bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Retinal Side Effects of Fingolimod (Gilenya) Used in Treatment of Multiple Sclerosis Patients
Authors: Elshahed Hala Kamal Hassan , Salman Abd El Rahman Gaber , Mohammed Thanaa Helmy , Zamzam Dina Abdelgawad , Abdelgawad Randa Hesham Ali 
Published: August 2023

Background
Multiple sclerosis is an inflammatory demyelinating disease that affects CNS. It is thought that multiple factors were implicated in the pathology of MS such as immunological factors, vitamin d deficiency, vitamin b12 deficiency or infection by EBV or HHV6. It has a lot of ocular manifestations as optic neuritis, diplopia, oscillopsia, nystagmus and ophthalmoplegia. Fingolimod is the first approved oral drug for RRMS. Macular edema was reported as a side effect of fingolimod after 4 months of use.

Aim of the Work
The objectives of the study are screening of retinal side effects of fingolimod used for treatment of relapsing remitting multiple sclerosis patients having no previous ophthalmic complains before starting the treatment. To assess structural changes within the retina using SD-OCT and to correlate these structural changes with the function affection (visual acuity assessment and electrophysiological studies).

Patients and Methods
Thirty eyes of fifteen patients were included in this prospective one arm clinical trial study. These thirty eyes belonged to multiple sclerosis patients who will be candidate for treatment with fingolimod (Gilenya). Patients were recruited from MS unit, neurology department, Ain Shams University.

Results
We found that the mean best corrected visual acuity change after treatment slightly decreased but this was non-significant. IOP measurements were not changed after treatment. Despite the changes in visual acuity; fingolimod associated macular edema did not develop. Among 15 patients (30 eyes), 14 eyes have slightly increased MT, 5 eyes have stable MT and 11 eyes have slightly decreased MT. Regarding electrophysiology follow up there were significant change in P1 amplitude in MfERG in ring 1, and it happened without development of macular edema (ME), as 50% of patients had MfERG changes in spite of the absence of ME. So we recommend doing electrophysiological test (MfERG) in follow up protocol of fingolimod treatment.

Conclusion
Finglimod is an immunomodulatory drug used for treatment of RRMS, it is the first oral drug approved by FDA for MS. Fingolimod associated macular edema is a known complication with a low incidence. Patients on fingolimod should have baseline and 3 to 4 months ophthalmic examination as a part of their protocol OCT is non-invasive technique used for detection of macular edema and follow up, but in our study we found that after 4 months of treatment by fingolimod, affection of retinal function in same patients may happen before macular edema development, which spots the light on the importance of performing the mfERG as well in the follow up of patients who were treated with fingolimod. Further studies are needed to support our results.
Preliminary Study on the Effect of Intrastromal Anti-Vascular Endothelial Growth Factor Injections on Corneal Neovascularization Using Anterior Segment Optical Coherence Tomography Angiography
Authors: Ayoub Hussein Mohamed Sherif Ahmed , Mousa Amr Saleh Galal , Hamdi Momen Mahmoud , Mousa Rasha Mohamed , Abd-elRazeik AwadAllah Mo’mena Ahmad 
Published: August 2023

Background
Corneal neovascularization, is a serious condition affecting large percentage of the population. Not only does corneal neovascularization decrease vision and cause corneal edema, but also, it is highly associated with graft rejections. Anti-VEGF has been used in many studies to treat corneal neovascularization with promising results. Recently, evaluation of corneal neovascularization using Optical Coherence Tomography Angiography (OCTA) has been explored and has shown to be promising.

Objective
To evaluate the effect of intrastromal injection of Anti-VEGF using the swept source anterior segment OCTA on corneal neovascularization.

Patients and Methods
This pilot study was done in a cohort, prospective manner. The study was done on 10 eyes of 10 patients with corneal neovascularization who were planned for keratoplasty or after keratoplasty. Intrastromal injection of Anti-VEGF using a 30 Gauge needle at a concentration of 5 mg/0.2 mL [2.5%] was done for patients involved in this study. OCTA was done 48 hours before injection, 1 week and 1 month after injection. OCTA images were compared to evaluate the effect of Anti-VEGF on corneal neovascularization.

Results
Compared with the pre-operative period, at 1 week postoperatively, 9 cases have shown decreased corneal neovascularization, with only 1 case that showed no regression and seemed to be unresponsive to the single injection of Anti-VEGF. At 1 month period, 8 cases had increased vascularization (re-vascularized), 1 case had decreased vascularization again (completely disappeared) and 1 case stayed the same with no change. Cases that have revascularized, have not returned back to the original vascularization level. Using OCTA colored, black and white images, we were able to picture blood vessels in 3-D image and detect subtle changes in corneal neovascularization. Using the OCTA cross-sectional images, we were able to estimate the vessels depths. In 6 cases, vessels were located in the posterior 25% of the cornea (Deep), in 2 cases they were located in the anterior 25 % (Superficial) and in 2 cases they were between the anterior 25 % and the posterior 25% (Mid-stromal). Vessel density was not possible to calculate in this study.

Conclusion
Bevacizumab intrastromal injections seem to be a very effective temporary method in decreasing corneal neovascularization despite the level of neovascularization. Repeated Bevacizumab injections might be needed to eliminate corneal neovascularization completely. Bevacizumab seems to have a peak action at 1 week period and then its effect seems to ware off gradually. OCTA was able to visualize vessels in 3-D image, even under vascularized corneal scars. OCTA was able to recognize subtle changes in corneal neovascularization, that were not visible by slit lamp.
Screening of Oral Tamoxifen Ocular Toxicity in Breast Cancer Patients
Authors: Ahmed Mai Mohamed Ahmed , Salman Abdelrahman Gaber , Fawzy Samah Mahmoud , Abdelmotal Ahmed Said Ibrahim , Tharwat Ahmed , Abdelgawad Randa Hesham Ali 
Published: August 2023

Background
Breast cancer is one of the leading cancer types among females worldwide. Prevalence of breast cancer is reported to be the second most common among women. Several treatment lines were prescribed in treatment of breast cancer besides surgical, radiological interventions. Tamoxifen is one of the medical treatments used in postsurgical prophylaxis of breast cancer. Various visual problems were reported with tamoxifen therapy. These include posterior subcapsular cataracts, color vision changes, optic neuritis, and intra-retinal crystals.

Aim of the Work
The aim of the work was to screen for ocular toxicity of tamoxifen used for treatment of breast cancer patients having no ophthalmic complains and treated with tamoxifen for at least 2 years with dose (20mg per day).

Patients and Methods
We included 50 female patients with breast cancer treated with Tamoxifen therapy for at least 2 years then we divided them into two groups regarding duration of tamoxifen intake from (2-4) years group and from (5-8) years group, all subjects underwent complete careful history taking and full ophthalmological examination, BCVA was measured using Snellen chart with conversion to log. MAR notation for statistical analysis.

Results
There was significant correlation between duration of tamoxifen intake and RPE mottling, no other significant correlations were detected, there was no significant difference in mean of BCVA, IOP, cup values, disc parameters, GCC thickness, RNFL zones between the two groups except for (inferior quadrant), macular thickness except in (superior quadrant), OCT layers thinning shows RNFL affection in (34%) of cases, GCC affection in (48%) of cases and macula affection in (64%) of cases, color vision defects was found in (12%) and electrophysiological test changes found in few cases.

Conclusion
Tamoxifen therapy causes minimal affection on the ocular structure and function, OCT layers thinning (34-64% of cases) preceed the clinical changes this highlights the importance of OCT examination in those patients to evaluate tamoxifen toxicity and further studies will be needed to evaluate reversibility of these changes after stoppage of therapy, main ocular complications associated with tamoxifen therapy were correlated to duration of treatment.
Study of the Efficacy of Indocyanine Green Enhanced Transpupillary Thermotherapy as a Treatment Modality for Retinoblastoma
Authors: Aziz Nada Abdel Salam Abdel , El Barbary Magdy Mohamed , Ziko Othman Ali Othman , Said Azza Mohamed Ahmed , El Zankalony Yasser 
Published: August 2023

Background
Retinoblastoma represents approximately 4% of all pediatric malignancies and is the most common ocular malignancy in children. It has one of the highest survival rates among all pediatric malignancies owing to improving treatment methods over the years.

Objectives
The purpose of our work was to evaluate the efficacy of intravenous indocyanine green dye injection combined with diode laser transpupillary thermotherapy (TTT) as a treatment modality for Group (B) intraocular retinoblastoma compared to the standard protocol of treatment.

Patients and Methods
A prospective interventional comparative study was conducted in the Ocular Oncology Clinic, Ophthalmic Department, Ain Shams University Hospital in the period from August 2017 to December 2020. The study was conducted on twenty tumors, classified as Group (B) retinoblastoma according to International Classification of Intraocular Retinoblastoma (ICRB). It includes; Tumors &gt;3 mm (in basal dimension or thickness), tumors located in the macula (≤3 mm to foveola), juxta-papillary tumors (≤1.5 mm to disc) or tumors surrounded by subretinal fluid (≤5 mm from the tumor margin). They were divided into two main groups: Group I: It included ten (10) tumors; newly diagnosed or recurrent. This group was treated with systemic chemotherapy plus ICG enhanced diode laser TTT, Group II (control group): It included ten (10) tumors; newly diagnosed or recurrent. This group was treated with systemic chemotherapy plus conventional diode laser TTT.

Results
The study found that ICG has significantly improved uptake of diode laser, eliminating the need for increasing the laser power to the photocoagulation levels which would disrupt the inner retinal layers. ICG-TTT allowed rapid tumor regression and decreased the number of laser sessions needed to achieve tumor regression.ICG-TTT was successful with 3 challenging recurrent masses on a hypopigmented scar and achieved complete regression. There was no statistically significant difference between the two groups as regards the disease-free survival curves using Kaplan Meier analysis. During the period of post chemotherapy follow up, 3 tumors in Group I (30%) and 2 tumors in group II (20%) developed recurrence. And one case in group I (10%) developed a new mass in a remote site.

Conclusion
The study concluded that ICG-TTT is both efficient and safe despite some potential complications.
Different Modalities in Management of Recurrent Patellar Dislocation
Authors: Kamel Ahmed Samy , Mansour Saleh Gameel , Hamza Mohammed Safwat , Ragab Abdelrahman Mohammed 
Published: August 2023

Background
Patellar instability is a complex pathoanatomical phenomenon that requires an intricate understanding in order to properly treat patients. Often, the etiology of this entity is multifactorial, and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus.

Objective
To review the currently available different modalities for management of recurrent patellar dislocation. This Review will analyze results concerned with Patellar instability to reach the most efficient modality that gives the best results.

Material and Methods
This systematic review study based on inclusion and exclusion criteria conducted to evaluate the outcome of different techniques of medial patellofemoral ligament reconstruction analyzing their efficacy and possible complications. This systematic review demonstrates that MPFL surgery for recurrent patellar dislocation isolated or in combination with other procedures results in a significant improvement in Kujala scores, a low redislocation rate, and an acceptable complication rate. Despite this, there is no consensus on indications for MPFL reconstruction, graft type, surgical technique, and rehabilitation program. The inclusion criteria for future studies were highly important, and consensus agreement within an expert panel should be sought prior to undertaking such a study.

Data Sources
Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021.

Data Extraction
If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Results
Several fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction. However, the optimal management of patients with recurrent patellar dislocation remains controversial. This short-term study showed that after MPFL reconstruction (suture anchors or transosseous sutures), patellar stability could be restored. And no significant differences in outcome scores were observed between patients in the transosseous suture and suture anchor groups.

Conclusion
Evaluate the outcome of different techniques of medial patellofemoral ligament reconstruction analyzing their efficacy and possible complications.
Proximal Femoral Nail versus Dynamic Hip Screw in Unstable Intertrochanteric Fractures (Systemic Review and Meta-Analysis)
Authors: Morsi Ahmed Mohamed , Ashour Mahmoud Ahmed , Zahran Ahmed Mohamed 
Published: August 2023

Objective
To compare the results of operative management using two different kind of internal fixation modality devices either PFN or DHS, to achieve fracture union and to determine the rate of union, complications, operative risks and functional recovery and outcomes. Compare the results obtained and determine the effectiveness of PFN in comparison to DHS in treatment of intertrochanteric fractures.

Introduction
Intertrochanteric fractures form about 50% of all fractures that occur in proximal part of femur. The mean patient age is 66 to 76 years. In United States of America, the rate of intertrochanteric fractures in elderly men is about 34 per 100,000 and in women it is 63 per 100,000 annually. Intertrochanteric fractures mostly unite, provided that reduction and fixation are correctly done. There are large area of bone is involved, mostly consist of cancellous bone and both fragments are richly supplied by blood. Determination of stability is the most important aspect of intertrochanteric fracture classification. Stability is provided by an intact or a reconstructible posteromedial buttress. Reverse obliquity fractures, loss or comminution of the posteromedial buttress and subtrochanteric extension are factors that results in unstable fracture patterns.

Management
The treatment goal of intertrochanteric fracture is restoration of early mobility safely and adequately while decreasing the hazard of medical complications and technical failure and to restore the patient to preoperative status of function. Trochentric femoral fracures have been estimated to occur in more than 200,000 patients annually in the United States, with reported mortality rate from 15% to 30%.

Study design
Randomized controlled trials and quasi-random studies.
Updated Trends of Fractures, A Single Trauma Centre Prospective Observational Study
Authors: Hassan El-Zaher El-Zaher , El Deen Abdelhamid Radwan Gamal , Ezzat Bibars Amr Mamdouh AbdelAziz 
Published: August 2023

Background
Trauma, specifically physical trauma, is the damage to the body caused by an external force. This may be caused by accidents, falls, hits, weapons, and other causes.In medicine, traumatology is defined as the study of wounds and injuries caused by accidents or violence to a person, together with the surgical therapy and repair of this damage.

Aim of the Work
This study primarily aims to identify the prevalence of fractures in our population and fracture patterns as regards the age, the gender, the comorbidities of the patients, the mode of trauma, the classification, the associated injuries and the management at our institute.

Patients and Methods
This study is a cross sectional observational study in which the STROBE layout was used. It was conducted in a university hospital which is considered as a tertiary trauma center “Ain Shams University hospital.”. Data regarding the patients were collected over a period of six months started from the first of January 2021 and ended by the end of June 2021. No follow up was needed for any patients.

Results
Results showed that most prevalent fractures were femur fractures especially in geriatrics, followed by radius fractures that mainly occurred in pediatric age group, tibial fractures were the third most common fractures and mainly affected adult age group, humeral fractures were the fourth most common with pediatrics age group mainly affected. Malleolar fractures were the fifth prevalent fractures followed by the ulnar fractures.

Conclusion
Fracture prevalence numbers vary substantially according to age and gender for different locations and presumably the percentage of osteoporotic fractures are on the rise. Careful assessment of fragility fractures is needed, developing a trauma registry and filing systems is mandatory in order to accurately collect and save this important data. Femur fractures especially geriatric femur fractures, radius especially distal end and tibial fractures (especially the shaft), accordingly the learning curve should be guided towards mastering the management of those fractures. Hospital preparation, instrumentation and creation of special dedicated units like the orthogeriatric unit should be encouraged to provide better care for patients along with enhancing the inter-specialty communication and aiming for multi-disciplinary team management. Data from the study should be implemented nationwide to help develop preventative strategies aiming for lowering the occurrence of fractures
Superior Capsular Reconstruction for Massive Irreparable Cuff Tears: A Systematic Review for Clinical & Functional & Radiological Outcomes
Authors: El Saeed Ahmed , El Sedaway Ashraf , Youssef Andrew Magdy 
Published: August 2023

Background
Massive rotator cuff tears (MRCT) are defined as a full-thickness tear of at least two tendons or measuring greater than five centimeters in diameter in the coronal plane. They represent about 20% of all rotator cuff tears and 80% of recurrent tears.

Aim of the Work
The treatment of massive irreparable cuff tears (MIRCT) is considered a consistent challenge for the orthopedic surgeons regarding the best management and the postoperative outcomes.

Patients and Methods
Search were conducted using the following databases: MEDLINE database, PubMed, Cochrane Bone and Muscle Trauma Group Specialized Register, Cochrane Register of Controlled Trails (The Cochrane Library). Data will be independently extracted by two reviewers and cross-checked.

Results
In radiological parameters, this review makes radiological assessment based on acromiohumeral distance and MRI graft integrity. AHD showed significant improvement in mean change postoperatively rather than preoperatively. As regarding MRI graft integrity, despite this high failure rate (20%) most patients still experienced improved functional outcome scores with two studies reporting no significant differences in functional scores between the intact and re-tear group. but on the other hand Denard et al. demonstrated that 100% of patients with healed grafts had a successful outcome compared to 45.5% when the graft did not heal (p = 0.009).

Conclusion
Not all patients with massive cuff tears are appropriate candidates for complex joint preservation surgery such as SCR because of age, comorbidities, and ability to participate in the lengthy postoperative rehabilitation, so rTSA is an optimal option for elderly, low-demand patients who can benefit from the speed of surgery and rehabilitation with rTSA for massive rotator cuff tears without arthritis.
Sensitization to Rice in Allergic Children Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University
Authors: Awad El-Sayed Zeinab , Elhattab Amira Fouad , Al Fiqy Alyaa Essam Mohammed 
Published: August 2023

Background
The prevalence of food allergy among Egyptian children is largely unknown, more so for the different food allergens. Although there are several studies reporting on the common food allergens, yet none was done to explore the allergy to rice, a food allergen that is much less recognized both by pediatricians and allergic patients.

Objectives
To estimate the frequency of sensitization to rice in pediatric allergic patients in Egypt.

Patients and Methods
This analytical cross-sectional study was carried out in the period from April 2019 to September 2020. The study included 150 physician-diagnosed allergic patients aged 6 months to 18 years, enrolled consecutively from the Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams university. They were 90 (60%) males and 60 (40%) females. SPT was done using a commercial rice allergen extract, Prick-to-prick test with cooked rice. Patients with clinical and /or SPT results suggestive of rice allergy were subjected to oral challenge test under medical supervision in hospital.

Results
None of the screened allergic children (n = 150) gave a self/parentally reported history of allergy to rice, nor after inquiry by the investigator. SPT using commercial rice extract revealed that only 8 reacted positively (&gt;3mm) and were considered sensitized. PPT was done to all patients using a home prepared cooked rice extract and the test was positive in 5 patients; 2 of these were positive also by SPT. A total of 11 patients (7.3%) were considered sensitized and were subjected to OCT and none had a positive test. There was statistically significant difference in age between rice sensitized and non sensitized, being higher in rice-sensitized patients, with p-value = 0.043.

Conclusion
Our study is a pilot research which draws the attention to the existence of sensitization to rice in allergic children. PPT is a useful test with a reliable specificity which when positive, would aid in diagnosing rice allergy in settings with limited resources and unavailability of rice protein extracts.