bluuebunny/crossref_metadata_2025 huggingface dataset:
Immediate and Short Term Outcomes for Using Drug Coated Balloons in Treating Coronary Bifurcation Lesions
Authors: Kamel Ahmed M M H , Nassar Ahmed I , Fathy Ahmed M , Fakhry Emad E , Fahmy Yousef M
Published: November 2024

Background

lesions at the bifurcation of coronary arteries pose a substantial difficulty due to their intricate anatomical structure and the increased risk of complications during or after the procedures. Drug-coated balloons (DCBs) have recently been recognized as a promising therapeutic strategy for managing bifurcation lesions.

Objective

to compare the use of drug-coated balloons versus ordinary balloons in provisional stenting of coronary artery bifurcation lesions and its impact on the procedural success rate & short-term MACE

Patients and Methods

The current study is a prospective, longitudinal cohort, interventional two arm study that included a total of 66 patients. 40 in Control group (group A) and 26 in case group (group B). every patient is assigned to a particular group based on the operator’s preference. In both groups provisional stenting was employed, with dilation of the side branch using a standard balloon in group “A” and a drug-coated balloon in group “B”. The evaluation of the outcomes of the indexed procedure and a six-month follow-up were conducted to monitor the incidence of Major Adverse Cardiac Events (MACE).

Results

The mean age of patients assigned to the Group A was 57.18 ± 9.84 years, while patients assigned to the Group B had a mean age of 55.50 ± 7.74years, both groups were similar in demographic data, baseline clinical characteristics and Echocardiographic Data. The study’s primary endpoint was the occurrence of major adverse cardiac events (MACEs), at a 6-month follow-up. A significant difference was observed between the case and control groups in terms of MACE after 6 months. The incidence of MACE was 23.7% (9 out of 38 patients who continued the study after 2 cases of in- hospital mortality) in the control group, compared to only 3.9% (1 out of 26 patients) in the case group, with a p-value of 0.039. the secondary endpoints of the study, which encompassed the attainment of lesion success and procedure success, did not show a statistically significant difference between the case and control groups despite the observed variation in the complication rat

Conclusion

The application of drug-coated balloons in provisional stenting for coronary artery bifurcation lesions demonstrated superiority over conventional balloons in terms of short-term major adverse cardiac events (MACE), and exhibited non-inferiority in relation to lesion or procedural success.
Role of Impulse Oscillometry (IOS) Together with Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) and High-Resolution Computed Tomography for the Chest in Early Diagnosis of Interstitial Lung Disease in Patients with Connective Tissue Diseases
Authors: Mohamed Abdel Dayem Aya Mohamed , Gomaa Ashraf Adel , Hendawy Mahmoud Mokhtar , rezk Mohamed Mohamed , raafat Ali Wafaa , Shawky Hiekal Abdel Hamid Mohammed
Published: November 2024

Background

Connective Tissue Diseases (CTDs) are systemic autoimmune conditions characterized by frequent lung involvement. Interstitial lung disease (ILD) is a severe pulmonary complication in CTD and associated with significant increased morbidity and mortality, so early detection of ILD is essential.

Aim of the Work

To find the best modality for early diagnosis of interstitial lung disease in patients with connective tissue disorders by using DLCO, impulse oscillometry and HRCT chest.

Patients and Methods

This observational, analytical and cross sectional study was conducted upon 60 patients whom were diagnosed as connective tissue disease during the period from march 2022 to march 2023 who were admitted to chest and rheumatology department or outpatient clinics visitors, to Ain Shams University Hospitals.

Results

regarding our results, there was high statistical significance between DLCO and IOS (Best x5). Sensitivity and specificity of Diffusion lung of CO2; DLCO score in prediction of outcome in CT Chest Findings showing significance in DLCO score; p = 0.024 with CI ranged between 53.9-81.4% and sensitivity 67.6%. Sensitivity and specificity of the impulse oscillation method; R5, R20,and Best-X5 score in prediction of outcome in CT Chest Findings. Showing no significance in all with sensitivity 50.2%, 46.1%, 43.4% and 57.5% respectively

Conclusion

ILD should always be considered in patients with CTD. Diagnosis of CTD-ILD is challenging so Early diagnosis of ILD using DLCO, HRCT chest or by using IOS is important as it could affect therapy plans.
Assessment of the Effect of COPD on Intraocular Pressure in Ain Shams University Hospitals Patients
Authors: Saad Hussein Alaa Khaled , Mohamed Abd-Eldayem Aya Mohamed , Abdelkader Maryam Ali
Published: November 2024

Background

Chronic Obstructive Pulmonary Disease (COPD) is a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis. COPD is a preventable and treatable disease. COPD is one of the main reasons of morbidity and mortality in all over the world, and its prevalence is generally associated with the prevalence of direct tobacco use.

Aim of the Work

To assess the effect of COPD on intraocular pressure in Ain Shams University Hospitals patients.

Patients and Methods

This is a controlled cross sectional study which recruited from clinical chest department at Ain Shams University Hospitals. The study was done on 50 diagnosed chronic obstructive pulmonary disease with age more than 40 years old included in the study diagnosed using standard clinical and diagnostic criteria to assess intra ocular pressure and 50 age and sex- matched healthy control subjects included in the study.

Results

Study results showed that there was a statistically significant Relation between severity of COPD and IOP measurement in right and left eye and also there was significant positive correlation between IOP in right and left eye with smoke pack and duration of smoking.

Conclusion

COPD as a disease had many effects on eye structures and cause increase in IOP which will lead to Glaucoma. The more the severity of COPD the more the increase in IOP.
The Role of Screening of Patient Proved to have Gastroesophageal Reflux Disease by Upper Gastrointestinal Endoscope for Early Detection of Interstitial Lung Diseases
Authors: Elsharkawy Samar Hassan , Osman Ahmed Mohamed , Ghaly Ragy Mamdouh , Rashad Asmaa , Hamed Abdou
Published: November 2024

Background

Gastroesophageal reflux disease (GERD) is a common digestive disorder in North America, causing symptoms and complications. It affects 18.1-27.28% of people and is associated with decreased quality of life. Treatment improves quality of life, but treatment costs are higher.

Aim and Objectives

The study aims to assess the role of screening of patient proved to have gastroesophageal reflux disease by upper gastrointestinal endoscope for early detection of interstitial lung diseases.

Subjects and Methods

this study was Cross sectional study. The study will be conducted at Chest diseases Department of Ain Shams university hospitals. This prospective cross-sectional study will be conducted on 90 randomly selected patients diagnosed with GERD by upper gastrointestinal endoscopy. For one year.

Result

the findings of chest HRCT for enrolled patients is 15 patients (16.7%) showed positive CT findings suggestive of interstitial lung disease, whereas 75 patients (83.3%) had normal CT scan. The most common CT finding was atelectasis reported in nine patients (10%). a statistically significant correlation between age and fibrosis and reticular infiltration, female gender & reticular infiltration. no statistically significant correlation between CT findings and each of chest symptoms and GERD symptoms.

Conclusion

The study found that gastrointestinal endoscopes are effective in early detection of interstitial lung diseases, with 16.7% of patients showing positive CT findings. Age, gender, hiatal hernia presence, cough, dyspnea, and wheezes were significant factors in fibrosis. and reticular infiltration
Role of Interleukin-17F Gene Polymorphism in Susceptibility to Acute Myeloid Leukemia: Relation to Serum Level of IL-17
Authors: Mahmoud Esraa Adel , Abdel-Ghaffar Afaf Abdel-Aziz , Eisa Deena Samir Mohamed , El-Gamal Rasha Abd El-Rahman , Abdelmaksoud Mariam Fathy
Published: November 2024

Background

The pathogenesis of acute myeloid leukemia (AML) is complex and not fully understood. A variety of interleukins have been shown to regulate the survival, growth, and apoptosis of leukemia cells. The IL-17 family includes interleukin-17F [rs763780; A7488G]. The IL-17F rs763780 polymorphism inhibits the wild-type IL-17F's activity and raises tumor susceptibility contributing to the emergence of certain tumor types including AML.

Objectives

This work aimed to study the relation between IL-17F gene polymorphism and susceptibility to AML and evaluated IL-17 plasma levels in AML with different IL-17F genotypes.

Results

There was no statistically significant difference in the distribution of different IL-17F genotypes between cases and controls. While the statistical comparison between both groups showed a significant difference with p-value <0.001 regarding IL-17 plasma level being higher in the case group with cutoff value >35 ng/L.

Conclusion

We concluded that IL-17 gene polymorphism doesn’t increase susceptibility to AML in Egyptian adults. IL-17 plasma level is an excellent diagnostic biomarker in AML patients.
Identification and Antibiogram of Clinically Relevant Non-Diphtheriae Corynebacterium species
Authors: Aboul Fotouh Taha Nada Ahmed , Abd El Alim Manal , Saber Sally Mohamed , Ahmed Sherin , Masry El , Alaa Noha , Fahim Eldin
Published: November 2024

Background and Objectives

With the increase in immunosuppressed patients and antimicrobial misuse, Non-diphtheriae Corynebacterium species (NDC spp.) have risen as opportunistic pathogens in hospitalized patients. The present study aimed at comparing Vitek 2C automated identification cards versus MALDI-TOF as the gold standard method for the identification of different NDC spp. and determining the antimicrobial susceptibility of NDC spp. by the disc diffusion method for proper management of patients.

Materials and Methods

The study included 30 NDC spp. isolates recovered from different samples and were subjected to identification by MALDI-TOF and Vitek 2C. The disc diffusion method was performed to determine the antimicrobial susceptibility of the following antibiotics: pencillin G, tetracycline, gentamicin, ciprofloxacin, vancomycin, and Linezolid.

Results

Our study showed that Corynebacterium striatum (C. striatum) was the most commonly isolated species (83.3%), followed by C. amycolatum (10%). 36.7% of the isolates were recovered from blood culture while 20 % were recovered from deep wounds. The age of the patients included in the current study ranged from 55 to 85 years with a mean of 46.7 years. 56.7 % of the isolates were collected from female patients and 43.3% from male patients. As Regard isolate identification by Vitek-2C ANC ID CARD compared to MALDI-TOF (matrix-associated laser-induced desorption ionization-time of flight) as the gold standard method, the agreement was 86.7%. Regarding the antimicrobial susceptibility by disc diffusion method, all the isolates showed increased resistance against pencillin (100%), ciprofloxacin (70%), gentamicin (93.3%), tetracycline (76.6%), and clindamycin (70%). On the other hand, vancomycin and linezolid showed promising results where 100 % of the isolates were susceptible.

Conclusion

We spotlight that NDC spp. should no longer be considered contaminant bacteria in cultures, particularly in immunosuppressed patients. Timely identification, proper clinical correlation, and appropriate therapeutic intervention can lead to favorable outcomes. The high resistance to multiple classes of antibiotics as compounds of the MLSB group, fluoroquinolones, tetracyclines, and β- lactams, thus potentially limiting effective empirical treatment. However, vancomycin and linezolid are still effective against 100 % of the isolates.
Dermatoscopic Evaluation of Nail Changes among End Stage Renal Disease Patients
Authors: Khafagy Naziha Hafez , Abd-ElfattahAfify Ahmed , Hassan Mohamed Saeed , Saber Amal Hosny
Published: November 2024

Background

Nail changes observed in end stage renal disease (ESRD) patients undergoing regular hemodialysis (HD) are polymorphic and diverse. HD causes heterogeneous pathology of nail which may be related to renal condition itself, complications related to it and drugs.

Aim of the Work

To study nail changes in ESRD patients undergoing regular HD by clinical and dermoscopic examination and to correlate these changes with age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access.

Patients and Methods

The study consists of 100 ESRD patients on regular hemodialysis. Nails of these 100 patients were examined clinically and by dermoscopy. Different nail changes were detected and their frequencies were noted. Also, we correlated these changes with age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access.

Results

Nail changes found in ESRD patients on HD were scales, leukonychia, thickening and crumbling, longitudinal striations, transverse striations, onycholysis, splinter hemorrhage, subungual hematoma, trachyonychia, subungual hyperkeratosis, Terry’s nail, onychomycosis, pincer nail, melanonychia, pitting, Lindsay nail, onychomadesis, dilated nail bed capillaries, Beau’s lines, Muehrcke’s lines, onychodystrophy, Mee’s line, loss of lunula, koilonychia and onychogryphosis in decreasing manner. Also, we found statistical significant correlation between some of these changes and age of patients, duration of hemodialysis, laboratory investigations, etiology of renal failure and type of vascular access.

Conclusion

Nail changes that were seen on examination of ESRD patients undergoing regular HD were very frequent and the dermoscopic examination helped us to detect nail changes not seen by clinical examination.
Serum Irisin and its Relation to Insulin Resistance in Patients with Psoriasis
Authors: Lotfi Ahmed Amany Ahmed , Ahmed Saleh Hanan Mohamed , Elhusseiny Rania Mahmoud , Ismail Mostafa Shimaa Mostafa
Published: November 2024

Background

Psoriasis is a chronic inflammatory disease that affects the skin and joints. Psoriasis affects about 2-3% of the world population. The pathogenesis of psoriasis involves dynamic interactions between multiple cell types and numerous cytokines in response to triggers leading to disruption of skin immune homeostasis in genetically predisposed individuals.

Aim of the Work

This study done aimed to evaluate serum irisin level in psoriatic patients and elucidate possible associations with insulin resistance and disease activity.

Patients and Methods

This comparative case control study included thirty five psoriatic patients with generalized plaque psoriasis and thirty five non psoriatic, sex and age matched persons who served as a control group. The patients were selected from patients attending the Outpatient Clinic of Dermatology, venerology and Andrology Department of Ain Shams University Hospitals, from March 2022 to July 2022.

Results

We measured serum level of irisin, fasting insulin and glucose level then calculated HOMA IR. Our results showed statistically significant increase in fasting insulin levels, FBG levels and HOMA IR between Psoriasis patients and controls. Also, median serum irisin level was higher in psoriatic patients compared with controls and there was statistically positive correlation found between serum levels of irisin and severity of psoriasis (PASI). Yet, no significant correlation found between serum irisin levels and HOMA-IR among studied subjects.

Conclusion

Serum irisin levels were insignificantly increased in patients with psoriasis reflecting its possible role in pathogenesis of psoriasis. Moreover, it was positively correlated with severity of disease. Thus, can be possibly used as an indicator of disease severity.
Assessment of Serum CXCL10 in the Sera of Patients with Active Vitiligo before and after Treatment with Oral Mini-Pulse Steroid Therapy versus Parenteral Corticosteroids Therapy: An Interventional Prospective Clinical Study
Authors: Abdel-Rahim Abdallah Marwa M , Soltan Marwa Yassin Ahmed , Fahmy Mary Wadie
Published: November 2024

Background

Vitiligo is the most common depigmenting skin disorder. The complexity of its pathogenesis, influenced by genetic factors, oxidative stress and abnormal cell adhesion that collectively impact melanocyte survival and trigger immune system attacks, resulting in melanocyte death. Melanocytes in vitiligo are believed to exhibit genetic susceptibility and defects in cellular mechanisms, such as defects in autophagy, that reduce their ability to resist oxidative stress. leading to increased expression of the pro-inflammatory protein HSP70. The low expression of adhesion molecules, such as DDR1 and E-cadherin, accelerates melanocyte damage and antigen exposure. Consequently, autoimmune attacks centered on IFN-γ-CXCR9/10-CXCR3-CD8+ T cells are initiated, causing vitiligo

Objective

To study the difference between weekend oral mini-pulse steroids or depot triamcinolone acetonide injection given every 3 weeks in stabilization of active vitiligo by measuring serum level of CXCL10

Methods

This study was an interventional prospective clinical trial study that included 46 cases with active vitiligo divided as 23 cases in group A received low dose oral minipulse dexamethasone 2.5 mg on two consecutive days per week and 23 cases in group B received IM triamcinolone acetonide injection every 3 weeks. Both groups were evaluated at baseline, 4,8 and 12 weeks using activity scores as VIDA, VASI, VES, Score/7and at laboratory level by measuring serum CXCL10

Results

When comparing both regimens as regarding halting vitiligo activity, both treatments could stop disease activity as assessed by activity scores and serum level of CXCL10 this effect was as early as week 4 in both groups with no statistically significant difference

Conclusion

We concluded that the level of CXCL10 was elevated in active vitiligo patients and decreased after the treatment with systemic steroids both low dose oral minipulse dexamethasone and Triamcinolone acetonide intramuscular injection. These findings may point to the role of CXCL10 in the activity of vitiligo which should be furtherly investigated
Value of Sulfotransferase Enzyme Assay in Predicting Minoxidil Response in Patients with Androgenetic Alopecia
Authors: Lotfi Ranya Adel , Youssef Merna Ashraf , ElNahas Khaled Ahmed
Published: November 2024

Background

Androgenetic Alopecia (AGA) is the most common type of progressive nonscarring hair loss in men and women. AGA features a progressive miniaturization of the hair follicle leading to transformation of terminal hair to vellus hair. These results from an alteration of hair cycle dynamic in which anagen phase duration gradually decreases and that of the telogen phase increases.

Objective

To compare Minoxidil result among patients with low versus high sulfotransferase activity in order to evaluate the validity of sulfotransferase enzyme testing before minoxidil use.

Patients and Methods

This was a prospective observational study that was conducted at Dermatology outpatient clinic, Ain Shams University Hospital on 60 male patients presenting with androgenetic alopecia grade II, III, IV.

Results

Vellus hair count/cm2 increased from baseline (17.4±9.2) to Month-4 (20.1±9.6), the differences (2.7±5.6) were statistically significant (p < 0.001). Terminal hair count/cm2 increased from baseline (6.1±3.3) to Month-4 (9.5±6.3), the differences (3.4±5.3) were statistically significant (p < 0.001). Terminal hair percent increased from baseline (25.7±3.6) to Month-4 (29.8±8.2), the differences (4.1±8.8) were statistically significant (p < 0.001). Total hair count/cm2 increased from baseline (23.5±12.4) to Month-4 (29.6±15.3), the differences (6.1±10.2) were statistically significant (p < 0.001). Mean hair width increased from baseline (0.04±0.02) to Month-4 (0.06±0.03), the differences (0.02±0.03) were statistically significant (p < 0.001). Less than half of the study cases showed increasing response (46.7%). Baseline Sulfotransferase enzyme was higher in responder cases (0.78±0.37) than in non-responder cases (0.31±0.16), the differences were statistically significant (<0.001).

Conclusion

The clinical response to 5% minoxidil commonly seen after 3-6 months and approximately 40% of patients will experience hair growth. considering the long time of treatment needed to produce a response by minoxidil in AGA, Sulfotransferase enzyme assay has a significant impact on minoxidil response in hair follicles and can be used as a diagnostic test perior the use of minoxidil to exclude the nonresponders.
Comparative Study between the Efficacy of Microneedling with Topical Triamcinolone Application and Intralesional Triamcinolone Injection for Treatment of Alopecia Areata
Authors: Salem Khamis Sally Mohammed , Fattah Nermeen Samy Abdel , El Nahas Khaled Ahmed
Published: November 2024

Background

Alopecia areata presents as one or more round bald patches that appears suddenly and affect males and females at any age. It starts in childhood in about 50%, and before the age of 40 years in 80%. The exact mechanism is not yet understood. There is not yet any reliable cure for alopecia areata. Several topical treatments used for alopecia areata are reported to result in temporary improvement in some people.

Aim of the Study

The aim of the present study is to assess the efficacy of uses of microneedling with topical triamcinolone versus intralesional injection with triamcinolone in treatment of alopecia areata.

Patients and Methods

This study included 30 patients with scalp AA of at least 2 patches. One patch was treated with microneedling with Derma roller and topical triamcinolone acetonide (10 mg/mL) and the second patch was treated with intralesional injection of triamcinolone acetonide (2.5 mg/mL). Clinical, photographic and trichoscopic examination were performed before and 1 month after last session.

Results

Comparison of clinical response between the 2 treated patches revealed statistically significant better response with intralesional triamcinolone acetonide compared to microneedling and topical triamcinolone acetonide treated patches.
Efficacy of Interalesional Botulinum Toxin Type A vs Cryotherapy in Treatment of Keloids: Comparative Clinical, Histopathological and Immunohistochemical Study
Authors: Obaid Hamad Alhafeity Shamsa Mohamed , Salem Samar Abdallah , Afify Ahmed Abdelfattah , Ahmed Naglaa Samir
Published: November 2024

Background

Keloid is a common dermatological complaint produced by disruption of the normal wound healing process. Several treatment modalities for keloids are available with variable degrees of response such as surgical excision, topical and intralesional corticosteroids, interferon, botulinum toxin, cryotherapy and laser therapy.

Aim of the Study

The aim of the present study is to compare the clinical efficacy and safety of intralesional botulinum toxin type A and cryotherapy in the treatment of keloids.

Patients and Methods

This study included 10 patients complaining of keloids (at least 2 lesions). Keloids were treated by either cryotherapy (one session every two weeks) or intralesional BTX-A (5 IU/cm2 once every 4 weeks). Punch biopsy was done for every lesion before the start of treatment and repeated 4 weeks after the end of treatment.

Results

Both treatment modalities achieved statistically significant clinical response (keloid pliability, height and VSS score) histological response (epidermal thickness) and immunohistochemical response (fibronectin spot count). Both treatments were well tolerated and satisfying to included patients.
Stem Cells Therapy in Sensorineural Hearing Loss (Systematic Review)
Authors: Ezzat Waleed Farag , Askoura Anas Mohamed , Mady Ossama Mustafa , Elbadawy Gamal Mohamed Gamal
Published: November 2024

Background

Damage to the inner ear or cochlear nerve results in sensorineural hearing loss (SNHL), which is typically a persistent deafness. SNHL can range in severity from mild to profound. The shape of the audiogram is used to categorise it as high frequency hearing loss, low frequency, flat, peaked, or notched. Pure tone audiometry can be used to diagnose SNHL.

Objective

To summarization the recent updates in usage of stem cells in sensory neural hearing loss (SNHL).

Methods

Published studies about using stem cell therapy in ENT practice through comprehensive Pubmed, EKG and Google Scholar search (from 2010-2022).

Results

Progenitor stem cells may be employed to repair damaged cells and restore sensorineural hearing function, according to 37 of the publications. The majority of these articles—about 90%—discussed animal model-based experimental investigations; the remaining 10% were reviews.

Conclusion

The application of stem cells in the treatment of SNHL will be a significant step in the future since it will change the way that patients are now treated in the hopes of regaining their hearing. The application to the clinical setting is still in its early stage. Although, a number of encouraging researches illustrate how progenitor stem cells differentiate into sensorineural cells.
Language and Speech Outcome of Young Children with Bimodal Fitting versus Unilateral Cochlear Implants
Authors: Ahmed Nehal Adel Lotfy , Hegazi Mona Abd El-Fattah , Saber Amal El Said , Darweesh Mohamed El Said , El Fiky Youmna Hassan
Published: November 2024

Background

Hearing impairment is the most common sensory loss in the human population. The ability of hearing challenged individuals to communicate is influenced by factors such as the level of remaining hearing, the specific kind of deafness, their language proficiency, the age at which hearing difficulties began, their ability to understand speech via lip-reading, and their educational background. The objective of this study was to evaluate the language and speech acquisition and perception in children who had bimodal fitting (combining a hearing aid and a cochlear implant in opposite ears) and those who with unilateral cochlear implantation to determine whether there is a more favourable outcome of either condition or not. The study was applied on 30 children (15 with unilateral cochlear implant and 15 with bimodal fitting). The baseline evaluation was done 6 months after finishing programming of the cochlear implant device. Then they were re-evaluated after 12 months during which they received intensive language and speech therapy. The evaluation was done by the Modified Preschool Language Scale (PLS4) and the Standardized Arabic Articulation Test.

Results

On comparing unilateral CI and bimodal fitting results, there was statistically significant differences between total, receptive and expressive language age in 1st and 2nd evaluations as well as various aptitudes of receptive and expressive language, while there was no statistically significant difference in articulatory defects between the same groups.

Conclusion

The findings indicated that the use of both cochlear implants (CI) and hearing aids (HA) (bimodal fitting), has an advantage over unilateral CI on language skills development in children.
Role of Sublingual Immunotherapy in Management of Patients with Moderate to Severe Allergic Rhinitis
Authors: Mohamed Waled Ahmed Mohieldin , Elbeltagy Yasser Mohamed Fawzy , Youssef Tamer Ali , Mady Ossama Mustafa , Sayed Fatma Samy , Mohamed Manar Farouk
Published: November 2024

Background

Specific immunotherapy is the only effective etiological treatment for allergic rhinitis. Subcutaneous immunotherapy has several disadvantages like inconvenience, invasiveness, potentially severe systemic reaction and poor compliance. SLIT as an alternative route has been demonstrated. The safety and efficacy of sublingual immunotherapy (SLIT) have been confirmed by many studies. However, in Egypt, the research on efficacy and safety in patients with allergic rhinitis (AR) is still has to be elucidated.

Objective

The aim of this prospective study is to evaluate the efficacy and safety of SLIT in moderately to severe monosensitized and polysensitized allergic rhinitis patients.

Methods

In this study, 75 patients with moderate to severe allergic rhinitis were randomized to receive SLIT (n = 50) or placebo (n = 25) for one year duration. Evaluation of the patients regarding TNSS, RQLQ scores, TMS and VAS score were performed at baseline, and then at 6 and 12 months of therapy. Allergen specific IgG, nasal smear for eosinophilic count were studied at baseline and 12 months.

Results

A total of 40 of 50 SLIT and 20 of 25 placebo patients completed the study. SLIT demonstrated a significant reduction of miniRQLQ score (p<.001), (TNS) (p<.001), (TMS) (p<.001) and VAS (p<.001) when compared with placebo. In objective parameters, Serum sIgG levels increased significantly in the SLIT group at 12 months (13.36 to 35.19) compared with placebo group (7.72 to 9.82) (p<.001). Nasal smear for eosinophilic count significantly decreased in SLIT group at 12 months (from 1.477 to 0.542) compared to placebo (1.547 to 1.409) (p =.012). No relevant systemic symptoms were registered, the only advere events occurred in SLIT group was oral itching and tingling with no effects on patient contiuity of the study

Conclusion

SLIT is effective, safe and well tolerated treatment for allergic rhinitis and the clinical efficacy on rhinitis symptoms was more evident when compared with the placebo.
Troponin I versus Creatinine Kinase-MB as Predictor Markers of the Severity and Outcomes in Acute Theophylline Toxicity
Authors: Abdel Hafiz Selim Hadeer Nady , Mahmoud Suzan Mostafa , El Helaly Hend Mohammad Abdelrahman
Published: November 2024

Theophylline is a type of diethylxanthine that continues to be widely used in many developing countries for the treatment of acute and chronic bronchial asthma, chronic obstructive pulmonary disease (COPD) and apnea of prematurity. Methylxanthine cardiotoxicity is based on diverse, complex mechanisms. PDE inhibition and blocking adenosine receptors cannot explain all the cardiotoxic effects of methylxanthine. In addition, methylxanthines are cardiac stimulants and result in positive inotropy and chronotropy even with therapeutic dosing; myocardial ischemia and myocardial infarction (MI) are associated with acute theophylline poisoning. The current study aimed to investigate troponin I and creatine kinase-MB as predictors of the severity and outcomes in cases of acute theophylline intoxication. No previous studies have proposed early predictors of cardiovascular toxicities among methylxanthine users, early recognition of the severity of theophylline toxicity can be lifesaving and needs aggressive supportive care to improve clinical outcomes in patients. This study was a prospective cohort study conducted on 34 patients admitted to the Poison Control Center at Ain Shams University Hospitals (PCC-ASUH) for a 6-month duration from January 2022 to June 2022 with a history of acute exposure to theophylline toxicity. with history of acute exposure to theophylline toxicity. Patients were subjected to personal and toxicological history taking, vital signs collection, grading of acute theophylline toxicity and measurement of serum theophylline level. Both troponin I and creatine kinase-MB were measured at 6 and 12 hours post admission. Results revealed that, troponin I level at 6 hours post ingestion and 12 hours post ingestion in addition to creatine kinase-MB level at 12 hours post ingestion were significantly higher in cases with severe acute theophylline intoxication and patients who required intensive care unit admission and hemodialysis. It was concluded that, troponin I could predict the severity and the requirement of ICU admission and hemodialysis in patients with acute theophylline toxicity either with early or delayed presentation. On the other hand, CK-MB could be considered for patients with delayed presentation. Depending on time of admission, proper choosing of the biomarker to be investigated will allow for better evaluation of patients with saving extra cost.
Medico-Legal Importance of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 in Traumatic Brain Injuries: Prospective Study
Authors: Abo-Seria fahmy Manar , Abdel-Rahman Amany El-Sayed , Hammad Omar Yousef , Mohamed Noha Farid
Published: November 2024

Traumatic brain injuries are one of the most common causes of lifelong disability and violent death (Refaat et al., 2019). Since several complications may occur after traumatic brain injuries, some of them are fatal. So, the allegation of negligence may be common. The patient relatives may claim that death is the result of improper management of treating medical team rather than the unavoidable complications (El- Sarnagawy et al., 2018).

Objectives

The present study was designed to investigate the medico legal importance of serum GFAP and UCHL-1 as predictive biomarkers of outcome and evaluation of medical care in mild and moderate TBIs to ascertain malpractice claims.

Subjects and Methods

The present study was carried out on 60 admitted cases with mild and moderate traumatic brain injuries in neurosurgery department, Ain Shams University Hospitals in the period between March2021 to Febraury2022. Serum level of GFAP and UCHL-1 was measured within 12 hours after traumatic brain injuries.

Results

Males cases were more predominant than females. Age group (18-25 years) represents the most common group subjected to TBIs while age group (>61 years) was the least common among the studied cases. Road traffic accidents were the most frequent cause of traumatic brain injuries while firearm was the least frequent among the studied cases. There was a high significant increase in serum UCHL-1 levels in moderate TBIs cases in comparison to that in mild TBIs cases with 95% and 90% sensitivity and 95% and 75% specificity respectively. Also, there was a high significant increase in serum GFAP and UCHL-1 level in diffuse brain lesions than focal lesions seen in CT scan of the studied cases with TBIs with 78.95% and 89.46% sensitivity and 100% and 91.43% specificity respectively. The combination of GFAP and UCHL-1 increased the sensitivity to 94.74% and specificity to 97.14%.

Conclusion

The accuracy of serum GFAP alone was greater than accuracy of measurement of both biomarkers, the accuracy of combination of all variables was slightly better than the accuracy of serum GFAP alone as predicators of unfavorable outcome. So, depending on serum GFAP alone instead of combination of all variables didn’t change the sensitivity, specificity and accuracy of predication of unfavorable outcome obviously.
A Comparative Study between Laparoscopic One Anastomosis Gastric Bypass and Laparoscopic Roux-en-Y Gastric Bypass in Morbidly Obese Patients with Pre-Existing Gastroesophageal Reflux Disease, A Retrospective Study
Authors: Hasan Mashal Anas , Afifi Amr Hamed , Azzam Ahmed Rabee , Elraouf Ahmed Saeed Abd
Published: November 2024

Background

Obesity is a significant problem worldwide, and it is a leading cause of several serious diseases that decrease patient quality of life and increase mortality as well as it is significant risk factor for GERD.

Objective

To compare between RYGB and OAGB regarding improvement of the symptoms of GERD post operative considering the comparison between the two techniques and the complications post operative of the two types of surgeries.

Patients and Methods

This is a retrospective comparative study that will be conducted on Morbidly obese patients with pre-existing GERD. Data of patients will be collected retrospectively starting from march 2017 till the end of February 2021. Approval of the Ethical Committee and written informed consent from all participants will be obtained. 40 morbidly obese patients divided into two groups; group A underwent laparoscopic single anastomosis gastric bypass and group B underwent laparoscopic Roux-en-Y gastric bypass.

Results

This study clarified that OAGB had favorable comparable results with RYGB in patients with obesity having GERD with easier technique, less operative time, and fewer complications. Both procedures have reduced the BMI and PAGI SYM significantly 6 months postoperative. Further larger scale studies for more severe cases of GERD and longer periods of follow-up should be conducted to obtain full picture of the most suitable procedure for weight loss in patients with obesity suffering from GERD.

Conclusion

This study clarified that OAGB had favorable comparable results with RYGB in patients with obesity having GERD with easier technique, less operative time, and fewer complications. Both procedures have reduced the BMI and PAGI SYM significantly 6 months postoperative. Further larger scale studies for more severe cases of GERD and longer periods of follow-up should be conducted to obtain full picture of the most suitable procedure for weight loss in patients with obesity suffering from GERD.
The Effect of Laparoscopic Sleeve Gastrectomy on Gastroesophageal Reflux Disease, A Prospective Observational Study
Authors: Nasr Allah Nasr Khalil El-Azzazi Ahmed Shokry , El-Maleh Mohamed Gamal Elsayed Haitham Mostafa Mohamed , Farrag Ahmed Magdy
Published: November 2024

Background

Obesity, defined by the world health organization as a body mass index (BMI) greater than 30, it is an epidemic issue that has major complications on health. It is estimated that more than 200 million men and 500 million women around the world more than 10% of the world’s population are obese.

Aim of the Work

to examine the effects of LSG on GERD. Depending on gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) questionnaire before and after undergoing elective LSG by 6 months (at least) and result will be confirmed by pH metry for positive cases only (score >35).

Patients and Methods

This study is a prospective observational study. Conducted patients from outpatient clinic of the general surgery department in Ain Shams university hospitals during the period starting from August 2022, till March 2023.

Results

Regarding the GERD-HQOL score distribution among study group (n = 100), we found that There were 92 cases (92%) score <35 &8patients (8.0%) score >35; with ranged score 0-38 with mean 14.73±4.27. Regarding the Relation between positive GERD- HQOL score and pH metry (n = 8) among study group, we found that there was a 8 patients were positive GERD-HQOL out of them 7 patients were positive pH metry with agreement 87.5% while there was one cases were negative pH metry, with p-value <0.001 highly significant.

Conclusion

we found that GERD-HQOL Questionnaire is comparable to pH metry with high index of agreement between questionnaire and pH metry after LSG.
The Use of Tissue Markers of Kidney Injury KIM1 and NAG to Compare between Effect of Extra Corporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery on Renal Tissue for Early Detection of Kidney Injury in Managing Renal Stone ≤ 2 cm
Authors: Mahmoud Mahmoud Ahmed , Reyad Essam , Essily Khaled El , Hanna David Raef Kamal , Awady Hossam El
Published: November 2024

Background

Retrograde Intrarenal surgery (RIRS) and Extracorporeal shock wave lithotripsy (ESWL) are well-established treatment options for treatment of kidney stones. Kidney injury molecule 1 (KIM-1) and N-acetyl-β-D-glucosaminidase (NAG) are two proteins secreted by the kidney into the urine and have been found to be sensitive markers of acute kidney injury. The aim of this study is to compare between RIRS and ESWL effect on renal tissue and detect early signs of kidney injury by measuring urinary levels of KIM-1and NAG in patients with kidney stone who were treated by ESWL and RIRS.

Objective

To compare between effect of ESWL and RIRS on renal tissue and detect early signs of AKI through using new biomarkers for AKI (KIM-1, NAG) in managing renal stone ≤ 2 cm

Patients and Methods

This prospective randomized study was conducted in urology department Ain Shams university hospitals and in urology department of Theodor Bilharz Research Institute hospital during the period from 4/2022 till 4/2023 after obtaining Ain Shams university ethics committee approval (No. FWA 000017585).

Results

This study revealed highly statistically significant increased 24-hour post-operative KIM-1/Cr and NAG/Cr in group A (ESWL) (4.59 ± 0.94) and (0.22 ± 0.04) when compared with group B (RIRS) (2.22 ± 0.65) and (0.13 ± 0.03). In group A (ESWL) there was high statistically significant increase in 24-hour post-operative KIM-1/Cr (4.59 ± 0.94) and NAG/Cr (0.22 ± 0.04) when compared with pre-operative KIM-1/Cr (2.26 ± 0.45) and NAG/Cr (0.12 ± 0.04), while in group B (RIRS) there was only statistically significant increased 24-hour post-operative NAG/Cr (0.13 ± 0.03) when compared with pre-operative NAG/Cr (0.11 ± 0.03) with no statistical significant difference between pre-operative KIM-1/Cr (2.22 ± 0.51) and 24-hour post-operative KIM-1/Cr (2.22 ± 0.65).

Conclusion

Patients with known renal impairment or decreased renal functions suffering from renal stone ≤ 2 cm we recommend management of stone using RIRS over ESWL and in case of ESWL being the only option we recommend use of lower number of shock waves per setting.
Early versus Delayed Cholecystectomy in Mild Gallstone Pancreatitis (Prospective Comparative Study)
Authors: Abdelwanis Wael Abdelazim , Kamel Kareem Ahmed , Ragab Khalil Ethar Alaa
Published: November 2024

Background

Gallstone pancreatitis is the most common etiology of acute pancreatitis accounting for up to sixty percent of all cases. In patients with mild gallstone pancreatitis – characterized by the absence of organ failure, peripancreatic fluid collections or necrosis, and typical resolution within one week – cholecystectomy is the definitive treatment.

Aim of the Work

To determine the feasibility of early cholecystectomy during index admission as long as the symptoms and laboratory values are improving for patients with gallstone pancreatitis predicted to be mild on admission and to obtain unbiased estimates of the effect of early cholecystectomy on hospital LOS, complications, and patient-reported outcomes (PROs) in order to determine the need for further evaluation.

Patients and Methods

This Prospective comparative study was conducted at tertiary care hospitals at Ain Shams University hospitals and Nasser institute for medical research and treatment from May 2022 till December 2022 and performed on a total of 20 adult patients who aged 18 years old and over with mild pancreatitis and without cholangitis.

Results

Patients treated with early or late procedure experienced approximately the same intra operative bleeding (30 vs 50%), conversion to open (10 vs 10%), biliary injury (0 vs 0%), and operation time (50 vs 50 minutes) with no statistically significant differences between them (p value= 1.00, 0.65, 0.912) respectively.

Conclusion

Early cholecystectomy after gallstone pancreatitis is more advantageous than late cholecystectomy after gallstone pancreatitis because it is associated with less rate of recurrence of biliary pancreatitis, less complication of pancreatitis, less perioperative complication (adhesions, blood loss, biliary events, infection, postoperative pain) and shorter duration of postoperative hospital stay.
Percutaneous Transluminal Angioplasty as a Treatment of Arteriovenous Fistula Stenosis for Hemodialysis
Authors: Nafei Ahmed Mohammed Khalifa , Abdulrahman Abdulrahman Mohamed Ahmed , Eldieb Khaled Abdelsattar Elsayed , Zayed Hisham Mohammed Ibrahim
Published: November 2024

Background

The main option of renal replacement therapy (RRT) in patients with end stage renal disease (ESRD) is still the hemodialysis (HD). The cornerstone of efficient hemodialysis is the ability to maintain a proper vascular access. The first recommended type of vascular access is the native arteriovenous fistula (AVF) which has a higher patency and lower complication rates compared to other access types such grafts and catheters. Dysfunctional vascular access is a major cause of hospitalization and morbidity in hemodialysis patients.

Objective

To evaluate the endovascular option for treatment of arteriovenous fistula failure stenosis regarding success rates and primary patency rate after the angioplasty procedure at 3, 6 months.

Methods

This is a non-randomized prospective study was conducted at Ain Shams University hospital and Ahmad Maher Teaching hospital. Involving 30 patients having End Stage Renal Disease (ESRD) with failing native AVF.

Results

Percutaneous transluminal angioplasty (PTA) for dysfunctional AVF is an excellent treatment option for AV fistula stenosis. As it has the following advantages: It is more durable than the creation of new access or the catheter placement. Percutaneous transluminal angioplasty (PTA) is relatively simple, less invasive, enables us to spare other access sites for further use, helps in minimizing the insertion of central catheters and allowed the patient to start dialysis in the day after intervention.

Conclusion

PTA has several advantages as it can be considered a safe procedure with low complication rate, less invasive, shorter procedure, enables immediate dialysis without using of central venous catheter, reduces the risk of infection, doesn’t exhaust the patient’s veins and spares them for further use and can be repeated several times before abandoning the fistula.
Comparative Study between Plant Extracts “Lithospermum erythrorhizon” Dressings and Standard Moist Wound Dressings in Management of Diabetic Foot Ulcers
Authors: Kamal Ahmed Mohamed , Ahmed Abdelrahman Mohamed , Zekri Mina Gamil , Abdelazeem Bakheet Mahmoud Elsayed
Published: November 2024

Background

DFU is a common complication of DM that has shown an increasing trend over previous decades. In total, it is estimated that 15% of patients with diabetes will suffer from DFU during their lifetime.

Objective

To compare wound outcome, limb salvage, healing time of diabetes related foot ulcers. and cost effectiveness in terms of usage of hospital resources and numbers and easiness of dressings between Lithospermum erythrorhizon dressings and standard moist wound therapy (SMWT) in management of diabetic foot ulcers.

Patients and Methods

This is a prospective observational study involving 34 patients with active diabetic foot ulcers, in a high-volume tertiary referral vascular center. They were divided into 2 groups: 17 patients (group A) were prescribed SMWD and the other 17 patients (group B) received Lithospermum erythrorhizon wound dressing. Study Period: 6 months from September 2022 to March 2023.

Results

Analyzing the results of our study, we suggest that Lithospermum erythrorhizon wound dressing has a definitive role in promotion of proliferation of granulation tissue, reduction in the wound size, and rapid clearing of bacterial load. Our data demonstrates that Lithospermum erythrorhizon wound dressings decrease the wound depth more effectively than saline gauze dressings over the first 8 weeks of therapy. It is suggested that Lithospermum erythrorhizon wound dressing is a cost-effective, easy to use and patient- friendly method of treating diabetic foot ulcers which helps in early closure of wounds, preventing complications and hence promising a better outcome.

Conclusion

Application of Lithospermum erythrorhizon wound dressing over wound bed increases the effectiveness of local circulation, which assists in the proliferation of granulation tissue and epithelialization. We have also found that the patients on Lithospermum erythrorhizon wound dressing therapy had earlier complete granulation.