bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Study between Incremental Hemodialysis and Conventional Thrice Weekly Hemodialysis in Prevalent Hemodialysis Patients
Authors: El-Sayed Mady Gamal , Ezzat Abd-Elaziz Haitham , Tawfik Ahmed Mohamed , Ahmed Samah Ahmed Elsayed
Published: August 2023

Background

The concept of incremental dialysis is inherent to the increasingly accepted idea of a new patient-centered prescription of dialysis.

Objective

To compare the intervention arm (incremental HD) with the control arm (standard3 HD/week).Incident patients will be randomized to one of the two treatment groups in equal proportion. Primary outcome is the preservation of RKF assessed as time to anuria (UO < 100 mL/day). Secondary outcomes are all-cause mortality and significant events, including vascular access failure and associated interventions, cardiovascular events and hospital admissions.

Patients and Methods

Type of Study: Prospective cohort study. Study Setting: Multi centric patients selectionfrom hemodialysis units. Study period: 6 months.

Results

These findings support the assumption in hand, that a twice weekly regimen is in fact adequate for preserving the RKF. As regarding the occurrence of cerebrovascular events, chest pain, there were no statistically significant differences between the two groups. Arrhythmia was not recorded in the incremental group, while in the conventional group it was recorded in 2 patients with a percentage of 8.0%, and there was no statistically significant difference between the two groups; P-value was 0.490. As regarding the need for hospital admission, there was no significant difference between both groups. As regarding the occurrence of vascular access failure, it was recorded in 2 patients in the incremental group with a percentage of 8.0%, compared to 4 patients in the conventional group with a percentage of 16.0%. There was no significant difference between the two groups; P-value was 0.667.

Conclusion

HD, RCTs are lacking and are urgently needed. If the potential benefits of incremental HD will be confirmed by RCTs, then starting dialysis at a full dose will be subjecting patients to unnecessarily long or more frequent treatments for an unnecessarily long time, and at higher cost.
Comparison of Standard Fine Needle Aspiration versus Fine Needle Biopsy for Endoscopic Ultrasound Guided Sampling of Solid Lesions
Authors: Sayed Moataz Mohammed , Aziz Ayman Mohammed Abdel , Ragab Khaled Mohammed Abdelaziz , Abdelnaby Kareem Ahmed Mahmoud , Ahmed Shaimaa Youssef
Published: August 2023

Background

Endoscopic ultrasound (EUS) -guided tissue acquisition is the standard of care for the diagnosis of solid pancreatic lesions. Traditionally, sampling is performed through fine-needle aspiration and the diagnosis is made through cytology. The challenge in solid pancreatic lesions is that they are often fibrotic, with significant necrosis limiting the cellularity of samples obtained via fine-needle aspiration.

Aim of the Work

The aim of the current study was to compare fine needle aspiration versus fineneedle biopsy for the diagnostic yield of malignancy. - The secondary objectives are to compare fine needle aspiration versus fine-needle biopsy for: 1) The overall diagnostic yield from solid lesions. 2) The diagnostic yield from pancreatic and nonpancreatic solid lesions. 3) The crossover diagnostic yield. 4) The sample quality obtained by either the slow-pull or suction approaches, respectively.

Patients and Methods

This is a cross-sectional study, included 92 patients (52 male and 40 female), age ranges from (18-80 y); with indeterminate pancreatic lesions and gastric lesions selected randomly from April 2021 till March 2022 from the outpatient clinics of Theodor Bilharz Research Institute.

Results

The most common lesion founded in fine needle aspiration group by CT or MRI was Pancreatic soft tissue mass in 86.9% and in the fine needle Biopsy group was also Pancreatic soft tissue mass in 80.4% with a statistically difference in between. The most common lesion founded in FNA group by EUS was Pancreatic soft tissue mass in 73.9% and in the FNB group was also Pancreatic soft tissue mass in 89.1% with a statistically difference in between. The cytologic examination shows 60.8% of FNA group and 69.5% of FNB group are malignant lesions. the majority of the lesions were Pancreatic adenocarcinoma in the FNA group was 47.8% and in FNB group was 56.5%. The sensitivity was 97.8% versus 92.5%, specificity 96.4% versus 92.8%, PPV 95% versus 90%, NPV 100% versus 96%, and accuracy 97.2% versus 92.7% for FNA and FNB, respectively

Conclusion

EUS-FNA is superior to EUS-FNB in sampling pancreatic masses. EUS-guided FNA and FNB are safe, appropriate procedures that have comparable diagnostic accuracy for solid lesions within the gastrointestinal tract. The 22-G FNB needles are easy handling in anatomically challenging locations and required fewer needle passes to reach diagnosis.
Effect of Fasting Ramadan on Different Laboratory Parameters on Type 2 Diabetic Mellitus Patients
Authors: Amer Hanan Mohamed , Eid Yara Mohamed , Mahdy Maram Mohamed Maher , Kabany Yomna Neamt Allah A L
Published: August 2023

Background

Diabetes mellitus (DM) is one of the most common chronic diseases in nearly all countries, and continues to increase in numbers and significance, as changing lifestyles lead to reduced physical activity, and increased obesity. It has been estimated that by the year 2030, there will be 8.6 million adult with diabetes in Egypt, making it the country with the tenth largest population of diabetic in the world. Diabetes is associated with reduced life expectancy, significant morbidity due to micro and macro vascular complications and diminished quality of life.

Objective

To study the impact of Ramadan fasting on metabolic parameters and anthropometry in type 2 DM in Egypt.

Patients and Methods

This study was conducted on 80 type 2 diabetic patients who were intending to fast Ramadan. During Ramadan (2014) the average fasting hours were 15 h. Patients were recruited from the internal medicine outpatient clinic at Ain Shams University hospitals and from the nutrition institute. 6 Patients were under insulin treatment (Biphasic human insulin) & 74 patients were under oral hypoglycemic treatment {52 on combination treatment sulfonylurea + metformin & 9 on metformin only &13 of them were on sulfonylurea only}.

Results

We found that there was a statistically significant increase as regard lipid profile (serum triglycerides, serum total cholesterol, LDL-cholesterol and HDL-cholesterol) in after Ramadan measurement. Also CVD risk parameters have untimely increased after Ramadan this parameters including (10 years risk (Framingham score) systolic and diastolic blood pressure). In addition (Creatinine, HOMA IR and fasting insulin) showed increased level in after Ramadan measurement which indicate deterioration of blood glucose parameters. There was no statistical significant changes seen as regard anthropometric measures (BMI, WHR) in pre Ramadan and after Ramadan measurement. Also there was no statistical significant changes regarding fasting, 2 hours plasma glucose, A1c levels between pre-Ramadan fasting & after-Ramadan. In addition CRP and ACR showed no significant changes as regard measurement between before and after Ramadan.

Conclusion

Ramadan fasting appears to have significant effect on lipid profiles that could adversely impact cardiovascular outcome. These effects are mostly due to quality and quantity of food intake during Ramadan and the negative impact of sedentary life style. In addition the number of fasting days and period of daily fasting could affect glycemic control and renal function tests. Bad dietary habits, lack of exercise and irregular drug intake during Ramadan has a negative impact on glycemic control.
Radiological Assessment of Aphasia Outcome: A Case Report
Authors: Alloush Taha Kamel Taha , Emara Tamer Hussein Fahmy , El-Sudany Ayman Hassan Othman , Mahmoud Mostafa Khalf Ramadan
Published: August 2023

Background

Stroke is a leading cause of major adult disability, and aphasia is one of the most common consequences of stroke. It has been reported that 21%–38% of patients with stroke have aphasia in the acute stage.

Case presentation

A 64- year old Egyptian male diagnosed with recent ischemic stroke in the form of the form of inability to express himself in spoken words; Broca’s aphasia. Diffusion tensor tractography (DTT) was done to assess the integrity of the arcuate fasciculus in the acute stage as a method to predict the possible outcome of the patient aphasia. DTT showed affection of broca’s territory of the arcuate fasciculus (AF) and it could be reconstructed measured by fractionated anisotropy (0.469). The patient initial aphasia test measured (47). Three months later, the patient improved and follow up aphasia test measured (74.4).

Results

Reconstruction of the arcuate fasciculus by DTT in the early stage of aphasia as shown in our patient carries a good clinical prognosis. Our patient aphasia improved markedly at 3 months follow up visit.

Conclusion

DTT could be a helpful tool to assess the outcome of aphasia at the early stage of acute ischemic stroke.
Comparison between the Effects of Ultrasound Guided Local Insulin Injections versus Hydrodissection of Normal Saline in Carpal Tunnel Syndrome Patients with Diabetes Mellitus
Authors: Mohamed Muhyadin H , Al-sadek Ahmed M , Moustafa Ramez R , Mohamed Amr A
Published: August 2023

Background

Hydrodissection is a minimally invasive procedure of injecting fluid into anatomic spaces to facilitate dissection and adhesiolysis in peripheral nerve entrapments. The near-nerve local insulin injection is thought to promote neuronal growth and regeneration, and could be important in restoring nerve function following metabolic or vascular damage.

Aim of the Work

to compare the short-term effects of insulin and normal saline local injections in the treatment of patients with diabetes mellitus who have mild-to-moderate carpal tunnel syndrome.

Patients and Methods

A comparative study was conducted on 30 carpal tunnel syndrome patients with diabetes mellitus during recruited from Ain Shams University Hospital, Neurosonology, neurology department during the period January 2020 to March 2021 according to the regulation of Ain Shams University ethical and scientific committee. The privacy of participants and confidentiality of the data were guaranteed during various phases of the study.

Results

the Hydrodissection (10 ml of normal saline) of the median nerve is significantly effective in the treatment of mild to moderate carpal tunnel syndrome in patients with diabetes mellitus and alleviates the symptoms of CTS. Also the study showed that the local insulin injection (10 IU of NPH) alone is significantly effective in the management of mild to moderate carpal tunnel syndrome of diabetic patients, which shows significant response within two weeks of follow up. The study shows that Hydrodissection is slightly superior to insulin for treatment of CTS. Furthermore our current study compares the failure rate of both treatment modalities which implies that Hydrodissection group are less failure rate than insulin group, but this difference is insignificant due small sample size of both groups.

Conclusion

Hydrodissection and local insulin injection are effective methods in the management of mild to moderate Carpal Tunnel Syndrome of diabetic patients with superiority of ultrasound guided hydrodissection to Insulin. It is noteworthy this study is considered a pioneer in comparing HD and Insulin in managing CTS.
Post Stroke Epilepsy: The Prevalence and Predictive Factors among Egyptian Adults
Authors: ELNahas Nevine , Shokri Hossam , Fathy Mai , Allam Osama
Published: August 2023

Introduction

In Egypt, few epidemiologic reports have highlighted the burden of PSE although cerebrovascular strokes are the 3rd most common cause of death among Egyptians. In this study we aim to investigate the prevalence of PSE among Egyptian adults.

Materials and Methods

Patients who presented with strokes at ASU and ASUSH stroke centers from January 2016 till December 2019 were interviewed through phone call questionnaire and were asked about occurrence of PSE.

Result

Among the study population 450(64.3%) patients were hypertensive, 322(46%) patients were diabetic, 128(18.3%) patients had significant carotid stenosis,127(18.2%) were smokers,94(13.4%) were dyslipidemic, 83(11.9%) patients had atrial fibrillation

Conclusion

HTN and DM are the most common risk factors among patients with PSE.
Endoscopic Endonasal versus Conventional MicroscopicTranscranial Approach in Management of Patients with Supra-Sellar Meningiomas
Authors: Ghobashy Mohamed Ashraf , Elsayed Desouky Ahmed , Elgayar Abdel Rahman Hesham , Arakeep Ashraf Mohamed
Published: August 2023

Background

Meningiomas located at the anterior skull base are amenable to surgical resection. tuberculum sellae meningioma (TSM) originate in the sellar region, and similarly, account for approximately 5–10% of all intracranial meningioma. Although slow-growing, these tumors through mass effect upon, the optic nerve, pituitary gland and carotid arteries, can present symptomatically. The intention of surgery is to alleviate these symptoms without incurring neurological deficit.

Objective

To review and summarize available knowledge on the comparison between Endoscopic Endonasal versus conventional Microscopic Transcranial approach in Management of patients with supra-sellar Meningiomas with regard to clinical outcome and extent of tumor excision and complications.

Materials and Methods

This Systematic review/Meta-analysis included 10 studies from 2007 to 2019, all were retrospective studies summarize available knowledge on the comparison between Endoscopic Endo-nasal versus conventional Microscopic Trans-cranial approach in Management of patients with supra-sellar Meningiomas with regard to clinical outcome and extent of tumor excision and complications.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal).

Results

Gross total resection (mean, 95% CI: 1.12,2.66) Z = 2.47, (p0.01). Visual improvement (mean, 95% CI: 1.72,7.33) Z = 3.42, (p0.0006). CSF leakage (mean, 95% CI: 1.87,10.39) Z = 3.39, (p0.0007) Near total resection (mean, 95% CI: 0.28,1.0) Z = 1.95, (p0.05). Overall Complications (mean, 95% CI: 0.80,4.58) Z = 1.45, (p0.15). Recurrence (mean, 95% CI: 0.64,2.71) Z = 0.78, (p0.45). Mortality (mean, 95% CI: 0.34,5.78) Z = 0.46, (p0.64).

Conclusion

Supra Sellar Meningiomas is amenable to surgical resection. This can be performed by the traditional Trans-cranial Approach, or the Endoscopic Endo-nasal Approach with largely comparable operative outcomes. However, this meta-analysis demonstrated through direct comparative studies, that differences in postoperative complications do exist, where the Endoscopic Endo-nasal Approach is associated with lower likelihood of worse vision, and higher CSF leak, the Endoscopic Endo-nasal Approach was significantly better than trans-cranial approach as regard gross total resection. There was insignificant differences between two procedure in recurrence and mortality. Neurosurgeons caring for patients with these supra-sellar meningiomas should be prepared to offer an appropriate approach based on current available evidence involving the specific meningioma type.
Surgical Management of Sphenoid Wing Meningioma
Authors: El-Bahy Khaled M , Kabil Mohamed S , Ahmed Omar E , Hassan Hamdy T
Published: August 2023

Background

Sphenoid ridge meningiomas constitute about 11.9% of all intracranial meningiomas. In 1938, they were classified by Cushing and Eisenhardt into outer (pterional), middle (alar), and inner (deep, clinoidal) lesions. Despite technical advances in neuroimaging and microsurgical techniques, large meningiomas arising from the sphenoid wing still a surgical challenge.

Patients and Methods

Between May 2015 and October 2019, 40 patients with meningiomas primarily originating from sphenoid ridge were planned for surgical management either with total excision or subtotal +GKS or for GKS from the start,9 cases were lateral, 11 were meddle,14 were medial and 6 enplaque and we can summarize that in lateral and middle meningioma total excision is the main role in treatment as long as vascular structures are secured, while GKS playing essential role in medial group, small conviened lesions less than 3 cmm in maximum diameter could be treated directly with GKS, larger lesions subtotal excision as safe as possible is 1st step followed by GKS for residual, meningioma en plaque carry high incidence of recurrence as total excision is difficult and GKS could not treating hyperostotic bone.

Results

GKS plays a very essential role in treating medial sphenoid meningiomas (63.6%) while surgical incision is the golden standard management of other types of meningiomas (88.8%) in lateral and middle groups and (50%) in meningioma enplaque.

Conclusions

The surgical treatment of sphenoid wing meningiomas still represents a challenge for neurosurgeons. Surgery for sphenoid wing meningiomas poses a variety of problems reflecting the complex anatomy of the sphenoid region. The surgical decision for these tumors should depend primarily on clinical finding of the patient and radiological finding of the tumor. Location of the meningioma is an important factor determining the degree of tumor resectability. Encasement of MCA and their branches and extension into superior orbital fissure and cavernous sinus are limiting factors for radical removal.
Predictors of the Need for Cerebrospinal Fluid Diversion in Patients with Myelomeningocele
Authors: Abdelfatah Mohamed A R , Mamdouh Ibrahim Michael , Elsayed Abdelbar Ahmed , Khalil Hamdy Ibrahim , Elsayed Ali Nosseir Mohamed
Published: August 2023

Background

There is no consensus about the optimal timing and the criteria for cerebrospinal fluid diversion in children with myelomeningocele (MM). The aim of this work is to assess the predictors of the need for cerebrospinal fluid diversion in patients with myelomeningocele to avoid the unnecessary shunting with its complications.

Patients and Methods

This prospective study included fifty infants with myelomeningocele that were managed in the Neurosurgical department in Ain shams University hospital and October health insurance hospital from August 2016 till December 2018.

Results

In this study, 22 (44%) patients needed a shunt surgery after repair of the myelomeningocele. The age at presentation was highly significant (HS) for the need for shunt (P-value 0.006), with median age of 4.25 months. There were 22 cases (44%) that crossed the head circumference percentile for age while 28 cases (56%) matched; This was statistically highly significant (P-value 0.000). All patients with lax anterior fontanel (AF) or with mild bulge didn’t need a shunt, while all patients with tense AF needed a shunt (P-value 0.000). It was noticed that persistent vomiting was a sensitive indicator of the increased intracranial pressure since it occurred in all the cases who required shunt, this was statistically highly significant (P-vale 0.000). Four cases (8% of the cases) suffered from cerebrospinal fluid leak from the myelomeningocele wound within the first week post MM repair.

Conclusion

AF status & HC percentile for age represent the most reliable clinical signs to identify those who will need & benefit from a CSF diversion. The VP shunt should be preserved for cases exhibiting progressive signs of increased ICP (moderate to severe AF bulge- HC crossing percentile for age), while cases showing ventriculomegaly on imaging without signs of increased ICP should be followed up.
Comparative Study in Recurrent Disc Surgery between Posterior Lumbar Fusion with Interbody Fusion versus Posterior Lumbar Fusion Alone
Authors: Ali Ali Kotb , Saoud Khaled Mohamed , Farghaly Ahmed Roshdy , Mohammed Mohamed Abdel Moaty
Published: August 2023

Background

Although surgical treatment of lumbar disc herniation is successful in most patients, discectomy can lead to unsatisfactory outcomes, such as recurrent or increased and/or sciatic pain. Standard open discectomy is associated with a 5% to 20% failure rate

The main causes of this clinical entity, known as failed back surgery syndrome, include inadequate diagnosis, improper patient selection, inadequate surgical decompression (e.g. failure to recognize lateral recess stenosis, lateral disc herniation or sequestrated free fragments), recurrent disc herniation at the operated level or at another level, and epidural fibrosis. Recurrent herniation is one of the most common reasons for an unsatisfactory outcome and occurs in 5%–11% of surgically treated patients

Aim of the Work

is to evaluate and compare the results of recurrent disc surgery with transpedicular screw fixation alone and transpedicular screw fixation with interbody fusion using either in posterior lumbar interbody fusion (PLIF) or Transforaminal Lumbar Interbody Fusion (TLIF) techniques and outcome and complications of both techniques.

Patients and Methods

This study was 60 patients with recurrent lumbar disc herniation divided into two groups:

Group A

treated by a repeat discectomy with postero-lateral fusion and transpedicular screw insertion.

Group B

treated by a repeat discectomy with transpedicular screw insertion and interbody fusion either by (PLIF) or (TLIF).

Result

In Our study was conducted on 60 patients with first time recurrent lumbar disc herniation after exclusion of cases with disc herniation with other pathology such as (multi segmental spinal canal stenosis, adjacent level disc herniation, spondylolythesis, and spinal deformities). After a mean follow-up of 14.13 (±2.39 STD) months, in 30 patient undergo recurrent discectomy with pedicle screw fixation only, a mean follow-up of 10.50 (±1.81STD) months, in 30 patient undergo recurrent discectomy with pedicle screw fixation with interbody fusion. Considering these data, we can note that both pedicle screw fixation alone comparing it with in pedicle screw fixation with inter body fusion have comparable results when used with revision discectomy but PLF has significantly less total cost than PLF+Interbody fusion.

However, the complication occurs in pedicle screw fixation with inter body fusion is more than that occur in pedicle screw fixation alone, more time consuming in the theater and more total prosthetic cost.

Conclusion

repeat discectomy with posterolateral fusion and interbody fusion for true recurrent lumbar disc herniation with evident recurrent sciatica and low back pain is more effective than discectomy with posterolateral fusion alone.

Abbreviations

PLIF: posterior lumbar interbody fusion; TLIF: Transforaminal Lumbar Interbody Fusion
Efficacy of the Non-Surgical Treatment of Chronic Subdural Hematoma: A Systematic Review
Authors: Abdallah El Wardany Mohammed , AbdelFatah Mohamed Abdel Rahman , Ismaiel Ibrahim Abdelmohsen Abdelnaiem , El Shawady Sherif Bahaa Eldin Abdel Mohsen
Published: August 2023

Background

Chronic subdural hematoma (CSDH) is one of the most common neurological diseases. Surgical treatment is the gold standard treatment. However, the hematoma recurs in up to 25% of cases. In addition, many complications may occur after surgery. Despite the fact that conservative treatment for CSDH has grown in popularity, no medicine currently has level 1 evidence to back it up.

Objective

To figure out the efficacy of the non-surgical treatment of CSDH and to highlight its role in mildly symptomatic or asymptomatic patients.

Patients and Methods

The following electronic databases were searched for studies from 2000 to 2020: PubMed, Google Scholar, EMBASE, and Science Direct, using appropriate combinations of the following Keywords: chronic subdural hematoma, hemorrhage, CSDH, bleeding, non-surgical treatment, conservative management or treatment, alternative management or treatment, dexamethasone, steroids, corticosteroid, pharmacological treatment.

Results

Fifteen studies met our selection criteria. A total of 616 patients received medical treatment for CSDH. Their mean age was 70.49 years, including 468 males (76%) and 148 females (24%). Improvement of the presenting symptoms occurred in 477 patients (77.44%), and 139 patients (22.56%) required surgical intervention.

Conclusion

The results of the previous studies suggested that medical treatment in selected patients was a valid option as a primary treatment and as an adjuvant therapy with surgical evacuation for CSDH. Further randomized controlled studies with larger patient cohorts are needed to determine the true value of each drug in the conservative treatment of CSDH.
Pre-Operative Evaluation of Color Doppler Ultrasonography to Predict Malignancy in Ovarian Masses at Ain-Shams University
Authors: Harb Hesham , Husseiny Ahmed , Salama Mohamed , Elshawarby Hadeer
Published: August 2023

Background

Ovarian cancer is the second most common gynecologic malignancy in developed countries and the third most common gynecologic malignancy in developing countries. This cancer is characterized by high malignancy, difficult early detection, low survival rate, and high fatality rate. Transvaginal ultrasonography is the first choice for imaging to differentiate between a benign and a malignant adnexal mass.

Aim of the Work

The aim of the study is to determine predictive value of pre-operative resistance index (RI) of color Doppler of ovarian vessels in identifying potential ovarian malignancy at Ain Shams maternity hospital between May 2015 and May 2020.

Methods

this retrospective observational study, was done on total 379 patients who underwent laparotomy for adnexal masses at Ain Shams University hospitals over five years period between May 2015 and May 2020 with inclusion and exclusion criteria. Medical records of the study population were revised to assess demographic data, ultrasound criteria and histopathological result

Results

Thin wall and clear content are negatively correlated with ovarian malignancy and these correlators statistically significant. While presence of papillae and septation are positively correlated with ovarian malignancy and these findings were statistically highly significant. Masses proved to be ovarian malignancy were mostly unilateral, more than 5 cm size, thick wall, with turbid content, solid consistency, unilocular with papillae and septation. RI in our study was lower in malignant lesions ranging between (0.22–0.60) and the Mean±SD of resistance index values in the ovarian cancer (0.48±0.07). Resistance index at cut off value ≤0.54 had high specificity and negative predictive value but moderate sensitivity and positive predictive value in diagnosing ovarian malignancy.

Conclusion

As evident from the current study, thick wall, turbid content, solid consistency, papillae and septations were significantly most frequent in ovarian cancer. Resistance index was significantly highest in ovarian malignancy. In current study RI was lower in malignant lesions. From the results of current study we can conclude that the pre-operative resistance index (RI) of color Doppler of ovarian vessels had significant high diagnostic performance in predicting ovarian cancer. Resistance index at cut off value≤0.54 in diagnosis of ovarian cancer has sensitivity (85.2%), specificity (91.6%), accuracy (90.2%), positive predictive value (73.4%) and negative predictive value (95.8%).
Evaluation of Fetal Kidney Length in Relation to Femur Length as an Accurate Method of Estimation of Gestational Age in Third Trimester
Authors: AdDeen Mohammad Abd ElHameed Mohammad Nasr , Hemeda Hosam Mohammad Mohammad , Makram Mina Tharwat Nassif
Published: August 2023

Background

Accuracy in estimation of gestational age (GA) has become more demanding as technology used in ultrasonography has become more advanced. Patient’s expectations have also increased and they expect exact estimations to plan their pregnancies.

Aim of the Work

To compare the accuracy of fetal kidney length in relation to FL regarding to estimation of gestational age in third trimester.

Patients and Methods

In our study we concluded about 120 pregnant women who fulfilled the inclusion criteria and women who did not fulfil the inclusion criteria were excluded from the study. We compared the gestational age derived from the regression equation from Femur Length and Mean Fetal kidney length in regarding to the gold standard method of estimation the gestational age which is early ultrasound scan and dating between 7-11 weeks of gestation using the Crown Rump Length CRL.

Results

We found that gestational age from FL has an accuracy of ± 1.04 weeks (standard error of estimate [standard deviation of residuals] = 1.04 weeks) and good overall fit (coefficient of determination R2 = 0.869). And the gestational age from MKL has an accuracy of ± 0.82 weeks (standard error of estimate [standard deviation of residuals] = 0.82 weeks) and good overall fit (coefficient of determination R2 = 0.918).

Conclusion

Fetal kidney length has been studied and shown to strongly correlate with the gestational age in late trimesters.
Matching between Clinical and Dosimetric Results in Comparing Intensity Modulated Radiotherapy with Three-Dimensional Conformal Radiotherapy in Locally Advanced Lung Cancer
Authors: Abdullah Aseel Ibrahim , Abdelhafeez Zeinab Mohammed , Elsayed Amin Amin , Abdelaal Dalia Abdelghany , Elhefny Mohamed Mohamed
Published: August 2023

Background

Radiation therapy plays an essential role in the treatment of locally advanced lung cancer, but it inevitably leads to incidental and unnecessary dose to critical organs, including the lung, heart, and esophagus.

Objective

A dosimetric study to compare 3D CRT to IMRT in locally advanced lung cancer as regards normal tissue irradiation and target coverage using COSI & modified COSI indices, DVH, homogeneity index, conformity index, target coverage index. Also to evaluate acute and late toxicity of esophagus, heart and lung in three-dimensional conformal radiotherapy and intensity modulated radiotherapy, in patients with locally advanced lung cancer who received definitive concurrent chemo-radiation or sequential chemo-radiation according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Patients and Methods

20 patients were selected to participate in our retrospective study from 2014 till 2019. They were recruited from bronchogenic cancer clinic, clinical oncology department in Ain Shams University Hospitals using a convenient sampling method. Diagnosis of NSCLC or SCLC was confirmed histologically and further radiological assessment for TNM staging was performed. All patients where 18 years old or older and were prescribed for either combined or sequential chemoradiotherapy for treatment of locally invasive lung cancer with ECOG PS equal or less than 2. They received 3D CRT of total 60 Gy. On the same CT contour defined for 3D CRT another plan was done for IMRT by computer based inverse planning with specific dose constrains to surrounding organs.

Results

In our study IMRT technique helped in sparing doses delivered to heart, lung & esophagus in comparison with 3D CRT, but it was statistically significant for the lung only with p-value = 0.003. As regard the dosimetric indices IMRT showed better target coverage, dose homogenity & dose conformity in comaparison with 3D CRT, but it was statistically significant for CI with p-value= 0.028. Using the COSI & mCOSI also was in favor of IMRT but it was stastistically significant in mCOSI with pvalue=0.023

Conclusion

IMRT showed superior outcomes as regards delivered doses (both to target and at-risk organs) compared to the conventional 3D CRT achieving the main purpose for patients with locally advanced lung cancer receiving chemoradiothrapy which is better target volume coverage and less unnecessary dose to at-risk nearby vital organs. As IMRT spares OAR it’s expected that clinical toxicity noticed with 3DCRT will be less thus, more tolerability to CCRT.
A Meta-Analysis of Changes in the Retinal Thickness and Vasculature after Phacoemulsification Surgery
Authors: Gaafar Ayman A , Eliwa Tamer F , Wessam Moataz M , Jibreel Aeshah A
Published: August 2023

Background

Phacoemulsification is the most popular cataract surgery nowadays. However, phacoemulsification provokes discharge of pro-inflammatory molecules not only affecting the anterior but also posterior eye segments.

Aim of the Work

the aim of the study was to evaluate through the available literature the correlation between cumulative dissipated energy and total ultrasound time in one hand, and retinal thickness and vasculature in the other hand after phacoemulsification surgery through systematic review and meta-analysis.

Subjects and methods

This meta-analysis study included randomized controlled trials and retrospective or prospective observational studies evaluating the correlation between cumulative dissipated energy, and total ultrasound time and retinal thickness and vasculature after phacoemulsification surgery. In this systematic review a thirty studies were included in the period from 2006 to 2020 with 29 prospective studies and one Quasiexperimental study.

Results

The mean preoperative central foveal retinal thickness (μm) was 232.6±25.8(μm) and increased to 243.66±29.2(μm) Postoperatively. Mean preoperative average RNFL thickness was 89±10.2 (μm) and increased to 96.6±10.0 (μm) postoperatively. mean GCL thickness (μm) was 80.56±60(μm) preoperatively and increased to 84.74±7.20(μm) postoperatively. parafoveal perfusion density percentage was 0.28% pre-operative and increased post- operative to be 0.29%, the pre-operative perifoveal perfusion density percentage was 0.45% which increased post-operatively to be 0.53%, the pre-operative peripapillary perfusion density percentage value was 0.49% which increased to 0.53% post operatively.

Conclusion

the retinal vessel density and vascular perfusion were found to be increased significantly in both macular and peripapillary areas p = 0.003. This increase was accompanied with changes of retinal layer thickness p = 0.00001.
Prevalence of Diabetic Retinopathy in Adult Diabetics at National Institute of Diabetes and Endocrinology in Cairo
Authors: El Rahman Gaber Salman Abd , Rehan Raafat Ali , El Fatah Hatem Fawzy Abd , Mohamed Aml Shehta
Published: August 2023

Background

Type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes worldwide. The prevalence of type 2 diabetes is high and increasing across all regions worldwide. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus. It is one of the leading causes of blindness in the working age population and has a great economic impact on society especially on healthcare systems. Optical coherence tomography (OCT) and fundus photography are noninvasive examinations that help the clinician to observe signs of neurodegenerative changes in the retina and detects neuroretinal changes in the early stages of DR and DME.

Aim of the Work

The aim of our study was to estimate the prevalence and severity of diabetic retinopathy among patients with diabetes mellitus type 2 over 30 years old they will be screened clinically and by fundus photography and optical coherence topography at national institute of diabetes and endocrinology.

Patients and Methods

This study included 600 eyes from 300 patients. Diabetics were recruited from patients recruited from National institute of Diabetes and endocrinology in the ophthalmic clinic. It was designed as cross sectional hospital based study. This study conducted to estimate the prevalence and severity of diabetic retinopathy and diabetic macular edema among patients with diabetes mellitus type 2 over 30 years old. Using fundus photography and optical coherence topography (SD-OCT) at National Institute of Diabetes and Endocrinology.

Results

The findings of our study showed that the prevalence of DR irrespective to type was 34% of studied eyes. Also it revealed that 22.3% of studied eyes had diabetic macular edema. Non-proliferative diabetic retinopathy in our study was more common than proliferative diabetic retinopathy. The prevalence of nonproliferative diabetic retinopathy in DR patients in our study was (72.5%) but proliferative diabetic retinopathy (27.5%) in DR patients. The commonest type was mild NPDR (33.3%). There is a strong relation between duration of DM, control of HbA1c, age, treatment with insulin and DR and DME. The longer duration of DM and high levels of HbA1c considered main risk factors of DR and DME.

Conclusion

The prevalence of DR and DME were 34%and 22.3%, respectively of studied eyes in ophthalmology clinic in National Institute of Diabetes and Endocrinology. These data highlight the substantial public health burden of DR and DME. Old age, Insulin treatment, poor control and the longest duration of DM patients groups are more liable to develop DR and DME.
Efficacy of Intravitreal Bevacizumab in management of Chronic Central Serous Chorioretinopathy: A Meta-Analysis of Prospective Studies
Authors: Samuel David G , Mahgoub Mohamed M , Habib Ahmed M , Karim Marwa A
Published: August 2023

Background

Central serous chorioretinopathy (CSC) is described as a chorio-retinal disease, associated with the serous detachment of the neurosensory retina and/or retinal pigment epithelium (RPE) most commonly seen in the macular region.

Aim of the Work

To evaluate the efficacy of Bevacizumab, an intravitreal vascular endothelial growth factor antagonist, in treatment of chronic central serous chorioretinopathy by conducting a Meta-Analysis of the available data from prospective studies.

Materials and Methods

A comprehensive literature search was conducted using the databases Google scholar, PubMed, MEDS, web of science, EMBASE and Cochrane Library for published studies till June 2021.This meta-analysis included eight studies. They were prospective studies, six of them were case series and the remaining two were randomised controlled trials (RCTs). 105 patients with chronic CSC (105 eyes) participated in these studies.

Results

This study demonstrated a statistically significant change in the mean of best corrected visual acuity (BCVA) improvement and central macular thickness (CMT) reduction when comparing the baseline to one- three- and six-month follow-ups after the injection. No adverse effects were reported in any of the included studies.

Conclusion

Intra-vitreal injection of bevacizumab is an excellent alternative and conceivable treatment among currently available treatment options for chronic or recurrent or refractory cases of central serous chorioretinopathy.
Anterior Segment Optical Coherence Tomography (OCT) Assessment of Corneal Epithelium and Tear Film in Psoriasis Vulgaris
Authors: Kamel Dina Tarek Mohamed , Shafik Wahba Sherine , Abd El Rahman Sameh Hany , Soltan Marwa Yassin Ahmed , Ashour Doaa Maamoun
Published: August 2023

Background

Psoriasis is a chronic inflammatory skin disease with a strong genetic predisposition and autoimmune pathogenic traits. Psoriasis has multiple ocular effects; dry eye disease (DED) being one of the most important.

Aim of the Work

The aim of this study is to evaluate corneal epithelial changes using anterior segment OCT and tear film changes in patients with psoriasis vulgaris by comparing the findings with healthy matched controls by conducting a case control observational study.

Materials and Methods

A cases control observational study that included 30 patients with psoriasis vulgaris, one eye from each patient and 30 control healthy subjects. Dermatological assessment that was done by an expert dermatologist for full history taking including drug history, confirmation of diagnosis, severity assessment using psoriasis area and severity index score (PASI score). Ocular history taking including name, age, medical history, previous ocular trauma or surgery, Schirmer test, and anterior segment OCT were done with assessment of the central corneal thickness and corneal epithelial mapping among both groups.

Results

The study demonstrated that there was no statistically significant difference between patients’ and control groups regarding their Schirmer test results and epithelial map parameters. Patients with a lower central corneal thickness showed a significantly lower central epithelial thickness with a p-value (<0.05).

Conclusion

There is no significant change in the Schirmer test results and the anterior segment OCT corneal epithelium map among patients with psoriasis vulgaris and their healthy controls. But there is a positive correlation between the central corneal thickness and central epithelial thickness in psoriatic patients with pvalue (<0.05).
Evaluation of Retinal Toxicity by SD-OCT due to Long-Term Exposure to Hydroxycholorquine among Rheumatoid Arthritis Patients
Authors: Bakr Hoda Mohammed Abu Bakr Abu , Atef Caroline , Hamdy Khalid Mahmoud , Raslan Osama
Published: August 2023

Background

Hydroxychloroquine is used increasingly in the management of a variety of autoimmune disorders, with well-established roles in dermatology and rheumatology and emerging roles in oncology. However, Hydroxychloroquine and chloroquine (CQ) have been associated with irreversible visual loss due to retinal toxicity. Cessation of the use of hydroxychloroquine at an early stage of damage might prevent functional loss; however, after maculopathy has developed, cessation of the drug does not show clinical recovery. Because discontinuation of Therapy may reverse retinal toxicity, early detection of toxicity changes is vitally important.

Objective

to evaluate the involvement of retina in hydroxychloroquine (HCQ) retinopathy among rheumatoid arthritis patients using data from spectral domain optical coherence tomography (SDOCT) and to correlate toxicity with dose, duration of use and cumulative effect of HCQ.

Patients and Methods

Cross sectional Study. In total 13 patients (26 eyes) attending the rheumatological outpatient clinic of El Demerdash hospital, from October 2019 to February 2020 were enrolled in the study after the approval of the research ethical committee in the Faculty of Medicine, Ain Shams University. A full history was taken from the patients and full ophthalmological examination was done. In our study we perform OCT for all patients by using the Nidek RS-3,000 Advance SD-OCT with the “Macula Map” protocol that imaged a 6 × 6 mm area with 64 raster B-scans, each composed of 1024 A-scans.

Results

The study showed that was highly significant negative correlation between duration of exposure and CMT (p-value =0.008) and highly significant negative correlation between cumulative dose and CMT (p-value =0.005). Also, there was statistically significant negative correlation between age and thickness of inner and outer nasal quadrant (p-value= 0.015, p-value= 0.001) respectively and between age and inner and outer superior quadrant (p-value= 0.048, p-value= 0.000) respectively, in ETDRS thickness map. It also found statistically significant negative correlation between daily dose and thickness of outer nasal quadrant of thickness map (p-value= 0.045).

Conclusion

The present study show the presence / absence of retinal toxicity in rheumatoid arthritis patients use hydroxychloroquine for 5years or more using SD-OCT and found a statistically significant negative correlation between central macular thickness and cumulative dose of HCQ and between central macular thickness and duration of HCQ use.
Evaluation of Corneal Endothelial Cell Density Changes in Eyes with Silicone Oil Tamponade after Pars Plana Vitrectomy
Authors: Afify Mohamed A M R , Assaf Ahmed H , Rehan Raafat Ali , Elnashar Hazem Abdallah , Karim Marwa A
Published: August 2023

Aim

To assess the changes in corneal endothelium by non-contact specular microscopy in eyes treated by pars plana vitrectomy (PPV) with temporary silicone oil (SO) tamponade with or without phacoemulsification.

Patients and Methods

We enrolled 24 patients, assigned into two groups: 12 patients underwent pars plana vitrectomy with SO injection (group 1) and 12 patients underwent combined phaco-vitrectomy with SO injection (group 2). All of them underwent an ophthalmological examination, which included: best corrected visual acuity (BCVA), intraocular pressure measurement, fundus examination and specular microscopy follow ups at the 1st week,1st month and 3rd month visits.

Results

The initial count of endothelial cell density (ECD) in group 1 was 2543.58 ± 759.62 cell/mm2 which decreased at 3rd month visit to 2299.33 ± 729.87 cell/mm2, while in group 2 was 2621.08 ± 514.50 & 2307.50 ± 575.55 cell/mm2 respectively. We found statistically significant decrease in the mean cell density (MCD) in group 1 and group 2, at the 3rd month than at the 1st week. Three months after operation, coefficient of variation (CV) was 34.58 ± 4.29 % and 35.75 ± 4.16%, hexagonality (HEX) was 46.83 ± 8.67 % and 47.83 ± 10.50%, while mean central corneal thickness (CCT) was 553.08 ± 22.13 μm and 548.17 ± 33.12 for group 1 and 2 respectively, and no corneal edema reported at the study end.

Conclusion

The pars plana vitrectomy (PPV) with silicone oil (SO) injection procedure caused changes in corneal endothelial cells in varying between pleomorphism (decreased HEX), polymegathism (increased CV) and endothelial cell loss. A higher incidence of CV increase (polymegathism) reported after combined phaco-vitrectomy than pars plana vitrectomy alone with silicone tamponade. We recommend SO removal after achieving the proposed tamponading action of SO to avoid SO keratopathy.
Longevity of Cemented Total Hip Replacement in Patient Younger than 50 Years Systematic Review and Meta-Analysis
Authors: Kamel Ahmed Samy , Mohassab Ahmed , Mohammed Abdulrahman Hossam
Published: August 2023

Background

Total hip replacement is a common and highly effective operation. All hip replacements would eventually fail if in situ long enough and it is important that patients understand when this might happen.

Aim and objectives

to perform an evaluation and meta-analysis of all available trials and studies demonstrating the different clinical outcomes following cemented total hip replacement in patients younger than 50 years.

Subjects and Methods

This study is Published observational analytical studies (Case-control, case reference or cohort studies) on the outcomes of cemented total hip replacement in patients younger than 50 years. Trials which involve English papers from the year 2000 till 2021. Only studies on human subjects younger than 50 years were included.

Result

19 studies were included from 2000 to 2021. There was statistically significant heterogeneity in the studies (I288.47%, P < 0.0001). Using the random effects model, total Event rate for revision was 17.847% (95% CI: 12.834 – 23.485).

Conclusion

this study demonstrates good comparable outcomes for young patients having cemented both components THR. The trend towards using expensive uncemented fixation may be driven largely by marketing and ease of prosthesis insertion rather than real world performance gains for the patient. A THR with a cemented socket offers good outcomes to patients.