bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Corneal Endothelial changes in type II Diabetes Mellitus by Non-Contact Specular Microscope
Authors: Gendy J E F , Elmowafy N M , Elfiky M M , Shaaban Y M
Published: May 2020

Introduction

Numerous studies were dedicated to explaining the effect of type II diabetes on corneal endothelium. There seemed to be a conflict in the results of the studies, some highlighted that diabetes did not affect the corneal endothelium but rather the corneal thickness. While others disagreed stating that there was damage to the endothelium. The rest cited low endothelial cell density only in poor glycaemic control. This prospective analytical study will extensively investigate the effect of diabetes on the corneal endothelium using non-contact specular microscopy.

Aim

Prospective analysis of the effect of type II diabetes mellitus on the corneal endothelium performed by specular microscopic examination using KONAN Non-Contact Specular Microscope CC-5000 Cellchek; with regards to cell count, density, size, morphology and comparing them to normal subjects of the same age group. The aim of the study is to completely understand the changes that occur to the corneal endothelium in diabetic patients.

Patients and Methods

This is a cross-sectional study, in which 30 Diabetic eyes and 30 Control eyes were examined using non-contact specular microscope. Patients were recruited from the Specialized Eye Hospital Kobry El Kobba Military Medical Complex.

Results

The study included 17 males and 13 females in the non-diabetic control group while in the diabetic group it included 16 males and 14 females. By comparing the demographic data of the two study groups, no significant difference (p > 0.05) was found. The same results were obtained in data regarding the age. Comparing both groups regarding the cell count, density and average cell size showed a highly significant difference (p < 0.05). While comparing the coefficient of variation and the percentage of hexagonal cells in both groups showed a significant difference (p > 0.05).

Conclusion

Diabetes has been implicated in the morbidity of the corneal endothelium. Our study concluded that it appears that diabetes has a significant impact on the corneal endothelial anatomy, causing endothelial cell loss and a decrease in cell density producing compensatory polymegathism. Triggering a disturbance in the physiological functions of the endothelium when under stress e.g. trauma, surgery or intraocular inflammation. However, under normal physiological conditions we found out that there was no abnormality or impairment in the corneal endothelial functions; in keeping the corneal deturgesence (relatively dehydrated, 70% hydration). Therefore, we concluded from the results that special caution should be taken in diabetic patients to whom any stress is applied on the corneal endothelium so that they do not develop corneal decompensation leading to significant morbidity.
Reliability of Visual Field testing and its learning curve among children
Authors: Abdelmalek S N N , Mansour S Z , Roshdy M M S , Elsawy A M A
Published: May 2020

Background

Vision is a combination of distinct measurable functions including visual acuity, visual field and others. The visual field includes the area of space seen when the individual’s gaze is directed at any central object.

Objective

The aim of work in our study was to detect the learning curve of visual field testing in a young age group.

Methods

This study included 72 eyes of 36 children from both sexes aging from 6 to 12 years. All children were from Ain-shams university hospitals outpatient clinics. A detailed questionnaire was answered by both the care-giver and the child on the time spent playing video-games in terms of days per week and hours per day and children were categorized accordingly into VGP and NVGP. Children are devided according to Green and Bavelier’s criteria for VGP participants. The visual field testing was performed twice with a 7-day interval apart and the results of the first session were compared with those of the second. Learning effect was defined as an improvement at results for duration and perimetric reliability indices.

Results

Mean age of participant children was 8.94 ±1.90. Mean reliability parameters were: 68.25 ± 25.78% of fixation losses in the first perimetric test and 71.02 ± 30.84% in the second, 39.14 ± 28.27% of false positive errors in the first test and 44.01 ± 31.24 in the second, 9.67 ± 5.97% of false negative errors in the first test and 9.22 ± 7.74 in the second. The mean test duration was 6.91 ± 1.78 in the first test and 6.58 ± 1.33 in the second.

Conclusion

There was remarkable enhancement in the time taken to complete the second perimetric test in VGP with respect to NVGP indicating a better learning curve.
Effect of Femtosecond Lasik for Myopes on Corneal Hysteresis and Tonometry
Authors: Mansour S Z , Mohamed T H , Saadeldin H S , Awadallah E M
Published: May 2020

Background

Near-sightedness, also known as short-sightedness and myopia, is a condition of the eye where light focuses in front of, instead of on, the retina. This causes distant objects to be blurry while close objects appear normal. Other symptoms may include headaches and eye strain. Severe near-sightedness increases the risk of retinal detachment, cataracts, and glaucoma.

Objectives

The aim of the present study is to quantify the biomechanical effects of Femtosecond LASIK for myopes using the Ocular Response Analyzer.

Patients and Methods

This is a prospective study that was conducted on 30 eyes. 20 patients signed an informed written consent. The (30) eyes underwent refractive surgery using Femto-LASIK flap creation by (IntraLase iFS, Abbott Medica Optics, California, USA) and excimer laser by (WaveLight Allegretto, Alcon, Fort Worth, Texas, USA).

Results

The same parameters used in our study, 40 eyes of 20 patients who underwent LASIK for myopia treatment using a femtosecond laser were enrolled. IOP and the corneal biomechanical markers were measured preoperatively and 1 month after LASIK using ORA and GAT. The mean preoperative CCT was548.63 µm with SD ± 27.71, mean preoperative CH was 10.89 mmHg with SD ± 1.50and CRF was 10.47 mmHg with SD ± 1.64. The postoperative CCT, MRSE, CH &CRF were 493 µm with SD ± 30.84, -0.80 with SD ± 0. 14 (D), 8.41 mmHg with SD ± 1.19 &7.16 mmHg with SD ± 1.33 respectively. The values are significantly lower than preoperative.(p <0.001). The mean preoperative IOPcc, IOPg, IOP by GAT was 14.31mmHg with SD ± 2.42,14.19 mmHg with SD ± 2.54, 13.42 mmHg with SD ± 2.19.respectively, while the mean postoperative IOPcc, IOPg and IOP by GAT was 13.64 ±2.09, 10.27± 2.26, 10.83± 2.83 respectively.

Conclusion

Myopic photorefractive surgery using Femto-LASIK flap creation causes reduction in CH and IOP; obvious change in the IOP-G value postoperatively, so it is more accurate to measure IOP-CC as it is a major factor to be taken into consideration.
The Effect of Short Acting Mydriatics on Intraocular Lens power Measurement Using IOLMaster® Biometry
Authors: Fata A F , Elebiary H H , Elewa L S , Elbayomi A M
Published: May 2020

Objective

In this study, we aimed to investigate the dynamics affecting IOL power calculations and the effect of pupillary dilation on these dynamics.

Patients and Methods

Thirty eyes of cataract patients who visited Embaba ophthalmic hospital outpatient clinic were included in this study. Patients with past history of ocular trauma, ocular surgeries, corneal opacities, Ocular pathology like glaucoma, uveitis, retinal disease or any systemic disease were excluded from this study. Our candidates were subjected to full ophthalmological examination including VA, slit lamb biomicroscopy, BCVA, applanation tonometry, fundus examination and IOL power measurement using IOL Master 700 before and after pupillary dilatation using 1 % tropicamide eye drops.

Results

Our study revealed that dilatation does not affect the Holladay 2 calculated IOL power and we found that AL and keratometric biometry (K1, K2) were not affected by dilatation (p-value was 0.584, 0.804, 0.436, respectively); however, the ACD was significantly increased post-dilatation (with mean difference 0.056; P-value < 0.05), that may be because the lens and iris plane move backward on dilatation.

Conclusion

This study revealed that biometric measurements as axial length (AL), K1 and K2 were not affected by pupillary dilatation. While ACD was significantly affected with p value 0=024. Although anterior chamber depth (ACD) was affected it did not affect IOL power. Which means that IOL power measured with dilatation is reliable and it can be used to decide IOL used in cataract surgery.
The Effect of Pterygium Surgery on Corneal Topography
Authors: Welson N M , Samy M M M , Gaafar A A , Badran T A
Published: May 2020

Objective

To evaluate the effect of pterygium surgery on corneal topography by comparing wave front analysis before and one month after the surgical treatment.

Methodology

Fifty eyes of forty-one patients were included in this study. Twenty five male and sixteen female patients seeking pterygium surgery were recruited from the Ophthalmology Department Outpatient Clinic in Sohag Teaching Hospital during the period from July 2017 to May 2018. All eyes underwent pterygium excision with conjunctival autograft.

Results

In this study we found a highly statistically significant improvement in the mean uncorrected visual acuity from 0.44±0.21SD preoperatively to 0.62±0.18SD postoperatively (p < 0.001) and a highly statistically significant difference in the mean logMAR visual acuity as it was decreased from 0.43±0.28 SD preoperatively to 0.34±0.23 SD postoperatively (p < 0.001). Also, there was a highly statistically significant improvement in mean of manifest refractive astigmatism from -4.08±3.28 SD preoperatively to -1.46±1.40 SD postoperatively (p < 0.001). We also found a highly statistically significant improvement in the mean cycloplegic astigmatism from -4.00±3.01 SD preoperatively to -1.39±1.33 SD postoperatively (p < 0.001) and also there was a highly statistically significant improvement in the mean topographic astigmatism from -5.17±4.08 SD preoperatively to -2.20±2.31 SD postoperatively (p < 0.001). We also found a highly statistically significant improvement in the mean of ISV (Index of Surface Variance) from 76.22±36.86 SD preoperatively to 33.56±15.02 SD post operatively (p < 0.001) and also there was a highly statistically significant improvement in the mean IHD (Index of Height Decentration) from 0.042±0.027SD pre-operatively to 0.023±0.036 SD post operatively.

Conclusion

There was a highly statistically significant difference in the mean logMAR visual acuity and a highly statistically significant improvement in the mean uncorrected visual acuity. A highly statistically significant improvement in both refractive and topographic astigmatism after one month of the surgery was noted also. Here were also a highly statistically significant improvement in ISV and IHD that indicate improvement after pterygium removal.

Recommendations

Patient with pterygium that inducing astigmatism will benefit from surgical removal of the pterygium.
Anterior Chamber OCT Changes Following Penetrating Keratoplasty
Authors: Elmowafy N M I , Elfiky M M , Rashed H O , Alrialy R M A
Published: May 2020

Background

penetrating keratoplasty (PKP) is performed for a wide spectrum of corneal disorders. Glaucoma due to pupillary block or synechial angle closure or aqueous misdirection is a major complication after keratoplasty. Peripheral anterior synechia (PAS) is recognized as one of the risk factors for graft rejection and may occasionally cause intraocular pressure (IOP) elevation, it is important to evaluate anterior chamber (AC) angle in eyes after PKP

Aim of the Work

to document OCT changes in the anterior chamber angle after PKP for different pathologies.

Patients and Methods

this prospective non-randomized study included 10 eyes of 10 patients undergoing penetrating keratoplasty (PKP) for a variety of indications. The patients age ranged from 20 to 60 years.

Results

the mean postoperative IOP was higher (15.4 ± 4.03 mmHg) than preoperative IOP (12.5 ± 2.46 mmHg), but this difference was not statistically significant [P value = 0.088]. The postoperative mean Temporal TISA was lower (0.24 ± 0.08 mm2) than preoperative Temporal TISA (0.3 ± 0.1 mm2). This difference was statistically significant [P value = 0.015]. The postoperative mean Nasal TISA was lower (0.26 ± 0.1 mm2) than preoperative Nasal TISA (0.34 ± 0.15 mm2). This difference was statistically significant [P value = 0.010]. The postoperative mean IOP in infectious keratitis was higher (16.14 ± 4.63 mmHg) than postoperative mean IOP in keratoconus (13.67 ± 1.53 mmHg), but this difference was not statistically significant [P value = 0.565].

Conclusion

there is an increase in IOP post PKP but the difference was not statistically significant. There is narrowing in angle post PKP. The difference was statistically significant in temporal and nasal angles but not statistically significant in superior and inferior angles. The mean IOP was higher in infectious keratitis than keratoconus but the difference was not statistically significant. There is no correlation between corneal diameter and the changes in IOP and angle measurements.
Systematic review of Surgical Management of Early Stages of Kienböck’s Disease
Authors: Abouelela A A K H , Nabil A , Lami M A
Published: May 2020

Background

Kienbock’s disease, or avascular necrosis of the lunate, is a rare debilitating condition that can lead to chronic pain and dysfunction in the wrist. It is classified into four stages according to lichtman staging. Different modalities of surgical treatment are proposed for early stages in which no carpal collapse is found. These modalities include radius core decompression, joint leveling procedures and vascularized bone graft.

Objective

To conduct a systematic review comparing the different surgical modalities in management of early stages of kienbock’s disease.

Methodology

The search was conducted by using the databases: MEDLINE, Cochrane library and JBJS {Journal of bone and joint Surgery} and PubMed. Data was independently extracted by two reviewers and crosschecked. Outcome measures included improvement of pain, range of motion, hand grip and postoperative complications.

Results

This systematic review included 11 paper of which 3 papers about core decompression, 7 about different joint leveling procedures and only one paper about vascularized bone graft. Core decompression papers included 41 patients most of them reported good improvement in the VAS score postoperatively. Joint leveling papers included 108 patients and reported mild improvement in range of motion and grip strength but complications like residual ulnar-sided wrist pain and carpal collapse were reported postoperatively. Vascularized bone graft paper included 13 patient of mean age 39 years and reported good improvement in grip strength, range of motion but mild improvement in VAS score.

Conclusion

Till now literature has no strong evidence to support that one of Core decompression, joint leveling procedures or lunate vascularized bone graft is superior in management of early stages of kienbock’s disease.
The Modified Dunn Procedure for Unstable Slipped Capital Femoral Epiphysis: A Systematic review and Meta-analysis
Authors: Hassan T , Abdelmaguid T , Ahmed Z
Published: May 2020

Source of Support

None,

Conflict of Interest

None.

Background

The management of unstable slipped capital femoral epiphysis is controversial and evolving as insight into the condition develops. Almost half of patients with unstable slip developed femoral head osteonecrosis. The modified Dunn procedure through safe surgical hip dislocation has rapidly gained popularity as a treatment for unstable slipped capital femoral epiphysis. In this review we analyzed the results and complications following this procedure.

Materials and Methods

We performed a retrospective chart review of 297 consecutive patients (302 hips) who had undergone the modified Dunn procedure through safe surgical hip dislocation from Feb 2009 to Feb 2017. Patients were169 males and 128 females, between the age group of 7 to 18 years (mean age 12.66 years) and BMI ranged from 14.7 to 42.1 Kg/m2 (mean BMI 26.32 Kg/m2). The duration of symptoms among the studied group ranged from 2 to 360 days with mean 84.75days. Regarding site and severity 57% had lesions in left side, 40.9% had lesions in right side, 2.1% had bilateral lesions and 58% had severe lesions. The duration of operation among the studied group ranged from 75 to 162 min with mean 128.19 min. Regarding time of operation 61.1% had operation after more than 24 h from admission. All the patients were assessed with slip angle degree, Harris hip score, alpha angle, flexion degree, internal rotation, external rotation and neck shaft angle.

Results

At the mean follow up of 26.3 months (range 12 months to 4.5 years), the mean slip angle improved from a preoperative Value10 to 80 degree with mean 55.6 degree and after operation it ranged from 0 to 28 degree with mean 6.7 degree with mean reduction 48.9 degree, the Harris hip score among the studied group after operation ranged from 46 to 100% with mean 90.98%, regarding post-operative range of motion alpha angle ranged from 23.6 to 52.8 degree with mean 44.3 degree, flexion ranged from 80 to 120 degree with mean 105.84 degree, internal rotation ranged from 5 to 60 degree with mean 30.08 degree and external rotation ranged from 10 to 60 degree with mean 42.3 degree and finally neck shaft angle ranged from 128 to 164 degree with mean 137.2 degree.

Conclusion

Unstable slipped capital femoral epiphysis is associated with a high rate of avascular necrosis. Etiology of the AVN is not completely known and likely multifactorial. The modified Dunn osteotomy through Ganz surgical hip dislocation is the treatment of choice for those with moderate and severe unstable SCFE, allowing anatomical restoration of proximal femur, direct inspection, and preservation of physeal blood supply and inspection of intra-articular pathology which can be evaluated and treated at the time of operation.
Ilizarov versus internal fixation in management of complex tibial plateau fracture. Which is better?
Authors: Fayed M M , Elgebeily M A , Elkersh M A , Eisa M M
Published: May 2020

Back ground

In this prospective randomized clinical study, we report results of management of complex tibial plateau fracture shatzker five and sex (type 41C) by Ilizarov external fixator in comparison with internal fixation according to three column classification with average follow up 18 months

Patients and Methods

In this study we managed 40 cases with complex tibial plateau fracture shatzker five and sex (type 41c). Twenty cases were surgically managed by Ilizarov technique and the other twenty cases were surgically managed by double internal fixation. We compare between both group as regard clinical, radiological results and rate of complications.

Results

while using Knee society score, the results are the following Regarding ilizarov group the range of knee society score is 31-90 with Mean±SD 76.05±14.86 (11 excellent, 4 good, 3fair, 2 poor) while group with internal fixation the range of knee society score is 44-93 with Mean±SD 73.95±13.38 (8 excellent, 5 good, 3 fair, 4 poor).According to these results; p value is 0.641 with no significant difference between two groups.

Conclusion

ilizarov is superior when compared with internal fixation as by ilizarov we can achieve more biological fixation especially when there highly comminuted fractures Complications rate was higher in internal fixation group (7cases) while external fixation group complications were presented in (3 cases).
Arthrodiastasis in the Management of Perthes’ Disease: A Systematic Review
Authors: Fahmy H , Alkersh M , Ibrahim Y H
Published: May 2020

Background

This systematic review explores the relevant literature to assess the efficacy of the use of arthrodiastasis in the management of Perthes disease. Until this moment, arthrodiastasis is not well established for its use in Perthes disease as opposed to other containment procedures. Furthermore, there are no clear indications for its use in this disease.

Methodology

12 articles were matched to the inclusion criteria and all articles were reviewed and radiological and clinical data was collected and compiled.

Results

a significant increase in postoperative range of motion compared to the preoperative ones was found. Final Stullberg classification was ascertained showing majority of patients ending with stages two and three. Complications were also assessed with majority of them being superficial pin tract infections.

Conclusion

the use of arthrodiastasis is a valid treatment option for Perthes disease however more articles need to be produced showing comparative data of arthrodiastasis versus other containment procedures.

Index Terms- Arthrodiastasis, Perthes’ Disease, LCPD, Hinged Distraction the preservation of an intact and congruent femoral head. It is proposed that by applying distraction early in the disease, before any significant collapse of the femoral head had occurred, further fragmentation would be halted.[3]Articulated hip distraction maintains the proper head position by containment in abduction, extension, and neutral rotation. It also decreases joint pressure and thus decreases the deforming force and provides a good environment for cartilage repair. The femoral head deformity that develops in Perthes’ disease is believed to occur during this fragmentation phase of the disease. The possibility for joint motion allows for articular cartilage nutrition and the molding effect of the acetabulum. The aim of the articulated distraction method is to neutralize muscle and weight-bearing forces, to prevent stress fractures of subchondral immature bone, and to encourage synovial circulation and promote creeping substitution by breaking the ‘vicious circle’ of necrosis.[4]
Extramedullary versus Intramedullary bone fixation Treatment of peritrochanteric fractures
Authors: Farag O M E , Mohasseb A M , Hefny A M M M
Published: May 2020

Background

In the last few decades the rate of peritrochanteric fractures has increased because of increased rate of high velocity trauma accident and bone rarefaction due to osteoporosis in old age. DHS and PFN are the gold standard treatments used in treatment of these fractures. Nineteen studies were identified for analysis from 2007 to 2017 that meet our points of comparison.

Aim of the Work

Assessing of efficacy and complications of treatmeant of preitrochantric fracture by DHS versus PFN.

Materials and Methods

Outcomes from included trials will be combined using the systematic review manger software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion /exclusion criteria. After pooling of the collected data from the desired search studies, the relative risk of each of intended outcome measures of interest will be calculated and compared between each of the two main methods of peritrochanteric bone fixation treatment to reach a satisfactory conclusion. Evidence of publication bias will be sought using the funnel plot method.

Results

PFN is better for treating unstable peritrochanteric fractures as it has less complications and better efficacy than DHS.

Conclusion

The present study supports the treatment of peritrochanteric fractures with PFN, as it has less failure of fixation, decreased wound infection, less duration of surgery and less non-union complication than DHS.
Arthroscopic management of bursal sided rotator cuff tears, In situ repair vs conversion. A Systematic Review of Literature
Authors: Samy A , Khalil T , Khater A H
Published: May 2020

Background and Rational

Rotator cuff tears are a common source of pain and dysfunction in various groups of age and occupation. The tear can either be complete or partial thickness rotator cuff tears (PTRCTs). PTRCTs involving <50% of the thickness have been managed arthroscopically by debridement alone without acromioplasty. While massive PTRCTs involving more than 50% were repaired either arthroscopically by convergence to full thickness tears then tendon repair or in situ repair. There is no widely accepted technique in repairing Bursal sided PTRCTs. This study is to conduct a systematic review to compare the results of two of the most commonly used surgeries for management of bursal side rotator cuff tears, repair in situ vs tear completion then repair, as the search for the optimal surgery is crucial to improve long term outcomes, decrease side effects and costs and enhance patient quality of life.

Methodology

The search was conducted using the databases Medline, PubMed, Medscape, Cochrane library, using the following keywords: “partial rotator cuff tears”, “ bursal sided tears”, “in situ” “convergence” and “arthroscopic management” for published studies from 1990 to 2018.

Results

Our search included 11 studies, 5 tear completion, 4 repair in situ and 2 were comparative of both techniques. Studies showed insignificant difference in clinical outcomes between both surgical procedures, both repair in situ and tear completion techniques produce good results in rotator cuff tears techniques thus both remain in their places in management of bursal side rotator cuff tears.

Conclusion

Both in situ and tear completion techniques remain in their places in management of bursal side rotator cuff tears. We suggest that the final consensus should be postponed until further studies are the future, systematic reviews & comparative studies with longer term follow up period are needed to evaluate and guide for the best arthroscopic management of bursal side rotator cuff tears.
CRISPR/Cas9 gene editing: Applications in Parasitology
Authors: Khalifa K E
Published: May 2020

Clustered regularly interspaced short palindromic repeats–CRISPR-associated protein 9 (CRISPR-Cas9) technology is adapted from the bacterial immune system and has rapidly revolutionized the editing of many genomes. This system is based on two components: an RNA-guided endonuclease, classically the Cas9 protein, and an RNA molecule that guides (gRNA) the nuclease to a complementary locus in the target DNA. The technique has allowed researchers to do gene knock-out, knock-in, insertions and deletions in cell lines and animals in rapid efficient way. The technique has many applications in the study of genes function, gene drive, cancer research, development of disease models and new therapeutic targets and crops enhancement.

In the field of parasitology, using CRISPR/Cas9, significant advancements have been made in genome editing of Plasmodium spp, Leishmania, Typanosoma cruzi, and Toxoplasma gondii, as well as vectors like the mosquito, water flea and ticks.

The aim of the talk is to present the basics of CRISPR/Cas9 and summarize some of its applications in the field of parasitology
The diagnostic Value of Cadherin 17 & CDX2 Expression as Immunohistochemical Markers in Colorectal Adenocarcinoma
Authors: Abouelkhair M B , Mabrouk S H , Zaki S S A , Nada O H , Hakim S A
Published: May 2020

Background & Objective

Colorectal cancer is a major cause of morbidity and mortality throughout the world. In Egypt, it is the seventh commonest cancer representing 3.47% of male cancers and 3% of female cancers. Although the diagnosis of colorectal cancer is straight forward in primary site, yet it may represent a diagnostic problem in metastatic tumour of unknown primary origin. Pathologists are often called upon to suggest a site of origin in patients with metastasis of an unapparent primary tumour site. This is because some specific tumour types may respond well to targeted molecular therapies. Most tumours of unknown primary site are evaluated with immunohistochemical analysis in combination with morphologic assessment and correlation with clinical data. Therefore, establishment of reliable diagnostic markers that confirm or rule out colorectal origin are mandatory especially in adenocarcinomas of unknown primary site which is one of the most clinical problems. The aim of this work is to study the expression of Cadherin 17 & CDX2 in colorectal carcinoma to evaluate their roles when metastatic colorectal carcinoma is suspected in cancer of unknown primary site.

Material & Methods

This retrospective study included (65) cases of adenocarcinomas: 35 cases of colorectal adenocarcinoma (whether primary or metastatic) and 30 cases of non colorectal adenocarcinoma from other different sites. Our cases were retrieved from the archives of Pathology Department of Ain Shams University Hospitals and Ain-Shams University Specialized Hospital during the period from (2010 to 2015). Immunohistochemical study was performed using monoclonal cadherin 17 & CDX2 antibodies.

Results

The sensitivity of CDX2 and cadherin 17 were 97.1% and 100% respectively in detecting colonic adenocarcinoma. The specificity of CDX2 was 53.3% while cadherin 17 showed a specificity of 50%. The PPV, NPV and overall accuracy of CDX2 versus cadherin 17 were 70.8%, 94.1% and 76.9% versus 70%, 100% and 76.9% respectively.

Conclusion

Cadherin 17 is a more sensitive marker than CDX2 in diagnosis of carcinoma of unknown primary site especially when colorectal carcinoma is suspected.
The role of hepatic progenitor cells in predicting response to therapy in Egyptian patients with chronic hepatitis C, genotype 4
Authors: Helal T E A , Radwan N A , Mahmoud H A , Zaki A M E , Ahmed N S , Wahib A A A
Published: May 2020

Background

Interferon therapy is used as a line of treatment of chronic hepatitis C virus (HCV) in several areas of the world including Egypt.

Objective

Our aim is to investigate the value of hepatic progenitor cells (HPCs) in predicting response of patients with chronic HCV, genotype 4 to pegylated interferon (PEGIFN) plus ribavirin (RBV) therapy.

Methods

Pretreatment liver biopsies obtained from 110 patients with chronic HCV, genotype 4 were examined immunohistochemically for HPCs using cytokeratin 19. The mean number of HPCs as ductular reaction (DR) and as isolated progenitor cells (IPCs) was counted in each case. The patients were classified into: those with sustained virological response (SVR) and those who did not achieve SVR. The results were compared between the two groups. Also, the relationships between HPCs and other clinico-pathologic variables were estimated using multivariate analysis.

Results

The mean number of HPCs was the only independent predictor of therapeutic response, being significantly higher in non-responders (P = 0 for DR and P = 0.03 for IPCs). On the other hand, fibrosis stage and steatosis were the only independent factors which showed a significant direct association with the mean number of HPCs in the form of DR and IPCs (P = 0 for each).

Conclusion

The number of HPCs provides prognostic information in chronic HCV since it is significantly associated with stage of fibrosis. More importantly, it can be used as a marker to predict response of patients with chronic HCV to PEGIFN plus RBV therapy.
Pediatric Surgery Rate of Constipation After Sagittal Anorectoplasty For Rectoperineal Fistula
Authors: Bayoumi M M M , Allam A M , Abouzeid A A
Published: May 2020

Background

Rectoperineal fistula is a congenital low anorectal malformation that is presented with constipation and straining at stool. There is argument as regarding name, diagnosis and surgical treatment.

Objectives

to estimate the incidence of postoperative constipation among patients with rectoperineal fistula treated with anorectoplasty using Krickenbeck classification for postoperative outcomes.

Patients and Methods

The study was conducted between January 2018 and August 2018. The study included patients with rectoperineal fistula who underwent sagittal anorectoplasty (SARP) in the last five years in two tertiary hospitals; Ain Shams University Children Hospital and Banha Specialized Children Hospital. We excluded patients who underwent operations other than SARP and patients having Currarino syndrome and sacral anomaly like hemisacrum and caudal regression. Krickenbeck classification was used for assessment of constipation before and after operation. A simple questionnaire was used for follow up assessment.

Results

The study included 30 patients (19 female and 11 male). Their age at time of repair ranged from 3m to 78 months with a median age of 7.5 months. Rate of constipation in patients with rectoperineal fistula after SARP was 39%, while improvement rate was 65%. 14 patients out of 23 having preoperative constipation (61%) were treated from constipation, and one patient (4%) got improved regarding constipation grade and frequency, while remaining 8 patients (35%) were still having the same degree of constipation. There were 7 children who had no constipation before and after repair. These results were statistically significant as measured using McNemar test. Postoperative soiling was recorded in 7 patients; all of them had pseudo-incontinence (ORSI).

Conclusion

Rectoperineal fistula patients can gain benefit from SARP not just cosmetically, but also functionally (65% of constipated patients got improved).
Early detection of premature atherosclerosis in β-thalassemia patients by measuring carotid intima-media thickness
Authors: Ibrahim W E , Youssef O I , Ali H G A , Alnagar D M A
Published: May 2020

Background

Beta-thalassemia patients still suffer from many complications. Transfused patients may develop complications related to iron overload including growth retardation and failure or delay of sexual maturation, cardiac involvement (dilated cardiomyopathy or rarely arrhythmia), liver (fibrosis and cirrhosis), endocrine glands (diabetes mellitus, hypogonadism, insufficiency of parathyroid, thyroid, pituitary and less commonly, adrenal glands).

Purpose

The present study was undertaken to evaluate the role of Carotid artery intima media thickness (CIMT) measurement as an early detector of premature atherosclerosis in beta-thalassemia children and early adolescents and its relation to biochemical risk factors as iron overload and lipid profile.

Patients and Method

Twenty-two β-thalassemia major (TM), 8 β-thalassemia intermedia (TI) with confirmed diagnosis of beta-thalassemia (major and intermedia) proved by clinical and laboratory investigations, frequent blood transfusion, chelation therapy with their age ranging from 10 to18 years old and 30 age-and sex matched healthy controls were included. Lipid profile (by colorimetric assay), serum ferritin, and CIMT measurements using high-resolution B-mode ultrasonography were estimated.

Results

CIMT of thalassemic patients (major and intermedia) was highly significantly increased compared to controls with no significant difference between β-thalassemia major and β thalassemia intermedia groups could be detected. CIMT was positively correlated with serum ferritin, TG, Total cholesterol level in both diseased groups and LDL level in B-TM group only. This provides a good evidence of the presence of premature atherosclerosis in vascular-free TM and TI patients and its relation to increased body iron and dyslipidemia.

Conclusion

Carotid artery intima media thickness represented a simple, accurate and non-invasive method for early detection of premature atherosclerosis which started early in β- thalassemia patients This study identified a relationship between body iron status, dyslipidemia and increased carotid IMT..
1,3 β-D-Glucan versus blood culture for the diagnosis of invasive fungal infection in formula-fed preterm neonates
Authors: Awad H A , Ismail R I H , Elbadrawy M A
Published: May 2020

Background

1,3 β-D-Glucan is an important marker for diagnosis of invasive fungal infection (IFI).Its value in comparison to blood culture is not yet established in neonates.

Aim

primary aim is to study the value of 1,3 β-D-Glucan in comparison with culture on Sabouraud dextrose agar in diagnosis of IFI, Secondary aim is to study the prevalence of IFI in preterm neonates.

Subjects and methods

a prospective observational study carried on 75 non-exclusively breast fed preterm neonates ≤34 weeks gestational age. Tollner and Rodwell sepsis scores, SNAPII and blood culture were done to all neonates initially and on day 10&17 of life. 1,3 β-D-Glucan was done for all neonates on day 10 of life.

Results

fungal growth was found in 9.3% of included preterm neonates.1,3β-D-Glucan was higher in culture proven fungal sepsis compared to culture proven bacterial sepsis and culture negative preterm neonates (83.28±26.22 pg\ µl, 51.42±16.71 pg\ µl, 43.07±12.87 pg\ µl respectively). 1,3 β-D-Glucan was related to Tollner (r = 0.286,p=0.013), Rodwell (r = 0.317,p=0.006) sepsis scores and to SNAPII score (r = 0.331,p=0.04). Its cut off point for diagnosis of IFI is 79pg\µl with sensitivity of 71% and specificity of 98%.

Conclusion

1,3β-D-Glucan is an easy, rapid and specific marker for diagnosis of IFI in neonates. Further studies are needed to evaluate it as a therapeutic monitoring for IFI.
Neuron-Specific Enolase, Serum-100B, Electroencephalogram as Indicators of Extent of Brain Damage in Post Cardiac Arrest Patients
Authors: Elseify M Y , Ahmed A R , Shattah M O , Salaheldin S A
Published: May 2020

Background

Post cardiac arrest patients have high risk of mortality and morbidity. Brain injury plays an important role in determining patients’ outcome. Aim of the Work: To correlate the levels of Neuron-specific enolase (NSE), Serum-100B (S100B) and Electroencephalogarm patterns in post cardiac arrest pediatric patients with cardiac arrest circumstances and patients’ outcome. Patients and Methods: This prospective observational study was conducted in Pediatric Intensive Care Unit, Ain Shams University. It included 41 post cardiac arrest patients who underwent serum sampling for NSE, Serum 100B and Electroencephalogram. Results: In our study, 19.5% of patients survived to hospital discharge. Convulsions and sepsis were present in 21.9% and 82.9% of the study group respectively. Convulsions and sepsis were associated with higher mortality with relative risk 1.33 and 1.99 respectively. Serum NSE and serum 100B showed no statistically significant relation with outcome. NSE levels were positively correlated with duration of arrest. EEG patterns showed statistically significant differences when related to outcome with p value of 0.01. Conclusion: Post cardiac arrest patients need intense care especially regarding sepsis and convulsions. NSE levels are related to duration of arrest but not survival. S100B levels aren’t related to survival or duration of arrest. Different EEG Patterns are related to patients’ outcome.
Arthralgia in Egyptian children
Authors: Kotby A A , Soliman N M S , Abdelsalam R M
Published: May 2020

Background

Children presenting with joint pains are a very common occurrence in any general pediatric outpatient department. About 15% of general pediatric consultations are for myriad pains of the musculoskeletal system.

Aim of the work

To screen Egyptian children presenting to a tertiary center for different causes of arthralgia.

Subjects and Methods

This is a descriptive study that was conducted on 200 pediatric patients (86 males and 114 females) presenting with arthralgia at the Children’s hospital Ain shams University from August 2017 till April 2018. Patients with chronic illness, skeletal deformity, past history of acute rheumatic fever, and any patient with acute febrile illness were excluded. All patients were subjected to full medical history, examination, laboratory investigation as complete blood picture, erythrocyte sedimentation rate, c reactive protein, electrocardiography and echocardiography.

Results

Around 18% of patients with arthralgia were proved to have post streptococcal arthralgia, 35% had collagen diseases, 10% with malignant conditions. no identifiable cause could be found in 36% of the patients and two patients diagnosed as acute rheumatic fever.

Conclusion

Arthralgia is a common symptom in the pediatric age group. Although it is a benign condition, sometimes it accurs due to serious illness like malignancy or collagen diseases.
Short Term Neurodevelopmental Outcome in Infants and Children Presenting with a Clinical Picture of Central Nervous System Infection
Authors: Deifalla S A M , Abdelhakam D , . Aly R H
Published: May 2020

Background

Morbidity evaluation of patients with acute encephalitis/encephalopathy (AEE) is an important aspect of pediatric outcomes research.

Aim of the Study

Assessment of the neurodevelopmental outcome of infants and children presenting with acute CNS infection 1 month after hospital discharge.

Patients and Methods

Twenty previously healthy infants and children of age range 6-36 months presenting clinically to the Children’s Hospital, Faculty of Medicine, Ain Shams University ER with acute CNS infection. Upon presentation; patients were clinically and functionally assessed. Also, Laboratory investigations including blood tests and lumbar puncture assessment were done. According to the bacterial meningitic score (BMS); patients were classified as having ‘very low risk’ of meningitis or ‘not low risk’. One month after discharge; patients were neurodevelopmentally assessed using the third edition of the Bayley scales of infant and toddler assessment.

Results

Nine patients had ‘very low risk of meningitis’ and 11 had ‘not low risk’ according the BMS. The functional assessment tools used upon admission were comparatively insignificant in the two classified groups p = <0.05. However, all Bayley scales composite scores were lower in the ‘very low risk’ group compared to the ‘not low risk’ group with significant difference regarding the language composite score; 78+/-14 and 94+/-13 for the ‘very low risk’ and the ‘not low risk’ groups respectively p = 0.02. Also, significant negative correlations were found between the functional tests used and all Bayely scales composite scores.

Conclusion and recommendations

Neurodevelopmental evaluation of patients with CNS infection is important to highlight the adverse consequences of the disease.
Thyroid Profile abnormalities of RHGH treated children
Authors: Mouharam W A , Soliman D A
Published: May 2020

Objective

Normal thyroid function is important for optimal growth. Contradictory studies are available on the impact of rhGH treatment on thyroid function. Study aim is to evaluate the effect of rhGH treatment on thyroid function.

Methods

Study involved 102 euthyroid, prepubertal patients with growth hormone deficiency treated with rhGH. For all children, basal thyroid function, height, height velocity after 1 year of treatment, thyroid function every 3 months during the first year of treatment, all were performed.

Results

At 3 months of treatment 12 patients had elevated TSH, with or without low free T4. The remaining patients had normal free T4 (but lower than the basal one in most of the patients), with no TSH difference. The latter results were normalized at 1 year. Growth velocity was significantly lower in patients with hypothyroidism.

Conclusion

Thyroid profile may be affected in patients with short stature on growth hormone treatment which may negatively impact treatment response.
Think renal, think wise
Authors: Sallam D E D
Published: May 2020

A fourteen-years-old male, suffered generalized abdominal pain, vomiting & non-bloody diarrhea, a week later, GTCs occurred

He was diagnosis as encephalitis, but was anuric, edematous & hypertensive.

Investigations were done and showed anemic with NO thrombocytopenia but with impaired KFT. Renal biopsy revealed TMA/TTP.

He received 12 TPE with partial improvement then he developed bleeding/Rectum not responding to medical management, lower GIT endoscopy revealed: Cobble stone appearance in transverse colon & active IBD (Croh’s) so Pentasa & Immuran started

GTCs developed again, MRI brain showed PRESS.

KFT deteriorated again with oliguria, so 10 TPE sessions with infliximab & FDS were given with partial improvement. Two weeks later, more deterioration occurred.

New Investigations:

• Non-microangiopathic Non-hemolytic anemia

• Normal platelet & TLC

• Coomb’s test: negative

• eGFR: 25 ml/min/1.732

• Normal Complements

• ANA, Anti-DNA-Ab, ANCA: negative

• Protein-C, S & Anti-thrombin-III: Normal

• ADMATS13 level: Normal

• Urinalysis: hemaruria & Heavy proteinuria

• MRI: encephalitis vs ischemic areas 2ry to Vasculitis

Revision of biopsies:

§ Colonic: Leukocytoclastic vasculitis

§ Renal: TMA

A diagnosis of MULTI-SYSTEMIC LEUKOCYTOCLASTIC-VASCULITIS was established and started:

1. Pulse steroid 5 doses then oral FDS then withdrawal till reaching the lowest dose

2. MMF 1.2 gm/m2/day

Marked improvement of his renal, GIT and CNS condition had achieved:

Clinically: No GIT bleeding, convulsion

Laboratory: GFR: 75ml/min/1.732, Urinalysis: trace albumin

Radiologically: Normal MRI, A & V.
Knowledge and experience with Sudden Unexpected Death in Epilepsy (SUDEP) among neurologists in the Eastern Mediterranean Region (EMR)
Authors: Saleh D A A , Kassie S , Alsaadi T
Published: May 2020

Objective

SUDEP is one of the causes of mortality in patients with epilepsy. We investigated SUDEP discussion practices among neurologists in the EMR to identify gaps in knowledge and to increase awareness.

Methods

An online survey was sent out to neurologists practicing in the EMR through registered emails and to attendees of local neurology conferences. Results: 132 practitioners completed the survey. 19.7% respondents were from Egypt, 15.2% from Sudan, 8.3% from KSA, and 4.5% from Syria. Only 1.5% of the respondents discussed SUDEP with their patients nearly all of the time, while 46.2% rarely discuss SUDEP. 18% of the respondents had experienced definite or probable SUDEP in the past 24 months of their clinical practice. Top three reactions to SUDEP discussion were distress (74%), anxiety (70.5%), and depression (65.9%). 77.3% of the respondents believe that patients are at minimal risk of SUDEP, 37.9% fear it would affect patients’ mood or quality of life, and 27.3% believe SUDEP is so rare and the risks of discussion outweigh potential benefits. We found no significant association between years of independent practice, number of patients seen annually, number of SUDEP in the past 24 months and how often respondents discussed SUDEP.

Conclusion

Neurologists in the EMR rarely discuss SUDEP with their patients / caregivers. Negative reactions and underestimating the risk of SUDEP may be the reason, suggesting lack of awareness among practitioners, patients, and caregivers. Framing the discussion positively and using different resources to support patients / caregivers around SUDEP may minimize negative reactions.