Kasr Al-Ainy Hospital Research Articles

Prevelance and risk factors of female sexual dysfunction in females attending infertility clinic at Kasr Alainy hospital: a cross-sectional descriptive study

Background: Female sexual dysfunction (FSD) is a common health problem that is inadequately investigated in Egypt. Sexual problems are reported by approximately 40 percent of females worldwide. There is a strong relationship between FSD, quality of life and infertility. Objective: The aim of this study is to assess the prevalence of female sexual dysfunction and also to investigate possible risk factors that may cause sexual dysfunction in the Egyptian infertile women seeking fertility Patients and Methods: This cross-sectional clinic-based survey was conducted at the infertility clinic, in Kasr Al-Ainy Hospital, Cairo, Egypt from October 2023 to February 2024. During this study, 186 women were enrolled and asked to answer the validated Arabic version of the Female Sexual Function Index and World Health Organization Quality of Life Questionnaire- Brief that were provided by female investigators. Results: 186 females were included in our study. The prevalence of FSD was 56 females (30.1%) while 130 females (69.9%) had good sexual function with FSFI >28.1. Also, patients with sexual dysfunction had mean value of QoL that was (38.5±8.7) while females with good sexual function had mean value of QoL that (64.2±11.2) respectively. We found that the most frequent risk factors of female sexual dysfunction were advanced maternal and paternal age, no maternal occupation, duration of marriage <5 years, nulliparous women ,maternal obesity, timed intercourse and number of IVF trials. On the other hand, no relations were reported between female sexual dysfunction and family income, residence, menstrual Rhythm, associated chronic medical diseases, drug intake, contraception, vaginitis, mode of delivery, circumcision and previous episiotomy. Conclusion: FSD is a major health problem that affect 30.1% of women attending infertility outpatient clinic in Kasr Alainy Hospital and greatly affected their quality of life.

Laryngeal mask airway versus endotracheal tube during percutaneous dilatational tracheostomy in critically ill adult patients

BackgroundOne of the most often used bedside surgical techniques in critical care units (ICUs) for critically ill individuals who need prolonged mechanical ventilation is percutaneous dilatational tracheostomy (PDT). Numerous difficulties may arise from puncturing the esophagus or making a false passage during surgery.ObjectivesTo compare the use of laryngeal mask airway (LMA) and endotracheal tube (ETT) during PDT guided by ultrasonography (US) or bronchoscopy.MethodsOur study was a prospective cohort of 120 patients admitted to the Critical Care Department at Kasr Alainy Hospital and Damanhur Medical National Institute between March 2020 and November 2021. Hemodynamics, arterial blood gasses, complications, and outcomes of the patients were recorded.ResultsThe studied patients were divided into the ETT and LMA groups (60 patients in each group). Then, each group was subdivided into two subgroups (ETT-US, ETT-Bronch, LMA-US, and LMA-Bronch; 30 patients in each subgroup) according to the guiding procedure used for puncturing the trachea: US-guided or bronchoscopy-guided. Regarding HR, there was no statistically significant difference between the two groups or four subgroups before, during, and after the procedure. In addition, there was no statistically significant difference between the two studied groups regarding MAP before the procedure. However, during and after the procedure, MAP was significantly higher in the ETT group. There was no discernible change in oxygen saturation or PaO2 before, during, or after the procedure. However, there was no discernible difference in PaCO2 levels before and after the procedure; it was much greater in the ETT group and ETT-Bronch subgroup during the process. Furthermore, there was no statistically significant variation in the number of punctures between the two groups or the four subgroups. The length of the process varied significantly across the two major groups and the four evaluated subgroups. The LMA group had the shortest procedure duration (5.05 ± 1.28 min), the LMA-Bronch subgroup (4.79 ± 1.42 min), and the LMA-US subgroup (5.31 ± 1.10 min), while the ETT had the longest procedure duration group (5.86 ± 1.11 min), the ETT-Bronch subgroup (6.09 ± 1.23 min), and ETT-US (5.63 ± 0.94 min). Regarding complications, there was no considerable difference between the two groups or four subgroups except aerophagia. Aerophagia was considerably more common in the LMA group (7 candidates) and was not observed in the ETT group.ConclusionsOur study concluded that the laryngeal mask airway improves ventilation during percutaneous dilatation tracheostomy, especially when used with ultrasound, and thus can be used for candidates with traumatic brain injury and brain edema.

Calcaneotalotibial arthrodesis by retrograde intramedullary nailing for Charcot osteo-neuroarthropathy of the foot and ankle

Background The Charcot’s foot and ankle presents a significant and complex clinical challenge for foot and ankle surgeons. Neuropathic arthropathy of the foot and ankle is a degenerative deformity that gradually worsens over time. It is most frequently observed in individuals with diabetic neuropathy. Aim and objectives To evaluate the efficacy, advantages, and disadvantages of calcaneotalotibial arthrodesis by retrograde intramedullary nailing for Charcot osteo-neuroarthropathy of the ankle. Patients and methods This prospective research was done on 20 cases with Charcot osteoarthropathy of the ankle using calcaneotalotibial interlocking nails at Helwan University Hospital, Al Helal Hospital, Boulak El Dakror General Hospital, and Kasr Al Ainy Hospital during the period between January 2021 and January 2022. Results Patients had both types of diabetes mellitus. As regard complications, they occurred in seven (35%) patients as follows: one patient had an intraoperative distal tibial crack during nail introduction, two patients had loosening of proximal screws and infection, three patients had skin infection at the site of distal screws, and one patient had deep infection improved with parenteral antibiotics. There was a statistically significant improvement in the American Orthopedic Foot and Ankle Society score among the studied patients with a P value less than 0.001. Conclusion We observed a satisfactory result in the treatment of severe abnormalities of the ankle and hind foot in Charcot neuroarthropathy utilizing the retrograde intramedullary arthrodesis nail. The transcalcaneal retrograde intramedullary represents a safe and efficacious fixation option.

Antimicrobial resistance patterns among critical priority pathogens in an intensive care unit at a tertiary hospital in Egypt: a descriptive analysis comparing pre- and COVID-19 eras.

Background. The intensified global challenge of antimicrobial resistance, set against the backdrop of the COVID-19 pandemic, is a cause for major concern. Within healthcare settings, intensive care units are recognized as focal points for Gram-negative infections. The study pursued to assess the prevalence and antimicrobial resistance patterns of critical priority pathogens (Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacteriaceae, comprising Klebsiella pneumoniae and Escherichia coli) during both pre- and COVID-19 periods.Gap Statement. The decision to explore this topic stemmed from the urgent need to understand how the exceptional healthcare crisis of COVID-19 affected AMR patterns.Methods. This was an observational retrospective analysis of 1056 clinical specimens obtained from 950 patients who were admitted to the Medical Intensive Care Unit at Kasr Al-Aini Hospital, Cairo University, Egypt.Results. In the period before COVID-19, 342 pathogenic isolates (135 K. pneumoniae, 83 P. aeruginosa, 76 A. baumannii and 48 E. coli) were obtained from samples collected from 450 patients. Conversely, during the COVID-19 period, 714 isolates (237 K. pneumoniae, 205 A. baumannii, 199 P. aeruginosa and 73 E. coli) were collected from the same number of patients. In the course of the pandemic, there is a slight increase in A. baumannii and P. aeruginosa infections, whereas E. coli and K. pneumoniae exhibit a distinct trend with a noticeable reduction in infection rates during COVID-19. During the COVID-19 period, a noticeable rise in resistance rates was observed for all antibiotics utilized. The results from Fisher's exact test indicated a substantial increase in resistance towards certain antibiotics. Specifically, a significant rise in resistance was observed for E. coli to ciprofloxacin (P = 0.00), gentamicin and P. aeruginosa (P = 0.02), levofloxacin and A. baumannii (P = 0.01), piperacillin-tazobactam and A. baumannii (P = 0.04), and piperacillin-tazobactam and P. aeruginosa (P = 0.01).Conclusion. Our results display how the pandemic impacted bacterial infections and antibiotic resistance, indicating a general increase in resistance rates. These findings are crucial for guiding healthcare practices, emphasizing the need for continued surveillance and potentially checking antibiotic usage schemes.

Role of exhaled carbon monoxide in assessment of chronic obstructive airway disease severity

BackgroundChronic obstructive pulmonary disease (COPD) is a critical public health issue. Spirometric measurements are used to diagnose chronic obstructive lung disease, as per the guidelines of the GOLD initiative. Post-bronchodilator forced expiratory volume in 1 s (FEV1) is a predictor of mortality from COPD and helps to classify the disease’s severity. Smoking contributes to the high levels of exhaled CO. Evidence suggests that the exhaled CO level in COPD patients varies with degree of blockage and can be used to assess treatment response. Estimating the exhaled CO level can help assess airway inflammation and severity of airflow obstruction in individuals with COPD.AimEvaluate role of exhaled CO in assessment of severity of COPD.Materials and methodsThis cross-sectional study included 132 patients who visited the outpatient clinics or were admitted to the Chest Department, Kasr Alainy Hospital, Faculty of Medicine, Cairo University. The study participants were divided into three groups: group 1 nonsmoker healthy control, group 2 smoker non-COPD, and group 3 smoker COPD which further divided according to GOLD 2023 into mild, moderate, and severe COPD. The smoking status, exhaled CO, and spirometry test including FEV1/FVC and FEV1 were measured for each patient.ResultsExhaled CO was significantly increased in the smoker group (mean 9.69, SD 3.11) compared to the nonsmoker group (mean 2.19, SD 0.98) with p-value < 0.001. Exhaled CO was also statistically significantly higher in the smoker COPD group (mean 10.45, SD 3.03) compared to the smoker non-COPD group (mean 7.05, SD 1.56) with p-value < 0.001. Although exhaled CO was increased in the severe COPD group compared to the mild and moderate group, there is no statistically significant difference between them.ConclusionExhaled CO is a fast, sensitive, noninvasive, and well-established method test that can be used to identify smokers from nonsmokers with 98.9% sensitivity at 4.5 cutoff value. Also, exhaled CO levels in COPD patients vary with different degrees of airway obstruction.

Prevalence and risk factors of female sexual dysfunction in low-risk women attending gynecology clinic at Kasr Alainy hospital: a cross-sectional study

Background: In Egypt, research on female sexual dysfunction, a prevalent health issue, is insufficient. Sexual dysfunction can develop later in life following a period of normal sexual functioning, or it can be an issue from the beginning of sexual activity. Objective: The purpose of this research is to determine the prevalence of female sexual dysfunction and to look into potential risk factors that could lead to it in Egyptian women. Methodology: This cross-sectional clinic-based survey trial was carried out at the Kasr Alainy gynecology outpatient clinic. 400 women were enrolled in the research after giving their consent, and data was gathered using a structured questionnaire, in which each participant was asked the same questions in the same sequence and manner throughout the interview. The validated Arabic version of the World Health Organization Quality of Life Questionnaire-Brief, which was provided by female investigators, was given to the participants to complete. Results: Prevalence of female sexual dysfunction was 63% (252 females). Sexual dysfunction was statistically significantly higher among women aged between 35-45 years, with low educational level, no occupation, cases with low family income, residents of rural areas and duration of marriage &gt;10 years. We noted highly statistically significant association between sexual dysfunction and nullipara, previous episiotomy, repeated CS, circumcision and no contraception and vaginitis or cervicitis. Conclusion: Two thirds of women who visited the Kasr Alainy Hospital's gynecological outpatient clinic had female sexual dysfunction, a serious health issue that affected their quality of life.

Association of low vitamin D level and full-term early-onset neonatal sepsis; a case-control study

BackgroundSepsis is one of the main causes of death in newborns worldwide. Vitamin D levels during fetal and neonatal periods have a significant role in the development of the immunological system. The study aims to evaluate the association between vitamin D levels and the risk of early-onset neonatal sepsis in full-term neonates in a developing country.MethodsThis case–control study was conducted at the Neonatal Intensive Care Units (NICUs) of Kasr Alainy Hospital, Cairo, Egypt. The study was composed of two groups; the sepsis group involved full-term neonates appropriate for gestational age with sepsis-related clinical signs. The control group included newborns with no signs of clinical/laboratory infection within 72 h of life. Blood samples were collected on admission during the first three days of life in both groups for the measurement of 25-hydroxyvitamin D levels, Complete Blood Count (CBC), C reactive protein (CRP), and blood culture.ResultsForty-five newborns with clinical and laboratory findings of early-onset neonatal sepsis within 72 h of life were enrolled, and the control group included forty-five newborns with no evidence of sepsis. Vitamin D levels in the sepsis group were significantly lower than in the control group. Apgar score at the first minute was significantly lower in the sepsis group. 57.8% of neonates with sepsis had positive blood cultures. There was a statistical difference between deficient, insufficient, and sufficient vitamin D levels regarding the duration of the NICU stay, which was longer in neonates with deficient vitamin D levels. CRP was significantly higher in neonates with deficient vitamin D levels. The area under the receiver operating characteristic curve for serum vitamin D in the prediction of neonatal sepsis was 0.76 at a cutoff < 19.7(ng/ml).ConclusionIn the current study, full-term newborns with EOS had considerably lower vitamin D levels than healthy controls. Through appropriate vitamin supplementation of the mothers during pregnancy, it could be possible to ensure adequate vitamin D levels for newborns. This may contribute to the reduction of the risk of EOS, together with the other well-known preventive measures (i.e. breastfeeding and intrapartum antibiotic prophylaxis).

Language profile of children with cochlear implants: comparative study about the effect of age of cochlear implantation and the duration of rehabilitation

PurposeThe analysis of different language domains and exploration of variables that affect the outcomes of cochlear implantation would help to document the efficacy of cochlear implantation and intervention programs. The aim of this work was to examine the language profile of children with Cochlear Implants (CI) and to assess the effect of age at the time of cochlear implantation and the impact of duration of rehabilitation on the development of linguistic abilities for cochlear implanted children.MethodsThe study was conducted on 46 Arabic speaking children using unilateral CI who are receiving regular post-cochlear auditory and language rehabilitation in the phoniatrics unit, Kasr Alaini hospital. A Proficient Preschooler Language Evaluation (APPEL TOOL) was applied for the assessment of different language domains.ResultsChildren who received post implant rehabilitation for ≥ 2 years showed significant improvement in all subtests' scores of APPEL tool than children who received same rehabilitation for ≤ 1 year. There was no significant difference of language scores between children who have received CI before age of 3 years and those who have been implanted after age of 3 years.ConclusionThis study showed that the language profile of CI children was beneficially affected by the longer duration of therapy post implantation.

Retrospective descriptive analysis of the demographic and clinicopathological presentation of breast cancer patients in Kasr Al-Ainy Hospital over 5 years

Background Breast cancer is the most common type of cancer and the second leading cause of mortalities among women. Early-stage diagnosis of breast cancer increases the chances of survival, and therefore, reduces mortality rates. A national initiative was implemented in Egypt in 2019 when women above the age of 18 years were granted free screening at 3538 healthcare units, and 114 hospitals nationwide. Objective To describe the sociodemographic factors and clinicopathological presentation of breast cancer among the patients presented to Cairo University Hospital over 5 years. Patients and methods We conducted a descriptive historical study at Kasr Al-Ainy Teaching Hospital of Cairo University, we retrospectively assessed all women with primary breast cancer diagnosed over 5 years during the period from the July 1, 2017 to the July 1, 2022. Data was collected from medical records, operative notes, radiology reports, and pathology reports from the database system of the Oncology Department of Cairo University Hospitals (Kasr Al-Ainy). The patient data is put into a spreadsheet that focuses on the demographic and clinicopathological characteristics of the patients (age, size of the tumor, side of breast affected, histopathology findings, imaging characteristics, immunohistochemistry, and TNM staging of breast cancer). Results We enrolled a total of 509 female patients who were screened for early detection of breast cancer during the past 5 years in general surgery, radio diagnosis, and oncology departments, Kasr Al-Ainy Teaching Hospital; they showed a mean age of 53.7±11.7 years and ranged between 26 and 88 years. In the current study molecular subtyping showed that 24.4% were Luminal A, 34% were Luminal B1, 19.4% were Luminal B2, 9.2% were HER2-enriched and 13% were triple-negative breast cancer subtype. We found that neoadjuvant therapy was prescribed for 190 (37.3%) patients, 36 (19%) of those patients achieved pCR, while the remaining patients had residual disease in the postoperative specimen. Conclusion We concluded that in our center, Egyptian females are diagnosed with breast cancer earlier compared with developed countries; however, the current study reports approximately the same percentages of molecular subtypes, rates of pCR, and metastatic disease at the time of presentation compared with developed countries.

Patient and Family Satisfaction with Intensive Care in a Mega University Hospital: An exploratory study

Background: Being admitted to the ICU is stressful for both patients and families, in addition to being very costly. Therefore, the ICU was chosen for conducting the study in this university hospital, the New Kasr Al-Ainy Hospital (NKHICU). This was the first such study. Objective: Identify NKHICU patient and family satisfaction to prioritize opportunities for quality improvement. Methods: This was health-system research, exploratory design. Work began by providing training for selected NKHICU administrative staff to help with data collection activities. Next, a well-prepared checklist was used to observe some quality dimensions. Finally, satisfaction was identified using two ICU-designed interview questionnaires for patients and family members who matched the eligibility criteria. Quantitative and qualitative findings were analyzed independently and combined in the discussion. The mean % satisfaction scores of the participants were calculated. The reliability of questionnaires was measured using Cronbach's Alpha. Results: The observation revealed 'excellent' results, except for some inconvenient conditions in the family waiting areas. The highest mean % score of patient and family satisfaction was for the neat appearance of NKHICU staff (96.4%, and 97.1%, respectively) and the continuous availability of nurses to respond to patient needs (94.7%, and 94.3%, respectively). The least mean % score of patient and family satisfaction was for the shortage of required drugs/supplies (51.5%, and 40.7%, respectively). The top suggestions raised by the participants were increasing the availability of medications/supplies and reduction in hospital bills. Conclusion: The provision of adequate drugs/supplies, reduction in bills, and addressing patients' and families' concerns will improve their satisfaction with services.

The correlation between the frequent intake of dietary migraine triggers and increased clinical features of migraine (analytical cross-sectional study from Egypt)

Despite the high prevalence of primary headaches, the role of food in modifying clinical characteristics among migraine patients is often overlooked. The aim is to detect the correlation between adopting unhealthy dietary habits and migraine severity and identify foods that have a greater chance of triggering specific subtypes of migraine. The present study was a cross-sectional analytical study that was conducted at Kasralainy Hospital, Cairo University, headache clinic at Alexandria University Hospital, and Al-Azhar University Hospitals from January to June 2020. We included 124 patients fulfilling the ICHD-3 criteria for migraine. A full clinical profile for migraine headaches was reported using a headache sheet applied to the Al-Azhar University headache unit. A nutritionist obtained data collected about dietary habits using many reliable scales and questionnaires such as food frequently sheets questionnaire. Logistic regression and Pearson correlation coefficients have been used to identify foods that are more likely to be associated with increased clinical features of migraine. Our participants reported that the fried meat, fried chicken, processed meats, fava beans, falafel, aged cheese “Pottery salted cheese” and “Rummy cheese”, salted-full fatty cheese “Damietta cheese”, citrus fruits, tea, coffee, soft drinks, nuts, pickles, chocolate, canned foods, sauces, ice cream, smoked herring, in addition to the stored food in the refrigerator for many days were significantly associated with the diagnosis of chronic migraine CM compared to episodic migraine (EM). Margarine, pickles, and smoked herring were significantly associated with the diagnosis of migraine with aura (MA) compared to migraine without aura (MO). Adopting unhealthy eating habits was a more prevalent dietary consumption pattern among people with chronic migraines compared to those with episodic migraine.

Comparative study to determine the proper sequence of simulation training, pelvic trainer versus virtual reality simulator: a pilot study

BackgroundIncreased surgical efficacy has led to a remarkable increase in the usage of minimally invasive surgical procedures since their inception. The use of simulation in surgical teaching has grown significantly during the past 10 years. Several laparoscopic simulators have been built. Virtual reality (VR) simulators and box trainers (BTs), often known as pelvic trainers, are the two primary training modalities used in hospitals and clinical training institutes for the development and acquisition of laparoscopic skills. Our study aimed to evaluate the proper sequence of pelvic trainers and VR simulator training to improve laparoscopic gynecological skills.MethodologyWe carried out this pilot study at the Virtual Endoscopic Simulation and Skills Acquisition Laboratory at the Obstetrics and Gynecology Department in the Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Egypt, from February to August 2022. All residents with minimal or without laparoscopic experience (twenty residents) were divided into two groups and classified as (group A versus group B). Group A’s training began with a pelvic trainer, which was tested using a checklist. Later, the group trained on a virtual reality simulator, which tested them using an electronic autoassessment. After training on a virtual reality simulator and passing an electronic autoassessment test, group B moved on to pelvic trainers and had a checklist-based assessment.ResultsWe compared pelvic trainer tasks between the training groups, and detected no significant differences in camera navigation, cutting pattern, peg transfer, or running stitches (P values 0.646, 0.341, 0.179, and 0.939 respectively); when we compared VR simulator tasks between the training groups, there were no significant differences in camera navigation, cutting pattern, peg transfer, or running stitches (P values 0.79, 0.3, 0.33, and 0.06, respectively).ConclusionThere was no difference in training, between residents who started on a pelvic trainer or the VR simulator; therefore, both could be used in laparoscopic training with no preferred order.Trial registrationThe trial was registered at clinicaltrials.gov with the name “Pelvic trainer vs VRS” and the identifier “NCT05255614.” The registration date was January 19, 2022, and the trial was prospectively registered. URL: https://register.clinicaltrials.gov/prs/app/action/ViewOrUnrelease?uid=U0004GED&ts=22&sid=S000BR5D&cx=t6mc14

Coronavirus disease 19 (Covid-19): A comparative study of pattern of liver injury in adult patients in different waves of Covid-19 infection

Background and study aimsLiver dysfunction is a common manifestation of the COVID-19 infection. We aimed to study transaminase abnormalities through different waves of COVID-19 and their relations to disease severity or mortality. Patients and MethodsA retrospective study included 521 Egyptian patients diagnosed with COVID-19. Data was retrieved from the medical records of patients who were admitted from April 2020 to October 2021 in Kasr Al-Ainy Hospitals, Cairo University, with categorization according to disease severity in correspondence to the four waves. ResultsThe median age was lower in the first wave compared to other waves, with male predominance across all waves. The most commonly encountered comorbidity overall was hypertension, followed by diabetes mellitus. White blood cells, ferritin, and interleukin-6 showed the highest median values in the second wave, with significantly higher median C–reactive protein on day 1 in the first wave. Forty percent of the patients showed elevated hepatic transaminases on admission in four waves, with no statistically significant difference between waves. On day 5, around half of the patients had elevated transaminases, with no significant difference between waves. Most CT findings were of moderate severity. Clinical severity was higher in the second wave. It was observed that the higher the disease severity, the greater the proportion of patients with elevated hepatic transaminases. The mortality rate was markedly high in cases who had elevated ALT or AST on day 5. The association between elevated enzymes on admission and mortality was seen in the first wave only, with a fatality rate of 22.5% in cases with increased baseline ALT and AST versus 5% in those with normal baseline enzymes. ConclusionThere was no significant difference in transaminases between the four waves. Elevated transaminases were positively associated with increased mortality and severity, reflecting their prognostic value.

Psychosexual dysfunction in male patients with cannabis dependence and synthetic cannabinoid dependence.

There are contradicting reports regarding the relationship between cannabis use and male sexual functions with almost no data about synthetic cannabinoids (SC) and its effect on male sexual functions. This study investigates psychological concerns related to male sexual functions among cannabis and SC users. The research aims to assess different sexual functions and aspects of sexual psychopathology in cannabis and SCs dependent men compared to controls. Thirty male patients with cannabis dependence, thirty male patients with SCs dependence and thirty matched controls from the outpatient clinic of Kasr Al Ainy hospital, Egypt, were assessed using Structured Clinical Interview for DSM-IV TR Axis I Disorders (SCID-I), International Index of Erectile Function (IIEF), and Sexuality scale. The means of IIEF questionnaire in the cannabis and SC group were significant lower than the means of the control group (P < .001) except the orgasmic function in cannabis group (P = .052). In the SCs group, sexual depression was higher and preoccupation lower than the cannabis (P < .020; P < .003, respectively) and control groups (P < .001; P < .001, respectively). The duration and dose of intake of cannabis and SCs correlated significant with sexual esteem, sexual preoccupation and all domains of IIEF. Cannabis and SC dependence were associated with lower erectile function, sexual desire, intercourse satisfaction and overall satisfaction, and lower orgasmic functions in the SC group than controls. Both groups showed higher sexual depression, lower sexual esteem and sexual preoccupation than controls. SC has a higher negative impact on male sexual functions and psychopathology than cannabis.

Clinical features and predictors of metabolic syndrome among obstructive sleep apnea patients

BackgroundObstructive sleep apnea (OSA) and metabolic syndrome (MetS) are two diseases associated with an increased risk of cardio-metabolic complications and both share the same risk factors such as obesity and smoking.ObjectivesTo study the clinical features and predictors of MetS in OSA patients.MethodologyA cross-sectional study was conducted in the sleep lab of the Pulmonology Department at Kasr Al-Ainy Hospital, Cairo University, during the period from September 2022 to March 2023. Eighty OSA patients were included, and each patient was subjected to history taking, body measurements, blood pressure measurements, Epworth sleepiness scale, STOP-BANG score, polysomnography, and laboratory investigations including lipid profile and (HBA1C), MetS was defined based on the International Diabetes Federation (IDF) guidelines. Then patients were classified into two groups; OSA with MetS and OSA without MetS, we compared both groups using a one-way (ANOVA) test.ResultsMetS was diagnosed in 66.3% of the study group. OSA with MetS had higher BMI (44.76 ± 9.55) with significant p values (< 0.001), lower average O2 saturation % (90.23 ± 5.5, p value = 0.013), and longer SPO2 time < 90% (37.39 ± 34.14, p value = 0.034) than the other group. BMI, waist, hip, and neck circumferences and SPO2 < 90% were predictors of MetS among OSA patients with significant p values. Females had significantly higher BMI (46.64 ± 9.58), p value = 0.015. Males had significantly higher AHI than females (32.99 ± 24.02 versus 19.83 ± 14.74 respectively), p value = 0.031.ConclusionMetS was diagnosed in 66.3% of OSA. BMI, neck, hip, waist circumferences, and SPO2 < 90% were predictors of MetS among OSA.Trial registrationRetrospectively registered, date of registration is 18/09/2023, and number of registration is NCT06051097. The link to the study on clinicaltrials.gov.

Brain Diffusion in Brainstem Infarctions and Lesion Segmentation using Fluidattenuation Inversion Recovery: A Diagnostic Accuracy Study

Introduction: Diffusion can efficiently detect infratentorial and brainstem infarctions. Fluid-attenuation Inversion Recovery (FLAIR) is a widely used Magnetic Resonance Imaging (MRI) technique for the segmentation of brain lesions and strokes. Aim: To investigate the sensitivity of the Lesion Prediction Algorithm (LPA) within the Lesion Segmentation Tool (LST) in the automated segmentation of acute and subacute brainstem infarctions. Materials and Methods: This study was a retrospective diagnostic accuracy study where 24 patients with brainstem infarctions were referred from the Emergency Department to the Department of Radiodiagnosis at Kasr Alainy Hospital, Cairo University, Egypt. The study was conducted from September 2016 to June 2023. It included 24 patients (14 males and 10 females) with acute and subacute brainstem infarctions. MRI of the brain and diffusion were performed on all patients. Automated segmentation of brainstem infarctions using FLAIR was conducted in all cases. Manual and segmented volumes of brainstem infarctions were calculated. Sensitivity and accuracy of the LPA within the LST in automated segmentation of acute and subacute brainstem infarctions were evaluated. Pearson correlation was used to correlate volumes of White Matter Lesion (WML) burden in patients with brainstem infarctions and patients’ age. Results: The mean age of the participants was 51.75±11.95 years. The sensitivity of the LPA in automated segmentation of acute and subacute brainstem infarctions was 63.6% and 76.9%, respectively. An insignificant correlation (r=0.08; p-value=0.68) between the volumes of WML burden in patients with brainstem infarctions and patients’ age was noted. Conclusion: The sensitivity of the automated method in the segmentation of subacute brainstem infarctions was higher than that in acute brainstem infarctions.

Variability of intraocular tumor height measurements by changing the probe position using a 20 MHz B scan ultrasonography

Purpose The aim of this study was to evaluate the accuracy of tumor height measurements with variable probe positions in relation to the center of the spherical shaped globe. Patients and methods This is a retrospective study that included 27 eyes of 27 patients with different types of intraocular tumors recruited from the Ocular Oncology Service at Kasr Alainy Hospitals, Cairo, Egypt. All patients were evaluated by ocular ultrasound using a 20 MHz B scan transducer. Frames of each tumor measurements were evaluated and reassessed to get three heights (in the same visit) at three different positions: H-1: perpendicular with the tumor at central of the scan, H-2: perpendicular with the tumor oblique to the scan, and H-3: oblique with the tumor oblique to the scan. Results Different types of intraocular tumors were evaluated, with choroidal melanomas being the most common (44.4%). The median measurement in H-1 was 4.76±1.89 mm (range=1.82–8.73 mm), while the median measurement in H-2 was 4.94±1.93 mm (range=1.96–8.40 mm), and that in H-3 was 4.93±2.00 mm (range=1.99–8.73 mm). There were no statistically significant differences either between H-1 and H-2 (P=0.92) or between H-1 and H-3 measurements (P=0.97). To evaluate if the tumor height measurements were affected by the tumor size, the lesions were categorized into three groups: small-sized (tumors up to 4.0 mm), medium-sized (tumors from 4.1 to 7.0 mm), and large-sized (tumors &gt;7.0 mm) in height. The large tumors (4/27=15%) showed differences in height measurements according to the positions of the calibers. Conclusion There was no statistically significant evidence on the effect of angulation on tumor height measurement using the 20 MHz B scan combined with vector A scan. However, large tumors should be more accurately calculated by the conventional perpendicular height (H-1) to avoid any error.

Impact of comorbid pulmonary disease on COVID-19 disease severity and outcome: a retrospective cohort study

BackgroundIdentifying patients with comorbid pulmonary disease may guide prognosis and aid in developing strategies regarding who would benefit the most from vaccines. This study was designed to clarify the influence of comorbid lung disease on COVID-19 severity and outcome.MethodsThis is a retrospective cohort analysis of 587 COVID-19 patients. The clinical, laboratory, and imaging data and comorbidities as reported by the patients were obtained from the Kasr Alainy Hospital medical records. Also, data regarding whether the patient is hospitalized or not, the length of hospital stay, complications, and mortality are gathered from the records.ResultsThe patients’ mean ages are 51 ± 15 years (63.9% are males with the remaining 36.1% which are females). Patients with chronic comorbid pulmonary diseases represented 113 patients among the whole study population. with the COPD being 11.4%. Patients with comorbid lung diseases associated or not with other comorbidities were at higher risk of acquiring severe COVID-19 and had higher complication and mortality rates compared to patients without comorbidities (p-value < 0.001). Patients with preexisting diabetes, hypertension, COPD, and chronic kidney disease have a significantly higher risk of severe infection (p-value < 0.001, 0.001, 0.001, < 0.001), complications (p-value 0.038, 0.005, < 0.001, < 0.001), and mortality (p-value 0.021, 0.001, < 0.001, < 0.001), respectively.ConclusionThis study provides a better understanding of COVID-19 patients with comorbid lung disease and highlights the importance of the data deduced from our study and similar studies in aiding the designation of vaccination programs for those patients if needed.

Substance use disorder in young adults with stroke: clinical characteristics and outcome.

Stroke incidence among young adults has risen in the last decade. This research attempts to determine the effect of substance use disorder (SUD) on the clinical characteristics of stroke, mortality, outcome after IV thrombolysis, and functional dependency after 1 month among young adults. Through a retrospective study, data were extracted from the electronic medical records of stroke in young adults admitted to intensive care units in Kasr Al-Ainy Hospital (February 2018-January 2021). The National Institute of Health Stroke Scale (NIHSS) and the Modified Rankin Scale were documented at the onset and after 1 month. The study included 225 young adults with stroke (median age of 40, IQR: 34-44). Only 93 young adults (41%) met the criteria of SUD. Anabolic steroid use disorder was significantly associated with cerebral venous thrombosis (P-value = 0.02), while heroin use disorder was significantly associated with a hemorrhagic stroke (P-value = 0.01). Patients with tramadol, cannabis, and cocaine use disorders had significantly more frequent strokes in the posterior than the anterior circulation. Patients with heroin use disorders had significantly higher mortality than those without heroin use disorders (P-value = 0.01). The risk of poor outcomes was doubled by alcohol or heroin use disorder, while it was tripled by cocaine use disorder (P-value = 0.01 for each). Forty-one percent of young adults diagnosed with a stroke had SUD, with a relatively higher posterior circulation involvement. Increased mortality was associated with heroin use disorder more than other substances. Poor stroke outcome was associated with alcohol, heroin, and cocaine use disorders.

Outcome of routine histopathological examination of gallbladder specimen following cholecystectomy in Egyptian population

Background Gallbladder diseases (GBDs) are one of the most common surgical diseases. Gallbladder stones (GBSs) are the commonest pathology affecting the gallbladder. Gallbladder cancers (GBCs) are rare though lethal malignancy. GBCs represent a diagnostic and clinical challenge, since its presentation is often nonspecific and its diagnosis commonly occurs at an advanced stage. Aim The aim of this study is to evaluate the outcome of the routine histopathological examination of all cholecystectomy specimens. Patients and methods This study was a retrospective analysis, conducted on 1011 patients who underwent cholecystectomy for symptomatic cholecystitis, in KASR AL-AINY Hospital, General Surgery Department between June 2021 and November 2022. Results Age of patients ranged from 14 to 79 years, females patients were 857 and male patients were 154. Chronic cholecystitis was the most common GBD, 1006 specimens were benign. One specimen was premalignant; dysplasia, and 4 specimens were malignant; 1 case was focal intraepithelial neoplasia, and 3 cases were adenocarcinomas. There was no statistically significant difference between both sexes. The mean thickness of gallbladder was 0.39 cm. multiple gallbladder stones were found in 619 patients, single stones were found in 249 patients, and no stones were found in 143 patients. The largest stone size was 6.00 cm. Female patients have increased preponderance for the development of all GBDs. Nonneoplastic lesions were more common below fifth decade and neoplastic lesions thereafter. Conclusion In this study, the rate of incidental GBCs is very low. All cholecystectomy specimens were routinely sent for histopathology to detect incidental GBC.