ORIGINAL_ARTICLE
COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND CONVENTIONAL BURCH COLPOSUSPENSION FOR TREATMENT OF GENUINE STRESS URINARY INCONTINENCE
Objective: To compare the efficacy and complications of laparoscopic and conventional approach for Burch colposuspension in treatment of stress urinary incontinence.Study design: Prospective randomised trial.Methods :After standered history and preoperative evaluation, groupA( n=30) offered open Burch colposuspension and group B (n =30) had laparoscopic colposuspension.Results: No significant differences regarding objective and subjective outcome of total 60 patients follow up at 1,6 and 12 months. More operative time found in group B (92±5.2min)versus group A(58.2±4.4min),P ˂0.001 . Laparoscopic approach was less in pain (P ˂0.001)and hospital stay(P ˂0.001) .No significant differences between both groups regarding intraoperative and post operative complications .Conclusion: Although laparoscopic burch offers an alternative to conventional burch with shorter hospital stay, less postoperative pain and quicker recovery, but still it has its drawbacks. It needs long learning curve and has prolonged operative time.
https://zumj.journals.ekb.eg/article_4552_c0606bc642c0e316c14cdce1ed543878.pdf
2015-09-01
1
6
10.21608/zumj.2015.4552
missed
Shafik
M
1
Obstetrics&Gynecology department, Faculty of Medicine, Zagazig University
AUTHOR
Amin
H,
2
Obstetrics&Gynecology department, Faculty of Medicine, Zagazig University
AUTHOR
Swelam
E
3
Obstetrics&Gynecology department, Faculty of Medicine, Zagazig University
AUTHOR
Abdel Dayem
H
4
Obstetrics&Gynecology department, Faculty of Medicine, Zagazig University
AUTHOR
Abo El Fath
A
5
Obstetrics&Gynecology department, Faculty of Medicine, Zagazig University
AUTHOR
ORIGINAL_ARTICLE
THE ROLE OF HRCT IN EVALUATION OF AQUAIRED MIDDLE EAR CHOLESTEATOMA OTITIS PRIOR SURGERY
Objective: Otoscopic examination is the best method for diagnosis of cholesteatoma which treated by explorative surgery. The need for pre-operative imaging studies is controversial. This study assesses the accuracy and usefulness of a pre-operative high-resolution CT scan in depicting the status of the middle ear structures in the presence of cholesteatoma.Patients and Methods: the surgical findings of 88 patients with acquired cholesteatoma were compared with the pre-operative CT findings in this prospective study. The following were analyzed: diagnostic features of cholesteatoma on CT, status of the middle ear structures (ossicles, facial nerve canal, bony labyrinth, tegmen tympani and scutum) and extension of the disease to the sinus tymapni and facial recess.Results: eighty-three (94.3%) cases had the two radiological features characteristic for cholesteatoma (a) a location typical for cholesteatoma in the epitympanum and mastoid antrum (b) bony erosion.The radio-surgical agreement was excellent for the malleus (Kappa statistics, K= 0.96), stapes (0.91), bony labyrinth (0.94), tegmen tympani (0.82) and scutum (1), good for the incus (0.75), but poor for the facial nerve canal (0.39). The scan accurately predicted the extension of the disease to the sinus tympani and facial recess.Conclusion: High-resolution CT scan is an important investigative tool prior to cholesteatoma surgery.There is good to excellent radio-surgical correlation in cholesteatoma for most middle ear structures except for the integrity of the facial canal. The scan alerts the surgeon to asymptomatic complication of the disease.
https://zumj.journals.ekb.eg/article_4553_c6df902fa45bc7bab4484b450b27c5a9.pdf
2015-09-01
1
13
10.21608/zumj.2015.4553
missed
Ghada
Abdulmonaem
1
Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Egypt
AUTHOR
Rania
almolla
2
Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Egypt
AUTHOR
Ahmad
Alsammak
3
Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Egypt
AUTHOR
Atef
Hamed
4
Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University
AUTHOR
ORIGINAL_ARTICLE
THE DILEMMA OF THE UNUSUAL DISTRIBUTION OF MR ENCEPHALOPATHY IN PRE-ECLAMPTIC/ECLAMPTIC FEMALE PATIENTS : DETECTION AND PITFALLS
Purposes: To evaluate the MRI findings in pre-eclamptic/ eclamptic encephalopathy and to evaluate the usefulness of diffusion weighted MRI (DW-MRI) as an imaging tool and its prognostic implication in changing treatment protocol. Patients & methods: Prospective study included24 patients, diagnosed clinically as preeclampsia (14 cases) and eclampsia in (10 cases). Their ages ranged from 25 to 45 years with mean age of 35.6 years. They examined on a standard 1.5 Tesla MR unit. Initially conventional T2 and FLAIRimages were done followed by Diffusion weighted imaging . Results: All 24 patients were acutely hypertensive at presentation. All patients develop abnormal increased signal on T2 and FLAIR sequences predominantly involving the posterior circulation. 20 ofthese patients demonstrate increased SI on diffusion weighted images denoting vasogenic edema while only 4 patients showed corresponding low signal on DW-MRI (cytotoxic edema). Follow up study confirmed the resolution of the lesions (in 20 patients) successfully with reversible neurologic impairment while those 4 patients with cytotoxic edema pattern,they develop permanent T2 / FLAIR hyper intense signal and neurological impairment. Conclusion: Involvement of the parietal and occipital lobes is common in patients with eclampsia, and the signal abnormalities on MRI are reversible if recognized and treated early.DWI can correlates well with the patient's outcome, and should be performed in all eclamptic patients and that may affect greatly their management.
https://zumj.journals.ekb.eg/article_4554_5f73adc8c080af02b9beb70ac2a3b57a.pdf
2015-09-01
1
15
10.21608/zumj.2015.4554
missed
Ghada
Abdulmonaema
1
Radiodiagenesis Deprtment, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
AUTHOR
Rania
Al-molla
2
Radiodiagenesis Deprtment, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
AUTHOR
Hosam
Almassrya
3
AUTHOR
Hala
Mwafi
4
AUTHOR
ORIGINAL_ARTICLE
INTERAUTERINE INSEMINATION VERSUS CONSERVATIVE MANAGEMENT AFTER LAPAROSCOPIC SURGERY IN INFERTILE WOMEN WITH MINIMAL OR MILD ENDOMETRIOSIS
Background: - Endometriosis is really a serious, estrogen based, inflammatory disease characterized by the growth of endometrial stroma and glandular epithelium in areas outside the uterus and is particularly associated with pelvic pain and infertility. Laparoscopy is the primary method of diagnosis of endometriosis as it can identify superficial peritoneal implants. COS-IUI enhanced fertility in women with minimal or mild endometriosis. Objective: -was to evaluate the effectiveness of controlled ovarian stimulation in addition to intrauterine insemination (COS/IUI) versus conservative management after laparoscopic surgery (resection or ablation) in infertile women with ASRM stage I ∕II endometriosis. Methods: - this prospective study included 40 infertile patients with minimal or mild endometriosis. The affected individuals underwent laparoscopic surgical procedures that involves destruction or removal of all visible endometriotic implants and also lysis of adhesions. After laparoscopic surgical management patients were randomly divided into 2 groups:- Group A: - included 20 infertile women who were managed surgically and left to conceive spontaneously for one year (follow up period). Group B: - included 20 infertile women who were managed surgically and followed by controlled ovarian stimulation and IUI (COS/IUI) up to 4 cycles within one year period. Results:- In group A, the pregnancy rat /couple was 15%.and pregnancy rat /cycle was 1.42%.on the other hand in group B, Pregnancy rate /couples was (35%), and a pregnancy rate /cycle was (11.47%). in group B the pregnant rates were significantly higher than that in group A. There were highly statistically significant difference regarding pregnancy rates per couple and pregnancy rates per cycle between both groups (p =0.049). Conclusions: - The present study revealed that the women who underwent COS and IUI up to 4 cycles had a higher pregnancy rates than those who were expectantly managed after surgical removal of minimal or mild endometriosis.
https://zumj.journals.ekb.eg/article_4555_eefd18de0083c83a2ecaf0a4c27ffc1c.pdf
2015-09-01
1
12
10.21608/zumj.2015.4555
minimal to mild endometriosis/infertility/laparoscopy ∕ ovulation induction ∕ intrauterine insemination
Ahmed
Mukhtar
1
Obstetrics and Gynecology Department Faculty of Medicine, Zagazig University,Egypt.
AUTHOR
Soha
Galal
2
Obstetrics and Gynecology Department Faculty of Medicine, Zagazig University,Egypt.
AUTHOR
Magdi
Ragab
3
Obstetrics and Gynecology Department Faculty of Medicine, Zagazig University,Egypt.
AUTHOR
Mahmoud
Ghareeb
4
Obstetrics and Gynecology Department Faculty of Medicine, Zagazig University,Egypt.
AUTHOR
ORIGINAL_ARTICLE
AZITHROMYCIN VERSUS ERYTHROMYCIN IN PRETERM PREMATURE RUPTURE OF MEMBRANES
The aim of this study was to compare the effectiveness of (azithromycin) compared to (erythromycin) in prolonging pregnancy in patients with Preterm Premature Rupture of Membranes (PPROM). In the present study 162 singleton pregnant women aged 18-40 years old with PPROM between 24 - 32 weeks gestation who were admitted to obstetrics and gynecology department of zagazig general hospital, within 36 hours of rupture of membranes and cervical dilation less than or equal to 4 cm. All patients received corticosteroid in the form of (dexamethasone) 24 mg IM injection in divided doses for 24hours to enhance lung maturity. Patients with known lethal fetal anomaly, vaginal bleeding not associated with labor , maternal or fetal indication for delivery , cervical cerclage in place , placenta previa or other known placental anomalies , use of antibiotic therapy within 5 days or allergy or other contraindications to erythromycin/azithromycin or steroid use were excluded from the study. All patients were randomly classified into two groups: Group І: included 81 patients received Erythromycin 500mg orally every 8hours for 5 days (erythromycin 500, Amirya) and Group ІІ: included 81 patients received Azithromycin 500mg orally every 12 hours for 5 days (Zithromax 500, Pfizer). The participants are completely unaware of which group they are in and what intervention they are receiving until conclusion of the study (single blind study). There were non-significant differences between the two studied groups as regard socio-demographic data, general, local examinations, and both fetal and maternal outcomes. There was high significant difference between the costs of treatment of the two groups, azithromycin is more expensive than erythromycin but this difference has no value in relation to more side effects of erythromycin which were gastrointestinal side effects which were (33 patient in the group in erythromycin in comparison to 17 patient in the group of azithromycin). We conclude that the two drugs show similar efficacy regarding latency and both fetal and maternal outcomes.
https://zumj.journals.ekb.eg/article_4556_c1fce6e70512e6a6a5aab3c7b663101d.pdf
2015-09-01
1
8
10.21608/zumj.2015.4556
Foley's catheter
prostaglandin
misoprostol
second trimester missed abortion
Manal
Mohamed
1
Obstetrics and Gynecology Department, Faculty of Medicine, Benha University
AUTHOR
Mohamed
El-Sherbeny
2
Obstetrics and Gynecology Department, Faculty of Medicine, Benha University
AUTHOR
Mostafa
A. Elsayed
3
AUTHOR
Ahmed
Rezk
4
AUTHOR
ORIGINAL_ARTICLE
RECTAL PREOPERATIVE TRAMADOL AND INTRAOPERATIVE BUPIVACAINE WOUND INFILTRATION AT CESAREAN DELIVERY FOR POSTOPERATIVE ANALGESIA
Background: Delivery by CS is increased and is one of the most common great operative procedures done worldwide. Prompt and adequate postoperative pain relief is an important issue of caesarean delivery. Pain relief may cause good psychological and physical effects in patients,lead to better recovery from surgical procedures and early mobilization of patients to prevent complications. Pain after operations is usually mannaged with opioids. These agents exert their analgesic effects through μ-receptors in the CNS. The effect of opioids is limited by the occurance of tolerance or side effects such as vomitin, nausea, sedation, or respiratory depression. Tramadol, is analgesic with weak mu-opioid receptor agonist and activity at serotonergic, noradrenergic and GABAergic systems, is another alternative parenteral ,oral and rectal analgesic for post caesarean pain. The local anesthetic may be used before or after abdominal nerve block, absorbed by systemic route and secreted in breast milk, but their effects on breast fed babies have not yet been demonstrated. This is in contrast to morphine or pethidine, both of which have significant transfer to breast milk and may have a sedative effect on the baby. Objectives: Of our study was to measure the effect of rectal tramadol and bupivacaine infiltration on pain relief after CS and on opioids requirement. Patients and methods: 312 parturient,scheduled for CS under general anashesia ,participated in this study, 156 parturient received placebo rectally and saline infiltration and the other 156 received Tramadol 100mg rectally and Bupivacaine 0.25% infiltration in the wound. Results: Rectal Tramadol and local Bupivacaine infiltration is effective in decreasing intensity of postoperative pain and the amount of the opioids consumption. Conclusion: Combination of the rectal Tramadol suppository and Bupovacaine infiltration of surgery wound cause longer duration of analgesia and decrease consumption of opiods. so can be a good choice for pain relief after cesarean delivery.
https://zumj.journals.ekb.eg/article_4557_713b077e00b74c7c51753fb438a2dcda.pdf
2015-09-01
1
7
10.21608/zumj.2015.4557
tramadol
Bupivacaine
wound infiltration
Cesarean delivery
Postoperative Analgesia
Rasha
Ibrahiem
1
AUTHOR
Ahmed
Rezk
2
AUTHOR
Seham
Elberry
3
AUTHOR
Mostafa
Elsayed
4
AUTHOR
ORIGINAL_ARTICLE
EFFECT OF SOCIAL MARKETING CAMPAIGN ON CHILD HEALTH CARE UTILIZATION IN RURAL SECTOR IN SHARKIA GOVERNORATE
Introduction: Primary health care (PHC) facilities are widely distributed throughout Egypt but they often seem to operate at suboptimal level. Therefore this study was carried out in a trial to increase the rate of utilization of PHC in rural sector of Sharkia Governorate using a social marketing campaign. Objectives of study: To assess the rate of utilization of child PHC services in rural sector of Sharkia Governorate, to determine causes of underutilization and to assesss the effect of social marketing campaign on utilization of health services. Method: Design: Pre- Post interventional study. Setting: El-Sharkia Governorate, Hehya district, El-Shabraween village. Sampling: multi-stage random sampling. Procedure: the study evaluated the utilization of all provided PHC services in El-Shabraween unit before and after a social marketing campaign using personal interviews of 205 households and the unit records. It also highlighted the causes of underutilization of the PHC unit. Results: There is a significant increase in El-Shabraween outpatient consumers from 23% before to 58.8% after the campaign. The percent proportion of recorded diarrhea cases among (U5) children to total U5 sick children increased from 35.1% to 46.3% after the campaign. Causes of underutilization were: lack of different specialty consultants (62.4%), followed by deficient skills of doctors (51.2%) and irregular presence of female gynecologist (42.0%). Conclusion and Recommendation: Social marketing can improve health care utilization in rural sector, so it's recommended to disseminate the marketing materials on a wider scale to attract more customers, also better training of physicians in family units, continuous presence of a female gynecologist for better maternal care, a recommendation for the MOHP to financially support marketing campaigns for better results and further studies in this area should be carried out.
https://zumj.journals.ekb.eg/article_4558_e314168c76a8286b4da93ff6b3f23b6f.pdf
2015-09-01
1
8
10.21608/zumj.2015.4558
utilization
Child Health Care
social marketing
Ghobashi
M.,
1
Department of Family Medicine Faculty of Medicine, Cairo University
AUTHOR
Foda
. Adel
2
Department of Family Medicine Faculty of Medicine, Cairo University
AUTHOR
Mowafy
Abd-ElRahman
3
Department of Family Medicine Faculty of Medicine, Cairo University
AUTHOR
Hussein
Nabil
4
Department of Family Medicine Faculty of Medicine, Cairo University
AUTHOR
ORIGINAL_ARTICLE
OSTEOPOROSIS IN DIABETICS AND ITS RELATION TO IGF-1
Background: Osteoporosis is a global age-related health problem in both male and female elderly, affecting the microstructure of bone. Although osteoporosis is normally associated with old age and estrogen deficiency, diabetes mellitus (DM), also contributes to and/or aggravates bone loss in osteoporotic patients Diabetes can affect bone through multiple pathways including obesity, changes in insulin levels, higher concentrations of advanced glycation end products in collagen, microangiopathy, inflammation and lower insulin-like growth factor-I (IGF1).Aim of the work: Studying the alterations in bone metabolism in diabetic patients and its relation to IGF1.Subjects and methods: The study included 83 participants, 53 of them were diabetics, and 30 participants were age and sex matched healthy subjects. Patients with hepatic or renal diseases, post-menopausal females,males older than 50 years, steroid medication intake,smoking, alcohol intake and other endocrinal disease causing osteoporosis were excluded. Blood samples were obtained from all subjects to measure calcium,phosphorus, parathyroid hormone, HBA1c and IGF1. DEXA scan were done to all subjects to evaluate bone quality.Results: IGF1 concentration did not show any significant difference between total diabetic patients and control but its concentration was lower in type 1 DM than type 2 but did not reach a significant value. Whole diabetic group showed significantly lower BMD when compared to controls. In addition , type 1 DM subgroup showed lower BMD than type 2 DM subgroup .Osteoporosis and/or osteopenia showed significantly higher incidence in whole diabetic group, type 1 DM subgroup when compared to controls and in type 1 DM subgroup when compared to type 2 DM subgroup,IGF1 was negatively correlated with HbA1C in type 1 DM. No other significant differences were found in laboratory data between different studied groups except for HbA1c which was significantly higher in whole diabetic groups in comparison to control group.Conclusion: Diabetes mellitus either type 1 or type 2 can lead to bone defects but in type 1 DM more damage to bone occurred than in type 2, IGF1 concentration is lower in type 1DM than in type 2 DM and is negatively correlated with HA1C in type 1 DM.
https://zumj.journals.ekb.eg/article_4559_2b4a85d232abccd756d4d6efbfaf8574.pdf
2015-09-01
1
10
10.21608/zumj.2015.4559
missed
Amer
M.
1
Departments of Internal Medicine,clinical pathology
AUTHOR
Shaat
A.
2
Departments of Internal Medicine,clinical pathology
AUTHOR
Abo EL-Aenin
N.R.
3
AUTHOR
Abdel Rasek
A.
4
Diagnostic radiology . Faculty of Medicine, Mansoura University.
AUTHOR
Abdel Gwad
S.
5
Departments of Internal Medicine,clinical pathology
AUTHOR
ORIGINAL_ARTICLE
THE RISK OF POST PARTUM HEMORRHAGE AFTER CESAREAN SECTION WITH GENERAL VERSUS SPINAL/EPIDURAL ANAESTHESIA
Background: In this study, we set out to compare the risk of PPH after CS for those who receive general versus spinal/epidural anesthesia with the use of a one-year dataset, we hypothesized that women who received general anesthesia would be at higher risk of PPH compared with women who received epidural anesthesia because adverse uterine contraction and platelet function might be associated with general anesthesia.. Objectives: To assess frequency of postpartum hemorrhage in general anaesthesia, to assess frequency of postpartum hemorrhage in spinal anaesthesia, to compare the risk of Postpartum Hemorrhage (PPH) for patients who will undergo CS with general versus spinal/epidural anesthesia and to assess risk of type of anaesthesia in developing PPH. Patients and methods: This is a retrospective study on patients complicted by PPH after CS with history of type of anaesthesia used; general or spinal/epidural anaesthesia to detect the risk of developing PPH. We included all women complicated by PPH after CS and collect data about the anaesthesia used during CS and other risk factors for PPH if recorded in files of operative sheet of the patients. Hemoglobin concentration before surgery and on first postoperative day was recorded for all patients. The total volume of crystalloid solutions infused during operation and duration of operation were determined. Results: Our results showed that 42.3% of the studied group had general anaesthesia and 57.7% of them had spinal anaesthesia. There was statistical significant difference between patients who received general anesthesia and patients who received spinal anaesthesia in number of cases having postpartum hemorrhage.. Conclusion: The odds that women will experience caesarean PPH with general anaesthesia are approximately 3.5times higher than for women who undergo CS with spinal anesthesia.
https://zumj.journals.ekb.eg/article_4560_d3afd7ae5e7fd27a67296f1ab060d868.pdf
2015-09-01
1
6
10.21608/zumj.2015.4560
Postpartum Hemorrhage
cesarean section
general anesthesia
Spinal anesthesia
epidural anesthesia
Tarek
El-Beheidy
1
Obstetrics and Gynecology and Anaesthesia and Surgical Intensive Care Departments, Faculty of Medicine, Zagazig University
AUTHOR
Amal
Nouh
2
Obstetrics and Gynecology and Anaesthesia and Surgical Intensive Care Departments, Faculty of Medicine, Zagazig University
AUTHOR
Ahmed
Abo Elmaaty
3
Departments, Faculty of Medicine, Zagazig University
AUTHOR
Hanaa
Abdel Hafeiz
4
Departments, Faculty of Medicine, Zagazig University
AUTHOR
ORIGINAL_ARTICLE
THE RELATION BETWEEN CLINICAL, EPILEPTIFORM DISCHARGES, AND NEUROMETABOLIC DYSFUNCTION IN TEMPORAL LOBE EPILEPSY
Background: Temporal lobe epilepsy (TLE) is the most frequent cause of focal and refractory seizures. Magnetic Resonance Spectroscopy (MRS) is a potentially useful tool in the investigation of brain metabolites in TLE. Objective: to clarify the role of MRS in the TLE epilepsy and to evaluate the relationship between the results of MRS, Electroencephalography (EEG), and the clinical data of TLE patients with negative Magnetic Resonance imaging (MRI). Patients & Methods: Thirty patients with TLE and negative MRI were investigated by EEG, MRS and neuropsychological tests that assessed memory function of temporal lobe. By using temporal metabolite identified on MRS, we could detect metabolic disturbance that occur in TLE and tried to lateralize epileptic focus. We correlated MRS results with, EEG results, and the patient's scores on memory function tests. Twenty age-matched volunteers were used as control subjects. Result(s): Ipsilateral temporal N-acetyl-aspartate (NAA)/ Creatine+Choline (Cr+Cho) and NAA/Cr ratios of the patients were significantly reduced compared with the mean ratios of contralateral hippocampus (p <0.001) and control subjects (p <0.001). EEG could detect epileptic focus in 17 (56.7%) patients, while MRS could detect epileptic focus in 27 (90%) patients and could lateralize about 76.9% of patients with bitemporal interictal epileptiform discharges (IEDs). Significant negative correlation between ipsilateral temporal NAA/Cr+Cho, NAA/Cr ratios and ipsilateral IEDs ratio (p < 0.05). Left temporal NAA/Cr ratio correlated significantly with patient's scores on Rey Auditory Verbal Learning Test (RAVLT) (p< 0.05) and right temporal NAA/Cr ratio correlated significantly with patient's scores on Rey Complex Figure Test (RCFT) (p < 0.05). Conclusion(s): These findings suggested that the temporal metabolite ratios identified on MRS could lateralize epileptic focus in TLE patients and they are closely related to the temporal IEDs and the cognitive function of temporal lobe.
https://zumj.journals.ekb.eg/article_4561_25cde4c34d7d62f2add822600533983b.pdf
2015-09-01
1
9
10.21608/zumj.2015.4561
temporal lobe epilepsy
Magnetic resonance spectroscopy
EEG
memory
Ashraf
Zitoun
1
Department of Neurology and Radiodiagnosis*, Zagazig University
AUTHOR
Ali
Soliman
2
Department of Neurology and Radiodiagnosis Zagazig University
AUTHOR
Ayman
Zeid
3
Department of Neurology and Radiodiagnosis Zagazig University
AUTHOR
Engy
Soliman
4
Department of Neurology and Radiodiagnosis , Zagazig University
AUTHOR