bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Vestibular Schwannoma
Authors: Moharram Hussien Al-Sayed M , Hamada Salah Mostafa , Hamza Emad Mamoon , Ali Hisham Tawfick 
Published: August 2023

Background
Vestibular schwannoma (VS) is considered histologically a benign tumor and is currently preferred over the older term (Acoustic neuroma) as it usually arises from the inferior division of the vestibular nerve and not the acoustic nerve in the cerebellopontine angle. VS were one of the most common intra cranial tumors, comprising 8-10% of tumors in most series. Annual incidence is probably about 1.5 cases per 100,000 population, over the past couple decades this estimate has increased and the typical size at the initial diagnosis has decreased as a result of the advances in the MRI scans & CT scan qualities, (VS) is found to be occurring among middle age groups with no gender prevalence in the fourth or fifth decade.

Aim of the Work
To evaluate the VS management especially partial resection of large VS followed by gamma knife.

Patients and Methods
This study is a retrospective prospective study. This study was carried out at Al-Demerdash University hospital, the authority of specialized institutes and teaching hospitals and international medical Centre (Gamma knife department). Time of the study: from March 2019 till March 2021.

Results
In this study we found that according to the demographic, characteristics & personal history of the study group, it is noted that vestibular shwannoma is common among middle aged group (mean =41 years), with no substantial difference between genders (53% F & 47% M), we found that as regard the clinical picture, most of patients suffered from hearing loss as a complaint (88%) of about 3.5 months duration (median IQR) while all the patients (100%) had a sensory neural sensory loss and verified by PTA, SDT & word discrimination, tinnitus & unsteadiness were found in 70% & 50% respectively. This study has some limitations which are small populations of patients with vestibular schwannoma who generally have short follow-up. We include patients with heterogeneous tumors in regard to size and hearing status. Further studies needed with large populations to establish our results.

Conclusion
We concluded that considering the good tumor growth control and facial nerve function preservation as well as the possibility of preserving serviceable hearing and the low number of complications, subtotal resection followed by Gamma knife can be the treatment option of choice for large Vestibular schwannoma.
Assessment of Post-Operative Outcomes of Surgical Excision of Gliomas of the Eloquent Areas of the Brain under Awake versus General Anaesthesia
Authors: Ahmed Mostafa A , El-Shehaby Amr , Abdulbar Ahmad , Yousry Ahmad 
Published: August 2023

Background
Surgical excision of eloquent gliomas can be done under general anaesthesia or awake anaesthesia. Surgical excision of eloquent gliomas using awake anaesthesia helps to avoid intra-operative manipulation of the eloquent areas of the brain and thus avoid post-operative neurological deficits.

Aim
to compare the operative outcomes of eloquent glioma resection performed under general anaesthesia compared to awake anaesthesia to assess the safety and effectiveness of each intervention.

Materials and Methods
This systematic review and meta-analysis were conducted in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Metaanalysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers reported their findings according to each of the items listed in those checklists (1).

Results
Seven studies reported the early motor deficit, while the rest of the studies have no data concerning early motor deficit. The overall effect estimates did not favor awake craniotomy over general anesthesia in terms of motor deficit (RR 0.92, 95% CI 0.48– 1.4). The pooled studies showed significant heterogeneity (p = 0.001; I2 =85%.

Conclusion
The use of awake craniotomy for surgical resection of gliomas of the eloquent areas is largely limited to small retrospective studies. Within these studies, awake craniotomy achieves both an acceptable rate of GTR and a low rate of persistent neurological deficits. The results of this study illustrate the potential feasibility of awake craniotomy for surgical resection of gliomas of the eloquent areas and emphasize the need for future prospective studies to better determine its efficacy and outcome.
A Systematic Review for Simultaneous versus Delayed Ventriculo-Peritoneal Shunting in Surgical Repair of Meningomyelocele sac in Patients with Chiari Type II Malformation
Authors: Abd El Khalek Salah , Mashaly Hazem A , Nagaty Ahmed M , Adly Omar A 
Published: August 2023

Background
The management of MMC-associated hydrocephalus has evolved over time. Many consultants now preferring to delay decision of shunting in those patients to avoid complications attributed to unnecessary procedures. MMC not treated on initial inpatient stay has increased.

Aim of the Work
Comparing simultaneous Ventriculoperitoneal Shunting versus Delayed shunting in surgical repair of meningiocele in neonates with Chiari Type II regarding outcome, shunt related complications, and analysing the importance of Ventriculo-peritoneal shunting in such cases.

Patients and Methods
This systematic review From January 1990 to January 2021 through Internet search through MEDLINE, Google Scholar and Cochrane Collaboration Library. The study included all available studies from 1990-2021 including randomized or non-randomized clinical trials, prospective or retrospective observational cohort, and case-control studies that address these criteria was collected. Articles that were excluded that articles not fitting the inclusion and exclusion criteria, duplicated articles, unavailable full texts, or abstract-only articles as preceding papers, conference, editorial, and author response.

Results
In recent few years, there’s an emerging trend of favoring the simultaneous shunting (ST) over delayed shunting (DT). This may be due to attributed risk carried by increase in the rate of shunt infection (2.79% vs 3.34), moreover shunt revision when both techniques are compared shows the superiority of the simultaneous shunting (3% vs 8%).

Conclusion
Delayed treatment of hydrocephalus during initial hospitalization resulted in decreasing shunt infection. Compared to NIS study that stated longer inpatient stay associated with DT increased rate of shunt infection and malfunction, in the short period of time.
Comparative Study between Bupivacaine 0.5% in TAP Block versus Diclophenac Sodium IM for Post-Operative Analgesia after Cesarean Section
Authors: Maklad Ahmed Khairy , Ashoush Sherif , Abbas Ahmed Mohamed , Ahmed Ahmed Fathy Mohamed 
Published: August 2023

Background
Cesarean section is one of the commonly performed surgical procedures in the field of obstetrics. It accounts for more than one-fourth of all births worldwide. The most common undesirable outcome following cesarean section is postoperative pain. Failure to treat the pain not only causes distress to the mother but also affects mother‑baby bonding, which, in turn, affects care and breastfeeding of the newborn.

Objective
The aim of the study is to compare the effectiveness of US guided TAP block using 0.5% bupivacaine versus declophinac sodium for postoperative analgesia in patients undergoing cesearean section and reducing nalufine dose.

Methods
This prospective study was conducted at tertiary care hospital at Ain Shams University hospitals for 6 months from June to December 2020 and performed on total 80 patients who underwent elective cesarean section.

Results
Our research study revealed that there was statistically significant increase in visual analogue score in diclofenac group than TAP block group explained by removal of effect of spinal anaesthesia and regaining of pain sensation in diclofenac group while persistence of anaesthetic effect of bupivacaine in TAP block group. Our study found that there was statistically significant increase in the time to first request of analgesia in TAP block group than diclofenac group. Also, there was statistically significant decrease in the total consumption of Pethidine (mg) in TAP block group than Diclofenac group. There was no statistically significant difference between Diclofenac group & TAP block group regarding adverse effects post operative nausea & vomiting.

Conclusion
The analgesic efficacy of the US-guided TAP block after Caesarean delivery compared to the combination of sodium diclofenac with less requirement of rescue analgesic.
Effect of Nitric Oxide Donors on Uterine and Subendometrial Blood Flow in Patients with Unexplained Infertility: A Randomized Controlled Trial
Authors: Kortam Mohamed A , Abdel Hafeez Mohamed A , El Rahman Rehab M Abd , Yousef Alaa M 
Published: August 2023

Unexplained infertility has been defined, by the Practice Committee of the American Society of Reproductive Medicine (ASRM), as inability of a couple to conceive for at least 12 months, with unremarkable standard infertility evaluation ((ASRM), 2006). Although estimates vary, the prevalence of unexplained infertility is approximately 15–30%

Aim of the Work
to evaluate the effect of nitroglycerine transdermal patches on uterine and subendometrial blood flow in women with unexplained infertility.

Patients and Methods
Transdermal nitroglycerine patch was administered to the allocated group from the 2nd day of cycle till maturation of the follicles ≥ 18 mm just for one cycle.

Results
The relatively underdeveloped endometrial thickness did not change significantly after treatment of women with unexplained infertility with nitroglycerin and remained significantly lower than women of the fertile group. Also, nitroglycerin treatment did not result in significant change in uterine artery Doppler indices. However, uterine artery indices of nitroglycerin-treated women did not also show a significant difference (P &gt; 0.05) from fertile women. On the contrary, nitroglycerin treatment in women with unexplained infertility significantly increased subendometrial 3D power Doppler indices to mean values that did not differ significantly from the fertile women. According to the results of the current study, biochemical pregnancy was more commonly achieved in the nitroglycerin group compared to the control group (6.67% vs 3.33%), Yet this difference failed to prove statistical significance. Although adverse effects of nitroglycerin treatment in the current study, namely headache, blurring of vision and hypotension, were more common on the nitroglycerin group compared to the control and fertile groups; this difference couldn’t reach statistical significance (P &gt; 0.05).

Conclusion
Doppler study of uterine hemodynamics can be considered in infertility work-up. Although still lacking evidence, women with suboptimal uterine perfusion may be offered therapies improving uterine blood flow, such as nitroglycerin.
Assessment of Tissue Expression of PIR2/RNF144b Protein in the Different Stages of Endometrial Cancer
Authors: Rami Ahmed Rami Mohammed , Mohammad Hayam Fathy , El Khazragy Nashwa Nagy , Allam Aya Helmy Zayed 
Published: August 2023

Background
Endometrial cancer is considered as one of the most common gynaecological cancers in developed countries. Its incidence has risen about 20% over the last decade and the rate 0f death has risen &gt;100% over the past two decades.

Aim of the Work
This retrospective cohort study will assess tissue expression of PIR2 protein in the different stages of endometrial cancer.

Materials and Methods
A retrospective cohort study was conducted at Ain Shams University Maternity Hospital (The Early Cancer Detection Unit), A Formalin fixed paraffin embedded tissues (FFPT) was collected from the patient's the pathology unit at Gynecology & Obstetrics hospital, Ain Sham University hospitals in a period of 12 months during 2017 – 2018. The study was conducted on 60 women diagnosed as endometrial cancer; they are subdivided into 2 groups: 1st group: 30 patients with stage 1 endometrial cancer by surgical staging, 2nd group: 30 patients with other advanced stages of endometrial cancer by surgical staging.

Results
In this study, we show that the E3-ubiquitin ligase PIR2/RNF144B is a potential targetable biomarker in endometrial cancer. There is a high significant association between the PIR2/RNF144b and different stages of EC and higher tumor grades are associated with higher protein expression. The paraffin -embedded endometrial tissue for each patient eligible for the study was analyzed for tissue expression of PIR2 protein using Immunohistochemistry.

Conclusion
We suggested that PIR2/RNF144b can potentially be used as a biomarker for endometrial cancer for early diagnosis and for monitoring clinical progress of cancer status and efficacy of used treatment.
Intraoperative Direct Vision of Transversus Abdominis Plane (TAP) Block versus Ultrasound Guided Transversus Abdominis Plane (TAP) Block for Pain Control after Caesarean Section (CS). A Randomized Controlled Clinical Trial
Authors: Hemeda Hosam M , Khalil Dalia A , Abdallah Mohamed M , Elsenity Mohamed A 
Published: August 2023

Background
Adequate postoperative analgesia following CS hastens post-operative mobilization, decreases maternal morbidity and facilitates bonding with the newborn.

Aim of the Work
to assess pain scores at (rest and movement), and need for opioids in women receiving intraoperative direct vision of transversus abdominis plane (TAP) Block versus women receiving ultrasound guided transversus abdominis plane (TAP) Block following cesarean section in first 24H.

Study Design
Randomized controlled clinical trial was conducted on Patients undergoing lower segment Cesarean section under spinal anesthesia with intra thecal hyper baric bupivacaine 0.5%. Patients were randomized to study group that received intraoperative direct vision transversus abdominis plane (TAP) Block and control group received ultrasound guided transversus abdominis plane (TAP) Block. Postoperative pain score was recorded using visual analog scale (VAS) score and analgesic consumption recorded from patient medication chart.

Result
A total of 220 eligible women planned to undergo elective lower segment caesarean section were recruited in the current trial, and were randomly allocated into one of the two groups, there were no significant differences between women of both groups regarding age, parity or BMI. No significant differences between the studied group regarding patient pain perception (VAS Score) during rest and movement at different times of follow up (6,8,12,24 H) postoperatively. The dose and the first time of analgesic requirement was non-significantly different among studied groups.

Conclusion
USG and surgical TAP blocks were safe and had similar efficacy in providing postoperative analgesia in pregnant women following cesarean section under spinal analgesia. Surgical TAP block is an efficacious, safe and rapid technique, particularly in patients in whom USG TAP block is technically challenging (obese women), and where the ultrasound isn’t available in operative theater.
Effect of Rectus Muscle Re-approximation and Postoperative Pain in Women with Previous Cesarean Delivery: A Randomized Controlled Trial
Authors: El Kader Fahmy Ahmed Abd , Hendy Marwa Mohamed Said Ebrahim , El Fattah Elsenity Mohamed Abd 
Published: August 2023

Background
Cesarean section rate has increased dramatically worldwide but there is still debate about the optimum operative technique of cesarean section. Rectus muscle reapproximation at cesarean delivery (CD) is performed frequently by some obstetricians; however, the effect on postoperative pain is unclear. To this end, we investigated whether rectus muscle reapproximation increases postoperative pain.

Objective
In women with previous cesarean delivery, the aim of this prospective double blind randomized controlled trial is to assess the effect of rectus muscle approximation on postoperative pain.

Patients and Methods
This study was a prospective, doubleblind, randomized controlled trial. It included 340 women with previous cesarean delivery, with a singleton pregnancy, who underwent elective lower segment cesarean section at term. The patients were randomly allocated into two equal groups; Group I (study group) in which rectus muscle approximation were done (surgeons were instructed to place three vertical midline loose interrupted sutures to re-approximate the rectus muscles by using Vicryl 0 suture) while in Group II (control group) rectus muscle approximation not done. Intra- and postoperative pain management was standardized within the study protocol.

Results
Both groups were comparable in age, body mass index (BMI), parity, gestational age (GA), sub-rectus hematoma, surgical site infection and subsequent hospital stay. While study group had significantly longer operation duration, significantly higher pain score from first day of operation and up to 6 weeks postoperative and significantly higher NSAID dose and opioid requirements at first and second day postoperative.

Conclusion
Our results suggest that rectus muscle reapproximation increases operative time & postoperative pain and subsequently associated with higher short-term postoperative opioid use among women undergoing cesarean section (CS). Surgical complications do not appear to be impacted by rectus muscle reapproximation. So, the benefits described with rectus muscle reapproximation such as less adhesions, should be weighed against the potential for a modest increased postoperative pain and corresponding opioid use.
Comparison between Intraoperative and Ultrasound Determined Cesarean Scar Thickness after Elective Cesarean Sections and Unplanned Cesarean Sections in Subsequent Term Pregnancies
Authors: Ahmed Salah T , Mamdouh Ahmed M , Elsenity Mohamed A , Salama Marwa O 
Published: August 2023

Background
Cesarean section (CS) rates are increasing worldwide. As a result, women presenting with pregnancy with previous CS are also rising. Previous CS is becoming the most common indication for CS, confirming the age old dictum proposed by Edward Craigin in 1914 “Once a cesarean always a cesarean.

Aim of the Work
Assessment of cesarean scar; as non-healthy or poor-healed scar are associated with some complications such as chronic pelvic pain, dyspareunia, and abnormal bleeding. Moreover, these poor-healed scars may predispose to preterm labour and uterine dehiscence or rupture in subsequent pregnancy. It was reported also that poor-healed scar may predispose to abnormal placental invasion.

Patients and Methods
This comparative cross-sectional study was conducted on 100 randomly selected pregnant women attending the outpatient clinic of Ain Shams University Maternity Hospital (ASUMH) in the third trimester at term aged &gt;18 years old with single intrauterine pregnancy, previous one cesarean delivery and not in labor. Pregnant women with abnormal placentation, uterine abnormalities and/or previous uterine surgeries other than one CS delivery were excluded from current study.

Results
there was no significant difference betweenn two studied groups according to demographic data as age (27.0±3.9 vs. 27.6±3.6, p = 0.382) and BMI (28.2 ± 3.3 vs. 28.7 ± 2.2, p = 0.283). Both groups were comparable with statistically significant difference regarding scar thickness in (ml) and LUS staging. The scar was thicker in elective cases compared with emergency ones (8.4±1.1 vs. 7.7±1.3, p = 0.002), stage I (34 (68.0%) vs. 16 (32.0%)), stage II (15 (30.0%) vs. 25 (50.0%)), stage III (1 (2.0%) vs. 7 (14.0%)) and stage IV (0 (0.0%) vs. 2 (4.0%)).

Conclusions
From the results of current study we can conclude that, Maternal age and BMI had no effect on cesarean scar quality, integrity and complications incidence. The scar was thicker in elective cases compared with emergency ones.
Comparison between Agonist Trigger with HCG Luteal Phase Supplementation vs HCG Trigger with Progesterone Luteal Phase Supplementation in Antagonist Controlled Hyperstimulation Cycle Regarding Clinical Pregnancy Rate
Authors: Soliman S , Guindy A , Tantawy W , Nawara M 
Published: August 2023

For the last two decades, exogenous progesterone administration has been used as luteal phase support (LPS) in connection with controlled ovarian stimulation combined with use of the human chorionic gonadotropin (hCG) trigger for the final maturation of follicles. The introduction of the GnRHa trigger to induce ovulation showed that exogenous progesterone administration without hCG supplementation was insufficient to obtain satisfactory pregnancy rates. This has prompted development of alternative strategies for LPS. Augmenting the local endogenous production of progesterone by the multiple corpora lutea has been one focus with emphasis on one hand to avoid development of ovarian hyper-stimulation syndrome and, on the other hand, to provide adequate levels of progesterone to sustain implantation.
The present study evaluates the use of micro-dose hCG for LPS support and examines the comparison between conventional HCG trigger and progesterone luteal phase support vs Agnosit trigger and HCG microsdose luteal phase support as regards to pregnancy rate.

Methods
100 patients were recruited for this trial Cases with Polycyctic ovaries were excluded from the study. The study was approved by Ethical committee of Ain Shams university. Patients received Gonal-F (Merck Serono S.p.A., Via delle Magnolie 15, I70026 Modugno (Bari), Italy.) in a dose ranginging between 150-300 IU for stimulation and the dose was adjusted according to response starting day 6. Premature LH surge was prevented with 0.25 mg of a GnRH antagonist (Cetrotide; Merck international) starting on day 6, when two or more follicles reach a size of 18–20 mm, patients were randamized into 2 groups of 50 each. Trigger of ovulation was done by a single dose of 0.2 mg triptorelin (Decapeptyl®ferring pharmaceutical company, Germany) and luteal phase support with daily 125 IU HCG injections in Group 1. Group 2 received A single dose of HCG 10000 IU was given followed by progesterone supplementation with 100mg IM progesterone (Prontogest® IBSA Swisserland). 2 Embryo were transferred and an ultrasound at 4 weeks after embryo transfer for cases with positive pregnancy test. As regards to clinical pregnancy group 1 had 28 of the 50 (56%) Positive clinical pregnancy while control was 26 of the 50 (52%), the difference was not statistically significant (P &gt; 0.68). No cases of moderate or severe ovarian hyperstimulation were observed during the study. To conclude, Agonist trigger combined with microdose HCG had a comparable pregnancy rate resulst to HCG trigger and conventional progesterone support for luteal support without increasing the risk of ovarian hyper stimulation.