bluuebunny/crossref_metadata_2025 huggingface dataset:
Echocardiographic Assessment of Aortic Pulse Wave Velocity as a New Diagnostic Parameter for Left Ventricular Diastolic Dysfunction
Authors: Ammar M A S , Elshazly A M , Ismail M F , Helmy H G M
Published: May 2020

Background

The association between increased arterial stiffness and Left ventricular (LV) diastolic dysfunction (DD) has been well characterized, suggesting a close interaction between the arterial system and the left ventricle. Aortic pulse-wave velocity (PWV) is a measure of aortic stiffness, and it has an established prognostic role in cardiovascular diseases and in the general population.

Aim

Evaluation of aortic PWV assessed by echocardiography as a new diagnostic parameter for LV DD by correlation with current echocardiographic LV DD indices, and also evaluation of aortic PWV prognostic value in patients with DD by correlation with Brain natriuretic peptide (BNP).

Methods

This study was conducted at Ain-Shams and Helwan University hospitals from December 2017 to December 2018. It included 100 subjects aged from 55 to 60 years; they were divided into two groups, 1st group (case group): 80 patients with asymptomatic LV DD with preserved ejection fraction ≥50%, 2nd group (control group): 20 patients with normal diastolic function. All patients were subjected to full history and thorough physical examination. BNP, ECG and full echocardiography with assessment of aortic PWV were done.

Results

A total of 100 patients were enrolled, 38 (47.5%) males in case group vs. 9 (45%) in control group. Hypertension, diabetes and dyslipidemia were significantly higher in case vs. control (P-values: <0.001, 0.005, 0.002 respectively). Aortic PWV has significant positive correlation with both age and body mass index (r = 0.422, r = 0.847 respectively with P < 0.001 for both). Aortic PWV has significant positive correlation with E/e’ (r = 0.957, P < 0.001), tricuspid regurge velocity (r = 0.941, P < 0.001), and left atrial volume index (r = 0.947, P < 0.001), but it has significant negative correlation with septal e’ (r=-0.970, P < 0.001) and lateral e’ (r=-0.932, P < 0.001). Aortic PWV has significant positive correlation with plasma BNP level (r = 0.958, P < 0.001). Aortic PWV was significantly higher in case vs. control group with mean values (15.5±1.32 vs. 10.11±0.78 m/s respectively; P < 0.001). The area under the ROC curve for aortic PWV to detect DD was 0.86 (95% CI, 0.76–0.98; P < 0.001) and the optimal cutoff point of 12.5 m/s produced 92.3% sensitivity and 75.0% specificity (the positive and negative predictive values were 93.5 and 72.7%, respectively with an accuracy of 89.0%).

Conclusion

Echocardiographic assessment of aortic PWV appears not only to be a highly sensitive, reliable, easy, rapid and practical parameter for LV DD detection but also has a promising prognostic value in patients with LV DD.
Demographic data and predictors of acute myocardial infarction in Egyptian young adults
Authors: Halim M M , Kamal D A , Onsy A M , Rayan M M
Published: May 2020

Background

Myocardial Infarction carries a significant morbidity, psychological effects, and financial constraints for the patient and the family when it occurs at young age. However there is limited data on the clinical features of young adults with AMI in Egypt and the Middle Eastern region. We therefore sought to investigate the clinical profile, risk factors and angiographic variables of this age group in Egypt.

Aim of the Work

To determine the clinical profile and prevalence of different risk factors including Cigarette Smoking, Tramadol use, Cannabis smoking, HDL & LDL levels, stressful lifestyle and bad sleeping habits in Egyptian patients presented with Myocardial Infarction for the first time at age ≤45 years.

Methods

We conducted a cross sectional observational study on 106 consecutive patients aged ≤45 years admitted with 1st time myocardial infarction in the period between February 2018 and August 2018 at Ain Shams University, Egypt. Clinical, and Angiographic variables were recorded from all patients.

Results

Out of 1207 patients admitted with 1st time MI, 106 were young that gave a prevalence of 8.8% in our center. Out of 106 patients, 101 were male. Mean age was 39.19 yrs. 71 patients had ST elevation myocardial infarction (MI) (67%) and 35 had non ST elevation MI (33%). Anterior wall MI was present in 49 patients (46.2%), inferior wall MI in 20 patients (18.9%) and lateral wall MI in 2 patients (1.9%). 93 patients (88%) were smokers, 31 patients (29.2%) were Tramadol users, 43 patients(40.6%) smoked cannabis, 50 patients (47.2%) had bad sleeping habits, 29 patients (27.4%) had high stress levels, 37 patients (34.9%) were hypertensive, 22 patients were diabetic (20.8%). Family history of CAD was present in 20 (18.9%) patients. Low High-density lipoprotein (HDL) was seen in 47 patients (44.3%), and high Low-density lipoprotein in 20 patients (18.9%). LAD was involved in 56% of patients, with a significant association between Tramadol use and LAD involvement. We found significant association between both Tramadol use and Cannabis smoking and the presence of Heavy thrombus burden in Coronary Angiography.

Conclusion

AMI in the young almost exclusively occurs in male, Anterior wall MI is most common, with LAD being involved in around half of patients. Smoking, hypertension, low HDL, Tramadol use, Cannabis smoking, and bad sleeping habits are the major risk factors. Tramadol use was associated with significant affection of LAD. Tramadol use and Cannabis smoking were associated with high thrombus burden on coronary angiography,
Value of 3D Rotational Angiography in Congenital Heart Diseases
Authors: Amin Y M , Ezzeldin D A , Roshdy A M , Atteya H M , Elsayed M H
Published: May 2020

Background

Cardiac catheterization continues to be the gold standard in the management of CHD because of its diagnostic accuracy and therapeutic advantages. Among the recent advances in cardiac catheterization is the use of 3DRA which has been introduced in CHDs nearly 10 years ago after its long use in neuroradiology with good outcomes.

Objective

The aim of this work is to describe our initial experience with rotational angiography at Ain Shams University and compare between conventional and rotational angiography in terms of contrast, radiation and procedure time.

Patients and Methods

The study included 100 patients presenting to Ain Shams University Hospital pediatric cath lab in the period between February 2017 and July 2018. Fifty patients underwent rotational angiography (RA) and 50 underwent conventional angiography. The 2 groups were matched regarding age, sex, weight, diagnosis and the procedure performed.

Results

The median age in the study was 4 years with a median weight of 15.5 kg. The study included 44 patients with PDA, 42 (95%) underwent PDA closure. 30 patients had PS of which 28 underwent BPV (93%). 8 patients had CoA, 6 had CoA balloon +/- stenting (75%). 12 patients were postGlenn, 2 had TOF, 2 had AS and 2 had history of TOF repair with either RPA or LPA stenosis. Diagnostic quality imaging was obtained in 74% of cases. The RA cases were divided into earlier and later groups which were compared with each other and with the conventional angiography group. The procedure time decreased significantly in the later RA cases (38 minutes compared to 49 minutes in earlier cases) but was still significantly more than the conventional angiography group (33 minutes). Total contrast decreased in later cases (3.56 ml/kg) but was still more than conventional angiography cases (2.55 ml/kg). Less DAP was needed in later RA cases than earlier cases and conventional cases (10 Graycm2, 24 Graycm2 and 16 Graycm2 respectively). The more procedure time in RA group can be explained by the time lost in preparing the room for 3DRA and processing of the reconstructed image. The more contrast is related to the routine use of biplane in conventional group and the simplicity of procedures involved in our study requiring little contrast and fewer injections in conventional angiography.

Conclusion

RA can be safely performed in diagnostic and interventional cases for better visualization of extra cardiac structures with significant reduction of radiation exposure on the expense of some more time and contrast. RA requires time to master it in a way that makes it a valuable additional tool in the cath lab.
Image quality and attenuation values of multidetector CT coronary angiography using high iodine-concentration contrast material: A comparison of the use of iopromide 300 and iopromide 370
Authors: Darwish A K M , Farouk M M , Hafez H , Adel A
Published: May 2020

Background

Iodine concentration is one of the main determinants of arterial enhancement in CTA, and current low-osmolar and iso-osmolar nonionic CM for intravascular administration still come in a handful of molecules, but a relatively wide range of different iodine concentrations. This gives the opportunity to optimize CTA protocols as a function of several factors such as patient characteristics, CT technology, and CM features in an attempt to maximize the diagnostic yield of CTA examinations while considering patient safety and avoiding unnecessary extra costs.

Objective

To compare image quality and attenuation values of multidetector CT coronary angiography (MDCT) between iopromide 300 and iopromide 370 and to evaluate whether the higher iodine contrast material has better image quality or not.

Material and Methods

Patients were prospectively enrolled and were randomized into two groups (group A, 30 patients received iopromide 300, iodine flux 1.2g I/s; group B, 30 patients received iomeprol 370, iodine flux 1.48g I/s). CT attenuation values were measured in the proximal end coronary arteries,ascending aorta and main pulmonary artery. The image quality of 15 coronary artery segments was graded by cardiologist in consensus with the use of a four-point scale (1 excellent enhancement to 4 poor enhancement). Non-parametric statistical approaches were used to compare the two groups.

Results

No statistically significant differences were found between the mean attenuation values (302 HU for iopromide 300 and 326 HU for iopromide 370, P = 0.175) in the coronary arteries in the two groups. The mean attenuation value of the proximal ascending aorta (AA)and main pulmonary artery (MPA) was found to be 345+/-63 HU and 241+/- 89 in group A respectively, whereas the mean attenuation value in proximal ascending aorta and main pulmonary artery in group B was found to be 348+/-74 and 238+/- 50 respectively. No significant difference was found between iopromide 300 and iopromide 370 in terms of contrast enhancement at the level of great arteries, P value AA = 0.826 and P value for MPA = 0.884. 92.9% of coronary arterial segments got score (range 1–2) in group A whereas 93.6 of coronary arterial segments got score (range 1-2) in group with no statistically significant difference P value = 0.755.

Conclusion

With the current CT technology iopromide 300 is not inferior to iopromide 370 in terms of coronary artery attenuation values and image quality. Iopromide 300 provides similar enhancement of coronary arteries and excellent image quality as compared with iopromide 370 using identical amount of total iodine with fewer cost and less estimated adverse effects owing to low iodine concentration of iopromide 300.
Impact of ventricular morphology on myocardial deformation in patients with single ventricle
Authors: Shoman K A E A , Ezzeldin D A , Esmail Y A , Attia H
Published: May 2020

Background

Functional single ventricle (FSV) is a spectrum of severe congenital heart disease, with multiple anatomic variations but similar surgical treatment strategies. FSV patients are living longer into adulthood compared to two or three decades ago, and they are more frequently undergoing imaging to assist in clinical and surgical management.

Objective

To determine impact of ventricular morphology on myocardial deformation in patients with single ventricle.

Material and Methods

From November 2017 to July 2018, 41 patients with single ventricle morphology or Physiology who were referred to Ain-Shams University hospitals for follow up Echocardiography or diagnostic cardiac catheterization were enrolled in the study.All patients subjected to history, clinical examination Echocardiography (conventional 2D and speckle tracking “global longitudinal strain and strain rate”.Dominant ventricular strain was analyzed using conventional two-dimensional echocardiographic. The region of interest was obtained by tracing the dominant ventricle endocardial borders at end-systole. An automated software program was used to calculate the frame-to-frame displacements of speckle pattern within the region of interest throughout the cardiac cycle.

Results

There is statiscially significance between the basic anatomy of the single ventricle and the ejection fraction (p value 0.001) and global longitudinal strain pattern by speckle tracking echocardiography with (p value 0.031) with no statistically effect of the side of dominance.

Conclusion:

Regarding the side of dominant ventricle there is no significant relation between the side of dominant ventricle on myocardial deformation (by ejection fraction, global strain and strain rate by speckle tracking echocardiography) but there is significant relation between the ventricular morphology and the myocardial deformation that was assessed by by the ejection fraction and global longitudinal strain (by speckle tracking echocardiography) but with no significant effect on the strain rate (by speckle tracking echocardiography)
Evaluation of Cardioprotective Effect of a Single Oral Dose of Nicorandil before Primary PCI in Patients presenting with Anterior STEMI
Authors: Louis B R , Elnozahi M A M , Abdeldayem T K
Published: May 2020

Background

Nicorandil in conjunction with primary percutaneous coronary intervention (PPCI) has been reported to exert cardioprotective effect in patients with ST segment elevation myocardial infarction (STEMI). Intravenous and intracoronary Nicorandil administration with PPCI have been reported to reduce reperfusion injury consequences and improve cardiac function in patients with STEMI even on the long term .However, there is limited information on the cardioprotective effect of oral Nicorandil in STEMI patients .

Objective

The Aim of this study was to evaluate Cardioprotective effect of a single oral dose of Nicorandil 20 mg given before primary PCI in patients presenting with a first anterior STEMI within 6 hours from symptoms onset.

Material and Methods

This study is a Prospective multicenter Study that included 80 Patients who were presenting with first anterior STEMI and undergone primary PCI as a myocardial reperfusion method in the period between June 2016 and May 2018. Patients were divided into two groups: Group A (40 patients) was the Study group which received Nicorandil 20mg single oral dose immediately on admission with the loading doses of aspirin and clopidogril prior to the PPCI procedure and Group B (40 patients) was the Control group that did not receive Nicorandil .

Results

There were no statistically significant differences between two groups as regards demographic data, risk factors for coronary artery disease and procedural data . There was statistically significant lower peak levels of cardiac enzymes and higher left ventricle ejection fraction (LVEF%) in group (A) compared to group (B). The peak level of CKT in group (A) was 1899.1± 601.000 compared to 2386.300 ± 844.318 in group (B), (P = 0.004) .The peak level of CK MB in group (A) was 264.100 ± 86.982 compared to 329.325 ± 147.404 in group (B), (P = 0.018) .The LVEF% in group (A) was (43.550±5.114) compared to (40.325±5.753) in group (B), (P = 0.010).

Conclusion

Single dose of Nicorandil 20 mg administered orally and given to patients who were presenting with a first anterior STEMI within 6 hours from symptoms onset prior to reperfusion with primary PCI had a significant cardioprotective effect in the form of higher left ventricular ejection fraction and lesser release of cardiac enzymes (CKT and CK MB) compared to control group which reflects more myocardial salvage of the area at risk and lesser reperfusion induced myocardial damage.
Short-term outcome of Manual Thrombus Aspiration for patients Undergoing Primary PCI for Acute STEMI Showing LargeThrombus burden
Authors: Penjameen M N , Elfekky E M , Elias R R , Nassar A I
Published: May 2020

Background

Thrombus aspiration (TA) might have a potential role in STEMI patients with heavy thrombus burden. The objective of several prospective trials whether routine TA in STEMI patients, contributes to a reduced mortality. After the first promising results, mainly based on the single center (TAPAS trial), results of the largest randomized trials to date (TASTE) study and (TOTAL) study, have not shown any significant differences in all-cause mortality, re-hospitalizations or stent thrombosis after a maximum of one-year follow-up period

Objectives

The aim of this prospective study is to study the in-hospital & short term out-come of using manual thrombus aspiration in STEMI patients undergoing primary PCI & showing large thrombus burden.

Results

The study included 209 patients referred to (CCU) of (Ain Shams University hospitals) with diagnosis of STEMI, who had under-gone primary PCI, with evidence of heavy thrombus burden . All the patients received DAPT, 99% had received GPIIbIIIa antagonists. The patients were divided into 2 groups: group (A) included 73 patients, who had under-gone manual thrombus aspiration followed by PCI to culprit lesion +/- other vessels & and group (B) included 136 patients, who had under-gone primary PCI of culprit lesion+/- other vessels, using the standard technique, without thrombus aspiration, within the period from 11/2016 till 7/2018(21 months),and they were followed up during hospital stay & for one month following hospital discharge. No stents were used in 13.7% of group (A), but no stents were used on 3.7% of group (B) (p value= 0.007). TIMI III flow had been achieved in 94.5% of group (A), 80.1% of group (B)(p value = (0.020) . MBG 3 had been achieved in 82.2% of group (A), 58.1% of group (B) . ST-segment resolution > 70% had been achieved in 8.2% of group (A), that hadnot been achieved in group (B) (p value =0.003). Mortality(among MACE) was the only event detected (p value 0.026). Follow up MACE were statisticalLy significant results (p value=0.022) . Statistically highly significant results regarding, LV systolic function EF %, p vaue= 0.001, had been achieved .

Conclusion

In STEMI patients with evidence of heavy thrombus burden, a strategy of manual aspiration thrombectomy is valuable in reducing index hospitalization mortality, and 1 month follow-up rates of mortality, TIMI flow, better MBG, ST-segment resolution, in addition to left ventricular systolic function .
A predictive model for the left atrial diameter in estimating success rates of radio-frequency ablation treating atrial fibrillation
Authors: Elsayegh M T , Elghannam M A , Ammar A M , Taha A S , Elkerdany A B
Published: May 2020

Background

Ablation devices are being utilized in surgical procedures treating atrial fibrillation. Few studies seek to define a cut-off value for left atrial diameter size beyond which risks of procedure outweigh chance of sinus recovery. This study aims to identify a cut-off value for pre-operative left atrial diameter to assess the efficacy of surgical radio-frequency ablation for treatment of chronic atrial fibrillation in patients undergoing mitral valve surgery.

Methods

A prospective 6-month follow-up cohort study was done, in which 40 patients were recruited during the period from May 2016 till April 2018. All patients had rheumatic mitral valve disease and permanent atrial fibrillation. Receiver operator characteristic (ROC) curves were used to calculate the area under the curve and cut-off value for left atrial diameter. The efficacy of the overall survival time was estimated using the Kaplan-Meier method.

Results

Pre-operatively left atrial diameter of > 59 mm was significantly associated with decrease in the possibility of reverting to sinus rhythm after surgery (OR 0.292, p-value = 0.001). The cut-off value for left atrial diameter was 59mm (sensitivity = 93.3%, specificity = 96.1%). Kaplan-Meier survival estimates were 175.07 days (156.3 - 193.9) for patients with left atrial diameter < 59mm and 62.64 days (26.6-98.7) for patients with left atrial diameter > 59mm.

Conclusion

In patients undergoing mitral valve surgery, higher degrees of ablation success are associated with smaller left atrial diameter in terms of conservation of the sinus rhythm post operatively.
Major Adverse Cardiac Events after first time elective isolated Coronary Artery
Authors: Hikal T , Hassouna A , Ashour H , Tarek A
Published: May 2020

Background

Major adverse cardiovascular events (MACE) are useful endpoints to evaluate cardiovascular outcomes. The aim of this study was to report our results in concordance with the expected improvement of records after using the online Research Electronic Data Capture (RedCap) software. Methods: We included patients who benefited from first time elective isolated coronary bypass grafting (CABG) at Ain-Shams university main hospital, in the period between April 2014 and April 2016; providing a minimum 2 years follow-up . Incidences, risk factors and independent predictors for MACE were calculated including; mortality, the occurrence or re-hospitalization for: heart failure, recurrence of angina or myocardial infarction (MI), cerebrovascular stroke (CVS), need of coronary angiography (CA), repeat percutaneous intervention (PTCA) or CABG. Results: 607 cases met our inclusion criteria and 105 patients (18.7%) developed 184 MACE, including 45 hospital mortalities (7.4%), 13 late mortalities (2.1%) and 126 non-fatal events recorded in 47 patients (7.7%); a majority (40 patients; 6.6%) had suffered from at least 3 non-fatal events. Two-years follow-up was complete for the 562 hospital survivors with a total of 1113 patient-years. The annualized incidence rates of ICU admission, repeated angina or MI, need for CA, PTCA, or CABG, development of CVS, heart failure, and late mortality were: 3.6%, 2.8%, 1.8%, 0.5%, 0.09%, 0.35%, 2% and 1.2% per patient-year; respectively. Independent predictors of hospital mortality were: advanced age at surgery (OR 1.06: 1-1.12; P = 0.049), female sex (OR 3.4: 1.3-8.9; P = 0.01), prolonged durations of: cardiopulmonary bypass CPB (OR 1.02: 1.01- 1.04; P < 0.001), mechanical ventilation (OR 1.07: 1.04- 1.09; P < 0.001) positive inotropic support (OR 1.03: 1.02- 1.05; P < 0.001) and ICU stay (OR 1.09: 1.07- 1.11; P < 0.001). Independent predictors of overall MACE were advanced age at surgery (OR 1.04: 1.01-1.07; P = 0.011), prolonged durations of: aortic cross clamp (OR 1.09: 1.04-1.11; P = 0.003), CPB (OR 1.06: 1.04-1.08; P < 0.001) and mechanical ventilation (OR 1.02: 1.01-1.03; P < 0.001). Conclusion: Our results suggested that more care should be given to females, elderly and to shorten and improve the quality of our operative times. The repetition of non-fatal MACE could be modified by closer observation of the patient, once developing his first event.
Clinical Utility of Serum Adipocyte Fatty Acid Binding Protein (A-FABP) in Type 2 Diabetes Mellitus Patients Complicated with Metabolic Syndrome
Authors: Elfeky S , Elhadidy E , Maher M , Awad D M
Published: May 2020

Objective

The adipocyte fatty acid-binding protein (A-FABP) has been described as a biomarker for adiposity and obesity-related disease. The aim of this study was to assess the association between fasting serum A-FABP level and the development of metabolic syndrome (MetS) among type 2 DM patients.

Methods

Fasting blood samples were obtained from 60 type 2 diabetic patients for assessment of serum A-FABP level (30 subjects without MetS and 30 subjects with MetS) compared to 30 healthy control subjects recruited from Endocrinology Department, Ain Shams University Hospitals. A-FABP protein was assayed using ELISA technique, MetS component (waist circumference, fasting serum glucose, triglycerides (TG), high density lipoprotein cholesterol (HDL-C) and blood pressure), as well as homeostasis model assessment of insulin resistance (HOMA-IR) and highly sensitive C-reactive protein ( hsCRP) were assayed for all subjects.

Results

Diabetic persons who had MetS had significantly higher serum A-FABP levels than either without MetS or healthy controls [Median (25-75 percentiles): 10.5(8.25-14.25); 3.4(0.20-6.00) and 1.5(0.78-2.63) respectively ; p < 0.01). However (HOMA-IR) and hsCRP did not show significant difference between diabetic patients with MetS versus diabetic patients without MetS (p > 0.05).

Conclusions

Our results indicate that serum A-FABP level is an early marker for the development of MetS in type 2 DM patients, thus its assessment could be beneficial in diagnosis of MetS.
Assessment of CYP1A1 (MspI) Gene Polymorphism in Patients with Chronic Obstructive Pulmonary Disease
Authors: Atta R S , Shaheen K Y , Hamed A I , Kabiel W A Y
Published: May 2020

Background

Chronic obstructive pulmonary disease (COPD) is one of the most important causes of morbidity and mortality worldwide, characterized by persistent and progressive airflow limitations. The etiology seems to be an interaction between genetic and environmental factors.

Objectives

We aim in this present study to evaluate the role of Cytochrome P450 1A1 (CYP1A1 MspI) (3801 T/C) gene polymorphism in the development of Chronic Obstructive Pulmonary Disease ( COPD) by PCR-RFLP.

Subjects and Methods

Our study was performed on 50 subjects ( 35 COPD patients & 15 control ). Pulmonary function test was performed for patient group,DNA extraction was done and polymorphism was assayed for all participants by polymerase chain reaction-restriction fraction length polymorphism ( PCR-RFLP).

Results

We found that smoking rate among COPD patients was significantly higher than the control group ( P value = 0.003). The genotypic distribution of the single nucleotide polymorphisms (SNP) 3801 T/C did not differ significantly between patients and healthy controls (P value = 0.78).As regards disease severity , the genotype distribution was found to be significantly different between GOLD 1&2 and Gold 3&4 groups. Combined TC +CC alleles was found in 6 patients ( 100%) of Gold 3&4 ( P value<0.001)

Conclusion

Our study demonstrated that there is no relation between CYP1A1 gene polymorphism and development of COPD.It shows significant relation between COPD development and smoking, it also shows significant relation between MSPI gene polymorphism and disease severity regarding Gold staging and decline in lung function.
Using Reticulocyte Hemoglobin Equivalent (RET- He) in Diagnosis of Iron Deficiency Anemia
Authors: Ahmed R A R , Fayek M H A , Salem D A D
Published: May 2020

Background

Anemia is a significant worldwide health problem. Approximately one third of the world's population suffers from anemia, half of which is due to iron deficiency (ID). Evaluation of parameters relating to serum ferritin and iron is critically important in the diagnosis of iron deficiency anemia (IDA). The recent development of automated systems for hematology analysis has made it possible to measure reticulocyte hemoglobin equivalent (RET-He), which is thought to reflect iron content in reticulocytes, in the same sample used for complete blood count tests.

Aim of the work

We aimed to assess the role of RET- He in diagnosis of iron deficiency anemia.

Subjects and Methods

Blood samples were obtained from 102 subjects. Patients were classified into three groups: IDA, ID, and anemia of chronic disorder (ACD). In addition 20 age and sex matched healthy volunteers were enrolled as control. RET- He was assessed by Sysmex XN1000 hematology analyzer.

Results

Patients in the IDA group had significantly lower RET-He levels than those in the control group. RET-He was correlated with serum ferritin in the IDA and ID groups. The area under the curve for RET-He was 0.883. The cut-off value of RET- He for detecting IDA was ≤ 26.5 pg with 80% sensitivity and 90% specificity.

Conclusion

RET-He facilitates the diagnosis of IDA with high accuracy and may be a clinically useful marker for determining IDA.
Implication of Flow Cytometry-Based Maturity Score in Risk Stratification of Acute Myeloid Leukemia in Adult Egyptians
Authors: Eldebaky E A M , Afifi H M E , Pessar S A , Ahmed A M S
Published: May 2020

Background

Already for decades, controversy exists as to whether immunophenotyping has a prognostic significance in acute myeloid leukemia (AML). However, the impact of the immunophenotypic assessment of blast maturity is largely unknown.

Objectives

Studying the influence of the degree of immunophenotypic maturity, via the application of the flow-cytometric based maturity score, on the clinical outcome as well as the laboratory and clinical parameters of patients with AML.

Methods

This study was conducted on 40 newly diagnosed AML patients with the quantifications of the variable expressions of three early myeloid progenitor markers namely CD34, CD117 and TdT. After that, the estimation of the blast maturity was based on a previous score proposed in a study by Schneider et al. (2015).

Results

Out of forty patients enrolled, 8 patients (20%) were assigned to the mature group whereas 32 patients were assigned to the immature group. There was no statistically significant difference between both groups in terms of demographics, clinical and laboratory data, cytogenetic risk groups as well as treatment outcome determined by mortality and response to chemotherapy on day 28 and at 6 months. Mature group showed slightly higher median survival in comparison to the immature group.

Conclusion

There is no evident relationship between maturity score of the blast population of a patient and the clinical outcome despite mild prolongation of median survival of the mature group. Higher sample size is needed to confirm this observation.
Expression of G Protein–Coupled Receptor 56 (GPR56) in Acute Myeloid Leukemia
Authors: Afifi H M S , Elgamal R A , Abdelbary H M , Rashad M A
Published: May 2020

Background

Acute myeloid leukemia (AML) is a heterogeneous marrow-based clonal group of neoplasms that affects hematopoietic cells responsible for the production of myeloid lineages. Prognosis of AML is multifactorial and has been extensively studied, yet it’s highly dependent on the presence of leukemic stem cells (LSCs). G protein–coupled receptor 56 (GPR56) was introduced as a novel human LSC marker in AML patients as acknowledged by the engraftment potential of GPR56+ cells sorted from selected AML specimens, which contributed to leukemia propagation in mice.

Aim of the work

The aim of this study is to analyze GPR56 expression in de novo AML patients using flow cytometry. The results of GPR56 expression will be correlated with the clinical outcome of the patients as well as other laboratory parameters.

Subjects and Methods

The study was carried out at Ain Shams University hospitals on a total number of 40 AML patients attending hematology-oncology unit during the period from November 2016 to July 2017, in addition to 20 healthy control subjects. Patients were assessed at day 28 after induction of treatment by bone marrow examination and minimal residual disease analysis, and follow up of the disease course was done.

Results

GPR56 was highly expressed above mean in 62.5% of AML patients. High values were significantly related to failure to attain complete remission, whereas it lacked prognostic significance to patient outcome and cytogenetic subgroups.

Conclusion

The poor prognostic impact of GPR56 was partially validated in our study.

Recommendations

Flow cytometric evaluation of GPR56 should be incorporated into the initial laboratory work-up for all newly diagnosed AML patients.
Risk Perception and Occupational Accidents among a Group of Egyptian Construction Workers in a Construction Company in Cairo
Authors: Ellaban M M I , Rady M H , Gabal H M S , Mostafa N S
Published: May 2020

Background

Construction sector is one of the main pillars of the global economy, even though it is a risky business in which fatal and non-fatal occupational injuries occur frequently. Information about workers’ awareness about health and safety hazards, risk perception and safe work practices can help to understand where to apply prevention strategies. Unfortunately, construction sites are workplaces with limited access for research; studies at work level represent 2.28% of all available research.

Objectives

To estimate the perception of construction workers to the occupational hazards, to identify types of common occupational accidents involving construction workers in an Egyptian company and to identify the workers’ personal and work related characteristics determinants on their risk perception.

Material and Methods

A cross sectional study was conducted among construction workers in one of the projects in Cairo. During the period from January to August 2018; a sample of 104 workers were interviewed using a structured questionnaire inquiring about socio-demographic characteristics, work related variables together with assessment of workers’ risk perception.

Results

the majority of the workers had low risk perception for falls, contact with chemicals, struck by objects, sharp objects, manual lifting, repetitive movements and heat stress, while the noise was reported as “ no or acceptable risk category”. The study identified age, health and safety training, working hours and the use of PPEs as significantly related factors to risk perception.

Conclusion

risk perception among studied workers in average is low. Older age, prolonged working hours, lack of training and not wearing PPEs are significant risk factors shaping workers’ perception.

Recommendation

safety training and change of work environment may improve workers’ perception toward occupational accidents and subsequently reduce the risk of injuries.
Impact of Health Education program on health related quality of life among patients with End Stage Renal Disease on hemodialysis and their Caregivers at Ain Shams University Hospital
Authors: Ibrahim A M , Shoman A E , Mady G E , Hassan A M , Mohamed D H
Published: May 2020

Background

Patients with renal failure had poorer quality of life than patients with other chronic diseases such as heart failure, diabetes mellitus and even cancer which makes them more susceptible to withdraw dialysis treatment.

Objectives

The study was conducted to implement a health education program for patients with end stage renal disease on hemodialysis and their caregivers at Ain Shams University Hospital and measure its effect on their quality of life.

Methods

A controlled interventional study was carried out on three phases. A sample of 56 patients on chronic regular hemodialysis and their caregivers (HD) were selected from the two hemodialysis units at Ain Shams university hospital and data were collected at the beginning and after six months of the health education program.

Results

The intervention group of the patients after the intervention reported significant better quality of life scores than the control group in all the domains except in work status, quality of social interaction, sexual function, social support and patient satisfaction and there were statistically significant increases in the intervention group of the caregivers than the control group in social function, emotional well-being, role emotional and mental component summary scores.

Conclusion

The health education and individualized nutritional program had a positive effect on many components of quality of life of the hemodialysis patients and their caregivers
Angiographic study of internal pudendal artery in patients with erectile dysfunction and ischemic heart disease
Authors: Saleh H , Zuelfakkar N , Said K , El-Nahas K
Published: May 2020

Background

ED and coronary artery disease (CAD) have been shown to share common risk factors such as advanced age, diabetes, hypertension and dyslipidemia. ED is emerging as an identifiable risk factor for the subsequent development of cardiovascular events.

Materials and Methods

This study included 20 male patients with ED, who were selected from the andrology clinic after being scheduled to undergo cardiac catheterization at the Department of Cardiology, Ain Shams University. All the patients were subjected to full history taking, general examination, evaluation of the erectile state, risk factor assessment and angiographic study involving coronary and pelvic arteries.

Results

There was a highly significant negative correlation (P = 0.0001) between IIEF score and the percent of obstruction affecting right, left & mean internal pudendal artery (IPA). As regard the relation between IPAs obstruction and coronary arteries obstruction, our results showed a significant correlation between right IPA and right coronary (RCA) obstruction. IIEF score also correlated with the degree of obstruction affecting coronary arteries, showing a negative significant correlation between IIEF score and right coronary artery percent of obstruction.

Conclusion

Erectile dysfunction is an independent risk factor for coronary heart disease, may be through increased atherosclerosis risk. Cardiac assessment is mandatory for patients presented with erectile dysfunction.
Comparative Study on the Efficacy of Intralesional Minoxidil Injection Alone and in Combination versus the Standard Intralesional Corticosteroid Injection in the Treatment of Alopecia Areata
Authors: Abdallah M A , Soltan M Y , Mohammed R S
Published: May 2020

Background

Alopecia areata (AA) is a common, inflammatory, non-scarring type of hair loss. Although hair loss can affect all hair bearing sites, patchy alopecia affecting the scalp is the most common type. Hair loss may progress to alopecia totalis (AT) which is complete balding at the scalp, or to alopecia universalis (AU), describing loss of all hairs on the scalp and body. Consequently, this can cause a devastating emotions effects on patients and may be expose them to psychological comorbidities such as depression, anxiety and social phobia.

Objectives

To assess the efficacy and safety of intradermal delivery of minoxidil 5% alone and in combination with intralesional triamcinolone acetonide for treatment of alopecia areata.

Patients and Methods

This study is prospective randomized intra-patients comparative control clinical trail that include 20 Egyptian patients suffering from multiple patches of AA during December 2017 till November 2018 which approved by The Dermatology Research Ethical Committee, Faculty of Medicine, Ain Shams University. Each patient had at least 5 scalp patches of approximately similar size (minimally 3 cm2) with a severity of alopecia tool (SALT) score up to S2 (less than 50% of scalp involvement) either in stable or progressive course. Patients were recruited from outpatient clinic of Dermatology, Ain Shams University Hospital and Al-houd Al-marsoud Hospital and informed written consent was obtained from all of them after explanations the study objective before enrollment in it.

Results

Considering the side effects of the treatment, all patients in all groups develop different types of side effects only the intolerable pain of injection was common between them and it was statistically not significant in comparison between the treatment groups. All the treatment groups showed significant reduction in dermoscopic finding of AA after treatment except in control group.

Conclusion

Standard intralesional corticosteroids are the mainstay first line treatment of patchy alopecia that involving less than 50% of the scalp and for cosmetics areas such as beard and eyebrows.
Assessment of Plasma Homocysteine in Acne Patients isotretinoim Therapy
Authors: Sallam M A , Alzawahry K M A , Haki R M Z
Published: May 2020

Background

Acne is a chronic inflammatory disorder of the pilosebaceous unit. Oral isotretinoin is a highly effective treatment for patients with moderate and severe, but causes significant side effects.

Objective

To estimate homocysteine level in acne patients after treatment with isotretinoin.

Patients and Methods

The prospective study was conducted at Ain Shams University Faculty of Medicine, Egypt, from June 2017 to November 2017, including male or non-pregnant female patients more than 18 years of age, categorized by the Global Evaluation Acne (GEA) into 22 patients with moderate acne vulgaris and 22 patients with severe acne. Isotretinoin was started in a dosage of 0.5 mg/kg/day, and 1.0mg/kg/day in moderate and severe acne patients respectively. Baseline homocysteine level, liver function tests, serum cholesterol and lipid profile were tested before and after 3 months.

Results

There was significant difference (p = 0.001) in homocysteine level among all cases Moreover, homocysteine serum level in patient's group who received high dose isotretinoin (1 mg/kg/d) showed highly significant results (p = 0.001) in contrast to patient's group who received low dose isotretinoin (0.5 mg/kg/d) = 0.003). A significant increase in lipid profile and liver function test was seen in all cases.

Conclusion

low dose isotretinoin seems to have less side effects on basic laboratory data such as CBC, liver function tests, lipid profile and homocysteine serum levels than high dose.
Autologous Plasma Filler in Treatment of Nasolabial Folds
Authors: Abdelfattah N S , Elhusseiny R M , Mahmoud A A
Published: May 2020

Background

There is an increasing demand for aesthetic correction of deep NLFs. Dermal fillers are one of the nonsurgical options for soft tissue augmentation, plasma filler is a recent technique tried in soft tissue augmentation. This procedure could be performed on an outpatient basis at a moderate cost, without any rejection reactions.

Objective

The presented study aimed to confirm the efficacy and safety of autologous plasma filler in treating nasolabial fold wrinkles.

Subjects and Methods

The present study included 40 females attended the Dermatology outpatient clinic of Ain Shams University Hospitals from March 2017 to November 2017. The age of patients ranged from 20 to 60 years old, with the mean age of 38.60 years old ± 11.48 SD.

Results

The overall success of our study was defined according to clinical improvement of NLFs subjectively by patients' satisfaction score which showed that 42.5% of patients rated their improvement as excellent, 35% as good and 22.5% as poor. The mean of WSRS decreased significantly from (3.20 ± 0.96) before treatment to (1.50 ±0.630) after 4 weeks of the treatment session. Furthermore, the mean value of GAIS scores 2 weeks after treatment session was (4.47 + 0.730) then become (4.03±0.964) 4 weeks after the treatment session.

Conclusion

In conclusion, Treatment with plasma filler injection resulted in significant improvement of NLFs with minimal complications.
Seminal Plasma Clusterin as a Biomarker for Spermatogenesis in Varicocele Patients before and after Varicocelectomy
Authors: Saleh H M A , Afify A A , Ahmed W A , Daruish M S
Published: May 2020

Introduction

a varicocele is an abnormally dilated pampiniform plexus of veins. Hyperthermia, oxidative stress, and elevated apoptotic index have been described in men with variocele and infertility. Clusterin (Clu) is a chaperone-like glycoprotein which is synthesized by Sertoli cells in high concentrations and is deposited onto the membranes of and mature spermatozoa, giving rise to the possibility that it has a role in sperm development. Secreted form of clusterin is a powerful anti-apoptotic.

Aim

To explore clusterin level in seminal plasma of infertile men with varicocele in comparison to normal healthy fertile subjects and to compare the seminal plasma clusterin level before and after varicocelectomy

Methods

The study included 25 patients suffering from varicocele with infertility (whether primary or secondary) for 12 months, and 10 healthy volunteers of matched age and sex as control. For all the patients Sub-inguinal varicocelectomy was done. Semen analysis, and seminal plasma clusterin assay were carried out before and three months after varicocelectomy.

Results

there was a statistically significant difference between patients and controls as regards sperm count, progressive motility, and seminal plasma clusterin (P < 0.01). Three months after varicocelectomy, the sperm count had a highly significant improvement in the patient’s group (Mean= 17.90 + 8.86) compared to a preoperative count (Mean= 11.43 + 7.56). There was a highly significant improvement in post-operative progressive motility in the patient’s group (Mean= 34.5 + 20.2) compared to a preoperative progressive motility (Mean= 22.05 + 15.5).

Post-operative clusterin showed a highly significant elevation in the patient’s group postoperative (Mean= 10.73 + 4.5) compared to a preoperative clusterin (Mean= 6.68 + 3.8).

Conclusion

Based on our study we could suggest another way of contribution of varicocele to male infertility by affecting seminal plasma clusterin level.
Evaluation of Topical Photo-Enhancer Assisted Intense Pulsed Light versus Methylene Blue Assisted Intense Pulsed Light for Treatment of Seborrheic Keratosis
Authors: Mohammed G F , Alzawahry K M A , Atef M M , Salahuldin I M
Published: May 2020

Background

seborrheic keratosis is one of the most common benign epidermal tumors that affects both sexes equally, and usually arises in individuals older than 50 years. It presents as sharply demarcated, slightly raised brownish patches or plaques, usually on sun-exposed surfaces of the skin. The clinical presentation can be quite variable and includes clinical variants, such as stucco keratosis and dermatosis papulosa nigra.

Aim of the Work

to evaluate the efficacy and safety of topical carbon gel photo-enhancer assisted intense pulsed light versus methylene blue assisted intense pulsed light photodynamic therapy for treatment of Seborrheic Keratosis.

Patients and Methods

this is a comparative prospective study that included thirty patients of skin types III to V Fitzpatrick class having multiple Seborrheic Keratosis lesions with no sex or age predilection. They were randomly recruited from Dermatology out-patient clinic of Ain –Shams University Hospitals, during period from June 2017 till March 2018. The study was approved by Research Ethical Committee of Ain Shams University and fulfilled all the ethical aspects required for human research.

Results

this denoted that the methylene blue-mediated photodynamic therapy (MB-PDT) (liposomal-loaded methylene blue gel 10%).and topical carbon gel photo-enhancer assisted intense pulsed light). could be effective in treating patients with Sks. Our findings denote the efficacy of them in curing multiple Sk lesions. The efficacy of methylene blue-mediated photodynamic therapy (MB-PDT) (liposomal-loaded methylene blue gel 10%).

Conclusion

that Intense Light Pulse using liposomal-loaded MB and Topical carbon suspension-assisted IPL treatment could be a good option for patients with indistinct pigmented or thick melanogenesic lesions. Adverse reactions to this treatment were minimal and the results acceptable, though appropriate lesions need to be chosen care- fully.