bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and Efficacy of Day Case Tubeless Percutaneous Nephrolithotomy
Authors: Adel Mourad Mohamed Sherif , Mousa Waleed Elsayed , Abdelhameed Ahmed Himdan
Published: October 2021

Objective

to determine the outcome of day cases tubeless PCNL with only 12 hours hospital stay regarding vital data, postoperative bleeding and pain.

Materials and Methods

We prospectively reviewed 50 patients presenting to our university hospital with renal pelvic radioopaque stones less than 2 cm underwent tubeless PCNL discharged within 12 hours postoperatively. Operation time ,Occurrence of intraoperative complications and Post operative vital data , hemoglobin level were recorded

Results

All 50 patient ,16 female ,34 male patient underwent totally tubeless PCNL , intraoperatively , the operation time ranging from 45 to 85 minutes . postoperatively , the study revealed that 3 patients were found hypotensive( 6%), fever more than 38 degree occurred in 7 patients (14%) . Hemoglobin level dropped more than 1gm/dl in only 4 patients 8% , blood transfusion needed in only 2 patients , hospital readmission was needed by 7 patients (14%) within 1 week postoperatively. Outpatient follow up of the patients underwent daycase PCNL revealed that 39 patient returned to normal activities within 4 days (78%) but 11 patients took 4-7 days( 12%)

Conclusions

Tubeless PCNL is safe, feasible, and less morbid alternative to classic PCNL . decreased period of hospital stay , rapid return to normal social activities decreasing the economic burden regarding person and society.
Comparative Study between Percutaneous Approach and Transurethral Approach for Treatment of Urinary Bladder Stones
Authors: Taema Khaled , Awady Hossam Mohammed El , Mohammed El Shahawy Mahmoud
Published: October 2021

Purpose

The aim of this study is to compare outcome of percutaneous cystolithotripsy approach (pccl) vs transurethral cystolithotripsy approach (tucl) in treatment of large urinary bladder stones regarding efficacy, safety and peri-operative complications.

Methods

This study included 60 patients who had urinary bladder stone, treated at Ain Shams University hospitals in Egypt from March 2019 to March 2020 and randomly assigned into two groups: group A: percutaneous cystolithotripsy (PCCL) and group B: transurethral using nephroscope combined with meurmayer stone punch (tucl). Baseline and perioperative data were recorded and compared between two groups.

Results

Baseline parameters and the peri-operative complications (fever, transient haematuria, urinary bladder perforation, suprapubic wound infection and persistent leakage from suprapubic site) were compared between the two groups. Complete stone clearance was achieved in all the patients. The mean operative time in pccl group and tucl group was (30±7 min and 32±7 min) respectively. Urinary catheter duration in Pccl group was significantly more than Tucl group. Till the last follow-up, 6.6% patients (n = 2) developed urethral stricture in Tucl group.

Conclusions

PCCL is a safe procedure with acceptable morbidity and can be used as an alternative to tucl in treating (2-4 cm) urinary bladder stones.
Fecal screening of Dientamoeba fragilis: relative efficacy of permanent smear and culture
Authors: Abou-Gamra Maha M , Tawfik Rania A , Alkady Sara F
Published: October 2021

Dientamoeba fragilis (D. fragilis) is an enteric trichmonad protozoan parasite that remains obscure and neglected. The aim of this study is to detect D. fragilis as a neglected pathogen in children aged 6-12 years old complaining of gastrointestinal illness by stool culture and light microscopy with comparison between the results of both techniques. A total of 100 fresh stool samples were included in this current study. All specimens were subjected to microscopic examination using iron- hematoxylin stained stool smears and stool culture using a Loeffler’s culture medium. Culture detected 2 positive stool samples (2%) while microscopy detected (1%). Sensitivities of culture and microscopy were 100% and 50% respectively. Specificity of culture and microscopy were 100% and 95% respectively. There is a moderate agreement between culture and microscopy (K = 0.4). In conclusion, culture had a high performance compared to microscopy in the diagnosis of D. fragilis infection. Culture can be applied for routine diagnosis for the detection of D. fragilis in clinical samples.
Impact of Congenital Heart Disease on Growth of Down Syndrome Children (6-36 months)
Authors: Kotby Alyaa A , El Guindy Waleed M , Eissa Deena Samir M , Hussain Abeer Mohammed H
Published: October 2021

Background

Down syndrome (DS), the most common chromosomal abnormality is associated by congenital heart disease (CHD) in (44%) of cases. Children with DS might have different growth pattern compared to children without DS.

Objective

To assess the impact of congenital heart disease on the growth of Down syndrome children who attend the Genetic clinic, Children’s Hospital, Ain Shams University.

Materials and Methods

This case controlled study was conducted on 40 children with DS aged 6-36 months and compared to 40 age and sex matched healthy children. The DS children were divided in to two groups, the Cardiac Group: Included 20 DS children with CHD, Non Cardiac Group: 20 DS children without CHD. All children enrolled in the study were subjected to detailed history, thorough clinical examination including (anthropometric measurements (weight, height and HC) and cardiac examination.

Results

A statistically highly significant decrease was found in children with DS in comparison to normal children in all evaluated anthropometric measurements (P = 0.000) for weight, height, WT/length SDS, head circumference and Z-scores (weight, height and HC).A statistically highly significant decrease was found in DS children with congenital heart disease (cardiac group) in comparison with DS children without congenital heart disease (non-cardiac group) as regards weight (P = 0.002), Height (P = 0.000), head circumference (P = 0.000), Zscores (weight) (P = 0.001) and WT/length SDS (P = 0.001).

Conclusion

Children with trisomy 21 have well documented growth retardation. Congenital heart diseases have a negative influence on growth pattern in children with DS.
The effect of Head Covering on Phototherapy-Induced Hypocalcemia in Jaundiced Full-Term Neonates
Authors: Mohamed Amira Said , Abd El fattah Sherein M , Imam Safaa S , Shehata Basma M
Published: October 2021

Background

Phototherapy is the main method used in treatment of significant indirect hyperbilirubinemia and it reduces the risk of exchange transfusion. Hypocalcemia is one of the side effects of phototherapy due to inhibition of pineal gland via transcranial illumination, resulting in decline of melatonin secretion that further inhibits the effect of cortisol on bone calcium and ultimately increase the bone uptake.

Aim

To assess the effect of head covering to ameliorate hypocalcemic effect of different types of phototherapy in full term jaundiced neonates.

Patients and Methods

A prospective randomized controlled study that included 120 jaundiced neonates requiring phototherapy which divided into two main groups; group I (treated with lamp phototherapy) which was equally subdivided into two groups, group A (without head cover) and group B (with head cover) and group Il (treated with LED phototherapy) which was equally subdivided into group C (without head cover) and group D (with head cover).

Results

Head cover reduced the incidence of phototherapy induced hypocalcemia without affecting rate of decline of bilirubin on both types of phototherapy used. In lamp hypocalcemia (<8mg/dl) was detected in 33.3% in jaundiced neonates without head cover which was significant higher than those with head cover 6.7%. As for LED, yet not statistically significant hypocalcemia was detected in 13.3% in jaundiced neonates without head cover, which was higher than those with head cover 3.3%.

Conclusion

Incidence of phototherapy induced hypocalcemia is reduced by using head cover especially while using lamp phototherapy.
A study of heated, humidified high flow nasal cannula as an initial respiratory support in preterm neonates
Authors: Awad Hesham A , El-Farrash Rania A , Shinkar Dina M , Aly Yasmin A. F , Soliman Nanies , Alhassanin Arwa H.A
Published: October 2021

Background

There is an increased use of heated, humidified, high-flow nasal cannula (HHFNC) as a non-invasive respiratory support. Yet, there are limited data that compares it with nasal continuous positive airway pressure (nCPAP) as regard the efficacy & outcome when used for initial treatment in preterm infants with respiratory distress syndrome (RDS) shortly postnatal.

Method

A prospective study conducted aiming to evaluate the effectiveness & outcome of HHFNC compared to nCPAP for the treatment of preterm infants with RDS. Preterms < 35 weeks of gestational age with symptoms and signs of RDS early after birth were randomized to HHFNC or nCPAP. Primary outcome was the incidence of treatment failure (defined as need for upgrading to noninvasive positive pressure ventilation or invasive ventilation).

Results

Analysis of the randomly allocated infants to HHFNC and nCPAP showed no significant difference in treatment failure (P > 0.05). There was also no significant difference (P > 0.05) among groups as regard mortality, sepsis, necrotizing enterocolitis, incidence of interventricular hemorrhage and bronchopulmonary dysplasia.

Conclusion

This indicates that HHFNC may be used as an equally effective and safe method of non-invasive ventilation when compared to nCPAP for initial respiratory support in preterm infants with respiratory distress.
Neurocognitive Dysfunctions in Adolescents with Chronic HCV infection
Authors: El-Sayed Manal Hamdy , Habiby Mahmoud El , Mohammed Doaa Magdy , Ebeid Fatma Soliman Elsayed
Published: October 2021

Introduction

Globally, in 2015, an estimated 71 million people represented 1% of the world’s population including 5 million children, were living with chronic HCV infection, with the highest prevalence in the WHO Eastern Mediterranean region and the European region.

Aim

Primary objective was to assess the frequency of neurocognitive dysfunctions in children and adolescent with chronic HCV infection.

Subject and Methods

This prospective case–control study included forty adolescents with HCV recruited from the regular attendants of the Pediatrics Hospital, Ain Shams University and 20 healthy children from outpatient clinic. Psychiatric interviews and assessments were conducted by experienced qualified psychologist.

Results

Twenty adolescent with chronic HCV infection who fulfilled the inclusion criteria, were treatment naïve were recruited (Group1). They were five girls (25%) and fifteen boys (75%), their mean ages were 13.6 ± 2.37 years, were assessed before receiving Daclatasvir/Sofosbuvir, orally direct antiviral agents. They had statistically significant lower performance IQ and its subsets, verbal IQ and its subsets and total IQ as well as higher level of conduct, socializes aggression, attention problem, psychotic behavior, depression inventory and anxiety scale than control.

Conclusion

HCV may play a major role in cognition affection and the effect was more pronounced on the untreated HCV patients.
Estimation of D lactat level as amarker of bacterial translocation in gut failure incritically ill pediatric patients
Authors: Ibrahim Hanan M , Elgendy Eman I , Magdy Sondos M
Published: October 2021

Background

Sepsis is defined as life-threatening multi organ failure caused by a dysregulated host response to infection leading to development of gut failure, D-lactate is produced by indigenous bacteria in the gastrointestinal tract lactoferrin is important constitute of human milk and other body fluid act to improve gut function.

Aim of the Work

To test effect of lactoferrin supplementation for improving gut barrier function, prognosis and the outcome of septic patients using D lactate as a marker of bacterial translocation in sepsis with gut failure.

Patients and Methods

After ethical committee approval and informed consent from the parents, this double armed single blinded therapeutic clinical trial study was conducted on 40 Egyptian children admitted to PICUs of Ain Shams University Hospitals, by diagnosis sepsis and gut failure, twenty of them weren't supplemented with LF (group 1) and the other twenty were supplemented with it (group 2). D lactate level was measured in plasma using ELISA.

Results

The study show highly significant difference between Patient and control group in D lactate level, and we found no statistical difference before and after giving lactoferrin in our septic patient who weren’t in treatment of sepsis and gut failure. And we found plasma D lactate higher in non survivors with p value.048. and cut of point< 43.9 mmol\L

Conclusion

Lactoferrin supplementation was not beneficial in pediatric septic patient with gut failure and did not improve outcome or prognosis of patients, D lactate can be used as a predictor of intestinal failure severity and mortality. D lactate may be predictor of gut failure in sepsis and mortality
The Molecular Basis of Beta-Thalassemia Intermedia in Egyptian Children and its Association with the Clinical Phenotype
Authors: Ragab Iman Ahmed , El-Ghany Shereen Mohamed Abd , Kamal Tarek Mostafa , Elsayed Ghada Samir Abd El-Halim
Published: October 2021

Background

β-thalassemia syndromes involve a collection of extremely diverse phenotypes. The term β-thalassemia intermedia (β-TI) was suggested to describe patients who had clinical manifestations that are too severe to be termed minor thalassemia yet too mild to be termed major thalassemia. However, there remains substantial overlap between the three conditions.

Aim of the Work

To evaluate the variable clinical phenotypes among pediatric patients with βTI and to study the phenotype / genotype correlation with the encountered β-chain mutations.

Patients and Methods

A cross-sectional study was conducted on 37 Egyptian children and adolescents with TI following up regularly in the Pediatric Hematology clinic – Ain Shams University. Detailed Clinical evaluation and laboratory investigations were done. Reverse hybridization PCR based assay covering beta globin Mediterranean mutations onto specific biotinylated primers, was done.

Results

IVS 1.6 (T>C) was the most frequent mutation detected in 20 patients and 31 alleles (47.7%), followed by IVS 1.110 (G>A) detected in 7 patients and 8 alleles (12.31%), followed by IVS 1.1 (G>A) and CD27 knossos (G>T), each was detected in 6 patients and 6 alleles (9.23%). β+β+ was the most frequent genotype (54%), followed by β+β/β°β (21.6%) and β°β+ (13.5%). 60% of β°β+ patients had TDT(Transfusion dependent thalassemia), while 87.5% of β + β/β°β patients and 55% of β + β+ patients had NTDT ((Non transfusion dependent thalassemia).

Conclusion

Inheritance of mild β+ thalassemia mutations among Egyptian children; as IVS 1.6 (T>C) and IVS 1.110 (G>A) is the most frequent contributor to TI phenotype in either homozygous or compound heterozygous states. Patients with the same underlying genotype presented variable phenotypes with different degrees of severity.
Pollen Sensitization in Association with Allergic Rhinitis in preschool asthmatic Children
Authors: Hossny Elham M , Abd El-Lateef Hanan M , Salama Hadeer FM
Published: October 2021

Background

Grass pollens are significant elicitors of IgE-mediated allergic disease in the world and timothy grass (Phleum pratense) is an important pollen in allergy induction.

Objective

We sought to determine the rate of pollen sensitization in group of Egyptian asthmatic children with allergic rhinitis using timothy grass pollen as a potential triggering factor for allergic rhinitis.

Patients

and Methods

This analytical cross sectional study was conducted on a group of preschool children following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University during the period from December 2018 to April 2019. We enrolled 52 asthmatic children with concomitant allergic rhinitis sampled in a consecutive manner. They were subjected to skin prick testing for timothy grass pollen, positive histamine control and negative control.

Results

The study revealed high frequency of timothy grass pollen(TGP) sensitization occurring in 60.3% of patients with concomitant allergic rhinitis .wheal diameters pointed to sensitization only rather than actual allergy to TGP. TGP sensitization showed no significant correlation to disease duration. Children with rhinosinsuitis had comparable rates of TGP sensitization to those without rhinosinsuitis.

Conclusion

It is concluded from our results that sensitization to timothy grass pollen (TGP) is common in allergic rhinitis. The findings are limited by the sample size and consecutive manner of sampling. Wider scale studies are needed to accurately evaluate the frequency of timothy grass pollen (TGP) sensitization in our country.
Assessment of 25 Hydroxy Cholecalceferol Level in Autistic Children; is there a role for it in Treatment of Autism Spectrum Disorder?
Authors: Nakhla Martina Alfred Youssef , Zaky Eman Ahmed , Nabeh Enas Samir , El Aziz Asmaa Wafeeq Abd
Published: October 2021

Background

Autism is a group of neurodevelopmental disabilities with various genetic and environmental risk factors. Vitamin D is an important neurosteroid hormone which can affect brain development and function, but research on its use in treating autism has been limited.

Objectives

The current study aimed at assessing the level of 25 OH vit D3level in a group of autistic infants and children compared to controls and correlating it with the severity of autistic manifestations and evaluation of the role of therapeutic doses of vitamin D on the severity of autistic manifestations.

Methodology

Thirty autistic Egyptian children (group I) and 30 clinically healthy age and sex matched controls were enrolled (group II). Therapeutic doses of vitamin D were given for autistic children who showed insufficient levels of 25 OH cholecalceferol for a period of 4-6 weeks followed by maintenance doses for another 6 weeks. Psychometric and laboratory evaluation for this group was done thrice: at the onset of study, at 6 week after enrollment in the study, and at 12 weeks after that enrollment.

Results

Serum vitamin D level was substantially reduced in patients with ASD in comparison to control group, and on the other hand, 25 (OH) vitamin D level was significantly negatively correlated with ATEC score and Total CARS score. Autistic children who received vitamin D3 treatment had significant improvement of CARS and ATEC scores.

Conclusion

vitamin D supplementation significantly improved the outcome of enrolled autistic children. It is recommended to follow up our studied sample to check the consolidation of improvement for how long it will be needed.
The Effect of Ketogenic Diet on Neutrophil Count
Authors: Nassar May Fouad , El Gendy Yasmin Gamal Abdou , Hamza Mohamed Tarif , Mohamed Marwa Nasser , Radwan Nesrine
Published: October 2021

Background

The Ketogenic Diet (KD) is a high-fat, low-carbohydrate, and adequate-protein diet and a well-established treatment option for drug resistant childhood epilepsies. Neutrophils are important component of humans` innate phagocytic defense which usually arrive first at sites of infection and/or inflammation.

Objectives

The objective of this study was to assess the effect of ketosis induced by KD on neutrophils count.

Methods

This case control study was done in the Ketoclinic, Children’s Hospital, Ain Shams University, during the period of May 2018 till December 2019. It included 21 patients and 9 age and sex matched healthy children as a control group. Neutrophil counts were measured in both patients and controls both initially and after 6 months of KD usage.

Results

Although three patients reported increased incidence of infection after commencement of KD, the current study showed no significant change in the neutrophil count in studied patients compared to the controls after 6 months of KD.

Conclusion

KD has no effect on neutrophil number, however, further detailed studies for the full immunological profile including their function is needed to ensure that patients receiving this line of therapeutic nutrition aren`t susceptible to increased risk of infections.
Serum neutrophil-gelatinase associated lipocalin as a predictor of post-contrast acute kidney injury in children
Authors: Kotby Alyaa A , Nasef Marwa W , Kabiel Walaa A , Mohammad Yasser H , Elmaghrabi Rana M
Published: October 2021

Background

Diagnosis of post-contrast acute kidney injury (PC-AKI) by serum creatinine can be delayed because of various factors. A new biomarker neutrophilgelatinase associated lipocalin (NGAL) is postulated to be more sensitive for recognizing patients prone to PC-AKI.

Objective

To assess serum NGAL changes as an early biomarker of PC-AKI in children with congenital heart disease undergoing cardiac catheterization.

Methods

This observational study included 30 children with congenital heart disease who underwent cardiac catheterization at the Pediatric Cardiac Catheterization Unit, New Children’s Hospital, Ain Shams University. They had a median age of 30 months and 63% were females. Serum NGAL was measured just before the catheterization, 6hrs and 24hrs after contrast media administration while serum creatinine was measured before and after 24hrs of contrast media administration.

Results

Significant rise of serum NGAL was noted within 24hrs after contrast administration (p < 0.05) while serum creatinine showed a non-significant rise (p > 0.05). Serum NGAL was positively correlated with age, weight, height, body surface area and rate of contrast injection (p < 0.01). Higher levels of serum NGAL were found among patients who underwent diagnostic cardiac catheterization and those who received Midazolam for initial sedation during induction of anesthesia (p < 0.05).

Conclusions

Serum NGAL was elevated as early as 6 hours post contrast injection, however its serum level is affected by many factors. It’s important to be aware of other possible risk factors of PC-AKI rather than contrast media as type of cardiac catheterization and the anaesthetic Midazolam.
Visual field defect due to Hydroxychloroquine in systemic lupus erythematosus
Authors: Hossny Elham M , Abdel Latif Mona K , Radwan Nesrine M , Gah Al-Rassoul Rou’ya A
Published: October 2021

Background

Hydroxychloroquine (HCQ) is used in the management of a variety of autoimmune disorders, with well-established role in dermatology and rheumatology. However, Hydroxychloroquine and chloroquine (CQ) have been associated with irreversible visual loss due to retinal toxicity.

Aim of the Work

screening for field affection resulting from HCQ therapy in patients with SLE and assessing the diagnostic accuracy of the investigational methods employed.

Subjects and Methods

This is a cross-sectional controlled study that was carried out on 90 subjects (<18 years old). It included 45 physician diagnosed SLE patients taking HCQ for more than 1 year. A 45 age-matched healthy subjects were enrolled as a control group. Visual field assessment was performed by Central 10-2 visual field testing using automated Humphery perimetry.

Results

In comparison to the normal field in the control group, 13 out of 45 (29%) of the patients treated with HCQ had visual field defects most commonly in the central/paracentral area in-spite of no complaint.

Conclusion

HCQ can affect the visual field and this was not related to the cumulative dose of the drug. Regular field assessment should be done for patients on regular HCQ treatment.
The Relationship between Iron Deficiency Anemia and Dental caries
Authors: AbdelFattah Salahuldeen Hamid , Ibrahim Wafaa Ezzat , Fathy Rasha Adel , Abou-El-Fadl Reham Khaled
Published: October 2021

Background

Iron deficiency anemia and dental caries are among the most prevalent diseases in some developing countries. However, few studies have been conducted to assess the association between Iron deficiency anemia (IDA) and early childhood caries (ECC).

Objectives

The aim of the study was to assess the association between IDA and ECC.

Methods

40 children with proved iron deficiency anemia (using iron profile panel done initially) and another 40 healthy age and sex-matched children were examined by one trained and calibrated dentist where the oral status of all enrolled children was assessed in terms of the Decayed, Missing, Filled (DMF) index and

gingival health using Gingival index of Loe and Sillness.

Results

Children with anemia had a significantly higher DMF index (4.37±4.44) than children without anemia (0.50±0.90) (P < 0.001). It was found that there was a negative significant correlation between DMF index and the presence of anemia (r= -0.60, P < 0.001), hemoglobin level (r= -0.454, P < 0.001) and MCH level (r= -0.380, P = 0.001). The multiple regression model statistically significantly predicted DMF index (P = 0.001), (R2=0.34) and only the presence of anemia was found to add significantly to the model (P = 0.027).

Conclusion

Children with iron deficiency anemia have increased risk for development of dental caries than children without anemia. Any children with significant dental caries should be investigated for IDA and anemia should be treated if present.
Screening for Cow Milk Allergy in Infants and Preschool Children
Authors: El-Sayed Zeinab Awad , Abdel-Lateef Hanan Mohamed , El-Owaidy Rasha Hassan , Shaker Shady Sarwat
Published: October 2021

Background

Cow milk allergy (CMA) is the third most common food allergy that triggers anaphylactic reactions. Lactose intolerence, infantile colic and gastroesophageal reflux are the most common conditions which overlap with CMA causing both over and underdiagnosis. There are no wide population based epidemiological studies for the prevalence of CMA among Egyptian children. We sought to evaluate the prevalence of CMA among infants and preschool children and to correlate the parental reporting of CMA to the available diagnostic tools.

Methods

We conducted a cross sectional study that included 800 Egyptian children aged 3 months -5 years, who were enrolled consecutively from the primary care units and outpatient clinics of Children’s Hospital, Ain Shams University. Detailed history taking and clinical examination were done and those with suggestive history of CMA were subjected to further evaluation including skin prick test (SPT) and oral challenge test (OCT).

Results

The study comprised 390 girls (48.8%) and 410 boys (51.2%). Their weight centiles ranged between 5th and 97th percentiles, with median (IQR)=25(5-50) percentiles and mean(SD)=36.1(31.9). CM was introduced at age of 1-12 months, mean (SD): 9 (6) months with median (IQR): 12 (9-12) months. Forty (5%) subjects had suggestive history of CMA, 32 of whom completed their evaluation. The diagnosis of cow milk allergy was confirmed in 8/40 children (20%), comprising 1 % of the whole study sample. CMA was probably excluded at the time of the study in 21 subjects (52.5%), while diagnosis remained undetermined in 11/40 cases (27.5%) (8 refused to undergo SPT & OCT while 3 were lost to follow up).

Conclusion

The prevalence of CMA in Egyptian infants and preschool children is estimated to be around 1 % with possible overestimation of cow milk allergy diagnosis according to parental reports.
The Role of the Inflammatory and the Vascular Pathogenesis in a Model of Streptozotocin Induced Diabetic Neuropathy in Rats
Authors: Raafat Fatma A , Hasanin Amany H , Hendawy Nevien AF , Habeeb Eman MK , Hassan Ahmed N
Published: October 2021

Background

Peripheral diabetic neuropathy (DN) is one of the major health problems facing the whole world. There is no treatment that could completely reverse or prevent progression of DN except for good glycemic control. The inflammatory and vascular pathways are two main domains that are incorporated in the pathogenesis of diabetic neuropathic pain (DNP) and DN. Thus, targeting both of them could be an appropriate way to delay progression of DN.

Aim

To investigate the role of the inflammatory and the vascular pathogenesis in diabetic mechanical allodynia.

Method

Twenty male Wistar rats were divided randomly into naïve and diabetic groups (n = 10). Diabetes was induced through i.p injection of single dose of streptozotocin (STZ) (50mg/kg), then 8 weeks after induction of diabetes, the sciatic content of tumor necrosis factor alpha (TNFα) and vascular endothelial growth factor (VEGF) was assessed using ELISA technique. Additionally, the number of intercellular adhesion molecule-1 (ICAM-1) as well as CD31, the most specific vascular marker, positively stained vessels was counted manually in sciatic nerves cross sections. Whereas, DNP was assessed weekly throughout the experiment using 60%mechanical threshold of paw withdrawal test.

Results

There was a significant increase in the sciatic content of TNFα, VEGF and ICAM-1 positively stained vessels and a significant decrease in CD31 positively stained vessels in the diabetic group as compared to the naïve group. There was a correlation between TNFα, VEGF, ICAM-1, CD31 positively stained vessels in one side and the 60% mechanical threshold on the other side (r=-0.8, -0.9, -0.8 and 0.7 respectively).

Conclusion

The diabetic mechanical allodynia is negatively correlated to the sciatic nerve content TNFα, VEGF, ICAM-1 and positively correlated to the CD31.
The effect of Hyoscine Butylbromide on the rate of vaginal delivery in cases of secondary arrest of cervical dilatation: A rondomized controlled clinical trial
Authors: Elkady Mohamed Ahmed , Mansour Dina Yahia , Elshamy Alyaa Mostafa
Published: October 2021

Background

For decades, health providers have worked to manage labor actively and safely, with the goal of shortening the duration of painful labor. Reduction of cesarean sections and maternal complication is also an important aspect of labor management. Antispasmodic are commonly administrating during labor in both developing and developed countries, although there is a paucity of scientific reports validating this. Hyoscine butylbromide is an effective antispasmodic drug. Therefore, We aim to assess efficacy of Hyoscine butylbromide on rate of vaginal delivery in cases of 2ry arrest of cervical dilatation.

Objective

To assess whether the intravenous injection of hyoscine butylbromide is effective in progress of labor in which cases with 2ry arrest of cervical dilatation.

Patients and Methods

The study included 100 pregnant women (PG, P1, P2, P3) conducted at Ain Shams University Maternity Hospital, the inclusion Criteria were: term uncomplicated singleton pregnancy in a spontaneous active labor, with cephalic presentation. The patient must be free from any medical disorder associated with pregnancy and free from any obstetric complication. Cases were subdivided into 2 groups: Study group: 50 patients received 40mg iv Hyoscine Butylbromide (as Buscopan 20mg\mrl) when the cervix >4cm dilated and was >50% effaced. Control group: 50 patients received 2ml saline as placebo.

Results

Significant increase in vaginal delivery rate (72%) in Hyoscine group; compared to Saline group (52%); with significant statistical difference (p = 0.04). Highly significant decrease in 1st and 2nd stage labor time in Hyoscine group; compared to Saline group; with highly significant statistical difference (p < 0.05 respectively). These results observed without significant difference as regards 3rd stage labor time and postpartum hemorrhage (p > 0.05), APGAR score and NICU admission (p > 0.05).

Conclusion

From the current study we can conclude that HBB 40 mg is safe and effective in increasing vaginal delivary rate in cases of 2ry arrest of 12 dilatation. It is effective in decreasing first and second stage of labor. It has no maternal or neonatal adverse effect. It is easy and available.
Assessment of Risk Scoring Model for Prediction of Endometrial Cancer Among Symptomatic Postmenopausal Women (A Prospective Cohort Study)
Authors: Abd Elgawaad Magdy M , El Helaly Amr M , Faisal Malames M , Kasem Asmaa F
Published: October 2021

Background

Endometrial carcinoma is the most common gynecological malignancy in the developed countries and the third common gynecological malignancy in Egypt after breast and ovarian cancers.

Aim of the Work

to evaluate this risk scoring model on Egyptian patients and to study the effect of adding other patient characteristics (DM, BMI and relevant family history) on the sensitivity and specificity of RHEA scoring model.

Patients and Methods

The current study was conducted in Ain Shams University Maternity Hospital in the period between September 2017 and December 2018. A total of 100 women with postmenopausal bleeding and endometrial thickness > 4mm were included in the study.

Results

Histological examination revealed that benign pathology (n = 65) (73%) was found to be: most common cause was endometrial hyperplasia without atypia (20.3%) followed by chronic endometritis (13.5%), then endometrial polyp (11.3%), cystic atrophy of endometrium (8.9%), proliferative endometrium (8.9%), endometrial hyperplasia with atypia (6.7%) and lastly mucous polyp (3.4%) while malignant histopathology(n = 24)(27%) which is significantly higher than the international rates showed: Endometriod adenocarcinoma (n = 19)(21.3%), papillary serous carcinoma (n = 4)(4.5%) and undifferentiated carcinoma (n = 1)(1.1%). The current study showed that RHEA score performs in our study population with a comparable validity to that reported by its inventors with sensitivity 79.2% (57.8% - 92.9%) vs. 87.5% and specificity 84.6% (73.5% - 92.4%) vs. 80.1% respectively. In results of the current study it was found that the time since onset of menopause rather than age was associated with endometrial cancer with the optimum cut-off for postmenopausal duration was estimated to be 9 years achieving a sensitivity of 87.5% and a specificity of 60.0%, but it needs multivariate analysis on larger and more representative sample size to confirm this association, A statistically significant regression model was including only postmenopausal duration, recurrent bleeding and endometrial thickness. None of age, BMI, family history or hypertension proved a statistically significant predictive effect after adjustment for other predictive variables.

Conclusion

Taking in consideration the higher prevalence of endometrial carcinoma in the sample of the current study, the wide 95% confidence intervals for the different validity indices for the RHEA scores derived from this study, it seems that RHEA score performs in this study population with a comparable validity to that reported by its inventors.
Effect of Metformin on Chemical Pregnancy Rate in women with Unexplained Infertility (A randomized controlled trial)
Authors: Fathy Hisham M , BahaaEldin Ahmed M , Safwat Sarah , Mohammed Elham R
Published: October 2021

Background

There is controversy regarding treatment of unexplained infertility due to absence of specific pathophysiological rational which allows curative intervention. The main three lines of treatment of such cases are confrolled ovarian hyperstimulation, IUI with spontaneous or induced ovulation and third is IVF.

Aim of the Work

to evaluate the effect of metformin on chemical pregnancy rate in women with unexplained infertility. Patients and Methods: This was a prospective randomized controlled trial study which was conducted on 170 women with unexplained infertility in Ain Shams Maternity Hospital.

Results

:. Incidence of chemical pregnancy was not statistically sigfificantly different between both groups (PR: 18.8% vs.16.5% P 0.84) in metfonnin and clomiphene y•oup respectively. (NNT) was estimated to be 42.5.

Conclusion

our study showed little benefit was added to the patients by using metfonnin as adjuvant therapy to clomiphene citrate during ovulation induction as regards chemical pregnancy. 42 women are needed to be freated with metformin to get one more pregnant woman by pregnancy test
Effect of Follicular Fluid Estradiol Level on Oocyte Quality, Fertilization and Pregnancy Outcome in Intracytoplasmic Sperm Injection Cycles
Authors: Al-Kady Mohamed A , Mostafa Mohamed H , Mansour Dina Y , Mohamed Noha R , Ahmed Heba A , Rushdy Emad E
Published: October 2021

Background

Infertility is the third most serious disease worldwide estimated by the WHO. Despite the worldwide use of ICSI, it still has a low birth rate (30%).

Patients and Methods

The current study was a prospective study that included 180 women undergoing Intra-cytoplasmic sperm injection (ICSI) procedure. Using Flexible Antagonist protocol; during oocyte retrieval, follicular fluids of mature follicles (>17 mm) aspirated.

Results

The number of retrieved oocytes ranged from (1 to 33 oocytes) mean number 10±7. Follicular fluid E2 concentration ranged from 246±199 (0 to 700) (ng/ml). Oocyte maturation about 116 were MII (64.4%) of oocytes. And 64 (35.6%) were MI and GV. 107 cases (59.4) had normal fertilization lamos_zzzz@hotmail.com and 73(40%) had abnormal fertilization of MII injected oocytes. Embryo quality 63.9% (115) of fertilized MII oocytes were blastocysts and 65 (blastomere and others) and 60.6% of cases had embryo transfer on day 5 and 39.4 had transfer on day 3. Chemical pregnancy was positive in 85 cases (47.2%) and the clinical pregnancy positive in 66 cases (%).

Conclusion

Follicular fluid E2 concentration had fair predictive value in oocyte maturation, fertilization, embryo quality, chemical and clinical pregnancy. But it was an independent predictor of MII-grade oocytes production.
Cesarean section incisional infiltration with lidocaine and Epinephrine versus Lidocaine alone in reducing postoperative pain. A randomized controlled double-blinded clinical trial
Authors: El-Shahawy Hazem F , El-Mekkawi Sherif F , Mohmmed . Haitham F , Afifi Hend M
Published: October 2021

Background

Cesarean section delivery is becoming more frequent. Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation

Aim of the Work

to assess the efficacy and safety adding ef Epinephrine to lidocaine 2% in dose-related manner 1:200.000 in prolongation of anesthetic effect of lidocaine as a local anesthetic to reduce post; caesarean section pain after general anesthesia.

Patients and Methods

A total number of 200 women planned for elective caesarean section at Shams University Maternity Hospital Was recruited, 2 groups were randomized with a study group included 100 women received lidocaine 2% and epinephrine in dose-related manner and a control group included 100 women received lidocaine 2% only.

Results

women who received lidocaine and epinephrine were more satisfied and hadsignificant more time after caesarean section free of pain in comparison to women who received lidocaine only by 120 minutes. Also. adding Of epinephrine helped in decrease in amount of analgesic consumption after caesarean section. Women who received lidocaine and epinephrine started breast feeding and mobilization earlier than women who received lidocaine only. Epinephrine prolonged the action of lidocaine as a local anesthetic, this prolongation of action of local anesthetic had a significant effect in early mobilization and breast feeding and decrease in cost of analgesics. Nobody in our candidate had a post-operative infection, past operative pyrexia, Allergic reactions tar general anesthesia or complications with local anesthesia.

Conclusion

Adding of epinephrine to local anesthetics (such as lidocaine 2% in dose-related manner 1:200.0000) prolonged anesthetic effect by more than double of its original anesthetic time, This prolongation on anesthetic effect of local anesthesia by epinephrine helps in eariy mobilization; early breast feeding and less hospital duration stays. No complications (local nor systemic) developed with local infiltration of post-caesarean section incision with lidocaine 2% even aficr adding epinephrine in dose-related manner 1:200.000
Analysis of Cesarean Delivery at Ain Shams Maternity Hospital Using the Ten Group Classification System
Authors: Elzenini Hazem Amin , Mansour Radwa , Elnagar Ismail Mohamed Ismail
Published: October 2021

Background

Cesarean section is an invasive surgical procedure in which a baby is delivered through an abdominal and uterine incision & carries with it many immediate and delayed morbidity and mortality risks.

Objective

To evaluate the feasibility of using the Robson Ten Group Classification System (TGCS) for cesarean delivery indications at Ain Shams Maternity hospital.

Methods

This is a retrospective study on women who delivered by cesarean delivery at Ain Shams Maternity hospital between July 1, 2016 and June 30, 2018. All patient files have been revised and data has been collected then categorized. The indications for this mode of delivery: suspected fetal growth impairment, fetal distress, preeclampsia/eclampsia, pregnancy duration in weeks or more pre-partum hemorrhage, cephalopelvic disproportion, dystocia, failure of progress, multiple pregnancy, suspected/imminent uterine rupture, breech or other malpresentations, previous cesarean delivery, failed induction of labor, tubal ligation, sterilization, maternal request genital herpes, extensive condyloma, any other obstetric complication, any other fetal indication or any other maternal medical complication.

Results

15808 women delivered in the hospital during the study period, The CS rate was 58.04%. According to the Robson classification, Group5 and Group 10 were the most represented groups (31.72% and 29.91% of population, respectively). The major contributors to the CS rate were group 5 (27.10%), group10 (14.02%).The most commonly reported indications for CS included past CS, suspected fetal distress, preeclampsia, eclampsia.These suggested the need for further discussion on CS practices

Conclusion

This study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected.
Intravenous Dexamethasone Versus Vaginal Misoprostol in Enhancing Cervical Ripening and Labor Induction
Authors: Salman Mohamed Mahmoud , Salama Fekria Ahmed , Yacoub Mina
Published: October 2021

Background

Induction of labor is one of the most common procedures performed in the world of Obstetrics. Traditionally, labor induction is performed using prostaglandin and oxytocin. However, usage of corticosteroids nowadays is gaining a lot of interest regarding its effects on cervical ripening and shortening the physiological process of labor.

Aim of work

to evaluate the efficacy of intravenous dexamethasone versus vaginal misoprostol in enhancing cervical ripening and labor induction.

Patients and Methods

A randomized controlled clinical trial was carried out at Ain Shams University Maternity Hospital on (60) full term pregnant women between 39 – 42 weeks undergoing induction of labor, during a period from April 01, 2019 to November 30, 2019. Pregnant women were divided into two groups; vaginal misoprostol (control) group and intravenous dexamethasone (experimental) group (30 cases each).

Results

Our study showed that the mean time interval (hours) from initiation of labor induction to initiation of active phase was statistically significantly shorter among the dexamethasone (experimental) group 7.36 ± 2.23 versus 12.20 ± 4.92 hours among the vaginal misoprostol (control) group (p value < 0.001). Also, the mean time interval of the total duration between the induction of labor to successful vaginal delivery was statistically significantly shorter among the dexamethasone group 10.90 ± 4.17 versus 19.20 ± 5.62 hours among the vaginal misoprostol group (p value < 0.001). The results of this study showed the rate of initiation of active phase and rate of successful vaginal delivery were more in the experimental dexamethasone group than the control vaginal misoprostol control group.

Conclusion

Intravenous injection of 8 mg of dexamethasone before induction of labor is found to shorten the duration of labor induction by reducing the time interval between the initiation of labor induction and onset of active phase and the total duration from initiation of labor induction to delivery with no marked maternal or fetal complications.

Recommendations

Intravenous Dexamethasone can help cervical ripening and accelerate induction of labor. Further research should be taken in consideration with more population for more global evaluation.
Transvaginal sonographic assessment of the cervix for prediction of successful induction of labor in nulliparous women
Authors: Abd-Elhafeez Mohammed Abd-Elhameed , Elguindy Alaa Eldin , Hamed Mohamed Abu El Fetoh Mohamed , Nawara Maii
Published: October 2021

Background

Induction of labor is commonly performed in obstetric practice. Many methods have been suggested as good predictors of the outcome of labor induction, yet none of them is satisfactory enough.

Objective

To assess cervical length and uterocervical angle measured by transvaginal ultrasound as predictors of successful induction of labor.

Methodology

Prospective cohort study was conducted in a university-affiliated hospital over 150 nulliparous women undergoing induction of labor, in the period between May 2018 and August 2019. Transvaginal sonographic measurement of cervical length and uterocervical angle was done before induction of labor by prostaglandins. The patients were followed up till delivery and the outcome was recorded.

Results

The best cut-off value of cervical length for prediction of success of labor induction was 32.3 mm with 60% sensitivity and 56% specificity and the best cutoff value of uterocervical angle was 110.2 degrees with 87% sensitivity and 93% specificity. The cervical length showed a significant negative correlation while the uterocervical angle showed a significant positive correlation with the success of labor induction.

Conclusion

Cervical length and uterocervical angle are good predictors of successful labor induction.
Efficacy and Safety of Different Doses of Vaginal Misoprostol Prior to Intra Uterine Contraceptive Device Insertion: A Randomized Double-Blind Clinical Trial
Authors: Helmy Shaimaa G , El-Kadi Mohammed A , Elhodiby Mohamed E , Salama Mohamed H
Published: October 2021

Objective

This study aims to compare the efficacy and safety of different doses of vaginal misoprostol prior to IUCD insertion among women with nulliparous cervix “those who 29never delivered-vaginally”. Study design: The current study was a randomized, double-blind, placebo-controlled trial conducted in the Family Planning Clinic of Ain Shams University’s Maternity Hospital Egypt. It involved women who delivered only by elective CD (cesarean delivery). One hundred and eighty women were randomized into three groups, Group 1 received misoprostol 200 mcg. Group 2 received misoprostol 100 mcg. Group 3 received placebo. The primary outcome was pain scores which were measured using a visual analogue scale (VAS), the secondary outcome was the ease of insertion score (ES).

Results

VAS and ES were significantly lower in group 1 compared to group 2 and group 3 (P < 0.001).There was insignificant difference among the three groups as regards successful IUD insertion (P = 0.477). Duration of insertion was significantly lower in group 1 than group 2 (P < 0.001). Satisfaction was significantly higher in group 1 compared to group 2 and group 3 (P < 0.001)

Conclusion

The effect of misoprostol seems to be dose-dependent. Dose of 200mcg seems to be ideal with best efficacy and with no significant increase in the adverse effects Implications: The dose of 200mcg vaginal misoprostol prior to IUD insertion in women, who had never delivered vaginally before, seems to be the most effective dose. Trail to lower the dose to100mcg significantly compromises the efficacy without remarkable benefit on the side effect profile.