Ain Shams University Research Articles

COVID-19 Infection in a Group of Egyptian Children with Bronchial Asthma: A Single Center Study

Abstract Background Impact of asthma on COVID-19 severity and outcome in infants is not well investigated. Therefore, we sought to assess the presentation, severity and outcome of COVID-19 infection in a group of Egyptian asthmatic children. Patients and Methods We conducted an observational follow up study on 30 asthmatic children with probable/confirmed COVID-19, aged 6-10 years, who were enrolled consecutively from the Emergency department and Isolation Ward, Children`s Hospital, Ain Shams University, Egypt. COVID-19 clinical manifestations, severity and outcome were studied. Results The median age of the children was 9 years (IQR: 6-18 years). Out of the 30 studied patients, we had 9 boys and 21 girls. COVID-19 was asymptomatic in 2/30 (6.7%), mild in 20/30 (66.7%), and severe in 8/30 (26.7%). Clinical manifestations of COVID-19 included constitutional (22,73.3%), respiratory (21, 70%), gastrointestinal (7, 23%), cardio- vascular (5, 16.7%), and dermatological (1, 3.3%) manifestations. Multisystem inflammatory syndrome (MIS-c) was diagnosed in only one patient. Chest X-ray abnormalities were found in (36.7%). The median duration of hospital stay was 10 days, Complete resolution was the final outcome of all patients. Conclusion Asthma does not represent a risk of severe COVID-19 or poor outcome and COVID-19 course, and the outcome in asthmatic children is similar to the general pediatric population. However, our study is limited by the small sample size and short duration of follow-up. Further longitudinal studies are needed to investigate the exact impact of different SARS-CoV-2 variants with respect to asthma phenotypes and asthma biological treatments and allergen immunotherapies in children.

Surgical Options for Treatment of Medically Intractable Neuropathic Facial Pain: An Outcome Assessment Study

Abstract Background Facial pain is a common condition with a worldwide prevalence of 10-25% in adults. It often us a serious condition that can have a significant impact on patients’ daily life activities. The three main categories of facial pain are trigeminal neuralgia, trigeminal neuropathic pain and persistent idiopathic facial pain. To date, trigeminal neuropathy remains a potentially surgical pathology for the purpose of pain control with poor response to medical treatment. Aim and Objectives The aim of this study is to present our experience in the management of different pathologies of trigeminal neuropathy and to review the effectiveness and long-term efficacy of the different surgical procedures. Subjects and Methods This is a mixed prospective-retrospective study conducted at Ain Shams University (ASU) hospital and Oregon Health and Science University (OHSU) during the period from December 2012 till July 2020 for the retrospective part and from January 2019 till September 2021 for the prospective part. Patients with neuropathic facial pain treated during this time frame were included in the study. Result 28 patients were included in this study. They underwent 40 surgical interventions for the management of different categories of trigeminal neuropathy. Neuro-modulatory procedures were performed in 9 patients (3 ucSCS and 6 PNS) while neuro-ablative procedures were performed in 19 patients. Median time to pain recurrence after SCS device implantation for the neuropathic trigeminal neuralgia was 19.5 months. For the patients treated with PNS, 2 out of 6 of patients had satisfactory pain relief, whereas half of the patients had no improvement. Overall median time to pain recurrence after CT guided T/N was 5.6 months. In the cohort of patients treated with caudalis DREZ, 4 patients out of 6 had grade I pain relief at last follow up and the overall median time to pain recurrence was 3.9 months. Conclusion Trigeminal neuropathy is a difficult to treat entity of facial pain syndromes. Although many neuro- modulatory and neuro-ablative interventions are available in the armamentarium for the treatment of such pathology, outcomes remain suboptimal. Pain relief in the immediate postoperative period is usually higher than at last follow up which is a common finding in after these interventions. The long-term efficacy of most available interventions does not meet patients’ satisfaction.

Study of the Efficacy and Safety of Darbepoetin Alfa versus Epoetin Alfa in the Treatment of Anemia in Pediatric Patients on Regular Hemodialysis

Abstract Background Anemia is a common comorbidity in patients with chronic kidney disease (CKD). That affects the vast majority and can have a significant impact on patient morbidity and mortality. Erythropoiesis-stimulating agents (ESAs) are the main lines in management of anemia in hemodialysis patients. Replacement therapy with recombinant human erythropoietin (r- HuEPO) has provided an effective treatment for patients with renal “Epoetin alfa” is a recombinant erythropoietin with the same amino acid sequence as human erythropoietin (EPO). In comparison to epoetin alfa, darbepoetin alfa (DPO) contains an increased amount of sialic acid-containing carbohydrate chains. It shows a much longer elimination half-life than epoetin alfa, with prolonged erythropoietic effect. Aim of the Work to evaluate whether darbpoetin and epopoetin alpha can be used interchangeably on the same patient, achieving the same desired effect and to detect any difference in the occurrence of side effects between both ESAs. Patient and Methods This was a crossover study that took place in the Pediatrics Dialysis unit, Children’s Hospital, Ain Shams University. The study was conducted on 40 children with end stage renal disease on regular hemodialysis over a period of 6 months. The patients were randomly put into two groups A and B, each group contained 20 patients. Each group received one type of ESA either ( darbpoetin alpha or epopoetin alpha )for 3 months and then shifted to the other type of ESA for another 3 months. The dosage of epoetin alfa used was (200 IU/kg/week) and a conversion rate of EPO: DPO, 300:1. A period of 6 weeks was agreed as a washout period after the first drug given in both groups in which no results were recorded but ESA was not stopped due to its essentiality. Blood tests (hemoglobin (Hb), serum urea, serum creatinine and iron profile; (S. iron, S. ferritin, TIBC, and transferrin saturation)) were withdrawn at the start and the end of the 3 months’ period of each drug. Results We found no difference on the Hb level with both drugs. The interchange between them did not yield any significant drop in the Hb levels. Hb target in both EPO and DPO was reached in 22.5% of total cases, and was not reached in 62.5%. This proved that both drugs give the same effect with nearly negligible difference. No serious Sside effect as convulsions, hypertension, and thrombosis were noticed in both groups. Conclusion The target Hb was not reached in most patients of both groups of ESRD on regular hemodialysis at the unit and none of both drugs showed superior results or less side effects than the other.

Comparison Between the Efficacy & the Safety of Single Use Flexible Ureteroscopy Lithotripsy and Miniaturized Percutaneous Nephrolithotomy (Mini PCNL) for the Management of Renal and Proximal Ureteral Calculi of ≤ 2CM

Abstract Background Urolithiasis has become a common medical problem with about 2- 3% prevalence rate and still increasing in the general population. Renal calculi represent about 80- 90% of all urinary calculi with high recurrence rate. Single Use Flexible Ureteroscopy Lithotripsy and Percutaneous Nephrolithotomy Lithotripsy are recommended in the 2013 European Association of Urology guidelines as the first line in management of lower pole calculi when renal anatomy is unfavorable for Extracorporeal Shock Wave Lithotripsy. Furthermore, Single Use Flexible Ureteroscopy Lithotripsy is extremely effective for management of calculi of ≤ 2 cm in diameter and complex renal calculi. Aim of the Work The aim of our study is to compare the outcome of using Single Use Flexible URS versus Mini-PCNL with ≤22 Fr tract accessin management of pelvic, lower calyceal and proximal ureteral calculi ≤ 2cm. It was conducted on 40 patients that were randomly divided into 2 groups. Group A were treated with Mini-PCNL (20cases), whereas group B were treated with Single Use Flexible URS (20 cases). Patients and Methods A clinical trial, it was carried out at Ain Shams University, Urology department from October 2020 to October 2021 and done over 40 patients complaining of single pelvic, lower calyceal or upper ureteric stone ≤ 2 cm. The patients underwent either Mini-PCNL or Single Use Flexible URS randomly according to simple randomization using Gpowa computer program with ratio 1:1. Results Our study showed that Single Use Flexible URS achieves a comparable stone free rates to Mini- PCNL as there is no statistically significant difference between group A and group B in the stone free rate.Flexible URS reduces the risks associated with Mini-PCNL.Blood loss is highly significant in Mini-PCNL group more than in Single Use Flexible URS group.The incidence of post-operative fever and infection is non- significant between 2 groups. It is (15%)3 cases from 20 cases in group A although, (5%)1case from 20 cases in group B. There is highly significant difference between group A and group B in both operation time and hospital stay. This means that the patients take more intra operative time in Flexible URS group than in Mini-PCNL group,but more hospitalization in Mini- PCNL group than Single Use Flexible URS group.There is no statistically significant difference between 2 groups in the need for double J stent or auxiliary procedure such as ESWL. Conclusion Single Use Flexible URS is widely used nowadays and the treatment of choice for management of renal calculi due to its high efficacy and low morbidity in management of renal stones up to 20 mm. This study indicated that Single Use Flexible URS is an effective technique for management of renal and proximal ureteric calculi ≤ 2cm. In comparison to Mini-PCNL, it not only has a similar stone free rate, but also is associated with lower complication rates, more favorable recovery time. But it has longer operative time.

Serological Screening for Severe Acute Respiratory Syndrome Coronavirus-2 in Type 1 Diabetic Children and Adolescents

Abstract Background Diabetes was identified as a risk factor for many infections. In the SARS-CoV-2 pandemic, diabetes is one of the leading comorbidities associated with infection severity. Aim of the Work To determine the severity of COVID-19 symptoms in type 1 diabetic children and adolescents. To Determine the effect of SARS-CoV-2 lockdown on glycemic control. Patients and Methods A cross sectional observational study was carried out in Pediatric and Adolescent Diabetology Unit (PADU), Children's Hospital, Ain Shams University between September 2020 and January 2022. The study included 500 randomly selected diabetic children and adolescents. They were tested for Hemoglobin A1C and SARS-CoV-2 IgM and IgG antibody. Results There is a significant relation between myalgia (p = 0.012 ), diarrhea( p = 0.007) and IgM positivity, and a significant relation between diarrhea and both IgG and IgM positivity (p = 0.005). Other symptoms had a non-significant relation with COVID-19 IgM or IgG. All symptoms suggestive of COVID-19 infection that were detected in our patients were not severe. During COVID-19 pandemic, glycemic control deteriorated in our patients as mean HbA1c reached 9.6% as compared to a mean level of 8.8% before COVID-19 pandemic. Conclusion Diabetes comorbidity did not increase the severity of COVID-19 symptoms to our patients. Glycemic control as indicated by HbA1c level showed deterioration during lockdown due to impaired access to care.

Correlation between Acute Liver Injury and Disease Severity in Hospitalized Egyptian Patients with Covid-19

Abstract Background COVID-19 pandemic has brought new health threats and challenges to the world. However, the scientific progress over the last months has shed more light on several key questions concerning COVID-19-associated complications. Aim of the Work The aim of this study is to correlate acute liver injury in Covid-19 hospitalized patients with the severity of the disease. Patients and Methods This was a cross-sectional study that was conducted on 110 patients at Ain Shams University hospitals including Ain-Shams Quarantine field hospital, Ain Shams University Quarantine hospital in Al-Obour, and Quarantine ICU of Demerdash through twenty months. Results In total, 110 patients with positive SARS-CoV-2 PCR test were included in this study. The study population was mostly males with 58.2% and median age of the population was 65 years old. As regards to the morbidity status of the study population, 67.3% of the patient died due to disease severity, while 32.7% showed recovery. There was statistical significant relation between liver injury in terms of elevation of (AST-ALP-GGT-Bilirubin) and the increase in oxygen demand. As regards to the inflammatory markers, they significantly correlated with liver injury. Conclusion This study concluded that impaired liver function constitute a common finding in COVID-19 patients. Deterioration of liver function worsens the prognosis and prolongs duration of hospitalization. Thus, critically ill Covid-19 patients should be monitored closely to manage any possible complications.

Association between Autoimmune Hepatitis and Celiac Disease among Egyptian Children and Adolescents

Abstract Background Celiac disease (CD) is an immune-mediated intolerance to gluten .CD has been recognized as a multisystem disorder which may affect other extra intestinal organs, such as the skin, thyroid, heart, nervous system, pancreas and liver. Individuals with CD are at increased risk of liver disease namely cryptogenic liver disorder and autoimmune liver disorder. However, until now, it remains unknown whether these two forms of liver disease are really different entities or only different severities of the same disorder. Objective To evaluate the association of CD with autoimmune hepatitis in pediatrics. Subjects and Methods This was a cross-sectional study that was conducted at the Pediatric Hepatology Clinic and Pediatric Gastroenterology Clinic, Children’s Hospital, Ain Shams University. The study included 2 groups of patients each comprised 20 children and adolescents as follow: Group I: Patients with established diagnosis of autoimmune hepatitis (AIH). All patients were receiving corticosteroids and azathioprine Group II: Patients with established diagnosis of CD. In group I patients with AIH, CD was screened for using anti-tissue transglutaminase (tTG) IgA in addition to measuring serum IgA to determine the need to measure anti-tTG IgG. Immunological markers (ANA, anti-smooth muscle antibody (ASMA) and liver and kidney microsomal (LKM) antibodies in addition to protein electrophoresis were done for group II patients with CD to screen for AIH. Results All patients in group I with AIH had normal serum IgA levels and were found negative for anti-tTG IgA. Also, group II patients with CD were negative for ANA, ASMA and LKM antibodies with normal protein electrophoresis. Conclusion The current study showed that CD does not seem to have significant association with AIH, however, the small sample size is a study limitation. Further wider scale studies are needed to evaluate the risk of AIH in CD.

Clinical and Biochemical Profile of Patients with 46, XY Disorders of Sex Development

Abstract Background Disorders of sex development (DSD) comprise a wide range of conditions with varying features and pathophysiology that most often present in the newborn or the adolescent. Affected newborns are born with ambiguous genitalia, whereas adolescents present with atypical sexual development during the pubertal years. Aim of the Work To study the clinical and biochemical profile of patients with 46, XY disorders of sex development. Patients and Methods This was a descriptive study, conducted on 50 patients with 46, XY DSD attending the Pediatric Endocrinology clinic, Children's Hospital, Ain Shams University were recruited from April 2019 till April 2020. Results In our study 88% of cases were reared as males, while 12% were reared as females. The mean age at diagnosis was 2.48 ± 1.33 years with a range of 1-7 years. Parental consanguinity was present in 28 (56.0%) patients and a positive family history in 10 (20.0%). Mean external masculinization score (EMS) in our study was 3.30 ± 1.81 and ranged from 0 to 9 with a median of 3. The mean of stimulated Testosterone / Dihydrotestosterone (T/DHT) ratio was 17.5 (7.8-26) and ranged between 1.5 and 66.6. The median of Anti Mullerian Hormone (AMH) was 56 ng/ml and ranged between 19.08 and 105 ng/ml. There was correlation between EMS final score and stimulated DHT (r = 0.54, P = 0.000). Of note 6 (12.0%) patients had reconstruction of scrotum, 7 (14%) had undergone inguinal hernia repair, 12 (24%) had undergone correction of hypospadias, 6 (12.0%) bilateral gonadectomy,6 (12.0%) left orchiopexy, 3 (6.0%) right orchiopexy and 10 (20%) bilateral orchiopexy. Conclusion Due to the overlapping clinical and biochemical parameters in various subsets of DSD, only a preliminary etiological diagnosis can be made in some cases. Genetic examination with long-term follow-up are needed for a precise diagnosis. Management of these patients is multidisciplinary which needs an endocrinologist, gynecologist, psychologist, pediatrician, and clinical geneticist.

The Association between Visfatin as A Marker of Isolated Coronary Ectasia and Its Severity: A Cross-Sectional study

Abstract Aim and objectives to assess the association between Visfatin level-as an independent marker -and the presence of coronary artery ectasia in patients undergoing diagnostic coronary angiography. Patients and Methods A total of 90 participants were recruited from candidates undergoing diagnostic coronary angiography in the Cath lab of Cardiology Department at Ain Shams University. They were then divided into three groups. The first group included individuals with normal coronaries, the second patients with coronary artery disease (CAD) without ectasia, and the third is patients with isolated coronary artery ectasia (CAE). After history taking, they all underwent biochemical tests for serum Visfatin, HBA1C%, serum creatinine and CRP. Univariate and correlation analysis was done. Results regarding demographic and clinical characteristics of our study population, we found that only higher age and being a smoker was significantly associated with the presence of ectasia. High level of serum Visfatin was strongly significantly associated with the presence of ectasia. Serum creatinine and CRP displayed a similar pattern. Moreover, we found that the mean level of serum Visfatin increases with the severity of ectasia according to Markis classification. Finally, Roc showed that a cut- off value of > 34 ng/ml demonstrated a sensitivity of 89% and a specificity of 87% of predicting CAE. Conclusion high serum Visfatin level is significantly associated with the presence of coronary artery ectasia. Also, it is positively correlated with its severity according to Markis classification. Hence, it can be a valuable predictor of CAE.

Diagnostic Yield of Same Setting Oesophago-Gastro-Duodenoscopy (OGD)and Colonoscopy for Pediatric Patients with Chronic Diarrhea

Abstract Background In patients with unexplained chronic diarrhea colonoscopy and upper GI endoscopy are helpful in the diagnosis. It is the routine practice in Ain Shams University pediatric endoscopy unit to perform both procedures at same setting for patients with unexplained chronic diarrhea. Aim of the Work To find out whether doing Oesophago-gastro-duodenoscopy (OGD) and colonoscopy in patients with chronic diarrhea in one setting is essential for the diagnosis of all cases. Patients and Methods Fifty patients presenting with chronic unexplained diarrhea (>4 weeks duration) in Paediatric Gastroenterology Unit, Children’s Hospital, Ain-Shams University were enrolled. After full history taking, physical examination, both endoscopies were performed biopsy taken and histopathological recording for each sample. Results Of 50 patients with chronic diarrhea included in our study; 23 (46%) had positive endoscopic findings in the OGD. Most common findings in esophagus and stomach were inflammation and erythema. while most common findings in duodenum were edema and flattened mucosa. Colonoscopy findings were positive in 50% of patients including inflammation, nodularity, and edema mostly in the ileum. 50% of endoscopied patients reached final diagnosis based on endoscopy and histopathology. Definitive diagnosis reached through EGD alone in (12%) of cases, through colonoscopy alone in (28%) and through both techniques in (60%). There was no statistical significant agreement between endoscopy findings and predominant gastrointestinal manifestations including different types of diarrhea, fecal calprotectin with p-value =0.150, and 0.833 respectively. There was no statistical significant agreement between final diagnosis and suspected GIT part involvement on initial clinical evaluation with p- value=0.805. Conclusion Endoscopy for upper gastrointestinal tract and colonoscopy at same day may be helpful in diagnosis of cases with chronic diarrhea as we can't decide which one to perform based on clinical presentation.

Acute Kidney Injury in COVID-19 Patients

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

Assessment of Anthropometric and Pubertal Growth of Children and Adolescents with Type 1 Diabetes Mellitus

Abstract Background Type 1 diabetes mellitus (T1DM) is a wasting disease which is characterized by a severe deficiency or absence of insulin. It can interfere with growth and pubertal development, especially in uncontrolled patients with diabetes. Aim of the Work Our primary aim was to assess the anthropometric measures and pubertal growth of children and adolescents with T1DM regularly attending Pediatric and Adolescents Diabetes Unit (PADU), Ain Shams University. Our secondary aim was to detect risk determinants affecting these measures and their link to glycemic control. Patients and Methods This cross-sectional observational study was carried out on 200 children and adolescents with T1DM attending the PADU clinic. Patients were assessed using anthropometric measurements, lipid profile (Fasting serum triglycerides, total cholesterol, HDL and LDL) and HbA1c%. Those with short stature were further evaluated using insulin like growth factor1 (IGF1), bone age, lipid profile and thyroid profile. while those with delayed puberty were evaluated using sex hormones. Results we found that 12.5% of our patients were short (SD<-2), Cut off point of IGF-1 SDS (≤ -1.2) and GF1( 2ng/ml) was low in72% of them. Diabetic patients with short stature have significantly earlier age of onset of diabetes, earlier age at diagnosis and longer duration of diabetes compared to those with normal stature (P < 0.05). Additionally, patients with short stature and those with delayed puberty have higher HbA1c. Patients with short stature also have higher lipid profile and lower IGF1 compared to those with normal stature (p < 0.05). Conclusion Children with uncontrolled T1DM are at risk of being short and had delayed puberty. IGF-1 level can be used as a screening test for short stature in diabetic children.

Evaluation of a Rapid PSA Test for Prostate Cancer Screening

Abstract Background Prostate-specific antigen (PSA) is a protein produced by normal prostate cells. This enzyme participates in the dissolution of the seminal fluid coagulum and plays an important role in fertility. The highest amounts of PSA are found in the seminal fluid; some PSA escapes the prostate and can be found in the serum. Aim of the Work to detemine accuracy, sensitivity, specificity of one-step PSA test (Fortel Test®) “FDA approved” for screening for prostate cancer in comparison to a conventional quantitative assay. Patients and Methods This Prospective cohort clinical study was conducted at tertiary care hospital at Urology Department, Outpatient clinic, Faculty of Medicine, Ain Shams University from January 2022 till June 2022 and performed on a total of 150 patients who were above 50 years old or above 40 years old with family history of prostate cancer. Results Our study results revealed that Fortel PSA test had high Sensitivity (97.2%), specificity (96.2%), positive predictive value (95.9%) and negative predictive value (97.4%) in accuracy of screening of prostatic cancer. Conclusion The Fortel PSA test is a simple, feasible, and reproducible tool for PC screening. The lower cost, ease of handling, and rapid procedure could make this test useful in the general practitioner or urologist office setting as well as for mass primary PC screening.

I Pack Block versus Adductor Canal Block for Post-Operative Pain Management in Total Knee Arthroplasty

Abstract Background Total knee arthroplasty (TKA) is a highly distressful major surgery, with a significant potential for complications, not only because of the surgical and anesthetic impact of the procedure, but also because of the demographic and clinical characteristics of the target population. Careful pain management is necessary post-operative to achieve early post-operative mobilization while ensuring patient comfort throughout and preventing post-operative complications. Objective we aim to compare postoperative pain management and post- operative analgesic consumption between IPACK block and Adductor canal block in total knee arthroplasty cases. Methods After obtaining approval from the medical ethical committee in Ain Shams University, this Prospective randomized controlled double-blind clinical trial study was conducted in the operating theatres of Ain shams University Hospitals. Study period March 2022 to August 2022. Physical status: ASA 1 or 2 and candidates for spinal anaesthesia undergoing total knee arthroplasty. Age group: 40-65 years. Sample sizes of 30 patients in total; 15 in group I (group I) and 15 in group II (group A). Results As for the comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty, it showed that there is significance regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block. Conclusion The comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty showed significant difference regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block. These findings with our study primary and secondary outcomes showed that Adductor canal block has more analgesic effect with respect to IPACK block regarding pain assessment but with no significant difference regarding the by the time till first analgesia postoperative and Total analgesics consumption (in mg.) over 24-hour period post-operative.

MRI in Postero-Lateral Corner Injuries of the Knee Joint: Clinical-Radiological Correlation

Abstract Background The posterolateral corner (PLC) was once regarded as the “dark side of the knee” owing to the complex and variable anatomy superimposed on the inconsistent terminology used in the literature to describe the structures in this region. Aim of the Work To describe the role of MRI in assessment of posteriolateral corner injury of knee joint. Patients and Methods This cross sectional study was conducted in department of Radiology in Ain Shams University, the data collected from database to reach sample size number and enrolled data of 20 patients in period was 18-24 months. Results We were able to show that the MRI procedure we gave accurately visualises the majority of the complex individual components of the posterolateral knee, as well as damage to these structures, in this investigation. When the diagnosis of grade III injuries to the posterolateral knee is in doubt, we believe that MRI of the posterolateral knee is a useful complement to the surgeon. In our capacity to correctly diagnose damaged structures on MRI, there were no clear differences between acute and chronic knee injuries. On MRI, avulsions or tears of the direct arm or anterior arm insertion off the fibular styloid show focal discontinuity, nonvisualization, increased signal intensity, or proximal retraction, often with a contemporaneous bone avulsion. The damage pattern can also be seen in axial and sagittal views. Conclusion When posterolateral rotatory instability is suspected, the MRI approaches that described for visualizing particular injuries to the posterolateral knee will almost always reveal the bulk of the affected structures. When a posterolateral knee injury is assessed on MRI, using a special MRI protocol that covers the full fibular head and styloid on all imaging sequences will help in identifying these structures.

Effect of BAL Lipoxin A4 Level in Children with Bronchiectasis on Disease Severity

Abstract Background A central feature of most cases of bronchiectasis is airway inflammation. The elevated neutrophil count has been strongly correlated with impaired lung function, bronchiectasis severity, and disease duration. There is a failure of resolution of inflammation in bronchiectasis, leading to irreversible damage and dilatation of the bronchial airways with loss of mucociliary function. Lipoxins were the first agents to be identified as anti-inflammatory endogenous lipid mediators involved in the resolution of inflammation. Aim of the Work This study aimed to measure Lipoxin A4 level in bronchoalveolar lavage (BAL) of children with Cystic Fibrosis bronchiectasis (CF) and Non-CF bronchiectasis as a prognostic marker for clinical and radiological severity in these children as regard Bronchiectasis severity score. Methods A cross-sectional study was conducted at Children’s Hospital, Ain Shams University from December 2020 to December 2021, on children following up at the Pediatric Pulmonology Clinic. The study included 15patients with cystic fibrosis (CF) bronchiectasis, 15 patients with non-CF bronchiectasis, and 30 control cases,without breathing difficulty or signs of RDS. Human Lipoxin A4 was measured in BAL by ELISA. Results There was a significant difference between patients and controls as regards Lipoxin A4 level (p = 0.002),being higher in control group, but no significant difference in its level between CF and non-CF bronchiectasischildren(p = 0.663). Conclusion Severe bronchiectasis is associated with decreased airway Lipoxin A4 levels as lowest level of lipoxinA4 was found in severe cases by bronchiectasis severity score.

Assessment of Wide Local Excision in Patients with Multifocal Breast Cancer using Wire Clip Bracketing

Abstract Background Breast-conserving surgery, also known as BCS, is both oncologically and surgically safe and has a long term survival rate in comparison to modified radical mastectomy. BCS can be performed with a simple wide excision or with variant levels of oncoplastic surgical techniques. There are many factors that can affect aesthetic outcomes, these factors are either both patient-related or surgeon-related, however the volume of breast tissue that needs to be excised is the most important factor. Aim To assess the feasibility and the safety of wide local excision in patient that have multifocal breast cancer using wire clip bracketing. Patients and Methods The Population was female patients with multifocal breast cancer at Breast unit general surgery department, Ain shams university. Results The mean size of tumors were 2.2 ± 1.1 mm according to mastographic characteristics, There were 55.0% with Non-palpable masses, 45.0 % with Palpable. 40% Positive LNs, we had 100% free resection margins with least resection margin being 0.8 cm as we confirmed all margins intraoperative with frozen section, 13 patients (65%) got excellent degree of satisfaction with the post-operative cosmetic outcome of our surgical procedure, 4 patients (20%) got good degree and 3 patient (15%) got fair degree of satisfaction. Conclusion Wide local Excision using the wire bracketing technique leads to more optimal resection volumes for multifocal breast cancer without compromising margin status with good aesthetic outcomes.

Study of the Efficacy of Sublingual Route Administration of Levothyroxine Na Tablets vs Oral Route in Cases with Refractory Primary Hypothyroidism

Abstract Background Hypothyroidism is a common disorder, with a prevalence of approximately 5% and incidence of approximately 250 /100,000 per year in the adult population both prevalence and incidence keep raising. Levothyroxine is the recommended hormone for replacement therapy in both overt and subclinical hypothyroidism. Aim of the Work Levothyroxine (L-T4) is the standard therapy of hypothyroidism. Our purpose was to compare the efficacy of the L-T4 sublingual tablet administration to standard oral L-T4 tablet in hypothyroid patients with refractory hypothyroidism. Subjects and Methods Our study was conducted on 40 patients who were documented to be refractory to oral thyroxine age range 18- 55, 38 females and 2males. Patients were recruited from Endocrinology and Metabolism clinic at Ain-Shams University and Internal medicine outpatient clinic at 6th of October University during the period from June 2019 to October 2020 Informed consent was obtained from all subjects. Results In our study showed a significant decrease in mean TSH (write the figures) on sublingually administrated levothyroxine tablets compared to orally administrated levothyroxine tablets and a significant rise of mean free T4 after 1 week. yet after 6 weeks there was insignificant difference of FT4 compared to oral levothyroxine. Patients who were antiparietal cell antibody positive demonstrated a non significant rise of free T4 level with almost doubling of level compared to oral levothyroxine at 1 week and 6 weeks interval, this was associated with a significant decline of serum TSH at 6 weeks interval. Also This was associated with a significant improvement in hypothyroidism symptoms Conclusion In conclusion, our study indicated that sublingual route for LT4 tablet administration was safe and innovative route for LT4 administration,it could improve compliance, overcome many obstacles with oral administration for intake with food,coffee,drug interaction and GI malabsorption.

Evaluation of Thyroid Nodule by US Including Elastography versus MRI T2W and Diffusion Sequences

Abstract Background The thyroid gland frequently develops thyroid nodules. Effective treatment of malignant thyroid nodules depends on an early and accurate diagnosis. Benign and malignant thyroid nodules are typically distinguished using conventional thyroid ultrasonography (US). In order to explore changes in tissue stiffness, strain elastography (SE) uses an external force and a deformation response detector. A promising method for distinguishing between benign and malignant thyroid nodules is ultrasound elastography. Malignant versus benign thyroid nodules might be distinguished using MRI apparent diffusion coefficient (ADC) values. This study compares MRI T2W and diffusion sequences with ultrasound, which includes elastography, to assess thyroid nodules. Methods This cross-sectional research was carried out at Ain-Shams University's radiodiagnosis department. It included 23 female or male patients with suspicious thyroid nodule by clinical examination, or ultrasonography including some cases elastography if present for further work up with MR diffusion subjected to DWI and ADC value and results were compared with histopathology if present or follow up of the patients. The duration of the study was 24 months. Results Diffusion had an accuracy of 91.3%, while the ADC value and elastography had a greater diagnostic accuracy with an area under the curve of 95.7% in discriminating between benign and malignant cases. Conclusions When describing thyroid nodules, ADC value provided better diagnostic performance than US TIRADS rating. Over and above ACR-TIRADS classification, useful information is added by ultrasound elastography and strain ratio analysis of thyroid nodules. It is advised as an auxiliary tool. However, the distinction of cancerous and benign thyroid nodules might potentially be done with greater precision using diffusion weighted MRI.

Risk Factors of Cognitive Impairment in Relapsing Remitting Multiple Sclerosis

Abstract Background Multiple sclerosis is an immune-mediated neuro-inflammatory and neurodegenerative disease. It affects mostly young adults between 20 and 40 years of age and women about 2–3 times more often than men. Disease severity and prognosis are hard to predict, different disease courses are observed in patients. It is the second most common cause of disability in young adults, and it is one of the costliest chronic diseases. Aim of the Study Our study aims to Asses risk factors affecting cognitive impairment (CI) in MS patients, focusing on risk factors including; Body Mass Index (BMI), Vitamin D level, Smoking and Alcohol and Physical activity. Patients and Methods It is a cross-sectional study carried on 50 patients with definite MS from MS unit at Ain-Shams University with inclusion and exclusion criteria was conducted, where the subjects were assessed regarding their basic demographic data, Body Mass Index (BMI), Vitamin D level, Smoking and Alcohol and Physical activity and correlated these data with their cognitive function where patients were classified to cognitive impaired or cognitive preserved using SDMT scale. Results Patients’ weight, height and BMI showed no significant correlation with the cognitive impairment assessed by SDMT. There was no significant correlation between cognitive impairment assessed by SDMT and smoking, Alcohol intake, BMI, vitamin D level, caffeine intake past or current physical activity. Our study showed a significant correlation between the cognitive impairment and the type of treatment of MS, where patients on 1st line DMD showed the majority of Cognitively preserved patients; 15 out of 18 patients with a percentage of 83.3 % while patients on 2nd line DMD showed the majority of Cognitively impaired patients, 17 patients with a percentage of 53.1 %. And thus could be related to disease progression not type of treatment itself as patients who are on 2nd line DMD are mostly the most progressive. Conclusion Cognitive affection of MS could be part of disease progression itself and not related to risk factors. This exploratory study underscores the complexity of physiopathological mechanisms underlying CI in MS and provides a few clues to further research in this area.