bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison between Ultrasound Guided IPACK Block (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) and Adductor Canal Block in Patients Undergoing Total Knee Replacement in Postoperative Pain
Authors: Hamdy El-Kabarity Reem , Sayed Ahmed El Sersi Mayar Hassan , Mahmoud Amin Omar Sameh , Abdel-Azim Metwally Mohamed Fathy
Published: November 2024

Background

Total knee replacement (TKR) is associated with significant postoperative pain. The need for effective analgesia without compromising function is a priority.

Aim of the Work

The aim of the study is to compare postoperative pain management and post-operative analgesia between IPACK block and Adductor canal block in total knee replacement cases.

Patients and Methods

The study was conducted on 60 patients who were scheduled to undergo total knee replacement and were divided into 2 equal groups: group 1: Patients in group 1 (n = 30) will receive IPACK block at the beginning of operation with 20 ml bupivacaine (0.25%) under complete aseptic conditions, group 2: patients in group 2 (n = 30) will receive Adductor canal block at the beginning of the operation with 20 ml bupivacaine (0.25%) under complete aseptic conditions.

Results

The two groups were adequately monitored and assessed post-operatively for 24 hours and they were compared regarding analgesic outcome by recording time for first for analgesic need, total consumption of opioid and pain score during walking and climbing stairs. Side effects were also monitored and compared.

Conclusion

The comparison between effect of IPACK block and adductor canal block as regard post- operative pain in total knee replacement showed significant difference regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for adductor canal block and 2-4 for IPACK block.
Inferior Vena Cava Collapsibility Index vs Central Venous Pressure for Assessment of Intravascular Volume Status in Patients with Ischemic Heart Diseases
Authors: Elbanna Mohamed Mohamed , Boulos Ghobrial Bassem , Nofal Waleed Hamed , Nassif George Maher
Published: November 2024

Background

Intravascular volume status assessment is one of the most challenging tasks for clinicians in intensive care unit so fluid therapy is considered as cornerstone in improving the outcome of the ischemic heart patients. Monitoring of intravascular volume status usually required to optimize blood flow and tissue oxygen delivery to organs to avoid any disturbance of fluid status of patient either excess fluid administration which lead to hypervolemia or insufficient fluid administration which lead to hypovolemia and Both conditions have negative effects on patient prognosis with increased risk of morbidity and mortality.

Aim of the Work

To assess inferior vena cava collapsibility index and central venous pressure to predict the intravascular volume status in ischemic heart patients.

Patients and Methods

This study was carried in intensive care unit of anesthesia department, Faculty of medicine, Ain Shams university hospitals with a duration of 6 months.

Results

At the first day (r = - 0.775, p value <0,001), in the 2nd day (r =-0.864, p value< 0,001) and in the 3rd day (r = -0,923, p value <0,001). The best cutoff of IVC in diagnosis of low CVP is ≥ 28.5% with area under curve 0.998, sensitivity 100%, specificity 94.7%, positive predictive value (PPV) 94.4%, negative predictive value (NPV) 100% and accuracy 97.2%.

Conclusion

This study is that IVC collapsibility index has a strong statically significant inverse correlation with central venous pressure which is more accurate at low central venous pressure values. Point-of-care in this study is to evaluate intravascular volume status non- invasively by using ultrasound through assessing inferior vena cava collapsibility index in ischemic heart patients. Although there is high sensitivity and specificity of ultrasonography to assess IVC collapsibility index as an indirect method of assessment of CVP.
Efficacy of Virtual Reality Distraction Technique for Anxiety and Pain Control in Knee Arthroscopy under Spinal Anesthesia. A Randomized Controlled Trial
Authors: Mohamed Omnia Ahmed , Mohamed Waleed Abdelmgeid , Ibrahim Dalia Ahmed
Published: November 2024

Background

Regional anesthesia (RA) allows surgery without impacting the patient’s level of consciousness. This avoids disadvantages related to general anesthesia, especially the maintenance of upper airway.

Aim of the Work

The proposed study aimed to compare the effect of using non- pharmacological methods, i.e., virtual reality, on anxiety level and satisfaction with that of the sedating effect of midazolam.

Patients and Methods

In this study we compare Efficacy of virtual reality distraction technique for anxiety and sedation in knee arthroscopy under spinal anaesthesia. The study is conducted in Anesthesiology Department, Faculty of medicine, Ain Shams University. The study period is 6 months. The sample size is 100 patients divided in two groups randomly (Group I and Group II). Each group has 50 patients.

Results

The results showed that the application of virtual reality as a complementary modality might help manage perioperative anxiety in a way that is safe, effective, time-efficient, and enjoyable similar to that of sedating effect of midazolam with an advantage of excluding the undesirable adverse effect of sedative drug.

Conclusion

Virtual Reality is effective for reducing the anxiety of patient perioperative and increasing satisfaction in a safe, effective, time- efficient, enjoyable, and maintained patient's level of consciousness, in addition to the fact that preoperative sedatives and antianxiety drugs often have adverse side effects and may prolong patient recovery and discharge.
Evaluation of Meatal Mobilization in the Management of Distal Hypospadias
Authors: Gad Hany Hamed , Mohameden Haitham Mohamed Ali , Yosef Soliman Seif Abd Elmo’men
Published: November 2024

Background

Hypospadias refers to a urethral opening proximal to the normal glanular location along the ventral side of the penis. The defect is commonly considered arrested development, due to incomplete fusionof urethral folds. Hypospadias occurs in 1 in 300 males (0.3%).

Objective

To evaluate the Meatal Mobilization technique in management of distal hypospadias to achieve better cosmoses and function with less complication.

Patients and Methods

This is Prospective Cohort with historical control study [operations which were done for distal hypospadias e.g: MAGPI, Thiersh Duplay, snodgrass] that was done on 35 patients with distal hypospadias age ranging from 1.5 year to 12 years complaining of abnormal site of micturition at Urology department, Ain Shams University starting From October 2022 till April 2023.

Results

Our results confirmed the viability of the meatal mobilization (MEMO) technique in the management of distal hypospadias with no fistula, no recurrence, no meatal stenosis, no glanular disruption, and better cosmetic appearance.

Conclusion

Meatal Mobilization (MEMO) technique is a viable option for management of distal hypospadias with better cosmoses and minimal complications after evaluation by HOPE score.
Prospective Randomized Controlled Trial for the Effect of Perineural Injection of Bupivacaine for Sciatic Nerve in above Knee Amputation on Postoperative Stump Pain
Authors: Farouk Abadeer Ashraf , Wahba Ramez Mounir , Eldieb Khaled Abdelsattar Elsayed , Hassan Mostafa Mohamed Abdelsamie
Published: November 2024

Background

Despite advances in limb-salvage surgery, lower extremity amputation is still commonly required as an end result of the progression of arterial occlusive disease, failed arterial reconstruction or sever infection. Furthermore, the increasing prevalence of diabetes has led to the appearance of more patients with foot complications leading to eventual lower extremity amputation.

Objective

To assess the efficacy of perineural injection of Bupivacaine for sciatic nerve in above knee amputation on postoperative stump pain and consumption of analgesia.

Patients and Methods

This is a prospective study, in which we follow up patients who went for above knee amputation and record the severity of post operative stump pain. The study included 30 patients undergoing lower limb amputation in Ain Shams University hospitals divided randomly into two groups each group of 15 patients, one group will receive the injection for sciatic nerve and the other group will not, postoperative pain follow up for one weeks, and the outcome measured is the severity of post operative stump pain.

Results

Regarding pain score assessment between the two groups at the first one week, there is highly significant decrease in pain score in our study group that received the perineural injection more than the other group at the first 18 hours postoperative (P-value <0.001), and there is significant decrease in pain score for the perineural injected group with P-value 0.013. Up to 36 hours there is decrease in pain score in group I than group II but with no significant statically results. Regarding the total analgesia (opioids) intake in group I Mean ±SD (1.8 ± 1.935) while in group II Mean ±SD (6 ± 1.69), group I in less than group II in total opioids in take in the first one week with p-value <0.001 with highly significant difference between the two groups.

Conclusion

Intraoperative perineural bupivacaine injection of sciatic nerve found to decrease the postoperative pain especially at the first 24 hours, and also decrease the opioids consumption and its side effects.
Intrathecal Nalbuphine versus Fentanyl as Adjuvants to Hyperbaric Bupivacaine in Hip Arthroplasty
Authors: Abdul-Aziz Mohammed Saeed , Mohamed Hanna , Elgendy AbdAllah , Fahim Hany Magdy , Hashim Ziad , Mahmoud Abdel Karim
Published: November 2024

Background

Hip surgeries are one of the most cost-effective and consistently successful surgeries performed in orthopedics. Hip surgeries provide reliable outcomes for patients suffering from end-stage degenerative hip osteoarthritis (OA), specifically pain relief, functional restoration, and overall improved quality of life. Subarachnoid block is the preferred anesthesia for hip surgeries, being simple to perform and economical with rapid onset.

Objective

To compare intrathecal fentanyl in patients undergoing hip arthroplasty with nalbuphine as intrathecal adjuvant to 0.5% hyperbaric bupivacaine. The primary endpoint was the postoperative analgesia as assessed by VAS. The secondary outcomes were the onset and duration of sensory and motor blockade, hemodynamic changes, and incidence of side effects (bradycardia/ hypotension/ pruritus/ shivering/ respiratory depression/sedation).

Patients and Methods

This prospective double-blinded randomized clinical trial was conducted at Ain Shams University Hospitals from February 2022 until February 2023.

Results

As regard analgesic efficacy, there was increase pain in the two groups over the periods, but the most increase was in the fentanyl compared with nalbuphine group. There was a statistically significant difference between groups according to VAS score after 2:3 to 3:3 hours, while the rest times have insignificant difference. Sixteen patients received rescue analgesia with Fentanyl within 6h postoperatively, whereas six patients received with Naluphine which was found to be highly significant.

Conclusion

From our study we can conclude that there was increase pain in the two groups over the periods, but the most increase was in the fentanyl compared with nalbuphine group. There was a statistically significant difference between groups according to VAS score after 2:3 to 3:3 hours, while the rest times have insignificant difference. Sixteen patients received rescue analgesia with Fentanyl within 6h postoperatively, whereas six patients received with Naluphine which was found to be highly significant.
The Impact of Cardiac Rehabilitation on Quality of Life and 6 Minute Walk Test in Post Glenn Patients
Authors: Abubakar Abdelhady Abdifatah Omar , Bakr El Missiri Ahmed Mohamed Abo , Abdelhady Araquib Ahmed Kadry , Mohammed Fahmy Youssef Mohammed
Published: November 2024

Background

The impact of cardiac rehabilitation on quality of life and 6 minute walk test in post Glenn patients. The present study conducted on 35 patients of both sex and age of 6 years old and above and at least 6 month after Glenn surgery at Ain Shams university Hospitals recruited during the period of 6 month.

Objective

To investigate the impact of a 12-week completed cardiac rehabilitation program on 6-minute walk test and quality of life in-patients of post Glenn shunt.

Methods

This was a 2-arm parallel prospective, randomized, controlled Study conducted on 35 patients of both sex and age of 6 years old and above and at least 6 month after Glenn surgery at Ain Shams university Hospitals recruited during the period of 6 month.

Results

We found that a significant improvement of Quality of life with reduced functional capacity in exercised group only after 3 months from enrollment in CR program, while control group didn’t show any improvement. Improvement was not only in quality of life but also there was a significant improvement in 6MWD in CR group when compared with control group (32.33 vs 2.25, p = 0.032 respectively).

Conclusion

Completed CR program improves quality of life and 6MWD in patients with post Glenn shunt with restricted physical activity.
Quality of life and psychological effects of congenital heart diseases in a sample of Egyptian adults
Authors: Elsayegh Ayah Tarek , Emara Ahmed Youssef , Elfiky Azza AbdAllah , Mohamed AbouTaleb Mariam Yehia , Amin Youssef Mohamed
Published: November 2024

Background

Complex congenital heart disease (CHD) had very poor prognosis just a few decades ago. Nowadays, more than 90% of them, survive into adulthood, yet the complete “correction” or “repair” of CHD is not the rule and many of those patients undergo palliative interventions or surgeries. Many psychiatric and mental disorders could be seen in this group of patients. Furthermore, this could affect quality of life (QOL).

Objectives

Find out how prevalent anxiety and depression are among adult congenital heart disease (ACHD) patients and understand how it affects their lifestyle quality.

Patients and Methods

Observational case-control, cross-sectional study on 300 Adults with CHD vs 300 controls. Controls and patients were asked to fill three questionnaires to determine the prevalence of anxiety, depression, and QOL.

Results

Cases had higher anxiety and depression scores than controls and had poorer QOL than controls.

Conclusion

Congenital heart conditions adversely affect the QOL compared to a matched control group. Additionally, this cohort of patients suffers psychological distress, with more anxiety and depression in comparison to the control group. These results emphasize the drastic impact of CHD on the overall well- being of affected individuals, stressing upon the importance of holistic care that addresses both the physical and psychological aspects of their health.
Long Term Follow Up of Biatrial Function after Transcatheter Closure of Atrial Septal Defect
Authors: Khaled Amr , Tarek El-Sayegh Aya , Ezz eldin Dina Adel , Roushdy Alaa Mahmoud
Published: November 2024

Aim and Objectives

The aim of the study is to evaluate long term right and left atrial function using volumetric analysis and strain indices in patients who underwent transcatheter atrial septal defect (ASD) device closure more than 3 years ago.

Patients and Methods

This study included a group of 40 patients diagnosed with ASD who came for regular follow up at congenital heart disease clinic and another group of 40 healthy controls (age and sex matched). Basic transthoracic echocardiographic examination was done to both groups followed by assessment of atrial function using modified simpson’s method to measure right and left atrial volumes and 2D speckle tracking technique to assess biatrial strain in the three different phases (reservoir, conduit and contractile strain).

Results

In our study the results showed that there is no significant difference between the patients group and control group regarding volumetric analysis. Regarding left atrial (LA) strain values, there was no difference in reservoir and conduit strain while contractile strain was significantly lower in the patients group (p- value=0.047). On the other hand, all right atrial (RA) strain values were significantly lower in the patients group than control group (p-value<0.05). A subgroup analysis based on age at closure showed that patients underwent closure at age less than 15 years old had significantly higher strain values for all right and left strain indices compared to those who underwent ASD closure at age of 15 years old or older.

Conclusion

ASD closure at earlier age is associated with better outcomes regarding atrial function. Long term follow-up in patients who underwent ASD closure more than 3 years ago showed similar LA strain values to control except for lower contractile strain while RA strain values were significantly lower in the patients group. Patients who underwent closure at age less than 15 years old had almost normal right and left strain values while those who underwent closure equal to or more than 15 years old had impaired strain values. Earlier closure is associated with better reverse remodeling and atrial function can turn into normal in patients treated earlier.
Impact of Successful Antegrade & Retrograde CTO PCI on Short Term Prognosis
Authors: Etriby Khaled A El , Okasha Nireen K , Mohamed Tarek R , Zahran Mohamed E
Published: November 2024

Background

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) carries risk of complications and should be attempted when the anticipated benefits exceed the potential risks. The primary indication for CTO-PCI is symptom improvement. However, the impact of CTO PCI on angina and subsequent incidence of major adverse cardiovascular event (MACE) rate remains controversial.

Objective

Our aim was to study the impact of the antegrade and retrograde approaches for elective CTO PCI on the procedural success rate & short-term MACE.

Patients and Methods

The current study was a prospective cohort study that included a total of 80 patients who were referred to our center (Ain Shams University Hospitals) for elective CTO PCI and underwent technically successful CTO PCI. Data was collected on patient arrival to our department and then the patients were observed during hospital admission to record any In-Hospital MACE. These patients were then followed up for 6 months to record improvement or worsening of their symptoms and to assess occurrence of any MACE including hospitalization and undergoing symptom driven coronary angiography.

Results

The mean age of our patients was 56±9.6 years and 91% of the patients were men. Seventy- seven % of patients were done via an ante-grade approach and 23% were done via a retro-grade approach with an overall procedural success rate of 91.25% (Antegrade 93.5%, Retrograde 83.3%). The overall mean procedure time was 102 minutes, the mean contrast volume used was 371 ml and the mean cumulative Air Kerma dose was 7.2 Gy. The retrograde group required longer procedure times, larger volumes of contrast and higher exposure to radiation. The overall in-hospital MACE was 8.75%. 81.25% of patients in our study showed an improvement in the grade of their exertional dyspnea or angina within the 6-month follow-up period. 16.25% of patients in our study needed re-hospitalization within a 6-month period after PCI. The overall Target lesion re-vascularization rate at 6 months was 8.75%. Three out of the 7 patients (42.86%) who suffered from in-hospital MACE developed another Major adverse cardiac event during the 6 months follow up period. This was a higher percentage than the patients who did not suffer from in-hospital MACE and was statistically significant.

Conclusion

Technically successful CTO PCI in a well-equipped center with highly qualified CTO operators resulted in high procedural success rates and low incidence of short-term MACE.
C-Reactive Protein to Albumin Ratio as a Marker of Atheromatous Plaque Instability in NSTE-ACS
Authors: Mohamed Abulnasr Mahmoud Khairy , Atteya Amr Adel Alsayed , Ellias Ramy Raymond , Abdalla Iskandar Mina Magued
Published: November 2024

Background

Acute coronary syndrome (ACS) can be divided into subgroups of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina. ACS carries significant morbidity and mortality and the prompt diagnosis, and appropriate treatment is essential. The current 2018 clinical definition of myocardial infarction (MI) requires the confirmation of the myocardial ischemic injury with abnormal cardiac biomarkers.

Objective

to assess correlation between C-reactive protein to albumin ratio (CAR) as a marker of instability of atheromatous plaque and the extent of CAD and the presence of coronary ectasia as a secondary endpoint.

Methods

This is a Case control Study that included one hundred patients who presented to Ain Shams University hospitals.

Results

CAR was higher in patients group than in control group with a highly significant relation with p – value 0.000. CAR was correlated to syntax score revealing a highly significant correlation with p –value 0.000. There was no statistical significance between CAR and coronary ectasia. CAR is superior to albumin in detecting the patient group, but not superior to CRP.

Conclusion

CAR was found higher in the patient group than in the control group suggesting its potential use as a marker of atheromatous plaque instability. CAR can serve as a marker of Coronary artery severity as it was observed that patients with higher SS also had higher CAR levels.
Effect of Empagliflozin on No-Reflow in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Authors: Nasef Mostafa Ayman , Saber Mohamed , Kamal Diaa , Gomaa Yasser
Published: November 2024

Aim and Objectives

To Assess the effect of Empagliflozin preloading in non-diabetic STEMI patients before PPCI on procedural, in-hospital outcomes and short-term MACE in a single tertiary center.

Patients and Methods

The study was carried out on 200 non-diabetic STEMI patients presenting to Ain Shams university hospitals within the first 8 hours of symptom onset. Patients were randomised into 2 groups, the intervention group received 10mg Empagliflozin before primary percutaneous coronary intervention (PPCI)with the standard medical therapy while the control group received only the standard medical therapy. Patients were assessed for demographic data, risk factors, procedural outcomes, clinical and in-hospital outcomes, and short-term MACE up to 1 month.

Results

Our study found a significant difference between the intervention and control groups regarding contrast volume with a mean of 131 ml in intervention group and 144 ml in control group with a p value of 0.009, incidence of no-reflow with 34.5% in the control group and only 18.2% in the intervention group and a p value of 0.014, myocardial blush grade were 84.1% of the patients in intervention group showed MBG III while only 65.5% of the patients in the control group showed the same results with a p value of 0.019, St-segment resolution post PCI as 59.1% had complete ST segment resolution and only 39.1% in the control group with a p-value of 0.027, and total Major Adverse Cardiovascular events (MACE) in the first month affecting 44.8% of the patients in the control group and only 28.4% in the intervention group with a p- value of 0.024.

Conclusion

Our study showed that pre-loading of STEMI patients with Empagliflozin resulted in improvement in procedural outcomes, decreasing the incidence of coronary no-reflow, improvement in patient’s course during hospital stay and short-term MACE. Improvement in MACE was mainly due to reduced HF hospitalisations and anginal symptoms.
Effect of Cardiac Rehabilitation Program on Left Ventricular Systolic Function in Patients with Breast Cancer Receiving Anthracycline-Based Chemotherapy Using Two-Dimensional Speckle Tracking Echocardiography
Authors: Mahmoud Sarah M , Hasanen Adel G , Elias Ramy R , Shabana Adel M , Abdelhady Ahmed K
Published: November 2024

Background

Anthracyclines used in the treatment of breast cancer are known for their cumulative cardiotoxic effect, which remains a limiting factor. Cardio-oncology rehabilitation (CORE) is an new concept which aims to simultaneously decrease the risk of CVD and improve cardiopulmonary fitness among cancer patients during and after treatment. Two dimensional speckle tracking echocardiography is a promising technique for the early detection of nonclinical cardiotoxicity.

Objective

to determine the Effect of cardiac rehabilitation program on Left Ventricular systolic function in patients with breast cancer receiving Anthracycline based chemotherapy using two-dimensional speckle tracking echocardiography

Patients and Methods

The current study is a prospective, randomized, single-blind trial that included a total of 100 female patients with newly diagnosed breast cancer who received anthracycline-based chemotherapy. Patients were randomly assigned in a 1:1 ratio into two groups, the study group (Group 1) in which patients were allocated cardiac rehabilitation program in addition to their regular chemotherapeutic drugs and the control group (group 2) in which patients received chemotherapy. A comprehensive echocardiographic examination was performed to all patients before receiving the chemotherapy and at 3 and 6 months after, assessment of LV- Global longitudinal strain was done by 2D- speckle tracking echocardiography.

Results

The mean age of patients assigned to the Group 1 was 49.10 ± 9.31 years, while patients assigned to the Group 2 had a mean age of 52.20 ± 7.07 years, both groups were similar in demographic data, baseline clinical characteristics and Echocardiographic Data. At 3 months, no significant difference was found in
Left Ventricular Global Longitudinal Strain and H2FPEF Score in Chronic Kidney Disease Patients with Preserved Left Ventricular Ejection Fraction
Authors: Sallam Tarief O , El-Demerdash Salah Eldin H , El-Kilany Wael M , Hassan Mohamed S , Bastawy Islam M
Published: November 2024

Background

Cardiovascular disease is the leading cause of mortality in patients with chronic kidney disease (CKD). Although they have mostly normal left ventricular systolic functions using conventional echocardiography some of them develop symptoms of heart failure with preserved ejection fraction (HFpEF) (Dubin et al, 2017), (Edwards et al, 2008).

Objective

This study aims to assess left ventricular global longitudinal strain and H2FPEF score in chronic kidney disease patients with preserved left ventricular ejection fraction.

Patients and Methods

The current study was a prospective study that included a total of 100 patients who were referred to our center (Ain Shams University Hospitals) nephrology clinic. Data was collected on patient arrival to our hospital and then echocardiography including LVGLS was done to all patients. All clinical and echocardiographic data were utilized do assess HfPEF probability using H2FPEF score.

Results

The mean age of our patients was 43.2±15.7 years and 58% of the patients were men. Ninety- five % of patients were hypertensives with more than 94 % receiving two or more anti-hypertensive medications while atrial fibrillation was found in 30% of the patients. Dialysis patients (stage Vd CKD) represented 52% of patients while stage III CKD represented 43% of patients. The patients’ hemoglobin ranged from 9-13.5 gm/dl with mean 10.415 ± 1.259. According to H2FPEF score, 29 (29%) patients had high probability to have HFpEF. Left ventricular Global longitudinal strain (GLS) in 54 patients was less negative than -16 (65.85%). Global longitudinal strain GLS showed positive correlation with H2FPEF score r = 0.406, P-value <0.001. Figure 1

Conclusion

Chronic kidney disease is strongly associated with reduced global longitudinal strain and with high probability of HFPEF.
Bronchial Bacterial Colonization in Patients with Lung Cancer
Authors: Saad Melegy Amira Sabry , Madkour Ashraf Mokhtar , Elhady Elkady Mona Ahmed , Mahmood Ali Ibraheem Yasmeen Mohammad
Published: November 2024

Background

The first step in bacterial respiratory tract infection is bacterial colonization of the lower respiratory tract. The lower respiratory tract is sterile in contrast to the gastrointestinal tract. This sterility is maintained through a variety of mechanisms that counteract bacterial adherence and virulence factors and once overwhelmed bacterial colonization and infection occurs. The clinical course of lung cancer is often complicated by lung infections proved in 84% of cases.

Objective

to evaluate the prevalence and nature of bronchial bacterial colonization in patient with primary lung cancer at time of diagnosis.

Methods

This prospective cross-sectional study was performed on a total of 69 consecutive patients with suspected lung cancer during study duration from December 2022 to June 2023 referred to our bronchoscopy unit at chest department-Ain Shams University for diagnostic bronchoscopy.

Results

In 26 (52%) of 50 patients no bacterial growth was found in the bronchial tree. In four cases (8%), potentially pathological bacteria were cultured but their number was < 104 cfu/ml. In 20 (40%) cases, the colonization of potentially pathogenic bacteria was ≥ 104 cfu/ml. most common organisms were Gram-negative. The most frequently was pseudomonas (n = 15), and in the second group klebsiella (n = 5). In three cases (61%) the bronchial tree was colonized simultaneously by two types of micro-organism.

Conclusion

The current study found that 48% of patients with lung cancer are colonized by potentially pathogenic bacteria during their initial bronchoscopy work up. The dominant organisms colonizing the lower respiratory tract were gram negative bacteria and in which 40% of bronchial bacterial colonization had a cut-off level ≥104 CFU/ml. Oldest and COPD patients have higher risk of colonization. However, additional studies are suggested to further examine the clinical impact of bronchial colonization on lung cancer patients outcomes as regards infection rate and survival.
Comparison between Ultrasound Guided Pleural Biopsy and Thoracoscopy in Diagnosis of Exudative Pleural Effusion
Authors: Mansour Mona A , Ali Eman R , El-maraghy Ashrf A , Abbas Enas K
Published: November 2024

Background

Ultrasound guided pleural biopsy is a good alternative to thoracoscopy in friable cases and in places where thoracoscopy is not available.

Objective

To review the benefits, complications and outcomes of ultrasound guided pleural biopsy versus thoracoscopic pleural biopsy.

Patients and Methods

A prospective study was conducted on 114 subjects. They were divided into 2 groups. 62 patients underwent thoracoscopic pleural biopsy (group A), 52 patients underwent ultrasound guided pleural biopsy (group B).

Results

In comparing the 2 groups, there was no statistically significant difference between the two groups concerning comorbidity, complaint, diagnosis, diagnostic yield and complications. While there was highly significant statistical difference between the two groups regarding radiology (p value < 0.001). Furthermore, duration of procedure and length of hospital stay were statically significant higher in group A (p value < 0.001).

Conclusion

Both thoracoscopy and ultrasound guided pleural biopsy have comparable diagnostic yields. But ultrasound guided pleural biopsy has the advantage of being done in shorter time with less hospital stay. Patients who cannot stand thoracoscopy or cannot afford for it have the choice of ultrasound guided pleural biopsy when there is clear radiological pleural lesion
Implementation of Antimicrobial Stewardship Program in A Tertiary Surgery Hospital: Barriers and Challenges
Authors: Elshamy Amira , Halim Rania Abdel , Elmasry Shereen , Mokhtar Amira , Girgis Samia
Published: November 2024

Introduction

Many interventions have been demonstrated to beat the spread of antimicrobial resistance, one of which is the antimicrobial stewardship programs on the international, national and facility levels. One of the major pillars of the antimicrobial stewardship programs is the perioperative antibiotic surgical prophylaxis (PAP) which is critical to preventing the emergence of bacterial resistances. On the other hand, it is critical to preventing surgical site infections (SSIs), which are the second most common healthcare-associated infection and complicate approximately 5% of surgical procedures each year, according to the Centers for Disease Control (CDC).

Materials and Methods

In our study, we conducted improvement project with the use of FOCUS PDCA method to implement antimicrobial stewardship program and find the barriers to implementation.

Results

According to the WHO assessment checklist, almost all of the core elements declared by CDC concerning ASP were implemented. Leadership commitment elements increased from 33% to 66%. Accountability and education elements were 100% implemented although none of them were implemented before. ASP actions were increased from 57% to 100 as well. Although there was a trained clinical pharmacist representing 100% of pharmacy expertise elements, only 50% of tracking antibiotics use and outcomes elements were implemented. On the other hand, Reporting antibiotics Use and Outcomes elements were increased from 50% to 100%. The main challenge we faced was the behavioral change and proper tracking of the dispensed antibiotics.

Conclusions

Preauthorization combined with training, monitoring and reporting were effective in the implementation of the ASP but some challenges may interfere with the full implementation of the program.
Evaluation of CD96 Expression in Acute Myeloid Leukemia Patients: Relation to Prognosis and Induction Chemotherapy
Authors: Mohamed Soliman Ayat Soliman , Osman Amany Ahmed , Diaa El-Dine Dalia Ahmed
Published: November 2024

Background

In acute myeloid leukemia (AML), leukemic stem cells (LSCs) form a distinct group of leukemia cells showing stem cell-like features like self-renewal and proliferation. These potent cells significantly contribute to chemotherapy resistance, a major obstacle in AML therapy. LSCs express the characteristic phenotype CD34+/CD38- and have several specific markers, including CD33, CD96, CD123, CD90 and Death associated protein kinase (DAPK). Successful LSC eradication demands a combination of approaches, including targeting LSC-specific surface molecules.

Objective

To assess the expression of CD96 in AML patients at initial diagnosis and to correlate it with prognostic factors and response to induction chemotherapy.

Materials and Methods

This Case control study was conducted on 40 newly diagnosed AML patients in addition to 10 controls at Ain Shams University Hospitals between March 2022 and March 2023. Multicolor flowcytometry was employed to analyze CD96 expression in the CD34+/CD38- cell population of AML patients. The study further investigated the correlation between CD96 expression and both prognostic factors and response to induction chemotherapy.

Results

CD96 expression was significantly higher in AML patients group than control group (p-value = 0.008). CD96 was positive in 60% of AML patients and there was a highly significant association between CD96 expression and response to induction chemotherapy (p-value = <0.001). However, there was no statistically significant relation between CD96 expression with laboratory findings and standard prognostic factors.

Conclusion

Our study identified CD96 as a promising marker for LSCs in AML patients. Its frequent expression in the CD34+/CD38- LSC population and association with lower response rate to induction chemotherapy suggest its potential as a valuable tool for LSC identification, targeted therapy development and improved treatment outcome prediction in AML.
Prognostic Impact of CD200 and CD56 Expression in Patients with Acute Myeloid Leukemia
Authors: Ahmed Israa Yosry Ali Elsayed , Omar Iman Mohamed Amin , Metawaa Maha Ahmed Abdel Rady
Published: November 2024

Background

Acute myeloid leukemia (AML) is a clonal malignant disease of hematopoietic tissue which results from a block of normal differentiation of hematopoietic progenitor cells along with uncontrolled proliferation of cells of myeloid origin with maturation arrest leading to infiltration of bone marrow and other tissues by myeloblasts. It escapes from immunosurveillance by induction of immunosuppression through expression of specific cell surface molecules with immune modulatory function. Novel immune-directed therapeutic approaches form a major focus of current and clinical research.

Objective

to assess the expression level of CD200 and CD56 in de-novo acute myeloid leukemia patients and evaluate the prognostic value of their positive expressions in patients with AML.

Methods

This Cohort study was conducted at Ain Shams University Hospitals, on 51 newly diagnosed adult AML patients attending the Hematology Oncology Unit of Ain Shams University Hospitals from February, 2022 until June, 2023.

Results

CD200+ expression was reported in 74.5% of patients while 9.8% of patients showed CD56+ expression. M1-M2 were found to be the most common FAB subtypes. CD200+ was higher among female patients (p = 0.045). On the other hand, CD56+ patients were younger in comparison to CD56- patients (p = 0.002). Total death was higher among CD200+ patients than CD200- patients (p = 0.037).

Conclusion

Our study reveals that CD200 expression is associated with higher incidence of mortality which suggests a negative impact of CD200 expression on survival rate while CD56 is not associated with a significant mortality.
The Role of Neutrophil to Lymphocyte Ratio and Platelet Indices as Markers of Inflammation in Acute Coronary Syndrome
Authors: Ismail Mona Ahmed , abdel Rady Metawaa Maha Ahmed , Farouk Mohamed Moustafa , Mohamed Salah Lobna Tarek
Published: November 2024

Introduction

Inflammation plays an important role in atherosclerosis that is the primary cause of acute coronary syndrome (ACS) which includes acute myocardial infarction (AMI) and unstable angina (UA).

Objective

To investigate neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), C-reactive protein (CRP), white blood cell (WBC) count and platelet count in patients with ACS.

Patients and Methods

This case control study included 50 patients with ACS (38 males, 12 females), aged 36 to 80 years, classified into three groups: ST segment elevation myocardial infarction group, non ST segment elevation myocardial infarction group and UA group. Patient group was compared to 50 apparently healthy subjects as a control group of matched age and sex. Patients were admitted to either the emergency department, cardiology outpatient clinic, or the coronary care unit (CCU) of Ain Shams University Hospitals. From patients’ medical records, the following data were obtained: WBC count, NLR, MPV, platelet count, C-reactive protein (CRP), troponin, total CK and creatine kinase MB (CKMB). The results were analyzed using software package SPSS.

Results

A highly statistically significant difference as regard WBC count, neutrophil count, NLR, MPV, and CRP level was found between ACS patients and healthy control group being higher in ACS patients. The study encountered a statistically significant difference among patients’ subgroups as regard NLR being higher in NSTEMI and lower in unstable angina. A statistically significant positive correlation between NLR and other parameters as WBCs count, neutrophil count, MPV and cardiac biomarkers was found. There was a statistically significant difference as regard MPV between ACS patients and control group. There was a statistically significant difference as regard CRP level between ACS patients and healthy control group.

Conclusion

NLR was high in ACS patients compared to controls. Median values of NLR were significantly higher in patients with AMI in relation to patients with UA, indicating the importance of this inflammatory marker in discrimination of clinical forms of ACS. A positive correlation was established between NLR and markers of myocardial necrosis, indicating the importance of NLR in the assessment of the extent of the myocardial lesion and in inflammation intensity assessment in ACS. The MPV is an independent risk factor for MI in coronary artery disease. The CRP has been found to be strongly associated with diagnosis and risk stratification of cardiovascular diseases.
Changes in D-Dimer Levels During Anticoagulation in Patients with Venous Thromboembolism (VTE)
Authors: Riad Himdan Marwa Hossam , EL-Sewefy Mohamed Dalia Ahmed , Ismail Ismail Mohamed , Abuelela Soha Ahmed
Published: November 2024

Background

Venous thromboembolism (VTE) is a term including deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE is potentially a fatal disease because of its high morbidity and mortality in outpatients and inpatients, especially in hospitalized patients. Therefore, timely and accurate diagnosis of both is essential as delayed or missed diagnoses can result in death or longer-term complications. At the same time, the lack of subjective clinical symptoms and objective clinical signs complicates the diagnosis.

Objective

To assess the influence of oral anticoagulants on D-dimer levels in patients with VTE.

Methods

This Cohort study was conducted at Ain Shams University Hospitals, on 50 patients with radiologically confirmed DVT attending Ain Shams University Hospitals outpatient clinics from September 2021 until March 2022.

Results

To the comparison of the absolute values of D-dimer levels in the patients’ plasma, we correlated the frequencies of D-dimer levels above cut-off value in the studied patients. For this analysis, D-dimer levels ≥ 0.50 mg/l were defined as cut-off. D-dimer levels above this cut-off were statistically significantly higher in patients on DOACs (direct oral anticoagulant) which are Rivaroxaban and Apixaban than in vitamin K-antagonists (VKA) users after 30 days, with a p value of 0.042.

Conclusion

Our study reveals that the rate of positive D-dimer levels assessed serially during anticoagulation (at days 14 and 30 post anticoagulation) was significantly higher in patients treated with DOACs than warfarin. This may highlight the value of extended anticoagulation for patients who present with persistently elevated D-dimer levels to avoid the risk of VTE recurrence.
Diagnostic and Prognostic Values of Eosinophil Derived Neurotoxin in Pediatric Patients with Allergic Respiratory Diseases
Authors: Aly Mahmoud Fadlullah Ragy Abdulhameed , Abdel Ghaffar Aisha Yassin , Zeitoun Yasser Ahmed , Shousha Ghada Abdel Haleem , Abdelhady Walid
Published: November 2024

Background

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation. In bronchial asthma (BA), the levels of eosinophils are elevated both in the airways and in the blood and they are correlated to asthma severity and control. Activated eosinophils release eosinophil derived neurotoxin (EDN), eosinophil cationic protein (ECP), major basic protein (MBP), eosinophil peroxidase (EPO), and newly developed major basic protein 2 (MBP2). EDN has RNase with broad anti-viral and anti-bacterial activity that may also promote further leukocyte activation and is implicated in the pathophysiology of asthma.

Objective

The aim of the work is to assess the diagnostic and prognostic value of serum EDN levels via ELISA in pediatric patients with BA and preschool wheezes in relation to their clinical and laboratory parameters particularly absolute eosinophilic counts.

Patients and Methods

This is a case control study that had been conducted on a stratified random sample of 90 subjects who were seen in Pediatric Allergy, Immunology and Rheumatology unit, and Clinical Pathology Immunology Laboratory Ain Shams university Hospitals, in the period between June 2022 to November 2022, divided as 30 patients with BA, 30 patients with preschool wheezes and 30 age and sex matched healthy subjects.

Results

The comparison between the studied groups revealed the presence of statistically significant increase in percent and absolute count of eosinophils among the cases group compared with the controls (P value<0.001). There was a statistically significant increase in serum EDN among the cases group, preschool wheezers and asthmatic patients compared with the controls (17.96 ± 4.95 ng/ml vs. 5.52 ± 1.4 ng/ml), (16.97 ± 4.24 ng/ml vs. 5.14 ± 1.39 ng/ml) and (18.95 ± 5.47 ng/ml vs. 5.89 ± 1.35 ng/ml) (P value<0.001) respectively. Elevated EDN level has been linked to eosinophilia, Th2-mediated inflammation and type 2 airway inflammations as well as increased eosinophil extracellular traps that promoted the degranulation of eosinophils.

Conclusion

EDN is a good biomarker for eosinophilic inflammation including bronchial asthma and preschool wheezes and may be useful as a screening tool. For prediction of allergic respiratory diseases (asthmatic and school wheezers), the best cutoff value is > 7.8 with sensitivity =100% and specificity =96.67%.
Evaluation of Tissue and Serum Levels of Interleukin-15 in Non-Segmental Vitiligo
Authors: Abdelaziem Manar Ashraf , Ragab Nader Fouad , Salem Lamyaa , El-Khateeb Ekramy Ahmed
Published: November 2024

Background

Vitiligo is a common autoimmune disease of skin depigmentation. The disease presents with many challenges, such as progression, resistance to treatment and recurrence. Recent studies reported a possible role of IL-15 in the pathogenesis, activity and recurrence of the disease.

Objective

Evaluation of tissue and serum levels of IL-15 in non-segmental vitiligo patients.

Methods

This Case-control study included 31 participants; 20 vitiligo patients and 11 controls. In patient group, we took serum samples and three punch biopsies (3mm) from active and recurrent vitiliginous patches as well as non-vitiliginous skin. In control group, we took serum sample and one tissue biopsy. IL-15 was assessed by ELISA technique in all samples.

Results

There was no statistically significant difference between IL-15 levels in tissue and serum of control group. All levels of IL-15 in patients were significantly higher than in control. In patients, level of IL-15 in serum was significantly higher than in active and stable patches but lower than in recurrent patches. IL-15 level, in recurrent patches, was significantly the highest of all parameters.

Conclusion

IL-15 may have an important role in the pathogenesis, activity and mainly recurrence of vitiligo. It seems to be a potential therapeutic target to control the disease and prevent recurrence.