bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Implementation of the CURE Protocol for Treating Pediatric Hydrocephalus: An Institutional Experience
Authors: Aglan Osama , Al-Abyad Ashraf G , Kotb Mohammed M , Abdel – Latif Assem M 
Published: November 2024

Abstract

Background
Paediatric hydrocephalus imposes a significant clinical and financial burden in developing countries, this study aims to assess the efficacy and safety of endoscopic third ventriculostomy (ETV), either alone or combined with choroid plexus cauterization (CPC), for preventing shunt dependence in paediatric hydrocephalus within a healthcare setting of a tertiary hospital in Egypt.

Patients and Methods
This prospective clinical case series included Patients ≤16 years old with clinical signs and/or symptoms of hydrocephalus requiring CSF diversion and accessibility for follow-up. Cases with active infection or brain imaging showing anatomical distortion or multiloculated hydrocephalus were excluded. Failed ETV+/-CPC cases were categorized into early and late failure groups, each with specific management strategies.

Results
Forty patients admitted to Ain Shams University Hospitals between March 2022 and August 2023. underwent ETV+/-CPC using a flexible neuroendoscope. Aqueductal stenosis was the most common etiology, observed in 13 patients (32.5%), followed by myelomeningocele in 11 patients (27.5%), and post-infectious causes in 6 patients (15.0%). The median age of the patients was 5.05 months. Twenty-five patients (62.5%) achieved successful outcomes following ETV/CPC procedures, with no procedure-related morbidity or mortality events observed. Fifteen patients (37.5%) experienced ETV failure, of whom 6 underwent ETV redo procedures. Twenty-eight patients (70%) remained shunt-free in the study cohort. The mean follow-up duration was 12 months.

Conclusion
ETV/CPC demonstrates effectiveness in decreasing the necessity for shunt placement across various patient demographics. Moreover, it supports a sustainable and cost-effective approach to hydrocephalus treatment.
Serum Progesterone Level on the Day of Embryo Transfer and Clinical Pregnancy Rate in Patients Undergoing Down-Regulated Frozen Embryo Transfer Cycles; Prospective Observational Study
Authors: El-Gamal Ahmed , Bayoumy Karam , Elsalamy Ayman , Abbas Mustafa 
Published: November 2024

Abstract

Background
Serum Progesterone concentration &lt;5 ng/ml on the day of frozen embryo transfer (FET) is associated with significantly decreased pregnancy and live birth rates.

Aim of the Work
This study aims at finding the critical cutoff value of serum progesterone on day of FET that significantly affects pregnancy rates.

Patients and Methods
The current study was conducted at Ain Shams University Maternity Hospital- IVF Unit during the period between April 2022 and December 2022. It included a total number of 108 patients who either were assessed for eligibility of the study, of which, 14 were excluded due to non-matching inclusion criteria or had exclusion criteria. 4 patients did not consent to participate in the study and 86 patients matched. They were preaped for frozen emberyo transfer according to IVF unit protocol at Ain Shams university and serum progesterone level on day of emberyo transfer was assessed and matched to clinical pregnancy rate.

Results
Progesterone on day of embryo transfer was significantly lower in cases with positive chemical pregnancy with a cut off value ≤39.2 ng/mL.

Conclusion
Progesterone is essential for establishing and maintaining embryo implantation and pregnancy; also, P4 is used for luteal phase deficiency in infertility treatment. Yet, progesterone therapy’s optimal timing and dose can influence the impact of P4 on pregnancy. Also, low or elevated P4 level can negatively impact embryo transfer timing and pregnancy rate. This study demonstrated that age, BMI and progesterone on day of embryo transfer had significant low diagnostic performance in predicting positive chemical pregnancy This study illustrated that no statistical significant difference according to chemical pregnancy regarding hormonal profile Before the start of estradiol valerate. Progesterone on day of embryo transfer was significantly lower in cases with positive chemical pregnancy.
Enhanced Recovery after Elective Cesarean Delivery at Ain Shams University Maternity Hospital: A Randomized Controlled Trial
Authors: Nagib Easa Amira Farag , Ahmed Swidan Khaled Hassan , Gomaa Ali Ihab Adel , Eltaieb Ebtihal Mohamed Mahmoud 
Published: November 2024

Abstract

Background
Enhanced recovery after cesarean delivery (ERAC) is perioperative care program to fasten patients recovery. ERAC protocols intended to improve patient outcomes and fasten return to normal function before surgery by standardization of practice at all stages: preoperative, intraoperative and postoperative.

Aim of the Study
The aim of this study was to evaluate whether the implementation of enhanced recovery after cesarean (ERAC) would decrease the length of hospital stay and pain score and improve postoperative patient satisfaction and breastfeeding and its effect on postoperative complications and hospital readmission.

Patients and Methods
86 pregnant women undergoing uncomplicated elective cesarean delivery were enrolled in this study. patients were randomized to two groups: 43 patients in the Enhanced recovery after cesarean delivery (ERAC) group and 43 patients in the standard care group. Enhanced recovery after cesarean involved multiple evidence-based interventions and were divided into the three major phases of patient care: antepartum, intrapartum and postpartum. The primary outcome was the length of hospital stay after cesarean delivery. Secondary outcomes included pain medication requirements and pain scores, breastfeeding and first time of start breastfeeding, maternal satisfaction, postoperative complications and hospital readmission.

Results
Enhanced recovery after cesarean delivery was associated with a highly significantly shorter length of hospital stay when compared to standard care (p- value &lt;0.001). There was a highly significant reduction in pain scores at 2h, 4h, 6h and 12h in the ERAC group in comparison to standard care group (p-value &lt;0.001). There was no statistically significant difference between the two groups of studied participants regarding breastfeeding (p-value=0.5). However, there was statistically highly significant difference between the two groups of studied participants regarding the time of starting breastfeeding (p-value &lt;0.001). The participants were more significantly satisfied in the ERAC group than in the standard group (p-value&gt;0.001).

Conclusion
Implementation of enhanced recovery after elective cesarean delivery (ERAC) pathway lead to significantly shorter length of hospital stay, lower pain scores, better patient satisfaction and earlier start of breastfeeding.
Impact of Bariatric Surgery Induced Weight Loss on Women Fertility: A Prospective Cohort Study
Authors: Gamal Abdelnasser Ahmed , Mahmoud Mohamed Taha Ismail , Hassen Dalia Ali Mohamed , Fouly Mohamed Gamaleldin Lotfy , Nawara Mai Medhat 
Published: November 2024

Abstract

Background
Obesity is a multifactorial chronic disease. It is one of the world's most significant public health issues because its prevalence is steadily rising in Occidental countries and because it is a major risk factor for a variety of chronic diseases, including tumors.

Aim of the Work
The aim of the study is to evaluate the impact of bariatric surgery induced weight loss on women fertility.

Methods
This prospective cohort study was conducted at Ain Shams University Hospitals (ASUH) from June 2022 till December 2022 and performed on total 75 obese women who attended Ain Shams University Hospitals for bariatric surgery (sleeve gastrectomy).

Results
BMI among the studied cases significantly decreased in 3-months postoperatively. After 3-months post operative Excess Body Weight Lost was significant, with average more than quarter of the excess 29.9±6.6 %. AMH, LH and FSH/LH among the studied cases significantly decreased in month-3 postoperatively. FSH among the studied cases significantly increased in month-3 postoperatively. There were significant positive correlations between month-3 BMI and each of postoperative AMH and LH. There was significant negative correlation between month-3 BMI and postoperative FSH/LH.

Conclusion
As evident from the current study, Antimullarian hormone, LH decreased after Bariatric surgery in reproductive age women with increased FSH, and there is improvement in cycle regularity. Consequently, bariatric surgery could be effective in improving the menstruation and reproductive related hormones for severe obese individuals.
Trans-Vaginal Cervical Length and Amniotic Fluid Index in Prediction of Delivery Latency Following Preterm Pre-Labor Rupture of Membranes
Authors: Fetouh Mohamed Fatima Ossama , Sammor Hazem Mohamed , Eid Sweed Mohamed Samir , Abbas Ahmed Mohamed 
Published: November 2024

Abstract

Background
After premature pre-labor rupture of membranes (PPROM), it is challenging to forecast with precision the time to delivery (latency). Predicting delivery delay may be useful in determining when to recommend hospitalization, close observation, prenatal steroid use, and magnesium sulfate for neuroprotection. In women who report with preterm pre-labor rupture of membranes (PPROM), our goal is to ascertain if transvaginal cervical length (TVCL), amniotic fluid index (AFI), or a combination of both can predict delivery latency.

Methods
70 pregnant women presented with PPROM between the gestational age of 28 weeks and 36 weeks +6 days were enrolled. Transvaginal ultrasound measurement of cervical length and amniotic fluid index was performed within 24 hours of admission, to assess number of women reached latency period of 7 days or more and assess other maternal and fetal parameters as number of women reached 36 +6 weeks, mode of delivery, development of chorioamnionitis, gestational age at PPROM and delivery, birthweight at delivery, presence of neonatal sepsis, Apgar score at 1 and 5 minutes and need for NICU admission and indication.

Results
The best sensitivity of TVCL in prediction of delivery latency was 100 % at TVCL&gt;3 cm in women with AFI &gt;5 cm. On the other hand, the best specificity was 80.5% at TVCL&gt;3 cm in women with AFI ≤5 cm.

Conclusion
When a woman presents with preterm pre-labor rupture of the membranes, it is recommended to employ either transvaginal cervical length, amniotic fluid index, or both to forecast delivery delay.
Diagnostic Accuracy of Fetal Thigh Volume in Comparison with Conventional Ultrasound in Prediction of Fetal Weight
Authors: Hassan Nashwa El Said , Ahmed Mortda El-Sayed , Elghareeb Nermeen Ahmed Mostafa , Barakat Mai Mokhtar Kamal , Abd-El Fattah Mohamed MennaAllah Hossam 
Published: November 2024

Abstract

Background
In utero estimation of fetal weight is an important component of management of pregnancy. It provides valuable information which aids the physician to take informed decisions concerning the timing and route of delivery. Fractional thigh volume can be added to two- dimensional sonographic measurements of the head and trunk to improve the precision of fetal weight estimation. This approach permits the inclusion of soft tissue development as part of a weight estimation procedure. The aim of this study to detect the accuracy of fetal thigh volume in prediction of fetal weight.

Objective
Detection the accuracy of fetal thigh volume in estimation of fetal weight in comparison to the gold standard method (hadlock’s formula) and comparing it with the actual birth weight after delivery.

Patients and Methods
Our study was conducted in Ain Shams University, maternity hospital/ultrasound unit from September 2022 to May 2023. This study was a cross-sectional study on 55 women who underwent delivery and fulfilled our inclusion criteria.

Results
There was statistically significant increase in the mean EFW by Hadlock’s formula (3192.35±488.46) than the mean actual birth weight after delivery (3024.36±439.36) with mean difference of 167.98±461.97 and with p-value = 0.009. There was no statistically significant difference found between mean EFW by fetal thigh volume (3138.04±441.46) and mean actual birth weight after delivery (3024.36±439.36) with mean difference of 113.67±429.36 and with p-value = 0.055.

Conclusion
Estimation of fetal weight is a very important antepartum assessment. Fetal 3D- fractional Thiv is consistent with actual birth weight The Measurement of fractional thigh volume can improve the accuracy of fetal weight prediction in comparison to the conventional method using Hadlock’s formula.
Letrozole Low Dose versus High Dose for Ovulation Induction with Timed versus Spontanous Intercourse in PCO
Authors: Houssieny Amro El , Hassanin Alaa Sayed , Mohamed Haitham Fathy , Atallah Hassan Mohamed Abouelhamd 
Published: November 2024

Abstract

Objective
to compare the effect of low dose and high dose of letrozole in ovulation induction in PCOS. Effect of (HCG) administration in ovulation rate and pregnancy rate. Effect of timed Versus spontaneous intercourse in pregnancy rate.

Study Setting
This study was carried out at. Ain Shams Maternity Hospital Infertility Clinic and Qena General Hospital Infertility Clinic.

Study Design
Four arm clinical randomized trial.

Study Time
Start from 4-October 2021 ended 10- Jan. 2023.

Results
The objective of this study was to investigate the effect of low dose and high dose of letrozole on ovulation induction and effect of spontaneous & timed intercourse with (HCG) on pregnancy rate in one treatment cycle. This four arm clinical randomized trial study was carried out at Ain Shams Maternity Hospital Infertility Clinic and Qena General Hospital Infertility Clinic. The current study was conducted on 136 women. They were divided into 4 equal groups:
A = letrozole 2.5 mg (Femra 2.5 mg NOVARTIS) (one tablet) without HCG.
B = letrozole 2.5 mg+ HCG 10.000 IU.
C = letrozole 10 mg (Femra 2.5 mg NOVARTIS) (four tablets) without HCG.
D = lertozole 10 mg + HCG 10.000 IU.
The study started 4-October 2021.ended 10-Jan 2023.

Conclusion
Conclusion, the present study revealed that, applying low dose or high dose of letrozole on ovulation induction and effect of spontaneous & timed intercourse with (HCG) had similar follicular response and pregnancy rates.

Recommendations
Good selection of PCO patients acording to Rotirdam critaria. Start mangement of PCO patients by wieght reduction for obes patients. Start induction ovulation by letrozole as first choice. Start by smallest dose of letrozole 2.5mg & can be titrated dose for not responding patient to high dose.
Evaluation of Apelin-13 and Apelin-36 Concentration in Women with Primary Unexplained Recurrent Pregnancy Loss
Authors: Mohamed Tasneem Abdelhamid , Ibrahim Moustafa Ibrahim , Raafat Tarek Aly , Nawara Maii Medhet 
Published: November 2024

Abstract

Background
According to the American College of Obstetricians and Gynecologists, recurrent pregnancy loss is a disease, defined as two or more failed pregnancies. Recurrent pregnancy loss is one of the most frustrating and difficult areas of reproductive medicine because up to 50.0% of cases lack clearly defined etiology. Common conditions that have been associated with recurrent pregnancy losses include uterine abnormalities, parental chromosomal aberrations, various endocrine disturbances and the presence of antiphospholipid antibodies.

Aim of the Work
to evaluate the potential role of apelin-13 and apelin-36 in patients with primary unexplained recurrent early pregnancy loss.

Patients and Methods
after ethical committee approval and informed consent from the patients, this case control study was conducted at tertiary care hospital at Ain Shams University hospitals from March 2022 to December 2022 and performed on total of 90 women who attended the outpatient antenatal clinics in their first trimester of pregnancy.

Results
The current study revealed that there were no significant differences between recurrent pregnancy loss group and control group regarding demographic characteristics; age, body mass index and gestational age (p values = 0.582, 0.278, 0.548) respectively. Our study results revealed that Apelin-13 and Apelin-36 were statistically significantly higher in recurrent pregnancy loss group than in control group (p value&lt;0.001). Our results enhance the prognostic significance of high Apelin sub-fragment concentrations in the pathophysiology of unexplained recurrent pregnancy loss and suggests that apelin-13 and/or apelin-36 may be inhibited or decreased by potential drugs for the treatment of unexplained recurrent pregnancy loss.

Conclusion
the current study investigated serum apelin-13 and apelin-36 concentrations in women with unexplained recurrent pregnancy loss and demonstrated markedly higher serum concentrations compared to healthy pregnant women. We are of the opinion that our findings are not only significant to reveal the role of the Apelin sub-fragments in the pathophysiology of unexplained pregnancy loss; but also, they will provide information as a reference for the future studies, which will investigate the treatment strategies for the treatment unexplained pregnancy loss, and its associated complications in pregnancy.
Study of PD-L1 Expression in Papillary Thyroid Carcinoma and its Correlation to the Clinico-Pathological Characteristics
Authors: Sayed Asmaa Gamal Mohamed El , Ibrahim Dina Ragab Diab , El-Leithy Mahmoud Mahmoud , Ezz El Din Mai Mohamed Ali , Gabal Hoda Hassan Abou , Faheim Reham Mohamed 
Published: November 2024

Abstract

Background
Thyroid carcinoma is the most common endocrine malignancy, diagnosed annually worldwide. Papillary thyroid carcinoma (PTC) is the most common histologic subtype of thyroid carcinoma, accounting for around 90% of new cases. The expression of PD-L1 is investigated as a potential prognostic and predictive biomarker of the clinical outcome.

Aim of the Work
The study aimed at assessing PD-L1 expression in patients with PTC and its variants, also to determine its correlation with clinico-pathological parameters.

Patients and Methods
This is a cross-sectional study conducted on 50 patients diagnosed with PTC and treated at the Head and Neck Clinic, Ain Shams University Hospitals in the period from 2020-2022.

Results
We assessed the PD-L1 status by immunohistochemistry on formalin fixed and paraffin embedded surgical tissues of 50 patients diagnosed with PTC and its variants. Monoclonal Mouse anti-Human PD-L1 clone 22C3 from Dako Company was used to detect the PD-L1 status in tumor cells using the clone 22C3. PD-L1 positive expression was detected in 16/50 patients (32%) at a 1% threshold. The clinico-pathologic factors over a median duration of 17 months was studied and its correlation with the PD-L1 status. The mean age of the study population at diagnosis was 43 years with 92 % of cases were female patients. All patients underwent total thyroidectomy with 21 patients underwent lymph node dissection. The most common stage was stage I, and the most common histopathologic subtype was the classical PTC subtype. Most of the study population received radioactive iodine (84%). Median disease free survival was not reached as only 7 patients developed recurrence in the follow up period. In our study, statistically significant correlation was found between patients with PD-L1 positive tumor cells and higher T stage (p = 0.021), and positive pathological lymph nodes (p = 0.01). All the 16 patients who were found to have PD-L1 positive expression, received RAI (p = 0.034). Whereas no association was found with age (p = 0.197), sex (p = 0.584), multifocality (p = 0.566), lymphovascular invasion (p = 0.061), extra-thyroid extension (p = 0.725), thyroiditis (p = 0.135), histological variants (p = 0.520), margins (p = 0.410), post-operative thyroglobulin (p = 0.120), and disease free survival (p = 0.239).

Conclusion
PD-L1 expression correlates with T stage and pathological lymph nodes and may be used as a prognostic marker for PTC patients. Further follow up needs to be done to confirm the prognostic value of PD-L1 expression in PTC.
Importance of PSA Kinetics as a Prognostic Factor in Locally Advanced/Metastatic Prostate Cancer Patients with Prior Androgen Deprivation Therapy
Authors: Mahmoud Mona Hanafy , Alorabi Mohamed Ossama , Ali Dalia Medhat , Kelany Mohamed Reda , Ismail Soheir Sayed 
Published: November 2024

Abstract

Background
Prostatic cancer ranks 2nd amongst men in worldwide while 4th in Egypt. Many factors are used to predict patients’ survival. PSA kinetics are one of the main prognostic factors used for treatment response in advanced or relapsed cases. However, its application as prognostic marker is lacking in Egyptian clinical settings and research.

Aim of Study
In this retrospective study, we aimed to assess correlation between PSA kinetics among locally advanced and metastatic prostatic cancer patients and their survival status for prognostic aspects.

Methods
We conducted a retrospective cohort study at Clinical Oncology department, Ain Shams University hospitals from January 2013 till December 2022 (10 years). All prostate cancer patients who were initially hormonal sensitive locally advanced or metastatic that later developed biochemical failure during follow up period were included in our study.

Results
Our study included 77 patients with a mean age of 66.4±7.4 years. Three cases were locally advanced while 74 cases were metastatic. The most frequent mode of ADT monotherapy prior biochemical failure was GnRH analogue in 55 cases. Upon disease progression, most of the cases were shifted to abiraterone acetate. The initial median PSA value was 100 (49.1-193.9) ng/ml. It took about 9 (6-14) months (median TTN) with a median declining rate of 10.5 (3.75-35.1) % for their PSA values to reach nadir level of median 1.2 (0.21-5.27) ng/dl. When ADT failed, PSA levels increased again reaching a median value of 8.9 (3.75-35.2) ng/ml. The median PSA velocity after progression was 35.2 (2.8-208) ng/dl/yr while median PSA DT was 3.6 (1.3-7.25) months. Univariate analysis revealed PSA nadir &lt;0.76 ng/dl level (P value= 0.003) and TTN &gt;11 m (p value = 0) significantly associated with longer PFS and improved survival. However, PSA DT &lt; 3.1 (p value=0.017) predicts higher mortality. Meanwhile, multivariate results showed that PSA declining rate (P value= 0.047) and age &gt; 67 years (P value 0.016) were statistically significant as independent factors when associated to PFS.

Conclusion
TTN &gt; 11 months and PSA nadir &lt;0.76 during initial treatment was associated with prolonged PFS and OS. They were associated with better clinical response to treatment in castration resistant prostate cancer patients. Thus, it could be helpful for decision making of early treatment strategy in castration resistant cases.