Ain Shams University Specialized Hospital Research Articles

C-Reactive Protein as an Early Marker of Severity and Outcome in Patients with SARS-CoV-2 Infection

Abstract Background SARS CoV-2 infection is a major cause of morbidity and mortality worldwide. The incidence of SARS CoV-2 infection is rising with millions of people getting infected daily. Mortality rate varies from a country to the other(0.3-6%), most of which are attributed to respiratory failure. Several studies have been performed to identify biomarkers for use in the early identification of patients at risk. Aim of the work This study was done to estimate and evaluate the plasma levels of CRP in patients with SARS CoV-2 and to study the association of CRP levels with severity of disease progression and prognosis of those patients. Patients and Methods This retrospective cohort study was conducted on 100 patients admitted to El-Obour Ain Shams University Specialized Hospital for Isolation during the period between January and October 2020. Results Regarding history patients whom were old or have any of the following comorbid conditons as hypertension, Diabetes mellitus, chronic liver disease and active cancer were statistically more prone to not surviving. Regarding complete blood picture, there was significant decrease in haemoglobin and or increase in total leukocytic count in those who did not survive. Serum Ferritin and D-Dimer were significantly high in those who did not survive. As regard CRP, it was significantly higher in the non-survivor group, Also it correlated with severity as ICU admission and need of respiratory support. Regarding the ROC curve result the best cut-off of CRP to predict mortality was >129mg/l, with Area under the curve = 0.981, Sensitivity = 90.91%, Specificity= 97.75%, positive predictive value = 83.3% and negative predictive value =98.9%. Regarding the ROC curve result the best cut-off of CRP to predict need of respiratory support was >55.3mg/L, with Area under the curve = 0.976, Sensitivity = 100%, Specificity= 86.21%, positive predictive value = 52.0% and negative predictive value =100.0%. Regarding the ROC curve result the best cut-off of CRP to predict need of ICU admission was >55.3mg/L, with Area under the curve = 0.987, Sensitivity = 100.0%, Specificity= 93.75%, positive predictive value = 80.0% and negative predictive value =100.0%. Conclusion Laboratory and clinical medicine groups should actively collaborate and optimize their individual expertise to potentially prove standardized biomarkers assays that will optimize patient care.

Effect of Central Dialysis Fluid Delivery System (CDDS) using high flux dialyzer versus Regular Water Treatment Stations on Endotoxemia and Inflammatory Markers among Prevalent Patients on Regular Hemodialysis

Abstract Background and Objectives Translocated endotoxins derived either from intestinal bacteria or backfiltration, have a wide range of adverse effects on patients. Most end stage renal disease (ESRD) patients have systemic inflammation which increases the risk of morbidity and mortality. The central dialysis fluid delivery system (CDDS) has been used exclusively in Japan since 1960s, and now is being used in Ain Shams University. Our aim of the study is to evaluate the effect of (CDDS) versus single patient dialysis fluid delivery system (SPDDS) on endotoxemia and inflammatory markers among prevalent patients on regular hemodialysis (HD). Methods Eighty Patients were randomly selected from HD units, then divided into two groups, (group I) doing HD using CDDS water purification system at El Demerdash Hospital, (group II) using regular water purification system at Ain Shams University Specialized Hospital. Pre- dialysis and post-dialysis serum samples were obtained to measure endotoxin levels of both groups, as well as postdialysis serum samples were obtained to measure interleukin 6 (IL6) level and highly sensitive Creactive protein (Hs CRP). Results Circulating endotoxemia was most notable in group II, The mean predialysis endotoxin level in group I was 0.07 ± 0.05 Eu/mL, while in group II was 0.20 ± 0.07 Eu/mL and mean of post-dialysis endotoxin level in group I was 0.04 ± 0.02 Eu/mL, while in group II was 0.15 ± 0.03 Eu/mL. IL6 as well as Hs CRP levels were higher in group II in comparison to group I. Conclusion Our data showed significant reduction in circulating endotoxins in CDDS group.

Risk Factors of Metabolic Syndrome among Post Living Donor Liver Transplant Egyptian Recipients: Single Center Study

Abstract Background For more than two decades, liver transplantation (LT) has been accepted as the most effective treatment for end-stage liver disease. However, complications following LT significantly affect the quality of life in long-term survival and metabolic syndrome (MS) is now considered to be the most common long-term complication after LT and has been increasing recently with an incidence of 50-60%. Aim of the Study To identify both pre-transplant and post-transplant risk factors which contribute to post-transplant MS (PTMS) among Egyptian recipients. Methods This study is retrospective prospective descriptive in nature. It was held at the Ain Shams Center for Organ Transplant (ASCOT), Ain Shams University Specialized Hospital with a total of 233 adult Egyptian patients who underwent living donor liver transplant (LDLT) from January 2010 through December 2020 were enrolled. Their data were extracted in detail from the medical records and were retrospectively analyzed. Results Our study has demonstrated that the recipient’s age (being old age), the presence of pre-transplant DM, the recipient being overweight prior to transplant, and the etiology of liver disease that served as an indication for liver transplant, especially cryptogenic cirrhosis, as well as the use of immunosuppressive drugs, mTOR inhibitors, in particular, were all strongly associated with the development of PTMS. However, only the presence of pre-transplant DM, the recipient being overweight prior to transplant, and the use of immunosuppressive drugs, mTOR inhibitors (Everolimus/Sirolimus), in particular, were considered independent risk factors of PTMS. Conclusion Early recognition and modification of risk factors of metabolic syndrome -if modifiable- would facilitate prevention of PTMS, which may reduce its prevalence among transplanted patients.

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.

Correlation between the serum level of ferritin and D-dimer and the severity of COVID-19 infection

BackgroundMany laboratory biomarkers were used for diagnosis of COVID-19 infection; however, their accuracy to assess the severity and prognosis are still to be evaluated. This study aims to correlate between the serum ferritin and D-dimer levels and the severity of COVID-19 infection and its outcome.ResultsRetrospective data retrieval of 150 confirmed COVID-19 infection patients admitted in Ain Shams University Specialized Hospital El Obour during period between April and July 2020 were studied. Ninety-six were survivors and 54 were non-survivors. The number of co-morbidities, the level of D-dimer and serum ferritin were correlated with ICU admission, need for mechanical ventilation and mortality with P value < 0.0001. Serum ferritin and D-dimer levels were significantly correlated with degree of HRCT chest severity with P value < 0.0001. The cut-off value of D-dimer for mortality was 700 ng/ml (sensitivity 83.33%, specificity 59.38%), and that for serum ferritin was 300 ng/ml (sensitivity 88.89%, specificity 58.33%), cut-off value of D-dimer for ICU admission was 863 ng/ml and that for serum ferritin was 300 ng/ml, cut-off value of D-dimer for mechanical ventilation was 700 ng/ml, and that for serum ferritin was 600 ng/ml.ConclusionD-dimer and serum ferritin are important biomarkers in predicting the mortality, ICU admission and need for mechanical ventilation in COVID-19 subjects. Thus helps in early detection of risk of progression and improving outcome. The current study also provides probable cut-off values for both biomarkers above which mortality, ICU admission, and mechanical ventilation need can be expected.Trial registrationClinicalTrials.gov ID: NCT0567281. Retrospectively registered. 4th January 2023.https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000CT6C&selectaction=Edit&uid=U00056R5&ts=2&cx=-tlu9xu.

Evaluation of diagnostic performance of SARS-CoV-2 detection kits: a comparative study

BackgroundCoronavirus Disease 2019 (COVID-19) pandemic has hit many countries worldwide. Rapid and accurate diagnosis is crucial to reduce disease burden. Many commercial kits have become available, but their performance needs to be assessed. This study aimed at evaluation of the diagnostic performance of real-time polymerase chain reaction (RT-PCR) and Rapid Antigen detection (RAD) kits for detecting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Five hundred sixty-four Nasopharyngeal swab specimens sent to Molecular Laboratory at Ain Shams University Specialized Hospital for SARS-CoV-2 PCR testing collected from 564 subjects who attended the outpatient clinic for sample collection were randomly selected. All samples were tested for SARS-CoV-2 PCR using Viasure. Each time a recent kit was introduced, 94 samples, previously tested using Viasure, were used to determine the performance characteristics of the recent kit in comparison with Viasure, including Fast Track Diagnostics (FTD), DNA Technology, QiaPrep, Xpress SARS-CoV-2, ID NOW COVID-19 assay and Artron COVID-19 Antigen test kit.ResultsUpon comparison, FTD, DNA Technology, QiaPrep, Xpress SARS-CoV-2 and ID Now showed positive percent agreement, 100%, 100%, 97.7%, 100%, 100% negative percent agreement, 86%, 100%, 98.8%, 90%, 100%, respectively. The RAD kit results, when compared with RT-PCR, showed high sensitivity at cycle threshold (Ct) < 30, low sensitivity at Ct ≥ 30, while specificity was 100%.ConclusionFast track, DNA Technology, QiaPrep, Xpress SARS-CoV-2 and ID Now showed good diagnostic performance. Positive RAD rule in SARS-CoV-2 infection, however negative results should be correlated with clinical condition and molecular testing.

C-reactive protein as an early marker of severity and outcome in patients with SARS-CoV-2 infection

ABSTRACT Background Infection with SARS-CoV-2 is a leading source of illness and death in the world. Millions of people contract SARS-CoV-2 every day as the incidence of infection rises. The mortality rate is mostly attributed to respiratory failure. Many studies have been carried out to identify biomarkers that can be used in the early detection of at-risk patients. CRP is a sensitive inflammatory biomarker; however, it can be measured by simple, inexpensive methods that are widely available in hospitals. Therefore, it was selected for this clinical trial. Methods This retrospective cohort analysis included 100 patients who were accepted to El-Obour Ain Shams University Specialized Hospital for Isolation between May and October 2020. Admission CRP was investigated, and data were analyzed in relation to severity and mortality. Results Regarding history, older patients or those who had been diagnosed with hypertension, diabetes mellitus, chronic hepatic diseases, or active cancer have been statistically more prone to mortality. Concerning the laboratory investigations, those who did not survive had significantly lower haemoglobin levels and a higher TLC count. In addition, serum ferritin and D-dimer levels were significantly higher in the non-survivors. As regards CRP, the non-survivor group had significantly higher levels, with a cutoff value of >129 mg/l to predict mortality. It has also been correlated with severity in terms of need for ICU admission and need for respiratory support, with a cutoff value of >55.3 mg/L. Conclusion CRP can be used as a prognostic biomarker in patients with SARS-CoV-2 infection as it is a simple and effective predictor.

Association of Interleukin-33 with Recurrent Pregnancy Loss in Egyptian Women

A successful pregnancy requires a distinct and complex immunological state. Cytokines appear to be critical for the establishment of a tolerogenic environment towards the semi-allogenic foetus during the foeto-maternal interphase, and a shift from a Th1- to a Th2-cytokine profile may be crucial. An imbalance of cytokines can be a significant factor in recurrent pregnancy loss (RPL). Interleukin-33 (IL-33) is a member of the IL- 1 cytokine family, involved in both the innate and adaptive immune responses coordinating immune cell function for a broad range of physiological and pathological processes, including the regulation of pregnancy outcome. The aim of this study was to investigate a possible association between IL-33 and RPL in Egyptian women. The study was conducted on 66 Egyptian females recruited from Ain Shams University Specialized Hospital and 66 matched healthy non-pregnant females of typical childbearing age without a history of RPL. Serum IL-33 was measured in all subjects using a sandwich ELISA technique. Serum IL-33 levels were significantly higher in patients with RPL than in the healthy control group. In addition, in the patient group, there was a positive correlation between serum IL-33 level and both age and number of miscarriages and a negative correlation between serum IL-33 level and the number of deliveries. In Egyptian women, serum levels of IL-33 are associated with RPL, thus IL-33 level could be a predictive biomarker for RPL in early pregnancy.

Molecular Identification of Multi Drug-resistant Klebsiella pneumoniae Isolated from Neonates with Sepsis in Egypt

Neonatal sepsis is one of the most prevalent infections today, claiming the lives of almost one million newborns in developing countries. Our objective is to determine the bacteria that cause sepsis in newborns in Egyptian hospitals, as well as to discover their resistance profiles, allowing for the selection of appropriate drug combinations against multidrug resistant (MDR) bacteria. Nine hundred and eighty-nine blood samples were collected from neonates in Al Demerdash and Ain Shams University Specialized Hospital from March 2019 to March 20121 according to the standard protocols. Bacterial identification and antimicrobial susceptibility test AST were performed using VITEK® 2 system. The results revealed that 51.4 % of patients had positive blood cultures, with 60.3 % females and 39.7 %. Males. Sepsis with late onset was detected in 95% of positive cases, while sepsis with early onset was observed in only 5% of the total positive cases. According to the study, 98.3 % of Klebsiella Pneumoniae isolates were resistant to Ampicillin, 91% to Ampicillin/sulbactam, and 90% to Ceftazidime and Cefotaxime. Quantitative Real-time RT-PCR analysis of the blaCTX-M-15 gene expression found that (69%) of MDR K. pneumoniae isolates expressed the gene at a significantly higher level than susceptible isolates, with a mean fold change of 10.0349 versus 1.8646. In conclusion, Klebsiella pneumoniae is the leading cause of neonatal sepsis in the majority of Egyptian hospitals' NICUs. Application of infection prevention and control strategies, in conjunction with appropriate antimicrobial stewardship programs, may be beneficial in overcoming this challenge.

Assessment of Food Services Pre-requisite Program in a Tertiary Hospital in Egypt

Abstract Background Hospital food service systems are one of the most complicated processes where safety in this sector is considered high priority issue due to high susceptibility of hospital population. Objectives Our objectives were to identify the pre-requisite program components and the degree of compliance with these components in Ain Shams University Specialized Hospital. Methods A team was formed, identification of the prerequisite program components was carried out and a check list for determining the compliance with the identified components was used. Results From our study it was found that there is a severe lack in the prerequisite program items. Only 25% of the items were achieved, and the implementation of the prerequisite items ratio was 59.4% with severe lack of temperature control in the different stages of the food flow. Conclusions The present study showed that the necessary founding element of any food safety program, comprising the policies, operating procedures and similar organizing documents which was deficient in the studied hospital. Similarly, implementation of the basic required sanitation aspects in food handling was almost half applied. Reconsideration of basic underlying system for food services is mandated in our hospital.

Evaluation of High Dose Preoperative Activated Vitamin D to Prevent Post Total Thyroidectomy Hypocalcemia

Abstract Background With increase in the number of thyroidectomies, the incidence of postoperative hypocalcemia has seen a rise as well. Deficiency of vitamin D has long been debated as a risk factor for post thyroidectomy hypocalcemia. The advantage of using vitamin D as a predictor for postoperative hypocalcemia may be (i) easy to estimate (ii) any deficiency can be easily corrected. Objective To determine the effectiveness of preoperative high dose calcitriol supplementation in reducing hypocalcemia following total thyroidectomy. Patients and Methods to assess the effect of preoperative vitamin D3 deficiency on post thyroidectomy hypocalcemia. For that purpose, 40 Egyptian patients for whom total thyroidectomy was performed in general surgery department at El-demerdash and Ain Shams University Specialized Hospital form March 2020 to September 2020. Patients were divided into 2 Groups; Group 1 included patients receiving preoperative single oral dose of active vit D(300000 IU) and Group 2 included patients receiving placebo instead of vit D. The incidence of postoperative hypocalcemia was investigated in all patients. Results Preoperative vitamin D measurements revealed a deficiency prevalence of 66.7% and a mean Vitamin D level of 17.09 ± 6.01. The main findings of the current study as regards to calcium was that the mean preoperative level of calcium was 9.61 ± 0.48 mg/dl, the lowest level of postoperative calcium was detected after 48 hours and 72 hours. With respect to relation between calcium and preoperative vitamin D, the results showed that there is no big difference between two groups (hypocalcemia occurred in 30% from patients in vit D group and 35% in placebo group) and no patients with normal preoperative vitamin D had a postoperative hypocalcemia 24, 48 or 72 hours after the operation. Conclusion Giving of single preoperative high dose vitamin D doesn’t reduce the overall rate of hypocalcemia after total thyroidectomy. Postoperative hypocalcemia is closely related to the preoperative vitamin D level and patients with hypovitaminosis D are more labile to develop hypocalcemia.

Effect of tele-stroke application on length of stay and outcome of stroke unit inpatients

Abstract Background Despite advances in acute stroke treatment, stroke remains the second most common cause of death and the leading cause for long-term adult disability worldwide Telemedicine, a method of healthcare delivery and support using telecommunication technologies, is becoming increasingly popular across a wide range of health conditions. Tele stroke has grown significantly in the past decade and has entered mainstream care for patients with acute stroke. It enables such patients to be remotely evaluated, thereby allowing optimal treatment and management even in clinically underserved areas and removing geographical disparities in access to expert care. Objective Study the effectiveness of Tele-stroke regarding length of stay&amp; stroke outcomes &amp;occurrence of medical comorbidities in admitted patients by comparing these measures before and after tele stroke application in ain shams university specialized hospital(ASUSH) Methods Comparative observational study. we stratified patients into two groups: “Group 1”: patients admitted 3 months before application of tele stroke “Group 2”: patients admitted 3 months after application of tele stroke We compared between two groups regarding sociodemographic data , length of stay and NIH scoring on admission &amp; discharge before and after implementation of tele stroke system Results regarding length of stay, it was ranged from 1 to 19 days with mean (4.3 ± 3.3) in group (I) comparing to range 1 to 12 with mean (3.5 ± 1.9) days in group (II) with significant decrease (p = 0.033*). By analysis of results by means for difference between NIH on admission and in discharge , the means difference in group I was 2.8±1.9 vs. 3.5±2.3 in group II with significant difference (p-value =0.29*) CONCLUSION Our study concluded that application of tele stroke had significant improvement in stroke unit care as regard length of stay, rapid improvement of patients according to NIH scoring and mRS

Value of vessel wall magnetic resonance imaging in the diagnosis and management of cerebrovascular diseases

Abstract Background Intracranial atherosclerosis, one of the leading causes of ischemic stroke, is associated with an increased risk for recurrent stroke and dementia. Objective This work was carried out to assess suspicious lesions detected by Magnetic Resonance Angiography (MRA) and Computed Tomgraphy Angiography (CTA) for further evaluation by vessel wall MRI . Patients and methods This study was conducted on 16 patients who were admitted to Ain Shams University Specialized Hospital with establilished diagnosis of stroke (11 patients with intracranial atherosclerosis, 3 patients with CNS vasculitis and 2 patients with Moya-moya disease ) performing MRI brain including magnetic resonance angiography (MRA) that showed intracranial stenosis, who then referred to Misr Radiology Center for the evaluation of intracranial vasculopathies by vessel wall MR Imaging using 3.0-tesla (T) field strengths. Results The results showed statistically significant difference between groups as regard to significant intracranial stenosis (&amp;gt;50%). It was prominent among moya moya disease group (100.0%) followed by intracranial atherosclerotic groups (81.8%), whereas CNS vasculitis group shows mild intracranial stenosis (0.0%). Conclusion Intracranial vessel wall MR imaging is an adjunct to conventional angiographic imaging

Effect of Dialysis Modality on Bone Disease in patient with End Stage Renal Disease

Abstract Background The kidney plays a vital role in the metabolism of minerals and bone health. It is not only the target organ of several regulating hormones such as parathormon (PTH) and fibroblast growth factor-23 (FGF-23), but it is also the main organ that activates vitamin D. Calcium and phosphorus are fundamentally important in a wide array of biological functions. Abnormalities in calcium, phosphorus, parathyroid hormone (PTH), and vitamin D metabolism (usually referred to as disordered mineral metabolism) are common in patients with (CKD). Aim of the work Comparing the effect of hemodiafiltration (HDF) versus conventional Hemodialysis on bone markers. Patients and Methods The study was performed on 50 patients in Ain Shams University Specialized Hospital with end-stage renal failure treated by means of chronic hemodialysis (n = 25) and hemodiafiltration (n = 25). Inclusion criteria were end stage renal disease patients on regular hemodialysis for &amp;gt; 6 months, their age&amp;gt; 18 years old, no recent infection (normal CRP), cardiac or vascular access complication, none of the patients had history of bone disease, fracture or malignancy. As regarding blood transfusion and drug intake (affect bone metabolism or hemostasis) had not administered for 1 month perior to study. Results Both groups had lower levels of serum creatinine before and after sessions of HD or HDF but Hemodialysis (HD) patients has higher levels of phosphate and bone ALP, than patients on HDF. Conclusion Hemodiafiltration (HDF) has better effect on bone metabolism than Hemodialysis (HD).

Association of Mucoid Degeneration of the ACL with Medial Tibiofemoral Osteoarthritis Progression at MR Imaging

Abstract Background Using MRI, ACL mucoid degeneration is defined as a thickened ACL with increased signal intensity on all MR pulse sequences, with discrete fibers easily distinguished on fatsaturated T2-weighted or fat-saturated proton-density (PD)-weighted images but poorly differentiated on T1-weighted or non-fat-saturated PD-weighted images. Objective To assess the prevalence of ACL mucoid degeneration in a population of patients referred for routine knee MRI, and its association with age and structural joint damage. Patients and Methods Our study is a retrospective study conducted at the radiology department of Ain Shams University hospitals and Ain Shams University Specialized Hospital including 81 cases of knees with ACL mucoid degeneration by MRI and no sex predilection. Cases and controls were scored with respect to independent articular features: cartilage signal and morphology, subarticular bone marrow abnormality, subarticular cysts, subarticular bone attrition, marginal osteophytes and medial meniscal integrity. Results Patients with ACL mucoid degeneration were older than patients with a normal ACL, without statistically significant sex difference. Knees with ACL mucoid degeneration had statistically significant medial meniscal injuries and cartilage damage involving the central and posterior MTFC compared to control knees with a normal ACL frequency matched for age, sex and MR field strength. Conclusion Our study proved that there is a strong association between ACL mucoid degeneration and cartilage damage in MTFC.

Diagnostic Utility of BAP1, EZH2 and Survivin in Differentiating Pleural Epithelioid Mesothelioma and Reactive Mesothelial Hyperplasia: Immunohistochemical Study.

Background: Epithelioid mesothelioma (EM) is the commonest subtype of malignant pleural mesothelioma. Its histopathological discrimination from reactive mesothelial hyperplasia (RMH) could be challenging. Thus, an immunohistochemical panel is mandatory for better discrimination. BAP1 is a newly identified diagnostic marker whose loss is specific to malignant mesothelioma. EZH2 overexpression is reported in different cancers, but its relation to BAP1 in malignant mesothelioma has not been fully understood. Survivin expression is said to be significantly higher in EM than in non-neoplastic pleural tissue, but its diagnostic utility as an immunohistochemical marker has not been thoroughly investigated in this field. To the best of our knowledge, no previous studies have been conducted to assess the diagnostic accuracy of the combined use of these three nuclear markers (BAP1, EZH2 and Survivin) in discriminating pleural EM from RMH. Methods: This retrospective study includes two groups: 81 cases of pleural EM and 67 cases of RMH, retrieved from the archives of Pathology Department of Ain Shams University Hospitals and Ain-Shams University Specialized Hospital during the period from January 2016 to December 2019. An immunohistochemical study was performed using BAP1, EZH2 and Survivin antibodies. Results: There were highly statistically significant relations between study groups as regards the studied markers (p = 0.001 for each). The specificity was 100% for all combinations of immunohistochemical markers. Sensitivity of any combination of the immunohistochemical markers used in this study was found to be higher than the sensitivity of any of these markers used individually. The combination of all three markers showed the highest diagnostic accuracy (95.9%) and the highest sensitivity (92.6%). However, the combination of Survivin and EZH2 yielded the same diagnostic accuracy and sensitivity. Conclusion: Adding EZH2, Survivin and BAP1 to the diagnostic IHC panel for differentiating pleural EM and RMH could enhance diagnostic sensitivity. Moreover, Survivin is a potentially promising marker in this context, especially when combined with EZH2.

Effect of Dialysis Modality on Bone Disease in Patient with End Stage Renal Disease

Background: The kidney has an important effect on minerals and bone metabolism in humans. Kidney is the target organ of many regulating hormones such as parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF-23), also it activates vitamin D. Abnormalities in phosphorus, calcium, vitamin D and parathyroid hormone are common in patients with chronic kidney disease (CKD). Objective: To compare the effect of online hemodiafiltration (HDF) dialysis versus high flux hemodialysis on bone markers. Patients and Methods: The study was performed on 50 prevalent hemodialysis (HD) patients in Ain Shams University Specialized Hospital on high flux dialysis and were divided into 2 groups (group 1), 25 patients who continued hemodialysis with high flux dialyzer and (group 2), 25 patients who were shifted to online HDF. Bone specific alkaline phosphatase (BSAP), calcium, phosphorus, blood urea nitrogen (BUN), creatinine, sodium, potassium and blood hemoglobin were measured at the start of this study and after 4 months. Only Parathyroid hormone (PTH) was measured at the end of the study in both groups. Results: there was significant increase BSAP and significant reduction of phosphorus levels after 4 months with online HDF compared to high flux HD; p value 0.036 and <0.001 respectively. Conclusion: Online HDF has significant effect on bone markers and phosphorus clearance than high flux Hemodialysis but we need more prospective with longer durations studies to confirm this effects.

Do CRP Levels Predict Severity in COVID-19 Hospitalized Patients?

Background: Coronavirus disease 2019 (COVID-19), has affected countless countries all over the world with rapidly increasing case fatality reports and a highly variable clinical course. Since the evolution of the clinical condition of these patients is difficult to forecast, early identification of prognostic indicators is an essential foundation to regulate treatment plans and promptly identify the severity of patients’ conditions.Method: A retrospective cohort study where the clinical data of patients with laboratory-confirmed COVID-19 infection were collected from El Obour Ain Shams University Specialized Hospital for Isolation records on admission from April 10, 2020 till July 30, 2020.we assessed the correlation between CRP level on admission with the severity of the COVID-19, the risk for ICU admission and the findings in CT chest in 276 patients.Results: Fever was the most common presenting symptom (total number 135; 41.7%), followed by cough (total number 133; 41.2%). High CRP levels were predictive of higher COVID-19 severity and ICU admission (p=0.000). Likewise, CRP levels were higher in patients with more chest affection as denoted by the CT chest findings (p=0.000).Conclusion: Serum CRP is a simple and effective prognosticator which casts light on potentially critical patients. Consequently, it can be used to reduce the mortality of patients.Funding Statement: None.Declaration of Interests: None.Ethics Approval Statement: Ethical approval or the current study protocol was obtained from Ain Shams University Faculty of Medicine Research Ethics Committee (REC) FWA 00017585.

Frequency and predictors of hypoglycemia in Type 2 diabetes: A population-based study

Background: Hypoglycemia presents a barrier to optimum diabetes management; however, data are limited on the frequency of hypoglycemia incidents outside of clinical trials. Aim: The aim of the present study was to investigate the frequency of self-reported hypoglycemic events in patients with Type 2 diabetes mellitus (T2DM) and to define factors that predict a higher risk of hypoglycemia. Materials and Methods: A sample of 1500 patients with T2DM were recruited in this prospective, observational study, selected at random from a validated community population, attending the outpatient clinic of diabetes, Ain Shams University Specialized Hospital. Eligible patients were followed up for 12 months and were instructed on the use of a diary to record hypoglycemic events. Ordinal logistic regression was performed to identify potential predictors of hypoglycemia. Results: Of a total of 1347 patients with data available for the present analysis, 583(43.28%) had experienced hypoglycemia. The participants experienced a total of 3816 hypoglycemic events during the study period, which amounts to 2.83 events (95% CI 2.74, 2.92) per patient per year. Of those who experienced hypoglycemia, 13(2.23%) recorded severe events and 125(21.44%) had evidence of impaired awareness of hypoglycemia. Patients who had experienced hypoglycemic events were elder and have higher body mass index, longer duration of diabetes, and higher HbA1c than those who had not experienced hypoglycemia, the difference was significant (all P < 0.05). Also, they were on insulin therapy, have diabetes complications, used to have irregular meals, and do not practicing exercise when compared with patients who had not experienced hypoglycemia (all P < 0.05). No significant difference was found based on gender (P = 0.25) between patients who experienced and those had not experienced hypoglycemia. Conclusions: Hypoglycemia is a frequent adverse effect in patients with T2DM, and particular attention is warranted in elder, obese patients with poor control and longer duration of diabetes. The presence of diabetes complications, insulin therapy, and unhealthy life style are also predictors of hypoglycemia.

PATTERNS OF ANTIMICROBIAL USE AND PREVALENCE OF ANTIBIOTIC RESISTANT BACTERIA STUDY AT AIN-SHAMS UNIVERSITY SPECIALIZED HOSPITAL (ASUSH)

Introduction: Antibiotics are prescribed for treating bacterial infections. However, Excessive use of antibiotics leads to the development and spread of multidrug resistant bacteria, currently regarded as a global public health crisis threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability and death. Aim of the work: To analyze the use and prescribing patterns of antimicrobials by physicians at Ain-Shams University Specialized Hospital (ASUSH) for inpatients among different infections and to determine the prevalence of different types of bacterial resistance among hospital infections. Subjects and methods: A cross- sectional study was conducted at (ASUSH). A total of 339 microorganisms isolated from several samples types were identified and studied using VITEK® 2 system. Physicians’ attitudes and knowledge were assessed using a questionnaire about antibiotic resistance problem. Results: Among (339) bacterial isolates Klebsiella pneumoniae was the most common isolate n=92 (27.1%), followed by E-coli n=60 (17.7%), Staph coag –ve (SCONs) n= 43 (12.7%) and Methecillin resistant staphylococcus aureas (MRSA), Pseudomonas aeruginosa and Acinetobacter baumanni n=33 (9.7%) for each. In this study, the majority of physicians had good knowledge about the antibiotic resistance meaning and the magnitude of that problem, with a positive attitude towards prescribing antibiotics. Conclusion: Strategies for control of resistant bacteria should consider variations among sample types, wards, and antibiotic resistance variability. There is a need to specifically address staff training and communication procedures for infection prevention and control with respect to drug resistant bacteria.