Ain Shams University Hospitals Research Articles

Evaluation of minimally invasive percutaneous transpedicular screw fixation as an evolving modality for the treatment of thoracolumbar fractures

BackgroundPercutaneous transpedicular screw fixation was recently introduced as a minimally invasive approach for the treatment of thoracolumbar spine fracture. This approach is superior to the traditional open surgical approaches in decreasing intraoperative blood loss, infection rates, and paraspinal muscle damage with less hospital stay.ObjectiveThis study aims to report our surgical experience, the feasibility and safety of percutaneous transpedicular screw fixation of thoracolumbar spine fractures.Methodwe retrospectively reviewed the charts of all adult patients with thoracolumbar spine fractures who underwent percutaneous transpedicular screw fixation during the period between January 2020 to January 2023 at Ain Shams University Hospitals and Prince Mohamed Ibn Abdelaziz Hospital. Collected data included: demographics, pre- and postoperative neurological assessment, radiological data including type of fracture and cobb’s angle pre- and postoperatively, operative time and amount of intraoperative blood loss.ResultsForty-three percutaneous pedicle screw fixation procedures were done for 42 patients. Thirty patients were males. Dorsal spine fractures accounted for 18 cases. Preoperative American spinal injury Association score was E in 37 cases. Mean operative time was 133 min (± 46.5), and mean intraoperative blood loss was 107.1 ml (± 84). The mean follow-up period was 8 months, and the average hospital stay was 7.7 days. Radiological complete bony fusion was achieved in 77% of fractures, and 93% had improved kyphotic angle with a mean correction degree of 7.9 (± 9).ConclusionPercutaneous transpedicular screw fixation is a safe and effective treatment option for the management of thoracolumbar spine fractures with or without spine decompression that provides satisfactory functional outcomes.

#332 Dermatological manifestations in pediatric CKD patients

Abstract Background and Aims Chronic kidney disease (CKD), regardless of its cause, may be accompanied by various skin lesions. The most common symptom in children suffering from CKD is pruritus however other signs that may be seen are xerosis, skin hyperpigmentation, ecchymoses, acquired perforating dermatoses, nail lesions, calcinosis cutis, as well as eczematous lesions at the site of an arteriovenous fistula and skin infections. Data on different skin lesions in children with CKD is very limited; only few reports have been published discussing xerosis in pediatric patients and most studies were conducted on a small number of patients who needed renal replacement therapy . This study aimed primarily to screen the different dermatological manifestations in pediatric patients with CKD, in addition to studying the relationship of dermatological manifestations with the CKD stage, types of dialysis, various clinical and metabolic parameters. Method This was a cross sectional study, that was conducted at Pediatric Dialysis and Nephrology unit, Children's Hospital, Faculty of Medicine, Ain Shams University Hospital, Cairo, Egypt, during the period from February 2023 to August 2023, where 70 patients were enrolled in our study being divided into two groups: group 1 including CKD patients stages (2-4) and group 2 including CKD patients with stage 5 on regular hemodialysis. Detailed dermatological & nail examination were conducted. Xerosis severity was assessed using a four-point xerosis assessment scale (0, normal skin, without any xerosis; 1, mild xerosis; 2, moderately dry skin with minimal flaking; 3, severe xerosis, heavy scaling visible), whereas pruritus was assessed using a visual analogue scale (VAS) on a scale of 1 (no itch) to 10 (worst possible itch). Laboratory data were withdrawn at the time of examination to correlate with different dermatological manifestation. Results In our study, xerosis was the most frequent dermatological manifestation (78.6%) following it pruritus (62.9%) then pallor (35.7%), hyperpigmentation (20%), hypertrichosis (10 %), nail and hair abnormalities (8.5%) & post inflammatory hyperpigmentation (4.3%). The prevalence of xerosis was not affected by clinico-demographic data, CKD duration & stage, type and duration of dialysis, the only significant relation was between efficacy of dialysis (Kt/V) and incidence of xerosis, where the higher dialysis efficacy rates were associated with low incidence rates of xerosis, in which effective hemodialysis contributes to better removal of uremic toxins, & hence decrease the xerosis. Leukocytosis was noticed in xerotic & pruritic patients, where xerosis & impaired skin barrier in children with CKD pose a risk for different cutaneous infections & inflammation, and hence pruritis. Conclusion Xerosis and pruritis are not uncommon dermatological manifestations among pediatric patients with chronic kidney disease, meanwhile the age of the patients and the underlying CKD etiology had no direct effect on skin changes. The most determinant factory affecting the xerosis was the hemodialysis efficacy, where higher efficacy was associated with less xerosis, meanwhile leukocytosis was associated with higher xerosis and pruritis. Further studies are needed to detect various skin manifestations in CKD patients with different CKD stages and correlate it with the used dialysis modalities.

Ionized hypocalcemia as a prognostic factor of early mortality in traumatic brain injury

ABSTRACT Traumatic brain injury (TBI) is a common neurological condition. It can affect mental, physical, and cognitive functions and is a common cause of mortality. Electrolytes imbalance is common in those patients. Effective therapy of electrolytes abnormalities improves neurological outcome and reduces mortality. Therefore, we studied the predictive significance of ionized hypocalcemia for early mortality in TBI patients. Patients and method This observational study in the intensive care units of the Ain Shams University hospitals was done on sixty adult patients with TBI of both sexes, divided into two groups: group A (ionized hypocalcemic patients), and group B (normocalcemic patients). On admission, medical history, physical examination including neurological evaluation, and appropriate investigations were performed. Ionized calcium was measured at the start of the 28-day study and then every five days after that. Results There was no statistically significant difference between the two groups for demographic data, brain injury type, or the number of intubated patients (p > 0.05). There was a statistically significant difference for diffuse axonal damage, subdural hemorrhage, cerebral edema, GCS, and mean blood pressure (p < 0.001). Serum ionized calcium in group A was significantly lower than in group B on the day of admission and day five (p < 0.001). On the day of admission, there was a significant difference in serum sodium (p < 0.05). In both groups, there was a significant difference in the ICU stay as regards survivors (p < 0.001). There was a statistically significant difference in 28-day mortality between the two groups (p = 0.001). Conclusion In TBI patients, ionized hypocalcemia on admission and on day five, hypernatremia and disturbed conscious level are strongly linked to greater fatality rates.

Role of Fetal Cardiac ECHO and Fetal Cardiac MRI in Prediction of Post Natal Hemodynamic Maladaptation in Fetuses of Diabetic Mothers

Background: Maternal diabetes mellitus (DM) is defined as a degree of glucose intolerance with recognition during pregnancy (pregestational or gestational, type 1 or type 2), and it is estimated to be 15% in pregnant females in 2019. The current study aimed to study the role of fetal echocardiography and fetal cardiac magnetic resonance imaging (MRI) in anticipation and diagnosis of hemodynamic maladaptation changes in fetuses of diabetic mothers as predictors for (closure of Patent ductus arteriosus (PDA), persistent pulmonary hypertension and diastolic dysfunction) which were confirmed with post-natal echocardiographic and clinical assessment. Methods: This study was an observational follow-up study that included 80 pregnant diabetic females who were following in the specialized clinics of Ain Shams University Hospitals during the period starting from August 2020 till December 2022. Results: Diabetes affected left ventricle (LV) diastolic function and global cardiac function but did not affect LV systolic function (p-value=0.000). Interventricular septum (IVS) thickness had a significant positive correlation with LV- Myocardial performance index (MPI) and indices of DM such as HbA1c. Diastolic dysfunction was the most affected cardiac parameter in infants of diabetic mothers (p-value=0.002). The hemoglobin A1c (HbA1c) was the most significant predictor for IVS thickness in diabetic mothers' fetuses, especially with a long duration of DM (p-value=0.012). Conclusion: Fetal echocardiography in diabetic mothers is essential and the gold standard modality not only for diagnosing structural abnormalities but also for evaluating the cardiac function of the fetuses. Fetal cardiac MRI could be considered a complementary imaging modality that uses no ionizing radiation, good tissue contrast, and a larger field of view.

Obeticholic Acid and Insulin Sensitivity in Overweight Patients with Prediabetes

BACKGROUND. Due to its role as a risk factor for the emergence of metabolic illnesses including type 2 diabetes, cardio-vascular disease, and certain cancers with pandemic evolution, obesity is a serious public health concern. Diabetes mellitus type 2 (T2DM) poses a major risk to human health. The byproducts of the breakdown of cholesterol are bile acids, which are crucial for preserving cholesterol homeostasis. Research indicates that bile acids might control insulin sensitivity, energy metabolism, and glucose tolerance. Farnesoid X receptors (FXRs) are crucial for controlling bile acid production and hepatic glucose metabolism. The ligand for FXR The semisynthetic derivative of chenodeoxycholic acid, a bile acid, is obeticholic acid (OCA). Research indicates that bile acids may be a viable therapeutic target for type 2 diabetes (T2DM) given that therapy with oleic acid (OCA) enhanced insulin sensitivity and decreased indicators of liver inflammation and fibrosis in individuals with T2DM and nonalcoholic steatohepatitis (NASH).AIM. To assess Obeticholic acid’s effectiveness in obese individuals with prediabetes.MATERIALS AND METHODS. Over the course of three months, we performed a randomized single blind placebo controlled trial on eighty-two overweight and obese patients with prediabetes in the outpatient clinic at Ain Shams University Hospital. Through block randomization, patients were split into two groups (Group A received daily oral tablets containing 5 mg of obeticholic acid, while Group B received non-sweet capsules as a placebo). Three follow-up visits were conducted to ensure adherence and monitor for any emergence of side effects.RESULTS. 82 patients of matched age and sex criteria who underwent block randomization into 2 equal groups, group (A) representing cases and group (B) the placebo controlled group, with 3 months’ regular follow up showed at end of treatment statistically significant difference in weight being lower in group (A) with p-value 0.004 with decreased parameters of glycemic profile (Fasting insulin, FPG, HOMA_IR, 2h PP, HbA1c) in group (A) with p-value &lt;0.001 except 2hpp which p-value is 0.006. Also ALT was much decreased in group(A) with p-value &lt;0.001. Lipid profile didn’t show significant difference between 2 groups except for TGs which deceased in follow up in group (A) with p-value &lt;0. 001. Additionally, it should be highlighted that there was no statistically significant difference between the control group’s baseline and post-treatment data.CONCLUSION. In individuals who are overweight or obese and have insulin resistance and prediabetes, activation of FXR by OCA results in enhanced insulin sensitivity. Patients who received OCA also lost weight.

Expression of serotonergic (5HT) receptors in patients with chronic rhinosinusitis with nasal polyposis and in normal nasal mucosa

Expression of serotonergic (5HT) receptors in patients with chronic rhinosinusitis with nasal polyposis and in normal nasal mucosa: a case-control study.Background Chronic rhinosinusitis with nasal polyposis is one of the challenging conditions regarding treatment and management. Many recent studies introduced new modalities for treatment like targeted immunomodulating drugs rather than antihistamines, local and systemic steroids, and endoscopic sinus surgery. Understanding the pathology behind the disease by studying its immunologic pathways and substances that take part in the inflammatory process can help in the introduction of new treatment options that can improve outcomes and decrease the costs of treatment.Objective The aim of our study is to demonstrate the presence of 5-HT receptors in nasal polyps and inferior turbinate mucosa in patients with chronic rhinosinusitis with nasal polyposis and then compare this expression of 5-HT receptors with inferior turbinate mucosa of the normal control group.Methods A case-control study was conducted on 80 patients. Specimens from nasal polypi and turbinate mucosa of patients with chronic rhinosinusitis (cases) and specimens from normal turbinate mucosa (controls) were stained with serotonin receptor Immunohistochemical staining by automated immunostainer in the pathology department laboratory in Ain Shams University Hospital with ratio 1:200–400 as recommended by the manufacturing company. Then, compared as regards stain distribution and intensity of mucosal lining, glands, and blood vessels.Results There was a significant difference between polyp cases and controls as regards lining epithelium and mucosal gland stain distribution and stain intensity. Also significant difference between the polyp cases and controls as regards blood vessel strain distribution. However, no significant difference was found as regards blood vessel stain intensity. There was a significant difference between turbinate cases and controls as regards lining epithelium stain distribution, and stain intensity. There was no significant difference between turbinate cases and controls as regards gland stain distribution. However, a significant difference was found between turbinate and controls as regards gland stain intensity. There was a significant difference between turbinate cases and controls as regards blood vessel stain distribution; however, no significant difference was present as regards stain intensity. There was no significant difference between polyp and turbinate cases as regards lining epithelium and blood vessel stain distribution and stain intensity. There was no significant difference between polyp and turbinate cases as regards gland stain distribution; however, a highly significant difference between polyp and turbinate cases as regards gland stain intensity.Conclusion Serotonin receptors are highly expressed in patients with chronic rhinosinusitis with nasal polyposis in both turbinate and polypoidal tissues which proves that serotonin has a strong role in the formation and growth of nasal polypi and allergic reactions. Hence serotonin modulating drugs can be studied as a new therapy for chronic rhinosinusitis with nasal polyposis.

Role of impulse oscillometry together with diffusing capacity of the lungs for carbon monoxide and high-resolution computed tomography for the chest in early diagnosis of interstitial lung disease in patients with connective tissue diseases

Abstract Background Connective tissue diseases (CTDs) are systemic autoimmune disorders characterized by repeated lung involvement. Interstitial lung disease (ILD) can arise from nearly any CTD, imposing a significant burden on patients and strongly affecting their prognosis. Addressing the gaps in early diagnosis, monitoring, and treatment of these patients requires a comprehensive and multidisciplinary approach for optimal management. Aim To find the best modality for early diagnosis of ILD in patients with connective tissue disorders through the use of diffusing capacity of the lungs for carbon monoxide (DLCO), impulse oscillometry (IOS) and high-resolution computed tomography (HRCT) chest. Patients and methods This study was cross-sectional, analytical, and observational was conducted on 60 patients who were diagnosed with CTD, during the period from March 2022 to March 2023, who were admitted to Chest and Rheumatology Department or outpatient clinics visitors, to Ain Shams University Hospitals. Results The sensitivity of DLCO, HRCT, and IOS in detecting interstitial affection in CTD patients was 90, 81.5, and 72.2%, respectively. There is high statistical significance between DLCO and both CT chest and IOS in detecting ILD in CTD patients. There is a highly significant correlation between DLCO with Spirometric parameters (forced vital capacity, forced expiratory volume 1 s) and between DLCO with IOS parameters (actual ×5). Conclusion ILD should always be considered in patients with CTD. Diagnosis of CTD-ILD is challenging so early diagnosis of ILD using DLCO, HRCT chest or by using IOS is important as it could affect therapy plans.

Evaluation of the effect of phacoemulsification surgery on retinal and choroidal microvasculature in diabetic patients using optical coherence tomography angiography

Aim To evaluate the effect of phacoemulsification surgery on retinal and choroidal microvasculature in diabetic patients using optical coherence tomography angiography (OCTA). Settings and design A prospective comparative case-control study was performed at the Ophthalmology Department of Ain Shams University hospital, between November 2020 and November 2022. Patients and material A total 50 eyes of 35 cataractous patients were included in this prospective study and divided into two groups: the control group (25 eyes of 19 patients) and the diabetic group (25 eyes of 16 patients with mild nonproliferative diabetic retinopathy). All patients underwent routine ophthalmic examination, OCT and OCTA scans of the macula before phacoemulsification surgery and 1 week, 1, 3, and 6 months after the surgery. Results The best corrected visual acuity significantly improved in both groups by ∼ 0.26 logMAR units in control and diabetic groups (P &lt;0.001 for both). The mean change in central subfoveal thickness was 23.44±43.7 versus 13.6±22 um (P=0.3) in the control group and the diabetic group, respectively but statistically insignificant. There was insignificant change in each group in all vascular parameters during the follow-up period. In addition, there was insignificant difference between the two groups at each visit in most vascular parameters of superficial vessel density, deep vessel density (DVD), and choriocapillaris vessel density (CC VD). On the other hand, the diabetic groups have significantly lower superficial vessel density of whole image and perifovea at 1 week than controls (42.92±4.54% vs. 46.16±3.98%, P=0.01 in the whole image, respectively) (44.29±4.87% vs. 47.32±3.85%, P=0.018 in perifovea, respectively). The diabetic group also showed significantly higher parafoveal deep vessel density than the control group at 1 month postoperatively: 52.67±4.00 versus 47.24±9.85% (P=0.014) that leveled up on month 3 and 6 (P=0.397, 0.538, respectively). The diabetic group showed lower CC VD of the whole image than the control group at 1 week postoperatively: 70.60±2.87 versus 72.22±1.98%, respectively (P=0.025), and also significantly lower CC VD of perifovea than the control group at 1 week: 71.19±2.82 versus 72.72±2.20% (P=0.038), 1 month: 71.08±2.87 versus 72.78±2.61% (P=0.033) and 3 months: 71.35±2.63 versus 72.83±2.52% (P=0.048). Those values leveled up at the last postoperative visit at month 6 (P=0.152). Conclusion Phacoemulsification surgery may lead to the transient and mild reduction of choroidal blood flow in diabetic eyes rather than retinal blood flow. Most of choroidal and retinal vascular changes happened in the perifoveal area within 1 week to 1 month postoperatively and rarely extended to 3 months.

Evaluation of the impact of breast-conserving surgery on cancer outcomes of multiple (multifocal or multicentric) ipsilateral breast cancer

Background Breast conservative therapy (BCT) includes conservative breast surgery (CBS) with adjuvant radiotherapy and is now considered a standard treatment for early-stage breast cancer to achieve survival with acceptable aesthetic outcomes. Management of multiple ipsilateral breast cancer (MIBC) is a challenge, since the choice of optimal surgical procedures is controversial. Recently, many breast surgeons have advocated CBS is technically feasible to safely excise MIBC in selected cases. Aim This study aimed to evaluate the outcome of MIBC patients who received CBS with special attention on local control and recurrence. Patient and method This retrospective study was carried out on 90 patients at Al Azhar University Hospital and Ain Shams University Hospitals between January 2021 and January 2023. Results The majority of patients 85 (94.4%) had two foci of disease while five (5.5%) patients had three foci. The distance between the lesions ranges between 0.5 and 6.5 cm. The most common type of CBS was wide local excision en bloc resection of all lesions with normal tissue in between was done in 85 (94.4%) patients and five (5.5%) patients had two separate incisions leaving normal tissue in between. Clear margins were reported in 79 (87.7%) patients. 15 (5.5%) patients had different pathological lesion types (heterogeneous). One patient had a recurrence and another had distant metastases. Conclusion With good patient selection, there is no difference between CBS and mastectomy in the management of MIBC. CBS is oncological safe provided that an adequate excision with clear margins followed by whole-breast radiation therapy and adjuvant systemic therapy.

Open distal pancreatectomy stump closure by linear stapling versus continuous suturing: a retrospective–prospective comparative study

Background Distal pancreatectomy (DP), performed for removing pancreatic lesions located to the left of the superior mesenteric vein, accounts for ~25% of all pancreatic resections. Most recently reported overall mortality rate of DP is less than 3%. However, albeit technically simpler to perform than pancreaticoduodenectomy, morbidity rate of DP remains substantial. Postoperative pancreatic fistulas (POPFs), which may result in numerous clinically significant and potentially life-threatening complications such as intraabdominal abscess, hemorrhage, and surgical site infection, is the leading cause of morbidity after DP, with an incidence of ~30–60%. Risk factors associated with POPFs after DP include decreased serum albumin levels, concurrent splenectomy, increased body weight, increased duration of surgery, higher American Society of Anesthesiologists score, and impaired renal function. Furthermore, POPFs often translate to significant increases in hospitalization costs. Objective To compare the technique of DP stump closure in two groups of patients; a group underwent stump closure with linear stapling technique and the other group underwent stump closure with continuous suturing technique. Patients and methods This was a retrospective–prospective clinical trial that was conducted at General Surgery Department, Ain Shams University Hospitals on 30 patients who were admitted to specialized hepatobiliary units in Cairo, Egypt for open DP. Between January 2020 and June 2022 with postoperative follow-up period of 2 months. In our study, there were 30 patients (15 in the continuous suturing technique group and 15 in the linear stapling technique group) with a mean age of 45.37±10.662 years. Groups were similar in demographic and clinical characteristics (P&gt;0.05). Results In our study, 13.33% patients in continuous suturing technique group developed clinically relevant POPF (grade B and grade C POPF), whereas 33.33% patients in stapling technique group develop POPF (P=1.00). The amount of the blood loss which was found to be statistically significant as the P value was found less than 0.05 and the t test was found to be −2.396 which mean that the amount of the blood lost was more in the stapler group. There was no statistically significant difference in the rate of clinically relevant POPF (grade B and grade C POPF) with suture closure compared with stapler closure (13.33 vs. 33.33%). There was no statistically significant difference in the risk of intraabdominal abscess. There were three (20%) patients with a biochemical leak in continuous suturing technique group. In stapling technique group, three (20%) patients developed biochemical leaks. There was no significant in difference between groups in terms of biochemical leak. In our study, mortality rates did not differ between stapler and suture closure techniques. Conclusion Our study showed no significant difference between suture and stapler closure of DP stump with respect to POPF or intraabdominal collection after DP. The amount of the blood lost was more in the stapler group.

The Health Outcomes of a Telegeriatrics Follow-Up Model on Dementia Patients and Their Caregivers in Cairo.

Background/Purpose: Older patients living with dementia and their caregivers are ideal beneficiaries of telemedicine, cost-effectiveness, caregiver satisfaction, and physician acceptance. The aim is to study the effect of a telemedicine dementia enabled program on the health outcome of dementia patients and their caregivers, as regard the patient outcome, caregiver stress, and caregiver satisfaction. Methods: Ninety-seven (n = 97) elderly subjects were recruited from the outpatient clinics and inpatient ward of Geriatrics Hospital, Ain Shams University Hospitals. Seventy subjects completed 6 months of follow-up using a telegeriatrics model. Patient outcomes (delirium, behavioral and psychological symptoms of dementia [BPSD], and need for home consultations, emergency room [ER] visits, clinic visits, and hospital admissions) were assessed and followed. Caregiver stress was evaluated and monitored using the abridged Arabic version of the Zarit Burden Interview ZBI-A. Caregiver satisfaction was assessed using dedicated satisfaction questionnaire designed by Ain Shams Virtual Hospital. Results: elirium episodes, BPSD episodes, and the need for home consultations, clinic visits, ER visits, and hospital admissions. This was statistically significant after the second, fourth, and sixth months of follow-up (p-value <0.001). In addition, the telegeriatrics follow-up model had a positive effect on both caregiver stress and caregiver satisfaction. Conclusions: The telegeriatrics follow-up model is a useful tool in the improvement of health outcomes of dementia patients, reduction of caregiver stress, and achievement of caregiver satisfaction.

Falls amongst elderly attending the outpatient’s clinic in the Geriatric medicine, in Ain Shams University Hospitals: Prevalence and risk factors.

Falls amongst elderly attending the outpatient’s clinic in the Geriatric medicine, in Ain Shams University Hospitals: Prevalence and risk factors.

Diagnostic Yield and Outcome Of Bronchoscopy Unit at Ain Shams University Hospital in Current Clinical Practice (Including Recent Modalities and Interventional Pulmonolgy) Marwa S Daif, Ragy Mamdouh Ghaly Lecturer of Chest Diseases, Lecturer of Ches

Diagnostic Yield and Outcome Of Bronchoscopy Unit at Ain Shams University Hospital in Current Clinical Practice (Including Recent Modalities and Interventional Pulmonolgy) Marwa S Daif, Ragy Mamdouh Ghaly Lecturer of Chest Diseases, Lecturer of Ches

Relationship of calcium-sensing receptor gene polymorphism CASR rs 1042636, CASR rs 1802757, and cinacalcet response among Egyptian hemodialysis patients with secondary hyperparathyroidism

Introduction: Secondary hyperparathyroidism (SHPT) is a common complication associated with morbidity and mortality among hemodialysis (HD) patients. Objectives: The current study aims to evaluate the frequency of CASR gene polymorphism variants related to parathyroid hormone (PTH) regulation (CASR rs1042636 and CASR rs1802757) and to test the hypothesis that single nucleotide polymorphisms (SNPs) in the CASR gene alter the response to cinacalcet among Egyptian HD patients with SHPT. Patients and Methods: A case-control study that included 50 HD patients with intact parathyroid hormone (iPTH) ≥300 pg/mL treated with cinacalcet for a 6-month duration and 40 healthy volunteers as a control group. Eligible patients were recruited from Ain Shams university hospitals. Blood samples were collected from patients and controls to assess allele frequencies of CASR gene polymorphism variants using real-time polymerase chain reaction (PCR), corrected calcium (Ca), phosphorus (P), Ca×P product, iPTH level, and alkaline phosphatase before and after treatment. HD patients were categorized into two groups based on the reduction percentage; responders’ patients (iPTH ≥20%) and non-responders to cinacalcet treatment. Results: Of 50 HD patients, 48 (96%) carried the rs1042636 AA wild gene, while only two (4%) carried the rs1042636 AG mutant gene, 42 (87.5%) carried the rs1802757 CC wild genotype, and 6 (12.5%) carried the CT mutant genotype. The minor alleles T and G were (6.3% and 2%) respectively, with no statistically significant difference between the patient and control groups regarding the CASR genotypes or alleles distribution. There was no significant difference between responders and non-responder’s patient groups regarding CASR genotypes or allele frequencies. Moreover, no significant correlation between CASR genotypes or alleles to delta change of Ca, P, Ca×P product, or PTH was seen. However, CASR rs1802757 CT mutant genotype was associated with a significant reduction in alkaline phosphatase levels after treatment. Conclusion: There is no significant association between the gene polymorphism CASR rs1042636 or CASR rs1802757 and the reduction in PTH levels as a response to cinacalcet treatment among Egyptian HD patients with SHPT.

Authentic Leadership and its Influence on Job Embeddedness among Staff Nurses

Context: A novel style of leadership known as "authentic leadership" involves leaders presenting how effectively a person is socially integrated inside their organization, fostering sincere relationships, and operating from an ethical base. Additionally affect the employee’s embeddings at work. Job embeddedness is the joint force that keeps an individual from leaving.&#x0D; Aim: The study aimed to assess authentic leadership and its influence on job embeddedness among staff nurses.&#x0D; Methods: A correlational descriptive design was employed to carry out this study at Ain Shams University Hospital on a random sample of 185 staff nurses out of 310 eligible to participate in this study. Two tools were utilized in this study: The Authentic Leadership Inventory and the Job Embeddedness Scale.&#x0D; Results: reveal that 61% of studied nurses had a low total perception level of authentic leadership, and 50% had a high total level of job embeddedness.&#x0D; Conclusion: A highly statistically significant negative correlation was shown between total staff nurses’ perception level of authentic leadership and job embeddedness. Managers should provide flexibility to staff nurses to keep them motivated and more productive. Nurse managers should meet with nurses frequently to hear about and address their concerns and to communicate their feelings.

Comparative study between rocuronium and magnesium sulfate as adjuvants to local anesthetics for peribulbar block

Background &amp; Objective: Peribulbar anesthesia is frequently used in cataract surgeries. Compared to retrobulbar anesthesia, this approach is associated with less significant consequences. However, the prolonged onset of orbital akinesia and the frequent need for block replenishment are considered drawbacks. We aimed to investigate the impact of adding rocuronium and magnesium sulfate to a commonly used local anesthetic combination on the onset of corneal anesthesia and the degree of lid and globe akinesia during peribulbar block in ocular surgeries.&#x0D; Patients and Methods: This prospective double-blinded randomized study was conducted in the ophthalmic surgery operating theater, Ain Shams University Hospital from January 2019 to April 2020. We enrolled 75 patients from both sexes, with American Society of Anesthesiology (ASA) physical status I–III, ages 40-80 y, and an axial globe length less than or equal to 26 mm planned for cataract surgery under peribulbar block in the study following institutional ethical board approval and written informed patient consents. Patients were randomly divided into three groups, 25 patients per group, based on the drugs they received: Group O (control group): received local anesthetic + 0.9% normal saline (1 ml). Group M: received local anesthetic + magnesium sulphate 50 mg in normal saline. Group R: received local anesthetic + rocuronium at a dose of 0.06 mg/kg (maximum 5 mg) in normal saline.&#x0D; Results: Our study found statistically significant more rapid onset of action (mean time to start surgery) in rocuronium group (7.00 ± 1.22 min) than control group and magnesium sulfate group (9.00 ± 1.47 and 9.00 ± 1.15 min) respectively, (P &lt; 0.001); Moreover, no significant difference was noted between control group and magnesium sulfate group. In addition, no relevant difference was reported regarding duration of surgery between the groups.&#x0D; Conclusion: During cataract surgery, the addition of rocuronium to the local anesthetic mixture in the peribulbar nerve block has been found to enhance ocular akinesia and corneal anesthesia. Furthermore, the use of rocuronium demonstrated a significantly faster onset and shorter time needed to achieve the appropriate conditions to initiate the surgical procedure compared to the use of magnesium sulfate. Addition of magnesium sulfate showed good results regarding akinesia, corneal anesthesia and need for supplementary injections but it did not significantly fasten the onset of block and hence the time to start surgery.&#x0D; Key words: Cataract; Magnesium Sulfate; Peribulbar Block; Rocuronium&#x0D; Citation: Nagy M, Abo El-Ella S, El-Shafey MA, Helal AM, Zekry MR. Comparative study between rocuronium and magnesium sulfate as adjuvants to local anesthetics for peribulbar block. Anaesth. pain intensive care 2024;28(1):55−61; DOI: 10.35975/apic.v28i1.2157&#x0D; Received: February 18, 2023; Reviewed: July 30, 2023; Accepted: December 23, 2023

Linear transmission between malleus and stapes in cases with incus necrosis.

The outcome of cartilage interposition ossiculoplasty was assessed in cases of incus necrosis after posterior malleus repositioning in the plane of the stapes, in terms of hearing gain after ossicular reconstruction. A retrospective observational study was conducted of 30 patients admitted to an Ain Shams University hospital from March 2021 to September 2021. All patients with ossicular disruption due to chronic suppurative otitis media and hearing loss of more than 40 dB were included in the study. Pure tone audiometry was conducted for each patient after three months, six months and one year post operation. The audiogram showed a post-operative air-bone gap of 20 dB or less in 83.33 per cent of patients (n = 25) at three months post-operatively and in 80 per cent of patients after six months; after one year, the results remained the same. The use of cartilage interposition after malleus posterior mobilisation represents an excellent partial ossicular replacement technique.

Epidemiological Study about Childhood Burns in the Burn Unit of Ain Shams University Hospitals

Epidemiological Study about Childhood Burns in the Burn Unit of Ain Shams University Hospitals

Health Literacy and Health-Related Quality of Life among Type 2 Diabetic patients in Ain Shams University Hospital

Health Literacy and Health-Related Quality of Life among Type 2 Diabetic patients in Ain Shams University Hospital

Effect of Training Program on Emotional Intelligence of Nurses Caring for Patients with Alzheimer’s Disease

Context: Nurses are the cornerstone of the health care systems, and their work is associated with great pressure, and nurses are often overwhelmed. Emotional intelligence and its significance to nursing have been increasingly emphasized throughout the last few years. Emotional intelligence comprises a deposit of interrelated skills involving a capability to appraise one's emotions and those of others, utilization and regulation of one's emotions, and social skills.&#x0D; This study aimed to evaluate the effect of training program on the emotional intelligence of nurses caring for patients with Alzheimer's.&#x0D; Methods: A quasi-experimental (pre/post-test) design was used. The study was conducted at the geriatric units of Ain Shams University Hospitals and the geriatric department of Abassia Hospital, affiliated with the Ministry of Health. A study employs convenience sampling with a total number of 70 nursing staff who are working in the mentioned setting. Tools used for data collection were a self-administered questionnaire including two parts; part one concerned with sociodemographic characteristics of the studied nurses, and part two included the Emotional Intelligence Scale (EIS) to assess emotional intelligence in managing the workplace.&#x0D; Results: The current study reveals that pre-program, 5.7% of the studied nurses have a high level of EI scores compared to about one quarter (22.9%) of the studied nurses who had a high level at post implementation of the program and increased to less than three quarters (71.4%) at follow up the program with a highly statistically significant difference between the levels of nurses’ emotional intelligence (p&lt;0.001) comparing between pre-intervention and follow-up.&#x0D; Conclusion: Emotional intelligence training program positively improves emotional intelligence levels among nurses caring for patients with Alzheimer’s disease. The study recommended that hospitals provide continuous in-service training, education, and awareness programs for nursing staff to enhance their skills regarding emotional intelligence. Nursing emotional intelligence skills should be included in undergraduate and postgraduate nursing curricula.