bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of Effects of Preoperative Oral Domperidone on Gastric Residual Volume after Clear Fluid Ingestion in Patients Scheduled for Elective Surgeries
Authors: Mahmoud Deabes Ahmed Abdelhamid Mahmoud , Ahmad Elewa Gamal Eldin Mohammad , Ali Sultan Sherif Sayed , Alansary Amin Mohammed
Published: July 2024

Background

Oral Dopmeridone is a prokinetic drug that enhance gastric emtptying, which has a positive effect in decreasing the gastric residual volume, subsequently decreasing the risk of pulmonary aspiration

Aim of the Work

This study to aimed to assess the effect of oral Domperidone preoperatively on gastric residual volume by ultrasound for patients undergoing elective surgeries under general anesthesia as a primary outcome and postoperative nausea and vomiting as a secondary outcome.

Patients and Methods

We applied our study on 40 patients were divided into two equal groups: Group A (study group): The patients received 400 ml of apple juice as a clear fluid, two hours preoperatively, and oral Domperidone tab (Motilium 10mg/tab, Janssen comp.) & Group B (control group): The patients received 400 ml of apple juice as a clear fluid two hours preoperatively with a placebo (Folic acid 500 mcg, dietary supplement), with the same inclusion and exclusion criteria.

Results

There was statistically significant decrease mean in group A compared to group B according to Ultrasound Measurements in the right lateral position after 2 hrs has been demonstrated about D1 right lateral position; D2 right lateral position; CSA right lateral position and calculated gastric volume right lateral position (ml). In addition to a statistically significant decrease mean in after 2hrs. compared to after 1hr. according to Ultrasound Measurements in the right lateral position about D1 right lateral position; D2 right lateral position; CSA right lateral position and Calculated gastric volume right lateral position (mL) in group A. There is also a statistically significant decrease mean in after 2hrs. compared to after 1hr. according to Ultrasound Measurements in the right lateral position about D1 semi-sitting; D2 right lateral; CSA right lateral position and Calculated gastric volume right lateral position (mL) in group B. At last, there has been a statistically significant higher change (after 2hrs.-1hr.) in group A compared to group B according to Ultrasound Measurements in the right lateral position about D1 right lateral position; D2 right lateral position; CSA right lateral position and Calculated gastric volume right lateral position (mL), with p-value (p < 0.05 significant).

Conclusion

Preoperative oral Domperidone intake was able to decrease the GRV measured by ultrasound, more than the decrease of GRV by applying placebo.
Prognostic Value of Prolonged QT Interval in Patients with Acute Ischemic Stroke
Authors: Said El Fayomy Mohamed Kamal , Moustafa Zakaria Abdelaziz , Eldin ElSerwi Heba Bahaa
Published: July 2024

Background

Early predictors of mortality and poor functional outcome are crucial for planning the level of care and optimizing resource utilization. Nonetheless, rapid and noninvasive methods for assessing the prognosis of patients with acute hemorrhagic stroke in the emergency department (ED) are currently lacking.

Aim of the Work

The aim of this work is to assess and evaluate the QT- prolongation in patients with acute stroke without known cardiac disease and to correlate between prolonged QT interval and different neurological outcomes.

Patients and Methods

This was a case control study. Data from patients with acute ischemic stroke (stroke patients) who were admitted to the neurological intensive care unit were collected for the period from June 2021 to December 2021 at the First Affiliated Ahmad Maher teaching hospital, and patients in other departments were enrolled as controls.

Results

This study had several limitations. First, the study was performed in a single center, which may reduce its generalizability. In addition, we were unable to determine non-fatal long-term outcomes, such as major adverse cerebro-cardiovascular events (MACCE). Second, the mechanism underlying QTc interval prolongation remains tentative because ECG was performed at single time points, not overtime. Furthermore, major cardiac and non-cardiac comorbidities were defined as the previous history and/or ECG results at admission, thus possibly underestimating subclinical conditions. In addition, the contribution of each cardiac and non-cardiac condition to QTc interval prolongation is not equally the same. We also could not absolutely exclude patients with coronary artery disease who shared similar risk factors because we did not conduct echocardiography or coronary angiography, and this may have affected the QTc interval changes in ECG.

Conclusion

Prolonged QTc interval was associated with the increased risk of long-term mortality, in parallel with the increasing trend of the prevalence of cardiovascular risk profiles and stroke severity, across sex differences, such as different distributions of age, comorbidities, morality, and QTc intervals in AIS patients. Acute ischemic stroke patients may have a longer QT interval and a higher incidence of electrocardiogram abnormalities. In clinical practice, careful attention should be paid to acute ischemic stroke patients to prevent malignant arrhythmia.
Comparative Study between Rocuronium And Magnesium Sulfate as Adjutants to Regional Anesthesia for Ophthalmic Surgeries using Peribulbar Block
Authors: Nagy Mohamed , El-Ella Sahar Abo , El-Shafey Mohamed , Ragaey Melad , Helal Amr
Published: July 2024

Background

Peribulbar anesthesia is frequently used in cataract surgeries. Compared to retrobulbar anesthesia, this approach is associated with less significant consequences. However, it has the disadvantages of a slower onset of orbital akinesia and the frequent requirement for block supplementation.

Aim of the Work

To evaluate the effect of addition of magnesium sulfate and rocuronium to standard local anesthetics mixture on the time of onset of globe and lid akinesia and corneal anesthesia for peribulbar block in ophthalmic surgeries.

Patients and Methods

This Prospective Double-blinded Randomized Study was carried out in the ophthalmic surgery unit, Ain Shams university hospital from January 2019 to April 2020. After institutional Ethical Board approval and obtaining written informed patients’ consents, 75 patients from both sexes, ASA physical status I-III, aged 40-80 years and having an Axial globe length less than or equals 26 mm scheduled for cataract surgery under peribulbar block were included in the study.

Results

Our study found statistically significant more rapid onset of action (mean time to start surgery) in rocuronium group (7.00±1.22) than control group and magnesium sulfate group (9.00±1.47 and 9.00±1.15) respectively, (p < 0.001); Moreover, no statistically significant difference was reported between control group and magnesium sulfate group. In addition, no significant difference was reported regarding duration of surgery between groups

Conclusion

Adding Rocuronium to local anesthetic mixture in peribulbar block during cataract surgery enhances ocular akinesia and corneal anesthesia and reduces the need for supplementary injections with no side effects and that was significantly better than Magnesium sulfate in term of rapid onset and time needed to achieve adequate condition to begin surgery. However, adding Magnesium sulfate showing good results regarding akinesia, corneal anesthesia and need for supplementary injections but it did not significantly fasten the onset of block and hence the time to start surgery.
Impact of Sub-Anesthetic Dose of Ketamine on Post Spinal Hypotension in Cesarean Delivery
Authors: Mahmoud El-Gamal Ahmed Adel , Abdel Hamid Amr Essam El Din , Abd Elsamie Hoda Shokri , Abdel-Tawab Samar Mohamed
Published: July 2024

Background

Spinal anesthesia is the commonest technique used in Cesarean Section (CS) and most frequently associated with maternal hypotension, for whicha lot of techniques have been described to prevent but an effective method is yet to be found.

Objectives

The aim was to study the effect of using a sub-anesthetic dose of ketamine to prevent post-spinal hypotension in CS delivery.

Methods

This double-blinded randomized controlled study was conducted on 60 participating parturients who were ASA І, П term pregnant. All the parturients received spinal anesthesia. The parturients were then randomly divided into two equal groups (n = 30 in each); ketamine group received a sub- anesthetic dose of ketamine of 0.5 mg/kg IV bolus in 3 ml saline and control group received the same volume of normal saline IV bolus. Heart Rate (HR) and Mean Arterial blood Pressure (MAP) were recorded at baseline (5 minutes prior to the intrathecal injection), at 5, 10, 15 and 20 minutes after the injection and then every 15 minutes till the end of the operation. Incidences of hypotension and severe hypotension were recorded. The total dose of ephedrine was recorded. Modified Ramsay sedation score was recorded at baseline then 5, 10, 15, 30, 45 minutes after injection and then at the end of the operation.

Results

The study revealed that ketamine didn’t prevent hypotension, it only delayed it for 10 min compared to control group 5 min. Also, observed that total ephidren dose significantly decreased in ketamine group compared to control group. And sedation scores in the first 30 min were higher in ketamine group. HR wasn’t affected. No changes in APGAR score were noticed between the two groups. No side effects from ketamine except for nystagmus.

Conclusion

This study concluded that the use of intravenous ketamine in low dose (0.5mg/kg) doesn’t prevent postspinal hypotension but it only decreases ephidren requirements.
Ultrasound Guided Erector Spinae Block Using Bupivacaine – Magnesium Sulphate versus Bupivacaine – Dexmedetomidine for Postoperative Analgesia in Lumbar Spine Surgeries
Authors: Soliman Hussien Ehab Hussien , Abdelmageed Waleed Mohamed , Alwedeny Hadeel Magdy , Refaat Sameh Ahmed , Fouly Mohammed Abdelmoneim
Published: July 2024

Purpose

Lumbar spine surgeries are associated with significant postoperative pain. Erector Spinae Plain Block (ESPB) is a new ultra-sound guided block technique for such surgeries . We aimed to explore the analgesic effect of adding dexmedetomidine and magnesium sulfate as adjuvants to bupivacaine in ESP.

Patients and Methods

Fifty two patients scheduled for lumbar spine surgery were randomly allocated into two groups to receive an ESP block., A total volume of 25 ml, [10 mL 0.5% bupivacaine diluted in normal saline (NS) and 2 mg/kg MgSO4 in group (MG group) and 10 mL 0.5% bupivacaine in NS with 2 μg/kg dexmedetomidine in group (DEX group)] were injected. The block was administered preoperatively before anesthesia induction. Postoperatively, hemodynamics, visual analog scale scores, the first request for analgesia, total analgesic consumption, and side effects were observed for 12 hours.

Results

The demographic data including age, gender, height, weight and BMI showed no difference between both groups, also, ASA classification and duration of surgeries done showed no difference between the studied groups (P > 0.05). There were no recorded complications in both groups (P > 0.05). There was no significant difference among both groups regarding basal, and follow up period at 15 min values of heart rate, and basal value of mean arterial pressure (P > 0.05), but for the intraoperative hemodynamic parameters including MAP and HR, both parameters decreased significantly in the group which received dexmedetomidine in comparison to the other group except follow up values at 180 and 210 min, as no significant differences were recorded among both groups (P > 0.05). Regarding postoperative pain, the visual analogue score (VAS) was used to record it postoperatively every 2 hours while we found a statistically significant difference regarding the VAS from 4 to 6 hours postoperatively as P < 0.005, but, we found no difference regarding the postoperative total consumption of nalbuphine (P < 0.005) . As for patient satisfaction in the studied groups, an anaesthesia satisfaction questionnaire was developed, validated (Kappa coefficient). Dexmedetomidine group was associated with a significant increase in satisfaction compared to MG group (P < 0.05).

Conclusion

Magnesium sulphate and dexmedetomidine seem to be both effective adjuvants to bupivacaine in ESP blocks for postoperative analgesia in patients undergoing lumbar spine surgeries, with slightly better analgesia provided by dexmedetomidine.
Predictive Value of Ultrasonic Diaphragm Thickening Fraction on Successful Weaning in Postoperative Cardiothoracic Surgery Patients with Chronic Obstructive Pulmonary Disease (COPD)
Authors: Zaki Gamal Fouad , Elkomos Samaan Paula Micheel , Jacoup Mina Samy , Kassem Amr Ahmed
Published: July 2024

Background

The diaphragm is the most important muscle of respiration and is largely responsible for the change in the intra thoracic pressure. In mechanically ventilated patients, the diaphragm can develop atrophy and weakness leading to prolonged duration of mechanical ventilation. Many studies reported a high prevalence of diaphragm dysfunction during weaning, and it was found to be associated with poorer clinical outcomes.

Objective

To assess the predictive value of diaphragm thickening fraction (DTF) by bedside ultrasound on successful weaning in postoperative cardiothoracic surgery patients with COPD.

Subjects and Methods

This prospective study was conducted on 40 subjects at cardiothoracic ICU unit at Elmaadi Military hospital during the period from (September,2021) to (July,2022) after approval of the research Ethical committee at faculty of medicine, Ain shams university.

Results

Regarding the relation between the two studied groups and diaphragmatic thickness, the thickness was decreased in the failed group than the successful group during inspiration, expiration and thickness fraction %, with significant difference between two groups as p-Value was <0.05. There was an increase in the duration of ICU stay & mechanical ventilation in the failed group compared to the successful group, with significant difference between two groups as p-Value was <0.05. Regarding the correlation between ICU stay & mechanical ventilation and diaphragmatic thickness, there were negative correlation between ICU stay & MV duration and all parameters of the diaphragmatic thickness, with significant difference as p-Value was <0.05.

Conclusion

Weaning success in mechanically ventilated postoperative cardiothoracic surgery patients with COPD can be predicted by ultrasonography-based evaluation of diaphragm function by analyzing diaphragmatic thickness fraction. It is a practical, feasible, non-invasive technique that may be used at the bedside to rule out diaphragmatic dysfunction.
Comparative Study between Pectoral Nerve Block Type-II (PECS II) and Serratus Anterior Plane Block (SAPB) in Postoperative Analgesic Efficacy in Modified Radical Mastectomy
Authors: Riad Moustafa Kamel , El Moneim Fouly Mohamed Abd , Awad Taeimah Mohamed Osman , Ahmed Ahmed Alaa Mohamed
Published: July 2024

Background

Breast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women.

Aim of the Work

The aim of this work is to evaluate the efficacy of ultrasound guided pectoral nerve block type two versus Serratus Anterior plane block regarding postoperative pain control in patients undergoing modified radical mastectomy.

Patients and Methods

After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospitals. It included 70 female patients undergoing modified radical mastectomy were divided randomly into two groups, each group consisted of 35 patients; Group I patients received pectoral nerve block type two (PECS II), Group II patients received Serratus Anterior Plane Block (SAPB).

Results

The results of our study showed that there was no statistically significant difference between groups regarding demographic data. There was a statistically significant decrease in Mean blood pressure (mmHg) in Group I compared with Group II from hour-4 to hour-16 postoperative. However, a statistically significant decrease in group I compared to group II regarding postoperative heart rate (beat/min) from hour-4 to hour-16. A statistically significant decrease in group I compared to group II regarding visual analogue score for pain from minute-30 to after 12 hrs also was found. The current study shows highly statistically significant difference between groups as regard the need to intraoperative fentanyl incremental doses, time of first rescue analgesia, number of patients who received postoperative pethidine and total dose of opioids during the first 24 hrs.

Conclusion

Our findings suggest that PECS II block is more effective regarding postoperative pain control in patients undergoing modified radical mastectomy under general anesthesia compared to SAPB especially in the first 16 hours postoperative. Also patients underwent PECS II block show less need to intraoperative fentanyl incremental doses, less need to postoperative opioids and longer duration for time of rescue analgesia compared to patients underwent SAPB.
Role of Follistatin-Like 1 in Development of Insulin Resistance in Overweight and Obese Children
Authors: Monir Eman Nader , Moustafa Amr S , El Gendy Yasmin G , Ibrahim Haya E , Tarek Marwa
Published: July 2024

The increasing prevalence of childhood obesity is considered a public health issue in both developed and developing countries. The state of chronic low-grade inflammation associated with obesity contributes to the development of insulin resistance. However, the molecular mechanisms that link obesity to inflammation are not fully understood. Follistatin-like 1 (FSTL1) is a proinflammatory cytokine that is expressed in adipose tissue and secreted by preadipocytes/adipocytes. The aim of this study is to evaluate serum level of FSTL1 in overweight/obese children as compared to normal healthy subjects, and correlate serum FSTL1 level with inflammation and insulin resistance. Our work showed that overweight and obese children had significantly higher levels of serum FSTL1, high sensitivity C-reactive protein (hs-CRP) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). In conclusion, serum FSTL1 can be a useful biomarker for obesity in children. Moreover, FSTL1, being a pro inflammatory cytokine, may provide a possible link between obesity, inflammation, and the development of insulin resistance in the overweight/obese children.
Effect of Right Ventricular Pressure versus Volume Overload on Right Ventricular Arterial Coupling Ratio: A 3-Dimensional Echocardiographic Study
Authors: Kamal Mohamed S , Amin Youssef , Roushdy Alaa , El fiky Azza
Published: July 2024

Background

In congenital heart disease, the RV has been the forgotten chamber for many decades. Congenital ASD leads to volume overload on the RV while PH leads to pressure overload. The 3D ECHO has become noninvasive and readily available method for assessment of the RV-PA coupling ratio by dividing the RV SV/ RV ESV which correlates with the RV function. The aim of our study was to compare that ratio between ASD (RV volume overloaded) patients and PH (RV pressure overloaded) patients .

Methods

The study included 90 patients divided into 3 equal subgroups; congenital ASD group, PH group and control group. ECG-gated 2D and 3D ECHO study was done to the whole subjects.

Results

Showed that ASD and PH groups showed statically significant difference as regarding RV volumes and RV-PA coupling ratio in relation to the control group. However, the PH group was affected more than the ASD group as regarding the RV- PA coupling ratio with mean coupling of ASD group was 1.14, 0.77 in PH group and 1.25 in controls with P value between ASD and control groups was 0.054 Vs < 0.0001 between PH and control groups.

Conclusion

In the current study the RV-PA coupling ratio as measured by 3D ECHO by dividing SV /ESV was markedly reduced (uncoupling) in patient with pressures overload (PH group) and to lesser extent in volume overload (ASD group) compared to the control group.
Efficacy and safety of colchicine use on LV systolic function using speckle – tracking Echocardiography in patients with anterior ST segment elevation myocardial infarction (STEMI) Undergoing Primary Percutaneous Coronary Intervention
Authors: Radwan Mohamed , EL Etriby Shehab , Khorshid Hazem , abdelrahman Ahmed
Published: July 2024

Background

acute ischemia causes myocardial necrosis with subsequent endogenous inflammation, leading to myocardial damage, ventricular dilatation, dysfunction, cardiac remodeling and dysfunction. Colchicine is a substance with potent anti- inflammatory properties, which allows for safe use in patients with cardiovascular disease, STE-based GLS can be used to assess global and regional LV function. The aim of this work is to study the efficacy and safety of colchicine administration on LV systolic function in patients with STEMI underwent primary PCI by using 2D speckle tracking Echocardiography.

Methods

The study included 200 STEMI patients divided into 2 equal subgroups; colchicine group, and control group. speckle tracking echocardiography was done to the whole subjects to asses LV systolic function.

Results

Assessment of LV systolic function (EF%) as calculated by Simpson’s method showed higher significant improvement in colchicine group (P-value = 0.011) and highly statically significant average GLS by speckle tracking echocardiography during follow up after 6 months, also colchicine was non inferior to placebo regarding acute and chronic complication.

Conclusion

the safety and efficacy of colchicine in anterior STEMI patients underwent PPCI. It significantly improve LV systolic function measured by Ejection fraction and average GLS speckle tracking Echocardiography after 6 months follow up.
Short-term outcomes of complete coronary revascularization compared to staged revascularization during primary percutaneous coronary intervention in patients with multivessel coronary artery disease: Presenting with ST segment elevation myocardial infarction
Authors: Alnashar Islam Alsayed , Almissiri Ahmed Mohamed , Guindy Ramez Raouf , Zahran Mohamed
Published: July 2024

Background

Complete revascularization has been recently popularized for management of ST-Segment–Elevation Myocardial Infarction (STEMI) patients with multivessel disease scheduled for Primary Percutaneous Coronary Intervention (PPCI). We assessed the three months outcomes of Compete Revascularization (CR) compared to staged revascularization in patients with multivessel disease undergoing PPCI.

Materials and methods

We conducted a randomized, open-label, comparative trial on STEMI patients with multivessel disease indicated for PPCI in the setting of STEMI. Patients were randomly assigned to undergo PCI revascularization of the non-culprit lesions during the index procedure, Complete Revascularization (CR) or within 30 days later after discharge, Staged Revascularization (SR). The primary endpoint was the composite of all-cause mortality, re-infarction, Heart Failure (HF), recurrence of angina symptoms, cerebrovascular stroke, and need for revascularization.

Results

A total of 100 patients were randomized in 1:1 ratio. The primary end point occurred in 24% of the patients in CR and 20% in SR group (p = 0.62). The incidence of HF (14% vs. 12%; p = 0.76), repeated revascularization (4% in each group), persistent angina (8% vs. 2%, p = 0.16), all-cause mortality (2% in each group), MI (4% in each group), stent thrombosis (0% vs. 4%; p = 0.15), and cerebrovascular accident (0% vs. 2%; p = 0.32).

Conclusion

Staged revascularization provided comparable short-term benefits to complete revascularization in STEMI patients with multivessel disease undergoing PPCI. The present trial demonstrated that complete revascularization was associated with a trend towards higher incidence of stent thrombosis and CVA than staged revascularization.

Key words: ST-segment–elevation myocardial infarction, Primary percutaneous coronary intervention, Revascularization, Multivessel disease.

Abbreviations: CAD: Coronary Artery Disease; FFR: Fractional Flow Reserve; PCI: Percutaneous Coronary Intervention; PPCI: Primary Percutaneous Coronary Intervention; STEMI: ST-segment–Elevation Myocardial Infarction; CVA: Cerebrovascular Accidents.
Prognostic Value of QRS Complex Fragmentation in Patients with Acute Anterior STEMI undergoing Primary PCI During in-Hospital Stay
Authors: Elgaly Mahmoud Gamal , Farouk Mohamed Moustafa , Abdeltawab Adham Ahmed
Published: July 2024

Background

Primary percutaneous coronary intervention (PCI) as a type of coronary reperfusion therapy may lead to recanalization and improved myocardial reperfusion in patients with ST elevation myocardial infarction (STEMI).

Aim of the Work

The aim of our study is sought to investigate the prevelance of fQRS complex in ECG of patients admitted with acute anterior STEMI undergoing primary PCI and its short-term prognostic value during hospital stay.

Patient and Methods

In the current study, 156 consecutive patients with anterior STEMI being treated with primary PCI between July 2021 and March 2022 were enrolled. Patients were included in the study if they presented with symptoms that were identified typically as typical chest pain lasting for more than 20 min; had ST-segment elevation ≥1 mm in two contiguous electrocardiographic and had undergone primary PCI including balloon angioplasty, thrombus aspira tion and/or stent implantation.

Results

Our results study showed that, in patients with a diagnosis of anterior STEMI, the presence of fQRS at admission ECG is associated with the development of MACE at short-term follow-up and higher mortality. In addition, fQRS was the strongest predictor of MACE in patients with acute MI after adjustment for the risk factors of ischemic heart disease.

Conclusion

Prevalence of fQRS complex on admission ECG in patients with acute anterior STEMI undergoing primary PCI is common. Presence of fQRS in these patients has independently predicted prognosis regarding LVEF values, Cath lab events, MACE and mortality during hospital stay. Therefore, fQRS can be incorporated in risk stratification tools and help in management of patients with acute anterior STEMI undergoing primary PCI.
COVID 19 Radiological Severity and Its Correlation with Complete Blood Picture Indices
Authors: Mohamed Sahar Mamdouh , Abd Eldaym Aya Mohamed , Ezzelregal Hieba Gamal , Eldiasty Shaimaa Elmetwally
Published: July 2024

Background

The International Committee on Taxonomy of Viruses (ICTV) named this novel coronavirus as SARS-CoV-2. This infection is still spreading but now less than before, and this virus poses a serious threat to public health, though joint prevention and quarantine mechanisms in almost all provinces of mainland China have been confirmed to be enacted. Due to a lack of specific antiviral treatments and pressure of clinical treatment, thousands of severe cases have died every day worldwide. Our university isolation hospitals as a part from the Egyptian isolation hospitals were in the first line in facing this epidemic.

Objectives

This work was to investigate the radiological severity in COVID 19 patients and its correlation with complete blood picture indices among a sample of Egyptians.

Patients and method

This was an observational, analytical & prospective study, recruited 30 cases of COVID 19 patients admitted to Ain Shams University isolation Hospitals. All patients were confirmed to be COVID 19 positive by PCR. Through history taking and clinical examination was done. On admission CBC and CT chest were documented analyzed and correlated.

Result

30 COVID 19 patients were recruited with 60% of them were mals, 66% have no comorbidities. Their ages were 54.833± 13.097 ranging from 25 to 85 years old, their most distressing symptom was dyspnoea (53%). Their radiological probability of CT chest were CORADS 5, CORADS 4 and CORADS 3 representing (63.33%, 23%.33, 13.33%) respectively. Almost more than 4/5 (83.33%) of them were admitted in the ward. All patients admitted in the ICU died (16.67%). A highly significant decrease in absolute lymphocytic count with the increase in the degree of probability of CT chest (CORADS degree) with (P value less than 0.001). Also a significant decrease in absolute monocytic count with the increase in the degree of probability of CT chest (P value 0.015). No other CBC indices were found to be have any significant correlation with CT chest severity or probability scoring. A cutoff value of 1.16 thousand /ml or less for lymphocytes and 0.4 thousand /ml or less for monocytes can predict CT chest to be CORADS 5.

Conclusion

A strong association with lymohocytic and monocytic count of the complete blood picture of COVID 19 patients with the radiological probability of CT chest.
Immunohistochemical Assessment of Phosphodiesterase 4A and Phosphodiesterase 4D in Relation to Serum Levels of Phosphodiesterase 4 in Patients with Chronic Plaque Psoriasis
Authors: Abou El-Fadl Dalia Abd El-Gawad , El-Sayed Mahira Hamdy , Abdel-fattah Nermeen Samy , Nada Ola Hassan
Published: July 2024

Psoriasis is an immune-mediated genetic skin disease. The underlying pathomechanisms involve complex interaction between the innate and adaptive immune system. T-cells interact with dendritic cells, macrophages, and keratinocytes, which can be mediated by their secreted cytokines. Dysregulation of the immune response is thought to result in a chronic imbalance in the production of pro-inflammatory and anti-inflammatory cytokines.

Phosphodiesterase (PDE4) act as proinflammatory enzymes via degradation of cAMP, whereas PDE4 inhibitors play an anti-inflammatory role in vitro and in vivo. In particular, topical and systemic PDE4 inhibitor has been approved for the treatment of psoriasis and psoriatic arthritis. However, little is known on the expression pattern of PDE4 in psoriasis. We report that serum PDE4 are overexpressed in blood of patients with chronic plaque psoriasis, as compared with normal controls. PDE4 expression is up-regulated in psoriatic dermis as compared with normal skin, with particular regard to dermal lymphocytes. Taken together, these results indicate that PDE4 play an important role in psoriasis pathogenesis and supports promises put on topical PDE4 inhibitors in treatment of psoriasis.
Comparative Study between Endoscopic Surgical Excision of Anterior Glottic Web with or without Keel Placement
Authors: Hasan Mohamed Amir , Elaty El Sersy Hesham Abd , Saad Alansary Mohamed Adel , Abd Elaty Ahmed Mohamed Kamel
Published: July 2024

Background

A focal narrowing of the airway caused by fibrotic tissue at the level of the true vocal folds is known as anterior glottic web. Congenital anterior glottic webs are less common than acquired anterior glottic webs. Endotracheal intubation, laryngeal trauma or surgery close to the anterior commissure, radiotherapy, and, in rare cases, inflammatory processes can cause them at any age.

Objective

To decide the need for endoscopic keel placement for management of anterior glottic web, prevention of vocal cord adhesions and to reduce the recurrence.

Patients and Methods

This study was systematic review and meta-analysis study included research articles with the following criteria; retrospective, prospective, case series, case report studies, published in English language, in the last 25 years, only studies on humans, studies on congenital and acquired anterior glottic web, studies with endoscopic keel placement, and studies without keel placement.

Results

The main findings of the current study was that; among keel used studies, the recurrence proportion was 13.5% with 95% Confidence interval (5.5%-24.2%), the proportion of granulation from pooled studies was found in 3.44% with 95% Confidence interval (1.16%-7.5%)and regarding voice improvement in this meta-analysis high significant improvement (94.2%) with 95% Confidence interval (85.8%-99%) was reported; Recurrence among the 3 studies did not use keel was 30.6% with 95% Confidence interval (7%-61. 8%). However, the voice improvement was reported among 97.4% with 95% Confidence interval (91.5 %-99.9%)

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2019.

Conclusion

The optimal treatment of acquired anterior glottic web remains controversial; Placement of a keel has low recurrent rate and good voice improvement but had several disadvantages such as the need for two separate operations under general anaesthesia, prolonged recovery, and the risk of infection and granuloma formation. However other techniques as the mucosal flap technique had better voice improvement without granulation formation with high success rates.
Serum Vitamin-D and Benign Paroxysmal Positional Vertigo (BPPV)
Authors: Elsayed Ahmed Rafat A , Taha Hesham M , Elserafi Gamal M , Elkabarity Rasha H
Published: July 2024

Background

Vitamin D deficiency can occur when usual intake is lower than recommended levels over time, exposure to sunlight is limited, the kidneys cannot convert 25(OH)D to its active form, or absorption of vitamin D from the digestive tract is inadequate. Decreases vitamin D levels show complex relationships with diseases, which can affect the inner ear. The aim of study: To examine the level of serum 25-OH vitamin D concentrations on patients diagnosed with BPPV.

Patients and Methods

This study included 60 subjects; 40 subjects with BPPV (study group) and 20 healthy persons (control group). Both groups underwent full history taking, vitamin D level assay, otological examination and audio-vestibular evaluation.

Results

Subjects with BPPV (study group) have lower vitamin D levels than norms (control group). The recurrence of BPPV occurs in subjects have lowest vitamin D levels. Vitamin D deficiency more in elderly & females. Hearing may be affected.

Conclusion

This study supports the relationship of lower vitamin D level with the occurrence of BPPV. Also, recurrent BPPV episodes are associated with a low level of vitamin D.
Assessment of Anti-Reflux Suture in One Anastomosis Gastric Bypass for Prevention of Biliary Gastritis
Authors: Abdelhamed Waleed Ebrahim , Abdelaziz Bassem Helmy , Rayan Mahmoud Talaat , Khayrat Moustafa Hassan Ahmed
Published: July 2024

Background

Obesity continues to be a leading public health concern associated with many comorbidities and major hindering effect on the daily lifestyle of many people around the world. Surgical treatment for obesity has proved that it is the best and most effective, durable means of preventing the life-threatening complications and serious problems associated with morbid obesity.

Objective

Assessing the effect of the anti-reflux suture on the incidence and clinical consequences of bile reflux in OAGB Procedure.

Patients and Methods

In this prospective randomized study, 30 patients were selected in Ain Shams University hospitals between November 2021 and May 2022 for assessment of impact of Anti reflux suture on the incidence of post OAGB biliary gastritis.

Results

The cases presented in this study did not undergo upper GI endoscopy when they presented with symptoms of reflux or gastritis and thus it was not possible to differentiate between the presence of GERD or biliary gastritis as the source of their symptoms.

Conclusion

OAGB is safe and one of the leading procedures for treatment of obesity but it is still surrounded by controversy regarding its relation and effect on bile reflux gastritis. As far as this study shows, the anti-reflux suture modification alone does not seem to prevent the incidence of biliary reflux gastritis post OAGB.
Comparative Study between Matrix Rotation Technique versus Wide Local Excision of Carcinoma of the Breast Located in the Upper / Upper Outer Quadrant
Authors: Khalaf Abotaleb Mohamed Ahmed Mohamed , El Din Osman Ahmed Gamal , El Tayeb Al Azazi Mohamed Atef Mohamed , Galal Ahmed Mahmoud
Published: July 2024

Background

The breast is a cornerstone image of femininity, and the heart of womanhood, as nourisher and comforter. These roles evoke the idea of the importance and the affection of this delicate organ has in the minds of women. Breast, according to national cancer institute, is the chief site of cancer in women in Egypt, representing ∼38.8% of total malignancies among Egyptian women; it is a crucial cause of mortality among women.

Aim of the Work

The aim of this work is to assess and evaluate wide local excision technique as an oncoplastic procedure for management of breast carcinoma in the upper/upper lateral quadrant with matrix rotation technique regarding cosmetic, surgical outcomes, and patient satisfaction.

Patients and Methods

This prospective randomized controlled study included 30 patients separated into two groupings cancer breast scheduled for oncology breast surgery divided to two equal group: Group I: wide local excision technique. Group II: matrix rotation technique.

Conclusion

Wide local excision is a safe oncoplastic technique, causing significantly less post- operative hematoma, mild seroma, minimal blood loss, less areolar deviation and better breast symmetry than matrix rotation technique.
Assessment of Wide Local Excision in Patients with Multifocal Breast Cancer using Wire Clip Bracketing
Authors: ElHiani Eslam Ibrahim , Rady Mohammed Ahmed , Eldin Osman Ahmed Gamal , Soliman Ahmed Hassan , Elsaid Kamal M , El-Bahnasy Mohammed Ahmed
Published: July 2024

Background

Breast-conserving surgery, also known as BCS, is both oncologically and surgically safe and has a long term survival rate in comparison to modified radical mastectomy. BCS can be performed with a simple wide excision or with variant levels of oncoplastic surgical techniques. There are many factors that can affect aesthetic outcomes, these factors are either both patient-related or surgeon-related, however the volume of breast tissue that needs to be excised is the most important factor.

Aim

To assess the feasibility and the safety of wide local excision in patient that have multifocal breast cancer using wire clip bracketing.

Patients and Methods

The Population was female patients with multifocal breast cancer at Breast unit general surgery department, Ain shams university.

Results

The mean size of tumors were 2.2 ± 1.1 mm according to mastographic characteristics, There were 55.0% with Non-palpable masses, 45.0 % with Palpable. 40% Positive LNs, we had 100% free resection margins with least resection margin being 0.8 cm as we confirmed all margins intraoperative with frozen section, 13 patients (65%) got excellent degree of satisfaction with the post-operative cosmetic outcome of our surgical procedure, 4 patients (20%) got good degree and 3 patient (15%) got fair degree of satisfaction.

Conclusion

Wide local Excision using the wire bracketing technique leads to more optimal resection volumes for multifocal breast cancer without compromising margin status with good aesthetic outcomes.
Incidence of Recurrence Post Hemi Thyroidectomy in Thyroid Papillary Carcinoma: A Meta-Analysis
Authors: Mohamed Abd El Mageed Shaban Mohamed , Saad Ahmed Saeed , Sami Shafie Hamza Mohamed
Published: July 2024

Background

Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid carcinoma. It has an excellent prognosis, with a 10-year survival rate of more than 95 per cent, although outcome is poorer for aggressive subtypes.

Aim of the Work

Our work in this study shows that the incidence of recurrence post hemi thyroidectomy is significantly higher compared to post total thyroidectomy and in case of multifocal and insular carcinoma with hemi thyroidectomy it increases the incidence of recurrence and drastically affecting the 10-year survival rate and the quality of life.

Material and Methods

We followed the PRISMA statement guideline during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till November 2021 relevant keywords. We used the following search strategy for searching different databases: (“Papillary Thyroid Cancer” OR “Papillary Thyroid Cancers” OR “Papillary Thyroid Carcinomas” OR “Papillary Carcinoma Of Thyroid” OR “Papillary Thyroid Carcinoma” OR “Familial Non medullary Thyroid Cancer” OR “Non medullary Thyroid Carcinoma” OR “Non medullary Thyroid Carcinomas” OR “Thyroid Carcinoma, Non medullary” OR “Thyroid Carcinomas, Non medullary”) AND (Hemithyroidectomy OR Thyroidectomy OR Thyroidectomies OR thyroid removal). All the references of the included studies were searched for relevant studies.

Results

Multifocality and insular carcinoma and bilaterality increase the incidence of recurrence drastically so it is recommended for total thyroidectomy. Gender plays a role in the aggressiveness of the tumor but not in the incidence of recurrence as this is determined by the selection criteria of the candidate and the surgical technique. We studied 7 risk factors through this meta-analysis and it is recommended for application of LNR as a post op prognostic tool for recurrence and to apply hemi thyroidectomy for tumor size <2 cm instead of < 4 also meticulous pre-operative workup, accurate risk assessment, stratification and staging this is to customize a road map for every patient through a multi-disciplinary team.

Conclusion

In this meta-analysis we found that in low grade differentiated papillary thyroid carcinoma the recurrence is higher with hemithyroidectomy than in total thyroidectomy after applying the ATA guidelines for 10 years retrospectively but in case of 10 year survival it showed no significant difference.
Comparative Study between Single Incision versus Two Separate Incisions in Conservative Breast Surgery and Excising the Sentinel Lymph Node in Upper Outer Quadrant Early Breast Cancer (Retrospective Study)
Authors: Mostafa Ashraf Abdelmoghny , Abdelmoty Kareem Fahmi , Abdalla Gamal Mohamed , Ahmed Hussain Asmaa Fathi
Published: July 2024

Background

Single incision technique is an oncoplastic surgery aimed to remove both the breast tumour and sentinel lymph node through one incision, thus providing better aesthetic results than the conventional breast conservative two incision technique. However, this procedure is more difficult, since visualization and the resection space are limited, demanding greater experience from the surgeon.

Objective

To compare between single incision in excising upper outer breast tumour and sentinel lymph node versus two separate incisions in conservative breast surgery as regard locoregional recurrence, cosmetic outcome and post operative complications. (seroma formation and wound infection).

Patients and Methods

This is a retrospective cohort study to compare between single incision in excising upper outer breast tumour and sentinel lymph node versus two separate incisions in conservative breast surgery as regard locoregional recurrence, cosmetic outcome and post operative complication.

Results

Lymphedema occurred in 3 patients 1 from Group A and 2 from group B but this shows no statistical significance. None of the previously stated complications resulted in delay of post- operative adjuvant therapy and all patients were sent to receive their appropriate therapy according to schedule. None of them have had any other problem such as delayed wound healing or compromised final cosmetic outcome. In our study only one patient from group B had malignant recurrence during follow up visits through 3 year after the surgical removal of the tumor but this has no significance proving that single incision technique is safe from oncological point of view like double incision technique.

Conclusion

The single incision technique was shown to be providing comparable post operative parameters with better cosmetic results suggesting that the single incision technique is superior to double incision in selected cases.
Effect of Mesenchymal Stem Cells-Derived Exosomes on Healing of a Rabbit Model of Corneal Alkali Burn. Histological and Immunohistochemical Study
Authors: Elyan Maryam Salah , Nada Hoda Fouad , Hamam Ghada Galal , El Din Bayomi Noha Salah
Published: July 2024

Introduction

Corneal alkali burn is one of the most severe ophthalmic emergencies that requires prompt treatment. Recently, the attention of researchers has been attracted to the use of exosomes as a novel non-cell therapy for treatment of corneal alkali burn.

Aim

to evaluate the possible role of mesenchymal stem cells (MSCs)-derived exosomes on healing of experimentally induced corneal alkali burn in rabbits by histological and immunohistochemical techniques.

Materials and Methods

Forty-five adult male New Zealand white rabbits were divided into three groups: group I (control group); group II in which corneal alkali burn was left for spontaneous healing, and group III (exosomes treated group): in which rabbits received a sub-conjunctival injection of 100 μg MSCs-exosomes after one hour from corneal alkali burn induction. Injection of exosomes was repeated every other day. All groups were further subdivided into two subgroups; subgroup A and B, where corneal specimens were collected after 7 days and 14 days, respectively. Characterization of exosomes was done using transmission electron microscope. Gross examination of the cornea was done at days 0, 1, 4,7,10 and 14. At the end of experiment, corneal specimens were collected and subjected to hematoxylin and eosin, Masson`s trichrome, periodic acid Schiff, transforming growth factor-beta and vascular endothelial growth factor immunohistochemical techniques. Histo-morphometric study and statistical analysis were also done.

Results

Administration of MSCs-derived exosomes in group III improved healing of corneal alkali burn by inhibiting angiogenesis and inflammation, enhancing corneal reepithelization, and providing better organization of newly formed stromal collagen fibers.

Conclusion

Sub-conjunctival injection of MSCs-derived exosomes could be effective in the healing of corneal alkali burn in adult rabbits.