bluuebunny/crossref_metadata_2025 huggingface dataset:
Intestinal Ultrasound in Diagnosis and Follow up of Patients with Crohn’s Disease
Authors: Bakr Saleh Shereen Abou , Ahmed Ahmed Almetwally , Abd El-Hafez Esam Mohammed , Hajaj Mahmoud Mohamed
Published: July 2024

Background

Crohn's disease (CD) causes transmural ulceration of any section of the gastrointestinal tract (GI), with the terminal ileum and colon being the most commonly affected.

Aim of the Work

The aim of this study is to assess the sensitivity & specificity of Intestinal ultrasound In diagnosis and follow up of patients with Crohn’s Disease, and related possible complications.

Patients and Methods

A Cross sectional study in Gastroenterology Department of Ain Shams University Hospitals for 30 Patients with Crohn’s disease and The Patients were selected from inpatient and outpatient clinic of gastroenterology department of Ain Shams University Hospitals, in the period from July to December 2021.

Results

The present study revealed that the mean age of our patients was 54.3± 7.69 years with range from 38-68 years. Male cases were more than females ones, as (70%) were males while (30%) were females, with male to female ratio was 2.33: 1. The present study revealed that the mean hemoglobin level was 11.66 ± 1.46 mg/dl, and the mean RBC, 4.18±0.48. The mean platelets was 267.73±61.94 (K/UL), mean WBCs was 9.94 ± 1.83 (K/UL), neutrophils was 7648.57 ± 1460.02 (/UL), and lymphocytic count was 1356.50 ±469.30 (UL) and neutrophil/ lymphocyte ratio (NLR) was 5.93 ±1.35. Regarding the renal function tests and electrolyte profile, the mean serum urea, creatinine and uric acid were 46.43-±10.18, 1.10-±0.25 and 5.30-±0.68 mg/dl respectively. The mean levels of Na and K were 140.43 ±3.50 and 3.82±0.26 mEq/L respectively, the mean AST was 37.63 ±8.27 U/L, the mean ALT was 26.30 ±8.36 U/L, the mean total bilirubin was 1.01±0.17 mg/dl and the mean direct bilirubin was 0.60 ±0.27 mg/dl. We found that the mean PT was 14.17±2.65 sec. and the mean Serum Albumin was 4.16 ± 0.29 g/dl. In this study the mean CRP was 4.91 ±4.55, the mean ESR at first was 21.67 ±4.22 and 2nd hour was 47.43±10.94.

Conclusion

Crohn's disease (CD) is a progressive, inflammatory disease that occurs in genetically predisposed individuals and necessitates continuous monitoring and development of various methods for diagnostic and therapeutic treatment options, as well as the discovery of new medications. While colonoscopy is the gold standard in CD, US, CT and MRI, can provide information not only about the luminal side of the bowel but also about the serous side and the peripheral structure; additionally, US is repeatable, safe, and well-accepted, but unlike CT is radiation-free, and unlike MRI is inexpensive, virtually hazard-free, and available to all patients without contraindications.
Post Covid-19 Vaccination Immune Response in Hemodialysis Patient Compared to Normal Population
Authors: El Sayed Hesham , Halim Aber , Elbraky Abdelrahman , Ibrahim Ghada Atef
Published: July 2024

Background

The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged viral shedding, but generally develop a robust and long-lasting humoral immune response that correlates with initial disease severity. However, protection against reinfection is incomplete.

Aim of the Work

This study aimed to studying the immune response to COVID-19 Viruse vaccination in hemodialysis patients compared to the normal population

Patients and Methods

This study is a prospective case control study which include 40 prevalent HD patients received COVID-19 vaccination in haemodialysis units, Ain Shams University Hospitals. In comparison to 20 healthy control individuals who also received COVID-19 vaccination.

Results

Our study showed that there was no statistically significant difference between the studied groups as regard demographic data. Where the age ranges from 24-60 years old. There was 11 female and 29 males in our participant. Regarding occupation, there were 11 participants not working and 29 were working. In our study, there was a significant negative correlation between, SARS COVID IgG Au/ml & age per year, duration of hemodialysis per year, and parathyroid hormone. Whereas, there is a significant positive correlation between SARS COVID IgG Au/ml and kt/v % of renal hemodialysis dialysis patients. Otherwise, there is no significant relation between, SARS COVID IgG. In our study, there is a lower significant value of SARS COVID igG in renal dialysis patients compared to the control group regarding the history of COVID19 infection before vaccination and occurrence of post- vaccine adverse effects.

Conclusion

Hemodialysis patients demonstrate a hyporesponsiveness to vaccination against COVID-19. Although most patients on maintenance hemodialysis developed a substantial humoral response following the COVID vaccine, it was significantly lower than controls.
Study the Effect of Adding Rebamipide on the Eradication Therapy for Helicobacter pylori Infection
Authors: Mohammed Yassin Azza Emam , Kaisr Saad Hany Haron , Naguib Gina Gamal , Ebrahim Abdo Ahmed Mohammed
Published: July 2024

Background

H. pylori infection is a leading etiological factor for various gastroduodenal diseases, including chronic gastritis, peptic ulcers and duodenal ulcers, as well as adenocarcinoma and MALT lymphoma of the stomach. In the last decad, there has been a negative trend in the effectiveness of classic eradication therapy regimens of H.pylori, which has largely been determined by the emergence and spread of antibiotic resistance.

Aim of the Work

Study the effect of adding Rebamipide on the eradication therapy for helicobacter pylori infection in Egyptian patients.

Patients and Methods

This study included 100 patients with H.Pylori infection who had been confirmed by tissue histopathology.

Results

Regarding the outcome, there was a statistically significant difference between the two groups (p = 0.027) as in Rebamipide group, there was 12% cases had positive results and 88% cases had negative results while in control group, there was 30% cases had positive results and 70% cases had negative results. Regarding side effects, there was no statistically significant difference between the two groups (p = 0.360). one case in Rebamipide group experienced mild skin rash at 1st day of treatment because of allergy to rebamipide and patient was completely free of symptoms after two days without stopping treatment.

Conclusion

This study demonstrated that the addition of rebamipide to H. pylori eradication regimens significantly increases the effectiveness of treatment. Based on our findings, abdominal discomfort was observed significantly higher in control group, there was a statistically significant difference between the two groups (more to rebamipide group) regarding outcome and there was no statistically significant difference between the two studied groups regarding side effects.
Smartphone Addiction and its Relation to Social Phobia in Female University Students
Authors: El Nahas Gihan Medhat , Hatata Hesham Abdel-Mageed , Mostafa El-Serafi Doha , Mahmoud Dalia Abdel-Moneim , Khaled Mohamed Zainab
Published: July 2024

Background

As smartphones become more accessible and more psychologically gratifying, problematic smartphone use has emerged with negative mental health consequences, especially in young adults with poor social skills and self -confidence issues. The current study aims to assess the rate of occurrence of smartphone addiction and to highlight the relationship between smartphone addiction and social phobia and its severity in a sample of female university students.

Subjects and Methods

This is a cross-sectional study including 540 female students in the first medical school year divided equally among practical and theoretical faculties after excluding students with psychiatric disorders except for those with social phobia using the SCID-I scale. Subjects were assessed with the Social Phobia Inventory and the Smartphone Addiction Scale for severity of both social phobia and smartphone addiction respectively.

Results

Out of 540 female students, 28.7% have severe smartphone addiction with higher number in students of academic faculties, also, 71.86% of the whole sample have social phobia with 22.78%, 21.85%, 16.3%, and 10.93% reporting mild, moderate, severe, and very severe social phobia scores respectively. The number of students having very severe social phobia scores in the academic group is higher than that in the practical group. Also the study shows a statistically significant relation between smartphone addiction and social phobia.

Conclusion

There is a high rate of distribution of social phobia in young adult females, which is accompanied with a high rate of occurrence of smartphone addiction, so, there is a need for raising the public awareness regarding hazards of problematic smartphone use especially in students and the for highlighting the importance of screening of different psychiatric disorders, as social phobia in such population.
A Phase II Trial of Celecoxib with Neoadjuvant Concurrent Chemoradiation for Patients with Localized Rectal Adenocarcinoma Stage II and III
Authors: Gaber Ayad Kyrillus Atef , Azmy Ali Mohammed , Ezz El Din Mai Mohamed Ali , Mosalam Nesreen Ahmed , Saleh El-Sayed Mohamed Essam
Published: July 2024

Background

In recent years, neoadjuvant chemoradiation and subsequent surgical resection with total mesorectal excision has been shown to increase local control with decreased toxicity in comparison to upfront surgical resection followed by adjuvant chemoradiation. Neoadjuvant chemoradiotherapy is the standard treatment for locally advanced rectal cancer. In this study we evaluated the efficacy of adding a selective COX-2 inhibitor to standart neoadjuvant chemoradiation on pathologic response, sphincter preservation and acute toxicity.

Materials and Methods

Thirty patients with Adenocarcinoma of rectum (up to 15 cm of anal verge) were enrolled in this phase 2 study. Patients undergone full colonoscopy, MRI rectal protocol, abdomino-pelvic and chest CT scan for staging then received neoadjuvant concurrent chemoradiation (capecitabine 825 mg/m2 bid in combination with celecoxib 200 mg bid and radiotherapy (50-50.4Gy/25-28fraction). Surgery was done 5-12 weeks after chemoradiation. Acute complications were scored by common toxicity criteria 5.0 and tumor response was graded according to AJCC and CAP guidelines for rectal adenocarcinoma.

Results

Of 30 patients, total mesorectal excision was done in 22 patients. Tumor regression grade was reported as: 7 patients (31.8%) had grade 0 or complete response, 7 patients (31.8%) had grade 1 or moderate response, 6 patients (27%) had grade 2 or minimal response and 2 patients (9%) had grade 3 or poor response. Primary tumor down staging was 63% and nodal down staging was 73% with sphincteric preservation rate of 77% among the operated cohort. No patients had hematologic or cardio-vascular toxicity.

Conclusion

Results indicate celecoxib in combination with neoadjuvant chemoradiation is safe and associated with low toxicity. This combination can promote pathologic complete response, tumor regression grade, sphincteric preservation, T and N down staging in rectal adenocarcinoma.
The Clinicoepidemiological Features and Treatment Outcomes in Cervical Carcinoma at Clinical Oncology Department of Ain Shams University Hospital: Retrospective Analysis
Authors: Elhusseiny Khalid , Gorban Nagy Samy , Elghamry Wesam Reda , Alorabi Mohamed Osama , Dweep Mohamed Mahmoud
Published: July 2024

Background

Through Increased education, access to care, and the expansion of screening and vaccination programs, reductions in cervical cancer incidence and mortality may be achieved.

Aim and Objectives

the aim of the study was to determine the clinicoepidemiological features and treatment outcome in cancer cervix at clinical oncology department of Ain Shams University Hospital.

Subjects and Methods

This retrospective analytical study included consecutive adult female patients ≥ 18 years with pathologically confirmed cervical cancer presented to the Clinical Oncology Department, Ain Shams Faculty of Medicine, Cairo, Egypt from January 2016 to December 2020.

Results

Most of the patients (71.3%) were under 60years, andthe median age at diagnosis was 53 years. In our cohort, about 54.5 % of patients were postmenopausal, with the median age of menopause around 51.0 years. In most cases, the age of menarche was between 9 and 12 years. 94.1.0 % of the patients were married, and most of them got married after reaching the age of 18 years (74.2%). In our cohort, CCRTH improved both DFS and OS for adjuvant groups as well as PFS and OS for patients who received definitive treatment. Univariate analysis including age, menopausal status, sociodemograhic data, tumor characteristsics, FIGO sataging and treatment received showed that significantrisk factors for reduced PFS and OS of patients who received palliative treatment was Diabetus mellitus as a comorbidity.

Conclusion

This data emphasizes that patient in rural setting present at later stages which could be improved by creating awareness in rural women, and help accessing adequate screening measures.
Comparison of the Response to Geftinib between EGFR Mutations in Exon 19 and Mutations in Exon 21 in Non-Small Cell Lung Cancer Egyptian Patients
Authors: Salem Dina Ahmed , Tawfik Amr Shafik , Meckawy Ghada Refaat , Mahmoud Essam Mohamed
Published: July 2024

Background

The management of epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC) has dramatically changed following the introduction of target therapy in the last 15 years. Comprehensive reflex biomarker testing, including EGFR, is recommended for all patients with a diagnosis of non-squamous NSCLCs, regardless of disease stage and should be initiated by the pathologist at the time of initial diagnosis.

Objective

To compare the response to Geftinib between EGFR mutation exon 19 and EGFR mutation exon 21 in non- small cell lung cancer in Egyptian patients.

Methods

Our retrospective analysis examined 60 patients with advanced NSCLC who had received gefitinib therapy and the specimen were available at Shefa Alorman Oncology Hospital from June 2017 to May 2020.

Results

Our study showed no statistically difference as regard response to first line treatment between exon 19 deletion and exon 21 mutation with P Value = 0.1273. Our study showed no statistically significance as regard progression free survival after first line treatment Gefitinib between exon 19 deletion and exon21 mutation with median PFS 12 months for patient with exon 19 deletion compared to 10 months for patients with exon 21 mutation (Hazard ratio of progression or death 1.57; 95 % confidence interval 0.87 – 2.82; P- Value= 0.1269).Median PFS of study population was 12 months. The median survival was 27 months for exon 21 group while median survival not reached for exon 19 group (Hazard ratio for death 2.95; 95 % confidence interval 0.78 – 11.20). Median survival of whole study population was 33 months.

Conclusion

The EGFR mutation subtype should be considered when making treatment decisions for designing new clinical trials for chemotherapy-naïve, EGFR mutation- positive patients with advanced NSCLC.
Management of Distal Tibial Deformity Secondary to Traumatic Physeal Arrest: Systematic Review and Meta-Analysis
Authors: Hassan Fayed Mahmod Mohamed , Kamal Hisham Mohamed , Armia Amir Ashraf
Published: July 2024

Background

Injuries of the ankle growth plate are the second most common physeal injury of the childhood and comprises 6% of all fractures of the tibia. These injuries are typically observed among children 10 to 12 years of age, usually as Salter-Harris (SH) Type 1 and Type 2 fractures followed by Type 3 and Type 4 fractures.

Objective

To review modalities of treatment for distal tibia deformity secondary to physeal arrest post traumatic and to perform a systematic review and meta- analysis of the outcome for different methods of treatment.

Methodology

The included studies published between 2000 and 2021. Regarding the type of included studies, 8 studies (out of 10 studies) were retrospective; while 2 studies were prospective.

Results

Meta-analysis study was done on 6 studies which described Epiphysiodesis technique for distal tibial deformities secondary to post-traumatic physeal arrest; with overall number of patients (N = 215). We calculated efficacy for each technique through (Bone union ―success rate‖) and (Excellent functional outcome). We calculated safety for each technique through (Revision rate) and (Complication’s rate).

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022.

Conclusion

Ilizarov technique for corrections of post-traumatic physeal arrest ankle deformities showed better efficacy and safety profiles, compared to Epiphysiodesis. Which also, showed relatively good efficacy and safety especially in children with post-traumatic physeal arrest ankle deformities.
Complication Rate and Patient Satisfaction Following Bilateral Simultaneous Total Knee Arthroplasty
Authors: Elkilany Mohab Essam , Elkader Hammad Amr Abd , El Sayed Awad Mohamed , Abd El Hamid Radwan Gamal Eldeen
Published: July 2024

Background

Advanced knee osteoarthritis (OA) is a common clinical problem requiring knee arthroplasty. Knee Osteoarthritis can be diagnosed by X-ray. Total knee arthroplasty can be done simultaneous or staged in 2 different sessions.

Aim of the Work

To assess the results of simultaneously bilateral total knee arthroplasty as regard complications and patient satisfaction and compare to results in the literature to provide a clear guideline for proper choice of patients.

Patients and Methods

In the period between August 2018 and October 2020, a prospective cohort study was conducted in Ain Shams University Hospital in Cairo and Taiba hospital in Kuwait on 45 cases who suffered from advanced bilateral knee osteoarthritis and underwent bilateral simultaneous total knee arthroplasty.

Results

The study was conducted on a wide age group ranging from 47 to 75 years, (mean age 64.29±6.23 years). There was female predominance with 41 females with percentage 91.1% and 4 males with percentage 8.9%. Regarding patient satisfaction, the comparison of Pre- and Post-operative was 15.24±2.45, compared to 32.18±4.08 respectively, the mean difference 16.93. In comparing objective knee score by the Knee Society Scoring system, in each of Pre- and Post- operative was 58.90±6.28, compared to 82.62±5.70 respectively. Also, in Functional knee score in each of Pre- and Post-operative was 51.39±8.67, compared to 73.80±7.75 respectively. 4 patients (8.9%) had complications out of them 3 patients (6.7%) had superficial infection and 1 patient (2.2%) had acute coronary syndrome.

Conclusion

With careful preoperative patient selection bilateral Simultaneous total knee arthroplasty can be safe with low mortality and complication rates.
Treatment of Acute Acromioclavicular Joint Dislocation Using Hook Plate: A Systematic Review and Meta-Analysis and Update of Current Literature
Authors: Kamel Samy Rasmy , Fathy Hewaidy Ayman Ibrahim , Khattab Mohammed Fawzy
Published: July 2024

Background

the hook plate metallic device showed early promise as an alternative implant to treat unstable acromioclavicular joint dislocation injuries. The hook plate can be used to provide an indirect reduction of a distal clavicle fracture. This indirect reduction technique is useful for comminuted fractures or fractures with very small distal fragments in which conventional reduction and fixation is difficult.

Aim of the Work

to evaluate the treatment of acute acromioclavicular joint dislocation and radiographic outcomes.

Materials and Methods

Studies were considered eligible if they expressed treatment of acromioclavicular joint dislocation using the hook plate and described the patient's clinical and functional outcomes; intra-operative, post-operative complications, full-text articles were available, randomized controlled trials, including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies. We will exclude cross-sectional studies, case series, case reports and literature not in English. All items that didn't match the above criteria were excluded.

Results

The total studies included 270 patients with average mean age 35.5 years and mean follow up 25.33 months. The Constant Murely score average 84 points (The CMS was developed for the evaluation of shoulder function with subjective and objective components) and the p value <.05 that means all patients had significant improvement. Full range of motion could be achieved in the patients. Patients with restrictions of range of motion mainly showed limitations in abduction and external rotation. These limitations are most probably caused by the post-operative immobilization, which is necessary after implantation of hook plates to ensure healing of the ligament structures and avoid damage of the acromion by the hook itself. Other studies also showed restrictions of range of motion for abduction and external rotation after hook plate implantation.

Conclusion

it has a good to excellent Constant Murely score (full range of motion) that enables quick return to activities. It is useful for (Rockwood III-VI). So good clinical results can be achieved with hook plate.
Arthroscopic repair of Non Traumatic Small to Medium Sized Full Thickness Rotator Cuff Tears with and without Acromioplasty
Authors: Samy Maged Mohamed , ELdeen Abdelhamid Radwan Gamal , Haron Haithem Kamel , Mekheimer Mohamed Mohamed
Published: July 2024

Background

The shoulder joint has the greatest range of motion of any other joint. Pain of the shoulder joint is very common and accounts for about 16% of musculoskeletal disorders taking the third place after spine and knee. Rotator cuff disorders including degeneration or tear are most common causes of chronic shoulder pain. Causes of rotator cuff tear (RCT) still unclear and occur as a result of many factors. As degenerative changes of the rotator cuff that occur in old age increase the risk of rotator cuff tear also overhead workers and athletes considered a risk factor.

Objective

To evaluate the role of acromioplasty in arthroscopic repair of small to medium sized full thickness tear of rotator cuff according to the complication rate, the active range of motion and the function scores of the shoulder to add surgeons in deciding whether acromioplasty must be done routinely during arthroscopic repair of rotator cuff or not.

Patients and Methods

During the period between February 2019 and May 2022, A Prospective, Randomized Controlled Clinical trial was conducted in Ain Shams University hospital in Cairo. This study was designed to involve 36 cases with symptomatic small to medium sized RC tear, the patients were separated into two groups of 18. Group A comprised those applied with arthroscopic rotator cuff repair, bursectomy and antero- inferior acromioplasty. In Group B, arthroscopic rotator cuff repair was applied with bursectomy only and no acromioplasty. Each patient in this study was carefully assessed clinically by taking a detailed medical history and adequate clinical examination.

Results

There was a significant difference between the pre-operative and post-operative ASES score, WORC score and ROM but according to postoperative evaluation regarding ASES score, WORC score and ROM there was no statistically significance between the group of acromioplasty and the group of non-acromioplasty. Regarding complications, 3 cases of study population (36) cases were complicated, one case in group A (frozen shoulder) and 2 cases in group B (frozen and revision). With respect of the literature, the results were comparable to that of the literature as regard the functional outcome and complication rate.

Conclusion

The result of this study showed that there may be no need for routine application of acromioplasty during arthroscopic rotator cuff repair as it has concerns being less cost effective. We acknowledge that the cost was not assessed in our study. However, they are intuitive. Also, more long term follow up studies are required to assess the incidence of retear in rotator cuff repair without-acromioplasty as controversy is still present in the literature.
Total Knee Replacement as Primary Management in Comminuted Tibial Plateau Fracture in Elderly Patients: A Systematic Review and Meta-Analysis
Authors: Ibrahim El-Abbassi Ahmed Magdi ElSayed , Ahmed El-Sebaie Mahmoud , Zakaria Eraky Zeiad Mohamed , Khaled ElGhazawi Ahmed Mohamed
Published: July 2024

Background

Fracture of the tibial plateau represents approximately 8% of fractures in elderly patients. These injuries occur with an estimated incidence of 13.3 per 100,000 adults annually, with nearly a quarter of these occurring in elderly patients with concomitant osteoporosis. In young patients, the mainstay treatment for displaced tibial plateau fracture is open reduction and internal fixation (ORIF). However, in elderly patients with periarticular fracture, the combination of poor bone quality, metaphyseal bone comminution, and friable soft tissue envelope creates unique challenges to traditional ORIF.

Aim of the Work

To evaluate the perioperative complication rates and clinical outcomes in patients following TKA for primary treatment of tibial plateau fracture and to establish whether TKA can be considered a reliable primary treatment option in selected individuals.

Patients and Methods

The present systematic review will be performed in accordance with the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search for all level I–IV evidence published articles using the online databases MEDLINE, Embase, and PubMed will be performed. The purpose of this search is to identify all eligible studies featuring perioperative complications or clinical outcomes in patients following TKA for primary treatment of tibial plateau fracture.

Results

The immediate management of acute tibial plateau fracture in elderly patients continues to be controversial. Although there is emerging evidence showing positive results for primary TKA for tibial plateau fracture, it is paramount to appreciate that performing TKA in the context of acute tibial plateau fracture is not a straightforward attempt. Many of these patients have notable loss of the articular surface, which disrupts normal anatomic references, and compromised soft tissue due to possible coexisting ligamentous injury.

Conclusion

Total knee arthroplasty for treatment of acute tibial plateau fracture is an enticing alternative to ORIF to allow early weight bearing, especially in elderly patients with poor bone quality and a friable soft tissue envelope. Our systematic review shows that functional scores are only average.
Muscle Ultrasonography in Relation to Motor Function in Children with Duchenne Muscular Dystrophy
Authors: Rihan Ahmed A , Hassanein Sahar M A , Elagouza Iman A , Sakr Hossam M , Deif-Allah Shaymaa Ahmed A M , Mohammed Maha Z R
Published: July 2024

Background and Aim

Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy of childhood and affects 1 per 3600 male births. Electromyography and muscle biopsy were a commonly ordered invasive diagnostic procedure, used to evaluate children with weakness suspected to be caused by muscle disease. Recently, neuromuscular imaging is used as non-invasive diagnostic tool for various muscle diseases. Muscle ultrasonography is increasingly used for the diagnosis and follow up of children with DMD.

Aim of the Work

The aim of this study was to describe the pattern of ultrasonographic thigh muscles involvement, and to correlate the US findings with motor functional status.

Patients and Methods

Functional motor assessment was the functional performance protocol (GSGC score) Gait (G), Climbing stairs (S), Gower's maneuver (G), and Arising from a chair (C). Sonographic assessment of quadriceps rectus femoris muscles.

Results

Twenty-four genetically confirmed ambulatory DMD children were enrolled in this cross- sectional study. Their mean age of 7.46 ± 1.82 (4.5–11 years). The Rt and Lt Quadriceps muscles positively correlated with the age. The Rt. and Lt. Quadriceps muscle assessment significantly related to the scores for gait, stairs, chair arising, GSGC total score, time to walk 10 m, Time to rise from the floor.

Conclusion

Ultrasonography could be used as a non-invasive method to assess progressive muscle hypertrophy in boys with Duchenne muscular dystrophy. Furthermore, Quadriceps muscle US correlates with the motor functions in ambulant DMD boys below the age of 12 years.
Utility of Neonatal Pain, Agitation and Sedation Scale and Amplitude Integrated Electroencephalogram for Detection of Different Levels of Sedation in NICUs
Authors: Mohamed Basem Bahaa , Mohammed Maha Zakayria , Abd el-AalDawoud Mohamed Omar , El-Raggal Nehal Mohamed , Amin Ibrahim Mariam John
Published: July 2024

Background

Sedatives are essential drugs in every intensive care unit used to ensure the patient's optimal level of comfort. Avoiding conditions of over and under sedation is a challenge in a neonatal intensive care setting. To date, there are no definitions of optimal levels of sedation in neonates. Testing the hypothesis that if a combined use of Neonatal Pain, Agitation and Sedation Scale (N- PASS) and amplitude integrated electroencephalography (aEEG) score might be helpful to distinguish different levels of neonatal sedation and therefore useful in titration of the drugs used.

Aim of the Work

The primary aim of the present study is to assess Neonatal Pain, Agitation and Sedation Scale (N-PASS) and amplitude integrated electroencephalography (aEEG) in the detection of different levels of neonatal sedation.

Patients and Methods

This was prospective observational study conducted on 30 full term neonates on mechanical ventilation reciving sedation (midazolam,fentanyl). we divided our patients into two groups (lightly sedated and deeply sedated patients) according to dose of sedation which determined by the expert opinion according to the clinical condition of the patients. all patients were subjected to the following:(demographic data, clinical signs & symptoms, laboratory investigations, N-PASS and aEEG before and after sedation from march 2021 to August 2022 to evaluate N-PASS and aEEG in the detection of different levels of neonatal sedation.

Results

In our study which was conducted on 30 patients admitted to NICU at Ain shams university hospitals, our patients were of mean gestational age 38.34, all patients presented with respiratory distress, were mechanically ventilated and received sedation (midazolam, fentanyl). we divided our patients into two groups (lightly sedated patients who were 11 patients (36.7%), deeply sedated patients who were 19 patients ( 63.3% ) according to dose of sedation. There was a significant decrease of co2 level in deeply sedated patients, mean co2 after deep sedation 43.36 mmHg while mean co2 after light sedation 51.52 mmHg (p 0.034),and regarding N-PASS significant decrease in N-PASS total score after sedation (p < 0.001 ),and regarding aEEG significant decrease of total burdjalov score after sedation (p < 0.001 )

Conclusion

We recommend combining a clinical scoring system such as the N-PASS, with a continuous brain activity monitor such as the aEEG for assessing the level of sedation in neonates.
Cardiac Follow up of Pediatric Patients Presented with Covid-19 Cardiovascular Affection
Authors: Mahmoud El-Samman Nora Hussein , El Guindy Waleed Mohamed , El-Ganzoury Mona Mostafa , Belal Hassan Hager Mostafa
Published: July 2024

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 carditis, presenting 4–6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation.

Aim of the Work

To Follow up of Pediatric Patients Presented with Covid-19 Cardiovascular Affection.

Patients and Methods

This was an analytical Prospective Cohort study conducted on 33 patients with post COVID-19 infection. all patients were subjected to the following:(demographic data, clinical signs & symptoms, laboratory investigations and Echocardiogrsphy at presentation, 1,6 weeks and 3months follow up from January 2021 to August 2021 to evaluate the short and mid- term effect of COVID-19 infection on cardiac function, and outcomes for pediatric multisystem inflammatory syndrome related to covid-19.

Results

In our study all patients fulfilled criteria of MIS-C presented with Kawasaki disease(KD)- like symptoms and gastrointestinal symptoms in addition to fever with shock or cardiac dysfunction. Our patients were presented with the following vital data: tacycardia with mean of 132.82 (18.74) beat/minute, hypotension with mean of 88.03 (14.06) (mmhg) for systolic blood pressure & mean of 49.39 (14.78) mmhg for diastolic blood pressure, spo2 mean 96.27 (2) %, high grade fever of mean 38.36(0.79). KD-like features were seen in many patients (skin rash in 66.7%, conjunctivitis in 75.8% and Cardiovascular abnormalities were seen in 100% e.g. (myocardial dysfunction, valvular regurgitation, pericardial effusion and shock. Our MIS-C patients had signs and symptoms of an inflammatory state e.g.(fever, rash, conjunctivitis and diarrhea(gastroenteritis).

Conclusion

MIS-C is a hyper-infammatory syndrome affecting multiple organs especially the heart and is triggered by SARS-CoV-2 infection. It is usually seen 2–4 weeks following infection. In our study,IVIG and steroids might have a beneficial role in MIS-C management.
Device Closure of Ventricular Septal Defect: A Retrospective Study at Pediatric Cardiac Unit, Pediatrics Hospital, Ain Shams University
Authors: Abdel Latif Doaa Shaaban , Mamdouh Nevin Mohamed , EL sayed Eman Mohamed
Published: July 2024

Background

The ventricular septal defect (VSD) accounts for 20% of all isolated congenital heart conditions. Nowadays, transcatheter closure is considered a feasible method of therapy for different types of VSDs.

Objective

To do a statistical analysis of VSD patients' data who underwent interventional cardiac catheterization to evaluate safety and outcome of transcatheter closure of VSDs.

Methods

This retrospective cohort study included review of files of 35 patients with VSDs who underwent interventional cardiac catheterization at the Pediatric Cardiac Catheterization Unit, Children’s Hospital, Ain Shams University during the period from first of January 2018 to the end of January 2021.Data were extracted from patients’ medical records, either through medical history, physical examination, pre- and post-intervention investigations, or procedural data.

Results

In our study, 35 VSD cases had attempts for device closure. Perimembranous VSD was present in 19 cases (54.3%), muscular VSD was present in 12 cases (34.3%), and basal muscular VSD was present in 4 cases (11.4%). Amplatzer Duct Occlude II (ADOII) was used in 17 patients (48.6%), a Muscular Amplatzer VSD device was used in 8 patients (22.9%), a PDA device was used in 8 patients (22.9%), and Amplatzer Duct Occlude I (ADOI) was attempted in 2 patients (5.7%). The most common complications in our study group were minor ones, such as mild tricuspid regurgitation, which occurred in 5 patients (14.3%), hemolysis, and blood transfusion in 1 patient (2.9%). There were no major complications such as aortic regurgitation, heart block, residual VSD, arrhythmia, device embolization, thrombus or clot at the device site, or hemolysis requiring surgical removal of the device. There was also no mortality in the study group. There was a statistically significant increase in the percentage of ADOI devices in complicated patients compared with non-complicated patients (p-value = 0.001), while no statistically significant difference was found between the two groups regarding the percentages of PDA, ADOII, and Muscular Amplatzer devices. The VSDs of all 35 patients were effectively closed, achieving a success rate 100%.

Conclusion

transcatheter closure is a safe and practical technique for VSDs with different morphologies. The outcomes of transatheter closure of VSDs done in our relatively new center were satisfactory and approximated to results of other international pediatric cardiac catheterization centers as regards complications, mortality, and success rate.
Impaired Hypoglycemia Awareness in Children and Adolescents with Type 1 Diabetes and its Association with Diabetic Autonomic Neuropathy
Authors: Matter Randa M , Elhenawy Yasmine Ibrahim , Mansour Mahmoud , Wahba Mahmoud , Waheed Marwa , Nasef Abd ELHady
Published: July 2024

Background

In general, hypoglycemia is more frequent among the young explaining the higher frequency of impaired awareness of hypoglycemia (IAH) among children andadolescents. Thus the aim of the current study was to assess the frequency of IAH among anEgyptian cohort of children and adolescents with type 1 diabetes and identify the possible association between impaired awareness of hypoglycemia and autonomic neuropathy.

Patients and Methods

A crosssectional study recruiting 100 patients with type 1 diabetesfor at least 6 months duration and aged less than 18 years old recruited from the Pediatric and Adolescent Diabetes Unit (PADU). Patients with other form of diabetes, cardiac disease,thyroid disease, anemia, other chronic disease, patients with intellectual disabilities or patients taking any medications were excluded from the study. The Gold and Clarke questionnaires were used to assess hypoglycemia awareness among the studied cohort.Cardiac autonomic neuropathy (CAN) was assessed using 15 minutes Holterelectrocardiography (ECG).

Results

Among the studied cohort, 42% showed IAH using theClarke’s and Gold's Questionnaires. When assessing CAN, 46% of the studied cohort showedresting tachycardia and patients with resting tachycardia showed significantly longer diseaseduration.There were no normative heart rate variability parameters values for the Egyptian children that can be used as a reference for diagnosis of cardiac autonomic neuropathy. So weused sex and age matched control group to find specific cutoff values for heart rate variabilityparameters to diagnose CAN. The results showed that the prevalence of CAN among studiedpatients was 88% and there were no significant correlation between CAN and both questionnaires score. 55.7% of CAN patients were aware while 44.3% were unaware. Thus,there were no association between impaired awareness of hypoglycemia and CAN. Theresults showed that there was significant positive correlation between cardiac autonomicneuropathy (CAN) and diabetic duration more than 5 years.

Conclusion

Although there were no association between impaired awareness of hypoglycemia and cardiac autonomic neuropathy, it is important to screen for CAN in patients with IAH, especially that CAN isusually asymptomatic among children with type 1 diabetes.
Frequency of CD4+CD25 + (High) Foxp3+ Regulatory T cells (Tregs) in Peripheral Blood of Pediatric Patients with Autism
Authors: Mostafa Gehan Ahmed , Elhossiny AbdelBasir Reham Mohammed , Haleem Shousha Ghada Abdel , Shehab Abeer Al Sayed , Mohamed Hala Khalid
Published: July 2024

Background

Immune system dysfunctions have been observed in autistic spectrum of disorders (ASD). Autoimmunity may have a role in ASD. In addition, skewed cytokine responses, differences in total numbers and frequencies of immune cells and their subsets, neuroinflammation, both adaptive and innate immune dysfunction, altered levels of immunoglobulins and the presence of autoantibodies in some autistic children were reported.

Objective

To measure the frequency of CD4+CD25 + (High) Foxp3+ Tregs in peripheral blood of children with autism in relation to the disease severity.

Patients and Methods

This cross-sectional study involved 30 ASD patients were enrolled from the Psychiatry and Development clinic, Children’s Hospital, Ain Shams University, after excluding children with concomitant allergic diseases or infections. Another 30 healthy children were included as a control group. Severity of ASD and associated convulsions or impaired intelligence were demonstrated. The frequency of CD4+CD25 + (High) Foxp3+ Tregs was assessed using flow cytometry. Data collected were coded, tabulated and analyzed using Microsoft Excel software Statistical analysis (SPSS) (version 21, Chicago, IL, USA).

Results

Thirty patients with primary ASD were recruited, including 24 males (80%) and 6 females (20%) with mean age of 6.62 ± 2.11 years. Mild illness was diagnosed in 20 patients (66.7%) and severe illness was defined in 10 patients (33.3%)%). CD4+CD25 + (High) Foxp3+ Tregs were significantly lower among autistic children compared to healthy control (mean percentage in patients 15.41 ± 32.1%, mean percentage in control 49.2 ± 42.6%, P-value <0.001). The markers were not correlated with disease severity, epilepsy status or IQ level (P = 0.716, 0.729, 0.472, respectively). However,CD4+CD25 + (High) Foxp3+ Tregs were significantly lower among male patients compared to females(Median in males 1.25 (0-96), Median in females 2.25 (1.5-84.2). CD4+CD25 + (High) lymphocytes less than 3.15 cells were found to be 80% sensitive and 73.5% specific for ASD probability (AUC was 0.816). Whereas percentage of FOXP3 less than 2.55% showed 73.3% and 76.7% sensitivity and specificity, respectively (AUC was 0.753).

Conclusion

CD4+CD25 + (High) FOXP3, the master promotor of Tregs, was detected in lower levels in ASD Egyptian children. A level of expression lower than 2.5% is both sensitive and specific for ASD diagnosis. We recommend considering CD4+CD25 + (High) FOXP3 as a future therapeutic target in children with ASD to achieve early, efficient management.
Follow Up of Cardiovascular Affection in Covid-19 Pediatrics Survivors
Authors: Abdel-Baset Ahmed Amira Mohamed , Mostafa El-Ganzoury Mona , Mamdouh Nevin Mohamed , Ibrahim Ahmed Samir , El-Samman Nora
Published: July 2024

Background

Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 is a rare complication of (SARS-CoV-2) infection. Presenting (4–6) weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation which is mostly due to post infection immune reaction.

Aim of the Work

to evaluate cardiac outcomes 6 months after initial presentation with MIS-C associated with cardiac affection.

Patients and Methods

This was a retrospective cohort study on 28 patients (19 boys & 9 girls) who were diagnosed as multi system inflammatory syndrome in children (MIS-C) related to COVID19 six months ago at children`s hospital, Ain shams university from January 2021 to October 2021. All patients were subjected to the following: (demographic data, clinical signs and symptoms, laboratory investigations) in the acute phase (obtained from patient’s medical records) and at follow up after 6- months.

Results

in our study all patients fulfilled criteria of MIS-C presented with fever, shock or cardiac dysfunction and gastrointestinal symptoms in addition to conjunctivitis and skin rash. Our patients were presented with hypotension with mean systolic blood pressure (87) mmHg & mean diastolic blood pressure (48) mmHg. Regarding symptoms: vomiting was seen in (60.7%), diarrhea in (32.1%), conjunctivitis in (82.1%) and cardiovascular abnormalities were seen in (100%) in the form of (myocardial dysfunction in (50%), coronary dilatation in (28.8%), valvular regurgitation in (100%) and pericardial effusion in (7.2%)). After 6 months there was significant improvement regarding vital signs. Regarding laboratory findings: at time of presentation most of the patients had high CRP, high troponin, and high CK-MB. On follow up after 6 months, all patients had normal values.

Conclusion

Our follow up study suggests that functional recovery and coronary outcomes are good in multisystem inflammatory syndrome in children.
Analysis of Risk Factors of Difficult Weaning from Mechanical Ventilation after Pediatric Cardiac Surgery: A Single Center Prospective Study
Authors: Eldeen Mansour Mervat Gamal , Youssef Moftah Hassan Mohamed El_Nabawy , Abdel Kareem Maha Ahmed Sayed , Azeem Khafaga Sabah Nasr Eldin Abdel , Magdy Sondos Mohamed
Published: July 2024

Background

Weaning from mechanical ventilation (MV( and timing of extubation are crucial components in the postoperative management of cardiac surgery as altered respiratory mechanics and positive pressure ventilation may have significant influence on hemodynamics. Aim: To evaluate risk factors for failure of weaning from mechanical ventilation after pediatric cardiac surgery and to assess the frequency of phrenic nerve injury.

Methodology

This Cohort study included medical records of 101 children admitted consecutively to Pediatric post-cardiac surgery ICU in Academy of Cardiovascular surgery in Ain Shams university Hospitals between April, 2020 and April, 2021, who had undergone heart surgery. The patients were divided into two groups : - successefully weaned group. - Difficult to wean group.

Diaphragmatic ultrasound was done for every difficult weaning patient to assess diaphragmatic paralysis. Result: Age (P < 0.001), Weight (P < 0.001), volum intake (P < 0.001), systolic blood pressure (P = 0.017), Diastolic blood pressure (P = 0.004), were significantly lower in patients who showed difficult weaning compared to patients with successful weaning. Furthermore operation time (P < 0.001), use of noradrenaline (P = 0.019), use of adrenaline ( P = 0.017), use of Milirinon ( P = 0.003), respiratory rate ( P = 0.003), inotropic support (P = 0.001), positive fluid balance (P < 0.001), heart failure, renal failure, Pulmonary complications, need of pace maker, sepsis ( P < 0.001), diaphragmatic paralysis ( P < 0.001), transposition of great arteries operations ( P = 0.009), were significantly higher in patients who showed difficult weaning compared to patients with successful weaning. While use of dobutamine, discharge with open chest, reoperation, transfusion > 50 ml / kg, urine output, reoperation bleeding and any operation other than atrial septal defect, transposition of great arteries all did not affect weaning difficulty.

Conclusion

younger age, operation time, as well as sepsis were the best predictors for difficulty of weaning.
The Effect of Chronic Restraint Stress Induced Alzheimer Like Changes In Male Adult Rats
Authors: Soliman El Bakly Wesam Mostafa , Magdy Yosra Mohamed , Tawfiq Sherin Shafik , Abdelazeem El Shal Amal Saaed
Published: July 2024

Chronic stress has become a common problem that cannot be ignored and has become an important risk factor for the onset of many diseases. Responses to chronic stress are systemic reactions involving multiple organs and can induce symptoms such as depression, cognitive impairment, cardiovascular disease, immune dysfunctions, impaired reproductive ability, bone loss, and reduced life expectancy.

Aim

The present study was designed to investigate the effect of chronic restraint stress on the cognitive function in male albino rats, further to demonstrate its relation to amyloid and tau protein accumulation.

Methods

24-albino male wistar rats were divided into 2 groups as Control group and Chronic restraint stress (CRS) subjected group (done by restraining rats for 3 hours daily for 4 weeks). Body weight, morris water maze test (MWM) and brain levels of p tau and amyloid beta were investigated

Results

CRS increased body weight significantly in week 4 and increased latency time as observed in MWM test compared to control group. Additionally, p tau and amyloid beta levels in CRS group were significantly increased.

Conclusion

chronic stress is able to accelerate the appearance of Alzheimer’s disease (AD) Changes upon chronic stress in the brain were related to accumulation of β-amyloid, TAU hyperphosphorylation in males.