bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Ultrasound Guided Foam Sclerotherapy of Incompetent Ankle Perforators on Healing of Chronic Venous Ulcers with Deep Venous Reflux. (A Comparative Study)
Authors: El-shafei Mahmoud Ahmed Mohamed , Abdelbary Mostafa Soliman Mahmoud , Basta Mina Gamil Zekri , Ali Abdelrahman Omar Azzam Abdelrahman
Published: October 2021

Background

Compression therapy is the standard of care for venous ulcers and chronic venous insufficiency, but the treatment of underlying venous disease to relieve venous hypertension appears to improve wound healing and to decrease recurrence. Benefits of saphenous ablation have been well demonstrated; however, evidence for the treatment of incompetent perforating veins is less clear.

Objective

To assess the benefit of ultrasound-guided sclerotherapy (USGS) of incompetent perforator on healing of chronic venous ulcers.

Patients and Methods

This is a prospective cohort study which is a double arm clinical study to assess the healing rate for patients after USGFS vs standard compression therapy of patients with incompetent perforators veins within 6 month.

Results

Our preliminary data add further weight to the suggestion that eradication of SVR by means of UGFS improves CVU outcomes when compared to compression alone. In this regard, UGFS appears to be more effective more than compression therapy does, therefore, appear the more attractive option in this elderly patient population. Furthermore, the follow-up data presented here does suggest long-term healing following UGFS probably requires careful follow-up and, if required. Encouraged by these promising early results the authors have embarked upon a larger study to look at the role of UGFS in the treatment of CVU in greater depth.

Conclusion

Ultrasound guided foam sclerotherapy of perforator incompetent veins is a welltolerated and effective outpatient procedure. This study presents a patient cohort with limited exclusion criteria, allowing a representative cross section of VLU in general. Because of its higher healing rate and lower RR compared to other therapeutic options, and the improvement in quality of life that it brings, this minimally invasive, easily repeatable procedure may become the treatment of choice for VLU. Foam sclerotherapy is a simple procedure, compared to surgical intervention, no hospitalization, no anesthesia, can be done in outpatient clinic and the patient can return home after 45 min and no work off period. The relative freedom from serious complications and its evident success, makes this modality as a possible candidate for being the first line treatment for venous ulcers.
Comparative Study between Laparoscopic versus Open Hernioplasty in Repair of Unilateral Non Recurrent Inguinal Hernia
Authors: Wagdy Hesham Hassan , Mohamed Mostafa Abdo , Khalil Ahmed , El Ebiedy Osama Mohamed Ali
Published: October 2021

Background

Laparoscopic surgery has led to many changes in the management of surgical patients and significantly reduced the incidence of complications associated with open surgical procedures 1. At present, laparoscopic hernia repair has gained clinical significance in patients with bilateral or recurrent hernia. 2

Objectives

The aim of this study is to compare open hernioplasty and laparoscopic hernia repair in unilateral non recurrent inguinal hernia. The present study will be performed on 30 patients to compare the effectiveness of laparoscopic hernia repair and open hernioplasty and to assess the intra operative and post-operative complications, duration of surgery, hospital stay, postoperative morbidity, recurrence and patient satisfaction.

Patients and Methods

. Comparative studies on 30 patients were classified according the type of operative technique into 2 groups: Group A patients underwent laparoscopic technique (15 patients), group B patients underwent open technique (15 patients) to evaluate and compare the open and laparoscopic techniques in unilateral non recurrent inguinal hernia repair as regard operative time,post operative pain, hospital stay, urine retention, parathesia, numbness, seroma,, wound infection and recurrence

Results

Our study revealed highly significant increase in operative time in laparoscopic group; compared to open group of patients; with highly significant statistical difference (p value < 0.0001), highly significant decrease in post-operative pain score in laparoscopic group; compared to open group of patients; with highly significant statistical difference. (p value = 0.00434),highly significant decrease in postoperative hospital stay in laparoscopic group; compared to open group of patients; with highly significant statistical difference. (p value = 0.000003), significant decrease in post operative parathesia and numbness in laparoscopic group; compared to open group of patients; (p value =0.000414),highly significant decrease in post-operative urine retention in laparoscopic group; compared to open group of patients; with highly significant statistical difference (p value= 0.000267).

Conclusion

The laparoscopic technique is superior to the open technique of tensionfree repair, in terms of immediate post-operative complications and delayed pain and paresthesia also in terms of safety.
Enhanced Recovery After Colo-Rectal Surgeries (ERAS) V.S Conventional Care A systematic review and meta-analysis
Authors: Hanna Hanna Habib , Abdelhalim Sherif , Khairy Aboelatta , Al-Abbasi Rihaj Mohammed Abdulfattah
Published: October 2021

Background

ERAS programs are not only used in abdominal surgeries, they are also used in cardiothoracic, gynecology, urology, orthopedic, and neurosurgery. Many authors and surgeons worldwide have been adapting this program, also trying to modify it due to its promising outcomes and it’s low damage toit’s continence.

Objective

To present an updated assessment of perioperative care in colorectal surgery from the available evidence and Enhanced Recovery After Surgery (ERAS) group recommendations.

Patients and Methods

We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. An electronic search was conducted from the inception till March 2019 in the following bibliographic databases: Medline via PubMed, SCOPUS, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar to identify relevant articles. We used different combinations of the following queries: ("Colorectal Surgery"[Mesh]) AND ("Enhanced recovery" OR "conventional care"). The search have been done with no limit regarding the year publication or language.

Results

In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till March 2019. The search retrieved 2861 unique records. We then retained 41 potentially eligible records for full-texts screening. Finally, 28 reports of 25 RCTs were included in the present systematic review and meta-analysis

Conclusion

ERAS was proven to be feasible, minimally invasive, cheap, relatively easy, which is safe and effective at the same time. This program can be ideal for patients undergoing elective colo-rectal surgery, yet more studies should be conducted in Egypt to compare results regarding different approaches of this program with longer follow up and randomization of patients.
Prospective Study to Evaluate Effect of Autologus Plasma Injection in the Wound Site immediately after Primary Wound Closure on Wound Healing
Authors: Elshafai Mahmoud A , Reyad Khaled A , Elrifai Ahmed Y , Sallam Samar E
Published: October 2021

Corresponding Background

Wound healing Process and Scars are still a nightmare for the surgeon and the author: patient as well, because of the large number and wide variability of factors affecting the process itself. Plasma injection is a very promising futuristic therapy and can be superior to PRP injection having more abundant growth factors, fibrin and healing promoters.

Aim of the Work

to evaluate the effect of injection of the whole plasma components in the wound site intradermally immediately after primary wound closure on the process of wound healing.

Patients and Methods

This prospective co-operative study included 20 patients having wounds in different sites of the abdomen after approval of research ethical committee of the Faculty of Medicine, Ain Shams University at July 2018, The patients are divided into two groups: an interventional group (group A) 10 cases which are received plasma treatment together with the usual wound care, and a control group (group B) 10 cases which are received the usual wound care only without plasma treatment, in the period between August 2018 to March 2019.

Results

We have found a faster wound healing process, higher cosmetic results, better color match, more patients' satisfaction and lower susceptibility to complications in the interventional group (A) that received plasma injection than in the control group (B) which received only the usual wound care without plasma injection reflecting the positive impact of plasma injection on the wound healing process.

Conclusion

We concluded that there are reasonable amount of data that warrant continued research and usage of plasma in the process of wound healing.
Effects of RTTN gene mutations and the need for complementary cDNA analysis for some transcripts: case report
Authors: PourMirza Afshin , Attia Azza Abd El Moneim , Tawil Mohamed Issa , Amin Dina A
Published: October 2021

RTTN is a gene coding for Rotatin protein which has been localized at ciliary body and centriole of human fibroblasts. Its exact function in human is not well identified. However, it is thought to play important role in maintenance of normal structure of primary cilia and hence in left to right organ specification, axial rotation, development of notochord as well as early cellular division in mice.

Overall 28 cases have been reported with homozygous pathogenic mutations of RTTN gene till 2019 to our knowledge. They presented with primary microcephaly, short stature, polymicrogyria with or without seizures (MPPS). These symptoms can be summarized in microcephaly, generalized growth delay, malformation of the developing cortex (MDC) and hence neurodevelopmental delay with or without seizures. Meanwhile all of these signs usually appear in late prenatal or even postnatal life which emphasizes the need for other diagnostic tools in case of detection of RTTN variables of unknown significance or in case of accidental detection of multiple transcripts by NGS in prenatal genetic testing.

A case with prenatal diagnosis of two different RTTN gene transcripts in fetal WES analysis. One of the transcripts showed RTTN homozygous gene mutation while the other transcript was normal. This article presents the multidisciplinary approach followed in prenatal as well as postnatal period. It also highlights the importance of gene expression analysis in prenatal genetics.
Mean platelet volume indicator for systemic inflammation in cirrhotic patients with spontaneous bacterial peritonitis
Authors: Abd El-Wahab Khaled Mohamed , Mohamed Sayed Moataz , Osama Ali Mohamed , Abd El-Azem Abd El-Azem Mostafa
Published: October 2021

Introduction

spontaneous bacterial peritonitis (SBP) is the most common infection in patients with cirrhosis [1] .Spontaneous bacterial peritonitis is found in patients where besides the increase of polymorphonuclear counting, they present a positive result of culture [2] . The BMN count as not always quickly available in clinical practice and the culture result usually takes 72 hours or more [3] .The use of additional markers that are rapidly and easily applicable, may add significant benefit for predicting the development of spontaneous bacterial peritonitis and achieving diagnostic accuracy [4] .Platelet size is a determinant factor of platelet proinflammatory functions. Several studies have found relationship between the mean platelet volume (MPV) and pro-inflammatory conditions, particularly acute infections [5] .

Aim

to identify a mean platelet volume (MPV) cutoff value which should be able to predict the presence of sponataneous bacterial peritonitis.

Settings and designs

a cross sectional observational study, carried out on 40 patients with AFI and 40 patients without AFI.

Methods

Patients were classified into two groups, group A (SBP) which included 40 patients with ascetic fluid PMN count ≤ 250 cells/mm3 and group B (non/SBP) which included another 40 patients with ascetic fluid PMN count < 250 cells/mm3. All studied patients were subjected to history taking, Clinical examination and routine laboratory investigations including: CBC including platelet number and MPV, liver function test including (ALT, AST, albumin, and direct & total bilirubin), kidney function test including (BUN &creatinine), PT, PTT, INR, ESR and CRP .Abdominal-pelvic ultrasonography was done for all patients. Aspirated ascetic fluid samples were immediately examined for bacteriological cultures.

Statistical analysis used

Statistical presentation and analysis of the present study was conducted, using the mean, standard deviation, independent samples t-test, Chi-square, Mann-Whitney U test and Analysis of variance [ANOVA] tests by SPSS version 22 software .Tukey test was used .Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of MPV and with maximum sensitivity and specificity for differentiation of cirrhotic patients with SBP from those without SBP. Spearman’s correlation analysis was done.

Results

MPV was significantly higher in SBP-patients (Group A) than that of non-SBP patients (Group B) (11.6820±1.19303 fL versus 9.0325±1.12441 fL) (P-value = 0.001) .MPV has positive correlation with Ascitic sample TLC and Ascitic sample PMNC in Group A. ROC curve shows that MPV cut off value is10.25with 85% sensitivity and 75% specificity .

Conclusion

MPV may serve as a non-invasive, cheap and rapid test for detection and diagnosis of spontaneous bacterial peritonitis (SBP) with a sensitivity and specificity of 85% and 75% respectively.
Endoscopic Ultrasound versus Conventional Ultrasonography as A Diagnostic Tool for Patients with Obstructive Jaundice
Authors: Saleh Shereen A , Abo Elezz Muhammad A , Elessawy Hagar A , Ali Ahmed Farahat Muhammad
Published: October 2021

Background

Patient presented with jaundice, initial evaluation should be ultrasonography for evaluation of liver parenchymal changes, cirrhosis and assessment of hepatic vascularity and evaluation of intrahepatic, extrahepatic biliary system.

Aim of the Work

to compare between the Conventional US and Endoscopic Ultrasound in diagnosis of obstructive jaundice and other diagnostic modality including CT/MRI, ERCP for diagnosis and evaluation of the cause of OJ.

Patients and Methods

This study was conducted on 60 patients with obstructed jaundice as evident by ultrasonography in the form of dilated CBD with IHBRDs, with visualization of Gall bladder content and pancreas if can be well visualized, all patients had clinically apparent jaundice with disturbance of liver biochemical profile, all patient underwent EUS and compare finding with US including CBD diameter and IHBRDs degree.

Results

EUS provide better visualization of CBD and IHBRDs with diagnosis of pathological lesion including stones, malignancy. EUS also has better visualization of pancreatic pathology including inflammation and malignancy and extent of the tumor including local extent, lymphatic spread with vascular invasion.

Conclusion

EUS is better than US and other modality CT&MRI and ERCP in diagnosis of distal CBD stricture including malignant obstruction especially in cases of early malignancy and small tumors, and calculary distal obstruction. CT is insensitive in diagnosis of periampullary cancer, EUS provide early diagnosis of Pancreaticobiliary malignancy and give better advandage for early resectability .
Effects of Oral Vitamin C on Hepcidin Levels and Erythropoietin Requirements in Functional Iron Deficiency Anemia among Hemodialysis Patients
Authors: Mohamed Zaki Ali Mahmoud , ElMoniem Behairy Maha Abd , El Sharabasy Reem Mohsen , Ahmed Gharib Ahmed Hamed
Published: October 2021

Background

Hepcidin has long been postulated as a key regulatory peptide in iron homeostasis. Its reduced clearance and elevated levels in hemodialysis (HD) patients lead to functional iron deficiency (FID) and ESA resistance. Vitamin C may be used as adjuvant therapy in FID anemia, but there are limited studies investigating the direct relation between vitamin C and hepcidin levels in HD patients. We aimed to test the reducing effect of Oral vitamin C therapy on hepcidin levels among hemodialysis patients with functional iron deficiency anemia.

Patients and Methods

This study is an open label randomized controlled clinical trial. It was conducted in the hemodialysis units of Ain Shams University hospitals. 48 adult prevalent HD patients were included and were divided into two groups. Group 1 (study group) included 31 patients who received the conventional treatment of erythropoietin stimulating agents (ESAs) together with oral supplementation of vitamin C 500 mg every other day for 3 months in addition to IV iron therapy. Group 2 (control group) included 17 patients who received only the conventional therapy of ESAs according to their hemoglobin (Hb) levels in addition to IV iron therapy. Laboratory parameters including serum hepcidin levels, highly sensitive CRP (hs-CRP) titer, CBC, kidney function tests and iron indices were measured at the baseline of the study and after 3 months.

Results

Oral vitamin C therapy resulted in a statistically significant reduction in both hepcidin and hs-CRP levels in the study group after 3 months. The study group showed a significant reduction in serum iron and ferritin levels (P < 0.05). A Decrease in EPO requirements and elevation of hemoglobin level were observed in the study group but were not statistically significant as a short term effect of oral vitamin C, in comparison to the control group. A highly significant correlation was observed between serum hepcidin and hs-CRP (R=0.46, P<0.01).

Conclusion

Oral vitamin C may be a promising therapy in decreasing serum hepcidin and hs-CRP levels in prevalent hemodialysis patients with functional iron deficiency anemia.
A Diagnostic Value of Serum Level Cyclase-Associated Plasma Protein 2 Versus Alpha Fetoproteins as a novel Biomarker for Detection of Hepato-Cellular Carcinoma in Egyptian Patients with Liver Cirrhosis
Authors: Moustafa Mohamed Abd Elmaghny , Ali- Eldin Zainab Ahmed Ahmed , Musa Nevine Ibrahim , Milad Milad Emad
Published: October 2021

Background

HCC is the third deadliest and fifth most common cancer worldwide, despite the widespread use of surveillance programs in at risk populations, more than half of HCC cases are diagnosed late, and curative therapies such as surgical resection, radiofrequency ablation or TACE are possible in less than 30% of patients.

Objective

To assess the value of plasma cyclase-associated protein 2 level in diagnosis of hepatocellular carcinoma among the Egyptian patients with chronic hepatitis c virus.

Patients and Methods

This study has been carried out in the department of Internal Medicine and Gastroenterology in Ain Shams University Hospitals and Manshiet El-Bakry general hospital, Department of Gastrohepatology. This study evaluate the significance of Plasma CAP2 level as a new diagnostic marker for HCC patients with post hepatitis C liver cirrhosis where (80) persons, divided into three groups; Group A included (30) patients with post hepatitis C liver cirrhosis without HCC, Group B included (40) patients with post hepatitis C liver cirrhosis and HCC, and Group C included (10) healthy subjects as a control group.

Results

In this study CAP2 was significantly higher in HCC group than in cirrhotic and control groups (p < 0.001) with mean levels (30.7±12.4), (14.4±7.6), and (6.9±4.3) ng/ml respectively although in HCC patients with negative or low AFP levels. This finding could imply the role of CAP2 in diagnosing early and AFP negative HCC patients.

Conclusion

CAP2 is significantly elevated in HCC group than in cirrhotic and control groups with better sensitivity and specificity than AFP at cut off values ≥15.9 ng/ml and ≥53.2 ng/ml respectively. Such results support using of CAP2 as a better diagnostic marker for HCC. AFP and CAP-2 were higher in multiple lesions than in single lesions, but the differences were significant only in CAP-2 with ≥27.3 ng/ml in differentiating multiple from solitary lesions Considering the HCC if both of them were positive decreased sensitivity but had perfect specificity.
Video Capsule Endoscopy In Comparison To Radiological Examination In Detection Of Small Bowel Lesions
Authors: Samy Amir Helmy , Musa Nevine Ibrahim , Bakr Saleh Shereen Abou , Elgammal Ahmed Sayed
Published: October 2021

BACKGROUND

Small bowel obscured its lesions as secrets which were difficult to diagnose before video capsule endoscopy as a new modality for investigation.

Aim of the study

Evaluation of video capsule endoscopy in comparison to radiological examination in detection of small bowel lesions.

Patients and methods

Fifty patients were recruited from Kafrawy Video Capsule Endoscopy Unit of Internal Medicine Department and endoscopy unit of Ain Shams University Hospital. The study included patients with occult or overt GIT bleeding, patients with unexplained microcytic iron deficiency anemia, patients with chronic diarrhea and abdominal pain, with normal upper GI endoscopy and colonoscopy. Exclusion of any patient younger than 18 years old, has intestinal stricture, achalasia, or dysphagia. All patients were studied biochemically with CBC and radiological by CT pelvis and abdomen with IV and oral positive contrast some of them were radiologically examined with CTE or CT mesenteric angiography. All patients were endoscopically examined by OGD, colonoscopy, VCE, and some of them were examined also with enteroscope.

Results

The study revealed that the detection rate of SB lesions with VCE was 84%.

In the current study, (44%) of cases had AVMs, (72.73) % of them were above the age of forty five, and (27.27) % were below the age of forty five. All patients who were investigated with CT mesenteric angiography revealed negative results. In this study (20) % of patients had SB masses and polyps, (70) % of them were at age of forty five or more and only (30) % of them were below the age of forty five. All patients underwent CT pelvis and abdomen with IV and oral positive contrast, and we found that all patients had a negative results regarding the SB lesions. In comparison between CTE and VCE in detection of SB vascular lesions CTE did not detect SB vacular lesions. On the other hand, VCE detected the AVMs in the cases with negative CTE results. In this study one patient (2)% was diagnosed with hookworm infection. All patient underwent for OGD. We found that (20)% of patients had a significant gastric or duodenal lesions (proximal to the papilla) by VCE but missed by upper GI endoscopy. In our study the concomitant of VCE and enteroscope increase the detection of SB vascular lesions than isolated use of VCE only.

Conclusion

VCE has a high detection rate of SB lesions (84)%. CTE has a low significance in detection of SB vascular lesions and CT mesenteric angiography sensitivity relatively low. AVMs more common with increasing the age. PHE and SB ectopic varicies, were found to be common causes of GIT bleeding in CLD patient. There is a significant rate of missed gastric and duodenal (proximal to the papilla) lesions that the cause of GIT bleeding and unexplained iron deficiency anemia in OGD examination that were detected by VCE.
Association of Hydroxy (Steroid) Dehydrogenase 11b1 Gene with Type 2 Diabetes Mellitus in Egyptian Population
Authors: Botros Raef M , Hendawy Laila M , Fahmy Eman M , Halawani Salah H , Younis Alaa T
Published: October 2021

Background

Type 2 diabetes mellitus is a heterogeneous group of metabolic disorders caused by the interaction between genetic predisposition and environmental factors. The incidence of type 2 diabetes mellitus has increased over the last decades with more than 170 million individuals suffering from type 2 diabetes mellitus all over the world which imposes a greater economic impact on individuals, families and health systems. Though the genetic susceptibility to type 2 diabetes mellitus is polygenic, single nucleotide polymorphisms (SNP) at Hydroxy steroid dehydrogenase (HSD11B1) gene have been strongly associated with type 2 diabetes risk in various populations and ethnic groups.

Objectives

The aim of this study is to assess the association of Hydroxy-Steroid-Dehydrogenase-11B1 gene (rs846910) with type 2 diabetes mellitus in a sample of Egyptian population.

Patients and Methods

In the present study, we included 60 diabetic obese patients and 40 age and sex-matched controls. The mean age of the included patients was 50.26 ±9.1 year; while the majority of them were females (70%). All the participating patients were subjected to detailed history and the following investigations: fasting blood sugar, post prandial sugar,HbA1c, and lipid profile. Detection of gene polymorphism by real time PCR was performed for all subjects in the study.

Results

The study showed that homozygous GG genotype was more prelevant than GA genotype. No significant difference between GG and GA in terms of fasting and postprandial sugar and in terms of lipid profile: cholesterol (p = 0.642), TG (p = 0.808), LDL (p = 0.238), and HDL (p = 0.945).It showed no statistically significant difference between cases and controls in terms of HSD11B1 polymorphism (rs846910). The regression analysis showed that the HSD11B1 polymorphism did not significantly increase the risk of diabetes mellitus (OR 1.724, 95% CI [0.601 – 4.94]).

Conclusion

In conclusion, multiple further studies involving other single nucleotide polymorphism of 11 beta hydroxysteroid dehydrogenase gene as well as other genes involved in type 2 diabetes mellitus and obesity need to be done.
Prevalence of Food Allergy in Egyptian Patients complaining of food adverse events attending allergy clinic at Ain Shams University Hospitals
Authors: Yousif Zeinab A , Mohammed Manar F , Zakaraya Dahab N
Published: October 2021

Background

Food allergy is defined as an immune reaction to proteins in the food and can be immunoglobulin (Ig)E-mediated or non–IgE-mediated. IgE-mediated food allergy is a worldwide health problem that affects millions of persons and numerous aspects of a person’s life. Allergic reactions secondary to food ingestion are responsible for a variety of symptoms involving the skin, gastrointestinal tract, and respiratory tract. While all other non-allergic food reactions are categorized as “food intolerance”.

Aims

to assess prevalence of Food allergy among Egyptian patients complaining of food adverse events attending Allergy clinic at Ain Shams University Hospital.

Methods

This was a randomized cross sectional study involving 200 patients complaining of food adverse events attending Allergy clinic at Ain Shams University Hospitals between the first of February 2019 till the end of January 2020, 90 patents had confirmed food allergy

Results

The Total patients who were presented to the Allergy outpatient clinic at Ain Shams University hospital between the first of February 2019 and the end of January 2020 were 200 patients presented complaining of food adverse events with the percentage (9.5%). Among the 200 patients presented complaining of food adverse events, there were 90 patients who were confirmed food allergy.

Conclusion

food allergy may be over estimated along patient with food adverse events.
Correlation between adiponectin level and the degree of fibrosis in patients with NAFLD
Authors: Youssef Tarek Mohammed , Mohamed Manal Sabry , Ahmed Ahmed El-Metwally , Abdullah Esraa Ebrahim
Published: October 2021

Background

Non-alcoholic Fatty Liver Disease (NAFLD) is one of the most prevalent chronic liver diseases particularly in Egypt. It is defined as accumulation of lipids inside the hepatocytes, in absence of other etiologies of hepatic damage. It is frequently associated with obesity, diabetes mellitus and metabolic syndrome.

Objective

To find out the correlation between the degree of liver fibrosis in Non-alcoholic Fatty Liver Disease patients and their serum Adiponectin level as a future non-invasive method for assessment of liver fibrosis to substitute liver biopsy to avoid its hazardous complication. Also to study the correlation between diabetes mellitus as well as obesity and serum Adiponetctin level.

Patients and Methods

50 patients were selected to participate in our study based on our inclusion criteria. They were recruited from the Internal Medicine department, Gastro-intestinal clinic in AlDemerdash Hospital using a convenient sampling method. Diagnoses of NAFLD (Non-alcoholic fatty liver disease) was confirmed by laboratory markers (AST, ALT, Lipid profile), ultrasound as well as fibroscan examination.

Results

Analyzing adiponectin levels showed that -besides its significant correlation with BMI, hypertension, diabetes mellitus and dyslipidemia- it was significantly lower in high grade fibrosis group compared to low grade fibrosis group with P-value of (0.000) and a cutoff value for stage 3/4 fibrosis of about 2.31μg/ml which marked a promising hope of adeponictin being of protective value against liver fibrosis. However, more studies performed on populations of different sizes and characteristics are recommended to allow more accurate generalization of the results and hopefully exploring a new horizon for the follow up and treatment of patients with chronic liver disease especially NAFLD.

Conclusion

Adiponectin is an abundant adipocyte-derived protein with well-established antiatherogenic, insulin-sensitizing and anti-inflammatory properties. The liver is a major target organ for adiponectin especially in fatty liver diseases and this adipocytokine has the ability to control many liver functions including metabolism, inflammation and fibrosis. Both serum levels and hepatic adiponectin receptor expression are decreased in NAFLD. Therefore, either adiponectin itself or adiponectin-inducing agents might be of key therapeutic interest in the near future in the treatment of NAFLD.
Role of Aspergillus fumigatus sensitization in Patients with Asthma- COPD Overlap compared to asthma patients
Authors: Elshayeb Mohamed Abd El Rahman , Abd el Sayed Sylvia Talaat Kamal , Ahmed Noha Othman , Elsaeed Ahmed Moustafa Mahetab Hany
Published: October 2021

Background

Distinguishing asthma from COPD can be difficult especially among old age and smokers. Some patients have common features of asthma and COPD.1 (GINA, 2018). Hence, the definition of asthma COPD overlap (ACO) was developed. ACO is a considerable risk factor for healthcare utilization versus the general population, the asthma population and the COPD population.2(Minchul Kim et al., 2019). Fungal sensitization increase severity of asthma.

Aim of the study

To compare the prevalence of aspergillus fumigatus sensitization among ACO patients versus asthmatic patients and healthy normal control.

Patients and Methods

90 individuals were included; 30 diagnosed as bronchial asthma

(According to GINA 2018), 30 ACO patients and 30 healthy normal control. All are group matched to age and sex and selected from the allergy and chest outpatient clinics at Ain shams University hospitals. Total IgE, skin test for Aspergillus and spirometry were done to all participants.

Results

Aspergillus sensitization was more prevalent among ACO group compared to asthma group however, all control individuals were negative to aspergillus. FEV1 was significantly lower among ACO and asthma groups when compared to control. FEV1 increased significantly in the three groups after albuterol inhalation.

Conclusion

sensitization to Aspergillus was more among ACO patients compared to Asthma and control groups.
Role of serum M2BPGi levels in diagnosing significant liver fibrosis and cirrhosis in patients with chronic hepatitis B
Authors: William Keddeas Marcel , Haroun Kaisar Hany , Ahmed Elessawy Hagar Ahmed , Abdel Hamid Elewa Mariam Samir
Published: October 2021

Background and aim

Mac-2-binding protein glycosylation isomer (M2BPGi) is a novel serum diagnostic marker for liver fibrosis in various liver diseases. We aimed to evaluate its role in assessment of liver fibrosis in chronic hepatitis B infection (CHB) with reference to liver stiffness measurement (LSM) by transient elastography (Fibroscan).

Design and Methods

A case control study. 50 CHB patients with LSM by transient elastography technology and retrievable serum samples and 20 normal volunteers as a control group were recruited.

Results

50 CHB patients (M: F = 30:20; mean age 43years ± 10.58) and 20 normal control volunteers (M: F = 12:8; mean age 37years ± 14.5) were recruited. The mean M2BPGi values for control group, F0-F1, F2, F3 and F4 progressively increased with more advanced stages of liver fibrosis: 0.282, 0.719, 1.322, 1.65 and 1.904 COI, respectively (p < 0.001). M2BPGi levels correlated well with liver stiffness (r = 0.911) and moderately with FIB-4 (r = 0.682), and with APRI (r = 0.536) (all p < 0.001). Using cut-off values of 0.455, 1.02, 1.16, 1.66 and 1.71COI for control, F0-F1, F2, F3 and F4 groups, respectively, the AUROCs were 0.996, 0.996, 0.691, 0.794 and 1.00 for control, F0-F1, F2, F3 and F4 groups, respectively. There was a statistically significant but with weak positive correlation between M2BPGi serum level and INR (r = 0.333, p = 0.018). And there was a statistically significant but with weak negative correlation between M2BPGi serum level and platelet count (r = -0.41, p = 0.003) and HBV DNA (r = -0.373, p = 0.008).There was a statistically significance between M2BPGi serum level and the history of varices (p = 0.023)

Conclusions

WFA+-M2BP is an accurate serum indicator for assessing different stages of liver fibrosis. WFA+-M2BP provides a simple and reliable alternative or complementary method to liver biopsy and FibroScan.
Serum Dickkopf-1 as a diagnostic & prognostic marker for Hepatocellular Carcinoma
Authors: Foda Enas Mahmoud , Mansour Khaled Amr , Hashem Walaa Mohamed , Ali Nancy Zakaria
Published: October 2021

Background

Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the second leading reason of cancer-associated deaths around the world.The poor outcome of patients with HCC is attributed to late detection, with more than two-thirds of patients diagnosed at advanced stages of the disease. However, a considerable improvement in survival has been observed (5-year survival up from 40% to 70%) when patients are diagnosed at an early stage and receive potentially curative therapy in the form of liver transplantation, surgical resection, or tumor ablation.

Objective

Evaluate levels of serum Dickkopf-1, & its significance as a diagnostic & prognostic marker for Hepatocellular Carcinoma.

Aim of the work

assess the possible diagnostic role of serum DKK1 compared to alpha- fetoprotein which is the slandered marker used for diagnosis of HCC.also DKK1 act as prognostic marker for Hepatocellular Carcinoma.

Pateints and Methodes

This study had been carried out on 45 subjects diveded into 2 groups,first group include 30 pateints with liver cirrhosis,and second group 15 pateints with HCC.In this group of patients DKK1 was withdrawn before TACE & 3 months post intervention, age range 25-73 year selected from Internal medicine and Hepatology outpatient clinics and inpatient wards at Ain shams university hospitals from March 2019 till January 2020.They were distributed as 25 males and 20 females. There were 13 pateints with child A,17 pateints with child B, & 15 pateints (20%) with child C.

Results

In this study, the serum levels of serum DKK1 were highest in patients with HCC compared to those with liver cirrhosis. Also DKK1 values significally decreased after intervention(TACE).

Conclusion

Serum DKK1 act as a diagnostic marker for HCC and its level significally decrease after TACE
Assessment of Magnesium level Among Hemodialysis Patients and Its Relation to Vascular Stiffness
Authors: Zaki Mahmoud , Khedr Abdel Rahman , Hassan Ashraf , Fattah Nouran Abdel
Published: October 2021

Background

The pathogenesis of vascular calcification in Chronic kidney disease (CKD) patients is multifactorial and complicated. It has been proposed that Magnesium (Mg) may be implicated in the process of vascular calcification on various levels.

Aim

This study aims to assess the level of magnesium in hemodialysis patients and its relation to the vascular stiffness.

Patients and methods

100 prevalent hemodialysis patients were included in the study and they were clinically stable with absence of cardiovascular complications, all patients underwent the following laboratory investigation including complete blood picture, median of magnesium level over 3 months, electrolytes, ipth, lipid profile and radiological investigations including transthoracic echocardiography and carotid duplex.

Results

The studied population was divided into two groups, group I included 68 patients with normal mg level and group II included 32 patients with low mg level. There was statistically significant difference between the two groups as regard hemoglobin level (pvalue=0.033), otherwise there was no statistically significant difference as regard other laboratory and radiological investigations. Then they were divided into another two groups according to the presence of mitral valve calcification (MVC), group III involved 85 patients without MVC and group IV involved 15 patients with MVC. There was statistically significant difference between 2 groups as regard aortic wave pulse velocity (aPWV) with (pvalue=0.002), presence of plaques with (pvalue <0.001) and intimal media thickness with (pvalue<0.001). Another group was divided according to presence of aortic valve calcification (AVC) into two groups, first group V included 39 patients without AVC and second group VI included 61 patients with AVC. There was statistically significant difference between two groups as regard age with (pvalue<0.001), ipth with (pvalue=0.033), presence of plaques with (pvalue=0.048) and intimal media thickness with (pvalue<0.001).

Conclusion

There was high prevalence of vascular calcification among hemodialysis patients which may be related to age and hyperparathyroidism but without statistically significant correlation to Mg level.
Serum Leptin in correlation to clinical severity in patients with chronic urticaria
Authors: Farres Mohamed N , El khoderee Mayada M , ELkady Hossam M , Eissa Nouran M
Published: October 2021

Background

Chronic urticaria (CU) is a complex disease associated with a systemic inflammatory response. This inflammation could be related to the release of adipokines with proinflammatory properties such as leptin. In recent years, leptin has been associated with different diseases, wound healing and immune cell activation.

Objective

to evaluate leptin levels in patients with chronic spontaneous urticaria, to investigate the possible role of leptin in chronic spontaneous urticaria pathogenesis and to outline relationships between serum leptin and urticaria severity.

Methods

A case-control study was conducted at the allergy and immunology outpatient clinic at Ain Shams University hospital, and included 60 patients with chronic spontaneous urticaria and 30 healthy individuals who were group matched with cases for age and sex serving as the control group. All the patients were subjected to the following: Full history, clinical examination, calculation of body mass index (BMI), CBC, ESR, CRP, Thyroid profile, AST, ALT, Skin prick test or Specific IgE for common allergens, and measurement of serum leptin level after overnight fasting by ELISA.

Results

The present study showed that patients with chronic spontaneous urticaria had higher level of serum leptin in comparison to control subjects and there was a positive correlation between leptin level and urticaria severity which was assessed by urticaria activity score.

Conclusion

serum leptin is increased in chronic spontaneous urticaria and it is positively correlated to urticaria severity.
Assessment of Minimal Residual Disease in Multiple Myeloma patients undergoing Autologous Stem Cell Transplant using Multiparameter Flow Cytometry
Authors: Mostafa NN , El-Salakawy WA , Abdelbary HM , Radwan RA , Fathy RK , Aboelmagd YA
Published: October 2021

BACKGROUND

Multiple Myeloma (MM) is still considered an incurable relapsing disease, despite major advances in multidrug combinations, incorporation of autologous transplant and achieving higher rates of CR. This suggests persistent presence of residual disease, not detected by current techniques. Minimal residual disease (MRD) monitoring by multiparameter flow cytometry (MFC) is a powerful tool to quantitatively measure residual disease and allow tailoring of the management plan on individual basis.

AIM

To assess the value of MRD by MFC in determining the efficacy of treatment, monitoring depth of remission and predicting impending relapse.

PATIENTS AND METHODS

We included 33MM patients, who were candidates for ASCT in this prospective study. MFC (with a 0.01% limit of detection) on a BM aspirate obtained before transplant and at day 100 post-transplant, was used to measure MRD for all patients. Patients were then later assessed for progression 1-year post-transplant.

RESULTS

MRD status at 100 days post-transplant was strongly related to the risk of 1-year post-transplant progression (p-value 0.001), and by using a ROC curve, we found that MRD (%) at 100 days post-transplant can predict progression after 1 year with a best cutoff value ≥ 0.04 achieving a 75% sensitivity and 81.2% specificity. On dividing the patients according to their MRD status before and after transplant, group 3 who were MRD positive pre- and post-transplant, had a high risk of progression 1year post-transplant (p-value 0.003). The use of bortezomib-based regimens resulted in a deeper response and a more negative MRD pre-transplant (p-value 0.01), that was maintained post-transplant. Also, ASCT resulted in the development of deeper remission (p-value 0.004) and more MRD negativity (p-value 0.02).

CONCLUSION

we recommend the use of MRD by MFC as a powerful prognostic tool that should be incorporated in routine myeloma workup.
Predictive value of serum chemerin and nafld fibrosis score to ultrasonographic detection and quantification of steatosis in nonalcoholic fatty liver disease patients
Authors: Byoumy Essam Mohamed , Mohamed Azza Imam , Ibrahim Wesam Ahmed , El-Shafie Ahmed Ibraheem Mohamed , Salama Mohamed Magdy , Ibrahim Mohamed El-Sayed Abd-Aullah
Published: October 2021

Background

It is difficult to diagnose spontaneous bacterial peritonitis (SBP) early in ascitic patients. Procalcitonin (PCT) is inflammatory marker used to diagnose severe bacterial infections. We evaluated the diagnostic role of this marker for spontaneous bacterial peritonitis (SBP) associated with liver cirrhosis.

The aim of the study

was to measure serum procalcitonin (PCT) levels to obtain an early diagnostic indication of SBP in ascitic patients.

Methods

A total of 90 patients diagnosed with liver cirrhosis devided in to three groups: Group (A):including 30 patients with SBP, Group (B) including 30ascitic patients without SBP and Group (C): including 30cirrhotic patients without ascites, groups were compared in terms of procalcitonin levels in predicting ascites infection. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of procalcitonin levels.

Results

Serum procalcitonin levels were determined to be significantly higher in patients with SBP compared to patients without SBP (median (min-max): 0.93 (0.4 - 1.23)vs. 0.13 (0.08 - 0.2), p = 0.100). Using ROC analysis, a serum procalcitonin level of > 0.315ng/mL (area under curve (AUC): 0.919, sensitivity: 87%, specificity: 97%, positive predictive value 96% and negative predictive value 88%) were determined to accurately help the diagnosis of spontaneous bacterial peritonitis.

Conclusion

According to our findings, determination of serum procalcitonin levels seems to provide accurate and rapid diagnosis of ascitic fluid infection.
Relationship of serum vaspin, nafld fibrosis score to ultrasonographic detection and quantification of steatosis in nonalcoholic fatty liver disease patients
Authors: Byoumy Essam Mohamed , Sayed Moataz Mohamed , El-Rahman Shereen Abo Baker Abd , Al-Nakib Sara Abd Elkader , Salama Mohamed Magdy , Mohamed Mohamed Gaber Abd El Maksoud
Published: October 2021

Background

Ectopic hepatic lipid accumulation is closely related to the development of insulin resistance, which is regarded as one of the most significant risk factors of non-alcoholic fatty liver disease (NAFLD).

The aim of the study

was to evaluate and validate the diagnostic value of serum vaspin, NAFLD Fibrosis Score and sonograghic parameters in detection and quantification of liver steatosis and determining further need for liver biopsy or other means to establish NAFLD diagnosis.

Methods

This study was carried out on 60 patients having bright liver in ultrasonography and 30 healthy persons as controls. The subjects were divided into the following groups; group A: 30 age and sex matched healthy volunteers (control group), group B: 20 patients with fatty liver grade I, group C: 20 patients with fatty liver grade II and group D: 20 patients with fatty liver grade III.

Results

serum vaspine levels and NAFLD fibrosis score, were significantly higher in patients than in controls with p-value:<0.001. There was a significant positive correlation between NAFLD fibrosis score and serum vaspin and ultrasonographic findngs of NAFLD with p-value: <0.001.

Conclusion

Vaspin seem to be the most suitable non-invasive biomarker in predicting both intrahepatic lipid contents in NAFLD group.