bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury
Authors: Ali A K , Abdelbar A E , Farghaly A R , Uthman M K A
Published: May 2020

Background

Traumatic brain injury (TBI) is among the most important public health problems associated with high healthcare and social burden and significant mortality and morbidity. Overall low income countries have the highest TBI associated mortality and morbidity.

Aim of the Work

Some studies have demonstrated that intracranial pressure (ICP) monitoring reduces the mortality of traumatic brain injury (TBI). But other studies have shown that ICP monitoring is associated with increased mortality.

Patients and Methods

Systematic review of Published English literature from 2000 to 2017. Using appropriate combinations of MeSH terms and key words, including intracranial pressure, intracranial hypertension, ICP monitor, intracranial pressure monitoring, TBI traumatic brain injury, and craniocerebral trauma. Brain Trauma Foundation guidelines, mortality. We performed this relatively wide search to include the maximum number of relevant patients.

Results

In total, 2552 studies were identified and screened for retrieval using the strategy described above. After careening the title and abstract, 1968 studies were excluded and 554 were retrieved and subjected to detailed evaluations. Based on the inclusion and exclusion criteria, 527 of those studies were excluded, and thus 27 studies were included in the systematic review. All included studies were published, peer-previewed papers.

Conclusion

ICP monitoring may play a role in decreasing the rate of electrolyte disturbances, rate of renal failure, and increasing favorable functional outcome. However, there was no significant effect for reducing the risk of hospital mortality, lowering occurrence rate of pulmonary infection, use of mechanical ventilation and duration of hospital stays. RCTs with larger sample size are necessary to further support the current results.
Oral Paracetamol versus Oral Paracetamol with Codeine as Intrapartum Analgesic in the First Stage of Labor: Randomized Controlled Trial
Authors: Hashad A M , Elbohoty A E , Ahmed M E , Ibrahim K M
Published: May 2020

Background

Labor pain includes components that differ completely from pain in general. It is the result of natural events and has a special meaning, leading in most cases to something extremely positive, the birth of a healthy child. Labor is a painful condition, considered to be one of the most intense and stressful experiences especially for nulliparous women. Although studies have found significant rise in pain threshold during labor. It is nonetheless an important goal to provide safe and effective methods of analgesia for women in a pain in order, amongst other reasons, to obtain her maximum cooperation.

Aim of the Work

The aim of this study is to evaluate the efficacy and adverse effects of oral paracetamol (500mg) during the active phase of labor compared with oral solpadeine (paracetamol 500mg with codeine 8mg) as a method for intrapartum analgesia.

Patients and Methods

This study double blinded randomized controlled trial was conducted on 220 low-risk gravid women have labor pain in first stage of labor and need analgesia comparing the effect of administration of oral paracetamol (500mg) and oral paracetamol 500mg with codeine (8mg) (solpadeine capsule) on managing of pain during active phase of labor. Study setting: The current study was conducted at Ain Shams University Maternity Hospital for about 6 months from February to August 2017.

Results

As recorded by the VAS score, there was significant pain reduction at 1, 2, 3 and 4 hours in both groups (P = 0.001). The reduction in pain was significantly greater in the solpadeine group only at hour 2 (P = 0.001). Maternal complication as nausea, vomiting, abdominal pain and indigestion were 2 fold to 4 fold more in solpadeine group than in paracetamol group.

Conclusion

The use of oral paracetamol as analgesia during labor appeared to be effective, safe, done anywhere of labor situations, with no fetal or maternal adverse effects. Using paracetamol as labor analgesia is a new line; it needs to have more chance in comparison with other forms and routs. Also it can be used as adjuvant drug with other types of analgesics.

Recommendations

Paracetamol may be a good alternative to codeine and opioids as regards analgesic in labor. Maternal and neonatal adverse effects of codeine and opioids as pethidine are good reasons to find another alternative, further randomized controlled trial on wider scale are needed and other forms of paracetamol as suppositories or intravenous are desired to be used as analgesia in different stages of labor and postpartum.
A Comparative Study between Lactoferrin versus ferrous sulfate in iron-deficiency during pregnancy
Authors: Borg T F , Labib K M , Darwish G M
Published: May 2020

Background

Iron deficiency anemia (IDA) is the condition in which there is decrease in the number of red blood cells or the amount of hemoglobin in the blood. It is caused by insufficient dietary intake and absorption of iron, or iron loss from bleeding. Bleeding can be from a range of sources such as the intestinal, uterine or urinary tract.

Aim of the Work

to compare the efficacy and the safety of lactoferrin versus ferrous sulphate for the treatment of iron deficiency pregnant women.

Patients and Methods

This randomized clinical trial was conducted on 98 women selected from pregnant women attending the antenatal outpatient clinic of Ain Shams University Maternity hospital. All patients were divided into two groups; the first group included 49 pregnant women who received lactoferrin (Pravotin100 mg sachets, Hygint pharmaceuticals, Egypt) twice daily orally for 30 days which was dissolved in 1/4 glass of water before meals by 15 minutes. The second group included 49 pregnant women who received 520 mg of dried ferrous sulphate tablets (Feosol tablets, Meda pharmaceuticals, Egypt) once daily orally for 30 days on empty stomach but may be taken with meals to avoid stomach upset.

Results

Total increase in HB after 1month with lactoferrin was higher compared to ferrous sulfate (-13.572 gdl)(p < 0.001). Gastroinestinal adverse events occurred more frequently with ferrous sulfate than the lactoferrin group (p < 0.001).The number of women requesting change the drug was higher in the ferrous sulfate group(p < 0.001).

Conclusion

Oral lactoferrin was better tolerated and more acceptable with higher increase in mean hemoglobin when compared to oral iron therapy over one month treatment. Oral lactoferrin can be used as a good substitute to oral iron therapy in iron deficiency during pregnancy.
Mode of Delivery in Gestational Diabetes Controlled by Metformin versus Insulin: Randomized Controlled Trial
Authors: Sammor H M , Sabaa H A , Abbas A M , Abouelwafa S H
Published: May 2020

Background

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is characterized by insulin resistance or decreased glucose tolerance, which increases throughout pregnancy

Objective

To compare mode of delivery in women with gestational diabetes, treated by insulin versus metformin.

Patients and Methods

The current study was conducted in Ain Shams University Maternity Hospital in the period between August 2016 and August 2018. A total of 124 women were included in the study.

Results

Our study compared mode of delivery in women with gestational diabetes, treated by metformin versus insulin. Our study found that the incidence of cesarean section was statistically significantly higher in the insulin group compared to the metformin group. Fasting glucose levels were statistically significantly lower in the metformin group compared to the insulin group, albeit with minor clinical relevance. No statistically significant differences in postprandial glucose levels or glycosylated hemoglobin were found between the two groups.
Correlation between Serum Levels of Progesterone on HCG Administration Day and Clinical Pregnancy Rate in ICSI cycles
Authors: Raafat T A , Mohammad H F , Hassan E I
Published: May 2020

Background

Infertility is an illness clinically defined as failure to achieve a clinical conception after 12 months of regular and unprotected normal sexual intercourse. It affects around 8 -12% of child bearing-aged couples globally. Premature progesterone elevation is considered for a long time a cornerstone factor to endometrial implantation failure. Although the extensive usage of GnRH analogues for down-regulation of pituitary, rise in progesterone serum levels, still occur at various levels on the day of administration of hCG for ultimate oocyte maturity in fresh IVF management cycles. Aim to investigate and evaluate the correlation between serum progesterone level on the day of HCG administration and the clinical pregnancy rate as a primary outcome, quality of embryo, quality of oocyte, fertilization rate and chemical pregnancy assessed by B-HCG level 2 weeks after embryo transfer as secondary outcomes.

Methodology

This prospective non interventional study was conducted at Assisted Reproduction Unit, Ain Shams University Maternity Hospital, Cairo, Egypt, starting from December 2015 till March 2017. The study included 240 women scheduled for ICSI presented with primary or secondary infertility, the causes of infertility in this study were male factor, tubal factor and unexplained infertility.

Results

the current research study displayed that there was unfavorable statistical correlation between serum progesterone elevation at the day of HCG trigger and the clinical pregnancy rates which was 34.2%, the cut off value of serum progesterone was 1.09 ng/ml; above this value the serum pregnancy rates were negatively influenced. Additionally premature rise of serum progesterone levels reduced the embryonic quality, oocyte quality and fertilization rate.

Conclusion

serum progesterone level equal to or above 1.09 ng/ml at the day of HCG trigger unfavorably influences on the clinical pregnancy rates in ICSI cycles.

Recommendations

All embryos should be cryopreserved when serum progesterone on the day of HCG trigger equals to or above 1.09 ng/ml during ICSI cycle to be transferred in subsequent cycle to avoid implantation failure.
Fetal and Maternal Outcome in Preterm Premature Rupture of Membranes (PPROM) at Ain Shams Maternity Hospital: A Retrospective Analysis of Last Five Years Admissions
Authors: Nageeb A H , Fares M A , Islam B A , Salem H M
Published: May 2020

Background

PPROM is defined as spontaneous rupture of the membranes before the onset of labour prior to 37 weeks gestation. It complicates 2-4% of all singletons and 7-20% of twin pregnancies and is associated with over 60% of preterm births.

Aim of the Work

to retrospectively compare the neonatal and maternal outcomes in women with preterm prelabor rupture of the membranes (PPROM) who delivered before versus who delivered after 34 weeks of gestation over a 5-year period (between January 2011 and December 2015).

Patients and Methods

This retrospective case-control study was conducted at Ain Shams University Maternity Hospital. The analysis covered the period between January 2011 and December 2015. The study included all women admitted to Ain Shams University Maternity Hospital during the period between January 2011 and December 2015 with a diagnosis of preterm prelabor rupture of the membranes (PPROM).

Results

The incidence of chorioamnionitis (p-value <0.001) and maternal sepsis (p-value = 0.001) were both significantly higher in those delivering before 34 weeks. The gestational age at ROM was significantly lower and the latent period was significantly shorter in patients delivering before 34 weeks of gestation (p-values <0.001). The Apgar score at 1 and 5 minutes as well as the birth weight were significantly lower in the group delivering before 34 weeks of gestation (p-values <0.001). The incidence of low Apgar score at 1 and 5 minutes (p-value <0.001 and 0.002, respectively), NEC (p-value = 0.006), IVH (p-value <0.001), RDS (p-value = 0.005) and neonatal death (p-value <0.001) were all significantly higher in patients delivering before 34 weeks of gestation.

Conclusion

In women with premature preterm rupture of membrane neonatal and maternal outcomes is better in those who delivered after 34 weeks of gestation when compared to those who delivered before 34 weeks of gestation.
Retrospective Analysis of Treatment Modalities and Survival of Patients with Cervical Cancer in Ain Shams University Maternity Hospital from 2012 to 2017
Authors: Elshalakany A H , Mamdouh A M , Helal M M O
Published: May 2020

Background

cervical carcinoma is considered the second most common cause of gynecological malignancy death following ovarian carcinoma. The incidence of invasive cervical cancer is higher in low-income countries due to lack of screening programs. There are many treatments for cervical carcinoma, namely surgery, chemotherapy and radiotherapy with different morbidity and survival rates (also according to the stage of the disease).

Aim of the Work

The aim of this work is to review the cervical cancer patients in Ain Shams University Maternity Hospital from 2012 to 2017 in the aspects of demographic characteristics, treatment modalities used, survival and morbidity.

Patients and Methods

the data includes patients diagnosed as having cervical cancer from 1-1-2012 to 31-12-2017 in Ain Shams University Maternity Hospital as retrospective analytical study. We collect name, age, parity stages, Histopathology, treatment, morbidity and survival about each woman and analyze this data.

Results

study included 147 women diagnosed as having cervical carcinoma from 2012 to 2017 in Ain Shams University Maternity Hospital. the most frequent residence was greater Cairo (81%). Majority of patients and their husbands were illiterate (91.8%). Two thirds of the studied cases were married (66.7%). Less than two thirds of the studied cases were postmenopausal (64.6%). The mean age of cases included in this study was 52.3 years. SSC was the most frequent pathology (82.3%). the overall survival rate was 61.7% (survival duration 1.2year with IQR (1→ 2.5 year). By the end of our study 81.8 % of the cases survived in stage I, 65.7 % in stage II, 55.6 % in stage III and 33.3 in stage IV. The most frequent treatment modality was primary radiotherapy without surgery 53.2% with 60% survival with median duration 1year (0.8-2 year) .Then primary radiotherapy with surgery 22.5 % (19.8 % with completion surgery and chemotherapy and 2.7% with salvage surgery) with 56.2 % survival with median duration 1.1 year (1-2.5 year) and the least frequent was 1ry surgery (21.6 %) with 80% survival with median duration 1.8 year (1-3.9 year). Recurrence was in less than tenth of cases (9.3%), the most frequent site was extrapelvic (75.0%).

Conclusion

In Ain Shams University Maternity Hospital the cases are usually clinically presented in late stages and usually with complications due to lack of screening. In developing countries like Egypt, brachytherapy may not be available for all patients. Our study proved that completion surgery after whole pelvic radiation can take place with comparable survival rates and morbidity. Our survival rates are comparable with other studies conducted in developed countries and are good with our limited resources but are less than other studies performed in developed countries.
Umbilical and fetal Middle Cerebral artery Doppler in Patients with Pregnancy Induced Hypertension in the Prediction of Adverse Perinatal Outcome
Authors: Habib S M , Eltaieb E M , Darwish M A H
Published: May 2020

Context

Hypertensive disorders complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality. Close antenatal care is considered the corner stone in early diagnosis of the disease and picking up of the severe cases with subsequent early management and intervention. On the other hand aggressive management of severe cases of high risk pregnancy is considered the second line of defense against maternal and preinatal morbidity and mortality.

Objective

The aim of this work is to assess the accuracy of middle cerebral artery and umbilical artery Doppler in predicting perinatal outcome in women with PIH in the third trimester.

Methodology

In this study which included 100 women with pregnancy induced hypertension who admitted to Ain Shams university maternity hospital our aim was to assess the accuracy of middle cerebral artery and umbilical artery Doppler in predicting perinatal outcome in women with PIH in the third trimester including predicting admission to NICU and the duration of treatment, low Apgar score at 5 minutes, Gestational age at delivery, fetal weight at birth and perinatal mortality.

Results

There was a significant association between MCA PI abnormalities and higher rates of NICU admission, 5-minutes Apgar score < 7, Low gestational age at delivery, Low birth weight and perinatal mortality. We found that the MCA PI for prediction of NICU admission was the best with (sensitivity 86.8 %, specificity 55.3 %, PPV 68.7%, NPV 78.8%).This was more predictive than either the UA-PI or the MCA/UA PI ratio. In our study, MCA PI was found to be a good predictor of poor neonatal outcome in patients with pregnancy induced hypertension especially in prediction of perinatal mortality and incidence of NICU admission.

Conclusion

Middle cerebral artery pulsatility index is more sensitive and more sensetive than umblical artery pulsatility index and middle cerebral arery/ umblical artery pulsitility index ratio in prediction of adverse perinatal outcomes. However middle cerebral arery / umblical artery pulsitility index ratio showed more specificity in predection of perinatal outcome in patients with pregnancy induced hypertension.
Evaluation of Serum Human Epididymis Secretory Protein 4 (HE4) in Benign Endometrial Disease and Endometrial Cancer
Authors: Mohamed S S , Abdelhafeez M A , Mohamed H F , Abukra F M
Published: May 2020

Objective

The incidence of endometrial cancer is constantly growing. More aggressive types of endometrial cancer as well as the incidence in younger women are being observed. More than 80% of cases are diagnosed in early stages due to early symptoms like abnormal bleeding. Aim of our study to evaluate the ability of serum HE4 concentration to differentiate between benign endometrial disease and endometrial cancer and ass’s correlation it with prognosis of EC.

Material and methods

Serum HE4 level was measured in 85 patients with abnormal uterine bleeding. Based on histology after curettage the study group was divided into the benign and malignant endometrial pathology groups. Statistical analysis was performed using Mann-Whitney test

Results

The difference of serum HE4 level between benign endometrial pathology and cancer was significant (p = 0.000) and the cut-off for identification of patients with endometrial cancer was 62 pmol/l. There was a significant difference between Stage (I – II) endometrial cancer, and Stage (III – IV) p = 0.01, Patients who needed lymphadenectomy had significantly higher HE4 level than those who had no indications for this procedure (p = 0,001).

Conclusion

HE4 is a useful biomarker in diagnosing endometrial cancer. HE4 is associated with high grade endometrial cancer. It can also serve as an useful preoperative counseling tool to identify patients, who may require pelvic lymphadenectomy.
Diagnostic Accuracy of 3D-transvaginal Ultrasound Compared to Hysteroscopy in Detecting Uterine Abnormalities Before ICSI
Authors: Alsherbiny M M , Riad A A M , Hamdoun H A
Published: May 2020

Introduction

Various forms of female infertility were associated with congenital uterine anomalies and acquired uterine disease. In fact, the myometrium can only be indirectly imaged by X-ray hysterosalpingography but is directly seen on Ultrasonography. More recently, further advances in ultrasonography have led to three-dimensional multiplanar or volume imaging (three-dimensional ultrasonography [3DUS]) in which sonographic images are obtained from a volume of ultrasonographic data (rather than from a slice of data) the application of 3DUS to gynecologic imaging has suggested a role for transvaginal 3DUS in the assessment of uterine anomalies and endometrial lesions.

Aim

To evaluate the diagnostic accuracy and sensitivity of Hysteroscopy vs TV3D in the evaluation of the uterine abnormalities in infertile women before ICSI.

Methodology

This is a study including 60 patients were selected from the outpatient gynecological clinic, private center at Sohag government (Ibn Sina Center) in collaboration with (Ain Shams University Hospital in IVF unit) from12/2017 -8/2018. All cases files are computerized and saved in Ibn Sina Center.

Results

The overall result of accuracy of different modalities was 98.3% for 3D sonography and the accuracy of different modalities in detection of endometrial polyp was 93.3% for 3D sonography and 100% for hysteroscopy. The accuracy of different modalities in detection of septate uterus was 100% for 3D sonography and hysteroscopy. The accuracy of different modalities in detection of intrauterine adhesions was 100% for 100% for 3D and hysteroscopy.

Conclusion

Hysteroscopy is the gold standard diagnostic & therapeutic tool for uterine anomalies (bicornuate, septate, arcuate, polyp), However 3D ultrasonography is diagnostic tool only but superior to hysteroscopy in certain lesions e.g. (subserous and intramural fibroid).

Recommendation

we recommend 3D to become soon as the diagnostic procedure of choice in assessment of suspected uterine lesions. Furthermore, we recommend that 3D US, if available, to be performed routinely for all cases of uterine cavity anomalies and prior to corrective uterine surgery.
Effect of oxytocin infusion versus tranexamic acid on reducing blood loss during hysteroscopic myomectomy: A Randomized control trial
Authors: Mohamed S E , Elhelaly A M , Salama M H , Dahman N F
Published: May 2020

Background

Women undergoing hysteroscopic myomectomy are prone to significant blood loss and hematological disturbances. Oxytocin is a uterotonic drug. Tranexamic acid has been used to reduce blood loss in many surgeries. The aim of our study was to compare between oxytocin and tranexamic acid as regard their safety and effectiveness on reducing perioperative blood loss and perioperative transfusion requirement during hysteroscopic myomectomy.

Methods

This study included 60 patients scheduled for hysteroscopic myomectomy allocated into 2 groups: group A: Patient received 10 mg/kg of tranexamic acid slowly intravenous after induction of anesthesia, group B: Patients received infusion of 10 IU of oxytocin at a rate of 400 mIU/min till the end of the procedure. Preoperative and postoperative hemoglobin and hematocrit, need for blood transfusion, duration of operation, complications and medications’ side effects were recorded.

Results

The 2 groups were comparable in terms of mean difference between preoperative and postoperative hemoglobin an hematocrit, operative time, operative complication and medications’ adverse effects. No patient needed any blood component transfusion in both groups.

Conclusions

We concluded that tranexamic acid and oxytocin are equally effective in reducing blood loss and transfusion requirements in hysteroscopic myomectomy with good safety profile. Both of them can be used according to the availability.
The Effect of Estradiol Valerate with and without Oral Sildenafil on Endometrial Thickness and Pregnancy Rates in Infertile Women: A R.C.T
Authors: Kortam M A M F , Mohammad H F , Mobarak M H , Bazazo A A I
Published: May 2020

Objectives

To evaluate the effect of sildenafil-estrogen combination compared to estrogen alone on endometrium thickness in infertile women received induction of ovulation by clomiphene citrate.

Study design

Randomized controlled clinical trial.

Settings

University hospital, Ain Shams University Maternity Hospital.

Materials and methods

90 infertile women with unexplained infertility, were recruited and randomly allocated into two equal groups, 45 patients in each. Both groups received induction of ovulation with CC 100mg/d from 2nd to 6th day of cycle and oral estradiol valerate 2mg 12 hourly from 2nd day of the cycle till the day of trigger of ovulation. In study group oral sildenafil citrate 25mg every 8 h from 2nd day of the cycle till the day of HCG trigger was added. Endometrium was evaluated as regards both endometrial thickness and pattern, uterine artery resistive index (RI) was measured at the day of trigger. Qualitative serum B-hCG level was checked 14 days after ovulation to assess chemical pregnancy rate.

Results

Mean endometrial thickness at the time of hCG trigger was 9.8 mm in study group and 8.42 mm in control group (P value <0.001). 88.9% patients given sildenafil had trilaminar endometrium whereas 29% patients without sildenafil had bilaminar endometrial pattern (P value = 0.006). Mean uterine artery resistive index (RI) after adding sildenafil was non-significantly lower among study group than among control group, the value were 0.66 and 0.72 respectively (P = 0.078). Pregnancy rates in study group and control group was 17.8% and 11.1% respectively.

Conclusion

Sildenafil-estrogen combination has a potent effect on improving the endometrium (thickness and pattern) in patients undergoing induction of ovulation by clomiphene citrate. This improvement in endometrial development has a weak positive feedback on pregnancy rate.
Clinico-Epidemiological Analysis of Characteristics and Outcome in Patient with Hepatocellular Carcinoma Retrospective Study
Authors: Elbassiouny M M , Mustafa M Y , Saleh M E , Gebril N G A
Published: May 2020

Background

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Globally, liver cancer is the 5th and 7th most common cancer in men and women, respectively. Most of HCC burden lies in developing countries. The regions of high incidence include Eastern and South-Eastern Asia, Middle and Western Africa. Worldwide, it is the third most common cause of cancer deaths

Aim of the Work

A retrospective study of Hepatocellular carcinoma patients presented to Ain Shams University Hospital clinical oncology department between the period of 1/2013 till the end of 12/2016 aiming to review of epidemiological and clinical risk factors, response to the therapy used, progression free survival and overall survival.

Patients and Methods

The current study is a retrospective analysis carried out in Ain-Shams clinical Oncology and Nuclear Medicine department, Faculty of medicine, Ain Shams University between the period of 1st January 2013 till the end of 2016, where 136 medical records were planned to be analyzed, from which 18 records were not included in analysis (8 records weren’t available in the archive, 10 contained inadequate data) and 118 were analyzed aiming at detection of the prognostic factors, response, progression free survival and overall survival of patients with HCC.

Results

Regarding age, the median age at diagnosis was 58 years (SD = 8.29), where the average median age was 57.5 years. In our study most of patients were presented with good PS, where 100 (84.7%) of them had performance status less than or equals 2 and only 18 patients (11.8%) were more than or equals 3 performance status < 2 in 84 % of all cases and >2 in 16 %.

Conclusion

To conclude, age as a prognostic factor significantly affects survival in favor of patients < =58 years. RFA affects survival. Performance status significantly affects survival. The quality of data reported was to some extent impaired due unavailability of complete clinical, analytical and radiological information in the charts.
The Role of Platinum Based Chemotherapy in Neoadjuvant Treatment of Locally Advanced Triple Negative Breast cancer
Authors: Abdelaziz H M , Diab D R , Adel A M , Mostafa M Y , Gaddalla M M
Published: May 2020

Background

The treatment of patients with TNBC is the biggest challenge in the breast cancer (BC) scenario. TNBC remains the poorest prognosis breast cancer (BC) subtype, usually high-grade tumors with higher incidence of visceral and cerebral metastases. Cytotoxic chemotherapy is the backbone of triple-negative breast cancer treatment.

Objective

A phase III prospective study designed to investigate the role of addition the platinum based chemotherapy to the neoadjuvant setting in treatment of locally advanced triple negative breast cancer, Considering pathological response, complete (pCR) and partial (pPR) as a primary end point, and toxicity, disease free survival as a secondary end point.

Patients and Methods

This study was a phase III prospective one. 51 female patients Included with locally advanced triple negative Breast Cancer referred to Clinical Oncology& Radiotherapy Department, AIN SHAMS University Hospitals.

Results

A total of 51 female patients between ages 23-73 years with median age was 45 years old and with locally advanced features of breast cancer, (stage IIIa-IIIb-IIIc) were enrolled in the study during a recruiting period from October 2013 till October 2017 at Ain Shams University, clinical oncology department. Six patients (11.8%) were excluded from the analysis after enrollment, they didn’t receive neoadjuvant treatment because they underwent surgery or they developed metastasis So, only 45 patients received the neoadjuvant treatment. The median follow-up duration was 19 months after surgery.

Conclusion

Clearly, there were no statistical significance neither survival benefit in addition of the platinum to the NST comparison with the classic anthracyclines + taxens treatment. Even there was more clinical regression with platinum, but more recurrence and relapse occurred. There for, there is a major need to better understand the characteristics and the clinical behavior of TNBCs with an aim to develop effective treatments for this BC subtype.
Diabetic Retinopathy Vascular Density Maps Using Optical Coherence Topography Angiography
Authors: Omran N A H , Salman A G , Farweez Y A T , Saif P S
Published: May 2020

Background

Diabetic retinopathy (DR) is one of the most common diabetic complications, which has become a leading cause for vision loss, mainly because of macular edema and vitreous hemorrhage.

Objective

Using Optical Coherence Tomography(OCT) and Optical Coherence Tomography Angiography (OCT-A) for qualitative and quantitative assessment of retinal vascular density in superficial capillary plexus, quantitative assessment of foveal avascular zone, choroidal vascular density map, assessment of retinal thickness and choroidal thickness in normal individuals and diabetic patients with and without diabetic retinopathy (DR).

Patients and Methods

This study included 64 eyes. Diabetics and control group were recruited from internal medicine clinic in Misr University for science and Technology Hospital and asked to participate in this study. This study was designed as an observational and cross sectional study in the period from 8/2018 to 2/2019.

Results

There is decrease in Choroidal vascular density in diabetic patients. There is decrease in retinal thickness in diabetic patients and there is no significant differences in the retinal thickness between control subjects and patients with NDR.

Conclusion

Our study suggested that OCTA can identify preclinical DR before the manifestation of clinically apparent retinopathy. Our findings highlight the potential role of OCT-A in monitoring and quantifying retinal vascular alterations in diabetes
The influence of corneal astigmatism on retinal nerve fiber layer thickness and optic nerve head parameter measurements by optical coherence tomography
Authors: Ahmed S M M S , Abdallah N H , Eliwa L S , Bayomy A M
Published: May 2020

Background

Astigmatism is a worldwide common ocular disorder. Total astigmatism is mainly driven by corneal astigmatism (CA), which occurs due to an irregular shape of the cornea. In eyes with astigmatism, retinal images can be distorted, and the image size could vary according to the axis of astigmatism assessed with computer-based methodology in astigmatic eyes.

Objective

to evaluate the influence of corneal astigmatism on the RNFL thickness and ONH parameters obtained by spectral-domain OCT.

Patients and Methods

40 patient chosen from outpatient ophthalmology of Ain Shams University Hospitals and Om El¬_Massrein General Hospital and classified in two groups, the study group (high astigmatic patients ≥ 3 diopter) and control group (normal astigmatism< 3 diopter) with no significant change in the age and sex. All cases were free of any ocular diseases with no past history of medical importance (DM, HTN or any neurological diseases), all this cases never had any previous refractive surgery or any retinal lesion.

Results

In this study all cases had average IOP > 21 mmhg, and randomly selected from the outpatient clinic. The study group had thinner retinal nerve fiber layer in temporal quadrant and larger disc area than the control group. These study support the concept that corneal astigmatism has an effect on retinal nerve fiber layer thickness and optic nerve head parameters.

Conclusion

In our study, we compare between the OCT pattern of retinal nerve fiber layer thickness (total, superior, nasal and inferior quadrants) and the optic nerve head parameters (cup area, disc area, vertical and horizontal C/D ratio) in the high astigmatic patients (≥ 3 diopter) and normal astigmatism < 3 diopter.
Role of preservative free steroids in treatment of inflammatory punctal stenosis guided by Anterior Segment Optical Coherence Tomography
Authors: Elalfy H Y E M , Rashad S M , Shafek A M , Alsamkary M A
Published: May 2020

Background

Acquired inflammatory punctual stenosis is a disease commonly presented with epiphora and most common cause is long term treatment with preservative containing topical eye drops. The inflammation causes a decrease in the clearance of the medication and preservative, and their continued use will result in more inflammation and stenosis, and therefore a longer clearance time resulting in a higher concentration and longer transit time, leading to a vicious cycle.

Objective

This study was conducted to compare between the effectiveness of topical preservative free steroids eye drops and preservative free artificial tears in treatment of punctal edema in Egypt.

Methods

This prospective comparative study comprised 40 eyes with punctal edema. Group A: 20 eyes Patients in this group received preservative free hydrocortisone 2.5% eye drops 4 times daily for 1 week with tapering over 3 weeks and followed up after 1 month. And after 3 months. Group B: 20 eyes Patients in this group received one of the preservative free artificial tears available in market 4 times/day for 1 month. All subjects were subjected to history taking, slit lamp examination, Flourescene dye disappearance test for diagnosis and follow up once/month for 3 months and measuring the punctual diameter pretreatment, after 1 month and after 3 months. From treatment.

Results

Comparing the two groups, the study found that there was no statistically significant difference found between the two studied groups regarding punctual diameter pretreatment, at 1 month and at 3 months and a highly statistically significant symptomatic improvement after 3 months in preservative free steroids group more than the preservative free artificial tears group.

Conclusion

The present study compared the effectiveness of topical preservative free steroid eye drops and preservative free artificial tears as regards increase in punctual diameter and symptomatic improvement and found a statistically significant increase in symptomatic improvement in preservative free steroid group more than the preservative free artificial tears group as after 3 months and statistically significant increase in punctual diameters in both groups in comparison to control group.
Efficacy of Brimonidine Tartarate 0.2% Ophthalmic Solution on Reducing Night Vision Difficulty and Improving Contrast Sensitivity After Laser in Situ Keratomileusis
Authors: Alashry A M Y , Salman A G , Fawzy S M , Abdelaziz T M
Published: May 2020

Background

The relation between scotopic pupil diameter and the optical zone is the most important factor in limiting night vision disturbances after LASIK. Brimonidine Tartrate is a selective alpha-2 agonist which significantly reduces scotopic pupil diameter. It can be used to improve contrast sensitivity and night vision after refractive procedures.

Objective

Subjective and objective evaluation of the effect of Brimonidine tartrate 0.2% ophthalmic solution on improving post-LASIK night vision complaints by studying its effect on the pupil diameter, contrast sensitivity, aberrations and symptoms of night vision difficulties.

Patients and Methods

This prospective study was conducted upon 34 eyes of 17 patients suffering from night vision difficulties after uneventful lasik surgery. They received one drop of Brimonidine Tartrate 0. 2% ophthalmic solution on each eye and were asked to apply one drop in each eye daily for two months. Testing was performed before drops instillation, 30 minutes, 4 hours after instillation and after 2 months of regular brimonidine use. All patients had photopic and scotopic pupillometry using Zywave aberrometer built in pupillometer, Contrast sensitivity testing using Pelli-Robson chart, Aberrometry using Zywave aberrometer. Visual night complaints was assessed with an FDA approved questionnaire taken from (LASIK quality of life collaboration project).

Results

There was a significant decrease in mean photopic and scotopic pupil diameter, spherical and total aberrations after 30 minutes, 4 hours and 2 month of once daily use of Brimonidine. Also there was a significant improvement of contrast sensitivity that remained at acceptable levels along the follow up time. All patients showed a significant visual satisfaction after 2 month of treatment.

Conclusion

Brimonidine tartrate 0. 2% ophthalmic solution can be effective in reducing night vision difficulties after LASIK by reducing scotopic pupil diameter, improving contrast sensitivity and decreasing higher order aberrations.
Comparison between limbal stem cell versus dry amniotic membrane transplantation in treatment of primary pterygium
Authors: Ghanem A M , Zaher F M , Salman A G , Nabil R M
Published: May 2020

Background

Pterygium is a degenerative disorder of the conjunctiva which leads to encroachment of bulbar conjunctiva onto the cornea. This invasion causes irritation of ocular surface, irregular astigmatism and loss of visual acuity.surgical treatment of pterygium is directrd towards excision, prevention of recurrence and restoration of ocular surface integrity. A myriad of techniques have been described for achieving these goals. Tha main complication of these procedures is the recurrence rate, which has been estimated as high as 30%_70%.

Purpose

to compare the efficiency of limbal stem cell transplantation versus dry amniotic membrane transplantation in treatment of pterygium.

Patients and Methods

The study carried out at ophthalmology department, Ain shams university and included 20 eyes which were classified into two groups; first group included 10 eyes of patients underwent pterygium excision with amniotic membrane transplantation. Second group included 10 eyes of patients underwent pterygium excision with limbal stem cell transplantation.

Results

the mean follow up duration was 1-3 months in both groups. On comparing recurrence rate between the studied groups which occurred only in the first group in two eyes 20%, there is no statistically significant difference found between the studied groups as regard recurrence. But it was statistically significant better with limbal conjunctival autografting. Graft rejection was not detected in the two groups during follow up period. There was no statistically significant difference found between the studied groups as regard clinical stability and graft rejection.

Conclusion

Limbal stem cell transplantation proved to be better than amniotic membrane transplantation in treatment of pterygium. As it is more effective in prevention of pterygium reccurence as well as it is of lower cost and better availability than amniotic membrane.
Correlation between optical coherence tomographic patterns and visual acuity in eyes with diabetic macular edema
Authors: Mansour HA A A , Mohamed A A , Abdeldayem H M , Mahmoud A F
Published: May 2020

Background

Diabetes mellitus is a disease of high prevalence as well as incidence and consequence worldwide. An approximate 387 million people have been found to be affected by diabetes mellitus worldwide in 2013. It is presumed that the number of people with diabetes will almost double the current numbers by 2035.

Aim of the work

To determine what is the most important predictor assessed by spectral domain optical coherence tomographic tomography (SD-OCT) correlates with best corrected visual acuity (BCVA) in eyes with untreated diabetic macular edema (DME).

Patients and Methods

Sixty eyes of forty three diabetic patients were included in this observational ,non intervention study. The patients’ ages ranged from 50 to 70 years. All cases had DM type2. This study was conducted at ophthalmic clinic of Al Mataria teaching Hospital from January 2018 till November 2018. Informed consent was obtained from all participants before enrolment. All applicable institutional regulations concerning the ethical use of human volunteers were followed during this research.

Results

In this study, we observed statistically significant correlation between best corrected visual acuity (BCVA) and central subfield thickness (C. S. T), moreover this study detect that the most important OCT pattern affecting vision is the presence of central macular edema.

Conclusion

In untreated diabetic macular edema cystoid macular edema was the most common OCT pattern and has worest vision during 1st ophthalmic examination
Ultrasound guided injection of platelet enriched plasma versus corticosteroids in patients suffering rotator cuff tendinopathy
Authors: Elzaher E H , Kotb A M , Hassaan E H A
Published: May 2020

Background

Shoulder pain is the third most common musculoskeletal complaint. Rotator cuff tendinopathy is an overuse condition that manifests itself as pain in and around tendon and happens when the body fails to regenerate properly. This painful condition is associated with tendon disorganization and thickening that reduces its physical properties, which causes the tendon to fatigue, further exacerbating the painful condition with ultimate failure. A lot of trials and modalities of treatment are studied to avoid the surgical choice such as physiotherapy, NSAIDs and/or ESWT. Local injection of shoulder joint is widely used and studied but the diversity of results lead us to establish further studies.

Objective

The purpose of my study is to compare between two important modalities in non-surgical treatment of supraspinatus tendinopathy.

Methods

This study was conducted on 40 patients divided into two groups: group 1 received 3 subacromial injections of platelet rich plasma 10 days interval and group 2 received single subacromial injection of corticosteroid, both are ultrasound guided. Clinical examination using Constant Score is used to evaluate the patients before receiving treatment (0), one month (1) and six months (6) after receiving the treatment.

Results

We can conclude the results of the 2 groups as there is high significant improvement of the 2 groups comparing base line start. However Corticosteroids shows earlier improvement than PRP after 1 month follow up, but at the end of follow up (6 ms) PRP shows significant improvements according to Constant-Murley Score. According to group 1 there was no complications reported except a discomfort in shoulder region 24 hrs post injection up to 3 days maximum. While in group 2 there was no complications reported all through the 6 months follow up.

Conclusion

Ultrasound subacromial injection of corticosteroid and PRP achieved significant improvement in pain and function of shoulder joint in RCTs. Corticosteroid achieved better improvements according to Constant-Murley Score in short term follow up (4 weeks) than PRP group, while PRP achieved higher significant improvements than corticosteroid in pain and function of the joint after 6 months follow up as corticosteroid group showed decline in the pain and function results after 6 months follow up.
Systematic Review of Literature on the Efficiency of Using PRP in Arthroscopic Rotator Cuff Repair
Authors: Samy T M , Khater A H , Ahmed A K M
Published: May 2020

Rotator cuff tears are one of the most common shoulder problems and the incidence of this condition is increasing along with an aging population. Despite satisfactory results for rotator cuff repair the quality and speed of healing remain problematic. Several studies have demonstrated that native tendon-bone insertions were not restored after tendon to bone repair. Healing of repaired tendons occurred via fibrous scar tissue formation rather than via the regeneration of a histologically normal insertion, and thus repaired tendons have inferior mechanical properties and are more susceptible to retear. Presumably, this is the most significant reason that account for tendon repair failure. Despite recent biomechanical advances in fixation, rates of retear are still high. Tendons consume little energy, and as a consequence healing is slow after injury. Increasing the speed of healing would allow earlier return to work, sport, and activities of daily living, which would be helpful for both the elite athlete and general public. Platelet rich plasma was first popularized in maxillofacial and plastic surgery, but now is thought to enhance and accelerate the repair and regeneration of a variety of tissues, such as bone, cartilage, tendon, ligament, and muscle. This systematic review reporting the effect of PRP after arthroscopic rotator cuff repair.
Cortical Bone Trajectory Screw Fixation of Lumbar Spine in Adult Patients with Degenerative and Traumatic Spine Disorders
Authors: Elbadrawy A M , Elkhateeb T M S , Hassan E M M A
Published: May 2020

Background

the CBT for placing lumbar pedicle screws is a technique used to improve fixation during instrumented fusion of the lumbar spine. In comparison with traditional trajectory (TT) for pedicle screws, CBT screws (otherwise known as pars screws or cortical screws) have a more medial starting point and are aimed in a medial to lateral, caudal to cranial direction. First reported in 2009 as a method to increase the purchase of lumbar pedicle screws within bone.(1)

Aim of the Work

to perform a systematic review and meta-analysis to determine whether traditional Pedicles Screw Fixation (PS Fx) or Cortical Bone Trajectory Screw Fixation (CBT Fx); has been successful for the treatment and fixation of lumbar spine in adult patients with degenerative and traumatic spine disorders; and to compare the 2 techniques to identify risk factor for unfavorable outcome through the recent researches about that issue.

Methodology

this review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines.

Results

meta-analysis study showed that; Successful fusion rate in fixed and random-effects models were (92.24% respectively); in SP group.Successful fusion rate in fixed and random-effects models were (92.44% respectively); in CBT group.Fixed and random-effects models showed non-significant difference in successful fusion rate; between the 2 groups of studies (p > 0.05).

We calculated safety for each technique through post-operative (failed fusion rate).

Conclusion

Although there were insignificant p-values in the most of the comparative items but the CBT showed lower average of intraoperative blood loss, operation time and higher average of decrease in VAS & increase in ODI, slightly higher fusion rate in comparison with PS. So we recommend, the use of CBT as an acceptable alternative of PS in lumbar spine fixation.