bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of direct-acting antivirals on liver fibrosis in Egyptian hepatitis C virus patients: a single center experience
Authors: Abdelkader Nadia Abdelaaty , AlBalakosy Amira Mahmoud , Sherief Ahmed Fouad Helmy , Gado Mohamed Soliman
Published: October 2021

Background

Hepatitis C virus (HCV) infection affects approximately 170 million people worldwide, causing liver cirrhosis and hepatocellular carcinoma (HCC) and leading to liver transplantation and ultimately death. Accurate evaluation of liver fibrosis in patients with chronic liver diseases is crucial, as liver fibrosis is important in order to make therapeutic decisions, determine prognosis of liver disease and to follow-up disease progression. Multiple non-invasive methods have been used successfully in the prediction of fibrosis; however, early changes in noninvasive biomarkers of hepatic fibrosis under effective antiviral therapy are widely unknown. The aim of this study is to evaluate changes of transient elastography values as well as FIB-4 and AST to platelet ratio index (APRI) in patients treated with DAAs.

Objectives

The aim beyond this study is to evaluate the changes in liver stiffness in hepatitis C Egyptian patients before and at least one year after treatment with DAAs using transient elastography and non-invasive liver fibrosis indices as FIB-4 and APRI scores.

Patients and methods

The present study was conducted on 100 patients with chronic hepatitis C patients attended to Ain Shams University Hospitals, Viral hepatitis treatment unit between October 2017 and December 2018, who were followed-up during treatment and after treatment for at least one year (retrospective and prospective study). Total number of cases during the study period was 117 patients. 17 patients were excluded from the study due to missed follow-up. Eventually, 100 patients were enrolled in the study fulfilling the inclusion criteria.

Results

The mean age of our patients is 47.9 years with Male predominance (52 males and 48 females). There was a significant improvement of, platelets counts, ALT and AST levels, which in turn cause significant improvement in FIB-4 and APRI scores. There was a significant improvement of liver stiffness after end of treatment, regardless of the DAA regimen used, as evidenced by Fibroscan.

Conclusion

Fibrosis regression –assessed by non-invasive markers of fibrosis is achievable upon removal of the causative agent.
Assessing the Outcome of Transforminal Lumbar Interbody Fusion and Posterolateral Lumbar Fusion with Instrumentation in Treatment of Degenerative Lumbar Disorders
Authors: Hemida Salah A , Saoud Khaled M , Sabry Hatem A , Abouelmaaty Emad M , Selim Fady K
Published: October 2021

Background

Degenerative lumbar disorders are relatively common condition that typically affects persons over the age of 50 and are more common in females. Patients typically present with a constellation of symptoms that include back pain, radiculopathy, and/or neurogenic claudication.

Aim of the Work

to assess the clinical and radiological outcome of Transforaminal Lumbar Interbody Fusion (TLIF) and posterolateral fusion (PLF) in the treatment of degenerative lumbar disorders.

Patients and Methods

a prospective study was conducted on patients with degenerative lumbar spondylolisthesis and degenerative lumbar spine stenosis who were admitted to Neurosurgical department at Ain Shams University hospital and Arab contractors medical center and underwent lumbar spine fixation with either transforaminal interbody fusion or posterolateral fusion from February 2017 to February 2019. The patients were divided into two groups according to the operative procedure done for each group. Group A (20 patients) included patients who underwent transforaminal lumbar interbody fusion. Group B (20 patients) included patients who underwent posterolateral fusion.

Results

We found that both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar disorders. TLIF is superior to PLF with regard to achieving radiographic fusion. There is no strong evidence to support the use of TLIF over traditional PLF in treatment of degenerative lumbar disorders, especially with the increased material costs associated with interbody fusion.

Conclusion

both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar disorders. TLIF is superior to PLF with regard to achieving radiographic fusion.
Evaluation of Functional Outcome Following Resection of Supratentorial Lesions at Eloquent Brain Areas
Authors: Al-Abyad Ashraf , Jalalod’din Hasan , Nosseir Mohamed , Ahmed Omar El Farouk , Alahwal Fathi
Published: October 2021

Objectives

Microsurgical management of intrinsic brain tumors aims to maximize the extent of resection and to minimize the postoperative morbidity. The purpose of this study is to evaluate the functional outcome following surgical excision of supratentorial lesions at eloquent brain areas such as language, motor and sensory cortex, regarding the extent of resection, the karnofsky performance scale, the neurological deficit and seizure control.

Methods

A prospective study of 25 patients aged 15-55 years, 15 females and 10 males underwent surgical excision of supra-tentorial lesions at eloquent brain, The Karnofsky Performance Score (KPS), seizure attacks and neurological deficits were analyzed before and after resection. Functional resection was implemented using preoperative functional magnetic resonance image (fMRI), intraoperative image guidance and electrophysiological monitoring under total intravenous anesthesia (TIVA) or awake craniotomy and the extent of resection was quantified postoperatively.

Results

Preoperative median KPS was 76.8%. It improved one year post-operatively to 89.2%. One patient died 3 weeks postoperatively due to neurological, cardiac and chest complications. The pathology report revealed recurrent metastatic adenocarcinoma GIII. Preoperatively, twenty-three patients had seizure attacks, 10 were controlled and 13 were uncontrolled on medication. Postoperatively seven patients were Engels classification IC and 17 patients were controlled on anti-epileptics (Engels classification ID). Preoperatively 19 patients had hemiparesis/ hemiplegia, while immediate (one week) postoperatively 13 patients improved, 8 patients experienced initial worsening of the preoperative deficits and 4 patients had the same deficit as preoperatively while at 1-year postoperatively, 24 patients improved. Gross total resection (>95%) was achieved in 19 patients, subtotal resection (>75%) in 4 patients and partial resection (>65%) in 2 patients.

Conclusion

Functional resection is believed to be a key prognostic factor in supratentorial lesions at eloquent brain regarding improving of karnofsky performance scale, neurological outcome and seizure control.
Evaluation of Pure Endoscopic Endonasal Approach in Management of Giant Pituitary Adenoma
Authors: Gerges Mina M , Sabry Hatem , din Hasan Jalalod , Ghobashy Mohamed Ashraf , Schwartz Theodore H
Published: October 2021

Background

Giant pituitary adenoma represents one of the challenging tumor for neurosurgeons. Many microsurgical approaches in the past were used for its management. Recently and with evolution of the endoscopic equipment and instruments, extended endoscopic transsphenoidal approach become one of the preferable approaches for its surgical excision.

Methods

We prospectively document the clinical , surgical and follow up data for all patients presented with giant pituitary adenoma to Ain-Shams university hospital and Weill Cornell Medical College, Presbyterian hospital and were surgically treated with extended transsphenoidal approach from 2015 till 2019.

Results

Our group study formed of 44 patients with mean age 53.03 (range 14.7-82.4) and a male predominance (59%). The main presentation was visual problems in 75% followed by partial hypopituitarism in 31.81% while headache was in 13.64%. Only 4 patients had functioning adenoma (3 prolactinoma and 1 acromegaly). Average tumor volume was 26.95 ± 17.25 cm3, while the mean maximum tumor diameter was 4.73 cm (range 4.0-8.0 cm). Radiographic invasion was found in 97.73% to suprasellar cistern, 61.36% to the cavernous sinus and in 34% to the sphenoid sinus. GTR was achieved in 45.45% with Knosp score is the only significant predictor factor for resection rate (p = 0.04). Visual improvement achieved in 75.76%. 50% (2 patient) of the patients with functioning adenoma were cured. Complications included CSF leak in 3 patients, permanent DI in 4 patients and postoperative hematoma in 2 patients. Recurrence and progression rates without upfront radiation therapy were 5.00 % and 31.81% respectively after mean follow up period 57.90 months.

Conclusions

Extended endoscopic approaches for achieving maximum resection with minimal morbidity for giant pituitary adenoma are very effective. Lateral tumor extension with cavernous sinus invasion represents the limiting point in achieving gross total resection. Upfront radiation therapy for patients with residual adenoma can be avoided but regular follow up should be warranted.
A Comparative Study Between Preoperative Subconjunctival Bevacizumab Injection And Postoperative Topical Application In Prevention Of Recurrence After Excision Of Primary Pterygium In Egyptian Patients
Authors: Mohamed Basma Helal , Othman Ziko Othman Ali , Khairy Abd El Dayem Hisham M , Khamis Ahmed Nancy Ezzelregal
Published: October 2021

Purpose

to compare between recurrence incidence after primary pterygium excision when using preoperative subconjunctival injection of Bevacizumab (Avastin) and using it as a postoperative eye drops.

Methods

thirty two eyes of thirty patients (two patients had bilateral pterygium) with primary pterygia were clinically examined, classified into 3 groups and operated by simple excision with bare sclera technique. Group 1 included 10 patients received Bevacizumab (Avastin) in the form of eye drops (10 mg/ml) 3 times daily for 6 days postoperative. Group 2 included 10 patients received preoperative Bevacizumab in the form of subconjunctival injection (1.25 mg/0.05ml) single dose 1 week preoperative. Group 3 included 10 patients (12 eyes) 2 patients with bilateral Pterygium didn’t receive any form of Bevacizumab. Postoperative follow up was done clinically and by serial photography at 1 week, 1 month, 3 months and 6 months searching for signs of recurrence and/or complications.

Results

The results showed different grades of recurrence in 18 eyes of 32.True recurrence was seen in 7 patients of 18 (1 patient in group 1, 2 in group 2 and 4 in group3).Recurrence grades in group 1and 2 who used the Bevacizumab (20%grade II, 50% grade III, and 30% grade IV). Recurrence could be predicted by 100% depending on fibrovascular tissue appearing in the surgical bed at 3 months postoperative (P value 0.038).Preoperative fleshy pterygium has high statistical significance in realation to recurrence(P value = 0.006).Patient’s sex, residence and occupation had no statistically significant value in the process of recurrence (P value > 0.05). Patients with recurrent Pterygia (in group 1&2) had statistically significant changes in the corneal K- readings at 3 months and 6 months.No significant difference in the limbal or central corneal thickness in the operated eye and the other eye (Pvalue > 0.05).

Conclusion

Bevacizumab (Avastin) is a well tolerated drug with multiple drug delivery methods.The eye drops give better results than the subconjunctival injection.Appearance of fibrovascular tissue in the surgical bed at 3 months predict the recurrence by 100%. Preoperative fleshy pterygia will mostly recur again whatever Bevacizumab form was used .The corneal thickness by anterior segment OCT has no role in prediction or detection of early pterygium recurrence.
Corneal Densitometry Changes after Epithelium-Off Corneal Collagen Crosslinking
Authors: Abbas Karim N , Sayed Raafat A. El , Mostafa Mouamen M
Published: October 2021

Background

Keratoconus is a progressive non-inflammatory, degenerative disease that affects the integrity of the collagen matrix within the corneal stroma. Corneal cross-linking (CXL) has been described as the only modality in halting the disease progression over the past decade.

Aim of the Work

To compare the change in corneal densitometry before and 6 months after CXL using our unique protocol.

Patients and Methods

A prospective observational study was conducted on 30 eyes of 30 patients with progressive keratoconus. Epitheliumoff CXL was done with application of Riboflavin (VibeX RapidTM) for 6 minutes at a rate of 1 drop/ minute. UVA was delivered using the Avedro KXL machine (Avedro, Waltham, MA, USA) using the following parameters: 7.2 joules, 12 milli watt/ minute and 10 minutes of accelerated continuous UV delivery.

Results

Within the anterior (120 um) stromal layer, the concentric zones (0 to 2 mm) and (2 to 6 mm) showed a significant elevation of mean densitometry 6 months post-surgery (P = 0.020) and (P = 0.023) respectively compared to the baseline, However the concentric zones (6 to 10 mm) and (10 to 12 mm) showed a non-significant elevation of mean densitometry 6 months post-surgery (P = 0.167) and (P = 0.234) respectively compared to the baseline.

Conclusion

There is a significant increase in corneal densitometry 6 months postsurgery of the anterior stromal layer within the central 6 mm zone.
Evaluation of Fusion and Stereopsis in Anisometropic Patients
Authors: Ahmed Rana Mohamed , Noah Hazem Hosny , Zawahry Walid Mohamed El , Ismail Ahmed Taha
Published: October 2021

Background

Binocular vision has many important advantages on monocular vision as it helps in determination of the distance of an object, gives much greater depth of perception, and the ability to have stereopsis and view the world in three dimension (3D). There is an evidence that binocular vision is present in many patients with anisometropia even who have amblyopia but with grades lower than normal.

Purpose

This study evaluates the effect of anisometropia on BSV functions.

Method

sixty-four patients above 6 years with anisometropia equal to or more than 2.5D never had their vision corrected either by glasses or refractive surgeries or went on patching treatment, Anisometropic patients were devided into two groups amblyopic group (AA) and non-amblyopic group (NA) were examined for assessing their fusion by Worth four dot test and their stereopsis by fly test (Titmus stereo acuity test) by their best corrective glasses based on their cycloplegic refraction.

Results

Anisomyopes shows better stereopsis 62% of them and better fusion 65% of them than anisohypropes which had only 8% with good stereopsis and 32% with good fusion. However, antimetropes showed bad fusion and stereopsis as all of the five cases have amblyopia. Only 29.5% of anisomyopes have amblyopia but 68% of anisohypropes have amblyopia. As regard worth four dot test (P < 0.001), as 90.6% of cases with amblyopia had suppressed eye but only 9.4 % of this amblyopic cases had normal fusion. However, in patients without amblyopia 15.6% had suppressed eyes but 84.4% had normal fusion. As regard Titmus test there was statistically significant difference between both groups (P < 0.001), as 100 % of cases with amblyopia had bad stereo acuity but 28.1% of patients without amblyopia had defect in their stereo acuity.

Conclusion

Fusion and stereopsis as binocular single vision functions were significantly affected in AA patients with best-corrected anisometropic glasses than in NA patients.
Comparison between different techniques for management of renal stones in horseshoe kidneys
Authors: Aggour Abdel Fattah Mohammed , Tolba Mohamed Kotb Ahmed , hatata Abdelrahman nazmy abbas
Published: October 2021

Objective

To report the operative management , intra and post operative complications and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidneys.

Materials and Methods

We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 20-year period. The stone burden, surgical management, complications and stone clearance rates were recorded.

Results

In all, 80 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 28 patients. 12 patients had laparoscopic assisted PCNL , 8 had flexible ureteroscopy and 18 had laparoscopic pyelolithotomy . PCNL was used for large stones = (mean digitized surface area= 614.32 mm 2 ) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures. only 33% of patients treated with flexible ureteroscopy was cleared from stones in one session and surprisingly, 89% of patients treated with laparoscopic pyelolithotomy was stone free after one session Complications were minimal, with 15% minor and 3% major complications in the PCNL group only..

Conclusions

Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.
Short-term surgical outcomes after Monopolar- versus Bipolar Transurethral Resection of the Prostate
Authors: Ramadan Ahmed , shoeb mohammed , Shabayek Mohamed
Published: October 2021

Background

Transurethral resection of prostate (TURP) is currently the gold standard for surgical treatment of benign prostatic hyperplasia (BPH), as this procedure results in the best improvement in symptoms and urine flow rate (1).

Aim of the Work

to compare between the two techniques used for transurethral resection of the prostate; Monopolar versus Bipolar resection as regards short term surgical outcomes, perioperative complications and early changes in quality of life..

Patients and Methods

Randomized controlled study with simple randomization (1:1) of 80 patients with BPH candidate for transurethral resection of the prostate, 40 patients underwent M-TURP, and other 40 patients underwent B-TURP, their age mean age of paients included in our study 57-61 years old, mean prostate size 68-71 gm.

Results

Comparing intra-operative data in monopolar and bipolar TURP groups, our study reported that there was statistically significant decrease in volume of irrigation and operative time in B-TURP group in comparison to M-TURP group. although intra-operative complications; bleeding, electrolytes disturbance, fever and LUTS were lower in BTURP group; however, did not reach statistically significant.

In M-TURP group ,there was statistically significance increase in change Hb, and time of post-oprative irrigation, IPSS in compared to B-TURP group. While in respect to PVR, time of catheterization and hospital stay, there was no statistically significant difference data among the two studied groups.

Conclusion

Bipolar TURP represents a promising endoscopic treatment for patients with BPH with decrease in volume of irrigation and reduced operative time, and less incidence of TUR syndrome, intraoperative bleeding, and postoperative complications .However, further investigations are needed with larger, preferably randomized multicentric controlled trials to confirm the results of this study in the future.
Evaluation of Galdakao-modified Valdivia Position in Combined Simultaneous Access to Upper and Lower Urinary Tract Pathologies
Authors: Abdelmotagely Yehia Hesham Mohamed Zaky , El Moneim Abu El Naga Mohamed Abd , Gad Hany Hamed , Maged Wael Ali
Published: October 2021

Background

Simultaneous retrograde and antegrade endoscopic combined intrarenal surgery in modified supine lithotomy positions offer significant progress in the endoscopic management of urolithiasis. The operative time has been significantly reduced.

Aim of the Work

To evaluate the Galdakao-modified Valdivia position in simultaneous handling of upper and lower urological pathologies in the same units.

Patients and Methods

The evaluation for the Galdakao-modified Valdivia position regarding the benefits in different upper and lower urological diseases was the aim of our prospective randomized clinical trial that will started on April 2017 and ended by April 2019.

Results

The study has included 60 patients comprising males and females.

Conclusion

We believe that GMSV provided a great versatility in the treatment for urolithiasis along the whole urinary tract, ante-retrograde access, treatment of uretero-ileal strictures in patients with urinary diversions or neobladders, missed double j stent, bilharizoma of the ureter and bladder mass involving the ureteric orifice. Also, the advantage provided by this approach to the surgeon, patient and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis.
A Study of Iron Status in Pediatric Patients with large complex Vascular Malfomations
Authors: Ellaboudy Mohamed Abdel-Mohsen , Ragab Iman A , Abo-Zeid Amr Abdel Hamid , Ali Heba G.A , Ahmed AliaaMourad
Published: October 2021

Background

Complex vascular malformations involving the gastrointestinal tract (GIT) are expected to develop iron deficiency.However, the haemoglobin and iron status of vascular anomalies unrelated to GIT were not addressed.

Our aim

was to study the frequency of anemia and iron status among pediatric patients with large/complex vascular malformations without evident bleeding and to correlate the findings with the type, site, severity and extension of vascular malformationand treatment with sirolimus.

Patients and method

A case control study of participants with large complex vascular malformationregistered at Ain Shams University vascular anomalies clinic during the period from June 2019 to June 2020.They were compared to 20 age, sex and socioeconomic standard matched healthy controls. Clinical and laboratory studies for iron status were performed.

Results

fifty percentof patients were anemic versus 65% of the control group (p value = 0.33).As regards iron status of patients, 35% has combined iron deficiency versus 40% of controls, 20% has functional iron deficiency versus 20% of controls, 5% has absolute iron deficiency versus 10% of controls (p value = 0.90). There was no significant difference between patients receivingsirolimus and who are not as regards anemia and iron status (p value = 0.36, 0.84, respectively).

Conclusion

The frequency of anemia and it s iron related classification are comparable in children with large vascular malformations with no bleeding manifestations to normal children.
Estimation of Intestinal Fatty Acid Binding Protein Level as a Marker of Gut Failure in Critically ILL Pediatric Patients
Authors: Ibrahim Hanan M , Hermina Christina E , Magdy Sondos M
Published: October 2021

Background

Sepsis is a life-threatening condition and frequently associated with gut failure manifestations. Gut failure was defined as a rapid reduction of smallbowel enterocytic function. Gut barrier function has been studied using serum IFABP level as a marker of functional enterocytic mass.

Objective

To estimate the serum IFABP level in septic pediatric cases associated with gut failure.

Patients and Methods

This cross-sectional study was conducted on 40 Egyptian children admitted to Pediatric Intensive Care Units (PICUs) of Ain Shams University Hospitals. Serum IFABP level was measured in plasma using enzyme-linked immunosorbent assay (ELISA). All critically ill septic patients diagnosed with acute gut failure admitted in the period from 1/4/2018 to 1/5/2019 were subjected to serum IFABP level measurement at the first and the tenth day of diagnosis.

Results

The serum IFABP median levels on day one and day ten were higher in patients group (5.08 µmol/ml - 9.34 µmol/ml) than control group (0 1.7 µmol/ml – 1.7 µmol/ml) with p value 0.014, 0.020 respectively. Also it was higher in survivors group (17.78 µmol/ml) than non survivors group (3.39µmol/ml) with p value 0.047. SOFA score was lower in survivors (5) than non survivors (8) with p value 0.020.

Conclusion

IFABP serum level can be a promising marker to detect early intestinal wall and enterocyte damage, taking into consideration time of sampling and inotropes administration.
Unfractionated Heparin (UFH) For Prevention of Central Venous Catheter Thrombotic Complications in Children: A systematic review and meta-analysis
Authors: Nasef Marwa W , El-gaffary Maha M , Mansour Mervet G , Abd El Aty Esraa S
Published: October 2021

Objective

To determine the efficacy of unfractionated heparin in reducing central venous catheter-related deep venous thrombosis and/or catheter thrombotic occlusion in children by systematically searching the literature and conducting a meta-analysis study.

Methods

Four electronic databases (PubMed, Google Scholar, Elsevier’s thrombosis journal, and the Cochrane Central Register for Controlled Trials) were searched for journal peer-reviewed articles published in the period from Jan 2000 to Dec 2018. The search criteria included observational studies, and randomized controlled trials on patients aged 0–18 years with central venous catheters (CVC), which compare between the effect of UFH (flushes, lock solutions, continuous infusion, and heparin bonded catheter) and no prophylaxis (Normal saline flush or no treatment) for the prevention of CVC thrombotic complications (CVC-related deep venous thrombosis (DVT) and/or catheter thrombotic occlusion). Two authors independently reviewed and identified the eligible studies, which were assessed for study methodology including bias, and extraction of unadjusted data whenever available. To pool data from eligible studies, the meta-analysis was performed on RevMan version 5.3. Odds ratios were generated with the corresponding 95% CI through the random-effect model.

Results

Of the 413 articles identified, only eight studies were eligible with 1380 patients. Our results revealed that UFH was significantly superior on control group in reducing thrombotic occlusion and/or CVC-related DVT (odds ratio 0.39, 95% CI: 0.19:0.8) (p 0.01).

Conclusion

The published data support the hypothesis that using UFH as a thromboprophylaxis may significantly reduce catheter thrombotic complication in pediatric patients with CVC.
Efficacy of Intravenous Immunoglobulin Replacement Therapy in Patients with Predominantly Antibody Deficiency
Authors: Reda Shereen M , Ramzy Mourad A , Waheed El-din Hebat_Allah MM , Radwan Nesrine
Published: October 2021

Background

Intravenous immunoglobulin G (IVIG) has been used as an antibody replacement therapy in primary immunodeficiency (PID) for more than 50 years. Most routinely, IVIG is used in patients with predominantly antibody deficiency such as: X-linked Agammaglobulinemia, common variable immunodeficiency and combined immunodeficiency such as: severe combined immunodeficiency.

Aim

To evaluate the efficacy and safety of regular IVIG therapy among patients with predominantly antibody deficiency in terms of frequency of infection and adverse effects.

Methods

Thirty patients diagnosed with predominantly antibody deficiency were recruited from the Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University. These patients were followed up for one year in order to evaluate the frequency of infection and and adverse reactions of regular monthly IVIG therapy. The adequacy of IVIG dose was evaluated by the trough level of serum immunoglobulin G (IgG).

Results

Of the 30 patients, 21 (70%) were males and 9 (30%) were females. They had a median age of 87 months (range:15-294). Their median age at presentation and at diagnosis were 36 months (range :3-168) and 87 months (range:15-204) respectively. The mean ± SD of serum IgG before commencement of IVIG and after were 265.10 ± 108.39mg/dl and 572.04 ± 186.72 respectively. The rate of major infection dropped after starting replacement therapy with a median of 2 (1-2) before and 0 (0-1) after treatment. In spite of the reduction in the rate of pneumonia occurrence in patients with IgG trough level >500 mg/dl, it had no statistical significance. This could be attributable to small sample size. One patient developed anaphylaxis and was shifted to another brand.

Conclusion

IVIG is a safe and effective drug for patients with predominantly antibody deficiency. Compliance, adherence to therapy and appropriate dosage is needed to achieve better infection control.
Reliability of Plasma Von Willebrand Factor Antigen in Prediction of Oesophageal Varices in Pediatric and Adolescent Patients with Portal Hypertension
Authors: Eldin Lerine B , Abd Elaziz Asmaa W , Ragab Dina A , Abdelhady Karim A
Published: October 2021

Background

Ruptured oesophageal varices (OVs) is a major cause of mortality in Portal hypertension (PHT) patients, It has been a great issue of interest and research to screen and early detect OVs via oesophageal varices non-invasive methods.

Objective

The aim of this study was to assess the reliability of measuring plasma von willibrand factor antigen (VWF-Ag) for prediction of the occurrence of oesophageal varices in patients with portal hypertension.

Subjects & Methods

This was a prospective cross-sectional study, done on 47 children with portal hypertension. The children were recruited from Pediatrics Hepatology clinic, Ain Shams University.

Patient’s data was collected including age, sex, etiology and duration of PHT, along with medical treatment. Also an upper GIT endoscope, abdominal doppler ultrasound, and laboratory tests including measuring of plasma VWF-Ag were done to each patient. Then the children were divided based on their endoscopic findings into two groups; variceal group which included 37 patients, and a nonvariceal group which included 10 patients Results:

The results of our study revealed an elevated plasma VWF-Ag in patients with oesophageal varices, whilst normal levels of plasma VWF-Ag in the non-variceal patients. In addition, there was a direct positive correlation between increased plasma VWF-Ag and the degree of oesophageal varices.

Conclusion

Since the plasma VWF-Ag level correlates with the presence and degree of OVs, it can be used as a noninvasive indicator of the presence and degree of OVs, However, further studies using larger sample might be needed to support this.
Influence of physical limitation in children with juvenile idiopathic arthritis
Authors: Hossny Elham Mohammad , El-Hattab Amira Fouad , Raouf Batoul Mohamed Abdel , Hassan Mahmoud Ramadan
Published: October 2021

Background

Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Health-related quality of life (HRQOL) is an important outcome measure in understanding the impact of chronic illness.

Aim of the Work

We saught to measure the amplitude of physical disability in children with juvenile idiopathic arthritis in relation to HRQOL.

Patients and Methods

This analytical cross sectional study was conducted on children with JIA following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University in the period from May 2018 to May 2019 The sample included 119 patients who were enrolled consecutively by using The Pediatric Quality of Life Inventory TM Version 4.0 (PedsQLTM).

Results

Physical problem score showed negative correlation with age, age at onset (years) and disease duration (years). The older the child was and the longer the duration of the illness the more severe was his awareness of physicaical disability.

Conclusion

Juvenile idiopathic arthritis has a negative impact on physical abilities in child which influence their quality of life.
ASSOCIATION OF STAT6 GENE SINGLE NUCLEOTIDE POLYMORPHISM WITH FOOD ALLERGY
Authors: El-Sayed Zeinab Awad , Elhattab Amira Fouad , Alamin Mostafa Khaled
Published: October 2021

Background

Food allergy (FA) may be IgE-mediated, non-IgE-mediated or mixed. Genetic predispositions result in dysregulation of the immune system and lead to FA when exposed to environmental triggers. The transcription factor STAT6 is activated by IL-4 and IL-13 and activates cytokine signaling in immune and target tissue cells; contributing in the pathogenesis of allergic disorders including FA. The rs324015 single nucleotide polymorphism (SNP) in the STAT6 gene was previously associated with nut and cow’s milk allergy.

Objective

to investigate the association of the rs324015 STAT6 gene SNP with food allergy.

Patients and Methods

After ethical committee approval and informed consent from the patients, this retrospective case control study was conducted on 100 Egyptian children divided into two groups. Group I consisted of 50 children with positive history of FA supported by positive skin prick test +/- oral food challenge and group II consisted of 50 healthy age-matched controls. Blood samples were collected and genotyped using Taqman® Realtime PCR assays.

Results

We found that the homozygous G genotype and G allele of rs324015 were significantly higher among food allergic subjects than controls. We report no effect of any specific genotype on the phenotype of allergic disease or reacting to a specific food more than others. Genotypes were also not related to disease severity, eosinophil counts, total IgE levels or a family history of atopic disease.

Conclusion

rs324015 STAT6 gene SNP may be involved in the pathophysiology of food allergy.
Hair Zinc content and its relation to Serum Zinc level in children with Idiopathic Epilepsy
Authors: El Rashidy Omnia Fathy , Maksoud Mariam Fathy Abdel , Zaitoun Raghda Mohamed Hesham , Hafez Nermine Farag Mohamed Abdel
Published: October 2021

Objective

to measure the level of hair zinc, as well as its level in serum, in patients with epilepsy and compare them to the levels found in non-epileptic age and gender matched children, and to explore any potential correlation between either serum or hair level of magnesium and seizure characteristics in children with idiopathic epilepsy.

Methods

An observational cross-sectional study including 50 children with idiopathic epilepsy and 100 non-epileptic age and gender matched control subjects. Cases were subjected to full history taking, examination and measurements of serum and hair levels of zinc, control subjects only had their serum and hair level of zinc measured as for the cases.

Results

The mean serum zinc was 1.13 (0.61 - 1.69) ug/ml for cases and 1.81 (0.75 - 3) ug/ml for controls and the median hair level of zinc was 116.58 ug/g with IQR of 74.97 - 176.58 for cases and 143.64 ug/g with IQR of 95.22 - 178.28 for controls. Serum zinc level was significantly lower in cases compared to controls, but the difference was not statistically significant for hair zinc. No statistically significant correlation was observed between either hair or serum levels of zinc and seizure characteristics.

Conclusion

Serum zinc levels are reduced in epileptic patients compared to healthy age and gender matched controls. Hair zinc levels do not seem to be affected in idiopathic epilepsy. Studies involving larger numbers of patients are needed to confirm these results.
Recurrent Abdominal Pain in School Age Children
Authors: Saber Ahmed Mohammed Hamdy , Ibrahim Ahmed Tohamy Ahmed , Mahdy Ola Adel Abdellah
Published: October 2021

Background

Abdominal pain defined as any type of pain or discomfort that occurs in any area from the lower chest to the groin. Abdominal pain is symptom of a wide variety of mild to serious diseases, disorders, conditions. Abdominal pain can result from infection, malignancy, inflammation, obstruction and other abnormal processes.

Aim of the Work

To define the causes of recurrent abdominal pain among a sample of school age children.

Subjects and Methods

This cross sectional study was carried out to evaluate those children who presented to the Pediatric Outpatient Clinic, Children Hospital, Ain Shams University because of recurrent abdominal pain they were diagnosed in the pediatric Gastroenterology unit between June 2016 and July 2017. History taking included full analysis of abdominal pain, associated gastrointestinal symptoms and associated systemic manifestations. Examination included anthropometric measurements, general and local abdominal examination. Routine investigations included complete blood counts, urine analysis and culture, microscopic stool examination and pelviabdominal US. Other specific investigations were selected according to clinical manifestations to reach an organic cause. After reaching the definitive diagnosis, patients were classified into 2 groups organic causes and functional abdominal pain.

Results

During the study period, 100 children presented with recurrent abdominal pain. Results revealed that only 28% of the recurrent abdominal pain causes were attributed to organic factors; the most commonly encountered organic causes of recurrent abdominal pain were urinary tract infection (12%) while 72% of children presented with functional recurrent abdominal pain. The most common causes of function recurrent abdominal pain in our study was irritable bowel syndrome.

Conclusion

Most of the cases of RAP among school age children are due to functional abdominal pain (72%).
Study of the Outcome of Pediatric Patients with Aplastic Anemia treated with Immunosuppressive Therapy at Ain Shams University Pediatric Hospital
Authors: Mohamed W , Matboly S , Morcy N
Published: October 2021

Background

Aplastic anemia (AA) is life threatening disorder in pediatric age group with an increasing incidence nowadays. Hematopoietic stem cell transplant being the 1st line therapy; immunosuppressive therapy (IST) is the alternative therapy and is the most commonly used modality of treatment especially in the developing countries.

Aim of the Work

to assess the outcome of IST in children with severe and very severe AA.

Patients and Methods

Data for 23 children treated with IST from January 201 0 to January 201 9 (10 years) were retrieved from clinic records. IST included rabbit anti thymocyte globulin (ATG) along with cyclosporine A and another group were treated by sandimmune alone.

Results

Patient characteristics included median age (9) with 73.9% male and 26.1% female. With median interval between diagnosis and start of IST 2(1 -5) months and around 30.4% with hepatitis A associated aplastic anemia. Complete response, and no response were seen in 4 (50%) patients and 4(50%) patients, respectively in patients received ATG and sandimune. While in patients received sandimune alone complete response, partial response and no response were seen in 7(46.7%) patients, 5 (33.3%) patients, and 3 (20%) patients respectively. The median time to best response in the whole cohort was 2 months. There was no difference in outcome related to severity of AA, or higher Hb or platelet level. There was a significantly better rate of response in both groups of patients with higher initial TLC count (p = 0.001) initial ANC (p = 0.002), initial ALC (p = 0.001), and initial ARC (p = 0.014) before start of IST. An overall response rate in both groups around of 43.47% reported a 5-year OS. With 45.5 of patients with complete response had HAAA. A delayed time to complete response with prolonged requirement of cyclosporine therapy was detected in the study.

Conclusion

In a developing country setting, IST with ATG and cyclosporine seems to be an alternative treatment for children with aplastic anemia lacking MRD.
Retinal microvascular analysis using Fundus Fluorescein Angiography in Egyptian sickle cell disease patients
Authors: El Sherif Nayera H , Kenny Mahmoud A , Elhalfawy Waheed S
Published: October 2021

Background

Sickle cell disease can affect retina of eye via vaso-occulsive changes that occur in micro-vessels of retina which could be analysed by using Fundus Fluorescein Angiography.

Aim

To analyze macular microvascular alternation in patients with SCD by Fundus

Fluorescein Angiography (FFA) and to assess the role of potentially contributory Clinico-pathological factors including Trans-Cranial Doppler, genotypes, hydroxyurea, transfusion therapy and finally iron overload state on the development of macular alterations.

Method

This was across-sectional study which included 30 Sickle cell disease patients randomly recruited from the Paediatric Haematology clinic, children Hospital, Ain Shams University, Cairo, Egypt. Complete blood count (CBC), Trans-Cranial Doppler (TCD) and Fundus Fluorescein Angiography.

Results

In our study, there were 30 patients with mean age (14.1± 4.02), 5 patients had abnormal/conditional Trans-Cranial, 15 patients had Vaso-occlusive crises, 11 patients were on regular simple blood transfusion; all 30 studied sickle cell disease patients had normal Fundus Fluorescein Angiography and eye examination and only one patient hadabnormal visual acuity;A 29 years oldgirl who had five attacks of cerebral strokes last year, on regular simple blood transfusion and Hydroxyurea treatment with abnormal TCD and recurrent Vaso-occlusive crises in last two years, Although her vision is hand movement yet Fundus Fluorescein Angiography was normal.

Conclusion

we didn’t find any Retinal microvascular alternation in our studied SCD patients using Fundus Fluorescein Angiography, we related our results to the fact that our studied SCD patients were young and all our studied patients were on hydroxyurea therapy with fair compliance, further studies using large sample size are warranted in order to illustrate the utility of Fundus Fluorescein Angiography (FFA) as a tool for better detection of sickle retinopathy.
The Role of Bilateral Internal Iliac Artery Ligation in Minimizing Blood Loss Prior to Cesarean Hysterectomy Patients with Abnormally Invasive Placenta
Authors: Yousef Magdy Mohamed kamal , Rateb Ahmed Mohamed , Mohamed Ahmed Mohsen Hassan
Published: October 2021

Background

Abnormally invasive placenta (AIP) is a term that describes cases in which there is complete or partial failure of separation of the placenta from the uterine wall following delivery of the fetus.

Objective

to detect the role of bilateral internal iliac artery ligation in minimizing blood loss, prior to performing Cesarean Hysterectomy in cases with confirmed preoperative or intraoperative diagnosis of Abnormally invasive placenta.

Patients and Methods

The study was carried out at Ain shams university maternity hospital in 2019. Women were recruited from the labor ward who underwent CS Hysterectomy. The total number of pregnant women enrolled in the study was 95 women. Approval from the Medical Ethics Committee were obtained.

Results

Our study showed that internal iliac artery ligation in CS hysterectomy cases for AIP has non significant lower blood loss than cases who did not underwent internal iliac artery ligation. In stead, it had increased the operative time. In comparison of 45 patients underwent internal iliac artery ligation and 45 without ligation blood loss was non significantly lower in the group who underwent ligation with mean 1933 ml blood loss in comparison with 2117 ml in the group who did not.

Conclusion

Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.
Analysis of Cesarean section delivery in Ain Shams University hospital according to the Robson’s 10-group classification system
Authors: SALAMA MOHAMMED H , MOHAMMED AHMED M , NABHAN ASHRAF F
Published: October 2021

Background

Cesarean delivery is increasing worldwide in the last few years, unnecessary CS is a growing problem affecting both developed as well as developing countries. There is no benefits either to mother or neonate when the procedure is not medically indicated. The ideal rate of CS is considered between 10%-15%, beyond which there is no benefits for either mother or fetus. However recent studies showed a much higher rate of CS. WHO proposes that health care facilities use the Robson's 10 group classification system to monitor their CS rates. This classification helps to understand the internal structure of the CS rates at each health facilities, the indications in each group and formulate strategies to reduce these rates.

Objectives

the aim is to describe the frequency of CS delivery in Ain Shams University Maternity Hospital by Robson classification. And to describe maternal and neonatal outcomes.

Methods

The study was a descriptive cross sectional study conducted at labor ward of Ain Shams University Maternity Hospital (a tertiary care center). All women delivered by CS during a period of six months were recruited and classified into 10-Robson's groups. The overall CS rate were calculated, and also the contribution of each groups to the overall CS rate.

Results

The highest contribution to the overall CS was by group five 38.98%, followed by group ten 34.20%. While group 9 was lowest frequency 0.50% of overall CS rates.

Conclusion

s: The use of Robson’s classification system allows to monitor the CS rates which helps to identify the main contributors for the increasing CS rates, also helps to identify the target groups that may benefit from implementations of interventions for reducing CS rates. Women with previous CS were an important determinant of overall CS rates, reducing primary CS rates, counselling for VBAC, encouraging versions when available, could reduce the CS rates.
Effect of Intravenous Dexamethasone on the Duration of Labor Induction: A Randomized Controlled Trial
Authors: Nour El-Din Hashad Ahmed M , Yehia Amr H , Mohammed Amany A
Published: October 2021

Background

Induction of labor is one of the most common interventions practiced in modern obstetrics. In the developed World, the ability to induce labor has contributed to the reduction in maternal and perinatal mortality and morbidity.

Aim of the work

to establish whether Dexamethasone plays a role in shorting the duration interval between initiation of labor induction and beginning of true contraction of labor in post-term pregnancy, so shorting the duration of labor.

Patients and Methods

This randomized controlled trial study was conducted in the labor ward of Ain Shams University Maternity Hospital on one hundred thirty five pregnant women with full term pregnancy divided into the following: Group I (Dexamethasone group) injected with 2 ml (8 mg) of the product (dexamethasone) 4 hours before initiation of labor induction and Group II (Control group) received 2 ml saline (as a placebo).

Results

There was a non-significant statistical difference between the two studied groups as regards the age, gestational age on admission, body mass index (BMI), Bishop Score, mode of delivery and Apgar score. There was a high significant statistical difference between the two studied groups as regards Induction- delivery interval, induction-contraction, contraction – delivery interval were shorter in cases of study than control.

Conclusion

From the above data we can conclude that the intravenous administration of dexamethasone appear to shorten labor duration.