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Medicine Updates
Number of Followers: 2  Open Access journalISSN (Online) 2682-2741 Published by Port Said University  [3 journals]
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- Role of ultrasound and ultrasound guided biopsy in the evaluation of
mammographically proved breast calcifications
Abstract: Abstract: Objective: To evaluate the ability of sonography to depict and guide biopsies of mammographically suspicious microcalcifications and to reveal the mammographic features and histologic outcomes of lesions amenable to sonographically guided biopsy Methods: The study was conducted on 30 patients referred to the Radiology Department at Alexandria Main University Hospital for assessment of sensible breast lumps or screening mammogram with accidentally discovered breast lesions. Each patient was subjected to full history taking ,clinical examination ,laboratory investigation e.g. bleeding time, mammography and ultrasound. Lesions visible on sonography subsequently underwent sonographically guided percutaneous core biopsy while lesions were not depicted on sonography were sent for mammographically guided wire localization with surgical excision. Results: In 26 cases, there were sonographically visible microcalcifications which seen on the background of associated hypoechoic masses or area of sonographically distorted parenchyma. The associated lesions were smaller in size in comparison with the corresponding mammographic abnormality in 64%. Calcifications were seen as tiny strongly echogenic non shadowing foci. All sonographically visible calcific foci were less in their number than in mammogram. The larger the cluster size, the more visible sonographically, 100% of clusters equal or more than 2 cm long were sonographically visible. Conclusion: Targeted US is an effective method for the characterization of microcalcifications. Ultrasound sensitivity for breast density categories III and IV is higher than the mammographic sensitivity. Visibility of malignant microcalcifications improves when the size of the clustered microcalcifications is greater than 10 mm.
- Assessment of Endovenous Microwave Ablation with High Tie versus
Traditional Surgery for Primary Varicose Veins
Abstract: Background: The high ligation and stripping (HLS) of great saphenous vein (GSV) is the traditional method for surgical treatment of varicose vein (VVs) with high postoperative recurrence rate up to 60%, slow recovery, and obvious scar. Endovenous microwave ablation (MA) with high tie is considered a new technique of thermal ablation. We aimed to compare between (MA) with high tie versus traditional surgery for lower limb VVs regarding return to activity, complications, recurrence rate, and affection the Quality of Life (QoL). Methods: This prospective comparative study was conducted on 50 cases, presented with symptomatic VVs, classified into two equal groups, MA with high tie group and traditional surgery group. The complications and possibility of recurrence were evaluated during 3, 6, and 12 m post intervention. The effect on QoL was assessed by the Aberdeen Varicose Vein Questionnaire. Results: Operative incision was significantly fewer in MA with high tie group (P value <0.001). Return to activity was significantly faster in microwave ablation group (P value <0.001). Incidence of Ecchymosis and sensory impairment were significantly lower in MA with high tie group. EMA is more Recurrence at 12 m was significantly lower in MA with high tie group compared to traditional surgery group with hazard ratio (95% confidence interval) 0.2836 (0.08855 to 0.9085) (P =0.033). AVVQ was insignificant between both groups during assessment. Conclusions: MA with high tie is an effective ablation method for VVs patients, that provides shorter time with less incisions, faster recovery with lower thermal-related complications, and recurrence rate.
- Balloon management of Dysfunctional Arteriovenous Fistula for Hemodialysis
with Ligation of Competitive Veins
Abstract: Introduction: Arteriovenous fistula (AVF) is the recommended access for patients in need for long term hemodialysis (HD). The primary dysfunction of AVF because of stenosis is a surgical problem and need to manage it. The aim of the study is to salvage AVFs by balloon angioplasty. Methods: a prospective clinical study was done from July 2019 to November 2022, including 42 dysfunctional native AVFs, and recommended for endovascular salvage. Follow up of patency of AVF along duration of the study (12 months) post-intervention using fistula-gram to estimate the success and patency rate with preserving function. Results: the study was done on 42 end stage renal disease (ESRD) patients. 42 AVFs, aged 45.6 ± 14.2 years, 27 (64.3%) were males, 15 (35.7%) were females, 3 (7.1%) patients were smokers, 33 (78.6%) of the patients were diabetics, 32 (76.2%) patients were hypertensive and 27 (64.3%) patients have ischemic heart disease. The stenotic lesions were detected in AVA in 4 (16.7%) patients, Juxta-anastomotic in 3 (12.5%) patients, Proximal venous outflow in 6 (25%), distal venous outflow in 7 (29.2%) and lesion in central venous in 2 (8.3%) patients. Success rate was recorded in 30 (71.4%) patients. Conclusion: Endovascular approach for treatment of non-functioning AVF is safe and efficient for maturation of the AVF and make it useful for hemodialysis.
- Role of Methylated RASSF1A Gene as a potential biomarker in the diagnosis
of lung cancer
Abstract: The leading reason of cancer-related mortality in the world is Lung cancer. human RASSF1A has been extensively recognized as an indispensable goal suppressor tumor gene. of expression of RASSF1A loss was once shown to take part in the pathogenesis of different human cancers. Aims: Verify the significance of DNA methylation of the RASSF1A gene as an early detection biomarker for lung cancers. Settings and Design: randomized managed scientific study Methods and Material: This finds out about included 50 folks in Aswan and Assiut University Hospitals, divided into two corporations along with 30 sufferers with lung cancer and 20 aberrantly wholesome heavy people who smoke as a management group. Both corporations were subjected to clinical examination, imaging modalities, activities laboratory investigation, and blood patterns for methylation-specific PCR and DNA extraction in addition bronchoscopy and histopathological examination have been executed on the group of lung cancer patients. Statistical analysis used: SPSS 20.0 for home windows and MedCalc thirteen for home windows Results: RASSF1A gene was hypermethylated by way of 64.8 folds in lung cancer sufferers extra than in the manage group. There used to be a statistically considerable difference between those with methylated shape and those with an un-methylated form of the RASSF1A gene in the two studied groups, the frequency of methylation used to be greater in patients with lung cancer than in the control crew. Conclusions identifying the methylation fame of the RASSF1A gene may be beneficial as a molecular biomarker in analysis and screening for lung most cancers.
- Which is worthy to be adopted, carotid endarterectomy or carotid stenting
for treatment of symptomatic carotid artery stenosis'
Abstract: Carotid endarterectomy (CEA) has shown a valuable role in preventing stroke in symptomatic patients. However, it is limited by the presence of high-risk medical comorbidities. Alternatively, carotid artery stenting (CAS) has evolved as a less invasive therapeutic modality. Objective: compare the outcomes of carotid endarterectomy and carotid artery stenting in patients with symptomatic carotid artery stenosis. Methods: 37 adult patients with symptomatic carotid artery stenosis who were scheduled for either CAS (N=20) or CEA (N=17). Carotid artery assessment via carotid duplex was recorded. The primary endpoint of the study was the incidence of stroke or myocardial infarction within 30-days, and the incidence of death, stroke, or myocardial infarction at 1-year. The secondary endpoints included cranial nerve injury, restenosis, vessel maturation, intracranial hemorrhage, and any complications at the surgical site within 30 days. Results: Within 30 days of the procedures, the incidence of stroke or transient ischemic attack was 20.0% in the CAS group compared with 17.6% in the CEA group . Myocardial infarction did not ensue in either group. None of the patients in the CAS group developed cranial nerve injury compared to two patients in the CEA group. The incidence of local hematoma was lower in the CAS group (5.0%) than in the CEA group (29.4%). A 1-year follow-up, equal death, and stroke rates in the CAS and CEA groups were 10.0% versus 11.8%. Conclusions: The findings of the present study indicate comparable results within 30 days and at 1-year follow-up among patients who underwent CAS or CEA.
- Improving job performance in the hospitals by Occurrence Variance
Reporting
Abstract: Occurrence variance reporting (OVR) may be very critical for making sure affected person and body of workers safety, nice of care and threat management. Variance is any occasion or condition now no longer regular with the usual habitual operations of the medical institution and its body of workers or the habitual care of a affected person/visitor. OVR trending and analysis. Result: prevalence variance reporting machine considerably stepped forward after implementation of an academic software on OVR to medical institution body of workers and directors than before. Recommendations: Continues month-to-month and quarterly tracking and collecting of information to keep the performance, Continuous -Occurrence variance reporting (OVR) may be very critical for making sure affected person and body of workers safety, nice of care and threat management. Variance is any occasion or condition now no longer regular with the usual habitual operations of the medical institution and its body of workers or the habitual care of a affected person/visitor. OVR trending and analysis. Result: prevalence variance reporting machine considerably stepped forward after implementation of an academic software on OVR to medical institution body of workers and directors than before. Recommendations: Continues month-to-month and quarterly tracking and collecting of information to keep the performance, Continuous
- A comparative study of microneedling versus microneedling with topical
Ascorbic Acid in the treatment of striae distensae
Abstract: ABSTRACT Background: Striae Distensae is a type of visible scar that develops in areas of dermal injury as a result of excessive skin stretching. Weight gain, pregnancy, long term systemic or topical steroid use are considered its most common causes. Aim of the work: the aim of our study is to compare and evaluate the effectiveness of microneedling and microneedling combined with Ascorbic Acid in treating and improving the appearance of Striae distensae. Patients and Methods: this study was conducted on 28 patients with striae distensae(rubra & aba), they were divided in to two groups: the first group was treated by microneedling only using dermapen device, while the second group was treated by microneedling combined with topical Ascorbic Acid. All patients received four sessions with one month interval, and followed up for three months after the last session. Results: our study revealed that both treatment modalities were safe and effective in treating and improving the appearance of Striae distensae, addition of topical Ascorbic Acid increases the treatment out come with no serious side effects and result in significant patient satisfaction. Conclusion: the current study concluded that the use of microneedling or microneedling combined with Ascorbic Acid in treatment of Striae distensae, both are promising therapeutic modalities with tolerated side effects .
- Volumetric Brain Parameters in Association with Cognitive functions in a
Sample of Egyptian Multiple Sclerosis Patients
Abstract: Background: Cognitive impairment is highly prevalent in multiple sclerosis (MS). Early detection of cognitive dysfunctions using radiological techniques may help in controlling and may prevent such complications. Objectives: To assess the relationship between cognitive impairment and brain volumes in Egyptian MS patients. Methods: A cross-sectional study was conducted including 50 Egyptian MS patients with diverse subtypes. Adult patients diagnosed with MS based on revised McDonald’s 2017 criteria, free from other neurological or systemic disorder affecting brain structure and had EDSS ≤ 8. The recruited patients were subjected to cognition assessment using Montreal Cognitive Assessment (MoCA)test and brain volume estimation using magnetic resonance imaging (MRI). Demographic, clinical, and radiological data were compared using appropriate tests and SPSS software version 26. Results: Out of 50 MS patients, MOCA was normal in 36% patients and abnormal in 64% patients. As regard regional brain volumes (Cortical, Cortical Normalized, left thalamus, right thalamus and lesion load) were statistically significant smaller in abnormal MOCA patients compared to normal with P-value were (0.004,0.001,0.002,0.001 and 0.004) respectively. Conclusion: Early estimating brain volume in Egyptian MS patients may help in prediction of cognitive impairment among them. large sample size is required to assess the predictive value of volumetry.
- Accuracy of combined serum micro RNA 21 and micro RNA let 7g expression
level in breast cancer diagnosis
Abstract: Abstract: Micro RNAs are single-stranded non-coding RNA molecules that regulate biological processes by inhibiting post-transcriptional activity. Many diseases including breast cancer have uncontrolled levels of microRNA. The current work aims to highlight the importance of miRNA let7g and miRNA 21 expression in blood for early detection of breast cancer. Methodology: Using quantitative real-time polymerase chain reaction the serum expression levels of micro RNA 21 and micro RNA let7g were evaluated in 52 female patients with primary breast cancer and 28 matched healthy females as a control group. Results: Serum expression level of micro RNA 21was highly increased in breast cancer patients when compared to the control group, while the serum expression levels of micro RNA let7g recorded a lower level in breast cancer patients when compared to control group and these differences were statistically significant. On studying the relation between the expression levels of the measured parameters and the different clinicopathological characteristics; a positive significant correlation was found between CA15.3 and microRNA 21 levels. A negative significant correlation was present between miRNA let7g levels and HER2, as well as with molecular subtype prognostic ranking. Receiver operating characteristic curve of both markers were exploited at a cut off points 0.82 and 1.785 respectively and showed a 100% sensitivity, 67.8% specificity. Conclusion: The effectiveness of serum mi RNA21 and mi RNA let7g as diagnostic biomarkers for detecting breast cancer has been convincingly proven. This innovative idea could be used to create a complementary tool for disease diagnosis, prognosis, and screening.
- A new look for the management of Painful Peripheral Neuropathy in Diabetes
Abstract: Diabetic peripheral neuropathy (DPN) is a common complication of diabetes that affects a large number of patients. DPN represent a paradox, at one extreme we can find patients with severe neuropathic pain but with minimal neurological deficit. At the other extreme are asymptomatic patients with insensate feet. Pain is very distressing symptom for the patient and also challenging for the treating physician. Excluding other causes of pain is essential before attributing pain to neuropathy. Also Neuropathic pain could be due to causes other than diabetes. Management of painful neuropathy should be more than just using pain alleviating modalities and a more comprehensive approach is needed. We have to measure the severity of pain and its impact on quality of life. The stability rather than the actual level of glycemic control may be more important in relieving neuropathic pain especially in its early stages. First line treatment for painful neuropathies are: Tricyclic antidepressant, Serotonin– noradrenalin reuptake inhibitors and Alpha-2-delta agonists. Non-pharmacological interventions e.g. transcutaneous electrical nerve stimulation still need more evidence. Foot care is essential to protect the foot that lost its protective mechanisms. Identification and treatment of risk factors for IHD may save not only limbs but also lives.
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