Zagazig University Medical Journal

Diagnostic Hysteroscopic Procedure Evaluation in Outpatient Clinic for Women with Perimenopausal Bleeding

2024-06-10T11:52:36+00:00

Background: Abnormal uterine bleeding means any variation from the normal menstrual cycle either increase in volume, duration or amount of bleeding or variation with respect to regularity, or bleeding in between the normal menstrual cycle for a period of 6 months. Diagnostic modalities for evaluating the cause of abnormal uterine bleeding are many. These include ultrasonography, dilatation and curettage (D & C), and hysteroscopy and hysteroscopic-guided endometrial biopsy. The current study aimed to compare the efficacy of hysteroscopy and transvaginal ultrasonography (TVUS) in diagnosing endometrial pathologies in patients with perimenopausal abnormal uterine bleeding (AUB).

Methods: The study included 120 patients with abnormal uterine bleeding. Patients were subjected to full medical taking, gynecological examination, transvaginal ultrasound and office hysteroscopy. Endometrial sampling was performed using either D&C or hysteroscopy and tissue biopsies were analyzed by histopathological examination.

Results: Ultrasonography can diagnose endometrial hyperplasia with 42.2% sensitivity with 84% specificity and overall accuracy 68.3%. Hysteroscopy can diagnose endometrial polyp with 60.9% sensitivity 93.2% specificity and overall accuracy 72.5%. Hysteroscopy can diagnose cervical polyp 77.8% sensitivity and 97.3% specificity and overall accuracy 95.8%. Ultrasonography can diagnose fibroid with 75% sensitivity and 86.9% specificity and overall accuracy 73.3%. While hysteroscopy had 52.8% sensitivity and 87.5% specificity and overall accuracy 75.8% Ultrasonography can diagnose adenomyosis with 71.4% sensitivity, 86% specificity and overall accuracy 85%. While hysteroscopy had 77.8% sensitivity with 91.9% specificity and overall accuracy 90.8%.

Conclusions: Ultrasonography and hysteroscopy can diagnose endometrial pathologies in patients with perimenopausal abnormal uterine bleeding with comparable results

Evaluation of right ventricular function in patients undergoing coronary intervention and presenting with non-ST-segment elevation myocardial infarction (NSTEMI)

2024-06-10T12:18:28+00:00

Background: Following an acute myocardial infarction (MI), right ventricular (RV) affection had been linked to increased morbidity and death. In individuals with acute myocardial ischemia, RV dysfunction has been identified as a predictor of death. The aim of this work is to evaluate the right ventricular function in patients undergoing coronary intervention and presenting with non-STsegment elevation myocardial infarction (NSTEMI).

Methods: The study was a case control study that included 44 individuals over the age of 18 who were hospitalized or referred to Zagazig University Hospital and National Heart Institute with manifestations of NSTEMI between 2019 and 2020. Patients were split into two groups based on their RV function: Group I (n = 22 patients) had normal RV function, and Group II (n = 22 patients) had impaired RV function. All patients were subjected to complete history, full clinical examination, ECG, echocardiography to assess RV function, laboratory investigations and PCI then follow up for three months to evaluate improvement in RV function.

Results: There was a statistically significant negative correlation between baseline TAPSE and peak Tpn and RVEDD. There was also a statistically high significant positive correlation between baseline TAPSE and RVFAC. In addition, there was a statistically high significant negative correlation between RVFAC and RVEDD with p value ≤0.001.

Conclusion: Patients with NSTEMI and poor RV function should be treated by PCI revascularization of the culprit lesion to enhance RV function, and it should be assessed by ECG and 2D echocardiography

Influence of subclinical hypothyroidism on early outcome of patients undergoing CABG surgery

2024-06-10T12:24:39+00:00

Background: Subclinical hypothyroidism is associated with elevated TSH with normal T3 and T4 levels. Its effect on cardiac surgery outcome is controversial. Some authors revealed adverse outcome in form of arrythmia and congestive heart failure. This study aimed to investigate the effect of subclinical hypothyroidism on early outcome of patients undergoing coronary artery bypass graft (CABG) surgery.

Methods: This study included 27 patients with subclinical hypothyroidism subjected to elective CABG surgery (Group A) and group B that contained 27 patients with normal thyroid function. Both groups were followed up for one month postoperative regarding operative mortality and postoperative outcomes.

Results: Cases required prolonged mechanical ventilation and postoperative inotropic support were significantly higher among the SCH group compared to the euthyroid group (p=0.024, 0.018 respectively). The occurrence of postoperative AF and the respiratory complications was significantly higher in SCH group in comparison to the euthyroid group (p=0.039, 0.022 respectively). Mortality was recorded in only one case of SCH group and in 2 cases of the euthyroid group (p=0.998).

Conclusion: SCH is associated with increased postoperative AF, need for inotropic support and prolonged mechanical ventilation. Preoperative assessment of thyroid functions is recommended to be performed routinely before surgery.

Assessment of the Serum Fibroblast Growth Factor 23 Level in Different Types of Rickets

2024-06-10T12:31:33+00:00

Background: Worldwide, rickets had a significant impact on children and adolescents', growth, and development as well as their general health. The fibroblast growth factor 23 (FGF23) gene, which encodes a secreted protein that is related to the fibroblast growth factors, is present in certain forms of rickets. This study aimed to assess the FGF 23 level among different types of rickets.

Methods: In this case control study, we included 64 children who were divided into four groups: hypophosphatemic rickets: 16 cases, vitamin D resistance: 16 cases, vitamin D deficiency: 16 cases, and normal: 16 cases. We measured parameters including age, weight, height, ionized serum calcium, total serum calcium, alkaline phosphatase, serum phosphorus, vitamin D, parathormone, serum creatinine, and serum FGF23 levels.

Results: Ionized and total serum calcium, serum phosphorus, alkaline phosphatase, vitamin D, parathormone, serum creatinine, and serum FGF23 levels showed highly significant differences (P-values < 0.0001). Compared to vitamin D deficiency, hypophosphatemic rickets displayed notably lower levels of serum phosphorus and parathormone. However, the hypophosphatemic rickets group demonstrated significantly higher levels of certain biomarkers in comparison to the vitamin D deficiency group. The prognostic performance of serum FGF23 levels indicated a high area under the curve, with a specificity of 50.0%, and a sensitivity of 93.8% using a cutoff value of 131.5 to identify hypophosphatemic rickets. Univariate and multivariate logistic regression analyses highlighted a significant association between high serum FGF23 levels and the likelihood of hypophosphatemic rickets, even when adjusted for age and weight.

Conclusions: Our findings highlight the potential of serum FGF23 levels as a diagnostic indicator for hypophosphatemic rickets.

Minimally Invasive Percutaneous Anterolateral Plate Osteosynthesis for Distal Tibial Pilon Fracture

2024-06-10T12:44:57+00:00

Background: Distal tibia fracture surgery can be quite difficult and have a lot of problems. In order to successfully treat distal tibial fractures, soft tissue recovery is crucial. Because of the adequate soft tissue cover on the anterolateral distal tibia, the use of anterolateral plates is on an upward trend. The aim of the study is to assess the effectiveness and side effects of a minimally invasive anterolateral locking device in management of distal tibial Pilon fractures.

Methods: It was an observational prospective cohort research. After receiving the ethical permission for our study, we recruited and treated adult patients with distal tibial fractures of the AO 43C type who were hospitalized to our level I trauma center between March 2022 and August 2023. Following surgery, every patient was monitored for a minimum of 9 months. The mechanism of trauma, comorbidities, classifications, fracture-surgery interval, radiological exposure, surgery duration, complications, and the American Orthopedic Foot and Ankle Society (AOFAS) score were collected.

Results: The 25 patients were monitored for 9 to 18 months. The anatomic reduction was achieved in all cases. With the exception of one case, the majority of incisions healed well without necrosis two weeks following surgery. The healing time for the fractures was between 12 and 18 weeks (on average, 13.71.2 weeks). In the meantime, period of 4.95 months (3e12 months), full weight bearing was permitted. In any event, no significant local wound complication requiring revision surgery was observed. Five instances had minor problems, including two cases of delayed union, one case of a muscle hernia, one case of a superficial infection, and one case of sensory disturbance over the anterolateral foot. The average distance (6–8 cm) between the posterolateral and anteromedial incisions was 7 cm. At one year following surgery, the AOFAS scores were excellent in 15 patients and good in 10 patients (average: 86.5 points, with excellent and good rates of 100%).

Conclusions: The anterolateral plating is a good one-step treatment for tibial pilon fractures. Using locking plates and minimally invasive procedures can reduce issues with soft tissue and bone healing.

Predictors of Gastro esophageal Reflux Improvement among Infants

2024-06-10T13:17:11+00:00

Background: Functional gastrointestinal disorders in infants and toddlers are common worldwide and cover a variety of disorders associated with chronic, recurrent symptoms attributable to the gastrointestinal tract, but not explained by structural or biochemical abnormalities.

Objectives: This study aimed to explore the main predictors for reflux disease improvements among infants.

Methodology: This cross-sectional study recruited 300 infants with reflux manifestations from the outpatient clinic of the Pediatrics Department at Aswan University Hospital from January 2021 till December 2022.

Results: after adjusting for age and sex, the main independent predictors for GERD improvement among the studied cohort were weight, length, skin manifestation, growth faltering, CoMiSs score at baseline and at 3rd visit.

Conclusion: When CoMiSs negatives the AR formula more evident than PPI finally domperidine having the least impact on improving GERD symptoms. CoMiSs Score is a simple, fast, and easy-to-use useful tool for screening infants who presented with recurrent or persistent GI manifestations including GERD symptoms.

Frequency and Determinants of Post Stroke Fatigue among Acute Ischemic Stroke Patients: Clinical, Laboratory and Hormonal Predictors

2024-06-10T13:22:33+00:00

Background: Post-stroke fatigue (PSF) is a common symptom that can have debilitating effects. Furthermore, it is cited as one of the worse symptoms by up to 40% of stroke survivors. Numerous risk factors for PSF, including clinical, laboratory, and hormonal variables, particularly thyroid hormones, were investigated. We aimed To assess the prevalence and contributing factors of post-stroke fatigue in AIS patients.

Patients and Methods: This prospective cohort study, which included 70 patients with their first-ever AIS, conducted from August 2022 to January 2023 in the stroke units of the Zagazig neurology department. Patients were evaluated using the fatigue severity scale (scale 7-item version) one month after the stroke's onset. At admission to stroke units, routine laboratory and specialized hormonal assays for thyroid function were performed.

Results: 16% of our patients reported post-stroke fatigue. Low T3, high TSH, and dyslipidemia were the three most frequently seen predictors.

Conclusions: Dyslipidemia and altered thyroid function are linked to post- stroke fatigue, pointing to a potential role for neuroendocrine responses in PSF.

Emergence Agitation: Mechanism, Risk Factors, Assessment and Management

2024-06-10T13:29:43+00:00

The effects of emergence agitation (EA), also known as emergence delirium, can be clinically substantial. EA's mechanism is yet unknown. Age, male sex, the type of surgery, an emergency procedure, the use of inhalational anesthetics with low bloodgas partition coefficients, a lengthy procedure, anticholinergics, premedication with benzodiazepines, postoperative pain, and the presence of invasive devices are among the proposed risk factors for EA. There are numerous tools available for evaluating EA. However, there are no established best practices for clinical research. Preoperative instruction for surgery, parent-present induction, localized analgesia, multimodal analgesia, propofol, Nefopam, N-methyl-D-aspartate receptor antagonists, and opioid agonists, and total intravenous anesthesia may all aid in preventing EA. However, it might be challenging to recognize high-risk patients and implement preventative strategies in varied therapeutic settings. The techniques of studies and the patients evaluated affect the risk variables and outcomes of preventative interventions. In this review, we cover significant findings from EA research as well as prospective research directions.

The Role of Grafting in Canal Wall down Mastoidectomy

2024-06-10T13:34:13+00:00

Background: Radical mastoidectomy is the outstanding standard technique for management of cholesteatoma. Long term studies showed increasing incidence of discharging cavities (1). Modified radical mastoidectomy was described to prevent recurrent cholesteatoma along with reconstruction of the ossicular hearing mechanismre. Exteriorization of the disease bearing areas is essential for effective follow up (2). However, there are many recesses which cannot be exteriorized regarding its anatomical location such as the mesotympanum. It will be a source of discharge or accumulation of keratin. Covering these recesses by grafting is an essential rather than optional step in all radical mastoidectomies to prevent problematic cavities.

Aim of work: Demonstrate the necessity of grafting in radical mastoidectomy for obtaining dry cavity.

Methods: A prospective, comparative study conducted from March 2016 to October 2019 on 60 cholesteatoma patients. Patients were randomized into 2 equal groups of 30 patients each. In group A, patients undergone modified radical mastoidectomy with grafting, while patients in group B have undergone radical mastoidectomy without grafting. Regular follow-up was done monthly for 1 year for both groups.

Results: In group A, 22 patients have intact grafts, and dry well epithelialized cavities, 2 patients had perforated grafts, 5 patients had small discharging granulations and 1 patient had a keratin pearl under the graft. In group B, 19 patients suffered persistent discharging cavity, 8 patients had less discharge with keratin debris and granulations and 3 patients had dry cavities.

Conclusions: Grafting is an essential step in radical mastoidectomy to prevent cavity problems.

Prospective Assessment of Minimal Invasive Plate Osteosynthesis Technique in Humeral Shaft Fractures

2024-06-10T13:40:23+00:00

Background: Shaft fractures account for 20% and 1-3% of all humerus fractures, respectively. Open dynamic compression plate fixation (Open fixation with DCP) with absolute stability is the current gold standard for treating shaft humerus fractures. The goal of MIPO was to provide a more stable fixation, which would increase the union rate and decrease open plating side effects including infection and radial nerve palsy.

Aim: The purpose of this study was to assess the clinical and radiological outcomes of the MIPPO technique in the treatment of humeral shaft fractures.

Patients and methods: thirty cases of shaft humerus fractures were examined during the period from August 2022 to March 2023. The history, clinical examination, and radiographic (X-ray) examination were used to select cases. According to UCLA score, the result was noted and filled up.

Results: Union was achieved in 17 to 22 weeks with the mean 19.4±4.1. Only 5% nonunion was seen in our cases. It was observed that the median UCLA score was excellent (34).

Conclusion: In shaft humerus fractures, results from minimally invasive plate osteosynthesis with anterior bridge plating were favorable. They offer the fracture site some support, and the fracture hematoma is not disturbed. MIPO keeps the blood vessels healthy, which lowers the danger of infection and wound disintegration

Assessment of Serum Neurofilament Light Chain Protein in Multiple Sclerosis Patients

2024-06-10T13:49:00+00:00

Background: .Serum neurofilament light chain (NFL) has been the subject of intensive research as a potential biomarker of treatment response as well as prognosis among multiple sclerosis cases because it can reflect disease activity in the clinical follow up of these patients and measured in serum.

Aim: to assess serum NFL in MS cases and its relation with disease severity & magnetic resonance imaging (MRI) finding in these patients.

Subjects and methods: Fifty MS patients were included in a case-control research conducted at three hospitals in Egypt: Zagazig University Hospital, ALMabara Hospital for Health Insurance in Zagazig, and Mansoura New General Hospital. Diagnosis of MS was done according to Modified McDonald criteria. Patients were divided into 25 patients with relapsing– remitting multiple sclerosis (RRMS), 18 patients with secondary progressive multiple sclerosis (SPMS), 7 patients with primary progressive multiple sclerosis (PPMS) & 25 sex and age matched healthy controls.

Results: There is a statistical significance increase serum NFL among cases than control group and a significance increase of Serum NFL among RRMS than SPMS and PPMS groups.

Conclusion: The results showed that NFL levels were associated with disease severity as assessed by Expanded Disability Status Scale (EDSS) as well as MRI findings in MS patients.

Evaluation of pregnancy outcomes and different management options used in Morbid Adherent placenta

2024-06-10T13:54:32+00:00

Background: Morbidly Adherent Placenta (MAP) is defined as invasion of the placental chronic villi in to the myometrium, either invading myometrium superficially (accreta), or deeply (increta), or fully and or neighboring organs (percreta). The management of MAP is caesarean hysterectomy. Conservative uterine sparing approaches are performed in patients with strong desire for future fertility and hemodynamic stability. The aim of this work was to evaluate different management options for MAP and its effect on pregnancy outcomes to find the best approach to decrease MAP associated morbidity and mortality.

Methods: Study included 42 MAP Previa patients who underwent history taking, examination, investigations, and different management operative options. Maternal and fetal outcome were recorded.

Results: The postoperative complications are DIC, reoperations, postpartum collapse in 2 patients (4.8%), ICU admission in 5 cases (11.9%), wound infection, retained products of conception, chorioamnionitis and pulmonary embolism in 1 patient (2.4%).

Conclusions: Multidisciplinary approach individualized according to hemodynamic stability; future fertility desire may reduce maternal morbidity and mortality in MAP patients. As CS hysterectomy, should be avoided in women with future fertility desire. Good anticipation and timely decision are the keys to success in this lifethreatening condition.

Physical features of Patients with Mucopolysaccharidoses and other correlated laboratorial examinations

2024-06-10T14:00:06+00:00

Background: Mucopolysaccharidoses (MPS) are genetic disorders of the catabolism of glycosaminoglycans (GAGs). MPS are categorized into different types; each type is caused by a deficiency in the activity of a specific lysosomal enzyme required for GAGs degradation[1]. This study was designed to identify the physical features, assay the enzymatic deficiency and examine the hematological pictures in patients with different types of MPS.

Methods: This cross-sectional study was conducted on 16 MPS patients, in the Pediatric department at Zagazig University Hospitals.

Results: The age of children in the studied groups ranged between 7 to 17 years, height ranged between 88 to 120 cm, and weight range of 15 to 29 Kg but without statistically significant difference. There was statistically significant relation between type of MPS and urinary GACs. On doing Tukey’s HSD (honestly significant difference) test, the difference was significant between type I and II. Also, between type II and IV-A. However, type IV-A did not differ from type VI or I. There was statistically significant relation between type of MPS and mental delay. Only patients with type I and II had mental delay. There was statistically non-significant difference between the studied groups with different types of MPS regarding complete blood count (CBC) except platelet and lymphocytic count. There was statistically non-significant difference between the studied groups with different types of MPS regarding liver function tests.

Conclusion: Diagnostic enzymatic assay in combination with different diagnostic tools as case history, physical features, hematological examination and liver function tests were essential for correct diagnosis and early interference.

Serum Level of CXCL12 in Rheumatoid Arthritis Patients and its Correlation with Disease Activity

2024-06-11T06:38:05+00:00

Background: Synovial angiogenesis and inflammation with articular damage are the main pathologic changes in rheumatoid arthritis (RA). The implication of the chemokine CXCL12 in disorders of the immune system had been identified. CXCL12 is involved in the inflammatory process by triggering leukocyte recruitment and neovascularization. Therefore, this research aims to investigate the serum CXCL12 level in RA patients and define how it correlates with disease activity.

Methods: This study comprised 44 RA patients as well as 44 matched controls. Health assessment questionnaire disability index (HAQ- DI) as well as disease activity score (DAS-28) were determined. CXCL12 level was assessed in the sera of participants.

Results: Serum CXCL12 concentration was significantly elevated in RA patients (1475.16 ± 480.78 pg/ml) compared to controls (484.6 ± 177.85 pg/ml; p<0.001). Significant relations were detected between CXCL12 with tender joint count (p<0.001), swollen joint count (p<0.001), morning stiffness duration (p<0.001), DAS-28 (p<0.001), HAQ-DI (p<0.001), rheumatoid factor (RF) titer (p<0.001), anti-cyclic citrullinated peptide (anti-CCP) level (p=0.001), C-reactive protein (p<0.001), and erythrocyte sedimentation rate (p<0.001). Serum CXCL12 significantly discriminated RA patients from healthy subjects (AUC = 0.99; p<0.001), as well as active RA cases from those in remission (AUC = 0.96; p<0.001).

Conclusion: This study indicated the fundamental utility of serum CXCL12 in RA activity monitoring.

Spontaneous Resolution of a High-Power Blue Laser Pointer- Induced Maculopathy: A case report

2024-06-11T06:51:45+00:00

A fifteen-year-old boy appeared at my clinic with impaired vision in his left eye to 20/70 following a brief exposure to a high power class IVb blue laser pointer. A mirror at a distance of one meter reflected the beam for two seconds onto his left eye. He reported having a left eye with a central black spot and a blurry vision. A sub-internal limiting membrane (ILM) haemorrhage near the fovea was discovered during a fundus examination. of the left eye was identified as a red, well-circumscribed patch in the foveal area. The optical coherence tomography (OCT) scan verified the existence of bleeding beneath the ILM layer. The central fovea of the left eye's fluorescein angiography showed a little early transmission deficiency without late staining. A relative central scotoma was discovered by perimetry in the left eye. Both eyes' anterior segments appeared normal. The fundus examination of the right eye revealed normal results. The haemorrhage was completely cured and the visual acuity recovered to 20/20 seven weeks later. These devices need to be properly warned of, and children shouldn't have unlimited access to them.

Impact of Albumin to Globulin Ratio on The Outcome of Women with Metastatic Breast Cancer

2024-06-11T07:17:19+00:00

Background: Breast cancer is the most frequent malignancy among women all over the globe. The albumin/globulin ratio (AGR) is a simple and cost-effective inflammatory measure that is strongly related with cancer patient prognosis and treatment response.

Aim: To evaluate the prognostic impact of albumin to globulin ratio on the outcome of women with metastatic breast cancer.

Methods: This study is a retrospective analysis of data obtained from sixty female patients diagnosed with metastatic breast cancer and treated in Medical Oncology Department, Zagazig University from January 2015 to December 2017. Several variables were extracted anonymously from patients’ medical records, then were analyzed by applying receiver operating curve (ROC) analysis.

Results: Kaplan Meier survival curves disclosed a 5-year overall survival rate which differed significantly in patients as regard the AGR (p < 0.001), with AGR cut-off value (≤1.1). The 5-year overall survival rate was 35%. On the other side, there were no statistically significant differences between neither AGR and PFS (p = 0.297), nor clinical or pathologic criteria of our studied patients.

Conclusions: Statistically significant correlation was found between AGR and OS; high AGR was associated with prolonged OS. Nevertheless, according to follow-up, a long-term follow-up should be done to assess its prognostic significance for disease-free survival.

An Audit of Rational Use of Antibiotics in Pediatric Department Zagazig University Children's Hospital

2024-06-11T07:25:17+00:00

Background: Antibiotics are one of the most widely used drugs in hospitals, but they are often misused. The proper antibiotic use improves medication and patients' safety, lowers drug intake, costs and reduces the proliferation of resistant species.

Aim and objectives: To determine the magnitude of inappropriate antibiotic prescription at Zagazig University Children's Hospital.

Methods: This cross-sectional study was carried out in the pediatric department, faculty of medicine, Zagazig university on 1000 children. All patients were subjected to full medical history with stress on age, sex, diagnosis, past history and antibiotic regimen (begin, course, end). The investigations carried out to the patient were recorded. Clinical outcomes after the use of the antibiotics were carefully evaluated and registered.

Results: 97.29% of the prescribed antibiotics were of the appropriate dose and 94.22% were of appropriate interval. 68.67% of the prescribed antibiotics fulfill the guidelines, while 31.32% not fulfill the guidelines. The most frequently prescribed antibiotics are Ampicillin/Sulbactam and 3rd generation cephalosporin while the least prescribed antibiotics are Amoxicillin/Clavulanic and cotrimoxazole.

Conclusion: Antibiotics misuse and overuse are common, contributing to the rise of bacterial resistance. As a result, the main challenges in prescription of antibiotics are to achieve a rational choice and appropriate use of antibiotics and to recognize their potential problems.

Assessment of Vascular Endothelial Growth Factor mRNA and miR-200b Levels in Type 2 Diabetes Mellites in Correlation with Clinicopathological and Anatomical Distribution of Diabetic Foot Ulcer

2024-06-11T08:11:10+00:00

Background: Diabetic foot ulcer (DFU) is one of the most distressing complications in patients with type 2 diabetes mellitus (T2DM). Vascular endothelial growth factor (VEGF) is a strong angiogenic factor associated with wound healing and development. This study aimed to investigate the VEGF mRNA and miR-200b levels in patients with T2DM and to discover their relations with the clinicopathological and anatomical distribution of DFU.

Methods: This case-control study enrolled 70 patients with T2DM and 70 healthy subjects as controls. Physical and neurological examination to assess Wagner classification. RT-PCR was done to assess VEGF mRNA and miR200b expression levels.

Results: There were significantly higher values of VEGF mRNA levels in patients with DFU (3.13±1.87) compared to patients without DFU (2.41±0.197) and controls (1.07±0.363), with P value ˂0.001* Additionally, miR-200b levels were significantly higher in patients with DFU (3.48±1.47) compared to patients without DFU (2.94±0.187) and controls (1.13±0.37), with P value ˂0.001*. The power of VEGF mRNA and miR-200b levels as a diagnostic marker for DFU were projected (2.5 and 3.1, respectively), which yielded a sensitivity of (77.1% and 74.3, respectively) and a specificity of (77.3% and 75.2%), with the AUC at (0.886 and 0.845, respectively). The size of DFU in cm was 3.5±0.421 and the number of ulcers was 2.45±0.433.

Conclusions: The VEGF mRNA and miR-200b levels were significantly higher in patients with T2DM, particularly those with DFU. Consequently, we believed that VEGF mRNA and miR-200b might serve as promising predictive biomarkers for diabetes and DFU.

Vitamin D receptor FokI (rs2228570) polymorphism in diabetic patients

2024-06-11T08:32:12+00:00

Background: Vitamin D is a steroid hormone. Many biological actions are triggered by vitamin D. FoKI (rs2228570) is VDR single nucleotide polymorphism. The FokI polymorphism is recognized by a start-codon alteration from cytosine to thymine, which results in three amino acids shorter protein. T2DM has been associated with the FokI VDR gene polymorphism. The aim of this study was to determine the relationship between the VDR gene polymorphism FokI and T2DM in Egyptians.

Method: This study was carried out on 111 subjects: 37 healthy individuals, 37 obese non-insulin-dependent diabetic patients with BMI > 30 kg/m², and 37 non-obese non- insulin-dependent diabetic patients with BMI < 24 kg/m². VDR FokI genotype was determined by PCR-RFLP, and the 25(OH)D level was measured using the ELISA method.

Results: Diabetic patients had a significantly higher prevalence of the polymorphic genotype of the VDR FokI polymorphism (ff) than the control group (OR = 4.9, 95% CI = 1.94-12.36, p = 0.0007). The FokI (f allele) allele frequency was greater in the T2DM obese patients than in the control group and T2DM non-obese patients (p < 0.0001). Diabetic patients had lower 25- hydroxyvitamin D (25(OH)D) levels than individuals in the control group (P< 0.001).

Conclusions: The VDR polymorphism FokI's f allele and f genotype may increase the risk of diabetes in Egyptians.

Percutaneous K wire fixation for Paediatric monteggia fracture

2024-06-11T08:41:56+00:00

Background: Monteggia, an Italian surgeon, first to describe the combination of a proximal ulna fracture and dislocated radial head. With the use of Kirschner wires, surgical stabilization could be achieved. The aim of the study was to determine closed reduction and percutaneous k-wire fixation can maintain satisfactory reduction and fixation in pediatric Monteggia fractures.

Methods: Twelve patients with Monteggia fractures were admitted to Zagazig University Hospital and Tripoli University HospitalLibya in this prospective study. All were treated by close reduction and percutaneous k-wire fixation. Postoperatively, patients were weekly dressed and checked for pin sites. AP / Lat X-rays elbow at 6 weeks for fracture union, wires removed. Using the Stewart Hundley, VAS, Mayo, and DASH scoring systems, the elbow and forearm were evaluated for a range of motion in all directions.

Results: Age was distributed as 7.88±2.63 years, regarding gender distribution males were 55.6% and females were 44.4%. Mechanism of injury FD was majority with 72.2% and DT 27.8%. Bado classification majority were type I 41.7%, type II 33.3%, type III 25%, and type IV no cases. The time of union was distributed as 2.72±0.80 months. Stewart Hundley's score excellent was the majority with 83.3%, good 8.3%, and fair 8.3%. Mayo's score was distributed as 88.33±10.44; regard Mayo's excellent were majority with 66.7% then good and fair with 16.7% each. And regarding DASH excellent was also the majority but with 61.1% then good 22.2% then fair 11.1% then poor only one case 5.6%.

Conclusions: Closed Reduction and Percutaneous Kirschner Wires Fixation of Monteggia Fracture in Children are less invasive, and give satisfactory radiological and clinical outcomes. Percutaneous interventions could be an option for Monteggia Fracture in Children.

Cerebrospinal Fluid Nitric Oxide as a Diagnostic Inflammatory Marker of Central Nervous System Inflammatory Condition

2024-06-11T09:00:59+00:00

Background: Incidences of death and morbidity are high worldwide for acute neuroinflammatory disorders like encephalitis. The most helpful fluid for examining brain metabolism is cerebral spinal fluid, which also offers a crucial chance to identify neuro-inflammation in conditions affecting the human central nervous system. This study aimed to assess the role of nitric oxide as a cerebrospinal fluid metabolomics in diagnosis of neuroinflammatory diseases.

Methods: This case-control study was conducted in the neurology unit in the pediatric and clinical pathology departments of Zagazig University Hospital on 52 cases with neuroinflammatory conditions, they were equally divided into two groups; Control group included 26 patients (16 males and 10 females) with gray and white matter diseases and a case group of 26 patients (12 males and 14 females) with inflammatory neurological diseases. Cerebrospinal fluid was analysis by ELISA to assay the level of Nitric oxide in samples.

Results: This study revealed that cerebrospinal fluid Nitric oxide levels, along with CSF Protein and CSF Cell Count, were significantly elevated in children with inflammatory neurological diseases compared to those with grey and white matter neurological conditions p<0.05. CSF Nitric oxide, with a cut-off level of ≥60.38 (mol/l), emerges as a highly sensitive (100%) and reasonably specific (88.5%) biomarker for discriminating neuroinflammatory diseases in children from other neurological conditions.

Conclusions: Can be used CSF Nitric oxide as a valuable tool for diagnosing and monitoring neuroinflammatory disorders in pediatric patients, offering a potential avenue for early intervention and improved patient care.

Evaluation of Surgical Techniques in Management of Bicondylar Tibial Plateau Fractures

2024-06-12T09:29:04+00:00

Background: Tibial plateau fractures are one of the most common intraarticular fractures caused by coronal or axial compressive forces. This study aimed to compare the functional outcome and the complication rate between double-plate and single lateral locked in patients with bicondylar tibial plateau fractures.

Methods: A prospective study was conducted in Zagazig University hospitals, in the period from August 2021 to February 2022, 18 patients complaining of tibial plateau fracture; either Schatzker type V or VI, were Included and divided into two groups: the single lateral plate (SLP) group including nine patients, and the double plate (DP) group including also nine patients. Majority of the patients were males in both groups. The road traffic accidents (RTA) were the leading cause of fracture in SLP group. While fall from height (FFH) was the most common cause of fracture in DP group. Anteroposterior and lateral radiographs of whole tibia from knee to ankle were obtained. CT scans were done for all cases to accurately delineate fracture type and extent, fragment size and location, the degree of articular depression or displacement. The clinical evaluation was based on Rasmussen scoring system with six months follow-up.

Results: Rasmussen functional score showed significant improvement from the 1st month till the 6th onth. There were no significant differences between the two methods with respect to functional and radiographic outcomes at the final follow-up. Also, both methods had no differences in complication rate.

Conclusion: This study concluded that both methods (single lateral plate and double plating) are effective methods for treatment of bicondylar tibial plateau fractures.

Therapeutic Effect of Mesenchymal Stem Cells in Neurological Diseases

2024-06-11T09:21:09+00:00

Background: Neurological diseases are becoming a more significant burden, and taking action on this developing issue is urgent. Developing solutions for these conditions using stem cell-based regenerative medicine is growing in appeal. Multipotent cells, or mesenchymal stromal cells, are used to treat various illnesses. The bone marrow (BM) and peripheral blood are the residence of mesenchymal stem cells (MSCs), also known as marrow stromal cells. By producing different integrins, growth factors, cytokines, and adhesion molecules, MSCs help hematopoiesis. Additionally, depending on the lineage of the MSCs, it will be possible to differentiate them. According to in vivo studies, injected MSCs have been identified in the host's adipose tissue, articular cartilage, lung, perivascular regions of the central nervous system. The preclinical and early clinical research on MSC therapy for neurological diseases like stroke, amyotrophic lateral sclerosis, multiple system atrophy, Parkinson's disease, and Alzheimer's disease is summarized in this article. Conclusions: Much is still unclear, despite the rise in clinical trials of MSCbased treatments for neurological illnesses during the past ten years and experimental investigations utilizing animal models. Therefore, more study is required to assess and quantify the hazards associated with cell-based versus cell-free treatments, create new methods for obtaining larger numbers of healthy cells, and lessen the variability of outcomes caused by the inherent terogeneity of MSCs.

Uterocervical Angle Assessment in the Second Trimester of Pregnancy as a Predictor for Preterm Delivery

2024-06-11T10:41:48+00:00

Background: The wide uterocervical angle (UCA) has been identified as a predictor of preterm delivery, and the goal of this study is to see how accurate UCA is at predicting spontaneous preterm birth in the second trimester. The aim of study is early prediction of preterm labor by uterocervical angle measurement using transvaginal sonography (TVS) in the second trimester of women at low risk for spontaneous preterm birth (SPB).

Methods: This is a prospective cohort study including seventy pregnant women in the second trimester (16-28weeks). They were classified into to preterm (group 1) and term (group 2) according to delivery of 28 and 42 women in each group, respectively. TVS was performed for all participants with measuring UCA.

Results: This study shows that all ultrasonographic parameters showed the mean UCA was 124.74±19.69 and 85.95±8.32 degrees in preterm and fullterm delivery, respectively, it had statistically highly significant difference (p <0.001).

Conclusions: An elevated risk of spontaneous preterm birth was linked to a wide UCA found during the second trimester. The uterocervical angle may be utilised as a screening tool for spontaneous preterm birth, according to this study.

Outcomes of Core Decompression for Avascular Necrosis Femoral Head: Ficat I, II or III

2024-06-11T10:52:34+00:00

Background: Treatment for osteonecrosis is still difficult, and it frequently affects young people who aspire to lead active lifestyles. The aim of the present study was to evaluate the clinical and radiological outcomes of core decompression for Ficat stage I, II or III femoral head avascular necrosis.

Methods: This interventional clinical trial included 30 hips in 18 patients with avascular necrosis (AVN) of femoral head Ficat type I, II or III, conducted at Orthopedic department, Zagazig University Hospitals. Preand post-operative clinical evaluation and radiological assessment were applied.

Results: There was a statistically significant increase in the Harris Hip scores. There was a highly statistically significant decrease in the Modified Kerboul angle. There was a statistically significant negative correlation between the improvement in Harris Hip scores and each of BMI, Ficat stage, and post-operative Modified Kerboul angle as an increase in each of them was associated with decreased percent of improvement.

Conclusions: Core decompression when performed before femoral head collapse has been advocated as an efficient technique to stop or delay the progression of the disease in young individuals.

Assessment of Rafting Screws versus Bone Grafts for Management of Depressed Tibial Plateau Fractures

2024-06-11T10:59:36+00:00

Background: Among the most common fractures in knee injuries, tibial plateau fractures have been demonstrated to heal better when treated with screws located closer to the joint. This study aimed for comparing the outcomes between the use of bone grafts versus using grafting screws in management of depressed tibial plateau fractures.

Subject & Methods: In our controlled study, a total number of 24 cases with depressed tibial plateau fractures were enrolled, group A: involved 12 cases who were managed using rafting screws and group B: involved 12 cases who were managed without using grafts. Follow up and X ray were done monthly for 2 months then every 2 months for till end of 2 years.

Results: The Visual Analogue Scale (VAS) on 1st day postoperatively showed less pain in group Athan group B with p<0.05.After 3 months, VAS returned to be higher in group A than group B with p-value= 0.02, the mean of the operative time was 93.33 minutes in group A (range; 60-180 mins) and 102.5 minutes (range; 90-180 mins) with P= 0.001,Group A had slightly less residual articular depression while group B had slightly higher residual condylar widening, three cases had complications, 1 case in group A and 2 cases in group B.

Conclusion: Mild to moderate depression (>1.5 cm) in the tibial plateau can be treated successfully with open reduction and internal fixation utilizing a large set buttress plate and screws or screws alone, without the need for bone graft or bone graft substitute.

Fatty Pancreas; Is It Related to Diabetes Mellitus, Acute Pancreatitis and Pancreatic Cancer

2024-06-11T11:11:00+00:00

Background: The accumulation of fat in the pancreas has greater clinical significance. It is unclear, though, how much the intermediate variables influence the fat deposition in these depots. This study aimed to determine the relation of pancreatic steatosis to Diabetes Mellitus, Acute Pancreatitis and Pancreatic Cancer.

Methods: This case-control study was conducted on fifty patients for pancreatic diseases in internal medicine department at Zagazig University Hospitals, equally divided into five groups; group I: 10 cases as a control group, group II: with fatty pancreas (FP), group III: with acute pancreatitis (AP), group IV: with Diabetes Mellitus (DM) and case group V: with pancreatic cancer (PC). Patients were subjected to full medical history, physical examination, laboratory investigations, and non- contrast Computed Tomography (CT).

Results: Age and males were significant increased in group V (PValue= 0.003 and P=0.019 respectively). Body Mass Index (BMI) (P=0.001) and females (P=0.006) were higher among fatty pancreas patients. Pancreatic steatosis diagnosed by CT in FP representing 100%, in acute pancreatitis 60%, DM 80% and PC 70% of patients, and it was worse in FP group as 40% ware grade 4 (P <0.001). Fatty liver diagnosed by CT in 100% of FP patients, 70% in AP and DM groups and 60% in PC group and was worse in FP group as 80% grade 3 (P <0.001). grades of fatty liver and Low-Density Lipoprotein (LDL) cholesterol significantly independently associated with fatty pancreas (P<0.001). High lipids, diabetes and grades of fatty liver were significantly associated with fatty pancreas (P<0.001) and LDL and fatty liver are independent risk factors (P<0.001).

Conclusion: Pancreatic steatosis is highly related to Diabetes Mellitus, Acute Pancreatitis and Pancreatic Cancer.

Evaluation of Cyclin-Dependent Kinase Inhibitor 2A and Hepatocyte Nuclear Factor-1A Gene Polymorphisms in Coronary Artery Diseases

2024-06-11T11:22:31+00:00

Background: Blood lipid-regulating and cell proliferation-regulating genes have both been connected to the development of coronary artery disease (CAD),we aimed to find the correlation between CDKN2A rs3088440, HNF1A rs55783344CT gene polymorphisms and CAD.

Methods : One hundred and six participants were subjected to this casecontrol study; case group I: patients with CHD and control group II: Normal healthy people. Subjects underwent a comprehensive history and physical examination, standard laboratory tests, and coronary angiograms. CDKN2A rs3088440 and HNF1A rs55783344CT gene polymorphisms was done by (PCR-RFLP).

Results: CT genotype and CT+TT of HNF1AC were statistically Signiant higher in CAD cases than controls. T allele of HNF1AC was much higher in CAD cases than controls, with a significant difference between 2 groups. Proportion of those with the CDKN2A GA+AA genotype in the CAD patients was significantly higher than in the control group. Also, the frequency of the CDKN2A A allele was significantly different between CAD cases and controls.

Conclusions: Coronary heart disease (CHD) has a complex etiopathogenesis and a multifactorial origin. SNPs are potential risk factors of CHD. CDKN2A rs3088440 (G>A) and HNF1A rs55783344CT gene polymorphisms be a factor in pathogenesis of CHD.

Recent Advances in MRI of the Articular Cartilage of the Knee

2024-06-11T11:40:18+00:00

Background: Articular cartilage is a vital component of the joint, as it is frequently exposed to trauma and is affected by several conditions and diseases such as osteoarthritis and hemophilic arthropathy. Therefore, its evaluation and assessment are crucial. Magnetic resonance imaging (MRI) plays a critical role in its evaluation. With the recent advances in MRI imaging, multiple techniques and modalities allow both morphological and physiological evaluation of articular cartilage. Morphological methods allow the evaluation of articular cartilage structural integrity, and physiological methods allow the evaluation of chemical changes in its components even prior to degeneration. This aids in the early detection and improved assessment of articular cartilage pathology. Therefore, it permits a more accurate evaluation of patients with articular cartilage issues and defects, allowing for prompt treatment and high better quality of life. This article reviews recent and innovative MRI techniques and sequences for morphological and functional evaluation of the cartilage.

Methods: A broad-based internet search, utilizing multiple academic search engines, Google Scholar, and PubMed, using the keywords for title and abstract. We found 17500 results and excluded 1700 papers from the title and abstract. Furthermore, papers emphasizing the imaging of specific peripheral joints without discussing the main techniques were excluded. Finally, our search yielded 15 articles highlighting the most recent imaging and evaluation techniques for articular cartilage. Recent advancements and new MRI techniques aid in elucidating the anatomical and physiological details of articular cartilage, allowing for the early detection and treatment of the articular cartilage.

Conclusions: Multiple recent advances and new MRI techniques help better delineate the anatomical and physiological details of the articular cartilage, so early interference and treatment of cartilage defects.

Comparing the use of Preoperative Ketamine or Midazolam or Ketamine versus Oral Dextromethorphan for Reducing Sevoflurane Emergence Agitation among Preschool Children Undergoing Adenotonsillectomy

2024-06-11T11:49:32+00:00

Background: An increased risk of dangerous emergence agitation (EA) has been linked to the use of sevoflurane. This study aims to compare the the use of preoperative ketamine, midazolam or Oral Dextromethorphan for reducing sevoflurane emergence agitation among preschool children undergoing adenotonsillectomy.

Methods: This randomized controlled double-blinded study was carried out at Zagazig University Hospitals on 56 children who were divided into 4 equal groups; 14 patients in each: Group (C): received 10ml oral placebo (clear fluid) 1 hour before the general anesthesia induction. Group (D): Patients received at a dose of 0.5mg/kg 1 hour from oral dextromethorphan before the general anesthesia induction. Group (K): received a dose of 0.5mg/kg 1 hour of oral ketamine before the general anesthesia induction. Group (M): received a dose of 0.5 mg/kg 1 hour of oral Midazolam before the general anesthesia induction.

Results: Regarding heart rate (HR); group (K) was significantly highest compared to other groups. (p<0.001). The postoperative agitation incidence >4 was significantly lowest in the ketamine group in comparison to the other groups (p=0.02). Group M was found to be significantly lowest in post-operative pain occurrence in comparison to the other groups (p=0.02). Group K was found to be significantly lowest in the amount of fentanyl consumption in comparison to the other groups (p=0.004).

Conclusion: Ketamine premedication is more effective for EA prevention among children during the early emergence time after sevoflurane c ompared to midazolam and dextromethorphan anethesia.

Clinical Features of COVID-19 Hospitalized Patients with different degree of Proteinuria

2024-06-11T11:55:34+00:00

Background: Coronavirus disease-19 (COVID-19) is a lung disease that also negatively affects several organ systems. Patients with COVID-19 frequently have kidney dysfunction. The exact impact of proteinuria and its degree on the clinical outcome of patients with COVID-19 is unclear. This study aimed to assess the effect of different degrees of proteinuria on the clinical outcome of hospitalized patients with COVID-19.

Methods: This study included 100 patients with COVID-19 at Isolation Department, Zagazig University and AlAhrar Teaching Hospitals who presented with proteinuria on admission. Patients were divided into two groups based on their urine protein creatinine ratio (UPCR): those with UPCR less than 1gm and those with UPCR greater than 1gm.

Results: There is a statistically significant relation between the two groups regarding neutrophil count (p=0.027) (higher in patients with UPCR > 1gm), and lymphocytes (p=0.003) (lower in patients with UPCR > 1gm). There is a statically significant relation between the degree of proteinuria and the incidence of acute kidney injury (p<0.001) (proteinuria higher in those who developed AKI). Also, there is a significant difference between the two groups regarding the conscious level (p=0.019) (disturbed conscious level more in patients with UPCR >1gm).

Conclusions: Proteinuria in COVID-19 hospitalized patients is associated with poor clinical outcomes and could lead to further renal deterioration and AKI, so it is important to screen for it.

Clinical characterization, imaging and response to treatment in a sample of Egyptian patients with idiopathic intracranial hypertension

2024-06-11T12:06:00+00:00

Background: Increased intracranial pressure with normal brain parenchyma and no evidence of a secondary cause, such as a mass lesion or hydrocephalic alterations, is known as idiopathic intracranial hypertension (IIH).

Objective: This study aims to examine the clinical manifestation and therapeutic response in a cohort of adult patients. Patient and methods: The Neurology Department of Zagazig University Hospitals conducted our prospective cohort study from March 2022 to February 2023. eighteen patients with idiopathic intracranial hypertension participated in the study (15 females and 3 males). Their age range from 19-42 year with a mean age (±SD) of 30.6 (± 6.2).A thorough neurological and ophthalmological examination was performed, including tests for contrast sensitivity, colour vision, assessment of visual acuity (VA) and visual field. After three months, follow-up was conducted.

Results: IIH was more prevalent among obese females. Headache with blurring of vision without nausea or vomiting was the most important symptom. Papilledema was the obvious sign for diagnosis. Treatment had significant improvement regarding headache and degree of papilledema and can be used as predictor for improvement.

Conclusions: In this study we found that clinical assessment of headache severity and papilledema grade are important findings in evaluating improvement in patients with IIH.

Stapedial Reflex Evaluation after Preservation of Stapedial Tendon during Stapedectomy

2024-06-11T12:13:00+00:00

Background: Otosclerosis is one of the leading causes of conductive hearing loss with an intact tympanic membrane in adults. The stapedius tendon is routinely transected during stapes surgery. This study aimed to evaluate the success rates of stapedectomy with preservation of the stapedial muscle tendon compared to stapedectomy without preservation of the stapedial muscle tendon in the operative management of otosclerosis.

Methods: This is a retrospective study. It was conducted in the Otorhinolaryngology Department, Faculty of Medicine, Zagazig University, from October 2018 to January 2021. The sample size was 36 cases, arranged into two groups: the first group with preservation, and the second group with a cut of the stapedial tendon. The size of each group is 18 cases.

Results: There was no significant difference between both groups in hearing improvement, but there was a significant difference between both groups in post-operative tinnitus improvement and acoustic reflex preservation.

Conclusions: Preservation of the stapedial tendon in the surgical treatment of otosclerosis is associated with improvement in functional outcomes as well as providing the patient with a stapedial reflex that has a primary protective effect against strong acoustic stimuli.

The Association between Follistatin like protein-1 Level and Severity of Asthma in Asthmatic Children in Zagazig University Hospitals

2024-06-11T12:23:49+00:00

Background: Over 300 million individuals worldwide suffer from asthma. Furthermore, during the past three decades, western nations have demonstrated increased prevalence. 7.7% of people in Egypt's Nile Delta were found to have bronchial asthma. Follistatin-like 1 (FSTL1) may be crucial for the respiratory system, according to several studies. FSTL1 controls the maturation of alveoli, cartilage, and the development of the lungs. This study aimed to evaluate follistatin like protein 1 level in the serum of pediatric patients with asthma and determine its association to asthma severity.

Methods: This case-control study was carried out on 60 children at pulmonology unit in pediatric department and clinical pathology department, Zagazig University Children Hospital in the period from May 2020 to June 2022. They were divided into group A: Consisted of 45 asthmatic children subdivided into 3 groups (mild – moderate – severe) and group B: consisted of 15 age and sex matched healthy children.

Results: There was highly statistically significant increased FST level in severe group when compared with moderate group, mild group, and control group.

Conclusion: In asthmatics, plasma FSTL1 levels were higher and positively correlated with severity of asthma.

Safety and Effectiveness of Single Portal Supra-Retinacular Endoscopic Carpal Tunnel Release in Treatment of Idiopathic Carpal Tunnel Syndrome

2024-06-11T13:03:21+00:00

Background: The most common entrapment neuropathy of the upper limb is Carpal tunnel syndrome (CTS). Endoscopic carpal tunnel release (ECTR) is superior to open CTR. Fewer techniques exist using instruments to guide endoscope from outside carpal tunnel and published reports regarding that are quite rare. This study is to evaluate safety and effectiveness of single portal supra-retinacular ECTR in treatment of idiopathic CTS.

Methods: This study included consecutive patients with idiopathic CTS underwent single portal supra- retinacular ECTR from December 2019 to June 2020 with postoperative follow-up period of 6 months. The Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) results at 1-, 3-, and 6-months postoperative compared to pre-operative scores as main clinical evaluation. In addition to scar tenderness scale, recurrence of symptoms and post-operative complications.

Results: 45 patients aged from 29 to 63 years were included (a total of 51 procedures). There was a significant improvement in Functional Status Score (FSS) and Symptom Severity Score (SSS) post-operative compared to pre-operative scores (P=0.0001). And also, a significant progressive reduction in mean FSS/SSS recorded 1, 3 and 6-months postoperative than pre-operative. Pillar pain recorded in 7 hands and disappeared in 3 patients during follow up. No wound infection. Recurrent symptoms were not detected at end of follow-up.

Conclusion: This technique is safe and effective alternative to Infra-Retinacular ECTR in treatment of idiopathic CTS. Also, it is simple, less expensive technique enabling complete division of transverse carpal ligament and avoiding higher risk for transient median nerve dysfunction.

Electrocardiographic Distinction of Culprit Artery in Patients with Acute Inferior ST Segment Elevation Myocardial Infarction and Multivessel Disease

2024-06-11T14:03:15+00:00

Background: Myocardial infarction (MI) is leading cause of death and disability globally. The electrocardiogram (ECG) is a critical component of the diagnostic workup for individuals with suspected MI. Electrocardiograms are essential in identifying the type and location of acute myocardial infarction. This study aimed to clarify the value of ECG for identification of the culprit artery in acute inferior STEMI with multivessel coronary artery disease.

Methods: This study included 55 patients with acute inferior STEMI who were divided into two groups based on the culprit coronary artery identification at time of primary percutaneous coronary intervention (PPCI). Electrocardiographic analysis was carried out to be compared with angiographic findings that correlate with culprit artery location (either right coronary artery (RCA) or left circumflex (LCX). Group I: Included 43 patients, (culprit was RCA), Group II: Included 12 patients, (culprit was LCX).

Results: After comparing the findings in electrocardiographic leads, it was evident that the degree of ST segment deviation in leads II and V6 was statistically significantly higher in LCX group VS RCA group (1.9±0.8mm VS1.5±1.1mm, pvalue=0.049 and 1.1±1.0VS -0.4±1.0 p-value <0.001 respectively). Also; the degree of ST segment deviation in leads aVL was statistically significantly higher in RCA group vs LCX group (-2.4±0.9mm VS - 1.3±1.4mm, p-value=0.001).

Conclusions: In patients with acute inferior STEMI and multivessel coronary artery disease where LCX is the infarct related artery (IRA), presenting ECG is more likely to reflect less pronounced reciprocal ST depression in aVL and more marked STE in V6.

The Impact of Genotype on Bone Complications in Beta Thalassemia Major Patients

2024-06-12T06:38:02+00:00

Background: Specific genetic mutations in β ‑ thalassemia lead to complete lack of β ‑ globin chain production, considered as β° thalassemia, others allow some synthesis of the β-globin and are known as β + thalassemia. Patients need regular blood transfusions to correct anemia and iron-chelating therapy, to control iron overload. Severe anemia, along with excess body iron, and chelation therapy, can result in complications, as bone abnormalities, growth retardation, liver, cardiac, and endocrine disorders.

Methods: Cross sectional study subjected to record the impact of genotype on occurrence of bone complications in β-thalassemia cases,while 50 thalassemic cases involved from July 2017 to June 2018. DNA sequencing allowed for the cases' genotype identification. Bone density is evaluated using a dexa scan, translated into a Z-score compared to an appropriate reference, as well as bone imaging and laboratory investigations, which all evaluated as biochemical variables.

Results: Low bone mineral density was the commonest bone complication, while osteoporosis and osteopenia represented 34% and 28% respectively, other bone problems presented in 16% of cases. Additionally, a positive correlation between occurrence of osteoporosis, older patients, longer transfusion times, high ferritin levels, and longer transfusion gaps. The three most common mutations discovered were IVS1-110, IVS1-1, and IVS1-6 (28, 26, and 16%, respectively). The β°β° genotype showed a significantly high incidence of complications and low bone density compared to those with β°β+ and β +β + genotypes.

Conclusion: Bone complications are common association in βthalassemia major cases with a clear correlation between genotype and clinical disease progression as well as its severity.

One Month Major Adverse Cardiac Events in Postmenopausal Females with Acute Coronary Syndromes; Conservative versus Invasive Management

2024-06-12T06:55:28+00:00

Background: Myocardial infarction (MI) and cardiovascular disease were long believed to be exclusively male conditions. Thankfully, there is growing recognition in both the medical literature and the public that heart disease is the leading cause of mortality for women and that cardiovascular illness is gender insensitive. This study aimed to compare MACE among post-menopausal females admitted to CCU with acute coronary syndromes.

Methods: The current study included 144 female patients with mean age 59.32 years. Mean BMI was 26.85 kg/m², and positive family history was 78.5%. As regards comorbidity, 41.7%, 48.6%, and 41.7% had comorbid diabetes, hypertension, and dyslipidemia. STEMI was 55.6% of patients in which 10 cases received thrombolytic therapy and 70 cases admitted to PCI. NSTEMI and unstable angina patients were 44.4% in which 20 cases were admitted for PCI and 44 cases received medical treatment.

Results: we enrolled 144 post-menopausal patients presented with acute coronary syndromes and in comparison between the conservative and invasive methods of treatment in each group of STEMI and NSTEMI and following-up the patients for one month for MACE, the MACE was higher in group of invasive arm than conservative arm with 37.8% versus 18.5 % respectively, Heart failure was 7.4% versus 21.1%, Serious arrhythmia was 14.8% versus 26.7%, Reinfarction was 6.7% versus 3.7%,Mortality was 6% versus 0%.

Conclusion: According to the findings of our research, it is possible to conclude, "Compared to the non-invasive approach, the invasive option is associated with worse outcomes in patients with NSTEMI. The noninvasive strategy is associated with better outcomes than the invasive option.

Prevalence study of Malaria among Travelers Coming from Endemic Areas to Egypt

2024-06-12T07:02:57+00:00

Background : The aim of the work is to assess the prevalence of malaria in travelers coming from endemic areas to Egypt either Egyptians or foreigners within two months of their arrival to Egypt.

Methods: Sites of study were Zagazig city, Tropical Medicine Department and Medical Parasitology Department, Zagazig University, Sharkyah Fever Hospitals and Abbasiah Fever Hospital, Cairo. Considering that all participants fulfilled the inclusion and exclusion criteria were included in the study.

Results: During the study period, the registered participants were 300 and were included as a comprehensive sample. The positive malaria patients were 18 (6% of all participants).

Conclusion: Foreign-acquired malaria infections have been elevated to a major concern for Egyptian travelers to African countries. To reduce the danger of catching the disease while traveling, high-risk groups should be made more aware of and given access to effective prophylactic measures against exposure to mosquito bites and malaria parasites. Increased capability for imported case detection is required to reduce the burden of fatal cases, severe malaria, as well as prevent secondary malaria transmission among Egyptians. RDTs have been found to be simple and effective for the rapid detection of malaria, which may encourage Egypt to put control measures against imported malaria into place.

Association between Interarm Systolic Blood Pressure Difference and Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography

2024-06-12T07:24:15+00:00

Background: An elevated risk of cardiovascular events, such as stroke, coronary artery disease (CAD), and all-cause mortality, may be linked to interarm systolic blood pressure difference (IASBPD). In the present study, we aimed to detect accurate risk association of interarm systolic blood pressure difference with coronary artery disease among patients who underwent elective coronary angiography.

Methods: A total of 80 patients who underwent elective coronary angiography and their systolic blood pressure measurement was between 90 and 200 mmHg were included in this cross sectional study. Forty-one patients did not have significant coronary artery disease while 39 patients had it. We examined the relationship between coronary artery disease and IASBPD in this well-defined patient sample.

Results: Among studied patients, systolic blood pressure in the right arm was (130 ± 19.58 mmHg), in the left arm was (113.63 ± 19.81 mmHg), and inter-arm blood pressure difference was (15.88 ± 8.49 mmHg). Inter-arm blood pressure difference (IRBP Difference) did not differ significantly between patients with significant coronary artery disease and those without (16.67 ± 10.34 vs. 15.12 ± 6.27, P= 0.4192). Gender distribution showed notable disparities, with a higher percentage of males in the significant artery disease group compared to those without significant artery disease (89.74% vs. 58.54%, P<.05). Ejection fraction (EF) differed significantly between both groups among cases without significant artery disease having a higher EF compared to cases with significant artery disease (62.12% ± 6.73% vs. 62.12% ± 6.73%, P<.05).

Conclusion: While we have observed significant gender-based disparities and a clear correlation between reduced ejection fraction and the incidence of significant artery disease, our study suggests that the predictive value of the inter-arm blood pressure difference in CAD patients appears limited.

Clinicopathological Impact of CPA4, UHRF1, Glypican-1, and CD90 Expression in Lung Adenocarcinoma and Epithelioid Malignant Mesothelioma

2024-06-12T07:56:33+00:00

Background: Accurate diagnosis, early detection, and differentiation of lung adenocarcinoma from mesothelioma; particularly the epithelioid subtype is needed to allow better management thus to improve their prognosis. Aim of our study was to assess applicability of CPA4, UHRF1, glypican-1 and CD90 expression by immunohistochemistry to differentiate between lung adenocarcinoma and epithelioid mesothelioma in addition to detection of their prognostic roles and relation to patients’ survival.

Methods: We collected samples from 30 patients diagnosed with lung adenocarcinoma and 30 patients diagnosed with epithelioid mesothelioma. For the immunohistochemistry, sections of all collected samples were incubated with CPA4, UHRF1, glypican-1 and CD90 to assess their diagnostic accuracy.

Results: A highly significant association was detected between positive CPA4, UHRF1 expression in lung adenocarcinoma and their diagnostic accuracy (p value <0.001). Also, highly significant association was detected between positive CD90, Glypican 1 expression in epithelioid mesothelioma and their diagnostic accuracy (p value <0.001). CPA4 expression was associated with shorter OS rate (P value 0.019, 0.009) UHRF1 expression was associated with shorter OS rate (P value=0.009)

Conclusions: CPA4, UHRF1, glypican-1 and CD90 were considered novel biomarkers that have important roles in differentiation between epithelioid malignant mesothelioma and adenocarcinoma of the lung with high sensitivity and specificity.

All-in-One Technique versus Lichtenstein Technique for Inguinal Hernia Repair: Comparative Study

2024-06-12T08:12:26+00:00

Background: Chronic inguinodynia is considered the most disabling complications post-inguinal hernia repair. A novel technique (All-in- One Mesh Hernioplasty) is viable for whole cases of the primary inguinal hernia which utilizes a smaller pre-cut mesh covering whole weak regions of the inguinal canal and is wrapped by a fibro-cremasteric sheath to avoid contact between the prosthesis and neural structures. The present study aimed to compare the outcomes of the Lichtenstein technique and the All-in-One Mesh Hernioplasty technique.

Methods: A randomized clinical trial was conducted on 80 patients with a primary inguinal hernia in the Department of General Surgery, Zagazig University Hospitals, Egypt, from January 2018 to January 2020. The patients were categorized equally into 2 groups: group A, involving 40 patients repaired by Lichtenstein technique and group B, involving 40 patients repaired by All-in-One Mesh Hernioplast technique.

Results: There was no significant variation (P> 0.05) among the two groups concerning demographic and clinical presentation. There was no significant variation (P> 0.05) among them as regards wound hematoma, infection, seroma, scrotal edema, and urine retention. Chronic groin pain, persistent numbness, and foreign body sensation were less in group B than in group A and this variation was statistically significant (P=0.003), while there was no significant variation (P> 0.05) between them in hospital stay, time of return to work or normal activity, and mean postoperative follow-up.

Conclusions: All-in-One Mesh Hernioplasty is a safe and effective technique in repairing the primary inguinal hernia with less postoperative chronic inguinal pain.

Correlation of Magnetic Resonance Imaging Changes of Multifidus Muscle with Other Degenerative Changes at Lumbosacral Spine in Patients with Low Back Pain

2024-06-12T08:18:17+00:00

Background: Multifidus muscle (MF) in the back of the vertebral column plays an important role in spinal stability. MF morphology and fatty infiltration can be influenced by factors affecting low back pain (LBP) and evaluated using MRI, CT and US, however MRI provides a igher resolution and allows for better detection of soft tissues. We proposed a new method to assess the degree of MF degeneration in this study.

Methods: The multifidus score was calculated by summation of degree of MF degeneration, with minimum score of 0 and maximum of 6. In cases of disproportion affection of MF on each side, we chose the higher degree of MF affection. A score of 6 means that MF degeneration is graded 2 in either side. We mentioned the influence of other vertebral degenerative pathologies including facet arthropathies, neural canal stenosis and Modic end plate changes. We defined disc pathology as disc bulge, herniation. The main factors affecting MF degeneration are age, body mass index (BMI), duration of compliant in years, presence of sciatica and VAS visual analogue scale (VAS) score.

Results: VAS scores were statistically significantly correlated with degree of MF degeneration, with p value < 0.001. The degree of MF degeneration was significantly correlated with a number of disc pathologies.

Conclusions: Our study concluded a significant relation between MF degeneration and each of VAS and duration of pain, although this relation was not related to the measurement of proportionate changes between each side and different degrees of MF degeneration.

Ventricular Functions in Congenital Heart Diseases: A Tissue Doppler Study

2024-06-12T08:24:43+00:00

Background: Congenital heart diseases (CHD) account for one third of all congenital anomalies. Doppler and Tissue Doppler evaluate cardiac performance and diagnose CHD. Study aim: evaluation ventricular functions in congenital heart diseases using tricuspid plane systolic excursion TAPSI and tissue Doppler-derived left ventricular myocardial performance index MPI.

Methods: The study was performed at Pediatric Cardiology Unit of Zagazig University Hospitals on 70 age and sex matched children classified into case group included 35 patients with CHD and control group included 35 healthy children underwent complete history, conventional echocardiographic and tissue Doppler examination.

Results: There was increase in cases regarding interventricular septum (IVS) and decrease in left ventricular diameter at end diastole (LVDd), left ventricular diameter at end systole (LVDs), right pulmonary artery diameter (RPA) and left atrium diameter more than control group with no difference in between regarding: posterior wall diameter (PW), fractional shortening (FS), main pulmonary artery diameter, left pulmonary artery diameter (LPA) and aorta diameter. There was a highly significant decrease in TAPSE in case more than control group and significant decrease in ejection time (ET) with no significant difference between case and control group regarding LV MPI.

Conclusions: TAPSE is lower in cases compared with control group indicating longitudinal RV dysfunction. The value of LV MPI was slightly higher than that of control that need further studies with a larger number of patients.LV FS did not show any abnormality in cases pointing out ability of tissue Doppler echocardiography to measure segmental LV dysfunction compared to conventional echocardiography.

Efficacy of Oral Omega-3 Fatty Acids on Uremic Pruritis in Hemodialysis Patients

2024-06-12T08:41:54+00:00

Chronic kidney disease-associated pruritus (CKD-AP) is a distressing, often overlooked condition in patients with CKD and end-stage renal disease. It remains one of the most tormenting, frequent, and potentially disabling problems in patients with an advanced or end- stage renal disease who are on dialysis including peritoneal dialysis and hemodialysis. Omega-3 fatty acids are increasingly being used for their clinical benefits some of which are relevant to individuals with advanced CKD. It was found to be a safe drug that has other benefits on uremic pruritis such as reducing cholesterol, triglycerides, LDL, blood pressure, atherosclerosis, and oxidative stress.

Patient and methods: This study was performed as a randomized, clinical trial study on 36 patients under hemodialysis three times a week, for 4 hours each session to assess the effects of Omega-3 fatty acids for treatment of pruritis in hemodialysis patients.

Conclusion: Omega-3 fatty acids was found to be a safe drug and achieved a high therapeutic response with a reasonable cost that is maintained for a relatively long period. In addition to reducing cholesterol, triglycerides, blood pressure, atherosclerosis, and oxidative stress.