bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparitive Study between the Analgesic Effect of Erector Spinae Plane Block and Transversus Abdominis Plane Block After inguinal hernia repair
Authors: Abd El Aleem Azza Atef , Hussein Noha Sayed , Moris Kerolos Emad , Abo Elseoud Mohamed Emad
Published: July 2024

Background

Multimodal analgesia is used to control postoperative pain in inguinal hernia repair. Transversus Abdominis plane block is an effective regional anesthesia technique for postoperative analgesia in inguinal hernia repairs. The Erector Spinae plane block applied to the low thoracic region was also reported to provide effective analgesia in these surgeries.

Aim and Objectives

To assess and compare the analgesic efficacy of Erector Spinae plane block with that of Transversus Abdominis plane block after inguinal hernia surgeries.

Subjects and Methods

A prospective randomized clinical study, conducted at Ain Shams University hospitals, Cairo, Egypt on 56 patients divided into 2 groups: (Group 1) (ESP group); 28 patients received unilateral ultrasound guided ESP block, (Group2) (TAP group); 28 patients received unilateral ultrasound guided TAP block during a period of 6 months.

Result

There was high statistically significant difference between the studied groups as regard first analgesic request and total analgesic consumption.

Conclusion

ESPB is a more effective regional block technique for postoperative pain relief in patients undergoing inguinal hernia repair than TAPB. In which The ESP block has a longer duration of analgesia, delays the time to first requirement for analgesia, and reduces analgesic consumption when compared with the TAP block and can be used in multimodal analgesia and opioid-sparing regimens
Comparison of Two Different Dexmedetomidine Doses and Their Effect on the Duration of Spinal Anesthesia in Lower Limb Amputation Surgeries
Authors: El-Nasr Mohamed Gihan Seif , Abdel-Malek Fady Adib , El- Khouly Ahmed Tarek , El-Sayed Waleed Ibrahim
Published: July 2024

Background

Spinal anesthesia is a very common technique used in lower limb surgeries. Dexmedetomidine is a highly selective α2-adrenergic agonist which has been used as pre-medication and as an adjuvant to general anesthesia. It is found that injection of dexmedetomidine intrathecally prolongs both sensory and motor block and has antinociceptive action for both visceral and somatic pain by depressing the release of nociceptive C fibers transmission and hyperpolarization of post synaptic dorsal horn cells.

Objective

To compare the effect of addition of different doses of dexmedetomidine to bupivacaine on the duration of spinal anesthesia, quality of block, intraoperative and postoperative complications and postoperative analgesia in patients undergoing lower limb amputation surgeries.

Methods

This prospective double blind randomized controlled clinical trial was done on sixty six adult patients of both sexes, aging from 21 to 60 years old, ASA I and II presented to Ain Shams University Hospitals for lower limb amputation surgeries were involved in this study during the period from July 2021 till May 2022.

Results

The addition of dexmedetomidine to bupivacaine in spinal anesthesia significantly prolonged both sensory and motor blockades duration compared with bupivacaine alone. It was significantly faster in group B (2.1 ± 0.124) compared with A and C groups (2.64 ± 0.34) and (4.72± 0.31) respectively and in group A compared with group C. They also prolonged the time of postoperative analgesia as evidenced by significantly longer time to first rescue analgesia Time to first call for rescue analgesia was significantly longer in group B (350 ± 45 mins) compared with A(287.41 ± 40.83 mins) and C(192 ± 42 mins) groups and in group B compared with group A. Also, there was significant difference in number of analgesic doses in group B compared to A and C groups and in group B compared to group A. Lower VAS scores with minimal adverse effects and hemodynamic stability. Comparing two different doses of dexmedetomidine showed that 15μg dexmedetomidine caused more prolongation of the spinal block duration and the time of postoperative analgesia than dexamethasone. It also decreased shivering during spinal anesthesia with only 4 patients compared to group A with 8 patients and group C with 9 patients.

Conclusion

5μg dexmedetomidine seems to be an attractive as an adjuvant to spinal bupivacaine in surgical procedures. It provided good quality of intraoperative analgesia, hemodynamically stable conditions, minimal side effects, and excellent quality of postoperative analgesia. Unfortunately, it had not any effect on incidence or severity of phantom pain and sensation in lower limb amputation surgery, but 15μg had better time of analgesia and longer time till the patient needed rescue analgesia with lower VAS score with no remarkable difference in the side effect as revealed.
Ultrasound Guided Bilateral Erector Spinae Plane Block vs Intravenous Patient-Controlled Analgesia for Pain after Total Laparoscopic Hysterectomy
Authors: Reyad Mostafa Kamel , Ahmed El-Fawy Dalia Mahmoud , Kamel Walid Youssef , Abdelrazek Saeed Hazem Khaled
Published: July 2024

Background

Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Total Laparoscopic Hysterectomy (TLH) is a minimally invasive procedure, it has certain advantages over an open abdominal hysterectomy, such as reduced pain, less incidences of wound infection, a rapid recovery, a shorter hospital stay and lower complication

Aim of the Work

The present study was designed to assess the analgesic efficacy and safety of ultrasound guided ESPB done at lower thoracic transverse process level in patients undergoing TLH for postoperative analgesia versus intravenous patient-controlled analgesia.

Patients and Methods

This study is as Prospective double blinded cohort study, it was performed on Patients undergoing elective Total laparoscopic hysterectomy (TLH) in the hospital of gynecology of Ain Shams university hospitals over a period of six months. Patients who fulfilled the inclusion criteria and agreed to participate in the study were randomly divided into two groups using computer-generated randomized list such that group A for ESPB and group B for PCA.

Results

The main finding in this study was that ultrasound guided ESPB at level of thoracic process provided a good analgesic effect in patients undergoing TLH also reduced the need for rescue analgesia and the total amount of postoperative opioid consumption in comparison to PCA group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting due to decrease opioids intake.

Conclusion

Ultrasound-guided erector spinae plane block was found statistically efficient in reducing postoperative opioid consumption, alleviating postoperative pain scores and improving patients’ satisfaction in the first 24 hours after TLH, without associated adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation.
Prognostic Value of Systemic Arterial Lactate Levels in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Authors: Abdelhasseeb Ahmed Hamdy , Ibrahim Moustafa Ibrahim , Abdelsalam Ahmed Mouhamed , Elsayed Amr Adel
Published: July 2024

Background

Acute myocardial infarction is the most severe manifestation of coronary artery disease, which causes more than 2.4 million deaths in the USA, more than 4 million deaths in Europe and northern Asia, and more than a third of deaths in developed nations annually.

Objective

To assess the prognostic value of systemic arterial lactate levels in patients with ST segment elevation myocardial infarction undergoing primary PCI and correlate with the results of primary PCI and 30 days MACE follow up.

Patients and Methods

This study included 300 patients who presented with documented STEMI and underwent reperfusion by successful primary PCI in Ain Shams University hospitals.

Results

There was statistically significant positive correlation found between serum lactate and (WBCs) count, (HbA1C) level and cardiac enzymes (CKtotal - CKmb – troponin) and negative correlation found between serum lactate and ejection fraction in echocardiography. Also, we found that other parameters were associated with MACE follow up in 30 days such as Killip class at admission, ST segment elevation resolution, heart block in ECG, lower ejection fraction, dyslipidemia, post-procedure TIMI flow, peri-procedural time intervals and occurrence of complications.

Conclusion

The value of an early lactate measurement in patients with STEMI is to be a part of the risk stratification of these patients and intensified medical care should be considered to patients with strongly elevated lactate levels. Also, increasing arterial lactate levels were associated with occurrence of MACE in 30 days, worse hemodynamics, lower ejection fraction in echocardiography, higher HbA1C level, large infarct area (cardiac biomarkers peak level), poor post-procedure TIMI flow and thrombus grade.
Carotid Intima-Media Thickness as a Cardiovascular Risk Factor in Patients with Chronic Kidney Disease
Authors: Naem Mariam , Karem Khalid , William Viola , Ghareeb Magdi
Published: July 2024

Background

Atherosclerosis is a systemic arterial disease which frequently involve multiple vascular beds. Etiologically, cases of atherosclerosis occurring in different arterial vascular beds may share the same set of traditional risk factors.

Aim of the Work

In this present study we aimed to- evaluate the effect of chronic kidney disease on carotid intima media thickness as a cardiovascular risk factor in these patients.

Patients and Methods

This is a Case-control study conducted at Ain shams university hospitals during the period between January 2022 and June 2022.

Results

We found that patients with chronic kidney disease had significantly higher values of carotid intima media thickness (mean value of 1.10± 0.16 mm) versus control group (mean value of 0.49± 0.15mm).Also we noticed that with progression of kidney disease carotid intima media thickness (CIMT) becomes higher.CIMT showed a trend of gradual increase with decreased eGFR.Also we found that CIMT correlated positively with age, blood pressure, serum reatinine, urea and total cholesterol, but negatively with eGFR and we found that patients with diabetes and hypertension had CIMT higher than patients without diabetes and hypertension.The ROC curve analysis showed that the AUC for using eGFR cut off value of ≤ 75 mL/min for predicting CIMT thickness (>0.7 mm) was 1.And both the specificity and Sensitivity of eGFR in predicting CIMT thickening to be 100%.

Conclusion

Carotid IMT is significantly increased in Chronic kidney disease patients and may be usefully applied for risk stratification in this group of patients.Our study shows that, eGFR (≤ 75ml/min) has a positive predictive value for CIMT thickness(>0.7mm) with specificity and sensitivity 100%.
Impact of DApagliflozin on Cardiac Functionnfollowing Anterior Myocardial Infarction in Non-diabetic Patients – DACAMI (a Randomized Controlled Clinical Trial)
Authors: Younis Omar , Attia Sameh , AbdelSalam Ahmed , Zarif Bassem , Dayem Khairy Abdul
Published: July 2024

Background

This study aims at identifying if there is a role for Sodium glucose co- transporter 2 inhibitors (SGLT2i) in the event of acute myocardial infarction. Patients who presented with anterior ST- elevation myocardial infarction (STEMI) & had undergone successful primary percutaneous coronary intervention for the left anterior descending coronary were randomized into a study group & a control group. The study group received dapagliflozin 10 mg once daily. The primary endpoint was cardiac function assessed by both; a biomarker (i.e.: N-terminal pro-Brain Natriuretic Peptide – NT-proBNP) measured at baseline & at 12 weeks post the cardiac event & echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension & left ventricular mass index) assessed at baseline, 4-weeks & 12-weeks post the cardiac event.

Results

From October 2021 to April 2022, a final 100 patients were randomized. The median drop of NT- proBNP in the study group was significant compared to the control group (p-value 0.043). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group.

Conclusions

Dapagliflozin seems to have a role in preventing left ventricular dysfunction & maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to further confirm these findings.

This trial is registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov) with identifier number: NCT05424315 – June 16th, 2022. (https://ClinicalTrials.gov/ct2/show/nct05424315)
Risk of Atrial Fibrillation Induced by Ivabradine in Correlation with Left Atrial Size
Authors: Ibrahim Mahmoud Mahmoud Ali , Sallam Walid Mohamed , Khorshid Hazem Mohamed , Tamara Ahmed Fathy
Published: July 2024

Background

Ivabradine (Procoralan, Servier) is a heart rate lowering drug which acts by specifically inhibiting the pacemaker If current, which causes spontaneous depolarization in the sino-atrial node that regulates the heart rate.

Objective

To correlate Left atrial size with development of AF in patients treated with ivabradine over a 12 week period.

Patients and Methods

Our study was conducted upon 180 patients referred to Ain Shams University Hospital and Misr University for Science and Technology hospital, from September 2020 to February 2021 to undergo treatment for HF or IHD with the appropriate medications with AF being the primary outcome of interest and how it correlates with Ivabradine therapy.

Results

Our results showed that there was no statistically significant difference between the two groups regarding the incidence of AF (p = 0.587). Likewise, there was no statistically significant difference between the two groups regarding duration till AF at 1st month, 2nd month and 3rd month (p > 0.05). This could be explained by the lower number of patients included in the study as compared to other similar studies. When the entire patient population who developed AF was pooled regardless of their Ivabradine use, there was a statistically significant increase in AF incidence with larger left atrial volume indices.

Conclusion

In the present study, Ivabradine treatment was not associated with a higher incidence of AF in patients with heart failure and/or ischemic heart disease. Also, there was no significant difference in the duration until AF occurrence when it was evaluated at the end of the 1st, 2nd, and 3rd months. Higher LAVI was associated with a higher incidence of AF in the total studied patient population regardless of Ivabradine use.
Predictors of Contrast induced nephropathy following percutaneous coronary intervention in patients with chronic total occlusion
Authors: Elshafei Talal A , Hassanein Adel Gamal , El-Fekky Ehab M
Published: July 2024

Objectives

The aim is to predict the development of contrast induced nephropathy (CIN) and corresponding parameters in patients with chronic total occlusion (CTO) after per-cutaneous coronary intervention (PCI).

Background

Up to this moment few data was collected on the effect of different parameters and approaches on the development of contrast induced nephropathy in patients undergoing per- cutaneous coronary intervention to chronic total occlusion (CTO) lesion to coronary vessels.

Methods

Our study involved 75 patients with documented CTO lesions with planned revascularization over period of 6 months commencing in June 2021. Detailed baseline clinical, angiographic and baseline/follow up creatinine level outcomes were evaluated using data from Ainshams University affiliated hospitals.

Results

The incidence of CIN among population was 17.3% and 26.7% at 24h and 48h consecutively. Four different parameters showed a good diagnostic value in predicting CIN at 48hrs among patients with CTO who underwent planned elective interventional therapy PCI. The receiver-operating characteristic (ROC) curve analysis for prediction of CIN at 48 h showed that contrast volume (sensitivity, 85%; specificity, 67.0%; AUC, 0.812; 95% CI, 0.705–0.893; P < 0.001); Procedure time (sensitivity, 100%; specificity, 60.0%; AUC, 0.835; 95% CI, 0.731–0.910; P < 0.001); Δ Creatinine at 24 h (sensitivity, 90%; specificity, 76.0%; AUC, 0.918; 95% CI, 0.831–0.969; P < 0.001); Δ% Creatinine at 24 h (sensitivity, 75%; specificity, 96%; AUC, 0.915; 95% CI, 0.827–0.967; P < 0.001) have impact on the development of CIN. The results of multivariable binary logistic regression analysis for prediction of CIN at 48 h. showed that both contrast volume (odds ratio = 1.007, 95% CI = 1.001 to 1.013, p = .021) and Percentage change in creatinine at 24 h (odds ratio = 1.132, 95% CI = 1.053 to 1.218, p = .0008) are independent predictors of CIN at 48 h.

Conclusions

Contrast volume, Absolute rise/percentage change of serum in creatinine in 24 hrs and procedure time Can be used as a simple pre-procedural predictor of CIN among patients with CTO who undergoing interventional therapy PCI for revascularization.
Outcome of Pulmonary Complications after Hematopoietic stem cell transplantations
Authors: Abdelwahab Koraa Emad Elden , Madkour Ashraf Mokhtar , Mohammad Rehab Maher , El Razzaz Mostafa Kamal , Abbas Mohamed Samer , Abdelrahman Abdelrazik Marwa Ibrahim
Published: July 2024

Background

Pulmonary complications (PCs) are common and often lethal in hematopoietic stem cell transplantation (HSCT) recipients.

Aim of Work

to evaluate incidence, types, diagnostic procedures used, risk factors, and outcome of PCs in cohort of HSCT recipients.

Patients and Methods

This study conducted prospectively on 80 HSCT recipients at Bone marrow transplantation unit, Ain-Shams University Hospitals during the period between January 2018 and March 2020.

Results

For patients suffering from a pulmonary complication, a diagnostic algorithm was performed. We identified 14 pulmonary complications in 80 patients: 12 (85.7%) were infections; 2 (14.28%) were non- infectious complications inform of engraftment syndrome and pulmonary embolism. 50% of infections were mixed, the most common bacterial pathogen was mycoplasma pneumonia, reported as isolated organism in 4 cases (28.57%) and mixed with other bacterial infections in 3 cases (21.42%), overall mortality was 21.43%.

Conclusion

17.5% of HSCT recipients develop PCs within 1 year of transplant. Most of the complications are infections.
Cell Free DNA in SLE Patients: A Possible Marker of Disease Activity and Organ Damage
Authors: Rafik Mona Mohamed , Amer Hanaa Ahmed , Zaitoun Yasser , El Shnnawy Dina , Lotfy Neama , El azizi Noran Osama , Youssef Mahmoud Amin
Published: July 2024

Background

Systemic lupus erythematous (SLE) is a prototypic autoimmune disease with a complex pathogenesis involving multiple genetic and environmental factors. Cell death has been regarded as an important event in lupus pathogenesis as it leads to release of antigens as nucleic acids for immune complex formation. DNA-antibody complex in the circulation are one of the hallmarks of SLE that leads to detrimental effects causing manifestations of SLE. Fluctuation in circulating DNA level might be one of the driving factors behind flare-ups of SLE.

Objectives

This study aims to measure the circulating cell free DNA (cf-DNA) in patients with SLE as a potential marker for disease activity and organ damage.

Methods

This case control study included 100 participants categorized into 75 SLE patients as patient group (Group I), further divided to 39 SLE patients without therapy (group Ia), 36 SLE patients with therapy (Group Ib) and 25 age and sex matched healthy subjects as a control group (Group II). All participants were subjected to full history taking, thorough rheumatological examination and lab assessment of complete blood count (CBC), ESR, CRP, C3, C4 levels, ANA titer, anti-ds-DNA concentration by ELIZA and measurement of plasma cf-DNA levels by real time PCR. Cf- DNA concentration is expressed as concentration (ng/ml).

Results

SLE patients (Group Ia and Ib) showed significant increase in (plasma cf-DNA,CRP, ESR, ANA, anti-ds-DNA), significant decrease in (C3 and C4, hemoglobin, total leucocytic count and platelet count). Plasma cf-DNA (ng/ml) was significantly lower in group Ib compared to group Ia. There was significant positive correlation between plasma cf-DNA (ng/ml) and levels of ANA and anti-ds-DNA in all SLE patients and with SLEDAI-2k score in all patients.

Conclusion

Plasma level of cf-DNA is significantly increased in SLE patients especially before starting therapy these data may suggest it to be a possible marker of treatment follow up. Further studies on a larger patient population are still needed to confirm these results.
Comparative Evaluation of Prostatic Smear and Semen Analysis in The Diagnosis of Chronic Prostatitis
Authors: Abdou Nada Ibrahim , El-Sayed Rasheed Ahmed Ibrahim , Abdallah Mahmoud Abdel-Rahim , Elhusseiny Rania Mahmoud
Published: July 2024

Background

Chronic prostatitis is one of the most common medical problems among andrology and urology patients. Besides being the primary problem in many cases, it seems to play an important contributing role “major or minor” in a significant proportion of patients whether at the level of fertility, sexology or venerology. Consequently, effective management of the prostatic pathology has a great impact on the overall successful management of such andrologic problem.

Aim of the Work

to provide an objective comparison between traditional prostatic discharge analysis and traditional semen analysis as regards detection of pus cells in cases of prostatitis as well as to assess the possible advantage(s) of applying some modifications to enhance the diagnostic value of the previous techniques. These would include preliminary centrifugation of expressed prostatic discharge and preliminary peroxidase staining of semen sample before microscopic examination.

Patients and Methods

This pilot study included 40 patients suffering from prostatitis except acute prostatitis. The patients were recruited from the outpatient clinic of Venerology and Andrology department of Ain Shams University Hospitals in the period from February 2021 to November 2021.

Results

The current study included 40 patients suffering from any kind of prostatitis except acute prostatitis. Their age ranged between 30 and 50 years old with a mean age of 39.60 ± 4.52 years. Duration of disease ranged from 4-18 months with a mean of 7 ± 3.1 months. Most of patients were married (38, 95%). Main symptoms presented among studied patients were groin pain (37.5%), groin pain and painful micturition (20%) and groin pain, painful micturition and sexual problems (42.5%)

Conclusion

prostatic smear examination revealed higher sensitivity in detection of infection compared to semen analysis especially if combined with centrifugation. In addition, peroxidase positive cell testing revealed a significant role in detection of infection if the diagnosis is made solely on semen analysis results.
Microneedling with Topical Insulin versus Microneedling with Topical Saline in Treatment of Striae Alba
Authors: Abdallah Marwa M A , Ibrahim Samah , Mohamed Aya Ragab
Published: July 2024

Background

Striae distensae, an extremely common condition, are a challenging cosmetic problem and pose a significant psychological burden for patients. Various treatment modalities have been applied with low satisfaction rate.

Objectives

To evaluate the clinical response, efficacy, safety and adverse effect of combined microneedling with topical insulin compared to microneedling alone in the treatment of striae alba.

Patients and Methods

This randomized prospective controlled comparative study included 20 patients suffering from stria albae on both sides of the abdomen. The diagnosis was made via clinical diagnosis of dermatological findings. All patients were consecutively selected from the dermatology outpatient clinic, Ain-Shams University Hospitals in the period from November 2021 till April 2022.

Results

The result The study showed that there was significant improvement in striea alba indentation index after treatment in both the insulin sides and placebo sides, the insulin sides being superior. In comparing both methods, there was no statistically significant difference between them as regards Erythema and hyperpigmentation. The current study showed nearly equal patient satisfaction scores in both groups.

Conclusion

Both microneedling alone and microneedling with topical insulin were effective and safe methods in treating patients with striae alba. Using topical insulin had better result than microneedling alone. Both methods are tolerated regarding Microneedling with insulin had no short term side effects.
Central Hepatectomy versus Major Hepatectomy for Patients with Centrally Located Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Authors: Abdelaal Amr Ahmed , Khalil Ahmed Abdelrazk , Fawzy Fawzy Salah , Youssef Gadallah Edward Atef
Published: July 2024

Background

Hepatocellular carcinoma (HCC) is the fifth-most common cancer globally and the third highest cause of cancer-related death exceeded only by cancers of the lung and stomach. It is estimated that 782,000 new cases are diagnosed with HCC annually and 600,000 die of this tumor globally each year. Therapeutic treatment modalities are available for patients with local disease including ablation, liver resection, and liver transplantation (LT). However, for those with respectable tumor and without an underlying liver disease, liver resection offers the best treatment.

Aim of the Work

The aim of this meta-analysis was to compare the short- and long- term outcomes including overall survival, recurrence rate and complications between patients treated with CH and patients treated with hemi-/extended hepatectomy for those with centrally located HCC.

Patients and Methods

A systematic review and meta-analysis, PubMed / MEDLINE, Scopes, Web of science, and the Cochrane Library were searched for data from inception to 1 April, 2022 with the following terms: major hepatectomy and Mesohepatectomy or central Hepatectomy and hepatocellular carcinoma. More searches by Google Scholar have been used to supplement the search with the sites mentioned above. according to the eligibility process. Abstract-based eligibility studies were obtained, and the manuscripts were fully reviewed. Report bibliographies that meet the eligibility criteria were reviewed for further studies.

Results

Our meta-analysis showed that the overall incidence of complications was comparable between the two modalities. However, on one hand, the incidence of post-operative liver cell failure was significantly higher in those who underwent major hepatectomy. This could be attributed to the fact that major hepatectomy is associated with the removal of 60–85% of liver parenchyma.6,7 On the other hand, a higher incidence of biliary fistula was detected for those who underwent central hepatectomy.

Conclusion

This study showed no significant difference in the short and long term survival and recurrence between CH and MH for CL-HCC. However, CH is associated with greater future remnant liver volume that decrease the incidence of LCF and provides more opportunities for a repeat hepatectomy after tumor recurrence.
Surgical Offloading versus Medical Conservative Methods in Management of Diabetic Foot Plantar Ulcers (Interventional study)
Authors: Abdelwahab S , AbdElbary M , Abd Elnasser A
Published: July 2024

Background

As a result, peripheral neuropathy is frequently caused by diabetes (DM). Diabetic plantar foot pressure ulcers develop from the lack of protective pain sensibility as a result of recurrent shear and tear pressures. Relieving pressure on the foot's sole is necessary for the ulcers to heal. The purpose of the study is to compare the effectiveness of surgical and nonsurgical unloading procedures in the healing of plantar ulcers.

Subjects and Methods

50 diabetic foot ulcer patients who visited Ain Shams University, the national institute of DM, and the endocrinology outpatient clinic participated in this interventional trial (NIDE). We employed mechanical and surgical unloading methods in this trial, and patients were monitored for 6 months to see how long it took for their injuries to recover.

Results

At the conclusion of the follow-up period, 88% of the surgical group's pressure ulcers were fully healed, compared to 86.7% of the non-surgical patients (6 months). Infection, recurrence, and non-healing were complications we encountered throughout the follow-up period. Regarding the treatment of plantar diabetic foot ulcers, offloading is crucial (DFUs). Compared to using only non-surgical methods, surgical offloading may hasten the recovery time. A well- trained team is necessary to prevent the issues with improperly fitting footwear and to teach the patient how to use them on a regular basis with the non-surgical offloading technique.
Evaluation of Focused Mini-Incision Parathyroidectomy in Primary Hyperparathyroidism
Authors: Lasheen Mohammed Fakhruddeen , Kamal Ahmed Mohammed , Abdelrahim Hossam S
Published: July 2024

Background

In the era of effective preoperative localization and availability of intraoperative parathyroid hormone (IOPTH) assay, the trend now in parathyroidectomy is shifting from bilateral neck exploration (BNE) into minimal invasive parathyroidectomy (MIP). The concept of MIP is based on the fact that 85% of cases have single adenoma. This study highlights the outcomes of focused mini- incision parathyroidectomy (FMIP) for the treatment of selected cases of primary hyperparathyroidism. Aim of study: To evaluate and assess the outcome and advantages of focused mini-incision parathyroidectomy in parathyroid adenoma of primary hyperparathyroidism.

Patients and Methods

This cohort study was conducted at endocrine surgery unit, Ain Shams University Hospital, and Sohag Cancer Institute including 22 patients with benign solitary parathyroid adenoma; 17 retrospective cases & 5 prospective cases. These included patients had been operated with focused mini-incision parathyroidectomy within the time period from January 2018 to December 2020 as retrospective cases and from January 2021 to December 2021 as prospective cases.

Results

In this study, age ranged from 30 to 70 years with mean age 50.23 ± 10.71 years. The preoperative serum calcium level ranged from 10.8 to 14.2 mg/dl (mean 12.28 ± 1.16 mg/dl). The preoperative parathyroid hormone level was elevated ranging from 256 to 2090 pg/mL (mean 970.68 ± 563.97 pg/mL). In this study, the operative time ranged from 55 to 75 minutes with mean 64.36 ± 6.33 minutes, percentage of IOPTH decrease level ranged from 75-95 % with mean percentage 85.72 ± 6.28 %. There were no cases with intraoperative bleeding or recurrent laryngeal nerve (RLN) injury. Hospital stay ranged from 6-16 days with mean 10.77 ± 3.10 days. There is no wound infection in all cases. All cases reached a success rate up to 100% (decrease the IOPTH level ≥ 75 %, and resolution of preoperative hypercalcemic manifestations).

Conclusion

Depending to the high successful rate, very low intraoperative morbidity and better postoperative recovery and cosmoses of FMIP technique, it should be the first choice for pHPT cases with solitary parathyroid adenoma, provided by the concordance localization study of U/S and MIBI scan preoperative.
Retrospective Study for Evaluation of TIRAD Scoring System Irrespective of FNAC in Decision Making Outcomes in Thyroidectomy
Authors: Elsayed Osama Mahmoud , Ghazy Mohamed Shaker , Elsayed Mohamed Gamal , Naeem Tasnim Rizk , Zaki Asmaa Ali
Published: July 2024

Background

Thyroid nodules present a common clinical problem. Palpable nodules are present in about 5% of the population, and are noted incidentally on ultrasound in up to 70% of people, with increased prevalence in older patients. The incidence of thyroid nodules has increased due to exposure to medical radiation, iodine intake, obesity, insulin resistance, genetics and inorganic phosphates. With a 300% increase in the annual thyroid cancer rate.

Aim of the Work

The aim of this study is to evaluate the value of Ultrasound and TIRAD scoring system for decision making outcomes in thyroidectomy done for thyroid nodules.

Patients and Methods

This Retrospective cohort study was conducted at (General surgery department), Ain Shams University Hospitals and Ain shams University specialized Hospitals and was conducted over a period of six months starting from date of approval of the protocol.

Results

In our study, Conventional sonography has 66.66% sensitivity and 92.5% specificity as it suspected malignancy (positive suspecting findings) in 14 patients; eight of them were proved to be malignant and six of them were benign by histopathology accounting for low positive predictive value (57.14%) and it suspected benignity (negative suspecting findings) in 78 patients; 74 of them were perfectly correlated with the histopathology accounting for high negative predictive value (94.87%). In our study, the rate of detecting patients with thyroid cancer (sensitivity) was calculated as 80%, the rate of distinguishing healthy individuals (specificity) was 88.88%, the Positive Predictive Value (PPV) was 57.14% and the negative predictive value (NPV) was 96% for FNAC. In our study, the sensitivity and the specificity of FNAC in detecting cancer was near to the literature but the (PPV) was lower than the literature and was non diagnostic in fourty patients (40%), we think that this discrepancy depends on many factors including radiology, pathology, and the materials used in FNAC method, and patients with multiple nodules.

Conclusion

Neck US and FNAC have proven low sensitivity in differentiating malignant from benign thyroid nodules
Safety and Efficacy of Directly Acting Antivirals (Sofosbuvir & Daclatasvir) in Treatment of Chronic HCV
Authors: Makhlof Mohamed Mari , AbdElsadk Ahmed Samir , AbdElrahman Gada , Ali Ahmed Mohamed
Published: July 2024

Background

The introduction of direct-acting antiviral agents, has revolutionized the treatment for chronic HCV with higher cure rates, shorter duration of treatment and more tolerability have been achieved.

Aim of the Work

The aim of our study is to estimate the efficacy and safety of DAAs in treatment of chronic HCV in patients co-infected with HIV.

Patients and Methods

This study of previously untreated HCV infection in patients with HCV and HIV co-infection conducted at Abbasia Fever Hospital, from July 2019 to February 2020. Patients included are chronic HCV infection and were receiving antiretroviral therapy for the HIV with a CD4 T-lymphocyte count of 200 cells/mL or greater. Serial measurements of safety parameters, virologic and host immune correlates, and adherence were performed during treatment by combination of daclatasvir 90mg and sofosbuvir 400mg+/- ribavirin 800mg daily for 12 weeks.

Results

In this study, the rate of a sustained virologic response (SVR) at post-treatment week 12 (SVR 12) were high (29/30, 96.67%). The most common adverse events were fatigue (73.33%), headache (46.67%), and there was a high safety profile on using DAAs. No patient discontinued treatment because of adverse events. No serious adverse events or mortality were reported. In this study, AST & ALT were significantly decreased at end of treatment and 12 weeks after treatment, CD4 count was significantly increased. Otherwise there are no significant changes in both hematological and biochemical laboratory results.

Conclusion

Combination of daclatasvir and sofosbuvir have showed 96.67% sustained virologic response at 12 weeks after treatment (SVR 12) among HIV/HCV co-infected patients, with a very good safety profile. Moreover, the treated patients showed a significant increase in CD4 count. Accordingly, HIV/HCV co-infected patients should be treated with sofosbuvir and daclatesvir containing regimens.
Serum Soluble B Cell Maturation Antigen Level as a Prognostic Marker for Low Grade Lymphoma
Authors: Hasan Esam Abdelwahid , Nabih Nermeen Adel , Ibrahim Nahed Moawad , Elmoaty Mohamed Inas Abd , Zakaria Maha Ibrahim
Published: July 2024

Background

Despite the Indolent lymphoma is a slowly growing tumor that has many therapeutic options and good initial response, it is usually incurable. Relapses and HT to aggressive form may occur and some patients die from their disease. For the RR iNHL Several novel targeted therapies may be recommended such as antibody–drug conjugates (ADC) and bispecific T cell engagers (BiTE). B cell maturation antigen is a transmembrane glycoprotein that regulate B cell proliferation, survival, maturation and differentiation into PCs. IT is expressed in multiple myeloma and B cell neoplasms. The effects of BCMA have been studied in multiple myeloma and a new BCMA-targeted immunotherapy has been approved for the treatment RRMM patients. Few studies done to detect BCMA in other Hematologic malignancies as a diagnostic or prognostic tool and a therapeutic potential of antiBCMa targeted therapy in these malignancies. In this study we detect sBCMA in the serum of iNHL patients.

Aim of the Work

To measure the levels soluble BCMA (sBCMA) in the serum of adult patients with indolent non Hodgkin lymphoma (iNHL).

Patients and Methods

A case control study conducted on adult patients of iNHL attending hematology department of Ain Shams university with a participant of 40 cases of newly diagnosed and RR iNHL plus 40 control.

Results

In the present study we found that there was no statistically significant difference between the studied groups as regard sex, TLC, Hb, platelet counts and tumor subtypes in relation to BCMA level . While there is a statistically significant correlation between Age, stage and LDH to the BCMA level. The results suggest that the BCMA level is significantly higher in patients with iNHL than the healthy controls.

Conclusion

This study suggest that the BCMA level is significantly higher in patients with iNHL than the healthy controls. By increasing the Age ≥ 40 years the risk of iNHL is increased by 1.71 folds than otherwise healthy controls. The BCMA level was positively correlated to LDH implying that BCMA could be related to iNHL proliferation rate and possibly lymphoma aggressiveness. The level of BCMA more than 430 ng/dL correlated with a more than a 4.5-fold rise in the risk of higher disease stage with borderline significance. Further studies are needed to detect the relation between The BCMA level and the disease prognosis that may be useful for a promising AntiBCMA targeted therapy for RR patients.
Assessment of Galectin 3 as a New Biomarker of Liver Fibrosis in Chronic HCV Egyptian Patients and its Correlation to Transient Elastography, FIB-4 Index, and APRI Score
Authors: Mohamed Badawy Hanan Mahmoud , El-Kilany Hesham Hamdy , Samaan Amira Isaac , Maksoud Mohamed Ibrahim Nasr Abdel
Published: July 2024

Background

Invasive liver biopsy is the current method for the assessment of liver fibrosis. In search of noninvasive alternatives, galectin-3-binding protein (G3BP) was introduced as a candidate-marker of hepatitis C-related fibrosis based on serum proteomics.

Aim of the Work

to evaluate serum Galectin-3 as a marker of liver fibrosis and correlate it to the stage of fibrosis assessed by FibroScan, FIB-4 index and APRI score

Patients and Methods

This was prospective study, was carried out on 30 patients with liver fibrosis/cirrhosis due to chronic HCV inthe Hepatic Virology Unit and the gastroenterology department of Ain Shams university hospitals and 30 health controls with normal, non fibrotic and non cirrhotic, liver, from January 2022 to June 2022

Results

There were high significant difference between both groups as regard Serum level of Galectin-3 and APRI score.

Conclusion

Serum level of galectin-3 was highly expressed in chronic HCV Egyptain patients and positively correlated to FIB-4 index, APRI score and fibroscan.so the serum level of galectin-3 beside other modalities, lab investigations and clinical examination may guide us about the progression to fibrosis and cirrhosis in those patients. In these patients, if galectin-3 levels were found to be high, serum alpha-feto protein level and ultrasonographic examination could be repeated at more frequent intervals. This may also guide us in terms of the treatment plan. Measurement of galectin-3 in sera of large number of patients and follow up may pave the way to pick up early fibrosis and showed its prognostic effect.
Late Onset Systemic Lupus Erythematosus: Different Clinical, Serological Presentations and Damage Compared to Adult Lupus in Egypt
Authors: Elsayed Mohamed Hefny Marwa Mohamed , Elbakry Samah Abd-ElRahman , Abdul-Rahman Maryam Ahmad , Mohammed Badr Fatma
Published: July 2024

Background

Comparing cases of adult onset and late onset systemic lupus erythematous (SLE) reveals significant differences in clinical, serological, disease activity, and damage score.

Objective

This study aimed to analyze clinical manifestations, laboratory data, serological markers, and prognosis of late-onset SLE (L-SLE) and for comparing with adult- onset SLE.

Patients and Methods

One hundred fifty individuals with SLE were included in a cross-sectional study conducted at Ain Shams University Hospital divide into Group 1: 100 cases with adult-onset (age of onset ≥ 19 years and below 50 years). Group 2: 50 Patients with L-SLE (age of onset ≥ 50 years). All patients were subjected to medical history, physical examination, disease activity measured by the SLE disease activity index (SLEDAI-2K) and a damage score. Laboratory investigations as complete blood count (CBC), serum creatinine, anticardiolipin antibodies, lupus anticoagulant, protein creatinine ratio, serum complement (C3, C4), anti-dsDNA antibody, and antinuclear antibodies (ANA).

Results

Mucocutaneous manifestations, frequency of hematuria, proteinuria, urinary cast, consumed C3, positive anti-dsDNA antibodies, anti-cardiolipin antibody and lupus anticoagulant titers had considerably greater rates in-group 1 compared to group 2 (P-value <0.05) while group 2 had significantly more musculoskeletal symptoms (P-value <0.05). The SLEDAI scores of the two groups were equivalent, however the damage index was greater in group 2 (P-value 0.00). Neuropsychiatric, cutaneous, renal, and skin damage were more frequent in group 1, while musculoskeletal, endocrinal, pulmonary, cardiovascular and ocular damage were more frequent in- group 2.

Conclusion

L-SLE is different from adult onset SLE with more frequent damage.
Role of Lipocalin-2 Levels in Non-Alcoholic Fatty Pancreatic Disease and its Association with Non-Alcoholic Fatty Liver Disease
Authors: Marei Makhlouf Mohamed Ali , Salama Mohamed Magdy , Abdo Ahmed Abbas , Gaber Hagag Heba El-Sayed
Published: July 2024

Background

Lipocalin-2 (LCN2) is a 25-kDa secretory protein with great importance as a sensitive and specific screening and diagnostic biomarker for hepatic inflammation, acute hepatic injury, hepatic cancer, and radiation-induced early phase hepatic damage and lipid abnormalities. However, little is known about LCN2's functions in the homeostasis and metabolism of hepatic lipids or in the development of steatosis as well as its actual role in the event of inflammation.

Aim and Objectives

To establish a correlation between the levels of lipocalin as a useful biomarker with increasing severity of steatosis in NAFLD and NAFPD patients.

Subjects and Methods

This was observational prospective case–control study, was conducted at Hepatology Unit of Ain Shams University Hospital on 50 patients diagnosed with NAFPD and 50 healthy age and sex-matched volunteers without NAFPD during a period of 6 months. All patients were subjected to; Full history taking and thorough clinical examination, Anthropometric measurements, Laboratory investigations, and abdominal ultrasonography.

Result

There was a significant Positive correlation between Lipocalin 2, BMI, LDL (mg/dL), Cholesterol (mg/dL), Insulin (μU/mL) and HOMA-IR in patient group(P-value ≤ 0.001), Conclusion; lipocalin-2 is a good blood biomarker for detection of hepatic and Pancreatic steatosis. The lipocalin levels increase with increasing severity of steatosis. In addition to this, lipocalin will be useful for early diagnosis of NAFLD, NAFPD and convenient to do with other blood tests. The early intervention may prevent high morbidity and mortality and to manage the disease properly.
Tenascin-C is a Promising Marker of High Bone Turnover and Vascular Calcification in Prevalent Hemodialysis Patients
Authors: El-Shenawy Howyda , Shawky Sahar , Fouad Mohammed , Abdelmegied Shaimaa
Published: July 2024

Background and Aims

Tenascin-C (TN-C) is an extracellular matrix glycoprotein associated with high cell turnover and vascular calcification and atherosclerosis. This study determines the frequency of Tenascin-C in uncontrolled parathyroid hormone state and its relation to vascular calcification.

Method

A cross sectional study included 90 prevalent hemodialysis patients divided into 2 equal groups: uncontrolled iPTH level >300 pg /ml and controlled iPTH (150-300 pg/ml) groups. Serum Tenascin-C was measured by ELISA and vascular calcification was assessed by simple vascular calcification score (adragao score): by Plain X ray on hands, pelvis & vascular access for all patients.

Results

The prevalence of Tenascin-C and vascular calcification in patient with uncontrolled PTH were 84.4% (38 patients), 46.7% (21 patients) respectively. Tenascin-C was positively correlated with PTH level (r 0.494 p < 0.001) in patients with high bone turnover. Tenascin-C was high in patients with uncontrolled PTH [median (IQR) 637 (4245)u/ml] compared with patients with controlled PTH [median (IQR) 211 (143) u/ml] P value <0.0001. According to Adragao calcification score, in uncontrolled PTH: 31.1% (14 patients) had score 1 and 15.6% (7 patients) score 2. In controlled iPTH all patients had score 0. Patients with vascular calcification had high Tenascin-C median [(IQR) 10697 (53974)] compared with patients without vascular calcification [median (IQR)7697 (18000) u/ml)] P value <0.001. Serum Tenascin-C can predict high bone turnover at cutoff value 7377 ng/ml with AUC 0.794, sensitivity 84.4% and specificity 60 % while predict vascular calcification at cut of value > 8859 ng/ml AUC 0.745, sensitivity 72.7 %, specificity 72.1 %. Patients who have elevated level of tenascin C had 10.3, 3.7 times the risk to have high bone turnover and vascular calcification than negative one respectively.

Conclusion

Tenascin-C appears to be a sensitive marker for assessment of high bone turnover and vascular calcification in Prevalent Hemodialysis Patients.
Effect of Enteral Protein Supplements on Malnourished Hemodialysis Patients
Authors: El-Said Tamer Wahid , Gharib Mohamed Sary , Nazeih Mariem Shaker
Published: July 2024

Background

Protein-calorie malnutrition is common in chronic hemodialysis patients and correlates with morbidity and mortality. There are limited trials evaluating the efficacy of oral nutritional supplementation in malnourished CHD patients.

Aim of the Work

To evaluate the effect of 6-month-long intradialytic amino acids (AA) supplementation on selected nutritional variables in malnourished hemodialysis (HD) patients.

Patients and Methods

This was prospective, intervention-controlled study, was conducted in haemodialysis unit Ahmed Maher Teaching Hospital, and other authorized hospitals nephrology clinics on 60 patients divided into 2 groups: (Group A); received oral formula, (Group B); the control group on their normal diet.

Results

There were high statistically difference between the studied groups on nutritional markers.

Conclusion

Malnutrition is common in incident and prevalent HD patients however enteral protein supplements can also help on increasing nutritional markers.