Benha University Hospital Research Articles

Predictors of COVID-19 outcome in type 2 diabetes mellitus: a hospital-based study

Abstract Background Diabetes has become a significant risk factor for COVID-19-related severe illness and death. Methods This was a retrospective cohort study of 104 patients, with or without type 2 (diabetes mellitus) DM, diagnosed with COVID-19 between June and September 2021 in Benha University Hospital, Egypt. Outcome measures including discharge after recovery, transfer to ICU and intubation, or death were recorded. Univariate and multivariate logistic regression analysis was done for the prediction of death in diabetic patients. Results Length of hospital stay was significantly higher in diabetic (median 15 days) compared to non-diabetic patients (median 10 days). ICU admission and intubation among diabetic patients were substantially higher than non-diabetics. Univariate regression analysis established that old age (p = 0.02: OR = 1.03: CI 1.00–1.07), multiple comorbidities (p = 0.005: OR = 8.66: CI 1.9–38.5), diabetic complications (p = 0.000: OR = 6.401:CI 2.5–16.3), HbA1c (p = 0.01: OR = 1.22: CI 1.04–1.43), length of hospital stay (p = 0.005: OR = 1.07: CI 1.02–1.12), and ICU admission (p = 0.00: OR = 44.1: CI 9.4–205.3) were predictors of death for diabetic patients as well as neutrophilic count, D-dimer, and CRP levels. Multivariate regression analysis concluded that ICU admission was the most significant predictor of death in diabetic patients. Conclusion Type 2 DM patients, infected with the COVID-19 virus exhibited more admission to ICU and intubation with longer hospital stays compared to those without diabetes with a similar death rate. Old age, HbA1C, comorbidities, diabetic complications, length of hospital stay and ICU admission, and inflammatory parameters were significant predictors of death in diabetic patients.

The Role of Lung Ultrasonography as a Diagnostic Tool in Different Pediatric Lung Diseases in Benha University Hospital

The Role of Lung Ultrasonography as a Diagnostic Tool in Different Pediatric Lung Diseases in Benha University Hospital

Assessment of Nurses' Knowledge, Attitude and Practice Regarding Nutritional Care Management of Diabetic Patients in Benha University Hospital

Assessment of Nurses' Knowledge, Attitude and Practice Regarding Nutritional Care Management of Diabetic Patients in Benha University Hospital

Concomitant Infection of Helicobacter pylori and Intestinal Parasites in Children Attending Benha University Hospital

Concomitant Infection of Helicobacter pylori and Intestinal Parasites in Children Attending Benha University Hospital

Epidemiology of Acute Kidney Injury and Associated Factors among Patients with Malignancy: Analysis of Hospital Inpatients Database in Benha university Hospital Internal Medicine Departement, Hematology and Oncology Unit

Epidemiology of Acute Kidney Injury and Associated Factors among Patients with Malignancy: Analysis of Hospital Inpatients Database in Benha university Hospital Internal Medicine Departement, Hematology and Oncology Unit

Aldehyde Dehydrogenase Enzyme in Relation to Cord Blood stem cells Potency

Abstract Introduction/Objective In umbilical cord blood transplantation (UCBT), the number of cluster of differentiation (CD)34+ cells and colony-forming units (CFUs) in the cord blood (CB) graft positively correlate with patient survival. Since aldehyde dehydrogenase (ALDH) activity is high in hematopoietic stem cells, the number of ALDH-bright (ALDHbr) cells was examined in comparison with the number of CD34+ cells and CFUs for the quality assessment of CB units, Aim and objectives; to correlate the aldehyde dehydrogenase (ALDH) enzyme assay with colony-forming unit–granulocyte/macrophage (CFU-GM) assay before cryopreservation of cord blood buffy coats (CBBC), in order to investigate the hypothesis that the ALDH assay might exclude apoptotic cells since it is based on enzyme activity. Methods/Case Report This study was carried out at Benha University Hospital on Fifty (50) samples of Human Umbilical Cord Blood which were processed for mononuclear cells (MNC) separation by density gradient centrifugation method using Ficoll-Paque media that layered on the diluted blood. In parallel, 1 million nucleated cells were sampled and prepared for flow cytometry for analysis of ALDH activity according to the manufacturer’s instructions. Results (if a Case Study enter NA) CD34+ ALDH+ (%) (Of MNC) showed significant positive correlation with ALDH++ (%) (Of CD34+) and numbers of total CFU/40000 cells. Also ALDH++ (%) (Of CD34+) showed significant positive correlation with numbers of total CFU/40000 cells. Conclusion The ALDH assay excludes nonviable and apoptotic cells, and therefore correlates well with CFU enumeration compared to the number of viable CD34+ cells. We propose that the ALDH assay might replace the CFU-GM method in CBU potency measurements.

Vaginal Cleansing with Povidone Iodine before Elective Caesarean Section at Benha University Hospitals

Vaginal Cleansing with Povidone Iodine before Elective Caesarean Section at Benha University Hospitals

Comparison between classic ‘Fisch’ and ‘corner-tag’ meatoplasty techniques after canal wall down tympanomastoidectomy

PurposeTo compare outcomes of two different methods of meatoplasty following Canal Wall-Down tympanomastoidectomy. MethodsA retrospective case review study of 48 patients with non-complicated unsafe chronic suppurative otitis media candidate for post-auricular canal wall-down tympanomastoidectomy via a post-auricular approach at Otolaryngology department, Benha university hospitals from January 2021 to January 2023, all were operated for the first time, and divided into 2 groups each of 24 patients. Group A submitted for classic ‘Fisch’, and group B ‘Corner-Tag’ meatoplasty. ResultsThe mean age was 28.88 ± 13.26 years in group A and 33.33 ± 16.04 years in group B. Only one patient (4.2 %) in each group developed wound infection and none in both groups developed perichondritis. Two patients (8.3 %) in group B compared to only one patient (4.2 %) in group A had granulations on the meatal incision. One patient (4.2 % of group A) needed revision meatoplasty. Group B needed more time for epithelization (mean 7.33 ± 0.96 weeks) than group A (mean 6.5 ± 0.88 weeks; P = 0.003*) also resulted in wider mean new meatus in group B (mean 10.50 ± 1.02 mm) than in group A (mean 9.63 ± 1.41 mm; P = 0.02*). ConclusionBoth techniques had comparable post-operative complications. ‘Corner-Tag’ technique needed more time for healing and epithelization but gave a wider new meatal diameter than ‘Fisch’ meatoplasty after one year of follow-up.

Incidence of Early Onset Neonatal Acute Kidney Injury in the NICU of Benha University hospital

Incidence of Early Onset Neonatal Acute Kidney Injury in the NICU of Benha University hospital

Role of Vitamin - D Deficiency in Term Neonates with late-onset sepsis at Benha University Hospitals

Role of Vitamin - D Deficiency in Term Neonates with late-onset sepsis at Benha University Hospitals

Role of Cardiovascular Magnetic Resonance Imaging in Early Detection of Myocarditis in Patients Recovered from COVID-19

Objective: To assess cardiac involvement in patients recovered from COVID-19 with no clinical evidence of myocarditis, using various non-invasive parameters including Transthoracic Two-dimensional Speckle Tracking Echocardiography (STE) and cardiac magnetic resonance imaging (CMR). Methods: This prospective study was conducted in the Cardiology Departments of Maadi Military Hospital and Benha University Hospitals. A total of 74 patients were initially enrolled during their hospital stay, but only 50 of them met the inclusion and exclusion criteria. The CMR examination was performed in conjunction with echocardiography, ECG, and laboratory investigations on the same day, which occurred 2-12 weeks after recovering from confirmed COVID-19 infection. Patient scheduling for CMR and other examinations depended on the availability of the CMR machine. Results: According to CMR diagnosis, 23 (46%) patients were diagnosed to have myocarditis by CMR, the patients were categorized into two groups based on these results: normal group (27 patients) & myocarditis group (23 patients). According to GLS, 21 (42%) patients were diagnosed to have myocarditis by STE (diagnosis of Myocarditis with Global longitudinal strain was considered with cut-off point of >-21.33 with Sensitivity of 91.30% and Specificity of 92.59% (P <0.0001). 2D STE showed 87.50% sensitivity, 92.31% specificity and 90.00% accuracy to diagnose myocarditis, while CMR showed a 95.83% sensitivity, 96.15% specificity of and 96.00% accuracy. Conclusion: Myocarditis was found in 46% of asymptomatic COVID-19-recovered patients. CMR is a valuable tool for early myocarditis detection when combined with 2D STE, offering high accuracy. Significant differences were observed between suspected myocarditis patients and those with normal results on both 2D STE and CMR.

Role of Speckle Tracking Echocardiography in Assessment of Right Ventricular Function in Heart Failure with Preserved Ejection Fraction

Background: Patients who exhibit signs and indicators of heart failure (HF) but usual or near to ordinary left ventricular ejection fraction are said to have HFpEF, which is an abbreviation for heart failure with preserved ejection fraction. Our goal was to assess the role that 2D-STE plays in the identification of RV dysfunction in HFpEF patients. Methods: Benha Teaching and Benha University Hospitals were both involved in the research for this study. It was carried out on a total of 100 individuals, each of whom was randomly assigned to one of two groups: group I involving 50 patients diagnosed with HFpEF. The patients who acted as control group were compared to another set of fifty healthy individuals who were the same age and gender. Result: No substantial changes were reported between both groups concerning Tricuspid annular plane systolic excursion (TAPSE), right ventricular diameter (RVD) (mid, basal, longitudinal) (P = 0.473), and right ventricular fractional area change (RVFAC) (P = 0.12). Conclusion: Patients with HFpEF who have features that are detected by 2D-STE have a much higher risk of experiencing a negative outcome. This is in contrast to the results of traditional 2D echocardiography. These results provide credence to the idea that RV 2D-STE might be used to identify individuals with HFpEF who are at a greater risk for unfavorable cardiac events.

Amyloid A in Serum and Ascetic Fluid as a Marker of Spontaneous Bacterial Peritonitis

Abstract Background Esophageal varices (EV) are a major complication of cirrhosis secondary to the development of clinically significant portal hypertension EV can lead to life-threatening bleeding, further decompensation and death among patients with cirrhosis. Aim of the Work The aim of this study is to assess the role of the clinical usefulness of the Amyloid A (serum and ascetic fluid) in patients with ascites (liver cirrhosis) and as a diagnostic marker for Spontaneous Bacterial Peritonitis. Patients and Methods This prospective study was conducted on 240 cirrhotic patients selected randomly presented for screening for esophageal varices at Hepatology, Gastroenterology and Infectious Diseases Department, Benha University Hospital Hospitals and at Kafr El- Shiekh Liver Research center Results The cause of cirrhosis was HCV in 205 patients (85.42%), HBV in 14 patients (5.83%), BHF in 47 patients (19.58%) with, AIH in 6 patients (2.5%) and other diseases in 21 patients (8.75%). the prevalence of oesophageal varices and its staging were 55 patients (22.9%) had no oesophageal varices, 44 patients (18.3%) had esophageal varices grade I-II (Small EVs) and 141 patients (58.8%) had oesophageal varices grade III-IV (Large EVs). According to Child-Pugh (CP) Score, 129 (53.75%) patients were Child A, 72 (30%) patients were Child B and 39 (22.9%) patients were Child C. ALBI ranged from -3.2 - (-0.42) with mean value −1.94 ± - 0.74. 67 (27.9%) patients were ALBI 1, 100 (41.7%) patients were ALBI 2 and 73 (30.4%) patients were ALBI 3. 50 (20.83%) patients were ALBI-PLT 2, 30 (12.5%) patients were ALBI-PLT 3, 88 (36.67%) patients were ALBI-PLT 4, 72 (30.0%) patients were ALBI-PLT 5. There was a significant difference among cirrhotic patients regarding EVs as regard to hemoglobin, platelets, APRI, albumin, total bilirubin, ALBI, ALBI-PLT, INR, Child-Pugh (CP) score, platelet count/spleen diameter ratio, spleen size and ascites (P < 0.001). Regarding the presence of EV, ALBI, ALBI-PLT, Child-Pugh (CP) Score and platelet count/spleen diameter ratio, are good predictors for the presence of oesophageal varices. ALBI at cut-off >-2.6 can predict oesophageal varices with sensitivity 83.77, specificity 53.06, PPV 87.4, NPV 45.6, AUC 0.711 and P-value <0.001, ALBI- PLT at cut-off >2 can predict oesophageal varices with sensitivity 96.48, specificity 87.76, PPV 96.9, NPV 97.7, AUC 0.982 and P-value <0.001. Regarding differentiation between Small EVs and large EVs, This study showed that ALBI, ALBI-PLT, Child-Pugh (CP) Scores, platelet count/spleen diameter ratio, spleen size and APRI could be used in prediction of the size of EVs, ALBI at cut-off >-2.03 can predict the size with sensitivity 95.28, specificity 93.75, PPV 96.8, NPV 90.9, AUC 0.971 and Pvalue <0.001. Conclusion Combined ALBI grade and platelet count (ALBI-PLT score), albumin-bilirubin ratio (ALBI), could be used as a serum non-invasive marker of the presence of oesophageal varices which may help in reducing unnecessary endoscopies and a good selection of patients who need an endoscopy to decrease intervention and burden on endoscopy units.

Effect of Body Mechanics Training Program on Low Back Pain and Disability among Patients with Lumbar Disc Prolapse

Context: Lumbar disc prolapse is one of the most common spinal pathologies, which can be associated with debilitating pain and neurological dysfunction. Evidence suggests that patients with disc prolapse and low back pain must be taught proper body mechanics to move safely and with the least strain possible on their back.
 Aim: Evaluate the effect of body mechanics training program on low back pain and disability among patients with lumbar disc prolapse. Methods: A quasi-experimental research design (study and control group) was utilized to achieve the aim of this study. This study was conducted in the neurosurgery department and neurosurgery outpatient clinic at Benha University Hospital on a purposive sample of patients diagnosed with lumbar disc prolapse. Three tools for data collection were used; a Structured interviewing questionnaire for patients; a visual analog pain scale, and Oswestry low back pain disability questionnaire.
 Results: Showed that the total mean knowledge score for the study and control group was 33.500±3.862 and 8.140±6.402, respectively, after one-month post-program implementation, with a statistically significant difference between both groups. Also, 75% of the study group had mild pain, and 58% of the control group had moderate pain post-program implementation, with statistically significant differences between the study and control group post-program, where p=0.000. Regarding functional disability scores among study and control groups pre and one month after program implementation. It shows that (67% and 63%) of the study and control groups had severe disability pre-program implementation. In contrast, post-program implementation, 65% of the study group had moderate disability, while 13% of the control group had moderate disability.
 Conclusion: Implementing body mechanics training program for patients with lumbar disc prolapse improved knowledge, reduced pain severity, and reduced disability among the study group compared to the control group. A simplified colored booklet about using body mechanics when performing activities of daily living should be available for all patients with lumber disc prolapse.

Self-care Practices of Diabetic Foot Patients at Benha University Hospital

Self-care Practices of Diabetic Foot Patients at Benha University Hospital

Obstructive Sleep Apnea in Patients with Central Obesity, in Benha University Hospital

Obstructive Sleep Apnea in Patients with Central Obesity, in Benha University Hospital

Ergonomics as Perceived by Staff Nurses and Its Relation to Their Job Satisfaction

Context: Ergonomics is a systems-oriented discipline that extends across all aspects of the work environment and human activity to enhance safety, efficiency, quality of work-life, operators’ comfort and productivity that increase job satisfaction of the health care team members as well as staff nurses.
 Aim: This research aimed to assess ergonomics as perceived by staff nurses and its relation to their job satisfaction.
 Methods: A descriptive-analytical cross-sectional design utilized for carrying out this study. The current study was conducted in surgical building at Benha University Hospitals, Qaliobia Governorate, Egypt. Study subjects were all available (200) staff nurses. Two tools used to collect data, namely, ergonomics assessment questionnaire and job satisfaction assessment questionnaire. 
 Results: The results of the study revealed that ergonomics was inadequate as perceived by more than two-thirds (71%) of the studied staff nurses. Also, more than two thirds (72.5%) of them had a low level of job satisfaction. Moreover, there was a highly statistically significant positive correlation at (P-value<0.001) between total ergonomics and total job satisfaction.
 Conclusions: The study concluded that there was a highly statistically significant positive correlation between total ergonomics and total job satisfaction. The study recommended that hospital administration should deploy more efforts in improving the workplace ergonomics; this includes the work setting, and equipment. Nursing administrators should develop strategies for improving the ways of work to perform tasks that distributed throughout the shift to enhance staff nurses' job satisfaction. Also, Future studies should be conducted to investigate the relationship between ergonomics and other variables, like job performance, turnover, and productivity.

Predictors of Suboptimal Reperfusion and Short Term Mortality in Patients Presented With Acute ST-Segment Elevation Myocardial Infarction and Treated With Primary Percutaneous Coronary Intervention

Background: Predictors of Suboptimal reperfusion are still unclear. Aim: This study aimed to determine the factors that may indicate suboptimal reperfusion and short-term mortality in patients who were diagnosed with acute ST-segment elevation myocardial infarction (STEMI) and underwent primary percutaneous coronary intervention (pPCI). Patients and methods: This multicenter prospective comparative study, conducted at Benha University hospitals and National Heart Institute, included 400 patients (age<18 years and both sex) with acute STEMI, who were treated with PPCI. They were divided equally into 2 groups; suboptimal and optimal reperfusion groups (TIMI < III Vs.TIMI III respectively). Clinical data was collected. ECG, laboratory investigations, echocardiographic study, PPCI and 6 months follow up were done to all patients included. Results: This study showed that advanced age (60.4±8.2), family history of CAD, dyslipidemia, being diabetic, prolonged Pain to PCI time, higher random blood sugar (RBG) at the time of presentation, Killip class >1, heavy thrombus burden, prediltation, multiple stents insertion and longer stent length are predictors of the SOR after PPCI. While, Patients on long term beta blockers (BB) and angiotensin-converting enzyme inhibitor (ACEI) are less likely to develop SOR. Furthermore, patients with SOR are more likely to develop in-hospital arrhythmias, heart failure, acute mitral regurge and inhospital mortality. Additionally, it increases 6-months risk of reischemia and mortality. Conclusions: Predicting the occurrence of no-reflow following pPCI can be achieved by considering various factors, such as clinical data, laboratory results, angiographic features, and procedural characteristics. Heavy thrombus burden, prediltation, dyslipidemia, longer stent length, pain to PCI time and RBG >300 (mg/dL) at the time of presentation were found to be the most predictable variables to SOR. Long term use of BB and ACEI were found to be significant independent factors that decreased the likelihood of TIMI9h were considered the most predictable variables to mortality in no reflow.

Extended Pedicled Perforator Plus Submental Flap for Large Cheek Defect Reconstruction.

Eight patients aged 58 to 81 years with cheek cancer presented to the surgery department at the Benha University Hospital in Egypt, from May 2019 to October 2021 for the removal of their tumors and reconstruction of the resulting defects, using the extended submental perforator plus pedicled artery flap. The average blood loss was 250 cm3 (range: 50-400 cm3). The average operation took 3 hours to complete, including excision and rebuilding (a range of 2.5 to 3.5 hours). The length of the postoperative hospital stay was 2 to 4 days. Fortunately, there was no complete flap loss; nonetheless, distal flap necrosis in one case left a raw area, which was allowed to heal naturally, and hemorrhages in two cases were conservatively handled. For the reconstruction of cheek abnormalities, the submental flap is a viable alternative, particularly in older patients or patients whose overall health has declined and who need less severe therapies and quicker surgery. The submental flap, which conceals the donor site, provides a dependable supply of skin for facial resurfacing with excellent color, shape, and texture matching. The flap is quick, and easy to raise.

CHA2DS2 - Vasc Score Predict No Reflow Phenomenon in Primary Percutaneous Coronary Intervention

Purpose: ST-Elevation Myocardial Infarction is the most acute manifestation of Coronary artery disease, with substantial morbidity and mortality. Early reperfusion (re-establishing the blood flow in the occluded artery) is the most effective way to preserve the viability of the ischaemic myocardium and limit infarct size. Early diagnosis of STEMI is crucial to initiate appropriate treatment and should ideally be made within 10 minutes of first medical contact. This study aimed to evaluate the CHA2DS2-VASc score as a simple tool for predicting the no-reflow among patients with STEMI who underwent primary percutaneous coronary intervention.
 Methodology: This was a case-control study which was conducted on 100 patients, diagnosed with acute STEMI and underwent primary PCI, who was admitted to Cardiology Department, Benha University Hospital and National Heart Institute. Patients were classified into two groups, control and no-flow, according to their final angiographic TIMI flow rates resulting from primary PCI. The control group: 78 patients with TIMI flow rate >2. The no-reflow group: 22 patients with TIMI flow rate ≤2, despite mechanical reopening of the infarct-related artery in patients without dissection of the coronary artery.
 Findings: In this study, LVEF was significantly lower in patients with no-reflow compared to patients with normal TIMI flow (p <0.001), but LVEDV was significantly higher (p =0.01). There was no significant difference in LVESV between patients with no-reflow compared to patients with normal TIMI flow. CHA2DS2VASC score was significantly higher in patients with no-reflow compared to patients with normal TIMI flow (p <0.001). CHA2DS2VASC score is a significant predictor of occurrence of no reflow phenomenon (AUC: 0.689, p =0.006). At a cut off value of ≥ 2it has a sensitivity of 68.2%, specificity of 58.9%, PPV of 31.9% and NPV of 86.8%.
 Recommendation: The study suggest that the CHA2DS2‑VASc score can be an independent predictor of no‑reflow phenomenon in patients undergoing primary PCI. As a simple and easy‑to‑calculate score, it might be a useful assessment tool to predict no‑reflow phenomenon before primary PCI interventions in patients with STEMI. Thus we recommend using CHA2DS2-VASc score as it is very simple and a quick tool to predict no-reflow before primary PCI