bluuebunny/crossref_metadata_2025 huggingface dataset:
Spirometric Assessment Before and After treatment of Prostatic Hyperplasia in Patients with Chronic Obstructive Pulmonary Disease
Authors: Dayem Aya Mohamed Mohamed Abdel , Elsayed Tarek Osman , Salem Hala Mohamed , Hiekal Abdel Hamid Mohammed Shawky
Published: October 2021

Background

Chronic Obstructive Pulmonary Disease (COPD) predominantly prevalent in men, is a chronic inflammatory disorder of the airway and lungs. COPD is associated with increased risk of Benign prostatic hyperplasia (BPH). Judging from the association between COPD and BPH in ageing male population, and the samilarities between receptors in airways and the urinary bladder.

Objectives

the aim of the study was to show the effect of treatment of symptomatic BPH on the airways of COPD patients by spirometric assessment before and after starting treatment of BPH.

Patients and Methods

The present study was conducted upon 60 subjects during the period from March 2019 to August 2019 in Ain Sham University Hospitals.

Type of Study

prospective study, there were two groups of patients first group received tamsulosin and the second group received tamsulosin and solifenacin

Results

By comparison of the two groups, there was non-significant change. as regard percent of change of forced vital capacity (FVC), first group’s median was 7.9% and second group median was 5.6%. as regard percent of change of forced expiratory volume 1 (FEV1), in first group’s median was 5.7% and second group’s median was 7.4%.

Conclusion

There was significant improvement in spirometric values in each group before and after starting treatment, but by comparison between the two groups, there was insignificant change.
Value of Neutrophil to Lymphocyte Ratio in Prognosis of Elderly Patients with Community Acquired Pneumonia Compared to CRP Level
Authors: Elassal Gehan M , Elsayed Mohamed A , Shehata Amal M
Published: October 2021

Background

Community-acquired pneumonia (CAP) is a common, potentially fatal disease despite advances in both diagnosis and treatment. Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities. Community acquired pneumonia (CAP) is a frequent and severe infection associated with a high mortality.

Objectives

This work aims to evaluate the role of neutrophil/lymphocyte ratio in prognosis of elderly patients with community acquired pneumonia compared to CRP level.

Patients and Methods

This prospective study was conducted upon 30 elderly patients in chest department at Ain shams University hospitals with community acquired pneumonia. All patients were diagnosed as having CAP by presence of new infiltrates in chest radiography associated with clinical picture. Clinical examination, traditional tests such as Confusion, Urea, Respiratory rate, Blood pressure, aged 65 and older (CURB-65), CRP level and NLR were evaluated at admission and after two weeks of admission. The predictive value for 30-day mortality of traditional tests and NLR were compared.

Results

The present study found that mean age of the studied cases was 72.9 ± 5.14 years old, 20 (66.7%) of patients were males while 10 (33.3%) were females. All patients had co-morbidities with diabetes mellitus and renal impairment the most common by percentage of 36.7%. There was highly significant correlation between neutrophil/lymphocyte count ratio (NLCR), neutrophil count and lymphocytic count and the outcome of CAP patients (p = 0.000, 0.004, 0.000 respectively) compared to other inflammatory biomarkers like WBC count (p = 0.02) and CRP (p = 0.521) and CURB-65 score (p = 0.074). This study showed that no deaths occurred in patients with NLR below 10, mortality was 8.3% in patients with NLR between 10 and 20 and 91.7% in patients with a NLR above 20. NLCR remain high with no significant difference in follow up labs among patients who died.

Conclusion

NLR showed emerging prognostic value in predicting outcome and 30day mortality rate in community acquired pneumonia. Unlike many other inflammatory markers and bioassays, NLR is an inexpensive, easy to handle, cost effective and readily available marker that is obtained from basic blood count providing an additional advantage in predicting hospitalization period and mortality.
Laryngeal air column width ratio in predicting postextubation stridor
Authors: Elsayed Amira Ahmed , Mansour Mona , Ali Tamer Mohamed
Published: October 2021

Background

Cuff leak test (CLT) has been used widely to assess upper airway patency before extubation but with low positive predictive value. Aim To assess the diagnostic accuracy of the airway column width ratio (ACWR) in predicting postextubation stridor (PES).

Patients and methods

50 Patients who intubated >24 hours were observed for postextubation stridor and reintubation. Laryngeal ultrasound was done to measure the ACW with ETT cuff deflated immediately after intubation and 3–4 h before extubation. Cuff leak test was done.

Results

Fifty patients were included with mean age 58 ± 14.71 years, 68% were males and 32% were females. PES developed in 8% of patients. There was highly statistically significant difference between both groups regarding ACW before extubation and ACW ratio (p-value =0.006 and 0.000 respectively). The mean ACW ratio in stridor group (0.79 ± 0.03) was significantly lower than in non-stridor group (0.94 ± 0.04). Reintubation was higher in stridor group (100%) than non-stridor group (23.9%), P = 0.001. There was statistically significant higher duration of mechanical ventilation in stridor group (7.50 ± 0.58 vs. 4.23 ± 2.50 days, P = 0.013). A cut off point of ACW ratio ≤0.81 has a sensitivity 100% and Specificity 100%.

Conclusion

ACW showed excellent utility in prediction of patients with PES. Air column width ratio of ≤ 0.81 was a good predictor of PES.
Incidence of Mesothelioma At Imbaba Chest Hospital From 2013 To 2016
Authors: Ahmed El Naggar Taher Abd Elhameed , Saeed El Maraghy Ashraf Abbas , Abd El Dayem Elwazier Mohamed Mohamed
Published: October 2021

Background

Malignant pleural mesothelioma (MPM) is a rare but aggressive and often fatal malignancy. Most patients present with advanced disease, and the median overall survival is approximately one year.

Objective

To review the cases of malignant mesothelioma admitted to Imbaba Chest Hospital in the period between 2013 and 2016.

Subjects and Methods

The current study spotted the light over the malignant mesothelioma from epidemiological view, as a retrospective cohort study, conducted on all cases of malignant mesothelioma that were diagnosed at Embaba Chest Hospital in the period between 2013 until 2016 to explore the incidence of that disease and its characteristic features. The medical records of patients had been revised for the demographic criteria of patients, which included; age, sex, smoking status, residence and occupation, clinical presentation of cases, radiological findings, cytological examination of pleural fluid, pleural biopsy either thoracoscopic or open, and finally, histopathological diagnosis.

Results

The prevalence of mesothelioma across years of the study was 1.5% (60 out of 4000cases) with increasing annual incidence; 1.7, 2 and 2.3% respectively. The mean age of mesothelioma patients was 57.96 years, most of them above 40 years (91.67%) and more than half of them were males (55%). In spite of decreasing percentage of male with mesothelioma within the study time (2014-2016), which was accompanied with increasing the percentage of female patients, it did not reach statistical significance.

Conclusion

The overall incidence of malignant mesothelioma was 1.5% with increasing annual incidence from 1.7% up to 2.3%. The male gender was the more presentable one with gradual growing of female percent. The urban area was more affected than the rural one, specially the area near industries. Non-exposed persons (unemployed industrial workers) showed higher frequency of MM. Right-sided MM was more common than Left one, beside that the epithelial form of MM was the dominant histological pattern.
Outcomes of Peripheral Blood Eosinophilia in Hospitalized Exacerbations of COPD
Authors: Sharkawy Samar El , Raafat Riham Hazem , Qassem Reem Osama Mohamed Ahmed
Published: October 2021

Background

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines define COPD as a disease state characterized by airflow limitation that is not fully reversible, is usually progressive, and is associated with an abnormal inflammatory response of the lungs to inhaled noxious particles or gases.

Objective

To identify outcomes of patients with eosinophilic COPD exacerbations requiring hospital admission.

Patients and Methods

This study is a prospective cohort study that was conducted on two groups of total 60 patients recruited from Ain Shams University hospitals between October 2019 and July 2020. Group 1: Eosinophilic COPD exacerbation if the peripheral blood eosinophil on admission is ≥ 200 cells/µL and/or ≥2% of the total leukocyte count Group 2: Non-eosinophilic COPD exacerbation if the peripheral blood eosinophil on admission is < 200 cells/µL and/or < 2% of the total leukocyte count.

Results

There was significant high diagnostic performance in predicting readmission at 6-month among eosinophilic group. Eosinophils count, percent (%) and NLR cutoff points had high characteristics (highest in NLR ≥3.1 at discharge) in predicting readmission at 6-month among eosinophilic group. Diagnostic performance of Eosinophils count, percent (%) and NLR were assessed. Eosinophils count, percent (%) and NLR had significant high diagnostic performance in predicting readmission at 6-month among eosinophilic group. Eosinophils count, % and NLR cutoff points had high characteristics (highest in NLR ≥2.1 at discharge) in predicting readmission at 6month among non-eosinophilic group.

Conclusion

Eosinophils can be used as a prognostic marker in non-infective COPD exacerbations. Validity of eosinophil count and percent as a prognostic parameter in COPD exacerbation can be increased by combining with other parameters for example NLR.
The Potential Role of The Long non-coding RNA MEG3 in Bronchial Asthma in children
Authors: Rezk Basma Tarek , Motaleb Fayda Ibrahim Abdel , Kamel Terez Boshra , Nabih Enas Samir , El-Khalek Marwa Ali Abd
Published: October 2021

Aim and Background

Asthma is an inflammatory disease affecting the airways of the lungs being characterized by reversible airflow obstruction and bronchospasm. Environmental and genetic factors play a role in the pathogenesis of the disease; these factors are controlled by epigenetic mechanisms. There is a demand of clinical biomarkers for diagnosis of asthma and monitoring the response to therapy. In this study, we aimed to evaluate the role of lnc-MEG3 expression and its downstream effector in the pathogenesis of bronchial asthma disease.

Methods

Based on bioinformatics analysis using online databases, the current work has been designed to study the expression status of lnc-MEG3 and GDF15 mRNA in serum and sputum of asthmatic children aiming to find its clinical significance. This study was conducted on 30 children, 15 children newly diagnosed with bronchial asthma as patient group (A) and 15 age and sex matched healthy children as control group (B). Quantitative PCR was carried out to evaluate the expression pattern of selected biomarkers in serum and sputum of asthmatic children.

Results

The expression of circulating lnc-MEG3 was highly significantly up-regulated in asthmatic children than in control group (p ≤ 0.01), while the expression of circulating GDF15 mRNA was highly significantly down-regulated in asthmatic children than in control group (p ≤ 0.01). The findings showed a negative significant correlation between both investigated biomarkers.

Conclusion

This study supports the role of lnc-MEG3 and GDF15 protein as potential biomarkers in diagnosis of bronchial asthma in children.
Sternotomy versus Mini-Sternotomy in Pediatric Patients undergoing Modified Blalock-Taussig Shunt
Authors: Azab Sherif , El Midany Ashraf A , Doghish Ayman A , Salah El-din Abugabal Abdelfatah E
Published: October 2021

Background

In the present era, primary correction is the preferred approach to the neonate or young infant with a cardiac anomaly who has two ventricles. However, when only one functional ventricle is present or pulmonary blood flow is reduced, an initial palliative systemic-to-pulmonary arterial shunt is mandatory. In this study we compare post-operative short term outcomes of sternotomy versus mini-sternotomy approaches in pediatric patients undergoing Modified Blalock Taussig Shunt.

Patients and Methods

A prospective randomized study was conducted on 90 patients who were schedueled for MBT shunt due to a group of cyanotic heart disease. They comprised 2 groups G1: sternotomy group (n = 45) and G2: ministernotomy group (n = 45).

Results

Mean age was 11± 3.39 months and mean weight was 6.75±1.96 kg in the sternotomy group, while for ministernotomy group the mean age was 10.55± 4.65 and mean weight was 7.00±2.03 kg. The change (%) between preoperative and postoperative oxygen saturation was 35.6% for sternotomy group and 43.8% for ministernotomy group. There were seven cases of mortality (15.6%) in sternotomy grouped compared to three cases of mortality (6.7%) in ministernotomy with P value of 0.314. Superficial wound infection occurred in one case (2.2%) in each group. Mean duration of ventilation was 52.53 ± 15.76 h for sternotomy group and 46.93±19.23 h for ministernotomy group with P value of 0.025, mean ICU stay was 7.42 ± 2.94 days for sternotomy group and 5.13± 2.37 days for ministernotomy with P value of < 0.001.

Conclusion

Upper ministernotomy is a safe alternative approach for MBT shunt in pediatric patients. It provides the advantages of less ventilation time, less post operative bleeding, and ICU stay.
Deep Wound Infection in Pediatrics after Open Cardiac Surgery
Authors: Shoeb Mohammed Ayman Abd-Elhakeem , El-Midany Ashraf Abd-Elhameed , Ibrahiem Waleed Ismail Kamel , Atiea Waleed Abd-Allah Abd-Elrazzak
Published: October 2021

Surgical site infection (SSI) is a serious complication requiring prolonged hospitalization, intravenous antibiotics, wound care and dressings resulting in increased cost and resistant bacteria. In pediatric cardiac surgery, Median sternotomy is the most frequently used incision for the correction of congenital anomalies. Sternal wound infections (SWIs) are well described complications of cardiac surgery and can occur in 3% to 8% of children. Furthermore, the mortality rate can increase 2-fold after SSIs. Also, SSIs are associated with an increased length of hospital stay, readmissions, and higher health care expenditures.

Mediastinitis is a retrosternal wound infection frequently associated with a macroscopically sternal osteomyelitis. Mediastinitis is uncomfortable for patients, is poorly accepted by parents, leads to a prolonged hospital stay repeated surgery and prolonged antibiotic therapy. Mediastinitis are costly for patients, providers, and health-care institutions. In A recent survey among congenital heart programs, the incidence of mediastinitis has been reported to occur in 0.2–1.4%. Gram-positive cocci are the most common pathogen. Gram negative organisms are increasingly recognized, especially in neonates, and are related to delayed sternal closure. Fungal organisms are not infrequently found.

Mediastinitis generally presents 2–3 weeks after cardiac surgery. Child often appear irritable, tired, and febrile. The incision is erythematous and painful. Wound separation and purulent drainage from the incision are frequent. Some but not all will also have sternal instability or dehiscence. Associated bacteremia is not uncommon, present in up to 40% of patients.

Postoperative mediastinitis is a life-threatening infection and increase health expenditure. Young age, malnutrition, hypothermia, hyperglycemia, longer duration of surgery, long time of delayed sternal closure, postoperative low cardiac output and long ICU stay were a risk factor of mediastinitis. Stick to1999 CDC's Guideline for prevention of surgical site infection and their update in 2017 especially proper timing of antibiotic prophylaxis and post-operative blood glucose management is important in prevention of these life-threatening complication. procalcitonin can be useful biologic marker of infection. Management of mediastinitis consist of debridement and culture-based antibiotics. Primary closure over mediastinal drain or high vacuum drain gave good result, less time consuming, more economic and more cosmetic. Vacuum assisted closure gave excellent result, but more time consuming, less economic and delayed closure is necessary. Larger studies are needed to compare both techniques in effectiveness and coast benefit.
Estimation of Radiation Exposure in the Pediatric Cath Lab in Ain Shams University; Cross-Sectional Observational Study
Authors: Abdelrazik Ahmed , Amin Youssef , Roushdy Alaa , El Sayed Maiy
Published: October 2021

Aim and objectives

The aim of the study is to assess the average radiation doses recorded per procedure in Ain Shams University Hospital pediatric cath lab to set benchmarks of radiation exposure in our institute.

Patients and Methods

The study included 198 patients who presented to Ain Shams cardiac pediatric cath lab who undergone interventional (BPV, BAV, ASD device closure, VSD device closure, PDA coil/device closure, Coarctation Stent/balloon) and diagnostic (Hemodynamics study, Diagnostic cath) heart catheterization. Radiation doses were measured without any interference with the operator’s preferences.

Results

Radiation dosages were measured in total AirKerma, Dose area product (DAP), and fluoroscopy time to set the benchmarks for radiation exposure in our institute per procedure. VSD device closure showed the highest radiation exposure followed by Coarctation stenting.

Lowest radiation dosage was in PDA coil closure followed by ASD device closure then BPV.

Conclusion

Benchmarks for radiation exposure per procedure in pediatric cath lab in our institute were set and compared to each other.
Echocardiographic Evaluation of Changes in Cardiac Hemodynamics, Loading Conditions, and Atrial Function after Transcatheter Closure of Atrial Septal Defect
Authors: Shoeir Mohamed Abdelfattah , Elshahed Ghada , Esmail Yasmin Abdelrazek , Ezz Eldin Dina Adel
Published: October 2021

Background

The changes in loading conditions, atrial function, and the different echocardiographic parameters before and after transcatheter atrial septal defect (ASD) closure are still under study. So we felt the need to evaluate the echocardiographic changes that occur and detect the timing after closure at which the right-sided heart hemodynamics, and measurements are back to normal.

Objectives

To evaluate the changes in cardiac hemodynamics, loading conditions, and atrial function after percutaneous closure of ASD using echocardiography.

Patients and Methods

The study included 30 patients referred to percutaneous closure of ASD in Ain Shams University hospital we performed echocardiography before, 1 week, and 3 months after closure.

Results

The study showed that RV dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure (p < 0.001). RA dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure (p < 0.001). RA peak systolic strain, and strain rate increased significantly 1 week, and 3 months after ASD closure (p < 0.001). LA dimensions and volumes increased significantly 1 week, and 3 months after ASD closure (P < 0.001). LA peak systolic strain showed no significant difference before, 1week, and 3 months after ASD closure (P = 0.063), and strain rate showed no significant difference before, 1week, and 3 months after ASD closure (P = 0.207).

Conclusion

In our study, we have concluded that RV dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure. RA dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure. RA peak systolic strain, and strain rate increased significantly 1 week, and 3 months after ASD closure, as a result of improvement of the RA wall velocity, due to relief of the volume overload after closure of the shunt. LA peak systolic strain, and strain rate showed no significant difference before, 1week, and 3 months after ASD closure.

Abbreviations list

ASD (atrial septal defect), RV (right ventricle), RA (right atrium), LA (left atrium).
Epicardial Fat Volume Assessed by Multi-Detector Computed Tomography and it’s Relation with the Severity of Coronary Artery Disease
Authors: Ali Mohamed Mohamed , Onsy Ahmed Mohamed , Abdelmonaem Mostafa Mohamed , Khashaba Ahmed Ahmed
Published: October 2021

Background

Recent studies have suggested that fat disposition in epicardial tissue may be a predictor of the severity of coronary artery disease (CAD). Epicardial adipose tissue (EAT) is defined as the adipose tissue located between the outer wall of the myocardium and the visceral layer of pericardium, surrounding the heart and the coronary vessels. EAT is closely related to the adventitia of the coronary arteries without a barrier that may directly influence the development and progression of atherosclerosis and CAD through pro-inflammatory mediators.

Objective

The aim of the work is to investigate the relation between epicardial fat volume (EFV) [assessed by multidetector computed tomography (MDCT)] and severity of CAD.

Methods

This cross sectional study was conducted on 40 patients referred for MDCT coronary angiography to assess their complaint. EFV was quantified during non-contrast phase and severity of CAD was assessed by segment involvement score (SIS) and segment stenosis score (SSS) during contrast phase at Nasr City Police Hospital in the period between August 2018 and April 2019.

Results

The 40 consecutive subjects consisted of 30 males (75%) and 10 females (25%) with mean age 56 ±10.27 years. Risk factors of atherosclerosis were analyzed among the studied population as followed; the BMI ranged between 24 and 30.9 kg/m2, hypertensive patients were 77.5%, diabetic patients were 55% and smokers were 67.5%. The laboratory finding of the studied group revealed that the serum LDL.C ranged between 70 and 218 mg/dl (Mean±SD =163.88±43.37, Median= 183.5). The serum HDL.C ranged between 30 and 62 mg/dl (Mean±SD = 41.45±9.87, Median= 37). The serum total cholesterol ranged between 136 and 280 mg/dl (Mean±SD = 214.35± 35.51, Median= 224). The serum triglycerides ranged between 110 and 215 mg/dl (Mean±SD = 164.13±27.38, Median= 173).The serum creatinine ranged between 0.8 and 1.8 mg/dl (Mean±SD = 1.12±0.19, Median= 1.1). 17.5% of the studied patients had normal coronaries while 37.5% had single vessel disease and 45% had multi-vessel disease. There was a significant relationship between EFV and CAC score (p = 0.011, r = 0.397), a highly significant relationship between EFV and SSS score (p = 0.001, r = 0.518) and significant relationship between EFV & SIS score (P = 0.003, r = 0.459). Patients with normal coronary arteries were noted to have a lower EFV value than those with coronary lesions (highly significant relationship, p = 0.004) either single vessel disease or multi-vessel disease. There is no significant difference between the effects of EFV on number of diseased coronaries either single vessel disease or multi-vessel disease.

Conclusion

EFV increased in patients with both significant coronary artery stenosis or coronary calcification. EFV is considered an independent risk factor for CAD.
The Relationship between Bariatric surgery-induced Weight Loss and Heart Rate Variability
Authors: Mikawy Mohamed G , Ramadan Ahmed Y , Badran Haitham A , Nabih Mervat A
Published: October 2021

Background

Obesity is associated with an increased risk of sudden death that may be due to abnormal cardiac vagal modulation reflected by reduced Heart rate variability (HRV). Weight loss after diet or gastroplasty in morbidly obese patients has been shown to reverse the deleterious impacts of obesity on cardiac autonomic nervous system modulation, with subjects showing enhanced HRV after reduction in body mass index (BMI), through increased cardiac vagal modulation

Objective

The aim of this study is to assess weight loss effect after bariatric surgery on Heart rate variability (HRV) by 24-hour Holter monitoring.

Methods

This is an observational cross section study was done on thirty morbidly obese patients (twenty female and ten males) undergoing bariatric surgery (Roux-en-Y gastric bypass) were enrolled in the study from Ain Shams University Hospitals within the period 1/7/2019 till 1/3/2020.

Results

Our study results proved that weight loss after bariatric surgery (Roux-en-Y gastric bypass) improves the heart rate variability and hence cardiac autonomic modulation. This is of importance because higher heart rate is associated with increased mortality, and decreased the heart rate variability is associated with increased cardiac mortality independent of ejection fraction. Weight loss after bariatric surgery (Roux-en-Y gastric bypass) achieved better glycemic control of the diabetic patients. Even more, a complete resolution of diabetes occurred in a large number of the diabetic patients (50% of total diabetic patients).

Conclusion

The Significant weight loss after bariatric surgery (Roux-en-Y gastric bypass) improves the heart rate variability and hence cardiac autonomic modulation.
CHA2 DS2 -VASc score as a predictor for contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention
Authors: Hamdy Montaser , Shehata Hassan , Abuarab Tamer
Published: October 2021

Background

Contrast induced nephropathy (CIN) is one of the most important complications of PCI. It is a common cause of acute renal failure following invasive procedures, resulting in increased medical resources, longer hospital stay, and higher mortality so it is important to detect early high risk patients for CIN and provide them with preventive measures. In recent years, several studies have demonstrated an association of CHA2DS2-VASc score with cardiovascular prognosis and adverse outcomes in different populations including heart failure, SCAD and ACS beyond the original AF field. The predictive value of the CHA2DS2-VASc score on CIN still remains unclear although all of the components of the CHA2DS2-VASc score are important risk factors for CIN. For this reason, the present study was designed to evaluate the predictive value of preprocedural CHA2DS2-VASc score on the development of CIN in patients with ACS who underwent PCI.

Objective

To assess the predictive value of the CHA2DS2-VASc Score for contrast induced nephropathy among acute coronary syndrome patients who underwent percutaneous coronary intervention.

Material and Methods

This study is a prospective study conducted over 300 patients with myocardial infarction who presented at ain shams university hospitals for primary coronary intervention. It took place from February 2019 till September 2019.

Results

From the study population collected (n = 300), 25.7% of which were females (n = 77), statistically significant relation was found between CIN and CHA2DS2-VASc score. (P value 0.000). A significant relationship existed between CIN and CHA2DS2-VASc score more than 3, and each of: age, female gender, DM, HTN, door to needle time, ACS type (NSTEMI) and killip class above one. (P values 0.000), Patients with previous intervention using contrast (P value = 0.001), anemia (P value 0.014) (p value = 0.000) and contrast volume (p value = 0.002) and number of coronary vessels affected (p value = 0.031). However, non-significant relationship could be concluded between CIN and each of Stroke, TIA and previous thromboembolism (P value = 0.446), ejection fraction (P value = 0.155), Time of procedure (p value = 0.131), culprit vessel (p value = 0.317), type of STEMI (p value = 0.140), Revascularization of culprit vessel (p value = 0.143), TIMI grade (p value = 0.278) and antiplatelet type. (P value 0.934)

Conclusion

CHA2DS2-VASc score is a simple risk score for bedside, preprocedure CIN risk stratification among ACS patients who underwent primary PCI.
The value of plasma D-dimer level in predicting no-reflow after primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction
Authors: Elsymbokhty Wafed Samir Mohamed , Mansour Hazem Mohamed , Tamara Ahmed Fathy , Alabd Ali Ahmed
Published: October 2021

Background

The no-reflow phenomenon is defined as the occurrence of areas with extremely low tissue flow after reopening the target vessel. Current knowledge suggests that the no-reflow phenomenon is caused by the damage to microvascular integrity established both during ischemia and during reperfusion.. D-dimer is a final product of fibrin degradation by plasmin, the plasma concentrations of which increase in subjects with ongoing or recent thrombosis; its levels reflect the fibrin turnover and gives an indirect estimation of the size of the thrombotic mass available for fibrinolysis and the severity of hypercoagulable state. Moreover, high thrombus burden is known to be associated with no-reflow phenomenon.

Objective: To

determine the value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction,

Patients and Methods

The study was conducted among 100 patients with STEMI admitted in coronary care unit and coronary catheterization lab unit of cardiology department in Ain Shams University Hospital & Misr University Hospital undergone successful primary PCI. 74 patients showed normal re-flow after PCI and 26 patients showed noreflow phenomenon after PCI and D –dimer level and other clinical parematers for the no re-flow phenomenon were analysed.

Results

patient with high plasma D-dimer levels showed higher risk of no-reflow phenomenon compared with patients with low plasma D-dimer in predicting no-reflow. D-dimer level ranged from 210 to 776 ng/ml with mean± SD was 415.35 ± 164.91 ng/ml. (55%) of the patients had D-dimer levels <500 ng/ml.and (45%) had D-dimer >500ng/dl. coronary angiography showed that (74%) showed normal flow and (26%)showed no re-flow. ROC curve of the relation of no-reflow, TIMI flow and MBG grade, showed that the best cut off point for D-dimer to detect cases with no reflow was found ≥ 560 with sensitivity of 96.15%, specificity of 79.73% and area under curve (AUC) of 86.5%.

Conclusion

D-dimer level on admission independently predicts no-reflow after p-PCI. High D-dimer level on admission has an independent prognostic value.
Relation between Epstein-Barr virus infection and Multiple Sclerosis
Authors: Abdul-Ghaffar Aisha Yassin , Samaha Dalia Youssef , Wahba Nancy Samir , Hussein Ahmed Essam Ali
Published: October 2021

Background

Multiple sclerosis (MS) is an immune mediated inflammatory disease that attacks myelinated axons in the central nervous system (CNS), destroying the myelin and the axon in variable degrees. The aetiology and pathogenesis of MS is complex and multifactorial, involving many interlacing mechanisms. Many theories had considered viral infections as a possible cause of MS. One of these viruses is Epstein-Barr virus (EBV), a herpes virus belonging to the family herpesviridae. There is obvious similarity between EBV and MS regarding their epidemiological pictures, and it was observed that most MS patients had a history of infectious mononucleosis (IM) a few years before onset. The relation between EBV and MS may give hope for development of biomarkers for prediction of disease development, early diagnosis, prediction of prognosis, curing or even preventing MS through an anti EBV vaccine or antiviral therapies.

Objectives

This study aims to analyze the association between EBV infection and multiple sclerosis.

Subjects and Methods

This is a case control study carried in the MS outpatient clinic at Ain Shams University Hospitals during the period from April 2019 till November 2019. Subjects included in this study were classified into two groups. The first group included 30 patients diagnosed as having MS, on the basis of their MRI finding, clinical presentation and according to revised Mc Donald criteria 2017. The patient group included 11 males and 19 females, their age ranged from 18 to 48 years. The second group included 30 age and sex matched healthy controls without any neurological or medical diseases. The control group included 11 males and 19 females, their age ranged from 18 to 48 years. Both groups were tested quantitatively for immunoglobulin G against Epstein Barr viral capsid antigen (VCA) using the enzyme linked immunosorbent assay technique (ELISA).

Results

All patients with MS (100%) were positive for EBV VCA IgG, whereas (93.33%) of controls were positive. In the MS group, the EBV VCA IgG mean level was (161± 66.32) U/ml compared with (78.53±47.63) U/ml in controls. The difference in serum level of EBV VCA IgG between both groups was statistically highly significant (P = < 0.001).

Conclusion

There were higher levels of EBV VCA IgG in the serum of MS patients compared to healthy controls. This finding postulates a relation between EBV infection and MS and its role in the pathogenesis of MS.
D1S111 and 33.4 Polymorphism as a Tool of Genetic Identity among Egyptians
Authors: Talkhan Hala Ahmed , Mamdouh Rasha Mohammed , El Najjar Marwa Rushdy , Ibrahim Marian George Asaad
Published: October 2021

Background

The variable number tandem repeats (VNTR) are highly polymorphic markers. Due to their high polymorphic content, VNTR constitute useful tools in population genetic studies in understanding population and ethnic migrations throughout history. They also constitute preferred systems for DNA “fingerprinting”, criminal and forensic examinations and paternity testing, evaluating hematopoietic chimerism and in determining the origin of leukemic cells in patients with recurrent disease after BMT.

Aim of the Work

To standardize PCR protocols of 2 VNTR loci (D1S111/33.6 and 33.4) in order to detect allelic polymorphism among Egyptians as a tool in following up the chimeric status after allogenic stem cell transplantation.

Patients and Methods

The current study was conducted at Clinical Pathology Department of Ain Shams University Hospital between January 2018 and December 2019, a total of 130 subjects [65 pairs (allogenic stem cell transplantation donors and their recipients)] were included. D1S111/33.6 and 33.4 VNTR loci were evaluated in every subject by PCR technique to study their relative distribution and number of informative alleles detected in order to be used in chimerism follow up and population studies.

Results

Five alleles were found at D1S111/33.6 in 130 subjects with molecular weight ranging from 364 to 993 bp, frequency of homozygous alleles were 30.8% and it was 69.2% for heterozygous, 90 out of the total 130 subjects were heterozygous for 33.6, that means that the heterozygosity index for D1S111/33.6 is 69.2%, from the 65 pairs tested 31 pair were informative or discriminative with discriminative power 47.69%. For 33.4 we tried many PCR programs but no bands were detected at all.

Conclusion

D1S111/33.6 VNTR polymorphism is a dependable cost effective method in following up of allogenic stem cell transplantation recipients.
Transcription Factor 7-Like-2 (TCF7L2) rs7903146 (C/T) Polymorphism in Patients with Type 2 Diabetes Mellitus
Authors: Seif Arig Aly , Hamed Amira Ibrahim , Bahaaeldin Ahmed Mohamed , Kabiel Walaa Ahmed Yousry , El Azm Mohamed Ahmed Abo
Published: October 2021

Background

Type 2 diabetes mellitus (T2DM) is a heterogeneous group of metabolic disorders characterized by the incapability of pancreatic beta cells to increase insulin secretion to compensate for insulin resistance in the peripheral tissues. T2DM is a multi-factorial disease including several environmental factors with the presence of genetic predisposition. The transcription factor 7-like-2 gene (TCF7L2) rs7903146 (C/T) polymorphism is one of the most susceptible genes to T2DM discovered to date, with contribution to the disease through the Wnt/β –catenin signaling pathway affecting pancreatic islet development, expression of several genes involved in insulin granules exocytosis and the incretin glucagon-like peptide 1 (GLP-1) gene.

Aim of the Work

In this study we aimed to investigate the potential association of the transcription factor 7-like-2 (TCF7L2) rs7903146 (C/T) gene polymorphism in patients with type 2 diabetes mellitus.

Patients and Methods

The study was a case- control study conducted on 70 T2DM patients recruited from the endocrinology clinic at Ain Shams University Hospitals, and 30 non diabetic healthy controls matched with the patients in age and sex. All subjects underwent full history taking, thorough clinical examination, routine laboratory investigations including haemoglobin A1c (HbA1c), lipid profile; total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) and determination of TCF7L2 gene polymorphism by real-time quantitative polymerase chain reaction (RT-PCR).

Results

The minor T allele of the rs7903146(C/T) SNP was associated with high risk of development of T2DM with an OR of 1.35 (95% CI: 0.68-2.6), the heterozygous genotype (CT) with an OR 1.16 (95% CI: 0.49-2.7) and the homozygous mutant genotype (TT) with OR of 3.16 (95% CI: 0.15-6.31), however, they were statistically insignificant (p-value >0.05).

Conclusion

Our study did not confirm the presence of significant association between the TCF7L2 rs7903146(C/T) polymorphism and T2DM, however, it pointed to the possibility of presence of high risk of development of T2DM in patients with TT genotype. Further studies with higher sample size are needed to clarify the association.
Exploring The Clinical Significance of Serum Angiopoietin-2 In Breast Cancer Patients
Authors: Abd Elmagid Abeer I , Al Hala Abdel , El Sayed Saad Wessam , Mohamed Seham Kamal
Published: October 2021

Background

Breast cancer is the most common cancer among women and one of the most important causes of death among them.Angiogenesis is an important step for primary tumor growth, invasiveness, and metastases. Angiopoietins are well-recognized endothelial growth factors that are involved in angiogenesis associated with tumors.

Aim

To explore the diagnostic significance of serum angiopoietin-2 (Ang-2) in breast cancer and to evaluate its prognostic efficacy through studying the degree of its association with the TNM staging of the disease.

Patients and Methods

This study was conducted on (35) Egyptian female patients who were diagnosed as breast cancer according to histopathological examination of breast biopsy (Group 1, Breast Cancer Patients) and (25) female patients with benign breast diseases (Group II, Pathological Control Patients), in addition to (20) age - matched apparently healthy, free mammogram, females serving as healthy controls (Group III, Healthy Controls). For all participants, measurement of serum Ang-2 was done using enzyme linked immunosorbent assay (ELISA) technique.

Results

A highly significant increased levels of Ang-2 was observed in breast cancer patients when compared to healthy control group (Z = 4.95, p < 0.01). However, no significant difference was observed in Ang-2 levels between breast cancer patients group and pathological control group (Z = 3.37, p > 0.05). No significant difference was detected in Ang-2 levels in relation to TNM stage and histological grade. No significant correlation was found between Ang-2 levels and serum levels of CA15-3, hormone receptors, HER2/new receptor status (p > 0.05, respectively).

Conclusion

This study revealed that Ang-2 serum levels were significantly increased in patient with breast cancer compared with healthy controls, indicating that high Ang-2 level is a promising non invasive biomarker for breast cancer diagnosis. However, no significant difference of Ang-2 levels was detected in relation of breast TNM staging in the population studied.
Study of The Association between TCF7L2 Gene Polymorphism (rs12255372) and Breast Cancer
Authors: Shaheen Karim Yehia , Al Ahmed Hala Abdel , Shaaban Menat Allah Ali , Emam Yasmeen Mohamed
Published: October 2021

Background

Breast cancer is a major health concern worldwide being the most frequently diagnosed cancer and a leading cause of cancer related death in females. It is a complex heterogeneous multifactorial disease where recently; genetic factors have emerged as major factors in the pathogenesis of the disease.

Aim of the Work

The aim of the present study is to investigate the association of TCF7L2 rs12255372 (G/T) gene polymorphism with breast cancer and the clinicopathological characteristics of the patients.

Subjects and Methods

It is a case control study conducted at Ain Shams University Hospitals, it includes 40 breast cancer female patients and 10 age matched healthy females.

Results

There was no statistically significant difference between the breast cancer patient group and the healthy female controls regarding TCF7L2 rs12255372 genotypes GG, GT and TT (p-value >0.05 respectively). Moreover, no statistically significant difference was observed between both groups as regards G and T allele frequencies (p-value > 0.05 respectively). Finally, no statistically significant difference association was recorded between the different genotypes of TCF7L2 gene and the clinicopathological characteristics of breast cancer patients (p-value > 0.05 respectively).

Conclusion

the present study demonstrated the absence of a significant association of TCF7L2 SNP rs12255372 (G/T) with breast cancer or with the clinicopathological characteristics of the tumor among the studied population.
Role of Platelet Rich Plasma in Accelerating the Healing Rate of Diabetic Foot Ulcer
Authors: Eldin Mohamed Mohamed Bahaa , Abd Elaziz Ahmed Abdel Razik , Mohamed Hamada Nader Mohamed , Mohamed Alaa Eldin Zaki
Published: October 2021

Background

Diabetes is a major health problem that is currently showing an alarming rise in its prevalence, this has recently been estimated at 7.8% in the United States, presenting a > 50% increase over the past 15 years while there exists a large population group in whom diabetes is undiagnosed.

Objective

To evaluate the effectiveness and rate of healing of autologous PRP gel in treatment of diabetic foot ulcers. Compare the effectiveness of PRP gel with standard treatment (normal saline dressings).

Methods

30 patients with non-ischemic DFU were classified into two groups: Group A: Patients with non-ischemic DFU and were treated with a novel modality i.e.: PRP injection in the healing edge and the floor of the targeted ulcer. GroupGroup B B:: Patients with non-ischemic DFU who had usual standard care i.e.: moist dressing with or without collagenase ointment. All cases had a minimal debridement prior to treatment, here in our study the demographic data i.e. Age, sex, medical history were homogenously distributed among both groups. All cases in both groups were non ischemic after successful revascularization either by OR or ER.

Results

The rate of complete healing for ulcers in group A was achieved in six patients (40%) at the fifth week, while five patients (33.33%) were healed completely by the sixth week and only one patient (6.67%) healed in the ninth week. 26.67% (n = 4 cases) in group B showed complete healing rate by eighth week and 40% (n = 6 cases) were healed by ninth week while 33.33% (n = 5 cases) were healed in the tenth week. P value was statistically significant <0.001 between the groups.

Conclusion

Activated platelet rich plasma is a novel modality in treatment of diabetic foot ulcers which is feasible, safe and effective with high rate of limb salvage rate and clinical improvement.
Study of Comparison of Serum CXCL10 in Vitiligenous Patients before and after NB-UVB
Authors: Zulfakar Nehal Mohamed , Hassan Samah Ibrahim , Salah Ahmed Abdel-moneim
Published: October 2021

Background

Vitiligo is a common, asymptomatic, acquired depigmentation disorder, clinically characterized by milky white sharply demarcated, macules and patches that are scattered symmetrically or asymmetrically over the body causing severe cosmetic distress and social stigma. It can be classified as nonsegmental, segmental, mixed, or unclassified. In vitiligo, melanocytes are targeted by multiple aggressions leading to marked reduction and destruction of pigment cells, including autoimmune process, altered cellular environment, defective melanocytes migration, stress, and genetic factors.

Objective

To evaluate the serum CXCL10 level in patients with more than one year stability, compare them with healthy controls and compare the serum and tissue level before and after treatment with NB-UVB.

Patients and Methods

The present prospective controlled study included 20 patients with stable vitiligo (according to the VIDA activity score age of patients ranged from 18 to 54 years old were divided into 10 males and 10 females, and were recruited from the outpatient clinic of dermatology of Ain Shams University Hospital in the period from october 2018 to march 2019, twenty healthy persons were used as controls. All the patients were subjected to a full history taking, general and local clinical examination laboratory tests, and graded via VIDA score as below, digital photography were taken before and after NB-UVB.

Results

A Total of 20 patients were enrolled in the study, completed the study till the end of follow up of 24 visits during 12 weeks, their ages ranged from 18 to 54years old with a mean of 32.88 ± 10.42 years. Patients were divided into 10 males (50%) and 10 females (50%). Only one patient (5%) had a past medical history of diabetes mellitus and five patients (25%) had similar vitiligo affection in their families. As regard the mean difference of serum CXCL10 in comparison to tissue levels after the treatment there was no statistically significant differences indicating that serum is good indicator for measurement of expression of CXCR3 expression with less invasive procedure and tissue CXCL10 is not necessary to be measured

Conclusion

Cxcl10 is a useful marker for vitiligo and its severity Serum CXCL10 is equally significant to tissue CXCL10, so serum CXCL10 can replase invasive tissue CXCL10 Some drugs can be directed against CXCL10 or its receptor CXCR3 and may be a useful tool to control vitiligo in the future.
Assessment of The Influence of Non-Genetic Risk Factors on The Disease Onset and Progression of Androgenetic Alopecia in Egyptian Males
Authors: Khafagy Naziha Hafez , Soltan Marwa Yassin , Adel Ali Ali Ahmed
Published: October 2021

Background

Androgenetic alopecia (AGA) is a patterned hair loss with multifactorial background including genetic, hormonal as well as environmental and lifestyle-related risk factors. The impact of non-genetic risk factors on the onset and disease progression of androgenetic alopecia in Egyptian males.

Objective

To explore the potential role of non-genetic risk factors on the disease development and progression of androgenetic alopecia in Egyptian males.

Patients and Methods

The study included 2000 subjects with and without AGA, during the period from February 2019 to September 2019. The study protocol was approved by faculty of medicine, Ain Sham University, Research ethics committee (FWA 000017585). An informed written consent for participation in this study was obtained from patients and controls before enrollment. One thousand male patients with AGA were recruited in the study. The diagnosis was made via clinical diagnosis, dermatological findings, trichoscopic assessment.

Results

Our study showed that after skin examination 416 patients had acne and 344 patients had seborrhea, with statistically significant association to AGA cases.

Conclusion

From our study, it can be concluded that AGA became a major type of hair loss complaint among Egyptian males especially young males. Many potential risk factors were found to be associated with the disease as smoking, stress, obesity, family history, exercise, HTN and unbalanced diet. Avoidance of such risk factors may help improve the disease.