bluuebunny/crossref_metadata_2025 huggingface dataset:
Different Modalities in Management of Recurrent Patellar Dislocation
Authors: Kamel Ahmed Samy , Mansour Saleh Gameel , Hamza Mohammed Safwat , Ragab Abdelrahman Mohammed
Published: August 2023

Background

Patellar instability is a complex pathoanatomical phenomenon that requires an intricate understanding in order to properly treat patients. Often, the etiology of this entity is multifactorial, and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus.

Objective

To review the currently available different modalities for management of recurrent patellar dislocation. This Review will analyze results concerned with Patellar instability to reach the most efficient modality that gives the best results.

Material and Methods

This systematic review study based on inclusion and exclusion criteria conducted to evaluate the outcome of different techniques of medial patellofemoral ligament reconstruction analyzing their efficacy and possible complications. This systematic review demonstrates that MPFL surgery for recurrent patellar dislocation isolated or in combination with other procedures results in a significant improvement in Kujala scores, a low redislocation rate, and an acceptable complication rate. Despite this, there is no consensus on indications for MPFL reconstruction, graft type, surgical technique, and rehabilitation program. The inclusion criteria for future studies were highly important, and consensus agreement within an expert panel should be sought prior to undertaking such a study.

Data Sources

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

Data Extraction

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

Results

Several fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction. However, the optimal management of patients with recurrent patellar dislocation remains controversial. This short-term study showed that after MPFL reconstruction (suture anchors or transosseous sutures), patellar stability could be restored. And no significant differences in outcome scores were observed between patients in the transosseous suture and suture anchor groups.

Conclusion

Evaluate the outcome of different techniques of medial patellofemoral ligament reconstruction analyzing their efficacy and possible complications.
Proximal Femoral Nail versus Dynamic Hip Screw in Unstable Intertrochanteric Fractures (Systemic Review and Meta-Analysis)
Authors: Morsi Ahmed Mohamed , Ashour Mahmoud Ahmed , Zahran Ahmed Mohamed
Published: August 2023

Objective

To compare the results of operative management using two different kind of internal fixation modality devices either PFN or DHS, to achieve fracture union and to determine the rate of union, complications, operative risks and functional recovery and outcomes. Compare the results obtained and determine the effectiveness of PFN in comparison to DHS in treatment of intertrochanteric fractures.

Introduction

Intertrochanteric fractures form about 50% of all fractures that occur in proximal part of femur. The mean patient age is 66 to 76 years. In United States of America, the rate of intertrochanteric fractures in elderly men is about 34 per 100,000 and in women it is 63 per 100,000 annually. Intertrochanteric fractures mostly unite, provided that reduction and fixation are correctly done. There are large area of bone is involved, mostly consist of cancellous bone and both fragments are richly supplied by blood. Determination of stability is the most important aspect of intertrochanteric fracture classification. Stability is provided by an intact or a reconstructible posteromedial buttress. Reverse obliquity fractures, loss or comminution of the posteromedial buttress and subtrochanteric extension are factors that results in unstable fracture patterns.

Management

The treatment goal of intertrochanteric fracture is restoration of early mobility safely and adequately while decreasing the hazard of medical complications and technical failure and to restore the patient to preoperative status of function. Trochentric femoral fracures have been estimated to occur in more than 200,000 patients annually in the United States, with reported mortality rate from 15% to 30%.

Study design

Randomized controlled trials and quasi-random studies.
Updated Trends of Fractures, A Single Trauma Centre Prospective Observational Study
Authors: Hassan El-Zaher El-Zaher , El Deen Abdelhamid Radwan Gamal , Ezzat Bibars Amr Mamdouh AbdelAziz
Published: August 2023

Background

Trauma, specifically physical trauma, is the damage to the body caused by an external force. This may be caused by accidents, falls, hits, weapons, and other causes.In medicine, traumatology is defined as the study of wounds and injuries caused by accidents or violence to a person, together with the surgical therapy and repair of this damage.

Aim of the Work

This study primarily aims to identify the prevalence of fractures in our population and fracture patterns as regards the age, the gender, the comorbidities of the patients, the mode of trauma, the classification, the associated injuries and the management at our institute.

Patients and Methods

This study is a cross sectional observational study in which the STROBE layout was used. It was conducted in a university hospital which is considered as a tertiary trauma center “Ain Shams University hospital.”. Data regarding the patients were collected over a period of six months started from the first of January 2021 and ended by the end of June 2021. No follow up was needed for any patients.

Results

Results showed that most prevalent fractures were femur fractures especially in geriatrics, followed by radius fractures that mainly occurred in pediatric age group, tibial fractures were the third most common fractures and mainly affected adult age group, humeral fractures were the fourth most common with pediatrics age group mainly affected. Malleolar fractures were the fifth prevalent fractures followed by the ulnar fractures.

Conclusion

Fracture prevalence numbers vary substantially according to age and gender for different locations and presumably the percentage of osteoporotic fractures are on the rise. Careful assessment of fragility fractures is needed, developing a trauma registry and filing systems is mandatory in order to accurately collect and save this important data. Femur fractures especially geriatric femur fractures, radius especially distal end and tibial fractures (especially the shaft), accordingly the learning curve should be guided towards mastering the management of those fractures. Hospital preparation, instrumentation and creation of special dedicated units like the orthogeriatric unit should be encouraged to provide better care for patients along with enhancing the inter-specialty communication and aiming for multi-disciplinary team management. Data from the study should be implemented nationwide to help develop preventative strategies aiming for lowering the occurrence of fractures
Superior Capsular Reconstruction for Massive Irreparable Cuff Tears: A Systematic Review for Clinical & Functional & Radiological Outcomes
Authors: El Saeed Ahmed , El Sedaway Ashraf , Youssef Andrew Magdy
Published: August 2023

Background

Massive rotator cuff tears (MRCT) are defined as a full-thickness tear of at least two tendons or measuring greater than five centimeters in diameter in the coronal plane. They represent about 20% of all rotator cuff tears and 80% of recurrent tears.

Aim of the Work

The treatment of massive irreparable cuff tears (MIRCT) is considered a consistent challenge for the orthopedic surgeons regarding the best management and the postoperative outcomes.

Patients and Methods

Search were conducted using the following databases: MEDLINE database, PubMed, Cochrane Bone and Muscle Trauma Group Specialized Register, Cochrane Register of Controlled Trails (The Cochrane Library). Data will be independently extracted by two reviewers and cross-checked.

Results

In radiological parameters, this review makes radiological assessment based on acromiohumeral distance and MRI graft integrity. AHD showed significant improvement in mean change postoperatively rather than preoperatively. As regarding MRI graft integrity, despite this high failure rate (20%) most patients still experienced improved functional outcome scores with two studies reporting no significant differences in functional scores between the intact and re-tear group. but on the other hand Denard et al. demonstrated that 100% of patients with healed grafts had a successful outcome compared to 45.5% when the graft did not heal (p = 0.009).

Conclusion

Not all patients with massive cuff tears are appropriate candidates for complex joint preservation surgery such as SCR because of age, comorbidities, and ability to participate in the lengthy postoperative rehabilitation, so rTSA is an optimal option for elderly, low-demand patients who can benefit from the speed of surgery and rehabilitation with rTSA for massive rotator cuff tears without arthritis.
Sensitization to Rice in Allergic Children Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University
Authors: Awad El-Sayed Zeinab , Elhattab Amira Fouad , Al Fiqy Alyaa Essam Mohammed
Published: August 2023

Background

The prevalence of food allergy among Egyptian children is largely unknown, more so for the different food allergens. Although there are several studies reporting on the common food allergens, yet none was done to explore the allergy to rice, a food allergen that is much less recognized both by pediatricians and allergic patients.

Objectives

To estimate the frequency of sensitization to rice in pediatric allergic patients in Egypt.

Patients and Methods

This analytical cross-sectional study was carried out in the period from April 2019 to September 2020. The study included 150 physician-diagnosed allergic patients aged 6 months to 18 years, enrolled consecutively from the Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams university. They were 90 (60%) males and 60 (40%) females. SPT was done using a commercial rice allergen extract, Prick-to-prick test with cooked rice. Patients with clinical and /or SPT results suggestive of rice allergy were subjected to oral challenge test under medical supervision in hospital.

Results

None of the screened allergic children (n = 150) gave a self/parentally reported history of allergy to rice, nor after inquiry by the investigator. SPT using commercial rice extract revealed that only 8 reacted positively (>3mm) and were considered sensitized. PPT was done to all patients using a home prepared cooked rice extract and the test was positive in 5 patients; 2 of these were positive also by SPT. A total of 11 patients (7.3%) were considered sensitized and were subjected to OCT and none had a positive test. There was statistically significant difference in age between rice sensitized and non sensitized, being higher in rice-sensitized patients, with p-value = 0.043.

Conclusion

Our study is a pilot research which draws the attention to the existence of sensitization to rice in allergic children. PPT is a useful test with a reliable specificity which when positive, would aid in diagnosing rice allergy in settings with limited resources and unavailability of rice protein extracts.
Diagnostic Delay in Pediatric Cancer; Causes and Effect on Survival Rates
Authors: Elhabashy Safinaz Adel , Wahdan Maha Magdy , Hussein Doha Salama Hassan , Ali Heba G A
Published: August 2023

Background

Currently, timely diagnosis immediately followed by effective treatment is an essential approach for control of the public health burden due to childhood cancers.

Our aim was to ascertain the median lag time till diagnosis, and treatment of pediatric patients with malignancy and to determine factors influencing the delayed diagnosis and relate delay times to diagnosis with overall and event free survival rates.

Methods

A cross sectional prospective study including children and adolescents with confirmed cancer diagnosis was conducted in Pediatric Hematology –Oncology Unit of Ain Shams University Children's Hospital, Egypt. A predesigned questionnaire was structured to collect data from parents or legal guardians of patients diagnosed with cancer about demographic and cancer characteristics the latter included presenting symptoms, type, site, risk, modalities of diagnosis, time to diagnose, treatment with calculation of event free survival and overall survival times.

Results

The study enrolled 115 children and adolescents with cancer during the period from August 2020 to May 2021. Misdiagnosis was initially recorded in 16 (13.9%) patients. Median total diagnostic delay or Lag Time (LT) for all patients was 53 days. Patients’ gender, age and socioeconomic status did not affect the median total delay, whereas residency, misdiagnosis, presence of health insurance, tumor location and presence of metastasis significantly influenced the total diagnostic delay. There was no significant correlation between overall and event free survival rates and total diagnostic delay.

Conclusion

Delayed diagnosis of solid malignant neoplasms except Wilms tumor, needs more attention to health care providers awareness especially in rural regions.
Vitamin D Level in Children with Acute and Relapsing Demyelinating Disorders of the Nervous System
Authors: Tomoum Hoda Yahya , Solimam Dina Ahmad , Zaitoun Raghda Mohamed Hesham , El-beshbeshy Hany Mohamed Alla
Published: August 2023

Background

Vitamin D has recently gained increased attention owing to its immunomodulatory role. Epidemiological evidence demonstrates that deficiency of Vitamin D is a relevant risk for acute acquired immune-mediated inflammatory demyelinating diseases in childhood, such as Multiple sclerosis (MS). Exact mechanism remains widely unexplored.

Aim

to measure the serum level vitamin D-25(OH) in pediatric patients diagnosed with acquired central and peripheral demyelinating diseases, and to compare these to levels found in healthy age and gender matched controls.

Patients and Methods

Twenty children (patients’ group) diagnosed with acute demyelinating diseases (Acute Disseminated Encephalomyelitis (ADEM, n = 7), Acute Necrotizing Encephalopathy of Childhood (ANEC, n = 3), Autoimmune Encephalitis (AE, n = 3), Transverse Myelitis (TM, n = 3), Guillain-Barre syndrome (GBS, n = 4)) and 40 healthy age and gender matched children (control group), were enrolled in the study. All patients were subject to full history, examination and measurement of serum levels of 25 (OH) vitamin D3 in both cases and control group.

Results

The mean level of vitamin D in cases was 4.4 ± 11.14 ng/ml, and it was deficient in 75% of the cases and insufficient in 15% of cases. The mean vitamin d level in cases was significantly lower than that in controls (27.18 ± 7.8 ng/ml).

Conclusion

Serum levels of 25 (OH) Vitamin D3 in pediatric acute acquired demyelinating diseases of the nervous system are significantly lower than levels in healthy controls, raising a possibility that vitamin D deficiency may be a risk factor for the development of various autoimmune neurological diseases.
Evaluation of Smectite Effect as a Food Thickener in Gastroesophageal Reflux Disease in Neonates Using Combined Esophageal Multichannel Intraluminal Impedance
Authors: Ismail Rania Ibrahim Hossni , Awad Hesham Abdel Samie , Shafik Emam Safaa , Shady Nancy Mohammed Abou , Fayez Ahmed Hend , Rabie Dina
Published: August 2023

Introduction

Gastroesophageal reflux disease (GERD) occurs when reflux of the gastric contents causes symptoms, MII-pH offer several advantages over the traditional diagnostic measures as it detects reflux regardless of its pH and distinguishes swallows from GER. Thickening of infant formulas has been recommended for the treatment of GERD. Agents that have been used include cereal, rice, bean gum, sodium carboxymethyl cellulose, pectin, cellulose and carobel. We aimed to assess the efficacy of (Smectite) as a food thickener in treating GERD in neonates using MII-pH before and after Smectite.

Patients and Methods

Twenty preterm neonates ≤ 36 weeks of age from maternity hospital, Ain Shams University, enrolled during the period 2018 to 2020, all had signs suggestive of GERD, Feeding intolerance, and repeated chest infections due to frequent apneas, aspiration or associated with bronchopulmonary dysplasia as well as nonspecific behavioral signs including arching, irritability, and apparent discomfort associated with feedings, GERD was confirmed by MII-pH for 24hrs. Diagnosis of reflux was done by total number of liquid and mixed Reflux > 100 as per (1) López-Alonso et al., 2006. patients then were prescribed Smectite (3 g/day for 7 days). On the 8th day, a second 24-hour MII-pH was performed to assess the response.

Results

Preterm infants with more than 100 impedance events were diagnosed with GERD most of these attacks were non acidic and weakly acidic attacks. Using Smectite as a food thickener was followed by a significant decrease in total reflux time and total frequency of reflux episodes (P. value <0.001), there was also a significant decrease in the frequency of impedance events per 24hrs. Total frequency of reflux episodes before and after Smectite decreased in terms of number of signs related to reflux before and after treatment such as vomiting, acute life threatening events like bradycardia, apnea, wheezy chest, desaturations all of which improved significantly after treatment.

Conclusion

MII-pH is one of the most sensitive tools for the diagnosis of reflux and Smectite could be used as a feed thickener to decrease reflux signs and symptoms for more studies on a larger scale to confirm.
Eating Disorders in Adolescents with Type 1 Diabetes
Authors: Elhabashy Safinaz Adel , Thabet Rasha Adel , Elrassas Hanan Hany , Abd ElMalak Mariam William
Published: August 2023

Background

Diabetes Mellitus is a chronic disease commonly associated with eating disorders especially in adolescents.

Objectives

to assess occurrence of eating disorders, and its nature, associated risk factors, comorbidities, and consequences in a cohort of adolescents with type 1 diabetes.

Methods

In this cross-sectional study, 138 patients were recruited to complete 3 questionnaires;Eating Attitude Test (EAT-26) and Eat Behavior questionnaire (ORTO-15) and Eating Disorder Examination Questionnaire version 6 (EDE-Q6) for assessment of any eating disorder (ED).

Results

Patients were categorized as having an ED according to predetermined cutoff value for each questionnaire. Of the 138 patients, 24 (17.4%) had risk for eating disorders by EAT-26 score, 53 (38.4%) have got Orthorexia nervosa by ORTO-15 and 45 (32.6%) were having a disordered eating behavior by EDE-Q6. Patients with risk of eating disorders had lower mean ORTO-15 score as compared to those without (p = 0.01), and higher mean Global EDE-Q6 (p < 0.001). A significant correlation was found between EAT-26 scores and both ORTO-15 and EDE-Q6 scores, (p < 0.05). As for risk factors, a positive correlation was found between EAT-26 scores and both age (p < 0.0001) and BMI (p < 0.0001). Also, ORTO-15 score correlated with duration of diabetes (p = 0.0418). Diabetic ketoacidosis, peripheral neuropathy and microalbuminuria occurred frequently in patients with any high score of the 3 questionnaires. Hypoglycemic episodes were reported more in those with high EAT-26 or global EDE-Q6 scores.

Conclusion

Subclinical eating disorders and abnormal eating behaviors are common in Egyptian adolescents with type I diabetes.
Study of Pentraxin-3 as an Early Marker of Diabetic Vascular Complications in Children and Adolescents with Type 1 Diabetes Mellitus
Authors: Afify Mohamed Abo El Asrar Mohamed Elbayoumi , Elzoghby Doaa M A , Ibrahim Marwa Elsayed Abd ElRaahman , Thabet Rasha Adel , Fekry Mohammed Diya Eldin Mahmoud
Published: August 2023

Background

Vascular complications are the major cause of morbidity and mortality in diabetic patients. These can result from interactions between systemic metabolic abnormalities, such as hyperglycemia, dyslipidemia, genetic and epigenetic modulators, and local tissue responses to toxic metabolites.

Aim of the Work

To assess the role of PTX3 as an early marker of vascular complications in children and adolescents with type 1 diabetes mellitus and its correlation with metabolic control and its relation to hsCRP level.

Patients and Methods

Fifty adolescents with type 1 diabetes mellitus and 40 age and sex matched control group, Detailed history taking, full systemic examination were done, Patients also were investigated using HbA1c, lipid profile, ALT, Alb/Cr ratio in urine, PTX3, hsCRP and carotid intima media thickness (CIMT). An informed consent was obtained from patients, controls or their legal guardians before enrollment in the study.

Inclusion criteria

Patients with type 1 diabetes their age ranging from 5 to 18 years old with at least 5 years disease duration and on regular clinic visits and multiple daily insulin therapy .

Exclusion criteria

Patients with proven vascular complications and those with any clinical evidence of infection, hematological diseases, tumors, liver dysfunction, urinary tract disorders, connective tissue disease, or other autoimmune diseases, also patients with morbid obesity were excluded.

Results

PTX3 and hsCRP were significantly higher in patients compared to control group. A significant positive correlation between serum PTX3 and level of HbA1c%, level of Triglycerides (TG), level of Total Cholesterol was observed. Additionally, PTX3 and hsCRP levels were elevated in patients with elevated lipid profile (TG and Cholesterol) and high HbA1c% level in comparison with those with normal lipid profile and those with controlled HbA1c% level (p < 0.001). No significant difference was found between patients and control groups as regard CIMT.

Conclusion

. The increased levels of PTX3 and hsCRP in patients with uncontrolled diabetes even before development of both microvascular and macrovascular complications add a promising tool for their follow up and applying early protective measures.
The Effect of Clover Honey Supplementation on the Anthropometric Measurements and Lipid Profile of Malnourished Infants and Children
Authors: Abdulrhman Mamdouh A , Mohamed Nagwa I , Abdelhaleem Bassma A
Published: August 2023

Background

Malnutrition in children is an increasing problem worldwide which may result in both short and long term irreversible negative health outcomes.

Objective

This study was to assess the effect of clover honey supplementation on the anthropometric measurements and lipid profile of malnourished infants and children.

Subjects & Methods

This was prospective interventional clinical trial done on 20 malnourished infants and children whose ages ranged between 1-5 years. The patients with primary malnutrition only included in our study and we excluded patients with secondary malnutrition or who had any diseases as (diabetes, GIT diseases, severe systemic illness or inborn error of metabolism).The patients were recruited from the Pediatric Nutrition Clinic Ain Shams University. The children received honey supplementation for 3 months and anthropometric measurements (weight, height, body mass index, head circumference and mid arm circumference) and fasting serum cholesterol level were measured baseline and after 3 months honey supplementation in a dose of 1.75ml/kg/dose twice weekly for 3 months to ensure compliance.

Results

The 3-month honey consumption has statistically highly significant effect on increasing weight, height, and body mass index and lowering fasting serum cholesterol level in primary malnourished infants and children. The statistical measurements of mean ± SD regarding weight, height, body mass index and fasting serum cholesterol level before honey consumption were (9.49 ± 2.03, 81.45 ± 8.31, 14.24 ± 2.15, 178.00 ± 20.91) and after 3 months honey consumption were (10.91 ± 2.11, 84.80 ± 8.23, 15.07 ± 2.05, 162.45 ± 19.73) respectively with P-value< 0.01.

Conclusion

Honey is a natural substance with a lot of benefits for nutrition and health. Our results showed a significant effect of consuming honey on changes in the nutritional status based on weight, height, and body mass index, and has a favorable effect on lowering fasting serum cholesterol level.
The Impact of COVID 19 on Glycemic Control in Children with Type 1 Diabetes on Insulin Pump Therapy: A Single Centre Study
Authors: Abdelmaksoud Abeer Ahmed , Salah Nouran Yousef , Ayoup Safaa Alshraki Alsayed
Published: August 2023

Background

Children with type 1 diabetes (T1DM) are at risk of glycemic deterioration during the COVID-19 pandemic due to several factors. However, some studies reported glycemic improvement in these children.

Aim

To assess the impact of COVID-19 on children with T1DM on insulin pump in terms of glycemic control and insulin therapy adjustments.

Methodology

Forty-two children with T1DM on insulin pump (Medtronic) for at least 3 months were recruited from the Pediatric and Adolescent Diabetes Unit (PADU), Ain-Shams University, Cairo, Egypt. They were assessed for insulin requirements, frequency of diabetic ketoacidosis and clinically significant hypoglycemia. Auxological parameters, HbA1c and lipid profile were assessed. Continuous glucose monitoring was performed using Medtronic i-pro device for 5 days for each patient. Data were compared to previous patients’ data obtained from their medical records. Study period was performed between 29/6/2020 until 29/12/2020.

Results

This study was carried out on 42 children with T1DM on insulin pump (15 males and 27 females with a male to female ratio of 1: 1.8) with a mean age of 11.31± 3.28 years, mean BMI of 18.80± 3.35 and mean disease duration of 4.40± 2.93 years. The mean insulin requirements of the studied children before the COVID- 19 pandemic was 0.83 ± 0.28 U/kg/d, range 0.5- 1.8 U/Kg/d with a mean basal percentage of 51.19 ± 3.46 %, range 45-60 % .As regards the laboratory data of the studied children with a mean HbA1c of 9.0±1.2%, range: 7-11.8%, mean fasting cholesterol of 184.88 ± 27.03 mg/dl, range: 142-233 mg/dl, mean fasting triglycerides of 89.81 ± 32.69 mg/dl, range: 43-148 mg/dl, mean LDL of 87.77±9.97 mg/dl, range: 68-98 mg/dl, mean HDL of 58.33± 12.28, range: 32-83 and median UACR was 13(10-21.9) mg/g, range: 7.0-94. There was a statistically significant increase in the total daily insulin units(P = 0.001), basal percentage (P = 0.011) and time in range (p = 0.009) with a significant decrease in the frequency of DKA (P = 0.001), hypoglycemia (P = 0.004), HbA1c (p = 0.001) and glycemic variability (p = 0.001) after the COVID-19 pandemic.

Conclusion

Glycemic control improved during the COVID-19 pandemic among children with T1DM on insulin pump therapy reflected by improvement in TIR and decrease in glycemic variability.

Declarations

Conflicts of interest disclosure

The authors declare that they have no conflict of interest.

Funding sources

No funding sources
The Effect of Intermittent Fasting on Isoproterenol-Induced Myocardial Infarction in Aged Rats: A Potential Role of Autophagy
Authors: El Agaty Sahar M , Nassef Noha A , Abou-bakr Doaa A , Hanafy Aya A
Published: August 2023

Background

Aging is associated with cardiovascular and metabolic changes, increasing the susceptibility to acute myocardial infarction (MI). Intermittent fasting (IF) was found to reduce the age associated cardiovascular diseases.

Aim

To investigate the possible protective effect of IF against acute MI induced by isoproterenol (ISO) in old rats and its underlying mechanisms, including autophagy.

Methods

50 male Wistar rats were equally divided into five groups: Adult; Old; Old-F (rats were subjected to IF for 4 weeks); Old-ISO (rats subjected to MI by ISO) and Old-F-ISO groups.

Results

IF significantly reduced troponin-I and creatine kinase (CK-MB), cardiac malondialdehyde (MDA) and TNF- α in Old-F-ISO compared to Old-ISO group. This was associated with a significant decrease in the age-related overall and visceral obesity; and dyslipidemia in Old-F and Old-F-ISO versus Old and Old-ISO groups. IF increases cardiac Atg-5 in Old-F-ISO versus Old group. Also, IF attenuated the age-related diabetic changes and significantly increased the pancreatic Atg-7 in Old-F-ISO versus Old group. Histological studies revealed attenuation of the local inflammatory response in Old-F-ISO versus Old-ISO group. Pancreatic Atg-7 and heart Atg-5 were significantly increased in Old-ISO versus Old rats.

Conclusion

IF protects against acute MI in old rats, in part, via alleviation of the age-related obesity, diabetic changes, and dyslipidemia. Chronic activation of heart and pancreatic autophagy by IF may possibly afford a cardioprotective effect. Acute activation of both heart and pancreatic autophagy by ISO could have a deleterious effect, augmenting cardiac injury.
Assessment of Pericardial Fat Volume and Carotid Intimal Thickness as Risk Factors for Developing Coronary Atherosclerosis Using Multi Detector Computed Tomography
Authors: Elkordy Mahmoud Moustafa Mahmoud , Mohammed Ahmed Moustafa , El Naggar Heba T-Allah Mohammed
Published: August 2023

Background

The real visceral fat deposit of the heart is epicardial adipose tissue, which exists directly on the epicardial surface of the myocardium and is totally confined within the pericardial sac. Because the coronary arteries and their major branches are embedded in fat, local contact between a metabolically active epicardial adipose tissue and the coronary vasculature was possible. Carotid artery increased intimal thickness is the initial step within the process of atherosclerosis, which is a major cause of coronary and arterial diseases.

Aim of the Work

To study the relation between pericardial fat volume measurements in Multi and detector computed tomography ‘MDCT’ with carotid intima-media thickness in duplex study for detecting the risk of developing coronary atherosclerosis.

Patients and Methods

This retrospective study was carried out at the Radiodiagnosis department; Ain Shams University Hospitals (ASUH) during the period from January 2021 to June 2021 on 30 patients; their ages ranged from 37 to 78 years old, with a mean age of 60 years. Patients were either self-referred or referred by a physician to follow up or investigate CAD. All patients underwent coronary CT angiography. They were evaluated for: (I) Coronary calcium score. (II) Pericardial fat volume. (III) Degree of atherosclerosis, then a carotid duplex study was performed to determine the carotid intimal thickness.

Results

we demonstrated that pericardial fat volume MDCT has a positive, significant, strong correlation with CAD (P. Value <0.001). In our study, a Post-hoc Bonferroni test was done regarding the obtained data and found a significant difference between (Moderate and Severe) versus all groups. This means a significant difference between the moderate group with minimal or mild, and a significant difference between the severe group with minimal or mild. So it could be considered as a screening test at an early stage for any patient with different degrees of CAD.

Conclusion

Multi-detector CT and Carotid duplex examination were both considered good non-invasive tools for evaluation of PAT volume (mean for unremarkable to minimal degree, volume of about 94 ± 14.73 cm3) and CIMT (mean for unremarkable to minimal degree, thickness of about 0.67 ± 0.06 mm). Both were found to be significant and positively proportionately correlated risk factors for coronary atherosclerosis, so it is suggested that both tests be used as an evaluating/screening tool for any patient with suspected or confirmed CAD to assess risk and severity.
Three to Six-Months Follow-Up Chest CT Findings after COVID-19 Pneumonitis, Incidence of Complications and Correlation to Different Risk Factors
Authors: Hebisha Omar Mostafa Ali Elsayed , Moftah Sherine George , Salama Asmaa Magdy Mohamed
Published: August 2023

Background

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, has become a global pandemic. As of November 19, 2020, World Health Organization stated that this disease has been found in more than 200 countries. Pathology studies have shown that COVID-19 causes injuries in multiple organs and tissues, with extensive pulmonary involvement similar to that found in other coronavirus infections (ie, severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus infection).

Aim of the Work

to evaluate pulmonary changes on 3-6 months follow-up chest CT scans and to explore the risk factors for fibrotic-like changes in the lung in patients who recovered from COVID-19 pneumonia.

Patients and Methods

This was a retrospective and prospective study that included 50 patients who had Symptoms of variable degree of fever, cough, and dyspnea with RT-PCR confirmed COVID- 19 infection at Ain Shams University Hospitals referred to the Radiodiagnosis Department for HRCT chest examination. All patients were evaluated for: (I): Incidence of complications (residual fibrotic like changes in their follow up CT chest scans). (Il): Correlation to different risk factors such as (smoking, diabetes mellitus, hypertension, pre-existing pulmonary disease, pre-existing renal disease and steroid therapy).

Results

56% of cases showed residual fibrotic like changes in their follow up chest CT scans while 44% of cases showed total resolution of the disease process. Smoking and old age were significant risk factors while steroid therapy decreased risk of fibrotic like change.

Conclusion

Twenty eight cases (56%) showed residual fibrotic like changes in their 3-6 months follow-up chest CT scan (CO-RADS III to V). Patients with older age and smokers have higher incidence of residual fibrotic like changes in their follow up chest CT scans, while patients on steroid therapy have less liability to develop fibrotic changes.
Role of MRI in Early Detection of Non-Neoplastic Articular Causes of Hip Joint Disability in Adults
Authors: Nassef Mohamed Amin , Hashish Mahmoud Ahmed Ibrahim , Hemida Ragab Samir Ibrahem
Published: August 2023

Background

Painful hip is a common problem in the absence of a known acute trauma, it can be a diagnostic problem as it can be attributed to many causes. The most common causes are avascular necrosis, transient osteoporosis, osteoarthritis, FAI or inflammatory causes.

Aim of the Work

The aim of this study is to clarify the role of MRI in diagnosis of the etiology of hip pain in adults that causes hip joint disability and to compare between the accuracy of both conventional radiography and MRI in various abnormalities and conventional MRI and MR arthrography in FAI and labrum tear.

Patients and Methods

This study was conducted on 96 symptomatic patients (14 males and 16 females with age ranged from 18 to 68 years) diagnosed clinically with hip joint disability due to certain hip pathology at Orthopedic and Physiotherapy Departments and referred to Radiodiagnosis Department of Ain shams University Hospitals.

Results

After statistical analysis of the results depending on the final outcome of the cases, it was found that MRI is more sensitive and specific than conventional radiography in detection of different hip joint pathologies with MRI sensitivity, specificity, and total accuracy ranging from 80 to 100% and conventional radiography sensitivity and specificity and total accuracy ranging from 50 to 90 %.

Conclusion

MRI has become an essential imaging modality in musculoskeletal system in general and in hip region specifically. It is a non-invasive technique with no radiation hazards, informative and essential in painful hip.
Role of DWI/ADC in the Assessment of Prostate Cancer Aggressiveness and Its Correlation to Gleason Score
Authors: El khalek Yasser Ibrahim Abd , Mohamed Mohamed Yosry , Hassan Rewan Ahmed Mohamed
Published: August 2023

Background

Cancer prostate represents a major health problem. it is one of the most common solid malignancies among male population. Prostate cancer (PCa) is considered one of the most common cancers among male population. Its incidence increases with age, ranging from 34% in the fifth decade, to 70% over the 80 years.

Aim of the Work

The objective of the study is to correlate and compare the DWI and ADC values of prostate cancer with the histopathological grading via Gleason score.

Patients and Methods

During a period of 6 months duration thirty patients were enrolled in the study. All patients with elevated PSA values greater than 4 ng/ml underwent sextant TRUS guided biopsies. MRI examination was done either prior to the TRUS biopsy or at least 3 weeks after the TRUS biopsy.

Results

In our study, we found that the ADC values correlated significantly with Gleason score of prostate cancer based on TRUS biopsy with significant p value < 0.001 and were significantly predictive of high-grade prostate cancer. This outcome agrees with recent reports that found an inverse correlation between ADC and Gleason score. They confrmed the correlation between ADC derived DWI and tumor alteration. ADC analysis seems to show a high capability in defining the tumor aggressiveness, as in monitoring radiation therapy effect or surgical recurrence.

Conclusion

ADC values showed a negative correlation with GS. This study suggests that ADC values may allow the noninvasive assessment of biological aggressiveness of prostate cancer, which may contribute in targeting biopsy to MRI-positive foci using a fusion of MRI and transrectal ultrasound. Incorporating the GS on targeted biopsy with the ADC value will further improve the detection of highgrade cancer foci also plays a role in planning initial treatment strategies.
The moral economy of land: from land reform to ownership society, 1880–2018
Authors: Dobeson Alexander , Kohl Sebastian
Published: August 2023

This article offers a comparative-historical perspective on the moral economy of land. We reconstruct the moral economy of the popular land reform movement that opposed the illegitimate income streams of rentiers and speculators in the early 20th century, tracing the movement’s legacy through a long-run analysis of political party platforms since 1880 in the USA, the UK, Germany and Sweden. We find that the land reformers’ conceptualization of land as a moral good was a key topic in early 20th-century party politics. Parties across the political spectrum called for wide-ranging interventions in unregulated land markets. But despite the movement’s relative success, the new ideal of the ownership society soon gained ground as an alternative to the more radical politics of land decommodification. We find growing multipartisan support for small property owners over time, culminating in the rise of a new moral conceptualization of land as capital. With the recent comeback of the land question, both rural and urban, we conclude that an understanding of historical land reform debates should inform future research toward a much-needed sociology of land.
Uterine cancer deaths certified as part unspecified: an unsolved issue
Authors: Esposito Giovanna , Santucci Claudia , Parazzini Fabio , Mignozzi Silvia , Malvezzi Matteo , La Vecchia Carlo , Negri Eva
Published: August 2023

Objective

A large percentage of uterine cancer deaths worldwide are not attributed to the cervix or corpus, but classified as uterus part ‘unspecified’. We provided the trend for the proportion of uterine cancer deaths certified as ‘unspecified’ in selected countries.

Methods

We derived the proportions of ‘unspecified’ uterine cancers for 20 selected high- and middle-income countries with reliable death certification over the period 1994–2021, using official mortality data from the WHO database coded according to the 10th Revision of the International Classification of Diseases.

Results

For the earliest available year, the proportion of deaths classified as ‘unspecified’ uterine cancers ranged from 5.8% in Mexico to 65.6% in Italy. In some countries only, this proportion decreased over time. For 10 countries the proportion of ‘unspecified’ uterus in the most recent available year was around 20%. The proportion of deaths at 20–44 years registered as uterus ‘unspecified’ was lower for all countries during the study period.

Conclusion

A substantial number of uterine cancer deaths worldwide coded as ‘unspecified’ was observed, also in high-income countries where death certification for other common neoplasms is accurate. Valid attribution of uterine cancer deaths to the cervix or corpus is feasible and should be adopted.
Implementation of upfront DPYD genotyping with a low-cost and high-throughput assay to guide fluoropyrimidine treatment in cancer patients
Authors: Pinheiro Manuela , Peixoto Ana , Rocha Patrícia , Santos Catarina , Escudeiro Carla , Veiga Isabel , Porto Miguel , Guerra Joana , Barbosa Ana , Pinto Carla , Arinto Patrícia , Resende Adriana , Teixeira Manuel R.
Published: August 2023

Objectives

Genetic variants in the dihydropyrimidine dehydrogenase (DPYD) gene are associated with reduced dihydropyrimidine dehydrogenase enzyme activity and can cause severe fluoropyrimidine-related toxicity. We assessed the frequency of the four most common and well-established DPYD variants associated with fluoropyrimidine toxicity and implemented a relatively low-cost and high-throughput genotyping assay for their detection.

Methods

This study includes 457 patients that were genotyped for the DPYD c.1129-5923C>G, c.1679T>G, c.1905 + 1G>A and c.2846A>T variants, either by Sanger sequencing or kompetitive allele specific PCR (KASP) technology. Of these, 172 patients presented toxicity during treatment with fluoropyrimidines (post-treatment group), and 285 were tested before treatment (pretreatment group).

Results

Heterozygous DPYD variants were identified in 7.4% of the entire series of 457 patients, being the c.2846A>T the most frequent variant. In the post-treatment group, 15.7% of the patients presented DPYD variants, whereas only 2.5% of the patients in the pretreatment group presented a variant. The KASP assays designed in this study presented 100% genotype concordance with the results obtained by Sanger sequencing.

Conclusions

The combined assessment of the four DPYD variants in our population increases the identification of patients at high risk for developing fluoropyrimidine toxicity, supporting the upfront routine implementation of DPYD variant genotyping. Furthermore, the KASP genotyping assay described in this study presents a rapid turnaround time and relatively low cost, making upfront DPYD screening feasible in clinical practice.
Understanding factors affecting the integration of geriatric nurse practitioners into health systems
Authors: Porat-Dahlerbruch Joshua , Ratz Shoshana , Aaron Eliana , Ellen Moriah
Published: August 2023

Background:

Geriatric nurse practitioners (NPs) are introduced into health systems to alleviate provider shortages and improve care for older adults. To achieve these goals, geriatric NPs must be integrated into the health system such that they can efficaciously practice. Internationally, little is known about factors affecting the integration of NPs. Such evidence would improve policymaking and the impact of geriatric NPs on care. In Israel, geriatric NPs were recently introduced. Their ongoing integration is an exemplar for other countries.

Purpose:

To identify factors affecting the integration of geriatric NPs in Israel and discuss application of these factors in international policy and research.

Methodology:

The Consolidated Framework for Implementation Research guided this qualitative descriptive study. A semistructured interview guide was used to collect data from four professional groups (geriatric NPs, physicians, administrators, and policymakers), which, together, provide a system-level perspective. Factors were identified using deductive content analysis and designated as facilitators, barriers, neutral, or mixed effects.

Results:

There were 58 participants across the four professional groups. Twenty-eight factors were identified, including patient needs and leadership engagement (facilitators), available information (barrier), culture (mixed), and evidence strength (neutral). Perspectives on several factors differed by the professional group's role in integrating NPs (e.g., costs).

Conclusions:

The barriers highlight lacking interprofessional support from a priori policymaking and communication breakdowns. Policies should reflect priorities of administrators, clinicians, and policymakers.

Implications:

These factors may inform policymaking in other countries but would be most effective if based on country-specific research. This implementation science approach may inform future studies.
Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children
Authors: Correia Alison A. , Weber Martin A. , Krishnan Usha
Published: August 2023

Objectives:

Fungal esophagitis (FE) is the most common cause of esophageal infection and its prevalence in immunocompetent adults is rising. However, there is minimal data on FE in children without human immunodeficiency virus. Therefore, the objective of this study was to determine the prevalence, symptoms, endoscopic appearances, and predictive factors of FE in children, regardless of immune status.

Methods:

A 2010–2020 retrospective case-control study was conducted on 1823 children presenting to Sydney Children’s Hospital for elective endoscopy with esophageal biopsy. Histopathology reports were reviewed to identify FE cases and determine prevalence rates. Thirty-two patients with FE were age- and sex-matched (1:2) to 64 controls. Significant symptoms and risk factors of FE were identified via univariate and multivariate logistic regression analysis.

Results:

The prevalence of FE in children was 1.76%. Common symptoms included dysphagia (25%), heartburn (25%), poor oral intake (21.9%), vomiting (18.8%), cough (15.6%), nausea (12.5%), and weight loss (9.4%). No significant differences in symptoms were found between cases and controls. On endoscopy, although white plaques were associated with FE (P < 0.001), visually normal findings were reported in 28.1% of cases. Topical swallowed corticosteroids were a significant independent risk factor for FE (adjusted odds ratio = 10.740, 95% confidence interval: 1.213–95.101, P = 0.033).

Conclusions:

The prevalence of FE in this pediatric cohort reflects rates among immunocompetent adults. Given that many of these children presented with a wide range of gastrointestinal symptoms, esophageal biopsy is required to accurately diagnose FE. Pediatricians should consider the risk of FE when prescribing topical swallowed corticosteroids.
Flushing in Intravenous Catheters
Authors: Ribeiro Gabriella da Silva Rangel , Campos Juliana Faria , Camerini Flávia Giron , Parreira Pedro Miguel Santos Dinis , da Silva Rafael Celestino
Published: August 2023

An observational study was developed with 108 nursing professionals who managed vascular access devices in 4 intensive care units of a university hospital in Rio de Janeiro, Brazil. The objective was to analyze the practice of the nursing staff in performing flushing for the maintenance of vascular access devices in critically ill patients. Data were collected by observing the flushing procedure using a structured checklist and analyzed using descriptive and inferential statistics. In 23% of the 404 observations, there was no flushing. When performed at some point during catheter management (77%), flushing was predominant after drug administration with 1 or 2 drugs administered. There were flaws in the flushing technique applied in terms of volume and method of preparation. Time of professional experience >5 years, knowledge about recommendations, and training on flushing were variables associated with technique performance. It was concluded that the flushing procedure did not meet the recommendations of good practices, with failures that constituted medication errors.