bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipocalin-2 Level in Patients with Polycystic Ovary Syndrome: Association with Insulin Resistance and Metformin Therapy
Authors: Halawa Mohamed Reda , Ali Hendawy Laila Mahmoud , Makram Mina Adel
Published: July 2024

Background

PCOS appears to be associated with an increased risk of metabolic aberrations, including insulin resistance and hyperinsulinemia, type 2 diabetes mellitus, dyslipidemia, and cardiovascular disease throughout womens’ lifespan.

Aim of the Work

The aim of this study is to: Assess the association of Lipocalin-2 with polycystic ovary syndrome in a sample of the Egyptian female. Study the effect of metformin therapy on Lipocalin-2 level in female patients with polycystic ovary syndrome

Patients and Methods

Our study was conducted on 52 females. Their age ranged between 17-43 years old. They were collected from the outpatient obstetrics and gynaecology clinics of Ain Shams University Hospitals, assess the association of Lipocalin-2 with polycystic ovary syndrome in a sample of Egyptian females and its association with insulin resistance. It was conducted from June 2018 to March 2019. The study was explained to all patients and control subjects, and written consent was obtained before starting the study.

Results

Serum lipocalin-2 levels did not differ between patients with PCOS and BMI-matched healthy controls (P-value 0.193). In the present study, there was no significant difference between the 2 studied groups as regard HOMA-IR (p = 0.375). Metformin therapy for 3 months in patients with PCOS in the present study, resulted in significant reduction in lipocalin-2 level (p- value<0.01), (mean 54.2±15.3 ng/ml before metformin therapy vs 42.9±14.2 ng/ml after metformin therapy). In our study metformin therapy in PCOS group resulted in significant reduction in weight, BMI, waist circumference and HOMA-IR. Furthermore, linear regression analysis for the parameters affecting lipocalin level in our study, showed that BMI was the only significant confounder affecting lipocalin level. So the reduction in lipocalin level following metformin therapy in PCOS group in our study may be due to weight reduction perse.

Conclusion

In conclusion, our results show that PCOS per se is not associated with elevated serum lipocalin-2 levels. Weight loss induces a significant reduction in serum lipocalin-2 levels in overweight/obese patients with PCOS. Treatment with metformin of patients with PCOS also induces a reduction in serum lipocalin-2 levels.
Violence in Relation to Cognitive Deficits and Symptom Severity in a Sample of Egyptian Patients with Schizophrenia
Authors: Okasha Tarek Ahmed , Omar Abdel Nasser , Elserafy Doha , Serry Samar , Rabie Eman S
Published: July 2024

Background

Patients with schizophrenia are significantly more likely to be violent than general population; and the consequences of this violence risk are often very serious for the patients, their caregivers and the entire community. This study assesses the risk of violence in patients with schizophrenia and its correlation with severity of symptoms and cognitive functions.

Results

There was a statistically significant difference between case and control groups regarding risk of violence assessed using HCR-20 scale; where 58% of the case group were found to have risk of violence compared to only 18 % in the control group, There was a significant correlation between this risk of violence and duration of untreated psychosis, no of episodes and history of substance use; also was significantly correlated with severity of symptoms assessed using PANSS and cognitive dysfunctions assessed using Wisconsin card sorting test subscales. Regarding logistic regression analysis for factors affecting violence risk; total PANSS score and history of substance use were significant independent factors that increase violence risk.

Conclusions

Violence risk in patient with schizophrenia is a cardinal factor that may affect life of the patients, their family and society; this risk can be affected by different factors including severity of symptoms, no of episodes, history of substance use and cognitive function of the patients as proven by the results of our study ;so our study recommends that proper comprehensive assessment of the violence risk in the routine psychiatric assessment is mandatory for rapid and better intervention.
Retrospective Study of Survival Outcome of Primary Debulking Surgery vs Neoadjuvant Chemotherapy for Advanced Epithelial Ovarian Cancer in Ain Shams University Hospitals Patients
Authors: Azmi Ali Mohammad , Sabry Elkady Mohammad , Hassan Abd-Elaziz Ahmad , Nofal Ahmad Maamoun , Mahmoud Ahmad Mohammad
Published: July 2024

Background

Role of Neoadjuvant chemotherapy in advanced Epithelial Ovarian cancer is evolving, but primary debulking surgery is still the main treatment approach.

Aim and Objectives

to investigate weather neoadjuvant chemotherapy followed by interval debulking surgery is equal or superior to primary debulking surgery in terms of progression free survival and overall survival in patients with advanced epithelial ovarian cancer.

Subjects and Methods

we conducted a retrospective study of 50 patients identified with epithelial ovarian cancer stages III &IV in Ain Shams University Hospital from January 2017 to December 2018, and stratified into two treatment groups 1st group was for patients who underwent primary debulking surgery followed by adjuvant chemotherapy, 2nd group was for patients who received neoadjuvant chemotherapy followed by interval debulking surgery, And followed them up to 3 years.

Results

out of 50 patients included in the study 36 patients (72%) underwent PDS followed by adjuvant chemotherapy, while 14 patients (28%) received neoadjuvant chemotherapy followed by IDS, among the PDS group, the median PFS time in months was 18 month, 95% CI(13.2-22.7) and for neoadjuvant chemotherapy group was 25 month 95% CI (16-52), this difference was not statistically significant, Log Rank test. P value = 0.373, the three year progression free survival was 32% among the studied population, and rates were, respectively, 27.8% and 42.9% in primary debulking and neoadjuvant group. Among primary debulking group the mean survival time in months was 32.6 month, 95% CI(30.2-34.7) and for neoadjuvant chemotherapy group was 30.26 month 95% CI (25.28-35.25), this difference was not statistically significant, Log Rank test. P value = 0.0.768. The three year overall survival rate among the studied group was 74.4%, and rates were, respectively, 75% and 73.3% in PDS and NAC group. Out of all sociodemographic and clinical characteristics of the patients included, Our study demonstrated 2 independent prognostic factors which are optimal debulking surgery and surprisingly positive family history.

Conclusion

our study demonstrated that neoadjuvant chemotherapy followed by interval debulking surgery provides equal survival compared with primary debulking surgery followed by adjuvant chemotherapy, NAC is a very considerable option to treat advanced EOC for selected cases in which surgery is infeasible or has very high risk morbidity and mortality.
Evaluation of the Protective Effect of Cystone against Cisplatin Induced Nephrotoxicity in Cancer Patients
Authors: Hatem Mohamed Abdallah Nourhan Mohammed , Abdelwahab S , Nofal Ahmed , Naguib Khaled
Published: July 2024

Purpose

Cisplatin is a cost effective widely used antineoplastic drug to treat a number of solid tumors. The major dose-limiting toxicity is nephrotoxicity. Cystone is one of drugs that have been tested to reduce the incidence of cisplatin-induced acute kidney injury (CIAKI). This study aimed to investigate the protective effect of Cystone against CIAKI in larger number of patients relative to previously conducted pilot studies .

Methods

A prospective phase II, open-label randomized controlled study was conducted in patients receiving cisplatin-based chemotherapy in Ain Shams University Hospitals, using cystone tablet (manufactured by the Himalayan Pharmaceutical Company, India) administered as two pills every 8 hours continuously through course of chemotherapy starting from the day before receiving chemotherapy. A total of 99 patients were randomized between the control and cystone arms. The primary endpoint was the incidence of AKI according to Common Terminology Criteria Adverse Events (CTCAE) in each treatment arm. Secondary endpoints include need to dose modification between both arms.

Results

There was clinical difference in the incidence of CIAKI any grade between the two arms (12% in cystone arm vs 34 % in control arm P = 0.4. Need to dose modification is 10.4% vs 12 % (P = 0.8). There was a statistically significant difference between the two arms as regards the difference between values (mean) of serum creatinine and creatinine clearance values initially and at the end of treatment favoring drop of renal functions in control group (P = 0.000 and 0.003) respectively.

Conclusion

Our study did not demonstrate clearly a protective role of cystone in decreasing the incidence of CIAKI in patients receiving cisplatin based chemotherapy. However, drop of renal function in control arm with comparison to study arm may give an indication to further study cystone in different doses to assess its protective role against CIAKI.
Assessment of Conjunctival Surface Changes in Post COVID Patients by Impression Cytology
Authors: Asaad Marwa Mohamed , Hamdi Momen Mahmoud , Hafez Fatma S , Nabil Radwa Mohamed
Published: July 2024

Background

The conjunctiva is a transparent, clear, thin membrane that covers part of the eye’s front surface and the inner surface of the eyelids. It is divided into three regions: the palpebral or tarsal conjunctiva, the bulbar or ocular conjunctiva, and the conjunctival fornices. The novel coronavirus (COVID-19), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in December 2019 after a series of acute atypical lung disease cases occurred in Wuhan, China.

Aim of the Work

The aim of the our study is assessment of the inflammatory and neoplastic changes that happened on the ocular surface especially the conjunctiva according to Nelson staging system in post-COVID-19 patients and evaluated by impression cytology.

Patients and Methods

This study was conducted on a selected sample of patients attending the Ophthalmology outpatient clinic of Ain Shams University Hospitals in Cairo, specimens of impression cytology were stained and examined in the Pathology department of Ain Shams University.

Results

In the present study, comparison between cases and controls groups as regards epithelial cells showed that in cases group there was normal, small, round cells in 19(59.4%) cases, slightly larger, more polygonal cell in 11(34.4%), and Larger, polygonal cells in 2(6.3%), and in controls group, there was normal, small, round cells in 25(78.1%) cases, slightly larger, more polygonal cell in 7(21.9%), there was no statistically significant difference between the two groups as regards epithelial cells (p > 0.05). Furthermore, As regards N/C ratio where in cases group the ratio was 1:2 in 19(59.4%) cases, 1:3 in 11(34.4%), and 1:4-1:5 in 2(6.3%), and in controls group, it was 1:2 in 25(78.1%) cases, 1:3 in 7(21.9%), there was no statistically significant difference between the two groups as regards N/C ratio. In the current study, as regards Keratinization where 6(18.8%) cases had mild keratinization in cases group in comparison to 2(6.3%) cases in controls group. There was no statistically significant difference between the two groups as regards Keratinization (p > 0.05). Moreover, we found that there was no dysplasia in both cases and controls groups. The comparison between cases and controls groups as regard Goblet cells where in cases group the goblet cells was stage 0 in 17(53.1%) cases, others was stage 1 in 13(40.6%), and the cells was stage 2 in 2(6.3%), and in controls group, there was stage 0 cells in 22(68.8%) cases, stage 1 in 10(31.3%), there was no statistically significant difference between the two groups as regard goblet cells density.

Conclusion

There is non significant inflammatory or neoplastic changes that have been occurred in conjunctival surface in post-COVID-19 patients. Except for lymphocytes infiltration.
Optical Coherence Tomography Angiography as a Diagnostic Tool in Cystoid Macular Edema
Authors: Abd-Allah Moustafa Dalia Ibrahim , Mansour Sherif Zaky , Mohamed Ahmed Abdel-Aleem , Elsayed Hassan Ahmed
Published: July 2024

Background

Cystoid macular edema (CME) represents a common pathologic sequel of the retina and occurs in a variety of pathological conditions such as intraocular inflammation, central or branch retinal vein occlusion, diabetic retinopathy and most commonly following cataract extraction.

Aim of the Work

To evaluate the role of optical coherence tomography angiography in the diagnosis of cystoid macular edema.

Patients and Methods

We applied our study on thirty eyes will be divided into two equal groups: CME group (n = 15 eyes) and Control group (n = 15 eyes), with the same inclusion and exclusion criteria. This study included thirty eyes of twenty four patients. There were 15 patients of unilateral; while the right eye was affected in 7 patients (46.7%) and the left eye in 8 (53.3% patients in CME group; while there were 6 patients of bilateral and 3 patients of unilateral; while the right eye was affected in 7 patients (46.7%) and the left eye in 8 (53.3%) patients in control group.

Results

This study showed that in term of Sex, there is no statistically significant difference between the groups with p-value (p = 0.134). There was a statistically significant higher mean age in CME group compared to control group with p-value (p = 0.005). Also laterality were comparable in each of CME group were 0 patients (%) and 15 patients (100%) were bilateral and unilateral, respectively compared to control group were 6 patients (66.7%) and 3 patients (33.3%) were bilateral and unilateral respectively in term of laterality, there was a statistically significant with p-value (p = 0.002). There was a statistically significant higher mean in CME group compared to control group according to unaided visual acuity and best corrected visual acuity, with p-value (p < 0.001). The mean BCVA was 0.2#0.15, 0.48÷0.23, and 1.06‡0.27 log MAR for early, advanced, and severe DME. Log MAR visual acuity was significantly different among different DME grades (P < 0.001). There was a statistically significant higher ocular surgeries in in CME group compared to control group, with p-value (p < 0.001). That was a statistically significant higher OCTA findings in CME group compared to control group, with p-value (p < 0.001); as for the CFT there was a higher mean value in CME group was 484.2070.05 compared to 233.93=13.51, with p-value (p < 0.001).

Conclusion

In conclusion, cystoid macular edema (CME) can be identified early and OCTA can contribute to the clinical characterisation of the disease.
Evaluation of Different Corneal Powers Measured by Corneal Tomography in Intraocular Lens Power Calculation
Authors: Abd EL-moneam Heba A , El-maamon Tarek A , Eliwa Tamer F M , Abd EL-aziz Mohammad H
Published: July 2024

Background

Corneal power measurement is essential for IOL power calculation. Conventional keratometry measures the anterior corneal surface using a standard keratometric index without measuring the posterior corneal surface. Schiempflug imaging have added the ability to measure posterior corneal surface which may affect IOL power calculation and postoperative refraction.

Purpose

To evaluate different keratometric measurements including Simulated keratometry (SimK), true net power (TNP), total corneal refractive power (TCRP) and equivalent K reading (EKR) obtained from corneal tomography in IOL power calculation and compare the predicted refraction of calculated IOL power with postoperative subjective refraction.

Materials and Methods

Sixty-five cataractous eyes were included in this prospective interventional case series. Four corneal power measurements using Pentacam AXL were analyzed: SimK over 3mm, TNP over 4mm, TCRP over 3mm and EKR over 4.5mm. The IOL power was calculated using Barrett Universal II formula.

Results

No statistically significant difference between SimK and EKR (p- value=1.000) while TNP and TCRP were statistically significantly higher than SimK (p-value<0.001) with mean difference 1.2+/-0.2D and 0.67+/-0.34D respectively. The mean prediction error of refractive outcome was -0.006+/-0.32D for SimK, -0.02+/- 0.5D for EKR, 1.08+/-0.4D for TNP and 0.56+/-0.46D for TCRP.

Conclusion

Corneal power measurements using SimK and EKR displayed comparable accuracy in IOL power calculation and postoperative refraction while TNP and TCRP were far away.
Minimally Invasive Sinus Tarsi Approach versus Extensile Lateral Approach for Sanders Type II & III Calcaneal Fractures (Systematic Review & Meta-analysis)
Authors: Zaher Nasser Hussien , Shafeek Elkhateeb Tameem Mohamed , Abdelfatah Elawam Tamer Salah
Published: July 2024

Background

Open reduction and internal fixation (ORIF) is becoming more common in Calcaneal fractures of Sanders types II and III. The extensile lateral approach (ELA) appears to be the gold standard.

Aim of the Work

We aimed to compare the clinical outcomes of intra- articular calcaneus fractures treated with open reduction and internal fixation with via Extensile lateral approach (routine treatment) versus those via a sinus tarsi approach (minimally invasive treatment).

Materials and Methods

This systematic review conducted on 7 studies enrolled 734 patients with Sanders type II & III calcaneal fractures comparing he clinical outcomes of intra-articular calcaneus fractures treated with open reduction and internal fixation (ORIF) via Extensile lateral approach (routine treatment). The outcome measures considered: Postoperative wound complications, AOFAS score, Time to surgery, Surgical operative time, 24 hours Postoperative VAS score, Bohler's angle improvement, Gissane's angle improvement, Calcaneus width reduction, Recovery of calcaneus length, Length of hospital stay.

Results

Regarding postoperative wound complication, minimal invasive procedure significantly reduced the rate of wound complications other than open reduction. Concerning American Orthopedic Foot and Ankle Society score (AOFAS) score, there was no significant difference between ORIF and minimally invasive (MI) method. With reference to time to surgery, there was a significant difference between ORIF and minimally invasive (MI) method. As regard surgical operative time, MI had a significant reduction in operative time. According 24 hours Post operative VAS score, there was no significant difference between ORIF and minimally invasive (MI) method. Concerning Bohler's and Gissane's angles improvement, there was no significant difference between ORIF and minimally invasive (MI) method. With reference to calcaneus width reduction, there was no significant difference between ORIF and minimally invasive (MI) method. According recovery of calcaneus length, the current study showed no significant difference between ORIF and minimally invasive (MI) method. Concerning length of hospital stay, the ORIF consume more hospital stay than minimally invasive methods.

Conclusion

In contrast to ELA, minimal invasive procedure (STA) reduced the rate of wound complication. There was no significant difference between ELA and STA regarding the anatomical and functional outcome. The STA showed significant reduction in time to surgery and operative time.
Sacral Fractures Treatment: Systematic Review and Meta-Analysis
Authors: Wafa Mohammad Abdelsalam , Fahmy Fady Micheal , Mahmoud Mohamed Metawea Hamed Mohamed Mahmoud
Published: July 2024

Background

The sacrum is a keystone structure that is important to the structural integrity of the base of the spinal column and posterior pelvic ring. Therefore, depending on the fracture pattern, fracture of the sacrum may have implications on posterior pelvic or spinopelvic stability. Sacral fracture classifications are based on fracture location, pattern of instability, and risk of neurologic deficits.

Objective

To review the literature about sacral fractures and to provide cumulative data about the outcome of different surgical modalities in management of sacral fractures.

Patients and Methods

This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines.

Results

We found 176 record; of them 82 unique records identified (duplicate removed) by the database searches; 94 were excluded based on title and Abstractreview; 82 article are searched for eligibility by full text review; 33 article cannot be accessed; 8 studies were reviews and case reports; 17 were not describing functional outcome; the desired procedure not used in 10 studies leaving 14 studies that met all inclusion criteria.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022.

Conclusion

Spinopelvic surgical stabilization represents the “gold standard” for sacral fractures treatment, this technique guarantees stability, neutralizes flexion deformation, allowing early mobilization of the patient, ensuring a reduction of comorbidities and a better recovery of neurologic lesions.
Salter versus Dega Osteotomy in Developmental Hip Dysplasia: A Systematic Review and a Meta-Analysis
Authors: Abdel Massih George Isaac Jacob , El Gebeily Mohamed A , Baraka Mostafa M
Published: July 2024

Background

The early treatment of developmental hip dysplasia is our goal to achieve concentric hip reduction and normal hip anatomy and function. Many osteotomies were used to achieve our goal, the most common techniques are used for maintaining this reduction, are Dega and Salter osteotomies. For this reason we have done our systematic review and meta- analysis to figure which technique has better radiological and clinical results with less complications.

Aim

The aim of the work is to review the difference between Dega and Salter Osteotomy according to surgical techniques, Suitable age of each technique, Advantages and disadvantages for each technique, Final clinical and radiographic outcomes and Complications.

Subject and Methods

This study performed a search for all published articles that evaluated Dega or Salter osteotomy in the management of developmental dysplasia of the hip.

Results

From a total of 879 articles, 24 with level of evidence grade IV articles were included in our review. A total of 1212 hips cases with a mean follow up of 294.5 months were included. For Severin score, we did not find significant difference after performing both techniques regarding hips with grade 1; Salter [OR = 0. 62, (95% CI = 0.47: 0.77), I2=96.46%, P < 0.001)] and Dega [OR = 0.65, (95% CI = 0.46: 0.84), I2=92.85%, P < 0.001)]. Also the proportion of hips with grade 4 was nearly similar in both groups; Salter [OR = 0. 02, (95% CI = 0.01: 0.03), I2=0%, P = 0.51)] and Dega [OR = 0.02, (95% CI = 0.003: 0.04), I2=11.61%, P = 0.34)]. For McKay score, we did not find significant difference after performing both techniques regarding hips with excellent classification; Salter [OR = 0. 50, (95% CI = 0.28: 0.72), I2=98.1%, P < 0.001)] and Dega [OR = 0.40, (95% CI = 0.16: 0.64), I2=95.56%, P < 0.001)]. In term of hips with poor classifications both techniques performed equally; Salter [OR = 0.027, (95% CI = 0.013: 0.04), I2=0%, P = 0.67)] and Dega [OR = 0.04, (95% CI = 0.003: 0.082), I2=74.78, P = 0.001)].

Conclusion

Based on the information in our publication, we believe that Salter and Dega are well-established surgical treatments for hip dysplasia with comparable efficacy. Dega demonstrates marginally superior radiological and clinical data.
Comparative Study between Percutaneous Ilioilial Fixator versus Percutaneous Iliosacral Screw in Managing Sacral Fractures
Authors: Sadek Shaalan Mohamed Ragab , El Zaher E L Zaher Hassan , El Sayed Farag Ossama Mohamed , Sallam Ahmed Mohamed
Published: July 2024

Background

The sacrum is the mechanical nucleus of the axial skeleton, located at the base of the lumbar spine and acts as the keystone at the centre of the pelvic ring. Traumatic sacral fractures are an increasingly recognized diagnosis. Sacral fractures remain a relative uncommon entity in the general population.

Objective

The aim of this work is to compare between percutaneous iliosacral screw and ilioilial fixation in sacral fractures fixation as regard operative time, need of intraoperative fluoroscopy, blood loss & related transfusion, infection, neurovascular complication, hardware failure and screws miss- displacement, clinical and radiological outcomes, revision rate and rate of non-union.

Patients and Methods

After obtaining the hospitals Research/Ethics Committee approval and written informed consents from the patients. This study was carried on 51 Patients with sacral fractures injuries through the period from August 2019 to November 2021. A prospective randomized controlled clinical trial was conducted to compare the functional and radiological outcome of closed reduction and percutaneous fixation of traumatic sacral fractures using iliosacral screw or ilioilial fixator.

Results

There is no statistically significant difference in functional outcome, radiological outcome operative time, blood loss, postoperative complication, union rate or follow up. There is statistically significant difference in incision length between the two groups as mean length of incision in iliosacral screw and Ilioilial fixator is 1.2 cm and 4.8 cm respectively. There is statistically significant relation between number of intraoperative fluoroscopic and fixation principles (P value <0.001) with higher risk for radiation exposure in IS screw group.

Conclusion

Iliosacral screw and ilioilial fixator have comparable functional and radiological outcome and similar biomechanical stability .We suggest the ilioilial fixator as an alternative to IS screw in sacral fracture management. The ilioilial fixator is a useful option in patients who do not qualify for IS screw fixation.
Dual Mobility Cup in Total Hip Arthroplasty
Authors: Elhamid Ahmed Salah Eldin A B D , Elhawi Ezzat Mohamed , Saad Mohamed Mgdy , Abdelazim Mohamed Haytham
Published: July 2024

Background

Proximal femoral fractures are considered a common problem in the elderly. Osteoporosis and the risk of fall especially in old age add to the complexity of management of these types of fractures. These fractures can be managed with different types of implants e.g. Dynamic hip screw, proximal femoral nail, proximal femoral plate, etc..

Aim of the Work

Prospective clinical trial study to assess the role of dual mobility unconstrained acetabular components in preventing and treating instability.

Patients and Methods

In the period between December 2014 to April 2017 a prospective study was conducted involving 25 patients with high risk of dislocation underwent total hip replacement using dual mobility cup either as primary hip arthroplasty or revision hip arthroplasty. All cases were operated upon in Ain Shams University Hospitals and the follow up of the cases was 1 year.

Results

There were no cases of prosthesis dislocation or loosening. There were only two cases of superficial wound infections who improved with wound debridement. Studies showed that the dual mobility cup did a great success in reduction in the risk of dislocation in specific conditions as patients with polio and other neuromuscular disorders and other risk factors for head dislocation.

Conclusion

Conversion of a failed implant to a total hip implant is a good and safe option in treatment of such cases. Dual mobility cups decreased the risk of dislocation in such cases with increased longevity of the prosthesis and a considerably accepted range of motion of the hip joint.
Direct Vertebral Rotation versus Simple Rod Derotation Techniques in Correction of Adolescent Idiopathic Scoliosis
Authors: Abdel Rasol Asem Mahmoud Sayed , El Badrawi Ahmed Mohamed , Abdel Latif Ali Ibrahim , Fahmy Fady Michel , El Zahlawy Hany Nabil , Ibrahim Mohammed Ali
Published: July 2024

Background

One method for treating adolescent idiopathic scoliosis (AIS), which is characterised by abnormal spinal alignment in the coronal, sagittal, and rotational planes, is surgical correction. The two surgical techniques most typically used to correct spine alignment are simple rod derotation (SRD) and direct vertebral rotation (DVR).

Aim

The study's goal was to assess the effectiveness of two treatment methods for adolescent idiopathic scoliosis: simple rod derotation and direct vertebral rotation.

Subjects and Methods

A randomised controlled research involving 36 adolescents with idiopathic scoliosis was done. patients were randomly split into one of two groups: 18 patients in group A had DVR treatment, while 18 patients in group B received SRD with a 2-year follow-up.

Results

Apical Vertebral Rotation measured from CT scans in DVR group was 24.4° ±8.38° preoperatively and it decreased significantly postoperatively to 14.4°±4.61 °with (42.22%) correction rate while in SRD group it was 25.03°±7.99° preoperatively and it also decreased significantly postoperatively to a mean value of 21.41°±7.01° with (14.65%) correction rate. There were statistically significant differences between both groups postoperative (P < 0.001)

Conclusion

The most noticeable difference between DVR and SRD was clinical rib hump correction, which was explained by apical vertebral rotation correction determined on an axial CT scan. It also demonstrates that there is no significant difference in coronal curve correction, shoulder height difference, or patient satisfaction between the two techniques.
Fibular Lengthening Surgeries in Treatment of Malunited Pott's Fracture Ankle: A Systematic Review
Authors: Helmy Saleh Mahmoud Mohammed , El-Shazly Osama Abd-El Raouf , Farouk Mohamed Amr
Published: July 2024

Background

The primary goal of ankle fracture treatment is restoration of ankle stability and alignment. Following an ankle fracture, the fibular fracture deformity is usually shortening and external rotation. This shortening permit lateral shift of the talus with persistent instability and valgus tilt. Many fibular malunions can be successfully salvaged using grafting and plating techniques. In malunited ankle fractures with a shortened fibula and lateral talar shift, reconstruction of the ankle has been advocated to restore function. Lengthening of the fibula is an important step in such cases.

Aim

to study the functional outcomes and results of fibular lengthening surgeries of malunited pott's fracture ankle and to know the complications of surgery.

Patients and Methods

The search strategy identified 77 unique citations. Screening of titles and Abstracts identified 27 potentially relevant articles. Full text review of these articles identified 10 studies meeting the inclusion criteria.

Results

The common interventions procedures used was Ankle joint re-balancing with fibular lengthening, Fibular Lengthening Osteotomy with Revision Syndesmotic Repair. Satisfactory (excellent\good) in 73 cases and unsatisfactory (fair\poor) in 12 cases. VAS score mentioned in 1 study and improved from 6.76 ± 1.03 pre to 2.03 ± 1.21 post. Six studies showed that the infection rate was 31.996 %.

Conclusion

Correction must be performed once diagnosed, and there is no maximum elapsed time subsequent to which treatment efficacy is reduced. Even if anatomical reduction cannot be achieved, the improved alignment can produce a satisfactory result.
Endoscopic Transforaminal versus Interlaminar Discectomy in Management of Lumbar Disc Herniation: A Systematic Review of Outcomes and Complications
Authors: Abdelkader Youssef Magdy Gamal , Ashour Mahmoud Ahmed , Yousef Salem Karim Atef Abdelghani
Published: July 2024

Background

Lumbar herniated discs are common manifestations of degenerative spine diseases, being the main cause of radiated lower back pain.

Aim of the Work

The aim of this study is to compare between the transforaminal approach and the interlaminar approach in the incidence of complications and clinical prognosis scores in patients with lumbar disc herniation.

Patients and Methods

Literature searches was conducted using the following databases:” PubMed, Web of Science, ScienceDirect, Scopus, Cochrane Library, Google Scholar, Medline” using the following key words: “percutaneous transforaminal endoscopic discectomy, percutaneous interlaminar endoscopic discectomy, operative complications, minimally invasive, discectomy, endoscopic” from studies published after 2010.

Results

Although there is no significant difference between the two groups of comparison regarding percentage of postoperative complications, VAS scores, or ODI scores, However, PEID was superior to PETD regarding fluoroscopy times and operative time. The increased radiation exposure might be caused by the higher iliac crest, narrower foramina, or larger facet joints, which increased the difficulty of percutaneous puncture. Repeated fluoroscopy must be used to guide the puncture. In addition, the hypertrophy of ligamenta flava might also contribute to the difficulty of puncture and further increase radiation exposure in the PETD group.

Conclusion

This review provides evidence that both PEID and PETD are safe, effective, and minimally invasive surgical methods for the treatment of lumbar disc herniation, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed.
Validation of Rome IV Criteria in Diagnosis of IBS as a Part of Functional Gastrointestinal Disorders among Children
Authors: Al-Aziz El-Hodhod Mostafa Abd , Hamdy Ahmed Mohamed , Mohsen Yosra Mohamed , Leon Sanad Sara Hani
Published: July 2024

Background

There are few validation studies of existing diagnostic criteria for irritable bowel syndrome (IBS). We conducted a validation study of the Rome IV criteria in diagnosis of IBS as a part of functional gastrointestinal disorders among children (FGIDs). These revisions are expected to improve clinical care in children with FGIDs. We hypothesize that red flags may appear after the initial diagnosis leading to categorization of patients to organic illness rather than functional.

Aim of the Work

The aim of this study is to validate the Rome IV criteria in diagnosis of IBS as a part of functional gastrointestinal disorders among children.

Patients and Methods

Enrollment was targeted at children(4-16yrs) with chronic abdominal pain for 3 months or more and any patient with red flags were excluded from the study. The resulting sample included 200 patients. They were then followed up for 3 months then re-classification of the patients according to Rome 4 criteria. Comparison between the initially diagnosed patients as functional Gastrointestinal disorders with the final diagnosis after the 3 months follow in order to pick up any red flags which might appear.

Results

Diagnosis and follow up of patients using Rome IV is efficient in excluding organic diseases and diagnosing IBS as one of the FGIDs in children however there was interchangeable results between sub-types of IBS after the follow up of patients. None of our patients developed red flags of organic illness.

Conclusion

Rome criteria is helpful in diagnosing IBS and its subtypes and avoiding the need for further investigations.
Insulin Resistance in Pediatric Migraine
Authors: Ibrahim Omnia Samy , Tomoum Hoda Yahya , Elhenawy Yasmine Ibrahim , Halim Michael Nabil
Published: July 2024

Background

Migraine is a common complaint in the pediatric population with a prevalence ranging from 3% to 10%. Several studies among adult population defined a link between migraine and insulin resistance (IR), however data among pediatric population is scarce, thus the aim of the current study is to assess the relation between IR and migraine among pediatric patients with migraine.

Patients and Methods

A case control study that was conducted on children aged between 4 and 16 years; 30 were patients with migraine who were recruited from the pediatric neurology department and 40 were healthy. The diagnosis of migraine was according to the criteria of the International Classification of Headache Disorders (ICHD) -II criteria. Anthropometric measurements of all patients were assessed. Insulin resistance was assessed by Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI equation).

Results

The mean age of patients with migraine was 10.03 ± 2.16 years with male predominance. Most of the patients (80%) were pre-pubertal. Headache with aura was present in 13 (43.3%), family history was present in 24 (80%), bilateral headache was the most common among our patients (71.4%). There was significant increase in BMI among migraine group (P = 0.03). 50% of migraine patients were overweight, 20% were obese. Incidence of insulin resistance by HOMA-IR and by QUICKI was significantly higher among patients with migraine (P = 0.007 and 0.033) respectively.

Conclusion

based on our results, it can be concluded that migraine is associated with insulin resistance in 36.7% of patients.
Screen Time and its Relation to Toddlers’ Development
Authors: Mohamed Zaky Eman Ahmed , Maher Deif-Allah Shaymaa Ahmed , Abdelaziz Asmaa Wafeeq , Ramadan Mohammed Maha Zakariya , Soliman Ibrahim Asmaa Mohammed , Abd Elhamid Salwa Amin
Published: July 2024

Background

Screen-time or digital-screen exposure is the duration of time spent by the individual in using electronic/digital media like television (TV), smartphone, tablet or computer. Even background television exposure has been shown to impact development by reducing the amount and quality of interactions between parents and children. Studies showed that while babies do not absorb content from TV, it can catch and hold their attention.

Aim of the Work

The aim of the current study was to determine the effect of screen time on different developmental aspects of toddlers.

Patients and Methods

This was a cross sectional observational study that was conducted in the outpatients’ and Neurodevelopment Clinics, Children’s Hospital, Faculty of Medicine, Ain Shams University on 83 toddlers aged from 1 year to 3 years old who were exposed to screens for a longer duration than the recommended according to the American Academy of Paediatrics (AAP) guidelines. Of 13 months’ time frame, total duration of screen exposure was calculated in minutes/day and was correlated to the composite scores of Bayley scales of infants’ and toddlers’ development third edition.

Results

A significant negative correlations were found between duration of screen time exposure and all Bayley scales (cognitive, language and motor) composite scores and language scale is more affected.

Conclusion

The results of this study supported the directional association between screen time and child development. Parents and all the society should be educated about the hazards of screen time exposure on infants and toddlers’ development.
Prognostic Value of Pentraxin 3 and Procalcitonin in Late onset Neonatal Sepsis
Authors: Abo Seif Ibrahim Saad , Abd El Aal Mohamed Omar , Abdel- Wahed Ali Marwa Ali , El Kareem Shimaa Ahmed Abd
Published: July 2024

Background

Sepsis is a major cause of intensive care unit (ICU) admission. Procalcitonin (PCT) could be an important prognostic marker for sepsis. Pentraxin 3 (PTX3) and PCT are detectable in patients with sepsis within a large time window after the onset of sepsis.

Objective

To assess the prognostic value of the PTX3, PCT in neonatal sepsis in comparison with other sepsis screen.

Patients and Methods

A prospective study included 40 neonates with sepsis. The study had been conducted in the neonatal intensive care units of Ain Shams University, Children’s Hospital during the period from January 2020 to May 2022. All neonates had been subjected to clinical examination, anthropometric measurements and sepsis scoring by neonatal sequential organ failure assessment (nSOFA). Laboratory investigations were collected from all pediatrics including Complete blood count (CBC), quantitative C- reactive protein (CRP), blood culture, serum pentraxin 3 (PTX3) and serum procalcitonin (PCT). Sepsis markers had been obtained from neonates at the day of being with suspected sepsis before starting the antimicrobial therapy (Day 0). While blood samples for sepsis markers reobtained only from neonates with positive blood cultures on the 3rd (Day3), accordingly our patients divided into improved and deteriorated groups.

Results

There was a significant decrease in CRP level and increase in procalcitonin and pentraxin 3 levels in deteriorated group than improved group at baseline with p-value = 0.004, 0.016 and 0.019; respectively. Also, the study shows that there was a significant increase in CRP, procalcitonin and pentraxin 3 levels in deteriorated group than improved group after 3 days with p-value = 0.002, <0.001 and <0.001; respectively. Furthermore, in improved group, there was a significant decrease in the level of CRP, procalcitonin and pentraxin 3 after 3 days than at baseline with p-value = 0.001, <0.001 and 0.001; respectively. Also in deteriorated group, there was statistically significant increase in the CRP and pentraxin 3 levels after 3 days than at baseline in deteriorated group with p- value = 0.002 and 0.019; respectively while no change found in procalcitonin level.

Conclusion

Serum pentraxin 3 and procalcitonin levels seem to be promising prognostic markers in neonatal sepsis with higher sensitivity and specificity for procalcitonin than pentraxin at 3 days.
Cardiac Disease in Egyptian Thalassemia Major and Sickle Cell Disease Adolescents in relation to Vitamin D Status Using Echocardiogram & Ultrafast Magnetic Resonance Imaging
Authors: Gad Nada Ayman , Pennell Dudley John , Samir Ahmed , Salama Dina Husseiny , Salah El Din Nanies Mohamed , El-Sayed Ebeid Fatma Soliman , Elalfy Mohsen Saleh
Published: July 2024

Background

Cardiovascular complications are well recognized in patients with β-thalassemia major (β-TM) and sickle cell disease (SCD). Vitamin D deficiency is prevalent in patients with transfusion-dependent thalassemia and there is an association between vitamin D deficiency and both left ventricular function and iron overload in thalassemia. However, the relationship between vitamin D and cardiac iron is not well studied in Egypt and the role of vitamin D in cardiac disease in SCD and β-TM needs to be assessed.

Aim

To assess vitamin D status in children and adolescents with SCD and β-TM in relation to cardiac complications using echocardiography and cardiac magnetic resonance (CMR) T2*.

Methods

Forty-one patients with SCD and 35 patients with β-TM without symptomatic cardiac disease were studied stressing on history of splenectomy and transfusion history. Markers of hemolysis, serum ferritin and vitamin D levels were measured. Liver iron concentration (LIC) was assessed by magnetic resonance imaging (MRI). Screening for cardiovascular abnormalities was performed by the non-invasive Doppler echocardiography and CMR was used to assess myocardial iron overload.

Results

Echocardiography showed that cardiac functions were significantly impaired in β-TM patients compared with SCD while the frequency of pulmonary hypertension risk (elevated TRV ≥2.5 m/sec) was consistent between both β-TM and SCD groups. Cardiac T2* (which reflects cardiac iron overload) was significantly lower while myocardial iron concentration (MIC) was significantly higher in β -TM patients compared with SCD group. Vitamin D levels were decreased in both SCD and β-TM patients than control levels; however, SCD patients had significantly lower vitamin D levels. Low vitamin D levels were significantly associated withincreased risk of pulmonary hypertension in the SCD group while In β-TM group, vitamin D levels were significantly lower in patients with cardiac disease and those with serum ferritin levels ≥ 2500 µg/L. A significant evidence of diastolic dysfunction was found in SCD and β-TM patients who had low serum vitamin D level < 20 ng/mL. Vitamin D levels were negatively correlated to serum ferritin and LIC while positively correlated to cardiac T2*.

Conclusion

Low vitamin D levels were associated with cardiopulmonary dysfunction in adolescents with SCD and β-TM. Vitamin D deficiency in those patients was linked to cardiac iron overload leading to iron induced cardiomyopathy. Proper chelation therapy is mandatory to improve cardiac disease, iron overload and consequently, vitamin D status in β-TM patients.
Serological Screening for Severe Acute Respiratory Syndrome Coronavirus-2 in Type 1 Diabetic Children and Adolescents
Authors: Aly Hanan Hassan , Elhabashy Safinaz Adel , Azeem Mansour Roaa Abdel , Hassan Azza Mohammed , Fahmy Mahmoud Basma Sherif
Published: July 2024

Background

Diabetes was identified as a risk factor for many infections. In the SARS-CoV-2 pandemic, diabetes is one of the leading comorbidities associated with infection severity.

Aim of the Work

To determine the severity of COVID-19 symptoms in type 1 diabetic children and adolescents. To Determine the effect of SARS-CoV-2 lockdown on glycemic control.

Patients and Methods

A cross sectional observational study was carried out in Pediatric and Adolescent Diabetology Unit (PADU), Children's Hospital, Ain Shams University between September 2020 and January 2022. The study included 500 randomly selected diabetic children and adolescents. They were tested for Hemoglobin A1C and SARS-CoV-2 IgM and IgG antibody.

Results

There is a significant relation between myalgia (p = 0.012 ), diarrhea( p = 0.007) and IgM positivity, and a significant relation between diarrhea and both IgG and IgM positivity (p = 0.005). Other symptoms had a non-significant relation with COVID-19 IgM or IgG. All symptoms suggestive of COVID-19 infection that were detected in our patients were not severe. During COVID-19 pandemic, glycemic control deteriorated in our patients as mean HbA1c reached 9.6% as compared to a mean level of 8.8% before COVID-19 pandemic.

Conclusion

Diabetes comorbidity did not increase the severity of COVID-19 symptoms to our patients. Glycemic control as indicated by HbA1c level showed deterioration during lockdown due to impaired access to care.