bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of the Effect of Vitamin D Deficiency on Ocular Dryness
Authors: Elsherbeny Mohamed Adel Ali , Salman Abdel-rahman Gaber , Mohamed Thanaa Helmy , Abdelgawad Randa Hesham Ali 
Published: August 2023

Background
Dry eye syndrome (DES) is one of the most common ocular diseases and has been recognized as an important public health problem. Dry eye is associated with chronic eye pain and an increased risk of ocular surface diseases, such as corneal ulcers and corneal abrasions. DES is a multifactorial disorder of the tear film and ocular surface,

Aim and objectives
was two-fold: (i) to demonstrate the relation between vitamin D deficiency, dry eye and impaired tear function; (ii) to investigate the possible associations among clinical parameters of hypovitaminosis D, such as fatigue, functional impairment and pain, with dry eye parameters including quantity of tears, the stability of the tear film layer and symptoms of ocular irritation.

Subjects and methods
Our study was a prospective, non-randomized study which was conducted on 36 patients with Vitamin D deficiency; The 36 vitamin D deficiency patients were classified according to dryness of eye into 2 independent groups:(1) DES group (25 patients) according to Schirmer test without anesthesia with results &lt;10mm and Tear break-up time TBUT &lt;10s, (2) Non-DES group (11 patients) according to Schirmer test without anesthesia with results &gt;10mm and Tear break-up time TBUT &gt;10s.To evaluate the relation between vitamin D deficiency, dry eye and impaired tear function The following tests were done to patients in our study: Careful history taking, full ophthalmological examination, Schirmer test, Tear break-up time and Optical coherence tomography (anterior segment).Follow up for our patients in the study after taking vitamin D supplement for 3 month and all the previous tests were repeated again.

Results
the results revealed that Comparative study between the 2 groups revealed; highly significant decrease in follow up Schirmer test, tear breakup time and tear-film height in DES group; compared to Non-DES eye group (p &lt; 0.01 respectively). Comparative study between the 2 groups revealed non-significant difference regarding follow up tear-film width and vitamin D level (p &gt; 0.05),

Conclusion
Our work supports that vitamin D deficiency may lead to dry eye which may carry the risk in development conjunctival squamous metaplasia and loss of goblet cells on the ocular surface, and that vitamin D plays a protective role in the development of dry eye, probably by enhancing tear film parameters and reducing ocular surface inflammation.
Pars Plana Vitrectomy for the Treatment of Diabetic Macular Edema with or without Internal Limiting Membrane Peeling: A Systematic Review and Meta-Analysis
Authors: Kh. Abdelhamied Omar , Salman Abdelrahman G , Zaki Mohamed A , Abdelhaleem Heba M , Moustafa Moustafa E 
Published: August 2023

Background
Diabetic macular edema (DME) is defined as a retinal thickening in one-disc diameter (DD) of the centre of the macula. It is a number of microvascular retinal changes that lead to blood–retinal barrier (BRB) disruption, causing leakage of fluid and plasma components into the inner and outer plexiform layers.

Aim of the Work
The aim of the study was to conduct a systematic review and a meta-analysis estimating the efficacy of pars plana vitrectomy with and without internal limiting membrane peeling in treating non tractional refractory diabetic macular edema.

Materials and Methods
A comprehensive literature search was conducted using the databases Google scholar, PubMed, MEDS, web of science, EMBASE and Cochrane Library for published studies from 1 January 2000 to 1 August 2020. This meta-analysis included 14 studies. They were randomized controlled clinical trials (RCTs), and about 647 patients with DME (753 eyes) participated in these studies.

Results
This study demonstrated no statistically significant change in the mean of best corrected visual acuity (BCVA) improvement and central macular thickness (CMT) in both groups when comparing the baseline to one- and three-month follow-ups after the procedure, though with no statistically significant difference in the ILM compared to the non ILM group.

Conclusion
Pars plana vitrectomy with or without ILM peeling improves the long-term visual acuity of nontractional diabetic macular edema. Internal limiting membrane peeling, does not affect the postoperative best-corrected visual acuity significantly.
Anterior versus Posterior Approach in Surgical Treatment of Tuberculous Spondylodiscitis of Thoracic and Lumbar Spine
Authors: Ibrahim Fady Michael fahmy , Ibrahim Zakaria Hassan , Ahmed Abdishakur Mohamud 
Published: August 2023

Background
Spinal tuberculosis is the most common encountered extra-pulmonary form of the disease and accounts for around 50% of musculoskeletal tuberculosis cases, thoracic spine is the most commonly affected, and involvement of lumbar and lumbosacral region is less common, spinal tuberculosis can cause severe neurological deficits, kyphotic deformities, and paraplegia.

Aim of the Work
The aim of this study is review the literature comparing the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis.

Patients and Methods
In this meta-analysis, we combined 25 studies that compared the clinical outcomes of the anterior and posterior approaches in treating 1797 patients with thoracic and lumber spinal TB. This study was approved by the Ethics Committee of Ain Shams University Faculty of Medicine. Written informed consent was not needed because of the study design (systematic review). Based on patient safety and the efficacy of the procedures, we raised three clinically crucial questions to determine the optimal surgical procedure in treating thoracic and lumbar tuberculosis. The primary data used as evidence to answer these questions were obtained from the treatment results, such as the radiologic data and patient-related outcomes.

Results
The results showed that there is no statically significant different in the operative time for the anterior approach (220.8-51.5 minutes) versus posterior approach (213.9-69.3 minutes), and no statistically significant difference was detected. Blood loss was significantly greater in the anterior approach (1125.0-275.5 mL) than in the posterior approach (710.4-192.4 mL).

Conclusion
The posterior approach showed a higher potential for maintaining the correction of deformity and a lower overall surgical complication rate; however, both groups showed no statistically significant differences in operative time, blood loss, radiological and clinical outcome; therefore posterior approach could be used as an alternative procedure to treat thoracic and lumbar tuberculosis patients in terms of pain control, Cobb’s angle, and reduction of complications, however; posterior-only approach alone cannot be used in cases of anterior abscess formation or multilevel involvement where an anterior debridement is mandatory, so; when deciding among the two procedures for treatment of thoracic and lumbar spinal tuberculosis, surgeons must thoroughly consider the patient’s specific features of spinal tuberculosis, the surgeon’s own surgical experience, the risks of surgical complications ranging from neurological to structural, and the different possible outcomes.
Minimally Invasive Plating Osteosynthesis Technique versus Anterolateral Approach for Fixation of Humeral Mid-Shaft Fractures (Systematic Review/Meta-Analysis)
Authors: Morsi Ahmed Mohamed , Ashoub Mostafa Mamdouh , Fekry Mena Rafat 
Published: August 2023

Background
In this study, we performed a meta-analysis to identify whether minimally invasive plate osteosynthesis (MIPO) was superior to conventional open reduction internal fixation for treating humeral shaft fracture.

Methods
A systematic literature search was conducted up to February 2020 in ScienceDirect, Springer, MEDLINE, and PubMed databases for relevant papers that compared the outcomes of MIPO with ORPF, such as open reduction with plate osteosynthesis (ORPO) and for treating humeral shaft fractures. Meta-analysis was performed with jamovi project (2019) (jamovi Version 1.0 Computer Software).

Results
According to the search strategy, six studies that covered 300 patients were enrolled, including three randomized controlled trials (RCTs), one prospective cohort trials, and two retrospective cohort trials. Our meta-analysis did not detect any significant difference between MIPO and ORPF in terms of operative time, fracture union rate, and fracture union time. However, MIPO has a less rate of complications and iatrogenic radial nerve palsy than that of ORPO.

Conclusions
From this study, we concluded that humeral shaft fractures could be effectively treated with the MIPO technique due to the advantages of shorter fracture union time and lower incidence of fracture nonunion and iatrogenic radial nerve palsies rather than the conventional open reduction and internal fixation technique.
Development of Egyptian Practice Guidelines in Management of Stroke in Pediatrics
Authors: Hassanein Sahar M A , Mohammed Maha Zakariya , El-Din Amin Ghada Essam , Khedr Hala AbdElkader Elsayed 
Published: August 2023

Background
Pediatric stroke, though not common but it is a severe disease with potentially lifelong restrictions, the etiology of acute ischemic stroke (AIS) in childhood is mostly multifactorial. Better understanding and development of practice guidelines improved the diagnosis and outcome of this disease.

Aim of the Work
This study aimed to develop Egyptian clinical practice pediatric stroke management guidelines that suitable for all resources at different Egyptian hospitals.

Subjects and Methods
Twenty six of Egyptian experts in the field of neurology in pediatrics were selected and invited to participate in this project. Two rounds Delphi techniques were applied to build up the consensus among the experts on the formulated guidelines, 75% agreement was used as cut-off.

Results
The experts agreed on the following, 60% agreed that Face, Arms, Speech, Time indications (the FAST tool) is the commonest presenting symptom of stroke in pediatrics. 80% agreed that the most common risk factors were thrombophilia, cardiac diseases followed by sickle cell disease and 100% that MRI is the best neuroimaging to be ordered for a child with suspected stroke. In terms of treatment, the panel had agreement76.9% on supporting safety of anticoagulation use in AIS and 92.3% on safety of aspirin use in prevention of stroke recurrence after exclusion of hemorrhagic stroke.

Conclusion
The present Delphi consensus process has supplied useful information on stroke diagnosis and management practice in a multicenter group of pediatric neurologists, influencing the development of a proposed local stroke guideline.
Early Onset Sepsis in Neonates
Authors: Mohamed Maha H , Mahmoud Ramy M , AbdRabou Mohamed E , Barakat Noha M K 
Published: August 2023

Background
Neonatal sepsis is one of the most important causes of neonatal morbidity and mortality. The most common risk factors associated with early onset sepsis (EOS) are preterm delivery, low birth weight, premature rupture of membranes, maternal urinary tract infection, Clinical manifestations of neonatal sepsis are nonspecific. These include temperature instability, respiratory distress, apnea, poor feeding, lethargy, irritability, convulsions, hypotonia, poor perfusion and abdominal distension

Aim and objectives
To describe epidemiology, demographic and incidence of early onset sepsis in neonate with risk factors at NICUS of Ain Shams University Hospitals.

Subjects and methods
This study is prospective cohort study, was carried out on 80 neonates with one or more maternal risk factors associated with EOS. Neonates will be completely evaluated and subsequently discriminated over the period of 1st 72hours of life in Neonates with risk factors for early-onset sepsis. diagnosis of EOS will be established based on the presence of any clinical evidence suggestive of sepsis, quantitatie C-reactive protein (CRP) levels ≥6 mg/dL, Rodwell’s hematological scores ≥3 and/or Tollner’s scores ≥ 10 with or without positive blood culture results, within the 1st 72 hours postnatal age.

Result
Among the studied maternal risk factors of neonatal sepsis in our study, 73.8% had PROM being the most common maternal risk factor for early neonatal sepsis followed by ceserian mode (C.S) of delivery 66.3%, and 26.2% had Chorioamintis.
The gestational age was distributed as 36.76±3.01 with minimum 30 and maximum 42 weeks, of Ballard score 37.05±2.88 and weight was 2.87±0.82. 58.8% were females and 41.3% were males. Also, 42.5% of the studied group was preterm. 42.5% of studied group was diagnosed with sepsis.

Conclusion
Early diagnosis is important for early intervention and treatment. This diagnosis in neonates is usually based on clinical and laboratory findings.
Iron Profile and Anemia in Gaucher Patients
Authors: Tantawy Azza A , Adly Amira A , Salah Nouran Y , Abdelhamed Mohamed N 
Published: August 2023

Background
Anemia associated with unexplained hyperferritinemia is a frequent finding in gaucher patients. Extensive gaucher manifestations including severe anemia and extreme splenomegaly can lead to a situation of iron-overload resembling hemochromatosis, and anemia.

Objective
of the study is to analyze hemoglobin level and iron profile in gaucher patients in comparison to normal population.

Patients and Methods
This is a case control study, comparing complete iron profile and haemoglobin level in 50 gaucher patients to 50 age and sex matched healthy controls.
Fifty gaucher patients confirmed to have gaucher disease by β glucocerebrosidase deficiency were compared to 50 age and gender matched healthy controls. Complete blood count, serum iron and ferritin were analysed.

Results
Ferritin levels were significantly higher in gaucher patients (ranging from10 to 460 μg/L) with mean 184.30, than controls (P = 0.003). Moreover serum iron was significantly lower in gaucher patients than controls (P = 0.037).

Conclusion
Hyperferetinemia is a universal laboratory finding in GD. Serum ferritin does not appear to be a useful biomarker of disease severity in GD, but can be used as a biomarker of response to treatment.
Systematic Approach of Basic Fetal Echocardiography in Normal and High Risk Pregnancy
Authors: El Deen Fatma Salah , Ali Hend Galal El Deen Mohamed , Ibraheem Mona Abdelaziz Mohamed 
Published: August 2023

Background
Fetal echocardiography was initially used to identify congenital heart defects (CHD) and arrhythmias. Since then, technical advances have enabled a notable improvement in the assessment of cardiac structure and function.

Objective
to highlight the importance of a systematic approach of basic fetal echocardiography in normal and high risk pregnancy.

Patients and Methods
Normal and high risk pregnant females will be studied in this research using colour doppler ultrasound. Two-dimensional imaging is still the gold standard and commonly used in fetal echocardiography. Therefore, we present standard views of the normal fetal heart obtained during the second trimester by two-dimensional ultrasound, and color and pulsed wave Doppler. Study place: Ain Shams university hospitals. Sample size: 30 normal and 30 high risk pregnant female patients.

Results
we have provided reference values for cardiac morphometric parameters across second trimester of pregnancy in a low-risk and high risk population including the Right and left atria longitudinal diameters, right and left ventricular longitudinal diameters, cardiothoracic ratio and heart rate and correlate low to high risk values. All dimensions showed a progressive increase with gestational age, some of the parameters show significant difference between low risk and high risk including the LV diameter with p value of 0.023, cardiothoracic ratio with p value of 0.001 and heart rate with p value of 0.001

Conclusion
Fetal Echocardiography at the second trimester of pregnancy is crucial for detection of any abnormality at the high risk group and their follow up along the whole pregnancy for a better outcome.
Effectiveness of Duplex Doppler Sonography of Portal Vein as a Supplementary Tool in Diagnosis of Pediatric Appendicitis
Authors: Shehata Omar Ahmed Mahmoud , Hussein Ahmed Mohamed , Ashraf Okba Ahmed 
Published: August 2023

Background
Acute appendicitis is the most common surgical emergency in pediatric patients. Ultrasound is the preferred initial imaging modality to evaluate children with clinically- suspected appendicitis. whether by directly visualizing the inflamed appendix or by using secondary signs. However. rate of falsely negative or equivocal exams is still high, leading to a risk of complications from negative appendectomies as well as delayed diagnosis.

Objective
To evaluate the diagnostic accuracy of portal vein flow velocity and diameter in diagnosis of pediatric acute appendicitis

Patients and Methods
A cross-sectional study over the course of 6 months from June until November 2021. Portal vein diameter and peak systolic flow velocity were measured for 75 pediatric patients with clinically suspected appendicitis referred to radiodiagnosis department at Ain Shams University Hospitals for a pelvi-abdominal ultrasound examination. The largest appendix diameter secondary sonographic signs, and total leucocytic count were recorded if available.

Results
The mean age of the population was 112 ± 4.12 years (range. 3-18 years). Mean portal vein flow velocity was 38.94 ± 9.59 cm/s in the appendicitis group and 27.96 ± 6.98 cites in the non-appendicitis group. Median portal vein flow velocity was significantly higher in the appendicitis group (p &lt; 0.001 with an overall diagnostic accuracy 82.1% at cut-off value of &gt; 33.3 cm/sec. Mean portal vein diameter was 9.37±2.01 mm in the appendicitis group and 8.84 ± 2.19 mm in the non-appendicitis group, showing no statistically significant difference (P = 0.27). The presence of right iliac fossa echogenic fat was highly significant (P &lt; 0.001) in predicting acute appendicitis.

Conclusion
The use of portal vein velocity as a supplementary tool improved the diagnostic performance and increased the sensitivity of ultrasound in diagnosing acute appendicitis. thus, decreasing the incidence of delayed appendectomies that have an increased risk of complications as well as decreasing the incidence of unnecessary appendectomies. Further studies are required to establish a comprehensive guideline to use it as a tool in ultrasound examinations of these patients.
Potential Role of MR Diffusion Tensor Imaging of the Spinal Cord in Early Detection of Cervical Spondylotic Myelopathy and Assessment of Its Severity
Authors: Ali Sara Hussein , Tantawy Salma Hassan , El Ghaffar Maha Mohammad Abd 
Published: August 2023

Background
Cervical spondylotic myelopathy is the most common cause of spinal dysfunction in adults. Recent studies have shown a potential role for diffusion tensor imaging as a novel method for early detection of cervical cord myelopathy as compared with conventional MR sequences.

Aim of the Work
To evaluate the role of MR diffusion tensor imaging in the early detection of cervical spondylotic myelopathic changes in comparison to conventional MRI sequences to determine best clinical management and outcome for the patients.

Patients and Methods
Our study is a prospective study that included patients from August 2021 to December 2021. The study included 20 patients with clinical symptoms of cervical spondylotic myelopathy, referred to the Radiology department, Ain Shams University Hospitals for MRI cervical study.

Results
Our results showed a highly significant reduction of FA values and highly significant increase of ADC values of the cord opposite to the level of the most affected disc (P value &lt;0.001 and 0.002 respectively). We also found that the magnitude of FA reduction and ADC increase correlated positively with the severity of disc affection, with the highest drop in FA values and increase in ADC values found to be in patients with established spinal cord hyperintensity on T2WI.

Conclusion
Diffusion tensor imaging could be used in early detection of cervical cord myelopathy before the appearance of altered cord intensity on conventional MRI sequences and in assessment of its severity.
Frobenius constants for families of elliptic curves
Authors: Roy Bidisha , Vlasenko Masha 
Published: August 2023

Abstract
The paper deals with a class of periods, Frobenius constants, which describe monodromy of Frobenius solutions of differential equations arising in algebraic geometry. We represent Frobenius constants related to families of elliptic curves as iterated integrals of modular forms. Using the theory of periods of modular forms, we then witness some of these constants in terms of zeta values.
Employment status and the on-demand economy: a natural experiment on reclassification
Authors: Johnston Hannah , Ergun Ozlem , Schor Juliet , Chen Lidong 
Published: August 2023

Abstract
This article uses data from a natural experiment to address one of the most contentious issues in the on-demand platform economy—whether gig work is compatible with standard employment. We analyze a US-based package delivery platform that shifted a subset of its workers from independent contractors to employees, thereby creating a natural experiment that allowed us to exploit variation over time and across locations. We examine the impact of employment status on work scheduling practices, hours of work and the firm’s ability to match workers’ scheduled hours with the amount of time they were actively engaged in parcel delivery. We find that after the transition to employment, flexibility with respect to how work schedules were determined was maintained, and drivers’ total hours of work increased. We also find that the switch to employee status increased the firm’s ability to match scheduled and actual working time, indicating greater operational efficiency. We conclude, contrary to claims commonly made by platform firms, that employment status can coexist with the platform model.
Mononeuropathy Multiplex After Severe SARS-CoV-2 Infection: A Case Series and Literature Review
Authors: Dupre Alicia E. , Slama Michaël C. C. 
Published: August 2023

Abstract

Introduction:
Peripheral nerve injuries are being increasingly recognized in patients recovering from severe SARS-CoV-2 infections. Axonal neuropathies can occur, leading to lasting and disabling deficits.

Case reports:
We present the cases of 3 patients who developed weakness and sensory symptoms after severe SARS-CoV-2 pneumonia. The clinical deficits revealed various patterns of injury including a mononeuropathy multiplex (MNM) in the first patient, a brachial plexopathy with superimposed MNM in the second patient, and a mononeuropathy superimposed on a polyneuropathy in the third patient. Electrodiagnostic studies revealed axonopathies. The patients with MNM were left with severe disability. The third patient returned to his baseline level of functioning.

Conclusions:
Severe SARS-CoV-2 infections can result in disabling axonopathies. Possible explanations include ischemic nerve damage from the profound inflammatory response and traumatic nerve injuries in the ICU setting. Preventing severe disease through vaccination and antivirals may therefore help reduce neurologic morbidity.