Assiut University Hospital Research Articles

Study of CRP, ferritin, and D-dimer in COVID-19 RICU patients as per HRCT severity in assiut university hospitals

BackgroundInflammatory markers were found to be elevated in patients with coronavirus disease (COVID-19). C-reactive protein (CRP), serum ferritin, and D-dimer levels may predict morbidity and mortality in (COVID-19) patients. Radiology plays a key role in the diagnosis, management, and follow-up of this disease. This study aimed to describe the radiological features of (COVID-19) infection, measure C-reactive protein (CRP), D-dimer, and ferritin levels and to correlate them with patient’s outcome and to consider them as predictors of morbidity and mortality in (COVID-19) patients.MethodsThis prospective cross-sectional analytic study had been done on 159 patients aged ≥ 18 years old, admitted at Assiut University Hospital RICU from November 2021 to November 2022, diagnosed as COVID-19 by positive RT-PCR. All patients were categorized on bases of HRCT chest disease reporting and data system (CO-RADS) scoring system into non-severe (CO-RADS 1,2,3) and severe (CO-RADS 4,5) groups. Inflammatory markers such as CRP, ferritin, and D-dimer were measured. Age, sex, comorbidities, need to mechanical ventilation MV, and mortality rate were reported. Correlation between HRCT(CO-RADS) score, inflammatory markers, and patient’s outcome was assessed.ResultsHigher CRP and serum ferritin levels, lower lymphocytic count, and higher frequency of need for mechanical ventilation were significantly greater in the severe group (P < 0.0001). Predictors of morbidity and mortality were CRP ≥ 133 mg/dl, DM, presence of chronic chest disease (P < 0.0001). A higher mortality rate was in patients of the severe group (65%) versus (9%) in the non-severe group (P < 0.0001).ConclusionsHRCT scan and measurement of CRP and ferritin plasma levels can be considered significant predictors for future prognosis and can early identify patients at risk of death and need for MV. Male gender, presence of DM, and chronic chest diseases are risk factors for severe illness.

The outcome of coronavirus disease 2019 in hospitalized patients with diabetes mellitus at Assiut University Hospital

Rationale The chronic nature of diabetes renders it a risk factor for lower respiratory tract infections, adversely impacting patient prognosis. Objective This study aimed to investigate the influence of diabetes on the outcomes of coronavirus disease 2019 (COVID-19) patients. Patients and methods This prospective cohort study enrolled 160 patients admitted and diagnosed with COVID-19. Patients were categorized according to glycated hemoglobin level into two groups: diabetic and nondiabetics (80 patients each). The COVID-19 severity index was calculated for all patients. Follow-up of their in-hospital stay and incidence of complications was documented. Results It was found that diabetic patients had a significantly higher percentage of severe COVID-19 cases (83.8 vs. 61.3%) [odds ratio (OR)=1.89, 95% confidence interval (CI)=1.02–3.48]. The diabetic group had higher rates of ICU admission (OR=2.21, 95% CI=1.06–4.57), invasive mechanical ventilation (OR=3.75, 95% CI=1.321–10.803), and mortality (HR=1.69, 95% CI=1.132-2.514) compared with nondiabetic patients (33.8 vs. 18.8%, 20 vs. 6%, and 41.5 vs. 21.2%, respectively). From the nondiabetic group, 68.4% of prediabetic patients had hyperglycemia requiring insulin treatment during their hospital stay versus 31.6% of normoglycemic patients. Conclusion Diabetes mellitus is associated with more severe manifestations of the disease, increased complications, ICU admissions, ventilatory requirements, and mortality rates compared to nondiabetic individuals. COVID-19 is associated with poor glycemic control.

Frequency and risk factors of congestive heart failure in hemodialysis patients in Assiut University Hospital

Background Cardiac failure is a leading cause of death for patients with chronic kidney disease and end-stage renal disease (ESRD). This study aimed to assess the prevalence of congestive heart failure (HF) in ESRD patients and evaluate its main risk factors. This data will help to provide better care to our patients and improve the outcome. Patients and methods A descriptive observational study was carried out on 290 individuals with ESRD who were on regular hemodialysis. The patients were categorized into two groups based on cardiac failure. The first group consisted of individuals diagnosed with HF, whereas the second group included people who showed no signs of HF. Results Logistic regression analysis revealed that smoking, hemoglobin level, ultrafiltration rate, ischemic heart disease, and ejection fraction were considered independent predictors for HF ESRD patients. Conclusion Congestive HF is prevalent among people undergoing hemodialysis. The main reasons for this high occurrence included the high prevalence of cardiovascular risk factors such as diabetes and hypertension, along with complications of renal failure such as anemia.

Clinicopathological characteristics and outcomes of patients with unexplained renal impairment: A single center study

BackgroundChronic kidney disease (CKD) is a growing health problem. About 20% of CKD patients have undetermined causes. Data describing histopathological patterns of unexplained impaired kidney functions in Egypt are lacking. We aimed to identify the clinicopathological characteristics and short-term outcomes of adult cases with unexplained impaired kidney functions. MethodsWe conducted a prospective study in Assiut University Hospital from August 2018 to May 2022. It included patients with unexplained elevated serum creatinine (serum creatinine>115μmol/L) who underwent renal biopsies. Descriptive statistics were used to summarize data on patient demographics, histopathological patterns, and outcomes after three months. Clinical trial registration number: NCT03586531. ResultsOverall, 210 native renal biopsies were included in the analysis. Glomerular diseases were the most common pathological finding (n=88, 44.9%), amyloidosis and FSGS were the most prevalent glomerular pathology (15.2%, 14.3%, respectively). Chronic kidney disease of unknown etiology (CKDu) was diagnosed in 8.1% of the cases; histology suggestive of genetic origin was found in 2.5%, and LECT amyloidosis was found in 3.8% of the cases. Poor outcomes were observed in 43.6% of the patients i.e., renal replacement therapy or death. Treatment strategies were changed based on the biopsy findings in 86 patients (40%). ConclusionAmyloidosis and FSGS were the most common causes of unexplained renal impairment. CKDu is not uncommon in Egypt, and more preventive measures are needed. This study supports the irreplaceable role of renal biopsy in disease diagnosis, treatment decisions, and predicting prognosis even in advanced stages.

Risks and outcomes among coronavirus disease 2019 patients admitted to Assiut University Hospital

Introduction The clinical characteristics present with coronavirus disease 2019 (COVID-19) encompasses asymptomatic to severe disease and mortality. Clinicians need to detect patients whose risk of illness progression and unfavorable outcomes is high. Aim To evaluate potential risk factors affecting the severity and outcome of coronavirus infection in patients admitted to Assiut University. Patients and methods From October 2021 to October 2022, Assiut University Hospital served as the site of this observational analytical cross-sectional single-centered study. A full medical history, examination, radiographic, and laboratory investigations were performed on patients. Results The primary risk variables for mortality of COVID-19 patients include a greater mean age (73.61 ± 10.51) (P value&lt;0.001). Individuals with chronic kidney disease (P value=0.005), and liver cirrhosis (P value&lt;0.001). Those unvaccinated against COVID-19 the (P value = 0.004). Laboratory findings can be used as a predictor of infection severity as higher median white blood cell count (P value=0.044), lower median lymphocytic count (P value=0.028), higher serum ferritin (P value=0.02). Radiologically, a significant higher mean computed tomography severity score percentage is noticed among died patients (16.61 ± 4.55%) (P value&lt;0.001). Conclusion Advanced age, patients with renal or hepatic impairment, patients with lower lymphocytic counts or with higher computed tomography severity score are linked to a worse clinical course and outcome among COVID-19 patients who were admitted to Assiut University Hospital. Trial registration ClinicalTrials.gov. NCT04860232.

Comparison of risk assessment scores in patients with pulmonary embolism

Background Pulmonary embolism (PE) is one of the most fatal emergencies with a high risk of mortality. Multiple risk stratification scores have been developed to assess a patient’s overall mortality risk. Objective This study aimed to validate modified FAST and modified Bova scores for risk stratification and predicting the risk of early mortality in patients presenting with acute PE. Patients and methods Patients admitted to Assiut University Hospital with PE were sequentially included. Pulmonary Embolism Severity Index (PESI), modified Bova, and modified FAST scores were calculated for all included patients. Results A total of 100 patients with PE were sequentially included. It was found that predictors of in-hospital mortality in patients with PE were; chronic heart failure [odds ratio (OR)= 1.87], chronic respiratory disease (OR= 1.99), chronic kidney disease (OR= 2.01), hypotension (OR= 2.99), intermediate-high risk- PESI (simplified version; OR=2.76), intermediate-high risk modified Bova score (OR= 3.01) and intermediate-high risk modified FAST score (OR= 3.90).It was found that the modified FAST score had the best diagnostic accuracy (89.2%) with an area under the curve (AUC) 0.962, followed by the modified Bova score with accuracy 76.8% and AUC 0.761. The two scores had higher accuracy than that for PESI score (53.4%, AUC= 0.627). Conclusion Modified FAST and modified Bova scores are simple and reliable tools for risk stratification of patients with acute PE.

A simple transconjunctival technique for the management of intraconal orbital hydatid cyst

Abstract Purpose: To present a simple transconjunctival technique for the excision of intraconal orbital hydatid cysts. Methods: This retrospective, non-comparative, clinical intervention case study was conducted between April 2018 and October 2023. The study included five patients presented to the Orbital unit of Assiut University Hospital with an intraconal orbital cyst, which histologically proved to be a hydatid cyst. In all cases, a conjunctival incision near the fornix was made depending on the cyst location as revealed by computed tomography (CT) or magnetic resonance imaging (MRI). A traction suture was applied to the two relevant recti muscles to guide the globe toward the desired direction. Blunt orbital dissection was made toward the cyst until exposing its anterior surface. A 20-gauge needle was introduced into the cyst and followed by aspiration of its content. The collapsed cyst was then removed by non-toothed forceps and followed by copious irrigation of the field. The follow-up period ranged from 11 to 58 months. Results: The age of patients ranged from 11 to 44 years. Three were males and two were females. The cyst was iso-dense to the vitreous on CT and iso-intense to the vitreous on MRI. In all cases after aspiration of the content, the collapsed cyst was easily removed. None of the five patients developed recurrence during the follow-up period. Conclusion: The removal of the collapsed orbital hydatid cyst in the intraconal space after the aspiration of its content via transconjunctival anterior orbitotomy is a simple, fast technique with early recovery and maximum cosmesis.

Vocal dysfunction following thyroid surgery: a multidimensional subjective and objective study

Background and objectiveFollowing thyroid surgery, vocal changes are a common complication and well-known morbidity that may be linked to neuronal and non-neuronal voice breakdown. Nevertheless, their effects on different voice characteristics are not fully understood, and their bases are still poorly characterized. In order to determine the diagnostic indicators that address the nature of such post-thyroidectomy voice alternations, this study was designed to provide a multidimensional assessment of vocal function after thyroid surgery.MethodsThis research was a 1-year prospective cohort study conducted on 100 adult patients aged 40.19 (± 12.82) years who were recruited from the outpatient clinic of Phoniatric Unit, Assiut University Hospital, and scheduled to undergo thyroid surgery during the period from November 2020 to November 2021. All subjects underwent vocal assessment preoperatively and 15 days, 1 month, and 2 months postoperatively by filled in subjective evaluation of voice complaints via voice handicap index (VHI-30), auditory perceptual assessment (APA) of the voice, and videolaryngoscopy in addition to acoustic analysis using computerized speech lab (CSL). Statistical analysis was performed to compare multi-parameter voice assessment tools across different assessment time points.ResultsThe voice changes were significantly decreased from 51.0% after 15 days postoperatively to 33.0% after 2 months of follow-up. Among these cases, 35.0% cases developed vocal fold paralysis and complained of a breathy voice (27% developed unilateral vocal fold paralysis, and 8% developed bilateral focal fold lesions), and the remaining 16.0% cases had no paralytic manifestations. Also, only one case developed gross lesion “bilateral vocal fold nodules.” The subjective evaluation of voice outcome after thyroidectomy showed significant improvement in VHI subscales and total score from 15 days postoperatively to 2 months of follow-up (P < 0.001). All of the acoustic parameters except HNR showed a significant difference across the different assessment settings (P < 0.001).ConclusionThyroidectomy can result in significant vocal alterations, even in cases where the laryngeal nerve is unharmed. These changes should be taken into consideration in patient having thyroid surgery, especially a total thyroidectomy because of malignant lesions. More efforts are needed in order to determine the extent and pathophysiological reasons for the vocal alterations following thyroid surgery in order to reduce the morbidity associated with one of the most popular surgical procedures performed globally.

Multidisciplinary team approach in management of anterior spinal dysraphism with unusual presentation: case series and surgical approach

ObjectivesTo report our experience with three cases of anterior lumbosacral meningocele with our multidisciplinary team plan and perioperative management and surgical approach for each case.BackgroundAnterior meningocele is a rare congenital form of spinal dysraphism that involves protrusion of the theca anteriorly into the retroperitoneal and presacral space through an anterior defect.MethodThree cases with anterior meningocele at different spinal levels (lumbar and sacral) were operated at Neurosurgery Department at Assiut University hospital from June to November 2020 with multidisciplinary management plans that were tailored separately for each case.ConclusionAnterior meningocele is a rare form of spinal dysraphism and a challenging congenital anomaly that requires proper diagnosis and selection of surgical approach. Our case series outlines the importance of multidisciplinary team approach for tailoring perioperative management and surgical approach with intraoperative important steps.

Prevalence and Risk Factors of Cerebral Microbleeds among Egyptian Patients with Acute Ischemic Stroke.

Cerebral microbleeds (CMBs) are markers of underlying hemorrhage-prone cerebral small vessel disease detected on MRI. They are associated with a heightened risk of stroke and cognitive decline. The prevalence of CMBs among Egyptian patients with ischemic stroke is not well studied. Our aim was to detect the prevalence of CMBs and associated risk factors among Egyptian patients with ischemic stroke. A prospective, cross-sectional, single-center study of consecutive patients with ischemic stroke. Patients were recruited between January 2021 and January 2022 at the Assiut University Hospital in the south of Egypt. Patients with known bleeding diathesis were excluded. All participants underwent full neurological assessment, urgent laboratory investigations, and MRI with T2* sequence. The study included 404 patients, 191 (47.3%) of them were females. The mean age of the study population was 61 ± 1 years, and the mean NIHSS on admission was 12 ± 5. The prevalence of CMB was 26.5%, of whom 6.5% were young adults (age ≤45 years). CMBs were detected in 34.6% of patients with stroke caused by large artery atherosclerosis, 28.0% with small vessel disease stroke subtype, 25.2% with stroke of undetermined cause, and in 12.1% with cardioembolic stroke. History of AF, hypertension, dyslipidemia, Fazekas score &gt;2, dual antiplatelet use, combined antiplatelet with anticoagulant treatment, and thrombolytic therapy remained independently associated with CMBs following multivariable regression analyses. The high number of identified CMBs needs to inform subsequent therapeutic management of these patients. We are unable to determine whether the association between CMBs and antithrombotic use is a causal relationship or rather confounded by indication for these treatments in our observational study. To understand more about the underlying cause of this finding, more studies are needed.

Peri-levator Betamethasone Versus Triamcinolone Injection in Management of Thyroid Eye Disease-related Upper Eyelid Retraction Without Proptosis.

To compare the efficacy of peri-levator injection of both betamethasone and triamcinolone in the management of thyroid eye disease-related upper eyelid retraction without proptosis. This prospective, double-blind, randomized clinical trial was conducted at Assiut University Hospital, Upper Egypt in the period between December 2021 and October 2023. The study included 47 patients (56 eyes) and was divided into 2 groups. In group A, 1 ml betamethasone was injected into the peri-levator area, while in group B, 1 ml triamcinolone was injected. The injection was repeated every month for up to 5 injections if there was an improvement in margin reflex distance 1 (MRD1). The injection was stopped if MRD1 reached the normal value or if 2 successive injections caused no improvement in MRD1. The postinjection outcome was divided into: 1) effective if MRD1 reached the normal ≤4.5 mm; 2) partially effective if MRD1 was improved but did not reach the normal; and 3) ineffective if there was no improvement in MRD1. The follow up ranged from 6 to 20 months. In group A, the injection was effective in 26 eyes (92.9%) and partially effective in 2 eyes (7.1%). In group B, the injection was effective in 17 eyes (60.7%), partially effective in 6 eyes (21.4%), and ineffective in 5 eyes (17.9%). The mean number of injections was significantly lower in group A than in group B: 1.61 ± 0.50 versus 2.36 ± 1.16. This study results suggest that betamethasone is more effective with a smaller number of injections than triamcinolone in the management of thyroid eye disease-related upper eyelid retraction.

Evaluation of the Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Mean Platelet Volume as Predictors of the Outcome in Patients with Hemotoxic Snake Bite: A Prospective Study on Patients in Poison Control Centers Ain Shams University Hospitals and Assiut University Hospitals

Abstract Background Snakebite envenomation is considered a major health problem especially in developing centuries. Snakebite envenomation cause major morbidities, disabilities and mortalities. Novel biomarkers as; neutrophils to lymphocytes Ratio (NLR) and plateletto lymphocytes Ratio (PLR)are hematological inflammatory indices that can be a guide for diagnosis, prognosis of the snakebite envenomation. Methodology This was a prospective case control study, which was carried out on 60 hemotoxic snake bite envenomed patients that admitted at Poisoning Control Center AinShams University Hospitals (PCCAUH) and Assiut University Hospitals (AUH) in the period from 1st of July 2019 to 31st of October 2021. In addition, 60 healthy volunteers were used as control subjects. The study aimed to evaluate the role of NLR, PLR and Mean Platelet Volume (MPV) at admission as predictors of the outcome in patients with hemotoxic snakebite envenomation. The patients were divided into mild, moderate and severe groups according to severity of snake envenomation. Result Sixty hemotoxic snake bite envenomed patients (28 patients admitted at PCC-ASUH and 32 admitted at AUH), were divided into (38.4%) mild, (31.6%) moderate and (30%) severe groups according to the severity of snake envenomation. Maximum incidence was found in male (95%) from rural areas (80%) and were farmers (43.3%) from total cases. It was observed that bite was more frequent at lower limbs (70%), outdoors (81.6%), at night (51%) and during autumn season (43.3%). It was found that there was significant positive correlation between NLR at admission and duration of hospitalization, PLR, creatine phosphokinase (CPK) level and whitebloodcells (WBCs) count. While, significant negative correlation was found between NLR and prothrombin concentration (PC), red blood cells(RBCs) and plateletcounts. Also, significant positive correlation was found between PLR at admission and duration of hospitalization, NLR, CPK level and platelets count. Inaddition, significant positive correlation was found between MPV and PT. About 47 (78.33%) patients had complete recovery and about 13 (21.67%) patients recovered with complications including; local complications in (21.67%), systemic complications in (13.33%) and chronic complications In (5%). There were no recorded deaths in the study. It was found that hemotoxic snake bit eenvenomed patients Admitted at PCC-ASUH were significantly more severe,required more antivenom vials and more intensive care unit(ICU) admission than those admitted at AUH. Conclusion NLR and PLR values at admission were significantly high in hemotoxic snake bite envenomed patients and can be used as predictors for diagnosis and prognosis of hemotoxic snake envenomation.In addition, NLR and PLR had significant association with severity of envenomation, duration of hospitalization.

Six surgical principles for safe excision of superotemporal dermolipoma

Purpose The aim of this study was to describe six surgical principles that were applied for safe excision of superotemporal dermolipomas. Patients and methods This retrospective interventional clinical study included 32 dermolipomas (in 29 patients) that presented to the Orbit Clinic of Assiut University Hospital, Assiut, Egypt and were subjected to surgical excision. The six surgical principles applied for safe dermolipoma excision were: conjunctival incision at the junction between normal and abnormal conjunctiva sparing as much bulbar conjunctiva as possible, hooking the lateral rectus muscle and dissecting the lesion free from the muscle and the covering Tenon’s capsule, eversion of the upper lid using Descemar’s retractor, incision at the upper bulbar conjunctiva, and dissection of the superior surface of the lesion away from the levator muscle, dissection of the lateral surface of the lesion from its attachment to the lateral canthus sparing a stump of the conjunctiva, dissection of the deep part of the lesion from the underlying normal orbital tissue, and suturing the bulbar conjunctiva to the preserved conjunctival stump at the lateral canthus. The follow up ranged from 3 to 35 months (mean=21±3.2 months) during which the patients were assessed for improvement in the presenting manifestations as well as for the presence of complications such as ptosis, dry eye, strabismus, limitation of ocular motility, or symblepharon. Results The surgery was successful in all patients without permanent dry eye, blepharoptosis, or permanent strabismus. Temporary limitation of adduction was observed in two patients that resolved spontaneously within 1 month. Conclusion Adherence to the six surgical principles outlined in the study allowed the authors to safely excise the dermolipomas without damaging the lateral rectus, levator complex, and lacrimal gland ductules. Thus, postoperative squint, ptosis, and dry eye were avoided. In addition, preserving the forniceal conjunctiva and suturing the bulbar conjunctiva prevented symblepharon formation and restricted mobility.

The association of serum uric acid level with metabolic risk factors in patients with type 2 diabetes and their relation to eGFR status

BackgroundThe importance of uric acid has been increasingly appreciated because of its association with the development of diabetes mellitus and related diseases, and with the increasing incidence of diabetes, studying the impact of hyperuricemia in patients with diabetes type 2 is necessary. So we aimed to measure serum uric acid (SUA) levels in patients with diabetes type 2 and to assess the relation between the estimated glomerular filtration rate (eGFR) and the SUA in patients with type 2 diabetes (T2DM).Subjects and methodsThis study is a cross-sectional conducted on 142 adult patients who attended the Outpatients Diabetes Clinic and Endocrinology Center in the Department of Internal Medicine, Assiut University Hospitals, in the period from the 1st of November 2021 up to October 2022. We measured serum uric acid level, serum creatinine, cholesterol, low- and high-density lipoproteins, triglycerides, and eGFR.ResultsOverall, 142 patients were enrolled in the study; all patients had type 2 diabetes. The mean age of the participants was 61.08 ± 9.73 years. Based on SUA level, 46 (32.4%) patients had normal SUA and 96 (67.6%) patients had high SUA. Sixty-nine (48.6%) patients had normal eGFR and 73 (51.4%) patients had reduced eGFR. We found that serum uric acid had a positive significant correlation with the number of metabolic syndrome criteria, cholesterol, low-density lipoproteins, and triglycerides. Meanwhile, it had a negative significant correlation with eGFR and high-density lipoproteins.ConclusionSerum uric acid was strongly associated with metabolic syndrome components and reduced eGFR in patients with T2DM.

Clinical and epidemiological characterization of eosinophilic ascites in Egypt: a single center experience

Background & aimsEosinophilic ascites is non-common and challenging disease. This study aimed to describe the clinical presentation and treatment of eosinophilic ascites.MethodsThis was a prospective single-center study that included cases with eosinophilic ascites who were admitted to Tropical Medicine and Gastroenterology Department, Assiut University Hospital, Assiut, Egypt, during the period between May 2020 to May 2023. The clinical presentation, investigations, treatment, and follow-up data of the included patients were collected and analyzed.ResultsSeventeen cases of eosinophilic ascites were included in the study. The main presenting manifestations were abdominal pain (47.1%), and abdominal pain with distension (29.4%). Two patients presented with a picture of intestinal obstruction. Moderate ascites was found in 10 patients (58.8%) by ultrasound. Eosinophilia in the peripheral hemogram was detected in 76.5% of the study population. Endoscopic examination showed gastro-duodenitis in 9 patients (52.9%) and duodenitis in 4 patients (23.5%). All patients showed complete improvement and disappearance of ascites after starting steroids within two weeks. Eleven patients (64.7%) relapsed after discontinuation of steroids.ConclusionEosinophilic ascites is an uncommon cause of ascites that is often underdiagnosed. The relapse rate after stopping treatment is high but with excellent response to retreatment.

The Relation of Shift Work to Nutritional Habits and Obesity Prevalence among Nurses in Assiut University Hospitals, Results from Cross-Sectional Study

The Relation of Shift Work to Nutritional Habits and Obesity Prevalence among Nurses in Assiut University Hospitals, Results from Cross-Sectional Study

Patient And Procedure Related Risk Factors of Post-ERCP Pancreatitis In Assiut University Hospital

Patient And Procedure Related Risk Factors of Post-ERCP Pancreatitis In Assiut University Hospital

Predictors of mortality of hospitalized COVID-19 pneumonia patients in university hospital

IntroductionCOVID-19 pneumonia is a leading cause for worse outcome of infected patients. Factors associated with mortality in COVID-19 pneumonia vary among studies; identification of most possible factors related to worse outcome might add for management.Patients and methodsConsecutive COVID-19 pneumonia patients referred to the Assiut University Hospital, Egypt, from June 2020 to August 2022 were included in our study. All the included patients were followed up from admission until discharge to identify the factors that worsen the outcome. Our cohort study includes two groups: survivors and non-survivors. Clinical, laboratory, and management data of both groups were recorded.ResultsTwo-hundred and fifty-one confirmed COVID-19 pneumonia patients were included in the study; 147 (58.6%) patients were improved (survivors’ group), and 104 (41.4%) patients were deteriorated and died (non-survivors’ group). Non-survivors’ group had significantly higher MMRC dyspnea scale, pneumonia severity index, CURB-65 score, and baseline respiratory rate. Non-survivors group had significantly lower mean lymphocytes (0.81 ± 0.61 vs. 1.25 ± 0.75; p < 0.001), higher ferritin (1272.45 ± 143.76 vs. 615.84 ± 75.47; p < 0.001), and higher d-dimer (6.65 ± 2.67 vs. 2.78 ± 0.38; p < 0.001), with interestingly significantly higher mean platelet volume (MPV) (10.34 ± 1.64 vs. 10.07 ± 1.93 (fl); p < 0.001). Non-survivors group was frequently admitted to ICU (88 (84.6%) vs. 38 (25.9%); p < 0.001) and had longer duration in ICU than survivors group (9.71 ± 3.36 vs. 5.90 ± 2.34 (days); p < 0.001). The predictors for mortality among patients with COVID-19 pneumonia were old age, high MPV, high CT score, and admission to ICU.ConclusionOld age, severe lung infiltrate with HRCT, high mean platelet volume, and ICU admission are the main clinical determinants of worse outcome of COVID-19 pneumonia.

Epidemiology, risk factors, outcomes, and role of Serpin A3 as a biomarker for transition of acute kidney injury to chronic kidney disease in critically ill patients

BackgroundSeveral studies have suggested a causal link between acute kidney injury and the consequent development of chronic kidney disease. The severity, frequency, and duration of acute injury are key factors in this process.AimsThis study aimed to determine the epidemiology and outcomes of AKI to CKD transition in critically ill adult patients and to study the role of Serpin-A3 in the early recognition of AKI to CKD transition.MethodsIn this prospective observational study, a total of 252 patients attending Assiut University Hospitals Critical Care Unit and developed AKI during their stay were recruited. Serum and urinary Serpin A3 were measured by ELISA Kit. Complete blood picture, kidney function tests, urine analysis, serum electrolytes (serum sodium, potassium, calcium, phosphorus, and magnesium), liver function test, coagulation profile, C-reactive protein, 24-h urinary protein or urinary albumin/creatinine ratio, abdominal ultrasound were assessed for all the recruited participants. Follow-up was done for three consecutive months and after 3 months using serum creatinine, BUN, and serum potassium.ResultsIt was found that old age is a risk factor for CKD following AKI, i.e., with 1-year increase in the patient’s age, there was 3% increase in the chance of transition. Significant association was found between rate of comorbidity and transition status. Also, cases with either infection or IV radio contrast exposure were 2.8 and 6.5 times more liable for transition. Cases with transition in this study had significantly higher renal function parameters. Higher median levels of Serpin A3 either serum or urinary was reported in transition patients. Improvement was reported in two-third of those without transition, and higher mortality rate was recorded in those without transition.ConclusionThe frequency of transition was 20%. Older age, male gender, cardiac and CVS disease, the presence of infection, higher BUN and creatinine level, higher median K and PO4 levels, and higher median levels of Serpin A3 are risk factors for transition from AKI to CKD.

Safety and Efficacy of Hook Diathermy in the Dissection of the Mesocolorectum During Laparoscopic-Assisted Pull-Through for Hirschsprung Disease in Low-Resource Settings.

Background: Surgical correction is the main line of treatment for the congenital disorder Hirschsprung's disease (HD). Laparoscopic techniques proved their safety and efficacy in previous studies. LigaSure™ is the gold standard for colorectal dissection. However, other sealing methods could be used during the unavailability of LigaSure. Purpose: This study aimed to assess the safety profile of the hook diathermy technique compared to LigaSure in colorectal dissection during laparoscopic-assisted pull-through for HD. Materials and Methods: This case-control study was held in the pediatric surgery department at Assiut University Hospitals between September 2017 and January 2023. The study included 57 HD patients who were surgically operated on during a laparoscopic-assisted pull-through. They were divided into 2 groups according to the sealing methods: the ligasure group included 25 patients, and the hook diathermy group included 32 patients. Results: Both groups had no statistically significant differences regarding age, sex, or weight. The transition zone was present in all patients, and most transition zones were rectosigmoid. No cases reported intraoperative blood transfusion or conversion to an open or transanal approach. Minimum intraoperative blood loss was reported in both groups, with no significant differences. As regards postoperative complications, including bleeding, leakage, perianal excoriation, and enterocolitis, no significant differences between both groups were found. Conclusion: The LigaSure and hook diathermy techniques are safe and effective sealing methods for colorectal dissection during laparoscopic-assisted pull-through for HD.