bluuebunny/crossref_metadata_2025 huggingface dataset:
Testing Tolerance in Cow Milk Protein Allergy Patients: Milk Ladder or Direct Milk Administration?
Authors: Saber Ahmed Mohamed Hamdy , El-Gendy Yasmine Gamal , Awad Yosra Mohamed Mohsen , Hammad Nesreen Mahmoud Mohamed
Published: November 2024

Background

Cow’s milk protein allergy (CMPA) is a major health concern; its prevalence is between 1.9% and 4.9% in the first year of life. Tolerance to cow’s milk is tested after at least 6 months of elimination diet through two common approaches which are the milk ladder method and direct milk administration.

Aim

To compare tolerance frequency between those who had milk products reintroduced via milk ladder to those who were directly exposed to pure milk antigen after 6 months of elimination diet, and to assess the factors affecting the overall tolerance frequency of cow’s milk after 6 months elimination diet.

Methods

A randomized controlled clinical trial involving 116 children recruited from the Pediatric Gastroenterology Clinic, Children’s Hospital, in Shams University, diagnosed as non-IgE mediated cow’s milk protein allergy proven by elimination re-challenge test and followed six months of elimination diet. The included children were randomly assigned into 2 groups, where one group had milk products reintroduced via 6 steps milk ladder, and the second group had direct milk antigen administration in gradual increments. They were followed up for 2 months after the introduction of milk or milk containing products to confirm resolution of allergy.

Results

The overall tolerance rate after 6 months elimination diet was 81% with no significant difference between the two approaches (Direct milk 84.5%, and milk ladder 77.6%), in addition, the regression analysis showed that weight was a significant factor influencing the resolution of CMPA patients, with normal weight patients having higher chance of resolution than underweight patients (odds ratio=3.73).

Conclusion

Non-IgE medicated CMPA has high rate of resolution after 6 months elimination diet. Both approaches of introduction were equivalent.
Clinical Presentation of Type 1 Diabetes among a Cohort of Children and Adolescents from El-Beheira Governorate
Authors: Salem Mona Abdelkader , Elhenawy Yasmine Ibrahim , Zereban Nema Hussien , Arafat Omnia Elsayed Elsayed
Published: November 2024

Background

Type 1 diabetes (T1DM) is multifactorial; family history and genetic predisposition, presence of autoantibodies, physical stress, and exposure to illnesses such as viral infections, disease of the pancreas, age, race, geography, and early diet are the main T1DM risk factors that have been identified.

Objective

To identify the patterns of clinical presentation among patients with type 1 diabetes from El-Beheira Governorate and to explore family history of type 2 diabetes (T2DM) and its impact on the presentation of type 1 diabetes among offspring.

Patients and Methods

This cross-sectional study was conducted at the diabetes clinic in El-Beheira Governorate and included 119 children with T1DM regularly following up during the period from March 2023 until June 2023. The study assessed the age of onset of diabetes, insulin dosage, the presence of a family history of both type 1 and type 2 diabetes among the study population, the initial presentation of diabetes, and the presence of complications.

Results

During the study period, a total of 119 patients were included, with a female predominance (64.7%). The median age at presentation was 6 years old. Hyperglycemia was the most frequent presentation in the studied population (66.4%), followed by DKA. Children with a positive family history of T2DM were significantly older at the onset of the diagnosis of T1DM, and they required significantly higher basal and mealtime insulin dosages to achieve glycemic control (P < 0.05). Furthermore, patients with a positive family history of T2DM had higher levels of cholesterol and triglycerides (P < 0.05).

Conclusion

Patients with a positive family history of T2DM required more insulin to achieve glycemic control, which could be attributed to factors related to insulin resistance. Further studies on a larger geographical scale with a larger sample size are required to emphasise our results. This may help to figure out the effect of family history of T2DM on the presentation of patients with T1DM.
Safety and Efficacy of L-Glutamine in Reducing the Frequency of Acute Complications Among Patients with Sickle Cell Disease: A Randomized Controlled Study
Authors: Mohamed Samah Mohamed Ahmed , Makkeyah Sara Mostafa , Aly Nihal Hussien , Okba Ahmed Ashraf Mahmoud , Shaheen Naglaa Mohammed , Ebeid Fatma Soliman Elsayed
Published: November 2024

Introduction

Patients with sickle cell disease (SCD) suffer from recurrent and unpredictable episodes of acute pain due to vaso-occlusive crisis (VOC) which may require hospitalization and they also develop chronic persistent pain. Since pain usually begins in infancy and continues throughout life, preventing the genesis of pain is comparatively higher than treating the pain once it has been evoked VOC represents the cause of almost 95% of hospitalizations for patients with SCD. L-glutamine is an amino acid needed for the synthesis of the pyridines for nucleotides, including nicotinamide adenine dinucleotide (NAD) and glutathione, in addition to glutamate, and becomes essential during oxidative stress exposure. The NADH: [NAD+ + NADH] (redox) ratio in sickle red blood cells (RBCs) is lower than in normal RBCs which is related to oxidative stress, so L-glutamine availability is important in SCD. Although the FDA-approved it for preventing acute complications in SCD, still has many gaps in our understanding of its therapeutic implications.

Aim

To evaluate the safety and efficacy of L-glutamine in reducing the number of VOCs in patients with SCD.

Methods

This is an investigator-initiated single-center phase 4 interventional randomized controlled trial at Ain Shams Pediatric Hematology Unit. Sixty SCD participants, their mean age was 9.2 ± 3.7 years, they were 35 males and 25 females, were randomly assigned in a 1:1 ratio to receive glutamine at a dose of 0.3 gm/kg/dose twice daily orally (up to a maximum of 15 g/dose) for 24 weeks or the standard of care (SOC) without glutamine intake.

Results

Thirty-seven (62%) had HbSS with 38% had other sickle cell variants. All participants were receiving HU therapy and were on stable dose during the last three months prior to enrollment. Almost half of the patients (48%) were on chelation therapy with deferasirox. Thirty SCD patients were recruited in each group either received glutamine or SOC, both groups were comparable as regards demographic data. All patients in both arms had VOCs in the last year more than two. For the primary endpoint, there was a decreasing trend in the number, severity, and hospitalization of VOC in the glutamine arm and there was a significantly lower cumulative number of VOCs in the glutamine group (38.9%) than SOC (52.8%) (p = 0.008) and lower cumulative number of hospitalizations (p < 0.001).

Conclusion

Glutamine reduced the number of VOCs and hospitalizations for VOC in our cohort with SCD.
Levels of Tumor Necrosis Factor Alfa and Iron Status in Pediatric Patients with Newly Diagnosed Solid Tumors
Authors: El-Laboudy Mohamed Abd El-Mohsen , Makkeyah Sara Mostafa , Mohamed Sara Sobhy , Elwafa Menna Allah Zakaria Abou , Kader Salwa Mostafa Abd El
Published: November 2024

Background

Tumor necrosis factor alfa (TNF-α) plays a crucial role in the etiopathogenesis of cancer related anemia. Aim: To assess the levels of TNF-α, erythropoietin (EPO), and iron status in relation to anemia in children with newly diagnosed solid tumors.

Methods

we measured serum levels of TNF-α, EPO and assessed iron status using enzyme linked immunosorbent assay in 42 patients (20 non-anemia and 22 anemic) with newly diagnosed solid malignancies and compared them to 25 age- and sex-matched healthy controls.

Results

Among the 42 patients enrolled, 14 (33.3%) patients had brain tumors, seven (16.6%) were diagnosed with neuroblastoma, and four (9.5%) with Wilms tumor. The mean hemoglobin levels were 12.39±0.8 g/dl and 9.57±1.3 g/dl in non-anemic and anemic patients respectively. We found significantly higher levels of serum TNF-α and lower EPO levels among patients when compared to the control group (p < 0.001). A post hoc analysis showed a significantly higher TNF-α and lower EPO levels among anemic versus controls (p < 0.001) and non-anemic versus control (p < 0.001). A significant positive correlation was found between both EPO and TNF-α in both anemic and non-anemic group (r = 0.48, p = 0.024) and (r = 0.44, p = 0.021) respectively. However, the median (IQR) levels of both TNF- α and EPO were comparable between both anemic and non-anemic patients (306 (237.5) pg/ml versus 353 (156.2) pg/ml, p = 0.47) and (93 (46) mIU/ml versus 87 (51) mIU/ml, p = 0.48) respectively. The median (IQR) levels of serum ferritin and transferrin saturation index (TSI), as well as; serum TNF-α did not correlate with any of the red cell indices yet; directly correlated with platelet counts (r = 0.491, p = 0.02).

Conclusion

Children with solid malignancies have significantly higher levels of TNF-α and impaired EPO responses than normal children, however, no significant effect was observed for either on hemoglobin and red cell indices. Whether the positive relationship between TNF- α and EPO suggest other mechanisms of TNF- α related anemia needs further studies.
Prefilled Saline Syringes versus Those Prepared at Bedside for Flushing Central Venous Catheters in Neonatal ICU
Authors: Imam Safaa Shafik , Ismaiel Elkomy Shereen Atef , Allam Rabab
Published: November 2024

Background

A central line-associated bloodstream infection (CLABSI) is defined as a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of a central line placement. CLABSI is the most common type of nosocomial infection in this population and is a leading cause of morbidity and mortality in NICU. Therefore, more efforts are needed to reduce the incidence of CVC-related infections among NICU patients, and to enhance their survival and prognosis.

Aim of the Work

To compare the effect of using of prefilled saline syringes prepared in the laminar flow under complete aseptic conditions vs using ones prepared at bedside for central venous access flushing regarding risk of CLABSI, catheter permanence time, risk of thrombosis, and length of stay in our NICU.

Patients and Methods

This prospective randomized controlled trial in Ain Shams University Hospital NICU over a 6-month period from January 2023 till July 2023. They were selected through simple random sampling method to be divided into 2 groups:

Group 1 (cases): 50 patients had their CVCs flushed by 3ml syringe prefilled with saline 0.9% prepared in the laminar flow on the same day.

Group 2 (controls): 50 patients had their CVC flushed through manually prepared 3 ml syringe prepared at bedside from a common bottle of saline 0.9%.

Results

It was found that Group 1 patients had significantly lower incidence of CLABSI than Group 2 patients (4 versus 13 neonates) (p-value <0.0001). The incidence of CVC thrombosis was shown to be less in Group 1, however, this difference was non-significant (2 versus 1 neonate) (p-value 0.557). This study showed there was no statistically significant difference between both groups regarding the catheter permanence time (8.56 ± 6.52 versus 10.46 ± 6.29) (p-value 0.146). There was no statistically significant difference between both groups regarding the length of hospital stay in studied patients, 26.5 (14 – 37) in Group 1 versus 25 (12 – 32) in Group 2 (p-value 0.704).

Conclusion

The use of prefilled saline syringes for flushing of central venous catheters in neonates has shown to significantly reduce the risk of CLABSI, reduce incidence of catheter- related thrombosis, and flushing time, thus improve quality of care in neonatal ICU.
Neonatal Modified Pediatric Risk of Mortality Scoring System III and Perfusion Index in Neonatal Intensive Care Units
Authors: Hassan Maha , Haseeb Walaa , Ibrahim Mariam
Published: November 2024

Background

Pediatric Risk of Mortality (PRISM) score III presents an excellent discriminatory performance and prediction, being used in many PICUs as a prognostic score to assess gravity of disease(Kaur et al., 2020). In our study we modified the PRISM score III variables to produce the neonatal modified PRISM score III (NM PRISM score III) using validated cut offs which were more specific to neonatal age to be able to predict risk of mortality in both preterm and full term neonates admitted to NICU. The perfusion index (PI), derived from the pulse oximeter signal, has been reported to reflect inadequate peripheral perfusion in critically ill newborns (Montiero et al., 2017). The combined use of NM PRISM score III and PI can be a helpful method in identifying mortality and morbidity in NICUs accurately.

Aim

to test the use of the NM PRISM score III in predicting risk of mortality in NICUs.

Methods

In this prospective observational study, we adjusted the PRISM score III to neonatal based parameters score; neonatal modified PRISM score III (NM PRISM score III) and applied it to 112 neonates admitted to NICU, Ain Shams university hospitals on day1 and day3 of admission using the most abnormal values of physiologic and laboratory data to calculate the score for patients who survived and patients who died. Perfusion index was also used as an adjuvant to the NM PRISM score III (combined use of NM PRISM score III and PI) as an indicator of peripheral circulation.

Results

There was a significant difference between patients who survived and patients who died for NM PRISM score III with median 4 and IQR 2.00-4.00 at day1 and median 3 and IQR 0.00-7.00 at day3, with p value < 0.001 both at day1 and day3 of admission. By using ROC curve NM PRISM score III can be used to predict mortality at day3 as the area under the ROC curve at day3 was 0.975, with sensitivity 93.1% and Specificity 91.6%. The combined use of NM PRISM score III and PI at day3 of admission can also be used as it represented the best discriminative tool for predicting mortality as the area under the ROC curve at day3 was 0.980 with sensitivity 96.6 % and specificity 91.6%.

Conclusion

Combined use of NM PRISM score III and Perfusion index at day III can predict mortality accurately in critically ill neonates admitted to NICU.
Different Modalities of Coverage of Acute Dorsal Hand Defects (Meta Analysis Study)
Authors: Mahmoud Nada Abdelsattar , Ahmed Hassan Lashin Riham Zakaria , Abdelhalim Mohamed Mamdouh , Alkholy Abdelraouf Abdelaziz Tawfik
Published: November 2024

Background

Injuries to the dorsal aspect of the hand often result in exposed tendons, joints, nerves, and bones, presenting significant challenges for reconstructive surgery. Various techniques, including skin grafts, local flaps, and free tissue transfer, are utilized to address acute dorsal hand defects, with the primary goal of restoring functionality while minimizing aesthetic impact.

Aim of the Work

This study aimed to review and analyze outcomes from previously published papers to evaluate different flap modalities' efficacy in dorsal hand defect coverage.

Patients and Methods

A comprehensive review of the literature was conducted to identify studies reporting outcomes of flap procedures for dorsal hand defects. Included studies varied in sample size, demographic data, and follow-up duration.

Results

The analysis revealed the limitations of conventional skin flaps, leading to the emergence of thinner flaps and free flaps as alternative options. While free flaps have become the standard for their versatility, thinner flaps offer advantages in aesthetics and reduced need for debulking procedures. Patient satisfaction rates were generally high across modalities, although outcomes varied based on individual factors and surgical techniques. Aesthetic outcomes did not significantly differ between flap types, with venous flaps demonstrating superior visual outcomes.

Conclusion

Dorsal hand reconstruction poses challenges necessitating meticulous surgical planning and postoperative care. While various flap modalities offer viable options, continued research is needed to optimize outcomes and address individual patient needs effectively.
Evaluation of Bovine Scapular Cartilage as a Valid Training Model for Auricular Carving
Authors: Ragab Aya Essam Ahmed ElSayed , Hweidi Ahmed Sobhi , Bakry Sameh Adel Desawy , ElShahat Ahmed
Published: November 2024

Background

Nowadays, surgical reconstruction with autologous tissue is the most common clinical practice. The procedure requires a high level of manual and artistic techniques of a surgeon in carving and sculpting of harvested costal cartilage of the patient to recreate an auricular framework to insert within a skin pocket obtained at the malformed ear region. The aesthetic outcomes of the surgery are highly dependent on the experience of the surgeon performing the surgery. For this reason, surgeons need simulators to acquire adequate technical skills out of the surgery room without compromising the aesthetic appearance of the patient.

Aim of the Work

The objective of this study is evaluation of Bovine Scapular Cartilage as a Valid Training Model for Auricular Carving.

Patients and Methods

15 Bovine scapular cartilages were used by 16 trainees as training model for ear carving. Some of cartilages were cut to resemble the 8th floating rib and the other were cut to resemble syncytium. 3/0 prolene sutures, needle holder and surgical blade were used, also carving of framework was done by using either 2D xray film patron or 3D printed auricle.

Results

Bovine scapular cartilage model is a valid model to teach the carving of the ear for ear reconstruction surgeries. All of the participants were able to successfully carve a satisfactory ear framework by using the surgical blade also make a suture by 3/0 prolene tip round suture in the cartilage. Moreover, this cartilage gives good replica of human cartilage in consistency and flexibility as it was easy to carve in it the 8th floating rib and syncytium part.

Conclusion

Bovine scapular cartilage is considered an ideal model for training to achieve experience in auricular carving.
The Effect of Adding Stromal Vascular Fraction (SVF) to Hydrocolloid Dressing to Enhance Healing of Donor Sites of Split Thickness Skin Grafts
Authors: ElShahat Ahmed , AbdelGelel Mohamed Youssef , Mamdouh Mohamed , ElSherbeny Khaled M , Erfan Moatasem
Published: November 2024

Background

Wound healing is complex process, which requires suitable environment to enhance the healing process. With the advancement in technology, many new wound dressings have been introduced for use on split-thickness skin graft donor sites to treat different types of wounds by targeting various aspects of healing process. An ideal donor site wound dressing can reduce pain, lower the risk of infection, encourage hemostasis, and accelerate the healing process. This dressing would also be simple to manage, simple to apply in the operating room, and affordable. The use of hydrocolloid dressing to promote healing of donor site of STSG is a well-established technique.

Aim of the Work

The main aim of this study was to evaluate the effect of adding Stromal Vascular Fraction (SVF) to Hydrocolloid Dressing to enhance reepithelization and quality of scars of donor Sites of Split Thickness Skin grafts.

Patients and Methods

Twenty-seven post burn and post traumatic patients admitted to plastic, burn and maxillofacial department in Ain Shams University hospitals which need coverage with STSG were included in this study. A prospective comparative interventional self-controlled clinical study was conducted on donor sites of STSG, In which donor sites of STSG were divided into two equal halves where the upper half was injected intradermally with SVF with application of hydrocolloid dressing (group A), and the other half was covered with hydrocolloid dressing only (group B).follow up of reepithelization at donor sites were evaluated at day 10th, 15th, 21th and 1 month post harvesting of STSG also Vancouver scar scale was used to assess the quality of the scar after 1 month.

Results

The result showed that among the studied population 51.9% were males and 48.2% were females with mean age of the study population was 33.37 ± 9.55 years ranged from 18 to 52 years. 85.2% of patients had burn raw areas, while only 14.8% had post-traumatic raw areas. The comparison between (group A) and (group B) according to time for reepithelization by days, we found that (group B) needed more time for healing by (18.56 ± 4.69) compared to (group A) which need (11.33 ± 1.92) days and this difference was statistically significant as p-Value <0.05. Also using Vancouver scar scale to assess the quality of scar, there was statistically significant difference between both (group A) and (group B) as (p-value = <0.001). Among study cases, there were only two cases (7.41%) where complicated by superficial infection, which settled in both halves of each case, was improved on repeated dressing.

Conclusion

The intradermal injection of SVF in donor site resulted in significant reduction in healing time, increased epithelium thickness and a significant improvement in scar quality with low rate of infection.
Evaluation of the Effect of Nanofat Grafting in the Healing Process of Chronic Ulcers
Authors: Saif Eldein Elsayed Sherief Mohamed , Helal Hesham Ali Ahmed , Ghanem Mohamed Abdelmohsen , Labib Jolly Mounir William , Abdelgawad Ebrahim Mohamed Amin
Published: November 2024

Background

Nano-fat is one of the richest sources of adipose-derived stem cells and other progenitor cells. This work aimed to assess Nanofat injection in chronic ulcers and evaluating its healing process.

Methods

This prospective randomized controlled study was carried out on 20 patients aged above 18 years old and less than 60 years old with no co morbidities, both sexes, with chronic ulcers with no healing for at least 3 months with conservative management, small sized ulcers maximum diameter of 5 cm, upper and lower limb traumatic ulcers. Patients were divided in to two equal groups: Group A: Scheduled for Nanofat injection. Group B: No plan for surgical intervention

Results

Collagen formation, re-epithelization, neovascularization, Vascularity, pigmentation, and height were significantly improved in group A than group B. Time frame for complete healing was significantly delayed in group B than group A. The median time for complete healing in Group A was 3 weeks, while in Group B was 16.5 weeks. Satisfaction was significantly increased in group A than group B. skin biopsies showed that epidermal thickness, the area % of elastic fibres and the number of proliferating cell nuclei of the group A were increased compared to the untreated ulcers of group B.

Conclusions

Nano fat grafting may be a promising treatment option for patients with traumatic ulcers, as it can improve wound healing outcomes and patient satisfaction.
Ultrasound-Guided Percutaneous Ethanol Ablation in Cystic and Predominantly Cystic Thyroid Nodules
Authors: Abdrabo Ahmed Abdelhaq Tawfik , Abd EL Hamid Hetta Waleed Mohamed , ElShimy Ahmed Mohamed Samy
Published: November 2024

Background

thyroid cystic and predominantly cystic nodules are frequent among the general population. Some can increase in size with time and cause pressure and cosmetic symptoms. Their standard line of treatment is usually simple aspiration which was found to have high recurrence rate. Recurrent cystic thyroid nodules were considered for surgical removal which had many serious adverse effects.

Aim of the Work

to evaluate the efficacy, and safety of ultrasound guided percutaneous ethanol injection in cystic and predominantly cystic thyroid nodules in patients referred to Interventional Radiology Unit; Ain Shams University Hospitals.

Patients and Methods

The study was conducted at the Interventional Radiology Unit; Radiology Department, Ain Shams University Hospitals and conducted 20 patients with cystic thyroid nodules.

Results

The present study concludes that EA should be considered as the first option for the treatment of pure cysts and predominantly cystic nodules that are not treated with simple aspiration. EA of thyroid cysts having solid component has limited therapeutic effect and may require multiple sessions. Unlike surgery, EA is a safe procedure that is easy to repeat, is inexpensive, can be performed easily on an outpatient basis, and has only transient side effects.

Conclusion

EA should be considered as the first option for the treatment of benign cystic thyroid nodules, especially pure cystic nodules that are not treated with simple aspiration. EA of thyroid cysts having solid component has limited therapeutic effect and may require multiple sessions. Unlike surgery, EA is a safe procedure that is easy to repeat, is inexpensive, can be performed easily on an outpatient basis, and has only transient side effects.
Chronic Hip Pain of Musculoskeletal Origins: Ultrasonographic Evaluation with MRI Correlation
Authors: Ismail Mohsen Gomaa Hassan , Allam Allam El-Sayed , El-Ghamry Saba Ahmed , Youssef Youssef Ahmed
Published: November 2024

Background

Hip pain can be difficult to attribute to one single specific cause, both clinically and radiographically. Yet, there are often subtle signs that point to the nature of the pathology differentiating intra-articular from extra-articular causes of pain.

Aim of the Work

The purpose of this study is to investigate and evaluate the accuracy of sonographic findings compared with magnetic resonance (MR) imaging findings in the diagnosis of different causes of chronic hip pain in adults in order to consider it as an adequate practical alternative when MRI primary assessment is not.

Patients and Methods

This is cross sectional study included 45 patients with chronic hip pain was conducted at Department of Radio-diagnosis, Ain Shams Universities and other private centers.

Result

The study is based on four findings that constitute the undergoing pathologies causing chronic hip pain, and were used as points of comparisons between the two imaging modalities to determine their ability to identify each.

Conclusion

Despite the fact that Ultrasound requires a skilled practitioner, it can be a reliable imaging modality in assessing tendon pathologies and we suggest it should be used not only as a complementary procedure to MR but also an effective alternative.
Role of Magnetic Resonance Elastography in Assessment of Hepatic Focal Lesions
Authors: Abo El Maaty Mohamed El Gharib , Hussein Ahmed Mohamed , Mohamed Hesham Salah , Abd EL Naby Ahmed Ali
Published: November 2024

Background

Hepatic focal lesions have been a common reason for consultation faced by gastroenterologists and hepatologists. It is important to consider not only malignant liver lesions, but also benign solid and cystic liver lesions.

Objective

to evaluate and confirm the role of magnetic resonant elastography in assessment of the hepatic focal lesions and differentiate benign from malignant hepatic focal lesions.

Patients and Methods

This is a cross sectional study included 30 patients with variety of focal lesions identified either by dynamic MRI or by histopathology.

Results

Our study showed that a cut off value of 4 Kpa had a 90% sensitivity, 85.7% specificity, 95% positive predictive value, 75% negative predictive value and accuracy 90 %.

Conclusion

MRE showed a great potential as a promising non invasive technique for quantitative evaluation of hepatic masses that could introduce more data useful in characterization of the focal lesions.
Comparative Study between Ultrasound and Magnetic Resonance Imaging for Inflammatory Peripheral Joints Pathology
Authors: Mahmoud Aly lnji wagdy , Azim Abbas Yasser Abdel , Ghandour Ahmed , Samy ElShimy Ahmed Mohamed
Published: November 2024

Background

Musculoskeletal ultrasound (US) and magnetic resonance imaging (MR1) are two new imaging methods that play a significant role in the diagnosis, therapy selection, and disease monitoring of inflammatory disorders of the joints.

Aim

To compare the ultrasound & MRI findings in inflammatory pathology of peripheral joints.

Methods

The study included patients who were referred with clinically suspected peripheral joints inflammatory pathology for MRI evaluation. All the patients had been subjected to MRI followed by Ultrasound assessment and the results had been compared.

Results

This research was conducted on 22 cases with clinically suspected peripheral joints pathology. There was a significant excellent agreement among US & MRI in detection of hands & feet muscles tenosynovitis, marginal osteophytes, bony calcaneal spur, planter fasciitis (kappa = 1.00, p < 0.00l). There was a significant good agreement among US & MRI in detection of joint effusion (kappa = 0.792, p < 0.00l). There were two cases that positive for talar head marrow contusion in MRI who cannot he detected by US with no agreement between US & MRI in detection of talar head marrow contusion.

Conclusion

Both ultrasound & MRI findings showed an excellent agreement and high accuracy in detection of non-traumatic pathology of peripheral joints.
The Role of Diffusion Tensor Images in the Evaluation of the Median Nerve in Patients with Carpal Tunnel Syndrome
Authors: Ali Suzan Bahig , Kamal Mai Mokhtar , Nesseem Karen Samy
Published: November 2024

Background

Carpal tunnel syndrome (CTS) is a common medical condition, which causes pain, numbness, and tingling in the hand and arm of the affected individual. CTS occurs when the median nerve is squeezed or compressed as it travels through the wrist. Risk factors for CTS include obesity, monotonous wrist activity, pregnancy, genetic heredity, and rheumatoid inflammation

Aim of the Work

The aim of this study is to evaluate the role of Diffusion tensor images in the detection the changes and abnormalities of median nerve entrapment in cases of carpal tunnel syndrome.

Patients and Methods

This Cross-sectional study was carried out on 25 Patients diagnosed as carpal tunnel syndrome from physical medicine, neurology and orthopedic clinics at Ain Shams University.

Results

Regarding the Clinical picture in the studied patients, we found that there was pain, parathesia and wastening of the thenar muscles (in 100%,96% and 12% respectively). Diabetics, rheumatic arthritis patients were found in 24% and 8% respectively), A case with bifid median nerve. Regarding the severity of the symptoms by Nerve conduction studies (NCS) in the studied patients, we found that symptoms were mild for 20 %, moderate for 64 % and severe for 16 % of the cases. Regarding the Cross sectional area (CSA) (mm∧2) in the studied patients, we found that the mean inlet and outlet were 21.92 ± 7.215, 14.41 ± 5.051 respectively. Regarding the T2 Weighted images (MRI sequence) in the studied patients, we found that increased T2 signal, bowing of capsule, thickening at inlet and flattening at outlet were noted in (100% for all), increased CS diameter was seen in (92%) and edema in (28%) of the cases.

Conclusion

In conclusion, we found that the mean FA and ADC were 0.431± 0.064 and 0.431± 0.064 respectively, FA was cutoff, sensitivity, specificity (0.47,20%, 70% respectively) and ADC was cutoff, sensitivity, specificity (1.054, 40%,25%/ respectively) and there was negative correlation and no statistically significant between FA and ADC (P-value 0.189) and therefore when we recommend new cutoff values for FA and ADC to be (0.412 and 1.049 respectively).
Safety and Efficacy of Carotid Artery Stenting without the Use of Protective Embolic Devices
Authors: Ismail Khalid Tarek , Ahmed Abd El-Samad Amr Mahmoud , Shokry Wessam Sherin
Published: November 2024

Background

Stroke is the third most common cause of disability and second most common cause of death worldwide. Extra cranial carotid stenosis accounts for about 15-20% of cerebral ischemic events.

Aim of the Work

To evaluate the efficacy, and safety of carotid artery stenting without using cerebral protection device in selected patients with symptomatic high risk carotid artery stenosis.

Patients and Methods

All available patients during the study duration will be included in the study, NIR unit archives of all available carotid artery stenosis cases meeting the inclusion who underwent carotid artery stenting without using embolic protection devices as well as patients who will be referred to NIR Unit with carotid artery stenosis meeting the inclusion and exclusion criteria and candidates for the procedure in the proceeding 6 months.

Results

In our study of assessing safety and efficacy of unprotected CAS all cases were clinically assessed using the NIHSS as a baseline before CAS. Immediately after the intervention, seventy-eight cases (97.5%) had no change in their initial NIHSS and two cases (2.5%) showed mild deterioration of the NIHSS with no cases showing major disabling strokes nor neurological related deaths peri procedurally and during follow up period.

Conclusion

Carotid stenting without the use of embolic protection devices performed by skillful experienced hands can achieve satisfactory safety and efficacy outcomes as long as we rely on tailored approach for patient selection especially in settings of low resources.
Pancreatic Shear Wave Elastography in Pediatrics with Type I DM
Authors: Mahmoud Marwa Ashraf , Osman Noha Mohammad , Ali Ali Haggag
Published: November 2024

Background

Type I diabetes milletus (DM) is one of the most prevalent autoimmune diseases in the pediatric age group. It is characterized by pancreatic inflammation in the early stages due to autoimmune destruction of the insulin producing beta cells with subsequent fibrosis in the late stages. Conventional gray-scale ultrasonography can provide detailed information about the bio- mechanical structure of tissues when used with the new method of elastography. As tissues affected by a variety of pathologic processes display different mechanical features, stiffness differences may be used to differentiate diffuse diseases or focal lesions.

Objective

To assess the role of pancreatic shear wave elastography (SWE) in children with type I diabetes in comparison to control subjects.

Methods

A cross-sectional study over the course of 6 months from March 2023 till September 2023. It included 41 cases with laboratory proven type I DM on insulin therapy and 41 age and gender matched non-diabetic controls referred to our department from the outpatient pediatric clinics for and abdominal ultra-sonography. C-peptide and HbA1C of the cases were measured. Conventional B-mode ultrasonography and pancreatic SWE were performed using the General Electric Logiq P9 ultrasound system.

Results

Conventional B-mode abdominal ultra-sonography together with pancreatic shear wave elastography were done to the entire study group. There was no significant difference by B-mode noted between the study subjects regarding echogenicity and homogeneity. Shear wave elastography (SWE) values of the diabetic cases and non-diabetic controls were compared and revealed a significant difference between both groups being faster in the cases than in the control group with p-value <0.05. Shear wave elastography values of the cases were compared to each other in respect to their disease duration, age, C-peptide levels and HBA1C levels and there was a statistically significant positive correlation between SWE, disease duration and age with p-value <0.001, while there was statistically significant negative correlation between mean of SWE and level of C-peptide with p-value <0.001. There was no significant correlation with HbA1c with p-value 0.116.

Conclusion

Type I DM affects pancreatic tissue stiffness as evident by the difference in the mean SWE values of the diabetic cases and the non-diabetic controls. Pancreatic SWE changes significantly in correlation to disease duration, age and C-peptide. Hence, SWE might serve as a new promising non-invasive imaging modality for monitoring and following up type 1 diabetes in children.
The Incidence of Breast Cancer in Egyptian Females in Correlation to Different Mammographic ACR Densities
Authors: Salem Marwa Ramzy Hamdy , Moneim Tewfik Chalabi Nivine Abdel , Boraei Mohammed Azza Abdel Ghaffar , Yacoub George Ezzat Elkess
Published: November 2024

Background

Breast density, radiologically, referred as fibro glandular mammary tissue, was found to be a predisposing factor for breast cancer (BC). However, the stated degree of elevated BC risk varies widely in the literature.

Objective

To detect the relationship between different breast mammographic densities and risk for BC in Egyptian females.

Patients and Methods

An analytical cross-sectional prospective study was conducted at Ain Shams University Hospital, National Project for Women Health and Private Centre in the period from December 2020 to December 2021. The study was applied to 814 asymptomatic females above 35 years old who came for BC screening using full-field digital mammography.

Results

The incidence of BC was found in 84 females (10.3%). The BC incidence in females with ACR-A was 6.3%, ACR-B was 8.5%, ACR-C was 16.3% and ACR-D was 27.8%, with a p- value (p < 0.001). Using logistic regression analysis showed that three types of breast densities increased the risk of BC, where patients with type-B, type-C, and type-D breast density had a 1.39, 2.92, and 3.12 times more risk for BC, respectively (p value= 0.010, 0.003, and 0.036 respectively).

Conclusion

Among Egyptian females, the incidence of BC is 10.3%. Our data revealed that the more breast density, the higher the incidence of BC, and affirmed that breast density is a risk factor for BC development.
Early Detection of Myocardial Iron Overload in Patients with β-Thalassaemia Major Using Cardiac Magnetic Resonance T1 Mapping
Authors: Selim Omar Mourad Hassan Zaki , Ibrahim Ahmed Samir , Abbas Sherif Nabil , Aly Nihal Hussien , Ebeid Fatma Soliman Elsayed
Published: November 2024

Introduction

Iron-induced cardiomyopathy is a leading cause of death in patients with β-thalassemia major. Chelation therapy is effective in removing cardiac iron and improving survival rates. However, early diagnosis is often delayed. The T2* technique, which is used for quantifying myocardial iron overload, has limitations in detecting early iron overload. In vivo mapping of the myocardial T1 relaxation time is a promising alternative that could improve early detection and management of iron-induced cardiomyopathy.

Methods

32 β-thalassemia major patients were enrolled in our study with mean age 11.5 ± 4 years. Measurement of the mid-level septal iron overload was done through T1 mapping using modified Look-Locker inversion recovery sequence with a 3 (3 s) 3 (3 s) 5 scheme. Septum was divided at the mentioned level into 3 zones namely zone 1, zone 2 and zone 3 which correspond to segments 8 & 9 in cardiac segmentation model.

Results

The T1 technique was able to detect 4 patients with myocardial iron overload, two of which were detected by the T2* technique. There was a statistically significant correlation between the average T1 values of the studied zones in patients with β-TM and the LIC, the T1 Values within segment 8 of the liver, age of patients, transfusion onset age, age of splenectomy and serum ferritin value.

Conclusion

The addition of the T1 Mapping sequence to the conventionally used T2* technique was able to increase the efficacy of the Myocardial iron overload detection protocol by earlier detection of Myocardial iron overload. This would guide chelation therapy to decrease myocardial morbidity.
Diagnostic Accuracy of Quantitative, Qualitative and Semi-Quantitative Delayed Post Gadolinium MR Imaging Criteria in Meniere's Disease
Authors: El Meguid Mohammed Radwa Abd , Mohamed Ahmed Mostafa , Elkhalek Yaser Ibrahim Abd , Hashish Mahmoud Ahmed
Published: November 2024

Clinical Relevance

The recent detection of endolymphatic hydrops (EH); the pathological hallmark of MD; on the delayed post gadolinium MR hydropic sequences has resulted shift in the diagnostic paradigm. Researchers defined various MRI qualitative, quantitative, and semi-quantitative criteria and grading scales for endolymphatic hydrops however, the best performance and combination of MRI criteria in distinguish MD affected ears is little explored. Establishing the most reliable and highly performing MRI features will improve the ability of the radiologist to diagnose Meniere’s Disease.

Objectives

To evaluate the diagnostic performance of MRI criteria used for the detection of Menière’s Disease (MD) ears on delayed post-gadolinium MRI. To determine which combination of descriptors should be optimally applied to establish the diagnosis.

Materials and Methods

This retrospective case-control study evaluated consecutive delayed post-gadolinium MRI of patients with Menièriform symptoms. 7 quantitative and semi-quantitative MR criteria of MD and qualitative perilymphatic enhancement (PLE) in the cochlea were evaluated within the study cohort. Definite MD ears according to the 2015 Barany Society criteria were compared to control ears. Sensitivity and Specificty were calculated for each descriptor to determined which combination of MRI descriptors would best predict MD ears, and the area under the ROC curve for this model was measured.

Results

50 patients (30 female, 20 males; age mean 50 ±13 years) with 30 definite MD and 15 control ears were evaluated. Of the defining MRI criteria, the grade 2 cochlear hydrops, the grade 2 vestibular hydrops, saccule as large as utricle and cochlear perilymphatic enhancement were associated with the presence of MD ears (p < 0.05). The highest sensitivity was achieved by severe vestibular hydrops and “saccule, as large as the utricle”.

Conclusion

The best predictors of MD are the quantitative detection of severe vestibular hydrops together with the Semiquantitative detection of enlarged or confluent saccules which add value to the diagnosis.
Radiological & Clinical Manifestations of COVID-19 in Children: A Review of 100 Cases
Authors: Ibrahim Mohamed Reham Abdelhamid , Mohammad Shaimaa Abdelsattar , Hussein Mahitab Morsy , Abdelkarim Maha Ahmed Sayed
Published: November 2024

Background

Severe acute respiratory distress syndrome that was caused by SARS-CoV-2, has become a global pandemic.

Aim of the Work

To describe the X-ray and CT features of COVID-19 in children and to correlate a CT and X-ray based semi-quantitative scores of pulmonary involvement in COVID-19 disease with clinical severity of the disease and to correlate CT and X ray scores to investigate whether X-ray sufficient in the clinical evaluation of patients.

Patients and Methods

A retrospective analysis of CT and x-ray pulmonary findings of 100 case of COVID-19 was included. CT& x-ray scores were calculated and correlated to patients’ clinical severity. The study included 49 girls and 51 boys. Their mean age was 6.25 years.

Results

Eighty-five children had done CT chest (85%), X-ray was available in fifty eight (58 %). Both X- ray and CT were available in forty three children (43%). According to the severity of COVID-19 among patients, 31 % of the patients were mild, 40% were moderate, 18 % were severe and 11% were critically ill. On CT, we found that consolidation patches were the most common radiological sign seen in 41.2% of the patients, followed by GGO which was found in 37.6% of the patients. The lesions were bilateral (40%), and multilobar (44.7%), predominant lobes affected were both lower lobes involved in 42.4 %, with a prominent peripheral distribution. Regarding the X-ray, the alveolar infiltrate in the form of GGO was the most common feature seen in 32.7% of the patients with predominant bilateral lower zones distribution (58.7 %). Cases with clinically severe and critically ill chest condition had a statistically significant higher CT and X-ray scores compared to other groups. (p value = <0.001 for CT score, p value=0.009 for x-ray score). X-ray score correlates to CT score (p value <0.001, r = 0.62). D dimer had a significant correlation with total CT score (p value=0.022).

Conclusion

X-ray score correlates to CT score. CT and X-ray scores are correlated to clinical severity. To reduce radiation exposure, X-ray may be sufficient in assessment of COVID-19.
Radiological Modalities in Frozen Shoulder Diagnosis: Role of MRI and US
Authors: Nassef Mohammed Amin , Hemida Tarek W , Abdelazim Shimaa Y
Published: November 2024

Background

The prevalence of frozen shoulder in the general population is 2–5 %, with most patients over 40 years of age and with women slightly more affected than men. Contralateral shoulder involvement is uncommon. Diagnostic imaging of the shoulder joint may be achieved with a number of modalities, including g plain x-ray, ultrasound, conventional arthrography, magnetic resonance imaging (MRI) and MR arthrography.

Objective

The objective is to examine the association between clinical features (stages) and MRI findings in adhesive capsulitis of the shoulder.

Methods

During this study, 28 patients with frozen shoulder were enrolled, after consenting each of them and subjected to MRI and US examination. The accuracy of magnetic resonance imaging versus ultrasound in early detection of frozen shoulder and exclusion of it among other painful shoulder cases was assessed.

Results

In detection of thickened inferior glenohumeral ligament (IGHL), the accuracy of ultrasound was 71.4%, sensitivity 65.2% and specificity 100.0% and MRI was statistically significant more accurate than ultrasound. As regard thickened coracohumeral ligament (CHL), the accuracy of ultrasound was 57.1%, sensitivity 66.7% and specificity 40.0%. Also, as regard altered signal or thickening within rotator interval, the accuracy of ultrasound was 71.4%, sensitivity 78.9% and specificity 55.6% with no significant between MRI and ultrasound. Finally the total accuracy of US in prediction of MRI findings was 78.6%, sensitivity 76.9% and specificity of 100.0%.

Conclusion

Ultrasound is advised to be used in assessment of cases shoulder stiffness rather than MRI. It is cheap, less invasive, accurate without radiation and suitable for all cases to them MRI is contraindicated. The present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes, to assess our results and conclusion.