Diabetes mellitus is the most common cause of chronic kidney disease in the world, leading to multiple complications including end-stage renal disease, cardiovascular disease and even death so, Screening is an important strategy to address the burden of CKD in diabetic population. International clinical guidelines recommend CKD screening for individuals with risk factors such as diabetes, using laboratory assessments of glomerular filtration rate (GFR) and urine albumin excretion. This study describes the implementation and outcomes of screening programme for chronic kidney disease in type 2 diabetic patients to assess the burden of renal disease in diabetic population. The present study included two hundred type 2 diabetic patients complicated with diabetic nephropathy. Fifty five percent of the studied patients were males. Age ranged from 42 to 82 years with mean ± SD of 60.09 ± 8.55 years. They were screened in Alagouza Hospital for CKD by using urinary ACR and average eGFR. Patients with CKD were further investigated for extrarenal diabetic complications as PVD, amputation and cardiovascular complications by using LL arterial duplex and echocardiography. As regard diabetic complications, nephropathy came in the 1st rank with 106 patients (53%) presented with either average eGFR<60 ml/min/1.73 m2(10.5%), ACR >30 mg albumin/gm creatinine (30%) or both(12.5%). That was followed by history of neuropathy which represented 44.5% of the studied patients. Retinopathy evidenced in fundus examination compromised about 34.516% out of our studied population. Patients with past history of stroke represented 17.5% of the studied population Peripheral neuropathy was more common in patients with nephropathy 69.7 % (n = 62) (4 patients with decline eGFR, 36 patients with albuminuria and 22 patients with both), compared to only 30.3 % (n = 27) non- nephropathic diabetic patients gave positive history of neuropathy. retinopathy was more common in patients with nephropathy (11 patients with declined GFR, 25 patients with albuminuria and 25 patients with albuminuria and declined GFR), versus only 8 patients in among the non-nephropathic diabetic patients had retinopathy evidenced in fundus examination. Stroke was more common among patients with nephropathy (4 patients with decline eGFR, 6 patients with albuminuria and 12 patients with albuminuria and declined eGFR), versus 13 patients with positive stroke history in non- nephropathic diabetic patients. Patients with nephropathy were further investigated for the presence of extra renal diabetic complications as PVD and cardiovascular complications. Arterial LL duplex revealed PVD in 32.1% (34 patients) with 3 patients underwent amputation. As regard cardiovascular complications, 17.9 % (19 patients) were found to have abnormal findings in echocardiography examination including heart failure and ischemic changes. From our study, we showed the high burden of diabetic complications among the patients with type 2 diabetes especially renal diabetic complications. Therefore, screening of diabetic nephropathy in patients with type 2 diabetes mellitus can help in early treatment and avoid its more serious complications not only the progression to ESRD but also development of other extra-renal diabetic complications.
Spinal tuberculosis is the most common encountered extra-pulmonary form of the disease and accounts for around 50% of musculoskeletal tuberculosis cases, thoracic spine is the most commonly affected, and involvement of lumbar and lumbosacral region is less common, spinal tuberculosis can cause severe neurological deficits, kyphotic deformities, and paraplegia. The aim of this study is review the literature comparing the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis. In this meta-analysis, we combined 25 studies that compared the clinical outcomes of the anterior and posterior approaches in treating 1797 patients with thoracic and lumber spinal TB. This study was approved by the Ethics Committee of Ain Shams University Faculty of Medicine. Written informed consent was not needed because of the study design (systematic review). Based on patient safety and the efficacy of the procedures, we raised three clinically crucial questions to determine the optimal surgical procedure in treating thoracic and lumbar tuberculosis. The primary data used as evidence to answer these questions were obtained from the treatment results, such as the radiologic data and patient-related outcomes. The results showed that there is no statically significant different in the operative time for the anterior approach (220.8-51.5 minutes) versus posterior approach (213.9-69.3 minutes), and no statistically significant difference was detected. Blood loss was significantly greater in the anterior approach (1125.0-275.5 mL) than in the posterior approach (710.4-192.4 mL). The posterior approach showed a higher potential for maintaining the correction of deformity and a lower overall surgical complication rate; however, both groups showed no statistically significant differences in operative time, blood loss, radiological and clinical outcome; therefore posterior approach could be used as an alternative procedure to treat thoracic and lumbar tuberculosis patients in terms of pain control, Cobb’s angle, and reduction of complications, however; posterior-only approach alone cannot be used in cases of anterior abscess formation or multilevel involvement where an anterior debridement is mandatory, so; when deciding among the two procedures for treatment of thoracic and lumbar spinal tuberculosis, surgeons must thoroughly consider the patient’s specific features of spinal tuberculosis, the surgeon’s own surgical experience, the risks of surgical complications ranging from neurological to structural, and the different possible outcomes.
Esophagogastroduodenoscopy is currently considered the first-line diagnostic procedure of choice for upper gastrointestinal (GI) bleeding; however, the etiology of bleeding remains unknown in a subset of patients. This study aims to evaluate the diagnostic yield of upper gastrointestinal endoscopy in upper gastrointestinal bleeding in pediatrics and determine the clinical predictors for unreached diagnosis during endoscopy. Cross sectional study, conducted at pediatric endoscopy unit, Ain Shams University, Cairo, Egypt, where 100 patients were recruited, as they were referred for diagnostic upper GI endoscopy due to overt upper GI bleeding in the form of hematemesis and/or melena. Full medical history, examination, laboratory investigations, endoscopic and histopathologic findings were documented. :100 patients with ages ranging from 3 months to 15 years, median age 4 years, 47% males and 53% females, 65% presented by hematemesis only, 7% with melena only, and 28 % presented with both hematemesis and melena. In 38 % of cases no endoscopic diagnosis was reached. While patients with a positive diagnostic yield 62%, had variable diagnosis, the most common of which was H pylori gastritis and reflux oesophagitis in 23% and 11% of cases respectively. Followed by nonspecific gastritis (8%), oesophageal varices (4%), and others (16%).. Melena was a negative predictor to reach a diagnosis by upper GI endoscopy. Diagnostic yield of upper GI endoscopy in pediatric patients with upper GI bleeding was only 62%. Combining upper GI endoscopy with other tools in cases presenting with melena alone is highly recommended since bleeding from a source in the small bowel or right colon may also be the cause.
Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disease that significantly affects patient quality of life, interfere with daily activities, physical intimacy, traveling, and self-esteem. Because of its clinical heterogeneity and the unclear etiology of IBS, robust biomarkers and therapeutic targets for IBS are difficult to identify. On the other side, Non-alcoholic fatty liver disease (NAFLD) has become a common disease worldwide, affecting 25% of the adult population. The aim of the study is to detect if there is a prevalent relation between those two diseases and the assessment of NAFLD prevalence and severity in IBS patients. Our study has involved 75 patients with different degrees of IBS syndrome and variable severity patterns of NAFLD. Using inclusion and exclusion criteria for selecting the patients; IBS diagnosed according to modified ROME IV critera regardless of the type either constipation predominance or diarrhea predominance. While NAFLD was mainly detected using abdominal ultrasonography, both were differentiated into three grades determining the severity of each and their correlation. Our current study included 75 patients diagnosed with IBS (37 males and 38 females). Mean age of included patients was 42.17 ± 8.3 years. Mean height of included patients was 173.6 ± 9.07 cm, mean weight was 88.02 ± 14.9 Kg while mean BMI was 29.39 ± 4.4. Regarding evaluating the association of IBS with NAFLD there were high statisitical significant assocaiton between both diseases. The study of lipid profile parameters and liver enzymes in relation to IBS grade revealed no-significant association. The study of IBS grade regarding liver enzymes revealed no significant statistical difference between grades of IBS. Study of lipid profile parameters (S.cholesterol, S.triglycerides and LDL) in relation to U/S grade revealed high significant association between increased serum TAG and severe grade of NAFLD. IBS had higher frequency of NAFLD. Also, there is significant association between IBS and NAFLD severity.
Nonalcoholic fatty liver disease (NAFLD) now refers to a spectrum of liver diseases that ranges from steatosis (i.e., fatty infiltration of the liver) to Non-alcoholic steatohepatitis (NASH) ie, steatosis with inflammation and hepatocyte necrosis, to fibrosis and cirrhosis with increased risk of hepatocellular carcinoma. NAFLD is the most common cause of cryptogenic cirrhosis, which is cirrhosis that cannot be explained by hepatitis, alcohol abuse, toxin exposure, autoimmune disease, congenital liver disease, vascular outflow obstruction, or biliary tract disease. To study serum levels of interleukin 32 in patients with NAFLD to detect its relation to the incidence and severity of NAFLD. Type of Study: Case control study. Study Setting: The study will be conducted at Ain Shams University Hospitals. Study Period: The study will take place from January 2019 to October 2019. To obtain this aim, we included 80 persons & divided them into 2 groups: Group I: 40 patients with NAFLD as a case group. Group II: 40 healthy subjects as a control group. We can sum up our results in the following points: Weight, BMI and Waist circumference were significantly higher among case group when compared with the control group (p < 0.001 for all). While there was non statistically significant difference found between two groups regarding Height. The best cut off point of Interleukin 32 Concentration (ng\ml) to detect Cases group was > 22.5 with sensitivity of 100%, specificity of 87.50%, PPV of 88.9%, NPV of 100% and total accuracy of 98.2%. The best cut off point of Interleukin 32 Concentration (ng\ml) to detect High group was found ≤165 with sensitivity of 90.91%, specificity of 28.57%, PPV of 85.7%, NPV of 40% and total accuracy of 55.8%. The best cut off point of Interleukin 32 Concentration (ng\ml) to detect Indeterminant group was ≤75 with sensitivity of 48.48%, specificity of 85.71%, PPV of 94.1%, NPV of 26.1% and total accuracy of 62%. Interleukin 32 can be considered as a diagnostic marker for nonalcoholic fatty liver diseases with sensitivity of 100% and total accuracy of 98.2%. Interleukin 32 Concentration was found to be negatively correlated with serum Albumin level. Although, We found no correlation between Interleukin 32 Concentration & each of Fatty Liver Index score, nonalcoholic fatty liver diseases Fibrosis Score and PAUS Size.
Primary liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide, with an estimated 841,000 cases (9.3 cases per 100,000 person-years) and 782,000 deaths (8.5 deaths per 100,000 person-years) in 2018. HCC being often associated with liver cirrhosis masks symptoms of cancer progression and thus the clinical course of HCC is mostly asymptomatic. To determine the value of mean platelet volume, Des gamma Carboxy prothrombin and Alfa-feto protein in early detection of Hepatocelluler carcinoma This case cross sectional comparative study had been carried out after the approval of the Ethics Committees of the faculty of medicine Ain Shams university on 105 subjects, age range 25-68 year selected from: Patients attending Hepatology and virology outpatient clinic at ElDemerdash hospital Also Liver transplantation center at Ain Shams specialized hospital in Cairo after informed consent were taken from the patients In this study HCC was found to be more prevalent in men 28 (80.0%) than in women 7 (20.0%). In our study AFP, MPV and DCP were highest in HCC group, followed by CLD group and lowest in control group. The differences between all groups were significant in MPV and DCP, with no significant difference between CLD and HCC in AFP. In the present study, DCP values of HCC group showed a highly significant increase upon comparison with the non malignant groups (II, and III). The sensitivity of DCP was higher than AFP in detecting HCC patients (97.1% versus 54.3%), Measurement of MPV is non-invasive, cheap and quick, and may therefore serve as a predictor of HCC in patients with CLD. Low sensitivity and specificity, on the other hand, suggests that this may be an adjunctive parameter to some other markers like AFP. Further studies with larger samples are needed to determine the association of MPV with HCC. For a single test DCP had highest significant diagnostic performance in differentiating HCC from CLD groups. In detection of HCC testing AFP≥ 40.0 if positive considered positive. If negative, retest for DCP≥ 69.3 if positive considered positive, otherwise is negative. This although deceased specificity and Positive predictive value, it raised sensitivity and Negative Predictive Value to 100.0% when combining both AFP and DCP.
Early diagnosis of neonatal sepsis and assessment of the severity of the disease is not yet effectively achieved. Some hematological parameters are used to formulate a hematological scoring system (HSS) and a modified hematological scoring system(MHSS), for diagnosis of neonatal sepsis. A promising biomarker is Presepsin, or Soluble Cluster of Differentiation 14 SubType (sCD14-ST), which is a proteolysis product of CD14, that is produced after immune activation during infections. To evaluate the performance of both HSS, MHSS and serum presepsin level, in neonatal sepsis, and compare them to C-reactive protein (CRP) as diagnostic tools and predictors of mortality. The study was divided into two groups, one group comprised 51 neonates who further subgrouped into suspected & proved sepsis, along with 30 neonates who were admitted for non-infectious causes who served as control group. Both groups were subjected to calculation of HSS, MHSS, serum presepsin levels, CRP measurement, blood culture and, assessed for clinical severity and mortality. Hematological sepsis scores and presepsin levels were significantly higher in sepsis group. Presepsin showed the best diagnostic performance at > 0.5 ng/ml (AUC 0.979; sensitivity of 94.1% and specificity of 100%). While HSS and MHSS at a cutoff value > 1 achieved comparable specificity but lower sensitivity, 72.6% for the former and 76.5% for the later. Presepsin also was significantly higher in died group with the best predictive performance over CRP at cut-off value >1.9 ng/ml (AUC 0.83; sensitivity of 85.7% and specificity of 79.6%) Hematological sepsis scores and presepsin were found to be useful diagnostic tools in neonatal sepsis with presepsin as a good predictor of mortality comparable to CRP. Disclosure: The authors declare that they have no conflict of interest.
pes planovalgus is a common foot deformity observed in adolescents which is characterized by a loss of the medial longitudinal arch and malalignment of the foot; hindfoot valgus and forefoot abduction which could progress with time causing pain that occur secondary to pressure medially over the prominent talar head. The treatment of this deformity should be directed to correct the foot malalignment, secure the stability of the foot during stance and correct the abnormal gait. The aim of the treatment is to obtain a foot with normal alignment which exhibits no pain and preventing the degenerative changes that may take place in the future. Surgical options should be offered to patients when conservative treatment failed. Numerous surgical procedures were described in pesplanovalgus correction that varies from bony osteotomies, subtalar extra-articular arthroeresis, intraarticular arthrodesis and triple arthrodesis accompanied with soft tissue procedures as indicated. When these are compared, all techniques have advantages and disadvantages. This study was conducted to evaluate the short term outcome of two methods of correction of pesplanovalgus; the extra-articular subtalar arthroereisis using subtalar sinus tarsi implant and bony corrective osteotomies in correction of flexible PPV in adolescents. Soft tissue procedures added to the operation if indicated mainly (gastroconemius recession and accessory navicular excision) Our study included 40 feet (25 patients) with pesplanovalgus. The patients divided into two groups 20 feet each. Group A underwent arthroereisis and group B underwent corrective osteotomies. The inclusion criteria were; Idiopathic flexible flatfoot deformity, symptomatic patients only and age between 10-14 years old. While the exclusion criteria were rigid flatfoot, flatfoot in adults (above 14 yrs old), severe talonavicular uncoverage angle (>40), neurogenic cases (cerebral palsy patient), patients with generalized ligamentous laxity. The outcome was assessed clinically by patient satisfaction, heel valgus angle, AOFAS hindfoot score and FAAM score. Radiologically the outcome was assessed by comparing the preoperative and postoperative measures of the lateral TCA, the AP and lateral talo-1st MTS angles, talonavicular coverage angle and the calcaneal pitch angle. Clinically the patient satisfaction was comparable in each of Group A were 17 patients (85.0%) were Satisfied; and 3 patients (15.0%) were unsatisfied compared to Group B were 18 patients (90.0%) were Satisfied and 2 patients (10.0%) were unsatisfied. Additionally, the two groups were comparable in heel valgus angle with the mean±SD in each of group A and group B was 2.75±2.62 compared to 2.05±2.01 respectively. Furthermore, the two groups were comparable in AOFAS score with the mean±SD in each of group A and group B was 89.25±8.34 compared to 91.25±8.97 respectively. As well as, the two groups were comparable in FAAM score with the mean & ±SD in each of group A and group B was 91.08±6.51, compared to 95.75±7.23 respectively. Radiologically; The two groups were comparable in lateral talus 1st met angle with the mean±SD in each of group A and group B was 3.45±3.06 compared to 2.02±2.08 respectively. Additionally, the two groups were comparable in lateral talocalc angle with the mean±SD in each of group A and group B was 32.65±5.05 compared to 30.50±5.62 respectively. Furthermore, the two groups were comparable in calc pitch angle with the mean±SD in each of group A and group B was 15.75±4.64 compared to 15.70±3.77 respectively. As well as, the two groups were comparable in AP talus 1st met angle with the mean±SD in each of group A and group B was 6.72±5.17 compared to 4.55±4.18 respectively. Also, the two groups were comparable in AP talonavicular coverage with the mean±SD in each of Group A and Group B was 6.95±4.77 compared to 4.10±3.30 respectively. There is no statistically significant difference between the group A and group B in all clinical and radiological measures. The extra-articular subtalar arthroereisis and bony corrective osteotomies in our study had been proved to be effective procedure for correction of flexible PPV feet in adolescents with comparable results.
The populations suffer from increasing over consumption of food, but continue to have high rates of micronutrient deficiencies. Adipose tissue of obese persons produces increased amount of pro-inflammatory cytokines contributing to the development of a low-grade systemic inflammation in these persons. To determine the relation between body mass index (BMI) and hemoglobin (Hg) level, serum iron, total iron binding capacity (TIBC) and C reactive protein (CRP). The study was carried out on 60 women attending the outpatient clinics of the National Nutrition Institute (Egypt). Participants were divided into two groups; 30 obese women (case group) and 30 normal weight women (control group). Diagnosis of obesity was based on BMI >30. Anemia was diagnosed according to Hg level, serum iron and TIBC. The mean Hb level of participant women was 11 gm/dl (SD 1.21) and ranged between 8.7 and 13.8 gm/dl. Hb levels showed no significant difference between obese and normal weight women. Serum iron was higher in normal weight women compared with obese women (P < 0.05). No significant correlation was observed between BMI and Hb levels. BMI had a significant negative correlation with serum iron. BMI has significant positive correlations with TIBC and CRP. Linear regression analysis showed a significant association between Hb levels and waist hip ratio. High BMI affected negatively levels of serum iron and is associated with inflammatory process as indicated by higher levels of CRP. High waist hip ratio is an important risk factor for anemia.
Acne vulgaris is a common chronic inflammatory disease of the pilosebaceous unit. It is characterized by the formation of non-inflammatory comedones and inflammatory papules, pustules, nodules and cysts. Lipocalin-2 (LCN2) is an attractive biomarker of inflammation, ischemia, infection, and kidney damage. The current study aimed to evaluate serum Lipocalin-2 levels in inflammatory acne vulgaris patients and to reveal the possible relation between its serum levels and the insulin resistance status in acne patients. The study included 60 patients suffering from inflammatory acne vulgaris and 60 healthy control subjects. Full general and dermatological examination were performed, recording of BMI, GAGS score was done. Then, measurement of fasting insulin and fasting glucose was performed to calculate HOMA-IR. Serum lipocalin-2, fasting insulin and HOMA-IR levels were significantly higher in acne patients compared to control subjects. Inflammatory acne vulgaris patients have higher levels of serum lipocalin-2 which might be related to acne pathogenesis.
Glioblastoma (GBM) is the most common and most aggressive primary malignant brain tumor in adults. It is characterized by its extremely poor prognosis despite the available treatment strategies. Immune evasion is described in Glioblastoma via the PD-L1/ PD-1 interaction. Programmed death ligand 1 (PD-L1) is a cell surface ligand expressed on the surface of several tumors including GBM and its receptor is the PD-1 (Programmed deasth-1). Other malignant tumors including melanoma and non-small cell lung cancer, showed promising results using PD-L1/PD1 blockade treatment strategies where PD-L1 was described as a potential predictive biomarker for patient selection in these tumors. In our study we will shed the light on the expression and role of PD-L1 in glioblastoma, the presence of tumor infiltrating lymphocytes (TILs) and its interaction with PD-L1 in glioblastoma. The role of PD-L1, CD-8+ TILs, other clinicopathologic parameters and patient’s survival will be also discussed in relation to glioblastoma. Paraffin embedded tissue blocks of thirty cases of GBN were retrieved, slides were prepared and stained via Hx& E for evaluation and confirmation of diagnosis according to the CNS WHO 2016. Immunohistochemistry using PD-L1 and CD-8 was performed on the 30 glioblastoma cases. Interpretation of the results and correlation between the expression of both markers and the clinicopathologic parameters was also done. Furthermore, survival analysis was done to correlate overall survival and progression free survival of the glioblastoma cases to the expression of PD-L1 and CD-8 markers and also the clinicopathologic parameters available. Diffuse/fibrillary PD-L1 was expressed in all cases (30/30) with variable percentages (16.7% in ≤ 25% of cases 5/30, 33.3% in > 25%- ≤ 50% of cases10/30, 16.7% in > 50%- ≤ 75% of cases 5/30 and 33.3% in > 75% of cases 10/30). The mean value of Diffuse/fibrillary PD-L1 expression was 57.6%. Membranous PD-L1 was expressed in 6/30 of the cases. TILs were set into two groups according to Han et al 2014; low infiltration group 17/30 (56.7%) of cases and high infiltration group 13/30 (43.3%) of cases. Expression of CD-8 was 10% (median percentage) and 14.3% (mean percentage). PD-L1 and CD-8 correlation was statistically significant (P 0.001) where high PD-L1 expression is associated with low CD-8 expression. PD-L1 expression was associated with worse overall survival (0.001) and worse progression free survival (P 0.026). CD-8expression did not affect the outcome. Correlation of age, sex, tumor site and laterality to outcome were statistically insignificant. In the results of our study PD-L1 expression was the only independent factor that affected the prognosis according to Cox variate analysis. The incidence of PD-L1 expression in GBM patients is robust. Higher expression of PD-L1 is associated with lower TILs expression and worse prognosis.
Gastroesophageal reflux disease (GERD) is one of the most prevalent gastric disorders, defined as a condition in which reflux of gastric and duodenal contents back into esophagus causing troublesome symptoms and complications impairing quality of life. To evaluate clinical efficacy of endosural suturing using gastroscope for patients with resistant GERD. This study is a prospective study. This study was carried out at Gastroenterology outpatient's clinic, endoscopic center of Ain Shams University Hospitals. The study was performed from September 2019 to December 2020. 25 adult patients having resistant GERD or Hiatus hernia. In our results we found that there was highly statistically significant difference according to symptoms grade between before treatment and after treatment. In our study we cleared that according to CBC, the mean of Hb 12.89 (± 0.80 SD), the mean of RDW 13.40 (±0.95 SD), the mean of platelets (*1000) 239.76 (± 60.37 SD), mean of RBCs 5.19 (± 0.51 SD). In study in our hands we found that there is highly statistically significant according to hill grade between before treatment and after treatment. Our study has shown that endoscopic suturing of the gastroesophageal junction has significant improvements in reflux control that is sustained to 6 months and significant improvement in quality of life after procedure and significant reduction in symptoms severity after procedure.
Oesophageal varices are the most critical porto-systemic shunts that develop secondary to portal hypertension, which is considered the main complication of liver cirrhosis. Many studies recommend the screening of all cirrhotic patients by endoscopy, but repeated endoscopic examinations are unpleasant for patients and have a high- cost impact and burden on endoscopic units. To investigate the value of measurement of (Rt. lobe diameter/ serum albumin ratio) in the prediction of esophageal varices. This was Case- control study, was carried out at outpatient clinics of Hepatology and inpatient department of Gastroenterology at Ain Shams University Hospital on 100 patients divided into 3 groups: (Group 1): 30 patients with Child-Pugh A, (Group 2): 30 patients with Child-Pugh, (Group 3): 40 patients with Child-Pugh C, during a period of 6 months. There were highly significant difference between both groups as regard Platelet count /spleen diameter ratio and Right liver lobe size/Serum Albumin ratio. The use of Right liver lobe/serum albumin ratio can help physicians by restricting the use of endoscopic screening only to patients presenting a high probability of esophageal varices. This is especially useful in clinical settings where resources are limited, and endoscopic facilities are not present in all areas.
Postinduction hypotension is a common problem that faces anesthesiologists on a daily basis, with incidence ranging from 25% to 67.5% when propofol is used as an induction agent. Post-induction Hypotension is even more common in the elder population because increase in age is an independent predictor of intraoperative hypotension as a result of the diminished cardiovascular reserves. This study assessed the efficacy of dexamethasone to alleviate the drop in blood pressure after induction of anesthesia. All patients were informed of their participation in the study and written consents were taken. They were assessed preoperatively by careful history taking, full physical examination, and laboratory evaluation. A Prospective randomized clinical study in Ain-Shams University hospitals, Cairo, Egypt form June 15, 2021 to October 15, 2021 on 100 randomly chosen patients aged ≥ 60 years, American Society of Anesthesiologists (ASA) class I or II who were scheduled for elective surgery in Ain Shams University Hospitals, after approval of the medical ethical committee. They were allocated in two groups of 50 patients each. The results of the study revealed that the Patients who received preoperative dexamethasone had a significantly less incidence of hypotension, nausea, vomiting and shivering. Accordingly, ephedrine and IV fluid boluses were less frequently needed. A single 8 mg IV dexamethasone given two hours preoperatively was able to decrease the incidence of postinduction hypotension in geriatric patients undergoing general anesthesia, leading to decreased use of ephedrine and IV fluid boluses. In addition, a significantly fewer percentage of patients developed nausea, vomiting and shivering after surgery than those who didn’t receive the drug.
Osteoarthritis OA is the commonest musculoskeletal disabling disease in adults. Most of the current available treatments provide only symptomatic relief. Adipose derivedstromal vascular fraction SVF has been recently introduced as potential regenerative therapy for OA. We aimed to study the therapeutic role of adipose – derived SVF in OA. This work included 42 female Wister rats for induction of osteoarthritis and 6 male Wistar rats acting as donors for the extraction of SVF from adipose tissue which yielded 106 cells/ml. Osteoarthritis was induced by intra-articular injection of collagenase type II in the right knee joint of all female rats and the left knee was considered as healthy controls. Rats were divided into three groups, healthy control Group (group I), induced osteoarthritis control group (Group II) which received no treatment and SVF treatment group (Group III). Group II and III were subdivided into 2 subgroups; IIa, IIb and IIIa, IIIb which were euthanized after 1 and 2 months of OA induction respectively. Modified Manikin score (MS) was used to assess cartilage degeneration. Image Analysis was used to assess chondrocyte count, articular cartilage thickness and optical density in slides stained with Hematoxylin and Eosin and Safranin-O-stain. It was observed that MS scored highest in Group II compared to Group III and Group I (P < 0.001). After 1 month, MS in Group IIa and Group IIIa was (10.75 ± 0.50 and 2.50 ± 0.53, P < 0.001). Similarly at 2 months MS was (8.50 ± 0.58, 0.50 ± 0.53, P < 0.001). Also, morphometric analysis revealed Group II contained least chondrocyte cellular count compared to Group III and Group I (P < 0.001). After 2 months, articular cartilage thickness was least in Group II compared to Group IIIb and highest in Group I (P < 0.001). Also, optical density OD measurement using imaging in slides stained with Safranin revealed OD was highest in Group I, followed by Group III and least in Group II (P < 0.001). Adipose derived SVF represents potential regenerative therapy for OA. It decreased development of degenerative changes at early stages of induced osteoarthritis in rats and promoted regeneration with increased cartilage thickness and proteoglycan content at later stage.
Otosclerosis is a process of bone resorption of the labyrinthine capsule followed by reparative deposition of new, immature sclerotic bone. It usually occurs during the postlingual period between the second and fifth decade of life. The most commonly affected location is around the oval window (fenestral otosclerosis), which results in conductive hearing loss due to stapes footplate fixation. As it undergoes a maturation process, the sclerotic bone increases in size and depth. To compare the hearing outcomes and complications of stapes surgery vs cochlear implantation in patients with far advanced otosclerosis. Medline databases (PubMed, Medscape, Scopus, Google Scholar, Cochrane, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA). The detailed steps of methods were described elsewhere as well as PRISMA checklist. The results of this meta-analysis show that comparing the outcomes and complications of cochlear implantation and stapes surgery in far advanced otosclerosis patients have different results, in some of them there was a highly favorable and recommended procedure than the other, other results declared no significant difference in postoperative outcomes. Both Stapes surgery and CI are reliable treatment options for FAO with very close success rates. Statistics of CI are greater than Stapes surgery and CI has a consistent improvement in speech discrimination scores in comparison to Stapes surgery. Patients must receive adequate counseling regarding all the factors mentioned above and the decision must be made by surgeons and the informed patients.
ABSTRACT Background Children’s agitation increases following sevoflurane anaesthesia. With indefinite results, nalbuphine and midazolam have been used as preventative treatments. Patients and Methods This study involved 90 children with American Society of Anesthesiologists score I-II and aged 4–10 who had sevoflurane-based adenotonsillectomy. Each child was randomly assigned to one of three groups; group N, group K, and group S. Nalbuphine was given to Group N at 0.1 mg/kg, ketamine was given to Group K at 0.25 mg/kg, and saline was given to Group S at equivalent volume. Sevoflurane was discontinued after the procedure, and the study drugs were given. The emergence agitation (EA) scale was used in the post-anesthesia care unit (PACU) to measure agitation upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25), and 30 min (T30). Clinical trials. gov ID: NCT05176119. Results In the PACU, the incidence of EA was significantly lowered in N (6.6%) and K Group (16.6%) compared to S group (33%) with (p = 0.044), the duration in PACU was significantly prolonged in S in comparison to K and N groups (p-value = 0.011), more patients experienced postoperative pain in S group compared to N group and K group (p-value < 0.001). Conclusion Children who had sevoflurane-induced adenotonsillectomy can avoid emergence agitation with ketamine 0.25 mg/kg or nalbuphine 0.1 mg/kg.
End stage renal disease patients are thought to be highly susceptible to emotional problems. Depression is generally accepted to be the commonest psychological problem in patients with end stage renal disease which will affect the quality of life of these patients. To assess depression in hemodialysis patients and its impact on physical and mental health. A cross section study was made in Ain shams university hospital and other hemodialysis units on 500 patients on regular Hemodialysis. the study show a lower quality of life (both mentally and physically using SF-12 questionnaire) in patients with severe depression compared with those with mild to moderate depression. As quality of life is a predictor of survival in HD patients. Hence, correlation between quality of life and BDI score focuses on the effects of depression on HD patients’ survival. Depression is so common among our dialysis patients whatever its degree. Different components of quality of life (physical and mental) are affected among our dialysis patients. Depression score (BDI score) is in direct relationship with age, marital status and employment. Physical, mental and total components of SF12v1 has a significant negative correlation with age, BMI, dialysis vintage and interdialytic weight gain. Associated comorbid diseases had significant correlation with depression and quality of life in our dialysis patients. Depression severity has significant negative correlation with PCS, MCS and the total score of SF12v1. Patients with mild depression have significantly higher scores of the various components of SF12v1 much more than those with moderate depression. Depression is highly statistically significant in predicting of PCS, MCS and the total score of SF12v1 and each increase in depression severity leads to significant decrease in them with different degrees.
