bluuebunny/crossref_metadata_2025 huggingface dataset:
Optical Coherence Tomography Angiography (OCTA) Study of Microvascular Changes in Systemic Lupus Erythematosus (SLE) Patients with no Clinical Ocular Manifestations
Authors: Aziz George Adel , Ezzat Nashwa , Ebeid Weam , Shabaan Elham , Raslan Osama
Published: November 2024

Purpose

The aim of this study is to evaluate retinal microvasculature using OCTA in patients with SLE without signs of retinopathy according to standard lupus retinopathy classification and correlate abnormal vascular density with disease activity and severity.

Methods

in this Prospective observational non-interventional study, 36 eyes of 18 SLE patients were compared with 36 eyes of normal subjects. The retinal capillary plexuses were examined by OCTA at time of enrollment and every 4 months for a year using Angio-OCT Optovue RTVue XR Avanti system (Optovue Inc., Fairmont, CA) with documentation of Foveal avascular zone (FAZ) area in mm, acircularity index(AI), Retinal vessel density in a 300-μm-wide region around the FAZ (FD-300), Retinal vessel density in superficial and deep retinal layers (foveal, parafoveal and perifoveal areas). The scanning area was captured in 6 × 6-mm sections, automatically centered on the fovea (HD angio retina 6 × 6-mm), also radial peripapillary vessel density (HD angio disc 4.5 × 4.5-mm) (superior, inferior, nasal and temporal) were studied. The disease activity and damage risk were evaluated by the SLEDAI-2 K and SLICC/ACR system and a correlation was done between changes found and disease activity.

Results

No difference was found between SLE patients and the normal in foveal avascular zone (FAZ) area, FAZ perimeter, Acircularity Index (AI)(P > 0.05). No difference was found between SLE patients’ macular thickness in foveal region and parafoveal region and the normal (P > 0.05),while mean perifoveal average macular thickness was significantly lower in SLE patients group (p = 0.025). There was a significant decrease in foveal thickness measurements in SLE patients group during follow up period (p = 0.007). SLE patients had significantly lower superficial vessel densities (SVD) than normal in the parafoveal and perifoveal regions (p = 0.001),(p < 0.001) respectively, and during follow up period significant decrease was observed in SVD values (p = 0.001). Regarding the deep capillary plexus (DCP), There was no significant difference between SLE patients group and the normal (p > 0.05), while during follow up period Significant decrease was observed in deep foveal vessel density in SLE patients group (p = 0.013). There was a significant negative correlation between disease activity (measured by SLEDAI-2K and SLICC/ACR scores) and SVD & foveal deep vessel density.

Conclusions

OCTA permits noninvasive quantitative assessment of retinal vessel density in SLE, allowing early detection of altered retinal circulation. superificial Vessel density and foveal deep vessel density could be included in future assessment of SLE activity and damage scores to early detect any changes for early management and treatment.
Study of Retinal Microvasculature Changes in Patients after Blunt Ocular Trauma by Using Optical Coherence Tomography Angiography
Authors: Gamal El-Din Omar A , El-Maamon Tarek A , Eliwa Tamer F , Fawzy Samah M
Published: November 2024

Purpose

To assess structural and vascular changes of the macula and optic nerve in patients with unilateral blunt trauma in comparison to the contralateral sound eye by using optical coherence tomography angiography (OCTA).

Methods

This prospective study was carried out on 50 traumatized eyes and 50 contralateral sound eyes of patients who were subjected to blunt trauma within 7 days of injury. We evaluated best-corrected visual acuity (BCVA), intraocular pressure (IOP), retinal vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP), radial peripapillary capillary (RPC) and the foveal avascular zone (FAZ) by OCTA. We also assessed the structural spectral domain (SD)-OCT parameters including central macular thickness (CMT), ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) thickness.

Results

The BCVA was statistically significantly better in controls (0.16 ± 0.24 LogMAR) than traumatized eyes (0.28 ± 0.31 LogMAR) (p = 0.015). There was no statistically significant difference between the traumatized and control eyes regarding the means of SCP, DCP, outer retinal slab and RPC, FAZ area, CMT, IOP, GCC thickness and RNFL average thickness (p  0.05). In the commottio retinae group, the SCP and outer retinal slab VD were significantly lower in some parafoveal quadrants (p`0.05) than the non-commottio retinae group, while IOP, DCP and RPC vessel density, FAZ area, CMT, GCC and RNFL average thickness didn’t show any statistically significant difference between the two groups (p > 0.05).

Conclusion

Blunt trauma did not induce vascular or structural changes in the macula and optic nerve. Only patients with commottio retinae showed a decrease in vascular densities in some parafoveal areas as compared to those without commottio retinae despite no changes in macular structural anatomy as measured by SD- OCT. This finding suggest that OCTA can detect subtle changes that may influence functional prognosis.
A Systematic Review and Meta Analysis of Endprosthetic Replacement versus Cement Spacer in Reconstruction of Proximal Humerus Following Proximal Humerus Metastasis
Authors: El Masry Ayman Mohammad , Zaki Mina Sameh , AbdAllah AbdelRahman Mohamed Ahmed Helmy Mohamed
Published: November 2024

Background

The choice between cement spacer and endprosthesis in the treatment of metastatic lesions to the proximal humerus is increasingly controversial. However, it may be easier to categorize the patients, their socioeconomic and perioperative parameters into two groups.

Aim of the Work

This work aims to review the available literature on the topic of endprosthetic replacement versus cement spacer in the reconstruction of the proximal humerus following metastatic lesions to the proximal humerus regarding the surgical technique, its indications, its advantages and limitations.

Patients and Methods

We followed the PRISMA statement guidelines during this systematic review, and performed all steps according to the Cochrane Handbook of Systematic Reviews of Intervention.

Results

Four studies were included in this systematic review, a total of 100 patients were included (22 of which had cement spacer and 78 had endprosthesis). Several parameters were compared in the reviewed studies including the MSTS score of the patients; the primary tumor; postoperative complications; the patients’ age; follow-up periods; and the presenting symptoms of the patients.

Conclusion

The choice of whether to use an endprosthesis or a cement spacer depends on dividing the patients into two groups. Endprosthetic replacement is an appropriate choice for patients with preserved deltoid and axillary nerve function following resection; solitary and non-aggressive metastatic lesion; long- life expectancy with minimal co-morbidities. Cement Spacer is a more appropriate choice in patients with non-functioning deltoid or axillary nerve following resection; multiple and aggressive metastatic lesions; short life expectancy with many co-morbidities, and poor socioeconomic status.
Results of Anterior Cruciate Ligament Reconstruction with and without Lateral Extra-Articular Tenodesis between High Demand Patients: Randomized Controlled Trial
Authors: Hady Amr Mohamed Abdel , Sobhy Mohamed Hassan , El Abd Mostafa Aly , Haroun Yahia Mohamed , Salam Abdel Halim Ahmed Abdel
Published: November 2024

Background

Rupture of the anterior cruciate ligament (ACL) is a serious and common injury among recreational sport players and high demand patients as manual workers. One of the causes of recurrent graft failure and need to revision surgery is persistent anterolateral instability following traditional ACLR surgery.

Patients and Method

This is a prospective, randomized clinical trial comparing the failure rate of an arthroscopic anatomical single-bundle ACLR with or without LET performed using Lemaire technique in a comparable patient population of high demand patient with isolated ACL tear. Patients 40 years or younger with an ACL-deficient knee were included and also had to meet the following 3 criteria: (1) high demand patients (athlete, manual worker,…), (2) isolated ACL tear, (3) and grade 2 pivot shift or greater. The primary outcome was ACLR clinical failure, a composite measure of rotatory laxity or a graft rupture. Patients were reviewed at 3, 6 and 12months postoperatively.

Results

From December 2020 till December 2022, 41 patients were included in our study. The patients randomized in two groups. Group A included 20 patients who underwent arthroscopic anatomical single bundle ACLR combined with LET by modified Lemaire technique. Group B included 21 patients underwent anatomical single bundle ACLR only. There were 2 patients lost during follow up excluded from statistical analysis in group B. So, in total 20 patients in group A and 19 patients in group B were available for follow for 12 months. In comparison between both groups regarding rotatory laxity assessed by Pivot shift test, all patients in group A (20/20) showed negative pivot shift tests, while (18/19) patients in group B (94.74%) showed negative pivot shift. Only one patient (1/19, 5.26%) (failed case) examination showed grade 2 pivot shift test. Regarding antero-posterior laxity measured by KT1000, there are statistically insignificant differences in favor to group A than group B during follow up at 3,6,9,12 months. However, Patients included in group A showed statistically significant improvement of side-to-side KT1000 difference at 12 months follow than patients included in group B (P = 0.002). Regarding failure rate, no failed cases included in group A. while, there was only one case (1/19) failed in group B (5.26% failure rate) with no statistically significant difference between the 2 groups.

Conclusion

The addition of the modified Lemaire LAET technique to anatomical single bundle ACLR showed statistically significant improvement in side-to-side anteroposterior laxity measure by KT1000 Lachmeter. While there is no statistically significant reduction in the failure rate between combined and isolated ACLR.
Clinical Efficacy of Medial and Lateral Plating in Distal Femur Fractures: Thesis Study
Authors: Zaher El Zaher Hassan El , Nagy Amr Mohammed , Ali Ahmed Ezzat Mahmoud
Published: November 2024

Background

The problem of treating distal femoral fractures is complicated. The principles of the surgical management of supracondylar femur fractures have changed. Up until 1970, conservative management of these fractures was the recommended course of care. This was mostly caused by a lack of adequate implants and procedures. In modern times, locking compression plates offer the benefits of locking head screws, offering better fixation and absolute stability. This is significant in the treatment of fractures in osteoporotic bone because it enables the use of monocortical screws in the diaphyseal region, preserving the periosteum's blood supply and preventing structural bone loss to the opposite cortex. Varus collapse was the main complication, especially in osteoporotic bone. Therefore, anatomical reduction and rigid, stable fixation provided by double plating was considered the best option for treating this type of fracture.

Patients and Methods

This is a retrospective cohort study done in El Demerdash Hospital, Ain Shams University specialised hospitals, Air Force specialised hospital, and El Helmia military hospital through 20 cases of distal femur fractures of types 33-A3 to 33-C3, all of which were managed by dual plating and followed up for 6 months. People with open fractures, fracture type 33-A1, periprosthetic, and pathological fractures were excluded.

Results

In our study, through 20 cases with distal femur fractures between types 33-A3 and 33-C3, all managed by double plating, the mean age was 51.50, 6 of our patients had comorbidities (DM, HTN, or Both), the rest were medically free, the average operation time was 150 minutes, 2 of our patients needed a bone graft, the range of full union was from 3 to 6 months, the average AKSS among the 20 patients was 81.05, 14 of our cases achieved uneventful union, 2 cases had superficial wound infection, and 1 case had implant failure (screw cut out) and needed revision, so double plating is one of the better options to achieve bony union and a better functional outcome in severely comminuted distal femur fractures

Conclusion

Even though there were problems such as a lengthy operation and longer recovery period in our study, double plating is one of the best options for achieving bone union and a better functional outcome in severely comminuted distal femur fractures. Functional outcomes were excellent in 75% of cases and fair in 25% of cases, and the union rate was 100% with no Varus deformity or malunion.
Outcome of Short Segment Fixation for Degenerative Scoliosis in Osteoporotic Patients Using Augmented Pedicle Screws; Prospective Case Series Study
Authors: Rahman Mohamed Farrage Ahmed Mohamed Abdel , Saoud Abdelfattah Mohamed Fathy , Abdel Kader Yousef Magdy Gamal , Elbadrawy Ahmed Mohamed , Mohamed Ahmed ElSayed Mohamed Nabil , Morsi Ahmed Mohamed Ahmed
Published: November 2024

Background

When a patient’s general condition is taken into account, long-segment fusion may not necessarily be the best approach for degenerative scoliosis management. Often, a patient’s symptoms may be alleviated by short segment decompression and fusion surgery that is limited to the upper and lower vertebral boundaries of the scoliotic region. In osteoporotic patients studies reported good functional outcomes and very low revision rates with polymethylmethacrylate augmented screws.

Aim of the Work

This study aims to evaluate the clinical and radiological outcomes of short segment fixation for degenerative scoliosis in osteoporotic patients using augmented screws.

Patients and Methods

This is a prospective Case series study carried out at Ain Shams University hospitals which included 23 patients resistant back pain and lower limb claudication pain not relieved by medical treatment or physical therapy for at least 6 months. All cases managed with Posterior decompression and short segment fixation using pedicle screws augmented with cement (PMMA).

Results

As regards the VAS for leg pain, it showed improvement from 7.18 (± 0.07) to 1.91 (± 0.14). The VAS for back pain also improved from preoperatively 8.17 (± 0.11) to postoperatively 2.52 (± 0.24). As regards the ODI score, there was a significant decrease in the ODI scores from pre-surgery 68.09 (± 1.13) to 12 months post-surgery 25.57 (± 2.02). The Cobb angle decreased dramatically from pre-operative 15.9 (± 0.57) to post- operative, and then increased slightly but remained stable at 6 and 12 months with mean value at last follow up 4.85 (± 0.45). We did not have nonunion cases but only 3 delayed union cases at 6 months and was full united at 12 months that assessed by continuity of osseous bridging between transverse processes in plain X rays and CT scan. compared to similar published literatures This study technique has average blood loss, operation time and hospital stay and decrease the need for revision surgery but with increased hazards of high intraoperative radiation exposure.

Conclusion

Short segment fixation using augmented screws showed a very good clinical outcome in management of degenerative scoliosis with osteoporosis as regards VAS for back pain, VAS for leg pain and ODI score. According to radiological parameters it showed a good result in cobb angle correction, fusion rate, screws and construct stability after 1 year follow up, less pedicle screw loosening and less rate of revision surgery.
Minimally Invasive Sacroiliac Joint Fusion versus Non Surgical Management in Chronic Sacroiliitis: A Systematic Review and Meta-Analysis
Authors: Soliman Ahmed Mohamed Ahmed , El-Sayed Mohamed Nabil , Ibrahim Mohammed Ali
Published: November 2024

Background

Sacroiliac joint fusion for low back pain attributed to sacroiliac joint is beneficial in a subset of patients. However, varied conservative treatments were measured in previous studies. Moreover, there are lack of well design and long-term follow-up studies.

Aim of the Work

The primary objective of this study was to determine whether sacroiliac joint fusion was superior to conservative treatment for patients with low back pain in pain and function.

Materials and Methods

In the current metaanalysis, the 18 studies included 1457 patients with chronic sacroiliitis, from which 841 patients underwent Non-surgical management & 616 patients underwent minimally invasive SI fusion. The mean age of pooled sample is 50 years. The follow up period ranged from 2 weeks to 72 months.

Results

In our meta-analysis, there was significant decrease in pain scores in patient treated with minimally invasive sacroiliac joint fusion. The decrease reported in the included studies of VAS and ODI after MISJF is clinically relevant statistically significant. In terms of pain reduction: all conservative treatment modalities showed statistically significant reduction of pain at the end of follow up except in local anesthetic injection. In terms of disability score (ODI): all conservative treatment modalities showed statistically significant reduction of ODI score at the end of follow up. There was a dramatic relief of pain in cases treated with joint fusion than those treated with conservative treatment. Using EQ-5D time trade-off scale, there was improvement in patient quality of life on patient treated with joint fusion higher than in cases of conservative management, but was statistically insignificant. We found that proportion of patients who were able to walk for distance more than one kilometer were higher in case treated with joint fusion, but it was statistically insignificant. By month 24, we observed 39 severe adverse events after sacroiliac joint arthrodesis, including sacroiliac joint pain, postoperative gluteal hematoma, and postoperative nerve impingement. With conservative treatment there were no reported complications except in one study. In fusion group few complication reported mostly were : hematoma formation, piriformis syndrome, cellulitis, deep-soft tissue infection, Implant penetration, non-displaced fracture and persistent joint pain.

Conclusion

In cases of low back pain related to chronic sacroiliitis, improvements in pain, and disability, observed following minimally invasive SIJF surgery was statistically significant compared to non-surgical management.
Management of Pediatric Distal Humerus Metaphyseal Diaphyseal Junction Fracture; A Systematic Review and Meta-analysis
Authors: Al-Kersh Mohamed Ahmed , Aly Ahmad Saeed , Mohamed Ahmed Mohsen
Published: November 2024

Background

Fracture at the distal humerus metaphyseal diaphyseal junction (MDJ) in children is less frequently found in literature. Until this moment, there is no gold standard technique regarding its management and most surgeons treat it as a regular supracondylar humerus fracture by conventional pinning. This systematic review explores the relevant literature to assess the efficacy of different techniques.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for this review. We searched online databases including PUBMED/MEDLINE, Scopus, Web of Science Core Collection, and Google Scholar. Data from papers that met our general inclusion criteria were extracted and categorized into treatment method groupings. Functional and cosmetic outcomes, demographic characteristics, and complications were the main parameters used to analyze the data.

Results

Ten (10) retrospective studies met our inclusion criteria with a total of 178 participants of unilateral pediatric distal humerus metaphyseal diaphyseal junction fractures. Most literature chose closed reduction and percutaneous pinning (CRPP) in 7 papers, followed by Elastic Stable Intra-medullary Nails (ESIN) used in 3 papers, then conservative treatment was chosen in 2 papers, while only one paper used lateral miniplate and assisted K-wire and another paper used combined CRPP and Intra- medullary (IM) K-wire. As regards the operation time; ESIN had the lowest time with a mean of 39.7 min (range: 37.5 – 41.9 min), while CRPP had the most prolonged time with a mean of 75.47 min (range: 55.9 – 92.1 min). The lowest healing time was observed in ESIN with a mean of 7.9 weeks (range: 6.8 – 9 weeks) while the most prolonged was in conservative management with a mean of 12 weeks and CRPP lies in between with a mean of 10 weeks. Regarding Flynn’s criteria, all participants received excellent and good except in CRPP; 13 cases were fair and 2 cases were poor. Regarding complications the most commonly observed complication after MDJ fracture was cubitus varus, the highest incidence was in conservative management 33% of cases, followed by CRPP 10.9% of cases, the least incidence was observed in ESIN 3.77% of cases, and none of the cases treated with mini plate developed this complication. Other complications were observed only with CRPP; 8.5% of cases developed fixation loss, 6.2% of cases had significantly reduced range of motion and one case refractured.

Conclusion

Pediatric distal humerus MDJ fracture should be differentiated from supracondylar fracture regarding management, as conventional pinning techniques are associated with a higher incidence of complications and increased both operative and healing times.
Bengin Tuomrs of the Spine: A Systematic Review
Authors: Elsaadany Ahmed Saeed , Mazyed Mohamed Ahmed , Ashour Mahmoud
Published: November 2024

Background

Spine tumors are classified as primary tumors which originate from the spine itself and its adjacent structures and secondary (metastatic) tumors of distant organs which spread hematogenously and lymphatically and are located in the spine and its surrounding tissues. As the spine is well vascularized and has close relationship with regional lymphatic and venous drainage systems (especially Batson’s venous plexus), it is generally susceptible to metastasis. Metastatic tumors are the most common (97%) tumors of the spine.

Aim of the Work

to give an overview of the most important benign tumors of the spine, their clinical pictures and the typical features in imaging.

Patients and Methods

Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. We will search the MED-LINE database, PubMed, Cochrane Bone and Muscle Trauma Group Specialized Register, Cochrane Register of Controlled Trails (The Cochrane Library) using the following keywords related to: Bengin tumors, spine.

Results

Giant cell tumors in the spine, particularly lumbar region, are rare but can present with pain and neurologic deficits. Osteoid osteomas and osteoblastomas, more common in the thoracolumbar spine, exhibit distinct radiological features. Osteoblastomas, locally aggressive, cause persistent pain, stiffness, and neurological deficits, often diagnosed in later stages. Spinal osteoblastoma diagnosis relies on CT scans, superior to plain radiography, and may necessitate biopsy for confirmation. Vertebral hemangiomas, usually asymptomatic, can cause compression-related symptoms and are identified through characteristic radiographic and CT appearances.

Conclusion

Searching the literature, Comparison between clinical picture in various types of begnin tumors we found that all begnin tumors have similar symptoms such as localized pain, neurological symptoms. Hence different methods of investigation should be used such as plain x-ray, CT scan and MRI.
Internal Fixation of Geriatric Native Distal Femur Fractures: A Systematic Review
Authors: Ahmed Yousry H , Mohamed Kamel S , Ahmed Emam T
Published: November 2024

Background

Distal femur fractures account for 4-6% of osteoporosis related fractures of the femur in the elderly population. As life expectancy continues to increase, the population worldwide is ageing, and the number of individuals over 65 years of age is increasing and hence the incidence of distal femur fractures in elderly.

Objectives

management of geriatric distal femur fractures by surgical fixation whether locked plate or Retrograde intra medullary nail.

Data Sources

Data Sources: PubMed, Embase, and Cochrane databases were searched for English language articles up to April 24, 2022, identifying 2500 papers

Study Selection

studies discussing the outcomes and complications of post op fixation of distal femur either by locked plated, double plating, NP or RIMN

Data Extraction

one study provided Level III evidence, whereas the remaining 16 studies provided Level IV evidence. Studies were formally evaluated for methodological quality using established criteria. Treatment failure between groups was compared using an Odds rate ratio.

Data Synthesis

Treatment failure was defined for locked plating, double plating and RIMN for reasons such as mechanical failure, nonunion, deep and superficial infection, ROM and extensor mechanism disruption, revision surgeries. There were no significant differences in most of the outcomes and complication rates with some advantageous ROM in plates and lower infection in nails.

Conclusions

biological fixation overall provides lower complication rates with no significance between RIMN and locked plates in Extra articular fractures. no strong conclusions can be effectively made between the methods of fixations with both offering very good results overall, more prospective research with unified items for data resemblance across different studies should be made.
A Comparative Study Assessing the Efficacy and Outcomes of Sub-Muscular Plating and Elastic Stable Intramedullary Nailing in Paediatric Diaphyseal Femoral Fractures: A Systematic Review
Authors: El Sheikh Andrew Mina Samaan , Ghali Nabil Abdel Moneim , Elshabrawy Waleed Elsayed
Published: November 2024

Background

Femoral shaft fractures are among the most common fractures of long bones. Paediatric diaphyseal femur fractures account for 1.4% to 1.7% of all paediatric fractures; the annual rate of children who present with femoral shaft fractures is estimated at 19 per 100,000. The management of paediatric diaphyseal femoral fractures depends primarily on the age of the child although the bone age and size of a child may determine the choice of treatment. The choice of management may also be determined by surgical experience and local trends in practice. Non- operative management plays a role in some cases still though current practice has veered towards operative fixation as it allows early mobilization and shorter hospital stays.

Aim of the Work

to evaluate efficacy and outcomes of submuscular plating and elastic stable intramedullary nailing in paediatric diaphyseal femoral fractures.

Patients and Methods

Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. A total of 303 cases were included with mean age 8.3 years. The majority of them were males.

Results

The current study showed that regarding Outcome; Mean operative time was 74.35 min in nail group vs 111.19 min in plate group. Mean intraoperative blood loss also was 58.1 ml in nail group vs 112.5 ml in plate group. As regarding hospital stay mean period was 4.4 days in nail group vs 5.5 days in plate group. As regarding time to full weight bearing was 10 wk in nail group vs 8.25 wk in plate group. Time to heal of fracture was 2.28 mn in nail group vs 2.35 in plate group. Total number of union in nail group was 161 cases vs 118 in plate. Our results showed that as regards complications; a total of 60 complications were found among included cases in form of infection in 3 with nail vs 4 with plate, malunion in 14 in nail vs 6 in plate group. Heterotopic ossification in 2 cases with plate fixation. Limb length discrepancy in 6 cases with nail vs 5 cases with plate fixation, refracture in 2 cases with plate fixation, pain in 7 cases with nail fixation. External rotation and antecurvatum in 4 cases with nail fixation vs 3 with plate fixation.

Conclusion

this review provides evidence that both ESIN and SMP are safe, effective, and minimally invasive surgical methods for the treatment of paediatric diaphyseal femoral fractures, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed carefully.
Fresh Femoral Head Allograft in Distal Femur Cartilage Lesions. A Case Series
Authors: Soubih Hesham Ossama , Mohammed Ahmed AI-Saed , AI-Ghazali Sherif Ahmed Farghali , Sobhy Mohammed Hassan , Haroun Haitham Kamel Omar , Al-Sayyed Kamel Mohammed
Published: November 2024

Background

Fresh osteochondral allograft transplantation is a good treatment option of cartilage defects. However, this treatment option is not available in all countries due to limited graft availability and tissue banks limitations. The purpose of this study is to assess the short term functional and imaging outcomes of fresh osteochondral allograft transplantation in the knee using the femoral head of living donors.

Hypothesis

Fresh osteochondral allografts from the femoral heads of living donors is a valid graft source for management of distal Femur cartilage defects. This technique can improve functional knee scores with good radiological outcomes.

Study Design

Prospective case series.

Methods

Ten patients with full thickness cartilage defects of the distal femur underwent osteochondral allograft transplantation from the femoral heads of living donors. Grafts were transplanted by both shell and multiple dowels techniques. The average follow up duration was 9.4 months (range, 6-13 months). Patients were evaluated by Lysholm and International Knee Documentation Committee (IKDC) scores, radiography and MR imaging using Osteochondral Allograft MRI Scoring System (OCAMRISS).

Results

There was a statistically significant improvement (P < 0.001) in both Lysholm (52 to 83) and IKDC (40 to 80) average scores at 6 months postoperative. Postoperative MRI was done at an average 6.8 months (range, 5-11 months) postoperative. The mean total OCAMRISS score was 3.4 (range, 1-7). A second look arthroscopy was done in three patients and showed intact articular cartilage in all three patients.

Conclusion

Femoral head of living donors is a valid new source for fresh osteochondral allograft transplantation of knee osteochondral lesions. Short term results showed improvement in clinical assessment scores. Follow up imaging showed graft incorporation and good MRI scores.
Evaluation of the potential therapeutic efficacy of Lactobacillus rhamnosus in ratsexperimentally infected with Blastocystis hominis
Authors: Alkady Sara F , Abou-Seri Hanan M , El Naggar Heba M , Thabet Hala S , El-Sayed Hoda S , Fathalaa Iman F
Published: November 2024

Blastocystis hominis (Blastocystis) is a common intestinal protist found in humans and various animals globally. Although its implications for health and diseases remains controversial, it has been suggested to be associated with gastrointestinal disorders, including abdominal pain and diarrhea, as well as cutaneous lesions such as urticaria. While metronidazole (MTZ) remains the primary treatment for blastocystosis, it is accompanied by several adverse effects. This underscores the pressing need for a safe therapeutic alternative, and probiotics emerge as a promising candidate. Probiotics exhibit the ability to treat gastrointestinal infections by modifying the composition of the gut microbiota and influencing the host’s immune response. Lactobacillus rhamnosus (L. rhamnosus) has demonstrated efficacy against several parasitic diseases such as giardiasis and toxocariasis. The present study aims to evaluate the in vivo anti- Blastocystis activity of L. rhamnosus in comparison to MTZ. Twenty-eight Sprague- Dawley rats were divided into four groups (seven rats per group), all infected with Blastocystis, except for the non-infected group 1 (G1). The treatment duration was 7 days for MTZ and 10 days for L. rhamnosus. The therapeutic efficacy was assessed through parasitological follow-up of fecal and intestinal fluid parasitic counts on the 3rd, 6th, 9th, and 12th days post-treatment, along with histopathological evaluation of selected segments of the ileum and colon. L. rhamnosus induced a statistically significant reduction in fecal and intestinal fluid parasitic counts compared to MTZ, accompanied by normalized villous architecture and restoration of the villous to crypt ratio. Hence, this study highlights the potential therapeutic effectiveness of L. rhamnosus as a safe alternative against blastocystosis.
The Diagnostic Value of Progranulin in Early Onset Sepsis in Preterm Neonates
Authors: Seif Ibrahim Saad Hassan Abu , Alhassanin Arwa Hamdy Alsharabasy , Elmihi Nouran Mahmoud Bahig , Emam El Bahnasawy Abdelhay Youssef Ali
Published: November 2024

Background

Neonatal sepsis is a leading cause of morbidity and mortality, especially in preterm Infants. It represents a deregulated host response to an infectious agent, resulting in multiple organ failure and long-term neurodevelopment delay. There is growing evidence that Progranulin is a promising biomarker in the early diagnosis of sepsis in neonates.

Aim of the Work

To assess the use of Progranulin as an early biomarker for detection of early onset sepsis in Preterm neonates and to detect whether Progranulin will provide us with earlier detection of EOS Than the usual used septic screen.

Patients and Methods

This was a case control study that was conducted in neonatal intensive care unit Department, Faculty of Medicine, Ain Shams university on 60 Neonates with early onset neonatal sepsis. Study groups were classified according to the blood culture into two groups: Group 1 (cases): 30 preterm neonates proved to have early onset sepsis with positive blood culture. Group 2 (control): 30 preterm neonates with negative blood culture. The study period was 6 months.

Results

PGRN levels were significantly elevated in the EARLY ONSET SEPSIS neonates compared with the levels in the non-EOS neonates (301.33 vs. 29.5 ng/ml (median), P < 0.001). Also, the receiver operating characteristic curve (ROC) showed that the best cut off point of PGRN (ng/mL) to detect Cases group was found to be > 50 with sensitivity of 100.0% and specificity of 100.0%.

Conclusion

Progranulin may can be used as a promising biomarker for the diagnosis of Early Onset Sepsis.
Psychological Outcomes in Children Following Pediatric Intensive Care Unit Hospitalization
Authors: Nasr Ahmed N , Youssef Azza M , Magdy Sondos M , Abdel Aziz Asmaa W , Abdelmageed Reham I
Published: November 2024

Background

Critically ill children may be at risk for developing negative psychological sequel following pediatric intensive care unit (PICU) hospitalization. The highly invasive technological interventions, lack of control over events, the severity of the child’s illness, and high levels of parental distress have been identified as particularly salient factors

Aim of the Work

To assess the psychological impact of admission to PICU among children and their parents

Methods

In this cross-sectional study, 100 children admitted to the PICU or ward and their parents completed the Strength and Difficulties Questionnaire (SDQ) and Hospital Anxiety and Depression Scale (HADS) at admission, 6 weeks, and 6 months after discharge.

Results

The PICU group (n = 50) had significantly higher disease severity scores than the ward group (n = 50) based on mean PRISM (9.5 vs 3.0, p < 0.001) and mean TISS scores (14.98 vs 6.7, p < 0.001). PICU children had a longer mean length of stay (9.8 vs 4.6 days, p < 0.001). At 6 weeks, 38% of PICU children scored in the high or very high risk range on the SDQ total difficulties score compared to 8% of ward children. At 6 months, 28% of PICU children remained at high or very high risk versus 4% of ward children. The SDQ emotional symptoms subscale was most affected. Regarding parental stress, at 6 weeks 12% of PICU parents had abnormal depression scores on the HADS versus 2% of ward parents, while 14% of PICU parents had abnormal anxiety scores versus 4% of ward parents. Multivariate regression found number of previous admissions, severity scores, and invasive procedures predicted SDQ scores at follow-up.

Conclusion

PICU admission has a significant psychological impact on children and parents lasting at least 6 months. Screening for those at high risk is recommended.
Clinical Characteristics and Outcomes of Young Patients with Thrombotic Microangiopathy at Ain Shams University Children’s Hospital
Authors: Makkeyah Sara Mostafa Mohammad , Andrawes Nevine Gamal , Wasel Asmaa El Saied Hassan , Sallam Dina Ebrahem Darweish
Published: November 2024

Introduction

Thrombotic microangiopathies (TMA) is a life-threatening condition that requires urgent management. Survival of patients has improved greatly over the past two decades with improved supportive care and other therapeutic options.

Objectives: to describe the clinical features and outcomes of patients with TMA at Ain Shams University Children’s Hospital.

Methods

In a retro-prospective study, we included patients diagnosed with TMA in the Pediatric Hematology and Pediatric Nephrology Units at Ain Shams University Children’s Hospital from 2009 through 2023.

Results

Thirty-three patients were enrolled, they were 15 females and 18 males with age ranges from 0.31 to 13.9 years and median (IQR) of 4.3 (1.4 – 9.0) years. Almost half of our patients had infection related hemolytic uremic syndrome (HUS) (51.5%), 30.3% had atypical HUS (aHUS), 9.1% had congenital thrombotic thrombocytopenic purpura (cTTP), while 9.1% were diagnosed with immune-mediated TTP (iTTP). Renal manifestations were the most common presenting symptoms (90.9%), hematological manifestations were present in (66.7%), while neurological manifestation were evident in (36.4%) of patients. Conservative management was the most commonly used approach (87.9%),while (75.8%) received plasma infusion and (69.7%) needed renal replacement therapy. On studying the outcome of our TMA cases, 33.3% had residual hematological manifestations, meanwhile 60.6% left with chronic kidney disease. Mortality was reported in 18.2% during the whole follow-up period.

Conclusion

infection-related HUS was the most common type of TMA in our cohort, and most patients were managed conservatively with disease resolution at 3 and 6 months follow up.
Neurological Complications and Cognitive Function after Pediatric Living Related Liver Transplantation
Authors: Yassin Tawhida , Elhakim Athar Abd , Rahim Suzan Abdel , Wafeeq Asmaa , Mohammed Maha Z
Published: November 2024

Background

Neurological complications in the post liver transplantation period increase morbidity and mortality, with most of them occurring within the first 1– 3 months. Many studies have found that long-term neurocognitive development in children after liver transplantation is not ideal.

Aim and Objectives

The aim of the study was to assess the frequency, types and risk factors for neurological complications among children who underwent liver transplantation and to determine the cognitive functions of those children after liver transplantation.

Subjects and Methods

fifty patients who underwent living related liver transplantation as well as fifty controls of same age and sex were recruited to the study, medical records were revised including history of any symptoms suggestive of neurological affection in the post-operative period (type, timing, imaging, prognosis). Neurological examination was done as well as cognitive assessment by Wechsler intelligence scale.

Result

Twenty percent of the studied cases with mean age11.58 ± 3.07 years (male 62%) (females 38%) had neurological complications; most common presentation was seizures 18%. All complications occurred in first fifty days after liver transplantation. Neurological examination at time of study showed that all patents resolved completely except one patient who is still on treatment) mean duration post liver transplantation was 3.5 years). Cognitive assessment revealed a potential decrease in verbal comprehension and significant decreases in perceptual reasoning, working memory, and full-scale IQ in the cases group compared to controls p value = 0.01

Conclusion

current research suggests that neurological complications in liver transplanted children is not uncommon. Those children are at higher risk for developing cognitive deficits compared to the age-matched normal population.
Effect of “Egyptian Acute Seizure Management Guidelines” Education on Emergency Room Pediatricians
Authors: Hassanein Sahar Mohamed Ahmed , Amin Ghada Essam Aldin , Mohamed Aya Abdelnaby Darweesh , Elmasry Ahmed Mostafa Ahmed , Shata Mennatallah Osama
Published: November 2024

Background

Acute convulsive seizure in children is the most terrifying experience to parents. Status epilepticus can be life threatening in children if not early and properly managed. There are no unified management guidelines for childhood acute seizure management in Egypt. The Egyptian acute seizure management in children's guidelines provides a framework for diagnosing and caring for children experiencing an acute convulsion, which is intended to assist health care providers

Aim of the Work

To assess pediatricians’ knowledge about acute seizure management in emergency department, and to evaluate the effect of education on their knowledge.

Methods

The current study is an interventional study, on physicians treating children with acute seizures in emergency departments, from August 2022 to May 2023, an online survey was prepared by the authors according to the “Egyptian acute seizure management in children’s guidelines”, then 3 electronic forms were designed online using Research Data Capture Software (REDCap). In the first form (pre-intervention phase) The public link is one link sent through whatsApp groups for pediatricians or general practitioner; containing their personal data and questions assessing their knowledge about acute seizure management in children, two hundred and twenty three pediatrician responded to it. The second form (intervention phase) educational materials (a PDF file contains the guidelines and educational video) sent automatically after the participant finished and submitted the pretest. One week later (post intervention phase) unique link was sent for each participant to his e-mail. Each participant initial (pre-test) and final (post-test) answers were analyzed for the level of knowledge and stratified into Poor ≤50%, 50-75% Fair and ≥ 75% good according to his/her correct answers.

Results

In the pre-intervention phase, the majority of the participants (66.8%) had poor knowledge about pediatric acute seizure management. Females were found to have lower knowledge levels than males. In the post-intervention phase of the study, the majority of participants (70%) who completed the post-intervention phase had good knowledge level (75%) and the rest (25%) had fair knowledge level.

Conclusion

We concluded that education to enhance healthcare providers' knowledge about acute pediatric seizure management is mandatory. The study's findings imply that focused education can significantly raise knowledge levels aiming at raising the standard of care given to children with acute seizures in the ER.
The Effect of Ketogenic Diet on Platelet Function in Children with Drug-Resistant Epilepsy
Authors: Nassar May F , Shata Mennatallah O , Ibrahim Haya E , Abou Elwafa Menna Allah Z , Ibrahem Dina M
Published: November 2024

Background

The ketogenic diet (KD) is a high-fat, adequate-protein, low-carbohydrate diet. As a special diet, the KD provides daily nutritional needs for children while controlling seizure and thus decreases the use of antiepileptic drugs. Several studies have reported pathological coagulation parameters and platelet abnormalities in patients treated with various antiseizure drugs (ASDs), especially for Valproic acid (VPA). The KD is frequently used in combination with antiepileptic drugs (AEDs), which may increase the risk of bleeding tendency, particularly with concomitant use of VPA or Topiramate.

Objective

To assess platelet count and function at baseline and six months after starting the KD in children with drug resistant epilepsy (DRE).

Methods

This prospective cohort study was conducted on 25 DRE children treated with KD for 6 months with age range of 4 months -14 years in the Children ‘s Hospital, Ain Shams University, Cairo, Egypt. They were assessed for anthropometric measurements, detailed medical history, history of bleeding symptoms, complete physical examination, neurological examination, and laboratory assessments as Complete Blood Count (CBC) and platelet function by ADP level at start and after 6 months of ketogenic diet treatment.

Results

There is no statistically significant change between platelet count and function initially and after 6 months of KD treatment, most of the patients (44%) were maintained on combination of Valproic acid and Levetiracetam and (40%) were maintained on triple therapy Valproic acid, Levetiracetam and Topiramate.

Conclusion

KD is an effective, safe, and tolerable therapy for children with DRE. No excessive bruising or other bleeding events were observed in any studied patient on KD.
Association between Serum 25 OH Vitamin D Level and Pediatric Complicated Community Aquired Pneumonia
Authors: Ezzat Deraz Tharwat , Hussien Mahitab Morsy , Kamal Tarek Mostafa , Mohamed Enas Maher Mahmoud
Published: November 2024

Background

The most common infectious killer of children under 5 years old worldwide is pneumonia. The frequency of vitamin D deficiency in children and teenagers has been found to be very high all over the world. It has been suggested that vitamin D deficiency may be a risk factor in the epidemic of acute lower respiratory tract infection (ALRTI), especially community acquired pneumonia (CAP).

Objectives

to investigate serum vitamin D level in pediatric patients hospitalized with complicated pneumonia (CP).

Patients and Methods

This was a case control study that was held in Children’s Hospital, Ain Shams University, where 100 children admitted to the hospital with complicated pneumonia, 100 children with uncomplicated pneumonia and 120 apparently healthy control children were enrolled in this study. The serum 25-hydroxy vitamin D (25D) level was assessed using ELISA method.

Results

In comparison to controls, 25-OH vitamin D serum level was significantly lower in patients with CP and uncomplicated pneumonia (p 0.001). Also compared to controls (19%), CP (60%) and uncomplicated pneumonia (40%) had higher rates of vitamin D deficiency. Also individuals with vitamin D deficiency are 1.7 times more likely to develop complicated pneumonia (CP) than individuals with uncomplicated pneumonia (OR = 1.69; (95% CI: 0.91-3.14), p = 0.001).

Conclusion

Vitamin D deficiency is a risk factor for the development of pediatric pneumonia and progression to complicated pneumonia.