bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphometric Study of the Mastoid Process and its Role in Sex Differentiation: A Nigerian Computed Tomography Study
Authors: Ominde Beryl Shitandi , Igabari John N. , Ikubor Joyce Ekeme
Published: March 2024

Background:

The mastoid process can be utilized in forensic identification due to its resistance to alterations and population variations in its morphology. The study investigated the role of mastoid parameters in the determination of sex in a Nigerian population.

Aims and Objectives:

The aim of this study was to determine the gender differences in measurements of the mastoid process. Furthermore, the study aimed at assessing the percentage accuracy of using the mastoid variables in sex discrimination.

Materials and Methods:

This cross-sectional study used computed tomographic images of the brain, stored in the radiology unit of a referral hospital in Delta State, Nigeria. Permission was granted by the hospital’s Ethics Board. The measurements of the mastoid process were taken on images of 310 patients (170 males and 140 females) aged 20–80 years. Data were summarized using means and standard deviations. Gender, side, and age group comparisons were assessed using the independentt-test, pairedt-test, and analysis of variance, respectively. The association between variables was probed using Pearson’s correlation test. The discriminant function analysis was used to determine the accuracy of correct sex allocation. The probability value was set at <0.05.

Results:

All the measurements were larger in males than in females (P< 0.05). All except the conventional height, oblique sagittal diameter, and mediolateral inclination angle showed significant differences between age groups (P< 0.05). The true height and oblique coronal diameter showed a significant positive correlation with age (0 <r< 0.05) (P< 0.05). The lateral intermastoid distance was the best sex-discriminating variable (89.4%). Using all nine variables, the accuracy of sex prediction was 89.7%.

Conclusion:

The sexually dimorphic mastoid dimensions can collectively be used for sex determination with acceptable accuracies, in cases where only the fragmented parts of the temporal bone are available in Delta State, Nigeria.
An Autopsy and Histopathology-based Study to Ascertain the Cause of Death of Brought Dead Cases
Authors: Bandyopadhyay Chandan , Paul Prabir Chandra , Chakraborty Prabhas Chandra
Published: March 2024

Background and Objectives:

The cases of apparent natural deaths are encountered in the hospital casualties who are noted dead at the time of the first medical attention and as such are labeled as “Brought Dead.” These include the cases of sudden death, unexplained death, and unattended death. The cause of such deaths is reported in the literature to emanate principally from the cardiovascular system, though there are some documented geographical, racial, and other variations. In the present study, we endeavored to detect the cause of such natural deaths in terms of the disease and the organ system involved, in the deceased individuals of the contemporary Bengali population, with cases due to obvious unnatural causes being excluded.

Materials and Methods:

An observational, cross-sectional study with 105 (n = 105, male: 89, female: 16) study subjects of age group of 20–80 years, selected by systemic random sampling, from the brought dead subjects coming to the mortuary of the NRS Medical College and Hospital for medicolegal autopsy from April 2011 to March 2012, excluding cases having a history of the obvious unnatural event. Organ system-wise gross examination was done, followed by tissue sampling for histopathological examination. The case-wise findings were tabulated and analyzed for descriptive statistics using SPSS software.

Results:

In the present study, 89 cases were male (84.8%) and 16 cases were female (15.2%), which reflects a male: female ratio of 5.56:1. The dead bodies are mostly recovered from the footpaths (47 cases, 44%). Sixty-four (61%) cases are of known identity. In 54 cases out of 105 (51.4%), morbid pathology is detected in the respiratory system (RS), lobar pneumonia, and cavitary pulmonary tuberculosis being the most frequent disease entity, in both genders. Fifty-one years–sixty-five years is found to be the most commonly affected age group, in both genders.

Interpretation and Conclusions:

The present study shows that the most common organ system involved in brought dead cases is the RS, which is supported by a few Indian studies.
Risk Factors for Death among Hospitalized and Nonhospitalized Patients due to COVID-19 in a Triple International Border Municipality
Authors: Gordillo Erica Alves Ferreira , Andrade Rubia Laine de Paula , Hoare Ismael , Izurieta Ricardo , Zilly Adriana , Cicchelero Laiz Mangini , Kunkel Merielly , Gordillo Ernesto Valdes , Silva-Sobrinho Reinaldo Antonio , Campos Regiane Bezerra , Silva Rosane Meire Munhak
Published: March 2024

Introduction:

The severity of COVID-19 in the general population ranges from minimally symptomatic disease to critical illness, which may require hospitalization and progress to death

Methods:

A retrospective cohort study carried out with all positive cases of COVID-19 reported in the municipality of Foz do Iguaçu (PR) between the period from March 2020 to December 2021. Data were collected from Bank Notifies COVID-19 is the name of the information system that provides notifications by professionals of suspected and confirmed cases of the disease. Data were analyzed using descriptive statistical techniques and calculation of relative risk

Results:

24,647 confirmed cases were identified in the study; among these, 22,211 (90.1%) were not hospitalized and 2436 (9.9%) were hospitalized. Among the 2436 patients hospitalized for COVID-19, 947 (38.9%) died and 1489 (61.1%) recovered. Among the 22,211 outpatients, 93 (0.4%) died and 22,118 (99.6%) recovered. An association between death and the following characteristics was identified among the cases that were hospitalized: male gender, all age groups over 40 years, indigenous race/color, hospital staylength of more than 10 days,hospitalization in a Unified Health System (SUS) bed and in an Intensive Care Unit (ICU). According to the clinical characteristics of symptoms and comorbidities, the following prevailed:ities dyspnea, intercostal retraction, cyanosis, hypertension, diabetes, obesity, cardiovascular disease, smoking, lung disease, kidneydisease, neurological disease, neoplasia, and immunodeficiency. Among the cases that were not hospitalized, death was associated with: malegender, all age groups over 50 years, dyspnea, cyanosis, hypertension, diabetes, obesity, cardiovascular disease, kidney disease, neurological disease, neoplasia, and liver disease

Conclusions:

Older adults, male, and Caucasian people are commonly affected by COVID-19 and can evolve with aggravation when they have modifiable risk factors such as obesity and smoking, as well as nonmodifiable risk factors such as: cardiovascular disease, neurological disease, renal, hypertension, diabetes, and immunosuppression.
Repetitive transcranial magnetic stimulation in complex posttraumatic stress disorder: A case report
Authors: Dharwadkar Nitin P.
Published: March 2024

Complex posttraumatic stress disorder (cPTSD) represents a unique clinical phenomenon. It is marked by traditional PTSD symptoms coupled with emotional instability, unfavorable self-perception, and challenges in interpersonal relationships. While the diagnostic recognition of cPTSD remains debated, emerging evidence supports its unique profile and clinical significance. This study presents an instance involving a 30-year-old woman who has been clinically determined to have severe cPTSD, comorbid borderline personality traits, major depressive disorder, and fibromyalgia. The patient underwent 25 bilateral sessions of repetitive transcranial magnetic stimulation (rTMS) targeting prefrontal cortices. Comprehensive assessments using standardized scales were conducted pre- and post-rTMS treatment. Results revealed significant reductions in cPTSD symptoms (PTSD Checklist-5 scores decreased from 55 to 21) and reduced borderline personality symptomatology (the Zanarini Rating Scale for borderline personality disorder scores decreased from 9 to 4), alongside improvements in other areas. These findings suggest the potential utility of rTMS as an adjunctive intervention for cPTSD. Aligned with previous PTSD research, the study highlights the capacity of rTMS to mitigate cPTSD symptoms, comorbidities, and subjective distress. Nevertheless, further exploration with larger samples and extended follow-up is needed to substantiate and generalize these findings. This preliminary evidence underscores rTMS’s promise as a prospective therapeutic avenue for complex PTSD, offering hope for improved treatment strategies.
Acute liver failure: The medical management
Authors: Pandey Chandra Kant , Singh Monika , Saxena Sumi , Danish Mohammad , Khanna Ashish , Srivastava Tanushree
Published: March 2024

Acute liver failure (ALF) is a clinical condition caused by multiple factors, such as drugs, viruses, and vascular causes. It is defined as coagulopathy and encephalopathy occurring in a time span of <6 months in a healthy patient with no preexisting liver disease. ALF is classified as, hyperacute, acute, and subacute on the basis of the duration of development of encephalopathy since the initial appearance of jaundice. The management of ALF comprises the treatment of hepatic and extrahepatic organ system dysfunction. The early recognition and treatment of raised intracranial pressure are the prerequisite for better neurologic outcome and survival. The main pathogenetic factor in the development of ALF is ammonia, but the role of newer ammonia-lowering agents is not well established. Once intracranial hypertension sets in, hypertonic saline and mannitol are the first-line therapy. Only liver transplants have been promising to be effective in patients with poor prognostic factors. Thus, it is vital to identify the complications and appropriate usage of different prognostic models in segregating the patients who require medical management or liver transplant, which is the mainstay of therapy.
Rapid detection of polymyxin resistance among carbapenem-resistant enterobacteriaceae
Authors: Alkhawagah Sabah M. , Rehim Soad E.-B.A , El-Nasser Asmaa M.
Published: March 2024

Background

Colistin is used currently as a last-line antibiotic for the treatment of infections caused by carbapenem-resistant Enterobacteriaceae (CRE). For colistin-susceptibility testing, the conventional methods are not reliable, and the standard broth microdilution (BMD) method is both laborious and time consuming. Therefore, there is an urgent need for a rapid diagnostic technique for identification of colistin resistance.

Aim

The aim was to report the prevalence of CRE among hospitalized patients, to evaluate the performance of the rapid polymyxin Nordmann/Poirel (NP) test for detection of polymyxin resistance among CRE, and to detect the mcr-1 gene among these isolates.

Patients and methods

A total of 300 samples were included. CRE isolates were isolated and subjected to BMD test, disk diffusion test, E-test, and rapid polymyxin NP test to detect colistin resistance. In addition, PCR assay was done to detect mcr-1 gene.

Results

Out of 300 different clinical samples, 132 Enterobacteriaceae isolates were obtained. The prevalence of CRE was 41.7% (55/132). The prevalence of colistin resistance among CRE isolates was 7.3% (4/55). Of the four colistin resistant isolates detected by the standard BMD, disk diffusion test and E-test detected 2 and 3 isolates as colistin resistant, respectively, giving low sensitivity (50 and 75%, respectively) and unacceptably high rates of very major errors (3.6 and 1.8%, respectively), whereas all four isolates were recorded as colistin-unsusceptible by the rapid polymyxin NP test, giving 100% sensitivity and specificity, with no very major errors. Only one isolate was detected as mcr-1 positive by PCR assay.

Conclusion

There is a high prevalence of CRE. Rapid polymyxin NP test is an accurate and rapid method for detection of colistin resistance. This research confirms the alarming spread of the plasmid-mediated mcr-1 gene among CRE.
Ultrasound biomicroscopy of sclerotomy sites after conventional and sutureless (23, 25 G) pars plana vitrectomy
Authors: Sokromy Ali A. , Aly Mona M. , Moustafa Tarek A.
Published: March 2024

Purpose

To evaluate postoperative outcomes of transconjunctival sutureless pars plana vitrectomy (PPV), using ultrasound biomicroscopy (UBM), conventional PPV, and transconjunctival sutureless vitrectomy (TSV) sclerotomy sites were compared using UBM.

Patients and methods

A total of 30 patients underwent complete ophthalmological examination. Conventional PPV was performed following the same surgical techniques, and all TSV procedures were performed by one surgeon. The 20-, 23-, and 25-G vitrectomy systems were used, with 10 patients in each gauge. UBM examination was performed after 1–30 days following surgery to locate and document the sclerotomy sites.

Results

The 20, 23, and 25 G sclerotomies showed no statistical difference in site diameter at UBM. All patients had at least two diameters of the incision measured, and all wounds were constructed obliquely. The mean size of 20 G sclerotomy was 375.40±83.70 µm (range, 280.4–695 µm) and coefficient of variation was 0.21. The mean size of 23 and 25 G sclerotomy was 315.5±56.8 µm (range, 253.2–362.5 µm; coefficient of variation=0.26; P<0.556).

Conclusion

Postoperative UBM examination allowed the evaluation of the wound architecture and showed no statistical difference between conventional 20 G and TSV 23, 25 G sclerotomies.
Detection of carbapenem-resistant enterobacteriaceae isolates harboring OXA-48 gene in a clinical setting
Authors: Muhammad Doaa M. , Elkholy Emtethal El-Sayed M. , Elmadbouly Asmaa A. , Montasser Karim A.
Published: March 2024

Background

Increasing frequency of blaOXA-48 gene, commonly identified in Enterobacteriaceae family, is alarming across the world. The poor hydrolytic profile of OXA-48 likely may obscure its detection in clinical isolates, complicating the treatment option.

Objective

To detect the prevalence of blaOXA-48 gene in carbapenem-resistant Enterobacteriaceae (CRE) isolates from patients in Al-Zahraa and Helwan University hospitals, Cairo, Egypt, and to compare the diagnostic performance of phenotypic tests for the detection of OXA-48-mediated carbapenem resistance.

Patients and methods

A total of 500 Enterobacteriaceae isolates were identified from different clinical specimens provided to the Microbiology Laboratory of Al-Zahraa and Helwan University hospitals, Cairo, Egypt. The identified isolates underwent antibiotic susceptibility testing. Phenotypic carbapenemase production was confirmed by the modified Hodge test, Carba Nordmann-Poirel test, and modified carbapenem inactivation method (mCIM), and the blaOXA-48 gene was detected using real-time PCR.

Results

Out of 500 Enterobacteriaceae isolates, 102 (20.4%) isolates showed resistance to one or more of carbapenems. Among these 102 CRE isolates, Klebsiella pneumoniae was the most common isolate. Carbapenemase production was detected in 67/102 (65.7%), 69/102 (67.6%), and 72/102 (70.1%) of isolates by modified Hodge test, Carba Nordmann-Poirel, and mCIM, respectively. Of the 102 CRE isolates, 74 (72.5%) harbored blaOXA-48 gene, and of them, 43 (58.1%) were K. pneumoniae, 25 (33.8%) were Escherichia coli, and 6 (8.1%) were Citrobacter.

Conclusion

blaOXA-48 gene was prevalent among Enterobacteriaceae isolates in the two hospitals, with more prevalence in K. pneumonia isolates. mCIM has the best performance in phenotypic detection of this resistance.
Updates in evaluation of optic nerve head in patients with multiple sclerosis
Authors: Abdel Ghany Mai E. , Abd Allah Ahmed S. , Kamel Rehab M. , El Sharkawy Rasha E.
Published: March 2024

Background

The most common demyelinating disease of the central nervous system is multiple sclerosis (MS), which is considered an acquired chronic progressive inflammatory process. Overall, 25% of the patients have an optic neuritis (ON) as a first neurological presentation.

Aim

To evaluate optic nerve head microcirculation in patients with MS without ON by using an optical coherence tomography angiography (OCTA).

Patients and methods

Our prospective study included 50 patients divided into two groups: patient group, which included 25 patients with relapsing-remitting MS without ON, and control group, which included 25 healthy participants matched with patient group regarding age and sex.

Results

The mean for average ganglion cell complex, average retinal nerve fiber layer thickness, and whole image retinal peripapillary capillary density % was 84.56±15.60, 80.64±21.89, and 46.42±5.48, respectively, for the patients group, whereas it was 95.84±5.13, 105.56±4.27, and 50.72±2.93, respectively, for the control group, and the differences between the two groups were highly statistically significant.

Conclusion

Significant decreases in vessel density and perfusion of optic nerve vasculature are evidenced in OCTA in patients with MS without ON in comparison with the normal control. So, OCTA is considered a promising paraclinical technology that can aid in early diagnosis of ON in MS for better management.
The effect of multiple sclerosis on retinal nerve fiber layer in eyes without history of optic neuritis
Authors: Azim Ghada S.A. , El-Haddad Nermien S. El-Dien Mohammed , Osman Marwa A.
Published: March 2024

Background

Multiple sclerosis (MS) is a disabling disease that is characterized by an axonal damage in the central nervous system, leading to progressive neurologic deficits. Evidence indicates that axonal damage occurs already in the early stages of the disease.

Objective

To discover the ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) changes using optical coherence tomography in patients with early relapsing-remitting MS [expanded disability status scale (EDSS)<3] and their relation to the degree of disability and duration of the disease.

Patients and methods

Overall, 48 eyes of 24 patients with relapsing-remitting MS [31 eyes without history of optic neuritis (ON) and 17 with history of ON] were scanned by using optical coherence tomography and compared with 12 eyes of six age-matched and sex-matched healthy participants. Full history taking and neurological and ophthalmological examination was done. In addition, assessment of disability by EDSS was done for patients.

Results

Both total and sectorial RNFL thickness were significantly decreased in affected eyes (with ON) and nonaffected eyes in comparison with control eyes; however, RNFL thickness (average and sectorial) was not significantly correlated with duration of the disease or disability assessed by EDSS. In contrast, superior and inferior GCC thickness was significantly correlated with EDSS, although they were not significantly decreased in nonaffected eyes in comparison with control eyes.

Conclusion

RNFL thinning takes place without a historical record of ON and may be considered as a chronic optic neuropathy in patients with MS. GCC thickness is perhaps a reliable marker for indicating progression of disease.
Endothelial dysfunction as an early marker for cardiovascular disease in patients with chronic kidney disease on maintenance hemodialysis
Authors: Abo Alia Mona M.S.A.E. , El-Wakil Hala S. , Abou Zeid Abla A. , Ahmad Lamia I. , Emara Doaa M. , Mohamed Ragaa R.
Published: March 2024

Background

Cardiovascular disease is a major cause of mortality in dialysis patients. Magnesium (Mg) level has been found to correlate positively with endothelial function. Moreover, it is suggested that low Mg is associated with increased all-cause and cardiovascular mortality in hemodialysis (HD) patients.

Objective

Therefore, this study was conducted to define the relationship between Mg level and endothelial dysfunction as an early marker of cardiovascular disease in patients with end-stage renal disease (ESRD) on maintenance HD.

Patients and methods

In this cross-sectional study, 85 patients with ESRD on maintenance HD were included. Serum angiopoietin-2 (Ang-2) level, brachial flow-mediated dilation (BFMD), and carotid intima-media thickness (CIMT) were measured as indicators of endothelial dysfunction and atherosclerosis. Patients’ serum Mg levels were measured. All data are presented as mean and SD or percent frequency. Statistical tests, mainly t test, Mann–Whitney test, or χ
2 test, are used in comparison between groups for quantitative and qualitative data correspondingly.

Results

Our results indicate that Ang-2 and BFMD are associated and can predict atherosclerosis early in HD patients (P=0.036 and 0.006, respectively). When the patients were divided according to their serum Mg, there was no significant difference regarding Ang-2, BFMD, and CIMT between the two groups.

Conclusion

This study demonstrated that endothelial dysfunction markers such as Ang-2 and BFMD are associated and can predict atherosclerosis early in HD patients. On the contrary, Mg might not affect neither endothelial function (FMD and Ang-2) nor CIMT as a marker of atherosclerosis in ESRD on HD.
Plasma homocysteine levels in polycystic ovarian syndrome with early recurrent pregnancy loss
Authors: Elhamid Shymaa A.A. , Hanafy Madiha M. , Elwahed Rania M.A.
Published: March 2024

Background

A pregnancy loss (miscarriage) is defined as the spontaneous demise of a pregnancy before the fetus reaches viability. The term therefore includes all pregnancy losses (PLs) from the time of conception until 24 weeks of gestation. Polycystic ovary syndrome (PCOS) is a common endocrine system disorder among women in which levels of the sex hormones are disrupted. Hyperhomocysteinemia has been associated with clinical vascular thrombosis, and this could be the cause for early decidual and chorionic vessel damage that might result in disturbed implantation of the conceptus.

Objective

To determine the plasma homocysteine levels in patients with PCOS having recurrent pregnancy loss (RPL) compared with women with PCOS without RPL.

Patients and methods

This is a case–control study on 30 women with PCOS with RPL and 30 control women with PCOS without RPL. Plasma homocysteine levels were assessed from February 2019 to February 2020 at Al Zahraa University Hospital.

Results

There was a significant increase in the mean homocysteine level in the case group (20.14±3.21) compared with controls (9.01±2.24) (P=0.001), with odds ratio=2.193 (confidence interval 0.171–23.294) by homocysteine through cut-off more than 12 mmol/l.

Conclusion

Risk of RPL in patients with PCOS is increased with hyperhomocysteinemia (P<0.001).
Occult hepatitis B virus among patients with chronic hepatitis and hepatocellular carcinoma
Authors: Naeima Khodeir A. , Eman Abd-El-Samae M. , Dina Aly R. , Ola El-Moatassem M.
Published: March 2024

Background

Hepatitis B virus (HBV) infection is diagnosed when the circulating HBV surface antigen (HBsAg) is serologically detected. Occult HBV infection is defined as the infection state negative for HBsAg serology, but it has shown viral genome persistence in infected individuals. The aim of the study is to determine the prevalence of occult HBV among patients with chronic hepatitis negative to HBsAg in the presence or absence of hepatitis C virus (HCV) infection.

Patients and methods

This study was conducted on a total number of 55 patients with chronic hepatitis (liver cirrhosis in 44 cases, nonalcoholic fatty liver in six cases) and hepatocellular carcinoma in five cases. All studied cases were subjected to routine liver function tests, HBsAg, HBsAb, hepatitis c virus immunoglobulin G (HbcIgG), α-fetoprotein, HCV RNA, and HBV DNA detection.

Result

All cases were negative to HBsAg and HBsAb in the presence or absence of HCV infection. HBV DNA detection by real-time RT-PCR confirmed the positivity of HBV infection [occult hepatitis b infection (OBI)] in two (4.5%) out of 44 cases of cirrhotic liver and represented 3.6% of the total cases studied with a viral DNA of 116 and 159 copies/ml, respectively. One case of OBI had a high level of α-fetoprotein (392 Iu/ml) and the second case had high copies of HCV RNA 127 000 copies/ml, that is coinfection. HbcIgG was positive in 31.8% in cirrhotic patients (including one out of the two positive OBI). HCV RNA was negative in 100.0% of nonalcoholic fatty liver, positive in 39 (one was positive OBI) cases with cirrhosis with a median value of 45 000 copies and in four out of the five hepatocellular carcinoma cases with a median value of 1.85E+08. This is statistically significant (P=0.01). We come to the conclusion that occult HBV do exist in our community. The diagnosis of OBI should be based on high sensitivity of HBsAg and HBV DNA testing.
The effect of laparoscopic sleeve gastrectomy on hemoglobin, calcium, and lipid metabolism
Authors: Hassan Sayed Eslam H. , Mostafa Elsayed A. , Futooh Zahraa
Published: March 2024

Background

Obesity is great health problem facing a large section of the population, being associated with many complications. Sleeve gastrectomy is one of the most popular, safe, and easy surgical ways for weight loss, though some nutritional deficiencies occur after removal of a large part of the stomach.

Objective

This study is designed to assess the effect of laparoscopic sleeve gastrectomy on blood hemoglobin, lipid profile, and calcium levels.

Patients and methods

This is a retrospective clinical trial conducted in Al-Zahraa University Hospital and Ahmed Maher Teaching Hospital that involved 40 patients who underwent sleeve gastrectomy 1 year ago. The data were collected during the period from October 2018 till November 2019, assessing hemoglobin, serum calcium, and lipid profile preoperatively and after 1 year postoperatively.

Results

There are decreases in postoperative laboratory results, as the mean of hemoglobin decreased from 11.61 to 11.54, serum calcium from 9.08 to 8.88, total cholesterol from 202.25 to 168.10, and triglycerides from 208.62 to 160.90, with a statistically significant difference regarding serum calcium, total cholesterol, and triglycerides (P=0.004, P<0.001, and P<0.001, respectively).

Conclusion

There is no significant decrease of hemoglobin level with minimal decrease in serum calcium level with supplements and significant decrease in lipid profile after 1 year of laparoscopic sleeve gastrectomy.
Biosynthesis of silver nanoparticles and study of their activities against drug-resistant pathogenic organisms
Authors: Ali Asmaa R. , Anani Haneya A.A. , Selim Fatma M.
Published: March 2024

Objective

To determine biosynthesis of silver nanoparticles (AgNPs) by different bacteria and Aspergillus species and to study the effect of these prepared AgNPs alone and in combination with selected antimicrobial agents against resistant bacteria and Candida.

Methods

AgNPs were synthesized using different bacterial isolates (Bacillus cereus, Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa, and Aspergillus niger). AgNPs were characterized by ultraviolet/visible spectrophotometer, transmission electron microscopy, scanning electron microscope, and energy-dispersive radiograph spectroscopy analysis. Antimicrobial activity of biosynthesized AgNPs was assessed alone and in combination with antimicrobial agents against resistant bacteria and Candida. Cytotoxicity assay of biosynthesized AgNPs was also assessed.

Results

The AgNPs thus obtained were confirmed through observed color change, and their evaluation using ultraviolet/visible showed the highest optical density at 410–430 nm wavelength. Transmission electron microscopy and scanning electron microscope showed that the small particle size ranged and strong signal was detected by the energy-dispersive radiograph spectroscopy analysis. Antimicrobial efficacy was increased in combination with biosynthesized AgNPs (P<0.001). There was low cytotoxic activity of B. cereus AgNPs on Medical Research Council cell strain 5 (MRC-5) cells.

Conclusion

B. cereus-biosynthesized AgNPs have the best antimicrobial effect against resistant bacteria and Candida, in addition to their low cytotoxicity effect on normal cells.
Three-dimensional hemodynamic study of carotid bulb in patients with evolving stroke
Authors: Sakr Ahmed K. , Sadek Yahia K. , Mostafa Alsayed A. , Abdel Wahab Maisa A.
Published: March 2024

Objectives

Determining carotid stenosis severity, monitoring of carotid plaque, and identification of vulnerable plaques are important in identifying patients who would benefit from carotid endarterectomy (CEA). Our work aimed to evaluate the role of three-dimensional (3D) hemodynamic study in patient with evolving stroke.

Patients and methods

The study enrolled 20 patients diagnosed with forebrain stroke selected from our university hospital from March 2017 to February 2019. The severity of stenosis and the length and type of plaques were quantified by 3D ultrasound (US). Overall, 17 patients underwent CEA. The follow-up after operation was done by 3D US with measuring the free lumen area and the operated artery.

Results

There are significant increases in postoperative peak systolic velocity and free lumen area in all patients with stenosis or occlusion, with P value 0.001 and 0.0001, respectively, in most critical cases of the soft plaques. Moreover, there is a higher significant P value (0.003) regarding peak systolic velocity related to carotid end-arterectomy (CEA) with patching than nonpatching.

Conclusion

3D US imaging is a recent tool for improving the visualization and quantification of complex anatomy and pathology as well as monitoring progression of atherosclerosis.
Intrathecal versus intravenous infusion of dexmedetomidine during subarachnoid block in lower abdominal surgeries
Authors: Ashour Fatma H. , Abdellah Asmaa S. , Sayed Ruqaya Mohamed El
Published: March 2024

Background

Adjunct analgesic strategy is an alternative to prolong the analgesic duration and decrease the potential risk of side effects. The objective of this study was to evaluate the efficacy of dexmedetomidine as an adjuvant to subarachnoid anesthesia during lower abdominal surgeries compared with dexmedetomidine intravenous infusion.

Patients and methods

Forty patients, classified as American Society of Anesthesiologists I and II patients, aged 20–50 years, undergoing elective lower abdominal surgeries, were randomly allocated into two equal groups. Group I (n=20) consisted of patients who received intrathecal 0.5% hyperbaric bupivacaine 15 mg (3 ml)+dexmedetomidine (10 µg) for subarachnoid block. Group II (n=20) consisted of patients who received intravenous infusion of dexmedetomidine 0.5 μg/kg/h (without loading) after subarachnoid block. The onset and duration of sensory and motor block, the hemodynamic effects, the duration of analgesia and the incidence of side effects were recorded. Interleukin-6 level was estimated.

Results

Hemodynamic data were comparable between both groups. The mean time taken for the sensory block to reach T10 dermatome and motor block to reach B3 was significantly fast in group I as compared with group II. The time for two segment regressions and regression of sensory block to S2 dermatome and B0 motor block were significantly prolonged in group I compared with group II. The time to first rescue analgesic was prolonged, and the amount of analgesic/24 h was decreased significantly by the addition of dexmedetomidine to bupivacaine. Ramsay sedation scores were highly significant, being higher in group II. The level of interleukin-6 and the incidence of side effects were significantly lower in group I compared with group II.

Conclusion

In lower abdominal surgery, the use of intrathecal dexmedetomidine as an adjuvant to local anesthesia provides good motor and sensory blockade and is associated with mild sedation, decreased incidence of side effects, and inflammatory response compared with intravenous infusion.
Evaluation of plasma fibrinogen and plasminogen activator inhibitor- 1 in type 2 diabetes mellitus patients with coronary artery disease
Authors: El Sayed Zeinab H. , Ismail Sahar Mohamed , ELhakeem Heba A.
Published: March 2024

Introduction

Coronary artery disease (CAD) remains the main cause of death in patients with type 2 diabetes mellitus (T2DM). It is more extensive and diffuse in diabetics in spite of antiplatelet therapy. Hence, the prevention and the early diagnosis of CAD among patients with T2DM are very important. There is a variety of hemostasis abnormalities in T2DM. Therefore, fibrinogen and plasminogen activator inhibitor-1 (PAI-1) may have a link between T2DM and CAD.

Aim

The aim was to evaluate the plasma fibrinogen and PAI-1 levels in some Egyptian patients with T2DM with and without CAD.

Patients and methods

A total of 30 Egyptian patients with T2DM attending the Internal Medicine Department of Al Zahraa Hospital were included in this study. Their ages ranged between 31 and 54 years. Based on ECG changes and echocardiography, the patients were divided into the following: 15 who had CAD and 15 without. Another 15 apparently healthy participants were enrolled as a control group. Blood samples were analyzed for routine blood tests, fasting lipid profile, renal function, liver function, glycosylated hemoglobin, plasma fibrinogen, and PAI-1, which was measured by enzyme-linked immunosorbent assay.

Results

Plasma fibrinogen and PAI-1 were significantly higher in Egyptian patients with T2DM with CAD than those who had only T2DM, and both markers were higher in Egyptian patients with T2DM than healthy controls. Fibrinogen and PAI-1 levels were positively correlated with glycosylated hemoglobin in Egyptian patients with T2DM.

Conclusion

Egyptian type 2 diabetic patients with T2DM are prone to develop CAD more often than not owing to increase in plasma fibrinogen and PAI-1 levels; therefore, we can give a small dose of anticoagulant for all patients with T2DM.
The relationship between Helicobacter pylori infection and control of type 2 diabetes mellitus
Authors: Eisa Shimaa Y. , Ahmed Karima Y. , El Sayed Wagenat E.
Published: March 2024

Backgrou

nd Dyspepsia is a common symptom with a heterogeneous pathophysiology. It occurs in at least 20% of the population. Helicobacter pylori is one of the most common human bacterial pathogen that is present in ∼50% of the global population. It normally is a resident of gastric epithelium. Type 2 diabetes mellitus (T2DM) is a major public health problem, with increasing prevalence globally. It is a metabolic disorder that occurs owing to insulin resistance and relative insulin deficiency.

Objectives

To study the association between H. pylori infection and T2DM and glycated hemoglobin (HbA1c) and comparing it with nondiabetic patients.

Patients and methods

This cross-section study was conducted on 60 patients with age more than or equal to 35 years, of either sex, with history of dyspepsia. There were 20 (33%) males and 40 (67%) females, and their ages ranged between 35 and 62 years, with mean age of 46.5±9.15 years. They were divided into two groups of patients: group I included 30 patients with T2DM, and group II included 30 nondiabetic patients. Patients in group II are subdivided into two groups (according to HbA1c results): group IIA (prediabetic) included 13 patients, and group IIB (nondiabetic) included 17 patients.

Results

H. pylori infection is significantly associated with T2DM, and the incidence of H. pylori in type 2 diabetic patients was significantly higher than nondiabetic patients. H pylori infection is significantly associated with HbA1c level, and HbA1c in H. pylori-positive group was significantly higher than H. pylori-negative group. Moreover, H. pylori infection is significantly associated with prediabetes, and the incidence of H. pylori in prediabetic patients was significantly higher than nondiabetic patients.

Conclusion

The incidence of H. pylori infection was significantly higher in T2DM and prediabetes than nondiabetic patients. Moreover, H. pylori was significantly associated with increased HbA1c level. Further studies are needed to evaluate the effect of H. pylori eradication in glycemic control of T2DM and prediabetes and the effect of glycemic control on reinfection with H. pylori.
Evaluation of early complications after laparoscopic sleeve gastrectomy for the treatment of morbid obesity
Authors: Abdel Razek Mahmoud Abdella , Rabie Omnia Mohamed H.
Published: March 2024

Background

Laparoscopic sleeve gastrectomy (LSG) nowadays is one of the most popular operations for the treatment of morbid obesity. It has good effect in weight reduction and has less complications. The most common complications include leakage, hemorrhage, splenic injury, gastric stenosis, and gastroesophageal reflux.

Aim

To evaluate our experience in LSG in the management of morbid obesity as regards intraoperative and early postoperative complications.

Patients

and methods One hundred and fifty patients with morbid obesity and/or obesity-related comorbidities were included in this study. Their BMI range from 35 to 60 kg/m2 and were managed at Al-Zahraa University Hospital from July 2015 to June 2018. Preoperative demographic data, operative procedure, intraoperative, and short-term follow-up results of LSG are analyzed.

Results

LSG was performed successfully on 149 cases while conversion to open was done in one case due to intraoperative bleeding. The mean operative time was 105±25 min. The mean postoperative hospital stay was 4 days (3–10 days). There was no intraoperative mortality but in two cases mortality was recorded in the postoperative period. Hemorrhage in 1.3%, leakage in 2%, and other complications such as vomiting in three cases and pulmonary embolism in one case were recorded.

Conclusion

LSG safe operation in the management of morbid obesity and the hazards of its complications can be avoided if diagnosed early and managed well. Leakage is the most serious complications which may end by death if not probably treated.
Comparative study between open preperitoneal mesh and Lichtenstein's mesh in inguinal hernia repair
Authors: Hefida Mohamed G. , Razek Mahmoud A.A. , Youssef Hoda A.A.
Published: March 2024

Background

There is still a great debate regarding the optimal approach for inguinal hernial repair.

Objective

This study aims to compare between the preperitoneal and Lichtenstein approaches in the management of inguinal hernias.

Patients and methods

We included 50 cases that were randomly divided into two groups: the first group included 25 cases that underwent the preperitoneal repair, whereas the other group included the remaining cases that underwent Lichtenstein repair.

Results

Intraoperative bleeding was encountered more in the preperitoneal group. Regarding complications, seroma and scrotal edema were encountered more in the Lichtenstein group (P<0.05). Moreover, chronic inguinal pain was more prevalent in the same group.

Conclusion

Preperitoneal mesh repair offers more advantages over Lichtenstein repair, especially regarding seroma, scrotal edema, and chronic inguinal pain.
Role of hemoglobin A1c in prediction of high-risk plaque and plaque extent assessed by coronary computed tomography angiography
Authors: Ali Nadia M.M. , Hady Bassem M.A. , Ahmed Ahmed M.
Published: March 2024

Background

Diabetes mellitus is a worldwide disease that is related to the distribution and severity of coronary artery disease (CAD). Hemoglobin A1c (HbA1c) was reported in many studies to predict the extent and severity of CAD. Coronary computed tomograghy angiograghy (CCTA) is a useful noninvasive tool for detecting CAD.

Aim

The study aimed to evaluate the role of HbA1c in prediction of high-risk plaque and plaque extent assessed by CCTA among patients with diabetes mellitus.

Patients and methods

A total of 30 diabetic patients who had chest pain or dyspnea or had multiple risk factors of CAD were included in the study. HbA1c was estimated in all patients. The severity and extent of CAD among study population were assessed by several CCTA scores including coronary artery calcium score, segment involvement score (SIS), and segment stenosis score (SSS).

Results

The patients were classified into two groups according to values of HbA1c: group 1 included patients with HbA1c less than 7.0 (14 patients), and group 2 included patients with HbA1c more than or equal to 7.0 (16 patients). The study revealed a significant increase in the SIS, SSS, coronary artery calcium score, number of all lesions, number of obstructive lesions, and number of vessels affected in patients in group 2 compared with those in group 1. There was a strong positive correlation between HbA1c and SIS, SSS, and the presence of obstructive lesions (r=0.663, 0.659, and 0.589, respectively).

Conclusion

HbA1c is associated with the extent and severity of CAD.
Role of duplex doppler ultrasound in evaluation of patients with diabetic nephropathy
Authors: Elshweehy Samar A. , Mohammed Hosnia A. , Osama Sally M.
Published: March 2024

Background

Color Doppler evaluation of the renal parenchyma may suggest functional or structural changes within the kidneys and could provide useful diagnostic and prognostic information in diabetic nephropathy.

Aim

The aim was to assess the usefulness of duplex sonography with Doppler waveform analysis in the evaluation and assessment of renal vascular resistance in diabetic patients.

Patients and methods

This case–control prospective study included a total of 30 patients: 20 diabetic patients and 10 healthy controls. Renal parameters such as renal length, renal parenchymal thickness, parenchymal echogenicity, intrarenal resistive index (RI), and biochemical parameters such as fasting blood sugar, serum creatinine, and urine protein were recorded in all study participants. For the purpose of comparison, the diabetic patients were further subdivided into preclinical nephropathy, incipient nephropathy, overt nephropathy, and renal failure subgroups based on the stage of diabetic renal disease.

Results

A progressive increase in renal RI values was noted with progression of diabetic nephropathy. RI values showed a positive correlation with albuminuria and serum creatinine, and this correlation was found to be statistically significant.

Conclusion

Intrarenal RI measured by color Doppler ultrasonography has an important value in identifying diabetic patients who are developing nephropathy and can be used as an additional diagnostic tool in diagnosing diabetic nephropathy as well as to monitor progression of nephropathy.
Retinal changes after uncomplicated phacoemulsification in diabetic patients
Authors: Ibrahim Rashed Rasha M. , Abd Allah Ahmed S. , Kamel Rehab M. , Muhammed Tamer F.
Published: March 2024

Aim

To detect the incidence and progression of diabetic retinopathy (DR) and macular edema following uncomplicated phacoemulsification in cataractous diabetic patient.

Patients and methods

A prospective randomized interventional study was performed at Al-Zahraa Hospital, during the period from April 2017 to December 2018. Informed written consent was taken from each participant in the study. A total of 60 eyes of 30 cataractous diabetic patients with type II diabetes were classified into two groups: group A included 30 cataractous eyes that underwent uncomplicated phacoemulsification surgeries with posterior chamber foldable intraocular lens implantation, and group B included contralateral nonoperated 30 eyes of the same patients.

Results

There was a statistically significant increase of mean postoperative central macular thickness (CMT) at 1, 3, and 6 months in comparison with mean preoperative CMT in group A (P<0.05). It was 223.43±15.95 preoperatively. At all duration of follow-up, the mean CMT in group A was more than that in group B, with a statistically significant difference (P>0.05).

Conclusion

Phacoemulsification surgery most probably does not cause acceleration of DR in patients having no DR or mild DR and no maculopathy preoperatively.
Role of coronary artery calcium score in prediction of coronary artery stenosis in symptomatic patients with suspected coronary artery disease
Authors: Zaki Eman Rashed , Abdel-Aziz Islam Shawky , Ismail Mona Sallam , Fereig Hanaa Mohamed
Published: March 2024

Introduction

The coronary artery calcium (CAC) score has been proposed as an alternative approach for stratifying cardiovascular risk.

Aim

To assess the role of CAC score in prediction of coronary stenosis in symptomatic patients with intermediate probability for coronary artery disease (CAD).

Patients and methods

A total of 80 symptomatic patients with intermediate probability for CAD underwent thorough history taking and clinical examination. Computed tomographic (CT) scan was done for all patients. A total of 48 (60%) patients with CAC score less than 400 HU (group A) underwent CT angiography: 30 (62.5%) patients had significant coronary stenosis (SCS) and were referred to invasive coronary angiography (ICA), whereas 18 (37.5%) patients had no SCS. Overall, 32 (40%) patients with CAC score more than 400 HU (group B) were referred directly for ICA.

Results

ICA for 62 patients was performed: 30 (62.5%) patients were referred from group A, and all had SCS (100%), whereas 30 (93.7%) patients of 32 referred from group B had SCS. Using logistic regression analysis, CAC score was the only predictor of SCS (P=0.024). Receiver operating characteristic curve data revealed CAC more than 311.2 HU as a cutoff point for prediction of SCS, with specificity of 85.0%, sensitivity of 63.3%, and area under the curve of 74.7%. CT angiography sensitivity for detection of stenosis less than or equal to 50%, stenosis more than 50%, and stenosis more than 70% was 73, 62.5, and 94%, respectively; specificity of 96.8, 99.4, and 99.4%, respectively; and overall accuracy of 85.0, 81, and 96.9%, respectively, with negative predictive value to rule out SCS 99%.

Conclusion

CAC score is predictive for the presence of SCS in patients, with intermediate probability for CAD.
Assessment of plasma concentrations of growth arrest-specific protein 6 in preterm infants with late-onset sepsis
Authors: Mohamed Samar F. , AbuShady Mariam , El Bagoury Iman M. , Ahmed Mohamed F.
Published: March 2024

Introduction

Late-onset sepsis (LOS) in preterm infants is a leading cause of mortality and morbidity.

Aim

To assess the level of plasma growth arrest-specific protein 6 (Gas6) in preterm infants with LOS and correlate its level with other clinical and laboratory factors in those patients.

Patients and methods

This is a case–control study that was carried out on 90 preterm newborns admitted at Ghamra Military Hospital, Cairo, Egypt. All patients were divided into three groups: group 1 included 30 preterm infants with confirmed LOS and positive blood culture; group 2 included 30 preterm infants with clinically evident LOS and negative blood culture, and group 3 (control group) included 30 nonseptic preterm infants. The preterm infants were subjected to full history taking, clinical examination, and all investigations, including Gas6, done by enzyme-linked immunosorbent assay.

Results

Our results showed a highly statistically significant increase in Gas6 in groups 1 and 2 rather than group 3, with P value less than 0.001. Moreover, there was a highly statistically significant increase in Gas6 in group 1 rather than group 2.

Conclusion

Our results indicate that Gas6 is an accurate biomarker for the diagnosis of LOS.