bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective Randomized Study Comparing the Outcomes of Single Anastomosis Sleeve Jejunal Bypass (SAS-J) with One Anastomosis Gastric Bypass (OAGB)
Authors: ElBanna Mohey Eldin Ragab , Abd-ElSamea Karim Sabry , Zaher Amr Sayed , Mohamed Ibrahim Essam Ibrahim
Published: November 2024

Background

One Anastomosis Gastric Bypass is one of the commonest bariatric surgeries worldwide, which has been demonstrated to produce excellent bariatric and metabolic outcomes. Single Anastomosis Sleeve Jejunal Bypass is a novel procedure that was developed in Hazrat e Rasool Hospital by Pazouki and Kermansavari in 2019 to form an anastomosis between the sleeved stomach and the jejunum rather than the ileum as a modification of the previously known SASI.

Objective

To compare the outcome of SASJ with OAGB as regards efficacy and safety in a 6- month postoperative follow up period.

Patients and Methods

This was a comparative prospective randomized study conducted in Ain Shams University Hospitals, over 40 patients devided into 2 groups. First group was composed of 20 patients who underwent SASJ operation, and second group was composed of 20 patients who underwent OAGB operation.

Results

The mean excess weight loss percentage after 6 months of SASJ group of patients was 51.55% ± 15.11, and 58.30% ± 24.32 in OAGB group. Both groups showed excellent outcomes as regards comorbidities resolution. In OAGB group, there was 1 patient who had postoperative bleeding. In SASJ group, we had one case of reflux alkaline gastritis that needed readmission. In addition, we had one case (5%) that needed reoperation and conversion to Roux-en Y configuration. In SASJ group, there were 7 patients complained from bile reflux, and 3 patients in OAGB group. In SASJ group of patients we had only 1 patient who developed postoperative gall bladder stones, and 6 patients in OAGB group.

Conclusion

Both OAGB and SASJ are effective bariatric procedures as regards weight loss and comorbidities resolution such as DM, HTN and hyperlipidemia. Incidence of biliary reflux was found more among the SASJ patients, but it was almost overcomed after performing the antireflux suture.
Comparison between Fibrin Glue vs Mechanical Mesh Fixation in Laparoscopic Inguinal Hernia Repair, A Prospective Study
Authors: Wakim Hany Rafik , Fawzi Fawzi Salah , Emad Moustafa M , Ali Mohammed Baraka Mahmoud AbdRabou
Published: November 2024

Background

Inguinal hernia repair is one of the most common surgical procedure in general surgery. The rate of occurrence of inguinal hernia is about 27– 43% in men and 3– 6% in women. An open or laparoscopic approach can be used. Mesh repair is recommended either by an open procedure or laparoscopic technique. There is no consensus on the best method to do inguinal hernia repair either open or laparoscopic.

Objective

To compare between glue vs mechanical mesh fixation in laparoscopic inguinal hernia repair as regard operative time, blood loss, hospital stay and short term complications.

Patients and Methods

This is a prospective comparative cohort study between fibrin glue versus mechanical mesh fixation in laparoscopic inguinal hernia repair. This study was conducted at (the General surgery department), Ain Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Between September 2022 and February 2023 with post-operative follow-up for maximum 6 months.

Results

There are many postoperative complications such seroma, numbness, wound infection and early recurrence. Early recurrence after open hernia repair which can occur in up to 63% of patients and affects quality of life in 5– 10% so there is increase in usage of the laparoscopic method to decrease the post-operative complication. Mesh fixation in laparoscopic inguinal hernia repair (LIHR) remains highly debated, being largely influenced by individual-surgeon preferences, the use of tackers or staples increase postoperative pain and associated with chronic and immediate postoperative pain and may risk neurovascular injury. Non-penetrative methods of mesh fixation using tissue glue have been used for LIHR, and been associated with improved postoperative complications and chronic pain.

Conclusion

The use fibrin glue in mesh fixation for laparoscopic inguinal hernia repair is a safe and viable option. It offers many advantages in terms of less fixation time, less seroma/hematoma rate and less wound infection. Whereas early recurrence and numbness was found to be similar in both groups.
Redo Nissen Fundoplication with and without Mesh to Re-Inforce Crural Repair: A Cohort Comparative Study
Authors: Omar Mohammed Mahfouz Mohamed , Abdelmenem Ayman Hossam Eldin , Abdelaziz Mohammed Hassan El Banna
Published: November 2024

Background

The incidence of hiatal hernias increases with age. Approximately 55%-60% of individuals over the age of 50 have a hiatal hernia. However, only about 9% have symptoms, and it depends on the type and competency of the lower esophageal sphincter. The vast majority of these hernias are type I sliding hiatal hernias. Type II, paraesophageal hernias, only make up about 5% of hiatal hernias where the LES remains stationary, but the stomach protrudes above the diaphragm. There is also an increased prevalence in women, which could be attributed to increased intraabdominal pressure during pregnancy. Hiatal hernias are most common in Western Europe and North America and are rare in rural Africa.

Aim of the Work

This prospective – retrospective study aims to compare the efficacy of redo laparoscopic Nissen fundoplication with and without mesh repair for treatment of recurrent hiatus hernia after failed primary repair, regarding improvement of recurrent GERD symptoms, sliding hernia recurrence, and postoperative patients’ satisfaction.

Patients and Methods

In our study, prospective - retrospective randomized study was conducted on 30 patients who underwent redo laparoscopic Nissen fundoplication for the treatment of recurrent hiatus hernia with at least 1-year follow-up. A total of 15 patients underwent redo laparoscopic Nissen fundoplication, whereas 15 patients underwent the same technique with mesh reinforcement.

Results

Significant differences in postoperative reflux-associated symptoms were observed in both groups than preoperatively, but with a significant higher score for dysphagia noticed in the group in which mesh has been used. Anatomical recurrence occurred in four (26%) patients in the group of repair with out mesh after 12 months with relatively higher regurgitation, heartburn scores. Overall, patient's satisfaction was higher in the mesh group

Conclusion

Mesh reinforcement is associated with less recurrence rate in comparison with redo laparoscopic Nissen fundoplication alone during the short-term follow-up, but it is associated with more incidence of postoperative dysphagia. Mesh reinforcement is specially recommended for large defects more than 6 cm.
Screening for Large Vessels Vasculitis in Patients with Acute Cerebrovascular ISCHEMIA
Authors: El-mnesy Abdel-Aziz Mohamed , Abogabal Mervat Mamdouh , Abdelmoneim Reem , Hassan Sameh Abdelmotelab , Khalil Nermeen Samy , Elsadek Ahmed Mohamed
Published: November 2024

Background

Systemic vasculitides are heterogeneous disabling diseases characterized by chronic inflammation of the blood vessels potentially leading to tissue destruction and organ failure, Giant cell arteritis (GCA) is a granulomatous subtype of vasculitis involving large and medium-size arteries, both cranial and extra-cranial, Imaging techniques, both morphological and metabolic, are required to confirm the diagnosis of large-vessel vasculitis, Arterial duplex is a moderately sensitive but highly specific test for exclusion of temporal arteritis.

Purpose

The purpose of this study is Screening of large vessels vasculitis in patients with cerebrovascular Ischemia by arterial transcranial and peripheral duplex.

Patient and Methods

100 patients with cerebrovascular ischemia were further categorized into 3 groups: Group A: Seventy-four (74 %) pt of acute cerebrovascular stroke diagnosed according to National Institutes of Health Stroke Scale, Group B: Twenty-one (21%) pt with TIA diagnosed according to National Institutes of Health Stroke Scale, Group C: Five (5%) pt with GCA diagnosed according to 2022 American College of Rheumatology/EULAR classification criteria for Giant cell arteritis.

Results

Screening for large vessels vasculitis in patients with cerebrovascular Ischemia we found that five patients (5%) had GCA 2% with ischemic stroke 3% with TIA.

Conclusion

Our study indicates a significantly increased risk of CVA among patients with GCA
Endoscopic Ultrasound versus Triphasic Computed Tomography for Detection of Hepatic Metastasis during Staging of Pancreaticobiliary and Upper Gastrointestinal Malignancies
Authors: Mohamed Farag Sherif Mounir , Ahmed Osama Ashraf , Aziz Tari Magdy , Bahloul Khella Mena Romany
Published: November 2024

Background

Endoscopic ultrasound (EUS) is a useful tool for detection of liver metastasis compared with Triphasic CT scan.

We aimed to assess the value of Endoscopic Ultrasound (EUS) in detection of missed hepatic focal lesions during staging of pancreatic and Upper GI malignancies.

Methods

we included 90 cases with pancreatic and upper GI malignancies, all patients were subjected to laboratory investigations and CT abdomen. EUS was done to all patients, During EUS examination the liver was examined thoroughly to detect hepatic focal lesions with possible EUS- FNA of any detected lesions.

Results

The mean age of the included patients in our study was 58.02 ± 11.9 years and the majority of the patients were males. In the present study, the most common type of tumors was pancreatic cancer. Triphasic CT detected 25 cases of metastatic hepatic focal lesions, while EUS detected 29 cases. EUS FNA was done for 4 small hepatic focal lesions, which were not detected by triphasic CT, and histopathological examination revealed them to be metastatic in nature. EUS yielded 100% sensitivity and 97.3% specificity in the detection of small-sized liver metastasis, compared with a 96.7% sensitivity and 93.8% specificity through triphasic CT.

Conclusion

EUS and EUS-FNA is a useful diagnostic modality for the detecting small-sized liver metastasis that may be missed by other methods during TMN staging of pancreatic and GI malignancy.
Serum Myostatin Predicts the Risk of Hepatocellular Carcinoma in Patients with Alcoholic Cirrhosis: A Multicenter Study
Authors: Bayoumi Essam Mohamed , Al-Sheikh Mazen Musa , Raafat Khaled Abdel Hamid , Okasha Mostafa Ahmed Ibrahim
Published: November 2024

Background

Sarcopenia, characterized by age-related muscle loss, is common in patients with liver cirrhosis (LC). LC's metabolic burdens include protein and energy metabolism disorders, potentially leading to secondary sarcopenia. This study explores the prognostic role of serum myostatin levels in predicting hepatocellular carcinoma (HCC) development in individuals with alcoholic liver cirrhosis (ALC).

Aim of the Work

The aim of this study is to investigate the prognostic performance of serum myostatin levels on HCC development in patients with alcoholic liver cirrhosis (ALC).

Patients and Methods

We conducted a retrospective observational study using stored serum samples from a single center. We analyzed serum myostatin levels and assessed their correlation with HCC development in ALC patients.

Results

Serum myostatin levels were significantly higher in patients with HCC compared to those without (p < 0.001). Our analysis revealed a significant correlation between baseline myostatin levels and various clinical parameters, including gender (p < 0.0001), serum albumin (p < 0.0001), prothrombin time (PT) (p = 0.0188), serum ammonia (p < 0.002), and Child Pugh score (p < 0.0001). Multivariate Cox analyses identified age, gender, body mass index (BMI), platelet counts, and serum myostatin levels as independent risk factors for HCC development (p < 0.001).

Conclusion

Elevated serum myostatin levels are associated with an increased risk of HCC development in ALC patients. Myostatin may play a role in hepatic fibrogenesis and carcinogenesis, making it a potential prognostic marker for HCC in this population. A serum myostatin level cutoff of 3.9 ng/ml exhibited high sensitivity (92.3%) and specificity (82.35%) for detecting HCC. These findings suggest that serum myostatin levels could serve as a valuable tool for identifying high-risk ALC patients who may benefit from closer monitoring for HCC development.
Procalcitonin Level in Systemic Lupus Erythematosus Patients and its Correlation with Disease Activity and Infection
Authors: Ahmed Fathi Radwa Ayman , Eldin Abdel Baky Mohamed Salah , Morad Caroline Samy , Mohammad Hawwash Amr Mohammad
Published: November 2024

Background

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease, characterized by a chronic autoimmune response to multiple autoantigens and involving multiple organs. With the development of medical technologies, the diagnosis and treatment of SLE have been significantly improved. So far, SLE treatment mainly relies on glucocorticoids and immuno- suppressive drugs. Thus, the SLE disease itself and the immunosuppressive therapy increase the risk of infection, multiple organ dysfunction syndrome, and multiple organ failure syndrome. Moreover, infection is considered as a common complication of SLE and one of the leading causes of death.

Aim of the Work

To evaluate the role of available biomarkers mainly procalcitonin (PCT) and C- reactive protein (CRP) to differentiate flare from infection in a febrile patient with SLE.

Patients and Methods

Patients age ranged between 18-50 years old from outpatient clinic and the inpatients of department of Rheumatology at Ain Shams University Hospital. Informed consent was taken from all subjects. Approvement by ethical committee of Ain Shams University was taken and included. All the patients were surely diagnosed with SLE and fulfilled the clinical criteria. Patients with other autoimmune diseases were excluded. Full history has been taken and thorough clinical examination was done including general and musculoskeletal system.

Results

Eighty patients (88.9%) of this study were females while 10 patients (11.1%) of them were males. Comparison between the study participants as regard clinical manifestations revealed that the most frequent SLE manifestations were 58.9% have arthritis, 51.1% have skin rash, 37.8% mucosal ulcers and 36.9% have nephritis. As regard laboratory data When we compared between active group and remission group as regard procalcitonin we found a statistically significant higher levels in active group of SLE patients. In the present study, there was a highly statistically significant difference between SLE patients with and without infection as regard procalcitonin. By comparing active SLE patients with and without infection, there was a statistically significant higher levels in infected group as regard N/L ratio and P/L ratio.

Conclusion

Although the serum PCL and CRP levels, and neutrophils to lymphocytes ratio rise with SLE disease activity, their levels are significantly higher when associated with infection, indicating that high levels of these inflammatory markers could be used in differentiation between infection and disease activity in SLE patients.
Role of Maternal Serum Fibroblast Growth Factor 21 Level in Prediction of Preeclampsia
Authors: Atef Karim El-din Alaa Mohamed , Kolib Magdy Hassan , Abdel-Rahman Bakhat Gehad Sayed , Yehia Amr Helmy
Published: November 2024

Background

Pregnancy complications resulting from hypertensive disorders are a serious problem that impact 2-10% of all pregnancies globally. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation which may be associated with other maternal organ dysfunction, such as liver or renal insufficiency, hematological or neurological complications, uteroplacental dysfunction and fetal growth restriction.

Aim of the Work

To establish the relationship between maternal serum fibroblast growth factor 21 levels and preeclampsia as a predictor for preeclampsia.

Patients and Methods

This was a Nested case-control study that was conducted on 90 primigravidas at Ain Shams University maternity hospital from April 2021 to April 2022.

Results

our study showed that there was a significant difference in FGF21 levels between the groups, patients with preeclampsia having higher levels than controls, 15.9% of patients with preeclampsia experienced maternal complications compared to none in the control group. Meanwhile, 18.2% of patients with preeclampsia experienced fetal complications compared to 0% in the control group.

Conclusion

Serum FGF-21 levels are significantly higher in preeclamptic pregnant women compared to healthy normotensive pregnant women. So, it can be used as a predictor for preclampsia and maternal complications
Circulating Maternal Serum Cell Free Fetal DNA Levels for Prediction of Preeclampsia
Authors: Mohamed Ibrahim Mohamed El Mandouh , Bahaa El Din Ahmed Mohamed , Mohamed Nassar Salma Ashraf , Mohamed Helmy Mohamed Mahmoud
Published: November 2024

Objective

To measure the maternal serum cell free fetal DNA and establish the relationship between maternal serum cell free fetal DNA levels and preeclampsia (PE).

Study Design

A nested case-control study was conducted on 30 patients with PE and 30 matched controls aged (18-40 years) attending Ain Shams university maternity hospital, with single viable fetus beyond 20 weeks gestational age. Blood samples were withdrawn upon enrollment; then measuring the cell free fetal DNA was done upon identification of cases and matched controls.

Results

The study showed that there was a significant difference in CFFDNA level between the studied groups, with patients with preeclampsia having higher levels than controls. Also, the maternal serum CFFDNA level can accurately predict preeclampsia, with area under the curve 0.979.

Conclusion

Maternal serum cell free DNA can be used for prediction of PE. The mean levels of CFFDNA correlate with probability of developing maternal complications in cases of PE.
Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-Types of GERD
Authors: Baiomy Essam Mohamed , El-Nakeep Sara Abdelkader , Ahmed Elessawy Hager Ahmed , Abbas Mostafa Mohamed
Published: November 2024

Background

Gastroesophageal reflux disease (GERD) is a prevalent condition characterized by the troublesome reflux of stomach contents into the esophagus, significantly impacting the quality of life. Pepsin, a protease originating from the stomach, has been implicated in the pathogenesis of GERD and can serve as a potential biomarker for objective assessment.

Patients and Methods

In this cross-sectional observational study, 45 patients with GERD and 45 healthy volunteers as a control group were examined. Clinical evaluations, laboratory tests, and salivary pepsin measurements were conducted, and esophagogastroduodenoscopy was performed.

Results

The study revealed a statistically significant increase in body mass index (BMI) among GERD patients (32.2 ± 3.9 kg/m²) compared to the control group (27.8 ± 2.4 kg/m²). Smoking was identified as a significant risk factor for GERD, with 44.5% of GERD patients being smokers compared to 24.4% in the control group. Salivary pepsin levels were significantly higher in GERD patients (108.5 ± 46.6 ng/ml) compared to the control group (24.4 ± 9.9 ng/ml). Additionally, a significant correlation was observed between salivary pepsin levels and the Los Angeles classification of GERD severity.

Conclusion

This study indicates that obesity negatively impacts esophageal function and smoking is a significant risk factor for GERD. Salivary pepsin levels are significantly elevated in GERD patients and show a strong correlation with GERD severity as classified by the Los Angeles classification system. Salivary pepsin holds promise as a non-invasive biomarker for GERD diagnosis and monitoring.
Total Laparoscopic Hysterectomy with Prior Uterine Artery Clipping versus Conventional Laparoscopic Hysterectomy: A Randomized Controlled Trial
Authors: Salama Mohamed Hamed Abdelaziz , Taha Yasmeen Ahmed Mohamed , Hassan Sabry ElSayed , Elskaan Rania Gamal Anwar
Published: November 2024

Objective

To compare the efficacy of total laparoscopic hysterectomy (TLH) with prior uterine artery clipping versus conventional laparoscopic hysterectomy

Methods

A randomized controlled study was conducted at Ain Shams University Maternity Hospital. The study included 42 women who were admitted from the general gynecology outpatient clinic and were planned to undergo TLH. Patients participating in the study were randomized into 2 groups; the control group, including women who were subjected to conventional TLH, and the study group, including women who were subjected to TLH with prior uterine artery clipping at its origin.

Results

The patient profiles in both groups were found to be similar, indicating a lack of confounding factors. No significant differences were observed between both groups in terms of age, BMI, parity, medical and surgical history, and the cause of hysterectomy. Regarding blood loss, no statistically significant difference was found between the two groups suggesting comparable outcomes in this aspect. However, a notable disparity was identified in terms of operative time. The study group had a mean operative time of 72.76±7.05 minutes, while the control group had a mean operative time of 63.76±6.28 minutes. This difference was highly statistically significant (p-value of < 0.001). All other outcomes (severe bleeding, post operative complications and operative time) were comparable between the two groups.

Conclusion

TLH with prior uterine artery clipping resulted in a longer operative time, without any added benefits regarding blood loss or other investigated outcomes.
Levels of Tumor Necrosis Factor Alpha and Serum Ferritin in Patients with Hemophilia and Correlation with Clinical Data and Joint Arthropathy
Authors: Saleh El-Alfy Mohsen , Makkeyah Sara Mostafa , Okba Ahmed Ashraf Mahmoud , Kader Salwa Mostafa Abdel , Hamdy Ibrahim Kholod Mohamed
Published: November 2024

Background

Hemophilic arthropathy still represents a major concern especially in resource- limited settings, despite major advances in the management of patients with hemophilia worldwide. TNF-α has been enrolled in the pathophysiology of chronic hemophilic arthropathy. Aim: To evaluate levels of TNF-α and ferritin in patients with hemophilia in relation to hemophilic arthropathy.

Methodology

We conducted a 6-months comparative cross-sectional study including 38 hemophiliacs with arthropathy (HA+) and without arthropathy (HA−), who are mild, moderate and sever hemophilia; as well as 53 age- and sex-matched healthy control. Patients with a history of acute bleeding or inflammatory conditions in the previous four weeks were excluded from the study. We assessed every patient annual bleeding rate(ABR) measured serum levels of ferritin and TNF-α by using enzyme linked immune-sorbent assay (ELISA). joint status was assessed clinically by the Hemophilia joint health score (HJHS), and radiologically by the six major joints ultrasound (US)

Results

The median (IQR) age of hemophiliacs was 11.8 (9-16.1) years opposed to 11 (8-13) years in the control group (p = 0.435). Most patients (97.3%) received regular low dose prophylaxis. The median (IQR) HJHS among (HA−) was 0 (0 - 1) versus 18 (9 - 22) in (HA+) group (p < 0.001), and HJHS correlated well with the US score (p < 0.001, p < 0.001 and p = 0.005 for knee, ankle and elbow joints respectively). The annual bleeding rate (ABR) was comparable between both hemophilia groups with median (IQR) 0.88 (0- 2.25) in HA− group versus 1.25 (0.5- 1.75) in HA+ patients (p = 0.571). There was no significant difference in ferritin levels among hemophiliacs with median (IQR) in (HA+) and (HA-) of 40 (35-70) ng/ml and 30 (30-50) ng/ml respectively. On the other hand, TNF-α levels was significantly higher in hemophiliacs compared to control (p < 0.001); with median (IQR) 500 (390 -780) in HA− patients, 485 (385 -580) in HA+ group and 65 (50 - 95) for healthy controls. In a post-hoc analysis TNF-α levels were comparable among patients with and without arthropathy (p = 0.56).

Conclusion

Hemophiliacs display higher TNF-α levels when compared to healthy controls, which may be a useful surrogate biomarker for bleeding episodes.
The Contribution of Intestinal Barrier and Microbiome Ecosystem in Progression of Chronic Kidney Disease
Authors: El-Kafoury Bataa M , Saad Dalia A , Ghonamy Elsayed , Din Bayomi Noha Salah El , Mehanna Nayra , Derias Marina Sorial Mina
Published: November 2024

Background

The introduction of concepts such as “Intestinal renal syndrome” and “The gut-kidney axis” has opened the door to the study of gut microbiota and intestinal barrier integrity.

Aim

This study is to focus on these two keys which link the interaction between CKD and intestine.

Material and Methods

This study was carried out on 20 adult male albino rats initially weighing 180 - 193 grams that were divided into sham operated (control) and 5/6th nephrectomized rats. After 8 weeks, all rats were subjected to anthropometric studies, measurement of serum level of creatinine, urea, NGAL, indoxyl sulphate, urine volume, eGFR, aIb/Cr ratio and arterial blood pressure. Serum SCFA an indicator for microbiome disturbances and tissue occludine an indicator for intestinal barrier as well as histological study to the wall of colon were determined. Also, serum TNF α, MDA, glutathione peroxidase was measured as possible interactive mechanism.

Results

In the present study, nephrectomy group showed significant decrease in body weight and body mass index gain compared to control group. In addition, 5/6th nephrectomy showed significant increase in mean arterial blood pressure and the levels of serum creatinine, urea, NGAL, indoxyl sulphate, alb / cr ratio, malondialdehyde and TNF- α. While volume of urine, eGFR and level of serum GPx were significantly decreased. Moreover, with nephrectomy SCFA in serum and intestinal tissue level of occludine were significantly reduced and the histological studies showed decreased thickness of mucosa, reduced number of goblet cell and increased inflammatory cell infiltration.

Conclusion

CKD could be considered as one of the chronic stressors affecting gut microbiota production of SCFA and intestinal barrier integrity marker and histology through the induction of gut inflammation and oxidative stress. This study provides a theoretical basis for subsequent targeted treatment.
Verification of Clot Burden Score Prognostic Value in Acute Middle Cerebral Artery Ischemic Insults
Authors: Hamid Soliman Abd El Aziz Mohamed Abd El , Rashad Abdel-Aziz Amany Mohamed , Ekladious Mena Elerian Youssef
Published: November 2024

Background

The Clot Burden Score (CBS) is a CT angiography-based grading system used to assess thrombus burden in acute ischemic stroke patients. CBS is a major determinant of stroke severity and outcome in anterior circulation stroke, offering advantages over invasive angiographic scores.

Aim of the Work

to investigate the prognostic value of CBS in predicting clinical outcomes using the modified Rankin Scale (mRS).

Patients and Methods

Type of study combined prospective and retrospective observational study. Sampling Method purposive sampling according to inclusion and exclusion criteria.

Results

The study included 40 patients with acute ischemic stroke, with a mean age of 58.35 ± 14.82 years. 60% of patients were male, and 40% were female. After 3 months, 17 patients (42.5%) achieved functional independence (mRS ≤ 2), while 23 patients (57.5%) had higher mRS scores (22 functionally dependent and 1 deceased). There was a statistically significant inverse correlation between CBS and mRS scores, indicating that patients with higher CBS scores had lower mRS scores. Receiver Operating Characteristic (ROC) curve analysis determined a CBS cutoff value of greater than 6 as predictive of a good prognosis, with high sensitivity and specificity.

Conclusion

The current study shows that CBS is a good predictor of patient outcome. It is a relatively easy and simple method in quantifying clot burden, apart from being systematic. This assists in selection of treatment strategies, and prognosticates patient outcome; and can be incorporated in routine radiological reporting of AIS cases.
Bayesian Selection of Relaxed-Clock Models: Distinguishing between Independent
and Autocorrelated Rates
Authors: Panchaksaram Muthukumaran , Freitas Lucas , dos Reis Mario
Published: November 2024

In Bayesian molecular-clock dating of species divergences, rate models are used to construct the prior on the molecular evolutionary rates for branches in the phylogeny, with independent and autocorrelated rate models being commonly used. The two classes of models, however, can result in markedly different divergence time estimates for the same data set, and thus selecting the best rate model appears important for obtaining reliable inferences of divergence times. However, the properties of Bayesian rate model selection are not well understood, in particular when the number of sequence partitions analyzed increases and when age calibrations (such as fossil calibrations) are misspecified. Furthermore, Bayesian rate model selection is computationally expensive as it requires the calculation of marginal likelihoods by Markov Chain Monte Carlo sampling, and therefore, methods that can speed up the model selection procedure without compromising its accuracy are desirable. In this study, we use a combination of computer simulations and real data analysis to investigate the statistical behavior of Bayesian rate model selection and we also explore approximations of the likelihood to improve computational efficiency in large phylogenomic data sets. Our simulations demonstrate that the posterior probability for the correct rate model converges to one as more molecular sequence partitions are analyzed and when no calibrations are used, as expected due to asymptotic Bayesian model selection theory. Furthermore, we also show the model selection procedure is robust to slight misspecification of calibrations, and reliable inference of the correct rate model is possible in this case. However, we show that when calibrations are seriously misspecified, calculated model probabilities are completely wrong and may converge to one for the wrong rate model. Finally, we demonstrate that approximating the phylogenetic likelihood under an arcsine branch-length transform can dramatically reduce the computational cost of rate model selection without compromising accuracy. We test the approximate procedure on two large phylogenies of primates (372 species) and flowering plants (644 species), replicating results obtained on smaller data sets using exact likelihood. Our findings and methodology can assist users in selecting the optimal rate model for estimating times and rates along the Tree of Life.
Erosive bilateral glenohumeral osteoarthritis caused by urosepsis-induced septic arthritis
Authors: Le Kiet , Lilley Tessa , Swanson Daniel , Jawa Andrew
Published: November 2024

Staphylococcus aureus is a common cause of bacterial infections of the skin, soft tissues, bones, bloodstream, and respiratory system. When the infection spreads to the joints, it is known as septic arthritis. The shoulder is the third most common location for septic arthritis in adults. Treatment is arthroscopic or open irrigation and debridement, but even after eradicating the bacteria, cartilage and bone destruction can occur. This article describes a patient who developed bilateral septic arthritis of the shoulders shortly after a urinary tract infection, and was treated with a relatively rare reverse shoulder hemiarthroplasty procedure.
Chronic Gabapentinoid Use and Lumbar Fusion Outcomes
Authors: Cetik Riza Mert , Glassman Steven D. , Mahoney Colleen , Gum Jeffrey L. , Crawford Charles H. , Owens R. Kirk , Dimar John R. , Kostic Benjamin , Carreon Leah Y.
Published: November 2024

Study Design.

Retrospective comparative cohort study

Objectives.

To examine the effects of chronic use of gabapentinoids (alone or with opiods) on the outcomes of lumbar fusions.

Summary of Background Data.

Opioids have historically been the mainstay medications for pain management, but the ongoing opioid epidemic led physicians to look for alternatives. Gabapentinoids (GPs) are used various indications, and chronic use for any indication may lead to a higher risk of adverse events, especially when combined with opioids.

Methods.

Patients ≥18 years of age who underwent posterior fusion of the lumbosacral spine and ≥1 year follow-up were included.Patients were grouped according to their preoperative chronic GP and opioid usage as GP and opioid non-user (-/-), GP user opioid non-user (+/-), GP non-user and opioid user (-/+) and GP and opioid user (+/+).

Results.

A total of 563 patients (M/F%=41/59, mean age 61.1 y) were included. 280 (49%) patients were in group -/-; while 110 (19%) were in +/-, 78 (15%) were in -/+ and 95 (17%) were in +/+. For ODI, back pain and leg pain, +/+ had the worst outcomes at all time points, while -/- had the best. Chronic GP users (+/-) showed back pain improvement similar to the -/- group, however the improvements in leg pain and ODI were considerably less. GP use resulted in increased postoperative opioid requirements, although not as much as chronic opioid use. Complication rates were similar.

Conclusions.

Chronic preoperative use of GPs may lead to inferior outcomes when compared with GP-naïve patients, and this is significantly accentuated when taken concurrently with opioids. Patients who are using both GPs and opioids had the worst results for almost every outcome measure. Given the significantly worse surgical outcomes documented in this study, concurrent use with opioids should be avoided.
Vascularized Fibular Graft With Femoral Head Epiphysis In Situ for Hip Reconstruction After Proximal Femoral Chondrosarcoma Resection in a Child
Authors: Mifsud Maximillian , Dangas Katerina , MacAulay Alexander
Published: November 2024

Introduction:

The expansion of bone and joint reconstruction in pediatric sarcoma has reduced the use of ablative approaches. Due to the need to maintain growth potential and the finite life of metal implants, biological reconstruction has been traditionally preferred to endoprosthesis whenever possible, particularly in younger patients.

Methods:

This case report describes a novel surgical technique for proximal femoral reconstruction in a 10-year-old boy with chondrosarcoma of the right proximal femur. After surgical dislocation of the hip and wide excision of the tumor with preservation of the femoral epiphysis, the proximal femur was reconstructed with an autologous vascularised fibular graft, including the fibular head and proximal fibular physis, fixed to the residual femoral epiphysis proximally and diaphysis distally. Fibular diaphyseal struts were used to reconstruct the femoral neck and greater trochanter. The vascularized autologous graft was preferred over the allograft or acellular graft. The folded-over fibular struts were held together with screws, and the new femoral neck area was held to the femoral shaft with a combination of intramedullary press-fit and a medial calcar plate to buttress the construct.

Results:

At 1 year postoperatively, the patient continues to be disease-free (locally and systemically) and independently ambulant.

Conclusion:

This novel technique for proximal femoral reconstruction in pediatric sarcoma adds to the biological reconstructive options available to sarcoma surgeons. The focus is on maintaining bone growth at the femoral head while preserving native hip function.
Exploring the Impact of ICU Diary on ICU Survivors’ Emotions and Feelings
Authors: Villa Marta , Morale Valentina , Valverde Brenda , Andreossi Mara , Chinali Irene , Vigo Veronica , Valentino Alessandra , Cesana Matteo , Citterio Stefano , Lucchini Alberto
Published: November 2024

Background

An intensive care unit (ICU) diary provides a powerful and moving account of a patient’s journey through critical care.

Aim

The primary goal of this research was to explore the qualitative perceptions of general ICU survivors toward the ICU diary, which was completed during their hospital stay and reintroduced to them during a follow-up visit 6 months after ICU discharge.

Setting

An Italian general ICU with structured follow-up and an ICU diary program.

Design

A qualitative descriptive method was used using semistructured telephone interviews involving 10 ICU survivors admitted between December 1, 2019, and April 30, 2021.

Findings

The main findings showed that the ICU diary is considered a very useful tool by ICU survivors to gain a better understanding of what happened during their ICU stay. Two main themes and 5 subthemes emerged from the analysis: (1) to fill the gap (clinical events in the ICU, family members’ experience, care provided by nurses and physicians) and (2) personal feelings (positive and negative). Reading the diary enabled participants, and hence unaware of their surroundings, to bridge a “time gap” and gain a clearer understanding of events that occurred during the ICU stay. The participants emphasized the significance of reading the ICU diary in understanding what their family members went through. The ICU diary has allowed individuals to become aware of the extensive efforts of health care professionals to meet their needs. Several emotions emerged from reading the ICU diary: amazement, contentment, gratitude, joy, love, affection, happiness, pain, and anguish.

Conclusions

ICU diaries are highly valued by ICU survivors because they allow them to gain a deeper understanding of ICU stay. Increased comprehension and processing of events can help reduce the symptoms of post–intensive care syndrome and empower patients to regain control of their lives with renewed motivation.
Evaluation of Traditional Liposuction, VASER Liposuction, and VASER Liposuction Combined with J-plasma in Management of Gynecomastia
Authors: Ouf Mohamed Ayman Abdelhalim , Kishk Tarek Fouad Abd El Hamid , Elnahas Mohamed AbdAllah
Published: November 2024

Background:

Because gynecomastia is one of the most considerable aesthetic procedures for men, we are researching in our article recent management methods for high grades of gynecomastia.

Methods:

This prospective study included 45 individuals with gynecomastia, divided into 3 groups: group A (15 individuals) managed by traditional liposuction, group B (15 individuals) managed by vibration amplification of sound energy at resonance (VASER)-assisted lipoplasty, and group C (15 individuals) managed by VASER and J-plasma. Authors used a skin fold caliper for measurement of subareolar disk size and a Cutometer for assessment of skin pliability and firmness. The study was conducted at the Department of Plastic Surgery, Menoufia University Hospital, Egypt, and Reflect Center for Plastic Surgery in Riyadh, Saudi Arabia.

Results:

Statistically significant differences were found among the groups in terms of reduction of subareolar disk size (assessed by skinfold caliper), skin redundancy (assessed by Cutometer), the need for a second stage of treatment, and patient satisfaction (by questionnaire).

Conclusions:

The combination of VASER and J-plasma is effective for managing grade 2 and 3 gynecomastia, resulting in significant reduction in subareolar disk size, minimal skin redundancy with enhanced skin firmness, reduced need for further procedures, and improved patient satisfaction compared with traditional methods.
Impact of Body Mass Index on Outcomes of Patients Undergoing Liposculpture in Private Practice
Authors: Cruz Vargas Johanna , Carbajal Barrios Miguel , De la Cruz Ku Gabriel
Published: November 2024

Background:

The popularity of liposculpture has increased due to the high patient satisfaction rate and low number of complications. However, in Latin America, serious complications have been reported due to various factors. Therefore, our objective was to determine the association of a BMI of 30 kg/m2 or more with the development of postoperative complications in patients undergoing liposculpture.

Methods:

A retrospective cohort study was performed in patients undergoing liposculpture at the Clinica Nova Quirurgica in Arequipa between 2020 and 2021.

Results:

A total of 231 patients were identified. The median age was 35 years, the majority of patients were women (97.4%), and 25.6% of patients had a BMI of 30 kg/m2 or more. Postoperative complications developed in 13.4%, the majority being seromas (10.8%), followed by superficial site infections (2.6%), hematomas (1.7%), asymmetry (1.7%), and deep vein thrombosis (0.4%). No other complications were identified. In the multivariable analysis, risk factors for the development of complications were a BMI of 30 kg/m2 or more [relative risk (RR) = 3.63; 95% confidence interval (CI), 1.27–10.32; P = 0.016], longer operative time (RR = 1.01; 95% CI, 1.00–1.02; P = 0.001), and greater volume of fat removed (RR = 1.01; 95% CI, 1.01–1.01; P = 0.002).

Conclusions:

Patients with a BMI of 30 kg/m2 or more undergoing liposculpture have a ~3.5-fold higher risk of developing postsurgical complications compared with patients without obesity. Other risk factors were longer operative time and greater volume of fat removed. Adequate patient selection is crucial to obtain optimal results.
Partially Reversible Episode of Blindness after Intravascular Hyaluronic Acid Filler Injection
Authors: Barrera Patricia , Murray Gillian , Pantano Alejandra
Published: November 2024

Blindness from hyaluronic acid filler injections is an uncommon but devastating complication. We present a case of blindness related to a “skin booster.” It is often assumed that skin boosters have no risk of visual problems, and this case underlines the need to understand products’ rheology and chemistry. Given the lack of agreed consensus in bedside and secondary care management, it is important to report and describe all cases of vision loss caused by fillers, including assessment and management, to allow understanding of what may give rise to better outcomes.
From the Bedside to the Boardroom: Developing Physician Leaders to Manage Tomorrow’s Healthcare Challenges
Authors: Hill James L. , Conroy Joanne M. , Azocar Ruben J.
Published: November 2024

Physicians are increasingly stepping into leadership roles that extend beyond the bedside. Their clinical expertise enhances quality outcomes, drives organizational change, and improves strategic decision-making. Physician leadership is critical for balancing quality patient care with the financial pressures faced by healthcare organizations today. With unique clinical credibility, physicians are well-positioned to influence strategic decisions, culture, and outcomes within their institutions.
Evaluation of a Commercially Available Radiochromic Film for Use as a Complementary Dosimeter for Rapid In-field Low Photon Equivalent Radiation Dose (≤50 mSv) Monitoring
Authors: Nivi Nicky , Moise Helen , Pejović-Milić Ana
Published: November 2024

This work investigates the low photon radiation dose (≤50 mSv) response of commercially available radiochromic films as a potential field dosimeter that could be used by the Canadian Armed Forces to complement their existing personal radiation dosimeters. The films were exposed to various photon energies from x-ray devices and radioisotopes (cesium-137, cobalt-60, and americium-241), and their radiation signal was read using three methods: net optical density, UV/visible spectroscopy, and Fourier transform infrared spectroscopy. A complimentary film dosimeter for field usage should, for military use, display a visual color change and detect doses ≤50 mSv. Given the film’s radiochromic properties, it was determined that the net optical density method was the most optimal read-out method, which ascertained a minimum detection dose limit of 4.5 mSv under exposure to a clinical orthovoltage operated at 100 kVp. The film presented an overall linear relationship between net optical density and radiation dose; however, they also portrayed a photon energy-dependent response between 0-100 mSv. Overall, the radiochromic films presented a real-time visual dose signal that could be interpreted rapidly in a mobile laboratory and possessed the ability to detect photon doses ≤50 mSv below the vendor’s recommended limits, making it a suitable option as a complementary, disposable, military dosimetric tool. Future work includes the investigation of the film’s response under multi- and unknown source environments and environmental-dependent factors such as UV/sunlight exposure and extreme temperatures.
Clinical Best Practices for Radiation Safety During an Alpha DaRT Treatment
Authors: Cohen Yadin , Feldman Jon , Chaswal Vibha , Heard Sarah , Shin Evelyn , Feliciani Giacomo , Giraud Jean-Yves , Kuptzov Eleonora
Published: November 2024

Alpha DaRT is a new alpha radiation treatment for treating solid tumors and is currently being evaluated through clinical trials worldwide. Being a novel radiation treatment, it is important to discuss the safety considerations and procedures that are needed to ensure safe use of this unique approach. The objective of this article is to provide a set of recommendations—radiation safety best practices that were developed based on operational and clinical experience.
INHERITED RETINAL DISEASE GENE PANEL IN POSTERIOR OR PANUVEITIS WITH DYSTROPHIC FEATURES
Authors: Abramowicz Stéphane , Meunier Audrey , Draganova Dafina , Caspers Laure , De Bruyne Marieke , Van de Sompele Stijn , De Baere Elfride , Leroy Bart P. , Postelmans Laurence , Willermain François
Published: November 2024

Purpose:

To evaluate the presence of American College of Medical Genetics and Genomics class 3, 4, and 5 genetic variants in inherited retinal disease (IRD) genes in posterior or panuveitis with dystrophic features (PUD) in a Belgian cohort.

Methods:

Multicentric, retrospective study of PUD cases diagnosed between January 2012 and February 2022. Inherited retinal disease gene panels were analyzed in every patient. Three PUD categories were defined as follows: idiopathic posterior or panuveitis with retinitis pigmentosa-like features (PURPL), idiopathic posterior or panuveitis with other dystrophic features (PUOD), and posterior or panuveitis with established ophthalmological or systemic etiology and dystrophic features (POSED).

Results:

The authors included 12 patients (7 women, 5 men). The mean age at inclusion was 52.2 years (26–80 years). Three patients demonstrated class 4 or 5 variants in genes that led to a diagnostic reclassification. One patient had a class 3 variant in an X-linked IRD gene that possibly explained his phenotype. Seven patients had variants in IRD genes that could not explain their phenotype. One patient had a negative panel result.

Conclusion:

Inherited retinal disease gene panel analysis allowed diagnosis refinement in 3/12 (25%) patients in the PUD cohort, all belonging to the PURPL subgroup. The authors recommend that all patients with PURPL benefit from gene panel testing to avoid overlooking undiagnosed IRDs.