Al-Azhar University Hospitals Research Articles

Comparitve study between synthetic brachio - axillary and brachio - vena comitans grafts for haemodialysis

Background: Hemodialysis is dependent upon the construction, maintenance and preservation of a good vascular access. Objectives: To compare between brachio venacomittant graft and brachio Axillary graft in patients with chronic renal failure with exhausted upper extremity superficial venous accesses, for the purpose of regular haemodialysis, as regard to patency, function criteria (fistula thrill) and complications. Subjects and methods: This prospective randomized study was being conducted on 50 patients with end stage renal disease. It was being carried out at the department of vascular surgery, Al-Azhar University Hospitals (Al-Hussein and Bab-Alsheryah University Hospitals). Cases were being divided into two groups: Group (A): 25 patients were undergone Brachio axillary graft and Group (B): 25 patients were undergone Brachio venacomittant graft. Results: Regarding Access failure, 12.0% at 6 m, in group A. 32.0% at 6 m, in group B, regarding Primary patency, 68.0% at 6 m, in group A. 56.0% at 6 m, in group B, regarding secondary patency, 72.0% at 6 m, in group A. 56.0% at 6 m, in group B. There was insignificant difference between both groups as regard Access failure, primary and secondary patency. 

Evaluation the results of antiglide plating of vertical medial malleolus fractures

Background; Vertical shear fractures of the medial malleolus occur through supination–adduction loading of the talus onto the articular surface of the medial malleolus, Aim and objectives; to assess the radiological and functional outcomes of open reduction and internal fixation with antiglide plate of vertical shear medial malleolus fracture, Subjects and methods; This prospective case series study was carried out at the Orthopedics Departments of Al-Azhar University and Health Insurance Hospitals. The study included 22 patients with antiglide plating of vertical medial malleolus fracture. The duration of the study ranged from 6-12 months, Result; Number of patients with Antiglide plate for medial malleolus Management in the study population was 9 (40.91%). Number of patients with Antiglide plate for medial malleolus & Semitubular Plate of lateral malleolus Management in the study population was 13 (59%), Conclusion; Surgical management of vertical shear of medial malleolus fracture gave excellent anatomical reduction and rigid fixation to restore articular congruity, help to facilitate early mobilization and hence to achieve optimal ankle function. The antiglide plate fixation is readily available and cost significantly less than a precountoured anatomicspecific type of fixation.

Role of fractional carbon dioxide laser resurfacing in post-operative transconjunctival lower eyelid blepharoplasty

Background: Transconjunctival blepharoplasty is the management of lower eyelid structures via the conjunctival approach and is usually applied to the cosmetic improvement of the lower eyelid using this approach. Aim and objectives: The study aimed to evaluate and compare the aesthetic result for residual fine wrinkles after transconjunctival lower eyelid blepharoplasty alone or combined with post-operative fractional CO2 laser. Subjects and methods: The present study was carried out on 20 patients with lower eyelid puffiness without skin redundancy just fine wrinkles who were selected from patients that were admitted to department of plastic and reconstructive surgery, AL-Azhar University hospitals. Results: Skin tightening and residual wrinkles improvement in group (A) show that 9(90.0%) were improved and 1(10.0%) were not improved while in group (B) 6(60.0%) were not improved and 4(40.0%) were worsen. There was highly statistically significant differences between groups where P<0.001 with better result in group (A) in comparing with group (B). Conclusion: Our results demonstrated that both lower eyelid transconjunctival blepharoplasty alone or with combination with postoperative fractional CO2 laser were safe and effective in the treatment of lower eyelid puffiness. Both of the investigated methods had comparable outcomes in terms of complications and satisfaction.

Management of posterior column tibial plateau fracture via a posterior approach

Background: Posterior tibial plateau fracture (PTPF) is a relatively uncommon injury. This kind of fracture appears confusing on initial radiographs because of the small displacement, so it is a special injury pattern. Aim and objectives: the aim of the study was to evaluate the safety and efficacy via a posterior approach in the posterior shearing tibial plateau fracture. Subjects and methods: The study was prospective study carried out in the Department of Orthopaedic surgery, Al-azhar university Hospital in Damietta. This study had been carried out on 24 patients. Results: there is statistically significant difference between immediate post-operative reduction and other post-operative reduction after 6 weeks, 3 months and 5 months. Conclusion: Posterior tibial plateau fracture is relatively rare in tibial plateau fractures. Our study highlights the importance of posterior tibial plateau fracture which was deemed unimportant in the past. Our results highlight the importance of fixation of PTPF and achieving an early and satisfactory functional outcome.

Correlation between fecal (calprotectin and lactoferrin) results and colonoscopic findings in chronic diarrhea and recurrent abdominal pain in children and adolescents

Background: Currently, endoscopy with biopsy is still considered the gold standard for the evaluation and diagnosis of mucosal inflammation and a number of scores exist to assess endoscopic activity in Crohn’s disease (CD) and ulcerative colitis (UC). Aim and objectives: the aim of the study was to determine the benefit of using both of fecal markers (calprotectin and lactoferrin) in patients presenting with chronic diarrhea and recurrent abdominal pain for differentiation between organic diseases, particularly inflammatory bowel disease (IBD) from non-organic disease, making colonoscope unnecessary. Subjects and methods: This prospective, observational and analytic study was carried out on 44 children who fulfilling the designed inclusion criteria. The study was carried out from Outpatient Clinic of Pediatric gastroenterology unit and from the Inpatient Units of the Pediatric department Faculty of Medicine, Al-Azhar University Hospitals (Al-Hussein & Sayed Galal Hospitals), as well as referral from other hospitals complaining of recurrent abdominal pain and chronic diarrhea from March 2020 to March 2022. Results: there was statistically significant difference between IBD group and functional abdominal pain group as regard fecal calprotectin with p-value≤ 0.001. There was statistically significant difference between IBD group and functional abdominal pain group as regard fecal lactoferrin with p-value≤ 0.001.

Aspartate transferase-to-platelet ratio index-plus: A new simplified model for predicting the risk of mortality among patients with COVID-19.

BACKGROUNDCoronavirus disease 2019 (COVID-19) has a spectrum of clinical syndromes with serious involvement of the lung and frequent effection of the liver and hemostatic system. Blood biomarkers are affordable, rapid, objective, and useful in the evaluation and prognostication of COVID-19 patients.AIMTo investigate the association between aspartate transferase-to-platelet ratio index (APRI) and in-hospital mortality to develop a COVID-19 mortality prediction model.METHODSA multicenter cohort study with a retrospective design was conducted. Medical records of all consecutive adult patients admitted to Al-Azhar University Hospital (Assiut, Egypt) and Chest Hospital (Assiut, Egypt) with confirmed COVID-19 from July 1, 2020 to October 1, 2020, were retrieved and analyzed. The patient cohort was classified into the following two categories based on the APRI: (1) COVID-19 presenting with APRI ≤ 0.5; and (2) COVID-19 presenting with APRI (> 0.5 and ≤ 1.5). The association between APRI and all-cause in-hospital mortality was analyzed, and the new model was developed through logistic regression analyses.RESULTSOf the 353 patients who satisfied the inclusion criteria, 10% were admitted to the intensive care unit (n = 36) and 7% died during the hospital stay (n = 25). The median age was 40 years and 50.7% were male. On admission, 49% had aspartate transferase-dominant liver injury. On admission, APRI (> 0.5 and ≤ 1.5) was independently associated with all-cause in-hospital mortality in unadjusted regression analysis and after adjustment for age and sex; after stepwise adjustment for several clinically relevant confounders, APRI was still significantly associated with all-cause in-hospital mortality. On admission, APRI (> 0.5 and ≤ 1.5) increased the odds of mortality by five-times (P < 0.006). From these results, we developed a new predictive model, the APRI-plus, which includes the four predictors of age, aspartate transferase, platelets, and serum ferritin. Performance for mortality was very good, with an area under the receiver operating curve of 0.90. CONCLUSIONAPRI-plus is an accurate and simplified prediction model for mortality among patients with COVID-19 and is associated with in-hospital mortality, independent of other relevant predictors.

Role of budesonide inhalation in treatment of meconium-aspiration syndrome

Background and aim Meconium-aspiration syndrome (MAS) is a common cause of respiratory distress. MAS is a serious disease that affects neonates born through meconium-stained amniotic fluid. The pathophysiology of MAS is multifactorial, inflammation has an important role in MAS, so anti-inflammatory drugs like corticosteroids may be effective in the treatment of MAS. Budesonide is a nonhalogenated glucocorticoid that can reduce vascular permeability, inhibit secretion of mucus, relieve edema and spasm, and help pulmonary ventilation. In this study we aimed to find out the effect of early nebulized budesonide in the treatment of MAS. Patients and methods This was a prospective study conducted during the period from October 2017 to July 2018 at El-Minia General Hospital and Al-Azhar University Hospital, Assiut. Intervention: budesonide inhalation in a dose of 50 mg every 12 h till clinical recovery, whichever was earlier. Results The present study revealed that nebulized budesonide improves the clinical outcome of newborns with MAS in terms of lowering the duration of O2 dependency, duration of respiratory distress, duration of hospital stay, duration of radiograph clearance, time for full feeding (P&lt;0.001), and thus early discharge from the NICU. Conclusion Early nebulized budesonide is effective in treating MAS and has high safety with almost no short-term complications.

Incidence of cerebral microembolization in patients with nonvalvular atrial fibrillation using transcranial Doppler

Background and aim Atrial fibrillation (AF)-related stroke represented more than 79% of all strokes of cardiogenic origin. AF is the crucial factor of cardiogenic stroke. AF-related stroke is manifested with severe clinical manifestation, significant disability, high mortality, and easier relapse. The incidence of mortality is twice as high as non-AF-related stroke. The AF type is usually of nonvalvular origin. The current work is aiming to determine the incidence of cerebral microembolization in nonvalvular AF patients. Patients and methods The current study was a prospective study of two groups of individuals: control and nonvalvular asymptomatic AF cardiac condition, hypertension, age, diabetes, sex, and stroke (CHADS) score 2 or more. Patients were collected from the cardiology clinic and department (Al-Azhar University Hospital, New Damietta, Egypt). Patients were submitted to history taking, clinical assessment, echocardiography, and transcranial Doppler ultrasonography, and microembolic signal detection and count. Also, the transcranial Doppler was used to monitor both middle cerebral arteries. Results There was a statistically significant difference between the control and study groups in relation to the number of microembolic signals. Signals of microembolizations were detected in eight cases (all were in the study group). There was a positive correlation between embolic signals and patient age (r=0.424, P=0.020) and there was a significant association with female sex. In addition, there was a positive correlation between embolic signals and left-atrium dimension (r=0.502). Regarding correlation, there was a negative interaction between embolic signals and anticoagulation use (r=−0.413, P=0.023). Conclusion Asymptomatic embolic signals occur in patients with nonvalvular AF who are not being treated with anticoagulants at a significantly greater frequency than in age-matched controls.

Evaluating Gender Differences in Egyptian Fibromyalgia Patients Using the 1990, 2011, and 2016 ACR Criteria.

BackgroundFibromyalgia (FM) is a common rheumatic illness distinguished by chronic pain, fatigue, cognitive problems, and functional disability. However, the differences between men and women have not yet been comprehensively studied, especially after the development of the last 2016 American College of Rheumatology (ACR) criteria. The aim of this study was to evaluate the gender differences in symptom characteristics, cognitive dysfunction, and disease severity in Egyptian FM patients considering both the ACR 1990, 2011, and the last 2016 ACR diagnostic criteria.MethodsThis is a prospective cross-sectional study that was carried out on 352 patients with FM in the Rheumatology Department, Al-Azhar University Hospital in Egypt, in the period between January 1, 2020, and June 1, 2021. In addition to the number of tender points (TPC), data was collected on age, gender, body mass index (BMI), marital status, disease onset, duration, and diagnostic delay. The widespread pain index (WPI), the symptom severity scale (SSS), fatigue, cognitive dysfunction, sleep disturbance, awakening unrefreshed, headache, abdominal pain, and depression were evaluated and scored according to 2010 and 2016 ACR criteria. A visual analog scale (VAS) for pain, fatigue, stiffness, anxiety, and depression is included in the questionnaire. The total score ranges were produced using total score ranges ranging from 0 to 80 (excluding job items), with higher scores indicating a stronger negative effect and/or intensity of symptoms. The polysymptomatic distress scale (PDS) has been calculated by the summation of the SSS with the WPI. The Revised FM impact questionnaire (FIQR) has also been evaluated.ResultsThe study shows that females have a significantly higher prevalence of fatigue, cognitive dysfunction, sleep disturbance, headache, and abdominal pain (p < 0.05). Also, females showed significantly higher scores than males regarding WPI, SSS, and mean TPC (p = 0.004, 0.027, and 0.001, respectively). While there was no difference regarding the FIQR (p=0.93), PDS was significantly higher in women (p= 0.001).ConclusionFemale patients with FM had greater disease severity scores, symptomatology, and number of tender points. Whatever the criteria applied, the prevalence and intensity of the disease features are higher in females, which may underestimate the disease in male patients.

Lichtenstein versus transabdominal preperitoneal (TAPP) inguinal hernia repair for unilateral non recurrent hernia: A multicenter short term randomized comparative study of clinical outcomes

BackgroundThe repair of inguinal hernia is still one of the most prevalent surgical procedures done worldwide. Among all repair techniques, open Lichtenstein repair is the most globally conducted. In the past few decades, laparoscopic technique for inguinal hernia repair has increased technical demand. Trans-abdominal pre-peritoneal (TAPP) technique is the main approach, which is featured by less postoperative pain and early recovery. ObjectiveThe current work is a short-term study to make a comparison between open Lichtenstein repair of inguinal hernia as well as laparoscopic trans-abdominal preperitoneal repair of inguinal hernia (TAPP) for unilateral non recurrent hernia regarding intraoperative, postoperative complications and hospital stay. Patients and methodsThe present prospective randomized study recruited 100 male subjects from General Surgery Department of Al-Azhar University Hospitals and Ain Shams university hospitals suffering from oblique inguinal hernia (unilateral non recurrent hernia) with an age above 18 years and good overall health, who were randomized into two groups: Group A: 49 cases were subjected to laparoscopic trans-abdominal pre-peritoneal repair (TAPP). Group B: 51 cases were subjected to open Lichtenstein repair. ResultsThis study detected less post-operative pain day 0, day 1, day 7 and 1 month postoperatively. There was no significant difference at 6 months post-operatively. ConclusionFinally, we concluded that TAPP repair for inguinal hernia (unilateral non recurrent hernia) safer with less early post-operative pain. Also, it has fewer complications, with a significantly longer operative time.

Comparison between Cutting Diathermy and Surgical Scalpel for Skin Incision during Cesarean Section

Introduction and aim: Caesarean section (C-section) is one of the commonest surgeries accomplished all over the world, and it has several surgical methods. This work aimed to study the safety and efficacy of cutting diathermy for skin incision during C-section in comparison to surgical scalpel.&#x0D; Methodology: This was a prospective randomized comparative study that was performed in the Obstetrics and Gynecology department, Al-Azhar university hospitals (New Damietta) in the interval between September 2019 to October 2020.&#x0D; Results: The visual analogue scale (VAS) score in the diathermy-group was statistically significantly lower as in comparison to the scalpel-group at 2, 6, 12 and 24 h post-operative. Also, there was an increase in the VAS score in the two groups at 2, 6, and 12 hours’ post-operative as in comparison to the first hour post-operative. This difference didn’t achieve a statistically significant difference except at 12 hours (0.005 and 0.001) in the diathermy-group and scalpel-group respectively.&#x0D; Conclusion: The utilization of diathermy for skin incision in C-section in this work was accompanying with decreased incisional bleeding, incisional period, surgical period and post-operative pains. It had no impact on wound closures (epithelialization) and wasn’t accompanied with any postponement in wounds healing. It was pronounced safely in this work if performed in the suitable way and method with slight or no side-effects.

Hearing profile in patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus

Introduction and aim: Rheumatoid arthritis (RA) and Systemic Lupus Erythematous (SLE) are chronic, inflammatory diseases with intra and extra articular manifestations. They affect 1% of the population. The auditory system can be affected in the course of these diseases. However, the pathogenesis of hearing impairment in these diseases is not clearly understood. The current work aimed to determine frequency and type of hearing impairment (HI) in patients with RA and SLE and possible correlation with different disease parameters.&#x0D; Methodology: Fifty RA and Fifty SLE patients, and 50 healthy, age and sex matched controls, were included. Their age ranged from 35 to 50 years. They were selected from the outpatient clinic of Al-Azhar university hospital (Damietta). HI was evaluated by pure tone audiometry and tympanometry including acoustic reflex threshold test and auditory brain stem response (ABR). Complete medical history and general &amp; local examination were done along with full laboratory and immunological investigation.&#x0D; Results: Hearing loss was found in 41(82%) in RA patients and in 19 (38%) in control group. Hearing loss in SLE patients was found in 27(54%) and 15(30%) in control group. In AR patients, the level of hearing loss varied from mild to moderate in 28(56%) and 13(26%) respectively, and in control group was 17(34%) and 2(4%) respectively. In SLE group, level of hearing loss varied from mild to moderate in 19(38%) and 8(16%) respectively, and in control group was 13(26%) and 2(4%).&#x0D; Conclusion: There was a high frequency of sensorineural hearing loss in both RA (82%) and SLE (54%) patients compared to normal controls. Careful surveillance of hearing profile in early stages of both diseases is important and follow up testing of hearing status should be part of patient care.

Free Hand One Stage Correction of Kyphoscoliosis

Background: Scoliosis is a complex musculoskeletal torsional deformity of spine that includes: Lateral curvature in the anterior-posterior plane with a Cobb angle greater than 10 degrees, Angulation in the sagittal plane, or Rotation in the transverse plane. Scoliosis classified into neuromuscular, idiopathic, or congenital. Radiological evaluation is done by plain radiography, computed tomography (CT), and magnetic resonance (MR). We aimed to evaluate patients with idiopathic kyphoscoliosis who underwent a freehand posterior approach for scoliosis correction through transpedicular screws fixation. Setting: Al-Azhar University Hospitals. Subjects and Methods: Study was performed on 12 patients with idiopathic kyphoscoliosis who underwent a freehand posterior approach for scoliosis correction through transpedicular screws fixation in Al-Azhar University Hospitals between 2015 to 2018 & follow up for one year. Results: Early outcome showed improved Cobb’s angle and coronal balance significantly after surgery. Correction is 95% in 2 cases (17%), 80% correction in 8 cases (66%), 60% correction in 2 cases (17%). 2 cases have CSF leakage which improved with conservative treatment. Late follow-up shows improvement of patient deformity and cosmetic appearance to the degree of patient satisfaction occur in 7 cases (58%) associated with high SRS-30 total scores. However, assessment of the pain in comparison to preoperative assessment show improvement of pain in 4 cases (33%), persistent in 4 cases (33%), appear in 4 cases (33%). Conclusion: Freehand one-stage correction management of idiopathic kyphoscoliosis through the posterior approach is a safe and effective for near-total correction of deformity with a good outcome with minimal complications.

Ultrasound, Fluoroscopic-Guided Caudal, Lumbar Epidural Steroid Injections and Blinding Paraspinal Lumbosacral Steroid Injections in Patients with Low Back Pain with Radiculopathy

Background and Aims: Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Chronic LBP (CLBP) was estimated to be between 5% and 10%, defined as LBP that lasts for 12 weeks. The most common causes of CLBP with radiculopathy are lumbar disc prolapse (LDP) and degenerative facet osteoarthropathy (DFO); the aim of this study is to investigate the efficacy of ultrasound (US) guided, fluoroscopy (FL) guided, Caudal Epidural Steroid Injection (CESI), lumbar epidural steroid injections (LESI), and blinding lumbosacral steroid injections (LSPSI) in patients with CLBP with radiculopathy. Patients and Methods: This is a randomized prospective study that was conducted at the department of rheumatology at Al Azhar University Hospital in Egypt between November 2020 and August 2021. A total of 100 patients with refractory CLBP with radiculopathy were enrolled in the study. Consequently, they were divided into 2 groups: the first consisted of fifty patients with CLBP and radiculopathy caused by LDP, as determined by lumbosacral magnetic resonance imaging (MRI), and the second group consisted of fifty patients with refractory low back pain and radiculopathy caused by DFO, as determined by lumbosacral plain x-rays and lumbosacral MRI. The following procedures were performed: US-guided CESI, FL-guided CESI, FL-guided LESI, US-guided LESI, and blinding LSPSI. Results: In the LDP group, there is a statistically significant difference between considered spinal nerve roots as regards Visual Analogue Scale (VAS) (at 2 months). Likewise, a statistically significant difference was found between blinding LSPSI and US-Guided LESI with respect to VAS (baseline) and VAS (2 months) (P-value = 0.018 and 0.003, respectively). Statistically significant differences were reported in VAS (2 months) for both FL-guided LESI and FL-guided CESI groups. Considering the VAS of studied spinal nerve roots in the DFO group, there is a statistically significant difference between the examined spinal nerve roots with respect to Oswestry Disability Index (ODI) (2 months). Similarly, there is a statistically significant difference in VAS (2 months) between US-guided LESI and para-spinal roots and FL-guided LESI and para-spinal roots (P-value = 0.038 and 0.021, respectively). Additionally, there is a statistically significant difference between the US-guided CESI, FL-guided CESI, FL-guided LESI, and spinal nerve roots with respect to ODI (at 2 months). (P-value = 0.033, 0.025 and 0.005, respectively). Conclusion: US is excellent in guiding CESI and LESI and should be the preferred alternative when FL is not provided, with a similar treatment outcome compared to FL-CESI and LESI.

Corneal densitometry before and after corneal collagen cross-linking in patients with keratoconus

Background Keratoconus is an ectatic corneal disorder characterized by progressive corneal thinning that results in corneal protrusion, irregular astigmatism, and decreased vision. Objective To evaluate changes in corneal density following corneal cross-linking (CXL) in keratoconic patients. Patients and methods This was a prospective case series study including all patients with keratoconus (50 eyes) undergoing CXL. The number of male patients in the study was 13 (26 eyes) cases, while female patients represented 12 (24 eyes) cases; the study was conducted at the outpatient clinic of the Ophthalmology Department at Al Azhar University Hospital. Results There was no statistically significant correlation between corneal densitometry and K1, K2, K-max, or thinnest corneal thickness preoperatively. There was no statistically significant correlation between corneal densitometry and K1, K2, K-max or thinnest corneal thickness at 1 month postoperatively. There was no statistically significant correlation between corneal densitometry and K1, K-max, or thinnest corneal thickness at 3 months postoperatively. Also, the table shows that there was statistically significant positive correlation between corneal densitometry and K2 with P value of 0.037 and r=0.296. There was no statistically significant correlation between corneal densitometry and K1, K2, K-max, or thinnest corneal thickness at 6 months postoperatively. Conclusion After CXL, the Scheimpflug corneal densitometry and clinical corneal haze peaked at 1 month followed by a gradual decline reaching baseline by 6 months after operation. Corneal thinning was correlated inversely with the corneal haze at 1 month postoperatively. Lens densitometry was not affected by CXL.

Lateral tarsal strip vs. lower lid retractors reinsertion for treatment of involutional entropion

Purpose The aim of this study was to report the clinical efficacy of lateral tarsal strip (LTS) procedure for correction of senile entropion compared with lower lid retractors reinsertion. Patients and methods This is a retrospective comparative, nonrandomized interventional study that was conducted on patients attending the outpatient clinic of the Ophthalmology Department in Al Azhar University Hospital (Damietta branch), Damietta, Egypt, during the period from February 2019 to April 2021. The study recruited 56 lower eyelids of 44 patients who had involutional entropion; 12 of them were bilateral. In 29 eyelids, LTS procedure (group 1) was performed, whereas 27 eyelids were treated by lower lid retractors reinsertion (group 2). Results There were no statistically significant differences between the two groups regarding age, sex, and laterality. Regarding the postoperative correction of entropion, the first group (treated by LTS procedure) achieved a 100% success rate, whereas the second group (treated by lower lid retractors reinsertion) had a success rate of 81.5%, with a statistically significant difference (P=0.015). Although lid lag occurred only in the second group, it was not statistically significant. Conclusion The advantages of the LTS procedure over the lower lid retractors reinsertion are less risk of undercorrection and good cosmetic acceptance of the lid margin because of the stability of the lid margin that is achieved by the LTS procedure.

Role of food allergy in otitis media with effusion

Background and aim The role of food allergy (FA) in chronic otitis media with effusion (OME) is argumentative. New proof from cellular biology and immunology clarifies the essentials of allergic responses and permits exact diagnosis more than before for allergies and inflammatory disease. We aimed to detect the occurrence of FA in patients with chronic OME. Patients and methods This a prospective, cohort randomized controlled study that was conducted at Al Azhar University Hospital, Otorhinolaryngology Department, on 40 patients divided into two groups: patient group included 20 patients with OME, and control group included 20 patients without any medical problems about FA or OME. The prevalence of FA was detected by skin prick test and assessment of serum immunoglobulin E and eosinophil count. Results There were highly statistically significant correlations between increase in the total serum immunoglobulin E and eosinophil count and developing OME (P&lt;0.00); however, there were no statistically significant correlations between age and developing OME (P&lt;0.396). Conclusion The possibility of association and the contribution of FA should be kept in mind in OME cases.

A comparative study between magnesium sulfate and dexmedetomidine as adjuvants to bupivacaine using ultrasound-guided lumbar-plexus block in lower abdominal surgeries

Background and aim Pain international association of described pain as an unpleasant sensory and emotional practice accompanied with actual or potential tissue injuries. Opioid administrations remain the cornerstone of postoperative pain relief, but it may cause significant side effects, including sedations, nausea, vomiting, and urinary retention. We aimed to compare the efficacy of ultrasound-guided lumbar-plexus block through adding magnesium sulfate and dexmedetomidine (DEX) to bupivacaine on postoperative analgesia and thereafter surgical operation. Patients and methods This prospective, randomized, double-blinded, controlled research was performed on Al-Azhar University Hospitals. A total of 75 cases of both sexes, age between 21 and 65 years, American Society of Anesthesiologists class I– II, were listed for elective lower-abdomen surgical operation underneath general anesthesia. Results Pain scores were decreased significantly in the study groups for 12 and 18 h in BM and BD, respectively, also, there was a significant decrease at 2, 4, 6, 8, and 12 h in the BD group lesser than the BM group postoperatively. The time to the initial analgesic appeal was significantly extended in the BD group (11.9±1 h) than the BM group (10.6±0.7 h). Conclusion Posterior lumbar-plexus block utilizing 22 ml of bupivacaine 0.5% with DEX 1 μg/kg decreases pain score, opioid consumption, prolongs duration of analgesia, better hemodynamics stability, and perfect outcome of cases’ satisfaction postoperatively compared with posterior lumbar-plexus block using 22 ml of bupivacaine 0.5% with magnesium sulfate 150 mg. DEX provides faster onset time and longer periods of MB and extended period of analgesia with smaller consumptions of postoperative rescue analgesia.

Prediction of wound complications after major amputation for patients with critical limb ischemia

Background/aim Management of patients with critical limb ischemia from peripheral vascular disease is still a big issue for vascular and endovascular surgeons. For patients who are not candidates for revascularization, 20–40% will undergo major amputation within 6–12 months. Mortality following major amputation of the lower extremity in these patients has been high. This study aims at identifying important factors that lead to wound complications following major amputation in patients with end-stage critical ischemia. Patients and methods This study enrolled 120 in patients who underwent major lower extremity amputations affected by critical limb ischemia, since January 2017 and till March 2020, in the Vascular Surgery Departments at Al-Azhar University Hospitals, Cairo, Egypt. A total of 67 patients underwent transfemoral above-knee amputations (AKA) and 53 underwent transtibial below-knee amputations (BKA). The follow-up was done at first week and first, third, and sixth months postoperatively, and 1-year mortality was assessed as well. The various risk factors were analyzed in this study, including age, coronary artery disease, chronic heart failure, cerebrovascular disease, hypertension, diabetes mellitus, hemodialysis, white blood cell (WBC) count, C-reactive protein-quantitative (CRP), lactate dehydrogenase, and serum albumin level. Results The present study exhibited that most cases were men (75%) and former smokers (64.2%). A total of 91 patients (75.8%) had a history of hypertension. Univariate analysis exhibited that there were defiantly more wound occurrences (P&lt;0.05) for those patients who underwent BKA in the greater than or equal to 55-year-old age group, smokers, patients with high WBCs, patients with low serum albumin level and with positive CRP, and dialysis-dependent patients. However, the patients who underwent an AKA, the multivariate analysis determined positive CRP and dialysis dependent as significant predictors (P&lt;0.05) of a wound occurrence. Conclusion Predictors that significantly increased the risks of delayed recovery for those who underwent BKAs are greater than or equal to 55-year-old group, smokers, patients with elevated WBCs, and patients on dialysis proved to be predictive, and for AKA the predictive factors were low serum albumin level, patients with high WBCs, and patients with dialysis dependence.

Clinical Benefits of Facial Nerve Monitoring during Cerebellopontine Angle Surgery

Background: The surgery of cerebellopontine angle tumours has remarkably progressed over the last 2 decades due to improved microsurgical techniques. The primary operative goals are microscopic total removal of the tumour while securing the adjacent cranial nerves. Facial Nerve plays a critical role in facial muscles function and one’s cosmetic appearance, and its weakness can have profound implications on a patient’s quality of life. Aim of the Study: To assess the impact of monitoring techniques on the preservation of facial nerve function during cerebellopontine angle tumours surgery. Patients and Methods: This is a prospective study. This study was conducted on 30 cases (2 groups, each had 15 patients) with CPA lesions that had undergone surgical excision of these lesions performed by retrosigmoid approach (Group A: the patients were operated under continuous intraoperative facial nerve monitoring (IOFNM) and Group B: the patients were operated without IOFNM). They were operated upon in neurosurgery departments at Al-Azhar university hospitals between August 2019 and August 2021. Results: This study showed that excellent facial nerve function (HB Grade I and II) was higher in group A than group B, immediately and at 6-month post op (80% and 93% VS 53.3% and 66.7%). Intermediate (HB Grade III and VI) and Poor (HB Grade V and VI) facial nerve function was higher in group B than group A; both immediately and 6-month postop (46.7% and 33.3% VS 20% and 6.6%). However, no statistically significant P-Value between both groups. Conclusion: We concluded that IOFNM can help, but cannot guarantee, the preservation of facial nerve. Furthermore, it is merely a technical adjunct and does not replace surgical skills, knowledge of anatomy and experience.