bluuebunny/crossref_metadata_2025 huggingface dataset:
PET/CT in the Staging of Non-Small Cell Lung Cancer
Authors: Ghoneim Nada Mohammed Farid Hassan , Elia Remon Zaher , Sheha Aliaa Sayed
Published: October 2021

Background

NSCLC accounts for about 80% of all lung cancers. The current criteria for its staging is based on the TNM system that determines treatment options and predicts survival rate in patients.

Objective

To evaluate the diagnostic accuracy of 18F-FDG PET/CT in staging of NSCLC patients

Methods

A prospective study, conducted at Ain Shams University hospitals on pathologically proven patients of NSCLC, the patients were investigated using CT and PET/CT in the period between October 2018 till end of June 2019.

Results

A total of 40 patients were evaluated with the age ranging from 37 to 77 years old, whether the mean was 55.63 years (SD ± 10.29). There were 31 male cases and 9 female cases. When we compared CECT against PET-CT for staging, PET-CT helped upstage disease in 10 of 40 patients (25%) and downstage in 3 of 40 patients (7.5%).

Conclusion

PET/CT is a useful imaging tool in initial staging of the newely diagnosed patients with NSCLC. It is better thаn СT alone for detection of malignant lesions for accurate staging. It can change the strategy of treatment according to its findings
Role of diffusion weighted MRI imaging in characterization of hepatic focal lesions in cirrhotic patients in comparison to dynamic cross sectional imaging
Authors: Ibrahim Nouran G , Kamel Faten M. M , Maarouf Rania A , Abdulhafiz Essam M
Published: October 2021

Aim of work

The aim of the study is to show the feasibility of diffusion weighted (DWI) MRI with calculation of the apparent diffusion coefficient in characterization of hepatic focal lesions as well as differentiating benign from malignant lesions in cirrhotic patients.

Patients and Methods

The study included 35 patients (25 males and 10 females) by cross sectional study and convenient sampling at the Demerdash hospital, inclusion criteria: patients diagnosed by hepatic focal lesions on top of post-viral induced cirrhosis, detected by ultrasound, triphasic CT or dynamic MRI imaging. All patients to be included in the study underwent characterization of hepatic focal lesions to differentiate benign from malignant lesions using a combination of characteristic imaging criteria, including contrast enhancement patterns on MRI. Sequences used were T2 weighted imaging, T2 Spectral Attenuated Inversion Recovery (SPAIR), and diffusion weighted imaging sequences with estimation of the ADC map and calculation of the ADC values.

Results

Our study was carried on a total of 35 patients including 25 males and 10 female patients having a mean age of 59 ± 10.2 years (58.1 ± 11 and 61.2 ± 8 years for the male and female patients respectively). DWI and ADC showed statistically significant difference among the benign and malignant focal lesions in terms of their diffusion restriction criteria ( P < 0.0001), with a sensitivity, specificity, positive and negative predictive values of 100% (95% CI = 89.5 – 100%), 92.3% (95% CI = 79.6 – 97.3%), 91.6% (95% CI = 78.1 – 97.1%) and 100% (95% CI = 90.3 – 100%), as well as a likelihood ratio of 13. On comparing the ADC values of the focal lesions for the benign and malignant focal lesions, the malignant lesions showed statistically significant lower means as compared to the benign lesions (malignant = 1.08 ± 0.28 x 10-3 mm2/s, benign =2.0 ± 0 x 10-3 mm2/s, P < 0.0001). ROC curve analysis of the ADC values of the benign and malignant focal lesions was highly significant (P < 0.0001), with an area under curve of 0.9745 (97.45% overall accuracy), giving an ADC cut-off value of (< 0.98 x 10-3 mm2/s) for malignant lesions with 97.2% sensitivity (95% CI = 85.83% - 99.86%), 97.2% specificity (95% CI = 85.83% - 99.86%) and a likelihood ratio of 35.

Summary and conclusion

DWI MRI and the calculation of the ADC are great non invasive possible tools to detect and characterize hepatic focal lesions as well as to differentiate benign from malignant lesions in cirrhotic patients especially in patients with renal impairment and allergy to contrast media also to avoid unnecessary biopsies.
The Updated Role of Ultrasound in the Assessment of Knee Osteoarthritis
Authors: Alaam Khalid Esmat , Rahman Hazem Ibrahim Abd El , Ahmed Nouran Saieed
Published: October 2021

Background

Osteoarthritis (OA) of the knee is the most common form of knee arthritis and a leading cause of chronic disability.

Objective

The aim of the current study is to reassess the utility of the updated ultrasound in the patients with knee osteoarthritis and outline its clinical application.

Patients and Methods

The studied group included 36 patient 23females and 13 males with their ages ranged between 39 and 58 years (average age 44 years). The patients were referred to US examination fulfilling the ACR clinical criteria for knee OA after orthopedic and /or rheumatologist consultation. The study was performed in Radiodiagnosis department Ain Shams University Hospitals (20 patients ) and at one private center (16 patients).

Results

There was a discrepancy between the results obtained by clinical examination and those demonstrated by ultrasonography. Clinical examination detected 22 (61.1%) of our cases. Prevalence of US findings in our cases were femoral articular degeneration in 28 (77.7%) patients, Tibiofemoral osteophytes were seen in 26 patients (72.2%), knee effusion in 22 patients (61.1%),meniscal extrusion in 22 patients (61.1%) meniscal degeneration in 17 patients (47.2%) and synovial hypertrophy in 15patients (41.6%). Baker’s cysts were demonstrated in 14patients (38.8%) while pes anserine syndrome was demonstrated in 4 cases. Meniscal degeneration and meniscal extrusion were correlated significantly with femoral cartilage degeneration (P<.001). Although knee effusion did not correlate with advanced knee effusion did significantly (P > 0.05). Baker's cysts is statistically related to the presence and severity of mensical changes and also related to the degree of femoral articular cartilage degeneration.

Conclusion

US is a valuable technique that can assess soft tissue structures within the knee and their involvement in the osteoarthritic process .US enables in guiding and monitoring therapy through detection of knee structural damage.
Utility of PET/CT for therapy response assessment in non-Hodgkin's lymphoma
Authors: Abdel-Aziz Sally Mahmoud Abdel-Aziz , BadrElden Safaa Kamal Mohamed , Salama Asmaa Magdy Mohamed
Published: October 2021

Aim of the study

to evaluate the role of PET/CT in initial diagnosis and staging of lymphoma, and to determine the predictive value of 18F-FDG PET by monitoring the early response and final response after completion of chemotherapy in patients with non-Hodgkin's lymphoma.

Patient and Methods

our prospective study included 25 patients with pathologically confirmed nonHodgkin Lymphoma diffuse large B cell lymphoma selected from Department of Radiology at Ain Shams University Hospital from January 2019 to March 2020. The patients included in this study performed the followings: Initial PET/CT for staging, interim PET/CT and end of the treatment PET/CT. We performed low dose non enhanced CT scan first, then a whole body PET study followed by diagnostic enhanced whole body CT scan. The whole study took approximately 20-30 minutes.

Results

PET/CT has greater sensitivity 100% and specificity 68.8% than CT alone for detecting sites of nodal and extra-nodal involvement and for assessment of therapeutic response in non-Hodgkin lymphoma.

Conclusion

PET / CT is an accurate method for evaluating tumor viability in the post-therapy setting of Non-Hodgkin lymphomas. PET / CT has a significant advantage for the diagnosis of diffusely infiltrating organs without mass lesions or contrast enhancement compared to contrast enhanced CT.
Current Applications of Susceptibility Weighted Images in Pediatric Neurological Diseases
Authors: Abdelwahab Sarah Mohamed Mahmoud , Abdelazem Yasser , Khater Nivan Hany
Published: October 2021

Background

SWI provides information and helps in the differential diagnosis of different pediatric neurological diseases as it accentuates the paramagnetic properties of intravascular hemoglobin in the brain, and is sensitive for other extravascular blood products such as de-oxy-hemoglobin, hemosiderin, calcifications and air.

Objectives

The purpose of this article is to present and discuss the susceptibility weighted imaging signal characteristics of the normal pediatric brain and those of a variety of pediatric brain pathologic abnormalities. We aimed to evaluate the influence of the SWI signal pattern in current pediatric neurological diseases we will make a comprehensive review and discuss the utility of SWI in pediatric neuroimaging in establishing the diagnosis, differential diagnosis, and also understanding the pathomechanism of various paediatric brain pathologies

Materials and Methods

This study was held in MRI imaging unit of radiology department of Ain Shams university hospital and included 34 patients pediatric age group with different neurological diseases focusing on stroke, haemorrhage, tumour, calcifications and vascular malformation.

Results

We included 34 pediatric patients with different neurological diseases that commonly seen in our department and in which 26 (76.5 % )of them gained more detailed information from SWI sequence than conventional sequences, we found that SWI shows better sensitivity 100 % compared to conventional sequences that were 79.4 % in other means SWI was clinically and statistically significant .

Conclusion

Its high susceptibility for blood products, iron depositions, and calcifications makes susceptibility-weighted imaging an important additional sequence for the diagnostic workup of pediatric brain pathologic abnormalities that should be routinely added in our department. Compared with conventional MRI sequences, susceptibility-weighted imaging may show lesions with better detail and higher sensitivity. Familiarity with the pediatric susceptibility-weighted imaging signal variance is essential to prevent misdiagnosis.
Role of contrast enhanced mammography in diagnosis of malignant breast lesion with histopathological correlation
Authors: Mohamed Shaimaa Khalil Abd El-Maged , Shebreya Naglaa Hussien , El-mahdy Manal Mohamed , Elmaati Amal Amin Abo , Nasr Merehan Ahmed
Published: October 2021

Background

Contrast-enhanced spectral mammography (CESM) is a relatively new tool in breast imaging, which combines the benefits of full field digital mammography (FFDM) with intravenous contrast utilization. FFDM alone is a two-dimensional modality in which summation of overlapping tissues accounts for false-negative and false-positive findings, resulting in increased recall rates and limited sensitivity of the examination, especially in the setting of heterogeneously dense or extremely dense breast tissue. CESM advantageously uses the concept of angiogenesis in tumors by allowing contrast agents to highlight the areas of blood vessel proliferation relative to the surrounding normal breast tissue (Bhimani et al, 2017).

Objectives

The purpose of this study is to assess the role of contrast-enhanced (CEM) mammography for detecting malignant lesions compared to histopathological results.

Methods

A cross sectional study including 35 patients suspecting breast mass clinically, concluded at Ain Shams University hospitals, Radiology Department, in the outpatient breast clinic, the patients were investigated using SenoBright spectral mammography device, the period between January 2018 till the end of b June 2019.

Results

In our study CESM had a sensitivity of 95.7 %, a specificity of 66.7 %, a positive predictive value of 84.6% (PPV), a negative predictive value of 88.9 % (NPV) and efficacy 85.7 %.

Conclusions

CESM has better diagnostic performance than the standard conventional imaging; mammography plus ultrasound and provides a valuable tool to evaluate equivocal and suspicious breast lesions and detect multifocal/multicenteric disease accurately.
The role of magnetic resonance imaging in the assessment of acromial morphology in association with rotator cuff tear
Authors: Abdelghany Ahmed Fathy , Osman Ahmed Mohamed , Hussein Taha Kamal
Published: October 2021

Background: The pathogenesis of rotator cuff tear (RCT) remains controversial. The acromion portion ofthe scapula and its morphology may be attributable for a variety of shoulder disorders such as RCT.

Patients and Methods: This was a retrospective study that included 40 patients divided into two groups; a group with RCT included 20 patients and a control group with no RCT included the other 20 patients. 19 were males and 21 females, their age 20-69 years old with a mean age of 45. Cases were selected from the PACS system of the Radiology department of Ain Shams University Hospital. Statistical data analysis was done using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp)

Results: The study revealed that Type Il acromion was encountered in most of the male patients (42.1%) and type Ill acromion was encountered in most of the female patients (42.9%) while type IV acromion was less frequently seen among males and females (5% & 0%) respectively. It also revealed that Type Ill is mostly encountered in RCT (50%); 58% of full-thickness tear and 37% of partial thickness tear. while type I is less frequently associated with a partial tear or full thickness tear (8%) for each.

Acromion type Ill was the commonest type of acromion found between the patients of the case group with a significant statistical difference found between the case and control groups

(P value: 0.006). However, type I acromion was the commonest acromion type found between the control group with also a significant statistical difference (P value: 0.011).

Conclusion: Type Ill acromion may be a risk factor leading to rotator cuff tear. This may help guide therapy in patients with shoulder pain and findings suggesting type Ill acromion shape

Keywords

acromion shapes, magnetic resonance imaging, rotator cuff tear
Visual Outcome Predictors After Surgical Excision Of Meningiomas Compressing The Optochiasmatic Complex
Authors: Ali Ali Kotb , Alsayed Ahmad , Hamdy Tarek , Abdulrahman Mohammed , Galaleldeen Mahmoud
Published: October 2021

Background

Meningioma arising from locations in the vicinity of optic nerve or chiasm may affect the visual function which sometimes the presentation of such tumors. Decompression of the optic nerve or chiasm can give a chance to the visual function to recover.

Methods

30 patients who had visual function affection and underwent meningioma excision are followed up for a period of one year with regular follow of their visual function periodically.

Results

In this study, females were more prevalent than males, 24 out of 30, age ranged from 24 to 72 years at the time of surgery, half the patients (15) presented with visual deterioration, the other patients presented with headache, seizure, proptosis or accidentally discovered. 22 patients improved concerning their visual function over time, 6 patients had stationary course and 2 patients deteriorated postoperatively.

Conclusion

Follow up of patients after surgical excision of meningioma compressing the anterior optic pathway showed gradual improvement in vision in follow up period up to one year, although the improvement in visual function showed a surge in early postoperative period, with continuous less steep improvement afterwards till the end of the observation period. Surgical excision of meningiomas compressing the anterior visual pathway give chance for recovery of visual function, more in younger patients, patients with shorter period of visual deterioration, patients with mild affection of the preoperative visual status. No statistically significant influence of tumor site, size, degree of excision and surgical approach on the postoperative visual outcome in this series.
Efficacy of Endoscopic Surgery Management of Craniopharyngiomas in Terms of Tumor Control and Postoperative Morbidity
Authors: El bahy KhaledM , Kabil Mohammed S , Elgayar Abdelrahman H , Beniamen Shady K
Published: October 2021

Background

Craniopharyngiomas represent a surgical challenge with resection via either a transcranial or a transnasal approach using microscopy or endoscopy. The selection criteria of the classic transsphenoidal route for the management of craniopharyngiomas were postulated >30 years ago and still are valid today.

Aim of the Work

to systematically review the literature published discussing the endoscopic management of craniopharyngioma as regard tumor control, symptomatic relief and post-operative morbidity.

Materials and Methods

This systematic review and meta-analysis was performed in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) statements. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists.

Results and Conclusion

The extended EEA for suprasellarcraniopharyngiomas avoids brain retraction, permits early exposure of the lesion, provides good visualization of the pituitary gland and stalk and the main vascular structures, and minimizes manipulation of the optic apparatus. The endoscopic technique, both standard and extended approaches, can be considered as a possible surgical treatment for craniopharyngiomas in the modern neurosurgical techniques.
Quantitative assessment of macular and peripapillary microvasculature using optical coherence tomography angiography in glaucomatous versus healthy eyes
Authors: Sanad Amr M , Mahgoub Mohamed M , Ebeid Weam M , Mahmoud Rabab A
Published: October 2021

Background

Glaucoma is the leading cause of irreversible blindness worldwide. With the growing burden of glaucoma, we looked for better tools for early diagnosis and monitoring.

Aim of the Work

using optical coherence tomography angiography (OCTA) vessel density (VD) to document, quantify and compare microvasculature changes in macula and peripapillary region between healthy and moderate to severe primary open angle glaucoma eyes.

Patients and Methods

A comparative interventional prospective study was conducted on 28 eyes of 14 subjects, recruited from Ain Shams University hospitals outpatient clinic, and were subjected to imaging procedure during the period from January 2020 to May 2020. Subjects were divided into two groups: Group 1 of 14 eyes of 9 patients with moderate to severe primary open angle glaucoma (POAG), and group 2 of 14 eyes of 7 healthy sex and age-matched controls.

Results

a statistically significant decrease was found in VD in the peripapillary region (P < 0.001) and superficial macular regions in glaucoma subjects (P < 0.001).

Conclusion

OCTA proved a quantitative decrease in both peripapillary and macular vessel density as a parameter of microvascular changes associated with moderate to severe POAG. These results reflect damage to tissues relevant to the pathophysiology of POAG demonstrating OCTA importance with respect to diagnosing glaucoma and understanding the pathophysiology of this disease and, guiding future studies to evaluate more potential uses of this technology in the actual assessment of patients with glaucoma.
Optical Coherence Tomography Angiography Features In Diabetic Patients With Unexplained Visual Loss
Authors: Ibrahiem Enas Ibrahiem Abdallah , Ebeid Weam Mohamed Ahmed , Abozeid Noureldin Hussein , Salman Abd AL Rahman Gaber
Published: October 2021

Background

Diabetic macular ischemia (DMI) has a conflicting impact on visual loss in diabetics. OCTA used as a new non-invasive technique allows for identification of several anatomical and vascular abnormalities of diabetic maculopathy.

Aim

This study aimed to detect quantitative and qualitative OCTA data of Foveal area in diabetic patients with unexplained visual loss.

Methods and Material

This cross-sectional study enrolled fifteen diabetic patients with unexplained visual loss. They underwent comprehensive ophthalmological assessment, Measurement Best-Corrected Visual acuity (BCVA) using a Snellen chart converted to LogMAR for statistical analysis. And OCTA imaging of the foveal area using AngioVue OCTA. Quantitative data analysed was Foveal Avascular Zone (FAZ) area.

Statistical analysis used

Descriptive statistics and Pearson correlation were performed.

Results

A positive significant correlation was noted between LogMAR BCVA and FAZ area (p = 0.004). DMI grade showed significant positive correlation with LogMAR BCVA (p = 0.011).

Conclusions

The current study demonstrated the significant correlation between FAZ area measured by AngioVue OCTA and BCVA in diabetic patients with unexplained visual loss. In addition, we elucidated Diabetic Macular Ischemia (DMI) as a leading reason for visual loss in diabetic patients by itself.
Subthreshold micropulse yellow (577nm) laser versus intravitreal Ranibizumab in treatment of center involving diabetic macular oedema
Authors: Diab Esraa Abdelhakeem , Mahmoud Alaa Fathy , Zaki Mohamed Abd el-hakim , Mohmaed Ahmed Abdel-aleem , Abdel-aziz Mohamed Hanafy
Published: October 2021

Purpose

To evaluate the effectiveness of subthreshold micropulse laser as compared to intravitreal injection of ranibizumab in treatment of center involving diabetic macular oedema.

Methods

A total of 76 eyes of 62 patients with center involving diabetic macular oedema were divided into two groups. Group A received intravitreal injection of ranibizumab while group B received subthreshold micropulse laser with rescue intravitreal injection of ranibizumab. The change from baseline in best correscted visual acuity and central subfield thickness were compared at 3, 6, 9 and 12 months follow-up. Any adverse effects were recorded.

Results

Group A (n = 34 eyes) experienced a statistically significant improvement in best corrected visual acuity (from 0.32±0.16 Log MAR at baseline to 0.21±0.14 Log MAR at 12 months) (P value =0.006), with a statistically significant reduction in central subfield ghickness (from 352.06±34.34µm to 289.47±58.88 µm) (P value=0.001). Group B (n = 42 eyes), also experienced a statistically significant improvement in best corrected visual acuity (from 0.34±0.22 Log MAR at baseline to 0.13±0.31 Log MAR at 12 months) (P value=0.001), with a statistically significant reduction in central subfield thickness (from 300±47.34µm to 253.12±39.60 µm at 12 months) (P value= 0.009). The mean difference in best corrected visual acuity between the group B and group A was -0.08 Log MAR with a 95% CI ranging from -0.197 to 0.037, which supports the claim of non-inferiority between the two treatment regimens. No adverse effects from subthreshold micropulse laser were recorded in both groups.

Conclusion

subthreshold micropulse laser with rescue intravitreal injection of ranibizumab was non inferior to intravitreal injection of ranibizumab in treatment of center involving diabetic macular oedema as regards the mean change in best corrected visual acuity.
Assessment of the Ocular Effects in Cardiac Catheterization Unit’s Medical Personnel Exposed to Ionizing Radiation
Authors: Abdelatty Azab Mariam Ramadan Ramadan , Mohamed Thanaa Helmy , Ebeid Weam Mohamed , Alaarag Noha Abdelsadek , Zaky Amr Mansour Mohamed , Saleh Waleed
Published: October 2021

Background

Gamma rays, x-rays, and high ultraviolet are classified as ionizing radiation as their photons have enough energy to ionize atoms, causing chemical reactions. People can be exposed to ionizing radiation under different circumstances, at home, in public places (public exposures), at their workplaces (occupational exposures), or in a medical setting (as are patients, caregivers, and volunteers). Radiation damage to tissue or organs depends on the dose of radiation received, or the absorbed dose which is expressed in a unit called the gray (Gy). The potential damage from an absorbed dose depends on the type of radiation and the sensitivity of different tissues and organs.

Objective

To investigate the long-term influence of the ionizing radiation on the human lens.

Patients and Methods

Type of Study: Cross-Sectional Study. Study Setting: Ain Shams University hospital, Ophthalmology Department. Study Period: 6 months. Results: A significant difference was found between groups regarding the presence of cataract.as 50% of exposed group had cataract compared to 26.9% of non-exposed group (P = 0.043). There was a significant positive correlation between exposure duration and cataract grade as it was longer in cases with cataract.

Conclusion

A significant difference was found between groups regarding the presence of cataract. As there is a risk that other ocular pathologies are related to occupational radiation exposure, further investigative studies are required to define these. It can be strongly recommended that all personnel exposed to occupational radiation have routine eye examinations.
Validation and Repeatability of Inferior minus Superior Value and its Cut-off Value in Anterior Sagittal Curvature Map Using Pentacam in Early Keratoconus
Authors: Yousef Mohammed El Sharkawy Mohammed , Elkitkat Rania Serag , Roshdy Maged Maher Salib , Eltagoury Khaled Abdel Wahab
Published: October 2021

Background

: Keratoconus (KC) is a bilateral asymmetric localised inferior and central corneal thinning and ectasia. Usually, it causes high myopia and irregular astigmatism resulting in a poor quality of vision. One of the most important ways of avoiding iatrogenic ectasia in cornea during refractive surgery is to detect KC in its earliest stage using the Pentacam. An important asymmetry decentration index is the inferior minus superior (IS) value.

Purpose

: Detection of Inferior minus Superior (IS) value and its Cut-off Value

Methods

: This is a cross-sectional, case control study that included 92 right eyes of 92 subjects, who presented to the outpatient clinic of “Al Watany Eye Hospitals” seeking refractive surgery or routine medical consultations. Our study focused on the measurement of the IS-value in early KC (TKC grade 1 and FFKC) and normal eyes. The right eye of each candidate was scanned 5 times in the same setting using the Pentacam. The study adhered to the tenets of the Declaration of Helsinki, and an approval was obtained from the ethical committee of Ain Shams University Hospitals.

Results

: We detected remarkably high statistically significant difference between patients and controls regarding the IS-value (p < 0.001). The mean (±SD) of control and cases group was 0.3 ± 0.2 and 1.4 ± 0.6, respectively. The cut-off point of 0.69 with high area under the receiver operating characteristic (AUROC). Coefficient of variation median (95% CI) for cases and controls were 1.4% (0.9 to 3.1%) and 6.2% (3 to 9.4%), respectively.

Conclusion

: The IS-value has a high repeatability and AUROC for differentiating early KC from normal corneas. It can be regarded as an accurate parameter for early KC detection.
The Relation between Vitamin D Levels and Cardiovascular Comorbidities in Obese Children
Authors: Elsedfy Heba Hassan , Amr Nermine Hussein , Mostafa Shereen Mohamed , Emam Abeer Mohamed
Published: October 2021

Background

Childhood obesity is accompanied by increased cardiovascular co morbidities and vitamin D deficiency. However, the relation between vitamin D deficiency and cardiovascular comorbidities remains uncertain.

Objectives

We aim to determine if there is an association between vitamin D deficiency and cardiovascular risks in obese children.

Patients and Methods

A case control study was conducted on 63 prepubertal patients with simple obesity recruited from the pediatric obesity clinic, Ain Shams University. They were divided into 2 groups: 33 cases with deficient 25(OH) D (< 20ng/ml) and 30 with sufficient 25(OH) D (≥ 20ng/ml). Both groups were subjected to full history taking, general examination including blood pressure, anthropometric measurements and laboratory evaluation including lipid profile, thyroid profile and glucose homeostasis parameters.

Results

There was a positive correlation between 25(OH) D and HDL cholesterol (r = 0.407, p = 0.026). Obese children with deficient 25(OH) D had significantly higher diastolic blood pressure percentiles (86.20 ±9.20 in deficient vs 78.44±15.50 in sufficient, p = 0.018).

Conclusion

A possible relationship exists between obesity related comorbidities and vitamin D status. Further studies should focus on the effect of vitamin D deficiency on obesity related comorbidities.
Effect of very early use of caffeine citrate in preterm neonates needing respiratory support
Authors: Awad Hisham A , Tawfik ameh A , Ibrahim Mariam JA , Hesham Bassem
Published: October 2021

Background

Caffeine citrate is one of the most widely used medications in neonatal intensive care units. It is a respiratory stimulant which has well established therapeutic effects in apnea and extubation. Little is known about the very early use of caffeine citrate in preterm neonates. We aim to explore the effectiveness of its very early use in reducing the duration of the respiratory support used and not just extubation.

Objectives

to study the effect of the very early use of caffeine citrate in preterm neonates on morbidity and short-term neonatal outcomes.

Subjects and Methods

A prospective phase 3 clinical trial was carried out on 54 preterm neonates less than 34 weeks of gestation who require respiratory support and were given caffeine citrate in two different settings, over a period of one year. Patients were randomly allocated to one of two groups, the first group was given caffeine citrate at initiation of respiratory support(CPAP, NIPPV and IPPV). The second group received caffeine citrate 6 hours before weaning of the respiratory support used. Caffeine citrate was stopped after complete removal of the respiratory support used. Both groups were compared as regard the duration of each respiratory support used separately and the total duration of respiratory support needed for each patient.

Results

The duration of IPPV used in patients was significantly lower in the patients that received early caffeine citrate. Total duration of the respiratory support needed for each patient was significantly lower in the early group. There was no significant difference in the development of complications related to the drug use between both groups. The total duration of NICU stay was significantly lower in the early group than the other group.

Conclusion

The Early initiation of caffeine citrate has effectively and safely decreased duration of respiratory support used and NICU stay without the development of any complications.

Key words

early caffeine citrate, preterm neonates, respiratory support.

*CPAP: Continuous positive airway pressure

NIPPV: Non invasive positive pressure ventilation

IPPV: Intermittent positive pressure ventilation

NICU: Neonatal Intensive care unit
Assessment of Mother-to-Child transmission of Hepatitis C Virus in Egyptian Pregnant Women
Authors: El-Sayed Manal Hamdy , Ebeid Fatma Soliman Elsayed , El-Din Aya Mostafa Kamal , Mostafa Rania Hassan , El-Monem Mohammed Belal Khaled Abd
Published: October 2021

Background

The World Health Organization (WHO) has an ambitious plan to eliminate HCV by 2030. This new approach was fueled by increased appreciation of the global morbidity and mortality caused by hepatitis C, and the remarkable recent treatment developments.

Objectives

To assess the mother-to-child transmission of hepatitis C virus in Egyptian pregnant women to inform on screening policies and strategy development. To measure prevelance of hepatitis C virus infection in pregnant women

Methods

The current study was conducted to six thousand and seven hundred and thirty four (6734) women delivered in El Demerdash Maternity Hospital in the period from January 2018 till June 2018. Collection of detailed data from Patients files and divided them into non screened and screened by antibodies and who do PCR for HCV and data of their neonatal outcome

Results

Comparison according to HCV PCR regarding labor characteristics show that cases with positive HCV PCR significantly had more frequent CS. Logistic regression for risk factors for HCV PCR among the studied cases show that only Previous hospitalization and previous transfusion were significant risk factors for positive HCV PCR.

Conclusion

Previous hospitalization and previous transfusion were significant risk factors for positive HCV PCR. Pregnants with positive HCV PCR significantly had more lower hemoglobin than non-infected pregnant one and previous abortion and hospitalization may play a role in that.
Clinico-radiological Profile in Children with Drug Resistant Focal Epilepsy
Authors: Younis Neveen Tawakol , Mohammed Shaymaa Abdel Sattar , Zaitoun Raghda Mohamed Hesham , Shokdef Mohammed Atia Abdel Hafez
Published: October 2021

Objective

To assess the clinical and neuroimaging findings of pediatric patients with drug-resistant focal epilepsy, comparing conventional MR technique to the "essential 6” protocol.

Methods

An observational study of 18 children with drug resistant focal seizures identified both clinically and/or by EEG findings. Available clinical data as well as EEG and MRI data in patients’ files at the pediatric neurology clinic at Ain Shams University was retrospectively evaluated and documented. All patients then underwent a new MRI study using a novel MR technique - the essential six sequence protocol to determine whether the latter technique was superior to standard at picking subtle anatomical abnormalities in children with drug resistant focal epilepsy.

Results

18 children (10 males and 8 females) with a mean age of 8.49 ±3.20 years were enrolled. The mean age at onset of epilepsy was 3.24 ±2.79 years. 15 out of 18 patients (83%) had an abnormal EEG. The mean Chalfont Seizure Severity Scale Score was 63.71 ±34.35. There was no statistically significant difference in Chalfont seizure severity scores between patients with normal vs abnormal EEG, and with normal vs abnormal MRI. The novel MRI technique could pick on an abnormality in 12 out of the 18 cases (66%), which is six times more than what could be identified using the baseline/conventional MRI technique.

Conclusions

The essential 6 MRI protocol is superior to conventional MRI protocols at picking structural abnormalities in patients with drug resistant focal epilepsy.
Assessment of the current practice of asthma exacerbation management in different health settings in Egypt
Authors: Salama Ashraf A , EL-Hatab Amira F , Wahdan Maha M , ElAnsary Manar M
Published: October 2021

Background

Asthma accounts for about one in every 250 deaths worldwide. Many of the deaths are preventable, being due to suboptimal long-term medical care and delay in obtaining help during acute exacerbation.

Aim

to assess knowledge, attitude and practice of Egyptian physicians about childhood asthma exacerbation treatment guidelines and to identify the barriers against application of guidelines in different hospital settings in Egypt.

Methods

a written questionnaire with different topics were added aiming at assessment of four important aspects about the involved physicians; physician's knowledge, practice, attitude and barriers against application of guidelines. This questionnaire was fulfilled by 200 pediatricians, all of them deal with childhood asthmatics. As regards Academic degrees, 94 (47.7%) had the Bachelor degree, 70 (35.5%) had Master degree, 23 had Diploma degree (11.7%), and 10 (5.1%) had Doctorate. As regards Hospital settings, 102 (51.8%) of the pediatricians were working in governmental hospitals, 76 (%38.6) of them were working in University hospitals, 13(6.6%) pediatricians worked in private hospitals and 6 (3%) pediatricians worked in other types of hospitals.

Results

low level of knowledge was found in 80.2% of participants, non adherence to guidelines was found in 59.4 % and negative attitude towards guidelines was found in 65.3% of them.

Conclusion

Most of the studied physicians have low level of knowledge, non adherence to guidelines and negative attitude towards guidelines. The main barriers against guideline application were the external barriers followed by patient related barriers then personal barriers. Guideline related barriers were in the last rank. So, Continuous training of physicians, increasing people’s awareness and improving facilities in hospitals are required to get better adherence to guidelines
Correlation between Non-invasive Measurement of Carboxyhemoglobin and Bilirubin Level Measurement in Near- Term and Term Neonates as a Predictor of Neonatal Hemolysis
Authors: Awad Hisham A , Shehata Basma M , Fouad Marina A
Published: October 2021

Background

Neonatal hyperbilirubinemia is common in the neonatal period. Yet, serious pathological hyperbilirubinemia may cause kernicterus with detrimental neurologic sequalae. Carbon monoxide (CO) is the byproduct of the breakdown of heme, it is transported as carboxyhemoglobin to the lungs to be exhaled. Thus, carboxyhemoglobin levels increase as a result of hemolysis, and is therefore considered a sensitive index for the degree and severity of the subsequent hyperbilirubinemia.

Objectives

To correlate between non-invasive carboxyhemoglobin levels and bilirubin levels in near-term and tem neonates starting hour I of life.

Subjects and methods

A total of 100 near-term and term neonates were studied, by measuring carboxyhemoglobin by a Pulse CO-oximetry and serum bilirubin level (hour l) and transcutaneous bilirubin (TcB) hourly since birth for the I st 6 hours then every 6 hours till the time of discharge in a cross sectional case-control study.

Results

A cut off value of 4 for non-invasive carboxyhemoglobin with sensitivity of 81.25%, specificity of 95.24% was found to the earliest non-invasive predictor for subsequent jaundice. In patients with proven hemolysis, carboxyhemoglobin when compared to TcB was found to increase significantly in the first 3 hours of life more than TcB, stalting hour 4 till time of discharge it was increased yet statistically insignificant

Conclusion

We found that non-invasive carboxyhemoglobin is an effective early predictor for subsequent jaundice starting first hour of life. It can be used as a screening tool for hemolytic jaundice especially in hospitals with early discharge policy.
Anaphylaxis in Children: Experience of an Egyptian Center
Authors: Ezzat Mohamed Hesham Mohamed , Shousha Ghada Abdel Haleem , Gabal HebatAllah Mohammed Salah , Mousa Mousa Mohamed Hani
Published: October 2021

Introduction

Anaphylaxis is a potentially life threatening allergic reaction that is rapid in onset and multisystemic in nature. Distribution of anaphylaxis tends to fluctuate based on age, gender, race, geographical residence and socioeconomic status of the involved subjects. Diagnosis of anaphylaxis in children is generally underestimated particularly in developing countries, and when diagnosed, proper management is occasionally lacking.

Aim of the study

to evaluate the frequency and pattern of anaphylaxis and mistakes in diagnosis and treatment among a group of Egyptian children and adolescents.

Subjects and methods

This observational study was conducted over 12 months duration, from 1st of March 2019 to the end of February 2020, in Children’s hospital, Ain Shams University, Cairo, Egypt, on children presenting to emergency department (ED). Anaphylaxis frequency, clinical presentation, triggers, diagnosis, management and long term follow up were assessed.

Results

frequency rate of anaphylaxis among children and adolescents was 0.43% (80/18816) over a year. Sixty percent of patients were infants. Biphasic reactions were reported in 11.3% of patients. The commonest trigger was food (22.5%) followed by medications (8.8%). Appropriate diagnosis of anaphylaxis by junior pediatricians was reported in all patients, with epinephrine given in most occasions in proper dosage and method (78.7%). Education of children and their caregivers, providing written plan, ready-to-use epinephrine and follow up appointment were deficient.

In conclusion

Anaphylaxis in children was relatively high particularly in infants, with food being the most common trigger. Diagnosis and early management of anaphylaxis in our University hospital was satisfactory, however, long term management and follow up were defective.
Role of Lung Ultrasound in the Diagnosis of Neonatal Respiratory Disorders
Authors: El Raggal Nehal M , Hegazy laila A , Sakr Hossam M , Farid Yasmin A , Eldafrawy Osama A , Ismail Rania I
Published: October 2021

lung ultrasound (LUS) was used traditionally in the assessment of pleural effusions and masses but LUS has moved towards the imaging of the pulmonary parenchyma, mainly as a point-of-care technique.

Objective

To assess the agreement between LUS and CXR for the diagnosis of RD in neonates.

Methods

This prospective cross sectional study was conducted on 100 neonates presents with RD in the first 24 hours of life in the neonatal intensive care unit (NICU) of the Ain Shams University. All enrolled neonates underwent LUS and CXR initially and on day 7. Neonatologists were blind to the LUS diagnosis and the clinical decisions were driven by CXR findings. Lung score was applied to describe lung aeration, interstitial, alveolar, or consolidation patterns for each lung area.

Results

125 different diagnoses were reported in 100 patients. The total agreement between LUS and CXR diagnosis was 96% (95% CI 88–98%) with a κ statistic of 0.94 (95% CI 0.86– 1.00). The agreement for RDS, Pneumonia, TTN, MAS, CDH, PE, Pnumothorax and atelectasis were 99%, 96%,98%, 99%,100%,100%,98% and 98% consequently.

Conclusion

LUS is a safe, low coast, easy to operate and has high agreement with CXR for the diagnosis of RD in neonates in the first week of life.

Key words

Neonatal intensive care, Point-of-care ultrasound, Chest X-ray

Abbreviations: NICU: Neonatal Intensive Care Unit, LUS: Lung ultrasound, CXR: Chest X ray, RDS: respiratory distress syndrome, TTN: Transient Tachypnea of Newborn, MAS: Meconium Aspiration, PE: pleural effusion, CDH: cong. diaphragmatic hernia.
Phototherapy effect on CD4 lymphocytes of Full Term Neonates with Jaundice
Authors: El Farrash Rania Ali , Shinkar Dina Mohammed , El Dine Salem Dalia Ahmed Diaa , El Azazy Reem Khalid Said
Published: October 2021

Background

Neonatal jaundice is one of the most common problems that affect newborn infants, and phototherapy is usually used for treatment. Phototherapy is generally considered a very safe and well-tolerated treatment for hyperbilirubinaemia. However, clinical users should be aware of the unwanted effects of using phototherapy. Affection of neonatal immune system due to phototherapy has been reported.

Objectives

Evaluation of the effect of phototherapy on neonatal immune system through measuring the level of CD4+ lymphocytes.

Methods

A prospective cohort study was conducted on full term newborns assigned to three groups: group1 neonates with hyperbilirubinemia treated by conventional phototherapy, group2 neonates treated by LED phototherapy and healthy neonates as control group. The percentages and absolute counts ofCD4+ lymphocytes were measured by flow cytometry before phototherapy and 48 h after exposure.

Results

The study showed a significant decrease in CD4+ percentage in patients after 48 h of exposure to conventional phototherapy (P value < 0.05). There was a significant decrease in CD4+ absolute counts after 48 h of exposure to both types of phototherapy.

Conclusion

Conventional and LED phototherapy which is used in the treatment of neonatal hyperbilirubinemia, caused a decrease in CD4+ absolute count 48 hours after phototherapy. Also conventional phototherapy caused a decrease in CD4+% 48 hours after exposure.
Effect of the loading dose of magnesium sulfate on the Doppler velocimetry parameters in the uterine, umbilical and fetal middle cerebral arteries in severe preeclampsia
Authors: ElKady Mohamed A , Rabie Noha H , Mostafa Mohammed H , Hafez Amany M
Published: October 2021

Background

Preeclampsia is pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation.

Aim of the Work

to assess the effect of injecting magnesium sulfate on Doppler parameters of uterine artery, umbilical and fetal middle cerebral arteries (MCA) in women with severe preeclampsia.

Patients and Methods

This study included eighty pregnant with severe preeclampsia or eclampsia who were given magnesium sulphate therapy in Ain Shams University Maternity hospital. The Study group included 80 pregnant patients Doppler flow velocity parameters (resistance index [RI], pulsatility index [PI] and systolic/diastolic [S/D] ratio) were evaluated in the uterine, fetal umbilical and middle cerebral arteries before and 20 minutes after intravenous administration of 6 grams of magnesium sulfate (Loading dose).

Results

Magnesium sulfate had significant hemodynamic effects with significant reduction of systolic and diastolic blood pressure. Regarding the Doppler studies, it was found that after administration of magnesium sulfate there was significant reduction in the Doppler velocimetry parameters (Resistance index[RI], Pulsatility index[PI] and systolic/diastolic[S/D] ratio) in the uterine, umbilical and fetal middle cerebral arteries denoting decreased vascular resistance with increased blood flow in these vessels.

Conclusion

Intravenous administration of magnesium sulfate in pregnant women with severe preeclampsia and eclampsia resulted in a decrease in uterine artery, fetal umbilical and middle cerebral arteries Doppler indices with reduced resistance to blood flow in these vessels.
A comparison of the efficacy and safety of repetitive hourly dose of oral misoprostol and two hourly dose oral regimens for cervical ripening and labor induction: A R.C.T
Authors: Mohamed Sabry S , Mohammed Hayam F , Essam El Din Mansour Ahmed M , Hagag Essam S
Published: October 2021

Background

Labor induction most frequently conducted through interventional procedures, and their use has been increasing in the past several decades. In a survey by the National Center for Health Statistics the rate of labor induction was noted to have increased from 9.5% in 1991 to 22.5% in 2006. This randomized controlled trial was conducted at Ain Shams University Maternity Hospital (pre-labour ward) in the period between January 2019 and January 2020.

Patients and Methods

This study was conducted on 150 pregnant women attending Ain Shams University Hospital outpatient clinic, they were classified according to the indication for labor induction into 2 groups, high risk group and low risk group.

Results

that there was no statistically significant difference between groups according to baseline characteristics, indication of induction and need for oxytocin. Regarding medications side effect and maternal outcomes, our results showed that there was statistically significant difference between groups according to pyrexia. Regarding mode of delivery, our results showed that there was no statistically significant difference between groups. Regarding no. of req. doses and duration of delivery, our results showed that there was statistically significant difference between groups according to no. of req. doses and duration of delivery (hrs) and total dose of misoprostol (µg), more in group I (hourly dose) than II (2 hours dose). Regarding fetal outcomes (Apgar score at 1 and 5 min, birth weight (kg), meconium staining, NICU admission), our results showed that there was no statistically significant difference between 2 groups.

Conclusion

The repetitive hourly dose of misoprostol solution (10 μg -10 mL- oral misoprostol administered hourly up to12 doses) has similar efficacy as oral misoprostol solution every 2 hours (20 μg -20 mL- administered every 2 hours up to 6 doses) but with more side effects.