rate of 98.93%, a specificity rate of 96.00%, a positive predictive value of 96.3 %, and a negative predictive value of 98%. RWA at a cut-off point of -1.2 was sensitive 95.02% and specific 94.0 % , a positive predictive value of 95.7%, and a negative predictive value of 96.6%. ST segment depression at a cut-off point of ≥ 0.45 was sensitive 77.1% and specific 80%, a positive predictive value of 78.4%, and a negative predictive value of 60.3%. Conclusion: ∆RST index was more useful in detection of coronary artery disease with higher sensitivity and specify among chronic ischemic patients than RWA difference or ST segment depression alone.

Retrospective Study of Redo Mitral Valve Surgery in Cardiothoracic Surgery Department Al-Hussein University Hospital

Background: Cardiac surgery became more common. This lead to increased redo-surgeries with expected increase of overall complications after the redo. The used approach could affect overall outcome. However, this is not addressed well in literature. Aim of the work: To examine the overall outcome of patients underwent redo-mitral valve replacement (redo-MVR).Patients and methods: This study is a retrospective comparative study that was conducted in Cardiothoracic Surgery Department, Al-Hussein University Hospital in the last three years [from January, 1st, 2017 to the end of December 2019). Collected data included patient demographics, surgical approach and overall short-term outcome.Results: The current study included 37 patients; the mean age was 45.19±9.16 years. The most common indication for redo was pannus formation (48.6%), followed by thrombosis (45.9%). There was no significant difference between preoperative and postoperative heart rhythm. Redo sternotomy was the commonest, reported in all patients, and femoral bypass done for 3 patients. Trans-atrial approach reported in 24 patients (64.86%) while Trans-septal approach reported in 13 patients (35.14%). No significant difference between preoperative and postoperative echo data (Ejection Friction, left atrial dimension or left ventricle end diastolic dimension). However, there was significant reduction of left ventricle end-systolic dimension (LVESD), pulmonary artery systolic pressure (PASP) and pressure gradient (PG) cross mitral valve after operation. Reoperation for bleeding was not reported in any cases, while need for new pacemaker reported in 2 patients (5.41%), new postoperative neurological dysfunction reported in new heart failure or need to dialysis in two patients (5.41%). The postoperative arrhythmia was reported in 7 patients (18.9%) and mortality was occurred in three patients (10.8%). Conclusion: The results of the current study showed that, both transseptal and transatrial approaches are comparable and no one is superior to the other.

RAFTING SCREWS VERSUS BONE GRAFTS IN DEPRESSED TIBIAL PLATEAU FRACTURES

Background: Tibial plateau fractures involve a major weight-bearing joint. They occur due to a combination of axial loading and varus/valgus applied forces leading to articular depression, malalignment and an increased risk of post-traumatic osteoarthritis. Objective: To evaluate the clinical, radiographic and functional results in a cohort of patients who sustained open reduction and internal fixation by rafting screws 3.5- 6.5mm cortical screws. Patients and methods: A total number of 30 cases were included in this study and divided into 2 equel groups: Group (A) and group (B). The demographic data showed sex distribution as 22 males & 8 females with closed lateral tibial plateau fractures (18 type II & 12 type III). As regard to radiological outcome, there was no significant difference between both groups during the period between December 2019 and November 2020 at Al-Hussein University Hospital. Results: Functional and radiological results without using graft were slightly lesser than when graft was used, but it avoided possible donor site complications of the graft, decreased blood loss and minimized operative time. Conclusion: Treating depressed tibial plateau fractures type II and type III with mild or moderate depression (<1.5cm) by open reduction and internal fixation using large set buttress plate and screws or screws alone without using bone graft or bone graft substitute represented a viable option.

PREVALENCE OF PERIPHERAL ARTERIAL DISEASE AMONG HEMODIALYSIS PATIENTS

Background: Peripheral arterial disease (PAD) is common in patients with end-stage renal disease on hemodialysis, but is frequently underdiagnosed. The risk factors for PAD are well known within the general population, but they differ somewhat in hemodialysis patients. This study aimed to determine the prevalence of PAD and its risk factors in patients on hemodialysis. Objective: To assess the prevalence of peripheral arterial disease in end stage renal disease patients on hemodialysis. Patients and Methods: This was across-sectional study carried out at Hemodialysis Unit of Al-Hussein University Hospital over a period of six month; from September 2019 to April 2020, and conducted on 80 hemodialysis patients. Demographic data and clinical information were recorded. Laboratory data including CBC, calcium, phosphate, total cholesterol, triglyceride, high-density lipoprotein, and iron profile were evaluated. The ankle-brachial index was measured in all patients. PAD was diagnosed if ankle-brachial index 0.9. Results: As regard description of demographic data, the mean age of all studied patients was 45.3 ± 8.8 years with minimum age of 24 years and maximum age of 62 years. There were 43 males (53.8%) and 37 females (46.3%). Thirty-five patients (43.7%) were diabetic, and 48 patients (60%) were hypertensive. According to laboratory profile, the mean of WBCs, Hb, platelets, serum calcium, PO4, and iPTH were 6.5 x10³/ul, 10.4 g/dl, 228.2 x10³/ul, 8.3 mg/dl, 9.4 mg/dl and 477.2 ug/ml respectively. Regarding lipid profile, the mean of total cholesterol, HDL and triglyceride were 214.7 mg/dL, 41.9 mg/dL,and 172.2 mg/dL, respectively. Regarding to iron profile, the mean of iron serum, ferritin and TIBC were 62.7 mg/dl, 603.3 ng/ml and 236.7 mg/dl, respectively. According to ABI, there were 22 patients (27.5%) ≤ 0.9, while there were 58 patients (72.5%) > 0.9. The prevalence of peripheral arterial disease among HD patients was 27.5%. Conclusions: High prevalence of peripheral arterial disease in CKD patients on hemodialysis and Ankle –brachial index was clearly more sensitive than physical examination in detecting of peripheral arterial disease in CKD patients on hemodialysis.

P-Wave Dispersion and Its Relationship with the Severity of the Coronary Artery Disease in Patients with Stable Angina

Background: In Electrocardiography (ECG), the term (PWD) refers to variation between maximum and minimum P-waves recorded from various Electrocardiography leads. P-wave analysis in ECG may become more widely used marker in many clinical contexts as a result of improved methods for capturing and analyzing this ECG. The link between (PD) and severity of coronary artery disease (CAD) was established among personnel who had stable form of CAD. Objective: We wanted to determine if there was an association between P wave dispersion and CAD severity in patients who had stable CAD. Patients and methods: At Al-Hussein University Hospital Cath Lab, 51 consecutive patients were referred for diagnostic coronary angiography in a cross-sectional trial. They were classified into group A (control group, n=8), who were found to have normal coronary angiography and group B (n = 43), who were found to have coronary artery disease. Results: P wave dispersion was significantly different across cases, with 95.3 percent of patients having abnormal P wave dispersion compared to 100 percent of control cases. P wave dispersion and Gensini score were statistically significantly different between cases and controls where cases had significantly higher scores than controls. Dispersion of P waves was statistically linked to number of vessels affected as well as Gensini scores. The P wave dispersion and the Gensini score showed a strong positive association. Conclusion: Stable coronary artery disease (CAD) patients had aberrant PWD, according to the findings of this study, in patients with stable coronary artery disease, severity of the CAD is correlated with P wave dispersion.

Relationship between Low Back Pain and Stress Urinary Incontinance in Middle - Aged Women

Abstract Background: Low back pain (LBP) and stress urinary incontinence (SUI) are common problems in women, there are many factors that associated with the development of LBP, but there are a limited research that evaluate the relationship between LBP and SUI. Aim of Study: To determine the relationship between stress urinary Incomitance and low back pain in middle-aged women. Material and Methods: One hundred multipara women participated in this study. 50 women complained from stress urinary incontinence (diagnosed by physician) and 50 women were free from stress urinary incontinence (diagnosed by physician). They were selected from Al-Hussein University Hospital in Cairo, Al-Azhar University from November 2020 to March 2021. Their ages were ranged from 35 to 45 years old. Their body mass index was not exceeding 30kg/m2. They were multipara women. Patients with corrected SUI, previous low back surgery, spondylolisthesis and chronic low back pain were excluded from the study. They were divided ran-domly into two equal groups (AB p-value=0.151. While in group (B). There was a statistical significant negative correlation between oswestry low back pain disability questionnaire (ODI) and pelvic floor muscle strength (PFMS) (r=–0.281; p-value=0.048) and in all studied cases (group A + B). There was a statistical signif-icant negative correlation between oswestry low back pain disability questionnaire (ODI) and pelvic floor muscle strength (PFMS) (r=–0.419; p-value=0.001). Conclusion: Accordingly, it can be concluded that there is a positive relationship between low back pain and stress urinary incontinence and presence of stress urinary inconti-nence is predisposing factor for low back pain.

IMPACT OF DOMESTIC VIOLENCE ON CONDUCT DISORDER AMONG AN ADOLESCENTS SAMPLE

Background: Researchers studying parent-adolescent relationships are increasingly investigating the significance of parenting influencing adolescent development and how experiences in the family and other contexts interact with genetic factors to influence behavioral and developmental outcomes. Methods: The study was conducted on two samples. The first (the control sample) consisted of 50 adolescents from the admitted cases in the orthopedic department at Al-Hussein University Hospital and Sayed Galal University Hospital Cairo, Egypt. Their ages ranged from 12 to 18 years. They were subject to the conditions of inclusion in the sample. And the second (cases) consists of 50 adolescents who suffer from conduct disorder according to DSM5 (Diagnostic and Statistical Manual of Mental Disorders 5th Edition) and Mini International Neuropsychiatric Interview (MINI) Kid. Results: By conducting more statistical analyses on the questionnaire results, We note that there are statistically significant differences between the conduct disorder variable and the types of domestic violence (physical - verbal - social - economic - the threat of violence) for all members of the sample. The results showed statistically significant between the conduct disorder variable and the total degree of domestic violence among all sample members. Conclusion: Adolescents are exposed to all typed domestic violence (physical, verbal, social, economic, the threat of violence), and there are statically significant results between the conduct disorder and domestic violence.

Study of high mobility group box 1 protein level in patients with diffuse large b cell lymphoma

Background: Diffuse large B-cell lymphoma (DLBCL) has been the most frequent form of non-Hodgkin lymphoma (NHL), accounting for roughly 24% of new instances per year. High mobility group box 1 protein is a nuclear DNA-binding protein that was discovered more than 30 years ago. It binds to DNA and functions as a cofactor for gene transcription . Overexpression of HMGB1 was being discovered in many cancers, including breast cancer , gastric cancer , and non-Hodgkin lymphoma. Aim of the work: to evaluate the effect of diffuse large B cell lymphoma on high mobility group box 1 protein level and how chemotherapy affects its level in patients with DLBCL. Patients and methods: This study was carried out at Al-Hussein university hospital. Patients were divided into two groups ,Group (A): composed of 35 patients with DLBCL for whom pre-treatment and post-treatment level of HMGB1 protein were measured. Group (B): composed of 35 normal subjects act as a control group . All procedures followed Al-Azhar University Ethical Committee regulations. Results: there is statistically significant improvement after chemotherapy as t value equaled 8.632 with P-value 0.000. Also, when comparing pre-value with normal, paired t test equaled 10.16 with p value 0.000. Using ROC curve, it was stated that area under the curve equaled 1 with standard error 0 and P=0.017. Conclusion: High mobility group box 1 protein is a significant indicator in patients with Diffuse large B-cell lymphoma .

RELATION BETWEEN DEGREE OF LIVER STIFFNESS AND DEVELOPMENT OF HEPATOCELLULAR CARCINOMA IN CHRONIC HEPATITIS C VIRUS PATIENTS

Background: Hepatocellular carcinoma is the fifth most common tumor worldwide and the second most common cause of cancer-related death. Hepatitis C virus (HCV) infection is a leading cause of liver cirrhosis and hence the development of hepatocellular carcinoma (HCC). Egypt has the highest HCV prevalence worldwide. The introduction of new direct acting antiviral agents in the past 5 years has dramatically improved the outcomes of HCV treatment response with > 90% of patients achieving a sustained virological response (SVR) after 12 weeks of end treatment. However, the effect of direct-acting antivirals (DAAs) induced HCV clearance on HCC recurrence after HCC treatment has emerged as a topic of controversy. Objective: To evaluate the relation between liver stiffness as measured by fibro scan and development of HCC in chronic HCV patients. Patients and methods: A prospective study was done at Kafar Alshaykh National Hepatology Institute conducted in collaboration with the Gastroenterology Unit Department of Internal Medicine, Al-Hussein University Hospital, and Cairo Egypt. The study included 150 patients with proven liver cirrhosis secondary to chronic hepatitis C (CHC) they were further sub classified into three equal groups: Group I with chronic hepatitis C, liver cirrhosis and HCC, Group II with CHC and HCC that appeared after treatment with DAA, and Group III (control group) with cirrhotic chronic hepatitis C (CHC) without HCC. Results: In this study, there was a statistically significant difference between group I (30.38 ± 11.32 kPa) and controlled group (25.0 ± 13.34 kPa), regarding fibro scan results (P = 0.004). On other hand there was no significant difference between group II (23.24 ± 7.69 kPa) and controlled group regarding LS. Conclusion: Fibro scan can be a good technique for detection of HCC high-risk cirrhotic patients not treated by DAA and can be of great added value if incorporated in the current HCC screening protocols in hepatitis C cirrhotic patients. On the other hand, LS tended to decrease dramatically after the treatment with DAA. Using TE in these patients would therefore be misleading liver stiffness measurement (LSM), the risk of HCC remains because advanced fibrosis or cirrhosis, which is the most important risk factor for liver cancer, not completely resolved by antiviral treatment. As a matter of fact, the degree of liver fibrosis seems to be a strong predictor of the risk of HCC development.

CLINICOPATHOLOGIC STUDY OF BASAL CELL CARCINOMA: A SINGLE-CENTRE RETROSPECTIVE STUDY

Background: Basal cell carcinoma (BCC) is the most common malignant neoplasm in fair-skinned individuals and accounts for about two-thirds of all skin cancers in Caucasians. BCC rarely metastasizes or causes death, but it can result in extensive morbidity through local invasion and tissue destruction. Objective: To evaluate the clinicopathologic features of basal cell carcinoma in Egyptian population. Patients and methods: Our study included 80 patients with BCCs from January 2015 to December 2019. A retrospective analysis of baseline clinical and histopathological data was for all subjects incorporated in the study. Data needed for the study were obtained from the case files. Patients were histologically diagnosed at Dermatopathology unit of Department of Dermatology and Venereology, Al-Hussein University Hospital, Cairo, Egypt. Results: The present study showed that the clinical types of BCC of the involved patients were 41 lesions (39%) of ulcerative type, 39 lesions (37.1%) of nodular non pigmented type, 13 lesions (12.4%) of nodular pigmented type, 9 lesions (8.6%) of superficial type, and 3 lesions (2.9%) of advanced type. As regards the histological subtypes, 52 lesions (49.5%) were nodular, 11 lesions (15.9%) were pigmented, 9 lesions (8.6%) were adenoid, 9 lesions (8.6%) were superficial, 8 lesions (7.67%) were infiltrative, 7 lesions (6.7%) were micro-nodular, 6 lesions (5.7%) were nodulo-cystic and 3 lesions (4.3%) were baso-squamous. Conclusion: Based on our findings, BCC was strongly associated with exposure to ultraviolet (UV) radiations. Tumors developed mainly on the sun-exposed skin of elderly individuals. Nodular BCC was the most common clinical and histological subtype.

COMPARATIVE EFFECTIVENESS OF MECHANICAL BOWEL PREPARATION WITH AND WITHOUT ORAL ANTIBIOTICS FOR ELECTIVE COLORECTAL SURGERY

Background: Surgical site infections (SSI) are a major cause of morbidity after surgery and are associated with increased hospital length of stay, readmissions, costs, and mortality. Surgical site infections are disproportionally high in colorectal surgery and are estimated to affect between 15% and 30% of patients. Surgical site infections (SSIs) increase the cost of care and are associated with increased morbidity and mortality and it is the third most common nosocomial infection. Objective: To clarify oral antibiotics (OAs) use together with mechanical bowel preparation (MBP) patients outcome following elective colorectal surgery. Patients and methods: The current study was conducted at Al-Hussein University Hospital and Kafr Elsheikh General Hospital. We selected forty patients who underwent elective colorectal surgery. All the studied patients were divided into two equal groups: Group I received mechanical bowel preparation with oral antibiotics, and Group II received mechanical bowel preparation with oral antibiotics. Results: We found that there was no significant difference between two groups of patients as regards mean age and sex distribution. Anterior resection was the most frequent surgical procedure done for the two studied groups of patients. The least frequent procedures done for group I patients were radical sigmoidectomy. Total colectomy and sigmoidectomy, the least frequent procedures done for group II patients, were total colectomy and extended right hemicolectomy. However, the difference between the two groups of patient as regards type of surgery and time of closure did not reach the significant value. All studied patients had ileostomy as a type of stoma. As regards complications after surgery, the most frequent complications among patients of group I were pneumonia and ileus. On the other hand, the most frequent complications among patients of Group II were ileus, leakage and intra-abdominal collection. The mean values of hospital stay in days significantly decreased among patients of group 1. Conclusion: Current study suggested a potentially significant role for prophylactic preoperative oral antibiotic in addition to mechanical bowel preparation, in the prevention of postoperative complications during elective colorectal surgery.

ASSESMENT OF CORONARY ARTERY BYPASS GRAFTS BY MULTIDETECTOR CT

Background: Multidetector computed tomography (MDCT) had made a revolution in coronary artery bypass grafts (CABG) evaluation due to high temporal and spatial resolution beside it is beingnon invasive and highly effective in assessment of extra coronary manifestations. Objective: To evaluate the feasibility of high-quality multi-detector computed tomography ((MDCT) in assessment of CABG patients in comparison with conventional coronary angiography. Patients and methods: Fifty patients were enrolled for ECG gated CT of coronary arteries bypass grafts between MAY 2020 and September 2020. Patients subjected to conventional coronary angiography within 10days after MDCT exam. at Al-Hussein University Hospital. Administration of beta blocker and nitroglycerin was done prior to CT exam. Breath hold training was mandatory. Results: Forty six grafts were arterial and 74 were venous. Thirty six of the arterial grafts (78.2 %) were patent, 6 (13 %) were significantly narrowed and 4 (8.8 %) were completely occluded. Regarding venous grafts, 52 (70.2 %) of them were patent, 14 (19 %) were significantly narrowed, 8 (10.8 %) were completely occluded. CT angiography compared to the conventional angiography as a gold standard technique gave us a sensitivity of 100%, a specificity of about 98% and an accuracy of about 93.6% in the assessment of any type of coronary artery grafts. Conclusion: Multi Detector CT is considered the imaging modality of choice at the current days to evaluate the patency and stenosis of coronary artery bypass grafts than the conventional coronary angiography due to its multiple drawbacks.

ROLE OF CARDIAC MAGNETIC RESONANCE IMAGING IN ASSESSMENT OF RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH PULMONARY HYPERTENSION

Background: Patients with pulmonary hypertension (PH) can develop cor pulmonale later which is the leading cause of death in those patients. Although echocardiography is the mainstay in the assessment of hemodynamic and ventricular function in PH, magnetic resonance imaging (MRI) has emerged as the gold standard for quantifying volume, function, and flow in the right side of the heart. Objective: To evaluate the role of cardiac magnetic resonance image in assessment of right ventricular functions in patients with pulmonary hypertension and to explore the relation between pulmonary artery pressures obtained from echocardiography and MRI -derived ventricular functions parameters. Patients and methods: A total number of 27 patients scheduled for elective conventional echocardiography with known or suspected pulmonary hypertension were enrolled for MRI examination of the heart between October 2018 and March 2020, in Radiology Department, Al-Hussein University Hospital. All patients underwent cardiac MRI and echo within one week. Results: We found that the mean value of left ventricular end systolic volume (LVESV) and left ventricular end systolic volume index (LVESVI) increased in pulmonary hypertensive patients. On assessment of the right ventricular mass index, the mean value was increased in our study compared to normal value. Right ventricular (RV) ventricular mass index (VMI) increased due to increased RV mass and decrease left ventricular (LV) mass. We visually assessed the position of the interventricular septum (IVS) during systole and diastole and had an abnormal position in some patients (nearly 38% of our cases either flattening or bowing toward the left ventricle). All of patients with abnormal septal position had systolic pulmonary pressure above 60 mmHg. We found that 79% of our patients had pulmonary regurge and the average velocity in the main pulmonary was 9.024±6 cm/sec which was less than normal average velocity (13.6±7cm/sec). There was a significant positive correlation between the mean pulmonary arterial pressure (mPAP), and the RV mass(r=0.4), and a significant positive correlation between mPAP and VMI (r=0.52). Conclusion: Cardiac MRI is a valuable tool to assess the effect of pulmonary hypertension on the ventricular functions and also valuable for assessment of treatment response, follow up and prognosis of such patients.