bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Giant Cell Tumor of Distal End Radius: Extended Curettage and Adjuvant Therapy vs Wide Resection and Reconstruction: A Systematic Review and Meta-Analysis
Authors: Masry Ayman Mohammad El , Mowafi Mohamed Ahmed El , Hassan Yousef Eldebies Hassan Mohammed
Published: November 2024

Introduction

Managing giant cell tumors (GCTs) located in the distal radius poses a considerable challenge, and determining the best surgical approach remains a subject of ongoing discussion. The primary treatment methods involve surgical interventions, specifically extended curettage with adjuvant therapy and wide resection with reconstruction. The objective of this comprehensive systematic review and meta- analysis is to compare functional scores, recurrence risk, metastatic rates, and total complications through these two surgical procedures.

Methods

We performed a systematic search of the existing literature. Our search encompassed prominent databases such as PubMed, Google Scholar, the Cochrane collaboration, ResearchGate, Scopus, and the New England Journal of Medicine. The primary focus of our inclusion criteria was on studies that offered a comparative evaluation between extended curettage, supplemented with adjuvants, and wide resection coupled with reconstruction in patients diagnosed with GCTs situated in the distal radius. We gathered data concerning the rates of recurrence, metastasis, overall complications, and functional outcomes.

Results

We included 17 retrospective studies (n = 527 patients). The average age of the participants was 33.49 years (SD ± 2.3), and the average follow-up period was 7.1 years (SD ± 3.7). Patients who underwent curettage were more likely to develop higher recurrence rate (OR = 3.48, 95% CI [2.02, 5.99], p < 0.01) than those who underwent wide resection. Patients who underwent curettage showed a significant reduction in overall complications compared to wide resection complications rate in the curettage group (OR = 0.23, 95% CI [0.13, 0.38], p < 0.01) and a greater improvement in Visual Analog Scale (MD= -1.43, 95% CI [−2.11, −0.74], p < 0.01) and lower Disabilities of the Arm, Shoulder, and Hand scores (MD= -7.49, 95% CI [- 9.62, −5.36], p < 0.01). No significant difference was found regarding metastasis (OR = 1.19, 95% CI [0.25, 5.61], p = 0.83). Patients who underwent curettage were more likely to develop higher recurrence rate (OR = 3.48, 95% CI [2.02, 5.99], p < 0.01) than those who underwent wide resection.

Conclusions

Concerning the surgical strategy employed for GCTs located in the distal radius, it was observed that curettage, when complemented with adjuvants, exhibited a greater likelihood of recurrence when compared to the approach involving wide resection and subsequent reconstruction. However, it is worth noting that the curettage approach yielded significantly reduced rates of operative complications, lower pain scores, and superior functional outcomes as opposed to the resection method.
Ankle Fusion Using Retrograde Intramedullary Nail versus Ilizarov External Fixator in Charcot Neuroarthropathy
Authors: Galal Karim Nagy Ahmed , Mohamed Salah Abd El Gawad , Husseiny Karim Tarek El
Published: November 2024

Background

Charcot neuroarthropathy is a destructive, non-infective process affecting bones and joints that occurs in association with a peripheral neuropathy and it has many etiologies but diabetes is the first cause of charcot neuroarthropathy.

Aim of the Work

to compare between retrograde intramedullary nail and ilizarov external fixator in ankle fusion in charcot neuroarthropathy regarding union rate, amputation, hardware complications, infection, need for reoperation.

Materials and Methods

This is systematic review done in Ain Shams University in December 2022 and Criteria for considering studies for this review:

Results

Retrograde intramedullary nail and ilizarov external fixator both are effective methods for ankle fusion in charcot neuroarthopathy. According to this review the union rate, amputation, hardware complications did not differ significantly between retrograde intramedullary nail and ilizarov in ankle fusion in charcot neuroarthropathy but the reoperation rate is higher with retrograde intramedullary nail. Regarding the infection rate there is no significant difference between the ilizarov and intramedullary nail but when considering the pin tract infection in ilizarov, the infection rate will become higher in ilizarov compared to the retrograde intramedullary nail.

Conclusion

this review provides evidence that both retrograde intramedullary nail and ilizarov external fixator are safe, effective and has comparable efficacy in limb salvage when used in ankle reconstruction in patients with charcot neurparthropathy, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed.
Structural Bone Allograft versus Titanium Trabecular Augment in Management of Acetabular Defects Paporosky Type III in Hip Arthroplasty
Authors: Bassiony Ayman Abdelaziz , Mansor Saleh Gameel , Abd Elrahman Ashoub Moustafa Mamdoh , Alsharkawy Mahmoud Lotfy Mostafa
Published: November 2024

Background

Rraditionally, major acetabular defects have been reconstructed for primary and revision THA by impaction bone grafting (IBG) and a cemented socket.

Objective

To compare the result of structural bone allograft versus titanium trabecular augment in management of acetabular defects paporosky type III during hip arthroplasty.

Methodology

This randomized controlled clinical trial was conducted at Orthopedic Department, Faculty of Medicine, Ain Shams University Maternity and Dar Elshefa Hospitals from February 2021 until February 2023.

Results

Our study reported that there were no differences between study groups as regard age, sex and associated medical disorders. As regard Harris hip score, our study reported that it was statistically significant higher among allograft group 6 weeks and 1 year postoperatively. On the other hand, no differences were noted between groups pre-operatively and 6 months postoperative. As regard operative data, our study reported no differences between study groups regarding operative time, blood loss, and postoperative complications as DVT, dislocation, heterophic ossification and superficial wound infection.

Conclusion

From our study we can conclude that structural bone allograft was associated with better postoperative outcomes compared with titanium trabecular augment in management of acetabular defects paporosky type III during hip arthroplasty. Harris hip score was statistically significant higher among allograft group 6 weeks and 1 year postoperatively. No differences between study groups were noted regarding operative time, blood loss, and postoperative complications as DVT, dislocation, heterophic ossification and superficial wound infection. Finally, no differences were reported between study groups regarding operative outcomes as bone ingrowth, restored high hip center and signs of loosening.
Comparative Study between Dynamic Hip Screw (DHS) with Lateral Stabilizing Plate versus Proximal Femoral Nail (PFN) in Fixation of Unstable Intertrochanteric Fractures. A Systematic Review & Meta-Analysis
Authors: Abdelfattah Ali Khorshid Mohamed Ahmed , Abdelmegid Wael Samir , Zakaria Zeiad Mohamed
Published: November 2024

Background

Intertrochanteric fractures are one of the elementary orthopaedic clinical problems accounting for 7% of osteoporotic fracture. These kind of fractures usually caused by low-energy trauma such as a fall from standing height with several risk factors including; increasing age, female gender, osteoporosis, a history of falls, and gait abnormalities. Usually intertrochanteric fracture is classified according to its stability. Fracture stability is dependent on the status of the posteromedial cortex. Stable fractures are commonly simple fractures which are less affected by vertical stress during one-leg standing. Unstable intertrochanteric fracture has decreased ability to resist stress due to affection of Posteromedial or Lateral femoral cortex.

Patients and Methods

Asystematic review & Meta analysis was design with a careful consideration of the Cochrane Handbook for Systematic Reviews of Interventions. We also will follow The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines during the design of our study. Population: Patients with unstable Intertrochanteric fractures, intervention: Dynamic hip screws (DHS) with lateral stabilizing plate(TSP), comparator: Proximal Femur Nail, outcome parameters: Functional and radiological, study design: Clinical trials whether randomized or nonrandomized prospective or retrospective cohort, case control studies.

Results

Use of TSP with DHS can give good results in unstable inter trochanteric fractures. As compared to DHS with TSP, PFN is technically more demanding surgery and in our meta analysis and systematic review study we found complication rate of PFN to be higher as compared to DHS with TSP. Addition of TSP to DHS gives good lateral wall buttress which prevent excessive medialization of shaft and gives comparable result to PFN which is considered as better implant in unstable fractures.

Conclusion

The current systematic review indicated that there is no statistically significant difference between patients operated with Dynamic Hip Screw with Trochanteric lateral Stabilization Plate and Proximal Femoral Nail.
Management of Comminuted Tibial in Adults Plateaue Fractures by Ligamentotaxis with Minimal Internal Fixation
Authors: Abou Seif Salah Abdel gawad , Thakeb Mootaz Fouad , Khaled Mohamed Al Sharkawy Shady Samir Fekry Mohamed
Published: November 2024

Purpose

To evaluate the clinical and radiological outcome of complex tibial plateau fractures treated with external fixation with or without minimal internal fixation.

Methods

This prospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov or LRS external fixation between September 2021 to February 2023 with the minimum follow-up duration of 18 months. There were 15 patients: 10 males and 5 females, mean age 36.7 years, four of them were open fractures; 13 cases were Schatzker type V fractures and two cases were type VI. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final followup.

Results

Out of the 15 cases, mini-open reduction was performed in 6 cases, minimal internal fixation in 8 cases. Mean duration of external fixation was 10.2 weeks. All fractures united except one case. Pin tract infections in 7 and common peroneal neuropathy was detected in one patient and was self limiting. Two patients had axial malalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS is 75.2 and mean RRS is 12.8. On statistical analysis; Schatzker type of fractures, use of minimal internal fixation and knee spanning did not influence the final outcome.

Conclusion

Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.
Dynamic Locked Plating Using Near-Cortical Over-Drilling versus Standard Locked Plating for Fixation of Lower Femur Fractures
Authors: Thakeb Mootaz Fouad , Mohamed Fayyad Tamer Abd El Maguid , El Gebeily Mohamed Abd El Moneim , Wahba Mohamed Kotb Mohamed , Al Kersh Mohamed Ahmed
Published: November 2024

Background

Fracture Healing in distal femoral fractures is greatly influenced by fixation method. Classic compression plate requires creation of a rigid plate/bone construct which involves soft-tissue stripping and devitalization of the underlying bone, this may lead to inhibited callus formation. Hence, the concept of “Dynamic” Locked Plates has been proposed to decrease construct stiffness and improve callus formation.

Aim of the Work

To compare functional and radiological outcomes in lower femur fractures treated by dynamic locked plating (using near cortical over drilling) to that treated by standard locked plating.

Patients and Methods

Prospective study was conducted starting from May 2020 to January 2023 including 30 patients aged from 18 to 65 years old with distal femur fracture treated by dynamic locked plating with near cortex over drilling (15 patients) or standard locked plating (15 patients). We excluded patients with open fractures, periprosthetic fractures, floating knee injuries and poly-traumatized patients. The follow up period was 1 year.

Results

The current study demonstrated no statistically significant difference between both groups regarding time of union, knee range of motion, nonunion rate, or other specific complications. However, the DLP group was noted to have statistically significant higher callus scores at six weeks postoperative (p value = 0.015) indicating increased callus formation.

Conclusion

Dynamic locked plating seems to result in improved callus formation and bone healing without sacrificing fixation strength compared with traditional locked plating when used for fractures of the distal femur.
Evaluation of SOX10 Immunohistochemical Expression in Mammary Carcinoma
Authors: El-Maraghy Maissa N , Farid Rola M , Elgohary Shimaa A E , Fawzy Bakinam M
Published: November 2024

Background

Invasive breast cancer (IBC) is the most frequent malignant neoplasm of female patients accounting for around 25% of all recorded cases globally. IBC is classified into five molecular subtypes. Triple-negative breast carcinoma (TNBC) are IBCs that lack expression of all three routine biomarkers; namely ER, PR, and Her2neu, it forms about 15-25 % of all IBCs. TNBC is characterized by its high degree of aggressiveness and greater recurrence and metastasis rates. Metastatic TNBC might be challenging to distinguish from other metastatic adenocarcinoma that are ER, PR, and Her2neu negative. Other sensitive & specific immunohistochemical markers are required to help distinguish primary from metastatic carcinomas, especially TNBC. Recently Sox10 has been suggested to be regularly expressed in primary breast cancers, particularly basal-like breast cancers and metaplastic TNBC.

Objective

This is primarily to evaluate the immunohistochemical expression of SOX-10 in invasive breast cancer in general and its expression in triple-negative breast cancers (TNBC) compared to other molecular subtypes.

Methods

This retrospective study included 62 TNBC cases and 21 non-TNBC cases. The immunohistochemical expression of Sox10 was tested, evaluated, and compared in different study groups with subsequent statistical analysis.

Results

Sox10 expression was positive in 39 cases of TNBC (92.9%) compared to only 3 cases of non-TNBC (7.1%). The SOX10 expression was significantly expressed in TNBC (p > 0.001). This expression was more frequent in TNBC compared to non-TNBC (p-value < 0.001). Moreover, Sox10 was more frequently expressed in TNBC than other molecular subtypes of primary breast cancer (p- value = 0.001).

Conclusions

Sox10 is more highly expressed in TNBC than other molecular subtypes of non-TNBC. It may represent a potentially valuable diagnostic marker for other hormone receptor-negative tumors in the metastatic setting.
Evaluation of GARP Immunohistochemical Expression in Papillary Thyroid Carcinoma
Authors: Atia Esraa Adel Mahmoud , Sammour Sanaa Abd Elmaged , Ibrahim Eman Abdel-Salam , Gabal Hoda Hassan Abou , Elgohary Shimaa Abdelraouf
Published: November 2024

Background

Glycoprotein A repetitions predominant (GARP) is a novel trans-membrane protein, highly expressed on the surface of regulatory T cells (Tregs). Tregs are a subset of immunosuppressive T-lymphocytes that play a major role in inhibiting antitumor immune response. Many studies documented increased GARP expression in various tumors. Our study was designated to evaluate the immunohistochemical (IHC) expression of GARP in differentiated thyroid carcinomas and their tumor infiltrating lymphocytes (TILs) in comparison to its expression in other benign and low-risk lesions and to assess the potential diagnostic role of GARP IHC expression in different thyroid lesions.

Material and Methods

Sixty-nine cases of different thyroid lesions subgrouped into: 37 cases of malignant thyroid neoplasms, 25 cases of benign thyroid lesions and 7 cases of low-risk neoplasms collected from pathology department laboratories of Ain Shams university hospitals during the period from January 2017 to December 2021 and stained immunohistochemically for GARP. IHC expression of GARP was evaluated in thyroid epithelial cells and TILs. The expression of GARP was correlated with the different clinicopathological parameters.

Results

GARP expression discloses significant statistical difference between the three studied groups (p < 0.001). High GARP expression was detected in 89.19% of the malignant cases and in 28.57% of low-risk neoplasms, while all benign lesions exhibited low GARP expression. No statistically significant correlation was detected between GARP expression and patient’s age or sex, as well as tumor focality, extrathyroid extension, and cervical lymph node metastasis (MTs). High GARP expression of TILs was detected in 60% of the malignant cases. Synchronous high GARP expression in tumor tissue and in the surrounding TILs was detected in 63.16% of the malignant cases yet, this result didn’t reach statistical significance.

Conclusion

GARP is a marker of Tregs, whose high expression is increased in malignant over benign and low-risk lesions. It might be a potential novel target for anticancer immunotherapy.
Component Restoration in the Unilateral Intermediate Cleft Lip Rhinoplasty: Technique and Outcomes
Authors: Albaghdady Ayman Ahmed , Ghanem Wael Ahmed , Soliman Mohamed Hisham , Shokry Shady Sheren , Mousa Ahmed Abdel Rahman
Published: November 2024

Background

The intermediate cleft tip rhinoplasty is performed in childhood to address residual tip asymmetries during the most critical period of psycho- social development. The authors describe and evaluate long-term outcomes of that approach for the unilateral cleft lip and palate patient based on the concept of individual restoration of each abnormal anatomical component.

Methods

This was a prospective comparative study in which the technique results were compared to age-matched unilateral cleft lip and palate control patients (n = 20). A separate group of unilateral cleft lip and palate patients who did not undergo intermediate cleft tip rhinoplasty were reviewed as control patients. Photographs of control patients were age-matched to each time point in the intermediate cleft tip rhinoplasty group. Technique of rhinoplasty was through an open approach. It was depending on restoration of the three main nasal cleft components; cartilage malposition, cartilage weakness and vestibular lining deficit. The authors here didn’t use cutaneous graft routinely to compensate the vestibular lining deficit. Instead, fine and complete dissection of the cleft side lower lateral cartilage from its vestibular lining before any cartilage repositioning. Standardized preoperative and postoperative basal view photographs were assessed at four time points: preoperatively (time 0), immediately postoperative (time 1), 3- 6 months (time 2), and more than 1 year postoperatively if available (time 3). Assessments of control and intermediate cleft tip rhinoplasty patients was carried out using four photo- morphometric relationships: Alar symmetry Nasal tip protrusion to alar base width, Cleft nostril dimensions, and Non-cleft nostril dimensions.

Results

Preoperative (time 0) baseline comparison between the study and the control groups showed significant differences regarding the nostril dimensions at the cleft side (P value 0.027) and alar symmetry (P value 0.000) denoting more severe deformity in the study group compared to the control group. At time 1, the study showed significant improvement regarding the alar symmetry (P value 0.000), and nasal tip protrusion (P value 0.004), while the changes regarding nostril dimension at the cleft side were non-significant (P value 0.057). At time 2, the study added significant improvement regarding the nostril dimensions at the cleft side (P value 0.049) that may reflect the importance of follow-up and using the nostril silicon retainer. At all times no significant changes regarding the nostril measures at non-cleft side were noticed.

Conclusion

The modified component restoration technique for the unilateral intermediate cleft lip rhinoplasty improves nasal relationships regarding alar symmetry, nostril dimensions at the cleft side, and nasal tip protrusion.
A Comparative Study between Early and Late Correction of Cases of Anorectal Malformation, Assessed by Fecal and Urinary Functional Outcome
Authors: Mahmoud Ahmed Himhamy , Naggar Osama Abdulellah El , Soliman Mohamed Hisham , Abo Halawa Nezar Abdelraof , Dahab Mohamed Mousa , Bersy Mohamed Ali
Published: November 2024

Background

Anorectal malformation (ARM) includes a wide spectrum of anomalies of the anorectal and urogenital region. They are not rarely associated with orthopedic, spinal, and neurologic abnormalities effecting the short- and long-term outcome. anorectoplasty at an early age is important for obtaining a better life quality in ARM patients.

Aim

Aim of the work to study defecation and urinary functional outcome according to timing of correction of ARM.

Patients and Methods

This was a cross sectional study conducted at patients with anorectal malformations (perineal fistula, rectourethral fistula, rectovesical fistula, vestibular fistula, no fistula, anal stenosis), at the Ain Shams pediatric surgery department and Qena pediatric surgery unit.

Results

bowel function and quality of life were significantly higher in early correction group compared to late correction group(p < 0.001). The mean of the quality of life in the early and late correction groups was 12.83± 0.59 and 11.13± 2.73 respectively.

Conclusion

Early anorectoplasty and early appropriate bowel management is advisable, as that is essential for less fecal and urinary functional complications, and for proper life quality.
Comparative Study between Grafts and Flaps in Staged Repair of Primary Proximal Hypospadias
Authors: Elsadek Menan Ahmed , Abouzeid Amr Abdullhamid , Abd-El-BakyFahmy Mohamed , Dahab Mohamed Mousa , Abdullhamid Hazem Samir , Shokry Shady Sherin
Published: November 2024

Background

Choosing between flaps or grafts to substitute the urethral plate in 2-stage hypospadias repair has been a matter of debate with no consensus in the literature. Flaps have reliable blood supply that maybe theoretically less liable for strictures or contractures. Grafts are more versatile, which can be used in primary and recurrent cases when healthy local skin is deficient. In this report, our aim was to compare outcomes of grafts and flaps when used to substitute the urethral plate in two-stage repair of primary proximal hypospadias with ventral curvature.

Methods

This retrospective study included primary cases of hypospadias with significant curvature who underwent two-stage repair using either grafts or flaps to substitute the urethral plate in the first stage. Cases included in the study were divided into two groups according to the technique of substituting the urethral plate at the first stage of repair. During first part of the study period (2015 through 2018), we mostly used grafts to substitute the urethral plate (group A); later, we shifted to skin flaps (Group B) during the period 2019 through 2021.

Results

The study included 37 boys with primary proximal hypospadias who underwent two-stage hypospadias repair. The meatus position was penoscrotal in 18, scrotal in 16, and perineal in three. Inner preputial graft was used to substitute the urethral plate in 18 cases (group A), while dorsal skin flaps were used in 19 (group B). Out of the 37 cases, 27 were available at follow-up after second stage (group A = 14; group B = 13). Follow up period ranged between 6 and 42 months (mean 19.7; median 18.5). Overall, 14 cases required reoperations for different indications: partial disruptions of distal part of the repair in six, closure of urethro-cutaneous fistula in six, and urethral strictures in two. The rate of complications was higher in group A (10 cases: 71%) compared to group B (4 cases: 31%) (Fisher exact test, p-value = 0.057).

Conclusion

Grafts were associated with higher complication rate than flaps when used to substitute the urethral plate in two-stage repair of proximal hypospadias with chordee. Type of Study and Level of Evidence. This is non-randomized comparative study (level III evidence).
Frequency of Delayed Puberty among Adolescent Females with Type 1 Diabetes
Authors: El Samahy Mona Hussein , El-din Nouran Yousef Salah , Mahmoud Rana Abdelhakim Ahmed , Mohamed Asmaa Khalifa Radi
Published: November 2024

Background

Female patients with T1DM may display menstrual disturbances, hyperandrogenism or early menopause at certain moments of their lives, thus representing a significant health problem.

Objective

To detect the frequency of delayed puberty among a cohort of Egyptian adolescent females with type 1 diabetes mellitus (T1DM).

Methods

This cross sectional study examined 175 adolescent females with T1DM aged(14-18)years following up at the Pediatric and Adolescents Diabetes Unit, Ain Shams University for delayed puberty. History taking with complete physical examination was done including: Tanner staging (delayed puberty was defined as puberty occurring two standard deviations beyond the mean age). Girls were evaluated for delayed puberty in the following situations: (1) no breast development by age 13, (2) no menarche within 3 years of the larche, (3) no menarche by age 14 with signs of hirsutism, (4) no menarche by age 14 with history or examination suggestive of excessive exercise or eating disorder, and (5) no menarche by age 15 (ACOG committee opinion, 2015). Clinical manifestations of insulin resistance, blood pressure and anthropometric measures were assessed with calculation of the z score for age and gender. Laboratory assessment including fasting glucose, HbA1C, fasting lipid profile was done.

Results

Delayed puberty was found in 6.3 % of the studied adolescent females with T1DM. Mean age at menarche was 13.2 years and the percentage of tanner V was 28 % of this cohort. Mean age was negatively correlated with delayed puberty, while duration of DM, waist circumference Z score, waist/hip ratio Z score and mean of LDL were positively correlated with delayed puberty. No significant relation was found with HbA1C, fasting glucose, cholesterol, triglyceride, HDL

Conclusion

Although uncommon, delayed puberty can be seen in girls with T1DM. It is correlated to glycemic control and hyperlipidemia.
Effect of a Hemodialysis Session on Intercellular Adhesion Molecule-1 (ICAM-1) in Children with Chronic Kidney Disease Stage 5 on Regular Hemodialysis
Authors: Dahshan Doaa R , Kasem Mohammed F , Mohammed Noha R , Said Ragia M
Published: November 2024

Background

During hemodialysis (HD) session leukocytes are activated and a number of proinflammatory cytokines and adhesion molecules are secreted. One of these adhesion molecules is intercellular adhesion molecule-1 (ICAM-1). ICAM-1 is a cell surface glycoprotein adhesion receptor responsible for regulating leukocyte recruitment from the circulation to sites of inflammation. It is incriminated in the endothelial cell injury in HD patients making them at risk of cardiovascular complications.

Objective

To assess the effect of a single HD session on the level of circulating ICAM-1 in children with chronic kidney disease stage 5 (CKD-5) on regular HD treatment.

Methods

This is a cross sectional study done at Pediatric Dialysis Unit (PDU), Children’s Hospital, Ain Shams University during the period from April 2023 to July 2023. It included 26 CKD-5 cases and 26 age and sex matched children as controls. CBC, CRP and serum ICAM-1 (ELISA) were done for all cases pre-HD. CBC and serum ICAM-1 were repeated for all patients post-HD. CBC, CRP and serum ICAM-1 were also done for controls.

Results

This study comprised 26 cases with mean age of 12.2±2.8 years. They were 16 males (61.5%) and 10 females (38.5%). All cases were receiving 3 hours HD session 3 times per week using low flux polysulfone dialyzer. It also included 26 controls with mean age of 10.9±2.7 years. They were 13 males (50%) and 13 females (50%). Cases and controls were age and sex matched. Our results revealed statistical evidence of significantly elevated pre-HD (Median= 676.6ng/L, IQR= 932.1ng/L) and post-HD (Median= 1749.5ng/L, IQR= 1812.5ng/L) serum ICAM-1 compared to its level (174.6 ±55.5ng/L) in controls (p < 0.001 for both). There was also statistical evidence of significantly higherlevel of post-HD serum ICAM-1 than its pre-HD one (p = 0.001). This study did not show any statistical evidence of significant differences in ICAM-1 levels regarding gender, dialyzer surface area, pump blood flow rate and the presence of hypertension. It did not also reveal any statistical evidence of significant correlations between ICAM1 and any of the studied variables including age, duration of HD and the parameters of CBC especially TLC, ANC & LC.

Conclusion

children with CKD-5 on regular HD had higher basal levels of serum ICAM- 1 than normal controls. These levels were further increased after HD session using low flux polysulfone membrane.
Effect of Oral N-Acetyl Cysteine in Prevention of Necrotizing Enterocolitis in Preterm Neonates with Feeding Intolerance
Authors: Naguib Youssef Ekram El-Hassan , EL-Ganzoury Mona Mostafa , EL-Farash Rania Ali , Allam Rabab Gameel
Published: November 2024

Background

Necrotizing enterocolitis (NEC) is one of the most challenging diseases in neonates. Prematurity alone is believed to be a major risk factor for NEC. Feeding intolerance can be the first clinical presentation of NEC, it can progress rapidly into fulminating disease. Therefore, identification of new strategies for prevention of NEC is needed.

Objective

The aim of this study was to evaluate the preventive effect of enteral N-acetylcysteine (NAC) on the development of necrotizing enterocolitis (NEC) in preterm neonates with feeding intolerance.

Patient and Methods

The study was a double blinded randomized controlled trial that was conducted on preterm neonates with feeding intolerance at Neonatal intensive care unit (NICU) department, Ain Shams University. Hundred and eight preterm neonates with feeding intolerance were randomly divided into two groups, intervention group and control group. The intervention group received enteral NAC by a dose (20mg/kg/6h) while the control group received placebo distilled water (1cc/6h) for either 10 days or when all signs and symptoms of feeding intolerance resolve, whichever comes first. Both groups were monitored clinically for improvement or progression to NEC.

Results

Our findings showed that there was a significant decrease in the incidence of NEC in the intervention group, who received enteral NAC, in comparison to the control group (n = 8 vs n = 26), with p value (<0.01). As well as significant reduction in the time needed to reach half, two-third and full enteral feeding, in the intervention group in comparison to the control group.

Conclusion

Enteral administration of N-acetylcysteine might reduce the incidence of NEC in preterm neonates with feeding intolerance.
Assessment of Neutrophil Activation in Children with Chronic Kidney Disease Stage 5 on Hemodialysis: Effect of a Single Procedure
Authors: Edris Eman R , Kasem Mohammed F , Hashem Noha U , Mohammed Noha R , Said Ragia M
Published: November 2024

Background

Hemodialysis (HD) process can trigger inflammation and induce cytokines activation. Neutrophils extrude neutrophil extracellular traps (NETs) which are extracellular chromatin containing a variety of granular proteins that have been implicated in infection, as well as vascular inflammation and occlusion.

Objective

To assess the effect of a single HD session on the level of circulating NETs in children with chronic kidney disease stage 5 (CKD-5) on regular HD treatment.

Methods

This is a cross sectional study done at Pediatric Dialysis Unit (PDU), Children’s Hospital, Ain Shams University during the period from April 2023 to July 2023. It included 26 CKD-5 cases receiving 3 hours HD session 3 times per week using low flux polysulfone dialyzer and 26 age and sex matched children as controls. Patients with the following medical conditions were excluded: failed renal graft, active infection, autoimmune disease, active thrombosis, diabetes mellitus, malignancy, cardiovascular disease like (infective endocarditis, vegetation and intracardiac mass) and patients on immunosuppressants. Complete blood cell (CBC), C-reactive protein (CRP) and serum NETs measured by enzyme-linked immunosorbent assay were done for all cases pre- and post-dialysis as well as the control group.

Results

The mean±SD age of the patient was 12.2±2.8 years. They were 16 males (61.5%) and 10 females (38.5%). The mean age of the controls was 10.9±2.7 years. They were 13 males (50%) and 13 females (50%). There was significantly elevated pre-HD (Median= 535.95ng/L, IQR= 519.6ng/L) and post-HD (Median=1310.5ng/L, IQR=916.4ng/L) serum NETs compared to its level (Median=149.1ng/L, IQR=69.7ng/L) in controls (p < 0.001 for both). There was also significantly higher post-HD level of serum NETs than its pre-HD one (p < 0.001). Gender did not have significant effect on serum NETs levels (p = 0.089). The age of patients, dialyzer surface area, pump blood flow rate, and duration of HD didnot correlate significantly with serum NETS levels (p = 0.95, 0.68, 0.23 and 0.83, respectively). In addition, there was no significant correlation between serum NETs and total leukocyte count, absolute neutrophil count and lymphocyte count (p = 0.29, 0.17 and 0.6, respectively).

Conclusion

Children with CKD-5 on regular HD had higher basal levels of circulating NETs than normal controls. These levels were further increased after HD session using low flux polysulfone membrane implying the associated subclinical inflammation.
Specific Epstein-Barr Virus Infection Immune Response in Children with Hemophagocytic Lymphohistiocytosis and B cell Lymphoid Malignancies
Authors: el-RaoufWahba Esraa Mohamed Abd , Aly Nihal Hussien , Ismail Mona Ahmed , Abdelwahab Hoda Ezz Elarab , Ragab Iman Ahmed
Published: November 2024

Background

Epstein Barr Virus Infection (EBV) is associated with significant morbidity and mortality in immunocompromised patients causing a wide spectrum of EBV associated immunopathologic conditions including lymphoproliferative disorders, hemophagocytic lymphohistiocytosis (HLH) and malignancy. The CD27/CD70 axis has a critical role in EBV immune surveillance. The clinical and immunological features of CD27 deficiency in patients presenting with B-cell malignancy and HLH remains to be identified

Aim

to evaluate of the frequency of CD27 deficiency in B cell lymphoid malignancy and HLH and to study its relation to EBV positivity.

Methods

A pilot study including twenty-one patients diagnosed with B cell lymphoid malignancy and HLH aged 4-10 years old (median 6 years) were initiated. EBV status was determined by detection of EBV nuclear antigen 1 (EBNA1) IgG by enzyme linked immune sorbent assay (ELISA) then quantification of CD27 on total lymphocytes and on CD3 by flow cytometry was performed. Immunoglobulin and HLH markers were reported from patients records in selected patients

Results

Patients with positive EBNA-1 IgG (n = 12) has significantly low percentage of CD27 expression on CD3 cells compared EBNA-1 negative ones (P = 0.028). CD27 expression did not differ according to EBV PCR status of the studied patients. The percentage of CD27 on lymphocytes showed a significant positive correlation with total leucocytic count and triglycerides level (p = 0.033 and 0.037 respectively) and a significant negative correlation with the fibrinogen level (p = 0.037) while absolute CD27 on lymphocytes was negatively correlated with age and fibrinogen level (p = 0.007, p < 0.001).

Conclusion

CD27 deficiency was found among chronic EBV infection in children with B cell lymphoid malignancy; However, further studies with higher sample size need to be pursued.
Pancreatic Affection in Children on Ketogenic Diet
Authors: Ward Hala Saeed Ahmed , Nassar May Fouad , Mohammed Maha Zakariya Ramadan , Awadallah Shrouk Mohammed , Mohammed Bassma Abdel Nasser
Published: November 2024

Background

The ketogenic diet (KD), a high-fat, low-carbohydrate, adequate-protein diet is an established, effective non-pharmacological treatment for children with drug resistant epilepsy (DRE). Relatively few serious complications have been reported in the more than 70 years use of KD. Hypertriglyceridemia, malnutrition, vit D and vit A deficiency are known complications of KD and are considered risk factors for pancreatitis as well.

Aim of the Study

The aim was to highlight the pancreatic affection during KD use in treatment of pediatric DRE patients.

Patients and Methods

This is a prospective observational (pilot) study conducted at pediatric ketoclinic, Ain Shams university children’s hospital, Cairo, Egypt during the period from September 2022 till October 2023. Twenty pediatric patients with DRE who were assigned to start KD were followed up for possibility of pancreatic affection. Pancreatic enzyme levels (amylase/lipase) were measured initially and after 3 and 6-months.

Results

In the current study, serum amylase and lipase levels increased significantly after 3- months interval (p value <0.001), and then decreased after 6-months KD usage, and was not significantly higher than baseline. However, there were no documented cases of clinical pancreatitis in our patients during the study period time.

Conclusion

Our study found that KD use in children with DRE led to significant increases in serum amylase, lipase, particularly in the first three months. Although no cases of pancreatitis were observed, close monitoring and further research are needed to assess the long-term safety of KD in this population.
The Value of Complete Blood Count Indices for Early Detection of Sepsis in Preterm Infants
Authors: Shabana Ayah M , Mahmoud Hassan A , Fattah Sarah I Abdel , El-Farghali Ola G
Published: November 2024

Background

Early-onset sepsis (EOS) remains a common and serious problem in neonates. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are easily accessible biomarkers that have been reported to have meaningful correlations with inflammatory markers.

Objectives

We aimed to evaluate the NLR, PLR and systemic immune-inflammation (SII) as a diagnostic tests for early detection of EOS.

Patients and Methods

This study was carried out on 100 preterm infants at the Neonatal Intensive Care Unit (NICU) of Ain Shams University Children’s Hospital. They were divided into two groups: Group A (patient group) which included 45 preterm, suffering from EOS and group B (controls group) which included 55 healthy preterm. History-taking, complete clinical examination, blood culture, complete blood count (CBC), C-reactive protein (CRP), NLR, PLR and SII were done.

Results

Patients group (high CRP, Rodwell Score positive, positive blood cultures) had significantly higher NLR, PLR, and SII at first and third day of life compared with the controls group(negative CRP, Rodwell Score non sepsis and negative blood cultures). NLR of 1.9 was determined as the predictive cutoff value of EOS (sensitivity 91.11%; specificity 92.73%). A PLR of 53.79 was determined as the predictive cutoff value of neonatal EOS (sensitivity 93.33%; specificity 43.64%). A SII of 333.97 was determined as the predictive cutoff value of neonatal EOS (sensitivity 97.98%; specificity 90.91%).

Conclusion

NLR, PLR and SII had high sensitivity and specificity as diagnostic markers for earlyonset neonatal sepsis.
Relation between Irritable Bowel Syndrome and Acute Infectious Gastroenteritis in Children
Authors: Wahed Mohamed Ashraf Abdel , Abdelhamid Dalia Hosni , Awad Yosra Mohamed Mohsen , Nabhan Dina Abdelhamid , Hussein Mai Hussein Mohamed Ali
Published: November 2024

Background

Post-infectious irritable bowel syndrome (PI-IBS) has been defined as a new onset of IBS following an episode of acute infectious diarrhea.

Objective

To determine the frequency of postinfectious irritable bowel syndrome (PI-IBS) among children who have an episode of acute infectious diarrhea.

Subjects and Methods

A case control longitudinal study was conducted on 93 children who fulfilled the criteria for diagnosis of acute infectious gastroenteritis. Patients were recruited from the Outpatient Clinic, Children’s Hospital, Ain Shams University, during a period of 6 months and were followed up for 3 months for the development of symptoms of IBS according to Rome IV criteria for diagnosis of IBS. They were compared to 100 age- and sex-matched controls who do not have history of acute infectious gastroenteritis during the last 3 months before enrollment.

Result

The age of studied cases ranged between (4-15) years old with a mean ±SD=9.26 ± 3.20 years. Females represented 61.3% of cases. PI-IBS occurred in 14%of cases with age ranged between (4-14) years old and females represented 61.5% of PI-IBS cases. Meanwhile, the incidence of IBS 3.2% of uninfected controls (relative risk, RR = 4.33). Most cases of PI-IBS were diarrhea prominent. There was no significant association with the causative organism identified among cases. Rota virus represented the most common organism among our patients with incidence of (32.3%) followed by campylobacter, salmonella, adeno virus, and giardia with incidence of (9.7%), (8.6%), (5.4%), (6.5%), respectively, while (37.6%) of patients have negative stool cultures for the mentioned organisms.

Conclusion

The frequency of PI-IBS is common among pediatrics but does not seem to be associated with the causative organism of the preceding episode of infectious diarrhea. Raising the awareness about this entity is of outmost importance as this will allow targeted treatment.
Maternal Voice Effect on Preterm Neonates in Neonatal Intensive Care Unit
Authors: Shatla Rania Hamed Mahmoud , Ismail Rania Ibrahim Hossni , Rabie Dina Essam Abdelhamid , Abuelazaim Marwa Magdy Ismail
Published: November 2024

Background

The mother's voice, along with other developmentally appropriate sensory events (ie, touch, light, smells), stimulates maturation of the sensory systems and helps shape normal fetal development. Few studies have addressed the effects of exposure to maternal voice for preterm infants’ stress.

Objective

To evaluate the effect of maternal voice on neonatal stress as assessed by NICU Network Neurobehavioral Scale (NNNS) scale.

Patients and Methods

This randomized controlled interventional study included 64 preterm infants (<36 weeks gestational age). They were divided into two groups; intervention group included 32 preterms who were exposed to mothers’ voice and standardized group included 32 preterms who were not exposed to mothers’ voice then neurobehavioral assessment was done through the NNNS scoring system through thirteen summary scores which are habituation, tolerance of handling, quality of movement, selfregulation skills, non-optimal reflexes, stress signs, arousal, hypertonia, hypotonia, asymmetry, excitability, lethargy and orientation, with exposure to recorded maternal voice for 30 minutes and assessment immediately before, after and at 60 minutes after exposure versus no intervention at all. Cases were recruited and assessed for eligibility from Ain Shams University NICUs.

Results

There was a statistically significant neurobehavioral improvement according to NNNS scoring system among cases in the intervention group immediately and after 60 minutes of exposure to the mother’s voice (P value<0.001).

Conclusion

Exposure to maternal voice has positive effects on the preterm infants’ behavior and emotions as assessed by thirteen summary scores of NNNS.
Level of CD11a among Newly Diagnosed ITP Patients and after 6 Months Follow Up
Authors: Elalfy Mohsen Saleh , Hamza Mohammad Tarif , Dakhel Medhat Saleh , Tolba Marwa Waheed
Published: November 2024

Background and Objectives

Immune thrombocytopenia (ITP) is a relatively frequent acquired bleeding disorders. Etiology is not yet well understood. Lymphocytic function associated antigen-1(LFA-1) might play an important role in signal coordination and lymphocyte activation. The aim of this study was to assess CD11a expression on lymphocytes in newly diagnosed ITP patients and to correlate it with bleeding severity in ITP and to evaluate the effect of immunomodulation medications on CD11a expression in children with ITP.

Patients and Methods

This is a prospective case-control study enrolling children with ITP attending pediatric Hematology clinic, Ain Shams University Hospitals through November 2021-November 2022 and near equal number of age and sex matched control subjects were randomly selected. All necessary laboratory tests for diagnosis of ITP were performed and the expression of CD11a on lymphocytes was analyzed by flow cytometry at the start of the study and after 6 months of follow up and assessment of bleeding manifestations according to ITP- specific bleeding assessment tool (ITP-BAT).

Results

Thirty-five patients aged (2-15) years with median age 6.5 years. 21 males and 14 females were enrolled as newly diagnosed primary ITP. The mean platelet count in these patients was 13(103/ul) initially and 239(103/ul) at follow up with response rate of 94.1%. The treatment received in ITP patients was corticosteroid (97.1%),IVIG (11.6%),thrombopoietin receptor agonist (17.4%) and anti CD20 monoclonal antibody (5.8%). The mean fluorescence intensity (MFI) of CD11a was 95.7% initially and 94.7 % at follow up and it was 94.3% in the control group. The mean fluorescence intensity (MFI) of CD11a on lymphocytes showed significant difference in ITP patients initially compared to healthy controls (p value= 0.001) and (MFI) of CD11a on lymphocytes show significant difference between patients before and after treatment (p value=0.001).

Conclusion

CD11a had a possible role in the pathogenesis of ITP. Immune-modulatory therapy for ITP affects the level of CD11a expression on lymphocytes. CD11a expressions on lymphocytes were not correlated with the platelet counts nor the bleeding score in ITP.