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Background: When the lungs fill with fluid as a result of an infection or injury, acute respiratory distress syndrome ensues. Inflamed and fluid-filled lungs occur. They become rigid as a result, making it difficult for them to breathe fully. Blood oxygen levels will fall, endangering the health of other organs. Patients will require a ventilator to help them breathe while their lungs mend. The aim of this study was: to evaluate safety and efficacy of high dose therapy in acute respiratory distress syndrome pediatric patients and to compare safety and efficacy of high dose versus low dose therapy in Acute respiratory distress syndrome patients. Patients and Methods: A Prospective open label randomized trial included 15 patients as group1 received high dose corticosteroid therapy for 3 consequent days, high dose Methyl prednisone 30mg/kg/day and 15 patients as group 2 received low dose corticosteroid therapy for 3 consequent days, low dose Methyl prednisone 2 mg/kg/day. Clinical and laboratory data chest ultrasound and bronchoalveolar lavage to measured pre collagen peptide were studied in each group before and after corticosteroid therapy. Results: In the present study 15(50%) patients received high dose steroid and 15 (50%) patients received low dose steroid, male 23 (70%), female 7 (30%), age 7 (3.0-30.0), weight (9.55 ± 6.63), there was no significant difference in prognosis and total days in pediatric intensive care unit between high and low dose corticosteroid therapy as prognosis improving 17 patients (55%), death 13(45%) and As regards total days in pediatric intensive care unit median in high dose corticosteroid therapy 24.0 (15.5033.0) and median in low dose corticosteroid therapy 18.50 (11.023.50) less days in pediatric intensive care unit in low dose steroid therapy group than high dose steroid therapy group but no significant difference between two groups as regarding decrease in chest ultrasound (BLUE Score) and increase in pre collagen peptide in bronchoalveolar lavage between study groups. Conclusion: there was no significant difference in prognosis and total days in pediatric intensive care unit between high and low dose corticosteroid therapy as regarding change in chest ultrasound (BLUE Score) and change in pre collagen peptide in bronchoalveolar lavage between study groups. [ABSTRACT FROM AUTHOR]

Background: Crohn's disease (CD) causes transmural ulceration of any section of the gastrointestinal tract (GI), with the terminal ileum and colon being the most commonly affected. Aim of the Work: The aim of this study is to assess the sensitivity & specificity of Intestinal ultrasound In diagnosis and follow up of patients with Crohn's Disease, and related possible complications. Patients and Methods: A Cross sectional study in Gastroenterology Department of Ain Shams University Hospitals for 30 Patients with Crohn's disease and The Patients were selected from inpatient and outpatient clinic of gastroenterology department of Ain Shams University Hospitals, in the period from July to December 2021. Results: The present study revealed that the mean age of our patients was 54.3± 7.69 years with range from 38-68 years. Male cases were more than females ones, as (70%) were males while (30%) were females, with male to female ratio was 2.33: 1. The present study revealed that the mean hemoglobin level was 11.66 ± 1.46 mg/dl, and the mean RBC, 4.18±0.48. The mean platelets was 267.73±61.94 (K/UL), mean WBCs was 9.94 ± 1.83 (K/ UL), neutrophils was 7648.57 ± 1460.02 (/UL), and lymphocytic count was 1356.50 ±469.30 (UL) and neutrophil/ lymphocyte ratio (NLR) was 5.93 ±1.35. Regarding the renal function tests and electrolyte profile, the mean serum urea, creatinine and uric acid were 46.43-±10.18, 1.10-±0.25 and 5.30-±0.68mg/dl respectively. The mean levels of Na and K were 140.43 ±3.50 and 3.82±0.26 mEq/L respectively, the mean AST was 37.63 ±8.27 U/L, the mean ALT was 26.30 ±8.36 U/L, the mean total bilirubin was 1.01±0.17 mg/dl and the mean direct bilirubin was 0.60 ±0.27 mg/dl. We found that the mean PT was 14.17±2.65 sec. and the mean Serum Albumin was 4.16 ± 0.29 g/ dl. In this study the mean CRP was 4.91 ±4.55, the mean ESR at first was 21.67 ±4.22 and 2nd hour was 47.43±10.94. Conclusion: Crohn's disease (CD) is a progressive, inflammatory disease that occurs in genetically predisposed individuals and necessitates continuous monitoring and development of various methods for diagnostic and therapeutic treatment options, as well as the discovery of new medications. While colonoscopy is the gold standard in CD, US, CT and MRI, can provide information not only about the luminal side of the bowel but also about the serous side and the peripheral structure; additionally, US is repeatable, safe, and well-accepted, but unlike CT is radiation-free, and unlike MRI is inexpensive, virtually hazard-free, and available to all patients without contraindications. [ABSTRACT FROM AUTHOR]

Background: Unilateral open inguinal hernia repair surgeries are one of the most frequently performed operations in the pediatric population. Regional anesthetic techniques are commonly used for better control of pain in pediatrics. the most widely used technique of regional anaesthesia in pediatrics is the caudal block. Objective: To evaluate the analgesic and sedative effect of dexmedetomedine when given caudally as an adjuvant to bupivacaine in caudal block vs bupivacaine alone in toddlers undergoing unilateral Open inguinal hernia repair surgeries. Patients and Methods: The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups; each group consisted of 25 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Results: The result of the study reveals that the addition of dexmedetomedine at 1 µg/kg to bupivacaine 0.25% in caudal blocks can effectively prolong the duration of postoperative analgesia and causes better sedation than using bupivacaine alone in caudal blocks at similar doses in pediatrics. Conclusion: From our study we can conclude that the addition of dexmedetomedine at 1 µg/kg to bupivacaine 0.25% in caudal blocks can effectively prolong the duration of postoperative analgesia and causes better sedation in the toddlers undergoing unilateral open inguinal hernia repair surgeries. It is better than using bupivacaine alone in caudal blocks at similar doses. [ABSTRACT FROM AUTHOR]

Background: The blood coagulation function is often abnormal in HCC patients due to hypercoagulatory state, hyperfibrinolytic state, and increased plasma D-dimer. HCC patients treated with locoregional treatment may show changes of D-dimer levels. Several studies explored the validity of D-dimer levels during locoregional treatment in HCC but definitive data are still lacking. Aim of the Work: Determination of the efficacy of D-dimer profile as a prognostic marker regarding tumor features, and post interventional response in HCC subjects undergoing TACE or RFA. Patients and Methods: The clinical data of 50HCC patients who underwent TACE or RFA in our hospital from October 2021 to June 2022 were collected, including the CBC, CRP Alfa-fetoproteins and plasma d-dimer level 1 week before TACE or RFA(D0), D-dimer level 1 month (D1) and 4 months(D2) after TACE or RFA. Contrast enhanced CT was performed within 1 week before locoregional treatment and was repeated 1month and 4 months after locoregional treatment to assess for treatment efficacy according to the mRECIST criteria based on change in tumor size as measured by CT scan. One month after TACE or RFA, these patients were divided into four groups according to the mRecist criteria: complete response, partial response, stationary disease and progressive disease. D0, D1 and D2 were compared between the 4 groups and the relation between D-dimer level and the efficacy of locoregional treatment was assessed. Results: In patients with negative D-dimer before locoregional treatment (D0), there was no significant difference between D0 and D1 (P > 0.05), while patients with elevated pretreatment D- dimer levels (D0), D1 was significantly higher than D0 (P < 0.05) and the D1 is higher than that in patients with negative Do. Progressive rise of D-dimer levels 4months post locoregional treatment (D2) in HCC was associated with tumor progression suggesting aggressive tumor biology and poor outcome(P = 0.02). Conclusion: The changes in plasma D-dimer level can be used as a potential prognostic biomarker in predicting the efficacy of locoregional treatment in HCC patients and thus, elevated D-dimer levels pre and post locoregional treatment may serve as predictors of adverse tumor profile and poor outcome. [ABSTRACT FROM AUTHOR]

Background: In December 2019, a cluster of patients with pneumonia of undetermined etiology was recognized in Wuhan, Hubei, China. Subsequently, a novel coronavirus (SARS-CoV-2) was identified from lower respiratory tract samples obtained from affected patients. The clinical manifestation of COVID-19 is broad and ranges from asymptomatic and mild upper respiratory tract symptoms to severe illnesses with multiorgan failure and death. Furthermore, it is challenging to predict the clinical course or determine patients at risk of deterioration. Aim of the Work: The aim of our study was to assess prevalence of GIT symptoms in patients of covid 19 infected patients Patients and Methods: This study was conducted on 100 adult covid 19 patients recently diagnosed by polymerase chain reaction (PCR). All patients were submitted to clinical examination, laboratory testing for ESR, CRP, CBC, and D-dimer. Radiological investigations in the form of CT Chest were be reported by radiologist for all patients. High resolution computed tomography Parenchymal abnormalities on HRCT were assessed. Nasopharyngeal, oropharyngeal and rectal swabs were collected for COVID-19 (PCR) test. All patients received Covid-19 treatment according to protocols of WHO and ministry of health and population, Egypt. Results: We found that GI symptoms are prevalent among COVID-19 Egyptian patients (64%). The most common GI symptoms were Nausea, vomiting and diarrhea. We observed that 25 patients (25%) had positive viral RNA in rectal swab. Conclusion: Severe COVID-19 was more frequent in older age. Dyspnea and increased respiratory rate were associated with severity of covid 19 infection. Increased CRP and high serum levels of ferritin, d-dimer and lactate dehydrogenase were significantly associated with COVID-19 severity. [ABSTRACT FROM AUTHOR]

Background: Physicians caring for patients with cirrhosis should recognize the acute or chronic character of renal disease; the causes of renal injury; the clinical conditions leading concomitantly to acute kidney injury (AKI) and liver dysfunction, and the prognostic factors associated with the progression of AKI. Hypovolemia (due to diuretics, hemorrhage, diarrhea), acute tubular necrosis, sepsis, nephrotoxic agents (such as non steroidal anti-inflammatory drugs, aminoglycosides radiological contrasts) and hepatorenal syndrome-type 1 are the most common causes of AKI in cirrhotic patients. Aim of the Work: The aim of this study was to evaluate urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) as a diagnostic biomarker for different causes of acute kidney injury in liver cirrhosis. Patients and Methods: This was a cross sectional study done in patients with liver cirrhosis hospitalized at the Gastroenterology Department of the Ain shams university hospital. Results: We found that in the comparison between HRS and AKI regarding HB, WBCs, Platelets, ALT, AST, Albumin, INR, Bilirubin, Urea, Creatinine, Na, Urinary Cr, Urinary Na and FeNa%, there was highly statistically significant difference found between two groups regarding Urinary Na and Fe Na%, Platelets, AST, Bilirubin and Na, and there was no statistically significant difference found between two groups regarding HB, WBCs, ALT, Albumin, INR, Urea, Creatinine and Urinary Cr. While in the Correlation between NGAL With Age, HB, WBCs, Platelets, ALT, AST, Albumin, INR, Bilirubin, Urea, Creatinine, Na, Urinary Cr, Urinary Na and FeNa%, we found that there was Non statically significant correlation Between NGAL, Age, HB, WBCs, Platelets, ALT, Albumin, INR, Bilirubin, Urea, Creatinine, Na and Urinary Cr, and there was statically significant Negative correlation Between NGAL, Urinary Na and FeNa%, and there was statically significant positive correlation Between NGAL and AST. Conclusion: It is well known that development of acute kidney injury (AKI) increases mortality in hospitalized cirrhotic patients; therefore many novel markers have been studied for early detection, differential diagnosis and prognosis in cirrhotic patients with AKI. NGAL is a newly identified member of the lipocalin family that is significantly expressed in injured epithelial cells. It can lead to rapid increases in NGAL secretion from glomeruli, thus increasing NGAL concentrations in the urine. In addition, its concentration often increases within 2 h of kidney injury. Urinary NGAL has the ability to differentiate between AKI types in patients with cirrhosis. This could improve risk stratification for patients admitted to the hospital with cirrhosis, perhaps leading to early ICU admission, transplant evaluation, and prompt initiation of HRS therapy and early management of AKI. These findings, if confirmed in larger cohorts, could lead to the development of biomarker algorithms to rapidly identify patients with HRS and ATN and accurately predict prognosis. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women. Aim of the Work: The aim of this work is to evaluate the efficacy of ultrasound guided pectoral nerve block type two versus Serratus Anterior plane block regarding postoperative pain control in patients undergoing modified radical mastectomy. Patients and Methods: After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospitals. It included 70 female patients undergoing modified radical mastectomy were divided randomly into two groups, each group consisted of 35 patients; Group I patients received pectoral nerve block type two (PECS II), Group II patients received Serratus Anterior Plane Block (SAPB). Results: The results of our study showed that there was no statistically significant difference between groups regarding demographic data. There was a statistically significant decrease in Mean blood pressure (mmHg) in Group I compared with Group 11 from hour-4 to hour-16 postoperative. However, a statistically significant decrease in group I compared to group II regarding postoperative heart rate (beat/min) from hour-4 to hour-16. A statistically significant decrease in group I compared to group II regarding visual analogue score for pain from minute-30 to after 12 hrs also was found. The current study shows highly statistically significant difference between groups as regard the need to intraoperative fentanyl incremental doses, time of first res cue analgesia, number of patients who received postoperative pethidine and total dose of opioids during the first 24 hrs. Conclusion: Our findings suggest that PECS II block is more effective regarding postoperative pain control in patients under going modified radical mastectomy under general anesthesia compared to SAPB especially in the first 16 hours postoperative. Also patients underwent PECS II block show less need to intraoperative fentanyl incremental doses, less need to postoperative opioids and longer duration for time of rescue analgesia com pared to patients underwent SAPB. [ABSTRACT FROM AUTHOR]

Objective: to assess the short-term prognostic aid of the initial Electroencephalography (EEG) in patients with acute viral encephalitis. Methods: An observational follow up study including 30 children with acute non-herpetic viral encephalitis. Cases were subjected to full history taking, examination and an EEG recording obtained during hospital admission. Functional outcome assessment was done using the Liverpool outcome score during admission and repeated again at 3 months post discharge. Results: The mean age of patients was 2.8 63.5 years old, with ages ranging from 6 months to 15 years. 73% of the cases were male. Clinical seizures were observed in 96.7% of the cases and EEG was abnormal in 26.7%. The Liverpool outcome scores were significantly lower at discharge and even more so after 3 months in cases with epileptiform activity on EEG. Abnormalities of EEG background did not significantly impact the Liverpool outcome score of the patients. Conclusion: The presence of EEG epileptiform discharges is associated with a worse clinical outcome in children with acute encephalitis. The same cannot be said for abnormalities of EEG background. [ABSTRACT FROM AUTHOR]

Background: Severe or major trauma is a worldwide pandemic and one of the leading causes of death and disability. Polytrauma always involves young, productive individuals and represents a substantial burden on the society. Aim of the Work: To detect the incidence and the pattern of intra-abdominal injuries in polytraumatized patients admitted to the general surgery department at El-Demerdash Hospital and to estimate the trauma burden in General Surgery Department Ain Shams University. Patients and Methods: Retrospective study of records of polytrauma patients admitted to general surgery department at ElDemerdash Hospital from the period of January 2018 to June 2018. Results: In the specified study period of 6 months from 1/1 /2018 to 31/6 /2018, the ER department of Ain Shams University hospital (El-Demerdash hospital) received 3,328 cases of trauma out of which 40 cases were admitted at General Surgery Department with incidence rate 1.2% of total polytrauma patients admitted in the hospital in various departments. There were 37.5% of patients with intra-abdominal collection with no documented organ injury. Most common intra-abdominal organ injured was spleen 17.5% then liver the largest intra-abdominal organ 5% and stomach 5%, least to be injured were bowel loops 2.5%. Conclusion: Polytrauma is a major health problem and a major cause of death in Egypt. 40 trauma cases were admitted to general surgery department. 80% of them were males and 20% were females. The mean age of trauma victims was 33.3 years old. 42.5% of them had surgeries. The study recorded 7.5% fatalities. [ABSTRACT FROM AUTHOR]