bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuous Infusion versus Intermittent Bolus Injections of Furosemide in Congestive Heart Failure
Authors: El Safty Omar Mohamed Taha , El Deek Abeer Mohamed Abdel Aziz Mohamed , El Far Marwa Mamdouh Mohamed , Wannas George Salah Farah
Published: August 2023

Background

Loop diuretic therapy (Furosemide) plays a pivotal role in the treatment of CHF. Despite the lack of mutual agreement about the best approach to use Furosemide in CHF, its demonstrated efficacy and the long clinical experience with it suggest that it will remain an integral part in management of the CHF. Ongoing investigation into the optimal strategy to administer furosemide is a must to maintain its efficacy and minimize its adverse effects.

Aim of the Work

To compare continuous infusion and bolus intermittent injection of Furosemide in patients admitted with congestive heart failure.

Patients and Methods

In our study we tried to distinguish the most useful method of Furosemide administration whether continuous infusion or intermittent bolus injections. 40 patients (31 males and 9 females) admitted with a diagnosis of CHF were randomized in 1:1 ratio into either continuous infusion or intermittent boluses of Furosemide. On patient admission, detailed history was taken including symptoms, risk factors and etiology. Clinical examination was performed to detect rales, other signs of pulmonary edema and peripheral edema. Body weight measurement was taken as a baseline. All patients were submitted to CXR, echocardiography and laboratory assessment of renal function and electrolytes.

Results

Patients were then compared daily regarding BWL, UOP and clinical improvement of pulmonary rales. They were monitored for electrolytes disturbance, renal function deterioration and hemodynamic instability for first 72 hours after admission. The length of ICU stay and mortality were observed as well. Our study revealed that Furosemide administered in continuous infusion group, in comparison with intermittent bolus group, was associated with more cumulative UOP (P value 0.002) and more total BWL in 3 days (P value 0.000). This was on the expense of more incidence of hypokalemia (P value 0.002), there was no significant difference between 2 routes regarding hemodynamic parameters, renal function, mortality or length of ICU stay.

Conclusion

Continuous infusion of Furosemide in patients with CHF appears to provide more efficient diuresis, together with more reduction of body weight when compared to intermittent bolus therapy. However, these obtained beneficial hemodynamic effects were not reflected on the clinical course and patient outcome. Moreover, they were associated with electrolyte disturbance.
Dexmedetomidine versus Dexamethasone as Adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdomins Plane (TAP) Block for Analgesia in Patients Undergoing Laparoscopic Cholecystectomy Surgery
Authors: Gadallah Raouf R , Hefni Amira F , Khalil George M , AbdelTwab Mohamed Z
Published: August 2023

Background

Ultrasound-guided transversus abdominis plane (TAP) block became a common analgesic method after surgery involving the abdominal wall. Different adjuvants have been used to intensify the quality and the duration of local anesthetics.

Aim of the Work

to compare dexmedetomidine versus dexamethasone added to bupivacaine as adjuvant to the local anesthetic bupivacaine during Ultrasoundguided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic cholecystectomy, characteristics including duration of postoperative analgesia, post-operative pain score and sedation score.

Patients and Methods

The current study included 40 patients scheduled for elective laparoscopic cholecystectomy surgery were given Ultrasound-guided transversus abdominis plane (TAP) block after induction of general anesthesia. The patients were randomly allocated into two groups. Group (DM): patients received 22 ml of Bupivacaine 0.25 %in 20 ml + 1 ug/kg of dexmedetomidine in 2 ml on both sides. Group (DS): patients received 22 ml of Bupivacaine 0.25 % in 20 ml + 4 mg of dexamethasone in 2 ml on both sides.

Results

VAS pain score at rest especially 6, 12, 24, 48 hrs is significantly less in dexmedetomidine group than in dexamethasone group. VAS pain score at movement especially 6, 12, 24, 48 hrs is significantly less in dexmedetomidine group than in dexamethasone group. 1st rescue dose of analgesics was delayed up to (19.76±2.51 hrs), in dexmedetomidine group in comparison to (12.92±2.17 hrs) in dexamethasone group. The total dose of paracetamol required by patients in the dexmedetomidine group was (3.18±1.07 gm) compared to (5.33±1.16 gm) in dexamethasone group, indicating longer pain-free period and less requirement of analgesia in the dexmedetomidine group. Therefore, use of dexmedetomidine in TAP block has a beneficial effect in reducing the dose of systemic analgesic requirements.

Conclusion

co administration of 1 ug/kg of dexmedetomidine vs dexamethasone 4 mg to 0.25 % bupivacaine on both sides by US guided TAP block leaded to significant changes in the form of lower HR at 12, 24, 48 hrs, lower sedation score at 1, 6, 12, 24, 48 hrs and no significant changes in systolic blood pressure, diastolic blood pressure, oxygen saturation and respiratory rate.
The Efficacy of Fascia Iliaca Block for Pain Control after Total Hip Arthroplasty
Authors: Elella Sahar Kamal Mohamed Abo , Elagamy Ashraf Elsayed , Ahmed Ahmed Moneir , Abdo Mohamed Atef Elsayed
Published: August 2023

Background

Total hip arthroplasty (THA) are common surgical procedures for treatment of the degenerative disorders and traumatic diseases. However, a majority of patients often experience moderate to severe postoperative pain after THA. Postoperative pain control has a significant impact on earlier ambulation, initiation of physiotherapy, and better functional recovery. In addition, effective pain control would lower the length of hospital stay and the risk of thrombotic events which improves patients’ satisfaction.

Aim of the Study

To assess the efficacy and safety of FICB compared with standard multimodal analgesia in patients undergoing THA.

Patients and Methods

Ninety adult patients scheduled for total hip arthroplasty (THA), under spinal anesthesia were included in this study. The patients' age was ranging from 18 to 65 years and with the American Society of Anesthesiologists (ASA) Class II and III. Patients were included in the study, and were divided into two groups (n = 42; each); group FICB and control group.

Results

At PACU arrival there is no difference between two groups as two groups were recovering from anesthesia then facia illiaca block group showed the best response as regard as pain control post operatively for 12 hours postoperative then there is no statistical difference between two groups. There was statistically significant difference between groups as regard as visual analog score. As regard to total dose of morphine used in each group, facia illiaca block scientifically used less amount of morphine than control group (P < 0.001).

Conclusion

Fascia iliaca compartment block is effective for pain relief during the early post-operative period after total hip arthroplasty. Meanwhile, it can reduce the cumulative morphine consumption and the risk of opioid-related adverse effects.
The Effect of Nitroglycerine on Myocardial Injury Induced by Ischemia/Reperfusion in Adult Male Albino Rats
Authors: Thabet Moubarak Hemdan , Habib Eman Kamal Mohammed , Sawy Marwa Mohamed El , Mohamed Reham Hussein , Mamdouh EL-Sabban Radwa
Published: August 2023

Background

Despite, early reperfusion is the current optimal way to rescue the heart and salvage of greater amount myocardium, the process of reperfusion could induce myocardial injury and cardiomyocyte death, that result in heart failure and death. Several therapeutic medications such as nitroglycerine is currently under investigation for preventing myocardial reperfusion injury which has the potential to improve clinical outcomes in patients with acute myocardial infarction treated

Aim of the Work

To investigate the effect of nitroglycerin on myocardial ischemic reperfusion injury as regard histopathological changes.

Materials and methods

30 Male adult albino rats were randomly divided into four groups (10 rats for each); Group I (2 subgroups: group 1A (control group) & group 1B (sham group)). Group II (ischemia/reperfusion animal model). Group III (nitroglycerine 0.5 mg/kg BW 15 min before I/R). Tissue samples of heart ventricles of all animals were collected and processed for light microscopic examination.

Results

The ischemia /reperfusion group showed massive disruption of the normal histological cardiac muscle picture, interstitial hemorrhage, inflammatory cells infiltration, pyknotic changes in the nuclei and dark acidophilic contraction bands. Nitroglycerine treated group revealed disruption of cardiac muscle fibers and with minimal improvement in the histological appearance.

Conclusion

Nitroglycerine injection attributed to potential improvement for myocardial ischemia reperfusion injury which. Therefore, it might be assumed that nitroglycerine could be used as a safe drug before induction of reperfusion.
Effect of Contrast Agent on Renal Functions in Patients with Renal Impairment Undergoing Percutaneous Coronary Intervention
Authors: El Mawardy Ramzy Hamed , Helmy Haytham Galal Mohamed , Azab Eslam Adel Mohamed
Published: August 2023

Background

Contrast induced nephropathy is one of the most important clinical complications associated with IV administration of radio-contrast media. This prospective study evaluating incidence and predictors of contrast induced nephropathy after administration of contrast agent in patients with renal impairment undergoing percutaneous coronary intervention.

Objective

To predict the effect of contrast agents on renal functions in patients with renal impairment undergoing percutaneous coronary intervention.

Patients and Methods

A prospective study that included 120 patients who underwent percutanous coronary intervention with glomerular filtration rate below 90 ml/min. All patients were subjected to full history, examination and investigation. Results were recorded using serum creatinine and glomerluar filtration rate before and 72 hours after procedure.

Results

CIN had occurred in 26.67% of studied group where these was high incidence of occurrence of CIN with elderly (p = 0.009), obese patients (p = 0.039), hypertensive (p = 0.004), Diabetics (p = 0.000) and amount of dye received (p = 0.000). 50% of patients who developed CIN where males and 50% where females which was non significant with p = 0.165.

Conclusion

CIN in patients with preexisting renal damage or risk factors for the development of kidney dysfunction is a potentially serious complication after PCI with increased short and longterm morbidity and mortality. Appropriate management of patients at risk is crucial for the prevention of CIN. Although a specific treatment for CIN is not available removal of modifiable risk factors and implementation of periprocedural measures such as CM reduction and intravenous hydration can significantly lower the risk of CIN in selected patients.
Impact of Different Right Ventricular Lead Positions on QRS Complex Duration Post Cardiac Resynchronization Therapy Device Implantation
Authors: Hesham T , Shehata H , Reda A , Badran H
Published: August 2023

Aim and objectives

The aim of the study was to evaluate the effect of different RV lead positions on QRS complex duration post CRT device implantation in patients indicated for CRT as a treatment of chronic heart failure based on the recommendations of ESC guidelines for diagnosis and treatment of acute and chronic heart failure published in 2016 and to assess the effect of change of QRS complex duration and morphology according to different RV lead positions on clinical response.

Patients and Methods

This study included 100 patients (age 60.02 ± 7.18) post CRT device implantation presented for follow up at electrophysiology clinics of the cardiology department of Ain Shams university hospitals at least 3 months post CRT device implantation, during the period form from December 2020 till May 2021. The patients were divided into 2 groups according to the site of RV lead implantation after confirmation of the RV lead position by fluoroscope in Right anterior oblique (RAO) and left anterior oblique (LAO) views, 54 patients had the RV lead implanted in the RV Apex (RVA n = 54) and 46 patients had the RV lead implanted in the RV Septum (RVS n = 46).

Results

OF the total 100 patients that enrolled in our study the rate of non-responders was 19% of the patients showed no clinical improvement, no improvement of NYHA class by at least one grade, 30% of the patients were non-Echocardiographic responders, no improvement of LVEF (Δ EF) by at least 5% with no decrease of LVES diameter by at least 15%, and 15% of the patient were nonECG responders, delta QRS (ΔQRS) didn`t increase by at least 20%. There was no significant difference between the two groups regarding clinical response (NYHA class) (P-value = 0.583), LVEF (Δ EF 6.26 ± 1.64 in RVS group vs. 6.07 ± 1.67 in RVA group, P-value = 0.575) LVES diameter (47.70 ± 8.03 in RVS group vs. 45.39 ± 7.48 in RVA group, P-value = 0.141) or QRS complex narrowing (ΔQRS 60.93 ± 24.68 in RVS group vs. 54.07 ± 26.12 in RVA group, P-value = 0.182). There was no significant difference in the rate of non-responders between the two groups (clinical non responders in RVS group n = 8 vs. RVA group n = 11, P value = 0.547) (Echo non responders in RVS group n = 13 vs. RVA group n = 17, P value = 0.726) (ECG non responders in RVS group n = 6 vs. RVA group n = 9, P value = 0.613), There was an inverse relationship between ΔQRS and clinical response (NYHA) class post CRT device implantation in both RVS and RVA groups (P value 0.016 in RVS group, P value 0.007 in RVA group).

Conclusion

The study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing regarding the primary objective of the study regarding clinical outcome, narrowing of QRS complex (ΔQRS) or LV reverse remodeling, thus no recommendation for optimal RV lead position can hence be drawn from this study.

Also, delta QRS complex duration may be used as indicator for electric remodeling and CRT response.
Pattern of Chronic Obstructive Pulmonary Disease Patients
Authors: Sayed Ahmed Abd El-Aal , Ahmed Mona Mansour , Salah Haitham
Published: August 2023

Background

Chronic obstructive pulmonary disease (COPD) is a widespread chronic respiratory disease with rising morbidity and death, resulting in enormous societal and economic costs. COPD is a widespread, avoidable, and curable condition characterised by usual symptoms such as dyspnea, coughing, and/or sputum production. The goal of this study was to use a COPD questionnaire to analyse clinical, demographic, and available prescription pattern for chronic obstructive pulmonary disease.

Results

Our findings suggest that patients' early knowledge of COPD risk factors and symptoms, as well as assistance in early illness detection and the provision of patient-centered treatment based on patients' unique requirements in disease management, are all necessary.

Conclusion

The major objective of COPD management is to control symptoms and limit the risk of exacerbation in order to enhance the quality of life of patients. In addition to pharmaceutical management, achieving these goals necessitates the adoption of a healthy lifestyle and the avoidance of risk factors.
The Effect of Thrombocytopenia in COVID-19 Patient in Comparison with Patient with Normal Platelets Count
Authors: Elasal Gehan Mohmed , Mahmoud Mahmoud Mohsen , Aly Dina Essam
Published: August 2023

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a novel coronavirus disease 2019 (COVID-19), which spreads rapidly around the world17.Changes in platelet count are common in COVID-19 patients. The platelet count is a sensitive indicator of illness severity that is of great clinical utility to monitor a quickly changing health condition of patients affected by aggressive viral infections.18

Aim of the Work

study thrombocytopenia as a prognostic factor in covid 19 patient and it’s relation with length of hospital stay and prognosis

Patients and Methods

A total of 60 COVID-19 patients were involved in the prospective study during the period from June 2020 to December 2020 who were admitted isolation hospital, Ain Sham University Hospitals. then for each patient, CBC at admission was done, repeated at day 7 from the start of symptoms, day 14 and day 21. all patient didnot recieve anticoagulation. patients were followed regarding length of hospital stay and Mortality.

Results

Out of 60 patients, 19 patients (31.7%) were thrombocytopenic.The length of hospital stay was significantly higher in thrombocytopenic group. There was high statistical significant difference between normal platelets count group and thrombocytopenic groups regarding outcome (P value <0.001).in thrombocytopenic patients, 5 (50%) showed deterioration, 4 (40%) patients died and one patient in this group showed complete recovery.

Conclusion

Thrombocytopenia is associated with increase length of hospital stay and poor prognosis in patients with COVID-19.
Detection of NCF-2 Gene Expression in Egyptian Children with Chronic Granulomatous Disease
Authors: Bakr Salwa Ibrahim , Samaha Dalia , Owaidy Rasha El , Samir Nancy , Ahmed Gehad
Published: August 2023

Background

Chronic granulomatous disease (CGD) is a rare inherited primary immunodeficiency disorder (PID) which is characterized by enhanced susceptibility to severe bacterial and fungal infections. It results from defects in one of the five polypeptide subunits of the nicotinamide adenine dinucleotide phosphate-oxidase (NADPH) complex; CYBB (gp91-phox), NCF-1 (p47phox), CYBA (p22-phox), NCF-2 (p67-phox), or NCF-4 (p40-phox) with a resulting failure of the phagocytes in generating a variety of microbicidal reactive oxygen radicals during respiratory burst.

Objectives

This work intended to diagnose autosomal recessive (AR)-type of CGD by detection of NCF-2 gene expression using real time RT-PCR as a cheaper diagnostic method for CGD subtypes categorization among CGD children.

Subjects and methods

This case-control study was conducted on 15 children provisionally diagnosed as CGD patients by the use of dihydrorhodamine (DHR) stimulation index (Group I) in addition to 12 mothers and 8 fathers of the studied patients (Group IIa and IIb respectively) to detect the genetic mutations in carriers, if any, and 14 apparently healthy children as a control group (Group III). In the present study, cases with a fold change of NCF-2 gene expression less than 0.67 were considered defective for NCF-2 gene expression. At this cut-off value, from our molecularly studied subjects, 2 CGD cases and one mother showed underexpression of NCF-2 gene. In conclusion, defect in the NCF-2 gene, which encodes gp67-phox of the oxidase enzyme could be done by RT-PCR as a cheaper diagnostic method for CGD without the need to use complex and expensive methodologies such as northern blot, or genomic DNA sequencing.
Quantitative Stool Culture of Candida in Autism Spectrum Disorder Patients
Authors: Amer Malaka Z , El Halim Rania M Abd , El Hussieny Reham M , Salem Ghada Elsayed
Published: August 2023

Background

Autism spectrum disorder (ASD) is a category of neurodevelopmental disorders characterized by social and communication impairment and restricted or repetitive behaviors.

Aim of the Work

to estimate the quantity of Candida in autism spectrum disorder (ASD) patients compared to normal children and to find the association between Candida colony count and severity of ASD.

Patients and Methods

The study was carried out on 40 children, diagnosed as autism and 40 normal children as control group recruited from Pediatrics and adolescent Psychiatric Clinic at Ain Shams University Pediatrics Hospitals and Main Microbiology lab in Clinical Pathology Department of Ain Shams University. The study was conducted on a wide age group ranging from 3 to 14 years, (mean age of 6.30±2.40 years), Stool sample was collected from each patient in a sterile container, cultured on Sabouraud Dextrose Agar (SDA) and colony count was determined. Identification of isolated Candida species was done using chromogenic media.

Results

The study revealed statistically significant difference in Candida isolation rate among patient and control group with p-value (p = 0.006). Candida species were isolated from 23 patients (57.5%) and from 10 child in control group (25%), But detected that stool count was nonsignificant in severe autistic group compared to mild to moderate autistic group with p-value more than 0.05 NS. There were 14 patients (60.9%) with C. Albicans; 2 patients (8.7%) C. Glabrata; 6 patients (26.1%) C.Krusie and one patient (4.3%) C. Utilis, among candida species.

Conclusion

ASD is more common among male than female; ratio about 4:1. The high rate of intestinal colonization by Candida species in ASD children may represent a part of syndrome related to immune system disorders that may play a role in the pathogenesis of ASD. C. albicans was the predominant isolate than other non-Candida albicans species in ASD. The degree of candida colonization represented as quantitative colony count is not related to the severity of CARS among ASD patients.
Role of Micro RNA-148a (miR-148a) as an Early Diagnostic Biomarker for Hepatocellular Carcinoma in Egyptian Patients
Authors: Elgohary Eman Abdel Monem , El assaly Nihal Moustafa , Shaaban Menat Allah Ali , Kabiel Walaa Ahmed Yousry , Amin Hanan S , Elsawy Hadeer W
Published: August 2023

Background

Hepatocellular carcinoma (HCC) is a difficult disease to diagnose in its early stages. It has a high mortality rate due to its dismal prognosis. MiRNAs are dysregulated in HCC, rendering them a promising marker of the disease's progress and outcome.

Objective

The purpose of this study was to look at the potential use of miR-148a as a non-invasive biomarker detection and prognosis of HCC.

Subjects and methods

This case-control study was applied on (64) subjects, divided into three groups: the first group (HCC patients “n = 34”); the second group (HCV patients “n = 20”) and the third group (control group “n = 10”). miR-148a expression was estimated by quantitative real time PCR. miR-148a expression was recorded and studied with the clinical parameters of each group.

Results

There was a highly statistically significant difference between three groups in terms of AFP, AST, ALT, Hb, and, platelets (p < 0.001); 82.4 percent of HCC patients tested positive for HCV and 50% tested positive for vascular invasion. T2 and T4 tumors were found in less than half of patients; TNM stage III was found in 50% of HCC patients and the majority of HCC patients (76.5%) had a tumor size of ≤ 5 cm. There was a significant statistical difference between groups in terms of miR148a expression (P < 0.05) with the lowest value in the HCC patients. In the HCC group, there was a negative correlation between serum miR-148a and AFP (p = 0.031), tumor size (p = 0.018), primary tumor (T) (p = 0.022), and TNM staging (p = 0.009). Receiver operator characteristics (ROC) curves showed that the best cut off value for early prediction of HCC using miR-148a was ≤ 7.331, with sensitivity of 82.4 percent and specificity of 80 percent in HCC. In addition, there was statistically significant difference between the HCC and HCV & control group, according to cut-off of miR148a (P < 0.001).

Conclusion

miR-148a was found to be down regulated in HCC patients; our findings suggested that it could be utilized as a non-invasive biological marker for HCC detection and prediction of the prognosis.
Assessment of Asymmetric Dimethylarginine Level in Pediatrics with Beta-Thalassemia: Relation to Cardiovascular Complications
Authors: Omar Iman Mohamed Amin , Safwat Nesma Ahmed , Kenny Mahmoud Adel , Abdel-Maksoud Mai Mostafa Mahmoud
Published: August 2023

Background

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthases (NOS) that limits nitric oxide (NO) bioavailability and can increase production of NOS derived reactive oxidative species. ADMA has been found as a novel risk marker in cardiovascular diseases.In Beta-Thalassemia, little is known about the importance of the baseline ADMA determination as a risk marker of cardiovascular complications in β thalassemic patients

Objectives

to assess the levels of ADMA in children and adolescents with β thalassemia major and intermedia and determine their correlation with cardiovascular complications.

Patients and Methods

The level of ADMA was measured in 60 children and adolescent with β thalassemia syndrome without known heart disease compared with 20 healthy controls using enzyme-linked immunosorbent assay (ELISA).

Results

ADMA levels were significantly higher in patients with β-thalassemia than control group (P< 0.001). Body weight, male gender, regular blood transfusion and blood transfusion index had significant impact on serum ADMA. A significant correlation was found between ADMA and both bilirubin and lactate dehydrogenas (LDH) levels.Moreover, a significant positive correlation was reported between ADMA level and both left ventricular end diastolic diameter (LVEDD) and right ventricular systolic pressure (RVSP) in addition to a significant negative correlation between ADMA and ejection fraction (EF) as well as fractional shortening (FS). Additionaly, association of serum ADMA concentration to left ventricular dysfunction and pulmonary hypertension in β thalassemia patients was found.

Conclusion

ADMA could be considered as an early marker of cardiovascular complications in thalassemic patients. It should be incorporated in follow-up of thalassemics so identifying and treating appropriately subclinical conditions, reducing the burden of deleterious heart failure.
Assessment of Serum Chitinase-3-Like Protein 1 (YKL-40) in Lichen Planus
Authors: Abdelhalim Hend Mohamed Mahmoud , Afify Ahmed Abdelfattah , Ahmed Walid Abdelhady , Diab Heba Mahmoud El-Sayed
Published: August 2023

Introduction

Lichen planus (LP) is a papulosquamous inflammatory disease of unknown etiology. Chitinase-3-like protein 1 (YKL-40) is proinflammatory multifunctional protein with significant role in immunity, inflammation and regulation of proliferation, differentiation and apoptosis of cell.

Aim of the Study

To investigate whether YKL-40 protein has any role in the pathogenesis of LP and to estimate its level in different LP patients with different degrees of severity in an attempt to reach a novel role of it in the pathogenesis of this disease in an attempt for better understanding and treatment of LP.

Patients and Methods

38 patients with LP and 32 controls were included. Full history recording and physical examination were performed. Assessment of LP severity was done by LPAASI score and VAS score. Measurement of YKL-40 was done using ELISA.

Results

Assessment of serum YKL-40 revealed higher serum YKL-40 level in LP cases compared to controls with excellent discriminative power and sensitivity and specificity of 100%. A significant positive correlation was demonstrated between the YKL-40 level and LPAASI and pruritis scores.

Conclusion

Serum YKL-40 revealed significant high levels in LP patients compared to control subjects.
Assessment of Serum Apelin Levels and Its Relation to Insulin Resistance in Acne Vulgaris Patients
Authors: Abdel-hamid Rana safwat moustafa , EMAM ADEL , SOLTAN MARWA YASSIN
Published: August 2023

Introduction

Apelin is one of the adipokines. Acne vulgaris is a very common dermatological disease with a multifactorial background and hyperinsulinemia and insulin resistance are considered to play a pivotal role in its development and severity.

Aim

To evaluate serum apelin levels in acne vulgaris patients and to reveal the possible relation between its serum levels and the insulin resistance state in acne vulgaris patients.

Material and methods

Thirty-two acne vulgaris patients and thirty-two healthy controls were enrolled into the study. The blood levels of apelin, insulin and glucose were measured in patients and controls. Homeostasis model assessment index (HOMA-IR) was calculated to evaluate the insulin resistance state.

Results

Acne vulgaris patients experienced significant higher levels of fasting insulin, serum apelin, and HOMA-IR compared to controls.

Conclusions

These results suggest that serum apelin and insulin resistance may have a role in the pathogenesis of acne.
Various Postoperative Medical Lines for Management of Allegic Fungal Rhinosinusitis (Meta-Analyical Study)
Authors: Youssef Tamer Ali , Askoura Anas Mohamed , Dhel Natale Tong Tong , Mohamed Mohamed Naguib
Published: August 2023

Background

Allergic fungal rhinosinusitits (AFRS) is a subset of polypoid chronic rhinosinusitis that is characterized by the presence of eosinophilic mucin with fungal hyphae within the sinuses and a type I hypersensitivity to fungi. The treatment of allergic fungal rhinosinusitis usually involves surgery in combination with medical therapies to keep the disease in a dormant state. However, what constitutes an optimal post-operative medical regimen is still controversial. Hence, the purpose of this study is to assess the efficacy of various postoperative medical lines for management of AFRS.

Objective

To find out the role and efficacy of various medical therapies for postoperative treatment of allergic fungal rhinosinusitis (through a systematic review study).

Materials and Methods

Fifty studies were included in the present systematic review and meta-analysis, the total number of patients included in all studies (No = 1,655 patients). Our review has investigated the literature on 5 medical therapies (steroids, antifungal, immunotherapy, mepolizumab, and omalizumab) concerning the management of postoperative AFRS patients.

Results

The results showed that the recurrence rate after postoperative systemic steroids was 26.3%, topical steroids was 38.4%, antifungals therapy was 32.1%, immunotherapy was 17.4%, the percentage of recurrence after combination of antifungal and steroids was 9.6%, recurrence risk difference between antifungal and placebo was 18.2%, recurrence risk difference between steroids and placebo was 6.5%. Base on the above results, the combination of steroids and antifungal therapy is the best treatment for postoperative patients with AFRS.

Conclusion

This review investigated the literature on 5 medical therapies (steroids, antifungal, immunotherapy, mepolizumab, and omalizumab) concerning the management of postoperative AFRS, and provided an evidence-based review with recommendations, the use of steroids alone or antifungals as well, resulted in some degree of recurrence reduction in disease, the evidence supports the use of postoperative combination (oral steroids and systemic antifungal) as a better line of post-operative medical treatment in AFRS patients.
Language Development in Egyptian Arabic Speaking Children with Attention Deficit Hyperactivity Disorder
Authors: Mohamed Sarah Mosaad , Abdel-Fattah Hegazi Mona , Khodeir Mona Sameeh , Khalil Ghada Moharram
Published: August 2023

Background

Children with ADHD were found to have language impairment in many studies. The way they use language in their everyday life may be affected, namely, the pragmatic aspect of language. Measuring the affected parameters in all aspects of language will help to reach better intervention.

Aim of the Work

This study was set out to observe relationships between hyperactivity/impulsivity and inattention with all language domains in the Egyptian Arabic speaking children with attention deficit hyperactive disorder with aim of better intervention.

Subjects and Methods

This study was an observational analytical study conducted on 30 Egyptian Arabic-speaking children who were diagnosed as having ADHD with age ranging from 4-7 years. The study was carried out at the Units of Phoniatrics and Audiology of Ain-Shams University hospitals (El-Demerdash and Ain-Shams University Specialized hospital). Children were evaluated to establish the diagnosis of ADHD and its type following the diagnostic criteria of the DSM-V criteria (1) and The Conners‟ Parent Rating Scale – Revised “CPRS-R” (8). The children language abilities were assessed using the Modified PLS-4, the Arabic version, the Standardized Egyptian Arabic Pragmatic Language Test “EAPLT” (13). This assessment covered receptive and expressive language abilities, as well as pragmatic and phonological skills.

Results

Compared to norms, it was found that the ADHD children who participated in this study had non-significant language delays in parameters of. Seventy % of the participating ADHD children had total pragmatic test scores below their 5th percentile, while 30% of the children had total pragmatic test score above their 5th percentile. Results also revealed that 50% of the ADHD children failed to master certain sounds corresponding to their phonological age. A statistically significant negative correlation was observed between each of Inattention scores, Hyperactivity scores, and Impulsivity with receptive language age, expressive language age, total language age, and pragmatic language scores.

Conclusion

Receptive and expressive language, children with ADHD in this study did not show major difficulties in areas beyond what would be expected in normally developing children. The majority of children with ADHD in the present study had problems with pragmatic aspects. Half of the children failed to master certain sounds corresponding to their chronological age.
Association of Maternal and Paternal Education and Developmental Domains in 2–36 Months Old Children in Primary Care Setting in Cairo Egypt
Authors: Mahmoud Omnya Atef , Maher Shaymaa Ahmed , El Din Amin Ghada Essam , Marzouk Diaa
Published: August 2023

Background

Developmental delays (DDs) in children are increasing in prevalence and necessitate routine screening of young children for early recognition and management.

Objective

To determine the association of Maternal and Paternal education and developmental delays among children 2-36 months of age and determine the associated factors in Saraya El Koba primary care center in Cairo, Egypt.

Methods

This crosssectional study that enrolled a total of 193 children at the ages 2 to 36 months. Data were collected using the official Arabic version of the Ages and Stages Questionnaires, third edition (ASQ-3) to assess five domains of development (Gross Motor, Fine Motor, Language and Communication, Problem-Solving, and Personal and Social Skills). Sociodemographic data and risk factors related to DDs of children and parents were asked for.

Results

The overall prevalence of children with DDs was 9. 3%. The most developmental domain with delayed children were the communication and gross motor (3.1%each). Lower rates of DDs were identified for fine motor (1.04%). Girls scored higher than boys in problem solving domain (p < 0.05). Maternal and Paternal education is associated with developmental domains in this group of children. Mothers with university education and above had children with higher fine motor and total developmental scores (p < 0.05). Fathers with university education and above had children with higher communication scores (p < 0.001).

Conclusion

The study recognized a high prevalence (9.3%) of DDs especially for communication and gross motor skills. Maternal and Paternal education was associated with DDs. Creating a standardized developmental screening program for prompt recognition and timely intervention is recommended.
Study of Knowledge, Attitude and Practice Regarding Adolescent’s Rights to Autonomy and Confidentiality among Physicians Working in Ain Shams University Hospitals
Authors: Aal Seham Fouad Abd El , Azab Sonya Mohamed Sayed Ahmed , Moustafa Emad Ahmed El Sayed , El-Safoury Alaa Ali Ahmed
Published: August 2023

Background

Legally, adolescents are not capable of making medical decisions and considered incompetent because of their age. However, psychological studies found adolescents are capable of making informed choices about involvement in health care and research.

Aim

This study aimed at assessment of physicians knowledge, attitude and practice regarding sharing of adolescents in medical decision making and their right in confidentiality.

Methods

An online self -administered structured questionnaire was used for 384 physicians working at Ain Shams University Hospitals during the period from December 2019 to December 2020.

Results

Most of the participants were knowledgeable of variable ages of legal consent between countries (54.7%) while 46.97% of them know the legal age for consent in Egypt. Most of them were aware that they should obtain consent from the adolescents before their involvement in clinical research (87.7%); their duty to breach the confidentiality of the patient’s medical information if this is necessary to protect him/ her or the surrounding people (85.4%). About 45% of them agreed with the adolescent’s ability to make a sound decision regarding his/her health and 47.1% of them were neutral with the adolescent’s right to refuse the proposed treatment even if this against parents’ decision. Most of them agreed with the adolescent’s right to confidentiality if there is no risk for the patient or the surrounding persons (64.3%). Almost all of them obtain consent from both the adolescent patients and their parents/guardians (either always (69.8%) or sometimes (26.3%,)); and give the adolescent an opportunity to speak in private (either always (43.5%) or sometimes (55.2%)).

Conclusion

Although of the participants’ positive attitude toward sharing the adolescent patient in medical decisions- making, and their right to confidentiality, their practice showed variable responses. This may be due to deficient knowledge of the laws and absence of definite ethical guidelines for health care of adolescent patients.

Recommendation

Training of the physicians on judgment and assessment of adolescent patient’s capacity is an important step to ensure their involvement in decision making. Also, it is important to formulate ethical guidelines for management of adolescent patients in our community.
The Role of Methylene Blue Spray to Keep Parathyroid Gland Safe during Thyroidectomy
Authors: elshafei Mahmoud , Omran Hisham , Hisham Mohamed , Ali Ahmed Mahmoud Abdelsalam
Published: August 2023

Background

Thyroidectomy is one of the most surgical interventions in endocrine surgery. When the operation is performed in respective surgical centers, the operation is safe with low morbidity and 0% mortality.

Patients and Methods

The study was a quasi-experimental study carried out at Ain Shams University Hospital. Sixty patients with benign and malignant goiter disorders underwent primary (not recurrent) total thyroidectomy. The patients were assigned into two groups: group 1 (interventional group) included 30 cases operated upon with methylene blue spraying technique and group 2 (control group) 30 cases established with the conventional technique. Methylene blue was sprayed over the thyroid lobe and perilober area. Parathyroides and recurrent laryngeal nerve were identified and evaluated.

Results

Recurrent laryngeal nerve was not stained and remained white in all cases while all other tissues were stained blue. Four to seven minutes later the parathyroid glands washed out the blue stain and regain their original yellow color. Thyroid gland wash-out time was 19 min.

Conclusion

Methylene blue spraying is a new technique that allows identification of both parathyroid glands and recurrent laryngeal nerves. This technique is safe, effective, and technically feasible.
Diagnostic Accuracy of Modified Alvarado Scoring System in Acute Appendicitis in the Egyptian Patients
Authors: Abdraboh Ayman Abdullah , Omran Hisham Mohamed , Younes Ali Ahmed Mohammed , Abdellah Khaled Hegazy
Published: August 2023

Background

Approximately 7% of population will suffer from acute appendicitis during their life time. In 1889 Mc Burney in New York pioneered early diagnosis of appendicitis and was the first to point out the importance of early surgical intervention.

Objective

To assess the diagnostic accuracy of modified Alvarado scoring system in acute appendicitis in the Egyptian patients correlated with the operative findings and histo-pathological results.

Patients and Methods

This was a prospective; was conducted in Ain Shams University Hospitals and Nasr City Police Hospital, over a period of 6 Months, from February 2019 to August 2019, the study was carried out on 40 cases of both genders presenting to the emergency department with suspected acute appendicitis.

Results

There was statistically significant association between Histo-pathological findings and MASS (p < 0.001). There was statistically significant association between MASS and US findings (p < 0.001). Modified Alvarado Scoring System (MASS) showed a very high diagnostic value (AUC = 0.84, specificity = 88.6%, sensitivity = 80%, PPV=96.9%, NPV=50.0%, p-value =0.0001.

Conclusion

The present study has shown that MASS provides high degree of sensitivity, specificity, PPV, NPV and accuracy in the diagnosis of acute appendicitis, Alvarado scoring system increases the sensitivity and specificity for diagnosis of acute appendicitis with the added advantages of being simple and easy to use. Moreover it is repeatable at no cost. Thus the application of this scoring system improves diagnostic accuracy and consequently reduces appendicectomy.
Management of Leakage after Gastroesophageal Anastomosis
Authors: Mohamed Mohamed Mahfouz , Hefny Amr Mohamed Mahmoud El , El Moenem Ayman Hossam El din Abd , Refaat Mohamed Riad Mohamed
Published: August 2023

Background

Esophagectomy is needed for a variety of esophageal disorders, the most common indication is cancer esophagus, however, it is needed in benign disorders as postcorrosive strictures & endstage achalasia with esophageal dilatation. Anastomotic leakage is one of the most severe complications leading to significant morbidity and increased risk of mortality.

Objective

To evaluate different approaches in management of leakage after gastroesophageal anastomosis in Upper GIT surgery unit in Ain Shams University Hospitals.

Patients and Methods

This study was conducted at General surgery department, Ain Shams University Hospitals. Approval of the Ethical Committee was obtained. The study was conducted over patients with postoperative gastroesophageal leakage during the period from 3/2019 to 3/2021.

Results

Patients managed after cervical anastomosis leakage needed less time to start oral intake& had shorter hospital stay in comparison to those managed after thoracic leakage. There was a higher perioperative morbidity and mortality in patients who underwent surgical intervention as compared with patients who underwent conservative treatment.

Conclusion

Anastomotic leak after surgery for esophageal diseases can vary in location, onset time, size, and extent. For local management, personalized treatment should be decided based on patient’s particular situations. Cervical anastomosis leakage has less morbidity & mortality compared to thoracic anastomosis. Conservative treatment is safe and successful in many cases, in cervical leakage conservative management is effective in most cases. Stent implantation is an effective method with other emerging endoscopic techniques. Resurgery should be considered carefully and reserved to uncontrolled leakage or patients with failed conservative management.
A Comparative Study between Onlay versus Sublay Mesh Repair in Treatment of Midline Incisional Hernia
Authors: Ahmed Sherif A , Abd_Elaksoud Ibrahem M , Saad Mohamed N
Published: August 2023

Background

Incisional hernia is a common complication following laparotomy and is the most common indication for reoperation. However, the optimal approach for its repair is still a matter of debate.

Aim of Study

The aim of this study was to compare between onlay and sublay mesh repairs in treatment of midline incisional hernia regarding the operative technique and postoperative complications.

Patients and Methods

This randomized controlled prospective comparative study was conducted in general surgery department Ain-Shams University Hospital and Damanhour Medical National Institute in the period between November 2019 and April 2020. It included 40 patients with Midline incisional hernia who were randomly divided into two equal groups: A (treated with sublay repair) and B (treated with onblay repair).

Results

The mean operative time in group A was 104.2 minutes and in group B was 82.9 minutes. The mean time of drain removal in group A was 4.3 days while in group B was 13.6x days. Seroma formation after drain removal was not recorded in any patients of group A while it occurred in 4 patients in group B (20%). The other postoperative complications were comparable in both groups. During 6 months of follow up, hernia recurrence didn’t occurs in any patient in group A nor group B.

Conclusion

Sublay mesh repair of incisional hernia is a good alternative to onlay repair. It is applicable to all sites of incisional hernia with a low recurrence rate and acceptable complication rates.
Comparative Study between Inverted U Shaped Incision & Round Block Technique in Management of Grade II & III Gynecomastia
Authors: Talaat Ayman Ahmed , Abdel-Moaty Karim Fahmy , Youssef Omar Abdelrahman Youssef
Published: August 2023

Background

Gynecomastia is defined clinically as generalized enlargement of the male breast tissue, with the presence of a rubbery or firm mass extending concentrically and symmetrically from the nipple, accompanied by histopathological benign proliferation of the glandular male breast tissue. It usually occurs bilaterally and is the most common breast condition in males.

Aim of the Work

To review the differentiate between Inverted U shaped incision & round block technique used in management of grade II & III gyencomastia according to results, complications and patient satisfaction for operation.

Patients and Methods

This is a prospective clinical trial that conducted on thirty two (32) patients presented to Ain Shams University Hospital & Um El Masyreen General Hospital with gynecomastia grade II & III. Study period was One year, including (operation and 3-6 months follow up).

Results

In our study, statistics shows to some extent the preference of inverted U shaped incision over round block technique according to operation time, but verses according to post-operative Drain duration. However, there is no significant difference between the two approaches in incidence of seroma, hematoma, nipple areola complex complications, patient satisfaction and Aesthetic outcome.

Conclusion

Surgical management of high grades gynecomastia is a big challenge and there is no single approach is recommended between surgeons.
Difficult Diagnosis in a Patient with Phenylketonuria (PKU) and Metachromatic Leukodystrophy (MLD)
Authors: mohamed Mohamed, E , Elsayed Solaf, M
Published: August 2023

Introduction

Since phenylalanine level was included in the national newborn screening program in Egypt, patients with phenylketonuria (PKU) were early diagnosed and management and have better outcome with nearly normal motor and mental development. Neuro-regression or poor cognition is never recognized in compliant patients.

Case presentation

Herein we present an Egyptian child who was diagnosed by neonatal screening as PKU who was compliant on dietary treatment and normal development. After the age of 18 months, he started to loose previously acquired developmental milestones. Because of his average phenylalanine levels all through, a second neurodegenerative disease was suspected. Several investigations were done and the diagnosis of metachromatic leukodystrophy was suspected and was later confirmed by molecular testing showing homozygous frame shift mutation in ARSA gene c.583del, p. (Trp 195Glyfs*5) in addition to homozygous Missense mutation in PAH gene c.842C>T, p. (Pro281 Leu).

Conclusion

The presence of two genetic diseases in the same family should be suspected in consanguineous communities like ours especially if the clinical data of the primary disease does not fit.