bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association between Diabetic Retinopathy and Cardiovascular Autonomic Neuropathy in People with Type 2 Diabetes
Authors: Mohammad Magda Shukry , Abdelsalam Mona Mohamad , Ibrahim Nesma Ali , Eldin Mai Mohamed Salah
Published: August 2023

Background

Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus, which is strongly associated with increased risk of cardiovascular mortality.

The aim of the present work

is to study the prevalence of CAN in diabetic subjects with retinopathy

Methods

Ninety subjects participated in the study. They were classified into three groups (Group I: 30 (T2DM) patients with diabetic retinopathy, Group II: 30 (T2DM) patients without retinopathy, Group III: 30 non diabetic volunteers). All patients were evaluated for detection of CAN (Basal Heart Rate, Supine and erect systolic blood pressure variation, Tilt Table Test), diabetes-related micro vascular complications (retinopathy), micro albuminuria (A/C Ratio).

Results

The prevalence of CAN (using tilt table test) is significantly higher (P = 0.004) in Group I compared to Group II and III. The percentage of positive tilt table test in Group I (43.33%), while in Group II (10%). In Group I, CAN prevalence is higher in proliferative diabetic retinopathy (PDR) compared to non-proliferative diabetic retinopathy (NPDR) (P = 0.007). Logistic regression analysis demonstrated that in T2DM, the odds [OR (95% confidence intervals)] of CAN increased with diabetes duration [4.99 (1.46-17.09)], A/C Ratio [9.99(2.41-41.36)].

Conclusion

This study indicated that DR and micro albuminuria could predict CAN. The results suggest that fundus photography and clinical assessment (A/C RATIO) may be an alternative to autonomic function testing when Tilt Table Test is unavailable
Role of Interleukin 6 as Predictive Factor for the Severity of COVID 19
Authors: Elmagid Nanees Ahmed Adel Abd , Riad George Safwat , Ahmed Ahmed Elmetwally , Khalifa Mohamed Fayez Abd Elkader
Published: August 2023

Background

Covid-19 is a disease with high morbidity and mortality among elderly residents of long-term care facilities (LTCF). During an outbreak of SARS-CoV-2 infection in the LTCF an effective screening tool is essential to identify the patients at risk for severe disease. Excessive interleukin-6 signaling is a key factor contributing to the cytokine release syndrome implicated in clinical manifestations of COVID-19.

Aim of the Work

To determine the Role of interleukin 6 as predictive factor for the severity of Covid-19.

Patients and Methods

This was Case Control study, conducted at Abassia Fever hospital and El Demerdash University Hospital on 75 participants (50 patients with Covid-19 disease manifestation and 25 controls) during a period of 6 months.

Results

There was no statistically significant difference between cases with less than 50% and more than 50% lung affection among mild cases groups as regard serum IL-6.

Conclusion

The concentration of IL-6 > 24 pg/mL at initial assessment predicted the development of hypoxemia requiring hospitalization with excellent sensitivity and good specificity. IL-6 appears as a potential predictor for the development of the severe Covid-19 and might serve for early identification of patients in need of hospitalization. Further studies are needed to evaluate the robustness of the use of IL-6 as an effective screening tool for the severe course of Covid-19.
Serum IL-22 as a Novel Non-Invasive Biomarker in Diagnosis and Assessment of Activity in Ulcerative Colitis Patients
Authors: Farag Sherif Mounir Mohamed , Halima Ahmed Samir Abd El-Sadek Abo , Faheem Heba Ahmed , Kortam Mohamed Sayed Mohamed Ali
Published: August 2023

Background

Ulcerative colitis (UC) is a multifactorial disease of unknown etiology. Mucosal healing is an important predictor of the course of disease and has therefore become the aim of UC treatment. Repeated endoscopies to identify mucosal inflammation are expensive. Interleukin (IL)22 is a member of the IL-10 family of cytokines that was recently discovered to be mainly produced by both adaptive and innate immune cells.

Aim of the Work

The aim of this study was to evaluate the role of serum IL-22 as a novel noninvasive biomarker in diagnosis and assessment of activity in ulcerative colitis patients.

Patients and Methods

This was a case control study that was conducted on 55 subjects at Ain shams university hospitals inpatients and outpatients settings throughout 6 months. Subjects were divided into 2 groups: Group (A): that included 40 patients with ulcerative colitis: 20 patients in clinical, laboratory and endoscopic remission and 20 patients in clinical, laboratory and endoscopic activity and Group (B) that included15 healthy controls.

Results

Statistical analysis revealed the following: Age ranges from 32_77 years and the mean age was 36 years in this study. Males were affected slightly more than females in our study. NO statistically significant difference found between three groups regarding HB, Total bilirubin, Creatinine and Urea, and there was statistically significant difference found between three groups regarding Platelets and AST, and there was highly statistically significant difference found between three groups regarding Wbcs, ALT, ESR, CRP and Albumin. For Interleukin 22, there was highly statistically significant difference found between three groups. There was highly statistically significant difference found between IL-22 (Pg/ml) and Colonoscopy, and there was statistically significant difference found between IL-22 (Pg/ml) and Histological examination, and there was no statistically significant difference found between IL-22 (Pg/ml) and Extend. Receiver operating characteristic curve (ROC) showed that the best cut off point of IL-22 (Pg/ml) to detect Patient group was found > 4.7 with sensitivity of 90.0%, specificity of 100%, PPV of 100.0%, NPV of 78.9% and total accuracy of 0.95%.

Conclusion

It is concluded that IL22 is an important marker of ulcerative colitis as it shows significant correlation with endoscopic and histological features, so it can be used instead of these interventions to achieve high satisfaction to patients.
Study of Cardiovascular Manifestations in Ankylosing Spondylitis in a Cohort of Egyptian Patients
Authors: Eldein Amina Badr , Aly El-Morshedy Nashwa , Teama Mohamed Abdelmoneam , Hassan Mostafa Kamel
Published: August 2023

Background

Ankylosing spondylitis is a chronic inflammatory autoimmune disease characterized by chronic arthritis of the sacroiliac joint and spine with ankylosis and ossification and may be associated with a variety of extra-spinal lesions involving the eye, bowel, and heart.

Objective

To study the cardiovascular manifestations in ankylosing spondylitis in a cohort of Egyptian patients.

Patients and Methods

In our study, 40 patients with AS were included; 32 of them were males and 8 females, all fulfilling the ASAS 2009 classification criteria.

Results

By performing ECHO, we found that valvular affection was the commonest findings as we detected TR in (42.5%), AR in (12.5%), MR in (7.5%), and PR in (2.5%) of patients. The second most common finding by ECHO among our studied patients is diastolic dysfunction in (25%) of patients followed by systolic dysfunction in (20%) of patients, intracardiac mass in (5%) and pericardial effusion in (2.5%). Regarding carotid duplex findings 21 patients (52.5%) had abnormal (increased) CIMT.

Conclusion

Cardiovascular system affection among ankylosing spondylitis patients is frequent, whether being clinical or subclinical and it is related in a way to high disease activity. Yet, it is still of question whether this affection is a result of the chronic inflammatory state and lack of activity both resulting from uncontrolled disease only or another multifactorial pathogenesis are coexisting.
Correlation between Severity of Liver Disease According to CHILD & MELD Scores and Degree of Cardiac Impairment
Authors: Nakeeb Noha Abd El- Razek El , Riad George Safwat , Naguib Gina Gamal , Darwish Nahed Abd ElMonem
Published: August 2023

Background

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. The prevalence of cirrhosis has nearly doubled over the last decade, and the number of hospitalizations has similarly increased.

Objective

To detect correlation between severity of liver disease according to Child and MELD scores and degree of cardiac impairment such as systolic and diastolic functions and ECG changes. To elucidate this aim 60 cases were included in the current study.

Patients and Methods

Type of Study: Cross-sectional Study. Study Setting: This study was carried out in El-Demerdash Hospital-Ain Shams University and El-Qabbary Hospital - Alexandria.

Study Period

6 months

Results

In the current study, there was statistically significant increase in age of positive ECG cases than negative ECG cases; also the percentage of males in positive ECG cases was found higher than those of negative ECG cases. There was statistically significant increase in child B and C in positive ECG group than negative ECG group. There was statistically significant increase in the level of Meld score, T. bilirubin and D. bilirubin in positive ECG group than negative ECG group; and statistically significant decrease in the level of albumin and NA in positive ECG group than negative ECG group. That there was statistically significant positive correlation found between MELD score and AST, ALT, total biliruibn, direct bilirubin, PT, INR and creatinine and also negative correlation found between meld score and albumin and NA levels.

Conclusion

There was statistically significant relation found between child score, MELD.S (the severity of cirrhosis) and ECG results. There was a high statistically significant difference in between ECHO and MELD.S but no statistically significant difference in between ECHO and CHILD.S, therefore, in order to prepare the best post-procedural management of cirrhotic patients, echocardiography is required for all patients before any interventional procedure or liver transplantation regardless of the stage of cirrhosis. The mechanism of cardiac involvement in patients with cirrhosis seems to be complex and multifactorial.
Clinical Value of CASR Gene Polymorphism on Cinacalcet Response in Hemodialysis Patients with Secondary Hyperparathyroidism
Authors: Shawki Sahar Mahmoud , Behairy Maha AbdELmoneim , Ahmed Abdelsattar Hoda , Hassan Somia Abdelhamid , Mohamed Ahmed Yehia , Abdelshaheed Neveen Nabil
Published: August 2023

Background

Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD) patients on dialysis, associated with increased cardiovascular mortality and morbidity.

Aim

to evaluate frequency of variants of CaSR genes related to PTH regulation and to assess the effect of these single nucleotide polymorphisms on cinacalcet response among prevalent hemodialysis patients (HD) with SHPT.

Patients and Methods

This study included 50 prevalent HD patients with SHPT were recruited from Ain Shams University Hospitals' dialysis units. Clinical stable end-stage renal disease (ESDR) (35 males (70%) and 15 females (30%)), ≥ 18 years old on adequate HD for ≥ 6 months, with intact PTH (iPTH) ≥300 pg/ml and had been treated by cinacalcet. The patient was followed retrospectively for 6 months by measuring serum calcium, phosphorous, alkaline phosphatase, PTH to evaluate the response of cinacalcet. CASR gene and single nucleotide polymorphism (SNP) (rs1042636 and rs1802757) were measured by real-time PCR.

Results

CASR Gene/SNP rs1042636 (A/G), AA homozygous gene (wild gene) was present in n = 48 (96%) while AG heterozygous gene was present in n = 2 (4%). CASR Gene/SNP rs1802757(C/T), CC homozygous gene (wild gene) was present in n = 42 patients (84%) while CT heterozygous gene was present in n = 6 patients (12%). 21 patients (42%) responded to treatment of SHPT with reduction percent and 29 patients (58%) were non-responding to cinacalcet treatment for 6 months duration. The results showed no significant correlation between CASR gene polymorphism and response to treatment (p-value >0.05).

Conclusion

There is no statistically significant correlation between single nucleotide polymorphisms (SNPs) of the calcium sensing receptor gene (CASR) and response to cinacalcet as treatment of SHPT among HD patients, for further investigation studies.
Angiopoietin-2 as a Predictor of Fibrosis Regression in Hepatitis C Virus-Patients after Direct Acting Antiviral Drugs
Authors: Bakouk Sarah H , Sakty Tarek Maged El , Ahmed Osama A , Samaan Amira I
Published: August 2023

Background

Hepatitis C virus (HCV) infection is the major cause of liver cirrhosis and hepatocellular carcinoma (HCC); thus, effective and safe treatment is crucial.

Aim of the Work

to evaluate the serum angiopoietin-2 as non-invasive marker of fibrosis regression in patients with Hepatitis C Virus receiving DAA drugs.

Patients and Methods

This study was conducted on 40 chronic HCV-patients who received DAA therapy in the Hepatic Virology Unit and the gastroenterology department of Ain Shams University hospitals. All patients were subjected to the following: Full history taking with stress concerning the hepatology system, clinical evaluation, laboratory investigations, Routine investigations: Abdominal and Pelvic ultrasonography and Transient elastography (Fibroscan) to measure liver stiffness measurement (LSM) for detection the degree of liver fibrosis in the chronic HCV-patients.

Results

Hematological findings, biochemical liver profile and liver fibrosis indices except hemoglobin level and platelets counts were significantly improved after DAA therapy. There was a significant improvement concerning the fibrosis stage after the treatment fibrosis staging at SVR12. The liver size, the spleen size and portal vein diameter were also significant after DAA therapy. There was improvement in the Child-Pugh score after successful HCV eradication by DAAs but the difference was no statistically significant. There was a statistically significant higher mean of Ang-2 levels in higher stages of liver fibrosis stages. Overall, serum Ang-2 levels significantly decrease after DAA therapy. In F0, F1, F2 & F3 fibrosis stage; the mean Ang2 levels decrease after DAA therapy but in F4 fibrosis stage; the mean Ang2 levels did not change almost. Baseline Ang-2 and WBCs, AST, ALT, total bilirubin, INR, serum albumin, alpha-fetoprotein, serum creatinine, LSM, FIB-4 index, APRI score, liver size and portal vein diameter were significantly correlated. There were also a significant correlation between Ang-2 and all the fibrosis stages (from F0 to F4) before DAA treatment. Ang-2 levels were significantly associated with LSM based liver fibrosis stage regression after successful DAA therapy. Ang-2 levels did not correlate with hemoglobin, platelets and spleen size at baseline. Ang-2 levels did not correlate with hemoglobin, platelets, WBCs, INR, spleen size and portal vein diameter after DAA therapy. Ang-2 levels did not show significant correlation with the Child-Pugh score after DAA therapy.

Conclusion

Liver fibrosis stage after successful HCV eradication by DAAs. But in stage F4 (cirrhosis), mean Ang-2 remained almost unchanged after DAA therapy. Significant decrease of Serum Ang-2 could suggest its use as a predictor of liver fibrosis regression in Hepatitis C Virus-patients after Direct Acting Antiviral drugs after DAA therapy.
Assessment of Nutritional State in Prevalent Hemodialysis Patients and Its Impact on Quality of Life
Authors: Bichari Walid Ahmed , Mahmoud Osama Mohammed , EL-fakharany Wesam Nasr , Abdelmobdy Ashraf Hassan
Published: August 2023

Objective

Malnutrition and poor quality of life are very common among the hemodialysis patients for many reasons, having also severe consequences such as increased hospitalization and mortality rates. Recently, both of them are considered as two important targets of dialysis adequacy so we aimed to hypothesize whether there is a relationship between nutritional status and quality of life among our hemodialysis patients.

Design and Methods

it was a crosssectional study among 100 patients on regular hemodialysis at Damanhur Medical National Institute. We assessed nutritional status using malnutrition inflammation score (MIS) and quality of life (QOL) using short form 12 questionnaire version1 (SF-12v1) with its valid Arabic version in order to find any correlation by Pearson correlation. Univariate analysis was also used to assess the degree of MIS effect on SF-12v1 components.

Results

MIS had significant negative correlation with SF-12v1 components regarding physical component summary (PCS) where (r= .498, p=.0001), mental component summary (MCS) (r= -.497, p=.0001) and total QOL score (r= .554, p=.0001). MIS of patients was highly statistically significant in predicting of PCS as Model explained (24.8%) of variability in PCS of QoL of patients, as each increase in MIS lead to significant decrease in PCS by 3.17 as (b, t, p) = (-3.17,-5.69, .0001) respectively. Also in affecting of MCS as Model explained (24.7%) of variability in MCS, where (b, t, p) = (-2.8,-5.67, .0001) respectively. As well, in affecting the total score, as Model explained (30.6%) of variability in total score, with (b, t, p) = (-2.97,-6.58, .0001) respectively.

Conclusion

MIS had significant negative correlation with PCS, MCS and the total score of SF12v1 among our patients. MIS of patients was highly statistically significant in predicting of PCS, MCS and the total score of SF12v1 and each increase in MIS lead to significant decrease in them with different degrees.
Evaluation of the Role of Serum Vimentin as a Diagnostic Biomarker for Hepatocellular Carcinoma
Authors: Salem Amira Ahmed , Mohamed Manal Sabry , Fathallah Ahmed Magdy , El Sayed Yousef El Sayed Mohamed
Published: August 2023

Background

Hepatocellular carcinoma (HCC) is a major unresolved medical issue, which is considered as the seventh most common cancer globally and the fourth leading cause of cancer deaths, with approximately 700,000 deaths per year.

Aim of the Work

The aim of this study; to evaluate the role of serum vimentin as a diagnostic biomarker in patients with HCC.

Patients and Methods

This case control study enrolled 60 patients; divided into two groups: Group (I): included 20 patients with liver cirrhosis without HCC as a control group and Group (II): 20 patients divided into 2 subgroups: (IIa): includes 20 patients with HCC and serum AFP is high and (IIb): includes 20 patients with HCC and serum AFP is normal.

Results

The present study found statistical significant decrease in Hb level in group IIb compared to group I, there was high statistical significant decrease in platelet count in patients of group IIa and IIb compared to control group. a statistical significant elevation of total bilirubin and INR with decrease of albumin in group II compared to control group.There was high statistical significant elevation in AFP in group IIa and IIb compared to control group and in group IIa compared to group IIb, a high statistical significant elevation in Vimentin level in group IIa and IIb compared to control group while there was no statistical significant difference between group IIa and group IIb.

Conclusion

Vimentin can be considered as an important independent and discriminative serological biomarker for detecting early stage HCC in patients with normal serum AFP.
Clinical Types of Movement Disorders in Patients with Multiple Sclerosis
Authors: Nasef Ayman , Elsayed Abdel Aty Ahmed Mohamed , Saad Mahmoud , Hamid Eman , Shalash Ali
Published: August 2023

Background

Little is known about the true prevalence and clinical characteristics of movement disorders in early multiple sclerosis (MS), associated clinical disability and their effect on QOL. We conducted a cross sectional study to fill this knowledge gap.

Objectives

to study the prevalence of movement disorders in early stages of multiple sclerosis, presence of other clinical disability and their effect on QOL.

Patients and method

This is a cross sectional observational study. The patients group included 250 patients with RRMS whom were recruited consecutively from the MS clinic of Ain Shams and Nasr institute hospitals. Each eligible patient was interviewed and examined for presence of movement disorders, Patients were divided into 2 groups, group A without movement disorders and group B showing movement disorders. General and neurological examination including Expanded Disability Status Scale (EDSS) score at time of interview for both groups. Magnetic resonance imaging (MRI) of brain and cervical spinal cord (with contrast whenever available) obtained at the time of interview with documentation of MS plaques involvement for both groups. RRMS patients with movement disorders (group B) are subjected to different assessment for depression by Beck Depression Inventory (BDI), cognitive assessment by Montreal Cognitive Assessment (MOCA) scale, disability and quality of life (QOL) by the Short Form 36 Health Survey Questionnaire.

Results

This study included 250 RRMS. onset of their movement disorders was 2.69 ± 2.34 years from MS diagnosis with mean EDSS 3.515 ± 1.04. Cerebellar signs are present in 97% of total number of movement disorders and 26% of total sample, regarding tremors, 36 patients in this study showed tremors representing 53.7% of movement disorders patients, 14.4% of total sample of RRMS patients. This study showed presence of 5 cases of restless leg syndrome 7.5% of total number of MD. 4 cases of dystonia are present in this study representing 6% of MD patients. Patients with MD showed presence of depressive symptoms and cognitive affection with negative impact on QOL. Tremors severity is not correlated with either cognition or depression scores where ataxia is correlated with depression score only. MRI assessment of patients with MD showed higher lesion load and involvement of infratentorial structures especially cerebellum and its connections and cerebellum.

Conclusion

Movement disorders are common to occur than previously known especially ataxia and tremors early in the course of the disease. Presence of MD is related to high lesion load and strategic location of these lesions. special assessment of movement disorders as independent cause of disability with concomitant depression and cognitive impairment especially early in the disease course should be taken in consideration due to their negative impact on QOL.
Registry of Patients with Spinal Muscular Atrophy in a Tertiary Care Unit in Egypt
Authors: Fahmy Nagia Ali , Saleh Hala Abdulhady , Rashed Hebatallah Reda , Elsayed Mekkawy Yosra
Published: August 2023

Background

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by degeneration of alpha motor neurons in the spinal cord, resulting in progressive proximal muscle weakness and paralysis.

Objectives

To register patients with SMA who are diagnosed clinically and genetically (typical and atypical forms) in a tertiary care unit in Egypt.

Patient and methods

80 Patients with SMA who are diagnosed clinically and genetically at Neuromuscular Unit of Ain Shams University Hospital were registered. Demographical data and genetics of the patients were collected and analyzed. The patients were assessed for skeletal deformities, cardiac evaluation by echo and pulmonary evaluation by PFTs (for patients above 5 years old) and functional assessment by motor scales according to age and type of each patient was done.

Results

SMA was more common in males with predominance of type II and median age of 4.5 years old, a considerable number of cases had positive history of consanguinity and similar cases in family, 98.8% of cases had the typical form of SMA with homozygous deletion of SMN1 gene with variable SMN2 copy number according to type. 32.5% of cases had skeletal deformities in the form of scoliosis with or without kyphosis, extremities contractures and chest cave deformities. 4 cases had restrictive pattern due to scoliosis cardiac abnormalities were detected in 3 cases of type I. 31 cases were assessed by CHOP INTEND and 49 cases were assessed by HFMSE giving a good tool for assessing disease progress and role of physiotherapy. Severe chest infection and respiratory failure was the cause of death of 3 cases of type I during the period of study.

Conclusion

registry of SMA patients will lead to a better understanding of the natural history of SMA and the influence of drug treatment. This is crucial to improve the care of SMA patients.
Evaluation of Outcomes of Percutaneous Endoscopic Discectomy in the Treatment of Patients with Lumbar Degenerative Disc Herniation
Authors: Abou kila Mohammad Yousof Mohammad Abd Alla , Sabry Ismail H , Fayed Zeiad Y , Ismaiel Ibrahim A
Published: August 2023

Background

Lumbar discectomy is one of the most common operations performed worldwide for lumbarrelated symptoms. During the latter half of the 19th century, more techniques were developed to remove the herniated disc with minimal invasiveness.

Aim and objectives

The aim of this study was to analyze the safety and efficacy of percutaneous endoscopic discectomy in the treatment of lumbar degenerative disc herniation for adult patients.

Subjects and methods

A systematic review was conducted, including adult patients (> 18 years and less than 80 years old) with surgical treatment of lumbar radiculopathy secondary to degenerative herniated discs.

Results

results revealed that mean preoperative VAS was 6.05 which improved post operation to 1.35. Mean preoperative ODI score was 56.5 which decreased to 14.2 post operation, and SF-36 physical was used by four studies and mean preoperative score was 42.07 which increased to 76.2 post operation. SF-36 mental score used by three studies with mean preoperative score was 41.08 which increased post operation to 65.5.

Conclusion

PELD appears to be an effective intervention for LDH, as it has a small amount of intraoperative blood loss, short postoperative hospital stay, and good clinical and functional outcomes. It needs more training, as it has a long learning curve.
Role of Prophylactic Dexamethasone Administration before Elective Cesarean Section at Term in Reducing the Incidence of Neonatal Respiratory Distress Syndrome (A Randomized Controlled Trial)
Authors: Bayoumy Hassan Awwad , Abbas Ahmed Mohamed , El Aziz Saleh Hayam Anwar Abd
Published: August 2023

Background

Caesarean section rate has been increased, half of which are elective. This may be due to abnormal presentation during pregnancy, increased maternal choice about mode of delivery and due to changing practice in the management of previous caeserean sections.

Aim of the Work

The objective of this study is to assess the effect of prophylactic dexamethasone 48 h before elective cesarean section at term (less than 39 weeks) on decreasing the neonatal respiratory distress syndrome and NICU admission.

Patients and Methods

Design: A randomized controlled clinical trial. 2 groups; (Group A, Dexa) which consists of 460 pregnants who received prophylactic 4 intramuscular doses of 6mg dexamethasone 12 hours apart 48 hours before delivery. And (Groups B, Control) 460 pregnants who received No treatment before elective caesarean section at term (37-39 wks).

Results

Regarding the indication for the C.S, there was no significant difference between women of both groups. There was no significant statistical difference between the two groups as regarding birth weight. Neonates of dexamethasone group significantly had higher APGAR scores. Transient tachypnea of neonates (TTN) was significantly less frequent among dexamethasone group (2.8%) while in the control group was (6.5%). Respiratory distress syndrome (RDS) was significantly less frequent among dexamethasone (A) group 3/460 (0.7%) while was 15/460 (3.3%) in control (B) group. Also (RDS) grade was significantly less frequent among dexamethasone group. The intraventricular hemorrhage was non-significantly less frequent among dexamethasone group (0.2%). The need to resuscitation was significantly less frequent among dexamethasone group (6.3%) while in control group was (11.5%). NICU admission was significantly less frequent among dexamethasone group (3.5%) vs (9.1%) in control group. Also NICU admission duration was significantly shorter among dexamethasone group. The need for mechanical ventilation was significantly less frequent among dexamethasone group (0.2%) while in control group was (1.7%). Mechanical ventilation duration was significantly shorter among dexamethasone group. Neonatal mortality was nonsignificantly less frequent among dexamethasone group (0.2%) while in control group (0.4%).

Conclusion

Antenatal Corticosteroids are effective in prevention of respiratory complications after elective caesarean section at term including: the incidence of neonatal respiratory distress syndrome, the incidence of admission with respiratory distress to neonatal ICU and the incidence of transient tachyponea of the newborn.
Accuracy of 2D Greyscale and 2D and 3D Color Power Doppler Ultrasound in the Diagnosis of Morbidly Adherent Placenta (MAP)
Authors: Fathy Hesham Mohamed , Hussain Sherif Hanafi , Nassar Salma Ashraf Mohamed , Mohamed Tamer Mohamed Faried
Published: August 2023

Background

Prenatal diagnosis of placental accreta (PA) is essential to carry out adequate surgical planning in centers where multidisciplinary teams are in place, which improve results and reduce complications. These ideal scenarios should be developed in countries with more significant difficulties in the availability of human and technological resources, through teamwork in the different hospital centres and the adequate transfer of patients at higher risk to centres with the best interdisciplinary management skills.

Objective

To evaluate the diagnostic accuracy of each sign (2D grayscale US signs), 2D Doppler signs, and 3D Doppler signs modified from Collins SL in diagnosis of morbidly adherent placenta in patients with one or more previous cesarean section diagnosed as placenta previa.

Methods

The present study is a diagnostic test accuracy study was carried out at Ain Shams University Maternity Hospital during the period from January 2020 to March 2021. 126 women were recruited from Special Care Center of the fetus – Ain Shams University Maternity Hospital. All included women were scanned by 2D grayscale, 3D power Doppler ultrasound.

Results

The current study showed that cases underwent cesarean hysterectomy had significantly higher previous cesarean sections. The results of the current study showed a significant association between all criteria of the 2D grayscale, Color Doppler, 3D Power Doppler ultrasound and presence of placental adherence, considerable intraoperative blood loss, need for added surgical steps, CS hysterectomy and bladder injury with the presence of more than 4 sign or more are predictive for placental invasion with the need of emergency hysterectomy.

Conclusion

The result of the current study proves the diagnostic accuracy of the ultrasound concerning the prediction of difficult placental separation, considerable intraoperative blood loss, CS hysterectomy and bladder invasion.
Assessment of Quality of Life in Patients with Malignant Pleural Mesothelioma
Authors: Taha Tarek Hussein Kamel , Ghali Ramy Refaat Youssef , Kamal Khaled Abdel-Aziz Mohamed , El-Sayed Fatma Radwan Ahmed
Published: August 2023

Background

Pleural mesothelioma represents 92% of all malignant mesotheliomas. There is no MPM curative treatment. Multimodality treatment is commonly used including chemotherapy, targeted therapy and radiotherapy. Because of MPM poor prognosis (OS 8-14 months), maintaining quality of life of patients became more important in MPM treatment.

Aim of the Work

To investigate the quality of life (QOL) of patients with malignant pleural mesothelioma and to determine the factors that correlate with their QOL comparing different therapies.

Patients and Methods

This is a prospective, observational multi-center study conducted between November 2018 and November 2019. 55 consecutive patients with newly diagnosed MPM were enrolled in Ain Shams University Hospital, El-Nasr Hospital in Helwan and Ismailia Oncology Hospital. The study was approved by the ethical committee at the faculty of medicine, Ain Shams University.

Results

In our study we evaluated quality of life of MPM patients using EORTC questionnaires (QLQ-C30 & QLQ-LC-13), and correlated the score with different chemotherapy types and other factors.

Conclusion

Our study found correlation between QLQ baseline scores and both weight loss & chest pain, and no correlation of QLQ scores change with types of chemotherapy. Median Progression-free survival was 6.5 months and correlated with disease stage and chemotherapy used.
Relation between Vitamin D Deficiency and Dry Eye
Authors: Samy Magda Mohamed Mahmoud , Naguib Karim Magdi , Ezzat Nashwa Mohamed , El-Din Mohamed Anwer Hagar Ahmed Ezz
Published: August 2023

Background

Tears are very important to the overall health of the eye and vision. The tear film is mechanically distributed over the ocular surface through a neuronally controlled blinking mechanism. Normal blink reflex, contact between the external ocular surface and the eye lids, and normal corneal epithelium are three factors required for effective resurfacing of the tear film (tear stability). (1)

Objective

To demonstrate the relation between vitamin D deficiency and dry eye disease searching for finding a correlation between dry eye parameters with vitamin D deficiency.

Patients and Methods

Cross sectional study. A total 50 patients attending the ophthalmology outpatient clinic of General Ain Shams Hospital, from February 2019 to October 2019 were enrolled in the study after the approval of the research ethical committee in the Faculty of Medicine, Ain Shams University. They were divided randomly into 2 groups. Group 1: consisted of 35 patients who were vitamin D deficient. Group 2: consisted of 15 patients who had normal vitamin D levels (control group).

Results

The study showed that there was statistically significant increase in symptoms of dry eye in female patients than male patients and there was statistically significant decrease in the level of tear film break up time, Shirmer test and serum 25 (OH) vitamin D in cases with dry eye than those without. It was found that there was statistically significant decrease in vitamin D level in female cases than male cases. Also, there was statistically significant decrease in vitamin D level in cases with symptoms of dry eye and conjunctival hyperemia than cases without. There was also statistically significant positive correlation between serum 25 (OH) vitamin D and tear film break up time and Shirmer test.

Conclusion

The present study suggests that patients with vitamin D deficiency may suffer from dry eye. Investigations to confirm and quantify a clinical diagnosis of dry eye should include serum 25 (OH) vitamin D when suspecting vitamin D deficiency especially in patients prone to this type of vitamin deficiency.
Assessment of Retinal Side Effects of Fingolimod (Gilenya) Used in Treatment of Multiple Sclerosis Patients
Authors: Elshahed Hala Kamal Hassan , Salman Abd El Rahman Gaber , Mohammed Thanaa Helmy , Zamzam Dina Abdelgawad , Abdelgawad Randa Hesham Ali
Published: August 2023

Background

Multiple sclerosis is an inflammatory demyelinating disease that affects CNS. It is thought that multiple factors were implicated in the pathology of MS such as immunological factors, vitamin d deficiency, vitamin b12 deficiency or infection by EBV or HHV6. It has a lot of ocular manifestations as optic neuritis, diplopia, oscillopsia, nystagmus and ophthalmoplegia. Fingolimod is the first approved oral drug for RRMS. Macular edema was reported as a side effect of fingolimod after 4 months of use.

Aim of the Work

The objectives of the study are screening of retinal side effects of fingolimod used for treatment of relapsing remitting multiple sclerosis patients having no previous ophthalmic complains before starting the treatment. To assess structural changes within the retina using SD-OCT and to correlate these structural changes with the function affection (visual acuity assessment and electrophysiological studies).

Patients and Methods

Thirty eyes of fifteen patients were included in this prospective one arm clinical trial study. These thirty eyes belonged to multiple sclerosis patients who will be candidate for treatment with fingolimod (Gilenya). Patients were recruited from MS unit, neurology department, Ain Shams University.

Results

We found that the mean best corrected visual acuity change after treatment slightly decreased but this was non-significant. IOP measurements were not changed after treatment. Despite the changes in visual acuity; fingolimod associated macular edema did not develop. Among 15 patients (30 eyes), 14 eyes have slightly increased MT, 5 eyes have stable MT and 11 eyes have slightly decreased MT. Regarding electrophysiology follow up there were significant change in P1 amplitude in MfERG in ring 1, and it happened without development of macular edema (ME), as 50% of patients had MfERG changes in spite of the absence of ME. So we recommend doing electrophysiological test (MfERG) in follow up protocol of fingolimod treatment.

Conclusion

Finglimod is an immunomodulatory drug used for treatment of RRMS, it is the first oral drug approved by FDA for MS. Fingolimod associated macular edema is a known complication with a low incidence. Patients on fingolimod should have baseline and 3 to 4 months ophthalmic examination as a part of their protocol OCT is non-invasive technique used for detection of macular edema and follow up, but in our study we found that after 4 months of treatment by fingolimod, affection of retinal function in same patients may happen before macular edema development, which spots the light on the importance of performing the mfERG as well in the follow up of patients who were treated with fingolimod. Further studies are needed to support our results.
Preliminary Study on the Effect of Intrastromal Anti-Vascular Endothelial Growth Factor Injections on Corneal Neovascularization Using Anterior Segment Optical Coherence Tomography Angiography
Authors: Ayoub Hussein Mohamed Sherif Ahmed , Mousa Amr Saleh Galal , Hamdi Momen Mahmoud , Mousa Rasha Mohamed , Abd-elRazeik AwadAllah Mo’mena Ahmad
Published: August 2023

Background

Corneal neovascularization, is a serious condition affecting large percentage of the population. Not only does corneal neovascularization decrease vision and cause corneal edema, but also, it is highly associated with graft rejections. Anti-VEGF has been used in many studies to treat corneal neovascularization with promising results. Recently, evaluation of corneal neovascularization using Optical Coherence Tomography Angiography (OCTA) has been explored and has shown to be promising.

Objective

To evaluate the effect of intrastromal injection of Anti-VEGF using the swept source anterior segment OCTA on corneal neovascularization.

Patients and Methods

This pilot study was done in a cohort, prospective manner. The study was done on 10 eyes of 10 patients with corneal neovascularization who were planned for keratoplasty or after keratoplasty. Intrastromal injection of Anti-VEGF using a 30 Gauge needle at a concentration of 5 mg/0.2 mL [2.5%] was done for patients involved in this study. OCTA was done 48 hours before injection, 1 week and 1 month after injection. OCTA images were compared to evaluate the effect of Anti-VEGF on corneal neovascularization.

Results

Compared with the pre-operative period, at 1 week postoperatively, 9 cases have shown decreased corneal neovascularization, with only 1 case that showed no regression and seemed to be unresponsive to the single injection of Anti-VEGF. At 1 month period, 8 cases had increased vascularization (re-vascularized), 1 case had decreased vascularization again (completely disappeared) and 1 case stayed the same with no change. Cases that have revascularized, have not returned back to the original vascularization level. Using OCTA colored, black and white images, we were able to picture blood vessels in 3-D image and detect subtle changes in corneal neovascularization. Using the OCTA cross-sectional images, we were able to estimate the vessels depths. In 6 cases, vessels were located in the posterior 25% of the cornea (Deep), in 2 cases they were located in the anterior 25 % (Superficial) and in 2 cases they were between the anterior 25 % and the posterior 25% (Mid-stromal). Vessel density was not possible to calculate in this study.

Conclusion

Bevacizumab intrastromal injections seem to be a very effective temporary method in decreasing corneal neovascularization despite the level of neovascularization. Repeated Bevacizumab injections might be needed to eliminate corneal neovascularization completely. Bevacizumab seems to have a peak action at 1 week period and then its effect seems to ware off gradually. OCTA was able to visualize vessels in 3-D image, even under vascularized corneal scars. OCTA was able to recognize subtle changes in corneal neovascularization, that were not visible by slit lamp.
Screening of Oral Tamoxifen Ocular Toxicity in Breast Cancer Patients
Authors: Ahmed Mai Mohamed Ahmed , Salman Abdelrahman Gaber , Fawzy Samah Mahmoud , Abdelmotal Ahmed Said Ibrahim , Tharwat Ahmed , Abdelgawad Randa Hesham Ali
Published: August 2023

Background

Breast cancer is one of the leading cancer types among females worldwide. Prevalence of breast cancer is reported to be the second most common among women. Several treatment lines were prescribed in treatment of breast cancer besides surgical, radiological interventions. Tamoxifen is one of the medical treatments used in postsurgical prophylaxis of breast cancer. Various visual problems were reported with tamoxifen therapy. These include posterior subcapsular cataracts, color vision changes, optic neuritis, and intra-retinal crystals.

Aim of the Work

The aim of the work was to screen for ocular toxicity of tamoxifen used for treatment of breast cancer patients having no ophthalmic complains and treated with tamoxifen for at least 2 years with dose (20mg per day).

Patients and Methods

We included 50 female patients with breast cancer treated with Tamoxifen therapy for at least 2 years then we divided them into two groups regarding duration of tamoxifen intake from (2-4) years group and from (5-8) years group, all subjects underwent complete careful history taking and full ophthalmological examination, BCVA was measured using Snellen chart with conversion to log. MAR notation for statistical analysis.

Results

There was significant correlation between duration of tamoxifen intake and RPE mottling, no other significant correlations were detected, there was no significant difference in mean of BCVA, IOP, cup values, disc parameters, GCC thickness, RNFL zones between the two groups except for (inferior quadrant), macular thickness except in (superior quadrant), OCT layers thinning shows RNFL affection in (34%) of cases, GCC affection in (48%) of cases and macula affection in (64%) of cases, color vision defects was found in (12%) and electrophysiological test changes found in few cases.

Conclusion

Tamoxifen therapy causes minimal affection on the ocular structure and function, OCT layers thinning (34-64% of cases) preceed the clinical changes this highlights the importance of OCT examination in those patients to evaluate tamoxifen toxicity and further studies will be needed to evaluate reversibility of these changes after stoppage of therapy, main ocular complications associated with tamoxifen therapy were correlated to duration of treatment.
Study of the Efficacy of Indocyanine Green Enhanced Transpupillary Thermotherapy as a Treatment Modality for Retinoblastoma
Authors: Aziz Nada Abdel Salam Abdel , El Barbary Magdy Mohamed , Ziko Othman Ali Othman , Said Azza Mohamed Ahmed , El Zankalony Yasser
Published: August 2023

Background

Retinoblastoma represents approximately 4% of all pediatric malignancies and is the most common ocular malignancy in children. It has one of the highest survival rates among all pediatric malignancies owing to improving treatment methods over the years.

Objectives

The purpose of our work was to evaluate the efficacy of intravenous indocyanine green dye injection combined with diode laser transpupillary thermotherapy (TTT) as a treatment modality for Group (B) intraocular retinoblastoma compared to the standard protocol of treatment.

Patients and Methods

A prospective interventional comparative study was conducted in the Ocular Oncology Clinic, Ophthalmic Department, Ain Shams University Hospital in the period from August 2017 to December 2020. The study was conducted on twenty tumors, classified as Group (B) retinoblastoma according to International Classification of Intraocular Retinoblastoma (ICRB). It includes; Tumors >3 mm (in basal dimension or thickness), tumors located in the macula (≤3 mm to foveola), juxta-papillary tumors (≤1.5 mm to disc) or tumors surrounded by subretinal fluid (≤5 mm from the tumor margin). They were divided into two main groups: Group I: It included ten (10) tumors; newly diagnosed or recurrent. This group was treated with systemic chemotherapy plus ICG enhanced diode laser TTT, Group II (control group): It included ten (10) tumors; newly diagnosed or recurrent. This group was treated with systemic chemotherapy plus conventional diode laser TTT.

Results

The study found that ICG has significantly improved uptake of diode laser, eliminating the need for increasing the laser power to the photocoagulation levels which would disrupt the inner retinal layers. ICG-TTT allowed rapid tumor regression and decreased the number of laser sessions needed to achieve tumor regression.ICG-TTT was successful with 3 challenging recurrent masses on a hypopigmented scar and achieved complete regression. There was no statistically significant difference between the two groups as regards the disease-free survival curves using Kaplan Meier analysis. During the period of post chemotherapy follow up, 3 tumors in Group I (30%) and 2 tumors in group II (20%) developed recurrence. And one case in group I (10%) developed a new mass in a remote site.

Conclusion

The study concluded that ICG-TTT is both efficient and safe despite some potential complications.