Kasr Al Ainy 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.

Public awareness about common ocular diseases among a sample of Egyptian population

Background Globally, the most common causes of blindness in adults are cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy. Inadequate knowledge of these conditions leads to lag in medical advice requisition, losing the opportunity for prevention and early intervention with an increased rate of disease complications. Aim This study aimed to detect the level of public awareness about common eye problems in Egypt to help build strategies to prevent complications related to these eye problems. Patients and methods This is a prospective cross-sectional analytical study that used a pre-tested e-questionnaire to collect data from the study participants during the period from September 2022 to June 2023 at Kasr Alainy School of Medicine, Cairo, Egypt. A Google form was created, and participants were invited through social media. It included four sections: socio-demographic characteristics, medical history of study participants, knowledge about common ocular diseases, and sources of gaining knowledge. Results The study included 802 participants, 54.2% of them were females, more than 55% of them were between the ages of 18–30 years, and 74.4% were university graduates. Awareness of cataracts, glaucoma, corneal opacity, diabetic retinopathy, and age-related macular degeneration was reported in 45.7, 34.8, 38.3, 80, and 77.5% of the study participants, respectively. Physicians and social media were the most common efficient sources of gaining knowledge. Higher education and working in a medical profession, especially physicians and pharmacists were associated with higher knowledge scores. Conclusion Low levels of knowledge of most of the blinding conditions among the study participants raise the importance of adopting health education programs by our healthcare systems taking into consideration that physicians and social media were among the most convenient routes to reach the targeted population.

Timing of Umbilical Cord Clamping in Preterm Neonates: A Randomized Controlled Trial

Background: The optimal timing for clamping the umbilical cord remains controversial. This study aimed to assess the optimal timing of umbilical cord clamping and its effect on preterm neonates. Methods: The study was a randomized controlled trial with the registration number: NCT06000800. It was conducted at Kasr Al Ainy Maternity Hospital, Cairo University Hospital, where a total of 80 pregnant women were randomly pooled and randomly divided into four groups with each group comprising 20 pregnant women. Umbilical cord clamping was performed in the first group immediately (5 sec after birth), after 30 sec in the second group, after 60 sec in the third group, and after 90 sec in the fourth group. After birth, clinical and laboratory parameters were assessed and recorded at the 1st, 6th, 12th, 24th, and 48th hours for all preterm neonates. Results: Delayed cord clamping at 90 sec was linked to improved preterm neonatal outcomes including heart rate at the 1st and the 6th hours; respiratory rate at the 12th hour; oxygen saturation at the 1st hour; hemoglobin, hematocrit, and blood glucose levels at the 6th, 12th, 24th, and 48th hours; but also linked to increase in bilirubin levels at the 12th, 24th, and 48th hours (P < 0.001). There was no statistically significant difference concerning APGAR score; respiratory rate at the 12th hour, temperature at the 1st, 6th, 12th, 24th, and 48th hours; hemoglobin, hematocrit, and blood glucose at the 1st hour; and bilirubin at the 1st, 6th, and 12th hours in all groups (5, 30, 60, and 90 sec) (P > 0.05). Conclusion: Better levels of blood glucose and hemoglobin were seen in preterm neonates whose cord clamping was delayed. Further studies should be carried out to determine the optimal timing of umbilical cord clamping with larger samples, for extended delay of clamping for more than 90 sec, and with recording of parameters for an extended period of follow-up even past the neonatal period.

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.

Psoriasis knowledge gaps and misconceptions in the Middle East and North Africa (MENA) regions: patients' survey-based study.

Misconceptions among psoriatic patients often lead to a negative impact on disease outcomes. Our main target was knowledge assessment among a sample of psoriatic patients in the Middle East and North Africa (MENA) region where data are scarce. The present study is a cross-sectional descriptive survey. It consists of an online questionnaire comprising 19 questions designed to assess psoriasis knowledge and five demographic questions. The questionnaire link was posted on the official Facebook page of the Kasr Al Ainy Psoriasis Unit (KAPU). The questionnaire was taken by 527 participants, but only 396 responses were complete and adequate for analysis. The mean psoriasis knowledge score was higher in females (P = 0.005) and participants with advanced education degrees (P < 0.001). Patients reporting regular follow-ups with dermatologists were more likely to acknowledge joint involvement (P = 0.044) but also incorrectly assume biologics are a final cure (P = 0.038). In addition, they were more likely to assume psoriasis affects pregnancy (P = 0.013). Patients with a family history of psoriasis showed a better mean knowledge score than those without (P = 0.01). Only 54.55% of participants reported knowledge of possible disease exacerbation by drugs. A minority (26.77%) of our patients responded that a diet change could not permanentlycure psoriasis. This study reports knowledge gaps in a cohort of Arabic-speaking psoriasis patients, especially regarding areas of extracutaneous involvement, the hereditary nature of the disease, and the effect of psoriasis on pregnancy and fertility. Most participants were unaware that biological therapy and a change in diet do not offer a permanent cure. Dermatologists in our region must reach out to their patients and correct the various misconceptions reported in this study.

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.

Effect of lung breather on hospital stay in patients with acquired pneumonia: a randomized clinical study

INTRODUCTION. Acquired pneumonia is a severe medical condition that is addressed as life-threating issue requiring intensive care. The Medical Breather device can activate and strengthen both the inspiratory and expiratory muscles, so it can be useful for patients with pneumonia. AIM. To investigate the breather effect on length of hospital stay in patients with pneumonia. MATERIALS AND METHODS. Sixty participants diagnosed with acquired pneumonia “30 women, 30 men stayed in hospital in ICU for two weeks; aged 30–40 years old” selected from chest department of Kasr Al-Aini Intensive Care Unit (ICU) at Cairo University. They were randomly allocated into equal groups; Group A received respiratory training via incentive spirometer, and traditional chest physiotherapy; and Group B received respiratory training via Breather, and traditional chest physiotherapy, both received 3 session daily/2 weeks. Diaphragmatic excursion, Respiratory Distress Observation Scale, and ICU discharge were assessed before and after the treatment. RESULTS. Both groups revealed significant improvement after the treatment, while Breather group showed a high significant increase in pH 1.23 %, PaO2 11.79 %, SaO2 6.1 %, and diaphragmatic excursion by 36.97 %, also decrease in PaCO2 2.78 %, RDOS 39.06 % and NEWS2 by 50.72 % in comparison to incentive spirometer group that recorded significant increase in pH 0.68 %, PaO2 6.69 %, SaO2 by 2.66 %, and diaphragmatic excursions by 8.15 %, also significant decrease in PaCO2 12.12 %, RDOS 15.01 % and NEWS2 by 20.93 %. HCO3 revealed no significant difference post treatment (p 0.05). DISCUSSION. Breather usage in inspiratory musculatures training (IMT) gained Maximum Inspiratory Pressure (Pimax) significant improvement. IMT enforces both diaphragm and accessory respiratory musculatures. Probably functional capabilities improvements based on enhanced respiratory musculatures’ both endurance and strength that improve pulmonary oxygen uptake thus minimize dyspnea severity. Respiratory muscles training program improves not only cognitive function. Moreover, IMT could be addressed as a prime component of respiratory training in combine with expiratory one that is why whom has preserved pulmonary function. CONCLUSION. Breather as a respiratory training technique has remarkable results in reducing hospital stays in patients with acquired pneumonia, and significant positive effects on diaphragmatic function, oxygenation levels. Therefore, it is recommended to use Breather for routine acquired pneumonia care. REGISTRATION: Clinicaltrials.gov identifier: No NCT06062862; registered April 30, 2022.

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.

Lower Third Leg Trauma Management Algorithm; Kasr Alainy Protocol.

Soft tissue defects in the lower third of the leg present significant challenges for surgeons. Despite various options available for soft tissue coverage, selecting the most suitable option is limited by potential complications. In response to this challenge, some surgeons have sought to develop algorithms to guide decision-making in the management of lower leg trauma. This prospective observational cross-sectional study included 53 patients with traumatic injuries to the lower third leg and ankle regions. Each patient underwent a management plan based on our proposed algorithm, which incorporated the utilization of negative pressure wound therapy and dermal substitutes. Outcomes were assessed in terms of the ability to achieve complete coverage, complication rates, duration of hospital stay, and return to normal daily activity. The proposed algorithm proved to be comprehensive and easily applicable, achieving complete coverage in 98.1% of cases. The mean duration for definitive coverage was 21.89 ± 12.84 days, and the majority of cases (81.1%) returned to normal daily activity within a mean duration of 60.69 ± 56.7 days. The use of dermal substitutes resulted in achieving coverage in wounds with exposed structures, with favorable outcomes in cases with a mean size of 11.39 ± 10.05 cm². Our algorithm provides a safe and effective approach to manage traumatic defects of the lower third leg and ankle, considering the patient's general condition and the complexity of the wound. Proper utilization of dermal substitutes and negative pressure wound therapy is emphasized in the algorithm.

Mitral Annular Plane Systolic Excursion (MAPSE) as a Predictor of Weaning Failure in Mechanically Ventilated Patients

Weaning failure is multifactorial in nature; it can result from diaphragmatic dysfunction, excess mechanical load, weaning-induced cardiovascular dysfunction, or a reduced ability to clear secretions. To investigate mitral annular plane systolic excursion (MAPSE) by using M-mode echocardiography as a predictor of weaning failure and its relation to length of intensive care unit stay, and to hospital mortality, and correlation of MAPSE with APACHE II and SOFA scores as predictors of outcome. This was a prospective observational cohort study conducted on 50 patients admitted to Critical Care Medicine Department, Cairo University Hospitals (Kasr Al-Aini Hospitals), with a diagnosis of acute respiratory failure who required mechanical ventilation, from January 2019 to December 2020. There was significant relation between weaning from mechanical ventilation and APACHE II score, we found highly significant difference with SOFA score. ROC curve for detection of weaning using MAPSE showed Area Under the Curve of 0.918 with highly statistically significant relation with cut off value is 13.9 with Sensitivity 83.3% and Specificity 92.3%; and thus, MAPSE could be a good indicator for successful weaning. We concluded that; Low Mitral annular plane systolic excursion (MAPSE) could be a good predictor of weaning failure and mortality, The higher MAPSE values are correlated with lower ICU stay duration. We found that RSBI and SOFA score are predictors for successful weaning, also SOFA and APACHE II scores are indicators of mortality.

The effect of physical therapy rehabilitation on fatigue and pain in female patients with fibromyalgia

This study aimed to examine the impact of physical therapy rehabilitation program on fatigue, pain and quality of life in female patients with fibromyalgia. It was designed as a single-blinded, randomized, pre and post-test controlled trial. Eighty female patients, aged 25 to 45, diagnosed with fibromyalgia were selected from the Kasr Al Ainy rheumatology outpatient clinic. The participants were allocated into two equal groups using a randomization procedure. Group (A) (control group, n=40) received transcutaneous electric nerve stimulation (TENS), moist heat, core muscle retraining, and manual therapy for trigger points, 3 times/week, for 4 weeks. Group (B) (study group, n=40) received the same treatments as Group A, plus aerobic exercises, flexibility exercises, and cognitive behavioural therapy (CBT), 3 times/week, for 4 weeks. Both groups were assessed before and after treatment using the Fatigue Severity Scale (FSS) and the Fibromyalgia Impact Questionnaire (FIQ). Statistically significant improvements were observed in FSS and FIQ scores for both groups post-treatment (p&lt;0.05). When the two groups were compared after therapy, the study group (B) showed significantly greater improvement in FSS and FIQ (p&lt;0.05). These findings suggest that physical therapy rehabilitation can effectively reduce fatigue, pain, and improve the quality of life for women with fibromyalgia.

Role of cancer ratio (serum LDH/pleural ADA) and carcinoembryonic antigen in diagnosis of malignant pleural effusion

Abstract Background Pleural effusion may be malignant or nonmalignant, Cytology has been used in malignant pleural effusion (MPE) diagnosis due to its high specificity. Its sensitivity is about 0.6. Cancer ratio (CR) and carcinoembryonic antigen (CEA) may be used in MPE diagnosis. Aim Evaluate the role of CR and CEA as diagnostic markers of MPE and their role in differentiating different types of MPE. Patients and methods This cross-sectional study included 70 patients with pleural effusion admitted to Chest Department, Kasr Alainy Faculty of Medicine, Cairo University. Thirty-five patients had benign pleural effusions and 35 patients had MPE. Pleural fluid sample obtained from each patient for ADA, CEA, and serum LDH. CR and pleural fluid CEA were compared between patients with MPE and those with benign effusion. Results CR was statistically significantly higher in the malignant group (mean 23.66 ± 7.75) compared with benign group (mean 14.47 ± 11.42) with P value less than 0.001. CR cut-off value was 19.79, the sensitivity and specificity were 74.3 and 82.9%, respectively. Pleural fluid CEA had higher levels in malignant group (mean 104.78 ± 262.7) compared with benign group (mean 2.08 ± 2.49) with P value less than 0.001. The cut-off value of CEA was 3.4 U/l with sensitivity 74.3% and specificity 94.3%. Pleural fluid CEA was significantly higher in metastatic adenocarcinoma (mean 154.58 ± 314.53) compared with other types of malignancy (mean 9.34 ± 17.98) with P value less than 0.001. Conclusion CR and CEA could be used together as simple screening tests in cytology negative MPE with high specificity and sensitivity. CEA was significantly higher in metastatic adenocarcinoma compared with other types of malignancy and could be used to differentiate different types of MPE.

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.

Autistic, schizotypal traits, and insight level in patients with obsessive–compulsive disorder

BackgroundComorbid personality disorders and obsessive–compulsive disorder (OCD) range between 33 and 87%. Patients having OCD more commonly receive cluster A (the odd and eccentric cluster) compared with other nonpsychotic patients. Poor insight levels within OCD increase disease severity and impair neuropsychological factors, where OCD patients exhibit poorer speech learning and memory.ObjectivesTo assess schizotypal, autistic traits, and insight levels in patients with OCD.MethodsForty subjects with OCD were recruited from outpatient clinics of Kasr Alainy Psychiatry and Addiction Prevention Hospital and assessed using the Dimensional Yale-Brown Obsessive–Compulsive Scale (DYBOCS), Schizotypal Personality Questionnaire-Brief Revised (SPQ-BR), and Autism Spectrum Quotient (AQ) while insight level was assessed using Brown Assessment of Beliefs Scale (BABS).ResultsTotal DY-BOCS score was positively correlated with the AQ score and SPQ score. Global distress and interference subdomains of DY-BOCS were positively correlated with AQ, SPQ score, and Insight level (BABS). Indicating that the worse the insight the higher the distress and interference in daily life. Global distress and interference were also positively correlated to all subscales of SPQ. Aggressive obsessions were correlated with SPQ score, cognitive-perceptual (CP) traits, ideas of reference, and magical thinking. Contamination/cleaning obsessions were positively correlated with the level of insight (BABS). While sexual and religious obsessions were negatively correlated with the level of insight.ConclusionIncreased severity of OCD is associated with more autistic symptoms, schizotypal symptoms, and poorer insight. No gender differences in OCD patients regarding severity, autistic symptoms, schizotypal symptoms, or insight.

Monocyte lymphocyte ratio, IL 6, and their association with increased carotid intima-media thickness as simple predictive markers for nephropathy in Egyptian diabetic patients

BackgroundInflammation is a cardinal mechanism of diabetic kidney disease (DKD). Interleukin-6 (IL6) is a reliable indicator that plays a role in the progression of DKD. Monocyte-to-lymphocyte ratio (MLR) is also implicated in this inflammatory process. The progression of DKD is associated with increased carotid intima-media thickness (CIMT), which is an independent predictor of atherosclerosis.AimThe role of IL6 and MLR ratio influencing the progression of DKD was assessed using the urinary albumin creatinine ratio (UACR) and glomerular filtration rate (GFR). Moreover, their contribution to increasing CIMT in DKD was assessed.MethodsAn observational prospective study was conducted on ninety diabetic patients presented to the Internal Medicine Clinic at Kasr AlAiny. The subjects were classified into three groups, thirty patients for each, according to UACR: with normoalbuminuria, microalbuminuria, and macroalbuminuria. A history and clinical assessment, CBC, MLR, HbA1c, lipid profile, IL6, creatinine, and eGFR were carried out. Furthermore, CIMT was measured using Doppler ultrasound.ResultsThe results showed that IL6 and MLR were significantly higher in the macroalbuminuria group compared to the other two groups with p < 0.001, suggesting that their higher level could predict the progression of DKD. According to the ROC curve, the cutoff values of MLR and IL6 were 0.3425 and 7 pg/ml, respectively. Moreover, CIMT increased significantly in micro and macroalbuminuric patients with p > 0.001. IL6 and MLR were positively correlated with CIMT in micro and macroalbuminuric patients.ConclusionBoth MLR and IL-6, as simple biomarkers associated with increased CIMT, play an important role in predicting the nephropathy of DKD patients.

Serum brain-derived neurotrophic factor in relation to craving and duration of abstinence in patients with heroin dependence-A case-control study.

Addiction is a chronic disorder that comes with emotional and financial burdens. Several neurobiological factors were correlated to opiate-use disorder which is brain-derived neurotrophic factor (BDNF). BDNF has been found to be involved in long-term potentiation of synaptic strength, a mechanism that is thought to motivate both natural adaption mechanisms as well as the development of addictive behavior. In this study, we aimed to address the relation between BDNF serum level and heroin craving and the effect of duration of abstinence on them. A case study was conducted on 80 subjects from Kasr Al-Ainy Psychiatry and Addiction Treatment Hospital with a history of heroin dependence and were divided into two groups: Group A had 40 active heroin-dependent subjects while in Group B, 40 subjects with 1-year heroin abstinence. Severity of addiction was assessed by the addiction severity index, heroin craving was measured by Brief Substance Craving Scale and serum BDNF level was investigated using an enzyme-linked immunosorbent assay. The findings show that active heroin users had significantly higher serum BDNF which is associated with high heroin craving in comparison to the abstinent group. This study revealed a significant positive correlation between serum BDNF levels and craving in active heroin users versus 1-year abstinent subjects. It is the first study to address the relationship between craving and serum BDNF level in a 1-year abstinent participants. These findings help to determine the brain alterations associated with illness and recovery in heroin dependence.