bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between osteoporotic fractures and statin use – A review of literature and results of a preliminary case control study done at National Hospital of Sri Lanka
Authors: Perera W.N.N. , Swarnakumaar V. , Kularathne R.M.P.D. , Jayasoma S.A.M.M. , Mendis D.C.D. , DeSilva E.T. 
Published: December 2023

A case control study was conducted among elderly patients presenting to NHSL accident service. A hundred patients aged more than 60 years who presented with newly diagnosed neck of femur, distal radial and vertebral body wedge fractures following minor trauma were recruited from April 2021 to July 2021. Patients who had previous osteoporotic fractures and previous hip, distal radius and spine surgery were excluded from the study. An additional group of 100 patients who were matched for age and sex presenting to the same unit following minor trauma without osteoporotic fractures were selected as the control group with the same exclusion criteria. Use of statins for more than 4 months and other sociodemographic and lifestyle factors were compared among the two groups.
As no other independent variable was found to be significantly related to osteoporotic fracturs between the two groups, univariable analysis was done. The odds of current statin use in cases with osteoporotic fracture (45.2%) were lower than the odds of current statin use (54.8%) in subjects without osteoporotic fractures adjusted OR 0.74, 95% CI 0.42, 1.32) (p=0.304).
According to our results there might be a protective effect in statin use against osteoporotic fractures although a statistical significance was not demonstrated. However further studies using larger sample size and randomized control studies are suggested to ascertain a statistically significant result.
Surgical and morphological outcome of one-stage laparoscopic orchidopexy with preservation of gubernaculum and interruption of spermatic vessels in comparison to two-stages fowler–Stephens’s orchidopexy technique with preservation of gubernaculum for impalpable testis
Authors: El Kashory Ahmed I. , Dahab Mohamed M. , ElSherbeny Mohammed S. , El Asmar Khaled M. , Abdelhamid Sameh A. 
Published: December 2023

Background
For the care of nonpalpable testis, laparoscopy has acquired complete acceptability in both diagnostic and therapeutic settings. Standard laparoscopic for situations where the length of the spermatic arteries can prevent tension-free testicular mobilization in the scrotum, Fowler-Stephens’ (F-S) orchidopexy is a widely used and acknowledged procedure. Maintaining a healthy testis’ vascularity requires gubernaculum sparing with testicular vessel cutting. Our research recommends using the F-S approach with the preservation of the gubernaculum in a single stage rather than two phases for the same outcomes. Setting: the pediatric surgery outpatient clinic at hospitals affiliated with Ain Shams University and the Armed Forces Hospitals.

Patients and methods
This was a Randomized controlled clinical trial (RCT), conducted on boys with nonpalpable testicles between 1 and 6 years old, in 2 Egyptian pediatric surgery units, between October 2019 and September 2022. The patients who met the inclusion criteria were divided into two groups to compare their outcome (atrophy and success rate): (group A with 25 impalpable testicles was subjected to one-stage laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculum, while group B with 25 impalpable testicles was subjected to two-stages laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculum).

Results
The mean age of all patients was (3.9±1.8), 113 nonpalpable testicles were examined during the period of our study, and 50 nonpalpable testicles met our inclusion criteria. They were divided into two groups according to surgical procedure. There were no significant differences between the two groups according to age, and preoperative testicular volume. Postoperative outcome (atrophy and success rate) had no significant differences. Operative time and hospital stay were statistically decreased in the group performed with one stage.

Conclusion
To conclude, one-stage laparoscopic F-S orchidopexy with preservation of gubernaculum is as effective as two-stage laparoscopic F-S orchidopexy with preservation of gubernaculum.
Laparoscopic minigastric bypass as a revisional choice for failed restrictive bariatric procedure and its metabolic impact
Authors: Hassan Mustafa Mohamed Gadelkareem , Mohammed Amer Yehia , Abdelhamed Waleed Ibrahem 
Published: December 2023

Background
Restrictive bariatric procedures, like laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG), are associated with an increased risk of long-term failure. The efficacy of One-anastomosis gastric bypass (OAGB) has been described in primary and revisional settings, with a lack of Egyptian studies regarding OAGB as a revisional surgery. Herein, we describe our experience regarding 1-year outcomes of OAGB as a revisional surgery after failed LSG or LAGB.

Patients and methods
Fifty patients with failed LSG or LAGB were enrolled in this prospective study. All cases underwent laparoscopic OAGB, and its effects on weight loss and obesity-related comorbidities were noticed after 3, 6, and 12 months.

Results
The duration of the operation ranged between 45 and 120 min Postoperative complications included leakage (2%), hemorrhage (2%), and port site infection (2%). OAGB as a revisional surgery led to a significant and effective weight loss, as the percent of excess weight loss (%EWL) had mean values of 23.72%, 51.54%, and 80.25% at the scheduled visits, respectively. The procedure was associated with a significant rise in hemoglobin and albumin, significant decline in blood sugar, glycosylated hemoglobin, vitamin B12, and most lipid profile parameters, with no significant changes in serum calcium and high-density lipoproteins. Beneficial effects (remission or improvement) were noticed in 88.9% of diabetic cases, 80% of hypertensive cases, and 100% of reflux cases at one-year follow-up visit.

Conclusion
Laparoscopic OAGB as a revisional surgery is a safe and efficacious procedure in the management of patients with failed previous restrictive procedures like LSG and LAGB.
Modified Blumgart versus modified Heidelberg technique for pancreatic anastomosis in pancreaticoduodenectomy, which is more effective?
Authors: Saber Hatem S. , Sabry Ahmed , Elsaid Kamal 
Published: December 2023

Introduction
Leakage from pancreatic anastomosis is the main cause of postoperative mortality and morbidity after pancreaticoduodenectomy (PD). Advanced studies suggested Blumgart anastomosis (BA) and modified BA (m-BA) as a technique that may minimize major complications after PD. This study compares m-BA with modified Heidelberg anastomosis (m-HA) for pancreaticojejunostomy (PJ) after PD as a single-center experience.

Methods
A total of 46 patients who underwent PD at Ain Shams University Hospitals between January 2021 and February 2023 were enrolled in this research. The patients were categorized into two groups according to the anastomosis type. 24 patients underwent anastomosis using m-BA (group A) and 22 patients underwent anastomosis using m-HA (group B). The primary outcome is postoperative pancreatic fistula (POPF), bleeding, and mortality. The secondary outcome is the duration of the procedure, the number of sutures used, and other complications.

Results
The demographic and all preoperative data were insignificantly different between both groups. The operative time was significantly less in m-BA group as the time of the pancreatic anastomosis was significantly lower (21.08±3.5 min) in comparison to m-HA (69.32±8.4 min) P value less than 0.001.
The polydioxanone suture (PDS) threads consumed were significantly less in m-BA in comparison to m-HA (median (IQR) 9 (9–9) and 28 (26–30), respectively, P value < 0.001)
POPF was less in the m-BA group than m-HA (16.7 and 31.8%, respectively, P value 0.229) and postpancreatectomy hemorrhage (16.7% and 22.7%, respectively, P value 0.609), and the POPF in the soft pancreas was much less in m-BA (10% and 50%, respectively, P value 0.051), although statistically insignificant but it is clinically significant.

Conclusion
The m-BA technique can provide a better solution for pancreatic remnant management with less POPF, especially in soft pancreas with high fistula risk score, however, a small sample size may be the cause of the statistically insignificant difference, so larger studies are required. Nevertheless, m-BA consumes a lower number of PDS sutures with much lower cost and also less operative time.
Outcomes of laparoscopic cholecystectomy in elderly patients
Authors: Ghanem Ahmed M. , Bakr Ahmed A. , Hussein Ahmed H. 
Published: December 2023

BackgroundLaparoscopic cholecystectomy (LC) is the conventional therapy for both symptomatic gallbladder stones and acute cholecystitis; nevertheless, these outcomes are representative of the overall population. Our study’s objective was to evaluate the efficacy of LC in individuals aged 60 and older.MethodsThis prospective research was performed on 200 elderly cases aged 60 or older who underwent LC. Cases were classified into two groups regarding the age, group (A): Cases aged greater than or equal to 70 years and group (B) Cases aged 60 −less than or equal to 69 years. Group (A) were subdivided into three groups: age from 70 to 72 years (group A1), age from 73 to 76 (group A2), and age from 77 to 80 (group A3) were the additional age categories created from the original group of patients.ResultsAmerican Society of Anaesthesiologists (ASA) score increased with age in both groups. In group B, 15.5% had ASA scores greater than or equal to 3, and increased to 37.5% in group A1, 68.8% in group A2 and 80.0% in group A3. ASA classification was significantly different between both groups (P<0.001). Acute cholecystitis was found in 8 (17.8%) patients in group A and 24 (15.48%) patients in group B whereas chronic cholecystitis was found in 37 (82.2%) patients in group A and 131 (84.5%) patients in group B, with no significant difference between both groups (P=0.890). The majority of surgically treated patients in all research groups were diagnosed with chronic cholecystitis.ConclusionLC in elderly patients is applicable with low mortality and morbidity rates. Despite the common prevalence of concurrent disorders involving the lung, heart, and diabetes mellitus (DM) in geriatric patients treated with LC, these medical conditions contributed slightly to the morbidity findings.
Management of borderline common bile duct stones: Retrospective comparative study
Authors: Taha Abdallah M. , Ahmed Saada , Abdelhameid Mahmoud , Maklad Ahmad A. , Abozeid Mahmoud A. , Abdelshafy Mohamed 
Published: December 2023

Background
Borderline Size common bile duct stones (BLS-CBDS) are associated with hepato-pancreato-biliary morbidity and complications. Its optimum management is still controversial till now.

Aim
Is to compare conservative treatment versus endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of BLS-CBDS.

Material and methods
This retrospective study included patients with BLS-CBDS less than or equal to 10 mm who were treated conservatively or by ERCP endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). The primary outcome was successful common bile duct (CBD) clearance, and the secondary outcomes were complications, impact on laparoscopic cholecystectomy, and hospital stay.

Results
Out of 270 patients, 150 were treated by ERCP and 120 by the Conservative approach. There was complete clearance of CBDS in 75 (50%) patients out of 150 patients in the ERCP group and useless procedure in the remaining 75 (50%) patients. In the conservative group, there was complete clearance of CBDS in 99 (82.5%) cases, and useless in the remaining 21 (17.5%) patients. Post-ERCP pancreatitis occurred in 33 (22%) patients.

Conclusion
BLS-CBDS increases the technical difficulty of ERCP and the risk of post-ERCP pancreatitis. Conservative management of CBDS is effective in clearing CBDS, it should be considered to avoid unnecessary ERCP and its complications.
N-terminal pro-B type natriuretic peptide as a predictor for myocardial preservation in cases of isolated severe Aortic stenosis
Authors: Doghish Ayman A. , Ahmed El Feky Tarek Y. , Jawad Mohamed N. A. , Hamid Osama A. A. , El Kerdany Ahmed B. 
Published: December 2023

Background
Myocardial hypertrophy is a common pathologic finding in the natural history of severe aortic stenosis. A hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis.
Myocardial protection techniques during cardiac arrest have been extensively investigated in the clinical setting of coronary revascularization. However, fewer studies have been carried out on patients affected by left ventricular (LV) hypertrophy, where the choice of type, and temperature of cardioplegia remains controversial.

Aim
The study investigates preoperative N-terminal pro-B type natriuretic peptide (NT pro-BNP), its relation to Troponin I levels, and whether it can predict a preferred cardioplegic solution by comparing the short-term outcomes of the two commonly used blood and Histidine-Tryptophan-Ketoglutarate (HTK) cardioplegic solutions in patients undergoing aortic valve replacement for severe aortic stenosis.

Patients and methods
A total of 72 patients will be randomly allocated into two groups; group (A=36) received HTK solution, and group (B=36) received blood cardioplegia. All anesthesia protocols are unified among all patients. All surgical procedures were conducted on a cardioplegic arrested heart via standard median sternotomy, utilizing full Cardiopulmonary bypass (CPB) via aorto-atrial cannulation and LV venting through a left atrial catheter under moderate hypothermia (28–32°C) by topical cooling.

Results
There was no statistically significant difference found between group A and group B regarding post-operative ejection fraction (EF) and newly developed postoperative Regional wall motion abnormalities (RWMA).
There was no statistically significant difference found between group A and group B regarding the percentage of patients with atrial fibrillation, ventilation hours, and exploration while there was a statistically significant increase in troponin, I level in group B than group A.
There was a statistically significant negative correlation between NT pro-BNP preoperative and aortic valve area (AVA) and also with ejection fraction preoperative while there was a statistically significant positive correlation found between NT pro-BNP and troponin I preoperative and postoperative.

Conclusion
HTK solution and Blood cardioplegia both offer sufficient protection for the myocardium. NT pro-BNP serves as a sensitive indicator for predicting the results and effectiveness of different cardioplegia types
Early and mid-term results of surgical treatment of atrioventricular septal defect; analysis of risk factors for adverse outcomes: left atrioventricular valve regurgitation
Authors: Ayoub Mina , Samir Khalid , El Midany Ashraf A.H. , El-Fattah Mohamed A. A. 
Published: December 2023

Background
Advances in the perioperative management and optimization of the timing of primary repair have gradually improved the early clinical outcome of surgical correction of atrioventricular septal defects (AVSDs). However, the late outcome still remains compromised by the substantial risk of reoperation, of which mainly the development of left ventricular outflow tract obstruction (LVOTO) and left atrioventricular valve (LAVV) dysfunction challenge the long-term survival and morbidity of these children.
In particular, LAVV regurgitation (LAVVR) is responsible for a reoperation rate between 5 and 19%, both for complete AVSD (cAVSD) and partial AVSD (PAVSD) children.
Results of surgical correction of AVSDs) have improved over the last decades; however, the need for reoperation after primary AVSD repair remains a major concern. We conducted this study to analyze risk factors leading to LAVVR in the early and mid-term follow-up postsurgical repair of AVSD.

Patients and methods
All patients who underwent biventricular repair for AVSD at our institute, in the time between Jan 2015 and Jan 2021, meeting the inclusion criteria and none of the exclusion criteria were enrolled in the study. Preoperative, operative and postoperative data were collected from the patients’ medical file. Last follow-up Echoes were reviewed.

Results
Patients who had preoperative and early postoperative more than moderate LAVVR are more likely to develop LAVVR in the late follow-up and also have a more risk to need a reoperation in their midterm follow-up.

Conclusions
Patients who had preoperative and early postoperative more than mod LAVVR are more likely to develop LAVVR in the late follow-up and also more likely to need reoperation.
Implementation and evaluation of axillary reverse mapping technique in breast cancer patients using patent blue dye
Authors: Khallaf Emad , Mokhtar Sherif M. , Mikhail Bishoy , Ali Mahmoud 
Published: December 2023

Introduction

Breast cancer is the most common malignancy among Egyptian women. Following axillary lymph node dissection, arm lymphedema can develop in 7–77% of cases. To detect and preserve upper-limb lymphatics and lymph nodes after axillary surgery, the axillary reverse mapping (ARM) technique was developed. This procedure may help avoid arm lymphedema.

Aim of work
To establish the ARM-node involvement of cancer cells and study their location to assess the effectiveness of ARM using patent blue dye.

Methodology
At Kasr Alainy University Hospital, this prospective randomized controlled study was carried out. There were 42 breast cancer patients in total, including 21 each in the study group and the control group. Following dye injection, stained ARM lymph nodes and lymphatics were preserved in the study group during axillary lymph node (ALN) dissection if grossly negative and removed if grossly positive, whereas individuals in the control group had the standard technique. After 1 month, all subjects underwent a second evaluation, during which the arm circumference was measured and recorded at a point 10 cm near the medial epicondyle.

Results
In the study group, in 18 patients (85.7%) their lymph nodes were stained. Six patients had suspiciously colored lymph nodes that were surgically removed, but no metastatic disease was apparent in the rest of the group. Early upper-limb lymphedema was not detected in the study group (0%), with 9.5% in the control group.

Conclusion
Arm lymphedema can be avoided by doing ARM while performing ALN dissection. Future research should be conducted on more patients and for a longer length of time, according to the findings of this study.
Outcome of gastric gastrointestinal stromal tumors at National Cancer Institute, Cairo University
Authors: Shaeir Sayed S. , Fouad Mohamed T. , Shafeik Fady , Sobeih Mohamed E. , Negm Dalia , Mamdoh Sara , Eltohamy Mahitab I. , Hussein Mostafa A. , Abdelkader Haytham , Hussien Alaadin 
Published: December 2023

Background
The purpose of this research was to inspect the tumor landscapes, surgical particulars, and survival distribution of patients of gastric gastrointestinal stromal tumors (GIST) that were surgically removed at the National Cancer Institute, Cairo University.

Materials and methods
Patients who submitted an application to our clinic and were ultimately diagnosed with gastric GIST were included in this retrospective analysis. Patients’ ages and sexes were recorded, as well as their original tumor sites, histological features, staging, treatments received, treatment methods, and survival rates.

Results
There were a total of 23 patients, with a female to male ratio of 1 : 3, who had a diagnosis of gastric GIST. They averaged 56 years of age. Tumor sizes, on average was 11.2 cm. In 18 (78.3%) cases, the tumor was located at the distal end, whereas in 5 (21.7%) cases it was located at the proximal end. 19 patients underwent first surgery, whereas only 5 got neoadjuvant treatment focused on the primary tumor. 17 (73.9%) individuals (73.9%) had sleeve gastrectomy, making it the most prevalent operation. 7 days was the typical duration of stay in the hospital. Two patients showed postoperative gastric leakage; the first was treated conservatively, while the second was treated surgically and resulted in a total gastrectomy. With regard to risk categorization, 10 (43.5%) patients had tumors with a high level of risk, 9 (39.1%) had tumors with an intermediate risk, whereas just 4 (17.4%) had tumors with a low risk (Table 3). 16 (69.6%) patients received supplemental targeted treatment. The median duration of patient follow-up was 42.6 months, and all patients were tracked. The cumulative overall survival at 5 years was 82.1%, while the cumulative disease-free survival was 65.4%.

Conclusion
For individuals who need their gastric GIST removed, extensive local resection that preserves the stomach yields excellent functional and oncological results.
Mapping cholera risk in Nairobi County, Kenya: a comprehensive analysis of environmental, socio-economic, and WASH factors
Authors: Manaseh Bocha A. , John Gachohi , Simon Karanja , Christine Mwachari 
Published: December 2023

Background : Cholera, a globally prevalent waterborne disease, is closely monitored in Kenya as part of the Integrated Disease Surveillance and Response strategy. Understanding regional variations in cholera risk factors and trends is crucial, particularly in Sub-Saharan Africa. This study aimed to construct a risk map for cholera outbreaks in Nairobi County, based on the spatial-temporal dynamics of environmental and socio-cultural factors, Water, Sanitation, and Hygiene (WASH) conditions, and historical cases reported between 2009 and 2019.
Methodology : We retrospectively analyzed historical cholera cases in Nairobi, employing spatial analysis to map the spatiotemporal variations in factors associated with cholera outbreaks. A cross-sectional descriptive research design was adopted to investigate the relationship between WASH conditions and cholera outbreaks. Stratified random sampling selected 399 respondents from all 85 wards in Nairobi County. We employed descriptive statistics (percentages and frequencies) and inferential statistics (Chi-square) to assess variable relationships.
Results : Cholera cases are concentrated in densely populated, especially informal, settlements. Population size significantly correlated with cholera cases (p-value=0.03). Dumping sites in Nairobi emerged as potential cholera sources within residential areas, with the vicinity showing a slight association with reported cases. Rainfall patterns and humidity levels across Nairobi County also influenced cholera risk.
Conclusions : Areas within 400 meters of rivers and sewage lines faced elevated cholera risk. Most cases occurred in slum or regular residential areas. Proximity to dumping sites increased the risk of cholera outbreaks. These findings offer valuable insights for cholera prevention and control strategies in Nairobi County.