Ain Shams University Hospitals Research Articles

Egyptian patients with cleft lip: our experience with primary rhinoplasty

BackgroundControversy exists regarding the timing of rhinoplasty for patients with cleft lip as some surgeons shy away from primary correction for fear of causing harm to the growth of the nose and the maxilla.We present our favorable experience with primary rhinoplasty with repair of unilateral cleft lip in Ain Shams University plastic surgery department, providing insights into the specific management of patients of middle eastern descent.MethodsProspective study of 32 patients, ages 3 months- 1 year with unilateral CL presenting to Ain Shams University hospitals between January 2019 and July 2022. Primary rhinoplasty was performed at the time of lip repair. Lip repair was done by Tennison-Randall technique. Evaluation of results was done by expert analysis of photographs, anthropometric measurements, and parents’ satisfaction.ResultsOver-all concordance rate was 93% and inter-observer concordance was 89%. Non-significant differences were found between cleft and noncleft sides regarding nostril dome height, columellar length, and alar width 6 months post-operatively. 81.25% of the parents were very satisfied with the results.ConclusionOur study targeted a cohort of Egyptian patients with unilateral cleft lip, who underwent primary rhinoplasty and the time of lip repair, showing favorable results, supporting the literature advocating for this timing, but limited by relatively short follow up period. To the best of the authors’ knowledge, this is the first study in Egypt to highlight the outcomes and direct experience for primary rhinoplasty with cleft lip repair in an Egyptian population.

FCGR3A V158F gene polymorphism and trastuzumab response in HER2-positive breast cancer patients

Breast cancer is considered a multifactorial disease, with genetic factors playing an important role in diagnosis and treatment. FCGR3A encodes the receptor for the Fc portion of immunoglobulin G that has been linked to the trastuzumab response. Our study aimed to investigate the association of FCGR3A-V158F gene polymorphism with breast cancer and to evaluate the impact of FCGR3A-V158F gene polymorphism on trastuzumab response in HER2-positive breast cancer patients. The study was conducted on eighty breast cancer patients who were collected from the Department of Oncology at Ain Shams University Hospitals; in addition, twenty age-matched healthy subjects were taken as a healthy control group. Patients were further sub-classified according to their responses. The study showed that there were no statistically significant differences between patients and controls regarding FCGR3A-V158F gene polymorphism genotypes. However, there was a significant association between the concordance of this polymorphism and the response to trastuzumab therapy among the patient’s group. V/V is associated with better treatment response and overall survival (OS) compared to F/V and F/F alleles. Assessment of FCGR3A-V158F gene polymorphism might be useful in making a treatment decision in HER2-positive breast cancer patients.

Clinical, laboratory, and echocardiographic characteristics of critical multisystem inflammatory syndrome in children: a retrospective, observational study

ObjectiveMultisystem inflammatory syndrome in children (MIS-C) is a critical childhood disease that is associated with coronavirus disease (COVID-19). We aimed to describe the clinical, laboratory, and echocardiographic characteristics and outcome of critical MIS-C cases in Egyptian children during the first wave of the COVID-19 pandemic.DesignA retrospective, observational study.SettingA single-center tertiary pediatric intensive care unit (PICU).In Ain Shams university hospitals Cairo EgyptMethodsChildren admitted to the PICU diagnosed with severe MIS-C as per the Centers for Disease Control’s definition from June 23, 2020, to August 22, 2020, were included.ResultsThe patient’s mean age was 7.45 (interquartile range [IQR], 4.23) years, and the cause of PICU admission was hypotension and shock. All patients had a fever for 4.8 (IQR, 2.5) days before shock developed. Overall, 68% had a gastrointestinal manifestation, and 55.6% had a rash. Thirty-five of 45 patients had ≥ 4 elevated inflammatory markers. The cardiac troponin I level was elevated in 35 of 45 patients. The most common cardiac condition was valvulitis (tricuspid regurgitation, 29/45; mitral valve regurgitation, 28/45; pulmonary valve regurgitation, 5/45; atrial valve regurgitation, 4/45). Twenty-one patients had an impaired ejection fraction < 50%, and 17 patients had coronary dilatation. Six patients had pericardial effusion, 1 patient had dilated pulmonary arteries, and 6 patients (13.3%) died of their associated comorbidities. The mean PICU length of stay among patients with no associated comorbidities was 7 days.ConclusionsCritical cases of MIS-C had a spectrum of different cardiac conditions, with valvulitis being the most common one. The worst outcome occurred in patients with comorbidities and infants.

Prognostic nutritional index as a predictor of mortality among patients admitted to ICU with acute exacerbation of chronic obstructive pulmonary disease

BackgroundThe PNI is a metric that may assess the combined impact of the inflammatory process and nutritional condition. It may be beneficial in evaluating the nutritional state of patients with AECOPD.In recent years, it has also been utilized for prognostic assessment of cases admitted to the critical care unit.Aim of the workThe objective of the research was to assess the relationship between PNI and the prognosis for ICU patients with AECOPD.Patients and methodsThis was a prospective cross-sectional observational research carried out in the RICU of Ain Shams University Hospitals from April 2023 to March 2024. The study included 161 AECOPD patients who were admitted to RICU. All patients underwent demographic data collection, special habits and comorbid conditions evaluations, and hematological indices with laboratory markers and ABG. ICU and hospital stay duration, SOFA score, and SAPS II were also documented. The PNI value was computed using the following equation: the formula to calculate the value is 10 times the serum albumin concentration in grams per deciliter plus 0.005 times the total lymphocyte count in cubic millimeters. The main measure of interest was the death rate within 30 days for all causes. Additional measures were the duration of stay in the ICU, the duration of hospitalization, and the rate of MV.ResultsThere was a significant relationship between PNI and type of respiratory failure, mechanical ventilation, fate, hypertension, and diabetes. One hundred five (65.2%) of the patients were extubated and discharged, while 56 (34.8%) of them died. The study also noted a significant positive relationship among PNI and HCT, lymphocytic %, HB, and albumin. However, there was a significant negative relationship between PNI and age, RDW, WBC, neutrophil count, neutrophil %, NLR, CRP, SAPSII, and SOFA. The SAPS II score (with SAPS II mortality) had greater AUROC in predicting mortality than PNI, NLR, and SOFA. The optimal cut-off value for PNI in this study was ≤ 29 with sensitivity 82.14% and specificity 56.19%.ConclusionThe study showed that PNI can be a useful biomarker for AECOPD. PNI with SAPS II scores on admission to ICU were closely correlated to adverse outcomes.

Psychiatric outcomes among COVID-19 egyptian patients at ain shams university quarantine hospitals: A cross-sectional study

BackgroundPsychological repercussions resulting from coronavirus disease 2019 (COVID-19) have been encountered, such as anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD). The study aimed to assess the frequency and severity of PTSD, depression, and anxiety in a sample of Egyptian patients with COVID-19 infection and analyze potential risk factors. The current study is a descriptive cross-sectional, hospital-based study, conducted from August 2020 to June 2021. The sample was selected from patients diagnosed with COVID-19 infection at Ain Shams University hospitals (outpatient clinics and inpatient units). Patients underwent a COVID severity criteria scoring system, structured clinical interview for DSM-IV (SCID-I), PTSD checklist–Civilian Version (PCLC), Beck depression inventory, and Taylor’s manifest anxiety scale.ResultsPTSD was observed in 79.29% of the study sample, 61.43% had depression, and 18.57% had anxiety. The severity of COVID-19 infection was significantly associated with PTSD severity mean scores (P value = 0.027). Furthermore, a significant relationship was observed between the severity of depression and COVID-19 infection severity (P value = 0.028). The number of comorbid medical risk factors demonstrated significance to PTSD severity (P value = 0.014).ConclusionA significant portion of the study’s patients experienced psychiatric consequences following COVID-19 infection, with 79.29% developing PTSD, 61.43% suffering from depression, and 18.57% experiencing anxiety. Various factors, such as the presence of chronic medical illnesses and the number of co-morbid medical risk factors, were observed to contribute to these psychiatric outcomes. Therefore, comprehensive psychiatric assessment and management in COVID-19 patients especially with severe forms of the disease and hospitalized patients are mandatory.

C-reactive protein/albumin ratio versus lactate/albumin ratio as an outcome predictor for patients with sepsis and septic shock in hospital stay

Background &amp; Objective: Pre-emptively identifying individuals at risk of developing sepsis and septic shock remains challenging. In septic patients, the Lactate/Albumin Ratio (LAR) and C-reactive protein (CRP)/Albumin ratio (CAR) have been suggested to be promising prognostic indicators for prediction of intensive care unit (ICU) mortality. We compared the prognostic values of CAR and LAR in patients with sepsis and septic shock. Methodology: Eighty adult patients diagnosed with sepsis and admitted to the ICUs of Ain Shams University Hospitals, were included in this observational prospective study. CRP levels, serum lactate, serum albumin, complete blood count (CBC), procalcitonin levels, and SOFA scores were assessed upon admission, with subsequently observing 28-day mortality among the selected patients. Results: CAR values were comparable between the mortality and survival groups (P = 0.807). However, LAR values were significantly elevated in the mortality group vs the survival group (P = 0.044). ROC analysis for mortality indicated that LAR had an AUC of 0.633 at a cutoff value &gt; 0.68, achieving sensitivity and specificity of 89.4% and 21.2%, respectively. In contrast, CAR had an AUC of 0.484 at a cutoff value ≥ 1.54, with sensitivity and specificity values of 63.8% and 57.6%, respectively. Length of ICU stay (P &lt; 0.001), duration of mechanical ventilation (P &lt; 0.001), cardiovascular support (P &lt; 0.001) and the need for renal replacement therapy (P &lt; 0. 039), were increased in the mortality group compared to the survival group. Conclusion: Lactate/albumin ratio is superior and more reliable bio-marker predictor compared to C-reactive protein (CRP)/albumin ratio for ICU mortality. Abbreviations: CAR - C-reactive protein/albumin ratio; CRP - C-reactive protein; ICU - intensive care unit; LAR - Lactate/Albumin Ratio; Keywords: Albumin; CRP To Albumin Ratio; Lactate; Lactate to Albumin Ratio; Mortality; Sepsis; Septic Shock; SOFA; Survival Citation: Abdou K, Mounir M, Abdelmohsen S, Salem S, Ali A. C-reactive protein/albumin ratio versus lactate/albumin ratio as an outcome predictor for patients with sepsis and septic shock in hospital stay. Anaesth. pain intensive care 2023;28(5):901−907; DOI: 10.35975/apic.v27i5.2571 Received: July 29, 2024; Reviewed: August 23, 2024; Accepted: August 28, 2024

Study of the relationship between thyroid autoimmunity, obesity and serum leptin level in a sample of Egyptian individuals

Obesity is a worldwide health problem, and its prevalence is increasing steadily all over the globe. Leptin, mainly produced by adipocytes, was identified to modulate the immune system, as well as contributing to increased production of thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibody (TG-Ab). Autoimmune thyroiditis, mainly Hashimoto's thyroiditis, is believed to be the main cause of hypothyroidism in iodine sufficient regions, (TPO-Ab) and (TG-Ab) are the hallmarks of this disease. This study aimed to assess the relationship between thyroid autoimmunity, obesity and serum leptin level in a sample of Egyptian individuals. This study was a case control study which included 60 participants, recruited from the outpatient of the Internal Medicine Clinic at Ain Shams University Hospitals, during the period from February 2022 to October 2022. They were divided into two groups: Group 1 included 30 participants, have Residual hematopoiesis is an important prognostic factor of immunosuppressive therapy in severe aplastic anemia (BMI) &gt;30 kg/m2, and Group 2 included 30 participants, have BMI (18.5-25 kg/m2). We detected serum leptin, thyroid profile and thyroid antibodies using the enzyme linked immunosorbent assay and other immunoassays. Serum levels of leptin, thyroid-stimulating hormone (TSH) and glycated hemoglobin (HbA1c) were statistically significantly higher in group 1 than in group 2 (p=0.0001 for all). Also, there was a statistically significant positive correlation between leptin level and Anti-TPO in group 1 (p=0.002). In addition, in group 1, there was a statistically significant positive correlation between serum leptin level and TSH (p=0.0001). In conclusion, there is a relationship between thyroid autoimmunity and serum leptin level in obese subjects.

A-236 Quality of Life in Egyptian Mycosis Fungoides Patients Attending Cutaneous Lymphoma Clinic at Ain Shams University Hospitals: A Cross-Sectional Study

A-236 Quality of Life in Egyptian Mycosis Fungoides Patients Attending Cutaneous Lymphoma Clinic at Ain Shams University Hospitals: A Cross-Sectional Study

Clinico-epidemiological Features of Patients with Endometrial Carcinoma in Clinical Oncology Department in Ain Shams University Hospitals in Egypt

Clinico-epidemiological Features of Patients with Endometrial Carcinoma in Clinical Oncology Department in Ain Shams University Hospitals in Egypt

The role of pulmonary rehabilitation in improving lung functions in patients with ankylosing spondylitis

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial and peripheral entheseal inflammation and new bone production(1). The development of syndesmophytes, enthesophytes, and spinal fusion along the course of the disease is linked to chronic pain, functional impairment, and disability(2). Fibrosis of the upper lobes of the lungs (interstitial lung disease) and chest wall abnormalities are two of the emerging forms of pulmonary involvement in AS. (3). Pulmonary rehabilitation is a multifaceted program of education, counselling, breathing exercises, and other modalities that can increase the patient’s independence and ease of functioning(4). Aim To estimate the role of pulmonary rehabilitation in enhancing lung function in AS individuals in relation to disease activity, clinical, and functional parameters. Patients and methods This study was an interventional study: single-arm group (prospective randomized clinical study). Thirty people (30) participated in that study from those presented to Physical Medicine, Rheumatology and Rehabilitation inpatient and outpatient clinic at Ain Shams University hospitals, diagnosed as radiographic axial spondyloarthropathy (SPA) from 02/2022 to 12/2022. All patients underwent pulmonary rehabilitation program and were exposed to a detailed history, clinical, and pulmonary function testing. Disease activity was evaluated by Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP), Valuation of function by using Bath Ankylosing Spondylitis Functional index (BASFI), 6-Minute walk test (6MWT), the Modified Borg Dyspnoea Scale (MBS), and Timed Up and Go (TUG) test. All function and clinical scores were done at baseline and repeated after completing pulmonary rehabilitation program. Result The mean age of patients was 36.57 ± 7.83 years (23–45 years), with a median disease duration of (5 (3–9) years). In total, there were 19 out of the studied patients with restrictive pattern. With comparison between pre- and postintervention of pulmonary rehabilitation, there was a significant statistical difference in all, disease activity (ASDAS and BASFI) and functional (MBS, TUG, and 6MWT) parameters (P &lt;0.001), except for occiput to the wall. Regarding pulmonary function tests, including forced vital capacity (FVC), expiratory volume in one second (FEV1), and peaked expiratory flow (PEF), there was a statistically significant change at baseline and at the end of exercise (P &lt;0.001). Conclusion Improved respiratory function and disease activity and overall functional activity are possible outcomes of pulmonary rehabilitation programs in combination with other rehabilitation interventions.

Study of malnutrition in patients with idiopathic pulmonary fibrosis

Background Although the interest in Idiopathic Pulmonary Fibrosis (IPF) has increased in recent years due to the appearance of new therapies however the interest has focused on pulmonary involvement with little concern for systemic manifestations such as the nutritional status abnormalities. Thus, our study assessed the malnutrition prevalence in patients with IPF and the best indicators for the assessment of malnutrition among them. Patients and methods This work was conducted on 110 stable IPF patients who attended the outpatient clinic of Ain Shams University Hospitals from October 2020 to July 2021. Data about the detailed history and nutritional assessment was collected. Results 22.7% and 20.9% were malnourished according to the definition of fat-free mass index (FFMI) and body mass index (BMI), respectively. Most malnourished patients according to low FFMI were female; not using PPI was a significant independent predictors of malnutrition. There was a statistically significant relation between low FFMI and low serum albumin, hemoglobin, and oxygen saturation. Our findings also revealed that measuring BMI and being less than or equal to 22.1 kg/m2 and mid-arm circumference (MAC) less than or equal 28.5 cm is significantly related to low free fat mass index (malnutrition) and increases that risk by 31.63 folds. Conclusion Nearly one-quarter of IPF patients were malnourished and it was found that measuring BMI less than or equal to 22.1 kg/m2 together with MAC less than or equal to 28.5 cm can predict low FFMI and that can be used in our clinical approach.

Clinical and epidemiological characteristics of amyotrophic lateral sclerosis in an Egyptian cohort.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder associated with progressive loss of motor neurons. It is a growing and underestimated disease, prompting this epidemiological study to describe the characteristics of ALS in Egyptian patients. This is a prospective hospital based study. ALS patients were recruited consecutively from Neuromuscular Unit in Ain Shams university Hospital from December 2018 to June 2023. Demographic data and disease related parameters were recorded. 203 ALS patients had a mean age of onset equal 39years and an inter quartile range IQR of (28.00-51.00). 76% of the cases were spinal onset ALS. Median disease duration was 2years with IQR of (1-4years); male to female ratio was 2.5:1; 18% of patients were familial ALS (FALS), while 19% were Juvenile ALS (JALS). Median diagnostic delay was 12 ± (6-36) months. Median Amyotrophic Lateral Sclerosis Functional Rating Scale Revised scores (ALSFRS-R) at presentation was 34.5 IQR of (26.00-40.00). Also, the mean rate of disease progression ALSFRS-R decline [points/month] was 0.76 ± 0.51. Our cohort was characterized by a younger age of onset, male predominance, more familial cases, within average Initial ALSFRS-R scores as well as diagnostic delay. Juvenile ALS patients were much more common in our population. These findings suggest an influential presence of genetic and epigenetic factors affecting the clinical phenotype of Egyptian ALS patients.

Incidence of In-Hospital MACE in Patients Presented with Acute STEMI in The Presence of CTO in Non-IRA

Abstract Background Previous studies have shown that approximately 40%–60% of patients with STEMI have multivessel diseases (MVD). A concurrent chronic total occlusion (CTO) in a non-IRA is incidentally found in about 8%–15% of patients with STEMI. The presence of a CTO in non-IRA has been associated with a worse prognosis in many studies, whether in the short or long term. This is probably due to many factors including more comorbidities in CTO patients, higher ischemic burden, and the “double Jeopardy theory”. Aims and objectives The aim of our study is to evaluate the incidence of in-hospital major adverse cardiovascular events (MACE) in patients presenting with STEMI and CTO in non-IRA. Methods This prospective observational study was conducted in the Cardiology Department, Ain Shams University hospitals to study the incidence of In-hospital MACE in STEMI patients presented with CTO in non-IRA. Our study included 111 patients divided into 2 groups: Group A: 52 Patients undergoing primary PCI for STEMI with concurrent CTO of a non-IRA as the study group and Group B: 59 patients undergoing primary PCI without concurrent CTO of any vessel and well-matching baseline clinical characteristics to the study group as the control group. We collected the Patient's demographic data, risk factors, family history, history of ischemic heart disease, ECG at presentation and predischarge, Predischarge Echocardiography, and Clinical in-hospital course for the development of MACE, which we defined in our study as the development of heart failure, Acute pulmonary edema (APO), arrhythmia, cardiogenic shock, and or death. Results Our study showed that only 40% of the cases developed In-hospital MACE, mostly in the form of APO and Cardiogenic Shock. It also revealed there was no statistically significant difference between cases with and without CTO regarding the demographic data except for DM. Diabetes was found higher in cases with CTO than in cases without CTO with p-value = 0.004. There was also a statistically significant difference between both groups with respect to ECG resolution being more common in cases without CTO with a P value of 0.0. In addition, there was a statistically significant difference regarding the Ejection Fraction being significantly lower in cases with CTO with a P value=0.001. Regarding the incidence of MACE in cases without CTO: there was no statistically significant difference between cases regarding the demographic data except for DM as more cases who developed In-Hospital MACE were found to be Diabetic with a P value= 0.03. Also, we observed a statistically significant difference with respect to ECG resolution as more cases who developed In-Hospital MACE didn't experience ECG resolution after primary PCI with a P value=0.018. Regarding the incidence of MACE in cases with CTO: we found a statistically significant difference regarding Blood pressure and Heart rate as more cases who developed In-Hospital MACE were found to have lower blood pressure and higher heart rate. In addition, we noticed that there was a statistically significant difference regarding Ejection fraction as 100% of the cases who developed MACE had heart failure with reduced ejection fraction. Conclusion In patients presenting with STEMI, we found the incidence of In-hospital MACE was higher in cases with CTO in non-IRA in comparison to cases without CTO in non-IRA including single vessel disease patients and MVD patients mainly in the form of APO and Cardiogenic shock. 50% of cases with CTO developed MACE, and 100% of the CTO cases that developed MACE had reduced ejection fraction.

Evaluation of GARP immunohistochemical expression in papillary thyroid carcinoma

BackgroundGlycoprotein A repetitions predominant (GARP) is a novel transmembrane protein highly expressed on the surface of regulatory T cells (Tregs), which are a subset of immunosuppressive T lymphocytes that play a major role in inhibiting the antitumor immune response. Many studies documented increased GARP expression in various tumors, which is related to a poorer prognosis, and only one single paper investigated its expression in thyroid tumors.AimTo evaluate the immunohistochemical expression of GARP in differentiated thyroid carcinomas and their tumor-infiltrating lymphocytes (TILs) in comparison to its expression in other benign and low-risk lesions.MethodsSixty-nine cases of different thyroid lesions were subgrouped into 37 cases of malignant thyroid neoplasms, 25 cases of benign thyroid lesions, and 7 cases of low-risk neoplasms collected from the Pathology Department Laboratories of Ain Shams University Hospitals during the period from January 2017 to December 2021 and stained immunohistochemically for GARP. Immunohistochemical (IHC) results were evaluated in thyroid epithelial cells and TILs. The expression of GARP was correlated with the different clinicopathological parameters.ResultsGARP expression discloses a significant statistical difference between the three studied groups (P < 0.001). High GARP expression was detected in 89.19% of the malignant cases and in 28.57% of low-risk neoplasms, while all benign lesions exhibited low GARP expression. High GARP expression of TILs was detected in 60% of the malignant cases. Synchronous high GARP expression in tumor tissue and in the surrounding TILs was detected in 63.16% of the malignant cases, yet these results did not reach statistical significance.ConclusionGARP is a marker of Tregs, whose high expression is increased in malignant over benign and low-risk lesions. It might be a potential novel target for anticancer immunotherapy.

Magnetic resonance spectroscopy as a diagnostic model for assessment of liver steatosis in metabolic dysfunction-associated steatotic liver disease in non-diabetic patients

BackgroundMetabolic dysfunction-associated steatotic liver (MASLD) disease is the commonest hepatic cause of liver fibrosis and cirrhosis after the introduction of the direct acting antivirals and eradication of hepatitis C. MASLD is usually associated with metabolic syndrome and elevated inflammatory markers. Magnetic resonance spectroscopy (MRS) offers a non-invasive diagnostic, alternative to liver biopsy. This is a case–control diagnostic-accuracy study conducted on 40 patients in the Hepato-gastroenterology Unit in the Internal Medicine Department, Ain Shams University Hospitals, to study the role of MRI spectroscopy as a new diagnostic model for assessment of liver steatosis in non-diabetic MASLD patients compared to the standard ultrasound and clinical criteria. MASLD was diagnosed by a combination of a validated ultrasound hepatic steatosis score grading system and hepatic steatosis index using clinical and laboratory parameters. MRS was performed in all patients and fat peak, water peak, and fat fraction % were measured, and diagnostic accuracy of different MRS is compared to the US scoring and different laboratory and clinical parameters. To our knowledge this is the first study conducted on MRS in our region and Egypt.ResultsThis study revealed no statistically significant difference between the two groups regarding HbA1C, creatinine, while there was highly statistically significant difference regarding fasting blood sugar, 2 h post-prandial glucose level, urine albumin, and low-density lipoprotein levels. Hepatic steatosis score grading by abdominal ultrasound on the 20 controls showed no fatty changes with grade 0 (50%), and on the 20 MASLD patients showed that 2 cases were grade 1 steatosis (5%), 9 cases were grade 2 steatosis (22.5%), and 9 cases were grade 3 steatosis (22.5%). The diagnostic accuracy of predicting hepatic steatosis using different MRS parameters: fat peak, water peak, and fat fraction had area under the curve of 99.9%, 88.6%, and 100%, respectively. The sensitivity and specificity of fat fraction in detecting hepatic steatosis were 100%. The sensitivity and specificity of the fat peak in detecting hepatic steatosis were 100% and 95%, respectively. Moreover, the sensitivity and specificity of the water peak in detecting the hepatic steatosis were 88.6% and 85%, respectively. There is a statistically significant correlation between the three MRS parameters and the abdominal ultrasound hepatic steatosis score grades.ConclusionMRS parameters: fat fraction, fat peak, and water peak, have high diagnostic accuracy for predicting the liver steatosis. Moreover, MRS has the added advantage of being a non-invasive and a tool with low radiation risk. MRS also shows the metabolic changes in the liver and could be an eligible outcome in therapeutic clinical trials.

Whole-genome sequencing of two multidrug-resistant acinetobacter baumannii strains isolated from a neonatal intensive care unit in Egypt: a prospective cross-sectional study

BackgroundAcinetobacter baumannii (A. baumannii) is a life-threatening and challenging pathogen. In addition, it accounts for numerous serious infections, particularly among immunocompromised patients. Resistance to nearly all clinically used antibiotics and their ability to spread this resistance is one of the most important concerns related to this bacterium.ObjectivesThis study describes different molecular mechanisms of two multidrug-resistant A. baumannii isolates obtained from endotracheal aspirates collected from the neonatal intensive care unit (NICU), Ain Shams University Hospital, Egypt.MethodsFollowing the identification of two isolates, they were examined for susceptibility to antimicrobial agents. This was followed by multilocus sequence typing as well as whole-genome sequence (WGS). Additionally, a Pathosystems Resources Integration Center (PATRIC) analysis was performed.ResultsTwo isolates, Ab119 and Ab123, exhibited resistance to all tested antibiotics except for tigecycline and colistin. The WGS analysis of antimicrobial resistance genes (AMR) indicated that both isolates shared beta-lactam, aminoglycoside, macrolides, and sulfonamide resistance genes. Furthermore, each strain revealed different resistance genes such as blaNDM-1, blaNDM-10, OXA-64, aph (3')-VI, Tet-B in Ab119 strain and blaOXA-68, blaPER-1, blaPER-7, Tet-39 in Ab123 strain. Multiple efflux pump genes were detected. Multilocus sequence typing indicated that both isolates belong to the same sequence type (ST931), which belongs to international clone (IC3). Both isolates exhibited the presence of multiple mobile genetic elements (MGEs), but no plasmid was detected in either of them.ConclusionsA low prevalence of the IC3 sequence type was identified among two A. baumannii isolates obtained from the NICU in Egypt, exhibiting a high resistance level. Healthcare workers must have knowledge regarding the prevalence of A. baumannii among different populations in order to administer suitable treatment, improve patient outcomes, and apply effective infection control practices.

Comparing the outcome of using high-flow nasal cannula oxygen therapy versus noninvasive ventilation for chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure

BackgroundNoninvasive ventilation (NIV) is frequently employed as a treatment option for acute hypercapnic respiratory failure (AHRF) resulting from chronic obstructive pulmonary disease (COPD). Limited research has substantiated the claims made in recent studies regarding the feasibility of employing high flow nasal cannula (HFNC).AimOur study assessed the outcome of using HFNC versus NIV for COPD patients with AHRF.Patients and methodsEighty COPD patients with AHRF were confined to the respiratory intensive care unit (RICU) at Ain-Shams University Hospitals from December 2021 to 2023 and subdivided into two groups (40/group), where the first group was placed on NIV while the second group was placed on HFNC. Data during their hospital stay as demographic data, vital data, arterial blood gases, device duration, treatment failure, and mortality were recorded.ResultsThe majority were males with mean age 63.75 ± 9.05 years along with treatment failure and complications 25%, 12.5.% in NIV versus 45%, and zero% in HFNC, respectively, with longer hospital stay in NIV 10–15 days to 7–10 days in HFNC, and with no difference in mortality rate in both groups.ConclusionBoth modalities NIV and HFNC were effective for treating COPD with AHRF. However, NIV group was significantly superior than HFNC along with apparently faster improvement in ventilatory and respiratory status especially in high CO2 level while less complications and duration of hospital stay in HFNC with no difference in mortality in both groups.

The role of screening of patients proved to have gastroesophageal reflux disease by upper gastrointestinal endoscope for early detection of interstitial lung diseases

BackgroundGastroesophageal reflux disease (GERD) is a frequent digestive illness in North America, causing symptoms and complications. It affects 18.1–27.28% of people and is associated with decreased quality of life. Treatment improves quality of life, but treatment costs are higher. The study aims to assess the role of screening of patients proven to have GERD by upper gastrointestinal endoscope for early detection of interstitial lung diseases.Subjects and methodsThis research was cross-sectional research. The study will be conducted at the Chest Diseases Department of Ain Shams University hospitals. This prospective cross-sectional research will be performed on 90 randomly selected cases diagnosed with GERD by upper gastrointestinal endoscopy. For 1 year.ResultThe findings of chest HRCT for enrolled patients are 15 patients (16.7%) showed positive CT findings suggestive of interstitial lung disease, whereas 75 patients (83.3%) had normal CT scans. The most common CT finding was atelectasis reported in nine patients (10%). a statistically significant correlation between age and fibrosis and reticular infiltration, female gender, and reticular infiltration. no statistically significant association between CT findings and each of the chest symptoms and GERD symptoms.ConclusionCT chest screen of patients diagnosed with GERD by upper gastrointestinal endoscopy plays a favorable role in the early detection of ILD to help in early management and treatment them. In patients diagnosed with GERD by upper gastrointestinal endoscopy, we revealed that: reticular infiltration is more prevalent in female gender. Reticular infiltration and fibrosis increase with older age. Reticular infiltration and atelectasis increase in patients who have a hiatus hernia. Cough, dyspnea, and wheezes increase in older age.

Retrospective ِِAnalysis of The Prognostic Impact Of Lymph Node Ratio (mLNR) In Colorectal Cancer at Clinical Oncology Department, Ain Shams University Hospitals and Damanhur Oncology Center

Retrospective ِِAnalysis of The Prognostic Impact Of Lymph Node Ratio (mLNR) In Colorectal Cancer at Clinical Oncology Department, Ain Shams University Hospitals and Damanhur Oncology Center

Impact of Androgen Deprivation Therapy on Cognitive Function of Elderly Men With Prostate Cancer.

Background Prostate cancer affects millions of men worldwide. Androgen deprivation therapy is the most prescribed medication for elderly men with prostatic cancer to slow and suppress the disease progression. Androgen deprivation therapy works on decreasing testosterone levels, and that can cause multiple side effects, including potential cognitive affection in the form of accelerating cognitive aging and potentially increasing the risk of dementia. This study is aimed at evaluating the impact of androgen deprivation therapy on the cognitive function of elderly men recently diagnosed with prostate cancer. Methods The current research is a prospective cohort study conducted on 85 elderly patients recently diagnosed with prostate cancer who are about to start androgen deprivation therapy within two weeks of the diagnosis. These patients were recruited from the oncology and geriatrics outpatient clinics of Ain Shams University hospitals and were followed up on androgen deprivation therapy for at least six months. Cognitive and depression assessments were done using the Montreal Cognitive Assessment Test and Montreal Cognitive Assessment Test-Basic (according to their education) and the Patient Health Questionnaire-9. The cases were assessed at the start, after two months, and after six months of androgen deprivation therapy use. Cognitively impaired or depressed patients were excluded at the beginning of the study. Results This study showed that 49 out of 85 (57.6%) of the studied participants had a lower Montreal cognitive assessment test score average after six months, indicating mild cognitive impairment. Cognitive domains such as visuospatial, language, and attention were affected. About one-third of the participants were diagnosed with depression after six months of the androgen deprivation therapy. All the depressed participants had cognitive impairment. Conclusion The use of androgen deprivation therapy carries the risk of cognitive decline and regression of some of the cognitive domains such as language, visuospatial, attention, and depression in the elderly with recently diagnosed prostate cancer who received ADT for six months. Conversely, depression could not be linked to cognitive decline. Further research should continue exploring the relationship between cognitive decline and ADT and seek strategies to mitigate these effects, ensuring comprehensive patient care targetingcognitive and psychological well-being.