Mansoura University Hospital

» Chronic Charcot arthropathy results from the convergence of genetic predisposition (OPG/RANKL/RANK polymorphisms), metabolic disturbances (AGEs, vitamin D deficiency affecting 84.2% of patients), and inflammatory dysregulation (RANKL/OPG axis, IL-17 family cytokines), explaining why only 0.08-1% of diabetic neuropathy patients develop this devastating complication.» The receptor activator of nuclear factor kappa-B ligand (RANKL)/receptor activator of nuclear factor kappa-B (RANK)/osteoprotegerin (OPG) axis dysregulation drives excessive osteoclastogenesis and bone resorption in the acute phase, while impaired Wnt/β-catenin signaling and advanced glycation end products-modified collagen compromise healing quality in the chronic phase, resulting in malunion and permanent deformity.» Magnetic resonance imaging is the best non-invasive imaging modality for differentiating chronic Charcot from osteomyelitis (single bone involvement beneath ulcer, sinus tract, and abscess favor infection; periarticular distribution favors Charcot), though bone biopsy remains the gold standard when diagnostic uncertainty persists.» Current management relies primarily on mechanical interventions (accommodative footwear, bracing, surgical reconstruction for unbraceable deformities), but emerging molecular therapies targeting RANKL (denosumab), pro-inflammatory cytokines (IL-17 inhibitors), and Wnt pathway (romosozumab) show promise for disease modification.» Integrated risk stratification models combining genetic risk scores, serum biomarkers (RANKL/OPG ratio, vitamin D levels), and clinical factors can identify high-risk individuals (AUC 0.89), enabling targeted preventive interventions including vitamin D supplementation, prophylactic off-loading, and potentially pharmacological prevention.

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.

Background: Emergency department (ED) visits have increased exponentially in many countries, leading to overcrowding. This overcrowding results in delays in care across most EDs and has been associated with poorer outcomes, including increased morbidity and mortality. Triage algorithms were developed and widely implemented in EDs worldwide to identify patients requiring resources and to allocate those resources appropriately. However, despite the use of algorithms, the care delivery remains highly variable. Machine learning (ML) models have been developed to improve clinicians’ predictive ability to identify high-risk patients and to improve resource allocation in EDs globally. This systematic review and meta-analysis, therefore, outlines the current evidence on the efficacy of artificial intelligence (AI) in predicting patients’ clinical deterioration in the ED. Methodology: A comprehensive literature search was conducted across five electronic databases—ScienceDirect, PubMed, Google Scholar, CENTRAL, and EMBASE—to identify all relevant articles published up to February 2025. Data were extracted from the studies that met the inclusion criteria, and the reported outcomes were pooled using the MedCalc statistical software. Results: A total of 743 articles were identified through the literature search; however, only nine met the inclusion criteria and were thus included in the review. We pooled the area under the receiver operating characteristic curve (AUROC) of ML models for predicting the occurrence of in-hospital cardiac arrest (IHCA) and observed a pooled Area Under the Curve (AUC) of 0.909 (95% CI: 0.889–0.929; p < 0.001). The models showed high predictive ability for the other clinical deterioration outcomes in the ED. However, we were unable to pool the results because only a limited number of studies reported these different outcomes. Conclusion: Our systematic review and meta-analysis found that ML models have a high predictive ability in identifying patients at risk of clinical deterioration in the ED. However, limited data exist on the additional benefits clinicians gain from incorporating AI into routine ED patient care. Moreover, although many models have been developed, further studies are needed to evaluate their clinical utility.

Hürthle cell carcinoma (HCC) -recently known as oncocytic carcinoma- is a rare type of differentiated thyroid cancer that presents a diagnostic and therapeutic challenge because of its morphological heterogeneity and uncertain biological behavior. This retrospective single-center cohort study included all the patients with HCC who underwent surgical treatment in our center from January 2009 to May 2024. The epidemiological, clinical, and oncological data of the included patients were analyzed. This study included nineteen cases of HCC (9 males and 10 females). The average age at diagnosis was 54.8 ± 12.2 years. Preoperative fine needle aspiration cytology (FNAC) classified 2 tumors as Bethesda I, 7 as Bethesda III, 6 as Bethesda IV, and 4 as Bethesda V. A variety of surgical procedures were used, including hemithyroidectomy in 3 patients and total thyroidectomy in 12 patients. Two patients underwent neck dissection. The median tumor size was 6.7cm. Pathological evaluation identified 9 patients with unifocal lesions and 10 with multifocal lesions. Only one patient showed positive lymph node involvement. The median times to death, distant metastasis, and locoregional recurrence were 4, 13, and 6 years, respectively. For locoregional recurrence, the restricted mean survival time (RMST) at five years was 4.4 years (95% CI 3.9-4.9), 4.6 years (95% CI 4.1-5.0) for distant metastasis, and 4.1 years (95% CI 3.6-4.5) for overall survival. There was a trend towards worse prognosis in females, younger age, and those with primary surgery outside the center. These differences did not achieve statistical significance, at least partly due to the small sample size. Diagnosing HCC remains challenging due to its overlapping features with other thyroid conditions, making fine-needle aspiration cytology less definitive. Surgical treatment remains the preferred therapeutic option. Age, gender, and the volume of the surgical center for the initial procedure can influence patient outcomes, particularly recurrence and survival rates.

Abstract Background Intradural spinal tumors, though rare, pose significant surgical challenges due to risks of mislocalization and neurological deficits. Intraoperative ultrasound (IOUS) offers real-time visualization to enhance resection accuracy, yet its utility compared to traditional methods remains understudied. The study aims to evaluate the feasibility of IOUS in improving visualization, localization, and complete excision of intradural spinal tumors (intramedullary/extramedullary). This was a Prospective observational descriptive study conducted on a total of 40 patients in Mansoura University Hospitals, Department of Neurosurgery from May 2022 to May 2024. Results Mean age was 42.6 ± 13.8 years; 52.5% were female. IOUS and MRI concordantly detected GTR in 77.5% (31/40). Residual tumor was identified by IOUS in 22.5% (9/40) versus MRI in 22.5%. Postoperative complications occurred in 22.5% (9/40), predominantly motor weakness. Vascularity assessment revealed poor (32.5%), average (35%), and high (27.5%) perfusion. Tumor echogenicity varied by pathology: hyperechoic (schwannomas, meningiomas), hypoechoic (ependymomas), and heterogeneous (astrocytomas). Modified McCormick scores improved significantly at follow-up (79.5% grade 1 vs. 17.5% preoperatively, p < 0.001). Conclusion IOUS enhances surgical precision by delineating tumor margins, guiding durotomy/myelotomy, and reducing residual tumor rates. It is cost-effective, minimizes spinal cord injury, and correlates strongly with postoperative MRI findings.

Intraarticular fractures of the phalanges and thumb base are challenging to manage due to the risks of stiffness and loss of motion. The Suzuki pins and rubbers traction system provides dynamic external fixation that maintains reduction while allowing early mobilisation. No prior systematic review and meta-analysis (SRMA) has comprehensively evaluated its outcomes. This study aimed to summarise radiographic union, functional recovery and complication rates to inform clinical decision-making. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines, MEDLINE and Embase were searched from 1994 to October 2025. Eligible studies included ≥5 patients with intraarticular phalangeal or thumb fractures managed using the Suzuki frame. Primary outcomes included range of motion (ROM), union rate and grip strength. Data extraction was performed in Microsoft Excel (Microsoft Corporation, Redmond, WA, US), screening in Rayyan and analysis in OpenMetaAnalyst, using fixed or random effect models with 95% CIsand Cochran's Q and I² tests. Twelve studies (183 patients, 185 fractures) were included in the analysis. The pooled union rate was 97.8% (95% CI 0.95 - 1.00, p<0.001). Functional recovery was favourable; pooled proximal interphalangeal joint (PIPJ) range of motion (RoM) was 89.6 degrees (95% CI 88.4 - 90.7, p<0.001). Distal interphalangeal joint (DIPJ) ROM was 66.0 degrees (95% CI 64.6 - 67.4, p<0.001), and grip strength was 81.2% (95% CI 78.3 - 84.0, p<0.001). Pin site infection rate was 10.3% (95% CI 0.0 - 0.2, p<0.001), and joint space narrowing was 5% (95% CI 0.0 - 0.1, p<0.05). Post-traumatic arthritis occurred in 2.7%. Pain was minimal (visual analogue scale (VAS) <2). The Suzuki traction system achieves high union, satisfactory ROM and low complication rates in intraarticular digital fractures. Maintaining traction for four to six weeks optimises healing. Its minimally invasive design enables early motion and supports functional recovery and quality of life.

In this prospective cross-sectional study (2019-2023), 162 obese adults undergoing bariatric surgery were enrolled. CAP was performed prior to intraoperative wedge liver biopsy. Histological grading of steatosis and NAS scoring were conducted by blinded pathologists. Diagnostic accuracy of CAP was evaluated using AUROC, sensitivity, specificity, PPV, and NPV. Hepatic steatosis was present in 63.6% of patients by liver biopsy. CAP overestimated steatosis in 40% of biopsy-confirmed S0 cases, misclassifying them as S3. CAP cutoff of 286 dB/m for ≥ S1, sensitivity, specificity, PPV, and NPV were 57.7%, 65.0%, 76.3%, and 44.1%, respectively (AUROC = 0.577). Only 14.2% had steatohepatitis. Multivariate analysis identified albumin (p = 0.040) and hemoglobin (p = 0.018) as independent protective factors. CAP significantly overestimated steatosis severity highlighting its limited reliability in obese populations.

Background. Chronic migraine (CM) is a debilitating condition with limited options for effective prophylactic treatment. Greater occipital nerve block (GONB), particularly when performed under ultrasound guidance, has emerged as a promising interventional approach for migraine prophylaxis. Objective. To evaluate the safety and efficacy of ultrasound-guided bilateral GONB in the management of CM. Methods. This prospective interventional study included 30 patients diagnosed with CM who underwent ultrasound-guided bilateral GONB using lidocaine, bupivacaine, and dexamethasone. Migraine frequency, pain severity, attack duration, and migraine-related disability were assessed at baseline and three months after the intervention. Results. At baseline, all participants (100%) had severe migraine-related disability. Three months after GONB, 79% of patients had no or only mild disability (p ≤ 0.001). Pain severity shifted from predominantly severe (VAS scores 8–10) to predominantly mild or moderate (VAS scores 1–3) (p ≤ 0.001). The median duration of migraine attacks decreased from 24 hours to 4 hours (p ≤ 0.001), and the median monthly attack frequency decreased from 14 to 3 attacks (p ≤ 0.001). No serious complications were observed. Conclusion. Ultrasound-guided bilateral GONB appears to be a safe and effective treatment option for CM, resulting in significant reductions in migraine frequency, severity, duration, and disability.