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Ain Shams Medical Journal
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Print) 0002-2144 - ISSN (Online) 2735-3540
Published by Ain Shams University Homepage  [5 journals]
  • IMPACT OF COLCHICINE ON THE CLINICAL OUTCOME OF COVID-19

    • Abstract: Background: Because of the emergence of the pandemic of SARS-Cov2 infection and the Global burden of COVID-19 on the worldwide healthcare systems, it became mandatory for all researchers to search for better preventive as well treatment strategies.Aim of the Work: The aim of the work is to study the effects of colchicine on the COVID-19 patients' clinical outcomes and the inflammatory markers during the disease.Material and Methods: This comparative, randomized controlled study has been conducted on patients confirmed to have COVID-19 attending Ain Shams Isolation hospital from Feb-2021 and May-2021. The institutional review board of Ain Shams University’s research ethical committee approved the study. A total of 260 participants were randomized with 130 assigned to each group as follows: The Study Group (colchicine group) (n=130): included patients who received COVID-19 treatment protocol plus colchicine according to the study protocol. The Control Group (n=130): included patients who received COVID-19 treatment protocol only without colchicine.Results: Both groups were comparable regarding age, BMI, and gender. Females constituted 58.1% & 56.0% of cases in the colchicine group & the control group, respectively. At presentation, as regards the severity, both groups are comparable (p = 0.553). In day 14, the improvement in the clinical status in the colchicine group 0.64 (0.96) is significantly (p-value = 0.002) higher than in the control group 0.28 (0.99).Conclusion: The beneficial effect of colchicine in COVID-19 cases is self-evident for both the clinical status and laboratory evaluation
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • ASSESSMENT OF NUTRITIONAL STATE IN PREVALENT HEMODIALYSIS PATIENTS AND ITS
           IMPACT ON QUALITY OF ...

    • Abstract: Background: Patients undergoing hemodialysis (HD) frequently suffer from malnutrition and low quality of life QOL, which can have severe consequences such as an increased risk of hospitalization and mortality. Both have recently been identified as two critical targets for dialysis adequacy.Aim of the work: We aimed to determine whether there is a relationship between nutritional status and QOL in our HD patients.Patients and Methods: At Damanhur Medical National Institute, a cross-sectional study was conducted on 100 patients on regular HD. We determined the correlation using the Pearson correlation test after assessing nutritional status with the malnutrition inflammation score (MIS) and QOL with the valid Arabic version of the short form 12 questionnaire version1 (SF-12v1) to determine the correlation using the Pearson correlation test. In addition, univariate analysis was used to assess the degree of MIS effect on SF-12v1 components.Results: MIS had significant negative correlation with SF-12v1 components regarding physical component summary (PCS) where (r= -.498, p=.0001), mental component summary (MCS) (r= -.497, p=.0001) and total QOL score (r= -.554, p=.0001). MIS of patients was highly statistically significant in predicting PCS as the model explained (24.8%) of variability in PCS of QoL of patients, as each increase in MIS led to a significant decrease in PCS by 3.17 as (b,t,p) = (-3.17,-5.69,.0001) respectively.Conclusion: Among our patients, MIS had a significant negative correlation with PCS, MCS, and the total SF12v1 score. Patients' MIS was highly statistically significant in predicting PCS, MCS, and the total score of SF12v1.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • STUDY THE ASSOCIATION BETWEEN SERUM ASYMETRICAL DIMETHYLARGININE LEVEL AND
           CARDIAC FUNCTIONS IN ...

    • Abstract: Background: It is well known that cardiovascular disease is the leading cause of death for those who suffer from chronic renal disease, making it a pressing global public health concern. Human blood contains a naturally occurring modified amino acid called asymmetric dimethylarginine (ADMA). It may have a significant role in the development of atherosclerosis by preventing the body from producing nitric oxide, a gas essential for maintaining healthy vascular tone.Aim of the work: This research aimed to examine the correlation between ADMA levels in the blood and heart function as measured by tissue Doppler imaging in patients with chronic renal disease.Patients and methods: Ninety individuals were enrolled in our study from the National Institute of Nephrology and Urology's outpatient clinics and inpatient units. All patients underwent a thorough history and physical examination as well as laboratory tests, echocardiography, and Tissue Doppler imaging.Results: There are a highly significant difference among three groups as regard as serum Creatinine level, estimated glomerular filtration rate (eGFR), serum calcium, Parathyroid hormone, serum ADMA, interventricular septal diameter (IVSD), left atrial diameter (LAD), Septal Peak E' and Lateral Peak E'. There is a positive correlation with between ADMA and serum phosphorus, and a negative correlation between ADMA and lateral peak E'.Conclusion: Tissue Doppler imaging is considered to be more accurate than echocardiography in estimating diastolic function, and serum ADMA is inversely correlated with diastolic function in chronic kidney disease (CKD) patients.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • STUDY OF RENAL TUBULAR DEFECT IN GRAVE’S DISEASE OR THYROID
           MALIGNANCY PATIENTS WITH AND ...

    • Abstract: Background: Thyroid diseases are the most common endocrinopathies to occur. Thyroid cancer is considered the most evalent endocrine tumour and is growing in most nations. RAI-131 is the most comfortable and cost-effective therapy for Graves' disease or toxic nodular goitre. Since the 1940s, it has been employed because thyroid follicular cells may concentrate sodium-iodide. RAI-131 works physiologically. This research concentrates on RAI-131's impact on renal tubules after treating thyrotoxicosis or thyroid cancer.Aim of the work: To study the possible hazardous effect of Radioactive Iodine-131 (RAI-131) on renal tubules in patients with and without kidney disease.Patients and Methods: This is a prospective observational study was conducted on 30 candidates with Grave’s disease or thyroid malignancy treated by RAI-131 and they were selected by endocrinology and oncology doctors at El-demerdash hospital during the period from October 2019 to March 2021. All patients were subjected to the following: Medical sheet taken in Ain-shams university hospitals, General examination. Laboratory investigations: Estimation of Thyroid function (measured by radioimmunoassay): To detect associated hypothyroidism or hyperthyroidism. TSH, FT3 and FT4, Serum creatinine, Blood urea, eGFR, Urine analysis and Urinary β2 microgloglobulin as a marker of tubular damage. Renal function assessment were done before RAI-131 administration, and then it will be repeated one week later after the dose. Investigations were repeated after 2 months for patients with deterioration of kidney function tests.Results: A total of 30 patients included in this study, mean age of them was 34.33±7.71 years, 90% of them were females. Diabetes mellitus was reported in 56.7% of patients, while 43.3% of them had hypertension. Majority of the studied patients had grave’s disease (93.3%), had picture grave’s disease. Also, 50% of the studied patients had chronic kidney disease and 50% hadn’t chronic kidney disease. Serum creatinine showed statistically significant increase after one week and two months of RAI-131 dose compared before dose (p < 0.001). While, eGFR MDRD was showed statistically significant decrease after one week and two months of RAI-131 dose compared before treatment (p < 0.001). Additionally, there were highly statistical significant differences between the studied patients regarding presence of WBCs cast in urine after 2 months (p <0.001)). Also, β2 microglobulin in urine was increased after RAI-131 dose than beforeit (p <0.001). In addition, from the Non-CKD group, 5 patients (33.3%) developed impaired renal functions after 2 months of RAI-131 dose.Conclusion: RAI-131 affects directly the renal tubular functions as detected by statistically significant increase of urinary β2 microgloglobulin in all study group after 1 week (p 0.002) and 2 months (p <0.001).
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • PLATINUM BASED VERSUS ANTHRACYCLIN BASED NEOADJUVANT CHEMOTHERAPY IN
           NONMETASTATIC TRIPLE ...

    • Abstract: Background: Triple Negative Breast Cancer (TNBC) is a poor prognostic subtype of breast cancer. Response to neoadjuvant chemotherapy was proved to be associated with better survival. Platinum-based chemotherapy was suggested to be associated with better response in the neoadjuvant settingAim of the work: The current study is a phase III prospective study aimed at comparing platinum-based chemotherapy to anthracycline/taxanes conventional therapy in the neoadjuvant setting.Patients and Methods: The study was carried out in Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University. Inclusion criteria: nonmetastatic breast cancer cases, age more than 18 years, ECOG performance status of 0-2, and tumor proved to be triple negative subtype. Exclusion criteria: chemotherapy treatment contraindications, pregnancy, history of prior malignancy, presence of distant metastasis, and bilateral cases.Results: The study included 45 patients who fulfilled the eligibility criteria. Patients were randomly allocated into 2 groups, Group A: included 22 patients received anthracycline containing regimen (FEC or FAC) followed by Docetaxel and Group B: included 23 patients received platinum-based chemotherapy (Cisplatin or Carboplatin) combined with Docetaxel. Three patients in each arm had pCR in tumor, while one patient in each arm had PD. In axillary lymph nodes, complete regression occurred in 8 patients of group A and 11 patients of group B. Treatment was well tolerated in both groups.Conclusion: Platinum based chemotherapy in treatment of TNBC was well tolerated and had non inferior outcome compared to the classic anthracycline/taxanes based treatment, yet better biological understanding of the TNBC subtypes is mandatory for better treatment outcome.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • A RETROSPECTIVE ANALYSIS OF EPIDEMIOLOGY AND CLINICAL OUTCOME OF HODGKIN
           LYMPHOMA PATIENTS IN ...

    • Abstract: Background: Lymphoma is the fourth most prevalent cancer among Egyptian adults, accounting for 76.6 percent non-Hodgkin lymphoma (NHL) and 23.4 percent Hodgkin lymphoma (HL). Most patients with classic Hodgkin lymphoma (cHL) achieve long-term survival free of HL, but late complications of treatment, such as second malignancies, cardiovascular disease, pulmonary disease, and other complications, have emerged as a competing cause of death and morbidity. Aim of the Work: The aim of this work is to analyse retrospectively epidemiological and clinical outcomes of Hodgkin lymphoma patients treated in Ain Shams University hospitals (clinical oncology department) in Egypt in the period from January 2017 till December 2020.Patients and Methods: This is a retrospective study that included 70 Hodgkin lymphoma patients who attended the lymphoma clinic at the Clinical Oncology Department, Ain Shams University. In the period between From January 2017 till December 2020. They either treated by chemotherapy only or chemotherapy and radiotherapy.Result: Overall, of the 70 patients in the present study, 7 patients (10 %) died, and sixty-three patients (90 %) are alive till the end of our follow-up. The median OS is 34.54 months, while the median PFS is 15.67 months which is preliminary results.Many prognostic factors were selected for analysis to evaluate their impact on EFS.Some of these factors: age gender, family history and special habits had no statistically significant impact on EFS.But other factors: ECOG status, staging, B-symptoms, interim PET CT and Radiotherapy had statistically significant impact on EFS.Conclusion: Despite the increasing availability of guidelines for the treatment of HL, there is always a room for individualization of treatment. In particular, patient preference must be considered with different treatment options, some of which result in a higher recurrence risk at the gain of less toxic initial treatment (without any difference in long-term survival). Treatment should also be individualized when a particular approach might result in a higher risk of a serious late complication eg, the use of lung irradiation and the risk of late breast cancer in young females and of lung cancer in smokers.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • SERUM LEVEL OF RETINOL BINDING PROTEIN 4 IN RELATION TO AMYOTROPHIC
           LATERAL SCLEROSIS AMONG ...

    • Abstract: Background: Amyotrophic lateral sclerosis is a progressive devastating neurodegenerative disorder. It is characterized by both upper and lower motor neuron degeneration, leading to progressive skeletal muscle atrophy, paralysis, and consequent death. The pathogenesis of ALS and the risk factors are still not fully understood. Yet, metabolic abnormalities and nutritional factors have been recently the focus of interest among the various aspects of consideration. Vitamin A metabolite; Retinoic acid plays an important role in motor neuron development and neurite regeneration and its only carrier protein is retinol-binding protein 4.Aim of the work: This study aimed to measure the serum level of retinol-binding protein4 (RBP4) and to investigate the association between the clinical aspects of ALS and serum retinol-binding protein 4 (RBP4) concentration as a potential biomarker for vitamin A metabolism in ALS patients.Subjects and methods: This is a case-control study performed in the neuromuscular unit, Neurology Department, Ain-Shams University hospital. The study period was one year. Forty ALS patients were recruited and matched with forty healthy controls of matched age and sex. A Quantitative determination of human retinol-binding protein 4 concentrations in serum was assayed by Quantikine ELISA kit (2017 R & D Systems, inc.).Results: Serum RBP4 level was statistically non significantly higher among the control group versus the ALS group.Conclusion: Serum RBP4 concentration was found to be lower although statistically nonsignificant in ALS patients than in the controls group, further studies are needed.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • CORRELATION BETWEEN MONOCYTIC CHEMOTACTIC PROTEIN-1 (MCP-1) AND THE
           SEVERITY OF COVID-19 INFECTION.

    • Abstract: Background: The ongoing pandemic of coronavirus disease 2019(COVID-19) poses several challenges to clinicians. Serum chemokine levels such as MCP-1and IL-6 are elevated in patients with COVID-19, and they are even higher in those who required intensive-care unit (ICU) admission, suggesting a relationship between these chemokines and both lung damage and disease severity.Aim of the study: To evaluate the level of monocytic chemotactic protein-1 (MCP-1) in mild, severe and post COVID-19 patients to explore the correlation between (MCP-1) and the severity of the disease. The findings of this study will add to our understanding the role of MCP-1 in diagnosis of COVID-19 patients and the relation between MCP-1 level and the severity of the disease, providing potential diagnostic, prognostic and even therapeutic strategies for COVID-19 patients using MCP-1 as a marker.Patients and Methods: This case control study was conducted as a collaborate work between the Clinical Pathology Department and the Intensive Care Units at Ain Shams University Hospital between March 2021 and November 2021.The study included 87 patients diagnosed as COVID-19 positive by PCR. Patients were subdivided according to the clinical condition into severe group (n =45) (51.8%), mild group(n=22) (25.2%) and convalescent group(n=20) (23%) as well as 60 age and gender matched healthy subjects were recruited as a control group.Results: Our results stated that MCP-1 can differentiate the current cases (either mild or severe) from the convalescent cases as well as the other lab markers (CRP, D-Dimer and ferritin). However, according to our results MCP-1 had even more sensitivity and specificity than other lab markers (CRP, D-Dimer and ferritin).Conclusion: This study added to our understanding the role of MCP-1 in diagnosis of COVID-19 patients and the relation between MCP-1 level and the severity of the disease, providing potential diagnostic, prognostic and therapeutic strategies for COVID-19 patients using MCP-1 as a marker. However, further research is needed about the advantages of MCP-1 over the other known markers in the diagnosis and the prognosis of COVID.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • EVALUATION OF AUTOMATED AUDITORY BRAINSTEM RESPONSE AND OTO ACOUSTIC
           EMISSIONS IN NEONATAL ...

    • Abstract: Background: Universal neonatal hearing screening (UNHS) has been implemented in countries all over the world to detect neonates with congenital hearing loss early and provide appropriate intervention in time. Therefore, it is extremely important to find a convenient and effective screening protocol to identify precisely all newborns with hearing loss. This study mainly explored the effectiveness of ATEOAEs and AABR as first screening tool in risky and non-risky neonates.Aim of the work: To compare performing time, referral rates, sensitivity and specificity of ATEOAEs and AABR as a screening tool in Neonatal Intensive Care Unit (NICU) and Well-Infant Nursery (WIN) and to identify obstacles against each screening tool.Patient and Methods:510 neonates were recruited from Neonatal Intensive Care Unit (NICU) and Obstetrics & Gynecology maternity hospital in Ain Shams University Hospital. All neonates were screened by Automated Transient Evoked Oto-Acoustic Emissions (ATEOAEs) and Automated Auditory Brain stem Response (AABR) tests in first hearing screening, and those failed any test were scheduled for retest after one week. Failed neonates were assessed by diagnostic ABR. The results of ATEOAEs and AABR were compared among the NICU and Well Born Neonates (WBN) groups. The time spent on screening by each tool was recorded, validity and referral rates were calculated.Results: AABR resulted in more pass and less refer outcome, with highly statistically significant difference in referral rates between ATEOAEs & AABR after first and second screening tests in both well born and NICU groups (P<0.001). As regards the total test time (including setting time plus the actual testing time), AABR test had significantly shorter total test time compared to ATEOAEs for both well born and NICU neonates. AABR was more valid than ATEOAEs in neonatal hearing screening in NICU neonates with higher sensitivity and specificity.Conclusions: AABR is more sensitive and specific than ATEOAEs in diagnosis of hearing loss in NICU neonates, and with the newly developed technologies (BERAphone), screening test is cost effective than ATEOAEs due to significantly lower referral rate. So AABR is the screening test of choice for high risk NICU neonates.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • COVID-19 AND AUDIO-VESTIBULAR SYSTEM IN EGYPTIAN ADULT SUBJECTS

    • Abstract: Background: Despite Audio-vestibular symptoms were reported in several studies, still limited and further investigations are necessary to confirm the effects of COVID - 19 on the audio-vestibular system and estimate their incidence.Aim of the study: This study aimed to highlight the extent of affection of the audio-vestibular system in post COVID 19 Egyptian subjects and to describe the pattern of affection, if any.Patients and Method: A total number of 105 confirmed post COVID-19 subjects, recruited from Ain shams University hospitals compared to 50 normal age and gender matched healthy volunteers with no history of COVID 19 participated as control group. All participants were subjected to: detailed history taking, Otological and otoscopic examination, Pure Tone & speech Audiometry, Acoustic immittancemetry testing and screening bedside tests for vestibular and balance impairment.Results: Thirty-four subjects (32%) had hearing loss. Twenty-nine subjects (28%) had SNHL, 5 subjects (5%) had CHL and 16 cases (15%) had vestibular affection.Conclusion: Post COVID-19 auditory-vestibular affection is to be documented. The majority of affected subjects had bilateral, moderate, high frequency SNHL with sudden onset. BPPV is the most common cause of post COVID-19 vertigo.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • DEVELOPMENT AND STANDARDIZATION OF ARABIC LOW-VERBAL SENTENCES- IN-NOISE
           TEST (LV–SIN) IN ...

    • Abstract: Background: Children’s reduced speech recognition abilities in noise may affect how well they learn in a noisy classroom, through both education and incidental learning. Various speech in noise tests in children have been developed to estimate the perception of speech in the presence of noise. This study was performed to develop a new Arabic open-set sentence material suitable for children aged 4 to 7 years using different types of noise.Aims of the work: Development of a new Arabic LV-SIN test and its standardization on Arabic-speaking normal hearing children of age ranging from 4 to 7 years.Studying the effect of different types of noise and sentence difficulty level on performance of children of different age groups.Patient and methods: Sixty-six normal hearing children classified into three subgroups: Subgroup A: (4 to< 5 years), Subgroup B: (5 to< 6 years) Subgroup C: (6 to 7 years). They were tested using the newly developed LV-SIN test using white, multi-talker babble and story noise. The sentences were divided into nine lists, with three levels of difficulty. Scoring was done by measuring the SNR50 which is the level at which the child repeated 50% of the number of words per list.Results: The majority of children reached SNR50 at -14 SNR in story noise, and -16 SNR in white noise and multi-talker babble noise. The mean average of number of trials until SNR50 score was reached was 2 - 3 in subgroup 1, and 3 - 4 in subgroups 2 and 3. There was statistically significant effect of age and list difficulty on SNR50 test scores. In contrast to white noise, multi-talker babble and story noise were able to segregate sentences based on difficulty level.Conclusion: Arabic LV-SIN test was developed and standardized for assessment of speech perception in noise in pre-school age children with age ranging from 4 – 7 years. Age, type of noise and list difficulty had a significant effect on LV-SIN test scores.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • ROLE OF ULTRASOUND AND DIFFUSION WEIGHTED MRI IN DETECTION OF THYROID
           CARTILAGE INVASION IN ...

    • Abstract: Background: Cartilage invasion is one of the critical determinants of tumour staging for laryngeal cancer and of particular importance in assessing the suitability for partial laryngectomy and/or chemoradiation therapyCompared to CT, diffusion-weighted magnetic resonance imaging (MRI) has a similar ability to define the interface between fat and tumor, but is superior for assessing muscle and cartilage invasion. Diffusion-weighted MRI may be indicated if there are equivocal findings in the CT, including possible cartilage invasion. ultrasonography has the advantage of its non-invasive and real-time imaging features and it has been used to evaluate laryngeal tumours and it could assist tumour staging in patients with advanced laryngeal cancer.Aim of the work: To compare between the role of US and diffusion weighted MRI in the detection of thyroid cartilage invasion in patients with laryngeal malignancy by correlating the radiological findings with the postoperative histopathological findings of the total or partial laryngectomy specimen.Patients and Methods: A prospective study was carried out between December 2018 to September 2021. The study included 36 patients. Thirty five patients underwent total laryngectomy and one patient underwent partial laryngectomy. Histopathology reports of resected specimens and pre-operative staging were blind to the consultant radiologist who reviewed the scans to comment on thyroid cartilage invasion with special emphasis on inner and outer lamina invasion by conventional MRI criteria, and DWI and ultrasound.Results: our study showed that DWMRI has sensitivity of 81.2%, specificity 50%, PPV of 86.7%, NPV of 40% and accuracy of 75% in detection of inner lamina invasion and it has sensitivity of84.6 %, specificity of 71.4%, PPV of 84.6%, NPV of 71.4% and accuracy of 80% in detection of outer thyroid lamina invasion. In our study, we found that ultrasound has sensitivity of 78.6%, specificity of 60%, PPV of 84.6%, NPV of 50% and accuracy of 73.7% in detection of inner cortex invasion. & it has sensitivity of 75%, specificity of 66.7%, PPV of 90%, NPV of 66.6% and accuracy of 78.9%in detection of outer thyroid cortex invasion.Conclusion: Diffusion-weighted MRI and ultrasound showed high validity and precision in detecting inner and outer thyroid lamina invasion. This can have an important impact on the decision making for management of laryngeal carcinoma.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • CATEGORIZATION OF EVERYDAY SOUNDS BY EGYPTIAN COCHLEAR IMPLANT CHILDREN

    • Abstract: Background: Cochlear implantation is a common surgical procedure for children with profound hearing loss who receive minimal or no benefit from traditional hearing aids. Auditory categorization is an important process in the perception and understanding of everyday sounds. This process involves both high level cognitive processes and low-level perceptual encoding of the acoustic signal.Aim of the work: To understand the ability of a cohort of Egyptian children with Cochlear Implant to perceive everyday sounds compared to normal hearing children.Patient and Methods: Ninety subjects divided into 2 groups were included in the present study. Group I: Fifty normal hearing children (NH). Group II: Forty CI users. A set of 18 natural stimuli were studied. They were chosen to cover a broad range of everyday sounds that corresponded to four mains a priori categories: nonlinguistic human vocalizations, animal vocalizations, environmental sounds& musical instruments. Children were asked to name/identify the sounds in an open-set identification task.Results: Results showed that cochlear implant users were different from normal hearing listeners regarding the perception of individual sounds. Normal hearing children could identify sounds better than the CI children. In normal hearing children, the best identification was for human vocalizations, while in cochlear implant children the best identification was for animal vocalizations. Both groups had lower identification scores for both environmental and musical sounds. Sound identification scores increased with increasing chronological age of both groups.Conclusion: Cochlear implant children have reduced relative ability toward identification of superordinate category of non-linguistic human vocalizations compared to age and gender matched normal hearing children.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • COMPARATIVE STUDY BETWEEN DIFFERENT MANAGEMENT MODALITIES OF IATROGENIC
           ESOPHAGEAL PERFORATIONS

    • Abstract: Background: Iatrogenic esophageal perforation accounts 60% of esophageal perforations and associated with 19% of mortality. Endoscopic procedures & invasive surgical maneuvers are the common causes. Pain, dysphagia and subcutaneous emphysema are common manifestations. Water soluble contrast study, CT scan, and endoscopy provide a high sensitivity for diagnosis. Early aggressive management within the first 24 hours is crucial for excellent outcomes; majority of patients is suitable for non-operative management while surgical intervention and esophageal stenting are alternative treatment options.Aim of the work: To compare efficacy of different management modalities in patients with iatrogenic esophageal perforations.Patient and Methods: Papers provided data from March 2007 to June 2022 related to patients with iatrogenic esophageal perforation & comparing different management modalities are reviewed between January 2021 and June 2022. We made pairwise meta-analyses of our outcomes using Comprehensive Meta-Analysis software (CMA version 3.9). Event rate with the corresponding 95% confidence intervals (95%CI) was also being calculated for categorical data.Results: In majority of patients non-operative management is the best option with successful rate of more than 90% and lowest mortality (6.3%). Surgical management is warranted in the patients who do not meet the criteria for conservative treatment with successful rate of more than 80%. Esophageal stent is an alternative treatment option with 50 to 83% of esophageal healing.Conclusions: The treatment method still has to be chosen on an individual basis. We recommend conservative treatment when indicated. Extended perforations should be treated with a surgical approach and esophageal stenting have a satisfactory outcome in suitable patients.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • THE ROLE OF DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING IN GRADING OF
           CERVICAL AND ...

    • Abstract: Background: Histological grade is one of the main prognostic factors in patients with endometrial and cervical carcinoma. DW-MRI provides important new information non-invasively. Aim of the Work: to investigate if there is a correlation between qualitative (visual) and quantitative (ADC value) provided by the diffusion weighted imaging and the pathological grade of endometrial and cervical carcinoma in order to reach the appropriate treatment options. Patients and Methods: Our study was conducted on twenty patients with pathologically proven endometrial (n=10) and cervical (n=10) carcinoma. It stressed on the role of Diffusion MRI in preoperative grading, aiming to emphasize its role in proper selection of patient’s management plan. We performed DWI using different b-values, and quantitative analysis, named apparent diffusion coefficient (ADC). Areas of restricted water diffusion of uterine malignancy demonstrated high signal intensity on DWI and lower ADC values on ADC map. Results: There was a significant difference (b < 0.01) between grades (1 and 2) from grade 3 in measuring the ADC values of both endometrial and cervical carcinoma, while there was no statistically significant difference between grade 1 and grade 2 or between grade 2 and grade 3. The mean ADC value of well differentiated tumors was (> 0.9 x 10-3 mm2/ sec), while that of poor differentiated tumors was (< 0.7 x 10-3 mm2/ sec). We also included in our analysis the size of the proved uterine cancer and aimed to establish another item that could reflect the tumor grading, but we haven’t reached a statistical significance in the current research; which could be due to the limited sample size. Conclusion: Lower ADC values were associated with poorly differentiated endometrial and cervical tumors. Therefore, the ADC value may represent a useful marker for assessing the biological features and grading of the uterine cancers. 
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • COVID-19 AND RHINO-ORBITAL MUCORMYCOSIS: WHAT'S THE LINK'

    • Abstract: Background: COVID-19 associated mucormycosis (CAM) is an emerging disfiguring and fatal problem, which affects particularly patients with uncontrolled diabetes. The complex relationship between COVID-19 and mucormycosis is still mostly unknown.Aim of work: The aim of this study is to find the incidence and risk factors of orbital mucormycosis among covid and post covid patients in one year at Ain Shams University Hospitals (ASUH).Patients and Methods: This descriptive retrospective cohort study was conducted at the Ophthalmology Outpatient Clinic, Ophthalmology Department, Ain Shams University hospitals in the period from 1 January 2021 until 31 December 2021. All the enrolled patients underwent detailed history, ophthalmic examination and imaging.Results: Our study results revealed ROCM cases in 2021 at ASUH were much higher than the numbers presenting during equivalent intervals before COVID-19 pandemic, and among 92 cases of rhino-orbital mucormycosis within one year, 93.5% was during or within 2 weeks of COVID-19 infection. The rate of these cases varied prospectively with number of new COVID-19 cases in Egypt within the same period. COVID-19, diabetes mellitus, frequent oxygen support and corticosteroid for COVID-19 management use were the dominant predisposing factors for ROCM. Older age >50 years, admission to an ICU, Haematological malignancy and brain involvement were independently associated with a higher risk for death.Conclusion: Clinicians should be vigilant about the appropriate use of steroids for COVID-19 management and ensure the use of aseptic precautions during oxygen support to minimize risk for mucormycosis following COVID-19 treatment.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • LUMBAR PUNCTURE IN THE MANAGEMENT OF POSTOPERATIVE CEREBROSPINAL FLUID
           (CSF) LEAKS FOLLOWING ...

    • Abstract: Introduction: Endoscopic third ventriculostomy (ETV) has become an established treatment for obstructive hydrocephalus. Success and failure criteria are, sometimes, debatable.Postoperative cerebrospinal fluid (CSF) wound leak is considered, by most, a clinical criterion of failure subsequently recommending revision surgery or shunt implantation.Aim of Work: to elucidate the impact of repeated lumbar puncture for postoperative CSF wound drainage on the final ETV outcomePatients and Methods: From a prospectively maintained registry of endoscopic ventricular surgery; clinical, radiographic and, operative data are compiled to calculate the ETV success score and an intraoperative score. Patients with symptomatic postoperative wound collection and/or CSF leak were identified and managed by repeated lumbar punctures. Clinical and imaging follow up was established to evaluate final outcome.Results: From a total of 75 patients with endoscopic interventions for hydrocephalus, 57 patients underwent ETV. Fifteen patients (26%) had postoperative CSF leak and/or wound bulge requiring a median of 3 lumbar punctures. This group had a mean ETV success score of 61 and a favorable intraoperative score in 93% of the cases. The scores were not different from those of the whole cohort. Repeated lumbar puncture was successful in 7 out 15 patients (47%). The difference between patients with successful and failed serial lumbar punctures in both the ETV success score and intraoperative score was not statistically significant.Conclusion: Partaking serial lumbar punctures in patients with CSF wound drainage or signs of potential ETV failure in the early postoperative period was successful in half of the instances. This could be recommended in presence of favorable ETV success score and intraoperative score to avoid premature shunting.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • RELATION OF ACTIVITY SCORE (DAS28) WITH FUNCTIONAL ASSESSMENT IN PATIENTS
           WITH RHEUMATOID ARTHRITIS

    • Abstract: Background: Rheumatoid Arthritis (RA) is characterized by chronic inflammation of joints with extra-articular systemic involvement. When managing RA, disease activity is assessed by (DAS28) score at regular intervals and treatment is changed according to disease activity. Although many studies have stressed upon DSA28 score to monitor improvement of RA on treatments, few studies have evaluated whether there is a concurrent improvement of the daily life functions and sleep of the patients or notAim of the work: To assess the relation between RA disease activity using DAS28 (ESR) score with functional status reflected by activities of daily living (ADLs) and sleep quality scores.Patients and Methods: Fifty-four RA patients underwent history, clinical examination, investigation, and assessed for disease activity using DAS28 (ESR) score, basic and instrumental ADLs (BADLs & IADLs), and sleep quality by medical outcome study sleep scale (MOSS-S).Results: Age of patients ranged from (20- 66) years with mean of 46.11 ± 10.19 years, disease duration ranged from (0.25- 28) years with mean of 5.5±2.5. The mean DAS28 was 4.63± 1.43. BADLs showed twenty-one patients with moderate impairment with a percent of 38.8%, and severe impairment in five patients with a percent of 9.2%. IADLs showed moderate impairment in twenty-five patients with a percent of 46.3% while there was no severe impairment. Highly significant correlation (r= 0.564, p-value < 0.01) was found between increased BADL score and increased IADL score, and between increased MOSS score and decreased BADL score (r=0.532, p-value < 0.01), and between decreased IADL score and MOSS score (r=0.485, p-value < 0.01).Conclusion: Functional ADLs and sleep quality are strongly correlated with disease activity in RA patients and they are multifactorial in origin and related to pain, fatigue, depression, educational level and physical deformity.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • RETROSPECTIVE ANALYSIS OF CPAP USE IN THOSE ADMITTED TO ICU WITH COVID-19

    • Abstract: Background: Initial guidance on managing COVID-19 respiratory sequalae suggested early intubation be used to treat deteriorating patients, however at James Cook University Hospital (JCUH) (centre name) a trial of CPAP (Continuous positive airway pressure) was used when patients required more than 15 litres of oxygen.Patients And Methods: We conducted a retrospective cohort study to see if this use of CPAP had protective properties against COVID-19 in Intensive Care Unit (ICU) patients. Patients included were admitted to JCUH ICU on or after 01/02/2020, and discharged before or on 31/05/2020, with their primary reason for admission to ICU being ‘Pandemic Influenza’. Patients were excluded if they were intubated before admission to JCUH, invasively ventilated before they had CPAP, or received CPAP via a tracheostomy.Results: 86 patients met the inclusion criteria (n=86). 6 did not receive CPAP or invasive ventilation, 67 had CPAP, of whom 23 were subsequently invasively ventilated, and 13 patients were invasively ventilated without prior CPAP. Patients escalated from CPAP to invasive ventilation had the highest mortality rate (95.65%), and the difference in outcome between patients who had CPAP and those who did not, was not statistically significant (p=0.885). There was a weak correlation (+0.25, p=0.042) between an increased number of days of CPAP and patients being discharged alive.Conclusion: Having CPAP was not associated with an improvement in patient mortality, however patients who received CPAP for a greater number of days were more likely to survive. Disease severity (PaO2/FiO2 ratio) was the most strongly correlated factor with patient outcome.Key Messages:Our centres' analysis suggests that patient selection and timing of intubation in COVID-19 patients is critical. Patients who received only CPAP had the lowest mortality, however, those who were subsequently intubated had a higher mortality than those who were intubated earlier in their disease progression (without receiving CPAP first).A higher number of days of CPAP received was significantly associated with a positive outcome whereas hours per day of CPAP was not.
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
  • COMBINED CAUDAL EPIDURAL WITH GENERAL ANESTHESIA FOR LUMBAR DISCECTOMY

    • Abstract: Background: Lumbar Discectomy can be effectively performed using various anesthetic techniques. General anesthesia is more frequently used for these surgeries, though regional anesthesia when combined with general anesthesia is proven to be safe in few studies. Aim of the Work: To compare the intra operative and short term post-operative outcome variable in patients undergoing primary single level lumbar discectomy under combined caudal epidural with general anesthesia versus general anesthesia alone. Patients and Methods: This study included 100 patients aging 25 – 40 years old, admitted to operating room in Ain Shams University hospitals for single-level lumbar discectomy. The patients were divided into two groups of 50 each: Group A received general anesthesia, Group B, in addition to GA, received caudal epidural using 20 ml Bupivacaine 0.25% injected in the caudal region. Results: Intra operative HR, MAP, narcotic consumption, blood loss were lower in the Caudal Epidural with GA group. Post-operative 1st analgesia needed was less in the GA group. Post-operative VAS score and PONV were higher in the GA group when compared to combined caudal epidural with GA. There was no motor affection in both groups and sensory affection was with a median at T10 in the group receiving Caudal epidural with GA. Conclusion: Epidural caudal anesthesia can safely be combined with GA for single leveled lumbar discectomy. It reduces intraoperative tachycardia and hypertension, blood loss, intra-operative and postoperative IV analgesic requirements and PONV. 
      PubDate: Wed, 31 Aug 2022 22:00:00 +010
       
 
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