bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immunohistochemical Expression of Programmed Death Ligand-1 and CD-8 in Glioblastoma
Authors: Elsamman Dina M , Kamar Zeinab A , Cousha Hala S , Mahdy Manal M El , Karim Khaled Abdel , Abou Gabal Hoda H 
Published: August 2023

Background
Glioblastoma (GBM) is the most common and most aggressive primary malignant brain tumor in adults. It is characterized by its extremely poor prognosis despite the available treatment strategies. Immune evasion is described in Glioblastoma via the PD-L1/ PD-1 interaction. Programmed death ligand 1 (PD-L1) is a cell surface ligand expressed on the surface of several tumors including GBM and its receptor is the PD-1 (Programmed deasth-1). Other malignant tumors including melanoma and non-small cell lung cancer, showed promising results using PD-L1/PD1 blockade treatment strategies where PD-L1 was described as a potential predictive biomarker for patient selection in these tumors. In our study we will shed the light on the expression and role of PD-L1 in glioblastoma, the presence of tumor infiltrating lymphocytes (TILs) and its interaction with PD-L1 in glioblastoma. The role of PD-L1, CD-8+ TILs, other clinicopathologic parameters and patient’s survival will be also discussed in relation to glioblastoma.

Methods
Paraffin embedded tissue blocks of thirty cases of GBN were retrieved, slides were prepared and stained via Hx& E for evaluation and confirmation of diagnosis according to the CNS WHO 2016. Immunohistochemistry using PD-L1 and CD-8 was performed on the 30 glioblastoma cases. Interpretation of the results and correlation between the expression of both markers and the clinicopathologic parameters was also done. Furthermore, survival analysis was done to correlate overall survival and progression free survival of the glioblastoma cases to the expression of PD-L1 and CD-8 markers and also the clinicopathologic parameters available.

Results
Diffuse/fibrillary PD-L1 was expressed in all cases (30/30) with variable percentages (16.7% in ≤ 25% of cases 5/30, 33.3% in &gt; 25%- ≤ 50% of cases10/30, 16.7% in &gt; 50%- ≤ 75% of cases 5/30 and 33.3% in &gt; 75% of cases 10/30). The mean value of Diffuse/fibrillary PD-L1 expression was 57.6%. Membranous PD-L1 was expressed in 6/30 of the cases. TILs were set into two groups according to Han et al 2014; low infiltration group 17/30 (56.7%) of cases and high infiltration group 13/30 (43.3%) of cases. Expression of CD-8 was 10% (median percentage) and 14.3% (mean percentage). PD-L1 and CD-8 correlation was statistically significant (P 0.001) where high PD-L1 expression is associated with low CD-8 expression. PD-L1 expression was associated with worse overall survival (0.001) and worse progression free survival (P 0.026). CD-8expression did not affect the outcome. Correlation of age, sex, tumor site and laterality to outcome were statistically insignificant. In the results of our study PD-L1 expression was the only independent factor that affected the prognosis according to Cox variate analysis.

Conclusion
The incidence of PD-L1 expression in GBM patients is robust. Higher expression of PD-L1 is associated with lower TILs expression and worse prognosis.
Expression of Interleukin 23p19 in Colorectal Carcinoma: An Immunohistochemical Study with Clinico-Pathological Correlation
Authors: Khamis Nahed Samy , Ahmed Hamed Mohamed , Rizk Manal Fawzy , Shakweer Marwa Mosaad , El Ghany Hassan Mona Mohamed Refaat Abd 
Published: August 2023

Background
Cancer of the colon is the fourth most common cancer in the world, while cancer of the rectum is the eight most common. Together, colorectal carcinomas (CRCs) are the third most commonly diagnosed form of cancer globally, comprising about 11% of all cancer diagnoses. In Egypt, a rapid increase in CRC incidence has been observed with an unusually high rate under the age of 40. Interleukin 23 (IL-23) is a member of a family of pro-inflammatory cytokines, consisting of a p19 subunit and a p40 subunit. Studies showed that IL-23 signaling causes up-regulation of MMP9, increased angiogenesis, and reduced CD8+ T cell recruitment to tumors. Therefore, IL-23–mediated inflammatory processes might provide a tumor-promoting microenvironment.

Objective
To evaluate the immunohistochemical expression of IL23p19 in colorectal carcinoma with clinico-pathological correlation.

Methods
This is a retrospective study consisting of formalin fixed paraffin embedded tissue blocks of 25 cases diagnosed as colorectal carcinoma. All tissue blocks were retrieved from the archives of the pathology department at Al-Demerdash Hospital.

Results
There was a significant difference between CRC cases with different tumor stages as regard total IL23p19 expression, as 100% of cases with higher stage (T4a/b) had positive expression compared to 42.9% and 92.9% of T2 and T3 respectively. However, no significant difference was detected between cases with different tumor grades as regard total IL23p19 expression.

Conclusion
It can be concluded from our study that there is an association between IL23p19 expression and the pathological stage in CRC patients. IL23p19 could be used as a prognostic biomarker and a potential treatment target.
Outcomes of Health Care Services Provided to Egyptian Patients with Type 1 Diabetes Mellitus Attending Pediatric Diabetology Unit, Children's Hospital, Ain-Shams University
Authors: Elhabashy S A , Elbarbary N S , Thabet R A , Ahmed A A 
Published: August 2023

Background
Efforts in treating patients with type 1 diabetes are targeting strict glycemic control to prevent long- and short-term adverse health outcomes.

Aim of the Work
to evaluate the current health care services provided to patients with type 1 diabetes registered in Pediatric and Adolescent Diabetology Unit (PADU), Children's hospital of Ain-Shams University, in terms of metabolic control and complications encountered.

Patients and Methods
This retrospective cross-sectional study was conducted on all patients attending diabetology clinic during the period between May 2017 and July 2018. Patients' data was extracted from patients records of clinic including baseline and follow up examination and investigations.

Results
The mean age of patients was 12.63 ± 3.41 years with mean diabetes duration 5.54 ± 3.07 years. The mean HbA1c was 8.75 ± 1.94 %, with mean number of blood glucose monitoring (SMBG) 2.43 ± 0.64 times/day. Patients with more than 5-year-diabetes duration have significantly higher cholesterol level (167.58 ± 38.02 versus 163.23 ± 35.54 mg/dl), higher LDL (100.23 ± 29.49 versus 95.70 ± 28.11 mg/dl), presence of celiac antibodies (5 cases versus 4 cases) and lower number of SMBG (2.24 ± 0.66 versus 2.58 ± 0.57 times/day), (p &lt; 0.05).

Conclusion
Patients with more diabetes duration have significantly higher incidence for microvascular complications and have less satisfaction than others with less duration of diabetes.
COVID 19 Related Multisystem Inflammatory Syndrome in Children Admitted to PICU in Ain Shams University Hospitals
Authors: Ibrahim Hanan Mohamed , Habeeb Nevin Mamdouh , Magdy Sondos Mohamed , AboBakr Ahmed Mohamed Hessain 
Published: August 2023

Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4–6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation.

Aim of the Work
To evaluate the clinical profiles and risk factors for pediatric multisystem inflammatory syndrome in children with COVID-19 admitted to PICU.

Patients and Methods
This was a cross sectional study conducted on 45 patients admitted to pediatric intensive care unit (PICU) from June 2020 to August 2020, they were diagnosed as MIS-C cases according to CDC definition for MIS-C, using a score to assess hyperinflammatory syndrome, all patients were subjected to the following:(demographic data, clinical signs & symptoms at presentation, sequential organ failure assessment (SOFA) score and laboratory investigations.

Results
In our study MIS-C patients presented with 100% Kawasaki disease(KD)-like symptoms and 62.2% gastrointestinal symptoms in addition to fever with shock or cardiac dysfunction. Our patients presented with the following vital data: 100% were tachycardic and hypotensive according to centiles, peripheral capillary oxygen saturation (spo2) mean 94.5(2) %, fever of mean 39(0.6) degree celsius and SOFA score mean of 9(2). KD-like features were variably seen in patients (skin rash in 55.6%, conjunctivitis in 46.7% and Cardiovascular abnormalities were seen in 100% e.g. (myocardial dysfunction, valvular regurgitation, coronary dilatation, pericardial effusion and shock). In our patients, 13 patients (28.9%) had comorbid conditions, like (hematologic e.g. ALL, Cardiac e.g. ASD&VSD, Endocrinologic e.g. Diabetes mellitus), 4 of them died revealing comorbidities as a cause of higher mortality with significant p value (0.028). 39 patients (86.7%) were discharged and 6 patients (13.3%) died.

Conclusion
MIS-C is a hyper-infammatory syndrome affecting multiple organs and is triggered by SARS-CoV-2 infection. It is usually seen 2–4 weeks following infection. comorbidities significantly affected the short term outcome of the disease.
5 Years Analysis of Therapeutic Hypothermia for HIE Neonates in NICUs of Ain Shams University
Authors: Gad Ghada Ibrahim , Attia Nayera Ismail , El fattah Atia Alaa Amir El dawla Abd , Saleh Ghada Ahmed 
Published: August 2023

Background
Therapeutic hypothermia (TH) is a standard of care for neonatal Hypoxic Ischemic Encephalopathy (HIE) in developed countries. Most data come from High income countries (HIC). Recently, experts suggest that the safety and efficacy data on cooling from HIC should not be extrapolated to Low and Middle Income Countries (LMIC).

Aim of the Work
Evaluation of the outcome of neonates with HIE treated with TH as a neuroprotective treatment who were admitted to NICUs of Ain Shams University from 1/2016 to 12/2020.

Patients and Methods
All HIE babies who were treated with TH were included. Retrospectively, patients’ medical paper notes of included babies were reviewed, recorded, and analyzed. Survived neonates were approached by telephone interview regarding parental views on their neurodevelopment and were offered a formal neurodevelopmental assessment for their babies using Bayley Scales III.

Results
A total 37 neonates (17 survived and 20 died) were included: 2 mild HIE (survived), 13 severe HIE (all died) and 22 moderate HIE (15 survived and 7 died) (mortality 54.1%). The most common causes of death are pulmonary hemorrhage (24.3%) and shock (18.9%). Of the 17 survivors, 6 patients couldn’t be reached while 9 patients had satisfactory neurodevelopmental progression as per their parents while 2 patients had poor outcome. Bayley III was done for only 3 babies: All had normal cognitive and language development. 2 of them had normal motor development while 1 patient had mild to moderate motor delay.

Conclusion
TH might not improve outcome of sever HIE but of great value on outcome of moderate HIE. Prospective RCTs are recommended to assess the role of TH as a neuroprotective agent for neonates with HIE in a low resource setting.
Psychological Impact of COVID-19 Pandemic on Pediatric and Adolescent Patients with Type 1 Diabetes Mellitus
Authors: Elmaksoud Abeer A Abd , Elhenawy Yasmine I , Abd- ElHamid Salwa A , Shokr Asmaa S 
Published: August 2023

Background
The COVID-19 pandemic and quarantine measures had actually affected the quality of life of general population. Pediatric and adolescent diabetic patients are vulnerable group with increased susceptibility to infections and increased morbidity and mortality. They are exposed to increase levels of stress, anxiety and depression during the COVID-19 pandemic.

Aim of the Work
This study aims to assess the psychological impact of COVID -19 pandemic among children and adolescents with type 1 diabetes.

Subjects and Methods
This study is observational cross-sectional study based on analysis of 100 patients with type 1 diabetes, aged 7-18 years old from Pediatrics Hospital, Faculty of Medicine, Ain Shams University. Patients were subjected to full history taking, physical examination, laboratory investigations and psychological assessment by assessing quality of life by PedsQLTM 3.0 Diabetes Module Arabic version which is a multidimensional diabetes-specific instrument assessing the broad age range of 2 - 18 years with both child and parent proxy-reports.

Results
The results showed that PedsQL (parents report) total score ranged from 40 – 92 with mean of 66.27 ± 12.48 and PedsQL (children report) total score range from 44-93 with mean of 68.41 ± 12.78. Both PedsQL (parents report) total score and PedsQL (children report) total score negatively correlated with age, weight, number of DKA, HbA1c post lockdown. There is a negative relation between PedsQL (parents report) total score and tanner stage, no. of sibling, hospital admission during pandemic and insulin regimen, so any increase in those parameters will lead to decrease in PedsQL (parents report) total score. There is a negative relation between PedsQL (children report) total score and no. of sibling.

Conclusion
There was a mutual relationship between the pandemic and lock down and HbA1c and quality of life in pediatrics and adolescences with T1DM in Egypt. Low quality of life during the COVID-19 pandemic negatively impacted glycemic control.
Epilepsy Surgery and Health Education Improved Quality of Life in Children with Drug Resistant Epilepsy
Authors: Hassanein Sahar M A , Sorial Dina M Sh , Abd El-Kader Mohamed S M , Hamada Salah M , Darwsih Ahmed M , Shata Mennatallah O 
Published: August 2023

Background
Epilepsy is a common neurological disorder that affects over 70 million people worldwide. Despite introduction of recent antiepileptic drugs (AEDs), there's about one-third of patients that suffer from epilepsy also have seizures refractory to pharmacotherapy.

Aim of the Work
To study the effect of epilepsy surgery and health education on seizure control, sleep, and quality of life in children with drug resistant epilepsy (DRE) postoperative.

Patients and Methods
This was an observational study that relied on data collection, health education on 30 children operated upon for DRE and their families throughout a 6-month period. Data collected included Chalfont Seizure severity scale (CSSS), Quality of life (QOL) questionnaire, IQ assessment, total sleep habits questionnaire (CQHQ), EEG and Engel scale after epilepsy surgery.

Results
Enrolled children age ranged between 4-18 years with a mean age of 7.8 ± 3.8 years, of which (65.6%) were males.
There was a significant reduction in CSSS after surgery from (78.5 ± 30.1) to (60.3 ± 33.6), quality of life from (91.3 ± 20.9) to (80.5 ± 18.1), and in CSHQ from (33.7 ± 10.2) to (25.1 ± 8.3). IQ increased after surgery from (46.7 ± 15.7) to (50.2 ± 16.5); P value &lt;0.001 for all. Mean reduction of Chalfont scale was 24.73% (range from 0 % to 70%). Quality of life was 10.98% (range from 0% to 36.2%), CSHQ was 23.03% (range from 0% to 70%) and mean IQ increase was 8.31% (range from 0% to 50%).
There was an improvement in seizure control as Engel classification postoperatively. In Engel (I) 3.1% were A and 3.1% were D. In Engel (II) 3.1% were A, 3.1% were B and 3.1% were D. In Engel (III) 28.1% were A and 3.1% were D. In Engel (IV) 15.6% were A, 28.1% were B and 9.4% were C.

Conclusion
Epilepsy surgery can effectively improve QOL in children with medicationresistant seizures, through sustained seizure freedom, which was associated with the greatest improvement in life quality, IQ and sleep habits.
Nutritional Screening of Sick Neonates in NICU and Its Relation to Short Term Outcome
Authors: Emam Safaa Shafik , ElDin Mohamed Nour , Elgendy Yasmin Gamal Abdou , Ali Doaa Nagy 
Published: August 2023

Background
Malnutrition during infancy has long-term physical and psychological adverse effect on development. Neonatal nutritional assessment is important to determine the daily energy and nutritional requirements needed for optimum growth and development.

Objectives
Assessment of the validity of Nutrition risk screening tools, and to stratify neonates admitted to the NICU according to their nutritional risk and correlate this to their outcome.

Methods
A cross-sectional study was conducted in NICU at Ain Shams University Hospitals. All neonates admitted to the NICU in a set period of 6 months from December 2017 to June 2018 were enrolled in the study after written and verbal consents were taken from parents.All neonates were subjected to the following: Anthropometric measurements (weight, length, head circumference, mid arm circumference, skin fold thickness and ponderal index at admission), Dietary assessment and laboratory investigations. The number of patients at this study were classified according to ‘Ohio neonatal nutrition screening tool (NNST) into a three risk groups:
•low risk group: no = 121
•moderate risk: no = 15
•High risk: no = 14

Results
The study showed that full intake enteral nutrition was reached in 100% of low and moderate risk groups and in only 64.3% of high risk group. Continuous parenteral nutrition was required in 100% of moderate and high risk groups and in only 7.4% of the low risk group. It also showed that the length of hospital stay was increased in the moderate risk group to 22 days (16-26) and in the high risk group to 8.5 days (3-16) while in the low risk group was only 5 days (4-7).Considering the hospital discharged patients: 100% of the moderate risk group, 99.2% of the low risk group and only 21.4% of the high risk group were discharged. According to the septic score, sepsis was recorded in 85.7% in the high risk group, 66.7% in the moderate risk group and only in 24% of the low risk group.

Conclusion
Nutritional screening tools were able to identify neonates at nutritional risk, as it showed that High risk group patients had higher rate of mortality and higher risk of Sepsis and thus they were in need for further assessment and support by nutrition specialist.
Hepatic Manifestations of Pediatric Hemophagocytic Lymphohistocytosis
Authors: El Sayed Manal Hamdy , Ebeid Fatma Soliman , El Kader Salwa Mostafa Abd , El-Shorbay Fatma Mohamed , Ragab Iman Ahmed 
Published: August 2023

Background
Hemophagocytic lymphohistiocytosis (HLH) is a rare hyper-inflammatory disorder.it is caused by benign systemic overgrowth of macrophages in the reticulo-endothelial system, leading to cytokine storm. The main features of HLH are; fever, splenomegaly, bi/pancytopenia; hyperferritinemia, hyper-triglyceridemia and hypofibrinogenemia; which if not diagnosed and early treated progresses to disseminated intravascular coagulopathy (DIC), multi-organ dysfunction with dismal outcome. Hepatic manifestations are not well recognized primary presentation in pediatric patients with HLH. This presentation mandates high levels of suspicious for early diagnosis.

Aim of the Work
To study the hepatic involvement clinical, laboratory, and pathological in patients with Familial/primary (1ry) HLH and in patients with secondary (2ry) acquired HLH.

Patients and Methods
A 6 month retrospective cohort study included 35 patients with genetically confirmed HLH divided into familial HLH by its types, X linked lymphoproliferative syndrome, HLH with partial albinism and secondary HLH; following at pediatric hematology/oncology clinic, Ain Shams University. By detailed review of clinical and laboratory data that include hepatic transaminases and synthetic liver function done at the time of presentation, at week 2, 8 from treatment start and at time of reactivation; Liver biopsy results and genetic analysis were recorded. Biochemical liver involvement was considered when alanine aminotransferase was three folds the upper level of normal at presentation. Overall and reactivation free survival were analyzed according to liver involvement

Results
Thirty five patients with HLH were recruited with age range of 2-108 months, 20(57.1%) of patients with HLH were genetically confirmed and 12(34.3%) of them had MUNC13D mutations, 3(8.6%) had STXBP2 mutation and 5(14.3%) had RAB27A mutation while 4(11.4%) had secondary HLH. 29(82.9%) had liver enlargement at diagnosis with hepatic reactivation in 18(51.4%). 8(22.8%) of patients had biochemical liver involvement; there was no significant difference in their demographic data or their clinical presentation, their final outcome or the type of mutant gene according to liver involvement.

Conclusion
HLH is a frequently lethal disease with a high variability in clinical presentation .it must be considered a differential in patients presenting with clinical signs of hepatic dysfunction especially when it is accompanied by cytopenias. Significant biochemical liver involvement is an under recognized presentation of HLH. Hepatic involvement did not impact response to treatment and disease outcome.
Evaluation of the Current International Registry Update for Children and Adolescents with Diabetes Mellitus Following Up in Diabetes Clinic, Pediatric Hospital, Ain Shams University
Authors: Sherif Eman Monir , Elbarbary Nancy Samir , Thabet Rasha Adel , Abdelwahab Gehad Saber 
Published: August 2023

Background
Diabetes team should have the access for receiving continuous feedback for the health care service to help successful improvement. Health professionals need to continuously work to improve the quality of pediatric diabetes care to reduce the risk of acute and chronic complications. Objective: To evaluate the current international SWEET registry update for the children and adolescents following regularly at Pediatric and Adolescents Diabetes Unit (PADU) during a period of six months and updating the existing electronic medical record (Database) in (PADU) to provide measures to improve patients outcome regarding both acute and chronic complications.

Patients and Methods
The present study is a prospective follow up study performed on 385 patients with diabetes mellitus type1, with a mean age 11.79 ± 4.16 years. All patient with diabetes mellitus type1 visiting diabetes clinic (PADU) were included in the study after obtaining an informed consent.

Results
Patients with longer diabetes duration have significant higher insulin dose, more attacks of DKA and less attacks of hypoglycemia comparing to those with shorter duration. Patients with poor glycemic control have more attacks of DKA (62 patients vs 58 patients), (p-value=0.046), and less attacks of hypoglycemia (25 patients vs 65 patients), compared to properly controlled patients (p-value=0.000). Patients on insulin pump show significant improvement of them HbA1c (11% vs 7.3%) (p –value=0.000), cholesterol (173 mg/dl vs 139.8 mg/dl) (p- value= 0.006) and SMBG (2.7 times vs 4.6 times) (p-value= 0.000), compared to patients on multiple daily injections (MDIs).

Conclusion
Diabetes care is the cornerstone for proper glycemic control and prevention of long term complications. This study showed the value of a registry system to enable monitoring of patients over many years. The study could be an important step in the development of a national registry system for diabetes in Egypt.