bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parameters of Conversion from Temporary External Fixation to Internal Fixation in Open Fractures in Adults
Authors: EL Menam Ghaly Nabil Abdel , Ahmed Ahmed Rayan , Badr Ahmed Atef Ahmed 
Published: August 2023

Background
Open fractures often have extensive soft-tissue damage requiring multiple procedures such as debridement, soft-tissue coverage, and definitive fixation through the cooperative work of orthopedic and plastic surgeons. Combined treatment for both the fracture and soft-tissue. Patients obtain many benefits from early fixation. Early stabilization facilitates patient mobility and alleviates pain and discomfort.

Aim of the Work
Systematically reviewing available evidence from published articles to assess points of conversion from this temporary external fixation to internal fixation in open fractures.

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

Results
The moderate negative correlation between CRP and duration of conversion from EF to IF is probably because the downward trend of CRP from the peak value was considered one factor in the timing of conversion to IF, Strategy to perform definitive IF as early as possible resulted in 91% of patients undergoing definitive IF within 3 weeks after injury. In addition, this strategy is described to be beneficial for early soft-tissue repair with low infection rate. Subsequent conversion to ORIF can safely be performed once the patient is hemodynamically and systemically stable and any local soft-tissue injury has resolved, union rate of 91%, an infection rate of 16% and one fixation failure. All the infections occurred in open fractures, of which 75% were Gustilo grade III.

Conclusion
In conclusion, temporary external fixation for open fracture of the lower limb followed by conversion to internal fixation, as early as soft tissue and general condition permit, may be a safe and effective procedure for patients with open fracture. It is not precisely known when is the best time to convert to definitive fixation without increasing the risk of infection.
Comparison of Plating Fixation versus Intramedullary Nailing in the Treatment of Fracture Both-Bone Forearm in Children: A Systemic Review
Authors: El-Kader Hammad Abouelela Amr Abd , Diab Ramy Ahmed , Eltaher Mostafa Eldoshy 
Published: August 2023

Background
Both bone forearm fractures (BBFFs) are a common injury in children, account for 41.1% of all fractures in children, the third most common fractures in the pediatric population. Diaphyseal forearm fractures account for the most common location of re-fractures in the pediatric population. The most common mechanism of injury is a fall onto an outstretched hand. There are many debates in the field of pediatric orthopedics, including when to operate, what constitutes an acceptable reduction and what age does remodeling capability inherent to children become less effective. Greater controversy exists regarding the optimal method of fixation in children between the ages of 10 and 14 years. Fractures in this age group that cannot be maintained in acceptable alignment with closed reduction can be treated with either IM nails or ORIF with plates. Closed reduction and cast immobilization remains the gold standard treatment for minimally displaced and stable pediatric forearm fractures.

Aim of the Work
is to introduce a systematic review comparing between plating and intramedullary nailing (IMN) for children with diaphyseal both-bone forearm fractures (BBFFs) as regards union, functional outcome and complications.

Methodology
This study is a systematic review. Children aged 5–14 years with both-bone diaphyseal forearm fractures were included. Surgical fracture fixation with plates and screws vs. IM nails were compared.

Results
We found no statistical difference in functional outcome as measured by range of movement. We also found no consistent difference in complication rates between the two groups, although this is a difficult outcome to objectively compare. There were more cases of compartment syndrome in the IMN group than in the plating group, although numbers were low for both, and it was not entirely clear if the cases in the IMN groups developed post-operatively as opposed to being consequences of the injuries themselves. Radiographically we found no study reporting significant difference in time to fracture union. Duration of surgery and cosmetic result (scar) seem to favor the IMN group.

Conclusion
Despite methodological deficiencies of the studies included, IM nailing has been shown as an effective and safe treatment option for those fractures, associated with shorter operation time, improved cosmesis, and easier hard ware removal.
The Effect of Tunnel versus Conventional Phototherapy on the T Lymphocytes in Full Term Neonates with Hyperbilirubinemia
Authors: El-Ganzoury Mona M , El-Farrash Rania A , Salem Dalia A , Saleh Ahmed M 
Published: August 2023

Background
Neonatal jaundice is one of the most common conditions. Phototherapy has been accepted as the standard treatment for neonatal jaundice and the decline in the number of exchange transfusions in recent years is, at least in part, likely a direct reflection of the effectiveness of phototherapy at treating hyperbilirubinemia. However, this treatment modality also has some complications. One possible harmful consequence is potential immunotoxic effects by affection of lymphocytes subtypes which can affect the immune system functions in infants.

Aim of the Work
current study was performed to compare the effect of both conventional and tunnel phototherapy on lymphocytes subsets in term neonates (≥37weeks) with unconjugated hyperbilirubinemia.

Patients and Methods
The present study was conducted on 60 term neonates (≥37weeks) 40 of them with unconjugated hyperbilirubinemia admitted to NICUs in Ain-Shams University hospital during the period from January 2019 to July 2019. They were randomly assigned to 3 groups: 20 patients were exposed to conventional phototherapy and 20 patients were exposed to tunnel phototherapy and the other 20 healthy full term were assigned as control group. Total serum bilirubin (TSB), direct serum bilirubin (DSB), CBC, CD4 and CD8 percentages and absolute count were measured before and 48 h after phototherapy in the phototherapy groups. Baseline lab was done in the control group at once.

Results
significant decrease in total and direct bilirubin post-phototherapy in both phototherapy groups proved that tunnel phototherapy is as effective as conventional phototherapy as both provided rapid decrease in bilirubin levels. As regards the effect of phototherapy on lymphocytic count, we found that lymphocytic count significantly decreased post-phototherapy in both phototherapy groups. As regards the effect of phototherapy on CD4+ and CD8+ percentages, we found that CD4+ % significantly decreased postphototherapy in conventional phototherapy group. Moreover, when we measured CD4+ and CD8+ absolute counts, we found that CD4+ and CD8+ absolute counts significantly decreased post-phototherapy in both phototherapy groups. In the view of the effect of phototherapy on CD4/CD8 ratio, we found that the ratio significantly increased in tunnel phototherapy group.

Conclusion
Conventional and tunnel phototherapy which are used in the treatment of neonatal hyperbilirubinemia, affects the function of the immune system in newborns via alterations in CD4+ and CD8+ absolute counts.
Evaluation of the Diagnostic and Prognostic Potential of Circulating miR-34a in Neonatal Sepsis
Authors: Fathalla Mostafa Mohamed , Nagy El Khazragy Nashwa , Metwally Gehan Anwer Mohamed , Rabie Dina Essam Abdelhamid 
Published: August 2023

Background
Neonatal sepsis is a complex syndrome which is characterized by systemic inflammatory response. The high mortality rate of neonatal sepsis is contributed to late diagnosis and improper management.

Aim of the Work
The aim of this research is to examine the diagnostic utility of miR-34a in newborns with sepsis (who were newly diagnosed according to the clinical sepsis score and the hematology score of sepsis) and compare them to neonates without sepsis by using real-time PCR.

Patients and Methods
This study was conducted on 70 neonates from NICU of Ain Shams University hospital and permitted by Ain Shams ethical committee. Neonates were classified into two groups: 35 neonate with sepsis and 35 neonate without sepsis. In consideration, these neonates’ ages were ≥ 35 weeks, had no Congenital anomalies, Chromosomal abnormalities and had not been given any kind of antibiotics before obtaining blood specimens from them. Moreover, the study didn’ t include neonates with an inborn error of metabolism or any surgical procedures. Neonates without sepsis and neonates with sepsis were matched in terms of gender and age.
In our study, blood samples of 2 ml were withdrawn from patients (within 72 hours from suspecting the diagnosis of neonatal sepsis) and from the control at matched gestation and postnatal ages, then patients were followed up.

Results
the obtained results showed that, the expression level of miR-34a was reduced by 5.2-fold in neonates with sepsis, with a P value of 0.001. Additionally, a negative correlation was detected between miR-34a expression level and either the clinical sepsis score (p = 0.163) and the hematology score (p = 0.122), and also a significant correlation was detected between the clinical sepsis and hematology scores in neonates with sepsis (p = 0.047). The study observed that, the miR-34a could discriminate neonates with clinical sepsis score, the biomarker sensitivity and specificity were 80% and 70%, respectively. In addition, the calculated sensitivity and specificity of miR-34a to discriminate neonates with hematology score were 85% and 87%; respectively. The cut-off value was &lt;0.04 .

Conclusion
Based on the obtained results, there is a significant difference between the serum expression level of miR-34a and either the clinical sepsis score and hematology score . the lower expression level of miR-34a was detected in neonates with CSS &gt;10. Similarly, the lower expression level of miR-34a was detected in neonates with high hematology score &gt;4.
Psychological Maladjustment in Siblings of Children with Type 1 Diabetes Mellitus in An Egyptian Cohort
Authors: Elhabashy Safinaz A , Elhenawy Yasmine I , Abdelmageed Reham I , Hassan Hossam A 
Published: August 2023

Background
Diabetes is a chronic life-changing event, not just for the sick child but for the entire family. It poses a number of challenges to family units as a whole

Objective
To assess frequency of psychological maladjustment among siblings of children with Type 1 diabetes (T1D).

Subjects and Methods
A cross-sectional study was conducted on 100 families with a child diagnosed with T1D; for each family one healthy sibling and one parent were included. All parents and siblings had face to face questionnaire. The Arabic version of the parent reported Strengths and Difficulties Questionnaire (SDQ) was used to assess sibling appraisal of living with a child with T1D and his/her adjustment. Siblings aged (11-18years) took the questionnaire on their own as well.

Results
On evaluating the parent reported SDQ, 60% of the healthy siblings scored within the normal range, 26% were borderline and 14% showed scores in the abnormal range. Comparing data from the current study with the UK norms, healthy sibling from the current study experienced more total difficulties (p &lt; 0.001). Regarding SDQ- self report, 40 % of healthy sibling were normal and 40% and 20% showed scores in the borderline and abnormal range respectively. Similarly, self- reported SDQ showed significantly higher total difficulties scores compared to UK norms (p &lt; 0.001). A significant positive correlation was found between poor glycemic control, as evidenced by HbA1C, as well as diabetes related complications and total difficulties reported by older healthy siblings (p &lt; 0.05).

Conclusion
Siblings of children with type 1 diabetes are at risk of psychological maladjustment and special attention must be directed to identify siblings at risk who may benefit from psychological support.
Study of 5 Alpha Reductase Enzyme Gene Mutations in a Group of Patients with 46XY Disorders of Sex Development
Authors: Elsedfy Heba Hassan , Amr Nermine Hussein , Khalaf Randa Ismail , Ageeb Olivia Elia 
Published: August 2023

Background
Disorders of sex development (DSD) are a wide range of conditions with diverse features and pathophysiology that most often present in the newborn or the adolescent periods. Affected patients usually present with atypical genitalia like hypospadias, isolated micropenis and undescended testis. These clinical situations can often be difficult to manage, particularly in those cases where the sex rearing is uncertain.

Aim of the Work
Studying 5alpha reductase enzyme gene mutations (SRD5A2) in patients with 46XY DSD to detect its molecular characteristics.

Patients and Methods
This cross-sectional study was performed on 25 male patients with clinical, laboratory and genetic molecular analysis of SRD5A2 gene mutation fitting the diagnosis of 46XY DSD. To assess the degree of virilization external masculinization score (EMS) was used where EMS less than 7 is considered ambiguous. All parameters were evaluated at the pediatrics endocrinology clinic and genetics department, Ain Shams University from December 2019 to December 2020.

Results
Only 12 patients showed laboratory and molecular results compatible with the diagnosis of SRD5A2 gene mutation, The mean age of the patients was 3.64 ± 4.75 years. Results showed EMS of 4.3 denoting the high degree of genital ambiguity in our cases. Scrotum was bifid in 5 patients (41.6%), underdeveloped in 5 patients (41.6%) and fused in 2 patients (16.8%). Cryptorchidism was found in 4 patients only (33.3%). Four patients (33.3%) had normal urethral opening while hypospadias was present in 8 patients being perineal in 1 patient (8.3%), perineoscrotal in 5 patients (41.6%) and scrotal in 2 patients (16.6%). Micropenis was present in 7 patients (58.3%), four patients had 2 openings (33.3%) compared to a single opening in 8 patients (66.7%).
Regarding type of SRD5A2 gene mutations 56.2% of mutations were Insertion deletion, 25% were Insertion, 12.5 % were Missense, 6.25% were Deletion.

Conclusion
This study demonstrated ten novel mutations of SRD5A2 gene were identified in association with 5alpha reductase enzyme deficiency. These mutations were reported among 12 patients with 46 XY DSD from total of 25 patients were fit for this study. No distinct relationships were observed between genotypic and phenotypic characteristics in the participants.
Safety of Intravenous Immunoglobulin Replacement Therapy in a Group of Patients with Primary Immune Deficiency
Authors: Reda Shereen M , Radwa Nesrine , Reem M A 
Published: August 2023

Background
Intravenous immunoglobulin (IVIG) has been used as antibody replacement therapy in primary immunodeficiency diseases for more than 50 years. Most routinely, IVIG is used in patients with predominantly antibody deficiency and combined immunodeficiency.

Aim
To evaluate the safety of regular intravenous immunoglobulin (IVIG) among patients with primary immunodeficiency diseases who receive IVIG as a replacement treatment.

Methods
Our study included 40 patients with primary immunodeficiency following up regularly in the Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, These patients were followed up for one year in order to evaluate the incidence of occurrence of adverse reactions among the patients who received IVIG monthly, Once patients with adverse reactions have been identified, the following data were taken and reviewed : a specific type of adverse reaction to IVIG; the time interval between onset of adverse reaction and beginning of IVIG infusion; IVIG preparation, dose and infusion rate; medical management done during side effects . Statistics were used to analyze and interpret the data.

Results
This study included 40 PID patients. They were 31 males (77.5%) and 9 females 22.5% with a male to female ratio of 3.4:1. At time of enrolment in the study, the median age was 73.5 months (14 – 218 months). In our studied population the median age of symptoms onset was 23 months (1 – 187 months), and age at diagnosis was 25 months (2-192 months). This made the diagnostic lag to have a median of 9 months (0-56 months). From our studied population only one patient (2.5%) out of the study groups developed anaphylaxis and was shifted to another brand.

Conclusion
IVIG is a safe drug for patients with primary antibody deficiency with minimal reported side effects.
Serious Drug Induced Hypersensitivity Reactions among Hospitalized Infants and Children
Authors: Hassan El-Owaidy Rasha , Ahmed Ahmed Rezk , Fawzey Turkey Saeid 
Published: August 2023

Background
There are very limited data concerning the epidemiology of drug hypersensitivity in Egypt.

Aim
We sought to investigate the magnitude of serious drug hypersensitivity reactions among hospitalized infants and children in a tertiary hospital over a period of one year.

Patients and Methods
This study is a cross sectional one that was conducted over a period of one year from the middle of October 2020 to the middle of October 2021. The study was carried out in Children’s Hospital, Ain Shams University. We screened for patients with serious drug hypersensitivity reactions among a total of 10440 hospital admissions over a period of 12 months. Positive cases were further assessed with complete clinical and laboratory assessment.

Results
Out of total admissions of 10440 patients over the study period, 35 (0.335%) patients had clinical manifestations of serious drug hypersensitivity reactions. Concerning those 35 patients, they were 21 (60%) males and 14 (40%) females with age ranging between 3 to 193 months with median (IQR) = 50 (24-96) months. Four patients (11.4%) were known to be allergic; with 1(2.9%) having allergic rhinitis, 1 (2.9%) having urticaria, and 2 (5.7%) having cow milk protein allergy. Ten patients (28.6%) had family history of allergic disorders. Eleven patients (31.4%) had manifestations of anaphylaxis, 18 (51.4%) severe urticaria/angioedema, while the remaining 6 (17.1%) had manifestations of Stevens-Johnson syndrome. Concerning results of laboratory investigations, anemia was found in 29 (82.9%) patients, leukocytosis in 9 (25.7%) patients, leukopenia in 8 (22.9%) patients and thrombocytosis in 4 (11.4%) patients, while none of them had eosinophilia. CRP and ESR were elevated in 24 (68.6%) and 15 (42.9%) patients respectively. All of the 35 patients could overcome the drug hypersensitivity reaction with proper management

Conclusions
Although rare, drug hypersensitivity reactions represent an important health issue that should be clearly well reported, registered, and properly managed. Further wider scale and multicenter studies are warranted to gather more data and investigate the prevalence of each type of drug hypersensitivity reactions among children including those which are not reported in our study.
Thyroid Disorders in Pediatric Long Term Survivors after Hematopoietic Stem Cell Transplantation
Authors: Mohamed Wafaa Ezzat Ibrahim , Sayed Safa Matboly , Hassan Marwa Magdy , Soliman Samia Aboualhaggag 
Published: August 2023

Background
Thyroid dysfunction is one of the major long term endocrinopathies shown after hematopoietic stem cell transplantation (HSCT), it is usually described after total body irradiation, thyroid dysfunction after the use of chemotherapy only in conditioning regimen was evaluated in our study.

Aim of the Study
To assess the frequency of thyroid dysfunction after HSCT in children using chemotherapy only in conditioning and to relate the thyroid dysfunction after HSCT to the underlying disease and transplant related factors.

Subjects and methods
This cross sectional observational study was conducted over 12 months duration, from 1st of September 2020 to 1st of September 2021, at Pediatric Transplant Unit, Children,s hospital, Ain Shams University, on pediatric long term survivors who received HSCT in the duration between 2011 to 2019. They were investigated for thyroid dysfunction by measuring Thyroid-stimulating hormone (TSH), free thyroxine (Free T4) and free triiodothyronine (Free T3), Antithyroglobulin antibody (Anti-TG) and by thyroid US.

Results
The frequency of thyroid dysfunction among the long term survivors was 30% (6/20) including: subclinical hypothyroidism 50%, subclinical hyperthyroidism 16.7%, primary hyperthyroidism 16.7% and graves’ disease 16.7%. The most common thyroid disorder was subclinical hypothyroidism. No significant correlation was observed between the frequency of thyroid disorders and type of conditioning regimen used (p = 0.16), underlying disease (p = 0.5), age at transplantation(p = 0.35). Also, no significant correlation was observed between the thyroid disorders and graft versus host disease (GVHD) (p = 0.92) or Anti-TG (p = 0.26).

Conclusion
HSCT recipients had a high frequencyyof thyroid gland disorders, therefore, the thyroid status of each HSCT recipient should be screened before and after transplant. These findings also emphasize the need for long-term monitoring of thyroid function following HSCT.
Validity of the GenXpert MTB/RIF in Diagnosis of Pulmonary Tuberculosis & Description of Pulmonary TB Resistance Profile in Abbasia Chest Hospital
Authors: Dawoody Mai M , Abouseif Hasnaa A , Shoman Ahmad E , Gabal Mohamed S 
Published: August 2023

Background
Tuberculosis (TB) is a global public health problem; early diagnosis will enhance the treatment and decrease the resistance to the anti TB drug which improve the overall treatment outcome

Objectives
Comparing the validity of GeneXpert Mycobacterium tuberculosis /RIF in diagnosing pulmonary TB and detecting Rifampicin resistance with Direct smear microscopy.

Subjects& methods
Cross sectional study was conducted to collect a sample of 393 clinically suspected cases (January,2016 to February 2018). All cases underwent Direct smear microscopy, GeneXpert (GX) MTB/RIF and Lowenstein– Jensen Cultures Golden standard test for diagnosis of TB and comparing the validity of the two tests. Comparison between GX and the golden standard culture results was done by sensitivity and specificity calculation as well as the Kappa test for agreement between results of tests.

Results
For 393 clinically suspected TB cases, TB culture confirmed 196 (49.9%) TB positive cases and 197 (50.1%) TB negative cases and 32 Rifampicin resistant cases (16.3%) of the positive TB cases. GX detected 206 (52.4%) TB positive cases and 187(47.6%) TB negative cases and 34 Rifampicin resistant cases. For TB diagnosis, GX sensitivity was 91.8%, specificity was 86.8%, PVP= 87.4%, PVN=91.4Accuracy= 89.3, and substantial agreement between GX and culture as level of agreement =78.6%. As for Rifampicin resistant cases the GX sensitivity =100%, specificity=98.9%, PVP= 94.1%, PVN=98.9%, Accuracy= 99%, and GOOD agreement between GX and culture as kappa = 0.964 (level of agreement is 96.4%). Direct smear microscopy detected 166 (42.2%) TB positive cases and 227(57.8%) TB negative cases. Sensitivity of direct microscopy was 53.6% while specificity was 69%, PVP= 63.3%, PVN=59.9%, Accuracy= 61.3%, and fair agreement between Direct smear microscopy and culture with level of agreement =22.6%.

Conclusion
GX has the advantage of pulmonary TB rapid testing of high sensitivity and specificity that allows early treatment and decrease of the disease transmission in comparison to the currently used Direct smear microscopy for TB diagnosis