bluuebunny/crossref_metadata_2025 huggingface dataset:
Sleep quality among a sample of Egyptian truck drivers
Authors: Yosef M , Abdelhamid M A , Salaheldin W , Elhabiby M , Rady M
Published: May 2020

Background

“Road traffic accidents” is a major health problem and it is significantly related to the mean daily sleep hours and sleep quality. This study aims to explore the sleep quality among a group of Egyptian truck drivers.

Methodology

A convenience sample of 117 male truck drivers working on Cairo – Suez highway was selected. Socio-demographic and occupational history were collected using an interview questionnaire and the Pittsburgh sleep quality index (PSQI) was calculated.

Results

The mean age of the studied drivers was 38.7 ± 9.7 y, 82.1% were married and 79.5% were current smokers. The mean driving hours per day was 15.35 ± 4.77, the mean sleeping hours per day was 5.8 ± 2.3 and 48 drivers (41%) had poor sleep quality according to the cutoff 5 for PSQI questionnaire. There was a significant difference between drivers with good vs poor sleep quality regarding number of cigarettes smoked per day, hours of work per day and mean distance travelled per day. Multivariate logistic regression showed that hours of work per day was the only significant predictor with poor sleep quality. Among drivers with poor sleep quality 16.3% reported having accidents in the past year which was significantly higher (p = 0.016) than those who had good sleep quality (2.9%), Odds Ratio: 6.4, 95% CI; 1.3-31.8.

Conclusion

Poor sleep quality is associate with increased risk of road traffic accidents among the studied truck drivers and the main factor that affect sleep quality is the number of working hours per day.
Tumor Necrosis Factor alpha 238 G/A polymorphism and its relation to severity and cardiovascular risk in psoriasis
Authors: ElSayed M H , Ahmed S E , Ali K , ElKhazragy N N , Attia M S
Published: May 2020

Background

Psoriasis is known as chronic immune-mediated inflammatory skin disease affecting about 3% of the world’s population. Cytokine gene polymorphism attracted considerable interest as they have been found to alter gene transcription thereby influencing inflammatory processes in response to various diseases.

Subjects

A total of 50 psoraitic patients and 50 controls were genotyped for TNF–α −238G/A polymorphism by using polymerase chain reaction. ECG and lipid profile were done to assess cardiovascular risk.

Results

Polymorphism of TNF–α −238 was not found to be associated with an increased risk for psoriasis (p value 0.98). There is significant difference between cases and controls as regard systolic and diastolic blood pressure .

Conclusion

Our findings suggest that there is no association between TNF alpha polymorphism and risk of psoriasis in Egyptian psoraitic patients.
Role of Lactoferrin in Chronic Telgon Effluvium
Authors: Milad G T , Diab H M , Elhusseiny R M
Published: May 2020

Background

Telogen effluvium (TE) is a widely prevalent hair condition and the second most common cause of hair loss after androgenetic alopecia. It presents as a nonpatterned increase in shedding of terminal hairs, diffusely over the entire scalp that can produce an apparent thinning of hair in severe cases. Both genders can experience telgon effluvium but females are the greater proportion of those who complain. Acute telgon effluvium is a form of non scarring alopecia with sudden conversion of large numbers of actively growing anagen to telogen hair leading to diffuse hair shedding. It is usually seen after severe illness, surgery, nutritional deficiency specially iron deficiency, postpartum, thyroid disease and in association with medications such as retionids, captopril and propranolol. It is reversible once the initiating factor is eliminated. Chronic TE (CTE) is a primary or idiopathic generalized telogen hair shedding from the scalp lasting more than 6 months without any apparent cause. It is characterized by insidious onset and fluctuating course. On examination, the hair appears normal in thickness with shorter re-growing hairs in the frontal and a bitemporal area, the hair pull test is commonly positive.

Objectives

The aim of this work was to assess the correlation between serum iron, ferritin and lactoferrin in chronic telgon effluvium with different clinical severities further supporting the notion for iron and lactoferrin supplementation in treatment of chronic telgon effluvium.

Patients and Methods

This study included 48 randomly selected patients suffering from chronic telogen effluvium attending outpatient clinics of Cairo hospital for dermatology and venerology (Al Haud Al Marsoud) and 40 control subjects, both cases and controls were age & sex matched. Laboratory assessment of CBC, serum iron, serum ferritin and lactoferrin in both cases and control groups.

Results

This study comprised of 48 patients with chronic telogen effluvium and 40 control subjects. Patients aged from 19-37 years old (mean 23.4 ± 5.4). 6 patients (12.5%) were males and 42 patients (87.5%) were females. The 40 control subjects involved in our study; aged from 20-36 years (mean 27.6 ± 5.4). 62.5% of patients had positive family history of similar condition; mean duration of disease was 25.4±14.9 months while associated androgenetic alopecia (diagnosed by trichoscopy) was seen in 56.3% of patients. Regarding severity, mean hair shedding visual scale was 4.38±1.47, while mean manual daily counting was 257.94±149.4.

Conclusion

Serum ferritin and lactoferrin were significantly lower in chronic telogen effluvium patients compared to controls while no significant difference in hemoglobin and serum iron was recorded.
The Effect of Atorvastatin on ADMA Level and Erectile Function in patients with Vasculogenic Erectile Dysfunction
Authors: Emam A , Abdallah M , Khalil M
Published: May 2020

Background

Erectile dysfunction (ED), the inability to achieve and/or maintain an erection sufficient to permit satisfactory intercourse, is a highly prevalent disease whose aetiology is mostly vasculogenic. It is associated with subclinical coronary artery disease (CAD) and is nowadays considered a marker of future cardiovascular events. The higher prevalence of ED in patients with cardiovascular risk factors(CVRF) reflects the underlying endothelial dysfunction.

ADMA is a naturally occurring amino acid that exists as a result of proteolysis of methylated proteins. Several factors, such as oxidative stress and increased levels of low-density lipoproteins (LDLs), are responsible for induced production of ADMA in endothelial cells.

In our study, atorvastatin administration resulted in a significant decrease in ADMA levels and improvement of erectile function

Aim

To demonstratethe effect of Atorvastatin on ADMA level and erectile function in patients with normal or high LDL level vasculogenic erectile dysfunction.

Patients and Methods

The study will include 30 patients aged 30-60 years old with vasculogenic erectile dysfunction.The patients will be collected from The Andrology Outpatient Clinic – Ain-Shams University Hospitals.

Results

Among the study group 10 subjects showed moderate elevation of plasma ADMA (33.3%), 10 subjects with high level (33.3%) and 10 subjects with normal level (33.3%), while in control group only 5 subjects had high ADMA level, one subjects with moderate elevation and 24 subjects had normal level (80%)

There was high significant reduction in both ADMA and LDL level after atorvastatin treatment and significant improvement in IIEF score, However no significant change in Testosterone level

CONCLUSIONS

We demonstrated that short-term treatment with atorvastatin has great influence on plasma ADMA levels with marked improvement in lipid profile (LDL) and erectile function in both normolipidemic and dyslipidenic patients.
Pathological Role of Biofilm in Fungal Rhinosinusitis
Authors: Ezzat W F , Askoura A M , Elshazly A N , Falah H Y
Published: May 2020

Background

The first case of fungal sinusitis was reported in 1885. This fungal disease occurred rarely until the past decade, when a worldwide increase in its incidence occurred. Till one decade back bacteria was implicated as pathogen in most form of chronic rhinosinusitis (CRS). Fungi were thought to be responsible for few specific forms, sine 1999, when ponikau and associates claimed that fungi were responsible for nearly all cases of CRS. Their study demonstrated the presence of fungi & eosinophils from nose & paranasal sinuses from ∼96 % cases of CRS.

Aim of the Work

The aim of the work was to detect the presence of fungal biofilm, in patients with fungal sinusitis trying to find its role in recurrence of fungal sinus infection, resistance to medical treatment and occurrence of intra orbital and intracranial complications.

Patients and Methods

The study consisted of 20 different cases of fungal sinusitis controlled by 10 cases of non fungal sinusitis. Control cases were divided into 5 cases of chronic sinusitis with nasal polyposis and 5 cases of deviated septum with no evidence of sinusitis undergoing nasal surgery.

Results

Using statistical analysis, there was evidence of pressure of fungal biofilm in different cases of fungal sinusitis whether primary or recurrent, also whether invasive or non invasive. Comparing cases with controls, There was statistically significant difference between them as regard Biofilm (p-value: < 0.001) with incidence reaching (70 %) in cases while (0%) in controls. By applying risk analysis for biofilm, we used relative risk (p value = 0.0001) which is statistically significant indicating higher risk of positive biofilm in cases of fungal sinusitis, also by Using odds ratio (p value= 0.0002) which is statistically significant indicating higher risk of positive biofilm in cases of fungal sinusitis.

Conclusion

The study showed the presence of fungal biofilm in different cases of fungal siunsitis whether primary or recurrent, also whether invasive or non invasive.
Early versus delayed oral feeding post total laryngectomy and relation to trachea-oesophageal fistula formation
Authors: Elibiary H A , Aboelezz T A , Mady O M , Keshk A O T
Published: May 2020

Background

total laryngectomy is the most common procedure in treatment of advanced laryngeal malignant tumors. Total laryngectomy although an important and reliable method of management, still carries a lot of short term and long term complications. One of the common complications is the pharyngocutaneous fistula. Being a major risk factor of longer hospital stay, morbidity and wound infection. Pharyngocutaneous fistula is studied carefully concerning causes, risk factors and management. Oral feeding and voice rehabilitation are two valuable outcomes for the patient. Both could be disturbed by occurrence of pharyngocutaneous fistula. Oral feeding usually starts by the seventh to tenth day postoperative to allow adequate time for pharyngeal closure as believed by many surgeons for decades. Recent studies including our study discuss the possibility of early oral feeding versus conventional delayed feeding and its advantages regarding hospital stay and incidence of fistula.

Aim

The aim of this study is to points out the rate of pharyngocutaneous fistulae incidence after total laryngectomy in two different groups of patients depending on timing of post-operative oral feeding. Oral feeding usually starts after 7-10 days of surgery to allow for complete healing and closure of pharyngeal repair.

Methodology

A meta-analysis study is done to assess the feasibility and the possibility of early oral feeding after total laryngectomy versus delayed oral feeding. The outcome is the occurrence of pharyngocutaneous fistula in each group.

Results

In all included studies the incidence of pharyngocutaneous fistula was 168/1374 (12.23%) in early feeding group versus 69/570 (12.11%) in the delayed feeding group. The statistical difference was insignificant P > 0.05

Conclusion

Early oral feeding after total laryngectomy during the first 72 hours post-operative is a safe clinical practice and results in shorter hospital stay.
Effectiveness of Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea (Meta-analytic Study)
Authors: Mahmoud M , Mohamed A , Mohamed A , Nasr H
Published: May 2020

Background

Obstructive sleep apnea (OSA) is a serious, potentially life-threatening disorder. There are many treatment modalities are being used, but none of them gained consensus. Continuous positive airway pressure considered the most widely accepted treatment of OSA but very poor adherence limits its effectiveness, thus was the need for alternative therapy of high compliance and effective for long term.

Aim of the Work

To perform a meta-analysis of the available studies included outcomes of hypoglossal nerve stimulation to evaluate its effectiveness as a choice of treatment of obstructive sleep apnea.

Patients and Methods

The study included published medical articles that evaluated the efficacy of hypoglossal nerve stimulation as treatment of obstructive sleep apnea with outcomes for primary outcome measures apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and for secondary outcome measures Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ) before and after implantation.

Results

Eight prospective studies with 329 patients were included in this met analysis. At 12 months, statistical analysis demonstrated significant reductions in AHI, ODI with standardized mean difference of -1.3940 (95% CI: -1.7745 to -1.0136; P = 0.0042), -0.9188 (95% CI: -1.3040 to -0.5337; p = 0.0002) respectively, and -not significant- reduction in ESS, FOSQ with standardized mean difference of -1.0365 (95% CI: -1.1889 to -0.8841; p = 0.2290), 1.0545 (95% CI: 0.8867 to 1.2223; p = 0.4922), respectively. Similar were observed at 6 months.

Conclusion

Hypoglossal nerve stimulation results in significant improvement of primary outcome measures of OSA with significant reduction of apnea episodes. It could be considered as an effective -but still of high cost- alternative for OSA patients. Further studies comparing HNS to other therapies are needed.
Acoustic Change Complex (ACC) using Speech and Non-Speech Stimuli in Normal Hearing Children
Authors: Elkholy W A , Hassan D M , Shafik N A , Eltoukhy Y E K
Published: May 2020

Background

Cortical auditory evoked potentials (CAEPs) are brain responses evoked by sound and are processed in or near the auditory cortex. ACC is a cortical auditory evoked potential (P1-N1-P2) elicited by a change within an ongoing sound stimulus.

Objective

To reach the best stimuli that can elicit ACC and act as an objective tool for assessment of cortical auditory discrimination in normal hearing children.

Patients and Methods

The present study was originally designed to standardize ACC evoked response in 41 children aged from 2 to 10 years. The mean age in our study group was 6.2 years with no significant difference between males and females. Stimuli used in this study were specifically designed to be used by AEP equipment that is capable of uploading short duration stimuli (500 msec.), thus can be used in a regular AEP lab. ACC was elicited by three groups of stimuli. Gap-in-tones stimuli represent temporal change (6, 10, 30 and 50 msec. gap introduced to 1000 Hz tone separately), frequency pairs stimuli represent frequency change (2%, 4%, 10% and 25% change from base freq. 1000 Hz) and vowel pairs stimuli represent spectral change (/i-u/, /u-i/, /i-a/. /a-i/, /u-a/, /a-u/). ACC response parameters were compared when using the different stimuli as regards percent detectability, morphology, latency and amplitude.

Results

Gap-in-tones at 6 msec. and 4% frequency change could elicit ACC response in 100% of subjects. For spectral change, /u-i/ was the highest in eliciting ACC (78%) followed by /i-u/ (68.2%) then /a-i/ (58.5%). ACC had the same morphology of the onset response in the majority of subjects, with longer latency and smaller amplitude. ACC amplitude is a better indicator of cortical discrimination compared to latency because it is consistently affected by magnitude of change.

Conclusion

ACC is a good electrophysiological tool for cortical auditory discrimination for temporal, frequency and spectral change.
Comparison between The Diagnostic Performance of Positron Emission Tomography and Diffusion-Weighted MRI in Detecting Recurrence of Head and Neck Squamous Cell Carcinoma during Post Treatment Follow-up
Authors: Talaat M A , Hakim E K , Taha M S , Rabie T M , Askoura A M , Youssef B G
Published: May 2020

Background

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy worldwide. (16) Despite aggressive combined-modality treatment regimens, there remains a high percentage (15-50%) of locoregional recurrences.(7) This problem make the clinician to rely on the functional imaging modalities such as Diffusion weighted MRI and Positron Emission Tomography to detect recurrence.

Objective

To perform a meta-analytical study on the comparison between the diagnostic role of DW/MRI and PET/CT scan in detecting recurrence of HNSCC during post-treatment follow-up.

Methods

This meta-analysis was conducted from 1/1/ 1998 to 31/3/2018 . Literature search on PubMed and Google scholar was done to identify randomised controlled trials and comparative studies either prospective or retrospective. MedCalc ver. 18.2 (MedCalc, Ostend, Belgium) was used for data analysis.

Results

Of the eight articles included, The meta-analysis was based on a total of 199 patients. All of them used DW/MRI and 186 of them used PET/CT. Comparative study between the two groups regarding sensitivity, specificity and accuracy revealed; highly significant difference in sensitivity in favor of PET/CT (p < 0.009), significant increase in specificity in favor of DW/MRI (p = 0.048) and no significant difference in accuracy between the two group.

Conclusion

PET/CT scan was found to be more sensitive than DW/MRI while DW/MRI was found to be more specific than PET/CT. Yet both have the same degree of accuracy.
Intracorporeal Suturing of MESH and Peritoneum during TAPP as Substituting for Tackers
Authors: Sabry A A , Ahmed D H , Mohammed O Z A
Published: May 2020

Background

groin hernia repair is considered to be one of the most commonly performed operations by general surgeons however; there is no “gold standard” operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, taking into account patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, and type of anesthesia, occupation, and leisure activities.

Aim of the Work

is to compare the outcome results of the laparoscopic total extraperitoneal TEP hernia repair with mesh or the transabdominal preperitoneal repair (TAPP) with mesh to those of open repair with mesh.

Patients and Methods

this is a prospective study conducted on those who are diagnosed to have inguinal hernia (direct, indirect). 40 cases with direct, indirect, unilateral or bilateral inguinal hernia and will be divided into two groups:

Group A

20 cases fixation a mesh with Tackers

. Group B

20 cases fixation a mesh with intracorporeal sutures. The study will be Conducted at Ain Shams University hospitals (El-Demerdash) and other authorized hospitals under supervision of thesis supervisors.

Results

smoking appears to be a risk factor for hernia development since almost 55% of the study group A and 65% of the study group B were smokers, obesity also appears to be a risk factor since BMI was about 30.20± 7.82 among group A and 32.05 ± 5.98 among group B. This is in contrast to age which seems not to be as strongly related.

Conclusion

we found the rate of postoperative early and late complications comparable in both groups. But in the LAP group we were able to discharge them from the hospital faster than the OPEN group, they also resumed full activity early.
Radiofrequency Ablation of the Great Saphenous Vein versus Conventional Surgery in Treatment of Venous Ulcers
Authors: Elazazy H H , Rizk M A , Elsehly M S M
Published: May 2020

Background

Chronic venous disease (CVD) is the most common venous disorder. It is caused by venous hypertension due to either reflux, outflow obstruction or both.

Aim of the Work

To analyze the benefit of Radiofrequency ablation of the great saphenous vein versus conventional surgery in healing of venous ulcers.

Patients and Methods

This randomized controlled clinical trial was conducted in the vascular surgery unit at the study was conducted at Ain Shams University Hospitals and Nasser institute hospital in Cairo under supervision of thesis supervisors with Follow up at 2, 4 and 6 months. The study included 40 patients (20 patient for EVLA & 20 patient for conventional Surgery) suffering from primary varicose veins with venous ulcer. Our range of age was 18-51 years.

Results

The present trial confirmed that both surgery and RFA are highly efficacious. Both resulted in significant decrease in venous ulcer size and improvements in the objective severity of venous disease.

Conclusion

RFA is less time consuming than stripping as regard operation time. As regard hospital stay RFA was done as one day surgery cases as they were done under local anesthesia, in stripping group almost patients discharged on the next day as they had been done under spinal anesthesia.
Round Block Technique Versus Reduction Mammoplasty in Treatment of Early Breast Cancer
Authors: Abdelrahman S A , Reda A A , Guirguis S M , Abdelmoaty K F , Abdelhakim S E
Published: May 2020

Background

Early breast cancer can be defined as the presence of a mobile tumor within the breast with or without associated mobile enlarged lymph nodes, and represents the vast majority of patients who present now with breast cancer. Breast-conserving treatment (BCT) has become the standard treatment in early-stage breast cancer; Its goal is to provide a treatment as effective as mastectomy, with the added benefit of a preserved breast.

Aims

The aim of the study is the comparison between Round block technique and Reduction mammoplasty in management of early breast cancer.

Methodology

This is a prospective controlled clinical study which included 30 patients, who were admitted to Ain Shams University Hospitals, with a diagnosis of early breast cancer T1 or T2, N0 or N1, M0. Patients were subdivided into 2 groups: Group I: This group is composed of 15 patients with early breast cancer (T1 or T2, N0 or N1, MO) underwent\Round block rechnique. Group II: This group is composed of 15 patients with early breast cancer (T1 or T2, N0 or N1, MO) underwent Reduction mammoplasty.

Results

In our study, there was no significant statistical difference between the two groups regarding: patients age, our patients were younger in comparable to other studies as we reported average age 47(30-62 years) and 43 (30-64 years). Family history, as 2(40%) and 1(30%) in first degree family members. Side of the lesion (mass), was in right breast in (53.3%) and (60%) in group (I) (Round block group) and group(II) (Reduction mammoplasty group), respectively. There was a significant difference, between the two groups as regard: Intraoperative blood loss, intraoperative time, hospital stay, postoperative complication and cosmetic outcome

Conclusion

Oncoplastic surgery gives a new tool for the treatment of breast cancer as much larger volume of breast tissue can be excised, and wider surgical margins can be achieved especially for larger tumors with better cosmetic outcome, in which a standard resection can lead to poor cosmetic results and tumor-involved surgical margins. Patients with early breast cancer with medium size breast with no major ptosis that are candidate for Round block technique and reduction mammoplasty, round block technique is better for them as there is less morbidity, less complications so no delay in radiotherapy, better cosmesis, mostly doesn’t need contralateral breast surgery for symmetrization and Reduction mammoplasty needs more surgeon’s experience.
Longevity and infection free survival of permicath
Authors: Abdelsalam H , Mohamed M I , Helal M A
Published: May 2020

Background

A hemodialysis catheter is a small biocompatible tube made of soft flexible material. It is inserted into a patient’s target vein to provide vascular access for hemodialysis. As important as catheter placing and handling guide-lines to prevent infection reporting standards are equally important, as they are the tools to enable us to evaluate our work attitudes, how much are we sticking to the guide-lines, how are we managing our resources, and are we aware of the resources we have or not.

Aim of the Work

to figure the outcome and infection rate related to tunneled-cuffed catheters in patients with ESRD needing dialysis who were submitted to tunneled cuffed catheter placement during the period from May 2017 to April 2018.

Patients and Methods

This retrospective descriptive study was conducted in 35 TTCs patients in the Vascular Surgery department ASU Hospital. Target population included patients of ESRD who were submitted for tunneled cuffed dialysis catheter placement in the Vascular Surgery department ASU Hospital in the period from May 2017 to April 2018.

Results

A total of 35 TCCs were inserted in end-stage renal disease patients for hemodialysis. Total number of catheter days was 6343 days. The primary unassisted patency rates at 6 months and 1 year were 51.4% and 11.4% respectively. Of the 35 cases 19 (54.28% of the total population) reported infection episode. 5 (26.3% of the infected population) TCCs were removed due to a severe episode of BSI, of the removed TCCs 2 (10.5% of the infected population) were died. The TCC bacteraemia rate was 2.186 per 1000 catheter days. The total number of the removed TCCs was 14 (40% of the total population). The reasons for removal were non-patency, infection, and completion of therapy with percentage of 22, 8%, 14.3%, and 2, 9% respectively.

Conclusion

Tunnelled cuffed haemodialysis catheters are vital line of treatment in patients requiring long term haemodialysis especially elderly population with weak vasculature or consumed peripheral accesses in which it is considered an access of choice.
Assessment of Port Site Complication in Laparoscopic Abdominal Surgery
Authors: Gad K H , Elhefny A M M , Gerges W B , Sebaie M S A
Published: May 2020

Background

Rapid expansion in the volume and complexities of laparoscopic surgeries has been accompanied by complications, many of which can be directly attributed to abdominal access with laparoscopic trocars including visceral injury, vascular injuries, air embolism, subcutaneous emphysema, port site infections, incisional hernia and metastasis occurred post operatively.

Objectives

This study aimed to detect the different port site complications encountered in laparoscopic abdominal surgery in terms of incidence and management.

Patients and Methods

This study was conducted in the surgical operating theatre of Ain-Shams University Hospitals (Demerdash and Ain Shams University Specialized Hospital), Cairo, Egypt, from January 2018 till July 2018.

Results

In this study complications occurred in 37 cases out of the 400 cases (Study subjects). The incidence of port site complications in our study was 9.25%. Vessel injury occurred in 19 out of the 400 cases with incidence 4.75%. Port site infection occurred in 11 out of the 400 cases with incidence 2.75%. Visceral injury occurred in 4 out of the 400 cases with incidence 1%. Port site hernia occurred in 3 out of the 400 case with incidence 0.75%.

Conclusion

Study incorporated 400 subjects operated for different indications laparoscopically and patients developing any kind of complications were recorded and analyzed. The results showed 3(0.75%) port site hernias, 11(2.75%) port site infections,19 (4.75%) vessel injury, 4 (1%) visceral injury and no port site metastasis was detected.
Study the Role of Loose versus cutting of Seton in Treatment of High Perianal fistula in a District Hospital of Health Insurance
Authors: Abdelhameed M S , Elghazawy I M H , Elsayed E A
Published: May 2020

When the track reaches the skin or another epithelialized surface then a fistula is formed. Anal fistula were classified on the basis of its relationship to the sphincters. The definition of high or low describes the height of the track as it traverses the sphincter muscles and not the position of the internal opening which is almost without exception at the dentate line. More accurately according to parks classification fistula in ano can result in an abscess between the internal and external sphincters, which in turn can spread to other parts of the perianal region. Infection can then track in many directions from this focus in the intersphincteric plane.

Background

Anal fistula is an abnormal communicative small channel that has an internal opening and an external opening and connected by the primary track. Our study evaluate the effectiveness of seton in high variety anal fistula.

Objectives

Evaluation the efficacy and safety of seton as surgical management of high anal fistula. Methods: This is a prospective study done on 30 patients in ELNile hospital in one Year period with high variety of anal fistula which is above the dentate line and were treated with seton .Outcome measured during follow up period were- successfully healed, recurrence, incontinence, percentage of complications and patients satisfaction.

Result

Among 30 patients mean age was 42.2+_6.8 years. Overall outcome of the patients showed-fistula completely healed in 27 patients, incontinence occurred in 3 patients and recurrence occurred in 3 patients.

Conclusion

Seton is relatively safe, effective and low cost for the management of high anal fistula with low rate of incontinence. It can therefore, be recommended as the standard of treatment for high variety fistula in ano.
Skin Sparing Mastectomy as an Oncoplastic Surgery Technique for Breast Cancer treatment
Authors: Alanwar A M , Osman A G , Abdelhamed M A , Ebrahim A N E
Published: May 2020

Background

The goal of modern breast surgery is to cure patients with preservation of breast tissue as much as possible with satisfactory physical and psychological outcome. This goal has led to introduction of a new scope of surgery into our clinical practice called oncoplastic breast surgery, with the advantage of combining oncological safety and satisfactory cosmetic outcome.

Objective

To focus on skin sparing mastectomy as a surgical procedure for treatment of breast cancer and to assess outcomes and benefits versus complications.

Patients and Methods

It was a retrospective analytical study that included 30 patients aiming to clinically assess the skin sparing mastectomy as an oncoplastic technique regarding oncological safety and patient satisfaction. This study was conducted at Ain-Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained.

Results

In our study 6 patients underwent SSM and 24 Patients underwent NSM owing to high tumor/breast volume ratio. In our study we were able to conduct an very good cosmetic outcome for a relatively large tumor excisions with 66.7% of the cases (20 patients) falling in excellent and very good score. In our study only one of the patients had malignant recurrence as confirmed by the pathologist in our multidisciplinary team proving that we had performed skin sparring mastectomy technique safely from oncological point of view. The follow up of the malignant recurrence was for the first year as this was the time limitation of our study.

Conclusion

Skin sparing mastectomy has been proven as an alternate to traditional radical mastectomy with the same oncological safety and better cosmetic outcome.
Role of Neoadjuvant Chemotherapy in Stage 1, 2a Breast Cancer in Female Patients Breast Cup (A-C)
Authors: Elilan W A , Osman A G , Abdelaziz M O , Adly K B
Published: May 2020

Background

breast cancer is considered the most common cancer diagnosed in women worldwide with an incidence of 1.7 million new cancer cases in 2012. It is the fifth most common cause for cancer related mortality worldwide with a trend for increased mortality rates despite recent advances in breast cancer management. Currently, breast cancer is the most common cancer and one of the major health burdens for both developing and developed countries.

Purpose

to evaluate the impact of neoadjuvant chemotherapy in female patients stage 1, 2a breast cancer with breast cup (A-C)

Patients and Methods

we collected data from the records of female patients with breast cancer of stage 1,2a who had undergone documented preoperative biopsy and underwent chemotherapy neoadjuvant therapy at Ain Shams University Hospitals from September 2017 to June 2018. An informed consent was taken from all the patients sharing in the study.

Results

this study favors the idea of Neoadjuvant chemotherapy usage prior to any surgical intervention in early stage breast cancer. However, there were other studies that questions its role and demand a reconsideration about the oncological and clinical outcome which require further investigation.

Conclusion

it is clinically important to evaluate the value of the neoadjuvant chemotherapy in early stage breast cancer as it directs the future therapy. Although there is no obvious opinion with or against the neoadjuvant chemotherapy but through our studies the result support its significant role in downsizing and downgrading the tumor.
Assessment of Effect of Preoperative Vitamin D Deficiency on Postoperative Hypocalcemia after Total Thyroidectomy, A Prospective Study
Authors: Farahat M S , Omran H M , Abbas R F , Ghida A A A
Published: May 2020

Background

One-day surgeries are routinely performed for hemithyroidectomy, but hospital stay duration is more controversial after total thyroidectomy due to postoperative, potentially life-threatening complications.

Aim of the Work

The aim of this study is to assess the effect of pre-operative vitamin D3 deficiency on post thyroidectomy hypocalcemia.

Patients and Methods

Type of Study: This was a prospective cohort study which included 60 Egyptian patients for whom total thyroidectomy had been performed. Study Setting: Patients were recruited from general surgery department at Kafr Elshiekh University Hospital and Ain Shams University Hospital. Study Period: The study duration was form April 2018 to October 2018.

Results

The main findings of the current study as regards to calcium was that the mean preoperative level of calcium was 9.61 ± 0.48 mg/dl, the lowest level of postoperative calcium was detected after 48 hours (9.03 ± 0.73) and the highest postoperative level was measured 12 hours after the operation. With respect to relation between calcium and preoperative vitamin D, the results showed that no patients with normal preoperative vitamin D had a postoperative hypocalcaemia 12, 24, 48 or 72 hours after the operation. After one month, however, 2 patients with normal preoperative vitamin D level, had hypocalcaemia. It worth mention that these two patients had border line normal preoperative vitamin D level. The percentage of patients with low preoperative vitamin D level who had postoperative hypocalcaemia was 5%, 5%, 25% and 15% after the operation by 12, 24, 48 and 72 hours respectively while after one month, the percentage was 10%. The differences between hypocalcaemia incidence between patients with normal and below normal vitamin D levels was statistically significant although it was a borderline significance. The sensitivity and specificity of preoperative vitamin D level in prediction of postoperative hypocalcaemia was 87.50% and 40.91% respectively.

Conclusion

After investigating the postoperative calcium level in patients with and without preoperative vitamin D deficiency, the study had the following conclusions: Vitamin D deficiency is significantly common among Egyptian population, postoperative hypocalcaemia is closely related to the preoperative vitamin D level and patients with hypovitaminosis D are more labile to hypocalcaemia and females are more likely to have postoperative hypocalcemia.
Management of Post-operative Leakage after Sleeve Gastrectomy (A Systematic Review)
Authors: Khalil A I , Lasheen M A , Elzayyat I M , Hammad O R K
Published: May 2020

Background

the prevalence of obesity and overweight have reached epidemic proportions in the last decades, with estimates by the World Health Organization (WHO) pointing that about 2 billion people are at least overweight worldwide.

Aim of the Work

to establish, through the available literature, what is the current management of leakage after sleeve gastrectomy in relation to each patient’s condition through the range of interventions available and their effectiveness.

Materials and Methods

the search is carried out using the electronic national library of medicine’s PubMed database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications focusing on post-operative leakage. Electronic results were screened by title to exclude duplicate studies. Articles were identified by keywords: “laparoscopic sleeve gastrectomy” “leakage after sleeve” “gastric leak” and “management of leakage” and will be limited to research papers of all designed on human patients in English languish. Articles with no focus on leakage after sleeve gastrectomy were excluded from eligibility in this review.

Results

through this study, it is found that: 1- Early detection and management are very important to control the leak. 2- The early unstable patient should be operated for lavage and drainage and re-suturing of leak site if the tissue still healthy. 3- Management of the leakage after LSG still non-standardized and there are multiple treatment options, so it is important to carefully choose the best treatment options for each patient.

Conclusion

early diagnosis and deciding the best treatment option is important to reach a complete resolution of the leak. From this study, we concluded that treatment of gastric leak after LSG mainly depend on three factors; time of the leak, clinical presentation of the patient and site of the leak.
Early results of negative pressure wound therapy in treatment of chronic wounds
Authors: Maaty S A , Gerges S M , El-desoki A A , Khalil M M
Published: May 2020

Background

Chronic wounds may affect only the epidermis and dermis, or they may affect tissues all the way to the fascia. Chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds often remain in the inflammatory stage for too long.

Aim of the work

to assess the effect of negative pressure wound therapy in management of chronic wound.

Patients and Methods

This is prospective study was conducted on 30 Egyptian volunteers participated; they were 20 males and 10 females, between the age of 18 and 70 years. This study was conducted from July 2017 to July 2018 at Ain shams university specialized hospitals and Alexandria armed forces hospital.

Results

VAC therapy, together with periodical surgical wound debridement and specific antibiotic therapy, could be helpful to promote and accelerate wound healing of foot lesions after restoration of an adequate distal blood flow through surgical revascularization or angioplasty.

Conclusion

Negative-pressure wound therapy (NPWT) devices are designed to apply controlled suction to a wound bed at continuous or intermittent pressure settings to stimulate wound closure. Negative pressure can result in numerous alterations in the wound environment, including removal of excess exudate containing high concentrations of proteases and inflammatory cytokines, stimulation of senescent cells, mobilization of macrophages, and stimulation of angiogenesis.
The Role of Adipose-Derived Mesenchymal Stem Cells in the Regeneration of Sciatic Nerve Injury in Rats
Authors: Saba C R , Abdeltawab S M , Omar S M , AboZeid A A
Published: May 2020

Background and Objectives

experimentally, peripheral nerve repair can be enhanced by Schwann cell (SC) transplantation but the clinical application is limited by donor site morbidity and the inability to generate a sufficient number of cells. We have investigated whether stem cells, isolated from adipose tissue, can enhance the regeneration of crushed sciatic nerves in adult male albino rats.

Materials and Methods

we divided our rats into 3 groups of 10 rats each. Group I was the control group. Group II underwent crushing of their left sciatic nerves and were left for spontaneous recovery. Group III underwent crushing of their left sciatic nerves with local transplantation of ASCs around the injured nerve. We then compared the effect of spontaneous recovery versus local injection of ASCs in the regeneration of the nerves.

Results

The results were evaluated 4 weeks postoperative; sciatic nerves were stained by H&E, and immunohistochemically using S-100. The results showed a significant increase in axonal regeneration with the ASCs treated group compared to the spontaneous recovery one.

Conclusion

Our results suggested that ASCs have a beneficial role in treatment of peripheral nerve injuries.

Keywords

ASCs, Sciatic nerve crush injury, S-100
Histological study on the effect of single prolonged stress model on the hippocampus of adult male albino rat
Authors: Moussa N , Elshakaa N , Kalleny N , Elwaseef D
Published: May 2020

Introduction: Post- traumatic stress disorder (PTSD) is a psychiatric disorder which occurs after the experience of life threatening events as natural disasters, military combat, serious accidents, or violent sexual assaults. It has a severe impact on quality of life.

Aim of the work

to study the effect of single prolonged stress on the structure of hippocampus in adult male albino rats.

Materials and Methods

20 adult male albino rats were randomly divided into four groups control group (group I) and single prolonged stress group examined at day 1(group II), day 7 (group III) and day 14 (groupIV). Rats were restrained by placing them in plastic restrainers, immediately followed by 20 minutes of forced swimming in 20–24°C water. Rats were exposed to ether until general anesthesia then they were placed in their home cages. At the end of the experiment, the hippocampi were taken and processed for light microscopic study.

Results

pyramidal cells of the CA3 region of the hippocampus showed progressive degeneration with passage of time from day 1 to day 14 with decrease in thickness. Transient increase in glial fibrillary acidic protein (GFAP) expression in the astrocytes of the hippocampus was detected at day 1 followed by reduction in GFAP expression started at day seven and continued to day 14.

Conclusion

post-traumatic stress PTSD causes significant structural hippocampal neuronal damage affecting the CA3 hippocampal subfield.
Taurolidine citrate and unfractionated heparin combination versus unfractionated heparin alone in prevention of inflammation in hemodialysis catheters
Authors: Elsharkawy M , Ezzat H , Rezk K , Emara A , Mohsen R , Mansour A M
Published: May 2020

Introduction and Aims

Patients on hemodialysis (HD) using dialysis catheters have significantly higher rates of morbidity and mortality which has been associated with chronic inflammatory state. In Egypt 6.6% of HD patients use catheters, of which short term catheters represent 59.6% and 40.4% with long-term catheters. In this study we aim to assess the possible effect of using Taurolidine citrate and unfractionated heparin (Taurolock-hep500™) in comparison to unfractionated heparin, as a lock solution for temporary hemodialysis catheters, on inflammatory status in HD patients.

Methods

a randomized controlled clinical trial that included 60 stable HD patients recruited from Ain Shams University hospitals at the time of catheter insertion. They were divided into two groups, Group 1: 30 Patients received taurolidine and citrate (4%) and 500 i.u of heparin as a catheter lock solution after hemodialysis sessions, Group 2: 30 patients received unfractionated heparin (5000i.u) as a catheter lock solution after hemodialysis sessions.

Standard aseptic techniques were used in handling catheters. High sensitive C-reactive protein (hsCRP) and interleukin 6 (IL-6) were measured in serum for both groups and samples were obtained at baseline and after 1 month of using the lock solutions.

Results

Group 1 (mean age 39.5 ± 14, 46.7% males), Group 2 (mean of age 39.3 ±14,60% males). At base line, there was no significant difference between both groups regarding hsCRP (P = 0.366) and IL-6 (p = 0.900). While after 1 month of using the lock solution there was significant difference as regard levels of hsCRP (p = 0.001) and IL-6 (p = 0.018),with the higher levels of inflammatory markers showed in group 2.

Conclusions

we may conclude that the use of Taurolidine citrate and unfractionated heparin combination as a lock solution for HD catheters reduces the inflammatory markers, and the inflammatory status in HD patients when compared to the standard unfractionated heparin lock as demonstrated by reducing the levels of inflammatory markers (hsCRP and IL-6). This may have good clinical consequences regarding the quality of life in HD patients.
Assessment of Vitamin D Status in Egyption Boys Aged 2-10 Years
Authors: Botros R M , Elbarbary N M , Bahaaeldin A M , Abdelshakour H F
Published: May 2020

Background

Vitamin D plays an essential role in calcium homeostasis and bone metabolism. Recent evidence suggests that vitamin D may also be important for a variety of non-skeletal outcomes including neuromuscular function, immunomodulation, and control of other hormonal system. It is well known that exposure of skin to direct sunlight is the most important source of vitamin D, so that according to many causes like fear of skin cancer, traditional clothing and spending most of the time indoors many Egyptian girls are exposed to vitamin D deficiency. Hypovitaminosis D is a widespread disorder in developing countries across all age groups, regardless of their latitude.

Objective

The aim of this study was to evaluate the magnitude of vitamin D deficiency/sufficiency in a sample of Egyptian boys children.

Subjects and Methods

The present study was conducted on 80 boys age from (2-10) years old randomly selected from outpatient clinic of Ain Shams University and their healthy relative. We excluded girls, boys whose age<2 years or > 10 years, boys suffering from chronic illness or on drugs as corticosteroid and anti-epileptic drugs.

Results

The results demonstrate that all boys studied have vitamin D deficiency with (36.25%of them with mild vitamin D deficiency, 46.25%of them have moderate vitamin D deficiency, and 17.50% of them have severe vitamin D deficiency. There was positive correlation between vitamin D and sun exposure.