Assiut University Hospital Research Articles

Admission Hyperglycemia and its Implications on Outcome in Patients Attending Medical Intensive Care Units at Assiut University Hospital

Background: Admission hyperglycemia is defined as any blood glucose (BG) level greater than 140 mg/dL (>7.8 mmol/L) in critical care unit (CCU) according to American Diabetes Association 2015. Stress hyperglycemia is related to multiple factors and can lead to insulin resistance and high hepatic glucose output. Aim: To determine the frequency, in-hospital mortality, and length of stay in a cohort of patients with admission hyperglycemia in unselected acute medically ill patients admitted to medical intensive care units (ICUs) (medical ICU and CCU) attending Internal Medicine Department, Assiut University Hospital, Assiut, Egypt, and to evaluate whether admission hyperglycemia or other comorbid conditions are responsible for outcome of critical ill patients. Subjects and Methods: This prospective, observational study involved 170 patients admitted at ICU unit of Internal Medicine Department at Assiut University Hospital between July and December 2016. Measurement of BG on admission to ICU was as following: normoglycemic if less than 140 mg/dL and hyperglycemic if more than 140 mg/dL. Then, follow up BG every 8h till either discharge or death or maximum 4 days in addition to fasting, postprandial BG, HbA1C, complete blood count and kidney function tests, serum sodium, serum potassium, arterial blood gases, and acute physiologic assessment and chronic health score were carried out. Results: This study included 170 patients, 35.3% were normoglycemic and 64.7% were hyperglycemic, which were further subdivided into 43% known diabetics, 14.1% stress hyperglycemia, and 7.6% newly discovered diabetics. Percentage of survivors was 72.9% versus non-survivors, which was 27.1%. Median hospital stay for all patients was 6 (4–28) days with in-hospital mortality of 46 (27.1%) patients. It was noticed that frequency of non-survivors was higher in patients with hyperglycemic versus that of survivors. Conclusion: Stress hyperglycemia and diabetes were independent predictors for in-hospital mortality in patients with admission hyperglycemia attending ICU.

Total Knee Replacement Patients Outcomes After Application Of Sports Activity Teaching Protocol

Abstract Background: Total knee replacement is a surgical procedure in which the knee joint is replaced by prosthetic implant to replace the weight-bearing surfaces of the knee joint to relieve pain and disability. Aim of the study: To evaluate the effect of application of sports activities teaching protocol on total knee replacement patients outcomes. Method: Aquasi-experimental study design was utilized in this study. This study was conducted in the department of orthopedic surgery at Assiut University hospital. A total number (60) adult patient undergoing total knee replacement divided into study and control group. Tools: Demographic, medical data and knee outcome survey sports activities scale. Results: Revealed that there was a highly statistical significant difference between the patient in the study and control groups regarding the symptoms and function limitation affect , level of sport activity post protocol in (post procedure ,after three weeks,2,4and 6months with p ≤.001**. Conclusion: Patient's outcome was improved after application of sports activities protocol for patient with total knee replacement. Recommendation: Replication of the present study on a larger probability for generalization of the results.

Comparative study between noninvasive ventilation with continuous positive airway pressure mask versus stacked breathing on chest expansion and pulmonary function in patients with pneumonia

Background: Majority of patients with pneumonia fail the treatment by the noninvasive ventilation (NIV), not because of its low efficacy for maintaining upper airway patency but because of intolerance. The current study was designed to compare the effectiveness of stacked breathing exercise (SBE) versus continuous positive airway pressure (CPAP) mask on the chest expansion and pulmonary functions for patients with pneumonia.
 Methodology: A randomized controlled experimental study was conducted in chest ICU in Assiut University Hospital in Egypt and registered at www.clinicaltrials.gov (NCT04576221 identifier). Sixty patients with pneumonia were selected by convenience sampling and randomly assigned into two groups (30 patients each), the patients in SB group received SBE and were instructed to perform the exercise 3 times per day for one week; and the CPAP group received NIV with using CPAP mask. Chest expansion and pulmonary functions were assessed before and after the exercise.
 Results: There were significant differences in chest expansion and pulmonary functions between the SB and CPAP groups after exercise in the first day, after 3 days and on the last day of the study (p=0.018, < 0.001 and < 0.001) respectively. Chest expansion and pulmonary functions in the SB group was much improved than those in the CPAP group.
 Conclusions: Implementing SB exercise had a significant effect on improving chest expansion and pulmonary functions in patients with pneumonia than NIV with CPAP mask.
 Key words: Chest expansion; CPAP mask; Pneumonia; Pulmonary Function; Stacked breathing
 Citation: Ahmed AT, Abou Galalah AA, Mahgoub AA, Mahran GS. Comparative study between noninvasive ventilation with continuous positive airway pressure mask versus stacked breathing on chest expansion and pulmonary function in patients with pneumonia. Anaesth. pain intensive care 2021;25(2):176-184. DOI: 10.35975/apic.v25i2.1470
 Received: 2 November 2020, Reviewed: 2 December 2020, Accepted: 24 March 2021

Clinical and Radiological Characteristics of Acute Cerebrovascular Diseases Among Egyptian Patients With COVID-19 in Upper Egypt

Background and Purpose: There is little information on the acute cerebrovascular complications of coronavirus disease 2019 (COVID-19) in Egypt. The aim of this study was to estimate the proportion of acute cerebrovascular disease (CVD) among COVID-19 patients and evaluate their clinical and radiological characteristics in comparison with non-COVID-19 CVD.Materials and Methods: In a retrospective study, COVID-19 patients whom presented with CVD in Assiut and Aswan University Hospitals were compared with non-COVID-19, CVD patients, admitted to Qena University Hospital, prior to the pandemic. The following data were collected: clinical history and presentation, risk factors, comorbidities, brain imaging (MRI or CT), chest CT, and some laboratory investigations.Results: Fifty-five (12.5%) of the 439 patients with COVID-19 had acute CVD. Of them, 42 (9.6%) had ischemic stroke while 13 patients (2.9%) had hemorrhagic CVD. In the 250 cases of the non-COVID-19 group, 180 had ischemic stroke and 70 had hemorrhagic stroke. A large proportion of patients with COVID-19 who presented with ischemic stroke had large vessel occlusion (LVO), which was significantly higher than in non-COVID-19 patients with CVD (40 vs. 7.2%, P < 0.001). Comorbidities were recorded in 44 (80%) cases. In COVID-19 ischemic stroke patients, risk factors [hypertension and ischemic heart disease (IHD)] and comorbidities (hepatic and renal) were significantly higher than those in non–COVID-19 patients. In addition, 23.5% had hemorrhagic CVD, and six patients with LVO developed hemorrhagic transformation.Conclusion: Acute CVD among patients with COVID-19 was common in our study. LVO was the commonest. Hypertension, IHD, and anemia are the most common risk factors and could contribute to the worsening of clinical presentation. Comorbidities were common among patients with CVD, although a large number had elevated liver enzymes and creatinine that were partially due to COVID-19 infection itself. The current results begin to characterize the spectrum of CVD associated with COVID-19 in patients in Upper Egypt.Registration ID: The ID number of this study is IRB no: 17300470.

Investigation of Inflammatory and Oxidative Stress Biomarkers in Multi Vessels Minimally Invasive Coronary Artery Bypass Graft Surgery Versus Off-Pump Coronary Artery Bypass Graft

Traditional Coronary Artery Bypass Graft (CABG) is currently among of the chief methods in dealing with patients suffering from atherosclerotic coronary heart disease. The current study aimed to measure and compare the levels of proinflammatory cytokines and oxidative stress marker in patients who underwent multivessels Minimally Invasive Coronary Artery Bypass Graft Surgery (MICS– CABG) versus off-pump Coronary Artery Bypass Grafting (off-pump CABG) in the cardiothoracic department, Assiut University hospitals, Upper Egypt. the study included 67 patients, all of them suffering from atherosclerotic coronary artery disease, which confirm by cardiac catheter angiography. The patients were divided randomly into two groups, first group (A) included 34 patients to whom Multi Vessels Coronary Artery Bypass Graft Surgery (MICS-CABG) under off pump had been done. The second group (B) included 33 patients whom underwent off pump Coronary Artery Bypass Grafting (off-pump CABG). Tumor Necrosis Factor-Α (TNF-α), interlukin-2 (IL-2), lipid peroxides, Superoxide Dismutase (SOD), total thiols and Nitric Oxide (NO) were estimated in sera of all patients by their corresponding methods; 48 h before the operation, 15 min before the operation end and 72 h after the operation. After testing the normality, Mann-Whitney U test and Spearman correlation coefficient were used to compare the two groups and tested the variables’ correlations with the duration of the operation. p≤0.05 was considered significant. Serum TNF-α, IL-2 and lipid peroxides levels were significantly higher while total thiols and SOD were significantly lower, intraoperative and postoperatively, while No was significantly higher intraoperative only, in off-pump CABG group compared to MICS-CABG group and in both groups, intraoperative and postoperatively compared to preoperative levels. Especially in the postoperative samples, TNF-α, IL-2 and NO levels correlated positively while those of SOD correlated negatively with the operation duration the clinical data obtained presented in details in the result sector and revealed that. MICS-CABG group associated with less post-operative pain, less need for blood transfusion, less hospital stays and rapid regain to normal activity. The current study revealed that MICS-CABG is an effective procedure that is associated with small surgical trauma and lower inflammations and oxidative stress compared to off-pump CABG.

Effect of Tele-Nursing (Phone- Based Follow Up) and Educational Package on Life Style and Clinical Status for Diabetic Patients

Background: Diabetes mellitus is one of the global health problems. Tele-nursing is the use of technological resources and communication systems in nursing to provide patient care. Aim of the study: to evaluate the effect of tele-nursing (phone- based follow up) and educational package on life style and clinical status for diabetic patients. Research design: Quasi-experimental design. Setting: The study was conducted at endocrine & diabetic unit in Medical Department at Assiut University Hospitals. Sample: A purposive sample of 100 male and female adult patients diagnosed with diabetes mellitus, their age ranged from18 to 65 years. Tools: tool (I) Patients assessment sheet, it was consisted of three parts: Part I: Demographic data, Part II: Medical data, Part III: Clinical and laboratory data including Body Mass Index (BMI), weight, height, blood pressure, fasting, postprandial blood glucose (PPG), Glycated Hemoglobin (HbA1c). Tool (II): Health promoting life style profile. Results: There was significant difference of life style and clinical data for patients before and after telenursing education. Conclusion: Tele-nursing was effective nursing strategy for improving life style and clinical status for diabetic patients. Recommendations: Tele nursing should be programmed as a part of health plan for patients with diabetes mellitus in different health setting.

Effect of Teaching Booklet on Compliance to Oral Anticoagulant Drugs among Patients with Deep Venous Thrombosis

Background: Treatment for patients with deep venous thrombosis relies on persuading the patient to adhere entirely to the therapeutic plan. Patient education is an important aspect in increasing compliance. Aim: To evaluate the effect of teaching booklet on compliance to oral anticoagulant drugs among patients with deep venous thrombosis. Research design: Quasi-experimental research design. Setting: The study was conducted at vascular surgery department and trauma unit at Assiut University Hospital. Sample: A purposive sample of 60 male and female adult patients. This sample was divided into study and control group (30 patient for each) diagnosed with DVT, their age ranged from18 to 65 years. Tools: Tool I: Patient assessment sheet, Tool II: Compliance of patients with medications by using Morisky Medication Adherence Scale. Results: There was a statistically significant difference between study and control group regarding compliance to oral anticoagulant drugs post application of teaching booklet. Conclusion: Teaching booklet was effective in improving patient's compliance to oral anticoagulant drugs, lower incidence of bleeding and recurrence of thrombus among patients with deep venous thrombosis. Recommendations: Teaching booklet for DVT patients to improve adherence to oral anticoagulant should be available in vascular surgery department.

DOES CRANIOPLASTY REDUCE DISABILITY IN CASES WITH POST TRAUMATIC SKULL BONE DEFECTS? OBSERVATIONAL STUDY IN ASSIUT UNIVERSITY HOSPITALS, EGYPT.

Abstract: Introduction: Permanent infirmity (disability) is defined as a functional limitation that restricts the ability of a person to perform the daily activities. The incidence of cranial bone defects related to head trauma have increased over the past decades. Cranioplasty could impact the work capability and employability. This study designed to assess the effect of cranioplasty as a method of skull repair on work capability of the patients and their employ‌ability. Subjects and Methods: The authors compared the work capability and employment of 35 patients with traumatic cranial bone defects after head trauma treated in the Neurosurgery Department of Assiut University Hospitals, Egypt from January 2013 to January 2018 before and after cranioplasty. Results: Before cranioplasty, 9 patients recorded that they were able to work without limitations according to the WHO classification, 6 patients recorded their ability to work with limitations and 20 recorded being unfit of working. After surgical reconstruction, 26 patients recorded they are able of working without limitations, 5 patients recorded they are able to work with limitations and 4 recorded being unfit to work for a variety of reasons. Conclusions: Cranioplasty is an efficient protective and cosmetic reconstructive operation, contributing to reduce disability and helping early return to work after traumatic cranial bone defects. This outcome may contribute to improved social and economic state of patients with cranial bone defects.

Surveillance Study of Acute Neurological Manifestations among 439 Egyptian Patients with COVID-19 in Assiut and Aswan University Hospitals

Background: COVID-19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study, we estimate the frequency of such complications among hospital inpatients with COVID-19 in Assiut and Aswan university hospitals. Materials and Methods: We screened all patients with suspected COVID-19 admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory tests, CT/MRI of the chest and brain, and neurophysiology study were performed for each patient if indicated. Results: 439 patients had confirmed/probable COVID-19; neurological manifestations occurred in 222. Of these, 117 had acute neurological disease and the remainder had nonspecific neuropsychiatric symptoms such as headache, vertigo, and depression. The CNS was affected in 75 patients: 55 had stroke and the others had convulsions (5), encephalitis (6), hypoxic encephalopathy (4), cord myelopathy (2), relapse of multiple sclerosis (2), and meningoencephalitis (1). The PNS was affected in 42 patients: the majority had anosmia and ageusia (31) and the others had Guillain-Barré syndrome (4), peripheral neuropathy (3), myasthenia gravis (MG, 2), or myositis (2). Fever, respiratory symptoms, and headache were the most common general symptoms. Hypertension, diabetes mellitus, and ischemic heart disease were the most common comorbidities in patients with CNS affection. Conclusion: In COVID-19, both the CNS and PNS are affected. Stroke was the most common complication for CNS, and anosmia and/or ageusia were common for PNS diseases. However, there were 6 cases of encephalitis, 2 cases of spinal cord myelopathy, 2 cases of MG, and 2 cases of myositis.

Evaluation of the Use of Intraoperative Subconjunctival Injection of Triamcinolone Acetonide and Limited Peritomy during Bare Scleral Pterygium Excision

Aims: To evaluate the efficacy and safety of subconjunctival injection of triamcinolone acetonide (TA) and limited peritomy during bare scleral pterygium excision in preventing pterygium recurrence.&#x0D; Study Design: A prospective non-randomized interventional case series.&#x0D; Place and Duration of Study: All surgeries were done at the department of ophthalmology of Assiut university hospital (27 eyes) and Alforsan eye center in Assiut (3 eyes), Egypt, between November 2017 to December 2019.&#x0D; Methodology: Thirty eyes of 26 patients who underwent pterygium excision with bare sclera combined with intraoperative subconjunctival TA injection and limited peritomy primary pterygium grade 2 (T2, 3 eyes) and grade 3 (T3, 30 eyes). All patients were followed up for 12 months after surgery. Pterygium recurrence and complications were the key outcome steps.&#x0D; Results: Pterygium recurrence was seen in 3 eyes (10.0%) as following: grade 2 in one eye (3.3%) and grade 3 in two eyes (6.7%). Intraocular pressure elevation was observed in 9 eyes (30%). The IOP rise ranged from (22.4 to 37 mmHg). All eyes were successfully treated medically and reached normal values by the end of postoperative sixth month.&#x0D; Conclusion: This procedure appears to be reasonably safe and successful in reducing pterygium recurrence.

Sleep disorders and their relationship to other psychiatric disorders in women with breast cancer: a case-control study

BackgroundBreast cancer is the most frequent cancer among women, impacting 2.1 million women each year. The aim of the study is to determine prevalence of sleep disorders among patients with breast cancer, its correlation with different psychological symptoms and the ability of such symptoms to predict sleep disorders among those patients. The current study is a case-control study compromised of 153 participants, 93 breast cancer patients versus 60 cross-matched healthy control persons recruited from the outpatient clinic of Oncology Department—Assiut University Hospital. Arabic versions of Beck’s Depression Inventory, symptom checklist, and Sleep Disorder Scale were used to evaluate depression, obsession, sensitivity, anxiety, hostility, phobic anxiety, paranoia ideation, psychoticism, and sleep disorders, respectively. The correlation of this data with clinical and social variables of these patients and the effect of such variables on each other were also determined.ResultsA statistically higher prevalence of sleep disorders and depression was reported among breast cancer patients compared to the control group. Also, patients with breast cancer scored statistically higher mean scores in somatization, obsession, sensitivity, anxiety, and phobic anxiety than those of the control group.ConclusionsPrevalence of sleep disorders, depression, obsession, sensitivity, anxiety, hostility, phobic anxiety, paranoia ideation, and psychoticism among breast cancer patients poses a challenge to the treatment of such patients. Misdiagnosis and mismanagement lead to poor treatment outcomes of both cancer disease and psychiatric disorders.

Determinants of persistent post-COVID-19 symptoms: value of a novel COVID-19 symptom score

BackgroundBeing a newly emerging disease, little is known about its long-lasting post-COVID-19 consequences. The aim of this work is to assess the frequency, patterns, and determinants of persistent post-COVID-19 symptoms and to evaluate the value of a proposed novel COVID-19 symptom score. Patients with confirmed COVID-19 in a hospital-based registry were included in a cross-sectional study (the hospitals including Assiut University Hospital, Assiut Chest Hospital, Aswan University Hospital, and Aswan Specialized Hospital). The patient demographics, comorbid disorders, the mean duration since the onset of the symptoms, history of hospital or ICU admittance, and the treatment taken during the acute state, as well as symptom score before and after convalescence, were recorded.ResultsThe most frequent constitutional and neurological symptoms were myalgia (60.0%), arthralgia (57.2%), restriction of daily activities (57.0%), and sleeping troubles (50.9%), followed by anorexia (42.6%), chest pain (32.6%), gastritis (32.3%), cough (29.3%), and dyspnea (29.1%). The mean total score of acute stage symptoms was 31.0 ± 16.3 while post-COVID 19 symptom score was 13.1 ± 12.6 (P < 0.001). The main determinants of the persistent post-COVID-19 symptoms were the need for oxygen therapy (P < 0.001), pre-existing hypertension (P = 0.039), chronic pulmonary disorders (P = 0.012), and any chronic comorbidity (P = 0.004). There was a correlation between the symptom score during the acute attack and post-COVID-19 stage (P < 0.001, r = 0.67). The acute phase score had 83.5% sensitivity and 73.3% specificity for the cutoff point > 18 to predict occurrence of post-COVID-19 symptoms.ConclusionsCOVID-19 can present with a diverse spectrum of long-term post-COVID-19 symptoms. Increased acute phase symptom severity and COVID-19 symptom score > 18 together with the presence of any comorbid diseases increase the risk for persistent post-COVID-19 manifestations and severity.

The role of Hematological Scoring System (HSS) in early diagnosis of Neonatal Sepsis

Background: Timely diagnosis of neonatal sepsis is critical. Early diagnosis of neonatal sepsis is still a great challenge. Objectives: To determine the significance of the hematological scoring system (HSS) for early detection of neonatal sepsis. Study design: A case control study done at the neonatal ICU, Al-Azhar Assiut university Hospital. It included sixty newborn infants divided into three groups (20 newborn infant for each one), septic, probably septic and control groups. Perinatal history with emphasis on risk factors for neonatal sepsis, Neonatal physical examination and laboratory investigation, including complete blood picture with differential, blood film, HSS (hematological scoring system) and blood culture. Results: HSS among septic group had a sensitivity (96%), specificity (90%), PPV (86.7%) and NPV (86%) and area under Receiver Operating Characteristic curve (ROC curve) with [95 % CI] was 0.76 (0.599 – 0.881). Immature/total WBCs ratio had a sensitivity (80.3%), specificity (78.2%), PPV (66.3%) and NPV (84.7%) in early detection of neonatal sepsis. Immature/mature WBCs ratio had a sensitivity (78.3%), specificity (66.5%), PPV (42%) and NPV (60%) in early detection of neonatal sepsis. Total leukocytic count in the septic group was statistically significantly increased compared with the corresponding values in the probable septic and control groups (P= 0.021*). Conclusions: HSS is a useful test to distinguish the infected from non-infected infants. HSS is a simple, quick, readily available effective tool with high sensitivity and specificity in the early diagnosis of neonatal sepsis.

Comparative Study Between Chest X-Ray and Lung Ultrasound in Neonatal Respiratory Distress

Background: In the past, ultrasound has not been widely used for neonatal chest imaging due to the obscuring artifact generated by normal air-filled lung. Aim of work: This study aimed to determine the value of chest ultrasonography in comparison to chest x-rays in diagnosis and follow up of neonates with respiratory distress. Methods: This prospective study has been conducted at Neonatal Intensive Care Unit (NICU), Al-Azhar Assiut University Hospital from 1st November 2019 to October 2020. The study was conducted to 50 neonates with moderate respiratory distress, 14 of them were females (28%) and 36 of them were males (72%). All newborns included in the study admitted to neonatal intensive care unit: 13 of them stabilized on nasal oxygen, 37 of them stabilized on Nasal Continuous Positive Airway Pressure (NCPAP) for 6 hours. 8 of them need mechanical ventilation based on clinical, arterial blood gases and lung ultrasonographic findings. Lung ultrasound was performed within 2 hours and repeated after 6 hours. Chest x-ray was performed and scored. Both Lung ultrasound score and chest x-ray score were used and compared for respiratory distress in neonates. Results: Lung ultrasound has important role in diagnosis and follow up of neonates with respiratory distress and considered higher than chest X-ray regarding its ability to detect different patterns of white lung in term of pulmonary oedema (B-Lines) (40%),consolidation(62%) and pleural effusion (8%). Conclusion: Lung ultrasound is a non-invasive , bedside and reproducible method that could improve the management of neonatal respiratory distress . After 6 hours of Nasal Continuous Positive Airway Pressure (NCPAP), neonatal lung ultrasound is a useful predictor of the need for intubation over chest x-ray. Respiratory distress syndrome was the main diagnosis of respiratory distressed infants followed by transient tachypnea of newborn, pneumonia, meconium aspiration syndrome (MAS), and finally pleural effusion.

Vascular complications after living-donor liver transplantation: Assiut University Hospitals’ experience

Background Posttransplant vascular complications (PTVCs) have a significant effect on graft and patient after living-donor liver transplantation. We aim to determine the incidence of these complications, focusing on the effects of using synthetic venous grafts in vascular reconstruction, versus performing nongraft primary anastomosis. We did not use natural grafts in this study. Settings and design We collected the preoperative/intraoperative and postoperative data prospectively from 39 recipients/donors who underwent living-donor liver transplantation from November 2014 to August 2019 at the department of surgery in Al-Rajehy Liver Hospital, Assiut University. Patients and methods The vascular reconstruction of hepatic veins (HVs) in all patients was performed using synthetic vascular grafts, anastomosing the grafts’ HVs (V5 and V8) to the recipients’ inferior vena cava, whereas portal veins were reconstructed without grafts. PTVCs were analyzed over 3 months to determine their effect on recipients’ morbidity and mortality, and their relation to the use of synthetic grafts in vascular reconstruction. Statistical analysis Data were analyzed via Statistical Package for the Social Science, version 22. We used Student t test or Mann–Whitney test for quantitative data, and χ2 test for qualitative data. Results Among 39 recipients, four (10.26%) died during the follow-up period. Vascular complications were the leading cause of death in three patients. Portal vein thrombosis had the highest incidence rates among the seven recipients having PTVCs, being developed in three (7.69%) of them. It represented the leading cause of death in one patient, whereas HVs thrombosis developed in one (2.56%) recipient, leading to his death on the seventh postoperative day. Conclusion PTVCs have significant effect on graft durability, as well as recipient’s morbidity and mortality. The use of synthetic grafting in vascular reconstruction has shown particularly a significant negative effect.

Role of grayscale transcranial ultrasound in the diagnosis of neonatal hypoxic–ischemic encephalopathy: a clinical audit study

Background Neonatal hypoxic–ischemic encephalopathy (HIE) is still accounts for a significant percentage of mortality and morbidity in the neonates. Transcranial ultrasound (US) is the investigation of choice for the initial assessment of these cases. Aim To evaluate the practice of transcranial US in the diagnosis of suspected cases of neonatal HIE in the ICU of Assiut University Hospital (AUH). Patients and methods This clinical audit study was conducted during the period from April 2017 till June 2018 (first audit cycle about 13 months and second audit cycle about 2 months) in the ICU in AUH on neonates who underwent transcranial US for the diagnosis of neonatal HIE. Six criteria were set and were measured with 40 indicators with a 100% standard set for each indicator. Results The study included 110 neonates (90 in the first audit cycle and 20 in the second audit cycle). The adherence to the audit criteria was about 17.5% in the first audit cycle and 25% in the second audit cycle, which indicates that there was just a slight improvement in the second audit cycle. Conclusion Transcranial US is the modality of choice in the initial evaluation of suspected cases of neonatal HIE. Adherence to the audit criteria of this study in the neonatal ICU of AUH fell below expected standards in both the audit cycles with a slight improvement in the second audit cycle. Further reauditing is recommended.

Production and Characterization of Staphylokinase Enzyme from Staphylococcusaureus ASIA4

Six clinical Staphylococcus aureus strains isolated from different clinical samples. Isolates ASIA1 and ASIA2 isolated from urine samples of urinary tract infected patients; ASIA3 isolated from swab samples of burn abscess patients at Assiut University hospital as well as ASIA4, ASIA5 and ASIA6 obtained from blood samples of different cancer patients at South Egypt Cancer Institute. All isolates showed varied abilities to produce halo zones of hydrolysis with different diameters on blood agar, heated plasma agar, casein agar and skim milk agar plates along with different clot lyses percent. Staphylococcus aureus ASIA3, ASIA4 and ASIA6 produced 4.83, 5.98 and 2.08 U/mL of staphylokinase on tryptone soy broth reduced to 1.95, 2.08 and 1.70 U/mL on casein hydrolysate yeast extract broth,respectively. On the other hand, Staphylococcus aureus ASIA1, ASIA2 and ASIA5 gave 2.20, 2.93 and 3.65 U/mL on CYEB compared to 2.10, 1.88 and 3.41 U/mL on TSB as production medium. The staphylokinase yielded from the hyperactive producer Staphylococcus aureus ASIA4 was increased for 7.64-fold (from 2.08 U/mL to 15.88 U/mL) on the optimized fermentation medium composed of 5.0 g sucrose as carbon source, 10.0 g soy bean as nitrogen source, 5.0 g NaCl, K2HPO4 5.0 g and pH 7.0 that inoculated with isolate ASIA4 and incubated for 24 h at 35°C. Moreover, Staphylokinase activity reached its peak at the optimal enzymatic reaction conditions which were reaction time 25 min, casein as substrate, reaction pH 8.0, reaction temperature 40°C. In addition it retained 100% of its activity at temperature ranged between 15 and 45°C and pH ranged from pH 6.0 to 9.0 EDTA inhibited the enzyme activity by 3.0% to 32.2% with increasing its values from 30.0 to 90.0 mM. MgCl2 at a concentration of 30 mM increased the enzyme activity by 4% and then slightly decreased at higher concentrations but NaCl was potent staphylokinase activator at concentrations lower than 90 mM.

Frequency of regulatory B cells phenotypes in breast cancer patients in Egypt

Accumulating evidence has indicated that immune regulatory cells are involved in the establishment of the anti-tumor activity, however; the role of regulatory B cells (B-regs) in breast cancer (BC) remains unclear. This study intended to assess the frequency of peripheral B-regs phenotypes in patients with BC, and to determine the relation between these phenotypes and the patient's clinicopathological characters. The expressions of the immune cell populations were analyzed by four-color flow cytometry in 40 naïve BC patients and 10 age-matched apparently healthy individuals as controls attending the department of Clinical Oncology and Nuclear Medicine at Assiut University Hospitals. The percentages of B-regs phenotypes CD19+IL10+ and CD19+CD24hiCD27+IL10+ were higher in BC patients than in the controls. The percentage of CD19+IL10+ B cells phenotype was significantly associated with the HER-2 expression levels, T, and N stages of BC. In conclusion, high percentage of B-regs phenotypes CD19+IL10+ and CD19+CD24hiCD27+IL10+ in BC patients indicates a possible role in immune suppression during the development of BC.

Hospital stay, morbidity, and mortality in polytrauma patients at Trauma Unit, Assiut University Hospital during 2017

Hospital stay, morbidity, and mortality in polytrauma patients at Trauma Unit, Assiut University Hospital during 2017

Semiology of epileptic seizures: Assiut University Hospital-based study

BackgroundEpilepsy diagnosis is mainly clinical, as it depends on the detailed analysis of the seizure semiology. This study reviews the systematic way to describe and classify seizure semiology with the help of using electro-clinical methods for better diagnosis and to choose the most effective medical treatment.Patients and methodsThis study was conducted on 60 epileptic patients throughout the period from 1st of October 2016 to 31st of March 2017 in Assiut University Hospital. We excluded patients who lacked eye witness and who had seizures owing to metabolic causes. All patients were subjected to complete general and neurological examination, epilepsy sheet with detailed seizure semiology analysis, and electroencephalogram (EEG).ResultsProdroma was found in 26 (43.3%) cases, and aura was recorded in 34 (56.7%) cases. Forty (66.7%) cases had automatism more in the form of picking cloths and unresponsiveness. Most cases (63.3%) reported loss of contact with surroundings and 28.3% lost their consciousness. Ipsiversive movement was recorded in 13.3% of cases, whole-body myoclonus was presented in 10% of cases, unilateral nonmarching sensory seizure in 3.3%, 23.3% presented with tonic seizure, and 16.7% with tonic–clonic seizure. Postictal amnesia was seen in 60% of cases, postictal confusion in 46.7%, and postictal Todd's paralysis in 6.7%. Distribution of epileptic activity in EEG was mostly in left fronto-temporal area (20%).ConclusionClinical semiology is the starting point of understanding seizure disorder and making the diagnosis of epilepsy. The correlation between analysis of the development and sequence of semiologic features and EEG findings can identify the seizure initiation and propagation.