bluuebunny/crossref_metadata_2025 huggingface dataset:
Per-Oral Endoscopic Myotomy versus Heller Myotomy in Patients with Achalasia: Meta-analysis Study
Authors: Mohamed Ezz Reda Saad , Kamel Kareem Ahmed , Younis Mohamed Abdelrahman Ahmed
Published: November 2024

Background

Achalasia is a primary esophageal motility disorder of unknown etiology characterized manometrically by insufficient relaxation of the lower esophageal sphincter (LES) and loss of esophageal peristalsis in the absence of mechanical obstruction, radiographically by esophageal dilation with minimal LES opening ―bird-beak appearance, poor emptying of barium; and endoscopically by dilated esophagus with retained saliva, liquid, and undigested food particles in the absence of mucosal structuring or tumor

Objective

To compare the efficacy of per-oral endoscopic myotomy and heller myotomy in achalastic patients

Patients and Methods

We searched for all relevant studies published between January 2000 and September 2018 that examined the post- operative Eckardt score, perioperative outcomes, and acid reflux-related adverse events between POEM and HM, using MEDLINE, EMBASE, and the Cochrane Library data- bases. The following search string was used: ((POEM) or (endoscopic myotomy)) and ((laparoscopic myotomy) or (surgical myotomy) or (Heller myotomy) or (Heller’s myotomy)). The detailed search strategies in each database are shown in (available online at www.giejournal. org). In addition, we examined the references of the screened articles to identify additional studies. The date of our most recent search update was September 18, 2018.

Results

Our meta-analysis provides a better understanding of the comparative efficacy of POEM and HM in patients with achalasia. Although long-term follow-up data in this regard are currently insufficient and considerable heterogeneity was identified in the meta- analysis, the short-term efficacy of POEM was superior to that of HM. The length of myotomy was also greater in POEM than in HM. The operation time and length of hospital stay tended to be shorter in POEM than in HM, however the difference was not big between both. Erosive esophagitis tended to be more common in POEM as fundoplication cannot be done with it.

Conclusion

Although long-term follow-up data are insufficient, the short-term efficacy of POEM was superior to that of HM. Erosive esophagitis tended to be more common in the POEM group; however, there was no difference in reflux symptoms and pathologic reflux on pH monitoring between the groups.
Evaluation of Sinus Laser Assisted Closure (SiLaC) for Pilonidal Disease: Technique and Short Term Outcomes
Authors: Masoud Amr Shahat , Ahmed Tarek Youssef , Abdel-Maksoud Ibrahim Magid , Khalil Ahmed Aly
Published: November 2024

Background

Pilonidal disease (PD) is an acute or chronic infection in the subcutaneous fatty tissue, mainly in the natal (inter-gluteal) cleft the term ―pilonidal‖ means ―nest of hair. Different Modalities were described to treat PD however, there is no consensus on the best method to eradicate this disease without recurrence.

Aim of the Work

To describe the technique for Sinus laser assisted closure (SiLaC) in the treatment of pilonidal disease and evaluate the short term outcomes regarding pain, wound infection, rate of wound healing and early recurrence.

Patients and Methods

A prospective clinical study, this study was conducted at the General surgery department, Ain Shams University Hospitals on 25 patients with PD. Approval of the Ethical Committee and written informed consents from all participants were obtained.

Results

The study included 25 patients with 18 males and 7 females. Their age ranged between 19 and 24. Pain score dropped from 4 on the first post operative day to 0 on the seventh day on VAS. Notably, there was no postoperative bleeding in all patients. Recurrence rate was 11.1% in non branched cases and 57.1% in single branched cases.

Conclusion

SiLaC is a feasible technique for the treatment of Pilonidal disease, It is proved to be safe, reproducible with early resumption of normal activities and return to social life. However, it gives best results in simple non branched cases. Further studies with larger number of patients and long-term follow-up will provide more precise data about the procedure with clearer understanding of its effectiveness and durability.
Evaluation of the Role of Intraoperative Cervical Lymph Node Frozen Section in Detection of Cervical Lymph Node Metastasis in Differentiated Thyroid Carcinoma Surgeries
Authors: Shehata Amr Maher Mohamed , El-Shafei Mahmoud Ahmed Mohamed , Hanna Hanna Habib , Ibrahim Eman Abdel-Salam , Ghaly Ayman Magdy Boutros
Published: November 2024

Background

Lymphatic metastases at the time of diagnosis are common in differentiated thyroid cancer. There is still continuing controversy regarding the role of prophylactic cervical lymph node dissection in patients with differentiated thyroid cancer, it is widely accepted that in the presence of cervical lymphadenopathy, cervical lymph node dissection is indicated at the time of initial thyroidectomy. Occasionally, skip metastases can occur, but in general lymphatic dissemination occurs in a stepwise fashion.

Objective

To evaluate the role of intraoperative frozen lymph node biopsy in detection of cervical lymph nodes metastasis to reduce incidence of unnecessary cervical lymph node neck dissection in differentiated thyroid carcinoma surgeries to avoid complications of neck dissection.

Patients and Methods

This is a prospective cross-sectional study to evaluate the role of intra- operative frozen lymph node biopsy in detection of cervical lymph nodes metastasis to reduce incidence of unnecessary cervical lymph node neck dissection in differentiated thyroid carcinoma surgeries to avoid complications of neck dissection. This study wasbe conducted at (the General surgery department), Ain Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Diagnosis and staging examinations were carried out according to the standard protocol being conducted at Ain Shams University Hospitals

Results

In our study about 50 patients with negative FNAC from lymph nodes underwent frozen section intra-operative. About 27 patients were positive malignant lymph nodes with percent 54% and underwent neck dissection and 23 patients with percent 46% were negative for malignant lymph node and aborted neck dissection with sensitivity 87% and specificity 98%. Paraffin section postoperative revealed about 30 patients were positive for malignant lymph nodes and 20 patients were negative for malignant lymph nodes with sensitivity 90% and specificity 97.4% Thus, the main role of the intra-operative Frozen section of the lymph nodes is the triage of patients who require surgery, thus reducing the number of unnecessary neck dissection and possible complications.

Conclusion

To sum up, the main role of the intra-operative Frozen section of the lymph nodes is the triage of patients who require surgery, thus reducing the number of unnecessary neck dissection and possible complications. Besides, frozen section has a high sensitivity and specificity percent that makes if effective to avoid overtreatment. The main drawback of the study is the low number of patients. A study with a bigger sample would throw more light on this comparison.
Laparoscopic Cholecystectomy with or without Abdominal Drain in Benign Non Complicated Gall Bladder Disease
Authors: eldin Hisham Adel Alaa , Omran Hisham Mohamed , Rayan Mahmoud Talaat , Moamen El Zohery Yasmine Hany Abdel , Khaliel Ebtsam Ragab Awees
Published: November 2024

Background

Gallstone disease is the pathologic state of stones or calculi within the gallbladder lumen and biliary tree. This is a common digestive disorder worldwide, with occurrence varying from 6-20%.

Patients and Methods

This study was done on 60 patients from Ain Shams University Hospitals and El- Sahel teaching hospital, who were provisional diagnosed with chronic calcular cholecystitis. Patients were randomly allocated into 2 groups, 30 patients for each group. Group (A) Lap cholecystectomy with a drain and Group (B) Lap cholecystectomy without a drain, then the two groups were compared according to operative time, length of hospital stay, postoperative pain and post-operative complications as wound infection, fever and bile leakage.

Results

The collected data showed that the operative time was significantly longer in the drain group, also post-operative pain showed significant difference between the two groups being more in the drain group. This study showed significant difference in length of hospital stay which is more in drain type. However no significant difference in post-operative complications between both groups. The benefits of not inserting a drain include a reduction in hospital stay, post-operative pain. a higher incidence of longer hospital stay and post-operative pain associated with drainage.

Conclusion

This randomized controlled trial concludes that the routine use of a drain in uncomplicated elective laparoscopic cholecystectomy has no benefit; in contrast, it is associated with longer hospital stay and more post-operative pain, however beginner or under training surgeons prefer to leave a drain if they are worry about post-operative complication hemorrhage or bile leak.
Meta-Analysis of Long Term Prognosis of Non-Operative Active Surveillance vs Completion Thyroidectomy after Hemithyroidectomy for Pathologically Proven Low Risk Papillary Thyroid Carcinoma
Authors: Abd El Mageed Shaaban Mohamed , Ahmed Dina Hany , Raslan Ibrahim Khaled , Morshed Kerlos Gamal Israel Salem
Published: November 2024

Background

Differentiated thyroid cancer (DTC) includes papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) and encompasses approximately 94% of all thyroid cancers. The majority of DTC carries an excellent prognosis, with 10-year survival rates of over 90% and when examining the subset of low risk DTC (approximately 48% of all thyroid cancers), 10-year survival rates are in the order of 98%, irrespective of management algorithms.

Aim of the Work

The goal of the current study was to evaluate active surveillance versus total thyroidectomy in patients with low papillary thyroid carcinoma.

Patients and Methods

These studies included 35579 cases who were divided into 2 group: 15929 cases in hemithyroidectomy group and 19650 cases in thyroidectomy completion group. About 1265 articles were identified and after exclusion of article which did not fulfill the inclusion criteria, 18 research articles were enrolled in the current study.

Results

The patients' age range was between 40 and 50 years, with a higher incidence of PTC reported in the 3rd and 4th decades of life. Most patients were females, with no significant differences between the two groups. The mean tumor size was approximately 0.5 cm, and most tumors were smaller than 3 mm. Only two studies reported a significant difference in tumor size between the two groups, with larger tumors found in the TT group. Other studies reported no significant difference between the two groups.

Conclusion

Hemithyroidectomy with active surveillance is a good option for treatment low risk papillary thyroid cancers with lower postoperative complications rate, comparable recurrence rate and overall mortality rate. In spite that, 10- year DFS rates were lower with hemithyroidectomy.
Evaluation of the Outcomes of Primary Closure after Open Common Bile Duct Exploration for Common Bile Duct Stones
Authors: Mohamed Magdy H , Alsaeid Ashraf Elzoghby , Abdelhamid Mohamed Abdel Sattar , Elsaid Kamal M
Published: November 2024

Background

The incidence of CBD stone develops in about 10–15% of patients with gall bladder stones and encountered in approximately 7–15% of patients undergoing cholecystectomy. It is common to be treated by endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST), however in cases who has large or multiple CBD stone or difficult to be cleared by ERCP.

Aim of the Work

To evaluate of the outcomes of primary closure after open common bile duct exploration for removal of common bile duct stones.

Methods

This descriptive prospective randomized clinical controlled trial was conducted on 30 patients at Hepatobiliary Pancreatic Department (HBP) - Faculty of Medicine – Ain Shams University from January 2022 until March 2023. Primary closure was performed after removal of CBD stones with follow up for 6 months.

Results

Operative time ranged from 1.3 to 3 hours with mean 2.03 and ± SD 0.48 hours. Biliary leakage was estimated 13.3% of the candidates (4 cases). One of the 30 patients developed CBD stricture. Total and direct bilirubin levels were statistically significant decrease in T and direct bilirubin in follow up “1st 5 days and post-operative 10th day”.

Conclusion

The primary closure after open common bile duct exploration for removal of common bile duct stones is a safe, effective and time saving procedure.
Robotic versus Laparoscopic Inguinal Hernia Repair; A Prospective Study
Authors: Sayed Mohamed Mohamed Hatem , Wagdy Hesham Hasan , Abdelhamid Mohamed Abdelsattar , Emad Moustafa M
Published: November 2024

Background

Robotic inguinal hernia repair has certain advantages over laparoscopic repair including less pain and earlier return to normal activity. Robotic surgery adds high definition visualization and articulating instruments. This enhanced dexterity can make laparoscopic hernia repair more refined while obtaining a critical view of the myopectineal orifice that should lead to fewer recurrences and complications.

Aim of the Work

To compare early postoperative outcomes and surgical ergonomics between robotic and laparoscopic inguinal hernia repair.

Patients and Methods

This study is a prospective study, conducted in Ain Shams specialized Hospital during one year (March 2022 - March 2023). Patients above 16 year old who had inguinal hernia.

Results

The RULA was used to assess the ergonomic status of surgeons involved in this trial. RULA is a survey method originally developed for use in workplaces where risk exists for work-related upper limb injuries, often related to poor ergonomics combined with repetitive motion. It provides an assessment of the postures of the neck, trunk, and upper limb along with muscle function and the external loads experienced. The NASA-TLX validated instrument was used to determine the mental workload of surgeons, and has precedent as a tool to evaluate the mental workload of surgeons in minimally invasive surgery. The NASA-TLX provides an overall index of mental workload as well as the relative contribution of 6 subscales: mental, physical, and temporal task demands, effort, frustration, and perceived performance. Mental demand determines the level of intellectual and perceptual work required for completion of a task and physical demand determines the level of physical work required for completion of a task. Temporal demand is the measure for time pressure during the completion of the task. The effort component assesses mental and physical work required to perform at a certain proficiency level.

Conclusion

The benefits provided by the robotic platform include better visualization, improved ergonomics and wristed movements allowing for easier dissection.
Evaluation of Targetive Axillary Dissection in Node Positive Locally Advanced Breast Cancer Patients with Complete Pathological Response to Neoadjuvant Chemotherapy
Authors: Sedky Mostafa K , Abdelmoghny Mostafa Ashraf , AboElazm Hossam Attia , Zaid Mohamed H
Published: November 2024

Background

This study aimed to evaluate targeted axillary dissection (TAD) in node locally advanced node positive breast cancer patients with complete pathological response to neoadjuvant chemotherapy.

Methods

This is a prospective cohort study including twenty-five females diagnosed with locally advanced breast cancer with proven lymph node involvement who had complete pathological response to the neoadjuvant chemotherapy regarding the clipped previously involved lymph node. Lymph node biopsy and frozen section of the clipped lymph node after wire localization and the sentinel lymph node after patent blue dye injection was done. This is followed by paraffin section examination of the lymph node biopsy and 6 months follow-up for the patients.

Results

Twenty-four patients out of twenty-five patients had successful localization of the clipped and sentinel lymph node with no macro-metastasis detected in frozen section. Twenty-two out of the twenty-four patients had no micro-metastasis in paraffin section. Two of the twenty-four patients had micro-metastasis on paraffin section and required axillary radiotherapy. One of the twenty-five patients failed localization of the clipped lymph node and received conventional axillary lymph node dissection. Two patients developed lymphoedema, one of them after axillary radiotherapy and the other one after axillary lymph node dissection.

Conclusion

The combination of TAD and SLNB can replace Axillary clearance in patients with node positive Locally advanced breast cancer with complete pathological response to neoadjuvant chemotherapy.
The Role of Hybrid Revascularization Procedures for Symptomatic Chronic Peripheral Arterial Disease
Authors: Salib Wafy Fouad , Wahba Ramez Mounir , Zekri Mina Gamil , Issa Hafez Ahmed Amr
Published: November 2024

Background

Peripheral arterial disease (PAD) is a chronic vascular disease characterized by impaired circulation to the lower extremities. While early stages of PAD may be asymptomatic, the hallmarks of its most severe stage, known as chronic limb threatening ischemia (CLTI). It is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration.

Aim of the Work

The aim of this study is to assess the clinical and hemodynamic outcome of CLTI treated by hybrid revascularization procedures and the possible risk of postoperative amputation.

Patients and Methods

The following electronic databases were searched up to 2022: PubMed, Google Scholar search engine, Cochrane database of systematic reviews, EMBASE, Science Direct, Wiley Online Library, ELSEVIER, Scopus and the European journal of vascular society searching keywords and terms listed below: “Critical limb threatening ischemia, management of peripheral arterial disease, multi-level occlusive arterial disease, hybrid revascularization, outcome of hybrid procedures”.

Results

In our meta-analysis, risk factors of PAD included gender, smoking, HTN, DM, coronary artery disease, CVS, CKD, Hyperlipidemia and COPD. Success rate of hybrid revascularization technique showed a significant effect than other techniques.

Conclusion

The results of this meta-analysis showed that Diabetes Mellitus and hypertension are two major risk factors that worsen the outcome of hybrid procedures. Hybrid procedures have added to the armamentarium for treatment of patients with multilevel arterial disease and offer a less risky option for elderly patients with multiple comorbid conditions. Hybrid procedures are effective to treat patients with either CLI or claudication.
Tumescent Technique for Transabdominal Preperitoneal Inguinal Hernia Repair (TAPP) versus Conventional TAPP
Authors: Abd El-Hamed El-Ashry Alaa El-Din , Mostafa El-Maleh Haitham , Taha Zaazoa Mohamed Moustafa , El-Aziz El- Shayeb Basem Helmy Abd , Mohammed Taha Yomna Medhat
Published: November 2024

Background

Laparoscopic hernia repair is more difficult technically than open surgery and there is evidence of learning curve in its performance and many complications reported from laparoscopic procedure. But also, laparoscopic approach has its benefits as rapid recovery, quicker return to work, less acute pain complication, better quality of life outcomes.

Objective

To compare between the conventional and tumescent technique in TAPP inguinal hernia repair as regards operative technique, intra & post-operative complications, early post-operative pain, hospital stay, restriction of physical activity, incidence of recurrence and post-operative chronic groin pain.

Methods

This was a prospective, randomized, comparative study, that was conducted at El-Demerdash hospital over one and a half years (October/2021 - March/2023). The 60 patients who were included divided into two groups, 30 for each. Group A; tumescent technique, Group B; conventional technique.

Results

Follow up started from the first day after operation and then visits at surgery outpatient clinic were arranged as follows, two weeks postoperative, then after one month. Interpretation of results revealed that there was significant difference between the two groups in operative time and early post-operative pain which decreased in tumescent group. There was no significant difference between the two groups as regards postoperative complications, the most reported complications were post- operative urinary retention and seroma formation. No reported cases of hernia recurrence and chronic groin pain in both groups.

Conclusion

Tumescent TAPP inguinal hernia repair appears to offer technical and clinical improvements to conventional TAPP, with small learning curve makes it easy procedure for unexperienced surgeons to use it for hernia repair and to learn it quickly. In general, TAPP inguinal hernia repair is considered both safe and effective for surgeons skilled in laparoscopic surgery; as all perioperative complications are well tolerated by patients and mostly there was no need for a second operative intervention, also the short-term treatment results were satisfactory.
Common Organic Acidemias in a Tertiary Hospital in Egypt
Authors: Mohamed Amany Hosny , Fattah Nada Hammad Abdel , Khalifa Ola Ali
Published: November 2024

Background

Organic acidemias (OAs) are a heritable group of heterogeneous metabolic disorders characterized by the accumulation of organic acids in body fluids and tissues. They are rare disorders and infrequently reported worldwide. Methylmalonic acidemia (MMA), propionic acidemia (PA), isovaleric acidemia (IVA), 3-methylglutaconic aciduria (3-MGA), and glutaric acidemia type 1(GA1), are considered the more common OAs, their prevalence is higher in Arab populations due to the high consanguinity rate.

Aim

This study aimed to: • Evaluate the spectrum of common organic acidemias among pediatric patients who followed up at the metabolic clinic of a tertiary hospital in Egypt. • Present different clinical and biochemical characterizations and the time of onset of these disorders, so that helps in raising the high index of suspicion among pediatricians and health care practitioners to make an early diagnosis.

Method

We conducted a descriptive retrospective study by reviewing the medical records of pediatric aged group patients diagnosed with common forms of OAs, followed up in Metabolic Clinic, Ain Shams University Hospitals, Egypt, over a 4-year period, between January 2017 and January 2021. All patients were investigated by metabolic work up, including the acylcarnitine profile and urinary organic acid analysis.

Results

A total of 76 patients with common OAs were included in the study. There were (56.6%) males and (43.4%) females. Most patients presented after the first year of life (58.7%); whereas the median age at diagnosis was 15 months. GA-1 was the most frequent disorder (39.5%), followed by MMA (36.8%). There were relatively high rates of consanguinity (80%) and affected siblings (23%). The most frequent presenting symptoms were developmental delay (69.3%), poor feeding (65.7%), and vomiting (50.7%). The main observed complications among studied patients were delayed motor development (67.1%), delayed speech (22.4%) and faltering growth (15.8%). Regarding the disease course and patientś outcome; 55.3% of patients exhibited regressive course, whereas 84.2% of patients were alive and well.

Conclusion

GA-1 is the commonest organic acidemias in Egypt and is more evident due to high rate of consanguinity. This urges the need to enhance awareness among pediatricians, primary healthcare providers and devise a governmental newborn screening program for the early detection and prevention of such disorders.
The Possible Therapeutic Role of MSC Derived Exosomes Extracted from Myocardial Infarction versus Healthy Rat Models in the Heart with Surgically Occluded Right Anterior Coronary Artery in Rats A Histological Study
Authors: Farid Alaa Sabri , Ali Eman Ali Negm , Sebay Sara Abdel Gawad El , Hussien Emara Maher M
Published: November 2024

Introduction

Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary arteries of the heart, causing damage to the heart Muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw. Often it occurs in the center or left side of the chest and lasts for more than a few minutes. MI may cause heart failure, an irregular heartbeat, cardiogenic Shock or cardiac arrest. Aim: this study is designed to compare between the therapeutic role of autologous exosomes versus homologous exosomes on surgically induced myocardial infarction model in adult male albino rats.

Material and Methods

Fifty adult male albino rats weighing 150–250 gm were included with age from 8 to 11 old months in the study. In addition, ten rats weighing 150 gm with age from 7 to 8 old weeks were used for adipose derived exosomes preparation. The rats were divided into the following three groups: Group I: control group, Group II: myocardial infarction group; rats were subjected to right (RACO Technique), Group III: rats were subjected to permanent RACO technique as in group II then rats were further subdivided into two subgroups; Subgroup IIIa received autologous exosomes in tail vein on the 2nd day of the experiment and Subgroup IIIb received homologous exosomes in tail vein on the 2nd day of the experiment.

Results

Group II showed disruption of cardiomyoctes which appeared deeply acidophilic and darkly stained nuclei with loss of the intercalated discs and muscle striations. Immunohistochemical stain revealed a significantly increased reaction to iNOS antibodies, caspase-3 antibodies, anti -PCNA and positive anti-VEGF in comparison to control group. Group III; including subgroups IIIa and IIIb; showed preservation of the myocardium integrity. However, subgroup IIIa revealed significant increase in anti-VEGF and decrease in iNOS antibodies as compared to subgroup IIIb.

Conclusion

Both exosomes from healthy rats and exosomes from rats with MI showed therapeutic and anti-inflammatory effects in surgically induced MI. These effects were more prominent in exosomes from rats with MI than healthy rats as detected by microscopic, morphometric, and statistical studies.
A Histological Study on the Effect of Whey Protein on Liver and Skeletal Muscle with or without Exercise in Adult Male Albino Rats
Authors: Hamed Gehan Ahmed , Kalleny Nagwa Kostandy , Tarek Mai , Salah El-Din Bayomi Noha
Published: November 2024

Introduction

Whey protein provides a rapid source of amino acids that the muscles can utilize. Whey protein is frequently used by people to increase their strength and improve sports performance. However, other people use whey protein as a dietary supplement because of its beneficial effects without performing any exercise.

Aim of the Work

to evaluate the effect of whey protein with/or without exercise on the histological structure of the liver and skeletal muscle in adult male albino rats.

Materials and Methods

Twenty adult male albino rats with weight ranged from 150 to 200 grams were used in this study, rats were randomly divided into two main groups: Group I (Standard diet group): subdivided into two subgroups. Subgroup IA (Standard diet, sedentary): left without intervention. Subgroup IB (Standard diet, exercise-trained): subjected to exercise training. Group II (Whey protein group): received high dose of whey protein daily (6 gram/kilogram) by oral gavage and were further subdivided into two subgroups. Subgroup IIA (Whey protein, sedentary). Subgroup IIB (Whey protein, exercise-trained): received whey protein within 30 minutes after exercise training. Rats of subgroups IB and IIB were subjected to swimming exercise training in swimming basin for four weeks, five days per week, in which the exercise time was increased gradually throughout the four weeks of the study. Liver and gastrocnemius muscle were subjected to microscopic examination, morphometric and statistical studies.

Results

Histological, morphometric, and statistical studies of liver of subgroup IB were nearly similar to that of subgroup IA. Histological examination of liver of subgroup IIA showed congestion of central vein and portal vein with surrounding mononuclear cellular infiltration and increased mean collagen percentage as compared to other subgroups. It also showed vacuolated hepatocytes with shrunken, irregular, and heterochromatic nuclei. Meanwhile, subgroup IIB showed improved hepatic architecture than subgroup IIA. Histological examination of gastrocnemius muscle of exercise-trained subgroups IB and IIB showed increase in mitochondrial content, mean glycogen optical density, and mean muscle fiber diameter with appearance of splitting and central nuclei, which were more pronounced in subgroup IIB as compared to subgroup IA. Meanwhile, subgroup IIA showed significant decrease in mean muscle diameter as compared to subgroup IIB, however it showed nonsignificant increase in mean diameter when compared to subgroup IA.

Conclusion

High intake of whey protein without physical exercise has its degenerative effects on liver, also it showed non-significant increase in mean diameter of skeletal muscle as compared to rats fed standard diet. Thus, whey protein should be taken within its recommended dose and accompanied by physical exercise.
Evaluation of the Accuracy of the Percentage of Neutrophils to Lymphocytes in Blood in the Diagnosis of Spontaneous Bacterial Peritonitis in Hepatitis C Patients
Authors: abd el gawad Ahmed Arabi , Kayser Hany Haroon , Samir El-Baz Hossam , Musa Sheikh Mazen
Published: November 2024

Background

Spontaneous bacterial peritonitis (SBP) is a severe complication among cirrhotic patients with ascites and is defined as an infection in the ascitic fluid without a clear source in the abdomen.

Aims and Objectives

To determine the role of neutrophil-to-lymphocyte ratio (NLR) as a predictor of spontaneous bacterial peritonitis (SBP) in patients with hepatitis C.

Subjects and Methods

This Prospective cohort study was conducted at Hepatology Unit of Ain Shams University Hospital in period of 6 months over 80 cases divided into 2 equal groups.

Study Group

40 patients with cirrhotic hepatitis C patients with sterile ascites.

Control Group

40 patients with cirrhotic hepatitis C patients with ascites with SBP.

Result

The study found significant differences in ascitic fluid, lymphocytes, neutrophil/lymphocyte ratio, MPV, total bilirubin and creatinine, and lab investigations at different times, indicating a multifactorial nature of the cases.

Conclusion

The findings suggest that assessing the neutrophil-to-lymphocyte ratio (NLR) may serve as a simple, accessible, and cost-effective method for identifying SBP in hepatitis C patients, offering a non-invasive alternative to conventional diagnostic approaches.
Incidence of Acute Kidney Injury, Acute Kidney Disease and Chronic Kidney Disease at Ain Shams University Hospital
Authors: Hassan Abdelmonem Ahmed Ayman , Elsharkawy Magdy Mohamed , Sayed Hussein Hussein , Abd-Elaziz Mahmoud Nady
Published: November 2024

Background

Acute kidney injury (AKI) and chronic kidney disease are common interconnected syndromes that represent a public health problem.

Aim of the Work

The aim of our study is To Determine the rate and aetiology of AKI, AKD and CKD in Ain Shams University hospital over period of 6 months.

Patients and Methods

This is a cross-sectional study on patients presented to ER at internal medicine, obstetric and general surgery hospitals of Ain Shams University.

Results

Regarding to serological markers there is high statistical significant between Acute and chronic patients as regard serum protein electrophoresis. In Acute patients, PTN electrophoresis was negative in 35 patients (16.1%) and not done in 183 patients (83.9%). In Chronic patients, PTN electrophoresis was negative in 89 patients (36.8%), positive in 5 patients (2.1%) and not done in 148 patients (61.2%). And Statistically significant difference between Acute and chronic patients as regard C3, C4, ANA and Anti DNA, In Acute patients, C3 was normal in 31 patients (14.2%), consumed in 18 patients (8.3%) and not done in 169 patients (77.5%). In Chronic patients, C3 was normal in 65 patients (26.9%), consumed in 23 patients (9.5%) and not done in 154 patients (63.6%) and as regard C4. In Acute patients, C4 was normal in 45 patients (20.6%), consumed in 4 patients (1.8%) and not done in 169 patients (77.5%). In Chronic patients, C4 was normal in 74 patients (30.6%), consumed in 14 patients (5.8%) and not done in 154 patients (63.6%). and as regard ANA and anti-DNA. In Acute patients, ANA & anti-DNA was normal in 26 patients (11.9%), positive in 16 patients (7.3%) and not done in 176 patients (80.7%). In Chronic patients, ANA and anti-DNA was normal in 60 patients (24.8%), positive in 13 patients (5.4%) and not done in 169 patients (69.8%). As regard renal US there is Statistically significant in increased kidney length and hilum to cortex in Acute patients when compared with Chronic patients and Statistically significant in increased kidney parenchymal thickness in Acute patients when compared with Chronic patients with high statistical significant by increased percentage of increased echogenicity of kidney in Chronic patients (215 patients, 90.7%) when compared with Acute patients (124 patients, 57.1%). But there is no statistical significant difference between Acute and chronic patients as regard kidney back pressure and regarding to patients who had backpressure and CTUT was done there is no statistical significant difference between Acute and chronic patients as regard CTUT back pressure.

Conclusion

The end-results of our study showed that marked increase in patient who had chronic kidney disease in compare with patient who had Acute kidney injury and acute kidney disease.
Serum Pentraxin 3 Level in Egyptian Patients with Nonalcoholic Fatty Liver Disease and Type 2 Diabetes
Authors: Mostafa Ahmed Mohamed Mahmoud , Aziz HossamEldin Abdel , Elshafie Ahmed Ibrahim Mohamed , George Tari Magdy Aziz , AlAshram Mohamed Nabil Badawy , Fors Mostafa Attya Attya El
Published: November 2024

Background

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver injury and is strongly associated with type 2 diabetes mellitus (T2DM). Pentraxin 3 (PTX3) is an acute‑phase reactant and an essential component of innate immunity. Plasma PTX3 level is, according to some data, a marker for NAFLD. We aimed to assess the value of serum Pentraxin 3 level as a non-invasive bio-marker of NAFLD in patients with Type II DM.

Methods

This case-control study included 96 subjects classified in to 32 patients with T2DM and NAFLD, 32 patients with T2DM and without NAFLD, and 32 healthy subjects. All studied subjects underwent a detailed clinical examination, laboratory tests, abdominal ultrasound, Fatty liver index score, and calculated serum Pentraxin.

Results

Serum Pentraxin demonstrated a high statistically significant correlation with the presence of NAFLD in patients with Type II DM and in healthy people.

Conclusion

Pentraxin 3 is a sensitive, specific, and a promising biomarker for detection of liver injury in NAFLD when suspected in patients with and without DM.
Assessment of Serum Zonulin in Patients with Irritable Bowel Syndrome and its Correlation with Stool Frequency
Authors: Bayoumi Hilal Essam Mohamed , El-Ghandour Ahmed Mohamed , Al- Ashram Mohamed Badawy , Zaki Mohamed Ahmed Mohamed
Published: November 2024

Background

Studies have shown increased intestinal permeability in irritable bowel syndrome. Validating serum biomarkers for altered intestinal permeability in irritable bowel syndrome will facilitate research and pathophysiology-based therapy.

Aim and Objectives

To compare serum zonulin level between diarrhoea-predominant irritable bowel syndrome and constipation-predominant irritable bowel syndrome.

Subjects and Methods

This was a Case control study, was carried out in Gastroenterology department, Ain Shams University Hospital, and military hospitals on 60 subjects classified into three groups: (First group): included 20 patients complaining of IBS-Diarrheal type, (Second group): included 20 patients complaining of IBS-constipation type, Third group (Healthy group): included 20 healthy persons, during a period of 6 months.

Result

There was high statistically significant difference between the two cases groups as regard frequency of stool.

Conclusion

We could not detect altered zonulin levels between individuals reporting IBS-D and IBS-C. On the other hand, higher zonulin levels are founded compared to healthy controls. These data suggest that zonulin might have utility as a simple serological biomarker for altered IP in patients with IBS. However, more research is needed to corroborate our findings of the role of zonulin in IBS. Identifying IBS patients with zonulin-mediated intestinal tight junction dysfunction may allow mechanistically focused IBS therapy (e.g., larazotide acetate).
Vitamin D Deficiency in Hemodialysis Patients and Cardiovascular Diseases Risk
Authors: Mahmoud Ahmed Zoheir , Shawky Sahar Mahmoud , Mohamed Ahmed Yehia
Published: November 2024

Background

Dialysis patients experience an excess mortality, predominantly of sudden cardiac death (SCD). Vitamin D deficiency is present in the vast majority of patients with chronic kidney disease (CKD), and correcting a poor vitamin D status is recommended as a treatment of CKD–mineral and bone disorders. Accumulating evidence suggests a role of vitamin D for myocardial and overall health.

Aim of the Work

To assess the correlation between vitamin D status and cardiovascular outcomes in prevalent hemodialysis patients.

Subjects and Methods

This was prospective interventional study, conducted Abo elnomros hemodialysis unit, on 50 prevalent HD patients. All patients were subjected to the following: Demographic data, laboratory investigations during the last 6 months, Echo-cardiogram before the study and after 6 months.

Results

The mean Ca was 7.94(±0.77 SD), the mean Po4 was 4.8(±0.8 SD), the mean PTH was 381(±127 SD), the mean vitamin D was 11.4(±1.5 SD).

Conclusion

High prevalence of vit D deficiency in dialysis patients, and showed a significant association between 25-OH vitamin D analogues supplementation and decrease cardio-vascular risk.
Protein Kinase C Delta as Novel Biomarker For HCC
Authors: Mohamed Kamal Maha Mohsen , Aziz Tary Magdy , Fathallah Ahmed Magdy , Rezk Zayan Amr Ahmed Ibrahim
Published: November 2024

Background

Hepatocellular carcinoma is one of the most common malignancies worldwide and the most common primary malignant tumour of the liver. It is the second leading cause of cancer related deaths in the world. It occurs most commonly on top of a cirrhotic liver due multiple risk factors ranging from viral hepatitis, aflatoxin, alcohol intake, and metabolic syndrome the most prevalent of which is HCV infection.

Aim of the Work

This work aimed to study the relation between PKCd and AFP in HCC patients. Also, to correlate PKCd with different laboratory parameters. And finally, to evaluate the diagnostic value of PKCd in patients with HCC at early stages, alone and in combination with AFP.

Patients and Methods

The study was conducted on 75 subjects who were divided into three groups. Group A included 25 patients with clinically diagnosed HCC most of whom were in the early stages of HCC. (Stage 0 and stage A by BCLC staging system), group B; 25 patients with clinically diagnosed with cirrhosis and group C; 25 apparently healthy subjects as the control group.

Results

Our analysis showed that the mean level of PKCd was significantly higher in patients with HCC (Group A) compared to the control group with moderate elevation in cirrhotic patients. PKCd shows higher sensitivity in group A compared to AFP. Another finding is that there was a significant positive correlation (r = 0.431, p = 0.031) in patients with early-stage HCC (Group A) between PKCd and AFP. This strengthens our conclusion about the possibility of using PKCd as a novel biomarker for diagnosis of early HCC.

Conclusion

We propose that PKCd can be used as a potential non-invasive biomarker that has several advantages in diagnosis of HCC especially in patients with early-stage HCC as it can potentially surpass the diagnostic performance of other conventional biomarkers such as AFP in those patients.
Lupus Activity in Lupus Nephritis Patients with End Stage Renal Disease Treated with Haemodialysis
Authors: Abd-Allah Khalil Amr Elsayed Mohammed , Hafez Eman Ahmed , Morad Caroline Samy , Arafa Shyamaa Gamal
Published: November 2024

Background

End-stage renal disease (ESRD) is the advanced stage of a progressive loss of kidney function. About 10% of all patients with lupus nephritis (LN) eventually progress to ESRD, which may necessitate renal replacement therapy (RRT), such as haemodialysis (HD). Assessment of lupus activity after haemodialysis initiation is crucial in improving outcomes. This issue is still under consideration by researchers.

Aim of the Work

The goal of this study is to analyze lupus activity in LN patients with ESRD treated with hemodialysis

Patients and Methods

70 LN patients were divided into two groups: group A (35 patients) who were ESRD treated with haemodialysis, while group B (35 patients) who were chronic kidney disease (CKD) stage 3, 4. Non-renal systemic lupus erythematosus disease activity index (nrSLEDAI) score was used to assess lupus activity in both groups.

Results

Group A (haemodialysis group) exhibited considerably declined lupus activity compared to group B (CKD) group. With long term period maintenance on haemodialysis, there was an obvious remission in both clinical and serological parameters of lupus activity. Current doses of oral corticosteroids were less in group A than group B.

Conclusion

The current study's findings suggest that haemodialysis improves lupus activity clinically and serologically in what has been called burn-out phenomenon.
Comparison of Safety and Efficacy of Neomycin versus Rifaximin in Chronic Recurrent Hepatic Encephalopathy
Authors: Ali Ahmed Alaasar Asmaa Ahmed , Monis Ahmed Ali , Riad George Safwat , Talkhan Mohamed Gamal
Published: November 2024

Background

Hepatic encephalopathy (HE) is a potentially reversible neuropsychiatric and functional syndrome occurring in 50%-70% of patients with advanced liver disease, the most recent guidelines from the American Association for the Study of Liver Disease (AASLD) and European Association for the Study of the Liver (EASL) suggest a universal definition of HE: “a brain dysfunction caused by liver insufficiency and/or portosystemic shunting. It manifests as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma.

Aim of the Work

To compare between the efficacy and safety of neomycin versus rifaximin in management of recurrent hepatic encephalopathy.

Patients and Methods

This retrospective study was conducted on 240 patients diagnosed with liver cirrhosis and experienced recurrent hepatic encephalopathy and collected from Internal Medicine and Gastroenterology Clinics, at Ain Shams university hospitals in a period of 6 months starting from April 2023 till October 2023.

Results

They were 123 females (51.25%) and 117 males (48.75%) with age ranged from 40 – 75 years and with mean±SD of 56.51 ± 9.10. hemoglobin level was significantly decreased post treatment in Rifaximin group [−8.75 (−15.65 – 1.11)] than neomycin [−1.96 (−3.57 – 0.89)] and mixed [0.11 (−4.55 – 4.91)] groups with p-value <0.001. Also, the level of WBCs was significantly increased in Rifaximin [12.73 (2.53 – 75)] and Mixed [15.56 (9.09 – 24.53)] groups than Neomycin group [6.45(−10.09 – 15.56)] with p−value <0.001 while the level of platelets was significantly increased in Rifaximin [10.93(−23.89 – 47.69)] and decreased in Neomycin [−5.41 (−9.02 – −2.94)] and Mixed [−5.36 (−10.00 – 3.8)] groups with significant difference between Rifaximin and the other two groups with p−value = 0.016.

Conclusion

Over a 6-month period, treatment with neomycin maintained remission from hepatic encephalopathy more effectively than did Rifaximin and mixed use of both neomycin and rifaximin. Also significantly reduced the risk of hospitalization involving hepatic encephalopathy, less hospital stay, better survival and quality of life, Neomycin in managing chronic recurrent hepatic encephalopathy was associated with lower serum creatinine levels and fewer nephrotoxic side effects in comparison to rifaximin and mixed use of neomycin and rifaximin together.
Evaluation of Level of Serum Immunoglobulin G, Serum Immunoglobulin M and Interleukin 10 in Hypertensive Patients
Authors: Abdelbasset Asmaa Mohammed Saleh , Ashour Zeinab Ahmed Youssif , Abdelwahab Hoda Ezz El-Arab , Khalil Eman Alsayed Ahmed , Aldeeb Mai Ahmed Youssif , Abdelsayed Sylvia Talaat Kamal
Published: November 2024

Background

Hypertension is the leading risk factor for cardiovascular disease worldwide, accounting for 9.4 million deaths and 7% of global disability adjusted life years. The etiology of essential hypertension is unclear, and its mechanisms are complex Perturbations of the sympathetic and parasympathetic nervous systems, the reninangiotensin-aldosterone system, the endothelin system, genetic predisposition and environmental factors in combination or independently contribute to elevation of blood pressure (BP), and BP and/or the prohypertensive stimuli induce cardiovascular injury.

Aim of the Work

To measure levels of serum IgG, IgM, and IL10 in hypertensive patients as compared to healthy control.

Patients and Methods

This was a case-control clinical study that was conducted at the internal medicine outpatient clinic and wards of Ain Shams University hospitals on 100 subjects who weredivided into 2 groups.

Results

Interestingly our study showed that interleukin10 level was significantly lower in both treated and untreated hypertensives relative to control, this indicates that there is immune dysfunction in patients with essential hypertension. Additionally We found that there is significant correlation between CRP, neutrophils and hypertension among study group this confirm that inflammation plays a role in the pathogenesis of vascular disease. As expected we found the grade of progression of retinopathy andcarotid intima media thicknessincrease significantly with the degree of hypertension.

Conclusion

Hypertension may represent an extreme phenotype of a multifaceted and complex disease, it seems reasonable that more than one or perhaps a significant number of factors, including inflammatory and noninflammatory ones, may play a role in the pathogenesis of this syndrome. Although based on a relatively small number of patients, our results are provocative and support the importance of additional studies aimed at identifying laboratory markers that may relate to treatment resistance and ultimately to the development of new therapeutic strategies.