bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Platelets Rich Plasma (PRP) on the Outcome of Zone II Flexor Tendon Repair and Proximal Interphalangeal Joint (PIPJ) Range of Motion
Authors: Gamal Ayman , Magdy Amr , Mahmoud Neven , El Sherif Ahmad F , Gad Ahmed M
Published: October 2021

Background

Flexor tendon injuries are a commonly occurring injury presenting to hand surgeons. Using PRP to augment tendon healing has been advocated only recently. Few studies discussed the effect of injection of PRP in tendon healing after tendon repair in large joints as regard functional outcome and range of motion (e.g. Achilles tendon and rotator cuff)

Objective

To study the effect of combination of PRP injection with physiotherapy on gliding and range of motion improvement after zone II flexor tendon repair.

Patients and Methods

prospective interventional controlled clinical study preformed on 40 patients with zone II flexor tendon injury. Patients were divided into two groups, group I (interventional group) PRP was injected around the tendon at the site of repair after one and six weeks of repair and patients received physiotherapy according to our unit protocol. In group II (control group) patients received physiotherapy only. Both groups were evaluated at six and twelve weeks regarding the range of motion according to Buck-Gramko II criteria.

Results

Based on the Buck-Gramcko II criteria, the overall results ranged between fair and good in both groups after six weeks of repair, the score ranged between 7-16 (mean= 11.5) in group I and 6-14 (mean= 10) in group II, There was no statistical difference between the two groups (P = 0.46).After 12 weeks of repair, the overall results ranged between good and excellent in both groups, the score ranged between 11-17 (mean= 14) in group I and 9-16 (mean=12.5) in group II. There was no statistical difference between the two groups (p = 0.207).

Conclusion

PRP injection had no statistical significant effect of on the gliding after flexor tendon repair at zone II.
Meta Analysis Study of Complications Following Repair of Mid Penile Hypospadius using Different Surgical Techniques
Authors: Hassan Ahmed Aly , Mahmoud Assist. Prof. Dr. Nada Abdel Sattar , Sabry Amira Hussein , Nashed Dina Samir Shalaby
Published: October 2021

Background

Hypospadias is one of the most common congenital defects affecting the external male genitalia. The incidence is 1 in 250 male newborns, although its incidence seems to be increasing. Hypospadias is defined as an insufficient development of the urethral fold and the ventral foreskin, with or without penile curvature. The urethral opening is located more proximally anywhere between the tip of the penis and the perineum.

Aim of the Work

The aim of this study is to determine the best surgical technique with the least complications for repair of mid-penile hypospadias.

Materials and Methods

This systematic review and meta-analysis was performed in accordance to the recommendations of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement. MOOSE is a reporting checklist for Authors, Editors, and Reviewers of Meta-analysis of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists.

Results

Fistula is less common after Preputial island flap technique. Fistula is more common with Modified koyanagi technique. Meatal stenosis is less common after Mathieu and Preputial island flap techniques. Meatal stenosis is more common after TIP technique. Wound Dehiscence is not common after lateral based flap and modified koyanagi and Onlay island flap techniques. Neourethral Stricture is not common after lateral based flap and Mathieu and Onlay island flap techniques.

Conclusion

The Mathieu and Preputial island flap techniques for mid-penile hypospadias reconstruction are associated with a significantly lower risk for postoperative urethral stricture and may be the preferred method for hypospadias. However, the clinical implications of the results can be discussed because the risk of stricture in all procedures was low. The implications for research are obvious because there had been no studies that provided firm guidelines on the best method for the operative intervention for hypospadias. Further trials are still needed to confirm our findings.
A Prospective Clinical Study of the Effect of Recombinant Human Growth Hormone in Wound Healing of Severely Burned Children
Authors: Mohamed Salah Nasser , Boghdady Nahed Samir , Estawrow Mina Agaiby , Mohamed Mariam Loutfy Ahmed
Published: October 2021

Background

A burn is a thermal injury caused by biological, chemical, electrical and physical agents with local and systemic repercussions. There are several ways of classifying burns: Classification by mechanism or cause, depth and extent of burn .

Objectives

The objective of this study was to determine the safety and efficacy of using recombinant human growth hormone (rhGH) in the treatment of pediatric burn victims and their probable effect on accelerating burn wound healing.

Patients and Methods

This study was an Interventional randomized controlled Double Blind Study in which Patients subdivided randomly into 2 groups: Group A received somatotropine hormone after their 3 days of resuscitation besides their conventional treatment during their stay in the Burn ICU. Group B received the conventional treatment only in the Burn ICU.

Results

The comparison between the GH group and the control group showed that that there was statistically significant difference found between the two studied groups regarding TBSA of burn at 3rd week. The mean TBSA in GH group was ( 9.06 ± 7.47 ) while in the control group (13.94 ± 11.96) with P value (0.041). There was highly statistically significant difference found between the two studied groups regarding Insulin like growth factor .the mean Insulin like growth factor in GH group was (16.48 ± 11.40) while in the control group(2.77 ± 0.64) with P value(0.000).

Conclusion

The use of recombinant Growth hormone with a dose of 0.2 mg/Kg SQ 2 days per week with 3 days time interval in pediatric burn patients after their primary resuscitation from the burn injury, shows a marvelous improvement concerning the total body surface area of burn(TBSA) as the patient received the growth hormone showed a decrease total body surface area of burn(TBSA) than the control group. This may be accounted for the faster wound healing and readiness for grafting .
Surgical Modalities of Repair of Intra Articular Fractures of Proximal Interphalangeal Joint: A Meta-analysis
Authors: Hussien Heba Diaaey , Sadek Eman Yahya , Reyad Associate Prof. Dr. Khaled Ahmed , Fayez Moaz Fathy Khalifa
Published: October 2021

Background

The proximal interphalangeal (PIP) joints of the fingers are extremely important for gripping things with hands, more specifically, what is called the ‘power grip’.

Aim of the Work

To compare the different modalities of repair of intra-articular fractures of PIP joint.

Materials and Method

A systematic review and meta-analysis were performed in accordance to the recommendations of the “Preferred Reporting Items for Systematic Reviews and MetaAnalyses” (PRISMA). PRISMA is reporting checklists for the authors, the editors, and the reviewers of Meta-analyses of the interventional and the observational studies. According to the International committee of medical journal association (ICJME), the reviewers must report their findings according to each of the items listed in those checklists.

Results

The results of this study includes the search results and data extraction results which includes summary characteristics and baseline characteristics of the included Studies, outcome measures and Complications of the included studies.

Conclusion

There is no consensus regarding the most effective technique for management of unstable PIPJ fractures. The extension block pinning, closed reduction and percutaneous pinning of the fracture fragments, dynamic distraction and external fixation, open reduction and internal fixation, and hemihamate reconstruction arthroplasty are safe and reliable and reduce the risk of iatrogenic damage when used to treat unstable dorsal fracture-dislocations of the PIP joint.
Usage of Dermal Substitutes for Hand Coverage and Reconstruction
Authors: Elbadawy Ahmed Mohamed Salah Eldin , ELmenoufy Tarek Salem , Tawfik Rghada El Sayed Talal , Sayed Sayed Tarek
Published: October 2021

Background

Hand coverage and reconstruction gives a challenge for plastic surgery. In this study we introduce a method for hand coverage and reconstruction by dermal substitutes which easy and simple to use.

Objectives

The aim of this study is to know the versatility of dermal substitutes in reconstruction & coverage of complex hand defects.

Patients and Methods

This was a cohort study conducted on 20 patients with hand tissue loss; to evaluate the versatility of dermal substitutes in reconstruction & coverage of complex hand defects. Patients attending El Helmeia armed forces hospital (plastic and reconstructive department) & Ain shams university hospital with follow up duration up to 6 months. All patients had clean wound & complex hand defects with exposed tendon and/or bone, Defects post trauma and after tumour excision and Post burn hypertrophic scars, keloid or contractures.

Results

We found that; the mean age of all patients was (23.5 ± 8.82) years. Regarding gender of the patients, the majority (80%) of patients were males; while (20%) were females. Regarding side of raw area; (55%) of patients had Rt-sided raw area, and (45%) had Lt-sided raw area. Regarding site of raw area; (20%) of patients had Finger-tip raw area, (20%) had Palm raw area, (10%) had Volar surface of little and ring raw area, (10%) had Volar surface of little finger raw area, (25%) had Dorsum raw area, (10%) had Dorsum of lateral 4 fingers raw area, while (5%) had Dorsum of middle finger raw area. Regarding Etiology of raw area; (70%) of raw areas caused by Trauma, (15%) caused after burn keloid removal, (10%) caused after burn contracture, and (5%) caused by donor site. Regarding Intervention data; (50%) of patients used Integra dermal substitute; and (50%) used Pelnac dermal substitute. Regarding follow up data; the average Time of removal was (3.65 ± 0.49) weeks, and the average Time for follow up was (3.25 ± 1.12) months. Comparative study between 20 hand tissue loss patients revealed; highly significant increase in Post-operative STSG satisfaction rate (70%); with highly significant statistical difference (p < 0.01), highly significant increase in Post-operative STSG good movement (80%); with highly significant statistical difference (p < 0.01).

Conclusion

The use of dermal substitutes cons gives an alternative reconstructive option for managing extended skin avulsion injuries of the upper extremity; it reduces postoperative immobilization, minimizes donor site morbidity and provides good functional and esthetic results in a single surgical procedure.
A Prospective comparative Study of Vermilion repair by Modified Vadvancement Vermilion Flap in Unilateral Cleft Lip Patients
Authors: Mabrouk Amr A , Alliethy Iman M , Al Mahmoudy Niveen F , El-sayed Yara S
Published: October 2021

Background

Oro-facial clefts include a range of congenital deformities most commonly presenting as cleft lip with or without cleft palate (CLP) or isolated cleft palate (CP). CLP is the second most common congenital birth defect in the U.S.

Aim of the Work

to assess modified v-advancement vermilion flap combined with Tennison technique for vermilion repair in unilateral cleft lip regarding aesthetic outcome in comparison with repair of cleft lip by Tennison technique.

Patients and methods

This study was conducted in plastic, maxillofacial and reconstructive surgery department in Ain Shams University between September 2019 to February 2020. It included 20 patients divided into two group; the first group consisted of 10 patients who underwent repair of cleft lip by Tennison technique and the second group consisted of 10 patients who underwent repair by Tennison technique combined with v- advancement vermilion flap. Both groups were assessed postoperatively by Asher-McDade et. al. scoring system.

Result

The study showed statistically significant difference between the two groups as regard the white lip length which was more symmetrical in cases repaired by Tennison technique combined with modified v-advancement vermillion flap (P = 0.01). The bulge and the deficiency in the lateral vermilion were decreased in the group treated by Tennison technique with modified v-advancement vermilion flap. However the difference was statistically insignificant (P = 0.66).

Conclusion

The choice of a technique for surgical correction of UCL should be based on an evidence that this technique has the best functional and aesthetic outcomes. The findings of this study support the view that these two methods of cleft lip repair have their own advantages and disadvantages. Tennison technique combined with vadvancement vermilion flap achieved less bulge in the vermilion with no statistically significant difference.
Role of High-Resolution Ultrasound in Detection and Assessment of Disease Activity in Rheumatoid Arthritis
Authors: Kassim Al Shaymaa Ahmed Mohamed , Aziz Mohamed Abdel , Soliman Ahmed Hassan
Published: October 2021

Background

Ultrasound imaging is currently a well-known, now frequently used method in the diagnosis of Rheumatoid arthritis. In recent years, it has become an essential supplement of physical examination in Rheumatologist practice. B-mode US & PDUS are very sensitive in detecting synovial hypertrophy, joint effusion, activity, tenosynovitis and any early bony erosions.

Aim of the Work

to demonstrate the role of Ultrasonography and Power Doppler in proper detection of activity of rheumatoid arthritis in the wrist and small hands joints among different aged population, compared with the laboratory results.

Patients and Methods

A prospective study was conducted on 40 patients (35 females & 5 males). They were referred from the Rheumatology Department to Ultrasound Unit at Ain Shams University hospitals for US examination of hand and wrist joints mainly.

Results

In our study, most of the 40 patients enrolled showed one or more of the B-mode or PDUS findings for Rheumatoid Arthritis or its activity. On adding the findings of US & PD to the clinical examination and laboratory protocol of Rheumatoid Arthritis, sensitivity and specificity for diagnosis of disease and disease activity raises.

Conclusion

Ultrasound and Power Doppler have additional value to clinical examination both in improving early detection of RA and defining true RA remission. B-mode US & PDUS are very sensitive in detecting synovial hypertrophy, joint effusion, activity, tenosynovitis and any early bony erosions.
Role of MRI in Screening of Non-Traumatic Pediatrics Hip Pain
Authors: Hafez Abeer Abd El Maksoud , Hameda Tarek Wahby , Attia Ghadier Ibrahim
Published: October 2021

Background

Magnetic resonance is the best imaging modality to assess hip joint in non-traumatic cases. It has a great ability to diagnose disorders of bone, cartilage, ligaments, muscles and soft tissue. MRI can also detect joint effusion and bone marrow edema. Aim of the Work: To assess the value of MRI as the imaging modality in children presenting with acute non-traumatic hip pain and its ability to assess the cause of the pain early without the use of another imaging modality.

Patients and Methods

A retrospective study was conducted on pediatric patients with non-traumatic hip pain, referred from the outpatient pediatric clinic, orthopedic clinic, Ain Shams University hospitals. The patients were investigated using magnetic resonance imaging (MRI) for detection the cause of non-traumatic hip pain.

Results

In this study we found that avascular necrosis is the commonest cause of non-traumatic hip pain followed by isolated hip effusion then synovitis. Other causes included perthes, septic arthritis, osteomyelitis, aneurysmal bone cyst, SCFE, PFFD and Osteomalacia. Magnetic resonance imaging doesn’t only demonstrate disorders of hip joint only; it also gives an accurate assessment of other extra-articular causes of referred hip pain.

Conclusion

Hip MRI is a practical, well accepted and accurate non-invasive imaging technique in children presenting with acute non-traumatic hip pain.
The Accuracy of High Resolution Ultrasound in the Diagnosis of TMJ Disc Displacement in Comparison With MRI
Authors: Youssef Hassan Mohamed Mohamed , Elia Remon Zaher , Ali Khaled Ahmed Mohamed
Published: October 2021

Background

The temporomandibular joint disorders (TMD) have been a major source of pathology. Being only second to chronic low back pain as a cause of pain and disability. MRI is currently considered the gold standard method for imaging of the TMJ. USG is a non-invasive, inexpensive procedure. And can provide a potential sensitive tool for diagnosis of anterior disc displacement.

Aim of the work

The aim of this study is to compare between the accuracy of ultrasound and MRI in diagnosis of TMJ disc displacement.

Patients and Methods

This study was carried out at the Radiology Department, Ain Shams University Hospitals. Twenty one patients with clinically suspected TMJ disc displacement underwent ultrasound (US) and MRI examination.

Results

The overall sensitivity of the US to diagnose disc displacement compared to MRI reached (94.7%), specificity (91.3%), Positive Predictive value (90.0%), Negative Predictive Value (95%) and accuracy (92.9%). The results indicated 1.8 mm was the most accurate cut-off distance between the articular capsule and the anterior surface of the mandibular condyle for diagnosis of MR positive disc displacement.
Role of ultrasonography in assessment of painful ankle
Authors: Nassef Mohamed Amin , Diasty Shaimaa El Metwaly El , Lamei Marina Sameh
Published: October 2021

Background

Ankle disorders are a relatively common pathological condition, and ankle injuries account for approximately 14% of sports-related orthopedic emergency visits. Various imaging modalities can be used to make a diagnosis in cases of ankle pain; however, ultrasound (US) has several benefits for the evaluation of ankle pain, especially in the tendons, ligaments, and nerves of the ankle.

Aim of the work

to assess the role of high resolution US as a valuable tool in the depiction of causes of ankle joint pain.

Patient & methods

our study is a cross sectional descriptive screening study including 25 patients with ankle joint pain (acute or chronic), post traumatic or not with no age or sex predilection.

Results

The study included 15 (60%) males and 10 (40%) females. Their age ranged from 10 to 60 years with a mean age of 33.84±13.31years.

Chronic ankle pain was the most common presenting symptom in 15 patients (60%) whereas 10 (40%) patients presented with acute ankle pain after trauma. The posterior ankle compartment was the most common affected compartment (24%) of cases. About 7 cases (28%) were presented by ankle swelling with or without pain.

Conclusion

In conclusion, MSK US is useful in detecting the underlying causes of ankle pain and still it has the potential to offer more valuable data if it is well mastered by the sonographers.
ROLE OF DIFFUSION WEIGHTED MRI IN ASSESSMENT OF BENIGN AND MALIGNANT HEPATIC FOCAL LESIONS IN ADULT AGE GROUP
Authors: Hanafy Hanan Mohammed , Ibrahim Ayman Mohammed , Nasser Haytham Mohamed , Elsayed Moataz Metwally
Published: October 2021

Purpose of this study is:

To evaluate the role of diffusion weighted magnetic resonance imaging in differentiation between malignant & benign hepatic focal lesions.

Methods

The study included 38 patients all of them were with hepatic focal lesions detected by ultrasound (between 20 and 85 years of age) referred from GIT and oncology departments. Each patient included in the study was subjected to full history taking, ultrasonography and conventional MRI sequences, post Gd- DTPA dynamic and Diffusion Weighted imaging as well as ADC value measurement. Technique was performed using a standard 1.5 Tesla unit (Ingenia, Philips).

Detailed MRI and laboratory investigations were done.

Results

The study showed significant results were obtained between ADC values of benign and malignant hepatic focal lesions (p < 0.001).

Conclusion

We concluded in this study according to the obtained results that DWI sequence together with quantitative ADC values should be used as an essential sequence to supplement the conventional MRI sequences for proper detection and characterization of hepatic focal lesions.
Evaluation of tendoAchilles Lesions by (MRI)
Authors: Elraouf Maha Mohamed Abd , Shalaby Mennatallah Hatem , Rabeai Mohamed AbdElaziz Yehia
Published: October 2021

Background: The AT is the largest tendon in the body; it plays an important role in the biomechanics of the lower extremity; despite its strength, the AT is also vulnerable to injury, due to its limited blood supply from musculotendinousa, also it withstands great forces, especially during sporting exercises and it's located superficially.

Aim of the Work: To evaluate the role of (MRI) in the diagnosis of AT disorders.

Patients and Methods:

Type of Study: retrospective and prospective studies.

Study Setting

The study was conducted in Radiology Department at Ain Shams University Hospitals.

Study Period

from march 2018 to march 2020.

Study Population

This study included 40 patients. The patients were referred from either the orthopedic, rheumatology outpatient clinics of Ain Shams hospitals or private clinics to radiology department in Ain Shams University.

Results

Full thickness tear (30.0%) and Tendenosis (30.0%) were the most frequently detected pathologies followed by partial thickness tear (27.5%) and bursitis ( 22.5%) with significant more risk in male gender and middle age ( >46 years). More than one pathology were found in the same MRI study and this led to development of degenerative theory, that consider almost ruptured AT develop on top of pathological one.

Conclusion

MRI is a gold standard and important diagnostic tool in the evaluation of AT lesions especially in chronic and complex cases, and who do not respond to conservative measures and provides precious information for surgical intervention in parallel with careful clinical examination. Full thickness tear and partial thickness tear may develop on top of pathological tendon.
Sono-Elastography in evaluation of the median nerve in carpal tunnel syndrome patients
Authors: Abdelraouf Maha Mohamed , Ahmed Amal Ibrahim , Elghitany Nouran Abdelrahman
Published: October 2021

Background

Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. It is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. The diagnosis of CTS is based on a combination of characteristic symptoms and electrophysiologic abnormalities. Electrodiagnostic testing (EDT) is uncomfortable for patients, time consuming and expensive.

Objective

To evaluate the role of greyscale and strain elastography ultrasound imaging in diagnosing patients with CTS and controls in comparison with nerve conductive studies.

Patients and Methods

Type of Study: Descriptive, prospective study. Study Setting: The study will be conducted at Ain Shams University Hospitals, Radiodiagnosis department. Study Period: 6 months. Study Population: Patients with carpal tunnel syndrome diagnosed clinically and underwent nerve conduction velocity study.

Results

In this study 7 wrists were diagnosed with mild CTS, 5 wrists demonstrated moderate CT, whereas only 3 wrists revealed severe CTS. The mean CSA would have increased if the number of cases with severe CTS had been higher. CSA of the median nerve has been reported to increase with the severity of entrapment. The cut off point of the average CSA to differentiate between cases and controls was found > 8 with sensitivity of 93.33%, specificity of 80% and area under curve (AUC) of 91.3% while the best cut off point for Elasto score was found > 1 with sensitivity of 86.6%, specificity of 80% and area under curve (AUC) of 93.3%.

Conclusion

We concluded that sonoelastography is a sensitive tool for prediction of CTS and it’s severity in correlation to NCV.
Detection of Central Pulmonary Embolism on Non-Contrast CT
Authors: Elia Remon Zaher , Hassan Hend Galal Eldeen Mohamed Ali , Samuel Remon Nader Nathan
Published: October 2021

Background

Pulmonary embolism (PE) is a common condition with considerable morbidity and mortality; it is more often diagnosed post-mortem by pathologists than in vivo by clinicians. Prompt and accurate diagnosis is difficult because PE may be clinically silent, the symptoms are vague and nonspecific, and in addition there is no definitive, non-invasive diagnostic test to establish its diagnosis.

Objectives

The aim of this study is to discuss the reliability and clinical effectiveness of the incidental detection of a PE on non-contrast CT which could be advantageous in the emergent context and also in patients with pre-existing renal disease or known allergies to contrast agents in a situation without viable alternative.

Patients and Methods

Results

In our study CTA was used as the method of choice in detection of central pulmonary embolism in highly suspected pulmonary embolism in twenty patients and we compared it with pre contrast scan to identify non contrast CT reliability in detection of central pulmonary embolism. Our study showed that non contrast CT chest have a good role in detection of central pulmonary embolism as hyper dense lumen sign.

Conclusion

Unenhanced MDCT is an alternative approach for the diagnosis of acute central PE when CTPA is inaccessible or contraindicated. In our study Non-contrast chest CT scans have good role in evaluation of PE through detection the hyper dense lumen sign that is a good indicator of acute pulmonary thromboembolism particularly in cases involving the central pulmonary arteries.
Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) in detection and characterization of neoplastic breast lesions
Authors: Elshaikh Yahya Eltaher , Ismail Mohsen Gomaa Hassan , Chalabi Nivine Abdel Moneim , Hussein Rasha Salah Eldin
Published: October 2021

Background

Breast cancer is a major health problem in women and early detection is of prime importance.

Objective

We aimed to evaluate the role of diffusion-weighted imaging with background body signal suppression (DWIBS) in detection of breast lesions and characterization of these detected lesions.

Patients and methods

40 female patients with suspicious 50 breast lesions detected by sonomammography, in addition to the routine protocol that includes T1Wi's, T2Wi's, STIR, DCE-MRI and DWI sequences (with ADC maps) all participants underwent DWIBS sequence (with ADC maps). The histopathology served as reference standard. First, we compared the detectability of breast lesions on DWIBS with that of the DWI. We then compared the ADCs of the malignant lesions (n = 35) to that of the benign lesions (n = 15) in both DWI and DWIBS.

Results

Thirty seven lesions were detected via DWIBS (detectability of 74.0%) which was less than that of DWI (detectability of 78.0%). In DWIBS, the mean ADC value of the malignant lesions (0.80 ± 0.27 × 10-3mm2/s) was significantly lower than that of the benign lesions (1.40 ± 0.41 × 10-3mm2/s). With a cut-off value of 1.3 × 10-3mm2/s for ADC, DWIBS achieved 85.7% sensitivity and 80% specificity for differentiating between benign and malignant lesions.

Conclusion

Although it showed lower detectability for breast lesions than DWI, our study suggests that DWIBS is superior to DWI in the characterization of malignant breast lesions.. Also based on ADC, DWIBS provides additional information that may further increase the specificity of breast lesion characterization.
The Role of Dynamic Ultrasound in the Assessment of the Pathological Changes of Acromioclavicular and Sternoclavicular Joints
Authors: Abdelhafiz Zeinab Yousif Ishag , Ali Khalid Ahmed Mohammed , Badraldeen Safaa Kamal Mohammed
Published: October 2021

Background

Sonography is a useful imaging tool for the examination of musculoskeletal pathology. There are many advantages to this technique, including easy accessibility, low cost, comparison with the asymptomatic limb, and patient comfort. Unlike other available modalities, dynamic assessment is readily performed using sonography. Furthermore, the use of Doppler technique allows assessment of vascularity, inflammation, and anatomical relationships of the structure in question to adjacent vessels.

Aim of Study

This study investigates the value of dynamic ultrasound in the evaluation of AC and SC joints abnormality in comparison with the asymptomatic limb.

Patients & Methods

This prospective study included fifty cases, thirty patients were clinically positive for shoulder pain. Twenty healthy persons examined as control group. The patients were referred from Rheumatology and Immunology Department of Ain Shams University.US evaluation was performed at the Radiology Department of Ain –Shams University Hospital in period from January to June2018, to characterizing the AC and SC joints, their pathogenesis and sequelae. Dynamic US examination was also performed in all the cases.

Results

This study included 30 patients. The most common presenting symptoms in the primary care were shoulder pain which present in all 30 patients. Appropriate history and physical examination coupled with correct radiographs usually lead to an accurate diagnosis, we add that dynamic US which served a role in directing the management plan in 18 patients, this further confirmed with a positive clinical examination, in contrast to the other 12 patients for whom there was negative clinical findings.

Conclusion

High-resolution US technology, coupled with good anatomical knowledge and proper technique, has become valuable in the assessment of ACJ pathology as can be a useful initial diagnostic modality in SCJ osteoarthritis. Using US as a first line investigative tool can eliminate the need for further more expensive investigation like CT/ MRI and serve as a guide for further imaging and management.
Effect of Sustained Virological Response with Direct Acting Antiviral Agents on Insulin Resistance in Patients with Chronic HCV Infection
Authors: Abdel-Aleem Mostafa Hamed , El-Folly Runia Fouad , Mahdy Maram Mohamed Maher , Aly Heba Hassan , El-Kassass Mohamed Mahmoud , Bahgat Mohamed Ahmed
Published: October 2021

Background

Infection with hepatitis C virus (HCV) is a major cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma worldwide. Liver disease is not the only problem caused by chronic HCV infection; many extra-hepatic complications such as insulin resistance (IR) can be associated with HCV infection as well.

Objective

To assess the effect of sustained virological response on insulin resistance in patients with chronic hepatitis C infection.

Patients and methods

This study was conducted in New Cairo Viral Hepatitis Treatment Center (NCVHTC), in the period between December 2017 and December 2018. The current study was conducted on 46 enrolled HCV patients with type 2 Diabetes Mellitus (T2DM). Fasting Insulin (FI) and fasting blood glucose (FBG) as well as lipid profile were assessed in all patients at three time points; before treatment, at the end of treatment (EOT) and 12 weeks after the EOT.

Results

Despite using 4 different DAA regimens, all patients achieved SVR regardless of the regimen used. As a measurement of IR, HOMA-IR was calculated at the three time points using FI & FBG, it was found that HOMA-IR decreased significantly at the EOT; however, when calculated at week 12 after EOT, the reduction of HOMA-IR was not significant compared to the baseline levels. on the other hand, total cholesterol & LDL increased at the EOT and continued to increase at 12 weeks after the EOT.

Conclusion

Improvements in IR and glycemic control were not statistically significant after achieving sustained virologic response (SVR) with DAAs in patients with chronic HCV infection. Changes in the lipid profile such as an increase in the levels of total cholesterol and LDL can be expected after treatment with DAAs.
The Use of Crosslinks with Posterior Pedicular Screw Fixation in Lumbar Spondylolisthesis
Authors: El Huseiny Hossam , El-Narsh Ahmed , El-Shehaby Amr , Hashim Sherif , Mohasseb Mohamed M
Published: October 2021

Background

Pedicle screw instrumentation has gained wide popularity for stabilization of spinal fusions. The use of pedicle screw fixation has increased fusion rates. The placement of segmental pedicle screws and cross-links in short segment posterior pedicle screw constructs has been shown to increase the construct stiffness in some planes.

Aim of the Work

to evaluate addition of crosslinks to posterior pedicular screw fixation as a modality for surgical management of lumbar spondylolisthesis.

Patients and Methods

This study included 50 patients with lumbar spondylolisthesis divided into two groups according to the surgical approach used in treatment. One group with Posterolateral fixation by transpedicular screws and rods and the other Group had cross-links added to the posterior construct.

Results

There was no significant difference in postoperative JOA score between both groups, while comparing mean of preoperative and postoperative JOA scores in each group showed a significant rise of the score in each group after surgery. There was no significant difference in the variables of postoperative sagittal alignment between both groups, while comparing mean of preoperative and postoperative sagittal alignment variables in each group revealed a significant reduction of the disc height percent in both groups, and in slip angle and lumbar lordosis angle in group B. Regarding postoperative rate and degree of improvement in the studied groups, there was no significant difference in the rate and degree of improvement between both groups.

Conclusion

no appreciable benefit from using cross-links was found in short-segment fixation of lumbar spondylolisthesis, where there’s no or little torsional instability encountered.
Retinal Nerve Fibre Layer Assessment in Glaucoma and Glaucoma Suspect by Optical Coherence Tomography (OCT)
Authors: El-Dabae Ahmed Mohamed , Omar Rashed Mohamed , Zaky Mohamed Abd El-Hakim , Ebeid Weam Mohamed Ahmed
Published: October 2021

Background

Glaucoma is a progressive optic neuropathy characterized by structural changes in the optic nerve head, retinal nerve fiber layer (RNFL) defect, and accompanying visual field damage (VFD). In glaucoma management, detecting progression is essential in both early and late stages of the disease. In patients with an established diagnosis of glaucoma, evidence of progression will influence a clinician’s decision whether to modify glaucoma therapy. In patients who are suspected of having the disease, progression detection can confirm the diagnosis, and help decide how to manage the patient. Although standard automated perimetry has been the most commonly used test to monitor glaucomatous progression, evidence suggests that in some eyes substantial structural damage can be detected before the development of clinically detectable VFD.

Objective

To compare retinal nerve fibre layer thickness between glaucoma and glaucoma suspects.

Methods

We conducted our cross sectional comparative study on Forty eight eyes from patients recruited from Ain Shams University Hospitals, Ophthalmology Department during the period from February 2019 to December 2019. The Forty eight eyes were recruited in this study and divided into 2 groups. Group A- (Twenty-four eyes with moderate open angle glaucoma) and Group B- (Twenty four eyes with criteria of glaucoma suspects).

Results

There was highly Significant difference as regards OCT parameters of the patients (p < 0.001 for all). As the mean value of Cup/disc ratio was lower in Glaucoma Suspected cases, while Total RNFL, RNFL Superior and RNFL Inferior was higher in Glaucoma Suspected cases than patients with Moderate glaucoma. This study showed that; by using ROC-curve analysis, cup to disc ratio (CDR) at a cutoff point (>0.59) detected patients with glaucoma, with excellent accuracy, sensitivity= 95% and specificity= 100%. Also, by using ROC-curve analysis, superior RNFL at a cutoff point (≤116) detected patients with glaucoma, with fair accuracy, sensitivity= 66% and specificity= 91%. While inferior RNFL at a cutoff point (≤113) detected patients with glaucoma, with good accuracy, sensitivity= 70% and specificity= 95%.

Conclusion

In conclusion, structural progression measured using SD OCT was associated with functional progression shown in VF loss in glaucoma suspect or preperimetric glaucoma eyes and in glaucomatous eyes. Average, inferior and superior RNFL attenuations were the most important risk factors for visual field progression.
Corneal epithelial mapping in different corneal conditions
Authors: El-Hennawi Fatma , Rashed Hazem , Fawzy Reham , Selim Kholoud
Published: October 2021

Background

Cataract surgery is traumatic to the corneal epithelium,scarring and opacity is the commonest cause of blindness.

Objective

To study the corneal epithelial thickness in different corneal conditions using anterior segment optical coherence tomography (AS-OCT).

Patients and Methods

A case-control study including 80 eyes divided equally into 4 groups; group 1:controls,group 2:corneal scarring ,group 3:cataract patients and group 4:pterygium. using AS-OCT epithelial mapping to document changes in epithelial thickness in controls, cataract patients pre and 1 month after phacoemulsification, patients with corneal scarring and patients with pterygium.

Results

In phacoemulsification group; we found that epithelial thickness became thinner in area (0_2) and thicker in area (7_9) mm in the map with no significant change in areas (2_5),(5_7) mm in the map. In corneal scarring group; we found that epithelial thickness became thicker compared to control group in all zones. In pterygium group; we found that epithelial thickness became thicker compared to control group in, areas (2_5), (5_7) & (7_9) mm in the map with no significant change in area (0_2) mm in the map.

Conclusion

The corneal epithelium thickness becomes thinner or thicker to compensate for changes in stromal thickness.
Efficacy of posterior sub-Tenon’s capsule injection compared to intravitreal injection of triamcinolone acetonide for treatment of diabetic macular edema: A systematic review and meta-analysis
Authors: Ibrahim Mohamed H , Salman Abdelrahman G , Said Azza M , Al-Feky Mariam A , Moustafa Moustafa E
Published: October 2021

Background

Diabetic macular edema (DME) is defined as a retinal thickening in one-disc diameter (DD) of the centre of the macula. It is a number of microvascular retinal changes that lead to blood–retinal barrier (BRB) disruption, causing leakage of fluid and plasma components into the inner and outer plexiform layers.

Aim of the Work

to conduct a systematic review and a meta-analysis estimating the efficacy and complications of posterior sub-Tenon’s capsule injection of triamcinolone acetonide (STTA) compared to intravitreal injection of triamcinolone acetonide (IVTA) for management of DME.

Materials and Methods

A comprehensive literature search was conducted using the databases Google scholar, PubMed, MEDS, web of science, EMBASE and Cochrane Library for published studies from 1 January 2000 to 1 September 2019.This meta-analysis included ten studies. They were randomized controlled clinical trials (RCTs), and about 343 patients with DME (469 eyes) participated in these studies.

Results

: This study demonstrated a statistically significant change in the mean of best corrected visual acuity (BCVA) improvement and central macular thickness (CMT) reduction in both groups when comparing the baseline to one- and three-month follow-ups after the injection, though with no statistically significant difference in the IVTA compared to the STTA group. At a six-month follow-up, both groups showed no significant differences in the BCVA and CMT compared to the baseline. Both groups showed no statistical differences in the BCVA or CMT over the follow-up periods. Regarding intraocular pressure (IOP) changes, the present study showed that the mean IOP was elevated in both groups at one- and three-month follow-ups after the injection compared to their baseline. There was a statistically significant difference between both groups at one and three-months. The IOP was more elevated in the IVTA compared to the STTA group. At a six-month follow-up, both groups showed no significant difference in the IOP elevation compared to the baseline. IOP elevation was the most reported adverse effect in all included studies. Cataract formation is also reported in some studies, though no other complications, such as endophthalmitis, vitreous hemorrhage (VH), and/or retinal detachment (RD), are reported in any of the studies.

Conclusion

: STTA injection has a comparable effect to the IVTA injection and carries a lower risk of intraocular complications. It is considered an easy, safe, and valid alternative to the intravitreal injection for the treatment of DME.
Prevalence of Diabetic Retinopathy among Type Two Diabetic Patients in Arab Countries
Authors: Awad El-Hariri Mona Mohsen Mahmoud , Al-Ebiary Hany Hasan , Elewa Lamia Salah , Moustafa Moustafa El-Husienni
Published: October 2021

Background

Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycaemia. Diabetes causes many complications like diabetic retinopathy (DR) which affects up to 80 percent of all patients who have diabetes for more than 10 years or more.

Objectives

To estimate the prevalence rate of diabetic retinopathy among type 2 diabetic (T2D) patients in some Arab countries and to compare the difference in the prevalence rate according to different patient’s characteristics.

Patients and Methods

In recent years, several studies have indicated occurrence of peripapillary retinal nerve fiber layer (RNFL) thinning in the retina of diabetic patient. We reviewed the full articles of the extracted 17 different studies across 10 Arab countries that were captured through our search strategy. Through 25 years (1991– 2016), most of the studies re-ported were carried, we captured 17 studies through our systematic search.

Results

The prevalence rate of diabetic retinopathy among type 2 females is 19.848%. The prevalence rate of diabetic retinopathy among type 2 males is 18.559%. Prevalence of Diabetic Retinopathy in those with up - 5 years duration of the disease is 7.597%. Prevalence of Diabetic Retinopathy in those with 5-10 years duration of the disease is 24.418%. Prevalence of Diabetic Retinopathy in those with >10 years duration of the disease is 52.913%. Prevalence of Diabetic Retinopathy in those aged <45 years is 9.505%. Prevalence of Diabetic Retinopathy in those aged 45-55 years is 20.346 %. Prevalence of Diabetic Retinopathy in those aged >55 years is 25.297%.

Conclusion

We present the first systematic review and meta-analysis of DR among Arab patients with T2D in 10 different Arab countries. Although our search strategy was broad, we were only able to find few reports compared to the scale of the problem in the Arab countries; our meta-analysis revealed that the prevalence is high (22.543 %) with significant variations among different Arab countries, even within the same country.
Comparative Study between Generic versus Brand Latanoprost in treatment of Open Angle Glaucoma Patients
Authors: Mansour Noha Abo Amer Ibrahim , Shafik Mohammed Adel Abdel , Hamdi Momen Mahmoud , Shaat Ashraf Abdel Salam
Published: October 2021

Background

Glaucomas are a group of optic neuropathies characterized by progressive degeneration of retinal ganglion cells. Degeneration of these nerves results in cupping, a characteristic appearance of the optic disc and visual loss. Glaucoma can remain asymptomatic until it is severe, resulting in a high likelihood that the number of affected individuals is much higher than the number known to have it. Without adequate treatment glaucoma can progress to visual disability and eventual blindness which is irreversible. Many types of glaucoma are usually controlled with daily medical treatment consisting of eye drops lowering IOP. Some do this by reducing the amount of aqueous fluid the eye makes. Others reduce pressure by helping aqueous fluid flow better through the drainage angle. A generic medicine is defined as a product having the same qualitative and quantitative composition in active ingredients, as well as the same pharmaceutical form, as the reference medicine and whose bioequivalence has been shown by adequate bioavailability studies, also its low price makes it more affordable.

Aim of the Work

To evaluate intra ocular pressure control and compliance of the patient using a generic prostaglandins eye drops in comparison to a brand one in the management of glaucoma patients and its safety profile, to determine the value of the generic drug in glaucoma management.

Patients and Methods

This is a prospective interventional cross over study was done on 30 patients recruited from Glaucoma Clinic of National Eye Center, Rod El Farag from January 2019 to July 2019.

Results

The mean baseline IOP of both main groups on day 0 was 23.9 ± 3.3 mmHg at 9 AM, 23.6 ± 2.7 mmHg at 1 PM, 23.6 ± 2.3 mmHg at 6 PM before treatment with original or generic latanoprost (P = 1). Both treatments reduced the IOP from baseline (day 0 of each drug) at each time-point, and for the three diurnal IOP measurements at 3 months. Original latanoprost had a greater efficacy than generic latanoprost after 3 months, Original Latanoprost reduced the IOP after 3 months of treatment by -8.6 ± 0.84 mmHg at 9.00 AM, 7.4 ± 1.2 mmHg at 1.00 PM hours and -6.4 ± 1.8 mmHg at 6.00 PM, While Generic latanoprost reduced IOP after 3 months by -7.03 ± 0.95, -5.8 ± 1.1 and -4.9 ± 1.8 mmHg, respectively.

Conclusion

Original latanoprost has a tendency of better efficacy and tolerability with low incidence of conjunctival hyperaemia and ocular irritation compared with the generic latanoprost in management of open angle glaucoma patient.
Ocular Response Analyzer versus Goldmann Applanation Tonometer for Measurement of Intra-Ocular Pressure
Authors: Fayez Rim Raafat , Abdelshafik Mohamed Adel , Aboulenain Ahmed Ibrahim , Hamdi Momen Mahmoud
Published: October 2021

Background

Goldmann applanation tonometry (GAT) has been the gold standard for intraocular pressure(IOP) measurement ,since its appearance in clinical practice around 50 years ago.(1) In spite of being almost unchallenged, the last few years have become a sustained search for a new standard method for IOP measurement,. One such recently marketed instrument is the Ocular Response Analyzer (ORA), which able to detect the corneal biomechanics.

Aim of the Work

is to compare the IOP measurement estimated by Goldmann applanation tonometer to that of ORA and detect the effect of state of refraction, corneal topography and central corneal thickness (CCT) on these measurements.

Patients and Methods

This cross-sectional study was done from March 2018 to October 2018 on 65 eyes of patients visiting the outpatient clinic.

Results

The mean GAT IOP was 15.938 ± 6.041 while the mean ORA (IOPcc) and (IOPg) were 19.711 ± 7.59 and 17.242 ± 7.35 mm Hg respectively. There is a strong positive relationship between GAT IOP & ORA IOPg measurement (r = 0.880 – p = <0.001*). Also finding a weak yet significant correlation between IOPg and CCT (r = 0.385, p = 0.001). None of the pressure measurements was affected by refraction or corneal curvature significantly.

Conclusion

In conclusion, our results suggest that mean IOPs obtained by ORA were significantly higher than that of GAT with different influencing factors that are not completely understood. caution has to be sought when using the ORA, the values obtained ought not to be used interchangeably with the values obtained by

1 GAT, despite the presence of a positive correlation between these values. This underlines the importance of using one and only method of evaluation of the IOP for every patient in successive follow-up visits.