Galal Hospital Research Articles

The Effect Of Implementing A Bundle Of Evidence-Based Pain Management On Patient's Perception Of Pain And Clinical Outcomes

Background: Evidence-based practice in pain management has been shown to provide improvements in patient outcomes. Aim: this study aimed to determine the effect of implementing a bundle of evidence-based pain management to improve patients' perception of pain and clinical outcomes. Research design: A quasi-experimental research design was used. Setting: the study was conducted on 3 surgical units (general, orthopedics and oncology surgery in Sayed Galal Hospital Sampling: a purposive sample of 70 adult patients was included in the study. Tools of data collection: four tools were used, first tool: a structured interviewing questionnaire. Second tool: Physiological parameters data. Third tool: Pain assessment by using The McGill Pain Questionnaire. Fourth tool: Groningen Sleep quality Scale. Result: the main results revealed that there was a statistically significant improvement in BP, HR, RR and Pso2 in the study group after intervention. There was statistically significant reducing total pain severity in the study group as well compared to control group with p-value = (0.01*). There was a highly statistically significant improvement of sleep quality at 3rd day postoperatively, with a p-value of 0.001* among study group. Conclusion: the implementation of a bundle of evidence-based pain management had a positive effect on reducing pain intensity, improvement of physiological parameters and sleep quality among the study group compared to control group. Recommendations: this study recommended that, reduplication this study in a large probability sample, using a bundle of evidence-based pain management in a different-surgical-wards. Set pain assessment scale as a part of a routine measurement like a vital-signs in surgical units

Ultrasonographic and Hysteroscopic assessment of Uterine Cavity post Myomectomy

Background: Growth of the uterus's smooth muscles and connective tissue is known as uterine fibroids. They are viewed as the most widely recognized harmless growth of the pelvis. Moderate a medical procedure stays the primary methodology for the board of uterine myomas. Myomectomy is viewed as a significant choice for ladies who want future childbearing or essentially need to protect their uterus. Objective: The review's goal was to assess the uterine cavity using hysteroscopic and ultrasonographic devices. Methods: A planned (observation) logical plan was utilized in this review. Our research was had 50 patients that chosen from the short-term gynecological facility, (Al-Hussien and Sayed Galal Hospital at Al-Azhar University). Results: our review pointed to assess uterine hole using hysteroscopic and ultrasonographic devices. This research was had 50 patients was chosen from the short-term gynecological facility, (Al-Hussien and Sayed Galal Hospital at Al-Azhar University); with similar incorporation and rejection standards. Conclusion: From our review we could reason that hysteroscopy further develops results 3-4D ultrasound imaging it's not as of now accessible in all units, its utilization has huge ramifications regarding cost and preparing. Saline implantation then again might be embraced effectively utilizing different devoted frameworks or changes of promptly accessible less expensive catheters, for example, Intra-uterine Insemination catheter.

Diagnostic accuracy of Uterine Artery Doppler Velocimetry in Patients with Placenta Previa

Background; The placenta previa (PP) is an obstetric problem in which the placental tissue is improperly located inside the lower uterine segment. Aim and objectives: was to see how effective uterine artery Doppler velocimetry was in detecting unusually morbidly adhering placentas in patients who had had one or more prior caesarean sections with placenta previa. Subjects and methods; Cross-sectional research of 100 patients was undertaken in the Department of Gynecology and Obstetrics, El- Sayed Galal Hospital, AL- Azhar University. Result; Our results showed highly statistically significant correlation between the presence of abnormal lacunae and histopathological confirmation (P-value > 0.001). In addition, the overall Sensitivity, specificity, PPV, NPV and accuracy were 90%, 100%, 100%, 64.2%, 91.6%. This criterion showed very high sensitivity and specificity with very high positive predictive value and accuracy to become the most important criteria, Conclusion; As a result of this, we conclude that the accuracy of abnormal placental lacunae, loss of the reto-placental clear zone, myometrial thinning, and utero-vesical hypervascularity are the most critical ultrasound criteria for diagnosing placenta accreta in patients who had a previous CS with a placenta previa overlying the previous uterine scar.

A COMPARATIVE STUDY BETWEEN CYSTIC DUCT CLIPPING AND LIGATION IN LAPAROSCOPIC CHOLECYSTECTOMY

Background: Laparoscopic cholecystectomy (LC) nowadays is the standard treatment for gallstone disease. In laparoscopic cholecystectomy cystic duct and artery are usually secured by titanium clips and there are other methods for securing the cystic duct and artery like intracorporeal ligation or harmonic scalpel. the application of clips is shown to have some complications. Objective: to compare the suture ligation versus clipping for securing cystic duct and artery in laparoscopic cholecystectomy in terms of efficacy and safety and operation time. Patients and methods: A Prospective study included (60) patients who were admitted to El-Sayed Galal Hospital to undergo elective laparoscopic cholecystectomy for symptomatic gall bladder stones. Patients were divided into groups (A, B). Results: Mean operative time in group A was 50.87 min. and in group B was 55.73 min. There was a mean difference in operation time of about 5 min increased in group B with a p-value (0.141) that was statistically insignificant. Conclusion: Suture ligation of cystic duct and artery by vicryl 2/0 is a safe, effective and cost-effective alternative to clips, especially in developing countries and non-functioning of clip applicators and has an advantage in case of the wide cystic duct.

Diagnostic accuracy of uterine artery doppler velocimetry in patients with placenta previa

Background; The placenta previa (PP) is an obstetric problem in which the placental tissue is improperly located inside the lower uterine segment. Aim and objectives: was to see how effective uterine artery Doppler velocimetry was in detecting unusually morbidly adhering placentas in patients who had had one or more prior caesarean sections with placenta previa. Subjects and methods; Cross-sectional research of 100 patients was undertaken in the Department of Gynecology and Obstetrics, El- Sayed Galal Hospital, AL- Azhar University. Result; Our results showed highly statistically significant correlation between the presence of abnormal lacunae and histopathological confirmation (P-value > 0.001). In addition, the overall Sensitivity, specificity, PPV, NPV and accuracy were 90%, 100%, 100%, 64.2%, 91.6%. This criterion showed very high sensitivity and specificity with very high positive predictive value and accuracy to become the most important criteria, Conclusion; As a result of this, we conclude that the accuracy of abnormal placental lacunae, loss of the reto-placental clear zone, myometrial thinning, and utero-vesical hypervascularity are the most critical ultrasound criteria for diagnosing placenta accreta in patients who had a previous CS with a placenta previa overlying the previous uterine scar.

Recurrent implantation failure hysteroscopy versus endometrial biopsy

Background: Between all of the complications that might be faced through in-vitro fertilization (IVF), recurrent implantation failure (RIF) management still the greatest challenge due to the total success speeds of IVF in females with RIF is very low, Objective: The purpose of this research is to assess function of Hysteroscopic stimulated Endometrial Biopsy in the Diagnostic of Endometrial Pathology in cases Un-clarified RIF. Design: This was A cross-sectional research. Participants and methods: This study was done on 100 patient attended Sayed Galal hospitals from September 2019 to May 2020 with RIF history. All cases were assessed by full-history tracking including the (Personal, Menstrual, Obstetric and Past), Complete clinical test (General, Abdominal and Local), transvaginal 3D ultrasound, hysteroscopy and biopsy. Samples were gathered to be tested for histopathology to diagnose any disease and to be arranged for computer analysis. Results: Of the 100 cases of infertility with a past of recurrent implantation failure (RIF) experiencing endometrial biopsy guided by hysteroscopy, 59 (59%) exhibited ordinary results and 41 (41%) exhibited anomalous results. Conclusion: For RIF instances, diagnostic hysteroscopy must be a comprehensive examination that assesses the whole uterine cavity and detects hyperemia, mucosal edema, and micro-polyps, which may otherwise be overlooked.

Minimally invasive fixations in management of pilon fractures in adults

Background: Pilon fractures make up one percent of all breaks in the lower extremities and five to seven percent of all fractures of the tibia. Pilon fractures are caused by events with a lot of force like car accidents and falls from a high place, which put direct axial pressure on the tibial plafond and push it into the joint. The most common way to break a pilon is to fall from a high place. Even though there have been a lot of improvements in how these fractures are treated in the last few years, there is still a lot of disagreement about which treatment is best. Aim of the Work: The goal of this study is to look at both the effectiveness of minimally invasive fixations and the results of these types of fixations in treating pilon fractures in adults. Patients and Methods: This research was carried out between January 2021 and December 2021 at the hospitals affiliated with the Al-Azhar University, which are known as the Al-Hussien and Sayed Galal hospitals.

Correlation between fecal (calprotectin and lactoferrin) results and colonoscopic findings in chronic diarrhea and recurrent abdominal pain in children and adolescents

Background: Currently, endoscopy with biopsy is still considered the gold standard for the evaluation and diagnosis of mucosal inflammation and a number of scores exist to assess endoscopic activity in Crohn’s disease (CD) and ulcerative colitis (UC). Aim and objectives: the aim of the study was to determine the benefit of using both of fecal markers (calprotectin and lactoferrin) in patients presenting with chronic diarrhea and recurrent abdominal pain for differentiation between organic diseases, particularly inflammatory bowel disease (IBD) from non-organic disease, making colonoscope unnecessary. Subjects and methods: This prospective, observational and analytic study was carried out on 44 children who fulfilling the designed inclusion criteria. The study was carried out from Outpatient Clinic of Pediatric gastroenterology unit and from the Inpatient Units of the Pediatric department Faculty of Medicine, Al-Azhar University Hospitals (Al-Hussein & Sayed Galal Hospitals), as well as referral from other hospitals complaining of recurrent abdominal pain and chronic diarrhea from March 2020 to March 2022. Results: there was statistically significant difference between IBD group and functional abdominal pain group as regard fecal calprotectin with p-value≤ 0.001. There was statistically significant difference between IBD group and functional abdominal pain group as regard fecal lactoferrin with p-value≤ 0.001.

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.

Impact of Maternal Body Mass Index on Progress and Outcome of Labor in Nulliparous Females

Background; the body mass index (BMI) is frequently used to classify the severity of obesity and to inform weight-gain guidelines throughout pregnancy. Aim and objectives; to evaluate the impact of BMI of nulliparous females on progress of labour, incidence of peri-partum complications (1ry outcome) and neonatal outcome of these women (secondary outcome). Subjects and methods; This is a prospective cohort study, was carried out on 330nulliparous patients attending the labor ward of Al-Hussein and Sayed Galal hospitals, Al-Azhar University, Egypt, during active phase of labor, divided into 4 groups, from January 2021 until the end of the specified cases. Result; In terms of weight and BMI, there is a considerable disparity between the 4 groups. Conclusion; Labor development and labor time varied by BMI category, as evaluated by cervical dilatation rates. As per recent research, a higher BMI in nulliparous women is linked to a higher chance of caesarean birth during labor. This training should be available to first-time mothers prior to conception, and labor ward staff should be informed of this group of women before labour, with a concentration on the issues of analgesia and anesthesia in obese parturients.

EVALUATION OF INSULIN- LIKE GROWTH FACTOR BINDING PROTEIN-1 IN DIAGNOSIS OF PRETERM PREMATURE RUPTURE OF FETAL MEMBRANES

Background: Premature rupture of membranes (PROM) is preterm (PPROM) when it occurs before 37 weeks gestation. It is a complication of 2% to 20% of all deliveries and is a known important contributor to maternal and perinatal morbidity and perinatal mortality. Objective: To assess the accuracy of the uses of insulin-like growth factor binding protein-1 (IGFBP-1) in prediction of preterm premature rupture of membranes. Patients and Methods: This comparative cross sectional study included 90 pregnant women between 28-36 weeks of gestation complaining of watery vaginal discharge, carried out at Sayed Galal hospital, Al-Azhar University between August, 2018 and August, 2020. Results: This study showed no statistically significant differences regarding maternal age, parity and gestational age at recruitment.IGFBP-1 (Actim PROM test) was more sensitive and specific in diagnosing rupture of membranes than Nitrazine test. The sensitivity and the specificity of IGFBP-1 (Actim PROM test) in diagnosing PROM was 89.7% and 86.9% respectively as compared to Nitrazine test which was 75.9% and 82.0%. The PPV and NPV of IGFBP-1 were 76.5% and 94.6% as compared to Nitrazinet test which were 66.7% and 87.7%. Conclusion: One step cervicovaginal IGFBP-1 (Actim PROM) dipstick was a rapid reliable, non-invasive, easy and accurate diagnostic test for PROM.

MEASUREMENT OF FETAL OCCIPUT-SPINE ANGLE DURING THE FIRST STAGE OF LABOR IN PRIMIGRAVIDA AS A PREDICTOR OF THE MODE OF LABOR

Background: Fetal head “attitude” (relationship of fetal head to spine) in the first stage of labor may have a substantial impact on labor outcome. The diagnosis of fetal head deflexion traditionally is based on digital examination in labor. Objectives: To quantify the degree of fetal head deflection via the use of Ultrasound during the first stage of labor, and the relationship with the course and outcome of labor. Patients and methods: This was a prospective study conducted at Sayed Galal Hospital, Al-Azhar University from June 2019 to December 2019. Nonconsecutive series of women with uncomplicated singleton pregnancies at term gestation (37 weeks or more) were submitted to trans-abdominal ultrasound during the first stage of labor. Fetal position was occipito-anterior, and the angle between the fetal occiput and the cervical spine (the occiput-spine angle) was sonographically obtained on the sagittal plane. The measurements of the occipito-spine-angle were performed offline by an operator who was blinded to the labor outcome. The intra- and inter observer reproducibility and the correlation between the occipito-spine angle and the mode of delivery were evaluated. Results: A total of 400 pregnant women were recruited, 350 of which underwent a spontaneous vaginal delivery, and 50 were submitted to cesarean delivery. The mean value of the occipito-spine angle measured in the active phase of the first stage was 126° ± 2.79° (SD). The occipito-spine angle was significantly narrower in women who underwent CS delivery due to labor arrest. A larger occipito-spine angle (i.e. >126°) showed to be significantly associated with a shorter duration of labor. Conclusion: Fetuses with smaller occipito-spine angle (<126°) were at increased risk for operative delivery.

EFFECT OF HEPATITIS C VIRUS ON DURATION OF PREGNANCY AND THE INCIDENCE OF CONGENITAL ANOMALIES OF THE FETUS

Background; In spite of reports of raised rates of hypertensive problems, pre-mature births, and cholestasis, the influence of mother HCV infections on gestation complications and obstetrical outcomes hasn’t been extensively defined. Aim and objectives; The current work aimed to examine the influence of Hepatitis C virus (HCV) infections during pregnancy on the duration of gestation as well as its possible effect on the incidence of congenital anomalies of the fetus. Subjects and methods; This work was a prospective observational case-control research had been done at Al-Hussein and Sayed Galal hospitals, Al-Azhar University during the period from December 2020 to June 2021. The study included 120 HCV infected and 120 HCV uninfected gravid females. Result; Congenital anomalies in Group (A) show that 7(5.8%) had congenital anomalies while in Group (B) 3(2.5%) had congenital anomalies. Nonsignificant changes have been found among studied groups. Significant changes have been found among studied groups as regard neonatal ICU admission where P=0.005. Conclusion; Gestations in females who are positive for anti-HCV have elevated rates of poor neonatal and obstetrical results, while correlations among neonatal and obstetrical results and HCV don’t essentially mirror a causal association, HCV positivity can be a substitute indicator for raised risk of poor gestation outcome and the HCV-positive gravid populations can need more clinical vigilance in this concern.

PREDICTIVE VALUE OF SERUM TUMOR NECROSIS FACTOR-Α LEVEL AND UTERINE ARTERY DOPPLER INDICES AT 11-13 WEEKS' GESTATION IN CASES OF PREECLAMPSIA

Background: Cytokines are involved in fetoplacental development, and have been suggested to be the placental factor capable of damaging endothelial cells and contributing to many of the pathophysiological changes associated with preeclampsia. Uterine artery Doppler measurements show that impedance to flow in the uterine arteries decreases with gestational age in normal pregnancies. That impedance to flow is increased in established pre-eclampsia and fetal growth restriction (FGR), and this increased impedance predates the onset of the clinical syndrome of pre-eclampsia or FGR. Objective: To determine the validity of using combined biophysical (uterine artery Doppler) and biochemical (TNf- α) markers at 11-13 weeks for early screening for pre-eclampsia. Patients and methods: This study was conducted at the outpatient clinic at Sayed Galal Hospital, Al-Azhar University. This was a prospective cohort study that carried out on three hundred pregnant women who attended to outpatient clinic for antenatal care at 11-13 weeks of pregnancy with 48 missed cases (in the form of 2 IUFDs, 3 preterm labors, 30 miscarriages, and inability to follow 13 cases up). Results: There were no statistically significant differences between women who developed pre-eclampsia and who did not develop pre-eclampsia as regard maternal age and BMI. The mean concentration of sTNF- α, was higher in women who developed pre-eclampsia than in women who did not develop pre-eclampsia, and the differences were statistically significant. The best cut off value of the serum TNF- α is ≥14 pg/ml and at this value, we have sensitivity 67.8%; specificity 98%; PPV 79.4%; NPV 96.4%. The mean PI of the right and the left uterine arteries was higher in women who developed pre-eclampsia than in women who did not develop pre-eclampsia, and the differences were statistically significant. The best cutoff value of the mean uterine arteries was 1.7 and at this value we have 100% sensitivity, 84.4% specificity, 41.7% PPV, 100% NPV. Conclusion: The combination of TNF-α and UA Doppler waveforms almost invariably predicts PET and other adverse pregnancy outcomes; therefore, when used together, biochemistry and ultrasound screening have the ability to improve the sensitivity of screening for PET.

COMPARATIVE STUDY OF CROSS LINKING VERSUS STROMAL PUNCTURE IN KERATOCONUS

Background: Keratoconus is a non-inflammatory condition where the cornea assumes a conical shape because of thinning and protrusion of the corneal stroma. The corneal thinning induces irregular astigmatism, myopia, and corneal protrusion, leading to mild to marked impairment in the quality of vision. Symptoms are highly variable and, in part, depend on the stage of progression of the disorder. Objective: To compare refractive and topographic outcomes between cross-linking (CXL) and corneal stromal puncture in stiffening the cornea and halt the progression of Keratoconus. Patients and Methods: This randomized controlled study included 19 patients (30 eyes) with keratoconus. They were not presenting with any eye disease and had never undergone eye surgery. The total number of subjects meeting the inclusion and exclusion criteria. They were divided into 2 groups, group (A) 9 patient: 15 eyes received cross-linking and group (B) 10 patient: 15 eyes received corneal puncture. All examination, investigation and the procedure were done at El Sayed Galal Hospital and Nour al Hyaa eye Hospital, Cairo. Results: The results showed significant improvement in postoperative value of UCVA, BCVA, than its preoperative value. In addition, a statistically significant decrease of postoperative K1 in both group than its preoperative value while there was a statistically significant increase of K2 postoperative value compared to preoperative value in puncture group, K2 showed significant decease postoperative in CXL group. There was significant increase in corneal thickness postoperatively compared to preoperative values in puncture group, corneal thickness showed significant decrease postoperatively in CXL group. Comparing both groups, there was significant improvement in postoperative UCVA, postoperative BCVA in puncture group than in CXL group. On the other hand, there was a significant decrease in mean of postoperative corneal thickness in CXL group than puncture group. Conclusion: Overall, the results of this study continue to support the efficacy of CXL in progressive keratoconus and explored new modality of its treatment by anterior stromal puncture (ASP), with an improvement in UCVA, and BCVA 3 months after operation.

EVALUATION OF POSTERIOR LUMBER INTERBODY FUSION WITHOUT INSTRUMENTATION IN LUMBER DEGENERATIVE DISC DISEASES

Background: Degenerative disc disease represents a common cause of chronic low back pain that makes some disabling and requires surgical intervention. Posterior lumbar interbody fusion (PLIF) represents one of the techniques used to deal with this disabling. Objective: To assess the results of the posterior lumbar interbody fusion (PLIF) without instrumentation in cases of degenerative disc diseases without instability. Patient and method: This was a prospective study of twenty patients who underwent surgical lumbar laminectomy and discectomy with interbody fusion and graft for degenerative lumbar diseases that not responsive to medical treatment for 6 months at Sayed Galal Hospital, Al-Azhar Faculty of Medicine. Result: There was a highly statistically significant decrease in the level of pain (VAS score) one week postoperatively compared to preoperative level with p-value < 0.001, and a statistically significant difference was found between preoperative pain (VAS score) level ,and post 6 months level with p-value < 0.001. Conclusion: Posterior lumbar interbody fusion technique without instrumentation showed several potential benefits in the treatment of degenerative disc disease (DDD).

CLINICAL COMPARATIVE STUDY BETWEEN INTRATHECAL DEXMEDETOMIDINE AND DEXAMETHASONE ON PROLONGING THE DURATION OF INTRATHECAL BLOCKADE IN LOWER LIMB ORTHOPEDIC SURGERY

Background: Spinal anesthesia is safer than general anesthesia during lower limb operations; many studies have been concerned about prolonging the duration of spinal anesthesia by adding different adjuvants. Objective: To compare the efficacy of intrathecal dexmedetomidine versus intrathecal dexamethasone in prolonging duration of spinal anesthesia, and postoperative analgesia, safety and hemodynamic stability. Patients and methods: Our study was carried out on 60 patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for orthopedic operation under spinal anesthesiadivided into A, B and C from March 2020 to November 2020. They were divided into 3 equal groups: Group A received 2ml bupivacaine (0.5%) and 10μg dexmedetomidine in 1ml normal saline intrathecal, Group B received 2ml bupivacaine (0.5%) and 4 mg dexamethasone in 1 ml normal saline intrathecal and Group Creceived 2ml bupivacaine (o.5%) and 1ml normal saline Intrathecal. The study was carried out at Al-Azhar University Hospitals (Al- Hussein and Sayed Galal Hospitals). Results: The present study showed statistically significant difference (P-value <0.001) between the three groups according to time of motor and sensory regression. The regression time of block (both sensory and motor) were prolonged in A (sensory 359.50±20.32, motor 319.00±21.06) and B (sensory 199.75±18.22, motor 170.00±20.00) when compared to the C group (sensory 149.55±10.83, motor 141.00±22.09). However, the duration was longest in A group among the three groups. According to amount of analgesic consumption postoperatively, there was significant decrease in amount in A group in comparison to B and C groups. The amount is insignificantly decreased in B group in comparison to C group. Regarding safety and hemodynamic stability there was no statistically significant difference between the three groups. Conclusion: Dexmedetomidine had prolonging the duration of spinal anesthesia more than dexamethasone and control group with statistically significant difference between the three groups and provided prolonged postoperative analgesia compared to dexamethasone and control group.

Effect of maternal iron deficiency anemia on fetal hemodynamics and pregnancy outcome

Background: In pregnancy, anaemia has detrimental impacts on maternal and fetal health. During pregnancy, chronic anemia may trigger glositis, stomatitis, alterations in the nails and skin, shortness of breath and heart failure in the mother. Obstetrical complications are also known, such as low birth weight babies, IUGR, elevated preterm delivery rate, and elevated perinatal deaths. Postpartum hemorrhage also aggravates the condition. Objective: To evaluate the impact on fetal hemodynamics of maternal iron deficiency anemia by Doppler parameters of umbilical and MCA, C/U ratio and to evaluate short term neonatal outcome by Apgar score and birth weight. Patients and Methods: This cross sectional cohort study included 300 pregnant women suitable candidates who attended Al-Hussein and Sayed Galal Hospital for delivery and casualty department in the period between December 2019 October 2020. Results: Our results showed that oral and parenteral iron were superior than blood transfusion as regards the clinical and sonographic outcome (IUGR, preterm labor, NBW, APGAR score and Doppler indices) with a more rapid improvement using parenteral iron. However, those patients who received blood transfusion (group C) had a better elevation in hemoglobin levels compared to oral and parenteral iron. CONCLUSION: Patients who received blood transfusion (group C) had a better elevation in hemoglobin levels however Patients who received oral and parenteral iron were superior than blood transfusion as regards the clinical and sonographic outcome .

Risk of hypocalcemia after total thyroidectomy and bilateral central neck dissection in patients with well differentiated thyroid carcinoma.

Background: Hypocalcaemia is a grave complication after thyroid surgery with signs ranging from paresthesia up to laryngospasm. Avoiding this complication is mandatory to avoid lifelong calcium and vitamin D supplements. Aim of the work: to assess the risk of hypocalcaemia after thyroid surgery and the factors contributing to it. Patients and methods: this study was conducted on 50 patients with well differentiated thyroid carcinoma admitted to Sayed Galal hospital and they were divided into 3 groups: A, B and C. Results: Group B patients had transient hypocalcaemia and PTH levels were in normal range, thus suffering from parathyroid dysfunction. Calcium levels returned to normal range after a mean of 15.5 days. Group C patients remained hypocalcemic for over six months and PTH levels were below normal range thus defining absolute hypoparathyroidism. In terms of age, gender, tumor size and stage, group C patients were older, had no female prevalence, had slightly larger tumors and presented at late stages. Preoperative calcium levels were not a risk factor as group C patients had the highest mean of ionized calcium and group B patients had lower mean of total calcium level than those of group C. Conclusion: The most important risk factor for post-thyroidectomy hypocalcaemia is the surgical technique. Meticulous dissection to preserve the blood supply to the parathyroid glands and careful handling of the parathyroid tissue are equally important to preserving the parathyroids themselves. Other risk factors include older age, large tumors and late stages.

EVALUATION OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN DIABETIC RETINOPATHY

Background: Diabetic retinopathy (DR) is a microvascular complication of diabetes, and it is a leading cause of blindness. Fluorescein angiography (FA) is a vitally important diagnostic tool for evaluating fundus features of DR. Objective: To evaluate optical coherence tomography (OCT) angiography in eyes with diabetic retinopathy in comparison to findings in fundus fluorescein angiography. Patients and Methods: This was a cross-sectional observational study conducted in the Ophthalmology Department of Sayed Galal Hospital from December 2016 to June 2017. Twenty eyes were included in the study with diabetic retinopathy with age between thirty three and sixty years of both genders, and those met the inclusion criteria. Patients were fully evaluated including history, examination and investigations. Investigations used Optical Coherence Tomography Angiography and Fundus Flouresien Angiography (FFA). Results: The comparison between groups regarding qualitative data was done by using Chi-square test and/or Fisher exact test the patients ages mean value was 48.95 ± 6.75 years, of which 75 % were females, and 25% were males. Microaneurysm was detected in all eyes in OCTA and FFA, retinal hemorrhage in DCP in 45 % (9/20) of eyes compared to 15% (3) in SCP with a significant difference that may allow better evaluation of level of retinal hemorrhage among diabetic eyes, detection of retinal capillary dropout. Areas of capillary loss obscured by fluorescein leakage on fluorescein angiography were more clearly defined on OCTA. Conclusion: Ability of FFA and OCTA in microanerysms detection in all eyes, but less numerous in OCTA than FFA, and OCTA could precisely locate their depth and origin which is not possible in FFA. The assessment of capillary non-perfusion areas in our study by OCTA showed higher accuracy compared to FA but with a difference that was not statistically significant.