bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of intrapleural instillation of MESNA in the management of pleural adhesions
Authors: Omar Amany , Abo Elfadl Abd-Elazim , Ahmed Yousef , Elkhayat Hussein , Gamal Montaser 
Published: January 2022

Context
Intrapleural adhesions and pleural fluid loculation is a common clinical problem. Several options are available to manage the intrapleural adhesions. MESNA has recently been used as a fibrinolytic agent and due to its efficacy and safety it is an option in treating intrapleural adhesions instead of other intrapleural fibrinolytics.

Aims
To assess the efficacy and safety of MESNA as a fibrinolytic agent in the management of loculated pleural effusions.

Settings and design
A prospective case series study at the Chest Department, Assiut University Hospital from October 2017 to March 2020.

Patients and methods
A prospective case series study has been conducted on 25 patients, who were admitted at the Chest Department, Assiut University Hospital. Patients presented with complex septated pleural effusion and their symptoms were anticipated to improve by pleural fluid drainage . MESNA was given daily for 3 consecutive days at a dose of 1800 mg diluted with 20 ml of normal saline and injected into the pleural cavity through the chest tube. The amount of drained fluid, chest ultrasound, and chest radiograph were used to evaluate the improvement of patients, assess the safety of MESNA, and detect any adverse effects.

Results
After installation of MESNA there is an increase in the amount of the fluid drained through the intercostal tube with significant difference before and after installation of MESNA (P<0.001) with a success rate of 64% in the studied patients.

Conclusions
Intrapleural installation of MESNA is a safe and effective therapy in the treatment of loculated plural effusions.
Lung transplantation from past to future
Authors: Mehfooz Nazia , Kaul Parvaiz A. 
Published: January 2022

Lung transplantation is performed on patients with terminal lung diseases and is generally done in two scenarios: when a patient with terminal stage lung disease is predicted to have 50% or less chances of survival in the next 2–3 years and/or advancement of lung disease to such a stage that clear survival advantage of lung transplantation is evident. It was first done in humans in 1963 by Dr James Hardy. Proper timing of transplant is important. It should be neither too late nor too early. Listing of patients for lung transplantation was initially a problem but subsequently with the introduction of lung allocation scores (LAS) by the United Network for Organ Sharing in 2005, the waiting list mortality has decreased significantly. LAS is a concept to prioritize organ allocation based on the expected survival advantage of transplantation. The LAS is aimed to pick up the best-suited candidates for transplant and to decrease waiting list mortality.
The decision to do single or double lung transplantation is multifactorial. It depends on transplant indications, recipient factors, and donor availability.
As with any other transplant, lung transplantation needs posttransplant immunosuppression. Postlung transplant immunosuppression generally consists of a regimen consisting of calcineurin inhibitors, purine synthesis antagonists, and prednisolone.
Immunosuppression and drug toxicity are the main cause of early complications. Complications vary with time postoperatively. Primary graft dysfunction is the major concern in the first month after transplant. Acute rejection infections predominate in the subsequent posttransplant period. Neoplasia and chronic lung allograft dysfunction predominate after the first year. The initial attempts resulted in a poor outcome but is now routinely performed as the results have been much more promising in this era due to advances in surgical techniques and immunosuppression regimens.
Lung transplantation no doubt offers better survival but is still unfortunately only 50% at 5 years.
There is somewhat unawareness among the clinicians about lung transplantation. Our primary aim of this review is to aware young clinicians about the possible role of lung transplantation in terminal lung diseases.
Thus, keeping in mind our primary aim, this review provides an overview of lung transplantation in terms of historical background, candidate selection criteria, concept of LAS, methods of bridging to transplantation, single versus bilateral transplantation, post-lung immunosuppression, outcome, and complications.
Registry of cases of pulmonary hypertension in army hospitals
Authors: Elwahab Koraa Emad E.A. , Farghaly Ayman A.E. , Wagih Khaled M. , Ali Eman R. , Abdelrady Marwa M. , Zaki Ahmed M.R. 
Published: January 2022

Background
Pulmonary hypertension (PH) is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation, which results, over time, from extensive vascular remodeling and increased pulmonary vascular resistance. Registries conducted since the National Institutes of Health study have enhanced our understanding of select aspects of pulmonary arterial hypertension (PAH). A network of 17 French university hospitals reported observations from a registry of 674 adults with PAH and described the minimum prevalence and incidence, as well as the clinical and hemodynamic characteristics, of this group.

Objective
To record all the cases of PH in all Egyptian army hospitals in the period between January 2015 and December 2019.

Patients and methods
This study was conducted on 150 patients with PH. They were recruited from the outpatient clinic and Department of Chest at specialized hospitals of Kobry Elkobba Armed Forces, as well as Air Force specialized and international medical center of the armed forces. This study was carried out on all patients diagnosed as having PH, as a retrospective and prospective study, starting from January 2015 till December 2019. The patients were subjected to the diagnostic algorithm of PH suggested by the 2015 European Cardiology Society/European Respiratory Society guidelines for the diagnosis and treatment of PH.

Results
The study was conducted on 150 patients with PH, including group 1 [88 (58.6%) patients], group 2 [16 (10.6%) patients], group 3 [eight (5.3%) patients], group 4 [34 (22.6%) patients], and group 5 [four (2.6%) patients], and there were seven patients of multigroups. The detailed data of different therapies were shown as important numbers. The diuretic therapies were given to 120 patients, 12 patients were on oxygen therapy, calcium channel blockers were only given to the five vasoreactive patients in our study, and 34 patients received oral anticoagulant, whereas specific drugs were given to 93 patients.

Conclusion
This was a preliminary study establishing patient characteristics in Egypt in the form of a registry. The most frequent PH etiologies were PAH and chronic thromboembolic PH, and patients were substantially younger at diagnosis compared with other international cohorts. Most patients with PAH received targeted therapy and showed significant improvement in disease severity (WHO Function Class). One of the most important limitation was the lack of the of the follow-up and survival data of many patients; however, many patients who were in the follow-up programs made a great survival but not to count on it as a result in the registry.
Serum uric acid level as a prognostic factor in sepsis outcome
Authors: El-Shebiny Emad , Daif Shymaa , Shoeib Sabry , Fathi Yasser , Zahran Enas 
Published: January 2022

Background
Uric acid (UA) is the final product of metabolism of purine base, with either an antioxidant or a pro-oxidant according to the metabolic state. It was found that UA can give information about outcomes in multiple diseases. Depending on this view, research studies focused on UA to act as a biomarker of seriousness of illness in patients suffering from sepsis.

Objective
This study was targeted to evaluate if serum UA level can reflect the severity of sepsis state in critically ill patients and the prognosis of these patients.

Materials and methods
This prospective study using data extracted from patients of the ward, ICU of Internal Medicine Department and critical care unit from May 2019 to November 2019. The outcome was reported after 28 day from the date of admission to hospital regarding patient’s survival or not. Characteristics of the included patients were: age greater than 18 years, first time to admit to hospital, and patients who were diagnosed to have gout, chronic renal failure, malignancy, and those on diuretics were excluded.

Results
Variable levels of serum UA on admission did not reflect the rate of survival between patients with sepsis according to statistical results. So UA cannot act a predictor for mortality from sepsis.

Conclusion
UA level at the time of hospitalization cannot predict the survival rate of patients with sepsis.
Assessment of noninvasive ventilation in patients with acute severe asthma
Authors: El Shinnawy Olfat M. , Metwally Mohamed , Abdel Aleem Nermeen A. , Eid Walaa M. 
Published: January 2022

Background
Despite improvements in asthma medication, intubation is deemed necessary in severe asthma with its complications. Noninvasive ventilation (NIV) is an evolving method to manage acute respiratory failure in those patients. However, the effect of NIV is unclear, and there are debates regarding its safety.

Aims
To evaluate the role of NIV in patients with acute severe asthma and to assess predictors for its use in those patients.

Patients and methods
In a prospective interventional study, 90 patients with acute asthma were divided into two groups: medical one and NIV group. The outcomes were the improvement in forced expiratory volume in the first second, as well as clinical and respiratory parameters.

Results
The respiratory rate showed a significant improvement after 6 h (16.6±3.7 breath/min), and also the heart rate (95.8±11.3 beat/min) and arterial partial pressure of oxygen (88.09±20.2). The time needed to alleviate accessory muscle use was shorter in the NIV group (1.93±0.3 vs. 3.07±0.4 h in the other group). The need for endotracheal intubation and invasive mechanical ventilation was more with group 1. There was no mortality in any group of our study.

Conclusion
NIV group demonstrated clinical improvement regarding the grade of dyspnea and accelerating the time needed for the absence of accessory muscle usage in acute severe asthma. NIV also has a significant benefit in improving oxygenation, lowering the intubation rate, and shortening the length of hospital and ICU stay in comparison with conventional medical therapy.
Correlation of menstrual hygiene management with cervical intraepithelial neoplasia and cervical cancer
Authors: Singh Nisha , Rajput Sapana , Jaiswar S. P. 
Published: January 2022

ABSTRACT

Purpose:
To find the correlation of menstrual hygiene management (MHM) with cervical intraepithelial neoplasia and cervical cancer.

Materials and Methods:
This case-control study was conducted in a tertiary care teaching hospital for 1 year. One hundred cases (CIN or cervical cancer) and 135 controls (normal cervical cytology, Swede’s score below 5, or normal cervical histology) were surveyed about MHM practices through a predesigned, semi-structured questionnaire by interview method. Data were analyzed on SPSS version 17.0 statistical analysis software through Chi-square test and bivariate regression analysis.

Results:
All Poor MHM practices except frequency of change of absorbent were significantly more commonly seen in women with CIN or Cervical cancer as compared to controls (P < 0.001). The bivariate regression analysis showed that old age, illiteracy, and the use of old cloth are significant risk factors for cervical cancer.

Conclusion:
Poor menstrual hygiene practices of using old cloth and disposal in open are significant risk factors of cervical cancer. Good MHM practices should be widely publicized and implemented in the community to reduce the risk of cervical cancer.
Corneal Haze and Densitometry in Keratoconus after Collagen Cross-Linking by Three Different Protocols
Authors: Badawi Amani E. 
Published: January 2022

Purpose:
To evaluate postoperative corneal haze and corneal densitometry following three different corneal cross-linking (CXL) protocols; standard, accelerated, and trans-epithelial (TE).

Methods:
The study recruited 104 eyes (53 patients) with progressive keratoconus divided into three groups: Group I were subjected to standard CXL, Group II to TE-CXL, and Group III to accelerated CXL (A-CXL) (10 mW/cm2 for 9 min). Subjective and objective corneal haze measures were evaluated before and 3, 6, and 12 months post-CXL using slit-lamp biomicroscopy and Pentacam Sheimpflug camera.

Results:
There was a significant difference in corneal densitometry between the three groups at 3 and 6 months post-CXL (P < 0.0001). By the 12th month, a significant statistical difference was observed only in zones (0–2 mm) and (2–6 mm) in both the anterior and the central layers. In Group I, the densitometry value of the preoperative anterior stromal layer (anterior 120 μm) was 19.42 ± 1.81. Then, it peaked at 23.12 ± 1.21 at 3 months (P < 0.0001), reached 19.82 ± 1.19 at 6 months (P = 0.007), and decreased to 19.33 ± 3.23 (P > 0.05) at 12 months. In Group II, the preoperative densitometry value of the anterior layer was 19.41 ± 1.21, peaked at 19.72 ± 1.12 at 3 months (P = 0.02), reached 19.04 ± 1.18 at 6 months (P = 0.052), and increased to 19.13 ± 1.37 at 12 months (P = 0.84). In Group III, the preoperative densitometry value of the anterior stromal layer was 19.53 ± 2.23. Then, it peaked at 24.80 ± 1.08 at 3 months (P < 0.0001), decreased to 21.75 ± 1.11 at 6 months (P < 0.0001), and reached 19.77 ± 2.26 at 12 months (P = 0.047). There was no significant correlation between the visual acuity changes and the total corneal densitometry.

Conclusion:
The TE-CXL group showed a better and earlier recovery from the haze, while the A-CXL group showed a delay in recovering and persistent increased corneal densitometry, mainly in the anterior 120 μ.
Recurrent Pterygium
Authors: Ghiasian Leila , Samavat Bijan , Hadi Yasaman , Arbab Mona , Abolfathzadeh Navid 
Published: January 2022

Purpose:
To summarize the recent evidence regarding different aspects of pterygium recurrence.

Methods:
Human-based studies from PubMed, Scopus, and Google Scholar were identified using the following keywords: conjunctival disease, pterygium, recurrent pterygium, pterygium recurrence, pterygium management/surgery, conjunctival autograft (CAU), amniotic membrane graft/transplant, and adjuvant therapy (January 2009 to February 2021). We reviewed risk factors associated with the recurrence of pterygium, timing of recurrence, medical treatments to prevent from recurrence, and nonsurgical and surgical alternatives for management of recurrence.

Results:
Dry eye disease, black race, and young age are considered definite risk factors for recurrence. However, fleshy appearance of the pterygium and preoperative size remain controversial. Surgical techniques such as excessive suturing, insufficient conjunctival graft size, thick conjunctival graft with remained Tenon tissue, and postoperative graft retraction are considered possible risk factors for recurrence. Using fibrin glue instead of sutures can further reduce recurrence rates. Although recurrence could occur even after many years, most recurrences happen in the first 3–6 months after surgery. Multiple kinds of adjuvant medications are used before, during, or after the operation including mitomycin C (MMC), 5-fluorouracil (5-FU), corticosteroids, and anti-vascular endothelial growth factors (anti-VEGFs). Multiple weekly subconjunctival 5-FU injections are shown to be safe and effective in halting the progression of recurrent pterygium. Although topical bevacizumab is found to inhibit the growth of impending recurrent pterygium, the effect is mostly temporary. CAU is superior to amniotic membrane transplantation in the treatment for recurrent pterygia.

Conclusions:
There is yet to be a panacea in treating recurrent pterygium. Currently, there is not a globally accepted recommendation for treating recurrent pterygium with anti-VEGFs or 5-FU as a nonsurgical treatment. We strongly recommend using MMC as an adjunct to surgery in recurrent cases, with consideration of its specific complications. CAU is the most effective surgical treatment for recurrent pterygium, and other new surgical therapies need further investigation.
Intraocular Pressure and Corneal Biomechanical Changes after Water-Drinking Test in Glaucoma Patients
Authors: Sharifipour Farideh , Malekahmadi Mohammad , Azimi Mehdi , Cheraghian Bahman 
Published: January 2022

Purpose:
To evaluate intraocular pressure (IOP) and corneal biomechanical changes after water-drinking test (WDT) in glaucomatous and normal eyes using Ocular Response Analyzer (ORA).

Methods:
This prospective study included 30 medically controlled, 30 surgically treated glaucoma patients and 30 normal individuals. Baseline measurements included central corneal thickness (CCT), ORA-derived corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg). Measurements were repeated 15, 30, and 60 min after drinking 1000 mL of water. Changes in ORA parameters were compared among the groups.

Results:
All groups showed a significant increase in IOPg and IOPcc at all test points. Peak IOP occurred at 15 min and decreased gradually over time but did not reach the baseline values at 60 min. The surgery group had significantly lower baseline IOPg and IOPcc (10.7 ± 3.1 and 12.8 ± 3.7 mmHg, P = 0.001 and 0.01), lower peak IOPg and IOPcc (14.4 ± 4.6 and 16.2 ± 4.6 mmHg, P = 0.003 and 0.034), and lower percent IOPg and IOPcc fluctuations (13 ± 5.6 and 15 ± 5.9, P = 0.0001 and 0.002), respectively, compared to the medical group. Baseline CH and its fluctuations were not significantly different among the groups. CH decreased to a trough corresponding to peak IOPcc. There was a significant negative correlation between IOPcc and CH (r = −0.609, P < 0.001). The medical group showed more CRF fluctuations compared to normal group.(P = 0.039).

Conclusion:
Surgically treated glaucomatous eyes show less IOP fluctuations and lower peak IOP after WDT compared to medically controlled and normal eyes.
Orbital Angioleiomyoma
Authors: Bagheri Abbas , Abbasnia Ehsan , Abrishami Alireza , Rezaie Kanavi Mozhgan 
Published: January 2022

Purpose:
To report a rare case of orbital angioleiomyoma (ALM) and its management.

Methods:
A 22-year-old woman presented with slowly progressive painless axial proptosis. Computed tomography and magnetic resonance imaging demonstrated a well-defined intraconal mass that was isointense in T1 and hyperintense in T2 weighted images, heterogeneously enhanced by gadolinium.

Results:
The tumor, despite having significant adhesions to surrounding tissues and noticeable hemorrhage, was excised completely via the lateral orbitotomy approach. Histopathologic analysis of the specimen was consistent with an orbital ALM. The patient recovered from the operation uneventfully.

Conclusion:
ALM must be considered in the differential diagnoses of orbital tumors.
Role of Anterior Segment Optical Coherence Tomography in Monitoring Epidemic Keratoconjunctivitis
Authors: Gouider Dhouha , Khallouli Asma , Maalej Afef , Khochtali Sana , Khairallah Moncef 
Published: January 2022

Purpose:
To describe, through anterior segment optical coherence tomography (AS-OCT) images, the different phases of epidemic keratoconjunctivitis (EKC) and show the impact of topical steroid on the course of this disease.

Methods:
A prospective observational study included 38 eyes (28 patients) with a presumed EKC complicated by subepithelial infiltrates (SEIs) and treated with topical fluorometholone. Slit-lamp examinations and serial AS-OCT were performed on days 7, 14, 30, 90, 180, and 210. The thickness of the whole cornea and thickness of the corneal epithelium were measured with AS-OCT and correlated to the clinical findings on slit-lamp examination in the different EKC phases.

Results:
In all patients, on day 7, the AS-OCT showed hyperreflective dots that were limited to the epithelial layers of the cornea and slightly rising above the epithelial surface, corresponding to the confluence of the punctuations of punctate epithelial keratitis. On day 14, a hyperreflective line in the Bowman's layer with intact epithelium was noted. On day 30, this hyperreflective band extended rapidly toward the anterior stroma, becoming thicker and more intense, corresponding to the SEI. They gradually decreased in number, intensity, and extent following treatment by topical steroids in 71.4% of the cases. Only two patients had persistent SEI. They were refractory to 3-month treatment by steroids. In these patients, who had persistent SEI, AS-OCT showed that the hyperreflective areas became well-defined, plaque-like lesions with sharp margins associated with disruption of Bowman's layer, localized epithelial thickening, stromal thinning, and a decrease in pachymetry.

Conclusion:
AS-OCT can be a valuable tool that provides a range of characteristic patterns of EKC and helps in monitoring it.
Dark-Field Scanning Laser Ophthalmoscopy for Prediction of Central Serous Chorioretinopathy Responsiveness to Laser Therapy
Authors: Kulikov Alexei N. , Maltsev Dmitrii S. , Burnasheva Maria A. , Chhablani Jay 
Published: January 2022

Purpose:
To study the potential of dark-field scanning laser ophthalmoscopy (DF-SLO) for the prediction of central serous chorioretinopathy (CSC) responsiveness to laser therapy.

Methods:
Fifty-two eyes of 52 patients (44 males and 8 females, mean age of 45.4 ± 8.8 years) newly diagnosed with CSC were included in this prospective cohort study. At baseline, all patients received multimodal imaging including DF-SLO and then were observed until resolution of subretinal fluid or, in nonresolving cases, treated with laser therapy. At the end of the follow-up, each case was categorized as either self-resolving, resolving after laser treatment, or nonresolving after laser treatment. Presence of granular retinal pigment epithelium (RPE) changes and lucency of RPE/choroid complex at the leak on DF-SLO images were used by two masked graders to identify cases nonresolving after laser treatment.

Results:
Using DF-SLO images, the masked grader correctly classified 45 of 52 (86.5%) CSC cases. Kappa value for the classification by two graders was 0.95 (95% confidential interval [CI] 0.85–1.0). The area under the receiver operating curve, sensitivity, and specificity of DF-SLO in identifying nonresolving after laser treatment cases were 0.92 (95% CI: 0.79–0.98), 86.7% (95% CI: 59.5%–98.3%), and 96.6% (95% CI: 82.2%–99.2%), respectively.

Conclusion:
DF-SLO may be a useful technique in prognostication of response to laser treatment in newly diagnosed CSC.
Closure of Recalcitrant Macular Hole after Choroidal Neovascularization
Authors: Ilhan Cagri , Citirik Mehmet 
Published: January 2022

Purpose:
To report the closure of a recalcitrant macular hole (MH) following the development of choroidal neovascularization.

Methods:
A 67-year-old female patient in this case report was diagnosed with a MH and operated twice, but anatomical closure of MH could not be achieved. The patient was followed up without further treatment, as she rejected any additional procedure.

Results:
Six months later, a lesion consistent with choroidal neovascularization appeared in the central macula, and the recalcitrant MH closed spontaneously. The MH defect remained closed in the following years.

Conclusion:
Besides being a new example of the presence of choroidal neovascularization after MH surgery, the most important aspect of this case report is to report the closure of a recalcitrant MH following the development of choroidal neovascularization.