El-Demerdash Hospital Research Articles

Odontogenic tumors: A Retrospective Study in Egyptian population using WHO 2017 classification.

Background Odontogenic tumors (OTs) are considered important among oral lesions because of their clinicopathological heterogeneity and variable biological behavior. The purpose of this retrospective cross-sectional study was to evaluate the frequency and distribution of different types of odontogenic tumors based on the current 2017 WHO Classification of Head and Neck Tumors over a period of 5 years. This was achieved by reviewing the records of Cairo's educational hospitals and institutions and comparing the results with findings in the literature.Material and Methods The records of patients diagnosed with odontogenic tumors were obtained from six educational hospitals and a single institute in Cairo which included: Oral and Maxillofacial Pathology Department, Faculty of Dentistry, Cairo University; General Pathology Department, Faculty of Medicine, Cairo University; Oral Pathology Department, Faculty of Dentistry, Ain Shams University; Eldemerdash Hospital, Ain Shams University; El-Sayed Galal Hospital, Al-Azhar University; Ahmed Maher Teaching Hospital and National Cancer Institute. These records were reviewed over a 5-year (2014-2018) period and the odontogenic tumors were investigated for frequency, age, gender and site. The data were recorded, then analyzed using SPSS software.Results Intraosseous (central) odontogenic tumors constituted 2.56% of all 8974 registered oral and maxillofacial biopsies. A total of 230 cases of OTs were collected and reviewed. Of these, 97.8% were benign and 2.17% were malignant. The mandible was the most commonly affected anatomic location. Ameloblastoma, with a predilection for the posterior mandible, was the most frequent odontogenic tumor (55.65%), followed by cemento-ossifying fibroma (14.78%) and odontoma (9.13%). Females were more commonly affected than males. Most of the patients were in the third and fourth decades of life. There were no peripheral odontogenic tumors diagnosed in this period.Conclusions Some similarities and differences between our findings and those of previous studies of various populations were witnessed. OTs may greatly diverge according to the version of the classification used and by the sample size of the study. Retrospective analysis of the relative frequency of OTs in different countries will be helpful in enhancing the understanding of OTs, which is important for both oral maxillofacial surgeons and pathologists. Key words:Odontogenic tumors, epidemiology, world health organization classification, oral pathology.

Effect of Positioning on Oxygenation and Hemodynamics among Patients on Mechanical Ventilation

Context: The routine practice of positioning is a vital procedure in critical care units, especially when prophylaxis is the aim. For many years, nurses have recognized that positioning prevents skin breakdown, mobilizes secretions, and provides comfort without identifying the impact of different positioning strategies on pulmonary gas exchange and ventilator weaning outcomes.
 Aim: The current study was conducted to assess the effect of positioning on oxygenation and hemodynamics among patients on mechanical ventilation.
 Methods: This study was conducted in the medical intensive care unit at El-Demerdash hospital, affiliated to Ain-Shams University. A descriptive exploratory study design was utilized in this study. A purposive sample of 93 patients was recruited in the present study. A structured interview questionnaire and patient assessment record were employed to collect data related to this study.
 Results: The results reveal that 39.8% of the studied patients’ age was between 45-<65, 30.1% had chronic obstructive pulmonary disease. Oxygenation significantly decreases in the supine position at p 0.003 and increases in the semi-recumbent position at p 0.020. Heart rate is significantly increased in semi-recumbent position at p<0.005. Systolic and diastolic blood pressure significantly decreased in semi-recumbent positions at p<0.010 and p=0.021, respectively, at T30, T60, and T120.
 Conclusion: Regarding oxygenation and hemodynamics, the results of this study concluded that the best oxygenation was in semi-recumbent position T120. Regarding hemodynamics, heart rate is significantly increased in the left lateral and semi-recumbent positions. Systolic and diastolic blood pressure were significantly affected by positioning. The time of changing position should be reviewed to be compatible with the most effective position for mechanically ventilated patients considering the patient oxygenation and hemodynamic states.

Effect of Foot Massage on Incisional Pain and Sleep Pattern among Post Abdominal Surgery Patients

Background: abdominal surgery is a trans-abdominal incision. Persistent postoperative pain is a well-known consequence of this surgery. Foot massage appears to be effective in reducing incisional pain and improve sleep patterns among post abdominal surgery patients. Aim: To assess the effect of foot massage on incisional pain and sleep pattern among post abdominal surgery patients. Subjects and Methods: Design: A quasi-experimental pretest-posttest control group research design was used. Setting: The study was conducted in the surgical adult department at El Demerdash Hospital affiliated to Ain Shams University. Subject: Non-probability purposive sampling technique was used to select a sample of 200 post abdominal surgery patients and were randomly assigned into two groups, 100 for each the experimental and control groups. Three tools were used: (I) a structured interview questionnaire, (II) a numerical pain rating scale, and (III) a sleep quality index scale. Findings: The current study findings showed that during the posttest all post abdominal surgery patients had a mild level of pain in experimental compared to the majority in the control group had a mild level of pain. During the pretest majority of abdominal surgery patients had poor sleep patterns in both the experimental and control group. during the posttest, more than four fifth of the abdominal surgery patients had a good quality of sleep pattern in the experimental group and poor quality of sleep pattern in the control group was among all abdominal surgery patients. The study revealed that there was a difference between mean pretest and posttest scores were found statistically significant at p < 0.05 level in the experimental group regarding pain level and sleep pattern. Conclusion: Foot massage was found to be useful in reducing incisional pain and improving the quality of sleep patterns in post- abdominal surgery patients. Recommendations: Post abdominal surgery patients should be provided with a simple and applicable strategy to control pain and improve sleep patterns.

Pattern of intra-peritoneal intra-abdominal injuries in polytrauma patients admitted to general surgery department at El-Demerdash Hospital

Abstract Background Severe or major trauma is a worldwide pandemic and one of the leading causes of death and disability. Polytrauma always involves young, productive individuals and represents a substantial burden on the society. Aim of the Work To detect the incidence and the pattern of intra-abdominal injuries in polytraumatized patients admitted to the general surgery department at El-Demerdash Hospital and to estimate the trauma burden in General Surgery Department Ain Shams University. Patients and Methods Retrospective study of records of polytrauma patients admitted to general surgery department at El-Demerdash Hospital from the period of January 2018 to June 2018. Results In the specified study period of 6 months from 1/1 /2018 to 31/6 /2018, the ER department of Ain Shams University hospital (El-Demerdash hospital) received 3,328 cases of trauma out of which 40 cases were admitted at General Surgery Department with incidence rate 1.2% of total polytrauma patients admitted in the hospital in various departments. There were 37.5% of patients with intra-abdominal collection with no documented organ injury. Most common intra-abdominal organ injured was spleen 17.5% then liver the largest intra-abdominal organ 5% and stomach 5%, least to be injured were bowel loops 2.5%. Conclusion Polytrauma is a major health problem and a major cause of death in Egypt. 40 trauma cases were admitted to general surgery department. 80% of them were males and 20% were females. The mean age of trauma victims was 33.3 years old. 42.5% of them had surgeries. The study recorded 7.5% fatalities.

The Etiology of Portal Hypertension in Egyptian Children and Adolescents

Abstract Background Portal hypertension is a clinical syndrome in which the portal venous pressure gradient between portal vein and inferior vena cava exceeding 5mmHg. Clinically significant portal hypertension is diagnosed when clinical manifestations of the disease appear or the portal pressure gradient exceeding 10 mmHg. For better management, it is important to determine the underlying cause. Objective To evaluate the aetiology of portal hypertension in pediatric who attending the hepatology clinic at El-Demerdash hospital, Ain Shams University. Materials and Methods This cross sectional study was done in the department of pediatric hepatology clinic at El-Demerdash hospital, Ain Shams University on 91 consecutive cases of portal hypertension enrolled from 2016 to 2019. All pediatric patients were subjected to full history, clinical examination, investigations and questionnaire about effect of portal hypertension and its complications on QOL. Results Age of children and adolescent was 5 months to 16 years with mean age of 5.55±4.30y and male to female ration was 1.5:1. Out of 91 children (51, 56.1%) developed portal hypertension due to extrahepatic causes and (39, 42.9%) due to hepatic causes. In extrahepatic causes (portal vein thrombosis was found 36, (39.6%) and Budd Chiari syndrome 15(16.5%)). On the other hand, hepatic causes (cong. hepatic fibrosis (CHF) was found in 21(23.1%), cases, hepatic cirrhosis 12(13.2%), extrahepatic biliary atresia 3(3.3%) and autoimmune hepatitis with secondary hepatic fibrosis 3(3.3%)). In extrahepatic cases first variant bleed much earlier than hepatic cases. Conclusion Extrahepatic disease were the most common aetiology of portal hypertension in studied cases. Portal vein thrombosis in extrahepatic cases and congenital hepatic fibrosis in intrahepatic cases were the most common causes.

Evaluating the role of serum apolipoprotein B to serum apolipoprotein A ratio in type 2Egyptian diabetic patient with retinopathy

Abstract Background Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both. Type 2 Diabetes encompasses individuals who have insulin resistance (IR) and usually relative (rather than absolute) insulin deficiency. The pathologic hallmark of DM involves the vasculature leading to both micro vascular and macro vascular complications. Diabetic retinopathy (DR) is a chronic progressive, potentially sight-threatening disease of the retinal microvasculature associated with the prolonged hyperglycemia and other conditions linked to diabetes mellitus such as hypertension. Legal blindness due to DR is estimated to be 25 times more common among the diabetic population than in those without diabetes Objective To evaluate the role of novel serum lipid markers (serum apolipoprotein B to serum apolipoprotein A ratio) in various grades of diabetic retinopathy . Methods This study was conducted on 80 type 2 diabetic patients. Their age between 40-70 years old. There were collected from outpatient ophthalmology clinic at el Demerdash hospital, it was conducted from March to September, 2018. The study was explained to all patients and control subjects, and consent was obtained from them before starting the study. They were subdivided into 3 groups; type 2 diabetic patients with proliferative diabetic retinopathy (group I), type 2 diabetic patients with non-proliferative diabetic retinopathy (group II) and type 2 diabetic patients without retinopathy as control group (group III). Results Our results showed that the serum apo B to serum apo A ratio is higher in the diabetic patient with proliferative diabetic retinopathy than the diabetic patient with non-proliferative diabetic retinopathy. Which is higher than the diabetic patient without retinopathy. Drawing attention to the possible relationship between the serum apo B to serum apo A ratio and the progression of diabetic retinopathy. Conclusion We found that the serum apo B to serum apo A ratio is higher in the diabetic patient with proliferative diabetic retinopathy than the diabetic patient with non-proliferative diabetic retinopathy. Which is higher than the diabetic patient without retinopathy. Drawing attention to the possible relationship between the serum apo B to serum apo A ratio and the progression of diabetic retinopathy. We found a highly significant difference regarding triglycerides, total cholesterol, Apo B and B/A ratio being higher in diabetic patient with proliferative diabetic retinopathy than diabetic patient with non- proliferative diabetic retinopathy and diabetic patient without retinopathy suggesting the relation between these factors and the progression of diabetic retinopathy. We found that hypertension duration is the most independent factor affecting B/A ratio. So lowering blood pressure can decrease retinopathy progression and improve prognosis in people with type 2 diabetes especially in the first 4- 5 years.

Prevalence of Dysphagia in Dysphonic Patients with Non-Neoplastic Vocal Fold Lesions

Abstract Background Dysphagia is the swallowing difficulties and trouble to move liquids, solids, medications and may be saliva from the mouth down to the stomach and is considered a serious red flag or alarm symptom. Aim of the Work to examine the prevalence of dysphagia on basis of subjective and objective measures in patients with the presenting symptom of dysphonia and diagnosed with non-neoplastic vocal fold lesions to consider the potential benefit of swallowing therapy hand in hand with the chosen management line of voice problem in the treatment of these patients if proved to have high prevalence of dysphagia. Subjects and Methods This study was applied on 50 patients with age ranging from 15-50 years diagnosed as being dysphonic secondary to non-neoplastic vocal fold lesions on objective and clinical measures, attending at the Phoniatric outpatient clinic at El-Demerdash hospital and Ain Shams University Specialized hospital. Results After the application of the A-EAT-10 questionnaire on 50 dysphonic patients who were selected to participate in this study, 12 cases (about 24%) were considered dysphagic with score above 3 and underwent VFSS. Within these 12 patients, Zero percent were found complaining of dysphagia according to VFSS. So there is No Correlation between frequencies of dysphagia by A-EAT-10 and by VFSS. Conclusion The present study showed that non-neoplastic vocal fold lesions are not an etiological factor for dysphagia despite the intricacy in the neuromuscular supply of pharynx and larynx. Diagnosis of Dysphagia can’t be confirmed depending only on subjective screening tools like A-EAT-10.

Endovascular Laser Therapy versus Open Surgery for the Treatment of Primary Varicose Veins of the Lower Limb

Abstract Background Venous drainage of the lower extremities is accomplished by a network of superficial veins connected to the deep veins by small perforator veins. Through a variety of pathophysiological mechanisms, weakness develops in the vein wall that results in varicosity over time. Varicosities typically form in the greater and lesser saphenous veins but also develop in branch vessels. Obstruction of the iliac veins or inferior vena cava can result in extensive varicose veins Objective s: The aim of this work is to compare the outcome of endovascular laser therapy versus open surgery in management of primary varicose veins in lower limb. Patients and Methods Type of study is a prospective, randomized, clinical study. This study was conducted on 30 patients with primary varicose veins of the lower limb, 15 patients were subjected to endovascular laser therapy for treatment of varicose veins of the lower limb (EVLA group) and 15 patients were managed by standard open surgery for treatment of varicose veins of the lower limb (surgery group). The patients were randomized selected from surgery clinic in Eldemerdash Hospital. The work was carried out in the period from June 2017 to December 2018. Results Both groups were well matched regarding age(P = 0.352) and sex (P = 0.713), type of vein diseased(P = 0.913), CEAP classification (P = 0.910) and also regarding BMI (P = 0.761). Regarding preoperative venous clinical severity score, the median(IQR) for group A (surgery group) was (5), and for group B (laser group) was (5) without statistical significant differences between both groups (P value =0.524). Many studies have shown that there was some difference in between two methods of treatment of primary varicose veins of the lower limbs open vascular surgery and endovascular laser therapy. Regarding Six weeks post-operative VCSS assessment, the VCSS score in the surgery group was statistically significantly higher (p &amp;lt; 0.001). However, at one and two years after the intervention The VCSS scores converged and the difference between the groups was no longer statistically significant. Conclusion The presented results show that intreatment of varicose veins with both endovascular laser ablation and open surgery there was improvement in the clinical status of the patient occur after both but EVLA was more effective early which was observed by measuring venous clinical severity score. EVLA show distinct advantages over open surgery especially in post operative pain, analgesia use and time needed to return to work.

Neutrophil to Lymphocyte Ratio in Diagnosis of Inflammatory Bowel Disease and Correlation with Disease Severity Assessed by Ultrasound and Colonoscopy

Abstract Background Inflammatory bowel disease (IBD) is a chronic idiopathic disease affecting author the gastrointestinal tract that is comprised of two separate, but related intestinal disorders; Crohn’ s disease (CD) and ulcerative colitis (UC). The diagnosis of IBD is most commonly made on the basis of clinical features in combination with findings on ultrasonography, endoscopy and histopathology. Patients and Methods This is a crosssectional prospective observational study. This study included 40 IBD patients (19 females and 21 males), presented to Internal Medicine department, El-Demerdash Hospital, Ain Shams University from June 2018 to June 2019. Patients were matched with 10 healthy subjects (7 females and 3 males) as a control group. All patients subjected to the following: Thorough medical history, clinical examination (general and local) and laboratory investigations including complete blood count with calculation of neutrophils to lymphocyte ratio, ESR and CRP on the day of the colonoscopic procedure. US examination and endoscopic examination were done for every patient. Results Mean value of NLR in IBD patients was significantly higher than those in control group representing 3.12±1.87 and 1.88±0.42 respectively but it was statisitically insignificant between active and inactive IBD patients with best cut off &amp;gt;2,01 to differentiate active from inactive patient.THE NLR value was correllating with CRP only with no correlation with ESR,NLR value also has association with US findings that suggesting activity with best cut off &amp;gt;2.5 to detect these findings by US in active patients.US has high sensitivity and specificity in discriminating patients with moderate and severe activity from those with mild activity or those in remission but it was unable to discriminate patient of moderate activity from patients with severe activity with strong assossiation with endoscopic scores of activity. Conclusion NLR values had higher sensitivity and specificity than CRP and ESR with the benefit of being readily available with an affordable price. They are more useful when utilized together with serum laboratory inflammatory indices (CRP and ESR).

Role of MRI in Cerebral Venous Thrombosis

Abstract Background Cerebral venous thrombosis CVT is a type of stroke where the thrombosis occurs in the venous side of the brain circulation, leading to occlusion of one or more cerebral veins and Dural venous sinus. CVT is a potentially life-threatening disease, accounting for approximately 0.5 % of stroke cases. Aim of the Work The aim of this subject is to illustrate the various aspects of CVT on MRI. Patients and Methods This is a retrospective study included 30 patients (19 females &amp;11 males), their ages range from 3 months to 74 years with the median age 22 years. Mean age 22.04 years. The study was performed in radiology department El Demerdash Hospital between March 2018 &amp; September 2019. The study included patients presented to the Medical Imaging Department of Ain Shams university Al-Demerdash hospital with cerebral venous occlusion neurological symptoms or imaging diagnosis. Results In our study,. Most common presenting symptom was headache noted in 22 patients (73.3%) followed by eye manifestations (blurring of vision or clinically having papilledema) was the second most seen in 18 patients (60%). Then comes convulsions in8 patients (26.7 %), Limb weakness in 5 patients (16.7%), finally disturbed consciousness level in 4 patients (13.3%). Most common mode of onset was subacute which was seen in 16 patients (53.3%) acute onset was seen in 6 patients (20%) as predominantly isointense on T1 weighted images and hypo intense on T2 weighted images, chronic onset was seen in 8 patients (26.7%) as hypo intense signal in both T1 and T2 WIs. MRV successfully diagnosed occlusion in most cases by absence of signal intensity with consequent non-visualization of occluded sinuses or veins in almost all patients and except 3 patients; those were having just cortical veins thrombosis detected by T2* sequence electing blooming artifacts with intact sinuses, and dilated distal collaterals seen in 18 patients. Conclusion Dural venous occlusion can occur due to many factors as thrombosis, inflammatory conditions of the brain and tumors. Cerebral venous thrombosis (CVT) has long been a neglected entity because of complexities in diagnosis and non-specific clinical presentation. Conventional MRI and phase contrast MRV in conjugation with recent techniques such SWI &amp; DWI were considered more accurate diagnostic tool, non invasive, non ionizing, with high resolution in evaluating patients with suspected cerebral venous occlusion or thrombosis. It is also considered very useful to demonstrate brain parenchymal affection, the age or stage of the thrombus and its extension

Short-Term Results of Single-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy

Abstract Background It is already known that Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain is considered as a complication. Demand for secondary surgery is rising, partly for this reason, but through that study we try to discover the efficacy of conversion of failed sleeve gastrectomy to one anastomosis gastric bypass (OAGB) regarding weight loss and metabolic outcomes. Objective To asses the efficacy and safety of one anastomosis gastric bypass (OAGB) as a conversion surgery post Sleeve Gastrectomy failure as regard weight loss and metabolic outcomes. Patients and Methods This study is a retrospective cohort study which included 20 patients underwent one anastomosis gastric bypass at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt and specialized bariatric center, Cairo, Egypt From February 2019 to July 2019 with 6 months of postoperative follow up till January 2019. Results In this study, we reviewed and analyzed the outcomes from the revision of the SG due to either inadequate weight loss or weight regain to one anastomosis gastric bypass (OAGB) with %EBWL of 6.65% at 1 month, 13.61 % at 3 months and 20.86% at 6 months. Conclusion OAGB appears to be an effective and safe therapeutic technique as a revisional surgery for failed primary SG with good short-term results for treating morbid obesity and its associated comorbidities with a significantly low rate of complications. However the EBWL was less than what is reported after primary OAGB weight. Multicenter studies with larger series of patients and longer term follow up after SG revisions to OAGB are warranted.

Role of hepatic Doppler as compared to Fibro-scan in evaluation of post virus C hepatic fibrosis

Abstract Background Chronic infection with hepatitis C virus (HCV) is a disease of global importance with a large burden of morbidity and mortality. hepatitis c virus can cause progressive liver damage which may result in liver cirrhosis and hepato-cellular carcinoma . Aim of the work The aim of our study was to examine the efficacy of hepatic Doppler indices, namely hepatic vein wave form, hepatic vein maximum velocity ,hepatic artery RI and portal vein maximum velocity and portal vein wave form for evaluating the degree of hepatic fibrosis in chronic hepatitis C (CHC) patients as compared to transient elastography. Patients and methods our study was done over period from September 2018 till April 2019 included 40 patients from eldemerdash hospital designed to include all hepatitis c positive patients with any age or sex excluding other cause of liver cirrhosis (negative hepatitis B, negative auto immune hepatitis) in absence of obesity or ascites. hepatic vein maximum velocity, hepatic artery RI, portal vein maximum velocity, TE were performed to all patients. fibrosis was assessed on semi quantitative scoring system (METAVIR score ). we examine the efficacy of each of Doppler indices in differentiating different stages of hepatic fibrosis and their diagnostic accuracy in predicting significant fibrosis and cirrhosis . Results on comparing the fibrosis &amp;non fibrosis groups by TE according to Doppler measurement we found statistically significant higher means of the portal vein maximum velocity (PVmax) for the non fibrosis group as compared to the fibrosis group (24.15±9.71 and 15.94±3.35 respectively with p value&amp;lt;0.001) also found significantly lower HAPSV/PVmax ratio for the non fibrosis as compared to fibrosis group (1.58±0.41 and 2.59±1.17 respectively with p value 0.011) finally, we found that there was significant change of the HV waveform pattern for the non fibrosis (normal triphasic ) as compared to fibrosis (monophasic or biphasic ) (x2=4.353 with p value 0.038)

Assessing Perception of Role Transition among Nurse Interns

Context: Nursing roles today constitute a vast and complex system. Nurse interns need to know their future roles to facilitate and prepare them socially to work professionally and decrease the reality shock when going outside to the labor market.&#x0D; Aim: This study aimed to assess the perception of role transition among nurse interns.&#x0D; Methods: The study was conducted in four hospitals affiliated to Ain Shams University where nurse interns have their training, namely Ain-Shams University Hospital (5 units), El-Demerdash Hospital (2 units), Pediatrics Hospital (3 units), and Cardiovascular surgery hospital. A convenient sample of all available nurse interns who started their internship in 2018 and their total number were100. Data collections included a role perception questionnaire to assess the perception of role and role transition knowledge questionnaire to assess role transition knowledge among nurse interns.&#x0D; Results: The present study revealed that most of the interns had low total roles perception, among 51% of the studied interns, and low total knowledge level regarding role transition among 70% of the studied interns.&#x0D; Conclusion: The study concludes a low total level of role perception among more than half of the studied nurse interns and a low total knowledge level of role transition among nearly three quarters. A statistically significant relationship was revealed between nurse interns' total transition knowledge score and their age, gender, and training program attendance.&#x0D; The study recommended conducting a training program and continuing education for the nurse interns to promote their perceptions about their role and role transition. Further studies for studying the relationship between role transition process and stress among nurse students and assessing the clinical learning needs of nurse interns periodically are recommended. Besides, develop a training program for them to the challenges facing in clinical practice.

Effect of platelet-rich fibrin on the donor site of Split thickness skin graft in burn patients

Background: Patients with massive burn areas have now a greater chance of survival thanks to improved modalities of new treatments. In some patients it is necessary to harvest multiple skin grafts from the same donor site which is restricted by the quality of the skin and the time required to recover; this procedure can take a long time and may increase the danger of bacterial contamination, resulting in increased morbidity and mortality in these individuals. Platelet-rich fibrin is one of the newest autologous growth factors utilized for wound management. PRF application can significantly improve the wound's condition by supplying growth factors to the wound environment, which aid in the epithelialization process's acceleration, resulting in cost-effective wound management. This will allow multiple harvesting from the same donor site, reducing costs, hospitalization time, scars, and co-morbidities. Aim of the Work: To assess the role of PRF in accelerating wound healing in the donor site following skin grafting in burn patients.patients and Methods: This prospective, controlled, clinical trial study was done from April 2020 to April 2021 included 20 patients at the burn unit of El Demerdash Hospital Ain Shams University.Results: The current study showed that healing days in donor sites injected with PRF were lower than those of controlled areas with statistical significance. Mean epidermal thickness was lower in the control area than PRF injected areas with statistical significance.Conclusion: PRF can significantly decrease the time of donor wound healing compared to that of conventional treatment.

Effect of Discharge Plan on Satisfaction of Patients with Lumbar Disc Herniation Surgery

Background: Discharge planning for patients undergoing lumbar disc herniation surgery is considered as a strategy for promoting their satisfaction at home and in the community. Aim: This study aimed to evaluate the effect of discharge plan on satisfaction of patients with lumbar disc herniation surgery through the following: 1) Assessment of needs of patients with lumbar disc herniation surgery.2) Developing and implementing discharge plan for patients with lumbar disc herniation surgery based on needs assessments 3) Assess the effect of discharge plan on satisfaction of patients with lumbar disc herniation surgery Study design: a quasi-experimental design was utilized to conduct this study. Setting: The study was conducted in neurosurgical ward at El- Demerdash hospital and outpatient clinic at Ain Shams University Hospital which affiliated to Ain Shams University. Subject: A purposive sample of 60 patients with lumbar disc herniation surgery were selected according to certain inclusion criteria. The sample size was determined statistically by power analysis considering the total number of patients with lumbar disc herniation surgery in El Demerdash hospital during the year (2016). Data collection: 1) Patients’ Interviewing questionnaire. and 2) Patient Satisfaction tool. Results: the present study revealed that, mean age of the patients under study was 39.58±8.69and 60% of them were female and There were a highly statistically significant difference among patients under study throughout discharge planning phases regarding their knowledge, There were statistical significant relations between patients' total satisfactory level of knowledge and their satisfaction level three months after implementing discharge plan. Conclusion: Application of discharge planning regarding lumbar disc herniation surgery has a positive improving effect on patients' satisfaction level Recommendations: The discharge plan should be available in the neurosurgical department and clinic for all patients who will be undergoing lumbar disc herniation surgery and should be updated periodically

Comparative Study between Anterior and Lateral Approaches of Laparoscopic Splenectomy

Abstract Background: The primary basis of treatment for ITP and many hematological disorders was splenectomy. There are many approaches and techniques that have evolved for splenec-tomy. Reports of laparoscopic splenectomy began appearing in the literature in 1991 and 1992. Over time it has become the standard for elective splenectomy for both benign and malignant indications although open splenectomy remains perfectly acceptable for all indications as well. Laparoscopic splenectomy developed many techniques and approaches through last years, examples of these are anterior approach laparoscopic splenectomy, lateral approach laparoscopic splenectomy, single port laparoscopic splenectomy, hand assisted laparoscopic splenectomy (HALS). Aim of Study: The goal of this study is to compare lapar-oscopic splenectomy anterior and lateral approaches, including operative time, blood loss, surgical complications, conversion to open surgery, postoperative morbidity, postoperative length of stay, number of trocars used and blood transfusion require-ments in each approach. Materials and Methods: The present study was a rand-omized controlled prospective study with 40 patients. Indicated for splenectomy at El-Demerdash Hospital between 2018 and 2020, splenectomy was done by the same surgical team. The 40 cases in our sample were obtained from Ambulatory Clinics in University Hospitals in Ain-Shams. The closed envelope system split the patients into two classes: Group 1 including 20 patients underwent laparoscopic splenectomy using anterior approach, group 2 including 20 patients underwent laparoscopic splenectomy using lateral approach. The inclusion criteria were all adult patients indicated for surgery, fit for anesthesia and consented to participate in the study, aged between 18 to 60 years with a diagnosis of: Hematological disorder (Idio-pathic thrombocytopenic purpura ITP, Thrombotic Thrombo-cytopenic Purpura TTP, chronic hemolytic anemia except sickle cell disease), hydatid cyst, splenic tumor; as lymphoma, felty syndrome and sarcoidosis. We excluded patients with bleeding tendency due to causes other than ITP, patients with previous upper laparotomies, patients with generalized diseases that contra-indicates laparoscopic maneuvers, patients with huge splenomegaly with longitudinal axis more than 20cm and pregnancy.Results: In the present study; there were statistically important ties between the types of approach used and both operative time and number of ports., we found that the lateral approach had a shorter operative time; as well as, the number of ports was less in lateral approach. On the contrary there was no statistically significant difference between two types of approach in terms of age, body mass index (BMI), gender, indication of surgery, complete blood count (CBC) findings, spleen size, blood loss, vascular or visceral injury, conversion to open surgery, hospital stay and post-operative complications (chest infection, wound infection, pancreatic leak and acute gastric dilatation). Conclusion: We find that for laparoscopic splenectomy, the lateral approach has a greater intraoperative benefit than the anterior approach. The lateral solution was connected to much shorter operative times and a smaller number of ports.

OUTCOME OF MINI GASTRIC BYPASS AFTER FAILED VERTICAL BAND GASTROPLASTY IN TREATMENT OF MORBID OBESE PATIENTS

Background: Bariatric surgery has long been introduced for weight control if conservative treatment failed and was widely accepted in the past decades. Compared with nonsurgical strategies, bariatric surgery proves more effectiveness for moderately to severely obese people to lose weight. Besides, bariatric surgery was demonstrated to induce significant and long-term remission of obesity related comorbidities.Aim of The Work: The aim of this study to review the outcome of Mini gastric bypass as a line of management of failed VBG operation in treatment of morbid obese patients as regard weight loos, intraoperative complications, postoperative complications and other comorbidities within one year follow up after operation.Patients and Methods: Our study includes thirty (30) morbidly obese patients who fulfilled the criteria for bariatric surgery with BMI >40 or >35 with associated co-morbidities with failure of previous restrictive operation (VBG). These patients were enrolled in a prospective study and had a retrospectively gathered outcome analysis at the department of surgery Ain-Shams University Hospitals. Our study was conducted in El-Demerdash hospital, Ain- Shams University. Thirty patients were selected and operated upon from June 2017 till June 2019 and followed up to June 2020.Results: In our study causes of revision in (30) patients: weight regain (10) patients severe GERD (9) patients, un satisfactory weight loss (8) patients, eating difficulties (3) patients. In our study The mean initial BMI for the patients was The preoperative BMI with mean ± SD: 42.9 ± 7.21 kg/m2, was higher than post-operative BMI at 3 months with mean ± SD value of 38.03± 5.62 kg/m2), than post-operative BMI at 6 months with mean ± SD value of 33.98 ± 4.58 kg/m2, than post-operative BMI at 12 months with mean ± SD value of 29.22 ± 3.60 kg/m2.Conclusion: Mini-gastric bypass offers major benefits with quite satisfactory results over most alternative procedures. Our data, which includes follow up of two years, indicates that mini gastric bypass is: An effective procedure for the treatment of failed restrictive procedure (VBG). Technically feasible. Safe operation with a low rate of major postoperative complications. Has a significant reduction in patient’s hospital stay. Helps in the achievement of a significant weight loss and improvement of obesity related metabolic co morbidities. Efficient in loosing excess weight and in maintaining the weight loss. so it is considered a promising revisional bariatric procedure operation for patients with failed prior open or laparoscopic VBG

ASSESSMENT OF URINARY IODINE LEVEL AND ITS RELATION TO THYROID FUNCTION IN SAMPLE OF EGYPTIAN PREGNANT FEMALES IN 1ST TRIMESTER

Background: Thyroid disorders are considered the second most common endocrine disorders affecting women during their reproductive years and can impact up to 4% of all pregnancies. Of all thyroid disorders, hypothyroidism is the most prevalent, impacting approximately 2- 3% of all pregnancies. Hyperthyroidism is far less prevalent, impacting approximately 0.2% of all pregnancies.Aim of the Work: To assess the level of urinary iodine in 1st trimester of pregnancy and its relation with thyroid hormones level and autoimmunity status.Subjects and Methods: To elucidate this aim 100 healthy pregnant female in their 1st trimester of pregnancy were included in the study. They were collected from Obstetrics and Gynecology Department El Demerdash hospital and Dar El shefa Hospital in the period from September, 2020 to November, 2020.Results: Median urinary iodine was 55(41.0-76.0) μg/l and their was99 females had insufficient iodine intake less than 150μg /l, one had adequate intake (150-249) μg /l and none showed more than necessary intake (250-499) μg /l or excessive intake more than 500 μg /l. As regard thyroid ultrasound there was normal Thyroid volume in 94 subjects,(94.0%)., increased volume in 6 subjects (6%). There was a Significant negative correlation between each of the following the age and the gestational age; and urinary iodineConclusion: There was a significant iodine deficiency in pregnant women within the study area, indicating that some women may need to increase their iodine intake during pregnancy. Additionally, diagnosis and treatment of thyroid dysfunction during pregnancy should be based on pregnancy and method specific reference intervals, and more detailed staging is needed to assess pregnant women's thyroid function.

Risk of bleeding after plasmapheresis!

Background: Plasmapheresis is a growing up method used for treatment of many diseases. it is considered as first line therapy for different diseases. During this therapeutic modalities there is an undesirable l removal of coagulation proteins particularly fibrinogen. Aim The aim of the present study was to assess the presence or absence of bleeding risk following therapeutic plasmapheresis. This was done by assessment of fibrinogen level pre and post plasmpharesis in different indication including the renal and non-renal disorders.Methods: The present case control study was conducted on 40 persons from El-Demerdash Hospital in Ain Shams University from the period of May 2019 till November 2019. The study was approved by the hospital’s research ethics board. The 40 patients were divided into 2 groups according to presence or absence of renal disoredes as renal and non-renal indication for plasmapheresis, Fibrinogen level, aPTT, INR were estimated pre and post session of plasmapheresis. Also, all patients were observed during plasmapheresis session and for 72 hours later for clinical evidence of bleeding tendency.Results: Fibrinogen levels and aPTT were reduced significantly following plasmapharesis but without increased risk of bleeding.Conclusions: Fibrinogen level should be assessed in patients undergoing plasmapheresis especially those indicated for invasive maneuvers or surgery following plasmapheresis.

Can the nutritional condition of chronic obstructive pulmonary disease patients influence the dyspnea severity and quality of life?

Background and objective Nutritional impairment is a frequent issue in patients with chronic obstructive pulmonary disease (COPD) and has a negative effect on both morbidity and mortality. Therefore, this study was designed to explore the nutritional condition of stable COPD patients and to investigate their influence on dyspnea severity and quality of life (QoL). Patients and methods This case–control study was done on 100 stable COPD patients greater than or equal to 65 years old and 80 healthy controls who visited the outpatient clinic of El Demerdash Hospital between January 2019 and December 2019. All patients underwent spirometry and finished the Arabic version short form of the ‘mininutritional assessment’ test. Their dyspnea severity and QoL were also assessed. Results The patients were divided into three groups according to short form of the ‘mininutritional assessment’ test results: well-nourished (n=24, 24%), at risk of malnutrition (n=31, 31%), and malnourished (n=45, 45%). About 90.6% of malnourished patients had dyspnea grade 4; their mean score of COPD assessment test was 36 and they also had the lowest values of spirometric parameters. Conclusion About 45% of stable COPD patients were malnourished; they had a high sensation of dyspnea (higher modified Medical Research Council dyspnea grade) and poorer QoL (high COPD assessment test score).