bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Intralesional Injection of Combined Furosemide and Digoxin Formula In Genital Warts
Authors: Muhammad Ghada Fathy , Hassan Samah Ibrahim , Radwan Tarek Nabil , Ibrahim Salama Ahmed Mohamed Reda Ahmed
Published: July 2024

Background

External genital warts (EGWs) are benign epidermal growths on the anogenital regions, which can occur in both women and men. They are caused by the human papillomavirus (HPV). More than 90% of cases of anogenital warts are caused by HPV types 6 and 11.There are several different ways to treat genital warts with varying degrees of success. However, till now no definitive treatment has emerged as the ideal standard of care in the treatment of genital warts and this has developed the need for new ways and modalities to help manage genital warts more efficiently.

Objective

To evaluate and verify efficacy, safety and tolerability of intralesional ionic anti-viral injection of combined furosemide and digoxin in treatment of multiple resistant genital warts.

Patients and Methods

This study included 30 patients divided into 2 groups, 15 patients each, the study group received intralesional injection of combined digoxin and furosemide, one injection every week for maximum 5 injection sessions (5 weeks). 0.3 ml of combined digoxin and furosemide solution was slowly injected into the base of each wart with maximum 5 warts in the session, and the other group received intralesional saline as a control group.

Results

Both groups demonstrated insignificant differences regarding all demographic characteristics (age, sex, size of warts before treatment, number of warts before treatment and number of sessions) as well as duration of disease. The treatment used in this study was safe and tolerable with no systemic exposure with regards to the cardiac system (by ECG before and after treatment). Future studies are recommended on larger number of the patients with multiple genital warts. It might be helpful to try increasing the number of treatment sessions, increasing the number of warts treated per session, decreasing the interval between the sessions or increasing the concentration of the active treatment.

Conclusion

Intralesional injection of combined digoxin and furosemide wasn’t effective intreatment of genital warts.
Effect of Corona Virus on Olfactory & Gustatory Functions (Systematic Review Study)
Authors: Sabra Reda Mohamed , Hamdy Tarek Abdel-Hamid , Mohamed Mohammed Nagiub , Abdel Hadi Farag Abdel Hadi Mohamed
Published: July 2024

Background

Because of the rapid spreading of severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) infection, the Coronavirus disease 2019 (COVID-19) outbreak was characterized as a pandemic by the WHO on March 11, 2020.

Materials and Methods

Following the PRISMA statement guidelines, we conducted this systematic review and meta-analysis according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane, and Web of Science, Embase, and Science Direct till December 2021 with relevant keywords. We included the whole clinical studies assessing olfactory and/or gustatory dysfunctions (OGD) in patients with COVID-19, studies including patients with a confirmed diagnosis of COVID-19 by a positive result of RT-PCR were included, studies that assessed the OGD by either subjective evaluation were also included, studies written in English languages only, all of the studies must have been written in English as a full-text manuscript, double or single-arm designs.

Results

A total of 12 studies were finally included for the final qualitative and quantitative analysis illustrating the association and the relationship between COVID-19 infection and olfactory and gustatory functions. The mean age of the participants was 49.12 years. The pooled analysis of the included studies showed a significant association of positive results between OGD and COVID-19 infection. Also, the analysis showed a significant association of positive results between either isolated olfactory or gustatory dysfunction and COVID-19 infection. Regarding the association between gustatory dysfunction in COVID-19 patients versus (Acute respiratory infection) ARI patients with no detectable virus, the analysis showed a significant difference between COVID-19 patients and ARI patients with no detectable virus regarding the gustatory dysfunction meaning there is a high association between gustatory dysfunction and COVID-19 patients other than ARI patients with no detectable virus. Finally, the pooled analysis of the included studies showed a significant difference between COVID-19 patients and ARI patients with other respiratory viruses (ORV) in terms of OGD.

Conclusion

Based on the available evidence, there are regional and chronological differences in the prevalence rates of olfactory and gustatory dysfunction. Future studies, particularly those that document the temporal relationship in the onset of these 2 symptoms, are needed.
Comparative Study between Vascularized Flap and Free Graft in CSF Rhinorrhoea (success rate): Meta-Analysis Study
Authors: Qamar Elsharnoby Mohamed Mohamed , Abdelazem Elbegrmy Marwa Mohamed , Mohamed Mohamed Naguib , Abdeltawab Amer Mohamed Mohamed Abdelraouf
Published: July 2024

Background

CSF rhinorrhea refers to CSF leakage into the nasal cavity. Most commonly, CSF enters the nasal cavity through defects in the anterior skull base. CSF leak is a serious condition occurring spontaneously or as a result of increased ICP, head trauma, surgery, neoplastic invasion, inflammatory erosion of the skull base, or congenital malformations.

Objective

Our meta-analysis study is to compare between free grafts and prdicled nasal flaps in repairing CSF rhinorrhea regarding success rate, complications, operative time and hospital stay.

Methodology

The total number of patients in all the included studies was 524 patients; 339 in the free graft group and 185 in the vascularized flap group.

Results

Our meta-analysis study showed that success rate in free graft group was 88.5%, while, in vascularized flap group was 93% and the complications rate in free graft group was 39%, while, in vascularized flap group was 39.3%. The result of our meta-analysis showed no significant difference between free grafts and vascularized nasal flaps in reconstruction of skull base in CSF rhinorrhea regarding success rate and complications rate.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021.

Conclusion

We found no significant difference between free grafts and vascularized nasal flaps in reconstruction of skull base in CSF rhinorrhea regarding success rate and complications rate. Choosing between them depends on the surgeon’s experience and the location and the size of the defect.
Detecting Aspiration Risk in Stroke Patients Using the Water Swallow Test (WST)
Authors: Bassiouny Samia El Sayed , Mohamed Ahmed Aya Adel
Published: July 2024

Background

The 3-ounce water swallow test (WST) is a widely used method during clinical (bed side) examination for screening of individuals who are at risk for oropharyngeal dysphagia and aspiration. Stroke represents the most frequent cause of neurological dysphagia.

Aim of the Work

The aim of this study is to detect the risk of aspiration in stroke patients using the 3-ounce water swallow test.

Patients and Method

This study included 40 stroke patients recruited from the Phoniatrics unit of Ain Shams University Hospitals. They were subjected to history taking, clinical assessment and the 3-ounce WST.

Results

The results of the 3-ounce Water Swallow Test showed that 18 (45%) patients had a positive test.

Conclusion

Almost half of participants are at risk of aspiration.
Value of Focused Assessment with Sonography for Trauma in Management of Hypotensive Polytrauma Patients – A Meta-Analysis
Authors: El-Shafeay Mahmoud , Omran Hisham , Hanafy Dina Mohamed , Adly Awad Philobater Bahgat
Published: July 2024

Background

Severe or major trauma is a worldwide pandemic and one of the leading causes of death and disability. Polytrauma always involves young, productive individuals and represents a substantial burden on the society Management of Trauma injuries generally emphasizes the importance of identifying and prioritizing the most serious life-threatening injuries and managing them. Management consists of a rapid primary survey, resuscitation of vital functions, a more detailed secondary survey, and, finally, the initiation of definitive care. Damage-control surgery has increasing role as it proves reliability in the most sensitive situations.

Objective

To assess the Value of focused assessment with sonography for management of hypotensive polytrauma patients.

Patients and Methods

All trials about the usage include participants who came to ER due to polytrauma with blunt or penetrating abdominal trauma or with undifferentiated shock, randomized controlled trials and prospective or retrospective cohort studies that assess the value of focused sonography in hypotensive polytrauma patients.

Results

The value of an odds ratio like that of other measures of test performance for example sensitivity and specificity and likelihood ratios depends on prevelance. For example, a test with pooled diagnostic odds ratio of 10.00 is considered to be very good by current standards, therefore pooled diagnostic odds ratio of 77.46 which is considered to be very good. Spearman correlation coefficient:-0.429 with p value 0.397 which is insignificant so, there was low threshold effect Positive and negative Likelihood ratio both are done on six studies with positive likelihood ratio is 21.27 and negative likelihood ratio is 0.29 sensitivity and specificity are done on the six studies with pooled sensitivity is 0.73 and pooled specificity is 0.98.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022.

Conclusion

FAST is significant in polytrauma patients especially in hypotensive patients with considerable accuracy rate 77.46 and good pooled sensitivity with 0.73 and pooled specificity with 0.98 and good ROC curve with are under the curve 0.70.
Role of Neo-Adjuvant Chemotherapy in Decision Making for Surgical Management of Cancer Stomach
Authors: Sayed Hassan Mohamed Salah Emam , Elfiky Khaled Abdallah , Abdalla Ashraf Kamal , Azmy Aly M , Hamed Mohammed Abdalmegeed
Published: July 2024

Background

Gastric cancer is the second most common cause of cancer related death worldwide. In Egypt, gastric cancer is the 12th most common cancer. The incidence rises with age and 55% of cases occur between 50 and 70 years of age. The complete resection partial or total gastrectomy is based on tumor location, stage, histology, and surgical margins. The extent of regional lymphadenectomy required has been a matter of debate. Neo-adjuvant chemotherapy could increase the curative resection rate, improve the tumor down staging possibilities.

Aim of Work

assess the role of the neo-adjuvant chemotherapy for surgical management of gastric cancer patients.

Patients and Methods

A prospective analysis of sixty patients with ranging age (18-60 years) who are diagnosed with gastric adenocarcinoma, received neo-adjuvant chemotherapy patients with minimal follow up 16 months, treated at the upper gastro-intestinal surgeries unit, Ain Shams University Hospitals. Primary end points include assessing overall survival, R0 resection rate, local recurrence, rate of pathological complete response.

Results

Patients aged (22-60 years old), mean age 46.67 ±12.76, the median DFS was 6 months, the mean OS is 26.3 months, recorded 1 year, 2 years OS rate was 75.8% and 67.9% respectively. However, the median OS was not reached.

Conclusion

This study favors the idea of Neo-adjuvant chemotherapy usage prior to surgical intervention in multiple stages of gastric cancer. However, there were other studies that questions its role and demand a reconsideration about the clinical outcome which require further investigation.
Mesenteric Vascular Occlusion after Bariatric Surgery: A Systematic Review and Meta-Analysis
Authors: Ibrahim Ahmed Mohamed , Eskandros Moheb Shoraby , Benjamine Fady Makram , Abdelmanaam Ayman Hosam edeen , Abdel Galil Mohamed Ahmed
Published: July 2024

Background

Portomesenteric vein thrombosis (PMVT) is a potentially severe complication that can occur after bariatric surgery. PMVT has gained importance because of the increasing number of bariatric surgeries being performed

Aim and Objectives

The main aim of this study was to assess how to investigate and manage the complications of the mesenteric vascular occlusion as well as to evaluate the clinical and radiological outcomes of patients undergoing bariatric surgery and the association of this surgical procedure and mesenteric vascular occlusion.

Subjects and Methods

This meta-analysis obtained 295 articles from PubMed, 603 articles from Scopus, 1 article from Cochrane library and 444 from web of science. 509 duplicated articles were removed using Endnote X8 program (Tompson Reuter, USA), 834 articles manually underwent titles and Abstracts screening and 247 articled underwent full-text review. 35 studies finally met our inclusion criteria.

Results

A total of thirty two studies reported the incidence of porto-mesenteric thrombosis with a total number of 41438 underwent different techniques of bariatric surgery. The overall incidence of porto-mesenteric thrombosis was 0.3% [OR = 0.003, (95% CI = 0.002: 0.004). Most of the studies were consistent in reporting an incidence rate nearby by 0.3% except few studies which reported higher incidence rate.

Conclusion

PMVT is a rare presentation after LSG, which requires early diagnosis and management. Conservative management through anticoagulants and thrombolytic therapy is quite effective and, if indicated, should always be considered as the primary treatment option.
Comparative study of Laparoscopic Sleeve Gastrectomy versus Laparoscopic Single Anastomosis Sleeve Ileal Bypass (SASI) as a Treatment Modality for Morbidly Obese Patients with Type 2 Diabetes Mellitus
Authors: Elsayed Fergany Mohamed Saied Ali , Abdelhafez Ahmed H , Abdo Mustafa , Elwardany Ibrahim Nabil , Elghandour Abdelrahman M
Published: July 2024

Background

Bariatric surgery has been shown to be the most successful approach in managing morbid obesity that can achieve and sustain great weight loss for a long period. Furthermore, bariatric surgery can achieve better resolution of type 2 diabetes mellitus (T2DM) than intensive medical therapy alone. The present study aimed to compare the effect of Sleeve Gastrectomy (SG) against Single Anastomosis Sleeve Ileal Bypass (SASI) regarding the control of Diabetes Mellitus and weight loss.

Patients and Methods

This is a prospective comparative study conducted on 60 obese patients (BMI of 30 kg/m2 associated with obesity-related comorbidities including T2DM) to evaluate the effect of SG Versus SASI on obese patients with type II DM. it was carried out in Misr University Hospital from January 2022 to June 2022. This study included 60 patients which are divided randomly into two groups; one group consisted of 30 patients underwent SASI, the other group consisted of 30 patients underwent SG. The main outcome measures were excess weight loss (EWL) and resolution of T2DM at 6 after surgery.

Results

The results of this study showed that there was no statistically significant difference between both groups regarding EWL (the mean EWL % was 47.39±8.07 & 48.09 ±1.4 for SASI & SG respectively). Improvement in T2DM after SASI was better than SG (80% vs 66.7%, respectively) with no statistically difference between them. SASI required longer operative time than SG (116.83±19.23 versus 60.5 ±9.77, respectively). Complications occurred in 2 (6.7%) patients after SASI and 5 (16.7%) patients after SASI.

Conclusion

There was a statistically significant effect of SASI and SG on morbidly obese patients with T2DM; improving both obesity and obesity related co- morbidities with no statically significant difference between both groups regarding EWL and Improvement in T2DM after 6 months. So, large sample size with long-term follow-up period should be performed to better evaluate these technical surgeries and their efficacy regarding postoperative weight loss, metabolic changes, and nutritional status of patients.
Prospective Randomized Controlled Trial for the Efficacy and Safety of Using Different Doses of Recombinant Tissue Plasminogen Activator in Pulse-Spray Thrombolysis of Thrombosed Hemodialysis Arteriovenous Access
Authors: Mohamed Ibrahim Mohamed Talat , Abd- Elbary Mostafa Soliman , Ala- Eldeen Hesham Adel , Mohamed Hamada Nader Mohamed
Published: July 2024

Background

Maintaining vascular access for hemodialysis (HD) is a major source of hospitalization, and patient morbidity. In cases of recently thrombosed arteriovenous access (AVA), minimally invasive thrombolysis and adjunctive angioplasty is considered as a reasonable management to restore patency & function of AVA.

Objectives

The study aims to compare the efficacy and safety of using two different doses (6ml vs 10ml) of recombinant tissue plasminogen activator (rTPA) for pulse-spray thrombolysis of AVA.

Methods

A Prospective randomized controlled clinical study conducted at Ain -shams university hospitals during the period from July 2022 to December 2022 on 32 patients with recently thrombosed AVAs recruited for ultrasound guided Pulse-Spray Thrombolysis followed by angiography +/- balloon dilatation of the stenosed segments. Patients were included in the study if their AVAs were mature, the duration of AVA thrombosis didn’t exceed two weeks and had no contraindications for rTPA. Patients had been divided randomly into two equal groups by closed envelops method, Group I received 6ml rTPA, Group II received 10ml rTPA, and followed up for six weeks post procedure.

Results

The immediate post-procedure technical success was 100% in both study groups. Clinical success was 81.25% in group I, and 93.75% in group II (P-value = 0.285), With mean period from thrombolysis till resuming HD 2.769 ± 1.878 days in group I, and 4.00 ± 2.726 days in group II (P-value =0.183). No mortality cases reported, no statistically significant difference between the two groups regarding the procedure- related complications.

Conclusions

Both doses were effective, we didn’t find statistically significant difference between the two groups as regard clinical and technical success, but using dose of 10ml rTPA yields slightly higher clinical success and longer patency than using 6ml with no statistically significant increase in the rate of adverse effects.
Comparative Study between Radiofrequency Ablation and Laser Ablation in Treatment of Varicose Vein
Authors: Ahmed Khedr Ahmed Elsayed Khaled , Al Abassy Alaa , Amer Mohamed , Monaem Rizk Mohammed Abdel
Published: July 2024

Background

Varicose veins are avery common problem all over the world. Surgery has been the gold standard treatment for many years, however now other less invasive options are available and sometimes more efficient.

Aim of the Work

The purpose of this study was to evaluate the RFA technique in treatment of GSV varicosities and to compare the results, clinical outcome, complications and recurrence rate after RFA and CS of GSV.

Patients and Methods

In this study 25 patients with varicose vein were randomized to laser ablation of GSV and another 25 patients underwent RFA of the GSV in Nasser institute. Both techniques were done under local (tumescent) anesthesia helped by sedation (Deprivan) in some patients or spinal anethesia in the other patients. Operative time was nearly the same in both techniques. no statistically significant difference between both techniques

Results

This study proved that radiofrequency and laser ablation techniques are safe and efficient in treating varicose veins and there was no statistically significant difference between both groups regarding postoperative complications or recanalization and recurrence.

Conclusion

Duplex guided radiofrequency ablation and laser ablation are efficient and safe modalities in the treatment of great saphenous vein varicosities. Conventional surgery has been used for a long time for treatment of varicose veins with variable degrees of minor to major complications. R radiofrequency and laser ablation of GSV in treatment of varicose vein provides high ablation rates in conjunction with a very moderate side effect profile
A Systematic Review of Banded vs. Non-Banded Sleeve Gastrectomy Regarding Long Term Results
Authors: Gawdat Khaled , Osman Ahmed , Magdy Mohamed , Fadl Abdulmoamen
Published: July 2024

Background

Laparoscopic Non-Banded Sleeve Gastrectomy (NBSG) is a widely popular weight loss procedure that has been around since the start of the millennium. Another variant, the Laparoscopic Banded Sleeve Gastrectomy (LBSG) started to emerge later. Questions have arisen on whether NBSG or BSG have better outcomes on the long run regarding weight loss, weight regain and reflux disease. This study aims to analyse previous studies performed on this subject and devise a conclusion regarding this matter. Obesity is a worldwide health issue with an unfortunate impact on an individual‘s quality of life. As of 2016, 39% of the world population suffered from obesity. Bariatric surgery is currently considered to be an effective and sustainable solution with increasing worldwide prevalence. Laparoscopic sleeve gastrectomy was first performed as the first step in biliopancreatic diversion with duodenal switch.

Objective

To scrutinize all English language papers written on the subject of comparing NBSG and LBSG as primary bariatric procedures and furthermore seeks to determine the superior surgery between them regarding weight loss, post-operative morbidity and complications like regurgitation, vomiting, reflux, dysphagia, and finally resolution of comorbidities like T2DM and HTN.

Methodology

This systematic review was carried out according to the updated PRISMA 2020 statement. A thorough search was executed in the Medline (PubMed) database, Elsevier‘s Scopus, Web of Science and the Cochrane Library in December 2022. Search was restricted to articles written in English. Search terms will be broad to encompass Banded Sleeve procedures.

Results

Our review revealed that the existing literature suggests increased weight loss following LBSG compared to NBSG; however, there‘s an increased risk of regular regurgitation episodes and of device related complications leading to revision surgeries (such as band removal).

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2023.

Conclusion

Laparoscopic banded sleeve gastrectomy provides apparent better outcomes than non- banded sleeve gastrectomy regarding sustainable weight loss results through 3-5 years of follow up as the studies we reviewed had demonstrated. Nonetheless, it poses a definite increase in the risk of regurgitation, vomiting and ring related complications that might require revision surgeries. More RCTs with longer follow up periods (>5 years) will significantly add to our understanding of the matter. Larger LBSG sample sizes are needed to further enhance our impression on efficacy and safety of the banded sleeve gastrectomy. Finally, larger T2DM and HTN patients‘ sample size is needed to form a conclusion on the relationship between banding and the resolution of these diseases.
Evaluation of the Role of Ultrasonography in Predicting a Metachronous Contralateral Inguinal Hernia in Children
Authors: Mansour Khaled Zaky , El-Shafie Ehab Abdelaziz , El-Ghandour Mostafa Mohammed , Allam Allam Elsayed , Abdelnour Ismail Ismail Fahmi
Published: July 2024

Background

Inguinal hernia remains one of the most common surgical disorders in children. Almost all pediatric hernias are indirect. The incidence of pediatric inguinal hernia is highest during the first year of life and then gradually decreases thereafter. The incidence of contralateral occurrence of an inguinal hernia after unilateral herniorrhaphy has been reported as 5.6 to 22%. The management of the contralateral inguinal hernia in a child with unilateral CIH has been always debated. Routine contralateral exploration of the inguinal canal has been practiced by many surgeons. Routine contralateral exploration may be associated with a high incidence of negative exploration and lengthening of the operative time in addition to possible increasing morbidity in those patients.

Aim of the Work

This study aims to evaluate the role of preoperative assessment by ultrasonography in predicting contralateral inguinal hernia in children with unilateral inguinal hernia without clinical evidence of contralateral inguinal hernia.

Patients and Methods

Fifty infants and children presented to pediatric surgery clinic at Ain Shams University and Nasr City Health Insurance Hospitals aged 1 month till 12 years of age complaining of unilateral inguinal hernia without clinical evidence of contralateral inguinal hernia underwent preoperative US.

Results

Cases with a width of the contralateral side >3.5 mm at the level of the internal ring determined using the US are likely to be at high risk of developing a contralateral hernia with a sensitivity of 80.0%, specificity of 77.5%, and area under the curve (AUC) of 78.4%.

Conclusion

Ultrasonography is a rapid, sensitive, convenient, and non-invasive method for screening patients with contralateral occult CIH. It is a reliable tool for preventing unnecessary exploration or additional operations at a later stage. It can be performed in all cases of inguinal hernia to determine the necessity for contralateral exploration. Children having a width of contralateral side >3.5 mm at the level of the internal ring determined using the US are likely to be at high risk of developing a contralateral hernia with a sensitivity of 80.0%, specificity of 77.5%, and area under the curve (AUC) of 78.4%.Therefore, we recommend routine preoperative use of ultrasonography for all patients with unilateral CIH to determine which patient should be subjected to a contralateral exploration.
Management of Common Bile Duct Stones: Evaluation of the Effect of Size of Stones as the Determinant for the Procedure for Treatment in Era of Laparoscopic and Endoscopic Surgery
Authors: Mahmoud AlShamy Abd Elghany , Kamal Kamal Mamdoh , Saber Hatem Sayed , Thabet Ahmad Ahmad Mohammad
Published: July 2024

Background

Common bile duct stones (CBDS) are estimated to be present in 10–20% of individuals with symptomatic gallstones. A variety of imaging modalities can be employed to identify the condition while management of confirmed cases of CBDS may involve endoscopic retrograde cholangiopancreatography (ERCP), surgery and radiological methods of stone extraction. Clinicians are therefore confronted with a number of potentially valid options to treat individuals with suspected CBDS.

Objective

To determine if ERCP sphincterotomy and extraction is effective in management of CBDS ranging from 10 to 20 mm or if surgical intervention is preferred in a sample of patients with common bile duct stones.

Patients and Methods

In this study, the data of (30) patients with CBDS who presented for the first time to the department of General surgery at Ain Shams University hospitals, Cairo, Egypt. Were collected during the period of August 2021 to February 2022.

Results

In the current study, all patients received proper pre-operative assessment and were operated on using same endoscope set and by experienced operators. Also, all patients were observed for post ERCP complications. The current study found that ERCP stone extraction in stones ranging from 10-20 mm success rate shows no significant difference in comparison with results that were published in different recent researches studying ERCP success rate in different stone sizes.

Conclusion

The current study found that success rate of ERCP in CBD stones extraction in stones ranging from 10-20 mm in size is similar to success rate in stone extraction compared to other studies not specifying stone size range. Also, complication rate was comparable to other recent published studies’ complication rate.
Thrombomodulin as a promising Marker of Endothelial Dysfunction in Hemodialysis Patients with Non Alcoholic Fatty Liver Disease
Authors: Hebah Hayam Ahmed , Sabry Mohamed Manal , El-Nagar Mohamed Kamel , Abdelmegied Shaimaa Zaki
Published: July 2024

Background

Non-alcoholic fatty liver disease (NAFLD) is associated with endothelial dysfunction which is a common problem in haemodialysis patients and risk for high cardiovascular mortality in haemodialysis. Thrombomodulin is a promising marker of endothelial cell injury in different pathological conditions. This study evaluates the additive effect of non-alcoholic fatty liver disease (NAFLD) in prevalent HD (hemodialysis) patients on endothelial dysfunction.

Methods

This is a case-control study which was conducted on 60 ESRD (end-stage renal disease) patients on conventional hemodialysis and 30 apparently healthy controls. Patients were divided into 2 groups: group A (N = 30): with NAFLD& group B (N = 30): without NAFLD, excluding elderly, diabetic, chronic liver disease, advanced heart failure, active infection, COVID-19 infection and autoimmune disease& patients withhemodialysiscatheters. Thrombomodulin was measured for all participants by ELISA technique.

Results

Thrombomodulin had the ability to detect endothelial dysfunction in patients with NAFLD at Cut off value <0.8 ng/ml with sensitivity 53.33, specificity 80, PPV 72.7 and NPV 63.2. On comparing Thrombomodulin in patients with NAFLD(4.378±3.762 ng/ml), Non NAFLD (1.126±0.591 ng/ml)and control (0.755±0.314ng/ml) there was significant difference (P- value<0.001). Post hoc analysis showed significantly high Thrombomodulin level in patients with NAFLD compared to Non NAFLD and control with p-value<0.001 while there was no significant difference between patients with (Non NAFLD and control) p-value 0.792. NAFLD patients with higher Thrombomodulin level have 2.5 times higher risk to have endothelial dysfunction. There was no significant correlation between Thrombomodulin and all variables in the study.

Conclusions

Thrombomodulin can be used as specific marker for endothelial dysfunction in hemodialysis patients with Non Alcoholic fatty liver.
Correlation between Acute Liver Injury and Disease Severity in Hospitalized Egyptian Patients with Covid-19
Authors: Al-Sakaty Tarek Maged , Riad George Safwat , Said Nouran Mohamed , Salama Zeedan Shrouq Hesham Mahmoud
Published: July 2024

Background

COVID-19 pandemic has brought new health threats and challenges to the world. However, the scientific progress over the last months has shed more light on several key questions concerning COVID-19-associated complications.

Aim of the Work

The aim of this study is to correlate acute liver injury in Covid-19 hospitalized patients with the severity of the disease.

Patients and Methods

This was a cross-sectional study that was conducted on 110 patients at Ain Shams University hospitals including Ain-Shams Quarantine field hospital, Ain Shams University Quarantine hospital in Al-Obour, and Quarantine ICU of Demerdash through twenty months.

Results

In total, 110 patients with positive SARS-CoV-2 PCR test were included in this study. The study population was mostly males with 58.2% and median age of the population was 65 years old. As regards to the morbidity status of the study population, 67.3% of the patient died due to disease severity, while 32.7% showed recovery. There was statistical significant relation between liver injury in terms of elevation of (AST-ALP-GGT-Bilirubin) and the increase in oxygen demand. As regards to the inflammatory markers, they significantly correlated with liver injury.

Conclusion

This study concluded that impaired liver function constitute a common finding in COVID-19 patients. Deterioration of liver function worsens the prognosis and prolongs duration of hospitalization. Thus, critically ill Covid-19 patients should be monitored closely to manage any possible complications.
Serum Levels of Interleukin-2 in a Cohort of Egyptian Systemic Lupus Erythematosus Patients with Glomerulonephritis
Authors: Eldin Abdelaziz Amina Badr , Abdelrahman Maryam Ahmad , Ahmed Walaa Thabet Mohamed , ElSherbiny Dalia AbdelHamid
Published: July 2024

Background

Lupus nephritis is a serious complication of systemic lupus erythematosus(SLE).It is clinically evident in 50-60% of SLE patients, and it is histologically evident in most SLE patients. Defective Interleukin-2(IL-2) production contributes to the unbalanced immune system in SLE.

Aim of the Work

To evaluate the relationship between serum IL-2 level and renal involvement in SLE patients.

Patients and Methods

60 adult SLE patients were studied. SLE Disease Activity Index-2000 (SLEDAI-2K) and serum IL-2 level by ELISA were assessed.

Results

Patients were (93.3%) females and (6.7%) males; their ages (19- 58 years) with median disease duration 4 (0.25-24years). The median IL-2 level was significantly lower in SLE patients with nephritis 25.5 ng/L (5-90 ng/L) than in patients without nephritis 53.5 ng/L (29-165 ng/L) (p ≤ 0.001). There was negative correlation between serum IL-2 and serum creatinine (r= -0.494 p ≤ 0.001) and between serum IL-2 and protein/creatinine ratio (r=-0.512 p ≤ 0.001). Although there was no relationship between SLE disease activity and serum IL-2; the level of serum IL-2 was higher with mild SLE disease activity (45-60 ng/L) followed by moderate activity (15-135 ng/L) and the lowest with high disease activity (5-165 ng/L). An increase in s.creatinine and a decrease in S.IL-2 had an independent effect on increasing probability of occurrence of nephritis in SLE patients (p < 0.01).

Conclusion

Serum IL-2 might have an important role in predicting the occurrence of lupus nephritis in SLE.
Patched Homolog Gene (PTCHI) as a Reliable Marker for Predicting Imatinib Response in Chronic Phase Chronic Myeloid Leukemia Patients in Correlation with Early Response to First Line of Treatment Imatinib
Authors: Ahmed Ibrahim Tamer Mohamed , Mohamed said Rasha Magdy , Abdalla Ahmed Nour Elhoda Hussein , Ibrahim Rakha Nahed Moawad Ibrahim , Abdullah Ali Esraa Shaaban
Published: July 2024

Background

Chronic myeloid leukaemia BCR-ABL1 + (CML) is a clonal disorder of a pluripotent stem cell. The disease accounts for around 15% of leukaemias and may occur at any age. The diagnosis of CML is rarely difficult and is assisted by the characteristic presence of the Philadelphia (Ph) chromosome. This results from the t (9;22) (q34; q11) translocation between chromosomes 9 and 22, as a result of which part of the oncogene ABL1 is moved to the BCR gene on chromosome 22. and part of chromosome 22 moves to chromosome 9. The abnormal chromosome 22 is the Ph chromosome.

Aim of the Work

To measure the level of PTCH1 in newly diagnosed CP-CML and to find correlation between the level of PTCH1in those patients and response to first line of treatment; imatinib and other prognostic factors

Patients and Methods

In our study there are 50 patients newly diagnosed cml recruited from hematology out patients clinic in ain shams university within duration august 2021 –april 2022.We have measured level of PTCH1 protein in newly diagnosed CP-CML and its follow up after 6months

Results

the studies show that 25% of patients discontinue imatinib due to lack of efficacy. A few years ago, two second-generation tyrosine kinase inhibitors (TKIs), Dasatinib and Nilotinib, were approved for first-line treatment, increasing the options available for patients diagnosed with CP- CML.Currently, the best way to adjust treatment to fit the severity of the disease is by assessing the response at different milestones. One milestone is the BCR-ABL1/ABL1 transcript level at 3 months; a level >10% 3 months after starting treatment has been related to a worse subsequent imatinib response. However, whether a change in therapy is warranted based on this single determination is controversial.

Conclusion

Patched homolog 1 gene (PTCH1) is marker for predicting first line of treatment imatinib response in chronic myeloid leukemia patients in chronic phase in correlation with response to imatinib. It is detected by PCR and proved to be a reliable marker to detect early imatinib response in chronic myeloid leukemia patients in chronic phase. In our study, we measured level of (PTCH1) in chronic myeloid leukemia patients in chronic phase using ELISA as a cost benefit in comparison to PCR in newly diagnosed cml patients on first line of treatment imatinib then follow up after 6 months. We found that it is a reliable marker, sensitive and specific to detect imatinib response.
Study the Effect and Safety of Oral Lactoferrin Therapy for Functional Iron Deficiency Anemia in Prevalent Hemodialysis Patients
Authors: Elshinnawy Howayda Abdelhameed , Mohamed Elsaed Tamer Wahed , Abdelwahab Sanad Khaled Gouda , Mohammed Mohammed Mohammed Ashraf
Published: July 2024

Background

Anemia is one of the main problems in hemodialysis patients, which is caused by inadequate production of erythropoietin. Functional iron deficiency (FID) anemia is a kind of anemia, which lack of functional iron therein leads to resistance and inappropriate response to erythropoietin in hemodialysis patients.

Aim of the Work

The aim of the present study was to study the effect and safety of oral lactoferrin therapy for functional iron deficiency anemia in prevalent hemodialysis patients.

Patients and Methods

This was Randomized clinical trial, was conducted at El Demerdash hemodialysis unit on 70 prevalent hemodialysis patients divided into 2 groups: (Group A): included 35 patients with functional iron deficiency anemia, received lactoferrin together with the recommended dose of ESA therapy for 3 months, (Group B): included 35 patients with functional iron deficiency anemia, received no lactoferrin apart from the recommended dose of ESA therapy for 3 months.

Results

There was no statistically significant difference between the two studied groups (group A and group B) as regard sex, occupation, residence and age. There was no statistically significant difference between the two studied groups (group A and group B) as regard height, weight and BMI. There was no statistically significant difference between the two studied groups (group A and group B) as regard history. There was no statistically significant difference between the two studied groups (group A and group B) as regard hemoglobin and WBCs. There was no statistically significant difference between the two studied groups (group A and group B) as regard PLT and Reticulocyte %. There was no statistically significant difference between the two studied groups (group A and group B) as regard ferritin, serum iron and TSAT. There was highly statistically significant difference between the two studied groups (group A and group B) as regard KT/V and URR at 3 months. There was nostatistically significant difference between the two studied groups (group A and group B) as regard KT/V and URR at baseline.

Conclusion

Oral lactoferrin could not be used as a substitute to totally replace IV ferrous sulphate in treating iron deficiency anemia in end stage renal disease (ESRD) on dialysis. Oral lactoferrin could not even control Hb level constant without dropping in patients with end stage renal disease (ESRD). Oral lactoferrin had some gastrointestinal effects on some patients which did not allow compliance on the medication.
Role of Endoscopic Ultrasound and Endoscopic Ultrasound Guided Fine Needle Aspiration in Endoscopic Biopsy Negative Gastrointestinal Lesion
Authors: Ghaly Sameh Mohammad , Okasha Hussein Hassan , Ali Eldeen Zainab Ahmed , Anwar Ayman Gamil , Aziz Tari Magdy , Mohammad Mahmoud Ahmad Mohammad
Published: July 2024

Introduction

The rapidly growing incidence of gastrointestinal malignancies, makes early detection of such lesions a mandatory issue. EUS is a very sensitive modality in diagnosis of GIT wall lesions with superiority in diagnostic yield over conventional endoscopy, and non- invasive diagnostic modalities as CT and MRI.

Aim

To assess the feasibility, safety and accuracy of endoscopic ultrasound and endoscopic ultrasound guided fine needle aspiration in diagnosis of endoscopic biopsy negative gastrointestinal lesions.

Material and Methods

We conducted this prospective study over the period of 2 years that included 245 patients with mean age 46 years. All included patients had suspected GIT lesions with repeated negative endoscopic biopsies. All patients underwent EUS examination and EUS- FNA in the same session.

Results

EUS diagnosis SE, SP, PVP, PVN, LR+, LR-, and, DiAc were 0.94, 0.90, 0.93, 0.91, 9.11, 14.7, and 0.92 respectively, while EUS-FNA SE, SP, PVP, PVN, LR+, LR-, and DiAc were 0.86, 0.99, 0.99, 0.83, 83.89, 7.32, and 0.91respectively, with 100% technical success. Size of the lesion, size of the needle, and number of needle passes had no impact on diagnostic yield of EUS-FNA. No procedure related complications were reported.

Conclusions

EUS with EUS-FNA is a safe, feasible modality with high diagnostic accuracy in diagnosis of endoscopic biopsy negative gastrointestinal lesions irrespective to anatomical location of the lesion, layer of origin, lesion size, lesion echotecture, and no impact of needle size and number of needle passes on the diagnostic yield of EUS and EUS-FNA.
Effect of Central Dialysis Fluid Delivery System (CDDS) using high flux dialyzer versus Regular Water Treatment Stations on Endotoxemia and Inflammatory Markers among Prevalent Patients on Regular Hemodialysis
Authors: Elshinnawy Howaida Abd ELhamid , ElSayed Hesham Mohamed , El Said Heba Wahid , Abdelsamie Marwa Shaban , Hammoda Hoda Mohamed , Tawfik Ahmed Mohamed
Published: July 2024

Background and Objectives

Translocated endotoxins derived either from intestinal bacteria or backfiltration, have a wide range of adverse effects on patients. Most end stage renal disease (ESRD) patients have systemic inflammation which increases the risk of morbidity and mortality. The central dialysis fluid delivery system (CDDS) has been used exclusively in Japan since 1960s, and now is being used in Ain Shams University. Our aim of the study is to evaluate the effect of (CDDS) versus single patient dialysis fluid delivery system (SPDDS) on endotoxemia and inflammatory markers among prevalent patients on regular hemodialysis (HD).

Methods

Eighty Patients were randomly selected from HD units, then divided into two groups, (group I) doing HD using CDDS water purification system at El Demerdash Hospital, (group II) using regular water purification system at Ain Shams University Specialized Hospital. Pre- dialysis and post-dialysis serum samples were obtained to measure endotoxin levels of both groups, as well as postdialysis serum samples were obtained to measure interleukin 6 (IL6) level and highly sensitive Creactive protein (Hs CRP).

Results

Circulating endotoxemia was most notable in group II, The mean predialysis endotoxin level in group I was 0.07 ± 0.05 Eu/mL, while in group II was 0.20 ± 0.07 Eu/mL and mean of post-dialysis endotoxin level in group I was 0.04 ± 0.02 Eu/mL, while in group II was 0.15 ± 0.03 Eu/mL. IL6 as well as Hs CRP levels were higher in group II in comparison to group I.

Conclusion

Our data showed significant reduction in circulating endotoxins in CDDS group.
Impact of Serum IL 10 on Early Prediction of Allograft Rejection in Liver Transplantation
Authors: El-Deeb Mai Ahmed , Okba Ashraf , EL-Meteini Mahmoud , El-Sayed Ahmed Eman , Mamdouh Rasha , Maged Mariam
Published: July 2024

Background

Tissue transplantation is the preferred treatment for end organ failure such as heart, lung, kidney and liver. Unless the donor and recipient of a transplant are genetically identical, the donated tissue is viewed by the immune system of the recipient as non-self. multiple cytokines are involved in this process, however little is known about their predictive role in rejection. IL10 which exhibit anti-inflammatory activity could be used as early predictor of acute rejection.

Objective

The aim of the current study is to evaluate the possible association between serum IL10 level in liver transplant patients and acute allograft rejection. Patients and Method: This study was conducted on 45 subjects. Patients will be followed up for 2months and they will be further divided into two groups: Those who developed early acute rejection and those who did not develop rejection (controls)

Result

The study included 38 patients did not develop rejection and 7 patients developed rejection. We found unchanged during rejection of the LT of the levels of IL-10

Conclusion

Several studymust be conducted on cytokines on large sample size to prove early prediction of acute rejection
Ascitic ENDOCAN as a Useful Marker in the Diagnosis of Spontaneous Bacterial Peritonitis
Authors: Mari Makhlouf Mohammad Ali , Abdo Ahmed Abbas , Abdel-Jalil Al-Knawy Mohi Mostafa
Published: July 2024

Background

Spontaneous bacterial peritonitis (SBP) is a serious, recurrent, and life-threatening condition developing in cirrhotic patients with a high mortality rate. Its diagnosis is based on ascitic fluid polymorphonuclear leukocytes (PMNs) to be more than 250/μL. Endocan is a proteoglycan (PG) secreted by vascular endothelium, its serum level is elevated with an inflammatory or a malignant process.

Aim of the Work

to evaluate the potential role of ascitic fluid levels of endocan as an appropriate marker for prediction and early diagnosis of spontaneous bacterial peritonitis in patients with liver cirrhosis.

Patients and Methods

This was Prospective cohort study, was conducted in hepatology Unit of Ain Shams University Hospital over 100 patients with liver cirrhosis classified into two groups: (Non-SBP): included 50 patients of decompensated cirrhosis with sterile (non SBP) ascites, (SBP): included 50 Adult patients with liver cirrhosis and SBP, during a Period 6 months. All patients were subjected to: Full history taking, Clinical examination, Routine investigations, Radiology investigations, Determination of ascitic endocan levels by ELISA.

Result

The main results of the study revealed that: There was no statistically significant difference between the studied groups as regard personal data. There was a high statistically significant difference between the studied groups as regardsChild-Pugh score. There was no statistically significant difference between the studied groups as regard LFT. There was statistically significant difference between the studied groups as regard WBCs. There was statistically significant difference between the studied groups as regard INR. There was no statistically significant difference between the studied groups as regard creatinine. There was statistically significant difference between the studied groups as regard Ascetic endocan.

Conclusion

In conclusion, this study demonstrates that ascitic endocan level is an independent risk factor for SBP and has a high diagnostic value for detecting SBP in patients with decompensated cirrhosis.