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Intl. J. of Medical Arts     Open Access   (Followers: 3)
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International Journal of Medical Arts
Number of Followers: 3  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2636-4174 - ISSN (Online) 2682-3780
Published by Al-Azhar University Homepage  [1 journal]
  • Online Basic Science Elective Course: From Theory to Implementation

    • Abstract: Background: Elective courses can contribute to both the professional and personal development of medical students in specific areas of interest outside of the standard curriculum. Alexandria Faculty of Medicine offered different elective courses since the start of the integrated medical program in 2009. The offered electives were mainly designed and implemented by clinical department as specialty specific electives. It becomes a mandate since implementation of the new medical program 5+ 2 in 2018. With the start of the new curriculum, humanities and miscellaneous electives were added to the list. Basic science departments were encouraged by the administration to offer new elective courses. Hybrid and pure online courses were also preferred specially after Covid -19 pandemic.    Aim of the work: The current research aimed to express our experience about using six step approach of curriculum design to develop a basic science hybrid elective course. Methods: A basic science elective coursewas created, on the basis of the six-step approach [problem identification, needs assessment, writing measurable objectives, choosing proper teaching methods, implementation and evaluation]. As a hybrid course, the community of inquiry framework was adopted to ensure adequate learning opportunities as face-to-face curricula. The course was a hybrid elective course titled “Cell activity translation in electron microscopic interpretation” which was created by Histology and Cell Biology Department, Alexandria Faculty of Medicine. The course had been implemented in the first semester of the academic year 2020-2021. Its objectives were designed to serve graduate as a scholar and scientist, and as a lifelong learner. Also, it was intended to serve the researcher competency area. The course included two face-to-face sessions, three synchronous and three asynchronous online sessions. The assessment based on individual and group assignment submission. Cognitive, social and teacher presence were ensured throughout the course design. Results:Five rotations were completed, which included 108 students, 305 individual assignments and 46 group assignments. All assignments were uploaded and evaluated. Eight faculty members and 10 assistant staff shared in the process of course delivery and assessment. Evaluation included, pre- and post-test results, student results, questionnaires and focus group discussions by students and sharing staff members. Conclusion: Using the six-step approach of curriculum design ensures perfect coverage of all needed curricular aspects. For hybrid courses, adopting the community of inquiry framework satisfies the student’s needs. In addition, the interactivelearning in online sessions maximizes the gain of skills.Continuous supervision and receiving feedbackfrom both students and trainers are the key of success.
       
  • Intercostal Nerve Schwannoma As a Rare Cause of Refractory Mid Back Pain

    • Abstract: Background: Schwannoma is the most common neurogenic tumor of the posterior mediastinum. It is a benign, slow growing neurogenic tumor of the posterior mediastinum which remain asymptomatic in most of the cases. Without any extension into the spinal canal, refractory back pain and intercostal neuralgia is one of the rarest presentation described in the available literature.Though commonly become asymptomatic, back pain with intercostal neuralgia mimicking post herpetic neuralgia is rare presentation and infrequently found in the available literature.Case description: A 22 years old female presented with constant dull aching mid-back pain with radiation into the intercostal space for 1 year. Clinically she diagnosed as a case of post herpetic neuralgia but she was refractory to the several analgesics and antidepressant medications. Later on, intercostal nerve Schwannoma diagnosed on radiological evaluation and she achieved complete relief from this disabling pain after total surgical excision of the lesion.Conclusion: This report emphasizes on early radiological evaluation of this kind of dull aching resting pain to avoid unnecessary medications for prolong duration.
       
  • Item Analysis and Decision Making for MCQ Exams

    • Abstract: Background: MCQ exam analysis is an important part of the assessment cycle. We should pay more attention to item analysis to ensure test validity and reliability. We need to make decisions regarding the exam results like Mark moderation or removing questions from Question Bank.    Aim of the work: 1. To highlight basic principles of MCQs item analysis and how to make maximum benefits from the data we got.  2. To make decisions regarding the exam like moderation of marks based on item analysis. Methods: An online presentation had been completed, where core principles of Item analysis had been reviewed. Then, an online survey had been completed to check the decisions of each participant when he will be faced by MCQ of aberrant discrimination or difficulty. Results:An online survey had been completed about the decision that each participant will take in different situations [e.g., low discrimination questions, or high difficulty questions]. Answers were reviewed and decision-making was clarified. As feedback, 80.0% of attendants reported that, they will increase their participation in the question bank-building process at Damietta Faculty of Medicine, and 65% requested more in-depth future events. Conclusion: Post examination item analysis is crucial for building a high-quality Question bank. Also, it supports informed decisions regarding the moderation of marks in MCQ exams.
       
  • Comparison between the effect of Trendelenburg 20 degree & straight
           leg raising 45 degree positions on the haemodynamic after tourniquet
           deflation in arthroscopy patients

    • Abstract: ABSTRACTBackground: Deflation of the pneumatic tourniquet after orthopedic surgery is associated with multiple cardiovascular adverse effects (hypotension and tachycardia). Trendelenburg position or passive leg raising (PLR) are commonly used as the initial treatment of shock and hypotension Aim of the work: To compare between Trendelenburg position 20˚ and passive leg raising 45° regarding the incidence of post-tourniquet deflation cardiovascular adverse effects in patients undergoing unilateral knee arthroscopy.Patients and methods: This prospective study included 98 cases that underwent unilateral knee arthroscopy. Patients were randomly allocated into two groups; group (1) included 49 cases who were exposed to the Trendelenburg position after deflation, and group (2) included the remaining cases who had the straight leg raising test after deflation. Mean arterial pressure, heart rate, and need for vasoactive substances were recorded.Results: No significant difference was noticed between the two groups regarding demographic variables. There was no significant difference between the two groups regarding heart rate before tourniquet deflation, and 1-minute after its deflation. However, there was a significant difference between the same groups on the subsequent readings apart from the last one. Also, group 1 showed significantly higher MAP compared to group 2 after deflation. Hypotension was more significantly encountered in group (2), and thus ephedrine requirements was increased. Conclusion: Trendelenburg position appears to be more efficacious when compared to the straight leg raising, regarding the prevention of cardiovascular adverse effects associated with deflation.
       
  • Association between Gastroesophageal Reflux Disease and Chronic Sinusitis:
           Salivary and Nasal Pepsin as a Biomarker

    • Abstract: Background: The relationship between gastroesophageal reflux [GER] and chronic rhinosinusitis [CRS] has been discussed in several studies, but a direct relationship could not be established. However, both conditions are highly prevalent.    Aim of the work: The study aimed to evaluate the nasal and salivary pepsin as a biomarker for GER in CRS patients. Patients and Methods: Fifty patients with CRS were included; 28 males and 22 females, and 50 healthy volunteers; 25 males and 25 females served as controls. Peptest was performed for all subjects. Results: Pepsin positivity was found to have a slight increase in CRS salivary samples than the control group. However, the difference was insignificant  [P >0.05], in contrast with nasal samples, which was estimated to have a statistically significant difference [P <0.05] in the second and third samples. As regard pepsin concentration in salivary samples, it was found to show a statistically significant difference [P <0.01] in all samples, while it was non-significant in all nasal samples [P>0.05]. Conclusion: CRS patients have a higher positive rate of pepsin in salivary and nasal secretions; however, no significant more pepsin in saliva or nasal secretions is regarded as CRS-patients than healthy controls.
       
  • Potential effect of curcumin versus atorvastatin on hepatic and metabolic
           changes in rat model of metabolic syndrome

    • Abstract: ABSTRACTBackground: Metabolic syndrome is defined as acluster of metabolic disorders, including hypertension, insulin resistance, dyslipedimia, diabetes, cardiovascular disease and abdominal (central) obesity. It is also found under different names, such as syndrome X, “deadly quartet” and insulin resistance syndrome (1).The im of the work: to clarify the potential effect of curcumin and compare it with the effect of metaformin and atorvastatin on hepatic and metabolic changes in metabolic syndrome.Methods: Fivty male sprague–dawely (8 weeks old) weighting 150-200 g obtained from animal house of pharmacology department of al azhar faculty of medicine. Rats were kept in regular dark – light cycle with free access to groups (specific diet and water) that were renewed daily and were observed for water intake, food intake, changes in body weight and abdominal circumference during 16- week study period.Results: Histopathological changes administration of HCHF revealed fatty change, balloning degeneration (vacuoles) and fibrosis Large numbers of inflammatory cells infiltration were detected in the portal area and inflammatory reaction dividing the hepatic parenchyma into lobules while Treating rats with curcumin- improved inflammation (few inflammatory cells,slight balloning and fibrosis, but still present moder n steatosis in liver samples and compare it with atorvastatin.and combination of them.Conclusions: According to these findings combination therapy of curcumin and atorvstatin was more effective in the management of NAFL/NASH; however, further clinical studies are required to evaluate the applicability of the present results in humanbeing and to judge the safety and efficacy ofCurcumin, atorvstatin and their combination to treat NAFL/NASH in patients with metabolic syndrome.
       
  • Comparative Study Between the Efficacy of Microneedling Combined with
           Trichloroacetic Acid Versus Microneedling with Tacrolimus in the Treatment
           of Stable Vitiligo

    • Abstract: Background: Many treatment options were used for Vitiligo. But there is no consensus on the precise treatment modality.   Aim of the work: The study aimed to assess and compare the efficacy of microneedling combined with trichloracetic acid [TCA] versus micro-needling with tacrolimus in the treatment of Vitiligo, Patients and Methods: 60 Vitiligo were included and classified into two equal groups. Group [A] included 30 patients who received micro-needling with dermapen then tacrolimus 0.03 ointments every two weeks for six sessions. Group B included thirty patients who received micro-needling with dermapen then TCA 25% every two weeks for six sessions. The outcome was documented.   Results: The repigmentation was slightly higher in TCA-treated patches than with tacrolimus. Excellent response in repigmentation occurred in 43.3%of TCA patches. In contrast, in 16.7% of tacrolimus-treated patches, Good improvement occurred in13.3% of TCA-treated patches while 23.3% of tacrolimus-treated patches. Moderate improvement occurred in10.0% TCA -treated patches while 30.0% of tacrolimus-treated patches, mild improvement occurred in 13.3% of TCA -treated patches. In comparison, only in 16.7% of tacrolimus-treated patches, However, there was a great difference between the two drugs regarding erythema, inflammation, and exfoliations, which occurred mainly with TCA. Conclusion: The mix of microneedling with either TCA 25% or tacrolimus is effective and safe in treating Vitiligo. However, TCA achieved a slightly increased percentage of repigmentation than tacrolimus.
       
  • Comparative study between topical Latanoprost versus topical 5
           Fluorouracil after dermabrasion for treatment of non-segmental stable
           Vitiligo

    • Abstract: Background: Latanoprost (LT), a prostaglandin F 2alpha (PGF2a) analogue used in the treatment of glaucoma, was found to induce skin pigmentation in guinea pigs.The rationale of trying 5‐FU in vitiligo treatment may come from the first report of hyperpigmentation induced by 5‐FU as a side effect in the skin tumors and psoriasis treatmentObjectives: The aim of this work is comparative study between the efficacy of topical latanoprost versus topical 5 fluorouracil after skin dermabrasion in induction of skin repigmentation in patients with stable non segmental vitiligo.Patient and Methods: This study included Egyptian patients ranged from 18-60 years old with non segmental stable vitiligo. All patients divided to groups group (A) subjected to 5 fluorouracil after dermabrasion and group(B)subjected to latanoprost after dermbrasion then follow up every 2weeks for 3 monthsResult: There is no statistically significant difference between both groups as regard total response to treatment and degree of repigmentation, although there was higher response to treatment in group A who treated with dermabrasionplus 5% 5- fluorouracil cream than group B who treated with dermabrasion plus topical latanoprost drops.Conclusion: In both groups patients were satisfied with the degree of improvement. As regard complication there were minimal complications only one case of kopenerization and two cases of post inflammatory hyperpigmentation.
       
  • The Association between Iron Deficiency Anemia and Chronic Suppurative
           Otitis Media [Safe Type]

    • Abstract: Background: Acute otitis media is considered as one of the most frequent childhood inflammatory disorders.Aim of the work: This study aimed to investigate the possible link between iron deficiency anemia and acute episodes on top of chronic otitis media.Patient and methods: This prospective study is included pediatric patients who attend the ENT outpatient clinic in Mallawi Hospital, El Minia; El Azhar University _Assuit, from July 2019 to June 2020. A total of 100 patients of age Group up to 18 years old and both sexes suffering from recurrent otitis media divided into Group A: Included 34 children treated with iron supplementation three months, Group B: Included 33 children treated with iron supplementation and medical treatment three months.Group C: Included 33 children treated with medical treatment for three months. Results: In group A the change of hemoglobin level from [10.15 ± 0.33] to [11.41 ± 0.43] decreasing occurrence rate of CSOM from 3.47± 0.51 to 1.41± 0.49 with statistically significant difference [p <0.001].In group B, the change of Hb level from [10. ± 0.32] to [11.48 ± 0.29] decreasing occurrence rate of Chronic Suppurative Otitis Media from 33.42 ± 0.92 to 1.39± 0.56 with statistically significant difference [p <0.001].In group C, the change of Hb level from [10.03 ± 0.43] to [10.09± 0.31] decreasing occurrence rate of CSOM from 3.39±0.66 to 2.33± 0.48 with statistically significant difference [p <0.001].Conclusions: The combination of iron and medical treatment in anemic patients can improve hemoglobin level and significantly decrease otitis media's occurrence rate.
       
  • Adult spinal hamartoma involving conus medullaris: Brief review about
           associated congenital abnormalities and surgical outcome

    • Abstract: Background: Spinal hamartoma is an extremely rare lesion for symptomatic spinal cord compression in adult population. Without any association of spinal dysraphism and neurofibromatosis, only 3 cases have been reported in the literature.Case description: A 40-year-old man presented with lumbago femorica for 6 months. Gradually the symptoms worsened and he developed features of Cauda equina syndrome. Magnetic Resonence Imagimg demonstrated a heterogeneously hyperintense intradural extramedullary mass in both T1 and T2WI, involving conus medullaris and cauda equina, opposite to L1. Patient underwent near total resection of lesion through posterior midline approach. Histopathological features were consistent with hamartoma. Patient neurologically improved and follow up MRI at 6 months showed static small nodular tumor residue.Conclusion: To the best of our knowledge, current report is the 4th case of spinal hamartoma in adult male, without any association of spinal dysraphism and neurofibromatosis .This may be the first reported case from Bangladesh.
       
  • Comparative Histopathological Changes Between Primary Versus Recurrent
           Rhinosinusitis with Nasal Polyposis

    • Abstract: Background: Chronic rhinosinusitis associated with nasal polypi [CRSwNP] is one of the two major chronic rhinosinusitis phenotypes. The histopathological changes of such condition may differ between primary and chronic types.Aim of the work: To differentiate between primary and chronic rhinosinusitis with polypi through detection of the histopathological changes of nasal mucosa.Patients and Methods: Eighty-five patients with CRSwNP scheduled for functional endoscopic sinus surgery (FESS) were divided into two groups; group (1) 35 patients with primary polyposis, group (2) 50 patients with chronic polyposis. A swab was taken from sinus mucosa during FESS and sent for histopathological investigation.Results: We studied 12 histopathogical findings of spacemen of sinus mucosa and found 7 of them had a significant value in comparison between primary and recurrent CRSwNP. The significant increases in chronic recurrent group (2) than primary group (1) were eosinophilic cell count (p=0.044), eosinophilic cell aggregation (p=0.049), basement membrane thickness (P=0.021), Mucosal ulceration (p=0.002), hyperplastic or papillary change (p=0.029), fibrosis (p=0.002) and fungal element (p=0.003).Conclusion: Histopathological findings of sinus mucosa during FESS operation found to be of great value in differentiating between primary and recurrent CRSwNP, however, further studies on large scale groups were recommended to confirm these results.
       
  • Correlation between Macular Non-Perfusion and Patterns of Corresponding
           Retinal Layers in Diabetic Patients

    • Abstract: Background: Diabetic retinopathy is a common deficiency of diabetes mellitus. Diabetic macular ischemia [DMI] is a permanent form of diabetic maculopathy, and its presence reduces the potential benefits of diabetic retinopathy management. Optical coherence tomography [OCT] is used to precisely and reliably measure the macular thickness and outline the retinal layers. Optical coherence tomography angiography [OCTA] can be utilized as a reliable tool to classify the superficial capillary plexus [SCP], the deep capillary plexus [DCP] and the capillary non-perfusion [NP]. Aim of the work: The current research aimed to investigate the correlation between macular non-perfusion that diagnosed by OCTA and patterns of macular layers that diagnosed by OCT scans through the same parts, in a trial to help in the evaluation of both structural and vascular integrity. Patients and Methods: The study included 250 eyes of 125 diabetic patients. All study participants were scanned by OCTA. OCT angiograms were re-sampled with OCT scans from the same region, permitting synchronous evaluation of structure and blood flow. Results: 250 of 125 diabetic patients were categorized into two groups according to capillary NP, ischemic [G1] and non-ischemic [G2]. In current study the incidence of DMI was 40%. The incidence of DCPNP was 100% in eyes with DMI while the incidence of SCPNP was 71%. The incidence of foveal avascular zone [FAZ] irregularity, disorganization of the retinal inner layers [DRIL], inner/outer segment IS/OS and external limiting membrane ELM disruptions were 100%, 83%, 95%, 71% respectively among eyes with DMI. DCPNP was more found in all eyes with FAZ irregularity, DRIL, IS/OS and ELM disruption than SCP NP which makes it as the central cause of structural changes in the retina during ischemia. There was a strong positive correlation between the appearance of FAZ irregularity, DRIL, IS/OS and ELM disruption with each of the duration and severity of DR. Conclusion: FAZ irregularity, DRIL, IS/OS and ELM disruption are considered reliable OCT/OCTA findings that reflect an underling DMI and their existence can influence the visual prognosis.
       
  • Prevalence and Determinants of First Antenatal Care Visit among Pregnant
           

    • Abstract: Background: Regular antenatal care [ANC] attendance is surely lead to healthier pregnancies and reposeful deliveries. Therefore, women with late visits considered at risk of poor pregnancy outcomes. Aim of the work: This study aimed to explore factors affecting early initiation of ANC attendance in Damietta governorate, Egypt. Patients and Methods: An institutional based cross-sectional study of 160 pregnant women that collected for five months from October 2019 to February 2020 in public health facilities in Damietta Governorate, Egypt were included in the study. The time of their first antenatal [early or late] had been documented. In addition their sociodemographic data were registered. Other obstetric factors were collected and include parity, past history of obstetric complications, previous antenatal care visits and intention of pregnancy,  access to information about ANC and interaction with health professional. Reinforcing factors [e.g., perception of mothers of the advantages of the ANC, intention of partner toward ANC service utilization, reasons that initiate mothers to start ANC after 13 weeks timing of ANC visit and frequency of the ANC, and a decision made to seek ANC]. Results: The mother’s age, husband’s age, number of living children and age of the youngest child were significantly lower in the early than late ANC groups [23.75±5.74, 29.11±6.54, 0.95±0.92, and 2.55±2.60 vs. 28.20±6.91, 34.16±7.98, 1.73±1.14, and 4.17±3.37, respectively]. Females from rural area were significantly increase in early ANC than late ANC [70.1% vs 29.9%], while urbans were lower in early than late ANC visits [47.9% vs 52.1%]. Early ANC visits were significantly associated with high income, gravidity, parity, mode of delivery, follow up status of the past pregnancy, number of visits in the past pregnancy, place of the last delivery, and planning for pregnancy.  Conclusion: There are numerous factors affecting early or late first ANC visit including mother and husband age, residence, gravidity, parity, and mode of the past delivery.
       
  • Burnout Syndrome and Its Predictors Among Female Medical Students at
           Al-Azhar University

    • Abstract: Introduction: Burnout is a condition resulting from chronic stressful work environment that hasn't been efficiently controlled. It is composed of three dimensions; depletion of emotional resources, negative attitude towards colleagues or patients and reduced academic achievement. It is expressed by many medical students due to stressful nature of their study. The aim of the work: The current study aimed to estimate the prevalence of burnout among female medical students and to explore the association between educational variables, general self-efficacy [GSE] and burnout. Subjects and Methods: A cross sectional study was conducted from October 2019 to March 2020 among students of the Faculty of Medicine for Girls [Al-Azhar University] from the first to six grades. The sample was taken by stratified random sampling technique, from 480 students 471[98.1%] responded to the questionnaire. Burnout was assessed using the Maslach Burnout Inventory-Student Survey [MBI-SS]. Socio-demographic, educational variables, general self-efficacy [GSE] were also included as possible predictors of burnout. Results: The study results revealed that burnout was prevalent [42.9%, n=202]; expressing high exhaustion [90.9%, n=428], high cynicism [65.8%, n=310], and low academic efficiency [58.4%, n=275]. Burnout was higher among those in clinical stage [75.7%]. Most of burnout students [91.1%] express uncomfortable feeling with teaching activities. A significant positive correlation was found between GSE and academic efficiency. Conclusion: Burnout is prevalent among female medical students. Clinical academic stage, difficulty in achieving academic goals, dissatisfaction with teaching strategy, dissatisfaction with medical study, and lower grade point average are predictors of burnout among them.
       
  • Efficacy of Nitazoxanide Alone or Loaded with Silica Nanoparticle for
           Treatment of Cryptosporidiosis in Immunocompetent Hosts

    • Abstract: Background: Cryptosporidiosis is a major health problem for humans and animals with severe consequences in immune deficient hosts. There is no effective approved drug therapy against Cryptosporidium till now and it is increasingly necessary for evaluating new potential drugs. Nanoparticles are promising for effective treatment of parasitic diseases, as an emerging drug carriers. The aim of the work: Studying nitazoxanide efficacy alone and compared to nitazoxanide loaded with silica nanoparticles in the treatment of cryptosporidiosis in immunocompetent mice infected with Cryptosporidium. Materials and methods: The study included 50 Swiss albino mice subdivided into five subgroups, including treatment either with silica nanoparticles alone, with Nitazoxanide alone or by Nitazoxanide loaded with silica nanoparticles. We included infected non-treated and non- infected non treated mice in the study as the positive and the negative controls, respectively. The post-treatment evaluation at two and three weeks was done using parasitological stool examination, histological examination of the intestine and liver, and serological screening for anti-cryptosporidium IgG and IgM using ELISA at the 3rd week only. Results: Decreased percentages of cryptosporidium oocyst passage in all treated immunocompetent mice groups and an improvement on the intestinal and liver histopathology observed after two weeks and a significant oocyst count reduction and near total histopathological cure observed after the third week with superior results observed in groups treated with Nitazoxanide loaded silica. Conclusion: Cryptosporidium infection is a potentially harmful condition. Major histopathological changes and clinical deterioration occur in immunocompromized hosts requiring more available therapeutic options. The nitazoxanide loaded silica showed promising results in the treated groups superior to nitazoxanide alone. This gives promising results encouraging further evaluation studies.
       
  • The Role of Multi-Detector Computed Tomography in Assessment of Chron’s
           Disease Progression: A Cross-sectional Study

    • Abstract: Background:There is a lack of information regarding the correlation between multi-detector computed tomography [MDCT] findings and clinical activity of Chron’s disease. The aim of the work: In this study, we aimed to investigate the correlation between MDCT and the degree of activity of Chron’s disease [CD]. Patients and Methods: In this prospective study, a total of 50 patients with CD were recruited The disease activity was assessed using the Crohn's Disease Activity Index [CDAI]. For MDCT evaluation, we used 256 Multislice CT scanners [Toshiba Medical System, Tochigi-ken, Japan]. Results: Forty-five patients [90%] showed signs of activity, while the other five patients [10%] were in the remission state [showed no signs of activity]. The most common sign of activity was mucosal hyper enhancement [93.3%], followed by mucosal thickening [91%], mesenteric congestion [64.4%], and mesenteric lymphadenopathy [33.3%].  The association analysis showed that there was a statistically significant association between CDAI and signs of activity in MDCT [360 ±64.5 in patients with signs of activity vs. 206.9 ±145.6 in patients with no signs of activity; p <0.001]. In addition, there were statistically significant associations between CDAI and presence of complications and extra-intestinal involvement [p >0.05]. Conclusion: Our study showed that the findings of MDCT are significantly correlated with clinical activity score. Clinical and radiological predictors of sever disease need to be assessed as predictors in future studies
       
  • Implementation of Personal Protective Measures by The public during
           COVID-19 Pandemic in Damietta Governorate, Egypt

    • Abstract: Background:In Egypt, the arrival of COVID-19 pandemic triggered national preparedness and integrated response including public commitment to personal protective measures [PPM]. The aim of the work: To investigate the public implementation of PPM in Damietta Governorate – Egypt during COVID-19 pandemic. Patients and Methods: This was a cross-sectional study based on web-based survey. A total of 500 adult participants [59% female: 18–72 years] were selected between April 10 and July 15, 2020, from Damietta, Egypt to complete a questionnaire. Participants were asked about their sources of knowledge and to indicate how often they implemented PPM recommended by World Health Organization [WHO] including hand hygiene, respiratory hygiene & etiquette, social distancing, and self-isolation. Results: The best practices were frequent hand washing [38.2%] followed by covering nose & mouth [23.6%] while avoiding hand greeting, self-isolation, social distancing and wearing face mask ranged only from 10%–15%. In total, only 11.6% reported accepted implementation of all PPM representing the overall prevalence. Reliable sources of information were represented by 13%–43.5% while 66% depended on social media. Participants with older age, female, married, university education or higher, urban residents, nonsmokers and working in health field were more likely to report accepted implementation of overall PPM. Conclusion: The protective measures implemented by ordinary citizens in Damietta are insufficient and further public awareness activities are required.
       
  • Short-term Individualized Dialysate Cooling in Chronic Hemodialysis:
           

    • Abstract: Background: Intra-dialytic hypotension (IDH) and pruritus are frequent and distressing complications during hemodialysis; moreover, they are associated with adverse outcomes.    The aim of the work: The current work aimed to investigate the effect of applying individualized cool dialysate (ICD) on IDH, dialysis adequacy, pruritus and its acceptance by both patient and nephrologists. Patients and Methods: This is a non-randomized single center study that was conducted at Al-Azher nephrology and dialysis unit. The study was carried out over a period of fvie weeks. Core body temperature (CBT) and dialysis adequacy (by Kt/v) were measured. Patients who fulfilled the inclusion and exclusion criteria underwent hemodialysis for six consecutive sessions at dialysate temperature of 37°C, followed by another six consecutive sessions at ICD temperature (0.5 oC below CBT). Blood pressure (BP) measurements, episodes of hypotension, pruritus score, patients and nephrologist questionnaire were collected during both standard and cool phases. Results: The study included 50 patients, the mean age 51.10±11.57 years, and males constituted 64% . The implementation of ICD has been associated with a significant reduction in IDH episodes (p <0.001). The lowest intra-dialytic and post-dialytic BP measurements were statistically higher during cool phase. There was a significant reduction in pruritus VAS score during cool phase (p <0.001), whereas Kt/v and ultrafiltration rate did not statistically differ between both phases. ICD was well tolerated by patients; although 60% of them experienced cold sensation that warranted no intervention. Nephrologists (n=20) trusted in cool dialysate as an effective intervention for IDH management. However, a proportion of them (60%) had a concern about patient tolerability. Conclusion: ICD is a well-tolerated intervention that is universally applied without additional cost. It improves hemodynamic instability and pruritus during hemodialysis treatment without negative impact on dialysis adequacy. It is accepted by nephrologists as an effective tool in stabilizing hemodynamic instability during dialysis treatment.
       
  • Peripheral Neuropathy Burden in Hemodialysis and Liver Cirrhosis in a
           Sample of Egyptian Patients

    • Abstract: Background: Chronic kidney disease [CKD] and liver cirrhosis [LC] are significant public health challenges in both developed and developing countries, resulting in an impairment in quality of life worldwide. Patients' morbidity and mortality are primarily due to neurological problems that occur as a result of these conditions. Peripheral neuropathy [PN] is a common neurological complication that has been related to the severity of the disability.    The aim of the work: To evaluate the prevalence and patterns of PN in cirrhotic and uremic patients on hemodialysis [HD] at Al-Azhar University Hospitals in Cairo, Egypt. Patients and Methods: A cross-sectional study was performed on patients recruited from nephrology unit, tropical and internal medicine departments at Al-Azhar University Hospitals in Cairo. Sixty HD patients and sixty cirrhotic patients were investigated. All patients were submitted to clinical evaluation as well as electrophysiological studies and laboratory investigations. Results: Neuropathy was diagnosed in 76.7% and 73.3% of HD and LC groups respectively. Patients with neuropathy showed significantly higher duration of dialysis and cirrhosis in both groups, higher urea and potassium levels and autonomic presentation [39.1%] in HD group and higher grades “B” & “C” in Child-Pugh classification and motor [18.2%] and asymptomatic [29.5%] presentations in LC group. Sensory symptoms were present in 45.7% and 34.1% in HD and LC groups respectively with no significant difference. Both axonal and mixed types were insignificantly more prevalent than pure demyelinating neuropathy in both groups. Conclusion: The present study emphasized the high prevalence of PN in patients with CKD on HD and patients with LC with different patterns of presentation denoting wide variety of pathological mechanisms.
       
  • Neutrophil and Platelet to Lymphocyte Ratio for Detecting Early-onset
           Neonatal Sepsis

    • Abstract: Background: Neonatal sepsis [NS] is associated with severe morbidity and mortality. Clinical manifestations range from subclinical infection to severe local or systemic infection. The diagnosis of NS remains a challenge as it has subtle and distinct signs and symptoms. Although blood culture is the gold standard in the diagnosis of NS, the search for high-sensitivity NS markers continues to overcome the drawbacks of blood cultures.    The aim of the work: This study aimed to investigate the effectiveness of the neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting early onset sepsis in neonates. Patients and Methods: A case control study, comprised 120 newborns [60 newborns with neonatal sepsis as a case group and 60 healthy newborns as a control group], based on patient records at neonatal intensive care unit [NICU] of Al-Azhar University Hospital [Damietta], from January 2018 to January 2019. All were subjected to adequate history taking, full clinical examination, complete blood picture, C-reactive protein and blood culture. After that, neutrophil to lymphocyte ratio [NLR] and platelet to lymphocyte ratio [PLR] were calculated. Results: NLR was significantly higher in neonates with sepsis. However, there were no association between PLR and early onset sepsis [EOS]. Although, the diagnostic cutoff value for NLR was 1.0 with 72% sensitivity, 100% specificity, there was no association between PLR and EOS. Conclusion: NLR increases significantly in neonatal sepsis, and can be used as a marker for detection of early onset neonatal sepsis.
       
  • Comparative Study between Modified Alvarado Score and Abdominal Ultrasound
           Diagnostic Value of Acute Appendicitis in Children

    • Abstract: Background: Diagnosis of acute appendicitis depends mainly on clinical diagnosis. However, the high negative rate remains a challenge and different aids for diagnosis had been proposed.    The aim of the work: The current work aimed to assess the sensitivity of Modified Alvarado Score [MAS] in diagnosis of acute appendicitis. Patients and Methods: One hundred children with clinical manifestations of acute appendicitis were included. Patients were categorized into two groups according to MAS: [group A] included 50 patients with [MAS] ≥ 7 regardless of sonography results. The second group [group B] included another 50 patients with MAS . Results: Tenderness in right iliac fossa was the most frequent sign in the study population [98%]. Histopathology revealed positive results among 49 patients [47 in group A and 2 in group B] with significant difference between groups A and B. The overall sensitivity and specificity of ultrasonography were 89.4% and 33.3% respectively and were 96.0% and 20.0% respectively of MAS score. Conclusion: In acute appendicitis, MAS is a good diagnostic [sensitive] tool. Sensitivity increased when combined with ultrasound, as the number of negative appendectomies was reduced.
       
  • Surgical Outcome of Endoscopic Transsphenoidal Surgery for Giant Pituitary
           Adenoma

    • Abstract: Background: Pituitary adenomas are benign neoplasms representing 10 to 15% of intracranial lesions. Giant pituitary adenomas describe tumors more than 4 cm in maximum diameter and represent 6-10% of pituitary tumors. The introduction oftruly ‘extended endonasal’ approaches has enabled thepituitary surgeon to achieve a more radical resection safely. The aim of the work: Evaluation of efficacy of the endoscopic endonasal approach in managing giant pituitary adenoma. Patients and methods: Fifteenpatients with giant pituitary adenomas were enrolled. They were submitted to full clinical examination, radiological, visual, and hormonal assessment in the pre and postoperative period. A purely endoscopic endonasal approach was used as the primary surgical management for all the patients. The collected data included preoperative data, tumor characteristics, resection rate, clinical outcome, recurrence rate, and need for adjuvant radiotherapy Results: The mean age was 40.7 [range 16-57] years, with a male predominance [60%]. Visual affection was reported in [86.6%] with pituitary hormonal hypersecretion in 53.3%. There was an improvement in 80% of patients with visual field defects and 83.3% of patients with diminished visual acuity. Prolactin hormone levels normalized in 40%, while growth hormone normalized in 33.3%. Follow-up MRI revealed gross total resection [GTR] in 41.6% of patients with suprasellar extension, subtotal removal [about 80% of the tumor] in 50% of patients, partial tumor resection in one patient [8.4%].  In para-sellar extension, subtotal resection achieved [in 66.6%], and partial resection in 33.3%. Postoperative CSF leak occurred in 13.3% due to uncomplete reconstruction of the sella. They were reoperated for sella repair and augmentation. Three patients [20%] had transient [for 3 weeks] postoperative diabetes insipidus [DI] in the early postoperative period. Conclusion: Endoscopic endonasal approach is an effective and safe approach for managing giant pituitary adenomas.
       
  • Fundectomy with Greater Curvature Plication; New Modification for Patients
           with Morbid Obesity

    • Abstract: Background: Obesity is a global epidemic. Laparoscopic greater curvature plication [LGCP] is a restrictive surgical procedure described for the first time on 1981 by Wilkinson. Fundectomy is a selective resection of the acid-producing segment of the stomach, with removal of peptide hormone-producing cells [the oxyntic mucosa] as a consequence of the fundectomy.    Aim of the work: Our aim is to assess the feasibility and advantages of the novel modification for morbidly obese patients which include fundectomy with greater curvature plication. Patients and Methods: Ten patients were included in this study, which carried out at Al-Azhar University Hospital [New Damietta]. Results: Body mass index [BMI] ranged from 30 to 48 kg/m2 [the mean was 38.8 kg/m2]. Operative time ranged from 60 to 120 minutes [Mean time: 93.5 minutes]. The mean hospital stay time was 1.35 days. The mean estimated weight loss percentage [EWL%] was 29.1% at three months, 44.6% at six months, 60.4% at one year, and 72.4% at two years. EWL% was less than 50% for one patient which needs reoperation with Laparoscopic Sleeve Gastrectomy. Two patients [20%] developed heartburn due to gastroesophageal reflux disease [GERD]. Nine patients [90%] presented nausea, and vomiting was present in four patients [40%]. Conclusion: Fundectomy and Greater curvature plication is a feasible, safe, effective as a bariatric operation with avoidance of complications of other bariatric operations. As a new modification for bariatric surgery, this operation needs more investigations and longer periods for follow up.
       
  • GATA3 and CK5/6 Immunohistochemical Expression in Urothelial Carcinoma:
           Diagnostic, Biological and Prognostic Significance

    • Abstract: Background: Urothelial carcinomas [UCs] can be diagnostically challenging, particularly transurethral bladder tumors resection biopsies with limited material. Immunohistochemistry is a valuable instrument for diagnosis when morphology alone is inadequate. GATA-binding protein 3 [GATA3] and cytokeratin 5/6 [CK 5/6] contributes to the growth of UC. However, their correlative expression in UC and prognostic value has not been sufficiently investigated.    The aim of the work: The current study aimed to evaluate the utility of GATA3 expression in UC and correlate that with CK 5/6 expression to verify different subtypes of UC and assess their prognostic significance. Methodology: Here, we immunohistochemically stained GATA3 and CK 5/6 in 90 UCs samples by transurethral bladder tumor resection in a retrospective study, between May 2018 and February 2020. All were histopathologically evaluated and immunohistochemically stained for GATA3 and CK 5/6, and then correlated them with the clinicopathological parameters to investigate their clinical significance. Results: GATA3 expression was seen in 76 patients [84.44 %]. There was significant correlation between GATA3 expression with the tumor histological grade and degree muscle invasion. There was a weak or even negative expression in high‑grade, invasive than the low‑grade, non-invasive tumor [P= <0.001]. CK5/6 was positive and focally positive in 27.78% with a significant correlation of CK5/6 expression with tumor grade and muscularis propria invasion. On the other side, tumors with diffuse GATA3 expression had low CK5/6 expression. Conclusion: GATA3 and CK 5/6 should be used as sensitive and specific markers for UC. They can also be effectively used in the prediction of probable grade and tumor invasion in biopsied material with poor morphological characters; and thus, help in the future appropriate treatment.
       
  • A Case of Central Pontine Myelinolysis due to Severe Acute Prolonged
           Hyponatremia in Our County Hospital

    • Abstract: Background: Central pontine myelinolysis (CPM)is unique and rare clinical entity. It could be a neurological complication of prolonged hyponatraemia. Many predisposing risk factors (chronic alcoholism, malnutrition, malignancy) may aggravate the development of CPM. CPM usually have a poor or even fatal outcome. However, CPM does not inevitably have a bad prognosis, and could occur with proper restoration of normal serum sodium concentrations.    Case Summary: Here, we presented a case of a 48-year-oldfemale. She used to drink alcohol. She presented to Our Lady’s Hospital/Navan with a history of four days feeling unwell, confused diarrhea, vomiting and by investigations, she had severe hyponatraemia. She was managed optimally in the ICU with close monitoring of her urea and electrolytes. Unfortunately, she got progressive neurological deficits (lower limbs weakness, and slurred speech) irrespective of gentle treatment of hyponatremia in intensive care unit. After Neurological and radiological input from Dublin institute, CPM confirmed under background of alcoholism and malnutrition. Following the diagnosis of CPM, she was discharged home after been rehabilitated with physiotherapy with ongoing recovery.
       
  • Anterior Chamber Configuration Changes after Phacoemulsification and
           Intraocular Lens Implantation Measured by Anterior Segment Optical
           Coherence Tomography

    • Abstract: Background: Phacoemulsification can cause changes in the measurements of the anterior segment. Anterior segment optical coherence tomography [AS-OCT] is a disconnected probe device that can detect variations in the anterior segment parameters.    The aim of the work: The current study aimed to investigate changes in anterior chamber angle [ACA] morphology and intraocular pressure [IOP] after phacoemulsification of cataract and intraocular lens implantation by comparing two groups of patients using two brands of IOL [Sensar 1 hydrophobic one-piece IOL] and [Eyecryl hydrophilic one-piece IOL] in patients with senile cataract using [AS-OCT]. Patients and Methods: Our study was a prospective randomized study including 30 eyes with impaired vision due to cataract, as the only cause of visual regression selected from the patients who attended Al-Azhar University Hospital [Damietta branch] Ophthalmic outpatient Clinic and were randomized into two groups. Group A [15 eyes] was implanted with [Sensar 1 hydrophobic IOL] and Group B [15 eyes] was implanted with [Eyecryl hydrophilic IOL]. Results: the results revealed that there was a significant increase in the AC angle in both groups, except for the AC depth in group A, but the difference between groups was statistically non-significant. Conclusion: Phacoemulsification with IOL implantation led to an increase in the ACA, a marked increase in BCVA and a reduction in IOP, if using [Sensar 1 hydrophobic one-piece IOL] or [Eyecryl hydrophilic one-piece IOL]. However, we cannot generalize the results because of the small sample size.
       
  • A Computer System for Classification of Burns and Determination of Fluid
           and Nutritional Needs for Burn Patients

    • Abstract: Background: The assessment and classification of burin severity and extent is very important for proper treatment. A computer system to assess burns seems to be crucial for the determination of fluid and nutritional requirements.    The aim of the work: The objectives of this work are to design a computer system to assess and classify burns according to burn depth and extent and to implement the designed system for the assessment of fluid and nutritional needs using a database system for the automation of the entire process.  Then test the computer system in reality through clinical application of the system on fifty patients with acute burn injury. Patients and Methods:This study was divided into two parts: Development of a burn management computer system [BMS]to facilitate the process of documentation, classification, and management of acute burn patients. The BMS contains three subsystems: Database, Classification, and Management subsystems. The second part was the clinical application of the system on fifty patients to test the efficacy, accuracy, and applicability of this system in comparison to the traditional method used at our unit. Results:Clinical application of the BMS has showed a reduction in the burn percentage calculation with 7.36%. It also decreased the amount of fluid calculated automatically by the system by about 7.28%, while the reduction in nutrition calculated automatically by the BMS was about 2.7%. Burn Management System has showed an overall shorter time in dealing with the cases. Conclusion: Clinical application of the BMS showed an accurate estimation of the burn percent, accurate and rapid calculation of resuscitation fluids and nutritional needs, and easy electronic documentation of patients’ data that required a minimal effort.
       
  • Effectiveness of Cerebroplacental Ratio Estimation Early in Labor as A
           predictor of Adverse Perinatal Outcomes in Full-term Low-risk Pregnancy

    • Abstract: Objective of the Study: To test the efficacy of the cerebroplacental ratio [CPR] in the prediction of early labor fetal distress and adverse neonatal outcomes in full-term [FT] low risk pregnancy. Patients and Methods:One hundred fifty pregnant women met the inclusion and exclusion criteria were subjected for the estimation of umbilical artery [UA] and middle cerebral artery [MCA] pulsatility indices [PI]]. CPR is calculated by dividing MCAPI by UAPI. All of these measures have been converted to multiple medians [MOMs]. The findings of CPR MOM were Correlated with the following; traces of cardiotocography; cesarean section [CS] for fetal distress; 5 min APGAR scoring; cord PH; and NICU admission. The ROC curve was used to test CPRMOM's predictive performance of adverse perinatal outcomes. Results:Out of 150 patients, 18 [12%] showed abnormal CPR MOM There was negative significant correlation between CPRMOM and both of emergency CS, [r=-0.293, p <0.001] and NICU admission [r=-0.302, p <0.001. ROC curve showed that CPRMoM is good negative predictor, in both CS due to fetal distress, and NICU admission at cut off values,≤0.97 and ≤0.84 with sensitivity, 72.7 % and 75.0 %, specificity, 91.4 % and 92.3 % with AUCs, 0.778 and 0.827, P = 0.005, and < 0.001 respectively. Conclusion: Reduced CPRMOM < 1 considers a good predictor for both of CS due to fetal distress and NICU admission; however normal CPR doesn’t rule them out. Reduced CPR MOM is a poor predictor for each of initial non reassuring CTG, APGAR score at 5 min and lower umbilical PH. Nevertheless, normal CPRMOM considers as good predictor for normal fetuses.
       
  • Clinical Outcomes of Plate Fixation Compared with Non-operative Treatment
           of Displaced Mid-shaft Clavicular Fractures in Adults

    • Abstract: Background: Clavicle fractures are representing 2.6% of total body fractures. The common fracture is the midshaft fracture of the clavicle. The outcomes of non-operative treatment are not preferred nowadays, so the trend to surgical treatment of these fractures has grown. The aim of the work: The current study aimed to compare the outcomes of conservative and operative treatment of displaced midshaft clavicular fractures with plate fixation to clarify the merits and possible disadvantages of each method. Patients and Methods:Twenty patients as a convenient sample were included. These patients were subdivided into two groups, group I for conservative treatment and group II for operative treatment with plate fixation. All patients will be subjected to complete history taking, clinical, general &local examination, a standard anteroposterior view of the clavicle was done and follow up average 6 months. Results:At the end of follow up period, according to Constant Shoulder Score (CSS), 11 patients had excellent results (CSS: < 11), 4 patients had good results (CSS: 11-20), 3 patients had fair results (CSS: 21-30), 2 patients had poor results (CSS: >30).  Pain VAS was significantly higher in group I compared with group II. There is a significant difference found between the groups as regard (outcome, pain VAS, the strength of abduction and the extent of internal rotation) P value < 0.05. There is no significant difference found between the groups as regard (socio-demographic data, comorbidities, fracture characteristics, fractures classification, degree of forward flexion, degree of lateral elevation and extent of lateral rotation) P value >0.05. Conclusion: Operative treatment with plate fixation is better than conservative treatment in management of pain, high union rate, good functional outcomes and greater patients satisfactory after displaced mid shaft clavicular fractures.
       
  • Comparative Study to Assess the Outcome of the Abdominohernioplasty Versus
           the Sole Hernioplasty

    • Abstract: Background: Abdominoplasty was increasingly performed in daily surgical practice. It is usually associated with hernia. Different surgeons prefer to carry out hernioplasty with abdominoplasty. However, this was challenged by longer operative time and theoretical increase of associated complications. Objective of the Study: The present study aimed to assess the surgical outcome of the hernioplasty alone versus combined abdomino-hernioplasty. Patients and Methods:This study was conducted between September 2019 and September 2020. Forty patients with ventral hernias were included and divided randomly into two equal groups; First group for combined hernioplasty with abdominoplasty and the other group for hernioplasty alone. All patients were evaluated preoperatively by full history, physical examination and preoperative routine Lab investigations to assure fitness for surgery. Postoperatively, patients were observed overnight in hospital. Pain was controlled and ambulation was permitted as early as possible after surgery. To ensure patient comfort and abdominal support, a compressive binder was used. Patients were clinically reevaluated 7 days and at one, three and six months after surgery. Results:Groups A and B were comparable regarding patient age, gender, body mass index, and hernia type. The operative time and intraoperative bleeding were significantly higher in abdominoplasty group compared to hernioplasty group [154.01±13.73 minutes, 417.5±106.72 CC vs 64.75±9.11 and 92.5±32.55 respectively]. Early and late postoperative complications showed non-significant difference, except significant increase of recurrence among hernioplasty than abdominoplasty group [25.0% vs 0.0% respectively]. Abdominoplasty was associated with significant increase of total drain output, longer duration of drain and early mobility. Finally, there was significant increase of satisfaction with body size, body shape, relief of lower back pain, easy sex practice satisfaction and scar satisfaction in abdominoplasty group . Conclusion: Abdominoplasty with hernioplasty is a safe approach for ventral hernia repair, with superior aesthetic outcome and patient satisfaction than hernioplasty alone.
       
  • Predictors of Malignancy in Thyroid Nodules

    • Abstract: Background: Better and early prediction of malignant thyroid nodule, and sure differentiation from benign one, is crucial need to decrease the rate of non-indicated surgeries. The aim of the work: To find risk factors and predictors of malignancy in patients with thyroid nodule[s]. Patients and Methods:Fifty patients with thyroid nodule[s] were included. All patients were evaluated by history taking, clinical examination and laboratory investigations. Imaging studies included thyroid ultrasound [US]. All were also submitted to fine needle aspiration cytology [FNAC] before treatment by total or subtotal thyroidectomy. Excised tissues were sent to histopathological analysis. Results:The incidence of malignancy was 22.0%. both benign and malignant groups were comparable as patient characteristics, complaints except the significant increase in cosmetic disfigurement among patients with benign nodules [92.3% vs. 45.5%].Patients with malignant nodules had a significant increase of ill-defined margins, intranodular vascularity and enlarged lymph nodes [72.7%, 63.6% and 72.7% vs 5.1%, 12.8% and 25.6% respectively].  Ill-defined margins, enlarged lymph node and high grade in FNAC were the predictors of thyroid malignancy. Conclusion: Predictors of malignant thyroid nodules are ill- defined edges, enlarged lymph node and high grade in FNAC. This helps clinicians to spare more benign cases from surgical interference.
       
  • The Use of Autologous Platelet Rich Fibrin Membrane as a Second Layer in
           Snodgrass Repair of Distal Hypospadias

    • Abstract: Background: Hypospadias is a common pediatric health problem. Snodgrass [Tubularized Incised Plate Urethroplasty]surgical repair was adopted as the standard technique, although different techniques had been described. However, higher complication rate continues to be a problem. The aim of the work: To evaluate the use of platelet rich fibrin membrane as an intermediate layer in the Snodgrass repair of distal hypospadias. Patients and Methods: Thirty children were included. All were evaluated preoperatively by full history taking, clinical examination and laboratory investigations. Then all were treated by Tubularized Incised Plate Urethroplasty with the use of platelet rich fibrin membrane as an intermediate layer. They then followed up and any early or late complications were registered.  Results: Hypospadias was recurrent among 83.3%. Patient age ranged between one and six years and the mean operative time was 67±5.4 minutes; the mean hospital stay duration was 7.0±1.2 days. The success rate was 93.3% and complication rate was 6.7%. Complications were edema in 6.7%, urethro-cutaneous fistula [UCF] in 6.7% and skin infection among 3.3%. Conclusion: The use of a platelet rich fibrin membrane is a feasible and safe intermediate layer for hypospadias surgery in Tubularized Incised Plate Urethroplasty.  The procedure is quick and straightforward and has a low postoperative complication.
       
  • Assessment of Suprachoroidal Injection of Triamcinolone Acetonide in Cases
           of Diabetic Macular Edema

    • Abstract: Background: Diabetic retinopathy [DR] remains one of the main causes of visual reduction in the world. The visual reduction in patients with DR is usually due to diabetic macular edema [DME].Suprachoroidal triamcinolone acetonide injection is a new effective modality used for the management of diabetic macular edema. The aim of the work: To assess the visual acuity [VA], central macular thickness [CMT] by optical coherence tomography [OCT] and intraocular pressure [IOP] measurement in patients with DME injected with Triamcinolone Acetonide through suprachoroidal space. Patients and Methods: Forty eyes of 37 patients [18 males and 19 females]] with DME were included and followed-up for 6 months to assess VA, CMT and IOP. Patients were included if they were diagnosed as DME.  Results: Baseline measurements were logMAR best corrected visual acuity [VA] which was 0.83 ± 0.09, [OCT] which was 422.42 ± 64.1 µm and [IOP] which was 15.25 ± 1.46 mmHg. Post injection measurements of VA during the four points of the follow-up period showed statistically significant improvement. At one-week post-injection,  logMAR VA was 0.82 ± 0.09, at one-month follow-up was 0.72 ± 0.09, at three months was 0.68 ± 0.1, at six months, was 0.62 ± 0.1,. OCT follow-up measurements showed highly significant improvements, which started from the first week post-injection till the end of the follow-up period at six months point. At one week, it measured 391.7 ± 60.6 µm, at one month the measurement was 337.1 ± 54.5 µm, at three months was 302.7 ± 46.5, at six months, was 267.9 ± 40.7. Conclusion: Injection of TA to the suprachoroidal space in DME, was well tolerated without any serious ocular adverse events and produced significant resolution in CST and significant improvement in BCVA.
       
  • Effect of Magnesium Sulfate on Epinephrine-Mediated Adverse Effects during
           Liposuction Procedures: A prospective Randomized controlled Study

    • Abstract: Background: During liposuction procedures, injection of wetting solution containing epinephrine is performed. This may increase the risk of cardiovascular side effects in large volume cases. Magnesium sulfate has cardioprotective effects, and can prevent complications related to epinephrine. The aim of the work: To assess the effect of adding intravenous magnesium sulfate, during the administration of epinephrine containing wetting solution, on the incidence of epinephrine-mediated cardiovascular side effects during liposuction surgery. Patients and Methods: This was a prospective randomized study comprised a total of 94 cases into two equal groups. The epinephrine group included 47 cases that had epinephrine in their wetting solution, and epinephrine-Mg group included the remaining cases that had adrenaline in the wetting solution along with intra venous. administration of MgSO4. Heart rate, blood pressure, arrhythmia incidence, isoflurane, and morphine consumption were recorded.  Results: No significant difference was noticed as regard basal and induction heart rate and mean arterial pressure [MAP]. However, the epinephrine-Mg group showed significantly lower readings on subsequent assessment. There was no significant difference among both groups regarding the incidence of arrhythmia; the epinephrine group had more cases with arrhythmia. Isoflurane consumption decreased significantly in the epinephrine-Mg group in comparison with the epinephrine group, while morphine consumption did not significantly differ between them. Conclusion: Based on our findings, intravenous administration of magnesium sulfate decreases heart rate, blood pressure, and inhalational anesthesia consumption during liposuction. However, it has no significant impact neither on the incidence of arrhythmia, nor morphine consumption.
       
  • Predictors of Mortality in Patients with Isolated Chest Trauma

    • Abstract: Background: Chest trauma remained an important type of trauma that carries the risk of morbidity and mortality. The Modified Early Warning Score [MEWS] is a unique score as it is a physiological and simple score which permits improvement in the patient management. The aim of the work: To assess frequency, risk factors of mortality and examine MEWS as a predictor of mortality in patients with isolated chest trauma. Patients and Methods: Prospective analysis of 157 patients presented to emergency department, with isolated chest trauma. Demographic data, MEWS, trauma characteristics, and laboratory data were recorded on admission. The patients received standard management and were followed up until discharge or death.  Results: Age of patients ranged from 4 to 79 years. Male constituted 79.6%. About 29% admitted with penetrating chest trauma. About 98% and 82% presented within 24 hours and had unilateral chest trauma. MEWS of them ranged from 0 to 12. There is a significant relationship between mortality and hemoglobin levels, length of hospital stay and MEWS. There is a non-significant relationship between mortality and gender, type of trauma or duration of admission. Unilateral trauma indefinitely protects against mortality. MEWS [≥7] and length of hospital stay [≥4 days] increase mortality risk by 127.3 and 4.7 folds respectively. The cutoff of MEWS for prediction of mortality was ≥ 6.5, with sensitivity of 100%, specificity of 84.9%, [p <0.001]. Conclusion: High on-admission MEWS ≥7, late presentation after 24 hour and bilateral injury were risk factors of mortality in isolated chest trauma.
       
  • Role of Laparoscopy in Management of Doubt Cases of Acute Abdomen

    • Abstract: Background: Acute abdomen is a surgical emergency, that needs early diagnosis and treatment to avoid complications and save patient life. However, accurate diagnosis is crucial to avoid unnecessary surgery. Laparoscopy could represent an optimal solution in these circumstances. The aim of the work:  To evaluate the role of laparoscopy in management of doubt cases of acute abdomen. Patients and Methods: It is a prospective study, which held at Al-Azhar University Hospital [Damietta] during the first six months of 2020 and included 30 patients who presented by acute abdominal pain. All were evaluated by full history taking, clinical examination, laboratory and radiological investigations. Then, all underwent diagnostic laparoscopy, which had been continued to therapeutic laparoscopy, or converted to laparoscopy-assisted laparotomy at the same setting. Rate of success, operative diagnosis and postoperative complications were documented. Results:The most common cause of acute abdomen was acute appendicitis [23.33%] followed by acute cholecystitis [13.33%], then perforated peptic ulcer [10.0%]. Negative exploration had been reported in 10%.  Therapeutic laparoscopy was successful in [56.7%] while [43.3%] required conversion to laparotomy. Complications were observed in 14 patients [46.7%] and wound infection is the most common [30.0%]. Radiological investigations failed to elaborate diagnosis in 12 patients, and laparoscopy achieved the diagnosis in 9 [75.0%] of them.  Conclusion: The laparoscopic approach in doubt acute abdomen is proved to be feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities. It reduces pain, improves recovery, shortens hospitalization and improves cosmetic results.
       
  • Early Versus Late Alveolar Cleft Repair Using Cancellous Iliac Bone Grafts
           in A developing country

    • Abstract: Background: Orofacial clefts are common congenital malformations, with alveolar cleft as the most common [75%] of all anomalies. Many treatment modalities are available. However, our clinical experience with bone graft modality is not well addressed.    The aim of the work: To evaluate the effectiveness of early [2 to 12 years; before complete eruption of the cleft canine] versus late [> 12 years; after complete eruption of the cleft canine] cancellous anterior iliac bone grafting for alveolar cleft reconstruction. Patients and Methods: Twenty-three patients with alveolar clefts who were admitted for alveolar cleft reconstruction surgery were included. They were categorized into early and late secondary grafting groups. All patients inquired about their history. Submitted to full clinical examination, laboratory and radiological examinations. The imaging studies include two-dimensional orthopantomogram for all patients, while 3-D fascial computed tomography and cone-beam computed tomography were done for selected patients. Both intraoperative and postoperative data were collected, any complications were registered and patients followed up regularly up to 6 months. Results: Both groups were comparable as regarding patient characteristics except younger age in early group, and there was a statistically significant difference between early and late groups regarding cleft side and cleft permanent canine full eruption. Males represented 69.9%. The cleft was on the left side in 56.4%. Seven patients [30.4%] had maternal risk factor [five in early and two in late group]. Blood loss was less than 80 ml in all patients in both groups. All oronasal fistulas were sealed off successfully in all patients [100%] and all had normal healthy gingival contour with vital teeth adjacent to the cleft.  All showed evidence of good bone filling in the alveolar defect after 6 months postoperatively. Only one patient developed hypertrophic scars at each group . Conclusion: Alveolar cleft reconstruction is preferred to perform autologous cancellous bone grafting harvested from the iliac crest bone to repair the cleft with excellent outcome on short-term follow-up .
       
  • Office Cervicoscopy versus Colposcopy for Evaluation of Suspicious Cervix
           ‎in Assiut Governorate

    • Abstract: Background: In developed countries, cervical cancer is the second most prevalent cancer between females. When it enters the invasive phase, but outside of all female genital tract cancers, cervical cancer is a deadly disease. If diagnosed in its early stages, it is the only preventable cancer, and the disease is almost 100% curable with accurate screening and early detection.    The aim of the work: To determine the effectiveness of both office cervicoscopy and colposcopy-directed biopsy in the assessment of clinically suspicious cervix. Patients and Methods: A prospective randomized controlled study, held on 200 patients randomly selected used closed envelopes with clinically suspicious cervix attending the outpatient clinic of Obstetrics and Gynecology Department, Al-Azhar University Hospital [Assiut]. Results: In case of inflammatory cases, the sensitivity with the pathology results were 97.7%, and 98.1% for colposcopy and office cervicoscopy respectively and specificity were 84.3%, and 94.7% for colposcopy and office cervicoscopy respectively. In case of abnormal vasculature, the sensitivity with the pathology results were 33.3%, and 85% for colposcopy and officecervicoscopy respectively and specificity were 80%, and 94.4% for colposcopy and office cervicoscopy, respectively. Conclusion: Colposcopy and office cervicoscopy have the same sensitivity and specificity for the detection of cervical polyps. But, in case of inflammatory and abnormal vasculature, office cervicoscopy was more sensitive with higher specificity than colposcopy more over office cervicoscopy had a great benefit in the assessment of endocervical canal and uterine cavity so, office cervicoscopy and colposcopy are complementary to each other.
       
  • Prediction of Neonatal hyperbilirubinemia by The Cord Blood Alkaline
           ‎Phosphatase

    • Abstract: Background: Owing to early discharge of neonates from the hospital, the readmission rate has been increased. Therefore, early detection of jaundice and prompt measures are important. Measurements of bilirubin and alkaline phosphatase levels in cord blood have been used for this function.    The aim of the work: To assess the cord blood alkaline phosphatase value in predicting neonatal jaundice. Patients and Methods: This study carried out during the period from August 2019 to January 2020 in pediatric department [Al-Azher University Hospital in Damietta]. This study included a total of 101 term infants with gestational age between 37 and 42 weeks, weighing more than 2500g born to healthy mothers. We performed an assessment of the complete medical history [maternal history and neonatal history]. Cord blood samples were collected for measurement of alkaline phosphatase. Neonates were followed-up for the emergence of jaundice. Infants with clinical jaundice were recalled and serum bilirubin level was measured. Significant indirect neonatal hyperbilirubinemia was considered. Results: The study showed that patients with neonatal jaundice had statistically significant higher reticulocyte count, alkaline phosphate level and total bilirubin than patients without neonatal jaundice. However, the study shows the best cut-off points of regarding ALP to predict neonatal jaundice in neonates. A value of 200 or more IU/L was the best cut-off point to predict occurrence with a sensitivity of 98.3%, a specificity of 97.6%. Conclusion: Increased alkaline phosphatase level in cord blood act as an indicator to neonatal jaundice, and may be used as a marker for early diagnosis.
       
  • Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction
           with ST Segment-Elevation: Effect on the Severity of Ischemic Mitral
           Regurgitation

    • Abstract: Background: Myocardial infarction is a daily challenging emergency. Proper diagnosis and intervention in a timely manner is crucial.    The aim of the work: We aimed to detect the impact of primary percutaneous coronary intervention [PPCI] on the development and severity of mitral valve regurgitation in patients presenting with acute myocardial infarction with ST-segment elevation [STEMI]. Patients and Methods: This was a cross-sectional comparative study that was conducted from January 2018 to November 2019 at the Department of Cardiology, Al-Azhar University Hospital, Damietta, Egypt. Patients were divided into four groups; Group I: STEMI patients with PPCI and single-vessel disease; Group II: STEMI patients with PPCI of culprit vessel and staged PCI with in-hospital admission; Group III: STEMI patients with streptokinase and pharmaco-invasive PCI of the single vessel; Group IV: STEMI patients with streptokinase and multi-vessel PCI at the same session. Results: One-hundred and five patients were included in this study. Patients in group I showed a significant improvement after six months of follow-up in terms of ejection fraction [p <0.001]. Regarding the coaptation height, it showed a significant elevation in group I [p <0.001], and a significant reduction in group II [p <0.001] and III [p=0.013]. Similarly, PISA reduced significantly after six months in group I [p <0.001], II [p=0.002], and IV [p=0.007]. EPSS was reduced significantly in group I [p=0.0004]. Likewise, the distance of intrapapillary showed a significant reduction in group I [p <0.001]. Regarding the regurgitant area, it was significantly [p <0.05] reduced in all groups. Conclusion: Our results showed that PPCI could decrease the incidence and the severity of IMR and improve IMR parameters, especially in patients with acute STEMI. Further well-designed longitudinal studies with a larger sample size are required to evaluate these findings.
       
  • Role of Uterine Artery Doppler Indices in Patients with Perimenopausal
           Bleeding for Diagnosis of Endometrial Pathologies: A Prospective Study

    • Abstract: Background: Abnormal uterine bleeding is nearly a daily challenge in gynecological practice. In addition, it responsible for a respected percentage of hysterectomies. Early diagnosis is crucial, especially if noninvasive, readily available method is used. Aim of the work: To investigate the usefulness of Doppler transvaginal ultrasound in diagnosis of uterine pathology responsible for abnormal uterine bleeding in the perimenopausal women. Patients and Methods: The study included 156 patients [106 with AUB and 50 healthy controls]. The study was carried out during the duration between February to September 2020. For all females, full history taking, clinical and laboratory investigations were carried out. In addition, transvaginal ultrasonic uterine artery Doppler was done and its indices [Pulsatility index [PI] and resistance index [RI]] were documented. After histopathological results from endometrial biopsy, females were subdivided into two groups [A and B]: Group A included 52 patients with non-significant [dysfunctional] causes of AUB. Group B included 54 patients with significant [pathological] causes of AUB as endometrial hyperplasia and carcinoma. Results: Both groups of AUB were comparable regarding patient age, BMI, pattern of bleeding, number of used vulval pads, and preoperative hemoglobin concentration. However, pathological ABU was associated with high parity, long duration of bleeding, increased number of bleeding days/last month, and significantly lower values of uterine artery PI and RI. Endometrial thickness was significantly increased in ABU when compared to control group. Finally, RI was sensitive than PI in diagnosis of pathological AUB. [area under the curve was 0.998 and 0.834 respectively]. PI had a sensitivity of 70.8%, specificity of 92. % at a cut-off value of 1.82; while RI had sensitivity of 96.2% and specificity of 100.0% at a cutoff value of 0.575.Conclusion: Transvaginal Doppler ultrasound seems to sensitive and specific modality for diagnosis of endometrial abnormalities in females with perimenopausal AUB
       
  • Long Term Effect of Mode of Delivery on Sexual Function: A cross-Sectional
           Study

    • Abstract: Background: Female sexual dysfunction [FSD] is a significant challenge. Some researchers reported an association between FSD and delivery mode, while others did not report such association. Aim of the work: To study the long term effect of delivery mode on female sexual function in primiparous mothers.Subjects and Methods: This is a cross-sectional analytical study aiming to evaluate FSD and its related factors after delivery. It included 260 primiparous mothers who attended the healthcare centers in Dakahlia and Damietta governorates. They were divided according to the delivery mode into two groups, each of 130 mothers; the first for normal vaginal delivery [NVD], and the second for cesarean delivery [CD]. All participants were evaluated by complete history taking [demographics, obstetric and medical history, duration since delivery, mode of delivery and use of contraception], and female sexual function assessment. Female sexuality was assessed by an Arabic version of the Female Sexual Function Index [FSFI] questionnaire, which is a brief, multidimensional, validated tool for evaluation of female sexual function [FSF] during sexual activity.Results: Results revealed a non-significant difference between females delivered by NVD and those delivered by cesarean section [CS]. Also, there was no significant difference between groups regarding female sexual dysfunction index [FSDI] single domains and total score. Female sexual dysfunction [FSD] was reported in 20.8% and 25.4% in NVD and CS groups, respectively. The duration since the last delivery, recurrent urinary tract infection [UTI], and Vulvo-vaginitis were the individual risks of female sexual dysfunction. Vulvovaginitis was the only independent predictor factor for sexual dysfunction. Conclusion: Female sexual function was not affected by the delivery mode, and there was no basis for advocating the cesarean section for delivery to prevent future female sexual dysfunction. However, identifying vulvovaginitis as the sole significant factor affecting FSD represented significant findings in the current work.
       
  • Laparoscopic Versus Open Abdominal Repair of Incisional Hernia

    • Abstract: Background: Incisional hernia is a common health problem and its method of repair [open or laparoscopic] is still under debate. Aim of the work: To evaluate the technique and results of the laparoscopic and the open abdominal incisional hernia repair. Patients and methods: This is a retrospective study conducted on 40 patients with abdominal incisional hernia, admitted to general surgery department of Al-Azhar University Hospital [Damietta]. All records were reviewed for patient demographics, preoperative evaluation, operative and postoperative data. The complications were reviewed and compared between groups. These complications included ileus, cellulitis, flap necrosis, infection, hematoma, seroma, cyst, recurrence and other injuries. Results: The open group had a shorter operative time than the laparoscopic group [85.3±13.21 vs 110.0±10.04 minutes, respectively]. However, time to oral intake [hours] and the duration of hospital stay [days] were significantly shorter in the laparoscopic when compared to the open group [9.20±1.2, 1.92±0.69 vs 20.0±2.4 and 2.70±0.68 respectively]. Postoperative complications showed no significant difference between groups. Conclusion: Thelaparoscopic repair of incisional hernia is a safe and effective alternative to the open repair with a shorter hospital stay, early oral feeding and a lower rate of complications.
       
  • Treatment of Calcaneal Fracture by Calcaneal Plate

    • Abstract: Background: Calcaneal fractures are not uncommon, accounting for 2% and 60.0% of all adult and tarsal fractures, respectively. Its treatment is still controversial.  Aim of the work: To assess results and complications of calcaneal fractures treatment by fixation with calcaneal plate on clinical and radiological basis. Patients and Methods: A convenient sample of 20 patients, with calcaneal fractures and treated by calcaneal plate fixation were included. They were assessed in preoperative period in a systematic manner. Then, treated with a locking plate. Postoperatively, immediate X-rays, examination of the neurovascular status had been done. Anti-edematous, pain therapy, intravenous antibiotics and anticoagulation medication were administered.  All patients had been followed up at 8, 16 weeks after operation and assessed for functional and anatomical state. RESULTS: According to the American Orthopedic Foot Ankle Society [AOFAS] Ankle-Hindfoot Score, the outcome was excellent [30.0%], good [40.0%], fair [20.0%] and poor [10.0%].   At the last follow‑up, Bohler’s angle was restored to normal [20°-40°] in 17 feet [85 %] while 3 feet [15 %] was less than normal. Wound infection was seen in [10%], each of varus heel deformity and flexion deformity of big toe was found in one patient [5.0%] and two case had reflex sympathetic dystrophy.Finally, there was no association between fracture type and subtalar arthritis. However, patients with subtalar arthritis had significantly lower AOFAS score when compared to patients with no subtalar arthritis [76.22±6.24 vs 87.0±6.05 respectively, p < 0.001]. Conclusion: Displaced calcaneal fractures treated surgically are associated with a relatively better functional outcome, provided that, Bohler's angle was restored to its normal or near normal values.
       
  • Feasibility of Laparoscopic Cholecystectomy in Patients with Previous
           Upper Abdominal Surgery

    • Abstract: Background: Previous abdominal surgery usually lead to adhesion formation, which considered as a contraindication of laparoscopic cholecystectomy (LC). However, it had been reported that, careful adhesiolysis could be performed and thus LC becomes feasible. Aim of the work: To assess the feasibility and outcome of laparoscopic cholecystectomy in patients with previous upper abdominal surgery. Patients and Methods: This study included 30 patients, who were presented by symptomatic gallstones. All participants assessed clinically. Then, a full lab profile was performed. Finally, abdominal ultrasound was done and if there was a dilatation of common bile duct, patients were submitted to magnetic resonance cholangiopancreatography. Both intra-and postoperative data were collected and any complications were documented.Results: 26 patients (86.7%) had chronic calcular cholecystitis, two had acute calcular cholecystitis and two had mucocele of gallbladder. Adhesions were grade 1 in 13.3%, grade 2 in 46.7%, grade 3 in 20% and grade 4 in 20.0%. Adhesiolysis was needed in twenty patients (66.7%). Intraoperative complications were reported in nine patients (40%). Bleeding reported in six patients and preformation of the gall bladder in three patients (10%). Three patients (10%) were converted to open surgery. Postoperatively, 12 patients (26.7%) had complications [3, 1, 2, 1 and 5 for port site wound infection, bile leakage, bleeding, and chest infection respectively). Post operative pain was mild in half of patients and moderate in other half. Conclusion: laparoscopic cholecystectomy after previous abdominal operations is relatively feasible and relatively safe, as nearly one third of patients had difficulties and complications.
       
 
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