bluuebunny/crossref_metadata_2025 huggingface dataset:
Parameters of Conversion from Temporary External Fixation to Internal Fixation in Open Fractures in Adults
Authors: EL Menam Ghaly Nabil Abdel , Ahmed Ahmed Rayan , Badr Ahmed Atef Ahmed
Published: August 2023

Background

Open fractures often have extensive soft-tissue damage requiring multiple procedures such as debridement, soft-tissue coverage, and definitive fixation through the cooperative work of orthopedic and plastic surgeons. Combined treatment for both the fracture and soft-tissue. Patients obtain many benefits from early fixation. Early stabilization facilitates patient mobility and alleviates pain and discomfort.

Aim of the Work

Systematically reviewing available evidence from published articles to assess points of conversion from this temporary external fixation to internal fixation in open fractures.

Patients and Methods

We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of the interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists.

Results

The moderate negative correlation between CRP and duration of conversion from EF to IF is probably because the downward trend of CRP from the peak value was considered one factor in the timing of conversion to IF, Strategy to perform definitive IF as early as possible resulted in 91% of patients undergoing definitive IF within 3 weeks after injury. In addition, this strategy is described to be beneficial for early soft-tissue repair with low infection rate. Subsequent conversion to ORIF can safely be performed once the patient is hemodynamically and systemically stable and any local soft-tissue injury has resolved, union rate of 91%, an infection rate of 16% and one fixation failure. All the infections occurred in open fractures, of which 75% were Gustilo grade III.

Conclusion

In conclusion, temporary external fixation for open fracture of the lower limb followed by conversion to internal fixation, as early as soft tissue and general condition permit, may be a safe and effective procedure for patients with open fracture. It is not precisely known when is the best time to convert to definitive fixation without increasing the risk of infection.
Comparison of Plating Fixation versus Intramedullary Nailing in the Treatment of Fracture Both-Bone Forearm in Children: A Systemic Review
Authors: El-Kader Hammad Abouelela Amr Abd , Diab Ramy Ahmed , Eltaher Mostafa Eldoshy
Published: August 2023

Background

Both bone forearm fractures (BBFFs) are a common injury in children, account for 41.1% of all fractures in children, the third most common fractures in the pediatric population. Diaphyseal forearm fractures account for the most common location of re-fractures in the pediatric population. The most common mechanism of injury is a fall onto an outstretched hand. There are many debates in the field of pediatric orthopedics, including when to operate, what constitutes an acceptable reduction and what age does remodeling capability inherent to children become less effective. Greater controversy exists regarding the optimal method of fixation in children between the ages of 10 and 14 years. Fractures in this age group that cannot be maintained in acceptable alignment with closed reduction can be treated with either IM nails or ORIF with plates. Closed reduction and cast immobilization remains the gold standard treatment for minimally displaced and stable pediatric forearm fractures.

Aim of the Work

is to introduce a systematic review comparing between plating and intramedullary nailing (IMN) for children with diaphyseal both-bone forearm fractures (BBFFs) as regards union, functional outcome and complications.

Methodology

This study is a systematic review. Children aged 5–14 years with both-bone diaphyseal forearm fractures were included. Surgical fracture fixation with plates and screws vs. IM nails were compared.

Results

We found no statistical difference in functional outcome as measured by range of movement. We also found no consistent difference in complication rates between the two groups, although this is a difficult outcome to objectively compare. There were more cases of compartment syndrome in the IMN group than in the plating group, although numbers were low for both, and it was not entirely clear if the cases in the IMN groups developed post-operatively as opposed to being consequences of the injuries themselves. Radiographically we found no study reporting significant difference in time to fracture union. Duration of surgery and cosmetic result (scar) seem to favor the IMN group.

Conclusion

Despite methodological deficiencies of the studies included, IM nailing has been shown as an effective and safe treatment option for those fractures, associated with shorter operation time, improved cosmesis, and easier hard ware removal.
The Effect of Tunnel versus Conventional Phototherapy on the T Lymphocytes in Full Term Neonates with Hyperbilirubinemia
Authors: El-Ganzoury Mona M , El-Farrash Rania A , Salem Dalia A , Saleh Ahmed M
Published: August 2023

Background

Neonatal jaundice is one of the most common conditions. Phototherapy has been accepted as the standard treatment for neonatal jaundice and the decline in the number of exchange transfusions in recent years is, at least in part, likely a direct reflection of the effectiveness of phototherapy at treating hyperbilirubinemia. However, this treatment modality also has some complications. One possible harmful consequence is potential immunotoxic effects by affection of lymphocytes subtypes which can affect the immune system functions in infants.

Aim of the Work

current study was performed to compare the effect of both conventional and tunnel phototherapy on lymphocytes subsets in term neonates (≥37weeks) with unconjugated hyperbilirubinemia.

Patients and Methods

The present study was conducted on 60 term neonates (≥37weeks) 40 of them with unconjugated hyperbilirubinemia admitted to NICUs in Ain-Shams University hospital during the period from January 2019 to July 2019. They were randomly assigned to 3 groups: 20 patients were exposed to conventional phototherapy and 20 patients were exposed to tunnel phototherapy and the other 20 healthy full term were assigned as control group. Total serum bilirubin (TSB), direct serum bilirubin (DSB), CBC, CD4 and CD8 percentages and absolute count were measured before and 48 h after phototherapy in the phototherapy groups. Baseline lab was done in the control group at once.

Results

significant decrease in total and direct bilirubin post-phototherapy in both phototherapy groups proved that tunnel phototherapy is as effective as conventional phototherapy as both provided rapid decrease in bilirubin levels. As regards the effect of phototherapy on lymphocytic count, we found that lymphocytic count significantly decreased post-phototherapy in both phototherapy groups. As regards the effect of phototherapy on CD4+ and CD8+ percentages, we found that CD4+ % significantly decreased postphototherapy in conventional phototherapy group. Moreover, when we measured CD4+ and CD8+ absolute counts, we found that CD4+ and CD8+ absolute counts significantly decreased post-phototherapy in both phototherapy groups. In the view of the effect of phototherapy on CD4/CD8 ratio, we found that the ratio significantly increased in tunnel phototherapy group.

Conclusion

Conventional and tunnel phototherapy which are used in the treatment of neonatal hyperbilirubinemia, affects the function of the immune system in newborns via alterations in CD4+ and CD8+ absolute counts.
Evaluation of the Diagnostic and Prognostic Potential of Circulating miR-34a in Neonatal Sepsis
Authors: Fathalla Mostafa Mohamed , Nagy El Khazragy Nashwa , Metwally Gehan Anwer Mohamed , Rabie Dina Essam Abdelhamid
Published: August 2023

Background

Neonatal sepsis is a complex syndrome which is characterized by systemic inflammatory response. The high mortality rate of neonatal sepsis is contributed to late diagnosis and improper management.

Aim of the Work

The aim of this research is to examine the diagnostic utility of miR-34a in newborns with sepsis (who were newly diagnosed according to the clinical sepsis score and the hematology score of sepsis) and compare them to neonates without sepsis by using real-time PCR.

Patients and Methods

This study was conducted on 70 neonates from NICU of Ain Shams University hospital and permitted by Ain Shams ethical committee. Neonates were classified into two groups: 35 neonate with sepsis and 35 neonate without sepsis. In consideration, these neonates’ ages were ≥ 35 weeks, had no Congenital anomalies, Chromosomal abnormalities and had not been given any kind of antibiotics before obtaining blood specimens from them. Moreover, the study didn’ t include neonates with an inborn error of metabolism or any surgical procedures. Neonates without sepsis and neonates with sepsis were matched in terms of gender and age.

In our study, blood samples of 2 ml were withdrawn from patients (within 72 hours from suspecting the diagnosis of neonatal sepsis) and from the control at matched gestation and postnatal ages, then patients were followed up.

Results

the obtained results showed that, the expression level of miR-34a was reduced by 5.2-fold in neonates with sepsis, with a P value of 0.001. Additionally, a negative correlation was detected between miR-34a expression level and either the clinical sepsis score (p = 0.163) and the hematology score (p = 0.122), and also a significant correlation was detected between the clinical sepsis and hematology scores in neonates with sepsis (p = 0.047). The study observed that, the miR-34a could discriminate neonates with clinical sepsis score, the biomarker sensitivity and specificity were 80% and 70%, respectively. In addition, the calculated sensitivity and specificity of miR-34a to discriminate neonates with hematology score were 85% and 87%; respectively. The cut-off value was <0.04 .

Conclusion

Based on the obtained results, there is a significant difference between the serum expression level of miR-34a and either the clinical sepsis score and hematology score . the lower expression level of miR-34a was detected in neonates with CSS >10. Similarly, the lower expression level of miR-34a was detected in neonates with high hematology score >4.
Psychological Maladjustment in Siblings of Children with Type 1 Diabetes Mellitus in An Egyptian Cohort
Authors: Elhabashy Safinaz A , Elhenawy Yasmine I , Abdelmageed Reham I , Hassan Hossam A
Published: August 2023

Background

Diabetes is a chronic life-changing event, not just for the sick child but for the entire family. It poses a number of challenges to family units as a whole

Objective

To assess frequency of psychological maladjustment among siblings of children with Type 1 diabetes (T1D).

Subjects and Methods

A cross-sectional study was conducted on 100 families with a child diagnosed with T1D; for each family one healthy sibling and one parent were included. All parents and siblings had face to face questionnaire. The Arabic version of the parent reported Strengths and Difficulties Questionnaire (SDQ) was used to assess sibling appraisal of living with a child with T1D and his/her adjustment. Siblings aged (11-18years) took the questionnaire on their own as well.

Results

On evaluating the parent reported SDQ, 60% of the healthy siblings scored within the normal range, 26% were borderline and 14% showed scores in the abnormal range. Comparing data from the current study with the UK norms, healthy sibling from the current study experienced more total difficulties (p < 0.001). Regarding SDQ- self report, 40 % of healthy sibling were normal and 40% and 20% showed scores in the borderline and abnormal range respectively. Similarly, self- reported SDQ showed significantly higher total difficulties scores compared to UK norms (p < 0.001). A significant positive correlation was found between poor glycemic control, as evidenced by HbA1C, as well as diabetes related complications and total difficulties reported by older healthy siblings (p < 0.05).

Conclusion

Siblings of children with type 1 diabetes are at risk of psychological maladjustment and special attention must be directed to identify siblings at risk who may benefit from psychological support.
Study of 5 Alpha Reductase Enzyme Gene Mutations in a Group of Patients with 46XY Disorders of Sex Development
Authors: Elsedfy Heba Hassan , Amr Nermine Hussein , Khalaf Randa Ismail , Ageeb Olivia Elia
Published: August 2023

Background

Disorders of sex development (DSD) are a wide range of conditions with diverse features and pathophysiology that most often present in the newborn or the adolescent periods. Affected patients usually present with atypical genitalia like hypospadias, isolated micropenis and undescended testis. These clinical situations can often be difficult to manage, particularly in those cases where the sex rearing is uncertain.

Aim of the Work

Studying 5alpha reductase enzyme gene mutations (SRD5A2) in patients with 46XY DSD to detect its molecular characteristics.

Patients and Methods

This cross-sectional study was performed on 25 male patients with clinical, laboratory and genetic molecular analysis of SRD5A2 gene mutation fitting the diagnosis of 46XY DSD. To assess the degree of virilization external masculinization score (EMS) was used where EMS less than 7 is considered ambiguous. All parameters were evaluated at the pediatrics endocrinology clinic and genetics department, Ain Shams University from December 2019 to December 2020.

Results

Only 12 patients showed laboratory and molecular results compatible with the diagnosis of SRD5A2 gene mutation, The mean age of the patients was 3.64 ± 4.75 years. Results showed EMS of 4.3 denoting the high degree of genital ambiguity in our cases. Scrotum was bifid in 5 patients (41.6%), underdeveloped in 5 patients (41.6%) and fused in 2 patients (16.8%). Cryptorchidism was found in 4 patients only (33.3%). Four patients (33.3%) had normal urethral opening while hypospadias was present in 8 patients being perineal in 1 patient (8.3%), perineoscrotal in 5 patients (41.6%) and scrotal in 2 patients (16.6%). Micropenis was present in 7 patients (58.3%), four patients had 2 openings (33.3%) compared to a single opening in 8 patients (66.7%).

Regarding type of SRD5A2 gene mutations 56.2% of mutations were Insertion deletion, 25% were Insertion, 12.5 % were Missense, 6.25% were Deletion.

Conclusion

This study demonstrated ten novel mutations of SRD5A2 gene were identified in association with 5alpha reductase enzyme deficiency. These mutations were reported among 12 patients with 46 XY DSD from total of 25 patients were fit for this study. No distinct relationships were observed between genotypic and phenotypic characteristics in the participants.
Safety of Intravenous Immunoglobulin Replacement Therapy in a Group of Patients with Primary Immune Deficiency
Authors: Reda Shereen M , Radwa Nesrine , Reem M A
Published: August 2023

Background

Intravenous immunoglobulin (IVIG) has been used as antibody replacement therapy in primary immunodeficiency diseases for more than 50 years. Most routinely, IVIG is used in patients with predominantly antibody deficiency and combined immunodeficiency.

Aim

To evaluate the safety of regular intravenous immunoglobulin (IVIG) among patients with primary immunodeficiency diseases who receive IVIG as a replacement treatment.

Methods

Our study included 40 patients with primary immunodeficiency following up regularly in the Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, These patients were followed up for one year in order to evaluate the incidence of occurrence of adverse reactions among the patients who received IVIG monthly, Once patients with adverse reactions have been identified, the following data were taken and reviewed : a specific type of adverse reaction to IVIG; the time interval between onset of adverse reaction and beginning of IVIG infusion; IVIG preparation, dose and infusion rate; medical management done during side effects . Statistics were used to analyze and interpret the data.

Results

This study included 40 PID patients. They were 31 males (77.5%) and 9 females 22.5% with a male to female ratio of 3.4:1. At time of enrolment in the study, the median age was 73.5 months (14 – 218 months). In our studied population the median age of symptoms onset was 23 months (1 – 187 months), and age at diagnosis was 25 months (2-192 months). This made the diagnostic lag to have a median of 9 months (0-56 months). From our studied population only one patient (2.5%) out of the study groups developed anaphylaxis and was shifted to another brand.

Conclusion

IVIG is a safe drug for patients with primary antibody deficiency with minimal reported side effects.
Serious Drug Induced Hypersensitivity Reactions among Hospitalized Infants and Children
Authors: Hassan El-Owaidy Rasha , Ahmed Ahmed Rezk , Fawzey Turkey Saeid
Published: August 2023

Background

There are very limited data concerning the epidemiology of drug hypersensitivity in Egypt.

Aim

We sought to investigate the magnitude of serious drug hypersensitivity reactions among hospitalized infants and children in a tertiary hospital over a period of one year.

Patients and Methods

This study is a cross sectional one that was conducted over a period of one year from the middle of October 2020 to the middle of October 2021. The study was carried out in Children’s Hospital, Ain Shams University. We screened for patients with serious drug hypersensitivity reactions among a total of 10440 hospital admissions over a period of 12 months. Positive cases were further assessed with complete clinical and laboratory assessment.

Results

Out of total admissions of 10440 patients over the study period, 35 (0.335%) patients had clinical manifestations of serious drug hypersensitivity reactions. Concerning those 35 patients, they were 21 (60%) males and 14 (40%) females with age ranging between 3 to 193 months with median (IQR) = 50 (24-96) months. Four patients (11.4%) were known to be allergic; with 1(2.9%) having allergic rhinitis, 1 (2.9%) having urticaria, and 2 (5.7%) having cow milk protein allergy. Ten patients (28.6%) had family history of allergic disorders. Eleven patients (31.4%) had manifestations of anaphylaxis, 18 (51.4%) severe urticaria/angioedema, while the remaining 6 (17.1%) had manifestations of Stevens-Johnson syndrome. Concerning results of laboratory investigations, anemia was found in 29 (82.9%) patients, leukocytosis in 9 (25.7%) patients, leukopenia in 8 (22.9%) patients and thrombocytosis in 4 (11.4%) patients, while none of them had eosinophilia. CRP and ESR were elevated in 24 (68.6%) and 15 (42.9%) patients respectively. All of the 35 patients could overcome the drug hypersensitivity reaction with proper management

Conclusions

Although rare, drug hypersensitivity reactions represent an important health issue that should be clearly well reported, registered, and properly managed. Further wider scale and multicenter studies are warranted to gather more data and investigate the prevalence of each type of drug hypersensitivity reactions among children including those which are not reported in our study.
Thyroid Disorders in Pediatric Long Term Survivors after Hematopoietic Stem Cell Transplantation
Authors: Mohamed Wafaa Ezzat Ibrahim , Sayed Safa Matboly , Hassan Marwa Magdy , Soliman Samia Aboualhaggag
Published: August 2023

Background

Thyroid dysfunction is one of the major long term endocrinopathies shown after hematopoietic stem cell transplantation (HSCT), it is usually described after total body irradiation, thyroid dysfunction after the use of chemotherapy only in conditioning regimen was evaluated in our study.

Aim of the Study

To assess the frequency of thyroid dysfunction after HSCT in children using chemotherapy only in conditioning and to relate the thyroid dysfunction after HSCT to the underlying disease and transplant related factors.

Subjects and methods

This cross sectional observational study was conducted over 12 months duration, from 1st of September 2020 to 1st of September 2021, at Pediatric Transplant Unit, Children,s hospital, Ain Shams University, on pediatric long term survivors who received HSCT in the duration between 2011 to 2019. They were investigated for thyroid dysfunction by measuring Thyroid-stimulating hormone (TSH), free thyroxine (Free T4) and free triiodothyronine (Free T3), Antithyroglobulin antibody (Anti-TG) and by thyroid US.

Results

The frequency of thyroid dysfunction among the long term survivors was 30% (6/20) including: subclinical hypothyroidism 50%, subclinical hyperthyroidism 16.7%, primary hyperthyroidism 16.7% and graves’ disease 16.7%. The most common thyroid disorder was subclinical hypothyroidism. No significant correlation was observed between the frequency of thyroid disorders and type of conditioning regimen used (p = 0.16), underlying disease (p = 0.5), age at transplantation(p = 0.35). Also, no significant correlation was observed between the thyroid disorders and graft versus host disease (GVHD) (p = 0.92) or Anti-TG (p = 0.26).

Conclusion

HSCT recipients had a high frequencyyof thyroid gland disorders, therefore, the thyroid status of each HSCT recipient should be screened before and after transplant. These findings also emphasize the need for long-term monitoring of thyroid function following HSCT.
Validity of the GenXpert MTB/RIF in Diagnosis of Pulmonary Tuberculosis & Description of Pulmonary TB Resistance Profile in Abbasia Chest Hospital
Authors: Dawoody Mai M , Abouseif Hasnaa A , Shoman Ahmad E , Gabal Mohamed S
Published: August 2023

Background

Tuberculosis (TB) is a global public health problem; early diagnosis will enhance the treatment and decrease the resistance to the anti TB drug which improve the overall treatment outcome

Objectives

Comparing the validity of GeneXpert Mycobacterium tuberculosis /RIF in diagnosing pulmonary TB and detecting Rifampicin resistance with Direct smear microscopy.

Subjects& methods

Cross sectional study was conducted to collect a sample of 393 clinically suspected cases (January,2016 to February 2018). All cases underwent Direct smear microscopy, GeneXpert (GX) MTB/RIF and Lowenstein– Jensen Cultures Golden standard test for diagnosis of TB and comparing the validity of the two tests. Comparison between GX and the golden standard culture results was done by sensitivity and specificity calculation as well as the Kappa test for agreement between results of tests.

Results

For 393 clinically suspected TB cases, TB culture confirmed 196 (49.9%) TB positive cases and 197 (50.1%) TB negative cases and 32 Rifampicin resistant cases (16.3%) of the positive TB cases. GX detected 206 (52.4%) TB positive cases and 187(47.6%) TB negative cases and 34 Rifampicin resistant cases. For TB diagnosis, GX sensitivity was 91.8%, specificity was 86.8%, PVP= 87.4%, PVN=91.4Accuracy= 89.3, and substantial agreement between GX and culture as level of agreement =78.6%. As for Rifampicin resistant cases the GX sensitivity =100%, specificity=98.9%, PVP= 94.1%, PVN=98.9%, Accuracy= 99%, and GOOD agreement between GX and culture as kappa = 0.964 (level of agreement is 96.4%). Direct smear microscopy detected 166 (42.2%) TB positive cases and 227(57.8%) TB negative cases. Sensitivity of direct microscopy was 53.6% while specificity was 69%, PVP= 63.3%, PVN=59.9%, Accuracy= 61.3%, and fair agreement between Direct smear microscopy and culture with level of agreement =22.6%.

Conclusion

GX has the advantage of pulmonary TB rapid testing of high sensitivity and specificity that allows early treatment and decrease of the disease transmission in comparison to the currently used Direct smear microscopy for TB diagnosis
Understanding the Effect of Large Subgroup Sizes on Overdispersion and Using Laney’s P’ Chart to Monitor Overdispersed Data
Authors: Fahmy Muhammad M M , Al-Tehewy Mahi M , Moustafa Moustafa E , Kandeel Sahar K I
Published: August 2023

Background

The traditional Shewhart’s P chart is an important statistical process control tool that’s used to monitor processes that yield binary data. However, it has been known for showing a high rate of false alarms (i.e. overdispersion) when handling data with large subgroup sizes. Large subgroup sizes were usually considered to be the cause of overdispersion while no solid evidence actually exists to support this believe. In an effort to manage overdispersion Laney’s P’ chart was proposed in 2002 as a superior alternative to the traditional P chart. And the P chart diagnostic test was also introduced in some software packages to detect any overdispersion in the data and to recommend the suitable chart.

Aim

In this study we aimed at exploring the effect of large subgroup sizes on the overdispersion of data and we also attempted to test Laney’s P’ chart and the P chart diagnostic test in detecting and handling overdispersed data.

Method

An Experimental study was conducted using a single set of real data in addition to nine sets of simulated data with variable characteristics. All data sets were used to perform the P chart diagnostic test and to plot Shewhart P chart and Laney’s P’ chart.

Results

Large subgroup sizes proved to have no effect on binomially distributed data but if the data is not truly binomial, increasing the subgroup sizes will exaggerate overdispersion. In this case using Laney’s P’ chart will successfully resolve the problem.

Conclusion

The problem of overdispersion is not due to large subgroup sizes rather than it’s due to the false assumption that the data follows a binomial distribution when it frequently doesn’t. An ideal remedy for this problem is to discover a better fitting distribution for the data.

Till then Laney’s P’ chart is a practical and capable remedy.

Recommendations

The P chart diagnostic tool should be used to detect any overdispersion before using Shewhart’s P chart. And if overdispersion is detected Laney’s P’ chart is a recommended alternative. We also recommend Further study of the performance of Laney’s P’ chart and other suggested distributions that can outperform the binomial distribution as a basis for the P chart.
Reliability of MRI in Pre-Therapeutic Assessment of Tumor Depth Invasion in Oral Cavity Carcinoma
Authors: Abdelaziz Tougan T , Raafat Wafaa , Fahim Reham M , Elsayed Ahmed Mostafa
Published: August 2023

Background

Head and neck carcinomas account for 5% of all cancers, with approximately half of those arising from the oral cavity, thus creating a significant health problem. Accurate loco-regional staging determines the appropriate treatment plan and subsequently favorable outcome and disease prognosis.

Patients & Methods

20 patients (12 females and 8 male) were included in this study. Conventional MRI, diffusion MRI and Dynamic contrast MRI were performed for local and nodal disease staging. MRI staging was correlated to operative histopathology as a reference standard. Diagnostic accuracy was estimated for MRI techniques.

Results

Results revealed high accuracy of MRI in local tumor and nodal staging.

Conclusion

MRI remains the cornerstone in loco-regional staging of tongue carcinoma. DCE-MRI is the most accurate MRI technique in evaluation of local extension and depth of invasion. Combination of DCE-MRI and DWI-MRI achieves highest accuracy for detection of regional nodal spread.
Correlation between ADC Values and Split Renal Function by Renal Isotope Scan in Assessment of Nephropathy
Authors: Mustafa Dina Nabil Hassan , Elhifnawy Suzan Bahig Ali , El Din Hussein Rasha Salah
Published: August 2023

Background

Early assessment of renal structure and function is crucial for the proper management and treatment of renal disease. DW-MRI show the Brownian motion of water molecules using the ADC values yielding information on water diffusion in the extracellular and extravascular space and capillary perfusion.

Aim of the Work

to study the ability of DWI in assessing and evaluating the individual renal function by correlating the ADC values calculated with split GFR obtained from dynamic renal scan among cases and healthy control group.

Patients and Methods

This prospective study was conducted on 30 patients and 30 control healthy group. Both MR examination and dynamic renal scan were performed on 30-case group, only MR examination was done on 30-healthy control group. DWI (b = 0, 200, 800 s/mm2) was done on 1.5T MRI unit. ADC map was calculated for every kidney. Split GFRs were measured from 99-Tcm DTPA scintigraphy.

Results

our study revealed that ADC values of normal control group is lower than that of case group. Cut off value of ADC, that discriminate between case and control group (using average ADC value of both kidneys), was ≤2.1 x10-3 mm2/s with Sensitivity = 87% and Specificity = 47%. We classified renal dysfunction, according to the total GFR measured from the dynamic renal scan and comparing it with the standard normalized GFR ranges according to age and sex in to 3 groups : suboptimal, decompensated and deteriorated renal dysfunction, the mean ADC values were 2.07 ± 0.21, 2.01 ± 0.13 and 1.45 ± 0.19 x10-3 mm2/s respectively.

Conclusion

There is a positive relationship between the ADC values and split GFR. DWI has a potential value for evaluating individual renal function, and may provide functional and morphological information at the same time.
Comparison of Digital Mammography with Tomosynthesis and Ultrasound to Magnetic Resonance Imaging in Assessment of Post Operative Scarring and Locoregional Recurrence of Breast Cancer
Authors: Mohamed Eman Khaled Ahmed Elmahdy , Habib Lobna Abdel Moneim , Barakat Mai Mokhtar Kamal
Published: August 2023

Background

Breast cancer is the most common type of cancer and the second cause of cancer associated death in women. It is the most common type of cancer in women and the third cause of cancer associated death in Egypt.

Aim of the Study

Our study aims to evaluate the role of digital breast tomosynthesis with complementary ultrasound compared to magnetic resonance imaging in assessment of post-operative changes and loco regional recurrence of breast cancer.

Patients and Methods

A Cross sectional study was approved by the ethics review board of Ain Shams University Hospitals. All MR imaging were conducted at the Department of Radiology at Ain-Shams University. Thirty patients who were surgically treated by conservative breast surgery were included in our study from March2021 to September 2021 according to the regulations of the ASU ethical committee. The resultant BIRADS were subsequently correlated with the final results by histopathology.

Results

In our study DBT with complementary US showed greater sensitivity (100 %) than MRI (80 %), yet it revealed lower specificity(96%) than MRI (100%). DBT with complementary ultrasound show a higher NPV (100%)but lower PPV (83. 3%) than MRI (96.1%) (100%) respectively. However, both of them revealed comparable accuracy: DBT with us (96.6%) and MRI (96.6%).

Conclusion

MRI has a lot of technical errors that limit its results and increase its numerous pitfalls. DBT with complementary ultrasound are a powerful imaging modalities that can be used to detect any recurrence in patients who are surgically treated for breast cancer with higher sensitivity and higher NPV than MRI and both of them revealed comparable accuracy.So, the use of these modalities enhance diagnosis of surgically treated breast cancer for early detection of recurrence.
Advances in Management of Osteoid Osteoma by Radiofrequency Ablation
Authors: Hetta Waleed , Khattab Rasha Tolba , El Hakim Mohamed Hamdy Mounir Abd
Published: August 2023

Background

Osteoid Osteoma is a benign painful skeletal neoplasm which is usually smaller than 1.5 cm. Surgery has been considered its standard treatment, currently, Percutaneous CT-guided Radiofrequency Ablation is proved to be the treatment of choice in such cases.

Objective

To evaluate the effectiveness of CT-guided radiofrequency ablation for the treatment of spinal and non-spinal osteoid osteomas, technical requirements needed for safe radiofrequency ablation and recent advances in this respect.

Patients and Methods

This study is a retrospective study conducted on patients with osteoid osteoma who underwent Radiofrequency ablation from January 2019 till July 2020 at Ain Shams University Hospitals, Maadi Military Hospital and El Galaa Military Hospital, followed by postprocedure computed tomography (CT) follow up.

Results

Location, calcification of the nidus, coagulation time, lesion size, and previous treatment are dependent risk factors compared regarding outcome.

Conclusion

We concluded that CT-guided RFA is a feasible, safe, and effective treatment for spinal and extra-spinal osteoid osteoma and is easily repeatable after unsuccessful treatment. Surgery should be reserved for lesions causing nerve root compression in spinal lesions.
The Time Course of Lung Changes on Chest CT during Recovery Coronavirus (COVID-19) Pneumonia
Authors: Ali Mohamed Abdelaziz , Zedan Nehal Sayed Mohamed , El atty Elsayed Muhammad Gamal Abd
Published: August 2023

Background

COVID-19 is a highly infectious disease that has been spreading widely worldwide. Early diagnosis is an essential disease management strategy. However, insufficient laboratory kits caused a challenge and dramatic dissemination of the disease.

Aim of the Work

The aim of the work is to describe the change in chest CT findings associated with COVID-19 pneumonia from initial diagnosis until patient recovery.

Patients and Methods

This was a retrospective study that included 30 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. An acceptance from the ethical committee of the Radiology Department and the ethical committee of Faculty of Medicine - Ain Shams University was obtained to use the data stared on PACs system with the patient’s consent waived being a retrospective study.

Results

The distribution of lesions and major CT findings were compared at the four stages of recovery. Overall, subpleural lesions were more common than central lung lesions. The majority of patients had bilateral lung involvement during the course of the disease.

Conclusion

The typical pattern of most involved cases mainly starts as small subpleural bilateral or unilateral GGO mainly within the lower lobes which later develop crazy paving pattern & subsequent consolidation. After more than 2weeks, the lesions are gradually absorbed with residual faint GGO & subpleural parenchymal bands.
Comparison of a Routine Magnetic Resonance Imaging & T2* Mapping of Articular Cartilage in Knee Osteoarthritis
Authors: Shaimaa Shawky M , El-Sharkawy Mohsen Gomaa , Sakr Hossam Moussa , Mansour Mohamed G
Published: August 2023

Purpose

To detect the knee articular cartilage lesions in T2* mapping as compared to a routine standard magnetic resonance imaging (MRI) at 3T.

Material and Methods

Twenty-five patients, complaining of knee pain and trauma, underwent knee MRI and were imaged with a standard knee MRI protocol (proton-density-weighted Fat Sat sagittal and axial series, T2weighted sagittal and axial series, and T1-weighted coronal series) and Proton density 3D sagittal and axial sequences are added, then images of T2* relaxation time is generated with color-coded mapping representing the relaxation time. The detected lesions were evaluated for lesion width (mm), lesion depth (1/3, 2/3, or 3/3 of cartilage thickness), and T2 values (20–40 ms, 40–60 ms, or 60– 80 ms).

Results

The study was conducted on 25 patients (13 female & 12 male with a mean of 44.92 ± 11.74 years). 87 lesions were detected both on MRI and T2 maps, while 41 lesions were visible only on T2* maps.

The cartilage lesions’ width and depth measurements showed no statistically significant difference on T2 maps as compared to standard knee MRI. Many lesions (45) had moderately (T2 40–60 ms) increased T2 values, while 29 lesions had slightly (T2 20–40 ms) and 13 lesions with remarkably (T2 60– 80 ms) increased T2 relaxation times.

Conclusion

T2 mapping of articular cartilage is efficient in cartilage evaluation and may reveal early cartilage lesions not visible on standard clinical MRI.
Role of Imaging in Diagnosis of Neurological Complications of COVID-19
Authors: Elia Remon Zaher , Abdelaziz Karim Ahmed , Gelany Toqa Hosni Abuzaid
Published: August 2023

Background

The COVID-19 pandemic has become a challenging world issue after its emergence in December 2019. Despite its most characteristic symptom of respiratory distress, patients with COVID-19 have also shown neurologic manifestations.

Aim of the Work

To investigate the yield of neuroimaging in patients with COVID-19 undergoing CT or MR imaging of the brain and to describe associated imaging findings.

Patients and Methods

A descriptive cross–sectional study conducted at Ain Shams University Hospitals over a course of eight months from December 2020 to July 2021. All patients with confirmed COVID-19 infection who presented with neurological symptoms and underwent neuroimaging were included.

Results

39 patients were included in the study, with both adults (84.6%) and children (15.4%). Acute ischemic stroke is found to be the most common complication among adult group (48.5%) followed by Post-covid invasive fungal sinusitis (45.5%). Among the children, the neurological complications are rare but severe including vasculitis (50%), infarctions (33.3 %), cerebritis (16.7 %), venous sinus thrombosis (16.7 %), PRES (16.7 %) and non-specific white matter signal abnormality (16.7 %).

Conclusion

COVID-19 primarily affects the respiratory system. However, neurological involvement is not uncommon and can result in serious complications if not detected and managed early. These complications in some cases can even precede the respiratory symptoms or may be the only symptoms in COVID-19 patients. Therefore, a high index of suspicion is required while dealing with such cases for proper treatment and prevention.
Role of En Bloc Resection in Staging of Non-Muscle Invasive Bladder Urothelial Carcinoma
Authors: Shorbagy Amr Fekry Al , Azazy Samir Sayed Muhammad , Tawfik Ahmed Mohamed , Mohammed Alaa Sobhy , Shorbagy Ahmed Amr Fekry Al
Published: August 2023

Background

Among cancers affecting both sexes, bladder cancer ranks as the fourth most prevalent cancer globally, and in the top 5 in prevalence in individual countries of all income levels and all regions enbloc resection approach of bladder tumors has a great effect in staging bladder tumors that help in early management of bladder tumors.

Objective

to review systematically studies whether en bloc resection of non-muscle invasive bladder cancer (NMIBC) could improve the identification of muscularis mucosa (MM) and muscle properia.

Patients and Methods

We searched PubMed, Google scholar search engine, Cochrane database of systematic reviews, EMBASE and science Direct, using the following Keywords “bladder tumors, enbloc resection, transurethral resection,”. The mentioned databases were searched for studies published during the last five years

Results

Total number of patients in included studies was 1940 of which 955 (49.2%) underwent en bloc resection and 985(50.8%) underwent conventional TURBT. after analyzing available data, en bloc resection has superiority in less recurrence rate and less hospital stay and higher in staging rate.

Data Sources

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

Data Extraction

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

Conclusion

In our review, ERBT show that it is an effective approach with some advantages over cTURBT regarding the treatment of NMIBC. This review revealed that hospitalization time and staging rate are superior in patients treated with ERBT than cTURBT, and complication rate and 24-month recurrence rate were also lower using ERBT. Accumulating evidence indicates that ERBT improves the quality of the surgical specimens and decreases the ReTUR frequency. Based on the previous evidence we recommend that, ERBT should be adapted by more surgeons in the treatment of non muscle invasive bladder tumors.
Preoperative Neutrophils to Lymphocytes Ratio in Predicting the Response to BCG in High Grade Non-Muscle Invasive Bladder Cancer
Authors: Abdallah Hany Mostafa , Radwan Ahmed Ibrahim , ElSawy Amr Ahmed Said
Published: August 2023

Background

Urinary bladder cancer (BC) is a highly prevalent disease affecting more than 400, 000 new cases and 165, 000 deaths yearly, it is the ninth most common cancer in the world, the 13th cause of cancer deaths and the seventh most common cancer worldwide in men with marked male predominance.

Aim of the Work

To assess the role of preoperative Neutrophils to Lymphocytes Ratio as a predictor for the response to BCG in patients with Non-Muscle invasive Bladder Cancer in patients who underwent Trans-Uretheral Resection of Bladder Tumour (TURBT).

Patients and Methods

This retrospective cohort study was conducted at tertiary care hospital at Urology department, Ain Shams University hospitals from January 2020 to January 2022 and performed on a total of 46 patients with high grade non-Muscle invasive Bladder Cancer who underwent Trans-Urethral Resection of Bladder Tumor and took BCG course.

Results

Study results revealed that there was a highly statistically significant relation between preoperative NLR and pathological improvement during Follow up (p-value=0.00) in addition to Tstage and histological grade during Follow up, also there is a statistically significant relation between NLR and tumor size as well as the age of the patient.

Conclusion

Pre-TURBT NLR when it is high (above 3) is associated with an increased risk of disease recurrence and progression in patients with high grade NMIBC. Moreover, it is an independent predictor of disease recurrence and progression in patients treated with BCG for high grade NMIBC. Pre-TURBT NLR could be a useful blood-based biomarker to improve patients’ risk-stratification facilitating clinical decision-making regarding therapy and follow-up scheduling.
PIRADS Score 3 of Multi-Parametric Magnetic Resonance Imaging in Patients with Suspicious Prostate Cancer, Is It Conclusive?
Authors: Nowier Amr , Mazhar Hesham , Salah Rasha , Shabayek Mohamed
Published: August 2023

Background

Prostate cancer (Pca) is the second most common type of cancer in men worldwide. One of the new modalities for diagnosis is multiparametric magnetic resonance imaging (mp-MRI). To improve the interpretation of mp-MRI, Prostate Imaging Reporting and

Data System (PI-RADS) scoring system was suggested by the European Society of Urogenital Radiology (ESUR). PI-RADS score 3 was found to be equivocal by many studies. Aim of our study is analysis of demographic, clinical, and histological data of patients with PI-RADS score 3 by mp-MRI.

Methods

Fifty patients were enrolled. Full history taking, digital rectal examination (DRE), PSA, mp-MRI followed by trans-rectal ultrasound (TRUS) guided prostate biopsy were performed for all patients. We analyzed data of the 34 patients who were proved to have prostate lesions with PI-RADS 3 score by mp-MRI.

Results

62.5% of the PI-RADS 3 lesions proved to be benign by TRUS guided biopsy, and the rest (37.5%) was detected as prostate cancer in biopsy. No statistically significant correlations were found between age, total PSA and density, prostate volume, or DRE and detection of Pca in patients with PI-RADS 3 score.

Conclusion

Lesions with score of PI-RADS 3 by mp-MRI cannot prove or exclude Pca and needs further evaluation by prostate biopsy.
Evaluation of RNA Based Biomarker Expression in Acute Kidney Injury after ESWL
Authors: Yassin Mohamed Mohamed , El Kholy Amr , Mousa Waleed , Sayed Marwa Matboli , Emam Mohamed Sahab
Published: August 2023

Background

Extracorporeal shock wave lithotripsy (ESWL) was introduced more than three decades as an authentic modern modality for the treatment of urinary stone disease. It is considered first choice of treatment for nearly all kinds of urinary tract calculi.

Objective

To evaluate the damage effect of ESWL on kidney tissue by measuring non-coding lncRNA profile in serum before and after ESWL session and assess their usefulness as diagnostic biomarkers for AKI and the relationship between the selected RNA based biomarker panel and clinicopathological changes of patients.

Patients and Methods

It is a prospective randomized control study assessing the damage effect of ESWL on kidney tissue by measuring non-coding lnc-RNA profile in serum before and after ESWL session(s) in 20 patients and compare it to control group of 20 healthy persons with no known urogenital disease and no known history of urologic pathology.

Results

The results favored outcomes of pre procedure lncRNA showed a statistically significant reduction after 48 hours after the procedure (p = 0.017). In comparison with control group the lncRNA showed a statistically significant difference between patients and controls at 2 hours and 48 hours after the procedure (p = 0.03 and 0.01, respectively).

Conclusion

Although ESWL is considered a safe and effective procedure in the treatment of renal stone disease yet it may cause acute renal injury. In this study, serum lncRNA rises significantly following acute renal injury caused by ESWL. Hence, serum lncRNA together with other kidney function tests as serum urea, creatinine can be used as acute renal injury markers following ESWL in patients with renal stone disease.