High Statistical Significant Difference Research Articles

Assessment of clinical and pathological response to neoadjuvant chemotherapy in breast cancer according to molecular subtypes

Background. Breast cancer (BC) is the commonest tumor in women. It is the leading malignancy in world, and representing an emerging oncologic issue in all countries. In Iraq, BC cases reached 7246 in 2021by Iraqi Cancer Registry reports. Objectives. The study conducted for assessment the clinical and pathological responses to neoadjuvant chemotherapy in BC among molecular subtypes and for description the clinico-pathologic features, and patterns of BC according to molecular subtypes. Methods. A prospective study of 60 females with breast cancer histologically confirmed were enrolled. All women received neoadjuvant chemotherapy. Then all patients underwent definitive surgery including MRM+AC or BCS+AC. The patients’ demographic, the pathologic and molecular subtypes date of the primary tumor were recorded. Results. The mostly distributed age group was belong to group 46-55 yrs in 22, 36.7%. The mean age was 49.7±10.8 yrs. The IDC represented the most common histopathological types of BC. The most of cases seen in upper-outer quadrant (UOQ). The results post-chemotherapy as followed: ypTx stage reported in 32 (53.3%), ypT1 in 15 (25.0%), ypT2 in 10 (16.7%) and ypT3 in 3 (5.0%). ypN0 stage in 40 patients (66.7%), ypN1 in 11 (18.3%), ypN2 in 6 (10.0%), and ypN3 in 3 (5.0%). There was a high statistical difference between cT and ypT in pre and post-chemotherapy (P<0.0001), between cN and ypN in pre and post-chemotherapy (P=0.001) and between M and ypM in pre and post-chemotherapy (P=0.002). The mass location (P=0.005) and tumor size (P = 0.011) had significantly impacted on BC responses post NACT. 18(30.0%) had clinical complete response (cCR), 32 women (53.3%) had partial response (cPR), six cases (10.0%) had stable disease, and four cases (6.7%) had progressive disease. The cCR was better seen in T1 (77.8%) than T2 (22.2%), with statistical significant difference (P=0.002). The cCR was better seen in N0 (61.1%) than N1 (38.9%), with a high statistical significant difference (P<0.0001). Conclusions. The commonest age breast cancer is four to five decade. The IDC and mass situated at UOQ are the most common features of BC. Approximately, 30.0% of women have clinical complete response (cCR), 53.3% have partial response (cPR), 10.0% have stable disease, and 6.7% have progressive disease post NACT. The ER positive, PR positive, and HER2neu negative are the mostly frequent subtype recorded in this study. The cCR is better seen in T1 and N0 stages. ER+ and PR+ are more reported after NACT whereas HER2neu- is more post NACT.

Changes in Serum Oncostatin M Levels During Treatment of Inflammatory Bowel Disease

Abstract Background Inflammatory bowel diseases (IBD) consist of Crohn’s disease (CD) and ulcerative colitis (UC). They are characterized by a chronic relapsing and remitting disease course that results in intestinal symptoms but also frequently in extra-intestinal manifestations. Among potential targets and biomarkers, oncostatin M (OSM) has gained a lot of interest. OSM is a pleiotropic cytokine produced by activated T cells, monocytes, macrophages, and neutrophils. It is considered proinflammatory given its ability to promote leukocyte recruitment. Objective To evaluate the changes in serum Oncostatin M levels during treatment of inflammatory bowel disease. Patients and Methods To elucidate this aim 30 IBD patients and 30 controls were included in this study. Results The mean Oncostatin M in IBD cases before treatment was 120.13 while after treatment was 91.17 with high significant difference. There was high statistical correlation in between Fecal Calprotectin Level after treatment and Oncostatin M After Treatment. The relation between UC, CD and Oncostatin level before and after treatment shows high statistical significant difference. There was no statistical relation in between Oncostatin level (after treatemnt) and type of treatment. That there was a high statistically significant difference in between cases and control group regarding to HB, WBCs, ESR, CRP, Urea, ALT, Oncostatin M and a statistically significant difference in between cases and control group regarding to Platelets. Conclusion Oncostatin M is a promising marker for the diagnosis and follow up of IBD patients, however it has a limited predictive performance for the prediction of the response for IBD treatment.

Autoimmune thyroiditis in psoriatic disease

Objectives. To assess autoimmune thyroiditis prevalence in subclinical and clinical psoriatic arthritis (PsA). Materials and methods. 45 female adult Egyptian patients with psoriatic disease were classified into 3 equal groups: PsA, subclinical PsA, and psoriasis. A full assessment was done including Health Assessment Questionnaire, Psoriasis Area Severity Index (PASI), Leeds Enthesitis Index (LEI), PsA disease activity score (DAPSA), MAdrid Sonographic Enthesitis Index (MASEI), thyroid hormones (TSH, FT4, and FT3), thyroglobulin and thyroid peroxidase antibodies (Tg and TPO Abs), and thyroid ultrasound. Results. Thyroid abnormalities prevalence was: 33.3% with subclinical hypothyroidism, 80% with positive TPO Ab, and 46.7% with positive Tg Ab in PsA group, 26.7% with subclinical hypothyroidism, 60% with positive TPO Ab, and 33.3% with positive Tg Ab in subclinical PsA group and none in psoriasis group. PsA patients had higher TPO Ab levels compared to psoriasis patients with high statistical significant difference and lower FT3 levels compared to psoriasis patients with statistical significant difference. In subclinical PsA group, MASEI was positively correlated with TPO Ab with high statistical significance and with FT3 and Tg Ab with statistical significance, FT4 was negatively correlated with LEI with high statistical significance, and FT4 was correlated with PASI with statistical significance. In PsA group, TPO Ab was correlated with DAPSA with statistical significance. Conclusions. Autoimmune thyroiditis is more common in PsA than subclinical PsA patients. PsA patients are advised to be tested for TPO and Tg Abs. Musculoskeletal ultrasound is a screening tool to detect enthesitis in psoriasis patients.

The Effect of Thrombocytopenia in COVID-19 Patient in Comparison with Patient with Normal Platelets Count

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a novel coronavirus disease 2019 (COVID-19), which spreads rapidly around the world17.Changes in platelet count are common in COVID-19 patients. The platelet count is a sensitive indicator of illness severity that is of great clinical utility to monitor a quickly changing health condition of patients affected by aggressive viral infections.18 Aim of the Work study thrombocytopenia as a prognostic factor in covid 19 patient and it’s relation with length of hospital stay and prognosis Patients and Methods A total of 60 COVID-19 patients were involved in the prospective study during the period from June 2020 to December 2020 who were admitted isolation hospital, Ain Sham University Hospitals. then for each patient, CBC at admission was done, repeated at day 7 from the start of symptoms, day 14 and day 21. all patient didnot recieve anticoagulation. patients were followed regarding length of hospital stay and Mortality. Results Out of 60 patients, 19 patients (31.7%) were thrombocytopenic.The length of hospital stay was significantly higher in thrombocytopenic group. There was high statistical significant difference between normal platelets count group and thrombocytopenic groups regarding outcome (P value <0.001).in thrombocytopenic patients, 5 (50%) showed deterioration, 4 (40%) patients died and one patient in this group showed complete recovery. Conclusion Thrombocytopenia is associated with increase length of hospital stay and poor prognosis in patients with COVID-19.

Role of Circulating Ectodysplasin A as a Biomarker in Non-Alcoholic Fatty Liver Disease

Abstract Background The liver is a dynamic organ that plays critical roles in many physiological processes, including the regulation of systemic glucose and lipid metabolism. Dysfunctional hepatic lipid metabolism is a cause of nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disorder worldwide, and is closely associated with insulin resistance and type 2 diabetes. Objective To study serum level of Ectodysplasin A in patients with non-alcoholic Fatty Liver disease (NAFLD) to detect its relation to the incidence and severity of non-alcoholic Fatty Liver Disease (NAFLD). Patients and Methods Type of Study: Case-Control clinical study. Study Setting: Internal medicine and hepatology outpatient clinic at Ain Shams University Hospital Study period: this is a 6-month study period starting from July 2020 till January, 2021. Results There was a significant difference in between the two groups regarding to platelet, ALT, AST, GGT and albumin. The mean Ectodysplasin A was 337.54 ± 196.63 (pg/ml) in NAFLD group and 221.43 ± 115.89(pg/ml) in control group with high statistical significant difference in between. There was a significant positive correlation in between Ectodysplasin A and Weight, BMI, WC (cm), FPG, HbA1c and LDL-C in NAFLD group. Conclusion Ectodysplasin A level is elevated in NAFLD patients than in control. Ectodysplasin A level could be used as an inflammatory biomarker for the prognosis of patients NAFLD. Therefore, measurement of Ectodysplasin A level provides a new strategy to more aggressive treatments for high-risk groups.

The Role of Extra Corporeal Shockwave in Treatment of Trigger Finger

Background Trigger finger, or stenosing tenosynovitis, is a condition where the normal smooth gliding of the flexor tendons through the fibrous tendon sheath of the digit is altered. Inflammation where the flexor tendon enters the sheath leads to either thickening of the fibrous pulley and/or inflammation or nodular enlargement of the tendon. This enlargement of the tendon results in locking and clicking symptoms of the affected finger, Treatments for trigger finger in order of invasiveness include splinting, NSAIDs, physical therapy, corticosteroid injections, and surgical release of the tendon sheath. Ultrasound allows for noninvasive visualization of the soft tissues, and also provides good depiction of annular pulleys and flexor tendons; the extracorporeal shock waves are defined as sound waves that can maximize the pressure of the target tissue over a few nanoseconds.Recently, extracorporeal shock wave therapy (ESWT) has been proposed as an alternative treatment in patients not responding to conservative treatments. Currently, extracorporal shock wave therapy (ESWT) has been widely used in tendinopathies, including trigger fingers with high success rate, while the complications are low and can be neglected. Objective To evaluate the efficiency of shockwave therapy in the treatment of trigger finger. Patients and Methods This prospective single-center study was carried out on 15 patients (aged 53.133± 9.039 years, 66.67% females and 33.33% males) complaining of symptomatic trigger finger. 6 sessions of ESW therapy were given to all patients with one week interval. Before and after treatment with ESWT sessions, scoring was done to all patients using Numerical Pain Rating Scale (NPRS), Quick Disability of Arm, Shoulder and hand score (Quick DASH), Range of motion assessment of fingers: Active and passive. MSUS was done for all patients before starting the sessions for accurate diagnosis and was repeated one month after patients had finished 6 sessions of ESWT as an assessment tool. Results Our patients showed a high statistical significant difference after one month follow up regarding the numeric pain rating score (NPRS), the Quick DASH score, range of motion (Active Flexion MCP of affected finger), Green`s classification, locking and snapping, thickness of A1 pulley & synovial thickness. Before ESWT sessions, we found that duration of pain was correlated positively with thickness of A1 pulley and negatively with ROM “Active Flexion MCP”. Also ROM “Active Flexion MCP” correlated negatively with thickness of A1 Pulley. Thicknesses of synovial membrane was positively correlated with NPRS and Quick DASH score. After ESWT sessions, ROM “Active Flexion MCP” was correlated negatively with and thickness of A1 pulley. Thicknesses of synovial membrane was positively correlated with NPRS, Quick DASH score and thickness of A1 pulley, But it was negatively correlated with ROM “Active Flexion MCP”. Conclusion We concluded that ESWT is an effective method for treatment of trigger finger and is non invasive compared with surgical treatment. It improves pain, finger ROM and thickness of synovial membrane. We also concluded musculoskeletal ultrasonography is helpful for objectively understanding the severity of trigger finger and its response to treatment, by examining the thickness of the flexor tendon and A1 pulley.

Detection of NCF-1 Gene Expression as a Diagnostic Tool for Autosomal Recessive Chronic Granulomatous Disease among Egyptian Children with Phagocytic Dysfunction

Abstract Background Chronic granulomatous disease (CGD) is an inherited primary immunodeficiency disorder caused by functional impairment of the nicotinamide dinucleotide phosphate (NADPH) oxidase complex in neutrophilic granulocytes and monocytes and characterized by recurrent and severe infections, dysregulated inflammation and autoimmunity. Aim of the Work To diagnose the autosomal recessive (AR) type of CGD among a group of Egyptian pediatric patients with phagocytic dysfunction by detection of Neutrophil Cytosolic Factor-1 (NCF-1) gene expression using reverse transcription polymerase chain reaction (RT-PCR) and to correlate it with other diagnostic tests. Subjects and Methods A case-control study was conducted on 15 provisionally diagnosed CGD pediatric patients (Group I) by the use of DHR test, with the stimulation index using PMA < 30%. They were recruited from different university hospitals in Egypt. The study also included 12 mothers of the studied patients to detect the genetic mutations in carriers, if any, (Group II) and 14 apparently healthy children as a control group (Group III). Full medical history was taken and thorough clinical examination was done. The selected groups underwent testing for phagocytic and lytic indices, measurement of NCF-1 gene expression by real time RT-PCR. Results The comparative statistics between group I and group III as regards the phagocytic index (PI) revealed a high statistical significant difference between both groups. In addition, a statistically significant difference between both groups as regards lytic index (LI) was also revealed. Correlation studies were done between fold change of NCF-1 gene expression and each of PI, LI and DHR and showed no significant statistical correlation between these parameters in the 3 studied groups. Cases with a fold change of NCF-1 gene expression less than 0.48 (cut-off value calculated by the 25th percentile fold change of the control group), are considered having defective NCF-1 gene expression. At this cut-off value 2 out of 15 CGD cases and 3 mothers out of 12 showed NCF-1 gene under-expression. Conclusion Assessment of NCF-1 gene expression which encodes p47phox by real time RT- PCR in the present study could detect defective gene expression only among two CGD children and their mother as well as two other mothers with no correlation to other studied parameters. Since CGD is a genotypically heterogeneous disease; the findings of the present study highlight the importance of molecular testing for diagnosis after screening for NADPH oxidase protein deficiency by flow cytometry.

Isolation insult during COVID-19 pandemic on the psychological status of medical students.

BackgroundCOVID‐19 is a newly discovered infectious disease that spread and caused a global health problem. Medical students, especially those in clinical stages are among groups exposed to the disease. The study aimed to show the impact of social distancing on the mental health of Iraqi medical students.MethodA convenient sampling technique involved 105 participants was obtained through a questionnaire. The participants were from all stages of College Of Medicine. Questions were regarding the mental health status of the students, which included sleeping hours, nightmares, eating habits, weight problems, relationship with the family, starting to have bad habits, memory loss, attention problems, irritability, and study rank affect.ResultsOf about 105 participants, 64 (60.9%) of them were females and 41 (39.1%) were males. The mean age of the participants was (21.26 ± 1.065) ranging from 19 to 24 years. Feeling stressful when hearing news about COVID‐19″ found in 82 (78.1%) of the participants. A high statistical significant difference (p = 0.035) among feeling isolated. About 77 (73.3%) of the participants had become easily irritable and angry. About 82 (78.1%) student started for having calculation problems. The stress with sleeping hours (p = 0.019), sleeping disturbance (p = 0.022), eating habit (p = 0.015), weight problems (p = 0.002), fear of familiar places (p = 0.004), recent memory loss (p = 0.034) and being easily irritable or angry (p = 0.0001), revealed a statistical significant association, respectively.ConclusionCOVID‐19 news and social distancing had made medical students more stressed and irritable, affecting their sleeping hours and pattern with a general tendency for weight gain and recent memory loss in stressful students.

Effect of an education program on nurses' knowledge regarding pregnancy induced hypertension at primary health care centers

Background: Pregnancy-induced hypertension is a major health issue in the obstetric population, as it is one of the leading causes of maternal and perinatal morbidity and mortality. The Present study aims to determine the nurses' knowledge, effect of education program about pregnancy induced hypertension, and find out the association between the effect of education program with their demographic characteristic such as (age, gender, level of education, year of experiences, and training course. Method: A quasi-experimental study design was carry out in the primary health care centers at Holy Karbala City between the periods 15th of November 2021 to 5th of April 2022. A non-probability (purposive) sample of (52) nurses were selected. Results: The results of the study indicated that there were high statistical significant difference between the pre and post-test of the education program related to the pregnancy induced hypertension. The study found no statistical significant association between the effects of the education program related to the pregnancy induced hypertension with the demographic characteristics. Conclusion: The study concluded that the education program had a positive impact on nurses’ knowledge concerning pregnancy induced hypertension. Recommendations: Recommendation, Continuous educational program to improve nurses’ knowledge regarding pregnancy induced hypertension.

The Efficacy of Health Education Program on Quality of Life among Menopausal Women

Background: Menopause is a life event that can profoundly affect quality of life among menopausal women. More than 80% of women report physical and psychological symptoms that commonly accompany menopause, with varying degrees of severity and life disruption. Aim of the study to evaluate the effect of educational program on quality of life among menopausal women. The study design: Aquasi experimental study design. Sample: was used purposive sample included 120 menopausal women. The study setting: study was conducted at outpatient clinics of the maternity hospitals affiliated to Ain Shams University hospitals. Tools: Two tools used for data collection, the first tool, an interview questionnaire which divided into four parts. The first for assessing socio demographic characteristics, the second for assessing menstruation history, the third for assessing Women’s knowledge about menopausal pre-posttest design to determine the effectiveness of educational program on women’s knowledge, the fourth for the assessment women’s reported practice toward menopausal symptoms pre-posttest design to determine the effectiveness of educational program on women’s practice toward menopausal symptoms. The second tools: menopausal quality of life assessment scale (MENQOL), for assessing menopausal women‘s quality of life by questionnaire. Results: The finding of this study proved the effect of the health educational program on quality of life among menopausal women through; high statistical significant between total score level of menopausal women and total practice score level pre/post educational program, High statistical significant difference between quality of life among menopausal women pre/ post educational program. Conclusion: Health educational program had positive efficient on improving menopausal women‘s knowledge and practice toward menopausal symptoms and improving quality of life among menopausal women. Recommendations: Increase women awareness about peri- menopausal period so reduce the severity of menopausal symptoms. Also further research addressing women's health needs is also essential for improving the quality of life

Evaluation of the Role of Hyaluronic Acid as a Potential Marker for Diagnosis of Non-Alcoholic Fatty Liver Disease

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide, ranging from simple steatosis and nonalcoholic steatohepatitis (NASH) to liver cirrhosis, with its complications including hepatocellular carcinoma (HCC). Aim of the Work to evaluate the efficacy and reliability of Hyaluronic Acid as a potential noninvasive biomarker for diagnosis and prognosis of NAFLD and to compare it with the traditional noninvasive techniques and if it can replace liver biopsy. Patients and Methods This cross-sectional study was conducted on 63 subjects from the Gastroenterology and Hepatology Department of Ain Shams University Hospital. They were divided into three different groups as following: a healthy control group, fatty liver and nonalcoholic steatohepatitis (NASH). All patients and controls were subjected to routine laboratory tests and serum Hyaluronic acid test. Results There were high statistical significant differences between groups as regard INR. Regarding to liver functions, there was a high statistical significant difference between groups as regard AST and ALT ,Bilirubin and Albumin.. Comparison between groups regarding to RBS, there was high statistical significant difference between groups as regard RBS. Comparison between groups regarding to lipid profile, there was high statistical significant difference between groups as regard LDL and cholesterol. Regarding to APRI and Fib4, there was high statistical significant difference between groups as regard APRI and Fib4. Regarding to H.A, there was high statistical significant difference between groups as regard H.A. The study shows that there is non-significant correlation between either APRI or Fib4 and H.A in fatty liver, and there is also nonsignificant correlation either APRI or Fib4 and H.A in NASH. Conclusion Hyaluronic Acid can be reliably used as an accurate and specific noninvasive biomarker for the diagnosis of Nonalcoholic fatty Liver Disease and staging of the severity of disease compared with the traditional known noninvasive scores

Role of Activin A as A Novel Marker for Diagnosis and Evaluation of Nonalchoholic Fatty Liver Disease

Background: Nonalcoholic fatty liver disease (NAFLD) is a disease gaining increasing interest worldwide. It ranges from simple nonalcoholic steatosis to nonalcoholic steatohepatitis (NASH), which is characterized by steatosis, inflammation and fibrosis, and may lead to liver cirrhosis and hepatocellular carcinoma. Objectives: To study the role of activin A, a member of the transforming growth factor (TGF) superfamily, in diagnosis and evaluation of non-alcoholic fatty liver disease (NAFLD). Patients and Methods: This study is a comparative case-control study. This study was carried out at Outpatient Clinics of Internal Medicine Department of Ain Shams University.The study included 90 patients that were divided into 3 groups. Group 1 thatincluded 35 patients with NAS (steatosis) with exclusion criteria of intake of hepatotoxic drugs, group 2 that included 35 patients with fatty liver and elevated liver enzymes (NASH) and group 3 that included 20 patients as a control group. Results: There was a high statistical significant difference between the studied groups as regards ALT, AST, total and direct bilirubin, plts count, activin A, and Albumin. There was a high statistical significant difference between the studied groups as regards APRI score and FIB-4. There was high correlation between activin A and BMI, APRI score, FIB-4 and liver size with high significance (p < 0.001). Using activin A, it was shown that above 858.5, it can discriminate between NAFLD and non-NAFLD with level of sensitivity 100% and specificity 100%. Conclusion: Serum activin A showed a trend towards progressive level increase from controls, to steatosis and NASH patients.

The Effect of Hemodiafiltration on Inflammatory Biomarkers in Comparison to High Flux Dialyzers in Prevalent Hemodialysis Patients

Abstract Introduction Inflammation in patients with ESRD undergoing HD is an increasing concern for physicians and has been related to increase the rates of morbidity and mortality. Interestingly, patients with ESRD in conventional HD have frequent infections and a suboptimal response to vaccines; this is probably related to an immune inflammatory disorder associated either with uremia and/or nutritional status. In addition to CRP, which seems to be the most important marker for the identification and control of inflammation in clinical practice, many other markers are also available for the evaluation of inflammatory state. Decreased renal clearance clearly accounts for higher levels of circulating cytokines, although increased production has also been described. Hemodiafiltration has been shown to improve cardio-protection and the immunologic system and reduces infection and mortality compared with conventional HD. A recent study showed that hemodiafiltration compared with conventional HD reduced the risk of mortality in ESRD patients. Analysis of pooled individual participant data from randomized controlled trials has shown survival benefits of high volume-HDF on all-cause mortality and especially cardiovascular mortality rate. The mechanisms that lead to improved outcomes are not clear, but it is thought that HDF may reduce the production of inflammatory mediators through the use of biocompatible dialysers and ultrapure dialysate and also improve clearance of larger molecular weight substances, many of which are associated with oxidative stress, inflammation and endothelial dysfunction. Objective The aim of this study is to detect, prospectively, the effect of 3 months dialysis with Hemodiafiltration on inflammatory and nutritional biomarkers in comparison to conventional dialysis with high flux dialyzer in stable HD patients. Patients and methods 30 adults aged 20-75 years who were selected from Dialysis Unit, Kobary El-Kobba Military Hospital. 30 male patients known to have chronic kidney disease and are on dialysis with high flux dialyzer more than 3 months were divided into 2 groups:15 Patients are shifted to be on dialysis with HDF and 15 Patients are continued to be on Regular Hemodialysis with high flux dialyzer. Full medical history and clinical examination. Anthropometric measurements and Laboratory investigations including Complete Blood Picture (WBCs, platelets, Hb), Coagulation profile PT, PTT&amp;INR, Liver function tests (ALT, AST, T. Bilirubin and S. Albumin), Lipid profile (Triglycerides, total cholesterol, VLDL), S. creatinine, BUN, Na, K, Uric acid, Total Proteins, Serum Calcium, Serum Phosphorus, PTH, Serum ferritin, High sensitivity CRP (Enzyme- Linked Immunosorbent Assay (ELISA)) and IL6 (ELISA). Results The current study was conducted on 30 patients with chronic kidney disease on regular dialysis. The patients were divided into two groups A representing patients on hemodiafiltration (n = 15) and group B representing patients on dialysis with high flux dialyzer (n = 15). A high statistical significant difference (P &amp;lt; 0.01) was found regarding K 4.3±0.6 meq/l in group A while it is 5.2±0.5 meq/l in group B, a high statistical significant difference (P &amp;lt; 0.01) was found regarding phosphorus 4.6±1.0 mg/dl in group A while it is 6.1±0.9 mg/dl in group B and no statistical significant difference (P &amp;gt; 0.05) was found as regard the uric acid. A statistical significant difference (P &amp;lt; 0.05) was found regarding CRP 63.5±40.9 mg/dl in group A while it is 73.4±33.2 mg/dl in group B, a statistical significant difference (P &amp;lt; 0.01) was found regarding IL6 85.3±37.6 mg/dl in group A while it is 156.7±151.9 mg/dl in group B after 3 months and no statistical significant difference (P &amp;gt; 0.05) was found as regard those inflammatory markers before 3 months. A statistical significant difference (P &amp;lt; 0.05) was found regarding CRP. A statistical significant difference (P &amp;lt; 0.05) was found regarding IL6. Conclusion The present study revealed that there was no significant change in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer before 3 months but there was a significant decrease in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer after 3 months.

Role of Musculoskeletal Ultrasound in Detection of Hemophilic Arthropathy

Abstract Background Hemophilia is an X-linked congenital bleeding disorder, with hemophilia A comprising the majority of cases and hemophilia B. Von Willebrand disease (VWD) is a bleeding disorder of variable severity, caused by deficiency of von Willebrand factor (VWF) especially type III. The severe form of the bleeding disorders is characterized by spontaneous hemoarthrosis which occurs mainly in large synovial joints and results in hemophilic arthropathy (HA) that is characterized by soft tissue changes such as synovial hypertrophy and effusion as well as cartilage and bony damage., MRI is the gold standard, however ultrasound (US) was proven to be a sensitive tool in detecting synovial hypertrophy with results comparable to MRI, as well as differentiate between hemoarthrosis and arthritis-metiated joint pain, together with having more advantage to the MRI, making it an excellent tool in assessing disease activity. Objective To describe the value of MSK ultrasound in assessment of intra-articular findings in hemophilic arthropathy (HA) in the pediatric age group. Methods A descriptive, cross-sectional study that included 120 joints in 20 patients with bleeding disorders, (moderate or severe hemophilia A/B or vWD). Evaluated joints included elbows, knees and ankle joints on both sides for every patient. One additional patient was evaluated for a hip joint affection. The abnormal US findings among the involved joints were compared to the sonographically-normal contralateral side. We excluded patients with recent joint surgeries, those who have any other rheumatological disease. Results Out of the 120 joints examined, 28 joints showed US abnormal findings. The knee was the most common involved joint (75%), followed by the ankle (30%) then the elbow (15%). The most frequent US lesion was synovial hypertrophy (82%), followed by joint effusion (78.6%), synovial hyperemia (53%) and lastly comes the ostochondral lesions (7.1%). Other juxta-articular findings were reported as myositis, tenosynovitis and intra-/intermuscular hematoma. Hemoarthrosis was found in 6 out of 16 knee joints, 2 out of 7 ankles, yet no elbow nor hip joint bleedings were reported. There was a significant correlation between the incidence of synovial thickening, bone and cartlage damage and bleeding incidence and increasing age. A high statistical significant difference was found between the normal and abnormal joints (by US) and especially the knee and ankle joints. Conclusion MSK US has now emerged as a promising imaging modality for the early detection and management of HA, and for the evaluation of hemarthrosis and painful MSK episodes in hemophilic patients. It has a high efficacy in assessment of the soft tissue abnormalities such as synovial hypertrophy, vascularity and joint effusion, as well as late-onset degenerative changes. Global standardization of the different US scoring systems and clear definitions of the US pathologies in HA are needed with high-level MSK US training practice as well, for accurate assessment of HA using US.

Comparison between Early Results of Laparoscopic Mini Gastric Bypass and Sleeve Gastrectomy regarding Weight Loss, Remission of Type II Diabetes Mellitus and Hypertension

Abstract Background Bariatric Surgery leads to a dramatic improvement in morbid obesity and associated type 2 Diabetes Mellitus (T2DM) and hypertension. Objectives The aim of the study was to compare between early results of Laparoscopic Mini Gastric Bypass and Sleeve gastrectomy regarding excess weight loss, remission of Type II diabetes mellitus and hypertension. Patients and Methods Type of the study, retrospective study. study setting, Our study was carried out at The General Surgery Department Ain Shams University Hospitals. study period,. All cases were operated during the period February and march 2019. Follow up of patients 6 months after operation was done (retrospective study). Last follow up was done on September 2019. The study included 50 patients aged 18-60 years with Type II Diabetes Mellitus and hypertension of at least 6 months duration, BMI 35 65 kg/m2 for at least 5 years. Results In this study There was no statistical significant difference between studied groups as regard age,gender,and baseline clinical data. there was a statistical significant difference between patients in LMGB group as well as between patients in LGS group before and six months after surgery as regard weight in kg, BMI and HbA1C and.remission of hypertention (P value 0.000). there was high statistical significant difference between studied groups as regard percentage of change of weight and BMI(P value 0.000) However, there was no statistical significant difference between studied groups as regard percent of change of HbA1C. (P value 0.613),remission of T2DM.(p value 0.123 ) and control of hypertension. (p value 0.136 ). Further results and data could be reached on long-term follow up of patients involved in this study. Conclusion Patients receiving mini-gastric bypass had more advantageous indexes than patients receiving sleeve gastrectomy, such as higher six months EWL% (excess weight loss), higher T2DM remission rate and higher hypertension remission rate. Especially on long term follow up and that was proved by meta analysis of previous studies but on short term follow up there is no statistical singnificant difference between both studied groups except in percentage of change of weight and BMI. Mini-gastric bypass is simple, safe and more effective bariatric procedure than laparoscopic sleeve gastrectomy.

Comparison Of The Prevalence Of Helicobacter Pylori Infection in Patients With Ulcerative Colitis Versus Normal Egyptian population

Abstract Background The prevalence of inflammatory bowels diseases (IBD) increases in societies adapting a Western life style. Thus, it appears that there is an inverse relation between the prevalence of IBD and H. Pylori infection. Aim To compare the prevalence of H. Pylori Ag in stool between Ulcerative colitis patients and a normal healthy Egyptian sample. Patients and methods The current study was conducted on 70 patients recruited from the IBD study group clinic in Tropical medicine department of Ain Shams University Hospitals .This study group was compared to historical Control samples of healthy Egyptian subjects who were retrieved from a previously conducted study (saad et al.,2008). The enrolled patients fulfilled the inclusion and exclusion criteria and were divided to two groups o Study group: All patients who were diagnosed with U.C. based on clinical history, laboratory and endoscopic finding according to ECCO 2017 guidelines (Sandro et al., 2017). o Control group: Historical Control samples from healthy Egyptian subjects. Both groups were compared according to basal epidemiologic data and H. pylori Ag in stool positivity, gastrointestinal symptoms, colonscopic and microscopic findings, mainstay treatment lines of U.C., biological therapy and criteria of disease activity . Results Most of the enrolled patients in the current study were aged between 20-39 years with 48.6% aging between 20-29 years old and 38.6% between 30-39 years. While the majority of the cases were females (62.9%), only 11.4% of the included cases were smokers . We found that of the 70 patients in the cases group with ulcerative colitis, only 34 (48.6%) had positive H. pylori versus 555 reported positive samples in control group (91.7%). So there was a high significant statistical difference between the 2 groups Conclusion There is a significant association between H. pylori infection and ulcerative colitis that supports a possible protective benefit of H. pylori infection against the development of U.C. but still further studies are needed

Effect of Intravenous Dexamethasone on the Duration of Labor Induction: A Randomized Controlled Trial

Abstract Background Induction of labor is one of the most common interventions practiced in modern obstetrics. In the developed World, the ability to induce labor has contributed to the reduction in maternal and perinatal mortality and morbidity. Aim of the work to establish whether Dexamethasone plays a role in shorting the duration interval between initiation of labor induction and beginning of true contraction of labor in post-term pregnancy, so shorting the duration of labor. Patients and Methods This randomized controlled trial study was conducted in the labor ward of Ain Shams University Maternity Hospital on one hundred thirty five pregnant women with full term pregnancy divided into the following: Group I (Dexamethasone group) injected with 2 ml (8 mg) of the product (dexamethasone) 4 hours before initiation of labor induction and Group II (Control group) received 2 ml saline (as a placebo). Results There was a non-significant statistical difference between the two studied groups as regards the age, gestational age on admission, body mass index (BMI), Bishop Score, mode of delivery and Apgar score. There was a high significant statistical difference between the two studied groups as regards Induction- delivery interval, induction-contraction, contraction – delivery interval were shorter in cases of study than control. Conclusion From the above data we can conclude that the intravenous administration of dexamethasone appear to shorten labor duration.

Accuracy of Optic Nerve Sheath Diameter Measurement as a Predictor of Intracranial Pressure in Traumatic Brain Injury

Background: Ultrasound assessment of optic nerve sheath diameter (ONSD) has been used as a promising tool to aid in the diagnosis of elevated intracranial pressure (ICP). Optic nerve sheath is contiguous with the dura matter surrounding the brain and contains cerebrospinal fluid, which allows transmission of pressure from the cranium. Objective: To determine the diagnostic accuracy of measurement of ONSD by using ocular ultrasonography to detect elevated ICP in patients with TBI in Emergency Department. Patients and methods: This prospective cross-sectional observational study that was carried out on 99 patients presented and admitted to Mansoura University Emergency Hospital with traumatic brain injury (TBI) over a year from June 2020 to June 2021. Results: The clinical features of raised ICP had low specificity (38%), positive predictive value (PPV) (61.7%), and accuracy (69%) for diagnosis of raised ICP with high significant statistical difference (62% vs 100%) towards group 2. The ONSD were much higher (P 5 mm with sensitivity of 100 %, specificity of 96%, and accuracy of 99%. The optimal cutoff value to predict mortality rate was >6.8 mm with modest sensitivity and accuracy. While the optimal value to predict unfavorable Glasgow Outcome Scale (GOS) was >6.05 mm with high sensitivity and accuracy. Conclusion: ONSD measurement via bedside ocular ultrasound is a useful, non-invasive method for early diagnosis of elevated ICP in adult patients with TBI in the Emergency Department.

Assessment of Hepatic Steatosis Before and After Treatment In Egyptian HCV Patients Treated With DAAs Using Non Invasive Parameters

Abstract Background Hepatitis C virus (HCV) is a major health problem worldwide. More than one million people die each year from hepatitis C virus (HCV) related diseases. Aim of the Work to evaluate the effect of direct acting antiviral drugs on hepatic steatosis in naïve HCV chronically infected Egyptian patients after reaching SVR12. Patients and Methods study was carried out on 100 treatment naive patients with chronic infection of HCV attending the out-patient clinic. The patients were diagnosed having HCV by detecting HCV antibodies by ELISA &amp; PCR for HCV RNA at The Gastro-enterolgy and Hepatology Department, Ain Shams University and Kobry El Koba Military Hospital between August 2017 till February 2019. Results The mean TG, mean s. cholesterol and APRI Score decreased significantly showing a high statistical significant difference between baseline and SVR12. The mean HDL and LDL significantly increased showing a high statistical significant difference between baseline and SVR12. NAFLD Score increased from baseline to SVR12 showing a statistical significant difference in NAFLD Score between baseline and SVR12. Fibroscan median mean decreased showing a highly statistical difference in Fibroscan Median between baseline and SVR12. Out of 100 patients, cirrhosis regressed to F3 in 33 patients, F2 in 3 patients and didn’t regress to F1 in any patient, while the majority (43 patients) remained as F4 at SVR12. Conclusion APRI Score mean and Fibroscan median mean were significantly decreased, while NAFLD Score was increased among the studied groups from baseline and SVR12.

Effectiveness of Educational Package Regarding Knowledge of Somatic Symptom Disorders among Adolescent Girls- A Pre- Experimental Study

Objective : This study was undertaken to assess the effectiveness of educational package regardingknowledge of Somatic symptom disorders among adolescent girls.Methods : 75 adolescent girls were selected by using non probability convenient sampling technique. Thedata was collected by using a reliable and validated tool to assess the knowledge regarding Somatic symptomdisorders.Results : The quantitative assessment of knowledge regarding Somatic Symptom Disorders revealed thatafter administration of educational package, 56 (74.67%) adolescent girls had average knowledge and19 (25.33%) adolescent girls had adequate level of knowledge. There was significant difference betweenknowledge in pre testand post test after administration of educational package. Also, thepost test knowledgewas statistically associated with educational level of father of adolescent girls (0.043), educational level ofmother of adolescent girls (0.046) and occupation of mother of adolescent girls (0.003). The study revealedthat, the pretest mean score value of knowledge was 9.52 with standard deviation (SD) of 2.21 and thepost-test mean score value of knowledge was17.00 with SD of 4.01 with a mean difference of 7.48.Thecalculated-t value was 13.87. This indicated that there was a high statistical significant difference in the preand post test knowledge level regarding Somatic symptom disorders among adolescent girls, p value 0.05.Conclusion: Results of this research generates evidence that educational package regarding knowledge ofSomatic symptom disorders among adolescent girls was effective.