El-Hussein University Hospital Research Articles

RETRACTED ARTICLE: Oxytocin versus a combination of tranexamic acid and ethamsylate in reducing intraoperative bleeding during abdominal myomectomy: a randomized clinical trial

ObjectiveMyomectomy is the preferred surgical approach to manage uterine fibroids. However, uterine fibroids are highly vascular tumors and, consequently, extremely susceptible to problems from myomectomy-related hemorrhage. Hence, we aim to compare oxytocin efficacy and safety profile versus tranexamic acid (TA) with ethamsylate for reducing bleeding during myomectomy.MethodsThis randomized, double-blinded multicenter study was performed between 20th August 2020 and 20th October 2020 at El-Galaa Teaching Hospital, El Hussein University Hospital, Al-Azhar University Hospitals of Assiut, and Al-Azhar University Hospitals of Damietta. One hundred and eighty patients were enrolled and divided into three groups: group (1) received an injection of 30 IU of oxytocin in 500 ml of normal saline; group (2) received injections of 1 g of TA, 250 mg of Ethamsylate, and 110 ml of normal saline IV; and group (3) received an injection of 110 ml of normal saline IV just before surgical incision.ResultsIn 180 premenopausal women, oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy (666.25 ± 183.03, 630.72 ± 145.83, and 646.67 ± 168.92, respectively (P = 0.506)). Non-significant trends were observed for a reduction in operation time (P = 0.760), intra/postoperative blood transfusion (P = 0.624), hospital stay (P = 0.986), postoperative fever (P = 0.659), and wound infection (P = 1).ConclusionOxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy which opens a new question about the role of the use of the hemostatic drug during myomectomy especially in centers with limited resources and had higher rates.Trial registrationThe study was registered on Pan African Clinical Trials Registry with the following number: PACTR202008739887429 and was approved on 24/08/2020.

New biomarkers for diagnosis of polycystic ovary syndrome

Background and aim The popular endocrine syndrome happening in women of reproductive age is polycystic ovary syndrome (PCOS). It is long understood that chronic ovaries with many tiny cysts, hyper vascularized androgen-secreting stroma, signs of extra androgen, and menstrual cycle irregularity are all related. The aim was to compare several biochemical measures in women with PCOS and age-matched control for a definite diagnosis of PCOS by using by using anti-müllerian hormone (AMH), sex hormone binding globulin (SHBG), total testosterone, serum insulin and lipid profile. Patients and methods Case-control research had been performed for patients who were admitted to El-Hussein University Hospital and EI-Minia University Hospital, Department of Obstetrics and Gynecology. The study included two matched groups: group (1) involved 40 eligible women sonographically evaluated and biochemically diagnosed with PCOS (cases group). Group (2): equal number of normal women 40 in a ratio of 1 : 1 had been chosen in the (control group). Results Mean value of triglycerides, low-density lipoprotein (LDL), total cholesterol, and very LDL had been greater between the cases group than the control one although there had been no variation among cases and controls regarding high density lipoprotein (HDL). Mean value of serum insulin and homeostasis model assessment-estimated insulin resistance (HOMA-IR) had been greater between cases group than the control. Conclusion This research confirms that obese women having PCOS have atherogenic lipoprotein profiles that are marked by elevated levels of cholesterol, LDL, and triglycerides and could be a danger point for later leading to cardiovascular complications.

Toxicity Profile of Intensity Modulated Radiotherapy Vs. 3D-Conformal Radiotherapy in Head and neck cancer: A Retrospective study

Background: Most head and neck patients have historically been treated with photon-based radiation techniques such as intensity modulated radiation therapy (IMRT), there is a growing awareness of the potential clinical benefits of proton therapy over IMRT in the definitive, postoperative and reirradiation settings given the unique physical properties of protons. Aim of the work: to assess toxicity profile of IMRT in comparison to 3D conformal radiotherapy (3DCRT) and to assess predictors for progression free survival and overall survival rates. Patients and Methods: This retrospective cohort study included 131 head and neck cancer patients who were recruited from El Hussein University Hospital over 10 years then they were divided into 2 groups according to the type of radiotherapy. Results: Both groups were comparable regarding age, sex and associated medical disorders except for ischemic heart disease and smoking. Sites of primary tumors were comparable except tongue and nasopharynx. Most of 3DCRT group received TPF as induction chemotherapy and most of IMRT group received concurrent chemotherapy. Dose of irradiation was higher significantly among IMRT group. Grades of early and late toxicity were higher among 3DCRT group. There was no statistically significant difference between both groups regarding response to treatment. Mortality cases were higher significantly among 3DCRT group. Cox regression analysis was performed to assess predictors for progression free survival and overall survival in each group. Conclusion: IMRT provide good choice as radiotherapy technique for head and neck cancers with adequate efficacy similar to other techniques and better toxicity profile.

A case oriented study: Whole genome sequencing (WGS) on a wild urease negative Proteus mirabilis isolated from deep surgical site infection (SSI) at El Hussein University Hospital, Al Azhar University Cairo, Egypt

A case oriented study: Whole genome sequencing (WGS) on a wild urease negative Proteus mirabilis isolated from deep surgical site infection (SSI) at El Hussein University Hospital, Al Azhar University Cairo, Egypt

Effect of moderate iron deficiency anemia during pregnancy on maternal and fetal outcome.

Background: The most frequently identified dietary deficiency worldwide is iron deficiency, especially during pregnancy. Aim of the Work: To evaluate the impact of moderate maternal iron deficiency anemia on maternal outcome (atonic postpartum hemorrhage or postpartum infections after delivery), and fetal outcomes (neonatal weight and Apgar score). Patient and Methods: This study was carried out at El Hussein University Hospital and Om El-Masryeen General Hospital on 100 pregnant females, who were admitted to the labor ward for delivery. They were split into two equal groups after the assessment of hemoglobin levels. The first group included non-anemic pregnant women and the second group included pregnant women with moderate iron-deficiency anemia. After delivery, the maternal outcome was assessed for atonic postpartum hemorrhage or postpartum infections and all newborns were assessed for neonatal weight and Apgar score. Results: After delivery, the discrepancy in the rate of atonic postpartum hemorrhage, postpartum endometritis, post-cesarean wound infection, and episiotomy wound infection among both groups was statistically insignificant (P value 0.204, 0.307, 0.485, 0.481 respectively). There were positive correlations between maternal parameters (maternal serum hemoglobin, MCV, MCH, serum iron, and serum ferritin) and fetal outcomes (neonatal weight and Apgar score). There were negative correlations between maternal total iron-binding capacity (TIBC) and fetal outcomes (neonatal weight and Apgar score). Conclusion: Maternal iron deficiency anemia affects both maternal and fetal outcomes. Keywords: Iron deficiency anemia; Maternal outcome; Fetal outcome.

Effect of high levels of human chorionic gonadotropin and estradiol on degree of hyperemesis gravidarum

Hyperemesis gravidarum is a condition that affects pregnant women (HG),serum levels of human chorionic gonadotropin (hCG) and estradiol are increased than in pregnant women who are not influenced.Objective:This study's major goal was to learn moreabout how elevated human chorionic gonadotropin levels and estradiol affect the intensity of hyper emesis gravidarum during the first trimester.Methods: At El Hussein University Hospital, our prospective study was conducted from May 2020 to Nov. 2020; duration of the study was 7 months. The key sign of severe Hyper Emesis Gravidarum was a lengthy in the hospital (HG).The term extended hospital stay describedas ≥4 days, as this cut-off value demarcates the top quartilef orhospitalization timein our study population. Results: There was a highly significant difference between cases with hospital stay< 4 days and cases with hospital ≥ 4 days as regard HCG, cases with longer have higher median HCG (300637) compared to cases with

Comparison of Intra-Articular versus Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Study

Background: Total Knee Arthroplasty (TKA) is widely used in clinical applications. Considerable postoperative blood loss, however, is an unavoidable occurrence due to the extensive soft-tissue release, and the large area of cancellous bone osteotomy associated with the procedure. Besides, knee flexion and extension activities those begin the day after the operation adds to the problem. Aim of the Work: To compare between the intra-articular and the intravenous application of Tranexamic Acid (TXA) in total knee arthroplasty. Patients and Methods: It is a prospective Double-blinded Randomized controlled trial. This prospective study was conducted at El-Hussein University Hospital &amp; El Agouza Hospital on 30 patients who undergo total knee arthroplasty and fulfill all inclusion and exclusion criteria. Results: The results were the average total blood loss in the drain after 48hrs. In the 1st group was 365±74.722 while average blood loss in the 2nd group was 575±88.976. This indicates a significant decrease in blood loss in the 1st group (intraarticular TXA group) than the 2nd group (intravenous TXA group) the P value &lt;0.001 which is highly significant. It was found that The decrease in Hb level is less in the 1st group than in the 2nd group which indicates less postoperative anemia in the blood count, the P-value &lt;0.05 considered significant.

Effect of An Educational Guidelines on Compliance level Regarding Standard Precautions Measures among the Operating Room Nurses

Background: The Operating Room (OR) is considered one of the high-risk areas in hospital that encounter high rate of infection and mortality. Standard precautions considered as barriers and work practice controls established to prevent sharp injuries and blood exposure. Aim: This study aims to assess the effect of an educational guideline on compliance level regarding standard precautions measures among the operating room nurses. Research design: A quasi- experimental design was used in this study. Setting: The present study was conducted at the operating room unit at El-Hussein University Hospital. Subjects: A convenience sample of all available nurses (40) who are working in operating room unit at El-Hussein University Hospital and accept to be in the study was selected as a study sample. Data collection tools: Nurses' structured self-administered questionnaire, nurses' compliance self-reported scale and nurses' practices observational checklist. Results: Regarding the total level of knowledge and practices regarding to infection control among operating room nurses the present study reported that all of the study nurses had unsatisfactory level of total knowledge and practices at pre educational guidelines implementation phase, while this level was improved at post and follow up phases. Regarding the total compliance level with standard precautions, the present study revealed that all of the study nurses had low level of total compliance pre educational guidelines implementation phase, while compliance level was improved at post and follow up phases. Regarding correlation between total level of knowledge, practice and compliance with standard precautions measures post educational guidelines implementation, the present study showed that there was highly positive correlation between total level of knowledge, practices and compliance with standard precautions measures among the operating room nurses post educational guidelines implementation. Conclusion: This study concluded that the educational guidelines for nurses’ in the operating room was effective in improving their compliance level (knowledge, practices and self-reported compliance) regarding standard precaution measures, so the study results supporting the hypothesis of the present study. Recommendation: The importance of periodic in-service training program for nurses in OR regarding compliance standard precautions of infection control for continues updating their knowledge and focusing on areas of non-compliance and close supervision is needed to ensure that quality of care is provided by nurses while compliance standard precautions of infection control.

CORRELATION BETWEEN MYOCARDIAL PERFUSION IMAGING AND CAROTID ULTRA-SONOGRAPHY IN PATIENTS WITH CHEST PAIN

Background: Atherosclerosis is a major risk factor for coronary artery disease (CAD). Carotid ultrasound (U/S) may be a useful method for prediction of CAD through measurement of intimio-media thickness (IMT) of right and left common carotic arteries. Objective: To emphasize the correlation between myocardial perfusion imaging using single photon emission computed tomography (SPECT) and carotid ultrasound through measuring IMT in early prediction and diagnosis of CAD. Patients and methods: The study included 80 patients complaining from chest pain. Single photon emission computed tomography (SPECT) and carotid U/S were done to each of them. All Patients were recruited from El-Hussein university hospital outpatient clinic and Kobry El-Koba military hospital outpatient clinic between February 2020 and November 2020. Results: The study included 80 patients, 57 of them were males while 23 of them were females. 52 patients were hypertension (HTN), 31 patients were diabetes mellitus (DM), 33 patients were smokers, 15 patients of them had positive family history. 52 patients had positive SPECT stress test revealing CAD “ischemic group”, while 28 of them had negative SPECT stress test “Non-ischemic group”. For the ischemic group, 43 patients (82.7%) had increased intimio-media thickness IMT. Right IMT mean ± SD “0.69±0.10”, t-test “7.771”, weighted Kappa test 0.655 substantial agreement and P-value “p <0.001”. Lefy IMT mean ± SD “0.77±0.12”, t-test “5.122” , weighted Kappa test 0.614 substantial agreement and p-value “p <0.001”. Only 9 patients (17.3%) from the ischemic group had below 75th percentile IMT. For Non-ischemic group, only 9 patients (32.1%) had abnormal IMT while the other 19 patients (67.9%) had normal IMT. Conclusion: Carotid ultrasound and intimio-media thickness are good predictors and highly correlated to coronary artery disease.

SUBLINGUAL MISOPROSTOL VS SUBLINGUAL MISOPROSTOL WITH VAGINAL ESTRADIOL FOR LABOR INDUCTION

Background: Induction of labor is usually performed when the risks of continuing pregnancy are higher than the benefits of delivery. Uterine cervical tissue ripening or its softening has a close relationship with success rate of delivery. Objective: To compare the safety and effectiveness of sublingual misoprostol with combined sublingual misoprostol and vaginal estradiol for induction of labor in unfavorable cervix. Subjects and methods: This was a prospective single blinded study conducted in Obstetrics and Gynecology Departments, El-Hussein University Hospital ELAlamin Standard Hospital, Matrouh including 160 women with unfavorable cervix and gestation ≥ 40 till 42 weeks with clinical indication for induction of labor. They would be randomly assigned to either the misoprostol+ placebo or misoprostol+ estradiol. The duration of the study was 12 months from 01 May 2019 till 01 may 2020. Results: Women’s Time to active labor in women with misoprostol+ placebo ranged between 5-9 hours with mean± S.D. 6.99±1.419 hours while in women with misoprostol+ estradiol was ranged between 5-9 hours with mean± S.D. 6.96±1.400 hours. There were no statistically significant differences between groups. Conclusion: Sublingual misoprostol alone was as effective as sublingual misoprostol and vaginal Estradiol for induction of labor at term.

SUBLINGUAL MISOPROSTOL VS SUBLINGUAL MISOPROSTOL WITH VAGINAL ESTRADIOL FOR LABOR INDUCTION

Background: Induction of labor is usually performed when the risks of continuing pregnancy are higher than the benefits of delivery. Uterine cervical tissue ripening or its softening has a close relationship with success rate of delivery. Objective: To compare the safety and effectiveness of sublingual misoprostol with combined sublingual misoprostol and vaginal estradiol for induction of labor in unfavorable cervix. Subjects and methods: This was a prospective single blinded study conducted in Obstetrics and Gynecology Departments, El-Hussein University Hospital ELAlamin Standard Hospital, Matrouh including 160 women with unfavorable cervix and gestation ≥ 40 till 42 weeks with clinical indication for induction of labor. They would be randomly assigned to either the misoprostol+ placebo or misoprostol+ estradiol. The duration of the study was 12 months from 01 May 2019 till 01 may 2020. Results: Women’s Time to active labor in women with misoprostol+ placebo ranged between 5-9 hours with mean± S.D. 6.99±1.419 hours while in women with misoprostol+ estradiol was ranged between 5-9 hours with mean± S.D. 6.96±1.400 hours. There were no statistically significant differences between groups. Conclusion: Sublingual misoprostol alone was as effective as sublingual misoprostol and vaginal Estradiol for induction of labor at term.

Risk Analysis of Specific Environmental Heavy Metals as a Trigger of CD4 &amp; CD8 Among Cases of Multiple Sclerosis:Case - control study.

Background: Environmental pollutants might be among the etiological factors for multiple sclerosis. The high rise of CD8 and CD4 are the common accepted pathway for the chronic inflammation to myelin sheath proteins developing the different clinical types of MS. Objectives: To measure the level of blood lead, cadmium, mercury, CD4 and CD8 among the different clinical types of MS cases compared to controls, to find out if there is correlation between the level of the measured heavy metals and the degree of disability among the studied cases of multiple sclerosis. Methodology: Case-Control study was conducted at El Hussein University Hospital, Cairo, Egypt during the period (April 2017- February 2020). The calculated sample size was 50 for cases and controls. Subjects were selected by simple random technique. Results: Mean blood lead of cases was higher that observed among controls (62.1±3.2 μg/L versus 19.3±1.5μg/L) with statistical significant difference p=0.000001). In regard to blood mercury: mean among cases was higher than controls (25.1 ± 0.88 μg/L versus 2.3 ± 0.2 μg/L) with statistically significant difference between two groups by Levine’s t test (t=5.5, p=0.000001). There was a positive correlation between lead and Mercury with CD4 and CD8 among cases of Relapsing Remitting MS and among cases of Primary Progressive MS. Conclusion: Lead and Mercury might be a risk factor for trigger CD4 and CD8 among the studied cases of MS.

Pulmonary versus Extrapulmonary Acute Respiratory Distress Syndrome: Clinical Characteristics and Outcome

Abstract Background: Acute respiratory distress syndrome is a clinical syndrome characterized by a refractory hypoxemia due to an inflammatory and high permeability pulmonary edema secondary to direct or indirect lung insult (pulmonary and extrapulmonary form). These two categories of ARDS patients are different regarding the respiratory mechanics, lung recruitment, gas exchange, and positive end-expiratory pressure response. Aim of Study: The aim of this work was to compare the clinical characteristics and outcomes between the two major ARDS subtypes; pulmonary and extrapulmonary. Patients and Methods: A prospective study was conducted during the period from July 2014 to January 2016 in Intensive Care Unit, El-Hussein University Hospital. It included 60 patients diagnosed as ARDS. They were subclassified into pulmonary and extrapulmonary ARDS groups according to the cause of lung injury. Both groups were compared regarding the clinical features, response to treatment and clinical outcome. Results: Patients with extrapulmonary ARDS developed more deteriorated liver and renal functions and arterial blood gases with a better response to elevated levels of PEEP and vasopressors with a mortality rate of 75%. In patients with pulmonary ARDS, mild organs dysfunction were developed with a better response to low levels of PEEP and a mortality rate of 25%. Conclusion: Subdivision of ARDS into pulmonary and extrapulmonary categories has worthy effect on both treatment and clinical outcome. Additionally, they are different in the degree of organ dysfunction and severity of clinical pictures. Recommendation: Proper assessment of patients with ARDS at admission to put them within a major category whether pulmonary or extrapulmonary ARDS. This simple classification will help physician to decide on treatment and to predict prognosis.

Histopathological patterns of endobronchial lesions and the role of flexible fiberoptic bronchoscopy in their diagnosis

Background Flexible bronchoscopy has become the most commonly used invasive procedure in pulmonary medicine used for diagnosis of multiple lesions of respiratory system presenting as endobronchial mass lesions, either benign or malignant in nature.Aim The aim was to detect the histopathological patterns of endobronchial lesions and the role of flexible bronchoscopy in their diagnosis.Patients and methods This is a retrospective study of bronchoscopy reports especially with endobronchial mass lesions diagnosed by fiberoptic bronchoscopy, which was performed at Chest Department, El-Hussein University Hospital, Al-Azhar University, over a period of 5 years from January 2012 to December 2016.Results The fiberoptic bronchoscopy was helpful in the diagnosis of endobronchial mass lesions in 65 (28.7%) patients of 350 patients who underwent bronchoscopy during this period. Their age ranged from 15 to 80 years. The patients comprised 35 males and 30 females. Overall, 42 (65%) lesions were malignant, 18 (28%) lesions were benign, whereas five (7%) lesions were inconclusive. Diagnostic yield was ∼92.3%. Repeat bronchoscopy for inconclusive results improved the diagnostic yield.Conclusion Fiberoptic bronchoscopy is the most important tool in pulmonary medicine used in the diagnosis of malignant as well as benign lesions that present as endobronchial mass lesions that mimic each other on visual impression, and thus adequate sampling is an essential diagnostic modality for confirming the diagnosis of such lesions.

Diagnostic experience of flexible fiberoptic bronchoscopy in al-azhar university hospital

Background Fiberoptic bronchoscopy (FB) is an endoscopic technique for visualizing the inside of the airway for diagnostic and therapeutic purposes. FB is a simple, useful examination suitable for investigation without general anesthesia. Aim We aimed to report our 5-year experience with the diagnostic yield of FB at the Al-Azhar University Hospital. Patients and methods A retrospective review of bronchoscopy reports was performed at the Chest Department, El-Hussein University Hospital, Al-Azhar University, during the 5 years from January 2012 to December 2016. Data collected were encoded into MS Excel 2017 for windows XP professional. Age was presented as mean. Due to the descriptive nature of this study; all other data were presented as percentage. The calculation was done using Excel. Results Bronchoscopy was successful for giving a final diagnosis in 275 (78.6%) patients out of 350 patients. Of these, 190 patients were men and 160 patients were women. Malignancies were diagnosed in 66.3% of cases; tuberculosis was diagnosed in 2.8%; and interstitial lung diseases were diagnosed in 3.7% of cases. Conclusion FB can be performed easily in hospitals with appropriate preparation, observation, and attachment to protocol. This study confirms that FB is a valuable diagnostic tool, with low cost and low rates of complication, particularly in patients with lung cancer. Bronchoscopists face many challenges to reach the correct diagnosis of peripheral lung diseases. Some diagnostic bronchoscopies fail to reach the diagnosis, so bronchoscopy can be repeated or search for other diagnostic modalities. Bronchoscopy, performed under local anesthesia in the endoscopy suite, gives a solution in most cases with minimal complications. Recommendation Every pulmonologist should be aware and well trained in bronchoscopy.

Assessment of Nursing knowledge and Practices in Caring of Neonatal Intestinal Obstruction

Background: Intestinal obstructions are the most common surgical emergencies in the neonatal period. Nurses play an important role in caring of neonates with intestinal obstructions includes pre-operative care and post-operative care. This study aimed to: Assess nurses' knowledge and practices in caring for neonates with intestinal obstruction. Setting: This study was conducted at the Neonatal Intensive Care Units (NICUs) in El-Kasr Al-Ainy University Hospital and El-Hussein University Hospital. Design: A descriptive design was used. Sample: A purposive sample of 86 nurses included in the study working at the previously mentioned setting. Tools: The first tool is a predesigned questionnaire sheet to assess nurses' knowledge about neonates with intestinal obstruction; the second tool was observational check list to assess nurses' practices for neonates with intestinal obstruction. Results: Revealed that less than two thirds of the studied nurses had unsatisfactory level of knowledge regarding neonatal intestinal obstruction. While less than three quarters of the studied nurses had incompetent level of practices regarding care of neonates with intestinal obstruction. Conclusion: This study concluded that the majority of the studied nurses had unsatisfactory level of knowledge. While most of the studied nurses had incompetent level of practices regarding neonatal intestinal obstruction. There were statistically significance relation between total level of the studied nurses' knowledge and their practice. Recommendations: Collaboration and continuing education of the pediatric nurses staff in the NICUs are vital to improve their knowledge and practices about care provided for neonates with intestinal obstruction.

Effect of Nursing Guidelines on the Severity of Frozen Shoulder among Patient with Artificial Implanted Pacemaker

Background: Cardiac implanted pacemaker technique and therapies play an essential role in the treatment of some clinical heart disease. These disorders include bradyarrhythmias resulting from dysfunction of the sinus node or the atrioventricular node; implantable pacemakers consider as a life-sustaining devices that can return patients to a normal quality of life. Shoulder pain and disability in the first year after implant one of the complications can occur with implanted pacemaker. Aim: The aim of the study was to assess the effect of nursing guidelines on the severity of frozen shoulder among patient with artificial implanted pacemaker, through measuring: 1.The knowledge of patient with artificial implanted pacemaker pre and post implant. 2. The visual analog scale for pain before and after the implant. 3. The disabilities of arm shoulder and hand before and after the implant. Design: A quasi-experimental research design with two groups (control and study) was used to conduct this study. Setting: The study was conducted at outpatient of coronary care unit at EL-Hussein University Hospital. Subject: A purposive sample: The sample size calculated by using Open Ebi version 3. It indicated the sample size was 60 adults patients based on comparing 2 means- 30 for control group and 30 for study group. Tools: Four tools were utilized to collect data in the current study. 1. Patient demographic characteristics 2. Interview questionnaire to assess patients' knowledge (pre-post) 3. A visual analog scale for pain assessment and 4. DASH (disabilities of the arm, shoulder and hand) tool) it was standardizes. Results: high significant positive difference between pre and post test which reveals improvement in both groups knowledge regarding pacemaker implantation, indication, complication, and follow up at p-value 0.000**. Also study indicates that, an improvement in the measurements of all visual analog scale in both groups but there is a significant improvement in study group which return to mild level of pain at 6 month measurement while the control group still in high moderate level of pain and an improvement in the measurements of all DASH scale in both groups but there is a significant improvement in study group at 6 month measurement with a maximum score 8 /30 which indicate minimum disability. Conclusion: The findings of this study concluded that, there is the frozen shoulder and arm discomfort was improved after implementing arm exercise, so practicing simple educational technique can prevent many of complications can occur to patient with implanted pacemaker. Recommendations Based on the results of the current study the following recommendations are suggested; 1. Designing educational guidelines for nurses, patient and their family about arm exercise and 2. Recommended continuous education for such patient in outpatient clinic

Anti-Mullerian Hormone as A new Marker for Diagnosis of Poly Cystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a complex disease characterized by various endocrine disorders that are the potential cause of anovulation and hyperandrogenism. This heterogeneous syndrome affects about 5– 10% of reproductive-age female population and it can be considered the most common endocrine disorder affecting women during reproductive life. PCOS is a multifactorial polygenic disease. Genes that regulate steroidogenesis and folliculogenesis are interested. Hence, AMH measurement has been found to offer a relatively high specificity and sensitivity as a diagnostic marker. Objectives: The study aimed to assess the accuracy of AMH in the prediction of PCOS in patients admitted to Elsayed Galal and El Hussein University Hospital. Subjects and methods: This was a retrospective study that was done on 130 women, divided into two groups, group I include 100 PCOS patients and group II, 30 control subject. Results: The results of this study showed that there was no significant difference between the two groups regarding age, while there was a significant increase in BMI in patients more than in control. The level of LH showed a significant increase in patients more than in the control. The level of FSH showed a significant decrease in patients less than in the control. The Testosterone showed a significant increase in patients more than in the control. The androstenedione showed a significant increase in patients more than in the control group. The AMH showed a highly significant increase in patients more than in the control and in turn the number of follicles in group II (patients) was significantly higher than in the control. The sensitivity of AMH in diagnosis PCOS was 98.0, specificity was 80.0% and the total accuracy was 93.0 at the cutoff of point 0.911. Conclusion: Additional advantages of AMH as diagnostic tool are that it is biological, objective, quantitative marker not affected by day of menses or OCP intake. So in future, more studies should be undertaken to validate its role as diagnostic tool for PCOS.

Urinary Level of Tumor Necrosis Factor Alpha in Patients with Type –2 Diabetic Nephropathy

Background: Diabetic nephropathy is the principal cause of end stage renal disease (ESRD) in the Western world, with renal disease as a major cause of morbidity and mortality in the diabetic population. Inflammation is a potential factor in the development and progression of DN and recent data indicate that diabetes includes an inflammatory component which may contribute to diabetic complications. Objectives: Aiming to investigate possible correlation between the presence and degree of albuminuria and urinary tumor necrosis factor-alpha as a marker of inflammation in diabetic nephropathy in type 2 diabetes mellitus. Patients and Methods: This study was conducted at El-Hussein University Hospital on 60 patients with type-2 diabetes mellitus and 20 healthy volunteers for the matched age and sex. Diabetic patients were divided into 3 groups according to the degree of proteinuria. Controls: 20 healthy controls, Group A: 20 type 2 diabetic patients without albuminuria, Group B: 20 type 2 diabetic patients with microalbuminuria. Group C: 20 type 2 diabetic patients with macro-albuminuria. Results: urinary TNF-alpha and serum hs-CRP were significantly higher in diabetic than controls. It was also significantly higher in patients with macroalbuminuria than those with microalbuminuria and normoalbuminuria. There was significant positive correlation between urinary TNF-α and urine protein excretion in diabetic patients as well as age, CRP, duration of diabetes and glycemic control. Conclusion: urinary TNF-α is independently and significantly correlated with the presence and degree of albuminuria in diabetic nephropathy in type 2 diabetes mellitus. This suggests that TNF-α play a significant role in the pathogenesis and progression of renal injury in diabetes.

To Evert or not to Evert Tunica Vaginalis during Low Inguinal Approach Varicocelectomy

Background: Varicocele is the most common correctable etiology found in infertile men. The aim of all surgical methods that treating varicocele is to increase the potential for future fertility. Objective: The aim of work was to evaluate the outcome of varicocelectomy through the low inguinal approach as a compare of eversion or non-eversion of the tunica vaginalis. Patients and methods: This prospective study included a total of 40 patients with a diagnosis of primary testicular varicocele and underwent low approach varicocelectomy, attending at Department of General Surgery, El-Hussein University Hospital. The patients were divided into two groups: group I included 20 patients with everted tunica and group II included 20 patients without everted tunica. Results: show that eversion of tunica vaginalis proved statistically to be effective in avoidance of hydrocele formation after varicocelectomy as there is no case developed hydrocele during the follow up period and as effective as microsurgical varicocelectomy. Conclusion: It could be concluded that for reduction of the incidence of hydrocele after varicocelectomy, eversion of tunica vaginalis can be afforded as adjunctive in operation theatre performing sub inguinal varicocelectomy without the aid of an operating microscope.