Kidney Diseases and COVID-19 Pandemic – A Review Article

In December 2019, first cases of a novel coronavirus were identified in Wuhan, China. A state of global pandemic was shortly declared among a very rapid contagious spread of the virus. The causative virus was identified as the SARS-CoV-2 viruses and is genetically related to the previous SARS outbreak in 2003. The virus causes a wide clinical spectrum from mild flu-like symptoms to adult respiratory distress syndrome. Kidney involvement has been reported in several reports in patients with various degrees of severity of SARS-CoV-2 infection. As knowledge is evolving, the accurate incidence of acute kidney injury (AKI) is not known. Many questions are yet to be answered regarding the effect of epidemiological variables and comorbidities on the occurrence of AKI. Some reports have observed the occurrence of hematuria and proteinuria in a percentage of infected patients. Moreover, chronic kidney disease has not been found, in some reports to add to the adverse outcomes, an aspect that merits further exploration. Patients on regular hemodialysis may be vulnerable to coronavirus infection due to the lower status of immunity and the need for frequent attendance at health-care facilities. Due to the previous factors, prevention and mitigation of the SARS-CoV-2 virus, in this vulnerable population, constitutes a major challenge

Applications of integration of AI-based Optical Character Recognition (OCR) and Generative AI in Document Understanding and Processing

The adoption of AI-based Optical Character Recognition (OCR) and Generative AI can streamline document processing, shifting from manual to automated digital methods, thus increasing efficiency and accuracy in data handling. This study examines the applications of these technologies across various stages of document management. Initially, OCR technology can scan and digitize physical documents, transforming text images into machine-encoded text. This process is essential for converting paper-based records into digital formats. Additionally, OCR can decipher handwritten notes, making it invaluable for processing historical documents and manually filled forms. In the subsequent phase, these technologies can categorize and organize data. AI algorithms, combined with OCR, can classify text into various categories such as invoices, legal documents, or personal letters, thereby streamlining document sorting and retrieval. Generative AI can further enhance this process by producing concise summaries of lengthy documents, enabling quick comprehension without the need to read the entire text. Error detection and correction are also critical areas where these technologies can be applied. Despite its effectiveness, OCR may misinterpret characters, and AI algorithms can identify these errors by comparing the scanned text against language models. Generative AI can then suggest corrections, improving the accuracy of the digitized text. Moreover, the combination of OCR and Generative AI can be employed for data extraction and analysis, extracting specific information from documents, and conducting sentiment analysis on texts like customer reviews to gain insights into customer opinions. In terms of language translation and localization, Generative AI can translate digitized text into various languages and adapt content for different cultural contexts, crucial for international businesses. Document accessibility is enhanced as AI can convert text to speech and introduce interactive elements, making documents accessible to visually impaired users. Furthermore, in ensuring security and compliance, these technologies can identify and redact sensitive information to comply with privacy laws and verify the authenticity of documents to detect alterations. Finally, AI can generate customizable document templates and content, tailoring documents to specific needs and preferences, demonstrating the extensive impact of AI-based OCR and Generative AI in modern document processing and management

Hypoglossal Facial Nerve Anastomosis for Post-Operative and Post-Traumatic Complete Facial Nerve Paralysis

AIM: This study aims to evaluate the outcome of patients with complete facial paralysis following surgery to cerebellopontine angle tumours or following traumatic petrous bone fractures after reanimation by hypoglossal-facial anastomosis as regards clinical improvement of facial asymmetry and facial muscle contractility as well as complications associated with hypoglossal-facial reanimation procedure. METHODS: This thesis included a prospective study to be carried out on 15 patients with unilateral complete lower motor neuron facial paralysis (11 patients after cerebellopontine angle tumour resection and 4 patients after traumatic transverse petrous bone fracture) operated upon by end to end hypoglossal-facial nerve anastomosis in Cairo university hospitals in the period between June 2015 and January 2017. RESULTS: At one year follow up the improvement of facial nerve functions were as follows: Three cases (20%) had improved to House Hrackmann grade II, eleven cases (73.33%) had improved to grade III, and one patient (6.66%) had improved to House Brackmann grade IV. CONCLUSION: Despite the various techniques in facial reanimation following facial nerve paralysis, the end to end hypoglossal-facial nerve anastomosis remains the gold standard procedure with satisfying results in cases of the viable distal facial stump and non-atrophic muscles. Early hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm

Neuron Specific Enolase in Children with Diabetic Ketoacidosis: Does it Correlate with Impaired Consciousness and Disease Severity?

Background: Diabetes ketoacidosis (DKA) is the leading cause of death in children with diabetes, especially when it is complicated by cerebral edema. The predictors of CNS dysfunction/injury are largely unknown. In many neurological disorders, neuron-specific enolase (NSE) is a marker of neuronal damage. Objective: This study aimed to investigate the role of serum neuron-specific enolase as a marker of neuronal damage in patients with DKA.Patients and methods: A cross-sectional study with 90 DKA patients (aged 9.58 ± 2.89 years) presenting to Pediatric Intensive Care Unit (PICU), Children Hospital Zagazig University. Patients subjected to clinical history and examination including Glasco coma scale (GCS), blood glucose, serum electrolytes, blood PH and computed tomography of the brain for children with disturbed consciousness. Blood NSE at admission (baseline point) and after 24 hours of starting treatment of DKA (2-time points). Results: There was a significant difference between NSE level on admission and NSE level 24 hours after start of treatment. Patients with low GCS scores had higher serum NSE at baseline and 2-time points than those with normal CGS (P=0.001; P=0.053). Patients with moderate and severe DKA had higher NSE at baseline and 2-time points in comparison with those with mild DKA (P=0.001; P=0.098).Conclusions: Children with moderate to severe DKA and impaired consciousness had higher serum NSE. The high levels of NSE in patients with abnormal GCS, in the absence of cerebral edema on brain imaging indicate that NSE is a reliable marker of neuronal injury

Traumatic Dural Venous Sinuses Injury

The traumatic dural venous sinus injury is one of the most dangerous complications of TBI, either due to fatal intracranial compressing venous bleeding, or disturbing the intracranial pressure which could be caused by injury to the SSS On the other hand, post traumatic dural sinus thrombosis is considered a rare complication which may lead to hemorrhagic infarction with its serious consequences including epilepsy, neurological deficits, or death. Therefore, knowledge of the appropriate treatment of this kind of head injury is essential

Comparison between Results of Microdiscectomy and Open Discectomy in Management of High-Level Lumbar Disc Prolapse

AIM: This work aims to compare between results of microdiscectomy and open discectomy in management of high-level lumbar disc prolapse. METHODS: This is a controlled randomised study, where patients having upper lumbar disc herniations were evaluated preoperatively both clinically and radiologically, randomisation was planned to perform open discectomy in odd number patients and to perform microdiscectomy in even number patients, patients were evaluated and followed up for deficits and outcomes. RESULTS: We operated ten patients in this study, five cases were operated upon with microdiscectomy, and five cases were operated upon with open discectomy, the median age of presentation in this study was 44 years, there were five males and five females, postoperative pain improvement was better in microdiscectomy. Hospital stay, blood loss, bone loss and postoperative complications were less in microdiscectomy. CONCLUSION: Microdiscectomy allows good surgical visualisation and is less traumatic to the involved tissues. The results of this study indicated that microsurgery reduces hospitalisation time, improves the overall surgery-related outcome. The main differences between the two procedures were the length of the incision and blood loss. We found that lumbar microdiscectomy allows patients earlier return to work and normal life with less reliance on postoperative narcotic analgesic agents

Novel Urinary Biomarkers and Chronic Kidney Disease After Coronary Angiography: A Prospective Case-Controlled Study

BACKGROUND: Novel urinary biomarkers may have potential for early detection of acute kidney injury. AIM: The aim of the study was to test two urinary biomarkers: Kidney injury molecule-1(KIM-1) and liver-type fatty acid binding protein (L-FABP) as markers of kidney injury following coronary angiography. METHODS: This is a prospective non-randomized controlled trial, performed in two large teaching hospitals. Patients were recruited from the catheter lab or form nephrology outpatient clinics. In group (A), 100 patients with AKI on top of CKD after coronary angiography and Group B: Thirty-one patients with stable CKD as a control. KIM-1 and L-FABP were measured at base line and after 3 months. RESULTS: In group (A), 100 patients who had acute on top of CKD after coronary angiography, stage progression occurred in 15 patients in group (A) compared to two patients in group (B) (p = 0.28). The median change in eGFR after 3 months was not statistically significant between both groups (p = 0.8). Median baseline urinary liver-type fatty acid binding protein was higher in Group A compared to Group B (3.7 μg/g vs. 1.82μg/g). The change in L-FABP from baseline to 3 months was significant between both groups (p < 0.001). The median urinary concentrations of KIM-1 and L-FABP were higher at the end of the follow-up compared to base line values in both groups, (p < 0.000). CONCLUSION: Urinary L-FABP correlates with kidney function decline in patients with acute on top of CKD after coronary angiography. Urinary levels of KIM-1 and L-FABP at 3 months increase significantly compared to baseline in patients with progressive CKD

The serum thyroid hormone profile in mechanically ventilated children: Does euthyroid sick syndrome exist?

Background: The term "euthyroid sick syndrome" refers to alterations in thyroid function testing during critical illness. Mechanically ventilated children's thyroid hormone levels may be altered, although the reason for this remains a mystery.Objective: This study was aimed to evaluate thyroid hormone profile in mechanically ventilated children and their correlation with mortality.Patients and Methods: Thirty-four mechanically ventilated children were enrolled in a prospective cohort study. On the first and third days of mechanical ventilation, serum TSH, FT3, FT4 and reverse T3 were measured.Results: The mean age of the studied patients was of 31.06 ± 35.94 months. After three days of mechanical ventilation, the serum levels of FT3 and FT4 in the blood were significantly lower than the serum levels on the first day. The serum reverse T3 levels increased significantly on the third day of mechanical ventilation compared to the first day. There was a statistically significant increase in the number of patients with low FT3 and FT4 serum levels on the third day compared to the first day. Twenty-two patients (64.7%) died, and the frequency of low FT3 among dead patients was signiisignificantlycantly higher than among surviving patients.Conclusions: It could be concluded that the mechanically ventilated children had signs of euthyroid sick syndrome, shown by low levels of FT3 and FT4 and a rise in rT3 without a compensatory rise in TSH. Serum FT3 and FT4 decreased, but reverse T3 increased, on the third day of mechanical ventilation compared to the first day. Patients who had low FT3 levels died at a higher rate