bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case Report of Pulmonary Alveolar Proteinosis with Associated Opportunistic Infection of Pneumocystis jirovecii and Molluscum Contagiosum
Authors: Patel Sapna , Gurumurthy Deepika , Rani Smitha , Devi Sheela
Published: March 2024

Pulmonary alveolar proteinosis (PAP) is an idiopathic rare diffuse pulmonary disease, first described in 1958 by Rosen et al. Its estimated prevalence is about 1 in 3.7–6.9 × 106 with a male: female ratio of 1:1–2:1. Majority of the patient’s age ranges between 20 and 50 years. PAP on microscopy is characterized by the presence of massive insoluble, amorphous, phospholipid-rich protein deposits in the bronchial and alveolar cavities. Most patients with acquired PAP present with cough and exertional dyspnea. It has been studied that there is increased risk of superinfection in PAP with opportunistic organisms like pneumocystis and vice versa. Definitive diagnosis of Pneumocystis jirovecii pneumonia rests on the demonstration of the organism within the alveoli by special stains like Grocott Methenamine Silver stain. Molluscum contagiosum (MC) is a common superficial skin infection caused by the poxvirus. MC is characterized by painless papules commonly seen in children and immunocompromised individuals. Here, we present a 34-year-old female who had complaints of severe difficulty in breathing and was brought dead to our hospital. On external examination, she had multiple warts over chest, abdomen, and over genitalia. Internal examination was unremarkable. Specimens of kidney, lung, and skin biopsy of genital warts sent for histopathological examination revealed acute tubular necrosis, P. jirovecii with PAP, and MC respectively.
Pattern of Clinical and Laboratory Presentation of Cerebral Malaria among Children in Nigeria
Authors: Jegede Tolulope O. , Oseni Saheed B. , Okeniyi John A. O. , Kuti Bankole Peter , Adegoke Samuel A. , Salau Qasim A. , Bello Emmanuel Olaseinde , Jegede Temitope Oyinlola , Kareem Abiodun John , Oyelami Oyeku A. , Samuel Ibitoye Bayode , Oluwatuyi Korede O. , Ekogiawe Foluwakemi T. , Obasohan Stanley E. , Abazu Ikechukwu S. , Babalola Emmanuel O.
Published: March 2024

Introduction:

Cerebral malaria (CM) is the most lethal form of severe malaria with high case fatality rates. Overtime, there is an inherent risk in changing pattern of presentation of CM which, if the diagnosis is missed due to these changing factors, may portend a poor outcome. Variations in the pattern of clinic-laboratory presentations also make generalization difficult. This study was, therefore, set out to report the pattern of clinical and laboratory presentation of CM

Methods:

This was a cross-sectional study among children aged 6 months to 14 years admitted with a diagnosis of CM as defined by the World Health Organization criteria. A pretested pro forma was filled, and detailed neurological examination and laboratory (biochemical, microbiology, and hematology) investigations were done. P <5% was considered statistically significant

Results:

Sixty-four children were recruited with a mean age of 34.9 ± 24.9 months and a male-to-female ratio of 1.9:1. There were 87.5% of under-five children. Fever (96.9%) was the major presenting feature closely followed by convulsions (92.2%). Convulsions were mainly generalized (94.9%) and multiple (76.5%). Profound coma (Blantyre coma score of 0) was present in 12.5% of cases, and the leading features on examination were fever (84.4%) and pallor (75.0%). Retinal vessel whitening (48.4%) was the most common funduscopic abnormality. Metabolic acidosis (47.9%), severe anemia (14.1%), hyperglycemia (17.2%), and hypoglycemia (7.8%) were seen among the children. Few (1.6%) had hyperparasitemia and bacteremia (3.2%)

Conclusion:

Early recognition of the clinical presentation and prompt management may improve the outcome of cerebral malaria.
Comparison of Waterlow and Braden scores for predicting pressure ulcer development in intensive care unit patients: A prospective observational cohort study
Authors: Kumar Pankaj , Dinesh C.
Published: March 2024

Background and Objectives:

Intensive care unit (ICU) patients are highly vulnerable to the development of pressure ulcers (PUs). Risk score scale that would efficiently predict the formation of PU in such patients includes the Waterlow Scale and the Braden Scale. Our objective was to determine the cutoff values of these scores for predicting PU formation in the ICU.

Materials and Methods:

A prospective observational study was conducted in the ICU of tertiary care center with 74 admitted patients. Inclusion criteria were Braden score ≤18 and Waterlow score >15 at admission to ICU and without preexistent ulcer. Assessment was done at 24-h intervals, after admission using Braden and Waterlow Scales till the patient reached a predefined endpoint development of PU, discharge, or transfer from ICU or death.

Results:

Thirty-nine patients developed PUs during their ICU stay. Waterlow score on the penultimate day for those who developed ulcers had a lower coefficient of variance (13.30) and greater area under receiver operating characteristic (0.977) than that of Braden (14.20; 0.888). A Waterlow score >20 (sensitivity 97.4%, specificity 88%, and accuracy 93.75%) and Braden score of <12 (sensitivity 97.4%, specificity 60%, and accuracy 82.81%) were predictors of impending ulcer formation in ICU patients.

Conclusion:

A Waterlow score >20 (19.5) may be taken as a cutoff for predicting impending ulcer formation for ICU patients. Whenever Braden scores are used instead of Waterlow, a cutoff of <12 (12.5) is indicative of higher chances of ulceration.
Role of sonoelastography and thyroid imaging reporting and data system in assessment of thyroid nodules
Authors: Elewa Eman M.S.A. , Hassan Rawhia T. , Amer Talal A.
Published: March 2024

Background

Thyroid nodules are very common and may be observed at ultrasound (US) in 50% of adult population. US elastography is a noninvasive technique for evaluating thyroid nodules to decrease the number of tissue biopsies. Thyroid imaging reporting and data system (TIRADS) is the assessment of risk stratification of thyroid nodules using a score.

Patients and methods

This cross-sectional study was carried out on 100 patients with 146 thyroid nodules. The study was conducted in the period from October 2018 to October 2020 at the Radiology Department and approved by the Ethics Committee, and all patients gave their informed consent before inclusion in the study. Results were collected and then analyzed using a specialized computer statistical program.

Results

We found 124 (84.9%) benign nodules and 22 (15.1%) malignant nodules. The accuracy of elastography color score in detection of malignancy was found to be 95.1%, 89.7% for strain ratio, and 88.4% for TIRADS.

Conclusion

Adding elastography examination and TIRADS score to the routine thyroid US will be of high diagnostic value in detection of malignancy.
Transforaminal lumbar interbody fusion in degenerative spondylolisthesis
Authors: Dawood Ahmed M. , Abdel Baky Gad R. , Soliman Hany A.G.
Published: March 2024

Introduction

Spinal fusion surgery is a common technique used to treat degenerative lumbar pathologies including disc herniation with instability, spinal stenosis, and degenerative spondylolisthesis (DS). Minimally invasive transforaminal lumbar interbody fusion (TLIF) is a common surgical procedure for treatment of DS.

Aim

We aimed to assess the outcomes of TLIF in DS.

Patients and methods

This study was conducted on 15 patients treated for DS treated with TLIF. A written informed consent was taken from all participants after proper explanation of the study. The study assessed perioperative results related to the operative procedure such as blood loss, operation time, hospital stay, and complications. Oswestry Disability Index (ODI) questionnaire was filled for functional evaluation, and the visual analog scale was used to assess pain preoperatively and postoperatively.

Result

A total of 15 cases were included. The mean age of the included cases was 53.67 years, the mean BMI was 26.73, 53.3% of cases were female, and 33.3% of patients were smokers. There was a significant decrease in visual analog scale ODI after operation. Regarding complications, 73.3% had no early complications but 13.3% had wound infection and 6.7% had positioning neuropathy and postoperative hematoma. Late complications were founded in 33.3% in the form of adjacent segment disease in 13.3%, arthrodesis in 13.3%, and fusion failure in 6.7%.

Conclusion

This study shows that TLIF is an effective procedure in surgical management of DS. The TLIF gives better results regarding reduction of low back pain and leg pain, as well as reduction in ODI score in early follow-ups and similar results in late follow-ups.
Comparative study between preoperative ketamine bolus dose versus ketamine bolus plus infusion for perioperative analgesia in orthopedic surgery
Authors: Abdullatif Esraa B. , Amin Mohamed A. , Lotfy Soad A.
Published: March 2024

Background and aim

Postoperative pain severity depends on patient factors, anesthesia-related factors, and type of surgery. Pain after orthopedic surgery has been found to be immediate and severe, which necessitates more attention for its management. The aim of this study was assessment of the effectiveness of intravenous ketamine to provide postoperative analgesia after orthopedic surgery. This randomized double-blind study had been performed in Al-Zahraa University Hospital from December 2019 to October 2020.

Patients and methods

A total of 75 patients subjected to major orthopedic surgery were registered in the study. The patients had been randomly assigned into three equal groups (control, bolus, and bolus with infusion groups) to receive intravenous ketamine bolus dose alone (0.3 mg/kg) (bolus group); ketamine bolus (0.3 mg/kg) plus infusion (5 µg/kg/min), which terminated at the end of operation (bolus with infusion group); or placebo in the form of normal saline (control group). Visual analog pain scale score, postoperative 24 h morphine requirements, time to first analgesic requirement, and postoperative adverse effects were recorded and compared.

Results

Postoperative visual analog pain scale score and total morphine requirements were significantly less in bolus with infusion group, followed by bolus group, whereas the highest score and requirements were in control group. Regarding the time to first analgesic requirement, there was a statistically significant increased time to first analgesic in bolus with infusion group, followed by bolus group, whereas the shortest time was in control group, and there were nonsignificant differences among groups regarding postoperative complications.

Conclusion

Ketamine bolus dose alone before skin incision or followed by infusion had the capability of decreasing postoperative pain and total analgesic requirement and increasing the time to first analgesic requirement after orthopedic surgery, with superiority of ketamine bolus dose plus infusion without increasing the incidence of adverse effects.
Role of calponin 1 and cervical length measurement in predicting preterm labor
Authors: Youssry Lamiaa M. , Effat Doaa M. , Zaid Nesreen H.
Published: March 2024

Background

Birth at less than 37 weeks of gestation is considered preterm, which is 11% of all live births. Most of symptomatic women who have preterm birth before 32 weeks of gestation are transferred to a tertiary referral center and receive treatment. However, 80–95% will not deliver within 7 days after admission, and 50% of these are delivered at term.

Aim

To decide whether serum calponin 1 level when combined with measurement of the cervical length may be used as a biomarker for prediction of delivery within 24 h in threatened preterm labor (PTL) pregnancies between 24 and 34 weeks of gestation.

Patients and methods

This is a prospective cohort study that was conducted at Al Azhar University Al-Zahraa Hospital within 1 year and included 50 pregnant women with threatened PTL between 24 and 34 weeks of gestation. Pelvic ultrasound and serum calponin 1 level were done for all cases.

Results

Calponin 1 level was significantly higher in women who delivered within 24 h (P=0.003). The cutoff value of calponin 1 level was 1.08 ng/ml, with 95.2% sensitivity and 100% specificity (area under curve: 0.986, confidence interval: 0.955–1.018). There was a significant positive correlation between cervical length and delivery interval (r=0.543, P=0.001). Cervical length less than or equal to 2.56 cm was 89.2% sensitive and 100% specific to identify delivery within 24 h (area under curve: 0.886, confidence interval: 0.865–1.011). There was a significant negative correlation between cervical length and calponin 1evel (−4.244, P<0.001).

Conclusion

Serum calponin 1 level and cervical length measurement can be used for predicting PTL in threatened pregnancies.
Subarachnoid versus intravenous dexmedetomidine and fentanyl for minimizing stress response in laparoscopic cholecystectomy
Authors: Abdalla Mofeed
Published: March 2024

Background

The magnitude of stress response depends on several factors such as duration and intensity of surgical trauma, patient's age, surgical method, anesthetic technique, blood loss, and postoperative pain.

Aim of the work

The aim of this work was to study the effect of intravenous versus intrathecal dexmedetomidine and fentanyl on stress response during laparoscopic cholecystectomy.

Patients and methods

Sixty patients fulfilling the inclusion criteria who were undergoing laparoscopic cholecystectomies were randomly assigned to receive either intravenous fentanyl and dexmedetomidine (group I) or intrathecal fentanyl and dexmedetomidine (group II). Mean arterial blood pressure and heart rate were recorded before induction of anesthesia (T0), 5 min after intubation (T1), 30 min after start of surgery (T2), at skin closure (T3), 6 h postoperatively (T4), and 24 h postoperatively (T5). The number of patients who required intraoperative intravenous fentanyl and total intraoperative fentanyl consumption (µg), and the number of patients who required intravenous morphine at the end of surgery were recorded. Visual analogue scale and total postoperative morphine consumption (mg) at the end of surgery (M0), and at 6, 12, 18, and 24 h (M1, M2, M3, and M4, respectively) were recorded. Blood interleukin-6, cortisol, and glucose were measured before anesthesia (F0) and after recovery (F1). Postoperative complications were recorded.

Results

Heart rate and mean arterial blood pressure were statistically lower in group II at T2 and T3. The number of patients requiring intraoperative intravenous fentanyl and total intraoperative fentanyl consumption (µg), and the number of patients requiring intravenous morphine at the end of surgery were statistically lower in group II. Visual analogue scale and postoperative morphine consumption (mg) were statistically lower in group II at M0 and M1. Blood cortisol and blood glucose level were statistically lower in group II at F1. There were no statistical differences as regards complications.

Conclusion

Apart from lowering heart rate and BP, intrathecal dexmedetomidine and fentanyl was superior to intravenous dexmedetomidine and fentanyl, wherein it lowered pain score and analgesic consumption with attenuation of stress response.
The added value of digital breast tomosynthesis over digital mammography in evaluation of suspicious breast lesions
Authors: Abdullah Riham A.S. , Oun Abdel A.K. , Ahmed Abdullah H.
Published: March 2024

Background

Breast cancer is the most frequent cancer among women worldwide and also in Egypt and causes the greatest number of cancer-related deaths among women. Mammography remains the method of choice for breast imaging. In the field of mammography, significant technical improvements have been realized, mainly owing to the introduction of digital mammography (DM) and digital breast tomosynthesis (DBT).

Aim

To determine the added value of DBT over DM in evaluation of suspicious breast lesions.

Patients and methods

A total of 50 female patients who had breast lumps or positive findings in screening by mammography were included.

Results

The study population was 50 female patients. They were subjected to imaging by DM and DBT. The study reveals that DBT has a superior role in assessment and characterization of suspicious breast lesions over DM.

Conclusion

DBT showed higher sensitivity and specificity and diagnostic accuracy over DM.
Intralesional vitamin D3 vs purified protein derivative in treatment of recalcitrant cutaneous and venereal warts
Authors: Pessar Doaa A.E.-M.H. , Mohamed Asmaa S.F. , Galal Sara A.
Published: March 2024

Introduction

Human papilloma virus (HPV) can produce a significant amount of anxiety and stress in patients. Many therapeutic options are available for treating warts. More recent and effective treatment, including intralesional immunotherapy, have been tried in the recent times with variable success rates.

Aim

The aim was to compare the efficacy, safety, and the clinical response of intralesional vitamin D3 (Vit D3) vs purified protein derivative (PPD) in the treatment of recalcitrant cutaneous and venereal warts.

Patients and methods

This study was carried out on 30 patients with cutaneous and venereal recalcitrant warts. Fifteen patients (11 patients with recalcitrant cutaneous warts and four patients with recalcitrant venereal warts) were subjected to intralesional injection of Vit D3 in one up to three warty lesions in every patient; the other 15 patients (11 patients with recalcitrant cutaneous warts and four patients with recalcitrant venereal warts) were subjected to intralesional injection of PPD in one up to 15 warty lesions in every patient. Assessment of the results was done by clinical evaluation, patient satisfaction, and multiple digital photographs.

Results

We found that the total response rate to immune therapy was 83.3% in both groups of patients collectively. In the Vit D3-treated group, complete response was achieved in 73.3% of patients and partial response in 26.6%. However, in the PPD-treated group, complete response was achieved in 46.6% of patients, partial response in 20%, and 33.3% of the patients showed no response. The overall clinical response in Vit D3-treated group was significantly higher than in the PPD-treated group (100 vs 66.67%, respectively). We also found that the longer the duration of HPV infection, the poorer the response rate to treatment and the need for more sessions.

Conclusion

Clinical efficacy and safety of intralesional injection of Vit D3 vs PPD for treatment of HPV, the high response rate, the absence of adverse effects, low cost, and the affordability of the Vit D-treated group makes it a very useful tool in the treatment of HPV and is more superior than the PPD.
Expression of TWIST1 and CD44 as diagnostic and prognostic biomarkers in patients with gastric cancer
Authors: El Kholy Marwa A. , El Sayed Hala A. , Ahmed Eman M.
Published: March 2024

Objective

The aim of this study was to investigate the association of TWIST1 and CD44 in gastric cancer (GC) with clinical parameters and their relation to prognosis, which may be beneficial for targeted therapeutic strategies in the future.

Materials and methods

The material of this work consisted of 40 primary GC specimens from patients who underwent radical gastrectomy. Patients who received neoadjuvant chemotherapy or chemoradiotherapy, those who presented with other cancers at the same time, or the patients with incomplete clinical data were excluded from the study. Hematoxylin and eosin-stained sections from all cases were re-evaluated and further stained immunohistochemically using antibodies against TWIST1 and CD44.

Results

TWIST1 and CD44-positive expressions were significantly increased in GC cases of diffuse type (P=0.019 and 0.002, respectively). Moreover, there was a statistically significant correlation between both markers and tumor grade, stage, and lymphovascular invasion (P=0.027 and 0.010, P=0.002 and 0.012, and P=0.001 and 0.005, respectively). A statistically significant correlation was found between TWIST1 and CD44 expressions in GCs (P=0.000).

Conclusion

The presence of TWIST1-positive carcinoma cells and CD44-positive cancer stem-like cells in GC tissue can be used as a diagnostic tool for GC and regarded as a marker of poor prognosis in patients with GC, which may provide potential targets for GC therapy.
Assessment of growth and nutrition in children with chronic diseases
Authors: Mohamed Walaa E.A. , Fayed Sohier B. , Manalabd-Elsalam  , Abdel-Dayem Soha , Rashad Hend
Published: March 2024

Background

Growth failure in chronic childhood disease is a multifactorial entity. The nutritional outcome is affected by baseline nutritional status, disease state, and, rarely, an inherent genetic abnormality.

Aim

To assess growth and nutritional status in children with some chronic illnesses, including children with chronic kidney disease on regular hemodialysis and children with type 1 diabetes.

Patients and methods

This case–control study was conducted on 120 children. Their ages ranged from 6 to 18 years. The study was carried out at the nephrology and hemodialysis unit of Al-Zahraa Hospital, Al Azhar University, and at National Research Center. The study population was divided into three groups: group 1 included 40 children with end-stage renal disease on regular hemodialysis, group 2 included 40 children and adolescents with type 1 diabetes, and group 3 included 40 healthy controls of comparable age and sex. The patients were subjected to full medical history; etiology, onset, and duration of disease; and medication regularity. Moreover, selective routine follow-up laboratory investigations were done for patient and control groups in the same line with anthropometric measurements and dietary assessments and were compared regarding their daily recommended diet for each group.

Results

Children on regular hemodialysis consumed fewer proteins, fats, fruits, and vegetables in comparison with their standard dietary recommended daily intake, which was 82.9, 57.9, 70.1, and 33.6%, respectively, with a significant decrease in their anthropometric measurements in comparison with diabetic and healthy groups. Children with type 1 diabetes consume more starches, proteins, and dairy products in comparison with their standard dietary daily intake but consumed less fat, fruits, and vegetables, and they had poor glycemic control and a significant increase in their anthropometric measurements in comparison of those values with available norms. We found a significant positive correlation between starches consumption and anthropometric measurements in type 1 diabetic children.

Conclusion

It is necessary to consider nutritional status in the assessment of the etiology and treatment of growth failure in children on regular hemodialysis. Nutritional policies and nutritional assistance programs and actions must be taken in children with chronic kidney disease to avoid growth failure and in type 1 diabetes to achieve normal glycemia and normal growth.
Effect of recanalization of anterior tibial artery and peroneal artery on targeted angiosomes of posterior tibial artery in the foot through different aspects
Authors: Khedr Alhussein M. , Elimam Sameh E.
Published: March 2024

Objective

The purpose of this study is to evaluate the outcome of percutaneous transluminal angioplasty of ipsilateral peroneal artery and the anterior tibial artery for revascularization of targeted angiosomes in the vascular territory of posterior tibial artery (PTA) in the foot, through interconnecting branches, and the resulting effect on existing wound healing and limb salvage, in comparison with the effect of percutaneous transluminal angioplasty on PTA alone on revascularization and wound healing in these angiosomes.

Patients and methods

We included 80 patients for 80 angioplasty procedure (80 limbs) who were divided into two equal groups. Group A included patients with peroneal and anterior tibial patent vessel runoff, who were fit for percutaneous transluminal angioplasty for both vessels, whereas group B were candidates for PTA angioplasty. We studied the arterial supply in 80 limbs with TASC C-D lesions with follow-up along 1 year, all with PTA occlusion. Patients with single-vessel or three-vessel runoff were excluded from the study. Outcome measures included wound healing of targeted angiosomes of PTA with complete epithelialization of the affected lesion with or without secondary interventions such as debridement or skin grafting and limb salvage with absence of major amputation.

Conclusions

We found that recanalization of peroneal artery together with anterior tibial artery can supply angiosomes of PTA and accelerate wound healing through communicating branches in the foot with comparable outcome on wound healing and decreased incidence of major amputation to single recanalization of PTA as primary and secondary outcome, obviating the need for lengthy and more risky interventional procedure.
The outcome of oral sildenafil therapy on persistent pulmonary hypertension of the newborn with respiratory distress
Authors: Monazea Esaad M. , Khattab Sahar S. , Ebrahim Asmaa A.W. , Mohamed Layla A. , Ahmed Howayda A.A.R.
Published: March 2024

Background

Persistent pulmonary hypertension (PPHN) is defined as failure of normal pulmonary vascular adaptation at or soon after birth, resulting in a persistent high pulmonary vascular resistance, which leads to diminished pulmonary blood flow and shunting of unoxygenated blood into systemic circulation through an opened foramen ovale and/or the ductus arteriosus. The prevalence of this syndrome is about 1.9/1000 in the population of neonates born at term.

Objective

The aim was to evaluate the efficacy and safety of oral sildenafil in the treatment of PPHN.

Patients and methods

This prospective interventional study was conducted on 50 neonates who were of more than or equal to 37 weeks gestational age and less than 3 days old and were diagnosed as PPHN by echocardiogram and had an oxygenation index (OI) more than or equal to 20. All included cases were given oral sildenafil as per the study protocol with a starting dose of 0.5–2 mg/kg/dose. OI, oxygen saturation, alveolar arterial oxygen gradient, and mean airway pressure were monitored serially.

Results

This study showed a significant decrease in OI after 30 min of starting treatment and after 24 h of treatment in the studied cases 16.1±1.7 (P=0.010); also, there was a significant decrease in ESPAP? after treatment estimated by ECHO from mean 49.4±5,9 to 42.5±5.7 (P<0.001). Furthermore, this study showed a significant decrease in brain-type natriuretic peptide in studied cases after treatment with sildenafil.

Conclusion

Oral sildenafil may be of benefit in improving oxygenation in infants with PPHN as it can effectively improve OI and reduce right ventricular systolic pressure.
Efficacy of 24-week treatment with sofosbuvir/daclatasvir/ribavirin in chronic hepatitis C virus-infected Egyptian patients with previous sofosbuvir-based treatment failure
Authors: Sabal Aisha A. , Omar Hanaa M.M. , El-Taher Salwa M. , El-Deen Nesreen M.B. , El Kassas Mohamed
Published: March 2024

Background

Hepatitis C virus (HCV) is a globally prevalent pathogen and a common leading cause of morbidity and mortality. Egypt has the highest HCV prevalence worldwide, with more than 14.7% of the Egyptian adults having been exposed to the virus.

Aim

To evaluate the efficacy of 24-week treatment with sofosbuvir (SOF)/daclatasvir/ribavirin in chronic HCV-infected Egyptian patients with previous SOF-based treatment failure.

Patients and methods

This cohort study was conducted on 247 patients with chronic hepatitis C infection. They all relapsed on SOF-based treatment regimens. Their ages ranged between 22 and 72 years. They were divided according to FIB-4 results into two groups: group I included 132 cirrhotic patients, and group II included 115 noncirrhotic patients. All patients were followed for 24 weeks with liver function tests, complete blood count, and international normalized ratio, and then along with PCR at 4 and 12 weeks after treatment, with recording of adverse events.

Results

Sustained virologic response (SVR) was achieved in 96% of patients. There was a significant improvement of platelet counts, alanine aminotransferase, and aspartate aminotransferase, causing significant improvement in FIB-4 (points from <1.45 to 3.25), APRI score (points from <0.5 to >2), and LOK index (fractions from <0.2 to >0.5), where all significantly declined at SVR 4 and 12. Anemia and hyperbilirubinemia were the most commonly reported adverse events.

Conclusion

The combination of SOF plus daclatasvir with ribavirin for 24 weeks has favorable outcomes with high SVR rates and safety profile in treatment of chronic HCV-infected Egyptian patients who relapsed on SOF-based regimens.
Aldosterone hormone levels in preeclamptic women in comparison with normal pregnancy
Authors: Mahar Aml S.M. , Abdel-Hakam Faiza A. , El Hakim Samia F.A. , El Baky Nashwa M.A.
Published: March 2024

Objective

To assess the level of aldosterone hormone in preeclamptic pregnant woman and comparing it with normal pregnancy.

Patients and methods

A prospective case–control study that was conducted on 80 pregnant women with gestational age from 28 to 40 weeks and attended Al Zahraa University Hospital, Al Azhar University, in the period from December 2019 to December 2020. The selected participants were divided into two groups: group I (control group) (n=40), which included 40 normal pregnant women, and group II (n=40) (cases group), which is further subdivided into two subgroups: subgroup A (n=20): cases with mild preeclampsia, and subgroup B (n=20) cases with severe preeclampsia. Approximately 5 ml of venous blood was collected once from both study group and control group by antecubital venipuncture, using a sterile disposable syringe, without using elastic band tourniquet. Half of the amount collected was transferred immediately into commercially prepared concentration of ethylene diamine tetra-acetic acid containers. The remaining half was allowed to clot and the serum was obtained by centrifugation at 3000 rpm for 10 min or the remaining investigations including serum aldosterone concentration estimation by enzyme immunoassay.

Results

Regarding the serum aldosterone levels, there was a highly statistically significant difference among control, mild preeclampsia, and severe preeclampsia groups (P=0.003). The mean aldosterone of the study participants was 0.76, with SD of 0.27, and ranged from 0.2 to 1.39 in control group; 0.83, with SD of 0.13, and ranged from 0.59 to 1.06 weeks in mild preeclampsia group; and 1.10, with SD of 0.59, and ranged from 0.65 to 2.88 in severe preeclampsia group.

Conclusion

The aldosterone hormone may play an important role in the pathogenesis of elevated blood pressure in this pathological state and may be used in the prediction of the severity of preeclampsia.
Conservative breast surgery versus modified radical mastectomy in surgical management of early breast cancer
Authors: Ahmed Mostafa A.-E. , Bader Hazem Ahmed , Al Zamek Mona Mohammad Farid , Ali Rasha M.M.
Published: March 2024

Objectives

To compare the advantages of conservative breast surgery (CBS) to modified radical mastectomy (MRM) regarding the outcome, prognosis, and survival in management of early breast cancer.

Patients and methods

This study included 100 patients attending Al Zahraa University Hospital from March 2016 to February 2019 diagnosed as having early breast cancer (stages I and II breast cancer). Their age ranged from 25 to 60 years old. They were classified into two group: group A, which underwent breast-conservative surgery (n=15), and group B, which MRM (n=85).

Results

The goals of using CBS and radiation therapy to treat patients with early breast cancer (stages I and II) are to provide surgical equivalent to that obtained with MRM. There was only a small risk of recurrence in the treated breast and had satisfactory cosmetic result. The success of CBS depends not only on appropriate patient selection but also on the combination of adequate surgical margins and an acceptable cosmetic result.

Conclusion

Breast-conservative surgery and mastectomy result in nearly equivalent survival rates for patients with stages 0, I, or II disease. The decision to conserve the breast must be made individually.
Serum irisin level and its relation to diabetic nephropathy in patients with type 2 diabetes mellitus
Authors: Salama Doaa M. , Hammad Fatma K. , Mohamed Eman E. , Ahmad Inass H.
Published: March 2024

Background

Irisin is an adipo-myokine, which has broad implications for metabolism and energy homeostasis. However, evidence about its association with diabetic nephropathy (DN) is limited.

Aim

To evaluate serum irisin level and its relation to DN in patients with type 2 diabetes.

Patients and methods

This case–control study was conducted on 60 patients with type 2 diabetes and 30 healthy age-matched and sex-matched individuals. Patients were divided into three groups according to urinary albumin–creatinine ratio (ACR), namely, normoalbuminuric group, which included 15 patients; microalbuminuric group, which included 30 patients; and macroalbuminuric group, which included 15 patients. Detailed history, clinical examination, and anthropometric measurements were assessed for all participants. Fasting blood glucose and 2-h postprandial blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, urea, creatinine, uric acid, estimated glomerular filtration rate, and irisin were measured for all participants. Glycosylated hemoglobin and urinary ACR were measured for patients only.

Results

Irisin was significantly lower in diabetic groups compared with controls. Irisin was positively correlated with estimated glomerular filtration rate but negatively correlated with fasting blood glucose, creatinine, and ACR. Multivariable regression analysis revealed that lower irisin level was considered as an independent predictor for DN.

Conclusion

Serum irisin is significantly related to diabetic kidney disease, and it might be progressively decreasing with development of the different stages of DN.
Comparative study between sleeve gastrectomy and gastric bypass in morbid obese patient
Authors: Abdel-Razik Mahmoud A.A. , Rabia Omnia M. , El Menem Mohammed Hany A.
Published: March 2024

Background

Morbid obesity is associated with many comorbidities. Our aim was to evaluate the reduction in weight and resolution of comorbidities after sleeve gastrectomy (SG) and gastric bypass operation.

Aim

To evaluate SG versus gastric bypass in morbid obese patient.

Patients and methods

A prospective review was conducted on patients who underwent SG and Roux-en-Y gastric bypass from 2015 to 2019 at General Surgery Department in Al-Zahraa University Hospital for Girl, Egypt. Outcomes include weight loss; improvement or resolution of comorbidities such as hypertension, type 2 diabetes, and hyperlipidemia; and postoperative complication at 12 months.

Results

A total of 50 patients met our inclusion criteria. Mean preoperative weight and BMI were 136.54±20.92 and 48.78±7.08, respectively. At 12 months, mean weight and BMI were 85.98±10.22 and 33.94±2.60, respectively. There was marked improvement or resolution of hypertension, type 2 diabetes, and hyperlipidemia.

Conclusions

SG and Roux-en-Y gastric bypass result in marked weight loss and improvement or resolution of comorbidities in morbidly obesity patients.
Tragal cartilage versus tragal perichondrial graft in tympanoplasty type 1
Authors: Hasan Manar I. , Mekhemer Sayed M. , Ibraheim Huda A. , Mohamed Bothina A.
Published: March 2024

Background

Chronic suppurative otitis media is a common health problem. It causes tympanic membrane perforation, otorrhea, and conductive hearing loss. Type 1 tympanoplasty is a common otological procedure done to eliminate the infection and improve hearing and quality of life.

Objective

To compare graft uptake and hearing outcome using autologous grafts (tragal cartilage, temporalis fascia (control group), and tragal perichondrium) in tympanoplasty type 1.

Patients and methods

A total of 45 patients with chronic suppurative otitis media were included in this comparative study. They were divided into three groups, with 15 patients in each group: group A received tragal cartilage graft, group B received temporalis fascia graft (control group), and group C received tragal perichondrial graft. Patients were subjected to detailed history taking, proper clinical examination, routine blood investigations, audiometry, and tympanometry preoperatively. They underwent underlay tympanoplasty type 1. Postoperative follow-up was done after 3 months by otoscopy to evaluate graft uptake and hearing outcome by audiometry, and results were compared.

Results

Graft uptake was 93.3% in the cartilage group, 73.3% in fascia (control) group, and 66.7% in perichondrium group. There was hearing improvement in cartilage group than fascia (control) group, which was better than perichondrium group, with no statistically significant difference among the three groups regarding graft uptake (P=0.188) or hearing gain.

Conclusion

Graft uptake and hearing improvement were better with tragal cartilage graft in comparison with fascia (control group) and perichondrium grafts, with no statistically significant difference between them.
Architect HCV Ag assay is an efficient alternative tool to RNA qRT-PCR quantification for assessing viral load in HCV infection
Authors: El-Hassan Ahmed Abd El-Aleem Abue , Abdallah Mohamed Gaber , Azab Mohammed Mohammed , Hassan Tarek A. , Atta Abd-ElHameed , Elsawy Mohamed Abdelhamed , AboElenin Mabrouk M.
Published: March 2024

Objective

To evaluate the performance characteristics of the automated Architect hepatitis C virus (HCV) core Ag assay versus HCV RNA by PCR among Egyptian patients and to assess its use for valuable clinical workup.

Background

HCV diagnosis by conventional anti-HCV assays has high rate of false positivity, false negativity, and a limited sensitivity for detection. Although HCV RNA assays are a reliable method for HCV diagnosis, they need technical skills and may also have false-positive results because of contamination. Moreover, the test is time consuming and more expensive. In contrast, the HCV core antigen test detects circulating HCV core antigen and identifies individuals who are actively infected with HCV. A commercialized test (the Architect HCV core antigen test) is supposed to have a sensitivity to detect ∼0.06 pg/ml and consequently a significant increase in sensitivity over the previous assay and a stronger correlation with HCV RNA testing.

Patients and methods

A descriptive, cross-sectional study was conducted on 60 HCV antibody-positive patients attending the outpatient clinic of Tropical Medicine Department, Al-Hussein University Hospital, Cairo, Egypt. The patients were classified into four groups based on the level of HCV viremia: group A included five patients with PCR below detection limit (12 IU/ml), group B included 39 patients with low viremia (<100 000 IU/ml), group C included 13 patients with moderate viremia (100 000–10 000 000 IU/ml), and group D included three patients with high viremia (>10 000 000 IU/ml). Each case was subjected to thorough clinical evaluation, HCV RNA quantification by Abbott Real Time HCV assay, and HCV Ag quantification by Architect HCV core antigen test.

Results

HCV Ag was found to be negative only in five of 55 HCV RNA-positive patients who had low level of viremia. The levels of HCV Ag showed a good correlation with those from the HCV RNA quantification (r=0.913, P≤0.001). Regarding HCV core antigen/HCV RNA ratio, it was not fixed for all patients. In most of them, each 1 pg/ml core Ag was equal to ∼10 000 IU/ml of RNA.

Conclusion

The Architect HCV Ag assay could be used as an alternative tool to HCV RNA PCR quantification in assessing viral load in HCV infection, and it has the advantages of lower cost, easy testing, and rapid reporting.
Immunoglobulin E level in children with chronic hypertrophied tonsils either symptomatized or not symptomatized
Authors: Mousa Asmaa M. , Abd-Elhady Mohammed R. , Ebrahim Huda A.
Published: March 2024

Background

Hypertrophy of tonsils is common in the pediatric population, primarily affecting younger children, aged 3–6 years. Tonsillar hypertrophy symptoms are among the most common causes for pediatric or ENT visits in children. Hence, doctors also need to be informed of the potential complications of tonsillar hypertrophy and the surgical indications. Therefore, the physiology of tonsils, their function for the immune system, and the early and late effects of tonsillar hypertrophy also need to be understood.

Objective

The aim was to measure the total serum and tonsillar tissue immunoglobulin E (IgE) level in children with chronic hypertrophied tonsils who will undergo for tonsillectomy (symptomatized children) and serum IgE level in nonsymptomatized children.

Patients and methods

This is a prospective comparative study that was carried out at the Otorhinolaryngology Department at Al-Zahraa University hospital and Al Mataria General Hospital. The study included 40 children, and their ages ranged from 5 to 15 years. Overall, 19 were males and 21 were females diagnosed with chronic hypertrophied tonsils. Half of them were symptomatized and underwent tonsillectomy, and the rest were not symptomatized.

Results

There was no significant difference in the serum IgE level in symptomatized and nonsymptomatized children. A statistically significant difference was found between the serum IgE level and the grades of tonsillar hypertrophy in both symptomatized and nonsymptomatized children. Tonsillar IgE level was also increased with increase in the grade of tonsillar hypertrophy. The relation between the serum and the tonsillar IgE levels in symptomatized children was found to be significant.

Conclusion

The authors observed a strong relationship between the serum IgE level and the grade of tonsillar hypertrophy in the two groups. Regarding the tonsillar IgE level in symptomatized children, there was an increase with increase in the grade of tonsillar hypertrophy, and there was also a positive correlation between serum and tonsillar IgE levels.
Gait Data-Driven Analysis of Parkinson’s Disease Using Machine Learning
Authors: Panda Archana , Bhuyan Prachet
Published: March 2024

INTRODUCTION: Parkinson's disease is a progressive and complex neurological condition that mostly affects coordination and motor control. Parkinson's disease is most commonly associated with its motor symptoms, which include tremors, bradykinesia (slowness of movement), rigidity, and postural instability.
OBJECTIVES: Determine any minor alterations in walking patterns that could be early signs of Parkinson's disease. Track the course of Parkinson's disease over time by using gait data.
METHODS: In this study, we applied three types of VGRF datasets ("Dual Tasking, RAS, and Treadmill Walking") and    developed an ML-based model using six different classifier methods. The datasets were analysed using 16 sensors, of which 8 were applied to each foot and the total pressure of the left and right foot. The aforementioned three distinct gait patterns movement disorders were the sources of the dataset. The gait signals dataset benefited by the participant demographic data. 
RESULTS: Then, we passed the outcome of applying the model and measuring performance through a cross-validation operator to check the accuracy and decision-making of the five algorithms i) Deep Learning, ii) Neural Networks, iii) Support Vector Machine (SVM), iv) Gradient Boost Tree (GBT), v) Random Forest”. The following findings compare the effectiveness of the various algorithms utilized and the observed PD very well.
CONCLUSION: The different ML classifier algorithms demonstrated good detection capability with different accuracy. Our proposed ensemble model is superior to compare with the existing models. Because we can observe the proposed ensemble model result and accuracy better than the other classifier model. The other classifier model’s highest accuracy is 92.08% whereas our ensemble model got 92.31%. So, it has proved that our proposed ensemble model is excellent and robust.
OPC UA Application Study in Oil and Gas Pipeline Network Monitoring Data Forwarding
Authors: Mao Bingqiang , Qi Guocheng , Mi Liang , Yan Feng , Xian Yulong , Chen Peng , Li Chen , Zhao Xiaochuan , Sun Yanguo , Pei Wenyu
Published: March 2024

INTRODUCTION： With the continuous development of oil and gas pipeline network monitoring and control technology, the need for data transmission and communication is becoming more and more prominent. In this context, OPC UA has attracted wide attention. This study aims to explore the application of OPC UA in data forwarding for oil and gas pipeline network monitoring in order to improve the efficiency, reliability and security of data transmission.PURPOSE: The purpose of this study is to evaluate the applicability of OPC UA in oil and gas pipeline network monitoring and to verify its performance in data forwarding through empirical studies. By gaining an in-depth understanding of the characteristics of OPC UA, it aims to provide a more advanced and efficient monitoring data transfer solution for the oil and gas industry.METHOD: The study adopts a combination of field monitoring and laboratory simulation. First, the essential characteristics and requirements of monitoring data in oil and gas pipeline networks were collected. Subsequently, a monitoring system with OPC UA as the communication protocol was established and field tested. In the laboratory environment, data transmission scenarios under different working conditions were simulated, and the performance of OPC UA under different conditions was analyzed.RESULT: The field monitoring results show that the data transmission efficiency is significantly improved by using OPC UA as the communication protocol for data forwarding in oil and gas pipeline network monitoring. Meanwhile, the system performs well in different environments with high reliability and security. The laboratory simulation results further verify the stability and adaptability of OPC UA under complex working conditions.CONCLUSION: OPC UA is an effective communication protocol that can meet the data transmission requirements for oil and gas pipeline network monitoring. Its efficient, reliable, and secure characteristics make it an ideal choice for improving the communication performance of monitoring systems in the oil and gas industry. The empirical results of this study provide reliable technical support for the oil and gas industry in the field of data transmission and a vital reference for the optimization and upgrading of monitoring systems in the future.
Lattice walks confined to an octant in dimension 3: (non-)rationality of the second critical exponent
Authors: Hillairet Luc , Jenne Helen , Raschel Kilian
Published: March 2024

In the field of enumeration of walks in cones, it is known how to compute asymptotically the number of excursions (finite paths in the cone with fixed length, starting and ending points, using jumps from a given step set). As it turns out, the associated critical exponent is related to the eigenvalues of a certain Dirichlet problem on a spherical domain. An important underlying question is to decide whether this asymptotic exponent is a (non-)rational number, as this has important consequences on the algebraic nature of the associated generating function. In this paper, we ask whether such an excursion sequence might admit an asymptotic expansion with a first rational exponent and a second non-rational exponent. While the current state of the art does not give any access to such many-term expansions, we look at the associated continuous problem, involving Brownian motion in cones. Our main result is to prove that in dimension three there exists a cone such that the heat kernel (the continuous analog of the excursion sequence) has the desired rational/non-rational asymptotic property. Our techniques come from spectral theory and perturbation theory. More specifically, our main tool is a new Hadamard formula, which has an independent interest and allows us to compute the derivative of eigenvalues of spherical triangles along infinitesimal variations of the angles.