Assiut University Hospitals

Dengue fever is arthropod born disease transmitted by the bite of a mosquito called Aedes aegypti. Some researchers have suggested a link between previous dengue infection and leukemia. The aim of this pilot study is to determine the frequency of dengue infection in acute lymphoblastic leukemia patients (ALL) compared to age and sex matched controls and to find the impact of this infection on the disease outcome. This is a single center pilot study that included two groups, 30 newly diagnosed pediatric ALL patients and 22 newly diagnosed adult ALL patients that were compared with 50 age and sex matched healthy controls (25 for each group) and 8 pediatric immunosuppressed controls. ELISA was used to detect IgM and IgG antibodies in serum samples at presentation and clinical and laboratory data at admission were collected. Positive and negative dengue patients were followed up for a minimum of six months (hybrid case control –cohort study). Among pediatric patients who were evaluated for dengue infection by the serological tests, 46.7% (14/30), 8% (2/25) and 0% (0/8) tested positive for IgG in patients, immuno-competent and immunocompromised controls respectively (p value 0.002). There was a significant association between acute dengue infection and BCR-ABL fusion oncogenic gene only in pediatric patients. No statistically significant difference in short term outcomes was observed. This pilot study provides preliminary data to guide large scale research on the role of dengue infection as a predisposing or exacerbating factor in genetically susceptible children.

BACKGROUNDPercutaneous nephrolithotomy (PNL) is the standard treatment for medium-sized and large kidney stones. Many potential complications of PNL may warrant hospital readmission (HR) after discharge, threatening patient safety and increasing the costs.AIMTo estimate the rate of unplanned HR after PNL and identify its urological and nursing-related predictors.METHODSOne hundred sixty-one patients were prospectively studied for HR after PNL from April 2022 to December 2022. The relevant urological and nursing-related characteristics of patients with and without unplanned HR after PNL were studied for association with HR, using univariate and multivariate analyses. Variables such as the demographic characteristics, comorbidities, laboratory and imaging characteristics, dietary status, operative time, number of kidney punctures, blood loss, urinary tract infections, and the receipt of instructions for catheter care and activities of daily living were included. A risk score was created.RESULTSThe mean age of patients with HR (44.4 ± 12.7 years) and without HR (43.9 ± 12.6 years) was similar (P = 0.847). The overall stone-free rate was 88.8%. The total complication rate was 32.3% (52 patients), and the highest grade was IIIa, according to the modified Clavein grading system, resulting in an HR rate of 22.4%. History of preoperative pyuria (P = 0.001), hydronephrosis (P = 0.001) and mean stone size (P = 0.012), multiple renal punctures (P < 0.001), double J stent (P = 0.033), total operative time (P = 0.001), intraoperative injury (P = 0.011), postoperative urinary tract infection (P < 0.001), and inadequate instructions for urethral catheter (P = 0.001) and activity daily living (P = 0.048) were significantly associated with HR after PNL. On multivariate analysis, only preoperative pyuria (P = 0.004), intraoperative injury (P = 0.001), and inadequate instructions on urethral catheter care (P = 0.035) were associated with HR. The risk score of the independent predictors was 0-17; 0-4 (low risk), 5-9 (moderate risk), and 10-17 (high risk).CONCLUSIONThe rate of unplanned HR after PNL was relatively high (22.4%). The presence of pus cells in the preoperative urine analysis, intraoperative injury, and receiving inadequate instructions on urethral catheter care were independent predictors of HR after PNL. Combined studying of the urological and nursing-related predictors may promote the implementation of enhanced recovery protocols after PNL.

Right ventricular dysfunction is a major risk factor in coronary artery disease. In patients undergoing revascularization for left ventricular ischemia, the incidence of RVD is reported in about 20%. This study aimed to assess right ventricular function as a possible risk factor in patients undergoing coronary artery bypass graft. This prospective study was conducted on 77 patients who underwent coronary artery bypass grafting. All cases were subjected to detailed medical history, full physical examination, electrocardiogram, routine laboratory tests including echocardiography or STE, and all parameters obtained before, within one week, and six months after surgery. Though LVEF preoperatively was comparable between the two study groups, LVEF one-week postoperatively was significantly lower in the RVD group compared to non RVD group; at the same time, there was a significant reduction in LVEF in both groups one week postoperatively compared to preoperatively, and this was more obvious in RVD group compared to non RVD group. Moreover, RVD developed shortly after CABG in less than one-third of our study population, but it recovered in most of them soon at the 6-month follow-up visit. It is suggested that in the early days after the CABG surgery, there is a decline in right ventricular function, which is relatively reversible at longer intervals (6 months after surgery). The right ventricular global longitudinal strain is a reliable way to address RVD.

Fractures of the metacarpals and phalanges are among the most common upper extremity injuries. They can be managed non-operatively or operatively; the latter offers a wide range of options, including plate fixation, Kirschner wires, and intramedullary headless screws (IMHS), which rely on the surgeon’s preference and the fracture characteristics. Most of the previously mentioned fixation methods showed acceptable outcomes; however, IMHS fixation emerged as a promising technique, with some reports showing superior functional, radiological, and complication outcomes compared to other management options. For managing metacarpal fractures, IMHS can be inserted in a retrograde fashion, while for phalanx fractures, they might be inserted in an antegrade or retrograde fashion. Here, we described the various possible techniques for IMHS fixation of metacarpal and proximal phalanx extra-articular fractures. Furthermore, we mentioned some of the precautions, advantages, and disadvantages of this fixation method.

Abstract Background: Urinary diversion after radical cystectomy (RC) is a complex surgery that has effects on different patient aspects. The aim was to compare the surgical outcomes and to identify the factors influencing quality-of-life (QoL) after RC with cutaneous ureterostomy (CU) or ileal conduit (IC). Methods: A prospective non-randomized study was performed on patients who underwent RC from April 2019 to March 2022. The demographic and clinical characteristics and QoL were compared in patients with IC and unilateral CU. The primary outcome was the difference in the operative time between patients underwent CU (group A) and IC (group B). Results: This study included 32 patients with median age (range) of 61 (48-83) years and median (range) body mass index of 23.95 (19.2-30.2) kg/m 2 . Urinary tract infections (UTI; 68.8%) patients and paralytic ileus (50%) were the commonest complications. The mortality rate was 18.8%, and the main cause was septicemia. The median time of shunt procedure was significantly longer in group B (p&lt;0.001). Also, the postoperative anemia (p=0.029), the interval of exchange of the base of the collecting bag (p&lt;0.001), and the rate of febrile UTI (p=0.017) were higher in group A. However, the score of QoL (p=0.025) and survival rate (p=0.004) were significantly better in group B than in group A. The median QoL score for group A was 68 (52-90) while the median QoL score for group B was 80.50 (62-103) (p=0.029). Serum creatinine level (p=0.045), recurrent UTI (p=0.025), and the number of re-interventions (p=0.010) had significant inverse association with QoL. However, the eGFR showed a significant proportional relation (p-value 0.006). Conclusions: Considering the need for re-intervention in patients in the IC group, unilateral CU with separate stomas may represent a good alternative to IC despite the relatively better QoL and long-term outcomes of the latter. Trial registration : NCT04610385

Heart failure (HF) is characterized by increasing prevalence, high morbidity and mortality, poor quality of life, and substantial healthcare costs. Despite advancements in pharmacologic and device-based therapies, translating evidence from randomized controlled trials into clinical practice remains suboptimal. The Global Registries and Surveys Programme-Heart Failure (GRASP-HF) is a pan-European, snapshot, observational study, aiming at assessing the real-world implementation of evidence-based HF management. GRASP-HF captures both acute and chronic HF presentations to assess the adherence to the 2021 and 2023 European Society of Cardiology (ESC) HF Guidelines. It also serves as a platform for the accreditation of HF centres for the Improving Care through Accreditation and Recognition in Heart Failure (ICARe-HF) programme. This manuscript outlines the rationale, methodology, and design of GRASP-HF. Unlike previous registries, GRASP-HF ensures that all patients are consecutively enrolled over a pre-defined 2-month period, minimizing selection bias. GRASP-HF offers a real-time perspective on diagnostic strategies, use of guideline-recommended medical therapy and implementation of quality-of-care indicators. In addition, GRASP-HF addresses less explored domains by other registries, such as frailty, rare aetiologies (e.g. amyloidosis, genetic cardiomyopathies, Takotsubo syndrome), as well as non-fatal events during hospitalization and follow-up. GRASP-HF is also designed to inform ESC educational strategies and to benchmark progresses in HF care across European and non-European centres. In conjunction with ICARe-HF, annual repetition of GRASP-HF aims to facilitate continuous feedback between evidence, practice, and quality improvement. GRASP-HF will assist National Cardiac Societies in shaping national and institutional policies and will contribute with data-driven insights to future guideline development.

Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious condition with varied manifestations of systemic lupus erythematosus (SLE) that involves the central and peripheral nervous systems. While seizures and psychiatric components are common findings, brain atrophy is not frequently reported, especially in young individuals. We present a case of a 22-year-old Saudi female who presented with a generalized tonic-clonic seizure and a significant history of undiagnosed psychiatric suffering. Neuroimaging of the brain demonstrated cortical atrophy and extensive subcortical hyperintensities. Autoimmune serology revealed SLE with the positivity of anti-dsDNA and anticardiolipin antibodies. The patient was diagnosed with NPSLE and treated with corticosteroids, hydroxychloroquine, and rituximab. A one-year follow-up MRI showed radiological stability with no new lesions or progression of atrophy. Clinically, she achieved complete seizure remission and improved neurocognitive function.We performed a structured literature review following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Databases were searched, including PubMed, Google Scholar, Springer, and Web of Science, for publications between 2013 and 2025. A total of 1,770 results were screened, and 20 studies were included in the review. The literature review and the case that is discussed support the link between neuroinflammation, injury mediated by autoantibodies, and structural brain changes in NPSLE. Seizures are regularly observed; cortical atrophy is atypical but could represent significant, long-term damage, especially among adults. Immunosuppressive therapy with rituximab can help stabilize both radiological findings and clinically significant manifestations of the disease. This report highlights the necessity of early recognition of neuropsychiatric symptoms in young individuals with an undiagnosed SLE. If an MRI shows central nervous system (CNS) atrophy, then aggressive immunosuppressive therapy is warranted despite the rare nature of findings during clinical presentation. Longitudinal imaging combined with multidisciplinary care may be particularly appropriate, as coordination among the neurologist, rheumatologist, and primary care physician is essential to achieving favorable outcomes in NPSLE.

Introduction: The use of musculoskeletal ultrasonography (MSUS) for patients with Juvenile idiopathic arthritis (JIA) is gaining rising attention in the current clinical practice, being a simple non-invasive tool in diagnosing and assessing JIA patients. We sought to describe MSUS findings in a group of pediatric patients with JIA and correlate these findings to their clinical assessment. Methods: This cross-sectional included 60 JIA patients, aged 1-16 years, 40 were already diagnosed as JIA and on treatment and 20 were newly diagnosed at enrollment in the study They were subjected to clinical assessment and MSUS radiological assessment and were assessed by the 27-joint Juvenile Arthritis Disease Activity Score (JADAS27 score). Results: Oligoarticular was the commonest JIA subtype. Strong agreement was observed between MSUS features and clinical findings (kappa=0.937, P<0.001). Thirty-five cases were diagnosed as oligoarticular JIA, confirmed by MSUS examination at enrollment in 33, while 2 were reclassified as having polyarticular JIA. Also, clinically 22 cases were diagnosed to have polyarticular JIA, 18 of them were confirmed by MSUS examination at enrollment. In addition, significant moderate agreement was observed between the MSUS features and the JADAS27 score (kappa = 0.353, P = 0.003). Conclusions: MSUS is a valuable tool for the diagnosis and follow-up of synovitis in children with JIA.