Multidetector computed tomography (CT) in evaluation of congenital cyanotic heart diseases

Background: The aim of the study is to emphasize the role of 128 MSCT angiography in the diagnosis of congenital cyanotic heart diseases. Material/Methods: This study included sixty patients and was conducted from December 2014 to July 2016 in the Multidetector CT unit of Zagazig University hospitals. All images included axial, MPR, MIP, and VRT and were interpreted in one session. Pulmonary veins were assessed for PAPVR or TAPVR, PDA, cardiac apex and heart chambers, interatrial or interventricular septal defects, pericardium, and site and size of the great veins (IVC and SVC). Results: This study included 60 patients. Thirty-four were boys (56.7%), and 26 were girls (43.3%). The age ranged from nine months to five years, and the mean age was 34.5 months. We found the following anomalies: tetralogy of Fallot (15 patients, 25%), tricuspid atresia (12 patients, 20%), Ebstein's anomaly (4 patients, 6.5%), pulmonic atresia or stenosis (7 patients, 11.5%), truncus arteriosus (6 patients, 10%), TGA (10 patients, 17%), and TAPVR (6 patients, 10%). Conclusions: MDCT proved to be an important modality for decision-making in patients with congenital cyanotic heart diseases

Magnetic resonance cholangiopancreatography in conjunction with 3D for assessment of different biliary obstruction causes

AbstractObjectiveTo assess the diagnostic value of magnetic resonance imaging in conjunction with 3D-MRCP, with maximum intensity projections and volume rendered images in different biliary obstruction causes.Patient and methodsThis study retrospectively reviewed the radiology records of 29 patients (18 females and 11 males) suffering from obstructive jaundice. All patients were subjected to magnetic resonance imaging (MRI), 3D-MRCP with maximum intensity projection (MIP) and volume rendered (VR) reformatted images for biliary obstruction diseases in Zagazig University Hospitals between November 2008 and January 2010. MR studies were performed with 1.5-T superconductive magnet (Philips Achieva, class II a). The patient ages were ranging from 23 to 66years (mean age: 34years). This study was done to evaluate the diagnostic value and accuracy of the new MRI techniques as a non-invasive tool to diagnose and differentiate between benign and malignant variants of biliary obstruction diseases and to facilitate the management planning. All cases were evaluated by clinical examination, laboratory values, grey and colored scale ultrasonography, conventional MRI, three-dimensional (3D-MRCP), MIP, and VR images. Our results were correlated with the histology of the resected specimen, operative (ERCP) or image-guided biopsy in inoperable patients.ResultsThe mean age of benign patients was 30years compared with 54years in malignant biliary obstruction. Seventeen patients had benign cases 58.6% (6 cases of benign stricture and 11 cases with choledocholithiasis). The other 12 cases had malignant aetiology. Twenty-three patients were subjected to operative procedures, while the remaining six had ERCP/PTC and stenting. The MRI/MRCP images were of good quality in all patients. The intra- and extra-hepatic biliary radicals were visualized completely including the proximal and distal extent of the stricture. Regarding the benign cases (16/17) were satisfactorily diagnosed, however, one case was false negative, due to missed small stone at the MIP reconstructions. The 12 malignant biliary obstruction cases were as follows: five cases were cholangiocarcinoma (one peripheral type, one perihilar position, one Klatskin’s type, and two cases of the distal type), three pancreatic neoplastic lesions, two ampullary carcinoma, and two malignant lymph nodes. Regarding the benign cases 3D-MRCP had 94.1% diagnostic accuracy, otherwise more accuracy reported in malignant causes 100%.Conclusion3D-MRCP with MIP creates global images for pancreatico-biliary system. It is as effective as ERCP in detection of biliary obstruction and can precisely determine its level as well. Furthermore, it can provide a road map for management planning. By avoiding the flow artifacts, the false negative results that previously reported in past studies can be reduced

Correlation between Anti cyclic-citrullinated-‎eptide and rheumatoid Factor Antibodies ‎‎“levels in” Patients with from Rheumatoid ‎Arthritis

للتعرف على استخدام الانتي سايكلك للبروتين سيتروليناتد ببتايد  والعامل الروماتزم ونسبة ترسيب كريات الدم الحمراء في تشخيص المرضى المصابين بالروماتزم الرثياني. جمعت  خمسين عينه لمرضى مصابين بالروماتزم الرثياني  من قسم الامراض الثيانيه في مدينة الصدر الطبية التعليميه , حدوث نسبة مستوى عامل الروماتزم  والانتي سايكلك سيتروليناتد ببتايد  بطريقة الامتزاز المناعي المرتبط بالانزيم , بينما تم  قياس نسبة ترسيب الخلايا الحمراء بطريقة الويستركرين. بينت الدراسه بأن نسبة توزيع المرضى المصابين بالروماتزم في النساء اكثر من الرجال 80%, 20% بالتتابع حسب مجاميع المرضى. قسمت المرضى الى ثلاث مجاميع حسب العمر  أقل من (30),  (30 – 50) وأكثر من (50)  أظهرت نسبة هذه المجاميع كالتالي 16%, 52% , و 32%  كما بينت الدراسه بأن نسبة (49) 98%  كان لديهم فحص موجب للانتي سايكلك ستروليناتد ببتايد ونسبة (22) 44% لديهم فحص لعامل الروماتزم و نسبة (37) 74% كان لديهم ارتفاع في مستوى ترسيب كريات الدم الحمراء.  أخيرا̋ أظهرت النتائج بأن متوسط القيم للانتي  سايكلك ستروليناتد ببتايد وترسيب كريات الدم الحمراء كان عالي المنويه (0.05 P< )  بينما اظهرت النتائج ارتفاع معنوي في مستوى عامل الروماتزم. لذلك فأن استخدام سايكلك ستروليناتد ببتايد  يعتبر فحص مفيد لتشخيص الروماتزم, وكذلك استخدام عامل  الروماتزم  والانتي سايكلك ستروليناتد ببتايد  ممكن ان يعطي قيمة تشخيصيه للروماتزم الرثياني.To  identify  diagnostic   utilities  of   Anti   citrullinated   protein   (ACCP)   and Rheumatoid   factor  (RF)   are  autoantibodies (Abs  directly  against an self-individual antigens),  Analytical  study.  The  questioner  reported  for  50  patients  with  RA were collected  from  Department  of  Rheumatology¸  AL˗Sader  Teaching  Hospital.  Serum levels  of  RF & (ACCP)  Abs  were  determinated  by enzyme ˗ linked immunosorbent assay”, while  the  level  of  erythrocyte  sedimentation  rate  (ESR)  was determined by westergreen  method.   Distribution  of  RA occur  in  females  more  than  males which  reached  (80%)  &  (20%)  respectively  according  to  the  patients group. The patients divided  according  to the  age  into  three  groups (<30)¸ (30˗50) &  (>50). The  percent for  these  groups  were  (16%)¸ (52%) & (32%). Among the 50 patients with RA¸ CCP and  ESR  49  patients  (98%)  tested  positive  for  (ACCP)  antibodies¸ and 22 patients (44%)  tested  positive for RF. and 37  patients(74% ) tested increasing levels of ESR in RA  patients. The  mean  value of (ACCP) & ESR shows highly significance  (P<0∙05), while the  RF serum  levels increase significantly. Demonstrate  the (ACCP) antibodies assay is a useful test for diagnosing RA. However, the use of RF and (ACCP)auto- antibodies  in  combination  further  elevated   the diagnostic  value  for  R

The value of dynamic MRI in the evaluation of the breast following conservative surgery and radiotherapy

AbstractObjectiveTo assess the value of dynamic contrast-enhanced magnetic resonance mammography (DCE-MRM) in breast cancer patients treated by conservation breast surgery and radiotherapy.Materials and methodsThis prospective study were performed on 20 consecutive female patients, from January 2008 till January 2010 at Zagazig university hospitals. All cases had undergone breast conservative therapy (BCT) at least 9–12months since the end of radiation therapy up to 5years. All cases were suspected for either recurrence or post-operative complications by clinical examination in conjunction with mammography or/and US. DCE-MRM was performed at 1.5 T. The findings were correlated with the histopathology in all cases.ResultsWe found that DCE-MRM accurately revealed the presence or absence, location, and extent of recurrent tumor more accurately than mammography or US. US had high sensitivity and specificity (85.7% and 76.8%) compared to mammography (71.4% and 38.4%, respectively). Seven recurrent cases were found, two of them were multifocal. False-positive contrast enhancement was seen in only one patient pathologically proved as granuloma. MRI showed 95% accuracy, 100% sensitivity, 92.3% specificity with 83% positive predictive value and 100% negative predictive value.ConclusionThe conventional imaging was insufficient to detect the recurrent lesions after BCT, so DCE-MRI should be the imaging modality of choice in detection of the tumoral recurrence, and differentiating it from other complications. One limitation of the DCE-MRM is the persistent false-positive enhancement due to granulation tissue

Relationship Between Entrance Surface Skin Exposure for Iraqi Women with Compressed Breast Thickness in Mammography

Background: The evaluation of compressed breast thickness has been conducted based on the results of mammography examinations. While it is well-established that breast compression influences breast tissue, its effect on the axillary (armpit) region remains unclear. Increased compression of breast tissue in women can lead to a reduction in breast tissue thickness. Objective: To determine the correlation between entrance surface skin exposure with compressed breast thickness and compare the mean of entrance surface skin exposure results from mammography in Iraq with other studies. Patients and Methods: A study was conducted at Al-Alwiya Teaching hospital from December 2023 to January 2024 and involved 100 Iraqi women. The study used a mammography (model GE healthcare) to determine compressed breast thickness and skin exposure for craniocaudal and mediolateral oblique projections. Results: The mammography findings revealed a statistically significant correlation between entrance surface skin exposure (ESE) and compression breast thickness (CBT) in Iraqi women. Specifically, it was observed that increased CBT was associated with higher ESE values. Conclusion: The study demonstrates that breast compression thickness and radiation exposure were notably higher in the mediolateral oblique (MLO) view compared to the craniocaudal (CC) view. A significant positive correlation was observed between compression breast thickness and radiation dose. These findings underscore the importance of region-specific guidelines and standards in mammography practices to ensure optimal patient care and safety. Keywords: Axillary region, Breast parenchyma, Entrance surface skin exposure, Mammography, Compressed breast thickness.

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Results of the COVID-19 mental health international for the general population (COMET-G) study.

INTRODUCTION: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study. MATERIAL AND METHODS: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed. CONCLUSIONS: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020