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Telescoping nail osteosynthesis in management of osteogenesis imperfecta in growing child

Background and aim Osteogenesis imperfecta (OI) is a hereditary disorder that mainly affects the bones. Bones break easily. The severity may be mild to severe. OI includes short height, a blue tinge to the sclera of the eye, loose joints, breathing problems, hearing loss, and problems with the teeth. Complications may include aortic and cervical artery dissection, and our study aims to evaluate the results of the management of OI with telescoping nails in growing children. Patients and methods This case series study was conducted at Al-Azhar University Hospital, Assuit; 20 patients with OI were included in this study. They underwent telescopic nail osteosynthesis. Result The functional score of the studied sample shows that the highest functional score frequency was 2–5 and 3–6 (15 and 15%, respectively). Radiological scores show that the majority had a score of 11 (95.0%), telescoping of the studied sample shows that 19 (95.0%) had telescoping. Conclusion The treatment of multiple fractures and severely deformed long bones due to OI by the telescoping nail of the Fassier–Duval generation is one of the best choices. One of the challenging problems of OI cases is the late presentation; another challenging problem in such cases is that the growing mechanism is still present.

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The relationship between blood pressure measurement in both arms and the severity of coronary artery disease by SYNTAX score

Background and aim This study aims to evaluate the relationship between inter-arm blood pressure difference and the severity of coronary artery disease assessed by SYNTAX score in patients undergoing coronary angiography (CA). Patients and methods A total of 100 patients undergoing CA were enrolled in the study, with calculation of inter-arm blood pressure difference by BP measurements 1 day before CA, and mean BP was calculated for both arms using all measurements to be compared with SYNTAX score. Results In our study, there was a highly significant relationship between mean inter-arm blood systolic pressure difference (IASBPD) and incidence of SYNTAX score more than or equal to 20 (P<0.001). Moreover, there was a significant relationship between the incidence of SYNTAX score more than or equal to 20 and the incidence of diabetes mellitus, dyslipidemia, high total cholesterol level, high low-density lipoprotein level (P=0.022, 0.035, 0.016, and 0.021, respectively). The mean IASBPD was highly significantly higher and also exaggerated IASBPD was significantly higher in patients with high SYNTAX score compared with patients with low SYNTAX score (P<0.001 and P=0.001, respectively). Conclusion There was a highly significant positive linear correlation between SYNTAX score and mean IASBPD.

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Cranial ultrasound evaluation of relation between degree of prematurity and development of intra-ventricular hemorrhage in preterm neonates

Background and aim Preterm infants are at risk for a variety of brain lesions, which can be diagnosed by cranial ultrasound imaging. Many brain damage develop within the first few weeks of birth. It is critical to diagnose brain injury as soon as possible to implement an effective preventive measures. This study aims to distinguish the relation between grades of prematurity and development and severity of intraventricular hemorrhage (IVH) in preterm neonates. Patients and Methods In this prospective cohort study 150 preterm neonates were enrolled who admitted to the Neonatal Intensive Care Unit, Faculty of Medicine, Al-Azhar University Hospital during the study period from January 1, 2023 to July 31, 2023. All the included patients underwent cranial ultrasound. Results The commonest maternal risk factor for the development of IVH among the studied preterm neonates was premature rupture of membrane, followed by preeclampsia and eclampsia. While the commonest fetal risk factors were early gestational age, low birth weight, and fetal hypoxia. Early gestational age, low birth weight, and premature rupture of membrane were shown to be significant risk factors for development of IVH among the studied preterm neonates. Multivariate logistic regression analysis shows both early gestational age and low birth weight are still significant risk factors for development of IVH. Conclusion Using trans-cranial ultrasound we found that the occurrence and severity of IVH is directly proportional with the degree of prematurity.

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A prospective study to evaluate neonatal trigger score as an early warning system in postnatal wards

Background and aim The newborn baby’s first few days after birth are crucial to their development. This study plans to survey the adequacy of neonatal trigger score (NTS) for recognizable proof of babies in the postpregnancy ward requiring clinical mediation in the ward and neonatal intensive care unit confirmation. Patients and methods A prospective observational study was conducted at Tema Central Hospital for 4 months (March 2023–June 2023). The study included 79 neonates with a mean age of 38.16±1.16 weeks and ranged from 35 to 41 weeks. Twenty (25.2%) of the 79 neonates for whom NTS was administered triggered the NTS, while the remaining 59 (74.8%) did not. The statistically significant (P=0.001) predictive ability of NTS for the detection of neonatal intensive care unit admission by using the receiver operating characteristic curve analysis. Results Seven of the 20 cases that were examined had abnormal heart rates (35.0%), whereas all of the neonates who did not trigger the NTS chart had heart rates that were normal (100%). The areas under the receiver operating characteristic curves had a sensitivity, specificity, and accuracy of 100.0% (95% confidence interval: 1.0–1.0, P=0.001) with a cutoff value of less than 2. Conclusion NTS is an easy, simple, and costless, good predictive and sensitive score for follow-up and early detection of a neonate who needs intervention and admission

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Effects of computerized group drawing and implementation of conceptual diagrams on divergent thinking among the nursing students of Saveh

Background and aim The conceptual diagram is an effective method for the evolution of medical education that helps improve problem-solving, group skills, and creativity. This study aims to determine the effects of the computerized group drawing and implementation of conceptual diagrams on divergent thinking among the nursing students of Saveh. Materials and methods In this quasiexperimental study, the enumeration sampling technique was used to select 102 nursing students in an academic year. The lottery method was then adopted to assign them equally to case and control (comparison) groups (51 members each). Peter Honey’s questionnaire was used to measure divergent thinking of students. The conceptual diagram was then drawn and presented in MindMapper in groups during seven, 90-min sessions. Finally, the data were analyzed in SPSS 20. Results According to the repeated measures analysis of variance, there was an upward trend in the mean (and SD) of divergent thinking scores of students in the case group before, right after, and 1 month after the intervention; however, there was no change in the comparison group (P<0.0001). Conclusion Since this education method had a positive, significant effect on the divergent thinking of students, it is recommended to employ the student-centered method for teaching and learning processes of higher education programs.

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Betadine versus saline in swapping of subcutaneous tissue to prevent surgical site infection after cesarean section

Background and aim The frequency of abdominal wound infection following cesarean delivery ranges from 2 to 10% based on risk factors, so this study aimed to compare betadine (10%) and saline (0.9%) in swapping of subcutaneous tissue for prevention of surgical site infection after primary elective cesarean section. Patients and methods This controlled randomized prospective study was done on 300 patients admitted to the Obstetrics and Gynecology Department at Lsis Specialized Hospital Luxor and Al-Azhar University hospitals of Assiut. Patients were divided into three groups. Results Hospital stay was significantly lower in the povidone–iodine group and saline group in contrast to the control group. No statistically significant variance was noticed among three groups concerning postoperative pyrexia, the need for additional doses of antibiotics, and secondary sutures (P>0.05). No significant variance among the three groups as regards discharge of pus at first, second, and third visits (P>0.05). No significant variance among the three groups as regards infection score at the first, second, and third visits (P=0.880, 1.00, 1.00, respectively). Conclusion The infection rate and infection score remained stable across visits and showed no significant variances among the examined groups. The choice between betadine and saline for subcutaneous tissue irrigation in cesarean sections may influence specific outcomes, including hematological parameters, hospital stay, and signs of infection.

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Ultrasonographic evaluation of major salivary glands in patients with juvenile idiopathic arthritis: a comparative case series

Background and aim Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. Impaired salivary gland function has been previously reported in children with JIA. Our study explores the possible subclinical lesions of major salivary glands in children with JIA by musculoskeletal ultrasound (US) and correlates the findings with disease activity and inflammatory indices. Patients and methods Major salivary glands of 28 children with JIA (according to International League of Associations for Rheumatology criteria) and 20 healthy controls were evaluated by ultrasound. The findings were correlated with other disease parameters. Ages of participants ranged from 5 to 16 years, with a mean of 11.04± 2.968 years and 33 (68.75%) participants were females. Results According to the Grey-scale score, there were 16 (57.1%) patients with normal parenchyma (grade 0), four (14.3%) patients with minimal change (grade 1), two (7.1%) patients with moderate change (grade 2), and six (21.4%) patients with severe change (grade 3). Power Doppler signal has been detected in the submandibular glands of only two patients with systemic-onset JIA. No abnormality has been detected in the healthy control group. There was a significant positive correlation between Grey-scale total score with erythrocyte sedimentation rate (r=0.694, P<0.001), juvenile arthritis disease activity score (r=0.713, P<0.001), and parents’ disease assessment (r=0.678, P<0.003). Conclusion Ultrasound detected subclinical salivary gland abnormalities are frequent in JIA patients and are associated with disease activity. However, more studies are needed to support these preliminary results.

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Role of sclerotherapy in treatment of non-neoplastic ovarian cysts

Background and aim Ovarian cysts, fluid-filled sacs, are common, benign, and typically go away on their own. Ovarian cysts can be diverse, including theca-lutein, follicular, polycystic, peritoneal inclusion, and hemorrhagic cysts. Therefore, this study aims to investigate the role of sclerotherapy in the treatment of recurrent or persisting non-neoplastic ovarian cysts. Patients and methods A cohort study enrolled 52 patients who presented with non-neoplastic ovarian cysts based on ultrasound findings and Tumor markers analysis, underwent sclerotherapy (injection of 1 ampule of Polidocanol 20 ml amount (AMOUN)), to detect its effect in the rate of cyst recurrence, all patients were followed-up with ultrasound and Color Doppler sonography at 1, 3, and 6 months after the procedure. In some cases of cyst persistence, a second aspiration and re-injection with Polidocanol were attempted (n=9), while the rest refused repeated aspiration and needed medical management or surgery. The main outcome measure was the disappearance of the cyst and the avoidance of surgery. The cyst was considered resolved if follow‑up revealed either no cystic lesion or only a follicle‑like cyst no more than 30 mm in diameter. This study was conducted at Al-Azhar University Hospital, Assiut, from September 2022 to January 2024. Results As regards the total recurrence of studied cases, there were 35 (67.3%) cases with resolved cysts and 17 (32.7%) cases with recurrent or persistent cysts. High statistically significant relation between recurrence and cyst size (P<0.001). It was found that the larger the cyst, the greater the recurrence rate. Conclusion Sclerotherapy emerges as an effective therapeutic option for the management of non-neoplastic ovarian cysts.

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