bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Study of Morphine, Fentanyl or Nalbuphine Patient Controlled Analgesia (PCA) for Mucositis Pain in Pediatric Patients Undergoing Cancer Therapy. A Prospective Randomized Clinical Trial
Authors: Ibrahim Ahmed Ibrahim , Shams Manal Kamal , Akl Diaa Abdelkhalek , Abd-Elmaksoud Iman Shawky , Ghobrial Hossam Zarif , Hanalla Masoud Hany Guirguis
Published: July 2024

Background

Cancer treatment may cause several side effects, including severe oral mucositis (SOM). Oral mucositis is an inflammation of the oral mucosa that causes severe pain and ulceration. Children and adolescents are more prone to develop chemotherapy-induced SOM. Opiates have been the cornerstone of pain management for moderate to severe oral mucositis. The effective use of opiates requires balancing the desired effects of pain relief with undesired adverse effects

Aim of the Work

We evaluated the efficacy and safety of Nalbuphine (agonist – antagonist) in comparison with the pure agonist opioids (Morphine and Fentanyl) when used for oral mucositis pain in pediatric patients undergoing cancer therapy. Primary outcomes measures were Pain intensity self- assessment by using VAS, Number of active and total pushes of PCA buttons, Total opioid consumptions for each patient, and Patient satisfaction at the end of the 7 days using Patient Satisfaction Score PSS were assessed using a linear scale where 0 = very satisfied; 10 = very dissatisfied. Secondary outcomes measures were Adverse events including Respiratory depression, Bradycardia, Hypotension, Over sedation, Nausea and vomiting, Pruritus, Urinary retention.

Patients and Methods

This was a Randomized Clinical Trial conducted on 90 Pediatric patients who were diagnosed with cancer, admitted to Children Cancer Hospital -Egypt (CCHE-57357) and underwent cancer therapy that was complicated with Mucositis grade 3 and 4 (severe oral mucositis) according to the WHO scale for oral mucositis. Patients were randomly allocated into 3 equal groups each included 30 patients using of: PCA Morphine (Group M), PCA Nalbuphine (Group N) and PCA Fentanyl (Group F). Using equipotent doses of the three medications.

Results

Highly significant decrease in VAS score (7th day) and total opioid consumption (7th day), in Nalbuphine and Morphine groups; compared to Fentanyl group (p < 0.01 respectively). Significant increase in patient satisfaction score PSS in Nalbuphine drug group; compared to other drug groups (p = 0.032). Highly significant decrease in serious side effects (especially respiratory depression and sedation problems), in Nalbuphine and Morphine groups; compared to Fentanyl group (p = 0.0004).

Conclusion

Nalbuphine proven to be adequately effective, not inferior to Morphine in terms of improving pain relief, decreasing opioid consumptions in pediatric PCA users. However patients reported less satisfaction with Nalbuphine than Fentanyl or Morphine. In terms of safety profile, Nalbuphine had less adverse effects in pediatric patients with oral mucositis related to cancer therapy in comparison to Fentanyl or morphine.
Screening for Cardiac Abnormalities in Asymptomatic Patients Undergoing low to Intermediate Risk Non-Cardiac Surgery
Authors: El-Sayed Ahmed , Ibrahim Ahmed , Mohamed Hazem , Rayan Mona
Published: July 2024

Background

Perioperative cardiovascular complications are the predominant cause of morbidity and mortality in patients undergoing non cardiac surgery. Major cardiovascular and cerebrovascular complications, including death, myocardial infarction or stroke, occur in approximately 1 of every 33 hospitalizations for non-cardiac surgery.

Objective

To uncover hidden cardiac problems that may cause complications during and after non- cardiac major surgery.

Patients and Methods

This observational cross-sectional study was conducted on 250 asymptomatic patients coming to Ain Shams University Hospitals and police hospitals clinics for preoperative assessment to undergo low to intermediate risk non cardiac surgery.

Results

most of the study group were males (68%) with a mean age of 47 years. Diabetes and hypertension were found in 45% and 41% of patients respectively. Most patients had GIT operations (34%) followed by cataract extraction (14%), orthopedic operation was done in 11% of patients. clinical examination was normal in 98% of patients with 2% had AF and systolic murmur. Significantly abnormal ECG was found in 10% of patients. Preoperative significantly abnormal TTE was detected in 9% of patients. post-operative cardiovascular complications occurred in 7% of patients who had completely normal preoperative clinical, ECG and echocardiographic data. Most of these patients had orthopedic operations and hysterectomy.

Conclusion

The clinical and predictive value of routine preoperative ECG and echocardiography for major cardiac adverse events is limited especially in low-risk patients groups undergoing low to intermediate risk operations. However, it helps uncovering of hidden conditions that alter patient's plan of treatment. The type of surgery was an important factor for the occurrence of post-operative complications.
Role of Serum Progranulin as a Biological Marker in SLE Patients
Authors: Zeitoun Yasser Ahmed , Soliman Dina Ahmed , Gamal Dalia Mohamed , Attia Mirette Eskander , Wahba Nancy Samir
Published: July 2024

Background

Systemic lupus erythematosus (SLE) is an autoimmune disease caused by the disorders of immune regulation. In the past few years, increasing evidence has shown that progranulin (PGRN) is an immunomodulatory protein that is upregulated in SLE patients. Progranulinmay be involved in the pathogenesis of SLE, so, it might be a marker for disease activity.

Objectives

This work aimed to investigate the clinical significance of PGRN in patients with SLE regarding its role in pathogenesis and its relation to clinical manifestations and disease activity.

Subjects and Methods

This case-control study was conducted on 50 SLE patients classified according to the 2019 European League Against Rheumatism and the American College of Rheumatology (2019 EULAR/ACR), and were subdivided according to SLE Disease Activity Index-2000 (SLEDAI-2K) score into 25 patients with low disease activity (LDA) and 25 with high disease activity (HDA), in addition to 20 patients with autoimmune diseases other than SLE, and 20 healthy adults as a control group. We measured concentrations of serum PGRN with quantitative enzyme-linked immunosorbent assay (ELISA) in all studied participants. We assessed the correlation between the serum PGRN levels and different laboratory parameters, clinical symptoms and established disease-activity indices.

Results

Serum PGRN levels were significantly higher in SLE patients than healthy controls as well as when compared to the group of patients with autoimmune diseases other than SLE. They also significantly correlated with values of laboratory assays and clinical parameters such as ESR, 24 hours urine protein, SLEDAI-2kscore, and total damage scores; and inversely correlated with C3, C4 and Hb concentrations.

Conclusion

Serum PGRN could be a useful biomarker for disease activity of SLE.
Efficacy of Topical Anticholinergic in Control of Symptoms in Patients with Vasomotor Rhinitis and non-Vasomotor Rhinitis Patients and Normal Individuals. A Controlled Comparative Study
Authors: Sabry Sabry Magdy , Fawaz Samia Ahmed , Salman Manal Ibrahim , Askoura Anas Mohamed , Mady Ossama Mustafa , Anter El sordy Moustafa Ahmed Mahmoud
Published: July 2024

Background

The use of a topical anticholinergic medication, ipratropium bromide, and its ability to inhibit methacholine and rhinitis-induced hypersecretion is emphasized. Ipratropium bromide appears to be both safe and effective in reducing this troublesome symptom. This study is designed to show the therapeutic effect of anticholinergic local treatment on nasal mucosa in patients with vasomotor rhinitis.

Objective

To assess the therapeutic effect of local anticholinergic treatment on nasal mucosa in patients with vasomotor rhinitis compared to non-vasomotor (allergic) patients and normal individuals, and if there any down regulation of the muscarinic receptors or not.

Patients and Methods

This prospective interventional study was conducted in Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University. This study was conducted on 60 cases. All patients were divided into 3 groups: Study group (1): includes 20 patients diagnosed clinically non allergic rhinitis suggestive to be vasomotor rhinitis. Study group (2): includes 20 patients diagnosed as allergic rhinitis. Study group (3): includes 20 patients performing surgery for non-vasomotor rhinitis non allergic causes (as septoplasty or rhinoplasty).

Results

Comparison between the pre and post SNOT questionnaire of symptoms among vasomotor group showed that there was a significant difference between the pre and post treatment SNOT questionnaire symptoms; Nasal obstruction, runny nose, post nasal drip, thick nasal discharge and lack of good night sleep. Among allergic cases group, there was a significant difference between the pre and post treatment immunohistochemistry findings considering epithelium, glands, arteries and veins. 20% of cases had grade 3 epithelium before treatment while after treatment, this was dropped to 0%. Comparison between the pre and post SNOT questionnaire of symptoms among allergic group showed that there was a significant difference between the pre and post treatment SNOT questionnaire symptoms; runny nose, post nasal drip, and thick nasal discharge. Among non- vasomotor rhinitis non allergic causes (as septoplasty or rhinoplasty) group, there was a significant difference between the pre and post treatment IHC findings considering epithelium, glands, and arteries, however no significant difference between the pre and post IHC veins grade. Also, there was no significant difference between the pre and post treatment SNOT questionnaire symptoms.

Conclusion

Topical anticholinergic such as ipratropium bromide nasal spray are effective in treating rhinorrhea symptoms in allergic and non-allergic rhinitis. Further controlled studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.
Incidence of Pancreatic Leakage in Isolated Biliary Limb Roux-en-Y Reconstruction in Whipple Procedure
Authors: Wagdy Hesham Hasan , Khalil Ahmed Abdelrazik , Saber Hatem Sayed , El Din Rashed Amier Mohamed Ahmed Gamal
Published: July 2024

Background

Whipple is currently the procedure of choice in the treatment of localized pancreatic cancer. Isolated Roux-en-Y loop pancreaticojejunostomy was proposed as a method of reconstruction following pancreaticoduodenectomy. The idea is to isolate the bile from pancreatic secretions to minimize pancreatic enzyme activation and ultimately pancreatic fistula formation. It was also proposed that if a pancreatic fistula develops, it will be a pure fistula and thereby more benign as opposed to a mixed pancreatic fistula containing bile.

Objective

To estimate the incidence of pancreatic fistula in patients undergoing isolated Roux-en- Y hepaticojejunostomy reconstruction following pancreaticoduodenectomy.

Patients and Methods

In this prospective observational study, our aim is to calculate the incidence of post-operative pancreatic fistula in 20 patients that underwent Roux-en-Y isolated biliary limb reconstruction following pancreaticoduodenectomy for the treatment of pancreatic cancer. The study includes patients that underwent this procedure at Ain Shams University Hospitals in the period between January 2021 and July 2022 with a post-operative follow up period of 3 weeks. Patients were diagnosed with pancreatic cancer using MRI or CT scans with some of them also undergoing endoscopic US with biopsy. They were then admitted to one of the two main Ain Shams University Hospitals for pre-operative preparation.

Results

Our study did no estimate post-operative complications such as delayed gastric emptying and wound infection. Pancreaticoduodenectomy is a major surgery that carries a significant burden in terms of morbidity and mortality. Post-operative pancreatic fistula can be fatal as it can lead to vascular pseudoaneurysms that may fatally rupture. The idea behind using isolated biliary limb roux-en-y reconstruction is to alleviate the morbidity caused by post-operative pancreatic fistula.

Conclusion

Further comparative studies with a higher number of patients are recommended to assess and compare the value of isolated biliary limb reconstruction when compared to conventional reconstruction.
Assessment of Progastrin Releasing Peptide in Gastric Cancer Patients
Authors: Mohamed Kamal Maha Mohsen , Saady Khayyal Ahmad El , Anwar Christina Alphonse , Abdel Rady Allam Radwa Adel
Published: July 2024

Background

Gastric cancer is the 3rd cause of cancer related deaths and fifth most common malignant tumor worldwide. It`s prevalence is increasing in conjunction with H.Pylori infection, smoking, alcohol consumption, bad nutritional habits (smoked food, food rich in salt and nitrites, processed meat), obesity, genetic predisposition.

Aim of the Work

To investigate associations among serum ProGRP levels and clinicopathological parameters, and to evaluate the diagnostic value of serum ProGRP for GC.

Patients and Methods

The current study was conducted at Damietta cardiology and gastroenterology center in association with Ain Shams University Hospitals aiming to elucidate the diagnostic value of serum progastrin releasing peptide in patients with gastric cancer. A total of 75 subjects were enrolled in the current study, and they were divided into three equal groups; the first one included 25 healthy controls, the second one included 25 patients with benign gastric lesions, while the third one included 25 patients with malignant gastric lesions.

Results

Our study showed the following findings: CEA had sensitivity and specifity of 64% and 60 % for differentiating between benign and malignant group which means low diagnostic ability of CEA in detecting gastric cancer. Progastrin Releasing peptide (Pro GRP) had 96% sensitivity and 96% specifity in differentiating between benign and malignant groups which means higher diagnostic abilities of Pro GRP in cancer stomach.

Conclusion

Based on thde previous findings we recommend: Use of progastrin Releasing peptide (PRP) as screening marker for patients suspected to have gastric cancer as it has been proved to higher diagnostic abilities than CEA. Evaluate PRP role in monitoring for tumor staging and prognostis.
Measurement of Vitamin D Level among Covid-19 Patients and its Correlation with Severity of the Disease
Authors: Morad Caroline , Habeeb Reem , Yassin Esraa , Khalil Salma
Published: July 2024

Background

Coronavirus disease 2019 (covid-19) is defined as illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first identified among an outbreak of respiratory illness cases in Wuhan City, China. Vitamin D is known to play a key role in the maintenance of bone health and calcium–phosphorus metabolism, yet many other functions of this vitamin have been recently postulated, such as modulation of the immune response in both infectious and autoimmune diseases. Different studies showed that severity of covid-19 infection is directly related to vitamin D level.

Methods

This is an observational cross-sectional study, which includes 80 COVID-19 patients, and admitted in the ward and ICU of EL Medany Hospital, EL Demerdash and EL Obour specialized hospital. All patients had positive PCR for COVID-19. Chest CT without contrast was done for all patients and categorized according to CORAD staging. Serum vitamin D level was measured, besides laboratory inflammatory markers (CRP, ferritin, d-dimer), kidney and liver function tests, and complete blood picture.

Results

Our study included 80 patients; 33 males and 47 females with mean age of (51±10.5 years). Measured Vitamin D level range was (10±9 ng/mL). It was found that male patients had higher level of serum vitamin D (12.6±8.6 ng/mL) than female patients (11.5±9.5 ng/mL) but with no statistically significant difference. The commonest presentations were sore throat (97.5%), and fever (93.75%). COVID-19 patients presenting with cough and fever had highly significantly lower levels of vitamin D than patients not presenting by these symptoms (P-value 0.006, 0.032) respectively. In the current study, patients with CORAD 5 in chest CT had the lowest vitamin D level (9.6±7.8 ng/mL), compared to patients with CORAD 3 (13.6±9.7 ng/mL), and CORAD 4 (11.8 ±8.8 ng/mL). According to the correlation analysis, a decrease in vitamin D levels was associated with more severe COVID-19 cases, with significantly higher blood levels of inflammatory markers CRP and ferritin (P-value 0.02, 0.01). No correlation was found between vitamin D levels and hemoglobin level, white cell count, platelet count, or D-Dimer.

Conclusion

Our findings suggest that the COVID-19-positive individuals with lower vitamin D levels, had significantly higher blood levels of inflammatory markers (Ferritin and CRP), and increased frequencies of ground-glass opacity appearance in chest CT scans. Accordingly, vitamin D deficiency may be a marker of poor prognosis in COVID-19 patients.
Study of the Efficacy of Sublingual Route Administration of Levothyroxine Na Tablets vs Oral Route in Cases with Refractory Primary Hypothyroidism
Authors: Muhammed Eid Yara , Abu Shady Manal Mohammed , Eldin Ahmed Nour , El Halawany Salah Hussien , Nesim Mina Mikhael , Muhammed Elshamy Gehad Soliman
Published: July 2024

Background

Hypothyroidism is a common disorder, with a prevalence of approximately 5% and incidence of approximately 250 /100,000 per year in the adult population both prevalence and incidence keep raising. Levothyroxine is the recommended hormone for replacement therapy in both overt and subclinical hypothyroidism.

Aim of the Work

Levothyroxine (L-T4) is the standard therapy of hypothyroidism. Our purpose was to compare the efficacy of the L-T4 sublingual tablet administration to standard oral L-T4 tablet in hypothyroid patients with refractory hypothyroidism.

Subjects and Methods

Our study was conducted on 40 patients who were documented to be refractory to oral thyroxine age range 18- 55, 38 females and 2males. Patients were recruited from Endocrinology and Metabolism clinic at Ain-Shams University and Internal medicine outpatient clinic at 6th of October University during the period from June 2019 to October 2020 Informed consent was obtained from all subjects.

Results

In our study showed a significant decrease in mean TSH (write the figures) on sublingually administrated levothyroxine tablets compared to orally administrated levothyroxine tablets and a significant rise of mean free T4 after 1 week. yet after 6 weeks there was insignificant difference of FT4 compared to oral levothyroxine. Patients who were antiparietal cell antibody positive demonstrated a non significant rise of free T4 level with almost doubling of level compared to oral levothyroxine at 1 week and 6 weeks interval, this was associated with a significant decline of serum TSH at 6 weeks interval. Also This was associated with a significant improvement in hypothyroidism symptoms

Conclusion

In conclusion, our study indicated that sublingual route for LT4 tablet administration was safe and innovative route for LT4 administration,it could improve compliance, overcome many obstacles with oral administration for intake with food,coffee,drug interaction and GI malabsorption.
Surgical Outcome of the Endoscopic Endonasal Approach in Giant Pituitary Adenomas: A Systematic Review
Authors: El-Bahy Khaled M , Kotb Mohamed M , Abdel –Latif Assem M , Ahmed Abd El Rahman E
Published: July 2024

Background

Pituitary adenomas are the third most common intracranial tumors comprising about 10%–15% of all tumors. Giant pituitary adenomas (GPAs) are a subset of pituitary tumors. Most giant adenomas are slowly growing and histologically benign in nature despite the giant in size and difficulties to manage. Diverse surgical techniques including microscopic transsphenoidal, endoscopic transsphenoidal, transcranial transcavernous, and a combination of both suprasellar and infrasellar techniques have been developed to treat giant tumors with extension into surrounding structures. The development of the endonasal endoscopic approach for the resection of pituitary adenomas has been one of the most important advances for the treatment of pituitary tumors in the last decades since 1997.

Aim of the Work

analyze the collective outcomes from studies discussing endoscopic endonasal transsphenoidal approach in managing giant pituitary adenomas regarding extent of tumor resection, visual improvement and hormonal control.

Methodology

This systematic review included a discussion of all available studies meeting the eligible criteriaincluding: well conducted descriptive studies, cohort, articles, analytic studies and the literature of reviews.

Results

Surgical intent of gross or near total resection, primarily for the purpose of improving outcome, can be complicated by injuries that lead to a worse outcome and protracted clinical course. In this respect, patient-oriented outcomes (POEMs) are a point of emphasis in this review.

Conclusion

The endoscopic endonasal approach is an effective approach for giant pituitary adenomas with high rates of near or complete resection, visual improvement, and low rate of complications.
The Role of Corticosteroids in Prevention of Neonatal Respiratory Morbidity in Term Elective Cesarean Section A Prospective Observation Study
Authors: Salama Mohamed Hamed , Nabhan Ashraf Fawzy , El-Posty Faten El-Sayed , Zeinhom Ahmed Mohamed
Published: July 2024

Background

Caesarean sections continue to increase day by day in both developed and developing countries, which is associated with increased respiratory distress syndrome (RDS), the key reason for early neonatal morbidity and mortality.

Objective

To assess the effect of routine prophylactic corticosteroids before elective caesarean section after 37 weeks of gestational age, on neonatal respiratory morbidity.

Methods

A prospective observational study was conducted on all pregnant women undergoing elective caesarean sections between 37-42 weeks at Ain Shams University Maternity Hospital. Over an 8- month period (from November 2020 to June 2021), 1105 cases were divided into the exposed group (A), (N = 877) who received prophylactic dexamethasone, and 228 cases in the non-exposed group (B) who did not receive dexamethasone. Outcome measures were the incidence of transient tachypnea of the newborn, and NICU admissions due to respiratory morbidity. Data were analyzed using SPSS 22.

Results

Overall, there was no statistically significant difference in the incidence of TTN or RDS. No cases of TTN were found in exposed subgroup, versus 1 (0.4%) in non-exposed group (p = 0.745). The respiratory distress (RDS) in the exposed subgroup was 4 cases (16.7%) versus 18 (7.9%) in non- exposed group (p = 0.148). While the admission to the neonatal intensive care unit (NICU) due to respiratory morbidity after an elective caesarean section was 4 cases (16.7%) in the exposed subgroup versus 19 cases (8.3%) in the non-exposed group (p = 0.178).

Conclusion

Routine administration of prophylactic antenatal corticosteroids before elective caesarean sections at term does not reduce the risk of admission to the NICU compared to non- administration.
Open Reduction and Internal Fixation versus Minimally Invasive Plate Osteosynthesis in Management of Distal Tibia Extra-Articular Fracture (Mini Thesis)
Authors: Abdelmalek Hesham Abdelhameed , Nassar Wael Ahmed , El-Sayed Awad Mohammed
Published: July 2024

Background

Extra-articular distal tibia fracture is one of the difficult fractures to treat and the optimal treatment remains controversial, however plates seem to be the obvious choice for treating this type of fractures. The mechanism on how to achieve the balance between anatomic reduction and indirect reduction as well as direct and indirect healing remains unclear. Thus, the key point is whether to use ORIF or MIPO in treating fractures.

Aim of the Work

to provide a complete overview of the optimal plating technique for distal tibia fractures by evaluating and comparing the clinical and functional outcomes of minimally invasive plate osteosynthesis (MIPO) vs Open reduction and internal fixation (ORIF) for treating extra- articular distal tibial fractures. Outcomes of interest include operation time, time to union, non-union, mal-union, infection, secondary operations, and functional outcomes (AOFAS score).

Patients and Methods

From August 2020 to August 2021, a prospective randomized study was conducted at the department of orthopedic surgery of Ain-shams University Hospital including 36 patients to compare MIPO vs. ORIF in fixation of extra-articular distal tibial fractures. The patients were allotted to the MIPO or ORIF group with the flip of a coin.

Results

Regarding complications rate, no cases developed infection in MIPO technique. On the other hand, the ORIF technique had an infection incidence of 16.6% overall, with two cases (11.11 %) developing superficial infection and one case (5.56 %) developing deep infection. There was no significant difference in the incidence of mal-union between both techniques with no cases of non-union in both groups. The MIPO group had only one case of sagittal plane malunion (5.56%), compared with no cases in the ORIF group. There was no significant difference between both groups in secondary operations rate, with one case in each group.

Conclusion

Both MIPO and ORIF have similar therapeutic efficacy regarding the functional outcome and can be used safely in distal tibial extra-articular fractures. Although MIPO is advantageous over ORIF with earlier weight-bearing, earlier union, and clinical lower incidence of infection, it has delayed operation time.
Management of Massive Irreparable Posterosuperior Cuff Tears: A Systematic Review for Clinical & Functional & Radiological Outcomes
Authors: Saed Ahmed E L , Haroun Haitham , Mohamed Abdelghany Badr Ahmed Mohamed
Published: July 2024

Background

The management of massive irreparable cuff tears (MIRCT) remains a highly controversial subject with many possible surgical and non-surgical interventions and no clear evidence regarding the most effective and beneficial intervention. Different management options include: conservative management, partial repair, tendon transfer, superior capsular reconstruction, subacromial spacer insertion, reverse total shoulder arthroplasty (RTSA).

Aim of the Work

The aim of this systematic review is to compare the various methods of management of posterosuperior cuff tears without arthropathy to reach the most effective and sustainable mode of management.

Patients and Methods

A randomized controlled trial, non-randomized clinical trials, prospective and retrospective comparative cohort studies and case series. We will exclude cross-sectional studies, case reports and literature not in English.

Results

There is no high quality evidence on management of MIRCT. There was no Level I or II evidence. We included 69 papers that studied different modalities of management of MIRCT, 31 of level III and the remaining were of level IV evidence. Consequently, it’s still difficult to recommend one method of management over the other regarding the management of irreparable cuff tears. Patient age, demands, expectations, thorough clinical examination, surgeon experience and preference are still a major deciding factor when choosing and appropriate method.

Conclusion

Due to the unavailability of high-quality clinical studies available for guiding management of irreparable MRCT, it is consequently not possible to recommend for or against any specific treatment strategy. Rather, clinical experience, patient factors, patient expectations, and rotator cuff tear characteristics should guide clinical decision-making. Physical therapy compared to surgical treatments may have inferior outcomes. Standardized data collection, reporting and terminology are key to enhancing the quality of evidence-based medicine.
Prevalence of Intestinal Parasitic Infections among Food Handlers from Greater Cairo, Egypt
Authors: El Araby A , Shihata M A , Aminu H A , Khalifa K E
Published: July 2024

Background

Foodborne illnesses caused by intestinal parasitic infections (IPIs) are among the major health problems especially in developing countries. Food handlers play an important role in transmission of IPI during manufacturing, processing, handling, and serving of foodstuff.

Objectives

The aim of the present study was to determine the prevalence of IPIs among food handlers in Greater Cairo, Egypt and their associated risk factors.

Methodology

A cross sectional study was designed whereby 250 food handlers attending four provision health offices from different governorates of Greater Cairo were examined. The demographic data, job title and position, health certification as well as risk factors that might increase the transmission of IPIs were collected in a pre-designed questionnaire. Stool samples were collected from all participants and examined by direct wet/iodine mounts, formol diethyl acetate and modified Ziehl_Neelsen staining techniques.

Results

65 food handlers (26%) were found to have IPIs. The commonest parasites detected were Entamoeba histolytica (24.6%), Entamoeba coli (20%), Blastocystis hominis (16.9%), Giardia intestinalis (12.3%), followed by Enterobius vermicularis (10.8 %), Ascaris lumbricoides (7.7 %) and Schistosoma mansoni (3.1%). Higher, statistically significant (P < 0.001), prevalence of IPIs was found among food handlers from rural areas, having low educational levels, not having previous health certificates and among those working in popular restaurants and those having poor personal hand hygienic measures. While no differences in prevalence of IPIs was found regarding age, sex, and work experience duration.

Conclusion

It was concluded that implementation of governmental policies ensuring routine medical checkup and continuous professional training and education of food handlers are essential for prevention of IPIs among food handlers.
Non-Invasive Electrical Cardiometry versus Echocardiography for Assessment of Patent Ductus Arteriosus Hemodynamic Response to Medical Treatment in Preterm Neonates
Authors: Gad Ghada Ibrahim , Abd–El-Aziz Eman Mahmoud , El-Samman Nora Hussein , Saleh Ghada Ahmad
Published: July 2024

Background

Patent ductus arteriosus (PDA) poses a diagnostic and a therapeutic dilemma for neonatologists. Although echocardiography (Echo) has been the gold standard diagnostic tool for PDA, it requires a trained cardiologist or neonatologist to perform and it is usually not available around the clock. Echo provides also a single rather than continuous assessment of the sick neonates, whose hemodynamic status changes quickly. Electrocardiometry (EC) is a new device for continuous hemodynamic monitoring of neonates.

Aim of the Work

To evaluate the accuracy and precision of EC in comparison to ECHO in assessment of PDA response to treatment in preterm neonates.

Patients and Methods

This diagnostic accuracy study was conducted in the neonatal intensive care units (NICUs) of Children’s Hospital of Ain Shams University, Cairo, between (1/5/2021 and 31/3/2022). The study was approved by the ethical committee of Ain Shams University. Preterm neonates<35weeks gestational age admitted during the study period were eligible for enrollment. Neonates with hemodynamically non-significant PDA and those with other congenital anomalies were excluded. A baseline echo and electrical cardiometry were done at the time of enrollment and on day 5.

Results

Forty neonates were enrolled (27 females, 13 males). Closure rate of oral ibuprofen was 100% (39/39) while paracetamol failed to close the PDA in one patient (closure success 0%). Echo and EC didn’t agree upon the tested parameters (stroke volume (SV), cardiac index (CI), ejection fraction (EF), cardiac output (CO) but agreed in measuring heart rate (HR). In patients with inotropes, Echo detected significant changes in CO (p = 0.044) and CI (p = 0.047) but no changes in SV, EF and HR (p = 0.41, 0.506 & 0.105 respectively). In patients who needed mechanical ventilation, Echo detected significant changes in CI (p = 0.008), CO (0.006) and SV (0.042). No changes were detected in any parameter by EC in patients who needed either inotropes or mechanical ventilation (p > 0.05 in all parameters).

Conclusion

While EC is safe and an easy to apply device, our results show that electrocardiometry is not as accurate as the echocardiography in predicting the hemodynamic changes that might correspond to the closure of PDA in preterm neonates with hemodynamically significant PDA.
Cord Blood Hemoglobin Levels in Full Term Neonates of Mothers with Iron Deficiency Anemia
Authors: El-Deen El-Farghali Ola Galal Bader , Ahmed Mortada El-Sayed , Abdel Hamed Azzam Nesmahar Tark , El-Mohamdy Hasb El-Nabi Marwa Adham , AbdElaziz Rezk Sara Helmy
Published: July 2024

Background

Iron is a critical micronutrient for tissue oxygenation, cellular metabolism, energy generation, and the metabolism of toxins. Iron transfer from mother to fetus is a regulated process involving iron status in the maternal circulation, its transport across the placenta and subsequent transfer into the fetal circulation.

Objective

To evaluate cord blood Hemoglobin (Hb) levels in neonates of mothers with iron deficiency anemia (IDA).

Patients and Methods

This prospective case-control study was conducted at Ain Shams University Hospitals. It included 60 full terms newborn who were born at Obstetrics and Gynecology Hospital. The study population included full term neonates delivered at ≥ completed 37 weeks of gestation which was divided into two groups according to maternal risk factor: Case: full term neonates with maternal risk factor. Control: full term neonates without maternal risk factor. Thorough clinical examination and investigations were performed including cord blood samples collected for measurement of the level of complete blood count (CBC; (Hb, MCV and MCH). For the mothers, venous blood samples were withdrawn with standard precautions and strict sterile conditions for CBC, transferrin saturation and serum ferritin.

Results

In comparison between cases and controls as regard RBCS parameter, there was no significant difference between cases and controls regarding neonatal hemoglobin( 14.93±1.14 vs 15.44 ±1.35(g/dL), p = 0.12) and MCH (32.51±2.9 vs33.57 ±1.9 (pg), p = 0.10), but there was significantly lower MCV in cases compared to controls (104.07± 7.36 vs 109.60±4.93 (fL), p = 0.001). There was no significant difference between cases and controls as regard maternal clinical characteristics including (age, weight, height, maternal diseases, gravidity, consanguinity and mode of delivery, p > 0.05 for all). Also, there was no significant difference between cases and controls regarding neonatal weight, Z score for weight, length (cm), head circumference (cm) and gestational age by Ballord Score and Apgar Score in 1-minute and 5-minute score p > 0.05 for all).

Conclusion

There was no relation between the maternal Hb deficient levels and neonatal Hb. The first sign of iron deficiency in neonates reflected in lower MCV in cases, but not reached to decrease Hb levels in neonates.
Evaluation of Vitamin (A) Deficiency among Critically Ill Children with Sepsis
Authors: Ibrahim Hanan M , Abd El Aziz Manal M , Magdy Sondos M , Essam Haya M , Gad Ebthal E
Published: July 2024

Background

Vitamin A is an immunomodulatory, and its deficiency may cause impaired immune function, which are found in sepsis. There is a biological rationale that vitamin A deficiency (VAD) may be a contributing factor related to poor clinical outcomes in patients with sepsis.

Aim of the Work

to assess the prevalence of vitamin A deficiency in critically ill children with sepsis and its association with clinical outcomes.

Patients and Methods

This cross-sectional study included 40 critically ill children with sepsis who were admitted to the paediatric intensive care unit. The control group consisted of 40 age- and sex-matched approximate-health children from outpatient clinic. For the measurement of serum vitamin A status, blood samples were taken from all patients within the first 24 hours of admission. The vitamin A status of the sepsis and control groups were compared. Univariate and multivariate approaches were used to assess the link between vitamin A deficiency and sepsis.

Results

The study enrolled 40 children with sepsis and 40 matched healthy children so there was no statistically significant difference between controls and patients among age and sex, with median age 4 (2 – 12) months for both groups with male predominance (60.0%). Regarding body measures there was a high statistically significant lower values among patients group than controls group for z score of weight, height/length, body mass index (BMI) and mid arm circumference (MAC) of the studied subjects, that indicated increased malnutrition prevalence among septic children than control group. In the present study, by comparing VAD between patients and controls, there was high statistically significant difference as all septic patients (100%) had VAD and the VAD among healthy control was found in 30% of them. We also found that patients with septic shock, patients who were nothing per os (NPO), patients on ventilators and died patients were more deficient in vitamin A level than other patients compared with them (high statistically significant difference), illustrated that VAD may be had a role in sepsis related morbidity and mortality. There was a positive correlation between vitamin A and BMI z score and MAC while there was a negative correlation with prism 3 and prism 4.ROC curve for assessment of vitamin A as a predictor of sepsis, found that at cut off value ≤9 μg/dl, the Sensitivity, Specificity, positive predictive value (PPV) and negative predictive value (NPV) were 100% for each.

Conclusion

low level of vitamin A, lower than or equal to 9 μg/dl was associated with sepsis, septic shock, and higher PRISM score. Vitamin A deficiency may be a marker of morbidity and mortality in critically ill children with sepsis.
Assessment of the Validity and Reliability of an Arabic Version of Autism Behavior Checklist: One Center Study
Authors: Rihan Lamiaa Safwat , Youssef Azza Mohamed , Abdelaziz Asmaa Wafeeq , Abdelmageed Reham Ibrahim
Published: July 2024

Background

Autism behavior checklist (ABC) is a list of questions concerning a child's behaviors as a part of a broader tool, the Autism screening instrument for educational planning (ASIEP). To date, this checklist has not been translated into Arabic, and therefore, it cannot be used with Arabic speaking patients.

Objective

To translate the Autism Behavior Checklist from English to Arabic and to assess the psychometric properties of the Arabic version.

Patients and Methods

A total of 400 Arabic fluent mothers or caregivers of autistic and typically developed children aging 2-14 years recruited from Developmental and behavioral clinic and outpatient clinic-pediatrics hospital, Faculty of Medicine, Ain Shams University participated in the study. The Arabic version of Autism behavior checklist was checked for its structural validity and reliability.

Results

Of 400 children included in the study, the autism group consisted of 114 boys (76%) and 36 girls (24%), mean age was 7 years ± 1.8 years, and the typical development group consisted of 145 boys (58%) and 105 girls (42%),mean age was 7.4 years ±1.6 years. The Autism behavior checklist was translated following the international guidelines. Autism behavior checklist yielded a five factors model by exploratory factor analysis (EFA). Kaiser-Meyer-Olkin (KMO) statistic was (0.671), Bartlett's Test of Sphericity was statistically significant (P-value< 0.05) with chi square test value of (χ2 = 22231.064, df = 1596). Overall, the 75 items revealed good internal consistency, Cronbach's alpha was (0.972), the intra- class correlation coefficients (ICC) of the five subscales ranged from 0.423 to 0.677 (P < 0.01). At two weeks interval the ICC of the five subscales ranged from 0.335 to 0.856 and the total score was 0.869 (P < 0.01).

Conclusion

The Arabic version of Autism Behavior Checklist (AV-ABC) is a valid and reliable tool to screen and assess cases with autism spectrum disorder.
Possible Protective Effect of Trimetazidine Alone and in Combination with Methotrexate in Attenuating Joint Inflammation in Freund’s Adjuvants Induced Rheumatoid Arthritis in Rats
Authors: Omran Enas , Mohamed Doaa I , Ezzat Samar F , El Lithy Ghada , Tarek Marwa
Published: July 2024

Rheumatoid Arthritis is a complex chronic auto-immune systemic illness. It is primarily characterized by synovial hyperplasia and localized pro-inflammatory cytokine production that causes chronic synovitis and a long-lasting inflammation of the joints and bones. The study's goal was to look into the potential anti-arthritic effects of trimetazidine in a rat model of Freund’s complete adjuvant (FCA)-induced arthritis, which has many clinical and biochemical similarities to rheumatoid arthritis (RA). The underlying antirheumatoid arthritis mechanism, as well as its impact on TLR4/NFKB pathway were investigated to understand and confirm its potential efficacy in RA treatment. Our study was based on 4 groups, control group received saline injections, trimetazidine (7.2 mg/kg/day) treated group, methotrexate (0.75 mg/kg/week) treated group and combination group that received both medications in the same doses for 21 days. The degree of ipsilateral paw swelling, ankle diameter, body weight, tissue expression levels of TLR4(toll like receptor) and NFKB (nuclear factor kappa b) in paw, and serum ACPA (anticitrullinated protein antibodies) were all measured. With a slight but not statistically significant impact on ankle diameter, trimetazidine and methotrexate considerably reduced the arthritic symptoms as indicated by ipsilateral paw volume. It had no discernible impact on body weight. Together with the overall improved synovial hyperplasia and cartilage disarrangements, TLR4 and NFKB expression in synovial tissue were reduced. In a rat model of CFA-induced arthritis, trimetazidine displays a considerable anti- inflammatory impact that is even better than methotrexate and has the potential to be anti-arthritic. Additionally, there is a large additive effect between the two medications.
Role of Vascular Endothelial Growth Factor A in Pediatric Hemophilic Arthropathy
Authors: Mohamed Saboony Omar Ahmed , El Sebaie Mona Abdullah , Mohamed Ragab Iman Ahmed , El Din El Mikkawy Dalia Mohamed Ezz , Abdelmohsen Labib Hossam Salaheldin
Published: July 2024

Background

Hemophilia A is a hereditary bleeding disorder caused by the lack of blood clotting factor VIII. The incidence is about 1 in 5000. Although some progresses have been made in the treatment of the disease, arthropathy caused by joint bleeding is still a challenge to prevent and treat, which often results in joint deformity and disability, Biomarkers may give us the chance to early predict the joint arthropathy.

Objective

assess the level of serum VEGF-A as a vascular biomarker in children with hemophilia A to identify its possible role in hemophilic arthropathy and its severity.

Methods

This study included thirty child patients with clinical evidence of hemophilic arthropathy and thirty healthy matched age and sex as controls. All underwent history taking, clinical examination, Laboratory investigations including Vascular endothelial growth factor A.

Results

serum VEGF-A levels were significantly higher in patients than control group (p > 0,001) with sensitivity of 83.33% and specificity of 70.0%.it showed significant positive correlation with hemophilia severity (r=-0.734)(p < 0.001).

Conclusion

serum VEGF-A level was higher in Hemophilic patients which serve as a diagnostic marker for HA, also its significant correlation with severity may serve as a marker for disease progression and severity.
Aesthetic and Functional Evaluation of Abdominal Contouring Using Lipo-Abdominoplasty versus Lipo-Abdominoplasty with TULUA Procedure: A Comparative Clinical Study
Authors: Fahmy Hany Fouad A , Helal Hesham A , Afifi Salah Nasser M , Elsherbeny Khaled M , Mohamed Eman Nagy
Published: July 2024

Background

Lipoabdominoplasty techniques may be followed by a wide range of complications as flap necrosis, wounddehiscence, surgical site infection, epigastric bulging, malpositioned umbilicus, high transverse scar and seroma formation. Villegas in 2014 introduced the TULUA abdominoplasty to improve the aesthetic outcome and to avoid the many associated complications mentioned. The objective of this study is to compare the aesthetic and functional outcomes between the traditional lipoabdominoplasty and TULUA abdominoplasty.

Methods

in this prospective comparative clinical study, sixty adult women with excess subcutaneous abdominal fat and skin laxity after repeated pregnancies with mild to moderate degree of diastasis of recti were included. The patients’ ages ranged between 28-55 years, their BMI scores were 25-35 kg/m2. Group A (30 patients) underwent lipoabdominoplasty while group B (30 patients) underwent TULUA abdominoplasty. The patients were followed up for a minimum of 6 months where the comparative study included aesthetic results as regards the abdominal contouring using clinical outcome scaling systemin addition to functional aspects assessing anatomical features, changes in anterior abdominal wall and finally the complication rate between both techniques.

Results

The average total liposuction aspirate volume of the abdomen was 2400 ml in group A, while in group B, the average volume was 3500 ml. The mean surface area of vertical plicature measured intraoperatively was 211.93 (±54.66) cm2 in group A, while in group (B) transverse plicature surface area was 369.47(±84.22) cm2. The increase in intra-abdominal pressure IAP after plication and skin closure in group A was 7.93±1.26 cmH2O; while for group B there was a highly significant increase by 9.87±1.01 cmH2O. Flap sloughing was seen in 4 cases(13.3%), wound dehiscence 2 cases (6.6%) seroma in 3 cases(10%) for group A,conversely no cases reported flap necrosis, wound dehiscence or seroma that need to be aspired in group B. The aesthetic outcomes were evaluated using a 5 points likert scale system through three indicators, f or group A,an overall result that was 4.50 ± 0.87, umbilical appearance 4.61±0.73, and scar quality 4.35 ± 0.82; On the other hand group B showed overall result 4.53 ± 0.71, umbilical appearance 4.52 ± 0.82, and scar quality 4.43 ± 0.87.

Conclusions

TULUA procedure is a safe, reproducible shift in abdominoplasty, with fewer complications to occur.
Assessment of Patients’ Satisfaction after Reconstruction of Unilateral Microtia Using Modified Questionnaire Form
Authors: Shafik Fady Rezk , Abdelhalim Mohamed M , Gad Ahmed M , Elshahat Ahmed
Published: July 2024

Background

Microtia is a rare and severe craniofacial abnormality that impairs newborns' appearance. The most favored treatment for microtia is regarded as autologous ear reconstruction. Patient satisfaction is paramount element in improvement of surgical outcomes. Most studies depended on medical stuff reviews for reconstruction.

Aim of the Work

Thus, this study aims to help define items that individual’s own satisfaction is based on.

Patients and Methods

In this cross sectional study, 44 patients, 28 females and 16 males ; with unilateral microtia underwent autologous ear reconstruction using costal cartilage graft were selected. Bilateral cases and Anotia types were excluded.6th to 8th costal cartilage were harvested in the 1st stage to shape the framework. Elevation was done in the 2nd stage. Satisfaction was recorded using a questionnaire form 4 months postoperatively.

Results

All patient were satisfied with their surgery and never regret doing it. Helix and lobule get higher satisfaction rates than those for antihelix and concha.

Conclusion

Helix and lobule of reconstructed auricle get the highest level of satisfaction while antihelix and concha still need more continuous work and follow up to enhance their aesthetic outcome.