bluuebunny/crossref_metadata_2025_split huggingface dataset:
Letrozole versus clomiphene in prevention of premature LH surge in women undergoing intrauterine insemination
Authors: Hafiz Doaa M.S. , Elshinawy Nashwa M.N. , Elebesy Hanaa A.-E. , Elmadbouly Asmaa A.-A.A. 
Published: March 2024

Introduction
Soft stimulation protocols were developed to impart a less stressful and less expensive mode of stimulation for patient insemination.

Aim
To evaluate the effect of letrozole versus clomiphene citrate (CC) in prevention of premature luteinizing hormone (LH) surge.

Patients and methods
This is a prospective comparative study held at Obstetrics and Gynecology Department, Alzahraa University Hospital. A total of 90 infertile patients between 18 and 35 years of age with unexplained infertility or mild male factor were included. Overall, 30 patients had induction by human menopausal gonadotropin and then CC from seventh day of the cycle; 30 patients had induction by human menopausal gonadotropin and then letrozole from seventh day of the cycle, and 30 patients had induction by human menopausal gonadotropin only and were evaluated according to LH and estradiol (E2) on triggering day, folliculometry, and pregnancy outcome.

Results
We found that the letrozole was associated with lesser LH on triggering day and higher endometrial thickness than the other two groups, and CC was associated with higher E2 on triggering day and number of mature follicles than the other two groups. The difference between the study groups in LH, E2, number of mature follicles, and endometrial thickness was statistically significant, whereas the differences in pregnancy rate was statistically insignificant.

Conclusion
The study shows that clomiphene and letrozole are available options to prevent LH surge.
Efficacy and efficiency of hepatitis B core antibody in the diagnosis of occult hepatitis B in hemodialysis patients
Authors: Rashed AL-Sayed M. , Mohamed Emad A. , AL-Dahshan Magdy A. , Said Mohamed A. , AL-Shorbagy Mohamed S. 
Published: March 2024

Background
Occult hepatitis B viral infection (OHBI) is defined as hepatitis B virus (HBV) DNA detection in serum by sensitive diagnostic tests in hepatitis B surface antigen (HBsAg) negative patients with or without serological markers of previous viral infection.

Aim
This study aimed to evaluate hidden infection of hepatitis B among HBsAg negative chronic kidney disease patients on regular hemodialysis (HD) using hepatitis B core antibody as a marker in the sera of these patients, HBV DNA by PCR, and to evaluate the efficacy and efficiency of hepatitis B core antibodies in the diagnosis of occult hepatitis B in HD patients.

Patients and methods
Eighty chronic kidney disease patients on regular HD were included in this study; the mean age of studied patients was 41.8±12.72 years. They were recruited from HD Unit, Internal Medicine Department, Bab Alshearia University Hospital, Al-Azhar University, Cairo, Egypt, after exclusion of HBsAg positive, HBV antibody positive, intravenous drug users, and alcoholic patients. All patients were subjected to a full assessment of history, blood chemistry, HBsAg by ELISA, hepatitis B core immunoglobulin G (anti-HBcIgG), HB DNA by PCR, hepatitis C antibody (HCV Ab) by ELISA, and abdominal ultrasound.

Results
Our results showed that HCV Abs were positive in 50% of cases (40 cases); of these patients, 30% (12 cases) were positive for HBcIgG, whereas 50% of the cases (40 cases) were negative for HCV Ab. Of these, 20% (eight cases) were positive for HBcIgG, but the remaining 32 patients were negative for both HCV Abs and HBcIgG. All these results showed negative PCR in all cases (0% of cases).

Conclusion
OHBI among Egyptian HD patients is low, with a 0% prevalence by PCR; 6 months of repeated PCR is recommended as liver biopsy is difficult in HD patients and HBc Abs are not sufficient for the diagnosis of OHBI in HD patients.
The impact of preformatted medical order sheet on decreasing the incidence of medication errors in NICU
Authors: El Akber Hanan S. , AbuShady Mariam , Elbaz Mona Z. 
Published: March 2024

Back
ground Medication errors are one of the most common types of medical errors. Medication errors can occur at different phases of the medication administration process.

Aim
This study was planned to identify the incidence of medication errors in neonates in the neonatal intensive care unit (NICU) of El Sadat Central Hospital (SCH) and design a new preformatted medical order sheet (PMOS), and then evaluate its effect on reducing the incidence of medication errors in NICU of the same hospital.

Patients and method
The study was a three-phase interventional study in which PMOS was used. The study took 3 months for detection of medication errors among neonates and then 1 month for construction of PMOS. This was followed by training of health care workers for the use of PMOS for another 1 month, and after which detection of medication errors among all neonates admitted to NICU was done for another 3 months.

Results
A total of 270 medication errors in phase I and 97 in phase III were analyzed. The rate of medication errors decreased significantly from 89.1% in phase I to 31.5% in phase III (P<0.05). Compared with phase I, prescription, transcription, dispensing, and administration errors decreased in phase III from 41.9 to 12.9% (P<0.05), 19.1 to 7.14% (P<0.05), 4.62 to 1.29% (P<0.05), and 23.1% to 10.1 (P<0.05), respectively.

Conclusion
The application of PMOS in NICU of El Sadat Central Hospital resulted in marked reduction in total medication errors.
High-resolution ultrasound versus MRI in evaluation of triangular fibrocartilage complex
Authors: Elreweiny Nahla M.M.A. , Abd-Elaziz Emam M. , Khaled Manal F. 
Published: March 2024

Introduction
Pain on the ulnar side of the wrist is a complex diagnostic dilemma and the triangular fibrocartilage complex provides much needed support to the wrist, and extensor carpi ulnaris (ECU) tendon is part of the complex. The most important investigations to diagnose wrist pathologies include ultrasound, computed tomography, and MRI.

Aim
The aim of this study is to evaluate the diagnostic performance of both ultrasonography and MRI findings in ECU tendon part of triangular fibrocartilage complex.

Patients and methods
This control study was carried out on 50 patients with ulnar side wrist pain. The study was conducted in the period from May 2018 to May 2020 at the Radiology Department and approved by the Ethics Committee, and all patients gave their informed consent before inclusion in the study. Results were collected then analyzed using a specialized computer statistical program.

Results
MRI detected ECU injury in 13 joints, whereas ultrasound detected it in 17 joints. They both agreed in 46 joints. MRI missed four joints with ECU injury detected by ultrasound. Statistical analysis of the results showed a highly significant agreement (P value) between both MRI and ultrasound in the detection of ECU injury.

Conclusion
Both MRI and musculoskeletal ultrasound have complimentary roles in the evaluation of different causes of ulnar sided wrist pain. Musculoskeletal ultrasound is highly recommended for the examination of tendons and inflammatory changes of the wrist.
The role of diffusion-weighted MRI in the evaluation of pediatric patient with orbital masses
Authors: Reda Ayatallah , Badran Bahira , Farag Manal , Youssef Ayda 
Published: March 2024

Background
Orbital lesions represent a spectrum of benign and malignant lesions in children that can be challenging to diagnose and treat. Imaging plays an important role in diagnosis, owing to a potentially limited clinical examination and risks associated with biopsy. MRI is a powerful tool for imaging the orbit, owing to the excellent tissue contrast it provides.

Aim
This study aims at assessing the ability of diffusion-weighted MRI to differentiate the benign from malignant orbital lesions.

Patients and methods
This study population included 50 pediatric patients; they all attended with orbital lesions. All patients had fulfilled specific inclusion and exclusion criteria. The patients were evaluated by MRI orbit and diffusion study in an attempt to differentiate the benign orbital lesions from malignant ones.

Results
The pool of our study is 50 pediatric patients (26 females and 24 males) with orbital lesions. The patients’ age ranged from 3 weeks to 18 years. A total of 27 (54%) patients were diagnosed as having malignant masses and 23 (46%) patients had benign lesions. Retinoblastoma is the commonest between the pathological diagnoses (28%) followed by rhabdomyosarcoma (18%). The calculated apparent diffusion coefficient (ADC) values of the lesions ranged from 0.69 to 0.95×10−3 mm2/s, with cutoff value of 1.04×10−3 mm2/s between benign and malignant orbital masses.

Conclusion
We concluded that the combination of conventional MRI finding and ADC calculation together with clinical finding could improve the diagnostic efficacy of MRI in the differentiation between benign and malignant orbital masses in pediatric age group with considering the cutoff ADC value between benign and malignant orbital masses.
Management of unstable metacarpal shaft fractures by k-wires versus mini-plate fixation
Authors: Mahmoud Wael Shaaban , Omar Mohammed Abd El Hay , Elbandrawy Ahmed Mmdouh 
Published: March 2024

Objective
To compare the clinical and functional outcome of treatment of unstable metacarpal shaft fracture by K-wires versus open reduction and mini-plate fixation prospectively.

Place and duration
The study was conducted at the Department of Orthopedic, Al-Zahraa Hospital, Faculty of Medicine for Girls, Al Azhar University, for a duration of 1 year from 1st January 2019 to 30th December 2019.

Patients and methods
A total of 20 patients with unstable metacarpal shaft fracture were divided into two groups. Group A included 10 patients who were fixed by mini-plate and screws. Group B included 10 patients who were fixed by K-wires. Hand function was assessed 3 months postoperatively and when the patients finish physiotherapy by using Quick DASH score.

Results
Union occurred in all cases. In group A, only one (5%) case reported tendon adherence. In group B, three (15%) cases reported joint stiffness.

Conclusion
The mini-plate fixation is superior to K-wire fixation in the treatment of unstable metacarpal shaft fractures.
Role of multislice computed tomography in assessment of epicardial adipose tissue in coronary artery diseases
Authors: Badran Bahira , Abdel-Aziz Emam M. , Helmy Ibrahim M. , Mohamed Enas H. 
Published: March 2024

Background
This study aims to evaluate the relationship between epicardial fat volume and the severity of coronary artery disease (CAD) using multislice computed tomography (CT) coronary angiography.

Patients and methods
This was prospective study conducted in Misr Radiology Center, International Medical Center, and National Heart Institute and included 70 patients with clinical suspicious of CAD. They were aged from 35 to 73 years, with a mean age of 53.6±9.6 years.

Results
The study was performed on 70 patients with clinical suspicion of CAD. They were referred to undergo CT coronary angiography in the period from January 2018 to December 2019. They aged from 35 to 73 years, with a mean age of 53.6±9.6 years.

Conclusion
In our study, we found that epicardial fat volume is associated with presence and degree of CAD, although most multidetector CT fat depot measurements showed good association and correlation with grade of CAD.
Role of arterial duplex of both lower limbs in the evaluation of diabetic foot
Authors: El-Sayed Yasmin A. , Hak Mohamed T. , Mostafa Ahmed M. 
Published: March 2024

Introduction
Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia and dyslipidemia. Abnormalities in nutrient metabolism and vascularity resulting from DM lead to lower limb arterial diseases and ischemia, and this leads to infection, foot ulcers, and impairment of wound healing. Color Doppler ultrasound is a widely available noninvasive technique in the assessment of arterial affection of lower limbs that occur with DM. Color Doppler ultrasound has lots of advantages over other diagnostic imaging modalities; it is a feasible modality available in nearly all hospitals, being cheap, accurate, and safe.

Aim
The aim was to highlight the role of arterial duplex to better delineate vascular anatomy, localize the obstruction, assess the severity of stenosis, and detect the presence of collaterals, and distal runoff in patients with diabetic foot disease.

Materials and methods
Ultrasound color and Doppler examinations were performed to 20 patients previously diagnosed to have DM; the arterial supply of lower extremities was divided into these segments: common iliac artery, external iliac artery, common femoral artery, superficial femoral artery, profunda femoris artery, popliteal artery, anterior tibial artery, posterior tibial artery, peroneal artery, and dorsalis pedis. Arterial lesions were located by changes in vessel caliber, changes in color flow patterns, and broadening of Doppler waveform, quantified by measuring the peak systolic velocity (PSV) ratio across a lesion and by comparing the PSV within stenosis with that proximal to the lesion; this ratio was independent of individual variations in blood pressure, vascular compliance, and cardiac function.

Results
In all, there were 20 patients (400 segments), 35 segments showed significant stenosis (luminal narrowing ≥50% of artery diameter and PSV ratio ≥2), 21 segments were occluded, eight of them were with no distal collateral refilling, and 100 segments showed nonsignificant stenosis (luminal narrowing <50% of artery diameter and PSV ratio <2). Of 400 examined arterial segments, 297 arterial segments showed normal triphasic flow, 95 segments showed monophasic flow, eight segments had no flow indicating there was no distal refill in these segments. Of 400 arterial segments, 104 segments had low PSV (which were measured at the distal part of each segment).

Conclusion
Duplex ultrasound is an accurate easily acquired noninvasive diagnostic modality in diabetic foot patients. There was very high incidence of atherosclerosis in diabetic foot patients with more affection in below-knee arteries.
Magnified subinguinal varicocelectomy versus conservative methods in treatment of adolescent varicocele
Authors: Sallam Ahmad M. , Shebl Salah E. , Sabry Khaled M. 
Published: March 2024

Background
Elimination of varicocele in adolescent with lower complication rates is the best treatment modality. Therefore, the ideal technique should aim to ligate all internal and external spermatic veins with preservation of spermatic arteries and lymphatics.

Aim
We compared the outcome of magnified subinguinal varicocelectomy versus conservative methods in the treatment of adolescent varicocele.

Patients and methods
A total of 40 adolescent males (aged between 15 and 19 years) with refluxing varicocele and affected semen parameters and testicular volume were included. Overall, 20 patients were treated by magnified subinguinal varicocelectomy and 20 patients treated by conservative methods. All patients were reevaluated and followed for 6 months by several semen parameters and changes in testicular size by Doppler ultrasound.

Results
A significant improvement was seen in postmagnified subinguinal varicocelectomy group regarding sperm volume, sperm motility, sperm count, progressive movement, vitality, abnormal morphology, testicular volume, and varicocele grade, but in conservative method group, patients showed significant improvement regarding percent of rapid sperm, progressive movement and vitality, and a slight increase in testicular volume. After 6 months, there was a significant difference between both groups regarding sperm volume, progressive movement, vitality, testicular volume, and varicocele grade, so magnified subinguinal varicocelectomy is superior to conservative methods in the management of adolescents with symptomatic varicocele.
Study of cases of fever of unknown origin in Damanhur Fever Hospital
Authors: Ghaly Sara A.A.M. , Mousa Sabila G. , Abo Shady Doaa M.Z. , Elhassan Hanaa A.E.A. 
Published: March 2024

Background
Fever of unknown origin (FUO) is a syndrome that has long tested the skills of physicians to achieve a diagnosis in affected patients. Patients included in this syndrome will be more difficult to diagnose as they have already resisted classification during baseline investigations.

Aim
To study the characteristics of cases of FUO attending Damanhur Fever Hospital and to explore the different diagnostic types of fever among them.

Patients and methods
The present study is an observational analytical hospital-based cross-sectional study. This study was carried out on 70 patients more than or equal to 18 years old who met the criteria of Durack and Street for classic FUO. All participants were subjected to a questionnaire that included data about their sociodemographic characteristics, and smoking and alcohol consumption, in addition to a complete history taking and the results of routine laboratory and image investigation.

Results
Mean age of the patients was 33.32 with 10.82 standard deviation (sd) and range 18–58 years. Males accounted for 65.7% of the patients, and 75.7% of them were residing rural area and 41.7% were farmers. Most of the patients (74.3%) were smokers, whereas the majority (94.3%) were nonalcoholics. Infectious diseases accounted for 82.9% of the diagnosis of FUO, whereas 7.1% of the patients were diagnosed as having noninfectious inflammatory diseases, and 10% of them presented with neoplasm. Brucellosis was found among 24.3% of the patients, whereas arthritis and rheumatic fever accounted for 2.9% of the patient for each, and leukemia was found among 5.7% of them.

Conclusion
The main characteristics of the patients represented with FUO were middle age males who were residing in rural area, worked as farmers, and were smokers and nonalcoholics. Infectious diseases were the main cause of FUO, and brucellosis was the commonest cause of infectious type of FUO.
Serum fibroblast growth factor-21 in relation to insulin resistance in Egyptian women with metabolic syndrome
Authors: Abujami Alaa M. , Fawzy Olfat A. , Mohammed Doaa S. , Khidr Emad G. 
Published: March 2024

Background
Metabolic syndrome (MetSyn) and type 2 diabetes mellitus (T2D) are globally and exponentially increasing. One of the important cytokines that plays a role in metabolic modulation is fibroblast growth factor-21 (FGF-21).

Aim
The aim was to assess serum FGF-21 in Egyptian women having MetSyn with and without T2D and to study its relation to insulin resistance.

Patients and methods
This is a case–control study. Blood samples were obtained from 30 women fulfilling the criteria for diagnosis of MetSyn (15 women with and 15 without T2D) and 15 age-matched controls. Serum levels of FGF-21 were quantitatively determined by enzyme-linked immunosorbent assay.

Results
Patients with MetSyn had significantly elevated FGF-21 values. This was more pronounced in the group having MetSyn including T2D. FGF-21 levels correlated positively with obesity, insulin resistance indices, and low-density lipoprotein cholesterol level and negatively with high-density lipoprotein cholesterol. FGF-21 was significantly related to waist circumference, the main visceral obesity index by linear regression analysis (P<0.007). Logistic regression analysis demonstrated an independent association between MetSyn and FGF-21 value.

Conclusion
MetSyn was found to be associated with serum FGF-21. This association was stronger than that with homeostasis model assessment-insulin resistance and fasting plasma glucose. This suggests that serum FGF-21 may be used as a potential diagnostic biomarker for MetSyn.
Prevalence of insomnia and daytime sleepiness in poststroke patients
Authors: AbdElaziz Shaimaa Y. , Elattar Rasha S. , Kasim Sammar A. 
Published: March 2024

Background
The relationship between sleep disorders and stroke has been well-documented through multiple direct or indirect mechanisms.

Participants
and methods This was a cross-sectional (comparative case–control study) study. A total of 75 poststroke patients attending the neurology and internal medicine outpatient clinics at Al Zahraa University Hospital were selected, along with 75 matching individuals as a control group. All poststroke patients had a modified Ranken Scale less than or equal to 3 and interval was 8–12 weeks after stroke. All participants were subjected to complete neuropsychiatric history and medical history, the Pittsburg sleep quality index, insomnia severity index, and Epworth sleepiness scale. Strokes were divided into right and left cerebral hemispheres and the localization of stroke to cortical, subcortical, basal ganglion, or brain stem.

Results
Comparison between poststroke patients and the control group regarding Pittsburg sleep quality index shows statistically significant difference regarding all components of the scale except the use of sleep medication. Regarding insomnia severity index, poststroke patients scored more than the control group, denoting more insomnia ranging from subthreshold insomnia (30.67%) to moderately severe (32%) and severe (30.6%) insomnia. Epworth sleepiness scale shows a statistically significant difference between both groups, denoting more daytime sleepiness. It was more in right-sided hemispheric lesions and subcortical infarctions.

Conclusion
Increasing awareness about poststroke sleep disorders is mandatory among physicians to improve the prognosis and quality of life of these patients.
Correlation between serum cytokeratin 18 and fibro touch transient elastography interpretation in evaluation of nonalcoholic fatty liver disease in Egyptian patients
Authors: Hammam Nour H. , El-Shazly Sumaya H. , Elshemy Eman E. , Morsy Amal A.A. 
Published: March 2024

BackgroundApproximately 20–45% of the population around the world are affected by nonalcoholic fatty liver disease (NAFLD), and it is the liver pandemic in the 21st century. It has become a leading cause of end-stage liver disease, hepatocellular carcinoma, and liver transplantation in many regions of the world. Noninvasive markers are needed for assessment of patients with NAFLD.ObjectiveEvaluation of serum cytokeratin 18 (CK18) as a noninvasive marker of NAFLD and its correlation with fibro touch elastography.Patients and methodsA case–control study was conducted on 90 participants, and they were divided into three groups: group I included 30 matched healthy controls, group II included 30 patients with NAFLD diagnosed by abdominal ultrasonography with normal liver enzymes, and group III included 30 patients with NAFLD diagnosed by ultrasonography with elevated liver enzymes. Abdominal ultrasonography and fibro touch transient elastography (TE) were done for all participants.ResultsThere was a highly significant increase in CK18 in group II and group III versus group I and highly significant increase in group III versus group II. The cutoff value of serum CK18 level to differentiate between group I and group II was more than 15.5 ng/ml. The cutoff value of serum CK18 level to differentiate between group II and group III was more than 22.4 ng/ml. The cutoff value of TE to differentiation between group I and group II was more than 241 dB/m. Moreover, the cutoff value of TE to differentiate between group II and group III was more than 286 dB/m.ConclusionCK18 and control attenuation parameter can be used as noninvasive markers of NAFLD and positively correlated with the grades of steatosis.