bluuebunny/crossref_metadata_2025 huggingface dataset:
Ministernotomy for Aortic Valve Replacement Versus Conventional Sternotomy, a Choice for a Better outcome
Authors: Refaat Ahmed Refaat Mohamed , Samy Gamal , Morad Faisal , Gawad Nabil Abd
Published: October 2021

Background

​ In the era of minimal invasive cardiac surgery, Ministernotomy Aortic valve .replacement have been proposed as an alternative to conventional full sternotomy approach

Aim of the Work

​: ​​To evaluate the safety and efficacy of AVR through ministernotomy in comparison to full sternotomy AVR in terms of Cardiac cause mortality, Neurological and .Renal complication​s

Patients and Methods

​After gaining the institutional ethical committee approval, the study included all patients who underwent isolated, DE novo, open aortic valve replacement during the period from June 2017 till June 2019 performed by multiple surgeons at cardiothoracic .academy Ain Shams University

Results

​ The study included 60 patients; 32 patients performed through full sternotomy (53.3%) and 28 patients through ministernotomy (46.6%).​ ​Post-operative arrhythmias occurred in full sternotomy in 6 cases (18.8%) where in mini-sternotomy, only 3 cases (12%) developed arrhythmias with no significant statistical difference (p value = ​0.558)​. Cerebrovascular stroke was recorded 1 patient (3%) versus 4 cases (14.3%) in the full sternotomy versus the ministernotomy groups respectively with no Statistical difference between the 2 groups (p value = 0.119).​ Postoperative acute renal impairment was recorded​ in 3 cases (9.4%) vs 2 patients (7.1%) in the full sternotomy vs the ministernotomy groups respectively (p value = 0.755). There was no​ mortality in either groups. Mean post-operative Ventilation hours were 17.21hrs with SD ± 11.026 versus 14.97hrs with SD ​± ​6.473 (p value is 0.35) for the full sternotomy versus the ministernotomy groups respectively. Mean blood loss was 305.51ml with SD ± 282.662 versus 230.36ml with SD ​± ​247.708 (p value is 0.277) for the full versus the ministernotomy groups respectively. Mean units of blood transfused was 2.31Units with SD ​± ​0.926 versus 1.14Units with SD ​±​ 0.591 in the full sternotomy versus the ministernotomy groups with high statistical significance between both groups (p value less than 0.01). Mean ICU stay was 2.66 days with SD ​±​ 0.915 and was 3.1days with SD ​±​ 2.743 (p .value is 0.424) for the full sternotomy versus the ministernotomy groups respectively

Conclusion

​ Ministernotomy Aortic valve replacement was found to be a safe procedure​ compared to full sternotomy approach. Patients who had their surgery through the mini approach had less amount of blood loss, blood transfusion requirements, ventilation time which all led to less duration of ICU and hospital stay, resulting in a better outcome for the .patients
Importance of Intraoperative Detection of Graft Patency by Using Transit Time Flowmetry and Its Impact on Revascularization of the Myocardium
Authors: Ezzat Mohamed Ayman , Ibrahim Ahmed Abdel-Aziz , El Nahhas Yasser Mahmoud , El-din Ahmed Mohamed Seif , Mostafa Mohamed Ahmed Gamal
Published: October 2021

Background

Coronary artery bypass surgery (CABG) has contributed to an increase in survival, quality of life and life expectancy. The anastomotic quality and graft patency is directly associated with both early and long-term clinical results after CABG. It is a complication that can lead to refractory angina, myocardial infarction, arrhythmias, and even mortality.

Objectives

This study was aiming to evaluate the effect of use of TTFM on the outcome of CABG operations and it was carried out on 100 patients and examined 282 grafts, we use inotropic agents to maintain the systolic pressure at 90- 100 mmHg if the blood pressure was lower than that limit.

Patients and Methods

An observational exploratory study was carried on 100 patients operated in Police authority hospitals, cardiothoracic surgery department. The study period of the study was 6 months, study population: The included population will be patients with Coronary Artery Disease (CAD) undergoing Coronary Artery Bypass Grafting (CABG) surgery.

Results

TTFM data was described as two main readings which are MF in ml/min (mean flow), PI (pulsatility index) and it was measured for the all types of the grafts. In MF it was the highest in AO-OM system (34.5 ± 18.46) followed by LIMA- LAD system (33.0 ± 19.65) then AO-Diagonal (31.0 ± 26.38) and lastly AO-RCA(29.50 ± 32.22). For the PI the lowest measurements was 0.8 and it was for both LIMA to LAD and then 1.2 for AO-OM system and 1.4 for AO-DIAG system and 1.8 for AO-RCA system. The most important finding in this study which represents the usefulness of the usage of TTFM is how much grafts needed to be revised according to the grafts measurements and it was 14 grafts in 14 patients (one grafts for each patient) among 100 patients which account for 14%.

Conclusion

Regarding the other studies that compare the TTEM with other ways for detection of graft patency, they prefer the TTFM due to: TTFM is easy to use, accurate and relatively inexpensive, TTFM helps prevent missed technical surgical errors in distal and proximal anastomosis, it has shown that TTFM improved outcome in many situations, TTFM provides excellent documentation of the surgical outcome and allows for better understanding of procedural complications.
Sutureless aortic valve replacement: a meta-analysis
Authors: Metwaly Hani Abd El Mabood , Omar Ahmed Helmy Ali , Jawad Mohammed Nabil Mohammed Abd Al , Amer Mohamed Saad Mohamed
Published: October 2021

Background and objectives

Sutureless aortic valves aim to achieve better outcomes and to aid and facilitate the minimally invasive aortic valve replacement procedure by tackling the issue of cross clamp time, which is an independent predictor of post-operative outcomes especially in patients with serious comorbidities. (2, 3) By reducing the number of sutures, the time for sutures placement is reduced. (1)

Our Meta-analysis tries to assess the safety and hemodynamic performance of the sutureless aortic valve prosthesis’s in an attempt to ascertain their benefits as a viable alternative to current established measures.

Methodology

From their beginnings to February 2017, electronic searches were conducted using six databases. Relevant studies using commercially accessible suture-free valves to replace the aortic valve have been recognized. Based on the predefined endpoints, data were collected and analyzed.

Results

FC For incorporation in qualitative and quantitative analyses, twenty-four studies were recognized, with a total number of 5073 patients undergoing sutureless aortic valve replacement (SU-AVR). Mortality incidence at 30 days and 12 months follow-ups were 2.5% and 2.7%, respectively, while the incidence of thromboembolic events (1.6%) and paravalvular leak (PVL) (0.5%) were acceptable.

Conclusion

Current available evidence indicates that sutureless aortic valve replacement is a safe operation showing low mortality and complication rates, with satisfactory hemodynamic performance.
Predictors of Right ventricular Pacing induced Left Ventricular dysfunction in Pacemaker Recipients with Preserved Ejection Fraction
Authors: Sayed Mohamed Abdelmohsen , Effat Emad , Badran Haitham , Khaled Said
Published: October 2021

Background

Pacemaker (PM) has been an effective treatment in the management of patients with brady-arrhythmias. Chronic RV pacing may cause electrical and mechanical dyssynchrony which lead finally to reduced left ventricular ejection fraction (LVEF). This deterioration of LVEF has been defined as pacemaker induced cardiomyopathy (PICM). The incidence of PICM was described by many studies and ranged between 10% to 26%. The predictors for PICM have not been well studied. These studies were limited by variation in follow-up period and definition of PICM.

Objective

to study the incidence and predictors of PICM in patients who underwent pacemaker implantation in Ain shams University hospital.

Patients and Methods

This retrospective study included 160 patients who underwent single or dual chamber pacemaker implantation in Ain shams university hospital between 2010 and 2017 with the mean period 4.7±2.0 years. Implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) patients were excluded. Individuals who had baseline transthoracic echocardiography (TTE) with normal LVEF ≥ 50% before implantation were included.

Results

This study included 160 patients who had single or dual chamber pacemaker implantation between 2010 and 2017. 45% were males and 55% were females, mean age was 55.5 years. It showed that the incidence of PICM is 7.5%. Wider native QRS durations, particularly >140 ms (p < 0.001), wider pQRS duration >150 ms (p < 0.001), Low normal ejection fraction <56 % preimplantation (p = 0.023) and increased LVEDD>53 mm and LVESD>38 mm (p < 0.001) are predictors for the development of PICM. Female gender was independent predictor for PICM (p = 0.058). There was no association between burden of right ventricular pacing (p = 0.782) or pacing site (p = 0.876) with the risk of development of left ventricular dysfunction.

Conclusion

The incidence of right ventricular pacing-induced left ventricular dysfunction is not uncommon, with an observed incidence of 7.5% in the current study. Wider native and paced QRS durations, Low normal ejection fraction (< 56 %) pre-implantation and increased LVEDD /LVESD post implantation are the most important predictors for the development of PICM.

List of abbreviations

PM= pacemaker, RV= Right ventricle, PICM = pacemaker induced cardiomyopathy, TTE= transthoracic echocardiography, DM= Diabetes Mellitus, HTN= Hypertension, BMI= Body Mass index, pQRSd= Paced QRS duration, SWMA= segmental wall motion abnormality, AF= Atrial fibrillation, SSS= Sick sinus syndrome, CHB= Complete heart block, AVB= Atrioventricular block, LVEF = left ventricular ejection fraction, LVEDD= Left ventricular end diastolic diameter, LVESD= Left ventricular end systolic diameter, ms= milli second.
Growth Differentiation Factor 15: An Emerging Diagnostic Biomarker of Liver Fibrosis in Chronic Hepatitis C Patients
Authors: Sebai Aziza Ahmed El , Ahmed Ossama Ashraf , Saab Azza Abdel Rahman , Adel Abou Zaghla Heba M , Naguib Gina Gamal , Ahmed Ayat Fawzy
Published: October 2021

Background

Chronic liver disease and cirrhosis are a major health concern worldwide being the sixth leading cause of all-cause mortality in people aged 25–64 years. Assessment of liver fibrosis is necessary to determine disease severity and prognosis at the time of presentation to determine suitable treatment. The gold standard method of diagnosis is liver biopsy; however, this procedure is invasive; thus, multiple laboratory and radiologic tests are used to help determine the degree of fibrosis. Growth differentiation factor 15 (GDF-15) is a pleiotropic cytokine involved in regulating inflammatory and apoptotic pathways. It plays a role in cardiovascular disease, inflammation, body weight regulation and cancer. It is suggested that GDF-15 plays an important role in pathogenesis of liver fibrosis.

Aim of the Work

In this study we aimed to evaluate efficiency of growth differentiation factor 15 in diagnosing liver fibrosis.

Patients and Methods

The study was a case- control study conducted on 55 chronic HCV patients recruited from Hepatitis C virus Clinic at Faculty of Medicine Ain Shams Research Institute (MARSI), and 30 healthy subjects age and sex matched. The patients were classified into three subgroups according to the degree of liver fibrosis assessed by fibro-scan. Serum concentration of GDF-15 was determined by enzyme-linked immunosorbent assay (ELISA).

Results

Results of our study revealed a highly significant statistical rise in GDF-15 levels among studied chronic HCV patients with liver fibrosis when compared to the control group (p < 0.01). Furthermore, there was a significant positive correlation between the degree of fibrosis assessed by fibro-scan and GDF-15 serum levels. Levels of GDF-15 were significantly higher in patients with mild degree of fibrosis (patients’ subgroup І when compared with the controls’ group (p < 0.01) suggesting the role of this marker in early detection of liver fibrosis. A statistically significant increase in serum GDF-15 levels was noticed among patients with advanced fibrosis “subgroup ІІІ” compared to those with mild fibrosis “subgroup І” (p < 0.05). The diagnostic sensitivity and specificity of GDF-15 were 96.7%, 98.2%, respectively at a cutoff value of 150 ng/L for discrimination between patients’ and controls’ groups.

Conclusion

Growth differentiation factor 15 could be a potential marker of liver fibrosis especially in early detection as its levels were significantly higher in patients’ group with liver fibrosis than controls’ group and there was a significant positive correlation between the degree of liver fibrosis and GDF-15 serum levels.
Expression of BECN1 gene in Acute Myeloid Leukemia: Association with Hematological and Clinical Parameters
Authors: Ahmed Mohamed Moustafa , Ghozlan Manal Fawzy , Mohamed Walaa Ali , Safwat Nesma Ahmed , Hassan Noha Bassiouny
Published: October 2021

Background

In acute myeloid leukemia (AML), there is copy number loss in autophagic genes such as BECN1. Accordingly, decreased autophagy and the development of AML are related. BECN1 is a critical mediator that influences the onset and progress of autophagy.

Objective

To investigate the expression status of BECN1 gene in newly diagnosed adult AML patients and its association with various hematological parameters and clinical outcomes.

Methods

Case control study to study BECN1 gene expression variability between 50 newly diagnosed adult AML patients and 20 healthy age and sex matched controls, with follow up of the patients to detect its effect on induction therapy. All AML patients underwent full history taking, through clinical examination, laboratory investigations such as complete blood count (CBC) with examination of peripheral blood and bone marrow Leishman stained films, immunophenotyping, cytogenetic analysis (karyotyping/FISH analysis) and BECN1 gene expression analysis using real-time quantitative polymerase chain reaction (qRT-PCR).

Results

In our study, a highly significant difference was found as regards reduced expression of BECN1 gene in patients group compared to control group. We also found reduced BECN1 gene expression in both intermediate and adverse risk groups compared to favorable risk group. Reduced expression of BECN1 gene was associated with increasing age and total leukocytic count (TLC), peripheral blood (PB) and bone marrow (BM) blasts, the presence of FLT3-ITD mutation, CD34 and CD117 and in non-responders group. No statistically significant difference was found as regards haemoglobin (Hb) level, platelet (PLT) count and FAB subtypes.

Conclusion

Autophagy plays an important role in the pathogenesis of AML. Furthermore; the reductive regulation of the BECN1 gene may carry a poor prognosis and is associated with many well established bad prognostic factors especially FLT3-ITD mutation. Targeting autophagy pathways especially its major regulator (BECN1 gene) may become an effective and promising new line of therapy for AML patients.
Study of Platelet Rich Plasma Injection versus Plasma Gel in Periorbital Rejuvenation
Authors: El-Sayed Diab Heba Mahmoud , Elhusseiny Rania Mahmoud , Elsayed Bedair Nermeen Ibrahim , Abdel-Aziz Rostom Khorshed Ahmed Hamid
Published: October 2021

Background

Aging of the skin consists of a combination of genetically predisposed factors (intrinsic aging) and environmental factors (photo aging). The resulting clinical manifestations include mottled pigmentation, wrinkles, and change of the superficial texture leading to coarseness of the skin Dermal components such as collagen and elastic fibers gradually decrease, skin loses its elasticity and shows wrinkles. Loss of skin moisture and subcutaneous fat accelerates the process.

Objective

To evaluate the efficacy, possible side effects, durability and study of platelet rich plasma injection versus Plasma gel injection in periorbital rejuvenation.

Methods

This comparative split face study included 40 females with periorbital wrinkles and/or dark circles recruited from the Dermatology outpatient clinic of Ain-Shams University Hospitals.Right periorbital wrinkles was injected by platelet rich plasma while left periorbital side was injected by plasma gel.

Results

Treatment with plasma gel resulted in significant improvement of periorbital wrinkles with minimal complications compared to platelet rich plasma. While, dark haloes and skin texture were minimally affected whether with plasma gel or PRP injection.

Conclusion

Plasma gel as well as platelet rich plasma injections may play role in treatment of periorbital wrinkles but mostly for short durations. Plasma gel injection is more effective in periorbital rejuvenation than PRP injection although it has relatively higher complications rate. Both plasma gel and PRP injections has only minimal role in treatment of periorbital dark hallows.
A comparative Study Between Needling and Homologous Autoimplantation Techniques in Treatment of Multiple Plantar Warts
Authors: Abdel Fattah Nermeen Samy , Elhusseiny Rania Mahmoud , Darahem Aml Magdy
Published: October 2021

Background

Warts are a common dermatologic complaint resulting from infection with HPV which spread by direct skin-to-skin contact or by autoinoculation. The clinical appearance of warts is variable depends on the type of HPV involved and the site of infection. There are various types of viral warts including common warts, plantar warts, plane warts and genital warts, usually diagnosis of warts is made through clinical examination of the lesions and no laboratory investigations are required.

Objective

To compare between the therapeutic efficacy and safety of needling versus homologous autoimplantation techniques in treatment of multiple plantar warts and assess their recurrence rate.

Patients and Methods

Our study included 40 patients with multiple de novo planter warts(3 -10 warts) of (>1 and <3 years duration) divided into 2 groups, 20 patients per group, one group subjected to autoimplantation of wart tissue and the other subjected to needling procedure. Follow up of studied patients was assessed by physician after 2,8 and 12 weeks of procedure through clinical and dermoscopic examination to assess treatment response and after 16 weeks to assess recurrence

Results

Results of our study reported that there was high statistically significant difference between the 2 studied groups as regard response to treatment after 12 weeks being higher among autoimplantation group (p = 0.001). Moreover, there were no significant relations between treatment response of both patient groups and each of gender, age of patients, number of warts and duration of lesions.

Conclusion

Autoimplantation technique is more effective and less painful than needling procedure in treatment of multiple plantar warts (both manipulated and remote warts). No significant relations were found between treatment response of either techniques and demographic or clinical characteristics of studied patients.
Effectiveness of Photodynamic Therapy for Management of Primary Palmar Hyperhidrosis
Authors: Shaheen Maha Adel , Soltan Marwa Yassin , Shabaik Aya Hassan Ahmed
Published: October 2021

Background

Hyperhidorsis is a condition in which sweat production exceeds that which is needed for thermoregulation, and can affect the hands, feet, axiall, face, back, grain, and legs. It is adisabling condition that affect, both children and adults, with in audience rate of 1-3% and onset usually during childhood or adokscne. Although not a dangerous condition, hyperhidrosis can cause social and occupational impairment and emotional distress and facilitate the development of secondary morbidity.

Objectives

So our aim to study the efficacy and safety of photodynamic therapy in management of primary palmar hyperhidrosis using two photosensitizers [MB2% and eosin].

Patients and Methods

Twenty patients with primary palmar hyperhidrosis were recruited from the outpatient clinic of the Dermatology and Venereology department, Faculty of Medicine – Ain Shams University during the period from 2017 to 2018. The protocol was approved by Faculty of Medicine, Ain Shams University ethical committee (FWA000017585). An informed written consent was obtained from all patients prior to enrolment in the study. It is a right-left controlled study which included 20 patients with primary palmar hyperhidrosis.

Results

Our study showed that the PDT had positive treatment outcome in palmar hyperhidrosis with sustainable efficacy for at least twelve weeks after treatment stoppage.

Conclusion

Photodynamic therapy is an effective, safe and cheap method for management of primary palmar hyperhidrosis. Both eosin and methylene blue 2% can be used effectively as photosensitizers for photodynamic therapy with good results for treatment of primary palmar hyperhidrosis with minimal tolerable side effects.
Prevalence of Metabolic Syndrome in Men with Erectile Dysfunction
Authors: Abd-Elnaeem Sallam Mohamed , Salah Eldin Zaki Marwa , Gamal Elsalibi Mohamed
Published: October 2021

Background

Erectile dysfunction, as defined by the International Consultation on Sexual Medicine, is the consistent and recurrent inability to acquire or sustain an erection of sufficient rigidity and duration to engage in satisfactory sexual intercourse.

Objectives

The aim of this study was to identify the prevalence of MetS among patients with ED.

Patients and Methods

This was a cross sectional study conducted on 200 patients attending the Andrology clinic of Dermatology, Venereology and Andrology department, Ain-Shams University starting from March 2019 till December 2019. The 15-question IIEF Questionnaire is a validated, multi- dimensional, self-administered investigation that has been found useful in the clinical assessment of ED and treatment outcomes in clinical trials.

Results

The mean ± SD of age of patients with ED in our study was 58.3 ± 20.1 years. Out of the 200 patients, 110(55%) of them had BMI (25-29.9). and over 30 in 35(17.5%) patients. The mean ± SD of WC was 41.4±4.9 inches. Among the 200 patients, hypertension was present in 125(62.5%) and smoking in 165 (82.5%) patients. Among the 200 patients, 96 (48%) patients had MetS. Among 200 patients, 90 (45 %) had mild, 54 (27.0 %) had moderate. and 56 (28 %) had severe ED. A significant association was determined between the presence of MetS and severity of ED. The prevalence of moderate and severe ED was significantly higher in patients with MetS than patients without MetS. There was a negative significant correlation between IIEF scores and age, systolic BP, and diastolic BP.

Conclusion

Among the 200 patients, 96 (48%) patients had MetS. Incidence of moderate to severe ED was higher among patients with MetS versus those without. There was a negative significant correlation between IIEF scores and age, systolic BP, and diastolic BP.
Epidemiological and Biochemical Factors (Serum Ferritin and Vitamin D) Associated with Premature Graying Of Hair
Authors: taher Alrgig Nawres , Samy Abdel Fattah Nermeen , Mahmoud Elhusseiny Rania
Published: October 2021

Background

Premature graying of hair (PHG) is defined as graying of hair before the age of 20 years in Caucasians and before 30 years in Blacks. Several factors contribute to development of hair graying as genetics, environmental factors, life style and stressful events. Also, many biological markers were associated with development of hair graying as vitamin D, ferritin, vitamin B12 and many other electrolytes as calcium and magnesium.

Aim of the study

assess various epidemiological factors and biochemical variables (serum ferritin and vitamin D) associated with premature graying of hair.

Patients and methods

The current study included 75 premature hair graying patients, and 75 apparently healthy controls of matched age and sex. Assessment of epidemiological, clinical characteristics, estimation of serum levels of vitamin D and ferritin was done for included subjects.

Results

We detected positive correlation of sedentary life style, stress perception and family history with PHG development. No significant difference of vitamin D between the two groups, while low serum ferritin was significantly associated with PHG patients.
Study of The Relationship Between Psoriasis of Different Clinical Varieties and Osteoporosis
Authors: El Sayed Mahira Hamdy , El Husseiny Rania Mahmoud , Al Saadi Omar Adnan Hoom
Published: October 2021

Background

Psoriasis is considered as a systemic disease since it is an inflammatory skin disorder associated with increased level of many inflammatory cytokines, which can result in many comorbidities. It was hypothesized that there is an association between psoriasis and osteoporosis and many studies investigated this association, but the majority of them focused on the association between psoriatic arthritis and osteoporosis, while this study excluded psoriatic arthritis and investigated the association between psoriasis of different clinical varieties and osteoporosis.

Objective

to assess the associated relationship between psoriasis and osteoporosis in psoriatic patients of different clinical varieties, by measuring the prevalence of osteoporosis in a sample of these patients.

Subjects and methods

Our cross-sectional study included 42 psoriatic male and female patients with non specific ages, 48% of them were males (20 patients) and 52% of them were females (22 patients), and it excluded any patients with endocrinal disorders, chronic renal failure, liver cell failure, other chronic inflammatory disoredres, malabsorption, history of alcohol misuse, history of intake of steroids for longer than 6 months, pregnant women and psoriatic arthritis. All patients were subjected to a questionnaire for detailed history taking, complete general and dermatological examinations, evaluation of psoriasis severity by Psoriasis Area and Severity Index (PASI) score and bone mineral density (BMD) measurement using the DEXA method of the lumbar spine (L1L4) and femoral neck.

Results

The prevalence of osteoporosis among psoriatic patients was (9.5%), (10%) in males and (9%) in females, which was lower than the prevalence of osteoporosis in the population. While the prevalence of osteopenia was 50%, (45%) in males and (54.5%) in females, which was higher than the prevalence of osteopenia in the population. Additionally this study showed a statistically significant negative correlation between the age of the patients and BMD, and a highly significant positive correlation between the BMI of the patients and BMD, while there were non significant negative correlations between both (duration of psoriasis and PASI score) and BMD, and no significant correlations between clinical variants of psoriasis and BMD.

Conclusion

Psoriasis is associated with a decrease in the bone mineral density more in males, with higher incidence of osteopenia rather than osteoporosis. The decrease in BMD increases with increasing age, duration of psoriasis and PASI score, decreases with increasing BMI, while the clinical variants of psoriasis didn’t seem to affect the BMD of psoriatic patients.
Efficacy of Fractional Co2 Laser and Human Lyophilized Growth Factors in the Treatment of Stretch Marks: A Clinical and Histopathological Study
Authors: Abdallah Mahmoud Abdel Reheem , Mostafa Azza Esmat , Abdel Hameed Mohammad Shawkat Mohammad
Published: October 2021

Background

Striae distensae are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The natural evolution of striae is from red or purple, raised wavy lesions (striae rubra) to white atrophic lesions with wrinkly surface (striae alba).

Objectives

The present study was designed to compare the efficacy of fractional CO2 laser alone or combined with lyophilized growth factors or to its efficacy alone in the treatment of striae distensae.

Patients and Methods

The present study included 20 female patients with SD; they were all recruited from Dermatology Outpatient Clinic, Ain Shams University from may 2017 to march 2018. An informed consent for treatment, photography and punch biopsy was taken before enrollment and the study was approved by Dermatology Research Ethical Committee.

Results

The present study showed statistically significant clinical and histopathological improvement in areas A and B after treatment. This impronment was in rubra more than alba. Area C showed no clinical and histopathological improvement. Area B showed better results than area A.We propose that LGF alone did not show clinical or histopathologiacl improvement. Treatment was tolerated well by all patients where side effects were minimal in the form of transient PIH that resolved after using bleaching creams. There was no statistically sgnificant difference in the incidence of PIH between areas A& B.

Conclusion

We concluded that fractional CO2 alone is effective in treatment of SD especially stria rubra in skin type III and IV.
Role of intratympanic steroid injection in treatment of otitis media with effusion: A systematic review/ Meta -Analysis
Authors: Mohammed Ahmed A , Hamdy Tarek A , Askoura Anas M , Abdulhakim Ahmed M
Published: October 2021

Background

Otitis media with effusion (OME) is a worldwide major health problem for both children and adult, who have a history of chronic eustachian tube dysfunction.

Aim of the Work

to review the effect of intratympanic injection of steroids in treatment of chronic otitis media with effusion (persistent more than 3 months after failure to medical treatment [e.g. local & systemic steroids or decongestants] or surgical ventilation tubes).

Material and Methods

This systematic review was done as a collective analysis of 5 retrospective and prospective cohort studies done on patients with OME. Studies on Patients who were diagnosed with chronic otitis media with effusion not responding to conventional methods of treatment.

Results

The data analysed and results showed an improvement of 41.2% of the cases treated with intratympanic injection of steroids compared to 11% improvement in cases treated by conventional medical methods with a relative improvement around 6.4 folds to intratympanic injection of steroids over medical treatment. All of these studies have shown that there are more advantages of directed ototopical steroid therapy over systemic therapy. Topical medications often have limited systemic effects due to their limited systemic uptake. It may be less expensive as compared to systemic medications.

Conclusion

Intratympanic injection of long acting steroids has good effect in management of OME resistant to medical and surgical treatment and has superior effect and high rate of recovery on local nasal steroid spray. In children combination of ventilation tubes and intratymapnic injection of steroids is the best known modality of treatment. Further studies are needed to evaluate the best medical treatment of chronic OME.
SYSTEMATIC REVIEW AND META-ANALYSIS OF THE PALATAL SURGERIES IN THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA
Authors: Rabie Amr Nabil , Mady Ossama , El-Shazly Ahmed Negm , Abouzeid Alaa
Published: October 2021

Background

The first description of a patient with obstructive sleep apnea was in ‘The Posthumous Papers of the Pickwick Club’ published by English writer Charles Dickens in 18361. The first introduction of the terms ‘sleep apnea syndrome’ and ‘obstructive sleep apnea syndrome’ was by Guilleminault et al in 1967. Subsequently, Guilleminault coined the term ‘upper airway resistance syndrome’ in 19932.

Objectives

This paper aims to examine published articles between January 2008 and January 2019 on the different palatal surgeries performed on OSA patients and the treatment outcomes, which in turn will be used to determine two things. The first being the effectiveness of various palatal surgical techniques in treating OSAS and the second (if applicable) the most effective of the palatal surgical techniques in treating OSAS.

Patients and Methods

The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA)5. The detailed steps of methods were described elsewhere as well as PRISMA checklist. The quality of relevant studies was assessed using NIH quality assessment tool for observational cohort and cross -sectional studies as well as NIH tool for quality assessment for case series studies.

Results

Meta-analyses of relevant studies showed that the surgical technique that achieved the best reduction on AHI was the lateral pharyngoplasty followed by the Anterior Palatoplasty, with a significant mean reduction of [(SMD= -0.848, 95% CI (-1.209 – -0.487), p-value<0.001) and (SMD= -0.864, 95% CI (-1.234 – -0.494), p-value<0.001), respectively]. The technique responsible for the best improvement in ESS was the Relocation Pharyngoplasty, with a significant mean reduction of [SMD= -0.998, 95% CI (-1.253 – -0.743), p-value<0.001]. Minimal O2 saturation level improved most with the Expansion Sphincter Pharyngoplasty, with a significant mean reduction of [SMD= 1.011, 95% CI (0.581 – 1.440), p-value<0.001]. The surgical procedure that result in the best post-operative VAS was Z-Palatoplasty, with a significant mean reduction of [SMD= -1. 551, 95% CI (-2.049 – -1.052), p-value<0.001]. soft palate length change with a significant mean reduction of [SMD= -2.219, 95% CI (-2.730 – 1.708), p-value<0.001]. Finally, meta-analyses of relevant studies showed that expansion sphincter pharyngoplasty achieved the overall highest success rate [Event rate= 77%, 95% CI (65.4%– 85.5%), p-value<0.001]

Conclusion

The best procedure for treating OSA varies from patient to patient and there is no universal cure-all. Careful patient selection and pre-operative evaluation are mandatory.
Endoscopic Coblation versus Cold Curettage Adenoidectomy
Authors: Rabie Amr Nabil , Mohammed Mohammed Abdelaleem , Ibrahim Amany Farid Saad
Published: October 2021

Background

Adenoidectomy remains one of the surgical procedures most frequently performed by otolaryngologist. Adenoid hypertrophy causes nasal obstruction and airway problems such as snoring, obstructive sleep apnea, recurrent sinusitis, and/or Eustachian tube dysfunction. There is also reduced ability to smell and taste, hyponasal speech and craniofacial abnormalities. These complications frequently lead to a need for adenoidectomy.

Aim of the Work

Compare between endoscopic coblation versus cold curettage adenoidectomy as regard operative time, blood loss, post-operative pain and complications.

Materials and Methods

We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists.

Results

We performed a comperehensive search of five electronic databases to comperehensively include all eligible studies. In addition, the risk of bias was low among the included studies. However, we acknowledge that the present study has some limitations. Some included studies were observational studies with inherent limitations of possible misclassification and ascertainment bias. In addition, most of the studies were a single-center experience and therefore the results cannot be generalized to the general population.

Conclusion

Endoscopic coblation technique is superior to cold curettage adenoidectomy in pediatric population. The present systematic review and meta-analysis showed that endoscopic coblation technique had better outcomes in terms of intraoperative blood loss and postoperative pain. However, special attention should be paid for operation time with endoscopic coblation. Nevertheless, further studies are still needed to confirm our findings and to identify patient factors that significantly increase the rate of recurrence in both techniques.
The Impact of the Age at the Cochlear Implantation on the Pragmatic Development of the Prelingual Hearing Impaired Egyptian Arabic Speaking Children
Authors: Moussa Dina Fouad El Sayed , Shoeib Rasha Mohammed , Mona Sameeh Khodeir
Published: October 2021

Background

Hearing impaired children have delayed development of pragmatic skills as hearing impairment (HI) deprives them from exposure to natural communication interactions. The rehabilitation of children with HI aims to improve their listening skills for better language development and better communication and social interactions.

Aim of this work

to compare the pragmatic language development of the prelingual hearing impaired children who were cochlearly implanted before the age of 3 years and those who were cochlearly implanted after the age of 3 years.

Methods

Sixty Egyptian Arabic-speaking children with prelingual severe to profound sensory neural hearing loss, thirty children who were cochlearly implanted before the age of 3.0 years compared to thirty children who were cochlearly implanted after the age of 3.0 years. Language assessment was done by Modified Preschool Language Scale – 4th edition (PLS–4), the Arabic version and pragmatic development was assessed by Standardized Egyptian Arabic Pragmatic Language Test (EAPLT).

Results

The two study groups showed no significant differences regarding the receptive, expressive, and total language test scores by PLS-4. Group I showed a significant difference (improvement) regarding the pragmatic factors while there were no significant differences between the two study groups regarding the rest of the pragmatics scores by EAPLT.

Conclusion

The pragmatic language of cochlearly implanted children either who have been implanted before or after 3 years old is affected. This higher susceptibility to pragmatic impairment in prelingual cochlearly implanted children, as well as the importance of pragmatic skills for further social-communicative and academic careers, should be considered in their rehabilitative plan and advocate the importance for early incorporation of pragmatic behaviors into their intervention programs.
Construction of a Therapy program targeting Expressive language in non verbal autistic children
Authors: EL-Sady Safaa R , Shadi Mariam S , Rezk Marwa G
Published: October 2021

Background

Some autistic children remain non verbal even after receiving multiple interventions. There is no obvious cause can explain failure of those autistic children who have adequate cognitive ability and communicative intent to acquire spoken language, except childhood apraxia of speech (CAS) that is treated differently than autism. Little is written about specific therapy programs that apply CAS treatment strategies to promote speech production for non verbal autistic children.

Purpose

The aim of this work is to detect the effectiveness of a therapy program targeting expressive language for non verbal autistic children by applying CAS treatment strategies.

Methods

pre – post single subject design in which each child acts as his or her own control. All the twenty children included in the study had been received previous language therapy at least for 6 months before the starting of the study with no improvement in verbal output.

Results

Of the twenty children enrolled in this study, eighteen children developed spoken language at least multiple single words used both during therapy session and at home.

Conclusion

a structured conversational language therapy program that apply CAS treatment strategies can help non verbal autistic children to acquire expressive language.
Use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions
Authors: El-Halaby Hesham , El-Begermy Marwa M , Hakim Mina Zakaria
Published: October 2021

Background

Benign superficial lesions of vocal fold (nodule, polyp, cyst and Reinke's edema) arise from the epithelium and the lamina propria. Vocal abuse and misuse presumably lead to excessive mechanical stress and trauma in the membranous portion of vocal fold, resulting in wound formation. Wound healing leads to remodeling of the superficial layer of the lamina propria. This tissue remodeling leads to formation of benign vocal fold lesions. These lesions are classically treated by conventional microsurgery and recently by CO2 laser. The use of the CO2 laser for the surgical treatment of Minor Associated Pathological Lesions (MAPL's) is still controversial. Some preferred cold instruments, whereas others appreciate CO2 laser as a novel alternative to conventional microsurgery for benign vocal fold lesions. To summarize the reviewed literature the issue of CO2 laser versus cold instruments is still controversial and the stage is open for more studies.

Aim

The aim of this study is to investigate the effect of Co2 Laser versus cold instruments in the treatment of benign lesions of the vocal folds regarding voice outcome & vocal fold function.

Methodology

A meta-analysis study is done to assess the use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions.

Results

This study does not reveal any detectable differences in clinical outcomes in patients with nodules, polyps and cysts who underwent excision via CO2 laser or cold instruments.

Conclusion

There is no sufficient evidence to determine if conventional surgery or CO2 assisted surgery is better.
Prevalence and predictive factors for exclusive breastfeeding in the first 6 months among mothers attending Primary Health Care Centers in Cairo, Egypt
Authors: Emara Zeinab Abdelhay , Amin Ghada Essam Aldin , Hamid Diaa Marzouk Abdel , Allam Mohamed Farouk
Published: October 2021

Background

Although most organizations recommend breastfeeding for at least one year due to its well-known beneficial effects, the prevalence of exclusive breastfeeding in many developing countries was quite low and the current prevalence of breastfeeding and predictive factors for its discontinuation are not well-known.

Objectives

To identify prevalence and predictive factors affecting exclusive breastfeeding in Primary Healthcare (PHC) Centers in Cairo, Egypt.

Methodology

A cross sectional study, among mothers attended first six months immunization sessions in three PHC Centers were selected via a convenient sample, A total sample of 180 mothers, 60 from each PHC Center, accepted to participate in our study and were subjected to an interview questionnaire. The questionnaire used was previously validated and pre-tested. Data collection took the period from April to August 2019. Comparison between exclusive and nonexclusive breastfeeding according to possible risk factors was done.

Results

The frequency of breastfeeding among the participants was 90.6%; however the total (0-6 months) exclusive breastfeeding frequency was only 39.4%. Our logistic regression model showed that exclusive breastfeeding decreased with progressive increase in infant’s age with OR of 0.74, and mothers with good knowledge about proper practice of breastfeeding (e.g. infant’s chin should be immersed in mother's breast and most nipple halo in the infant lower lip) adhered more to exclusive breastfeeding with OR of 2.51. Also, it showed that, during working hours, mothers who fed their infants other than breast milk adhered less to exclusive breastfeeding with OR of 0.19.

Conclusions

The prevalence of exclusive breastfeeding is quite low, a problem seen in most of developing countries. The predictive factors for exclusive breastfeeding are, younger infant’s age, good knowledge of the mothers about proper practice of breastfeeding, and mothers insisting on breastfeeding during working hours.
Surgical Site Infections; A Study of Incidence, Risk Factors and Causative Organisms in Emergency Abdominal Surgeries
Authors: Omran Hisham , Elmageed Shaaban Mohamed Abd , Arab Ahmad Gamal Abu , Saeed Mohamed Hesham
Published: October 2021

Background

Surgical site infection (SSI) is the most commonly reported nosocomial infection. Surgical site infections are responsible for increase in cost, morbidity, and mortality related to surgical operations. Surveillance with information feedback to surgeons and other medical staff has been shown to be an important element in the overall strategy to reduce the numbers of SSIs.

Objectives

To determine the incidence and factors responsible for, causative micro-organisms and effective antibiotics for surgical site infections following emergency abdominal operations.

Patients and methods

a total of 252 patients were enrolled in the current study and were retrospectively followed till the tenth day post-operatively. Data collection sheets were filled in for all the patients. If any symptom or sign of infection appear during this period then proper investigation was instituted for the diagnosis of infection and to assess the type and severity of the infection. If any collection of pus identified it was drained out and sent for culture and sensitivity test. Proper antibiotic was given to every patient both preoperative and post-operative periods. Antibiotic was changed where necessary after getting the report of culture and sensitivity test.

Results

Surveillance of SSIs in the current study revealed an SSI incidence of 21.4%. The most frequent organisms detected by wound swab cultures were E. coli (55.5%), followed by Klebsiella and coagulase negative staphylococci, with the emergence of resistant strains like MDR, AMPC, ESBL strains. Sensitivity to antiobiotics showed Colistin, Polymyxin B, Vancomycin and Tigecycline to be fully functional, next in sensitivity was piperacillin tazobactam, then meropenem, followed by imipenem and amikacin. SSI was found to be increased with the advancement in age, Smoking cigarettes and HCV positive cases. The fourth post-operative day was the commonest day for the occurrence of SSI with discharge from the wound being the most prevalent sign.

Conclusion

A surveillance system for SSI with feedback of appropriate data to surgeons and hospital authorities is highly recommended to reduce the SSI rate General Surgical Departments at Ain Shams Specialized Hospital - Police Hospital and other Departments as well.