Menoufia University Hospital Research Articles

Detection of multidrug-resistant Klebsiella species with overexpressed efflux pumps in neonatal intensive care units at Menoufia University Hospitals

Detection of multidrug-resistant Klebsiella species with overexpressed efflux pumps in neonatal intensive care units at Menoufia University Hospitals

Comprehensive analysis of MRSA in ICU settings: Antibiogram, molecular characterization, risk assessment, and infection control strategies in Menoufia University Hospitals

Comprehensive analysis of MRSA in ICU settings: Antibiogram, molecular characterization, risk assessment, and infection control strategies in Menoufia University Hospitals

Laryngo pharyngeal affection of COVID-19 during Delta and Omicron variant (Comparative Study)

BackgroundSince the declaration of COVID-19 as a pandemic in 2020, its main symptoms have primarily affected the respiratory system. However, it also presents other systemic manifestations, including symptoms related to the larynx and pharynx. COVID-19 has evolved into subsequent variants, starting from the alpha variant and currently dominated by the Omicron variant, with the Delta variant being the most severe.The study aimed to elucidate the laryngo pharyngeal manifestations related to Delta and Omicron variants of COVID-19 as well as the associated risk factors.ResultsThis study adopted a case–control design. The data were collected from patients who attended the phoniatric outpatient clinic at Menoufia University Hospital from January to December 2022. Patients were categorized into three groups (50 patients each). Group I consisted of patients who exhibited COVID-19 Laryngo pharyngeal symptoms during the Delta wave (Group 1) and the Omicron wave (Group 2). The control group included non-COVID-19 participants. The symptoms related to the larynx and pharynx were documented. In addition, laryngoscopic and stroboscopic examinations were done. The age of individuals affected by the Delta variant was higher. Delta cases exhibited a higher rate of smoking, diabetes, hypertension, and COPD compared to Omicron cases. Additionally, Delta cases displayed greater severity. Dysphagia, dysphonia, choking attacks related to swallowing, and stridor had significant higher rate in the Delta variant compared to the Omicron variant. The Delta variant primarily exhibited unilateral vocal fold paralysis in 38% of cases, as well as bilateral vocal fold paresis and paralysis in 20% and 22% of cases, respectively. In contrast, Omicron cases predominantly showed vocal fold congestion (80% of cases). Delta cases were more prone to experiencing abnormalities in amplitude, symmetry, and periodicity.ConclusionsThe Delta variant is more prone to neurologic affection of the vocal folds manifesting as paresis and paralysis, whereas the Omicron variant, which has maintained its dominance thus far, experiences milder affection, primarily manifesting as congestion. Consequently, laryngeal affection with various degrees of severity is still suspected.

CELF4 (rs1786814) gene polymorphism and speckle-tracking Echocardiography for cardiovascular complications in childhood cancer survivors.

Despite a well-known dose-dependent association between the risk of cardiac dysfunction and anthracycline, the risk of cardiac dysfunction for any given anthracycline dose varies between patients. So, we assessed CELF4 (rs1786814) gene polymorphism on anthracycline-related cardiotoxicity in childhood cancer survivors (CCS). This comparative cross-sectional study included 53 CCS who had regular follow-up visits at the Pediatric Oncology Unit, Menoufia University Hospital. CELF4 (rs1786814) gene polymorphism and conventional and speckle-tracking Echocardiography were done for all survivors. Regarding CELF4 (rs1786814) genotypes, significant differences existed between the studied groups with a predominance of GG homozygous mutation. For Echocardiographic findings, the ejection fraction and end-systolic diameter compared to the control group, were significantly lower in the survivors group. Speckle- tracking Echocardiography showed a significant difference regarding (GLPS-A4C) and (GLPS-LAX), with no significant difference regarding (GLPS-A2C), (GLPS-Avg) and left atrium between the studied groups. Multivariate logistic regression analysis illustrated a statistically significant relation between cumulative anthracycline dose >300 mg/m2 and CLEF4 (rs1786814) genotypes (GG and GA) and the risk of cardiotoxicity with more significance in GG mutation. Early detection of ventricular dysfunction in CCS with subclinical cardiotoxicity with regular follow-up is promising before the development of life-threatening complications. Early detection of anthracycline-related cardiotoxicity in childhood cancer survivors (CCS) after finishing chemotherapy. CLEF4 (rs1786814) GG variant is more significant in CCS exposed to high-dose anthracycline. GLPS holds promise as an early predictor of late left ventricular dysfunction and subclinical cardiotoxicity in CCS.

Interleukin (IL)-1B and IL-1 receptor antagonist gene polymorphisms in children with primary immune thrombocytopenia.

The pathophysiology and susceptibility of children to primary immune thrombocytopenia (ITP) are linked to polymorphisms of the interleukin (IL)-1B and IL-1 receptor (IL-1R) antagonist genes. To investigate the association between the susceptibility and severity of primary ITP in children and the IL-1B and IL-1R antagonist gene polymorphisms. This comparative case-control study was conducted at the Menoufia University Hospital Hematology and Oncology Unit, Pediatric Department, between August 2022 and September 2023. The children were divided into patients (28 boys, 22 girls) who received hospital and outpatient clinic care and controls (50 healthy age- and sex-matched children). The mutant homozygous GG genotype and mutant G allele of rs16944 of the IL1B gene were considerably greater in patients than in controls (P<0.001). Furthermore, the mutant homozygous II/II genotype and heterozygous I/II genotype of the IL-1R antagonist gene were considerably greater in the case versus control group. The mutant II allele was significantly more prevalent in patients versus controls (P<0.001). IL-1B and IL-1R antagonists may have a major impact on the development of immune thrombocytopenia. Furthermore, we found a relationship between IL-1B and IL-1R antagonist gene polymorphisms and the etiology of and children's susceptibility to primary immune thrombocytopenia.

Prevalence and Factors Associated with Medication non-adherence among diabetic patients Attending at Menoufia University Hospitals

Prevalence and Factors Associated with Medication non-adherence among diabetic patients Attending at Menoufia University Hospitals

Frequency of spontaneous bacterial peritonitis among cirrhotic ascitic patients and predictors for its outcome in Menoufia University Hospitals

Frequency of spontaneous bacterial peritonitis among cirrhotic ascitic patients and predictors for its outcome in Menoufia University Hospitals

Serum Paraoxonase 1 and Gene Polymorphism (PON- Q192R) as an Atherosclerotic Marker in Chronic Kidney Disease Patients in Menoufia University Hospitals- Egypt

Serum Paraoxonase 1 and Gene Polymorphism (PON- Q192R) as an Atherosclerotic Marker in Chronic Kidney Disease Patients in Menoufia University Hospitals- Egypt

Optical coherence tomography angiography findings in high myopia

Background Optical coherence tomography angiography (OCTA) is a sophisticated ophthalmic imaging technique, enables us to obtain images of blood vessels and blood flow at different levels of the retina and choroid without the use of contrast. Therefore, its potential application could be useful in the early detection of retinal vascular and macular pathologies and to recognize the pathogenesis of various ophthalmic diseases. Aim In this study, OCTA was utilized to detect the macular changes in eyes with high myopia. Patients and methods This cross-sectional study was carried out at the Department of Ophthalmology of Menoufia University Hospital according to the Helsinki Declaration and the Code of Ethics for Human Research of the World Medical Association and after obtaining approval of the institutional review board (IRB) 10/2022 OPHT 32. A total of 152 eyes of the study participants were included in this study and were divided into group A, which includes 76 eyes of highly myopic participants (&gt;−6 D), and group B includes 76 eyes of nonmyopic (emmetropic) participants. Result In our study, there was a high statistically significant difference between the studied groups as regards axial length. In group A, it was 27.26±0.74 mm, while in group B, it was 23.14±0.73 mm (P&lt;0.001). Regarding the comparison between studied cases according to the superficial and deep vascular density (SVD and DVD), there was a statistically significant difference between the studied groups. As regards overall SVD in group A, it was 46.48±4.78 while in group B, it was 51.78±2.8 (P&lt;0.001). Meanwhile, the overall DVD in group A was 56.67±3.98, while in group B was 58.76±2.27 (P&lt;0.001). Conclusion In the light of our study, OCTA shows significantly reduced SVD and DVD in eyes with high axial myopia, which could be an important aspect of understanding the natural history and etiology of pathologic myopia.

Linezolid-resistant Enterococcus isolates in Menoufia University Hospitals and community-acquired infections: Genetic determinants and risk factors

Linezolid-resistant Enterococcus isolates in Menoufia University Hospitals and community-acquired infections: Genetic determinants and risk factors

Assessment of olfactory and gustatory functions in COVID-19 patients

BackgroundOlfactory and gustatory disorders are common problems encountered during the COVID-19 pandemic with a significant impact on the patient’s quality of life: The aim of this study was to assess the olfactory and gustatory functions in COVID-19 patients with correlation between them and clinical and laboratory markers. This was a cross-sectional study conducted on 63 subjects recruited from the COVID-19 clinics at Police Authority and Menoufia University hospitals. The patients were assessed using history taking, anterior rhinoscopy, endoscopic examination, computed tomography, and polymerase chain reaction (PCR) test. Olfactory functions were assessed using the alcohol threshold test. Gustatory functions were assessed using the three-drop method. The olfactory and gustatory functions were correlated with age, gender, and laboratory parameters. Also, the recovery of smell and taste disorders was correlated with our assessed laboratory markers.ResultsThe prevalence of olfactory dysfunction among study participants was 41 patients (65%) of the participants including 12 patients (19.1%) having mild hyposmia, 10 patients (15.8%) having moderate hyposmia, 9 patients (14.3%) having severe hyposmia, and 10 patients (15.8%) having complete anosmia. The prevalence of gustatory dysfunction among study participants was 24 patients (38.1%). Age, gender, and laboratory parameters did not show any statistically significant difference between those who experienced olfactory dysfunction or gustatory dysfunction and those who did not. However, there was a significant positive correlation between the total leucocytic count, serum level of CRP, and serum level of D-dimer and the degree of olfactory dysfunction (0.049, 0.03, and 0.02, respectively). There was a nonsignificant correlation between recovery of olfactory and gustatory dysfunction and laboratory markers.ConclusionOlfactory and gustatory dysfunction are established clinical presentations among COVID-19-positive patients. The laboratory markers had no correlation with the incidence of these dysfunctions or their recovery. However, TLC, serum CRP, and serum D-dimer had a significant positive correlation with the severity of olfactory dysfunction.

Pan-immune-inflammation value and body mass index to predict survival in diffuse large B-cell lymphoma

Abstract Background Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma (NHL), constituting 31% of all NHL. Malignancy and inflammation are closely linked. Inflammatory processes have been identified to play an important role in the pathogenesis of lymphoma. Obesity is a well-known risk factor not only for the development of cardiovascular disease and diabetes but also for the development of several types of cancer, including lymphomas. Objective To find out the association of pan-immune-inflammation value (PIV) and body mass index (BMI) with survival in adults with diffuse large B-cell lymphoma. Patients and methods We conducted an observational retrospective study on 110 patients to unravel the association of PIV and BMI with survival outcome in a cohort of adults diagnosed as de novo DLBCL (NOS) and treated at the hematology units of International Medical Center, Helwan and Menoufia University Hospitals, in the period from 2014 to 2018. Results The mean age of the studied patients was 54.27 years, the mean BMI was 28.91, and the median and IQR for PIV were 195.84 (96.20–498.52). The cutoff value for detecting mortality in BMI was 29.74 kg/m2 with poor sensitivity (44.4%) and poor specificity (67.2%). The cutoff value for detecting mortality in PIV was 250.49 with poor sensitivity (50.0%) and poor specificity (67.2%). The mean duration of overall survival was 21.596 months. There was nonsignificant difference regarding 2-year overall survival according to BMI grouping (p-value = 0.195) and PIV grouping (p-value = 0.275). Conclusion Neither PIV nor BMI were associated with 2-year overall survival in patients with DLBCL.

Effect of Vitamin D Supplementation on Post-COVID-19 Manifestations in Menoufia University Hospitals: A Randomized Controlled Clinical Trial

Effect of Vitamin D Supplementation on Post-COVID-19 Manifestations in Menoufia University Hospitals: A Randomized Controlled Clinical Trial

Fear Of Falling and Associated Factors among Elderly People Attending Outpatients Clinics at Menoufia University Hospital

Fear Of Falling and Associated Factors among Elderly People Attending Outpatients Clinics at Menoufia University Hospital

Cardiovascular Disease and Stroke Risk Among Egyptian Resident Physicians: A Cross-Sectional Multicenter Study.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide and are considered silent killers that threaten different age groups. The stressful lifestyle of resident physicians might make them vulnerable to CVDs. Since 2021, Egypt has recently reported more frequent sudden deaths of junior physicians after long shifts. Many factors can be associated with this prevalence, such as diabetes mellitus, increased blood pressure, or a sedentary lifestyle. Therefore, this study aimed to estimate the risk of developing heart attack and stroke within 10 years among resident physicians in Egypt with the goal of informing health policymakers to improve the healthcare systems for Egyptian physicians. This cross-sectional study was conducted at six university teaching hospitals around Egypt: Cairo, Al-Azhar, Zagazig, Menoufia, South Valley, and Sohag. Data were collected on the ground using a questionnaire developed from a validated tool, the QRISK3 calculator, developed by the National Health Service, and used to measure the development of CVDs and stroke over the next 10 years. Four hundred twenty-eight resident physicians filled out the study questionnaire, including 224 (52.3%) females. The mean age of the participants was 28.22 years (±2.54). The study revealed that 258 (60.3%), with a median (IQR) = 0.2% (0.1%-0.5%), of the resident physicians are at high risk of having a heart attack or stroke within 10 years. Migraine symptoms (n=65, 15.2%) and angina or heart attack in a first-degree relative (n=26, 6.1%) were the most reported risk factors. The risk was variable among the six university hospitals, with a significant P-value <0.001, where Menoufia University hospitals ranked first, followed by Zagazig University hospitals. However, the percentage of each specialty differs from others. The highest risk was among anesthesiology and ICU residents (n=18, 78.3%), followed by surgery residents (n=44, 62.9%). About 258 (60.3%) of the resident physicians are at risk of having a heart attack or stroke within 10 years. There is an urgent need to increase resident physicians' awareness about their heart attack and stroke risks and for health policymakers to ensure a better lifestyle and friendly training environment for resident physicians in Egypt.

High velocity nasal insufflation versus non-invasive ventilation in acute respiratory failure: a comparative study

Background In order to treat respiratory failure, thermo-humidified nasal high flow oxygen (NHFO) therapy is being used more and more. In several clinical scenarios, NHFO has recently gained popularity as alternative noninvasive respiratory ventilation. Aim The aim is to assess the role of high velocity nasal insufflation (HVNI) versus noninvasive ventilation (NIV) in acute respiratory failure. Patients and methods This is a prospective randomized clinical study conducted on 60 patients admitted to the Chest Department at Menoufia University Hospital with acute respiratory failure. Patients were randomized to receive either noninvasive positive pressure ventilation using an oronasal mask or high-velocity nasal insufflation (initial flow was at 30-40 l/min; temperature was adjusted to 37°C; fraction of inspired oxygen 1.0) with clinical monitoring and arterial blood gas (ABG) monitoring after 2, 6, 12, and 24 h. Results The therapeutic impact of both, HVNI and NIV, on pressure of arterial carbon dioxide (PaCO2), hydrogen ion concentration, arterial oxygen saturation and pressure of arterial oxygen (PaO2) over time was almost similar. There was an improvement in dyspnea and a decrease in respiratory rate over time when compared with baseline results in both groups. There was no statistical difference between both groups. The failure rate in type I respiratory failure (RF) was 33.3% in the HVNI group and 28.6% in the NIV group (P-value 0.7). The failure rate in type II RF was 41.7% in the HVNI group and 25% in the NIV group (P-value 0.3). HVNI was more comfortable for patients and provided better communication and oral intake. Conclusion This study demonstrates that the HVNI was comparable to the NIV in the management of hypoxemic respiratory failure and could be used as a noninvasive method of ventilation alternative to the BiPAP in hypercapnic RF, with more comfortability and better communication in the HVNI group.

Evaluation of preoperative melatonin on emergence agitation after herniorrhaphy surgeries in pediatrics

Background and objective Emergence agitation is a common phenomenon in children recovering from general anesthesia. An emergence agitation reaction increases the risk of injuring the surgical repair, the patient, and the caregivers. Thus, we aim to explore the efficacy of melatonin premedication on emergence agitation in children undergoing herniorrhaphy surgeries. Patients and methods A randomized prospective triple-blinded trial was conducted on 117 children with herniorrhaphy surgeries conducted at the Anesthesia, ICU, and Pain Management Department, Menoufia University hospitals from April 2022 to July 2023. Results Yale preoperative scale at the start did not significantly differ among the studied groups (P&gt;0.05). However, the Yale preoperative scale at 1 was significantly higher in group 1 with a mean of 10.2±1.9 than in group 2 (9.5±1.4) and group 3 (5.9±1.4) (P&lt;0.001). The agitation score at 5 h was significantly higher among group 1 with a mean of 2.77±0.67 than group 2 (2.56±0.64) and group 3 (2.03±0.96) (P&lt;0.001). Also, agitation scores at 10 and 15 h were significantly higher in group 1 (3.36±0.63, 4.2±0.66) than in group 2 (3.2±0.66, 3.79±0.73) and group 3 (1.74±0.88, 2.03±1.04), respectively (P&lt;0.001). Conclusion Melatonin premedication decreased the agitation scale postoperatively. The decrease was significantly higher in high doses in preventing emergence agitation in children. High-dose melatonin compared with low dose might have a significant effect in preventing emergence agitation.

Rationale of on admission surgical intervention on outcomes after cholecystectomy for mild gallstone pancreatitis

Objectives To evaluate the association of timing for cholecystectomy with clinical outcomes in patients with gallstone pancreatitis (GSP). Background Patients with mild GSP who undergo cholecystectomy sooner rather than later tend to have shorter hospital stays. Patients and methods From October 2019 to January 2023, the number of adult hospitalizations at Menoufia University Hospitals due to GSP was recorded. We classified patients into early (operated on within 2 days of admission) as well as late (operated on over 2 days after admission) groups based on when they had laparoscopic cholecystectomy. The date of cholecystectomy was then correlated with nonhome discharge, postoperative hospital length of stay, and readmission rate within a month of discharge using multivariable logistic and linear regression. Results An estimated 129 patients were admitted with acute GSP, and 25.6% of those admissions were classified as belonging to the early cohort. The remaining admissions were classified as belonging to the late cohort. After taking into account potential confounding factors, a late cholecystectomy was found to be linked with a greater risk of significant adverse outcomes [adjusted odds ratio 1.40, 95% confidence interval (CI): 1.24–1.51]. Also, participants in the late cohort had a greater chance of being readmitted within 30 days (adjusted odds ratio 1.12, 95% CI: 1.03–1.23) and nonhome discharge (adjusted odds ratio 1.41, 95% CI: 1.29–1.53). Conclusion Cholecystectomy that was performed after 2 days of admission for mild GSP was associated with increased major adverse events and 30-day readmissions, in addition to nonhome discharge.

Cardiovascular risk in elderly Egyptians with myelodysplastic syndromes

BackgroundMyelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell-derived disorders manifested by cytopenias peripherally. MDS initiates an inflammatory process which lead to atherosclerosis. Patients with MDS have 1.5-fold higher risks of cardiovascular risks.ObjectiveEvaluation of cardiovascular risk and unraveling the possible correlation of carotid intima media thickness (CIMT) with clinical, hematologic, and laboratory variables in elderly patients with MDS.MethodsWe conducted a case–control research on 168 participants to elicit the serum level of homocysteine, serum high-sensitive C-reactive protein (Hs-CRP), and CIMT in relation to cardiovascular risk, 84 of whom had MDS diagnoses. From March 2021 to the end of May 2023, we chose them among the inpatients and outpatients of the Menoufia University Hospitals’ Clinical Hematology Division. We contrasted the chosen MDS patients with 84 healthy individuals as controls.ResultsRight and left CIMT were significantly higher in MDS patients than controls as well as for lipid profile, blood pressure, blood sugar, and Hs-CRP. Homocysteine was higher in MDS patients but of no statistical significance.ConclusionAs CIMT and C-reactive protein level were significantly higher in studied patients, we may consider MDS group of patients to have higher risk for cardiovascular disease than normal people.

Gut microbiota analysis in colorectal diseased patients in Menoufia University Hospitals, Egypt.

Gut microbiota analysis in colorectal diseased patients in Menoufia University Hospitals, Egypt.