Full Examination Research Articles

Evaluation of Adhesive Capsulitis of the Shoulder with Fat-Suppressed T2 Weighted MRI: Association between Clinical Features and MRI Findings

Introduction •Adhesive capsulitis of the shoulder or frozen shoulder is a debilitating condition characterized by progressive pain, stiffness and limited range of motion about the glenohumeral joint, the term (adhesive capsulitis) to describe the findings of chronic inflammation and fibrosis of the joint capsule, characterized by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder. (Zhao W, ZhengX, liu Y, et al.,2012). •MRI has, in recent years, allowed for the visualization of several characteristic signs seen with this condition, including thickening and shortening of the coracohumeral (CHL) ligament, thus limiting external rotation is due to fibroblastic proliferation within the CHL, thickening of axillary pouch and rotator interval joint capsule, in addition to the obliteration of the subcoracoid fat triangle.(Cheng X, et al.,2017). Aim of the work to examine the association between clinical features (stages) and MRI findings in adhesive capsulitis of the shoulder. Methods and material seventy patients confirmed or suspected adhesive capsulitis of the shoulder. The diagnosis is based on MRI findings and clinical criteria. Patients who complain from shoulder pain and restricted ROM with detailed clinical information and history which permit the clinical staging of AC and patients with normal ROM in the opposite shoulder are also included (the initial diagnosis was based on the history and clinical symptoms) clinical criteria for the diagnosis of AC includes: restricted passive motion for greater than 30 degrees in the two or more planes of movement, gradually increasing shoulder pain that was more severe at rest at least 1 month duration, and normal radiographic findings .Patients who fullified these criteria underwent shoulder MRI to correlate MRI findings with pain intensity, range of motion and clinical stage. Study is approved by the ethics review board of Ain Shams University Hospital. For the MRI examination, (a 1.5 tesla Philips Healthcare) MRI machine at El-Demerdash University Hospitals with a dedicated shoulder surface phased –array coil. During imaging, patients were in supine position .MRI protocol consisted of the following sequences:Fat-suppressed T2: coronal oblique, sagittal and axial weighted images, proton density(PD), fast spin echo T1-Weighted sagittal images.All patients will be subjected to complete history taking, full clinical examination. All MRI imaging examinations were conducted at radiology department of Ain Shams University. All patients were subjected to full history taking prior to scanning and full clinical examination. Results Regarding the diagnostic performance of shoulder MRI there is a statistically significant difference between degree of pain intensity according to Capsular thickening regarding humeral “mm” with p-value (p < 0.05). The highest value was found moderate and severe pain group (5.67±1.39) compared to absent, minimal & mild pain group (4.42±1.29)., there was a statistically significant difference between two groups according to axillary recess regarding height “mm” with p-value (p < 0.05). The highest value was found absent, minimal & mild pain group (7.02±2.68) compared to moderate and severe pain group (5.73±2.25). There is no statistically significant association between pain intensity and MRI finding regarding Capsular Edema, Extra Capsular Edema, Obliteration of Subcoracoid Fat Triangle, Effusion of Biceps Tendon Sheath, Capsular Thickening Glenoid (mm) and Axillary Recess Width (mm), with p-value (p > 0.05 NS). •Qualitative and quantitative analysis a highly statistically significant difference between absent and present of limitation of ROM “abduction” according to Capsular Thickening Glenoid (mm) with p-value (p < 0.001). The highest value was found absent group (6.29±0.99) compared to present group (5.21±1.39). •Additionally, the results showed 25 patients out of 70 having extra capsular edema anterior, 20 patients (48.8%) belong to absent abduction group and 5 patients (17.2%) belong to present abduction group, as there was a statistically significant negative relation with p-value (p = 0.014). •There is no statistically significant association between absent and present of limitation of ROM “abduction” and MRI finding regarding Capsular Edema Glenoid, Capsular Edema Humeral, Extra Capsular Edema Posterior, Obliteration of Subcoracoid Fat Triangle, Effusion of Biceps Tendon Sheath, Capsular Thickening Humeral (mm), Axillary Recess Height (mm) and Axillary Recess Width (mm), with p-value (p > 0.05 NS) Conclusion MRI can be useful for assessment several measures of clinical impairment in patients with adhesive capsulitis . thickening and hyperintensity of the joint capsule in the axillary recess on MRI is associated with limited ROM and duration of symptoms.

Effect of Cardiac Rehabilitation on the Psychological Changes in Post Myocardial Infarction Patients

Abstract Objectives To assess the effect of cardiac rehabilitation on the psychological changes in post myocardial infarction (MI) patients. Background Cardiac rehabilitation (CR) is a acceptable treatment strategy adding to the basic medical plan for the patients with coronary artery disease. Subjects and methods A prospective study that was conducted on 60 myocardial infarction patients and they were subdivided into 2 groups; group 1 included 30 myocardial infarction patients who underwent cardiac rehablitation and group 2: included 30 myocardial infarction patients who didn’t undergo cardiac rehablitation. All the included subjects underwent full history taking, full examination and echocradiography and psychological evaluation tests (state–trait anxiety inventory (STAI), Beck depression inventory (BDI) and hospital anxiety and depression scale (HADS)), before and after cardiac rehablitation. Results Comparison between the 2 groups regarding cardiac changes on follows up, there was significant difference between 2 groups regarding Left ventricular end diastolic diameter (LVEDD), Left ventricular end systolic diameter (LVESD) and ejection fraction (EF) (P-value = 0.0001, 0.0082 & 0.0261). Comparison between the 2 groups regarding psychiatric changes on follows up revealed that there was significant difference as regard STAI, BDI and HADS (P-value = 0.0001, 0.0.0001 & 0.0001). Conclusion Cardiac rehabilitation in post-MI patients could have beneficial effects on cardiac function without adversely affecting LV remodeling or causing serious cardiac complications. Participating in a cardiac rehablitation beneficially contributed to a decrease in depression and anxiety manifestations in post-MI patients. Abbreviations A-state: State-anxiety A-trait, Trait-anxiety; BDI: Beck depression inventory; BP: Blood pressure; CAD: Coronary artery disease; HADS: Hospital Anxiety and Depression Scale; HF: Heart failure; LVEF: Left ventricular ejection fraction; MI: Myocardial infarction; STAI: State–trait anxiety inventory

Interleukin-18, Interleukin-18 Gene Polymorphisms and Interleukin18 Binding Protein in Children and Adolescents with Immune Thrombocytopenia

Background Immune thrombocytopenia (ITP) is an autoimmune illness characterized by an aberrant T cell response, which is supported by autoreactive B cell growth and differentiation. IL-18 expression has been linked to a number of autoimmune and inflammatory illnesses. IL18BP is a protein that binds IL-18 with high affinity, suggesting a potential mechanism for regulating IL-18 activity. Corticosteroids may play a significant role in reversing the IL-18- IL18BP ratio by upregulating IL18BP. Objective The aim was to study associations between IL-18 and two associated gene polymorphism sites -607 & -137 with incidence and response to therapy in patients with ITP. Patients and Methods It is a case control study conducted on children and adolescents with ITP.A total of 55 patients with different stages of ITP (25 acute, 18 persistent & 12 chronic patients) were recruited with 30 age matched healthy controls. All patients were subjected to full history and physical examination. Laboratory investigations included serial blood counts, IL-18 and IL-18BP serum levels using enzyme linked immunosorbent assay (ELISA) and IL-18 gene polymorphisms using polymerase chain reaction (PCR). Results At diagnosis the median platelet count was 16× 109/L (range 2-79) & eventually increased to a median of 90× 109/L after treatment. IL-18 level was significantly higher than that of control (P < 0.001) & even after treatment. There was no significant difference between patient and control groups regarding the studied gene polymorphism sites -607 & -137. The mean IL-18 was still significantly elevated in all stages of ITP compared to control group & as well the drop after treatment. This was also observed in IL-18 BP which increased significantly after response to steroid therapy. However, it was observed that the decline in level of IL-18 as well as increment in IL-18 BP was the least in the patients tested during the acute phase. Mean IL-18 & IL-18 BP levels show no significant relation with gender, family history of ITP, mode of treatment or genotype. Conclusion Among the studied IL-18 gene polymorphisms, no significant difference was detected among ITP patients or had a significant correlation with clinical or laboratory markers. Reversed IL-18/IL-18BP ratio is an important modulator in pathogenesis of ITP. Increasing levels of IL-18BP could have a significant role in treatment.

Diagnostic Yield of Endoscopy in Upper Gastrointestinal Bleeding in Pediatrics

Introduction Esophagogastroduodenoscopy is currently considered the first-line diagnostic procedure of choice for upper gastrointestinal (GI) bleeding; however, the etiology of bleeding remains unknown in a subset of patients. This study aims to evaluate the diagnostic yield of upper gastrointestinal endoscopy in upper gastrointestinal bleeding in pediatrics and determine the clinical predictors for unreached diagnosis during endoscopy. Methods Cross sectional study, conducted at pediatric endoscopy unit, Ain Shams University, Cairo, Egypt, where 100 patients were recruited, as they were referred for diagnostic upper GI endoscopy due to overt upper GI bleeding in the form of hematemesis and/or melena. Full medical history, examination, laboratory investigations, endoscopic and histopathologic findings were documented. Results :100 patients with ages ranging from 3 months to 15 years, median age 4 years, 47% males and 53% females, 65% presented by hematemesis only, 7% with melena only, and 28 % presented with both hematemesis and melena. In 38 % of cases no endoscopic diagnosis was reached. While patients with a positive diagnostic yield 62%, had variable diagnosis, the most common of which was H pylori gastritis and reflux oesophagitis in 23% and 11% of cases respectively. Followed by nonspecific gastritis (8%), oesophageal varices (4%), and others (16%).. Melena was a negative predictor to reach a diagnosis by upper GI endoscopy. Conclusion Diagnostic yield of upper GI endoscopy in pediatric patients with upper GI bleeding was only 62%. Combining upper GI endoscopy with other tools in cases presenting with melena alone is highly recommended since bleeding from a source in the small bowel or right colon may also be the cause.

Change in Serum Chloride and Its Relation to Acute Kidney Injury in Septic Shock Patients

Abstract Background Septic shock is a dysregulated host response to infection resulting in potentially lifethreatening organ dysfunction. Acute kidney injury (AKI) id one of the most common and serious complications associated with septic shock patients especially in intensive care units. Aim of the Work To evaluate the predictive value of change in serum chloride and its relation to acute kidney injury in septic shock patients. Patients and Methods The study was included 65 septic patients who admitted to intensive care units of Ain Shams University Hospitals, Cairo, Egypt. All the included cases were subjected to full history taking and full general and local examination. Full laboratory investigations were taken from all the cases. The following were done; GCS, SOFA and APACHE II score. The initial serum chloride level and the highest level of chloride during stay was recorded with calculation the difference as the change of serum chloride level. Results In our study, diabetes was the most common comorbidity in the included cases (49 cases – 75.4%), followed by hypertension (40 cases – 61.5%), chest infection was the commonest source of sepsis in our study (33 cases – 50.8%), followed by UTI (23 cases – 35.4%). Other causes included intra-abdominal infections, skin and soft tissue infections and blood stream sepsis. Conclusion Acute kidney injury is a frequent complication in septic patients and optimization of fluid management is fundamental in order to limit the detrimental role of fluids on renal metabolism.

Assessment of Carotid Atherosclerosis in Egyptian Chronic Hepatitis C Patients after Treatment by Direct Acting Antiviral Drugs

Abstract Background Recent studies suggested association between hepatitis C virus (HCV) infection cardiovascular disorders, including carotid atherosclerosis with evidence of an effect of HCV clearance on carotid atherosclerosis. Objectives We aimed to evaluate the impact of direct acting antiviral (DAA) therapy for chronic hepatitis c virus (HCV) infection on carotid atherosclerosis. Subjects and methods This is a prospective cohort study that was carried out in Internal Medicine and Hepatology Department and outpatient clinics of the Ain shams university hospitals included 80 Egyptian patients with chronic HCV infection who started treatment in form of IFN-free, DAA-based regimen and completed the course of treatment and six months follow up period. All patients were subjected to detailed history taking, full physical examination, full laboratory investigations. Radiological assessment by abdominal ultrasonography and high-resolution B mode ultrasonography of both the common carotid arteries. Results the mean age of cases 58.13± 7.56 years 49 (61.25%) males and 31 (38.75%) females. IMT was significantly decreased after treatment 1.24 vs. 1.57 mm p < 0.001. The number of patients with IMT ≥ 1 mm was significantly decreased after 6 months 45 (56.3%) vs 57 (71.3%). there was significant positive correlation between baseline carotid IMT and age, BMI, bilirubin, INR, CTP score, Carotid plaques, total cholesterol. Meanwhile, there was significant negative correlation between baseline carotid IMT and hemoglobin, platelets, albumin, HDL. In patients who achieved SVR, total cholesterol, triglycerides, LDL and HDL was significantly increased after treatment. IMT was significantly lower in SVR group compared to non- SVR (p = 0.016). Conclusion Hepatitis C virus eradication by DAAs improves carotid atherosclerosis in by decreasing intima media thickening.

Assessment of the Effect of Vitamin D Deficiency on Ocular Dryness

Background Dry eye syndrome (DES) is one of the most common ocular diseases and has been recognized as an important public health problem. Dry eye is associated with chronic eye pain and an increased risk of ocular surface diseases, such as corneal ulcers and corneal abrasions. DES is a multifactorial disorder of the tear film and ocular surface, Aim and objectives was two-fold: (i) to demonstrate the relation between vitamin D deficiency, dry eye and impaired tear function; (ii) to investigate the possible associations among clinical parameters of hypovitaminosis D, such as fatigue, functional impairment and pain, with dry eye parameters including quantity of tears, the stability of the tear film layer and symptoms of ocular irritation. Subjects and methods Our study was a prospective, non-randomized study which was conducted on 36 patients with Vitamin D deficiency; The 36 vitamin D deficiency patients were classified according to dryness of eye into 2 independent groups:(1) DES group (25 patients) according to Schirmer test without anesthesia with results <10mm and Tear break-up time TBUT <10s, (2) Non-DES group (11 patients) according to Schirmer test without anesthesia with results >10mm and Tear break-up time TBUT >10s.To evaluate the relation between vitamin D deficiency, dry eye and impaired tear function The following tests were done to patients in our study: Careful history taking, full ophthalmological examination, Schirmer test, Tear break-up time and Optical coherence tomography (anterior segment).Follow up for our patients in the study after taking vitamin D supplement for 3 month and all the previous tests were repeated again. Results the results revealed that Comparative study between the 2 groups revealed; highly significant decrease in follow up Schirmer test, tear breakup time and tear-film height in DES group; compared to Non-DES eye group (p < 0.01 respectively). Comparative study between the 2 groups revealed non-significant difference regarding follow up tear-film width and vitamin D level (p > 0.05), Conclusion Our work supports that vitamin D deficiency may lead to dry eye which may carry the risk in development conjunctival squamous metaplasia and loss of goblet cells on the ocular surface, and that vitamin D plays a protective role in the development of dry eye, probably by enhancing tear film parameters and reducing ocular surface inflammation.

Diffuse Alopecia: Clinical, Trichoscopic, Histopathological and Immunohistochemical Challenges in the Diagnosis

Abstract Background Diffuse alopecia is characterized by a general loss of hair with no patches of full baldness. In dermatology, diffuse hair loss, particularly in women, is a common complaint. Common illnesses such as telogen effluvium, androgenetic alopecia, and widespread alopecia areata can be difficult to distinguish. The clinical signs of these three types of alopecia may be identical. Aim of Work The current study aimed to study the clinical, trichoscopic findings, histopathological in patients with acute diffuse hair shedding: female pattern hair loss (FPHL), acute telogen effluvium (TE) and alopecia areata incognita (AAI). Immunohistochemistry analysis for CD3 was done for differentiation and detection of the prognostic values of these markers. Subjects and methods: The study included 40 patients with acute diffuse hair shedding within the last 6 months with the diagnoses of AAI, TE, FPHL. All patients were subjected to full history recording, general and local examination. Hair evaluation was performed through trichoscopic assessment and punch scalp biopsy that was analyzed by hematoxylin and eosin and immunohistochemical analysis for CD3. Results Trichoscopic assessment of studied patients revealed that hair diameter diversity was significantly presented in FPHL patients. Number of thin hairs in frontal area, number of hair units with one hair, and vellus hairs were significantly presented in FPHL and TE+ FPHL patients compared to TE patients. Short regrowing hair was significantly presented in TE patients and TE +FPHL patients compared to FPHL patients. Peripilar sign and empty hair follicles in frontal area were significantly presented in FPHL patients. Multiple upright regrowing hair in all areas was significantly presented in TE+ FPHL patients. Conclusion FPH and TE represents common types of hair loss disease, each with specific trichoscopic and histochemical findings.

Characteristics of Helicobacter pylori-Seropositive Subjects According to: A) The Stool Antigen Test Findings. B) Serum Pepsinogen Level. C) Upper Endoscopic Findings

Abstract Background Helicobacter pylori infection can be diagnosed by invasive methods using the gastric biopsied specimens or non-invasively by examining serum, urine, breath, or stool. Histological examination by Giemsa staining is usually recommended for the diagnosis, but it is difficult to visualize the bacterium when there is alow density of H.Pylori on the gastric mucosa with atrophic and metaplastic changes, Limitations of histological examination include increased false negative test findings due to various density of H. pylori at a different sites, high cost, long turn-around time, and inter observer variability. Therefore, in endemic countries like Egypt with s higher risk of chronic atrophic gastritis (CAG), intestinal metaplasia, and gastric cancer, noninvasive tests need to be added for a more reliable diagnosis of H.Pylori infection. Aim of the Work The aim of this study is to compare between the prevalence of chronic atrophic gastritis (CAG) and gastric corpus atrophy in Helicobacter pyloriseropositive subjects according to the stool antigen test, serum pepsinogen(PG) level and upper endoscopic findings. Patients and Methods The current study represents Cross- sectional study -Descriptive -Diagnostic study. This study had been carried at Ain Shams University and Abbasia fever hospital on 80 seropositive- patients attending to endoscopy ward for a regular check-up, All patients subjected to full history, clinical examination and investigation in the form of; complete blood count, serum antiH.Pylori immunoglobulin G (IgG), stool antigen test and serum pepsinogen. Results The current study showed that there was a significant difference between positive and negative H. pylori regarding pepsinogen I & II and endoscopic finding regarding CAG and CSG. Conclusion In conclusion, there is a link between positive stool H. pylori antigen test findings and a serum PG assay and upper endoscopic findings in seropositive subjects. Positive stool H. pylori antigen test findings are common in seropositive subjects with increased serum PG I levels indicating an ongoing H. pylori infection. Our study findings further suggest that, to reduce the infected subjects with H. pylori in their fecal material, seropositive subjects with increased gastric secreting ability need to be treated.

Assessment of Corneal Endothelial Cell Parameters Using Specular Microscopy in Previously Infected SARS-CoV-2 Patients

Purpose To assess the effects of severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) infection on the endothelium of the cornea. Methods A cross-sectional, comparative study with subjects previously infected by SARS CoV 2 infection for not less than six months (group 1) and a group of sex and age-matched controls without previous infection of SARS CoV 2 (group 2). Endothelial cell parameters were examined using specular microscopy. Following full ophthalmologic examination the groups were matched with controls of the same sex and age with no prior ocular surface pathologies. Results 64 and fifty-three right eyes were examined in both groups one and two, respectively. Between the 2 groups no differences in any of the examined specular parameters were detected that are statistically significant. Conclusion No delayed effects on the corneal endothelium appear to be caused by SARS CoV 2 infection. Further studies comparing the same subject before and after infection will be of significance.

Prevalence of Selective Immunoglobulin A Deficiency in Egyptian Asthmatic Patients

Abstract Background Asthma is the most common chronic illness in childhood and a major cause of morbidity in adults, affecting 9.6-13% of children, 7.7-10.1% of adults in the US, and 300 million people globally. Aim of the Work to assess prevalence of selective immunoglobulin A (sIgA) deficiency in Egyptian Asthmatic patients. Patients and Methods This case control study conducted on patients 60 with bronchial asthma according to GINA2011 attending allergy and clinical immunology outpatient clinic at Ain Shams University hospital. They were divided into three groups: the first group includes 20 Asthmatic patients with recurrent chest infections. The second group includes 20 Asthmatic patients without recurrent chest infections and the third group includes 20 healthy controls. All participants were subjected to the following: full history, full clinical examination in addition to the following investigations, complete blood count (CBC) with differential, spirometery, chest X-ray, serum IgG, serum Ig A, serum Ig E, serum IgM and CRP. Conclusions Asthma is one of the most common diseases in the world that can be triggered with SIgAD. Asthmatic patient is more prone to the risk of infections. It may be due to impaired innate and adaptive immune system that predisposes individuals to microbial infections or may be related to the presence of one type of primary immune deficiency such as; SIgAD.

CXCL13 Level in Children with Acute and Relapsing Demyelinating Disorders of the Nervous system

Background The chemokine, C-X-C motif ligand 13 (CXCL13) plays an important role in B cell recruitment within the central nervous system (CNS). CXCL13 has been implicated as key regulatory factor in inflammatory CNS disorders including autoimmune CNS diseases. Aim of the Work To compare between the serum level of CXCL13 in patients diagnosed with acute central or peripheral demyelination and in healthy age and gender matched controls. Patients and Methods Twenty patients (patients’ group) diagnosed with acute demyelinating diseases (acute disseminated encephalomyelitis (ADEM; n = 7), acute necrotizing encephalopathy of childhood (ANEC; n = 3), autoimmune encephalitis (AE; n = 3), transverse myelitis (TM; n = 3), Guillain-Barré syndrome (GBS; n = 4) and 40 healthy age and gender matched children (control group), were enrolled in the study. All patients were subject to full history, examination and measurement of serum levels of CXCL13 in both cases and controls. Results Serum CXCL13 level status was significantly higher in cases compared to controls (p < 0.001). The mean serum CXCL13 level in cases was (341.75 ± 164.71 pg/ml) and in control was (51.5 ± 18.99 pg/ml). Conclusion Serum CXCL13 levels are significantly increased in pediatric patients with acute acquired central and peripheral demyelinating diseases of the nervous system.

Evaluation of Retinal Toxicity by SD-OCT due to Long-Term Exposure to Hydroxycholorquine among Rheumatoid Arthritis Patients

Background Hydroxychloroquine is used increasingly in the management of a variety of autoimmune disorders, with well-established roles in dermatology and rheumatology and emerging roles in oncology. However, Hydroxychloroquine and chloroquine (CQ) have been associated with irreversible visual loss due to retinal toxicity. Cessation of the use of hydroxychloroquine at an early stage of damage might prevent functional loss; however, after maculopathy has developed, cessation of the drug does not show clinical recovery. Because discontinuation of Therapy may reverse retinal toxicity, early detection of toxicity changes is vitally important. Objective to evaluate the involvement of retina in hydroxychloroquine (HCQ) retinopathy among rheumatoid arthritis patients using data from spectral domain optical coherence tomography (SDOCT) and to correlate toxicity with dose, duration of use and cumulative effect of HCQ. Patients and Methods Cross sectional Study. In total 13 patients (26 eyes) attending the rheumatological outpatient clinic of El Demerdash hospital, from October 2019 to February 2020 were enrolled in the study after the approval of the research ethical committee in the Faculty of Medicine, Ain Shams University. A full history was taken from the patients and full ophthalmological examination was done. In our study we perform OCT for all patients by using the Nidek RS-3,000 Advance SD-OCT with the “Macula Map” protocol that imaged a 6 × 6 mm area with 64 raster B-scans, each composed of 1024 A-scans. Results The study showed that was highly significant negative correlation between duration of exposure and CMT (p-value =0.008) and highly significant negative correlation between cumulative dose and CMT (p-value =0.005). Also, there was statistically significant negative correlation between age and thickness of inner and outer nasal quadrant (p-value= 0.015, p-value= 0.001) respectively and between age and inner and outer superior quadrant (p-value= 0.048, p-value= 0.000) respectively, in ETDRS thickness map. It also found statistically significant negative correlation between daily dose and thickness of outer nasal quadrant of thickness map (p-value= 0.045). Conclusion The present study show the presence / absence of retinal toxicity in rheumatoid arthritis patients use hydroxychloroquine for 5years or more using SD-OCT and found a statistically significant negative correlation between central macular thickness and cumulative dose of HCQ and between central macular thickness and duration of HCQ use.

Serum Galectin-1 Level in Egyptian Patients with Rheumatoid Arthritis: A Pilot Study

Background Rheumatoid arthritis (RA) is an autoimmune disease that primarily affects the small joints of the hand, wrist, and feet. If left untreated, it can lead to extensive impacts on quality of life, with loss of productivity due to damaged and deformed joints. It is also associated with significant extra-articular manifestations and mortality. The cause of developing the disease is still unknown which leads to ongoing studies to further understand the pathogenesis and find new treatment targets and new classes of therapeutics. One of the studied markers is Galectin-1 (Gal-1). Gal-1 is a part of Galectin family and is their prototype. It could be found in a large number of tissues with pro-inflammatory and antiinflammatory effects depending on the cellular microenvironment. Objectives To evaluate the serum level of Galectin-1 in Egyptian rheumatoid arthritis patients and controls. Patient and methods This case-control study included 20 Egyptian patients with rheumatoid arthritis diagnosed according to 2010 ACR\EULAR criteria and 20 Egyptian healthy controls. Every patient is subjected to full clinical examination; swollen joints, tender joints, deformity, laboratory investigations; serum Galectin-1 level, ESR, CRP, CBC, SGPT, SGOT, creatinine, urea, Anti-CCP, RF. Results Comparing serum Galectin-1 levels between Egyptian RA cases and controls, there was a highly statistically significant increase in the serum Galectin-1 level in RA Cases group than the control group with a p-value <0.001 with a cut-off point between the control group and Cases group > 15 (ng/ml). There was a non-significant change in serum Galectin-1 level between different disease activity categories according to DAS28-ESR and DAS28-CRP. Conclusion Our study demonstrated the usefulness of measuring serum Galectin-1 in Egyptian patients with RA with high validity. This proves the role of Galectin-1 in RA pathogenesis.

Assessment of Right Lobe Size/Serum Albumin Ratio as a Non-Invasive Marker for Esophageal Varices in HCV Patients

Abstract Background Viral hepatitis was estimated to be the 7th leading cause of mortality globally. HCVassociated disease is one of the leading causes of HCC and the main indications for liver transplantation. Approximately 71 million people are chronically infected worldwide, with a total global HCV prevalence estimated at 2.5%. Egypt has the highest world prevalence of hepatitis C virus (HCV) infection, which is associated with substantial disease and economic burden. Chronic HCV infection can result in hepatic fibrosis, cirrhosis, HCC and death. One of the major complications of cirrhosis is gastroesophageal varices, the incidence of which ranges from 35% to 80%). Current guidelines recommend that all cirrhotic patients should undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. Noninvasive identification of patients at highest risk for esophageal varices would limit investigation to those most likely to benefit. Aim of the Work The aim of our study is to determine the predictive value of noninvasive parameters (Rt. lobe diameter/ serum albumin ratio) in the prediction of esophageal varices. Patients and Methods It is a cross-sectional study carried on 100 patients collected from the Hepatology outpatient clinics and from Hepatology and Gastroenterology unit, Internal medicine department at Ain Shams University Hospital over 6-month period, with inclusion and exclusion criteria aiming at the elimination of other factors that might affect the study results. All patients were divided into 3 groups: 30 patients with Child-Pugh A, 30 patients with Child-Pugh B, and 40 patients with Child-Pugh C. patients were subjected to the following: Clinical assessment: including; Full medical history and clinical examination, laboratory investigations: (AST, ALT, Bilirubin, Albumin, INR, Alpha feto-protein, CBC), abdominal ultrasonography and doppler ultrasonography: performed after overnight fasting and the patient in supine position with emphasis on the liver right lobe diameter (cm), splenic bi-polar diameter (long axis) (cm), ascites, presence of periportal thickening, portal vein diameter (mm) and patency, upper GI endoscopy. Results Our study showed that regarding platelet count, INR, serum albumin, Liver size, liver size / serum albumin ratio there was a significant difference among esophageal varices grades. Liver size / serum albumin ratio had non-significant diagnostic performance in differentiating esophageal varices grade-I from grade-0, had significant moderate diagnostic performance in differentiating other esophageal varices grades from each other. Liver size / serum albumin ratio cutoff points had high specificity & PPV but low sensitivity& NPV in differentiating grade-I from grade-0, had high sensitivity& NPV but moderate specificity & PPV in differentiating other grades from each other. Conclusion Our study showed that there was significant moderate agreement between endoscopy and liver size / serum albumin ratio regarding esophageal varices grades. Our study stresses on the use of some of the non-invasive parameters in predicting the grade of esophageal varices in cirrhotic patients without submitting them to the invasive, time consuming and expensive procedure of endoscopy.

Characteristics of Autism Spectrum Disorder among a Sample of Egyptian Children

Background Autism spectrum disorder (ASD) is a biologically based neurodevelopmental disorder characterized by impairments in two major domains; deficits in social communication and social interaction and restricted repetitive patterns of behavior, interests and activities. Aim of the Work Understanding and correlating the socioeconomic status (SES), clinical characteristics and the severity of ASD. Patients and Methods 100 autistic patients were assessed using DSM-V criteria, intelligence quotient (IQ) assessment using Stanford Binnet intelligence scale, assessment of severity of autistic symptoms using childhood autism rating scale (CARS), and psychometric evaluation for comorbid psychiatric conditions by using Pediatric Symptoms Checklist (PSCL), Full clinical examination, neurological examination, Electroencephalography (EEG) for some patient & socioeconomic status (SES) assessment were also done. Results Severity of ASD was correlated with each of motor & social delay (p = 0.007) (p = 0.000) respectively, impairment in Sphincter control (p = 0.012), imitation impairment (p = 0.010) and stereotypic behavior (p = 0.015. Our patients had comorbidities in the form of; gastrointestinal tract (GIT) symptoms, eating disorders and EEG findings (p = 0.004) (p = 0.005) (p = 0.038) respectively. Our patients mainly belonged to middle SES (57%) and severity of ASD was correlated with family possessions domain of SES (p = 0.001). Children who belonged to high SES were more likely to be diagnosed earlier (p = 0.016) with better IQ (p = 0.003) than those from lower SES. Conclusion It is important for developing countries to have their own research and to increase public awareness in all socioeconomic strata and establish integrated services for autism.

Efficacy of Dexamethasone in Attenuation of Postinduction Hypotension in Geriatric Patients Undergoing General Anesthesia: A Randomized Controlled Trial

Abstract Background Postinduction hypotension is a common problem that faces anesthesiologists on a daily basis, with incidence ranging from 25% to 67.5% when propofol is used as an induction agent. Post-induction Hypotension is even more common in the elder population because increase in age is an independent predictor of intraoperative hypotension as a result of the diminished cardiovascular reserves. Aim of the Work This study assessed the efficacy of dexamethasone to alleviate the drop in blood pressure after induction of anesthesia. All patients were informed of their participation in the study and written consents were taken. They were assessed preoperatively by careful history taking, full physical examination, and laboratory evaluation. Patients and Methods A Prospective randomized clinical study in Ain-Shams University hospitals, Cairo, Egypt form June 15, 2021 to October 15, 2021 on 100 randomly chosen patients aged ≥ 60 years, American Society of Anesthesiologists (ASA) class I or II who were scheduled for elective surgery in Ain Shams University Hospitals, after approval of the medical ethical committee. They were allocated in two groups of 50 patients each. Results The results of the study revealed that the Patients who received preoperative dexamethasone had a significantly less incidence of hypotension, nausea, vomiting and shivering. Accordingly, ephedrine and IV fluid boluses were less frequently needed. Conclusion A single 8 mg IV dexamethasone given two hours preoperatively was able to decrease the incidence of postinduction hypotension in geriatric patients undergoing general anesthesia, leading to decreased use of ephedrine and IV fluid boluses. In addition, a significantly fewer percentage of patients developed nausea, vomiting and shivering after surgery than those who didn’t receive the drug.

Anti-Ficolin-2 Antibody: Could It Be a Predictor of Proliferative Lupus Nephritis in Lupus Patients?

Abstract Background Nephritis is a challenging domain of systemic lupus erythematosus (SLE). There is a growing need for identification of a non-invasive marker for diagnosing and monitoring nephritis. Objective To explore the relevance of using anti-ficolin-2 antibody (Anti-FCN2) as a biomarker for detecting lupus nephritis (LN), and its relation to renal biopsy histopathology and disease activity. Patients and Methods Sixty SLE patients were compared to 30 apparently healthy individuals. Thirty of the patients were LN patients (documented by a recent renal biopsy). Full history, examination and laboratory investigations were done. Activity was assessed by SLE disease activity index (SLEDAI) score, and Anti-FCN2 titer was measured by enzyme-linked immunosorbent assay technique (ELISA). Results Forty-four of our SLE patients were in disease activity by SLEDAI score. Anti-FCN2 titer was significantly higher among SLE patients compared to control group (p value <0.001). It was also higher among patients with high disease activity compared to those with low disease activity and cutoff value was at 37 ng/ml (p value is < 0.001). AntiFCN2 titer was significantly higher among patients with LN compared to those without LN (p value is < 0.001) with best cutoff value at 72.50 ng/ml. Regarding LN patients, it was significantly higher among patients with proliferative changes than LN patients with non-proliferative changes (p value is 0.05) with best cutoff value at 155 ng/ml. Conclusion Anti-FCN2 shows promising results as a biomarker for lupus disease activity, especially regarding LN and proliferative changes. Further longitudinal studies on larger samples are needed to confirm.

Evaluation of Myopic Macular Function and Structure

Purpose to assess the functional and structural changes in non-pathologic myopia in relation to the degree of myopia. Methods Cross sectional study of myopic patients. Our participants are classified into age matched four groups according to the degree of their spherical equivalent (SE): emmetropia, mild myopia; moderate myopia and high myopia. Participants underwent full ophthalmological examination, axial length (AL) measurement, Spectral domain optical coherence tomography and multifocal ERG (mf-ERG). Results Central foveal thickness showed significant thinning among the control participants in comparison to myopes, while inner and outer macular ring thicknesses were significantly thicker in the control participants than myopic ones. Subfoveal, inner and outer macular ring choroidal thickness were significantly thicker in the controls than myopes. Mf-ERG retinal response density [RRD] and P1 amplitudes of the three rings (R1-R3) were significantly higher in the control participants than myopic ones while P1 latency showed significant delay in the myopes in comparison to their control participants. Conclusion Macular thickness is related to the degree of refractive error, AL, choroidal thickness and multifocal changes in myopic patients. We should consider the correlation between functional and structural alterations in the macula when interpreting retinal structure in the assessment of macular diseases in the context of refractive errors.

The Predictive Value of Urinary Trypsinogen-2 Dipstick for Early Diagnosis of Acute Pancreatitis in Intensive Care

Abstract Background Acute pancreatitis is a sudden inflammation in the pancreas, with potential and variable involvement of adjacent organs or other organ systems. Aim of the Work to evaluate the rule of urinary trypsinogen-2 using dipstick test in the diagnosis of acute pancreatitis. Patients and Methods This cross-sectional study was carried out in surgical intensive care unit, Ain Shams University hospitals, during a period of 6 months. Forty five patients were included in our study, thirty patients were diagnosed as acute pancreatitis and fifteen patients weren’t diagnosed as acute pancreatitis through cross sectional study. All patients were subjected to full history taking, full clinical examination, laboratory investigations including serum levels of renal function tests, CBC, total and direct bilirubin, liver enzymes, alkaline phosphatase, INR, amylase and lipase. Urinary trypsinogen-2 dipstick test was done. Also, radiological examinations were done using ultrasonography of abdomen and pelvis, computed tomography of the abdomen. Results The most common cause of acute pancreatitis was gall stone obstructive pancreatitis (70%) and we found that serum amylase and lipase were elevated in (83.3% and 86.7% respectively) in acute pancreatitis patients. While the sensitivity of urinary trypsinogen-2 dipstick test was 93.3% in acute pancreatitis patients. The specificity of serum amylase, serum lipase was 73.3% for both of them, while the specificity of urinary trypsinogen-2 was 100% in diagnosis of acute pancreatitis. Conclusion In-conclusion urinary trypsinogen-2 dipstick test is a promising low cost, bed side and easy test to be done in the diagnosis of acute pancreatitis.