Alexandria University Research Articles

Assessment of breast cytoarchitecture and its associated axillary lymph node status under normal and pathological conditions in Egyptian women

ObjectiveHerein, we compare the features of neoplastic cancer cells in invasive ductal carcinoma (IDC) grade II and III patients to their corresponding normal cells both in breast and axillary lymph node (ALN) tissues. MethodsA retrospective cohort of 70 female breast cancer patients enrolled between 2018 and 2020 at Medical Research Institute, Alexandria University, Egypt, was analyzed for clinicopathological features presentation. Fresh tiny pieces of breast tissue and its associated ALN tissues were then processed to investigate the morphological appearance by scanning electron microscopy. Moreover, the histological architecture of tissue sections stained with hematoxylin and eosin was studied by light microscope, while the characterization of the ultrastructure features of breast and ALN tissues was analyzed by transmission electron microscopy. ResultsClinicopathological presentation of patients revealed that the Egyptian female breast cancer population adhered to the global trends of breast cancer disease with elevated incidence rate among postmenopausal women (61.3%), high frequency of IDC (95.7%), and increased ALN metastasis (65.7%). The percentage of estrogen receptor alpha (ERα) and human epidermal growth factor receptor 2 (HER2) expression, as key indicators for carcinogenesis and disease progression was 87.1% and 55.8%, respectively. The present study points to the observed discrepancies among the investigated variables in the diagnostic separation between IDC grade II and grade III. Ductal epithelial cells organization, nuclei size and irregularity, chromatin amount and uniformity, mitochondrial abundance and dysfunction were differentially manifested in IDC grades. Moreover, aberrations in the cellular organelles like lysosomes, endoplasmic reticulum, and lipid droplets vary according to the grade of IDC and the aggressiveness of the invasive breast cancer. ConclusionsTo sum up, this study emphasizes the importance of accurate specimen evaluation for treatment choice and decision.

Prospective study of management in surgical emergency laparotomy patients in Alexandria Main University Hospital

Background Emergency laparotomies form a broad group of time-sensitive surgeries done on variable patient population. Purpose The purpose of this study was to evaluate the incidence and details of emergency laparotomy, its complications, and mortality rates. Patients and methods This prospective study was held in Alexandria University Hospitals in the duration between April 2022 and September 2022 and included all patients were subjected to emergency laparotomies (481 patients). Preoperative, operative, and postoperative data were recorded. Results Out of 481 patients, 398 patients had nontraumatic causes and 83 patients had traumatic cause. The commonest nontraumatic cause was appendicitis, and the commonest traumatic cause were stab and road traffic accident. Most of trauma patients were males and had younger age than nontrauma groups. Intraoperative complications were reported at comparable frequencies between both groups and the commonest complications were atrial fibrillation (AF) and failed extubation. Postoperative complications were higher among nontrauma group and septic shock was the main complication. Postoperative mortality was higher among nontrauma group. Conclusion Emergency laparotomies were indicated for nontraumatic causes at higher rate the traumatic cause with higher postoperative complications and mortality rates.

Lidocaine Infusion Versus Duloxetine for Prevention and Management of Taxane-Induced Peripheral Neuropathy among Breast Cancer Patients-A Randomized Controlled Study

BACKGROUND: Taxane-induced peripheral neuropathy (TIPN) among breast cancer patients is considered one of the most devastating side effects affecting compliance to chemotherapy protocol and patients’ quality of life (QOL). OBJECTIVES: This trial aimed to evaluate the effect of lidocaine infusion vs oral duloxetine on the incidence and severity of TIPN and QOL in patients with breast cancer scheduled for neoadjuvant taxane therapy (TT). STUDY DESIGN: Prospective, randomized, single-blinded, controlled trial. SETTING: This study was carried out on 60 patients with breast cancer scheduled for 12 weeks of TT at the Medical Research Institute Hospital, Alexandria University after obtaining local Ethics Committee approval (IORG008812) and getting a written informed consent from each patient. It was registered in the “clinical trials library for protocol registration and results system” with the number NCT04732455. METHODS: Sixty women scheduled for TT weekly for 12 weeks, were randomly allocated to receive intravenous saline infusion in the control group (GC), or lidocaine 2mg/kg with saline infusion in the lidocaine group (GL), or saline infusion and 30 mg duloxetine in the duloxetine group (GD). All infusions were administered over 40 minutes before each TT. Oral duloxetine was prescribed once daily starting from the night before commencing TT and continued for 12 weeks. Douleur Neuropathique en 4 Questions (DN4) questionnaire was filled weekly to detect the incidence of neuropathic pain (NP). The nerve conduction study (NCS) aimed to detect and measure the degree of neuropathy before starting the chemotherapy protocol and post-12 weeks of Taxol Therapy. NP Scale was measured weekly to assess the severity of NP symptoms. Patients’ QOL was evaluated by the European Organization for Research and Treatment of Cancer QOL Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20-Item Scale. RESULTS: Thirty-five percent of patients reported DN4 > 4 points in GC after 6 weeks of TT in comparison to 5% in GL and 0% in GD (P = .005). Moreover, the incidence rose to 75% in GC compared to 20% in GL and 25% GD at the end of TT (P < 0.001). The severity of symptoms, global pain intensity, and patients’ unpleasantness were significantly more in GC than GL and GD in the last 4 weeks of TT (P < 0.05). NCS showed that 55% and 25% of patients developed mild and moderate axonal neuropathy, respectively, in GC. In contrast, mild neuropathy was developed in 20% and 25% of patients in GL and GD, respectively, and moderate neuropathy in 5% in both groups. The negative impact of TT on QOL was more significant in GC than GL and GD at weeks 8 and 12 of TT (P < 0.001). LIMITATIONS: Limited reference data for all treatment regimens to include in the Discussion section. CONCLUSIONS: Lidocaine and duloxetine have a comparable effect to decrease the incidence and severity of TIPN. Moreover, patients’ QOL was significantly better in both groups. KEY WORDS: Lidocaine infusion, duloxetine, taxane-induced peripheral neuropathy, breast cancer, DN4

Evaluation of the referral system for electrodiagnostic testing in the main Alexandria University hospital

BackgroundNerve conduction studies and electromyography (NCS/EMG) play a key role in the evaluation of patients with neuromuscular diseases. It serves as an extension of a clinical and neurological examination. Patients should be referred to electrodiagnosis (EDX) examination with an appropriate request, including history and neurological findings. When the referring diagnosis is appropriate, the examination is quicker, less invasive and limited to the verification of the provisional diagnosis. The referral system at the hospital involves only one paper asks for (NCS/EMG) with no specific information, the electromyographer is responsible for taking the patient history and performing clinical examination. Consequently, the current referral system had many flaws that needed to be corrected to enhance it.AimTo evaluate the current referral system to the electrodiagnosis unit and to assess the electromyographers’ satisfaction with the new referral system.MethodsA simple questionnaire was filled by all working electromyographers to assess their satisfaction about the referral system, then a new approved referral sheet was applied by a specialized physician to all patients attending the EDX unit for two months, then the same questionnaire to evaluate the new referral system was filled again by the same electromyographers.ResultsThere was a statistically significant difference regarding the electromyographers’ satisfaction with the new referral system.ConclusionThe electrodiagnosis examination could be easier, quicker, and more organized if preceded by a proper referral system and electrodiagnosis sheet.

Impact of epicardial adipose tissue on coronary arteries thrombus burden and early outcomes in STEMI patients

Abstract Aim Evaluation the relationship between the epicardial adipose tissue thickness (EAT), the coronary arteries thrombus burden and the early major adverse cardiovascular events (MACE) in patients presented with STEMI undergoing primary percutaneous coronary intervention. Method The study was prospective and included patients (n = 80) who were referred to the cardiology department in Alexandria University Hospitals with STEMI between the 1st of March 2021 and the last day of August 2022. Patient clinical, laboratory, angiographic and echocardiographic data were described. Patients were put under observation to detect the occurrence of any major adverse cardiovascular events either in hospital or during a period of 30 days follow up. Special concerns for measuring EAT as an echo free space between the myocardium and visceral epicardial and measured perpendicular to the free wall of the right ventricle in parasternal long and short axis views at end diastole and angiographic assessment of thrombus burden was scored as follows: 0 (no thrombus), 1 (possible thrombus), 2 (definite thrombus < 0.5× reference vessel diameter), 3 (definite thrombus 0.5–2× reference vessel diameter), 4 (definite thrombus >2× reference vessel diameter), and 5 (complete vessel occlusion). According to thrombus grade the patients were grouped as low thrombus burden (grades 0–3) and high thrombus burden (grades 4 and 5). Results 25 subjects were in the low thrombus burden group and 55 in the high thrombus burden group. There were no differences in the two groups for age, sex, smoking and drug addiction status, family history of coronary artery disease, diabetes mellitus, hypertension, and total cholesterol, triglyceride, LDL-C and HDL-C, The mean Wall motion score and Wall motion score index. The means levels of high sensitivity troponin I and Creatine Kinase MB are measured higher in the low thrombus burden group with statistically significant difference (P = 0.025) and (P = 0.032). Balloon predilation was statistically significant difference between the two groups (P = 0.006). Thrombus’ aspiration, balloon post dilation of the culprit vessel, GpIIb/IIIa inhibitors, and one stent only were insignificant difference between the two groups. The receiver operating characteristic curve analysis was undergone to determine the cutoff value of EAT to predict the presence of high thrombus burden setting a significance level at P < 0.05. The thickness of 2.48 mm for EAT has 74.55% sensitivity and 72.0% specificity for prediction of the high thrombus burden. The predictors of the high thrombus burden were analyzed by univariate analysis shows EAT, the waist circumference, Wight, the body mass index, and balloon predilation were found as an independent predictors of high thrombus burden. The multivariate analysis shows EAT and balloon predilation were found as an independent predictors of high thrombus burden. The overall MACE at 30 day follows up has statistically insignificant difference between low and high thrombus burden groups. There was statistically insignificant difference between patients with or without MACE according to epicardial adipose tissue thickness. Conclusion EAT was an independent predictor of coronary thrombus burden in STEMI patients. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Multidisciplinary management of invasive vertebral hemangioma: the role of different neurointervention modalities—a retrospective study

BackgroundCatastrophic intraoperative bleeding is a major complication of surgical removal of invasive vertebral hemangioma. Interventional neuroradiology techniques could be more useful tools to manage such hemorrhagic lesions.ResultsRetrospective analysis of cases of invasive vertebral hemangioma revealed 17 cases treated at the Alexandria University School of Medicine from 2006 to 2020. The study included 52.9% of males with a mean age of 38.4 ± 18.6 years old. All patients reported local and sometimes radicular pain; 64.7% exhibited progressive neurological deficits. Imaging revealed thoracic spine affection in 11 cases, lumbar vertebral in four cases, and cervical vertebra in two cases. Vertebral involvement occurred in 10 cases and paravertebral extension in 13 cases. Neurointervention modalities included transarterial embolization followed by corpectomy and fixation (one case with C4 lesion), direct surgery with corpectomy and anterior fixation (one case with C7 lesion), vertebroplasty alone (four cases), vertebroplasty with fixation (seven cases), and direct transpedicular alcohol injection with immediate devascularization and necrosis of the vascular channels inside the lesions (six cases). The alcohol injection use ranged from 4 to 10 ml in each pedicle. All patients did well during the follow-period post-intervention. The neurological deficits improved over six months. All patients showed improved Nurick grade regardless of the intervention (preoperative mean 2.7 ± 1.9 vs. postoperative mean 1.1 ± 1.3, p value 0.0001). Two patients were completely paraplegic, but with intact deep sensation, they improved dramatically and can walk unsupported post-intervention.ConclusionsVertebral hemangioma can present in an invasive manner that necessitates intervention. Preoperative embolization, alcohol injection, or vertebroplasty are helpful methods to decrease intraoperative catastrophic hemorrhage. Alcohol injection is cost-effective with immediate devascularization of the lesion. The extensive 360 surgery utilization can be decreased with the use of alcohol and vertebroplasty. More cases are needed to validate these conclusions.

What an adult multiple sclerosis registry can tell us about pediatric onset multiple sclerosis?

BackgroundMultiple Sclerosis (MS) is an immune-mediated, chronic disease of the central nervous system that affects mainly adults. However, it is increasingly recognized that MS may start in childhood resulting in a relentlessly progressive disability and cognitive impairment. Registries across the globe are reporting inconstant data about their Pediatric-Onset Multiple Sclerosis (POMS) patients. Moreover, newer lines of treatments are emerging and showing efficacy in controlling the MS disease regardless of the onset. Therefore, there is a requirement for more research into the clinical profile of POMS in different populations and ethnicities. MethodsThis study was a cross-sectional study that included MS patients who visited the MS unit at Alexandria University from January 2019 to January 2021. We analyzed their epidemiological, clinical, radiological data, and cerebrospinal fluid (CSF) results from their updated records as well as follow-up interviews. ResultsAnnual Relapse Rate (ARR) was marginally less in POMS than AOMS (0.72 ± 0.57 vs 1.04 ± 0.78 relapse/year, P =.008). POMS patients had a bigger gap to their first relapse (40.0 ± 47.35 vs 22.71 ± 34.33 months, p= .066). The difference in relapse rate between the two groups was abolished after the exclusion of patients who had a gap of more than 5 years to their first relapse. AOMS patients were significantly more likely to start with a second-line disease-modifying treatment (DMT) than POMS patients (11.5% vs 31%, p= .04), whereas POMS patients were more likely to be escalated to the second line (34.6% vs 19.3%, p= .07). ARR had a positive and significant correlation with expanded disability status scale (EDSS) progression per year (rs(24)= .57 p=.003). A Mann-Whitney test indicated that POMS patients who had infratentorial involvement in the initial MRI brain had higher EDSS (3.08 ± 1.99) than POMS who did not (1.07 ± 0.79) U=24 P =.013. IgG index had a significant and positive correlation with annual EDSS progression rate rs (8) = 0.8 p=.001. ConclusionEarly disease onset does not mean a higher relapse rate when including the full spectrum of POMS and longer follow-up duration. POMS patients relapsed more on the first-line DMT and escalation should be considered early. Infratentorial involvement in the initial magnetic resonance imaging (MRI) brain and high IgG index are potential predictors for aggressive disease course in POMS.

Bacteremia and antimicrobial resistance pattern of uropathogens causing febrile urinary tract infection in a Pediatric University Hospital.

Febrile urinary tract infections (UTIs) in children are among the most serious bacterial infections. Inadequate treatment can lead to kidney scarring and permanent kidney damage. Eight to ten percent of children with UTIs could have concomitant bacteremia. The study aimed to estimate the prevalence of UTI-associated bacteremia and identify common organisms causing UTIs and their antimicrobial susceptibility patterns to help guide empiric antimicrobial therapy. The current study was conducted over a 6-month period on children admitted with febrile UTIs at Alexandria University Children's Hospital. Blood and urine samples were collected for culture and antimicrobial susceptibility. A total of 103 children with a median age of 12 months (IQR 6.0-24.0) were included in the study. Concomitant bacteremia was present in 63.1% (n=65). The median temperature of 38.40°C (IQR 38.15-38.60) and the median creatinine level of 0.18 mg/dL (IQR 0.14-0.25) were significantly higher in the bacteremic group compared to the non-bacteremic group (p=0.005, p=0.034, respectively). E. coli (n=51; 49.5%) and Klebsiella pneumoniae (n=30; 29.1%) were the most common isolated organisms. Most (n=68; 66%) of the isolated organisms were multidrug-resistant (MDR), followed by extensively drug-resistant (XDR) (n=16; 15.5%), and pan-drug-resistant (PDR) organisms (n=1; 1%). E. coli showed lower resistance to gentamicin and ceftriaxone (9.8 % and 13.7%, respectively). E. coli remains the most important UTI pathogen. Ceftriaxone and gentamicin are good empiric options for febrile UTIs in our hospital.

Screening of iron deficiency anemia in children with chronic functional constipation

Background Iron deficiency anemia (IDA) is one of the most common nutritional deficiencies worldwide. Constipation is one of the most common gastrointestinal disorders in childhood. Aim To screen for IDA or iron deficiency (ID) among children with chronic functional constipation (CFC). Patients and methods It was a prospective study. Two groups of children in the age range of 1–15 years were collected for 6 months from June 2022 to December 2022 at Alexandria University gastroenterology clinic. Children who fulfilled Rome IV criteria of CFC were assigned to CFC group. Children who did not have constipation were considered as the control group. Complete blood count, serum iron, total iron binding capacity, and serum ferritin were done for both groups. Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. Quantitative data were described using range (minimum and maximum), mean, standard deviation, and median. Results Hemoglobin levels, serum ferritin and serum iron were significantly lower in the CFC group when matched with the control group. ID and IDA were significantly higher in the CFC group. The longer days of constipation were correlated with significantly lower hemoglobin, serum iron, and serum ferritin. Conclusion CFC causes mild IDA or ID. The longer the days of CF, the lower values of hemoglobin, iron and ferritin are present. ID and IDA are more common in the CFC group.

Ultrasound-guided Shoulder Intraarticular Ozone Injection Versus Pulsed Radiofrequency Application for Shoulder Adhesive Capsulitis: A Randomized Controlled Trial

BACKGROUND: A diseased shoulder due to pain, stiffness, or weakness negatively affects patients’ quality of life and their ability to carry out activities of daily living. Adhesive capsulitis is a disease characterized by shoulder pain and global limitation of movement in the shoulder joint. Many interventions have been proposed for the treatment of primary adhesive capsulitis. The current study compares the effect of ultrasound-guided intraarticular injection of ozone versus steroid versus intraarticular application of pulsed radiofrequency. OBJECTIVES: The primary outcome of the current study was to compare the improvement in the Visual Analog Scale (VAS) after the 3 treatment modalities. The secondary outcomes included functional improvement measured by the Shoulder Pain and Disability Index (SPADI) and level of inflammatory biomarkers measured by serum intercellular adhesion molecule (ICAM-1) and high-sensitivity C-reactive protein(hs-CRP). STUDY DESIGN: The current study is a prospective, double blinded, randomized controlled trial. We employed a double blinding technique for both the patients and the outcome assessors. SETTING: Our study was carried out at the Medical Research Institute, Alexandria University, Egypt, after approval of the local ethical committee (IORG0008812). The study was registered in the “clinical trials library for protocol registration and results system” with number NCT04724317. The study included 45 patients with a diagnosis of primary adhesive capsulitis. METHODS: Patients were randomly assigned to 3 equal groups: steroid group, ozone group, and pulsed radiofrequency group. Pain and global shoulder functions were assessed using the VAS at rest and with movement, range of motion (ROM), and the SPADI. Moreover, ICAM-1 and hs-CRP were measured as inflammatory markers. RESULTS: The results of the current study reveal that all patients in all groups have had a statistically significant improvement after their intervention regarding pain, disability, ROM, and inflammatory markers. Pairwise comparisons revealed that improvement of the VAS during movement had a statistically significant improvement starting from the second week and continuing to the fourth and eighth week. VAS during rest had a significant improvement starting from follow-up week one in the steroid group. Moreover, improvement in the ROM and SPADI scores started from the second week follow-up. Percent improvement was calculated for each group and there was a statistically significant difference between groups in VAS at rest and ROM in the pulsed radiofrequency group compared to the steroid group. Regarding inflammatory markers, both ICAM-1 and hs-CRP had a significant improvement after all 3 interventions with no statistically significant difference among the groups. LIMITATIONS: This study is a single-center study. A shortage of previously published data, and heterogeneity in the published methodology of the 3 interventions limited our discussion data for comparison with the previous literature. CONCLUSION: Ultrasound-guided shoulder joint intraarticular injection of steroid, ozone, or pulsed radiofrequency application all result in a significant improvement in pain, disability, and ROM in primary adhesive capsulitis. They can be used as an effective treatment modality for this condition. Comparing groups statistically, the pulsed radiofrequency group had a more delayed, but statistically better long-term improvement compared to the other 2 groups. KEY WORDS: Adhesive capsulitis, pulsed radiofrequency, ozone, shoulder, glenohumeral joint, pain, hs-CRP, triamcinolone acetonide

Transobturator Tension-Free Vaginal Flap Operation versus Synthetic Transobturator Tape for Treatment of Female Stress Urinary Incontinence: A Prospective Randomized Study

Introduction: Synthetic mid-urethral slings (MUSs) are the gold standard treatment for female stress urinary incontinence (SUI). Recently, there have been reports of serious adverse events with synthetic tapes such as urethral erosion, vaginal erosion, and mesh infection. Tension-free vaginal flap (TVF) operation has been proven to be successful as a natural alternative to synthetic slings. We propose our novel technique, the transobturator tension-free vaginal flap (TO-TVF), utilizing native vaginal tissue and being suspended via transobturator route. Methods: This prospective study was conducted on 72 female patients with SUI, presenting at Alexandria University Hospital. Patients were randomized into 2 groups, group 1: 37 patients subjected to TO-TVF and group 2: 35 patients to conventional transobturator tape (TOT). In TO-TVF, a rectangular vaginal wall flap is created. A polypropylene monofilament mesh is sutured to each edge of the vaginal flap. This is inserted like conventional outside-in TOT. Patients were subjected to PGI and UDI-6 questionnaires and urodynamic study before and 6 months postoperatively. Results: Both groups showed comparable and significant improvements in questionnaires. Mean operative time for TO-TVF and conventional TOT was 26.31 ± 5.2 min and 21.8 ± 3.1 min, respectively. Cure rate was 89% in group 1 and 91.4% in group 2, which was not statistically significant. No significant intraoperative complications were encountered. We had no cases of vaginal or urethral erosion in both groups. Conclusions: TO-TVF is a cost-effective, feasible, safe, and effective surgical alternative to synthetic MUS. Synthetic mesh tissue anchoring properties are maintained for better adjustment of tension. However, long-term follow-up on a large cohort of patients is still needed.

Study of the gut microbiome in Egyptian patients with Parkinson’s Disease

BackgroundRecently, an important relationship between Parkinson’s disease and the gut microbiota, through the brain-gut axis interactions, has been established. Previous studies have declared that alterations in the gut microbiota have a great impact on the pathogenesis and clinical picture of Parkinson’s disease (PD). The present study aimed to identify the gut microbiome that is likely related to Parkinson’s disease as well as their possible relation to clinical phenotypes.MethodsThirty patients with Parkinson’s disease, who presented to the Parkinson’s disease Neurology Clinic of Alexandria University Hospital were enrolled in our study. A cross-matching control group of 35 healthy subjects of similar age and sex were included. Stool specimens were taken from each. Quantitative SYBR Green Real-Time PCR was done for the identification and quantitation of selected bacterial phyla, genera and/or species.ResultsThere was a significant increase in Bacteroides and a significant decrease of Firmicutes and Firmicutes / Bacteroidetes ratio and Bifidobacteria in PD patients. Although Prevotella was decreased among PD patients relative to the healthy control, the difference was not statistically significant. Comparing the PD clinical phenotypes with the control group, the Mixed phenotype had significantly higher Bacteroides, Tremors predominant had lower Firmicutes and Firmicutes / Bacteroidetes ratio, and both tremors and postural instability and gait disability (PIGD) phenotypes had lower Bifidobacteria. However, there was no statistically significant difference between these phenotypes. Furthermore, when comparing tremors and non-tremors predominant phenotypes; Lactobacilli showed a significant decrease in non-tremors predominant phenotypes.ConclusionsThe current study showed evidence of changes in the gut microbiome of Parkinson’s disease patients compared to the healthy controls. These observations may highlight the importance of the identification of microbiome and specific bacterial changes that can be targeted for the treatment of Parkinson’s disease.

Retrospective study of congenital airway malformations detected by flexible fiberoptic bronchoscopy in Alexandria University Children’s Hospital

BackgroundCongenital airway malformations affect the quality of life and increase the family burden. The care of children who have these lesions requires considerable expenditures of time and other resources within a tertiary care center.AimThis work aims to determine the incidence of congenital airway malformations in children with airway-related manifestations detected by flexible fiberoptic bronchoscopy at the bronchoscopy unit of Alexandria University Children Hospital during the period from 1st of January 2019 to 31st of December 2019.Patients and methodsThis retrospective study includes symptomatic children who underwent flexible fiberoptic bronchoscopy from 1st of January 2019 to 31st of December 2019.ResultsThe incidence of congenital airway malformations in the studied population was 32%. The mean age of patients at time of diagnosis was 7 months and the most common congenital anomaly was laryngomalacia.ConclusionWe concluded that congenital airway malformations are not uncommon in newborns and their early detection can be beneficial for optimum management.

Comparison between quadratus lumborum and transversus abdominus plane blocks for analgesia in abdominal surgeries

Background Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Aim The aim was to compare ultrasound (US)-guided quadratus lumborum block and transversus abdominis plane block in abdominal surgeries as regards duration of analgesia, postoperative opioid consumption, and visual analog scale score. Patients and methods A randomized-controlled trial study was carried out at Alexandria University Hospital on 40 American Society of Anesthesiology (ASA)-I and II adult patients scheduled for elective abdominal surgery. The recorded data were analyzed using IBM SPSS software package version 20.0. The Kolmogorov–Smirnov test was used to verify the normality of distribution. Quantitative data were described using range (minimum and maximum), mean, SD, and median. Significance of the obtained results was judged at the 5% level. Results There was no significant difference between the two groups as regards age, sex, heart rate, mean arterial blood pressure, and complications. There was a highly significant difference between the two groups as regards duration of analgesia, visual analog score value, and the opioid analgesic requirements. Conclusion US-guided quadratus lumborum block is superior to US-guided transversus abdominis plane block for control of postoperative pain in abdominal surgeries in terms of pain scores, duration of analgesia, and total analgesic consumption.

Microbiome diversity in African American, European American, and Egyptian colorectal cancer patients

PurposeAlthough there is an established role for microbiome dysbiosis in the pathobiology of colorectal cancer (CRC), CRC patients of various race/ethnicities demonstrate distinct clinical behaviors. Thus, we investigated microbiome dysbiosis in Egyptian, African American (AA), and European American (EA) CRC patients. Patients and methodsCRCs and their corresponding normal tissues from Egyptian (n = 17) patients of the Alexandria University Hospital, Egypt, and tissues from AA (n = 18) and EA (n = 19) patients at the University of Alabama at Birmingham were collected. DNA was isolated from frozen tissues, and the microbiome composition was analyzed by 16S rRNA sequencing. Differential microbial abundance, diversity, and metabolic pathways were identified using linear discriminant analysis (LDA) effect size analyses. Additionally, we compared these profiles with our previously published microbiome data derived from Kenyan CRC patients. ResultsDifferential microbiome analysis of CRCs across all racial/ethnic groups showed dysbiosis. There were high abundances of Herbaspirillum and Staphylococcus in CRCs of Egyptians, Leptotrichia in CRCs of AAs, Flexspiria and Streptococcus in CRCs of EAs, and Akkermansia muciniphila and Prevotella nigrescens in CRCs of Kenyans (LDA score >4, adj. p-value <0.05). Functional analyses showed distinct microbial metabolic pathways in CRCs compared to normal tissues within the racial/ethnic groups. Egyptian CRCs, compared to normal tissues, showed lower l-methionine biosynthesis and higher galactose degradation pathways. ConclusionsOur findings showed altered mucosa-associated microbiome profiles of CRCs and their metabolic pathways across racial/ethnic groups. These findings provide a basis for future studies to link racial/ethnic microbiome differences with distinct clinical behaviors in CRC.

Seroprevalence of hepatitis E viral infection among apparently healthy personnels and patients with certain neurological disorders in Alexandria University Hospitals

IntroductionHepatitis E virus (HEV) is one of the leading causes of acute viral hepatitis. There are thought to be 20 million infections per year in poorer nations with inadequate sanitation. In Egypt, awareness about the possible hazards linked to HEV infection is limited due to low socioeconomic and educational levels. Only a small number of sequences have been characterized, making HEV study in Egypt constrained. Numerous factors may have contributed to this neglect. Various extra-hepatic symptoms of HEV infection include neurological problems are recognized. Many European nations have implemented regular HEV monitoring, or targeted screening of blood provided by patients at greater risk to stop the spread of HEV by transfusion.AimAssess the prevalence of HEV infection in asymptomatic blood donors. Increasing awareness about HEV testing in patients with some unexplained neurological disorders.MethodsCross-sectional study involving 550 patients: 500 apparently healthy blood donors and 50 patients with some neurological disorders. All subjects were tested for serological markers (IgG and IgM) for HEV using ELISA technique in addition to HEV RNA PCR testing for seropositive patients.ResultsFive hundred asymptomatic blood donors (370 males and 130 females), ages ranging from 20 to 50 years (median 33), 22.6% of them tested positive for HEV (IgG and IgM) of which 2 subjects only had positive HEV RNA PCR testing. In the second group 50 patients (26 males and 24 females) with various unexplained neurological disorders. Liver functions were within normal or showed only a mild increase. Forty-four percent of the patients had positive serology for HEV, with 6 patients testing positive for HEV RNA on PCR.ConclusionNo need for mass screening for HEV serology among blood donors. HEV infection needs to be considered in patients with unexplained neurological disorders even if the liver functions are not markedly elevated.

Assessment the Level of Self-Efficacy among Newly Graduate Nursing Students Faculty of Nursing – Alexandria University

Assessment the Level of Self-Efficacy among Newly Graduate Nursing Students Faculty of Nursing – Alexandria University

Effect of Scouting Activities on Managerial Life Skills Level among Alexandria University Students "Comparative Study"

Effect of Scouting Activities on Managerial Life Skills Level among Alexandria University Students "Comparative Study"

Post COVID-19 workplace ostracism and counterproductive behaviors: Moral leadership.

The wide proliferation of Covid-19 has impacted billions of people all over the world. This catastrophic pandemic outbreak and ostracism at work have posed challenges for all healthcare professionals, especially for nurses, and have led to a significant increase in the workload, several physical and mental problems, and a change in behavior that is more negative and counterproductive. Therefore, leadership behaviors that are moral in nature serve as a trigger and lessen the adverse workplace effects on nurses' conduct. this research is directed to explore the impact of post-COVID-19 workplace ostracism on nurses' counterproductive behavior and examine the role of moral leadership as a mediating factor in post-COVID-19 workplace ostracism and nurses' counterproductive behavior. Ethical review and approval Was received from Ethical Committee at the Faculty of Nursing, Alexandria University, Egypt. A cross-sectional and correlation study was implemented in all units of medical, surgical, critical and intensive care units by using three tools; moral leadership questionnaire, Workplace Ostracism Instrument (WOS), and Counterproductive Work Behaviors Questionnaire (CWBs). A convenient sample of 340 from 699 bedside nurses was granted. This study revealed that nurses' perceived moderate mean percent (55.49 ± 3.46) of overall workplace ostracism and counterproductive behavior (74.69 ± 6.15). However, they perceived a low mean percentage of moral leadership. There was a significant positive correlation between workplace ostracism and counterproductive behavior. Otherwise, a significant negative correlation was found between moral leadership, workplace ostracism and counterproductive behavior. Also, this study proved the mediating effect of moral leadership in decreasing workplace ostracism by 79.3% and counterproductive behavior by 36.7%. Hospital administrators need to be aware of the significance of moral leadership and apply integrity in the clinical setting to reduce the drawback of isolation on nurses' conduct and increase value for the organization as a whole and nurses in particular.

Correlation between Germinal Center Differentiation and Double/Triple Hit Score in the Classification of Diffuse Large B Cell Non-Hodgkin Lymphoma: A Clinicopathological Approach

Background: Diffuse large B cell lymphoma (DLBCL) is considered the most common type of non-Hodgkin lymphoma. The global incidence of DLBCL has been doubled in the past decades, highlighting the need for more effective treatment regimens. The curability of DLBCL is heavily influenced by a number of factors, such as the age, the international prognostic index (IPI) score, the molecular cell of origin (COO) subtype, and presence/ absence of specific chromosomal rearrangements or protein expression. Recent gene profiling studies have classified DLBCL into two main categories, germinal center B-cell type (GCB) and activated B-cell type (ABC). Validation of these subtypes has become more applicable after the immunohistochemical algorithm suggested by Hans, which included three commercially available markers, CD10, BCL6, and MUM-1/IRF4. In addition to this classification, DLBCL prognostic models based on different sets of genes or immunohistochemical markers have been proposed. More recently, DLBCLs with translocations of MYC, along with a B-cell lymphoma 2 (BCL2) and/or B-cell lymphoma 6 (BCL6) rearrangement, are now called double-hit lymphoma (DHL) or triple-hit lymphoma (THL), respectively. Furthermore, the co-expre sion of MYC and BCL2 proteins without underlying rearrangements is considered a new adverse prognostic indicator termed double-expressor lymphoma (DEL). The present study is aiming to combine morphological, immunophenotypical, and genetic features of DLBCLs to reach a more reproducible subtyping. Aim: To identify the relation between clinicopathological features as patient age, sex, site of tumor, clinical presentation and tumor stage and the germinal center differentiation in DLBCL (germinal center B-cell (GCB) or activated B-cell (ABC)) and the double/triple genetic hits status.Material and Methods: The material of this study comprised 52 formalin-fixed paraffin- embedded blocks representative of diffuse large B cell lymphoma cases retrieved from the archival material available at the Pathology Department, Faculty of Medicine, Alexandria University. Subclassification of cases into (germinal center / and post-germinal center types) using a panel of immunohistochemical markers including CD10, BCL6 and MUM1 was done and scoring of double/triple hit expression using a panel of immunohistochemical markers including c-MYC, BCL6 and BCL2 was also done and correlation with their subtypes and clinical data was performed.Results: there was significant association between germinal center differentiation and tumor stage (MCp= 0.018).Conclusion: Germinal center differentiation status is a valid method to evaluate the prognosis of DLBCL.