bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Proxmal Femoral Locked Plating for Peritrochanteric Fractures (Systematic Review & Meta-Analysis)
Authors: Mahmoud Ahmed Nageeb , Selim Ahmed Samir Mahmoud , Kamel Ahmed Sami
Published: August 2023

Background

In this study we performed a systematic review aiming to evaluate the efficacy of proximal femoral locked compression plate in treatment of peritrochanteric fractures as regard it’s indications, functional, radiological outcomes and possible complications.

Methods

A systematic literature search was conducted by using the databases MEDLINE, Cochrane library using the papers about the role of proximal femoral locked plate for treatment of peritrochanteric fractures starting on 2000 till 2021.

Results

According to the search strategy, 18 studies that covered 746 patients. PFLCP could offer optimum fixation of comminuted and highly unstable fractures that are associated with more shearing and pull-out forces

Conclusions

From this study, PFLCP shows overall good clinical and radiological outcomes in treatment of patients with peritrochanteric fractures who are osteoprotic and/or have unstable complex comminuted fractures (Comminution of the lateral trochanteric wall, postero-medial communition, reverse oblique fractures and in revision surgeries) without significant complications.
Patient Dissatisfaction Following Total Knee Arthroplasty (Systematic Review and Meta-Analysis)
Authors: Badawy Basem Ahmed , EL-Ghazaly Sherif Ahmed , Ashoub Mostafa Mamdouh
Published: August 2023

Background

TKA is a very successful form of treatment for degenerative osteoarthiritis of the knee. The demand for TKA is growing around the world because of the aging population and the need to preserve people's quality of life. However, one in every 300 knee arthroplasties, pain without any known explanation will be present. The pain may occur either at rest or with movement. The knee may have a good range of motion, and objective evaluation of the prosthesis may show a perfect result, with good positioning of the implants seen on radiographs, yet the patient complains of pain. Adequate assessment of this condition is important for orthopedists who carry out TKA.

Objective

To identify the causes and predictors of patient`s dissatisfaction after complicated TKA (eg., component malalignment, post early/late infection, patellar tendon rupture, … etc), factors of residual pain during activities of daily living and/or at rest, relation of pain and function in determining dissatisfaction, improvement of TKA outcome measures.

Patients and Methods

The review included Randomized controlled trials (RCT) that studied patient dissatisfaction particularly related to pain following TKA. Also, we included cluster RCTs, controlled (non randomized) clinical trials, prospective comparative cohort studies, and case – control studies. Cross –sectional studies, case series, and case reports were excluded. Only studies on human subjects were included (studies on patients having TKA).

Results

25 studies were included from 2009 to 2019; 24 were prospective studies and one prospective randomized control trial.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021.

Data Extraction

If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Conclusion

There was a need to consider new interventions to promote mental health and wellness amongst patients receiving TKA but this should, of course, be subjected to evaluation of its costs and benefits before implementation. Further research is needed to quantitatively analyze the discontentment factors that emerged from this study.
Open versus Arthroscopic in Management of Tennis Elbow. A Systematic Review
Authors: ElMahy Mohammed Mostafa M , Mohamed Amr Mostafa , Hussein Diaa Eldin Abdelhay Ahmed
Published: August 2023

Background

Treatment of resistant tennis elbow (lateral epicondylitis) still challenging, which may require surgery in order to gain pain relief and improve function.

Aim of the Work

The aim of this study is to systematic review and meta-analysis arthroscopic to open surgery for resistant TE regarding ROM, grip strength, DASH score, VAS, and complications.

Methodology

This study was approved by the Ethics Committee of Ain Shams University Faculty of Medicine. Written informed consent was not needed because of the study design (systematic review). We included randomized control trails (RCTs), controlled clinical trials, retrospective cohort studies, case series studies and we excluded case reports, cross sectional studies, non English study. Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria.

Results

Our systematic review found that the most relevant conclusion from the current study is that there is a significant difference between the 2 operative techniques when examining VAS score, Mayo elbow performance score, grip strength, DASH score and time to return to work in favor of arthroscopic technique. While the arthroscopic surgery had a longer surgical time than the open technique. Additionally, it was found that the complication rates, DASH score, range of motion and failure rates were similar between the arthroscopic and the open technique.

Conclusion

We found a similar effectiveness of both arthroscopic and open techniques in improving failure risk, complication rate and range of motion postoperative in the treatment of tennis elbow. There is significant difference between arthroscopic and open surgery with regards to self-reported function (DASH), pain intensity (VAS) at follow up, time to return to work and grip strength postoperative in favor of arthroscopic technique. The current meta-analysis found that arthroscopic surgery had a longer surgical time than the open surgery for lateral epicondylitis.
Role of Denosumab in the Management of Aneurysmal Bone Cysts
Authors: Mohamed Mohamed Abdel Hameed Deif , Mostafa Mohamed Abdel Rahman , Elseddawy Ashraf Mohamed
Published: August 2023

Background

The management of aneurysmal bone cysts (ABCs) has evolved and less invasive methods have been tried. Denosumab is a monoclonal antibody that inhibits osteoclasts. It is effective in giant cell tumours of bone (GCT) and based on the immunohistochemical similarity and relationship between GCTs and ABCs, Denosumab may also be effective in the treatment of ABCs.

Aim of the Work

This study aims to assess the therapeutic importance, effectiveness and side effects of denosumab administration in the management of aneurysmal bone cysts.

Materials and Methods

Embase, Cochrane Library, and MEDLINE/PubMed databases were searched for the articles published from Jan. 2013 to May 2021 that reported the efficacy and safety of denosumab in patients with aneurysmal bone cysts (ABCs).

Results

Thirteen studies were reviewed, involving a total of 40 patients who had aneurysmal bone cysts and were treated with denosumab. Of the 13 studies, 82.5% of the patients were from case series studies (33 patients) and 17.5% were from case reports (7 patients). The clinical response rate for denosumab as a treatment for aneurysmal bone cysts was 94.7%, with statistical significance (P < .0001). No treatment-related deaths occurred in the reviewed studies.

Conclusion

We conclude that denosumab represents an effective treatment option for patients with ABC especially when high surgical morbidity is expected. Although denosumab therapy is associated with minimal complications, however, relapse following cessation of treatment is still possible. Finally, denosumab is a potentially safe and promising modality for medically managing ABCs that requires further investigation with prospective clinical trials.
Unicompartmental Knee Arthroplasty versus Total Knee Arthroplasty in Treatment of Unicompartmental Knee Osteoarthritis
Authors: Osman Wael S A , Mounir Ayman F , Yusuf Mohamed A
Published: August 2023

Objectives

This is a systematic review conducted to compare the outcomes between unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA).

Material and Methods

Collection of data from different websites in the period from 2010 to May 2021 that studied UKA or TKA in treatment of knee osteoarthritis (OA). Comparison was made between the two techniques was performed of 12 literatures according to the study criteria and the PRESMA figure.

Results

There is no difference in age between the two techniques, however, there is a significant difference in gender and BMI (P < 0.05). The mean follow-up period of the patients was 4.14 ± 3.05 years and 3.94 ± 2.65 years in UKA and TKA groups, respectively. There is good improvement of VAS, KSS, OKS, KSS, WOMAC, ROM postoperatively regarding both techniques.
Effect of a New Antibiotic Protocol Adopted by ASU Hospitals on Patients with Intra-Medullary Nailing of Femoral and Tibial Diaphyseal Fractures as Regard Post-Operative Infection
Authors: El Zaher El Zaher Hassan , Abuzaid Mohamed Hamza , El Abd Mostafa Aly
Published: August 2023

Background

This study postulated that systemic antibiotic prophylaxis delivered preoperatively in intramedullary nailing of femur and tibia procedures significantly reduces the incidence of infection. Prophylactic antibiotics should be taken IV before skin incision by 30-60 minutes and no need for antibiotics more than 24 hours after operation. This protocol of antibiotics has multiple benefits such as saving a lot of money, decrease the risk of surgical site infection and decrease antibiotic resistance.

Aim of the Work

To assess the effect of antibiotic choice, duration on prevalence of surgical site infection among patients with intramedullary nailing of femoral and tibial fractures, and identify risk factors.

Patients and Methods

This study conducted on 50 cases of femoral and tibial fractures admitted from Al-Demerdash University Hospital in the period from June 2019 to December 2020 with age ranged from 18 to 56 years and with mean ± SD of 28.14 ± 10.14. This study was based on the antibiotic protocol adopted by Ain Shams University Hospitals that we give first generation cephalosporin (zinol) for all patient undergoing intramedullary nailing of femur and tibia, 30 – 60 minutes before skin incision and for 24 hours post-operative.

Results

The results of this study showed 1 case infected postoperative from 50 cases with a percentage of 2%, by this result we found that by studying the risk factors for infection there was no specific risk factor for infection except for obesity and diabetes. By studying of the results of application of our new antibiotic prophylaxis protocol in our hospital (Ain Shams University Hospitals) from the period from 6-2019 to 12-2020 the new protocol have the benefits of the following: Decrease of the total percentage of infection in all orthopedic surgeries in our department to less than 2%, Presence of fixed, known and effective prophylactic antibiotic protocol in our hospital unlike before every surgeon has his opinion about type and dose of antibiotics causing less controversy and confusion among surgeons in the practice of postoperative antibiotic use.

Conclusion

This study postulated that systemic antibiotic prophylaxis delivered preoperatively in intramedullary nailing of femur and tibia procedures significantly reduces the incidence of infection.
A Systematic Review of the Clinical Efficacy of Oxidized Zirconium as a Bearing Surface in Hip Arthroplasty
Authors: Fekry El-Husseini Timour , Ashoub Moustafa Mammdouh , Ahmed Mohammed Sayed
Published: August 2023

Background

Total hip replacement (THA) is an established treatment for end stage hip arthritis providing reliable pain free function. The long-term survival of THA depends on multiple factors, But aseptic loosening and wear induced osteolysis are most common causes of failure and search for alternative bearing surfaces became an important issue.

Aim of the Work

Our aim in this study is to evaluate efficacy of Oxide zirconium femoral head as a bearing surface in Total hip arthroplasty patients regarding clinical and radiological outcomes.

Patients and Methods

The types of study was a prospective and retrospective comparative cohort studies. Search results were conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart was produced based on the search results and the inclusion/exclusion criteria.

Results

OxZr was found to be less sensitive than CoCr to these variations and maintained a lower coefficient of friction when articulated with UHMWPE, even in poor lubricants.

Conclusion

Most of studies which were included in this review reported no significant differences in the mean polyethylene wear rate, survival rate, mean postoperative clinical subjective scores and complications’ rate of patients treated with OxZi femoral heads compared with the respective mean wear values of those who treated with CoCr femoral heads, While OxZi is offered at a cost premium, it seems that this type of alternate bearing surface is not clinically superior to the traditional metal bearing surface inTHA.
Bipolar Hemiarthoplasty versus Proximal Femoral Nail in Management of Unstable Intertrochanteric Femur Fracture
Authors: Khairy Amr , Mostafa Sherif , Khalil Eldeeb Mostafa Ebrahim Sayed
Published: August 2023

Background

Intertrochanteric fractures (ITFs), commonly occurred in the elderly, are still a big challenge for orthopedic surgeons due to the multitude of co-morbidities and high 1-year mortality rate associated with them.

Aim of the Work

The aim of this study is to review systematically studies about the use of bipolar hemiarthoplasty versus proximal femoral nail in management of unstable intertrochanteric femur fracture.

Patients and Methods

We included randomized control trails (RCTs), controlled clinical trials, retrospective comparative cohort studies and prospective comparative cohort studies and we excluded case reports, case series studies, cross sectional studies and non English studies. Search results was conducted to systematic review management software and manually screened for eligibility to be included. Surgical treatment of unstable intertrochanteric femur fractures by bipolar hemiarthoplasty versus proximal femoral nail.

Results

Regarding the patients included in the review there is no significant difference in the age or sex between the two groups of comparison. This review provides us with enough evidence regarding the superiority of PFN, which being a significantly faster surgery and has relatively lower incidence of intraoperative blood loss this in turn provides general wellbeing to the patient and gives better function. Although there is no significant difference between two group of comparison regarding percentage of failure and percentage of reoperation, PFN shows the superiority of duration of hospital stay which could be beneficial for the mental health of the patients, which adds to their overall quality of life, also PFN show the superiority regarding percentage of infection, decreasing patient suffering and risk of reoperation, also PFN show the superiority regarding percentage of mortality increasing life expectancy of patients, percentage of DVT decreasing pulmonary complications and also PFN show the superiority regarding Harris hip score so show better outcomes.

Conclusion

PFN proves itself as a better modality than hemiarthroplasty in unstable intertrochanteric femur fractures in the elderly, with decreased post-operative mortality and better functional results. Hemiarthroplasty is best reserved for individuals with short life expectancies who require immediate weight bearing and mobilization.
Outcomes of Four in One Osteosynthesis in the treatment of Congenital Tibial Pseudarthrosis: A Systematic Review
Authors: Samir Shady , Kersh Mohamed Ahmed Al , Ayoub Muhammad Ahmad Muhammad
Published: August 2023

Background

CPT has a natural history of recalcitrant nonunion, bone atrophy, progressive LLD and deformity, and persistent refracture even after surgical union.

Aim of the Work

The aim of treatment for CPT is to achieve and sustain union.

Methodology

Studies were considered eligible if the authors described the surgical procedure of tibial pseudarthrosis, patient‘s clinical and/or functional outcomes were reported, any complications intraoperatively and post-operatively were reported, the full- text articles were available, and the articles were written in English. The MED-LINE database, PubMed, science direct, Cochrane Register of Controlled Trails (The Cochrane Library), and Google Scholar were searched upon using the following keyword: congenital tibial pseudarthrosis, CPT, tibiofibular fusion, tibiofibular osteosynthesis, four in one osteosynthesis, tibia and fibula one mass fusion, Paley x method, and cross union.

Results

The cumulative data extracted provided 96 patients in 6 papers of which 60% were male and the other 40 % were females. The mean age was around 4.1 Years ranging from the first year till nearly eleven years old and the mean follow up was around 4.1 Years. The percentage of patient with neurofibromatosis type 1 was 53.13 % and 41.1 % had previous surgical intervention. All studies have mentioned that cross sectional area of healing mass increased and the relative crosssectional area was large in comparison to proximal shaft or proximal metaphysis. Unfortunately, no single method of assessing the cross-sectional area and relative cross-sectional area were used by different authors.

Conclusion

According to the findings of our research, cross sectional area is the most important factor in preventing refracture. New technology and therapeutics will emerge as new pharmacologic therapeutics and a deeper understanding of this disease emerge. Meanwhile, the best current combination treatment for CPT is hamartoma resection, periosteal grafting, bone grafting, Cross union, internal rodding, external fixation, tibiofibular Cross union, BMP, and bisphosphonate.
Posterolateral Plate vs. Lateral Plate in Fixation of Weber B Ankle Fractures. A Systematic Review/Meta-Analysis
Authors: Kamel Ahmad Samy , El-Sayed Awad Mohammed , El Raffa Nabil Wafik Anwar Hassan
Published: August 2023

Introduction

Ankle fractures represent 10% of all fractures making it the second most common lower limb fractures after hip fractures. Danis-Weber classification describes the injury based on the location of the lateral malleolar fracture as type A, B and C. Management of type B ankle fracture is often surgical through open reduction and internal fixation by plate and screws. The plate can be positioned laterally or postero-laterally.

Aim of work

To compare between posterolateral plate versus lateral plate in management of DanisWeber type B fibular fracture.

Materials and methods

A systematic review and meta-analysis in which search strategy done from 2000 to 2020. This study is done on 4 articles with total number of participants 333. The outcomes of interest are operative outcome, functional outcome measured by AOFAS and Olerud and Molander scoring system, complication rates outcome.

Results

Posteo-lateral plate is superior in less hardware irritation. Regarding operative timing, wound infection, screw loosening and functional outcomes both techniques are comparable with no statistically significant difference.

Conclusion

Both techniques are comparable with no stasticially difference regarding operative time, wound infection, screw lossening and functional outcomes. However, fixation of lateral malleolar fracture by posteo-lateral plate is superior in less hardware irritation.
Antegrade Intramedullary Pinning versus Retrograde Intramedullary Pinning versus Transverse k-Wires Fixation of Neck of 5th Metacarpal Fracture: A Systematic Review
Authors: Elkhateeb Tameem Mohamed Shafik , Hamed Islam Koriem Fattouh , Elattary Sayed Hussein Mohamed
Published: August 2023

Background

The 5th metacarpal fractures accounts for 40% of all hand fractures. Neck fractures are the commonest, as it is the weakest point in metacarpals, and accounts for about 10% of all hand fractures. Improper management of hand fractures has negative economic effect due to disabilities that occur to hands of workers, athletes and housewives.

Objective

To do a systematic review on literature that compares between using the antegrade verses retrograde intra-medullary k-wires and transverse pinning techniques in treatment of fifth metacarpal's neck fracture (boxer's fracture) regarding union, functional outcome and complications.

Patients and Methods

Recent clinical trials or cluster trials, prospective and retrospective comparative cohort studies. Search results will be uploaded to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be introduced on the search results and the inclusion/exclusion criteria.

Results

Application of inclusion and exclusion criteria to study abstracts yielded 8 articles. The full-text articles for these 100 studies were then reviewed and subjected to our inclusion criteria. A total of 8 articles were eligible for final systematic review.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022.

Data Extraction

If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Conclusion

Despite the limitations of this review, we found some evidence that the IM technique could have advantages over the use of transverse pinning in the treatment for the fifth metacarpal neck fractures. The quantitative analyses indicated probable better efficacy of IM particularly in relation to VAS, TAM, active ROM of the fifth ray and residual angulation. Our results can fit into the context of current practice where many hand surgeons consider the IM technique as their preferred method to treat neck fractures of the fifth metacarpal.
Mono-Focal Distraction Osteogenesis in Management of Traumatic Bone Loss (Systematic Review of Literature)
Authors: Abou-Seif Salah Abdelgawad , Kotb Mohamed Ismail , Abdelwahab Mahmoud M , El Rahman Shady Ahmed Abd
Published: August 2023

Background

Traumatic bone loss poses a serious problem for orthopedic surgeons added to the long standing risk of infection implied by open type fractures.

Aim of the Work

This study aims to assess the efficacy of distraction osteogenesis in compensating bone defects using the Paley score for functional and radiological outcomes.

Methodology

We searched the literature through PubMed database with publication date restricted to 10 years range from 2009-2019 English literature of prospective studies only were selected with strict inclusion criteria where repeated articles were excluded unless they presented follow up with functional outcome data about cases. Seven studies were included satisfying the predetermined inclusion criteria with total of 242 cases. Patients’ data were collected and analyzed with only: 176 cases mentioned demographic data with average age of ‘37’ and no comorbidities to decrease the risk of bias in our results. 125 patients had fractures in tibia without soft tissue loss and 51 patients needed skin grafting, 3.4% of total cases underwent late amputation, 14.2% experienced pin tract infection.

Results

Our results appear to demonstrate the efficacy of mono-focal distraction osteogenesis technique in compensating long bone defects of the lower limbs in traumatic events. We isolated studies reporting exclusively on either proximal tibia or distal tibia bone defects compared the respective outcomes of interest in the absence of statistical heterogeneity. The only significant difference that could be established was a four-fold decrease of the likelihood of fair functional results in the ‘distal tibia’ subgroup compared with the ‘proximal tibia’ subgroup. In distal tibial defects, we explored the impact of the size of a bone defect and duration of external fixation on outcomes of interest. We noticed a 3.7-times increase in the odds of re-fracture when the size of the distal tibial defect exceeded 8 cm

Conclusion

Mono-focal distraction osteogenesis (Ilizarov method) is effective in managing bone defects larger than 3 cm² however for defects larger than 8cm² there’s increased risk of re-fracture.
Immunohistochemical Expression of Programmed Death Ligand-1 and CD-8 in Glioblastoma
Authors: Elsamman Dina M , Kamar Zeinab A , Cousha Hala S , Mahdy Manal M El , Karim Khaled Abdel , Abou Gabal Hoda H
Published: August 2023

Background

Glioblastoma (GBM) is the most common and most aggressive primary malignant brain tumor in adults. It is characterized by its extremely poor prognosis despite the available treatment strategies. Immune evasion is described in Glioblastoma via the PD-L1/ PD-1 interaction. Programmed death ligand 1 (PD-L1) is a cell surface ligand expressed on the surface of several tumors including GBM and its receptor is the PD-1 (Programmed deasth-1). Other malignant tumors including melanoma and non-small cell lung cancer, showed promising results using PD-L1/PD1 blockade treatment strategies where PD-L1 was described as a potential predictive biomarker for patient selection in these tumors. In our study we will shed the light on the expression and role of PD-L1 in glioblastoma, the presence of tumor infiltrating lymphocytes (TILs) and its interaction with PD-L1 in glioblastoma. The role of PD-L1, CD-8+ TILs, other clinicopathologic parameters and patient’s survival will be also discussed in relation to glioblastoma.

Methods

Paraffin embedded tissue blocks of thirty cases of GBN were retrieved, slides were prepared and stained via Hx& E for evaluation and confirmation of diagnosis according to the CNS WHO 2016. Immunohistochemistry using PD-L1 and CD-8 was performed on the 30 glioblastoma cases. Interpretation of the results and correlation between the expression of both markers and the clinicopathologic parameters was also done. Furthermore, survival analysis was done to correlate overall survival and progression free survival of the glioblastoma cases to the expression of PD-L1 and CD-8 markers and also the clinicopathologic parameters available.

Results

Diffuse/fibrillary PD-L1 was expressed in all cases (30/30) with variable percentages (16.7% in ≤ 25% of cases 5/30, 33.3% in > 25%- ≤ 50% of cases10/30, 16.7% in > 50%- ≤ 75% of cases 5/30 and 33.3% in > 75% of cases 10/30). The mean value of Diffuse/fibrillary PD-L1 expression was 57.6%. Membranous PD-L1 was expressed in 6/30 of the cases. TILs were set into two groups according to Han et al 2014; low infiltration group 17/30 (56.7%) of cases and high infiltration group 13/30 (43.3%) of cases. Expression of CD-8 was 10% (median percentage) and 14.3% (mean percentage). PD-L1 and CD-8 correlation was statistically significant (P 0.001) where high PD-L1 expression is associated with low CD-8 expression. PD-L1 expression was associated with worse overall survival (0.001) and worse progression free survival (P 0.026). CD-8expression did not affect the outcome. Correlation of age, sex, tumor site and laterality to outcome were statistically insignificant. In the results of our study PD-L1 expression was the only independent factor that affected the prognosis according to Cox variate analysis.

Conclusion

The incidence of PD-L1 expression in GBM patients is robust. Higher expression of PD-L1 is associated with lower TILs expression and worse prognosis.
Expression of Interleukin 23p19 in Colorectal Carcinoma: An Immunohistochemical Study with Clinico-Pathological Correlation
Authors: Khamis Nahed Samy , Ahmed Hamed Mohamed , Rizk Manal Fawzy , Shakweer Marwa Mosaad , El Ghany Hassan Mona Mohamed Refaat Abd
Published: August 2023

Background

Cancer of the colon is the fourth most common cancer in the world, while cancer of the rectum is the eight most common. Together, colorectal carcinomas (CRCs) are the third most commonly diagnosed form of cancer globally, comprising about 11% of all cancer diagnoses. In Egypt, a rapid increase in CRC incidence has been observed with an unusually high rate under the age of 40. Interleukin 23 (IL-23) is a member of a family of pro-inflammatory cytokines, consisting of a p19 subunit and a p40 subunit. Studies showed that IL-23 signaling causes up-regulation of MMP9, increased angiogenesis, and reduced CD8+ T cell recruitment to tumors. Therefore, IL-23–mediated inflammatory processes might provide a tumor-promoting microenvironment.

Objective

To evaluate the immunohistochemical expression of IL23p19 in colorectal carcinoma with clinico-pathological correlation.

Methods

This is a retrospective study consisting of formalin fixed paraffin embedded tissue blocks of 25 cases diagnosed as colorectal carcinoma. All tissue blocks were retrieved from the archives of the pathology department at Al-Demerdash Hospital.

Results

There was a significant difference between CRC cases with different tumor stages as regard total IL23p19 expression, as 100% of cases with higher stage (T4a/b) had positive expression compared to 42.9% and 92.9% of T2 and T3 respectively. However, no significant difference was detected between cases with different tumor grades as regard total IL23p19 expression.

Conclusion

It can be concluded from our study that there is an association between IL23p19 expression and the pathological stage in CRC patients. IL23p19 could be used as a prognostic biomarker and a potential treatment target.
Outcomes of Health Care Services Provided to Egyptian Patients with Type 1 Diabetes Mellitus Attending Pediatric Diabetology Unit, Children's Hospital, Ain-Shams University
Authors: Elhabashy S A , Elbarbary N S , Thabet R A , Ahmed A A
Published: August 2023

Background

Efforts in treating patients with type 1 diabetes are targeting strict glycemic control to prevent long- and short-term adverse health outcomes.

Aim of the Work

to evaluate the current health care services provided to patients with type 1 diabetes registered in Pediatric and Adolescent Diabetology Unit (PADU), Children's hospital of Ain-Shams University, in terms of metabolic control and complications encountered.

Patients and Methods

This retrospective cross-sectional study was conducted on all patients attending diabetology clinic during the period between May 2017 and July 2018. Patients' data was extracted from patients records of clinic including baseline and follow up examination and investigations.

Results

The mean age of patients was 12.63 ± 3.41 years with mean diabetes duration 5.54 ± 3.07 years. The mean HbA1c was 8.75 ± 1.94 %, with mean number of blood glucose monitoring (SMBG) 2.43 ± 0.64 times/day. Patients with more than 5-year-diabetes duration have significantly higher cholesterol level (167.58 ± 38.02 versus 163.23 ± 35.54 mg/dl), higher LDL (100.23 ± 29.49 versus 95.70 ± 28.11 mg/dl), presence of celiac antibodies (5 cases versus 4 cases) and lower number of SMBG (2.24 ± 0.66 versus 2.58 ± 0.57 times/day), (p < 0.05).

Conclusion

Patients with more diabetes duration have significantly higher incidence for microvascular complications and have less satisfaction than others with less duration of diabetes.
COVID 19 Related Multisystem Inflammatory Syndrome in Children Admitted to PICU in Ain Shams University Hospitals
Authors: Ibrahim Hanan Mohamed , Habeeb Nevin Mamdouh , Magdy Sondos Mohamed , AboBakr Ahmed Mohamed Hessain
Published: August 2023

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4–6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation.

Aim of the Work

To evaluate the clinical profiles and risk factors for pediatric multisystem inflammatory syndrome in children with COVID-19 admitted to PICU.

Patients and Methods

This was a cross sectional study conducted on 45 patients admitted to pediatric intensive care unit (PICU) from June 2020 to August 2020, they were diagnosed as MIS-C cases according to CDC definition for MIS-C, using a score to assess hyperinflammatory syndrome, all patients were subjected to the following:(demographic data, clinical signs & symptoms at presentation, sequential organ failure assessment (SOFA) score and laboratory investigations.

Results

In our study MIS-C patients presented with 100% Kawasaki disease(KD)-like symptoms and 62.2% gastrointestinal symptoms in addition to fever with shock or cardiac dysfunction. Our patients presented with the following vital data: 100% were tachycardic and hypotensive according to centiles, peripheral capillary oxygen saturation (spo2) mean 94.5(2) %, fever of mean 39(0.6) degree celsius and SOFA score mean of 9(2). KD-like features were variably seen in patients (skin rash in 55.6%, conjunctivitis in 46.7% and Cardiovascular abnormalities were seen in 100% e.g. (myocardial dysfunction, valvular regurgitation, coronary dilatation, pericardial effusion and shock). In our patients, 13 patients (28.9%) had comorbid conditions, like (hematologic e.g. ALL, Cardiac e.g. ASD&VSD, Endocrinologic e.g. Diabetes mellitus), 4 of them died revealing comorbidities as a cause of higher mortality with significant p value (0.028). 39 patients (86.7%) were discharged and 6 patients (13.3%) died.

Conclusion

MIS-C is a hyper-infammatory syndrome affecting multiple organs and is triggered by SARS-CoV-2 infection. It is usually seen 2–4 weeks following infection. comorbidities significantly affected the short term outcome of the disease.
5 Years Analysis of Therapeutic Hypothermia for HIE Neonates in NICUs of Ain Shams University
Authors: Gad Ghada Ibrahim , Attia Nayera Ismail , El fattah Atia Alaa Amir El dawla Abd , Saleh Ghada Ahmed
Published: August 2023

Background

Therapeutic hypothermia (TH) is a standard of care for neonatal Hypoxic Ischemic Encephalopathy (HIE) in developed countries. Most data come from High income countries (HIC). Recently, experts suggest that the safety and efficacy data on cooling from HIC should not be extrapolated to Low and Middle Income Countries (LMIC).

Aim of the Work

Evaluation of the outcome of neonates with HIE treated with TH as a neuroprotective treatment who were admitted to NICUs of Ain Shams University from 1/2016 to 12/2020.

Patients and Methods

All HIE babies who were treated with TH were included. Retrospectively, patients’ medical paper notes of included babies were reviewed, recorded, and analyzed. Survived neonates were approached by telephone interview regarding parental views on their neurodevelopment and were offered a formal neurodevelopmental assessment for their babies using Bayley Scales III.

Results

A total 37 neonates (17 survived and 20 died) were included: 2 mild HIE (survived), 13 severe HIE (all died) and 22 moderate HIE (15 survived and 7 died) (mortality 54.1%). The most common causes of death are pulmonary hemorrhage (24.3%) and shock (18.9%). Of the 17 survivors, 6 patients couldn’t be reached while 9 patients had satisfactory neurodevelopmental progression as per their parents while 2 patients had poor outcome. Bayley III was done for only 3 babies: All had normal cognitive and language development. 2 of them had normal motor development while 1 patient had mild to moderate motor delay.

Conclusion

TH might not improve outcome of sever HIE but of great value on outcome of moderate HIE. Prospective RCTs are recommended to assess the role of TH as a neuroprotective agent for neonates with HIE in a low resource setting.
Psychological Impact of COVID-19 Pandemic on Pediatric and Adolescent Patients with Type 1 Diabetes Mellitus
Authors: Elmaksoud Abeer A Abd , Elhenawy Yasmine I , Abd- ElHamid Salwa A , Shokr Asmaa S
Published: August 2023

Background

The COVID-19 pandemic and quarantine measures had actually affected the quality of life of general population. Pediatric and adolescent diabetic patients are vulnerable group with increased susceptibility to infections and increased morbidity and mortality. They are exposed to increase levels of stress, anxiety and depression during the COVID-19 pandemic.

Aim of the Work

This study aims to assess the psychological impact of COVID -19 pandemic among children and adolescents with type 1 diabetes.

Subjects and Methods

This study is observational cross-sectional study based on analysis of 100 patients with type 1 diabetes, aged 7-18 years old from Pediatrics Hospital, Faculty of Medicine, Ain Shams University. Patients were subjected to full history taking, physical examination, laboratory investigations and psychological assessment by assessing quality of life by PedsQLTM 3.0 Diabetes Module Arabic version which is a multidimensional diabetes-specific instrument assessing the broad age range of 2 - 18 years with both child and parent proxy-reports.

Results

The results showed that PedsQL (parents report) total score ranged from 40 – 92 with mean of 66.27 ± 12.48 and PedsQL (children report) total score range from 44-93 with mean of 68.41 ± 12.78. Both PedsQL (parents report) total score and PedsQL (children report) total score negatively correlated with age, weight, number of DKA, HbA1c post lockdown. There is a negative relation between PedsQL (parents report) total score and tanner stage, no. of sibling, hospital admission during pandemic and insulin regimen, so any increase in those parameters will lead to decrease in PedsQL (parents report) total score. There is a negative relation between PedsQL (children report) total score and no. of sibling.

Conclusion

There was a mutual relationship between the pandemic and lock down and HbA1c and quality of life in pediatrics and adolescences with T1DM in Egypt. Low quality of life during the COVID-19 pandemic negatively impacted glycemic control.
Epilepsy Surgery and Health Education Improved Quality of Life in Children with Drug Resistant Epilepsy
Authors: Hassanein Sahar M A , Sorial Dina M Sh , Abd El-Kader Mohamed S M , Hamada Salah M , Darwsih Ahmed M , Shata Mennatallah O
Published: August 2023

Background

Epilepsy is a common neurological disorder that affects over 70 million people worldwide. Despite introduction of recent antiepileptic drugs (AEDs), there's about one-third of patients that suffer from epilepsy also have seizures refractory to pharmacotherapy.

Aim of the Work

To study the effect of epilepsy surgery and health education on seizure control, sleep, and quality of life in children with drug resistant epilepsy (DRE) postoperative.

Patients and Methods

This was an observational study that relied on data collection, health education on 30 children operated upon for DRE and their families throughout a 6-month period. Data collected included Chalfont Seizure severity scale (CSSS), Quality of life (QOL) questionnaire, IQ assessment, total sleep habits questionnaire (CQHQ), EEG and Engel scale after epilepsy surgery.

Results

Enrolled children age ranged between 4-18 years with a mean age of 7.8 ± 3.8 years, of which (65.6%) were males.

There was a significant reduction in CSSS after surgery from (78.5 ± 30.1) to (60.3 ± 33.6), quality of life from (91.3 ± 20.9) to (80.5 ± 18.1), and in CSHQ from (33.7 ± 10.2) to (25.1 ± 8.3). IQ increased after surgery from (46.7 ± 15.7) to (50.2 ± 16.5); P value <0.001 for all. Mean reduction of Chalfont scale was 24.73% (range from 0 % to 70%). Quality of life was 10.98% (range from 0% to 36.2%), CSHQ was 23.03% (range from 0% to 70%) and mean IQ increase was 8.31% (range from 0% to 50%).

There was an improvement in seizure control as Engel classification postoperatively. In Engel (I) 3.1% were A and 3.1% were D. In Engel (II) 3.1% were A, 3.1% were B and 3.1% were D. In Engel (III) 28.1% were A and 3.1% were D. In Engel (IV) 15.6% were A, 28.1% were B and 9.4% were C.

Conclusion

Epilepsy surgery can effectively improve QOL in children with medicationresistant seizures, through sustained seizure freedom, which was associated with the greatest improvement in life quality, IQ and sleep habits.
Nutritional Screening of Sick Neonates in NICU and Its Relation to Short Term Outcome
Authors: Emam Safaa Shafik , ElDin Mohamed Nour , Elgendy Yasmin Gamal Abdou , Ali Doaa Nagy
Published: August 2023

Background

Malnutrition during infancy has long-term physical and psychological adverse effect on development. Neonatal nutritional assessment is important to determine the daily energy and nutritional requirements needed for optimum growth and development.

Objectives

Assessment of the validity of Nutrition risk screening tools, and to stratify neonates admitted to the NICU according to their nutritional risk and correlate this to their outcome.

Methods

A cross-sectional study was conducted in NICU at Ain Shams University Hospitals. All neonates admitted to the NICU in a set period of 6 months from December 2017 to June 2018 were enrolled in the study after written and verbal consents were taken from parents.All neonates were subjected to the following: Anthropometric measurements (weight, length, head circumference, mid arm circumference, skin fold thickness and ponderal index at admission), Dietary assessment and laboratory investigations. The number of patients at this study were classified according to ‘Ohio neonatal nutrition screening tool (NNST) into a three risk groups:

•low risk group: no = 121

•moderate risk: no = 15

•High risk: no = 14

Results

The study showed that full intake enteral nutrition was reached in 100% of low and moderate risk groups and in only 64.3% of high risk group. Continuous parenteral nutrition was required in 100% of moderate and high risk groups and in only 7.4% of the low risk group. It also showed that the length of hospital stay was increased in the moderate risk group to 22 days (16-26) and in the high risk group to 8.5 days (3-16) while in the low risk group was only 5 days (4-7).Considering the hospital discharged patients: 100% of the moderate risk group, 99.2% of the low risk group and only 21.4% of the high risk group were discharged. According to the septic score, sepsis was recorded in 85.7% in the high risk group, 66.7% in the moderate risk group and only in 24% of the low risk group.

Conclusion

Nutritional screening tools were able to identify neonates at nutritional risk, as it showed that High risk group patients had higher rate of mortality and higher risk of Sepsis and thus they were in need for further assessment and support by nutrition specialist.
Hepatic Manifestations of Pediatric Hemophagocytic Lymphohistocytosis
Authors: El Sayed Manal Hamdy , Ebeid Fatma Soliman , El Kader Salwa Mostafa Abd , El-Shorbay Fatma Mohamed , Ragab Iman Ahmed
Published: August 2023

Background

Hemophagocytic lymphohistiocytosis (HLH) is a rare hyper-inflammatory disorder.it is caused by benign systemic overgrowth of macrophages in the reticulo-endothelial system, leading to cytokine storm. The main features of HLH are; fever, splenomegaly, bi/pancytopenia; hyperferritinemia, hyper-triglyceridemia and hypofibrinogenemia; which if not diagnosed and early treated progresses to disseminated intravascular coagulopathy (DIC), multi-organ dysfunction with dismal outcome. Hepatic manifestations are not well recognized primary presentation in pediatric patients with HLH. This presentation mandates high levels of suspicious for early diagnosis.

Aim of the Work

To study the hepatic involvement clinical, laboratory, and pathological in patients with Familial/primary (1ry) HLH and in patients with secondary (2ry) acquired HLH.

Patients and Methods

A 6 month retrospective cohort study included 35 patients with genetically confirmed HLH divided into familial HLH by its types, X linked lymphoproliferative syndrome, HLH with partial albinism and secondary HLH; following at pediatric hematology/oncology clinic, Ain Shams University. By detailed review of clinical and laboratory data that include hepatic transaminases and synthetic liver function done at the time of presentation, at week 2, 8 from treatment start and at time of reactivation; Liver biopsy results and genetic analysis were recorded. Biochemical liver involvement was considered when alanine aminotransferase was three folds the upper level of normal at presentation. Overall and reactivation free survival were analyzed according to liver involvement

Results

Thirty five patients with HLH were recruited with age range of 2-108 months, 20(57.1%) of patients with HLH were genetically confirmed and 12(34.3%) of them had MUNC13D mutations, 3(8.6%) had STXBP2 mutation and 5(14.3%) had RAB27A mutation while 4(11.4%) had secondary HLH. 29(82.9%) had liver enlargement at diagnosis with hepatic reactivation in 18(51.4%). 8(22.8%) of patients had biochemical liver involvement; there was no significant difference in their demographic data or their clinical presentation, their final outcome or the type of mutant gene according to liver involvement.

Conclusion

HLH is a frequently lethal disease with a high variability in clinical presentation .it must be considered a differential in patients presenting with clinical signs of hepatic dysfunction especially when it is accompanied by cytopenias. Significant biochemical liver involvement is an under recognized presentation of HLH. Hepatic involvement did not impact response to treatment and disease outcome.
Evaluation of the Current International Registry Update for Children and Adolescents with Diabetes Mellitus Following Up in Diabetes Clinic, Pediatric Hospital, Ain Shams University
Authors: Sherif Eman Monir , Elbarbary Nancy Samir , Thabet Rasha Adel , Abdelwahab Gehad Saber
Published: August 2023

Background

Diabetes team should have the access for receiving continuous feedback for the health care service to help successful improvement. Health professionals need to continuously work to improve the quality of pediatric diabetes care to reduce the risk of acute and chronic complications. Objective: To evaluate the current international SWEET registry update for the children and adolescents following regularly at Pediatric and Adolescents Diabetes Unit (PADU) during a period of six months and updating the existing electronic medical record (Database) in (PADU) to provide measures to improve patients outcome regarding both acute and chronic complications.

Patients and Methods

The present study is a prospective follow up study performed on 385 patients with diabetes mellitus type1, with a mean age 11.79 ± 4.16 years. All patient with diabetes mellitus type1 visiting diabetes clinic (PADU) were included in the study after obtaining an informed consent.

Results

Patients with longer diabetes duration have significant higher insulin dose, more attacks of DKA and less attacks of hypoglycemia comparing to those with shorter duration. Patients with poor glycemic control have more attacks of DKA (62 patients vs 58 patients), (p-value=0.046), and less attacks of hypoglycemia (25 patients vs 65 patients), compared to properly controlled patients (p-value=0.000). Patients on insulin pump show significant improvement of them HbA1c (11% vs 7.3%) (p –value=0.000), cholesterol (173 mg/dl vs 139.8 mg/dl) (p- value= 0.006) and SMBG (2.7 times vs 4.6 times) (p-value= 0.000), compared to patients on multiple daily injections (MDIs).

Conclusion

Diabetes care is the cornerstone for proper glycemic control and prevention of long term complications. This study showed the value of a registry system to enable monitoring of patients over many years. The study could be an important step in the development of a national registry system for diabetes in Egypt.