bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Serum Zinc, Urinary Sodium and Urinary Uric Acid in Multiple Sclerosis in Egypt
Authors: Mahmoud Heba Ramadan , Nasef Ayman Mohamed , Awad Eman Mahmoud , Elhafez Mohamed Aly Abd
Published: August 2023

Background

Studies have suggested that zinc (Zn), sodium (Na) and uric acid (UA) have a role in multiple sclerosis (MS).

Objectives

Aim of study is to measure serum Zn, urinary Na and urinary UA levels in MS patients compared to healthy control (HC) subjects, and investigate the difference between the MS subtypes and correlate it with disease activity and disability.

Patients and Methods

It is a case control study was carried on 60 clinically definite MS patients, 30 Relapsing Remitting MS (RRMS) and 30 secondary progressive MS (SPMS), recruited from MS unit at Ain Shams University Hospitals, and 30 HC subjects.

Results

Regarding Zn level, there was no significance between MS and HC groups. However, significant higher level in SPMS group. There was significant higher Zn level in males of HC group only. Regarding Na level, there was significant higher level in MS group and higher level in SPMS group. There were positive correlations with duration of illness, number of relapses per year and EDSS. Regarding UA level, there was significant higher level in MS group and higher level in RRMS group. There was negative correlation with relapses rate.

Conclusion

The role of Zn level in MS is linked to disability, not its diagnosis nor its activity, due to its disturbed metabolism in CNS diseases. In addition, the role of Na level in MS is linked to higher disease activity and disability. However, the lower UA level in MS is linked to higher relapse rate, but its higher level may be a cause of disease or a consequence to effect of DMTs.
Prognostic Factors for Survival in Adult Patients with Cerebral Low-Grade Glioma
Authors: Al-Abyad Ashraf G , Abdelraheem Hesham A , Radwan Hesham M , Johny Michael Z
Published: August 2023

Background

Low-grade gliomas are considered a therapeutic dilemma because of the heterogeneity of their clinical behavior. Patients affected by these tumors are often young and management decisions should put into consideration the potential indolent nature of these tumors and the potential long-term side effects of available therapies.

Aim of the Work

to analyze the collective data from studies to define prognostic factors for overall survival in adult patients with cerebral low-grade gliomas.

Materials and Methods

We prepared this systematic review with a careful following of the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We conducted a literature search till December 2020 using PubMed, Scopus, Web of Science, and Cochrane Library. We performed a search for all published articles that evaluated the impact of several factors (patient’s age, KPS, neurological symptoms, histological subtype, pre-op tumor size, tumor crossing the midline, tumor enhancement, extent of resection, radiotherapy, and chemotherapy) on the overall survival (OS) and progression-free survival (PFS) of adult patients with cerebral low-grade glioma (LGG), Studies were independently assessed for risk of bias using (Cochrane Risk of Bias 2.0) for randomized controlled trials, and (Newcastle–Ottawa Scale) for retrospective cohort studies.

Results

Patient-related factors (age was found significant according to 14 of total 19 studies, KPS according to 7 of total 11 studies, and presence of seizures according to 5 of total 7 studies). Tumor-related factors (tumor subtype was significant according to 10 of total 13 studies, IDH-mutation according to 4 of total 5 studies, 1p/19q codeletion according to 5 of total 5 studies, and tumor enhancement according to 4 of total 7 studies), and treatmentrelated factors (extent of resection was significant according to 18 of total 20 studies, while timing and dose of radiation, combined chemotherapy and radiotherapy failed to show major statistical significance, with better PFS in delayed radiotherapy “till progression”, and slightly better OS in combined chemo, radiotherapy).

Conclusion

Highly significant factors are extent of tumor resection, patient’s age, pre-op tumor volume and molecular subtype.
Effect of Laparoscopic Suturing versus Bipolar Coagulation on Ovarian Reserve in Patients Undergoing Endometriotic Ovarian Cystectomy. A Randomized Controlled Trial
Authors: Hemeda Hosam M , Aboelnaga Ahmed Y , Elsenity Mohamed A
Published: August 2023

Background

Women enter menarche with approximately 500000 primordial follicles, which slowly drop in number throughout their reproductive lifetimes.

Aim of the Work

to determine which hemostatic procedure (hemostatic suture or electrocautery) may be less harmful after laparoscopic cystectomy, based on the status of the ovarian reserve.

Patients and Methods

The study was conducted at Ain Shams University Maternity Hospital, Obstetric and Gynecology Department, Faculty of medicine. The study population comprised females in childbearing period undergone laparoscopic endometriotic ovarian cystectomy at Ain Shams University Maternity Hospital, Obstetric and Gynecology Department, Faculty of medicine.

Results

There was no statistically significant difference found between the two studied groups regarding AMH, AFC and FSH preoperative with p-value = 0.188, 0.533 and 0.812 respectively. While there was statistically significant increase in AMH and AFC in suturing group than cautery group postoperative with p-value < 0.001 and 0.005 respectively and also statistically significant decrease in FSH in suturing group than cautery group postoperative with p-value 0.004. Results of this study showed that there was statistically significant increase in the percentage of change of FSH in cautery group (61.59 ± 39.29) than suturing group (23.46 ± 17.87) with p-value < 0.001 while there was statistically significant lower rate of change in AFC and AMH in suturing group than cautery group with p-value = 0.001 and < 0.001 respectively.

Conclusion

laparoscopic cystectomy reduces the ovarian reserve, which is more affected by hemostatic electrocoagulation than hemostatic sutures.
The Effect of Intra-myometrial Methylergonovine Injection versus Placebo on Decreasing Blood Loss during Transabdominal Myomectomy: A Randomized Controlled Interventional Clinical Trial
Authors: Tharwat Ahmed A , Maaty Aliaa M , Selim Aliaa E
Published: August 2023

Background

Uterine leimyomas are tumors of the smooth muscles and the connective tissues of the uterus. They are considered to be the most common benign pelvic tumor affecting about 20% of women above the age of 35.

Aim of the Work

to compare the efficacy of intra-myometrial methylergonovine injection and placebo injection on reducing blood loss during trans-abdominal myomectomy.

Patients and Methods

The study was conducted in Ain Shams University Maternity Hospital, where 60 patients complaining of symptomatic myomas and fulfilling the inclusion criteria of the study were recruited from the gynecology outpatient clinic of the hospital. The patients were randomly categorized into two groups; Group A: the patients received 2 ampoules of methylergonovine (Novartis India Ltd) intra-myometrial, each ampule equals to 1 ml containing 0.2 mg (Methergine)® which was infiltrated sporadically into the myoma using a 5ml syringe and avoiding direct injection into vascular area and Group B: the patients received 2ml saline intra-myometrial which was infiltrated sporadically into the myoma using a 5ml syringe and avoiding direct injection into vascular area.

Results

the mean intraoperative blood loss in the methylergonovine group was 408 ± 70.9 ml and 573 ± 88.4 ml in the control group. There was high statistically significant difference between both groups regarding estimated intraoperative blood loss as methylergonovine injection decreased the blood loss by; 164.9±20.mL (Mean±SE). The mean post-operative haemoglobin was significantly greater in study group compared with control group (10.9±0.9 versus 10.3±1.1 g/dl) as methylergonovine injection decreased the hemoglobin drop by; 0.4±0.1 mL (Mean±SE). The mean post-operative haematocrit was significantly lower among control group compared with study group (21.4-34.2 versus 25.1-37.0 %) (P < 0.001). Methylergonovine injection decreased the hematocrit drop by; 1.4±0.1 mL (Mean±SE). In the present study, the mean difference in operative time in both groups was 8.4±2.5 minutes which had a high statistically significant difference.

Conclusion

Intra-operative intra-myometrial injection of 2ml methylergonovine during trans-abdominal myomectomy significantly reduces blood loss, operative time and the need for blood transfusion.
Oral Contraceptive Pill Pretreatment in Polycystic Ovary Syndrome Patients Undergoing IVF/ICSI Using the Gonadotrophin Releasing Hormone Antagonist Protocol (A Randomized Controlled Trial)
Authors: Tamara Tarek Fathy , El-Saed Abou Gamrah Amgad , Gomaa Mostafa Fouad , Abbas Ahmed Mohamed , El-Sawy Khaled Afifi
Published: August 2023

700 women with PCOS undergoing IVF/ICSI using flexible GnRH antagonist protocol, were included in the study, and randomized to either OCP pretreatment (n = 350), or no pretreatment (n = 350). The latter group received OCP pretreatment in the form of 30µg ethinyl estradiol / 3mg drospirenone (Yasmin®, Bayer AG, Berlin, Germany) pills for an interval of 21 to 28 days; after which COH was started following a 5-day pill wash-out period.

OCP-pretreated PCOS women had more retrieved oocytes, albeit, on the expense of increased gonadotropin consumption. However, this increased oocyte yield did not translate to a significant effect on conception rates among intended-to-treat PCOS woman receiving OCP pretreatment. Conversely, it shifted among OCP-pretreated women who actually started COH cycle, to a significant 18% reduction in the probability of successful pregnancy.
Efficacy of Intravaginal Administration of Isosorbide Dinitrate Together with Misoprostol versus Misoprostol Alone in Induction of Labor
Authors: Mohamed Magdy Hassan Ahmed , Haleem Mohamed Abd ElLatif Abdel , El-Ghareeb Nermeen Ahmed Mostafa , Abd El-Hameed Nada Hisham Mahmoud
Published: August 2023

Background

Cervical ripening is a complex process involving extensive remodeling and dynamic anatomic and physiologic alternations governed by hormonal changes, inflammatory responses, vasodilatory changes, and other biological processes. Prostaglandins, produced both locally in the cervix and uterus as well as originating from the fetal membranes, play a critical role in cervical ripening and uterine contractility by increasing inflammatory mediators in the cervix and inducing cervical remodeling.

Objective

To assess the adjunctive Role of intravaginal administration of Isosorbide dinitrate in induction of labor.

Patients and Methods

This randomized controlled clinical trial was conducted at tertiary care hospital at Ain Shams University Maternity hospital (labor ward) and was randomly selected from full term patients attending the labor ward and scheduled for induction of labor.

Results

Our results revealed that the need to cesarean section was statistically significantly less frequent among Isosorbide dinitrate group. Our results revealed that the duration of induction to active phase interval and the duration of active stage of labor were significantly shorter among Isosorbide dinitrate group than among Control group.

Conclusion

As evident from the current study, both intravaginal misoprostol and combination of vaginal Isosorbide dinitrate and misoprostol are safe and effective modes of labor induction. Vaginal isosorbide dinitrate and misoprostol is more effective than misoprostol alone in terms of post induction Bishop Score, shorter induction to active phase interval and induction to delivery interval. Thus, the combined use of vaginal isosorbide dinitrate with misoprostol for preinduction cervical ripening at term may prove to be a major therapeutic advance.
Assessment of Quality of Life among Colorectal Cancer Survivors
Authors: El Husseiny Khaled , Gobran Nagy Samy , Saleh Mohamed Essam , Ahmed Ammar Abubakr Abuelwafa
Published: August 2023

Background

The concepts of quality of life and patient-centered outcomes have become popular in medical communities; however, the wide application of Quality-of-life investigations remains an obstacle for most clinicians due to the limited validation studies performed to date and the lack of disease-specific measuring instruments. Health-related quality of life has become an indispensable component of research outcomes, particularly for cancer therapy. Colorectal cancer (CRC) ranks the third in terms of incidence, but second in terms of mortality, and its incidence is steadily rising in developing nations. The burden of colorectal cancer is rapidly increasing due to the high incidence and consequences of cancer therapy. Patients who survived colorectal cancer therapies may continue to suffer from physical or psychological problems.

Objective

Validating a tool for Assessment of quality of life among colorectal cancer survivors using EORTC CR29 questionnaire, by assessment of construct Validity of the Egyptian version of the questionnaire.

Methods

This is a cross-sectional study was held in Ain Shams University Hospitals and Nasser Institute Cancer Centre for 6 months between January 2020 and July 2020 on 85 patients with colorectal cancer, received neo- adjuvant, adjuvant or palliative Therapy (Chemo or Radiotherapy), underwent palliative or radical surgery and not on treatment at time of study.

Results

85 patients (62.4% males and 37.6% females) participated in the study. All patients were diagnosed with colorectal cancer. Age was ≤ 60 years among 52.9% of patients while age was > 60 years among 47.1%. after assessing the quality of life (symptoms scale) in our studied patients using EORTC QLQ-CR29 scoring Manual, mean urinary frequency during day score was 28.47± 8 out of 100, mean Urinary Frequency during night score was 31.87 ± 10 out of 100, mean Urinary incontinence score was 32.94 ± 7 out of 100, mean Dysuria score was 16 ± 5 out of 100, mean Abdominal pain score was 25.86 ± 9 out of 100, mean Buttock pain score was 39 ± 12 out of 100, mean Bloated feeling score was 34 ± 11 out of 100, mean Blood and mucus in stool score was 18 ± 7 out of 100, mean Dry mouth score was 30.8 ± 5 out of 100, mean Trouble with taste score was 19.31 ±5.7 out of 100 & mean Hair loss score was 34.8 ± 16 out of 100. We assessed Quality of life (functional scale Table 5).Mean Anxiety for health in our studied patients was 70 ± 18 while Mean Anxiety for weight was 65.8 ± 9. Mean Body image - Attractive was 63.5 ± 8, Mean Body imageSatisfaction was 60.4 ± 12.

Conclusion

This study shows that the Egyptian version of the EORTC QLQ- CR29 is a valid tool for measuring QOL, as determined by application to a sample of Egyptian colorectal cancer patients.
The Prevalence of Punctal Stenosis as a Cause of Obstructive Epiphora in Ain Shams University Hospitals Ophthalmology Clinic
Authors: Elwan Sheriff , Zaki Rania Gamal Eldin , Elkitkat Rania Serag , El-Wakil Farah Reda
Published: August 2023

Background

Epiphora or tearing is the presence of a watering eye, which is a common complaint to be referred to oculoplastic clinics for evaluation. Not only does it cause social embarrassment, epiphora can also affect the quality of a patient's life as it may interfere with daily activities, especially reading and driving. Excessive tearing may also hinder proper visual performance.

Aim of the Work

To calculate the prevalence of punctal stenosis in patients presenting with obstructive epiphora to the outpatient ophthalmology clinic at Ain Shams University Hospitals.

Patients and Methods

This descriptive cross sectional study included 75 eyes of 51 patients, with the age ranging from 4.5 to 77 years and a mean age of 52.32 ± 16.19 years. The study results showed that punctal stenosis is the most commonly encountered cause of obstructive epiphora in the study population with a prevalence of 62.7%. There was a female predominance of epiphora and punctal stenosis (68%).

Results

Our study results revealed that epiphora was more prevalent in the older age subgroups, where the highest prevalence was among the oldest age subgroup (> 60 years old) (45.1%). Similarly, punctal stenosis was the most prevalent in the > 60 years old age sub group (56.3%).

Conclusion

Punctal stenosis is the most commonly encountred cause of obstructive epiphora in the study population, with a female predominance. Moreover, increasing age was shown to be the most important determinant for the existence of punctal stenosis.
Assessment of the Effect of Vitamin D Deficiency on Ocular Dryness
Authors: Elsherbeny Mohamed Adel Ali , Salman Abdel-rahman Gaber , Mohamed Thanaa Helmy , Abdelgawad Randa Hesham Ali
Published: August 2023

Background

Dry eye syndrome (DES) is one of the most common ocular diseases and has been recognized as an important public health problem. Dry eye is associated with chronic eye pain and an increased risk of ocular surface diseases, such as corneal ulcers and corneal abrasions. DES is a multifactorial disorder of the tear film and ocular surface,

Aim and objectives

was two-fold: (i) to demonstrate the relation between vitamin D deficiency, dry eye and impaired tear function; (ii) to investigate the possible associations among clinical parameters of hypovitaminosis D, such as fatigue, functional impairment and pain, with dry eye parameters including quantity of tears, the stability of the tear film layer and symptoms of ocular irritation.

Subjects and methods

Our study was a prospective, non-randomized study which was conducted on 36 patients with Vitamin D deficiency; The 36 vitamin D deficiency patients were classified according to dryness of eye into 2 independent groups:(1) DES group (25 patients) according to Schirmer test without anesthesia with results <10mm and Tear break-up time TBUT <10s, (2) Non-DES group (11 patients) according to Schirmer test without anesthesia with results >10mm and Tear break-up time TBUT >10s.To evaluate the relation between vitamin D deficiency, dry eye and impaired tear function The following tests were done to patients in our study: Careful history taking, full ophthalmological examination, Schirmer test, Tear break-up time and Optical coherence tomography (anterior segment).Follow up for our patients in the study after taking vitamin D supplement for 3 month and all the previous tests were repeated again.

Results

the results revealed that Comparative study between the 2 groups revealed; highly significant decrease in follow up Schirmer test, tear breakup time and tear-film height in DES group; compared to Non-DES eye group (p < 0.01 respectively). Comparative study between the 2 groups revealed non-significant difference regarding follow up tear-film width and vitamin D level (p > 0.05),

Conclusion

Our work supports that vitamin D deficiency may lead to dry eye which may carry the risk in development conjunctival squamous metaplasia and loss of goblet cells on the ocular surface, and that vitamin D plays a protective role in the development of dry eye, probably by enhancing tear film parameters and reducing ocular surface inflammation.
Pars Plana Vitrectomy for the Treatment of Diabetic Macular Edema with or without Internal Limiting Membrane Peeling: A Systematic Review and Meta-Analysis
Authors: Kh. Abdelhamied Omar , Salman Abdelrahman G , Zaki Mohamed A , Abdelhaleem Heba M , Moustafa Moustafa E
Published: August 2023

Background

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

Aim of the Work

The aim of the study was to conduct a systematic review and a meta-analysis estimating the efficacy of pars plana vitrectomy with and without internal limiting membrane peeling in treating non tractional refractory diabetic macular edema.

Materials and Methods

A comprehensive literature search was conducted using the databases Google scholar, PubMed, MEDS, web of science, EMBASE and Cochrane Library for published studies from 1 January 2000 to 1 August 2020. This meta-analysis included 14 studies. They were randomized controlled clinical trials (RCTs), and about 647 patients with DME (753 eyes) participated in these studies.

Results

This study demonstrated no statistically significant change in the mean of best corrected visual acuity (BCVA) improvement and central macular thickness (CMT) in both groups when comparing the baseline to one- and three-month follow-ups after the procedure, though with no statistically significant difference in the ILM compared to the non ILM group.

Conclusion

Pars plana vitrectomy with or without ILM peeling improves the long-term visual acuity of nontractional diabetic macular edema. Internal limiting membrane peeling, does not affect the postoperative best-corrected visual acuity significantly.
Anterior versus Posterior Approach in Surgical Treatment of Tuberculous Spondylodiscitis of Thoracic and Lumbar Spine
Authors: Ibrahim Fady Michael fahmy , Ibrahim Zakaria Hassan , Ahmed Abdishakur Mohamud
Published: August 2023

Background

Spinal tuberculosis is the most common encountered extra-pulmonary form of the disease and accounts for around 50% of musculoskeletal tuberculosis cases, thoracic spine is the most commonly affected, and involvement of lumbar and lumbosacral region is less common, spinal tuberculosis can cause severe neurological deficits, kyphotic deformities, and paraplegia.

Aim of the Work

The aim of this study is review the literature comparing the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis.

Patients and Methods

In this meta-analysis, we combined 25 studies that compared the clinical outcomes of the anterior and posterior approaches in treating 1797 patients with thoracic and lumber spinal TB. This study was approved by the Ethics Committee of Ain Shams University Faculty of Medicine. Written informed consent was not needed because of the study design (systematic review). Based on patient safety and the efficacy of the procedures, we raised three clinically crucial questions to determine the optimal surgical procedure in treating thoracic and lumbar tuberculosis. The primary data used as evidence to answer these questions were obtained from the treatment results, such as the radiologic data and patient-related outcomes.

Results

The results showed that there is no statically significant different in the operative time for the anterior approach (220.8-51.5 minutes) versus posterior approach (213.9-69.3 minutes), and no statistically significant difference was detected. Blood loss was significantly greater in the anterior approach (1125.0-275.5 mL) than in the posterior approach (710.4-192.4 mL).

Conclusion

The posterior approach showed a higher potential for maintaining the correction of deformity and a lower overall surgical complication rate; however, both groups showed no statistically significant differences in operative time, blood loss, radiological and clinical outcome; therefore posterior approach could be used as an alternative procedure to treat thoracic and lumbar tuberculosis patients in terms of pain control, Cobb’s angle, and reduction of complications, however; posterior-only approach alone cannot be used in cases of anterior abscess formation or multilevel involvement where an anterior debridement is mandatory, so; when deciding among the two procedures for treatment of thoracic and lumbar spinal tuberculosis, surgeons must thoroughly consider the patient’s specific features of spinal tuberculosis, the surgeon’s own surgical experience, the risks of surgical complications ranging from neurological to structural, and the different possible outcomes.
Minimally Invasive Plating Osteosynthesis Technique versus Anterolateral Approach for Fixation of Humeral Mid-Shaft Fractures (Systematic Review/Meta-Analysis)
Authors: Morsi Ahmed Mohamed , Ashoub Mostafa Mamdouh , Fekry Mena Rafat
Published: August 2023

Background

In this study, we performed a meta-analysis to identify whether minimally invasive plate osteosynthesis (MIPO) was superior to conventional open reduction internal fixation for treating humeral shaft fracture.

Methods

A systematic literature search was conducted up to February 2020 in ScienceDirect, Springer, MEDLINE, and PubMed databases for relevant papers that compared the outcomes of MIPO with ORPF, such as open reduction with plate osteosynthesis (ORPO) and for treating humeral shaft fractures. Meta-analysis was performed with jamovi project (2019) (jamovi Version 1.0 Computer Software).

Results

According to the search strategy, six studies that covered 300 patients were enrolled, including three randomized controlled trials (RCTs), one prospective cohort trials, and two retrospective cohort trials. Our meta-analysis did not detect any significant difference between MIPO and ORPF in terms of operative time, fracture union rate, and fracture union time. However, MIPO has a less rate of complications and iatrogenic radial nerve palsy than that of ORPO.

Conclusions

From this study, we concluded that humeral shaft fractures could be effectively treated with the MIPO technique due to the advantages of shorter fracture union time and lower incidence of fracture nonunion and iatrogenic radial nerve palsies rather than the conventional open reduction and internal fixation technique.
Development of Egyptian Practice Guidelines in Management of Stroke in Pediatrics
Authors: Hassanein Sahar M A , Mohammed Maha Zakariya , El-Din Amin Ghada Essam , Khedr Hala AbdElkader Elsayed
Published: August 2023

Background

Pediatric stroke, though not common but it is a severe disease with potentially lifelong restrictions, the etiology of acute ischemic stroke (AIS) in childhood is mostly multifactorial. Better understanding and development of practice guidelines improved the diagnosis and outcome of this disease.

Aim of the Work

This study aimed to develop Egyptian clinical practice pediatric stroke management guidelines that suitable for all resources at different Egyptian hospitals.

Subjects and Methods

Twenty six of Egyptian experts in the field of neurology in pediatrics were selected and invited to participate in this project. Two rounds Delphi techniques were applied to build up the consensus among the experts on the formulated guidelines, 75% agreement was used as cut-off.

Results

The experts agreed on the following, 60% agreed that Face, Arms, Speech, Time indications (the FAST tool) is the commonest presenting symptom of stroke in pediatrics. 80% agreed that the most common risk factors were thrombophilia, cardiac diseases followed by sickle cell disease and 100% that MRI is the best neuroimaging to be ordered for a child with suspected stroke. In terms of treatment, the panel had agreement76.9% on supporting safety of anticoagulation use in AIS and 92.3% on safety of aspirin use in prevention of stroke recurrence after exclusion of hemorrhagic stroke.

Conclusion

The present Delphi consensus process has supplied useful information on stroke diagnosis and management practice in a multicenter group of pediatric neurologists, influencing the development of a proposed local stroke guideline.
Early Onset Sepsis in Neonates
Authors: Mohamed Maha H , Mahmoud Ramy M , AbdRabou Mohamed E , Barakat Noha M K
Published: August 2023

Background

Neonatal sepsis is one of the most important causes of neonatal morbidity and mortality. The most common risk factors associated with early onset sepsis (EOS) are preterm delivery, low birth weight, premature rupture of membranes, maternal urinary tract infection, Clinical manifestations of neonatal sepsis are nonspecific. These include temperature instability, respiratory distress, apnea, poor feeding, lethargy, irritability, convulsions, hypotonia, poor perfusion and abdominal distension

Aim and objectives

To describe epidemiology, demographic and incidence of early onset sepsis in neonate with risk factors at NICUS of Ain Shams University Hospitals.

Subjects and methods

This study is prospective cohort study, was carried out on 80 neonates with one or more maternal risk factors associated with EOS. Neonates will be completely evaluated and subsequently discriminated over the period of 1st 72hours of life in Neonates with risk factors for early-onset sepsis. diagnosis of EOS will be established based on the presence of any clinical evidence suggestive of sepsis, quantitatie C-reactive protein (CRP) levels ≥6 mg/dL, Rodwell’s hematological scores ≥3 and/or Tollner’s scores ≥ 10 with or without positive blood culture results, within the 1st 72 hours postnatal age.

Result

Among the studied maternal risk factors of neonatal sepsis in our study, 73.8% had PROM being the most common maternal risk factor for early neonatal sepsis followed by ceserian mode (C.S) of delivery 66.3%, and 26.2% had Chorioamintis.

The gestational age was distributed as 36.76±3.01 with minimum 30 and maximum 42 weeks, of Ballard score 37.05±2.88 and weight was 2.87±0.82. 58.8% were females and 41.3% were males. Also, 42.5% of the studied group was preterm. 42.5% of studied group was diagnosed with sepsis.

Conclusion

Early diagnosis is important for early intervention and treatment. This diagnosis in neonates is usually based on clinical and laboratory findings.
Iron Profile and Anemia in Gaucher Patients
Authors: Tantawy Azza A , Adly Amira A , Salah Nouran Y , Abdelhamed Mohamed N
Published: August 2023

Background

Anemia associated with unexplained hyperferritinemia is a frequent finding in gaucher patients. Extensive gaucher manifestations including severe anemia and extreme splenomegaly can lead to a situation of iron-overload resembling hemochromatosis, and anemia.

Objective

of the study is to analyze hemoglobin level and iron profile in gaucher patients in comparison to normal population.

Patients and Methods

This is a case control study, comparing complete iron profile and haemoglobin level in 50 gaucher patients to 50 age and sex matched healthy controls.

Fifty gaucher patients confirmed to have gaucher disease by β glucocerebrosidase deficiency were compared to 50 age and gender matched healthy controls. Complete blood count, serum iron and ferritin were analysed.

Results

Ferritin levels were significantly higher in gaucher patients (ranging from10 to 460 μg/L) with mean 184.30, than controls (P = 0.003). Moreover serum iron was significantly lower in gaucher patients than controls (P = 0.037).

Conclusion

Hyperferetinemia is a universal laboratory finding in GD. Serum ferritin does not appear to be a useful biomarker of disease severity in GD, but can be used as a biomarker of response to treatment.
Systematic Approach of Basic Fetal Echocardiography in Normal and High Risk Pregnancy
Authors: El Deen Fatma Salah , Ali Hend Galal El Deen Mohamed , Ibraheem Mona Abdelaziz Mohamed
Published: August 2023

Background

Fetal echocardiography was initially used to identify congenital heart defects (CHD) and arrhythmias. Since then, technical advances have enabled a notable improvement in the assessment of cardiac structure and function.

Objective

to highlight the importance of a systematic approach of basic fetal echocardiography in normal and high risk pregnancy.

Patients and Methods

Normal and high risk pregnant females will be studied in this research using colour doppler ultrasound. Two-dimensional imaging is still the gold standard and commonly used in fetal echocardiography. Therefore, we present standard views of the normal fetal heart obtained during the second trimester by two-dimensional ultrasound, and color and pulsed wave Doppler. Study place: Ain Shams university hospitals. Sample size: 30 normal and 30 high risk pregnant female patients.

Results

we have provided reference values for cardiac morphometric parameters across second trimester of pregnancy in a low-risk and high risk population including the Right and left atria longitudinal diameters, right and left ventricular longitudinal diameters, cardiothoracic ratio and heart rate and correlate low to high risk values. All dimensions showed a progressive increase with gestational age, some of the parameters show significant difference between low risk and high risk including the LV diameter with p value of 0.023, cardiothoracic ratio with p value of 0.001 and heart rate with p value of 0.001

Conclusion

Fetal Echocardiography at the second trimester of pregnancy is crucial for detection of any abnormality at the high risk group and their follow up along the whole pregnancy for a better outcome.
Effectiveness of Duplex Doppler Sonography of Portal Vein as a Supplementary Tool in Diagnosis of Pediatric Appendicitis
Authors: Shehata Omar Ahmed Mahmoud , Hussein Ahmed Mohamed , Ashraf Okba Ahmed
Published: August 2023

Background

Acute appendicitis is the most common surgical emergency in pediatric patients. Ultrasound is the preferred initial imaging modality to evaluate children with clinically- suspected appendicitis. whether by directly visualizing the inflamed appendix or by using secondary signs. However. rate of falsely negative or equivocal exams is still high, leading to a risk of complications from negative appendectomies as well as delayed diagnosis.

Objective

To evaluate the diagnostic accuracy of portal vein flow velocity and diameter in diagnosis of pediatric acute appendicitis

Patients and Methods

A cross-sectional study over the course of 6 months from June until November 2021. Portal vein diameter and peak systolic flow velocity were measured for 75 pediatric patients with clinically suspected appendicitis referred to radiodiagnosis department at Ain Shams University Hospitals for a pelvi-abdominal ultrasound examination. The largest appendix diameter secondary sonographic signs, and total leucocytic count were recorded if available.

Results

The mean age of the population was 112 ± 4.12 years (range. 3-18 years). Mean portal vein flow velocity was 38.94 ± 9.59 cm/s in the appendicitis group and 27.96 ± 6.98 cites in the non-appendicitis group. Median portal vein flow velocity was significantly higher in the appendicitis group (p < 0.001 with an overall diagnostic accuracy 82.1% at cut-off value of > 33.3 cm/sec. Mean portal vein diameter was 9.37±2.01 mm in the appendicitis group and 8.84 ± 2.19 mm in the non-appendicitis group, showing no statistically significant difference (P = 0.27). The presence of right iliac fossa echogenic fat was highly significant (P < 0.001) in predicting acute appendicitis.

Conclusion

The use of portal vein velocity as a supplementary tool improved the diagnostic performance and increased the sensitivity of ultrasound in diagnosing acute appendicitis. thus, decreasing the incidence of delayed appendectomies that have an increased risk of complications as well as decreasing the incidence of unnecessary appendectomies. Further studies are required to establish a comprehensive guideline to use it as a tool in ultrasound examinations of these patients.
Potential Role of MR Diffusion Tensor Imaging of the Spinal Cord in Early Detection of Cervical Spondylotic Myelopathy and Assessment of Its Severity
Authors: Ali Sara Hussein , Tantawy Salma Hassan , El Ghaffar Maha Mohammad Abd
Published: August 2023

Background

Cervical spondylotic myelopathy is the most common cause of spinal dysfunction in adults. Recent studies have shown a potential role for diffusion tensor imaging as a novel method for early detection of cervical cord myelopathy as compared with conventional MR sequences.

Aim of the Work

To evaluate the role of MR diffusion tensor imaging in the early detection of cervical spondylotic myelopathic changes in comparison to conventional MRI sequences to determine best clinical management and outcome for the patients.

Patients and Methods

Our study is a prospective study that included patients from August 2021 to December 2021. The study included 20 patients with clinical symptoms of cervical spondylotic myelopathy, referred to the Radiology department, Ain Shams University Hospitals for MRI cervical study.

Results

Our results showed a highly significant reduction of FA values and highly significant increase of ADC values of the cord opposite to the level of the most affected disc (P value <0.001 and 0.002 respectively). We also found that the magnitude of FA reduction and ADC increase correlated positively with the severity of disc affection, with the highest drop in FA values and increase in ADC values found to be in patients with established spinal cord hyperintensity on T2WI.

Conclusion

Diffusion tensor imaging could be used in early detection of cervical cord myelopathy before the appearance of altered cord intensity on conventional MRI sequences and in assessment of its severity.
Frobenius constants for families of elliptic curves
Authors: Roy Bidisha , Vlasenko Masha
Published: August 2023

The paper deals with a class of periods, Frobenius constants, which describe monodromy of Frobenius solutions of differential equations arising in algebraic geometry. We represent Frobenius constants related to families of elliptic curves as iterated integrals of modular forms. Using the theory of periods of modular forms, we then witness some of these constants in terms of zeta values.
Employment status and the on-demand economy: a natural experiment on reclassification
Authors: Johnston Hannah , Ergun Ozlem , Schor Juliet , Chen Lidong
Published: August 2023

This article uses data from a natural experiment to address one of the most contentious issues in the on-demand platform economy—whether gig work is compatible with standard employment. We analyze a US-based package delivery platform that shifted a subset of its workers from independent contractors to employees, thereby creating a natural experiment that allowed us to exploit variation over time and across locations. We examine the impact of employment status on work scheduling practices, hours of work and the firm’s ability to match workers’ scheduled hours with the amount of time they were actively engaged in parcel delivery. We find that after the transition to employment, flexibility with respect to how work schedules were determined was maintained, and drivers’ total hours of work increased. We also find that the switch to employee status increased the firm’s ability to match scheduled and actual working time, indicating greater operational efficiency. We conclude, contrary to claims commonly made by platform firms, that employment status can coexist with the platform model.
Minimal differences in acute postoperative pain after anterior cruciate ligament reconstruction with quadriceps versus hamstring autograft
Authors: Varakitsomboon Shing , Holland Erica L. , Schmale Gregory A. , Saper Michael G.
Published: August 2023

Studies are lacking that evaluate early postoperative pain after all-soft-tissue quadriceps tendon anterior cruciate ligament reconstruction (ACLR), particularly in young patients. The purpose of this study was to investigate differences in early postoperative pain between adolescent patients undergoing ACLR with quadriceps tendon versus hamstring autograft. A retrospective review was performed of 60 patients (mean age, 15.6 ± 1.3 years) who underwent ACLR using either quadriceps tendon (n = 31) or hamstring (n = 29) autografts between January 2017 and February 2020. Intraoperative and postoperative milligram morphine equivalents (MMEs), postanesthesia care unit (PACU) length of stay and PACU pain scores were recorded. Pain scores and supplemental oxycodone use were recorded on postoperative days (POD) 1–3. Differences were compared between the two groups. There were no statistically significant differences in age, sex, body mass index or concomitant meniscus repairs between the two groups (P > 0.05). There were no statistically significant differences in intraoperative MMEs, PACU MMEs or PACU length of stay between groups (P > 0.05). There were no statistically significant differences in maximum PACU pain scores (3.7 ± 3.0 vs. 3.8 ± 3.2; P = 0.89). Maximum pain scores on POD 1–3 were similar between groups (P > 0.05). There were no statistically significant differences in supplemental oxycodone doses between groups on POD 1–3 (P > 0.05). Adolescent patients undergoing ACLR with quadriceps tendon and hamstring autografts have similar pain levels and opioid use in the early postoperative period.
Risk of repeated drainage in pediatric septic arthritis: patient or method?
Authors: Royer Julia , Castel Louis-Charles , Lefevre Yan , Pfirrmann Clémence , Lalioui Abdelfetah , Harper Luke , Angelliaume Audrey
Published: August 2023

How drainage of septic arthritis should be performed remains controversial. The aim of the present study was to compare arthrocentesis (Ac) using double intra-articular needle lavage to arthrotomy (At) as first-line drainage treatment for pediatric hip and knee septic arthritis. The secondary objective was to identify risk factors of second articular drainage. A retrospective review of medical records of children with knee and hip septic arthritis was conducted. Inclusion criteria were: children treated for septic arthritis between 2014 and 2020 with a positive culture of joint fluid. Clinical, biological, radiographical and ultrasound data were recorded at presentation and during follow-up. Patients were divided into 2 groups according to the type of drainage performed: Ac or At. 25 hips and 44 knees were included, 42 treated by Ac (15 hips, 27 knees) and 27 by At (10 hips, 17 knees). There is no significant difference between Ac and At regarding the need for repeated drainage and Ac nor At was reported as risk factor for repeated drainage. The presence of associated musculoskeletal infection (MSI) was a significant risk factor of repeated drainage [odds ratio = 11.8; 95% confidence interval = 1.2–114.2; P < 0.001]. Significantly more associated MSI (P < 0.001), level I virulence germs (P < 0.001) and positive blood culture (<0.001) were found in patients who underwent repeated drainage. There was no significant difference between Ac and At regarding rate of repeated drainage. The risk factors for repeated drainage were: associated with MSI, virulent germs and positive blood culture.
Mobile Health Intervention Contents and Their Effects on the Healthcare of Patients with Left Ventricular Assist Devices
Authors: Yoo Hye Jin , Shin Soyoung
Published: August 2023

Self-care in daily life is important for patients with a left ventricular assist device. Mobile health interventions that use an application, the cloud, or telemonitoring enable active health management. This study reviewed the literature on the contents of mobile health interventions for patients with left ventricular assist devices and their effects. We searched four electronic databases (CINAHL, Cochrane Library, EMBASE, and MEDLINE) and reference lists in May 2022. The search terms consisted of “heart-assist devices” and “residence characteristics,” combined with “mobile applications,” “telemonitoring,” “medical informatics applications,” “cell*,” “app*,” “smartphone,” and “cloud.” In total, seven studies were included in the review. Mobile health interventions included (1) self-management contents and (2) interactions between patient and healthcare providers. The mobile health device and patient's health management were evaluated as a measure of the effect. This review provides a unique understanding for leveraging mobile health interventions as an effective approach to improve healthcare among patients with left ventricular assist devices. Future mobile health intervention strategies targeting these patients should fully consider the patient's perspective. Furthermore, they should be designed and applied to help with long-term health management, accompanied by an evaluation of their effectiveness on self-care improvement.
Mononeuropathy Multiplex After Severe SARS-CoV-2 Infection: A Case Series and Literature Review
Authors: Dupre Alicia E. , Slama Michaël C. C.
Published: August 2023

Introduction:

Peripheral nerve injuries are being increasingly recognized in patients recovering from severe SARS-CoV-2 infections. Axonal neuropathies can occur, leading to lasting and disabling deficits.

Case reports:

We present the cases of 3 patients who developed weakness and sensory symptoms after severe SARS-CoV-2 pneumonia. The clinical deficits revealed various patterns of injury including a mononeuropathy multiplex (MNM) in the first patient, a brachial plexopathy with superimposed MNM in the second patient, and a mononeuropathy superimposed on a polyneuropathy in the third patient. Electrodiagnostic studies revealed axonopathies. The patients with MNM were left with severe disability. The third patient returned to his baseline level of functioning.

Conclusions:

Severe SARS-CoV-2 infections can result in disabling axonopathies. Possible explanations include ischemic nerve damage from the profound inflammatory response and traumatic nerve injuries in the ICU setting. Preventing severe disease through vaccination and antivirals may therefore help reduce neurologic morbidity.
Atypical Presentation of Tangier Disease—Expanding the Clinical Spectrum
Authors: Baskar Dipti , Vengalil Seena , Nashi Saraswati , Menon Deepak , Bevinahalli N Nandeesh , Thomas Aneesha , Bardhan Mainak , Sanka Sai Bhargava , Manjunath Nisha , Nalini Atchayaram
Published: August 2023

Tangier disease is an autosomal recessive multisystem metabolic disorder with neuromuscular manifestations including peripheral neuropathy such as multifocal mononeuropathy or pseudosyringomyelia patterns. We report a novel phenotype of Tangier disease with predominant anterior horn cell involvement. A 16-year-old adolescent girl born to consanguineous parents had a 1-year history of hip girdle weakness with waddling gait and progressive atrophy of the right leg. She had orange tonsils, prominent lingual tonsils, soft skin, distal joint laxity, diffuse hypotonia with asymmetric wasting of legs, proximodistal moderate weakness in lower limbs, and tendon reflexes were hypoactive. The creatine kinase level was 70 U/L. Serum showed an abnormally low level of high- and low-density lipoprotein. Whole-exome sequencing showed a novel likely pathogenic splice site homozygous mutation c.2542+1G > A in the ABCA1 gene at intron 17. Hence, a high degree of suspicion and search for peripheral clinical markers is needed in patients with unusual anterior horn cell syndromes.