Qena University Hospital Research Articles

Impact of the COVID-19 pandemic on endoscopic retrograde cholangiopancreatography: a single center experience.

the COVID-19 pandemic has impacted on several aspects of health care services worldwide. The aim of the study was to determine its influence on the case volume, success rate and complication rate of endoscopic retrograde cholangiopancreatography (ERCP). all patients who underwent ERCP one-year before and after applying COVID-19 safety measures at the Qena University Hospital were included. Data were collected from the patients' records, analyzed and compared. a total of 250 patients underwent ERCP between April 1st, 2019 and March 31st, 2021, and the mean age of participants was 52 ± 18 years. There was a 5 % increase in case volume after applying COVID-19 safety measures (128 vs 122) and the total procedure time was significantly shorter (42 vs 46 minutes, p = 0.04). There was no significant difference in the overall success rate and complication rate. Procedure success significantly correlated with cannulation attempts and total procedure time in both groups, and serum bilirubin and cannulation time in the pre-COVID-19 patients and alkaline phosphatase (ALP) in post-COVID patients. ERCP-related complications significantly correlated with cannulation attempts in both groups, and ALP, international normalized ratio (INR), cannulation time and total procedure time in pre-COVID-19 patients, and platelet count and amylase in post-COVID patients. Two patients were confirmed COVID-19 cases at the time of ERCP; therapeutic targets were achieved in both with a smooth post-ERCP recovery. Three out of nine ERCP team members caught a mild to moderate COVID-19 infection and recovered after receiving proper management. our result show that there was no negative impact of using COVID-19 safety measures and precautions on the case-volume, indications, overall outcome or complication rate of ERCP.

Outcome of screening of patients with hepatitis B virus infection

Background: Hepatitis B is a major health problem worldwide, with over two billion people with evidence of infection and more than 350 millions chronically infected. Chronic hepatitis B virus (CHB) infection is responsible for 60-80% of hepatocellular carcinomas, and it is the tenth leading cause of death worldwide. The household transmission of hepatitis B virus (HBV) is a major health problem. High incidence of HBV infection is observed within the household contacts of HBV carriers.Transmission of HBV infection mainly occurs through parenteral and sexual exposure. Vertical transmission occurs from infected mother to her baby during the perinatal period. In addition, horizontal transmission among close contacts is well recognized as a mode of transmission of HBV infection.Patients and Methods: This is a prospective study that included 63 patients with chronic HBV infection that follow up in HBV outpatient clinic in Qena university hospital “between January 2019 to June 2019”. All patients subjected to: full clinical evaluation, diagnostic modalities as: laboratory investigation and abdominal sonography.Results:The whole number of screened members of all families are 300,while 77( 25.66%) of all family members are infected.Conclusion: The present study has clearly explored the role of the HBV intra-familial transmission and spread in upper Egypt. Three patterns of HBV transmission were determined in the current cohort infected with HBV genotype D; maternal and paternal, spousal, and between siblings.

Effect of educational nursing guideline about paracentesis procedure care on nurses' performance

Background: paracentesis is a common invasive method for managing patients with ascites; but it is associated with many potential complications. Nurses play a crucial role in preventing theses complications by providing special care before, during and after the procedures. Aim of the study: To evaluate the effect of educational nursing guideline about paracentesis procedure care on nurses' performance. Methodology: Research design: A pre/ posttest quasi-experimental research design was utilized in the present study. Sample: A convenient sample of (40) nurses was included in this study. Setting: The study was carried out at the tropical medicine departments of Qena University Hospital and Qena General Hospital, Qena governorate, Egypt. Tools of data collection: Two tools were utilized to collect data, First Tool: Structured interviewing questionnaire covered 2 parts: First part: Demographic data of the nurses. Second part included knowledge assessment sheet about paracentesis procedure. Second Tool: Observational checklist about paracentesis procedure. Study Duration: Data collection for this study was carried out through six months, from the beginning of January 2019 till the end of June 2019. Results: The study results revealed that there was a highly statistical improvement in total level of nurses' performance regarding paracentesis procedures at post and follow up phases after implementation of educational guidelines than before, with (p < 0.001). Conclusion: The application of educational nursing guidelines about paracentesis procedure enriched nurses' knowledge and practice than before. Recommendations: Continuous nursing education about paracentesis procedure is recommended to upgrade the knowledge and skills of nurses, replication of the current study on a larger probability sample from different geographical areas to achieve generalizable results.Also it is important to investigate the effect of applying this educational nursing guideline on ascetic patients' outcome.

Effect of Preoperative Nursing Protocol on Pain and Daily Activities for Post Inguinal Hernia Repair Patients

Background: Pain is the most serious long-term complication occurring after inguinal hernia repair with negative effects on all daily activities. As teaching is considered an important part of nursing care, interventions aimed to reduce pain and improving daily activities following surgical inguinal hernia repair are critically needed. Aim of the study: Toinvestigate the effect of Preoperative nursing protocol on reducing pain and improving daily activities post inguinal hernia repair. Methodology: Research design: Quasi-experimental research design was utilized in the present study. Sample: A purposive sample of (60) male patients undergoing inguinal hernia repair surgery. Setting: The study was carried out at the general surgical unit of Qena University Hospital, Qena governorate, Egypt. Tools of data collection: Three tools were utilized to collect data, First Tool: Structured questionnaire covered 3 parts: First part: Demographic data of the patients. Second part: Medical profile of the patients. Third part: Included knowledge assessment sheet about inguinal hernia disease, pain-relieving strategies and, how to prevent inguinal hernia recurrence. Second Tool: Pain numerical rating scale. Third Tool: Physical self-maintenance scale (Activities of daily living). Study Duration: Data collection of this study was carried out through six months, from the beginning of December 2019 till the end of May 2020. Results: our results revealed that ages among the study and the control groups ranged between (51 to 60 years), with a mean age (51.7±9.42 years and 55.4±6.21 years) respectively. Also, the study group demonstrated low level of pain as compared to control group after application of nursing interventions with a statistical significant difference between the mean score of pain level among the study and the control groups whereas the 1st follow-up was (2.03±0.66 & 0.16±0.37) respectively, at the 2nd follow-up was (5.83±0.46 & 3.57±0.50) respectively, and at the 3rd follow-up was (5.97±0.183 & 5.53±0.507) respectively, moreover the mean score of daily living activities of the study group improved versus the control group with a statistical significant difference in which the 1st follow-up was (1.93+.691 & 0.23+0.43) respectively, at the 2nd follow-up was (5.33+0.661 & 3.6+0.563) respectively, and at the 3rd follow-up was (5.93+0.2454 & 5.53+0.507) respectively. Conclusion: application of preoperative nursing protocol reflected a significant effect on patient's outcomes among the study group as postoperative pain level declined and level of activities increased as compared to the control group. Recommendations: Educational classes with a guide booklet should be provided at regular intervals for patients undergoing hernia repair, and replication of the current study on a larger probability sample from different geographical areas to achieve generalizable results are recommended.

Risk Factors for Systemic Lupus Erythematosus in Qena University Hospitals

Background: Systemic lupus erythematosus (SLE) is one of the most widely studied diseases in medicine Objectives: To study the relation between risk factors and clinical manifestations of systemic lupus erythematosus (SLE) at Qena governorate. Patients and methods: Assessment of 61 lupus patients was done through clinical and laboratory evaluation of musculoskeletal system (MSK), mucocutaneous involvement and renal involvement in addition to evaluation of smoking status, combined oral contraception (COC) and family history in each patient. Results: MSK manifestations were detected in all smoker lupus patients, all COC user lupus patients and half of those of familial lupus. Mucocutaneous manifestations were detected in 83 % of COC user lupus patients, 75 % of familial lupus patients and 50 % of smoker lupus patients. Lupus nephritis was detected in all COC user patients and half of either smoker lupus patients or familial lupus patients. Conclusion: Smoking, COC using and family history affect upon renal, MSK and mucocutaneous manifestations of SLE patients at Qena governorate.

Clinical Evaluation and Management Outcomes of Isolated Anterior Wall Frontal Sinus Fractures Fixation with Low Profile Miniplates

Background: Frontal sinus fractures are relatively commonwith high-velocity injury trauma. Isolated anterior wall fracturesrepresent one third of all cases. The main goals offixation are to restore the premorbid aesthetic condition andto preserve a safe and functional sinus. The ideal platingsystem used for fixation of the anterior frontal wall fracturesis the micro plating system owing to its many advantages.However, it is also feasible to utilize the low-profile miniplatingsystem as it has the same advantages.Patients and Methods: A prospective study conducted onpatients admitted to trauma unit in two departments (Maxillofacialdepartment; Assiut University Hospital and PlasticSurgery Department; Qena University Hospital) from August2017 to July 2019 (two years’ duration). The study includedall patients with anterior wall fracture of frontal sinus thatneeded open reduction and internal fixation (ORIF) with sinuspreservation. Materials used: Low profile miniplate system;KLS Martin compact system; 1.5mm craniofacial plates withthickness 0.7mm, miniscrew 1.5mm with 5mm in length anddrill bit 1.1mm diameter. Statistical analysis: Data was analyzedusing the Statistical Package for Social Sciences (SPSS)version 22. p-value <0.05 was considered significant.Results: Follow-up period ranged from 6-12 months.Clinical data revealed that none of the patients complainedfrom these miniplates concerning its palpability under theskin, sensitivity to temperature changes. No plate exposureor extrusion recorded. Only two patients had wound infectionsthat resolved by antibiotic therapy. Patients complained onlyfrom minor symptoms such as pain, supraorbital paresthesiaand facial edema. CT imaging showed good fracture healing,good alignment of the anterior wall and no plate failure(fracture). Patients were satisfied with restoration of theforehead contour and excellent aesthetic results.Conclusion: Isolated anterior wall frontal sinus fracturesare common due to high incidence rate of motor car accidentsin our country. Main lines of treatment aimed to restore a safefunctional sinus, prevent forehead contour deformity andobtain good aesthetic results. These goals can be obtained byfracture fixation with this low profile miniplate system withresultant patient satisfaction.

The Connection between Serum Level of Paraoxonase (PON 1) and Atherogenesis in Egyptian Patients with Type II Diabetes Mellitus

Background: Diabetes is considered a health problem all around the world that affects people at different age levels with increasing incidence and spread of disease leading to many complications. Paraoxonase is known as an anti- oxidant enzyme, it was originally found to stimulate the hydrolysis of paraoxonase and has a wide range of important analytical activities. Objective: To evaluate the serum level of paraoxonase1 (PON 1) in patients with type 2 diabetes mellitus with or without hypertension as a predictor marker of atherogenesis. Patients and methods: This study was a case-control study and carried out on 90 persons (45 males, 45 females) they were selected from the outpatient and inpatient clinic of Qena University Hospital. The study was conducted during the period between October 2019 and March 2020. Results: There was an increase in the level of blood glucose, serum cholesterol, serum triglycerides, serum LDL, serum Hs CRP, decreased serum PON 1, and serum HDL in (diabetic group) as compared to (healthy individuals group). The study also showed a positive correlation between the decreased level of serum PON 1 in patients and decreased serum HDL. The study also showed a negative correlation between the decreased level of serum PON 1 and increased serum glucose serum cholesterol, serum triglycerides, serum LDL, and serum Hs CRP. Also, measurement of serum PON 1 may become a useful, expanding tool for evaluating atherogenesis diabetes and hypertension. Conclusion: Therefore, measurement of the proportion of serum PON 1 as a biomarker of atherogenesis in Egyptian patients with type 2 diabetes mellitus.

The Connection between Serum Level of Paraoxonase (PON 1) and Atherogenesis in Egyptian Patients with Type II Diabetes Mellitus

Background: Diabetes is considered a health problem all around the world that affects people at different age levels with increasing incidence and spread of disease leading to many complications. Paraoxonase is known as an anti- oxidant enzyme, it was originally found to stimulate the hydrolysis of paraoxonase and has a wide range of important analytical activities. Objective: To evaluate the serum level of paraoxonase1 (PON 1) in patients with type 2 diabetes mellitus with or without hypertension as a predictor marker of atherogenesis. Patients and methods: This study was a case-control study and carried out on 90 persons (45 males, 45 females) they were selected from the outpatient and inpatient clinic of Qena University Hospital. The study was conducted during the period between October 2019 and March 2020. Results: There was an increase in the level of blood glucose, serum cholesterol, serum triglycerides, serum LDL, serum Hs CRP, decreased serum PON 1, and serum HDL in (diabetic group) as compared to (healthy individuals group). The study also showed a positive correlation between the decreased level of serum PON 1 in patients and decreased serum HDL. The study also showed a negative correlation between the decreased level of serum PON 1 and increased serum glucose serum cholesterol, serum triglycerides, serum LDL, and serum Hs CRP. Also, measurement of serum PON 1 may become a useful, expanding tool for evaluating atherogenesis diabetes and hypertension. Conclusion: Therefore, measurement of the proportion of serum PON 1 as a biomarker of atherogenesis in Egyptian patients with type 2 diabetes mellitus.

Multidrug resistant tuberculosis in Qena governerate and it's socioeconomic burden

Background: Resistance to tuberculosis (TB) drugs is a formidable obstacle to effective TB care and prevention globally. Patients and Method: This study included 100 patients of both sexes were chosen from outpatient clinic and inpatient word in Qena University hospital. Patients were subjected to: Full history and examination, chest X-Ray, ESR, CBC, sputum microscopic examination, Genexpert for sputum samples, sputum cultures. Results: : Patients with treatment failure were 64 with mean age 48.9±16.1 and 34.4% of patients were male and 65.6% females. The mean ESR in was 1ST hr 101 and after 2nd hr 120. About 43.8% stopped working and 38.5% borrowed money. Chest x-ray showed 50.1% cavitary lesion, 21.8% consolidation, and 28.1% miliary shadow. Patients with treatment response were 36 with mean age 57.3±19.3, about 55.6% of them males and 44.4% females. The mean ESR 1ST hr 54±24, 2ndhr 96.1±32.Chest x-ray showed 22.2% cavitary lesion, 44.4%consolidation and 33.4% miliary shadow. About 38.9% stopped working and 55.6% borrowed money. Conclusion: This study showed increase social and economic burden in TB resistant patients. We noticed that TB resistant patients were reported income loss and work affection.

Safety and Efficacy of Direct-Acting Antivirals for Treatment of Chronic Hepatitis C in Population Aged 60 Years and Older in Upper Egypt

Abstract: Background: Egypt is the country of highest prevalence of chronic HCV infection. Elderly infected individuals are more liable than younger infected individuals to have increased course of infection, increased risk of disease progression, and consequently increased incidence of occurrence of advanced liver disease. Aims: The current study aimed to assess the safety and the efficacy of the treatment with direct acting antivirals based regimens in hepatitis C virus infected individuals aged ≥60 years. Setting: Unit of Hepatic Viruses Treatment, Qena university hospital, South Valley University, Qena, Egypt Patients and methods: three hundred elderly individuals with chronic hepatitis C virus infection, Child–Pugh grade A, were involved in this study, treated with DAAs for twelve weeks, either dual therapy or triple therapy(with addition of ribavirin), according to criteria of the national committee for chronic viral hepatitis. Results: The Overall CHC infected individuals mean age were 69.9 ± 5.3 years, 71.7% were male and 18.3% were females. The sustained virological response (SVR) rate at 12 weeks post-treatment was 96% (288/300). We discovered a statistically important association between virological failure and degree of fibrosis, rates of sustained virological response were 98.8% in patients with no liver cirrhosis and 84.5 % in patients with established liver cirrhosis, there were high important difference between cirrhotic and non-cirrhotic patients (P < 0.001). Conclusion: DAAs treatment reached 12weeks-sustained virological response in 96% of chronic hepatitis C virus-patient with high safety profile. Liver Cirrhosis has negative effect on 12weeks-SVR. Key Words: Direct-acting anti-virus, SVR, HCV.

MPN-316: Impact of Comorbidities in Philadelphia Chromosome-Negative Myeloproliferative Neoplasms

Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) are hematological disorders that occur due to clonal proliferation. Thrombosis and bleeding are more common in MPN patients in comparison to normal population. Comorbidity is a well-known negative prognostic factor for survival of patients with cancer. The aim of this study is to show the impact of comorbidities using the Charlson Comorbidity Index (CCI) on thrombotic events and bleeding episodes, as well as survival outcome in Philadelphia-negative MPNs. A retrospective cross-sectional study was carried out at Upper Egypt in Qena University hospital and Assiut University hospital between January 2014 and December 2018, in which clinical, molecular, and laboratory data of MPN patients were included. This cohort included: 62 primary myelofibrosis (PMF; 32.7%), 89 polycythemia vera (PV; 46.8%) and 39 essential thrombocytosis (ET; 20.5%) patients. Diagnosis was based on the WHO classification 2008. We computed the CCI on 190 MPN patients at diagnosis; CCI is a list of 19 comorbid conditions: each condition has a weight assigned from 1 to 6 to study the effect of comorbidity on risks of vascular events in patients with MPN, as well as survival. The endpoints were a venous or arterial thrombotic event and bleeding episodes. One-quarter of patients (n=50; 26.3%) had CCI zero (low comorbidity), 83 (43.7%) had a CCI 1–2 (moderate), and 57 (30%) had a CCI > 2 (severe). The most common comorbidities were hypertension (32.1%), coronary artery disease (12.1%), diabetes (12%), and others as reported accordingly. Forty-two patients (22.1%) had a thrombotic episode (29/42) at the time of diagnosis. CCI was significantly higher in patients with a thrombotic event vs. patients without a thrombotic event (P ≤ 0.001). CCI was higher (although not significantly) in patients with bleeding episodes of any grade vs. patients without a bleeding event (P=0.42). Overall survival (P ≤ 0.001) and progression-free survival (P

Post-stroke depression: frequency, risk factors, and impact on quality of life among 103 stroke patients\u2014hospital-based study

BackgroundPost-stroke depression (PSD) has worse functional outcomes and quality of life. Despite the extensive literature on this topic, there is no agreement on the frequency or risk factors for post-stroke depression.ObjectivesTo establish the frequency and risk factors of post-stroke depression and its impact on quality of life.Patients and methodsOne hundred three stroke patients were recruited from the out-patient clinic of Qena University Hospital who satisfied the WHO definition for stroke, together with a control group of 50 age- and sex-matched healthy volunteers. A complete history, neurological examination, and CT brain were obtained for each patient. DSM-IV TR criteria were used for diagnosis of depressive disorders which was scored with the Hamilton depression rating scale (HAM-D); Barthel Index (BI), and quality of life were also measured.ResultsThirty-eight (36.9%) stroke patients had PSD which was significantly higher than in the normal population (control group 12%). Statistically significant risk factors for PSD included low educational level, low socioeconomic status, smoking, and post-stroke functional impairment. Post-stroke depression has an impact on quality of life.ConclusionPost-stroke depression is a relatively common complication of stroke and can affect the quality of life. Low educational level and socioeconomic status, as well as smoking and functional impairments, were considered as risk factors for the occurrence of post-stroke depression. Early detection of predictors of post-stroke depression may improve the outcome of stroke and prevent the psychiatric consequences.

Evaluating protocol of management of unconjugated hyperbilirubinemia in neonatal intensive care unit at Qena University Hospital

Background: Neonatal hyperbilirubinemia is a common problem in neonates with an incidence of about 60% in term babies and 80% in preterm babies. It is the commonest cause of admission to the hospitals in the newborn period. We should assess all babies for jaundice at every opportunity. Methods include visual assessment, transcutaneous bilirubinometer (TcB) or total serum bilirubin (TSB). Objective: This is a descriptive study aimed to evaluating the protocol of management of unconjugated hyperbilirubinemia in neonatal intensive care unit at Qena University Hospital. Patients and method(s): This descriptive study included neonates admitted to neonatology unit at Qena university hospital from (April to October 2019), Total number of admitted neonates in our NICU through this period were 1274, from which 517 neonates had jaundice as a primary cause of admission or developed during the course of NICU stay. Result(s): In this period the total number of NICU admission was 1274 cases, out of 517 jaundiced neonates, 100 (19.3%) were diagnosed to have unconjugated jaundice on admission without any associated other diseases and 417 (80.7%) of them were admitted due to other causes and developed jaundice during the course of the disease. The other 417 neonates were admitted to our NICU due to RD in 409 (79.1%) cases, 4 (0.8%) cases due to sepsis, two (0.4%) cases due to CHD and two (0.4%) cases due to surgical causes. The unconjugated neonatal jaundice represented (7.8%) (100 cases out of 1274 neonates admitted during the period of the study). Physiological jaundice represented 89.4% while pathological jaundice represented 10.6% of causes of neonatal jaundice. Regarding treatment of studied neonates 12% of cases need only follow up with no need for Phototherapy, 62.8% of cases needed single or double Phototherapy, 12.4% needed extensive Phototherapy (triple phototherapy), 12.8% of cases needed capsule Phototherapy and no cases needed neither exchange transfusion nor drug therapy. Only 0.4% of jaundiced neonates developed prolonged hyperbilirubinemia, while no complications were detected in 99.6% of cases. We started treatment based on measuring bilirubin by TSB in 62.3% of jaundiced neonates and 37.7% by TCB. The mean values of TSB in jaundiced neonates (11.46 ± 4.92) were significantly higher than the TCB (10.31 ± 4.61), P =0.0005. There was significant positive correlation between mean TSB and mean TCB (R= 0.946, P < 0.001). There was no significant difference regarding mean TSB between different gestational age groups p= 0.242). Conclusions: Hyperbilirubinemia is one of the most common causes of hospital admission in our nursery. Among the causes of hyperbilirubinemia, physiologic jaundice was the most common. Intensive phototherapy is effective in lowering TSB in unconjugated jaundice at / or near levels of exchange transfusion, and this may be helpful in decreasing needs for and risks of exchange transfusions. TcB measurements may underestimate the TSB values, so it should be considered only as a screen and samples should be sent to the laboratory for confirmation especially at high risk groups and high levels of TCB.

Laparoscopic appendectomy for perforated appendicitis; a comparison with open appendectomy

Background: Perforated appendicitis is one of the common surgical emergencies which need immediate surgical intervention.For many years, the classic open appendectomy still seems to be the routine treatment of perforated appendicitis. The improvement of technology and an increase in laparoscopic experience have been central to the development of laparoscopic surgery.The aim of this study is to compare outcome of laparoscopic versus open surgery for surgical management of perforated appendicitis in our locality. Patients and Methods: This is a prospective study that included 40 patients with perforated appendicitis admitted at general surgery department in Qena university hospital “between April 2018 to April 2019”, 20 patients underwent open appendectomy and 20 had laparoscopic surgery. All patients subjected to: full clinical evaluation, diagnostic modalities as: laboratory investigation, plain X-ray erect and abdominal sonography. Results:All cases were completed successfully.A20 patient underwent open conventional surgery their mean age 29.80±7.32 years. While those underwent laparoscopic surgery were 20 patients and their mean of age 28.80±7.37 years. There were statistically significant differences between studied groups regarding operative time,time to return to a normal diet, length of hospital stayand postoperative complications. Conclusion: Laparoscopicsurgery for perforated appendicitisis safe and carries many advantages of minimallyinvasivetechniques. So, it should beused selectively, reservingthe traditionalopen approach.

Isolation, identification and Antibiogram study of pathogenic bacteria mediated Children Chronic Tonsillitis at Qena University Hospital, Egypt.

Background:Inflammation of tonsils is a common disease of the throat that occurs predominantly in thechildren. Sothis prospective study was carried out to determine the pattern of bacterial strains and theirantibiotic sensitivity amongst children with tonsillitis admitted to the E.N.T Department, Faculty ofMedicine,Qena University Hospital for elective tonsillectomy.Patients and Method(s): Thirty-five children (2 to 17 years old) suffering from chronic tonsillitis weresampled. The bacterial isolates were identified phenotypically based on morphological, hemolysispattern and biochemical characters using different media or identified genotypically through 16S rRNAgene sequencing.Results: The bacterial strains were identified as Staphylococcus aureus (40%) followed byStreptococcus pyogenes (35%), Streptococcus australis (15%), and Streptococcus pneumoniae (10%).The susceptibility of the isolates was tested towards 8 different types of antibiotics (Bioanalyse®). Theresults showed that most bacterial isolates were multidrug-resistant bacteria that showed resistant tothree or more tested antibiotics.Conclusion: The present study revealed that the s-haemolytic Streptococci (BHS) is a significant causalagent of tonsillitis in our environment which causes a potential danger of rheumatic fever andrheumatic heart disease.

Impact of obesity on asthma severity and control in school aged children

Background:Childhood asthma and obesity are significant public health problems. The prevalence of asthma and obesity in children have increased significantly during the past decades. The basis for the relationship between pediatric asthma and obesity is not well established. Objective: our study aimed to find the relation between obesity and bronchial asthma and whether obesity may contribute to more severe asthma symptoms in asthmatic children at Qena University Hospital. Patients and method(s): This was a cross-sectionalstudy of asthmatic school aged children who were admitted at pediatric department or attendedemergency department or the outpatient clinic of Qena University Hospital through the period from MAY 2018 to April 2019.They classified according to BMI to two groups, asthmatic obese and asthmatic non-obese. The included asthmatic children are subjected to full through history, clinical examination and pulmonary function tests. Result(s):This was a cross-sectional study which was carried out in Pediatric department of Qena university hospitaland included 60 asthmatic children with intermittent to severe persistent asthma with age range 6-12 years through the period from MAY 2018 to April 2019 and classified to two groups, 30cases asthmatic obese and 30 cases asthmatic non-obese, based on calculated BMI in both groups. The patients were diagnosed according to the global strategy for asthma management and prevention classification. The mean age in asthmatic obese patients was (8.94±1.99)versus (9.13±1.97) in asthmatic non-obese group with no significant difference between them (p-value =0.707). The percentage of moderate persistent asthma was statistically significantly higher in asthmatic obese than asthmatic non-obese group (53.3% versus 26.7%, p-value= 0.035), respectively. 13.3% of asthmatic obese had severe persistent asthma versus 0% in asthmatic non-obese group (p-value=0.038).46.7%of the asthmatic obese children received high dose of steroids versus 10%of asthmatic non-obese with statistically significant difference (p value =0.001). The mean numbers of emergency visits in asthmatic obese were significantly higher than that in asthmatic non-obese (5.9±2.66versus 3.93±1.6), (p-value= 0.001), respectively. FEV1, FVC, FEV1/FVC, were not significantly different in asthmatic obese patients compared with asthmatic non-obese (p-value =0.742, 0.849, 0.751, respectively). Conclusion:obesity was associated with significantly more severe asthma symptoms together with poor asthma control. Pulmonary function tests were not affected by increased BMI.

Short-Term Outcome of Tricuspid Valve Annuloplasty Using the Modified De Vega Technique

Objectives: The aim of this study is to evaluate short-term results and efficacy of tricuspid valve annuloplasty by the modified De Vega technique. Study design: A prospective cohort study. Setting:Cardiothoracic Surgery Department in collaboration with general surgery department, Qena University Hospital, South Valley University, Qena, Egypt. Duration: FromOctober 2018 to January 2020. Subjects and Methods:25 patients underwent tricuspid valve annuloplasty for functional TR caused by Rt sided dilatation secondary to the left-sided valvular lesion. Informed consent was obtained from all patients in this study. Pts with mild TR, (organic) tricuspid regurgitation or TV endocarditis, and isolated TV lesions were excluded from the study. Result(s):Follow-up echocardiography after 6 months did not show any severe tricuspid regurgitation, but otherwise, most of the patients with mild tricuspid regurge 17 pts (68%) and 8 patients (32%) with moderate regurge, as regard ejection fraction and LV dimensions there were no difference, while there was a significant reduction in LA diameter, pulmonary artery pressure, and RV diameter with p value <0.05. Conclusion(s): Tricuspid valve annuloplasty with a modified De Vega technique in functional TR was associated with a lesser residual degree of TR and could be considered a reliable procedure in TV repair in short term follow-up. Recommendations: Larger sample size and longer follow-up duration should be done

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Hepatic Focal Lesions

Background: Diffusion-weighted imaging (DWI) is a novel imaging technique with a growing application in oncoimaging. This modality evaluates the diffusion of water molecules in various tissues, which is restricted in hypercellular regions such as malignant tissue. Apparent diffusion coefficient (ADC) is a method that can quantify the degree of restriction in tissues and can have diagnostic roles in the characterization of hepatic lesions. Aim of the Work: To study the role of diffusion-weighted MRI sequence with quantitative ADC measurements as a useful tool in the differentiation between benign and malignant liver lesions. Patients and Methods: The current study was carried out on thirty adult patients, 24 males (80%), and 6 females (20%). They were presented to Qena University Hospitals at the Radiodiagnosis Department. Results: Both, qualitative evaluation of high b-value DW-MR images and quantitative evaluation of ADC maps are employed for lesion characterization. The ADC values of benign lesions are significantly higher than those of malignant lesions, with variable degrees of overlap between the pathological entities. Conclusion: DW MR imaging has the potential to be a reasonable alternative technique to contrast-enhanced imaging.

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Hepatic Focal Lesions

Background: Diffusion-weighted imaging (DWI) is a novel imaging technique with a growing application in oncoimaging. This modality evaluates the diffusion of water molecules in various tissues, which is restricted in hypercellular regions such as malignant tissue. Apparent diffusion coefficient (ADC) is a method that can quantify the degree of restriction in tissues and can have diagnostic roles in the characterization of hepatic lesions. Aim of the Work: To study the role of diffusion-weighted MRI sequence with quantitative ADC measurements as a useful tool in the differentiation between benign and malignant liver lesions. Patients and Methods: The current study was carried out on thirty adult patients, 24 males (80%), and 6 females (20%). They were presented to Qena University Hospitals at the Radiodiagnosis Department. Results: Both, qualitative evaluation of high b-value DW-MR images and quantitative evaluation of ADC maps are employed for lesion characterization. The ADC values of benign lesions are significantly higher than those of malignant lesions, with variable degrees of overlap between the pathological entities. Conclusion: DW MR imaging has the potential to be a reasonable alternative technique to contrast-enhanced imaging.

Clinical and surgical aspects of congenital lobar over-inflation: a single center retrospective study

BackgroundCongenital lobar overinflation (CLOI) is one of the most important causes of infantile respiratory distress (RD). We aim to evaluate our experience in CLOI management emphasizing on clinical features, diagnostic modalities, surgery and outcomes.MethodsThis is a retrospective study for all CLOI cases undergoing surgical management at Qena University Hospital. Demographic data, clinical data, radiographic findings, surgery and postoperative follow-up were reviewed.ResultsA total of 37 neonates and infants with CLOI were presented to our center between January 2015 and January 2019; their mean age was 111.43 ± 65.19 days and 22 were males. All cases presented with RD; and cyanosis in 19 cases. 15 cases presented with recurrent pneumonia and fever. Diminished breath sounds on the affected side and wheezes were the main clinical findings in 30 and 22 cases respectively. On CXR, emphysema was detected in all cases. A confirmatory CT chest was done for all cases. Left upper lobe was affected in 23 cases, right middle lobe in 7 and right upper lobe in 7 cases.Lobectomy was done in thirty-one cases; their mean age at surgery was 147.58 ± 81.49 days and 19 were males. Postoperative complications were noted in 5 cases and postoperative ventilation was required for 2 of them. No morbidity or mortality was reported. The follow-up duration ranged from 3 months to 1 year and all patients were doing well except one case that lost follow up after 3 months.ConclusionCLOI is a rare bronchopulmonary malformation that requires a high index of clinical suspicion, especially in persistent and recurrent infantile RD. CT chest is the most useful diagnostic modality. Early management of CLOI improves outcome and avoid life-threatening complications. Surgical management is the treatment of choice in our center without recorded mortality.