bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome of Superomedial Pedicle Flap for Lower Outer Quadrant Breast Cancer
Authors: Shehab Mohammad Helmy , Aref Muhammad Abdel Raheem Hussein , Ahmed Dina Hany
Published: August 2023

Background

Breast cancer is the most common cancer among women and is the second leading cause of cancer deaths. The surgical treatment of patients with breast cancer involves either breast conserving surgery or mastectomy, both of which can result in considerable asymmetry of the breasts. Breast reconstruction offers restoration of breast symmetry to such women. The patient needs to be aware that the reconstructed breasts will neither feel nor function like a normal breast but may help in restoring body image and self-confidence.

Objective

To evaluate the intraoperative and postoperative outcomes and showing advantages and disadvantages of Superiomedial pedicle flap for lower outer quadrant breast cancer in cup ≥ c.

Patients and Methods

It was a prospective study that included 10 patients aiming to assess outcome of the superomedial pedicle flap oncoplastic technique for lower outer quadrant breast cancer in oversized breast. This study was conducted at Ain Shams University Hospitals. Approval of the ethics committee and written informed consent from all participants were obtained.

Results

In our study, all of the patients had free safty magins as confirmed by the pathologist in our MDT proving that we had performed a superior medial technique safely from the oncological point of view. We were able to conduct an excellent cosmetic outcome for relatively large tumor excisions which fall in good and fair score groups as those two patients noticed asymmetry of the two breasts. None of our cases have had a poor or an ugly score. Overall, the satisfaction rate with this technique was high, with very few and easily manageable complications. There were no cases of NAC loss.

Conclusion

Superomedial pedicle can be safely utilized in large size breast reduction without increase of NAC necrosis. The technique is an efficient method to achieve minimal to moderate breast reduction with minimal NAC transposition. The primary surgical goals are attained by appropriate resection of the breast parenchyma. Moreover, a youthful and aesthetically appealing breast is achieved by maintaining superior and medial fullness and reshaping the breast using the parenchyma and skin envelope for support. Superomedial pedicle flap technique offers breastconserving surgery with wider margins offering safer oncologic control with more satisfactory cosmetic outcome.
Factors Favouring Laparoscopic over Laparotomy Technique of Vp Shunts: A Systematic Review and Meta-Analysis
Authors: Alyan Walid Atef , Osman Ahmad Gamal El-Din , Khalil Abdallah Hamed , Al-Sabbagh Muhammad Ahmad
Published: August 2023

Background

A systematic review and meta-analysis of studies concerning laparoscopically assisted ventriculo-peritoneal shunt placement. After using selection criteria, a total of 12 studies with 3173 patients were included in the systematic review.

Aim of the Work

To review, revise and redefine the role of laparoscope in the effectiveness of ventriculo-peritoneal shunt placement in a Meta-analytical form, minimizing procedurel and hospital stay together with postoperative complications in comparison to laparotomy techniques in patients with hydrocephalus and its role in revision of ventriculo-peritoneal shunts.

Methods

A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.

Results

There was a significant difference in terms of the distal shunt failure rate between the 2 groups, but the significance disappeared when proximal shunt failure was also considered, leaving a non significant trend toward lower overall shunt failure in the laparoscopic compared with the laparotomy group. The results of our meta-analysis clearly show that the laparoscopic technique is a safe, minimally invasive treatment option for the insertion of distal catheters. Laparoscopy can reduce the distal shunt failure rate and length of operation, while not reducing the overall shunt failure, overall infection rate, and length of hospital stay and might not reduce intraoperative complications.

Conclusion

The results of our meta-analysis clearly show that the laparoscopic technique is a safe, minimally invasive treatment option for the insertion of distal catheters. Laparoscopy can reduce the distal shunt failure rate and length of operation, while not reducing the overall shunt failure, overall infection rate, and length of hospital stay and might not reduce intraoperative complications.
The Possible Effect of Grape Seed Extract on the Adrenal Cortex in Streptozotocin-Induced Diabetes in Male Albino Rats: A Histological Study
Authors: Fahmy Esraa T , Saleh Hanan A , Raafat Mona H , Elkhateb Lobna A
Published: August 2023

Introduction

Induction of diabetes in rat models injected with streptozotocin (STZ) had led to increase activity of the hypothalamic-pituitary-adrenal (HPA) axis accompanied with hypercortisolism and adrenocortical growth. Proanthocyanidin, a grape seed extract (GSE) that was observed to have beneficial effect on different metabolic and inflammatory diseases.

Aim

To study the structural changes of the adrenal cortex in diabetic rats and the beneficial effect of GSE on the suprarenal cortical injury.

Materials and methods

35 adult male albino rats were divided randomly into 4 groups. Group I (control). Group II (GSE), rats received GSE orally (200 mg/kg), daily for 21 days. Group III (STZ), rats were injected with STZ (40 mg/kg) given intraperitoneal once. Group IV (STZ + GSE), rats received STZ as in group III. After rats confirmed to be diabetic, they were treated with GSE as in group II. After 21 days, the adrenal glands from all groups were dissected and processed for light microscopic examination. Morphometric and statistical analysis were also done.

Results

H&E stained section of Group III (STZ) showed increase in the capsular thickness and congested blood capillaries. Both zona glomerulosa & zona fasciculata showed increased thickness with some cells appeared with vacuolated acidophilic cytoplasm while others were shrunken with closely packed pyknotic nuclei. Inflammatory cells infiltration was also observed. Moreover, silver stain showed focal significant increase in thickness of the capsule, dense trabeculae and dense irregular reticular fibers of the cortex. Meanwhile, immunohistochemical results showed significant increase in the reaction for caspase 3 antibodies. Group IV (STZ + GSE) showed restoration of the cortical structure & organization nearly similar to that of control group.

Conclusion

It can be considered that GSE might have a protective effect on the structure of diabetic rats’ adrenal gland.
The Potential Role of Mesenchymal Stem Cells Derived Exosomes on the Healing of Grade II Experimentally Induced Skeletal Muscle Injury in Adult Male Albino Rats. Histological Study
Authors: Abdelbary Omar Ahmed , khalaf Megahed Gehan , Hamam Ghada Galal , Al- Khalek Ali Hadwa Ali Abd
Published: August 2023

Background

Musculoskeletal injuries are the most common cause of severe longterm pain and physical disability. However, there is still no efficient treatment that leads to prevention of muscle fibrosis. Cell-Free therapy using mesenchymal stem cells (MSCs) derived exosomes could provide a new promising therapy.

Aim

To study the potential role of MSCs-derived exosomes on the healing of experimentally induced grade II skeletal muscle injury in adult male albino rats.

Materials and Methods

Forty male albino Wister rats were used in this study. Five out of them were used for isolation of exosomes. The rest were randomly divided into three groups. Group I (Sham group), Group II (muscle injury group left for spontaneous healing), Group III (muscle injury treated with exosomes). Rats from each group were subdivided into two subgroups; subgroup “a and b” in which rats were sacrificed after ten days and twenty days, respectively. Muscle specimens were collected and prepared for proper histological techniques. Immuno-histochemical staining for detection of collagen type I and developmental myosin (MHCd) were also done. Morphometric study and statistical analysis were also performed.

Results

Granulation tissue and inflammatory cellular infiltration with significant increase in the mean area percentage of collagen fibers were noticed in subgroups of untreated muscle injury compared to the corresponding exosomes treated subgroups. This was confirmed by collagen type I immune histochemical reaction. Group III (treated with exosomes) showed better muscle regeneration and significant decrease in muscle fibrosis. Significant increase in immunohistochemical reaction of developmental myosin was noticed in exosomes treated subgroups compared to corresponding untreated muscle injury subgroups.

Conclusions

Exosomes enhance muscle regeneration after induced muscle injury. Exosomes also decreased muscle fibrosis and improve muscle healing.
Directly Acting Anti-Viral Drugs and Its Metabolic Side Effects in Patients with Chronic HCV
Authors: Makhlouf Mohamed Marei , Said Moataz Mohamed , Amr Khaled , Abdallah Abdallah Mohamed
Published: August 2023

Background

Hepatitis C virus (HCV) infection is still one of the leading causes of chronic liver disease, with chronically infected making up approximately 1% of the global population.

Aim and Objectives

The aim of this work was to study side effects of directly acting anti HCV drug (DAA) and its progression in metabolism of lipid profile, blood sugar level, and renal function.

Subjects and Methods

This case study had been carried out on 200 subjects presented to Department of Internal Medicine at Kobbri ELkobba hospital inpatient and outpatient clinics between March 2016 and September 2016. All subjects participating in the study was asked to sign informed concept before inclusion.

Results

There are non-significant changes in liver enzymes, AST, ALT, INR, and CBC. But in lipid profile, non-significant changes in HDL, But noticed significant decrease in LDL and significant increase in TG from (172.53 ± 36.11) to (267.84 ± 63.24 ) and Total cholesterol, significant increase from (203.60 ± 53.85) to ( 216.15 ±55.67). In HbA1C, there was significant increase.

Conclusion

Once-daily oral daclatasvir plus sofosbuvir with or without Ribavirin was associated with high rates of sustained virologic response among patients infected with HCV, including chronic cirrhotic patients and relapsers, successful treatment associated with Improvement of liver function parameters in the majority of patients, Increase in urea level, serum creatinin and HbA1C. There is significant decrease in LDL and mild increase in TG level.
Study Association of Serum Immunoglobulins and Non-Alcoholic Fatty Liver Disease in Egyptian Patients
Authors: Awad Ahmed Emad , Saleh Shereen Abou Bakr , ElGhandour Ahmed Mohamed , Elmaradny Abdul-Aziz Mahmoud Mahmoud
Published: August 2023

Background

Non-alcoholic fatty liver disease represents a spectrum of liver diseases which occurs in the absence of alcohol consumption, it has become a clinical burden around the world because of its independent relationship with increased risks of cardiovascular disease, hyperglycemia and tumor malignancy, as an example it's the most common chronic liver disease in North America, with reported prevalence rates of 10%–50% in the general population. However, only 10%–30% of NAFLD patients progress to advanced fibrosis, cirrhosis, and/or hepatocellular carcinoma.

Aim of the Work

The aim of this study was to further investigate the association between NAFLD and the serum immunoglobulins.

Patients and Methods

Atotal of one hundred Egyptian people were enrolled in the study and divided into two groups: Group 1: 50 patients with non-alcoholic fatty liver disease diagnosed by clinical, laboratory and radiological investigations. Group 2: 50 patients with non-alcoholic steatohepatitis diagnosed by clinical, radiological features of NAFLD and elevated liver enzymes.

Results

Results of the present study revealed that the mean age of NAFLD was 44.4±9.3 and in NASH 50.6±8.5. In our study it was proven that Nafld prevalence increases with age. Concerning gender in our study there was predominance of female gender in NASH group by about 70% but in NAFLD they represent only 48%. In our study, it was proven that BMI and waist circumference were signifcnatly higher in NASH group. DM were signifciantly more frequent in NASH group. In the present study, there was no significant difference between the studied groups regarding hemoglobin, TLC and platelets.

Conclusion

Our results revealed that IgA was significantly higher among NASH group, IgM and IgG were significantly higher among NAFLD group. Results of this study showed statistically significant relation between ALT, AST, GGT and INR and degree of steatosis, they were higher among NASH group and also the albumin was significantly lower among NASH group on the other hand bilirubin was non-significantly higher in NASH.
Assessment of the Value of Mean Plathlet Volume, Des Gamma Carboxy Prothrombin and Alpha Feto Protein in Early Detection of HCC
Authors: Ahmed Osama Ashraf , Samier Elbaz Hosam , Nageb Gena Gamal , Elzayet Adel Magdy Mohammed Saleh
Published: August 2023

Background

Primary liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide, with an estimated 841,000 cases (9.3 cases per 100,000 person-years) and 782,000 deaths (8.5 deaths per 100,000 person-years) in 2018. HCC being often associated with liver cirrhosis masks symptoms of cancer progression and thus the clinical course of HCC is mostly asymptomatic.

Aim of the Work

To determine the value of mean platelet volume, Des gamma Carboxy prothrombin and Alfa-feto protein in early detection of Hepatocelluler carcinoma

Patients and Methods

This case cross sectional comparative study had been carried out after the approval of the Ethics Committees of the faculty of medicine Ain Shams university on 105 subjects, age range 25-68 year selected from: Patients attending Hepatology and virology outpatient clinic at ElDemerdash hospital Also Liver transplantation center at Ain Shams specialized hospital in Cairo after informed consent were taken from the patients

Results

In this study HCC was found to be more prevalent in men 28 (80.0%) than in women 7 (20.0%). In our study AFP, MPV and DCP were highest in HCC group, followed by CLD group and lowest in control group. The differences between all groups were significant in MPV and DCP, with no significant difference between CLD and HCC in AFP. In the present study, DCP values of HCC group showed a highly significant increase upon comparison with the non malignant groups (II, and III). The sensitivity of DCP was higher than AFP in detecting HCC patients (97.1% versus 54.3%),

Conclusion

Measurement of MPV is non-invasive, cheap and quick, and may therefore serve as a predictor of HCC in patients with CLD. Low sensitivity and specificity, on the other hand, suggests that this may be an adjunctive parameter to some other markers like AFP. Further studies with larger samples are needed to determine the association of MPV with HCC. For a single test DCP had highest significant diagnostic performance in differentiating HCC from CLD groups. In detection of HCC testing AFP≥ 40.0 if positive considered positive. If negative, retest for DCP≥ 69.3 if positive considered positive, otherwise is negative. This although deceased specificity and Positive predictive value, it raised sensitivity and Negative Predictive Value to 100.0% when combining both AFP and DCP.
Colonoscopy versus Bowel Ultrasound in Assessment of Disease Activity and Severity in Patients with Ulcerative Colitis
Authors: Badawy Hanan Mohammed , Mohammed Eslam Safwat , samir Ghait Ramy , El Kasem Ahmed Ahmed Abo
Published: August 2023

Background

Ulcerative colitis [UC] is a chronic inflammatory bowel disease characterized by relapsing and remitting episodes of inflammation usually limited to the mucosal layer of the colon. Treatment targets for UC patients nowadays include patient-reported as well as endoscopic remission. Recently, endoscopy is increasingly being used to guide treatment, because evidence suggests that mucosal healing is associated with improved long-term outcomes. However, it is challenging to repeatedly perform colonoscopies to assess mucosal disease activity due to the high cost and burden for the patient. Hence, alternative and reliable non-invasive methods to assess disease activity are needed.

Aim of the Work

The aim of this study is to to comparison colonoscopy versus bowel ultrasound in assessment of disease activity and severity in patients with Ulcerative Colitis.

Patients and Methods

This was a case control study, was conducted at Internal Medicine and Gastroenterology outpatient clinics in Ain Shams University over 90 patients suffering from morbid obesity and in whom surgical management is indicated. Participants were divided into two groups: Group (1): (n = 30) healthy individuals, matched for age and gender, group (2): (n = 60) Active and inactive (in remission) ulcerative colitis patients.

Results

The main findings of the study revealed that: There was no statistically significant difference between the studied groups as regard Demographic data. The mean age at diagnosis was 36.11 (±10.42 SD) with range (20-53), the mean duration of disease was 1.95 (±0.83 SD) and according to Disease extent there were 48 (80%) left-sided, 11 (18.3%) extensive and 1 (1.7%) pancolitis. There was high statistically significant difference between the studied groups as regard Laboratory investigations. There was high statistically significant difference between the studied groups as regard Radiological Examination. According to Endoscopic Findings there were 21 (35%) 0 or 1 (remission) and 39 (65%) 2 or 3 (active). There was high statistically significant relation between Endoscopic Findings and Laboratory investigations. There was high statistically significant relation between Endoscopic Findings and Radiological Examination.

Conclusion

BUS may represent a useful first-line, non-invasive tool for assessing endoscopic activity, severity, and extent, and may be helpful to determine in a rapid manner whether a significant flare has occurred and to guide the management of UC patients, delaying or avoiding colonoscopy when it is not needed. In addition, BUS may be preferred in clinical practice for monitoring disease course and for assessing short-term treatment response, reducing the necessity of repeated CS, although specific data on monitoring will be needed.
Significance of Serum Butyrylcholinesterase in Evaluating the Liver Reserve in Chronic Hepatitis (C) Cirrhotic Patients
Authors: Nashaat Ehab Hassan , Ahmed Osama Ashraf , Allam Ahmed Samir , Shatla Ahmed Attia Elsayed
Published: August 2023

Background

Hepatitis C virus can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, HCC and the need for liver transplantation. Liver cirrhosis is one of the major leading causes of morbidity and mortality worldwide including Egypt. Cirrhotic patients evaluated for the presence of complications by using Child-Pugh score. However; the cirrhotic patients particularly those with Child grades B and C with ascites or hemorrhagic tendency are usually treated with albumin or blood transfusion which may affect the numerical value for calculating the Child- Pugh score.

Objective

To evaluate serum cholinesterase level as a biomarker for detecting liver damage in patients with chronic hepatitis C.

Subjects and Methods

The aim of this study is to evaluate serum cholinesterase level as a biomarker for detecting liver injury in patients with CHC. For this propose 40 patients with liver cirrhosis due to HCV infection and 10 healthy adults were selected and divided into 3 groups: Group 1: 20 Patients having compensated liver cirrhosis due to HCV infection. Group 2: 20 Patients having decompensated liver cirrhosis due to HCV infection. Group 3: 10 Healthy subjects matched for age and sex as a control.

Results

Sensitivity of cholinesterase is 100%, its specificity is 100% and its accuracy is 100%, in predicting liver injury in patients with chronic hepatitis C. Cholinesterase is positively correlated with Hb, platelets and albumin. Cholinesterase is negatively correlated with ALT, AST and ALP, total, direct bilirubin, PT, INR, urea, creatinine and AFP.

Conclusion

Serum cholinesterase is an excellent biomarker of the synthetic function of liver in CLD with hepatitis C. Cholinesterase levels should be routinely checked to assess liver function. It can be effectively used to follow the staging of liver disease in hepatitis C.
Amphiregulin as a Novel Biomarker in Diagnosis of Hepatocellular Carcinoma before and after Treatment
Authors: Mohamed Sherif Mounir , Ahmed Osama Ashraf , Samaan Amira Isaac , Hassan Ahmed Gamal Mohamed
Published: August 2023

Background

Hepatocellular carcinoma is the fifth most common tumour worldwide and the second most common cause of cancer-related death with a male-to-female predominance greater than 2:1. Our study depended on assessment of the diagnostic performance of serum AREG in HCC detection in addition to their correlation with different clinicopathological parameters in HCC and cirrhotic patients.

Aim of the Work

The aim of this work is to evaluate the diagnostic value of serum level of Amphiregulin for HCC and its prognostic value after transarterial chemo-embolization (TACE) or radiofrequency ablation (RFA).

Patients and Methods

The study included 60 subjects divided into two groups: group I was 30 randomly patients with liver cirrhosis as a control, group II was 30 patients with hepatocellular carcinoma who underwent intervention with TACE or RF.

Results

Serum AREG levels was significantly higher between HCC group and liver cirrhosis group and it is suitable for diagnostic use. It was shown that the follow up level of AREG had a significant diagnostic performance in diagnosis of HCC recurrence at cut off value of ≥ 29.7 with sensitivity of 60% and specificity was 96%.

Conclusion

AREG is not suitable as a diagnostic marker for HCC but can be used as a prognostic marker for HCC after treatment, as it was found to be useful in prediction of possible tumour recurrence.
Role of Circulating Ectodysplasin A as a Biomarker in Non-Alcoholic Fatty Liver Disease
Authors: Sayed Moataz Mohamed , Mohamed Manal Sabry , ElGhandour Ahmed Mohamed , Ali Ahmed Hafez Ezzat El-Sayed
Published: August 2023

Background

The liver is a dynamic organ that plays critical roles in many physiological processes, including the regulation of systemic glucose and lipid metabolism. Dysfunctional hepatic lipid metabolism is a cause of nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disorder worldwide, and is closely associated with insulin resistance and type 2 diabetes.

Objective

To study serum level of Ectodysplasin A in patients with non-alcoholic Fatty Liver disease (NAFLD) to detect its relation to the incidence and severity of non-alcoholic Fatty Liver Disease (NAFLD).

Patients and Methods

Type of Study: Case-Control clinical study. Study Setting: Internal medicine and hepatology outpatient clinic at Ain Shams University Hospital Study period: this is a 6-month study period starting from July 2020 till January, 2021.

Results

There was a significant difference in between the two groups regarding to platelet, ALT, AST, GGT and albumin. The mean Ectodysplasin A was 337.54 ± 196.63 (pg/ml) in NAFLD group and 221.43 ± 115.89(pg/ml) in control group with high statistical significant difference in between. There was a significant positive correlation in between Ectodysplasin A and Weight, BMI, WC (cm), FPG, HbA1c and LDL-C in NAFLD group.

Conclusion

Ectodysplasin A level is elevated in NAFLD patients than in control. Ectodysplasin A level could be used as an inflammatory biomarker for the prognosis of patients NAFLD. Therefore, measurement of Ectodysplasin A level provides a new strategy to more aggressive treatments for high-risk groups.
Comparative Study Evaluating the Effect of the Administration of Vitamin K1 versus Placebo on Vascular Calcification in Haemodialysis Patients
Authors: Elshinnawy Howayda Abdelhamid , Elsaid Tamer Wahid , Sharabasy Reem Mohsen El , Shamseldin Ahmed Mohamed Elsayed
Published: August 2023

Background

Cardiovascular calcification is a risk factor and contributor to morbidity and mortality in End stage kidney disease patients. Patients with chronic kidney disease develop accelerated calcification of the intima, media, heart valves and myocardium as well as the rare condition of calcific uremic arteriolopathy (calciphylaxis). Pathomechanistically, Cardiovascular calcification is most likely due to an imbalance of promoters (e.g. Calcium and phosphate) and inhibitors (e.g. fetuin-A and matrix Gla protein).

Objective

to study the effect of oral vitamin k1 on serum Matrix gla protein in patients on maintenance hemodialysis and to study its effect as an important marker of vascular calcification.

Patients and Methods

This Placebo Controlled clinical trial was conducted for 3 months on 80 adult ESRD patients on regular Hemodialysis recruited from Ain shams university Hospitals hemodialysis unit, their age ranged from 18 to 75 years each participant signed informed consent classified into two groups, with the study group containing 40 patients who received Vitamin K1 therapy 5 mg every other day for three months duration and the control placebo group containing 40 patients who received Placebo every other day for three months duration.

Results

There was no statistically significant difference between the two groups according to their risk factors regarding smoking, HTN, HCV, DM, and ISHD. In this clinical trial only 29 % of patients were diabetic, but their diabetes was well controlled and there was no significant difference between groups regarding incidence of diabetes. There was no significant difference between groups regarding vascular access (AVF, Double lumen tunneled dialysis catheter) and duration of dialysis (P > 0.05). The current study showed that vitamin k1 therapy resulted in no significant effect in comparison to the placebo group on calcium, phosphorus, calcium-phosphorus product and (P = 0.435), (P = 0.142), (P = 0.191) respectively. Age has non-significant effect on MGP level neither in the study group (P = 0.636) before vitamin k1 therapy nor in the placebo group (P = 0.841) and after vitamin k1 therapy in study group (P = 0.605) and placebo group (P = 0.332).

Conclusion

Different risk factors including Hypertension, Diabetes Mellitus, Smoking, Heart failure, Ischemic heart disease and hepatitis c virus has no significant effect on serum MGP levels neither before nor after therapy in both study and placebo groups.
Value of Glypican-3 as a Diagnostic and Prognostic Biomarker for Hepatocellular Carcinoma before and after Treatment. A Prospective Study
Authors: Isaac Amira , Badawy Hanan Mahmoud Mohamed , Mohamed Inas Elkhedr , Ibrahim Al Saeed Ezzat
Published: August 2023

Background

Hepatocellular carcinoma is a highly prevalent tumor globally and the world's second leading cause of cancer-related deaths. Glypican-3, a heparan sulfate proteoglycan expressed on the surface of HCC cells, has emerged as a new molecule with a strong link to occurrence and progression of HCC. This study was done to determine the role of Glypican-3 in diagnosis of HCC and its prognostic value following different treatment modalities. The study included thirty patients with liver cirrhosis and HCC on top, and thirty patients with liver cirrhosis without HCC, standard laboratory investigations, abdominal ultrasound and triphasic computed tomography were done for all patients. serum Alpha fetoprotein and Glypican-3 were measured in all patients before and one month after different treatment modalities

Results

Glypican-3 was significantly higher in HCC group (2.28 ± 0.97) in comparison to cirrhosis group (0.56 ± 0.31) with P-value 0.000. Glypican-3 level was higher in larger sized lesions with p value 0.023, one month after treatment with different modalities, Glypican-3 declined significantly (from 2.28 ± 0.97 to 1.44 ± 0.93) with p value 0.000. At a Cut-off point of > 1.1 ng/ml Glypican-3 has 93.3% sensitivity, 96.67% specificity, 96.6% PPV and 93.5% NPV for detection of HCC.

Conclusion

Glypican-3 can be a valuable diagnostic marker for HCC diagnosis and prognosis after various treatment modalities. And may be complementary to Alpha fetoprotein increasing overall sensitivity of HCC detection.
Association between Blood Ammonia Level and Severity of Portal Hypertensive Gastropathy in Egyptian Patients with Post Hepatitis C Virus Cirrhosis
Authors: Sayed Moataz Mohamed , Mohamed Eslam Safwat , Mohamed Marwa Ahmed , Hasan Al sayed Hasan Mohamed
Published: August 2023

Background

Cirrhosis often is an indolent disease; most patients remain asymptomatic until the occurrence of decompensation, characterized by ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, or variceal bleeding from portal hypertension. In most persons, approximately 80 to 90 percent of the liver parenchyma must be destroyed before liver failure is manifested clinically. When complications of cirrhosis occur, they typically are related to impaired hepatic function or actual physical disruption and re organization of the liver parenchyma.

Aim of the Work

The aim of this study is to assess the correlation between blood ammonia level and severity of PHG (to determine if serum ammonia level could be used as a non invasive predictor for severity of PHG). Also, to find out if there is a causal relationship between blood ammonia level and severity of PHG which encourage trials of ammonia-lowering treatments for the management of severe PHG with a tendency to bleed)

Patients and Methods

This case control study was conducted upon 100 Egyptian cirrhotic patients attending at Ain Shams University Hospital (gastroenterology and hepatology department) and Kafr –El Sheikh liver center after informed written consent.

Results

There was a significant difference between studied groups regarding ammonia levels, with a significant increase in serum ammonia level in group 1, group 2 and group 3 versus group 4 (Pvalue ˂ 0.001). There was a significant difference between studied groups regarding haemoglobin, Platelet count, serum albumin, INR, serum bilrirubin (P-value 0.006, ˂0.001, ˂0.001, ˂0.001, ˂0.001, ˂0.001 respectively). There was a significant difference between studied groups regarding SLD (P- value ˂0.001). Splenic longitudinal diameter can be used as a good predictor for OVs. There was a significant difference between studied groups regarding PVD, portal vein flow direction and PVV (P-value ˂0.001, ˂0.001,˂0.001 respectively). There was a significant positive correlation between blood ammonia level and Child Pugh score (P 0.004), PVD (P 0.005) and SLD (P˂0.001), but ammonia has a negative correlation with PVV (P ˂0.001). There was a positive correlation between PHG score and serumammonia level (r0.830, P ˂0.001).

Conclusion

Blood ammonia levels correlate with the presence, severity, and score of portal hypertensive gastropathy in cirrhosis
Evaluation of the Effect of Glycemic Control on Insulin-Like Growth Factor 1 and Growth in a Sample of Pre-Pubertal Egyptian Children with Type 1 Diabetes Mellitus
Authors: Botros Raef M , El-Sherbeeny Aliaa A , Barbary Nancy S El , Ali Hanan M , Abulayla Ala M
Published: August 2023

Background

Pre-Pubertal children with type 1 diabetes mellitus are shorter than their non- diabetic peers. We aimed to evaluate the role of HbAlc and IGF-1 in this phenomenon.

Methods

This study was a cross sectional study conducted on 80 prepubertal Egyptian children, divided into 30 Males and 30 Females with T1DM and 20 age matched controls (10 Males and 10 Females), the participants were recruited from the Outpatient Clinic of the Pediatric Department of Ain Shams University Hospitals and the National Institute of Diabetes and Endocrinology in Cairo, Egypt during the period from July 2018 to January 2019. Anthropometric measures including height and weight were obtained and used to calculate the height and weight percentiles using the CDC calculators. HbA1c as well as IGF-1 levels were tested.

Results

The mean age (years) of the participants was (9.781 ± 2.23) for male patients, (9.126 ± 2.199) for female patients and (8.437 ± 2.034) for controls. The height and weight percentiles (%) were found to be lower in the children with T1DM when compared to the disease-free controls with median values of 14.50 (IQR 27.98) in male patients, 17.95 (IQR 29.18) in female patients and 87 (IQR 20.58) in the controls. A negative correlation between serum IGF-1(ng/ml) and HbA1c (%) as well as height and weight percentiles (%), was found with (P = 0.014, 0.009 and 0.05 respectively). Serum IGF-1 levels were also found to be significantly lower in patients (P < 0.001) with a mean value of (77.60 ± 69.377) in male patients and (64.0 ± 29.402) in female patients and (201.0 ± 102.798) in the disease-free controls. HbA1c (%) was also found to be negatively correlated with height percentile (P = 0.012).

Conclusion

Serum IGF-1 levels (ng/ml) as well as growth are negatively affected in pre-pubertal children with T1DM in relation to the glycemic control.
Validation and Sensitivity of HCV Core Antigen in Patient with HCV Infection in Diagnosis and Monitoring Post DAA Therapy
Authors: Al Malatawy Mohamed Abd Alfatah , Alkelany Hesham Hamdy , Rafat Khalid Abd Alhamid , Sheta Alaa Mohamed Mohamed
Published: August 2023

Background

Successful eradication of hepatitis C virus (HCV) has great impact on the prognosis of HCV-related complications and the associated mortality. The development of the new directacting antiviral drugs (DAAs) has revolutionized the treatment of HCV infection. HCV core antigen (HCVcAg) is a recently developed marker that displayed a good correlation with HCV RNA assays,

Aim of the Work

to evaluate the clinical utility of hepatitis C virus core antigen in detection of chronic hepatitis C virus at pre-treatment and eradication of HCV post DAAs treatment using core antigen ELISA and detection of its sensitivity and specificity in comparison to HCV RNA,

Subjects and Methods

This was Cross sectional study, carried out at El Galaa and Kobri Al koba military hospitals on 90 Egyptian individuals, divided into 3 groups: (Group A); included 30 healthy individual with HCV Ab and HCV RNA negative as a control, (Group B); included 30 patients with chronic HCV infection in pre-treatment, (Group C): included 30 patients who have received anti HCV treatment (DAAs) 12 weeks post treatment,

Result

There were insignificant correlation between laboratory parameters of the patient group with HCV-cAg before treatment,

Conclusion

Fast and immediate results, lower costs of the technique are some of the main advantages of HCVcAg. Therefore, ELISA for HCV-cAg can replace the high sensitivity HCV RNA molecular assay to confirm the presence of HCV infection and to monitor treatment outcome especially in low-income countries with limited resources,
Neutrophils to Lymphocytes Ratio and Platelets to Lymphocytes Ratio as Predictors of Small Intestinal Lesions Detected by Video Capsule Endoscopy
Authors: Samy Amir Helmy , Saleh Shereen Abu Bakr , Ahmed Ghada Abd Elrahman , Hussein Alaa Salah Khaled
Published: August 2023

Background

Capsule endoscopy (CE), also known as wireless capsule endoscopy or video capsule endoscopy, is a gastrointestinal study that uses a pill camera to take images of the intestinal lumen.

Objective:

Patients and Methods

The study was conducted on 93 subjects from the Gastroenterology and Hepatology Department of Ain Shams University Hospital. They were divided into three different groups as following: Crohn’s disease group, arteriovenous malformation group and small intestinal tumor group. All patients and controls were subjected to routine laboratory tests and NLR and PLR was estimated.

Results

There was statistically significant difference between control group and AVM group and Crohn's group as regard N/L ratio, while this difference is less significant in tumor group patient. Receiver operating characteristic curve (ROC) shows that the best cut off point of N/L ratio to detect AVM group was found >1.97 with sensitivity of 67.74, specificity of 72.04% and total accuracy of 73%, and the best cut off point of P/L ratio to detect AVM group was found >158.02 with sensitivity of 61.29%, specificity of 96.77%, and total accuracy of 78%. Receiver operating characteristic curve (ROC) shows that the best cut off point of N/L ratio to detect Tumor group was found >1.97 with sensitivity of 45.16%, specificity of 72.04% and total accuracy of 59%, and Receiver operating characteristic curve (ROC) shows that the best cut off point of P/L ratio to detect Tumor group was found >145.83 with sensitivity of 32.26%, specificity of 91.40% and total accuracy of 62%. Receiver operating characteristic curve (ROC) shows that the best cut off point of N/L ratio to detect Crohn's group was found >2.44 with sensitivity of 100.0%, specificity of 84.95 and total accuracy of 96%, and Receiver operating characteristic curve (ROC) shows that the best cut off point of P/L ratio to detect Crohn's group was found >138.35 with sensitivity of 80.65%, specificity of 89.25% and total accuracy of 92%.

Conclusion

N/L ratio and P/L ratio can be used as non- invasive and cheap predictors for severity of crohn's disease, arteriovenous malformations and stage of malignancy in small intestinal tract.
Role of FGF21 in Gestational Diabetes Mellitus in a Sample of Egyptian Population
Authors: Sabry Inas Mohamed , Mahdy Maram Mohamed Maher , Ahmed Ammar Ramadan Abdelrahman , Nassim Mina Mikhail
Published: August 2023

Background

Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Gestational diabetes mellitus (GDM) affects approximately 5 to 7% of pregnancies and is associated with increased risk for fetal overgrowth, cesarean delivery, birth trauma, and pre-eclampsia.

Objective

To investigate serum FGF21 concentrations in a sample of Egyptian patients with GDM as compared with healthy pregnant controls matched for gestational age And its correlation to clinical and biochemical changes (Glucose, insulin, lipids) and fetal wellbeing using obstetric ultrasound to assess fetal size and development of congenital malformation.

Methods

This cross-sectional study was conducted on 80 participants collected from Obstetrics and Gynecology clinic at Ain Shams University Hospital during the period from November 2019 to March 2021.

Results

Shows that there is statistically significant increase in FGF21 in female pregnants with GDM as compared to female pregnants without GDM. The high FGF21 level didn’t affect fetal wellbeing. And both groups had normal fetal development with absence of macrosomia and congenital malformation as shown on results of obstetric ultrasound. In addition, there is statistically significant positive correlation between fasting FGF21 level and each of total cholesterol, LDL, HDL and TG (R +ve, P.< 0.05).

Conclusion

This high level of FGF21 may be FGF21 resistance or compensatory response to the underlying metabolic stress. FGF21 may have reduced an even higher level of blood glucose than the measured one, blood glucose level could have been in the Range of 400-500 mg/dl instead the measured range 200-300 mg/dl. Obstetric ultrasound results revealed normal fetal wellbeing and no change in fetal size nor development of congenital malformation between both groups.
The Use of Nuetrophil Gelatinase Associated Lipocalin (NGAL) as a Novel Marker in Early Diagnosis of Hepato Renal Syndrome in Advanced Cirrhotic Patients
Authors: Musa Nevine Ibrahim , Halima Ahmed Samir Abo , Allam Ahmed Samir , Okasha Amr Ahmed
Published: August 2023

Background

Acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome (HRS), is a common and serious complication in cirrhotic patients, leading to significant morbidity and mortality.

Objective

To predict value of serum and urinary NGAL as an early predictor of hepatorenal syndrome in cirrhotic patients.

Patients and Methods

The study was conducted on 60 participants with cirrhosis child C on Child-Pugh score, each one was investigated for both Urinary and Plasma NGAL level. Randomized controlled clinical trial. This study is a prospective, random, clinical trial conducted at Kafr El Sheikh Liver Institution

Results

Group I had Urinary NGAL ranged from 12 - 120, with a mean value of 61.45 ± 36.17. While group II A, ranged from 211-493 with a mean value of 379 ± 72.825. And in group II B, ranged from 306- 732 with a mean value of 438.05 ± 111.26. There was statistical difference between studied groups, p value <0.001. It was found that Urinary NGAL not only good predictor for early renal affection, but also it can differentiate between HRS and non HRS AKI due to the marked difference readings of its level in groups with renal impairment.

Conclusion

Both Plasma and urinary NGAL levels are markedly elevated in renal affection whatever the cause, so they are highly sensitive in detecting early renal impairment. However, the rate of elevation of plasma NGAL is so close in different types of AKI so it’s not advisable to use it alone to diagnose HRS. On the other hand, Urinary NGAL show noticeable differences between degree of elevation with different causes of AKI, so it’s somehow could be a trusted diagnostic tool to diagnose HRS.
Study for the Significance of Osteopontin vs Alpha Feto Protein as a Diagnostic Marker for Hepatocellular Carcinoma in Cirrhotic Patients with HCV
Authors: Mostafa Mohamed Abdelmoghny , Kaisar Hany Haroun , Ghait Ramy Samir , Aty Amr Salah El-din Abdel
Published: August 2023

Background

Outcome of hepatocellular carcinoma (HCC) depends mainly on its early diagnosis. The performance of traditional biomarkers is not satisfactory. Alpha-fetoprotein (AFP) is the most widely used serum biomarker for hepatocellular carcinoma (HCC), despite its limitations. Several studies have reported that osteopontin (OPN) is a promising marker for the diagnosis of hepatocellular carcinoma (HCC); however, some studies emerged with conflicting results,

Aim of the Work

To evaluate the clinical significance of the plasma osteopontin (OPN) versus alpha-fetoprotein (AFP) in the diagnosis of HCC in cirrhotic patients

Patients and Methods

This study was Case-Control study, was conducted at internal Medicine and Gastroenterology outpatient clinics and ward in Ain Shams University Hospitals on Patients divided into 3 groups: (Group 1): 50 patients with previously diagnosed HCC on top of chronic HCV induced cirrhosis, (Group II): 15 chronic HCV patients with cirrhosis, (Group III):15 healthy controls during a period of Six months

Results

There was high statistically significant difference between the studied groups as regard OPN and AFP,

Conclusion

Plasma OPN level was elevated in the HCV-related HCC patients by comparison to the chronic HCV patients with cirrhosis and healthy controls. OPN is a promising tumor marker that could be added to the current standard tests for the diagnosis of HCC in patients with liver cirrhosis, due to Chronic HCV infection, in order to detect the disease at an early stage and, hence, improve the prognosis and survival rates of these patients
Nitazoxanide Based New Regimens versus Metronidazole Standard Quardable Regimen as Rescue Therapy in Treatment of Resistant H. Pylori gastritis
Authors: Abd El-Aziz Hossam , Safwat George , Kader El-Nakeep Sarah Abdel , Mustafa Amr Samir Labeeb
Published: August 2023

Background

Helicobacter pylori (H. pylori) is a small, Gram-negative spirochete inhabiting the mucous layer overlying the gastric epithelial cells in humans. It is the most common prevalent chronic human bacterial infection estimated in 50% of the global population

Aim of the Work

This study aimed to evaluate the efficacy of nitazoxanide and doxycycline as a new regimen in treatment of H.pylori

Patients and Methods

A Prospective observational cohort study for each patient the time for antibiotic therapy for two weeks and continue PPI therapy for three months.

Results

In this study we found that there is insignificant difference between both studied groups as regards demographic data. This table shows that there is insignificant difference between both studied groups as regards smoking, chronic illness, main complaint and pelvic-abd US. In this study we demonstrated that there is significant difference between both studied groups as regards PLT and INR. In study in our hands, the eradication rates were found to be higher in LOAD therapy group compared to Concomitant therapy group (83.3% vs. 71.4%), Also there is insignificant difference between both studied groups as regards outcome (P = 0.03) In this thesis we found that increased age is independently associated with higher probability of cure (negative Ag in stool).

Conclusion

We concluded that LOAD therapy is preferable to clarithromycin-contained triple therapy in H. pylori infection eradication particularly in countries like Egypt with great clarithromycin resistance. This is at least until we can get the bismuth in our country. Recently, the increasing concepts about levofloxacin resistance and decreasing efficacy as a second line treatment directed us towards thinking in levofloxacin contained quadruple therapy including doxycycline and NTZ as alternative line of regimen therapy for better H. pylori eradication in our country. Further studies are needed on larger scale of patients, and culture and sensitivity tests are frequently required to evaluate the resistant emergent bacteria. Although culture and sensitivity might not be carried out, the detection of mutations by molecular methods provides an alternative way in which we can relay in the future.
Correlation between Gastrointestinal Symptoms Questionnaire and Findings of Upper Gastrointestinal Endoscopy in Gastrointestinal Disorders
Authors: Majeed Khaled Hamdy Abd El , El Fattah Allam Ahmed Samir Abd , El Hamid Raafat Khaled Mohamed Abd , Ahmed Asmaa Ibrahim Sayed
Published: August 2023

Background

Gastrointestinal diseases are among the most common problems in tropical countries and commonly manifest as diarrhea, abdominal pain, abdominal distention, gastrointestinal bleeding, intestinal obstruction, malabsorption, or malnutrition.

Aim of the Work

The aim of this work is to compare the efficacy of gastrointestinal Symptoms questionnaire and results of upper gastrointestinal endoscopy to create an optimally reliable tool for measuring the presence and severity of GI symptoms and to measure the symptomatic response to treatment more objectively.

Subjects and Methods

This study has been conducted on 100 patients complaining of gastrointestinal symptoms attending the gastrointestinal endoscopy unit in Faculty of Medicine, Ain Shams University hospital. All patients have been evaluated by upper GI endoscopy to measure the correlation between gastrointestinal symptoms questionnaire and upper GI endoscopy.

Results

There was significant correlation between gastrointestinal symptoms questionnaire and results of upper gastrointestinal disorders.

Conclusion

Gastrointestinal symptoms questionnaire is an easy used tool which can be used to measure the presence, severity of gastrointestinal symptoms and the symptomatic response to treatment more objectively.