Ain Shams University Hospitals Research Articles

Developing bullying prevention guidelines for nurse interns’ and its effects on their assertiveness

BackgroundBullying is a serious problem that has short and long term negative consequences for nurse interns. Bullying prevention guidelines have a great impact on reducing the incidence of bullying among nurse interns.AimThe present study aimed to evaluate the effect of developing bullying prevention guidelines on nurse interns’ assertiveness levels.MethodsA methodological study design was used to conduct the study at Ain Shams University Hospitals in Cairo Governorate, Egypt. The study subjects consisted of all nurse interns enrolled in the 2022–2023 internship year and their number 121 nurse interns. The data were collected using four tools: the Bullying Knowledge Questionnaire, the Negative Act Questionnaire Revised (NAQ-R), the Individual Bullying Behaviors in Clinical Practice Survey, and the Assertiveness Inventory.ResultsThe scores for total bullying knowledge and assertiveness after the implementation of the prevention guidelines were significantly increased (91.4% and 86.3%, respectively) among those who were exposed to bullying than among those with pretest scores of (34.7% and 11.8% respectively) (P < 0.001).ConclusionBullying prevention guidelines significantly reduced nurse interns bullying and improved their assertiveness. The study recommended the dissemination and generalization of the developed bullying prevention guidelines in different training settings.

Prevalence of Helicobacter pylori infection among Patients with Acne Vulgaris

Abstract Background Acne vulgaris is one of the most common dermatologic complaints. About 85% of adolescent population and 3% of the adults between the age of 35-44 years have this disease worldwide. It is a chronic inflammatory disorder of the pilosebaceous unit. Helicobacter pylori is a gastric Gram-negative, spiral-shaped microaerophilic pathogen closely associated with gastric and extra-gastric diseases (chronic gastritis, peptic ulcers, gastric mucosa-associated lymphoid tissue lymphoma, gastric cancer, iron deficiency anemia, etc). It has been shown that H. pylori may play a potential pathogenic role in extra-intestinal diseases such as hepatobiliary, respiratory, cardiovascular, and dermatological disorders. The latter included chronic urticaria, psoriasis, henoch-schonlein purpura, and rosacea. Objective To determine the prevalence of H. Pylori infection among AV patients and correlate it with the disease severity. We included 45 patients with AV and 45 matched age and sex apparent healthy controls. Methods This case control study included 45 Patients with AV. They were recruited from the Dermatology outpatient clinic, Ain Shams University Hospitals and Teba specialized hospital in Luxur government. The study also included 45 age and sex matched healthy volunteers as a control group. They were recruited from people who don't have AV attending Al Demerdash Hospital Ain Shams University and Tepa Specialized Hospital. The study was done in the period from November 2021 to October 2022. Results Detection of H. pylori antigen in stool and H. pylori antibody IgG in serum in both groups revealed that the rates of H. pylori antigen in stool and H. pylori antibody IgG in serum were significantly higher in AV patients compared to control subjects. Also the patients with severe AV had statistically significant higher rates of H. pylori antigen in stool and H. pylori antibody in serum as compared to the patients with mild Acne and healthy controls. Also the number of AV involved sites and severity of AV were significantly correlated with H. pylori Ag in stool and H pylori Ab in serum. While there was no statistical significant correlation between (the type of AV, onset of AV and duration of AV) and H. pylori Ag in stool and H. pylori Ab in serum. Conclusion The prevalence of H. pylori infection in patients with acne vulgaris is high so it may represent a risk factor for this skin disease. Also the indicators of H. pylori infection were positively correlated with the severity of AV.

Peripheral Perfusion Index as a Predictor of Post-Spinal Hypotension in Patients Undergoing Lower Abdominopelvic Surgeries

Abstract Background One of the main complications of spinal anesthesia is post spinal hypotension. And since noninvasive hemodynamic &amp; blood pressure monitoring are the standards in most surgical procedures, ensuring best &amp; safest monitoring standards has been of utmost importance. The use of plethysmography in anesthesia monitoring has become one of the essential tools in any anesthetic procedures. However, its varying interpretations &amp; usages haven't been explored to the fullest. Objective To assess predictability of baseline peripheral perfusion index to Post spinal hypotension in patients undergoing elective lower abdomino-pelvic surgeries. Methods This Prospective Observational study was conducted in Ain Shams University Hospitals’ operating rooms. And was conducted over a period of 6 months after approval of ethical committee of Faculty of Medicine, Ain Shams University, All patients undergoing elective lower abdominopelvic surgeries at El-demerdash Hospital of Surgery during the study period. Surgeries include inguinal / inguinoscrotal hernia repair, paraumbilical hernia repair, lower laparotomies, transurethral resection of bladder tumor, simple gynecological procedures. Results This study showed that Perfusion index can be used as a predictor for hypotension in patients undergoing elective lower abdominopelvic surgeries under spinal anesthesia. Patients with baseline PI &amp;gt; 0.9 are at greater risk of developing hypotension after spinal anesthesia when compared with those with baseline PI ≤ 0.9. Hence, peripheral perfusion index usage can be recommended in this regard. Conclusion This study concluded that Perfusion index can be used as a predictor for hypotension in patients undergoing elective lower abdominopelvic surgeries under spinal anesthesia. Patients with baseline PPI &amp;gt;0.9 are at greater risk of developing hypotension after spinal anesthesia when compared with those with baseline PPI ≤0.9 .Hence, peripheral perfusion index usage can be recommended in this regard.

Quality of Life in Pediatric Iritable Bowel Syndrome among a Sample of Egyptian Children at Ain Shams University Hospitals

Abstract Background Iritable bowel syndrome (IBS) is one of the pediatric functional gastrointestinal disorder with upper and lower gastrointestinal symptoms.IBS afects the child’s daily activities and quality of life (QoL) negatively, and can often persist into adulthood. Objectives To measure the dimensions of QoL of children with IBS among a sample of Egyptian pediatric patients at Ain Shams University Hospitals. Methods A cross-sectional study was conducted on 80 children aged 5-15 years old, who were diagnosed as IBS, according to Rome IV criteria Pediatric quality of life Inventory Generic Core (PedsQL generic core scale was used to measure QoL of the patients,where 100 is the maximum quality score. Results A total of 80 children participated in the study ; 48 (60%) males and 32 (40%) females with mean age 10.6 (SD2.7) years. Physical functioningscorewascalculatedtobe96.04(SD5.5), socialfunctioning score was 99.37 (SD3.95), emotional functioning score was 90.37 (SD8.85), and school functioning score was 73.25 (SD27.34).The school functioning scale was higher among male participants (P-value0.31), also the emotional scale was higher among male participants with no statistical significant diference (P-value0.70). Conclusion IBS afects the school functioning dimension of OoL among the pediatric age group rather than other dimensions.

Immunogenicity and Adverse Events after Covid-19 Vaccination in Patients with Systemic Inflammatory Autoimmune Diseases

Abstract Background The first cases of COVID-19 began in Wuhan, Hubei Province china, in December 2019. Since then, this disease caused by a highly pathogenic virus, severe acute respiratory syndrome coronavirus (SARS-COV-2), has been labelled as a global pandemic. It is believed that the primary means of viral spread is via respiratory droplets during close-range, human-to-human contact. Aim of the Work To assess immunogenicity and to compare adverse effect following COVID-19 vaccinations in patients with systemic inflammatory autoimmune diseases vs matched healthy controls. Patients and Methods This is a cross sectional study. Two groups of subjects were enrolled in the study after consideration of both inclusion and exclusion criteria. Group A: patients with systemic inflammatory auto immune disease (60 subjects) including (30 patients with systemic lupus erythematosus, 30 patients with rheumatoid arthritis) who received two doses of COVID-19 vaccine. Group B: age-matched healthy controls who received two doses of COVID-19 vaccine (30 Subjects). All patients were recruited from the outpatient clinic of department of Internal Medicine – Rheumatology division at Ain Shams University Hospital. Control group were recruited from medical and non-medical staff working at Ain Shams University Hospital. Results There was no statistically significant difference in the titre of anti-spikes antibodies with the use of different immune suppressive drugs in RA group such as methotrexate and leflunomide with p-value =0.935,0.257, respectively,also in SLE patients there was no statistically significant difference in the titre of anti-spikes antibodies with the use of different immune suppressive drugs in SLE group such as azathioprine, mycophenolate mofetil and cyclophosphamide with p-value = 0.317, 1.000 and 0.513 respectively,(all patients in our study were on corticosteroids and hydroxychloroquine). There was statistically significant difference as regarding disease activity in RA patients before and after covid-19 vaccine with p-value = 0.001,with a total percentage of 26.70% of patients developed mild disease activity,13.30% developed moderate disease activity while 3.3% of patients developed severe activity and as regarding SLE patients there was statistically significant difference as regarding disease activity in SLE patients before and after covid-19 vaccine with p-value = 0.002,with a total percentage of 23.3% of patients developed mild disease activity,6.7% developed moderate disease activity while 10% of patients developed severe activity. Conclusion Comparable side effects in both control and patients group with only minor side effects were reported. The Sinopharm BIBP COVID-19 vaccine was immunogenic in the majority of patients in comparison to control group, with an acceptable safety profile. The use of different immune suppressive therapies (methotrexate, azathioprine, mycophenolate mofetil,cyclophosphamide) didn’t affect humoral response after two doses of the vaccine. Apparent impact on disease activity of both SLE and RA patients but mainly in the form of mild disease activity.

Screening for Retinopathy of Prematurity in Neonatal Intensive Care Unit in Ain Shams University Hospital

Abstract Purpose to evaluate the Retinopathy of prematurity prevalence and screening outcome in a tertiary hospital in Cairo, Egypt. Also, to assess the risk factors for its development and to suggest modifications to the international guidelines for screening for Retinopathy of prematurity to fit the Egyptian population. Methods A prospective observational study was carried out in Neonatal Intensive Care Unit (NICU) in Ain Shams University Hospital. In this study 159 premature infants born in the period between 1 September 2018 to 1 September 2021 were screened for Retinopathy of Prematurity (ROP). Screening was based on the most inclusive criteria reported to date. All premature infants with gestational age (GA) of ≤ 34 weeks or birth weight (BW) of ≤ 2000 grams were included. Infants were also included if GA &amp;gt; 34 weeks or BW &amp;gt; 2000 grams, but multiple co-morbidities existed. The prevalence of retinopathy of prematurity and plus disease and their correlation with risk factors of interest were studied. Results The gestational age of the included infants ranged from 27 to 36 weeks, with a mean (SD) of 31.87 (± 1.81) weeks. Infants had birth weight ranging from 640 to 3900 grams, with a mean (SD) of 1784.71 (± 560.30) grams. The prevalence of ROP changes more than stage 0 in the screened infants was 25.8% (41 infants) with 7.3% of cases (11 infants) showing plus disease and 6.3% of cases (10 infants) showing severe changes that needed treatment. Of those, 2 cases (20%) fell outside the British Guideline’s criteria for Screening. there was a highly significant (p &amp;lt; 0.0001) correlation between appearance of Retinopathy of prematurity changes more than stage 0 and low gestational age, low birth weight of the screened infants, receiving mechanical ventilation, respiratory distress syndrome stage, presence of Necrotizing enterocolitis, Intraventricular haemorrhage and blood transfusion. On the other hand, no significant correlation was found between appearance of Retinopathy of prematurity changes more than stage 0 and gender (p = 0.911), presence of PDA (p = 0.187), or sepsis (p = 0.998). Conclusion Retinopathy of prematurity is a significant problem in the premature infants in Cairo, Egypt. Extremely premature infants with lower birth weight are more prone to develop this disease. However, cases with higher gestational age and birth weight than mentioned in the British guidelines screening criteria especially with multiple comorbidities showed severe Retinopathy of prematurity changes that needed intervention, which implies the need to develop a screening guideline for the Egyptian population.

Analgesic Effect of Intrathecal Nalbuphine versus Intrathecal Fentanyl as Adjuvant to 0.5% Bupivacaine for Cesarian Section under Spinal Anaesthesia

Abstract Background One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. The use of opioids in intrathecal or epidural anesthesia has become common to increase postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Objective To assess the postoperative analgesic requirements and the spinally mediated analgesic effects of intrathecal nalbuphine as an adjuvant to intrathecal bupivacaine after cesarean section in comparison to intrathecal bupivacaine with fentanyl. Methods This randomized comparative clinical trial was conducted in Ain Shams University Hospitals’ operating rooms on 48 patients undergoing cesarean section within a period of six months after approval of ethical committee of Faculty of Medicine, Ain Shams University. Results This study showed that the addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia prolonged the time of postoperative analgesia. In this study, there was no significant difference regarding the demographic data, duration of operation, maximum sensory level, and maximum motor blockade level. Adding to this, there was also no significant changes regarding the vital data of the patients. On the other hand, there was a significant difference regarding the duration of analgesia which was longer with nalbuphine. It was also noticed that with nalbuphine less patients required rescue analgesia in comparison to fentanyl. There was higher number of side effects recorded with fentanyl in comparison to nalbuphine. Conclusion Either intrathecal nalbuphine (0.8 mg) or intrathecal fentanyl (25 μg) combined with Bupivacaine improves intraoperative analgesia and prolongs post- operative analgesia in cesarean section. There was statistically significant difference between them, intrathecal nalbuphine had a prolonged duration of post-operative analgesia, lesser amount of rescue analgesia needed and fewer side effects than intrathecal fentanyl.

Association of Serum M2BPGi Levels with Nutritional Status (Using CONUT score) in Hepatitis C Virus Related Compensated Liver Cirrhosis Patients

Abstract Background Protein-energy malnutrition (PEM), which is one of the most common complications seen in LC patients and associated with high morbidity and mortality. So, predicting the presence of PEM and providing appropriate nutritional support help improve the prognosis of those patients. Mac-2-binding protein glycosylation isomer (M2BPGi) was recently identified as a serum glycobiomarker for liver fibrosis. However, the relationship between M2BPGi and malnutrition in patients with chronic liver disease (CLD) is unclear. Aim of the Work The aim of this study is to evaluate the role of serum M2BPGi levels as a surrogate marker for malnutrition in HCV related cirrhotic patients, correlated with CONUT score as the nutritional status marker. Patients and Methods This is a Cross-sectional - Analytic study that included patients with chronic HCV infection and normal control group selected from patients attending to Hepatology Outpatient Clinics at Ain Shams University Hospital. This study was carried out from 30 patients (child A) attending to Hepatology Outpatient Clinics at Ain Shams University Hospital and 30 healthy individuals as a control. Results The M2BPGi levels increased with CONUT score. The correlation coefficient between M2BPGi and CONUT score was r = 0.315 (p = 0.05), indicating a positive weak correlation between M2BPGi and CONUT score. The cut-off for M2BPGi to predict CONUT low vs. moderate was 1.43 with a sensitivity 93.33% and specificity 100% when AUC =0.9 and CONUT moderate vs. severe was 1.7 with a sensitivity 91.67% and specificity 100% when AUC =0.9. Conclusion We found that there is correlation between M2BPGi and CONUT score and both can be useful as a marker for malnutrition in HCV related cirrhotic patients cut of point

Detecting Potassium Rebound in a Prevalent Hemodialysis Population

Abstract Background One of the fundamental goals of hemo dialysis (HD) prescription is to maintain serum potassium (K) levels within a narrow normal range during both the intradialytic and interdialytic intervals. Considering the extraordinarily high rate of cardiovascular mortality in HD population, clinicians are obligated to explore whether factors related to dialytic K removal can be modified to improve clinical outcomes. Aim of the Work The aim of the study was to detect potassium rebound after HD sessions in patients on maintenance HD Patients and Methods This was a prospective cohort study that was held in Hemodialysis units in Nephrology department - Ain Shams University Hospital and Sheikh Zayed Specialized Hospital for 3 months. The study included 60 male and female ESRD patients on maintenance HD, in which prevalent HD patients on maintenance HD 3 times/week. Results We found that that there were significant positive correlations between K levels before the sessions, immediately after the sessions and after 6 hours of the sessions. While there was significant negative correlations between K levels immediately after HD sessions and Hb levels and urea levels. There was also a highly significant negative correlation between K levels before the sessions and time of session (in hours). While there were highly significant negative correlations between K levels immediately after the sessions, after 6 hours of sessions and time of session (in hours). There was non-significant negative correlations between all K levels (before HD sessions, immediately after the sessions and 6 hours after the sessions) and frequency of sessions (per week), with p value 0.388, 0.299 and 0.086 respectively. Also, it showed non-significant negative correlations between all K levels (before HD sessions, immediately after the sessions and 6 hours after the sessions) and frequency of sessions (per month), with p value 0.086, 0.089 and 0.083 respectively. Our results showed a significant positive relation between the number of K raising antihypertensive drugs used by the patients and K levels before HD sessions. Conclusion Patients with end-stage renal disease (ESRD) on maintenance dialysis have a high risk of developing hyperkalemia, generally defined as serum potassium (K+) concentrations of &amp;gt; 5.0 mmol/l, particularly those undergoing maintenance hemodialysis. Currently, the key approaches to the management of hyperkalemia in patients with ESRD are dialysis, dietary K+ restriction, and avoidance of medications that increase hyperkalemia risk. Management of these modifiable factors plays a crucial role in preventing hyperkalemia in patients undergoing dialysis. The availability of new oral K+-binders may potentially reduce the need for a highly restricted diet in patients with ESRD, and reduce the risk of potentially life-threatening hyperkalemia and the cardiovascular complications associated with rapid shifts in serum K+ concentrations that can occur with HD.

Serum Stabilin1 as a Prognostic Marker in Adults Acute Leukemia Patients

Abstract Background STAB-1 (common lymphatic endothelial and vascular endothelial receptor) was found to be expressed on tumor lymphatic vessels in different malignancies and it is a bad prognostic marker. This study will assess the role of serum stabilin1 (STAB1) as a prognostic marker in adult patients with newly diagnosed acute leukemia and correlate it with the other well established prognostic markers. Acute lymphoblastic leukemia (ALL) is a hematologic malignancy arising from precursors of the lymphoid lineage. Conventional cytotoxic chemotherapies have resulted in high cure rates of up to 90% in pediatric ALL, but the outcomes for adult patients remain suboptimal with 5-year survival rates of only 30%-40%. Aim of the Work To measure STAB1 expression in patients with AML and patients with ALL and assess its role as a prognostic factor with correlating it with other prognostic factors. Patients and Methods A case control study in Ain Shams University Hospitals, Clinical Haematology and Oncolgy division of Internal Medicine Department for one year on total 75 subjects divided into: 25 patients with newly diagnosed acute myeloid leukemia (AML), 25 patients with newly diagnosed acute lymphoblastic leukemia (ALL) and 25 age and sex matched healthy control subjects. The study population was recruited from Ain Shams University Hospitals, Clinical Haematology and Oncolgy division of Internal Medicine Department. Results There was no significant difference between cases of acute leukemia pts and control group as there was no statistically significant difference between control and patients group regarding sex, age, spleen size, liver size, LDH, CRP, uric acid and ESR of the studied subjects. Our study shows that as regard CBC; there was significant difference between the studied groups as regard leucocytic count, BUT Platelets, and hemoglobin was insignificant, which was also described in the study. Our study showed that there was high statistically significant difference between the acute leukemia patients and the healthy control group as regard sabilin1. Our study shows that the mean serum level of stabilin1 in the patients who didn’t respond to chemotherapy was higher than that of the patients that responded to chemotherapy. Conclusion There was high statistically significant difference between the studied groups as stabilin1. There was significant correlation between stabilin2 and chemotherapy response. Stabilin1 expression levels also identified a new subgroup at a higher risk for relapse and with a poor prognosis in acute leukemia patients. Stabilin 1 can be used as a prognostic factor in patients with acute leukemia.

Significance of Ultrasound in Assessment of Painful Knee: A Comparative Study to Magnetic Resonance Imaging

Abstract Background Knee pain is one of the most frequent symptoms that bring patients to the hospital. It affects approximately 25% of adults, with an increasing incidence nowadays the pain may result from the muscles, ligaments, tendons, and menisci, from trauma due to non-traumatic injuries like infection, bursitis, osteoarthritis, and tendinitis. Aim of the Work Aim of study is to evaluate the role of US in assessment of painful knee compared to conventional MRI sequences as an alternative cost-effective screening modality for an accurate diagnosis. Patients and Methods This study is a cross-sectional study was conducted at Ain Shams University Hospitals at Radiology department. Our study included forty patients complaining of acute knee pain from (1 day to 3 months’ duration). The main source of data for this study was the prospectively conducted scans and clinical history of the patients referred to the MRI section of the department of Radiology, Ain Shams University Hospitals at 6 months. Results Forty patients complaining of acute knee pain from. Every single one of them went through MRI and US assessments indiscriminately and independently, US succeeded in evaluating soft tissue structures pathologies including knee effusion, meniscal injury (degeneration, tear, and extrusion), MCL, LCL, bursitis. muscle, tendon injury and osteoarthritic changes. aside from the cruciate ligaments. US showed an overall sensitivity of 70.1% and specificity of 99.2% with accuracy of 95.2%. The overall PPV and NPV were 93.1% and 95.5% respectively. Conclusion US has proved that it can be used as an alternative cost effective screening modality for patients complaining of acute pain, US has reasonable sensitivity, specificity and accuracy in detecting knee effusion, meniscal injury including degeneration, tear, and extrusion, collateral ligaments, bursitis, baker cyst. Muscle, tendon injury and osteoarthritic changes, with no contraindications it can be used as the first choice in assessment of acute knee pain. MRI can be reserved for further workup if clinically warranted.

Immunogenicity and Adverse Events after Covid-19 Vaccination in Patients with Systemic Inflammatory Autoimmune Diseases

Abstract Background The first cases of COVID-19 began in Wuhan, Hubei Province china, in December 2019. Since then, this disease caused by a highly pathogenic virus, severe acute respiratory syndrome coronavirus (SARS-COV-2), has been labelled as a global pandemic. It is believed that the primary means of viral spread is via respiratory droplets during close-range, human-to-human contact. Aim of the Work To assess immunogenicity and to compare adverse effect following COVID-19 vaccinations in patients with systemic inflammatory autoimmune diseases vs matched healthy controls. Patients and Methods This is a cross sectional study. Two groups of subjects were enrolled in the study after consideration of both inclusion and exclusion criteria. Group A: patients with systemic inflammatory auto immune disease (60 subjects) including (30 patients with systemic lupus erythematosus, 30 patients with rheumatoid arthritis) who received two doses of COVID-19 vaccine. Group B: age-matched healthy controls who received two doses of COVID-19 vaccine (30 Subjects). All patients were recruited from the outpatient clinic of department of Internal Medicine – Rheumatology division at Ain Shams University Hospital. Control group were recruited from medical and non-medical staff working at Ain Shams University Hospital. Results There was no statistically significant difference in the titre of anti-spikes antibodies with the use of different immune suppressive drugs in RA group such as methotrexate and leflunomide with p- value = 0.935,0.257, respectively,also in SLE patients there was no statistically significant difference in the titre of anti-spikes antibodies with the use of different immune suppressive drugs in SLE group such as azathioprine, mycophenolate mofetil and cyclophosphamide with p-value = 0.317, 1.000 and 0.513 respectively,(all patients in our study were on corticosteroids and hydroxychloroquine). There was statistically significant difference as regarding disease activity in RA patients before and after covid-19 vaccine with p-value = 0.001,with a total percentage of 26.70% of patients developed mild disease activity,13.30% developed moderate disease activity while 3.3% of patients developed severe activity and as regarding SLE patients there was statistically significant difference as regarding disease activity in SLE patients before and after covid-19 vaccine with p-value = 0.002,with a total percentage of 23.3% of patients developed mild disease activity, 6.7% developed moderate disease activity while 10% of patients developed severe activity. Conclusion Comparable side effects in both control and patients group with only minor side effects were reported. The Sinopharm BIBP COVID-19 vaccine was immunogenic in the majority of patients in comparison to control group, with an acceptable safety profile. The use of different immune suppressive therapies (methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide) didn’t affect humoral response after two doses of the vaccine. Apparent impact on disease activity of both SLE and RA patients but mainly in the form of mild disease activity.

Enhanced Recovery after Surgery Protocol (ERAS) versus Standard Protocol for Undergoing Radical Cystectomy in an Egyptian Population

Abstract Background bladder cancer has been one of the commonest cancer. The gold standard for treatment of muscle invasive bladder cancer is radical cystectomy with pelvic lymphadenectomy and associated with considerable morbidity and mortality and healthcare cost. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures. Aim and Objectives The aim of this study was to compare between the standard preoperative bowel preparation (SP) and ERAS protocol in terms of postoperative length of stay (LOS) and postoperative morbidity. Subjects and Methods This was a prospective randomized study was conducted in Ain shams university hospital – Alexandria university hospital involving fifty (50) patients were randomly divided into two equal groups twenty-Five (25) patient in group A follow ERAS protocol and twenty-Five (25) patients in group B following standard protocol. The duration of the study ranged from 6-12 months. Results There was statistically significant difference found between group A and group B regarding the studied parameters ( Readmission in 30 days, Ileus, Vomiting, and UTI) while there was no statistically significant difference between them regarding (early mobilization, urine leakage, dehesince and DVT), there was no statistically significant difference found between group A and group B regarding (Length of stay). Conclusion In patients undergoing radical cystectomy, enhanced recovery protocol is considered as a safe procedure and not associated with any increase in intraoperative and postoperative complications compared to standard protocol. The length of hospital stay was shorter in ERAS group.

Impact of Exercise-Based Cardiac Rehabilitation on Metabolic Syndrome in Post-Acute Coronary Syndrome Patients

Abstract Background Metabolic syndrome (MetS) is characterized by a cluster of cardiovascular risk factors including hypertension (HTN), impaired fasting blood sugar (FBS), increased central obesity (WC) and dyslipidemia; hypertriglyceridemia (TG) and low high-density lipoprotein- cholesterol (HDL-C). The MetS adversely affects cardiovascular outcomes, individuals with at least 4 out of 5 features of MetS have a 3.7-fold increased risk of coronary artery diseases at a 5-year follow-up. Objective to determine the effectiveness of exercise based-cardiac rehabilitation (CR) program on MetS in post-Acute Coronary Syndrome (ACS) patients versus guideline directed medical therapy over a 12 weeks period. Patients and Methods The study included 62 patients who suffered from ACS with evidence of MetS. All patients were recruited from Ain Shams University Hospitals (ASUHs) from July 2021 to December 2021 and were assessed at baseline and after 12 weeks of follow up for MetS parameters. After approval by the local ethics committee all patients were provided voluntary informed consent. The study subjects were classified into two groups: Group A (case group): included 32 patients who completed at least 80% of 12 weeks of CR program in ASUHs. Group B (control group): included 30 patients who did not attend the CR program and completed 12 weeks of guideline directed medical therapy alone. Results The results revealed that -when compared group A at baseline and after 12 weeks of CR-program there was a significant reduction in WC, FBS and TG levels, while there was a significant rise in HDL-C level. However, there was no statistically significant difference found regarding BP in this group. Regarding group B there was no statistically significant difference between the baseline MetS parameters and at follow up after 12 weeks of guideline directed medical therapy alone. Conclusion The present study revealed that there was a statistically significant improvement regarding WC, FBS, TG and HDL after completion of 12 weeks of the CR Program, while there was no statistically significant difference found regarding BP in the study group. In the control group there was no statistically significant difference found at baseline and follow up after 12 weeks of guideline directed medical care alone. Thus, the exercise-based CR program is superior than the regular medical care alone in improving the WC, FBS, TG and HDL. Key words: Metabolic Syndrome, Cardiac Rehabilitation, Exercise Training, ACS. Abbreviations and Acronyms. Acronyms: ACS: Acute Coronary Syndrome ASUHs: Ain Shams University Hospitals BP: Blood Pressure CR: Cardiac Rehabilitation FBS: Fasting Blood Sugar HDL-C: High Density Lipoprotein-Cholesterol HTN: Hypertension MetS: Metabolic Syndrome TG: Triglyceridemia WC: Central Obesity

Acute Kidney Injury in COVID-19 Patients

Abstract Background This was a prospective study that was held in KOBRY ALKOBBA military complex to evaluate the prognosis of COVID-19 patients with Acute kidney injury (AKI). Evaluation of AKI in hospitalized patients with COVID-19, which included adult patients with laboratory and radiologically confirmed SARS-COV-2 infection admitted to ward and ICU patients at KOBRY ALKOBBA military complex, Cairo, Egypt. Aim of the Work The aim of this work is to study the incidence and outcome of Acute Kidney Injury (AKI) in all patients admitted with COVID-19 infection in ward and ICU during 3 months at Ainshams university hospitals. Patients and Methods A prospective cohort study for 3 months on Inward and ICU patients at Ainshams university hospitals. Informed consent was taken from each patient and study will be approved from ethical committee of the department of internal medicine faculty of medicine Ain Shams university. Results As a result, the findings of our study required additional validation. This study was conducted during the COVID-19 pandemic in a single medical center in Cairo governorate: thus, we were unable to generalize our findings to all individuals infected with COVID-19 in Egypt. Conclusion Incidence of AKI in our study was 9.19% in all patients admitted in ICU and ward during 3 months. Our findings suggest that COVID-19 cases, particularly those in ICU, should be closely monitored for the progression of AKI. Early detection of AKI and prompt meditation may improve COVID-19 patients outcomes. The occurrence of AKI is a poor prognostic factor in SARS-CoV-2 infected patients. The mortality rate in COVID-19 patients complicated with AKI group is very high.

Residual Stone Fragments after Percutaneous Nephrolithotomy: Shockwave Lithotripsy vs Retrograde Intrarenal Surgery

Abstract Background Post-PCNL treatment for 0.5-1.5 cm calculi is contentious. SWL has noninvasiveness, less anaesthetic, and improved subjective acceptability, but a lower stone-free rate and higher retreatment rate (RR). Retrograde intrarenal surgery (RIRS) is increasingly employed to treat after PCNL residual calculi with a greater success rate (SR), but with disadvantages of invasiveness and anaesthesia. Aim To compare the outcomes of retrograde intrarenal surgery (RIRS) to extracorporeal shockwave lithotripsy (SWL) for treating patients with RSFs after a previous standard PCNL. Subject and Methods A retrospective study of 70 adult patients with residual stone fragments after a standard PCNL submitted to RIRS or SWL (35 patients per each group) in ain shams university hospitals and police hospitals. Results There no significant difference between the groups regarding ASA, PCNL Guy’s classification, percutaneous tracts, stone composition and postoperative complications. There a significant difference between the groups regarding inferior calyx located stone and postoperative hospital stay. &amp;gt;2 mm stones were significantly more frequent in SWL group compared to RIRS group. Conclusion From the findings of this study we can conclude that RIRS has better SFR for the treatment of RSFs after standard PCNL

Evaluating Pediatric Appendicitis Score and Alvarado Scoring System for Detecting Acute Appendicitis in Pediatric Population

Abstract Background Acute appendicitis is the most common surgical condition of children. About 1 to 10% of children presenting in surgical emergencies with acute abdomen fall within the domain of acute appendicitis. In few of these cases, clinical signs and symptoms at presentation are such that acute appendicitis is a clear diagnosis while more often it is challenging for a surgeon to make a clinical diagnosis of acute appendicitis. In these circumstances, explorations reveal negative appendectomies and an organ with potential functions can be lost. Objective To evaluate the Pediatric Appendicitis Score and Alvarado Scoring System in Detecting Acute Appendicitis in Pediatric Population in terms of applicability, safety, and specificity in the diagnosis of Acute Appendicitis among the study group and to suggest improvements and/or modifications to increase the predictive values of Pediatric Appendicitis Score and Alvarado Scoring System, decrease the rates of false diagnosis or reduce costs. Methods a prospective cohort study that was conducted on 50 patients aged under 14 years admitted to pediatric surgery department in Ain Shams University Hospital within a period of 6 months with an expected diagnosis of Acute appendicitis. Each patient was subjected to a detailed medical history taking (with emphasis on The age, gender, duration of pain, complaint complaints ofabdominal pain and duration, fever, nausea-vomiting, diarrhea or constipation), Clinical examination:(right lower quadrant sensitivity,defense, rebound tenderness, percussion/ cough/ right lower quadrant sensitivity with jumping). Laboratory investigations:(complete blood count, the total white blood cell (WBC) and total neutrophil counts c-reactive protein ) and Ultrasound examination. Alvarado score as well as PAS were calculated for each patient . the results were then compared to the intra operative findings confirming or excluding the diagnosis of acute appendicitis. Results in the study group that was 38% males and 62% females with ages ranging from 3 to 14 years .Pediatric appendicitis score (PAS) was found to significantly predict acute appendicitis in the studied patients at cutoff 5.0 with sensitivity, specificity, PPV and NPV was 60.5%, 100%, 100% and 71.9% respectively (p &amp;lt; 0.001). Alvarado score can significantly predict acute appendicitis in the studied patients at cutoff 4.0 with sensitivity, specificity, PPV and NPV was 79.1%, 85.7%, 84.7% and 80.4% respectively (p &amp;lt; 0.001). Conclusion The results of this study showed the higher sensitivity of Alvarado score and more specificity of the Pediatric Appendicitis score. However, the sensitivity, specificity, PPV, and NPV of these criteria were not considered enough to confirm the diagnosis of acute appendicitis alone. There is a need for new parameters in the scoring systems. Such as including ultrasonagraphic findings and additional laboratory investigations such as CRP.

Retrospective Study of Clinicopathologic Features and Outcome of Colonic Cancer in Relation to Primary Tumor Location

Abstract Background Colon cancer is one of the most common cancers worldwide and outcomes of colon cancer are different according to the primary tumor location and could be considered as distinct disease entities of the same organ. Objectives Analyzing and comparing clinical, epidemiological, pathologic features and outcome of colon cancer according to primary location whether the patients are right sided colon cancer (RSCC) and left sided colon cancer (LSCC) patients in different situations. Patients and Methods This is a retrospective, descriptive and analytical study conducted between January 1st, 2013 and January 1st 2019. One hundred and fifty patients diagnosed with colon cancer were enrolled in GIT unit, Department of Clinical Oncology, Ain Shams University Hospital. Results In our study right sided colon cancer patients were more females and clinically presented with higher frequency of anaemia (P value = 0.001) and perforation (P value = 0.02). Left sided colon cancer on the other side were more males (P value = 0.032) and was associated with more constipation (P value &amp;lt;0.001) and intestinal obstruction (P value = 0.085). RSCC was more associated mucinous adenocarcinoma, more advanced T stage (T4), lymphovascular invasion, larger tumor sizes and more poorly differentiated tumor. LSCC was associated with more advanced stage and lymph node positivity. Right side tumor has highest disease-free survival period which is 34.63 months (95% confidence interval [CI] 28.39-40.86) comparing with the left side tumor which was 24.94 months (95% confidence interval [CI] 19.61-30.27). left side tumor has highest progressive free survival period which is 4.77 months (95% confidence interval [CI] 3.33-8.22) comparing with the right-side tumor which was 2.21 months (95% confidence interval [CI] 0.63-3.79). Conclusion RSCCs and LSCCs show different characteristics in clinical presentation and prognostic features, so we can consider the side of tumor is helpful in determining the behavior and the outcome of the disease. We can consider RSCC and LSCC as two separate disease entities.

231 A Comparative Study Between Open Pre-Peritoneal Approach Versus Laparoscopic Trans-Abdominal Pre-Peritoneal Approach in Recurrent Inguinal Hernia Repair: A Prospective Cohort Study

Abstract Aim To compare the open pre-peritoneal approach and Laparoscopic trans-abdominal pre-peritoneal approach in the management of recurrent inguinal hernia which was previously managed through an open anterior approach regarding their intra-operative time, the post-operative outcomes. Method The current study is a prospective cohort study, a single-center trial conducted from June 2021 to June 2022 at Ain Shams University Hospitals. Results There were 74 patients in our study 37 patients in each group. Group (I) underwent an open pre-peritoneal approach and group (II) underwent a Laparoscopic trans-abdominal pre-peritoneal approach. Regarding intra-operative time, the mean time in minutes in the group (I) is 63.33 with a standard deviation of ±11.95. While in group (II) the mean time in minutes is 81.21 with a standard deviation of ±18.03 (p=0.015). Regarding the hematoma occurred in 4(10.8%) patients in group (I). While in 2(5.4%) patients in group (II) (p=0.674). The wound infection was found in 5 (13.5%) patients in group(I) and zero patients in group (II)(p=0.021). Finally, recurrence after one year was found in 3(8.1%) patients in group(I) and 1(2.7%) patient in group (II) (p=0.615). Conclusions The results of this study demonstrate that both approaches are effective for recurrent inguinal hernia following anterior approach mesh hernioplasty, with comparable results. Laparoscopy has been associated with a lower rate of recurrence and overall complications compared to open technique, however, it is difficult to draw definitive conclusions about the preferred option due to its lengthy learning curve and difficulty to perform.

Complication Rate and Patient Satisfaction Following Bilateral Simultaneous Total Knee Arthroplasty

Abstract Background Advanced knee osteoarthritis (OA) is a common clinical problem requiring knee arthroplasty. Knee Osteoarthritis can be diagnosed by X-ray. Total knee arthroplasty can be done simultaneous or staged in 2 different sessions. Aim of the Work To assess the results of simultaneously bilateral total knee arthroplasty as regard complications and patient satisfaction and compare to results in the literature to provide a clear guideline for proper choice of patients. Patients and Methods In the period between August 2018 and October 2020, a prospective cohort study was conducted in Ain Shams University Hospital in Cairo and Taiba hospital in Kuwait on 45 cases who suffered from advanced bilateral knee osteoarthritis and underwent bilateral simultaneous total knee arthroplasty. Results The study was conducted on a wide age group ranging from 47 to 75 years, (mean age 64.29±6.23 years). There was female predominance with 41 females with percentage 91.1% and 4 males with percentage 8.9%. Regarding patient satisfaction, the comparison of Pre- and Post-operative was 15.24±2.45, compared to 32.18±4.08 respectively, the mean difference 16.93. In comparing objective knee score by the Knee Society Scoring system, in each of Pre- and Post- operative was 58.90±6.28, compared to 82.62±5.70 respectively. Also, in Functional knee score in each of Pre- and Post-operative was 51.39±8.67, compared to 73.80±7.75 respectively. 4 patients (8.9%) had complications out of them 3 patients (6.7%) had superficial infection and 1 patient (2.2%) had acute coronary syndrome. Conclusion With careful preoperative patient selection bilateral Simultaneous total knee arthroplasty can be safe with low mortality and complication rates.