bluuebunny/crossref_metadata_2025 huggingface dataset:
Alloimmunization in Egyptian Children with Sickle Cell Disease
Authors: Elalfy Mohsen Saleh , Kenny Mahmoud Adel , Saed Fatima Zahrra Abdelkarim , Ebeid Fatma Soliman Elsayed
Published: October 2021

Background

Transfusion is critical in the management of sickle cell disease (SCD) complications. The resultant alloimmunization to RBC group antigens is a major complication of allogeneic blood transfusion and generally presents significant challenges in the management of SCD patients.

Aim

To measure the frequency of the occurrence of the alloimmune markers in sickle cell disease and to investigate its predicators.

Subjects and methods

This cross-sectional study included 50 children and young adults with SCD, all patients were subjected to detailed medical history thorough clinical examination. Laboratory investigations included complete blood count, markers of hemolysis and serum ferritin. The D, C, c, E, e, M, NJKa and JKb antigens were typed using monoclonal antisera. Fya, Fyb, Jka, Jkb, S, s and Anti Lua antigens were typed by commercially prepared polyclonal anti- human sera. Antibody screening was performed using Ortho screening panel.

Results

The study Sickle SS was the most common type of SCD representing more than half of the recruited patients. Frequency of antibody positive screening among SCD was 16%. Comparison between SCD patients with positive and those with negative antibody screening showed that higher frequency of positive antibody screening in those with SB+ than those SS and SB0. Patient with positive antibodies screening were significantly older when they received their first blood transfusion and had lower transfusion index (p = 0.037) than those with negative antibodies screening (p=0.013). There were no significant difference between patients with positive and those with negative antibodies screening as regards age, gender, transfusion frequency and as regards comorbidities; painful crisis (p=0.117), stroke (p=0.398), ACS (p=0.363).

Conclusion

The distribution of the blood group antigens in patients with SCD has important clinical significance especially those who often require regular blood transfusion and who may have developed multiple antibodies. The resultant alloimmunization is serious necessitates early recognition and management.
Evaluation of brain iron content in Egyptian Patients with Sickle cell disease and its impact on Neurocognitive functions
Authors: Elalfy Mohsen Saleh , Ebeid Fatma Soliman Elsayed , Ibrahim Mohammed Ahmed Samir , Hussein Hanaa Midhat Abdel Gader
Published: October 2021

Background

Sickle cell disease (SCD) is considered the most prevalent monogenic diseases worldwide. Iron overload is one of the major complications in those patients, especially who in need for frequent transfusion, affecting many organs including the brain. MRI is a valuable, reliable and non-invasive method for quantifying iron concentration in many organs as the liver and heart and it is now used for monitoring of the chelation therapy in SCD patients. Several studies began reporting differences in global cognitive function, particularly for children with SCD, they are at a high risk for neurocognitive impairment they often scored lower on general IQ measures than healthy children which is due to iron overload in brain tissue from the chronic transfusions which can lead to strokes and may be a silent stroke.

Objective

The current study assessed brain iron content (using R2* values) in the caudate and thalamic regions through quantitative brain MRI study in SCD patients in comparison to age and sex-matched healthy controls.

Methods

A case-control study recruited 32 patients with SCD and 11 healthy controls. Brain MRI study using multi-echo fast gradient echo sequence was done for all the patients and controls. Brain R2* values of both caudate and thalamic regions (right and left sides) were calculated for only 15 SCD patients and the 11 controls. All recruited SCD patients and controls were examined for the neurocognitive functions by these tests: Wechsler IV Intelligence Scale for Adult shows (Verbal, Perceptual, Memory, Processing and Total IQ), their all normal values between 90 – 110. Benton Visual Retention Test have cut of point at (> 4 or = 4). Those values are the same for the difference between the obtained correct and the expected correct, and the difference between the obtained error and expected error.

Results

The fifteen patient with SCD who underwent brain MRI were age and sex matched with the eleven healthy control (15 SCD patients: mean-age: 16.93 ± 3.41 years, 40.6% females and 11healthy controls: mean age: 18.73 ± 4.84 years, 54.5% females) were enrolled in the study. As regards the brain MRI, there was no statistically significant differences between SCD and control group in all regions of interests (p > 0.05). Our study showed that 72.7% of our SCD patients had under threshold TIQ scores. Also18% of the patients showed moderate anxiety, 9% mild anxiety and 9% showed severe anxiety.

Conclusion

The results of our study showed that even in cases of iron overload which affects vital organs as the liver, cardiac and brain iron overload don't occur.
Neurodevelopmental Outcomes after Neonatal Mechanical Ventilation
Authors: Zaky Eman Ahmed , Shaaban Hebatallah AM , Dawoud Mohamed OA , Madbouly Kareem SEF , Deifalla Shaymaa M
Published: October 2021

Background

A majority of extremely preterm infants are treated with mechanical ventilation, which is associated with an increased risk for future development of chronic lung disease, neonatal brain damage, and neurodevelopmental impairments.

Objectives

The aim of the current study was to evaluate the current and follow up neurodevelopmental status of an Egyptian sample of newly and previously discharged mechanically ventilated infants following them up for a period of 6 months for the earlier group and a year for the latter.

Patients and Methods

The current study was designed to be a descriptive study with retrospective (50 infants) and prospective (50 infants) domains. It was carried out on 100 neonates who were recruited from the Pediatric Neonatology Clinic, Children's Hospital and Neonatal Intensive Care Unit, Ain Shams University using clinical evaluation, Bayley Scales of Infant Development, and Childhood Autism Rating Scale (CARS)..

Results

There was statistically significant negative correlation between CARS score and Bayley Scale by using Composite Score (Cognitive, Language and Motor) on first assessment and follow up in the Prospective group while no correlation was found in the retrospective group. The study results showed that there was no statistical significant difference between two groups as regards gestational age, gender, residency, consanguinity, maternal disease, maturity, mode of delivery, respiratory distress, duration of stay in NICU, duration on mechanical ventilation, weight on admission, audiometry and fundus examination (P > 0.05).

Conclusion

Using a mechanical ventilator in the neonatal period for a prolonged duration increased the risk for ASD and neurodevelopmental delay. Future studies on large samples are recommended from multicenters to confirm the validity of such findings, Bayley scale is a predicative for neurodevelopmental delay in neonates with long duration stay at NICU especially preterms with low birth weight.
A Study of the Prognostic Value of Initial EEG in Children with Acute Encephalitis
Authors: Hassanein Sahar Mohamed Ahmed , Ahmed Ahmed Rezk , Zaitoun Raghda Mohamed Hesham , El-Kodous Marina Gamal Alfy Abd
Published: October 2021

Objective

to assess the short-term prognostic aid of the initial Electroencephalography (EEG) in patients with acute viral encephalitis.

Methods

An observational follow up study including 30 children with acute non-herpetic viral encephalitis. Cases were subjected to full history taking, examination and an EEG recording obtained during hospital admission. Functional outcome assessment was done using the Liverpool outcome score during admission and repeated again at 3 months post discharge.

Results

The mean age of patients was 2.8 ±3.5 years old, with ages ranging from 6 months to 15 years. 73% of the cases were male. Clinical seizures were observed in 96.7% of the cases and EEG was abnormal in 26.7%. The Liverpool outcome scores were significantly lower at discharge and even more so after 3 months in cases with epileptiform activity on EEG. Abnormalities of EEG background did not significantly impact the Liverpool outcome score of the patients.

Conclusion

The presence of EEG epileptiform discharges is associated with a worse clinical outcome in children with acute encephalitis. The same cannot be said for abnormalities of EEG background.
QTc interval in Acute Severe Asthma
Authors: Kotby A A , El sayed M , Selim M K
Published: October 2021

Background

Prolonged QTc interval in children may be congenital or acquired. It could be fatal if it induces tachyarrhythmias and cardiac arrest.

Objectives

This work studied the QTc interval in acute asthma attacks and its relation to the severity of the attack and the bronchodilators used.

Patients and Methods

This is a descriptive prospective study of 30 children with moderate and severe asthma. Patients were divided according to GINA guidelines 2016: Group 1:10 patients with moderate acute attack, Group Il: 20 patients with severe acute attack. 12 lead ECG was done before start of medication, then repeated daily till discharge. QTc interval measured in lead V5 using Bazett Formula was considered prolonged if > 445msec.

Results

Our study showed that 4 patients (13%) developed prolonged QTc interval; 3 (75%) had severe attack and one (25%) had moderate attack. QTc interval increased with number of bronchodilators used, but not reaching statistical significance. On day2, QTc was 340—435msec in patients on 2 medications and 350—460msec in patients on 3 medications. However, on 3rd day QTc interval was between 348-410msec,346—420msec,350—446msec in patients having 1, 2, 3 medications respectively. Also, there was no relation between theophylline and prolonged QTc interval.

Conclusion

Prolonged QTc interval can occur in 13% of children with moderate and severe asthma. QTc interval increased with number of bronchodilators used yet not reaching statistical significance. Bronchodilators must be used judiciously since they might be potentially arrhythmogenic drugs that induce fatal arrhythmia .
Association between Maternal and Neonatal Vitamin D status and the Development of Congenital Anomalies
Authors: EL Barbay Mohamed N , Abd El Maksoud Sahar S , Mohamed Suzan A
Published: October 2021

Background

Vitamin D (VD) is a remarkable problem during pregnancy. VD plays a crucial role in cellular growth and differentiation during embryogenesis. VD deficiency in pregnancy is associated with various maternal and neonatal comorbidities. In this study, we aimed to evaluate the potential association between maternal and neonatal vitamin D status and the subsequent development of congenital anomalies.

Patients and methods

A case-control study involving 30 mothers and their neonates born with gross structural congenital anomalies as cases and 30 mothers and their healthy neonates as controls recruited from Ain Shams University Children Hospital. Maternal and Neonatal blood samples were obtained to determine serum 25hydroxyvitamin D. The 25-hydroxyvitamin D concentration was stratified into a severe deficient<10ng/ml, deficient <20ng/ml, insufficient 20-29ng/ml and sufficient >30ng/ml. Status above 150ng/ml presents high risk of toxicity.

Results

There were statistically significant differences between the two groups regarding maternal and neonatal vitamin D serum level within 29 days postpartum. Mean maternal vitamin D level in cases was 23.8ng/ml versus 42.13ng/ml in controls (P = 0,000). Mean neonatal vitamin D level in cases was 15.97ng/ml versus 28.9ng/ml in controls (P = 0,000).There was significant positive correlation between both maternal and neonatal vitamin D level with birth weight.

Conclusion

A compromised maternal vitamin D status is associated with an increased prevalence of congenital anomalies in offspring. Therefore, improvement of the periconceptional maternal vitamin D status is recommended.
Effect of Melatonin on Feeding Intolerance and Incidence of Necrotizing Enterocolitis in Preterm Infants
Authors: Awad Hisham A , El-Farghali Ola G , Shaaban Hebatallah A , El-Gammall Mona M
Published: October 2021

Background

Necrotizing enterocolitis (NEC) is one of the most dangerous gastrointestinal diseases that affects neonates especially preterm neonates. It is considered one of the oxygen radical diseases of neonatology as it is attributed to accumulation of reactive oxygen species (ROS) and free radicals leading to cellular oxidative damage. Melatonin proved to be an effective antioxidant and free radical scavenger with no documented side effects.

Objective

We aimed to evaluate the efficacy and safety of melatonin as adjuvant therapy in feeding intolerance and prophylaxis against NEC.

Methods

This was an interventional trial conducted on 90 preterm neonates with feeding intolerance. They were simply randomized to Group I that received melatonin treatment (n = 45) and Group II that received traditional treatment only (n = 45). Melatonin was administered at a total dose of 20 mg enterally in two divided doses of 10 mg each, 1 h apart. Tumor necrosis factor alpha (TNFα) level was assessed in patients 72 hours after starting treatment and both groups were observed for incidence of NEC, clinical improvement of feeding intolerance and time needed to reach full intake.

Results

Group I reported significantly less incidence of NEC in Group I treated with melatonin. Improved tolerance to feeds was observed in Group I resulting in earlier achievement of full enteral intake. Significantly higher levels of TNF alpha were found in Group II that received traditional treatment, indicative of higher level of oxidative stress and free radicals.

Conclusion

Melatonin in an effective and safe antioxidant and free radical scavenger associated with improvement of clinical and laboratory data in preterm infants with feeding intolerance and significantly less incidence of NEC.
Developmental Care Implementation on preterm neonates in Ain Shams University Pediatric Hospitals: An interventional study
Authors: Gad Ghada Ibrahim , El Kholy Nour El Eman Magd El Deen Menchawy , Rabie Dina Essam Abd El Hamid
Published: October 2021

Introduction

Developmental care is an approach to individualize care of infants to maximize neurological development and reduce long term cognitive and behavioral problems which may result from the stressful experience in the neonatal intensive care units like neonatal exposure to loud noise, bright light, heel pricking, orogastric suction and endotracheal intubation. It includes minimizing exposure to noise, light, proper skin to skin contact or kangaroo care, proper positioning, applying clustering of care and non-nutritive suckling.

Objectives

To study developmental care implementation and its relation to time to achieve full feed, length of hospital stay, amount of feeding, incidence of IVH, NEC & ROP, and consequently death in preterm neonates admitted to NICU.

Patients and methods

A Double arm randomized controlled clinical trial, care application, carried out on 60 preterms in the Neonatal Intensive Care Unit, Children's Hospital, Ain Shams university. Inclusion criteria of Developmental care group & controls (conventional care group) was; gestational age 29-36 week, no major congenital anomalies, and no pharmacological analgesics nor sedation were received before enrollment in the study. N-PASS (neonatal pain agitation sedation scale) and NISS (neonatal infant stressor scale) scores were assessed in both groups before and after developmental care implementation on developmental care group and conventional care application in conventional care group.

Results

N-PASS & NISS scores were decreased significantly with developmental care application, developmental care implementation resulted in a significant decrease in time to achieve full feed & length of hospital stay, there was a tendency to a decrease in incidence & grading of IVH, NEC & ROP, and consequently death in developmental care group compared to conventional care group.

Conclusion

Application of developmental care measures to NICU admitted preterm babies minimizes neonatal pain, stress, helps reaching amount of full feeding in a shorter time, with an increase in neonatal weight gain & a decrease in length of hospital stay.
Selection of children with drug resistant epilepsy who are candidates for epilepsy surgery: pre and post-operative evaluation
Authors: El Sharkawy Osama Salah Mohamed , El kabbany Zeinab Anwar , Younis Neveen Tawakol , Ahmad Khaled Aboulfotouh , Mahmoud Ahmed Darwish , Shata Mennatallah Osama
Published: October 2021

Objective

To select patients with drug resistant epilepsy following up in Pediatrics Neurology Outpatient Clinic of Children's Hospital, Ain Shams University who are candidates for epilepsy surgery and to detect outcome of epilepsy surgery in such children as regards seizures control.

Methods

This prospective study was conducted over a period of 36 months and comprises of 3 stages. Stage 1 includes selection of candidates for epilepsy surgery and preoperative evaluation. Evaluation included clinical assessment, video EEG, MRI epilepsy protocol. Stage 2 include surgery phase where decision of surgery was made by a multidisciplinary team. Stage 3 includes post-operative evaluation as regards Seizures frequency, Seizures Severity using Chalfont score, Engel Epilepsy Surgery Outcome Scale and the International League Against Epilepsy (ILAE) outcome classification. Data was tabulated and analyzed with SSPS package for windows.

Results

17 patients underwent epilepsy surgery. Results revealed significant decrease in seizures frequency and severity at 6 and 12 months after surgery. As regards Engel Epilepsy Surgery Outcome Scale 11 (64.7%) patients were class I at 12 months. As regards the ILAE outcome classification 10 (58.8%) patients are class 1 at 12 months.

Conclusions

epilepsy surgery can be a hope for patients with drug resistant epilepsy who are well selected and evaluated preoperatively. New studies on larger number and for longer duration are recommended.
Screening for Celiac Disease in Newly Diagnosed Children with Type I Diabetes
Authors: El Samahy M H , Thabet RA , Ragab DA , Ibrahim SI
Published: October 2021

Background

Type I diabetes (T1D) is an autoimmune disease caused by the immune-mediated destruction of insulin-producing pancreatic β cells.. Celiac disease is 5-7 percent more common in people with T1D than in the general population.

Objectives

The aim of this study was to detect the incidence of coeliac disease among newly diagnosed T1D children by assessment of Anti-tissue Transglutaminase Antibody (anti-tTG), IgA.

Methods

Fifty children with newly diagnosed T1D and another 15 age and sex –matched healthy individuals were subjected to screening for celiac disease by measuring total body IgA and antiTtg(IgA).

Results

the incidence of positive anti tTG(IgA) Ab among our T1D patients was found to be 12%. Upon comparing children with positive anti tTG(IgA) Ab with those with negative anti tTG(IgA) Ab we found that children with +ve anti tTG(IgA) Ab were significantly shorter than those with -ve anti tTG(IgA) Ab(p < 0.05). Also HbA1c among our diabetic children with +ve anti tTG(IgA) Ab was significantly higher than those with -ve anti tTG(IgA) (p < 0.05). Gastrointestinal manifestations were significantly higher among T1D patients with anti tTG (IgA)+ve than those with anti tTG(IgA)- ve.(p < 0.001).

Conclusion

Anti tTG(IgA) Ab levels are elevated in children and adolescents with type 1 diabetes compared with healthy controls with incidence rate of about 12%. Anti tTG(IgA) Ab test can be used as screening test for celiac disease among type1 DM.
Potential Therapeutic Effects of Ursodeoxycholic Acid in Comparison to Ramipril in a Rat model of Diabetic Nephropathy
Authors: Elsheemy Maha Safwat Abd-elrahman , Elmelegy Ahmed Abdel-Salam M , Elaziz Lobna Fouad Abd , El hefnawy Nadia Galal M , El shaer Mohammad Mahmoud , Sedky Amina Ahmed
Published: October 2021

Background & Aim

Diabetic nephrectomy (DN) is a chronic progressive disorder that complicates long standing diabetes. Albuminuria is a prominent clinical feature of DN. Ursodeoxycholic acid (UDCA) is a physiologic hydrodrophillic bile acid that is therapeutically used in the treatment of primary biliary cirrhosis. It is known to alleviate endoplasmic reticulum (ER) stress in podocytes. In comparison to Ramipril as a standard ACEI therapy of DN, the present study was designed to investigate the effect of UDCA treatment on DN in association with renal biomarkers changes.

Method

Four groups of male Wister rats (6 per group) were designed; Normal control group, DN untreated group (High fat diet + STZ injection of 45 mg/kg + uninephrectomy), DN/Ramipril group; (1 mg/kg/d orally for 12 weeks) and DN/UDCA group (40 mg/kg/d orally for 12 weeks).

Results

DN rats treated with UDCA for 12 weeks exhibited significant decrease in ER stress marker, ATF6 with mean percentage value of 73.8% and improvement of podocyte structural deformities that is accompanied by a significant reduction in albuminuria by mean percentage value of 43.8% comparatively to Ramipril that caused reduction in ATF6 level with mean percentage value of 65.5% and reduction in albuminuria by mean percentage value of 50.2%. The remarkable improvement in metabolic profile and the neutral effect on blood pressure in UDCA treated group could explain the renoprotection at histopathological basis rather than the proved hemodynamic effect of ramipril.

Conclusion

Participation of ER stressmediated apoptosis in the pathophysiology of diabetic nephropathy make the UDCA a potential therapeutic option or add-on therapy due to its anti-apoptotic property apart from classic metabolic and hemodynamic aspects.
A Comparative Study of Surgical versus Medical Management of Cases of First Trimesteric Missed Abortion
Authors: Harb Hesham Mahmoud , Mansour Dina Yahia , Sayed AbdelRhman Badawi Lethi
Published: October 2021

Background

Missed abortion is a common obstetric problem constitutes approximately 15% of clinically diagnosed pregnancies and it was reported that about 80% of early pregnancy loss occurs in the first trimester. Missed abortion can be managed expectantly, surgically and medically. Surgical evacuation is the standard treatment for missed abortion with around 95% success rate and it had been widely performed all over the world in the last five decades, there are some complications associated with surgery such as higher cost, infection and bleeding. Medical management might be more suitable instead of surgical evacuation, it may be less costly than surgical treatment and consequently due to its lower complications most patients prefer it.

Objective

To compare the efficacy, safety and patient satisfaction of medical treatment of 1st trimestric missed abortion using misoprostol versus surgical evacuation.

Patients and Methods

Types of study: Randomized controlled open labelled clinical trial. Study setting: Maternity hospital, Ain Shams University. Study period: For six months from 1st of March 2019 to 31st of August 2019.

Results

The study shows no significant differences were found between groups regarding systolic blood pressure, diastolic blood pressure, pulse rate and body temperature before and after treatment. The results also show that occurrence of abdominal pain was frequent in both groups but, with no significant difference between groups but time needed to induce abortion was significantly higher in medical management group compared to surgical management one.

Conclusion

Medical management is found to be as effective as surgical management in the 1st trimesteric missed abortion, by using Misoprostol.
Sildenafil Citrate adjuvant Ovulation Induction Therapy with Clomiphen Citrate in Polycystic Ovarian Syndrome for Successful Ovulation; Cross-Over, Randomized Controlled Trial
Authors: Abbas Mustafa M , Fattah Ihab H. Abdel , Kolaib Magdy H , Mohammed Walid E , Salman Mohammed M
Published: October 2021

Background

Sildenafil Citrate (Respatio® 20 mg) as an adjuvant therapy in induction of ovulation along with Clomiphen Citrate (Clomid ®), is settled to enhance the endometrial receptivity through enhancing endometrial thickness and echogenicity. Yet, the exact role of Sildenafil in ovulation itself is still under study assuming that through increasing ovarian blood flow as a part of pelvic blood flow, will enhance the ovulation measured by the number and diameter of the growing follicles.

Aim of the Work

The aim of this study is to evaluate the efficacy of sildenafil citrate on the ovulation in PCOS women undergoing induction of ovulation using clomiphene citrate.

Patients and Methods

The current study was conducted in Ain Shams University Maternity Hospital- Infertility outpatient clinic during the period between January 2018 and December 2019. It included a total number of 595 patients who either were assessed for eligibility of the study, of which, 141 were excluded due to non-matching inclusion criteria or had exclusion criteria. 22 patients did not consent to participate in the study432 patients were matched, randomized and allocated to the two groups of the study each with 216 and received induction of ovulation according to the protocol of the study with either Clomiphen Citrate and Sildenafil Citrate or Clomiphen Citrate only, then they were followed up for 3 months. Those who didn't get pregnant given 2 months with no induction to wash over the effect and croos over the groups was done and followed up for another 3 months.

Results

Pregnancy test was positive in 39.8% in Clomiphen/Sildenafil group compared to just 30.1% in Clomiphen group. The patients that did not have positive pregnancy test in the first three months, have a rest for 2 months and then cross over of the groups took place. 145 patients shifted to Clomiphen/ Sildenafil protocol while 126 patients shifted to Clomiphen protocol and follow up for 3 months again and positive pregnancy test was 38% and 25% in the two groups in order.

Conclusion

using sildenafil citrate in patients with PCO syndrome undergoing induction of ovulation increases the chemical and clinical pregnancy rates through not only increasing the endometrial thickness and improving the endometrial pattern with improving the endometrial Doppler indices but also improving the ovulation by improving the ovarian arteries Doppler indices as well.
Therapeutic Effect of Vitamin D3 Supplementation to Clomiphene Citrate Resistant PCOS Women: A Randomized Controlled Trial
Authors: Hashaad Ahmed Mohamed Nour El-Din , Ghanem Reda Mokhtar Kamal , Dawoud Sara Abouelfath Abouelasrar Gad
Published: October 2021

Background

Polycystic ovary syndrome (PCOS) is considered one of the most common endocrine disorders affecting females in their reproductive age. In PCOS, an imbalance between androgens, anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH), cause a halt of follicular growth. Insulin resistance (IR) is another important component of PCOS. There is increasing evidence that vitamin D affects insulin and glucose metabolism, Vitamin D plays a vital role in the regulation of glucose-insulin homeostasis.

Objectives

to assess the efficacy of vitamin D supplementation in improving ovulation induction in PCOS women (1ry outcome) and increasing pregnancy rate (secondary outcome).

Patients and Methods

120 women diagnosed PCOS according to Rotterdam criteria and were resistant to CC treatment were randomly allocated into equal two groups: Group V: number of 60 patients received cholecalciferol + Metformin for 2 months. Group C: 60 patients received Metformin 2 months. After two months from the start:Both study groups started induction with Clomiphene Citrate added every month starting from the 3rd month to the 5th month (3 cycles of ovulation induction) in addition to previous drugs mentioned.

Results

In our study results, regulation of menstrual cycle occured in 63.6% of women who recieved vitamin D + metformin (group V) and ovulation was confirmed in 34.5% of the total number (55 women). Later, 18% of them got pregnant after 3 months of treatment. Added to that 16 women out of 39 (41%) got pregnant by the end of the follow up period with cumulative pregnancy rate (53%). On the other hand menstrual regularity in (group C: metformin) recorded 61% with ovulation percentage of 26.9% (n = 54). Followed by 14.8% pregnancy rate at the 3rd month., which increased to 27.5% by the end of the study out of 47.5% ovulated women (n = 40). Cumulative pregnancy rate 40%.

Conclusion

From the current study we can conclude that there is no significant difference of adding vitamin D to CC resistant PCOS regarding ovulation and pregnancy rates. However, it can augment metformin action and improves its outcome.
Methotrexate induced lung diseases in rheumatoid arthritis patients
Authors: Zaki Mohamed Gamal , El Yasaky Ahmad Mohamed , El Hilaly Rana Ahmed , Mostafa Mayada Taha
Published: October 2021

Background

Rheumatoid arthritis (RA) is a progressive, systemic autoimmune disorder characterized by articular and extra-articular manifestations. The lung is commonly a site of extra-articular disease. The lung manifestations of RA vary and may include airways, parenchymal, vascular, and pleural disease. Manifestations of lung disease in RA typically follow the development of articular disease. Methotrexate (MTX)has shown efficacy for the treatment of several diseases, especially RA.

Methotrexate has also been implicated as a causative agent in interstitial lung disease.

Objective

to find any association between MTX intake and lung abnormalities in RA patients.

Patients and Methods

This study included sixty adult RA patients, recruited from Ain Shams University Hospitals. Patients were divided into thirty patients on MTX therapy, and another thirty patients on non-methotrexate therapy. All underwent history, clinical examination, chest examination, evaluation of RA by modified disease activity score 28 (DAS 28) and pulmonary function tests(PFT).

Results

The age of patients receiving MTX ranged from 35-65 years and the non-MTX group was 35-57 years with a mean ±SD of 47.733±5.265 and 40.700 ±5.187, respectively. Male to female ratio of MTX group was about 1:3, while Non MTX group was about 1:9.There was no significant difference regarding age and sex. There was no difference between both group regarding modified DAS score and chest manifestations. There was no difference in PFT findings between patients on high or low dose of MTX therapy .Similarly, no association was found between disease activity score and PFT findings in both groups. On the other hand, a significant association between chest symptoms and PFT, P value<0.05 . Also a strong significant association was found between anticitrullinated protein antibodies (ACPA) status and PFT in both group, p value <0.05.

Conclusion

MTX treatment was not associated with an increased risk of RA-ILD diagnosis. On the contrary, evidence showed that MTX may delay the onset of ILD. There seems no reason to confuse the association of MTX and hypersensitivity pneumonitis with the onset of RAILD.ACPA antibody is considered a major risk factor in RA-ILD, ACPA titers constitute an independent factor associated not only with the presence but also with the severity of RA-ILD
Subclinical Atherosclerosis in Psoriatic Patients: Relation with Vitamin D
Authors: Moussa Shaymaa Ali , Khaled Henaz Farouk , ElShishtawy Heba Fawzy , Elnaggar Heba
Published: October 2021

Background

Psoriasis is a chronic, inflammatory disease that mainly affects skin and nails. Approximately 13%-25% of Psoriasis patients develop Psoriatic arthritis (PsA). Psoriasis and PsA are strongly associated with numerous comorbid diseases and among them, cardiovascular diseases are of particular importance. Low levels of serum vitamin D are associated with increasing risk of metabolic diseases and cardiovascular diseases. Vitamin D deficiency is observed in numerous chronic systemic inflammatory diseases including psoriasis. Carotid intima-media thickness (CIMT) is a marker of arterial vascular disease used to predict a future vascular event. It can serve as a surrogate marker for subclinical atherosclerosis and cardiovascular diseases. Coronary artery calcification score (CACS) is a non-invasive and highly reliable method to measure coronary atherosclerosis through non-contrast cardiac CT.

Objective

To detect subclinical atherosclerosis and study its relation with serum levels of 25hydroxyvitamin D in psoriatic patients with and without arthritis.

Patients and Methods

This study was carried out on 25 Egyptian psoriatic patients and 25 healthy individuals matched as regarding age, sex and BMI as a control group. Patients were classified into 2 groups; Group I: 13 patients with PsA and Group II: 12 patients with psoriatic skin lesion without any arthritic manifestations. All patients were subjected to full medical history taking, thorough clinical examination. Basic laboratory investigations in addition to assessment of serum levels of 25-OH vitamin D were done to all patients and control. carotid duplex for measurement of CIMT in addition to measurement of CACS using coronary CT.

Results

Patients with PsA had lower values of vitamin D than psoriatic patients and controls despite being statistically insignificant (median; 5, 5.5 & 11). CIMT and CACS were statistically higher among PsA patients (CIMT mean; 0.57, 0.52 & 0.44) and (CACS median; 53, 1.5 & 0) respectively. Vitamin D was found to be negatively well correlated with PASI, ALT, AST, serum creatinine and CACS in psoriatic patients. A significant relation between higher PASI and low vitamin D levels in psoriatic patients. CIMT was significantly positively correlated with age, BMI, LEI, ALT, AST, SUA, cholesterol and CACS in psoriatic patients, while CACS was positively correlated with age, ALT, SUA and cholesterol.

Conclusion

Psoriatic patients especially those with PsA had lower values of vitamin D than controls despite being statistically insignificant. They also suffered from increased risk of CVDs and subclinical atherosclerosis due to increased burden of inflammation and lack of physical activity. Vitamin D was negatively correlated with CACS in psoriatic patients in addition to a strong positive correlation between CIMT and CACS among them.
The Possible Protective Effect of Selenium on Liver Dysfunction in a Rat Model of Extrahepatic Cholestasis
Authors: Lebda Fatma M , El Agaty Sahar M , Nassef Noha A , Aziz Marina A
Published: October 2021

Background

Oxidative stress and inflammation are primarily implicated in the development and progression of liver injury during cholestasis. Selenium, a known essential antioxidant trace element, was found to provide a remarkable antioxidant and anti-inflammatory effects on various diseases.

Aim

This study was planned to evaluate the possible protective effect of selenium supplementation in a rat model of chronic cholestasis.

Design

Experimental study.

Methods

This study was carried out on adult male rats allocated randomly into sham, bile duct ligated (BDL), and BDL-selenium treated (BDL-Se) groups. Sodium selenite was given by gavage daily, in a dose of 100 µg/kg for 6 weeks, starting 2 weeks before the BDL.

Results

BDL group presented a significant increase in serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and liver levels of malondialdehyde (MDA), tumor necrosis factor alpha (TNF-α), and transforming growth factor beta 1(TGF-β1), associated with a significant decrease in serum levels of total proteins (TP) compared to sham group . Selenium supplementation significantly lowered serum levels of AST, ALT, ALP, and liver levels of MDA, TNF-α, and TGF-β1 along with a significant increase in serum TP in BDL-Se group versus BDL rats. Histological analysis of liver showed a significant attenuation of the inflammatory score and a significant decrease in the percentage area of collagen deposition in BDL-Se group versus BDL rats.

Conclusion

Selenium supplementation reduces liver injury and improves liver functions in experimental cholestasis probably by its antioxidant and anti-inflammatory activities, which further alleviate the liver fibrosis.

Abbreviations

BDL: bile duct ligated group, BDL-Se: bile duct ligated-selenium group, MDA: malondialdehyde, TNF-α: tumour necrosis factor-alpha, TGF-β1: transforming growth factor- beta1, ROS: reactive oxygen species, mRNA: messenger RNA, IL-6: interleukin-6, BW: body weight, AST: aspartate aminotransferase, ALT: alanine aminotransferase, ALP: alkaline phosphatase, TP: total proteins, CCl4: carbon tetrachloride, GPx: glutathione peroxidase enzyme, SOD: superoxide dismutase, IL-1: interleukin-1.
Possible Protective Effects of Stem Cells Treatment on Ischemic/Reperfused Hearts in Hypertensive Rats Model
Authors: Hamed Gehane M , Abd-El Hamid Manal S , Nagib Einas M , Amer Hanaa Ahmed , Hussien Nahla Mohamed
Published: October 2021

Back Ground

Hypertension and its cardiovascular complications as myocardial infarction are the leading causes of morbidity and mortality worldwide. Reperfusion strategies are the current standard therapy but they result in cardiac ischemia reperfusion injury. Stem cell transplantation has emerged as a promising therapeutic strategy and showed many beneficial effects in different medical disorders as reno-vascular hypertension.

Aim of Work

To assess the possible protective effects of bone marrow derived mesemchymal stem cells treatment on ischemic/reperfused hearts in hypertensive rats.

Materials & Methods

49 adult female Wistar albino rats, were allocated into three main groups: control group, hypertensive untreated (Ht-u) group and hypertensive stem cells (Ht-SCs) treated group. Body weight, arterial blood pressure, ECG recording, isolated heart study with exposure to ischemia reperfusion injury and fluorescence imaging of labeled MSCs in the heart, aorta and liver were performed. Plasma lipid profile, nitric oxide, MDA and SOD levels and cardiac MDA and SOD levels were estimated. Cardiac tissues were weighed. Heart, aorta and liver were histopathologically assessed.

Results

Ht-SCs treated group demonstrated significant increase in body weight gain %, significant decrease in R voltage, SBP, DBP and MAP sixth week values compared to HT-u group, with DBP and MAP showing non-significance from the control. Significant increase in heart rate basal and all reperfusion values and non-significant increase in basal PT/LVW were detected compared to HT-u group. Basal TPT and HRT were significantly shortened and MFR/LVW was significantly increased than HT-u group, being non-significantly changed from the control denoting systolic and diastolic function improvement.TPT and HRT prolongation and MFR/LVW decrease after IR injury was significantly lower in HT-SC group than HT-u group. This was accompanied by significant decrease in atherogenic index, plasma and cardiac MDA and significant increase in plasma nitrites, SOD and cardiac SOD. BM-MScs were detected in cardiac and aortic tissues.

Conclusion

Single injection of BM-MScs exerted anti-hypertensive and anti-hypertrophic effects, reduced systolic and diastolic dysfunction after ischemia reperfusion injury and improved coronary flow in hypertensive rats, through homing into aortic tissues mitigating endothelial dysfunction and exerting angiogenic effects and homing into cardiac tissues exerting anti-oxidant, anti-inflammatory and anti-apoptotic effects.
Incidence and Association of Patient Safety Indicator 9 (Perioperative hemorrhage or hematoma) and clinical outcomes in Cardio-thoracic surgery hospital, Ain Shams University, Egypt
Authors: Al-Tehewy Mahi M , Abd AlRazak Sara E. M , Wahdan Maha M , Hikal Tamer S. F
Published: October 2021

Background

Patient Safety Indicators (PSIs) were developed as a tool for hospitals to identify potentially preventable complications and improve patient safety performance.

Aim

the study aimed to measure the association between the AHRQ patient safety indicator PSI9 (Perioperative hemorrhage or hematoma) and the clinical outcome including death, readmission within 30 days and length of stay at the cardiothoracic surgery hospital Ain Shams University.

Methods

exploratory prospective cohort study was conducted to follow up patients from admission till 1 month after discharge at the cardiothoracic surgery hospital who fulfills the inclusion criteria. Data were collected for 330 patients through basic information sheet and follow-up sheet.

Results

the incidence rate of PSI9 was 49.54 per 1000 discharges. Demographic data was not significantly associated with increased incidence of PSI9. The risk of development of PSI9 was significantly higher in patients admitted directly to ICU [relative risk (RR) =5.6]. The risk of death and readmission was higher in cases developed PSI9 than the cases without PSI9 [RR = 2.40 (0.60-9.55) and 2.43 (0.636 - 9.48) respectively].

Conclusion

high incidence rate of PSI9 and the incidence is higher in male gender and 60 years old and more patients. Those patients developed PSI9 were at high risk for readmission and death.

Recommendations

the hospital administration should consider strategies and policies to decrease the rate of PSI9 and subsequent unfavorable clinical outcomes.
Evaluation of Hepatitis C Patients' Satisfaction Regarding Care and Treatment in Different Hospitals in Cairo, Egypt, 2020
Authors: Yousef Shaimaa S , Al Bagoury Lamyaa S , Dewedar Sahar A , Sabbour Sahar M , Anwar Wagida A
Published: October 2021

Background

Patient satisfaction can be considered as an indirect measure of health outcomes and quality of provided services.

Objectives

To compare HCV patients' satisfaction regarding care and treatment in different selected Viral Hepatitis Outpatients Clinics in Cairo. Method: The current study is a cross sectional study. It recruited 300 HCV patients from Viral Hepatitis Outpatients Clinics in University, Ministry of Health (MOH) and Insurance Hospitals (100 HCV patients from each clinic). Recruited HCV patients attended at least 2 visits to the Viral Hepatitis Clinics. They completed an interview questionnaire about socio- demographic data, history of diagnosis of HCV, onset and type of treatment and Hepatitis Patients Satisfaction Questionnaire (HPSQ).

Results

Mean age of HCV patients were (48.9 ±13.5), (50.4 ± 10.4), and (54.8 ± 10.9) from University, MOH and Insurance Hospitals, respectively. Females accounted for (63%) of HCV patients in University Hospital sample however, males were (54%) and (57%) in MOH and Insurance Hospitals, respectively. Most of studied HCV patients were referred by specialists; (59%), (86%) and (87%) from University, MOH, and Insurance Hospitals, respectively. A statistically significant difference was found between the 3 Clinics as regards rating the quality of received HCV services, meeting patients’ needs, coping with HCV disease, and helping patients access to specialist services (p < 0.01). The study revealed that the majority of health providers in the 3 Viral Hepatitis Clinics didn't involve HCV patients in making decisions about their treatment.

Conclusion

HPSQ findings identified University Hospital's patients more satisfied about their HCV treatment management than MOH and Insurance Hospitals' patients except for involvement of HCV patients in making decisions which was lacking in the 3 hospitals.
IMPACT OF COLLIMATION ON RADIATION EXPOSURE IN ADULT AND PAEDIATRIC DIGITAL X-RAY IMAGING
Authors: Satharasinghe Duminda , Jeyasugiththan J , Jeyasuthan M , Amalaraj T , Abeyweera A L , Wanninayake W M N M B , Pallewatte A S
Published: October 2021

This study aimed to evaluate the collimation practices and quantify the overexposure due to extensive X-ray field area. The study was carried out in four digital X-ray units (including one paediatric X-ray unit). A total of 749 X-ray projections (555 adult and 194 paediatric) were evaluated. In adult X-ray units, the radiation field size was two times larger than the electronically collimated field. In the paediatric unit, the radiation field was 3.7 times larger than the electronic collimated field. The average additional entrance surface dose due to the excess radiation field used in a paediatric X-ray unit varied between 9.3 (2.5%) and 201.4 $\mu $Gy (10.9%). Therefore, proper pre-patient collimation should be applied whenever feasible, which reduces the patient radiation dose considerably.
Draft Genome Sequence of Alternaria longipes Causing Tobacco Brown Spot
Authors: Feng Zhonghong , Li Yaxin , Ma Xueyan , Duan Yangbo , Zhang Rong , Hsiang Tom , Niu Yongchun , Sun Guangyu
Published: October 2021

Alternaria is a cosmopolitan fungal genus associated with diverse hosts. Tobacco brown spot caused by Alternaria longipes is one of the most destructive diseases of tobacco. A. longipes can also infect many other plants, some animals and even humans. Here, we report a genome assembly of A. longipes CBS 540.94 using Oxford Nanopore Technologies. A total of 15 contigs were assembled, and the genome size was 37.5 Mb with contig N50 of 4.33 Mb. This genome resource will provide information for further research on comparative genomics of the genus Alternaria and be a valuable resource in investigations of the molecular interactions of pathogen and hosts.
A New Real-Time PCR Assay for Detecting Fungi in Genus Ceratocystis
Authors: Dharmaraj Karthikeyan , Merrall Alice M. , Pattemore Julie A. , Mackie Joanne , Alexander Brett J. R. , Toome-Heller Merje
Published: October 2021

The genus Ceratocystis contains several significant plant pathogens, causing wilt and canker disease on a wide range of plant species. There are >40 known species of Ceratocystis, some of which are becoming increasingly important in agricultural or natural ecosystems. The diagnostic procedures for most Ceratocystis species rely on time-consuming and labor-intensive culturing approaches. To provide more time-efficient and sensitive molecular diagnostic tools for Ceratocystis, a generic TaqMan real-time PCR assay was developed using the ITS gene. This novel two-probe TaqMan assay amplified DNA from all tested Ceratocystis species. Some nonspecific amplification of a few species from closely related genera was observed under certain conditions; however, these false-positive detections could be ruled out using the additional PCR primers developed for further sequence-based identification of the detected species. The assay was found to be highly sensitive, as it detected 0.2 pg/μl of Ceratocystis DNA in water as well as in host DNA matrix. Further validation with artificially inoculated fig stem tissue demonstrated that the assay was also able to effectively detect the pathogen in infected asymptomatic stem tissue. This newly developed real-time PCR assay has practical applications in biosecurity, conservation, and agriculture; it will enable the detection of Ceratocystis species directly from plant material to facilitate more sensitive screening of imported plant germplasm, and allow rapid tracking of pathogens in the case of disease outbreaks.