bluuebunny/crossref_metadata_2025 huggingface dataset:
OCT Angiography Biomarkers in Diabetic Macular Edema Patients Treated with Intravitreal Injection of Anti-VEGF
Authors: Mahgoub Mohamed Moghazy , Ebeid Weam Mohamed , Habib Ahmed Mohamed , ElAnwar Ali Elhussainy Ali Mohamed
Published: November 2024

Purpose

To correlate quantitative OCT angiography (OCTA) biomarkers with clinical features and to predict the responce after ranibizumab treatment for diabetic macular edema (DME) with OCTA biomarkers.

Design

Non randomized non controlled observational study on 20 eyes with DME set in the Ophthalmology Department, Ain Shams University. Study subjects were selected randomly from patients attending the ophthalmology outpatient clinics during the recruitment period, which took place between December 2020 and December 2022.

Participants

The study was conducted on twenty eyes from 20 patients of with diabetic macular edema, with the exception of media opacity and high refractive error, from Ain Shams University hospital.

Methods

All patients underwent Spectral Domain Optical Coherence Tomography (SD-OCT) (RTVue XR OCT Avanti; Optovue, Fremont, USA) with Macular scan including 6x6mm scans centered on the fovea at baseline evaluation and at 1 month, 3 months and 6 months while on treatment with intravitreal antiVEGF (Ranibizumab) injections following the PRN protocol without loading.

Main Outcome Measures

OCTA biomarkers, including foveal avascular zone (FAZ) area (FAZ-A), FAZ acircularity index (FAZ-AI), FAZ perimeter and vessel density (VD), were analyzed comprehensively. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) also were obtained.

Results

After the ranibizumab treatment, there was a statistically significant decrease in the FAZ area and FAZ perimeter during the follow up period denoting improved vascular perfusion, and the FAZ AI decreased significantly denoting that the FAZ regained its regularity. There was a statistically significant increase in the mean vessel density including the overall, parafoveal and perifoveal vessel density in the superficial and deep plexus during the follow up period, this might be explained by decreased artifacts due to macular edema. There was a statistically significant difference in the parafoveal vessel density in the SCP, FAZ area, FAZ perimeter, and AI at baseline between good and poor responders. These biomarkers could be used as predictors for response after treatment with anti VEGF in eyes with DME.

Conclusions

For eyes with DME, parafoveal VD in the superficial layer, FAZ area and perimeter at baseline were independent predictors for visual improvement after the ranibizumab treatment.
Effect of Intracameral Injection of Epinephrine 1:10,000 with Sodium Bisulfite Preservative during Phacoemulsification on Corneal Endothelium Using Specular Microscopy
Authors: Atef Sayed Ali Mohamed Ali , Al-Maamoun Tarek Ahmed , El-Awamry Amr Ismail , Aziz Assistant Bassem Fayez
Published: November 2024

Background

Endothelial cell density (ECD), morphology and central corneal thickness (CCT) are important because they facilitate the assessment of the functional reserve of the endothelium in patients before any intraocular surgery.

Aim of the Work

The goal of this study was to measure the changes in corneal endothelium using non- contact specular microscopy in eyes that underwent uneventful phacoemulsification and intraocular lens implantation.

Patients and Methods

A randomized controlled clinical trial was conducted for a period of six months on a group of 50 patients at the Ophthalmology Department, Ain Shams University Hospital, half of which underwent phacoemulsification and IOL implantation with injection of intracameral epinephrine 1:10,000 with sodium bisulfite as a preservative, and the other half underwent the same procedure without injection of intracameral epinephrine.

Results

There was no statistically significant difference between both groups regarding CD (Cell Density), with a P-value = 0.089, and also regarding SD (Standard Deviation), CV (Coefficient of Variation), HEX (Hexagonal Cells) and CCT (Central Corneal Thickness), with P-value 0.177, 0.770, 0.144 and 0.961 respectively.

Conclusion

Intracameral epinephrine 1:10,000 with sodium bisulfite could improve pupillary dilatation and is safe on the corneal endothelium as well.
Evaluation of the Effect of Phacoemulsification Surgery on Retinal and Choroidal Microvasculature in Diabetic Patients Using Optical Coherence Tomography Angiography
Authors: Abdel Malek Sara Nazem Naguib , Eleiwa Tamer Fahmy , Amin Mona Kamal Abdellatif , Mahmoud Alaa Fathy
Published: November 2024

Aim

To evaluate the effect of phacoemulsification surgery on retinal and choroidal microvasculature in diabetic patients using optical coherence tomography angiography.

Settings and Design

A prospective comparative case control study performed at the Ophthalmology department of Ain Shams University hospital, between November 2020 and November 2022.

Methods and Material

50 eyes of 35 cataractous patients were included in this prospective study divided into two groups: the control group (25 eyes of 19 patients) and the diabetic group (25 eyes of 16 patients with mild non proliferative diabetic retinopathy). All patients underwent routine ophthalmic examination, OCT and OCTA scans of the macula before phacoemulsification surgery and 1week 1month, 3months and 6months after the surgery.

Results

The BCVA significantly improved in both group by ∼ 0.26 logMAR units in control and diabetic groups (p < 0.001 for both). the mean change in CST was 23.44±43.7 vs 13.6±22 um (p = 0.3) in the control group and the diabetic group, respectively but statistically insignificant. There was insignificant change in each group in all vascular parameters during the follow up period. In addition, there was insignificant difference between 2 groups at each visit in most vascular parameters of SVD, DVD, and choriocapillaris VD. On the other hand, the diabetic groups has significantly lower SVD of whole image and perifovea at 1 week than controls (42.92 ± 4.54 % vs 46.16 ± 3.98 %, p = 0.01 in whole image respectively) (44.29 ± 4.87 % vs 47.32 ± 3.85 %,p=0.018 in perifovea respectively). The diabetic group also showed significantly higher parafoveal DVD than the control group at 1 month postoperatively : 52.67 ± 4.00 vs 47.24 ± 9.85 % (p = 0.014) that levelled up on month 3 and 6 (p = 0.397, 0.538 respectively). the diabetic group showed lower CC VD of whole image than the control group at 1 week postoperatively: 70.60 ± 2.87 vs 72.22 ± 1.98 % respectively (p = 0.025), and also significantly lower CC VD of perifovea than the control group at 1 week: 71.19 ± 2.82 vs 72.72 ± 2.20 % (p = 0.038), 1 month: 71.08 ± 2.87 vs 72.78 ± 2.61 % (p = 0.033) and 3 months: 71.35 ± 2.63 vs 72.83 ± 2.52 %(p = 0.048). Those values levelled up at the last postoperative visit at month 6 (p = 0.152).

Conclusion

Phacoemulsification surgery may lead to the transient and mild reduction of choroidal blood flow in diabetic eyes rather than retinal blood flow. Most of choroidal and retinal vascular change happened in the perifoveal area within 1 week to 1 month postoperatively and rarely extended to 3months.

Further research is needed to detect its influence on diabetic retinopathy progression.
Reconstruction of Anterior Cruciate Ligament Using Peroneus Longus Autograft. Systematic Review
Authors: Mohamed Abdel Rahman Haitham Abdel Azeem , Hafez Sallam Haitham Emad Eldin , Badr Ashraf Magdy Abdel Aziz
Published: November 2024

Background

ACLR provides surgical restoration of the injured ACL using the placement of graft material. The choice of graft is principal in providing optimal knee stability after surgery. Peroneus longus tendon PLT is an autograft modality that offers unique benefits for ACL reconstruction cases.

Aim of the Work

Our study was conducted to evaluate. PLT as an autograft modality benefits in ACL reconstruction and asses if this modality has any complications. Post-operative biomechanical outcomes were evaluated using the International Knee Documentation Committee (IKDC) and the American Orthopedic Foot and Ankle Score (AOFAS) score.

Materials and Methods

In our metaanalysis, 11 studies were included evaluating the outcome of the Anterior Cruciate Ligament Reconstruction with the Peroneus Longus Tendon. The total number of patients was 600 patients. The mean age was 29 years.

Results

The mean follow up time was 24 month our results revealed that: functional outcomes using PLT autograft were satisfactory. There was a significant difference between the mean pre-operative and postoperative IKDC scores with a mean difference 30.50, statistically significant decrease in AOFAS after PLT harvest was identified, PLT harvest does not appear to affect foot and ankle function to any clinically significant degree. In our meta-analysis there was non significant decrease in FADI score. The use of peroneus longus tendon graft in ACL reconstruction did not cause significant changes or major complications at the donor ankle site. Complications in the form of infection were detected only in three studies. Re-rupture was detected only in one study.

Conclusion

ACL reconstruction with peroneus longus autograft has an excellent functional score. Excellent results were achieved in both the knee and the donor site according to the Modified Cincinnati, International Knee Documentation Committee (IKDC) and Lysholm scores, American Orthopedic Foot and Ankle Score (AOFAS). Foot and Ankle Disability Index (FADI) showed insignificant change between pre-operative and post-operative scores. PLT autograft is a suitable alternative graft choice from outside the knee for patients undergoing ACL reconstruction.
Treatment of Fracture Neck Femur with Biplane Double Screws Fixation Method in Elderly Patients
Authors: Fekry Shady Samir , Kotb Mohamed Ismail , Elmezayen Eslam Yosri Gamal
Published: November 2024

Background

In active elderly patients with displaced femoral neck fractures, the total hip replacement is a golden standard. However, there are also patients with high operative risk for a large surgical intervention, defined by the presence of comorbidities and the arthroplasty procedure with these patients is contraindicated.

Objective

To assess the efficacy of Biplane double support screws in fixation of fracture neck of femur in elderly patients.

Patients and Methods

This was prospective study that was conducted in operative rooms of Ain Shams University Hospital, twenty one elderly patients with fracture neck of femur was treated using biplane double support screws fixation.

Results

Regarding garden classification of femur neck fracture, 47.6% of the patients were type 4. Regarding outcome, 10 patients were excellent, 6 patients were good, 3 patients were fair and 2 patients were poor. Mean ± SD of Union duration is 10.59 ± 1.46 weeks and only 2 cases (9.5%) complicated by Femoral head resorption.

Conclusion

In elderly and in those patients who cannot afford arthroplasty or in those patients where arthroplasty is contraindicated, BDSF method is an alternate method for fixing fracture neck of femur.
Management of Fracture Neck Femur in Elderly Patients Using Dual Mobility Cup Arthroplasty versus Bipolar Hemiarthroplasty
Authors: Heshmat Hany , Samir Wael , Abdel-Moneim Mohamed , Zakaria Zeiad M
Published: November 2024

Purpose

Femoral neck fractures represent a major public health problem worldwide. The purpose of this study is to evaluate the clinical, functional outcome and rate of complications of dual mobility cup total hip arthroplasty versus bipolar hemiarthroplasty in the management of displaced fracture neck femur in elderly patients.

Methods

A prospective Randomized control study was done in a university specialized unit between January 2018 till January 2021 on forty elderly patients had a mean age of 70.5 years (range 60-91) with displaced Fracture neck of femur. Twenty patients were managed by Dual Mobility Cup Total Hip Arthroplasty (DM group) and 20 patients underwent Bipolar Hemiarthroplasty (BHA group) for the treatment of their femoral neck fractures with a minimum 24 months folow up (range 24- 35). Functional outcome (Haris Hip Score) and rate of dislocation postoperatively were the primary outcomes while intraoperative blood loss, blood transfusion rate, length of operation, postoperative infection and mortality rate were the secondary outcomes.

Results

The Harris hip score (HHS) was higher in the DM group and was most significant after 6 and 12 months with p-value (p < 0.05). The dislocation rate was less in the DM group. The BHA group demonstrated less intra-operative blood loss (p < 0.001). and a shorter length of operation (p < 0.001). However, there was no significant difference in two-year mortality with p-value (P > 0.05), blood transfusion rate with p-value (p = 0.471) and infection rate with p-value (p = 1.000).

Conclusion

The use of THA DMC did not seem to increase mortality, morbidity, or complications rate like infection or bleeding but it decreases dislocation rate and increase functional outcome (especially in active healthy patients) when compared to BHA. Also, THA DMC is not affected by pelvic morphological factors and dysplasia which may lead to dislocation with BHA.
Proximal Femoral Nail vs Arthroplasty for Unstable Intertrochanteric Fracture in Elderly (Systematic Review & Meta Analysis)
Authors: Abou El Hasan Kareem Mohamed , Kamal Asal Mohamed , El Din Hafez Sallam Haitham Emad
Published: November 2024

Background

Hip fractures impose a considerable economic burden on healthcare, with intertrochanteric fractures contributing to increasing morbidity. The global incidence of hip fractures is expected to rise to 4.5 million by 2050, primarily due to aging and osteoporosis. Osteoporosis weakens bones, making them susceptible to fractures even from minor traumas, with femoral intertrochanteric fractures being prone to comminution.

Aim of the Work

To compare between proximal femoral nail and arthroplasty for Unstable intertrochanteric fracture in elderly. The objective is to perform a systematic review to better management procedure.

Patients and Methods

This systematic review and meta-analysis aimed to compare arthroplasty and proximal femoral nail (PFN) fixation for unstable intertrochanteric fractures in elderly patients. The study included 24 studies with 2699 patients, analyzing factors such as surgery duration, peri-operative blood loss, blood transfusion, complications, Harris hip score (HHS), and mortality.

Results

PFN had a significantly shorter surgery duration compared to arthroplasty, with the latter exhibiting higher blood loss. Arthroplasty also required more blood transfusion, attributed to its invasive nature. While complications did not significantly differ between groups, arthroplasty showed a higher rate of thromboembolic complications. Mortality rates were significantly higher in the arthroplasty group, emphasizing the importance of early mobilization for patient outcomes.

Conclusion

Underscores the significant superiority of PFN over hemiarthroplasty in treating elderly patients with intertrochanteric fractures. The PFN group had a statistically shorter operative time, less blood loss, lower mortality compared to the arthroplasty group. However, no significant differences in functional outcomes using HHS were observed between the two compared groups. In addition, no significant differences were found concerning complications between the PFN and arthroplasty groups.
Arthroscopic Capsular Release Versus Subscapularis Recession for Internal Shoulder Contracture in Obstetric Brachial Plexus Palsy: A Systematic Review and Meta-Analysis
Authors: Abdelaziz Tarek Hassan , Mohammed Amr Moustafa , Beshay Kirollos Samir Saad
Published: November 2024

Background

Shoulder internal rotation contracture, active abduction and external rotation deficits are frequent secondary complications observed in children with obstetric brachial plexus palsy (OBPP). Soft tissue shoulder operations are often done for treatment as arthroscopic capsular release and open subscapularis recession. There is a lack of studies regarding the subscapularis recession and also regarding the comparison between the two techniques.

Aim of the Work

to review systematically and meta-analyze the currently available literature regarding arthroscopic capsular release (ACR) and open subscapularis recession (OSR) in internal shoulder contracture in OBPP regarding the clinical efficacy and complications.

Methods

A literature search pooled the studies pertaining to the children with OBPP in early age treated with ACR and OSR. A systematic review and meta-analysis was conducted to assess the success rates of the two techniques using the Mallet score. We excluded the studies or the patients with history of any concomitant surgical interventions eg: humeral osteotomy, tendon transfer.

Results

Data from eight studies (152 patients) were compiled for our meta-analysis. The mean follow-up duration was 23.87 months with average age 2.4 years. The standardized difference in means (SMD) for the active abduction (ABD. score was 0.59 for the ACR in comparison to the OSR (SMD= 0.427). The Std. diff. regarding the ACR was 1.22 in passive abduction, 1.68 in passive external rotation (ER) in ABD., 2.31 in passive ER in adduction, 2.38 in hand to mouth, 2.67 in hand to neck, -0.49 in hand to spine, 2.84 in total Mallet score, 3.18 in the active ER (in comparison to the OSR the SMD was 0.427) and -2.06 in active internal rotation (in comparison to the OSR the SMD was 0.128). Recurrence of internal shoulder contracture was documented in 8 of 93 children after ACR and regional pain syndrome with shoulder stiffness was reported in only on case out of 28 cases after ACR.

Conclusion

In this study, we found that the ACR is highly effective than the OSR technique regarding the functional outcome of the shoulder in all the Mallet score items except in hand to spine and internal rotation. The ACR shows more advantages than OSR intra-operatively regarding soft tissue identification and post-operatively regarding scarring and infection, but with higher risk of recurrence and axillary nerve injury.
Are Outcomes of Dynamic Locking Plates Better Than Cannulated Screws Augmented with Anteromedial Buttress Plate in Treating Fracture Neck Femur in Adults Less Than 60 Years Old? A systematic Review
Authors: Attia Mina Aymen , Rahman Amr Ahmed Abdel , Kamel Mohamed Elsayed
Published: November 2024

Background

A displaced femoral neck fracture (FNF) in a young adult is still an unsolved problem with considerable debate and represents a great challenge for orthopedic surgeons. Literature shows that when using DHS or cannulated screws, the most commonly used implants, there is a high chance of post-operative complications such as avascular necrosis, non-union, and fixation failure leading to unacceptable high rate of 2ry reoperation. A 2015 meta-analysis of 41 studies regarding young femoral neck fractures found a reoperation rate of 20% after internal fixation of isolated femoral neck fractures, with AVN (14.35%) and nonunion (9.3%) being the most common complications leading to repeat surgeries.

Aim of the Work

To compare the clinical outcomes, radiological outcomes and complications of dynamic locking plates and cannulated screws augmented with anteromedial buttress plates in treating fracture neck femur in adults less than 60 years old.

Materials and Methods

This systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Literature was searched till 31 December 2022 using Web of Science, PubMed, and Cochrane databases. A search was performed for all published articles in English using the following keywords “femoral neck system”, “FNS”, “femoral neck fracture” and “femoral neck system”, “femoral neck fracture” and “medial plate”, “femoral neck fracture” and“ buttress plate”.

Results

According to this review, the reporting FNS studies had mean age 51.4 years with male percentage 58%, displaced fracture was 81%. The weighted mean Operation time 62 min mean and blood loss was 73ml. The weighted mean postoperative HHS was 89. Nonunion occurred in 2.6%, AVN occurred in 1.3%, Femoral neck shortening in 9.5% and Cut out or implant failure 2.6% The reporting CS augmented with anteromedial femoral neck plate studies had mean age of 40.5 years with male percentage 70%, displaced fracture was 100%. The weighted mean Operation time 82 min and mean blood loss was 196 ml. The weighted mean postoperative HHS was 90. Nonunion occurred in 6.5%, AVN occurred in 3.2%, femoral neck shortening in 6.3% and Cut out or implant failure 4%. There was statistically significant difference in blood loss and operation time, but there was no statistically significant difference in postoperative HHS, Nonunion, AVN, Femoral neck shortening and Cut out or implant failure.

Conclusion

Femoral neck system (FNS) and cannulated screws combined with antero- medial femoral neck plates have no significant difference in nonunion rate, AVN rate and femoral neck shortening rate with almost similar Harris Hip score. However, Femoral neck system (FNS) has significantly less blood loss and operation time compared to cannulated screws combined with medial plates.
Femoral Neck System versus Cannulated Screws in Management of Fracture Neck Femur in Adults
Authors: Sallam Mohamed Ihab Shawky , Salem Ahmed , Koriem Islam
Published: November 2024

Background

Femoral Neck Fractures (FNF) accounts for about 3.6% of adult fractures, which is one of the more common fractures in the body. FNF is more common in elderly patients, generally refers to the fracture in the part of the femoral head down to the base of the femoral neck. Garden classification is often adopted for FNF in the elderly, type I and type II, because no displacement or displacement of fracture end to a lesser degree, damage degree of fracture is lesser, belongs to the stable fractures.

Aim of the Work

To review systematically studies about the use of Femoral Neck System versus Cannulated screws in management of non displaced femoral neck fracture in elderly.

Materials and Methods

We prepared this systematic review with a careful following of the Cochrane Handbook for Systematic Reviews of Interventions. We also adhered to The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines during the design of our study.

Results

This meta-analysis compared the clinical outcomes of FNS and CS fixation for femoral neck fracture in young adults. The study found that FNS is superior to CS in terms of intraoperative fluoroscopies, weight-bearing time, Harris Hip Score, total complications, femoral neck shortening, and nail retreat. However, the two fixation methods were similar in terms of the operation time, length of hospital stay, healing time, intraoperative blood loss, non-union, femoral head necrosis, and internal fixation cut-out. From the perspective of surgical outcomes, intraoperative fluoroscopies were used less in FNS fixation than in CS fixation.

Conclusion

Femoral neck system fixation shows improved outcomes compared to the cannulated screw fixation for neck femur fractures regarding intra operative surgery, prognosis and reduced complication rates, more Studies and RCTs for this new fixation method are needed to obtain more conclusive results.
Modified Broström Repair versus Internal Ankle Bracing Augmentation with Modified Broström procedure in Chronic Lateral Ankle Instability: A Systematic Review and Meta-Analysis
Authors: Barsoum Samuel Maher Naguib , Diab Hossam Saeed , Haroun Yahia Mohammed
Published: November 2024

Background

Lateral ankle instability can be treated conservatively, but surgery may be necessary if conservative treatment fails. Approximately 20-40% of patients will require surgical intervention due to recurrent sprains.

Objective

To compare complications in treating chronic lateral ankle instability, a systematic review and meta-analysis were conducted using former studies of the Modified Broström procedure versus Internal ankle bracing augmentation.

Patients and Methods

This study was conducted following the preferred items for systematic reviews meta-analysis (PRISMA) 6 guided items and a checklist to answer the question of which result in less complications either modified Broström procedure or Internal ankle bracing augmentation between 1/1/2010 -1/6/2022.

Results

The metanalysis showed that there is no significant statistical difference in both groups as regards Recurrence of instability rates, Irritation of peroneal nerve, Revision surgery rates and Overall complications.

Conclusion

We conducted this systematic review and meta-analysis study to compare the complications of two surgical procedures used to treat lateral ankle instability after conservative measures have failed. Both surgical techniques showed no significant statistical difference in terms of complications.
E-Cadherin and Snail Immunohistochemical Expression in Multiple Ipsilateral Breast Carcinoma Disease
Authors: El-Maraghy Maissa N , Salman Manal I , Osman Wesam M , Shash Lobna S , Al Gammal Eman A N
Published: November 2024

Background

As compared to invasive breast cancer- no special type (IBC-NST), Invasive lobular cancer (ILC) traditionally shows loss of function of the E-cadherin- catenin membrane complex, frequent downregulation of E-cad expression and is significantly more associated with Multiple Ipsilateral Breast Carcinoma (MIBC). Nevertheless, E cadherin downregulation was also described in MIBC with IBC-NST phenotype. MIBC was suggested to have a more aggressive biologic nature than unifocal disease, Epithelial mesenchymal transition (EMT) has been suggested as an attribute to such poorer prognosis. The transcription factor Snail commonly acts as one of the earliest switches of the EMT process and E-cadherin downregulation is one of its major downstream effects. Causation and association links between EMT and MIBC in different types of breast cancer needs further elucidation.

Objective

to investigate whether the association betweenE-cadherin downregulation and MIBC is attributed to EMT and whether such association and expression of EMT markers is differentially presented in ILC and IBC-NST.

Methods

This study was conducted retrospectively on 77 breast cancer cases diagnosed at Ain Shams University Hospitals (2012-2022). We included all ILC cases meeting study criteria (20 unifocal, 14 MIBC) and randomly selected sets of IBC- NST cases (13 unifocal, 16 MIBC) and mixed ductolobular IBC (7 unifocal, 7 MIBC). Immunohistochemical expression of E-cadherin and Snail was evaluated and compared in different study groups with subsequent statistical analysis.

Results

E- cadherin expression showed 15/40 (37.5%) negative expression, 15/40 (37.5%) with low expression, and 10/40 (25%) with high expression in the unifocal group, compared to 14/37 (37.8%) negative result, 13/37 (35.1%) low E-cadherin expression, and 10/37 (27%) with high E-cadherin expression in the MIBC group. There was no significant difference in E-cadherin expression regarding focality neither in all cases (p-value: 0.97) nor in each of the histological subgroups (p-values: 0.34 for IBC- NST, 1.00 for mixed, 0.2 for ILC). On the other hand, Snail expression was extensive in 24/37 MIBC cases (64.86%) as compared to 17/40 unifocal cases (42.5%), this was statistically significant (p-value: 0.038).

Conclusions

E-cadherin downregulation doesn’t seem to contribute to MIBC whether ILC, mixed or IBC-NST, however snail overexpression is significantly associated with MIBC. This suggests that EMT may have a role in multiplicity of IBC.
Speckle Tracking Echocardiography and Cardiac Biomarkers in Multi-System Inflammatory Syndrome in Children
Authors: Hassan Abdelwahab Ahmed , Kotby Alyaa Amal , El-Ganzoury Mona Mostafa , Habeeb Nevin Mohamed , Hashem Azza Elsayed , Hady Marwa Waheed Abdel
Published: November 2024

Background

Cardiac affection in multisystem inflammatory syndrome in children (MIS-C) occurs in ∼80% of patients. Left ventricular (LV) systolic dysfunction is the most frequent finding.

Methods

In this prospective cohort study, we assessed LV function and cardiac injury in 22 patients with MIS-C using Cardiac biomarkers (Troponin I and CK-MB) and Speckle Tracking Echocardiography. We compare those patients at initial presentation and at 3 months follow up.

Results

Among the 22 patients with MIS-C cardiac biomarkers (cardiac troponin and CK-MB) showed statistically significant regression on comparing their values at initial presentation and after 10 days follow up (P value <0.01). Ejection fraction was impaired in 43.7%, with a mean value of 52.3% (Range: 32% to 69%). Patients with abnormal strain had a lower EF, more organ system involvement and were more likely to require inotropic support. Lower peak longitudinal strain rates were detected in 59% of MIS-C patients at initial presentation in comparison to follow up assessment 3 months later. Patients with initially depressed function, EF normalized in 21 of 22 patients (95.4%) (P value 0.000), but 5 of 22 (18.1%) of patients had persistently abnormal systolic strain at 3 months follow up (P value 0.817).

Conclusion

LV systolic dysfunction is common in the acute phase of MIS-C, and detection may be improved with global longitudinal strain assessment. Longitudinal cardiac follow-up is imperative, as patients may be at risk for persistent LV dysfunction.
Environmental Risk Factors for Relapses in Pediatric Onset Inflammatory Bowel Disease
Authors: Hamdy Ahmed M , AbdelMageed Reham I , Mohammed Basma A , Mohammedy Dina F , Fahmy Basma S , mahmoud Ahmed G
Published: November 2024

Background

Inflammatory bowel disease (IBD) in pediatric age group is influenced by the complex interactions of genes, the immune system, intestinal microbiota, and the external environment. There is currently little knowledge on environmental factors associated with its relapse.

Objective

The aim of this study is to assess the environmental risk factors of relapse of IBD in pediatric patients.

Methods

Patients diagnosed with pediatric IBD at one tertiary centre were included in a cross-sectional study. Clinical and endoscopic data together with medications were reported and laboratory investigations including stool analysis and culture and sensitivity were done. Food frequency questionnaires were obtained initially at remission and at relapse time.

Results

Fifty IBD patients were included; 30 males and 20 females with mean age of 12.91± 2.68 years. Of these, 28 patients (56%) had Ulcerative colitis (UC) and 22 patients (44%) had Crohn’s disease (CD). Most of them came from Urban (76%) and (24%) from rural areas. None has family history of similar cases of IBD. About one third of them (36%) has history of previous hospital admissions, surgeries or blood transfusion and 46% were exposed to smoking. All subjects were fully vaccinated according to national program of immunization. Unexpectedly, stool culture & sensitivity for the common incriminated organisms in relapse showed positive results in only 16% of cases (14 %and 2%) for E-coli and salmonella respectively. The application of food frequency questionnaire revealed that disease activity index during relapses was significantly correlated to higher lipids and lower fibers dietary consumption (P-value 0.000 and 0.005) respectively.

Conclusion

Achieving disease remission is one of the main objectives in treating IBD patients. Enteric infections and certain dietary habits are important environmental risk factors for IBD relapse. Patients presenting with relapse of IBD should have stool examined microbiologically and are candidates for dietary modification. This might lead not only to relief of symptoms but also a better quality of life.
Cardiac Affection in COVID-19 Pediatrics and its Correlation with Inflammatory Markers
Authors: Ishak Sally Raafat , Ganzoury Mona Mostafa El , Fouda Eman Mahmoud , Anwar Maha Ahmad , Kamal Amany Moustafa , Bakry Nehad Ahmed
Published: November 2024

Background

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a pandemic of respiratory and cardiovascular diseases, known as coronavirus disease 2019 (COVID-19). However, the respiratory system is the primary target of SARS-CoV-2, it also causes a systemic illness with widespread inflammation and cytokine flood, resulting in acute respiratory distress syndrome (ARDS), severe cardiovascular injury, multiorgan failure (MOF), and death in its most severe form. COVID-19 progression severity can be detected by cardiac signs. Detection of subtle cardiac damage early allows for providing efficient treatment.

Objective

The current study aimed to detect cardiac involvement in COVID-19 and its correlation with other inflammatory markers elevated in COVID-19 patients.

Methods

This retrospective analytical observational study included a total of 72 patients diagnosed as positive for COVID-19, depending on PCR of nasopharyngeal swabs, at Children’s Hospital, Ain Shams University in the period between December 2021 to March 2022. Patients included were within the pediatrics age group, from 4 months to 16 years old. They underwent full clinical examination, laboratory investigations, chest radiological studies, and echocardiographic assessment after 48 hours of admission. These patients were admitted in the isolation unit and later 30 (41.6%) patients were admitted in PICU. Patients were further grouped into 2 groups: Group I without cardiac affection, and Group II with cardiac affection.

Results

Patients with cardiac affection (group II) had more thrombocytopenia (61.5%) (P-value = 0.037), higher ESR (Median (IQR) = 62.5 (33 – 90))(P-value = 0.000), higher D- dimer (Median (IQR) = 4.25 (2.33–7.37))(P-value = 0.001), higher serum ferritin (Median (IQR) = 1200 (1022–3421))(P-value = 0.281), higher CK-MB (Median (IQR) = 33.5 (28–46)) (P-value = 0.000) and as a consequence, higher troponin I (Median (IQR) = 0.24 (0.1–0.46))(P-value = 0.000). Regarding Echo findings, cardiac affection showed a lower ejection fraction in (88.5%) of group II patients with Mean±SD (50.23 ± 6.69) (P-value = 0.000). The most frequent Echo finding was carditis (46.2%), followed by valvular lesions (42.3%), especially Tricuspid regurge. All the non-survivor (dead) cases (only 8 patients) were with cardiac affection.

Conclusions

COVID-19 can cause cardiovascular complications in pediatrics and correlate with inflammatory markers of COVID-19, which also can predict severe prognosis.
Musculoskeletal Problems in Children with Inborn Errors of Immunity
Authors: El-Owaidy Rasha H , Shousha Ghada A , lotfy Amal A , soliman Asmaa M , Baraka Mostafa , El-Sayed Zeinab A
Published: November 2024

Background

Inborn errors of immunity (IEIs) are inherited disorders of the innate or adaptive immune systems, or combinations of both. Several types of IEIs might present with arthropathy that may be related to infections, an autoimmune process or part of immunodeficiency syndromes. This work aimed at assessing the frequency and clinical burden of arthropathy in certain groups of IEIs.

Methods

This retrospective study included 108 children diagnosed as combined immunodeficiency and antibody deficiencies, and were following up in the Pediatric Allergy, Immunology and Rheumatology Unit, Children’s Hospital, Ain Shams University, in the period from December 2020 to February 2022. Medical records were revised for their immunological profile and articular presentations and possible underlying etiologies beside clinical assessment of survivors.

Results

In this study, patients with antibody deficiencies represented 60.2% of the studied population. Arthropathy was demonstrated in both categories; antibodies deficiency and combined immunodeficiency, 7% of combined immunodeficiency patients had arthropathy (4.7 % had arthritis and 2.3 had arthralgia), septic arthritis was demonstrated in 2.3 % of patients who had arthritis. In antibody deficiencies, 27.7 % of patients had arthropathy (15.4 % had arthritis and 12.3% had arthralgia), 7.7% of arthritic patients had septic arthritis.

Conclusion

Arthropathy is a common association/complication in IEIs in Egyptian children, due to infectious and non-infectious etiologies. Our study was limited by its retrospective design and small sample size.
Molecular Study of SP1 Binding Site of COL1A1 Gene in Children Affected with Vitamin D Deficiency Rickets
Authors: Ahmed Rana Abdelhakim , Kamal Tarek Mostafa , Shawky Rabah Mohamed , Gaber Elham , Abdelgayed Aya Elnady
Published: November 2024

Background

Rickets is a disease associated with delayed bone growth in infants and children due to impaired mineralization and ossification of the growth plates. The main cause of rickets is Vitamin D deficiency. Collagen type I is one of the key proteins involved in the maturation, development and mineralization of bone.

Objective

To investigate the possible association between occurrence and severity of vitamin D deficiency rickets and the allelic polymorphisms within COL1A1 Sp1 binding site gene.

Patients and Methods

This case-control study included 30 cases with active vitamin D deficiency rickets aged (6-36) months as well 30 healthy controls with matching age and sex. All subjects in the study were subjected to complete history taking with complete clinical examination and investigated for serum calcium, phosphorus, alkaline phosphatase (ALP), X-rays of distal ends of long bones (radius, ulna, tibia and femur), X- ray chest and genetic analysis for Sp1 binding site polymorphisms within Collagen 1 Alpha 1 (COL1A1) gene of type 1 collagen genotyped by Polymerase Chain Reaction (PCR)-RFLP method.

Results

The study subjects were 30 cases, 16 (53.3%) males and 14 (46.7%) females, and 30 controls, 15 (50.0%) males and 15 (50.0%) females, with matched age and sex. All signs of rickets were evident in cases than controls with p-value <0.001. According to laboratory data, there was no significant difference between cases and controls regarding calcium levels 8.80 ± 0.99 versus 9.24 ± 0.73 mg/dl respectively, while there was significant decrease in the level of phosphorus and increase in the level of ALP in cases than controls, phosphorus 3.50 ± 0.73 versus 4.99 ± 0.53 mg/dl and ALP 641.80 ± 283.86 versus 142.13 ± 54.30 U/L, respectively. Regarding molecular genetics, dominant homozygous type (SS) was higher among controls 73.3% while dominant heterozygous type (Ss) was higher among cases 56.7% with p-value = 0.004 and 0.008; respectively. Also there was no significant difference between controls and cases regarding the percentage of recessive homozygous type (ss) with p-value = 0.554. The comparison between the two groups regarding allele distribution showed higher percentage of (s) allele in cases than controls 35.0% versus 15.0%; respectively with p-value = 0.011.

Conclusion

Our study found that Genetic polymorphisms of SP1 binding site of Collagen 1 Alpha1 (COL1A1) gene are associated with vitamin D deficiency rickets, low bone mineral density and higher risk of fractures in children. The study highlights the importance of genetic factors in the development of rickets in infants and children and suggests that COL1A1 gene polymorphisms may serve as a potential genetic marker for identifying children at-risk.
Minor Blood Group Incompatibility in Patients with Neonatal Jaundice: A Single Centre Study in Egypt
Authors: Khafagy Soha , Khaled Aya , Ibrahim Mariam
Published: November 2024

Background

Neonatal jaundice is the most common cause of hospitalization in the neonatal period. It is estimated that 60% of term newborns develop jaundice and 2% reach severe hyperbilirubinaemia.

Aim and Objectives

to study the frequency of cases of minor blood groups incompatibilities in patients with neonatal jaundice necessitating management.

Subjects and Methods

This prospective observational study was done on 220 patients in Neonatal intensive care units at Ain Shams University Hospitals diagnosed with neonatal jaundice and needed further investigations and treatment. patients were divided into 5 groups (RH, RH& ABO, minor blood group, non- hemolytic and ABO group). minor blood group patients identified according to positive antibody screen.

Result

4.5% of the studied neonates were minor blood groups, Total serum bilirubin was significantly higher in minor blood group than the other four groups RH, Rh and ABO, non- hemolytic and ABO groups with (p-value=0.037, 0.006, <0.001, and <0.001 respectively). 50% of minor blood group needed exchange transfusion which was significantly higher than ABO group with p-value< 0.001.

Conclusion

minor blood group incompatibility compromise (4.5%) of the studied neonates who needed therapeutic management of hyperbilirubinemia, the higher level of total serum bilirubin, and more frequent need of exchange transfusion were seen in the patients with minor blood group incompatibilities compared with the other patients. Minor blood group incompatibility other than anti-D remains under diagnosed entity which needs to be kept in mind among cases of hemolytic disease of newborn.
Diagnostic Yield of the Number of Duodenal Biopsies in Celiac Disease
Authors: El-Hodhod Mostafa Abdel-Aziz , Ghazal Faten Abdel Aziz , Hamdy Ahmed Mohamed , Awad Yosra Mohamed Mohsen , Mohamed Deshnawy Azza Abdellatef
Published: November 2024

Background

The diagnosis of celiac disease relies on a combination of clinical evaluation, serological testing, and histopathological examination of duodenal biopsies. However, there is ongoing debate regarding the optimal number of duodenal biopsies required for an accurate diagnosis, as well as the isolated yield of water interface directed biopsy.

Aim

The primary objective is to determine the cumulative benefit of multiple duodenal biopsies, establishing the specificity and sensitivity of each biopsy separately with focus on the isolated yield of water interface directed biopsy.

Methods

A Cross-sectional study conducted on 22 children with symptoms and signs suggestive of celiac disease (CD) and positive serology with antitissue transglutaminase antibodies at the pediatric gastrointestinal endoscopy Unit at EL Demerdash Hospital, Ain Shams University for 6 months. four biopsies were taken, one from duodenal bulb, and 2 from rest of duodenum and the fourth one using water immersion technique visualizing the most affected area.

Results

Among the 22 enrolled children, 18 patients were histopathologically positive for celiac disease and 4 children were negative. The bulb, duodenal, and water interface biopsies were positive in 94.4%, 88.8%, and 66.7% respectively, of those positively diagnosed as celiac disease by Marsh criteria. In addition, bulb, and duodenal biopsies have the highest sensitivity of 94.4%, and 88.9%, respectively, also, they have the highest accuracy. Duodenal bulb biopsies were capable alone to diagnose 17 out of 18 definite cases. The missed case diagnosis was reached either by water interface or any random duodenal biopsy.

Conclusion

Bulb biopsy showed to be the most accurate in diagnosing celiac disease, on the contrary, water interface biopsy was not sensitive in diagnoses, so the celiac diagnostic efficacy can be reached by assessment of 2 duodenal biopsies, one of them from the duodenal bulb.
Thoracic Fluid Content as a New Predictor of Successful Weaning in Neonates Compared to Lung Ultrasound
Authors: Gad Ghada Ibrahim , Ashraf Okba Ahmed , Hussein Dalia Mahmoud Shawky , Shehata Basma Mohamed
Published: November 2024

Background

Accurate timing for neonatal extubation is needed to avoid complications resulting from prolonged ventilation or extubation failure. No known universal predictors for successful weaning. Thoracic fluid content (TFC) by Electrical cardiometry can be used in this matter as lung congestion may cause extubation failure. Moreover, Lung Ultrasound Score (LUS) which assesses lung aeration can help in this matter.

Aim of the Work

This study aims to assess the accuracy of TFC as a predictor of successful weaning compared to LUS in neonates.

Patients and Methods

In this prospective observational study 62 invasively ventilated neonates were included. According to gestational age (GA), they were split into two equal groups group (1) < 34 weeks and group(2) > 34 weeks. Then both were compared as regards ventilation settings, TFC and LUS score on intubation and prior to extubation.

Results

Lower Postnatal age on initiation of mechanical ventilation (MV)(1-5 days versus 2- 15 days/P-value= 0.007) and longer duration on MV (1-18 days versus 1-7days /P-value= 0.007) were found in group (1) than group(2). In addition to higher respiratory rates (mean 70 BPM versus 67 BPM / P-value<0.001), Downes score(mean 7 versus 6 / P-value<0.001) and ventilation settings (means were PIP 16, PEEP 8,and FIO2 0.50) in group(1) versus (PIP 14, PEEP 7, FIO2 0.45) in group (2) with P-value 0.001) on initiation of ventilation. TFC mean was 44.35 kΩ−1in group (1) versus 42.5 kΩ−1 in group (2), LUS score mean was 6 in group (1) versus 5 in group(2). the both groups were comparable as regards TFC and LUS score. TFC and LUS score were positively correlated (r*=0.74). the best cut off value for TFC at which the neonate can be extubated successfully was < 41.5 kΩ−1 with sensitivity 75.3% and specificity 81.3%. the best cut off value for LUS score was < 5 with sensitivity 73.1% and specificity63.3%.

Conclusion

TFC and LUS score can be used as predictors of successful extubation in neonates.
The Utility of Whole Exome Sequencing in Diagnosing Neurogenetic Disorders: UAE Experience
Authors: Saleh Dina Amin , Khalaf Tamam Eyad , El-Hattab Ayman W
Published: November 2024

Background

The application of whole exome sequencing (WES) served as a helpful tool in the diagnosis of neurological disorders.

Aim

We aimed at investigating the diagnostic yield of WES in obtaining a molecular confirmation of neurogenetic disorders and identifying novel disease-causing variants in a highly consanguineous population.

Methods

This is a retrospective multicenter study that included pediatric patients presenting to the neurology and genetic clinics with neurological disorders who underwent WES across four cities in the United Arab Emirates (UAE). The patient's charts were reviewed in detail during the period from December 2019 to December 2022 for the core clinical features, analysis of the molecular data, and recording of the previously unreported mutations.

Results

338 patients were enrolled of which 71% wereconsanguineous. Their main clinical presentation was developmental delay (78.3%), seizures (55%), distinctive facial features (42.9%), behavioral abnormalities (36.9%) and weakness (25.7%), respectively. Disease-causing variants were identified in 57.1%, of which half of them (50.1%) showed novel mutations. 4.6% of candidate genes have not been linked to human diseases yet and 7.8% of potentially treatable disorders were reported.

Conclusion

We report a high yield from WES in a highly consanguineous population, where almost a third of our patients showed novel variants for neurogenetic disorders. Potentially treatable disorders were described highlighting its importance in modifying the treatment plan and offering better knowledge and standards of care. We also spotted candidate genes that can potentially be novel genes associated with previously undescribed new syndromes. However, further cases are needed to confirm this gene- disease relationship.