bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the Prognostic value of the Prechemotherapy Platelet to Lymphocyte Ratio in Malignant Pleural Mesothelioma
Authors: Elsheikh E , Ezzeldin N , Ghali R , Elghamry W , Canaan M
Published: May 2020

Background

The prognostic value of Platelet-to-lymphocyte ratio (PLR) in patients with malignant pleural mesothelioma is still indistinct. We conducted this study to assess the prognostic significance of pretreatment PLR in patients with MPM.

Aim of the Work

to assess the prognostic significance of pre-treatment PLR in patients with MPM.

Material and Methods

we retrospectively reviewed 1!0 patients treated for MPM with chemotherapy in Ain-Shams University hospital, Clinical Oncology department between January 2013 and December 2017. Pre-treatment CBC was available for the 110 patients to calculate PLR by dividing the absolute platelet count by the absolute lymphocytic count.

Results

Out of 110 patients with available pre-treatment complete blood picture, population age ranged from 28 to 70 years. Male to female ratio was 5:6 .Epithelioid subtype represent 85% of cases. Stages III and IV present 48.2% and 35.5, respectively while stages I and II present 3.6% and 12.7%, respectively. The median PLR in the study population was found to be 177.9,

Conclusion

PLR is an easy , reproducible and inexpensive prognostic factor that needs to be more investigated in MPM.
Optical Coherence TomographyStudy of peripapillary Nerve Fiber layer ThicknessinThyroid Associated Ophthalmopathy
Authors: Elkady Z I R , Elwan S , Said A M A , Farweez Y A T , Mahdy M M M
Published: May 2020

Background

Thyroid Associated Ophthalmopathy (TAO) or Graves Opthalmopathy (GO) is a very common autoimmune disorder of the thyroid gland which activates the gland function and result in hyperthyroidism. Some patients with graves disease(GD) develop localized manifestations including GO and dermopathy. Dysthyroid optic neuropathy (DON) is impairment of optic nerve function due to GO, the most serious complication of GO which occurs in about 4–8% of patients, it occurs due to ischemia and inflammation of the optic nerve, also compression of the optic nerve due to enlargement of extraocular muscles at the apex of orbit.

Objective

To assess peripapillary retinal nerve fiber layer (pRNFL) thickness in GD and to correlate it with the severity of the disease.

Patients and Methods

This study was conducted on 40 eyes of 21 recently diagnosed GO patients (two patients were single eyed) recruited from Endocrinology clinic and examined at Ophthalmology clinic, Ain Shams University Hospital in the period from March 2018 to September 2018. Complete ophthalmologic examination, proptosis assessment of direction and degree, Visual Field (VF) examination, clinical activity score (CAS), severity score assessment and Optical Coherence Tomography (OCT) were performed to all patients .

Results

In the whole group of patients; the mean average pRNFL was 109.53 um ± 12.33 SD (range: 86 – 140), median MD was -4.53 (range:-0.66 to-18.95) and -8.04 ± -2.15 SD, mean PSD was 5.55 ± 3.8 SD (range: 1.11 to 12.73). Normal average pRNFL thickness (according to normative data base included in the OCT program) was found in 15 eyes (37.5%) and those had abnormal increase in thickness was 12 eyes (30%). Abnormal decrease in thickness was detected in 13 eyes (32.5%).

Conclusion

PRNFL thickness abnormalities were detected in 25 eyes (62%) of recently diagnosed GO patients. This might be associated with localized visual field defects. Regular follow up of intra ocular pressure (IOP), serial VF examinations, are required to decide further management of those patients, as OCT results were correlated with degree of eye protrusion and the severity of the disease (CAS and severity score).
Comparative Study between Femtosecond Laser Assisted in-situ Keratomileusis and Femtosecond Small Incision Lenticule Extraction for Correction of Myopia and Myopic Astigmatism
Authors: Abutaleb A A , Metwally M G , Elraggal T M , Salem O A
Published: May 2020

Purpose

This study aimed at comparing femto-LASIK with small incision lenticule extraction (SMILE) as regards the safety, efficacy, accuracy and post-operative complications with special emphasis on the post-operative dry eye, corneal sensation and corneal biomechanics in cases of myopia and myopic astigmatism.

Patients and Methods

The study was a prospective comparative study that was conducted in a private eye hospital on 60 eyes of 30 patients with myopia or myopic astimgatism. Each patient was fully assessed preoperatively including visual acuity, refraction, tear breakup time, Schirmer test, corneal sensation & Ocular Response Analyzer®. Femto-LASIK was done to 15 patients and SMILE was done to 15 patients. Postoperative visual acuity, refraction, tear breakup time, Schirmer test, corneal sensation at 1 month, 3 months and 6 months and Ocular Response Analyzer® at 6 months were done and data was retrieved and analyzed.

Results

Cylindrical error was higher in SMILE group at all postoperative points. Tear breakup time was better in SMILE group in 1st month, but no significant difference in later follow ups. Corneal sensation was better in SMILE group in 1 month and 3 months, but this difference disappeared at 6 months. Corneal hysteresis & corneal resistance factor were significantly better in SMILE group.

Conclusion

Both techniques are safe and efficient. Femto-LASIK is more efficient in correcting cylindrical error. SMILE is better in early postoperative dry eye, corneal sensation and in corneal biomechanics.
Visual Field Changes in Multiple Sclerosis
Authors: Mansour D E A , Abdelhamid A M E , Fahmy S S M
Published: May 2020

Background

multiple sclerosis (MS) is a demyelinating disease of the central nervous system and the leading cause of disability in young adults. Afferent pregeniculate visual pathways (retina, optic nerves, chiasm, and tracts) are preferential targets of inflammation, demyelination, and axonal degeneration.

Aim of the Work

in our study was to find and correlate visual field findings in multiple sclerosis patients with clinical data.

Patients and Methods

this study included 30 eyes of 17 patients previously diagnosed as multiple sclerosis according to the international panel on diagnosis of MS (McDonald criteria 2001) and its revision by Polman etal 2005. All our cases were from both sexes and of different age group ranging from 18 years old to 51 years old. there were subtypes of MS included in our study which were relapsing remitting (RR), and secondary progressive (SP). All cases were from Ain-shams university hospitals, outpatient clinics.

Results

this study was conducted in Ain-shams university hospitals out-patient clinics, it included 17 patients previously diagnosed as MS. The age in our study was ranging from 18 to 51 years old with mean age of 33.67± 9.37.Our cases were from both sex with prevelance of female patients.

Conclusion

these findings illustrate the role of perimetry in detecting both clinically overt & and clinically occult optic nerve involvement in patients with MS. It quantifies the depth of visual field loss, identifies atypical cases of optic neuritis, aids in counseling patients about prognosis.
The Effect of Multiple Sclerosis on Nerve Fiber Layer of the Retina
Authors: Mohamed A A A , Saad A M , Mohamed T H , Elzanklony Y A
Published: May 2020

Background

Multiple Sclerosis is a chronic idiopathic inflammatory demyelinating disease involving Central Nervous System white matter with relapsing-remitting nature. Optic neuritis is a common initial manifestation. Multiple Sclerosis is characterized by dual pathological process of inflammation and neurodegeneration. It causes prominent retinal neural ganglion cell layer loss in addition to related axonal loss which can be identified by thinning of RNFL seen in OCT.

Patients and Methods

This case control study was carried out at Ain Shams University Hospitals in MS clinic of neurology department and Ophthalmology outpatient clinics. with a total of 100 eyes, from 50 subjects, Group A (10 patients, 20 eyes): normal persons with normal eyes as a Control group and 40 patients (80 eyes) having multiple sclerosis who satisfied the inclusion and exclusion criteria subdivided into 2 groups,(group B) 20 patients having previous attack of Optic Neuritis & (group C) 20 patients not having previous Optic Neuritis. Informed consents were obtained from all subjects and ethics approval were obtained from Ain Shams University Hospitals Ethical Commitee: A complete ophthalmic history and ophthalmological examination were done for each subject. Visual acuity assessment using Auto Refractometer, refraction, uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) assessment using Snellen chart and also calculated in Logarithm of Minimum Angle of Resolution (LogMAR).Pupil reaction. Color vision assessment. Anterior segment detailed Slit Lamp examination. Posterior segment examination (ONH examination) using Slit lamp biomicroscopy, Volk +90 Diopter lens. Intraocular tension measured by Goldmann applanation tonometry. OCT to evaluate RNF layer thickness and c/d ratio.

Results

Our study results demonstrated that: VA & BCVA were statistically significant lower in MS group than the control group (P = 0.011, 0.006 respectively). Total, superior, inferior and temporal RNFL thickness were statistically significant lower in MS group than the control group(P = 0.003, 0.004, 0.028, 0.018 respectively), while there was no statistically significant difference between the two studied groups regarding nasal RNFL thickness. Total, all the four quadrants superior, inferior, temporal and nasal RNFL thickness were statistically significant lower in MS group with previous attack of ON compared with the MS group not having previous ON (P = 0.000, 0.000, 0.004, 0.004, 0.024 respectively).

Conclusion

This study also suggests a great role of ocular imaging techniques such as OCT as an effective noninvasive, high-resolution, non contact tool in mapping of subclinical retinal changes (GCIP layer) in MS patients. It may also serve as a diagnostic adjunct for monitoring disease activity and responses to neuroprotective drugs.
Comparison between surgical outcome between levator resection and levator aponeurosis tucking with non absorbable sutures in mild and moderate unilateral congenital ptosis
Authors: Sargious A A S , Ziko O A O , Fawzy S M , Elsamkary M A M
Published: May 2020

Purpose

To compare levator tucking with resection in mild and moderate congenital ptosis:

Methods

Prospective comparative randomized trial involving 20 eyes of 20 patients, simple mild-to-moderate congenital ptosis with good-to-fair amount of levator action were included. Patients were randomized to either levator resection or tucking. Outcome was compared in terms of eyelid height and course of postoperative events. Data collected included margin reﬂex distance (MRD1), symmetry of eyelid height, contour and complications. Surgery was considered successful if the following three criteria were simultaneously met: A postoperative MRD1 of ≥ 2 mm and ≤4.5 mm, inter-eyelid height asymmetry of ≤ 2 mm, and satisfactory eyelid contour.

Results

Mean age was 12.9 years in resection group (range 5–25 years) and 12.20 years in tucking group (range 4-23 years) postoperative follow-up was 3 months comparing post operative levator function between resection and tucking group was statistically significant (P-value 0.025) tucking didnot improve levator function as much as levator resection did. Mean preoperative palpebral fissure height was 7.8 ml in resection group and6.9 ml in tucking group and the mean postoperative palpebral fissure height was 10.0 mm in resection group and 8.9 mm in tucking group.

Conclusion

Both levator resection and levator tucking are safe and efficient in correcting minimal and moderate degree of congenital blepharoptosis, with less recurrence in levator muscle resection
Surgical Versus Nonsurgical Treatment for Acute Achilles Tendon Rupture A Systematic Review/Meta-Analysis
Authors: Elshazly O A , Mohamed A F , Mohamed Y R A
Published: May 2020

Background and Introduction

Tendon Achilles injury affects 31.17 per 100000 per year, it has major impact on quality of life of affected patients, mostly active young patients. Different management options exist ranging from conservative treatment, to operative repair either open or percutaneous repair.no consensus has been reached on which treatment modality is preferred for each patient .in this study we systematically reviewed the literature for available evidence regarding management of tendon Achilles rupture.

Aim of the Study

to compare the two methods for treating Acute Achilles tendon rupture in a systematic review with meta-analysis and evaluate the functional outcomes of each methods. The objective is to perform a systematic review of overlapping meta-analysis regarding surgical versus non-surgical management of Acute Achilles tendon rupture to assist the decision makers in selecting their decision and provide intervention recommendations by the best available evidence.

Methods

This systematic review consisted of 5 studies, including a systematic search of the literature (PubMed, SCOPUS, and The Cochrane Library), selection of studies, extraction of study characteristics, assessment of methodological quality and bias. and extraction of data on clinical outcomes and their comparisons between different surgical groups.

Results

a total of 9 studies were included, 822 patients were extracted from the included studies. Of the 822 patients, 415 (50.4%) had undergone surgical intervention and 407 (49.6%) had received non-surgical treatment. The minimum follow-up duration was 12 months. The left Achilles tendon was relatively more prone to rupture. The interval from injury to treatment was within 2 to 14 days. Five 5 different surgical techniques were used; end to end, modified Kessler, augmented repair, Krackow type and interrupted circumferential stitch. Operative repair was found to significantly decrease rupture rate (risk ratio of 0.36, 95% CI 0.21-0.64; P = 0.0005) with higher risk of wound complications. No statistically significant difference between the two groups in functional outcome scores and range of motion.

Conclusion

We conclude that surgical technique lowers the risk of re-rupture rate but associated with higher complication rate which can be reduced by using the minimally invasive techniques. Multicenter randomized clinical trials are needed to obtain a high-quality level of evidence for the comparison between the different modified surgical techniques and the gap effect on making different decision of managements.
Bone Graft Vs Bone Substitutes in Treatment of Cavitary Benign Bone Tumors (A Systematic Review Study)
Authors: Mostafa M A , Azmy S I , Helmy K S
Published: May 2020

Background and Introduction

Extended curettage is the commonest mode of treatment of cavitary benign bone tumors. If a tumor is very large and threatening to involve the joint, complete excision with joint reconstruction may be necessary. Cure rates of 90–95% have been achieved using curettage as the sole mode of treatment in benign bony lesions. However this treatment is not devoid of controversy and many authors recommend that bone defect after curettage of benign bone tumors should be filled with bone grafts or bone substitutes.

Aim of the Work

To compare clinical and radiological outcomes, when possible after using of synthetic bone substitutes and bone grafts in surgical treatment of cavitary benign bone tumors.

Materials and Methods

This systematic literature review has included 22 studies and consisting of 4 steps which are a systematic search of the literature (PubMed, SCOPUS, Cochrane Library), selection of studies , recording of study characteristics and extraction of data based on clinical outcomes and their comparisons between different surgical groups.

Results

This systematic review has included 1071 patients of which 742 were treated using different types of bone substitutes, while the remaining 329 were treated using bone grafts (allografts or autografts). Comparing between both groups we have found that the difference in the graft incorporation time between both groups was statistically insignificant which was 6.65 months in group A and 7.01 months in group B with P value = 0.355(NS). The difference in the postoperative fracture rate as well was statistically insignificant; 1.9% in group A and 3.9% in group B with P value = 0.294(NS). However, there was a significant difference in the postoperative infection rate between group A (2.1%) and group B (12.8%) with P value = 0.01(S) and in the recurrence rate as well, which was 10% for group A and 4.3% for group B with P value = 0.002(HS).

Conclusion

Synthetic bone graft substitutes have evolved in response to the downsides of autograft and allograft. No level I studies regarding their use in the treatment of bone tumors have been performed. This study indicates that all of the bone substitutes are safe and may be as effective as other bone graft options and with no limitation in their source for filling the large defects. Prospective randomized clinical trials in the treatment of bone tumors comparing bone graft substitutes versus other grafts (autograft and allograft) are necessary to properly delineate the real indications for bone grafting and to demonstrate the graft’s efficacy in this regard.
Management of Complex Distal Femur Fractures: Comparative Study between Ilizarov External Fixation and Double Plating
Authors: Thakeb M F , Gooda A H , Fayyad T A , Elkersh M A , Abourisha E N
Published: May 2020

Background

In this prospective randomized clinical study, we report results of management of type C2 and C3 distal femur fractures by Ilizarov external fixator in comparison with double plating through separate medial and lateral approaches with a mean of 42.8 ± 6.84 weeks follow-up.

Patients and Methods

In this study we managed 30 cases with highly comminuted distal femoral fractures AO classification type C2 or C3. Fifteen cases were surgically managed by Ilizarov technique and the other fifteen cases were surgically managed by double plating technique. We compare between both group as regard clinical, radiological results and rate of complications.

Results

while using Knee society score, the results are the following: In Ilizarov group: 7 cases (46.67%) are excellent, 4 cases (26.67%) are good, 3 cases (20.00%) had fair results while 1 case (6.67%) had poor results. In internal fixation group, 8 cases (53.33%) had excellent results, 3cases (20%) had good results, 2 cases (13.33%) had fair results while 2 cases (13.33%) had poor results.

Conclusion

In fixation of complex distal femur fracture, both Ilizarov and double plating methods had no significant difference in clinical outcome by knee society score and in rate of complications. Ilizarov allow earlier weight bearing and less blood loss while double plating gives better ROM of knee joint and rapid radiological healing.

Level of Evidence

Level I Randomized controlled study.
Imported Malaria confirmed by immuno-assay
Authors: Abdelgawad S S , Abusarea E Y , Shaapan R M , Ghieth M A
Published: May 2020

Background

Malaria is the most clinically critical parasitic infection worldwide with undesirable morbidity and mortality.

Aim of the Study

This study detected the efficacy of rapid diagnostic test for detection of imported malaria among patients with history of fever and/or had travelled to malaria endemic region.

Subjects and Methods

Blood samples were collected through a year from 732 patients attending three medical laboratories at El Wasta city, Beni-Suef, Egypt. Malaria was tested using thin and thick Geimsa stained blood film and rapid diagnostic test (RDTs) for immunological detection of malaria antigen.

Results

Microscopy reveled malaria in 4 samples (0.5%) distributed as follow, P. vivax, P. falciparum, mixed P. falciparum and P. vivax infection (0.5%, 0.25%, 0.25%, respectively). Antigen detection was positive in 7 cases (0.9%) with maximum sensitivity, satisfied specificity (100%, 98.5%, respectively) and substantial Kappa agreement (0.677). All positive samples for malaria by microscopy were confirmed by malaria antigen detection. All positive samples by microscopy and/or immune-assay were traveled to Sudan (71.4%) or Yemen (28.6%).

Conclusion

Sudan is considered a major focus for imported malaria in Egypt, much restriction rules are needed for travellers and immigrants. Antigen detection using RDTs is a satisfied confirmatory test for suspected cases with fever history.
The Role of Pre-B-cell Colony- Enhancing Factor in Egyptian Children with Hemophagocytic Lymphohistiocytosis
Authors: Ibrahim W E , Ebeid F S E , Mohamed R M
Published: May 2020

Background

Hemophagocytic lymphohistiocytosis (HLH) caused by a highly active but ineffective immune response, including impaired or absent function of natural killer cells and cytotoxic T cells, and the release of pro-inflammatory cytokines. Pre-B-cell colony-enhancing factor (PBEF) is an inflammatory cytokine involved in several inflammatory diseases and it has been identified to react with several cytokines involved in HLH.

Objective

we aimed to evaluate the role of PBEF as a diagnostic and prognostic marker in Egyptian children with HLH.

Subjects and Methods

This is a cross-sectional study, recruited fifteen children with HLH from the Pediatric Hematology/Oncology unit. Patients underwent thorough clinical assessment lying stress on disease manifestation, classification, treatment and prognosis. Plasma concentration of PBEF was determined using an enzyme-linked immunosorbent assay.

Results

PBEF was significantly increase in patients group than control group. Four patients were classified as primary HLH, seven patients were as secondary HLH and four patients had unknown classification due to waiting for genotyping. Seven patients of the study group were died and eight patients still alive. PBEF level showed a significant positive correlation with serum ferritin and triglycerides level and negative correlation with fibrinogen level.

Conclusion

The elevated PBEF level and its correlation with the widely available biochemical markers for diagnosis of pediatric HLH indicating that it may be involved in its inflammatory process.
Screening of vitamin B12 in children diagnosed as Autism Spectrum Disorder
Authors: Metyas M M , Abdelhakim A S , Ghandour H H
Published: May 2020

Background

Vitamin B12 deficiency causes megaloblastic anemia and disorders of the nervous system. In Autism spectrum disorder intestinal problems in absorption of some minerals like Vitamin B12 which lead to Vitamin B12 deficiency.

Aim of the Work

to investigate level of vitamin B12 in autistic children in an attempt to reach such etiological factor and to be incorporated in management if proved.

Patients and Methods

a Case control study. The subjects of this study comprised a convenient sample of 15 children diagnosed as ASD and other 15 children not diagnosed as ASD as control group with age range between 3 years 8 months. Modified Arabic preschool language scale (PLS-4) Test, Stanford Binet intelligence scales, fifth edition were done for all children and Child autism rating scale (CARS) was done for children of 2 groups.

Results

Vitamin B12 level in ASD is significantly deficiency compared to the Vitamin B12 level of normal subjects.

Conclusion

Vitamin B12 in ASD was found to be decreased in cases group than the controls group also below the total language level of cases group than the controls group.
Assessment of Subtle Myocardial Dysfunction in Asymptomatic Infants of Diabetic Mothers
Authors: Kotby A A , Elguindy W M , Soliman N M S , Aboelmaati S A
Published: May 2020

Background

Cardiovascular abnormalities in infants of diabetic mothers (IDMS) occur in the form of congenital heart diseases (CHD), and hypertrophic cardiomyopathy (HCM).

Aim of the Work

We hypothesized that two dimensional speckle tracking imaging and pulsed wave tissue Doppler imaging (TM) may uncover subtle myocardial dysfunction in asymptomatic IDMs.

Patients and Methods

This study was a cross sectional descriptive study conducted at Ain shams University Children’s Hospital Pediatric cardiology unit during the period from June 2017 till January 2018. Thirty IDMs were recruited. IDMs with CHD and HCM were excluded. We further subdivided them into 2 groups; Infants of gestational diabetic mothers (IGDM) and infants of pregestational diabetic mothers (IPGDM). They were all examined using TDI and STI echocardiography in the first week of life. This group was compared to a group of age and sex matched healthy controls.

Results

All IDMs had normal cardiac dimensions and global cardiac functions as controls, IVS (P = 0.434), LVED (P = 0.318), EF (P = 0.291), LVFS(P = 0.644) and GLS(P = 0.240). However, evidence of LV dysfunction proved by increased Tei index (p = 0.018). This subtle affection of myocardial function was more prominent in infants of IPGDM when compared to IGDMs (P = 0.004).

Conclusion

Subtle affection of myocardial functions may occur in IDMs even in the absence of morphological cardiac changes. This was detected by TDI. Neither conventional assessment of myocardial functions, nor STI are sensitive tools in detecting these changes. IPGDMs are at risk of more profound affection of myocardial function than infants of IGDMs.
Bovine Colostrum For Prevention Of Late Onset Sepsis In Preterm Neonates: A Randomized Control Trial
Authors: Awad H A , Imam S S , Aboushady N M , Ismail R I H , Abdou R M , Azzam N T
Published: May 2020

Objective

to determine whether gut priming with bovine colostrum reduces nosocomial sepsis episodes and to determine its effect on sepsis severity and weight increment.

Study Design

In this prospective, placebo-controlled, double-blinded, randomized trial, infants born before 34 weeks were assigned to receive either placebo (n 33) or bovine colostrum (n 32) as gut priming. Episodes of nosocomial sepsis (diagnosed by using Rodwell and Töllner sepsis scores) were recorded. A third comparison was made with standard care group of preterm neonates (n 17).

Results

Fewer sepsis episodes were observed in bovine colostrum-treated infants (3 vs. 6, p-value 0.482) with none developed severe sepsis. There was no significant difference in the weight increment (p-value 0.355)

Conclusion

Gut priming with oral Bovine Colostrum decreases severe sepsis in preterm neonates.
Double Negative Alpha Beta T Cells in Pediatrics Patients with Hemophagocytic Syndromes
Authors: Hossny E M , Elowaidy R H , Afifi H M , Ahmed H R
Published: May 2020

Introduction

Autoimmune lymphoproliferative syndrome (ALPS) and hemophagocytic lymphohistiocytosis (HLH) share clinical and laboratory features including lymphandenpathy, splenomegaly and pancytopenia. We sought to measure αβ double negative T cells (αβ DN T cells) among patients with established diagnosis of HLH and study its relation to disease activity and severity.

Methods

we conducted a follow-up controlled study, comprising 25 patients fulfilling diagnosis of HLH according to criteria set forward by the pediatric HLH study Group of the Histiocyte Society, in addition to 25 healthy matched controls. Patients were subjected to clinical evaluation and flow cytometric measurement of αβ DN T Cells percentages at presentation and 9 weeks after start of HLH induction treatment.

Results

In 17 (68%) patients, infection was the trigger of HLH while the trigger was malignancy in three (12%), and rheumatological disorders in two patients (8%). At enrollment, 15 patients (60%) has elvated αβ DN T cells (>2%), with median (IQR) counts of 1.71 (1.25-2.12) that were significantly higher that the control values (median (IQR): 0.7 (0.4-0.8) (p < 0.001). Initial αβ DN T cells counts of patients were also higher at enrollment as compared to results at the end of week 9 (median (IQR): 0.76 (0.45–1.17), p = 0.018). Survivors (n = 17 [68%] )and non-survivors (n = 8 [32%]) had comparable levels of αβ DN T cells at enrollment (p = 0.861).αβ DN T cells correlated positively with ALT (p = 0.019) and negatively with CD4/CD8 ratio (p = 0.023).

Conclusion

Elevated αβ DN T cell counts may not be specific for ALPS and their mild elevation might be related to the HLH process. Wider scale studies with longer periods of follow up are needed to validate the results and properly anticipate the correlation between both medical conditions.
Levosmindan: A new step up in Management in Neonatal Cardiogenic shock
Authors: Awad H A , Mahmoud M Z , Aboelwafa M S , Shabana A M , Shehata B M , Ahmed W O , Ismail R I H , Imam Safaa S
Published: May 2020

We report the use of Levosimendan, calcium sensitizer, inodilator in a neonate with post-operative refractory cardiogenic shock. Currently, no data are available on the use of levosimendan in newborns outside the cardiosurgical setting. A 38-week neonate -with isolated exomphalos major-presented post-operatively with pulmonary hypertension, refractory cardiogenic shock (inspite of receiving, a bolus of 10ml/kg, Dopamine and Dobutamine 15µg/kg/min, Adrenaline up to 1mg/Kg/min, Noradrenaline 0.5mg/Kg/min, Terlipressin 20µg/Kg/hour, Milrinone 25µg/Kg/min) and arrhythmia (supraventricular tachycardia). Levosimendan was introduced as an intravenous infusion with an initial rate of 0.1 up to 0.2µg/Kg/min in addition to Noradrenaline 1µg/Kg/min, Dopamine 15µg/Kg/min and Furosemide infusion 0.1mg/Kg/hour. The patient improved evidenced by normalization of vital signs and restoration of perfusion with better cardiac functions by echocardiography. Conclusion: Levosimendan has positive inotropic, lusitropic and vasodilating effects for the treatment of heart failure yet further studies in neonates are still required.
Helicobacter pylori Antibiotic resistance patterns among Egyptian children and predictors of resistance
Authors: Awad Y M M M , Eldeeb M T , Fathi M S , Mahmoud N , Morsy R M E
Published: May 2020

Background

Most individuals are infected by Helicobacter pylori during early childhood; in developing countries, 50% of children are infected by the age of 5 years. Successful eradication is important to prevent the development of antibiotic resistance, as well as to reduce the number of treatments and procedures. Among children receiving the standard triple therapy regimen, eradication rates are declining. Thus, national/ regional antibiotic resistance data could be used to guide treatment regimens for H pylori infection

Aim of the work

to evaluate the antibiotic resistance patterns of Helicobacter pylori strains among pediatric patients and the predictors of this resistance.

Patients and Methods

Cross sectional, carried out on 30 pediatric patients who presented to gastroenterology unit Ain Shams University for endoscopic evaluation of their upper GI symptoms including hematemesis, vomiting and abdominal pain. Five gastric biopsies were taken, two from the corpus for histopathology and culture, and 3 from the antrum, where one of them was sent for histopathology, and the second one for rapid urease test, and the third one was sent for culture and sensitivity.

Results

Results of culture and sensitivity has shown that resistance to amoxicillin was 20%, to clarithromycin was 50%, metronidazole resistance was 86.7%, tetracycline resistance showed to be 13.3%, finally levofloxacin resistance was 6.7%. Excess intake of fat was associated with resistance to amoxicillin and clarithromycin. While, duodenal ulcer and duodenal nodularity were associated with resistance to tetracycline and levofloxacin respectively.

Conclusion

The eradication regimen in Egypt should be revised according to our national antibiotic resistance data. Further studies are needed to assess predictors of resistance to antibiotics.
Nutritional and feeding Assessment of neurologically impaired children: a single center study
Authors: Younis N T , Elgendy Y G , Shata M O , Sheha H G
Published: May 2020

Background

Neurologically impaired (NI) children are at increased risk of malnutrition due to several nutritional and non-nutritional factors. Under nutrition, growth failure, overweight, micronutrient deficiencies, and osteopenia are nutritional comorbidities that can affect them.

Patients and Methods

A case control study,302 patients were recruited from Children’s Hospital Ain Shams University with age range from 6 months to 16 years. They were divided into (group 1) 151 neurologically impaired children and (group 2) 151 age and sex matched healthy controls, group 1 was further classified into 4 subgroups according to motor or mental deficit. All patients were subjected to detailed History, dietetic history (3 day food diary), Feeding assessment questionnaire and Complete anthropometric measurements

Results

majority of studied patients (47.6%) had motor and mental affection ,feeding difficulties were high where Gagging occurred in (44.37%) Choking (39.47%)( Vomiting 21%) Limited volume(50%) Limited variety(40.4%) aspiration ( 51.66%) and food retention (41%)

NI patients had significant lower values of recommended dietary allowance of calories, protein ,CHO ,fat ,iron, vitamin B1 and vitamin B2(p < 0.001)

Conclusion

feeding difficulties were significantly high in NI Children they suffered from restricted daily caloric intake required for their energy needs, resulting in a decrease of linear growth and a serious risk of malnutrition. Micronutrients deficiency is common in younger children with neurological disorders.
Liver disease in children and Adolescents with Type1 Diabetes Mellitus
Authors: Elsayed M H , Hamza M T , Elsaeed M M , Thabet R A F
Published: May 2020

Glycogenic hepatopathy (GH) is a very rare complication seen mostly in patients with type 1 diabetes mellitus (T1DM) in whom glycemic control has been poor for a long time. We assessed liver diseases in children and adolescents with type 1 diabetes mellitus by detection of elevated liver transaminases and confirmed by fibro scan and ultrasound. One hundred and seven children and adolescents with T1DM were subjected to detailed history, physical examination, laboratory investigation and radiological investigation. Liver transaminases, mean HbA1c and pelviabdominal ultrasound were done for all patients while fibro scan for those with elevated liver enzymes only. Patients with elevated liver enzymes were reassessed after one year. Only nine of our patients have elevated liver enzymes. HbA1c and fibro scan abnormalities (F stage) were significantly higher in patients with elevated liver enzymes. (p < 0.001) After follow up a significant decrease in liver enzymes, fibro scan abnormalities and HbA1c in the group with elevated liver enzymes initially was detected. (p < 0.001) We concluded that liver disease is not a common complication in patients with long standing uncontrolled diabetes which can be reversed after proper control.
Anti GAD Negative Autoimmune Limbic Encephalitis in Diabetic Ketoacidosis: A Case Report
Authors: Zaitoun R M H , Abdelsalam O A , Aly H H
Published: May 2020

A 4-year-old boy presented to the emergency room with severe abdominal pain, tachypnea and vomiting followed by progressive obtundation. He was found to have hyperglycemia, ketonuria and metabolic acidosis. A diagnosis of Diabetic ketoacidosis was hence made and the boy was managed as such, with improvement in his laboratory parameters as well as in his level of consciousness.

On day 6 after admission, the boy developed a recurrence of altered consciousness and repeated seizures. On examination the boy had spastic quadriparesis lateralizing to the right side. MRI of the brain showed multiple inflammatory lesions involving both temporal lobes. CSF analysis was unremarkable and CSF Herpes Simplex virus PCR was negative. Based on the inflammatory nature of lesions on MRI, with negative PCR for HSV and otherwise unremarkable CSF, together with progressive worsening of level of consciousness and spasticity, the possibility of autoimmune encephalitis was raised and the boy received 2 grams per kilogram of intravenous immunoglobulin with mild improvement in level of consciousness. The boy then received intravenous pulsed methylprednisolone, with a clear improvement in both his motor and mental capabilities. Three months post hospital discharge, the child was back to normal.

This case highlights the importance of considering autoimmune encephalitis in the differential diagnosis of altered level of consciousness in a child with type 1 diabetes, especially in the presence of suggestive MRI findings and a lack of an alternative explanation.
Cardiac Troponin T in very low birthweight preterm infants with patent ductus arteriosus
Authors: Mohamed M H , Aboraya H M , Makawy M A , Elgebaly H H
Published: May 2020

Aim

to assess the role of cardiac troponin C (cTnT) as a marker of cardiac injury in VLBW infants with clinically significant PDA and its relation to echocardiographic findings.

Methods

Seventy-seven VLBW preterm infants, were included, divided according to their diameter of PDA and its hemodynamic significance into patients and control groups. For all neonates, CBC, CRP, cTnT and echocardiography, were done at 48 hours of life and as follow up 5-7 days later.

Results

41 preterm infants with a mean gestational age of 31.7±1.57 weeks and birth weight of (1.38±0.2kg) were included as patients group, 36 preterm infants were included as control group with a mean gestational age of 32.2±0.9 weeks and birth weight of (1.33±0.2kg). At 48 hours, cTnT concentrations in patients group was significantly increased than in control group (0.31±0.06 ng/dl, 0.16±0.03 ng/dl, respectively, P < 0.001) and was positively corelated to PDA diameter in patients group (r:0.313, P:0.046). Mean left ventricular end systolic diameter was significantly decreased in patients than in control groups (9.00±1.94, 14.72±1.56, P:0.023).

On 5th day, cTnT concentrations (0.15 ±0.03 ng/dl) significantly decreased with closure of the duct (p: 0.004) together with increase in ejection fraction and fraction shortening (P < 0.001, P:0.008 respectively)

Conclusion

cTnT may provide the basis for early diagnosis and detection of hemodynamically significant PDA in VLBW neonates for trials of medical treatment.
Effect of Botulinum Toxin Injection in Treatment of Upper Limb Spasticity in Childhood Cerebral Palsy: A Systematic Review
Authors: Alkadery N A , Mohammed M O , Elzohiery A K , Ahmed S M
Published: May 2020

Cerebral palsy (CP) is the most common cause of childhood disability globally. It manifests in restricted functional mobility and impacts the quality of life negatively. Botulinum toxin injections are widely used to manage limb spasticity in children with cerebral palsy. In the upper limbs of CP children intramuscular botulinum toxin-A has been used to manage pre and post-operative pain, facilitate nursing and achieve functional and/or cosmetic improvement of hand position. These goals are achieved primarily through reduction of spasticity.. This review aims at providing the evidence for effect of botulinum toxin-A injections to manage upper limb spasticity in spastic cerebral palsy cases. The literature extraction process yielded 15 articles for inclusion in this review. After reviewing these articles we concluded that botulinum toxin-A had a positive effect on the degree of spasticity, motor functions and cosmetic appearance of the injected upper limb but its effect increased by addition of another regimen as O.T.,P.T, casting or splintage.
Role of Dynamic Subtraction MRI in Assessment of Reactivity of Hepatic Focal Lesions post Trance arterial chemoembolization
Authors: Hassan M G , Abdelrahman A S , Abdu E M H
Published: May 2020

The aim of this work was to assess HCC cases after trans-arterial chemoembolization by subtraction dynamic contrast enhanced MRI to detect its accuracy, sensitivity and specifity in detecting residual tumor and assess the need for further treatment. Patients and methods: This was a retrospective comparative study will be conducted on 35 patients hepatocellular carcinoma (HCC); to assess HCC cases after trans-arterial chemoembolization (TACE) by subtraction dynamic contrast enhanced MRI to detect its accuracy, sensitivity and specificity in detecting residual tumor and assess the need for further treatment. We found that; the mean age of all patients was (62.31 ± 7.14) years. Regarding gender of the patients, the majority (88.6%) of patients were males; while only (11.4%) were females. Regarding residence, the majority (77.1%) of patients live in rural areas, while only (22.9%) live in urban areas. Comparative study between D-MRI and DS-MRI assessments revealed; highly significant increase in disease detection rate, sensitivity, and NPV in favor of DS-MRI in HCC patients; with highly significant difference (p < 0.01 respectively). Comparative study between D-MRI and DS-MRI assessments revealed; non-significant difference in specificity and PPV in HCC patients; with non-significant difference (p > 0.05). We found a moderate agreement between D-MRI and DS-MRI assessments of reactivity among HCC patients (kappa =0.44). Conclusion: Dynamic MRI is valuable in detecting recurrent lesions however, this value is augmented by the addition of subtraction technique especially in lesions having high signal before administration of contrast medium. So we recommend adding the subtraction technique in the protocol of MRI in the follow up after transarterial chemoembolization as it increases the diagnostic confidence. This may help to facilitate the appropriate clinical management of patients including the need for re-treatment sessions.
Assessment of Uterine Cervical Cancer by Means of MR Spectroscopy
Authors: Abdelmawla Y A M , Ali M A A , Ali F H
Published: May 2020

Background

Proton magnetic resonance spectroscopy has been shown to have clinical value in managing cancers of the brain, breast, cervix and prostate, it is useful for diagnosing and monitoring treatment of cervical cancer by analyzing the metabolite composition of cervical tumors, providing details of tumors metabolism that might assist tumor grading and leading to a better understanding of the biochemical pathways found within the lesion, serving as a noninvasive biomarker of metabolism in tumors. 1H-MRS has achieved great strides as a molecular imaging technique since its introduction, and its scope in many clinical scenarios and research settings is rising.

Objective

In this study, MRS was performed in all cases using single voxel spectroscopy (SVS) and patient spectra were interpreted qualitatively by inspection of the peaks of lipid and choline.

Aim and Patients and Methods

This study was carried out during the period between December 2017 and September 2018. Twenty three patients with cancer cervix diagnosed clinically and/or pathologically proved cancer were recruited from (Oncological department) in Ain Shams University Hospitals.

Results

Our study revealed high lipid level in 65% of cervical cancer patients which has 100% sensitivity and 74% specificity in detecting cervical cancer, choline level which considered most consistent difference between majority of normal tissue and tumors shows high level in measured 69.2% of the patients.

Conclusion

Abnormal metabolism is a key tumor hallmark. Proton magnetic resonance spectroscopy (1H-MRS) allows measurement of metabolite concentration that can be utilized to characterize tumor metabolic changes. 1H-MRS measurements of specific metabolites have been implemented in the clinic. This study interpret ate the role of 1H-MRS for cancer evaluation, evaluates its strengths and limitations, and correlates metabolite peaks at 1H-MRS with diagnostic and prognostic parameters of cervical cancer.
Role of Ultrasound Guided Injection of Platelet Rich Plasma (PRP) in Rotator Cuff Tendinopathy
Authors: Niazy G M , Ali A H , Mahmoud M S S
Published: May 2020

Background

Rotator cuff tendinopathy is a leading cause of shoulder pain and a significant source of disability. It is a common disorder, with its prevalence increasing substantially with age and affecting more than 50% of the general population by the age of 60 years

Objectives

Based on these facts, our study efforts seeked assessment of the role of ultrasound guided platelet rich plasma injection (PRP) in cases of rotator cuff tendinopathy.

Patients and Methods

Type of Study is single arm interventional study was conducted in Ain shams university hospitals in the period between October 2018 and March 2019, 15 patients were included in the study ranging from 25 to 60 years old, were referred to the Radiology department at Ain Shams University Hospitals. Study Setting: all US examinations were performed by the same senior musculoskeletal radiologist with a large experience in the musculoskeletal US at the radiology department of Ain Shams University hospitals. Study Period: 6 months for data collection.

Results

Our study showed remarkably noticeable change on comparing the pre-injection and post-injection SPADI Scoring system at 4,8,12 and 24 weeks. There is highly statistically significant pain and disability score and percentage improvement, yet on the other hand the radiological improvement shows no statistically significant difference found between baseline tendon thickness and its follow up at 4, 8 and 12 weeks while only there was statistically significant decrease in tendon thickness found at 24 weeks with p-value = 0.043.

Conclusion

The ultrasound-guided PRP injection for supraspinatus tendinopathy cases is a safe, cheap, and easily prepared outpatient procedure which showed competitive, promising, and well-proved results when compared to other modalities outcomes such as conventional surgeries, arthroscopic procedures, and physiotherapy. It deserves our attention to its value and efficacy for the sake of the patient as a minimally invasive procedure providing better quality of life.
Comparative Study between Diabetic and non- Diabetic Patients Regarding Prevalence of Coronary Artery Disease and Plaque Composition by Multi-detector CT Coronary Angiography
Authors: Morsy H A , Habib L A , Abdeldayem E H , Sayed A I
Published: May 2020

Diabetes is known to be a major cardiovascular risk factor associated with significantly increased morbidity and mortality and particularly increased risk of major cardiac events especially myocardial infarction as a manifestation of highly incident coronary artery disease (CAD).This can lead to decreased life expectation and life quality. Major cause for myocardial infarction is plaque rupture. Prevalence of obstructive and non-obstructive plaques is increased in diabetic patients.

Background and Objectives

The prevalence of coronary heart disease in diabetic patients compared to non- diabetics and evaluating the composition of the plaque in diseased individuals in both groups by usage of multislice computed tomography (MSCT) angiography .

Subjects and Methods

A total of 80 consecutive MSCT angiography examinations were performed between August 2017 and June 2018. Of these, the patients were evaluated for the presence and type of atherosclerotic plaque and severity of luminal narrowing.

Results

Eighty (40 in the diabetic group and 40 in the non-diabetic group) patients underwent MSCT angiography with DM prevalence of 0.212 (95% Cl for AOR 0.056 -1.896). Among them, 20 patients (50 %) in the diabetic group and 14 patients (35 %) in the non-diabetic group had +ve coronary heart disease, 33.3 % had significant and moderately significant coronary narrowing on diabetic group and 31.3 % in non-diabetic group on MSCT angiography. Diabetic patients had more soft plaque compared with non-diabetic patients.

Conclusion

DM is not an independent factor for the disease occurrence in coronary artery disease but is a dependent factor in the association of other risk factors such as smoking ,hypertension and dyslipidemia.