bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association between Visfatin as A Marker of Isolated Coronary Ectasia and Its Severity: A Cross-Sectional study
Authors: Almaleh Ranya , Mortada Ayman , Elmahmoudy Ahmed , Elnozahi Mostafa
Published: July 2024

Aim and objectives

to assess the association between Visfatin level-as an independent marker -and the presence of coronary artery ectasia in patients undergoing diagnostic coronary angiography.

Patients and Methods

A total of 90 participants were recruited from candidates undergoing diagnostic coronary angiography in the Cath lab of Cardiology Department at Ain Shams University. They were then divided into three groups. The first group included individuals with normal coronaries, the second patients with coronary artery disease (CAD) without ectasia, and the third is patients with isolated coronary artery ectasia (CAE). After history taking, they all underwent biochemical tests for serum Visfatin, HBA1C%, serum creatinine and CRP. Univariate and correlation analysis was done.

Results

regarding demographic and clinical characteristics of our study population, we found that only higher age and being a smoker was significantly associated with the presence of ectasia. High level of serum Visfatin was strongly significantly associated with the presence of ectasia. Serum creatinine and CRP displayed a similar pattern. Moreover, we found that the mean level of serum Visfatin increases with the severity of ectasia according to Markis classification. Finally, Roc showed that a cut- off value of > 34 ng/ml demonstrated a sensitivity of 89% and a specificity of 87% of predicting CAE.

Conclusion

high serum Visfatin level is significantly associated with the presence of coronary artery ectasia. Also, it is positively correlated with its severity according to Markis classification. Hence, it can be a valuable predictor of CAE.
The Predictive Value of Estimation of N Terminal - Pro B- Type Natriuretic Peptide in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention for the Outcome of Myocardial Reperfusion
Authors: Megahed Dina , Altoukhy Sherif , Hamid Ibrahim Abdel , Tamara Ahmed
Published: July 2024

Background

Primary PCI is considered to be the preferred reperfusion strategy for STEMI. The goal of reperfusion is to resume normal blood flow to the cardiac tissues, and not just to achieve an open epicardial artery.

Aim of the work

The aim of this study was to evaluate the predictive value of NT-pro BNP before primary PCI in patients presenting with STEMI, for myocardial reperfusion assessed by the degree of ST resolution in the ECG 90 minutes post primary PCI, the TIMI flow and the MBG post primary PCI.

Patients and Methods

This study included 40 patients who presented to emergency departments of Ain Shams University hospitals and Misr University for Sciences and Technology hospital from September 2021 till June 2022, diagnosed with STEMI and had been revascularized by primary PCI as per the recommendations of The European society of cardiology guidelines for diagnosis and management of ST elevation myocardial infarction published in 2017. Serum samples for NT-pro BNP level were obtained before primary PCI to be correlated with the TIMI flow grade, the MBG, and the ST resolution post primary PCI.

Results

Our study had demonstrated that a higher baseline NT-pro BNP level is significantly associated with higher risk of poor myocardial reperfusion following primary PCI expressed by ST resolution less than 50%, TIMI flow grade less than 3 as well as MBG less than 3 and was also associated with higher incidence of No Reflow.

Conclusion

Initial NT-pro BNP level in STEMI patients correlates with myocardial reperfusion following primary PCI. This supports the potential use of NT-pro BNP as an early marker for risk stratification of patients with STEMI. High risk patients will be in need of more aggressive complementary treatment strategies to improve microvascular perfusion and optimization of the medical therapies to help decrease the development of heart failure.
Current incidence, risk factor and outcome of acute respiratory distress syndrome in Nasser Institute ICU, Cairo, Egypt
Authors: Ahmed Mona Mansour , Mohammed Rehab M , Abd ElKader Radwa Hassan
Published: July 2024

Background

Acute respiratory distress syndrome (ARDS) represents the severe end of a spectrum of acute lung injury due to many different insults. It manifests as acute and persistent lung inflammation with increased lung permeability.

Aim of the study

To assess the current incidence, risk factors and outcome of acute respiratory distress syndrome at Nasser Institute ICU during the period from January 2019 till the end of July 2019.

Methodology

The study enrolled 50 patients who were admitted to Nasser Institute ICU and met the Berlin criteria for ARDS during the study period.

Results

The incidence of ARDS was (3.12%), 54% of which were severe, 26% were moderate, and 20% were mild. Mortality rate was 52%, 88.46% of which were severe cases. Severity index was positively correlated with mortality rate (P- value <0.001). Pneumonia with sepsis was the most common risk factor (74%) and had statistically significant positive correlation with mortality (P = 0.017).

Conclusion

Incidence of ARDS was relatively small at our institute (3.12%), yet, it has a serious and a potentially fatal outcome with high mortality rate (52%).

Key words: Acute Respiratory Distress Syndrome, ARDS, ICU, incidence, risk factor, outcome, mortality, Nasser Institute.

Abbreviations: ARDS: Acute Respiratory Distress Syndrome. PaO2: Partial pressure of oxygen. FiO2: Fraction of inspired oxygen. PEEP : Positive end expiratory pressure.TV: Tidal volume. ABG: Arterial blood gases. PH: potential hydrogen. PaCO2: partial pressure of carbon dioxide. HCO3: Bicarbonate. SO2: blood oxygen saturation. ICU: intensive care unit.
The Role of Chest Ultrasound in the Diagnosis of Thoracic Tuberculosis
Authors: AL Makkawy Marwa Hassan , Elwahab Korraa Emad Eldin Abd , Madkour Ashraf Mokhtar , Ahmed Noha Othman
Published: July 2024

Introduction

There is limited data on the role of chest ultrasound (CUS) in thoracic tuberculosis (TTB). If the diagnostic accuracy of CUS for pulmonary TB (PTB) is similar to that for CUS in diagnosis of pneumonia, CUS could play an important role in diagnosis of PTB in areas without ready access to chest x-ray.

Aim of the work

This study aimed to describe the diagnostic features and utility of CUS in TTB. Comparing CUS findings in PTB versus community acquired pneumonia (CAP).

Patients and methods

Consecutive patients presenting with TTB and CAP to Abbasia Chest hospital between May 2019 to April 2020 were enrolled in this cohort study. CT of the chest, CUS, mediastinal ultrasound (US) and abdominal US to detect pericardial effusion were performed. CUS lesion pattern in thoracic TB, pulmonary TB and CAP cases were recorded.

Results

Sub-pleural nodules (97 patients, 95%), air-bronchograms (79 patients, 77,45%) and sub-pleural consolidations (SPC) (77 patients, 75.49%) were the most frequent features recorded by CUS in TB patients, CUS was able to report; pleural gap (28 patients, 27%), fragmented pleura (35 patients,34%), sub-pleural fluid collection (3 patients, 2.9%), and sub-pleural nodules (97patients, 95%) not detected by CT with P value < 0.05 for all. CUS was not only equal to CT in visualizing air-bronchogram (24 patients, 96%) and pleural effusion (4 patients,100%) in CAP, but also could detect fragmented pleura (12 patients, 48%) and SPC (8 patients, 32%) not detected by CT with P value < 0.05 for all.

Conclusion

CUS was more accurate than CT chest in diagnosis of TTB and CAP, it can report new patterns (pleural gap, fragmented pleura, sub-pleural fluid collection, SPN and SPC) not detected by CT.
Role of confocal laser endomicroscopy compared to high definition i- scan video bronchoscopy in patients with suspected lung cancer
Authors: Elwahab Koraa Emad Elden Abd , El-Assal Gehan Mohamed , Elhamid Farghaly Ayman Abd , Mohammed Ali Tamer , Hassan El_Sayed Maha Araby
Published: July 2024

Background

Lung cancer is the leading cause of cancer-related mortality worldwide. Overall 5-year survival is poor at 15% with little improvement over the last twenty years (1.59 million deaths). Besides effective prevention strategies against the commonest risk factor; tobacco smoking, lung cancer mortality can be reduced if cases are detected and treated early. It is important to detect bronchial carcinoma in situ (CIS) since over 40% of these can develop into invasive cancer. Screening tests using sputum cytology and chest radiograph have been used with limited success

Objective

to study the diagnostic performance of confocal laser endomicroscopy in comparison to high definition i-scan videobronchoscopy in patients with suspected lung cancer.

Patients and Methods

The study was performed at Pulmonary diseases hospital in Kobry Elkobba military complex for 2 years since January 2018 to December 2019. The study included 25 patients all had chest CT findings suspicious of lung cancer.

Results

i-scan findings showed 68% accuracy and 73.3% specificity, and findings of confocal laser endomicroscopy were 92% accuracy and 90% specificity.

Conclusion

This was the preliminary study establishing patient characteristics in Egypt in the form of a comparison between tow methods of diagnosis of lung cancer. The study showed the higher sensitivity of confocal laser endomicroscopy in the diagnosis of lung cancer approved by the results of the pathological specimens optioned under the visual of confocal laser endomicroscopy in comparison to I-scan method.
CTNNB1 Polymorphism (rs121913407) in Circulating Tumor DNA (ctDNA) in Egyptian Hepatocellular Carcinoma Patients: A Case Control Study
Authors: Kassem Perihan Hamdy , Mahmoud Ahmed Ramy Mohamed , Fawzy Montasser Iman Mohamed , Abdel Wahed Marwa Ali , Zakaria Hassan Safeya Hamdy , Abdel Rahman Amer Eman Mohamed
Published: July 2024

Background

Hepatocellular carcinoma (HCC) represents the sixth most common cancer worldwide and the fourth in Egypt. Persistent inflammation and specific somatic mutations in driving genes play major role in the development of HCC. One of these somatic mutations is CTNNB1 mutations with subsequent activation of ß-catenin in HCC, associated with a risk of malignant transformation. In this study, we investigate the clinical utility of peripheral blood circulating tumor DNA (ctDNA) CTNNB1 SNP (rs121913407) (c.133T>C) in HCC patients compared to pathological chronic hepatitis C virus (HCV) patients and healthy controls.

Aim of the Work

The aim of this work is to study the clinical utility of peripheral blood ctDNA to assess CTNNB1 SNP (rs121913407) (C. 133T>C) in HCC patients and the results will be compared to findings in pathological (Chronic Hepatitis C virus patients) and healthy controls.

Patients and Methods

Case-control study at Ain Shams Centre for Organ Transplantation, Ain Shams University Hospitals, enrolling twenty-eight adult HCC patients (twelve early HCC patients and sixteen advanced HCC patients), ten patients with chronic hepatitis C as a pathological control group, and ten healthy controls, plasma were collected, and stored at -80 °C. Detection of mutations in the gene locus CTNNB1 rs121913407 (c.133T>C) was done by Real-time PCR.

Results

There was statistical significant difference between early and late cases of HCC as regards AFP, AST however, all of our studied cases (early and advanced HCC) in addition to HCV and healthy control groups were CTNNB1 wild (TT) genotype.

Conclusions

None of our recruited subjects showed CTNNB1 rs121913407 gene mutation. Further studies on larger number of patients are needed to clarify and confirm the clinical utility of CTNNB1 Polymorphism (rs121913407) in the pathogenesis of HCC related to HCV in Egyptian population.
Diagnostic Utility of Free Kappa Light Chain Index in Egyptian Multiple Sclerosis Patients
Authors: Bakr Salwa Ibrahim , Ali Shehab Abeer Elsayed , Mamdouh Abdo Saleh Rasha Mohamed , Aly Ragab Dina Aly Mohamed , Abdel Hafeez Mohamed Aly , Ahmed Salem Maryam Gamal
Published: July 2024

Background

Multiple sclerosis (MS) is a chronic autoimmune-mediated demyelinating disease of the central nervous system (CNS) that is usually associated with varying degrees of progressive disability. Free Kappa light chain (FKLC) has attracted growing attention as a significant diagnostic marker of MS.

Aim of the Work

The aim of this work was to study the diagnostic utility of free kappa light chain index in a sample of Egyptian MS patients versus IgG oligo clonal bands (OCBs) in CSF and serum in an attempt to throw light on a new simpler non subjective potential diagnostic marker in MS.

Patients and Methods

This was a case control study of MS patients carried at Ain Shams University Hospitals during the period from January 2021 till January 2022. Subjects included in this study were 30 patients with symptoms suggestive of MS yet undiagnosed and 20 controls, on the basis of their MRI findings, clinical presentation and according to the revised McDonald criteria 2017. Accordingly, patients were diagnosed as MS including 4 CIS patients, 18 RRMS patients and 3 PPMS patients and non-MS including 2 NMO patients, 1 ADEM patient, 1 APS and 1 SLE patient. They were 8 males and 22 female patients, their age ranged from 20 to 40 years old with mean 30.13 ± 6.85 SD. The control group included 5 males and 15 females; their ages ranged from 20 to 40 years with mean 30.13 ± 6.85 SD.

Results

We found a statistically significantly higher FKLC index and FKLC IF among MS patients in comparison to both control and non-MS group. it could be used for diagnosis of MS with a diagnostic sensitivity of 100 % and a diagnostic specificity of 100 %.

Conclusion

The significant association between FKLC index and MS led us to conclude FKLC index can be used as a promising diagnostic marker of MS.
Impact of Psoriasis on Male Fertility: A Case-Control Study
Authors: Mahmoud Alsukhni Mohamed Adel , Elsayed Mahira Hamdy , Abdallah Mahmoud Abdelrehim
Published: July 2024

Background

Psoriasis is a common, chronic, relapsing skin disease, currently considered to be an immune mediated inflammatory disease. Several epidemiological studies have shown that patients with immune-mediated inflammatory diseases, including psoriasis, have a higher risk of developing comorbidities, such as cardiovascular disease, metabolic syndrome, diabetes and nonalcoholic fatty liver disease compared to the general population.

Aim of the Work

to assess gonadal function in psoriatic male patients to know the effect of psoriasis on fertility in these subjects. This evaluation was conducted on a hormonal and seminal background.

Patients and Methods

This case control study included 40 patients (20 with psoriasis & 20 healthy age and body mass index (BMI) matched controls). They were recruited from the dermatology out-patient clinic of Ain–Shams University Hospitals, during the period from November 2021 till April 2022. The study was approved by Research Ethical Committee of Ain Shams University (FMASU M S 667/2021) and fulfilled all the ethical aspects required for a human research.

Results

Twenty patients, with a mean age of 30.15 ± 8.04 years, fulfilled the inclusion criteria and were enrolled in our study. The mean BMI was 25.11 ± 3.02. The mean disease duration was 4 (2.5 – 8) years, and the mean PASI score at the time of enrollment 11.25 (5.1 – 15.8)., and. twenty healthy subjects, matched for age and BMI, were also enrolled as a control group

Conclusion

The evaluation of seminal fluid analysis and hormone profiles among psoriasis patients showed minor variability. However, it was evident that the levels of sex hormones were different in patients with psoriasis compared to healthy controls. Serum estradiol & SHBG levels were significantly increased among psoriasis patients relative to control group while, serum testosterone levels were significantly lower among psoriasis patients relative to control patients.
Epidemiological Study of Leprosy in Elqalaah Dermatology and Leprosy Clinic
Authors: Hussein Abdelhameid Engy Mansour , Sallam Mohammed Abdelnaeem , El- Khateeb Ekramy Ahmed
Published: July 2024

Background

Leprosy is a chronic, infectious disease caused by Mycobacterium leprae. It mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. Nerve damage may result in lack of ability to feel pain, which can lead to loss of parts of a person's extremities from repeated injuries or infection due to unnoticed wounds. Egypt is one of the first countries in the region to achieve the elimination target at the national level as early as 1994, However Leprosy is still endemic in certain foci in Egypt. Thus, our study aims to evaluate the epidemiology of leprosy in Elqalaah leprosy clinic in Cairo over the last decade to support the current national control program of leprosy with updated data.

Objective

This study presents an analysis of pattern of new cases of leprosy detected annually from 2009 to 2020 in Elqalaah Dermatology and leprosy clinic in Cairo as the new-case detection rate is better than prevalence as an indicator of disease trends.

Methods and Material

Data about patients with newly diagnosed leprosy were collected from Elqalaah dermatology and leprosy clinic registry, the main referral center in Cairo governorate. Case detection rates (CDR) were calculated for each year by dividing the newly diagnosed cases by mid-year populations for the same year.

Results

504 patients were newly diagnosed between 2009 and 2020. The mean age of patients at diagnosis was 38.16 years, 64.5% were males, and 5.4% were children below 14 years of age. The new case detection rate ranged from 0.66/100,000 population in 2009 to 0.12 /100,000 population in 2020. 82.5% were classified as multibacillary. 75.6% were detected by notification method, and 82.5% of patients completed their treatment course. Macules was the most common clinical finding and was found in 67.7% of patients. 18.5% of cases had previous history of contact with other leprosy patient. 13.1% and 2.4% suffered type one and type two leprae reactions respectively. 11.9% of cases had grade two hand disabilities, 6.7% had grade two feet disabilities and 1.8% had grade two eye disabilities.

Conclusions

The new case detection rate is acceptable compared to the global level and there was a decline in the number of cases throughout the years of the study, however community- based research should be encouraged and leprosy trends over years from different regions need to be reported to know the actual status of leprosy in different regions of country and continued surveillance of patients and their contacts is required to detect relapses and undiagnosed cases.
Fractional Ablative Carbon Dioxide Laser-Assisted Photodynamic Therapy for keloids: Clinical, Histopathological and Immunohistochemical Evaluation
Authors: El Tayeb Nasser Nada Mohamed , El Samah May Hussein , El Fattah Nermeen Samy Abd , El Badawy Nafissa Amin
Published: July 2024

Background

Keloids present a therapeutic challenge due to lack of satisfactory treatment and high rate of recurrence. Various treatment modalities exist, including intralesional steroids, photodynamic therapy (PDT), lasers and different combinations have been used to reach better results.

Aim

To study whether fractional ablative CO2-assisted delivery of Methylene blue-PDT is an effective method of treatment of keloids.

Methods

twenty patients with untreated keloids have been treated with 3 monthly sessions of fractional CO2 laser and methylene blue PDT. In the first session debulking of the keloid’s height by at least 50% with ablative CO2 was performed. Patients were photographed and assessed before treatment and 2 months after last session, clinically using modified Vancouver Scar Scale (mVSS) & patient and observer scar assessment scale (POSAS), histopathologically by H&E, Masson trichrome and immunohistochemically by TGF-b.

Results

total score for mVSS dropped from 8.25 ± 2.489 to 6.45 ± 2.8 (p = 0.013) after treatment, with a percentage change of -18.6 ± 39.6. Also, POSAS (observer) decreasaed from 26.90 ± 6.545 to 18.75 ± 8.045 (p = 0.001). POSAS (patient) decreased from 27.40 ± 6.644 to 19.05 ± 7.722 (p = 0.0001) Histopathologically, collagen improved from 3.45 ± 1.05to 2.65 ± 0.875. The TGFb staining increased post treatment but not significantly.

Conclusions

clinical and histopathological improvement was seen after MB-PDT but further controlled studies are needed to compare its effectiveness with other established modalities. Also compare results of different parameters of fractional CO2-PDT, more treatment sessions and study the long term follow up results.
A Meta Analysis of Endoscopic Surgical Management of Choanal Atresia with and without Stent
Authors: Mabrouk Ashraf AbdelZaher , Mahmoud Mohammad Salah , Kamel Fadel Michael Mounir , Mohamed Gaafar Karim Mohamed
Published: July 2024

Background

Congenital choanal atresia is a rare abnormality, affecting approximately 1 in 7000–8000 newborns, with a female predominance. In congenital choanal atresia, the widened vomer fuses with the atretic plate, resulting in an hourglass configuration of the nasopharynx and the choanal region.

Materials and Methods

This meta analysis included 17 studies all were published between 2016 and 2021. Two different techniques, endoscopic management with and without stents, this study demonstrated success with no stent approach and lower rate of re stenosis when compared to stent used approach, however there are some indications and benefits of using stents.

Results

For our knowledge this is the second systematic review and metaanalysis to report the pooled success of endoscopic repair of choanal atresia with and without the use of nasal stents. Analysis of 5 studies that included 142 patients who were not stented demonstrated that the weighted pooled proportion of successful surgery was higher and significantly different when compared with three studies that evaluated 57 patients who were stented 86% (79%, 92%) vs 61% (40%, 81%). From an analysis of nine comparative studies including 405 patients Overall odds ratio (95% CI) = 3.56 (2.10, 6.05) with unimportant heterogeneity across studies (I-squared = 37%, Cochrane Q p = 0.12) favoring no stenting over stenting.

Conclusion

Success rates for management without stents is higher than using stents. The use of nasal stents may be associated with more frequent and more severe complications. Perioperative adjuncts such as nasal stenting should be considered in the context of the individual patient and surgeon preference. If the surgeon decides to stent, a duration of 1 week or shorter may be associated with better surgical outcomes; however, the evidence is limited.
Different Recent Scoring Systems for Better Diagnosis of Acute Appendicitis
Authors: Hanna Hanna H , Abd El-Moaty Karim F , Abd El-Maksoud Ibrahim M , Fatoh Mohammed Essam M
Published: July 2024

Background

Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven.

Aim of the Work

to compare RIPASA score, (AIR) score and Modified Alvarado Score widely and easily used scoring systems, in order to identify which one is the best in sensitivity, specificity, positive predictive value, negative predictive value and accuracy, So which one leads to the most accurate diagnosis of acute Appendicitis.

Patients and Methods

A randomized prospective study that was conducted in Ain-Shams University Hospitals. The study started in February 2022 till the number of cases is fulfilled. 50 patients presented with RT iliac fossa tenderness. Each patient was scored by the three scoring systems using history, examination, clinical labs.

Results

66.0% of cases were positive confirmed histology and (34.0%) cases were negative confirmed histology. There were highly statistically significant difference between Negative Confirmed histology and Positive Confirmed histology regarding RIPASA score, (AIR) score and Modified Alvarado Score. In this study, receiver operating characteristic curve (ROC) shows that the best cut off point of Modified Alvarado Score to detect Positive Modified Alvarado Score group was found >5 * with sensitivity of 87.88%, specificity of 64.71%, PPV of 82.9%, NPV of 73.3% and total accuracy of 77.0%.

Conclusion

the Appendicitis Inflammatory Response score and Raja Isteri Pengiran Anak Saleha Appendicitis score have high discriminating powers and outperform the Modified Alvarado score. They could aid in selecting patients who require timely surgery or those who require further evaluation. Both these scores have the potential to turn out into scoring systems of choice if future research can substantiate our study findings.
Laparoscopic versus Open Appendectomy in Appendicitis Cases (Retrospective Comparative Study)
Authors: Gad Khaled Hussein , Mahmoud Al-Hefny Amr Mohammed , Abd-Elmonem Ayman Hossam Eldin , Yousef Kereet Aliaa Mahmoud
Published: July 2024

Background

Appendectomy is one of the most commonly performed surgeries worldwide. It is commonly done by conventional open method but with progress of laparoscopic surgical procedures, laparoscopic appendectomy is also practiced nowadays. Ever since its initial description by Semm in 1983, laparoscopic appendectomy has struggled to prove its superiority over the open technique. The concept of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities has made laparoscopic surgery for acute appendicitis very attractive.

Objective

To compare the intraoperative and post operative outcomes of laparoscopic versus open appendectomies for Appendicitis cases.

Patients and Methods

This study was done from April 2022 to September 2022 on 60 patients with clinical diagnosis of acute appendicitis admitted in surgical wards of Aldemerdash hospital. The patients were selected by random sampling technique. All the patients were followed every day in post operative period till they were discharged and then later followed for a period of 4 weeks in and out patients department.

Results

In the study, 8 patients in open group (26.7%) and 4 patients in laparoscopic group (13.3%) have post op fever. In the study, 8 patients in open group (26.7%) and 1 patients in laparoscopic group(3.3%) have post op wound infection. The difference was significant (p < 0.01) In the study, The mean hospital stay score was 1.77 ± 0.728 days in the laparoscopic group and 7.73 ±1.363 days in the open group. The difference was significant (p < 0.0001). In the study, the mean score return to work was 9.6 days in laparoscopic and 17.67 days in the open group. The parameter difference was significant p < 0.0001 In the laparoscopic group, 26 (86.7%) patients were satisfied with cosmetic benefit, 4 (13.3%) patients were equivocally satisfied, 0 patients were unsatisfied.

Conclusion

We conclude that laparoscopic appendectomy is better than open appendectomy in respect to post operative pain, post operative complications, duration of the hospital stay, return to the work, cosmetic benefit. Duration of time of surgery is higher in laparoscopic compared to open appendectomy.
Laparoscopic versus Open Appendectomy in Appendicitis Cases (Retrospective Comparative Study)
Authors: Gad Khaled Hussein , Mahmoud Al-Hefny Amr Mohammed , Eldin Abd- Elmonem Ayman Hossam , Yousef Kereet Aliaa Mahmoud
Published: July 2024

Background

Appendectomy is one of the most commonly performed surgeries worldwide. It is commonly done by conventional open method but with progress of laparoscopic surgical procedures, laparoscopic appendectomy is also practiced nowadays. Ever since its initial description by Semm in 1983, laparoscopic appendectomy has struggled to prove its superiority over the open technique. The concept of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities has made laparoscopic surgery for acute appendicitis very attractive

Objective

To compare the intraoperative and post operative outcomes of laparoscopic versus open appendectomies for Appendicitis cases.

Patients and Methods

This study was done from April 2022 to September 2022 on 60 patients with clinical diagnosis of acute appendicitis admitted in surgical wards of Aldemerdash hospital. The patients were selected by random sampling technique. All the patients were followed every day in post operative period till they were discharged and then later followed for a period of 4 weeks in and out patients department.

Results

In the study, 8 patients in open group (26.7%) and 4 patients in laparoscopic group (13.3%) have post op fever. In the study, 8 patients in open group (26.7%) and 1 patients in laparoscopic group(3.3%) have post op wound infection. The difference was significant (p < 0.01) In the study, The mean hospital stay score was 1.77 ±0.728 days in the laparoscopic group and 7.73 ±1.363 days in the open group. The difference was significant (p < 0.0001). In the study, the mean score return to work was 9.6 days in laparoscopic and 17.67 days in the open group. The parameter difference was significant p < 0.0001 In the laparoscopic group, 26 (86.7%) patients were satisfied with cosmetic benefit, 4 (13.3%) patients were equivocally satisfied, 0 patients were unsatisfied.

Conclusion

We conclude that laparoscopic appendectomy is better than open appendectomy in respect to post operative pain, post operative complications, duration of the hospital stay, return to the work, cosmetic benefit. Duration of time of surgery is higher in laparoscopic compared to open appendectomy.
Serial Transverse Enteroplasty (STEP) versus Longitudinal Intestinal Lengthening and Tailoring (LILT): Systematic Review and Meta-Analysis of Outcomes and Complications
Authors: Khalil Ahmed Ibrahim , Abbass Ahmed Adel , El Monaem Ayman Hossam El din Abd , Yousef Salem Ahmed Atef Abdelghani
Published: July 2024

Background

The prevalence of SBS is 3-4 per million. It occurs in about 15% of adult patients who undergo intestinal resection, with 3/4th of these cases resulting from massive intestinal resection and 1/4th from multiple sequential resections. About 70% of patients in whom SBS develops are discharged from the hospital and a similar percentage remain alive a year later. This improved survival rate has been achieved primarily by the ability to deliver long-term nutritional support.

Objective

To compare between Serial Transverse Enteroplasty (STEP) and Longitudinal Intestinal Lengthening and Tailoring (LILT) in the incidence of complications and clinical prognosis regarding morbidity and mortality in patients with Short Bowel Syndrome (SBS).

Patients and Methods

The search was carried out using the electronic national library of medicine PubMed database, Cochrane library and manual reference of articles published on serial transverse enteroplasty (STEP) versus longitudinal intestinal lengthening and tailoring (LILT) in management of patients with SBS. Conclusive search was done and duplicate studies were excluded.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available on the Internet till 2022.

Results

LILT and STEP are both valuable treatment strategies used in the management of pediatric SBS. However, currently, it is not possible to advise surgeons on accurate patient selection and to predict the result of either intervention. There is very limited published data on bowel lengthening procedure exclusively in adults. Most reported series exclusively or predominantly discuss the pediatric population with some adults included in one series and two additional single case reports.

Conclusion

Both STEP and LILT are potentially safe and effective methods for the treatment of SBS, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed. This review should be a gateway to open the scope on the field of Autologous Intestinal Reconstruction Surgeries (AIRS) and plan for a more detailed prospective studies with close monitoring of the data regarding outcomes, complications and follow up.
Causes Responsible For Failure of Fundoplication: A Meta-Analysis
Authors: Mohamed Ezz Reda Saad , Gerges Wadie Boshra , Ali Fadl Ehab Mohammed , Hanna Labib Ibrahim Wadie Labib
Published: July 2024

Background

GERD is a very common disease nowadays. When medications like Proton Pump Inhibitors fail, Surgery becomes the treatment of choice.

Objective

To review and study the most common causes responsible for failure of Fundoplication and development of the most common postoperative complications (recurrence of reflux, dysphagia and gas-bloat syndrome).

Patients and Methods

Types of studies Published studies about the complications of Laparoscopic Fundoplication (carried out in the period between 2000 – 2021). Types of participants Patients with clinically proven complications like GERD, belching, dysphagia or unintentional slipping after Fundoplication.

Results

A copy of each paper identified was obtained, and relevant data was Abstracted for a quantitative overview. In case of discrepancies or when the information presented in a study is unclear, Abstraction by a second reviewer was sought to resolve the discrepancy. All included articles was assessed for quality regarding methodological strength as per the 2009 Cochrane collaboration updated guidelines for systematic reviews.

Conclusion

According to our results, paraesophageal hernia in addition to, disruption and tight wrap are significant causes of failure of Nissen fundoplication.
Pedicled Descending Branch Latissimus Dorsi Mini-Flap For Breast Reconstruction: Shoulder Functional and Aesthetic Outcomes
Authors: El-Attar Usama Mohamed , Kamal Ahmed Nabil , Zaid Mohamed Hamdy , Fouad El-Shimy Mohamed Ahmed , Elsayed Moghazy Mahmoud Elsayed
Published: July 2024

Background

The cosmetic drawbacks of BCT are asymmetry, nipple or skin retraction, and volume loss which results in an unsatisfactory cosmetic outcome. Therefore, many volume replacement techniques were invented to counteract this. The commonest volume replacement technique for breast reconstruction is autologous LD flap in which skin paddle and subcutaneous tissue are harvested with the flap resulting in increased donor site morbidity.

Objective

To evaluate the latissimus dorsi mini-flap (LDMF) regarding the cosmetic outcomes and patient satisfaction. Moreover, it will evaluate procedure related complications and the benefit of using this procedure as a volume replacement to large breast defect after wide local excision in different breast quadrants excluding the lower inner quadrant (LIQ).

Patients and Methods

Our study was conducted on 15 patients to evaluate post-operative complications and patient satisfaction primarily. The results have demonstrated the safety of this procedure which is associated with a low rate of complications. Our study was designed to assess breast-sparing approaches using LD mini flap (LDMF) for reconstruction of the breast after wide local excision of large breast tumors that would result in otherwise unacceptable deformity.

Results

The LDMF generally is not a time-consuming technique as the average operative time was generally less than three hours. This time included the time for resection and the time waiting for frozen section results. The LDMF reconstruction was associated with considerable sensory preservation. This technique not only preserves most of the breast tissue but also, it spares us doing additional procedures such as nipple reconstruction. Avoidance the use of an implant is an additional advantage to the LDMF as this decrease the rate of infection and decrease the cost of the procedure.

Conclusion

LDMF volume replacement extends the role of breast-conserving surgery to a group of patients who are traditionally offered mastectomy. Despite the increasing use of Neoadjuvant chemotherapy, some patients have a disease that fails to respond or extensive DCIS and can, therefore, benefit from this oncoplastic technique. Frozen-section analysis of the tumor cavity is essential for surgical decision making. Our study had demonstrated the safety of this procedure which is associated with a low rate of complications. This technique has a high patient satisfaction rate wit agreeable cosmetic outcome. This technique can be used as a volume replacement to large breast defect in different breast quadrant except in lower inner quadrant which was not included in this study.
Tacker Fixation versus Suturing of Mesh in Laparoscopic Inguinal Hernia Repair
Authors: Mohamed Amer Hazem Abdelsalam , Abdelmoaty Karim Fahmy , Raslan Ibrahim Khaled , Ahmed Mostafa Ahmed Mostafa
Published: July 2024

Background

Laparoscopic hernia repair is more difficult technically than open surgery and there is evidence of learning curve in its performance and many complications which reported from laparoscopic procedure is due to learning curve lead to operative complications.

Objective

To compare the outcome results of the fixation of mesh by intracorporeal sutures and by tackers in TAPP hernia repair.

Patients and Methods

In our study, 30 patients were included divided on two groups, 15 for each. Group A; fixation mesh with tackers, Group B; fixation mesh with intracorporeal sutures. Both groups were compared in terms of operative technique, operative time, mesh device fixation cost, intra & post operative complications, early post operative pain within two weeks and in first month, hospital stay, restriction of physical activity and incidence of recurrence and chronic pain.

Results

We found that using Intracorporeal sutures for fixation mesh is available, cheaper and more handle than using the Tackers which are expensive and less available so it makes a laparoscopic hernia more practical and decrease need for open surgery so we avoid the complication of open surgery. Both techniques are considered safe and effective with similar rates of recurrence and chronic pain although further wider scale studies are recommended.

Conclusion

TAPP hernia is considered safe as all perioperative complications are well tolerated by patients and mostly there was no need for a second operative intervention. Mesh fixation technique did not affect long-term persistent pain. A large number of patients reported persistent pain regardless of mesh fixation technique, which emphasizes the need for preoperative information. Preoperative pain was a risk factor for persistent pain. The optimal surgical approach must be selected individually for the patient, taking into account patient age, hernia size, unilateral or bilateral, primary or recurrent status, strangulation and type of anesthesia, occupation, and leisure activities. Both techniques are effective in the management of inguinal hernia and were associated with same recurrence rate. However, due to small sample size and short follow up duration, longer- term studies are also recommended.
Remission of Diabetes Mellitus Type 2 after Mini Gastric Bypass In BMI Less Than 40 (Meta-Analysis)
Authors: Wasfy Shaaban Mohamed Ibrahim , Abdelhameed Walid Ibrahim , Abdelaziz El Shayeb Bassem Helmy
Published: July 2024

Background

Obesity is a potent risk factor for the development and progression of type 2 diabetes, and weight loss is a key component of diabetes management. Bariatric surgery results in significant weight loss and remission of diabetes in most patients. After surgery, glycemic control is restored by a combination of enforced caloric restriction, enhanced insulin sensitivity, and increased insulin secretion.

Aim and Objectives

to review the currently available evidence for the effect of laparoscopic mini gastric bypass in obese patients on remission of diabetes type 2.

Subjects and Methods

This was a systematic review, including all available studies meeting the eligible criteria: well conducted descriptive studies, case reports and series, cohort, articles, accepted manuscripts, clinical trials, analytic studies and literature of reviews. Excluding other systematic reviews, technical notes, letters, and comment. Intervention done in all the studies concerning this subject including laparoscopic mini gastric bypass.

Result

Mean number of Improved, % (no.) [HbA1c <7%] were 64%, mean Partial remission, % (no.) [HbA1c <6.5%] was 77% and mean Complete remission, % (no.) [HbA1c <6.0%, glucose <110 mg/dl] was 50.5%.

Conclusion

GB surgery is an effective treatment strategy for diabetes remission and control of metabolic syndrome. Duodenum exclusion plays a role in the mechanism of diabetes mellitus remission.
A Comparative Study between Intra-Operative Difficulties and Early Postoperative Complications in Laparoscopic Inguinal Hernia Repair Using Conventional Polypropylene Mesh and 3D Mesh – A Meta-Analysis
Authors: Mohammed Nada Mohamed Ali , Abbas Abdelshafi Ahmed Adel , Kamel Karim Ahmed , Abdelaziz Hassan Basma Hussein
Published: July 2024

Background

The fundamental mechanism of abdominal wall hernia formation is the loss of structural integrity at the musculotendinous layer. The exact cause of inguinal hernia is still unknown but the factors contributing in its occurrence include; preformed congenital sac, chronic passive rise in the intra-abdominal pressure and weak abdominal wall.

Objective

To assess laparoscopic inguinal hernia repair using two different meshes: The conventional polyproline mesh and the three-dimensional (3D) mesh, as regard the operative application time, early post-operative complications including seroma, early pain, sensory impairment, surgical site infection (SSI) and hospital stay time using meta-analysis approach.

Patients and Methods

In our study ten trials included, three trials regarding 3d mesh versus conventional mesh in laparoscopic inguinal hernia repair including 9,118 participants were selected from electronic databases. Three trials regarding 3d mesh and four trials regarding polyprolene mesh.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021.

Results

There is significant heterogeneity among trials (P = 0.002, I2 = 84%), mean difference 1.17, 95% CI -2.18, 4.52 and there is no statistically significance z = 0.49.

Conclusion

There is no difference between conventional polyprolene and 3d mesh regarding intra- operative difficulties (operative time) and post-operative complications (chronic pain, recurrence, operative time and seroma).
Effect of Lactoferrin versus Dexamethasone on Induced Acute Lung Injury in Adult Rat: A Histological Study
Authors: Marzouk Breehan Alaa , Sadek Doaa Ramadan , Eldin Amin Hanan Alaa , Kamal Ahmed Sohier
Published: July 2024

Introduction

acute lung injury (ALI) is one of the most critical illnesses affecting the lung and is commonly associated with severe complications. management of ALI without major side effects remains a continuous challenge. Lactoferrin (LF) is an iron-binding glycoprotein having potential anti-inflammatory effects.

Aim

the study was conducted to compare the therapeutic role of lactoferrin (LF) versus dexamethasone (DEXA) on the microscopic structure of the lung in a model of lipopolysaccharide (LP) induced acute lung injury.

Material and Methods

thirty-five adult male albino rats weighing (180-200gm) were divided randomly into 4 groups. Group I (control group), Group II (LP group): rats received a single IP injection of Lipopolysaccharide (3mg/kg). Group III (LP+LF group): rats received LP as in group II followed one hour later by IP injection of lactoferrin (5mg/rat). Group IV (LP+DEXA group): rats received LP as in group II followed one hour later by IP injection of dexamethasone (5mg/kg). after 24 hours, lung specimens were proceeded for light microscopic examination, as well as Morphometrical and statistical analyses.

Results

H&E-stained section of Group II showed marked inflammatory changes, interalveolar septa were significantly thickened and were heavily infiltrated with inflammatory cells and extravasated red blood cells were occasionally detected. Many alveoli appeared collapsed. The lining epithelium of bronchi appeared occasionally desquamated and peri-bronchial lymphoid aggregation were observed. An apparent increase in mucus production and significant increase in number of goblet cells were detected by PAS-stain. Orcein-stained section showed disruption of elastic fibers. immunohistochemical stain revealed a significantly increased reaction to iNOS antibodies. On the other hand, the lung structure in group III and group IV were much more improved, with group IV very similar to the control group.

Conclusion

Both lactoferrin and dexamethasone showed therapeutic and anti-inflammatory effects in LP induced ALI. These effects were more prominent in dexamethasone than lactoferrin as detected by microscopic, morphometric, and statistical studies.
Detecting Potassium Rebound in a Prevalent Hemodialysis Population
Authors: Afify Essam NourEldin , Tawfik Ahmed Mohamed , Ahmed Mohammed Hager EzzEldin
Published: July 2024

Background

One of the fundamental goals of hemo dialysis (HD) prescription is to maintain serum potassium (K) levels within a narrow normal range during both the intradialytic and interdialytic intervals. Considering the extraordinarily high rate of cardiovascular mortality in HD population, clinicians are obligated to explore whether factors related to dialytic K removal can be modified to improve clinical outcomes.

Aim of the Work

The aim of the study was to detect potassium rebound after HD sessions in patients on maintenance HD

Patients and Methods

This was a prospective cohort study that was held in Hemodialysis units in Nephrology department - Ain Shams University Hospital and Sheikh Zayed Specialized Hospital for 3 months. The study included 60 male and female ESRD patients on maintenance HD, in which prevalent HD patients on maintenance HD 3 times/week.

Results

We found that that there were significant positive correlations between K levels before the sessions, immediately after the sessions and after 6 hours of the sessions. While there was significant negative correlations between K levels immediately after HD sessions and Hb levels and urea levels. There was also a highly significant negative correlation between K levels before the sessions and time of session (in hours). While there were highly significant negative correlations between K levels immediately after the sessions, after 6 hours of sessions and time of session (in hours). There was non-significant negative correlations between all K levels (before HD sessions, immediately after the sessions and 6 hours after the sessions) and frequency of sessions (per week), with p value 0.388, 0.299 and 0.086 respectively. Also, it showed non-significant negative correlations between all K levels (before HD sessions, immediately after the sessions and 6 hours after the sessions) and frequency of sessions (per month), with p value 0.086, 0.089 and 0.083 respectively. Our results showed a significant positive relation between the number of K raising antihypertensive drugs used by the patients and K levels before HD sessions.

Conclusion

Patients with end-stage renal disease (ESRD) on maintenance dialysis have a high risk of developing hyperkalemia, generally defined as serum potassium (K+) concentrations of > 5.0 mmol/l, particularly those undergoing maintenance hemodialysis. Currently, the key approaches to the management of hyperkalemia in patients with ESRD are dialysis, dietary K+ restriction, and avoidance of medications that increase hyperkalemia risk. Management of these modifiable factors plays a crucial role in preventing hyperkalemia in patients undergoing dialysis. The availability of new oral K+-binders may potentially reduce the need for a highly restricted diet in patients with ESRD, and reduce the risk of potentially life-threatening hyperkalemia and the cardiovascular complications associated with rapid shifts in serum K+ concentrations that can occur with HD.