bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurosurgical Aspect of Management of Movement Disorders
Authors: Mohamed Adel N , Mashaly Hazem A , Hamza Emad M , Ibrahiem Eslam R
Published: August 2023

Background

People with movement disorders can experience involuntary movement such as tremor, abnormal posture, slowness, walking difficulty, and stiffness due to neurological conditions.

Aim of the Work

to conduct a meta-analysis of surgical treatment of patients with movement disorder diseases and help patients for living normal life and performing all sports and hand skill work without any limitation of movement, and improve surgical management, learn indication of surgery, patient selection, techniques, and complications among functional neurosurgeons.

Methods

Searching procedures will be conducted focusing on the following sources: electronic databases: Medline; 2) Bibliographies and 3) Hand searches of journals:

-Online internet search from the electronic database of Medline via PubMed, “Related articles” function will be used to obtain any relevant articles. Additionally, references of the articles included in the analysis were reviewed for any other citations. After screening full text of the included studies the following data was extracted from each primary study: study design, full reference of article including author, year and source, population description: criteria for diagnosis, severity of disease. Intervention: Thalamotomy and DBS alone. Comparative Group (if relevant) and outcome.

Results

The efficacy in reducing drug-resistant tremor was non-significantly equal among DBS group and thalamotomy group. Cognitive changes were nonsignificantly less among DBS than thalamotomy groups. Gait disturbances were non-significantly lower among DBS than among thalamotomy group. Ataxia risk was non-significantly lower among DBS than among thalamotomy group. Dysarthria risk was non-significantly different among DBS and thalamotomy groups. Hypresthesia risk was non-significantly lower among DBS than among thalamotomy groups. Seizures risk was non-significantly higher among DBS group than among thalamotomy group. Paresis risk was non-significantly lower among DBS than among thalamotomy groups. Psychiatric disturbances risk was non-significantly different among DBS and thalamotomy groups. Intracerebral hemorrhage was significantly lower among DBS than among thalamotomy. That mean DBS is Equal in efficacy and less adverse effects but more expensive than thalamotomy.

Conclusion

Net result of complications of Thalamic stimulation is less than thalamotomy due to our meta-analysis which show that the incidence of intra cerebral hemorrhage is more in thalamotomy than thalamic stimulation, and the incidence of ataxia, gait disturbance, hypoesthesia and paresis are more in thalamotomy than thalamic stimulation but the incidence of seizers is higher in thalamic stimulation than thalamotomy. But there are another complication which is different in results between both such as dysarthria and psychiatric disturbance.
Management of Vestibular Schwannoma
Authors: Moharram Hussien Al-Sayed M , Hamada Salah Mostafa , Hamza Emad Mamoon , Ali Hisham Tawfick
Published: August 2023

Background

Vestibular schwannoma (VS) is considered histologically a benign tumor and is currently preferred over the older term (Acoustic neuroma) as it usually arises from the inferior division of the vestibular nerve and not the acoustic nerve in the cerebellopontine angle. VS were one of the most common intra cranial tumors, comprising 8-10% of tumors in most series. Annual incidence is probably about 1.5 cases per 100,000 population, over the past couple decades this estimate has increased and the typical size at the initial diagnosis has decreased as a result of the advances in the MRI scans & CT scan qualities, (VS) is found to be occurring among middle age groups with no gender prevalence in the fourth or fifth decade.

Aim of the Work

To evaluate the VS management especially partial resection of large VS followed by gamma knife.

Patients and Methods

This study is a retrospective prospective study. This study was carried out at Al-Demerdash University hospital, the authority of specialized institutes and teaching hospitals and international medical Centre (Gamma knife department). Time of the study: from March 2019 till March 2021.

Results

In this study we found that according to the demographic, characteristics & personal history of the study group, it is noted that vestibular shwannoma is common among middle aged group (mean =41 years), with no substantial difference between genders (53% F & 47% M), we found that as regard the clinical picture, most of patients suffered from hearing loss as a complaint (88%) of about 3.5 months duration (median IQR) while all the patients (100%) had a sensory neural sensory loss and verified by PTA, SDT & word discrimination, tinnitus & unsteadiness were found in 70% & 50% respectively. This study has some limitations which are small populations of patients with vestibular schwannoma who generally have short follow-up. We include patients with heterogeneous tumors in regard to size and hearing status. Further studies needed with large populations to establish our results.

Conclusion

We concluded that considering the good tumor growth control and facial nerve function preservation as well as the possibility of preserving serviceable hearing and the low number of complications, subtotal resection followed by Gamma knife can be the treatment option of choice for large Vestibular schwannoma.
Assessment of Post-Operative Outcomes of Surgical Excision of Gliomas of the Eloquent Areas of the Brain under Awake versus General Anaesthesia
Authors: Ahmed Mostafa A , El-Shehaby Amr , Abdulbar Ahmad , Yousry Ahmad
Published: August 2023

Background

Surgical excision of eloquent gliomas can be done under general anaesthesia or awake anaesthesia. Surgical excision of eloquent gliomas using awake anaesthesia helps to avoid intra-operative manipulation of the eloquent areas of the brain and thus avoid post-operative neurological deficits.

Aim

to compare the operative outcomes of eloquent glioma resection performed under general anaesthesia compared to awake anaesthesia to assess the safety and effectiveness of each intervention.

Materials and Methods

This systematic review and meta-analysis were conducted in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Metaanalysis 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 reported their findings according to each of the items listed in those checklists (1).

Results

Seven studies reported the early motor deficit, while the rest of the studies have no data concerning early motor deficit. The overall effect estimates did not favor awake craniotomy over general anesthesia in terms of motor deficit (RR 0.92, 95% CI 0.48– 1.4). The pooled studies showed significant heterogeneity (p = 0.001; I2 =85%.

Conclusion

The use of awake craniotomy for surgical resection of gliomas of the eloquent areas is largely limited to small retrospective studies. Within these studies, awake craniotomy achieves both an acceptable rate of GTR and a low rate of persistent neurological deficits. The results of this study illustrate the potential feasibility of awake craniotomy for surgical resection of gliomas of the eloquent areas and emphasize the need for future prospective studies to better determine its efficacy and outcome.
A Systematic Review for Simultaneous versus Delayed Ventriculo-Peritoneal Shunting in Surgical Repair of Meningomyelocele sac in Patients with Chiari Type II Malformation
Authors: Abd El Khalek Salah , Mashaly Hazem A , Nagaty Ahmed M , Adly Omar A
Published: August 2023

Background

The management of MMC-associated hydrocephalus has evolved over time. Many consultants now preferring to delay decision of shunting in those patients to avoid complications attributed to unnecessary procedures. MMC not treated on initial inpatient stay has increased.

Aim of the Work

Comparing simultaneous Ventriculoperitoneal Shunting versus Delayed shunting in surgical repair of meningiocele in neonates with Chiari Type II regarding outcome, shunt related complications, and analysing the importance of Ventriculo-peritoneal shunting in such cases.

Patients and Methods

This systematic review From January 1990 to January 2021 through Internet search through MEDLINE, Google Scholar and Cochrane Collaboration Library. The study included all available studies from 1990-2021 including randomized or non-randomized clinical trials, prospective or retrospective observational cohort, and case-control studies that address these criteria was collected. Articles that were excluded that articles not fitting the inclusion and exclusion criteria, duplicated articles, unavailable full texts, or abstract-only articles as preceding papers, conference, editorial, and author response.

Results

In recent few years, there’s an emerging trend of favoring the simultaneous shunting (ST) over delayed shunting (DT). This may be due to attributed risk carried by increase in the rate of shunt infection (2.79% vs 3.34), moreover shunt revision when both techniques are compared shows the superiority of the simultaneous shunting (3% vs 8%).

Conclusion

Delayed treatment of hydrocephalus during initial hospitalization resulted in decreasing shunt infection. Compared to NIS study that stated longer inpatient stay associated with DT increased rate of shunt infection and malfunction, in the short period of time.
Comparative Study between Bupivacaine 0.5% in TAP Block versus Diclophenac Sodium IM for Post-Operative Analgesia after Cesarean Section
Authors: Maklad Ahmed Khairy , Ashoush Sherif , Abbas Ahmed Mohamed , Ahmed Ahmed Fathy Mohamed
Published: August 2023

Background

Cesarean section is one of the commonly performed surgical procedures in the field of obstetrics. It accounts for more than one-fourth of all births worldwide. The most common undesirable outcome following cesarean section is postoperative pain. Failure to treat the pain not only causes distress to the mother but also affects mother‑baby bonding, which, in turn, affects care and breastfeeding of the newborn.

Objective

The aim of the study is to compare the effectiveness of US guided TAP block using 0.5% bupivacaine versus declophinac sodium for postoperative analgesia in patients undergoing cesearean section and reducing nalufine dose.

Methods

This prospective study was conducted at tertiary care hospital at Ain Shams University hospitals for 6 months from June to December 2020 and performed on total 80 patients who underwent elective cesarean section.

Results

Our research study revealed that there was statistically significant increase in visual analogue score in diclofenac group than TAP block group explained by removal of effect of spinal anaesthesia and regaining of pain sensation in diclofenac group while persistence of anaesthetic effect of bupivacaine in TAP block group. Our study found that there was statistically significant increase in the time to first request of analgesia in TAP block group than diclofenac group. Also, there was statistically significant decrease in the total consumption of Pethidine (mg) in TAP block group than Diclofenac group. There was no statistically significant difference between Diclofenac group & TAP block group regarding adverse effects post operative nausea & vomiting.

Conclusion

The analgesic efficacy of the US-guided TAP block after Caesarean delivery compared to the combination of sodium diclofenac with less requirement of rescue analgesic.
Effect of Nitric Oxide Donors on Uterine and Subendometrial Blood Flow in Patients with Unexplained Infertility: A Randomized Controlled Trial
Authors: Kortam Mohamed A , Abdel Hafeez Mohamed A , El Rahman Rehab M Abd , Yousef Alaa M
Published: August 2023

Unexplained infertility has been defined, by the Practice Committee of the American Society of Reproductive Medicine (ASRM), as inability of a couple to conceive for at least 12 months, with unremarkable standard infertility evaluation ((ASRM), 2006). Although estimates vary, the prevalence of unexplained infertility is approximately 15–30%

Aim of the Work

to evaluate the effect of nitroglycerine transdermal patches on uterine and subendometrial blood flow in women with unexplained infertility.

Patients and Methods

Transdermal nitroglycerine patch was administered to the allocated group from the 2nd day of cycle till maturation of the follicles ≥ 18 mm just for one cycle.

Results

The relatively underdeveloped endometrial thickness did not change significantly after treatment of women with unexplained infertility with nitroglycerin and remained significantly lower than women of the fertile group. Also, nitroglycerin treatment did not result in significant change in uterine artery Doppler indices. However, uterine artery indices of nitroglycerin-treated women did not also show a significant difference (P > 0.05) from fertile women. On the contrary, nitroglycerin treatment in women with unexplained infertility significantly increased subendometrial 3D power Doppler indices to mean values that did not differ significantly from the fertile women. According to the results of the current study, biochemical pregnancy was more commonly achieved in the nitroglycerin group compared to the control group (6.67% vs 3.33%), Yet this difference failed to prove statistical significance. Although adverse effects of nitroglycerin treatment in the current study, namely headache, blurring of vision and hypotension, were more common on the nitroglycerin group compared to the control and fertile groups; this difference couldn’t reach statistical significance (P > 0.05).

Conclusion

Doppler study of uterine hemodynamics can be considered in infertility work-up. Although still lacking evidence, women with suboptimal uterine perfusion may be offered therapies improving uterine blood flow, such as nitroglycerin.
Assessment of Tissue Expression of PIR2/RNF144b Protein in the Different Stages of Endometrial Cancer
Authors: Rami Ahmed Rami Mohammed , Mohammad Hayam Fathy , El Khazragy Nashwa Nagy , Allam Aya Helmy Zayed
Published: August 2023

Background

Endometrial cancer is considered as one of the most common gynaecological cancers in developed countries. Its incidence has risen about 20% over the last decade and the rate 0f death has risen >100% over the past two decades.

Aim of the Work

This retrospective cohort study will assess tissue expression of PIR2 protein in the different stages of endometrial cancer.

Materials and Methods

A retrospective cohort study was conducted at Ain Shams University Maternity Hospital (The Early Cancer Detection Unit), A Formalin fixed paraffin embedded tissues (FFPT) was collected from the patient's the pathology unit at Gynecology & Obstetrics hospital, Ain Sham University hospitals in a period of 12 months during 2017 – 2018. The study was conducted on 60 women diagnosed as endometrial cancer; they are subdivided into 2 groups: 1st group: 30 patients with stage 1 endometrial cancer by surgical staging, 2nd group: 30 patients with other advanced stages of endometrial cancer by surgical staging.

Results

In this study, we show that the E3-ubiquitin ligase PIR2/RNF144B is a potential targetable biomarker in endometrial cancer. There is a high significant association between the PIR2/RNF144b and different stages of EC and higher tumor grades are associated with higher protein expression. The paraffin -embedded endometrial tissue for each patient eligible for the study was analyzed for tissue expression of PIR2 protein using Immunohistochemistry.

Conclusion

We suggested that PIR2/RNF144b can potentially be used as a biomarker for endometrial cancer for early diagnosis and for monitoring clinical progress of cancer status and efficacy of used treatment.
Intraoperative Direct Vision of Transversus Abdominis Plane (TAP) Block versus Ultrasound Guided Transversus Abdominis Plane (TAP) Block for Pain Control after Caesarean Section (CS). A Randomized Controlled Clinical Trial
Authors: Hemeda Hosam M , Khalil Dalia A , Abdallah Mohamed M , Elsenity Mohamed A
Published: August 2023

Background

Adequate postoperative analgesia following CS hastens post-operative mobilization, decreases maternal morbidity and facilitates bonding with the newborn.

Aim of the Work

to assess pain scores at (rest and movement), and need for opioids in women receiving intraoperative direct vision of transversus abdominis plane (TAP) Block versus women receiving ultrasound guided transversus abdominis plane (TAP) Block following cesarean section in first 24H.

Study Design

Randomized controlled clinical trial was conducted on Patients undergoing lower segment Cesarean section under spinal anesthesia with intra thecal hyper baric bupivacaine 0.5%. Patients were randomized to study group that received intraoperative direct vision transversus abdominis plane (TAP) Block and control group received ultrasound guided transversus abdominis plane (TAP) Block. Postoperative pain score was recorded using visual analog scale (VAS) score and analgesic consumption recorded from patient medication chart.

Result

A total of 220 eligible women planned to undergo elective lower segment caesarean section were recruited in the current trial, and were randomly allocated into one of the two groups, there were no significant differences between women of both groups regarding age, parity or BMI. No significant differences between the studied group regarding patient pain perception (VAS Score) during rest and movement at different times of follow up (6,8,12,24 H) postoperatively. The dose and the first time of analgesic requirement was non-significantly different among studied groups.

Conclusion

USG and surgical TAP blocks were safe and had similar efficacy in providing postoperative analgesia in pregnant women following cesarean section under spinal analgesia. Surgical TAP block is an efficacious, safe and rapid technique, particularly in patients in whom USG TAP block is technically challenging (obese women), and where the ultrasound isn’t available in operative theater.
Effect of Rectus Muscle Re-approximation and Postoperative Pain in Women with Previous Cesarean Delivery: A Randomized Controlled Trial
Authors: El Kader Fahmy Ahmed Abd , Hendy Marwa Mohamed Said Ebrahim , El Fattah Elsenity Mohamed Abd
Published: August 2023

Background

Cesarean section rate has increased dramatically worldwide but there is still debate about the optimum operative technique of cesarean section. Rectus muscle reapproximation at cesarean delivery (CD) is performed frequently by some obstetricians; however, the effect on postoperative pain is unclear. To this end, we investigated whether rectus muscle reapproximation increases postoperative pain.

Objective

In women with previous cesarean delivery, the aim of this prospective double blind randomized controlled trial is to assess the effect of rectus muscle approximation on postoperative pain.

Patients and Methods

This study was a prospective, doubleblind, randomized controlled trial. It included 340 women with previous cesarean delivery, with a singleton pregnancy, who underwent elective lower segment cesarean section at term. The patients were randomly allocated into two equal groups; Group I (study group) in which rectus muscle approximation were done (surgeons were instructed to place three vertical midline loose interrupted sutures to re-approximate the rectus muscles by using Vicryl 0 suture) while in Group II (control group) rectus muscle approximation not done. Intra- and postoperative pain management was standardized within the study protocol.

Results

Both groups were comparable in age, body mass index (BMI), parity, gestational age (GA), sub-rectus hematoma, surgical site infection and subsequent hospital stay. While study group had significantly longer operation duration, significantly higher pain score from first day of operation and up to 6 weeks postoperative and significantly higher NSAID dose and opioid requirements at first and second day postoperative.

Conclusion

Our results suggest that rectus muscle reapproximation increases operative time & postoperative pain and subsequently associated with higher short-term postoperative opioid use among women undergoing cesarean section (CS). Surgical complications do not appear to be impacted by rectus muscle reapproximation. So, the benefits described with rectus muscle reapproximation such as less adhesions, should be weighed against the potential for a modest increased postoperative pain and corresponding opioid use.
Comparison between Intraoperative and Ultrasound Determined Cesarean Scar Thickness after Elective Cesarean Sections and Unplanned Cesarean Sections in Subsequent Term Pregnancies
Authors: Ahmed Salah T , Mamdouh Ahmed M , Elsenity Mohamed A , Salama Marwa O
Published: August 2023

Background

Cesarean section (CS) rates are increasing worldwide. As a result, women presenting with pregnancy with previous CS are also rising. Previous CS is becoming the most common indication for CS, confirming the age old dictum proposed by Edward Craigin in 1914 “Once a cesarean always a cesarean.

Aim of the Work

Assessment of cesarean scar; as non-healthy or poor-healed scar are associated with some complications such as chronic pelvic pain, dyspareunia, and abnormal bleeding. Moreover, these poor-healed scars may predispose to preterm labour and uterine dehiscence or rupture in subsequent pregnancy. It was reported also that poor-healed scar may predispose to abnormal placental invasion.

Patients and Methods

This comparative cross-sectional study was conducted on 100 randomly selected pregnant women attending the outpatient clinic of Ain Shams University Maternity Hospital (ASUMH) in the third trimester at term aged >18 years old with single intrauterine pregnancy, previous one cesarean delivery and not in labor. Pregnant women with abnormal placentation, uterine abnormalities and/or previous uterine surgeries other than one CS delivery were excluded from current study.

Results

there was no significant difference betweenn two studied groups according to demographic data as age (27.0±3.9 vs. 27.6±3.6, p = 0.382) and BMI (28.2 ± 3.3 vs. 28.7 ± 2.2, p = 0.283). Both groups were comparable with statistically significant difference regarding scar thickness in (ml) and LUS staging. The scar was thicker in elective cases compared with emergency ones (8.4±1.1 vs. 7.7±1.3, p = 0.002), stage I (34 (68.0%) vs. 16 (32.0%)), stage II (15 (30.0%) vs. 25 (50.0%)), stage III (1 (2.0%) vs. 7 (14.0%)) and stage IV (0 (0.0%) vs. 2 (4.0%)).

Conclusions

From the results of current study we can conclude that, Maternal age and BMI had no effect on cesarean scar quality, integrity and complications incidence. The scar was thicker in elective cases compared with emergency ones.
Comparison between Agonist Trigger with HCG Luteal Phase Supplementation vs HCG Trigger with Progesterone Luteal Phase Supplementation in Antagonist Controlled Hyperstimulation Cycle Regarding Clinical Pregnancy Rate
Authors: Soliman S , Guindy A , Tantawy W , Nawara M
Published: August 2023

For the last two decades, exogenous progesterone administration has been used as luteal phase support (LPS) in connection with controlled ovarian stimulation combined with use of the human chorionic gonadotropin (hCG) trigger for the final maturation of follicles. The introduction of the GnRHa trigger to induce ovulation showed that exogenous progesterone administration without hCG supplementation was insufficient to obtain satisfactory pregnancy rates. This has prompted development of alternative strategies for LPS. Augmenting the local endogenous production of progesterone by the multiple corpora lutea has been one focus with emphasis on one hand to avoid development of ovarian hyper-stimulation syndrome and, on the other hand, to provide adequate levels of progesterone to sustain implantation.

The present study evaluates the use of micro-dose hCG for LPS support and examines the comparison between conventional HCG trigger and progesterone luteal phase support vs Agnosit trigger and HCG microsdose luteal phase support as regards to pregnancy rate.

Methods

100 patients were recruited for this trial Cases with Polycyctic ovaries were excluded from the study. The study was approved by Ethical committee of Ain Shams university. Patients received Gonal-F (Merck Serono S.p.A., Via delle Magnolie 15, I70026 Modugno (Bari), Italy.) in a dose ranginging between 150-300 IU for stimulation and the dose was adjusted according to response starting day 6. Premature LH surge was prevented with 0.25 mg of a GnRH antagonist (Cetrotide; Merck international) starting on day 6, when two or more follicles reach a size of 18–20 mm, patients were randamized into 2 groups of 50 each. Trigger of ovulation was done by a single dose of 0.2 mg triptorelin (Decapeptyl®ferring pharmaceutical company, Germany) and luteal phase support with daily 125 IU HCG injections in Group 1. Group 2 received A single dose of HCG 10000 IU was given followed by progesterone supplementation with 100mg IM progesterone (Prontogest® IBSA Swisserland). 2 Embryo were transferred and an ultrasound at 4 weeks after embryo transfer for cases with positive pregnancy test. As regards to clinical pregnancy group 1 had 28 of the 50 (56%) Positive clinical pregnancy while control was 26 of the 50 (52%), the difference was not statistically significant (P > 0.68). No cases of moderate or severe ovarian hyperstimulation were observed during the study. To conclude, Agonist trigger combined with microdose HCG had a comparable pregnancy rate resulst to HCG trigger and conventional progesterone support for luteal support without increasing the risk of ovarian hyper stimulation.
Estimation of Progression Free Survival (PFS) in Patients with Hormone Positive Metastatic Breast Cancer in Cohort of Egyptian Patients (Retrospective Cohort Study)
Authors: Azmy Ali M , EL-Qady Mohammed S , Shafik Amr , Abd El-Fattah Ahmed M
Published: August 2023

Background

Breast cancer (BC) is the second most common cancer in the world and the most frequent cancer among women with approximately 1.7 million new cancer cases diagnosed yearly. It is the most common female malignancy accounting for 22.9% and 37.7% of all female cancers worldwide and in Egypt, respectively. BC in Egypt carries an unfavorable prognosis with 29% mortality and 3.7:1 incidence to mortality ratio.

Aim of the Work

to assess progression free survival (PFS) in patient with hormone positive metastatic breast cancer and prognostic factors affecting it in series of Egyptian patients treated in Ain Shams University hospitals and Maadi Medical Armed Forces Complex.

Patients and Methods

This retrospective cohort study was conducted in Clinical Oncology Department, Ain Shams University Hospitals and Medical Oncology Department, Maadi Medical Armed Forces Complex from January 2019 till December 2020. Progression free survival was estimated for all patients. Age of the studied patients ranged from 32 to 85 years with mean age of 58 years, 77.9% of the patients with MBC were postmenopausal, 22.9% of patients had positive family history. Most of our patients were IDC (95%) while only 5% were ILC, hormonal and molecular status among studied groups showed ER +ve in 100% of patients.

Results

Regarding to progesteron receptor (PR) status, 8.7% of patients were negative and 91.3% were positive. Ninety percent had HER2 overexpression. In 240 breast cancers, proliferative index Ki-67 was low in 84.6%. High levels were seen in 15.4% of cases. Progression free survival ranged from 1 to 66 months with median of 15 months. There are statistically significant relations of progression free survival with menopausal status, family history, HER2 overexpression, proliferative index Ki67, onset of metastasis evolution, site of metastasis, 1st line of treatment for metastasis, type of hormonal treatment for metastasis and ovarian ablation for premenopausal MBC patients.

Conclusion

There are statistically significant relations of PFS with 1st line of treatment of metastasis, as we find that Patients who received hormonal treatment only was significantly higher PFS (median PFS 17 months) compared to patients whose received both hormonal therapy and chemotherapy (median PFS 15 months) and patients whose received chemotherapy only (median PFS 5 months).
Retrospective Study about the Impact of the Negative Lymph Node Count on the Survival Rate of Stage III Colon Cancer
Authors: Barakat Heba Allah Amin Sanad , El Bassiouny Mohamed , Farag Amr Lotfy , Saleh Mohamed Essam
Published: August 2023

Background

Colorectal cancer is the fourth most frequently diagnosed cancer and the second leading cause of cancer death in the United States. In 2019, an estimated 101,420 new cases of colon cancer and approximately 44,180 cases of rectal cancer occur. During the same year, an estimated 51,020 people will die of colon and rectal cancer combined.

Aim of the Work

The aim of this study was to assess the role of negative lymph node count as a predictor of prognosis in patients with stage III colon cancer.

Patients and Methods

During the five years period from January 2013 till the end of December 2018; about 2417 patients presented to the Clinical Oncology Department, Ain Shams University Hospital per year. Out of which, about 132 cases were pathologically diagnosed as colorectal cancer cases of which 42 cases met the inclusion criteria of our study.

Results

The current study showed that increased NLN was insignificantly correlated with improved PFS in stage III colon cancer. Subgroup analysis found that the prognostic value of NLN was independent on gender, age, sideness of disease. These findings may be related to the lack of our sample size; more importantly, other mechanisms involved are unclear. Here, it must be mentioned that there was no significant difference in the survival between the NLN ≤11 and >11 groups in stage IIIB disease compared with that in stage IIIA and IIIC disease. The patients with stage IIIB accounted for 59.5 % of the total number of patients, while the number of IIIA and IIIC patients only accounted for 40.4%, making it difficult to draw meaningful results.

Conclusion

Our study suggests that NLN cannot function as independent indicator of survival of patients with stage III colon cancer. Regardless patient characteristics (gender, age or sideness of disease).
The Effect of Cardiac Rehabilitation on Quality of Life and 6-Minute Walk Test in Breast Cancer Survivors
Authors: Haddad Mohammed Malek , Kamal Khaled Abdel Aziz , Kadry Ahmed , Raymond Ramy
Published: August 2023

Background

Breast cancer (BC) is the most diagnosed cancer in women, contributing to 24.6% of malignancies in females and responsible for 15% of all cancer-related deaths among women worldwide.[1] Over the last 20 years, BC survival rates have significantly improved.[1] However, this survivorship is often marked by fatigue, poor quality of life (QoL), reduced functional capacity along with treatment-related adverse effects.[2] The implementation of a model similar to cardiac rehabilitation (CR) program as a preventive strategy may provide a potential solution to improve functional capacity, quality of life and reduce cardiovascular disease (CVD) risk in cancer survivors.[3]

Objective

to investigate the effect of 12-week completed cardiac rehabilitation program on quality of life (using FACT-B questionnaire) and 6-minute walk test in breast cancer survivors.

Patients and Methods

In this 2-arm parallel prospective, randomized, controlled clinical trial, sixty breast cancer survivors 3 months to 1 year after completion of chemotherapy were recruited at Ain Shams University hospitals and divided into two groups Study group (n = 30); participated in 12-week CR program and Control group (n = 30) did not participate in CR program but still received the usual cancer care. Cardiac rehabilitation program consisted of education, diet control, drug adherence, 12 weeks exercise sessions, Behavior and psychosocial management, Sexual activity education Smoking cessation. Functional capacity was assessed before and after study period by sixminute walk test (6MWT) and exercise test (using modified Bruce protocol). All patients were personally interviewed for assessment of quality of life before and after study period using (FACT-B) questionnaire. In addition patients underwent echocardiography assessment before and after study period.

Result

Sixty female breast cancer survivors were enrolled. Nine patients dropped from CR program, some due to social commitments (n = 2), others due to long distance issues (n = 2), and the remaining were not interested in continuing the program (n = 5). There were no significant differences between the two groups regarding age, baseline BMI, hemoglobin (Hb) levels, medical history, chemotherapy protocol, and radiation. When comparing two groups, the study group showed significant increase in age-predicted 6MWD (p = 0.02), ET (p < 0.001), METs (p < 0.001), QoL score (p < 0.001), along with significant decrease in SBP (p < 0.001), HR (p < 0.001), RPP (p < 0.001).

Conclusion

The results of this study demonstrated that completed cardiac rehabilitation program improves functional capacity and quality of life in breast cancer survivors.

Recommendation

We recommend that multicomponent supervised cardiac rehabilitation program should be incorporated within the usual care of breast cancer survivor
Effect of Cigarette Smoking on Macular, Choroidal, and Retinal Nerve Fiber Layer Thickness: A Systematic Review and Meta-Analysis
Authors: Abd El-aziem Aya M , Haleem Heba M Abdel , Eliwa Tamer F , El-Shazly Amany A , Moustafa Moustafa E
Published: August 2023

Background

Smoking is one of the most significant and preventable health problems of our time causing various chronic illnesses including ocular problems; however, its effect on thickness of the retinal layers or choroid is still unknown.

Aim of the Work

to conduct a systematic review and attempt a meta-analysis to determine the effect of tobacco smoking on central macular (CMT), choroidal (CT), and retinal nerve fiber layer thickness (RNFL).

Materials and Methods

comprehensive literature search was conducted using the databases Google scholar, PubMed, web of science, EMBASE and Cochrane Library for published studies from 1 January 2000 to 1 June 2021.This meta-analysis included thirteen studies. They were Observational studies.

Results

This study demonstrated no significant effect of tobacco smoking on central macular, choroidal or retinal nerve fibre layer thickness. However, advanced analyses showed that smoking has acute effect on choroidal thickness and would influence the thickness of superior and inferior RNFL quadrants.

Conclusion

There was no evidence of an association between tobacco smoking and changes in choroidal, central foveal or retinal nerve fibre layer thickness. Future research on this interesting and important topic could aid in the prevention and treatment of smoking-related illnesses.
Comparison between Posterior Capsular Opacification Following Implantation of Hydrophilic & Hydrophobic Acrylic IOLs
Authors: Elwan Sheriff , Elkitkat Rania Serag , Nada Ossama Tarek Sayed , Rehan Karim Raafat Aly Elsayed
Published: August 2023

Background

Nowadays, care of a cataractous patient greatly exceeds surgical removal of the opacified lens. In a step forward to the welfare of the elderly, special concern is given for posterior capsular opacification (PCO), which remains one of the most common complications after cataract surgery.

Aim of the Work

The aim of that work was to compare the incidence of posterior capsular opacification in patients who underwent hydrophilic IOLs versus hydrophobic IOLs implantation.

Patients and Methods

The present study was conducted at the Ophthalmology Outpatient Clinic, Ophthalmology Department, Ain Shams University, and assessed patients, who underwent uneventful phacoemulsification cataract surgery and hydrophilic or hydrophobic acrylic nonheparinized IOL implantation. Surgeries were done by equal caliber experienced surgeons. ―In-thebag‖ fixation of a square-edged IOL and continuous curvilinear capsulorhexis with cortical cleanup was performed. Patients’ data were collected from the electronic medical records.

Results

The study revealed that neither the IOL material nor the general medical condition significantly delayed the onset of PCO development. However, we need to collect more clinical records of cases and conduct multicenter logistic regression analyses on a larger sample using a prospective study design.

Conclusion

The present study found no significant difference between the incidence PCO development between hydrophobic and hydrophilic IOLs. Moreover, the patients’ general conditions did not show a significant association with PCO incidence.
Assessment of Corneal Endothelial Cell Parameters Using Specular Microscopy in Previously Infected SARS-CoV-2 Patients
Authors: Elshalkami Mohamed Anis , Abdalla Tarek Mohamed Mahmoud , Abdellatif Mona Kamal , Fawzy Samah Mahmoud
Published: August 2023

Purpose

To assess the effects of severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) infection on the endothelium of the cornea.

Methods

A cross-sectional, comparative study with subjects previously infected by SARS CoV 2 infection for not less than six months (group 1) and a group of sex and age-matched controls without previous infection of SARS CoV 2 (group 2).

Endothelial cell parameters were examined using specular microscopy. Following full ophthalmologic examination the groups were matched with controls of the same sex and age with no prior ocular surface pathologies.

Results

64 and fifty-three right eyes were examined in both groups one and two, respectively. Between the 2 groups no differences in any of the examined specular parameters were detected that are statistically significant.

Conclusion

No delayed effects on the corneal endothelium appear to be caused by SARS CoV 2 infection. Further studies comparing the same subject before and after infection will be of significance.
Incidence, Causes, and Management of Post Vitrectomy Endophthalmitis: A Metaanalysis Study
Authors: Mahgoub Mohamad Moghazy , Naguib Karim Magdy , Abo El maaty Mahmoud Rabab , Hanna Pola Nageh
Published: August 2023

Background

Endophthalmitis is a rare but severe form of ocular inflammation due to infection of the intraocular cavity that can lead to irreversible visual loss if not treated properly and timely. Clinical features of endophthalmitis following PPV (Pars Plana Vitrectomy) are similar to those of endophthalmitis following cataract surgery. Some cases, however, may demonstrate a delayed presentation.

Objective

To do a meta-analysis of studies to know the incidence, causes, and management of post vitrectomy endophthalmitis.

Patients and Methods

The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis) statement 2009 PRISMA (Preferred Reporting Itims for Systematic Reviews and Meta analysis).

Results

Electronic search yielded 306 articles from two databases. After duplicates removal, 102 articles were screened in title/abstract screening, while 33 articles were screened in full text screening for inclusion. Finally, 18 articles were included in qualitative and quantitative meta-analysis. The manual search resulted in no additional studies.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021.

Data Extraction

If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Conclusion

The overall incidence of post-PPV endophthalmitis across all studies was low. More recent data indicate that using 25 gauge needle during vitrectomy was significantly has the highest endophthalmitis incidence rate than others. While using 20 gauge needle during vitrectomy was significantly has the lowest endophthalmitis incidence rate than others. Vitreoretinal surgeons need to pay close attention especially when performing 25 G PPV, including a meticulous sclerotomy preparation, balancing the potential benefits of nonfluid tamponade, and removing all vitreous wicks, to reduce the risk of endophthalmitis.
Correlation between Visual Acuity, Contrast Sensitivity and Depth of Vision before and after Partial Time Occlusion Therapy in Strabismic and Anisometropic Amblyopes
Authors: Ragheb Tarek Rezk , Saleh Galal Amr , Hamdi Momen Mahmoud , Fawzy Samah Mahmoud
Published: August 2023

Background

Amblyopia is known as the visual developmental disorder that follows selective disruption of the visual input to one eye early in life. It is considered the second most common cause of decreased visual acuity in both children and adults affecting greatly both economic and social life. It affects most of the visual parameters, so great efforts are carried out in developing effective methods controlling different deficits in amblyopia, being a great concern for all the society. However, monocular occlusion therapy remains the easiest and most popular way despite that there are many doubts in its reliability in controlling visual abnormalities other than acuity.

Purpose

To compare the different performance of anisometropic and strabismic eyes with moderate amblyopia, using partial occlusion therapy regarding visual acuity, contrast sensitivity and depth of vision.

Methods

Forty-nine children between 7 and 12 years old suffering from moderate amblyopia were classified into two groups: 25 anisometropic amblyopes and 24 strabismic ones. Two hour occlusion regimen with near activity was conducted by patients, assured by parents monitoring. Evaluation of visual acuity, contrast sensitivity and stereoacuity was conducted at each visit throughout the treatment regimen which was continued for 6 months on monthly follow up basis.

Results

Children in both groups improved significantly in visual acuity. There was a considerable difference among the distribution of improvement within each group where 9% of strabismic amblyopes achieved full visual recovery as compared to 40% in the anisometropic group, and 62.5% had residual amblyopia as compared to 36% in the anisometropic one, in spite of no significant difference of average improvement between groups (<0.0001). Only 42% of the strabismic amblyopes improved in stereoacuity as compared to 88% of the anisometropic ones, however, the difference in mean improvement was not significant between the two groups.

Conclusion

Children with moderate anisometropic or strabismic amblyopia 7-12 years old, can get considerable benefits from part time occlusion therapy in different visual aspects. The anisometropic amblyopes have better contrast sensitivity improvement and more reliable expectations of recovery being largely dependent on the initial visual acuity.
Measurement of Sub-Foveal Choroidal Thickness in Hyperthyroid Patients with Thyroid Associated Ophthalmopathy, Using Spectral Domain OCT
Authors: El Rahman Gaber Salman Abd , Mohamed Thanaa Helmy , Abdelgawad Randa Hesham Ali , Galal Yosra Ismail
Published: August 2023

Background

Thyroid associated ophthalmopathy (TAO) is an auto-immune orbitopathy, associated with thyroid dysfunction. It results in compression of the orbital contents, impairment of the blood flow and thus affects the choroidal and retinal microstructure and function.

Aim of the Work

The purpose of this study is to measure the central choroidal thickness in active and inactive TAO using Optical Coherence Tomography (OCT) and compare it to the control group.

Patients and Methods

The cross section study was conducted on participants recruited from the ophthalmology clinic of the National Institute of Diabetes and Endocrinology (NIDE). The study included 160 eyes from 80 participants (40 hyperthyroidism patients and 40 control subjects). Data was collected during the period of December 2019 to June 2020.

Results

There was no significant difference regarding age, gender, vision and IOP between TAO patients (either active or inactive) and normal subjects. Our study showed that there was a significant increase in sub-foveal choroidal thickness in patients with TAO compared to the control group. It also showed a significant increase in sub-foveal choroidal thickness in the active subgroup more than the inactive subgroup. In addition, a decrease in central foveal thickness was found in patients with TAO compared to the control group, but there was no significant difference found between active and inactive subgroups.

Conclusion

The findings of this study suggest that there is a significant affection of sub-foveal choroidal thickness and central foveal thickness in thyroid-associated-ophthalmopathy (TAO) patients.
Comparison of the Central Corneal Thickness between a Scheimpflug Imaging-Based Device and an Optical Measurement-Based Device
Authors: El Raggal Tamer Mohamed , Mostafa Mouamen Mohamed , Fayez Aziz Bassem , Hanna Youssef Wadie Labib
Published: August 2023

Background

Central corneal thickness is a critical parameter in corneal evaluation for a wide range of purposes in ophthalmology such as refractive surgeries including LASIK, cataract surgeries to assess endothelial pump function preoperatively to preserve the corneal transparency, and glaucoma in terms of diagnosis, management and follow up to avoid over/underestimation of intraocular pressure due to variations in CCT.

Aim of the Work

The study will investigate the discrepancy in measuring the CCT between Scheimpflug imaging using the Nidek AL-Scan and optical pachymetry using the Nidek Specular Microscope CEM-530.

Patients and Methods

In our study, we compared CCT measurements of both devices among 70 eyes of 35 normal subjects with a nonsignificant past ocular history. All subjects attended Ophthalmology Department at Ain Shams University Hospitals and all measurements were taken by the same examiner at the same time of the day. Our study is an observational comparative crosssectional study for six months in Ain Shams University Hospitals, Cairo, Egypt after approval of the research ethical committee on normal people without any history of ocular pathology except for refractive errors.

Results

The mean age of the study subjects was 29.49 ± 7.98 years (range 20-48 years). Regarding age, sex, and refraction, there was no statistically significant difference between CCT measurements by each individual device. However, there was a statistically significant difference between CCT measurements when compared by both devices. The difference between the mean ± SD of both devices was 7.17 ± 0.98 µm.

Conclusion

There is a statistically significant difference in central corneal thickness measurement between Nidek AL-Scan and Nidek Specular Microscope CEM-530. Several studies are needed to further correlate CCT with other parameters measured by both devices, namely anterior chamber depth and axial length.