bluuebunny/crossref_metadata_2025 huggingface dataset:
Internalizing Behavioral Problems in Children with Specific Language Impairment
Authors: Hassan S , Hegazi M , Ghandour H , Abdelrazek G , Elrefaie D
Published: May 2020

Background

Specific language impairment (SLI) occurs when children present language maturation, at least 12 months behind their chronological age in the absence of sensory or intellectual deficits, pervasive developmental disorders, evident cerebral damage, and adequate social and emotional conditions. Internalizing behavior is actions that are taken out toward the self. The symptoms of internalizing behavior problems are depression, anxiety, somatic complaints and withdrawal.

Aim of the Work

This study aimed to investigate the presence of internalizing behavioral problems among SLI and their frequencies if present.

Patients and methods

We assessed SLI by PLS-4 and assessed internalizing behavioral problems with CBCL 1 1/5-5. Fifty children with SLI with an age range of (4-5 years old), divided into 2 subgroups according to the type of SLI, are compared to fifty children with normal language development with the same age and gender regarding internalizing behavioral problems.

Results

SLI group had more internalizing behavioral problems than control group and there is significant association between behavioral problems and the severity of language deficits.

Conclusion

the most frequently behavioral problem found in preschool (SLI) children were withdrawn and anxiety, which need therapeutic interventions to remediate them.
The Effectiveness of the Photoangiolytic Potassium Titanyl Phosphate (KTP) Laser in Managing Vocal Folds Reinke’s Edema A Systematic Review
Authors: Saad M N , Elshoubary A M , Hassan S M , Khodeir M S
Published: May 2020

Background

Recently, photoangiolytic potassium titanyl phosphate (KTP) laser treatment has been proposed as an alternative treatment for managing Reinke’s edema. Unlike traditional methods that involve the physical removal of the lesion, the KTP laser causes lesion regression by disrupting the blood supply through targeting the oxyhemoglobin. Moreover, KTP could be used as an office-based procedure, indicating its advantage over other operating room surgical procedures, with lower cost and avoidance of the potential complications of microlaryngoscopy.

Aim

The aim of this work is to conduct a systematic review on the effectiveness of the photoangiolytic KTP Laser as a surgical method for treatment of patients with Reinke’s edema.

Study Design: This was a systematic review.

Methods

Two electronic databases of (PubMed and Cochrane Library) were searched for articles. Relevant studies were further evaluated and studies that met inclusion criteria were reviewed and included.

Results

The literature search yielded 167 studies. 25 articles were further evaluated to be included. Three studies met all the inclusion criteria and were chosen for the review. The studies investigated the effectiveness of using Photoangiolytic KTP Laser in the management of Rienke’s edema.

Conclusion

The current systematic review suggested that photoangiolytic KTP Laser has not yet proven as an effective approach for treatment of Reinke’s edema and furthermore studies are needed to assess its effectiveness.
Assessment of subtypes of dyslexic dysgraphia
Authors: Mohamed D M , Rifaie N A , Hassan S M , Elfeky Y H
Published: May 2020

Background

Writing requires a complex set of motor and information processing skills. It requires not only the ability to organize and express ideas in the mind but it also requires the ability to get muscles in hands and fingers to form these ideas, letter by letter, on paper. Many people have poor handwriting, but dysgraphia is more serious. It's a neurological disorder that generally appears when children are first learning to write and is showing increased incidence among young children.

Aim of the Work

is to make a depth assessment of the developmental dyslexic dysgraphia to clarify its subtypes (surface and deep dysgraphia).

Patients and Methods

Spelling and copying tasks included in Modified Arabic Dyslexia Screening Test (MADST) were applied on the subjects of this study who comprised a convenient sample of 40 children diagnosed as being dyslexic ranging in age from 8-10 years.

Results

There was statistically significant difference between the mean scores of children with surface and deep dysgraphia regarding spelling of regular sense, irregular sense words and nonsense words.

Conclusion

it was proved that dyslexic dysgraphia which is common among young Egyptian children could be further subdivided into surface and deep dysgraphia.
Incidence of Attention-Deficit/Hyperactivity Disorder in Learning Disabled Children, A Systematic Review
Authors: Mohamed H A , Khodeir M S , El-sady S R
Published: May 2020

Background

Children diagnosed with learning disability (LD) have a high incidence of psychiatric comorbidities especially Attention-Deficit/Hyperactivity Disorder (ADHD). These comorbidities are either a direct consequence of the same deficits in the central processing patterns that generate the learning problems, or they tend to stress the role of frustration and failure in academic achievement. These difficulties are claimed to move a vicious circle that leads the child towards ever-greater cognitive and social–emotional impoverishment.

Aim

The aim of this work is to conduct a systematic review of ADHD as a comorbid condition in learning disabled children to determine its incidence in learning disabled children in order to estimate the size of the problem to be able to delineate an efficient program in therapeutic intervention later.

Study design

This was a systematic review.

Methods

Two electronic databases (PubMed and Science Direct) were searched for articles. Relevant studies were further evaluated and studies that met inclusion criteria were reviewed.

Results

The literature search yielded 593 studies. Twenty-eight articles were further evaluated to be included. Five studies met all inclusion criteria and were chosen for review. The studies provide prevalence of ADHD in learning disabled children. We have found higher scores of ADHD in learning disabled children than in the normal population, in all the included studies. The studies reviewed demonstrated the effect of this comorbidity and the importance of its diagnosis for improvement of prognosis of the learning disability.

Conclusion

The current systematic review determines the probable prevalence of the ADHD in learning disabled children.
Comparison between lip-reading ability in normal and hearing impaired children
Authors: Saad A M , Hegazi M A , Khodeir M S
Published: May 2020

Background

Lip-reading is considered an important skill which varies considerably among normal hearing and hearing impaired (HI) children. It helps HI children to perceive speech, acquire spoken language and acquire phonological awareness. Speech perception is considered to be a multisensory process that involves attention to auditory signals as well as visual articulatory movements. Integration of auditory and visual signals occurs naturally and automatically in normal individuals across all ages. Many researches suggested that normal hearing children use audition as the primary sensory modality for speech perception, whereas HI children use lip-reading cues as the primary sensory modality for speech perception.

Aim of the Work

The aim of this study is to compare the lip-reading ability between normal and HI children.

Participants and methods

This is a comparative descriptive case control study. It was applied on 60 hearing impaired children (cases) and 60 normal hearing children (controls) of the same age and gender. The age range was (3-8 years). The Egyptian Arabic Lip-reading Test was applied to all children.

Results

There was statistically significant difference between the total mean scores of the EALRT between normal and HI children.

Conclusion

The results of the study proved that normal children are better lip-readers than HI children of the matched age range.
Significance and relation of vitamin D levels in head and neck cancers
Authors: Mahmoud O , Adly A , Askoura A , Abuelela S A , Salah S
Published: May 2020

Background

Vitamin D and its metabolites reduce the incidence of various cancers including head and neck SCC by inhibiting tumor angiogenesis, stimulating mutual adherence of cells, and enhancing intercellular communication, thereby strengthening the inhibition of cellular proliferation. Epidemiologic and case-control studies have demonstrated that low vitamin D levels are associated with head and neck SCC risk. Some studies showed that patients with HNSCC who received vitamin D at the time of diagnosis had diminished peripheral blood and intratumoral levels of immunosuppressive CD34+ cells and increased levels of mature dendritic cells. In addition, they showed the quantitative increase of the immune cells within the HNSCC tissue following vitamin D treatment.

Aim

to investigate the significance and relation of vitamin D levels in head and neck cancers.

Patients and Methods

The study included 100 participants; they were categorized into two groups. Group A comprised 50 patients (40 males and 10 females) with various HNSCC sites, and with a mean age of 53.04±13.56 years. Group B comprised 50 (32 males and 18 females) sex-matched and age-matched healthy volunteers as controls, and with a mean age of 42.04±14.09 years. In total, 22 participants of group A were smokers while 28 of the control group (group B) were smokers. Both groups were subjected to Lab detection of vitamin D level.

Conclusion

This study showed that there is a non-significant relation between vitamin D levels and the different types of head and neck cancers. But vitamin D deficiency may expose the patients to increased risk of therapy-related morbidity and poor outcome; as a significant relation between vitamin D levels, HCV and Hb levels among the cases is reported. It may constitute an inexpensive prophylactic and cost-effective option in the therapeutic armamentarium as a synergistic agent to traditional treatment options.
Value of the Use of Facial Nerve Monitoring in Otorhinolaryngological Surgeries
Authors: Mohamed N E , Rabie N A , ElSharnouby M M K , Mikahail P M
Published: May 2020

Background

The anatomy of the facial nerve is among the most complex of the cranial nerves. Facial nerve is not just a pure voluntary motor nerve but comprises parasympathetic, general sensory, and special sensory components as well. Facial nerve monitoring is one of the most exciting innovations in neurotologic surgery in the past decade.

Objective

To determine the effect of intraoperative facial nerve monitoring on postoperative facial nerve function and on operative time.

Patients and Methods

In general terms, FNM means electrophysiological monitoring. This technique provides for monitoring of facial muscle activity via electromyography (EMG).The EMG is typically recorded with needle electrodes placed in facial nerve muscles. Voluntary activation of the facial nerve in the alert patient as well as intraoperative electrical stimulation or mechanical irritation during surgery generates motor evoked potentials. In this meta-analysis, the included studies are ten in number with total 593 patient (control= 311, IOFNM = 282)

Results

Comparison of facial nerve monitoring vs. no monitoring as regards incidence of facial nerve dysfunction shows there is no evidence of heterogeneity and statistically significant (p-value <0.01) which indicate that the incidence of FN dysfunction in the monitoring group is lower than the dysfunction in the no monitoring group. Comparison of facial nerve motoring vs. no monitoring as regards operative time shows there is no evidence of heterogeneity. Under the random effect model, the standardized mean difference (SMD) is -0.62 which is statistically significant (p-value <0.01) favoring facial nerve motoring over no monitoring. Which indicate that the mean surgery time was lower in the group of patients operated with facial monitoring as compared with the unmonitored group.

Conclusion

So, our meta-analysis shows statistically significant results which favor facial nerve monitoring over no monitoring as regards decreasing the operative time and improving of postoperative facial nerve dysfunction.
Predictive Factors For Nutritional Behavior Among Pregnant Women Attending Ante Natal Care Clinic In 6th Of October City
Authors: Nasrallah D A , Ez-elarab H S , Allam M F , Sultan E A
Published: May 2020

Background

Good maternal nutrition during pregnancy is important to ensure health for the mother and the fetus. This study aimed to establish optimal health of Egyptian mothers and their babies through proper nutrition, by assessing nutritional knowledge and behavior among a group of Egyptian pregnant women in addition to identifying the factors influencing their nutritional knowledge and behavior.

Methods

This descriptive cross sectional study included 300 pregnant women attending the antenatal care clinics in 6th of October University private hospital and EL-Hussary primary health care unit. The data was collected through a modified nutritional survey that was translated from Spanish to Arabic and revised by language experts for clarity.

Results

Almost all of the women attending the private hospital were university educated while about half of the women attending the PHC unit were graduated from technical education (skills diploma). In general, the level of knowledge about food requirements of both groups was satisfactory good; however, neither of them fulfilled the WHO recommendations of food intake during pregnancy or the optimum number of meals per day. The mean of random blood glucose was higher among the women attending the PHC unit; the BMI, mid arm circumference and subcutaneous fat were higher among the same group as well. In regard to fulfilling the WHO recommended servings per day, only starch and fat items were fulfilled by both groups, whereas the other three items (vegetables, fruits and dairy products) were merely included in the diets of both groups.

Conclusion

Women with higher education showed an active lifestyle with a lower BMI but showed no relation to the choice of a good and healthy diet. These findings could give an insight to the policy makers in order to update nutritional care programs for pregnant women addressing all aspects of sociodemographic differences among women.
Rapid stain biomarker: A novel tool for forensic detection of semen (effect of time, different fabrics and vaginal secretions on its reliability)
Authors: Abdelrahman A A , Mahmoud S A , Attia E A
Published: May 2020

Background

The identification of semen stain is one of the most common human stains that can provide crucial information for crime scene reconstruction and forensic investigation. In sexual assault cases semen identification helps to prove victim’s allegations it also provides a material for DNA analysis that generate the genetic profile of the alleged suspect. The rapid Stain Identification of Human Semen (RSIDTM-Semen) bioassay is designed to detect specifically the presence of human semenogelin. Test development is completed within 10 minutes and can detect as little as 2.5 nL of human semen and it does not cross-react with other human or nonhuman tissues. The detection protocol can be completely integrated into the procedures for DNA extraction and analysis.

Aim

To assess the efficacy of RSIDTM – Semen strip test for the detection of human semen under some different variables (different fabrics, different time intervals and mixed with vaginal secretions) in order to be used in the routine forensic work of sexual assault cases and for further personal identification.

Methodology: Semen samples were collected from four male participants. Vaginal specimens were collected from four female participants on cotton, linen or nylon-tipped swabs (2 swabs from each female). Each semen sample was divided into two portions; one used for semen only test group and the other mixed with vaginal secretions for the mixed test group. One of the fabrics tipped vaginal swab was mixed with semen for the mixed test group and the other used as a positive control group to test the sensitivity and specificity of the RSIDTM – Semen strip. The semen samples were deposited over different fabrics at the same time. All the samples were left to dry for 15 minutes at room temperature then extracted and analyzed according to the protocol designed for The Rapid Stain Identification Test (RSIDTM – Semen). The collected samples were studied as two test groups and one control group. Each of the previous groups, was categorized into 4 subgroups (a, b, c and d) according to the time interval of semen extraction (zero (on the spot), 2, 4, 6 and 10 days respectively).

Results

Semen could be identified in 100% of tested samples of the semen only group as well as of the combined semen and vagina group over cotton and linen fabrics at all the different tested time intervals. However, semen extracted from nylon fabric was identified in tested samples of the semen only group and of the combined semen and vagina group only at zero time only and couldn’t be identified at the rest of tested time intervals.

Conclusion

the current study evidenced that the new RSIDTM-semen kit is a reliable method for semen identification over different types of fabrics even in the presence of vaginal secretions. It also resists environmental factors up to 10 days.
Assessment of Intravenous Lipid Emulsion as an Adjuvant Therapy in Acute Aluminum Phosphide Poisoning: A randomized Controlled Trial
Authors: Elgazzar F M
Published: May 2020

Background

In Egypt, Aluminium phosphide (ALP) poisoning is a major cause of suicidal deaths. Nevertheless, no efficient antidote has been found so far. Intravenous lipid emulsion (ILE) has been successfully used in resuscitation of two ALP-poisoned patients.

Aim

was to evaluate efficacy and safety of ILE as an adjuvant therapy of acute ALP poisoning.

Methods

ALP-poisoned patients were recruited from Tanta University Poison Control center. Eligible patients were randomly allocated into experimental and control groups (25 patients each). Patients in the experimental group have received ILE 20% at a rate of 10ml/h continuous IV infusion, in addition to the standard treatment. Whereas, the control group have only administered the standard treatment.

Results

The mortality rate in the experimental group was non-significantly lower than the control group (56% versus 76% respectively). The need for intubation and mechanical ventilation was significantly lower in the experimental group compared to the control group (36% versus 92% respectively). Moreover, the median length of hospital stay was significantly lower in survivors of the experimental group.

Conclusion

Adjuvant ILE use along with the supportive treatment could have a therapeutic effect in ALP poisoned patients. Additionally, it was an overall safe therapy.
Recent Advances in Management of Aluminium Phosphide Poisoning
Authors: Tawfik H M
Published: May 2020

Compounds containing phosphide used as rodenticide are among most fatal poisonings encountered in Poisoning Control Center, Ain Shams University Hospitals (PCCA) Cairo, Egypt. Its toxicity is associated with challenging oxidative damaging effects that involve all tissue cells. Patients develop severe hypotension and metabolic acidosis. No available data about specific antidotes for these compounds, however we assume that antioxidants may play a beneficial role in improving intoxicated patient outcome. N-acetyl cysteine (NAC) is supposed to have a protective role.

Objective

To evaluate the role of antioxidant N- acetyl cysteine in improving outcome of phosphide intoxicated patients.

Methods

The study is double blind randomized clinical trial, carried on patients presented to PCCA over 3 years period (2015-2017) with sever zinc and aluminum phosphide intoxication. They are randomly classified to NAC treated group (receiving conventional treatment plus NAC intravenous (IV) infusion in a dose of 300mg/kg over 20hours then 150mg/kgm/day until improvement) and placebo group (receiving conventional treatment plus saline IV infusion). Clinical data such as(age, sex, mode of poisoning and vital data), blood PH, liver function test, ECG, usage of mechanical ventilation, mortality and period of stay were recorded and compared for each group.

Results

statistical analysis revealed significant decrease in mortality and mechanical ventilation in patients with the group of NAC administer. However no significant difference was observed regarding period of stay.

Conclusion

The study concluded that NAC may have good role in decreasing mortality and incidence of mechanical ventilation in phosphide poisoning patients.
The potential role of palatal rugae pattern in sex determination among an adult Egyptian population sample
Authors: Elrewieny N M , Ismail M M , Zaghloul H S , Ali M M , Abielhassan M H
Published: May 2020

Background

Sex determination is the first step in personal identification in the forensic field.

Participants and Methods

The study sample included 200 participants of equal number of both sexes in the age group between 20 and 30 years. They were collected from the outpatient clinics of the Faculty of Oral and Dental Medicine, Cairo University after taking their informed consent. Maxillary arch impression was taken, with an alginate impression material using a stainless steel impression tray, for subsequent palatal rugae study.

Results

The mean number of primary palatal rugae was more than the secondary rugae, the wavy rugae were the most predominant type followed by the straight rugae. There was a highly statistically significant difference between males and females with a higher male values regarding the total palatal rugae number, wavy rugae number and primary rugae number while, there was a highly statistically significant difference with higher female values regarding the straight rugae numbers. There was a statistically significant negative correlation between age and primary palatal rugae number. An Egyptian equation was constructed using discriminant function analysis to determine the sex of an unidentified person.

Conclusion

Palatal rugae pattern study is a useful science for sex determination in the forensic field.
A Prospective Study of the Inferio-Medial pedicle technique As an Oncoplastic Procedure for Upper and lateral Quadrants Breast Masses; Oncological Safety and Clinical Outcomes
Authors: Elatrash O A , Osman A G , Almahmoudy N F , Ahmed A T
Published: May 2020

Background

the goal of modern breast surgery is to cure patients with preservation of breast tissue as much as possible with satisfactory physical and psychological outcome. This goal has led to introduction of a new scope of surgery into our clinical practice called oncoplastic breast surgery, with the advantage of combining oncological safety and satisfactory cosmetic outcome.

Objective

it was to focus on the infero-medial pedicle technique as an oncoplastic procedure for management of breast cancer and to assess the technique clinically regarding oncological safety, surgical outcomes and patient satisfaction.

Patients and Methods

a prospective analytical study included 15 patients, which was conducted at Ain-Shams University Hospitals. An approval of the Ethical Committee and written informed consent from all participants were obtained. Septum based infero-medial pedicle technique was proposed for patients in whom oncoplastic surgery were possible on oncologic grounds for upper outer quadrant of breast.

Results

the mean age of our study was 39 years, 50% of the cases fall between 38 to 57 years. In our study only 3 cases (33%) have had complications, 2 cases got wound infection; they were diabetics reflecting the immune compromisation with diabetes mellitus. We reported lower results of surgical site infection (15%). The operative duration of our study was long at first (240 minutes) but with progression of our study and as we build up more experience the operating time was reduced to (120 minutes).

Conclusion

the choice of the oncoplastic technique is mainly based upon the location of the tumor, size of the breast and distance of the tumor from the nipple areola complex.
Predictive Factors for Remission of Diabetes Mellitus Type 2 after Sleeve Gastrectomy
Authors: Youssef A H A , Elmaleh H M , Khalil M M H , Qamry E A A
Published: May 2020

Background

obesity and its associated type II diabetes mellitus (Type II DM) are an ongoing health-care problem worldwide. Both diseases are closely related and difficult to control by current medical treatment, including diet, drug therapy and behavioral modification. There is strong evidence that bariatric surgery can cure type II diabetes mellitus in patients with obesity.

Aim of the Work

to determine different predictive factors affecting the outcome of type II diabetes mellitus after laparoscopic sleeve gastrectomy.

Patients and Methods

this prospective study included 40 obese diabetic patients with type II DM who underwent laparoscopic sleeve gastrectomy. DM type II was diagnosed according to ADA criteria: FPG > 126 mg/dl, HbA1c ≥ 6.5%, random blood glucose ≥200 mg/dl, or use of insulin or oral diabetes medication. Glycemic marker in the form of HbA1c and fasting blood sugar were measured just prior to surgery and at 3 months and 6 months postoperatively.

Results

a total of 40 patients (70% women) with T2DM were included in the study. Mean age at the time of surgery was 42.48 ± 10.95 years. Median Inter Quartile Ratio (IQR) of diabetes age (diabetes age was calculated from the diagnose date to the operation date) was 4 years (from 3 years to 6 years) with range of 1-20 years. Remission of T2DM was achieved in 42.5% of patients underwent SG.

Conclusion

This study showed that younger patients, with shorter diabetic age, not using insulin and optimum pre-operative glycemic control(normal fasting blood sugar and HbA1c) were the best candidates to achieve remission (HbA1c <6.5% and no need for antidiabetics) after SG.
Role of Laparscopy in appendectomy versus open Technique: Prospective Randomized Study
Authors: Mohamed A M A , Maaty S A , Abbass A A
Published: May 2020

The appendix is a small, worm-like, tubular appendage attached to the cecum of the colon. Appendicitis occurs when the appendix becomes blocked, and bacteria invade and infect the wall of the appendix Appendectomy is one of the commonly performed procedures in General surgery. The incidence rate of appendicitis is about 7%.

Aim of the Study

He aim of this study was to compare the effectiveness and safety of laparoscopic and conventional “open” appendectomy in the treatment of acute appendicitis.

Patients

This study was conducted in El Demerdash Hospital; Ain shams University, from September 2017 to March 2018. The study was conducted on 80 patients with suspected appendicitis.

Tools

The patient was placed in the supine position and underwent general anesthesia with endotracheal intubation. While the patient was anesthetized and the abdominal musculature relaxed, the patient’s abdomen was carefully examined for appendicular mass. The skin incision on McBurney’s point was carried through the subcutaneous tissue until the external oblique fascia was exposed.

Results

This study was conducted on 80 patients with suspected appendicitis randomly allocated (by alternation) into two groups 40 patients each: Group (A): the patients underwent open appendectomy by gridiron incision at McBurney’s point. Group (B): the patients underwent laparoscopic appendectomy. Patient’s characteristics: The patient’s ages ranged from 14→ 45 years with median age 27 years in Group A and 27.5 years in Group B and mean age 28 years in Group A and 27.85 years in Group B as shown in table (2).

Conclusion

The laparoscopic approach is a safe and efficient operative procedure in appendectomy and it provides clinically beneficial advantages over open method including shorter hospital stay, decreased need for postoperative analgesia, early food tolerance, earlier return to normal daily activities, lower rate of wound infection.
Fasting Insulin Level Changes after Large Volume Liposuction
Authors: Habib H , Abdalazeem S , Abdalazeem N
Published: May 2020

Background

Obesity is a disabling disease which has gained greater attention worldwide. It significantly increases the risk for other diseases such as insulin independent diabetes mellitus also known as diabetes type 2. The most common surgical procedure for obesity is liposuction. It is traditionally performed either as small-volume liposuction or large-volume liposuction.

Aim of the Work

to spot the light on the effect of large volume liposuction on fasting insulin level changes after 3 months postoperative and to find if LVL may obtain any improvement in metabolic variables. This study will provide the clinician with a more valid basis on which to advise patients undergoing body-contouring procedures, particularly to ensure realistic expectations regarding the effects of body-reshaping procedures on general health.

Patients and Mehtods

This is prospective study was conducted on a total of 15 overweight and obese (BMI 26–35 kg/m2) premenopausal women (age 21–40years). All subjects were at their maximum body weight and weight stable for at least 3 months. The study took place at Ain Shams University Hospitals and other authorized hospitals under supervision of thesis supervisors studying fasting insulin changes after 3 months following large volume liposuction.

Results

The present study demonstrates that large-volume abdominal liposuction should, by itself, be considered a clinical therapy for obesity and its metabolic sequelae. Aspiration of large amounts of subcutaneous abdominal fat in women with abdominal obesity, besides having cosmetic benefits, does significantly improve fasting insulin levels. Therefore, the procedure is safe and could successfully help obese subjects to reduce their potential metabolic risks.

Conclusion

The analysis of the study suggests that plastic surgery could play a role in metabolism. The surgical removal of fat is not detrimental with regard to variation of metabolic indices.
Effect of Single Anastomosis Duodeno-ileal Bypass (SADI) on Type 2 Diabetes Mellitus: A Meta-analysis
Authors: Youssuf A H A , Elabbassy I H , Elfouly M G , Abdelgawad M T G
Published: May 2020

Background

Among the competition between the various surgical school, each to prove the superiority of its surgical method to treat obesity & metabolic syndromes, here comes our meta-analysis to search through & collect the various trials to avoid bias concerning the effect of single anastomosis duodeno-ileal bypass with sleeve gastrostomy on the rapidly growing type 2 diabetes mellitus population.

Objective

To assess the effect of single anastomosis duodeno-ileal bypass (SADI) on type 2 diabetes mellitus patients and the magnitude of their metabolic benefit from undergoing surgery, to help both surgeons and patients make their decisions through giving them a realistic and neutral clearer picture of the expected postoperative outcome.

Patients and Methods

10 papers included, our total number of assessed diabetic patients in this meta-analysis reached approximately 257 patients (excluding one study which did not specify the number of its diabetic participants).

Results

Concerning the need for post-operative medication (whether insulin or oral hypoglycemic: In 5 studies there was no more need for medication post-operatively and in the other five the overall remission rate exceeded 90%. Concerning C-peptide results: C-peptide was mentioned as a quantitative post-operative result in only 3 studies. Fortunately it was within normal ranges post-operatively in the 3 studies. However the other studies pointed to it indirectly when mentioning their complete remission rates. Concerning HbA1c: 7 studies revealed the outcome of their patients’ Hba1c postoperatively and it reached the normal in all. In fact; neither fasting nor post-prandial blood sugar data were provided by any of the studies.

Conclusion

Single anastomosis duodeno-ileal bypass proved to be very convenient and competitive surgical option for the treatment of resistant diabetes mellitus cases associated with mild to severe obesity.
Impact of preoperative portal vein thrombosis on the outcome of living donor liver transplantation
Authors: Abdelghaffar M F , Rady M A , Kamal K M , Mahgoub M A
Published: May 2020

Background

Portal vein thrombosis (PVT) is a common complication in terminal-stage liver disease. Its incidence in liver transplantation (LT) ranges from 2.1% to 26%. In the past, PVT was considered an absolute contraindication for LT, especially due to the technical difficulty involved. Nonetheless, since the mid-1980s, with the introduction of new surgical techniques, PVT is no longer considered an absolute contraindication in a larger percentage of patients.

Aim of the Work

to show the effect of preoperative portal vein thrombosis with its different extension degree on both patient and graft survival post living donor liver transplantation.

Patients and Methods

This retrospective cohort study was conducted on all the patients who performed living donor liver transplantation during the period from January 2010 till June 2017 at Ain Shams centre for organ transplantation (ASCOT). Our study included 240 cases who performed right lobe LDLT in that time interval and fulfilled the required data and time interval follow up. Those 240 cases were classified into 2 groups:

group A

Patients without preoprative PVT (200);

group B

Patients with pre-operative PVT. (40).

Results

1-year patients survival rates of patients with and without PVT were 75% vs. 85%. t 2-year patients survival rates of patients with and without PVT 75% vs. 84%. 1-year graft survival rates of patients with and without PVT were 75% vs. 84%; that 2-year graft survival rates of patients with and without PVT: 65% vs. 77%.

Conclusion

P.V.T not only makes the surgery more difficult and complex but it also affects the outcome of LT. However Further studies should be done taking in consideration different degree of extension of the thrombus as it has crucial effect on the outcome of the liver transplantation.
Review of Different Management Modalities of Penetrating Thoracic and Abdominal Trauma
Authors: Almaraghy A M , Farahat M S , Sallam K R , Elsaigh M M A
Published: May 2020

Introduction

The advanced trauma life support (ATLS) training program was developed to provide uniformity in the assessment and management of trauma patients. Every trauma patient is evaluated using the primary survey; a rapid reproducible physical exam designed to diagnose those conditions that are immediately life-threatening first. The primary survey consists of the sequential assessment and treatment of airway, breathing, circulation, disability and exposure/environment, represented by the mnemonic (A.B.C.D.E)

Objectives

To review the different management strategies of penetrating abdominal and thoracic trauma.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2018.

Conclusions

In summation, most patients with PAT, especially gunshot wounds, still require surgery. On initial survey, patients who are hemodynamically unstable, have diffuse abdominal pain; evisceration, or peritoneal findings must go to the operating room. Patients with an altered sensorium, head injury, inability to cooperate with serial abdominal exams, or patients who will be undergoing an operative procedure somewhere other than the abdomen may be explored as well, depending on the comfort level of the trauma surgeon. This leaves a clinical subset that can be managed non operatively. In these patients, SNOM can drastically reduce the rates of negative and nontherapeutic laparotomies and result in a cost savings and safety benefit to the patient.
Incidence of Dysplasia in Patients with Barrett’s Esophagus
Authors: Elakkad H A , Elhefny A M M , Alsayed M A , Shawky K W
Published: May 2020

Background

Barrett’s esophagus is a condition which predisposes towards development of dysplasia and finally towards esophageal adenocarcinoma, a highly lethal tumour which has been increasing in incidence over the past three decades. Although BE is the single best identified risk factor for the development of esophageal adenocarcinoma, yet the overwhelming majority of Barrett’s patients will never develop this cancer.

Objective

To evaluate the incidence of dysplasia in patients with BE regarding risk factors such as gender, smoking, obesity, patient’s age, duration of reflux, treatment received, associated disease as DM and esophageal histopathology.

Patients and Methods

The study was conducted on 30 patients previously diagnosed with BE. The patients were selected according to some inclusion criteria such as being diagnosed by upper GI endoscopy and a biopsy was taken. Patients with history of previous anti-reflux surgery were excluded.

Results

A strong correlation was found between the incidence of dysplasia and male gender, mean age 58.17 years, smoking, DM, hiatus hernia and esophagitis.

Conclusion

As the incidence of dysplasia and esophageal adenocarcinoma continues to rise at an alarming rate, widespread endoscopic surveillance of Barrett’s esophagus patients is performed in order to detect any abnormality at an earlier and potentially curable stage. In addition to highlighting the risk factors that aggravates this pre-malignant condition.
LDLT Portal Vein Thrombosis: Technical Advances
Authors: Ahmed M B , Rady M A , Abd-errazik M A , Azzam A R M A
Published: May 2020

Background

portal vein thrombosis (PVT) is a common complication of end-stage liver disease with an incidence of 0.6–16% in patients with well-compensated disease (1–3), increasing up to 35% in cirrhotic patients with hepatocellular carcinoma.

Aim of the Work

the aim of the study is to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis, and post-operative complications.

Patients and Methods

This is a retrospective cohort study to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis & post-operative complications.

The study was conducted as retrospective study of 33 adult patients who underwent LDLT at Ain Shams Specialized Hospital, Ain Shams University, Cairo, Egypt, between January 2016 and July 2018.

Results

the mean child score was 9.55 and the median hospital stay was 12 days. Based on review manager statics program, the PVT recurrence was non-significant (P = 0.295, Test value: 1.096). However, the blood loss was significant (p < 0.029, test value: -2.186) and the surgical time was significant (p = 0.013, test value: 2.633).

Conclusion

portal vein thrombosis (PVT) represents a significant technical challenge in liver transplantation and for many years was considered a relative contraindication. While advances in surgical techniques, axial imaging, and alternative inflow reconstruction options have made liver transplantation possible in transplant candidates with PVT.
A Comparative Study of Residual Volume in Donors for Living Donor Liver Transplantation
Authors: Asaad N M D , Shaker H Z , Abdelbaset H S , Abdelhamid M A
Published: May 2020

Introduction

Living donor liver transplantation (LDLT) was introduced in 1989 to overcome the severe shortage of size-matched DD organs for pediatric recipients. Given the increasing shortage of DD grafts for adults in North America and Europe, living donation (LD) was now being explored as a potential solution to the shortage of DD organs for adults also.

Aim

This study aims at the exploration of this last point. Whether or not minimizing the residual volume in donors after LDLT affects donors’ morbidity. Concentration will be on postoperative donors’ bilirubin level, liver transaminases pattern and complications according to Clavien’s scale.

Patients and Methods

It is a Comparative Retrospective Observational Cohort study included 44 liver donors operated upon in Ain Shams Specialized Hospital Liver Transplantation Unit and in Egypt Air Liver Transplantation Unit from January 2014 to April 2017.

Results

There was no significant difference between two groups regards age, gender, fibrosis, steatosis, operation center, postoperative bilirubin (After how many days it returned to normal, maximum and mean postoperative bilirubin), postoperative complications (didn’t pass grade 2 in group A and grade 3 in group B), liver enzymes (postoperative AST and ALT) and Hospital stay, There were no difference between the two groups in the follow up except for elevation of liver enzymes that didn’t return to normal for more than 15 days in donor 9 and elevation of bilirubin in donors 3, 4 and 10 in group (A) and in donors 13, 24, 25, 26, 32, 33 and 43 in group (B).

Conclusion

It is concluded that donors with low RVs “not less than 33%” could be chosen and operated upon with no significant complications postoperatively that could affect donors’ safety, We suggest that regular follow up of donors is recommended for 5 years. Also more research regarding RV, donors’ safety, selection and complications is recommended as Egypt is the first country in liver disease worldwide.
Laparoscopic sleeve Gastrectomy and its effect on Gastro oesophageal reflux disease
Authors: Abadir A F , Hefny A M M , Elghandor A M , Kirolos A M A
Published: May 2020

Background

Obesity continues to be a leading public health concern associated with many comorbidities and major hindering effect on the daily lifestyle of many people around the world. Surgical treatment for obesity has proved that it is the best and most effective, durable means of preventing the life-threatening complications and serious problems associated with morbid obesity.

Objective

This study aims at identifying the effect of LSG on UGI symptoms after a mean of 6 months of follow up.

Patients and Methods

Our study was conducted on 25 morbidly obese patients undergoing LSG for weight reduction. Thorough history, clinical examination and investigations were applied including the validated Rome III Diagnostic questionnaire and UGI endoscopy on cases with sever symptoms. Patients were examined before surgery and had no primary complications as bleeding or leakage in the early post-operative period. Patients were followed up for a mean of 6 months regarding UGI symptoms specially GERD using the same validated Rome III Diagnostic questionnaire.

Results

GERD prevalence didn’t significantly change although a significant number of patients recovered from GERD which support the theory that the mechanism of upper GI symptoms after LSG is mainly due to altered motility patterns rather than acid-related disorders.

Conclusion

Our results show that LSG represents a safe and effective procedure to achieve significant weight loss. GERD which was considered to be a main troublesome impact of LSG showed no significant change in prevalence, on the contrary appear to abolish the symptom in a significant number of patients who complained of GERD.
Analysis of Adult to Adult Living Donor Liver Transplant Biliary Complications Using Non-Stented Biliary Anastomosis
Authors: Abdelaal A A , Abdelbasset H S , Saber H S , Sayed R M
Published: May 2020

Background

biliary tract reconstruction during liver transplantation (LT) is the final technical step and the cornerstone of the procedure and is often performed by a duct-to-duct anastomosis. Rarely, recipient and donor biliary stump discrepancies or liver disease-related reasons could lead to a hepaticojejunostomy.

Purpose

To clarify the role of non-stented biliary anastmosis in reducing biliary complications in adult to adult living donor liver transplant and ending the era of using intraductal removable stent.

Patients and Methods

this is a retrospective Single arm Cohort study. Our study was performed in Egypt by following the results of 80 cases of adult to adult living donor liver transplant using non-stented biliary anastomosis in Airforce specialized hospitals and Nasser institute in Cairo. Study period was from July 2015 to June 2018.

Results

The rate of biliary complications in non-stented patients was 23/80 (27%), and (27%) is subdivided as follow; (18%-strictures, 9%-leaks, and 1%-mixed), ) . All biliary complications had been treated with successful outcome representing 20/23(87%), while persistent biliary complication was in 3 (13%). Treatments used in biliary complications were (ERCP n = 22, PTC n = 5, Rendezvous n = 2, Surgical biliary-reconstruction n = 2).

Conclusion

Stentless biliary anastomosis is a well established and trusted method in biliary reconstruction in adult living donor liver transplant and has a less complications than stented duct to duct biliary anastomosis and biliary-enteric anastomosis and allow better management of biliary complication if occurred.
Congenital inguinal hernia repair with and without opening the inguinal canal
Authors: Sabry A A , Hassan T A , Allam A , Ali O K A
Published: May 2020

Background

Elective repair of congenital inguinal hernia is the most common surgery performed by pediatric surgeons and is considered the treatment of choice. The exact technique and steps involved in the repair differs widely among pediatric surgeons, many surgeons open the roof of inguinal canal while preserving the external ring or opening it, this is called the modified Ferguson, s technique. In infants, the inguinal canal is short and virtually the internal and external rings lie over each other so many surgeons also like to perform the whole operation without opening the external oblique aponeurosis distal to the external ring, this technique is called the Mitchell Banks technique.

Objective

To compare both techniques regarding intraoperative time, incidence of intraoperative and postoperative complications to pass our experience in a trial to reach an ideal surgical technique for congenital inguinal hernia repair.

Patients and Methods

In this study, 60 cases of congenital inguinal hernia were randomly selected and divided into two equal groups where group A underwent the repair with opening the external oblique aponeurosis and group B underwent the repair without opening the external oblique aponeurosis.

Results

As regard the postoperative complications, the patients who underwent the Ferguson’s technique experienced more postoperative pain with statistically significant more incidence of postoperative hydrocele than the Mitchell banks technique, no complications occurred postoperatively other than hydrocele in our study.

Conclusion

Our study results, we can approve that Mitchell Banks technique is easier, consumes less time than Ferguson’s technique with less incidence of postoperative complications and pain which can make this technique better for congenital inguinal hernia repair in children aging 2 years or less.