Assiut University Hospital Research Articles

Accuracy of chest ultrasonography in the diagnosis of coronavirus disease 2019 pneumonia

Abstract Background Coronavirus disease 2019 (COVID-19) virus infection is an ongoing, catastrophic, worldwide pandemic with significant morbidity and mortality. Large numbers of people who are getting COVID-19 virus infection are at high risk of developing COVID-19 pneumonia; early diagnosis of COVID-19 pneumonia, patient care, and isolation using simple, less expensive images are required. High-resolution computed tomography chest (HRCT chest) is the reference standard method for the diagnosis of COVID-19 pneumonia; however, it is expensive with increasing the exposure risk; chest ultrasonography (CUS) may be an alternative method. Patients and methods CUS is performed on patients accepting to participate in the study at presentation of COVID-19 suspicious cases. HRCT chest to confirm COVID-19 pneumonia were done within 24 h of CUS examination. Two chest consultants who are experts in CUS at Assiut University Hospital performed CUS. The CUS is done using a convex probe of 3.5 MHz. The CUS was considered positive for pneumonia if the examiners find the presence of abnormal multiple vertical B lines with or without the presence of consolidation dots unilateral or bilateral with good cardiac function; HRCT chest results are recorded. Results In all, 197 patients were included in the study (102 males, mean age 48 ± 16.2 years). Regarding comorbidity: 10% had diabetes mellitus and 9% had hypertension. Ten (5%) patients needed hospitalization with a mean oxygen saturation of 95 ± 5%. One hundred fifty-two patients confirmed COVID-19 pneumonia with HRCT chest, while 45 patients had normal HRCT chest. CUS showed positive pneumonic finding in 128 patients and normal picture in 69 patients. There was good association (r=0.690, P<0.001) between both diagnostic modalities in COVID-19 pneumonia diagnosis. Sensitivity and specificity and accuracy of CUS in the diagnosis of COVID-19 pneumonia were 84.56, 95.83, and 87.31%, respectively, when compared with HRCT chest. One hundred and two patients were successfully followed; all of them showing clinical and ultrasonographic improvement.

COVID-19 associated mucormycosis in Assiut University Hospitals: a multidisciplinary dilemma

Mucormycosis is a life-threatening opportunistic angioinvasive fungal infection. We aimed to describe the frequency, presentations, predictors, and in-hospital outcome of mucormycosis patients in the scope of CoronaVirusDisease-19 (COVID-19) during the third viral pandemic wave. This cross-sectional retrospective study included all patients who fulfilled the criteria of mucormycosis with concurrent confirmed covid19 infection admitted to Assuit University Hospital between March 2021 and July 2021. Overall, 433 patients with definite covid-19 infection, of which 33 (7.63%) participants were infected with mucormycosis. Mucormycosis was predominantly seen in males (21 vs. 12; p = 0.01). Diabetes mellitus (35% vs. 63.6%; p < 0.001), hypertension (2% vs.45.5%; p 0.04), and Smoking (26.5% vs. 54.5%; p < 0.001) were all significantly higher in mucormycosis patients. Inflammatory markers, especially E.S.R., were significantly higher in those with mucormycosis (p < 0.001). The dose of steroid intake was significantly higher among patients with mucormycosis (160 mg vs. 40 mg; p < 0.001). Except for only three patients alive by residual infection, 30 patients died. The majority (62%) of patients without mucormycosis were alive. Male sex; Steroid misuse; D.M.; Sustained inflammation; Severe infection were significant risk factors for mucormycosis by univariate analysis; however, D.M.; smoking and raised E.S.R. were predictors for attaining mucormycosis by multivariate analysis.

New biomarkers for the diagnosis of pleural effusion

BackgroundPersistent undiagnosed effusion is present in approximately 15% of all causes of exudative effusion. Pleural effusion caused by immunoglobulin G4 (IgG4) is a new type of pleural effusion. Tumor markers such as Carcinoembryonic antigen (CEA) may play a role in the diagnosis of malignant pleural effusion. This study aimed to evaluate the use of serum Immunoglobulin G4 and carcinoembryonic antigen in diagnosing pleural effusion.MethodsThis observational descriptive cross-sectional study comprised 89 individuals with exudative pleural effusion who visited the Assiut university hospital's chest department. All patients were examined and asked about their medical history. Also, chest X-ray, MSCT chest, transthoracic ultrasonography, pleural fluid analysis and cytology, serum level of carcinoembryonic antigen, and immunoglobulin G4 were performed. In addition, pleural biopsy, bronchoscopy, and thoracoscopy were performed when required.ResultsIn comparison to another diagnosis, the level of serum IgG 4 was observed to be substantially greater in individuals with IgG4-associated effusion (725± 225.45). Patients with malignant mesothelioma (70± 16.24) and metastatic adenocarcinoma (93.52± 19.34) had lower levels of IgG4. In contrast, the serum level of CEA was significantly higher in individuals with malignant mesothelioma (79.50± 29.47) and metastatic adenocarcinoma (68.71± 28.98). Patients with para-pneumonic effusion had a minor serum level of CEA (0.36 ± 0.26). At cutoff point > 152 mg/dl serum IgG-4 had 100% sensitivity and 94% specificity in the diagnosis of IgG4 related pleural effusion with an overall accuracy of 95.3% and area under the curve of 0.97. At the cutoff point > 5 ng/ml serum CEA had 77% sensitivity and 100% specificity in diagnosing malignant pleural effusion with an overall accuracy of 91.1% and area under the curve of 0.88.ConclusionSerum IgG4 higher than 152 mg/dl has good diagnostic accuracy in cases of undiagnosed pleural effusion. Carcinoembryonic antigen aids in diagnosing malignant pleural effusion with a cutoff point higher than 5 ng/ml in serum.Trial registrationClinicalTrials.gov registration ID NCT03260088

Educational program among pregnant women about Coronavirus (COVID-19) at Assiut University Hospitals

Educational program among pregnant women about Coronavirus (COVID-19) at Assiut University Hospitals

Hyponatremia in elderly patients with fractures around the hip; role of glutamate (CSF glutamate study)

Background &amp; objective: Hyponatremia is the most common electrolyte disorder and is a predictor of osteoporosis, inflammation and cognitive dysfunction leading to falls in the elderly patients. We compared glutamate levels in normonatremic elderly patients with those with hyponatremia, admitted with osteoarthritis, to find correlation between the cognitive status with cerebrospinal fluid (CSF) glutamate as a biomarker for hyponatremia.&#x0D; Methodology: In an observational prospective study; 70 patients, more than 70 y of age, admitted to trauma unit of Assiut University Hospital with fractures around the hip, were investigated for the frequency of on-admission hyponatremia. The CSF glutamate level was determined using radio-immune assay. We compared glutamate level in 18 hyponatremic patients with 10 normonatremic elderly patients admitted with osteoarthritis for elective joint replacement (control group) to find correlation between the cognitive status assessed by Modified Mini-Mental State (3MS) examination and CSF glutamate as a biomarker for hyponatremia.&#x0D; Results: Hyponatremia is highly prevalent in elderly with fractures around the hip; we recorded it in 41.4% of the study sample. Most patients were females (62.86%). CSF glutamate was significantly increased in hyponatremic patients than the controls (P &lt; 0.001).&#x0D; Conclusion: Prevalence of hyponatremia is high in old aged patients probably due to due to prevalent hot weather in the south of Egypt. CSF glutamate level can be a marker for mild cognitive impairment caused by hyponatremia.&#x0D; Abbreviations: 3MS: Modified Mini-Mental State examination; CSF: cerebrospinal fluid; RPM: revolutions per minute; ELISA: enzyme-linked immunosorbent assay; SD: standard deviation&#x0D; Key words: Geriatric anesthesia; Chronic Disease; Cognition Disorders / blood; Cognition Disorders / etiology; Glutamic Acid / metabolism; Hyponatremia / blood; Hyponatremia / complications; Hyponatremia / psychology; Inappropriate ADH Syndrome / complications; 3MS&#x0D; Citation: Kotb HI, Hassan A, Sayed AA, Seddik MI, Maghraby HH, Kamel EZ. Hyponatremia in elderly patients with fractures around the hip; role of glutamate (CSF glutamate study). Anaesth. pain intensive care 2022;26(3):332-337&#x0D; DOI: 10.35975/apic.v26i3.1900&#x0D; Received: November 28, 2020; Reviewed: December 25, 2020; Accepted: April 25, 2022

Outcome of micro vascular reconstruction of the lower limb after resection of primary bone tumors

Background: Surgical and medical care for patients with bone and soft tissue tumors of the extremities continues to improve with advancement of chemotherapeutic strategies, surgical techniques, and understanding of pathogenesis. Aim and Objective: To Analysis of the results of lower limb preservation after neoplastic resection to reproduce an advisory algorithm for surgical decision making to achieve optimal functional results.Methods: This retrospective study was performed in the microsurgery unit Assiut university hospital between 2013 and 2019, involved (40) patients with primary malignant bone tumors and benign aggressive bone tumors who had wide local resection and reconstruction by vascularized fibula (osteoseptocutaneous flap). Results: The highest mean time of union rate was 5.75±2.06 for GCT. The least mean time of union rate was 3.86±1.21 forChondrosarcoma. the least Mean±SD of function was 2.83±0.75 in chondrosarcoma while the highest Mean±SD of emotional acceptance was 4±0.82 in Ewing sarcoma. The Mean±SD of pain were equal in both Ewing sarcoma and GCT. Conclusions: Benign aggressive tumors &amp; primary malignant bone tumors now become not a rare tumor. Free vascularized fibular graft is one of several methods of bone reconstruction after bone tumor resection. Using as a means of reconstruction.

Early rehabilitation program and weaning outcomes in critically ill chronic obstructed airway disease patients: a randomized trial

BackgroundTo compare the effectiveness of early rehabilitation program on mechanical ventilated COPD patient in RICU to those using current usual care regarding diaphragm function and weaning outcomes.MethodsThe study was a randomized controlled trial. It included 108 newly admitted COPD patients to RICU, Chest Department, Assiut University Hospital, Egypt, in the period from June 2018 to May 2020. They were divided into two groups: group Ι received the usual care plus pulmonary rehabilitation program, and group II received the usual care alone. The outcomes (MV duration, rates of successful weaning, diaphragm function, and lengths of hospital and ICU stay) were recorded and evaluated. The data was analyzed using Student t-test, Mann–Whitney U-test, Wilcoxon signed-rank test, chi-square (χ2) test or Fisher Exact test, receiver operating characteristics (ROC) curve, and logistic regression analysis.ResultsOne-hundred and eight COPD patients were included. Early rehabilitation program for COPD patients in the ICU shortened the duration of their MV, increases the rates of successful weaning and decreases 30-day mortality, and shortened the duration of their ICU and hospital stays, as compared to COPD patients who received usual care.ConclusionsManagement of COPD patients with early rehabilitation program is associated with better outcome with improvement of the quality of life of COPD patients.Trial registrationClinical trial.gov: NCT03253380

Complications Of Suppurative Otitis Media Still Occur In The 21st Century

Chronic suppurative otitis media is chronic inflammation affected the middle ear and divided in 2 types benign and malignant type, Where the complication most aggressive with the malignant type. This study is aretrospective chart review for files of patients with suppurative otitis media complicated with one or more of the cranial and or intra-cranial complications of CSOM and attended to Assiut University Hospital (AUH) for management of their diseases during the 10 years from 1- 1-2005 to 31-12-2014. The patients were grouped into 3 groups: Group I: - with Cranial complications. Group II: - with Intra-cranial complications. Group III: - with mixed complications. The aim of study was to Identification of cases with different cranial and intra-cranial complications of suppurative otitis media that presented to AUH from 1-1-2005 to 31-12-2014, analyzing the factors surrounding these patients with complications, and Identification of the ways of management done.

Is Corneal Collagen Cross-Linking Beneficial as an Adjunct to the Conventional Treatment of Bacterial Keratitis?

Background: To evaluate the therapeutic effects of corneal collagen cross-linking CXL as an adjuvant to standard antimicrobial agents in the treatment of bacterial keratitis when compared to treatment with antimicrobial agents alone. Methods: This prospective comparative interventional study included 20 eyes of 20 patients with clinical and laboratory evidence of bacterial keratitis who attended the Outpatient Cornea Unit, Ophthalmology Department, Faculty of Medicine in Assiut University Hospital, Assiut, between January 2019 and December 2020.Patients were divided into two groups: group A, treated with CXL using the Dresden Protocol at the EL-Nour Eye Centre, and group B treated with antibiotics alone. Results: Group A had ten patients in the age range of 20-80 years (mean age 49.2 years), while that of group B (ten patients) was 19 -70 years (mean age 47.3 years). The ulcer sizes started to decrease significantly from week 2 in group A to week 3 in group B. The epithelization time was significantly different between the two treatment groups as reepithelization in 60% of group A cases started at week two, while it began at week three in group B. There was no significant difference in the V/A between the two groups after treatment. Conclusion: CXL as an adjunct to topical antimicrobial treatment was more effective in treating bacterial keratitis than conventional antimicrobial therapy alone, as it led to shorter recovery times due to more rapid ulcer healing, resolution of infiltration, and faster symptomatic relief in patients. Despite CXL promoted the ulcer to heal quickly, there was no significant change in V/A before and after CXL or between the CXL with antimicrobial or antimicrobial therapy alone .

Prevalence and patterns of symptoms of dysautonomia in patients with long-COVID syndrome: A cross-sectional study.

BackgroundThe association between autonomic dysfunction and long‐COVID syndrome is established. However, the prevalence and patterns of symptoms of dysautonomia in long‐COVID syndrome in a large population are lacking.ObjectiveTo evaluate the prevalence and patterns of symptoms of dysautonomia in patients with long‐COVID syndrome.MethodsWe administered the Composite Autonomic Symptom Score 31 (COMPASS‐31) questionnaire to a sample of post‐COVID‐19 patients who were referred to post‐COVID clinic in Assiut University Hospitals, Egypt for symptoms concerning for long‐COVID syndrome. Participants were asked to complete the COMPASS‐31 questionnaire referring to the period of more than 4 weeks after acute COVID‐19.ResultsWe included 320 patients (35.92 ± 11.92 years, 73% females). The median COMPASS‐31 score was 26.29 (0–76.73). The most affected domains of dysautonomia were gastrointestinal, secretomotor, and orthostatic intolerance with 91.6%, 76.4%, and 73.6%, respectively. There was a positive correlation between COMPASS‐31 score and long‐COVID duration (p < 0.001) and a positive correlation between orthostatic intolerance domain score and post‐COVID duration (p < 0.001). There was a positive correlation between orthostatic intolerance domain score and age of participants (p = 0.004). Two hundred forty‐seven patients (76.7%) had a high score of COMPASS‐31 >16.4. Patients with COMPASS‐31 >16.4 had a longer duration of long‐COVID syndrome than those with score <16.4 (46.2 vs. 26.8 weeks, p < 0.001).ConclusionsSymptoms of dysautonomia are common in long‐COVID syndrome. The most common COMPASS‐31 affected domains of dysautonomia are gastrointestinal, secretomotor, and orthostatic intolerance. There is a positive correlation between orthostatic intolerance domain score and patients' age.

Positive impact of pre-Ramadan education on glycemic control and reducing risk of hypoglycemia in type 2 diabetic elderly patients during COVID 19 pandemic

BackgroundElderly patients have higher risks for complications during Ramadan fasting. Educating patients is essential for fasting safely. AimTo evaluate the impact of pre-Ramadan education in reducing risk of hypoglycemia and achieving glycemic control in elderly. MethodsA prospective study carried out in outpatients clinics of Internal Medicine department in Assiut university hospital. It included 316 type 2 diabetic patients who intended to fast. They were grouped into 2 groups; < 65 years and ≥ 65 years patients. The patients received pre-Ramadan individual education sessions. A semi-structured questionnaire was used to collect the data to stratify the risk of fasting. The study was carried out in 3 phases. Assessment of hypoglycemia and biochemical parameters after the education was the primary outcome. ResultsFasting blood glucose decreased during and after Ramadan in elderly significantly (p = 0.0001). The patients who achieved fasting blood glucose less than 8 mmol/L increased from 29.3% to 46.6% after Ramadan in elderly patients. HbA1c decreased significantly after Ramadan (p = 0.001). The main cause of breaking fast was hypoglycemia in both groups; 9% vs.7.7% in patients < 65 and ≥ 65 years respectively. The waist circumference showed significant decrease in patient with 65 years old or more (p = 0.05). Total cholesterol and LDL increased with no statistical significance in patients ≥ 65 years (p = 0.512, 0.470). Both groups showed improvement of HDL cholesterol during and after Ramadan (P = 0.0001). ConclusionPre-fasting education had positive impact on decreasing the risk of symptomatic hypoglycemia in elderly diabetic patients.

Comparative Study Between the Efficacy of Oral Verapamil and Oral Diltiazim on Reduction of Intraoperative Bleeding During Endoscopic Sinus Surgery Under General Anesthesia: A Randomized Controlled Trial

Background: Intra-operative bleeding presents a larger obstacle to endoscopic visualization. When profuse bleeding occurs, the blood pressure drops. This drop leads to a reduction or cessation of the bleeding, blood pressure stabilization, and recovery Objectives: Was to study the effect of addition of verapamil and diltiazim to general anesthesia aimed reduction in heart rate and blood loss during endoscopic sinus surgery, to study surgeon's assessment of the surgical field and hemodynamic and to study effect of addition of verapamil and diltiazim to general anesthesia on serum cortisol and norepinephrine during endoscopic sinus surgery. Patients and Methods: Quasi experimental research study conducted at Assiut University Hospital. A convenience sample of 135 male and female adult patients were classified into three equal groups included control group (45 patients) received placebo per oral (PO) 3 hours preoperative; diltiazim group (45 patients) received diltiazim 90mg (PO) 3 hours preoperative; and verapamil group (45 patients) received 80 mg PO 3 hours preoperative. The Primary outcome was to study the effect of addition of oral verapamil or diltiazim to general anesthesia on the Intraoperative hemodynamics: heart rate (HR), noninvasive blood pressure(NIBP), mean arterial blood pressure(MAP), and the blood loss during endoscopic sinus surgery and the Secondary outcome was To study the effect of addition of oral verapamil or Diltiazim to general anesthesia on the serum cortisol and norepinephrine during endoscopic sinus surgery and to study the surgeon assessment of surgical field. Results: There was statistically significant difference between the three studied groups regarding the blood loss. The mean blood loss was 170.9± 19.0, 118.6± 17.3, and 100.5± 15.8 mL among the three studied groups. By post-hoc test there was statistically significant difference between group 1 and 2 (p&lt;0.001), group 2 and 3 (p&lt; 0.001) and group 1 and 3 (p&lt;0.001). There were 11% in grade 1 among group 3. There was statistically significant difference between the three studied groups regarding the bleeding scale. There was statistically significant difference between the three studied groups regarding HR at different points of time intraoperative (5, 15, 30, 45, 60, 90, 120, 150 minutes). By post-hoc test there was statistically significant difference between group 1 and 2 (p&lt;0.001), group 2 and 3 (p&lt; 0.001) and group 1 and 3 (p&lt;0.001). There was a statistically significant difference in the mean systolic blood pressure among the three studied groups at different points of time intraoperative (5, 15, 30, 45, 60, 90, 120, 150 minutes). By post-hoc test there was statistically significant difference between group 1 and 2 (p &lt;0.001), group 2 and 3 (p &lt; 0.001) and group 1 and 3 (p&lt;0.001), and there was a statistically significant difference in the mean diastolic blood pressure among the three studied groups at different points of time intraoperative (5, 15, 30, 45, 60, 90, 120, 150 minutes). By post-hoc test there was statistically significant difference between group 1 and 2 (p &lt;0.001), group 2 and 3 (p &lt; 0.001) and group 1 and 3 (p &lt;0.001). Conclusion: Both diltiazim and verapamil are effective and safe drugs for this purpose. The results revealed that better heart rate control in lesser time was achieved with verapamil. Thus, verapamil may be a better drug in cases where the goal is to achieve stricter rate control in less time. The results of this study support the use of verapamil for reduction of intraoperative bleeding than diltiazim when treatment with a calcium channel blocker is warranted. However, verapamil was better as it provided optimum surgical condition with only mild reduction in blood pressure. Reduced intra operative bleeding and less tachycardia throughout the surgery were added advantages.

Targeted newborn hearing screening in the neonatal intensive care unit of Assiut University Hospital

BackgroundEarly detection of congenital hearing loss (HL) and appropriate intervention is essential to minimize its dramatic impact. Target-based newborn hearing screening (TNHS) was initially targeted high-risk register (HRR) newborn. The advance techniques in neonatology in neonatal intensive care unit (NICU) lead to decrease mortality among low birth weight and preterm infants, but significant morbidities including hearing loss persist. In this study, we aimed to assess the prevalence of hearing loss and the percentage of different risk factors among the HRR neonates admitted to NICU at Assiut University Hospital.ResultsThe prevalence of hearing loss among the study group is 1%. The most common risk factor present between the study group was prematurity associated with the low birth weight (57%). The combination of preterm and low birth weight has statistically significant effect on hearing loss (p < 0.006). There was statistically significant difference in the pass rate of the transient evoked otoacoustic emission (TEOAE) frequencies included in the screening program. The highest pass rate 91% and 85% was at 4 KH and 3 KH, respectively, while the least pass rate was at 1 KH (11.5%).ConclusionTEOAE screener is safe, noninvasive, and doesn’t require sedation and cost-effective method in the newborn hearing screening at NICU. For HRR, it is better to do screening before hospital discharge so allowing enough time for comorbidities of the neonate to improve. Neonatal hearing screening in high-risk neonates in NICU allows early identification of children with hearing loss with early intervention.

Lower Extremity Vascular Trauma Assiut University Hospital Experience

Background: There is globally increase incidence in vascular trauma as a result of increase rate of civilian violence and increase rate of road traffic accident. Vascular injury affects young males and associated with high mortality and long-term morbidity. Here, we present our experience as tertiary health centers in the management of this type of injury, also we present our result as regards to primary and secondary amputation rates. The most important factors affecting these rates were ischemia time and condition of surrounding soft tissue. Aims and Objectives: Detect rate of limb salvage after trauma injury in assuit university hospital, and risk factors for limb loss. Materials and Methods: Our study is prospective study of all patients who vascular lower extremity trauma from January 2014 to January 2015 during the period of the study(from January 2014 to January 2015), 135 cases of vascular injury presented to Assiut University Hospital, 87 of them had lower limb vascular injury representing 64.4%. Results: Surgical intervention was done in 82 patients representing 94.3%, endovascular intervention was done in 2 patients representing 2.3, 1 patient had endovascular balloon control then surgical intervention representing 1.15%, and two patients had conservative management representing 2.3%. Conclusion: vascular trauma is prevalent health problem in our locality, which have huge socioeconomic impact in our community as it affects mainly young men. The main controlling factor in secondary amputation rate is ischemia time, infection which accompanies severe soft tissue damage. At the end trauma with vascular injury is considered, a complex process needs urgent intervention with multidisciplinary team in well-equipped facility.

Effect of Health Promotion Nursing Interventions on Functional Status among Elderly with Cardiovascular Diseases at Assiut University Hospital

Effect of Health Promotion Nursing Interventions on Functional Status among Elderly with Cardiovascular Diseases at Assiut University Hospital

Detection of carbapenem resistance among Escherichia Coli and Klebsiella Pneumoniae in Chest intensive care unit at Assiut University Hospitals,Egypt.

Detection of carbapenem resistance among Escherichia Coli and Klebsiella Pneumoniae in Chest intensive care unit at Assiut University Hospitals,Egypt.

The Authority of Gene Modifiers in β-Thalassemia Major and Its Relationship to the Pathophysiology of the Disease

β-Thalassemia, an inherited red blood cell disorder, presents a significant health problem worldwide and is caused by defects in the β-globin gene, resulting in the reduction or absence of β-globin chain synthesis. That leads to blood transfusion dependency with its terrible complications. Polymorphisms at position -158 of XmnI-HBG2 on chromosome 11 and BCL11A site on chromosome 2p16 might be linked with elevated hemoglobin F (HbF) appearance, which may, in turn, improve β-thalassemia sternness. This study aims to walk around the amending effects of XmnI and BCL11A loci on HbF levels in Egyptian β-thalassemia patients. Material and Methods. A prospective case-control study of 70 multi-transfused β-thalassemia major patients and 22 controls was performed in the Paediatric hematology unit of Assiut university hospital from June 2019 till April 2021. PCR-RFLP was used to detect single nucleotide polymorphisms at XmnI and BCL11A site loci. Results. XmnI Polymorphism was detected in 9 of 70 patients and associated with higher mean HbF levels (53.48%) than patients without polymorphism (mean Hb level was 42.23%)(P-Value=0.035). The frequency of CT heterozygous genotype was 8 (11.4%), TT homozygous genotype was (1.4%), while the wild genotype CC was detected in 61 (87.1%) of the cases. While BCL11A Polymorphism detected in 21 of 70 patients did not affect either Hb or HbF levels (P-Value =0.26). The TT genotype frequency was 49 (70%), and TC heterozygous genotype was detected in 21 (30 %) of patients. The CC genotype was absent. Conclusion: XmnI -158Gγ polymorphism, but not BCL11A polymorphism, has a modifying effect on both Hb and HbF levels in Egyptian β-thalassaemia major patients. Our research goal is to investigate the frequency of XmnI and BCL11A polymorphism in thalassemia major and investigate the HbF level difference according to the XmnI and BCL11A polymorphism of phenotype group in thalassemia major.

Radiological characteristics of neuromyelitis optica spectrum disorder in Egypt

AbstractBackgroundNeuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system, which mainly affects the optic nerves and the spinal cord. Magnetic resonance imaging (MRI) plays an important role in the diagnosis of NMOSD based on the 2015 consensus criteria.MethodsThe objective of this study was to describe the MRI characteristics of NMOSD patients in Egypt. This were a prospective, observational study on patients fulfilling the 2015 diagnostic criteria of NMOSD. Patients were recruited consecutively from the Neurology, Psychiatry and Neurosurgery hospital, Assiut University Hospitals, Egypt from March 2019 until August 2020. Data on demographics, clinical and laboratory features were collected. MRI scan results were reviewed for each patient and compared according to Aquaporin4‐seropositivity.ResultsNinety patients fulfilled NMOSD diagnostic criteria. The mean age at onset was 30.7±11.8 with a female predominance of 3:1. AQP4 antibodies were positive in 77/90 patients (85.6%). Seventy‐two patients (80%) had acute myelitis, 44 cases (61.1%) had longitudinally extensive transverse myelitis (LETM) and 61 cases (87.1%) had a central position in the cord. Bright spotty lesions (BSL) were found in 44 cases (61.1%). The most common site of cord involvement was the cervical region. Abnormal MRI brain scans were found in 81.1% of patients. No statistically significant differences could be found between the two groups.ConclusionThere was a high frequency of abnormal spine and brain MRI findings in the Egyptian population. Even though no specific patterns were typical for AQP4‐specific serostatus, certain findings may suggest NMOSD diagnosis and warrant AQP4‐IgGs testing.

Regulatory T-lymphocyte subsets in children with chronic immune thrombocytopenia after high-dose of dexamethasone

BackgroundImmune thrombocytopenia (ITP) is an acquired autoimmune disease. This study’s objective was to estimate the variations in the population of CD4+CD25+High FoxP3+ cells (CD4+ regulatory T-lymphocytes; Tregs) in previously untreated children with chronic ITP managed in Assiut University Hospitals, as well as to evaluate the efficacy of high-dose dexamethasone (HD-DXM) in these patients.MethodsIn this study, we investigated the frequencies of T-lymphocyte subsets in 27 untreated children with chronic ITP.ResultsPrior to treatment, the percentages of CD4+CD25High cells and Tregs were significantly lower in the chronic ITP group compared to the control group (p = 0.018 and p < 0.0001, respectively). After treatment with HD-DXM, Tregs and platelets were significantly increased in these patients (p < 0.0001 for both).ConclusionsOur results suggest that Tregs are deficient in children with chronic ITP and that HD-DXM immunosuppressive therapy can restore the levels of these cells.ImpactCD4+CD25High cells and Tregs were significantly lower in children chronic ITP compared to healthy control.HD-DXM treatment led to significantly increased Tregs and platelets in these patients.Our results suggest that Tregs are deficient in children with chronic ITP and that HD-DXM immunosuppressive therapy can restore the levels of these cells.

The Role of Surfactants in Inhibition of Uropathogenic E. coli Biofilm in Catheterized Patients in Assiut University Hospitals.

The Role of Surfactants in Inhibition of Uropathogenic E. coli Biofilm in Catheterized Patients in Assiut University Hospitals.