bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Macular Perfusion Analyzed by Optical Coherence Tomography Angiography after Uncomplicated Phacoemulsification
Authors: Abdelmoniem Alaa M , Gaafar Ayman A , Rashed Hazem O , Gharieb Hesham M
Published: November 2024

Background

Age related cataract is one of the commonest causes of diminution of vision worldwide. Phacoemulsification is one of the most common surgical procedures in the world1. Changes in arterial blood pressure, position of blood vessels, venous return of blood and CO2 levels all influence eye perfusion during cataract surgery. The exact impact of phacoemulsification on macular perfusion is unknown2&3.

Purpose

To investigate the changes of macular perfusion parameters after uncomplicated phacoemulsification using an optical coherence tomography angiography (OCT-A).

Subjects and Methods

Thirty eyes of 30 cataractous patients, who had uneventful phacoemulsification with implantation of IOL in the bag, were enrolled in this cohort study. Participants underwent a complete ophthalmologic assessment and measurement of macular perfusion parameters using optical coherence tomography angiography preoperatively and one week, one month, and three months postoperatively.

Results

There was statistically significant increase in the level of parafoveal retinal thickness and perifoveal retinal thickness in postoperative visits than preoperative visits. We have also found statistically significant increase in the level of grid central vessel density in both superficial and deep capillary plexuses in postoperative visits than preoperative visits.

Conclusion

Phacoemulsification positively increases retinal thickness particularly at parafovea and increases vascularity in the center of fovea which makes phacoemulsification beneficial even beyond visual restoration.
Operative versus Conservative Management of First-Time Anterior Glenohumeral Dislocation, A Systematic Review and Meta Analysis
Authors: Sobhy Ahmed Mohamed Hassan , Fakhry Ebeid Wessam Eldin , Dardeer Abdelrahman Mansy Ahmed Abdelhameed
Published: November 2024

Background

Traumatic Anterior Shoulder Instability is quite common especially in young males and high demand athletes. Management of first-time anterior shoulder dislocation remains controversial, with no consensus on whether arthroscopic stabilization or only shoulder immobilization should be offered to these patients.

Aim of the Work

To systematically review the existing literature to compare long-term results after operative stabilization and conservative primary treatment following first-time anterior shoulder dislocation, regarding recurrent instability and redislocation rates as a primary outcome, and secondary clinical outcome parameters like functional shoulder scores.

Patients and Methods

A total of 5 studies met our inclusion criteria for this systematic review and meta-analysis, performed to identify and analyze level 1 randomized controlled studies comparing the outcomes of arthroscopic stabilization versus conservative management in the form of immobilization for the treatment of primary anterior shoulder dislocation. Patients with soft tissue injury alone as well as those with additional minor bony lesions (Hill-Sachs, Bankart) were included. Recurrent instability and functional outcome were evaluated.

Results

Our results show that in young patients, arthroscopic Bankart repair after the first episode of ASD significantly reduced the risk of recurrent instability and decreased the need for a future stabilization procedure, but did not seem to significantly affect functional outcome, when compared with patients treated non-operatively with immobilization.

Conclusion

This review and meta-analysis shows that in patients younger than 40 years, arthroscopic Bankart repair after the first episode of ASD significantly reduced the risk of recurrent instability and decreased the need for a future stabilization procedure when compared with patients treated non- operatively with immobilization.
Accuracy of Preoperative Scoring System in Prediction of Postoperative Survival in Patients with Metastatic Bone Disease: A Systematic Review and Meta-Analysis
Authors: Mansour Ahmed Abdallah Abdelazim , Azmy Sherif Ishak , Mowafi Mohamed Ahmed El
Published: November 2024

Background

Management of patients with metastatic bone disease for which there is risk of pathological fracture remains a clinical challenge. Surgeries performed in cancer patients are procedures at a high risk of thromboembolic and infectious complications. Expected survival is the most important factor to determine the treatment modality. This study evaluated preoperative different survival scores in metastatic bone disease surgery.

Methods

An electronic search of medical literature was conducted through MEDLINE (accessed via Ovid), EMBASE (accessed via Ovid), and PubMed. We performed a systematic review for studies involving prognostic scores that assessed the survival rates of patients with bone metastases. Further, we conducted a meta-analysis including studies that measured the sensitivity and specificity of the Tokuhashi and Tomita score in predicting 6- month survival rates for spinal metastases.

Results

A total of 68 studies were included in our study; of them, 35 studies were included in the meta-analysis. Sensitivities ranged from 27 to 92% for the Tokuhashi score and from 76 to 99% for the Tomita score, and specificities ranged from 44 to 96% for the Tokuhashi score and from 1 to 44% for the Tomita score. The pooled DOR was 6.04 (95 % CI, 3.96– 9.21; Tau-squared= 0.90; I2= 86%) for the Tokuhashi score and 1.34 (95 % CI, 0.67–2.67; Tau-squared = 1.02; I2= 85%) for the Tomita score. The SORG Nomogram, developed in a large surgical cohort, showed good discrimination on 3-month and 1-year survival, good calibration and was superior in direct comparison with low risk of bias and low concern regarding applicability. PATHFx 3.0, 2013-SPRING and potentially Optimodel were found to be the best models in terms of performance in predicting survival for surgery for extremity metastasis.

Conclusion

Regarding spinal metastases, the SORG Nomogram and machine learning algorithms showed better performance in survival prediction for surgery. Regarding extremity metastases, we found PATHFx 3.0, 2013-SPRING and Optimodel to be the best models in terms of performance. Although Tokuhashi score was more accurate than Tomita score slightly, both showed low accuracy to predict 6 months residual survival.
Comparative Study between Dual Mobility Total Hip Replacement versus Bipolar Hemiarthroplasty in the Treatment of Displaced Femoral Neck Fractures in the Elderly
Authors: Mohamed Haytham Abdel-Azim , Sallam Ahmed Mohamed , Abdallah Ahmed Ali Ahmed
Published: November 2024

Background

Total hip arthroplasty (THA) or hemiarthroplasty are the most popular treatments for dislocated intracapsular hip fractures.

Objective

to compare dual mobility total hip arthroplasty and bipolar hemiarthroplasty as a management for the femoral neck fracture in elderly and evaluating the functional outcome. The objective is to perform a systematic review of the outcomes of use of the dual mobility total hip arthroplasty compared to bipolar hemiarthroplasty.

Patients and Methods

We included randomized controlled trials, including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies and case control or nested case-control studies.

Results

There was statistically significant decrease in the Harris Hip score in BA group (78.31±9.25) than THA group (82.72±7.53). There was statistically significant increase in the percentage of patients with dislocation in BA group (6.2%) than THA group (1.9%).

Data Sources

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

Conclusion

dual mobility cup total hip arthroplasty offers for the patients many advantages such as stability, lower dislocation rates and longevity, all those pros make it a superior treatment choice that bipolar hemiarthroplasty.
Systematic Review and Meta-Analysis of Management of Failed Arthroscopic Bankart Repair
Authors: Abdelaal Ahmed Mahmoud , Khater Ahmed Hany , Abd Mostafa Aly El
Published: November 2024

Background

The shoulder joint has the largest range of motion of all joints with little inherent bony stability. As such, it is one of the most frequently dislocated joints in the body with an incidence of up to 47 per 100,000 person years.

Aim of the Work

This review will focus on the etiology, evaluation, and management of patients after a failed primary arthroscopic Bankart repair.

Patients and Methods

Search strategy will be designed to include both manual and electronic data available. Electronic searches will involve searching databases of PubMed (from Jan. 2000 till July 2022), EMbase, CINAHL and Cochrane database searching keywords and terms listed below: “Bankart, Shoulder instability arthroscopic repair, open repair, revision, failure, and salvage”. Moreover, a manual search of the reference lists of the included studies will be searched for additional eligible articles.

Results

The main result of our study is that the Revision arthroscopic bankart repair in the setting of even below critical bone loss likely results in higher recurrent instability as compared to open bankart repair and laterjet procedure. The findings in the current study suggest that in the revision setting, open bankart repair offers the lowest recurrent instability rate (5.4%) compared to laterjet rate (8.8%) and revision arthroscopic bankart (23.8%). The first purpose of this review was to gather data from multiple studies to analyze the reasons of Failure of arthroscopic bankart repair.

Conclusion

We found that open bankart repair is superior to laterjet and arthroscopic bankart repair for failed arthroscopic bankart repair with acceptable recurrence rates of instability. Further comparative studies are needed to gain better understanding the possible solutions to the failure.
Physeal Growth Arrest after Traumatic Injury of Distal Tibial Physis A Systematic Review and Meta-Analysis
Authors: Ebrahim Ali Ebrahim Salah , Hefny Hany Mamdouh , Aly Ahmed Saeed
Published: November 2024

Background

Injury to the physis of the distal tibia in children can lead to subsequent growth arrest. This can result in physeal bars, leg-length discrepancies and angular deformities.

Aim of the Work

Is to review & meta-analysis the distal tibia physeal injury, treatment & how to decrease complications e.g premature physeal closure (PPC), angular deformity & leg length discrepancy.

Patients and Methods

We considered randomized controlled trials, prospective or retrospective cohort studies and case–control studies that directly compared ORIF to closed treatment of distal tibia physeal fractures in children and reported the rate of PPC. PPC was defined on radiographs by the presence of a bony bar in the distal tibia physis of the injured limb. Participants were young patients below 18 years old who have distal tibial physis fractures treated by closed reduction & internal fixation (CRIF), open reduction & internal fixation (ORIF).

Results

this systematic review we found that the degree of initial displacement was significant risk factor for growth arrest after physeal fracture of the distal tibia. Therefore, physicians should consider the possibility of growth arrest in patients with severely displaced physeal fractures of the distal tibia. The displaced S-H II distal tibia physeal fractures have a high risk of periosteal entrapment. ORIF is an effective choice of treatment to obtain an anatomical reduction for patients with > 3 mm of initial displacement. However, PPC is a common complication following ORIF. The presence of associated fibula fracture plays an important role in the fracture outcome.

Conclusion

the degree of initial displacement was significant risk factor for growth arrest after physeal fracture of the distal tibia. Therefore, physicians should consider the possibility of growth arrest in patients with severely displaced physeal fractures of the distal tibia. The displaced S-H II distal tibia physeal fractures have a high risk of periosteal entrapment. ORIF is an effective choice of treatment to obtain an anatomical reduction for patients with > 3 mm of initial displacement. However, PPC is a common complication following ORIF. The presence of associated fibula fracture plays an important role in the fracture outcome.
Total Elbow Arthroplasty Follow Up 10 Years in Rheumatoid Arthritis, A Systematic Review/Meta-Analysis
Authors: Atiyya Ahmed Naeem , Fathy Mounir Ayman , Touni Hani Nagati
Published: November 2024

Background

Rheumatoid arthritis is the most common form of chronic inflammatory arthritis and affects about 1% of adults. It is characterized by progressive, symmetrical arthritis involving many joints, most commonly the knee, wrist and interphalangeal joints. The elbow is affected in between 20% and 65% of patients, often causing severe painful disability. In patients with severe arthritis, many forms of treatment are available to relieve pain and improve function. Total elbow arthroplasty is commonly performed for end-stage arthritis. However, Total elbow arthroplasty has inferior implant survival and higher complication rates compared with arthroplasties of other major joints. This is usually thought to be due to the high risks associated with Rheumatoid arthritis and the complex anatomy of the elbow joint.

Aim of the Work

The aims of this study were to report on the long term outcome of total elbow arthroplasty in patients with rheumatoid arthritis, and to identify factors that affect the outcome patients satisfaction.

Patients and Methods

We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2005 and March 2020. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim is to identify the overall complication rate, associated risk factors and clinical performance. A meta- regression analysis completed to identify the association between each parameter with the outcome. The initial literature search resulted in 4776 studies, with 4665 duplicates subsequently removed. The remaining 111 studies were screened using our exclusion criteria. Following application of our exclusion criteria, the full texts of 111 studies were thereafter evaluated with our inclusion criteria to screen for eligibility. Overall, 13 clinical studies including 349 elbows were included in this study

Results

According to the movement degree, flexion was recorded in 5 studies with 229 elbows and it was found that there was a significant difference in pre and post-operative groups (p < 0.001, I2 = 90%). Extension was recorded in 5 articles with 229 elbows. It was found that there was no significant difference in pre and post-operative groups (p = 0.12, I2 = 53%). Supination was recorded in 5 articles with 229 elbows. It was found that there was a significant difference in pre and post-operative groups (p = 0.008, I2 = 79%). Pronation was recorded in 5 papers with 209 elbows. It was found that there was a significant difference in pre and post-operative groups (p = 0.003, I2 = 83%).

Conclusion

Although elbow replacement is performed far less frequently than hip, knee, or shoulder replacement, its use is increasing and information for patients and clinicians on the longevity of implants and impact on quality of life is vital. Patients experienced a sustained improvement in pain and function for the 10 years following surgery.
Efficacy of Teriparatide in Improving Fractures Union and Healing: A Systematic Review and Meta-Analysis
Authors: Khalil Ibrahem Yasser Ibrahem , Salem Ahmed , Kotb Ahmed Sayed
Published: November 2024

Background

Fractures often contribute to high mortality and adverse outcomes in the geriatric population. During recovery from fracture, most patients experience fracture reduced mobility and impaired ability to perform routine daily activities, with a large proportion failing to regain their refracture functional level after 1 year.

Aim of the Work

This systematic review and meta-analysis study aimed to determine the role of teriparatide (recombinant human parathyroid hormone) for bone fracture healing in adults by comparing the different effects between PTH analogues and any other treatments (e.g. anti-osteoporosis drugs, placebo, standard care….etc.), regarding functional recovery, fracture union, and adverse events.

Methods

Searching process was performed using advanced search strategy on scientific databases. Inclusion criteria were adult patients administrated teriparatide after surgical fixation of fractures. We included all types of study design except case report and case series. The searching and identification process resulted in 16 papers which included in this study.

Results

Time to union were lower in TPTD group than non-TPTD group. The rates of fracture union after 3 and 6 months were similar in both groups. There were a significant improvement in bone mineral density when using teriparatide more than 6 months after surgical intervention for treatment of fracture. Varus collapse were lower in TPTD group than non-TPTD group. There were a significant improvement in functional outcome when using teriparatide post-operatively. HHS were higher in teriparatide (TPTD) group than non-TPTD group. Incidence of mal- union/nonunion and subsequent fracture were lower in TPTD group than non-TPTD group. Mortality rate were lower in TPTD group than non-TPTD group. Reoperation rate, complications’ rate and deformity rate were similar in TPTD group and non-TPTD group.

Conclusion

The using of teriparatide after fractures’ surgical fixation improve functional and radiological outcome and reduce time to union, rate of femoral shortening, degree of varus collapse and mortality rate especially in osteoporotic patients.
Causes of Failure of Subtrochanteric Fracture Fixation, Systematic Review and Meta-Analysis
Authors: Mahran Mahmoud Ali Salaheldin , Abdellatif Mohammed Ali Ibrahim , Desoky Ibrahim Mohamed Ismail
Published: November 2024

Background

Subtrochanteric (ST) femoral fractures is defined as fractures of proximal femoral shaft that is located within 5 cm of the lesser trochanter. Any internal fixation device for trochanteric fractures is subject to significant concentrated bending stresses, leading to implant fatigue and fixation failure. Fixation of sub-trochanteric femoral fracture is considered a critical challenge.

Objective

To assess causes of failure of sub-trochanteric fracture fixation.

Methods

This meta-analysis study included 12 papers which included 999 patients, fixation failed in 163 patients. The included studies mentioned approximately 7 causes for fixation failure which included deep infection (in 2 studies), delayed union (in 2 studies), non-union (in 6 studies), screw cut-out (in 3 studies), Poor reduction (in 3 studies), implant breakage (in 4 studies) and varsus deformity /malrotation (in 3 studies).

Results

This study included 12 studies recruited 999 patients with sub- trochanteric femoral fracture, fixation was failed in 163 patients. The incidence of sub-trochanteric fixation failure was 17% in all included studies 62% of patients with fixation failure were smokers The incidence of fixation failure after intramedullary fixation was lower than after extra-medullary fixation. The incidence of fixation failure after open surgery increases 2.41 times compared with closed surgery. The incidence of fixation failure was higher in patients with post- operative hip varus compared with patients without post-operative hip varus.

Conclusion

The incidence of sub-trochanteric fixation failure was 17%. The causes for fixation failure included smoking, poor reduction, nonunion, implant breakage, screw cutout, varus deformity, extra-medullary nailing.
A Systematic Review of Fixation Modalities in Supracondylar Fracture Femur in Geriatric Age Patients
Authors: Mohamed Ali Islam Ahmed , Abd-elaziz Basiony Ayman , El-khateeb Tameem Mohamed
Published: November 2024

Background

Surgical management has become the preferred treatment strategy for distal femur fractures due to improvements in alignment and functional outcomes over nonsurgical management, although bracing may be sufficient in stable, non-displaced fractures or for patients who are non-ambulatory or of high surgical risk

Aim and Objectives

The aim of this study was to systematically review the literature regarding Fixation modalities in supracondylar fracture femur in geriatric age patients with an emphasis on recent advances.

Subjects and Methods

In this systematic review, we searched Medline (Ovid), PubMed, Cochrane library, and EMBASE from Jan 2000 to July 2020. The search retrieved 779 unique records. We then retained 13 potentially eligible records for full-texts screening. Finally, 10 studies were included

Results

Mean Modifed RUST score pre − 3 changes to 10.1 post operation, mean Lysholm knee score post was 65.3, mean Knee society score was 83.5 and mean HSS knee score was 85.1 as shown in table8

Conclusion

The current systematic review suggested that the surgical fixations with different fixation techniques were all safe and effective in the treatment of supracondylar fracture femur in geriatric age patients, however minimally invasive treatments were recommended among this age group.
Dorso Lumbar Fractures Type A1 Treated by Segmental Fixation versus Conservative Treatment
Authors: Badrawy Ahmed Mohamed El , Fahmy Fady Micheal , Abdelradi Abdelradi Mahmoud , Mazeed Magdy Gamil
Published: November 2024

Background

Thoracolumbar fractures types A1 of AO classification are very common spine injuries. However, its management is usually without operative intervention especially if its patients are neurologically intact.

Objective

Dorsolumbar fractures are treated either with operative (posterior fixation) or conservative. The aim of this study is to compare the results of conservative versus operative treatment in a certain type of fracture (type A1 dorsolumbar fracture) regarding fracture and radiological parameters.

Patients and Methods

60 patients were enrolled in the current study, 29 were males and 31 were females with a mean age of 31.300 years old in non operative patients and 33.867 years old in operative patients at time of surgery.

Results

Regarding radiological parameters, this study included measurements of local kyphosis angle, and vertebral body wedging. The results showed statistically significant differences between preoperative values in comparison to both postoperative and follow up values. Regarding the functional assessment scores, the mean VAS was 1.125 in non operative patients and the mean VAS was 1.040 in operative patients. The mean ODI was 10.633 % in non operative patients and about 8.700% in operative patients at the last follow up visit. There is no great difference between operative and non operative patients in VAS and ODI but there is more satisfaction in operative patients. The degree of kyphosis is more in non operative patients which made few of them in mild pain in the last follow up. The complications encountered were very few, not including any major or neurological complications.

Conclusion

The only purpose to do fixation on those patients of type A1 fracture is to permit early ambulation and to protect them from kyphosis. but VAS and ODI have no big difference between the two groups but more in non operative in cases suffering from post traumatic kyphosis.
Charcot Ankle Treatment with Ilizarov versus Intramedullary Nail Systematic Review and Metaanalysis
Authors: Fayed Mahmoud , Kotb Ahmed Mostafa , El-Sharkawy Mohamed Hassan Abd-Elhamid
Published: November 2024

Background

Charcot neuropathic osteoarthropathy or neuroarthropathy (CNO) of the foot and ankle constitutes a great clinical challenge for a poorly understood destructive process. The CNO is due to sensory and motor neuropathies which lead to a chronic and progressive destruction of the foot architecture involving bones, joints, and soft tissues. Secondary fractures and dislocations predispose to deformity and ulceration with a great decrease of the gait-related quality of life and an increasing potential for major amputation.

Objective

The aims of the arthrodesis reconstructive procedure are realignment and stabilization of the severely deformed ankle in order to avoid ulcers and amputation. Retrograde intramedullary nails (IMN) and ilizarov. are two of the most common fixation techniques used for arthrodesis in CNO.

Materials and Methods

This review seeks to collate evidence from comparative studies to look for significant differences in terms of fusion rate, salvage rate, and complications following ilizarov. and IMN techniques for tibiotalo-calcaneal arthrodesis. Recent clinical trials or cluster trials, prospective and retrospective comparative cohort studies. Search results will be uploaded to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be introduced on the search results and the inclusion/exclusion criteria.

Results

As regard the American Academy of Orthopedic Surgeons Foot and Ankle score (AAOS- FAO), comparison between the two treatment groups was statistically insignificant preoperatively and postoperatively. Intergroup study, Ilizarov and IMN showed statistically highly significant difference between preoperative and postoperative scores (p < 0.01).

Conclusion

Charcot arthropathy of the foot and ankle is a difficult problem that significantly affects the diabetic population. Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques. Use of a retrograde intramedullary nail or ring fixator resulted in high rates of successful limb salvage when used for ankle arthrodesis in patients with Charcot arthropathy. In conclusion, retrograde IMN and the Ilizarov external fixator both yielded better union for tibiotalar arthrodesis in Charcot neuroarthropathy. Comparison between Ilizarov and IMN showed statistically non-significant difference regarding union. Also, Comparison showed that Ilizarov technique had higher rate of complications than IMN, However, the need for revision surgery was more frequent in the retrograde nail group compared to the ring fixator group. The added stability offered by external fixation may benefit patients who are at high risk for complications or require extended arthrodesis.
Targeted Muscle Reinnervation in the Hand for the Prevention and Treatment of Symptomatic Neuroma Following digit and Hand Amputations, A Prospective Case Series
Authors: Fathy Aly Howeidy Ayman Ibrahim , Attiya Aly Ahmed Naeem , Diab Ramy Ahmed , Mohamed Aly Amr Moustafa , Aly Soliman Ramy Ahmed , Fouad Mohamed Mohamed Magdy Ahmed
Published: November 2024

Background

Neuromas are a common complication after digital and hand amputations, resulting in significant pain, discomfort, and functional impairment. Various management methods are available, including surgical excision, nerve blocks, and nerve stump protectors, but these treatments may have limited success rates and potential complications. Targeted muscle reinnervation (TMR) is a promising technique that involves surgically rerouting a severed nerve into a nearby muscle, which can prevent the formation of neuromas and provide improved muscle function.

Aim of the Work

The aim of this work is to assess the efficacy of Targeted muscle reinnervation in the treatment and prevention of symptomatic neuromas in digit and hand amputations, to evaluate the surgical technique and to record any possible postoperative complications or improvements of the technique in the hand.

Materials and Methods

We conducted a prospective case series at Ain Shams University hospitals, we recruited 20 patients eligible for our study by our criteria with digit or hand amputation distal to the wrist crease or a symptomatic neuroma within the hand or digits starting from August 2021 and for 24 months. We excluded patients with cognitive impairment for better outcomes assessment and patients below 18 years old. Either 1ry or 2ry TMR was performed on each patient.

Results

It has resulted in remarkable improvement in the neuroma pain experienced by our hand trauma patients and showed a promise as both a therapeutic and preventative tool to reduce the formation of symptomatic neuromas.

Conclusion

The technique requires good knowledge of hand microsurgical anatomy and good training in microsurgery, we observed a decrease in the operative time towards the conclusion of the study which proves the learning curve. TMR has minimal morbidity and is easily reproducible as demonstrated by multiple surgeons performing the surgery with consistent results.
Comparison between Intramedullary K Wires versus Mini Plate Fixation in Isolated Displaced Shaft Lesser Metatarsal Fractures
Authors: Farouk Amr , Koriem Islam , Mashaly Shehab Mahmoud Abdelhamid
Published: November 2024

Background

Metatarsal (MT) fractures are common foot injuries and account for almost half of all foot fractures. The five metatarsals are the biggest bones in the forefoot and are essential for weight bearing in the last stages of the stance phase.

Objective

to compare between intramedullary K wires versus mini plate fixation in isolated displaced shaft lesser metatarsal fractures regarding the time and rate of fracture healing, as well as the functional outcome of the surgically treated and American Orthopedic Foot and Ankle Society (AOFAS) functional score for the forefoot and related complications of each fixation method. The objective is to perform a systematic review of comparison between intramedullary K wires versus mini plate fixation in isolated displaced shaft lesser metatarsal fractures.

Patients and Methods

This study was conducted following the preferred items for systematic review meta-analysis (PRISMA) to answer the question of which is better k-wire intramedullary nailing fixation or Open reduction and internal fixation with plate and screws according to the AOFAS score and time until union and complications.

Results

Our study represents that fixation techniques by K-wire intramedullary nailing has statistically significant superiority of surgical treatment for lesser metatarsal acute shaft fractures. Optimal reduction and fixation of the fracture with less surgical insult can be achieved by K-wiring, leading to a significantly quicker recovery as a comparison with the plate and screws fixation. Open reduction and internal fixation with plate and screws are accompanied with prolonged healing period, longer timeline of rehabilitation and hardware discomfort.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021.

Conclusion

Lesser metatarsal fractures with good prognosis have been well treated by percutaneous closed antegrade intramedullary pinning in di placed fractures because it offers immediate mobilization of the joint and partial weight-bearing in a stiff-soled shoe. In elite injured personnel as athletes and dancers etc., they need special methods of rehabilitation depend on the patient’s career and his or her available period of rehabilitation. Open reduction and internal fixation with plate and screws are accompanied with prolonged healing period, longer timeline of rehabilitation and hardware discomfort.
Evaluation of Candidate Antischistosomal Drugs in a Murine Model of Schistosomiasis Mansoni
Authors: Hussein Hesham M , Sayed Samia W Abdel , Shehata Mai A , Mohammad Omnia S , Mohamed Ghada A
Published: November 2024

Background

Schistosomiasis is a neglected tropical disease with a considerable morbidity. Despite being safe and efficacious, praziquantel (PZQ) does not prevent reinfection. In addition, the emergence of drug resistance is of a great concern.

Objectives

The current study was performed to evaluate the therapeutic efficacy of amiodarone, spironolactone, and combinations of drugs on S. mansoni- infected mice compared to PZQ through parasitological and histopathological parameters.

Methodology

Mice were divided into 2 major groups: early treated group (3 weeks post-infection) and late treated group (6 weeks post-infection), Each mouse was examined for total worm burden, tissue egg load, oogram and histopathological granuloma formation.

Results

For the early-treated group, spironolactone had the best therapeutic outcome considering its effect on the total worm burden, ova count, oogram pattern and liver granuloma parameters. Whereas, for the late-treated group, amiodarone combined with PZQ added to the effect of PZQ alone on the total worm burden, ova count, oogram pattern and liver granuloma parameters.

Conclusion

It is concluded that spironolactone and amiodarone have considerable antischistosomal effects. Spironolactone was superior to PZQ and amiodarone in the early treatment phase targeting the immature stages. Meanwhile, amiodarone had a synergistic effect when combined with PZQ in the late treatment phase targeting the mature schistosomes. The current work recommends further investigations considering drug combinations strategy for the treatment of intestinal schistosomiasis with different doses and durations.
Evaluation of TRPS1 as a Diagnostic Marker for Breast Carcinoma
Authors: Mohamed Sarah S , Helal Thanaa , Nada Ola , Elgohary Shimaa A
Published: November 2024

Background

Breast cancer (BC) is a very important health challenge worldwide. It is the leading cause of global cancer incidence and the leading cause for cancer related mortality in women. BC is a disease with high metastatic potential always a suspect in the differential diagnoses of metastatic carcinoma of unknown primary. Based on the expression of ER, PR, Her2 BC is categorized into molecular subtypes as luminal (A&B), Her2-postive and triple negative (TNBC) subtypes. TNBC is the most aggressive form with high tendency for metastasis and overall poorer clinical behavior. Diagnosis of metastatic TNBC breast cancer is usually a diagnostic dilemma due to absence of sensitive and specific immunohistochemical marker for breast origin. Trichorhinophalangeal syndrome-1 (TRPS1) is a recently discovered breast marker with high expression in different molecular groups especially TNBC, making it a potential useful tool for diagnosis of BC.

Objective

To evaluate the immunohistochemical expression of TRPS1 in breast carcinoma as a highly sensitive and specific marker for breast carcinoma, especially for TNBC.

Methods

The current study was conducted retrospectively on 80 cases of invasive breast carcinoma as archived formalin fixed paraffin embedded blocks obtained the Pathology Department lab of Ain Shams University Hospitals (2019-2023). The cases included in the current study were divided into 3 groups; Group 1: included 25 Luminal cases, Group 2: included 20 Her-2 positive cases and Group 3: included 35 TNBC cases. Data concerned with gender, age and type of procedure were obtained from the electronically archived reports. The histopathological data were re-examined microscopically by at least two authors. After then, the expression of TRPS1 was evaluated in different molecular groups, followed by statistical evaluation of the obtained results.

Results

TRPS1 was expressed in 88.8% of the studied cases. No statistically significant relationship between TRPS1 expression and the histopathological subtype, tumor size, tumor grade, lymph node status nor in-situ duct component. TRPS1 high score was detected in 66.3% of the studied cases. TRPS1 showed high expression in different molecular groups, as it was detected in 96% of luminal group, 85% of Her2-positive group and 85.7% of TNBC group. These differences were not statistically significant.

Conclusion

TRPS1 is a sensitive marker for all molecular subtypes of breast cancer. It might be a valuable addition to determine breast origin in clinical practice especially for TNBC.
Rectal Colonization Study and its Impact on Blood Stream Infection in Hospitalized Pediatric Oncology Patients
Authors: Ragab Iman , Gawad Amira NAbdel , Anwar Maha Ahmad , Soliman Ahmed Adly Abd-El Hamied
Published: November 2024

Background

Colonization with multidrug resistant organisms (MDRO) is associated with bacterial translocation, which can result in subsequent endogenous blood stream infection (BSI) with high morbidity and mortality. Surveillance rectal swabs can aid in the choice of empiric antimicrobial during episodes of neutropenic fever.

Aim

To compare types of organisms and prevalence of MDRO obtained from both surveillance rectal swabs and blood cultures among leukemia patients with BSI.

Methodology

we conducted a 6 month-cross-sectional observational study that included 45 patients with acute leukemia during hospital admission at the pediatric hematology/oncology inpatient ward, Ain Shams University, with review of any antimicrobial intake or hospital admission in the last 3 months before initial presentation. Surveillance rectal swab were done upon 1st admission before start of antimicrobials. Repeat surveillance swabs with any subsequent admission, complete blood counts (CBC) and blood culture were withdrawn with the 1st febrile episode, antimicrobial susceptibility were assessed by disc diffusion.

Results

The mean (±SD) age of the studied cohort was 6.84 (±3.16) years, 60.0% were B-ALL, 31.1% AML and 8.6% T-ALL. Nine patients (n = 20.0%) received antibiotic prior to admission. Seventeen patients (37.7%); including n = 3 (18.7%) with prior antibiotic intake; had initial positive rectal swab with 94.1% with gram negative resistant strains (GN R), 56.2% of them were extended spectrum beta lactamase (ESBL), 25% MDRO Carbapenem sensitive and 18.7% carbapenem resistant. With development of febrile episode, 48.8% developed bacteremia with 45.4% showed growth of GN R, among which 13.6% demonstrated same type of organism and pattern of resistance of surveillance swab. As for follow up surveillance swabs only 11.6% had positive swabs, with only 1 patient (5.8%) was persistently positive for the same GN R organism as the initial swab.

Conclusion

Rectal colonization are present in high frequency in children with cancer at diagnosis, many of them were gram negative resistant strains. The same types of organism in rectal swab and BSI are encountered in the majority of neutropenic patients, which needs to be identified for proper empiric antimicrobial selection during febrile episodes.
Hemodynamic Monitoring of Stable Neonates Using Electrical Cardiometry in Comparison to Functional Echocardiography, A Cross-Sectional Study
Authors: ElSayed Eman Mohamed , EL-Farrash Rania Ali , Kamal Ahmed Hamdy , Saleh Ghada Ahmad
Published: November 2024

Background

Hemodynamic monitoring is an essential component in the care of term and preterm infants in neonatal intensive care units (NICUs). Echocardiography (Echo) can provide real time assessment of cardiac function, loading conditions (preload and afterload) and cardiac output (CO), but it requires training and can only be obtained intermittently. Electrical cardiometry (EC) has been approved by FDA as a safe, non-invasive, accurate and reproducible technique for hemodynamic assessment in children and infants.

Aim of the Work

To evaluate the accuracy of the electrical cardiometry in comparison to functional echocardiography in hemodynamically stable neonates.

Patients and Methods

This cross-sectional agreement study was conducted in NICUs of Children hospital of Ain Shams University, between (01/03/2021- 31/08/2021), and was approved by the Ethics committee of Ain Shams University (approval no: - MS 336\2021). Hemodynamically stable neonates admitted during the study period were eligible for enrollment and were included if their age was less than 7 days. Neonates with congenital anomalies, those requiring or recovering from surgeries and those with sever neonatal sepsis were excluded.

Results

Ninety neonates were included (55.6% females, 44.4% males), (41 preterm, 49 full term). In all study population, there was positive correlation between EC and Echo for heart rate, stroke volume, cardiac output, and cardiac index (p-value <0.001 for all). For EC readings for all patients, Cardiac Performance Index (CPI) mean was 0.41 (ranged from 0.23 to 0.65 W/m2), Stroke Volume Variation (SVV) ranged from 10 - 40% with mean 18.53 %, Systemic Vascular Resistance Index (SVRI) range from 608 to 2886 dyn-sec/m2 (mean of 1482.2 dyn- sec/m2), and Total Fluid Content (TFC) ranged from 19 to 61 ml (mean was 34.3 ml).

Conclusion

Electrical cardiometry is a safe and convenient way of neonatal hemodynamic monitoring. Our data suggests the possible benefit of using EC continuously in monitoring the trend of hemodynamic parameters rather than comparing its measurements to Echocardiography. Further studies in larger number of patients are recommended.
Effect of Timing of Insulin Degludec in Relation to Age in Type One Diabetic children and Adolescents (Single Center Study)
Authors: Mohamed Asmaa Abdallah , Sherif Eman Mounir , Aly Hanan Hassan , Fereig Yasmeen Abd Elaziz
Published: November 2024

Background

Glycemic control needs optimal adjustment of basal insulin timing for better health in children with diabetes, optimal adjustment of basal insulin to overcome hypoglycemia and glycemic variability (GV) depend on its duration of action and peakless profile.

Aim of the Work

This study aims to identify the best timing of long-acting basal insulin (degludec) in children with type 1 diabetes mellitus.

Patients and Methods

The current study is an observational study studying glycemic control as evidenced by HbA1c % in relation to the time of long-acting insulin (degludec) The study included 20 patients (age between 4:18 years), with type 1 diabetes received morning dose of insulin degludec then same dose but at night. participants are regularly following up at the Pediatrics and Adolescents Diabetes Unit (PADU), children’s Hospital, Ain Shams University in the period between October 2022 and April 2023, detailed history from participants was taken including: age, history of onset and duration of DM, associated co- morbidities, family history, Insulin regimen including mode of insulin delivery, total daily insulin dose (unit per Kg per day), type of insulin, frequency of injection and current injection timing, Thorough clinical examination: anthropometric parameters were assessed on WHO Z score and clinical evaluation of injection sites for apparent lipodystrophy. Investigations included the annual follow up investigations of the patient (CBC, lipid profile, thyroid profile, liver function tests, urinary albumin creatinine ratio, celiac screening, last hemoglobin A1c) and fundus examination. Glycemic control was assessed by pre-prandial and post-prandial readings and Hb A1c.

Results

The current study compares participants on morning regimen degludec followed by same dose at night regarding the impact on glycemic control, showed that Hb A1c % was better in children and adolescents using insulin degludec in the morning (mean of Hb A1c (8.23 ± 0.45%) compared to when using insulin degludec at night (mean of Hb A1c 9.16 ± 2.50%), irrespective of age.

Conclusion

Hb A1c as a measure of glycemic control was better when insulin Degludec was used in a morning regimen than when insulin degludec was given at night. Larger studies are needed to support this and recommend the best timing for insulin degludec in Pediatric age group.
Natural Anticoagulants in Transfusion Dependent Beta-Thalassemia Patients
Authors: Yousef Aya Ahmad Mohamed , Sayed Safa Matbouly , Nagy El-Khazragy Nashwa , Mohsen El Laboudy Mohamed Abdel
Published: November 2024

Background

Thromboembolic events have been recorded in Beta-Thalassemia Patients. Several etiologic factors may play a role in the pathogenesis of the hypercoagulable state in thalassemia among which is decreased levels of naturally occurring anticoagulants such as protein C, protein S and anti-thrombin III.

Objective

To evaluate levels of naturally occurring anticoagulants in transfusion dependent beta-thalassemia patients and to assess the relationship between natural anticoagulants levels and the risk for thromboembolic complications among these patients.

Patients and Methods

This case control study included 40 transfusion dependent beta-thalassemia patients and 40 healthy participants as controls. Patients were recruited and assessed for eligibility from Ain Shams University Haematology unit. Protein C%, anti-thrombin-III (AT III) % and protein S% levels were measured and their correlations to liver enzymes were evaluated.

Results

The mean level of protein C (77.0%), protein S (79.50%) and AT III (90.0%) were significantly reduced in patients' group in comparison with control subjects (p-value <0.001). These findings were significantly positively corelated withthrombotic events, age, transfusion index, platelets count, serum ferritin, and aspartate transaminase (p < 0.05). Type of the chelation therapy, splenectomy, T2 star liver, T2 star heart, serum creatinine and albumin did not affect significantly the serum levels of the studied natural anticoagulants (p > 0.05).

Conclusion

Natural anticoagulants namely protein C, protein S and anti-thrombin III were significantly reduced among transfusion dependent beta-thalassemic patients which seem to contribute to the increased risk of thromboembolic events in these patients. This study supports the use of early prophylactic anti-coagulant therapy for this high-risk group.
Total Body Fat Mass in Relation to Insulin Resistance in Type 1 Diabetic Patients
Authors: Elhabashy Safinaz Adel , Salah Nouran Yousef , Hilal Basma Abd El-Nasser , Kamal Christein Monir
Published: November 2024

Background

The introduction of intensive insulin therapy improved glycemic control among people with type 1 diabetes (T1DM). However, an increased prevalence of obesity occurred in those with T1DM with increased insulin resistance.

Aim

to determine the relationship between total body fat with each of glycemic control and insulin resistance among children with T1DM.

Methodology

Hundred twenty children with T1DM aged 10-18 years were recruited from the Pediatric and Adolescent Diabetes Unit (PADU), Ain Shams University. They were assessed for insulin requirements, fasting lipids profile, glycated hemoglobin (HbA1c%) and bio- impedence to assess total fat mass with calculation of the estimated glucose disposal rate (eGDR) for insulin resistance.

Results

The body mass index Z score of the studied children with T1DM was 0.6 (0 – 1.2) and their mean HbA1c% was 9.14±1.99%. Children with T1DM having insulin resistance had significantly higher BMI z score, insulin dose, LDL level and total body fat than those without (p = 0.024, p = 0.005, P = 0.009 and p = 0.007, respectively). Total body fat was significantly correlated with duration of diabetes (p < 0.001), BMI z score (p < 0.001) and eGDR (p = 0/009) among the studied children with T1DM. eGDR significantly correlated with both total and visceral fat (P = 0.009 and P = 0.007 respectively) in the studied children and adolescents with T1DM.

Conclusion

T1DM children having insulin resistance had significantly higher total body fat than those without insulin resistance.