bluuebunny/crossref_metadata_2025 huggingface dataset:
MRI versus US in diagnosis of meniscal injury in the knee joint
Authors: MBChB Nourhan Nasery Demian Saad , Nassef Hana Hamdy , Shalaby Mennatallah Hatem
Published: October 2021

Background

Meniscal injuries are the most common type of knee injuries.MRI is the gold standard in the diagnosis of meniscal injuries.

Aim of the work:-

The aim of this study is to compare between the accuracy of ultrasound and MRI in diagnosis of meniscal injury.

Patients and Methods:-

This study was carried out at the Radiology Department, AinShams University Hospitals.Twenty patients with proven MRI meniscal tear underwent ultrasound(US) examination.

Results :-

The overall sensitivity of the US to diagnose meniscal injuries reached (85.0%), specificity (100%) and accuracy (92%),
Voiding cystourethrography in children: spectrum of findings with clinical correlation
Authors: Mostafa Abdalla Samy Salem , Ragheb Samar Ramzy , Mohammad Shaimaa Abdelsattar
Published: October 2021

Background

Voiding cystourethrography (VCUG) is a gold standard diagnostic tool in the detection of lower urinary tract structural abnormalities in children.

Objective

To study the spectrum of different urinary tract abnormalities that could be detected in pediatric patients who underwent VCUG.

Methods

A retrospective study was carried at pediatric radiology unit Ain Shams university hospitals, starting from March 2019 till September 2019. Spectrum of findings were quantified in relation to patients’ symptoms. The number of true acquisitions and fluoroscopic frames, as well as the time of examination, were used as an indicator for radiation dose exposure.

Results

Out of 134 patients who were included in our study and underwent VCUG, the majority was males (n = 85, 63.4%) and patients who had more than 24 months and less than 216 months with median (IQR) 72 (48-108)months being (n = 82, 61.2%). We found that half of the cases had abnormal VCUG findings (n = 67, 50%). The most common abnormality was vesicoureteric reflux (VUR) (n = 38, 28.4%) followed by bladder abnormalities (n = 14, 10.5%).The commonest presented complaint was urinary tract infection symptoms (n = 58, 43.3%). Infants below 24 months of age showed more abnormal findings than older children. Males showed more abnormal findings than females. High-grade VUR (IV-V) was more frequent than low grade. Both recurrent urinary tract infection (UTI) and bladder abnormalities were found to be strong predictors for VUR (p = 0.019 and 0.013, respectively). The median (IQR) of static films within patients who had abnormal VCUG findings was greater than the median (IQR) of static films within patients who had normal VCUG findings being 7.0 (7.0 – 8.0) versus 6.0 (5.0 – 7.0), respectively with a significant statistically difference (F = 6.571, p = 0.011).

Conclusion

VCUG can detect different lower urinary abnormalities in children. VUR is the commonest encountered finding during VCUG, especially among patients with recurrent UTI.
Efficacy of Ligamentotaxis for Thoracic and Lumbar Traumatic Fractures and Factors Influence Outcome
Authors: Ghobashy Mohamed A , Hamad Ahmed M , Hefni Sameh M , Elsayed Ahmed R
Published: October 2021

Background

Traumatic thoracic and lumbar fractures are very common specially in the thoracolumbar junction and the most common causes are road traffic accidents and falling from height.

Aim of the Work

to evaluate efficacy of ligamentotaxis in thoracic and lumbar compressed and burst spine fractures using intact posterior longitudinal ligament and factors affect its outcome without anterior vertebral decompression through repositioning retropulsed segments, restoring vertebral height.

Patients and Methods

This study was conducted on 20 patients (with Non-propability convenience sample) with traumatic thoracic and lumbar spine fractures with intact posterior longitudinal ligament in El-maadi military hospital, Ain Shams university hospital during the period of 2017-2018.

Results

The most common postoperative complication was infection in 5 % of patients and CSF leakage infection in 5 % of patients.

Conclusion

The outcome in the study were successful in 95% of patients as reduction of retropulsed part occurred by the intact posterior longitudinal ligament.
Correlation between Subfoveal Choroidal Thickness and Disease Activity in Wet Age-Related Macular Degeneration Using Spectral Domain Optical Coherence Tomography
Authors: Abouelregal Aya Raafat , Mahmoud Alaa Fathy , Eliwa Tamer Fahmy , Naguib Karim Magdi
Published: October 2021

Background

Age-related macular degeneration (AMD) is the leading cause of severe irreversible visual impairment worldwide. The disease has a deep impact on the quality of life of affected person and represents a major socioeconomic challenge. Neovascular age-related macular degeneration (nAMD) is a rapidly progressing disease which impacts central vision. It is responsible for 90% of cases of AMD associated severe vision loss. Choroidal thicknening is hypothesized to occur in the active phase of neovascular AMD. On the other hand, multiple studies reported progressive choroidal thinning in nAMD.

Aim

to study the correlation between choroidal thickness, and the activity of choroidal neovascularization in cases of neovascular (wet) Age related macular degeneration using Spectral domain Ocular coherence tomography.

Methodology

Our study included 33 eyes of 30 participants subdivided into neovascular AMD group (23 eyes of 20 patients), and age matched control group (10 eyes of 10 participants). Spectral domain optical coherence tomography (Avanti RTVue XR AngioVue OCT (Optovue Inc, Fremont, USA) was used to measure central foveal thickness (CFT), and subfoveal choroidal thickness (SFCT) after conduction of complete ocular examination and history taking.

Results

Our study shows a significant decrease in subfoveal choroidal thickness in neovascular AMD group (157.82 + 68.67 µm) when compared to the age matched control group (266.9+ 48.37 µm) with (P value <0.001). But, we found no clinically significant difference in SFCT between active CNV (179.23 + 64.36 µm) and inactive CNV groups (136.4 + 72.97 µm) (P value = 0.19).

Conclusion

there is a significant thinning of choroid in nAMD in comparison to control. But no statistically significant difference in SFCT between active and inactive choroidal neovascular groups.
Evaluation of daily changes of Intraocular pressure in glaucomatous patients with modified diurnal tension curve versus water drinking test
Authors: Ahmed Eman Sayed , Abdelshafik Mohammed Adel , Hamdi Momen Mahmoud , Mahmoud Noha Mohsen
Published: October 2021

Background

Glaucoma is a chronic optic neuropathy characterized by the excavation of the optic disc due to atrophy of the retinal ganglion cells. A progression of such atrophy leads to reduction of the visual field and eventually to the loss of sight at the end-stage of the disease, Glaucoma is the second leading cause of blindness worldwide

Objectives

To study the correlation between intraocular pressure (IOP) fluctuation during water drinking test (WDT) and the IOP fluctuation of modified diurnal tension curve (mDTC) in glaucomatous eyes

Patients and Methods

Fifty participants (24 males and 26 females) were recruited in this prospective study; forty participants with known Primary Open Angle Glaucoma and the other ten participants with non- glaucomatous healthy eyes which served as control. Patients attending the outpatient clinic at Al-Demerdash Hospital and Cairo Fatemic Hospital from October 2018 to March 2019 were prospectively recruited. Four IOP measurements were taken at 8:00 am, 12:00 pm, 4:00 pm and 8:00 pm which represented the mDTC, while WDT was represented by a single measurement of IOP before ingestion of one liter of water over five minutes, followed by three IOP measurements after ingestion of this amount of water at thirty minute intervals.

Results

Distribution of the studied participants as regards Age and sex: 50 participants were included in the this study. 40 presented the case group (20 males and 20 females) and the mean age of the case group was 54.7 years, 10 presented the control group(4 males and 6 females) and the mean age of the control group was 51.2years. 59% of participants had a peak IOP at 8:00 am, while 10% had a peak IOP at 12:00 pm, 6% at 4:00 pm and 25% of the participants had IOP peak at 8:00 pm during the mDTC. In the WDT, 96% of the participants had a peak IOP after 30 minutes of ingesting one liter of water, while 4% had a peak IOP after 60 minutes. None of the participants had IOP peak after 90 minutes of ingesting one liter of water.. The IOP fluctuations detected during the WDT were significantly correlated to fluctuations observed during the mDTC.

Conclusion

The data of this study suggested that WDT can be used as a useful provocative test for the detection of the diurnal IOP peaks and fluctuation observed in the glaucoma patients.
Study on Ocular Diseases in Ain Shams University New Medical Students and Its Value on Future Subspecialty
Authors: Ramadan EsraaA , Rashad Mohammad A , Salman Abd el Rahman G
Published: October 2021

Purpose

Our aim is to study ocular diseases in symptomless and symptomatic newly admitted medical students in the Faculty of Medicine, Ain Shams University

Patients and Methods

This cross-sectional clinical study was conducted in Faculty of Medicine Ain Shams University. The study included 304 new medical students of class 2015 and 2016 who were randomly selected upon admission to college on October 2015 and October 2016 and who agreed to participate in this study. All participants underwent a complete ophthalmologic evaluation including detailed history and unaided visual acuity, best corrected visual acuity, anterior and posterior segment examination and assessment of binocular vision by titmus test.

Results

301 students (99.0%) have normal gross stereopsis and (1.0%) have no gross stereopsis using Titmus fly test. Fine stereopsis among studied group ranged from 0-9 (800-40 sec of arc) which was the ability to define the circles in titmus test but with mean of 7.29 ± 2.33(i.e. mean stereopsis was 60 sec of arc). Anisometropia was found in 32/304 (10.5%) of total population and 32/169 (18.9%) of total number students with refractive errors, 10 students were males and 22 students were females. Myopia was the commonest refractive error (51.90%).

Conclusion

Normal vision is integral to an individual understanding of his visual world, and those with visual defects can experience difficulties in everyday life. From these visual impairment problems are refractive errors, and abnormal binocular vision which if left uncorrected can affect performance of medical students.
Comparative study of the central corneal thickness in healthy individuals and diabetic patients with and without retinopathy using anterior segment optical coherence tomography
Authors: El-Mekkawi Tamer F , Rashed Hazem O , Eldin Hisham S. Saad , Faisal Hagar M
Published: October 2021

Background

Chronic hyperglycemia in diabetes mellitus causes different morphologic and functional corneal changes.

Aim of the Work

to assess the central corneal thickness in diabetic patients with and without diabetic retinopathy using anterior segment optical coherence tomography.

Patients and Methods

This comparative study was conducted at Ain Shams University hospitals . It included 45 eyes divided into three groups: Group A: 15 eyes of diabetic patients without diabetic retinopathy , Group B: 15 eyes of diabetic patients with diabetic retinopathy and Group C: 15 eyes of non-diabetic individuals.

Results

: The mean CCT in diabetic patients without diabetic retinopathy was 551.13µ ± 37.93 with range 475-622. Diabetics with retinopathy was 558.93µ ± 39.32 with range 508-618 and non diabetics 534.73µ ± 33.67 with range 475-588. There was no significant difference in corneal thickness between the three groups (p = 0.201)

Conclusion

: Diabetic corneas tended to be thicker though this was not statistically significant in our work.
Percutaneous Nephrolithotomy (PCNL) versus Retrograde Intrarenal Surgery (RIRS) in Medium Sized Renal Pelvic Stones
Authors: Ghareeb Mohamed E. Abo , Elsaid Mohamed H , Abdallah Abdelrahman A
Published: October 2021

Corresponding Background

Stone size is a key factor in the determination of the success of author: treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery

Aim of the Work

to compare the outcome of PCNL and RIRS in medium sized renal pelvic stoned in adults regarding operative time, fluoroscopic time, intra and postoperative complications, stone free rate, hospital stay and postoperative stenting.

Patients and Methods

This prospective randomized clinical study was conducted on 30 patients from April 2019 to January 2020, all patients had single renal pelvic stone (10 to 20 mm) and had no contraindication to perform these operations at the Urology department, Ain Shams University Hospitals and National Institute of Urology and Nephrology. The patients were randomized by (1 : 1) manner for either PCNL or RIRS. All preoperative, intraoperative and postoperative parameters, results and complications between both groups were recorded.

Results

Mean fluoroscopic time and hospital stay were significantly greater in PCNL group than RIRS group. The stone free rate was 86.7% (13/15) in PCNL group and 80% (12/15) in RIRS group and for complications (according to Cliven-Dindo score) there were no statistically significant difference between two groups.Complications occurred in 3(20%) patients in PCNL group and in 2(13.3%) patients in RIRS group. PCNL and RIRS are safe and effective methods for medium sized renal pelvic stones. For selected patients, RIRS may represent an alternative therapy to PCNL, with acceptable efficacy and low morbidity. RIRS compared to PCNL offers the best outcome in terms of radiation exposure and hospital stay.

Conclusion

RIRS may represent an alternative therapy to PCNL, RIRS compared to PCNL offers the best outcome regarding radiation exposure and hospital stay.
The Efficacy of Tamsulosin Monotherapy and Its Combination with Mirabegron for Overactive Bladder Induced by Benign Prostatic Hyperplasia
Authors: Kotb Yousef Mahmoud , Tawfeek Ahmed Mohamed , Mohamed Ali Hamouda Mohamed Mahmoud
Published: October 2021

Background

Alpha 1 adrenoceptor antagonists such as (tamsulosin) are developed for treating of overactive bladder (OAB) associated with benign prostatic hyperplasia (BPH), Acting by blockage of adrenoceptors so can cause relaxation of smooth muscle of the bladder neck and prostate, resulting in an improvement in urine flow and reduction in lower urinary tract symptoms (LUTS). Recently the beta-3 adrenoceptor agonist (mirabegron) has been shown to treat the(OAB) symptoms act by relaxation of detrusor smooth muscle of the bladder, increase the bladder capacity and minimize lower urinary tract symptoms (LUTS) that is associated with (BPH) with less side effect than other pharmacotherapies. We will study the efficacy and safety of this combination therapy.

Objective

To compare the efficacy and safety of the combination therapy mirabegron and tamsulosin versus tamsulosin monotherapy in case of overactive bladder associated with benign prostatic hyperplasia.

Material and method

this prospective randomized controlled study conducted in 60 patients between ages of 50-70years and complaining of lower urinary tract symptom(LUTS) associated with(BPH) benign prostatic hyperplasia, Before and 12 weeks after mirabegron additional therapy (50 mg once daily), we evaluated the efficacy of this treatment using the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS), and changes in the maximum flow rate (Qmax) and post-void residual urine volume (PVR).

Results

60 men were enrolled in this study. The combination therapy improved the OABSS, IPSS total score and quality of life(QOL), the QMAX improved after treatment and there was no significant change in PVR.

Conclusions

Mirabegron add-on therapy was effective for male patients whose having LUTS particulary the OAB symptoms and storage symptoms that was not controlled by tamsulosin monotherapy with no effect on voiding function therefore the combination therapy considered effective more than monotherapy.
Tubeless Percutaneous Nephrolithotomy with Hemostatic Plug Using Surgiflo® versus Standard Percutaneous Nephrolithotomy using a Nephrostomy Tube: A Prospective Randomized Controlled Study
Authors: Elshawaf Hisham Mohamed Fathey , Shabayek Mohamed Ismail , Ahmed Mohamed Ahmed Saleh
Published: October 2021

Background

Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large renal stones (over 2cm in diameter). It involves keyhole surgery performed through a small skin incision overlying the kidney.

Objectives

Our study aimed at evaluating the safety and efficacy of local hemostatic sealant (surgiflo®) use in tubeless PCNL to enhance postoperative outcomes of PCNL.

Patients and Methods

We randomized our patients into two groups, Group A nephrostomy tube was used as standard PCNL, and at group B tubeless PCNL was done followed by injection of the local hemostatic flowable gelatin matrix (surgiflo®) under fluoroscopic guidance in the prone position

Results

There was no statistically significant difference between two groups regarding demographic data age, sex and BMI (P- value 0.280, 0.736 and 0.440 respectively), stone site and size (P- value 0.525 and 0.533 respectively), operative time (P- value 0.855), intraoperative complications as blood loss and pelvicalyceal perforation, (P- value 0.92 and P- value 0.83 respectively), postoperative complication as fever, haematuria and UTI (P- value 1.000, 0,113 and 1.000 respectivly), and Hb drop (P- value 0.735).

Conclusion

Tubeless PCNL with hemostatic sealant use is associated with less pain, no leakage from nephrostomy tract, less narcotic agent use, and a shorter hospital stay.
Diagnostic Role of Collagen Type III Alpha in Fibroepithelial Lesions of the Breast: An Immunohistochemical Study
Authors: Sedky Amir A , Ghazal Faten A , AbouGabal Hoda H , Salem Huda H
Published: October 2021

Background

The fibroepithelial lesions (FELs) are heterogeneous biphasic tumors composed of epithelial and stromal components, they include fibroadenoma (FA) and phyllodes tumor (PT). The most FAs are benign, while the PTs have unpredictable biologic behavior, where they can recur if incompletely excised, and can even metastasize. According to the WHO Classification of Tumors of The Breast, PT is classified by the histological features into benign, borderline, and malignant. There is difference in management of the FELs, where a FA is treated conservatively or by simple enucleation. While PT must be excised with wide surgical margin to avoid the recurrence of this tumor, where it can recur as high grade. For this reason the preoperative distinction between FA and PT is critical for management. On another hand, still this differentiation is difficult and challenging in some cases especially on limited sample of core needle biopsy (CNB) and also on excision due to the heterogeneity of PT and overlapping features between the FELs. Recently, the use of immunohistochemical markers may have helpful role in differentiation between FA and PT, and grading of the last one. Collagen III α (Col A ) has been emerged as a potential new diagnostic maker useful in differentiation between fibroepithelial lesions.

Methodology

In this retrospective study we evaluated the histopathological features of Cases of FELs including FA and PT with its subgrades. We also evaluated an immunohistochemical diagnostic potential of collagen III α (Col A) in differentiating FA from PT, and categorizing the last one. Furthermore, correlations between Col A expression and clinicopathological parameters were performed.

Results

The staining expression of Col A was increased significantly in PTs when compared with FAs (P<) . Col A expression increased with increased grade of PT but without significant difference between benign PT and borderline PT, and between borderline PT and malignant PT. By pairwise comparison, there was a significant difference between CFA and benign PT according to Col A expression (P<) , and also between the typical FA and FA with PT like features (P<) . There was a trend of increased expression but did not reach the significance between FA with PT like features and benign PT (P=) . Distinct periductal cuffing pattern of Col A staining was present in all PTs and absent in most FAs (P<) , and only cases of FA with PT features exhibited this pattern.

Conclusion

Col A is a diagnostic marker can differentiate between FA and PT, especially between CFA and benign PT, and the Col A expression increased with increased grade of PT but without significant difference. FA with PT like features might be a distinct category that should be distinguished from typical FΑ as it may an initial event of tumor progression to PT.
Cord Blood Ischemia-Modified Albumin Levels in Preterm Infants with Intrauterine Growth Restriction
Authors: El-Raggal Nehal M , Nawara Maii M , Abd El-Ghani Amani M , Zareif Mary E , Shehata Basma M
Published: October 2021

Background

Intrauterine growth restriction (IUGR) is one of the causes of perinatal mortality and morbidity. It is the failure of the fetus to achieve intrinsic growth potential. Since IUGR neonates are more likely to suffer complications including perinatal asphyxia, cold stress, hypoglycemia, hypocalcaemia, hyperbilirubinemia, feed intolerance, NEC, sepsis and even mortality. So, it is important that these infants are identified and managed appropriately at birth.

Purpose

The present study aims to determine the possible association between cord blood ischemia-modified albumin (IMA) levels and intrauterine growth restriction (IUGR) in preterm infants with or without complicated gestations.

Patients and Method

Eighty mothers and their preterm neonates (<37 weeks’ gestation) identified in 2 groups according to antenatal ultrasound: a group with prospective antenatal diagnosis of IUGR and the other group with normal fetal development, after consideration of inclusion and exclusion criteria. Cord blood Albumin and Ischemia modified albumin were estimated by double-antibody sandwich Enzyme-Linked Immunosorbent Assay (ELISA).

Results

Cord blood IMA was significantly higher in IUGR group compared to control group. Consequently, albumin level was significantly lower in IUGR group compared to other group. IMA was inversely correlation with Hb level and albumin level was inversely correlated with liver function tests (ALT and AST).

Conclusion

There is a positive association between IMA level and IUGR. This sent a message that combined antenatal ultrasound and serum IMA is a better predictor of intrauterine growth restriction and subsequent better care of neonates with IUGR.
Effect of Pentoxifylline on Diabetic Neuropathic Pain in Rats
Authors: Salama Raghda A.M , Hasanin Amany H , Hamza May , Saleh Lobna A , Habib Eman K
Published: October 2021

Background and Aim

Diabetic neuropathy (DN) is the most common diabetic complication, which has a lifetime prevalence of about 50%. About 20 to 30% of patients with DN suffer from neuropathic pain. This study was designed to investigate the role of early and late treatment of pentoxifylline (PTX) in management of diabetic neuropathic pain (DNP).

Method

Diabetic rats were administered PTX (50 and 200 mg/kg/day, in drinking water) either one week after STZ injection and for 7 weeks or 6 weeks after STZ injection and for 2 weeks. Mechanical allodynia were assessed weekly, Iba-1 and GFAP immunorectivity, spinal NFκB & spinal sciatic TNF-α were estimated at the end of the study. Epidermal thickness of the food pad and Na+/K+-ATPase activity in sciatic nerve were measured as an outcome measure for predegenerative markers of DN.

Results

The results of the present study suggest that activated microglia and not astrocytes are involved in the development of experimental diabetic neuropathy. PTX inhibit neuroimmune activation of microglia, reduce the levels of proinflammatory cytokines and improve epidermal thickness of the food pad and Na+/K+-ATPase activity in sciatic nerve. Only PTX 200 mg/kg/day when administered early and late treatment in diabetic rats produced antiallodynic effect.

Conclusion

PTX is a fundamental drug whose antiallodynic effect depends on the pathogenetic mechanisms and has the ability to halt or inhibit the progression of the disease. The earlier the use of PTX in the developmental phase of mechanical hyperalgesia the more the antiallodynic effect of the drug.
Effect of indomethacin (Non steroidal anti-infilammatory drug) on intestinal permeability and liver functions
Authors: Mahmoud Shaimaa H , Elshaer Asmaa M , El-Waseef Dalia A , Erfan Dina M , Nabih Enas S , El-Kharashi Omnyah A , AboZeid Mahdy S
Published: October 2021

Background

Many theories tried to connect liver and gut as they have close anatomical, metabolic, and immunologic connections so exposure to large numbers of foreign molecules coming from the gastrointestinal tract via the portal vein like the bacterial components and other products may lead to liver damage by disturbing intestinal barrier and permeability which can be induced by indomethacin, one of non-steroidal anti inflammatory drugs(NSAIDs).

Aim

To investigate whether liver injury is linked to disturbance in intestinal permeability or not.

Methodology

Indomethacin was used to induce dysbiosis in male Wistar rats which were divided into two groups: Naive and Indomethacin groups. The later was received indomethacin (3mg\kg\day) by oral gavage. Liver function tests, micrbiological and histological studies were performed.

Results

Indomethacin induced elevation in liver enzymes, bacteremia and histological changes as compared to vehicle group.

Conclusions

Indomethacin induced dysbiosis with disturbance in the intestinal permeability that yield to hepatic injury.
Serum Amyloid A Level in Women with Unexplained Infertility
Authors: Ibrahim Mostafa , Mohammad Hayam Fathy , el-Khazragy Nashwa Nagy , El wahab Zeinab Saad Abd
Published: October 2021

Background

By various molecular and cellular research efforts it was displayed that folliculogenesis, ovulation, and corpus luteum formation is considered as an inflammatory processes that hav raised the research interest to investigate that serum amyloid A as an inflammatory mediator to reveal its possible role in infertility.

Objective

This study aims to assess the association between SAA and unexplained infertility in women.

Methods

The current research study have been conducted at Ain Shams University Maternity Hospital during the period from September 2018 to April 2019. Women approached were recruited from outpatient clinic of Ain Shams University Maternity Hospital. The recruited 90 research study subjects have been divided into two research groups

Results

Serum amyloid A was statistically significantly higher among the unexplained research group versus control group (SAA had excellent discriminative value with an area under the ROC curve (AUC) of 0.992 (95% CI = 0.945 to 1.000, Pvalue <0.0001). A best cutoff criterion is SAA of 28.7 mg/l (sensitivity = 98%, specificity = 96%, J-index = 0.93)) denoting that amyloid A as an acute phase inflammatory modulator is higher among the unexplained research group reflecting a form of chronic inflammatory process in those category of cases. Analytical research results of multivariable binary logistic regression analysis as regards the correlation between SAA and unexplained infertility after adjustment for age and BMI, it was revealed that serum amyloid A an independent predictor for unexplained infertility.

Conclusion

s: Serum amyloid A as a biomarker for could be implemented as a predictability tool for unexplained infertility since it is a reflector of an chronic inflammatory process that is ongoing that could affect the process of implantation and ovulation however the clear molecular and cellular processes linked to the pathophysiological process that reflects the fertility hindering process should be implemented in future research efforts taking in consideration to have multicentric fashion of research with larger sample sizes to verify the value of serum amyloid A as biomarker that reflects the fertility potential besides the routine infertility work up.
Perineural injection as an alternative treatment of resistant lateral elbow pain
Authors: El-Naggar Hanaa Ahmed Hany Abd Eldayem Ahmed , El-Naby Mona Mansour Mohammed Hasab , Assaf Naglaa Youssef Mohammed , El-Fattah Elbadawy Mohja Ahmed Abd
Published: October 2021

Background

Lateral elbow pain (LEP) or lateral epicondylitis (LE) is a common problem affecting both males and females. Multiple therapeutic modalities are used with different outcomes.

Objective

The current study aimed at description of the effectiveness of a newly introduced modality, Perineural Injection (PNI) therapy in comparison to the already used therapeutic ultrasound (TUS) as a conventional modality in the treatment of resistant LEP (LE).

Patients and methods

This is a longitudinal interventional study. Thirty patients of both sexes aged between 21 to 62 years old who had LE were randomly allocated into two groups (15 each). In PNI group, 5% buffered dextrose was injected subcutaneously around the lateral epicondyle once weekly for 8 weeks. In TUS group, continuous US was used 3 sessions per week for 4 weeks. Tenderness grading scale, visual analogue scale (VAS), Patient- Rated Tennis Elbow Evaluation Questionnaire (PRTEE) score, and ultrasonographic evaluation were used before and 12 weeks after treatment.

Results

In both groups, there was a high significant clinical improvement at 12th week after treatment. However, the improvement was better in the PNI group than the TUS group. By US evaluation at 12th week after treatment, there was a significant decrease in hypoechoic areas and disturbed fibrillar pattern in PNI group compared to before therapy (p < 0.001 and = 0.025) respectively. But in TUS group, there was decrease in hypoechoic areas and tendon thickness compared to before treatment (p = 0.02 and 0.026) respectively.

Conclusion

Both PNI and TUS therapies for LE gave clinical improvement for pain, functional limitations and some ultrasonographic findings (as echogenity, fibrillar pattern and tendon thickness). However, PNI therapy gave better outcome as compared to TUS.
Timing of Triazole-Based Spray Schedules for Managing Mungbean Powdery Mildew in Australia: A Meta-Analysis
Authors: Melloy Paul , Del Ponte Emerson Medeiros , Sparks Adam H.
Published: October 2021

Powdery mildew (PM), caused by two fungal species, Podosphaera xanthii and Erysiphe vignae, is a yield-limiting foliar disease commonly found in mungbean (Vigna radiata) cropping areas of the eastern region of Australia. Effective control of the disease relies largely on fungicide applications, mainly of the triazole group. Uncertainty in the current fungicide spray schedule recommendations, which advise commencing with a spray at the first signs of PM, prompted this study to evaluate PM severity and crop yield data obtained from fungicide trials, which also tested spray schedules starting before (early) or after (late) first signs, applied singly or combined with a follow-up spray. A meta-analytic approach was used to obtain mean differences of the PM severity and crop yield between plots sprayed with specific triazole-based spray schedules and nontreated plots. From 26 trials, 14 trials and 15 trials met the criteria for inclusion in PM severity and yield analyses, respectively. The schedule with the first spray starting at first sign, with a follow-up spray 14 days later, resulted in significantly lower disease severity compared with all other schedules. However, the yield protected was only numerically higher and not statistically different compared with single-spray at first sign, single-spray late, or two-spray starting late. PM severity and yield in the early sprayed plots did not differ from the nontreated plots. These findings support the current recommendations and provide additional evidence that yields are still protected when delaying the first spray up to a week after disease onset. They also suggest that additional sprays may not always be necessary, thus reducing direct fungicide costs, indirect costs related to fungicide insensitivity, and potential adverse effects to the environment.
Complete Genomic Data of Pantoea ananatis Strain TZ39 Associated with New Bacterial Blight of Rice in China
Authors: Yu L. , Yang C. , Ji Z. , Zeng Y. , Liang Y. , Hou Y.
Published: October 2021

Pantoea ananatis is a phytopathogen infecting many economically important crops, including rice worldwide. Here, we report the complete genome of P. ananatis strain TZ39 identified as causative agent of a new bacterial blight of rice that emerged in China in 2020. The assembled genome consists of one circular chromosome of 4,483,976 bp and two plasmids of 135,135 and 276,579 bp. This complete genome of the first Chinese pathogenic P. ananatis strain will provide new insights into the traits of pathogenicity on genomic level from China and worldwide.
The Efficacy of Preoperative Duloxetine in Patients Undergoing Major Abdominal Cancer Surgery
Authors: Hetta Diab Fuad , Elgalaly Nourhan Alaa , Mohammad Montaser A. Fattah
Published: October 2021

Objective:

We aimed to evaluate the analgesic efficacy as well as the postoperative quality of recovery of preoperative oral duloxetine a serotonin and norepinephrine reuptake inhibitor for patients undergoing major abdominal cancer surgery.

Materials and Methods:

Sixty-two patients, undergoing major abdominal cancer surgery were divided into 2 equal groups, received oral duloxetine 60 mg (2 h preoperative) or placebo. Postoperative 48 hours morphine consumption, visual analog scale pain score, and quality of recovery were measured.

Results:

The cumulative 48 hours morphine consumption was significantly reduced in the duloxetine group compared with the placebo group (mean±SD) (5.2±3.2 vs. 12.9±3.4 mg), mean difference (95% confidence interval) 7.6 mg (5.9–9.3) P<0.001. The time to first morphine request was delayed significantly in the duloxetine group, median (interquartile range), 25 (19 to 38) versus 8 (4 to 9) hours, P<0.001. The duloxetine group had lower pain scores than the placebo group at 8, 12, 16, and 24 hours postoperatively, however, nonsignificant changes were observed at 0, 2, 4, 36, and 48 hours postoperatively. Participants in the duloxetine group had a better postoperative quality of recovery than the placebo group. The median (interquartile range) of the global quality of recovery-40 scoring system for the duloxetine group was 185 (180 to 191) compared with 170 (163 to 175) in the placebo group (P<0.001).

Discussion:

A single preoperative dose of oral duloxetine, 60 mg for patients subjected to major abdominal cancer surgery reduced postoperative pain, decreased opioid consumption, and improved the quality of recovery.
Implementing an Evidence-Based Feeding Protocol
Authors: McKenna Laura L. , Bellini Sandra , Whalen Mary , Magri Eileen , Akerman Meredith
Published: October 2021

Background:

Evidence-based feeding practices are often variable among neonatal providers due to lack of knowledge and neonatal intensive care unit (NICU) feeding culture norms.

Purpose:

To evaluate changes in NICU nurses' knowledge, perceptions, feeding practices and culture following education about, and implementation of, an evidence-based Infant-Driven Feeding (IDF) protocol.

Methods:

A pre-/postprospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation.

Results:

The preeducation survey yielded 59 respondents; of these, 30 responded to the same survey after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings (P = .035), greater use of gestational age to increase frequency of oral feeding attempts (P = .03), less reliance on weight loss to decrease oral feeding attempts (P = .018), an increase in use of combination interventions to prepare infants for oral feeding (P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding (P = .03).

Implications for Practice and Research:

Trends in several survey categories following the education program and implementation of IDF support the use of evidence-based practices (EBPs) such as IDF. Future research focused on nurses' perceptions of how education influences integration of specific EBPs into practice is needed. Evaluating EBP mentorship combined with education about EBPs can provide insights on how best to integrate EBPs into practice.
A Rare Case of Neonatal Disseminated Herpes Simplex Virus (HSV) With Concomitant Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia
Authors: Sykes Stephanie R. , Sharpe Elizabeth L.
Published: October 2021

Background:

Neonatal herpes simplex virus (HSV) infections can be challenging to diagnose and often occur without maternal history of infection. Routine initial pharmacologic management when a neonate presents with signs of sepsis in the first weeks of life typically targets antibiotic therapies. This case illustrates the importance of the addition of antiviral coverage, especially when a neonate demonstrates temperature instability and neurologic changes.

Clinical Findings:

This case report describes the unique presentation of a 9-day old neonate with clinical findings significant for sepsis. This neonate was diagnosed with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia with concomitant disseminated HSV-2 infection after presenting with temperature instability, lethargy, and signs of multisystem organ impairment.

Primary Diagnosis:

This neonate was diagnosed with disseminated HSV infection, which occurs in 25% of neonatal HSV disease.

Interventions:

Treatment was initiated with high-dose intravenous acyclovir at 20 mg/kg/dose every 8 hours along with broad-spectrum antibiotics. Management should include anticipating and monitoring for progressive multisystem organ failure in bacterial or viral infection.

Outcomes:

This patient did not survive despite maximal intervention from the neonatal intensive care unit team. Disseminated HSV neonatal infections are associated with high mortality rates when they are present alone, and mortality is higher with concurrent bacteremia.

Practice Recommendations:

Providers should have a high index of suspicion for HSV infection in neonates presenting in the first 1 to 3 weeks of life with signs of sepsis. Prophylactic treatment with high-dose acyclovir as an adjunct to broad-spectrum antibiotics while awaiting laboratory confirmation can be lifesaving.
A Neonate With Vertical Transmission of COVID-19 and Acute Respiratory Failure
Authors: Farmer Meredith L.
Published: October 2021

Background:

This case describes a case of vertical transmission of COVID-19 from a mother to her neonate. The neonate subsequently developed acute respiratory failure consistent with adult symptoms of COVID-19.

Clinical Findings:

This preterm neonate was born at 33 4/7 weeks' gestational age to a COVID-19–positive mother and admitted to the neonatal intensive care unit (NICU) for prematurity and respiratory distress. The neonate developed acute respiratory failure with severe persistent pulmonary hypertension of newborn (PPHN) and required intubation and maximum respiratory and cardiovascular support. The neonate subsequently tested positive for COVID-19 at 24 hours of life.

Primary Diagnosis:

Acute respiratory failure related to COVID-19 infection.

Interventions:

The neonate was admitted to the NICU on CPAP. At 11 hours of life, the neonate began to exhibit signs of worsening respiratory distress requiring intubation, mechanical, and high frequency ventilation. An echocardiogram revealed severe PPHN. The neonate required dopamine to manage hypotension and was treated with steroids to decrease inflammation associated with airway edema noted during intubation. Pharmaceutically induced paralysis, analgesia, and sedation was used to manage persistent hypoxia.

Outcomes:

The neonate fully recovered from acute respiratory failure and was discharged home with the mother.

Practice Recommendations:

Newborns born to mothers who are positive for COVID-19 are at risk for vertical transmission of COVID-19 and should be monitored closely for acute respiratory failure. Respiratory medical management should include supportive care. Staff should also encourage parents to consider receiving the COVID-19 vaccine to protect their newborn from the possibility of developing acute respiratory failure.
Increasing Safe Sleep Practices in the Neonatal Intensive Care Unit
Authors: Paul Eveline Treiber
Published: October 2021

Background:

The American Academy of Pediatrics (AAP) encourages healthcare providers to practice and model safe sleep practices (SSPs) in the neonatal intensive care unit (NICU) when it is developmentally and medically appropriate for the infant. Preintervention data were collected as a baseline prior to the quality improvement (QI) initiative and revealed that 87% of eligible infants were in unsafe sleep environments (n = 331/379). This data revealed the need for an improvement project to help increase the percentage of infants placed in safe sleep in this NICU.

Purpose:

The purpose of this QI initiative was to increase the percentage of eligible infants being placed in safe sleep environments by registered nurses in a NICU.

Methods:

The development of an evidence-based safe sleep bundle was implemented in a level IV NICU at an academic medical center in the Southeastern United States. Data were subsequently collected for 5 months via bi weekly crib audits.

Results:

Of the 744 infants audited in the QI period, 604 were observed in a safe sleep environment. From the pre- to postintervention period, SSPs increased by 68% (preintervention: 13%, postintervention: 81%, P value < .001). Adherence to the varying components of SSPs also reflected statistically significant improvements.

Implications for Practice:

SSPs should be endorsed and modeled in all NICUs. Introducing proper SSPs in the hospital setting may lead to better compliance at home by the infants' caregivers.
Association Between Sleep Disturbance and Low Back Pain
Authors: Yabe Yutaka , Hagiwara Yoshihiro , Sekiguchi Takuya , Sugawara Yumi , Tsuchiya Masahiro , Yoshida Shinichirou , Tsuji Ichiro
Published: October 2021

Study Design.

A longitudinal study.

Objective.

The aim of this study was to clarify the association between sleep disturbance and low back pain (LBP) using 3-year longitudinal data after the Great East Japan Earthquake, with a focus on the duration or frequency of sleep disturbance and the effect of sleep disturbance on LBP.

Summary of Background Data.

Sleep disturbance and LBP are common health problems in the general population and natural disaster survivors. However, a longitudinal study in this field is rare, and the association between sleep disturbance and LBP has not been clarified.

Methods.

A 3-year longitudinal study was conducted among people living in disaster-stricken areas after the Great East Japan Earthquake (n = 2059). Sleep disturbance and LBP were assessed at 4, 5, 6, and 7 years after the disaster. Multiple logistic regression analysis was performed to assess the association between the duration or frequency of sleep disturbance and LBP, and the effect of preceding sleep disturbance on the onset of LBP. The χ2 test and crude and multiple logistic regression models were used in data analysis.

Results.

The duration and frequency of sleep disturbance were significantly associated with LBP, and the effect was stronger with longer duration and increased frequency of sleep disturbance. Furthermore, the duration and frequency of preceding sleep disturbance were significantly associated with the onset of LBP, and the effect was stronger with an increase in the duration and frequency of sleep disturbance.

Conclusion.

Sleep disturbance is associated with LBP in a dose-dependent manner. Attention should be paid to sleep disturbance for the treatment and prevention of LBP, especially with regard to the duration and frequency of sleep disturbance.

Level of Evidence: 3
Evaluation of Gait and Functional Stability in Preoperative Cervical Spondylotic Myelopathy Patients
Authors: Hassanzadeh Hamid , Bell Joshua , Dooley Evan , Puvanesarajah Varun , Kamalapathy Pramod , Labaran Lawal , Shimer Adam , Shen Francis , Russell Shawn
Published: October 2021

Study Design.

Prospective cohort study.

Objective.

The aim of this study was to 1) determine postural stability and spatiotemporal gait parameters and 2) characterize dynamic stability and variances in angular momentum (AM) of preoperative cervical spondylotic myelopathy (CSM) patients compared with healthy controls.

Summary of Background Data.

CSM is the most common cause of spinal cord dysfunction in the world and can lead to significant functional deficits including proprioception and gait disturbances. Biomechanical feedback mechanisms compensating for these deficits, specifically AM regulation, have remained largely unexplored.

Methods.

Fifty-six subjects: 32 preoperative Nurick grade 2 or 3 CSM patients and 24 controls were included. Standing balance trials were performed on a single force plate, while walking trials were conducted at self-selected pace over a 15 m runway and a series of five force plates. All trials were recorded with three-dimensional motion analysis cameras and gait modeling software was utilized to calculate stability, spatiotemporal gait parameters, and joint kinematics.

Results.

Tilted ellipse area, a measure of center of pressure variance and postural stability, was significantly greater among CSM patients (847.54 ± 764.33 mm2
vs. 258.18 ± 103.35 mm2, P < 0.001). These patients had two times as much variance medial-lateral (72.12 ± 51.83 mm vs. 29.15 ± 14.95 mm, P = 0.001) and over three times as much anterior-posterior (42.25 ± 55.01 mm vs. 9.17 ± 4.83 mm, P = 0.001) compared with controls. Spatiotemporal parameters indicated that the CSM patients tending to have slower, shorter, and wider gait compared with controls, while spending greater amount of time in double support. Compensatory AM among CSM patients was significantly increased in all three anatomic planes, where whole-body AM was approximately double that of controls (0.057 ± 0.034 vs. 0.023 ± 0.006), P < 0.001).

Conclusion.

Preoperative CSM patients showed significant alterations in spatiotemporal gait parameters and postural stability compared with controls, consistent with prior literature. Likewise, angular momentum analysis demonstrates that these patients have globally increased body excursion to maintain dynamic balance.

Level of Evidence: 3