bluuebunny/crossref_metadata_2025 huggingface dataset:
Interrelationship Between Chitotriosidase, Type2 Diabetes Mellitus and Atherosclerosis
Authors: Hosny S S , Maher M M , Bekhet M M , Bahaaeldin A M , Mahmoud H M A , Saleh A M M A
Published: May 2020

Background

Type-2 diabetes mellitus (T2DM) is the leading cause of cardiovascular morbidity and mortality worldwide . Poor glucose control, hypertension, and dyslipidemia are the main factors that increase the risk of atherosclerotic disease in T2DM.

Aim of the Work

To study the relationship between Chitotriosidase level in patients with Type 2 Diabetes Mellitus and the development of atherosclerosis.

Patients and Methods

This study was conducted on 75 persons. Cases were selected from Internal medicine & endocrinology outpatient clinics at Ain Shams University Hospital.

They were divided into Two groups:

Group 1

formed of 50 Type 2 Diabetic patients.

Group 2

formed of 25 healthy subjects as control

Results

Serum Chitotriosidae level was higher in type 2 diabetic patients than healthy control.and its level was significantly higher in type 2 diabetic patients with atherosclerosis. There was also positive significant correlation between Chitotriosidase and Fasting blood glucose, 2 h p.p,HBA1C, cholesterol, LDL, Triglycerides, BMI and W/H

Conclusion

serum chitotriosidase can be used as predictble marker for diabetic vasculopathy.
Study of Vitamin D Deficiency in Adolescent Females (10-18 years old) In Cairo
Authors: Botros R M , Eid Y M , Mostafa B M , Elmeligy Y H E
Published: May 2020

Background

Vitamin D deficiency is a common problem among Egyptian females across all age groups, for whom contributing factors include inadequate sun exposure possibly related to cultural/social factors, and insufficient dietary calcium, wearing a sunscreen reduces vitamin D synthesis in the skin by more than 95%. Not only environmental factors, such as sun exposure and nutrition, but also genetic and possibly also epigenetic factors are determinants of serum 25(OH) D.

Aim

We sought to determine the frequency of occurrence of vit D deficiency in Egyptian adolescent females aged 10-18 years in Cairo.

Methods

Study was conducted on 90 healthy adult females aged (10-18) years and classified them into: Sufficient group: with vitamin D level >30ng/ml, (40%) of participants. Mild deficient group: with vitamin D level between 21-29ng/ml (14.44%) of participants. Moderate deficient group: with vitamin D level between 10-20ng/ml (11.11%) of participants. Severe deficient group: with vitamin D level <10ng/ml (34.44%) of participants.

Results

Our study showed a high prevalence of low vitamin D level among healthy adolescent females aged (10-18) years old. There were a significant difference On comparing vitamin D status groups as regard vitamin D rich food intake, duration of sun exposure and height for age (p < 0.001), (p < 0.001) and (p = 0.012) respectively. There were significant difference on comparing vit D status groups with s.Ca, PTH and Alk.Ph (p < 0.001).

Conclusion

Vitamin D deficiency became endemic in Egypt. Large-scale studies are needed to properly evaluate the size of the problem.
Cryoablation of goiter irrespective of thyroid profile
Authors: Hamed M S , Mansour S Z , Halawa M R , Bahaaeldin A M , Ibrahim N A , Ghoneim A Z
Published: May 2020

Background

Thyroid nodules are extremely common. By age 60, about one-half of all people have a thyroid nodule. Cryoablation is used in a variety of clinical applications, using hollow needles (cryoprobes). Cryoprobes are inserted into or placed adjacent to diseased tissue which is desired to be ablated.

Aim of work

To evaluate the effect of Cryoablation on the size & function of thyroid noduleWhich may replace the need for surgery or radiotherapy.

Patients & methods

This is an interventional therapeutic study, conducted in Ain-Shams University hospitals; endocrinology clinic. Our study sample included 80 subjects, age between 20 & 60, having thyroid nodule diagnosed by ultrasound. Subjects were divided into 2 groups: Group 1 included 40 subjects “control group” who were not subjected to cryoablation. Group 2 included 40 subjects “cases” upon which cryoablation was done. Neck ultrasound was done for subjects & they were sampled for their TSH, free T4 & free T3 levels at start and after 3 & 6 months.

Results

There was high statistical significant difference between group 1 & group 2 regarding nodule size after 6 months. Group 1 showed mean nodule size (0.89 cm ± 0.25 SD) while group 2 showed (0.62 cm ± 0.35 SD),(p-value<0.001). Non-thyrotoxic cases were 6 times more liable to show nodule size reduction, from 0-6 months, more than thyrotoxiccases, which shows thyrotoxicosis as a factor against nodule size reduction in significant statistical relation. Females were more liable than males, to show nodule size reduction. There was no statistical significant difference between cases & controls regarding TSH, free T4 nor free T3 values, before study, at 3 months nor after 6 months.

Conclusions

Cryoablation causes nodule size reduction, especially after 2nd session. Cryoablation doesn’t affect thyroid function tests, all through our study.
Assessment of 25-hydroxy vitamen d in patients on regular hemodialysis in ain shams university hospital
Authors: Elshinnawy H A , Shawky S M , Abdelgawad M A , Ebrahim M H M
Published: May 2020

Address correspondence to M.H.M. Ebrahim, Department of Nephrology, Abo Kir Insurance Hospital, Alexandria, Egypt. email: d.mohamedhosny3@gmail.com
Comparison of Disease Characteristics, Course and Outcome between Adults with Juvenile and Adult- onset Systemic Lupus Erythematosus
Authors: Al-Hefny A M , Mohammad R A , Abdelrhaman M A , Morshedi N A , Soliman M E E
Published: May 2020

Aim of the Work

This study was performed to evaluate disease characteristics, activity and damage in adult patients with either juvenile or adult onset SLE.

Patients and Method

One hundred and fifty consecutive patients with SLE fulfilling the SLICC criteria for the classification of SLE were included in the study. The patients were classified according to the age at disease onset, 100 Adult-onset (ASLE) and 50 juvenile onset (JSLE). Patients records were reviewed for clinical and laboratory evaluation. Disease activity was assessed using SLE Disease Activity Index (SLEDAI). Disease damage was assessed using Systemic Lupus International Collaborating Clinics (SLICC/ACR) damage index.

Results

The mean age at disease onset of JSLE was 14.120± 1.534 and of ASLE was 22.460± 2.732. The female to male ratio was 9:1 in JSLE compared to 13:1 in ASLE. JSLE had butterfly rash (66%), photosensitivity (30%), oral ulcers (34%), arthritis (44%) and neuropsychiatric manifestations (6%).While ASLE had butterfly rash (35%), photosensitivity (10%), oral ulcers (17%), arthritis (65%) and neuropsychiatric manifestations (13%). There was higher prevalence of anemia, thrombocytopenia, ESR, CRP, 24 h and creatinine in JSLE more than ASLE with statistically significant differences. The mean SLEDAI was significantly higher in JSLE (14.080 ± 4.780) compared to ASLE, (10.760 ± 2.738) (P < 0.001).

Conclusion

The age at onset of SLE influences its clinical manifestations and laboratory findings. JSLE patients have a more aggressive presentation and course than ASLE patients with a higher frequency of lupus nephritis, more cutaneous symptoms and hematological manifestations. JSLE patients have more severe disease activity with very high SLEDAI and SLICC damage scores. ASLE patients have more musculoskeletal manifestations.
Effect of Using Direct Acting Anti-Virals In Treatment of HCV Naive Patient with and without Portal Hypertension
Authors: Alkarmouty K Z , Mohamed E S , Fahim H A , Elsabagh A R E A
Published: May 2020

Background

Hepatitis C Virus (HCV) infection is a major global health challenge; it is estimated that more than 80 million people are chronically infected worldwide. Egypt has the highest prevalence of HCV in the world (predominantly genotype 4) secondary to the previous schistosomiasis eradication campaigns with very high incidence rates among elderly, rural areas and in lower social classes.

However, several oral anti-HCV drugs (direct acting antivirals; DAAs) have been developed over the last several years. Now, HCV can be eliminated from the infected host within 12 wk of DAA combination therapy without noticeable side effects

Aims: to evaluate the Effect of presence of portal hypertension on the results of treatment of chronic HCV infected naive patient with direct acting antivirals

Patients and Methods

200 subjects were divided into 2 groups: group I: including 100 cirrhotic patients with HCV infection and portal hypertension, group II: including 100 cirrhotic patients with HCV infection without portal hypertension.

Diagnosis of portal hypertension was confirmed by presence of esophageal varices in endoscopy.

Both group received combination of IFN-free DAAs.

Results

CK-18 was significantly elevated in patients of group I in comparison to group 11, with mean ± SD: 460 ± 279, 167 ± 56 and 149 ± 57, respectively, and P value: 0.001. with mean ±SD: 59.6± 28, when compared with control group (with 23±8) P value < 0.001. ROC curve between Cases and Control as regards CK18 with Area Under the Curve (AUC): 0.925. Cutoff > 30 ug/l With Sensitivity: 86.67% & Specificity: 83.33%. Ck-18 was found to be correlated with steatosis and fibrosis assessed by fibroscan with P value< 0.001.

Conclusion

treatment of 200 patients with HCV and compensated cirrhosis, HCV eradication reduced risk for liver decompensation, regardless of whether the patients had EVs.
Evaluation of microRNA-34a as a molecular link between insulin resistance and nonalcoholic fatty liver disease
Authors: Mohamed M A , Yosef T M , Samy A H , Salama M M , Agwa S H , Ahmed A A A , Abdelsamie A M
Published: May 2020

Background

Non-alcoholic fatty liver disease (NAFLD) is a chronic progressive disease of the liver that occurs in the absence of excessive alcohol consumption, evolving from simple hepatic steatosis, non-alcoholic steatohepatitis (NASH), fibrosis to cirrhosis and hepatocellular carcinoma (HCC). With a global prevalence of 25.24% (22.10-28.65), NAFLD has become a major public health problem. The principal risk factors associated with NAFLD include metabolic syndrome such as obesity, type-2 diabetes and hyperlipidemia. In particular, the prevalence of obesity in European patients with NAFLD varied from 25% to 94%. Insulin resistance resulting in a hyperinsulinemic state increases de novo lipogenesis, which further exacerbates hepatic lipid deposition and boosts the development of the disease.

Objective

The aim of this study is to evaluate Circulating microRNA-34a as a molecular link between insulin resistance and nonalcoholic fatty liver disease.

Methods

This study was carried out on 40 participants between June 2017 and June 2018. They were classified into 2 groups: Group I included 20 patients newly diagnosed as Nonalcoholic fatty liver disease (NAFLD) and had not received any treatment. Group II included 20 apparently healthy volunteers defined as those with normal transaminases, normal hepatic ultrasound and negative for HBsAg, HCV¬Ab.

Results

Results were compared to results of similar researches; where this study found that there was statistically significant increase in MiR-34a levels in group I Clan group II with p-value < 0.001. Also there was statistically significant positive correlation between MiR-34a and age, BMI, HOMA-IR, NAFLD-fibrosis score, ALT, AST, TGs, F.ins and F.Glu. The best cut off point to differentiate between normal and NAFLD group regarding MIR34-a was found > 1.46 with sensitivity of 80%, specificity of 100% and area under curve (AUC) of 92.2%.

Conclusion

Circulating microRNA-34a provides a good molecular link between insulin resistance and nonalcoholic ratty liver disease. All data were statistically analyzed. Results were compared to results of similar researches; where this study found that the best cut off point to differentiate between normal and NAFLD group regarding MIR34-a was found > 1.46 with sensitivity of 80%, specificity of 100% and area under curve (AUC) of 92.2%.
Cardiovascular Autonomic Nervous System Dysfunction in Patients with Systemic Lupus Erythematosus
Authors: Hussein D A , Abdelaziz A B E , Abdelmoteleb A M , Elserwy M A , Arafa S G
Published: May 2020

Background

involvement of central and peripheral nervous systems are well-documented in SLE but literature on prevalence and pattern of autonomic neuropathy are few. Women with SLE have been found to have 5-8 fold increased risk of coronary heart disease. Autonomic dysfunction in the presence of structural cardiovascular disease is associated with adverse prognosis.

Aim of the Work

the purpose of this study is to evaluate the cardiovascular autonomic function in patients with Systemic lupus erythematosus, and to correlate it with SLE clinical features.

Patients and Methods

we conducted our study on one-hundred Egyptian SLE patients diagnosed according to SLICC classification criteria for SLE recruited from rheumatology outpatient clinic and inpatient department at Ain Shams University Hospitals. All the studied patients were subjected to history taking, clinical examination, and laboratory and radiological investigations related to SLE diagnosis and activity. SLE disease activity was assessed by SLE disease activity index-2000 (SLEDAI-2K).Tilt table test was used to assess for presence of cardiovascular autonomic neuropathy.

Results

we found that fifty (50%) of our SLE patients had symptoms suggestive for autonomic dysfunction, including orthostatic hypotension, palpitation and or Raynaud’s phenomenon. Regarding the result of tilt table test, sixty eight (68%) of the studied SLE patients were found to have positive tilt table responses. By doing the uni-variate analysis for predictors of SLE patients with positive tilt table test, we found that vasculitis, proteinuria, DNA, low TLC and complement levels, high SLEDAI, ESR and urinary P/C all were predictors for positivity of tilt table testing.

Conclusion

The prevalence of autonomic dysfunction was high among SLE patients.
Brain Volumetric Changes and Cognitive Functions in Epileptic Patients
Authors: Ashour A A , Nassef A M A , Awad E M , Hazzou A M , Nada M A , Abdullah Y A
Published: May 2020

Background

Epilepsy is a serious common neurological disorder that can affect any age. Cognitive functions are highly prevalent in patients with epilepsy and is more likely to occur in patients with idiopathic generalized epilepsy (IGE). Associations were found between cognitive functions and brain volume loss in patients with epilepsy.

Objective

This work was carried out to assess the volumetric changes in brain of epileptic patients to use it as a biomarker for cognitive dysfunction in adult and adolescent patients with epilepsy.

Patients and Methods

A case control study was conducted to include 61 patients, 20 of which diagnosed with idiopathic generalized epilepsy (IGE), 21 with temporal lobe epilepsy (TLE) and 20 with frontal lobe epilepsy (FLE) who were selected from the epilepsy outpatient clinic in Ain Shams university hospitals along with 23 age and sex matched healthy controls. Both cases and control groups were subjected to Magnetic resonance imaging MRI brain volumetry and detailed cognitive testing. An informed consent was taken from each adult patient, guardian of adolescent patient and healthy control.

Results

Statistically significant difference in comprehension subcategory of the Wechsler adult intelligence scale (WAIS) between patients with IGE and healthy controls denoting poorer social judgment in the IGE group. The IGE group also showed poorer performance in digit symbol subcategory of the same test denoting worse psychomotor speed and sustained attention. Also, significant difference in similarities subcategory was found between TLE group and control group denoting poorer abstract thinking among the TLE group. The IGE and TLE groups also showed lower attention and concentration than control group in the mental control subcategory of the Wechsler memory scale (WMS) yet failed to show superiority over each other.

No statistically significant difference was found on comparing the whole brain volume between cases and control groups.

A statistically significant direct relationship was found between the arithmetic subcategory of WAIS and the whole brain volume of the patients among the patients of the FLE group.

Conclusion

Patients with IGE had worse psychomotor speed, sustained attention and concentration than healthy controls in addition to poorer social judgment. Also, patients with TLE showed lower attention and concentration together with poorer abstract thinking despite normal IQ. The study also concluded that increased whole brain volume in patients with frontal lobe epilepsy is associated with better mathematical problem solving.
Causes of delayed management of multiple sclerosis patients in Nasr city health insurance hospital
Authors: Wahib M M , Abdulghani M O , Aref H M A , Nasef A M A
Published: May 2020

In multiple sclerosis (MS), the immune system attacks and destroys the fatty myelin coating that surrounds and insulates nerve cells in a process known as demyelination. MS is a lifelong condition, and common symptoms include fatigue, muscle spasms, walking difficulties, or numbness and tingling of the face, body, arms and legs. These symptoms can worsen with time, affecting daily activities and reducing a person’s quality of life.

The disease is highly variable, and some people are affected more than others upon and after diagnosis. Treatments are available to help manage a number of symptoms.

Life expectancy for people with MS has increased considerably in the last 20 to 25 years. On average, however, a person with MS can expect to live seven fewer years than someone without this disease.

According to the National MS Society, on average, an MS patient lives about seven fewer years than someone in the general public, largely because of disease complications or other medical conditions, like cardiovascular disease. Only rarely does the disease progress so quickly that it is deadly.

Due to advances in treatments, care, and lifestyle adjustments, MS often progresses slowly. Many studies show that, nowadays, about two-thirds of all patients retain a fair degree of mobility—the ability to walk, although likely with an assisted device—some 20 years after being diagnosed. Assisted devices can range from supports to aid in walking, to scooters used on occasion to save energy and avoid fatigue.

The course of the disease depends on each patient’s risk factors, like having a family member with MS, cigarette smoking, and vitamin D sunlight exposure. And, among African-Americans, the disease tends to be a more progressive form and progression can be quicker.

MS prognosis is thought to be better for people with relapsing-remitting MS than for those with progressive forms of MS, likely because of a better response to disease-modifying therapies.
The Prognostic Value of Reversed Ophthalmic Artery Flow Direction in Acute Stroke Patients with Ipsilateral Extra Cranial Carotid Artery Stenosis
Authors: Abouelnaga Y , Hazzou A , Helmy S , Fahmy Y M
Published: May 2020

Background

According to the World Health Organization, about 15 million people suffer a stroke each year with roughly one-third resulting in death and another one-third sustaining severe permanent disability. Even in developed nations, stroke is the third leading cause of death. It also costs billions of dollars through lost productivity, premature mortality and care for stroke survivors. The evaluation of hemodynamics, autoregulation and collaterals is cardinal for clinical outcomes. The Use of Transcranial Doppler (TCD) in detecting reversal of blood flow direction especially in anterior communicating and ophthalmic arteries, and flow diversion between anterior and posterior circulation provide critical information on ipsilateral collateral status. The impact of collateral status has been correlated with clinical symptoms, reperfusion success and functional outcome at discharge. A rationale now exists for imaging assessment to guide physicians in the precision medicine of stroke care.

Aim of the work

This study is performed for evaluation of hemodynamics in ophthalmic artery as a collateral and its value as a prognostic factor in patients with carotid artery extra cranial stenosis in acute cerebrovascular stroke.

Patients and Methods

30 patients with acute cerebrovascular stroke were recruited in this cross-sectional study admitted in stroke unit at the department of neurology of Ain Shams University hospitals.

Results

There was a statistically significant difference between the Modified Rankin Scale on discharge and follow up after 3 months in patients suffering from acute cerebrovascular stroke with ipsilateral severe extra cranial carotid artery stenosis and reversed ophthalmic artery flow direction (p value =0.042), compared to the group with direct ophthalmic artery flow direction where the (p = 0.086).

Conclusion

Transcranial Duplex is a diagnostic tool that provides a non-invasive, real time, safe technique information data on intracerebral hemodynamics. It was used in this study to detect that there is a significant difference in functional outcome between patients with forward and reversed ophthalmic artery flow direction with acute cerebrovascular stroke and ipsilateral extracranial carotid artery stenosis.
Outcome of Endovascular Treatment of Cerebral Arteriovenous Malformations with Ethylene Vinyl Alcohol Coploymer
Authors: Mohram H E , Habib M A , Mourad S H , Abozeid A H , Salem A M M
Published: May 2020

Background

Cerebral AVMs are very rare lesions, and this rarity contributes to the difficulty of treating them. There is no consensus concerning the method of treatment to be chosen among neurosurgery, radiosurgery or embolization. Onyx embolization could serve as a curative option with accepted morbidity and mortality. The introduction of Onyx and of catheters with detachable tips has no doubt increased the rate of endovascular occlusion, and decreased the risks associated with treatment in our experience.

Objective

The aim of the study was to assess the outcome of the use of Onyx in the treatment of intracranial AVMs as curative embolization or before neuro- or radiosurgery

Patients and Methods

This analytical prospective study was conducted on 25 patients who were diagnosed with cerebral arteriovenous malformations and underwent endovascular embolization with EVOH copolymer with curative intent during the study period. Interventional procedures were done in the neuro – endovascular unit, neurosurgery department Ain Shams University Hospitals and associate neuroendovascular unit in El Matarya Teaching Hospital in the period between September 2014 and April 2017.

Results

Actually comparing these results especially concerning the cure rate along with other studies was somewhat confusing and problematic owing to the diversity in results between studies across the last 15 years.

Conclusion

For the cases that are not fulfilling these criteria, embolization should be offered as preparing step for other modality of treatment. In our experience, for curative embolization, the AVM should be small sized (< 3 cm), supplied by one vascular territory, with feeders that can tolerate reflux up to 2–3 cm, with clear proximal parts of the draining veins, and not located in deep structures.
Clinical and Neuroradiological Features of Hereditary Ataxia Patients: Hospital Based Study
Authors: Fahmy N A , Shalash A S A , Roushdy T M E , Gaber M A
Published: May 2020

Background

Ataxia (GK Taxis mean lack of orders) is defined by imbalance in coordination in gait, limbs and speech. It usually results from disorders in cerebellum or its connections. It is disorder of rate, range, direction and force of movements.

Aim of the Work

to investigate and identify the prevalence of hereditary ataxias regarding clinical and radiological.

Subjects and Methods

our study is composed of 23 patients, (their age range from 15 years old to 40 years old).We study the effect of positive family history and consanguinity on the prevalence of hereditary ataxias. We assess patients functionally using SARA score.

Results

there was positive relationship between positive family history and consanguinity and appearance of disease in cases so, it is important to ask about family history, similar condition and do family pedigree to know mode of inheritance if possible. Also, we found positive correlation between duration of disease and SARA score. There was positive correlation between MRI brain finding (cerebellar atrophy or brain stem atrophy), neurophysiological studies (axonal neuropathy) and disease.

Conclusion

positive family history and consanguinity are risk factors for hereditary ataxias. SARA score is a useful tool to assess hereditary ataxias functionally. MRI brain and neurophysiological studies are useful tools to diagnose hereditary ataxias.
Causes of delayed diagnosis of multiple sclerosis in egypt
Authors: Tohamy A A , Swelam M S , Abdelgawad D M , Aref H A
Published: May 2020

© 2018 Institute of Psychiatry, Ain Shams University

Copyright r 2018 Institute of Psychiatry, Ain Shams University. Unauthorized reproduction of this article is prohibited.

Background

MS is an inflammatory and neurodegenerative disease. Early inflammatory activity might have a profound impact on the risk of developing early disability, and might be a risk factor for early transition into the progressive phase of the illness. However, there are a number of barriers implementing early MS diagnosis and treatment as the patients may delay consulting a physician about their neurological symptoms or may be reluctant to start DMT.

Objective

The aim of this study is to highlight the causes of delayed diagnosis of multiple sclerosis in Egypt to shorten the time of diagnosis and improve the prognosis for patients with MS.

Patients and Methods

Retrospective descriptive study .500 Patients coming to multiple sclerosis unit at Ain Shams University hospitals with delayed diagnosis of MS for more than 2 years had been screened. A questionnaire could be applied on 320 patients out of 500. Contacting (direct and via phone calls) the patients for evaluating the causes of delayed diagnosis of MS was done.

Results

In this study we found number of significant factors adversely affected a timely diagnosis including the age at onset finding that those younger at onset of MS (vs. older) experienced diagnostic delays (P-value = 0.005) and denial of symptoms which was a leading cause for delayed time to first doctor consultation and delayed diagnosis of MS (P-value =0.009). Also there was a correlation between types of MS and delayed diagnosis as we found that PPMS versus RRMS had delayed diagnosis for more than 2 years. Meanwhile, sensory symptoms at onset of the disease were associated with longer diagnostic delay. Although the first specialties the patients visit were ophthalmology and orthopedic services, that the most common Source of referral to a neurologist was suggestion by family and media.

Conclusion

multiple causes significantly affect time to diagnosis of MS including age at onset of the disease, denial of symptoms sensorial symptoms at the disease onset and referral delay from other specialties.
Depression and suicidal ideations in relation to occupational stress in a sample of Egyptian medical residents
Authors: Elbatrawy A N , Mahmoud D A , Mohamed M Y , Mohamed M M
Published: May 2020

Background

Studies have suggested that medical students experience high rates of depression and suicidal ideation. However, estimates of the prevalence of depression or depressive symptoms among students vary across studies from 1.4% to 73.5% and those of suicidal ideation vary from 4.9% to 35.6%.

Reliable estimates of depression and suicidal ideation prevalence during medical training are important to prevent, treat, and identify causes of emotional distress among medical students, especially in light of recent work revealing a high prevalence of depression in resident physicians

Aim of the work

to assess the occurrence of depression and its severity in a sample of Egyptian medical residents of Ain Shams university hospitals, as well as demonstrate the occurrence of suicidal ideations in residents and highlight relation between it and occupational stress.

Patients and Methods

This is a Cross sectional analytical study conducted in Ain Shams University hospitals. This present study aimed at analyzing the data of 256 medical residents graduation year 2013-2016, and at different periods of residency, 36 of which were excluded due to previous diagnosis with psychiatric illness before residency, over six months period from June 2018 to January 2019, and were screened for depression, suicidal ideations, socioeconomic stress and stressful aspects of residency.

Results

A total of 256 questionnaires were done by medical residents of Ain Shams University, 36 were excluded mostly due to previous psychiatric diagnosis before residency. Only 60 (27.27%) of the remaining 220 residents had normal ups and downs according to Beck depression inventory (BDI) with the rest of the 160 residents having depression of different severity ranging from mild (54, 24.55%), borderline (38, 17.27%), Moderate (51, 2.18%), severe (10, 4.55%), extreme(7, 3.18%). 50(22.7%) out of the 220 residents were considered to have high suicide risk according to beck suicidal ideation scale.

Conclusion

Professional and personal stress is a significant and frequently overlooked component of a resident’s life. In addition, residents are at higher risk to develop depression as studies have suggested that medical students experience high rates of depression and suicidal ideation.

Intervention studies are needed, e.g. support groups, more intense coaching by senior physicians, training programs on ‘breaking bad news’ and teaching of stress management skills to study how to prevent or reverse burnout.
Correlation of psychopathology and white matter abnormalities in fathers of children with ADHD: Cross sectional study
Authors: Effat S M , Elshahawy H , Sakr H M , Shorub E M , Azab S E
Published: May 2020

Background

Attention-deficit/hyperactivity disorder (ADM)) is one of the most common neurobehavioral disorders of childhood. Children with ADHD may experience significant adaptation problems because their functional level and behavior may not correspond to their chronological age or expected development level. ADHD is a chronic disease, the symptoms of which can persist into adulthood and become lifelong.

Aim of the work

evaluating the biological substrate in fathers of children with ADHD, assessing rate of occurrence of ADHD among fathers of children with ADHD.

Subjects and Methods

This descriptive observational cross-sectional study was conducted on 40 children with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) according to the DSNI-IV criteria who attended to the Child and Adolescent Outpatient clinics of the Institute of Psychiatry, Ain Shams University Hospital.

Results

Prevalence rate of diagnosis of adult ADHD among fathers of children with ADHD (6 to 12) years old was 60%, 20% with mixed hyperactive—inattentive type, 15%.predominantly hyperactive—impulsive type and 25% predominantly inattentive type. There were statistically significant differences between ADHD group of children’s fathers in comparison to Non-ADHD group, as the mean ADC of right and left middle cerebellar peduncle, was lower in ADHD group which indicates absence of abnormalities in white matter integrity in those areas.

Conclusion

prevalence rate of adult ADHD among fathers was 60%. There were no abnormalities in white matter integrity in group of fathers with diagnosis of adult ADHD.
Treatment Strategies of Complex Intracranial aneurysm
Authors: Abdelrahman N N , Habib M A , Shehata T H , Fakhr M A , Alabyad A G , Desouky A E
Published: May 2020

Introduction

Treatment of complex aneurysms is amongst the most challenging for neurosurgeons. Complex aneurysms are those aneurysms that could not be normally clipped or treated by conventional endovascular approaches, labeling an aneurysm complex implies increased risk of worse outcome in terms of natural history and/or therapy.

Aim of the Work

To detect the validity of different lines of management, either surgical or endovascular interventions in treating complex intracranial aneurysms.

Methods

A prospective cohort study for 80 patients diagnosed with complex intracranial aneurysm lesions that were treated in Ain-Shams and Alexandria University hospitals by surgical or endovascular intervention. Clinical evaluation, radiological diagnosis, treatment options were offered for all patients in details and follow-up after six months were recorded and analyzed.

Results

The mean age of patients was 39.6 years, with a male to female ratio of 1:0.87 and the commonest age of presentation was (41-60y age group). Amongst 80 patients with 83 aneurysms, 52 (65%) were non-ruptured and 28 (35%) were ruptured. Initial radiological diagnostic tools were CT brain and the commonest finding was SAH in 28 (35%) patients. CT angiogram showed 74 (89%) of the aneurysms in the anterior circulation and 9 (10.8%) in the posterior circulation. Among the 83 aneurysms 56 (67%) were giant and 20 (24.1%) were large in size. ICA aneurysm were 65 and were further sub-classified to Infra-ophthalmic segment (40.9%), Ophthalmic segment (19.2%) and Supra-ophthalmic segment (18.1%). Aneurysms in the vertebro-basilar system 9 aneurysms were further sub-classified to Infra-pica segment (3.61%), PICA segment (1.2%) and Supra-pica segment (6.02%). In this study 22 (26.5%) aneurysms underwent surgical intervention, 12 had ICA ligation PVO, 7 (31.8%) patients clip reconstruction and 3 (13.6%) did STA-MCA bypass surgery. As for Endovascular interventions 61 (76.2%) aneurysms underwent 78 endovascular procedures and five aneurysms did combined endovascular with surgical procedures. All patients were followed by GOS and mRS score over a period of 6 months.

Conclusion

Patient with ischemic tolerance to BOT, PVO either surgical or by endovascular approach is the first line of management. Surgical clip reconstruction takes the higher hand to endovascular intervention for complex aneurysms with wide neck or those with intracerebral hematoma. Follow-up of all patients post-procedure over a time period is most important for early avoiding any early complications.
Depressed Skull Fracture over Cranial Venous Sinuses
Authors: Moharam H E , Jalalod’din H M , Hefni S M , Abuoun W A H
Published: May 2020

Background

Depressed skull fracture overlying venous sinuses deserves a special attention among skull fractures. It puts high demand on every neurosurgeon, as the management of this kind of trauma carry high risk of mortality. It is considered as one of the most dangerous complications of head injuries. Either it is due to fatal venous bleeding, or disturbing the intracranial pressure via thrombosis or stenosis. Therefore, knowledge of appropriate treatment of this kind of head injury is essential. Moreover, it should always be treated with high cautions.

Aim of the Work

This study aims at reviewing available scientific data based on clinical trials about the proper management approaches for the treatment of depressed skull fractures overlying major cranial venous sinuses. Either through surgery or medical and conservative management.

Patients and Methods

The study review yielded 22 relevant papers, with a total number of 85 patients. These patients presented to different institutes, at the period between 1996 and 2017. Diagnosed with depressed skull fracture overlying major venous sinuses. The cases divided according to the way of management as follow: 72% of patients treated with surgical approaches. While 28% of patients treated with conservative care.

Results

In total surgical intervention showed to be successful in 53 patients, out of 85 patients included in the study, without any intraoperative complication of bleeding. While 6 patients passed away during the surgical interventions. On the other hand, 18 patients who treated conservatively did not need any further intervention. While 2 studies reported the need of medication following surgery. Furthermore, 6 studies reported failure of conservative management, and needed urgent surgical elevation of the depressed fragment that compressing the sinus. Based on the results, the mortality rate over all was 7%; death was mainly due to inability to control the profusely bleeding from the injured sinuses. With a success rate over the surgical cases in 87%. While it was 75% over the conservative cases. However, this pooled data need further statistical analysis to obtain guiding evidence for current practice.

Conclusions

Clinical decision making must be tailored to each patient independently. In the presence of clinical and radiographic evidence of sinus occlusion surgery is preferred. In such instances where there is a clear need for surgery, adequate precautions should be taken, and an expertise in neurotrauma should always be available. Delayed intracranial hypertension is a possible complication and should always be considered in all patients.
Extended Endoscopic Endonasal Surgery to Ventral Skull Base Lesions
Authors: Montaser A S , Ismail M S , Hammad O Y , Fayed Z Y , Prevedello D M
Published: May 2020

Introduction

In the last two decades, Endoscopic endonasal approaches (EEAs) have undergone a significant evolution with a major shift from a transsellar approach to a variety of approaches that can directly access the midline and paramedian ventral skull base. Once the technical feasibility of any surgical approach is established; its safety (assessed through complications), and treatment outcomes (assessed through long-term follow-up) should be addressed.

Aim of the Study

To assess the feasibility, safety, and efficacy of EEA as a minimally invasive approach to ventral skull base lesions.

Methodology and Materials

this is a prospective observational study of group of 30 patients with ventral skull base lesions that were managed via endoscopic endonasal approaches. All patients’ clinical data, radiographic evaluations, procedural detail, complications, and follow-up data were recorded and analyzed.

Results

The mean age of patients was 50.8 years (range: 18-74 years), with a male:female ration of 1:1.72. The most commonly encountered pathological entities in the cohort was meningiomas (43.3%), pituitary adenomas (23.3%). and craniopharyngiomas (13.3%). Postoperative CSF leak was observed in 6.6% of cases and was managed successfully. There were no cases with postoperative infection in the cohort. Other procedure-related complications include transient diabetes insipidus (10%), pneumocephaly (3.3%), Syndrome of inappropriate ADH secretion (3.3%). Gross total resection was achieved in 93.3% of cases. Improvement of preoperative symptoms was recorded in 89.2% of cases. The mean follow-up duration was 17.8 ± 2.7 months.

Conclusion

EEAs provide direct access and better visualization to the ventral skull base without brain retraction and with minimal neurovascular manipulation, leading to less morbidity and mortality. EEA can be considered a feasible, safe, and effective tool on the armamentarium of skull base surgery. EEAs should not be considered as a replacement to the traditional transcranial approaches; rather. EEAs are deemed as a complementary route and a potential alternative to conventional skull base surgery in select cases.
Endoscopic transtuberculum transplanum approach to suprasellar meningiomas
Authors: Elsawy A , Hamada S , Ibrahim H , Yousef O , Elhusseiny H
Published: May 2020

Introduction

Extended endoscopic approaches to suprasellarmeningiomas have been proposed recently as a viable option or alternative to traditional microsurgical transcranial approaches. Endoscopic approaches have been presented as a minimally invasive route to such formidable lesions of the skull base, obviating the need of large craniotomies & brain retraction. Endoscopic approaches were shown to provide comparable rates of gross total resection, in selected cases, better visual outcomes than transcranial approaches, on the other hand high CSF leak rate was a major cornerstone for criticism for endoscopic approaches.

Objective

Assessing the feasibility & safety of extended endoscopic approaches to suprasellarmeningiomas.

Methods

Interventional prospective study including 23 patients harboring suprasellarmeningiomas assessed for gross total resection, visual outcome, CSF leak rates & other surgical morbidities.

Results

23 patients 18 females (78%) & 5 males (22%); mean age was 59 years with range of 37-86 years. Tuberculumsellae meningioma compromised 15 cases (65%), planumsphenoidale 2 cases (9%) &planum/tuberculum 6 patients (26%) of the studied patients. Gross total resection wash achieved in 17 patients (74%).Vision was improved in 80% of patients presenting with visual symptoms & was stable in 20% post-operatively. All patients (100%) without pre-operative visual deficit were able to preserve their pre-operative visual state. CSF leak was the most common compilation occurring in 4 patients (17%). Lumbar drainage was sufficient to control the CSF leak in 2 patients while the other 2 patients required surgical repair of the skull base reconstruct. Transient DI was encountered in 2 patients (9%).

Conclusion

Extended endoscopic approach to suprasellarmeningiomas is safe & feasible. Comparable outcomes regarding gross total resection with superior visual outcome can be attained in carefully selected patients. CSF leak is major limitation of endoscopic approaches, however the introduction of vascularized naso-septal flaps helped overcome this issue.
The Value of Hysteroscopy in Women with Persistently Elevated Post-Evacuation Serum Human Chorionic Gonadotropin (hCG) Level Following Evacuation of Molar Disease
Authors: Bakhat M A H , Fayed S T , Ibrahim A M , Naguib A H , Faris M A
Published: May 2020

Background and rational

Gestational trophoblastic disease (GTD) is a spectrum of trophoblastic diseases that encompass the hydatidiform mole (both complete and partial), as well as the potentially-malignant and malignant forms: invasive mole, choriocarcinoma and placental site trophoblastic tumor. Gestational trophoblastic neoplasia (GTN) refers to persistent elevation of serum levels of human chorionic gonadotropin (hCG). The subsequentmanagement of GTD after evacuation of the uterus relies on serial surveillance of serum hCG levels. When serum hCG levels plateau or rise, chemotherapy should promptly be initiated.

Patients and Methods

This study for accuracy of a diagnostic test. The current study was conducted at Gynecologic Oncology Unit and Early Cancer Detection Unit at Ain Shams University Maternity Hospital during the period between January 2016 and June 2018.

Results

In the present study, the case who had a vascular mass, the patient was 44 years old and she was para 4, so board decision was for TAH. Postoperative serum hCG surveillance for this case showed adequately declining levels. She, accordingly, did not receive chemotherapy. For the 19/44 (43.2%) cases who had a hysteroscopic finding of ‘an empty cavity’ were diagnosed as persistent GTN and received chemotherapy according to the protocol. The remaining 25/44 (56.8%) cases, who had a hysteroscopic finding of ‘remnants’, underwent re-evacuation. Postoperative serum hCG surveillance showed persistently elevated levels in 9/44 (20.5%) cases, who, therefore, received chemotherapy according to the protocol; and adequately declining levels in 16/44 (36.4%) cases, who, accordingly, did not receive chemotherapy.

Conclusion

The hysteroscopy significantly reduced the risk of chemotherapy in women with hydatidiform mole and have persistent post-evacuation elevated serum hCG level and sonographic criteria of invasive disease.
Hysteroscopy in the Evaluation of Recurrent First Trimesteric Miscarriages
Authors: Abdelmageed A I , Alsherbiny M M , Abdelhamed A M , Alsaleem W Y
Published: May 2020

Background

Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the etiology is often unknown and there are few evidence-based diagnostic and treatment strategies. Studies on the etiology, evaluation, and management of RPL are often flawed, uterine factors (acquired and congenital)are responsible for 10 to 50 %of recurrent pregnancy loss,hysteroscopy is the gold standard for evaluation of the eendometrial cavity.

Aim of the work

to evaluate the role of hysteroscopy in the diagnosis of possible uteri.ne congenital and acquired causes of recurrent first trimesteric miscarriages.

Patients and methods

This prospective cohort study was conducted on 164 patients with recurrent (3 or more), first trimester miscarriage planned to undergo office (diagnostic) hysteroscopy to assess the uterine cavity, who attend Ain Shams University maternity Hospital Early Cancer detection Unit during period from July 2018 to December 2018.

Results

the largest proportion 53% of our study population had abnormal hysteroscopic findings, and the uterine septum had the highest prevalence among women with recurrent first trimesteric miscarriages.

Conclusion

In women with recurrent pregnancy loss, hysteroscopy is a useful diagnostic tool in the diagnosis of possible uterine causes of recurrent miscarriages. Uterine septum is the most common congenital uterine abnormality found in patients with recurrent first trimesteric miscarriages.