bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Different Modalities of Treatment in Management of Different Types of Fungal Sinusits
Authors: Al-Nashar AbdElhamid AbdElhamid , Ezzat Waleed Farag , Mohammed Mohammed Abdelaleem , Al-Bahet Mohammed Al-Shahat Ibrahim
Published: October 2021

Background

Fungal sinusitis is generally classified into invasive and non invasive fungal sinusitis based on histological features, invasive fungal sinusitis divided into acute, chronic and chronic granulomatous invasive fungal sinusitis. While non invasive fungal sinusitis include saprophytic fungal infestation, fungal ball, and fungus-related eosinophilic. Distinguishing invasive disease from noninvasive disease is important because the treatment and prognosis are different for each.

AIM

A systemic review of effective and safe method in management of different types of fungal sinusitis either by medical or surgical approaches or even combined. Be up to date with the different upcoming new modalities.

Methodology

A meta-analysis study is done to evaluate the medical and surgical outcomes of patients with invasive and noninvasive Fungal Sinusits.

Results

Finally, forty-five studies were included in the present systematic review and metaanalysis. Fifteen included studies (No = 539 patients) assessed different modalities for management of fungal ball, via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach for FB of the maxillary sinus. The results showed that functional endoscopic sinus surgery has led to success rate of 98.1%. Twenty included studies (No = 806 patients) have assessed the efficacy and safety of different modalities for the management of allergic fungal sinusitis via,Endoscopic Sinus Surgery, Post-ESS Systemic steroids, Antifungals and immunotherapy. The results showed that ESS represents the firstline management strategy of AFRS, followed by aggressive medical therapies, the recurrence rate after postoperative steroids was 20.6%, postoperative antifungals was 40% and after immunotherapy was 9.1%. Ten studies (No = 327 patients) for Invasive Fungal Sinusitis.the results showed that combination of systematic antifungal therapy and aggressive surgical debridement are the treatment of choice.

Conclusion

FESS is the treatment of choice of fungal ball via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach. AFS treatment consists of surgical extirpation of the allergic mucin and polyps with maintenance of adequate sinus drainage followed by medical therapy consists of topical steroids, anti fungal therapy, Immunotherapy, and systemic corticosteroids. Treatment of invasive fungal sinusitis includes surgical resection of necrotic tissues, systemic antifungal therapy and reversal of immune dysfunction.
Evaluation Of Central Auditory Function In Migraine Patients
Authors: Tawfik Somia , Rahman Tayseer Taha Abdel , Ameen Randa Mohammed , Tolba Sahar Ibrahim Abdel Ghany
Published: October 2021

Background

Migraine is a neurological disease associated with abnormal excitability in visual, somatosensory and motor cortex. Previous researches reported abnormalities in the auditory brainstem response (ABR) and in vestibular functions. These results are an indicator of impending auditory malfunction in Migraine and disruption of central auditory processing mechanisms.

Objectives

This study aimed to assess and compare central auditory processing (CAP) performance in migraine patients with and without dizziness and healthy controls.

Subjects and method

Sixty subjects aged between18 and 60 years divided into 3 groups; control group (twenty normal healthy subjects), study group I (twenty subject diagnosed with migraine) and study group II (twenty subjects diagnosed with vestibular migraine). They were subjected to a headache sheet, central auditory processing questionnaire and Psychophysical central auditory tests: including Arabic Speech Intelligibility In Noise (SPIN) test for adults, Arabic Dichotic digit test, Gap In Noise (GIN) test, Duration pattern test and Arabic memory tests.

Results

Statistically significant difference was found between the 2 study groups and control group regarding right dichotic (p = 0.004),right and left duration pattern tests (p = 0.01) with highly statistically significant difference(p < 0.001) Gap In Noise (GIN) test, left dichotic digit test, right and left speech in noise. But there was no statistically significant difference between the two study groups regarding all tests.

Conclusions

Patients with migraine and vestibular migraine had poor performance in all central auditory tests when compared with control this mean that migraine lead to impaired central auditory processing in adults. Also, there was no significant difference between the 2 study groups regarding central auditory test results which may support that both migraine with and without dizziness have the same pathophysiology.
Prevalence of Dysphagia in Dysphonic Patients with Non-Neoplastic Vocal Fold Lesions
Authors: Hadhoud Yara Hany , Ghandour Hassan Hosny , Elfiky Yomna Hassan
Published: October 2021

Background

Dysphagia is the swallowing difficulties and trouble to move liquids, solids, medications and may be saliva from the mouth down to the stomach and is considered a serious red flag or alarm symptom.

Aim of the Work

to examine the prevalence of dysphagia on basis of subjective and objective measures in patients with the presenting symptom of dysphonia and diagnosed with non-neoplastic vocal fold lesions to consider the potential benefit of swallowing therapy hand in hand with the chosen management line of voice problem in the treatment of these patients if proved to have high prevalence of dysphagia.

Subjects and Methods

This study was applied on 50 patients with age ranging from 15-50 years diagnosed as being dysphonic secondary to non-neoplastic vocal fold lesions on objective and clinical measures, attending at the Phoniatric outpatient clinic at El-Demerdash hospital and Ain Shams University Specialized hospital.

Results

After the application of the A-EAT-10 questionnaire on 50 dysphonic patients who were selected to participate in this study, 12 cases (about 24%) were considered dysphagic with score above 3 and underwent VFSS. Within these 12 patients, Zero percent were found complaining of dysphagia according to VFSS. So there is No Correlation between frequencies of dysphagia by A-EAT-10 and by VFSS.

Conclusion

The present study showed that non-neoplastic vocal fold lesions are not an etiological factor for dysphagia despite the intricacy in the neuromuscular supply of pharynx and larynx. Diagnosis of Dysphagia can’t be confirmed depending only on subjective screening tools like A-EAT-10.
Early Dementia Questionnaire (EDQ): A Screening Instrument for early Dementia among elderly in Cairo governorate
Authors: Sayed Aya Ashraf , Mostafa Nayera Samy , El Said Salma Mohamed Samir
Published: October 2021

Objectives

To screen elderly participants for early Dementia in primary care in Egypt using a newly developed Early Dementia Questionnaire (EDQ) and comparing it with standard assessment tool, Mini Mental State Examination (MMSE).

Design

A cross-sectional study.

Setting and Participants

The study included 220 elder adults (both men and women) recruited from a primary healthcare center, the outpatient geriatric clinic at Ain Shams University hospitals and elderly clubs (Community dwelling) in Cairo Governorate, Egypt.

Methods

A cross-sectional study was conducted on a group of elderly patients using systematic random sampling. Elderly depression was excluded using the Geriatric Depression Scale (GDS). Diagnosed cases of dementia and other mental or psychiatric disorders and illiterate participants were excluded from the study. A face-to-face interview was done using EDQ with the participants to elicit symptoms of early dementia. The participants were then assessed with MMSE using variable cut-off points according to age and educational level.

Results

Prevalence of dementia among the study participants was 81.4% by EDQ and 19.5% by MMSE. The EDQ demonstrated a sensitivity of 97.7% with specificity of 22.6%. Positive predictive value of EDQ was 23.5% with the negative predictive value of 97.6%. A significant association was found between possible dementia, hypertension, Mini Nutritional Assessment and urinary incontinence.

Conclusion

The EDQ is more sensitive than MMSE for screening of early dementia.
Autologous Platelet-rich Plasma Versus Conventional Dressing in Treatment of Chronic Venous Leg Ulcers
Authors: Aldein Hesham Adel Alaa , Salib Wafi Fouad , Nageeb Ramy Mikhael , Mohamed Abdelrahman Ahmed , Radwan Ahmad Farid Elsayed Mostafa
Published: October 2021

Background

Prevalence of active venous leg ulcers was reported to be around 0.5% in different populations severely reduces quality of life, and increases the cost of health care. Management of VLUs include many modalities to obtain good result and improving patients life-style, these modalities include compression therapy, medical treatment, surgical and interventional procedures and local wound care. Objective: To compare between autologous platelet rich plasma and saline dressing in treatment of chronic leg venous ulcer concerning reduction of ulcer area.

Patients and Methods

That prospective study included 40 patients with chronic venous leg ulcers recruited from Ain shams university hospitals for whom treatment with PRP was done for 20 patients weekly for up to 3 weeks(one session of injection per week)(study group) and applying saline dressing for 20 patients(control group) in addition to compression therapy and follow up for4 months. Our objective was to compare rate of wound healing.

Results

A total of 44 venous ulcers from 40 patients who met the inclusion criteria were treated. Application of PRP was done for 20 patients weekly for up to 3 weeks(one session of injection per week)(study group) and applying saline dressing for 20 patients(control group) in addition to compression therapy and follow up for4 months.

Conclusion

We can draw the

conclusion

our study's results reveal that the use of PRP contributes to improving the results of treatment of venous ulcers and that it is an effective and safe therapy. Nonetheless, we need to consider that application of this or any other treatment should always be accompanied by the necessary management of the underlying disease, in addition to a suitable pressure bandage that improves venous return and facilitates favourable clinical course of lesions.
Management of Hemorrhoids with Doppler-Guided Hemorrhoidal Artery Ligation
Authors: Mohamed Reda Saad , Ahmed Tarek Youssef , AbdAlmegeed Mohammed Hamed , Hegazy Ahmed Ragab
Published: October 2021

Background

An innovative therapy for symptomatic hemorrhoids has been recently proposed it relies on the reduction of hemorrhoidal vascular flow by suturing hemorrhoidal arteries, which are previously located by means of an ultrasound transducer.

Objective

To evaluate retrospectively the outcome of Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids.

Patients and Methods

Aretrospective study. The study conducted in Ain Shams University Hosptial (El Demerdash) under supervision of these supervisors. Study period: Six months.

Results

In our series, the HAL technique has achieved complete control of symptoms in 93.3% of patients after six-monthes follow-up.

Conclusion

Hemorrhoid ligation with mucopexy is a simple, safe and cost-effective ambulatory treatment for the patients of symptomatic hemorrhoids. It can be performed on an outpatient or day care basis on all grades of hemorrhoids to control bleeding and prolapsing hemorrhoids. Overall the results of hemorrhoid ligation and mucopexy were satisfactory with good control of patients complains.
Comparative study between Single Anastomosis Sleeve Ileal Bypass (SASI) and Mini Gastric Bypass (OAGB) in treatment of Morbid Obesity
Authors: Sabry Alaa A , Abd El-Sameea Karim S , Elmoez Ahmed A Abd
Published: October 2021

Background

Single anastomosis sleeve ileal bypass (SASI) procedure appears as anew metabolic and bariatric surgery based on santoro's operation, in which sleeve gastrectomy is followed by side to side gastro-ileal loop anastomosis.

Aim of the Work

to compare between Single Anastomosis Sleeve Ileal Bypass (SASI) and Mini Gastric Bypass (OAGB) in treatment of morbid obesity.

Patients and Methods

Our study was a prospective randomized comparative study in Ain Shams University hospitals involving 50 patients suffering from morbid obesity and in whom surgical management was indicated. Our patients were randomly divided using closed envelopment method into two groups: Group (1): (25 patients) were treated by laparoscopic SASI. Group (2): (25 patients) were treated by laparoscopic MGB.

Results

One year after the surgery, there was significant diabetic remission rate and there was improvement of most of obesity-associated metabolic parameters

Conclusion

Our study suggests that both SASI and MGB are highly effective in controlling diabetes mellitus, hypertension and hyperlipidemia.
Extreme Oncoplastic Breast Surgery in Patients Presented to Ain Shams University Hospital, Initial Experience
Authors: Elrahman Samy Ahmed Abd , Osman Ahmed Gamal El Din , Abd-erRazik Mohammad Ahmad , Zaid Mohamed Hamdy , Sayed Ahmed Mohamed Hanafy
Published: October 2021

Background

Breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women.

Objective

s: Assess the feasibility of extreme oncoplasty and achievement of negative margins in the enrolled patients. Assess the aesthetic results of the extreme oncoplasty of the enrolled patients.

Patients and Methods

This is a prospective cohort study to assess the feasibility of extreme oncoplasty and achievement of negative margins in the enrolled patients and the aesthetic results of the extreme oncoplasty. This study was conducted at Ain-Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Extreme oncoplasty techniques was proposed for patients in whom inclusion criteria was met. Diagnosis and staging examinations were carried out according to the standard protocol being conducted at Ain Shams University Hospitals.

Results

We report the oncoplastic outcomes after EO in a single institutional cohort of 20 patients with multifocal/Multicenteric or large tumors (≥50mm).While no major complications were observed after EO procedure, a low rate of minor complications (7.7%) was observed.

Conclusion

The combination of plastic surgery techniques with breast oncology surgery gives the surgeon a new tool for treatment of breast cancer. The preliminary results of our study indicate that selective patients (with multifocal/Multicenteric or large tumors) who were initially considered for mastectomy can be alternatively treated using Extreme oncoplasty (EO) followed by radiotherapy. EO can be considered as a safe and feasible surgical option for such patients without compromising aesthetic outcomes.
Recent management of surgically correctable hypertension
Authors: Ibrahim Emad EL-Din Farid , Abd-Elmgeed Shaaban Mohammed , Eweda Fawzy Salah Fawzy , Felebs Gerges Hosney Loka
Published: October 2021

Background

Surgical hypertension is elevated blood pressure that results from an underlying, identifiable, often correctable cause. Obstructive sleep Apnea, Aldosteronism, presence of renal artery Bruits (suggesting renal artery stenosis), renal parenchymal disease (Bad kidneys), excess Catecholamines, Coarctation of the aorta, Cushing's syndrome, Drugs, Diet, polycythemia, and some neuroendocrine tumors.

Objective

To assess, through the available literature. The role of surgery in the management of endocrine, renal and vascular causes of hypertension and outcome benefits of surgery.

Data Sources

Medline databases (PubMed, Medscape, Science Direct. EMF-Portal) and all materials available in the Internet till 2018.

Data Extraction

If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Conclusion

Secondary hypertension may be due to underlying correctable cause. Diagnosis and surgical correction of the underlying cause may improve hypertension and improve life quality of the patient especially in young patients resistant to medical therapy for hypertension.
Weight Loss Failure after Sleeve Gastrectomy and its Management
Authors: Moustafiz Alaa Abbas Sabry , Marzouk Mohamed Abd Elmoniem , El Shayeb Basem Helmy , Tawfik Karim Al Amir Mohamed
Published: October 2021

Background

Obesity has become an increasingly important global health problem. Laparoscopic sleeve gastrectomy is the most widely performed bariatric surgery.

Aim of the Work

To evaluate patients who failed to lose weight or regained weight after perfonning sleeve gastrectomy and how to manage them.

Patients and Methods

This study has been conducted at Ain Shams university hospital (Al Demerdash hospital) Ain Shams University. This is a prospective randomized controlled study (RCT) where 30 patients (20 females and 10 males) attended the outpatient clinic of the bariatric surgery unit complaining of failure of sleeve gastrectomy defined as: (failure to lose 500 0 of excess body weight or regain up to 200 0 of lost excess weight within one year or more from sleeve gastrectomy).

Results

All three operations have promising outcomes regarding weight loss and comorbidities resolution like diabetes mellitus and hypertension in morbidly obese patients. When compared to RE-LSG, SADI and OAGB have better results regarding weight loss.

Conclusion

Weight loss failure and revisional surgery remain primary long term concern after laparoscopic sleeve gastrectomy. There are currently no guidelines or systemic reviews directing the standered of practice tör revisional surgery in patients with failed primary sleeve gastrectomy.
Results of Gastrojejunal Plication for Inadequate Weight Loss follow Roux-en-Y Gastric Bypass
Authors: Khalil Ahmed Ibrahim , Eskandaros Moheb Shoraby , Gerges Kerolos Samy Messed
Published: October 2021

Background

Obesity is a serious global epidemic and poses a significant health threat to humans.

The prevalence of obesity is increasing not only in adults, but also among children and adolescents. Non-operative treatment of obesity has commonly been ineffective, and bariatric surgery has been shown to be effective in achieving substantial weight loss and improving obesity related comorbidities in the long-term.

Aim of the Work

Our objective in this study is to assess the effectiveness of Gastro-jejunal stomal plication (GJP) for inadequate weight loss follow Roux-en-Y gastric bypass surgery (RYGB).

Patients and Methods

The study will use the following search tools and databases: PubMed, Google Scholar, Cochrane Clinical Trials Database, Cochrane Review Database, EMBASE, and Allied and Complementary Medicine. Search terms included Revisional Surgery, inadequate weight loss And Roux en Y gastric bypass, then gastro-jejunal plication. These studies were published from (2009-2017).

Results

Eleven studies were included and these studies worked on 420 patients. Comparisons between these were done according to age, sex, time interval between (RYGB) & GJP, weight loss after GJP, laparoscopic vs open technique and overall complications of revisional surgery (GJP).

Conclusion

The exact reasons for weight loss failure after RYGB remain incompletely elucidated and are probably multifactorial. Pouch resizing could be a valuable option for weight loss failure or regain in selected patients with a dilated gastric pouch after RYGB in the short term. Careful selection of candidates for this procedure through psychiatric and nutritional evaluations and volumetric measures of the gastric pouch, preferably using CT, is mandatory to identify those patients most likely to benefit from revision.
Fistulotomy with Primary Sphincter Repair in High Anal Fistula
Authors: Ahmed Tarek Youssef , Mustafa Mohab Gamal El-din , Elshawy Mohamed Elemam , Abdelaziz Modaser Hashim
Published: October 2021

Background

Anal fistula is abnormal communication between the anal canal and the perianal skin or perineum or buttocks. Anal fistula is almost always a consequence of an anorectal abscess that was drained. While the abscess represents the acute phase of the disease, fistula represents the chronic phase as the fistulous pathway may persist in about 1/3 of cases.

Aim of the Work

In this study we will perform fistulotomy with primary sphincter repair in high cryptoglandular fistula with assessment of recurrence rate, incontinence rate and patient satisfaction according to pain score, wound healing, discharge and return to daily activity parameters.

Methods

This was prospective cohort study on 30 patients of high peri-anal fistulae and fistulotomy and reconstruction (primary suture repair) of anal sphincter was done., the patients were followed up 6 months postoperatively regarding their continence using Wexner score, recurrence, discharge and their return to work by scheduled outpatient clinical examination.

Results

Among 30 patients only three patients complaining usual incontinence mostly as post defecation soiling. Three patients reported anal fistula recurrence: One occurred at the 5th month, while the other two occurred at the 6th month after surgery. The procedure was well tolerated by the patients as most of them complaining only minimal pain and returned to work after two weeks without need of other stage like other procedures.

Conclusion

Fistulotomy with primary sphincter repair is an effective therapeutic option for patients with high anal fistula. Our study demonstrated that immediate reconstruction of the sphincters after fistulotomy achieved high success rates and low risk of postoperative fecal incontinence, compared to reported rates after simple fistulotomy.
Early versus delayed operative management of appendicular mass
Authors: Tantawy Hassan sayed , El Hefny Amr Mohamed , Abd El Halim Ahmed Yasser , Nasr Mohammed Ali Abdel Ghaffar
Published: October 2021

Background

Acute appendicitis is one of the most common causes of acute abdomen. It may be either complicated or uncomplicated. Sometimes the acute inflammation of the appendix may be enclosed by the patient’s own defense mechanisms to form inflammatory phlegmon. Complicated appendicitis is a palpable appendiceal mass, phlegmon, or a localized abscess. A phlegmon is an inflammatory tumor consisting of the inflamed appendix, with the greater omentum and adjacent viscera.

Aim of the Work

To determine the preferred approach taken to the management of the appendicular mass, to compare between acute appendectomy and delayed surgical intervention for appendicular mass, and to determine patient outcome following appendectomy for appendicular mass.

Material and Methods: Study

A retrospective study.

Study Setting

The study has been conducted in Ain Shams University Hospital (El-Demerdash) and military hospitals in Cairo and Alexandria under supervision of thesis supervisors.

Study Period

The study retrospectively analyze data of patients diagnosed as appendicular mass between January 2017 and December 2017.

Study Population: Inclusion Criteria

Patients with acute abdomen, diagnosed as appendicular mass by clinical examination and imaging (US and CT).

Exclusion Criteria

Females with right ovarian problems. Cases with right ureteric stones. Cases of recurrence. Abdominal ultrasonography and CT did not confirm the mass.

Results

The present study was a descriptive, retrospective, study that included 20 patients diagnosed with appendicular mass attended to surgery clinics at El-Demerdash and Military hospitals between January 2017 and December 2017. The patients were divided into two groups: Group I including 10 patients started conservative treatment then received delayed appendectomy. Group II including 10 patients received early appendectomy.

Conclusion

In conclusion, early appendicectomy is a safe and superior option in patients with appendicular mass compared to delayed appendicectomy. The results indicate that early appendicectomy leads to shorter hospital stay and return to normal activities than delayed appendicectomy. Moreover, postoperative difficulties and complications were less following early appendicectomy. The early appendectomy appears to achieve more favorable outcomes in patients with more severe symptoms, high fever, and high inflammatory markers. Nonetheless, more studies are necessary to confirm our findings.
Using Prophylactic Prolene Mesh to Reduce the Incidence of Incisional Hernia at the Site of Stoma Closure
Authors: Tantawy Hassan Sayed , Mohamed Mohamed Mahfouz , Halim Ahmed Yasser Abdel , Aziz Mostafa Mohamed Abdel
Published: October 2021

Background

Incisional hernias at stoma sites are not an infrequent problem, occurring in up to 30% of cases and it also varied in a range of studies from 0-48%.

Objectives

This is a prospective study to detect the feasibility of application of prolene mesh at the site of stoma closure in reducing the rate of post stomal incisional.

INTRODUCTION

Abdominal wall hernias are common and are a significant cause of morbidity.

Stomas are commonly constructed following colorectal surgery to protect distal anastomosis or when sepsis prevents primary anastomosis. There is a risk of a wide range of morbidity following both stoma formation and stoma reversal (Chow et al., 2009).

Incisional hernias at stoma sites are not an infrequent problem, occurring in up to 30% of cases and it also varied in a range of studies from 0-48% (Tilney et al., 2008).

They occur over time and are generally under-reported, which may be due to the elderly nature of the population, the significant co-morbidities or early discharge from follow-up (Cingi et al., 2006).

One in three patients may develop a hernia after stoma closure, and around half of hernias that are detected require repair.Risk of hernia is greater after colostomy closure than after ileostomy closure(Bhangu et al., 2012).

A meta-analysis published in 2012 investigated the incidence of incisional hernia following closure of stoma, The overall mean incisional hernia rate following stoma closures was 7.4%. The authors reported a lower risk of hernia following reversal of ileostomy when compared to respectively (Bhangu et al., 2012).

A further systematic review found a similar incidence for stoma site incisional hernias to be 8.3% (0–33.9%) (Nguyen et al., 2014).

Two factors should be noted with regard to the incidence of stoma site hernia. Firstly, that the long-term risk is not known and secondly, that clinical examination alone is shown to have a lower detection rate of incisional hernia post stoma closure when compared to clinical imaging (Bhangu et al., 2012; Cingi et al., 2006).

Therefore, studies focusing on only clinical examination may be underestimating the prevalence, as radiological detected herniae may become symptomatic over time and may be missed in studies with a short follow-up period.

AIM OF THE WORK

This is a prospective study to detect the feasibility of application of prolene mesh at the site of stoma closure in reducing the rate of post stomal incisional.
The role of surgical clips in Breast Conserving Therapy: Systematic review of the Literature
Authors: Ouf Tarek Ismail , Osman Ahmed Gamal El-Din , Hafez Ramy Fouad , Mohammed Omnia Mahmoud
Published: October 2021

Introduction

Conservative breast therapy consists of wide local excision followed by local control of the breast cancer by boost radiotherapy. For radiologists, identification of breast tumor bed (TB) is an essential first step for them to start their radiotherapy. There is number of ways to identify the tumor bed, one of them is inserting the metallic clips in the tumor bed cavity intraoperative. They mark the tumor cavity against the whole breast normal tissue as they appear radioopaque during radiotherapy.

Purpose

The primary aim of this study is to investigate the need & validity of surgical clips insertion in breast tumor bed and its effect on further breast radiotherapy through a systematic review that includes all published studies which used clips for marking the breast tumor bed. The secondary aim is to define the needed number of surgical clips to define the breast tumor bed clearly and obviously and what are the best types of surgical clips to be used for this purpose.

Methods

The literature review was done by searching on different databases using the keywords for only English studies reporting using surgical clips for localization in breast surgeries. There was no restriction to specific period or study design. Assessment of included studies was done by 2 independent researchers.

Results

54 articles (n = 3427 patients) were the total number of studies that met our inclusion criteria. These studies were of different study designs. Cohort studies were the most representing type about 40 articles. The most common used clips type (21 study, n = 1444 patient) was metallic hemostatic clips according to the sum of operated patients and count of studies. Although all studies confirmed the importance and effectiveness of using clips for tumor bed localization, there was no standard optimum number of clips that can be used for localization. However, most studies used definite number of clips as 4 or 5 clips or used number ranging from 1-5 clips. The same for inserted clips margins at tumor bed, only few studies mentioned definite cavity margins. The 4 main margins (anterior, posterior, superior, inferior) were the commonest reported sites.

Conclusion

Using surgical clips whatever their type is very helpful for radiologists to define breast tumor bed especially with the obvious increase in using oncoplastic techniques. It’s recommended to use more than 5 clips at tumor bed cavity with special concern to insert them at least 4 margins of tumor bed.
Comparative study between using of quilting sutures vs. using of fibrin sealant in prevention of seroma after abdominoplasty
Authors: Isaac Therese Wagih Mickael , Farid Emad EL Deen , Omran Hesham Mohammed , Hweidi Ahmed Sobhi
Published: October 2021

Background

Abdominoplasty is one of the most common body-contouring procedures. It is among the top five procedures in aesthetic surgery. The aim of abdominoplasty is to remove excess fat and skin and restore weakened muscles to create smoother firmer abdominal figure

Aim of study

The aim of the present study is to compare between the rate of seroma in patients undergone abdominoplasty using quilting sutures technique and patients undergone abdominoplasty using fibrin glue.

Patients and Methods

This study was conducted on 20 patients complaining of variable degrees of abdominal wall laxity seeking for surgical repair of abdominal wall, conducted from april 2019 till october 2019.on patients admitted at ain shams university hospitals and cairo university hospitals

Results

This study includes twenty patients with abdominal wall redundancy presented to Ain-Shams university hospital and kasr AL Ainy university hospital in the period (April 2019 - October 2019). The patients were divided into two groups: group A ten patients undergone abdominoplasty with quilting sutures technique, group B ten patients undergone abdominoplasty with fibrin glue.

All 20 patients were females aging between 25 and 50 and with BMI between 25 and 30.

Conclusion

Within the limitations of our study we have concluded that this study adds to the mounting evidence that placement of quilting sutures or the application of fibrin glue is safe and effective and will contribute to a decrease in the seroma rate, the total amount of drain output, the time of drain removal and complications. It produces a safe and less eventful postoperative period.
Identification of Mortality Predictors among Elderly Patients Admitted to Geriatrics and Gerontology Department, Ain Shams University Hospitals
Authors: Hassan Nourhan E , Elaraby Mennatallah S. S , Abdul-Rahman Samia A , Allam Mohamed Farouk , Ebeid Somaia M
Published: October 2021

Background

Elderly persons are prone to frequent hospitalization for a longer period of time. It has been reported that approximately 5% of elderly die during hospital stay, whereas 20%– 30% die within one year following hospital discharge. Many factors including aging-associated diseases, chronic diseases, drug abuse, poly pharmacy, functional disability, feeding problems, prolonged length of hospital stay are associated with increasing mortality risk. In addition, symptoms and signs are significantly variable in the elderly and usually atypically represented.

Objective

To identify predictive factors associated with in-hospital mortality in elderly patients admitted to Ain Shams University Geriatric hospital wards and intermediate care unit.

Methods

A prospective cohort study of all Egyptian elderly patients (aged 60 years old or above) admitted at Geriatric Hospital (general ward and intermediate care unit), Ain Shams University Hospitals (Cairo, Egypt), over a period of 6 months (from April 2019 to September 2019). Patients were subjected to structured interview questionnaire including data pertaining socio-demographic data, past medical history, relevant physical examination, Short-form of Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and SOFA score. Association between different risk factors and mortality rate was done to identify the most significant predictive factors leading to mortality in elderly in order to implement specific geriatric interventions in the future to prevent such fatal consequences.

Results

The present study included 140 patients, of whom 73 (52.1%) were females and 67 (47.8%) were males. Nearly, 80% of the studied sample were discharged, while 20% died during hospitalization. The most common pre-morbid conditions were hypertension (58.6%), diabetes mellitus (40%), gastrointestinal tract diseases (40.7%), cerebrovascular strokes (37.8%) and ischemic heart disease (35.7%). On admission, the mean SOFA score of the discharged group was (6±2.8) while the mean score of the deceased group was (8.9± 3.6). Evaluation of the general characteristics of the discharged and deceased groups revealed that the mortality rate is significantly associated with male gender (p = 0.018), depressive disorders (p < 0.001), hepatic diseases (p = 0.008), gastrointestinal tract diseases (p = 0.048), length of hospital stay (p = 0.001) and initial SOFA score on admission to acute care setting (p < 0.001).

Conclusion

Predictors of mortality during hospitalization of elderly patients include; male gender, depression, hepatic diseases, GIT diseases, length of hospital stay and initial SOFA score on admission. These factors must be evaluated to identify the potential candidates for specific geriatric interventions and specific plan of care.
Relation between pre-procedural increase in urinary albumin excretion and changes in estimated glomerular filtration rate after coronary angiography in diabetic patients
Authors: El Sharkawy Magdy M , Mohammed Abd El-monem , Ramadan Ahmed Yehia , Khedr Lina Essam
Published: October 2021

Background

Contrast-induced nephropathy (CIN), is an acute impairment in renal function, and typically occurs within 3 days following the exposure to a contrast medium (CM). It is associated with increased hospital stay and increased morbidity and mortality, Adult patients with diabetes have a higher risk than the general population for developing contrast induced nephropathy.

Methods

The current study includes 40 patients with diabetes mellitus, scheduled for coronary angiography with estimated GFR >60 ml/min .the patients were divided according to their pre-procedural urinary albumin creatinine ratio (ACR) results into 3 groups: Group 1 included patients with pre-procedure urinary albumin creatinine ratio < 30mg/g, Group 2 included patients with pre- procedure albumin creatinine ratio 30- 300 mg/g and Group 3 included patients with pre-procedure albumin creatinine ratio >300 mg/g . Estimated GFR (glomerular filtration rate) calculated using MDRD and serum creatinine were measured at day 2 and 3 (Day +2 +3) after coronary angiography.

Results

There was no statistically significant difference in the age and gender distribution, the use of ACEIs (angiotension converting enzyme inhibitors) or diuretics between the cases who developed and who didn’t develop CIN. The mean ACR in the group with no contrast induced nephropathy was 225.38 ± 209.53 which was statistically significantly lower when compared with the cases with contrast induced nephropathy (420.43± 348.52) (p = 0.033). The mean HbA1c in no contrast induced nephropathy group was 7.11 ± 0.64 and in contrast induced nephropathy group it was 9.09 ± 0.66 which is significantly higher (P > 0.001).With univariate regression analysis, ACR, HbA1c and number of vessels affected were shown to be risk factors for occurrence of CIN after use of contrast, but with multivariate analysis, both ACR and HbA1c were shown to be risk factors for CIN.

Conclusion

An increase in albumin creatinine ratio in itself can be a risk factor for development of contrast induced nephropathy in diabetic patients.
The Effect of Hemodialysis vintage on pulmonary functions in patients with End Stage Renal Disease
Authors: Abouellail Hesham Atef , Hussien Hussien Sayed , Raafat Riham Hazem , El-Sayed Ibrahim Ahmed Ibrahim
Published: October 2021

Background

Chronic kidney disease (CKD) is an irreversible and progressive disorder characterized by loss of kidney function. CKD gradually progresses to end-stage renal disease (ESRD). ESRD patients eventually need renal replacement therapy via dialysis (subdivided into hemodialysis and peritoneal dialysis) or kidney transplantation in order to survive.

Aim of the Work

To see the effect of hemodialysis vintage on pulmonary function in patients with ESRD in Ain-Shams University Hospitals.

Methods

This was a prospective study at the Ain-Shams University hospitals for six month duration on patient with ESRD on regular dialysis, 100 patients were chosen for this study, divided into 2 groups each group consists of 50 patients. Incident group (on chronic hemodialysis for 1-6 months duration) and Prevalent group (on chronic hemodialysis for more than 2 years).

Results

this study reveals that there was statistically higher indices among incident compared to prevalent hemodialysis research groups before and after hemodialysis as regards improved Pulmonary Functions.

Conclusion

prevalent cases on hemodialysis sessions have been improved clinically as regards basal crepitations and lower limb edema but didn't improve significantly in comparison to incident cases as regards Pulmonary functions on the other hand incident cases have been improved as regards Pulmonary functions In a more significant manner then prevalent cases but didn't improve as regards clinical basis concerning lower limb edema and basal crepitations.
Culture and Susceptibility of Levofloxacin Resistant H.pylori
Authors: Ghaly Sameh Mohamed Fahiem , Ali Hussien Abd El-Rahman Hany , Osama Aly Aly Mohamed , Youssef Ibrahim Youssef Ahmed Medhat
Published: October 2021

Background

Antibiotic resistance in Helicobacter pylori is the major cause of eradication failure. Prevalence of H.pylori antibiotic resistance is increasing worldwide, and it is the main factor affecting efficacy of current therapeutic regimens. Our aim is to investigate H.pylori resistant patients toward Levofloxacin and detect the most effective antibiotic in eradication of H.pylori.

Objective

To investigate H.pylori resistant patients toward Levofloxacin including regimens and to detect the most effective antibiotic in H.pylori eradication.

Patients and Methods

The present study aimed to investigate the Susceptibility of Levofloxacin Resistant H.pylori in patients who had been diagnosed and received any regimen including Levofloxacin and still signs and symptoms of H.pylori infection not releaved and after proper time of stoppage of PPI and antibiotics H.pylori Ag in stool still positive at the period from January 2019 to February 2020.

Results

In the present study we found a wide spectrum of resistance to rates of H. pylori, from nearly negligible rates of Rifampicin (0%), Imipenem (0%), Cefotaxime (2%), Tetracycline (6%), Doxycycline(10%), and Amoxicillin(38%). To high rates resistance to Metronidazole (100%), Erythromycin (72%), Clarithromycin (68%), Azithromycin (60%), Ciprofloxacin (52%), and Levofloxacin (48%).

Conclusion

Helicobacter pylori is the most common chronic bacterial infection in humans. Antibiotic resistance is a major issue nowadays. Prior use of macrolide antibiotics or metronidazole appears to increase the risk of H. pylori resistance. Clarithromycin resistance appears to be an "absolute" condition that can not be overcome by increasing the macrolide dose. Levofloxacin resistance seems to be increasing. Culture and susceptibility should be done before starting second line treatment.
Assessment of Doppler haemodynamic changes suggestive of portal hypertension in cirrhotic HCV patients after sustained virological response to direct antiviral agents
Authors: Ezzat Mennatullah M , Abdelhakam Sara M , Al-Balakosy Amira M , Ghalwash Ahmed A
Published: October 2021

Background

Egypt has the highest prevalence rate of HCV in the world. About 14.7% of the Egyptian people have HCV antibodies and 9.8% have an active infection. The death rate due to liver disease about 40,000 each year (near10% of all deaths). It is the second after the cardiac diseases.

Aim of Work

to assess Doppler haemodynamic changes suggestive of portal hypertension in cirrhotic HCV Egyptian patients after sustained virological response to direct antiviral agents, and their correlation with liver stiffness measurements by Fibroscan.

Patients and Methods

This prospective cohort study was conducted at Viral Hepatitis Unit at Ain Shams University Hospital and Al-Agouza Police Hospital during the period from May 2018 to July 2019. The study included 50 Egyptian treatment-naïve chronic hepatitis C patients with cirrhosis on Sofosbuvir, Daclatasvir for 12 weeks. Patients were subjected to history and full physical examination, radiology assessment (Abdominal Ultrasound and color Doppler), Upper GI endoscopy and Fibroscan before treatment and 6 months after treatment. Followed up with CBC, AST, ALT, Total bilirubin, Albumin, creatinine and Coagulation profile before and after 12 weeks of treatment And HCV RNA by PCR and HCV CORE Antigen before and then after 12 weeks of treatment.

Results

Treatment with sofosbuvir plus Daclatasvir for 12weeks resulted in undetectable HCV RNA by PCR in 100% of the patients at the end of treatment. There was a significant improvement in portal hemodynamics 6 months after treatment as well as a significant correlation between Doppler indices and fibroscan. Conclusion: Doppler portal hypertensive parameters, as a marker of portal hypertension, were improved in parallel with the improvement in fibroscan values after viral clearance and its improvement in the current study mandate urgent treatment to avoid possible complications.
Prevalence of Occult Hepatitis C Virus Infection among Egyptian Haemodialysis Patients
Authors: EL-Razek El-Nakeeb Noha Abd , El-Sayed Moataz Mohamed , George Tari Magdy Aziz , El-Araishy Amira Mohamed Helmy Okasha
Published: October 2021

Background

Hepatitis C Virus (HCV) infection is a global health problem. OCI is characterized by presence of HCV-RNA in the liver tissue only and/or Peripheral Blood Mononuclear Cells (PBMCs) with undetectable HCV-RNA or antibodies in the serum. Support for presence of this entity comes from the observation that HCV, even though a hepatotropic virus, can replicate as well at extrahepatic sites, including peripheral blood mononuclear cells.

Objectives

The current study evaluated the hidden infection of hepatitis C virus among patients on maintenance hemodialysis with negative ELISA and PCR by using PCR in mononuclear cells as a marker in these patients. Our study was done in Sharkia Governorate.

Patients and Methods

In our study, the 60 included subjects had an average age of 48.27 years with range from 19 to 77 years and included 33 males (55%) and 27 females (45%). The subjects had average dialysis duration of 6.51 ± 4.10years with range from 7 months to 19 years.

Results

Our study showed no statistically significant differences between occult HCV cases and negative cases in frequency of blood transfusion. There were no statistically significant differences between occult HCV cases and negative cases in splenomegaly, hepatomegaly or coarse liver but there was a statistically significant increase in frequency of severe ascites, moderate LL edema and jaundice among occult HCV cases compared to negative cases. There were no statistically significant differences between occult HCV cases and negative cases in urea, creatinine, ALT, AST or albumin. In our study total bilirubin>1.7 and direct bilirubin >0.4 were significant predictors for the presence of occult HCV in hemodialysis patients. Our study showed that there were no statistically significant correlation between viral load in PBMCs and laboratory findings among occult HCV cases.

Conclusion

Hemodialysis patients are liable for occult HCV infections with a considerable impact on their health. Total and direct bilirubin are predictors of presence of occult hepatitis C infection at cut-off values of 1.7 mg/dl and 0.4 mg/dl respectively.
Study the Relation between Peripheral Arterial Disease and vitamin D Level among Maintenance Hemodialysis Patients
Authors: Bichari Walid Ahmed , Abdelmobdy Ashraf Hassan , Aboud Amr Abd Elshafy
Published: October 2021

Background

Chronic kidney disease (CKD) represents a global health concern. The Global Burden of Disease study stated that, worldwide mortality attributed to renal failure showed a tremendous rise with around 1.2 million deaths from renal failure in 2015. Hemodialysis

(HD) patients are at increased risk for atherosclerotic disorders including peripheral arterial disease (PAD). Among dialysis patients, many of the risk factors for PAD are the same as for the general population, but there are associations that seem to be unique to dialysis patients.

Objective

To study the relation between PAD assessed by ankle brachial index (ABI) and serum level of 25(OH) vitamin D among Maintenance HD Patients.

Patients and Methods

The present study included 90 subjects, 45 end stage renal disease patients patients(ESRD) on maintenance HD with PAD assessed by ABI (value less than 0.9) and 45 ESRD patients on maintenance HD without PAD assessed by ABI (value more than or equal 0.9).

Results

There was a statistically significant difference between the two studied groups as regard serum 25(OH) vitamin D level (P = 0.000). We also found a statistically significant positive correlation between ABI and serum vitamin D level in both patients and control groups (P = 0.000).

Conclusion

Vitamin D deficiency is associated with PAD among maintenance HD patients.