bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Chitinase-3-like Protein 1 (YKL-40) as a Marker of Disease Activity in Ankylosing Spondylitis Patients
Authors: Abd ElBar Nadia Salah Kamel , Elwy Mohamed Ali , El-Leithy Sally Abdel-Samie , Hassanien Khaliel Radwa Raafat
Published: July 2024

Background

Ankylosing spondylitis is a prototype of spondyloarthritides that primarily affects the axial skeleton. Sacroiliitis is the hallmark and accompanied by inflammation of the entheses and formation of syndesmophytes, leading to spinal ankylosis in later stages. Prevalence estimates vary between 0.1% and 2% in different populations.The most utilized peripheral blood biomarkers of ankylosing spondylitis activity in clinical practice and clinical trials are ESR and CRP. However, they have low sensitivity and specificity.

Objective

To detect the role of YKL-40 as an objective Marker of disease activity in ankylosing Spondylitis Patients.

Patient and Methods

This study was a case control study, included fifteen ankylosing spondylitis patients were recruited from the outpatient clinic and inpatient department of Physical Medicine, Rheumatoloy and Rehabilitation of Ain Shams university hospitals and fifteen adult healthy volunteers as a control group. Approval of the Ain shams university research and ethical committee was obtained.

Results

There was no statistically significant difference between patient and control group as regard age and sex. YKL-40 showed 100% sensitivity and 100% specificity. large scale studies with follow up of patients in response to drug treatment are needed to be done to assess its uses as a disease activity marker. large scale prospective studies are needed with the assessment of comorbidities and their time of development in correlation to YKL-40 as it has an excellent potential for prediction of these comorbidities.

Conclusion

YKL-40 marker is a good predictor for ankylosing spondylitis disease.
Metformin Protects Non Diabetic rats from LPS-Induced Cognitive and Locomotor dysfunctions and Role of vitamin B12 Supplementation
Authors: Hamed Gehane Mahmoud , Saad Dalia Abdelsalam , Mohammed Nancy Yahia , Elsayed Mohamed H
Published: July 2024

Background and Objectives

Alzheimer’s disease (AD) is a neurodegenerative disorder characterized by a progressive deterioration of cognitive functions and its initial symptoms are easily mistaken for stress or ageing. The current study was conducted to throw light on the effect of metformin, solely and in combination with vitamin B12, on LPS –induced AD like neurodegeneration and to elucidate the underlying mechanisms in non diabetic rats.

Methods

35 adult albino male rats, were randomly allocated into the following groups: Group I: Control rat group (C), Group II: LPS- induced Alzheimer group (LPS), Group III: LPS-induced Alzheimer’s disease group supplemented with metformin: (LPS-Metformin), Group IV: LPS- induced Alzheimer’s disease group supplemented with metformin & Vitamin B12: (LPS- Metformin & vit B12). Behavioral assessment tests were done. At the end of the study, serum glucose, insulin, and plasma vit B12, malondialdehyde (MDA), glutathione peroxidase (GPX), tumor necrosis factor α (TNF α), and interleukin-6 (IL-6) levels were assessed. Histopathological examination of the brain tissue was also performed.

Results

The results of behavioral tests revealed that the time consumed by the animal for reaching the platform at the water maze test was significantly prolonged, while the time stability values by the animal at low and high velocities at rotarod test were significantly decreased in the LPS group compared to the control group. The biochemical results revealed that serum glucose and insulin, as well as HOMA-IR values, were significantly increased while plasma vit B12 was significantly decreased in the LPS group compared to the control group. Upon treatment with metformin solely or in combination with vitamin B12, these changes were improved. These results were further confirmed by histopathological examinations.

Conclusion

Metformin had a prophylactic effect on LPS induced neurodegenerative disease like dementia as it enhanced cognitive function, however it did not change locomotor and balance performance. This was explained, partially by its anti-inflammatory and anti-oxidant effects.
Metabolic Effects of Synbiotic Supplementation in High Fat Diet Fed Rats: Possible Role of GLP-1 and Serotonin
Authors: EL Kafoury Bataa Mohamed , Ebrahim Asmaa Tarek , Abd-El Hamid Ali Manal Said , Mehanna Nayra Shaker , Ibrahim Ramadan Gamil El-Sayed , Morsy Wessam Ezzat
Published: July 2024

High fat diet (HFD) predisposes to many metabolic changes; it may disrupt gut barrier integrity and gut microbiota composition. Synbiotic supplementation may promote host’s metabolic health by selective activation of the healthy microorganisms. This study aimed to probe the interaction between synbiotic supplementation, gut microbiota and GUT hormones in HFD states. Twenty-seven adult male albino rats, 3 groups, group I: control, group II: HFD received HFD for 12 weeks and group III: synbiotic-supplemented HFD received synbiotic in the last 6 weeks. The anthropometric measurments were measured. Liver transaminases, lipid profile, parameters of insulin resistance, serum serotonin, glucagon like polypeptide-1 (GLP-1), oxidant/antioxidant markers (MDA/GPx), zonulin levels and quantitative cecal short chain fatty acids (SCFA) were 3 assessed. Samples of liver and colon were employed for histopathological studies. Compared to HFD group, synbiotic led to a significant reduction in anthropometric measurements, liver enzymes, atherogenic index, HOMA-IR and MDA denoting improved dyslipidemia, insulin resistance and oxidative state. Moreover, synbiotic supplementation decreased serum zonulin and increased both serum serotonin, GLP-1 and cecal SCFAs. Synbiotic supplementation ameliorated the metabolic derangements and the disturbed integrity of the intestinal barrier induced by HFD through reducing serum GLP-1, serotonin and cecal SCFAs.
Protective Effects of Stem Cells and Vitamin D3 Against Hepatic Ischemia/Reperfusion Injury in Rats
Authors: Hamed Gehane M , Abou-Bakr Doaa Ahmed , Hassan Ali Radwa , El Masry Maryam Mosad
Published: July 2024

Background

Liver transplantation is one of the most efficient life-saving treatments for various end-stage hepatic diseases. However, hepatic ischemic reperfusion injury (IRI) remains a major problem in liver surgeries morbidities and mortalities. Stem cells (SCs) have been recently received increasing attention for cell-based therapy, especially in regenerative medicine, including liver diseases.

Aim

to investigate the effect of vitamin D and Bone Marrow Mesenchymal Stem Cells (BM- MSCs) solely or combined on hepatic IR injury.

Methods

Sixty adult male Wister rats were allocated into 5 groups; Sham, IR: underwent hepatic IR, vit. D-IR: received vit. D in a dose of 500 IU/Kg/day, by gavage, 5 days/week for 2 weeks, then subjected to hepatic IR, Stem cell-IR: received single IV injection of 1 × 106 BM-MSCs prior to hepatic IR and Combined-IR: received both vit. D and BM-MSCs prior to hepatic IR. All rats were subjected to estimation of Liver index (LI), assessment of serum levels of alanine, aspartate transaminases (ALT, AST) and vitamin D, hepatic tissue levels of Malondialdehyde (H.MDA), Superoxide dismutase (H.SOD), Interleukin-2, 10 (H.IL-2, H.IL-10), Caspase-3 (H.Casp-3), H.LC3B and hepatocyte growth factor (H.HGF), as well as histopathological liver examination and scoring.

Results

Hepatic IR resulted in significant elevation of ALT, AST and H.MDA, H.IL-2, H. Casp- 3 as well as significant reduction in LI, vit. D, H.SOD, H.IL-10, H.LC3B and H.HGF with evident hepatic sinusoidal congestion, cytoplasmic vacuolation and cellular necrosis. Treatment either solely or in combination mitigate these changes with the combined treatment showed the best results compared to the individual use.

Conclusion

In vivo coadministration of vitamin D and BM-MSCs prior to hepatic IR attenuated hepatocellular damage through preventing oxidative stress and inflammatory response, augmenting autophagic, regenerative capacity and anti-apoptotic effect.
Abdominoplasty Combined with the Anterior Component Separation Technique for Reconstruction of Midline Large Ventral Hernias: Functional and Aesthetic Outcome Clinical Study
Authors: Akila Abdulaziz A , Affifi Salah Nasser M , Amr Adel Hussein , Desawy Bakry Sameh Adel
Published: July 2024

Background

Large midline ventral hernias, diastasis of recti and the associated laxity and abdominal shape deformity, represent aesthetic and functional problems for the patients. So, the surgical treatment of both pathologies at the same time is highly recommended if the patient’s general condition permits. This can be achieved by a comprehensive technique incorporating abdominoplasty performed by a transverse lower abdominal incision into any of the hernia repair techniques.

Objective

The aim of this study is to evaluate the functional and aesthetic outcome of the combined abdominoplasty and anterior component separation technique in the management of midline ventral abdominal hernias.

Patients and Methods

This study is a prospective case control study that evaluates both functional and aesthetic outcome of performing abdominoplasty on patients with large midline ventral hernias. This study was conducted between December 2020 to March 2022 at the Plastic Surgery Department, Demerdash University Hospital, Cairo, Egypt. Study consisted of fifteen patients with different presentations of abdominal wall laxity and ventral hernias. Patients were evaluated regarding their age, BMI, degree of rectus diastasis, Pre-operative radiological findings, post Operative complication and hernia reoccurrence, patients’ satisfaction, and the pre-operative and post-operative umbilical measurements were compared.

Results and Conclusion

The current study showed that Abdomioplasty can be combined with complex hernia repair by anterior component separation technique within the same setting in high-risk patients safely with an excellent functional outcome and acceptable satisfactory aesthetic results. Although, this can be associated with an increased risk of postoperative surgical site complications such as; skin necrosis and wound infection. Patient characteristics associated with the development of complications following anterior component separation combined with abdominoplasty include obesity, previous abdominal procedures and previous pregnancies.
Effect of Heparin on Post-Operative Ultrasonographic Changes in Flexor Digitorum Profundus Tendon Trauma Of The Hand
Authors: Abdelrahman Mohamed Asmaa Nabil , Gamal Elden Noha Mohamed , Ahmed Khalid
Published: July 2024

Background

Flexor tendon injuries especially zone II are a challenging problem for both surgeons and patients as they need careful post-operative early physiotherapy to decrease adhesions and improve gliding which carry risk of early tendon rupture. Many drugs were tested for their role in decreasing paratendinous adhesions and enhance clinical outcome, this study by ultrasound examination test effect of intraoperative addition of heparin in limiting paratendinous adhesions and improving clinical outcome.

Aim of the Work

to evaluate the effect of intraoperative heparin addition in preventing postoperative adhesions and on clinical outcome.

Patients and Methods

This clinical trial study included 21 patients with 31 surgically repaired zone II flexor digitorum profundus tendons. The 21 Patients were divided randomly into two groups, group A (study group) with heparin injection during surgical repair and group B (control group) without heparin injection, with a total number of eleven patients in group I and ten patients in group II.

Results

There was no statistically significant difference between the two groups in tendon margins, gliding or granulation tissue severity, which can support why it does not affect clinical outcome. There was no statistically significant relation between the heparin injection and tenosynovitis although heparin is known for its anti-inflammatory effect. Tendon re rupture was more presented in heparin injected group yet not of statistical significance.

Conclusion

The intraoperative heparin injection at repair site didn’t show any significance in enhancing clinical outcome or in limiting paratendinous adhesions. Although it wasn’t of statistical significant but tendon re-rupture was more seen in cases managed with heparin injection group so heparin injection is not recommended in treatment such cases yet further investigations are needed.
Diagnostic Accuracy of Ultrasound in Evaluation of Obstructive Jaundice with MRCP as a Gold Standard
Authors: El Maksoud Abeer Abd , Madkour Sherihan Said , El Razik Mohammed Marwa Mahmoud Abd
Published: July 2024

Background

MRCP has high sensitivity for CBD stones, strictures and malignancies in cases of obstructive jaundice especially cases with suspicion (clinical/CBD-IHBR dilatation on USG). As MRCP has more diagnostic accuracy compared to ultrasound in detecting the cause of obstruction in cases of obstructive jaundice, USG may be considered as an initial screening test and MRCP for definitive treatment planning. The limitation of the study is the small sample size.

Objective

To evaluate cross sectional retrospective study was done From June 2021 to June 2022 on 31 patients (17 females and 14 males) presenting with obstructive jaundice were referred from Internal Medicine, General Surgery and Clinical Oncology Department to Diagnostic Radiology Department in Ain Shams University hospitals, MRCP were done for all the patients and then Abdominal US examination were performed and then comparison between US & MRCP result were done.

Results

The US has sensitivity of 100.0%, specificity of 100.0% and accuracy of 100.0 % in detection of level of obstruction and also has sensitivity of 71.0% and accuracy of 71.0% in detecting cause of obstruction taking MRCP as a gold standard.

Conclusion

MRCP is an excellent tool for detecting the cause of obstructive jaundice, Use of MRCP could therefore spare the patients from invasive preoperative endoscopic procedures and it can also most likely reduce overall surgical costs. We propose MRCP as the method of choice for the diagnostic imaging of obstructive jaundice.
Value of Ultrasound as an Alternative to X-Ray in Assessment of Paediatric Upper Limb Trauma
Authors: Mohammed Ibrahim Ola Medhat , El Kader Morsy Hossam Abd , Sayed Abd el Karim Maha Ahmed
Published: July 2024

Background

Pediatric fractures are a common presentation in the Orthopedic Emergency Department. Trauma is the commonest cause of injury and disability in children and young adults worldwide.

Aim of the Work

This study aimed to establish the value of ultrasound compared to plain radiography (as a standard care imaging modality) in the assessment of pediatric upper limb traumatic fractures.

Patient and Methods

This prospective observational study was done among 30 patients with limb fracture who referred to Ain Shams University Hospital and Sohag Teaching Hospital.

Results

Our results showed that the sensitivity of sonography was 100% and its specificity 62.5%; the positive and negative predictive values were 88% and 100%, respectively with accuracy 90%. These results show that US had high sensitivity and specificity in assessment of pediatric upper limb traumatic fractures.

Conclusion

Our prospective observational study was done among 30 patients with limb fracture who referred to Ain Shams University Hospital and Sohag Teaching Hospital and In summary, the findings of this research showed that ultrasound, Alternative To X-ray, has high sensitivity and specificity in the diagnosis of pediatric upper limb traumatic fractures.
Role of Ultrasound in Evaluation of Median and Ulnar Nerves in Rheumatoid Arthritis Patients in Correlation with Nerve Conduction Studies
Authors: Abbas Aly Mohamed Hassan , Hassan Sayed Mohammed Sobhy , Aly Hussein Safaa Abdelsalam , Allam Allam El Sayed
Published: July 2024

Background

Rheumatoid arthritis (RA) is a systemic inflammatory disease of unknown etiology characterized by the involvement of the joints. RA is also associated with vasculopathy, peripheral, autonomic, and entrapment neuropathy. The presence of peripheral neuropathy contributes significantly to the functional limitation in rheumatoid arthritis patients. Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and consists of the compression of the median nerve as it courses through the carpal tunnel followed by the cubital tunnel syndrome which is the most common site for entrapment for the ulnar nerve.

Aim of the Work

to evaluate the role of ultrasound in evaluation of median and ulnar nerves in rheumatoid arthritis patients in correlation with nerve conduction studies.

Patients and Methods

to elucidate this aim, 25patients diagnosed with RA, diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for diagnosis of RA. And 25 healthy control subjects (matched for age and body mass index) were enrolled.

Results

this study was carried on 25 patients, 9 (34.7%) of whom were females, and 17 (68%) were males. The mean age of the studied group was (38.96±6.24 years old). The mean disease duration was 7 ±1.13 years; the mean disease activity index was 4.28 ±0.15. All the studied cases suffer from needle sensation, 24 (96) had numbness and 17(68) had burning sensation. All the studied cases in patient group had distal weakness and negative sensory testing (light touch, pinprick, temperature and vibration). As regarding to extra-articular manifestations, the most common was dry mouth and dry eye in all the studied cases followed by itchy skin in 13(52) patient, then joints aches and subcutaneous nodules in 2(8) patient and purpura was seen in only a case.

Conclusion

US has the advantage of early detection of median and ulnar nerves neuropathy and can assess the morphology of median and ulnar nerves and its surroundings. US measurements of median and ulnar nerves have a comparable diagnostic value as a non- invasive and an alternative modality for the evaluation of carpal tunnel syndrome and cubital tunnel syndrome.
Significance of Ultrasound in Assessment of Painful Knee: A Comparative Study to Magnetic Resonance Imaging
Authors: Sayed Ibrahim Nadine Mohamed , Mohamed Fahmy Marwa Ibrahim , EL-Diasty El-Metwaly Shaimaa El-Metwaly
Published: July 2024

Background

Knee pain is one of the most frequent symptoms that bring patients to the hospital. It affects approximately 25% of adults, with an increasing incidence nowadays the pain may result from the muscles, ligaments, tendons, and menisci, from trauma due to non-traumatic injuries like infection, bursitis, osteoarthritis, and tendinitis.

Aim of the Work

Aim of study is to evaluate the role of US in assessment of painful knee compared to conventional MRI sequences as an alternative cost-effective screening modality for an accurate diagnosis.

Patients and Methods

This study is a cross-sectional study was conducted at Ain Shams University Hospitals at Radiology department. Our study included forty patients complaining of acute knee pain from (1 day to 3 months’ duration). The main source of data for this study was the prospectively conducted scans and clinical history of the patients referred to the MRI section of the department of Radiology, Ain Shams University Hospitals at 6 months.

Results

Forty patients complaining of acute knee pain from. Every single one of them went through MRI and US assessments indiscriminately and independently, US succeeded in evaluating soft tissue structures pathologies including knee effusion, meniscal injury (degeneration, tear, and extrusion), MCL, LCL, bursitis. muscle, tendon injury and osteoarthritic changes. aside from the cruciate ligaments. US showed an overall sensitivity of 70.1% and specificity of 99.2% with accuracy of 95.2%. The overall PPV and NPV were 93.1% and 95.5% respectively.

Conclusion

US has proved that it can be used as an alternative cost effective screening modality for patients complaining of acute pain, US has reasonable sensitivity, specificity and accuracy in detecting knee effusion, meniscal injury including degeneration, tear, and extrusion, collateral ligaments, bursitis, baker cyst. Muscle, tendon injury and osteoarthritic changes, with no contraindications it can be used as the first choice in assessment of acute knee pain. MRI can be reserved for further workup if clinically warranted.
Role of Posterior Eye Color Doppler in Assessment of Retinopathic Changes in Long Term Type 2 Diabetic Patients
Authors: Salaheldin Elhosseni Salma Mohamed , Nasr Annie Mohamed , Abo-Elhoda Darwish Pasant Mohamed
Published: July 2024

Background

there have been different results in relation to abnormal ocular hemodynamics in the posterior eye (retrobulbar) vessels of patients with diabetic retinopathy (DR). Detection of early signs of retinopathic changes in long-term diabetic patients is urgently needed.

Aim of the Work

to compare Color Doppler indices of selected posterior eye arteries using Color Doppler sonography in long term type 2 diabetic patients without diagnosed retinopathy and non-diabetic patients.

Patients and Methods

posterior eye grey scale ultrasound and color Doppler were performed in 60 patients aged 40-70 who had been divided into 2 groups: non-diabetic controls (n = 30), long-term non controlled type 2 diabetic patients (n = 30). The peak systolic velocity (PSV), end-diastolic velocity (EDV), and the resistivity index (RI), of the central retinal artery and posterior ciliary arteries were measured.

Results

compared with healthy controls, the age-adjusted resistivity indices, PSV and EDV of the posterior ciliary arteries and central retinal artery were lower in patients with long term type 2 diabetes.

Conclusion

Resistivity index, PSV and EDV alteration of the posterior ciliary arteries and central retinal artery may be prevalent among patients with long term type 2 diabetic patients for prediction of early changes of DR.
Role of Doppler Ultrasound and Triphasic CT in Differentiation between Benign and Malignant Portal Vein Thrombosis
Authors: Abo El Maaty Mohamed Al Ghareib , Said Madkour Sherihan , Tolba Fawzi Mohamed Mohsen , Daood Gerges Amira Mounir
Published: July 2024

Background

Portal vein thrombosis is typically a consequence of cirrhosis that already exists, abdominal malignancy, hypercoagulable conditions, or abdominal inflammation. Imaging techniques are used to identify portal vein thrombosis. Once a thrombus has been identified using ultrasound, Doppler ultrasonography can be used to determine if it is benign or malignant. The following step is contrast-enhanced computed tomography or magnetic resonance angiography if more information is needed. If these tests are insufficient, digital subtraction angiography should be carried out.

Patients and Methods

The study included 40 patients diagnosed by B mode ultrasound to have PVT and referred to the radiology department of the National Hepatology And Tropical Medicine Institute to differentiate between benign and malignant PVT using color Doppler and Triphasic CT.

Results

those 40 patients were classified according to triphasic CT criteria into 17 patients with benign PVT and 23 patients with malignant PVT which all of them had neovascularity and show early arterial enhancement and delayed wash out. Intra-thrombus pulsatile flow by color Doppler was detected in 19 patients with percentage of agreement 80%, sensitivity of 73.9% and specificity of 88.2%.

Conclusion

Color Doppler US considered an effective non invasive tool to differentiate between benign and malignant PVT, but it is an operator dependent which need an expertise to detect the vascularity within the thrombus. But is an easy, low cost, available, no contraindications to be done and no exposure to radiation. Although absence of intra-thrombus vasculature doesn`t exclude the malignant nature of the thrombus, and here come the role of Triphasic CT.
Particles versus Other Embolic Agents in Emergency Renal Artery Embolization, Various Indications And Techniques
Authors: Niazy Gamal , Sherin Wessam , Ali Farahat Said Seleim
Published: July 2024

Background

Renal artery embolization (RAE) refers to the occlusion of the renal artery, or some of its branches, by injection of an embolic agent through an endovascular catheter.

Aim and Objectives

to compare various embolic agents such as metallic microcoils, microspheres (embospheres), polyvinyl alcohol (PVA), gelfoam and histoacryl in emergent indications and techniques for RAE in management of emergency renal diseases.

Subjects and Methods

This combined retrospective and prospective observational study was conducted at Egyptian Military Hospitals, Radiodiagnosis and Intervention departments, and Ain Shams hospitals. The study included 18 patients with clinical and radiological confirmation of symptomatic indications for urgent RAE from 2019 to 2022. The duration of the study was 3 years.

Result

small sample sized and emergent cases showing mean embolization time was 12.6 minutes with no detected recanalization nor post embolic syndrome.

Conclusion

Renal artery embolization has become an effective, versatile therapeutic and adjuvant tool for many urologic conditions, both acute and chronic. It can be applied successfully in improving preoperative management of renal tumors prior to nephrectomy, achieving hemostasis in cases of hemorrhage from trauma or from tumors such as angiomyolipomas, treating complications of renal transplantation and biopsies such as arteriovenous fistulas and pseudoaneurysms, improving symptoms in patients with arteriovenous malformations and certain chronic renal parenchymal diseases, and for treating renal artery aneurysms.
Abbreviated Breast MRI Protocols in the Screening of High-Risk Females
Authors: Chalabi Nivine AbdelMoneim , Shaaban Marwa Adel , Tantawy Salma Hassan , Maher Kotb Nada Mohamed
Published: July 2024

Background

Standard MRI breast more often than not, have lengthy protocols that make them much more expensive and time-consuming. And in spite its great potential for early detection of breast cancer in high-risk females, its wide application remains difficult, therefore the use of abbreviated MRI protocols in breast cancer screening is introduced.

Results

This study was done on high-risk women with a lifetime risk of over 20%. The majority of the examinations were performed on women with previous history of breast cancer (63.3%), while 36.7% had moderate to high family history. An abbreviated protocol was created form the sequences obtained from the full diagnostic protocol, which consisted of a pre-contrast T1, post-contrast T1, subtraction and MIP images. On MRI examination using the conventional protocol, 36% of the women in our study were diagnosed with breast mass lesions, of which 20% were malignant masses. Benign findings, whether mass or non-mass lesions constitutes of a total of 50.1%, and about 26.7% were normal. All the malignant lesions were identified on the abbreviated protocol by the designated reader after review of the clinical history. So, the cancer detection rate in our study using the abbreviated MRI protocols revealed a Kappa agreement test of 1.000, i.e., perfect agreement with the conventional protocols for the participant females.

Conclusion

The use of abbreviated MRI breast is feasible without compromising the cancer detection rate compared to a full protocol. It also achieved a significant reduction in scanning time, interpretation time, and total cost of the study, proving its efficacy and making it a more accessible first line of screening high-risk females.
The Frequency, Patterns and Management of Bacterial Cholangitis in Living-Donor Liver Transplant Recipients with Biliary Complications: A Single Center Study
Authors: Abdel Wahed Ahmed Nagah Bassiony , Kamal Sanaa Moharram , Abdelhakam Sara Mahmoud , Khalil Dabbous Hany Mansour , Kandil Doaa Mahmoud , Mohammed Fahim Noha Alaa eldin
Published: July 2024

Background

Biliary complications are still frequent after liver transplantation especially living donor liver transplantation (LDLT). Bacterial cholangitis is a potentially life-threatening complication. Management is based on antimicrobial therapy and surgical drainage. Bile cultures can play a role in determining the causative agent and optimizing antibiotic therapy.

Aim

We aimed to assess the incidence of bacterial cholangitis among recipients of LDLL, identify the most common bacteria and their antibiotic susceptibility, and evaluate the role of bile culture and endoscopic retrograde cholangiopancreatography (ERCP) in the management of potential biliary infection.

Methods

This study was conducted at Ain Shams Center for Organ Transplantation between February 2019 and April 2022. The study included 39 LDLT recipients who developed post-transplant cholangitis on top of biliary complications. Liver function tests, imaging, ERCP, and blood and bile culture and sensitivity were performed in all patients.

Results

The incidence of biliary complications was 38.2%. Imaging and ERCP findings were consistent regarding the diagnosis of anastomotic stricture. Stones were detected by ERCP in 12 patients when magnetic resonance cholangiopancreatography detected them in only one patient. The most common organism isolated from both bile and blood cultures was E. coli. Antibiotics that matched bile and blood cultures were linezolid, ceftazidime/avibactam, imipenem + cilastatin, and amoxicillin/clavulanic acid. Three bile cultures showed multidrug resistance for combination therapy.

Conclusion

Anastomotic strictures and cholangitis are common complications of LDLT. E coli is the most common organism detected in bile and blood cultures. Therefore, antibiotic selection based on concurrent blood and bile culture interpretation can help optimize therapy.
Comparison between Guy’s Stone Score and S.T.O.N.E. Score System in Predicting Stone Free Rate after PCNL
Authors: Maged Wael Ali , Hassan Ahmed Tawfick , Fahmy Nakhnoukh Tamer El-sayegh
Published: July 2024

Background

PCNL is the gold standard treatment modality of large and complex kidney stones. We compared the stone free status predicting ability of Guy’s stone score and S.T.O.N.E. score system.

Objective

To compare to compare between Guy’s stone score and S.T.O.N.E score system in predicting stone free rate after PCNL.

Patients and Methods

A total number of 40 patients underwent PCNL in the period between December 2021 and May 2022. All cases were evaluated and graded using both Guy score and S.T.O.N.E. score based on preoperative computerized plain ctut. The post operative stone free status was evaluated using post operative plain KUB xray and ctut. Statistical analysis was done to determine relation of the scores with the post-operative stone free status. Also receiver operating characteristics curves (ROC) was drawn and area under the curve was calculated to assess the scores predictability of post-operative stone free status.

Results

The overall stone free rate of our study was 80%. Mean age of study population was 43 years (±SD10.60). we found that stone free patients had lower mean Guy score (2.00 vs 3.38) and lower mean S.T.O.N.E. score (7.84 vs 9.75). both scores had statistically significant relation with stone free status the P value was 0.001 for Guy score and 0.022 for S.T.O.N.E. score. The post operative stone free status predictability of both scores was assessed by drawing receiver operating characteristics curves (ROC) and the area under the curve was calculated by ROC curve. When comparing area under the curve for both scores we found no great difference between guy score and S.T.O.N.E. score (0.867 – 95% CI 0.735-1.000) vs (0.760– 95% CI 0.569-0.951).

Conclusion

The study shows that both Guy score and S.T.O.N.E. score systems have similar predicting ability of post PCNL stone free status with strong correlation with post operative stone free status.
Evaluation of Tamsulosin 0.4 mg versus 0.8 mg in Management of Patients Suffering from Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia
Authors: Al Sayed Tarek Othman , Essam Mohammed Darweesh , Al Saeed Kareem Omar
Published: July 2024

Introduction

Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are common among older men. Beside watchful waiting and surgery, medical therapy includes alpha adrenergic blockers, 5 alpha reductase inhibitors, and phytotherapy. Alpha blockers are considered to be the main treatment for BPH-associated LUTS depending on the evidence that prostatic smooth muscle contraction is responsible for bladder outlet obstruction via alpha adrenergic receptor- mediated mechanism. Tamsulosin is a super selective alpha blocker. Improvement of LUTS can be assessed by maximum flow rate (Qmax), average flow rate (Qavg), post void residual (PVR) urine volume and international prostate symptom score questionnaire (IPSS).

Objectives

To compare the efficacy and the safety of Tamsulosin 0.4 mg/day and 0.8 mg/day in patients suffering from lower urinary tract symptoms due to benign prostatic hyperplasia.

Patients and Methods

A Prospective Interventional, double-blinded, controlled study was carried out on 93 patients who met the criteria and divided randomly into 2 groups; group A for Tamsulosin 0.4 mg/day and group B for Tamsulosin 0.8 mg/day. International prostate symptom score, Post void residual urine volume, and maximum flow rate of urine were assessed before and after 4 weeks of treatment.

Results

Both study groups showed a significant reduction in storage sub-score but only frequency was significantly reduced in group B (P < 0.001). On the other hand, Tamsulosin 0.8 mg was superior to Tamsulosin 0.4 mg regarding voiding sub score except for straining (P = 0.325). Accordingly, the total international prostate symptom score was significantly improved in group B (P < 0.001). Furthermore, maximum flow rate and post-void residual urine volume were notably improved with Tamsulosin 0.8 mg compared to Tamsulosin 0.4 mg (P < 0.001). Although the adverse events; such as headache, orthostatic hypotension, and retrograde ejaculation were more frequent, but not significant, to occur with Tamsulosin 0.8 mg, only dizziness was noted to be significant.

Conclusion

Tamsulosin 0.8 mg has shown better outcomes in treating patients who suffer from lower urinary tract symptoms due to benign prostatic hyperplasia than Tamsulosin 0.4 mg, and besides that, it is well tolerated.
Evaluation of the Role of Preoperative Pharmacological Ureteral Dilatation in Ureteroscopic Stone Surgery
Authors: Kotb Youssef Mahmoud , Hefnawy Ahmed , Ahmed Khaled Adel
Published: July 2024

Background

Urinary stone disease is very common, with an estimated prevalence among the general population of 2% to 3% and an estimated lifetime risk of 1 in 8 for white males and 5% to 6% for white females, with men forming stones three times as often as women.

Aim of the Work

To compare the effectiveness of antispasmodics (hyoscine-N- butylbromide), α-blockers (tamsulosin), placebo as control (in the form of multivitamins), as preoperative medications for ureteral dilatation prior to semirigid ureteroscopic stone surgery.

Patients and Methods

This prospective randomized control clinical study conducted on 90 patients admitted from Urology department, Faculty of Medicine, Ain Shams University hospitals in a period of 6 months starting from March 2022 till September 2022; they were randomized into 3 groups 30 patients per group: Group (A) received Tamsulosin 0.4 mg once daily for 7 days, Group (B) received Hyoscine-N- butylbromide 10 mg three times per day for 7 days, Group (C) received Placebo.

Results

The operation time and the need of double J stent insertion significantly decrease with Tasmulosin or Hyoscine-N-butylbromide versus Placebo. Operative and postoperative complications significantly decrease while using Tamsulosin or Hyoscine- N-butylbromide versus Placebo.

Conclusion

The administration of adjunctive alpha-blockers and/or antispasmodics prior to ureteroscopic management of lower ureteric stones seems to be associated with better advancing of the ureteroscope to access the stone, shorter procedure time, higher stone-free rate, lower incidence of intra- and postoperative complications and lesser need for postoperative analgesia.
Validation of two automatic sphygmomanometers according to the modified International Standardization Organization 81060-2:2018 protocol in adults with a mid-upper arm circumference of 22 centimeters or less
Authors: Posokhov Igor N. , Praskurnichiy Evgeny A. , Orlova Olga S. , Sukhodolova Ekaterina A. , Lystseva Aleksandra V.
Published: July 2024

Objective

A recent International Organization for Standardization (ISO) Task Group report calls for research to investingate potential special populations in validation studies of automated blood pressure (BP) devices. Accordingly, we aimed to determine the accuracy of two previously validated BP monitors passed in a general population when measured in adults with a mid-upper arm circumference (MUAC) ≤ 22 cm.

Methods

Test device A was the OMRON HEM 7121 equipped with the HEM CS24 cuff designed for an arm circumference of 17–22 cm. Test device B was the YuWell YE660Е with the YuWell ‘360°’ cuff (18–36 cm). Data from 37 participants aged 20.14 ± 2.23 (18–28) years were analyzed according to criterion 1 of ISO Standard 81060-2 : 2018.

Results

According to criterion 1, the mean ± SD of the BP differences for the device A was −7.81 ± 5.20/−10.66 ± 5.48 mmHg (systolic/diastolic) and for the device B was −8.00 ± 6.30/−16.11 ± 5.15 mmHg (systolic/diastolic), respectively. This means that neither device met the requirements.

Conclusion

Since devices A and B, which had passed in a general population study, failed in adults aged 18–28 years with an MUAC ≤ 22 cm, such individuals might be considered as new special population for validation studies.
Anatomical Comparison of Endoscopic and Microscopic Exposure of the Petroclinal Core Area Through the Extended Middle Skull Base Approach
Authors: Sun Guoqing , Wang Hu , Shang Yanguo , Shi Minggang , Wang Xuan , Tong Xiaoguang
Published: July 2024

Objective:

To compare the range of endoscopic and microscopic exposure of the petroclival core area through the middle skull base and to observe the corresponding anatomical structures.

Methods:

Ten intact adult cadaveric head specimens fixed with formaldehyde were craniotomized through an expanded middle skull base epidural approach on 20 sides. The distance from the greater superficial petrosal nerve to the petrous ridge was measured. When different degrees (1–3 degrees) of the Kawase triangle bone were removed, the exposed anatomical structure was observed, and the exposed core area of the rock slope was measured under an endoscope and microscope.

Results:

The average distance from the greater superficial petrosal nerve to the petrous ridge was 14.26 mm. During 1 to 2 degrees of bone removal, the petrous segment of the internal carotid artery (ICA) was not exposed, whereas during 3 degrees of bone removal, the petrous segment of the ICA was exposed. At 1 degree of bone removal, 400.62 ± 15.73 mm2 of the area was exposed by endoscopy and 170.87 ± 8.93 mm2 by microscopy, and the abducens nerve was not exposed. However, there was a significant difference between the two areas (P < 0.001). During 2 degrees of bone removal, 689.30 ± 32.06 mm2 of the abducens nerve was exposed by endoscopy, but 366.84 ± 30.30 mm2 of the abducens nerve could not be exposed by microscopy; moreover, there was a significant difference in the area of exposure between the two (P < 0.001). At 3 degrees of bone removal, the endoscopic exposure area was 875.92 ± 31.87 mm2, the microscopic exposure area was 699.26 ± 48.00 mm2, and the abducens nerves were exposed. There were significant differences between the two areas (P < 0.001). However, the difference between the 2-degree endoscopic exposure area and the 3-degree microscopic exposure area was studied by using paired t tests, and there was no difference (P > 0.05).

Conclusion:

When the same degree of the Kawase triangle bone was removed, the extent of endoscopic exposure of the petroclival core area was significantly greater than the extent of microscopic exposure. At 2 degrees of bone removal, an endoscopic application can maximally expose the petroclival core area, thus reducing the probability of exposure damage to the ICA and abductor nerve.
Healthcare Students' Experiences of Learner-Educator Cocreation of Virtual Simulations
Authors: Killam Laura A. , Åkerlind Gerlese S. , Lock Mercedes , Camargo-Plazas Pilar , Luctkar-Flude Marian
Published: July 2024

Introduction

Cocreating virtual simulations with learners during a course is an innovative approach to improving student preparation for real-world practice while helping simulationists meet learner needs, support authentic assessment, and maximize the impact of simulation-based learning. This study explores differences in healthcare students' experiences of learner-educator cocreation of virtual simulations (LECoVSs) using phenomenographic methods. Identifying differences in perceptions of LECoVSs enables educators to make evidence-informed decisions about engaging in simulation cocreation as a tool to maximize learning.

Methods

Phenomenography focuses on identifying different ways that participants can experience the same phenomenon, in this case, LECoVSs. The setting was a collaborative interprofessional simulation assignment between navigation and nursing students. Participants completed a demographic survey then submitted reflective journals completed during the course and/or an open-ended survey. Data analysis occurred in iterative stages, from familiarization with the data to grouping and interpreting themes.

Results

Nineteen open-ended surveys and 13 reflective journals from navigation and nursing students who completed the simulation assignment between 2021 and 2023 were analyzed. Students experienced LECoVSs in 4 increasingly complex ways: (1) supporting consistent student progress, (2) amending course expectations, (3) sharing decision-making, and (4) fostering mutual growth.

Conclusions

Simulationists may leverage cocreation to improve student learning, access, empowerment, and professional growth. However, for students to achieve higher learning outcomes, educators need to clearly communicate the full potential of cocreation, how it can occur, and why it can support learning. This study's findings may be used as a framework for explaining simulation cocreation to students to maximize their learning.
Catch me if you can: free-living mice show a highly flexible dodging behaviour suggestive of intentional tactical deception
Authors: d'­Isa Raffaele , Parsons Michael H. , Chrzanowski Marcin , Bebas Piotr , Stryjek Rafal
Published: July 2024

Intentional tactical deception, the employment of a tactic to intentionally deceive another animal, is a complex behaviour based on higher-order cognition, that has rarely been documented outside of primates and corvids. New laboratory-to-field assays, however, provide the opportunity to investigate such behaviour among free-living mice. In the present study, we placed laboratory-style test chambers with a single entrance near a forest outside Warsaw, where we observed the social interactions of two territorial murids, black-striped and yellow-necked mice, under food competition for seven months. Notably, among the social interactions, we video-recorded 21 instances of deceptive pursuer evasion. In the most obvious cases, an individual inside the chamber, to avoid an incoming mouse, hid by the chamber opening (the only means to enter or exit), paused until the pursuer entered and passed by, and then exploited the distraction of the back-turned pursuer by fleeing through the opening in a direction opposite to the one the pursuer came from. This deceptive dodging is the first evidence of a behaviour suggestive of intentional tactical deception among mice. As such, this deceptive behaviour may be of interest not only for rodent psychology but also, more generally, for the fields of non-human intentionality and theory of mind.
ICTV Virus Taxonomy Profile: Turriviridae 2024
Authors: Chase Sydnie K. , Snyder Jamie C.
Published: July 2024

The family Turriviridae includes viruses with a dsDNA genome of 16–17 kbp. Virions are spherical with a diameter of approximately 75 nm and comprise a host-derived internal lipid membrane surrounded by a proteinaceous capsid shell. Members of the family Turriviridae infect extremophilic archaea of the genera Sulfolobus and Saccharolobus. Viral infection results in cell lysis for Sulfolobus turreted icosahedral virus 1 infection but other members of the family can be temperate. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the family Turriviridae, which is available at ictv.global/report/turriviridae.
The role of N-acetylcysteine on adhesion and biofilm formation of Candida parapsilosis isolated from catheter-related candidemia
Authors: Zuo Xiao-shu , Wang Qian-yu , Wang Sha-sha , Li Guang , Zhan Li-ying
Published: July 2024

Objectives. Anti-fungal agents are increasingly becoming less effective due to the development of resistance. In addition, it is difficult to treat Candida organisms that form biofilms due to a lack of ability of drugs to penetrate the biofilms. We are attempting to assess the effect of a new therapeutic agent, N-acetylcysteine (NAC), on adhesion and biofilm formation in Candida parapsilosis clinical strains. Meanwhile, to detect the transcription level changes of adhesion and biofilm formation-associated genes (CpALS6, CpALS7, CpEFG1 and CpBCR1) when administrated with NAC in C. parapsilosis strains, furthermore, to explore the mechanism of drug interference on biofilms.

Hypothesis/Gap statement. N-acetylcysteine (NAC) exhibits certain inhibitory effects on adhesion and biofilm formation in C. parapsilosis clinical strains from CRBSIs through: (1) down-regulating the expression of the CpEFG1 gene, making it a highly potential candidate for the treatment of C. parapsilosis catheter-related bloodstream infections (CRBSIs), (2) regulating the metabolism and biofilm -forming factors of cell structure.

Methods. To determine whether non-antifungal agents can exhibit inhibitory effects on adhesion, amounts of total biofilm formation and metabolic activities of C. parapsilosis isolates from candidemia patients, NAC was added to the yeast suspensions at different concentrations, respectively. Reverse transcription was used to detect the transcriptional levels of adhesion-related genes (CpALS6 and CpALS7) and biofilm formation-related factors (CpEFG1 and CpBCR1) in the BCR1 knockout strain, CP7 and CP5 clinical strains in the presence of NAC. To further explore the mechanism of NAC on the biofilms of C. parapsilosis, RNA sequencing was used to calculate gene expression, comparing the differences among samples. Gene Ontology (GO) enrichment analysis helps to illustrate the difference between two particular samples on functional levels.

Results. A high concentration of NAC reduces the total amount of biofilm formation in C. parapsilosis. Following co-incubation with NAC, the expression of CpEFG1 in both CP7 and CP5 clinical strains decreased, while there were no significant changes in the transcriptional levels of CpBCR1 compared with the untreated strain. GO enrichment analysis showed that the metabolism and biofilm-forming factors of cell structure were all regulated after NAC intervention.

Conclusions. The non-antifungal agent NAC exhibits certain inhibitory effects on clinical isolate biofilm formation by down-regulating the expression of the CpEFG1 gene, making it a highly potential candidate for the treatment of C. parapsilosis catheter-related bloodstream infections.