bluuebunny/crossref_metadata_2025 huggingface dataset:
Retained guidewire following the use of the straight end of Seldinger guidewire for hemodialysis catheterization
Authors: Ghatak Tanmoy , Kumar Neeraj , Singh Ratender K
Published: March 2024

Renal replacement therapy for kidney diseases usually requires hemodialysis catheterization. In literature, loss of a guidewire into the circulation is reported and this complication is preventable if appropriate measures are being used. This case report is of a 21-year-old female, who presented with intermittent fever and had dengue shock syndrome and acute kidney injury. A failed attempt to introduce a hemodialysis catheter of the right internal jugular vein was reported at some other hospitals. Using ultrasonography, X-rays, and computed tomography angiography of the neck, unraveling and guidewire loss were revealed. An unraveled Seldinger guidewire was removed after neck exploration. Migration of the guide in the central vein was revealed after puncturing the vascular wall. After surgical retrieval, the location of the retained guidewire revealed that the straight end of the Seldinger guidewire might have been used during catheterization. Proper training, skill-based learning, and early recognition of the signs of retained Seldinger guidewire are of utmost priority.
A population proportion to each stratum study on knowledge, attitude and practices on vaccine preventable hospital acquired infections
Authors: Ellenkil Anitta Jose , Bharadwajj Nitin Dutt , Mishra Uday Bhaskar
Published: March 2024

Background and Objective:

Health-care workers (HCWs) need to be immunized against vaccine-preventable diseases such as hepatitis B virus and tetanus. The study was conducted to assess knowledge, attitude, and practices on immunization against vaccine-preventable hospital-acquired infection (HAI).

Materials and Methods:

It was a cross-sectional descriptive study conducted in the clinical care areas of a tertiary care government teaching hospital. The study was conducted from June 2019 to June 2020. Institutional Ethics Committee approval was attained before taking up the study. A study sample of 407 was calculated by applying the population proportion to size formula to each stratum and was drawn among the resident (academic) doctors, staff nurses, and paramedical and housekeeping staff of the institute. The results were analyzed statistically.

Results:

Out of 407 study participants, 91 (22.4%) were resident (academic) doctors, 122 (30%) were staff nurses, 23 (5.7%) were paramedical staff, and 171 (42%) were housekeeping staff, respectively. The overall mean score for all the study participants’ knowledge, attitude, and practice for immunization against vaccine-preventable HAIs and health checkup among HCWs was 1.71 out of 2, 0.96 out of 1, and 1.18 out of 2, respectively.

Conclusion:

The knowledge with respect to immunization against vaccine-preventable HAIs and health checkup for HCWs was good for resident (academic) doctors. However, with respect to attitude and practice, it was found that the housekeeping staff and the staff nurses had better scores than the resident (academic) doctors. The author has suggested a few administrative measures in the article.
Huge lipoblastoma engulfing Hunter’s canal in a 3-year-old male child
Authors: Thakur Vinit Kumar , Runu Ritesh , Srivastava Saurav
Published: March 2024

Lipoblastoma in children is not an unheard entity. It is normally a benign mass seen in extremities and rarely involves deeper structures. Its complete excision is warranted to alleviate the symptoms and avoid future recurrence. We report an unusual case of huge lipoblastoma engulfing Hunter’s canal in a 3 years’ male child.
Anterior chamber parameters in simple myopia and hypermetropia using Pentacam
Authors: Anwar Fatma K.H. , Saleh Nashwa M.L. , Mohammed Ssnaa A.
Published: March 2024

Background

Measurement of the anterior chamber parameters of the eye is an essential test and must be done in ophthalmic practice. Many studies were focused on the differences between the values of anterior segment parameters of myopic and hypermetropic eyes from that of emmetropic eyes. A significant correlation has been found between the RE and anterior chamber parameters. However, the strength of the correlation varied according to the race and the age of individuals.

Objective

To measure anterior chamber parameters (central corneal thickness, thinnest corneal thickness, apex corneal thickness, corneal volume, anterior chamber depth, anterior chamber volume, and anterior chamber angle) in simple myopia and hypermetropia and emmetropia to evaluate their effect on the anterior chamber.

Patients and methods

Patients presented with errors of refraction. Their SE ranged between −5 and +5.37 D. Their mean age was 29.70±5.55 years, ranging from 20 to 39 years old. The study included 63 (52.5%) right eyes and 57 (47.5%) left eyes. We examined 120 eyes divided into three groups according to their SE. Group I (control group) included 40 eyes with normal refraction, group II included 40 eyes with simple myopia less than −6 D, and group III included 40 eyes with hypermetropia less than 6 D.

Results

The main central corneal thickness in emmetrope, myope, and hypermetrope was 518.45±50.99, 531.95±43.04, and 552.90±34.44 μm, respectively; corneal volume was 58.10±4.35, 60.17±3.94, and 61.03m3±3.99 m3, respectively; mean anterior chamber depth was 2.98±0.29, 3.34±0.29, and 2.63 ±0.28 m2, respectively; mean anterior chamber volume was 178.98±30.63, 202.25±28.50, and 133.68±25.76 m3m3, respectively; and mean anterior chamber angle was 37.61±6.00, 42.87±3.62, and 31.10±3.76°, respectively. Our results add to the evidence that errors of refraction have an effect on anterior chamber parameters.

Conclusion

This study provided valuable measurements of anterior chamber parameters of the Egyptian adults with error of refraction.
The role of MRI in the assessment of different causes of epilepsy
Authors: Moussa Dalia M. El Saeid Mohamed , Maghraby Hala M. , Hassan Rawhia T.
Published: March 2024

Background and aim

Seizures are one of the most common medical problems affecting children, and epilepsy is the most common chronic neurological condition in children. The aim of this study was to highlight the different causes of epilepsy and to demonstrate and emphasize the usefulness of MRI epilepsy protocol on high-field magnet 3 T as imaging modality in the evaluation of pediatric epilepsy and its value in detecting subtle abnormalities that were commonly missed by previous nondedicated studies.

Patients and methods

This prospective study was conducted upon 40 pediatric patients diagnosed with epilepsy referred to a private center for MRI evaluation done on high-field magnet 3 T MRI, including the following sequences: three-dimensional T1 coronal (1 mm thick partition) with multi-planar reformat (MPR) on axial and sagittal, three-dimensional sagittal fluid attenuated inversion recovery (FLAIR) (1 or 1.5 mm thick, partition) with MPR on coronal and axial planes, high-resolution two-dimensional coronal T2‐weighted MRI, two-dimensional axial T2 (3 mm thickness), susceptibility weighted image (SWI) sequences (1.5 mm thick partition), and diffusion weighted image (DWI), as well as optional sequences, such as T1 MRI with gadolinium to look for contrast enhancement in the time interval between April 2018 and May 2020.

Results

The most common cause of epilepsy in our patients was malformation of the cortical development, accounting for 35% (14 patients), followed by neurocutaneous disorder and mesial temporal lobe lesions, each accounting for 25% (10 patients), followed by miscellaneous causes including brain tumors and vascular malformation [arterio-venous fistula (AVF), developmental venous anomaly (DVA), and cavernoma], accounting for 15% (six patients).

Conclusion

The dedicated MRI epilepsy protocol is a valuable tool in detection and illustration of the MR spectrum of different structural lesions causing pediatric seizures, describing the main MRI features of these disorders.
Assessment of portal hypertensive enteropathy in patients with liver cirrhosis
Authors: Afifi Mohammed A. , Hamid Gamal A. , Mousa Waleed M. , Ghareb Mohamed
Published: March 2024

Background

Portal hypertensive enteropathy remains difficult to diagnose in patients with cirrhosis and portal hypertension (PHT). Limited test choices exist for the inspection of the small bowel in these patients. Small-bowel endoscopy like double-balloon enteroscopy (DBE) is ideal in this situation but rarely performed. We aimed to determine the prevalence of portal hypertensive enteropathy using DBE in the patient population with PHT and correlate its presence with clinical, radiological, and histological findings.

Patients and methods

Thirty-two patients with PHT were included along with 10 controls without the criteria of PHT. All patients and control groups underwent blood tests, ultrasonography, gastroscopy, and enteroscopy. The small-bowel findings by DBE were categorized as inflammatory-like and vascular lesions. The small-bowel changes either endoscopically or histologically were analyzed to find out any association with various demographic, clinical, ultrasonographic, and endoscopic variables.

Results

The frequency of portal enteropathy in our study was 65.6% (21 patients out of 32) and it had positive correlation with the presence of esophageal varices, PHG, and Child-Pugh score. We found that there is statistically significant difference between the results of histology among patients and control groups not only in the jejunal specimen but also in the gastric and duodenal ones. The correlation with the endoscopic picture was statistically not significant.

Conclusion

Small-bowel mucosal and vascular changes related to PHT were seen in a significantly higher number of patients with cirrhosis and PHT.
Synovitis evaluation in Egyptian patients with early rheumatoid arthritis
Authors: Abdelrahman Ghada H. , Abdelkader Mona A. , Mousa Sabila G. , Mohamed Nagwa A. , Abdelsalam Eman M.
Published: March 2024

Background

Evaluation of synovitis in early rheumatoid arthritis (RA) is a crucial subject for appropriate management. Ultrasound (US) with high-resolution study has been confirmed a helpful aid in synovitis evaluation. Chemokine CXC ligand 13 protein (CXCL13), a potent B-cell chemoattractant, is expected to play a valuable role in pathobiology of RA.

Aim

To evaluate synovitis in early RA using serum CXCL13, US with high resolution, and power Doppler ultrasonography (PDUS), and their correlation with disease activity.

Patients and methods

A total of 40 patients with early RA fulfilling 2010 EULAR/ACR criteria of RA were assessed using disease activity score 28 for disease activity in RA, serum CXCL13, and US with high resolution. Moreover, 20 healthy age-matched and sex-matched patients were included as a control group.

Results

Serum CXCL13 levels were highly significantly increased in patients with early RA than controls (P<0.001). Regarding US with high resolution, patients with early RA had a significant increase in thickness of synovium and PDUS score compared with controls (P<0.001). In patients with early RA, serum CXCL13 significantly correlated with erythrocyte sedimentation rate, C-reactive protein, anti-cyclic citrullinated peptide, disease activity score 28, synovial thickness, and PDUS score. Moreover, there was a significant increase in serum CXCL13, synovial thickness, and PDUS score in patients with active RA when compared with patients with remitting RA (P<0.001).

Conclusion

Serum CXCL13 appears to be a new marker of synovitis in patients with early RA and correlates with thickening of synovium and PDUS scores that might reflect disease activity.
Vascular endothelial growth factor and its relation to ultrasonographic findings in juvenile idiopathic arthritis
Authors: Rageh Eman A. , Fahmy Fahmy E. , Alhamshary Azza A. , Mahmoud Sobhia A. , Hassan Asmaa S.
Published: March 2024

Introduction

Vascular endothelial growth factor (VEGF) is a potent proangiogenic factor that acts selectively on endothelial cells, promoting angiogenesis. Angiogenesis plays a critical role in the pathogenesis of inflammatory arthritis, including juvenile idiopathic arthritis (JIA). Power Doppler ultrasonography is a noninvasive valuable technique that provides a reliable image of synovial angiogenesis that helps in evaluation of disease activity.

Aim

To evaluate serum VEGF in patients with JIA and correlate it with disease activity and ultrasonographic (US) findings and power Doppler of arthritic joints.

Patients and methods

A total of 50 patients with JIA were subjected to full history taking, clinical examination, routine laboratory investigations, measuring serum VEGF level, and musculoskeletal US examination. Moreover, 25 apparently healthy children were enrolled as controls.

Results

There was no statistically significant difference regarding serum VEGF between patient and control groups. No statistically significant correlation was found between VEGF and disease activity or US findings in patients with JIA.

Conclusion

The possible role of VEGF in disease activity of JIA remains unclear and needs further research.
Study of plasma methylglyoxal level in patients with type II diabetes mellitus
Authors: El-Hakeem Aml G.A. , Kotb Hend G. , Ahmed Amal M. , Youness Eman R.
Published: March 2024

Background

Type II diabetes is a major risk factor for cardiovascular complications. Methylglyoxal (MGO) is the most hazardous glycating agent.

Objective

To assess the role of MGO in diabetic patients with cardiovascular diseases (CVD).

Patients and methods

This is a prospective study that was conducted on 60 patients with type II diabetes mellitus, comprising 30 males and 30 females, with age ranged from 50 to 62 years. They were classified into two groups: group 1 included 30 patients with type II diabetes mellitus with CVD based on patients known to have ischemic heart disease, hypertension, pervious history of angina pectoris, or myocardial infraction, along with positive findings in ECG and echocardiography. It included 15 males and 15 females. Their age was between 51 and 62 years, with mean±SD of 55.9±5.5 years. Group 2 included 30 patients with type II diabetes mellitus without CVD, based on not being hypertensive, having no history of chest pain, along with normal ECG and echocardiography. It included 15 males and 15 females. Their age was between 50 and 61 years, with mean±SD of 55.5±5.2 years.

Results

There were highly significant increases in MGO in patients with type II diabetes mellitus with CVDs compared with patients with type II diabetes mellitus without CVDs, with P value less than 0.001. There was a positive correlation between MGO and indices of glycemic control (fasting blood sugar, 2 h postprandial, and glycated hemoglobin). There was a positive correlation between MGO and cholesterol, triglycerides, low-density lipoprotein, BMI, diastolic dysfunction of the heart, and diabetic retinopathy, but there was a negative correlation between MGO and high-density lipoprotein and ejection fraction of the heart, which means that MGO level is increased in heart failure.

Conclusion

Our study proved the importance of MGO in type II diabetic CVD in humans. We need future studies to assess the role of MGO in diabetic complications.
Interpretation of conventional magnetic resonance imaging with diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient map in characterization of uterine adnexal lesions
Authors: Abdelrahman Sarah A. , Abdullatif Nahed A. , Elfeshawy Mohamed S.
Published: March 2024

Background

Diffusion-weighted imaging (DWI) is one of the promising new functional imaging techniques that have shown to be effective in the differentiation of benign from malignant adnexal masses.

Patients and methods

This prospective study was conducted on 21 female patients with 25 adnexal masses based on pelvi-abdominal or trans-vaginal ultrasound study. The study was conducted during the period from September 2019 to March 2020 at the Radiology Department and approved by the ethics committee, and all patients gave their informed consent before inclusion in the study. Pelvic MRI with DWI was performed for all cases. The radiological and histopathological results were collected and then analyzed using a specialized computer statistical program.

Results

Among the 25 ovarian masses included in our study, 80% (20/25) were benign and 20% (5/25) were malignant according to histopathological results. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI have been increased from 80, 75, 44, 94, and 76%, respectively, for conventional MRI to 100, 90, 71, 100, and 92%, respectively, for DWI.

Conclusion

Combination of DWI and conventional MRI provides an effective noninvasive technique for assessment of the adnexal masses. It improves the sensitivity and specificity of MRI and thus increasing radiologist's confidence in image interpretation which will finally reflect on patient's outcome and prognosis.
Vitamin D status in Egyptian young children and its correlation with iron deficiency
Authors: Menazie Esaad M. , Okda Heba T. , El Tabiey Noha M. , Kamel Noha M.
Published: March 2024

Background

Vitamin D deficiency (VDD) and iron deficiency are two common nutritional problems and cause a variety of health issues in children even if they are asymptomatic. The potential relationship between the two remains poorly understood.

Propose

To study the status of vitamin D in Egyptian young children and its correlation with iron deficiency.

Patients and methods

This cross-sectional study included 85 apparently healthy Egyptian children between 6 and 9 years old randomly selected from pediatric outpatient clinic of General Port Fouad Hospital, Port Said City, in the period from July to November 2019. A written informed consent was taken from all participants’ parents after proper explanation of the study. All children were subjected to complete history taking, anthropometric measurements, systemic examination, and laboratory investigations, including complete blood count, serum vitamin D level, serum iron, and ferritin level, which were performed for children expected to have iron deficiency through red blood cells indices in complete blood count.

Results

A total of 85 patients (age, 7.36±1.1 years; male to female ratio was 1 : 1) were classified according to their 25-hydroxyvitamin D levels into three groups: VDD 40% (<20 ng/ml), vitamin D insufficiency 40% (20–29 ng/ml), and vitamin D sufficiency 20% (≥30 ng/ml). Of 24 suspected iron-deficient cases, 80% of them were in the VDD+insufficient vitamin D groups compared with 20% in the sufficient group (P<0.001).

Conclusion

Among the apparently healthy young Egyptian children, VDD is common with increased risk of iron deficiency. There is a significant positive correlation between vitamin D level and age, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, and serum iron levels but not with serum ferritin level. Physicians should therefore ensure that vitamin D levels are evaluated in anemic children and provide adequate supplementation to prevent deficiencies of both nutrients.
Outcome of limb salvage in single peroneal versus other tibial revascularization in infra-popliteal arterial disease
Authors: Abdelhafez Abdelaziz A. , Shalamesh Mohamed , Amin Mohammed A.
Published: March 2024

Background

The importance of the angiosome concept in critical limb ischemia remains controversial. The peroneal artery is relatively spared from the terminal stages of atherosclerosis and is often the last tibial vessel to become occluded in diabetes or end-stage vascular disease. The main prejudice, on the contrary, against its use in distal revascularizations is that the perfusion of the foot is indirect, via collaterals from its anterior and posterior branches, despite an extensive collateral arterial bed, so the target vessel may be inadequate for treating a septic or gangrenous foot. The value of peroneal artery revascularization has always been debatable, especially in patients with tissue loss. As one of the most important factors of wound healing is the establishment of in-line flow to the foot, the role of peroneal angioplasty has to be defined. The aim of this retrospective study was to assess the outcomes of single peroneal indirect revascularization (IR) (nonangiosome-targeted tibial angioplasty) versus other tibial direct revascularization (DR) (angiosome-targeted), in infra-popliteal arterial disease.

Patients and methods

Thirty patients were included and presented to the Vascular Surgery Department of Al-Azhar University Hospitals and El araby Specialized Hospital, Menoufia with infra-popliteal arterial lesions, distributed into two equal groups: 15 patients were treated with single peroneal IR, while 15 patients were treated with other tibial DR during the period from June 2019 to June 2019.

Results

Fifteen patients reached the endpoint of adequate healing (nine patients with ‘DR’ technique and six patients with ‘ID’ technique) and nine patients underwent major amputations. The limb salvage after 1 year was 70%.

Conclusion

DR of tibial vessels appears to improve wound healing and limb salvage rates compared with IR, with no effect on patency, morbidity, mortality, or reintervention rates.
Association between serum apolipoprotein B and diabetic retinopathy in type 2 diabetic patients
Authors: Yousef Aya M. , Hammad Fatma K. , Abdelrahman Heba M. , Mohammed Shaymaa A. , Ahmad Inass H.
Published: March 2024

Background

Diabetic retinopathy (DR) is a major microvascular complication of diabetes.

Aim of the work

To study the association between serum apolipoprotein B (Apo-B) and DR in type 2 diabetes.

Patients and methods

This comparative study was conducted on 75 patients with type 2 diabetes recruited from the Endocrinology and Ophthalmology Departments of Al-Zahraa University Hospital. They were divided into three groups according to DR grading: group A included 31 patients without DR, group B included 27 patients with nonproliferative DR, and group C included 17 patients with proliferative DR. Detailed history, clinical examination, and anthropometric measurements were assessed for all selected patients. Fasting and 2-h postprandial blood glucose levels, glycosylated hemoglobin, total cholesterol (CHO), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and Apo-B were measured. Fundus examination was done for all participants.

Results

CHO, TGs, LDL-C, and Apo-B were statistically significantly higher in group C followed by group B and then group A. However, HDL-C was statistically significantly lower in group C followed by group B and then group A. A significant positive correlation was found between DR on one hand and age, diabetes duration, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, CHO, TGs, LDL-C, and Apo-B on the other hand. DR correlated negatively with HDL-C.

Conclusion

Serum Apo-B levels may be a strong biomarker for DR than traditional lipids.
Direct detection of Acinetobacter baumannii by loop-mediated isothermal amplification in patients with respiratory tract infection
Authors: Khirala Seham K. , Elthoqapy Azza A. , Awad Ragaa A. , Badr Gamal A.
Published: March 2024

Background

Rapid detection and treatment of Acinetobacter baumannii which is a health-care-associated pathogen that causes outbreaks and frequently encountered in ICU patients on mechanical ventilation is very important.

Aim

The present study aimed to detect the frequency of A. baumannii in sputum sample by loop-mediated isothermal amplification (LAMP) assay in comparison with the different culture methods.

Patients and methods

In all, 200 sputum samples and 100 tracheal aspirates (TA) were included to detect the frequency of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, A. baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE) pathogens by cultural methods and to detect A. baumannii from sputum sample by LAMP assay comparing its results with CHROMagar Acinetobacter and conventional culture methods referring to the rate of multidrug-resistant A. baumannii.

Results

By conventional culture, positive culture was reported in 228/300 (76%) of all samples. A. baumannii and Klebsiella spp. were the most identified pathogens as they were detected in 27/145 (18.6%) and 19/145 (13%) of sputum samples and 19/83 (22%) and 43/83 (51.8%) of TA. Regarding culture on CHROMagar 46 isolates were identified as A. baumannii, 27 were from sputum sample, and 19 from TA. Out of 46 A. baumannii isolates multidrug-resistant A. baumannii were detected in 9/27 (33.3%) and 15/19 (78.9%) in sputum samples and TA, respectively. DNA of A. baumannii was detected in 28/200 (14%) by LAMP assay from sputum samples. Sensitivity and specificity of LAMP assay were 100 and 99.5% when compared with the conventional culture.

Conclusion

CHROMagar Acinetobacter and LAMP assay are cost-efficient methods in comparison to conventional culture. LAMP assay is distinguished from the others for its simplicity and rapid detection of pathogens.
Evaluation of carotid intima-media thickness and serum homocysteine level as markers of subclinical atherosclerosis in lichen planus
Authors: Omar Nouran , El-Barbary Rasha , Maghraby Hala , Alhabibi Alshaymaa M. , Abd-Elhafeez Hala
Published: March 2024

Background

Lichen planus (LP) is a chronic mucocutaneous inflammatory disease. Its etiology remains unknown and may be caused by a cell-mediated immunological response, where autoreactive cytotoxic T lymphocytes are the effector cells, which cause degeneration and destruction of keratinocytes. Inflammation produces disturbances of lipid metabolism such as serum increase of triglycerides or decrease of high-density lipoprotein. Hyperhomocysteinemia has been regarded as a new modifiable risk factor for atherosclerosis and vascular disease. Homocysteine increases the damage to the cardiovascular system in different ways. It is widely seen now as an independent risk factor of cardiovascular disease in adults. Carotid intima-media thickness (CIMT) is a well-recognized clinical predictor of subclinical atherosclerosis. In several previous studies, patients with psoriasis exhibited greater CIMT than did the controls. In light of these studies, authorities might think that LP would also be associated with the formation of subclinical atherosclerosis, given the similarity between the pathogenesis of psoriasis and that of LP.

Aim

To assess carotid intima thickness and serum homocysteine level as markers of subclinical atherosclerosis in patients with LP.

Patients and methods

Abstract Peripheral blood samples were collected from 25 patients with LP and 25 controls to assess serum homocysteine level, blood glucose, cholesterol, and triglycerides. CIMT was measured by B mode ultrasound.

Results

Both serum homocysteine and CIMT were significantly higher in patients with LP than controls.

Conclusion

Serum homocysteine and CIMT could be reliable predictors of subclinical atherosclerosis in LP.
Recent evaluation of decompressive craniectomy in severe traumatic brain injuries
Authors: Ellabbad Mohamed A. , El Shokhaiby Usama M. , Abd El-Aziz Amr M.
Published: March 2024

Background

An injury to the brain or intracranial hemorrhage may cause it to swell. The pressure within the skull then increases as the brain has no room to expand; this excess pressure, known as intracranial hypertension, can cause further brain injury. High intracranial pressure (ICP) is the most frequent cause of death and disability in brain-injured patients. If high ICP cannot be controlled using general or first-line therapeutic measures such as adjusting body temperature or carbon dioxide levels in the blood and sedation, second-line treatments are initiated. One of these is a procedure called decompressive craniectomy (DC). DC involves the removal of a section of skull so that the brain has room to expand and the pressure decreases.

Patients and methods

We studied 20 patients who presented to the Neuroemergency Unit in AL-Azhar University Hospitals in Cairo and Damanhur Medical National Institute in Damanhur from January 2017 to December 2017 with severe traumatic brain injury with clinical and radiological evidence of increased ICP and indicated for DC. All patients were followed up postoperatively in ICU with serial follow-up computed tomography. Consciousness level was evaluated using the Glasgow Coma Scale and Glasgow outcome score.

Results

The overall mortality was five (25%) cases, four severely disabled (20%), and 11 (55%) patients had favorable outcome.

Conclusion

In 20 cases with severely raised ICP resistant to conservative management, DC allowed 55% of cases to be discharged from hospitals with mild degree of disability for rehabilitation.
Assessment of right and left ventricular functions in interstitial lung diseases
Authors: Salama Khadiga S.M. , Abou Bakr Samiha M. , Farag Taghreed S. , Eid Hoda A. , Mohamed Layla A.
Published: March 2024

Background

Subclinical or overt cardiovascular affection in patients with interstitial lung diseases (ILD) may expect to have increased mortality and/or reduced exercise capacity.

Objective

Echocardiographic (echo) assessment of right ventricular (RV) and left ventricular (LV) functions in patients with ILD.

Patients and methods

Conventional echo, tissue Doppler imaging (TDI) and two-dimensional speckle tracking echo (2D STE), spirometry [forced vital capacity (FVC%), forced expiratory volume in 1 s% and forced expiratory volume in 1 s/FVC], and functional exercise capacity (6 min walking test) were performed on 60 patients with ILD and 60 age-matched and sex-matched controls. Pulmonary involvement was identified in high-resolution computed tomography (HRCT) and scored according to a semiquantitative Warrick score.

Results

Using conventional echo-Doppler, TDI, and 2D STE, there are statistically significant impairments in both RV systolic and diastolic functions, as well as LV diastolic functions in ILD patients compared with controls (P<0.05). LV systolic dysfunction was detected by TDI and STE only; however, ejection fraction was normal by standard echo. In the ILD group, the tricuspid annular plane systolic excursion was positively correlated with PaO2 and FVC%, while it was negatively correlated with the HRCT score. RV global longitudinal strain% was positively correlated with both 6 min walking distance and FVC%. Moreover, LV global longitudinal strain% was positively correlated with both 6 min walking distance and PaO2, while it was negatively correlated with HRCT score.

Conclusion

Both RV and LV systolic and diastolic dysfunctions were detected by echo in ILD patients. Ventricular dysfunctions were related to hypoxemia, radiological score, and vital capacity of the lungs. Ventricular dysfunction has a negative impact on function exercise capacity of patients with ILD.
Ultrasonograph versus β-human chorionic gonadotropin titer for verification of termination of missed first trimester miscarriage
Authors: Nassef Aziza H. , Mohammed Nahed H. , Ibrahim Samar M.
Published: March 2024

Introduction

Miscarriage is one of the common complications of pregnancy. Up to 20% of recognized pregnancies will end in miscarriage. However, when women were followed with serial serum human chorionic gonadotropin (hCG) measurements, the actual miscarriage rate was found to be 31%. Many pregnancies are lost spontaneously before a woman recognizes that she is pregnant, and the clinical signs of miscarriage are mistaken for a heavy or late menses. In some countries with low resources, ultrasound may be not available in all medical centers. So, confirmation of complete termination of first trimesteric miscarriage may be not possible, and these cases may present with complications of inadequate treatment. So, we need to study other method for verification of successful management such as β-hCG titter.

Objective

The aim was to assess the usefulness of testing serum β-hCG titer to confirm the effective medical termination of the first trimester miscarriage.

Patients and methods

A prospective study was conducted at the Department of Obstetrics and Gynecology at Al Zahraa university Hospital in the period between December 2017 and April 2018. A total of 34 pregnant women with first trimester miscarriage (7–13 weeks from the first day of last menstrual period) were submitted for medical termination of miscarriage, and each case was subjected to ultrasonography 7 days after termination of miscarriage (for measurements of endometrial thickness) and serum β-hCG at 3 and 7 days after termination of miscarriage.

Results

Endometrial thickness decreased after termination of miscarriage (with cut-off value <15 mm). Moreover, β-hCG decreased after medical termination of miscarriage. In our study, receiver operating characteristics curve was used to define the best cut-off value of β-hCG, which was greater than 34 mIU/ml, with sensitivity of 90%, specificity of 70.8%, positive predictive value of 56.4%, and negative predictive value of 94.4%, with diagnostic accuracy of 83.5%.

Conclusion

Measuring β-hCG level is an effective alternative to transvaginal ultrasound measurements of endometrial thickness to verify the completion of termination of early miscarriage.
Bone mineral density in young adult Egyptian women and its relations to different anthropometric measures
Authors: Hamoda Noura Z. , Eltokhy Hanan M. , Mohamed Eman F. , Mohammed Doaa S.
Published: March 2024

Background

Low bone mass often leads to osteoporosis and increased risk of bone fractures. Body composition is a new aspect that may contribute to an imbalance, leading to decreased bone mineral density (BMD) and general bone health.

Objective

This study was done to evaluate the BMD in young adult Egyptian women by using dual-energy radiograph absorptiometry (DEXA) technique and to identify probable relations between different anthropometric measures and BMD.

Patients and methods

This study was performed at the Internal Medicine Department of Al-Zahraa University Hospital from March 2019 to August 2019 on 80 adult Egyptian women. Their ages ranged from 18 to 40 years old. All study participants were subjected to anthropometric measurements, including weight, height, BMI, waist circumference, hip circumference, and waist/hip ratio; assessment of body composition, including fat mass, lean mass, and water volume in the body, using bioelectrical impedance by body fat analyzer 905; and assessment of BMD using dual-energy radiograph absorptiometry technique at the lumbar spine, left femoral neck, and left forearm.

Results

Based on WHO diagnostic criteria, osteoporosis was present in 3.75% of samples, whereas osteopenia represented 25% of the cases. There were highly positive significant associations between BMD and each of weight, height, serum alanine transferase, and CA levels, and there was a positive significant association between BMD and each of age, BMI, waist circumference, and hip circumference.

Conclusion

A significant portion of adult women are at high risk of development of osteoporosis and increased risk of bone fractures. So young women in particular need to be aware of their vulnerability to osteoporosis. They can take steps early to slow its progress and prevent complications.
Plasma cell-free erythroid DNA as a new marker for differentiation between many types of anemia
Authors: Elwardany Reham M. , Kotb Fatma M. , Alhabibi Alshaymaa M. , El-ghafour Seham Mohamed Abd
Published: March 2024

Background

The study of cell-free DNA (cfDNA) has attracted great interest these years. Some research studies detected the origin of cfDNA and used it to monitor the treatment response and predict disease progression.

Objective

We aimed to detect the erythroid cfDNA as a valuable noninvasive marker for differentiation between many types of anemia.

Patients and methods

A total of 76 patients and 25 age-matched and sex-matched controls were enrolled in this study. Patients were divided into four groups depending on type of anemia: group I (n=20, patients with ß-thalassemia major), group II (n=20, patients with chronic kidney disease), group III [n=16, patients with aplastic anemia (AA)], and group IV (n=20, patients with iron-deficiency anemia). Group III was further subdivided into two subgroups: subgroup A (n=8 patients with AA responsive to treatment) and subgroup B (n=8 patients with AA not responding to treatment). Erythroid cfDNA (E%) was estimated using quantitative real-time PCR.

Results

There was a highly significant difference in the percentage of erythroid DNA (E%) when comparing each group with the control group; furthermore, E% was more sensitive than the reticulocyte count for discrimination between group II and the control group, and more specific for discrimination between groups III and IV and the control group.

Conclusion

The erythroid cfDNA is a sensitive noninvasive tool when compared with reticulocytic count for discrimination between different types of anemia.
Treatment of three-part fracture of proximal humerus in adults with plate and screws
Authors: Yehya Mohamed A. , Hassan Yaser E. , Gaafar Ahmed K.
Published: March 2024

Objective

The aim of this study was to evaluate our results for the treatment of three-part fracture of proximal humerus in adults with plate and screws.

Patients and methods

The study was done and followed up on 15 patients for 2 years. Deltopectoral approach has been used for all the patients. All patients had clinical and radiological evaluation at regular periods during their follow-up. The age of patients range from 23 to 77 years with a mean age of 51.9 years.

Results

The constant score was used for clinical evaluation of patients. In the constant method of functional assessment, a 100-point score is based on the assessment of a number of individual subjective and objective parameters in an entirely clinical setting. We have four cases representing 26.67% of all patients who had complications; one patient was complicated by stiffness, two patients with nonunion, and one patient with infection.

Conclusion

With short-term follow-up, the internal fixation with plate and screws is effective in the treatment of three-part fractures of the proximal humerus in adults.
Serum Beclin 1 in HCC and correlation with MDA as an oxidant
Authors: Mohammed Zeinab A. , Attia Fatma A.K. , El-Senosy Fatma M. , Younes Eman R. , Elsayed Fadila M.
Published: March 2024

Background

Hepatocellular carcinoma (HCC) is the second most lethal cancer worldwide with persistently increasing mortality in Europe, North/South America, and Africa, in contrast to the decreasing trend in East Asia. Cirrhosis was estimated to cause more than 1.2 million deaths (2% of global deaths) in 2013, an increase of 47% since 1990.

Aim

The aim was to assess serum Beclin 1 as a biomarker in HCC regarding its role in pathogenesis and its correlation with serum malondialdehyde (MDA) as an oxidant.

Patients and methods

This is a case–control study conducted on 60 participants who were divided into two groups: group 1 included 30 patients with HCC, comprising 26 males and four females, with ages ranging from 55 to 75 years. Group II included 30 healthy participants as a control group, comprising 21 males and nine females, with ages ranging from 25 to 42 years. Routine laboratory investigations were done, and serum Beclin 1 and serum MDA were measured in both groups. Abdominal ultrasonography and triphasic computed tomography were done for the patient group. All patients were recruited from Internal Medicine Department (Al-Mansoura University Hospital) after obtaining oral consent to be participated in the study.

Results

There was a highly significant decrease in serum Beclin 1 levels (<0.001) in patients with HCC when compared with the control group. The significant association between Beclin 1 and HCC suggests that low Beclin 1 levels may play an important role in the development of HCC. Moreover, there was a statistically significant increased serum MDA level (>0.001) in patients with HCC as compared with control group. There was a positive correlation between Beclin 1 and BMI in the patient group (r=0.42 and P=0.02), a negative correlation between MDA and red blood cells in the patient group (r=−0.40 and P=0.03), and a positive correlation between MDA and aspartate transaminase in the patient group (r=0.41 and P=0.02).

Conclusion

Findings of our study have demonstrated that serum Beclin 1 and MDA levels could be used as possible predictors of pathogenesis of HCC.
The correlation between the size, site, and type of vocal fold polyp and voice quality, before and after laryngeal microsurgery
Authors: Kadah Sayed M. , Sallam Yossra A. , Mohamed Bothina A. , Zakzouk Hend M.
Published: March 2024

Introduction

Vocal fold polyps have detrimental effects on voice quality. These effects vary according to their site, size, and histopathological type.

Patients and methods

This observational prospective study was performed on 30 patients with unilateral vocal fold polyp. Their voice quality was analyzed perceptually and acoustically preoperatively and 3 and 6 weeks postoperatively. Results of voice analysis were studied against polyp size (small ≤3 mm and large >3 mm), site (anterior and middle), and histopathological type (fibrous, edematous, and vascular).

Results

Results showed that Jt-per, Sh-per, and HNR were significantly affected in large anterior vascular polyps both preoperatively (P=0.023, 0.008, and 0.034, respectively) and postoperatively, together with large anterior edematous polyps (P=0.002, 0.004, and 0.025, respectively). In addition, grade of dysphonia showed significant improvement in second follow-up in edematous and vascular anterior large polyps than fibrous ones (P=0.027).

Discussion/conclusion

Small polyps have the least effect on voice quality regardless of its site and histopathological type preoperatively. Large anterior edematous polyps have the worst effect on voice quality with subsequently most significant improvement postoperatively.
Evaluating the use of fibrin glue in the treatment of pilonidal sinus disease
Authors: Alfy Mohamed O. , Mohamed Sawsan S.
Published: March 2024

Background

Pilonidal sinus disease (PSD) is frequently encountered in clinical practice affecting the natal clefts of the buttocks and is associated with high morbidity and discomfort. There are various surgical and nonsurgical methods for its treatment. The use of fibrin glue in PSD is relatively new and encouraging results have been reported. This study aimed to evaluate fibrin glue as a primary treatment for PSD.

Patients and methods

This was a prospective observational study on 54 patients with PSD, who were admitted to our hospital during the period from September 2017 to September 2019. Patients with signs of acute abscess and complicated cases were excluded from this study. Patients had curettage of the sinus with a small Volkmann's spoon; fibrin glue was then injected through the sinus opening to the sinus bed to obliterate the dead space.

Results

In all, 54 patients were identified, 42 (77.7%) men and 12 (22.3%) women. The mean duration of operative time was 20 min. Thirty-six (66.6%) had returned to normal activities within a week. There were six (11.1%) recurrences after one glue application and had subsequent excision and lateral closure.

Conclusion

Fibrin glue treatment for pilonidal sinus can be used as a first-line treatment. It is associated with patient satisfaction and rapid return to normal activities.
Video-assisted thoracoscopic bullectomy with pleurectomy versus pleural abrasion in the treatment of primary spontaneous pneumothorax
Authors: Abogamila Rezk Zenhom
Published: March 2024

Background

Comparative study between partial pleurectomy and mechanical pleural abrasion in the treatment of primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopy (VATS) to show its efficacy and safety.

Patients and methods

Between August 2014 and January 2018, 120 patients with PSP underwent VATS pleural abrasion and partial pleurectomy with bullectomy for both groups in the Security Force Hospital, Riyadh, KSA. All patients were reviewed retrospectively according to medical records.

Results

Partial pleurectomy was performed in 60 (50%) patients while other 60 patients underwent pleural abrasion. There is no significant differences in sex, age, weight, or history of smoking at the time of surgery. There was longer operative duration in the pleurectomy group (90±12.4 min) versus the pleural abrasion group (40±7.55 min) but with more blood loss in the latter one (P<0.001). There was no significant differences between studied groups regarding number, site, and size of bullae (P>0.05). There was no significant difference in major postoperative complications (P=0.132). Nine (7.5%) patients developed pneumothorax after surgery with mechanical pleurodesis. The incidence of recurrent pneumothorax in patients who underwent pleural abrasion was higher than in patients who underwent pleurectomy (13.3 vs. 1.7%, P=0.045).

Conclusion

In our study, VATS pleurectomy is more effective in the treatment of PSP than pleural abrasion. The recurrent rate of pneumothorax is significantly lower in the pleurectomy group than in the pleural abrasion group. So, VATS pleurectomy is the procedure of choose in the management of PSP.
Acupuncture in polycystic ovary syndrom
Authors: Gazar Nadia M. , Mahmoud Maher F. , Alkafrawy Mona E. , Hafez Mai I.
Published: March 2024

Introduction

Polycystic ovarian syndrome (PCOS) is characterized by the clinical signs of oligomenorrhoea, infertility, and hirsutism. Biochemically, women with PCOS often show signs of hyperandrogenism (excessive production of androgen).

Aim

The aim was to evaluate the use of acupuncture to prevent and reduce symptoms related to PCOS in patients with infertility.

Patients and methods

This study was carried out on 32 women with PCOS of reproductive age (20–35 years) who presented with infertility. The diagnostic criteria of PCOS applied in this study were based on the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine consensus in Rotterdam, 2003.

Results

A total of 15 (46.9%) women experienced a good effect. Women with good effect from acupuncture had significantly lower BMI (from 27.68±3.36 to 26.97±3.34; P=0.006), but there was no significant change in waist-to-hip circumference (from 0.85±0.14 to 0.84±0.14; P=0.188). There was a significant decrease in mean serum concentration of luteinizing hormone (LH) (from 13.81±3.91 to 10.30±5.14), LH/follicle stimulating hormone ratio (from 2.32±0.81 to1.69±0.90), serum testosterone (from 1.26±0.68 to 1.08±0.75), and fasting insulin (from 31.32±9.90 to 27.53±7.67); a decrease in mean and SD for serum concentration of LH (from 13.81±3.91 to 10.30±5.14), LH/follicle stimulating hormone ratio (from 2.32±0.81 to 1.69±0.90), serum testosterone (from 1.26±0.68 to 1.08±0.75), and fasting insulin (from 31.32±9.90 to 27.53±7.67); and a significant increase in serum E2 (from 34.23±15.32 to 49.02±26.08).

Conclusion

Acupuncture is a safe and effective treatment of PCOS, as the adverse effect of pharmacologic interventions are not present in patients with PCOS who use acupuncture. Acupuncture therapy increases the blood flow to the ovaries, reducing ovarian volume and the number of ovarian cysts. Reducing serum testosterone, increasing insulin sensitivity, and decreasing insulin level also assist in weight loss.