bluuebunny/crossref_metadata_2025 huggingface dataset:
New Pro-inflammatory Cytokines in Children and Adolescents with Type 1 Diabetes Patients with Microvascular Complications
Authors: Moharram Sarhan Alaa Sarhan , Elbyoumi Afify Mohamed Abo El-Asrar Mohamed , Shaaban Elmetwally Rasha Eladawy , Awad Abdelhady Doaa Mostafa
Published: July 2024

Background

Type 1 diabetes mellitus has become a global health burden, and poor glycemic control, in combination with prolonged diabetes duration, leads to the early development of microvascular complications, including diabetic kidney disease, retinopathy, and neuropathy. Therefore, it is urgent to establish new biomarkers for the early identification of at-risk patients.

Objectives

To investigate the role of inflammatory proteins (human growth differentiation factor 15 and interleukin 29) in the course of microvascular complications and glycemic control in T1DM.

Patients and Methods

Our study included 40 children with T1DM (18 T1DM patients had microvascular complications and 22 T1DM patients were free of these complications; their ages ranged from 8 to 18 years); there was also another T1DM subgroup based on glycemic control (11 T1DM patients had controlled HbA1c < 7% and 29 patients had uncontrolled HbA1C > 7%). 40 children of the same age were selected as a control group. The diagnosis of TIDM was made based on the criteria of the International Society of Pediatric and Adolescent Diabetes (ISPAD) (2022). A detailed medical history was collected, including the age of onset of diabetes, disease duration, and symptoms of diabetic complications. In the study, GDF15 and IL29 values in serum blood were investigated using the ELISA method.

Results

The mean age was 14.05 years in the diabetic group and 13.25 years in the control group (P = 0.178). In the T1DM patient group, the GDF15 and IL29 values were found to be significantly higher than those in the control group (P = 0.041 and 0.013, respectively). In diabetic patients, GDF15 was significantly higher in the complicated T1DM group versus the uncomplicated group (P = 0.001). Furthermore, GDF15 levels were significantly higher in uncontrolled patients with HbA1C > 7% than in the control group with HbA1C < 7% (P = 0.004); however, no significant statistical differences in IL29 levels were found between diabetic patient subgroups (P > 0.05).

Conclusion

The data from this study showed that GDF15 has an impact on glycemic control and that the presence of microvascular complications in the course of T1DM is very possible, but IL29 does not appear to play a role in the course of microvascular complications.
Studying Hemodynamics during Weaning from Mechanical Ventilation among Critically ill Pediatric Patients
Authors: Abdelhamid Nehad Salah , Abd El Gawad Tarek Ahmed , Ibrahim Youssef Hanan Mohammed , Elsaid Mohamed Iman Mohamed , Hassan Bawady Somia Abdel Hamid , Ahmed Rezk Ahmed Rezk
Published: July 2024

Background

Among the multiple causes of weaning failure from mechanical ventilation, cardiovascular dysfunction is increasingly recognized as a quite frequent cause that can be treated successfully. Knowledge of the changes in the cardiopulmonary pathophysiology occurring during mechanical ventilation and its withdrawal is a prerequisite for early recognition of weaning failure of cardiovascular origin and optimal patient management.

Aim of the Work

Identification of hemodynamic and biomarkers changes during weaning process from mechanical ventilation and how these changes predict weaning success

Methodology

This cross sectional study was conducted on 50 children who were admitted to Pediatric Intensive Care Units and were mechanically ventilated and ready to be weaned according to weaning criteria. assessment of hemodynamic changes during weaning was done by tracing and comparing vital data, echocardiography parameters and levels of serum BNP and troponin in all patients during pressure support ventilation and at the end of spontaneous breathing trial (SBT) for identification of changes during weaning and risk factors for weaning failure.

Results

There was statistically significant increase in heart rate, cardiac index and E/A ratio at the end of SBTin all studied patients with lower cardiac index in patients who failed weaning, significant increase in TAPSE at the end of SBT with lower TAPSE in patients who failed weaning. Levels of BNP1 during pressure support were significantly higher in patients who failed weaning however levels of troponin didn’t show significant changes.

Conclusion

Transthoracic echocardiography can accurately detect changes in central hemodynamics induced by the SBT. It helps the attending physician to identify patients at high risk of weaning failure, when documenting a lower cardiac index, low TAPSE values.
The Diagnostic and Prognostic Values of Soluble CD14 Subtype (Presepsin) in Early Detection of Early Onset Neonatal Sepsis in Preterm Newborns
Authors: El Sherif Dalia Fathi Ali , Ibrahim Elkholy Ahmed Nasser , Atif Ismail Heba Mohamed , Amin Ibrahim Mariam John
Published: July 2024

Background

The diagnosis of “suspected sepsis” in neonates in the NICU is one of the most common and challenging diagnoses due to the nonspecific signs of sepsis. therefore, laboratory investigation is necessary in cases of doubt or if there are risk factors. A promising biomarker: Presepsin (P-SEP), or Soluble Cluster of Differentiation 14 Subtype (sCD14-ST) is generated as a part of the body’s response to bacterial infection. It is effective in the early phase of inflammation, and it is detected as an early marker of sepsis in neonates.

Aim and Objectives

to evaluate the diagnostic value of presepsin in early neonatal sepsis and prognostic value for severity, mortality and hospital stay length.

Subjects and Methods

This prospective observational study include two groups, one group included 36 neonates with risk factors for early-onset sepsis, along with 20 uninfected neonates as the control group. Both groups were subjected to the calculation of Rodwell score, SNAP II score, serum presepsin levels, CRP measurement, and blood culture and assessed for clinical severity, mortality, and hospital stay length.

Result

Serum baseline presepsin was significantly elevated in sepsis group (P < 0.001), Presepsin showed the best diagnostic performance over Rodwell score (AUC 0.989; sensitivity of 93.8% and specificity of 95%). Presepsin levels on day 3 were significantly elevated in non-survived patients (P < 0.001), with better predictive performance for 28-day mortality and rapid progression to death than SNAP II score (AUC 0.880; sensitivity of 83.3% and specificity of 87.5%).

Conclusion

presepsin day 1 was useful diagnostic tools in culture proven early onset neonatal sepsis, presepsin at day 3 could be a good predictor for gram negative infections, 28-day mortality, and sepsis severity.
Different Regimens of Vitamin D in treatment of children with chronic liver disease
Authors: Mahmoud Ahmed Hebatallah Saad , Eldin Lerine Bahey , EL Masry Shereen Mohamed , Naguib Gina Gamal , Toaima Nadin Nabil , Abdel-Ghaffar Tawhida Yassin
Published: July 2024

Background

Vitamin D is a steroid based hormone that has crucial role in calcium metabolism and bone homeostasis and potential role in fibrosis including liver. Patients with chronic liver disease has tendency for vitamin D deficiency with possible sequalae including hepatic osteodystrophy. Safe and effective regime of vitamin D that can be used in children with chronic liver disease is still not well established. Moreover, the potentiality of reversing fibrosis process or halting it by correction of vitamin D is still not well studied.

Aim of work

The primary aim of the study is to assess the efficacy and safety of vitamin D regime using two different mode of administration. The secondary aim is to assess the possible antifibrotic effect of vitamin D therapy by assessment of fibroscan.

Methodology

Twenty four children with different etiologies of chronic liver disease but age and sex matched as well as anthropometric measures are enrolled in the study. They were distributed randomly among the two arms of the study and followed up for 6 months using different laboratory and imaging variables. The two regimes were group A who received intramuscular stoss dose once (200.000 IU) vitamin D therapy while group B received oral vitamin D therapy with dose 50.000 IU for four weeks. All children received maintenance vitamin D (600 IU) and Ca doses thereafter for the whole follow up period. All patients were subjected to complete history taking, complete clinical examination including abdominal examination, signs of liver decompensation and signs of vitamin D deficiency. As regard laboratory investigations done were CBC, liver function tests, serum calcium and phosphorous. Serum vitamin D level and fibroscan were also done at the beginning and the end.

Results

There were significant improvement of vitamin D level in both arms with no development of toxic s/o of vitamin D toxicity with p-value of < 0.001 and 0.000 respectively in group A and B. The difference of improvements between both arms were not significant display the equal efficacy of both regimes (P = 0.885). There were no significant improvement of fibroscan parameters following vitamin D treatment in either group A or B with p-value 0.637 and 0.931 respectively.

Conclusion

Stoss and oral vitamin D regimes suggested in the study are both equally effective and safe in the treatment of vitamin D deficiency among children with chronic liver disease. Despite no proof of antifibrotic effect upon vitamin D correction, further study is required to evaluate this issue.
Role of Serum Procalcitonin in Monitoring the Response to Treatment of Pediatric Bacterial Meningitis
Authors: Elhaddad Eman , Shatla Rania , Mohammed Maha Z
Published: July 2024

Background

Early diagnosis and initial therapy are important to reduce the complications of acute bacterial meningitis (ABM). The gold standard in diagnosing bacterial meningitis is by demonstrating the presence of bacteria in cerebrospinal fluid (CSF) samples via CSF cultures. However, CSF culture requires at least a day or more, and has limited sensitivity. Serum procalcitonin (PCT) is one of the most sensitive biomarkers for identification of bacterial from non-bacterial meningitis. This study was done to evaluate serum PCT as a marker to help in ABM diagnosis specially after oral antibiotics intake or when cerebrospinal fluid (CSF) culture is negative and to assess its correlation with outcome of ABM in children.

Methods

This is a prospective cohort study that included children who presented to Ain Shams University Children hospital over a period of 6 months. Participants were confirmed cases of ABM (laboratory- confirmed by culture) or suspected to have ABM (presented with sudden onset high fever and signs of meningeal irritation with CSF examination showing at least one of the following: 1. turbid appearance; 2. leukocytosis (> 100cells/mm3); 3. leukocytosis (10-100 cells/mm3) and either an a) elevated protein (> 100 mg/dl) or b) decreased glucose (< 40mg/dl)). The PCT levels were measured on admission and 72hours after treatment.

Results

A total of 38 ABM cases participated in this study. All the 38 cases showed elevated levels of PCT on admission. There was a significant drop in the mean of PCT level after 72h of treatment compared to level on admission (7.1±6.5 vs. 11.4±3.7, p = 0.001) respectively. There was a significant difference in the mean of PCT level between cases with good outcome (full recovery) versus poor outcome (death or neurological sequalae), on admission (7.2±2.8 vs. 13.2±4.4, p < 0.001) and 72h after treatment (4.2±3.5 vs. 12.9±5.3, p < 0.001) respectively.

Conclusion

Serum PCT levels were high in all patients with ABM, including those who received oral antimicrobials for 1-3 days before admission. The decline in PCT levels after treatment was associated with good outcome in our cohort.
Iron Metabolism in Pediatric Living related Liver Transplantation
Authors: Abdel Ghaffar Tawhida Yassin , Gawad Tantawy Azza Abdel , El Din El Shazly Lerine Bahy , Rahim El Naghi Suzan Abdel , Safwat Nesma Ahmed , Nasef Amani Abdo
Published: July 2024

Introduction

Iron deficiency is a frequent cause of anemia in liver transplant recipients, especially children. Rejection and infection are incriminated causes for occurrence of anemia after liver transplantation (LR).

Aim of the Work

We aimed to assess iron homeostasis in children who have undergone living related LT (LRLT) and its correlation with occurrence of rejection and infection.

Patients and Methods

The study was conducted on 35 children who have undergone LRLT. The patient characteristics, frequency of infection and rejection episodes, laboratory investigations including complete blood picture (CBC) and Iron profile (total iron binding capacity (TIBC),serum iron and ferritin) during the patient follow up visits were reported.

Results

Males were 68.58% of the studied patients and females were 31.42%. Their ages ranged from 1.3-15 years at time of LT with mean (SD) of 7.18 (3.8)years. The mean (SD) duration since LT was 4.83 (4.2) years. The commonest indication to LT was highgamma-glutamyl transferase (GGT) cholestasis (34.7%) followed by biliary atresia (21.7 %). Thirteen percent of patients had low hemoglobin (Hb) of whom 4.3% had normocytic normochromic anemia and 8.7% had microcytic hypochromic anemia. Serum iron was normal in 79.6% of patients and low in 20.4%, and ferritin was normal in 58.7% of patients and low in 41.3% while TIBC was normal in 82.6% of patients and low in 17.4%. Only serum iron showed significant negative correlation with white blood cells (WBCs) (P < 0.05). The iron parameters levels were not different in patients with no rejection or only one attack of rejection and the patients with multiple rejection episodes (P > 0.05).

Conclusion

Anemia is a reported complication after pediatric LT. Further studies are needed to assess the long term effect of post-LT anemia on patient outcome after LT.
Role of CXCL-10 as a Biomarker for Rheumatoid Arthritis
Authors: Abdulhakim Mervat Mohamed , Ibrahim Soha El-Dessouki , Salama Sherihan Mahdy , Saad Zaghloul Ahmed Saeed
Published: July 2024

Background

CXCL-10 has been detected within sera, synovial fluid, and synovial tissue in patients with RA and identified as a pro-inflammatory chemokine that mediate leukocyte trafficking and modulate innate and adaptive immune responses. It plays a critical role in the inflammatory response and is involved in several biological processes.

Objective

To evaluate the predicative significance of chemokine CXCL10 in rheumatoid arthritis (RA) and to focus on its relation to disease activity.

Patients and Methods

A case control study included 30 patients; were diagnosed with RA, and 30 healthy controls. Clinical examination was done for all patients. Measurement of serum CXCL10 level was done by ELISA, while assessment of disease activity in patients was done using disease activity score (DAS-28). Serum levels of CXCL10 were significantly higher in RA patients than controls.

Results

Serum level of CXCL-10 was ranging from 349–1380 pg/ml with a mean of 784.6 ± 152.2 in RA patients, which was very high level compared to control group the serum level was ranging from 137 – 476.8 pg/ml with a mean of 338.1 ± 125.5. The difference was statistically highly significant (p < 0.001). AUC for CXCL-10 was 0.951 and the 95% CI was ≤ 1. The cutoff point of CXCL-10 was 450 pg/mL were able to differentiate between RA patients and control group. Most of RA patients (70%) were on methotrexate with dose ranged from 12.5–25 mg per week. Thirty-five (58.3%) patients were on steroids with dose 5-20 mg per day. Comparison of CXCL-10 levels in patients with different grades of disease activity had a statistically significant difference between different grades.

Conclusion

Our study supports the critical role of CXCL10 in the RA inflammatory cascade. The correlation of CXCL10 with clinical disease activity suggests that CXCL10 plays a central role in RA inflammation and may serve as a disease activity marker in RA. CXCL10 has a significant role as a biomarker for prediction of RA.
Surgical Management of Painful Digital Neuroma: A Systematic Review
Authors: Zaki Abdelsamie Amany Elsayed , El Barbary Amir Samir , Gad Ahmed Mohamed , Abdelhalim Mohamed Mamdouh
Published: July 2024

Background

Neuromas of the digits can be a mentally and physically disabling condition for patients in this systematic review, the authors discuss a variety of surgical techniques for digital neuroma management.

Aim of the Work

This systematic review aims to analyze and combine the results of relevant studies on surgical treatment for digital neuroma. It aims to determine the overall success of the surgical procedure and identify which techniques are more effective.

Patients and Methods

Four databases, including Embase, Scopus, PubMed, and Google Scholar, were searched for relevant studies. The search spans the years 1990 to 2022. Out of 1490 initial studies, 672 remained after removing duplicates. After screening the Abstracts, 647 were excluded for various reasons, leaving 12 eligible studies for inclusion in the systematic review, which included a total of 309 patients. Outcomes reporting included the visual analogue scale (VAS) to report pain, patient satisfaction, the Semmes-Weinstein Monofilament Test, The two-point discrimination test, a non-standard ordinal scale and the mean follow-up duration.

Results

The studies included neuroma excision, neuroma excision (and implantation into adjacent tissues), centro-central union, proximal relocation, interdigital direct neurorrhaphy, nerve allograft reconstruction, regenerative peripheral interface, dorsal transposition and epineural coaptation, collagen conduits, and muscle-in-vein conduits (MVCs).The results show that a majority of patients achieved pain relief after surgery, with high levels of satisfaction reported in some studies. The most successful surgical approach was not determined since there were no statistically significant differences between the various surgical techniques. However, neuroma excision followed by nerve repair/reconstruction (centro-central union, proximal relocation, direct neurorrhaphy, nerve allograft, regenerative peripheral interface, dorsal transposition and nerve conduit )show magnificent results compared to neuroma excision alone with or without implantation. Factors such as old age, smoking, and high PROMIS Depression scores were found to be independently associated with higher levels of pain interference.

Conclusion

The results suggest that surgical treatment is effective in reducing pain levels, with most patients reporting complete pain relief or improvement. Neuroma excision followed by nerve repair/reconstruction was found to result in better outcomes compared to neuroma excision alone with or without implantation.
Characteristics of Rapid Response Team Calls in a Tertiary Hospital in Egypt
Authors: Hosny Rania , Hussein Rasha Saad , Hakim Sally Adel , Shehad Ihab
Published: July 2024

Background

Rapid Response Teams (RRTs) help in the early recognition of deteriorating patients in hospital wards, and provide the needed management at the bedside by a qualified team.

Aim of the Work

To describe the characteristics of the RRT calls in a tertiary hospital in Egypt.

Patients and Methods

A prospective cohort study for a one-year duration from January 2021 till December, 2021was conducted, during this period a total of 2338 patients were reviewed, and 34 RRT calls were recorded.

Results

Our results showed that 10 calls (63%) of Rapid Response Team calls were in the daytime, and Nurses were the main activators with 27 activations (90%). Modified Early Warning scoring system (MEWS) and Pediatric Early Warning Score (PEWS) used were the main cause of RRT activation with a total of (66.7%), the majority of cases didn’t refer to the Intensive Care Unit (ICU), 19 patients stay in the ward (76%) and 22 cases (100%) were recovered.

Conclusion

More than half of RRT calls were in the daytime, and nurses were the main activators. Most rapid response team activations involve relatively few interventions, patient-activated RRT should consider as a patient right in the future, and further studies showed be conducted to evaluate the best effective methods for applying RRT among different health care facilities.
Comparing the Efficacy of US Guided Pudendal Nerve Block plus Periprostatic Nerve Block versus Periprostatic Nerve Block Alone for Pain Control of Patients During and After Transrectal Biopsy of the Prostate Gland
Authors: Mohamed Eid Mohamed Wael , Abdelwahab Sameh Mohamed , Ibrahim Mohamed Adel
Published: July 2024

Background

Cancer prostate is considered one of the most common cancers among male population. Trans rectal ultrasound (TRUS) guided biopsy has become the main procedure for diagnosing prostate carcinoma, In order to definitively diagnose prostate carcinoma, (TRUS)-guided prostate biopsy is needed.

Aim of the Work

To compare the efficacy, safety of Pudendal nerve block plus periprostatic nerve block with the standard technique (periprostatic nerve block).

Patients and Methods

during a period of 6 months duration A total of 30 patients (group 1 [Pedundal nerve block plus periprostatic nerve block], n = 15; group 2 [periprostatic nerve block], n = 15) were included in the study. all patients were instructed about how to assess pain and discomfort level using a visual analog scale (VAS) from 0 to 10, with an 11-point score (0 = no pain, 10 = intolerable pain).

Results

in our study 30 male patients were divided into 2 groups, group 1 underwent to (PPNB) and group 2 (PPNB + pudendal block). The mean age of the studied group was 58.8 ± 10 years old. All patients hadn’t previous history for prostate surgery nor for rectoanal disease. In our study we evaluated pain scores immediately after the procedure. Regarding the relation between VAS and two studied group, there was an increase in VAS in group 1 more than group 2 along the three sets of follow up with statistical difference between two studied groups in all follow ups as p-Value was <0.05.

Conclusion

our data suggest that combined bilateral pudendal nerve block plus periprostatic nerve block is more effective than periprostatic nerve block alone in reducing the pain during TRUS guided prostate biopsy.
Role of MRI in Assessment of Central Nervous System Lesions and Post Treatment Complications in Pediatric Patents with Leukemia
Authors: Mohamed Hadeer Ramadan , Shawky Geneidi Eman Ahmed , Awadallah Shrouk Mohamed
Published: July 2024

Background

In terms of pediatric oncology, leukemia is one of the most frequent deadly illnesses. Early CNS problem identification and appropriate therapy were enhanced by MRI.

Aim

Describe the MRI results brought on by leukemia's involvement in CNS structures and treatment-related CNS side effects, and evaluate their efficacy for early therapy and preventing long-term adverse effects.

Patients and Methods

A prospective observational study included 52 children with leukemia. All patients undergone MR examination including conventional MRI, MR diffusion imaging and MR venography (MRV).

Results

Regarding MRI finding of CNS, leukemic infiltration was found in 57.7%, sub volimic changes in mild manner in 50% and about 26% in a moderate manner while absent in 23.1%, PRES was present in 19.2%, venous thrombosis present in 30.8% and post treatment complications were found in 7.7%.

Conclusion

Diffusion-weighted MRI proved very helpful in the early diagnosis and distinction of various CNS lesions seen in young patients with leukemia and post-treatment CNS sequelae. These techniques included conventional, post- contrast, MR venography, and diffusion-weighted MRI.
Role of Bowel Hydrosonography in Evaluation of Inflammatory Bowel Diseases Compared to CT or MR Enterography
Authors: Allam Khaled Esmat , Elia Remon Zaher , Ahmed Fouad Mohamed Hassan , Abd El Hafiz Rezk Essam Mohamed , El Aleem Mohamed Aya Tareaa Abd
Published: July 2024

Background

bowel diseases (IBD). CT entrography (CTE), bowel US, magnetic resonance enterography Crohn’s disease and ulcerative colitis are chronic, relapsing inflammatory (MRE) are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications. They assess the degree of activity, help clinicians to identify patients in need of surgery, and can be used for patient follow-up.

Aim

To evaluate the utility of small bowel hydrosonography (SBH) in assessment if patient s with proven IBD in comparison to the currently available CT/MR enterographic techniques.

Methods

The study was conducted on 41 patients with histologically proven IBD. All patients were subjected to clinical assessment, laboratory investigations, MRE/CTE then bowel ultrasound.

Results

This study was conducted on 41 patients (19.5%) with ulcerative colitis and (80.5 %) with Crohn's disease; Terminal illeum is the most affected detected segment (22.1%) by bowel ultrasound and(22.5%) by CTE/MRE, ultrasound also showed statistically significance results in detection evidence of complicated Crohn’s disease such as fistula and abscess.

Conclusion

In comparison to MRE/CTE, bowel hydrosonography is a useful, non- invasive, and feasible bedside imaging tool for the detection of inflammation, detection of complications, and follow-up of IBD patients.
Role of Endovascular Thrombectomy in Improving the Functional Outcome in Acute Stroke Patients Presenting 6-12 Hours after Stroke Onset
Authors: Elmahdy Abdalla Ramez Nader Mohamed , Guirguis Mounir Sobhy , Andsari Sameer A , Abdelsamad Amr Mahmoud , Soliman Ahmed Hassan
Published: July 2024

Background

Based on the World Health Organization (WHO) statistics, there are 15 million strokes annually. The aim of the treatment in acute ischemic stroke is rapid restoration of perfusion to the ischemic area by minimizing the time between the occurrence of symptoms and the treatment. This is crucial for saving the salvageable brain tissue (penumbra) by restoration of flow and metabolism to normal

Aim of Work

The aim of work is to evaluate the safety and efficacy of endovascular thrombectomy (EVT) in patients presenting 6-12 hours from onset of stroke symptoms secondary to large vessel occlusion.

Patients and Methods

50 Patients presenting with acute ischemic stroke with causative occlusion of major vessels in anterior circulation, underwent mechanical thrombectomy

Results

Two-thirds of the patients had their intracranial arterial occlusion at M1 segment of the middle cerebral artery. The median baseline NIHSS score, ASPECTS, and mRS score of the studied patients was 16 (IQR 11-20), 8 (IQR 7-9) and 0 (IQR 0-1), respectively. The median final infarct volume, NIHSS score, ASPECTS post-intervention and mRS score at 90 days of the studied patients was 40 ml (IQR 26.5-70) (P < 0.001), 9 (IQR 4-16) (P < 0.001), 8(IQR 5-9) (P < 0.01), and 2 (IQR1-4) (P < 0.001), respectively and (90 %) of them had revascularization type TICI 2b- 3. More than half of the studied patients (52%) had mRS score at 90 days of ≤ 2 and mortality rate was 12%.

Conclusions

The current study showed that endovascular thrombectomy techniques are safe and effective in the treatment of acute ischemic stroke.
Detection of Breast Cancer in Digital Mammograms by Using Artificial Intelligence
Authors: Hasan Ali Alshazly Hasan Hosameldeen , Guirguis Mounir Sobhy , Elshimy Ahmed Mohamed
Published: July 2024

Background

Daily reading of a large number of normal mammograms ni breast cancer screening programs is a tedious task reducing the attractiveness of the field. The advent of Artificial Intelligence (AI) in medical imaging could, however, provide means to improve the efficiency of mammography screening.

Objective

Our study aims to emphasize the role of AI system as an aid in detection of breast cancer in digital mammograms.

Patients and Methods

The main source of data for this study were the mammography studies on the picture archiving and communications system (PACS) of theradiology department, i n Shams university hospitals of the patients referred to the radiology department at Ain Shams university hospitals for screening mammography.

Results

Our study showed that the improvement in diagnosticperformance and reading times with AI support was observed for the radiologists who were least experienced with mammography while the Al is increased the reading times and had no effect on diagnostic performance on the more experienced radiologists.

Conclusion

Using the AI as an aid has proven to improve the overall performance of less experienced radiologists allowing them to reach expert like levels of diagnostic performance in the detection of breast cancer at mammography by using an AI computer system for support without the need for additional reading time.
Prevalence of Antiphospholipid Syndrome in Primary Budd Chiari patients and their intervention outcome
Authors: Sayed Farag Mahmoud Ahmed , Elsalam El-Folly Runia Fouad Abd , Hafez Eman Ahmed , Abo Elmaaty Mohamed El-Ghareeb , Fathy Badran Ethar Mokhtar
Published: July 2024

Background

Budd-Chiari syndrome (BCS) is a rare but potentially life threatening hepatic disorder that results from obstruction of the hepatic venous outflow tract. Obstruction can occur at any level from the hepatic venules to the right atrium. According to the etiology, BCS can be classified as primary (due to intrinsic intraluminal thrombosis or webs) or secondary (due to intraluminal invasion by a parasite or malignant tumor or extraluminal compression by an abscess, cyst or solid tumor) the clinical presentation of BCS has a wide spectrum and ranges from asymptomatic cases to fulminant hepatic failure The classic triad of abdominal pain, ascites, and hepatomegaly is nonspecific.

Aim of the Work

To assess the prevelance of Antiphospholipid syndrome (APS) in primary Budd Chiari syndrome (BCS) patients and their management outcome.

Patients and Methods

Patients presented to BCS outpatient clinic, Tropical medicine department, Ain Shams University Hospitals were enrolled in the study from 2005 to 2020. Some patients with APS have no evidence of any definable associated disease, while, in other patients, APS occurs in association with SLE or another rheumatic or autoimmune disorder. Traditionally, these have been referred to as primary or secondary APS, respectively.

Results

Regarding laboratory data, Lupus Anticoagulant, ACL IgG antibodies and ACL IgM antibodies were positive in 60 (83.3%), 49 (68.1%) and 27 (37.5%) patients respectively. For 42 patients (58.3%), intervention was performed. TIPSS was performed on 33 (45.8%) patients, while Angioplasty with Stent was performed on 9 (12.5%) patients. There was no intervention in 30 (41.7%) of the patients. In the studied patients, rate of mortality of the total 72 patients was 48.6%. The mean cause of death was Hepatorenal syndrome (31.4%).

Conclusion

BCS, although infrequent, is not a rare complication in patients with APS and may be the first clinical manifestation of this syndrome. However, no predisposing factor to BCS has been identified in patients with APS. This supports the need for systematic screening for LA and aCL in all cases of hepatic vein thrombosis. In these patients, TIPS placement may be an effective treatment for portal hypertension, but in any case, long-term high intensity anticoagulation treatment is essential in order to prevent recurrent thrombosis. Lupus anticoagulant is much more common than anticardiolipin antibodies (83.3%, 68.1% respectively) among BCS patients due to antiphospholipid syndrome.
Residual Stone Fragments after Percutaneous Nephrolithotomy: Shockwave Lithotripsy vs Retrograde Intrarenal Surgery
Authors: Shoeb Mohamed Shoukry , Radwan Ahmed Ibrahim , Atia Moustafa Diaa Eldin Mahmoud
Published: July 2024

Background

Post-PCNL treatment for 0.5-1.5 cm calculi is contentious. SWL has noninvasiveness, less anaesthetic, and improved subjective acceptability, but a lower stone-free rate and higher retreatment rate (RR). Retrograde intrarenal surgery (RIRS) is increasingly employed to treat after PCNL residual calculi with a greater success rate (SR), but with disadvantages of invasiveness and anaesthesia.

Aim

To compare the outcomes of retrograde intrarenal surgery (RIRS) to extracorporeal shockwave lithotripsy (SWL) for treating patients with RSFs after a previous standard PCNL.

Subject and Methods

A retrospective study of 70 adult patients with residual stone fragments after a standard PCNL submitted to RIRS or SWL (35 patients per each group) in ain shams university hospitals and police hospitals.

Results

There no significant difference between the groups regarding ASA, PCNL Guy’s classification, percutaneous tracts, stone composition and postoperative complications. There a significant difference between the groups regarding inferior calyx located stone and postoperative hospital stay. >2 mm stones were significantly more frequent in SWL group compared to RIRS group.

Conclusion

From the findings of this study we can conclude that RIRS has better SFR for the treatment of RSFs after standard PCNL
Prognostic Ability of the Wound, Ischemia, Foot Infection (WIfI) Classification System in Diabetic Patients with Non-Healing Ulcer
Authors: Helmy Hanna Andrew Samy , Kamal Ashraf , Almegeed Mohammed Abd , Gamil Mina
Published: July 2024

Objectives

Several classifications have been published to predict limb salvage in diabetic patients with non-healing ulcer to aid in the management plan. The Society for Vascular Surgery (SVS) Lower Extremity Guidelines Committee has composed a new classification system that reflects the three major factors that impact amputation risk and clinical management Our goal was to evaluate the predictive ability of this wound, ischemia and foot infection(WIfI) classification as a predictor of limb salvage in diabetic patients with non-healing ulcer

Methods

a prospective single arm observational cohort study conducted on 50 patients within 2022 at single center, Ain Shams University Hospitals, Patients are diabetics who had non healing ulcers some of the cases underwent angioplasty or debridement, then follow up of the wounds was done. Limbs were stratified into clinical stages 1 to 4 based on the SVS WIfI classification for amputation risk.

Results

Our study included 38 males (76%) and 12 females (24%). The age range between 35 years and 73 years with mean age of 59±8.81. All of the patients are diabetic. The percentage of patients with hypertensive ( 76 %), 54% of them were smoker & 7 were suffering from ESRD. limb salvage was achieved on 75 % of cases. All cases have been classified according to WIFI classification into clinical stages I-IV and their percentage were 6%,12%,40% and 42% respectively. WIfI classification was significant in predicting the major or minor amputation as well as ulcer healing. As Major amputation among each WIfI classification group low, moderate and high risk was 0%, 10%, 47% respectively. Risk of minor amputation was 22%, 40% and 76% respectively. While ulcer healing was 100%, 85% and 52% respectively.

Conclusion

The likelihood of an amputation after one year in patients with non healing ulcer increases with higher WIfI stages, so The WIfI classification is applicable in prediction of limb salvage in diabetic patients with non-healing ulcer. Smoking and aging also decreases the chance of limb salvageability
Students’ ways of using video lectures in a linear algebra course
Authors: Feudel Frank , Panse Anja
Published: July 2024

Video lectures have become a common element in many university mathematics courses, and students often believe that these support their learning in various ways. However, some studies indicate that students who use such video lectures frequently perform lower in exams. Hence, it is important to investigate how students use video lectures. We interviewed nine students of a linear algebra course about the activities they carried out when watching prerecorded video lectures. In these interviews, all our participants reported in detail lots of activities they engaged in while watching, and our study contextualizes these activities with content-specific examples. However, our study also indicates that even if students are very active while watching video lectures, their cognitive engagement with the actual content might nevertheless be rather low. Possible consequences concerning the implementation of video lectures are then discussed.
Scutellarin alleviates renal ischemia–reperfusion injury by inhibiting the MAPK pathway and pro‐inflammatory macrophage polarization
Authors: Deng Ge , Zheng Bingxuan , Dou Meng , Gao Yang , Zhang Xingzhe , Niu Zejiaxin , Wei Tian , Han Feng , Ding Chenguang , Tian Puxun
Published: July 2024

Renal ischemia–reperfusion injury (IRI) is an integral process in renal transplantation, which results in compromised graft survival. Macrophages play an important role in both the early inflammatory period and late fibrotic period in response to IRI. In this study, we investigated whether scutellarin (SCU) could protect against renal IRI by regulating macrophage polarization. Mice were given SCU (5–50 mg/kg) by gavage 1 h earlier, followed by a unilateral renal IRI. Renal function and pathological injury were assessed 24 h after reperfusion. The results showed that administration of 50 mg/kg SCU significantly improved renal function and renal pathology in IRI mice. In addition, SCU alleviated IRI‐induced apoptosis. Meanwhile, it reduced macrophage infiltration and inhibited pro‐inflammatory macrophage polarization. Moreover, in RAW 264.7 cells and primary bone marrow‐derived macrophages (BMDMs) exposed to SCU, we found that 150 μM SCU inhibited these cells to polarize to an inflammatory phenotype induced by lipopolysaccharide (LPS) and interferon‐γ (IFN‐γ). However, SCU has no influence on anti‐inflammatory macrophage polarization in vivo and in vitro induced by in interleukin‐4 (IL‐4). Finally, we explored the effect of SCU on the activation of the mitogen‐activated protein kinase (MAPK) pathway both in vivo and in vitro. We found that SCU suppressed the activation of the MAPK pathway, including the extracellular signal‐regulated kinase (ERK), Jun N‐terminal kinase (JNK), and p38. Our results demonstrated that SCU protects the kidney against IRI by inhibiting macrophage infiltration and polarization toward pro‐inflammatory phenotype via the MAPK pathway, suggesting that SCU may be therapeutically important in treatment of IRI.
Cryptic late‐onset myocarditis after coronavirus vaccination
Authors: Forsdyke Donald R.
Published: July 2024

As we enter a new era of mRNA‐based therapeutics, evidence on genetic or environmental factors that might predispose to unknown off‐target side effects, gains in importance. Among these factors, exercise appears likely to have influenced otherwise cryptic cases of early‐onset postvaccination myocarditis. And the existence of a distinct late‐onset myocarditis is now being recognized. Here, three case‐history reports suggest crypticity (the author's own case), unless provoked by a preexisting cardiac morbidity (one case), or by immune checkpoint blockade to enhance anticancer autoimmunity (several cases). These reports are supported by noninvasive fluorodeoxyglucose‐based cardiac scan comparisons of multiple vaccinated and unvaccinated subjects. In pre‐pandemic decades, applications for funds by the leading innovator in mRNA‐based therapeutics seldom gained peer‐review approval. Thus, at the start of the pandemic, the meager data on such side effects could justify only emergency approval. We must do better.
Does Marijuana Smoking Increase the Odds of Surgical Site Infection After Orthopaedic Surgery? A Retrospective Cohort Study
Authors: Ruckle David , Chang Alexander , Jesurajan Jose , Carlson Bradley , Gulbrandsen Matthew , Rice R. Casey , Wongworawat M. Daniel
Published: July 2024

OBJECTIVES:

Does marijuana smoking increase the risk of surgical site infection (SSI) after open reduction and internal fixation of fractures?

METHODS:

Design:

Retrospective.

Setting:

Single academic level 1 trauma center in Southern California.

Patient Selection Criteria:

Adult patients who underwent open treatment for closed fractures between January 2009 and December 2021, had hardware placed, and had at least 6 months of postoperative follow-up.

Outcome Measures and Comparisons:

Risk factors associated with the development of SSI were compared between current inhalational marijuana users and nonmarijuana users.

RESULTS:

Complete data were available on 4802 patients after exclusion of 82 who did not have a complete variable set. At the time of surgery, 24% (1133 patients) were current users of marijuana. At the final follow-up (minimum 6 months), there was a 1.6% infection rate (75 patients). The average age of the infection-free group was 46.1 ± 23.1 years, and the average age of the SSI group was 47.0 ± 20.3 (P = 0.73) years. In total, 2703 patients (57%) in the infection-free group were male compared with 48 (64%) in the SSI group (P = 0.49). On multivariate analysis, longer operative times (OR 1.002 [95% CI, 1.001–1.004]), diabetic status (OR 2.084 [95% CI, 1.225–3.547]), and current tobacco use (OR 2.493 [95% CI, 1.514–4.106]) (P < 0.01 for all) were associated with an increased risk of SSI; however, current marijuana use was not (OR 0.678 [95% CI, 0.228–2.013], P = 0.48).

CONCLUSIONS:

Tobacco use, diabetes, and longer operative times were associated with the development of SSI after open reduction and internal fixation of fractures; however, marijuana smoking was not shown to be associated with the development of SSI.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Actual Cost of Extracorporeal Cardiopulmonary Resuscitation: A Time-Driven Activity-Based Costing Study
Authors: Nanjayya Vinodh B. , Higgins Alisa M. , Morphett Laura , Thiara Sonny , Jones Annalie , Pellegrino Vincent A. , Sheldrake Jayne , Bernard Stephen , Kaye David , Nichol Alistair , Cooper D. James
Published: July 2024

OBJECTIVES:

To determine the actual cost and drivers of the cost of an extracorporeal cardiopulmonary resuscitation (E-CPR) care cycle.

PERSPECTIVE:

A time-driven activity-based costing study conducted from a healthcare provider perspective.

SETTING:

A quaternary care ICU providing around-the-clock E-CPR service for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in Australia.

METHODS:

The E-CPR care cycle was defined as the time from initiating E-CPR to hospital discharge or death of the patient. Detailed process maps with discrete steps and probabilistic decision nodes accounting for the complex trajectories of E-CPR patients were developed. Data about clinical and nonclinical resources and timing of activities was collected multiple times for each process . Total direct costs were calculated using the time estimates and unit costs per resource for all clinical and nonclinical resources. The total direct costs were combined with indirect costs to obtain the total cost of E-CPR.

RESULTS:

From 10 E-CPR care cycles observed during the study period, a minimum of 3 observations were obtained per process. The E-CPR care cycle’s mean (95% CI) cost was $75,014 ($66,209–83,222). Initiation of extracorporeal membrane oxygenation (ECMO) and ECMO management constituted 18% of costs. The ICU management (35%) and surgical costs (20%) were the primary cost determinants. IHCA had a higher mean (95% CI) cost than OHCA ($87,940 [75,372–100,570] vs. 62,595 [53,994–71,890], p < 0.01), mainly because of the increased survival and ICU length of stay of patients with IHCA. The mean cost for each E-CPR survivor was $129,503 ($112,422–147,224).

CONCLUSIONS:

Significant costs are associated with E-CPR for refractory cardiac arrest. The cost of E-CPR for IHCA was higher compared with the cost of E-CPR for OHCA. The major determinants of the E-CPR costs were ICU and surgical costs. These data can inform the cost-effectiveness analysis of E-CPR in the future.
Beyond Mastectomy: The Incidence of Subsequent Aesthetic Procedures after Mastectomy with and without Breast Reconstruction
Authors: O’Neill Elizabeth S. , Toms John A. , Hansdorfer Marek A. , Kokosis George
Published: July 2024

Background:

Mastectomy poses significant challenges to a woman’s body image and psychological well-being, and breast reconstruction plays a pivotal role in postoperative quality of life. Following breast reconstruction, many patients choose to have subsequent aesthetic procedures. Data on the prevalence of such subsequent aesthetic interventions are lacking in the literature. The aim of this study was to analyze trends in aesthetic procedures in patients following mastectomy with and without breast reconstruction.

Methods:

The PearlDiver database was queried within its capabilities for patients who underwent mastectomy with and without breast reconstruction, and a variety of aesthetic procedures after mastectomy. Aesthetic procedure rates were compared between cohorts.

Results:

We identified 365,525 mastectomy patients: 282,815 without reconstruction and 82,710 with reconstruction. In total, 609 patients with reconstruction and 329 without underwent subsequent aesthetic procedures. The rate of aesthetic procedures was higher in the reconstruction group (0.7%) compared with the nonreconstruction group (0.1%; P < 0.001).

Conclusions:

Patients who chose to have breast reconstruction after mastectomy underwent significantly more subsequent aesthetic procedures compared with those who chose mastectomy alone. Our findings provide insights on the prevalence of aesthetic procedures in postmastectomy patients, highlighting the potentially longitudinal nature of the reconstructive and aesthetic journey beyond the index oncologic procedure. Further research is needed to address motivations for such procedures as well as patient-reported outcomes and satisfaction.
Outcomes of Biodegradable Temporizing Matrix for Soft Tissue Reconstruction of the Hand and Extremities
Authors: Struble Sarah L. , Patel Niki K. , Graham Emily M. , Tipps John A. , Vaile John R. , Leeflang Elisabeth J. , Goodwin Isak , Mendenhall Shaun D.
Published: July 2024

Background:

NovoSorb biodegradable temporizing matrix (BTM) is a novel, bilayer, synthetic skin substitute made of biodegradable polyurethane foam covered with a sealing membrane. BTM has demonstrated excellent outcomes in burn literature; however, few studies have been published for hand and extremity soft tissue reconstruction.

Methods:

All patients who underwent extremity reconstruction with BTM from 2018 to 2023 were reviewed. Demographics, presentations, and clinical outcomes were recorded.

Results:

A total of 86 cases from 54 patients (53.7% pediatric; age range: 0–81 years) were included. Common indications included trauma (36%), infection (18.6%), and malignancy (11.6%). BTM was placed over exposed tendon (38.4%), bone (19%), joints (12.8%), nerves (8.1%), and/or blood vessels (7%). BTM served as temporary wound coverage in 26 cases. Complications included hematoma (8.1%), infection (4.7%), and spontaneous delamination (4.7%). Wound closure was successfully obtained without flap use in 93.3%. Poor BTM take was associated with peripheral vascular disease, hypertension, immunosuppression, and BTM hematoma and infection (<0.05).

Conclusion:

This study contributes to the growing body of evidence favoring BTM use in challenging reconstructive cases. Although prospective comparative studies are forthcoming, BTM likely has broad applications in reconstructive surgery.