bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Study of Pulmonary Artery Pressure Assessment by Both Pre-Operative Echocardiography and Direct Intra-Operative Catheterization with its Impact on Surgical and Postoperative Outcome
Authors: Mansour Mervat Gamal Elden , Abdelshahid Youstina Wagdy Gerges , Elgendy Waleed Mohamed Mohamed , Kamel Ibraheam Waleed Ismail , Sheehata Beshoy Attaallah Ebrahim
Published: November 2024

Background

Pulmonary arterial hypertension (PAH) is defined as an increase in mean pulmonary arterial pressure ≥ 25 mmHg at rest as assessed by right heart catheterization. PAH is a relatively common complication of congenital heart disease (CHD). While invasive assessment of hemodynamics in the catheterization is the gold standard for diagnosing PAH in children, transthoracic echocardiography (TTE) serves as the initial diagnostic tool as misinterpretation of TTE variables can lead to delayed diagnosis and therapy.

Aim and Objectives

To compare the directly measured intra-operative PAP to preoperative measurement of PAP by transthoracic echocardiography. To assess the impact of pre-operative echocardiographic findings of PAH on surgical decision and post-operative outcome.

Subjects and Methods

This was an observational cross-sectional study that was conducted on 22 infants and children aged from 1 month to 5 years old diagnosed with congenital heart disease with left to right shunt: {atrial septal defect (ASD) or ventricular septal defect (VSD)} referred for surgical intervention in Cardiothoracic Academy, Ain Shams University. Patients were needed to detect pre-operative and post-operative assessment of pulmonary artery pressure using trans- thoracic echocardiography and intra-operative direct assessment of pulmonary artery pressure using direct catheterization.

Result

In this study, before repair, the mean pulmonary artery pressure measured by TTE was (34.27 ± 5.64) mmHg, significantly lower than the corresponding direct catheterization measurement (53.09 ± 10.93) mmHg (p < 0.001, highly significant). After repair, the mean pulmonary artery pressure decreased substantially to (15.77 ± 4.69) mmHg, signifying a successful intervention (p < 0.001, highly significant). There was statically significant positive correlation between hospital length of stay and pulmonary artery pressure before repair by direct catheterization.

Conclusion

pre-operative echocardiography may be a useful tool for assessing pulmonary artery pressure, but that it may under-estimate pulmonary artery pressure compared to intraoperative assessment by direct catheterization. Elevated pre-operative pulmonary artery pressure, as assessed by echocardiography, may be associated with certain postoperative outcomes. Echocardiography alone may be insufficient to obtain the anatomic and functional information needed for surgical repair in CHD and may require preoperative catheterization. In conclusion, cardiac catheterization is necessary to delineate pulmonary artery anatomy, origin and hemodynamic assessment for operability in CHD with severe PAH
Role of Folic Acid on Ischemia-Reperfusion-Induced Renal Injury in Rats: Folic Acid Prophylactic Effect Revisited
Authors: Hamed Aya E H , Khedr Sherif , Mahros Elsayed Ghonamy , Mahmoud Faten A , Ahmed Mona A
Published: November 2024

Background

Acute kidney injury (AKI) is a medical condition that has been associated with high morbidity and mortality rates all over the world. Ischemia-reperfusion (IR) has been claimed for AKI incidence especially among hospitalized patients. Unfortunately, there are no definitive preventive measurements or treatment for such a condition stemming from the underpinning complicated pathophysiologic mechanisms. Folic acid has been used for decades as a supplementary nutrient with many positive effects in different pathologies.

Aim

Our study aims for characterizing the impact of folic acid supplementation on acute kidney injury induced by IR, understanding the molecular mechanisms involved.

Materials and Methods

The study was conducted on 50 male Wister rats. Experiments were assigned randomly into 4 experimental groups. Group I; Sham-operated control, Group II; FA- treated, Group III; subjected to IR injury, and Group IV: FA- treated and subjected to IR injury. The kidney function was assessed by serum urea and creatinine level, hand in hand with the histopathological analysis. Moreover, plasma total homocysteine (Hcy) level was measured as an independent marker for renal injury. In addition, we measured oxidative stress parameters, inflammatory indicators and apoptotic/ antiapoptotic markers.

Results

FA pretreatment in renal IR group resulted in a statistically significant reduction in serum creatinine and urea levels, plasma total homocysteine levels and renal tissue levels of malondialdehyde, (MDA), nitrite, high mobility group box-1 (HMGB1), nuclear factor kappa-B (NF-κB) and caspase-3. Meanwhile, FA pretreatment in IR group caused a marked and statistically significant increase in the renal tissue superoxide dismutase (SOD) activity and mitochondrial membrane potential (MMP), when compared to the untreated IR group. The histopathological analysis confirmed the biochemical results underscoring the renoprotective effect of FA.

Conclusion

Our data show, and for the first time, the beneficial protective impact of FA treatment against renal IR injury, that is associated with subsequent lowering of the renal inflammatory, oxidative stress and apoptotic status. This valuable renoprotective effect of FA could have a positive influence on the trajectory renal function.
Potential Effect of Nigella Sativa on the Development of Type 2 Diabetic Nephropathy in Rats: Possible Role of Hypoxia Inducible Factor
Authors: Hussien Nahla , Khedr Sherif , Sabry Yasmine Gamal , Seif Ansam , Nassef Noha
Published: November 2024

Objective

This study was conducted to delineate the beneficial effect of Nigella Sativa (NS) on the development and progression of diabetic kidney disease.

Methods

Rats were allocated into 3 groups: control, T2D (type 2 diabetes), and T2D-NS-treated group. Animals were assessed for renal function, lipid profile, fasting glucose, insulin resistance, RT-qPCR was used to detect mRNA of AMPK, PI3K, AKT, mTOR, HIF-1α, and VEGF, and histopathological analysis was conducted using H&E staining.

Results

T2D group showed a significant elevation in the blood glucose, insulin, HbA1C, renal function tests, microalbuminuria as well as marked dyslipidemia compared to the control. Moreover, there were an increase in the expressional level of PI3K, AKT, mTOR, HIF-1α, and VEGF and downward regulation of AMPK associated with histopathological deleterious changes. NS treatment ameliorated the biochemical, and histopathological changes to comparable levels with the control.

Conclusion

NS exerted a clear antidiabetic, antihyperlipidemic, and renoprotective effect in T2D.
Incidence of Medication Errors and Most Common Drugs Involved during Management of Isolated Patients with COVID 19 in an Egyptian General Hospital
Authors: Mostafa Alaa Mohamed , Fahim Al Tehewy Mahi Mahmoud , Gaafary Maha El , Basyoni Nashwa Ismail
Published: November 2024

Background

The second wave of the COVID-19 pandemic presented significant challenges to healthcare systems worldwide. This retrospective cohort study aimed to investigate incidence and type of medication errors among patients isolated in an Egyptian general hospital during the early months of 2021.

Methods

A total of 468 patient records were reviewed for medication errors. Data collection included patient demographics, comorbidities, admission details, and clinical pharmacist data. Medication errors were categorized based on ordering, administration, and monitoring processes. Statistical analysis included descriptive statistics, and visual representations of key variables.

Results

A total of 934 medication errors were found with a prevalence of 42 per 100 patient days and almost 2 errors per patient. All participants experienced drug therapy problems, with the most prevalent issues related to dosing regimen (31%), needs drugs (27%), and monitoring (18%). The main drugs involved in medication errors were anticoagulants (17.6%), antibiotics (12.3%), corticosteroids (10%) and antiviral drugs (9%).

Conclusion

This study highlights the very high incidence of medication errors among COVID-19 patients during the second wave of the pandemic. The main issues were related to “dosing regimen”, “needs a drug” and “needs monitoring”. Also, the main drug groups involved in theses errors were anticoagulants and antibiotics, followed by corticosteroids and antiviral drugs.

Recommendations

Addressing medication errors, especially in critical care settings, is crucial for improving patient safety and outcomes. Future interventions should focus on enhancing healthcare professionals' knowledge and communication, particularly in high-stress environments like ICUs. These findings can guide healthcare practice improvements and enhance patient care during pandemics and other healthcare crises.
Role of High-Resolution Ultrasound in Assessment of Median and Ulnar Nerve Lesions
Authors: Abdeldayem Ahmed Hassan Mohamed , Botros Ibrahim Samer Malak , Sabry Kareem Ahmed Abdelaziz , Fahmy Marwa Ibrahim
Published: November 2024

Background

Peripheral nerve disorders happen when one or more peripheral nerves are damaged. Damaged nerves may not carry messages correctly, or they may not work at all. As a result, you may have pain, trouble walking, or a variety of other problems, depending on which nerves are involved. Peripheral nerve disorders are very common. There are more than 100 different types.

Aim

To detect the value of high resolution ultrasound in assessment and characterization of some median and ulnar nerve lesions, Including, mainly, compressive, traumatic and inflammatory nerve injuries.

Patients and Methods

26 participants were included in our study either from outpatient clinics (neurology, rheumatology and diabetic clinics) or inpatient wards (vascular surgery department). The study was designed as a case series study; we studied 26 cases with diabetic peripheral neuropathy, carpal tunnel syndrome and traumatic/neoplastic nerve lesions. All selected cases were subjected to proper history taking and ultrasound detection of cross-sectional area (CSA) measurements of median/ulnar nerves in cases of diabetic peripheral neuropathy/carpal tunnel syndrome, compression/flattening of median nerve in cases of carpal tunnel syndrome, loss of integrity in traumatic nerve lesions and neuroma incontinuty in traumatic/neoplastic nerve lesions.

Results

Regarding the ultrasound findings of the peripheral nerves (median/ulnar nerves), there were 38.5% cases were carpal tunnel syndrome, 23.1% were ulnar nerve diabetic neuropathy and 3.8% were complete tear of digital branch of median N, median N complete transection with neuroma, median N entrapment by scar tissue, median N injury neuroma old crush injury, median N injury with neuroma in continuity, median N injury with small hematoma& bifid median N, median ulnar nerve traumatic injury, ulnar nerve crush injury neuroma, ulnar nerve penetrating wound neuroma and ulnar nerve shwanoma. We found that there are significant increase in ulnar/median nerves CSA among diabetic patients with diabetic peripheral neuropathy (DPN)/patients with carpal tunnel syndrome (CTS), compression/flattening of median nerve in patient with CTS, loss of integrity in cases of traumatic nerve lesions and neuroma incontinuty of traumatic/neoplastic nerve lesions.

Conclusion

High resolution ultrasound of median and ulnar nerves proved very helpful in the early diagnosis and distinction of various median and ulnar nerves lesions seen in patients with carpal tunnel syndrome, ulnar nerve diabetic neuropathy clinically suspected, patients with median/ulnar nerves traumatic lesions and patients with ulnar nerve neoplastic nerve lesions. Upper limb peripheral nerve ultrasonography can serve as a useful diagnostic tool in the diagnosis of peripheral nerve lesions.
Clinical Value of Deep Gray Matter 3T MRI Perfusion in Patients with Multiple Sclerosis
Authors: Metwaly Ahmed Mohammed Rezk , Amin Sherin Kadry , Abdelrahman Ahmed Samy , Kamal Teiba Mohamed
Published: November 2024

Background

Multiple sclerosis is one of the most common non traumatic neurological disorders between adults. Magnetic resonance imaging is the most sensitive imaging modality for assessment of multiple patients. New MRI techniques have been improved which help in more accurate assessment of the disease extent, activity, severity and treatment prognosis. Recently, advanced quantitative MRI techniques have detected micro-structural alterations even in the normal appearing white and gray matter of multiple sclerosis patients. In dynamic susceptibility contrast MRI perfusion, the tissue perfusion is assessed by evaluation of a series of rapidly repeated T2*-weighted MR images resulting from the first pass of a contrast agent bolus through the tissue.

Objective

To highlight the role of MRI perfusion in detection of deep gray matter perfusion alteration in multiple sclerosis patients and its relation to the clinical disability and cognitive impairment

Methods

40 patients who were proven as multiple sclerosis patients clinically were enrolled in this study, fulfilled the inclusion criteria. They were divided into two groups (group A with mild clinical disease and preserved cognitive functions, and group B with marked clinical disease and cognitive functions impairment) they were divided according to their clinical disability and cognitive functions status assessed by single experienced neurologist blind to the MRI findings, Additional 20 normal control cases in the same age group were included in the study. Perfusion parameters including cerebral blood volume, cerebral blood flow and mean transit time of the deep gray matter were compared for healthy controls and for the two study groups.

Results

The cerebral blood flow, cerebral blood volume and mean transit time values averaged over the thalamus, putamen, and caudate nuclei were significantly changed in group B (marked clinical disease with cognitive functions impairment) that shows marked decrease in perfusion parameters (cerebral blood volume and flow) and increased mean transit time compared with group A (mild clinical disease with no cognitive functions impairment) and the controls, With respect to group (A), there was no significant difference between the patients and controls

Conclusion

The decrease of tissue perfusion in the deep gray matter of patients with multiple sclerosis is associated with the severity of the clinical disease and cognitive impairment.
Diagnostic Performance of Abbreviated MRI Protocol for Colorectal Liver Metastasis Compared to Dynamic MRI Protocol
Authors: Ragaey Alaa Ahmed , Diaa ElDeen Mohammad Noha , Mostafa Mai Ahmed Mostafa
Published: November 2024

Background

Colorectal cancer is the 7th commonest cancer in Egypt, representing 3.47% of male cancers and 3% of female cancers. New treatments and the technological improvements of imaging increase the detection of secondary lesions and consequently improve the survival of these patients. Imaging is an important tool in the management of patients with liver metastases by evaluating and following up the lesions regarding the number, size, site and assessing the resectability. Ultrasound and contrast-enhanced computed tomography (CECT) were the first-line imaging tools for the assessment of metastatic liver lesions. However, these modalities have a low sensitivity and specificity for the detection and characterization of liver lesions. These limitations have paved the way for contrast-enhanced magnetic resonance imaging (CE-MRI), which has now become the modality of choice in triaging patients with suspected colorectal liver metastasis. Abbreviated MRI protocols have emerged as an alternative to standard MRI protocols thus eliminating unnecessary sequences that increase the cost, MRI table time, patient discomfort, and image interpretation time. However, the diagnostic competency is not generally compromised. The purpose of our study is to assess whether an Abbreviated MRI protocol consisting of DWI and T2-W fat- suppressed (FS) sequence has a similar lesion detection performance compared with standard gadoxetic acid–enhanced MRI protocol for colorectal liver metastasis surveillance.

Results

we found in our study that in the detection of hepatic metastasis in colorectal cancer, abbreviated protocol showed 92.86% sensitivity, 93.55% specificity, 86.67% PPV, 96.67% NPV, and 93.33% overall accuracy. Also, the complete protocol showed 100% sensitivity, 96.8% specificity, 93.3% PPV, 100% NPV, and 97.8% overall accuracy.

Conclusions

A comparison between abbreviated and complete protocols showed in the detection of hepatic metastasis in colorectal cancer that the complete protocol had higher sensitivity, specificity, PPV, NPV, and accuracy than the abbreviated protocol. However, these differences did not reach a significant level (p > 0.05).
Added Value of Diffusion-Weighted Magnetic Resonance Imaging in Evaluation of Musculoskeletal Soft Tissue Masses
Authors: Helal Ayman Amgad , Sakr Hossam Moussa , Elsayed Samar Shehata Mohamed
Published: November 2024

Background

Magnetic Resonance Imaging is the method of choice for the diagnostic work- up of soft tissue tumors. It is the modality of choice to evaluate such masses, because of its excellent soft tissue contrast. Although there are some findings are indicative for malignancy, such as infiltration of adjacent tissues, destruction of bones and tendons, and the size of the mass, there are no criteria available to clearly distinguish benign masses from malignancies.

Aim of the Work

To evaluate the added value of diffusion-weighted magnetic resonance imaging in detection and characterization of musculoskeletal soft tissue masses.

Patients and Methods

This study is a cross-section hospital based retrospective study. This study conducted at Ain Shams University Hospitals. The main source of data for this study was the PET/CT scans and clinical history of the patients referred to the department of Radiology, Ain Shams University Hospitals and the period of the study is 12 months.

Results

Mean of enrolled patients was 37.1 ± 18.0 years and majority (72%) of them was females. It was noticed that thigh (28%) was frequently affect in the those patients followed by the leg (20%). Mean size of these masses was 101.14 ± 78.87 mm. based on histopathological evaluation of these mass; 15 (60%) masses were benign while malignant mass present in 10 (40%). Lipoma and Dermoid fibromatosis were the most frequent tumors in the current study (12%) following by Neurofibroma, Osteosarcoma, Sarcoma and Synovial sarcoma each one of them is (8%). Patients with malignant lesions had significantly lower ADC value in comparison to those with benign lesions (0.78 ± 0.09 vs. 1.56 ± 0.55 (10-3 mm2/s). Haemangiomas had the highest ADC value that was (2.35 ×10 − 3mm2/s.) while sarcoma had lowest value that was 0.54 ± 0.03 (103 mm2/s). It was noticed that MRI had 100% sensitivity and 93.3% specificity for diagnosis of malignant musculoskeletal soft tissue masses with overall accuracy was 96% and area under curve was 0.96 at cut off value was < 1.14 (103 mm2/s). Based on final diagnosis; MRI was successful in diagnosis of all cases with malignant musculoskeletal soft tissue masses but as the same time, MRI falsely diagnosed one case with benign nature to be malignant. Those one case was finally diagnosed to be lipoma.

Conclusion

The ability to differentiate benign musculoskeletal soft tissue tumors from malignant disease is limited clinically. Magnetic resonance imaging is an established modality for comprehensive diagnosis of musculoskeletal tumor. A non-invasive technique is needed to obtain information about the function of the tissue of interest. Diffusion-weighted (DW) MRI is an advanced technique used in combination with MRI to improve its diagnostic accuracy.
The Relationship between Vertebrobasilar Circulation Anatomic Variations and Posterior Fossa Stroke
Authors: Saber Hamad Ayman Mohamed , Taha AbdelAziz Tougan , Teiba Mohamed Kamal Ahmed
Published: November 2024

Background

Posterior circulation stroke accounts for 20% of all ischemic strokes and carries a high mortality up to 85%, posterior circulation includes vertebral, basilar arteries and their branches, anatomical variations are very common in the posterior circulation, in particular vertebral arteries, the most common variant is asymmetry, left vertebral artery dominance presents in 50% of the population, right vertebral artery dominance presents in 25% of the population while similar size vertebral arteries present with an only 25% prevalence, other variations of vertebral artery include fenestration and they may vary in origin. Basilar fenestration is the most common intracranial arterial fenestration and the most common congenital anomaly of the basilar artery. This anatomic variation is characterized by duplication of a portion of the artery that is connected proximally and distally, which may predispose to basilar artery aneurysm formation, other variants include persistent carotid-vertebrobasilar anastomoses and basilar artery hypoplasia, anatomic variation of posterior cerebral artery includes fetal posterior cerebral artery incidence reaches 15%, other variations include fenestration.

Objective

To determine the relationship between anatomic variations of the vertebrobasilar circulation and posterior fossa stroke in patients who underwent MRI brain stroke protocol at our MR unit for evaluation of ischemic stroke.

Patients and Methods

This study was a retrospective study, and the study was conducted at Ain Shams University Hospitals, radio diagnosis department. The study period 7 months. Including sample of 50 Patients radiologically diagnosed with posterior fossa stroke.

Results

There was a significant ratio of posterior fossa anatomic variations especially vertebral artery hypoplasia in patients with posterior fossa stroke reaching 66%

Conclusion

In our study, we demonstrate the high incidence of posterior fossa anatomic variations in patients with posterior fossa stroke.
Diagnostic Accuracy of Contrast Enhanced Spectral Mammography in Assessment of Indeterminate Breast Lesions in Patients after Breast Conservation Surgery
Authors: Shaban Dalia Ahmed Mohamed , Boraei Azza Abdel Ghaffar , Chalabi Nivine Abd Elmoneim Tawfik , Ali Nagi Mona Ali Mohamed
Published: November 2024

Background

Breast cancer in women represents a major public health problem being the most common cancer among women in both developed and developing countries, it accounts for 22.9% of all new female cancers. In Egypt breast cancer accounts for 37.7% of the total new cancer cases. Contrast Enhanced Spectral Mammography (CESM) is an emerging advanced technique that depicts breast tumor angiogenesis. CESM has higher diagnostic accuracy compared to MG with or without US and can depict tumor neovascularity in an analogue manner to breast MRI.

Aim of Work

To evaluate the diagnostic accuracy of contrast enhanced spectral digital mammography in assessment of indeterminate breast lesions in patients after breast conservation surgery.

Patients and Methods

30 female patients underwent breast conservative surgery presenting with indeterminate breast lesion on mammography had been evaluated by dual-energy contrast enhanced spectral mammography. The age ranged from 32 to 77 years (mean=50.07). Results of histopathological examinations of surgical or biopsy specimens were obtained and served as the gold standard.

Results

The surgical and pathological results of our patients revealed 23/33 (69.7%) benign lesions and 10/33 (30.3% malignant lesions. CESM had a sensitivity of 88.9%, a specificity of 83.3%, a positive predictive value of 66.7%, a negative predictive value of 95.2%.

Conclusion

CESM is a promising tool for increasing the sensitivity and the diagnostic accuracy of conventional mammography in follow-up of patients with breast conservative surgery.
Role of Ultrasonography and Color Doppler versus Nerve Conduction Test Results in Evaluation of Cases of Carpal Tunnel Syndrome
Authors: Geneidi Eman Ahmed Shawky , Shalaby Mennatallah Hatem , Morshedy Dina Mohsen Abdelrahman
Published: November 2024

Background

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy with incidence rate of 2.7 to 5.8% of the general population. Nerve conduction studies (NCS) were considered gold standard for diagnosis. Due to false negative rate, Ultrasonography (US) evaluation of median nerve (MN) was suggested as a diagnostic test for CTS.

Aim of the Work

Our aim was to investigate the diagnostic accuracy of US derived measurements compared to NCS for the diagnosis of CTS and comparing different US derived measurements and ratios to know which could be used efficiently for the diagnosis of CTS.

Patients and Methods

This case control study included 52 participants; 26 cases and 26 healthy controls. Our results showed comparable sensitivity between US and NCS results which was 88% and 96.2, respectively. On the other hand, specificity with US measurements was 92% compared to 88% in case of NCS.

Results

Many US derived measurements as inlet MN CSA, outlet CSA, largest CSA between inlet and outlet, WFR and IOR showed statistically highly significant correlation with clinical diagnosis of CTS. Other measurements like CSA at proximal border and proximal third of pronator quadratus muscle failed to show statistically significant correlation.

Conclusion

US results are comparable to NCS results in cases of CTS. US derived measurements as MN CSA at carpal tunnel inlet and largest CSA between inlet and outlet were best to be used for correlation with clinical diagnosis with cut-off value = 9.35 and 9.3 cm2, respectively. WFR and IOR have also high correlation with clinical diagnosis with cut-off value = 1.1 and 1.02, respectively.
MRI Correlation between Lumbar Disc Herniation and Multifidus Muscle Degeneration
Authors: Mohie Eldin Mounir Dina Sherif , Gomaa Elsharkawy Mohsen , Elhoda Passant Abo
Published: November 2024

Background

The lumbar multifidus muscle (LMM) is the largest group of posterior muscles in the lumbosacral region. it specifically acts to maintain segmental stability of the spine, maintain lumbar physiological lordosis, control facet joint movement, and adjust the distribution of the intervertebral load and pressure, this study is to investigate if correlation could exist between multifidus muscles degeneration and lumbar disc herniation (LDH), that may be a process of mutual influence and interaction.

Aim of the Work

To investigate the correlation between lumbar disc herniation (LDH) and multifidus muscle degeneration via the comparison of the cross-sectional area and degree of fatty infiltration of the lumbar multifidus muscle.

Patients and Methods

This study is a retrospective study. The study will be conducted at Ain Shams University Hospitals. The main source of data for this study will be the retrospectively conducted scans and clinical history of the patients referred to the department of Radiology, Ain Shams University Hospitals.

Results

the patients with ULDH are significantly different from healthy people in the measurement indexes of the multifidus muscles. Moreover, the mean and range of relevant indicators are smaller. The results indicate that multifidus muscle atrophy is closely related to upper lumbar disc herniation. both the cross-sectional area and the degree of fatty infiltration exhibited excellent evaluation efficiency. Clinical practice had often neglected the paravertebral muscles, and it was not well protected during spinal surgeries in the past. This study also confirmed that there is significant atrophy of the multifidus muscle in patients with ULDH. Future clinical practise should emphasise on the negative effects of multifidus muscle atrophy. Reinforcing the lumbar spine muscles can help improve this atrophy, which could benefit the prevention and rehabilitation of ULDH.

Conclusion

A relationship could exist between multifidus muscles degeneration and ULDH entailing a process of mutual influence and interaction; however, prospective studies should confirm this. Evaluation of multifidus muscles should be considered when using MRI scans to assess the ULDH patients. Lumbar muscle strengthening training could prevent and improve muscle atrophy and degeneration.
Role of Magnetic Resonance Spectroscopy in Dementia
Authors: Ismail Salwa Taha Ahmed , Geneidi Eman Ahmed Shawki , Ekladious Mena Elerian Youssef , Elgawad Marwa Abd Elazeem Abd , Arab Enas Arafa Anwar
Published: November 2024

Background

Dementia is becoming a significant public health problem of the century due to increasing life expectancy and aging populations around the world. The most common pathology underlying dementia in older adults is Alzheimer’s disease (AD). vascular dementia and Lewy body disease pathologies are other common causes of dementia in the elderly and in many instances AD is also present in patients with dementia with Lewy bodies (DLB) and vascular dementia (VaD). A relatively less common type of dementia is frontotemporal lobar degeneration (FTLD), which tends to affect younger individuals compared to other dementia pathologies.

Aim of the Work

Aim of the work is to identify the role of MRS in common dementia. Ethical considerations: Oral approval from the patients or responsible relatives were obtained after explaining the procedure to them, the study was conducted according to the stipulations of ASU ethical and scientific committee.

Patients and Methods

Our study included 36 patients diagnosed as dementia patients clinically, fulfilled the inclusion criteria. They were 22 females and 14 males; their ages ranged from 40-89 years with the mean age 68 years in addition to 13 healthy control cases in the same age group 7 females and 6 males, their ages ranged from 50 to 75 years.

Results

In our study, The most remarkable findings was reduction of cerebral volume in most of the patients in all types of dementia. NAA peak in dementia patients was reduced compared to the control groups with more reduction was noted in the Alzheimer’s group indicating demyelination with progressive neural and axonal damage. The Myoinositol increase is indicator for glial cell proliferation and gliosis. It’s peak was expected to be increased, however in our study it shows increased level in patients with advanced AD only, no significant change compared to the control group in other types of dementia or early diagnosed patients with Alzheimer’s disease.

Conclusion

Our study showed significant reduction of cerebral volume as well as some metabolic changes that proves that MRS is a non invasive imaging tool can be used to identify dementia after more researches to find disease specific changes.
The Value of Intra-Voxel Incoherent Motion (IVIM) in Evaluation of Inflammatory Bowel Diseases
Authors: Abo Al-Maaty Mai Wahid Mohammed , Elia Remon Zaher , Abdulhafiz Essam Mohamed
Published: November 2024

Background

Crohn’s disease is a chronic inflammatory segmental bowel disorder characterized by attacks of remission and exacerbation that can significantly affect the patients’ quality of life. Hence monitoring the disease activity is crucial to achieve longer symptom free intervals which may result either from active inflammation and its complications as deep ulceration, fistulae formation and abscesses or sequelae from longstanding inflammatory process as fibrotic scarring and strictures.

Aim of the Work

to determine the efficacy of intravoxel incoherent motion (IVIM) in assessing inflammatory activity in IBD.

Patients and Methods

The study conducted at the Diagnostic Radiology Unit; Radiology Department, Ain Shams University Hospitals. From 6 to 9 months. Convenience sample of 32 patients who met the inclusion and exclusion criteria of the study based on clinical suspicion, biomarkers, endoscopy and histopathological specimens referred for MR enterography

Results

We studied the correlation between IVIM parameters with the four known parameters used for IBD activity evaluation (Biochemical, clinical, endoscopy, and MRE) and presence of complications. We studied the correlation of the previously mentioned prameters to each other

Conclusion

IVIM-DWI seems to be a potential noninvasive imaging approach that could provide specific quantitative markers, such as D*, ADC and f values, to objectively assess bowel inflammation with no concern about contrast agent complications.
Validation of Artificial Intelligence in Chest X-ray Interpretation
Authors: Elkholey Nada Khaled Eid , Nasr Mehana Annie Mohammed , Raafat Ali Wafaa
Published: November 2024

Background

Chest radiography is widely used for its portability and cost-effectiveness, providing crucial information for detecting thoracic diseases. However, interpretation challenges and the COVID-19 pandemic have led to stressed medical staff and increased misinterpretations. Automated systems, employing deep learning, are showing promise in classifying chest X-ray abnormalities. These advancements can enhance clinical workflow, decision support, and contribute to global health initiatives.

Aim of the Work

The study aims to evaluate the diagnostic performance of an Artificial Intelligence (AI) system in interpreting chest X-rays, specifically assessing sensitivity, specificity, and accuracy. Additionally, the research explores the impact of AI assistance on the diagnostic performance of radiology residents, examining changes in sensitivity, specificity, and accuracy.

Patients and Methods

A cross-sectional study at Ain Shams University Hospitals assessed the diagnostic performance of an AI system in interpreting chest X-rays, using a sample of 63 images. The study analyzed sensitivity, specificity, and accuracy, incorporating AI assistance for radiologist residents. Data management included descriptive and analytical statistics, employing ROC curves and Kappa statistics for agreement assessment. The study found diagnostic improvements with AI aid.

Results

The study investigated the diagnostic performance of an AI algorithm, Lunit INSIGHT CXR3, and a radiology resident in interpreting AP frontal chest X-rays. The AI demonstrated high sensitivity (100% in calcification and consolidation) and varying specificity (72-100%) and accuracy (71-100%) across different findings. The radiology resident showed significant sensitivity and accuracy improvement as well as increase in agreement with AI assistance, while no significant changes could be detected in specificity. The study suggests that AI can enhance diagnostic performance, aiding radiologists in clinical practice.

Conclusion

In conclusion, our study demonstrates that using AI as an aid has proven to improve the overall performance of radiology residents allowing them to reach expert like levels of diagnostic performance in the CXR interpretation.
Fetal Soft Marker in Obstetrics Ultrasound
Authors: Geneidi Eman Ahmed Shawky , Ragheb Samar Ramzy , Louka Amir Louis , Saad Saad Rafat Fahim
Published: November 2024

Background

Mid trimester scans in specific have become a standard part of antenatal care. Soft markers are reported to be present in approaching 11-14% of all second trimester ultrasound scanning

Aim of the Work

Detection of the soft markers and evaluating the benefit of each ultrasound soft marker and identify if there is a specific soft marker should be looked for standard on ultrasound scanning.

Patients and Methods

Routine 16-24 weeks of gestational scan had been performed at the outpatient clinic radiological department to detect all soft markers. Patients had been followed up and chromosomal karyotyping done for the new born to confirm the final diagnosis. Generally studied soft markers included fetal ventricomegaly, choroid plexus cysts, absent or hypo plastic nasal bone, thickened nuchal fold, intracardiac echogenic focus, short long bones, single umbilical artery, echogenic bowel and pyelectasis.

Results

As regards the validity of different soft markers in the detection of aneuploidy in this study we found that the existence of two soft markers or more had the highest sensitivity 66.7%, NVP 92.0%, inter cardiac echogenic foci had the highest specificity100 % &= PPV 100%, NPV 87.2%, followed by large choroid plexus's cyst NVP 87.9%, Specificity 85.3%.

Conclusion

We establish a relation between ultrasonic soft markers and post natal aneuploidy. Maternal age ≥35.0 years had highest balanced characteristics of diagnosis, followed by having two or more signs & positive history of consanguinity.
Incidental Extracardiac Findings in Cardiac MRI
Authors: Aziz Ali Mohamed Abdel , Osman Mohamed Elhardalo , Mohamed Shaimaa Salah
Published: November 2024

Background

Cardiac magnetic resonance imaging (cMRI) has nowadays emerged as a novel noninvasive imaging technique which offers superior structural and functional evaluation of the heart. cMRI done with a large field of view, that consequently can detect incidental extracardiac findings (IEFs). This study aimed to evaluate the frequency and significance of IEFs reported from clinically indicated cMRI scans.

Aim of the Work

To discuss prevalence of extra-cardiac incidental findings in cardiac MRI.

Patients and Methods

Our study is a retrospective study that included patients who have done CMR from period July 2021 to July 2023. The study included 219 patients who were suspected as having cardiac diseases, referred to the Radiology department, Ain Shams University Hospitals for a cardiac MRI.

Results

A total of 219 studies were included in the analysis. The mean age of the subjects was (38.2 year), SD (±18.2), (range 1– 75 years). The male (62%) female (38%) male to female ratio was 1.6:1, From the 219 patients scanned, a total of 162(74%) patients without Extra-cardiac findings, 57(26%) patients with Extra-cardiac findings

Conclusion

A significant number of IEFs can be detected during cMRI, with high accuracy. It is therefore extremely important that whoever reports cMRI should be able to properly assess normal and abnormal thorax and superior abdominal findings. IEFs should be searched, for potentially modifying the clinical management of patients with such findings
Serum Sclerostin as a Biomarker of Disease Activity in Ankylosing Spondylitis in Correlation with Radiographic Imaging
Authors: Sakrana Nouran M , Badr Nevine M , Azab Manar A , kamel Marwa A
Published: November 2024

Background

Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease defined by the development of new bone in the spine, resulting in joint fusion and functional impairment. The role of sclerostin has been evaluated in AS pathogenesis to identify a possible link with bone formation.

Objective

Evaluating serum sclerostin level in AS patients and investigating the presence of any correlations with radiographic damage, disease activity and function.

Patients and Methods

A total of 20 patients diagnosed as ankylosing spondylitis according to Ankylosing Spondylitis International Society (ASAS) criteria were enrolled in addition to 20 healthy age matched control cases. All patients were subjected to skin, nail, hair, enthesitis, dactylitis, peripheral and axial joint examination. Also, assessment of disease activity was done by using Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. Serum sclerostin level was measured in all cases and correlated with disease activity. Radiographs of the spine and pelvis performed within three months from the enrollment in the study were collected in all patients. Each radiograph was evaluated by an expert reader using the modified Stoke Ankylosing Spondylitis Spinal Score. Finally, MRI examinations for both sacroiliac joints and spine were performed.

Results

Positive correlation was noted between serum sclerostin level and both intermalleolar distance and cervical rotation. A negative correlation between serum sclerostin level and BASMI score. Hemoglobin and hematocrit levels were lower while ESR and CRP levels were higher among AS cases with significant correlations with serum sclerostin level. Negative correlation was reported between serum sclerostin level and SIJs SPARCC score, spine SPARCC score and total SPARCC score. Also, significant positive correlation was noted between mSASSS with BASMI score. Cutoff point ≤20 pmol/L had sensitivity 100% and specificity 100%.

Conclusion

Serum sclerostin was found to be an accurate biomarker with good discriminating power between ankylosing spondylitis cases and healthy control individuals. Finally, serum sclerostin is advised to be used as a routine, less invasive, cheap and valid biomarker in patients with ankylosing spondylitis.
De-novo Peripheral Neurological Complications Following COVID-19 Vaccinations
Authors: Badr Nevine Mohamed Elsayed , El-Zohiery Abeer Kadry , Moussa Salwa Galal , Abo Aldahab Salma Rafat Mohamed
Published: November 2024

Background

Following the COVID-19 virus epidemic, extensive, coordinated international research had led to the rapid development of effective vaccines. Although COVID-19 vaccines were considered the best way to achieve collective safety and control mortality, they had the potential to induce a plethora of peripheral nervous system diseases (PNS).

Aim of the Work

The aim of this study was to analyze the changes in peripheral nervous system in case of post COVID-19 vaccinations by using electrophysiological modalities. This study identified a specific peripheral neurological risk profile for each vaccine and a clinical profile for those who more vulnerable to develop neurological complications after COVID-19 vaccines.

Patients and Methods

This study was conducted on twenty-five patients who started to develop de-novo peripheral neurological complications after COVID-19 vaccination. The patients were enrolled from the outpatient clinic of Rheumatology, Rehabilitation and Physical medicine as well as neurology department of Ain Shams University hospitals.

Results

Twenty-five reported cases of peripheral nervous system (PNS) affection manifesting after receiving COVID-19 vaccines had been analyzed in this work. Thirteen (52%) were previously infected with SARS-CoV-2 infection. Mostly, cases manifested after receiving AstraZeneca 15 (60%) and Pfizer 5 (20%) vaccines. Affected individuals usually presented following the first dose 16 (64%). Furthermore, the most frequently reported symptom was paresthesia (52%). The side-effects severity was greater after the AstraZeneca vaccine (88.89%). Moreover, several manifestations of PNS affection were observed, but the Guillain-Barre-Syndrome (GBS) was of higher incidence (48%).

Conclusion

This is one of comprehensive reviews discussing the new onset of clinical presentation of various peripheral neurological adverse events following the four most commonly available COVID-19 vaccines, confirmed by using electrodiagnostic studies.
Bowel Ultrasound versus Endoscopic Findings in Crohn’s Disease
Authors: Mahran Zakaria , Kamel Shimaa Youssef Youssef , Salem Hossam EL-den Mohamed , Mohamed Aya Samy Mohamed
Published: November 2024

Background

Inflammatory bowel diseases include Crohn’s disease (CD) and ulcerative colitis (UC), are chronic, relapsing-remitting diseases that constitute a growing worldwide health burden. Crohn’s disease is a chronic relapsing lifelong condition disease. It is characterized by trans-mural inflammation of bowel wall and by skip lesions that may be found in any segment of the gastro- intestinal tract

Objective

To improve management of patients with Crohn's disease, objective measurements of disease activity are needed. We evaluated BUS activity finding in comparison to Endoscopic findings with introduction of new BUS score.

Subjects and Methods

Thirty-two adult patients with Crohn's disease were included in our study. They were presented to our IBD clinic at Tropical Medicine Department, Ain Shams university in the period from 2022 to 2023. All our patients were subjected to history taking, clinical evaluation, laboratory investigations and diagnostic evaluation, BUS and colonoscopy.

Results

Our results paved the way for the use of BUS as a simple and non-invasive tool for monitoring activity and follow up CD patient although more studies with longer follow up periods may be needed to confirm our findings.

Conclusion

Bowel ultrasound considered an efficient tool for diagnosing and locating bowel lesions with its extramural extent and complications. It can be used to assess the degree of activity and thus an important tool for follow-up. Bowel ultrasound has the potential to become a tool for monitoring of bowel inflammatory activity in patients with Crohn’s disease, it allows the location & extent of the disease and complications, thus can be used in long-term follow-up. Bowel ultrasound is a good predictor for crohn’s activity with sensitivity and specificity 100% and 100% respectively. Bowel ultrasound score range from 2-8 with cut of point 4 (mild less than <2, Moderate from 2-4, Severe more than >4) can be used as indicator for activity of the disease.
Interleukin-6 as a Prognostic Factor of Severity in SARS-CoV-2 Infected Egyptian Patients
Authors: El-Metwally Loay Mohammed , El-Tabbakh Mohamed Mahmoud , Abdelkader Nadia Abdelaaty
Published: November 2024

Background

Coronavirus disease 2019 (COVID-19) was announced in early December 2019. The pandemic situation is declared. Patients diagnosed as severe or critical cases are prone to multiple organ dysfunction syndrome, acute respiratory distress syndrome and even death This study aimed to evaluate the role of biomarkers in estimating the severity and predicting the prognosis of COVID-19.

Objectives

This cohort retrospective and prospective analysis were carried out to evaluate the association between IL-6 and severe disease and mortality in COVID-19 disease.

Patients and Methods

An analytical cohort retrospective and prospective study, it was performed in Fever Military Hospital-Almaza-Cairo-Egypt in period between 1/11/2020 till 1/11/2021 including all confirmed cases presented by moderate or severe symptoms and signs of covid19 manifestations.

Results

227 patients were included in this study, 72% of them were males and the mean age was 61years old. About 37% of patients needed ICU admission and 46% of all patients died. The median level of IL-6 after 5 days of admission time in patients who still alive was 290.2 while more than level in died patients was 415. In patients who had extra- pulmonary manifestations we found that the median level of IL-6 after 5 days of admission time was 405.5 while in patients without extra-pulmonary manifestations was 242.45 with significant association. The median level of IL-6 after 5 days of admission time in patients who needed ICU admission was 300.4 while in patients didn’t need ICU was 408.8 without significant association.

Conclusion

This study revealed that elevated IL-6 is significantly related to prolongation of hospital stay in COVID-19 patients and Severity of disease. Also, the occurrence of death among patients who had increased IL-6 in the time of admission was higher than patients with normal or lower serum levels of IL-6. There was a significant relation between elevated IL-6 and extrapulmonary manifestations.