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  • 1
    In: Open Access Macedonian Journal of Medical Sciences, Scientific Foundation SPIROSKI, Vol. 8, No. B ( 2020-10-22), p. 1071-1076
    Kurzfassung: BACKGROUND: Minimally invasive nephrectomy is considered a technically challenging procedure requiring a long learning curve to reach acceptable warm ischemia time and perioperative complications. These minimally invasive techniques result in a shorter hospital stay and less post-operative pain. AIM: This study aims to demonstrate the National Cancer Institute experience regarding the benefits of laparoscopic and robot-assisted nephrectomy over open technique. METHODS: This is a retrospective descriptive cohort study including 62 patients with renal masses treated with nephrectomy whether partial, total or radical, 26 cases were treated by minimally invasive techniques (8 robotic and 18 laparoscopic), while 36 cases were treated by open technique. Inclusion criteria were patients between 20 and 70 years with renal neoplasm without renal vein thrombosis, with tumor stage T1 or T2 N0 M0. Exclusion criteria were patients with medical comorbidities that preclude surgical management or minimally invasive techniques and patients refusing surgery in general. RESULTS: Minimally invasive nephrectomy resulted in shorter hospital stay (mean hospital stay was 2.2 days for the minimally invasive group and 3.6 days for the open group) and less post-operative pain than open technique (p 〈 0.001 and = 0.002, respectively), while open technique resulted in shorter operation time (p = 0.039, mean operation time 147.8 min compared to 184.8 in the minimally invasive group). CONCLUSION: Minimally invasive nephrectomy (laparoscopic and robotic) resulted in less post-operative pain and shorter hospital stay compared to open technique despite consuming longer operation time which may be decreased by improving the learning curve of operating surgeons.
    Materialart: Online-Ressource
    ISSN: 1857-9655
    Sprache: Unbekannt
    Verlag: Scientific Foundation SPIROSKI
    Publikationsdatum: 2020
    ZDB Id: 3032255-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
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    Scientific Foundation SPIROSKI ; 2019
    In:  Open Access Macedonian Journal of Medical Sciences Vol. 7, No. 17 ( 2019-08-20), p. 2829-2837
    In: Open Access Macedonian Journal of Medical Sciences, Scientific Foundation SPIROSKI, Vol. 7, No. 17 ( 2019-08-20), p. 2829-2837
    Kurzfassung: BACKGROUND: The spinal epidural space, covering the dural sac, is located along the posterior longitudinal ligament anteriorly, the ligamentum flavum and the periosteum of laminae posteriorly, and the pedicles of the spinal column by the intervertebral foramina containing their neural elements laterally. It could be affected variably by different types of diseases, either as primary lesions or as an extension from a disease process in the nearby tissues and organs. AIM: We aimed to present clinically and surgically patients with spinal epidural masses operated in the Neurosurgery Department of Cairo University Hospitals, Cairo, Egypt, along a time interval of one year. METHODS: In this prospective cohort study, we analysed motor deficits, sensory deficits, and bowel and bladder dysfunction. We have performed decompressive laminectomy on 19 patients with spinal epidural masses together with mass excision as long as the tumour was accessible, with or without fixation. RESULTS: All patients were radiologically assessed by MRI over the affected side of the spine. D10 was the commonest site in our study to be affected in 10 cases of our participants (23%), followed by D5, D7, and D12 each of them was affected in 6 cases (14%), in another word spinal segments by order of frequency to be affected were dorsal followed by lumbar spine. All patients included in this study (100%) showed an obvious improvement as regard pain and tenderness. CONCLUSION: Surgical interventions have improved the quality of life for our patients with spinal epidural masses.
    Materialart: Online-Ressource
    ISSN: 1857-9655
    Sprache: Unbekannt
    Verlag: Scientific Foundation SPIROSKI
    Publikationsdatum: 2019
    ZDB Id: 3032255-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
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    Scientific Foundation SPIROSKI ; 2022
    In:  Open Access Macedonian Journal of Medical Sciences Vol. 10, No. B ( 2022-05-19), p. 1432-1439
    In: Open Access Macedonian Journal of Medical Sciences, Scientific Foundation SPIROSKI, Vol. 10, No. B ( 2022-05-19), p. 1432-1439
    Kurzfassung: Background: Uterine fibroids are the most common benign tumors in women. Their clinical presentation includes menorrhagia, metrorrhagia, lower abdominal pain and infertility. Treatment of uterine fibroids includes medical management, surgical resection known as myomectomy as well as minimally invasive options like uterine artery embolization. Uterine artery embolization can be done via unilateral or bilateral femoral arterial access. We aim to define the differences between unilateral and bilateral femoral access in concern to radiation dose, procedure time , fluoroscopy time as well as the number of angiographic images. Methods: A total of 48 patients were divided into two groups equally; one with a unilateral femoral access and the other group with a bilateral femoral arterial access. Results: The age of the patients ranged between 25 to 40 years, embolization was done with calibrated spheres. Bilateral procedures compared to the unilateral ones had less fluoroscopy times (8.6 minutes vs 24.3 mins) , less total procedure time (28.4 minutes vs 54.4 minutes) and less dose area product (155 Gy cm2 vs 340.5 Gy cm2) as well as less mean number of angiographic images (93.8 vs 176.5) with no significant difference in puncture site complications. Conclusion: Fluoroscopy times, procedure times, number of angiographic images as well as radiation dose were significantly lower in the bilateral approach with no significant difference in the rates of puncture site complications between the two approaches. Keywords: Uterine Artery Embolization, uterine fibroids, unilateral versus bilateral access.
    Materialart: Online-Ressource
    ISSN: 1857-9655
    Sprache: Unbekannt
    Verlag: Scientific Foundation SPIROSKI
    Publikationsdatum: 2022
    ZDB Id: 3032255-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
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    Scientific Foundation SPIROSKI ; 2019
    In:  Open Access Macedonian Journal of Medical Sciences Vol. 7, No. 15 ( 2019-08-13), p. 2447-2451
    In: Open Access Macedonian Journal of Medical Sciences, Scientific Foundation SPIROSKI, Vol. 7, No. 15 ( 2019-08-13), p. 2447-2451
    Kurzfassung: BACKGROUND: The growing needs to extract cardiovascular implantable electronic devices warrants the need to improve the outcome and prevent complications. AIM: This study aims to analyse the findings and identify factors associated with complications of Percutaneous Transvenous Lead Extraction in the Critical Care Department, Cairo University. METHODS: We studied 52 candidates for Percutaneous Transvenous Lead extraction of a Permanent Pace Maker (PPM) regarding extraction indications, comorbidities, device type, complications and outcome. Extraction was first attempted by simple manual traction using regular non-locking stylet and if failed, locking stylet, and evolution dilator sheath were used. RESULTS: We extracted 110 leads with a mean lead age of 4.67 ± 3.6 years. The most common extraction indication was an infection (71.15%). Indications correlated significantly with comorbidities (p = 0.024), the most common being Diabetes Mellitus (40.38%). Simple traction was successful in 31 % of the leads, while 69% were extracted using locking stylet and evolution dilator sheath. The method of lead extraction correlated significantly with lead age (P ≤ 0.001). Complications were significantly higher with extraction by evolution dilator sheaths than by simple traction (P = 0.003) and in older patients (P = 0.008). Complications also correlated significantly with extractions indications (p = 0.012), type of PPM (P = 0.037), number of extracted leads (P = 0.041), and lead age (p= 0.011). CONCLUSION: Among the studied variables, extraction indications particularly infection, was the only preventable factor significantly associated with complications. While focusing on preventable factors, improving, implantation and extraction techniques should also be addressed.
    Materialart: Online-Ressource
    ISSN: 1857-9655
    Sprache: Unbekannt
    Verlag: Scientific Foundation SPIROSKI
    Publikationsdatum: 2019
    ZDB Id: 3032255-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
    In: Open Access Macedonian Journal of Medical Sciences, Scientific Foundation SPIROSKI, Vol. 9, No. B ( 2021-08-03), p. 793-796
    Kurzfassung: BACKGROUND: Paresthesia with intrathecal anesthesia occurs when the entry of the needle causes an uncomfortable pain, burning, or electric sensation that usually radiates to the buttocks or legs. The importance of avoiding paresthesia is to lower the risk of postoperative neurological problems, in addition to reducing the incidence of that unpleasant sensation. The majority of reported occurrences of nerve injury caused by spinal anesthesia were preceded by paresthesia during the spinal anesthesia needle insertion. To the best of our knowledge, no studies have been done to compare the incidence of paresthesia in cesarean sections using median and paramedian routes to provide spinal anesthetic. AIM: Our study aimed to compare the incidence of paresthesia in the median and paramedian approaches of intrathecal anesthesia to predict its association with nerve injury. METHODOLOGY: Two hundred-ninety-six parturients scheduled for elective cesarean sections under spinal anesthesia were in the study from November 2020 to January 2021. They were divided into two groups. The median group (n = 157) and the paramedian group (n = 135) according to the approach used for providing spinal anesthesia. The incidence of paresthesia was compared between both groups. The number of trials in each approach and the occurrence of postoperative neurological complications (for example: nerve injury, paraplegia, or foot drop) were also documented. RESULTS: The sample size was calculated based on a pilot study that was conducted before the original study. The calculated sample size was based on an alpha error of 0.05 and 90% power. The incidence of paresthesia was higher in the median group (10.7%) than the paramedian (3.7) group with statistical significance (p = 0.039). In both groups, no postoperative neurological problems were noted in any groups. CONCLUSION: The median group has significantly more incidence of paresthesia than the paramedian group. The significance of this finding is that the paramedian approach is expected to be less likely to cause neurologic problems during spinal anesthesia.
    Materialart: Online-Ressource
    ISSN: 1857-9655
    Sprache: Unbekannt
    Verlag: Scientific Foundation SPIROSKI
    Publikationsdatum: 2021
    ZDB Id: 3032255-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
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    Scientific Foundation SPIROSKI ; 2022
    In:  Open Access Macedonian Journal of Medical Sciences Vol. 10, No. D ( 2022-01-03), p. 14-27
    In: Open Access Macedonian Journal of Medical Sciences, Scientific Foundation SPIROSKI, Vol. 10, No. D ( 2022-01-03), p. 14-27
    Kurzfassung: BACKGROUND: This trial aims to study the difference between prostheses screwmented on full-arch implants using the intraoral luting cement technique on titanium bases versus transmucosal abutments in terms of prosthetic complications. MATERIALS AND METHODS: Twenty patients were recruited in this trial, there were mainly two groups. A screw-retained full-arch implant-supported prosthesis was constructed over four dental implants on upper or lower jaws. For the control group, multiunit abutments were used to construct a screw-retained prosthesis. As for the experimental group, Ti-base abutments were used over the dental implants to construct a screw-retained prosthesis. In both groups, the prosthetic framework was made using polyether ether ketone (PEEK) material and luted intraorally over the titanium sleeve using resin cement. A binary outcome of prosthetic complication was taken in 6 and 12 months. Abutment screw loosening, prosthetic screw loosening, prosthetic screw fracture, abutment screw fracture, veneer fracture, framework fracture, Ti-base decementation, and overall prosthetic loosening were the prosthetic complications included in the trial. RESULTS: At the end of the study, a total of 19 patients adhered to the trial. Throughout the exposure process of implants, two implants failed in one patient from the Ti-base group. This patient was excluded from the study on his request. There was no statistically significant difference present between Ti-base and multiunit abutment groups in terms of abutment and prosthetic screw loosening, abutment and prosthetic screw fracture, veneer and framework fracture, Ti-base decementation, and overall prosthesis loosening for 6 and 12 months. Data were explored for normality using Kolmogorov–Smirnov and Shapiro–Wilk tests, data showed non-parametric (not-normal) distribution. Qualitative data were presented as frequencies and percentages. Wilcoxon and Mann–Whitney tests were used to compare the qualitative outcomes in this study. CONCLUSION: Both multiunit and Ti-base are considered a viable line of treatment to construct a screw-retained full arch implant-supported prosthesis.
    Materialart: Online-Ressource
    ISSN: 1857-9655
    Sprache: Unbekannt
    Verlag: Scientific Foundation SPIROSKI
    Publikationsdatum: 2022
    ZDB Id: 3032255-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
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    Scientific Foundation SPIROSKI ; 2021
    In:  Open Access Macedonian Journal of Medical Sciences Vol. 9, No. B ( 2021-06-26), p. 480-485
    In: Open Access Macedonian Journal of Medical Sciences, Scientific Foundation SPIROSKI, Vol. 9, No. B ( 2021-06-26), p. 480-485
    Kurzfassung: Background: Pneumonia is a common cause of Intensive care unit (ICU) admission, requiring frequent imaging for following up parenchymal lung involvement and antibiotic response. Being bedside and non-invasive technique; lung ultrasound (US) is increasingly used in ICU. Objectives: Assessing accuracy of lung ultrasound in detecting parenchymal lung recovery following antibiotic administration in critically ill patients with pneumonia. Methods: Fifty patients with pneumonia were included in the study with time-dependent analysis for APACHEII, CURB-65 and modified CPIS. Lung US at day 0 described basal lung condition then according to changes in lung parenchyma, US score could be first calculated at day 3. At day 5 US score was calculated again and changes in score (delta score) was calculated to asses ability of US to predict early good antibiotic response and finally lung US was repeated at day 7, score calculated to detect lung parenchyma recovery and compared with follow up CT for accuracy and agreement. Air bronchogram was reported whenever seen, described as static or dynamic and assessed in follow up examinations to be compared with CT follow up. Results: Lung US score ranged from -2 to 17 with mean value of 8.75 ± 3.88 for improving patients, while worsening patients showed lung US score of -11 to -20 with mean value of -10.08 ± 6.95 with high statistical significance (p 〈 0.001).The best cutoff value of lung US score changes for detecting good response to antibiotic was 2.5, detected using area under the curve (AUC) (p 〈 0.001). Ultrasound score on day seven showed excellent sensitivity and specificity of 91.89% and 92.31% respectively when compared to CT with PPV of 97.14% and NPV 80% and accuracy 92% with strong statistical significance (p 〈 0.001). Air bronchogram showed sensitivity of 61.5% and specificity of 89.1% and with PPV of 66.67% and NPV of 86.84% and accuracy of 82% and moderate agreement (0.52) with CT while B-lines were significant for assessing lung reaeration with sensitivity of 69.2% and specificity of 67.5% and accuracy of 68% but with fair (0.31) agreement with CT (p 〈 0.027) in detecting parenchymal lung recovery. Conclusion: Lung US is a reasonable bedside method for quantifying parenchymal lung recovery in patients with pneumonia who are successfully treated with antibiotics.
    Materialart: Online-Ressource
    ISSN: 1857-9655
    Sprache: Unbekannt
    Verlag: Scientific Foundation SPIROSKI
    Publikationsdatum: 2021
    ZDB Id: 3032255-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
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    Scientific Foundation SPIROSKI ; 2021
    In:  Open Access Macedonian Journal of Medical Sciences Vol. 9, No. B ( 2021-08-17), p. 878-884
    In: Open Access Macedonian Journal of Medical Sciences, Scientific Foundation SPIROSKI, Vol. 9, No. B ( 2021-08-17), p. 878-884
    Kurzfassung: Background: We intended in this study to evaluate the impact of the different techniques of unprotected left main coronary artery (ULMCA) stenting on the clinical outcomes. Methods: The study included 65 patients with ACS and left main disease subjected to UPLMCA intervention [46 males (70.8%) with median(Q1-Q3) age of 63(53-70) years old] in an observational prospective cohort study. Data were collected through reviewing patient’s medical records and angiographic procedures. Angiographic assessment included evaluation of Syntax II score, EURO II score, and TIMI flow grading. The primary outcome was the major adverse cardiac and cerebral events (MACCE) at 1 year while the secondary outcomes included the development of acute kidney injury (AKI), one year mortality, and need for CABG post PCI. Results: One-year MACCE was 46.2 % when the angle between LAD and LCX was 〉 70o compared to 81.5% when it was less than 70o (P=0.008). The wide angle was also associated with 0% 1-year mortality compared to 18.5% for narrow angle, a difference which is statistically significant (P=0.03). The 1-year MACCE was 35.7% compared to 74.4% when it was not used (P=0.013). When POT was used, the 1-year MACCE was 47.6% compared to 75% when it was not used (P=0.041). None of the other studied parameters including those related to procedure technique was significantly affecting the outcome in our study. Conclusion: We concluded that the non-use of FKI nor POT together with the lower angulation between LAD and LCX could predict worse clinical outcome at one-year in unprotected left main PCI.
    Materialart: Online-Ressource
    ISSN: 1857-9655
    Sprache: Unbekannt
    Verlag: Scientific Foundation SPIROSKI
    Publikationsdatum: 2021
    ZDB Id: 3032255-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
    In: Open Access Macedonian Journal of Medical Sciences, Scientific Foundation SPIROSKI, Vol. 9, No. B ( 2021-12-09), p. 1640-1646
    Kurzfassung: Background: Evidence supporting environmental risk factors of autism spectrum disorder (ASD) is rising. Phthalates are assumed to contribute to this risk due to their extensive use in daily life as plasticizers and additives in numerous customer products. Phthalates are also accused as a neurotoxic agent affecting brain development. Aim: The main objective of this study is to compare the concentrations of urinary phthalate metabolites as biomarkers of phthalate exposure in children with autism to that of a healthy control group and to compare their exposure to suspected environmental sources of phthalate. Methods: It was a case-control study; conducted over a period of one year. Thirty-eight children with ASD and 99 apparently healthy children comprised the control group, were enrolled in the study. Urinary concentrations of four phthalate metabolites were measured, using a combination of solid phase extraction, high pressure liquid chromatography, and tandem mass spectrometry. Results: Children with ASD comprised 38 children (32 boys and 6 girls), their mean age was 8.95 + 4.17 years. There were significant higher levels of urinary Mono (2ethylhexyl) phthalate (MEHP), mono benzyl, and mono butyl phthalates in cases vs. controls with p value equals (0.006, 0.017 and 〈 0.001) respectively. Regression analysis revealed that male gender and the level of mono butyl are the main predictors of ASD (p 〈 0.001). Conclusion: This study suggested a link between phthalates and ASD with higher urinary levels of phthalate metabolites in children with ASD. These high levels are either due to increased exposure or defective metabolism in children with ASD. The study declined any relationship of the studied sources of phthalate exposure to ASD except the exposure to wall painting with plastic.
    Materialart: Online-Ressource
    ISSN: 1857-9655
    Sprache: Unbekannt
    Verlag: Scientific Foundation SPIROSKI
    Publikationsdatum: 2021
    ZDB Id: 3032255-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
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    Scientific Foundation SPIROSKI ; 2018
    In:  Open Access Macedonian Journal of Medical Sciences Vol. 6, No. 6 ( 2018-06-06), p. 955-960
    In: Open Access Macedonian Journal of Medical Sciences, Scientific Foundation SPIROSKI, Vol. 6, No. 6 ( 2018-06-06), p. 955-960
    Kurzfassung: BACKGROUND: Preclinical studies have demonstrated that renin-angiotensin system (RAS) signalling has strong tumour-promoting effects and RAS inhibition was associated with improvement in the overall survival in some cancer types including hepatocellular carcinoma (HCC).OBJECTIVE: We aimed to investigate the effect of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-II-receptor blockers (ARBs) on the survival of mice with diethylnitrosamine (DEN) induced HCC.METHODS: HCC was induced by weekly i.p. administration of DEN. Mice were treated with sorafenib (SO) (30 mg/kg), perindopril (PE) (1 mg/kg), fosinopril (FO) (2 mg/kg), losartan (LO) (10 mg/kg), PE (1 mg/kg) + SO (30 mg/kg), FO (2 mg/kg) + SO (30 mg/kg), or LO (10 mg/kg) + SO (30 mg/kg). Survival analysis was done using the Kaplan-Meier method, and the log-rank test was used for assessing the significance of difference between groups.RESULTS: The administration of PE, FO and LO as monotherapy or as combined with SO resulted in marked improvement in the liver histologic picture with no impact on overall survival of mice.CONCLUSION: Interfering the RAS either through the inhibition of ACE or the blockade of angiotensin II type 1 (AT1) receptors has similar effects on the liver of DEN-induced HCC mice and is not associated with longer survival due to detrimental effects of DEN on other organs. Hence, repetitive administration of DEN in such models of HCC is not suitable for mortality assessment studies.
    Materialart: Online-Ressource
    ISSN: 1857-9655
    Sprache: Unbekannt
    Verlag: Scientific Foundation SPIROSKI
    Publikationsdatum: 2018
    ZDB Id: 3032255-8
    Standort Signatur Einschränkungen Verfügbarkeit
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