bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin-like growth factor 1 and insulin-like growth factor binding protein-3 as predictive biomarkers of depression and migraine in obese women
Authors: Rashad Nearmeen M. , Gomaa Ahmed F. , Sabry Hanan M. , Fouad Amira A. , El Shabrawy Shereen M.
Published: September 2023

Introduction

Obesity and its comorbidity, depression and migraine, are highly prevalent conditions and public health problems of enormous scope that are responsible for the significant quality of life impairment and financial cost. Insulin-like growth factor-1 (IGF-1) and its main binding protein, insulin-like growth factor binding protein-3 (IGFBP-3) are related to metabolic diseases such as growth deficiency, obesity, cancer, neurological, and cardiovascular diseases. The objective of this study was to explore IGF-1 and IGFBP-3 in obesity-associated depression and migraine. Also, we aimed to evaluate the association of IGF-1 and IGFBP-3 with clinical features of depression and migraine.

Patients and methods

A cross-sectional controlled study included 50 healthy lean control group and 100 obese women who were subdivided into three subgroups: obese without depression and migraine (n=27), patients with depression (n=24), and patients with migraine (n=49). Clinical, neurological, and psychiatric evaluation of all patients was done. We measured IGF-1 and IGFBP-3 by commercial enzyme-linked immunosorbent assay.

Results

Our study showed a significantly lower level of IGF-1 and IGFBP-3 in obese women compared with lean ones. Even more importantly, obese women with depression as well as migraine had significantly lower IGF-1 and IGFBP-3 than those without depression and migraine. Interestingly, the lower levels of IGF-1 and IGFBP-3 in obese women with depression and migraine were significantly negatively correlated with depression score, BMI, and homeostasis model assessments of insulin resistance. Linear regression analysis test in obese patients showed that BMI and depression scores were independently correlated with serum IGF-1. However, BMI, fasting serum insulin, and depression scores were independently correlated with serum IGFBP-3.

Conclusions

Obese women with depression and migraine had significantly lower IGF-1 and IGFBP-3 than those without depression and migraine.
The importance of education and training for noninvasive ventilation: suggestions from the literature
Authors: Elena Barbagelata , Tommaso Perazzo , Gianluca Ferraioli , Mario Santo , Antonello Nicolini
Published: September 2023

Noninvasive ventilation (NIV) is a commonly used respiratory support. The use of the NIV is expanding over time and, but its knowledge and skills are very important for the proper use of this life-saving support. This study aims to evaluate the available evidences for the education and training of NIV. There are no clinical trials examining the impact of education and training of the NIV as the primary objective. However, few studies with indirect evidences, and evidence from a simulation-based training, and some reviews were found. Organized training to increase NIV skills is also limited mostly within few developed countries. Education and training in NIV have the potential to increase knowledge and skills of the staff. The development of organized education and training program in NIV appears to be the need in several types of disciplines and care environments.
Association of new obesity indices; visceral adiposity index and body adiposity index, with metabolic syndrome parameters in obese patients with or without type 2 diabetes mellitus
Authors: Rashad Nearmeen M. , Emad George
Published: September 2023

Background

Obesity is the cornerstone of metabolic syndrome (MetS); it is not possible to use BMI to differentiate between lean mass and fat mass. We aimed to investigate, for the first time, the possible association of new obesity indices; visceral adiposity index (VAI) and body adiposity index (BAI), with parameters of MetS in Egyptian obese patients.

Patients and methods

This was a case–control study that included unrelated 150 obese patients and 50 healthy controls. Obese patients were then subdivided into two subgroups, nondiabetic patients (n=85) and 65 patients with type 2 diabetes mellitus. We measured the anthropometric measures; BMI, waist/hip ratio, waist/height ratio, BAI, and VAI.

Results

Among obese patients, we found significant positive correlations between parameters of MetS and obesity indices. Among obesity indiced, the highly significant positive correlations were found between VAI and parameters of MetS. After adjusting for the traditional risk factors, logistic regression analysis test found that the VAI value was the best predictor of type 2 diabetes mellitus in comparison with BMI and BAI. Receiver operating characteristic curve was used to assess the power of obesity indices; the sensitivity and the specificity of BMI were 94.7 and 99.9%, for VAI, they were 74.4 and 99.9%, and, for BAI, they were 83.3 and 58%, respectively.

Conclusion

BMI is still the most powerful diagnostic tool for obesity. Although, in certain conditions, where there are limitations of using BMI, we can use other obesity indices, VAI and BAI could be used to discriminate cardiovascular risk among obese patients.
Effect of vitamin D replacement on cardiometabolic risk factors and electrophysiological pattern of peripheral neuropathy in vitamin D-insufficient or deficient type 2 diabetic patients
Authors: Rashad Nearmeen M. , Sabry Hanan M. , Gomaa Ahmed F. , Ebaid Amany M. , Abomandour Hala G. , Allam Reem M.
Published: September 2023

Background

Diabetic neuropathy is one of the commonest chronic complications of diabetes seen in routine healthcare and considered the most common cause of peripheral neuropathy all over the world. Vitamin D (VD) deficiency is now recognized as a pandemic disease. This study was designed to explore the levels of 25-hydroxycholecalciferol [25(OH) D] in patients with type 2 diabetes mellitus (T2DM) with peripheral neuropathy. We also aimed to clarify the effect of VD supplementation on cardiometabolic status and electrophysiological pattern of peripheral neuropathy.

Patients and methods

This clinical trial enrolled 95 patients with T2DM with peripheral neuropathy. The enrolled patients were divided into three groups according to serum 25(OH) D levels. VD deficiency and insufficiency groups received VD supplements (42,000 IU oral VD per week and 500-mg calcium carbonate per day for 12 weeks). Clinical, electrophysiological pattern, and laboratory parameters were evaluated at baseline and after 12 weeks of intervention. Serum 25(OH) D levels were measured by using a competitive enzyme-linked immunosorbent assay kit.

Results

Our results revealed that, among 95 patients with T2DM with peripheral neuropathy, 32 patients had VD insufficiency [20 ng/ml <25(OH) D <30 ng/ml], 50 patients had VD deficiency [25(OH) D < 20 ng/ml], and 13 patients had VD sufficiency [25(OH) D >30 ng/ml]. Our results reported that 25(OH) D levels were negatively correlated with cardiometabolic risk factors and Toronto Clinical Scoring System. On the contrary, 25(OH) D levels were positively correlated with nerve conduction velocities (NCV). Stepwise multiple linear regression analysis revealed that glycated hemoglobin and Toronto Clinical Scoring System were the main predictors of 25(OH) D levels among other clinical and laboratory biomarkers. Logistic regression analysis observed that motor NCV and sensory NCV of median nerve and glycated hemoglobin were independent predictors of response to VD supplementation. NCV in studied groups showed that motor NCV and sensory NCV in the median, posterior tibial, and ulnar nerves were significantly decreased in both VD deficiency and insufficiency groups compared with VD sufficiency groups, and supplementation with 42 000 IU oral VD per week and 500-mg calcium carbonate per day for 12 weeks improved cardiometabolic risk factors and electrophysiological pattern of peripheral neuropathy.

Conclusion

The supplementation of VD for 12 weeks to VD deficiency and insufficiency groups improved the cardiometabolic and electrophysiological pattern of peripheral neuropathy.
Association between 25-hydroxyvitamin D and hemoglobin A1c levels in patients with type 2 diabetic kidney disease
Authors: Azeem Haitham A. , Mohammed Arafa I. , Hashim Alaa M.
Published: September 2023

Introduction

Vitamin D is suggested to influence glucose homeostasis. An inverse relationship between serum 25-hydroxyvitamin D (25(OH)D) and glycemic control in non-chronic kidney disease (CKD) patients with type 2 diabetes was reported. We aimed to examine this association among type 2 diabetes patients with CKD.

Objectives

To examine the relation between plasma 25-hydroxyvitamin D3 (25(OH)D3) levels and glycemic state in diabetic patients at various stages of CKD.

Patients and methods

A total of 70 participants (40 men and 30 women) with a mean age of 65.3±11.5 years suffering from type 2 diabetes mellitus with various stages of CKD were recruited. Blood for glycated hemoglobin (HbA1c), serum 25(OH)D3, renal profile, and estimated glomerular filtration rate was drawn at enrollment. Correlation and regression analyses were carried out to assess the relationship of serum 25(OH)D, HbA1c, and other metabolic traits.

Results

Our study shows the following results:

Most of the participants are urban with age range from 50 to 70 years.

Forty percent of the participants are with good glycemic control, 30% with moderate control, and 30% with bad control.

Fifty percent of the patients were at CKD stage 3. Stage 5 patients differed significantly from stages 1 to 4 patients where they were younger, with lowest mean HbA1C value and a much higher mean 25(OH)D level (around twice of stage 1 patients).

Half of the cases are vitamin D deficient, nearly a third of them are insufficient, and about 20% are sufficient.

The level of 25(OH)D3 correlates inversely with the level of HbA1C irrespective of estimated glomerular filtration rate or the age of the patients.

Conclusion

The present study reported a significant inverse relationship between serum 25 (OH)D3 and HbA1c levels in type 2 diabetics with suboptimal glycemic control and concomitant different stages of CKD.
A review of bone marrow niche cellular spectrum
Authors: Shoieb Sabry A. , Abdel Hafez Mohammad A. , Abd El-Hamid Alaa E. , Ezz Walaa Hamdy
Published: September 2023

To perform a narrative review on the role of bone marrow (BM) niche in normal hematopoiesis.

MEDLINE databases and Ovid database were searched. The search was performed on 10 October 2018 and included articles published from 2015 to 2018 in English language.

The initial search presented 45 articles, which were included in the study.

Hematopoietic stem cells which produce a variety of hematopoietic lineage cells throughout the life are located in a specialized microenvironment called the ‘niche’ in the BM where they are governed. Several types of cells in the BM have been suggested to contribute to hematopoietic stem cell niche activity.
Predictors of myocardial injury in patients with cirrhosis presenting with upper gastrointestinal bleeding
Authors: Shaheen Rehab , Gouda Tarek , Bahgat Monir , Selim Tarek , El-Menshawy Hazem Hakim El-Beltagy , Awad Elsayed
Published: September 2023

Background

Myocardial injury in conditions other than coronary artery disease (CAD), known as type 2 myocardial infarction, is mostly related to mismatch between myocardial oxygen supply and demand. Cirrhotic patients with acute upper gastrointestinal bleeding (UGIB) are usually hemodynamically unstable. Hypovolemia, hypotension, and decreased oxygen-carrying capacity as consequences of UGIB may precipitate subclinical heart failure and myocardial injury.

Aim of work

Assessment of the prevalence and potential risk factors of myocardial injury in patients with liver cirrhosis with acute UGIB.

Patients and methods

The study was conducted on 132 patients diagnosed with liver cirrhosis presenting by UGIT bleeding at Mansoura University Hospitals during one year. Patients were divided into 2 groups: group 1 (76 patients) with myocardial injury or ischemic heart disease and group 2 (60 patients) without.

Results

The incidence of myocardial injury in this study (elevated troponin levels above cutoff value and/or ECG changes) was 55% of patients. Troponin I was positive in 25% of patients. ECG ischemic changes were found in 36.3% of patients in the form of ST-segment deviation or T-wave inversion. On univariate analysis, predictors of myocardial injury in patients with UGIB included MELD score and variceal source of GI bleeding. On multivariate analysis variceal source of GI bleeding is an independent predictor of myocardial injury. Variceal bleeding was found in 95 % of the ischemic group versus 63% in the other group.

Conclusion

More than half of the study patients presented with UGIB have suffered from unnoticed subclinical myocardial injury. Variceal source of GI bleeding was found to be an independent predictor of myocardial injury.
Serum omentin-1 as a predictor of activity in Crohn’s disease
Authors: Mohammed Mohammed A. , Omar Nesreen M.
Published: September 2023

Background and aim

Crohn’s disease (CD) is associated with alterations in fat mass and fat distributions, with changed productions of adipokines, including omentin-1. Omentin-1 may be involved in the pathogenesis of inflammatory bowel disease. The aim was to determine the serum and mucosal omentin-1 levels in CD patients and to evaluate its potential as a marker for disease activity.

Patients and methods

Seventy-five adult consecutive outpatients, with a confirmed diagnosis of CD, and 45 age-matched, sex-matched, and BMI-matched healthy volunteers were enrolled in this study after written conscious consent and approval by the Institutional Review Board of Mansoura University. CD was diagnosed by conventional clinical, radiological, endoscopic, and histopathological criteria. Serum levels and mucosal mRNA expression of omentin-1 were measured by commercially available kits according to the manufacturer’s protocols.

Results

Serum omentin-1 and its mucosal gene expression were significantly lower in patients with CD (53.3±12.8) than in healthy controls (72.7±16.8, P<0.0001). Moreover, serum omentin-1 levels were significantly lower in patients with active CD (36.2±9.6) than in patients in remission (69.2±14.4, P≤0.0001). No significant differences were demonstrated between patients in remission and healthy controls (P>0.05). In CD patients, the decrease in serum omentin-1 was associated with a significantly higher BMI, C-reactive protein, erythrocyte sedimentation rate, Crohn’s disease activity index, simplified endoscopic score for CD and inflammation scores (P≤0.05). Moreover, omentin-1 was much superior to C-reactive protein in predicting CD activity and severity.

Conclusion

Serum and mucosal expression of omentin-1 might be a reliable surrogate noninvasive marker of disease activity in CD with significantly high sensitivity, specificity, and diagnostic accuracy.
Early addition of rituximab in the management of myositis associated with systemic lupus erythematosus
Authors: Behiry Mervat E. , Shaker Ahmed , Shohdy Kyrillus , Nagy Fadi
Published: September 2023

Targeting B-cell in systemic lupus erythematosus (SLE) seems to be a promising approach. Although rituximab failed to show efficacy in refractory SLE in clinical trial setting, real-world experience still shows some efficacy in certain situations. A 20-year-old woman was diagnosed with SLE with coexistent myositis. The patient’s muscular condition did not improve on corticosteroids, addition of rituximab could achieve complete response. Introducing rituximab early for the nonrenal manifestations of SLE merits further investigation.
Can hepatitis C virus core antigen replace quantitative RNA in the assessment of a sustained virologic response?
Authors: Musa Nevine I. , Safwat Eslam , Ghait Ramy S. , Aly Heba , Abdelhamid Dalia H.
Published: September 2023

Background

The widespread use of direct-acting antivirals (DAAs) in the treatment of hepatitis C virus (HCV) infection has reduced the need for monitoring HCV-RNA levels because viral kinetics do not predict a sustained virologic response (SVR). However, the performance of cheaper tests, such as the assay to quantify hepatitis C virus core antigen (HCV Ag), has not been determined. Our aim was to assess the accuracy of the HCV core Ag test in predicting the achievement of SVR and its predictive value as a monitoring test in the course of treatment.

Patients and methods

This prospective study was carried out on 90 patients, chronically infected with HCV, who received DAA therapy. Blood samples were collected and the levels of HCV core Ag and HCV-RNA were measured at baseline and at 12 weeks after the end of treatment. We compared the ability of these assays to predict which patients would achieve SVR12.

Results

The baseline level of HCV-RNA was 1 688 529.6±994 697.3 IU/ml (range: 312 700–3 491 100 IU/ml) and HCV core Ag was 179.2±83.5 pg/ml (range: 33.5–315.6 pg/ml). HCV Ag became undetectable in 92.2% 12 weeks after the end of treatment, whereas HCV-RNA became undetectable in 87.8% at the end of treatment (P<0001). Seventy-nine out of 90 (87.8%) patients achieved SVR12; the test for HCV Ag identified 63.6% of these patients.

Conclusion

Measurement of HCV core Ag can monitor the efficacy of DAA therapy for HCV infection. Thus, it can be applied in clinical practice.
Endoscopic endonasal prelacrimal recess approach for antrochoanal polyp
Authors: Ismaeil Wael F. , Abdelazim Mohamed H.
Published: September 2023

Background

The purpose of this study was to assess the effectiveness of endoscopic transnasal prelacrimal recess approach (ETPRA) in preventing the recurrence of antrochoanal polyps.

Patients and methods

A total of 32 patients with antrochoanal polyp were divided into two equal groups: group 1 included 16 patients who underwent endoscopic middle meatal antrostomy (EMMA), and group 2 included 16 patients who underwent a combined surgical technique using EMMA together with ETPRA. They were followed up from 24 to 36 months. Success rates for visualization of the origin of the polyps, surgical complications, and recurrence were evaluated.

Results

The most common symptoms were nasal obstruction (100%), snoring (75%), rhinorrhea (59.38%), headache (96.88%), and hyposmia (53.13%). The study found that postoperative complications varied between both groups. Recurrence was found in 18.75% in EMMA group and 0% in ETPRA group. They were statistically significant (P<0.05). However, nasolacrimal duct injury was found in two patients in ETPRA group, and postoperative lacrimation presented in only one (6.25%) patient of the same group. They were statistically insignificant (P>0.05).

Conclusion

Recurrence rate of antrochoanal polyp has been reduced with the usage of ETPRA in comparison with EMMA alone.
An unusual presentation of cervical necrotizing fasciitis in an immunocompetent adult patient: a case report and literature review
Authors: Bhati Jyan M. , Al-Shwareb Abdulmonem M. , AlKhunaizi Shahd M. , AlQudehy Zeinab A.
Published: September 2023

Necrotizing fasciitis is a sever and potentially fatal soft tissue infection, but its presentation in head and neck region is rare. Few reported cases of cervical necrotizing fasciitis secondary to tonsil infection were found in literature, which were proven to be dangerous life threatening condition.

In this short communication, we are presenting a 35-year-old, immune-competent Saudi female patient. She was presented to our hospital with ill looking picture of right peritonsillar abscess with mild degree of trismus. Patient was admitted, IV antibiotic was started and CT scan neck showed pus in the left tonsil parenchyma and in right peritonsillar region, with cellulitis in right parapharyngeal region with no clear collection noticed within the neck spaces. Patient was taken to OR where pus in the left tonsil surface was noted and cleaned, and incision and drainage of right peritonsillar fossae was done, pus came out and gas bubbles noted along with necrotic fleshy tissue in the lower pole of the right tonsil from which multiple biopsies were taken. Patient had postoperative bleeding after 24 hours. CT scan was repeated and patient was taken for OR for debridement of necrotic tissue from right tonsil, and right neck exploration and debridement. Necrotic tissues medial to the right submandibular gland was seen and removed. The cultured swab and aspirated pus showed coagulase-negative staphylococcus, antibiotic was changed based on sensitivity results and she responded very well. She was discharged home post operatively in stable condition and was followed up for 18 months with no history of recurrent tonsillitis.
Comparison between functional outcomes in patients with unilateral vocal fold paralysis undergoing injection laryngoplasty under general anesthesia versus local anesthesia
Authors: El-Badrawy Amr R. , El-Hoshy Hassan M. , Sheikhany Ayatallah R. , El-Rehim Wael S. A.
Published: September 2023

Introduction

Injection laryngoplasty (IL) continues to evolve, as new techniques, approaches, and injection materials are continuously being developed. Although it was performed under general anesthesia in the operating room, IL is now increasingly being performed in an office-based setting.

Aim

The aim of this study was to compare functional voice outcomes in patients with unilateral vocal fold paralysis undergoing injection laryngoplasty local versus general anesthesia.

Patients and Methods

A prospective interventional study was done to compare functional outcomes and patient satisfaction between group A (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under local anesthesia, versus group B (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under general anesthesia, by analyzing total Arabic Voice Handicap Index (VHI) scores and subscale scores preoperatively and post operatively.

Results

All results obtained in this study showed that there was no significant difference for the functional outcomes and patient satisfaction obtained for both groups under study.

Conclusion

In conclusion, IL under local anesthesia gives similar results as general anesthesia regarding functional outcomes and patient satisfaction of voice quality by themselves as well as by using the voice handicap index.
Erratum: Safety and efficacy of pediatric functional endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis
Authors: Elsisi Hossam
Published: September 2023

In the article titled “Safety and efficacy of pediatric functional endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis”, published on pages 616–622, Issue 4, Volume 33 of The Egyptian Journal of Otolaryngology,[1] the name of one of the authors and affiliation is missing. The name of the author is “Asser Abdel Raouf Elsharkawy” and the author’s affiliation is “Department of Otolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt”.
Papillary carcinoma thyroid coexisting with squamous cell carcinoma: series of two cases
Authors: Vamanshankar Hemanth , Ganesan Sivaraman , Alexander Arun , Saxena Sunil Kumar
Published: September 2023

Papillary thyroid cancer metastasizing to cervical nodes coexisting with squamous cell carcinoma of the upper aerodigestive tract is a rare finding. To the best of our knowledge, nearly 43 such cases have been reported in the literature. We present two such cases that were managed in our hospital. The first was a case of carcinoma of the lower alveolus with papillary carcinoma thyroid; the other was a case of carcinoma of the hypopharynx with an associated papillary carcinoma. The rarity of its presentation along with the dilemma in the management in such a patient has been discussed here, with a review of the relevant literature.
Video head impulse test in different age groups
Authors: Asal Samir I. , Sobhy Ossama A. , Raof Diana M. E. Abdel
Published: September 2023

Background and objective

The head impulse test is a well-known clinical test that uses video-oculography to quantify vestibulo-ocular reflex (VOR). Normative data for VOR gain are accessible, but most studies just report horizontal-plane VOR characteristics, overlooking variations in vertical-plane VOR gains. The aim of this study is to supply normative data for different age groups to permit future comparison of results to the matching norms.

Patients and Methods

The study was accomplished on 50 individuals who have normal peripheral hearing sensitivity, no otological disorder, and have no history of vestibular disorder, and were divided according to age into five groups, each one comprising 10 participants: individuals in the first group were aged 10–25 years, individuals in the second group were aged 25–35 years, individuals in the third group were aged 35–45 years, individuals in the fourth group were aged 45–55 years, and individuals in the fifth group were aged more than 55 years. Video head impulse test was done using GN Otometrics ICS Impulse in the lateral, left anterior right posterior, and right anterior left posterior semicircular canal planes.

Results

This study demonstrated that age has no impact on VOR gain, and it can be applied indifferently to all ages.

Conclusion

These normative values permit the correlation between the results of any specific patient and the values of healthy people of the same age range.
Safety and efficacy of extraturbinal microdebrider-assisted inferior turbinoplasty in children
Authors: Awad Osama Galal Abdelnaby
Published: September 2023

Background

Nasal obstruction is commonly seen in children and can be caused by a variety of factors. Turbinate hypertrophy has become a more frequent entity in pediatric patients presenting with nasal obstruction.

Aim

This study aims to assess the effectiveness and safety of extraturbinal microdebrider-assisted inferior turbinoplasty (MAIT) in relieving inferior turbinate hypertrophy in children.

Patients and methods

This prospective study was conducted from May 2016 to May 2017 in a tertiary referral hospital. Fifty pediatric patients with chronic hypertrophic rhinitis were enrolled in the study. We tried the extraturbinal MAIT technique to reduce inferior turbinate size. The degree of nasal obstruction was assessed using subjective, clinical symptom grading tools, visual analogue scale, and saccharin clearance test at 1 and 6 months postoperatively. Any postoperative complications were also noted.

Results

Mean age of patients were 12.7±9.5 years (range: 6–18 years). Significant postoperative improvement (P<0.001) was noted in the degree of nasal obstruction in 1 month and was maintained after a follow-up period of 6 months. Majority of patients had minimal crusting with good tissue healing with no adhesions or atrophic changes and with significant improvement of saccharin clearance time at 6 months postoperatively.

Conclusion

Extraturbinal MAIT is an effective and safe procedure in children compared with other reported procedures.
The impact of high intensity versus low intensity behavioral therapy in establishment of functional routines in Egyptian autistic children
Authors: Aboras Yehia A. , Abdou Rania M. , Gaber Heba E.
Published: September 2023

Objective

To compare the effect of high-intensity versus low-intensity treatment in the establishment of functional routines in autistic children.

Patients and Methods

This quasi-experimental study was conducted on 25 children of 2–6 years of age of both sexes at the Unit of Phoniatrics, Department of Otorhinolaryngology, Alexandria Main University Hospitals. An informed consent was taken from all patients in this part of the study. All cases included in the study underwent thorough history taking, comprehensive neurological examination, and diagnosis of autism based onDiagnostic and Statistical Manual of Mental Disorders, fifth ed., Childhood Autism Rating Scale, and Autism diagnostic interview-revised. The children were trained for 1 year using the STAR program. The children were divided into two groups: group I included 15 children who were trained 5 days per week, and group II included 10 children who were trained 3 days per week owing to family commitments.

Results

There was significant improvement in both groups in all lessons when comparing pretherapy and post-therapy results; however, group I showed significant degree of improvement when compared with group II in specific items.

Conclusion

Early intervention for autistic children helps in improving their prognosis and yields better results. The need to apply the treatment on daily basis is highly recommended.
Incus buttress approach as an alternative safe technique for cochlear implantation; preliminary results with review of literature
Authors: Mandour Mahmoud F. , Khalifa Mohammed A. , Khalifa Hossam M. Adel
Published: September 2023

Aim

Report our preliminary experience with an alternative technique for cochlear implantation.

Setting

Tertiary referral cochlear implant center.

Study design

Retrospective case series.

Subjects and method

Fifteen patients have been operated using incus buttress approach. The procedure involves classical cortical mastoidectomy and identification of short process of the incus. Bony incus buttress was removed moving inferiorly toward facial recess. Round window was identified then marginal cochleostmy was performed and finally insertion of the electrode into the cochlea via the widened aditus.

Results

Fifteen implants were performed on 15 patients. All were children (mean age of 3.2 years). All the children were pre-lingual. A Med-el SONATA implant (MED-EL, Innsbruck, Austria) was used in all patients. Mean duration of surgery was 12015 minutes. The minimum follow-up was 6 months. No complications were observed during the procedure or during postoperative follow-up.

Conclusion

Here, we describe a new alternative technique for cochlear implantation and report our preliminary results. The procedure has advantages over the existing alternatives techniques and avoids the potential complications of posterior tympanotomy.
Large oroantral fistula repair using combined buccal and palatal flaps: a case series
Authors: Abdelhamid Ahmed N. , Youssef Tamer
Published: September 2023

Aim

The aim was to detect the efficacy of combined buccal advancement and palatal rotational flaps in closure of large oroantral fistulas (OAFs) after dental extraction.

Materials and methods

A 3-year prospective study was conducted between February 2014 and May 2017. A total of 11 patients with large OAF after dental extraction were included in the study. Seven patients developed OAF after dental extraction of the maxillary first molar teeth, whereas two patients developed an OAF after dental extraction of the second maxillary premolars. The last two patients developed an OAF after dental extraction of the second maxillary molars.

Results

Closure of the defect was achieved in 10 cases, whereas only one case had failure. In addition to postoperative pain, swelling, and reduction of the vestibular sulcus, one patient experienced postoperative nasal adhesions between the nasal septum and inferior turbinate.

Conclusion

A combined buccal and palatal flap is efficient in closure of large delayed OAF secondary to dental extraction. Further study is required to assess new bone formation after repair of large OAF using this technique.
Vitamin D levels in children diagnosed with acute otitis media
Authors: Salem Mohamed A. M. , Abdullah Mohamed M. , Mohamed Zakria A. , Gad Mohamed O. A. , Gadalla Walla G.
Published: September 2023

Objective

To investigate the relationship between acute otitis media (AOM) and vitamin D level in children.

Patients and methods

This prospective study was conducted at Assiut University Hospital between December 2016 and March 2017. The study group comprised ambulatory children who were diagnosed with AOM and healthy controls. The blood sample (5 cm) was taken immediately after the diagnosis of AOM in the laboratory for measuring serum 25-hydroxyvitamin D. Abnormal value=deficiency+insufficiency.

Results

Of the 40 children included in this study, 30 were the cases and 10 were controls. The mean age of the cases was 4.92±3.08 and 5.92±4.04 years for the controls besides 18 (60%) of the AOM group were boys and 12 (40%) were girls, compared with five (50%) boys and five (50%) were girls in the control group. Otalgia and congested tympanic membrane were present in all children of the diseased group. Also 70% had upper respiratory tract infection preceding the attack of AOM and 33.3% had previous attack of AOM. Twenty-two (73.3%) out of 30 children of the AOM group have an abnormal value of vitamin D and it was statistically significant than the control group.

Conclusion

Both vitamin D deficiency and insufficiency were significant in children suffering from AOM than normal children.
Comparison between local steroids and local steroids plus itraconazole effect in prevention of recurrence of allergic fungal sinusitis in hypertensive and/or diabetic patients
Authors: Reda Ramez , Wageh Wael , Fawaz Mohammed , Mikhaiel Wassim
Published: September 2023

Background

Allergic fungal rhinosinusitis (AFRS) is the most common type of fungal diseases in nose and paranasal sinuses. It is due to hypersensitivity to fungal antigens. The standard treatment for control of AFRS is endoscopic sinus surgery followed by systemic and/or topical steroids. In spite of steroids known to have promising results for the management of AFRS, their prolonged use is not always advised. So, some authors have tried to decrease the recurrence rate of AFRS by using antifungal treatment. In this study, we compared the efficacy of local steroids (Fluticasone nasal spray) versus local steroids plus itraconazole postoperatively in the prevention of recurrence of allergic fungal sinusitis in patients known to be hypertensive or diabetic.

Patients and Methods

A total of 60 patients with AFRS and nasal polyposis were included in the study. Patients were divided randomly into two groups: group A used local steroid and group B used local steroid and itraconazole. Clinical parameters were compared at the end of 6 months.

Results

Patients of group B were better clinically and also by endoscopic examination.

Conclusion

Itraconazole is better to be added in the postoperative treatment of AFRS patients especially for patients who have contraindications for systemic steroids intake.
Subepithelial hydrodissection improves voice outcome of microflap surgery for vocal cord cyst
Authors: Merwad Ezzat A. , AbdElftah Magdy M. , Abdelmonem Said , Hasan Elham M. , El-Anwar Mohammad W.
Published: September 2023

Objective

The aim was to evaluate voice outcomes of microflap surgery with subepithelial infiltration for vocal fold cysts and to compare voice outcomes of microsurgery with and without subepithelial infiltration for vocal fold cysts.

Patients and Methods

This study was conducted on patients with vocal folds cysts. Patients who met selection criteria were divided into two groups: group A was operated by microflap surgery with subepithelial infiltration, and group B was operated by microflap surgery without subepithelial infiltration.

Results

Within the included 24 patients (12 in each group), a significant improvement of average fundamental frequency/fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, maximal phonation time (MPT), and dysphonia was detected postoperatively in group A (with subepithelial infiltration), with 58.3% of patients resorted to grade 0 dysphonia. Statistically significant improvement of MPT and dysphonia was registered after intervention in group B (without hydrodissection). However, average fundamental frequency/fundamental frequency, jitter, shimmer, and harmonic to noise ratio (HNR) showed nonsignificant improvement after intervention. It was clear that dysphonia improved significantly more in hydrodissection group than nonhydrodissection group (P=0.0063). However, there was no significant difference in postoperative MPT (P=0.3138).

Conclusion

Subepithelial infiltration is beneficial during microflap surgery for vocal fold cysts, with statistically significant better voice results. Therefore, we recommend using this technique during microflap surgery to enhance vocal outcomes; however, further studies are needed on a large number of patients and for a prolonged period of follow-up.
Frontal sinus nasopharyngeal carcinoma recurrence masquerading as chronic frontal sinusitis: a case report
Authors: Toong Liew Yew , Wah Lott Pooi , Bakri Adzreil , Prepageran Narayanan
Published: September 2023

Recurrence of nasopharyngeal carcinoma (NPC) is still a worrying issue despite the advent and advancement of treatment strategies. Presentation of recurrent NPC is different from primary NPC and indicates poor prognosis. Frontal sinus metastasis without any involvement of other sinuses is very rare and could be mistaken as sinusitis or mucocele. Owing to its rare occurrence, it presents a great challenge for clinicians to make a prompt diagnosis. The background chronic rhinosinusitis symptoms as a result of irradiation for NPC may masquerade the underlying paranasal sinus recurrence.
Oropharyngeal dysphagia profile in early versus late stage dementia
Authors: Sheikhany Ayatallah Raouf , Hady Aisha Fawzy Abdel , Farag Sheikhany
Published: September 2023

Objective

The aim of this study was to evaluate swallowing in early and late stage dementia cases referred to the swallowing clinic with oropharyngeal dysphagia in order to have a comprehensive view about their characteristic oropharyngeal dysphagia profile toward different food textures to address them in their rehabilitation program.

Patients and Methods

Fiber-optic endoscopic examination of swallowing (FEES) was conducted to evaluate formally the oropharyngeal stage of swallowing in 26 individuals diagnosed with early mild Alzheimer dementia and late severe Alzheimer dementia. The FEES protocol included symptoms of presentation, route of feeding, bedside evaluation using different textures followed by evaluation of the oral preparatory stage, and the pharyngeal stage through FEES. In addition to observing the ability of the patient to imitate various oromotor actions and ability to follow commands related to the oral phase of swallowing.

Results

For early stage dementia, all food consistencies were considered safe except for mixed consistencies, large volumes of thin liquids and jelly, while the safest consistencies to use with the late stage dementia cases for quality of life and pleasurable feeds were thickened liquids and jelly consistency.

Conclusion

Oropharyngeal dysphagia profiles in early stage Alzheimer dementia is different from late stage Alzheimer dementia indicating that the mechanism behind dysphagia is different in the two groups.
An Unusual Case
Authors: Nenwani Deepak Ramchand , Swaminathan N. , Venkatesan S. , Elangovan C. , Selvan K. Tamil
Published: September 2023

Intravenous leiomyomatosis (IVL) is a rare neoplasm characterized by histologically benign-looking smooth muscle cell tumor mass which grows within the intrauterine and extrauterine venous system. In this report, we present an unusual case of IVL which had originated from uterus and extended throughout the right cardiac chambers. A 36-year-old female patient came with a chief complaint of palpitation for 1-month duration. She also had a history of amenorrhea for 7 months. She had abdominal distension and doughy feeling of the abdomen. Seven months prior, ultrasound abdomen done during gynecological evaluation showed fibroid uterus. Echocardiography done showed multiple masses occupying almost all of the right atrium and moving in and out of the right ventricle. Inferior vena cava (IVC) was dilated and 90% of the IVC was filled with the mass. Cardiothoracic surgery and surgical oncology references were done. The patient was planned for simultaneous abdominal and cardiothoracic surgery. Large abdominal mass along with cardiac mass was resected along with mesentery, omentum, and abdominal lymph nodes. Histopathological and microscopic report was suggestive of leiomyoma and leiomyomatosis. Lymph node microscopy showed reactive hyperplasia.
A Patient with Type IV Unroofed Coronary Sinus Presenting with Wide QRS Tachycardia
Authors: Kumar Ashish , Tandon Rohit , Goyal Abhishek , Wander Gurpreet Singh
Published: September 2023

Unroofed coronary sinus (UCS) is a congenital heart disease characterized by defects in the formation of the coronary sinus. UCS usually manifests as dyspnea on effort, fatigue, or palpitation. However, here, we present a case of a 53-year-old female whose presentation was wide QRS tachycardia. In this interesting case, we describe the role of various echocardiographic modalities used to reach its elusive diagnosis.
Differences in the Presentation and Outcome between Premenopausal and Postmenopausal Primary Hyperparathyroidism Indian Women: A Single-Center Experience
Authors: Maldar Aasim N. , Shah Nishitkumar F. , Chauhan Phulrenu H. , Lala Murad , Kirtane Milind V. , Chadha Manoj
Published: September 2023

Introduction:

Primary hyperparathyroidism (PHPT) is an endocrine disorder wherein enlargement of one or more of the parathyroid glands causes autonomous overproduction of the parathyroid hormone (PTH), which leads to high serum calcium levels.

Objective:

The objective of this study was to compare the clinical, laboratory, and operative variables between premenopausal (pre-M) and postmenopausal (post-M) women with PHPT.

Materials and Methods:

A retrospective analysis of the data of female patients who underwent surgery for PHPT at a single center, from January 2011 to December 2020, was done. Patients with familial PHPT and secondary hyperparathyroidism were not included.

Results:

Of the 130 women with PHPT, 44.6% were pre-M and 55.4% were post-M. A significantly higher number of pre-M females were symptomatic compared to post-M females (pre-M vs. post-M, 84.5% vs. 68.1%, P = 0.031). Renal calculi were more common in pre-M women (34.5% vs. 18.1%, P = 0.032), while the rest of the clinical features were comparable between the two groups. The proportion of women with osteoporosis (6.7% vs. 19.4%, P = 0.071), hypertension (13.8% vs. 34.7%, P = 0.012), and diabetes mellitus (3.5% vs. 16.7%, P = 0.033) was lesser in the pre-M group. Elevated serum alkaline phosphatase levels were significantly more prevalent in the pre-M group (37.9% vs. 20.8%, P = 0.032). The mean serum calcium (12.35 ± 1.28 vs. 11.96 ± 1.22 mg/dL, P = 0.079), median serum PTH (334 vs. 239 pg/mL, P = 0.051), and median weight of the operated adenomas (1.75 vs. 1.45 g, P = 0.075) were also higher in pre-M females. The proportion of ectopic adenomas and multiple adenomas, presurgery adenoma localization rates, and disease cure rates did not differ according to the menopausal status. The occurrence of postoperative hungry bone syndrome was higher in the pre-M women (15.5% vs. 1.4%, P = 0.008).

Conclusion:

The majority of women with PHPT are post-M, but symptomatic presentation is more common in pre-M females. The severity of the disease appears to be more in pre-M women; however, imaging and operative variables generally did not significantly differ between the two groups.
Menopause Osteoporosis and Bone Intervention Using Lifestyle Exercise: A Randomized Controlled Study
Authors: Forsyth Jacky J.
Published: September 2023

Background:

The aim of the study was to examine the feasibility for postmenopausal women of a bone-strengthening jumping intervention, which has been previously successful for premenopausal women.

Materials and Methods:

Forty-nine participants (mean ± standard deviation [SD] age = 57.8 ± 4.3 years) were randomized into either an exercise intervention or sham-control group in a double-blinded fashion. The intervention consisted of 10 maximal, rest-inserted countermovement jumps, performed three times a week on a hard surface without shoes for 8 months. Sham-control participants performed unilateral balance exercises of equivalent duration.

Results:

The jumps were well tolerated, with women in the jumping group completing 95% of the prescribed exercise. Of the participants who completed the study (n = 23 intervention, n = 16 control), there were no significant differences in broadband ultrasound attenuation (BUA) using quantitative ultrasound (QUS) of the calcaneum within and between groups (mean ± SD BUA = 64.9 ± 7.3 and 66.6 ± 6.5 dB/MHz for intervention pre- and post-trial, respectively, versus mean ± SD BUA = 63.6 ± 4.2 and 64.4 ± 4.5 dB/MHz for sham-controls pre- and post-trial, respectively) or for any QUS parameters, although there was a 3% increase in BUA for intervention participants.

Conclusions:

Recruitment and participation rates were feasible for this duration of study and the exercise was acceptable. For a future study of this nature, 48 participants would be required to ensure adequate power, especially as lifestyle variations and post-menopausal hypoestrogenism prevent substantial gains in bone strength with high-impact exercise.
An Ensemble Models for the Prediction of Sickle Cell Disease from Erythrocytes Smears
Authors: Ayoade Oluwafisayo Babatope , Oladele Tinuke Omolewa , Lucky Imoize Agbotiname , Adeloye Jerome Adetoye , Awotunde Joseph Bambidele , Olorunyomi Segun Omotayo , Faboya Oulsola Theophilius , Idowu Ayorinde Oladele
Published: September 2023

INTRODUCTION: The human blood as a collection of tissues containing Red Blood Cells (RBCs), circular in shape and acting as an oxygen carrier, are frequently deformed by multiple blood diseases inherited from parents. These hereditary diseases of blood involve abnormal haemoglobin (Hb) or anemia which are major public health issues. Sickle Cell Disease (SCD) is one of the common non-communicable disease and genetic disorder due to changes in hematological conditions of the RBCs which often causes the inheritance of mutant Hb genes by the patient..
OBJECTIVES: The process of manual valuation, predictions and diagnosis of SCD necessitate for a passionate time spending and if not done properly can lead to wrong predictions and diagnosis. Machine Learning (ML), a branch of AI which emphases on building systems that improve performance based on the data they consume is appropriate. Despite previous research efforts in predicting with single ML algorithm, the existing systems still suffer from high false and wrong predictions.
METHODS: Thus, this paper aimed at performing comparative analysis of individual ML algorithms and their ensemble models for effective predictions of SCD (elongated shapes) in erythrocytes blood cells. Three ML algorithms were selected, and ensemble models were developed to perform the predictions and metrics were used to evaluate the performance of the model using accuracy, sensitivity, Receiver Operating Characteristics-Area under Curve (ROC-AUC) and F1 score metrics. The results were compared with existing literature for model(s) with the best prediction metrics performance..
RESULTS: The analysis was carried out using Python programming language. Individual ML algorithms reveals that their accuracies show MLR=87%, XGBoost=90%, and RF=93%, while hybridized RF-MLR=92% and RF-XGBoost=99%. The accuracy of RF-XGBoost of 99% outperformed other individual ML algorithms and Hybrid models.
CONCLUSION: Thus, the study concluded that involving hybridized ML algorithms in medical datasets increased predictions performance as it removed the challenges of high variance, low accuracy and feature noise and biases of medical datasets. The paper concluded that ensemble classifiers should be considered to improve sickle cell disease predictions.