bluuebunny/crossref_metadata_2025 huggingface dataset:
Thrombi in Acute Stroke Patients: Histopathological Analysis after Mechanical Thrombectomy
Authors: Salem Haitham Hamdy , Elbassiouny Ahmed Ali Ibrahim , Ali Riham Ahmed Ibrahim , Atiah Amr Saeed , Mohamed Sameh Medhat
Published: November 2024

Background

The introduction of stent retrievers has made the complete extraction and histological analysis of human thrombi possible, although many studies have evaluated the retrieved thrombus by mechanical thrombectomy to assess its impact on success of acute stroke treatment, the results remain controversial, in this study we attempt to assess the impact of thrombus composition on mechanical recanalization, clinical outcome and stroke etiology.

Objective

Study the histopathological composition of thrombi extracted from acute stroke patients through mechanical thrombectomy, and correlate the findings with the causes of stroke, the imaging findings as well as thrombectomy efficacy in terms of the number of recanalization maneuvers, retrieval resistance, and time to achieve successful reperfusion.

Patients and Methods

The study was carried out at Ain Shams University hospitals to Patients presented to emergency department with large vessel occlusion and were candidate for mechanical thrombectomy. Participants were selected as sample sizes of 26 according to those meeting the inclusion Criteria for participant: patients with acute ischemic stroke with evidence of middle cerebral artery occlusion or internal carotid artery occlusion confirmed via cerebral angiography, Age ≥ 18 years old, NIHSS ≥ 6, Aspect score ≥ 6, time from onset to groin puncture is Within 24 hours, Patients for whom cerebral thrombus could be retrieved and collected during mechanical thrombectomy for histopathological analysis, and Agreement for written informed consent for participation or their nearest relatives in this study).

Results

In our study, Erythrocyte-rich thrombi were present in 16 cases, while fibrin-rich thrombi were present in 5 cases. A cardioembolic etiology was significantly more prevalent among the patients with erythrocyte-rich thrombi than among those with fibrin/platelet and a P- value of < 0.001. Puncture to final reperfusion time was significantly highest in cases with RBC-rich with P-value of < 0.001, and Number of passes needed to achieve reperfusion was significantly highest in cases with RBC-rich with P-value 0.002.

Conclusion

The current study showed Erythrocyte-rich thrombi were associated with a reduced number of recanalization maneuvers, shorter arrival-to-recanalization time interval, and more favorable clinical outcomes. This study also suggests that the histological composition of retrieved thrombi is significantly different between stroke subtypes. Cardioembolic thrombi have a higher percentage of erythrocytes and fewer fibrin/platelet than do non cardioembolic thrombi.
Iron Metabolism in Adult Patients with Epilepsy
Authors: Ahmed Nahed Salah Eldin , Nada Maha Ali , Mohamed Noha Refaat , Abdel-Aty El-Seady Somaya Hani
Published: November 2024

Background

Epilepsy is a disease characterized by recurrent, episodic, and transient central nervous system (CNS) dysfunction resulting from an excessive synchronous discharge of brain neurons and both the morbidity and mortality are high.

Objective

To compare between epileptic and non- epileptic patients regarding iron levels.

Patients and Methods

This case control study (pilot study) was conducted at neurology outpatient clinic, Faculty of Medicine, Ain Shams University Hospitals from August 2022 until July 2023.

Results

Our study outcome, serum iron level (mcg/dL) 158.45 ± 60.67 vs. 07.90 ± 29.92, serum ferritin (ng/mL) 187.76 ± 71.70 vs. 113.86 ± 42.75 and transferrin (iron) saturation % 45.87 ± 15.69 vs. 31.18 ± 5.57 were statistically significant higher among epileptic cases compared with control group. On the other hand, total iron binding capacity (mcg/dL) was higher 353.75 ± 98.07 vs. 343.85 ± 55.40 among epileptic cases compared with control group but with no significant value. Of note, there is no statistically significant difference between male and female, patient's age and duration of epilepsy according to iron profile in epileptic group. Also, there is no statistically significant difference between focal and GTC according to iron profile in epileptic group.

Conclusion

Iron overload is related to epilepsy. Increasing evidence demonstrates that epilepsy is closely related to ferroptosis and iron metabolism. Currently, there are many ways to regulate ferroptosis, but the regulatory mechanism of ferroptosis in epilepsy has not yet been understood. Targeting iron metabolism and ferroptosis may be a novel method to slow the progression of epilepsy. This type of treatment is yet to be discovered and explored. Nonetheless, ferroptosis is a newly identified and critical mechanism of cell death, especially in CNS disease. Anti-ferroptosis mechanisms and ferroptosis inhibitors play an essential role in preventing epilepsy.
Radiological Characteristics among Egyptian Patients Suffering from Incidental Cerebral Small Vessel Disease
Authors: Abdelhamid Yasmine Hassan , Aref Hany , Zakieldine Hany , Shokri Hossam , Hamid Eman , Youssef Mena Elerian
Published: November 2024

Background

Cerebral small vessel disease (CSVD) causes significant disability at increasing age such as cognitive impairment, gait, and sphincteric problems affecting a person’s quality of life. That is why it’s essential to detect and manage early. The aim of this study is to investigate the radiological progression among Egyptian patients suffering from incidental cerebral small vessel disease.

Aim of the Work

To investigate radiological progression among a sample of Egyptian patients with incidental CSVD.

Methods

Ninety-eight patients with CSVD underwent an MRI brain at baseline and after 12 months.

Results

Regarding MRI lesions, Visual rating scales did not show any significance between baseline and follow-up.

Conclusion

More sophisticated tools are needed to assess radiological progression in CSVD.
Comparison between Different Surgical Options for the Management of Symptomatic Intracranial Arachnoid Cysts: A Systematic Review
Authors: Ismail Mohamed Awad Mohamed , Hamza Abou Elmaaty Emad Maamoun , Hesham Elgayar Abdelrahman Mohamed , Mohamed Ibrahim Hammad Ahmed Mohamed
Published: November 2024

Background

Arachnoid cysts are non-neoplastic, intracranial cerebrospinal fluid CSF-filled spaces lined with arachnoid membranes. Small arachnoid cysts are mostly asymptomatic and may warrant watchful waiting and serial imaging follow-up. However, large arachnoid cysts are often symptomatic because they compress surrounding structures causing increased intracranial tension, fits, behavioral changes or visual hallucinations according to its site/size, therefore, they must be treated surgically. As several surgical management options exist, the best approach should be chosen according to each type of arachnoid cyst. Ongoing research aims to enhance our understanding of the clinical characteristics of these lesions, refine diagnostic approaches, and optimize treatment strategies to improve outcomes and quality of life for affected individuals.

Objective

The objective of this study is to compare between different surgical approaches in treatment of symptomatic intracranial arachnoid cysts mainly microscopic fenestration, endoscopic fenestration & cystoperitoneal shunt in terms of short and long-term effectiveness and complications in different types of arachnoid cysts.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2023.

Data Extraction

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

Conclusion

Further prospective randomized controlled trials are recommended to evaluate the surgical options, using clear and explicit criteria for inclusion, objective outcome definitions and assessment, and ensuring a consistent long follow-up to minimize the uncertainty in some data such as long-term complications and incidence of permanent deficits.
Outcomes of Implementation of the CURE Protocol for Treating Pediatric Hydrocephalus: An Institutional Experience
Authors: Aglan Osama , Al-Abyad Ashraf G , Kotb Mohammed M , Abdel – Latif Assem M
Published: November 2024

Background

Paediatric hydrocephalus imposes a significant clinical and financial burden in developing countries, this study aims to assess the efficacy and safety of endoscopic third ventriculostomy (ETV), either alone or combined with choroid plexus cauterization (CPC), for preventing shunt dependence in paediatric hydrocephalus within a healthcare setting of a tertiary hospital in Egypt.

Patients and Methods

This prospective clinical case series included Patients ≤16 years old with clinical signs and/or symptoms of hydrocephalus requiring CSF diversion and accessibility for follow-up. Cases with active infection or brain imaging showing anatomical distortion or multiloculated hydrocephalus were excluded. Failed ETV+/-CPC cases were categorized into early and late failure groups, each with specific management strategies.

Results

Forty patients admitted to Ain Shams University Hospitals between March 2022 and August 2023. underwent ETV+/-CPC using a flexible neuroendoscope. Aqueductal stenosis was the most common etiology, observed in 13 patients (32.5%), followed by myelomeningocele in 11 patients (27.5%), and post-infectious causes in 6 patients (15.0%). The median age of the patients was 5.05 months. Twenty-five patients (62.5%) achieved successful outcomes following ETV/CPC procedures, with no procedure-related morbidity or mortality events observed. Fifteen patients (37.5%) experienced ETV failure, of whom 6 underwent ETV redo procedures. Twenty-eight patients (70%) remained shunt-free in the study cohort. The mean follow-up duration was 12 months.

Conclusion

ETV/CPC demonstrates effectiveness in decreasing the necessity for shunt placement across various patient demographics. Moreover, it supports a sustainable and cost-effective approach to hydrocephalus treatment.
Serum Progesterone Level on the Day of Embryo Transfer and Clinical Pregnancy Rate in Patients Undergoing Down-Regulated Frozen Embryo Transfer Cycles; Prospective Observational Study
Authors: El-Gamal Ahmed , Bayoumy Karam , Elsalamy Ayman , Abbas Mustafa
Published: November 2024

Background

Serum Progesterone concentration <5 ng/ml on the day of frozen embryo transfer (FET) is associated with significantly decreased pregnancy and live birth rates.

Aim of the Work

This study aims at finding the critical cutoff value of serum progesterone on day of FET that significantly affects pregnancy rates.

Patients and Methods

The current study was conducted at Ain Shams University Maternity Hospital- IVF Unit during the period between April 2022 and December 2022. It included a total number of 108 patients who either were assessed for eligibility of the study, of which, 14 were excluded due to non-matching inclusion criteria or had exclusion criteria. 4 patients did not consent to participate in the study and 86 patients matched. They were preaped for frozen emberyo transfer according to IVF unit protocol at Ain Shams university and serum progesterone level on day of emberyo transfer was assessed and matched to clinical pregnancy rate.

Results

Progesterone on day of embryo transfer was significantly lower in cases with positive chemical pregnancy with a cut off value ≤39.2 ng/mL.

Conclusion

Progesterone is essential for establishing and maintaining embryo implantation and pregnancy; also, P4 is used for luteal phase deficiency in infertility treatment. Yet, progesterone therapy’s optimal timing and dose can influence the impact of P4 on pregnancy. Also, low or elevated P4 level can negatively impact embryo transfer timing and pregnancy rate. This study demonstrated that age, BMI and progesterone on day of embryo transfer had significant low diagnostic performance in predicting positive chemical pregnancy This study illustrated that no statistical significant difference according to chemical pregnancy regarding hormonal profile Before the start of estradiol valerate. Progesterone on day of embryo transfer was significantly lower in cases with positive chemical pregnancy.
Enhanced Recovery after Elective Cesarean Delivery at Ain Shams University Maternity Hospital: A Randomized Controlled Trial
Authors: Nagib Easa Amira Farag , Ahmed Swidan Khaled Hassan , Gomaa Ali Ihab Adel , Eltaieb Ebtihal Mohamed Mahmoud
Published: November 2024

Background

Enhanced recovery after cesarean delivery (ERAC) is perioperative care program to fasten patients recovery. ERAC protocols intended to improve patient outcomes and fasten return to normal function before surgery by standardization of practice at all stages: preoperative, intraoperative and postoperative.

Aim of the Study

The aim of this study was to evaluate whether the implementation of enhanced recovery after cesarean (ERAC) would decrease the length of hospital stay and pain score and improve postoperative patient satisfaction and breastfeeding and its effect on postoperative complications and hospital readmission.

Patients and Methods

86 pregnant women undergoing uncomplicated elective cesarean delivery were enrolled in this study. patients were randomized to two groups: 43 patients in the Enhanced recovery after cesarean delivery (ERAC) group and 43 patients in the standard care group. Enhanced recovery after cesarean involved multiple evidence-based interventions and were divided into the three major phases of patient care: antepartum, intrapartum and postpartum. The primary outcome was the length of hospital stay after cesarean delivery. Secondary outcomes included pain medication requirements and pain scores, breastfeeding and first time of start breastfeeding, maternal satisfaction, postoperative complications and hospital readmission.

Results

Enhanced recovery after cesarean delivery was associated with a highly significantly shorter length of hospital stay when compared to standard care (p- value <0.001). There was a highly significant reduction in pain scores at 2h, 4h, 6h and 12h in the ERAC group in comparison to standard care group (p-value <0.001). There was no statistically significant difference between the two groups of studied participants regarding breastfeeding (p-value=0.5). However, there was statistically highly significant difference between the two groups of studied participants regarding the time of starting breastfeeding (p-value <0.001). The participants were more significantly satisfied in the ERAC group than in the standard group (p-value>0.001).

Conclusion

Implementation of enhanced recovery after elective cesarean delivery (ERAC) pathway lead to significantly shorter length of hospital stay, lower pain scores, better patient satisfaction and earlier start of breastfeeding.
Impact of Bariatric Surgery Induced Weight Loss on Women Fertility: A Prospective Cohort Study
Authors: Gamal Abdelnasser Ahmed , Mahmoud Mohamed Taha Ismail , Hassen Dalia Ali Mohamed , Fouly Mohamed Gamaleldin Lotfy , Nawara Mai Medhat
Published: November 2024

Background

Obesity is a multifactorial chronic disease. It is one of the world's most significant public health issues because its prevalence is steadily rising in Occidental countries and because it is a major risk factor for a variety of chronic diseases, including tumors.

Aim of the Work

The aim of the study is to evaluate the impact of bariatric surgery induced weight loss on women fertility.

Methods

This prospective cohort study was conducted at Ain Shams University Hospitals (ASUH) from June 2022 till December 2022 and performed on total 75 obese women who attended Ain Shams University Hospitals for bariatric surgery (sleeve gastrectomy).

Results

BMI among the studied cases significantly decreased in 3-months postoperatively. After 3-months post operative Excess Body Weight Lost was significant, with average more than quarter of the excess 29.9±6.6 %. AMH, LH and FSH/LH among the studied cases significantly decreased in month-3 postoperatively. FSH among the studied cases significantly increased in month-3 postoperatively. There were significant positive correlations between month-3 BMI and each of postoperative AMH and LH. There was significant negative correlation between month-3 BMI and postoperative FSH/LH.

Conclusion

As evident from the current study, Antimullarian hormone, LH decreased after Bariatric surgery in reproductive age women with increased FSH, and there is improvement in cycle regularity. Consequently, bariatric surgery could be effective in improving the menstruation and reproductive related hormones for severe obese individuals.
Trans-Vaginal Cervical Length and Amniotic Fluid Index in Prediction of Delivery Latency Following Preterm Pre-Labor Rupture of Membranes
Authors: Fetouh Mohamed Fatima Ossama , Sammor Hazem Mohamed , Eid Sweed Mohamed Samir , Abbas Ahmed Mohamed
Published: November 2024

Background

After premature pre-labor rupture of membranes (PPROM), it is challenging to forecast with precision the time to delivery (latency). Predicting delivery delay may be useful in determining when to recommend hospitalization, close observation, prenatal steroid use, and magnesium sulfate for neuroprotection. In women who report with preterm pre-labor rupture of membranes (PPROM), our goal is to ascertain if transvaginal cervical length (TVCL), amniotic fluid index (AFI), or a combination of both can predict delivery latency.

Methods

70 pregnant women presented with PPROM between the gestational age of 28 weeks and 36 weeks +6 days were enrolled. Transvaginal ultrasound measurement of cervical length and amniotic fluid index was performed within 24 hours of admission, to assess number of women reached latency period of 7 days or more and assess other maternal and fetal parameters as number of women reached 36 +6 weeks, mode of delivery, development of chorioamnionitis, gestational age at PPROM and delivery, birthweight at delivery, presence of neonatal sepsis, Apgar score at 1 and 5 minutes and need for NICU admission and indication.

Results

The best sensitivity of TVCL in prediction of delivery latency was 100 % at TVCL>3 cm in women with AFI >5 cm. On the other hand, the best specificity was 80.5% at TVCL>3 cm in women with AFI ≤5 cm.

Conclusion

When a woman presents with preterm pre-labor rupture of the membranes, it is recommended to employ either transvaginal cervical length, amniotic fluid index, or both to forecast delivery delay.
Diagnostic Accuracy of Fetal Thigh Volume in Comparison with Conventional Ultrasound in Prediction of Fetal Weight
Authors: Hassan Nashwa El Said , Ahmed Mortda El-Sayed , Elghareeb Nermeen Ahmed Mostafa , Barakat Mai Mokhtar Kamal , Abd-El Fattah Mohamed MennaAllah Hossam
Published: November 2024

Background

In utero estimation of fetal weight is an important component of management of pregnancy. It provides valuable information which aids the physician to take informed decisions concerning the timing and route of delivery. Fractional thigh volume can be added to two- dimensional sonographic measurements of the head and trunk to improve the precision of fetal weight estimation. This approach permits the inclusion of soft tissue development as part of a weight estimation procedure. The aim of this study to detect the accuracy of fetal thigh volume in prediction of fetal weight.

Objective

Detection the accuracy of fetal thigh volume in estimation of fetal weight in comparison to the gold standard method (hadlock’s formula) and comparing it with the actual birth weight after delivery.

Patients and Methods

Our study was conducted in Ain Shams University, maternity hospital/ultrasound unit from September 2022 to May 2023. This study was a cross-sectional study on 55 women who underwent delivery and fulfilled our inclusion criteria.

Results

There was statistically significant increase in the mean EFW by Hadlock’s formula (3192.35±488.46) than the mean actual birth weight after delivery (3024.36±439.36) with mean difference of 167.98±461.97 and with p-value = 0.009. There was no statistically significant difference found between mean EFW by fetal thigh volume (3138.04±441.46) and mean actual birth weight after delivery (3024.36±439.36) with mean difference of 113.67±429.36 and with p-value = 0.055.

Conclusion

Estimation of fetal weight is a very important antepartum assessment. Fetal 3D- fractional Thiv is consistent with actual birth weight The Measurement of fractional thigh volume can improve the accuracy of fetal weight prediction in comparison to the conventional method using Hadlock’s formula.
Letrozole Low Dose versus High Dose for Ovulation Induction with Timed versus Spontanous Intercourse in PCO
Authors: Houssieny Amro El , Hassanin Alaa Sayed , Mohamed Haitham Fathy , Atallah Hassan Mohamed Abouelhamd
Published: November 2024

Objective

to compare the effect of low dose and high dose of letrozole in ovulation induction in PCOS. Effect of (HCG) administration in ovulation rate and pregnancy rate. Effect of timed Versus spontaneous intercourse in pregnancy rate.

Study Setting

This study was carried out at. Ain Shams Maternity Hospital Infertility Clinic and Qena General Hospital Infertility Clinic.

Study Design

Four arm clinical randomized trial.

Study Time

Start from 4-October 2021 ended 10- Jan. 2023.

Results

The objective of this study was to investigate the effect of low dose and high dose of letrozole on ovulation induction and effect of spontaneous & timed intercourse with (HCG) on pregnancy rate in one treatment cycle. This four arm clinical randomized trial study was carried out at Ain Shams Maternity Hospital Infertility Clinic and Qena General Hospital Infertility Clinic. The current study was conducted on 136 women. They were divided into 4 equal groups:

A = letrozole 2.5 mg (Femra 2.5 mg NOVARTIS) (one tablet) without HCG.

B = letrozole 2.5 mg+ HCG 10.000 IU.

C = letrozole 10 mg (Femra 2.5 mg NOVARTIS) (four tablets) without HCG.

D = lertozole 10 mg + HCG 10.000 IU.

The study started 4-October 2021.ended 10-Jan 2023.

Conclusion

Conclusion, the present study revealed that, applying low dose or high dose of letrozole on ovulation induction and effect of spontaneous & timed intercourse with (HCG) had similar follicular response and pregnancy rates.

Recommendations

Good selection of PCO patients acording to Rotirdam critaria. Start mangement of PCO patients by wieght reduction for obes patients. Start induction ovulation by letrozole as first choice. Start by smallest dose of letrozole 2.5mg & can be titrated dose for not responding patient to high dose.
Evaluation of Apelin-13 and Apelin-36 Concentration in Women with Primary Unexplained Recurrent Pregnancy Loss
Authors: Mohamed Tasneem Abdelhamid , Ibrahim Moustafa Ibrahim , Raafat Tarek Aly , Nawara Maii Medhet
Published: November 2024

Background

According to the American College of Obstetricians and Gynecologists, recurrent pregnancy loss is a disease, defined as two or more failed pregnancies. Recurrent pregnancy loss is one of the most frustrating and difficult areas of reproductive medicine because up to 50.0% of cases lack clearly defined etiology. Common conditions that have been associated with recurrent pregnancy losses include uterine abnormalities, parental chromosomal aberrations, various endocrine disturbances and the presence of antiphospholipid antibodies.

Aim of the Work

to evaluate the potential role of apelin-13 and apelin-36 in patients with primary unexplained recurrent early pregnancy loss.

Patients and Methods

after ethical committee approval and informed consent from the patients, this case control study was conducted at tertiary care hospital at Ain Shams University hospitals from March 2022 to December 2022 and performed on total of 90 women who attended the outpatient antenatal clinics in their first trimester of pregnancy.

Results

The current study revealed that there were no significant differences between recurrent pregnancy loss group and control group regarding demographic characteristics; age, body mass index and gestational age (p values = 0.582, 0.278, 0.548) respectively. Our study results revealed that Apelin-13 and Apelin-36 were statistically significantly higher in recurrent pregnancy loss group than in control group (p value<0.001). Our results enhance the prognostic significance of high Apelin sub-fragment concentrations in the pathophysiology of unexplained recurrent pregnancy loss and suggests that apelin-13 and/or apelin-36 may be inhibited or decreased by potential drugs for the treatment of unexplained recurrent pregnancy loss.

Conclusion

the current study investigated serum apelin-13 and apelin-36 concentrations in women with unexplained recurrent pregnancy loss and demonstrated markedly higher serum concentrations compared to healthy pregnant women. We are of the opinion that our findings are not only significant to reveal the role of the Apelin sub-fragments in the pathophysiology of unexplained pregnancy loss; but also, they will provide information as a reference for the future studies, which will investigate the treatment strategies for the treatment unexplained pregnancy loss, and its associated complications in pregnancy.
Study of PD-L1 Expression in Papillary Thyroid Carcinoma and its Correlation to the Clinico-Pathological Characteristics
Authors: Sayed Asmaa Gamal Mohamed El , Ibrahim Dina Ragab Diab , El-Leithy Mahmoud Mahmoud , Ezz El Din Mai Mohamed Ali , Gabal Hoda Hassan Abou , Faheim Reham Mohamed
Published: November 2024

Background

Thyroid carcinoma is the most common endocrine malignancy, diagnosed annually worldwide. Papillary thyroid carcinoma (PTC) is the most common histologic subtype of thyroid carcinoma, accounting for around 90% of new cases. The expression of PD-L1 is investigated as a potential prognostic and predictive biomarker of the clinical outcome.

Aim of the Work

The study aimed at assessing PD-L1 expression in patients with PTC and its variants, also to determine its correlation with clinico-pathological parameters.

Patients and Methods

This is a cross-sectional study conducted on 50 patients diagnosed with PTC and treated at the Head and Neck Clinic, Ain Shams University Hospitals in the period from 2020-2022.

Results

We assessed the PD-L1 status by immunohistochemistry on formalin fixed and paraffin embedded surgical tissues of 50 patients diagnosed with PTC and its variants. Monoclonal Mouse anti-Human PD-L1 clone 22C3 from Dako Company was used to detect the PD-L1 status in tumor cells using the clone 22C3. PD-L1 positive expression was detected in 16/50 patients (32%) at a 1% threshold. The clinico-pathologic factors over a median duration of 17 months was studied and its correlation with the PD-L1 status. The mean age of the study population at diagnosis was 43 years with 92 % of cases were female patients. All patients underwent total thyroidectomy with 21 patients underwent lymph node dissection. The most common stage was stage I, and the most common histopathologic subtype was the classical PTC subtype. Most of the study population received radioactive iodine (84%). Median disease free survival was not reached as only 7 patients developed recurrence in the follow up period. In our study, statistically significant correlation was found between patients with PD-L1 positive tumor cells and higher T stage (p = 0.021), and positive pathological lymph nodes (p = 0.01). All the 16 patients who were found to have PD-L1 positive expression, received RAI (p = 0.034). Whereas no association was found with age (p = 0.197), sex (p = 0.584), multifocality (p = 0.566), lymphovascular invasion (p = 0.061), extra-thyroid extension (p = 0.725), thyroiditis (p = 0.135), histological variants (p = 0.520), margins (p = 0.410), post-operative thyroglobulin (p = 0.120), and disease free survival (p = 0.239).

Conclusion

PD-L1 expression correlates with T stage and pathological lymph nodes and may be used as a prognostic marker for PTC patients. Further follow up needs to be done to confirm the prognostic value of PD-L1 expression in PTC.
Importance of PSA Kinetics as a Prognostic Factor in Locally Advanced/Metastatic Prostate Cancer Patients with Prior Androgen Deprivation Therapy
Authors: Mahmoud Mona Hanafy , Alorabi Mohamed Ossama , Ali Dalia Medhat , Kelany Mohamed Reda , Ismail Soheir Sayed
Published: November 2024

Background

Prostatic cancer ranks 2nd amongst men in worldwide while 4th in Egypt. Many factors are used to predict patients’ survival. PSA kinetics are one of the main prognostic factors used for treatment response in advanced or relapsed cases. However, its application as prognostic marker is lacking in Egyptian clinical settings and research.

Aim of Study

In this retrospective study, we aimed to assess correlation between PSA kinetics among locally advanced and metastatic prostatic cancer patients and their survival status for prognostic aspects.

Methods

We conducted a retrospective cohort study at Clinical Oncology department, Ain Shams University hospitals from January 2013 till December 2022 (10 years). All prostate cancer patients who were initially hormonal sensitive locally advanced or metastatic that later developed biochemical failure during follow up period were included in our study.

Results

Our study included 77 patients with a mean age of 66.4±7.4 years. Three cases were locally advanced while 74 cases were metastatic. The most frequent mode of ADT monotherapy prior biochemical failure was GnRH analogue in 55 cases. Upon disease progression, most of the cases were shifted to abiraterone acetate. The initial median PSA value was 100 (49.1-193.9) ng/ml. It took about 9 (6-14) months (median TTN) with a median declining rate of 10.5 (3.75-35.1) % for their PSA values to reach nadir level of median 1.2 (0.21-5.27) ng/dl. When ADT failed, PSA levels increased again reaching a median value of 8.9 (3.75-35.2) ng/ml. The median PSA velocity after progression was 35.2 (2.8-208) ng/dl/yr while median PSA DT was 3.6 (1.3-7.25) months. Univariate analysis revealed PSA nadir <0.76 ng/dl level (P value= 0.003) and TTN >11 m (p value = 0) significantly associated with longer PFS and improved survival. However, PSA DT < 3.1 (p value=0.017) predicts higher mortality. Meanwhile, multivariate results showed that PSA declining rate (P value= 0.047) and age > 67 years (P value 0.016) were statistically significant as independent factors when associated to PFS.

Conclusion

TTN > 11 months and PSA nadir <0.76 during initial treatment was associated with prolonged PFS and OS. They were associated with better clinical response to treatment in castration resistant prostate cancer patients. Thus, it could be helpful for decision making of early treatment strategy in castration resistant cases.
Comparison of Intraocular Pressure Measurement by Air-Puff Tonometer and Goldmann Applanation Tonometer in Correlation to Corneal Pachymetry in Adolescence Age Group in Normal People
Authors: Abdellatif Mona Kamal , Maher Salib Roshdy Maged , Ahmed Doaa Ateya , Abdelhamid Ebeid Ahmed Abdelmonsef
Published: November 2024

Purpose

To assess the most accurate and practical technique for intraocular pressure (IOP) measurement in children and adolescents

Type of the Study

Cross-sectional observational

Methods

90 eyes of 45 patients were included in this study. Central corneal thickness (CCT) was measured using specular microscopy. IOP was assessed by Goldman applanation tonometer (GAT), Non-contact tonometry (Air-puff), and Tono- Pen in both right and left eyes.

Results

The mean age of participants was 14.8 years. Mean CCT was 548.7 µm in the right eye and 549.2 µm in the left eye (P = 0.687). Mean IOP measured by GAT, Air-puff, and Tono-Pen was 11.7, 14.1, and 11.3 mmHg in the right eye, respectively, and 11.7, 14.2, and 11.5 mmHg in the left eye, respectively. Air-puff readings were significantly higher than GAT and Tono-Pen (P > 0.0001) in both the right and the left eyes. On the other hand, Tono-Pen showed no statistically significant difference from GAT measurements either in the right (P = 0.447) or the left eye (P = 1). The highest correlation with GAT was seen with the Air-puff. CCT was positively correlated with all used devices.

Conclusion

Tono-Pen provides the most accurate alternative for GAT. Although Air-puff offers a more accessible option for IOP measurement in adolescents, attention should be taken as it gives significantly higher measurements.
Study of Retinal and Peripapillary Vascular Changes in Newly Diagnosed Acute Leukemic Patients Using Optical Coherence Tomography Angiography
Authors: Salman Abdelrahman Gaber , Zaki Rania Gamal Eldin , Madkour Nesrin Saeed , Labib Mariam Ahmed Mohammed
Published: November 2024

Background

Leukemia is a neoplastic blood disorder characterized by an abnormal proliferation of leukocytes. Knowledge of ocular involvement in leukemia is important because the eye is the only site where the leukemic involvement of nerves and blood vessels can be directly observed, because the eye symptoms may be the initial mode of presentation of the systemic illness. Almost all ocular structures have been found to be involved in patients with various types of leukemia.

Objective

To detect retinal and peripapillary vascular changes in newly diagnosed acute leukemic patients prior to chemotherapy treatment using optical coherence tomography angiography.

Patients and Methods

This comparative cross sectional study was carried out on 52 eyes of 26 patients and 52 eyes of 26 healthy subjects. Optical coherence tomography angiography was performed for all subjects. Central macular thickness. Retinal nerve fiber layer thickness, ganglion cell complex thickness, superficial and deep vessel density, foveal avascular zone area and radial peripapillary capillaries density were measured and analyzed.

Results

Significant decrease in the superficial capillary plexus and the radial peripapillary capillary density in the cases group. The FAZ area is larger in the cases group. The central macular thickness is lower in the cases group. But the RNFL thickness, and C/D parameters were higher in the case group. However, there was no significant difference between the two groups regarding the GCC and the DCP density.

Conclusion

Acute leukemia causes decrease in superficial capillary plexus density and radial peripapillary capillaries density and decreased macular thickness with no affection in deep capillary vessel density.
An OCT Study of Lower Lacrimal Punctal Stenosis
Authors: Salaheldin Mayar Mohammad , Nada Ossama , Fawzy Elshinawy Reham , Elwan Sheriff
Published: November 2024

Purpose

To assess the lower lacrimal measurements in stenosis versus non- stenosed punctiusing spectral domain anterior segment optical coherence tomography.

Patients and Methods

The study included 39 puncti of 21 healthy asymptomatic volunteers attending the general and oculoplastic outpatient clinics (Group I : Control group) and 30 puncti of 17 subjects with a clinical diagnosis of punctal stenosis defined as the punctal diameter less than 0.3 mm measured by slit-lamp biomicroscopy (Group II : Cases group). The punctal diameter was measured by slit-lamp biomicroscopy in all subjects. The external punctal diameter, the inner punctal diameter at 500 µm, the punctal depth and tear meniscus height were measured using anterior segment optical coherence tomography.

Results

The internal punctal diameter at 500µ (74.92 µm ± 60.99 vs 24.07 µm ± 34.30) showed statistically significant lower measurements in the stenosis group compared to the control group. No statistically significant differences were between the 2 groups otherwise: external punctal diameter (571.44 µm ± 148.78 vs 545.23 µm ± 201.72), punctal depth (824.49 µm ± 354.14 vs 707.63 µm ± 552.80),. (and tear meniscus height (356.19 µm ± 166.83 vs 403.57 µm ± 244.24 Conclusion : Anterior segment optical coherence tomography provides a superior ability to assess the patency of the proximal lacrimal drainage system over the regular routine slit lamp examination. This is probably useful in diagnosis of cases of epiphora with externally non-stenosed puncti and distally patent passages.
Value of Examination of the Central Ten Degrees of the Visual Field in Early Stages of Glaucoma
Authors: El-AzizEliewa Mona Mohamed Abd , Abdelshafik Mohamed Adel , Abdellatif Mona Kamal , Hussein Noha Mohsen Mahmoud
Published: November 2024

Purpose

To estimate the value of central 10 degrees field examination in glaucoma when 24 degrees shows normal central area.

Patients and Methods

This is a cross-sectional study carried out on 65 patients divided into 3 groups: glaucoma suspect (17patients), early glaucoma (33 patients) and moderate glaucoma (15 patients). Visual Field (VF) and Optical coherence tomography (OCT) were performed for all patients. VF was done using Humphrey visual field analyzer (SITA standard) using both 24-2 and10-2 programs. Macular ganglion cell complex thickness (GCC) and peri-papillary retinal nerve fibre layer (pRNFL) were measured using RTVue-100 software (Optovue, Inc., Fremont, CA).

Results

Our study demonstrated that the 10-2 VF detected more defects that those detected in the central 10o of the 24-2 VF in all quadrants of the visual field in all our cases and the difference was statistically significant in the lower temporal (p = 0.006), in the lower nasal in the upper nasal and in the upper temporal quadrants (P < 0.001). In the glaucoma suspect group 10-2 VF showed more defects than 24-2 VF which was statistically significant in the upper and lower nasal quadrants (p = 0.008). In the early glaucoma group, this difference was significant in the lower temporal (P = 0.007), the lower nasal(P < 0.001)and the upper nasal (P = 0.0016) quadrants. Although there was no statistically significant in moderate glaucoma group. Both GCC and 10.2VF defects agree in outcome in 54% of cases. 10-2 VF looks to be superior to OCT macular ganglion cells and that difference was statistically significant only in the lower nasal quadrant of 10-2VF (p > 0.001). In 49% of cases both GCC and the pRNFL were able to detect abnormalities in the superior hemisphere and 61% the inferior hemisphere. Defects were found in GCC only in 50% and 35% of cases in superior versus the inferior halves. This higher ability of the GCC over the pRNFL was found to be statistically significant (p = >0001). There was a weak positive correlation (r = 0.042) between the superior half GCC versus the antilog of sensitivity of the corresponding inferior half of 10-2 VF. On the other hand, moderate positive correlation (r = 0.52) was found between the superior half GCC and the corresponding part of the pRNFL.

Conclusion

The present study showed higher ability of 10-2 VF in detecting changes in the central area than 24-2 VF particularly in glaucoma suspect and early glaucoma. Which agrees with GCC measurments
Effect of Active & Passive Smoking on Macula & Optic Nerve Using Optical Coherence Tomography Angiography (OCTA)
Authors: Taha Nada Ahmad Mahmoud , Mohamed Thanaa Helmy , Zankalony Yasser Abdelmageuid El , Madkour Nesrin Said
Published: November 2024

Background

Smoking cause alterations in the retinal blood flow and damage of the blood retinal barrier, these retinal microvascular changes demonstrated by OCT-A may be an indicator of systemic microvascular changes.

Objective

The purpose of this study was to evaluate the effect of active and passive smoking on macula and optic nerve by measuring the macular thickness and microvasculature, GCC thickness, RNFL thickness and disc microvasculature using OCTA.

Methods

150 healthy participants of 76 males and 74 females, divided in to three equal groups active smoker, passive smoker and control group. Optical coherence tomography angiography scanning was performed for all subjects. All macular subfields thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, superficial and deep macular vessel density, foveal avascular zone (FAZ) area and radial peripapillary capillaries (RPC) density were measured and analyzed.

Results

Significant increase in the central macular thickness in the active and passive smoker, also there was significant decrease in the superior RNFL and deep parafoveal vessel density in the active and passive smoker, but no significant differences in GCC, FAZ, superficial capillary plexus(SCP) density, and radial peripapillary capillaries density between the three groups.

Conclusion

Active and passive smoking decrease deep parafoveal vessel density, superior retinal nerve fiber layer thickness, and increase central, inner and outer macular thickness in healthy middle age individuals.
Assessment of Corneal Epithelial Thickness in Dry Eye Patients by OCT
Authors: Abdelmaged El-Znkalony Yasser , Khamis Nancy Ezz El-Regal , Abdlazem Rehab Mohamed Ibrahim
Published: November 2024

Background

Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms. Tear film instability and hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities play important role in the etiology of dry eye.

Objective

To correlate the corneal epithelial thickness and grades of dryness using optical coherence tomography (OCT) in dry eye patients versus normal eye patients.

Patients and Methods

A prospective case control study was conducted on patients of the outpatient clinic at Ophthalmology department, Faculty of Medicine, Ain Shams University. The study was conducted on patients in middle age group (from 20 to 50 years old of both sexes). The sample size was 30 dry eyes and 30 normal eyes.

Results

Regarding the AS/OCT-C 5 mm results among the studied patients, we found that Avg. of superior quadrants in Dry eyes group ranged from 47 to 59.6 with mean ± SD = 53.63 ± 3.7 while in Normal eyes group the Avg. of superior quadrants ranged from 49 to 56 with mean ± SD = 52.7 ± 1.93 with no statistical significant difference (p = 0.227) between the two groups. Avg. of inferior quadrants in Dry eyes group ranged from 49 to 65.6 with mean ± SD = 55.62 ± 4.35 while in Normal eyes group the Avg. of inferior quadrants ranged from 49 to 56 with mean ± SD = 52.7 ± 1.93 with statistical significant difference (p = 0.002) between the two groups. Regarding Comparison, there was a highly significant difference between the two studied groups (p = <.001).

Conclusion

There was significant difference Fundus examination, AS/OCT-C 5 mm, highest thickness, AS/OCT-C 2mm and AS/OCT-P 9mm results between dry eye patients and normal subjects.
Outcomes of Arthroscopic Repair vs. Menisectomy of Radial Meniscal Tears: A Systematic Review
Authors: Salama Ahmed Salama Shabaan , El latif Hussein Ali Ibrahim Abd , Haroun Yahia Mohamed
Published: November 2024

Background

Radial tear is a vertical tear mostly occur in young individuals with traumatic incidence, which is perpendicular to the long axis of the meniscus and to the tibial plateau, sectioning the circumferential collagen fibers of the meniscus, affect the ability of the menisci to transmit the tibiofemoral load and the hoop stresses associated with weight-bearing.

Aim of the Work

A systematic review to compare clinical and MRI outcomes of arthroscopic repair and menisectomy for radial meniscal tears.

Patients and Methods

After conducting an initial search of PubMed, Embase, and Scopus databases using the keywords: meniscus, meniscus tear, radial tear, menisectomy, and meniscus repair, we found a total of 1170 articles. However, after screening the full-text analysis against the inclusion and exclusion criteria, only 11 studies on radial meniscus tear were deemed suitable for inclusion criteria.

Results

Following an analysis of 11 studies that involved 235 patients with radial meniscal tears, it was discovered that 180 of them underwent arthroscopic repair, while 55 underwent menisectomy. Patient- reported outcomes for both procedures were promising, with improvement in activity (IKCD and Tegner) scores recorded during the final follow-up in comparison to pre-surgery scores. Imaging and second look arthroscopy showed that the majority of patients experienced complete or partial healing, with a low occurrence of failure. These results indicate that both arthroscopic repair and menisectomy can serve as effective treatments for radial meniscus tears.

Conclusion

It has been found through short- and long-term follow-up that sparing the meniscus, either through repair or partial menisectomy, has excellent outcomes for radial tears.
Extra-Articular Distal Femoral Fractures Retrograde Nailing Versus Locked Plating A Systematic Review and Meta-Analysis
Authors: Rady Amr Sameh , Farag Osama Elsayed , Kotb Ahmed Sayed
Published: November 2024

Background

Extra-articular Distal femoral fractures remain a challenging matter due to the high energy trauma causing the injury and the association with soft tissue injury, vascular injury and physical disability. Different methods of fixation exist depending on a lot of factors; patient related factors, type of fractures, surgeon’s preferences.

Aim of the Work

to evaluate the outcome & complications of retrograde intramedullary nailing versus locked plating in management of extra-articular distal femur fractures.

Patients and Methods

The standard method of management of extra-articular distal femur fractures including either internal fixation by intramedullary nailing (Antegrade or Retrograde) or distal femur locked plate (LP).

Results

Retrograde nailing shows superiority over the Antegrade nailing especially the very distal fractures and the associated intra-articular extension. However every methods comes with its own advantage and disadvantage. Retrograde nailing gaining its popularity due to minimal insertion point and maintaining the fracture hematoma. Distal femur locked plate witnessed a lot of development including; multidirectional locking mechanism which comes very handy especially with osteoporotic bone and intra-articular extension; also the development of minimally invasive percutaneous osteosynthesis technique and system reducing time, blood loss and soft tissue dissection.

Conclusion

The present review shows lesser mean fracture union time and a lesser overall complication favoring the Retrograde Intramedullary Nailing (RIMN) over the Locked Plating (LP). We didn’t find a statistical significant difference between the two groups in non-union, delayed-union, mal-union, knee stiffness, knee pain, superficial/deep infection; implant related complication, re-operation rate and duration of surgery. But a less intra- operative blood loss and a better post-operative knee range of movement was seen in the LP group. Both the options of fixation appear to be feasible options, and specific indications should be considered for making the final choice.