bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of aerosolized Colistin and Gentamicin in mechanically ventilated patient
Authors: Dayem Aya Mohamed Mohamed Abdel , Eldin Haitham Salah , Elhamy Karim Mohamed
Published: October 2021

Background and Objectives

ineffective parental antibiotic use in treatment of Ventilator associated pneumonia (VAP) open the window for using inhaled antibiotic formula to achieve higher local concentration of antibiotics and subsequently good recovery response, the aim of that work was evaluation of aerosolized antibiotics (Colistin and Gentamicin) efficacy in improving the mechanically ventilated patient as adjunctive to intravenous systemic antibiotics

Methods

30 mechanically ventilated patients classified equally in to 3 groups;

Group I

10 patients received aerosolized Colistin along with systematic antibiotics (SA). Group II: 10 patients received aerosolized Gentamicin along with systematic antibiotics (SA) and Group III (Control): 10 patients received only systematic antibiotics (SA). All patients were followed up for clinical response by bacteriological culture (after 5 days of aerosolized antibiotics), development of VAP, days of mechanical ventilation, length of stay in the ICU, and mortality.

Results

The incidence of VAP was 10%; in group I no cases had VAP, while in group II and control group, just (20%) and (10%) of cases had VAP respectively, with insignificant association of VAP with particular group, (P = 0.3). Clinically; only group I showed significant lower degree of temperature in comparison with control group, (P = 0.01). The mean days of MV and ICU in each groups were (6.8±2.15; 8.9±3.11, 5.9±2.23; 7.2±2.7, 5.1±1.1; 6.1±1.85) respectively, with insignificant statistical difference between the treatment groups, (P = 0.2 and 0.07) respectively. Finally, the survival rate in group I was 90%, and was slightly lower in group II and control group; 60% and 50% respectively, with insignificant association of survival status in particular group, (P = 0.1)

Conclusion

the empirical treatment by AA (Colistin) was effective as an adjuvant to systemic antibiotics for protection of VAP than aerosolized Gentamicin, it had rapid resolution of respiratory infection signs, and subsequently the mechanical ventilation days, ICU stay days, and probably the cost of ICU admission, but did not affect mortality.
Study of the antineoplastic effect of modulating apoptosis-related noncoding RNA in human hepatocellular carcinoma cell line (HepG2)
Authors: Sherif Mai Abdel Azeem , Ismail Emtiaz Abd-elkawy , Kassim Samar Kamal , Shehata Hanan Hussein , Abdel Khalek Marwa Ali , Abdel Hamid Marwa Mahmoud
Published: October 2021

MiR-421 is considered an important molecule that can prevent tumor growth. Bioinformatics analysis indicated that mRNA caspase-3 gene is a target gene of miR-421. The current study aimed to explore the functional role of miR-421 in hepatocellular carcinoma (HCC) and explore the interaction between miR-421 and caspase-3. To validate bioinformatics data, RT-qPCR was used to detect the expression of miR-421 and caspase-3 in 10 HCC tissues. The results showed miR-421 expression was significantly higher in HCC than non HCC liver tissues (P<0.01), nevertheless caspase-3 gene expression was markedly lower in HCC than non HCC liver tissues (P<0.01). Besides, miR-421 expression was negatively associated with caspase-3 expression. MiR-421 mimic and inhibitor was transfected into HCC cell lines (HepG2). Proliferation assay, showed that low-expression of miR-421 inhibited the proliferation of HCC cells. RT-qPCR was worked for detection the expression levels of miR-421 and caspase-3 in HepG2 cells before and after transfection. The results showed that miR-421 expression in HepG2 cells was significantly lower in miR-421 inhibitor transfected group than in mimic- transfected and control groups (Mock) (P≤ 0.05), and caspase-3 gene expression in HCC tissues was markedly higher in inhibitor transfected group than those transfected by mimic and control group (Mock) (P≤0.05). Thus, miR-421 inhibitor may inhibit the proliferation of HCC cells via over- expression of caspase-3.
Early Outcomes of Closed Versus Open Left Anterior Descending Artery Endarterectomy In Patients Undergoing Coronary Artery Bypass Grafting
Authors: Almaboud Hani Abd , Ali Ihab , Adel Mohamed , Samy Ahmed , Awed Ahmed
Published: October 2021

Coronary endarterectomy is an old surgical procedure against coronary artery disease which was first described by Baily et al. in 1957. In spite of the first adverse effects, several recent publications have demonstrated that coronary endarterectomy (CE) with coronary artery bypass grafting (CABG) can be done safely with appropriate mortality and morbidity. The main objective of CABG is complete revascularization of coronary vessels and, particularly, left internal mammary artery to left anterior descending artery (LIMA-LAD) anastomosis, Since; patent LIMA-LAD is the single most significant determinant for long-term and eventfree survival. A best evidence topic in cardiac surgery was written according to a structured protocol. The problem was whether LAD artery open endarterectomy (open-CE) with CABG compares favorably with LAD artery closed endarterectomy (closed-CE) with CABG in the myocardial revascularization of patients presenting with diffuse coronary artery disease (DCAD). The purpose of this review is just to determine the safety and feasibility of CE in general and open-CE versus closed-CE particularly. The last search date was December 2019 and the search period was from 1992 till 2019. Open-CE with CABG may carry a lower early mortality rate (range from 2.9% to 8.8%) than closed-CE with CABG (range from 6.8% to 10.9%) and CE + CABG has a significantly higher risk of death than isolated CABG. Internal thoracic artery (ITA) use may enhance mortality, while the saphenous vein (SV) conduit or two CE vessels may worsen the clinical outcome. The main complication of CE can be found in post-operative atrial fibrillation (AF), in our review; the rate ranged from 9% to 29%. Another devastating complication is postoperative myocardial infarction (MI) with a range of 0% to 13.9%.
Intermediate and Long-Term Outcome of Percutaneous Trans-catheter Device Closure of Ventricular Septal Defects
Authors: El Sayed Maiy Hamdy , Attia Hebatallah Mohammed , Mousa Tarek Khairy , El Alfy Ahmed Amr
Published: October 2021

Background

Ventricular septal defect (VSD) is the most common congenital heart defect in children and adults. Until recently, open-heart surgical closure has traditionally been considered the mainstay of intervention for the majority of VSDs. The development of a trans-catheter occlusion technique with the advancement of the newer percutaneous occluding VSD closure devices that can safely and effectively close these defects was welcomed by cardiologists, patients, and their families making trans-catheter device closure an attractive and feasible alternative.

Objective

We aim to evaluate the intermediate and long-term follow-up outcome of patients who underwent percutaneous trans-catheter closure of isolated ventricular septal defects.

Patients and Methods

This study is an exploratory pilot single-tertiary center study. The study included 25 patients who have successfully undergone percutaneous ventricular septal closure in the cardiac catheterization unit of the cardiology department at Ain Shams university Hospitals in the period from June 2015 till June 2018. The follow up protocol includes detailed history taking, clinical examination, and full 2D echocardiography with additional circumferential and radial strain imaging by speckle tracking technique (STE), resting and Holter electrocardiograms.

Results

A significant increase in growth parameters were noticed during 6.3 month mean follow up time, with an overall mean weight increase by 10% and an overall mean height increase by 6.2%. Sequential echocardiographic follow-up showed highly significant decrease in LV dimensions and volumes, circumferential LV strain values, pulmonary to systemic circulation (Qp:Qs) ratio, RVSP and mPAP. Significant complications occurred in (12%) of patients: symptomatic/significant Brady-arrhythmia (Complete heart block) that required permanent pacemaker implantation (4%), significant residual shunt causing hemolytic anemia requiring re-intervention (4%) and significant valvular regurgitation (Severe Tricuspid Regurgitation) (4%)

Conclusion

The development of a VSD trans-catheter occlusion technique with the advancement of the newer percutaneous occluding VSD closure devices is an attractive and feasible procedure with high success rates
Impact of Left Atrial Posterior Wall Isolation Technique on the Outcome of Ablation in Persistent Atrial Fibrillation
Authors: Elbatran Ahmed I , Elmaaty Nabih Mervat Abou- , Saba Magdi M , Samir Rania , Tawfik Mazen , Nabil Ahmed , Gallagher Mark M , Li Anthony , Sohal Manav , Bajpai Abhay
Published: October 2021

Background

Left atrial posterior wall (LAPW) isolation is an adjunct to pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF).

Objective

To compare the effect of LAPW box isolation with LAPW point-by-point ablation and PVI in persistent AF on 12-month arrhythmia-free survival and procedure complications.

Methods

77 consecutive patients who underwent LAPW box isolation, 24 patients who underwent LAPW point-by-point ablation and 101 patients who underwent PVI for persistent AF were compared. All patients had undergone no prior ablation for AF and were followed up for one year.

Results

Mean time to atrial tachyarrhythmia recurrence was similar with LAPW box isolation (9.8 months, 95% CI = 9-10.7) and LAPW point-by-point ablation (10 months, 95% CI = 8.6-11.3), both were longer than PVI (8.2 months, 95% CI = 7.4-9.1, log-rank p = 0.003). There was no difference in peri-procedural complications (LAPW box isolation: 5/77, LAPW point-by-point ablation: 1/24, PVI: 6/101, p = 0.91). At 12 months, no difference in atrial tachyarrhythmia recurrence was observed between box isolation (23/77, 30%) and point-bypoint ablation (11/24, 46%, p = 0.15), but significantly higher recurrence occurred with PVI alone (58/101, 57%, p < 0.001). Procedure time was similar with both approaches, with longer fluoroscopy with point-by-point ablation (median: 38 min, IQR: 29-47.75) vs box isolation (median: 28 min, IQR: 7.5-39.5, p = 0.2).

Conclusion

In persistent AF, there was no difference between LAPW box isolation and point-by-point ablation in terms of mean arrhythmia-free survival, 12-month recurrence or procedure complications. Arrhythmia-free survival with either technique was longer than PVI alone, with no increase in complications.
A Morphological Study of Left Atrial Appendage in Egyptian patients Using multidetector computed tomography (MDCT)
Authors: Hassan Ahmed Mohamed , Abdel Menaem Hazem Mohamed , Onsy Ahmed Mohamed , Omran Azza Alaa , Mohamed Rayan Mona Mostafa
Published: October 2021

Background

The most common etiology of stroke is known to be cardio- embolic type and left atrial appendage is the site of origin of thrombi in 90% of cardio embolic stroke .Most literature reports that left atrial appendage thrombi tend to be more common in females and black people1. In the past, the left atrial appendage (LAA) has been considered to be a relatively insignificant portion of cardiac anatomy. It is now recognized that it is a structure with important pathological associations as thrombus has a predilection to form within the LAA in patients with non-valvar atrial fibrillation and to a lesser extent in those with mitral valve disease (both in atrial fibrillation and in sinus rhythm).

The exact pathogenesis of thrombus formation inside left atrial appendage is still not fully elucidated, but many literature suppose that the cause is the stagnation within the long, blind-ended trabeculaed pouch2

Objective

to describe left atrial appendage morphology and identify the prevalence of its different subtypes in Egyptian patients.

Material and Methods

the study analyzed retrospectively the data of 100 consecutive Egyptian patients who underwent multidetector computed tomography (MDCT) at Ain shams university specialized hospital from August 2019 to February 2020.Axial source images, two and threedimensional data sets were evaluated for each of the patients .All images were analyzed by a qualified cardiologist using dedicated software called “Horos Workstation”, and were blinded to patient data. All images were assessed and evaluated for LAA morphology and volume and were categorized according to the classification of Wang et al. 2010.

Results

windsock morphology existed in 32% of patients followed by chicken wing in 25% of patients. Cauliflower morphology was reported in 23% of patients whereas 20% of patients had cactus morphology. There was significant gender difference in LAA morphology where female patients had more cauliflower and cactus morphology as compared to male gender (p < 0.05). Left atrial appendage volume showed a statistically significant positive correlation with advanced age and significant negative correlation with Left ventricular ejection fraction.

Conclusion

Egyptian patients had predominantly windsock morphology in males and cactus morphology in females.
Differentiating the origin of outflow tract premature ventricular complexes using the QRS-right ventricular apex interval
Authors: Tawfik Ahmed Sayed , Abdelmoteleb Ayman Morttada , Zarif John Kamel , Fakhry Emad Effat
Published: October 2021

Background

For localization of outflow tract Premature ventricular complexes (PVCs) many ECG criteria have been proposed, however in some cases it is difficult to accurately localize the origin of PVCs using the surface ECG.

Objective

This study aims to study the relation between QRS-right ventricular apex interval and the origin of the outflow tract PVCs.

Patients and Methods

The study included 30 patients (27 female, age 37.20 ± 7.87, RVOT origin 18) referred for PVCs ablation and we measured the interval from the onset of the earliest QRS complex of premature ventricular contractions (PVCs) to the distal right ventricular apical signal, (the QRS-RVA interval) and correlated this interval with origin of outflow tract PVCs as identified by the successful ablation during the procedure.

Results

Compared to PVCs originating from RVOT, the QRS-RVA interval was significantly longer in PVCs originating from LVOT (67.33±7.56 for LVOT PVCs vs. 37.11±4.34 for RVOT PVCs, p < 0.001). Receiver operating characteristic (ROC) analysis showed that a QRSRVA interval ≥47 ms has a sensitivity, specificity, positive and negative predictive values of 100%, 100%, 100%, 100% respectively, for prediction of an LVOT origin of PVCs

Conclusion

The QRS-RVA interval is a simple and accurate criterion for differentiating the origin of outflow tract arrhythmia during electrophysiology study, A QRS-RVA interval ≥47 ms suggests an LVOT origin of PVCs.
Impact of Anti-Hepatitis C Therapy on Cardiac rhythm
Authors: Awad Mohamed Medhat , Desoky Ahmed Ibrahim El , Omran Azza Ahmed , Mohamed Ghada Abdelrahman , Missiry Ahmed Mohamed El , Rayan Mona Mostafa
Published: October 2021

Background

The use of direct-acting antiviral (DAA) has raised some concerns about the possibilities of cardiac toxicity after US Food and Drug Administration (FDA) issued a safety announcement of serious slowing of the heart rate when Amiodarone was used with hepatitis C treatment .

Aim

The aim of the present study was to assess the impact of Anti-Hepatitis C Therapy on cardiac rhythm using 24 hours Holter monitoring.

Methods

The current study was conducted on fifty consecutive adult patients with chronic hepatitis C infection eligible for DAA therapy supplied in the outpatient clinic of Ain shams University Virology Center .Patients have received Sofosbuvir 400 mg and Daclatasvir 60 mg / day for 12 weeks. All patients underwent 24 hour Holter monitoring before and after the completion of therapy. Both recordings were compared as regards: heart rate, minimum and maximum heart rate, the presence and frequency of ectopic atrial or ventricular activity. The measurement of QRS intervals such PR, corrected QT intervals in msec.

Results

The pre and post analysis of the Holter recording was done with comparing different baseline and post therapy parameters, The pre and post therapy mean average heart rates were 79.44±10.14 bpm vs.79.96±8.77 bpm respectively (p = 0.534) which are non-significant changes. There is also non-significant change was observed in mean maximum and mean minimum heart rate 129.08±20.07 bpm 128.98±16.89 bpm (p = 0.964), 55.88±9.20 bpm 56.66±9.45 bpm (p = 0.457) respectively. And as regard corrected QT duration and PR interval duration, the mean pre-therapy PR interval was 154.00 ± 25.95 ms as compared to the mean post-medication PR interval duration 151.40 ± 23.82 ms (p = 0.124) and The mean premedication Corrected QT duration was 397.34 ± 29.38ms vs. post therapy 395.04 ± 30.23ms ( p = 0.403) Which showing a non-significant change of both intervals. And as regard the median pre-therapy and post medication PACs and PVCs numbers and the median pre-therapy and post medication attacks of tachycardia and bradycardia, they showed non-significant changes with P-value > 0.05 .

Conclusions

Novel DAAs are safe to use as regards its effect on cardiac rhythm
Prevalence of paroxysmal atrial fibrillation in patients with cerebrovascular stroke of undetermined etiology
Authors: Elnwagy Mohammed , Shokery Hossam , Effat Emad , El Damnhory Hayam
Published: October 2021

Background

cerebrovascular stroke is major cause of morbidity and disability. Many causes may contribute to its presence, however. Some patients have none of the identified risk factors, yet face the consequences of stroke or transit ischemic attack. This type of stroke known to be stroke of undetermined source or etiology. It has a high rate of recurrence due to the persistence of the unknown etiology. Paroxysmal atrial fibrillation remains the hidden bottom of an iceberg representing a major part of the causes of ischemic cerebrovascular stroke of undetermined etiology .

Aim and Objectives: to

determine the prevalence of subclinical atrial fibrillation in patients with ischemic cerebrovascular stroke of undetermined etiology in a population in Egypt by 48h holter monitoring.

Patients and Methods

Patients diagnosed with acute cerebrovascular stroke of undetermined etiology at the neurology department of Ain Shams university hospitals underwent 48 hours holter monitoring within the first week of the insulting event.

Results

This study included 50 patients with cryptogenic stroke (CS) who underwent 48 hours holter monitoring. The patients' ages ranged between 22 and 77 years old (mean age 48.46 ± 12.74years). This study included 34 males and 16 females. Their body mass index BMI ranges from 21-35 kg/m2, with mean BMI of 24.78 ± 2.99 kg/m2. Their left atrial diameter ranges from 26-47mm, with mean diameter of 36.08 ± 5.23mm .Eight out of fifty patients newly diagnosed with subclinical atrial fibrillation with prevalence of 16%. There was statistically significant association between the atrial fibrillation (AF) and both age (p value, 009) and left atrial (LA) diameter (p value, 001) .There was an associated finding that need further investigation about the significant association between the ventricular ectopic beat VEB burden and the presence of AF or stroke.

Conclusion

The prevalence of paroxysmal atrial fibrillation among the population of ischemic stroke of undetermined etiology in a population in Egypt is close to worldwide percentage and the recent met analysis studies of 11%.
The Relationship between Elevated Pre-procedural Random Blood Glucose Level and Periprocedural Myocardial Injury in Patients Undergoing Elective Percutaneous Coronary Intervention
Authors: Elnahhas Nehal Badr , El-Menyawi Khaled , Mostafa Ahmad Elsayed , Nozahi Mostafa El
Published: October 2021

Background

Regardless of the diabetic status of patients with coronary artery disease, both hyperglycemia and hypoglycemia are adversely associated with cardiovascular events. Numerous studies have concluded that hyperglycemia is common in diabetic and non-diabetic patients with STelevation myocardial infarction (STEMI) and is associated with a higher risk of death and in-hospital complications.

Aim and Objectives

The aim of this study is to assess the relationship between elevated preprocedural random blood glucose level and peri-procedural myocardial injury in patients undergoing elective percutaneous coronary intervention.

Patients and Methods

This Cohort study included 110 patients who presented with chronic coronary syndrome to the cardiology department of Ain Shams university hospitals and underwent elective PCI. They were divided into 2 equal groups, 55 as hyperglycemic group and 55 as euglycemic group. Blood glucose level was measured immediately before the procedure. Blood samples for cardiac troponin (I) were obtained before the procedure and 12 hours after the procedure.

Results

There was statistically significant difference between the two groups regarding incidence of both myocardial infarction and myocardial injury, both being higher among the hyperglycemic group (P-value: 0.022) &(P-value: 0.001) respectively. All five patients who had myocardial infarction belonged to the hyperglycemic group. 23 patients with myocardial injury belonged to the hyperglycemic group while only 7 patients with myocardial injury belonged to the euglycemic group.

Conclusion

We conclude that abnormally high pre-procedural plasma glucose levels in patients undergoing coronary angioplasty are associated with an increased incidence of peri-procedural myocardial injury and infarction in patients undergoing elective PCI.
Prediction of Troponin elevation in Non- ST Acute Coronary Syndrome Patients presenting to The Emergency Department Using Neutrophil-lymphocyte ratio
Authors: Mahmoud Sarah Mohamed , Sobhy Bassam , Raymond Ramy
Published: October 2021

Background

The neutrophil–lymphocyte ratio (NLR) is considered an independent predictor of mortality and myocardial infarction (MI) in stable coronary artery disease (SCAD). Also NLR have prognostic value in patients with acute coronary syndromes (ACSs). However the diagnostic power of NLR in patients suspected of ACS is still under study

Objective

is to determine the ability of neutrophil-lymphocyte ratio to predict troponin elevation in patients presenting to emergency department with acute coronary syndrome

Material and Methods

From June 2018 to March 2019, 100 patients were enrolled who presented to the ER with NST-ACS. Patients were divided into 2 groups based upon the troponin positivity in the 12- to 24-hour follow-up. Baseline Complete blood count with calculation of NLR is done

Results

The study population was divided into 2 groups: troponin- negative group (n = 50) and troponin-positive group (n = 50). Mean age was 55.8 ± 11.3. 77% of the patients were male. No significance difference in the level of hemoglobin, WBCs and platelets between the 2 groups. The neutrophil count was significantly higher in the troponin-positive group (p < 0.001). The median admission. NLR was significantly higher in the troponin-positive group (2 vs. 3.9, P < 0.001). A cutoff point of 3.4 for NLR measured on admission had 84% sensitivity and 84% specificity in predicting follow-up troponin positivity. A highly significant correlation was found between NLR and level of troponin change (p value <0.01)

Conclusion

NLR can be used as a diagnostic tool in the differentiation of patients with acute coronary syndrome. NLR is a non-expensive, simple and available parameter that can be used in diagnosis of NSTEMI.
Frequency and Antibiotic Resistance Profile of Uropathogens Associated With Community Acquired Urinary Tract Infections
Authors: Saber Sally Mohammed , El-Ashry Marwa Abd el Rasoul , Assad Christina Magdy Lotfy Mikhail
Published: October 2021

Background

Community acquired urinary tract infections (CAUTIs) are among the most common bacterial infections diagnosed in community health practice resulting in high rates of morbidity and high economic costs associated with its treatment. CAUTIs are usually treated empirically. Geographical variations in etiologic agents and their antibiotic sensitivity patterns are common. Knowledge of antibiotic resistance trends is important for improving evidence-based recommendations for empirical treatment of UTIs. Adequate empirical treatment can cause decrease in unnecessary hospital stays, treatment cost, antibiotic side effects as well as reducing antimicrobial resistance spread.

Aim of the Work

To determine the implicated uropathogens associated with community-acquired UTIs and their respective antimicrobial resistance pattern to improve the efficacy of empirical treatment of this infection.

Patients and Methods

This a cross-sectional descriptive study conducted from November 2018 to November 2019 at the main Microbiology Lab in Clinical Pathology Department, Ain Shams University Hospitals. Samples were received from patients attending different outpatient clinics in Ain Shams University Hospitals having UTI symptoms and whose urine samples showed significant bacterial growth (≥105 CFU/mL) associated with pyuria (more than 8–10 pus cells by microscopic urine analysis) and nitrite and leukocyte esterase positive by chemical analysis of urine strip.

Results

A total of 1600 patients who fulfilled our inclusion criteria were sampled. Of these, 1058 patients had urine samples that showed significant bacterial growth while about 34% of the samples were contaminated and excluded . Of the 1058 significant samples, 764 (72.21%) were from females and 294 (27.79%) from males with female to male ratio 2.6:1. Escherichia coli was found the dominant bacteria among a with the prevalence rate of 24.4% followed by Klebsiella pneumoniae (13.8%). Tetracycline was found the most resistant antibiotic 929 (95.4%) followed by Ampicillin, Tazobactam-piperacillin, and Ampicillin- sulbactam by 90.1%, 81.7% and 77.7% respectively; however, the most sensitive antibiotics against all uropathogens were Carbapenems (Ertapenem 72.9% fol Imipenem 66.5% and Meropenem 66.4%) followed by Nitrofurantoin and Amikacin showing 64.3% and 58.01% sensitivity respectively . However, For gram positive uropathogens, Linezolid showed the highest sensitivity in 84% of the isolates.

Conclusion

The present study reveals a familiar pattern with respect to the species of uropathogens involved in community acquired urinary tract infections, however with considerable bacterial resistance to common empirically prescribed antibiotics.
Evaluation of Natural Killer Cells in HCV Patients undergoing Hemodialysis
Authors: Zeitoun Yasser Ahmed , HamdyEl-Kabarity Rania , Elsaid Tamer Wahid , Ragab Dina Aly Mohamed Aly , Sedhom Mariam Talaat Shaker
Published: October 2021

Background

Hepatitis C virus (HCV) is a hepatotropic virus and one of the major causes of liver disease and a potential cause of substantial morbidity and mortality worldwide. Patients on hemodialysis are at high risk for HCV, with frequency of infection several times higher than that in non-uremic patients. Natural killer (NK) cells are best appreciated for innate defense against viral infections and in tumor cell surveillance.

Objective

To study the percentage of peripheral blood natural killer cells among chronic hepatitis C patients undergoing hemodialysis compared to chronic HCV patients with normal kidney functionsby flowcytometry immunophenotyping.

Methodology

Frequency of CD3- CD56+ cells was assessed in two distinct groups. Group I: 35 chronic HCV patients with end stage renal disease and undergoing hemodialysis, group II: 35 age and sex matched chronic HCV patients with no kidney disease.

Results

No significant difference was observed between HCV hemodialysis patients with ESRD and HCV patients with normal kidney function regarding the frequency of both NK cells (CD3CD56+) and NKT cells (CD3+CD56+). However, group I had significantly higher percentage of CD3+ cells than group II.

Conclusion

no difference was found in this study between HCV patients on hemodialysis and HCV with normal kidney function regarding NK cell frequency. However, assessment of NK cell function in future studies might reveal differences.
Serum Leptin Level in Children with Acute Lymphoblastic Leukemia
Authors: Ghozlan Manal Fawzy , Eissa Deena Samir , AbdelRahman Nada Ahmed Hamed
Published: October 2021

Background

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer .It is a disease of monoclonal proliferation of hematopoietic precursor cells of the lymphoid series within the bone marrow. Leptin is a peptide hormone which is predominantly produced by white adipose tissue. The main function of leptin in the human body is the regulation of energy expenditure and control of appetite .It is supposed to be involved in the pathogenesis of hematological malignancy through its proliferative, anti-apoptotic, and differentiating effects on hematopoietic neoplastic cells, in addition to its synergestic effect on vascular endothelial growth factor (VGEF) .

Objectives

To evaluate serum leptin level in children with acute lymphoblastic leukemia at diagnosis and at day 28 post induction chemotherapy,and to test the association between serum leptin levels and anthropometric measures of ALL patients and prognostic markers of ALL as age, gender, initial WBCS count, extramedullary infiltration to organs and CSF, cytogenetics, and response to treatment .

Patients and Methods

This is a case- control study performed at Clinical Pathology Department, Ain Shams University Hospitals. The study was conducted on 30 ALL pediatric patients admitted to Hematology & Oncology Unit, Pediatric Department, Ain Shams University Hospitals.The patients were evaluated at diagnosis before intake of chemotherapy and at day 28 post-induction chemotherapy, and 25 healthy controls matched with patients in age, sex, BMI.

Results

Serum leptin level is elevated in ALL patients at diagnosis as compared to controls .It has no significant relation with patients age, sex, BMI. It is elevated in patients who received cranial radiotherapy and those who relapsed. .However, it has no significant relation with clinical data (fever, lymphadenopathy and organomegaly) and laboratory characteristics (CBC, percentage of blasts infiltrating bone marrow and peripheral blood, immunophenotyping and cytogenetics) of ALL patients.

Conclusion

Data from our study showed that elevated leptin level in ALL patients can be considered a risk factor involved in ALL pathogenesis.It can be used as a biomarker for ALL diagnosis, a prognostic factor for ALL patients on chemotherapy, and a predicting factor for relapse.
Phenotype of Memory HCV CD8+ T Cells in Chronic HCV
Authors: Yasin Aisha , Talkhan Hala , El-Aleem Afaf Abd , Shady Rania Abo , El-Kabareety Rania , Nasr Noha Ibrahim
Published: October 2021

Background

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. After acute infection, a majority of healthy adults will develop persistent viremia. An infection with HCV activates the immune system to defend the host with a broad range of innate and adaptive immune responses. Cellular immune response shows antiviral immunity by means of virus specific CD8+ T cytotoxic lymphocytes and CD4+ T helper cells. After resolution of infection, a population of the virus-specific memory CD8+ T cells protects the host against reinfection. These subsets of memory cells differ with respect to their anatomical localization, their phenotype and their protective potential.

Objectives

The aim of the present study is to find out the phenotype pattern of HCV specific memory CD8+ T cells in chronic HCV patients in comparison to HCV exposed seronegative high-risk individuals.

Patients and Methods

This case control study included 60 individuals categorized into two main groups, (group I) included 20 chronic HCV patients and (group II= control group) included 40 HCV seronegative healthcare workers. Both groups were subjected to carboxyfluorescein diacetate succinimidyl ester (CFSE) proliferation assay in response to HCV specific peptides. Group II was divided into 2 subgroups according to proliferation index (cut-off<2) into, proliferation index +ve high-risk group (+PIHRG) (20 healthcare workers) and proliferation index -ve high-risk group (-PIHRG) (20 healthcare workers). Then flow cytometric analysis of HCV specific CD8+ T cells was done for the all subjects to determine the expression of CD127, CCR7, CD45RO and CD45RA on both proliferating and non-proliferating fractions of cells.

Results

We found that expression of CD45RA was significantly increased and CCR7 was significantly decreased on HCV CD8+ T cells in the chronic HCV group than in the high risk groups in response to different HCV peptides.

Conclusion

During persistent viremia in chronic HCV infection subthreshold signal levels established by HCV different proteins provide anergy of virus specific memory CD8+ T cells that are unable to differentiate into full effector cells upon a possible reencounter with the antigen. So, chronic HCV patients in our study showed predominance of less differentiated effector memory phenotype (CD45RA+, CCR7-) in peripheral blood in comparison to HCV exposed seronegative high-risk individuals who don’t show overt infection.
Serum Interleukin-15 in Alopecia Areata and its correlation with dermoscopic findings
Authors: Khafagy Naziha Hafez , El Din Zaki Marwa Salah , Hussein Aya Mahmoud
Published: October 2021

Background

Alopecia areata is an autoimmune hair loss which frequently starts in childhood. Its presentation had an extreme variability not only in the time of initial onset but also in the duration, extent, and pattern of hair loss during any given episode of active loss. Moreover, the course of disease is unpredictable, with spontaneous regrowth of hair occurring in 80% of patients within the first year and sudden relapse at any given time. Due to the clinical variability and unpredictable nature of spontaneous regrowth, diagnosis and management may be difficult and challenging.

Objective

The aim of this study is to evaluate the serum levels of IL-15 in active alopecia areata and correlate them with disease severity and activity according to dermoscopic findings.

Methods

This case-control study were conducted in Dermatology, Venereology and Andrology department, Ain Shams University Hospitals included 30 patients with different clinical variants of AA, the diagnosis was made via clinical examination and dermoscopic findings. In addition, 30 apparently healthy individuals of matched age and sex as a control group were included in the study.

Results

Dermoscopic examination among cases showed that the most common dermoscopic findings in patients were vellus hair and yellow dots, while the least common finding was exclamation mark hairs. On comparing serum IL-15 in patients and control groups, it was found that serum levels of IL-15 in patients were significantly higher than those in the control group. There was no statistically significant difference in serum IL-15 levels between patients with negative and positive pull test, nail involvement, or body involvement. Similarly, no statistically significant difference in serum IL-15 levels in patients with various subjective disease activity was detected. However, there was a highly significant difference between serum IL-15 levels in different SALT score groups, with the highest levels being in the S3 group. There was a highly significant difference between IL-15 levels in patients with and without black dots. Also, there was significant difference between IL-15 in patients with and without broken hair, and exclamation mark hair. There was no significant difference in level of IL-15 among patients with and without yellow dots, and with and without vellus hair.

Conclusion

On the basis of the current study, we can conclude that IL-15 is significantly elevated in AA patients when compared to the control subjects. It is also a possible marker of AA severity. It is positively correlated with dermoscopic findings in AA patients, so dermoscopic findings can be useful in evaluating severity of alopecia areata.
Comparative Study between Intense Pulsed Light and Fractional CO2 Laser in the Treatment of Periorbital Wrinkles
Authors: El Sayed Ahmed Sahar , El Din Zaki Marwa Salah , Mahmoud Ali Eman
Published: October 2021

Background

The periorbital region is one of the areas showing the earliest signs of aging and is especially prone to skin wrinkles and discoloration. Both fractional carbon dioxide (CO2) laser and intense pulsed light (IPL) have been evaluated in treatment of periorbital wrinkles.

Objective

The objective of this study was to evaluate and compare the efficacy of fractional CO2 laser and IPL in the treatment of periorbital wrinkles.

Patients and Methods

The present study is a prospective comparative split face study which included 20 adult female patients with mild to moderate periorbital wrinkles. Their age ranged from 30 to 40 years. Each patient received four treatment sessions with three weeks intervals on each side of the periorbital region, one with IPL and one with fractional CO2 laser. Evaluation was done before each treatment session and two months after last session with ordinary photographs and by wrinkles indentation index as calculated by the Antera 3D camera.

Results

There was a highly statistically difference between the mean percentage of improvement of the wrinkles indentation index by fractional CO2 laser as compared to IPL.

Conclusion

Both IPL and fractional CO2 laser are promising effective modalities of treatment of periorbital wrinkles which are easy and safe to use. However, fractional CO2 laser is more effective and leads to more improvement in wrinkles indentation index by Antera camera score.
Fractional carbon dioxide laser, platelet –rich plasma and narrow band ultraviolet B in the treatment of Vitiligo (A prospective randomized comparative trial)
Authors: Eshafi Mohamed Abdullah , Zuelfakkar Nehal Mohamed , Elfattah Afify Ahmed Abd
Published: October 2021

Vitiligo is a disease that causes the loss of skin color in patches due to loss of melanin pigmentation of specific areas of the skin. Although several hypotheses have been proposed, the leading theory is still the auto-immune etiology linked to specific genetic mutations. Vitiligo can also be associated with several autoimmune diseases. There is no curative treatment for vitiligo but, several treatment modalities are considered. Topical therapies like steroids and Calcineurin inhibitors are of popular use in clinical settings also, steroids can be administered systemically in vitiligo patients. Physical therapies as fractionated CO2 (Fr: CO2) laser and Narrowband-UV (NBUV) phototherapy represent a gold standard in treatment in clinical practice. Moreover, intralesional therapies are emerging, one of which is autologous platelet-rich plasma injection.

Aim of the study

This study aimed to evaluate and compare the efficacy and safety of Fr: CO2 laser, PRP, combined Fr: CO2 laser and PRP, combined Fr: CO2 laser and NB-UVB, combined Fr: CO2 laser, PRP and NB-UVB in the treatment of vitiligo as well as reporting the side effects.

Patients and methods

This study included 20 vitiligo patients with at least 6 patches of stable vitiligo (120 patches), the patches were divided into six groups according to the treatment modality. Assessment of treatment response was done through patient satisfaction score and Vitiligo analysis by computer-assisted grid (VACAG).

Results

Regarding surface area reduction in included patients, fractional CO2 laser achieved the best results followed by triple combination therapy (CO2 with PRP and NB-UVB), the least response was with CO2 with PRP treatment. Patient satisfaction in the current study had a different outcome, PRP treated patients exhibited the highest satisfaction scores while triple combination treated group showed the least satisfaction scores.
Therapeutic Effect of Superficial Cryotherapy versus Intralesional Corticosteroids injection in Alopecia Areata
Authors: El-dissouki Ibrahim Nour , Elsayed Mahira Hamdy , Abdel-Fattah Afify Ahmed
Published: October 2021

Alopecia areata, one or more round bald patches appear suddenly, most often on the scalp. It can affect males and females at any age. It starts in childhood in about 50%, and before the age of 40 years in 80%. The exact mechanism is not yet understood. There is not yet any reliable cure for alopecia areata. Several topical treatments used for alopecia areata are reported to result in temporary improvement in some people. Their role and efficacy are unknown. Injections of triamcinolone acetonide 2.5–10 mg/ml into patchy scalp, its efficacy is temporary. Oral and pulse intravenous steroids in high dose can lead to temporary regrowth of hair. The sensitisers diphenylcyclopropenone provoke hair growth in treated areas

Now, superficial cryotheray is introduced as a possible treatment for Alopecia Areata. With minimial side effects and being less painful. So, this study clarifies the therapeutic efficacy and safety of superficial cryotherapy for treatment of patchy Alopecia areata.

Aim of the study

The aim of the study is to evaluate and compare the efficacy and safety of Superficial Cryotherapy and Intralesional corticosteroids in the treatment of patchy Alopecia Areata.

Patients and methods

study included 20 patients complaining of Alopecia Areata. 3 patches of scalp alopecia areata will be randomly subjected to either superficial cryotherapy twice monthly for 3 months (3 cycles, 2-3 seconds) or intralesional steroid injections once monthly for 3 months (triaminoclone acetonide 1:7, 1ml) or intralesional saline (1 ml). Assessment for the response to treatment will be done at one month and three month following treatment by digital photography and by phototrichogram by comparing number of Terminal, and vellus and hair thickness, Also assessment for side effects of therapy will be done.

Results

Patients treated with TCA showed statistically significant high response compared to patients treated with cryotherapy. Also, side effects assessment showed minimal side effects with treatment with TCA compared to cryotherapy.

Conclusion

TCA treatment of alopecia areata is much tolerable than treatment with cryotherapy with also better response rates.
Folliscope Assessment of Lyophilized Growth Factors Scalp Injection in Androgenetic Alopecia
Authors: El Samahy May Hussein , Fahmy Hossam Mostafa , Mostafa Azza Esmat , El Sawaf Samar Ibrahim Salama
Published: October 2021

Background

Androgenetic alopecia (AGA) is a non-scarring disease with a progressive thinning of the scalp hair that follows a characteristic pattern. It is the most common form of alopecia, affecting up to 80% of men and 50% of women in the course of their life.

Objectives

The aim of this study is to evaluate the possible clinical benefit of lyophilized platelet derived growth factors(L-GF) locally injected in cases of AGA.

Patients and Methods

The present pilot study included 20 female patients with AGA. Patients were recruited from the outpatient clinic of Ain Shams University Hospital, in the period at the period from September 2018 till March 2019. The study was approved by the Research Ethical Committee, Faculty of Medicine, Ain Shams University and fulfilled all the ethical aspects required in human research.

Results

Treatment with L-GF resulted in improvement of AGA patients with minimal side effects.

Conclusion

Lyophilized platelet derived growth factors (L-GF) injection for AGA could represent new therapeutic option for delivering platelet growth factors. As a pilot study, the sample size of this work was small, despite the fact that we had statistical significant results. Further randomized wide scale comparative studies between conventional autologous PRP and L-GF are demanding to draw concrete results.
Evaluation of Endoscopic Transnasal versus Non-endoscopic Routes as Surgical Treatment of Cerebrospinal Fluid Rhinorrhea
Authors: Farrag Mohamed Ashraf Mohamed , Samnni Talaat Ali Hassan El , Ezz Tamer Abdul Wahab El Sabri Abou El , Sayed Mohamed Naguib Mohamed El
Published: October 2021

Introduction

Cerebrospinal fluid (CSF) leak happens when there is an abnormal connection between the brain cavity inside and environment outside. It is important to establish a good barrier between the brain tissue and the nose to prevent cerebrospinal fluid leak and protect the brain from exposure to infection. which can be done either by endoscopic or non-endoscopic surgical repair.

Patients and methods

The aim of this work is to evaluate the effectiveness of endoscopic and non-endoscopic repair of CSF leakage in patients suffering from CSF rhinorrhea. The search retrieved 1693 unique records. We then retained 89 potentially eligible records for full-texts screening. Finally, 11 studies (Total No. of patients = 355) were included in the present systematic review and meta-analysis.

Results

CSF rhinorrhea resolved in endoscopic surgery group giving a success rate of 88.8%to 100%. recurrence rate is 2% to 12.2% and postoperative complications occurred in 5% to 16.7%.

Conclusion

The endoscopic approach is highly effective, better than non-endoscopic route and is associated with low morbidity for the management of CSF rhinorrhea .
Risk Factors of Stuttering
Authors: El-Ella Mahmoud Youssef Abou , Shawky Ayman Mohamed , Yehia Ahmed Nabil , Tolba Yasser Mohamed Mohamed
Published: October 2021

Background

Stuttering is a multifactorial and complex disorder that results from the influence of many factors, which include genetic predisposition, motor speech skills, linguistic skills and cognitive, emotional and environmental factors. A wide range of possible risk factors has been proposed in the literature, including age; gender; type and manner of onset; duration of the disfluency; type of disfluency; associated communicative and qualitative factors; physical and emotional stress; family history of stuttering; personal, familial and social reaction; and family attitudes.

Objectives

The aim of this work is to study the different risk factors of stuttering in children in order to understand more about its nature, etiology and to help to decrease its incidence if possible.

Patients and Methods

For this purpose; 96 patients complained from stuttering were evaluated. All data were collected after completing the assessment of patients and their parents. They were 60 (62.5%) male patients and 36 (37.5%) female patients, they showed a statistically significant difference. The age of the patients ranged from 4 to 18 years with mean ± SD of 7.75 ± 4.78 years. The age of onset of the studied patients ranged from 3 to 12 years with mean ± SD of 4.25 ± 2.31 years. Most of the patients were resident in rural areas; 64 patients (66.67%), while the urban resident was 32 patients (33.33%), they were statistically significant.

Results

The present study showed the etiology of stuttering in the studied patients. The most prominent cause was the developmental stuttering (86.45%) followed by neurological stuttering (13.55%). The dysfluency distribution of the studied patients. The most prominent was the Syllables and words repetition 65 (67.7%) of patients followed by IPDs 22 (22.9%) of the patients, 6 (6.25%) of the patients had prolongation and 3 (3.125%) of the patients had tonic blocks. Our study observed that family history of stuttering was found in 54 (56.25%) of patients, consanguinity was found in 30 (31.25%) of the patients, first degree relatives was found in 15 (15.625%) of the patients and second-degree relatives was present in 6 (6.25%) of the patients.

Conclusion

The data of the present study concluded that the presence of stuttering or defects in speech quality and communication. Risk factors include multifactorial dynamic pathways that include: positive family history, being male (as boys are more likely than girls to keep stuttering), the onset (as children who start to stutter before age 3½ are more likely to outgrow it than children who start to stutter at an older age), the amount of time that it's lasted.