bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Nissen Fundoplication surgery for neonates & infant with gastero-oesophageal reflux disease in Ain Shams university Hospitals
Authors: Elzoghby A , Rafik H , Hesham M , Elshafey M S M
Published: May 2020

The objective of this study was to evaluate the outcomes of Nissen fundoplication surgery for neonates and infants with Gastro-oesophageal Reflux disease in Ain Shams university Hospital . from June 2016 till June 2017 13 infant were evaluated to symptoms and signs of recurrence of reflux as (chest symptoms, malnutrition, dysphagia, hematemesis and melena) and assessment of contrast swallow. 8 patient show complete resolve of GERD symptoms, 3 patient show mild chest symptoms relieved by treatment, 2 patient show dysphagia and malnutrition and one of them show recurrence and need re-operation. In conclusion Nissen fundoplication is an effective operation to correct gastroesophageal reflux in infants and children when the drug therapy fails.

Background

Gastro-oesophageal Reflux disease (GERD) is one of the most recognized disorders among neonates and infants. GERD usually resolves physiologically after the developmental maturation of the lower oesophageal sphincter and lengthening of the intra-abdominal esophagus in the early months after birth (Czinn & Blanchard, 2013). Generally, the incidence of GERD is 85% in infants which occurs 1.6 times more inmales than females .Prevalence of GER decreases to 18% in childhood. However; symptoms of (GERD) in infants include coughing or choking, vomiting, chronic respiratory problems, growth failure, sleeping problems, and apnoea. GERD can also be life-threatening and affect the quality of life (Kültürsay, 2012). The current study, a consecutive sample of 13 infant with GERD were retrospectively analysed to investigate the outcomes of Nissen fundoplication surgery

Methods

In this study 13 infant were selected, retrospectively analyzed for outcomes of Nissen fundoplication surgery. Patient were analysed for clinical and radiological signs of GERD.

Results

8 patient show complete resolve of GERD symptoms, 3 patient show mild chest symptoms relieved by treatment, 2 patient show dysphagia and malnutrition and of them show recurrence and need re-operation .

Conclusion

Given these results, it is reasonable to believe that Nissen fundoplication is an effective operation to correct gastroesophageal reflux in infants and children when the drug therapy fails. The operation should be done before occurrence of complications to decrease the recurrence of reflux.
Mesh Fixation versus Non Fixation in Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair
Authors: Lachin A B , Abdrabbu A A , Darwish A A F , Ali M M K
Published: May 2020

Background

inguinal hernia repair is the most common procedure in general and visceral surgery worldwide. Several studies have shown that laparoscopic repair offers the advantage of minimally invasive surgery to the patient. The mesh can be placed without fixation or can be fixed into place with tuckers.

Aim of the Work

this study aimed to compare mesh fixation versus non-fixation in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia, as regards the operation time, hospitalization, postoperative complication, recurrence and chronic pain.

Patients and Methods

sixty adult males with inguinal hernia were repaired with laparoscopic transabdominal preperitoneal inguinal hernia repair, divided into; mesh fixation group (n = 35) versus non-fixation group (n = 25), and certain parameters were assessed during the operative, postoperative and follow-up periods.

Results

mean operation time and mean hospital stay time were significantly higher in mesh fixation group than non-fixation group. VAS scores 2days, 3months, and 6months postoperative were less for non-fixation group. Non-significant difference was found between both groups regarding intraoperative injury, hernia recurrence, wound seroma, mesh infection, chronic pain, return to physical activity.

Conclusion

TAPP inguinal hernioplasty without mesh fixation does not increase recurrence rate, but reduces operative duration, hospital stay duration and decreases the incidence of postoperative pain.
Evaluation of Direct versus Delayed Bariatric Surgery after Extraction of Intragastric Balloon
Authors: Sabry A A , Helmy M M , Mohamed K M S
Published: May 2020

Background

Obesity is nowadays considered as one of the public health problem which is associated with a great variety of diseases, most notably affecting the cardiovascular system.

Aim of the Work

is to evaluate and compare between the outcome of bariatric surgery directly after Intragastric balloon extraction versus delayed bariatric surgery (six weeks to three months) following balloon extraction.

Patients and Methods

The study was a Prospective Randomized study which included 30 patients who underwent a planned mini gastric bypass surgery following an intragastric balloon extraction. The patients were divided according to time of surgery to 2 groups: Group A (15patients): Delayed Second scheduled surgery after balloon extraction (6 weeks to 3 months). Group B (15 patients) Immediate surgery in the same session of balloon extraction.

Results

The mean age of the study was 35.36 years ranging from 21 to 50 years with ±8.227 standard deviation. The mean age of Group A was 35.6 versus 35.13 in Group B. The mean weight of the patients was 112.5±9.8kg ranging from 95 kg to 145kg. The mean weight of Group A was 110.13±8.27 versus 114.86±10.88 in Group B. The mean BMI of the study was 46.46±4.7 ranging from 38 to 60. The mean BMI for Group A was 45.66 versus 47.26 for Group B.

Conclusion

We concluded that a delayed bariatric surgery following an extraction of the balloon is more favorable than a same session surgery and extraction of the balloon in terms of duration of the operation, hospital stay and early post-operative complications.
Multiple Hepatic Veins Reconstruction in Right Lobe Grafts in Living Donor Liver Transplantation … Accept or Reject?
Authors: Al-Meteini M A S , Bahaaeldin M M , Elsayed K M K , Sadary A S N
Published: May 2020

Background

chronic liver disease and cirrhosis are important causes of morbidity and mortality in the world. Moreover, the burden of chronic liver disease is projected to increase due in part to the increasing prevalence of end-stage liver disease and HCC secondary to NAFLD and HCV.

Aim of the Work

in this study we will aim to clarify the importance of adequate venous drainage in right lobe grafts in living donor liver transplantation to determine its impact on the graft survival and avoidance of small for size graft syndrome as regard operative time, operative mortality rates (throughout the first month), normalization of liver functions and 6 month, 1 year survival rates of the patients.

Patients and Methods

our study population includes all the patients who performed right lobe living donor liver transplantation from January 2014 till June 2018 at the liver transplantation unit at Ain Shams Specialized University Hospital and will be classified in our study into 2 groups:

First group

Patients for whom we performed a single venous anastmosis including 42 cases.

Second group

Patients for whom we performed multiple venous anastmoses whether an additional single or double or triple anastmoses including 43 cases.

Results

our study was held as a retrospective cohort study to compare between the patients who received a single venous anastmosis as the first group (n = 42) and the patients who received multiple venous anastmosis as the second group (n = 43).

Conclusion

so here we can declare, according to our results, that the second group has better survival rates, less mortality rates, better graft survival, better course when daily follow up with full labs is done concerning platelets levels, ALT, direct bilirubin, INR and according to those results we highly recommend multiple hepatic venous anastmosis, if indicated, to acheive the best results in every single LDLT despite the longer cold and warm ischemic time.
Endovenous Laser Ablation and Radiofrequency Ablation versus Conventional Surgery in Treatment of Primary Varicose Vein of the Lower Limb)Prospective Randomized Controlled Study)
Authors: Bahaaeldin M M , Rady M A H , Dessouki A M E , Abdelhamid H I
Published: May 2020

Background

Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) of primary varicose vein are thought to minimize postoperative morbidity and reduce work loss compared with the conventional surgical procedure.

Aim of the Work

to determine, whether endovenous ablation (radiofrequency and laser) have any advantages or disadvantages in comparison with conventional surgery, in the treatment of primary varicose vein.

Patients and Methods

this is a prospective randomized study. Thirty Patients presented at Vascular Outpatient Clinic for management of chronic venous insufficiency. All patients underwent clinical examination and duplex ultrasonography. Ten (10) patients were treated with ligation and stripping of the GSV or SSV. Ten (10) patients were treated with Radiofrequency ablation. Ten (10) patients were treated with endovenous laser ablation. The study was conducted at Ain Shams University Hospitals and Helwan University Hospitals. The study took place from September 2017 to June 2018.

Results

Compared with conventional surgery, endovenous ablation methods reduce postoperative discomfort and pain, with a lower complication rate after treatment for avoidance of a groin incision and dissection at the saphenofemoral confluence. Cosmetic demands are also better satisfied. However, risks of EVLA and RFA remain in terms of recanalization and neoreflux via junctional tributaries.

Conclusion

RFA and EVLA are minimally invasive procedures. Their potential early benefits, by avoiding groin dissection and GSV stripping, have been confirmed by the findings from this trial. Current evidence based on randomized trials consistently demonstrates significant early benefits after RFA and EVLA in suitable patients with varicose veins.
Comparative Study between Conventional Surgery and Radiofrequency Ablation in Treatment of Varicose Vein
Authors: Elian W A , Mohamed M I , Aborahma M Z
Published: May 2020

Background

Varicose veins are a very common problem all over the world. Surgery has been the gold standard treatment for many years, however now other less invasive options are available and sometimes more efficient.

Aim of the Work

to evaluate the RFA technique in treatment of GSV varicosities and to compare the results, clinical outcome, complications and recurrence rate after RFA and CS of GSV.

Patients and Methods

This observational retrospective study included 41 patients with varicose vein recruited from general surgery department and vascular surgery unit at Ain Shams Hospitals and in Nasser Institute for Research and Treatment.

Results

Operative time was significantly less in CS compared to RFA. One , six and twelve months post intervention follow up using clinical examination and duplex imaging were used to asses outcome and detect complications and recurrence rate. No major complications were detected after both techniques; however minor post operative complications like paresthesia and ecchymosis were significantly less after RFA. Post operative pain, duration of analgesia use and time needed to return to normal activity were also significantly less in RFA group than CS group. Recanalization of GSV was not detected after radiofrequency maneuver nor CS. This study proved that radiofrequency ablation technique is a safe and efficient in treating varicose veins however long-term results and cost effectiveness need further evaluation.

Conclusion

Conventional surgery has been used for a long time for treatment of varicose veins with variable degrees of minor to major complications. Duplex guided radiofrequency ablation is an efficient and a safe modality in the treatment of great saphenous vein varicosities. Of most importance is an adequate Duplex scan to identify accessory channels and double superficial systems.
Health Effects of Abdominal Liposuction in Newly Diagnosed Type 2 Diabetes
Authors: ELkayal A H , Hefny A M , Mahmoud B A , Anany A M A
Published: May 2020

Background

Diabetes Mellitus (DM) is a metabolic disorder characterized by the presence of chronic hyperglycaemia accompanied by greater or lesser impairment in the metabolism of carbohydrates, lipids and proteins. DM is probably one of the oldest diseases known to man. It was first reported in Egyptian manuscript about 3000 years ago. In 1936, the distinction between type 1 and type 2 DM was clearly made. Type 2 DM was first described as a component of metabolic syndrome in 1988. The origin and aetiology of DM can vary greatly but always include defects in either insulin secretion or response or in both at some point in the course of disease.

Objective

The aim of this study is to evaluate the effectiveness of abdominal liposuction in improving quality of life in newly diagnosed uncomplicated type 2 diabetic patients.

Methodology

This study will take place in plastic Surgery Department, Port Said general Hospital. As total number of cases satisfying inclusion criteria not exceed 6 cases per month during the study period (3 months) the total sample 3x6=18 cases all will be included as comprehensive sample.

Results

In our study, the mean FPG was 163 ± 22 mg/dl preoperatively. At three months after surgery, it was 162 ± 29 mg/dl, but at six months after surgery, it was 147 ± 28 mg/dl. The mean PPBG was 218 ± 40 mg/dl preoperatively. At three months after surgery, it was 216 ± 40 mg/dl, but at six months after surgery, it was 200 ± 34 mg/dl. The mean HbA1c percentage was 8 ± 0.8% preoperatively. At three months after surgery, it was 7.7 ± 0.8%, but at six months after surgery, it was 7.6 ± 0.8%. The mean triglyceride level was 180 ± 48 preoperatively. At three months after surgery, it was 162 ± 41, but at six months after surgery, it was 159 ± 49. The mean cholesterol was 207 ± 42 preoperatively. At three months after surgery, it was 197 ± 52, but at six months after surgery, it was 189 ± 41. The HOMA-IR was 3 ± 0.7 preoperatively. At three months after surgery, it was 2.8 ± 0.7, but at six months after surgery, it was 2.8 ± 0.7. All the laboratory investigations change over time among the studied patients were not statistically significant.

Conclusion

So, we can conclude that large-volume abdominal liposuction should not, by itself, be considered a clinical therapy for type 2 diabetes mellitus. Aspiration of large amounts of subcutaneous abdominal fat in diabetic patients, despite having cosmetic benefits, It does not significantly improve insulin sensitivity through altering serum levels of obesity markers. Therefore, the procedure is safe and may could successfully help diabetic subjects to reduce their potential metabolic risks. Therefore, abdominal Liposuction is effective scarless operation for subcutaneous adipose fatty tissue reduction.
The ability of the Society for Vascular Surgery Wound, Ischemia and Foot Infection (WIFI) Classification system to predict risk of amputation in patients with non-healing ulcer during the first year atAin Shams University Hospitals
Authors: Salib W F , Desokey A A , Wahba R M , Zayed M O
Published: May 2020

Background

Classification systems are powerful tools for health care providers to use when managing patients with threatened limbs. The ability to define and delineate a heterogeneous group into fine-grained cohorts not only aids communication between providers, it allows for a more accurate analysis of outcomes across treatment strategies. Thus, classification systems are essential for clinical decision making as well as setting meaningful goals and expectations with patients and their families.

Aim of the Work

to evaluate the predicative ability of this classification in a real world selection at Ain Shams University at period of 1 year depending on the Society for Vascular Surgery Wound, Ischemia and Foot Infection (WIFI) classification system.

Patients and Methods

This study included 60 patients with non-healing wound ulcer at Ain Shams University hospitals during year 2017 and 2018.

Results

As our study showed WIfI classification was predictive of 1 year limb amputation and wound non healing and correlated significantly with outcomes predicted by the SVS consensus panel. The study showed 1 year amputation rates were 0% for stage 1, 7.7% for stage 2, 18.75% for stage 3 And 64.7% for stage 4. It also showed among the 60 patients studied 15 patients had done amputations where 6.7% were stage 2, 20% were stage 3 and 73.7% were stage 4.

Conclusion

WIFI classification can be very useful in predicting the possibility of amputation during 1 year; also the study showed the benefit of using WIFI to plan management of patients presented with foot ulcer.
Outcomes of skin sparing mastectomy with immediate breast reconstruction with Latissimus dorsi (LD) flap in surgical treatment of breast cancer
Authors: Othman S M , Elfekky A K , Elshinawi M E , Othman A G
Published: May 2020

Introduction

Breast cancer is a devastating disease affecting women of all ages worldwide with the age incidence in Egypt being one decade younger than the mean age incidence, the latissimus dorsi (LD) flap is an important volume-replacement option due to its stability and versatility as an autologous flap. LD flap could be used for total breast reconstruction after mastectomy in selective cases or to fill a large quadrantectomy defect.

Aim

The aim of this study is to estimate the oncologic and aesthetic outcomes and the procedure-related complications of latissimus dorsi (LD) flap with skin sparing mastectomy in management of breast cancer.

Patients

On 25 patients breast cancer underwent skin-sparing mastectomy with immediate reconstruction using LD flap,

Methods

All patients were subjected to : (Complete history taken, General examination, Local examination and routine investigations) Surgical procedures

25 patients with breast cancer underwent skin-sparing mastectomy with immediate reconstruction with LD flap.

Results

Mean age of included patients was 41.12 years with mean BMI 29.17 kg/m2, regarding tumor classification DCIS represented 8% LCIS represented 20% IDC represented 32% ILC represented 40% of all patients, Positive lymph node 1-3 in 40% of patients and more than 3 in 20% of patients and 40% of patients had negative lymph node,96% of patients had no recurrence on the other hand only 4% shows locoregoinal recurrence, Regarding postoperative immediate complications 72% of patients showed no complications.

Discussion

In the current study we aimed to estimate the oncologic and aesthetic outcomes and the procedure-related complications of latissimus dorsi (LD) flap with skin sparing mastectomy in management of breast cancer.

Conclusion

Skin sparing mastectomy with immediate breast reconstruction using latissimus dorsi muscular flap allows single-stage, totally autologous reconstruction with a satisfactory aesthetic result, low morbidity, and good quality of life.

Recommendations

Breast cancer patients are best managed by a multidisciplinary team, Breast conservation surgery does often leave a significant deformity which can best be corrected by an immediate LD flap reconstruction, this method is simple and effective, our concept should be further analyzed in larger comparative studies.
Value of the Ultrasound Elastography in the Diagnosis of Thyroid Nodules
Authors: Ouf T I A , Hanna H H , Ghaly A M B
Published: May 2020

Background

Thyroid disease is of common occurrence, especially in iodine deficient areas. Thyroid nodules have been reported in as many as 50% of the population, at autopsy. They may be discovered in up to 41% of the patients at ultrasonography (US).

Aim of the Work

The aim of this study is to evaluate the value of Ultrasound- Elastography in the Diagnosis of thyroid nodules for reducing the number of unnecessary Thyroidectomises which add burden to the patient and community, consequently the complications of this surgery will be reduced.

Patients and Methods

This prospective cohort study was conducted at El Demerdash, Ain Shams University Hospital on Fifty (50) patients with the diagnosis of multi-nodular goiter, who were treated by total thyroidectomy between November 2016 and November 2018 with minimum follow up of one month postoperatively. An informed consent was taken from all patients who accepted to participate in our study after ethical committee approval.

Results

Elastography has 100% sensitivity and 95.5% specificity as it suspected malignancy (positive suspecting findings) in 8 patients; six of them were proved to be malignant and two of them were benign by histopathology accounting for high positive predictive value (75%) and it suspected benignity (negative suspecting findings) in 42 patients; all of them were perfectly correlated with the histopathology accounting for high negative predictive value (100%). These results showed nearly the same values of the Elastography in the previous studies had been done regarding this concern.

Conclusion

Conclusively, In the future, FNAC perhaps will not be used for the diagnosis of malignancy in patients presented with multi-nodular goitres who were diagnosed as suspicious of malignancy by Sono-elastography.
Mortality rate in patients with Secondary Peritonitis in Ain Shams University Hospitals as regard Mannheim Peritonitis Index (MPI) score
Authors: Ouf T I , Jumuah W A A , Mahmoud M A , Abdelbaset R I
Published: May 2020

Introduction

Secondary peritonitis is one of the most common fatal surgical emergencies. The mortality rate is about 20% even in well- equipped places. The outcome can be improved be rapid surgical intervention and intensive care of the patient. Many scoring systems were developed to identify high-risk patients who may need rapid intervention or intensive care. Mannheim Peritonitis Index (MPI) is an easy and specific score for predicting the outcome of secondary peritonitis.

Patients and Method

It’s an observational prospective study over 50 patients presented with secondary peritonitis to our E.R during the period from January 2018 to June 2018 and patients were followed up for one month. Patients were divided into three groups according to their MPI score, Group I: with MPI score less than 21, Group II: with MPI score between 21 and 29, and Group III: with MPI score more than 29.

Results

In the present study, Mortality rate was about 24%. Mortality rates in those groups were 0%, 5.5% and 55% respectively which are similar to results of other studies performed in other places. Cut-off value is 28 with sensitivity 91% and specificity 76%.

Conclusion

MPI score is effective in predicting outcome of patients with secondary peritonitis in our hospitals.
The Possible Therapeutic Role of Platelet Rich Plasma on a Model of Osteoarthritis in Male Albino Rat. Histological and Immunohistochemical Study
Authors: Gamal N , Abourabia N M , Elebiary F H , Khalaf G , Raafat M H
Published: May 2020

Introduction and Aim of the Study

Osteoarthritis (OA) is a degenerative joint disease characterized by joint pain and progressive loss of articular cartilage. This study was conducted to evaluate the therapeutic effect of platelet-rich plasma (PRP) of the knee joint in a rat model of OA.

Materials and Methods

Forty adult male albino rats, weighing 200-250 gms, were used in this study, ten rats used as donors to obtain PRP. The other thirty rats were divided into two main groups. Group I: The control group (15 rats) in which the rats were subdivided into three subgroups. Subgroups IA and IB were sacrificed 4 and 6 weeks after the beginning of the experiment. Subgroup IC left for 4 weeks then received intra-articular injection of PRP in the right knee joint which was repeated three times per week for 2 weeks then the animals were sacrificed. Group II (The experimental group) (15 rats) in which OA was induced by surgical induction of cartilaginous defect in the right knee joints. The rats of group II were subdivided into three subgroups. Subgroups IIA and IIB were sacrificed 4 and 6 weeks after induction of OA respectively. Subgroup IIC received intra-articular injection of PRP (0.2 ml) in the right knee joints 4 weeks after surgery. The injection was repeated three times per week for 2 weeks then the animals were sacrificed. The right joints from all groups were collected, decalcified and processed for histological studies. Specimens were also processed for transmission electron microscopic study. Morphometric and statistical measurements were done.

Results

Histological examination of the right knee joints of OA (subgroups IIA and IIB) resulted in thickening of the intimal lining of the synovial membrane, cellular infiltration and increased collagen content of the subintima. The articular cartilage showed erosions, thinning of cartilage, chondrocytes and ground substance loss, and moderate expression of platelet derived growth factor (PDGF). Injection of PRP resulted in improvement of the structure of the synovial membrane and the articular cartilage and strong expression of PDGF.

Conclusion

Intra-articular injection of PRP resulted in a significant improvement in the histological structure of the knee joint in a rat model of OA.
Comparative study on the effect of adipose-derived stem cells versus alpha-lipoic acid in autologus fat graft survival in adult female albino rat: histological and immune histochemical study
Authors: Ibrahim S H , Omar S M M , Ibrahim G A , Omar A E
Published: May 2020

Background

Autologous fat transfer is a popular option for soft tissue augmentation, but has a low survival rate. So, enriching the transplanted fat with stem cells (cell assisted lipotransfer) or oral administration of alpha-lipoic acid (ALA) before and after graft injection, were thought to increase the survival rate of the transplanted fat.

Aim of Study

Is to compare between cell-assisted lipotransfer (CAL) and ALA therapy in improvement of fat graft survival.

Materials and Methods

Thirty adult female albino rats were used and divided into three groups. Group I: the control group. Group II: CAL group received autologous fat mixed with adipose derived stem cells (ASCs). Group III: ALA group in which animals received oral ALA four days before fat transplantation and continued throughout experiment. Fat grafts were collected from the sites of injection after twenty-eight days. Histological and immune histochemical studies were performed. Statistical analysis was also done.

Results

Histological evaluation of the fat grafts from animals of control group revealed atrophy and death of adipocytes with formation of fat cysts. Severe inflammatory infiltration with giant cells formation and fibrosis were detected. Significant decrease of VEGF reaction was seen. In CAL group significant increase in number of intact adipocytes together with decrease in inflammation and fibrosis occurred. Moreover, significant increase in VEGF reaction was observed. In ALA group, significant decrease in number of intact adipocytes and VEGF reaction was detected compared with CAL group. Also, significant increase in inflammatory infiltration and fibrosis were detected compared to CAL group.

Conclusions

Both ASCs and ALA showed improvement in all histological parameters compared with control group. However, enrichment of fat with ASCs showed the best results.
The Effect of Diet Carbonated Drinks and Monosodium Glutamate on the Cerebellar Cortex and the Kidney of Adult Male Albino Rats. Histological and Immuno- histochemical Study
Authors: Abdelwahed N A A , Geith E Z , Kalleny N K , Abdelkhalek H A
Published: May 2020

Background

The consumption of fast- food is increasing among children, adolescents and adults. Carbonated drinks are widely consumed with fast food that also exists in the form of diet drinks as Diet Coke. One of the thousands of chemicals used in our new high-tech foods is the monosodium glutamate (MSG).

Aim of the Study

This study was conducted to investigate the effect of Diet Coke and monosodium glutamate salt either separately or in combination on the cerebellar cortex and kidney of adult male albino rats.

Materials and Methods

Twenty five adult male albino rats were divided into four groups. Group I: control group (10 rats) divided equally into two subgroups, subgroup IA in which rats had free access to food and water and subgroup 1B in which each rat administrated 0.5 ml of distilled water once daily by oral gavage. Rats had free access to food and water. Group II (5 rats): in which rats received Diet Coke instead of water throughout the day. Group DI (5 rats): in which each rat received 0.5m1 of MSG salt solution by dose of 3ern MSG/kgm by oral gavage once daily. Group IV (5 rats): in which each rat received Diet Coke instead of water throughout the day and 0.5m1 of MSG salt solution by dose of 3gm MSG/kgm by oral gavage once daily. Cerebella and kidneys were dissected out and processed for histological, immunohistochemical and morphometric studies.

Results

Histological examination of the cerebellum and the kidney revealed that both Diet Coke and MSG either separately or in combination resulted in degenerative changes that were more significant in the combination group. The cerebellum showed degeneration of Purkinje cells and vaculations in the molecular layer. The kidney showed shrunken glomeruli, vacuolations of cells lining renal tubules with pyknotic nuclei. Hyaline debris detected in renal sections of combination group.

Conclusion

Diet Coke and MSG induced degenerative changes in both the cerebellum and the kidney that was more significant in their combination.
New rational in Treatment of Parkinsonism
Authors: Abdelkawy S A , Elsebay S A , Abdelhafez S M N , Ibrahim M F G
Published: May 2020

Parkinsonism disease is the second most common aging neurodegenerative disorders characterized by degeneration of dopaminergic neurons settled in the substantia nigra, leading to the appearance of both motor and non-motor symptoms. This work aims to show the effect of stem cell therapy on treatment of Parkinsonism and also to show the mechanism of the action.

In this work, Parkinsonism was induced by subcutanous injection of rotenone. Rats were divided randomly in to 3 groups; control, Parkinsonism, stem cell. Brain specimens were obtained for histological study.

In Parkinsonism group, marked pathological changes were noticed in the form of; shrunken dopaminergic cells with pyknotic nuclei.

Interestingly, improvement of some of the pathological changes was observed in the stem cell group.

It could be concluded that, stem cell has a beneficial effect in management of Parkinsonism and this need further investigations in the future.
Risk factors predicting Cytomegalovirus infection in post liver transplant recipients
Authors: Abdelrahman M G , Mahmoud H A , Mohsen M K , Ali M O , Mohamed A M N
Published: May 2020

Background

Liver transplantation is considered to be the only curative treatment for patients with end stage liver disease. Postoperative infection remains to be one of the most common causes of morbidity and mortality throughout the past years. Cytomegalovirus (CMV) infection although considered to be a weak viral infection that usually passes asymptomatic in immunocompetent patients, however, it is considered one of the most common pathogens causing morbidities and mortality in liver transplant recipients. Multiple studies have been done to assess the risk factors for developing CMV infection.

Objective

Identification of risk factors predicting Cytomegalovirus infection in liver transplant recipients following transplantation.

Methods

This retrospective study was conducted on 194 patients and their donors who underwent living donor liver transplantation operation at Ain Shams centre for organ transplantation (ASCOT) at Ain Shams specialized hospital in the period between January 2010 and December 2016 with at least one year follow up period after operation for the recipient group.

Results

In our study, 194 patients undergoing liver transplantation at Ain shams centre for organ transplantation over seven years from January 2010 to December 2016 have been followed to assess risk factors affecting CMV infection development. Chronic rejection was found to be the most common factor associated with CMV infection followed by Cyclosporin (Neoral) as main postoperative immunosuppressant following liver transplantation. Other factors that were found to carry risk for CMV infection included younger age, advanced MELD score, positive CMV IgM status of the donors and recipients.

Conclusion

Differentiation of Cytomegalovirus disease from Cytomegalovirus infection isn’t always available as it requires tissue invasive techniques. Multiple risk factors have been attributed to cause Cytomegalovirus infection (viremia) . In our study, rejection (chronic rejection) was the factor that carries highest risk for Cytomegalovirus infection development followed by Cyclosporin .
Evaluation of serum sclerostin level and its correlation with valvular calcification in haemodialysis patients
Authors: Gohar S A , Hebah H A , Kheidr A N , Rasheed A M
Published: May 2020

Background

The majority of hemodialysis patients are affected by the cardiovascular calcification. Vascular/valvular calcification contributes to an extremely high cardiovascular morbidity and mortality in HD patients.

Objective

To asses circulating levels of Scl in ESRD patients receiving HD and their relation to aortic and mitral valve calcification detected by echocardiography as well.

Patients and Methods

The study included 80 ESRD patients undergoing HD in Al-Sahel Nephrology and Dialysis unit. Routine chemical investigations, serum sclerostin by ELISA were done to all patients, as well a trans-thoracic Echocardiography.

Results

serum Scl level ranged from 0.41 ng\ml to 1.65 ng\ml. calcification was documented in 53/80 (66.2%) of our HD patients: 26/80 had aortic valve calcification only(32.5%), 6/80 patients (7.5%) had mitral valve calcification alone, while 21/80 of patients had both aortic and mitral valves calcification (26.25%). 27/80 (33.75%) patients had no calcification. We didn’t find any significant correlation between serum Scl level and valvular calcification nor age, sex or HD duration.

Conclusion

valvular calcification are prevalent in HD population. Serum Scl was not associated with valvular calcification.
Frequency of Hypoglycemia in Type 2 Diabetic Patients in Sample of Egyptian People in Clinic Based Study
Authors: Hamed M S , Mostafa B M , Bahaaeldin A M , Ibrahim N A , Mohamed M A
Published: May 2020

Background

Hypoglycemia is a true medical emergency which requires prompt recognition and treatment to prevent organ and brain damage. Hypoglycemia is not a disease in itself; it is a sign of a health problem; whose importance lies in its effects upon brain function. With increasing incidence of diabetes and with various modalities of intensive control of blood glucose levels, there is always a risk of a proportional increase in the incidence of hypoglycemia.

Aim of The Work

we measured the frequency of hypoglycemic attacks in type 2 diabetic patients (T2DM) in clinic based study and correlate the attacks of hypoglycemia with treatment regimens and duration of the diabetes mellitus (DM)

Methods

Copies of pre-tested questionnaire were administered directly to 1000 patients with T2DM at the study site. This questionnaire was previously published as a part of the Workgroup of the American Diabetes Association and The Endocrine Society (ADA) on 2013. After translating it into public traditional Egyptian Arabic language.

Results

Our main finding was that for people with T2DM the incidence of hypoglycemia was 36% (360 out of 1000 patients). 26.39% (95 out of 360 patients) on oral hypoglycemic drugs compared to 71.94% (259 from 360 patients) on insulin. hypoglycemia was 48.42% (46 out of 95 patients) in Diabetic patients having diabetes for more than five years and on oral hypoglycemic drugs, compared to 76.83% (199 out of 259 patients) in diabetic patients on insulin. there is a highly statistically significant difference between diabetic patients on insulin and long duration of diabetes (p < 0.001). Also show that there is a statistically significant difference between diabetic patients on oral hypoglycemic and long duration of diabetes p value 0.034. Prevalence of (IAH) impaired awareness of hypoglycemia is 49.94%&unawareness 27.72%

Conclusion

Hypoglycemia is common in T2DM (36%). It is a significant complication of diabetes therapy and although mild hypoglycemia causes unpleasant symptoms and disrupts patients’ daily activities, severe hypoglycemia can result in coma, seizures, and death.
Effect of Hepatitis C Virus Treatment on Rejection Incidence and Severity in Post-Liver Transplant Recipients
Authors: Othman M A , Elsayed M M , Kamaleldin M M M , Elshafie A I M , Nabil Z M
Published: May 2020

Background and Aims

HCV is a worldwide cause of chronic liver disease, particularly in Egypt where the most prevalent is genotype 4. HCV-associated cirrhosis is the most common indication for orthotopic liver transplantation (OLT) among adults. HCV infection remains a problem after transplantation, and recurrent hepatic infection is the leading cause of graft failure. Little is known about the long-term effects of direct acting antiviral therapy in patients after liver transplantation. We examined the incidence and severity of liver transplantation rejection in patients treated for HCV, post liver transplantation, with DAAs relative to the incidence and severity of liver transplantation rejection in patients treated for HCV, post liver transplantation, with Interferon based therapy and patients who didn’t receive any treatment for HCV after transplantation.

Patients and Methods

The study was conducted on 90 patients who had underwent liver transplantation between 2010 and 2017 at Ain Shams Center for Organ Transplantation (ASCOT) with a minimum follow up period of 6 months. Patients were divided into three groups: group I included 16 patients that didn’t receive antiviral treatment after liver transplantation, group II included 20 patients that had received interferon based therapy after liver transplantation and group III included 54 patients that had received direct acting antivirals after liver transplantation.

Results

Amongst group I, 2 patients (12.5%) developed acute graft rejection while in group II 2 patients (10%) developed chronic graft rejection and in group III 6 patients (11.11%) developed chronic rejection. In group I, all the patients (100%) had developed rejection that was diagnosed within one year of liver transplantation. In group II, 2 patients (100%) developed chronic graft rejection which occurred after one year of liver transplantation, one of them was on treatment with peg interferon and the other had already completed treatment. In group III, 2 patients (40%) had developed chronic rejection within one year of transplantation, while 4 patients (60%) had developed chronic rejection after one year of transplantation. One patient (16.67%) had developed rejection on treatment while 5 patients (83.33%) had developed rejection after the end of treatment.

Conclusion

It was found that the incidence of chronic rejection was more in patients that had received antiviral treatment after liver transplantation, however no difference was noted between DAAs and peg-interferon. Chronic rejection was found to be more common when treatment was given over one year after liver transplantation (6 cases) as compared to within the 1st year (2 cases). This may be related to the withdrawal of immunosuppression treatment after one year of transplantation and maintenance on monotherapy.
3-Nitro-Tyrosine as a Biomarker of Minimal Hepatic Encephalopathy in Patients with Liver Cirrhosis
Authors: Awad E A , Mohammed M N , Sayyed M M , Elkhayal A E , Ahmed M A S
Published: May 2020

Background

hepatic encephalopathy (HE) is a common complication in patient with liver cirrhosis. It comprises of a broad spectrum of neuropsychiatric abnormalities of varying severity, and affected patients usually suffer from psychomotor, cognitive, emotional, behavioural, and motor coordination dysfunctions. Patients with minimal HE (MHE), a subclinical form of HE, usually have a normal mental and neurological status upon routine clinical examination. The subtle deficits in patients with MHE can only be elicited by specialized neuropsychological tests.

Aim of the Work

the aim of this study was to evaluate the role of 3-Nitro-Tyrosine as a biomarker of Minimal Hepatic Encephalopathy in patients with liver cirrhosis.

Patients and Methods

our conducted study was a prospective case control study carried on 60 adult patients and 30 age matched controls. All were recruited from Internal Medicine and Hepatology and Gastroenterology Department at Ain Shams University Hospitals in the period between September 2016 and June 2018. All patients enrolled in the study were subjected to detailed history taking, full physical examination, laboratory investigations, psychometric tests for detection of MHE using specially digit symbol test (DST), Trail making test A (TMT A), Trail making test B (TMT B), serial dotting test (SDT) and 3-Nitro-Tyrosine level (3NT).

Results

our study found that the serum levels of 3-nitro-tyrosine are a good predictor of the presence of MHE in patients with liver cirrhosis, with good sensitivity (90%) and specificity (93.33%) and positive and negative predictive values were 93.1% and 90.3% respectively at a cutoff of 14.8 ng.

Conclusion

determination of 3-nitro-tyrosine in serum is easy and is not time consuming. It only requires taking a serum sample from the patient and determining 3-nitro-tyrosine concentration. This procedure can be therefore easily added to the routine clinical determinations in patients with liver cirrhosis. This would also allow extending the diagnosis of MHE to most clinical settings, helping to identify patients with MHE.
Assessment of the early reach ability of major molecular response (MMR) in chronic phase of CML Egyption patients on first(1st) and second(2nd) generation TKI(as regard 1st and 2nd line of treatment
Authors: Azzazi M O , Said R M M , Abdallah M , Elshazly A , Allam A A M
Published: May 2020

Background

Nilotinib has been shown to be a more potent inhibitor of BCR-ABL than imatinib. We evaluated the efficacy and safety of nilotinib, as compared with imatinib, in patients with newly diagnosed Philadelphia chromosome–positive chronic myeloid leukemia (CML) in the chronic phase

Aim of the work

Comparsion between the early reach ability of major molecular response (MMR) in chronic phase of CML patients on first(1st) and second(2nd) generation TKI(as regard 1st and 2nd line of treatmen t

Patients and methods

major molecular response (MMR) was assessed by quantative PCRfor BCR –ABL in 100 paients with newly diagnosed CML d ivided to three groups, group 1 included 40 patients on first generation tKI(imitinib), group 2 included 40 patients shifted from 1st generation (imitinib) to 2nd generation (nilotinib) and groups 3 included 20 patients on 2nd generation (nilotinib) from the start. The patients were recruited from clinical hematology department at Ain shams university hospital over the period from1/2018 to1/2019

Results

in CML patients, rate of MMRat 12 months of treatment on 2nd generation TKI (nilotinib) as 1st line was higher than other groups (p = 0.025*), rate of EMR was higher in patients on nilotinib 300 mg than on imitinib 400 mg(p = <0.001) in CMl patients started on imitinib 400mg with additional cyto genetics abnormalities had high numbers of failure of MMR(p = 0.001) in comparsion to patients on nilotinib either 1st line or shifted. in CMl patients started on nilotinib 300mg had rising of liver functions than patients on imitinib(p = 0.002 in CMl patients started on nilotinib 3oomg as 1st line had high numbers of ECG chnges than patients on imitinib4oomg(p = 0.005) in CMl patientswith high sockal score started on imitinib 400mg had high number s of failure of MMR in comparsion to patients on nilotinib 300 mg(p < 0.001) in CMl patients, rateof CCR at6 and 12month had higher in patients started on nilotinib 300mgthan imitinib 400mg (p = 0.020)

Conclusion

treatment with first-line nilotinib is a better clinical strategy than starting with imatinib followed by switching to nilotinib for inadequate responses
Diagnostic value of serum leptin as a tumor marker in hepatocellular carcinoma
Authors: Abdelwahab K , Abdelmaaboud M , Magdy M , Abdelhalim M A
Published: May 2020

Background

Leptin is a peptide hormone produced by adipocytes, acts on the energy balance of reproduction and immunomodulation, and this action is linked to the pathogenesis of many diseases. High levels of this hormone increase hepatic response to various stimuli of liver fibrosis. Leptin acts to mediate hepatic stellate cell activation and liver fibrosis throughout indirect effects on Kupffer cells

The aim

The aim is to evaluate diagnostic value of serum leptin as a tumor marker in hepatocellular carcinoma (HCC).

Methods

90 Egyptian subjects were conducted to this study after their written informed consent. They divided into 4 groups (30 patients with untreated HCC, 30 patients with treated HCC, 15 patients with end stage chronic liver disease without HCC and 15 healthy controls). They subjected to full history, examination, laboratory investigation and abdominal ultrasound. Serum leptin assessment is done using ELISA method.

Results

Leptin level is increased in all patients groups compared to control ((med. 40 IQR 37-50, med. 8 IQR 3-20, med. 2 IQR 1-4 VS med.1 IQR 1-1 ng/ml respectively) also it was higher in untreated HCC and treated HCC patients than patients without HCC. (med. 40 IQR 37-50, med. 8 IQR 3-20 VS med. 2 IQR 1-4) . Furthermore, leptin level is higher in untreated HCC than treated HCC(med. 40 IQR 37-50 VS med. 8 IQR 3-20)

Leptin positively correlated with HCC

Conclusion

Leptin level in HCC either untreated or treated patients and in end stage CLD patients is higher than healthy .Also, it’s higher in HCC patients either untreated or treated than cirrhotic patients without HCC . Furthermore, leptin level is higher in un treated HCC than treated HCC patients.
Studying Studying the relationship between Dipeptidyl peptidase-4 enzyme level, Tumor necrosis factor alpha enzyme level, and insulin resistance in type 1 Diabetes Mellitus patients
Authors: Amer H M , Mahdy M M M , Saad W E , Abdelsalam M N A
Published: May 2020

Background

Type 1 diabetes mellitus (T1DM) is an inflammatory disease of the pancreatic islets that results in absolute insulin deficiency and the consecutive hyperglycemia due to immune-mediated beta cell destruction throughout the globe, the incidence of T1DM is increasing at 3% to 5% per year

Purpose

To study the relationship between DPP-4 serum level, TNF a concentration measurements, and insulin sensitivity in T1DM patient

Patients and Methods

Patients were selected from the inpatient department of National Institute of Diabetes and Endocrinology during Januaray 2017, venous blood samples were collected to measure Serum level of creatinine, C-peptide, HbA1c%, DPP-4, TNFα . Measurement of eGDR was done using the formula

24.31 - 12.2 x (WHR) – 3.29 x (BLP) – 0.57 X HbA1c

Study Design

Cross sectional study that included 80 patients with type 1 Diabetes,

Results

The study population was divided according to median eGDR value of 6.125 mg kg-1 min-1 The group with higher IR(eGDR≤ 6.125)had higher value of DPP-4 enzyme level (1127.3 ± 40.9 ng/ml vs. 870.6 ± 30.2 ng/ml, p < 0.001) and TNF α concentration (11.4 ± 4.8 pg/ml vs 5.3 ± 1.6 pg/ml, p < 0.001). TNF α concentration negatively correlated with eGDR (r= -0.515, p value <0.001) DPP-4 level negatively correlated with eGDR (r= -0.826 and p value <0.001) while DPP-4 was positively correlated with TNF α (r = 0.441 p value ≤ 0.001)