Menoufia University Hospitals

Abstract Background Thyroid nodules are frequent in clinical settings. Accurate differentiation between benign and malignant lesions is essential for management. Although fine-needle aspiration cytology (FNAC) is the diagnostic reference standard, it is invasive, operator-dependent, and may yield inconclusive results. Ultrasound elastography has emerged as an adjunctive imaging technique that may increase diagnostic confidence and minimize the need for invasive procedures. Objectives To assess the diagnostic performance of ultrasound elastography in preoperative thyroid nodules evaluation and correlate it with histopathological outcomes. Methods This prospective study was conducted on 200 patients complaining of thyroid nodules (40 males and 160 females, aged 30–69 years). All patients underwent a comprehensive neck examination and laboratory evaluation, including thyroid function tests, prothrombin time, and complete blood count. Imaging evaluation included conventional and Doppler ultrasound, shear wave elastography, strain elastography, ultrasound-guided fine-needle aspiration biopsy with histopathological evaluation. Final diagnosis was established by histopathology in surgically treated nodules and by benign cytology with stable clinical and ultrasound follow-up in Bethesda II nodules. Results Malignant nodules demonstrated significantly higher shear wave elastography (SWE) parameters than benign nodules ( P < 0.001). The elasticity ratio (ER) showed superior diagnostic performance, with a cut-off value of 2.5 achieving an AUC of 96.3% (95% CI: 93.3–99.4), with 90.9 % sensitivity and 89.4% specificity. The strain index (SI) showed optimal diagnostic performance at a threshold value of 1.3 achieving an AUC 97%; (95% CI: 93.2–100), with a diagnostic sensitivity of 97% and specificity of 88%. Conclusions Ultrasound elastography demonstrates excellent diagnostic capability in distinguishing malignant from benign thyroid nodules. Its integration with conventional ultrasound may improve risk stratification and help reduce unnecessary FNAC or surgical procedures, particularly in low-to-intermediate risk (TI-RADS 3 and 4) nodules.

Abstract Introduction Transgender individuals on gender-affirming hormone therapy (GAHT) may have distinct cancer risks, and their perceptions of these risks and the adequacy of cancer screening counseling remain underexplored. Objective This study evaluates cancer concerns and perceptions of counseling among transgender adults on GAHT. Methods Transgender adults on GAHT for at least six months (N=55) completed questionnaires assessing perceptions of cancer risk and counseling. Perceived quality of cancer screening counseling was reported on a 5-point Likert scale (1 = Very poor, 5 = Very good). Results Among transfeminine participants (n=39), the mean perceived counseling quality was 2.97 (SD=1.50). Breast cancer was the most cited concern (41.0%), followed by prostate cancer (23.1%). Among transmasculine participants (n=16), the mean perceived counseling quality was 2.93 (SD=1.53). Breast (12.5%) and anal (12.5%) cancer were the most cited concerns. Conclusions Despite perceived adequacy of counseling, cancer risk perception among transgender individuals on GAHT may not align with their risk profiles. Transfeminine participants were concerned about breast cancer although literature indicates a lower risk than cisgender women. Fewer transfeminine participants expressed concern about prostate cancer, despite posing a risk. Tailored discussions and provider education are necessary to ensure screening recommendations reflect evidence-based risks and individual healthcare needs. Disclosure No

Background: Carpal tunnel syndrome (CTS) is the most common peripheral nerve compression disorder affecting the upper extremities worldwide. It develops as a result of median nerve compression at the wrist. Release of the transverse carpal ligament by an extended longitudinal incision is the classical performance of the open method. A variety of minimally invasive techniques were introduced for the purpose of preventing the classical method's complications. Transverse carpal ligament sectioning is typically performed with generic tools. A minimally invasive technique with short longitudinal palmar incision and an original knife was introduced by Avci and Sayli with satisfactory outcomes. This article analyzes the pain, healing, and the proximal incision complications of carpal tunnel release.Patients and Methods: A Prospective and retrospective study was conducted to evaluate the outcome of proximal incision in carpal tunnel syndrome release during the period from 12/2022 to 12/2024. The study included 32 patients. We used the pre- and post-operative Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), also referred to as the Levine scale, to evaluate the recruited participants.Results: Improvement of symptoms (burning, numbness, and worse night time pain) were noticed to all (32) operated patients. There was an extensive improvement of total pain and function score. No recurrence of symptoms for more surgery was reported by the patients. No other significant issues were identified.Conclusion: The proximal transverse incision for carpal tunnel release is superior because it isn't limited in practice. Pain is minimal and it heals fast with no significant complications. It also appears better, is less tense, and reduces the risk of problems with touch. The resolution of the symptoms was significant.

Potential properties of astaxanthin include immunomodulation, antioxidant, and anti-inflammatory effects. In diabetic rats, we examined the potential impacts and underlying mechanisms of astaxanthin on hippocampal DNA, cognition, and glycemic status. Rats were divided into five equal groups: non-diabetic, and diabetic (non-treated, metformin treated, astaxanthin treated, and treated with a combination of metformin and astaxanthin). Both spatial and non-spatial memory and learning were assessed. IL-6, malondialdehyde, total antioxidant capacity, lipid profile, and glycemic status were assessed. Phosphorylated tau expression level was measured, and H&E section analysis was used to evaluate the hippocampal tissue. DNA fragmentation, intact DNA, and hippocampal RNA were evaluated. Induction of diabetes led to a reduction in cognitive abilities along with significant hyperglycemia, dyslipidemia, oxidative stress, hyperphosphorylation of tau, and DNA fragmentation. Astaxanthin as monotherapy or in combination with metformin improved cognitive functions with reduction of hyperglycemia, dyslipidemia, oxidative stress, hyperphosphorylation of tau, and DNA fragmentation.

Abstract Introduction Advances in large language models (LLMs) have opened new avenues for healthcare applications. Recently, ChatGPT-4 successfully achieved the pass mark >80% in 5 of 10 sleep medicine examination domains, indicating a strong foundational knowledge of sleep medicine. However, the ability to answer USMLE-type multiple-choice questions may not equate to the capacity to offer accurate and comprehensive answers to clinical queries or real-world case scenarios. Current literature exhibits a significant gap in validation research examining the clinical utility of LLMs in evidence-based medicine practice. This investigation aims to evaluate the potential usefulness and reliability of LLMs as adjunctive clinical decision-support tools (namely, “curbside consultants”) in sleep medicine. Methods Six clinical sleep queries and six case scenarios were presented to 6 LLMs including 3 general-purpose LLMs (ChatGPT-4o, Gemini-1.5-Pro, and Llama-3.1-405B) and 3 medical-specialized LLMs (OpenEvidence, Clara AI, and MediGPT). Performance assessment was conducted independently utilizing two independently developed 5-point Likert scales evaluating two primary domains: answer content (accuracy, relevance, comprehensiveness/depth, clarity/coherence, and unique insightfulness) and reference quality (accuracy, relevance, currentness, comprehensiveness/depth, and searchability). Benchmark answers were established through consensus among four sleep medicine specialists. Analysis of variance was used to compare the performance of the LLMs. Results The medical LLMs demonstrated superior overall performance compared to the general LLMs (P< 0.001). The primary distinction was observed in reference quality metrics, where medical LLMs significantly outperformed general LLMs across all parameters: accuracy, relevance, and searchability (p< 0.001), currentness (p=0.001), and comprehensiveness/depth (p=0.010). Notably, Open Evidence achieved the highest reference quality (p< 0.001). In contrast, the answer content analysis revealed no significant overall differences between medical and general LLMs (p=0.659). Most answer content-related metrics, including accuracy, relevance, or unique insightfulness, did not differ significantly (p>0.050). An exception was clarify/coherence, where medical LLMs were superior to general LLMs (p=0.030). Furthermore, MediGPT and ChatGPT-4o displayed better content comprehensiveness/depth relative to other LLMs (p< 0.001). These two LLMs exhibited comparable performance in overall metrics (p=0.615), answer contents (p=0.922), and reference quality (p=0.621). Conclusion Both medical-specialized and general-purpose LLMs show promise as adjunctive decision-support tools in clinical practice. However, substantial improvements in reference quality are critically needed across most LLM platforms. Support (if any)

Abstract Introduction Upper airway patency is lost in obstructive sleep apnea (OSA). Research has primarily focused on the role of genioglossus muscle on maintaining airway patency. The stylopharyngeus muscle is an upper airway dilator muscle that supports the lateral pharyngeal wall. Its role in maintaining upper airway patency and effects on respiratory airflow is theoretical (Dewald, 2022) but functionally understudied. We hypothesize that bilateral transection of the stylopharyngeus muscles disrupts normal breathing. This study aims to assess the impact stylopharyngeus muscles have on respiratory airflow in conscious freely moving adult rodents. Methods Adult male Sprague Dawley rats were divided into two groups: 1) bilateral stylopharyngeus muscle transection (n=4) and 2) sham (muscle was exposed) surgery (n=2). Respiratory airflow was acquired using whole- body plethysmography before and 1 day after surgery. Epochs of stable breathing (minimum of 1 min) were selected from the airflow tracings for analysis using SPIKE CED. Results Significant alterations in respiratory airflow and tracings, particularly a flattening (plateau) in inspiratory flow, were observed on the first post-operative day in the transection group versus an early peak seen in the pre-operative airflow tracings. The average length of the inspiratory plateau among the transection group (0.23 ± 0.12s) was a 9-fold increase compared to the pre-operative values (0.02 ± 0.12s). The sham group did not exhibit a plateau and showed no significant changes in inspiratory airflow. Conclusion Bilateral stylopharyngeus muscle transections disrupt airflow in a conscious rodent model. The transections produce a flattening of the inspiratory airflow similar to inspiratory flow limitation traces seen in humans with upper airway resistance and OSA. Our results support the hypothesis that stylopharyngeus muscle plays a vital role in shaping respiratory airflow. Support (if any) This research was funded by divisional funds from department of pulmonary, critical care, and sleep medicine, Case Western Reserve University. E.H. is supported by The Japanese Respiratory Society Fellowship Grant.

INTRODUCTION: Sacral neuromodulation (SNM) is a well-established, minimally invasive therapy for the treatment of bowel and urinary dysfunction. SNM implantation carries the risk of postoperative surgical site infections (SSI s), as well as associated device explant or reoperation. Historically, mesh envelopes for antibiotic delivery have been utilized during implantation of cardiac electronic devices. The TYRX envelope, a Medtronic product, is a dissolvable mesh pouch used to locally deliver minocycline and rifampin. TYRX technology has been shown to reduce infection rate when used for cardiac electronic devices, and limited data suggests its utility when used for implantation of SNM devices. OBJECTIVE: The primary objective was to compare the rate of postoperative SSI and device explant in cases with and without TYRX envelope use. METHODS: This was a retrospective cohort study utilizing the Premier Healthcare Database. Patients were identified as having undergone SNM placement between January 2016 and March 2020 using CPT codes. The patients were grouped by those who received a TYRX envelope and those who did not, as identified by TYRX charge code. Patient characteristics, surgical information and postoperative complications within 3 months and 1 year were collected. Antibiotic administration at time of placement was categorized as cephalosporins, current AUA guidelines (Gram positive + broad Gram-negative coverage), or Other. Patients with and without TYRX charge code were matched via greedy nearest neighbor matching using a propensity score calculated from baseline characteristics. RESULTS: The study included 250 patients with TYRX envelopes and 250 matched patients. After propensity score matching, the groups were statistically similar based on demographics, preoperative characteristics and preoperative antibiotics. There were a total of 2 postoperative SSI in the group without TYRX and 0 in the group with TYRX, but no statistically significant difference in SSI noted between groups (p=0.48). Patients without TYRX were more likely to have undergone SNM removal at 3 months (7.6% vs. 1.2%, p=0.001) and 12 months postoperatively (10% vs. 1.6%, p<0.001). CONCLUSIONS: TYRX envelope use at time of SNM implant is not associated with a reduction in surgical site infections but is associated with a reduction in SNM removal within 1 year (Table 1).

The use of artificial intelligence (AI) in spinal surgery is expanding, yet its ability to match the diagnostic and treatment planning accuracy of human surgeons remains unclear. This study aims to compare the performance of AI models-ChatGPT-3.5, ChatGPT-4, and Google Bard-with that of experienced spinal surgeons in controversial spinal scenarios. A questionnaire comprising 54 questions was presented to ten spinal surgeons on two occasions, four weeks apart, to assess consistency. The same questionnaire was also presented to ChatGPT-3.5, ChatGPT-4, and Google Bard, each generating five responses per question. Responses were analyzed for consistency and agreement with human surgeons using Kappa values. Thematic analysis of AI responses identified common themes and evaluated the depth and accuracy of AI recommendations. Test-retest reliability among surgeons showed Kappa values from 0.535 to 1.00, indicating moderate to perfect reliability. Inter-rater agreement between surgeons and AI models was generally low, with nonsignificant p-values. Fair agreements were observed between surgeons' second occasion responses and ChatGPT-3.5 (Kappa = 0.24) and ChatGPT-4 (Kappa = 0.27). AI responses were detailed and structured, while surgeons provided more concise answers. AI large language models are not yet suitable for complex spinal surgery decisions but hold potential for preliminary information gathering and emergency triage. Legal, ethical, and accuracy issues must be addressed before AI can be reliably integrated into clinical practice.

To study the incidence of malignancy as well as neoplasia in the appendicectomy specimens routinely sent for histopathology. We conducted this retrospective cohort study of 947 patients diagnosed with acute appendicitis with subsequent appendectomy in the period between 1 January 2018 and 31 December 2022 (5 years) at Ibra hospital, North Sharqiya, Sultanate of Oman. We analyzed the clinical data of the cohort including demographic information, diagnosis, pre-operative imaging, histological diagnosis and incidence of malignancy in appendicectomy specimens. The median age of patients was 36.4 years (range 13-80 years). The male-to-female ratio in the appendicectomy cohort was 1.03:1. Post-operative histology revealed out of 947 cases just 8(0.8%) cases were diagnosed as cancer. Acute appendicitis 851(89.9%) and negative appendicectomy 88(9.3%). The incidental identification of appendiceal cancers in the resected specimens after acute appendicitis is not uncommon. It is recommended to consider such diagnosis when dealing with acute appendicitis in older patients with longer symptom history and in the presence of peri-appendiceal mass.

BackgroundGastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder characterized by diverse symptoms and lesions impacting the esophagus and adjacent regions, resulting from the backward flow of stomach contents into the esophagus. Eosinophilic esophagitis (EoE) has become a significant alternative diagnosis for persons with persistent GERD symptoms. This study aims to assess the prevalence of EoE in Egyptian patients who inadequately react to GERD treatments.MethodsEsophageal tissue samples were collected from all patients exhibiting persistent GERD symptoms. EoE was identified based on esophageal mucosal biopsies showing at least 15 eosinophils per high-power field (HPF) and symptoms suggestive of esophageal dysfunction, following the exclusion of other causes of eosinophilia.ResultsThirty hundred patients with persistent GERD symptoms were included in this study. These patients were divided into two groups: those diagnosed with EoE (n = 12) and those without this condition (n = 288). Dysphagia (p = 0.012), occult blood in stool (p = 0.024) and H. pylori antigen (p = 0.013) were significantly in favour of patients with eosinophilic oesophagitis and these factors were predictors of eosinophilic oesophagitis (p < 0.05).ConclusionThe prevalence of eosinophilic esophagitis (EoE) among Egyptian patients with refractory GERD was found to be 4%, indicating that EoE is relatively uncommon type of esophagitis. EoE showed a notable association with dysphagia, occult blood in stool and Hpylori infection which are considered predictors of this type of esophagitis.