Tanta University Hospital

Childhood obesity is a pressing global health issue with potential implications for musculoskeletal injury risk and recovery. Although the influence of obesity on bone metabolism is acknowledged, its specific connection to the incidence, patterns, and treatment results of long bone fractures in the pediatric demographic requires further clarification. This systematic review aims to evaluate the existing literature on the relationship between obesity and long bone fractures in children and adolescents, with a focus on fracture risk, anatomical distribution, management approaches, and clinical outcomes. We conducted a systematic literature search of PubMed, MEDLINE, Cochrane Library, and Google Scholar for studies published from January 2000 to March 2025. Search terms included “childhood obesity”, “bone health”, and “long bone fractures”. We included English-language original research that analyzed the relationship between pediatric obesity (BMI ≥ 95th percentile) and long bone fractures. Data on study characteristics, fracture patterns, treatments, and outcomes were extracted. Out of 2,152 articles screened, 14 met the inclusion criteria. Children who were overweight or obese had higher odds of lower extremity fractures, particularly of the tibia and femur (odds ratios 1.5–3.3). Obesity was linked to more complex fracture patterns, including physical involvement and displacement, and a higher failure rate of nonsurgical management, especially for forearm and supracondylar fractures. Operative complications, such as varus deformity and pin-related issues, were more frequent in obese patients. However, no consistent differences were observed between obese and non-obese groups regarding mortality and long-term functional outcomes. Pediatric obesity significantly elevates the risk and complexity of long bone fractures and complicates both nonoperative and surgical management. Acknowledging these challenges is crucial for optimizing treatment and preventing adverse outcomes. Further multicenter prospective studies are needed to clarify the underlying biomechanical and metabolic mechanisms and to guide the development of individualized management protocols. Systematic Review, Level III.

The current study attempted to investigate the effect of hydroxyapatite nanofibers (HANFs) added in different percentages upon the qualities of glass ionomer cement (GIC): fracture toughness, vickers microhardness and fluoride release. Synthesis and characterization of hydroxyapatite nanofibers were carried out before being added to the powder of high-viscosity conventional GIC in three varied weight ratios (1, 3 and 5%) resulting into 3 experimental groups which were next compared with basic GIC as a control group. Fracture toughness, Vickers microhardness and fluoride release on day1 and day 7 were evaluated. Results indicated significant improvement in fracture toughness, microhardness and fluoride release of GIC modified by hydroxyapatite nanofibers at varied tested ratios and this increase was directly proportional to their ratio of addition. According to these findings, glass ionomer cement modified with hydroxyapatite nanofibers in varying proportions could be a dependable restorative material with enhanced fracture toughness, microhardness and fluoride release.

In pediatric oncology, totally implantable venous access devices (TIVADs), or ports, are frequently used for long-term intravenous therapy. While insertion-related complications are well documented, difficulties during removal are rare but clinically significant. A retrospective review involved 851 pediatric patients underwent port removals between July 2012 and July 2024. Patient demographics, insertion site, catheter dwell time, and removal techniques were analyzed, with a focus on catheter removal-related complications. Removal was uncomplicated among 830 patients (97.5%). However, 21 patients (2.5%) experienced complications due to catheter adherence or migration. These cases required additional interventions, including extensive dissection (n = 10), controlled venotomy (n = 5), interventional radiology (n = 5), and guidewire-assisted stenting (n = 1). The mean catheter dwell time of the port devices in this cohort prior to removal was 39.35 months. Two patients experienced migrated fragments, which were successfully removed. One patient experienced bleeding during venotomy, which was successfully treated. Long-term central venous catheters removal is often complicated by peri catheter adhesions and calcification. Owing to the risk of significant complications, removal should be performed only when clinically indicated and preferably in specialized centers with access to interventional radiology and cardiac surgery. Comprehensive informed consent is a critical prerequisite for this procedure. This study offers practical guidance for clinicians and an open avenue for future research on preventative strategies and optimized removal protocols.

Aims: Evaluating the Role of Biodegradable Drug-Eluting Stents in Enhancing Outcomes after Frontal Endoscopic Sinus Surgery. Study Design: Prospective case control study. Place and Duration of Study: The Department of Otorhinolaryngology in Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia, and Helwan University Hospital (Badr Hospital), Egypt. From March 2025 to December 2025. Methodology: A total of 42 adult participants were enrolled and randomly assigned to either the Propel stent group (n=21) or the control group (n=21). Participants were monitored for nine months through clinical and radiographic evaluations, focusing on outcomes such as patency of the ostium, presence of adhesions, and recurrence of polyps. Results: After nine months, the Propel stent group exhibited significantly higher ostium patency rates compared to the controls. Additionally, lower rates of stenosis, retained secretions, adhesions, and polyp formation were observed in the Propel stent group. Conclusion: Propel stents significantly enhance frontal sinus patency and reduce the occurrence of postoperative adhesions and polyp recurrence in comparison to non-drug-eluting stents.

IntroductionDrowning is a leading cause of mortality in children worldwide. Near-drowning is a state of survival after asphyxia due to submersion in water. Drowning-related incidents have significantly increased in developed countries. Even survivors suffer from various long-lasting morbidities. Early prediction of mortality and morbidly life-threatening events is life-saving and guides decision-making in such critical situations. This study aimed to identify early predictors of mortality and other unfavorable outcomes (hypoxic brain injury and respiratory failure necessitating mechanical ventilation) in children diagnosed with near-drowning.MethodsThis retrospective cross-sectional study enrolled 247 children who nearly drowned and were admitted to National Guard Hospitals, Saudi Arabia, between 2,015 and 2024. The studied patients were categorized into two groups: patients with favorable outcomes and those with unfavorable outcomes. The all-subset regression method was employed to identify the best predictors for the investigated outcomes.ResultsThe death rate and incidence of brain insults constituted 15% each, while 25% of the investigated patients were complicated by respiratory failure. Most admissions (60%) occurred in the summer, and 86% of drownings occurred at swimming pools. Death was significantly associated with greater prehospital delay (time from exposure until arrival at emergency services) (p < 0.05). A proposed model that exhibited a performance of 92% identified the Glasgow Coma Scale score on admission as a significant predictor of brain insults. Significant predictors of mortality included lower bicarbonate levels [adjusted odds ratio (OR) = 0.598, p < 0.001], higher sodium levels (adjusted OR = 1.802, p < 0.001), lower chloride levels (adjusted OR = 0.721, p = 0.008), and greater red cell distribution width (adjusted OR = 2.158, p = 0.009).ConclusionThis study identified several available laboratory markers as early predictors of mortality in pediatric near-drowning patients. These markers help to identify patients at increased risk of life-threatening events when combined with established clinical predictors. This study emphasized the critical roles of prehospital factors, initial clinical presentation, and physiological derangements in pediatric near-drowning patients. The observed findings highlight possible areas accessible for public health interventions, including intensifying preventive measures at night, in the summer, and in swimming pools. Offering optimum on-scene resuscitation and rapid hospital transfer are other recommended actions expected to be associated with fewer adverse events.

Background: Fluid resuscitation is a cornerstone of early management, yet excessive fluid administration leading to positive cumulative fluid balance (CFB) has been linked to adverse outcomes. This study aimed to evaluate the effect of 72-hour CFB on mortality and length of ICU stay in sepsis patients.Methods: This retrospective analysis included 80 adult sepsis patients (age 20-60 years) admitted to Tanta University Emergency Hospital between July and December 2020 who required fluid resuscitation. Patients with chronic renal failure, heart disease, liver failure, massive edema, on mechanical ventilation, or with ICU stays of less than 24 hours were excluded. CFB was calculated as total fluid input minus total fluid output over the first 72 hours. Results: The mean 72-hour CFB was 2393.07 ± 1241.11 mL. Non-survivors had a significantly higher mean 72-hour CFB (3497.47 mL) compared to survivors (2024.93 mL) (p < 0.001). A 72-hour CFB cutoff of 2650 mL predicted mortality with 80% sensitivity and 73.3% specificity (AUC 0.847, p < 0.001). Significant negative correlations were observed between CFB and urinary output (r=-0.739, p<0.001), HCO3 (r=-0.366, p=0.001), pH (r=-0.689, p=0.001), and WBC (r=-0.300, p=0.007). . Higher CFB was significantly associated with the development of ARDS (p = 0.005) and the need for mechanical ventilation (p < 0.001), but not with AKI or the length of ICU stay.Conclusion: Positive cumulative fluid balance within the first 72 hours of sepsis diagnosis is a significant predictor of mortality and is associated with increased risk of ARDS and the need for mechanical ventilation.

Lumbar spine surgery is often associated with intense postoperative pain. We compared ultrasound guided erector spinae plane block (ESPB) and modified thoracolumbar interfascial plane block (mTLIP) in patients undergoing lumbar spine surgeries under general anesthesia. The primary outcome was total postoperative fentanyl requirements. The secondary outcomes included pain score at rest and during movement, time of first postoperative analgesic request, and opioid side effects. One hundred eighty patients scheduled for spine surgeries under general anesthesia were enrolled in this randomized trial. They were randomized to receive ESPB, mTLIP, or not receive any block (control group). Blocks were done by injecting 20 mL of 0.5% ropivacaine mixed with 2 mcg/ml adrenaline. Postoperative fentanyl (mcg) was significantly higher in the group C in comparison with the ESPB and the mTLIP groups P < 0.001; however, it was comparable between the ESPB and the mTLIP groups (P = 0.08). Also, Numerical Rating Scale (NRS) scores either during rest or during movement was higher in the early postoperative hours in the group C; however, both the block groups provide comparable NRS scores either during rest or during movement with P > 0.05 at all time intervals during the first 24 h. Both ultrasound guided ESPB and mTLIP decrease the perioperative amount of fentanyl consumption and provide comparable pain scores at rest and during movement during the first postoperative 24 h in lumbar spine surgeries.

Introduction: Intestinal obstruction is a frequent surgical emergency in children, yet rare and atypical etiologiesmay pose significant diagnostic and therapeutic challenges. Rapid identification and timely surgical managementare crucial to prevent bowel ischemia and adverse outcomes.Patients and methods: This retrospective case series reviewed eight children treated for uncommon causes ofintestinal obstruction at Tanta University Hospital between January 2021 and January 2025. Patient demographics,clinical presentation, imaging, operative findings, and outcomes were analyzed.Results: The study included patients ranging in age from the neonatal period to 14 years. The etiologies identifiedwere strangulated Morgagni hernia, pyloric web, jejunal phytobezoar, ileal atresia associated with omphaloceleminor, Peutz–Jeghers syndrome with solitary ileal polyp, Meckel’s diverticulum with mesodiverticular band,ascending colonic atresia, and sigmoid volvulus. The exact cause of obstruction was often uncertain before surgeryand confirmed intraoperatively in most cases. Each patient underwent definitive operative correction tailored to theunderlying pathology. Postoperative recovery was smooth in seven patients; one developed a wound complicationthat resolved after re-exploration. There were no deaths, and all children demonstrated favorable long-termoutcomes on follow-up.Conclusion: Uncommon causes of intestinal obstruction can closely mimic more frequent conditions, leadingto diagnostic delay. A high index of suspicion, careful imaging interpretation, and early surgical interventionare essential for successful management. Reporting such rare entities broadens clinical understanding, improvesdiagnostic awareness, and enhances perioperative decision-making in pediatric surgical practice.

Aluminum phosphide (ALP) is a highly toxic pesticide endangering the healthcare system. Higher central venous pressure (CVP) values may be linked to poorer outcomes in various medical conditions. This study evaluated the role of CVP and mean arterial pressure (MAP)/CVP ratio as prognostic factors for intensive care unit (ICU) admitted acute ALP-poisoned patients. This retrospective study included 145 acutely ALP-poisoned patients who were referred to the ICU during two years. Data regarding history, clinical manifestations, laboratory investigations, and outcome were collected and stratified by quartiles (Q1-Q4) of the measured CVP during the first 6 h after admission. In-hospital mortality and need for mechanical ventilation (MV) were significantly predominant in Q3 and Q4 groups of CVP levels (89.4% and 92% & 91.5% and 96%, respectively) (p-values < 0.001). After vasopressors administration, survivors demonstrated a significant mean reduction in CVP measurements (–4.5 mmHg), whereas non-survivors had a mean increase (+ 0.6 mmHg) (p = 0.011). MAP/CVP ratio has good discriminatory power (the areas under the curve (AUCs) = 0.836 and 0.846) for predicting the need for MV and in-hospital mortality, respectively. The CVP measurement (AUCs = 0.812 and 0.782, respectively) comes in second, followed by the poisoning severity score (AUCs = 0.778 and 0.768, respectively). There was a significant decrease in survival probability in patients with CVP ≥ 25 mmHg, and MAP/CVP ratio ≤ 2.48 (p-values < 0.001). Lower MAP/CVP ratios and higher CVP measurements are alarming signs, warranting a higher risk of the need for MV and in-hospital mortality in acute ALP poisoning.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1007/s12012-026-10103-0.

Tirzepatide, a dual Glucose-dependent Insulinotropic Polypeptide (GIP) and Glucagon-Like Peptide-1 (GLP-1) receptor agonist. Tirzepatide was first approved by the FDA for type 2 diabetes in May 2022 and subsequently for obesity in November 2023, and has demonstrated significant efficacy in glycemic control and weight reduction. Beyond its metabolic benefits, recent evidence highlights its relevance in dermatology. This review explores the dermatologic implications of tirzepatide, including its cutaneous adverse effects, therapeutic potential in inflammatory skin diseases, and cosmetic benefits. Cutaneous side effects such as hypersensitivity reactions, injection-site reactions, and rare severe dermatologic events have been documented. Across the SURPASS clinical trials, injection-site reactions occurred slightly more frequently, comparable to other GLP-1 receptor agonists as semaglutide. Meanwhile, tirzepatide's immunomodulatory properties suggest potential therapeutic roles in conditions like psoriasis and hidradenitis suppurativa; however, current evidence is limited to case reports and small studies. Additionally, its profound effects on fat distribution raise interest in its cosmetic implications. Tirzepatide's induced rapid weight loss may lead to aesthetic changes, including facial volume loss, which warrants cautious interpretation. This narrative review summarizes current data from clinical trials, case reports, and pharmacovigilance sources, based on a literature search of PubMed, Scopus, and Google Scholar up to May 2025, focusing on skin-related adverse events, therapeutic effects, and cosmetic outcomes of tirzepatide.