Background:Sleep disturbances are increasingly recognized among children with neurological diseases and may adversely affect cognitive performance, behavior, emotional regulation, and quality of life.Aim:To assess the prevalence and pattern of sleep disturbances among children attending a pediatric neurology clinic and identify associated clinical factors.Methods:This cross-sectional study included 95 children aged 4–12 years attending a pediatric neurology clinic. Sleep disturbances were assessed using the Arabic validated version of the Children’s Sleep Habits Questionnaire (CSHQ). Demographic and clinical data were collected and analyzed using SPSS version 27.Results:Only 9.5% of patients exceeded the pathological total CSHQ cutoff score (>41). However, abnormalities in individual sleep domains were highly prevalent. Daytime sleepiness was reported in 92.6% of patients, parasomnias in 90.5%, sleep-disordered breathing in 82.1%, and sleep anxiety in 80.0%. Sleep-onset delay and abnormal sleep duration were observed in 70.5% and 66.3% of patients, respectively. Severe cerebral palsy was significantly associated with sleep disturbances (p=0.004).Conclusion:Sleep disturbances are highly prevalent but frequently underrecognized among children with neurological diseases. Assessment of individual sleep domains may provide greater clinical sensitivity than reliance on the total CSHQ score alone.
background: Epilepsy exerts a profound impact on the QoL of affected individuals and their families, an effect that is often underrecognized in clinical practice.Objectives: The aim of this work was to identify the factors that maybe affect quality of life in a sample of Egyptian adult epileptic patients. Subjects and Methods: A prospective cross-sectional study was conducted at Ain Shams University Epilepsy Clinic including 150 adults with epilepsy and 150 age- and sex-matched healthy controls. Quality of life, anxiety, and depression were assessed using validated Arabic versions of QOLIE-31, EQ-5D, NDDI-E, and HADS, with clinical and neuroimaging data reviewed to confirm diagnoses and exclude secondary causes. Multivariate analysis identified factors independently affecting quality of life.Results: Patients with epilepsy reported significantly lower HRQoL scores compared to controls ((0.562 ± 0.082 vs. 0.746 ± 0.068; p < 0.001). Furthermore, patients exhibited higher levels of psychological distress (HADS total:12.7 ± 6.5 vs. 9.45 ± 6.8; p < 0.0001) with anxiety and depression prevalence rates of 35% and 31%, respectively. Within the epilepsy cohort, lower HRQoL was significantly associated with female sex, unemployment, illiteracy, positive family history, focal seizures, high seizure frequency, abnormal EEG findings, combination of old and new therapy and polytherapy. Stepwise multiple regression analysis identified depression, anxiety, seizure frequency, number of medications, and family history as the strongest independent predictors of poor HRQoL.Conclusion: Depressive symptoms and anxiety emerged as the most influential determinants of poor HRQoL, alongside clinical factors including higher seizure frequency, polytherapy, positive family history.
Background and Aims: Egypt is experiencing a surge in illicit drug use while combating the long-standing HCV epidemic through its national test and treat campaign. We aimed to characterize the profile of HCV-infected persons who used drugs (PWUDs) and study the outcome of sofosbuvir-based regimens in this marginalised population. Method: In the current study, 234 HCV-infected patients were recruited from addiction-specialized centres. To avoid stigma, patients were referred to receive their treatment and follow-up as part of the governmental mass treatment program without discrimination from other patients. Results: Sustained virological response (SVR) was achieved in 202 (86.3%) patients. There was no significant association between SVR and the type of drug substance used. SVR was highest among those treated with sofosbuvir/simeprevir (100%), and the least was paritaprevir/ombitasvir/ribavirin (68.0%). Lack of response (13.7%) to direct-acting antivirals (DAAs) therapy could be attributed to many factors, including non-compliance of patients. Twelve patients (5.1%) experienced addiction relapse, while 222 (94.9%) succeeded in maintaining abstinence from drugs. Conclusion: PWUDs should be tested for HCV infection and treated with the safe and highly efficacious DAA therapy in concentrated epidemics within their addiction centers (microelimination) or as part of a macroelimination program to avoid discrimination. Offering medical and mental health services and continuous behavioural advice were critical to overcome non-adherence to treatment, achieve elimination, and might help drug abstinence.
Background Dense breast tissue diminishes the sensitivity of conventional mammography for breast cancer detection. Purpose To evaluate the diagnostic performance of contrast enhanced mammography(CEM)for women with breast density BI-RADS C and D. This was a prospective clinical cohort with a low prevalence of malignancy.Materials and Methods We enrolled 100 women, all with dense breasts who had suspicious findings on their mammogram, or ultrasound, or had a clinical concern. After CEM, we compared the results with either biopsy findings, Ultrasound outcomes or at least 12 months of follow-up imaging. We estimated sensitivity, specificity, PPV, NPV, and accuracy, with 95% confidence intervals. Subgroup assessments were achieved for breast density category C versus D.Results Fifteen out of 100 women(15%) had breast cancer. CEM detected 14 true positives, 1 false negative, 10 false positives, and 75 true negatives. Sensitivity landed at 93.3%(CI: 70.2–98.8%),and specificity at 88.2%(CI: 79.7–93.4%).The positive predictive value was 58.3% (CI: 40.8–74.1%),while the negative predictive value was very high at 98.7%(CI: 92.9–99.8%).Overall accuracy was 89.0%(CI: 81.4–93.7%). Breaking it down, sensitivity was 85.7% for ACR C and a perfect 100% for ACR D. Notably,CEM led to a change in management for 25% of the women, thanks to BI-RADS reclassification. ConclusionCEM demonstrates excellent sensitivity and high negative predictive value in women with dense breasts,with particularly strong performance in extremely dense tissue. Despite moderate specificity, its overall diagnostic accuracy and practical advantages support its role as a reliable and effective imaging modality for the evaluation of breast lesions obscured on standard mammography.
AbstractBackground: Extracorporeal shock wave therapy (ESWT) has gained recognition as a non-invasive intervention for chronic knee osteoarthritis (KOA), offering pain relief and functional improvement. However, its molecular effects particularly on serum biomarkers remain insufficiently characterized. Aim: To explore the modulatory impact of ESWT on 16 serum biomarkers associated with inflammation, cartilage metabolism, and nociception in patients with chronic KOA. Methods: This narrative review synthesizes evidence from clinical and translational studies evaluating ESWT’s influence on biomarkers such as Interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), cartilage oligomeric matrix protein (COMP), matrix metalloproteinase-3 (MMP-3), and others. Studies were selected based on methodological rigor and relevance to KOA; most protocols utilized 3 to 5 weekly sessions of ESWT. Biomarker trends were analyzed in relation to clinical outcomes. Results: ESWT consistently downregulated pro-inflammatory cytokines (e.g., IL-6, TNF-α) and cartilage degradation markers (e.g., COMP, MMP-3), while upregulating regenerative and anti-nociceptive factors. These molecular shifts were associated with improved pain scores, joint mobility, and patient-reported outcomes. Conclusion: ESWT exerts measurable effects on key serum biomarkers in KOA, suggesting a dual mechanism of action clinical and molecular. These findings support its integration into multimodal pain management strategies and highlight the need for biomarker-guided therapeutic protocols.
Background: Percutaneous femoral cannulation with Perclose may mitigate groin morbidity and enhance recovery compared with open cutdown in minimally invasive mitral valve surgery.Methods: In this single-center randomized trial, 60 adult patients undergoing minimally invasive mitral surgery were randomized to Perclose-assisted percutaneous cannulation (n=30) or traditional femoral cutdown (n=30). The primary endpoint was a 30-day composite of access-site complications. Secondary endpoints included cannulation time, hemostasis time, pain, time to ambulation, transfusion, length of stay (LOS), and readmission.Results: Baseline demographics were similar. Composite complications were 3.3% with Perclose vs 53.3% with cutdown (p<0.001). Perclose significantly shortened cannulation (8±2 vs 16±4 min), hemostasis (6±3 vs 24±8 min), ambulation (10±4 vs 28±10 h), and LOS (5.5±1.4 vs 7.8±2.2 days), reduced pain (1.5±0.9 vs 4.8±1.6), and decreased transfusion needs (0.2±0.5 vs 1.2±1.3 units), all p<0.001. Individual complications such as infection, hematoma, pseudoaneurysm, and lymphocele were significantly less frequent with Perclose.Conclusions: Perclose-assisted percutaneous cannulation markedly reduced complications and improved recovery compared with cutdown, supporting its adoption as a default access strategy in suitable patients.Keywords: minimally invasive mitral surgery; femoral cannulation; Perclose ProGlide; percutaneous closure; randomized trial
Background:Managing multilevel degenerative cervical degeneration often involves an anterior cervical discectomy and fusion (ACDF). It is unclear if standalone cages provide results in multilevel surgery that are on par with plate-assisted fixation.objective:For multilevel ACDF, this study intends to compare plate-assisted fixation to solo cages in terms of radiological and clinical results.Methods:Patients undergoing multilevel ACDF with either plate fixation or stand-alone cages at Cairo University Hospitals between 2022 and 2024 were included in this retrospective comparative analysis. Neurological state and pain levels (neck and upper-limb VAS) were part of the clinical examination, whereas fusion rate and postoperative complications were part of the radiological evaluation.Results:When comparing the groups according to age, gender, clinical presentation, radiological findings, or number of operated levels, no significant differences were seen. Neurological status showed no significant baseline or postoperative differences between groups, although both groups demonstrated significant postoperative improvement (p ≤ 0.001). Neck and upper-limb pain scores were also similar between groups at baseline and after surgery, with both groups showing significant postoperative reductions (p ≤ 0.001). Fusion rates and complications were comparable, with no statistically significant variations among stand-alone and plate-augmented ACDF.Conclusion:Both stand-alone and plate-assisted ACDF yield significant and comparable improvements in neurological function and pain in multilevel degenerative cervical disease. Fusion rates and complication profiles were also similar, indicating no measurable added benefit from plate fixation in this cohort. These findings support the safety and effectiveness of both techniques in multilevel ACDF.
Background:Epilepsy is one of the most common chronic neurological disorders in childhood. Carbamazepine is widely used for focal epilepsies; however, real-world data on its effectiveness and tolerability in pediatric populations remain limited.Patients and Methods:This retrospective cohort study included 100 pediatric patients (≤16 years) with epilepsy treated with carbamazepine or its derivatives at a tertiary care center in Egypt. Patients were categorized into three subgroups: A1 (focal epilepsy, monotherapy, n=9), A2 (focal epilepsy, polytherapy, n=27), and A3 (generalized epilepsy, polytherapy, n=64). Clinical data, including seizure frequency and Global Assessment of Severity of Epilepsy (GASE) scores, were analyzed before and after treatment.Results:The median age was 9 years (IQR 6–11), with a median epilepsy duration of 6 years. Carbamazepine therapy resulted in a significant reduction in seizure frequency and GASE severity scores (p < 0.001). The median seizure reduction was 80% (IQR 50–90). Overall, 55% of patients achieved ≥50% reduction in seizure frequency, including 31.5% who became seizure-free. Improvement was observed across all subgroups. Adverse events were infrequent, occurring in 4.5% of patients.Conclusion:Carbamazepine is an effective and well-tolerated antiseizure medication in pediatric epilepsy, particularly in focal seizures. These findings support its continued use as a cost-effective therapeutic option in tertiary care and resource-limited settings.
Background: Pulmonary hypertension of the newborn (PHN) is a critical neonatal condition. Despite therapeutic advances, many neonates remain unresponsive to conventional treatment, prompting the need for adjunctive therapies. Melatonin, a neurohormone has shown promising results in animal models of PHN but has not been clinically evaluated in human neonates. Aim: we evaluated the efficacy of oral melatonin as an adjunct to intravenous milrinone in the management of full-term neonates with PHN.Methods: This randomized controlled clinical trial included 40 full-term neonates diagnosed with PHN. Neonates were allocated into two equal groups. The melatonin group received standard care, including milrinone, in addition to oral melatonin. The placebo group received standard care, including milrinone, and placebo. Clinical and echocardiographic parameters were assessed at baseline and after 72 hours.Results: The melatonin group showed significantly higher preductal saturation at 6h (85.3 ± 4.84 vs. 81.7 ± 6.09, p=0.045) and 24h (90.7 ± 4.19 vs. 88.05 ± 4.06, p=0.049), as well as higher post-ductal saturation at 6h (79.1 ± 5.2 vs. 75.4 ± 5.97, p=0.043). The required milrinone dose at 72 hours was significantly lower (0.38 ± 0.09 µg/kg/min vs. 0.61 ± 0.17 µg/kg/min; p < 0.001). The length of stay was significantly shorter (13.0 ± 2.94 days vs. 16.8 ± 2.93 days; p < 0.001). No adverse events were reported in association with melatonin administration.Conclusions: Adjunctive melatonin improved oxygenation, reduced milrinone requirements, and shortened hospital stay. Melatonin appears safe and may represent a promising adjunct in the management of neonatal pulmonary hypertension
AbstractBackground: Gallium-68 DOTATATE is a radioactive tracer used in PET examination to diagnose and manage neuroendocrine tumors (NETs). It specifically binds to somatostatin receptors (SSTRs), which show wide expression in NETs, allowing for highly sensitive and accurate visualization of tumors. Objectives: The role of PET/CT Ga-68 in diagnosis of neuroendocrine tumors. Patients and Methods: This exploratory cohort study was conducted at Ain-Shams university hospital and a Radiology Center in Cairo over a six-month period, utilizing PET/CT scans and clinical histories of referred patients as the primary data sources. Results: This study included 60 patients with suspected neuroendocrine tumors, Histopathology showed lesions in 52/60 patients (86.7%): neuroendocrine tumor (NET) in 44 (73.3%) and other lesions in 8 (13.3%); 8 patients (13.3%) had no lesion. Conventional CT yielded positive findings in 40/60 (66.7%), whereas Ga-68 DOTA PET/CT was avid in 50/60 (83.3%), reducing false negatives and improving diagnostic yield. Conclusion: Compared to CT, PET/CT Ga-68 demonstrated greater sensitivity and reliability, supporting its diagnostic advantage. Conclusion: Based on the findings of this study, Ga-68 DOTA PET/CT proved to be a more sensitive and accurate imaging modality than conventional CT in the diagnosis of neuroendocrine tumors, demonstrating higher detection rates, superior alignment with histopathology, and fewer false negatives.
Background: Electrolyte disorders are common in elderly patients and significantly affect morbidity and mortality.Aim: To detect the prevalence of electrolyte disturbances in hospitalized elderly patients across different units (inpatient wards, intermediate care units (IMCUs), and intensive care units (ICUs)), identify risk factors, and assess their associations with in-hospital mortality in ICU patients.Methods: A cross-sectional study was conducted on 400 elderly patients at Ain Shams University Geriatric Hospital from July 2024 to January 2025. We collected demographic data, medical history, Age-adjusted Charlson comorbidity index (ACCI), and serum electrolyte levels. Laboratory tests (WBC, Hb, CRP) were performed at admission, and ICU assessment tools (APACHE II, SOFA) were used. The primary outcome was in-hospital mortality among ICU patients.Results: Sodium imbalance was the most common electrolyte disturbance (42.4%), with hyponatremia affecting 36.1% of patients (ward: 31.9%, IMCU: 43.4%, ICU: 35.2%). Hypernatremia occurred in 6.3%. Hypokalemia prevalence was 18.3%, hyperkalemia 8.3%, hypocalcemia 30.5%, hypercalcemia 1.5%, hypomagnesemia 5.5%, hypermagnesemia 8.8%, hypophosphatemia 21.5%, and hyperphosphatemia 18%. Common comorbidities included hypertension (65.3%), diabetes (51.5%), cardiac disease (44.8%), CKD (28.7%), and stroke (24.8%). In-hospital mortality among ICU patients was 51.6%. Compared to survivors, non-survivors had significantly higher serum sodium, magnesium, phosphorus, and creatinine levels, and lower serum calcium levels.Conclusion: Electrolyte disturbances are highly prevalent among geriatric patients, with dysnatremia being the most common. These disturbances are significantly associated with in-hospital mortality among elderly ICU patients, emphasizing the need for routine monitoring and early intervention.
Background: Serum amyloid A (SAA) is a rapidly induced acute-phase reactant that may reflect mucosal inflammation in ulcerative colitis (UC) more sensitively than traditional serum markers.Aim: To evaluate the diagnostic accuracy of SAA for assessing UC activity and colonic extension in an Egyptian cohort.Methods: We conducted a cross-sectional observational study at Gastroenterology outpatient clinic, Al Demerdash Hospital, Ain Shams University (July 2025–January 2026) including 75 adults: active UC (n=25), UC in remission (n=25), and healthy controls (n=25). Clinical data and laboratory tests (CBC, CRP, ESR, liver profile, and fecal calprotectin) were obtained. Serum amyloid A (SAA) was measured using a nephelometric immunoassay. Disease activity was assessed by the Mayo endoscopic subscore and histopathology. Diagnostic performance was evaluated using ROC analysis, and correlations were assessed using Spearman’s coefficient. Ethical approval and informed consent were obtained.Results: UC patients showed lower hemoglobin and higher TLC, CRP, ESR, FC, and SAA versus controls (median [IQR] SAA 11 [5.54–21.4] vs 4.2 [3.8–4.8] mg/L). SAA correlated with CRP (r=0.413, p=0.003), ESR (r=0.340, p=0.016), FC (r=0.384, p=0.006), and ALT (r=0.464, p=0.001). SAA >5.3 mg/L discriminated UC from controls (AUC 0.864; sensitivity 76%; specificity 96%) and active UC from controls (AUC 0.956; sensitivity 92%; specificity 96%). SAA >7.22 mg/L differentiated active from remission (AUC 0.754; sensitivity 80%; specificity 60%).Conclusion: SAA is a sensitive, practical serum biomarker that complements fecal calprotectin in identifying UC activity and monitoring disease, with excellent discrimination for active disease and moderate performance for remission vs activity.
Background: Colorectal polyps are established precursors of colorectal cancer (CRC). Metabolic syndrome (MetS), encompassing central obesity, dyslipidemia, hypertension, and impaired glucose metabolism, has been implicated in CRC. This study evaluated the association between MetS and colorectal polyps in an Egyptian population.Methods: In this case-control study, 126 adults undergoing colonoscopy at Ain Shams University Hospitals were classified as cases with polyps (n=63) or controls without polyps (n=63). Anthropometrics, lipid profile, fasting glucose, and insulin resistance (HOMA-IR) were measured. MetS was defined using NCEP ATP III criteria. Colonoscopic findings were analyzed for polyp number, size, morphology, Paris classification, and location. Results: Cases were significantly older (52.6 ± 10.7 vs. 46.1 ± 13.1 years; P=0.003) with a significantly higher waist circumference (0.92 ± 0.08 vs. 0.88 ± 0.09 cm; P=0.003). Triglycerides were significantly elevated in cases (164.1 ± 41.9 vs. 147.7 ± 49.3 mg/dL; P=0.046). MetS prevalence was significantly higher among cases (58.7% vs. 39.7%; P=0.035), with a significantly higher mean number of MetS components (3.0 vs. 2.0; P<0.001). MetS and its components showed no significant association with polyp characteristics.Conclusion: MetS, particularly central obesity and hypertriglyceridemia, is associated with colorectal polyp presence but not with polyp morphology or distribution, supporting MetS as a proneoplastic condition.
Background Malignant pleural effusion (MPE) significantly impacts advanced cancer patients' quality of life (QoL). This study compares pigtail catheters and large-bore chest tubes regarding QoL, pain, dyspnea, and clinical outcomes in MPE patients.MethodsThis retrospective study involved 30 patients with symptomatic MPE (15 in each group) undergoing drainage with either pigtail catheters or large-bore tubes. QoL was assessed using the EQ-5D-5L index at baseline, 48 hours, and after complete evacuation. Secondary outcomes included VAS Dyspnea, VAS Pain (1-hour post-insertion), hospital stay, lung re-expansion, and complications.Results Baseline EQ-5D-5L scores were similar (0.443 vs 0.449, p = 0.950). At 48 hours, the pigtail group had significantly better QoL (0.569 vs 0.172, p < 0.001) and lower pain scores (38.2 mm vs 61.7 mm, p < 0.001). After complete evacuation, pigtail patients maintained higher QoL (0.735 vs 0.628, p = 0.064) and greater net improvement (+0.292 vs +0.179, p = 0.034). Dyspnea relief was comparable (VAS 32.5 vs 34.5 mm, p = 0.349). Hospital stays were shorter for the pigtail group (2.93 vs 5.13 days, p < 0.001).Conclusions Pigtail catheters offer comparable dyspnea relief with less post-insertion pain, improved early QoL, and shorter hospital stays than large-bore chest tubes, making them preferable for managing malignant pleural effusion in Egyptian clinical practice.Keywords: Malignant pleural effusion, Pigtail catheter, Chest tube, Quality of life, EQ-5D-5L
Background: The impact of tumor-related and patient-related parameters on perioperative surgical outcomes following living donor liver transplantation (LDLT) remains insufficiently explored.Aim: To evaluate the relationship between preoperative parameters (tumor site, size, type of preoperative locoregional intervention, transplant selection criteria, preoperative waiting time) with intraoperative, postoperative and mortality outcomes in HCC patients underwent LDLT.Methods: A comparative retrospective study was conducted at the Liver Transplantation Unit, Wadi El-Neel Hospital, including 100 patients who underwent LDLT for HCC. The relationships between the five parameters and perioperative outcomes including ICU stay, hospital stay, operative time, intraoperative blood product consumption, and mortality were analyzed.Results: No statistically significant associations were identified between tumor site, tumor size, type of preoperative intervention, or selection criteria and any of the measured perioperative outcomes (p > 0.05 for all). Postoperative mortality was comparable between the Milan and up-to-seven groups (34.0% vs. 31.4%, p = 0.989). Waiting time showed a significant positive correlation with intraoperative fresh frozen plasma consumption (r = 0.352, p = 0.004). Patients who died within 5 years post LDLT had significantly shorter waiting times compared to survivors (median 75.0 vs. 117.0 days, p = 0.018). Kaplan-Meier analysis confirmed comparable overall survival between the two groups (log-rank p = 0.587).Conclusion: In living donor liver transplantation (LDLT), perioperative outcomes and mortality are influenced by recipient-related factors rather than tumor morphological characteristics. Longer waiting time was associated with increased intraoperative coagulopathy-related transfusion requirements, while on the other hand it was associated with reduced 5 year mortality.
Background: The Warburg effect and pro-survival pathways are just two of the many cancer-related cellular processes that have been linked to phospholipase D (PLD) enzymes. The importance of PLD's involvement in carcinogenesis is ambiguous because of its genetic closeness to PI3Kinase-a, which is increased in several malignancies. Moreover, PLD signaling mechanisms are intricate and contingent upon context. Aim: Our goal was to investigate the expression of serum PLD1 and evaluate its potential role as a diagnostic and prognostic biomarker in individuals with newly diagnosed acute myeloid leukemia (AML).Methods: Thirty patients with newly diagnosed AML and thirty healthy controls matched for age and sex participated in this case-control study. Serum samples were collected, and PLD1 levels were measured by ELISA. Correlations between PLD1 level and clinical indicators have been investigated. Results: The results showed that compared to healthy controls, AML patients had a significantly higher serum level of PLD1 expression (p < 0.0001). Additionally, the serum level of PLD1 was significantly higher in AML patients with positive MRD than patients with negative MRD (p = 0.002). Conclusion: Elevated serum PLD1 is significantly associated with acute myeloid leukemia and correlates with MRD positivity. Although there was an association between PLD1 and tumor burden indicators like MRD, its direct correlation with overall survival remains unclear in this cohort. These findings suggest PLD1 may serve as a useful diagnostic and monitoring biomarker, though larger, multivariate studies are required for validation.
Background: Multifocal and multicentric breast cancers present a surgical challenge. Multifocality refers to multiple tumor foci arising from the same origin, whereas multicentricity indicates tumors arising from different sites. Oncoplastic breast surgery has emerged as an advanced breast-conserving approach that improves aesthetic outcomes and psychological well-being.Patients and Methods: This retrospective comparative study included 100 patients with multifocal and/or multicentric breast cancer treated at Ain Shams University Hospitals between 2015 and 2019. Patients were divided into two groups: oncoplastic surgery (n=50) and modified radical mastectomy (n=50). Patients were followed for three years to evaluate recurrence, overall survival (OS), and disease-free survival (DFS).Results: there was insignificant difference as regard recurrence outcomes, the oncoplastic group had 2 cases of local recurrence (4.0%), no regional recurrence, no distant metastasis, while the mastectomy group had 1 case (2.0%) of local recurrence, one case (2%) regional recurrence, and one case (2%) of distant metastasis. Regarding 3-year overall survival (OS), the oncoplastic group had an OS of 97.9%, while the mastectomy group had an OS of 95.9% (not statistically significant (p = 0.5676). The 3-year DFS for the oncoplastic group was 88.1%, compared to 77.0% in the mastectomy group. This difference was still statistically insignificant (p = 0.3861) Conclusion: The study demonstrated that there is insignificant difference between the groups regarding recurrence, OS and DFS after three years of follow up. The study recommended tailor the surgical approach to each patient’s tumor characteristics and preferences, as both Oncoplastic and Mastectomy demonstrate comparable long-term outcomes
Background: Diffuse LAD disease occasionally mandates arterial reconstruction rather than a standard distal anastomosis. Options include coronary endarterectomy (CE), long LIMA patch (LIMA-patch), and saphenous vein patch (SVG-patch). Contemporary series favor LIMA-patch for durability, while CE has been associated with higher early event rates.Methods: We conducted a single-center, three-arm, prospective randomized trial (2019–2024) including 90 patients with diffuse LAD requiring reconstruction. Participants were allocated 1:1:1 to CE, LIMA-patch, or SVG-patch (n=30 per arm). The primary endpoint was 30-day MACCE (death, MI, stroke, target-vessel reintervention). Secondary endpoints were operative times, transfusion, re-exploration, atrial fibrillation (AF), and 3-year LAD patency, freedom from angina, reintervention, and survival. Analyses were intention-to-treat.Results: Baseline characteristics were similar across groups. Thirty-day MACCE occurred in 5/30 (16.7%) after CE, 1/30 (3.3%) after LIMA-patch, and 7/30 (23.3%) after SVG-patch (p=0.034). Perioperative MI rates were 13.3%, 3.3%, and 10.0%, respectively. Cross-clamp and bypass times were modestly longer with LIMA-patch. At 3 years, LAD patency was 74% (CE), 88% (LIMA-patch), and 66% (SVG-patch) (p=0.006). Survival was 82%, 92%, and 80% (p=0.047); freedom from angina was highest with LIMA-patch (90% vs 76% CE vs 70% SVG; p=0.021).Conclusions: LIMA-patch provided the best balance of early safety and mid-term durability. CE was associated with more perioperative MI, while SVG-patch had inferior patency. When anatomy permits, LIMA-patch should be the first-line reconstructive strategy.
Background: Hepatocellular carcinoma (HCC) is frequently diagnosed at advanced stages, making systemic therapy the primary treatment option. Sorafenib, a multikinase inhibitor that targets vascular endothelial growth factors (VEGFS), demonstrates variable efficacy among patients. This variability may be partly explained by the VEGF-C gene rs4604006 polymorphism, which can influence VEGF-C expression and, consequently, treatment outcomes. Objective: To evaluate the prognostic significance of the VEGF-C gene polymorphism (rs4604006) in patients with advanced HCC receiving sorafenib, to identify those more likely to benefit from therapy. Methods: Fifty (50) patients with advanced HCC treated with sorafenib were classified by treatment response into good responders (Group I, n=27) and non-responders (Group II, n=23). All patients were analyzed for VEGF-C single nucleotide polymorphism (SNP) (rs4604006 T>C) using real time polymerase chain reaction (PCR). Results: Among good responders, the CT and TT genotypes were most frequent (44.4% each), while CC was least common (11.1%), compared to bad responders where TT was most frequent (47.8%) and CC least common (17.4%).Within good responders, the TT genotype was highest in the stationary subgroup (50%), CT was most frequent in the regressive subgroup (47.1%), and CC was lowest across all subgroups. There were no significant statistical differences between the studied groups. Conclusion: Although a trend toward better response was observed among patients carrying the T allele and TT genotype, this association did not reach statistical significance; therefore, the predictive value of VEGF-C rs4604006 polymorphism remains inconclusive. Future Large scale studies are recommended to explore VEGF-C rs4604006 potential in treatment response
• Background: Diabetes Mellitus (DM) is usually associated with patients admitted with decompensated chronic heart failure. Stress hyperglycemia ratio (SHR) reflects uncontrolled levels of blood glucose and stress induced hyperglycemia. Higher SHR levels are an indicator to increase the risk of adverse outcomes in patients with chronic heart failure, especially those with diabetes mellitus.• Aim of study: detect the ability of SHR to predict adverse outcomes in type II diabetic patients hospitalized for decompensated chronic heart failure (DCHF) during hospitalization guided with Get with the Guidelines–Heart Failure (GWTG-HF).• Patients and methods: All hospitalized patients with decompensated chronic heart failure (DCHF) and type II DM were included in this study. DCHF is defined as high BNP or NT-pro BNP values and severe LV diastolic dysfunction or LV systolic impairment or structural abnormalities previously diagnosed by echocardiography then presentation with rapid deterioration in signs and symptoms of heart failure resulting in unplanned emergency room visit and hospitalization. SHR is derived by dividing admission mean blood glucose levels (MGL) by HBA1c-derived estimated average glucose (eAG) which is detected by this equation [eAG = 28.7 × HbA1C – 46.7]. • Results: SHR above the cut-off value (1.62) had sensitivity 81.2 % and specificity 71.5% (AUC=0.745, P value< 0.00) to predict adverse clinical outcomes in hospitalized diabetic patients with DCHF correlated with (GWTG-HF) score calculated for these patients at time of hospital admission.• Conclusion: SHR had a significant role to predict in-hospital adverse clinical outcomes in diabetic patients hospitalized with DCHF.
