bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Wire Localization in Management of Non-Palpable Breast Cancer
Authors: Wagdy Hisham Hassan , Al-din Mohammad Mohammed Bahaa , Al-din Osman Ahmed Gamal , Ahmed Sherif Youssif , Gad Gad Mohammed , Hanoura Hatem Elsayed Mohamed Elsayed
Published: August 2023

Background

Breast-conserving surgery (BCS) is considered the goldstandard treatment for early breast cancer. Various techniques have been proposed for identifying non-palpable breast tumors, but the most popular method is the wireguided localization (WGL technique). The most important drawback of BCS is the possible presence of microscopic tumor at or close to the margin of excision.

Objective

To highlighting the significance of screening programs, early detection and recent advances in the management of early non palpable breast cancer.

Methods

This is a prospective study on 30 patients with a single nonpalpable breast lesion. A preoperative USG or MMG-guided hook wire localization technique was performed then intraoperative frozen section was done.

Results

Of the prospective study, 30 patients were treated with wire-guided localization and BCS. And intraoperative frozen sections. According to positive margins, patient age, menopausal status, tumor size and histologic type were associated with increased risk of positive margins. The reexcision at the time of original operation was (6/30) (20%) and need for second operation in (1/30) (3.3%) of cases. According to postoperative complication increased by neoadjuvant chemotherapy, size of mass, specimen volume, margin status and LNs affection.

Conclusion

In early diagnosis of breast cancer, the validity of the imagingguided hook wire localization biopsy of non-palpable breast lesions has been proved. The cooperation of surgeon, radiologist and pathologist increases the successful results of hook wire localization technique.
Effect of Post-Mastectomy Autologous versus Implant Reconstruction on Body Image and Quality of Life among Egyptian Women
Authors: Alamry Heba Hassan , ElAhmady Rania Mohamed , Aly Hesham Adel Sheshtawy , moaty Karim Fahmy Abdel , Rayan Mahmoud Talaat
Published: August 2023

Purpose

The ultimate goal is to evaluate patient satisfaction with autologous versus implant breast reconstruction, as well as the influence of these surgeries on the quality of life and body image of women who have had a mastectomy for breast cancer.

Method

A multicenter, retrospective, cross-sectional study included 117 patients who underwent mastectomy and subsequent breast reconstruction surgery at El Demerdash University Hospital and Alexandria Main University Hospital between January 2017 and March 2021. A BREAST-Q 2-0 Reconstruction module questionnaire was given to each patient.

Result

117 patients were divided into two groups: autologous breast reconstruction ABR (n = 77) and implant-based breast reconstruction IBR (n = 40). The ABR group was operated on using Transverse Rectus Abdominis Myocutaneous (TRAM) or latissimus Doris (LD) flaps. The average age of the participants in the study was 44.51 ± 6.88. Patients with silicone implants were younger on average than those with LD or TRAM flaps.

The patient's quality of life in the two areas evaluated (psychosocial and physical well-being) was excellent in implant repair but poor in TRAM flap, according to our findings. In TRAM flap, we also discovered that overall satisfaction with the breast was low.

Conculsion

TRAM flap produces a low quality of life and overall satisfaction with the breast, whereas implant reconstruction provides a high quality of life.
Management Strategies for Dysphagia Complicating Laparoscopic Nissen Fundoplication, Systematic Review
Authors: Albeialy Khaled Mohamed , Qassem Mohamed Gamal , Osman Tarek Abouzeid , Ibrahim Ahmed Mohamed
Published: August 2023

Background

Gastroesophageal reflux disease (GERD) is a common global disorder. Manifestations of the disease range from occasional episodes of heartburn and regurgitation to the more serious complications of stricture and Barrett’s esophagus. Most patients manage their symptoms with a combination of dietary and lifestyle modifications and overthe-counter or prescription medications.

Aim of the Work

This study aims to assess the incidence, etiology, diagnosis and management strategies for dysphagia following laparoscopic Nissen fundoplication.

Patients and Methods

Published studies discussing dysphagia as a complication of laparoscopic Nissen fundoplication. Patients developed dysphagia after laparoscopic Nissen fundoplication as primary anti-reflux surgery, the type of intervention was laparoscopic Nissen fundoplication. Types of outcome measures: Incidence, etiology, diagnosis and management strategies for dysphagia following laparoscopic Nissen fundoplication. The published English-language literature will be searched in the databases PUBMED, EMBASE, Google Scholar, Science direct and Cochrane Register of Controlled Trails (The Cochrane Library). The search terms will be employed: “Nissen fundoplication” “early dysphagia” “ late dysphagia”.

Results

In our present systematic review, we observed that the incidence of post-operative dysphagia after laparoscopic Nissen fundoplication among the included studies ranged from 8.2% to 42.8% with average percent of 33.2%. Transient postoperative dysphagia was more prominent in most of the included studies with average 52.8%, while persistent dysphagia was in reported in 47.2% of cases. In the present systematic review and meta-analysis, 707 of patients who developed postoperative dysphagia responded to conservative management with percent of 92.4%, while the remaining 58 patients required more invasive modalities. Endoscopic dilatation was performed in 54 (7.1%) of patients, while the remaining 4 patients (0.5%) were indicated for surgical reintervention.

Conclusion

Post laparoscopic Nissen fundoplication dysphagia is one of the most common complications, most cases present with a transient course that require no more than conservative management. In few conditions, more invasive procedures maybe required to control that condition.
Comparative Study between the Effect of Single Anastomosis Gastric Bypass versus Roux-en-Y Gastric Bypass in Morbidly Obese Patient as Regard Remission of Type-2 DM
Authors: Mahfouz Mohamed Fayek Mohamed , Abdelmonaem Ayman Hossam Eldin , Adly Nahla Nader , Abouzekry Nader Mohamed
Published: August 2023

Background

Accumulating evidence obviously supports the superiority of weight loss surgery over non-surgical treatments for management of morbidly obese patients in terms of outcomes as sustained weight loss, improved quality of life and prevention, reduction, or resolution of comorbidities (e.g., Type 2 Diabetes Mellitus, dyslipidemia), as well as reduced overall mortality.

Objective

To compare Type 2 DM remission as well as the metabolic effects of 2 types of bariatric surgery; Single Anastomosis gastric Bypass and Roux-en-Y Gastric bypass, in the first year postoperative follow up in relation to DiaRem Scoring system.

Patients and Methods

This is a prospective randomized clinical trial study conducted in AinShams University Hospitals bariatric surgery unit over 40 patients with minimal follow-up of 12 months. 2 groups of patients: Group A: composed of 20 patients that undergoing OAGB as a metabolic surgery for control of Type 2 DM. Group B: composed of 20 patients that undergoing Reux-en-Y gastric bypass as a metabolic surgery for control of Type 2 DM. Patients were randomly distributed among both groups using simple randomization odds and evens where odd patients were included in group A and even patients were included in group B.

Results

We find that Roux-en-Y operation is more potent as regard remission of DM than MGB/OAGB (80% versus 65%) and that remission of DM depends on diabetes itself (duration, HBA1C, C-PEPTIDE) and these are the main determinants of remission. And DiaRem score is good predictor of DM remission in low scoring categories however in high scoring categories it is poor in prediction of DM remission

Conclusion

No statistical difference between both groups as regard remission of DM however numerically it is obvious that Roux-en-Y is more potent metabolic surgery in order to be statistically significant the study needs to be repeated over larger sample size. The main determinant noticed during the study influencing remission is the duration of DM and preoperative C-peptide level-in addition to HBA1C level. We must put into our consideration the post operative complications of MGB/OAGB as regard biliary reflux and failure which are more less in Roux-enY operation but in order to be evaluated longer duration of follow up is needed. We recommend Roux-en-Y as a metabolic surgery for patients with early onset DM type II with BMI ranging from 30-40. The study needs to be repeated over larger sample size and longer duration to determine the long term effects of metabolic surgery.
Fibroscan as Non-Invasive Modality for Studying the Effect of Hepatic Steatosis on Viral Response to Direct-Acting Antiviral in Patients with Chronic Hepatitis C
Authors: Shawky Bakir Amal , El Kader Elnakeep Sarah Abd , Faheem Heba Ahmed , Elbasiony Mohamed Adel , El Mageed Ghoneim Abdallah Abd El Hameed Abd
Published: August 2023

Background

HCV is a major cause of viral hepatitis leading to chronic liver disease and liver failure. With an estimated prevalence of 3% in the world population (around 170 million infected individuals worldwide), HCV heavily burdens public health. Even though the incidence of new infections is declining, at least in industrialized countries where they are restricted to intravenous drug users, morbidity and mortality associated with HCV infection are expected to increase over the next decade.

Objectives

The aim of this study to the impact of hepatic steatosis on SVR in HCV infected patients receiving DAA therapy.

Patients and Methods

This prospective observational study was conducted on 40 patients with HCV (anti-hcv seropositive with detectable HCV-RNA). All included patients were subjected to full history taking, thorough clinical examination, full laboratory investigations including: complete blood count, liver profile tests, kidney function tests, lipid profile, abdominal ultrasonography and Transient elastography with controlled attenuation parameter (CAP).

Results

The total SVR and Non-SVR rates among treated patients were 90% and 10%, respectively. The comparison between SVR and Non-SVR patients through the baseline parameters showed that patients who failed to treatment had significantly higher bilirubin, BMI and ALT. Furthermore, liver function parameters was improved significantly in majority of cases. The Impact of treatment regimens on the liver enzymes indices; transaminases was significantly declines during and after complete treatment. On the other hand, serum albumin level was significantly decreased. Regarding the complete blood count indices we found the HB% level was significantly changed with transient declining during the treatment periods. The WBCs count, PLT count were not significantly changed.

Conclusion

Hepatic steatosis was common in HCV infection, the overall SVR-12 was 90%, so that, hepatic steatosis has no impact on SVR-12 in patient with HCV infection undergoing DAA therapy. Fibrosis has no impact on SVR-12 as shown by P-value 0.729. BMI has negative impact on SVR-12 as shown by P-value 0.035. Bilirubin has negative impact on SVR-12 as shown by P-value 0.001. ALT has negative impact on SVR-12 as shown by Pvalue 0.009. HSI has no impact on SVR-12 as shown by p-value 0.077.
Evaluation of Red Cell Distribution Width (RDW) to Platelet Ratio as a Novel Non-Invasive Index for Predicting Hepatic Fibrosis in Patients with Chronic Hepatitis C before and after Antiviral Treatment
Authors: Shawky Bakir Amal , Rahman Hany Ali Abdel , Galal Salah Shaarawy , Badr Ahmed Adel Abdel Fattah
Published: August 2023

Background

Globally, about 71 million people have chronic HCV infection. A significant number of those who are chronically infected will develop cirrhosis or liver cancer. Approximately 399, 000 person die every year from liver cirrhosis and hepatocellular carcinoma. Liver fibrosis reflects sustained liver injury often from multiple, simultaneous factors. Assessment of the effect of antiviral treatment on liver fibrosis is desirable end point for evaluation of the efficacy of therapy.

Aim of the Work

To validate and compare the diagnostic performance of RDW to Platelet ratio for prediction of liver fibrosis before and after antiviral treatment in patient with chronic HCV infection. In Comparison with other markers of fibrosis (fib-4, APRI) scores and fibroscan.

Patients and Methods

This study was conducted on 50 adult patients with chronic hepatitis C virus subdivided into two groups. First group: 25 Non cirrhotic patients having chronic HCV infection. Second group: 25 Cirrhotic CHILD A patients having chronic HCV infection and followed up in Gastroenterology out patient’s clinic, Al Demerdash Hospital, Ain Shams University.

Results

The results obtained can be summarized as follows: RDW/PLT can predict liver fibrosis and cirrhosis with agood degree of accuracy before HCV treatment. RDW/PLT can predict liver cirrhosis (F3 & F4) with an excellent degree of accuracy after HCV treatment. RDW/PLT cannot predict early liver fibrosis (F1 & F2) after HCV treatment as results assuming apoor degree of accuracy. According to above results RDW/PLT can be used instead of liver biopsy to detect degree of liver fibrosis and cirrhosis before HCV treatment with agood degree of accuracy. While after HCV treatment we can depend on RDW/PLT to predect degree of advanced liver fibrosis and cirrhosis (F3 & F4) with an excellent degree of accuracy. But we need further studies on RDW/PLT to detect the accuracy of prediction of early liver fibrosis (F1 & F2) after HCV treatment.

Conclusion

RDW/PLT can predict liver fibrosis and cirrhosis with agood degree of accuracy before HCV treatment. RDW/PLT can predict liver cirrhosis (F3 & F4) with an excellent degree of accuracy after HCV treatment. RDW/PLT cannot predict early liver fibrosis (F1 & F2) after HCV treatment as results assuming apoor degree of accuracy. According to above results RDW/PLT can be used instead of liver biopsy to detect degree of liver fibrosis and cirrhosis before HCV treatment with agood degree of accuracy. While after HCV treatment we can depend on RDW/PLT to predect degree of advanced liver fibrosis and cirrhosis (F3 & F4) with an excellent degree of accuracy. But we need further studies on RDW/PLT to detect the accuracy of prediction of early liver fibrosis (F1 & F2) after HCV treatment.
Risk Stratification in Egyptian Patients with Upper Gastro Intestinal Bleeding
Authors: Al swaff Reham , Hamdy Hesham , Gamal Gina , kamal Ahmed Elsayed
Published: August 2023

Introduction

Acute upper gastrointestinal bleeding is a common and life-threatening condition. It remains a common cause of visits to the emergency department with an estimated incidence of about 100 per 100000 hospitalizations and being associated with significant morbidity, 30 day mortality and health-care costs. Urgent triage in emergency departments and risk stratification can help to identify patients who warrant urgent diagnostic and therapeutic procedures. We aimed to assess the correlation between Glasgow-Blatchford Bleeding Score, the AIMS65 score and Rockall score in sixty Egyptian patients with upper gastrointestinal bleeding, and to evaluate the best scoring system for risk stratification in these patients.

Methods

This prospective study included 60 Egyptian patients presented to Ain shams university hospital with upper gastrointestinal bleeding. All patients underwent emergency endoscopic evaluation within 12 hours of presentation. Surgical and radiological interventions were considered for patients who failed or were not feasible for endoscopic therapy. Rockall score, Glascow-Blatchford and AIMS65 were calculated for each patient.

Results

the age of the studied patients ranging between 20 and 81 years old with a mean age of 55.57 ± 13.14, of them 66.7% were males and 33.3% were females. Most of the patients (90%) had co-morbidities in the form of hepato-billiary diseases (70%), HTN (30%), DM (26.7%), cardiac disease (8.3%), and GIT related disorders (6.7%). Portal hypertension gastropathy was the most common finding in UGIT endoscopy (58.3%) followed by esophageal varcies (56.7%), then gastritis (30%), then peptic ulcer (20%) and lastly gastric mass (6.7%). Rockall score had significant association with altered mental status and liver cirrhosis. Rockall score was found to be the most effective predictor for mortality (sensitivity 100%, specificity 67.92% and AUC 91.0%).

Conclusion

complete Rockall score is the most effective scoring system for prediction of in hospital mortality in patients with upper gastrointestinal bleeding.
Correlation of Circulating Cathelcidin Level and Inflammatory Bowel Disease Activity
Authors: Adel Nanees , Halima Ahmed Samir Abo , Samir Elbaz Hossam , Hossam Eldin Ahmed Farahat Saleh
Published: August 2023

Background

Inflammatory bowel diseases (IBDs), which include Crohn’s disease (CD) and ulcerative colitis (UC), are a group of idiopathic, chronic and relapsing inflammatory disorders of the gastrointestinal tract, whose incidence and prevalence has been increasing in the last decade.

Objective

To correlate circulating cathelicidin levels with mucosal disease activity in patients with IBD.

Patients and Methods

This case control cross sectional study was conducted on 45 adult subjects referred to Gastrointestinal Endoscopy and Liver Unit, EL-Haram Hospital.40 of the patients had IBD, the other 40 were non IBD patients studied as case control. All subjects were submitted to complete medical history, physical examination, laboratory investigations, colonoscopic examination and cathelicidin serum level.

Results

Our results showed that there was no statistically significant difference between both studied groups regarding both age and sex distribution. In this study we found highly significant decrease in Hemoglobin level in cases group compared to control group (p value < 0.001). Also, there was significant increase in platelets level among cases group compared to control (p value < 0.05). Also, we found that serum albumin was decreased among IBD patients compared to control.

Conclusion

Serum Cathelicidin has shown significant increase in patients with IBD activity. Serum cathelicidin levels showed statistically significant reverse correlation with Partial Mayo Scores of severity in UC patients. Serum cathelicidin levels showed Non-statistically significant correlation with Harvey Bradshaw Indices of severity in CD patients. Co-evaluation of LL-37 and CRP levels was more accurate than CRP alone or LL-37 alone in the correlation with Mayo Endoscopic Score of UC patients.
Study the Efficacy of Argon Plasma Coagulation or Endoscopic Band Ligation versus Their Companion in Management of Gastric Antral Vascular Ectasia in Cirrhotic Patients
Authors: Youssef Tarek Mohamed , Mohamed Enas El-Khedr , El-Talkhawy Mohamed Darwish , Fathallah Ahmed Magdy , Al-Bendary Ahmed Hamed Hamza
Published: August 2023

Background

Gastric antral vascular ectasia (GAVE) is a rare and often misdiagnosed cause of upper gastrointestinal bleeding accounts for up to 4% of all non-variceal upper gastrointestinal bleedings. Multiple options are available for the treatment of GAVE including endoscopic, surgical and medical therapies.

Aim of the Work

The aim of this study to evaluate the effect of APC followed by EBL in comparison to APC or EBL alone for the treatment of bleeding GAVE in cirrhotic patients.

Patients and Methods

We conducted this study on 45 adult cirrhotic patients with overt or occult bleeding from GAVE. Patients were divided into 3 groups: 15 patients in each group. Group I was treated with APC alone, group II was treated with EBL alone and Group III was treated with APC followed by EBL.

Results

In the current study, no statistically significant difference was detected between both groups regarding the etiology of liver cirrhosis, clinical presentation, laboratory or ultrasound findings with special emphasis on pre-treatment hemoglobin value, hospitalizations. APC alone was found to was found to be less effective in the treatment of GAVE when compared to both techniques (EBL and the combined therapy) which were effective in the treatment of GAVE and GAVE recurrence. EBL alone was found to require less number of treatment sessions but required more number of rubber bands and. Combined therapy (APC followed by EBL) successfully decreased the number of banding sessions and decreased the number of rubber bands required to treat GAVE.

Conclusion

Combined therapy (APC followed by EBL) and EBL alone are effective methods in the treatment of bleeding GAVE in Egyptian cirrhotic patients. EBL alone requires less number of treatment sessions but may require a big number of applied rubber bands. Combined therapy (APC followed by EBL) successfully decreased the number of banding sessions and decreased the number of rubber bands required to treat GAVE. So, in mild cases when less number of rubber bands seems to be required, it is advisable to start with EBL alone: while in severe cases where a large number of rubber bands seems to be required, it is advisable to use combination therapy of APC and EBL.
A Randomized Controlled Clinical Trial of Trisodium Citrate 30% versus Heparin as a Lock Solution for the Prevention of Catheter-Related Infections in Adult Hemodialysis Patients
Authors: EL-Sharkawy Magdy Mohamed , Khedr Lina Essam , Emara Ahmed Abdelmoniem , Elsayed Ahmed Kamal Abdelhamid Ali
Published: August 2023

Background

Central venous catheters (CVC) are the only option when hemodialysis is needed for patients without definitive vascular access. However, CVC is associated with complications, such as infection, thrombosis, and dysfunction, leading to higher mortality and expenditures. Interdialytic hemodialysis catheter-locking solutions could contribute to reduction of catheter-related complications, especially infections.

Aim of the Work

To assess the possible effect of using Trisodium citrate 30% (TSC 30%) in comparison to unfractionated heparin, as a lock solution for hemodialysis catheters, on inflammatory status in HD patients

Patients and Methods

This was a randomized controlled clinical trial, conducted on 70 patients on regular hemodialysis, selected from hemodialysis unit in Nasser Institute Hospital in Cairo government, divided into two groups: (Citrate Group); 35 patients received trisodium citrate, (Heparin Group); 35 patients received unfractionated heparin (5000i.u) as a hemodialysis lock solution after the end of HD session and followed up for 3 months.

Result

In our study, the catheter-related bacteremia episodes were significantly lower in the Citrate group when compared with those in the Heparin group. Only 2 patients (5.7%) in Citrate group had CRBSI, whereas in Heparin group, 8 patients (22.9%) had CRBSI (P = 0.04). Also, Bacteremia-free time was longer in the Citrate group. The mean bacteremia free time in Citrate group was 10.97 ± 2.36 weeks, while in Heparin group it was 9.43 ± 3.91 weeks (P = 0.032). At base line, there was no significant difference between both groups regarding hsCRP (P = 0.596) and WBCs (P = 0.528). While after 3 months of using TSC 30% as a lock solution, there was a significant difference as regards levels of hsCRP (P = 0.030) and WBCs (P = 0.036), with the higher levels of inflammatory markers showed in Heparin group. There was no difference between the two studied groups regarding thrombosis, however, catheter performance was higher in citrate group after 3 months assessed by URR (P = 0.005) compared to baseline (P = 0.108),

Conclusion

We found that Trisodium citrate 30% may be a better alternative to heparin as a catheter lock solution as it reduces the inflammatory markers and CRBSI incidence. We therefore believe that TSC 30% may be used safely as catheter lock solution in Hemodialysis
Assessment of Incidence of Metachronous Neoplasms after Surgical Resection of Colorectal Cancer
Authors: Moenis Ahmed Ali , Mohammed Eslam Safwat , Said Nouran Mohamed , Omar Ahmed Khaled Abd El-Razzak
Published: August 2023

Background

Cancer colon is the second most common cause of cancer in women and the third most common in men. Globally incidences vary 10-fold with highest rates in Australia, New Zealand, Europe and the US and lowest rates in Africa and South-Central Asia. However, in Egypt, CRC represent 4.2% of all cancers in male and 3.8% in females.

Aim of the Work

The aim of our study was to assess the incidence of Metachronous neoplasms after curative surgical resection of colorectal cancer and assess different risk factors for metachronous Cancer colon occurrence.

Patients and Methods

We enrolled 100 patients in this retrospective cohort study to predict incidence and risk factors of metachronous colorectal cancer (CRC) after 6 months of curative surgical resection of colorectal cancer.

Results

After 6 months of post-operative follow up, 90% of cases had no recurrence of CRC, 5% had polyps and did polypectomy, 5% had mass lesion. So patients were divided into two groups, Group (1) included patients with no recurrent CRC. Group (2) included patients with recurrent CRC. The incidence of metachronous CRC was 5% for mass and 5% for polyps in patients who underwent curative surgical resection of colorectal cancer. In both Univariate and multivariate Logistic regression analysis for the parameters affecting recurrent mass, DM was the only significant risk factor associated with the incidence of metachronous CRC with P values (0.043, 0.049) respectively.

Conclusion

The incidence of metachronous CRC in this study was 5% for mass and 5% for polyps in patients who underwent curative surgical resection of colorectal cancer. DM is a significant risk factor of metachronous CRC.
Screening of Cirrhotic Compensated Hepatitis C Virus Infected Patients Who Received Oral Direct Acting Antiviral Drugs for Hepatocellular Carcinoma and Other Malignancies
Authors: Aly Osama A , Fouda Enas M , Abdelrahman Magdy G E , Aboubakr Ashraf , Sabry Ahmed M
Published: August 2023

Background

HCV is now recognized as a major factor in the development of severe liver damage as chronic infection is associated with the development of hepatic steatosis, cirrhosis and hepatocellular carcinoma.

Aim of the Work

screening of our patients for the incidence of hepatocellular carcinoma and other malignancies during or after end of treatment with orally direct acting antiviral drugs to prove or disprove this allegation.

Patients and Methods

This retrospective observational study was performed at Maadi Military Hospital during the period from July 2015 to July 2016 including 290 naive compensated cirrhotic hepatitis C virus infected patients with no prior history of hepatocellular carcinoma or any other malignancy and divided into 5 groups: Group (A) patients treated with combined sofosbuvir and ribavirin for 24 weeks. Group (B) patients treated with combined sofosbuvir and daclatasvir and low dose ribavirin for 12 weeks. Group(C) patients treated with combined sofosbuvir and ledipasvir with weight based ribavirin for 12 weeks. Group (D) patients with chronic renal failure on regular hemodialysis treated with combined ompitasvir+paritaprevir+ritonavir and low dose ribavirin for 12 weeks. Group (E) patients with the same criteria were taken from the waiting list of treatment and studied as the control group and were subjected to the same investigations and follow up.

Results

Highly significant increase in HCC prevalence in A group (23.3%) during follow up period. Significant increase in HCC prevalence in B group (8%) during follow up period. Non-significant difference in HCC prevalence in C group; during follow up period. In group D; non-significant difference in HCC prevalence during treatment and follow up periods. There was no detected occurrence of HCC or any other malignancies during the course of the study in group E.

Conclusion

Increased HCV detection combined with the availability of simple, well-tolerated treatment regimens can potentially reduce the need for liver transplantation and reduce HCV-related mortality. No evidence of an increased risk of de novo HCC by patients treated with interferon free SOF-based regimens. However, cirrhosis was strongly associated with the short-term development of HCC after HCV eradication. Treatment of HCV in patients with CKD is highly effective, with SVR12 rates similar to those seen in patients without CKD. The role of SVR by DAAs on the incidence or recurrence of hepatocellular carcinoma (HCC) is still a matter of debate, although it is known that SVR does not eliminate the risk of HCC.
Role of Circulating Endocan as a Biomarker in Non-Alcoholic Fatty Liver Disease
Authors: El Nakeeb Noha Abd EL Razek , Mohamed Manal Sabry , ElGhandour Ahmed Mohamed , Awad Ahmed Mohamed Elsaid
Published: August 2023

Background

Nonalcoholic fatty liver disease (NAFLD) has a prevalence of 25% worldwide and is described as the leading cause of chronic liver disease. Liver disease was found to be the third leading cause of death among persons with NAFLD. Its prevalence is increasing in conjunction with metabolic syndrome due to engaged risk factors, which include high body mass index and abdominal obesity, type 2 diabetes, dyslipidemia (high triglycerides and/or low high-densitylipoproteins), age, male sex, and alcohol consumption.

Aim of the Work

The aim of this study is to study serum level of Endocan in patients with nonalcoholic Fatty Liver disease (NAFLD) to detect its relation to the incidence and severity of nonalcoholic Fatty Liver Disease (NAFLD).

Patients and Methods

This study was conducted at Ain Shams University hospitals to evaluate the role of serum endocan as a diagnostic biomarker for NAFLD. We included a total of 100 subjects who were divided into two equal groups; Group 1 included 50 patients with NAFLD, and Group 2 included 50 healthy controls.

Results

Both BMI and waist circumference showed a significant increase in cases compared to controls. The prevalence of DM in the NAFLD group was 36% which was statistically significantly higher as compared with the control group. The mean SBP was statistically significantly higher in the NAFLD group, while DBP showed comparable findings. The mean liver size as detected by US was statistically significantly higher in the NAFLD group as compared with the control group, while spleen size didn’t reveal a statistically significant difference between the two groups. The mean fasting blood glucose, mean HbA1C, mean post-prandial glucose, mean cholesterol level, mean TGs, mean LDL, mean ALT and mean AST, mean ALP, mean GGT and mean ferritin level were statistically significantly higher in the NAFLD group as compared with the control group. The mean HDL level was statistically significantly lower in the NAFLD group as compared with the control group. Other laboratory variables were comparable between the two groups. The mean serum endocan level was statistically significantly higher in the NAFLD group as compared with the control group (54.58 ± 18.61 and 30.69 ± 6.49 respectively). Each of APRI, FIB-4 and NAFLD scores showed significant difference between the two groups.

Conclusion

Based on the previous findings, one can conclude that: Serum endocan may act as a surrogate marker for the diagnosis of NAFLD as it was significantly elevated in cases compared to controls. As well as detection of disease severity as it has a positive correlation with APRI, FIB-4 score yet still further studies on larger scales are required. This confirms the state of endothelial dysfunction associated with this disease NAFLD is associated with impaired lipid profile, impaired liver functions, and higher incidence of diabetes compared to controls.
Diagnostic Value of Ascitic Endocan Levels in the Diagnosis of the Spontaneous Bacterial Peritonitis
Authors: Badawy Hanan Mahmoud Mohamed , Allam Ahmed Samir , Fathallah Ahmed Magdy , Abotaleb Ahmed Ragab Mohamed
Published: August 2023

Background

Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. One of the possible mechanisms of developing Spontaneous bacterial peritonitis is bacterial translocation.

Aim of the Work

The aim of this study is to assess the role of ascitic endocan levels in the diagnosis of SBP in decompensated cirrhosis.

Patients and Methods

90 cirrhotic patients with ascites were included in the current study and divided into 2 groups: SBP group with positive ascites culture or with an AF PMNL count ≥ 250/mm3 included 45 subjects. Non SBP group with negative ascites culture or with an AF PMNL count > 250/mm3 included 45 subjects. In the SBP group, the mean age was 58.77 years with male predominance (68.8%).As regard to Non SBP group, the mean age was 59.31 years with male predominance 57.8%.

Results

There was a statistical significant difference in between SBP group and Non-SBP group as regard to Platelets, ALT, ascetic Total leucocyte count, Protein and LDH. The most common presentation in SBP group was Upper GIT bleeding and Abdominal pain and the most common organism detected in the culture of ascitic fluid Escherichia coli (80%) followed by Streptococcus viridans (15.5%). Ascitic Endocan level was significantly higher in SBP group than Non-SBP group with P < 0.001. The sensitivity and specificity of Ascitic Endocan in detection of SBP were 84.85% and 82.69% respectively. There was a positive significant correlation in between Ascitic Endocan level and ALT, AST, bilirubin, CRP, Child class, MELD score, Blood Leukocytes and TLC (cell/mm3) in ascitic fluid in SBP group. The significant predictors of bad outcome in patients with SBP were higher ascitic fluid Endocan level, CRP and higher Glucose in ascitic fluid (mg/dl) levels

Conclusion

High Ascitic endocan level is common in cirrhotic patients with SBP than in Non-SBP and that means Ascitic endocan is related to the severity of the disease. Ascitic endocan level is an independent risk factor for SBP. High Ascitic endocan level is a significant predictor of bad outcome in patients with SBP. Therefore, measurement of Ascitic endocan level provide a new strategy to more aggressive treatments for high-risk groups. Ascitic endocan level could be used as an inflammatory biomarker for the prognosis of patients with SBP
Carpal Tunnel Syndrome in Rheumatoid Arthritis Patients
Authors: Gabal Mervat Mamdouh Abo , Elazizi Noran Osama Ahmed , Elserwy Maha Ahmed , Elkhayat Naglaa Mohamed , Benjamin Dina Benjamin Azmy
Published: August 2023

Background

Carpal tunnel syndrome (CTS) is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA).

Aim and objectives

to assess the presence and severity of Carpal tunnel syndrome in rheumatoid arthritis patients and its relation to disease activity.

Patients and Methods

This is observational cross sectional study, was carried out 30 rheumatoid arthritis patients recruited from Ain Shams University Hospital)inpatient internal medicine department and rheumotology outpatient clinic) in the period from November (2018) till November (2020).

Result

Only ultrasound assesment of CTS by measuring Of CSA>10 at wrist showed significant positive correlation with RA Patients ages, RA disease duration, CTS symptoms duration, CRP, RF and anti ccp positivity and negative correlation with HB% indicating association with disease compare to others activity.

Conclusion

CTS frequency in RA is found higher than normal population, especially in patients with additional risk factors of CTS. There was no relationship between CTS and disease activity, and CTS group had long disease duration and worse functional status. CTS could be a result of the chronic course in RA.
The Assessment of Immunological Status in Hemodialysis Patients Post COVID-19 Infection
Authors: El-Shinnawy Howayda Abd El-Hameed , Aref Hayam Mohamed , Abdelgawad Mostafa Abdelnasier , Elkholy Enas Fathe Hassan
Published: August 2023

Background

Coronavirus disease 2019 (COVID-19) infection emerged in Wuhan, China in December 2019 and has spread rapidly worldwide. On March 11, 2020, WHO declared COVID-19 a pandemic. COVID-19 is a single-strain RNA virus that typically causes respiratory damage in humans and animals.

Aim of the Work

Detection of the level of immunoglobulin (IgG) antibodies against covid -19 virus to assess the immunological status of the patients post covid-19 infection and the risk of reinfection with covid -19

Patients and Methods

This study is Cohort study, was carried out Hemodialysis unit in Nephrology department, Ain shams university Hospital and Ain shams specialized Hospital, on 60 of heamodialysis patients divided into these three groups; (Group 1): included 20 patients that have been infected with covid 19 and confirmed positive by PCR test, (Group 2): included 20 patients who were highly suspected infection with covid-19 by CT findings, (Group 3): included 20 patients with no history suggestive of covid-19 infection during the pandemic as acontrol study group.

Results

There is astrong significance between between patients in group A (who are confirmed positive covid 19 infection by pcr test) and group B (who are suspected covid infection by ct or symptoms and laboratory findings) and group C (who are not infected or have symptoms) as regard hospital admission and home isolation. There is a significance between patients in group A (who are confirmed positive covid 19 infection by pcr test) and group B (who are suspected covid infection by ct or symptoms and laboratory findings) and group C (who are not infected or have symptoms) as regard lymphocyte count during infection, and shows that there is no significance between the groups as regard (HB, MCV, MCH, MCHC, WBCS, Platelets). Significance positive Correlation of IgG Titer with age and there is a significance positive correlation of hospital admission duration with BMI in COVID suspected patients by CT (n = 20). There is a significance between duration of infection and IgG titre as patients who were 3 months from infection have strong significans more than who were 6 months or more from infection, and there is no significance between duration of infections and labs findings. There is significance between IgG titre and duration from infection in group A and group B if the duration of infection was less than 6 months or more than 6 months.

Conclusion

There was significance between patients in group A, group B and group C as regard IgG titer. There was significance negative Correlation of IgG Titer and hospital admission duration with lymphocytes count during infection and duration form infection respectively in COVID patients confirmed by PCR (n = 20). There was significance positive Correlation of IgG Titer with age and there was a significance positive correlation of hospital admission duration with BMI in COVID suspected patients by CT (n = 20).
The Assessment of Fibroblast Growth Factor 19 as a Non-Invasive Serum Marker for Hepatocellular Carcinoma
Authors: Nashaat Ehab Hassan , ElGhandour Ahmed Mohamed , Ahmed Ghada Abdelrahman , Fawzy Hadeer Mohammed
Published: August 2023

Background

Liver cirrhosis represents the end stage of several chronic liver injuries. It is characterized by degeneration, regeneration by nodules with loss of lobular architecture, which results in decrease of liver cell mass, portal hypertension and porto-systemic shunt opening.

Aim of the Work

To investigate the diagnostic performance of fibroblast growth factor 19 as a potential novel biomarker for hepatocellular carcinoma for the detection and prognostic stratification of HCC.

Patients and Methods

This was a case control study that was conducted on 90 Egyptian participants aged ≥ 18 years old in Internal medicine - Gastroenterology and Hepatology department Ain Shams University through 6 months.

Results

No statistically significant difference between three groups (control, HCC, CLD) regarding age and sex. There was highly statistically significant difference found between two groups regarding CHILD regarding HB, Platelets, ALT, AST, Albumin, INR and Bilirubin. No statistically significant difference was found between three groups regarding WBCs, creatinine and urea. The mean platelets count was highly significant lower in cirrhotic group than control group but there was no significant difference count the mean platelets count was highly significant lower in cirrhotic group than control group No significant difference was found between HCC and cirrhotic groups regarding platelets count.

Conclusion

FGF19 is promising marker for the diagnosis of HCC.
Impact of Hemodialysis Time Prolongation on Blood Pressure Control
Authors: El-Sharkawy Magdy Mohammed Saed , Teama Nahla Mohamed , Mohsen El-Sharabasy Reem , Soliman Heba Soliman Mohammed
Published: August 2023

Introduction

Hypertension prevalence among ESRD patients range from 76% to 90%. Sodium & volume overload is among the main mechanisms. Increasing the duration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours. We aim to study the effect of increasing hemodialysis session time on blood pressure control.

Methods

This observational study was conducted on 50 adult clinically stable hypertensive prevalent HD patients on thrice weekly maintenance HD. Patients with secondary causes of hypertension and Patients with decompensated medical conditions were excluded from our study. Patients were divided into 2 groups: (A) 25 patients who received longer session hemodialysis session (4.5 hour) and (B) 25 patients HD who received the usual 4 hours session. Revision of antihypertensive medications& dosages, dry weight was reassessed regularly, and they were instructed to restrict their salt intake as much as possible aiming at BP < 140/90 mmHg. they were followed up for a period of 6 months assess changes of pre-dialysis blood pressure to monitor response.

Results

Patients in both groups were age matched, with male sex predominance (64%in groupA&56% in groupB). Patients in both groups underwent their HD sessions mostly through AVF (68% and 92% for group A and B respectively). Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (pvalue <0.001 vs 0.523). Longer HD session time session was associated with highly significant decline in mean SBP, (p-value <0.001). Longer HD session time session was associated with highly statistically significant decline in mean DBP, (p-value <0.001). The decline in mean perdialysis SBP & DBP was -17.27 &-9 mmHg, respectively and the rate of decline of postdialysis SBP & DBP was -6.45 & -12.38 mmHg, respectively at 6th month compared to values in 1st month of follow up period.

Conclusion

Longer HD session duration is associated with better improvement in UF volume, mean SBP&DBP, pre-dialysis SBP&DBP and post-dialysis SBP&DBP as well.
Study of Serum Copeptin Level as a Novel Biomarker Predicting Liver Fibrosis in Hepatitis C-Infected Patient
Authors: Hussein Emad Ahmad Awad , Mohammed Khaled Abdulhameed , Elessawy Hagar Ahmed Ahmed , El- Sayes Hussein Mohamed Hussein
Published: August 2023

Background

There are many factors that can lead to liver cirrhosis and portal hypertension, which include viral hepatitis, alcohol abuse, sclerosing cholangitis, and common inborn errors of metabolism that include Wilson disease, hemochromatosis, and alpha-1 antitrypsin deficiency. Viral hepatitis accounts for the majority of chronic liver diseases (CLDs) worldwide, CLD can progress to significant liver fibrosis or cirrhosis.

Objective

To evaluate copeptin as a novel marker in predecting liver fibrosis in HCV infected patient.

Patients and Methods

60 patients were recruited from the Department of Internal Medicine and the Outpatient Clinic of Ain Shams University hospital in the period between June 2020 and June 2021.

Results

We found in our study that copeptin level at cut-off value 6.97 pmol/l with 93.3% sensitivity, 80% specificity,+ve pv82.4, _ve pv 92.3 and accuracy 73% to differentiate cirrhosis (F4) from fibrosis (F3) this was in agreement with Khaled et al., who found that copeptin at cut-off 7 pmol/l with 78%sensitivity, 85%specificity, +ve pv 83 and _ve pv 81 to differentiate compensated cirrhosis group from decompensated cirrhosis groups.

Conclusion

We studied serum level of copeptin in 60 HCV- patients classified in to two group aaccording to fibroscan score as discussed before. concluded for significant increase of serum copeptin in liver cirrhosis group than other fibrosis groups, Also concluded for Copeptin concentrations increase along with the severity of liver disease as well as some of its complication.
Serum Amyloid A as a Surrogate Marker for Mucosal and Histologic Inflammation in Patients with Crohn’s Disease
Authors: Abdellateef Hatem , Mohamed Inas Elkhedr , Samaan Amira Isaac , Yousef Mahran Allam Abdelhafeez
Published: August 2023

Background

Inflammatory bowel disease (IBD) comprises a heterogeneous group of conditions affecting the gastrointestinal tract; Crohn’s disease (CD) and ulcerative colitis (UC) are the two main recognize dentities.

Aim of the Work

The aim of the study is to assess the correlation between Serum Amyloid A and mucosal inflammation in patients with Crohn’s disease

Patients and Methods

This study a prospective cross-sectional single centered study which was carried out on CD patients sought medical advice at Ain Shams outpatient clinics.

Results

Our results showed highly significant relation between SAA and most of symptoms namely fever, abdominal pain, blood in stool, tenesmus, urgency and number of bowel movements. However, there was no statistically significant relation to weight loss. It worth mention that the relation between SAA levels and history of smoking had borderline statistical significance, while the relation to gender was not statistically significant. Finally, our results showed the sentivity of the major studied markers to detect active CD namely SAA, CRP and Calprotectin was 87.9%, 78.8% and 81% respectively while their specificity was 87.9%, 97% and 60% respectively. SAA was the overall best performing biomarker for CD activity in the current results.

Conclusion

We concluded that: SAA levels are always significantly higher in patients with CD activity. SAA levels correlate well with all clinical and laboratory signs of CD activity. SAA has an overall accepted sensitivity and specificity which is compared to CRP and fecal calprotectin. Despite higher sensitivity and specificity, using SAA alone as a marker of activity may not achieve a satisfactory diagnostic performance. It's better to be used in combination with other biomarkers.