bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic Review for Evaluation of Ilizarov External Fixator in Treatment of Open Fracture of Tibial Shaft
Authors: Fayed Mahmoud Mohamed H , Al-kersh Mohamed Ahmed , Elhalim Mohamed Adel Abd
Published: August 2023

Background

Tibial shaft fractures are one of the most common long bone fractures. Open fracture tibial shaft is common between those fracture. The Ilizarov external fixator (IEF) is a minimally invasive method that permits effective wound management, early weight-bearing, and bone lengthening.

Aim of the Work

We aim to systematically review the Ilizarov external fixator in the treatment of open fracture of the tibial shaft.

Material and Methods

Regarding the methodology of our study, we followed the PRISMA statement guidelines during this study preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane, and Web of Science, Embase, and Science Direct in June 2021 and updated the search in July 2021 using relevant Keywords.

Results

We found a significant difference regarding the outcome of operation time. IEF consumed more time than the other different approaches. The analysis favored IEF over other different approach regarding the overall postoperative excellent to good improvement. No significant different was found between both IEF and other approaches regarding the union time (per months) as well as the risk of reoperation. The postoperative superficial infection was the at the same risk between IEF and other different approaches, However, there is no significant difference regarding risk in postoperative deep infection after IEF. The overall postoperative infection rate was increased after IEF. No significant difference was found regarding the risk of either non-union or malunion rate, postoperative healing, and deep venous thrombosis (DVT).

Conclusion

We concluded that the IEF can be considered reliable alternative techniques over other techniques. The analysis demonstrated that it is possible to successfully treat diaphyseal tibial fractures using the Ilizarov method, a minimally invasive technique allowing immediate weight-bearing.
Endoscopic Rhizotomy in Management of Facetogenic Chronic Lumbar Pain
Authors: Askalany Sherine Yousery Gamal , Youssef Magdy Gamal Abdelkader , Fahmy Fady Michelle
Published: August 2023

Background

Facet Arthritis causing Chronic Low Back Pain (CLBP) is an increasingly controversial field. The diagnosis of Facetogenic pain is still deemed difficult by many physicians, and its pathophysiology, as well as its management are still not quite understood. From the available literature, we can conclude that Lumbo-sacral Facet Arthritis is attributed to a degenerative process affecting the facet joint, which is described as the articulation between the superior articular process of one vertebrae and the inferior articular process of a vertebrae above. This degenerative process is commonly attributed to the „wear-and-tear' theory coming with age, highly comparative to the same degenerative process affecting any other joint.

Aim of the Work

to evaluate its effectiveness in controlling short term and long term pain caused by lumbar facet arthritis resulting in Chronic Low Back Pain (CLBP), and its effectiveness in decreasing disabilities caused by the debilitating symptoms of progressive arthritis in the lumbar facet joints.

Patients and Methods

was done to evaluate a novel technique, the Endoscopic Rhizotomy, as one of the minimally invasive procedures that is implemented in the management of Lumbar Facet Arthritis. All the available papers in literature describing this intervention from May 2000 to December 2020 were included.

Results

The initial search resulted in 468 articles from five databases including PubMed, Science Direct, Cochrane Library, Scopus, and Google Scholar. 16 studies are retrieved from additional databases. The total number before duplicates removal is 484 records.

Conclusion

that Endoscopic Rhizotomy is a very safe procedure, with a very low complication rate. We also concluded that Endoscopic Rhizotomy significantly relieves Facetogenic CLBP, with up to 3 years of pain relief. The procedure improved the subjective and objective quality of the patients. With comparison to the traditional Radiofrequency Ablation (RFA), Endoscopic Rhizotomy does not use radiation and allows direct visualization, in addition to being superior to RFA considering improving both pain and disability post-operative. It is considered a single day procedure, and the patient can return to work the 2nd day, fully-functioning. Without doubt, several factors, however, have to be taken into account when offering the patient such a procedure, as the presence of spinal deformities, instabilities, hypermobility, and the overall assessment of the patient‟s condition.
Factor VIII Level in the Potential Female Carrier Mothers of Patients with Hemophilia A and Its Impact on Joint Health
Authors: Tantawy Azza Abd El Gawad , Ragab Iman Ahmed , El-Sayed Saqr Hossam Moussa , El Din El Mekkawy Dalia Mohamed Ezz , El Kader Salwa Mostafa Abd , Elkyal Ahmed Ebrahim Ebrahim
Published: August 2023

Background

Hemophilia A is an X-linked bleeding disorder. The characteristic bleeding phenotype in patients with severe hemophilia is recurrent spontaneous hemarthrosis with development of hemophilic arthropathy. Heterozygous female carriers with factor VIII (FVIII) activity level lower than 40% may be at risk for bleeding that is usually comparable to that seen in males with mild hemophilia.

Aim of the Work

To assess factor VIII level in mothers of known patients of hemophilia A correlating it with the frequency of clinically and radiologically documented arthropathy.

Patients and Methods

A cross sectional study included 40 mothers of patient with hemophilia A during the period from September 2020 to September 2021. Studied participants were subjected to detailed analysis of bleeding history, six major joints range of motion (ROM) examination, functional independence score in hemophilia (FISH), FVIII level one stage assessment and magnetic resonant imaging (MRI) of the reported affected joints.

Results

Mean age of mothers is 42.25 ± 7.74 years. Eleven mothers (27.5%) had no bleeding symptoms, 16 (40%) had one bleeding symptoms and 13 (32.5%) had two or more bleeding symptoms. As regard joint pain, 13 (32.5%) had severe pain, 3 (7.5%) had ankle pain and 2 (5%) had elbow pain with a mean pain score of 2.55±3.32, and 7 (17.5%) had bilateral pain. Mean FVIII activity was 43.33 IU (± 22.79), ranging from FVIII (0 < 30 IU) in 13 (32.5%), FVIII (30 <60) in 18 (45.0%) and FVIII ≥ 60 IU in 9 (22.5%) among the studied participants. Knees were the most affected joints with decreased mean ROM (±SD) in right and left knees of (123.25 (±12.06) and 120.00 (±15.81)) respectively. The median MRI scores were studied was 5 (2.6%) with median osteochondral changes of 4 (2.5%) and median soft tissue changes of 1 (0-1), their median FISH score of 8 (8-9). By comparing groups at the level of factor VIII, there was no significant difference according to anthropometric bleeding parameters, pain, and MRI score. None of participants needed hospital admission, factor VIII replacement or packed red cells replacement.

Conclusion

Potential female hemophilia A carriers are at risk of spontaneous bleeding which may entail bleeding in the joints, causing early joint damage. They showed reduced overall joint ROM and structural osteochondral changes in MRI joint examination which mandates further studies about early detection of potential female hemophilia carriers for the possible need of early medical intervention.
Predictors and Outcomes of Multidrug-Resistant Gram-Negative Bacterial Bloodstream Infections in Pediatric Oncology Patients
Authors: Hamdy El-Sayed Manal , Eltonbary Khadiga Yehia , Sayed Safa Matbouly , El-Salam Ahmed Yasser Abd
Published: August 2023

Background

Pediatric patients with cancer are at great risk of infection either from disease process or after being immuno-suppressed by chemotherapy and radiotherapy, this is especially with gram negative and multidrug resistant (MDR) pathogens.

The primary aim of our study is to detect the frequency of multidrug resistant gram negative bacteria (MDR-GNB) infections at the Pediatric Oncology Department.

The secondary aim is to identify the patterns of resistance of different pathogens to commonly used antimicrobials and detect the risk factors and outcomes of MDR-GNB infections in pediatric oncology patients.

Patients and Methods

We studied episodes of fever and /or bacteremia in children (aged 1 m to 18 y) with hematologic and solid malignancies in the pediatric oncology department in Ain Shams University Hospital between January 2020 and March 2021. We studied different risks for MDR-GNB including sex, age, underlying malignancy, the presence of indwelling catheter, absolute neutrophil count and other laboratory investigations.

Results

MDR bacteria were isolated in about 15% samples. The most commonly detected MDR-GNB pathogens were Klebsiella (61.1%) and Acintobacter (22.2%). Among studied patients, MDR-GNB were significantly reported among patients with T-lymphoblastic lymphoma (p = 0.006). Although most patients were neutropenic, neutrophil count was not significantly correlated (p = 0.981). Low serum albumin on the other hand was significantly correlated with MDR-GNB (p = 0.009).

Conclusion

MDR-GNB is a significant threat to pediatric oncology patients. Contact precautions for all patients with colonization or infection with MDR pathogens and an antimicrobial stewardship based on local epidemiology should be implemented to prevent MDR infections.
Tissue Cyclooxygenase-2 Activity in Juvenile Polyposis Syndrome versus Solitary Juvenile Polyps among Pediatric Patients
Authors: Saber Ahmed Mohamed Hamdy , Nada Ola Hassan , Abd-ElhamidNabhan Dina , Abou-Elhamd Riham Mohamed Sayed
Published: August 2023

Background

Polyps are the most common benign lesions of the colon; they arise from the inner lining and usually protrude into the lumen of the large intestine. Amongst these, the juvenile polyps are the commonest of the pediatric population and may occur in juvenile polyposis syndrome (JPS) or most often sporadically. Yet to mention that the expression "juvenile" points to the type of polyp, rather than to the age of onset of these polyps.

Aim of the Work

We aimed to evaluate tissue cyclooxygenase-2 activity in juvenile polyposis syndrome versus solitary juvenile polyps among pediatric patients. In order to identify a possible role of COX-2 inhibitors in treatment and management of children with JPS.

Patients and Methods

The study enrolled 15 patients with juvenile polyposis syndrome as cases and 15 patients with solitary juvenile polyps as control. The collected polyps’ samples from routine endoscopic polypectomies intervention were proceeded for immunohistochemistry method on tissue microarray using Anti-COX-2 antibody to evaluate and compare its activity in polyps of JPS and SJP. Demographic, clinicopathological, and endoscopic data were obtained.

Results

Thirteen children with JPS were included in the study with mean age ±SD (7.2± 3.2) years and 7 (46.7%) patients were males, SJP control group included 13 children with mean age ±SD (5.8± 3.5) years, 9 (60%) male patients. Number of lower endoscopies and upper endoscopies was significantly higher in JPS group with P-value=0.009, 0.032 respectively. Intussusception was significantly higher in juvenile polyposis syndrome patients compared to control group with P-value=0.032. COX-2 expression was nonsignificantly different in cases group compared to control group patients with P-value= 0.464.

Conclusion

COX-2 expression is nonsignificantly higher in polyps of JPS patients in comparison to solitary juvenile polyp patients.
The Role of Collagen Triple-Helix Repeat-Containing 1 (CTHRC1) as a Diagnostic Biomarker for Rheumatoid Arthritis
Authors: Mousa Marlin Adel Sabe , Hamed El-Arousi Nadia , El-Chamy Hebattallah
Published: August 2023

Background

Many patients are seronegative for anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF), and there is a need for novel serological biomarkers to help close this serological gap and improve early diagnosis. The purpose of this study was to determine whether plasma levels of the collagen triple helix repeat containing 1 (CTHRC1) protein can serve as a blood-based biomarker for improved diagnosis of rheumatoid arthritis (RA) patients.

Objective

Evaluate the levels of the collagen triple helix repeat containing-1 (CTHRC1) protein in RA patients' serum in order to detect its role as a diagnostic biomarker in Rheumatoid Arthritis patients & determine its value in assessment of disease activity in Rheumatoid Arthritis patients.

Methods

This study included twenty five adult patients with clinical evidence of rheumatoid arthritis and twenty five healthy matched age and sex as control subjects. All underwent history taking, clinical examination, assessment of disease activity with modified Disease Activity 28 (DAS28), Laboratory investigations including Complete blood count (CBC), erythrocytes sedimentation rate (ESR), C-Reactive Protein (CRP), Liver function tests, Kidney function tests, qualitative assessment of RF, anti CCP Ab and CTHRC1 serum levels. Special attention had been given to patients (nine out of twenty five patients) diagnosed in early disease process (1-2 months).

Results

Serum levels of CTHRC1 were significantly higher in patients than control group (p > 0,001) with sensitivity of 100% and specificity of 88%. It showed significant positive correlation with Anti-CCP (r = 0.498) (p < 0.011) and with RF (t= -6.489) (p <<0.001) as diagnostic markers for RA. Serum levels of CTHRC1 showed statistically significant difference between patients in early, late disease process and controls.

Conclusion

serum CTHRC1 level was higher in RA patients which serve as a diagnostic marker for RA with statistically significant correlation with early disease process highlighting its role as a diagnostic marker for RA.
Community Pharmacy Survey on Patient Safety Culture: A Pilot Study in Cairo
Authors: Al-Tehewy Mahi , Mohamed Samera , Ammar Nora
Published: August 2023

Background

measuring perception of patient safety culture among pharmacists working in community pharmacies is critical to identify opportunities of improvement, and actions required to improve patient safety. The aim of this work is to measure patient safety culture among pharmacists working in community pharmacies.

Methods

a crosssectional study was performed among pharmacists working in community pharmacies in the center and south of Cairo. Pharmacy Survey on Patient Safety Culture (PSOPSC), developed by the Agency for Healthcare Research and Quality (AHRQ), was used to collect data. PSOPSC is a self- administered questionnaire containing 36 items that measure 11 dimensions of patient safety culture.

Results

the study included 210 community pharmacies with 95% response rate. The mean age of pharmacists was 28 ± 5.4 years and males represent 55% of the sample. The overall positive response percent (PRP) ranged between 35% and 69% with a mean of 57.4%. The highest PRP was identified in the domains of “Teamwork” (68, 97%), “Organizational learning–continuous improvement” (64, 93%) and “Patient counseling” (61, 83%). The PRP was less than 60% in six out of the eleven composites. The lowest PRP was found in the “staffing, work pressure, and pace “domain which scored 34 (98%).

Conclusion

The average overall patient safety culture of community pharmacists highlights the need to put patient safety on the strategic priority at the level of community pharmacies. Attention should be given to the areas of weakness mainly in the dimension of “Staffing, Work Pressure and Pace”. It is recommended to allocate staffs and working hours more adequately and train the community pharmacists on the importance and principles of patient safety.
Applicability and Adherence to Essential Practices of WHO Safe Childbirth Checklist at Ain Shams Maternity Hospital (ASMH)
Authors: Al Tehewy Mahi M , Ghazal Sara M , Rami Ahmed R , Wahdan Maha M
Published: August 2023

Background

It is vital to comply with evidence-based essential birth practices to improve both maternal and neonatal health. The WHO Safe Childbirth Checklist (SCC) is a facility-based reminder tool that focuses on necessary care to improve intrapartum care quality.

Objective

To measure applicability and adherence of healthcare providers to essential practices as required by WHO safe childbirth checklist (SCC) at Ain Shams Maternity Hospital (ASMH).

Methods

A Prospective study was conducted to observe and follow a sample of childbirths presented at Ain Shams Maternity Hospital (ASMH) through the 4 pause points [on admission, just before the woman starts pushing (or before caesarean section), within 1 hour after births and before discharge from the facility].

Results

A total of 221 childbirths were included and followed in the study, with mothers’ average age of (30+6) years and mean gestational age was (37±2) weeks. Only one WHO SCC practice (maternal referral) was not applicable in ASMH, however, the rest of the recommended practices were applicable with total adherence of 94.7%. Non adherent practices were encouraging companion to attend birth and length of stay after childbirth 24 hours.

Conclusion

ASMH was highly adherent to WHO SCC evidence-based practices; however, two practices were not adopted by the hospital policy.

Recommendation

It is recommended to review the hospital policies to allow birth companion to attend delivery and extend length of stay after vaginal delivery to 24 hours.
Role of Ultrasound and Dynamic Contrast MRI Study in Diagnosis of Soft Tissue Vascular Anomalies in Pediatric Age Group
Authors: Ahmed Amira Ismail , Eissa Hanan Mohamed , Awadallah Shrouk Mohamed
Published: August 2023

Background

Vascular anomalies (VAs) represent a spectrum of disorders from a simple “birthmark” to life- threatening entities. Incorrect nomenclature and misdiagnoses are commonly experienced by patients with these anomalies. Accurate diagnosis is crucial for appropriate evaluation and management, often requiring multidisciplinary specialists.

Aim of the Work

The aim of this study is to emphasize the role of dynamic contrast MRI and ultrasound in evaluation of soft tissue vascular anomalies and subsequently in assigning the proper treatment.

Patients and Methods

All available cases of soft tissue vascular anomalies in the pediatric age group attending to the radiology department for a 6 months period were included in the study starting from February 2021.

Results

Our results showed that the US had a sensitivity of 100%, specificity of 86.4% and accuracy of 84.0% in detection of hemangioma compared to MRI. The US had a sensitivity of 53.8 %, specificity of 91.7% and accuracy of 88% in detection of venous malformation compared to MRI. US had a sensitivity of 33.3 %, specificity of 95.5 % and accuracy of 88% in detection of Klippel trenaunay syndrome compared to MRI. While the US had a sensitivity of 33.3%, specificity of 90.9 % and accuracy of 84% in detection of lymphatic malformation compared to MRI. In the case of mixed low flow malformation US had sensitivity of 0%, specificity of 91.3% and accuracy of 84%.

Conclusion

The previously stated results denote that US has high sensitivity & specificity in diagnosis of vascular anomalies especially in hemangioma; thus when imaging is needed in diagnosis of vascular malformations US should be considered positively.
Contrast-Enhanced Mammography Versus Dynamic Contrast-Enhanced MRI in the Evaluation of Sonomammographic BI-RADS 3 &4 Breast Lesions
Authors: Hussein Asmaa Magdy , EL-Shinnawy Maha Abdel Meguid , Moftah Sherine George , Nada Omnia Mokhtar , Hussein Rasha S
Published: August 2023

Background

Breast cancer is a major health problem and a leading cause of death. Early detection of breast cancer aims to reduce morbidity and mortality rates. Mammography has been established as the imaging modality for screening and early detection of breast cancer; however, it has low sensitivity and specificity in women with dense breasts. Nowadays, MRI of the breast is used as a problem-solving tool.

Aim of the Work

To assess and compare the diagnostic value of contrast-enhanced mammography and dynamic contrast-enhanced MRI in the evaluation of BI-RADS 3 and BIRADS 4 lesions detected in conventional imaging modalities (Mammography and US).

Patients and Methods

The study was conducted at Ain Shams University & National Cancer Institute (N.C.I). Thirty patients with no age predilection were enrolled in this study. The patients who presented with BI-RADS 3 and 4 lesions diagnosed by mammography and sonomammography were assessed by both contrast-enhanced digital mammography (CEDM) and dynamic contrast MRI (DC-MRI) mammography with the maximum dimensions of the lesion or lesions measured in both studies and correlation with histopathology was conducted.

Results

We found that the area under the curve of DC-MRI was of the highest value (AUC: 88.3%) followed by that of CEDM (AUC: 82.5%). Both were significantly superior to the area under the curve of sonomammography (AUC: 72.9%) and mammography (AUC: 67.1%).

Conclusion

CEDM and DC-MRI have higher diagnostic accuracy for the detection of intermediate breast lesions compared with mammography alone and with mammography interpreted in association with sonography. CEDM showed slightly lower sensitivity and accuracy compared to DC-MRI. However because of being relatively easier, available, cheap, and acceptable by women, CEDM be used as a problem-solving tool in the characterization of indeterminate breast lesions.
Maximum Standardized Uptake Value (SUV max) and Total Lesion Glycolysis Values (TLG) Measured in 18-Flourodeoxy Glucose (FDG) PET CT in Prediction of Histopathological Grading of Bronchogenic Carcinoma
Authors: Allam Khaled Essmat , Taha Noha Mohamed , Hasan Eman Mohamed
Published: August 2023

Quantitative analysis of glucose consumption measured by maximum standardized uptake value (SUVmax) and Total lesion glycolysis (TLG) in lung bronchogenic carcinoma is the first aim of this work to evaluate the correlation between SUV max, TLG and different histopathologic subtypes and grades of Bronchogenic carcinoma, also their correlation with TNM pathologic staging. Glucose consumption of primary tumor was quantified using SUVmax and TLG in 20 patients with histologically-confirmed bronchogenic carcinoma .Tumors were classified according to their histopathological reports into 4 different histological subtypes (Adenocarcinoma, Squamous cell, Small cell, Undifferentiated). Adenocarcinomas were grouped according to the histological tumor grade into : low grade (adenocarcinoma grade 1,2), and high grade (adenocarcinoma grade 3, 4). Tumors were grouped according to TNM pathological staging into 4 grades and their subtypes and correlated to SUVmax and TLG. Comparisons between SUVmax, TLG and histologic Types, Grades, stages were performed using the KruskalWallis test followed by a Dunn’s multiple comparison tests. The Mann Whitney-U test was used to assess differences when two groups were studied in Comparing High and Low grades.

According to Clinico-pathological characteristics of 20 patients with bronchogenic cancer, Association between SUVmax, TLG of the primary tumor and subtypes, stage showed that no significant difference between histological types regarding SUVmax and TLG (P value > 0.05). Association between SUVmax, TLG and histopathological grades shows statistical significant difference between histological Grades regarding SUVmax and TLG (P value < 0.05). Low SUVmax and TLG were associated with low-grade (grade 2) tumors, and higher with higher (3, 4 grades) grades. The sensitivity for SUV max is 100% and specificity is 85.7%.The sensitivity for TLG is 100% and specificity is 100% .
Gonadal Veins Embolization for the Management of Pelvic Varices in Females
Authors: Nassef Hana Hamdy , Hassan Mohamed Sobhi , Tantawy Salma Hassan , Abelmageed Hend Gamal Abdelglil
Published: August 2023

Background

Solid evidence suggests that the treatment of choice for pelvic varicose veins is embolization. The embolization procedure is a simple technique with high success rates in all cases. Recently many series have been published over the past decade regarding the use of various embolic agents namely; coils, N2 Butyl Cyano Acrylate (Medical glue), sclerosing agents namely Polydecanol as well as combination of the previously mentioned agents with a technical success rate close to 100% and clinical success rate for symptoms control of more than 90%. Our study shows the technical and clinical success rates in Ain Shams University Hospitals with the use of all known embolic agents.

Patients and Methods

18 patients were included in a prospective cohort study, Foam used as embolic substance in 7 of the included patients, coils used in 2 of them, combined foam and coils used in 8 patients and combined foam and glue used in one patient, follow up done using the Visual analogue scale (VAS) and trans-vaginal ultra-sound (TVUS) 2 weeks and 6months after the embolization.

Results

Catherization and embolization were successful in all patients. No major complications were observed during the procedure. With significant decline of the preprocedure VAS from 8.67±1.33 to 1.67±0.59 post-procedure revealing significant improvement in the degree of pain (p value= -3.740), technical success rate was 100%, two weeks after embolization TVUS in all the patients showed complete thrombosis of uteroovarian varices, 6 months after embolization 4 patients showed recurrence of the findings with presence of recanalized pelvic varices, with a recurrence rate of 22%, in all the recurrent cases, the embolic substance used was foam, among 7 patients were embolized by foam, 4 of them experienced recurrence 6 months after the procedure, so the recurrence rate using foam only is 57%, with no recurrence in the patients that were embolized using coils, combined foam and coil, or combined foam and glue.

Conclusion

Gonadal veins embolization in the management of pelvic congestion syndrome is a safe and effective procedure with no significant difference between the different used embolic substances as regard the technical success rate and pain improvement, however the recurrence rate is higher with foam only compared to no recurrence rate using combined embolic substances or coils.
Role of 68Ga-PSMA PET/CT in Initial Staging of Prostate Cancer and Correlation with PSA and Gleason Score
Authors: Saad Jilan Hassan , Shalaby Menatallah Hatem , Taha Noha Mohamed
Published: August 2023

Background

Prostate cancer is the second most common male malignancy. Its prognosis depends on the tumor stage as well as its aggressiveness; expressed histopathologically by Gleason scores. Furthermore, optimal patient management depends on the tumor stage. 68Ga PSMA PET/CT has a wide spectrum of uses in prostate malignancy, some of them are comprehensively studied while others are still under investigation. The most widely accepted use is the accurate initial staging of cancer prostate as well as predicting the long-term outcome, with SUVmax being a promising prognostic parameter correlating significantly with other established prognostic parameters, including the Gleason score and the PSA levels.

Objective

To evaluate the role of 68GA- PSMA PET/CT in initial staging of prostate cancer and correlate with PSA level and Gleason score.

Methods

A prospective descriptive study over the course of 6 months. It included patients with pathologically proven prostate cancer referred for a PSMA PET/CT scan for initial staging without any treatment or interventions.

Results

68Ga-PSMA PET/CT scans of 36 patients were evaluated for local staging (primary prostatic lesions, extra-prostatic spread, and seminal vesicle invasion), regional nodal staging, and metastatic spread (extra-regional lymph nodes, osseous lesions, and visceral lesions). PET/CT findings as well as the SUVmax of the most avid lesions were correlated with PSA level, Gleason scores, as well as Gleason grade risk groups. A statistically significant relationship was found between PSA level and SUVmax of prostatic lesion as well as that of the most avid metastatic regional lymph node, the presence of extra-regional lymph nodal spread, the presence of osseous metastatic lesions, the presence of seminal vesicle invasion, extra-prostatic extension, and the presence of PSMA-avid regional lymph nodal spread. On the other hand, a statistically significant relationship was found between Gleason scores and the presence of regional lymph nodal spread and osseous metastatic lesions. Lastly, a statistically significant relationship was found between Gleason grading risk groups and the presence of regional lymph nodal spread and osseous metastatic lesions.

Conclusion

68Ga-PSMA PET/CT is a powerful staging and stratifying tool for the majority of prostate cancer patients, being significantly correlated with PSA level and Gleason scores. However, patients with low PSA scores still pose a dilemma as they showed significantly low PSMA uptake, rendering the use of 68Ga-PSMA PET/CT for staging in such patients controversial. 68Ga-PSMA PET/CT based imaging findings should ideally be supported with histopathological documentation and/or follow-up imaging results in order to confirm the nature of detected lesions and help establish accurate sensitivity and specificity of 68Ga-PSMA PET/CT.
Pediatric Stroke: Clinico-Radiological Correlation
Authors: Mohamed Khaled Aboulfotouh Ahmed , Hassanein Sahar Mohamed Ahmed , Awadallah Shrouk Mohamed , Shaarawy Mahmoud Mohamed Abdel Fattah
Published: August 2023

Background

Pediatric Stroke (PS) is a major cause of morbidity and mortality in children worldwide. The reported annual incidence of childhood stroke ranges from 2.3 to 13 per 100,000 children per year in developed countries.

Aim of the Work

The objective is to correlate between radiological findings and clinical Findings, provide practitioners with a guide for neuroimaging children with various stroke subtypes.

Patients and Methods

A cross sectional study was conducted at Ain Shams University Hospital, Radiodiagnosis department. The study period was 6 months, Patients with radiologically proven pediatric stroke using one or more of the following modality (CT, MRI or DSA). The type of study design was a cross sectional study. The study included all images fulfilling the study inclusion criteria in the period from January 2017 till May 2021. Clinical data and imaging findings of the included patients were retrospectively obtained from the picture archive and communication system (PACS, Synapse 5.7. 002. Fujifilm Medical System) of the radiology department, Ain Shams University Hospitals.

Results

The current study showed that eleven cases (64.6%) started neuro-imaging studies with CT brain & six cases (35.3%) started with MRI stroke protocol with MRV sequence. Diagnosis of stroke was missed in (36.4%) of cases which started with CT brain. Then, MRI stroke protocol was done for these cases in addition to MV sequence. Abbreviated MRI protocols have emerged as an alternative to standard MRI protocols. These abbreviated MRI protocols seek to reduce longer MRI protocols by eliminating unnecessary or redundant sequences that negatively affect cost, MRI table time, time of anesthesia list, image quality, and image interpretation time. Some institutions have developed shortened brain MRI protocols which include diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps, hemorrhage specific sequences such as susceptibility-weighted imaging (SWI) or gradient echo (GRE), and time-of-flight (TOF) MR-angiogram (MRA).

Conclusion

Pediatric stroke is relatively rare but can lead to significant morbidity and mortality. Because incidence is much lower than the adult population and presentation is distinctly different, ongoing challenges exist in development of proven screening tools & diagnostic protocol.
Added Value of MRI Knee Cartigram in Assessment of Anterior Knee Pain in Comparison to Conventional Standard MRI
Authors: Ahmed Aya Yassin , Awadallah Shrouk Mohamed , Ali Mohammed Fawzy Mohammed
Published: August 2023

Background

Osteoarthritis (OA) is a multi-tissue, multi-factorial disease and worldwide a major cause of disability resulting from reduced joint mobility and function. Progressive loss of hyaline cartilage is one of the hallmark features of osteoarthritis, initiated by a loss of proteoglycans and an increase in water content, followed by a loss of type II collagen and a change in collagen fiber orientation.

Objective

To evaluate the role of T2 mapping in detection of degenerative changes in articular cartilage of knee joint as compared to standard clinical magnetic resonance imaging (MRI) at 1.5T.

Patients and Methods

From April 2020 to November 2020, this prospective Study was done to use T2 mapping to visualize the articular cartilage of the knee on 1.5 T MR Scanner using special software to evaluate the efficiency Of T2 mapping to detect cartilage lesions. The material of this study included 380 patients. The study includes all of them come complaining of knee pain and 2 of them had previous minor knee trauma, each patient had a single MRI exanimation including conventional MRI routine protocol and added a single complementary T2 mapping.

Results

there were significant differences between T2 mapping and conventional MRI sequence in the ability to detect cartilage degeneration as T2 mapping was capable of detecting all lesions that were visible on the clinical MRI. Moreover, T2 mapping showed more cartilage lesions than clinical MRI T2 mapping showed more cartilage lesions than clinical MRI, and in T2 maps the lesions appeared generally wider. This proposes that T2 mapping is feasible in the clinical setting and may reveal cartilage lesions not seen on the standard knee MRI.

Conclusion

Our results suggest that T2 mapping is an interesting MRI sequence for the exploration of patients articular cartilage in and should be included in the routine protocol if cartilage pathology is suspecting as it may improve the diagnostic accuracy of MRI for focal chondral lesions, and should help decide whether and MR-arthrography or CT-arthrography is necessary.
Doppler Ultrasound for Fetal Assessment in High Risk Pregnancies
Authors: Labib Sally Makarios , El Shibiny Aida Mohamed , Keriakos Nermeen Nasry
Published: August 2023

Background

When it comes to the provision of antenatal care or research, pregnant women tend to be divided into low- and high-risk populations; however, the boundaries between the groups are often blurred. For most researchers, ‘high-risk status’ includes maternal conditions associated with increased perinatal mortality and morbidity such as diabetes, hypertensive disorders (chronic hypertension and pre-eclampsia) and cardiac disorders. The waveform analysis of the feto- maternal circulation by Doppler ultrasound has become a quick and a simple way for the assessment of fetal well-being in high-risk pregnancies. It helps identify fetuses at risk of hypoxia and acidaemia, when the results are applied clinically; they contribute to reduced perinatal mortality rates.

Objectives

The main objective of this study is to evaluate Doppler flow indices as an index for assessing fetal wellbeing in high-risk pregnancies.

Methods

A total of 40 pregnant women with singleton pregnancies at a gestational age ≥3234 weeks were included in this study, 30 of them had a high risk factor were selected as 10 preeclampsia patient, 10 gestational diabetes patient, 10 cardiac patient, the remaining 10 women had no obstetric disorder or any risk factor were selected as control. All pregnant women underwent uniform antenatal assessment protocol that includes an Ultrasound examination and Doppler evaluation of fetoplacental circulation: umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) Doppler ultrasound studies.

Results

Our findings showed no statistically significant difference in the Doppler indices between gestational diabetes group and control group. There was only a considerable change in DV Doppler waveform in this study that is also insignificant. At preeclampsia group, it was found that there was statistically significant difference regarding UA RI, MCA RI, and MCA RI/UA RI ratio compared to control group. In the cardiac group, fetal Doppler indices were comparable to those of the control group.

Conclusion

The result of the present study suggest that Doppler indices in the third trimester may be useful markers of fetal well-being in high risk pregnancy. Hypertensive disorders with pregnancy can be considered the most important indication for third trimester Doppler examination. Two-vessel examination in these cases seems a good practice.
Role of Contrast Enhanced CT in Assessment of Blunt Abdominal Trauma in Comparison to Ultrasonography
Authors: Hetta Waleed Mohamad Abdelhamid , Kamel Omar Farouk , AL-Jamal Yasmeen Hani Mohamed Ibrahim
Published: August 2023

Background

Clinical examination fails to accurately diagnose many intraabdominal injuries in blunt abdomen and hence there is a well need for a good imaging technique.US and CT satisfy this to a great extent. With minimum technical limitations and a short time for examination US and CT become extremely useful in guiding the trauma surgeon. CECT is a highly useful imaging modality for diagnosis of blunt abdominal trauma. However US can be used as a useful initial modality. US and CT grading were of not much impact in the management of liver trauma, however extremely useful in the decision making of renal trauma and to a lesser extent in splenic injuries. CT is excellent in picking up clinically unsuspected trauma especially involving liver, kidney and bowel.

Aim of the Work

The aim of this study is to define and compare the role of CE-MDCT and FAST in detection of intraabdominal organs’ injuries and hemoperitoneum. And to highlight the value added by CE- MDCT in hemodynamically stable patients providing an accurate and highly sensitive diagnostic method for blunt abdominal trauma.

Patients and Methods

A prospective study was done in radio diagnosis department in Al Sherouk Police hospitals, and Zagzaig university hospitals-radiology department – ultrasound and CT units. 12 months, from 1/11/2018 to 1/11/2019.

Results

In this study CT detected 18 cases of splenic trauma compared to US which detected only 10 cases. Of the 8 additional cases detected on CT two were of grade IV injury and required surgery. CE-MDCT detected100% of splenic injuries confirmed clinically/surgically thus has been the gold standard method of detecting splenic injuries. CT detected 41 cases of haemoperitoneum which is 91% among all the cases of blunt injury to the abdomen.

Conclusion

CT is a superior diagnositic modality in the diagnosis of abdominal trauma.
Prevelance and Outcome of Liver Function Abnormalities among Egyptian Patients with COVID-19
Authors: Abdelhakam Sara Mahmoud , Hassan Azza Mohammed , Salem Hossam Eldeen Mohamed , Saber Manar Mohamed
Published: August 2023

Background

In December 2019, a novel corona virus was identified as the pathogen to cause pneumonia in Wuhan, China, which was temporarily named as 2019-nCoV by the World Health Organization, SARS-CoV-2 can be transmitted from person to person through respiratory droplets and close contact, The main manifestations of SARS-CoV-2 infection include fever, dry cough, weakness, and breathing difficulty. Abnormality in liver function tests has been reported; almost one-half of patients experience different degrees of liver test abnormalities, According to a recent study using single-cell RNA sequencing, angiotensin-converting enzyme 2 was highly expressed not only in type II alveolar epithelial cells, but also in bile duct cells. Importantly, recent studies confirmed that angiotensin-converting enzyme 2 receptor is the cell entry receptor of SARS-CoV-2

Objectives

To measure the prevelance of liver function abnormalities among Egyptian patients with COVID -19 and To measure relation between liver function abnormalities and outcome among Egyptian patients with COVID -19.

Patients and Methods

The present study was conducted on 299 patients with covid -19, patients attended to Ain Shams Isolation Hospitals, (retrospective cohort study). Total number of cases during the study period was 299 patients. patients diagnosed with acute hepatitis were excluded from the study, Eventually, 299 patients were enrolled in the study fulfilling the inclusion criteria.

Results

The mean age of our patients is 59.4 years with Male predominance (159 males and 104 females). AST baseline was (55.50%) normal and (5.70%) more than 3 fold, AST after 1 week was (52.5%) normal and (6%) More than 3 fold, AST after 10 days was (54.2%) normal and (6%) More than 3 fold., ALT baseline was (71.2%) normal and (3%) more than 3 fold, ALT after 1 week was (71.9%) normal and (3.3%) More than 3 fold, ALT after 10 days was (74.6%) normal and (3.3%) More than 3 fold.

Conclusion

Elevated liver function is very common in patients with COVID-19 infection and a significant difference was found between liver function abnormalities and outcome .
Polymorphism Detection of VKORC1 (Vitamin K Epoxide Reductase Complex, Subunit 1) Gene for Warfarin Dose Adjustment in Egyptian Patients with Budd Chiari and/or Portal Vein Thrombosis: A Single Center Experience
Authors: Abdellah Heba Mohamed , Sherif Ahmed Fouad Helmy , Abdel-Wahed Marwa Ali , Sayed Mohamed Osama
Published: August 2023

Background

Budd–Chiari syndrome is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction at the level of the hepatic venules, the large hepatic veins, the inferior vena cava till its junction with the right atrium.

The classic triad of abdominal pain, ascites, and hepatomegaly is observed in the vast majority of patients with Budd-Chiari syndrome, but it is nonspecific.

Warfarin was introduced into clinical practice in the 1950s, and has been the most widely prescribed oral anti-coagulant for prevention and treatment of thrombotic diseases despite its significant side effects as (bleeding tendency, drug drug interaction).

Vitamin K epoxide reductase complex subunit1 (VKORC1), a membrane protein located in hepatocytes, has an important role in the anabolism of vitamin K, which is essential for blood coagulation.

Objectives

The aim beyond this study is to evaluate effect of the allelic frequency of the VKORC1 (G1639A) polymorphic genes by real time PCR on response of Egyptian patients with Budd–Chiari syndrome or PVT to Warfarin.

Patients and Methods

The studied patients were selected from patients presented to Budd chiari study group clinic.tropical medicine department in Ain Shams University hospitals. Within 6 months from july 2020 to December 2020, total number of cases during the study period was 50 cases fulfilling the inclusion criteria

Results

The mean age of the patients was (32.40 ± 9.69) slightly more common in males. The chronic presentation represented 60% of the patients and the acute represented 32%.The most common cause of budd chiarri syndrome was MTHFRD (52%) followed by FVLM (36%) then Primary ant phospholipid antibody syndrome (26%). Patients with the −1639 promoter polymorphism GG genotype had lower dose requirements, whereas the AG/AA genotypes had higher dose.

Conclusion

Identifying these polymorphisms in patients prior to starting the therapy may help clinicians choose the appropriate warfarin dose & decrease its adverse effects.
Stone Density and Skin to Stone Distance in Non-Contrast Computed Tomography as Prognostic Indicators for the Success of Extra Corporeal Shockwave Lithotripsy in Ureteral Stone Disease
Authors: Abdallah Hany Mostafa , Abdelfattah El-Ghobashy Samir El-Sayed , Badawy Mohamed Hussein , El-Moazen Mohamed Ibrahim , ElShafei Ahmed Mahmoud
Published: August 2023

Background

Ureteral stones are a major health concern with a worldwide rising prevalence. Ureteral stones formed in the kidney and then descending the ureter commonly manifest themselves as renal colic. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are the two primary treatment modalities for the management of symptomatic ureteral calculi,

Aim of the Work

In this study we tried to assess the prognostic value of patient and stone characteristics in potential candidates for ESWL in ureteral stones.

Patients and Methods

We studied the records of 66 patients with upper ureteral calculi who underwent ESWL. We considered patients being stone free (SF) or when < 4 mm fragments were detected. Age, gender, skin to-stone distance, maximum stone length, stone Hounsfield units (HU) were explored in uni- and multivariate regression analysis.

Results

We found that obesity (BMI > 29.3), high stone density (HU) >935, skin to stone distance >10 and presence of ureteral stent were all factors impeding success of treatment. On the other hand, higher shock intensity and number of shocks per session were positive predictors of treatment success.

Conclusion

It was concluded that the evaluation of patient and stone characteristics pre ESWL can predict the success of treatment for ureteric stones and we recommend thorough evaluation of the parameters before treatment to determine the best treatment modality for each patient. To date there seems to be value in using these variables to aid in better selecting patients for ESWL and thus improving the efficacy of ESWL. Our study was limited by the number of centers and participants. A wider range of participants would probably achieve more efficient results. Further studies on a larger scale would be better to further validate these results.
Association between the initial dose urate-lowering drugs and gout flares in adult males with gout
Authors: Li Xiaoli , Shao Qin , Shen Jingfang , Ren Shaohui , Li Lianju , Lu Hua , Chen Shubo
Published: August 2023

Objectives

Frequent gout attacks in the initial introduction of urate-lowering therapy (ULT) are significant causes of poor drug adherence and ULT discontinuation. Initial low-dose urate-lowering drugs may be effective in reducing gout flares, however robust evidence is sparse. The aim of this study was therefore to assess the association of initial dose urate-lowering drugs with gout flares in adult males with gout during the initial introduction of ULT.

Methods

This cohort study obtained data on consecutive gout patients from a single-centre gout cohort study from August 2017 to October 2020. A standard questionnaire was applied to collect demographic and clinical information, and biochemical parameters were tested on the same day. The primary endpoint was to estimate the association of initial dose febuxostat with gout flares, using Cox hazard models with inverse probability of treatment weighting (IPTW).

Results

A total of 582 gout patients were included in this study. During the 6-week follow-up, 71 (12.2%) patients suffered gout flares. In the main analysis using Cox hazard models with IPTW, compared with colchicine prophylaxis, initial low-dose febuxostat alone had no statistical significance with the increased risk of gout flares [hazard ratio (HR) 1.26; 95% CI 0.58, 2.72], while initial high-dose febuxostat was associated with an increased risk of gout flares (HR 3.08; 95% CI 1.34, 7.07).

Conclusions

This observational study demonstrated that initial low-dose febuxostat was equally effective in preventing gout flares as colchicine prophylaxis, while initial high-dose febuxostat alone was associated with an increased risk of gout flares.