Ain Shams University Hospitals Research Articles

Predicting the Prognosis of Acute Pulmonary Embolism Using Computed Tomography Pulmonary Angiography Measurable Parameters in Comparison to Pulmonary Embolism Severity Index (PESI)

Abstract Background Pulmonary embolism is a leading cause of cardiovascular death and with CTPA being the gold standard in its diagnosis, it is feasible with radiologic parameters to stratify and early identify patients at risk of death. Aim of the Work To detect the prognostic value of radiologic parameters of CT pulmonary angiography (CTPA) in comparison to pulmonary embolism severity index (PESI). Patients and Methods This was a prospective study done at Ain Shams University Hospitals and included 84 patients diagnosed with acute pulmonary embolism and referred to the radio-diagnosis department for CT pulmonary angiography examination. Results 3.6% of patients died within 24 hours and 44% died within 30 days of diagnosis of PE. All patients who died within 30 days had abnormal CTPA findings especially RV/LV ratio, PT diameter, septal bowing and contrast reflux in the IVC which revealed significant relationship between them and 30-day-mortality. Meanwhile PESI showed contradictory results and was less reliable than the radiologic parameters. Conclusion The CTPA radiological parameters appeared valuable for the prediction of 30-day mortality in patients with acute PE, and was superior to the PESI.

The Efficacy of Intralesional Pentoxifylline Injection versus the Standard Intralesional Corticosteroid Injection in The Treatment of Alopecia Areata

Abstract Background Alopecia areata is a nonscarring skin disease affecting the scalp or other body parts. The etiology of AA is still controversial and various pathogenic causes are under investigation. Several treatment modalities are used in managing AA. Objective to evaluate the efficacy and safety of (PTX) injection in treatment of localized AA compared to intralesional corticosteroids TRA on 30 patients with multiple patches of AA. Patients and Methods The current study was a prospective intra-patient comparative controlled clinical trial. Patients were recruited form outpatient clinic of Dermatology, Ain Shams University Hospital in the period from November 2019 to May 2020. 30 Egyptian patients (11 males &19 females) with at least three patches were enrolled to the study. The diagnosis of AA patients enrolled in the study based on clinical signs. Results To sum up, both PTX and ILCS has good results in treatment of AA, as each of them has its own advantages. Corticosteroids are rapidly acting while PTX effects are delayed but increased progressively throughout consecutive sessions. So using corticosteroids in combination with PTX can augment each other and give better results. Conclusion Treatment of AA with intralesional PTX exerted significant increase in hair density, total hair count, terminal hair count and percentage of terminal hair which is evident after completion of the sessions. Treatment with ILCS exerted significant increase hair density, total hair count, terminal hair count and percentage of terminal hair after treatment. Comparison of both treatment modalities revealed slight better response with PTX compared to ILCS. In conclusion, the current study revealed that Intralesional combined administration of PTX and TRA can be beneficial for patients suffering from AA. Steroid showed a rapid response that could be maintained by adding PTX.

Pilot study: Measurement of first phase ejection fraction in a sample of Egyptian people

Abstract Background Left ventricular dysfunction (LVD) constitutes the final common pathway for a number of cardiac disorders. Ischemic heart disease (IHD) is the dominant cause of heart failure (HF). The remaining etiologies include cardiomyopathy, hypertension (HTN), valvular heart diseases (VHD) and myocarditis. Data from the Framingham heart study shows that it develops in approximately 16% of men and 18% of women who had diabetes; 12% of men and 8% of women who had HTN; and 30% of both sexes who had myocardial infarction (MI). Aim of the Work to measure the first phase ejection fraction (EF1) in a sample of Egyptian population and to determine its normal value and to assess its reliability in assessment of systolic function. Patients and Methods This study is a prospective and observational clinical that was conducted at El- Mokattam health insurance & Ain Shams University hospitals from October 2019 to March 2022. Results we found that mean EF1 was 35.41 ± 4.16 %, its minimal value was 26.9% and its maximal value was 43.4%. We found that EF1 was reliable and reproducible as there was no statistically significant intra observer nor inter observer variabilities (p-value was 0.547 & 0.602 respectively). We found that there was no significant statistical correlation between EF1 and gender or heart rate or other demographic or clinical data. Conclusion EF1 is a simple and reproducible measurement of LV systolic function that is easily measured by transthoracic echocardiography and is considered comparable to other indices that measure LV systolic function.

Serum Resistin Level as a Novel Marker of Disease Activity in Patients with Ulcerative Colitis

Abstract Background Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract, which clinically contains Crohn’s disease, ulcerative colitis, and other conditions. Aim of the Work The aim of our study is to asses serum resistin level in disease activity and remission in patients with ulcerative colitis disease. Patients and Methods A cohort study for 6 months on 40 Egyptian patients presented with ulcerative colitis disease over 18 years old visiting the outpatient clinics or admitted in Ain Shams University Hospitals. Results The present study revealed a highly significant elevation of serum Resistin in active ulcerative colitis patients with p-value <0.001 which shows direct relationship between the activity of ulcerative colitis and serum Resistin. Resistin was positively correlated with inflammatory markers (CRP and ESR) in UC patients. And there is negative relation between resistin and Hb, fecal calprotectin. Conclusion Serum Resistin is a valuable noninvasive marker in the assessment of disease activity in ulcerative colitis patients, correlated positively with inflammatory markers (CRP and ESR). Other studies should be done on larger size of participants to determine the the role of serum Resistin as a marker of disease activity in patients with Inflammatory bowel disease.

Evaluation of the Use of Negative Pressure Wound Therapy for Securing Split-Thickness Skin Grafts for Coverage of Chronic Wounds

Abstract Background Split-thickness skin grafting (STSG) is a versatile reconstructive option that has passed the test of time. However, many factors can cause poor graft take. Negative pressure wound therapy (NPWT) has transformed the management of complicated wounds and has been used as a means for securing split-thickness skin grafts (STSG). The role of NPWT in the fixation of grafts was compared to conventional Tie over bolster dressing. Aim of the Work To assess whether NPWT would result in a better graft take especially in wounds with large surface area. Patients and Methods This is a parallel group randomized control study. conducted from November 2021 to June 2022 in the Plastic, burns, and maxillofacial Surgery Department, Ain Shams University Hospitals. Block randomization of 52 patients into one of the two groups (NPWT vs. non-NPWT; 26 patients each) was done. Graft take/loss and length of hospital stay post-grafting were assessed. Results Mean graft take in the NPWT group was quantitatively and qualitatively better than that in the non-NPWT group. None of the patients in the NPWT group required a second coverage procedure. No major complication was encountered with the use of NPWT. Conclusion Compared with conventional tie over bolster dressing, NPWT is a simple, yet powerful and effective alternative in the integration of STSG. It significantly increases the rate of graft take especially in large wounds, while reducing rates of complications and hence re-operation.

CTNNB1 Polymorphism (rs121913407) in Circulating Tumor DNA (ctDNA) in Egyptian Hepatocellular Carcinoma Patients: A Case Control Study

Abstract Background Hepatocellular carcinoma (HCC) represents the sixth most common cancer worldwide and the fourth in Egypt. Persistent inflammation and specific somatic mutations in driving genes play major role in the development of HCC. One of these somatic mutations is CTNNB1 mutations with subsequent activation of ß-catenin in HCC, associated with a risk of malignant transformation. In this study, we investigate the clinical utility of peripheral blood circulating tumor DNA (ctDNA) CTNNB1 SNP (rs121913407) (c.133T>C) in HCC patients compared to pathological chronic hepatitis C virus (HCV) patients and healthy controls. Aim of the Work The aim of this work is to study the clinical utility of peripheral blood ctDNA to assess CTNNB1 SNP (rs121913407) (C. 133T>C) in HCC patients and the results will be compared to findings in pathological (Chronic Hepatitis C virus patients) and healthy controls. Patients and Methods Case-control study at Ain Shams Centre for Organ Transplantation, Ain Shams University Hospitals, enrolling twenty-eight adult HCC patients (twelve early HCC patients and sixteen advanced HCC patients), ten patients with chronic hepatitis C as a pathological control group, and ten healthy controls, plasma were collected, and stored at -80 °C. Detection of mutations in the gene locus CTNNB1 rs121913407 (c.133T>C) was done by Real-time PCR. Results There was statistical significant difference between early and late cases of HCC as regards AFP, AST however, all of our studied cases (early and advanced HCC) in addition to HCV and healthy control groups were CTNNB1 wild (TT) genotype. Conclusions None of our recruited subjects showed CTNNB1 rs121913407 gene mutation. Further studies on larger number of patients are needed to clarify and confirm the clinical utility of CTNNB1 Polymorphism (rs121913407) in the pathogenesis of HCC related to HCV in Egyptian population.

The Value of First Trimesteric 3D Ultrasound Placental Volume in Prediction of Pre-Eclampsia in High-Risk Pregnant Women

Abstract Background Hypertension with pregnancy remains a major health issue for women and neonates worldwide. Pre-eclampsia (PE) complicates 2–5% of all pregnancies and is a leading cause of maternal and neonatal mortality and morbidity. PE and eclampsia are responsible for approximately 14% of maternal mortality. PE is also associated with later-life cardiovascular disease among women and their offspring. Aim of the Work To determine the value of first trimesteric placental volume in predicting pre-eclampsia in high-risk pregnant women. Patients and Methods This Prospective observational study was conducted at tertiary care hospital at Ain Shams University hospitals from September 2019 till November 2021 and performed on a total of 125 pregnant women with high risk of PE at 12 to 12 + 6 week of gestation attending Fetal care unit, Ain Shams University Maternity Hospital. Results DBP statistically had significant moderate diagnostic performance with DBP cut-off value of ≥ 79.0 mmHg in predicting preterm delivery and SGA with significant low diagnostic performance in predicting NICU admission with DBP sensitivity of 83.3%, 67.9%, 64.5% and specificity of 74.8%, 76.3% and 76.6% in predicting preterm delivery, SGA and NICU admission respectively. Conclusion Placental volume and diastolic blood pressure (DBP) were significantly lower in cases with preeclampsia and predictive of maternal complications of HELLP syndrome, Renal impairment, ICU admission and predictive of preterm labor, SGA and NICU admission.

Evaluation of Serum Kallistatin in Patients with Hepatocellular Carcinoma

Abstract Background Liver cirrhosis is the most frequent long-term consequence of all chronic liver diseases. Cirrhosis is often asymptomatic and unsuspected until complications. The annual incidence rates of liver cirrhosis and hepatocellular carcinoma is related with chronic hepatitis B or C all over the world. The majority of patients with liver cirrhosis or hepatocellular carcinoma die from complications, which happened relatively early in the course of the disease. Thus, the early diagnosis of liver diseases is the only solution for this great problem. Aim of the Work In the current study we aimed to evaluate serum kallistatin in Egyptian patients with hepatitis C virus related liver cirrhosis and hepatocellular carcinoma. Patients and Methods This case control study enrolled 90 Egyptian subjects aged ≥ 18 years old at Ain shams university hospitals, participants were classified into 3 groups as follow: Group 1: 30 patients with hepatocellular carcinoma (patients have been diagnosed with triphasic CT). Group 2: 30 patients with hepatitis C virus related liver cirrhosis (patients diagnosed according to clinical, laboratory and radiological findings. Group 3: 30 healthy subjects serving as a control group. Results This study found that patients with liver cirrhosis and HCC have lower levels of serum Kallistatin compared to a control group. In the HCC group, patients with more severe liver disease (Child class C) had lower Kallistatin levels than those with less severe disease (Child class A and B). Kallistatin was negatively correlated with certain markers of liver disease and inflammation in both groups, and positively correlated with hemoglobin and albumin. The study also tested the diagnostic accuracy of Kallistatin for detecting liver cirrhosis and HCC, and found that it had 66.5% accuracy for cirrhosis and 98% accuracy for HCC at specific cutoff points. Conclusion Serum Kallistatin has a potential rule as a new biomarker for the diagnosis and evaluation of liver cirrhosis and HCC. The present study was limited by the small sample size. Also, all participants were from the Egyptian population with liver disease induced by HCV- infection with no information if our findings would be valid for other population with different etiologies. Thus, further investigation should be carried out in order to validate these findings

Effect of Intra-Operative Erector Spinae Plane Block on Post-Operative Consumption of Opioids after Video-Assisted Thoracoscopic Surgeries (VATS)

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Although VATS is less painful than an open thoracotomy, patients may still feel severe pain and restricted mobility during the first few postoperative hours. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Objective to assess the analgesic efficacy and safety of ultrasound guided ESPB done at lumbar transverse process level in patients undergoing VATS for postoperative analgesia. Patients and Methods The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients’ consent. It included a total of 30 adult patients aged 21-50 years, Scheduled for lumbar spine surgeries. Patients were randomly divided into two equal groups, 15 each, according to the inclusion and exclusion criteria. Group A (n = 15): Received fentanyl 1-2 mcg/kg during induction of anesthesia and maintained by additional boluses of fentanyl.5 mcg/kg, also received ketrolac 30mg and perfelgan 1gm before extubation in addition 40 ml bupivacaine 0.25% (20ml on each side) as a single level bilateral injection for ESPB. Group B (n = 15) (the controlled group): Received only fentanyl 1- 2 mcg/kg during induction of anesthesia and maintained by additional boluses of fentanyl.5 mcg/kg, also received ketrolac 30mg and perfelgan 1gm before extubation. Results The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analgesic effect in patients undergoing VATS also reduced the total amount of postoperative morphine consumption in comparison to controlled group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting due to decrease opioids intake. Conclusion Ultrasound-guided bilateral erector spinae plane block reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients’ satisfaction in the first 24 hours after VATS, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB slightly decreased the rate of PONV. This might be because the use of ESP might have decreased the use of intraoperative opioids.

Prognostic Value of Systemic Arterial Lactate Levels in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract Background Acute myocardial infarction is the most severe manifestation of coronary artery disease, which causes more than 2.4 million deaths in the USA, more than 4 million deaths in Europe and northern Asia, and more than a third of deaths in developed nations annually. Objective To assess the prognostic value of systemic arterial lactate levels in patients with ST segment elevation myocardial infarction undergoing primary PCI and correlate with the results of primary PCI and 30 days MACE follow up. Patients and Methods This study included 300 patients who presented with documented STEMI and underwent reperfusion by successful primary PCI in Ain Shams University hospitals. Results There was statistically significant positive correlation found between serum lactate and (WBCs) count, (HbA1C) level and cardiac enzymes (CKtotal - CKmb – troponin) and negative correlation found between serum lactate and ejection fraction in echocardiography. Also, we found that other parameters were associated with MACE follow up in 30 days such as Killip class at admission, ST segment elevation resolution, heart block in ECG, lower ejection fraction, dyslipidemia, post-procedure TIMI flow, peri-procedural time intervals and occurrence of complications. Conclusion The value of an early lactate measurement in patients with STEMI is to be a part of the risk stratification of these patients and intensified medical care should be considered to patients with strongly elevated lactate levels. Also, increasing arterial lactate levels were associated with occurrence of MACE in 30 days, worse hemodynamics, lower ejection fraction in echocardiography, higher HbA1C level, large infarct area (cardiac biomarkers peak level), poor post-procedure TIMI flow and thrombus grade.

Effect of Interleukin-6 Inhibitor (Tocilizumab) in Treatment of Severe Cases of COVID-19 in Intensive Care Unit, Prospective Clinical Trial

Abstract Background COVID-19 is a respiratory disease induced by a novel coronavirus (SARS- CoV-2), having already caused more than 2.5 million deaths over the world. Most people with COVID-19 have only mild or uncomplicated symptoms. Aim of the Work to study the effect of using Tocilizumab in treatment of severe cases of COVID-19 in ICU. Patients and Methods is a clinical trial study (Analytic, Intervention study, single arm, prospective); this study was carried out at Ain shams university hospitals. Results The mean Time to death from receiving Tocilizumab was 6.1888 ± 0.6 SD (Days), the mean Hospital length of stay 14.94 ± 1.85 SD (Days), the number of patients required Mechanical Ventilation was 29 Patients, the mean Duration of mechanical ventilation was 15.19 ± 1.094SD (Days), the number of patients who demonstrated clinical improvement was 38 (73%) and the number of patients who discharged alive was 31 (60%). Conclusion in critically ill adult patients with Covid-19 receiving organ support in ICUs, treatment with the interleukin-6 receptor antagonists, Tocilizumab improved outcomes, including survival. Many patients achieved clinical improvement and were eventually discharged from the hospital.

Retrospective Study for Evaluation of TIRAD Scoring System Irrespective of FNAC in Decision Making Outcomes in Thyroidectomy

Abstract Background Thyroid nodules present a common clinical problem. Palpable nodules are present in about 5% of the population, and are noted incidentally on ultrasound in up to 70% of people, with increased prevalence in older patients. The incidence of thyroid nodules has increased due to exposure to medical radiation, iodine intake, obesity, insulin resistance, genetics and inorganic phosphates. With a 300% increase in the annual thyroid cancer rate. Aim of the Work The aim of this study is to evaluate the value of Ultrasound and TIRAD scoring system for decision making outcomes in thyroidectomy done for thyroid nodules. Patients and Methods This Retrospective cohort study was conducted at (General surgery department), Ain Shams University Hospitals and Ain shams University specialized Hospitals and was conducted over a period of six months starting from date of approval of the protocol. Results In our study, Conventional sonography has 66.66% sensitivity and 92.5% specificity as it suspected malignancy (positive suspecting findings) in 14 patients; eight of them were proved to be malignant and six of them were benign by histopathology accounting for low positive predictive value (57.14%) and it suspected benignity (negative suspecting findings) in 78 patients; 74 of them were perfectly correlated with the histopathology accounting for high negative predictive value (94.87%). In our study, the rate of detecting patients with thyroid cancer (sensitivity) was calculated as 80%, the rate of distinguishing healthy individuals (specificity) was 88.88%, the Positive Predictive Value (PPV) was 57.14% and the negative predictive value (NPV) was 96% for FNAC. In our study, the sensitivity and the specificity of FNAC in detecting cancer was near to the literature but the (PPV) was lower than the literature and was non diagnostic in fourty patients (40%), we think that this discrepancy depends on many factors including radiology, pathology, and the materials used in FNAC method, and patients with multiple nodules. Conclusion Neck US and FNAC have proven low sensitivity in differentiating malignant from benign thyroid nodules

Effectiveness of cupping and aversion therapies as adjuvant methods for smoking cessation

Abstract Background Tobacco addiction affects both the mind and the body. Most people find that a mix of medicine, a strategy to change personal habits, and emotional support is the most effective way to quit. The aim of the work was to compare between the effectiveness of cupping therapy and aversion therapy as adjuvant methods in smoking cessation program. Patients and methods A prospective randomized study was done on 60 smokers recruited from Ain Shams University Hospitals who were divided into three groups. Group I : included 20 participants subjected to counseling only (the five A’S); Group II : included 20 participants subjected to counseling and aversion therapy using onion-powdered cigarettes by mixing tobacco with dried onion powder by an equal amount; Group III: included 20 participants subjected to counseling and a monthly bloodletting cupping session for 3 consecutive months, follow up visits were conducted every 2 weeks for 3 months to assess outcome and withdrawal symptoms. Results There was no statistically significant difference (p value >0.05) between the success rate in the three different groups. The success rate of quitting was the same among smokers in group I and group III ( complete success 10% and partial success 10%), while the success rate of quitting among smokers in group II was ( complete success 0% and partial success 15%). There were significant statistical correlations (P < 0.05) found between the outcome and the age, occupation, duration and pack/year smoking, while there was insignificant statistical difference (P < 0.05) between the outcome and marital status, comorbidities and previous quitting attempts. There was no significant difference between three groups in the frequency of withdrawal symptoms during follow up visits, while there was significant statistic reduction in frequency of dizziness, headache and fatigue between follow up visits in the three groups, weight gain increased during follow up visits. Conclusion Using adjuvant methods like aversion and bloodletting cupping therapy in smoking cessation programs doesn’t seem to produce significant change in success rate of quitting smoking.

Diagnostic Value of Plasma Methylated Septin 9 in Detection of Hepatocellular Carcinoma in Egyptian Patient with Post Hepatitis C Liver Cirrhosis in Comparison to Serum Level of Alphafeto Protein

Abstract Background Egypt has the highest hepatitis C virus (HCV) prevalence worldwide. Cirrhosis secondary to HCV is associated with the highest annual risk for developing hepatocellular carcinoma. The burden of HCC has been increasing in Egypt with a doubling in the incidence rate in the past 10 years. HCC contributes to 14.8% of all cancer mortality in Egypt. Most HCCs (80%) arise in a cirrhotic liver, a situation where there has been longstanding hepatocyte damage and chronic inflammation leading to fibrosis. Aim of the Work This study aims to evaluate the diagnostic value of plasma mSEPT9 assay in detection of HCC in Egyptian patients with post hepatitis C liver cirrhosis in comparison to serum level of α-fetoprotein (AFP). Patients and Methods This is a prospective case-control study conducted at the Gastroenterology department in Ain Shams University Hospital. The study population consisted of 80 subjects, divided into three groups: 40 patients with hepatocellular carcinoma, 20 patients with liver cirrhosis, and 20 healthy subjects as controls with matched age and gender. Results The study found that hepatocellular carcinoma (HCC) was more frequent in male patients and that the age of HCC patients was statistically significantly higher than patients with cirrhosis and healthy controls. Patients with HCC and cirrhosis had a higher Child Pugh score than healthy controls. Portal hypertension and portal vein thrombosis were more frequent in HCC and cirrhosis patients than in the control group. Liver enzymes were higher in patients with HCC and cirrhosis compared to healthy controls, while hemoglobin and platelet levels were lower in patients with HCC. Hepatitis C antibody and PCR were positive in HCC and cirrhosis patient groups. AFP and Methylated Septin 9 levels were higher in patients with HCC and cirrhosis than in healthy controls, and AFP had better diagnostic accuracy than Methylated Septin 9. Both AFP and Methylated Septin 9 levels were positively correlated with age, Child Score, liver enzymes, and coagulation profile and negatively correlated with platelet count and hemoglobin level. AFP level was positively correlated with the number of focal lesions and liver size. Conclusion This study demonstrated that plasma Methylated Septin 9 can be a promising noninvasive and circulating epigenetic biomarker for HCC diagnosis at the individual level. However, our results showed that AFP was superior than Methylated Septin 9 in the detection of HCC, Methylated Septin 9 has higher Sensitivity. It was suggested that the combination of plasma mSEPT9 and AFP could enhance the sensitivity of Methylated Septin 9 or AFP alone in the diagnosis of HCC. Further comparative studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.

Study of Serum Complement 3 Split Product iC3b /C3 Ratio in a Cohort of Systemic Lupus Erythematosus Patients

Abstract Background Systemic lupus erythematosus (SLE) is a chronic autoimmune systemic disease that causes widespread multi organ inflammation. The exact cause of SLE remains unclear; however, genetic, hormonal, and environmental factors contribute to the development of the disease. Aim of the Work The aim of this study is to measure the ratio of complement split product iC3b to C3 and its relation to disease activity and lupus nephritis in a cohort of SLE patients. Patients and Methods This study is a Cross sectional case control study conducted in internal medicine and Rheumatology unit, Ain Shams university hospital and Rheumatology unit, Maadi military hospital. Our study included. Results The present study shows that female were (76%) in active group of SLE patients and (60%) in inactive group while male were (24%) and (40%) respectively. with no significant difference. The mean of Disease Duration was (5.66 ± 1.97) with a range from 3 and 10 years in active group of SLE patients and (5.08 ± 1.54) with a range from 3 and 9 years in inactive group. with no significant difference. Regarding clinical manifestations of SLE the present study shows that active group of SLE patients had statistically highly significant increase in incidence of lupus nephritis, arthritis, serositis, oral ulcers, malar rash (p < 0.001) with significant increase in incidence of alopecia and neurological manifestations (p < 0.05). The current study shows that active group of SLE patients had statistically significantly higher mean ESR, anti-DNA titre, 24hr urinary proteins, serum creatinine, serum urea, and GFR levels (p = 0.000) than inactive group, Also active group had significant leucopenia, anemia (p = 0.000, 0.005 respectively) and C3 was significantly more consumed than inactive group (p < 0.05) Conclusion The ratio of complement split product iC3b to C3 concentrations correlates with the extent of SLE disease activity more than C3 alone. Furthermore, the iC3b:C3 ratio may discriminate between patients with lupus nephritis and patients without lupus nephritis. Detection of SLE disease activity and lupus nephritis by iC3b/C3 ratio help to make a proper decision in management to induce remission.

Prognostic Ability of the Wound, Ischemia, Foot Infection (WIfI) Classification System in Diabetic Patients with Non-Healing Ulcer

Abstract Objectives Several classifications have been published to predict limb salvage in diabetic patients with non-healing ulcer to aid in the management plan. The Society for Vascular Surgery (SVS) Lower Extremity Guidelines Committee has composed a new classification system that reflects the three major factors that impact amputation risk and clinical management Our goal was to evaluate the predictive ability of this wound, ischemia and foot infection(WIfI) classification as a predictor of limb salvage in diabetic patients with non-healing ulcer Methods a prospective single arm observational cohort study conducted on 50 patients within 2022 at single center, Ain Shams University Hospitals, Patients are diabetics who had non healing ulcers some of the cases underwent angioplasty or debridement, then follow up of the wounds was done. Limbs were stratified into clinical stages 1 to 4 based on the SVS WIfI classification for amputation risk. Results Our study included 38 males (76%) and 12 females (24%). The age range between 35 years and 73 years with mean age of 59±8.81. All of the patients are diabetic. The percentage of patients with hypertensive ( 76 %), 54% of them were smoker & 7 were suffering from ESRD. limb salvage was achieved on 75 % of cases. All cases have been classified according to WIFI classification into clinical stages I-IV and their percentage were 6%,12%,40% and 42% respectively. WIfI classification was significant in predicting the major or minor amputation as well as ulcer healing. As Major amputation among each WIfI classification group low, moderate and high risk was 0%, 10%, 47% respectively. Risk of minor amputation was 22%, 40% and 76% respectively. While ulcer healing was 100%, 85% and 52% respectively. Conclusion The likelihood of an amputation after one year in patients with non healing ulcer increases with higher WIfI stages, so The WIfI classification is applicable in prediction of limb salvage in diabetic patients with non-healing ulcer. Smoking and aging also decreases the chance of limb salvageability

Ticagrelor versus Clopidogrel in Prevention of No Reflow after 1ry PCI in Diabetic Patients with STEMI

Abstract Background Adequacy of coronary flow can be judged upon using several methods like TIMI Grade and myocardial blush grade. No-reflow phenomenon, defined as incomplete reperfusion at the microvascular level despite adequate patency of the occluded artery, remains an important limitation of primary percutaneous intervention in STEMI patients nowadays. We aim in this study to investigate the relationship between the antiplatelet loading dose whether to be Ticagrelor or Clopidogrel and post intervention coronary flow, bleeding risk in these patients. Aim of the Work To compare between the effects of preoperative loading dose of Ticagrelor and clopidogrel in Diabetic STEMI patients undergoing primary percutaneous coronary intervention regarding prevention of no reflow, Instent thrombosis and short term bleeding risk. Myocardial reperfusion was judged upon using TIMI Grade and myocardial blush grade. Patients and Methods a single center prospective randomized controlled trial based at the coronary care units in Ain shams university hospitals. The study included Three hundred Diabetic patients presenting to Ain shams university hospitals diagnosed with STEMI in the ER fulfilling the inclusion criteria were randomized to receive Ticagrelor (150 patients) or receiving clopidogrel (150 patients) Results As regard TIMI flow there was statistically highly significant highly significant difference between two studied groups with P value 0.000 where in group A 64 % of patients developed TIMI III flow, 22.7 % with TIMI II flow, 12.7% with TIMI I and 0.7% with TIMI 0 While in group B 86% of patients developed TIMI III flow, 9.3% of them developed TIMI II, 3.3 % developed TIMI I flow and 1.3 % developed TIMI 0. As regard MBG there was statistically highly significant difference between two groups with P value 0.00 where in group A where percentage of patients with MBG grades 0,1,2 and 3 were 4%, 16 %,18 % and 62 % respectively while in group B percentage of patients with MBG grades 0,1,2 and 3 were 1.3 %, 3.3 %, 9.3 % and 86 % respectively. As regard echo EF, there was statistically significant difference between two groups with P value 0.036 where mean EF in patients with group A was 40.50 ± 7.93 while the mean EF in patients with group B was 42.55 ± 8.88 . Conclusion Ticagrelor loading before primary PCI resulted in improved post-procedural TIMI flow. It also increased the post-procedural MBG. This resulted in a significant increase in the number of patients having more post-procedural Ejection fraction as measured by modified Simpson’s method. However, it did not decrease incidence of in-hospital MACE. Also there was no significant increase in risk of major nor minor bleeding in both young and elderly patients.

Serum Ferritin and Cellular Reactive Protein (CRP) in Non Alcoholic Fatty liver Disease (NAFLD) and Non Alcoholic Steatohepatitis (NASH) Patients

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, and it comprises a spectrum of hepatic abnormalities from simple hepatic steatosis to steatohepatitis, fibrosis, cirrhosis, and liver cancer. Simple steatosis (i.e., NAFL) rarely progresses to advanced disease whereas, in approximately 20% of patients with NASH, it progresses to fibrosis and cirrhosis and potentially to hepatocellular carcinoma over a 15-year time period. Aim of the Work To study the relation between serum ferritin and CRP levels and severity of non- alcoholic fatty liver disease NAFLD and non-alcoholic steatohepatitis NASH. Patients and Methods This case control study was conducted on patients attending the Hepatology Outpatient Clinic at Ain Shams University Hospital between December 2019 to May 2020. Results In group A there is significant correlation between ferritin and age, ALT, AST, albumin, CRP, LDL, BMI, cholesterol, triglycerides and NAFLD fibrosis score. But there is no significant correlation between ferritin and Hb, platelets, HDL and fasting blood sugar FBS in group A. In group B there is significant correlation between ferritin and ALT. Ferritin has cutoff point of > 168 with 80% sensitivy & 80% specificity. In group A there is significant correlation between CRP and age, BMI, ALT,AST, albumin, LDL, cholesterole, triglycerides and NAFLD fibrosis score. In group A there is no significant correlation between CRP and Hb, platelets, FBS and HDL. While in group B there is significant correlation between CRP and BMI, ALT, albumin, LDL, cholesterole and triglycerides. CRP cutoff point of > 1.3 with specificity 90% but sensitivity 35%. Conclusion In conclusion, in this study we tried to find a relation between serum ferritin and CRP levels and severity of non-alcoholic fatty liver disease NAFLD and non-alcoholic steatohepatitis NASH. We found that s. ferritin and CRP are significantly elevated in NAFLD and more elevated in NASH with a link between serum ferritin and insulin resistance and the whole metabolic syndrome. Serum ferritin and CRP are related to disease progression with significant correlation with NAFLD fibrosis score.

Assessment of Anti-Reflux Suture in One Anastomosis Gastric Bypass for Prevention of Biliary Gastritis

Abstract Background Obesity continues to be a leading public health concern associated with many comorbidities and major hindering effect on the daily lifestyle of many people around the world. Surgical treatment for obesity has proved that it is the best and most effective, durable means of preventing the life-threatening complications and serious problems associated with morbid obesity. Objective Assessing the effect of the anti-reflux suture on the incidence and clinical consequences of bile reflux in OAGB Procedure. Patients and Methods In this prospective randomized study, 30 patients were selected in Ain Shams University hospitals between November 2021 and May 2022 for assessment of impact of Anti reflux suture on the incidence of post OAGB biliary gastritis. Results The cases presented in this study did not undergo upper GI endoscopy when they presented with symptoms of reflux or gastritis and thus it was not possible to differentiate between the presence of GERD or biliary gastritis as the source of their symptoms. Conclusion OAGB is safe and one of the leading procedures for treatment of obesity but it is still surrounded by controversy regarding its relation and effect on bile reflux gastritis. As far as this study shows, the anti-reflux suture modification alone does not seem to prevent the incidence of biliary reflux gastritis post OAGB.

Erector Spinae Plane Block versus Patient Controlled Analgesia for Postoperative Analgesia in Patient Undergoing Urologic Surgeries with Lumbar Incision

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Urologic surgeries with lumbar incision are usually associated with acute postoperative pain and restricted mobility. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Aim of the Work The present study was designed to detect the effectiveness of ESPB for post-operative analgesia in urologic surgeries with lumbar incision and its effectiveness to decrease the use of analgesic drugs requirements compared to PCA. Patietns and Methods The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients‟ consent. It included a total of 60 adult patients aged 21-60 years, Scheduled for urologic surgeries with lumbar incision e.g: open nephrectomy. Patients were randomly divided into two equal groups, 30 each, according to the inclusion and exclusion criteria. Group A (n = 30): will receive fentanyl 1-2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation in addition 40 ml bupivacaine 0.25% as a single level unilateral injection for ESPB after induction of anesthesia and before skin incision. Group B (n = 30): will receive only fentanyl 1- 2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation and PCA will be started after the end of the surgery. Results The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analgesic effect in patients undergoing urologic surgeries with lumbar incision also reduced the total amount of postoperative morphine consumption in comparison to the PCA group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in first 24 hour and Decrease incidence of nausea, vomiting and constipation due to decrease opioids intake. Conclusion Ultrasound-guided unilateral ESPB reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients‟ satisfaction in the first 24 hours after urologic Surgeries with Lumbar Incision, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB markably decreased the rate of PONV. This might be because the use of ESPB might have decreased the use of intraoperative opioids.