Children's Hospital Mansoura University

High-alert medications (HAMs) cause a lot of safety issues in paediatric healthcare settings, and medication errors have three times the potential to harm this group than in adults. This quality improvement study was conducted to assess nurses' knowledge of HAMs, the barriers to safe HAM administration and the impact of targeted education. This quality improvement project assessed the knowledge of HAM administration before and after structured training among paediatric nurses in critical care units. Barriers to safe medication administration were identified through questionnaire responses, including both knowledge-related and organisational obstacles. Knowledge gain was measured using paired t-tests and Wilcoxon signed-rank tests. An exploratory regression analysis was conducted to investigate the associations with knowledge improvement. This study included 335 nurses. The improvement in knowledge regarding administration increased significantly after training, from an average score of 4.87 to 9.41. Main obstacles to safe medication administration identified include lack of knowledge (39.4%), unavailability of reference texts (34.6%) and ambiguous dose calculations (32.0%). Those under 25 years old, as well as those having less than 2 years of experience, recorded the absolute highest gains. Self-rated competency improved minimally, although those indicating low confidence dropped to below 10%. A great demand for additional education in HAMs was noticed, where 82% were asking for more training. Structured training significantly improved theoretical HAM knowledge and identified critical system barriers (lack of references and ambiguous protocols). Continuous education represents an essential foundation for subsequent medication safety quality improvement initiatives. For paediatric critical care nurses, these findings establish a knowledge foundation and identify system barriers essential for improving paediatric HAM safety.

Pediatric chronic diseases can be associated with hematologic abnormalities and psychiatric comorbidities, but data describing these associations remain limited. The current study aimed to compare demographic and laboratory characteristics between cases and controls, and to examine relationships between sociodemographic factors and psychiatric disorders among pediatric patients. A comparative cross-sectional study included 100 pediatric cases and 100 controls. Demographic variables, growth percentiles, and complete blood count (CBC) abnormalities were analyzed. Among cases, the relationship between demographic factors and the presence of psychiatric disorders was assessed. No significant differences were observed between cases and controls regarding age (p=0.061) or sex distribution (p=0.093). Growth percentiles showed no statistically significant differences in weight (p=0.064) or height (p=0.273). CBC abnormalities varied, with anemia and neutropenia being the most frequent findings among cases. Among the 200 children, 129 (64.5%) had psychiatric disorders. However, psychiatric status was not significantly associated with age, sex, weight percentile, height percentile, or disease duration. Children exhibited variable hematologic profiles, but demographic and growth parameters showed no significant correlation with psychiatric comorbidity. These findings underscore the need for an integrated pediatric and mental health assessment.

Artificial intelligence (AI) is affecting the practice of orthopedic surgery, offering innovative solutions from preoperative planning to intraoperative guidance and real-time adaptation. This review highlights current advancements in AI-driven imaging analysis, anatomical segmentation, and implant selection, highlighting improvements in surgical precision, efficiency, and patient-specific customization. Intraoperatively, AI enables real-time image processing, integration with robotic systems, and adaptive feedback mechanisms that enhance accuracy, reduce complications, and personalize care. Clinical applications span joint replacement, spine, and trauma surgery, where AI supports diagnosis and offers support in decision-making, often surpassing conventional methods. Despite these promising developments, challenges remain regarding data quality, model generalizability, transparency, and ethical considerations. Future directions emphasize explainable AI, multimodal data integration, and closer synergy between AI, robotics, and digital health to advance personalized orthopedic care.

Objectives Systemic lupus erythematosus (SLE) patients have a high-risk of developing lupus nephritis (LN). New markers are needed for early detection and for targeted treatment of LN. Aim This study aimed at investigating the urinary concentration of interleukin (IL)-27 of patients with SLE compared with healthy controls (HC). Patients and method An enzyme-linked immunosorbent assay (ELISA) was used to analyze urine concentration of IL-27 from 26 patients with LN, 14 patients without LN, and 25 HC. Results During activity of the disease there was an increased level of both total and corrected IL-27 in urine of LN patients compared with extra renal lupus patients and HC ( P <0.001). Urinary IL-27 level decreases following successful immunosuppressive treatment of LN patients ( P =0.001) and non-LN SLE patients ( P =0.009). Urinary IL-27 at cutoff value greater than 98 is a statistically significant discriminator of SLE from HC (area under the curve=0.919, P <0.001) with 80% sensitivity and 96% specificity. Corrected IL-27 at cutoff value greater than 56.14 is a statistically significant discriminator of SLE from HC (area under the curve=0.933, P <0.001) with 80% sensitivity and 100% specificity. Conclusions Urinary IL-27 expression decreases following successful immunosuppressive treatment of LN patients and non-LN SLE patients but still higher than HC in LN. So it can act as a biomarker for lupus nephritis in children.

Myeloma cancer (MC) is the second most common hematologic malignancy. It represents a clonal disorder of plasma B-cells arising in the bone marrow. Despite the wide advance in treatment options over recent years, the disease remains incurable. The current study was designed to evaluate Epigallocatechin3gallate (ECG) and simvastatin (SVN) anticancer effect on MC cells. MC cells were divided into the control, MC+ECG, MC+SVN, and MC+ECG+SVN groups. MC cells proliferation in all groups was evaluated using cell morphological status, qRT-PCR was used to analyze apoptotic gene expression, the cell cycle was examined using flowcytometry, and biochemical analysis of oxidative and antioxidant mediators was determined. The doses of ECG (100µmol/L) and SVN (0.1µmol/L) induced cytotoxicity in about 60% of myeloma cells. ECG induced apoptotic genes upregulation (P53, poly (ADP-ribose) polymerase 1 (PARP-1), B-cell leukemia/lymphoma 2 (Bcl-2)-associated protein x (Bax), and caspase-3), and anti-apoptotic gene downregulation (Bcl-2). Moreover, the current regimens have a potent effect on cancer cell growth through G2/M arrest, as observed Graphical abstract figure. The current regimens induced oxidative stress downregulation and antioxidant enzymes activity upregulation. In conclusion, both ECG and/or simvastatin caused MC cell toxicity. Nevertheless, the synergistic influence of ECG and simvastatin possesses a more potent consequence on minimizing the resistance of tumor cell and killing tumor cells.

Background: Laparoscopic sleeve gastrectomy (LSG) is a surgery that involves the removal of 75–80% of the stomach. It offers benefits like less postoperative pain and better recovery compared to open surgery, but it also carries the risk of developing gastroesophageal reflux disease (GERD) and hiatus hernia. Patients and Methods: This retrospective study included a group of patients who underwent LSG, divided into two groups: Group A, which contained 30 patients who received LSG without ligamentum teres reinforcement (LTR), and Group B, with 30 patients, who underwent LSG with the additional LTR procedure. Results: Group B experienced significantly fewer reflux symptoms during follow-up at 3, 9, and 18 months ( p < 0.05). Additionally, Group B had a lower incidence of endoscopic reflux at 6 and 18 months (3.3% vs. 26.7% and 6.7% vs. 30.0%). Hiatus hernia size was significantly smaller in Group B (1.2 cm vs. 2.5 cm, p < 0.001). Conclusion: Incorporating LTR during LSG may reduce postoperative GERD. The small sample size and retrospective design suggest the need for larger studies to confirm LTR’s long-term benefits as an adjunctive technique in bariatric surgery.

BackgroundThe WHO considers anemia in pregnancy a severe public health issue when prevalence surpasses 40%. In response, we conducted a systematic review and meta-analysis to examine anemia among pregnant women in Egypt, focusing on its prevalence, determinants, and associated complications.MethodsWe conducted a systematic literature search for studies published between January 1, 2010, and August 18, 2024, to identify studies from Egypt reporting on anemia in pregnant women, including its prevalence, associated determinants, and complications. A meta-analysis was conducted using a random-effects model to estimate pooled prevalence, odds ratios (OR), and standardized mean differences (SMD). Sensitivity analyses and publication bias were performed. All statistical analyses were conducted using R software.ResultsEighteen studies met the eligibility criteria with a total sample size of 14,548. The overall prevalence of anemia among pregnant women was 49% (95% CI: 42–57), with no significant difference between Upper and Lower Egypt (P = 0.66). The sensitivity analysis demonstrated the absence of influential outliers and Egger’s test indicated no evidence of publication bias (P = 0.17). Anemia prevalence was significantly higher in the third trimester (65%) compared to the second trimester (47%) (P = 0.03). Among anemic pregnant women, most cases were mild (47%) and moderate (47%). The determinants of anemia among pregnant women included being over 30 years old (OR: 1.95), residing in rural areas (OR: 1.76), illiteracy (OR: 1.93), birth spacing < 2 years (OR: 2.04), lack of iron supplementation (OR: 2.59), presence of intestinal parasites (OR: 1.38), antenatal visits < 5 (OR: 5.27), multiparity, and low income, all with statistical significance (p < 0.05). Regarding dietary determinants, a low intake of meat, vegetables, fruits, and high tea consumption was consistently associated with a higher risk of anemia. For neonatal complications, infants born to anemic mothers had significantly lower Apgar scores, gestational ages, and birth weights (P < 0.05), with birth weight being the most adversely impacted (SMD = -1.3).ConclusionsThis meta-analysis shows 49% anemia prevalence in pregnant Egyptian women, indicating severe health concern. The findings highlight the urgent need for targeted interventions aimed at addressing the key determinants identified in this study.

Lung cancer (LC) is a crucial rapidly developing disease. In Egypt, it is one of the five most frequent cancers. Little is known about the impact of deleted mismatch repair genes and its correlation to clinicopathological characteristics. This study evaluates immunohistochemical expression of the mismatch repair genes (PMS2), (MSH2), (MLH1) & (MSH6) & its correlation with clinicopathologic parameters & prognosis of LC. Age was higher with lost MLH1 & PMS2 but HTN was higher with lost four markers. Smoking was associated with expression of MLH1 & PMS2. A progressive course was associated with lost MSH2 & MSH6. Suprarenal metastasis was associated with lost all markers but bone metastasis was associated with lost MSH2 & MSH6. All the markers were significantly correlated with each other, with perfect correlations between MSH6 & MSH2 and between MLH & PMS2. Median overall survival among cases with lost markers was significantly lower than patients with preserved markers. We recommend evaluation of the four proteins as a biomarker that could guide LC therapy. In-depth biological research is imperative to elucidate the precise roles and mechanisms of these markers. This will advance management strategies and even guide immune checkpoint inhibitor therapy for LC.

Prostate cancer (PC) is considered the second most diagnosed cancer in men worldwide. It remains a leading cause of cancer-related death. Recently, many modalities have been discovered and used in the diagnosis and management of PC, with the incorporation of many treatment options such as hormonal therapy, chemotherapy, targeted therapies, immunotherapy, and precision medicine. Robotics and artificial intelligence (AI) have further modified the diagnosis and management of PCs, improving the diagnosis accuracy and disease progression. This comprehensive review offers an in-depth exploration of the historical modalities of treatments, an evaluation of current therapeutic techniques, a discussion of the use of robotic surgery and AI, and an examination of ongoing clinical trials and emerging procedures. Additionally, this review also covers the challenges. By inspecting these aspects, the review may provide valuable information regarding future research and clinical practice directions in PC treatment, contributing to a thorough understanding of the complex and emerging context of PC management.

Abstract Background This study aims to determine the incidence, clinical course and risk factors of hypothyroidism following cardiac catheter (CC) in infants with congenital heart diseases (CHD). Subjects and Methods: This prospective study involved 115 patients with CHD, all aged 3 years or younger, who underwent CC, as well as 100 healthy age- and sex-matched controls. Baseline thyroid function tests (TFTs) were conducted for both the patients and controls. In the CHD cohort, TFTs were reassessed 3 weeks after the CC, and for those with abnormal TFT values at this time, the tests were repeated 1week later. Levothyroxine was started in patients with persistent thyroid hypofunction at 3- and 4-weeks assessment following CC. Results Four weeks after CC, 12% of the studied group exhibited hypothyroidism. Univariate analysis identified significant predictors of hypothyroidism following CC: aortic stenosis (RR = 10.0 (1.49–66.99), P = 0.018), duration of fluoroscopy during CC (RR = 2.12 (0.99–4.26), P = 0.05), and total iodinated contrast media (iCM) during CC (RR = 2.5 (1.35–3.55), P = 0.019). Multivariate analysis indicated that iCM dose was the sole significant predictor of developing hypothyroidism (RR = 2.10 (1.01–3.23), P = 0.04). ROC curve analysis showed that the cut-off point of iCM dose for prediction of hypothyroidism evolution is 8.7 gm/kg (26.1 ml/kg), (sensitivity: 83%, specificity: 65%), while the cut-off point of fluoroscopy duration which predicts development of hypothyroidism is 24 minutes, (sensitivity: 83%, specificity: 66%). Conclusion Higher doses of iCM and longer duration of fluoroscope during CC are risk factors for evolution of hypothyroidism post-CC. We recommend assessing thyroid profile 4 weeks after CC, particularly in patients who received an iCM dose greater than 8.7 gm/kg and/or exposed to fluoroscopy for more than 24 minutes.