bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Safety and Applicability of Laparoscopic vs Open Non Anatomical Resection of Hepatocellular Carcinoma in Cirrhotic Patients
Authors: Mohammed Mohammed Mahfouz , Basset Hany Saeed Abdel , Elsayed Mohammed Abd Almegeed , Hegazi Ahmed Abdel Basset
Published: October 2021

Background

Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical technique and equipment evolved to overcome technical limitations, making laparoscopic liver resections (LLR) safe and feasible. Surgeons developed skills in a stepwise approach, beginning with low complexity operations for benign diseases and reaching high-complexity surgeries for malignant cases and living donor organ harvesting.

Objective

s: The aim of the study is to compare short term results of laparoscopic versus open hepatectomy regarding to intra operative details and post-operative management and complications for achieving a safe hepatic resection for treatment of HCC in cirrhotic patients.

Patients and Methods

In this prospective study, a comparison between laparoscopic resection and open resection was done to compare short-term results between laparoscopic and open liver resection. This study was conducted on 30 patients with hepatocellular carcinoma. 15 patients (50%) were treated by laparoscopic liver resection (Group A) while the other 15 patients (50%) were treated by open liver resection (Group B).

Results

Regarding the demographic data, the presence of past history of medical condition and the preoperative laboratory results, no statistical significance was found. The mean operative time has statistically significant difference between the 2 groups, with decreased operative time in the laparoscopic group (P < 0.001). The mean blood loss has no statistically significant difference relations between the 2 groups, (P = 0.866) with conversion rate of (13.3%) happened in two cases.

Conclusion

Laparoscopic liver resection is a safe and feasible treatment option for HCC in cirrhotic patient needing minor resection at laparoscopic segments (II, III, IVa,V,VI). Laparoscopic liver resection for HCC has superior short- term and comparable oncological outcomes to open liver resection. LLR should be performed for carefully selected patients and by an expert surgical team.
Surgical Management of Early Hepatocellular Carcinoma
Authors: Ewada Adel Abdel Aziz , Mohamed Sherif Boraii , Marie Alshimaa Khalil Abdelmonem
Published: October 2021

Background

Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy ranking sixth in the world among all malignancies and becoming the third cause of death due to cancer. Incidence has increased all over the world, mainly because of increase in the incidence of chronic hepatitis B (HBV) and hepatitis C (HCV) infections

Objective

To study hepatocellular carcinoma in terms of pathogenesis, staging and diagnosis as well as discuss its surgical management and follow up afterwards.

Patients and Methods

Design: Prospective, comparative study. Setting: NHTMRI (national hepatology and tropical medicine research institute). Study duration: Period 3 years from April 2017 - April 2020. Patients: A total of 50 early HCC patients enrolled in the study.

Results

After applying (Forward method) and entering some predictor variables; the increase in operative time; had an independent effect on increasing ICU stay (p < 0.01). After applying (Forward method) and entering some predictor variables; the increase in age and operative time; had an independent effect on increasing drain removal days (p < 0.05 respectively).

Conclusion

Laparoscopic liver resection (LLR) is now considered a feasible alternative to open liver resection (OLR) in selected patients. Nevertheless studies comparing LLR and OLR are few and concerns remain about long-term oncological equivalence. LLR has short-term advantages and seemingly equivalent long-term outcomes and can be considered a feasible alternative to open surgery in experienced hands.
White test versus conventional saline test in detecting intra-operative bile leakage in liver resection
Authors: Wagdi Hesham Hasan , Khalil Ahmed , Saber Hatem Sayed , Gamal Elden Karim Mohamed
Published: October 2021

Background

Hepatic surgery will be always one of the most challenging surgical procedures due to its anatomical and pathophysiologic varieties. Various problems may complicate the post-operative course. Bile leak remains a serious complication after hepatectomy. Bile leaks can significantly impact morbidity, mortality, and cost of treatment. Bile leak increases risk of sepsis, need for further intervention, either radiological or return to theatre, prolongs duration of intensive care unit and hospital stay, and can precipitate liver failure and death.

Objective

To assess the post-operative bile leak complication after using white test versus conventional saline test

Patients and Methods

A prospective study on 50 Hepatectomy cases divided into two groups, the first group consist of 25 cases using white test and the second group consist of 25 cases using conventional saline test from January 2019 to January 2020, at Hepatobiliary unit of the general surgery department of Ain Shams university hospitals.

Results

The White test has clear advantages in comparison with other bile leakage tests: it precisely detects bile leakages, regardless of size; it does not stain the resection surface, allowing it to be washed off and repeated ad infinitum; and it is safe, quick, and inexpensive. The white test is a feasible and sensitive bile leakage test with no obvious disadvantages. It could be a possible standardized method to prevent bile leakage in major liver resection.

Conclusion

Now after we discussed our study and reviewed other opinions discussing the optimal methods for intraoperative bile leakage testing, we have now settled on White test using fat emulsion solution to be best of all tests.
Gastric Bypass versus Sleeve Gastrectomy in Morbid Obesity Management
Authors: Gawdat Khaled A , El Shayeb Basem H , Naguib Kerolos R
Published: October 2021

Background

Obesity is caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications, or psychiatric illness. The main aim of obesity therapy is weight loss and maintenance by dietary interventions and increased physical activity.

Aim of the Work

to review two of the most commonly performed modalities of weight loss namely Sleeve Gastrectomy, Gastric Bypass, and to study their early post-operative complications, outcomes, effects regarding excess body weight loss (EBWL), life style changes and sustainability.

Patients and Methods

This is a prospective comparative randomize study included 40 patients presented with morbid obesity with BMI range between (40 to 60 kg/m2) were treated 20 cases by laparoscopic sleeve Gastrectomy and 20 cases by laparoscopic Gastric Bypass (15 cases one anastomosis gastric bypass – 5 cases Roux-en-Y bypass) in Ain Shams Hospital during the period from October 2017 till May 2018. Cases were followed up monthly for 6 months and after 1 year.

Results

Laparoscopic sleeve gastrectomy has higher incidence of complications (15%) than the incidence of complications of Laparoscopic Gastric Bypass (5%).

Conclusion

Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Bypass are both safe and effective procedures for the surgical management of morbid obesity. Laparoscopic Gastric Bypass has slightly higher mean of (EBWL%) than Laparoscopic sleeve gastrectomy at 6 months, and a higher mean of (EBWL%) than Laparoscopic sleeve gastrectomy at 1 year follow up.
Round Block Technique versus Grisotti Technique in Juxta Areolar Breast Cancer
Authors: Shehab Mohamed Ahmed Helmy , Elmoaty Karim Fahmy Abd , Elsebaai Mahmoud Refaat Mohamed
Published: October 2021

Background

Breast cancer is the most common cancer in women all over the world representing 18% of all women reported cases of cancer. It represents the leading cause of women mortality as representing 23% of all women cancer deaths.

Objectives

To compare aesthetic and surgical outcome of Round block technique and Grisotti technique in juxta areolar breast cancer.

Patients and Methods

In our study 20 breast cancer patients are subdivided into group (A) 10 females which underwent round block technique and group (B) 10 femaleswhich underwent grisotti technique. Patient and tumor criteria including age, co morbidities, tumor size and distance between tumor and nipple-areola complex were considered to be nonsignificant between 2 groups so the only difference is the surgical technique.

Results

The study shows that the round block technique and grisotti technique have the same results regarding operative time, intra-operative blood loss, post operative complications and re-excision rates with slight advantage to round block technique because of its slightly better cosmetic outcomes. So, the round block technique is slightly preferred for selected cases.

Conclusion

When to compare between round block technique and grisotti technique In treatment of juxta areolar breast cancer, there in no evident difference in operating time, post operative complications or need of re-excision between these two groups of patients
Blind Comparative study between Silver nanoparticles dressings and Standard Moist Wound Dressings (SMWD) in management of diabetic foot ulcers
Authors: Abdelaal Amr , Soliman Mostafa , Rafik Hany , Emam Mohamed , Mohamed Elsadek Mohamed Mahmoud
Published: October 2021

Background

Diabetic foot ulcers (DFUs) are the main cause of hospitalization in diabetic patients and they are considered a major worldwide health problem. Thus, there is a need to evaluate various treatment modalities. In this study we will assess the clinical efficacy of Silver nanoparticles dressing vs Standard Moist Wound Dressing (SMWD) in management of diabetic foot ulcers.

Objective

To compare wound outcome, limb salvage, healing time of diabetes related foot ulcers and cost effectiveness in terms of duration of hospital stay between Silver nanotechnology dressings and Standard moist wound therapy (SMWT) in management of diabetic foot ulcers.

Patients and Methods

This is a prospective randomized controlled study involving 34 patients with active diabetic foot ulcers, in a high volume tertiary referral vascular center. They were divided into 2 groups: 17 patients (group A) were prescribed SMWD and the other 17 patients (group B) received Silver nanoparticles wound dressing.

Results

Our study correlates with the study conducted by K.Suhas et al. which had observed that Silver nanoparticles wound dressing was safe and effective treatment for complex diabetic foot wounds and could lead to higher proportion of healed wounds and faster healing rates. At the end of the study, group B promised a better outcome as compared to group A.

Conclusion

The role of Silver nanoparticles wound dressing in healing of diabetic foot ulcers has been proposed as a novel method of manipulating the chronic wound environment in a way that it reduces bacterial burden and chronic interstitial wound fluid, increases vascularity and cytokine expression and to an extent mechanically exploiting the viscoelasticity of peri wound tissues.
Role Of Laparoscopy In Blunt Abdominal Trauma: A Comparative Prospective Cohort Study Between Laparoscopy And Laparotomy In Patients With Blunt Abdominal Trauma
Authors: Ouf Tarek Ismail , ElShinawi Mohamed ElSayed , Abbas Ahmed Adel , El Sayed Nagy Mostafa
Published: October 2021

Background

Trauma is considered to be the main leading cause of death in young adults under 35 years old. Blunt mechanisms accounts for about 95% of injuries. Generally, laparotomy is considered to be the standard procedure used in the trauma cases. Recently, laparoscopic techniques have been increasingly introduced as an alternative to open surgery in trauma cases. This study aims to assess the efficacy of Laparoscopy in management of patients with Blunt abdominal trauma in order to avoid unnecessary laparotomies.

Objective

To investigate the effectiveness and role of laparoscopy in the management of blunt abdominal trauma patients.

Patients and Methods

Observational prospective cohort study. Ain Shams University Surgery Hospital. All isolated blunt abdominal trauma patients at Ain Shams University Surgery hospital from 1/3/2019 to 1/9/2019. Eligibility and exclusion criteria applied as following:

Eligibility criteria

All patients with blunt abdominal trauma presented to ASUH. Patients with class I &class II according to ATLS guidelines for hemorrhagic shock in trauma patients. Patients aged 18 years old or above. Exclusion criteria: Patients with class III &class IV according to ATLS guidelines for hemorrhagic shock in trauma patients. Pregnant patients. Patients with old trauma presented after 24 hours. Patients discharged on demand.

Results

Laparoscopy decreased the operative time in comparison with laparotomy, the mean operative time for patients underwent laparoscopy is 123.28 minutes while in patients underwent laparotomy is 150.48. Also, time to pass gas post operative after laparoscopy is 1-3 days compared to 2-4 days after laparotomy which is in favor of laparoscopy which is associated with rapid recovery of patients. Laparoscopy is associated with decreased post operative ICU stay (1-3) days in comparison with Laparotomy (2-5) days and decreased total hospital stay. The rate of complications after laparoscopy is much less than after laparotomy, 2 patients with respiratory tract infections after laparoscopy and no mortality while six patients with respiratory tract infections, 6 patients with wound infection, one patient with deep venous thrombosis and 2 patients died after laparotomy.

Conclusion

Laparoscopy is found to be a good alternative to laparoscopy, as it is considered to be reliable and safe as a diagnostic and treatment method in hemodynamically stable patients with blunt abdominal trauma, it can be used to reduce the laparotomy rate, and it is associated with lower morbidity and mortality.
Reconstructive Techniques of Primary Distal Penile Hypospadias: A Meta-Analysis Study of Last 10 Years
Authors: Mohammad Omar Goda Hassan , Reyad Khaled Ahmed Mahmoud , Ali Hassan Ahmed , Abdelgawad Osama Fouad Mohamed
Published: October 2021

Background

Hypospadias is one of the most common congenital anomalies affecting males worldwide, with distal variants representing up to 70% of all cases. Several surgical techniques are adopted for distal hypospadias repair. However, there is still much controversy about the ideal technique.

Objectives

The aim of this study is to compare between the most popular reconstructive techniques for distal penile hypospadias repair. Highlighting their effectiveness, in term of success rate as well as the risk of postoperative complications.

Methods

For this systematic review, PubMed/Medline and ScinceDirect online databases were searched using the keywords ‘distal hypospadias, complications and outcome’. Inclusion criteria were primary repairs; distal hypospadias; pediatric case series and standard techniques. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable, which are postoperative fistula, meatal stenosis and glanular dehiscence. Data were pooled using CMA software, effect sizes were reported as event rates with 95% confidence intervals (CI) been calculated for each outcome.

Results

A total of 25 studies, which included 4572 patients, met the inclusion criteria. The tubularised incised plate (TIP) was the most commonly adopted procedure followed by the peri-meatal flap (Mathieu). Few studies reported data for other techniques like onlay flap, Thiersch-Duplay, meatal advancement and MAGPI procedures, in addition to urethral mobilization technique. The overall incidence of main complications was 10.5% with comparable results among different techniques. The results are in favor of urethral mobilization and TIP procedures over Mathieu regarding the incidence of both meatal stenosis and post-operative fistula. Overall, the quality of the included studies was determined to be satisfactory.

Conclusion

Compared with Mathieu technique, urethral mobilization and the TIP procedure for distal penile hypospadias (DPH) reconstruction were associated with a lower risk of overall complications specifically postoperative fistula and meatal stenosis.
A Histological study on the effect of Platelet Rich Plasma on Hair Growth in Male Albino Rat Model of Androgenic Alopecia
Authors: Nada Hoda Fouad , ElSebay Sarah Abdel Gawad , El-Waseef Dalia Alaa El-Din Aly , Saad Nancy Sultan
Published: October 2021

Background

Androgenetic alopecia (AGA) is the commonest cause of hair loss in men with limited treatment options. Platelet-rich plasma (PRP) is defined as an autologous concentration of plasma with a greater count of platelets than that of whole blood. Its action depends on the released growth factors from platelets. It has been investigated and used in numerous fields of medicine. Recently, PRP has received growing attention as a potential therapeutic tool for hair loss.

Aim of the work

This study aimed at evaluating the efficacy of PRP therapy on experimentally induced AGA in male albino rats.

Materials and Methods

Eighteen rats were divided into 3 groups - Group I (the control group), Group II (testosterone group): rats were injected 0.1 ml testosterone daily in the shaved area of the dorsum , Group III (PRP group): rats were injected 0.1 ml of testosterone daily+ 0.1 ml of PRP every 3 days in the shaved area of their dorsum. After 21 days from the start of the experiment, skin samples were collected from the site of injection and prepared for histological examination by hematoxylin and eosin stain and immunohistochemical examination by anti Ki 67. Morphometrical and statistical analysis were performed.

Results

Testosterone group when compared to the control group showed a significant decrease in the mean epidermal thickness, decreased mean number of anagen hair follicles, increase in the mean number of telogen hair follicles and decreased anagen/telogen ratio, all were statistically significant (P < 0.05). PRP group showed significant increase in the mean number of anagen hair follicles (p < 0.05), and a decrease in the mean number of telogen hair follicles (p < 0.05). This resulted in an increase in anagen/telogen ratio. There was also a significant increase in the mean epidermal thickness in the PRP group as compared to the other groups (p < 0.05). Immunohistochemical examination of anti Ki 67 stained sections showed significant decrease of the mean number of Ki 67 positive basal epidermal cells (P < 0.05) in the testosterone group compared to control group, and an increase in the mean number of Ki 67 positive basal epidermal cells in the PRP group (p < 0.05) as compared to the control group and the testosterone group.

Conclusion

Our data suggest that PRP injections may have a positive therapeutic effect on experimentally induced androgenic alopecia in adult male albino rats.
Study of serum Fetuin-A level in pateints with post HCV liver cirhosis with and without hepatocellular carcinoma
Authors: Mohamed Mansour N , Yousry Wael A , Soliman Mohamed L , Zaki Khalid A , Tawfik Abdalla M
Published: October 2021

Background

Measurement and assessment of the levels of glycoprotein as fetuin-A which provides insights into the pathogenic mechanisms of various liver diseases and improved capability to identify disease- specific profiles of proteins leads to more accurate prediction of disease classes and development of novel treatments.

Aim of the work

Assessment of diagnostic value of Fetuin –A in cases of liver cirrhosis due to HCV with and without HCC.

Patients and methods

This study was conducted at the Internal Medicine, Faculty of Medicine, Zagazig University, during the period from November 2014 to Decmeber 2015 on 80 patients with liver cirrhosis due to chronic HCV infection. Two groups of post HCV patients with liver cirrhosis as a first group & post HCV liver cirrhosis with HCC as a second group; each group included 40 patients. The study also included 20 healthy subjects as a control. Patients who were excluded, those who had received antiviral therapy within 6 months before the study, subjects with high triglyceride or had received lipid lowering drugs, HBV infected patients, patients with medical history of ESRD, diabetes mellitus.

Results

fetuin A was significantly lower in post HCV liver cirrhosis than a healthy control cases, fetuin-A was significantly lower in post HCV liver cirrhosis with HCC versus post HCV liver cirrhotic patients. Serum levels of fetuin A was a useful marker in post HCV liver cirrhosis with HCC, with AFP levels below cutoff value. Serum levels of AFP was a useful marker in post HCV liver cirrhosis with HCC, with fetuin-A levels above cutoff value.

Conclusion

Serum fetuin-A level is decreasing in post HCV liver cirrhosis and liver cirrhosis with HCC than in healthy control with the lowest level in HCC. Post HCV liver cirrhosis with HCC cases which are not diagnosed by alph-fetoprotein can be captured by Fetuin A and vice versa. Also, the results show no significant correlations of fetuin-A with the CP scores and MELD score in post HCV liver cirrhosis .
Incidence of intradialytic hypertension in hemodialysis patients in Beheira governorate and effect of high flux versus low flux dialysis on it
Authors: Mady Gamal E , El Leil Hisham Atef Abou , Tawfik Ahmed M , Elgendy Ahmed M
Published: October 2021

Background

Intradialytic hypertension (IDH) is a common complication of hemodialysis (HD) that is under-recognized and its significance is underappreciated. No standard definition of IDH exists. As a unifying criteria for the diagnosis of IDH has not been proposed, the focus of this review will be on systolic blood pressure (SBP) rise = 10 mmHg at = 4 over six consecutive sessions. IDH is estimated at 5–15% of HD patients. IDH has been associated with poor clinical outcomes in HD patients including increased hospitalizations, higher ambulatory blood pressure (BP), cardiovascular morbidity, and mortality.

Aim of the Work

To detect the incidence of IDH in HD patients in Beheira governorate and to compare the effect of high flux versus low flux dialysis on it.

Patients and Methods

This study was conducted on 200 patients on maintenance HD from different HD units in Beheira governorate. The patients were divided into two groups: Group 1: 100 patients on HD with high flux dialyzers and Group 2: 100 patients on HD with low flux dialyzers. Results: Incidence of IDH in HD patients in Beheira governorate was 23.5% at the start, 21% after one month and 13% after three months duration. Results of our study demonstrated that there were no significant differences between both groups as regards effect of high-flux vs low-flux dialysis on IDH after one month and at the end of the study (P > 0.05), but there was a significant decrease in number of IDH patients after one month duration and after three months in both high-flux and low-flux dialysis patients. In our study, there was significant improvement in the form of reductions in all of pre-dialysis BUN, post-dialysis BUN, serum creatinine levels and serum IPTH levels at the end of the study in high flux group compared to low flux group. Finally, our results showed significant improvement in serum hemoglobin levels in high flux group by the end of the study in contrast to the low flux group.

Conclusion

No significant difference in the effect of high flux versus low flux dialysis on IDH, but there was significant improvement in all of pre-dialysis BUN, post-dialysis BUN, serum creatinine levels and serum IPTH levels by the end of the study in the high flux group compared to the low flux group.
Impact of Hepatitis C Virus Eradication Following Direct Acting Antivirals on Liver Stiffness Measurement
Authors: Ghaly Sameh , El-Ray Ahmed , Castera Laurent , Al-Ashry Ahmed M
Published: October 2021

Background

Hepatitis C infection is a disease with significant global impact, about 130150 million people chronically infected with the hepatitis C virus (HCV), representing about 2-2.5% of the world’s population. In Egypt, the prevalence is 10% and according to the last DHS in 2015 it was 7%.

Aim of the Work

to evaluate the effect of SVR using DAAs on the stage of the liver fibrosis in HCV patients by measuring of liver stiffness, using transient elastography before and after receiving treatment.

Patients and Methods

This study was conducted in co-operation between Gastroenterology and Hepatology Department, AinShams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute between January 2019 to September 2019. It included 103 adult Egyptian patients who received SOF/DAC for three months and were assessed before and after achieving SVR-24. The patients were recruited from the outpatient clinic of Theodor Bilharz Research Institute Hospital (after consents were obtained).

Results

study showed that achieving SVR-24 was associated with improvement of LSM assessed by Transient Elastography and application of FIB-4 score and overall improvement of liver biochemistry as shown by reduction of AST, ALT and serum bilirubin and increase of serum albumin, INR and platelets. This was accompanied by increase of hemoglobin, Creatinine and BMI. The study also showed despite the fact that results were accompanied by significant improvement in LSM, Fib-4 and liver biochemistry, achieving SVR did not guarantee improvement of cirrhosis; only 29% of cirrhotics regressed to sub-cirrhotic range (LSM <12.5 kPa).

Conclusion

Sofosbuvir / Daclatasvir combination is effective and well tolerated for treatment of genotype 4 chronic hepatitis C patients. Achieving SVR-24 was associated with significant improvement of LSM using transient elastography to assess liver fibrosis. Achieving SVR-24 was associated with overall improvement of liver biochemistry. Improvement of LSM was more in cirrhotic patients than non-cirrhotic patients.
The role of hepcidin as a biomarker for iron status in patients with chronic kidney disease (stage IV and V) with negative virology
Authors: El Sharkawy Magdy M , Elsaid Heba W , Khedr Lina E , Ibraheem Ahmed M
Published: October 2021

Background

Anemia is a severe complication of chronic kidney disease (CKD) that is seen in more than 80% of patients with impaired renal function. Hepcidin, an acute phase reactant protein produced in the liver, is a key regulator of iron homeostasis.

Aim of the Work

to assess hepcidin level in 45 non-dialysis patients (CKD stage IV and V with negative virology) and its relation to iron parameters.

Patients and Methods

A cross sectional study was conducted at Nasser Institute for Treatment and Research on 45 patients with chronic kidney disease stage IV and V. All patients included in this study were subjected to the following: Careful history taking, full clinical examination and proper laboratory investigations.

Results

A statistically significant difference was found between CKD stage 4 and stage 5 according to Hb., iron, TIBC, Frerretin, serum and CRP. Also, there was a significant positive correlation of serum hepcidin with serum ferretin and hsCRP, while Hb and iron were significantly negatively correlated with hepcidin. We found statistically significant decrease in Hb level, serum Iron level, and TIBC in CKD stage 5 less than stage 4. We found statistically significant increase in Hepcidin level, serum ferritin, and hsCRP in CKD stage 5 more than stage 4. We found statistically significant Positive correlation between serum hepcidin with serum ferretin among patients with CKD stage 4 and 5. We found statistically significant Positive correlation between serum hepcidin with hsCRP among patients with CKD stage 4 and 5. We found statistically significant negative correlation between serum hepcidin with Hb among patients with CKD stage 4 and 5. A statistically significant Positive correlation between serum hepcidin with serum Iron among patients with CKD stage 4 and 5. Also we reported a statistically non-significant negative correlation between serum hepcidin and TIBC.

Conclusion

Elevated hepcidin can predict the need for parenteral iron to overcome hepcidin-mediated iron-restricted erythropoiesis and need for relatively higher rhEPO doses to suppress hepcidin in CKD patients with negative viral markers.
Correlation of Serum Vitamin D Levels to Vascular Access Dysfunction in Prevalent Hemodialysis
Authors: Abdel Salam Mona Hosny , Jan Farid Reem , Abdelgawad Mostafa Abdelnassier , Youssef Ismail Marwa Salim
Published: October 2021

Vascular access dysfunction in hemodialysis patients has been correlated to low serum vitamin D level in previous studies. Vitamin D deficiency and hepatitis C virus infection have been linked to endothelial cell dysfunction, promoting inflammatory cascade.30 negative - & 30 positive - hepatitis C virus patients on prevalent hemodialysis in Ain Shams University Hospitals, were enrolled in the study. All patients had access blood flow < 800 ml/min. For all patients we performed: complete physical examination, complete blood count, serum ferritin, ESR 1st and 2nd hours, CRP, blood urea, serum creatinine, serum albumin, total and direct bilirubin, alanine transferase, aspartate transferase, prothrombin time, International Normalized Ratio, serum calcium and phosphorus, and serum intact parathyroid hormone. Previous laboratory tests were performed using conventional methods within our hospitals laboratories. Serum vitamin Dlevel was measured by Enzyme Linked Immunosorbent Assay. Access blood flow was measured by Duplex Ultrasound. Vitamin D serum level was < 20 ng/ml within negative and positive groups with no significant difference between them. Vascular access flow was significantly lower within positive patients. Parathyroid hormone, Phosphorus, Prothrombin time, International Normalized Ratio, Alanine - and Aspartate - transferase were significantly higher within positive patients. We deduced that Vitamin D level < 20ng/ml was associated with reduced vascular access blood flow < 800 ml/min, with much more reduced access flow within hepatitis C virus positive patients.

[Mona Hosny Abdel Salam, Reem Jan Farid, Mostafa Abdelnassier Abdelgawad and Marwa Salim Youssef Ismail. Correlation of Serum Vitamin D Levels to Vascular Access Dysfunction in Prevalent Hemodialysis.
The Significance of “Fractional Excretion of Urea” in The Differential Diagnosis of Acute Kidney Injury in Cirrhotic Patients
Authors: Ghaly Sameh Mohamed , Seyam Moataz Serry , Aly Mohamed Osama , Hesham Abdelfattah Ahmed Mohamed , R. Mashaal Ahmed
Published: October 2021

Background

Patients with cirrhosis are more susceptible to develop AKI than the non-cirrhotic individuals. AKI has an estimated prevalence of approximately 20% to 50% among hospitalized patients with cirrhosis. Physicians caring for patients with cirrhosis should recognize the acute or chronic character of renal disease, the causes of renal injury, the clinical conditions leading concomitantly to AKI and liver dysfunction, and the prognostic factors associated with the progression of AKI. Hypovolemia (due to diuretics, hemorrhage and diarrhea), acute tubular necrosis (ATN), sepsis, nephrotoxic agents (such as nonsteroidal anti-inflammatory drugs, aminoglycosides and/or radiological contrasts) and hepatorenal syndrome (HRS)-type 1 are the most common causes of AKI in cirrhotic patients.

Objective

To evaluate the sensitivity of fractional excretion of urea (FEUrea) vas a diagnostic biomarker for different causes of acute kidney injury in liver cirrhosis.

Patients and Methods

This study was conducted in co-operation between Tropical Medicine Department, Ain-Shams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute between July 2019 to January 2020. It included 70 adult Egyptian patients admitted for treatment of complications of cirrhosis who fulfilled the eligibility criteria and compared to 10 cirrhotic patients without renal impairment. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations, Child-Pugh score was calculated for admission and urine samples were collected for urinary urea and creatinine levels to calculate FEUrea.

Results

Concerning the gender distribution in this study, male to female percent was 40 (57.10%) males and 30 (42.90%) females for gender, respectively. As regards to the causes of AKI, there were 24 (34.30%) PRA, 7 (10.00%) HRS and 39 (55.70%) ATN for final diagnosis. In the current study, there was significant difference (P = 0.0001; P < 0.05) in FE urea % among PRA, HRS and ATN groups (26.28±2.89, 11.76±3.44, and 47.37±10.53, respectively). Findings showed a higher FEUrea cut-off for ATN (>33%) compared to lower cut-off values for PRA (<33% and >21%) and HRS (<21%).

Conclusion

FEUrea was found to be an excellent simple tool for the differential diagnosis of AKI in patients with decompensated cirrhosis and ascites. FEUrea has also proven to be a useful “tubular injury” marker by differentiating ATN from non-ATN with high diagnostic accuracy (Sensitivity and Specificity exceeding >90%). FEUrea was found to be a good alternative and noninvasive tool for differentiating causes of AKI in cirrhotic patients instead of other non-available or expensive markers.
Assessment of Omentin- 1 AS AN Adipokine in obese male and females with and without fatty liver disease
Authors: Ali Marei Makhlouf Mohammed , Gamal Gina , Magdy Ahmad , Ali Mustafa Eid Amal Muatafa
Published: October 2021

Background

Omentin-1 (intelectin-1) “a new adipokine described in 2003,” acts centrally to modulate the insulin resistance, body weight, and inflammation. However, its role in the liver pathogenesis and in the metabolic consequences of the liver disorders is not fully elucidated.

Aim and objectives

the aim of the study was to assess the relation of serum omentin1 with fatty liver in obese and non-obese

Subjects and methods

This was a comparative case control study was conducted at Ain Shams university hospital. Patients were divided in to two group: Group1: 40 patient 20 patient with fatty liver 10 of them obese and 10 non-obese compared with 20 not have fatty live 10obese and 10 non-obese, group 2. The duration of the study ranges from 6-12 months.

Results

There was statistically significant difference between the four studied subgroups as regard Omentin1 and Apelin. There was statistically significant difference between group A and group B in obese as regard Omentin1 and Apelin.

Conclusion

Omentin-1 might be considered as a protective factor in the evaluation of occurrence of NAFLD, especially in central obese patients. Thus, the measurement of these novel adipokines may contribute to the evaluation of NAFLD occurrence.
Changes in Serum Level of Autotaxin with Direct-Acting Antiviral Therapy in Patients with Chronic Hepatitis C
Authors: Abdelwahab Khaled Mohamed Hussein , Saleh Shereen Abou Bakr , Ahmed Ghada Abdelrahman , Gomaa Mady Asmaa Mady
Published: October 2021

Background

Hepatitis C virus virus is global health burden and major health hazard in Egypt, since the virus is the etiological factor of chronic hepatitis. Hepatitis C virus (HCV) accounts for approximately 15%-20% cases of acute hepatitis. After acute infection, around 50% to 80% of HCV patients will develop chronic infection. Approximately, HCV infects 170 million individuals worldwide). Chronic hepatitis C (CHC) patients are at high risk to develop lifethreatening complications, including cirrhosis in 20% of cases and hepatocellular carcinoma.

Objectives

The aim of this study was to validate Changes in serum level of autotaxin in patients with chronic hepatitis C before and after antiviral treatment.

Patients and methods

This study was designed as a prospective observational cohort study to evaluate Changes in serum levels of autotaxin with direct-acting antiviral therapy in patients with chronic hepatitis C before (baseline) and after (sustained virologic response week 12) treatment. This prospective study was conducted on 48 chronic HCV infected patients eligible for antiviral treatment with direct acting antivirals, agreeable to regular follow up, recruited from Hepatology and virology outpatient clinic at DMNI (Damanhour Medical National Institute) during the period from September 2018 till Mars 2019.

Results

This study showed that Autotaxin level significantly decreased from baseline to 12 weeks post-treatment. ATX therefore represents a novel non-invasive biomarker for liver fibrosis and a prognostic indicator of disease activity.

Conclusion

Serum Autotaxin was found to be higher in chronic hepatitis c and ATX levels became significantly decreased from baseline to 12 weeks post-treatment with direct acting antiviral drugs in patients achieving a SVR.
Usefulness of AF Lactoferrin Levels in Patients with Liver Cirrhosis to Diagnose Spontaneous Bacterial Peritonitis
Authors: Youssef Tarek Mohamed , Khyal Ahmed El Saady Mohmmed , Salama Mohamed Magdy , Poles Elary Abdel Maseeh
Published: October 2021

Background

Cirrhosis represents the final common histological pathway for a wide variety of chronic liver diseases. Occurrence of ascites is the most common presentation of liver cirrhosis. Spontaneous bacterial peritonitis (SBP) is observed in 15–26% of patients hospitalized with ascites.

Objectives

The aims of this study was to evaluate the usefulness of AF lactoferrin for the diagnosis of SBP and to identify a clinically useful cut-off level that can be used for future development of an important clinical, economic and time saving rapid bedside test for the diagnosis of SBP in cirrhotic ascites.

Patients and Methods

This study was conducted on 40 patients with decompensated chronic liver disease and ascites with and without spontaneous bacterial peritonitis admitted to Nasser institute for researches and treatment Hospital and Internal Medicine department, Faculty of Medicine, Ain Shams University from November 2017 to April 2018.

Results

Females were affected more than males by SBP, SBP has higher incidence in elderly compared to control group, no significant difference between studied groups regards to risk factors and Child class, HCV infection was the main etiology of liver cirrhosis in both groups while HBV infection was much less common with no significant difference between studied groups. Patients in SBP group showed positive reaction to CRP compared to control group with significant difference between them. No statistical significant differences between studied groups regards to abdominal ultrasonographic findings. Liver enzymes (ALT) and ALP were higher in SBP patients compared to non SBP patients with significant difference between them. SBP patients have higher TLC and lower MCV and platelets count compared to non SBP patients with significant difference between them. No statistical significant difference between studied groups regards to INR, Hb and MCH values.

Conclusion

Outcomes of our study provide evidence of the clinical usefulness of AF lactoferrin levels in patients with cirrhosis to differentiate those with and without SBP.
Comparison of echocardiographic parameters during long and short interdialytic intervals in hemodialysis patients
Authors: Abdelazim Abdelbassit Shaarawy , Mahmoud Badawy Labeeb , Ahmed Fatma Abdelrahman , Ali Ibrahim Hoda Gamal Eldin
Published: October 2021

Background

Cardiovascular disease is the leading cause of mortality in patients receiving haemodialysis (HD). Most HD patients follow the typical schedule of three sessions per week, and thus remain outside dialysis for two short intervals (∼ 2 days in duration) and for a longer interval (∼3 days) at the end of each week. There is a link between the long interdialytic interval and worsened cardiovascular outcomes but few studies have examined the underlying mechanisms

Objective

To compare changes in echocardiographic parameters during the 2- day (short) and 3day (long) interdialytic intervals of prevalent HD patients.

Patients and Methods

The study involved 30 stable prevalent HD patients on thrice weekly regimen. Echocardiography was done before and after the short and long interdialytic interval to study left and right ventricle functions and inferior vena cava (IVC) diameter. Patients ages ranged between 28 and 75 years with mean age of 56.23±12.31 years (43.4% females and 56.7% males)

Results

Comparison of echocardiographic measurements was done before and after dialysis between the short (2-days) and long (3-day) interdialytic interval groups (Group 1 Vs Group 2). There were no statistically significant differences between left ventricular (LV) systolic and diastolic dimensions, septum affection, ejection fraction, or pulmonary artery pressure. There were statistically highly significant differences among left pulmonary capillary wedge pressure (PCWP), IVC diameter and interdialytic weight change after dialysis session between the short and the long interdialytic interval patients' groups. The intradialytic weight gain (2.45 ± 1.13 vs 1.19 ± 0.78 kg), IVC diameter (11 ± 2.98 vs 9.62 ± 2.32) and PCWP (11.13 ± 2.3 vs 10.13 ± 1.55) increase were higher during the 3-day versus the 2-day interval (P < 0.001) .

Conclusion

IVC, PCWP and intradialytic weight increase was higher during the 3-day versus the 2-day interval in post dialysis comparison. IVC, PCWP and intradialytic weight gain reflect degree of volume overload and their increase especially after interdialytic interval call for need to evaluate timing and frequency of prescribed HD regimens for some HD patients.
Effect of hepatitis C eradication with DAA on type II diabetes mellitus control as regard insulin resistance & lipid profile
Authors: El sayed Osama Abo El-fotoh , Foda Enas Mahmoud , Mohammed Azza Emam , El sawy Hsnaa Abdel Majeed abd Allah
Published: October 2021

Background

Patients with chronic hepatitis C have both higher prevalence of diabetes mellitus type 2 (T2DM) and increased cardiovascular risk compared to never infected people. The patients with chronic HCV infection can have fatty liver, hypobetalipoproteinemia, and hypercholesterolemia that may cause lipid and lipid protein metabolism disorders.

Objective

To determine the effect of HCV eradication (SVR 12) on type II Diabetic patients as regard insulin resistance & lipid profile.

Patients and Methods

This study was conducted at the gastroenterology and hepatology unit, Ain shams university hospital and Ahmed Maher teaching hospital, Written informed consent was obtained from all subjects before participating in this study. 100 Egyptian patients with chronic hepatitis C and type II Diabetes mellitus were recruited and received (sofosbuvir & daclatasvir) for 3 months. patients continue on same antidiabetics all over the study.

Results

The data from the present study provide evidence of an improvement in IR after clearance of HCV by oral DAA regimen. On the basis of these data, it is possible to hypothesize that HCV clearance by DAAs improving IR and reducing stress on beta-cell function prevents or delay the development of type 2 diabetes mellitus and/or metabolic syndrome in chronic HCV infected patients.

Conclusion

The overall data of this study show that glycemic control improves in patients with diabetes after DAA induced SVR. Patients not only have an improvement in HbA1c level after achieving SVR, they are also less likely to require insulin. the viral clearance due to DAA also led to an improvement of glucose metabolism associated with a global worsening of lipid profile. The HCV clearance by DAA treatment reverses or improves IR and reduces stress on beta-cell function by emphasizing the role of HCV in the development of IR and that this result can prevent IR-related pathological conditions such as worsening liver fibrosis, development of type 2 diabetes, metabolic syndrome and cardio-vascular disorders.
Groundwater in New Valley and kidney disease
Authors: Elshinnawy Howaida A , Elsaid Tamer W , Hussein Hussein A
Published: October 2021

Background

This study was performed to assess the possible association between groundwater and kidney disease in new valley governorate .

Methods

This hospital-based cross-sectional observational study was conducted at the Department of Nephrology, Ain Shams University, Cairo, Egypt, during the period from August 2018 to January 2019. After obtaining verbal consent from all participants; the general information of each participant was recorded, full history taken and general examination was done for each participant, then urine samples and serum blood samples taken for urine analysis, serum urea and serum creatinine, then estimated glomulurar filtratin rate (eGFR) was calculated for healthy subjects groups using MDRD Equation; after that three different groundwater samples and Nile water sample collected and analyzed for different solutes and heavy metals contents.

Result

Our data suggests that rural community as in Eldakhla; which depends on groundwater supply may affected by more risk of CKD than urban community as in Cairo city, which depends on Nile water supply.

Conclusion

there are increased prevalence of CKD in New Valley governorate and this may be due to groundwater consumption .
Evaluation of plasma M2-Pyruvate Kinase as a novel biomarker in the differentiation between Functional and Organic Colonic Disorders
Authors: Youssef Tarek M , Yousry Wael A , Salama Mohamed M , Ahmed Ahmed E , Awaad Islam A
Published: October 2021

Background

Differentiating between functional bowel disorders and organic colonic disorders can often be difficult as they may be present with similar symptoms.

Aim of the Work

to evaluate the diagnostic value of plasma M2-pyruvate kinase level in differentiating functional colonic disorders (e.g: IBS) from organic colonic disorders (e.g: IBD, colorectal polyps and colorectal cancer) and to assess its use as screening tools for inflammatory bowel disease, premalignant and malignant colorectal lesions.

Patients and Methods

This study was conducted on 80 patients who divided into four groups:

Group I

included 20 patients, representing functional bowel disorders (as a control group).

Group II

included 20 patients with inflammatory bowel diseases;

Group III

included 20 patients with colorectal polyps;

Group IV

included 20 patients with colorectal cancer.

Results

The current study showed that plasma M2 - PK can be used to differentiate functional from organic colonic lesions at a cut-off point > 3 U/mL, with 93.33% sensitivity, 100% specificity, 100% PPV and 83.3% NPV. Also, plasma M2-PK can be used to discriminate between benign (colorectal polyp) and malignant colonic lesions (CRC) with a cut-off level of > 12 U/ml, with 100% sensitivity, 100% specificity, 100% PPV and 100% NPV. Also, In the present study there was a highly significant + ve correlations between Plasma M2 PK level and CEA as (r = 0.787, p value = 0.000) and their combination can give higher sensitivity and specificity.

Conclusion

Plasma M2-PK can differentiate between functional and organic colonic disorders as it is more elevated in organic than functional colonic disorders. Also, it is considered a promising rapid noninvasive biomarker for organic colonic disorders early detection and screening to reduce unnecessary endoscopic intervention.