Ain Shams University Research Articles

Detection of the Association between Osteocalcin Level and Insulin Resistance in Obese Children

Abstract Background There is an increasing incidence of obesity among children which is associated with increasing occurrence of diseases which were originally adult diseases. Among these diseases is insulin resistance which was recently found to be related to osteocalcin level. Aim of Work Detect the association between osteocalcin level and insulin resistance among obese children. Subjects and Methods The study included 40 obese children and 20 age and sex matched controls who were recruited from the Clinical Nutrition Clinic, Children`s Hospital, Ain Shams University. All children were subjected to full history taking, dietary history and anthropometric measurements including weight, height, waist circumference, and hip circumference with calculation of body mass index (BMI), waist hip ratio (WHR) and waist height ratio (WHtR). Laboratory tests included fasting glucose, fasting insulin, HOMA-IR and osteocalcin level. Results Obesity was more prevalent among boys (57.5%) in the study population.. Insulin, fasting glucose and HOMA-IR were significantly higher in the obese children compared to the controls with p- values 0.000, 0.007 and 0.000 respectively.Serum insulin ranged between 7.8-37.55 mIU/L, with mean±SD 17.11±7.22 mIU/L in patients, compared to 3.03-9.21 mIU/L, with mean±SD 6.47±1.89 mIU/L in the controls. Fasting glucose ranged between 73-127 mg/dl with mean±SD 96.90±14.41 mg/dl in patients compared to 75-105 mg/dl with mean±SD 87.15±8.79 mg/dl in the controls. HOMA IR in patients ranged between 1.85-11.35 with mean±SD 4.19±2.12 compared to 0.6-1.85 with mean±SD 1.38±0.39 in the controls. Osteocalcin levels were lower ranging between 1.2-94.5 ng/ml with mean±SD of 57.66±28.43 ng/ml in patients compared to a range of 7.2-91 ng/ml with mean±SD of 66.21±19.71 ng/ml in controls, the difference was distinct, but not statistically significant with P-value of 0.233. There were non significant negative correlations between osteocalcin level and each of BMI, WHR and WHtR with r-values -0.136, -0.171 and -0.085 and p-values 0.404, 0.291 and 0.601 respectively. Additionally, there were negative correlations with no statistically significant difference between osteocalcin level and each of fasting glucose, insulin level and HOMA-IR as P-values were 0.687,0.977 and 0.790 respectively; and r - values were -0.066, -0.005 and -0.043 respectively. Conclusion Insulin resistance is demonstrated in pediatric obesity and correlated with osteocalcin levels. Additionally, osteocalcin was distinctly lower in patients and although it didn’t reach statistical significance further larger scale studies are recommended to highlight its possible role as a marker of comorbidities especially insulin resistance in paediatric obesity.

Frequency of CD4+CD25 + (High) Foxp3+ Regulatory T cells (Tregs) in Peripheral Blood of Pediatric Patients with Autism

Abstract Background Immune system dysfunctions have been observed in autistic spectrum of disorders (ASD). Autoimmunity may have a role in ASD. In addition, skewed cytokine responses, differences in total numbers and frequencies of immune cells and their subsets, neuroinflammation, both adaptive and innate immune dysfunction, altered levels of immunoglobulins and the presence of autoantibodies in some autistic children were reported. Objective To measure the frequency of CD4+CD25 + (High) Foxp3+ Tregs in peripheral blood of children with autism in relation to the disease severity. Patients and Methods This cross-sectional study involved 30 ASD patients were enrolled from the Psychiatry and Development clinic, Children’s Hospital, Ain Shams University, after excluding children with concomitant allergic diseases or infections. Another 30 healthy children were included as a control group. Severity of ASD and associated convulsions or impaired intelligence were demonstrated. The frequency of CD4+CD25 + (High) Foxp3+ Tregs was assessed using flow cytometry. Data collected were coded, tabulated and analyzed using Microsoft Excel software Statistical analysis (SPSS) (version 21, Chicago, IL, USA). Results Thirty patients with primary ASD were recruited, including 24 males (80%) and 6 females (20%) with mean age of 6.62 ± 2.11 years. Mild illness was diagnosed in 20 patients (66.7%) and severe illness was defined in 10 patients (33.3%)%). CD4+CD25 + (High) Foxp3+ Tregs were significantly lower among autistic children compared to healthy control (mean percentage in patients 15.41 ± 32.1%, mean percentage in control 49.2 ± 42.6%, P-value <0.001). The markers were not correlated with disease severity, epilepsy status or IQ level (P = 0.716, 0.729, 0.472, respectively). However,CD4+CD25 + (High) Foxp3+ Tregs were significantly lower among male patients compared to females(Median in males 1.25 (0-96), Median in females 2.25 (1.5-84.2). CD4+CD25 + (High) lymphocytes less than 3.15 cells were found to be 80% sensitive and 73.5% specific for ASD probability (AUC was 0.816). Whereas percentage of FOXP3 less than 2.55% showed 73.3% and 76.7% sensitivity and specificity, respectively (AUC was 0.753). Conclusion CD4+CD25 + (High) FOXP3, the master promotor of Tregs, was detected in lower levels in ASD Egyptian children. A level of expression lower than 2.5% is both sensitive and specific for ASD diagnosis. We recommend considering CD4+CD25 + (High) FOXP3 as a future therapeutic target in children with ASD to achieve early, efficient management.

Comparative Study between Pectoral Nerve Block Type-II (PECS II) and Serratus Anterior Plane Block (SAPB) in Postoperative Analgesic Efficacy in Modified Radical Mastectomy

Abstract Background Breast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women. Aim of the Work The aim of this work is to evaluate the efficacy of ultrasound guided pectoral nerve block type two versus Serratus Anterior plane block regarding postoperative pain control in patients undergoing modified radical mastectomy. Patients and Methods After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospitals. It included 70 female patients undergoing modified radical mastectomy were divided randomly into two groups, each group consisted of 35 patients; Group I patients received pectoral nerve block type two (PECS II), Group II patients received Serratus Anterior Plane Block (SAPB). Results The results of our study showed that there was no statistically significant difference between groups regarding demographic data. There was a statistically significant decrease in Mean blood pressure (mmHg) in Group I compared with Group II from hour-4 to hour-16 postoperative. However, a statistically significant decrease in group I compared to group II regarding postoperative heart rate (beat/min) from hour-4 to hour-16. A statistically significant decrease in group I compared to group II regarding visual analogue score for pain from minute-30 to after 12 hrs also was found. The current study shows highly statistically significant difference between groups as regard the need to intraoperative fentanyl incremental doses, time of first rescue analgesia, number of patients who received postoperative pethidine and total dose of opioids during the first 24 hrs. Conclusion Our findings suggest that PECS II block is more effective regarding postoperative pain control in patients undergoing modified radical mastectomy under general anesthesia compared to SAPB especially in the first 16 hours postoperative. Also patients underwent PECS II block show less need to intraoperative fentanyl incremental doses, less need to postoperative opioids and longer duration for time of rescue analgesia compared to patients underwent SAPB.

Spinal Cord Involvement in Children with Acquired Demyelinating Syndromes: A Single Centre Study

Abstract Background Myelitis may be the first presentation of relapsing acquired demyelinating syndromes (ADS) such as neuromyelitis optica (NMO) or multiple sclerosis (MS) and in association with connective tissue diseases. It may also occur in the context of acute disseminated encephalomyelitis (ADEM). Early recognition of myelitis in these disorders will allow better management plan including theprognosis. Objective To evaluate the frequency of myelitis among children with acquired demyelinating neurological diseases, and the variability of clinical features, neuroimaging findings and treatments given. Methods A pilot observational study with both retrospective and prospective components was conducted on children and adolescents fulfilling the diagnostic criteria for any of the acquired demyelination syndromes admitted inChildren’s Hospital, Ain Shams University whose ages were below 18 years during the period from July 2020 to February 2022. Results Forty-three children were included in our study with mean (SD)age of onset 7.63 (4.28) years. The most common diagnosis was ADEM (n (%) =20 (46.5%), followed by transverse myelitis (TM) (n (%) =11 (25.6%) and NMO (n (%) =7(16.3%). Progression to develop encephalopathy was recorded in 55.8%of cases (100% of ADEM and autoimmune encephalitis (AE) cases). Seizures developed in 23.3% of cases (35% of ADEM, 50% of AE and 14.29% of NMO cases). MRI brain abnormalities were observed in 76.7% of cases (100% of ADEM, NMO, AE and MS cases), and abnormalities of MRI spine were seen in 59% of cases (100% of TM and MS cases, 85.7% of NMO, 33.3% of AE and 23.5% of ADEM cases). Spinal cord affection was most commonly cervical(86.9%) and mostly short segment. All cases received pulsed methylprednisolone therapy, while intravenous immunoglobulins (IVIG) were used in 32.5% of cases and plasmapheresis in 13.9% of cases as a stepwise approach. Nearly half of the cases (53.5%) had monophasic illnesses without the need for long term therapy. Conclusion Spinal cord involvement is frequently observed in childhood acute demyelinating syndromes, and is most commonly cervical and short-segment. MRI spine should be regarded as a sensitive tool for diagnosis of myelitis in the context of ADEM and MS. MRI Brain is a sensitive tool accounting forfindings in 100% of ADEM, NMO, AE and MS cases. Patients with ADEM and AE has higher risk to develop encephalopathy and seizures unlike TM, NMO and MS patients.

Pulmonary and Extra-Pulmonary Persistent COVID-19 sequalae

Abstract Background This study aimed to assess the prevalence of the pulmonary and extrapulmonary symptoms and complications extending beyond the acute phase of COVID-19, Post COVID conditions can include a wide range of ongoing health problems; these conditions can last weeks, months, or longer, they are a wide range of new, returning, or ongoing health problems that people experience after being infected with the virus that causes COVID-19, it is a retrospective study conducted on 139 recovering patients of COVID-19 (3 months from the infection). Aim of the Work The aim of the work is to assess the prevalence of Pulmonary and extrapulmonary symptoms and signs extending beyond the acute phase of COVID-19. Patients and Methods A retrospective study conducted through self-reported surveys from May 2022 to October 2022. The study was conducted on 139 recovering patients of COVID-19, who presented to the Chest department at Ain Shams University after approval of the medical ethical committee. The study was conducted through self-reported surveys including Risk factors such as Diabetes mellitus, Hypertension, Ischemic heart disease, chronic obstructive pulmonary disease, interstitial lung disease, dna the severity of COVID-19 infection to assess the prevalence of the Pulmonary and extrapulmonary complications extending beyond the acute phase of COVID-19. Results Regarding the associated co-morbidities hypertension was the most frequent disease found in 28.1% of patients followed by DM which was found in 23% of patients then chronic lung disease in 18.7% of patients. Regarding general symptoms of COVID-19, dry cough was the most common symptom found in 81.3% of patients followed by fatigue in 79.1% of patients then fever in 71.9%. 59% of patients reported anosmia while sore throat was reported in 49.6% of cases. More than twenty-five (25.9) of COVID-19 patients required hospital admission, while 22.3 required oxygen therapy and 11.5 of patients required ICU admission. fatigue was the tsom common DIVOC-tsom general symptom found in 73.4% of patients. As regards DIVOC-tsom Pulmonary manifestations, the prevalence of dyspnea, chest pain, and persistent cough was the highest occurring in 54%, 46.8%, and 28.8% of patients respectively. Regarding DIVOC-tsom cardiac manifestations, the prevalence of palpitation, pulmonary embolism, and myocardial infarction was 24.5%, 2.9%, and 2.2% respectively. Regarding DIVOC-tsom neurological manifestations, the headache was the most common symptom found in 18.7% of the patients, while the prevalence of stroke, fits, and Guillain-Barré syndrome was 1.4%, 0.7, and 0.7% respectively. Concerning DIVOC-tsom psychological manifestations, the prevalence of lack of concentration, memory problems, and insomnia was 61.9,36%, and 23% respectively. In addition, the prevalence of mood changes, depression, and ertdmra-omeroo problems was 27.3%, 22.3%, and 18% respectively. And Concerning post-COVID gastrointestinal manifestations, the prevalence of abdominal pain and persistent diarrhea was the highest found in 13.7% and 7.2% of the patients respectively. Regarding post-COVID ENT manifestations, the prevalence of anosmia was 18.7%. Regarding post-COVID drug problems, the prevalence of gastritis, hypertension, and elevated random blood sugar was 25.2%, 22.3%, and 15.1% respectively. More than thirty two (32.4%) of the patients needed hospitalization due to post-COVID syndrome. Conclusion Long COVID syndrome is a frequent and may lead to very serious conditions, hospitalization and mental health problems. Follow up COVID 19 patients and make them familiar of the possible post covid complications especially the serious ones will help for early recognition and management of these complications. Post COVID 19 syndrome may affect multiple systems and symptoms vary from mild to very serious conditions.

Screen Time and its Relation to Toddlers’ Development

Abstract Background Screen-time or digital-screen exposure is the duration of time spent by the individual in using electronic/digital media like television (TV), smartphone, tablet or computer. Even background television exposure has been shown to impact development by reducing the amount and quality of interactions between parents and children. Studies showed that while babies do not absorb content from TV, it can catch and hold their attention. Aim of the Work The aim of the current study was to determine the effect of screen time on different developmental aspects of toddlers. Patients and Methods This was a cross sectional observational study that was conducted in the outpatients’ and Neurodevelopment Clinics, Children’s Hospital, Faculty of Medicine, Ain Shams University on 83 toddlers aged from 1 year to 3 years old who were exposed to screens for a longer duration than the recommended according to the American Academy of Paediatrics (AAP) guidelines. Of 13 months’ time frame, total duration of screen exposure was calculated in minutes/day and was correlated to the composite scores of Bayley scales of infants’ and toddlers’ development third edition. Results A significant negative correlations were found between duration of screen time exposure and all Bayley scales (cognitive, language and motor) composite scores and language scale is more affected. Conclusion The results of this study supported the directional association between screen time and child development. Parents and all the society should be educated about the hazards of screen time exposure on infants and toddlers’ development.

Role of MRI in Patellofemoral Pain Syndrome (Anterior Knee Pain)

Abstract Background MRI is a good diagnostic tool in identifying cartilage and soft tissue lesions as well as detecting underlying predisposing anatomical factors of patellar instability, it has a high specification for detecting the grades and the types of some of these diseases or factors that may predispose to them such as trochlear dysplasia and patella alta. Aim of the Work The aim of this study was to evaluate the role of MRI in diagnosis of Patellofemoralpain syndrome which is the most common cause of anterior knee pain. Patients and Methods This prospective study was done on patients referred from the orthopedic clinic to the department of radiodiagnosis, MRI unit at Ain Shams University hospitals.Thirty patients were included (18 females and 12 males) and their age ranged from 20 to 64 years. Conclusion This study shows that MRI is useful in detecting various predisposing anatomical factors of patellofemoral instability and associated lesions of knee joint thereby enabling orthopedic surgeons to treat joint pathology as well as correct underlying anatomical abnormality.

Compliance and Ketones Levels in Relation to Seizure Control in Children with Drug Resistant Epilepsy Treated with Ketogenic Diet

Abstract Background The ketogenic diet (KD) is a high-fat, adequate-protein, low-carbohydrate diet. Ketogenic diet therapy (KDT) has become an important option in the management of drug- resistant epilepsy and some of the inborn errors of metabolism in children, with increasing evidence of its favorable effects. Objective To evaluate patient's compliance to KD in children with drug resistant epilepsy (DRE) and the effect of KD on course and outcome of DRE. Methodology This cross-sectional study included 42 children whose age ranged between 1 month and 18 years with drug resistant epilepsy (DRE) on ketogenic diet for at least 3 months. They were recruited from the Ketogenic Diet Clinic, Children’s hospital, Ain Shams University, Cairo, Egypt. They were assessed for anthropometric measurements, betahydroxybutyrate (BHB) in blood,and acetone in urine, fasting lipid profile,serum random blood sugar;The frequency and severity of convulsions were assessed using chalfont severity scale before and after applying KD and correlated with the laboratory markers measured. Results Beta hydroxybutarate levels in blood ranged from (0.1 - 4.6) achieving ketosis in 37patient (BHB>2 mmol/L). As regard frequency of convulsions per day there was highly significant decrease after 3 month of KD with p < 0.001 compared to that before using the KD. On applying chalfont seizure severity scale on our patients there was highly significant decrease in the severity of the seizure with p < 0.001 after KD. Regarding the frequency of possible complications associated with KD, 69% of the patients had no complication, while 26.2% had constipation, 26.2% had hyperlipidemia, 2.4 % had vomiting, 2.4 % had kidney stones, and 2.4 % had urinary gravels. Conclusion KD is an effective, safe, and tolerable therapy for children with DRE where significant improvement in both frequency and severity of seizures after KD were found.

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.

Three years' registry on myocardial perfusion imaging patients in Ain shams university nuclear cardiology unit

Abstract Background The development in nuclear myocardial perfusion imaging (MPI) has provided diagnostic and prognostic implications in CAD patients, leading to an explosive increase in the performanceofthesestudies. Thisexpansionofimagingspectrumisassociatedwithwidespread concern regarding imaging utilization and increased healthcare costs. There is no comparative data that guide the use of these modalities with respect to appropriateness and patients’ benefit. Targeted data collection, through registry studies, enable analysis of both quality and outcomes with big advantages of reflecting real world daily practice and identifying the gaps in care which may not otherwise be feasible in high-quality randomized control trials. Objective To explore the extent to which stress myocardial perfusion imaging (MPI) studies met published appropriate use criteria (AUC), and the real world practice in the nuclear cardiology unit of Ain shams University. Patients and Methods It was a retrospective cohort study that included 2598 patients who underwent myocardial perfusion imaging in Ain Shams university nuclear cardiology unit throughout the period from January 2017 to December2019. All patients were subjected to thorough demographic data, history of cardiovascular risk factors (arterial hypertension, diabetes mellitus, smoking, family history of premature cardiovascular diseases), indication of the test, preprocedural ECG, ejection fraction by echocardiography, previous coronary angiography and PCI or CABG, calculation of pretest probability and Framingham risk score, determination of appropriateness use criteria and stress-rest Tc 99m imaging to detect the presence of ischemia and one day Tc 99m imaging to detect viability. Results The study included 2598 patients with mean age of 57.76 years, with male predominance (68.1%), 38.2% were diabetics and 53% had hypertension. The most common indications to undergo MPI was the exclusion of CAD as a cause of chest pain in 38.8% of patients followed by the evaluation of symptomatic post PCI patients in 21.9%. Moreover 63.8% of patients showed appropriate tests, while 18.6% of patients showed uncertain tests. Whereas 17.6% of patients had inappropriate studies. 81% of appropriate tests showed positive results of SPECT. Whereas in the inappropriate and the uncertain category, the negative test for ischemia predominated. Conclusion We have established that appropriateness criteria are effective in identifying appropriateness of SPECT in a university center located in Cairo. Also, we concluded that in our unit the appropriate tests were more prominent than inappropriate and unclassified tests. Most of the appropriate studies were positive for ischemia. While, most of the inappropriate and uncertain tests were normal and the commonest cause of referral for MPI was exclusion of CAD as a cause of chest pain.

Efficacy of Topical Anticholinergic in Control of Symptoms in Patients with Vasomotor Rhinitis and non-Vasomotor Rhinitis Patients and Normal Individuals. A Controlled Comparative Study

Abstract Background The use of a topical anticholinergic medication, ipratropium bromide, and its ability to inhibit methacholine and rhinitis-induced hypersecretion is emphasized. Ipratropium bromide appears to be both safe and effective in reducing this troublesome symptom. This study is designed to show the therapeutic effect of anticholinergic local treatment on nasal mucosa in patients with vasomotor rhinitis. Objective To assess the therapeutic effect of local anticholinergic treatment on nasal mucosa in patients with vasomotor rhinitis compared to non-vasomotor (allergic) patients and normal individuals, and if there any down regulation of the muscarinic receptors or not. Patients and Methods This prospective interventional study was conducted in Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University. This study was conducted on 60 cases. All patients were divided into 3 groups: Study group (1): includes 20 patients diagnosed clinically non allergic rhinitis suggestive to be vasomotor rhinitis. Study group (2): includes 20 patients diagnosed as allergic rhinitis. Study group (3): includes 20 patients performing surgery for non-vasomotor rhinitis non allergic causes (as septoplasty or rhinoplasty). Results Comparison between the pre and post SNOT questionnaire of symptoms among vasomotor group showed that there was a significant difference between the pre and post treatment SNOT questionnaire symptoms; Nasal obstruction, runny nose, post nasal drip, thick nasal discharge and lack of good night sleep. Among allergic cases group, there was a significant difference between the pre and post treatment immunohistochemistry findings considering epithelium, glands, arteries and veins. 20% of cases had grade 3 epithelium before treatment while after treatment, this was dropped to 0%. Comparison between the pre and post SNOT questionnaire of symptoms among allergic group showed that there was a significant difference between the pre and post treatment SNOT questionnaire symptoms; runny nose, post nasal drip, and thick nasal discharge. Among non- vasomotor rhinitis non allergic causes (as septoplasty or rhinoplasty) group, there was a significant difference between the pre and post treatment IHC findings considering epithelium, glands, and arteries, however no significant difference between the pre and post IHC veins grade. Also, there was no significant difference between the pre and post treatment SNOT questionnaire symptoms. Conclusion Topical anticholinergic such as ipratropium bromide nasal spray are effective in treating rhinorrhea symptoms in allergic and non-allergic rhinitis. Further controlled studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.

Chest Computed Tomography Severity Score to Predict Outcome of Patients with COVID 19

Abstract Background The coronavirus disease 2019 (COVID-19) is an acute infectious pneumonia caused by a severe acute respiratory syndrome-coronavirus-2. Some studies have suggested that C-reactive protein, lymphocyte count, and features from CT scoring as predictors of severity and prognosis of COVID-19. Non-contrast chest computed tomography (CT) scan was found to be a useful diagnostic instrument for screening COVID-19 pneumonia. This score uses lung opacification as a surrogate for extension of the disease in the lungs. Aim To assess the prognostic value of chest CT severity score (CSS) to predict the severity of symptoms and outcomes among patients with typical CT findings. Subject and Methods This Prospective Observational study was conducted at Radiology department, faculty of medicine, Ain Shams University on 94 patients. Results There is a significant difference between the groups regarding symptoms severity. there is no significant difference between the groups regarding CT findings. left lung severity scores and total severity score were significantly higher among poor prognosis patients compared to good prognosis patients. mortality rate was significantly higher among poor prognosis patients compared to good prognosis patients. severity score was significantly higher among severe symptoms patients compared to mild symptoms patients in good prognosis patients. Conclusion The current study showed that CT images and CT-severity scores can predict ICU admission and mortality in patients with COVID-19 pneumonia. Clinicians and radiologists can use the CT-severity score as a measure of disease severity and an indicator of poor prognosis, including the need for mechanical ventilation. Also, our findings showed the superiority of CT findings over other clinical information and co-morbidities in predicting the short-term outcome.

Functional Mobility Scale and Scoliosis Degree before and after Zoledronate Therapy in Children with Osteogenesis Imperfecta

Abstract Background Intravenous zoledronate, has been indicated for the treatment of Osteogenesis imperfecta (OI). It is a heritable disorder that causes bone fragility. The purpose of this study was to evaluate its effect on functional mobility scale and scoliosis degree on children with OI. Methods and Results This observational study was conducted on 28 OI patients (12 boys & 16 girls) aged 1.3-7.15years. All parameters were evaluated at Pediatric Endocrinology clinic, Children’s Hospital, Ain Shams University. Treatment was started with zoledronate dose 0.05 mg/kg every 6 months. Children less than 3 years of age received intravenous Zoledronate at a dose of 0.025 mg/kg per dose every 6 months with a maximum dose of 2 mg, while children above 3 years old received 0.05 mg/kg/dose every 6 months with a maximum dose of 4 mg. FMS and scoliosis degree using cobb anglewere evaluated before and after zoledronate therapy. Patients showed highly significant improvement in FMS. Patients with mild and moderate degree of scoliosis showed a non significant improvement in the degree of scoliosis while patients with severe scoliosis didn’t show any statistically significant difference. Conclusion Our study showed that intravenous zoledronate treatment, given once every 6 months, is an effective mode of treatment in OI children. It was associated with improvement in FMS. Longer follow-up is necessary to monitor the effect of treatment on degree of scoliosis by cobb angle.

The Clinical Significance of the Platelet Membrane Glycoproteins in Children with Primary Immune Thrombocytopenia

Abstract Background Primary immune thrombocytopenia (ITP) is an acquired immune-mediated disorder characterized by isolated thrombocytopenia. Although decreased platelet count is believed to be the main cause of hemorrhage in ITP, it is a poor predictor of bleeding risk by itself. Aim of the Work to measure CD62p and CD42b level in the pediatric ITP patients by using flow cytometer, measurement of platelet parameters in the pediatric ITP patients and to study its correlations to bleeding score. Patients and Methods sixty children with ITP were recruited and assessed for eligibility at the out-patients Hematology clinic – Pediatric Hospital at Ain Shams University, and compared with age and sex matched thirty healthy subjects. Results Pediatric ITP patients had a significant increase in the mean platelet volume, platelet distribution width and a significant decrease in plateletcrit among the ITP patient group in comparison with the control group (P value<0.001). The chronic ITP subgroup had significant increase of platelet count and plateletcrit in comparison with the acute ITP subgroup (P value<0.001). Pediatric ITP patients had significant increase in CD42b and a significant decrease in CD62p among the ITP patient group in comparison with the control group (P value<0.001). No statistically significant difference found between the acute, persistent and chronic ITP subgroups regarding CD42b and CD62p (P value>0.05). Conclusion Platelet function, platelet parameters and platelet glycoprotein CD62p, CD42b expression can be used as a clinical biomarkers in pediatric ITP.

Psychometric Assessment and Health Related Quality of Life of Children and adolescents With Cystic Fibrosis

Abstract Background Cystic fibrosis (CF) is an exhausting and time-consuming disease that can interfere or impair typical daily life activities and social interactions. Aim and Objectives Evaluation of psychological aspects and Quality of life in cystic fibrosis patients. Subjects and Methods This was a cross sectional study, conducted at the Paediatric Chest Clinic, Children's Hospital, Ain Shams University on 31 patients with verified diagnosis of CF compared to 31 healthy children. Psychological assessment was done using Children depression Inventory (CDI) Scale, Spence Children’s Anxiety Scale, and The Pediatric Quality of Life (PedsQLTM) Scales. Result: CF patients experienced statistically significant higher levels of depression and anxiety than their healthy peers (p < 0.001; p = 0.001, respectively). There were no significant differences in PedsQLTM Scales between the CF patients and the healthy controls (p > 0.05). Conclusion This study is significantly important for revealing that psychiatric symptoms are prevalent among children with CF, which implies that annual symptom screening is justified.

Efficacy of Combination Therapy Using Crystalloid, Colloid and Ephedrine in Prevention of Post Spinal Hypotension at Cesarean Delivery

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases, it can lead to serious maternal complications as well as impairment of the uterine and placental blood flow. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Objective To determine the most effective strategy to decrease the incidence and severity of post spinal hypotension by comparing three different combination therapies using crystalloid, colloid and ephedrine at cesarean delivery. Patients and Methods After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain Shams University, and written informed consent from all parturients this study was conducted in the operating theatres of Ain Shams Obstetric and Gynecology University Hospitals. Results In our study we found that a combination of an ephedrine infusion at 1.25 mg, minute with a crystalloid co-load was more effective in the prevention of hypotension. Conclusion Employing all mentioned combination treatments reduced the rate of hypotension occurrence following spinal anesthesia in parturients undergoing cesarean delivery. The most effective method was administration of crystalloid coloading plus ephedrine infusion.

Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy in the Management of upper Ureteric Stones Measuring from One to Two Centimeters: Randomized Prospective Study

Abstract Objective This prospective study aims to compare the clinical efficacy and safety of flexible ureteroscopy versus laparoscopic ureterolithotomy in the management of upper ureteric stones measuring from one to two centimeters. Methods his randomized-prospective study was conducted on 64 patients admitted from Urology unit, Ain Shams University in the period from October 2020 till September 2022; only 56 patients were analyzed statistically and 8 patients were excluded due to shortage in post- operative data and follow up. Patients were divided into two groups Group A consists of 31 patients and Group B consists of 25 patients with matched age, gender and body mass index (BMI). Results In our study, The VAS score at 6 hours post-operative and day 1 post-operative was found to be 5.32 and 2.71 in FURS group and was found to be 7.28 and 3.28 in RPLU group respectively showing significant difference with (p- value <0.001 and 0.016 respectively) between the two groups with more satisfaction in FURS group mostly due to the absence of trocars incisions. The complications were classified according to modified Clavien classification system. No major complications such as septic shock or death were reported in either treatment groups. As regards the recovery to work in postoperative and follow up periods in the present study, there was a significant difference between both groups with (P-value <0.001), as we found that it takes about 4.56 ± 0.82 days in RPLU group and 3.06 ± 1.91 days in FURS group to return daily routine activities. As regards the stone free rate in follow up periods in the present study, there was a significant difference between both groups with (P-value 0,02), as we found that it was 100% and 80,6% in RPLU and FURS group respectively. Our success rate in RPLU group was found to be 100% in comparison to Irfan Nazir Mir et al which was 93.4% (28/30) with two patients (2/30) converted to open ureterolithotomy, either due to technical snag or due to difficulty in localizing the ureter laparoscopically. Conclusion Both F-URS and RTLU were safe and effective surgical procedures for treatment of large proximal ureteral stones. However, RTLU had a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. Also as regards to postoperative pain, shorter hospital stay and faster return to daily activities, both have almost similar results.

Comparison between Standard Dose Methyl-Prednisolone and Mega Dose Methyl-prednisolone As Regards Outcome in SARS.COV.2 Patients in Intensive Care Unit: A Retrospective Study

Abstract Background Deadly pandemics and disease emergences are not new phenomena: they have been challenging human existence throughout recorded history. Some have killed sizeable percentages of humanity, but humans have always searched for, and often found, ways of mitigating their deadly effects. Objective to compare between standard dose methyl prednisolone (1-2 mg/kg) and mega dose methyl prednisolone (0.5 g to 1g) as regards outcome reflected by mortality rate, percentage of mechanically ventilated patients and ICU length of stay of COVID 19 patients admitted in ICU. Patients and Methods After obtaining approval from the Research Ethical Committee of Ain Shams University (FMASU MS 41/2022) this study was obtained from Ain Shams University Isolation Hospitals records. Group A: Patients admitted in ICU, COVID PCR positive and requiring oxygen therapy who received methyl prednisolone standard dose (1-2 mg/kg). Group B: Patients admitted in ICU, COVID PCR positive and requiring oxygen therapy who received methyl prednisolone mega dose (0.5-1 g per day). Results This study showed that there is no significant statistical difference between receiving standard dose and mega dose methyl prednisolone as regards mortality rate or need for mechanical ventilation. Conclusion This study showed that there is no significant statistical difference between receiving standard dose and mega dose methyl prednisolone as regards mortality rate or need for mechanical ventilation. But showed significant statistical difference as regards ICU length of stay denoting that patients received mega dose methyl prednisolone showed increased ICU stay.

Serum Selenium Status in Egyptians Patients who had Graves’ Disease with and without Ophthalmopathy

Abstract Objective Selenium is effective in improving quality of life and reducing the progression of active Graves’ orbitopathy. The effect of correcting relative selenium deficiency on improving Graves’ orbitopathy is unknown, as baseline selenium levels have not previously been measured. The study aims to determine whether serum selenium levels are reduced in patients with Graves’ disease with orbitopathy (GO) compared with without orbitopathy (GD). Design A prospective, case–control study performed between 2019 and 2021 at endocrine and ophthalmology clinics in Ain SHams University, Cairo. Subjects A total of 75 subjects, 25 as control and a total of 50 patients with Graves’ disease participated in the study: 25 with Graves’ orbitopathy and 25 without Graves’ orbitopathy. Measurements Serum selenium levels in all groups. Results Mean serum selenium levels were significantly lower in GO (16.6 +- 7.5 ng/ml) than in GD (42.9 +- 8.2 ng/ml) with (P < 0.001). Mean selenium levels appeared to decrease in parallel with increasing severity of GO; selenium level was 30-55 ng/ml in GD, 21-28ng/ml in mild GO, 18-22 ng/ml in moderate GO and 5-16 ng/ml in severe GO (P < 0.001). Conclusion Serum selenium levels are lower in patients with GO compared with GD in an Egyptian study population with marginal selenium status. selenium deficiency may be an risk factor for orbitopathy in patients with Graves’ disease.

Adherence of Mild and Asymptomatic Covid-19 Positive Patients to Ain Shams University Home Isolation Protocol

Abstract Background Egypt has reported almost 515,103 confirmed cases of coronavirus disease (COVID-19) with 24,779 deaths from January 3rd, 2020 to May 29th, 2022. To date, the clinical picture of coronavirus infection among Egyptian patients has not been well-characterized. Asymptomatic infection and mild cases make up a large proportion of infections all over the world. According to Ain Shams University guidelines, asymptomatic and mild cases can be isolated at home; however it is unclear to what extent patients adhere to home isolation guidelines, and whether home isolation was in fact effective in reducing infection among the patient’s family contacts. Aim of the Work The aim of this study was: Describe the socio-demographic characteristics of asymptomatic and mild patients eligible for home isolation and measure the adherence of patients isolated at home to the recommended control measures with telemedicine follow up. Patients and Methods This is a retrospective cohort study conducted in Ain Shams University on 400 patients who were diagnosed as positive for covid-19, classified as asymptomatic or mild cases at presentation and recommended for home isolation. Results In our cohort, Patients that were adherent to home isolation guidelines had similar household infection rate to those with less compliance except for those who had more than one bathroom, household infection had significant negative correlation to number of bathrooms (p = 0.003) because the patient was able to have personal bathrooms. Regarding family members, 57.8% of cases had members with no symptoms of COVID-19 and 43.2 % had members with symptoms or positive test. Conclusion Our study was limited with the low number of patients from a single centre. However, our findings showed that self-isolation at home may be an alternative to manage mild cases or asymptomatic patients when applied with careful and close observation.