Kasr Al Ainy Research Articles

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.

Conventional manual technique of post placental IUD insertion versus intra-cesarean post placental introducer withdrawal IUD insertion technique: a new standardized technique for IUD insertion during cesarean section: a randomized controlled trial

BackgroundInserting IUDs during cesarean section reduces the need for more manipulation and discomfort. The current conventional manual technique for IUD insertion during cesarean section is not standardized with many modifications and high rates of expulsion, displacement, missed threads, and discontinuation. This study aims to find a standard technique for IUD insertion during cesarean section with the least possible problems, especially displacement and missed threads.MethodsA randomized controlled study was conducted at Kasr Al-Ainy Maternity Hospital, Cairo University, Egypt. The study was performed over 12 months, from September 2020 to September 2021. Two groups of patients were selected; each group included 420 patients with a desire for IUD insertion during cesarean section. Group (A) (Control group) was subjected to a post-placental intrauterine device (Copper T380) during cesarean section using a conventional manual method; Group (B) (Study group): the IUD (Copper T380) was placed at the top of the uterine fundus using a new technique (intra-cesarean post placental introducer withdrawal IUD insertion technique).ResultsThere was a significant statistical difference between the two groups regarding displacement of the IUDs at the end of puerperium, at 6 months, non-visibility of IUD threads, and continuation of use with p-value < 0.05. There was no significant statistical difference in the term of duration of surgery.ConclusionThe new technique of post-placental IUD insertion can be the standard technique of intra-cesarean section IUD insertion as it is associated with more favorable outcomes among the included women in the form of lower incidence of IUD displacement, non-visibility of IUD threads, and higher rates of continuation without increasing the duration of surgery as compared with the conventional manual technique.Trial registrationClinicalTrial.gov ID: NCT05788354, registration date: 28/03/2023 (retrospectively registered).

Risk Factors for Recurrence of Nasal Polyps after Endoscopic Sinus Surgery in Patients with Allergic Chronic Rhino Sinusitis.

Rhino sinusitis, is a common inflammatory disease that affects the nasal cavity and paranasal sinuses in millions of individuals. Chronic sinusitis patients complain of a combination of nasal obstruction, rhinorrhea, post nasal drip and facial pain. To identify the risk factors of the recurrence of nasal polyps in chronic rhino sinusitis patients after endoscopic sinus surgery. After a review of 60 patients with chronic rhino sinusitis with failed medical treatment requiring FESS presenting in Kasr Alainy Hospital in Cairo University and October 6 University Hospital from May 2022 to March 2023. All patients were subjected to history taking, clinical examination including endoscopy, subjective evaluation of symptoms and CT-scan. Of our patients, six patients (15%) were diagnosed with recurrence of nasal polyps with chronic rhino sinusitis and needed revision surgery. There are multiple risk factors related to the recurrence of nasal polyps including smoking followed by having a history of an asthma, the presence of an allergy, septal deviation, prior sinus surgery, and turbinate hypertrophy. Other factors, as proper medical treatment such as topical steroids and treatment of allergy had a significant role in decreasing the recurrence rate. Risk factors related to the recurrence of nasal polyps should be avoided before surgery. The avoidance of risk factors protects the patients from the recurrence of nasal polyps, the hazards of anaesthesia on surgical treatment, and the financial cost of surgery. Follow up is important in the prevention of recurrence of nasal polyps and improves the symptoms.

Migraine in bipolar disorder and schizophrenia; The hidden pain.

This study examined the prevalence of comorbid migraine in patients with bipolar disorder and those with schizophrenia and also examined the association between migraine comorbidity and disease characteristics of both psychiatric disorders. In this cross-sectional study, 150 patients with bipolar disorder and 150 with schizophrenia were evaluated for migraine diagnosis using the International Classification of Headache Disorders (3rd ed). Patients were selected from psychiatry outpatient clinics at Kasr Al Ainy hospitals, Cairo University. The Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS) were administered to the bipolar group, whereas the Positive and Negative Syndrome Scale (PANSS) was administered to the schizophrenia group. Both groups were evaluated by the Clinical Global Impression (CGI) scale. The diagnosis of migraine was made in 34 (22.7%) of the bipolar group and 24 (16.0%) of the schizophrenia group. Patients with schizophrenia showed a significantly higher frequency and intensity of migraine attacks on the Migraine Disability Assessment scale than did the bipolar group (p < 0.001). In the bipolar group, there was no significant difference between patients with and without migraine on the YMRS, HDRS, and CGI. Among patients with schizophrenia, the duration of the migraine attacks was positively correlated with CGI scores (r = 0.40, p = 0.02). Migraine is a significant comorbidity in patients with bipolar disorder and schizophrenia.However, the intensity and frequency of migraine attacks were higher in the schizophrenia than in the bipolar group.

Hospitalization and outcome of systemic lupus erythematosus patients admitted to the Rheumatology ward of Kasr Al-Ainy University Hospital

Hospitalization and outcome of systemic lupus erythematosus patients admitted to the Rheumatology ward of Kasr Al-Ainy University Hospital

Study of nasal mucosa histopathological changes in patients with hypersensitivity pneumonitis

Hypersensitivity pneumonitis (HP) is an interstitial lung disease that develops after inhalation of a variety antigens in susceptible individuals. The nasal mucosa is constantly exposed to these antigens that can irritate the respiratory mucosa. So, the purpose of this study was to study nasal histopathological changes in order to identify any shared pathological changes between the upper airways and the well-known pathological features of HP. 40 HP patients diagnosed at the Chest Department, Kasr Alainy hospital following ATS/JRS/ALAT guidelines were included. Patients were subjected to thorough history, high-resolution computed tomography, spirometry, cough evaluation test (CET), sinonasal outcome test-22 (SNOT-22), sinonasal examination and nasal mucosal biopsy by an otolaryngologist under visualization by a rigid nasal endoscope. The mean age of the patients was 46.2 ± 13.5 (85% were females and 15% were males). 90% of patients presented with cough and the mean CET was 17.15 ± 5.59.77.5% of patients suffered from sinonasal symptoms and the mean SNOT-22 was 12.18 ± 3.8. There was a significant correlation between the burden of sinonasal symptoms represented by the SNOT-22 and the severity of the cough represented by CET (r 0.40, p 0.01). 87.5% of HP patients had chronic inflammation of the nasal mucosa with predominant lymphocytic infiltration in 72.5% of patients. 77.5% of HP patients had a high burden of sinonasal symptoms which is positively associated with cough severity. 72.5% of patients had predominately lymphocytic infiltration of the nasal mucosa.Trial registration: retrospectively registered, registration number is NCT05723796, date of registration 13/02/2023.

Long Noncoding Rna GAS5 And Mir-137 And Two Of Their Genetic Polymorphisms Contribute To Acute Ischaemic Stroke Risk In An Egyptian Population.

To assess the serum expression levels of long non-coding ribonucleic acid growth arrest specific-5 and micro-ribonucleic acid-137, and the different genotypes of long non-coding ribonucleic acid growth arrestspecific-5 rs2067079 (C>T) and micro-ribonucleic acid-137 rs1625579 (T>G) in acute ischaemic stroke patients. The case-control study was conducted at Cairo University, Cairo, Egypt, from January to August 2020, and comprised adult acute ischaemic stroke patients of either gender selected from the stroke unit of the Neurology Department at Kasr Alainy Hospital of Cairo University. Healthy individuals matched for age and gender were enrolled as controls. Quantitative real-time polymerase chain reaction was used to quantify serum expression levels of long non-coding ribonucleic acid growth arrest specific-5 and micro-ribonucleic acid-137, and to genotype long non coding ribonucleic acid lncRNA growth arrest specific-5 rs2067079 and micro-ribonucleic acid-137 rs1625579 using TaqMan allelic discrimination. Data was analysed using SPSS 22. Of the 100 subjects, 50(50%) were patients; 34(68%) males and 16(32%) females with mean age 60.4±10.0 years. The remaining 50(50%) were controls; 28(56%) males and 22(44%) females with mean age 56.9±12.2 years (p>0.05). The patients had more smokers, more hypertensives and more diabetics than the controls (p<0.05). Long non-coding ribonucleic acid growth arrest specific-5 expression levels were significantly increased, while microribonucleic acid-137 expression levels were significantly reduced among the patients(p<0.05). Acute ischaemic stroke risk was significantly higher in patients with growth arrest specific-5 rs2067079 (C>T) recessive model (homozygous minor TT genotype), while micro-ribonucleic acid-137 rs1625579 (T>G) was protective against acute ischaemic stroke in allelic (G minor allele), codominant (GT genotype), dominant (GT+GG), and over-dominant (GT genotype) models (p<0.05). Long non-coding ribonucleic acid growth arrest specific-5 rs2067079 and micro-ribonucleic acid-137 rs1625579 may act as novel genetic markers of acute ischaemic stroke risk.

Guidelines and Protocol of Managing Patients with Breast Problems during Pregnancy and Lactation

Most of the breast lesions found during pregnancy are benign. Pregnancy associated breast cancer (PABC) is defined as cancer that occurs during pregnancy or within 1 year of delivery. Aim of the study: To diagnose breast lesions during pregnancy, detect incidenceof masses as well as the incidence and early diagnosis of PABC. Patients and methods: 500 pregnant women (190 primigravida, 254 mutigravidaand 56 lactating) attending Kasr Al Ainy outpatient clinic having breast complaints were included in the study. Ultrasound was performed for all patients. Further investigations were performed when indicated (Mammography, MRI or core biopsy). Results: Incidence of breast mass was 25.6%. Within those cases, 5.46 had PABC. The overall incidence of PABC was 1.4%. Biopsy was performed in 13 patients (9 pregnant and 4lactating). We diagnosed 7 malignant masses (4 lactating and 3 pregnant). Pathology revealed5 invasive duct carcinoma, 1 inflammatory carcinoma and 1 adenocarcinoma. Positive family historywas found in 85.7% of malignant cases. Conclusion: Most breast masses were benign. The overall incidence of PABC was 1.4% and 5.46% within patients diagnosed with a breast mass. Obstetricians should be aware of the importance of breast examination when there is a breast complaint during pregnancy.

The Impact of Laparoscopic Sleeve Gastrectomy on Thyroid Functions in Egyptian Patients with Obesity

BackgroundSleeve gastrectomy (SG) continues to be one of the most popular bariatric procedures all over the world. Thyroid-stimulating hormone (TSH) frequently shows a slight elevation in patients with obesity. The effect of SG on thyroid hormones has been rarely investigated. Aim of the StudyThis study aimed to assess the short-term effect of SG on thyroid functions in Egyptian patients with morbid obesity and the potential predictors of the postoperative thyroid functions. Patients and MethodsThis study included patients undergoing SG at kasr al ainy hospitals. The patients underwent preoperative 3-, 6-, and 12-month postoperative analyses of the thyroid functions and other biochemical markers. ResultsThe study included 106 patients who showed significant improvement in thyroid functions at the follow-up assessment. Twelve-month TSH positively correlated with the 12-month measures of LDL and HbA1c. TSH change at 12-month follow-up (TSH) was inversely correlated to 12-month BMI and positively correlated to preoperative TSH and 12-month percentage of total weight loss (TWL%). Univariable linear regression analysis demonstrated that preoperative TSH (p < 0.001), 12-month TWL% (p = 0.042), 12-month HbA1c (p = 0.001), and 12-month LDL (p = 0.049) were significant predictors for the 12-month TSH levels. Multivariable analysis showed that only preoperative TSH levels (p < 0.001) and 12-month HbA1c levels (p = 0.021) could affect the 12-month TSH levels. ConclusionThe current study supports the evidence of thyroid function improvement after sleeve gastrectomy. This improvement was affected by the amount of weight loss after surgery.

Kasr Alainy simplified uterine preserving surgery for conservative management of placenta accreta spectrum (PAS): A modified surgical approach

ObjectiveThe incidence of placenta accreta spectrum (PAS) is rising rapidly due to the global surge in Caesarean delivery. It is associated with significant maternal morbidity and mortality. It is usually managed with Caesarean hysterectomy. However, uterine preserving surgeries can have advantages over Caesarean hysterectomy and intentional placental retention techniques. Study designWe present a modified technique of uterine preserving surgery that uses a safe approach for placental bed surgical devascularization. This is followed by resection of the invaded uterine segment and uterine wall reconstruction. ResultsThe technique was used in the management of 20 patients with antenatally suspected PAS that were confirmed at laparotomy. It was successful in preserving the uterus in 18/20 (90 %) women. The mean intraoperative blood loss in was 1305 CC (SD: +361.6) with a mean operative time of 123 min (SD: ±38.7). There was only one urinary bladder injury and no other maternal morbidity. ConclusionOur surgical technique is safe and may be useful for conservative surgical management of PAS, particularly in low- and middle-income countries, where access to complex resources, such as interventional radiology, is limited.

Serum fatty acid-binding protein 4 as a biomarker for early detection of diabetic nephropathy in type 2 diabetes

BackgroundDiabetic nephropathy (DN) is one of the major causes of ESKD, and its complications are characterized by proteinuria, decreased glomerular filtration, and renal fibrosis resulting in the deterioration of renal functions, so early detection of nephropathy is essential to slow down and prevent the progression of the disease. Fatty acid-binding protein 4 (FABP4) is expressed in renal proximal tubule cells and released in response to hypoxia caused by decreased peritubular capillary blood flow, so serum FABP 4 is one of the promising biomarkers for early prediction of diabetic nephropathy in patients with type 2 diabetes.MethodsThis was a case–control study that included 120 patients with type-2 diabetes mellitus selected from Kasr Alainy Hospital, Cairo University Hospital, who were divided into 2 groups: the first group comprised 60 diabetic patients divided into 3 sub-groups according to their urinary albumin/creatinine ratio (normo-, micro-, and macroalbuminuria). The second group included 60 apparently healthy individuals. All patients were subjected to history, clinical examination, laboratory investigations, and serum FABP4 by ELISA.ResultsThere was a significant increase in serum FABP4 in the macroalbuminuria group, followed by the microalbuminuria group, then the normoalbuminuria group, in comparison to the normal control group. There was a significant positive correlation between serum FABP 4 level and the duration of diabetes and HBA1c. There was a significantly negative correlation between serum FABP4 and serum albumin in the macroalbuminuria group. Receiver operating characteristic curve analysis found that serum FABP 4 discriminate micro- and macroalbuminuric patients with diabetes from controls with 96.6% and 98.3% diagnostic specificity and 100% diagnostic sensitivity respectively.ConclusionSerum FABP 4 can be used as a biomarker for the early detection of diabetic nephropathy.

Association between Perceived Social Support and Psychosocial Adjustment of Geriatric Cancer Patients Undergoing Chemotherapy: A Cross- Sectional Study

In addition to demographic and clinical data. Data was collected from Kasr Al-Aini Center for Oncology

Impact of nutrition counseling on anthropometry and dietary intake of multiple sclerosis patients at Kasr Alainy Multiple Sclerosis Unit, Cairo, Egypt 2019–2020: randomized controlled clinical trial

BackgroundFaulty dietary habits and overnutrition are prevalent among Egyptian patients with multiple sclerosis (MS) who do not receive nutrition care as part of treatment. Thus, this study was conducted to identify the effect of nutrition counseling on the nutritional status of patients with MS. This endeavor might provide evidence for the value of counseling in such a setting and advance the integration of nutrition counseling into the routine management of patients with MS.MethodsA single-blinded, parallel-randomized controlled clinical trial was conducted at Kasr Alainy MS Unit on 120 eligible patients with MS from September 2019 to February 2020. Patients were randomly allocated to either the nutrition counseling intervention group (IG) or the control group (CG). Allocation concealment was performed by using sequentially numbered opaque sealed envelopes. All patients were assessed initially and complied with the Kasr Alainy MS Unit standard management protocol for the study period. Only patients in the IG underwent initial nutrition counseling sessions followed by a monthly evaluation. All patients were assessed at the end of the 3-month follow-up period. Sociodemographic data were gathered through a structured interview. Nutritional status was assessed anthropometrically and via 24-h recall. The 2 groups were compared initially and at the end of the follow-up. Both intention-to-treat and per-protocol analyses were conducted.ResultsAt baseline assessment, the prevalence of overweight and obesity was 31.7% and 32.5%, respectively, and the mean body mass index was 27.7 ± 5.7 kg/m2. Mean waist circumference was 93.5 ± 11.9 and 99.2 ± 13.1 cm for males and females, respectively. Approximately 27.3% of males and 83.9% of females showed abdominal obesity. After 3 months of counseling, weight, body mass index, waist circumference, nutrient intake and adequacy significantly improved in the IG (p < 0.05).ConclusionNutrition counseling significantly improved anthropometric measurements, dietary habits, nutrient intake and adequacy.Trial registrationThe study was registered on ClinicalTrial.gov and was given a code (NCT04217564).

Effectiveness of direct-acting antiviral (DAA) agents on hepatitis C virus-related mixed cryoglobulinemia syndrome: One-year follow-up

BackgroundMixed cryoglobulinemia syndrome (MCS) is a systemic vasculitis involving skin, joints, kidneys, and peripheral nerves. Hepatitis C virus (HCV) is a well-known etiologic agent. Therapy for HCV has been revolutionized by the approval of direct-acting antiviral (DAA) agents. Aim of the workTo evaluate the effect of the new DAA treatment on MCS in HCV-infected patients. A prospective study with one year follow-up after induction therapy was undergone. Patients and methodsSixty patients with HCV-infection having ≥ 1 extrahepatic manifestations and attending the Rheumatology outpatient at Kasr Alainy for treatment of immune-mediated disease were included. Patients were examined at baseline (before receiving HCV treatment), after six months, and after one year following receiving HCV treatment by sofosbuvir based regimen in specialized centers. All patients were treatment-naïve; Assessment for arthritis, vasculitis and nephritis was performed. ResultsPatients’ mean age was 51.1 ± 8.8 (30–68) years; 44 females and 16 males (F:M 2.8:1). Arthritis was present in 43 (71.6 %), cutaneous vasculitis in 30 (50 %): purpura in 19 (31.7 %), skin ulcers in 18 (30 %), peripheral neuropathy in 16 (26.7 %), and nephritis in 14(23.3 %) patients. Absolute viral clearance was sustained up to one year follow-up. The frequency of patients affected with MCS-related manifestations arthritis, cutaneous vasculitis, peripheral neuropathy, and nephritis tended to decrease. CDAI significantly decreased at six months compared to baseline (p = 0.04). BVAS, numeric rating scale (NRS) for neuropathic pain/paresthesia and proteinuria insignificantly changed from baseline at six months and at one-year (p = 0.28, p = 0.58 and p = 0.96 respectively). ConclusionClinical and immunological responses for MCS-related manifestations were less satisfactory than the virologic response.

Adolescent Lumbar Intervertebral Disc Herniation: Conservative versus Surgical Treatment

BACKGROUND: Lumbar disc herniation (LDH) in adolescents is relatively a rare condition among those cases presented with low back pain. Trauma and genetics are the most common predisposing factors. Furthermore, the clinical presentations differ from those of the adults. Back pain is not all marked in adolescent patients. AIM: This study was subjected to discuss the etiology, diagnosis and treatment modalities, and the variable outcomes for both medical and surgical treatment of LDH in adolescents. PATIENTS AND METHODS: This prospective study was conducted on 20 patients (12 males, eight females) age range 10–19 years presenting with LDH, managed and treated conservatively and/or surgically in Neurosurgery Department at Kasr Al Ainy School of medicine, Cairo University in the period from October 2015 to September 2016 with 12-month follow-up period. RESULTS: In our study, 12 patients (60%) gave a positive family history, also nine cases (45%) had a history of back trauma before affection with LDH. All the cases (100%) were presented with sciatic pain while only half of them had low back pain, also two cases with motor deficit. After performing magnetic resonance imaging of lumbosacral spine, L5-S1 disc level was the most common level affected. All the patients were subjected to medical treatment which was effective in 40% of the cases and surgical treatment was the only curative method in 12 cases (60%). In this study, the outcome was excellent in 90% of cases where significant to complete relief of pain and significant improvement in the neurological deficits was achieved. CONCLUSION: Conservative treatment is less effective for adolescent LDH patients as compared with adults, even though it remains the fi rst-line treatment for adolescent LDH.

Defensive medicine and medical liability: A Cross-sectional study in Kasr Alainy Obstetrics and Gynecology hospital

Background and Aims: Defensive medicine is medicine practiced in such a way primarily to avoid or defend against the threat of malpractice litigation. The rate of practice of defensive medicine has been increasing in recent years across the world. High percentages of defensive medicine have a significant economic cost through affecting doctors’ decisions. The problem is compounded in Egypt as it currently lacks a medical litigation law, and doctors in Egypt are tried by the criminal law instead. This study aims to identify the practice of defensive medicine in light of such conditions, as well as highlight some of its causes. Methods: This is a cross-sectional study conducted by a self-administered questionnaire among obstetricians and gynecologists of Kasr Alainy University OBGYN Hospital. It included 160 doctors from a total of 250 doctors. Binary logistic regression and Chi square tests were used to calculate the predictors of practice of defensive medicine and its forms. Results: (81%) of the doctors practiced at least one form of defensive medicine. Many predictors were significant including duration of practice, gender (male), witnessing a colleague getting sued or personally getting sued, and feeling limited in practice due to the current state of the law. Conclusions: The practice of Defensive medicine in Kasr Alainy OBGYN Hospital is considerably high but still in line with other countries. The lack of medical law is a significant factor, but there are other factors affecting the practice of defensive medicine. Efforts to reduce defensive medicine must start with enacting a medical law.

Protocol of Kasr Al-Ainy’s Phototherapy Unit-Cairo University for the management of photo-responsive skin diseases-part 2: protocol of phototherapeutic management of diseases

One of the most commonly used and effective lines of treatment in chronic skin diseases is phototherapy. A protocol of the Kasr Al-Ainy Phototherapy Unit has been proposed for the treatment of different dermatological diseases such as psoriasis, mycosis fungoides, and vitiligo based on the best current research-based guidelines and the experience of the phototherapy team. This protocol is the cornerstone of the everyday practice in Kasr Al-Ainy Phototherapy Unit and the authors believe that dermatologists dealing with such diseases in their hospitals or clinics can find it helpful and applicable to get better results with their patients. In part 2, the specific measures of the protocol for phototherapeutic management of different skin diseases will be discussed.

Health profile of pregnant women with asymptomatic bacteriuria

Background Urinary tract infections (UTIs) are the most common bacterial infection during pregnancy. UTIs in pregnancy are associated with maternal as well as fetal morbidity. The aim of the current study was to assess the health profile of pregnant women with asymptomatic bacteriuria (ASB). Design A descriptive research design was adopted to obtain the stated aim. Sample A purposive sample of pregnant women with UTIs without symptoms throughout 1 year but the sample not less than 100 pregnant women was recruited. Setting The study was performed at woman's care clinic at Al Kasr Al Ainy University Hospital. Tools Two tools were utilized: (a) urine analysis record and (b) structured interviewing questionnaire schedule. Results The study findings showed that the mean age of the pregnant women with ASB was 29.00±5.48 years old. Overall, 26% of them could not read and write, and 96% of them were housewives. Regarding place of residence, 82% of the selected sample was from rural areas. Half of the selected sample was multigravida, whereas 55% of them were multipara. Overall, 61% of them had a history of abortion. Furthermore, 86% of the selected sample used new latrine toilet, and 61% had a previous history regarding infection. In addition, 63% of the selected sample used contraceptive methods, and 58% of them had previous normal vaginal delivery. Concerning trimester, 73% were in the third trimester. Conclusion The current study's findings revealed that age, cannot read and write, rural areas, housewives, usage of new latrine toilet, multigravida, multipara, history of abortion, normal vaginal delivery, usage of contraceptive methods, history of previous infection, and third trimester were represented the health profile of the pregnant women with ASB that might increase the incidence of a symptomatic bacteriuria infection. Recommendation Pregnant women should be made aware regarding personal hygiene through classes on motherhood.

The novel derived preoperative-POSSUM score as a predictor of surgical patients’ allocation to an elective postoperative ICU ordered by anesthesiologists at Cairo University Hospital

Backgroun d Anesthesiologists depend on multiple factors to request a postoperative ICU bed after elective surgeries. This decision may be based on the risk of surgery and comorbidities. Some surgeries may be postponed, or some patients may be exposed to unnecessary ICU admission. So, this aroused the need for certain scores upon which anesthesiologist could build their request for ICU admission. Aim To evaluate the accuracy of the pre-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) score as a predictor for the need for postoperative ICU. Patients and methods This study calculated the POSSUM score preoperatively (pre-POSSUM) for 308 patients who underwent elective general surgeries at Kasr Alainy Hospital, a leading tertiary care hospital in Cairo, Egypt. Results Our study showed the possibility of having a cutoff value of pre-POSSUM score that could predict patients who would benefit most from a postoperative ICU stay. The best cutoff value for the estimated morbidity percent was 19.545, with 100% sensitivity and 64.3% specificity. Moreover, the estimated mortality percent at a cutoff value of 3.375 showed 100% sensitivity and 62% specificity. Conclusion The pre-POSSUM could be used as a reliable tool for the allocation of patients after elective general surgeries, identify those who require intensive postoperative care, and use the cutoff values shown in a study to help to triage patients after elective surgeries.

Comparative study between intramedullary kirschner wires fixation and cast immobilisation in pediatric displaced diaphyseal both bones of forearm fractures

Abstract Background Forearm fractures involving the diaphysis are the third most frequent form of fracture in paediatrics. Conservative management is associated with higher risks of complications; therefore, the author aim to compare Kirschner (K) wire fixation with conservative management. Methods 56 children with displaced diaphyseal ulnar and radial fractures were allocated and randomized into two groups at Kasr Al-Ainy University Hospital: the first group was managed by conservative management with cast immobilisation, and the second group was managed by K wire fixation. The primary outcomes were the degrees of postoperative ulnar and radial angulations, the required time of union, the limitation of movement degrees, and the functional outcomes. The secondary outcome was the rate of complications. Results K wire fixation had better significant results compared with the cast immobilisation regarding the residual radial angulation (P &lt; 0.001), ulnar angulation degree (P &lt; 0.001), the range of movement of forearm supination or supination (P = 0.003), and the functional outcome (P = 0.049); however, the time of union was significantly longer in the K wire group compared with the cast group (P = 0.003). Both groups were not significantly different in the complication rate (P = 0.163). Conclusion Cast immobilisation is safe in managing displaced diaphyseal in both bones of forearm fractures; however, K wire fixation is preferred and shows better results, especially when a good reduction cannot be achieved by conservative cast immobilisation.