Assiut University Hospital Research Articles

A simplified technique for correction of complete ptosis secondary to palpebral neurofibromatosis

ABSTRACT Purpose To present a simplified technique in management of complete ptosis secondary to neurofibromatosis. Methods This prospective, non-comparative, clinical interventional study included 13 patients with complete ptosis secondary to histologically proved plexiform neurofibromas. It was conducted at the Orbital Unit of Assiut University Hospital, the referral center of Upper Egypt in the period between June 2013 and October 2021. In all cases, a simplified technique of 5 surgical steps was applied: (A) Division of the involved eyelid surgically into three parts by drawing 2 curvilinear lines, the superior line 11 mm below and parallel to the lower eyebrow hairline and the inferior one 10 mm above the lid margin, (B) Resection (full-thickness) of the large middle part which involves the main pathology and lies between the 2 lines, (C) Preservation of the upper part with identification, dissection and clamping of the levator muscle, (D) Refinement of the lower part by removal of any tissue between the skin and the debulked tarsus and (E) Re-suturing of the upper and lower parts in layers; conjunctiva to conjunctiva, levator to tarsus (after resection of a part that corrects the ptosis) and skin to skin. Results Ptosis was completely corrected in 8 cases (61.5%) and residual mild ptosis occurred in 5 patients (38.5%). No exposure keratopathy or tumor growth was reported during the follow-up period of minimum 1 year. Conclusions This simplified technique could be considered as a surgical basis for correction of complete ptosis in neurofibromatosis.

Serum interleukin-21 level in patients with severe adverse cutaneous drug reactions and correlation with disease severity

IntroductionInterleukin-21 (IL-21) is accepted to play a pathogenic part in development of unfavorable cutaneous medicate responses. Adverse cutaneous drug reactions create a wide run of clinical signs such as pruritus, maculopapular ejections, urticaria, angioedema, fixed drug eruption, erythema multiforme, vesiculobullous responses (e.g. Stevens–Johnson syndrome and toxic epidermal necrolysis), and exfoliative dermatitis.Patients and methodsTwenty patients (drug-eruption group) and 14 healthy controls (control group) were recruited from Assiut University Hospitals' Dermatology Department and Outpatient Clinic. Data were collected in the period from October 2017 to December 2018. Patients were assessed clinically by percentage of surface area of the body involvement (body surface area %) and score of toxic epidermal necrolysis. At presentation and after 1 month of treatment, blood samples were taken to evaluate serum IL-21 levels using an enzyme-linked immunosorbent assay.ResultsInside the study, the cruel serum IL-21 level was considerably greater than in the control group, in drug-eruption group was 575.58 ± 94.67 ng/dl, and in the control group was 128.00 ± 73.94 ng/dl with P value of 0.000. The drug-eruption group had a significantly higher serum level of IL-21 before treatment than after treatment with P value of 0.000. Additionally, there was a critical relationship between IL-21 levels in the blood and the severity of the condition. Before and after therapy, there was a significant positive association between blood IL-21 levels and the proportion of body surface area involvement.ConclusionIL-21 levels in the blood were significantly higher in EM and SJS/TEN patients, suggesting that it may have a role in the etiology of EM and SJS/TEN and it could be employed as a marker for the severity of SJS/TEN and patient prognosis in the future.

Assessing the bleeding severity in patients with type I von Willebrand using the International Society on Thrombosis and Hemostasis-Bleeding Assessment Tool (ISTH-BAT) questionnaire

Abstract Background In the recent decade, bleeding evaluation methods have evolved to standardize the severity of bleeding symptoms in a uniform manner. In 2010, the International Society on Thrombosis and Hemostasis-Bleeding Assessment Tool (ISTH-BAT) was developed and validated. Aim and objectives The aim of the study was to evaluate bleeding score (BS) in Egyptian patients with von Willebrand disease (VWD) type I and correlate it with laboratory parameters. Patients and methods This cross-sectional cohort study was conducted at Assiut University Hospital. It included 100 participants that were divided into 49 patients with type I VWD and 51 healthy participants with no known problem with bleeding or bruising. The duration of the study was ~12 months. Results Study revealed that there was significant relation between BS severity and laboratory parameters such as level of von Willebrand factor: Ag (P=0.02) while there was no significant relation between BS and sex (P=0.390). By using receiver operating characteristic curve analysis, ISTH-BAT BS can detect type I VWD patients in total with excellent accuracy (98%), area under the curve was 0.989 with sensitivity and specificity of 96 and 100%, respectively (P<0.001). Conclusion The ISTH-BAT BS is designed to reflect the severity of bleeding. Our results demonstrate the inherent variability of this bleeding pattern. We also found that the ISTH-BAT BS has high sensitivity and specificity to detect type I VWD patients in total with excellent accuracy.

Effect of Gender on Clinical Presentation of SLE in Assiut University Hospitals

Effect of Gender on Clinical Presentation of SLE in Assiut University Hospitals

Assessment of routine use of critical view of safety in laparoscopic cholecystectomy, prospective cohort study

Background The reported frequency of biliary injuries has tripled to 0.4% since the advent and widespread usage of laparoscopic cholecystectomy in the 1990s. The goal of this study: in terms of practicality and safety, is to evaluate the effectiveness of a critical perspective on safety during laparoscopic cholecystectomy. Patients and Methods This prospective cohort research included 100 patients who received laparoscopic cholecystectomy between 2018 and 2021 at Assiut University Hospital and Assiut Police Hospital. Results According to the data, just one individual out of 100 suffered from bleeding, another from a bile leak, and no one suffered from liver or viscus damage. Conclusion The most secure approach to comprehend the triangle’s design is from the vital aspect of safety, and understanding so significantly aids in the prevention of ductal harm. Significant bile duct damage and accompanying complications may be avoided by employing Critical View of Safety in clinical practice.

Evaluation of primary congenital glaucoma at Assiut University Hospital

Evaluation of primary congenital glaucoma at Assiut University Hospital

Postoperative relapse after bilateral sagittal split osteotomy of the mandible for correction of dentofacial deformity: Is it common?

Aim To investigate the effect of the magnitude of mandibular movement during bilateral sagittal split osteotomy (BSSO) on the incidence of postoperative relapse. Patients and methods The present cohort study included patients presented to the Maxillofacial Unit, General Surgery Department, Assiut University Hospital, Egypt. All patients underwent BSSO to correct class II malocclusion. Patients were divided into two groups, the first group included patients with mandibular movement less than 7 mm and the second group included patients with mandibular movement more than 7 mm. Then, we investigated the incidence of postoperative relapse in both groups. Results The study included 32 patients (64 sides). The first group included 24 patients (48 sides) and the second group included eight patients (16 sides). The incidence of postoperative relapse is 12.5%. Conclusion magnitude of mandibular movement more than 7 mm during BSSO is considered to be a risk factor for postoperative relapse.

A retrospective study on pattern of pulmonary embolism in chestdepartment-Assiut University

BackgroundPulmonary embolism (PE) is a severe and fatal disease, and its incidence varies widely between countries.AimTo determine the frequency of PE in the Chest Department of Assiut University Hospital, to determine the risk factors and effective treatment, and to study the outcome of the disease in this locality.Patients and methodsIn this retrospective study, 222 patients suspected to have PE were screened for PE and underwent computed tomography-pulmonary angiogram to confirm or exclude a clinical suspicion of PE. All of the following were collected from patient data sheets: history, clinical examination data, ECG abnormalities, chest radiograph, Doppler ultrasound, echocardiography, chest ultrasound, laboratory reports, treatment lines, and the outcome in the form of mortality, ICU admission, length of hospital stay, and discharge to home.ResultsOf the included PE cases, all of them received heparin followed by warfarin, except for 10 patients who received rivaroxaban without any toxicity. Warfarin dose needed to reach therapeutic international normalized ratio (between 2 and 3) was 3–9 mg in –85% of the patients. A total of 71 patients needed admission to ICUs, and of them, 24 patients died, but there were no recorded deaths in the ward. Housewives represented 43.7%. The most common symptoms were dyspnea (84%) and chest pain (62%). Tachypnea was the most frequent sign (72%), and hypotension was observed in 13.5%. PE was common in patients with diabetes mellitus, patients with chronic obstructive pulmonary disease (COPD), patients with deep-vein thrombosis, and those who use oral contraceptive pills (18.5, 17.5, 17.1, and 14.4%, respectively). Regarding echocardiography findings, 16.4% of our patients were cardiomyopathic, 74.4% had mild to moderate pulmonary hypertension, with severe pulmonary hypertension detected in only 7% of patients. Computed tomography-pulmonary angiogram revealed main pulmonary artery embolism in 49.09% of the patients, and in 60 (27%) patients, it was bilateral.ConclusionPE is frequent in Upper Egypt. Diabetes and COPD are the most important risk factors of PE. Death owing to PE is markedly associated with OHS and COPD morbidity.

Transversus abdominis plane block versus paravertebral block for post-operative pain following open renal surgeries: A randomized clinical trial

ABSTRACT Background : Open renal surgeries are usually associated with significant pain which may increase morbidity and mortality if left untreated. Several methods are used to control pain after these surgeries including opioids, non-steroidal anti-inflammatory drugs and regional anesthetic techniques. This study aimed at comparing the thoracic paravertebral block (PVB) versus transversus abdominis plane block (TAP) in patients undergoing open renal surgeries. Methods : Between November 2017 and November 2018 at Assiut University Hospital, urology department 60 patients undergone open renal surgeries had been randomly allocated into two groups; group (PVB) (n = 30) who received (PVB), and group (TAP) (n = 30) who received TAP block. The regional anesthetic technique was performed in each patient after induction of general anesthesia and before performing the surgery. The primary outcome was the total analgesic consumption in the first 24 h postoperatively. Secondary outcomes included the time to the first analgesic request and the Visual Analogue Scale score (VAS) during the first 24 h postoperatively. Results : Total analgesic consumption during the first 24 h postoperatively was significantly lower in PVB group compared to TAP group. The VAS scores were significantly lower in PVB group compared to TAP group during the first 12 h postoperatively. However, the time to first analgesic request was non-significant between both groups. Conclusions : The TAP block was effective, safe and comparable to PVB for pain control following open renal surgeries. However, the paravertebral block was more potent. Trial Registry : ClinicalTrials.gov: NCT04697420

Dexmedetomidine versus propofol or midazolam in patients with abdominal sepsis regarding inflammatory response and capillary leak

ABSTRACT Background Abdominal sepsis patients suffer from profound intravascular fluid deficit due to concomitant inflammatory response and capillary leakage. It is reported that anti-inflammatory properties of sedative agents can control inflammatory cascade in many experimental septic conditions. We aimed to investigate the best sedative drug for inflammatory responses and capillary leak in patients with abdominal sepsis. Methods In this prospective randomized study, 60 patients with abdominal sepsis who underwent abdominal surgery and required post-operative sedation and mechanical ventilation were randomized into 3 groups in a 1:1:1 ratio. Group D (sedated with dexmedetomidine), group P (sedated with propofol), and group M (sedated with midazolam). This study was held in intensive care units of Assiut University Hospitals with primary outcome was serum IL-6 and IL-1β. Secondary outcomes were capillary leak index, lactate clearance, vasopressor requirements, total intake, total output, and fluid balance. Results Dexmedetomidine significantly reduced levels of IL-6 and IL-1β through 48 hours compared to both midazolam and propofol. Dexmedetomidine caused a significant decline in capillary leak index (p < 0.05) through 48 hours and significant higher lactate clearance (p = 0.03) in first 24 hours compared to both midazolam and propofol. Dexmedetomidine group had a significantly lower intake in first 24 hours and comparable vasopressor requirements through 48 hours. Dexmedetomidine group had a significantly higher output, lower serum creatinine levels and lower positive fluid balance compared to propofol and midazolam. Conclusions Dexmedetomidine reduced inflammatory response and capillary leak in mechanically ventilated patients with abdominal sepsis with better lactate clearance and less fluid intake.

Fig latex inhibits the growth of pathogenic bacteria invading human diabetic wounds and accelerates wound closure in diabetic mice

Impaired wound healing is one of the most critical complications associated with diabetes mellitus. Infections and foot ulcers are major causes of morbidity for diabetic patients. The current treatment of diabetic foot ulcers, commonly used antibiotics, is associated with the development of bacterial resistance. Hence, novel and more effective natural therapeutic antibacterial agents are urgently needed and should be developed against the pathogenic bacteria inhabiting diabetic wounds. Therefore, the current study aimed to investigate the impact of fig latex on pathogenic bacteria and its ability to promote the healing process of diabetic wounds. The pathogenic bacteria were isolated from patients with diabetic foot ulcers admitted to Assiut University Hospital. Fig latex was collected from trees in the Assiut region, and its chemical composition was analyzed using GC‒MS. The antibacterial efficacy of fig latex was assessed on the isolated bacteria. An in vivo study to investigate the effect of fig latex on diabetic wound healing was performed using three mouse groups: nondiabetic control mice, diabetic mice and diabetic mice treated with fig latex. The influence of fig latex on the expression levels of β-defensin-1, PECAM-1, CCL2 and ZO-1 and collagen formation was investigated. The GC‒MS analysis demonstrated the presence of triterpenoids, comprising more than 90% of the total latex content. Furthermore, using a streptozotocin-induced diabetic mouse model, topical treatment of diabetic wound tissues with fig latex was shown to accelerate and improve wound closure by increasing the expression levels of β-defensin-1, collagen, and PECAM-1 compared to untreated diabetic wounds. Additionally, fig latex decreased the expression levels of ZO-1 and CCL2.

Study the Relationship of MDCT Staging in Disease Extent with the Systemic Sclerosis Disease Parameters.

The highest incidence of death in systemic sclerosis due to pulmonary disease raises the need for early detection and treatment. The study aim is the assessment of interstitial pulmonary disease by Multi Detector High Resolution CT (MDCT) and finds its relationship with the other disease parameters and the Pulmonary Function tests (PFT). A prospective cross-sectional study was performed in Assiut University Hospitals from May 2018 to January 2020 and included 62 consecutive SSc female patients. Demographic, clinical, Laboratory, PFT and MDCT assessment were conducted for all participants. The coarseness of fibrosis was 8.32 (range 0.0-17), the average proportion of ground-glass opacification was 28.3% (range, 0.0%-75%). Honey-comb pattern was seen in (52.5%). Mean Extent of disease was 46.25±3.7 (range 5-81). Restrictive deficit found in 42 patients. Significant relation was found between the extent of disease and the percentage predicted FVC (r=0.373, p 0.018) and FEV1/FVC (r=0.593, p 0.000) and coarseness of fibrosis and proportion of ground glass opacification correlated inversely with VC (r=-0.385, p=0.014, r=-0.376, p=0.017 respectively), Rayanud's phenomena, modified Rodnan Skin Score and Medsger's general are positively correlated with MDCT disease extent. Scoring of systemic sclerosis (SSc) related interstitial lung disease (SSc-ILD) could be applicable as one of the important tools for disease assessment.

Study the Relationship of MDCT Staging in Disease Extent with the Systemic Sclerosis Disease Parameters

Background and objectivesThe highest incidence of death in systemic sclerosis due to pulmonary disease raises the need for early detection and treatment. The study aim is the assessment of interstitial pulmonary disease by Multi Detector High Resolution CT (MDCT) and finds its relationship with the other disease parameters and the Pulmonary Function tests (PFT). Patients and methodsA prospective cross-sectional study was performed in Assiut University Hospitals from May 2018 to January 2020 and included 62 consecutive SSc female patients. Demographic, clinical, Laboratory, PFT and MDCT assessment were conducted for all participants. ResultsThe coarseness of fibrosis was 8.32 (range 0.0–17), the average proportion of ground-glass opacification was 28.3% (range, 0.0%–75%). Honey-comb pattern was seen in (52.5%). Mean Extent of disease was 46.25±3.7 (range 5–81). Restrictive deficit found in 42 patients. Significant relation was found between the extent of disease and the percentage predicted FVC (r=0.373, p 0.018) and FEV1/FVC (r=0.593, p 0.000) and coarseness of fibrosis and proportion of ground glass opacification correlated inversely with VC (r=−0.385, p=0.014, r=−0.376, p=0.017 respectively), Rayanud's phenomena, modified Rodnan Skin Score and Medsger's general are positively correlated with MDCT disease extent. ConclusionScoring of systemic sclerosis (SSc) related interstitial lung disease (SSc-ILD) could be applicable as one of the important tools for disease assessment.

Infection and Severity of COVID-19 Infection Among Healthcare Workers: A Report from Egypt.

A cross-sectional study was performed that included one hundred health care workers that were confirmed by PCR to be COVID-19 cases admitted to Assiut University Hospital over six months between May 2020 and November 2020. All participants were subjected to thorough history taking and full clinical examination as well as investigations. Out of the 100 HCWs enrolled in the study, 52% were males, 26% were obese, 68% were doctors, and 38% were from the medical department. Fourteen percent of healthcare workers were admitted to ICU, of which 93% were cured. The predictors for severity of cases were as follows: being a doctor OR (6.804) P=0.037, old age OR (1.179) P=0.000, and hospital stay OR (0.838) P=0.015. Health care workers are at risk for severe COVID-19 infection. Being a doctor, old age, and duration of hospitalization were the predictors for the severity of cases of health care workers.

The First Report of Coxiella burnetii as a Potential Neglected Pathogen of Acute Hepatitis of Unknown Causes in Egypt.

The World Health Organization (WHO) recently alerted the emergence of new pathogens causing acute hepatitis in children across several countries. This new situation directs us to the screening of neglected pathogens that cause acute hepatitis. Q-fever is a zoonotic disease, caused by Coxiella burnetii. Although a high seroprevalence of Coxiella burnetii was recorded in animals present in Egypt, Q-fever is still a neglected disease, and the diagnosis of Q-fever is not routinely performed in Egyptian hospitals. In this study, we performed a retrospective assessment for Coxiella burnetii in cases of hepatitis of unknown causes (HUC) enrolled in Assiut University hospitals, in Egypt. Out of 64 samples of HUC, 54 samples were negative for all hepatitis markers, labeled as acute hepatitis of unknown etiology (AHUE), and 10 samples tested positive for adenovirus and Hepatitis E virus (HEV). Q-fever was detected in 3 out of 54 (5.6%) of AHUE, and one sample was confirmed as coinfection of HEV/Q-fever. Jaundice was the most common clinical symptom developed in the patients. In conclusion, Coxiella burnetii was found to be a potential cause of acute hepatitis in HUC. The diagnosis of Q-fever should be considered in acute hepatitis cases in Egyptian hospitals.

Streptococcus pseudopneumoniae as an emerging respiratory tract pathogen at Assiut University hospitals.

Streptococcus pseudopneumoniae is a member of viridans streptococci. It is non-capsulated, bile insoluble and optochin susceptible in ambient air but resistant in 5% CO2. This study aimed to isolate S. pseudopneumoniae from sputum specimens of patients admitted to Chest Department and Chest ICU of Assiut University hospitals, differentiate it from Streptococcus pneumoniae in addition, to evaluate the prevalence of Streptococcus pseudopneumoniae in clinical isolates by phenotypic and genotypic methods, to subject the isolates to antimicrobial susceptibility testing using agar disc diffusion method. Isolation of Streptococcus pseudopneumoniae from sputum sample and doing phenotypic test (optochin susceptibility test,bile susceptibility test and antimicrobial susceptibility test) and genotypic test by polymerase chain reaction (PCR) for five genes: CpsA, LytA, AliB-like ORF2, 16S rRNA and Spn9802 genes. Twenty isolates of S. pseudopneumoniae were diagnosed phenotypically by optochin susceptibility and bile solubility tests followed by genotypic characterization by polymerase chain reaction (PCR) for five genes: CpsA, LytA, AliB-like ORF2, 16S rRNA and Spn9802 genes. The prevalence of S. pseudopneumoniae among studied patients was 10% (20/200). The pure growth of S. pseudopneumoniae from sputum samples together with the great percentage of antibiotic resistance should raise attention to the clinical importance of this organism.

Nurses’ perspectives of families ‘needs of the maternal critically ill cases in woman health hospital: an educational program

Introduction: Meeting the family needs of patients in intensive care units is challenging for healthcare providers. The critical illness of one family member affects the wellbeing of other family members, causing changes in the life of the whole family. This study aimed to assess nurses' perspectives of the family needs of the critically ill maternal patient and to provide an educational program to nurses about these family needs. Methods: A Pre-posttest design was used. The study was conducted in the obstetric intensive care unit at Women's Health Hospital at Assiut University Hospital, Egypt. A convenient sample of 28 was recruited from the total 35 female nurses of the Women’s Health Hospital’s ICU. Results: There was a significant relationship between the sociodemographic items and family needs at P=0.00. There was also a statistically significant relationship between support needs, working hours, and years of experience at P&lt;0.03 and P&lt;0.01, respectively. There was a significant difference in the pre-post application of an educational program in all family needs items (P=0.000). Conclusions: The educational program improved nurses' perspectives and awareness toward family needs. A regular educational program should be conducted in all intensive care units to improve the understanding and management of patients’ needs, especially in an African context.

Inetrleukin-6 and C-reactive protein as predictors of mortality among critically ill COVID-19 patients in Assiut university hospitals (ICUs)

COVID-19 represents a serious global threat due to scarcity of definitive cure and its infectious nature. The death rate of COVID-19 patients admitted to hospitals was quite high, and cytokine storms could be the mechanism of severity. Interleukin-6 (IL6) and C-reactive protein (CRP) may predict severity and mortality. We attempted to determine the role of IL6 and CRP as predictors of death in intensive care unit (ICU) patients. This Cross-sectional hospital study included 100 patients admitted to ICUs at Assiut University Hospitals from October 2020 to October 2021. Data including age, sex and comorbidities were recorded, laboratory investigations included CRP, ferritin, and IL6. Data were collected and analyzed. Morality predictors in ICU patients with COVID-19 infection were older age (>60 years), presence of diabetes mellitus, chest diseases, CRP >49, IL-6 >70 pg/ml. In conclusion, early ranking and identification of people, who are at risk of death among ICU patients, by monitoring of CRP, IL6, early treatment of cytokine storm, and good management of pre-existing comorbidities would be a very useful approach to reduce the mortality among ICU patients.

Patterns and Outcome of Autoimmune Chronic Liver Diseases in Assiut University Hospital: A Retrospective Study

Patterns and Outcome of Autoimmune Chronic Liver Diseases in Assiut University Hospital: A Retrospective Study

The neutrophil-to-lymphocyte ratio as a prognostic index for short-term outcome in the ICU admitted COVID-19 adult patients

Context The neutrophil-to-lymphocyte ratio (NLR), which can be easily computed from a standard blood test, has been found to be useful in determining a patient’s overall inflammatory condition. Aim To find out if the NLR cut-off point could be used to predict mortality in coronavirus disease 2019 (COVID-19) patients admitted to the intensive care unit (ICU). Setting and design A prospective cohort study, carried out between March and August 2021, and included 92 COVID-19 ICU admitted patients of Assiut University Hospital. Methods and material The NLR, platelet-to-lymphocyte ratio (PLR), ventilation assessment, and short-term outcome were assessed throughout the study period. Results Receiver operating characteristic curves analysis on the 7th day was done for NLR and PLR in relation to mortality rate. There was a high AUC for both NLR and PLR (0.946 and 0.931, respectively). The cut-off points were NLR 6.9 and PLR 258.35; above these, the mortality was increased. Patients who were discharged to home were 62 (67.39%), those who were transferred to an intermediate care unit were 9 (9.78%), and those who died were 21 (22.8%). Conclusion NLR and PLR levels above a certain threshold were linked to severe COVID-19 and mortality. Prior to clinical application, more research is needed to determine the best cut-off value for NLR.