bluuebunny/crossref_metadata_2025 huggingface dataset:
Open Reduction and Internal Fixation Using Plate and Screws Versus Percutaneous Kirschner Wires Fixation for Second and Third Metacarpal Bones Fractures: A Meta-analysis
Authors: Masoud Karim Samir , El Sherif Ahmad Fathi , Tallal Raghda Elsayed , Mohamed Waly Mahmoud Mahrous
Published: October 2021

Background

Metacarpal fractures are among the most common fractures of the skeletal system and account for 36 % of hand and wrist fractures.

Aim of the Work

To determine the functional outcome and postoperative complications for both these surgical techniques in the treatment of second and third metacarpal bones fractures.

Patients and Methods

The systematic review was restricted to clinical studies of both these surgical techniques in the treatment of closed second and third metacarpal fractures. We reviewed studies that include management of metacarpal fractures with open reduction and internal fixation using plate and screws versus percutaneous crossed Kirschner wires fixation.

Results

No specification was made about the type of fracture, other than shaft fractures located in the second and the third metacarpal. All fractures were operated because of instability, angulations’ or rotational deformity. No comparison can therefore be made between fracture type (i.e. spiral, oblique) and functional results. As all studies reported identical indication for surgical fixation a comparison between type of fixation and functional result can be made.

Conclusion

Based on the reported results there is no evidence to suggest one fixation technique over another. The reported complications however for ORIF and K-wire fixation in the treatment of metacarpal fractures are unmistakably different for the two types of fixation.
Spectrum of 18F-FDG PET/CT extranodal findings in lymphoma
Authors: Hussein Ahmed Mohamed , Kamel Omar Farouk , Lotfy Abeer Gamal
Published: October 2021

Background

Extranodal lymphoma can be the primary presentation or secondary to systemic involvement of lymphoma. Positron emission tomography with computer tomography (FDG-PET/CT) is useful in detecting extranodal sites during staging, treatment response assessment or recurrence detection in patients with lymphoma.

Objective

To demonstrate the PET/CT imaging appearances of extranodal lymphoma.

Methods

A descriptive retrospective study, conducted at Ain Shams University hospitals on 40 Patients with different types of lymphoma enrolled in this study over a period of six months starting from December 2018 to May 2019 at Ain shams university hospitals.

Results

The 40 patients involved in this study showed 58 extranodal lesions in 19 different extra-lymphatic sites, where the most frequently impacted sites were bone and bone marrow (20.7%) while supraglottic larynx, oesophagus and para vertebral sites are the least affected (1.7% each).

Conclusion

Knowledge of the imaging appearances of extranodal lymphoma can aid in the differential diagnosis of mass lesions encountered in tissues throughout the body on PET/CT.
Role of diffusion-weighted MR imaging in differentiation between malignant and benign portal vein thrombosis in patients with Hepatocellular carcinoma
Authors: Hussien Ahmed Mohamed , El Sayed Allam Allam , Moharram Amr Mohamed Kamal
Published: October 2021

Background

Differentiation between malignant and bland thrombus of the portal vein in patients who have HCC using diffusion weighted MR imaging.

Objective

To determine the role of DW imaging in differentiating between the benign and malignant portal vein thrombosis in patient with HCC.

Patients and Methods

This is a retrospective study done in ain-shams hospitals and private centers. This is a retrospective study done in Ain-Shams Hospitals and private centers. We studied 20 cases, 13 males and 7 females with total mean age 59.5.

Results

Our study had some limitations. First, we did not use pathologic findings as our reference standard for characterizing the thrombi; instead, we have used accepted imaging criteria as a reference standard. In our study, we used oval ROI placement and although we avoided averaging ADC of the thrombus with the surrounding structures “by enlarging the images and placing the ROI within the thrombus “, we cannot completely exclude that some averaging could have occurred in the smallest thrombi.

Conclusion

In addition to the initial diagnosis of the PVT nature, subsequent contrast-enhanced MRI is actually necessary to evaluate further treatment response in daily routine. But the administration of I.V. contrast agent is problematic especially in patients with renal insufficiency. Therefore, DWI technique can be utilized in adjunction with routine MRI protocols to determine the nature of PVTs by the calculation of ADCs values.
Sonographic and Duplex Evaluation of Synovial activity in Wrist and Hand Joints in Rheumatoid Arthritis
Authors: Ibrahim Ekhlas Hassan , Allam Khaled Esmat , Hassan Rasha Mohammed , Bassiouny Ahmed Mohamed
Published: October 2021

Background

Rheumatoid arthritis is a long-term autoimmune disease and inflammatory disorder. The damaging effect on cartilage, bone, ligaments, and tendons has raised the importance of the accurate diagnosis of structural damage, disease activity and severity assessment to enable therapeutic decisions and to evaluate disease outcome. US is non invasive, relatively cheap and widely accessible imaging tool that facilitates the detection of synovitis joint effusin and erosions more better than clinical, laboratory investigations alone and x-ray.

Aim of the Work

assess the role of of gray-scale and Doppler ultrasound early detection and characterization of synovitis and structural bone changes in wrist and hand joints in patients with Rheumatoid Arthritis by comparing qualitative and quantitative US parameters with clinical and laboratory indicators of disease activity.

Patients and Methods

A cross sectional study conducted onthirty five adult patients with RA . All the patients were diagnosed according to the 2010 ACR/European League . The patients were recruited from the Rheumatology and Rehabilitation Outpatient Clinic, Faculty of Medicine, Ain Shams Hospitals .The study was approved by the ethical committee, and consents were taken from all patients enrolled in the study. Patients assessed by history taking, Clinical examination, Laboratory investigations and US gray scale and US power Doppler was done for each patient.

Results

This study included 35 patients with established RA, 27 females (77.1%) and 8 males (22.9%). Ranged in age between 20-70 years with mean age [45.66±12.76],the mean CDAS28 was [4.62±1.37], ESR [44.93±20.79], CRP [15.92±9.03], 33 patients (94.3%) were found to have synovial thickening, 14 patient (40%) were found to have increased vascularity by PD, joint effusion was detected in 12 patient (34.3%) particularly in MCP joints, 13 (37.1%) had bone erosion and only 9 patients (25.7%) had Tenosynovitis, most of them were detected at the extensor compartment of the wrist joint.positive correlations found between the clinical disease activity indices, laboratory investigations, duration of illness and components of the US findings.

Conclusion

Ultrasound is non invasive, relatively cheap and widely accessible imaging tool that facilitates the detection of synovitis and erosions,, high resolution gray scale images combined with Doppler technique have made it possible to detect slow low volume blood flow, thus improving the outcome of the standard clinical assessment in Rheumatoid synovial inflammation.
Role of High Resolution Ultrasound and Magnetic Resonance Imaging in Traumatic Soft Tissue Injuries of the Wrist and Hand
Authors: Guirguis Mounir Sobhy , Sakr Hossam Moussa , Atiyya Ahmed Naeem , Mohammad Shaimaa Abdelsattar , Mostafa Ghada Yahia Hassanien
Published: October 2021

Aim of the Work

To assess the role of ultrasound in the diagnosis of traumatic soft tissue injuries of hand and wrist.

Patients and Method

This study includes 30 patients with a mean age of 42.17 years ±9, all with history of traumatic soft tissue injuries in hand and wrist, all patients underwent ultrasound and MRI. The U/S&MRI diagnostic criteria of each patient were analyzed, compared and correlated with clinical diagnosis/ or operative findings .

Results

A comparison of the sensitivity of US versus MRI was done by correlating the final diagnosis of each modality with clinical diagnosis and/or operative findings. In general as regard all types of soft tissue injuries we found that, in correlation with clinical diagnosis US gives (93.3% sensitivity), while MRI gives (73.3% sensitivity). US & MRI result shows agreement in detection of all types of post traumatic soft tissue injuries except in chronic tendinopathy, tendon fibrosis ,and chronic tendon tear heals by fibrosis we found no agreement between them (in which ultrasound can diagnose them, while MRI couldn’t detect them).

Conclusion

Ultrasound shows higher sensitivity in diagnosis of soft tissue injuries of hand and wrist than MRI, as compared to operative findings and /or clinical data.
Role of pet/ct in detection of tumor of unknown origin
Authors: Elsayed Khadija R , Allam Khaled E , Kamel Omar F , Soliman Ahmed H , Elsayed Huda F
Published: October 2021

Purpose

To evaluate the role of combined positron emission tomography and computed tomography (PET/CT) imaging in the detection of tumors of unknown origin.

Methods

This study included 20 cases presented with pathologically proved metastases of unknown primary or with clinic-radiological suspicion of metastases with unknown primary.

Results

The number of patients with true positive primary tumor sites was 14 (70%), 2 patients with false-positive results (10%), 2 patients with true negative results (10%) and 2 patients with false-negative results (10%). A sensitivity of 87.5% was achieved, with a specificity of 50% and a total accuracy of 80%. The Positive predictive value was 87.5%%, while the negative predictive value was 50%. The detection rate of the origin of the primary tumor was 70%.

Conclusion

whole-body FDG-PET/CT has to be considered a useful tool in evaluating metastases from UPT, allowing identification of primary tumors and modifying the stage of the disease and affect the management.
Role of MRI in Cerebral Venous Thrombosis
Authors: Geneidi Eman Ahmad Shawki , Keriakos Nermeen Nasry , Khaled Khaled Mostafa Mohammad
Published: October 2021

Background

Cerebral venous thrombosis CVT is a type of stroke where the thrombosis occurs in the venous side of the brain circulation, leading to occlusion of one or more cerebral veins and Dural venous sinus. CVT is a potentially life-threatening disease, accounting for approximately 0.5 % of stroke cases.

Aim of the Work

The aim of this subject is to illustrate the various aspects of CVT on MRI.

Patients and Methods

This is a retrospective study included 30 patients (19 females &11 males), their ages range from 3 months to 74 years with the median age 22 years. Mean age 22.04 years. The study was performed in radiology department El Demerdash Hospital between March 2018 & September 2019. The study included patients presented to the Medical Imaging Department of Ain Shams university Al-Demerdash hospital with cerebral venous occlusion neurological symptoms or imaging diagnosis.

Results

In our study,. Most common presenting symptom was headache noted in 22 patients (73.3%) followed by eye manifestations (blurring of vision or clinically having papilledema) was the second most seen in 18 patients (60%). Then comes convulsions in8 patients (26.7 %), Limb weakness in 5 patients (16.7%), finally disturbed consciousness level in 4 patients (13.3%). Most common mode of onset was subacute which was seen in 16 patients (53.3%) acute onset was seen in 6 patients (20%) as predominantly isointense on T1 weighted images and hypo intense on T2 weighted images, chronic onset was seen in 8 patients (26.7%) as hypo intense signal in both T1 and T2 WIs. MRV successfully diagnosed occlusion in most cases by absence of signal intensity with consequent non-visualization of occluded sinuses or veins in almost all patients and except 3 patients; those were having just cortical veins thrombosis detected by T2* sequence electing blooming artifacts with intact sinuses, and dilated distal collaterals seen in 18 patients.

Conclusion

Dural venous occlusion can occur due to many factors as thrombosis, inflammatory conditions of the brain and tumors. Cerebral venous thrombosis (CVT) has long been a neglected entity because of complexities in diagnosis and non-specific clinical presentation. Conventional MRI and phase contrast MRV in conjugation with recent techniques such SWI & DWI were considered more accurate diagnostic tool, non invasive, non ionizing, with high resolution in evaluating patients with suspected cerebral venous occlusion or thrombosis. It is also considered very useful to demonstrate brain parenchymal affection, the age or stage of the thrombus and its extension
The Diagnostic Value of Normalized ADC Using Spleen As A Reference Organ In Assessment Of Liver Fibrosis
Authors: Kamal Omina Ahmed , Ahmed Aya Yassin , Ali Mona Mohamed , Mostafa Mai Ahmed
Published: October 2021

Objectives

To investigate the value of liver ADC normalization using spleen as a reference organ in liver fibrosis assessment, in comparison with transient elastography (Fibroscan).

Materials and methods

A total of 60 participants were included,30 HCV positive patients and 30 in the control group. We calculated mean Spleen apparent diffusion coefficient (ADC), liver mean ADC and normalized liver ADC (defined as the ratio of Liver ADC to spleen ADC) which were compared between cirrhotic patients and the control group. Data was analyzed and ROC was used to evaluate the performance of nADC.

Results

No significant difference between spleen ADC values of patient group and control group or in-between different fibrosis stages. A significant negative linear correlation between control and patient groups using ADC (r = -0.900; p = 0.0374) or nADC(r=-1:p<0,001).We also found that the mean liver ADC and nADC value in patients with hepatic fibrosis was significantly lower than that of volunteers (1.53 × 10 − 3 mm2/s vs.1.65 × 10 − 3 mm2/s, p = 0.001 &1.). Liver ADC only could distinguish F0 from F4. After analysis with ROC, there was a statistically significant difference between area under the receiver operating characteristic curve (AUC) of normalized liver ADC and ADC for all groups except for F4 stage. nADC AUC was 0.878 for detection of stage ≥ F2 with sensitivity and specificity of 87% & 80% respectively while ADC AUC was 0.548 with sensitivity and specificity of 62 % & 72% respectively(p = 0.021), ≥ F3 AUC of nADC was0.891 with sensitivity and specificity of 88.7 % & 80% respectively while ADC AUC is 0.603 with sensitivity and specificity of 72% & 72% respectively(p = 0.03), and F4 stage nADC AUC was0.879 for with sensitivity and specificity of 90% & 80% respectively ,while ADC AUC was 0.648 with sensitivity and specificity of 80 % & 72% respectively(p = 0.054)

Conclusion

Normalized liver ADC using the spleen as a reference organ increases the diagnostic performance of MRI in evaluation of liver fibrosis in comparison to ADC alone.
Role of susceptibility weighted imaging (SWI) in assessment of intra axial brain neoplasms in adults
Authors: Abo-Elhoda Pasant Mohamed Abo-Elhoda Darwish Mohamed , Mansour Hesham Mahmoud Ahmed , Abdullah Yosra Abdelzaher , Darwish Eman Ahmed Fouad
Published: October 2021

Background

Susceptibility weighted imaging (SWI) is a 3D gradient-echo MR technique that is based on blood oxygen level dependent (BOLD) induced phase effects between the venous blood and the surrounding brain parenchyma. SW-MR imaging allows for noninvasive visualization of small veins at submillimeter resolution and, therefore, is used to depict venous architecture in brain lesions. The extreme sensitivity of SWI for the detection of neovascularity (venous blood), haemorrhage, and calcification has been an indispensable tool for characterization of the internal architecture of brain tumours.

Objectives

Is to evaluate the role of Susceptibility weighted imaging in assessment of adults Intra axial brain Neoplasms, and its ability to characterize them into high and low grade lesions in comparison to histopathology which will be used as gold standard.

Methods

A cross sectional study including 31 patients suspecting intracranial brain neoplasm radiologically and clinically, conducted at Private center, the patients were investigated using Siemens machine Magnetom Skyra 3T, the period was between January 2018 till the end of June 2019 .

Results

Our study included 31 patients. Including 15 female and 16 male patients, with the patient’s age ranging from 20 to 68 years old with median 48 years old ranging from 35.75 (25% percentile) to 58.75 (75% percentile).

Among total cases, there were 8 patients with grade 2 glioma, 10 patients with grade 3 glioma and 6 patients with grade 4 glioma, 2 patients with lymphoma and 5 patients with brain metastasis (1 lung cancer and 4 breast cancer). All the patients were evaluated with MRI including SWI sequence with special comment on the number of the intratumoral susceptibility signal (ITSS), the size of the ITSS, its morphology as well as the ratio of the ITSS to the tumor size, which were then correlated with the patient histopathological results obtained later. The study revealed that the best parameter to accurately grade the tumor is the number of ITSS within the lesion with P value 0.001, followed by the size of the ITSS with P value 0.002 and Pearson Chi-Square value equals 20.6, while the lowest one was the ratio of the ITSS to the tumor size with P value 0.002 Pearson Chi-Square value equals 17.3. Our study showed that the morphology alone was not able to accurately grade the tumor with P value 0.007 ( Not significant)

Conclusion

SWI using 3T MR system provides quite useful information for preoperative tumor grading. There seems to be a strong correlation between pathological grading and that assessed with SWI.
Role of Laryngeal Ultrasonography in screening for laryngeal diseases in symptomatic patients
Authors: ElRayes Ramy Osama , Mansour Hesham Mahmoud , Hafez Nirvana GamalElDin , Nasr Merhan Ahmed
Published: October 2021

Background

Laryngoscopy is widely considered the most appropriate tool for evaluating the larynx, however, it is invasive and not all patients can tolerate it. Although laryngeal ultrasound has been proposed as a promising noninvasive technique that can play an important role in laryngeal imaging, there is lack of consensus regarding its role.

Objective

The aim of this study is to assess laryngeal ultrasound sensitivity compared to indirect laryngoscopy in screening for laryngeal diseases in symptomatic patients.

Patients and methods

30 undiagnosed symptomatic patients underwent laryngeal ultrasound and indirect laryngoscopy. Their results were compared.

Results

Technical success rate of laryngeal ultrasound was (83%). It showed overall sensitivity of (78.9%) in detecting organic laryngeal diseases with high sensitivity in detecting laryngeal masses, reinke’s edema, vocal cord cysts and polyps (100%), vocal cord palsy (83.3%), intermediate sensitivity for vocal cord nodules (66.7%), and poor sensitivity for laryngitis and non organic voice disorders (0%).

Conclusion

Laryngeal ultrasound is a useful non invasive imaging tool that can be used with acceptable sensitivity in detecting organic laryngeal diseases excluding laryngitis, hindered mainly by complete thyroid cartilage calcification in older males. Consequently we recommend its use as complementary to clinical examination and mirror laryngoscopy, or as an alternative to indirect laryngoscopy when required and in routine neck ultrasound exams when appropriate.
Neoadjuvant Chemotherapy for Breast Cancer: Evaluation by PET / CT
Authors: Maarouf Rania Ali , Abdel-Rahman Amgad S , Mohamed Samar Ibrahim
Published: October 2021

Background

Breast cancer (BC)is the most commonly occurring cancer in women and the second most common cancer overall.An increase in the rate of breast preservation has come to be expected because of tumor reduction using neo-adjuvant chemotherapy (NAC) for locally advanced cancer and it is important to accurately determine the effects of NAC.

Patients and Methods

This study was conducted on 30 female patients with histopathologically confirmed breast cancer referred for a PET/CT scan aiming to demonstrate the role of 18F-FDG PET/CT in detecting the pathological response to NAC in BC patients.

Results

No statistically significant differences were found between the baseline number of lesions and that after three cycles of chemotherapy. Also, no statistically significant differences were found between the mean values of baseline and after three cycles of chemotherapy of both liver activity and size of right breast lesions. Meanwhile, the mean values of SUV of right and left breast lesions as well as the size of left breast lesions were significantly lower after three cycles of chemotherapy when compared to their baseline values. And no statistically significant differences were found between complete and partial therapeutic response in the right breast lesions as well as between complete and no therapeutic response in the left breast lesions as regards baseline SUV and SUV after 3 cycles of chemotherapy.

Conclusion

It can be concluded that FDG-PET/CT is useful for evaluation of neo-adjuvant chemotherapy for breast cancer. However, more studies are needed to validate the results of the current study.
Association of Mucoid Degeneration of the ACL with Medial Tibiofemoral Osteoarthritis Progression at MR Imaging
Authors: Moustafa Samer Mohamed , Abdel-Aziz Amany Moh. Rashad , Shalaby Mennatallah Hatem
Published: October 2021

Background

Using MRI, ACL mucoid degeneration is defined as a thickened ACL with increased signal intensity on all MR pulse sequences, with discrete fibers easily distinguished on fatsaturated T2-weighted or fat-saturated proton-density (PD)-weighted images but poorly differentiated on T1-weighted or non-fat-saturated PD-weighted images.

Objective

To assess the prevalence of ACL mucoid degeneration in a population of patients referred for routine knee MRI, and its association with age and structural joint damage.

Patients and Methods

Our study is a retrospective study conducted at the radiology department of Ain Shams University hospitals and Ain Shams University Specialized Hospital including 81 cases of knees with ACL mucoid degeneration by MRI and no sex predilection. Cases and controls were scored with respect to independent articular features: cartilage signal and morphology, subarticular bone marrow abnormality, subarticular cysts, subarticular bone attrition, marginal osteophytes and medial meniscal integrity.

Results

Patients with ACL mucoid degeneration were older than patients with a normal ACL, without statistically significant sex difference. Knees with ACL mucoid degeneration had statistically significant medial meniscal injuries and cartilage damage involving the central and posterior MTFC compared to control knees with a normal ACL frequency matched for age, sex and MR field strength.

Conclusion

Our study proved that there is a strong association between ACL mucoid degeneration and cartilage damage in MTFC.
Potential Role of PET/CT in Evaluation of Thyroid Carcinoma Subtypes
Authors: Fahmy Yara Mohamed , Aziz Tougan Taha Abd El , Rahman Marwa El Sayed Abd El
Published: October 2021

Background

Thyroid carcinoma is the most common endocrine malignancy. The biology of its different subtypes differ dramatically leading to different treatment approaches. Role of 18FDG PET/CT in thyroid carcinoma is still highly debated and not well established. Its indications are still being investigated in the hope of utilizing it in diagnosis, risk stratification, and follow up of thyroid carcinoma patients.

Objective

To explore the role of 18FDG PET/CT in the evaluation of different subtypes of thyroid carcinoma.

Methods

A retrospective descriptive study over the course of 9 months from July 2018 till March 2019. It included patients with pathologically proven thyroid carcinoma referred to the Radiology department, Ain Shams University Hospitals for a 18FDG PET/CT scan.

Results

18FDG PET/CT scans of 16 patients were included in the study. Fourteen (87.5%) patients underwent thyroid surgery, two of whom (14.3%) displayed local operative bed recurrence. Eight patients (50%) were diagnosed with nodal disease of whom four patients (50%) had necrotic lymph nodes displaying average SUVmax of 3.7 (±1.3) compared to four patients (50%) with non-necrotic lymph nodes that achieved average SUVmax of 10.7 (±12.3). The mean SUVmax of the most metabolically active lymph nodes in patients who received chemotherapy was 3.5 compared to 7.7 in those who didn’t. On the other hand, the mean SUVmax of the most metabolically active lymph nodes in those who received radioactive iodine therapy was 3.2 compared to 14.2 in those who didn’t. Distant metastasis were detected in two (12.5%) patients.

Conclusion

The role of 18FDG PET/CT in thyroid malignancy remains unclear and controversial, whether in diagnosis, staging, risk stratification, follow up, or detection of recurrence. Further evaluation the role of 18FDG PET/CT in thyroid carcinoma is required. Moreover, more investigation particularly in the less common subtypes is warranted to provide a more comprehensive guideline for the use of 18FDG PET/CT in various subtypes of thyroid carcinoma.
Complications of Hepatocellular Carcinoma patients post living Donor Liver Transplantation
Authors: El-Sayed Ashraf Mahmoud , Massoud Yasmine Mahmoud , Abd-Elkalik Ayat Abdallah
Published: October 2021

Background

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, accounting for about 1 million related deaths annually. An estimated 372, 000 new cases of hepatocellular carcinoma (HCC) are diagnosed each year, constituting 4.6% of all new human cancers.

Objectives

The aim of our study was to study the complications of Hepatocellular Carcinoma patients post living Donor Liver Transplantation at Ain Shams Center for Organ Transplantation.

Patients and methods

The study population underwent Living donor liver Transplanation due to hepatitis C virus related hepatocellular carcinoma during the period from January 2008 to 2019.A total number of 114 patients underwent LDLT due to HCV related hepatocellular carcinoma.Fourteen patients(12.2%) were excluded because of the intraoperative death or postoperative early death, 7 patients(6%) were excluded because of overlapping etiologies with hepatitis C (HBV,autoimmune hepatitis,BCS,…etc) and 11 patients (9.6%) were excluded due to their age.Eighty two patients fulfilling the inclusion criteria for enrollment were recruited in the study.

Results

The most common complications were (45.1%) neuropsychiatric side effects induced by immunosuppressive treatment, malignancy, hypertension, renal impairment, stroke, small for size disease…etc. Biliary complications (34.1%) as well as sepsis (34.1%) were the second common complications then rejection (18.3%), recurrence (12.2%), death (11%) and vascular complications (10%).

Conclusion

There was no statistical significance for those within or out side the Milan criteria or UCSF criteria and its impact on the occurrence of graft rejection, sepsis, vascular complications, death, HCC recurrence and biliary complications post-transplant.
Characteristics of De novo Hepatocellular carcinoma (HCC) in Chronic HCV Egyptian patients received Direct Acting Antivirals (DAAs) therapy: A pilot study
Authors: Ibrahim Amany Ahmed , Montasser Iman M.Fawzy , Balakosy Amira Mahmoud AL , Farid Hoda Mohammed
Published: October 2021

Background

Direct-acting antiviral agents for chronic hepatitis C have initiated a revolution in the management and control of this important liver disease with cure rates over 90%. However, it has been suggested that HCC may occur or recur in patients with chronic HCV infection who received DAAs therapy.

Aim

To compare characteristics and behavior of de novo Hepatocellular carcinoma (HCC) in chronic HCV patients who received direct acting antiviral treatment with those who didn't receive DAAs .

Patients and methods

The current study was conducted on patients with de novo HCC presented at HCC clinic, Tropical medicine department Ain Shams University Hospitals between December 2017 and December 2018, aged (18-70 years old) .

Total number of HCC cases visited the clinic during the study period was 416 patients.

160 patients with de novo HCC were enrolled in the study fullfiling the inclusion criteria and divided to two groups, 80 patients with HCC who received Direct antiviral treatment, the other 80 patients who didn't receive Direct antiviral treatment.

Results

Unlike some previous concerns about increased biologic aggressiveness of HCC after DAA treatment, resulting in infiltrative pattern and multinodular HCC outside Milan criteria, our results on de novo HCC after DAAs were mostly single, small, and diagnosed in early stages, resulting in BCLC stage 0-B in the majority of patients. There were no statistical differences regarding total size of tumor,or vascular invasion or AFP, but there’s a statistical difference in largest size of HFLs that was more significant in group (A) P = 0.04

The mean Child score was 5.75 in group A, with 61 patients (76.3%) were Child class A,19 patients (23.8%) were Child class B and 0 patients were child C. For the patients in group (B) the mean Child score was 6.15, with 50 patients (62.5%) were Child class A, 26 patients (32.5%) were Child class B and 4 patients (5%) were child C.

Conclusion

The current study shows no differences between the 2 studied groups as regard tumor aggressiveness, but data on risk of HCC and behaviour after DAAs is still conflicting and further studies are needed
Evaluation Of The Use Of Probiotics In Patients With Irritable Bowel Syndrome
Authors: Abdel-Samie Omar Ahmed Mohamed , ElGindy Eman Mohamed , Fawzy Iman Mohamed , Saad Heba Ismail
Published: October 2021

Background

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders (FGIDs), afflicting around 11% of the adult population worldwide. Despite the availability of a great variety of therapeutic options, treatment satisfaction is suboptimal for both the patient and the doctor. There is good evidence that the microbiota is a predominant factor in the IBS pathophysiology. Probiotics confers a health benefit on the host associated with modulation of the microbiota . (Dorssman and Hasler, 2016)

Aim of the work

The aim of the current study is to evaluate the role of probiotics in the improvement of quality of life via Irritable Bowel Syndrome – Quality of Life survey (IBS-QOL).

Patients and methods

This Double armed clinical trial was conducted on IBS patients, who fulfill ROME IV criteria and the IBS diagnostic questionnaire in Egyptair hospital outpatient clinic, Cairo, Egypt between March and December 2019. Data of the patient, with suspected IBS during the study period, were reviewed and the patients who fulfilled the inclusion criteria were enrolled into this study. The patients who fulfilled the inclusion criteria were followed up after 4 weeks from the first visit.

Results

The study includes 90 patients divided to 2 equal groups the first were prescribed probiotic and itopride medication and the second were prescribed itopride only. There was a highly significant improvement in the overall QOL terms (dysphoria, interaction with activity, body image, health worry, food avoidance, social reaction, sexual activity and relationship scores) for group 1 with overall mean score (60.64±7.77) at baseline and (81.54±7.87) at 4 weeks (p value <0.001). For group 2 there were high significance for some terms (dysphoria, interference with activity, body image and health worry scores) while other terms (food avoidance, social reaction, sexual activity and relationship) showed no significant changes, the overall score was of no significance too (p value 0.18). Comparing the 2 groups that there was a high significant difference between the 2 groups regarding the overall QOL at 4 weeks (p value <0.001), but there were no significance between the 2 groups regarding; Body image (p value 0.16), food avoidance (p value 0.95) and sexual scores (p value 0.14).

Conclusion

Our data suggest that probiotics are useful for the improvement of quality of life of the IBS patients.
Pregnancy Outcome in Patients with Budd Chiari Syndrome: A Single Centre Experience
Authors: Gindy Eman Mohamed EL Said El , Hefny Zeinab Mohamed , Hassan Ahmed Hussein Abd Elhamid , Maghraby Safia Ramdan
Published: October 2021

Background

Budd-Chiari syndrome (BCS) is a rare disease caused by hepatic venous outflow obstruction and results in hepatic failure due to sinusoidal congestion, decrease in the blood supply to the to the liver and increase the pressure in portal vein .

Objectives

The aim beyond this study is assessment of the maternal and foetal events in a group of women who became pregnant while having BCS.

Patients and methods

It is a prospective and retrospective study which was conducted on 32 patients with Budd- Chiari syndrome admitted to Ain Shams University Hospitals, Tropical Medicine department or attended the outpatient clinics during the period from May 2006 to March 2019 who became pregnant after diagnosis by BCS .

Results

Number of cases that underwent tips revision 3 cases and one case underwent liver transplantation after delivery and 2 cases had died during follow up.Using . of enoxaparin in 1st trimester in our cases as a significant protective factor against abortion.

Conclusion

BCS isn’t a contraindication to pregnancy in patients with a well-controlled disease. Fetal outcome remains relatively poor, which is at least partly due to the underlying prothrombotic disorders. so patients should be accurately informed about the risk of this pregnancies .
CHOROIDAL THICKNESS, MACULAR THICKNESS, RETINAL NERVE FIBER LAYER THICKNESS BY OCT IN NON-PREGNANT, PREGNANT AND POST MENOPAUSAL WOMEN
Authors: Zaki Sherif , Helmy Thanaa , Samy Hisham , Fathy Nariman
Published: October 2021

PURPOSE

To evaluate the macular, retinal nerve fiber layer (RNFL) and choroidal thickness alterations by using spectral-domain optical coherence tomography (SD-OCT) in postmenopausal, pregnant and non-pregnant women.

PATIENTS AND METHODS

A comparative study included a total of 42 eyes (Right eye) of 42 healthy females in the period from march 2019 to September 2019 divided into 3 groups: a) Non pregnant women. b) Pregnant women.c) Postmenopausal women. Each subject underwent a comprehensive ophthalmologic examination. Following this detailed ophthalmologic examination, the Rs 3000 Nidek Japan OCT device was used for the assessment choroidal, macular and RNFL Thickness.

RESULTS

The mean age of non-pregnant females was 29.64 ±3.13, mean age of pregnant females was 28.93 ±3.89 and of postmenopausal women was 53.86 ± 1.75. There was no significant difference in all macular quadrants in the 3 study groups. Choroidal thickness was statistically significant thicker in healthy pregnant females (333.36 ±44.42) than in healthy non pregnant (326.93±31.50) and significantly thinner in healthy post-menopausal women (282.64±28.04) than healthy non pregnant females. There was no significant difference in RNFL thickness between the 3 study groups.

CONCLUSION

Oct has evolved over the past decade as one of the most important ancillary tests in ophthalmic practice. Pregnancy hormones may lead to an increase in fluid volume in many tissues of the body. There was no statistically significant difference in macular thickness and RNFL thickness between the 3 study groups. Choroidal thickness was statistically significant thicker in healthy pregnant than in healthy non pregnant and significant thinner in healthy post-menopausal women than healthy non pregnant.
Role of Aminophylline Intravesical Instillation on Enhancing Ureteral Dilatation prior to Ureteroscopy
Authors: Saafan Ahmed Mohamed , Shabayek Mohamed Ismail , Mohamed Marwa Mamdouh , Bayomi Ali Mostafa Mabrouk
Published: October 2021

Background

Semi-rigid uretroscopy (URS) is a common intervention approach for lower ureteric stones. Ureteral dilatation is frequently needed before URS to enable ureter accessing. Aminophylline is known by its muscle relaxant effect and has been suggested to be effective in ureteral dilation.

Objectives

To evaluate the effect of intravesical administration of aminophylline on ureteroscopy and to measure intraureteral pressure

Methods

This prospective randomized controlled study included 50 before and after aminophylline injection.

patients with lower ureteral calculi. In group A, the ureter was dilated by intravesical aminophylline whereas in group B balloon dilator was used. Intraureteral pressure was measured using pressure transducer connected to invasive pressure monitor.

Results

No statistically significant difference was noticed between both groups in operative time, intra operative complication, need for ureteral stenting or stone free rate. However, post-operative pain and haematuria were statistically significantly higher among balloon group compared to aminophylline group. In group A, there was statistically significant decrease in intraureteral pressure after injection of aminophylline (7.80 ± 1.71) compared to before injection (12.2 ± 1.85) with p-value < 0.001.

Conclusion

Aminophylline is effective in ureteral dilatation when intravesically injected with less frequent post-operative pain and hematuria.
Plasma Citrulline Level In Preterm Neonates With Necrotizing Enterocolitis
Authors: EL Tahry Adham H , Rashad Amira M , Rabie Dina E
Published: October 2021

Background

Necrotizing enterocolitis is a leading cause of mortality and morbidity in preterm neonates, lacks a reliable biomarker. Citrulline is primarily produced by enterocytes and correlates with intestinal function. Objective of the study is to test if Citrulline can be used as a biomarker of NEC and serving as a biomarker for intestinal recovery.

Subjects

This is a case control study, Plasma citrulline levels of neonates with a gestational age <35 weeks and 2000 gram who developed NEC were measured, comparing it to properly gestational age and weight matched pretrem neonates.

Patients and methods

sixty neonates were classified into two groups: the patients group which included 30 neonates with confirmed NEC and the control group which included 30 healthy preterm neonates.

Results

Plasma citrulline level was significantly lower in the patients group than in the control group With Median citrulline levels of NEC and control groups were 2 and 20 μmol/l respectively (P < 0.0001), with a sensitivity of 86.7%, specificity of 93.3% and cut off level of citrulline was ≤11μmol/l for diagnosis.

Conclusion

Plasma citrulline level is a very good non invasive marker for NEC diagnosis.
Lung Ultrasonography as Tool for Follow Up of Ventilated Neonates for Prediction of Weaning Readiness
Authors: Awad Hisham A , Khafagy Soha M , Ahmed Nivan T , Shehata Basma M , Shabana Ayah M
Published: October 2021

Background

Timing is crucial when deciding if a patient can be successfully extubated. Both premature discontinuation and unnecessary delay of mechanical ventilation weaning have been associated with poor outcome. There are no enough guidelines for the assessment of readiness of newborns for extubation. The degree of lung aeration loss in different clinical conditions can be quantified via lung ultrasound (LUS).

Objectives

To evaluate the lung ultrasound score as a follow up tool in ventilated neonates and its validity as predictor of extubation.

Subjects and Methods

Prospective study done on 39 mechanically ventilated neonates 27-42 weeks’ gestation. Lung ultrasound was done daily for each patient till the day of weaning and lung ultrasound (LUS) score was calculated. Patients were divided into 2 groups according to trial of weaning; Success “S” group: in which weaning succeeded and Failure “F” group: in which weaning failed.

Results

The “F” group had significantly higher LUS score at time of intubation, pre- extubation and post-extubation compared with the “S” group (P- value= 0.002, 0.003 and 0.001 respectively). A cut off value of ≤ 10 for LUS score pre-extubation predict successful weaning with sensitivity 76% and specificity 64.3%.

Conclusion

LUS is an indicator for lung aeration and can be used as a tool to predict success of weaning of ventilated neonates.
Sputum Neutrophil Elastase in pediatric cystic fibrosis and non-cystic fibrosis bronchiectasis
Authors: Fouda Eman M , Ali Heba A , Salem Mona A. A , Radwan Heba H
Published: October 2021

Objective

To assess the value of sputum neutrophil elastase as a biomarker of severity in cases of non-cystic fibrosis bronchectasis & cystic fibrosis.

Methods

This cross-sectional study was conducted on 50 bronchiectasis patients aged from 1 to 13 years presented to pediatric chest clinic and department of Ain shams university hospital., there were classified into 2 groups; Group A cystic fibrosis patients(30) and group B non-cystic fibrosis bronchiectasis patients(20).

Inclusion criteria :children aged from 1 to 16 years, patients were diagnosed with bronchiectasis clinically and with HRCT chest and cystic Fibrosis patients were diagnosed by positive sweat chloride test and genetic study. Exclusion Criteria includes no other known chronic lung diseases.

All patients were evaluated by full medical history and full clinical examination, the following lab investigations were done :sweat chloride test, CFTR mutation study, sputum sampling and culture.

Quantitative sputum neutrophil elastase assay was done, and the severity of disease was assessed using clinical scores as SK score ,FACED score and bronchiectasis severity index and by using radiological scores as Bhalla and modified Reiff score.

Results

Steatorrhea was more prevalent among cystic fibrosis patients (80%) than non-CF bronchiectasis patients (0%).(P = 0.00). Clubbing was more prevalent among non -cystic fibrosis bronchectasis (10) (50 %), than cystic fibrosis (2 patients) (6.7 %).(P = 0.00). In cystic fibrosis, neutrophil elastase was significantly higher among severe group (126 ng/mL) than among the moderate (30 ng/mL) and mild (16 ng/mL) groups.(P = 0.00). While in non-CF bronchiectasis patients, neutrophil elastase was significantly higher among severe group (67 ng/mL) than among the moderate (24 ng/mL) and mild (11 ng/mL) groups.(P = 0.00)

Conclusion

There was a significant correlation between sputum neutrophil elastase and disease severity in bronchiectasis (both cystic fibrosis and non-CF).
Effect of Lactoferrin Supplementation on Appetite And Weight Loss In Obese School Age Children
Authors: ElSayed Hoda L , Abdelsayed Marian G.R , Emara Islam S.A
Published: October 2021

Background

Obesity is one of the most common nutritional disorders in the world. Increased appetite is one of the main causes of obesity.

Objective

The aim of this study was to determine the effect of lactoferrin on weight loss and appetite in obese school age children.

Subjects & Methods

This was a double arm prospective clinical trial which done on 50 obese children with an age range of 6-12 years. The children were recruited from Pediatric Nutrition Clinic of Ain Shams University.

The children were equally divided into two groups; one group received 200 mg of oral lactoferrin for 12 weeks in addition to diet regimen and exercise. The other group did not receive lactoferrin but was only on exercise and diet regimen. Anthropometric measurements, body composition, dietetic history and appetite assessment using Child Eating Behavioral Questionnaire (CEBQ) were done for both groups before and after intervention.

Results

The results of our study revealed decrease in anthropometric measurements, serum leptin and Child Eating Behavioral Questionnaire (CEBQ) after lactoferrin supplementation. However, our study revealed only statistical significant decrease in CEBQ score after lactoferrin supplementation.

Conclusion

Despite decreasing weight, lactoferrin intake had no impact on weight loss when compared to patients who did not take lactoferrin. Lactoferrin intake decreased appetite in school aged obese children.
Joint health state in relation to different clinical, laboratory, and radiological variables of hemophilia A patients
Authors: Tantawy Azza Abdel Gawad , Elsherif Nayera H.K , Safwat Nesma Ahmad , El Seteha Khaled Anwar El Sayed
Published: October 2021

Background

Haemophilic (HF) arthropathy is a major complication in haemophilia. Collagen factors are responsible for maintaining the integrity of the vessel wall in the joint.

Our goal

was to assess the haemophilia joint state and its relation to the clinical, laboratory &radiological data.

Methods

This cross-sectional study included 50 hemophilia A patients recruited from the Pediatric Hematology / Oncology unit, Children’s Hospital, Ain Shams University,Cairo,Egypt. Assessment of joint status clinicallyand radiologically by X-rays& ultrasound was performed.

Results

48% of the studied hemophilia A patients had one, 40 % had two target joints or more. The elbow and knee are the most frequently affected joints (46%,62% respectively).There were no significant differences between inhibitor positive and inhibitor negative patients regarding the number of target joints.However, inhibitor positive patients had significantly lower annual bleeding rate; moreover, none of inhibitor positive patients had surgeries done and none were on celecoxib. There were no significant differences between inhibitor positive hemophilia A patients and inhibitor negative regarding US total score, hem QOL, total HJHS and total FISH score. Patients with 2 target joints had significant higher annual bleeding rate, worse quality of life score, higher total HJHS score compared to those with one or without target joints.

Conclusion

In our study, we argued the lack of significant difference between inhibitor positive and inhibitor negative Hemophilia A patients as regards the occurrence of hemophilic arthropathy. Nevertheless, patients with ≥ 2 target joints had worse annual bleeding rate, quality of life & total HJHS score.