Artificial Intelligence machine learning and conventional physical therapy for upper limb outcome in patients with stroke: a systematic review and meta-analysis.

OBJECTIVE: The goal of this study was to compare the effect of different artificial intelligence (AI) machine learning and conventional therapy (CT) on upper limb impairments in patients with stroke. MATERIALS AND METHODS: PubMed, PubMed Central, Google Scholar, MEDLINE, Cochrane Library, Web of Science, Research Gate, and Wiley Online Library were searched. Descriptive statistics about variables were reported to calculate standardized mean differences in outcomes of motor control (the primary outcome), functional independence, upper extremity performance, and muscle tone. The Physiotherapy Evidence Database (PEDro) Scale was used to assess qualitative papers. The primary outcomes of AI and CT have been included in the meta-analyses. RESULTS: Ten papers with a total of 481 stroke patients were included and upper limb rehabilitation, upper limb functioning, and basic manual dexterity were examined. The heterogeneity test of the whole included measures (I2=45%) was medium. There were significant differences between the included measures (p-value=0.03) with a total SMD of 0.10 [0.01, 0.19]. According to the test for subgroup difference, it was found that there was a highly significant difference between the subgroups of the included measures (p-value=0.01) and the heterogeneity test (I2=59.8%). CONCLUSIONS: AI is a feasible and safe method in post-stroke rehabilitation and improves upper-extremity function compared to CT. Significant AI post-treatment effects on upper-limb impairments have been observed. The findings showed that higher-quality evidence was detected in six assessment scales. However, a lower quality of evidence was detected in other scales. This indicated large or very large and consistent estimates of the treatment effects, and researchers were confident about the results. Therefore, the included observational studies are likely to provide an overestimate of the true effect.

Incidence of Guillain-Barré Syndrome post COVID-19: a systematic review of case reports and case series.

OBJECTIVE: The purpose of this systematic review was to study the incidence, risk factors and patients subjected to Guillain-Barré syndrome (GBS) after COVID-19. MATERIALS AND METHODS: For qualitative assessment and assessing the methodological quality, the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) checklist were utilized. Data from PubMed, Cochrane, Embase, CINAHIL, Medline, ResearchGate, and Scopus were searched. The relevant studies involved patients with confirmed COVID-19 diagnosis by RT-PCR, and GBS diagnosis based on typical clinical symptoms and/or confirmatory diagnostic results. A total of 12 English relevant articles (6 papers were case reports and 8 were case series with a total of 32 patients) published in a peer-reviewed journal from 2019 to 2021 were included. Following the review methodology, two independent raters were responsible for retrieving, extracting and checking for data eligibility. Demographic characteristics are presented as frequencies and percentages. Based on distribution of values, continuous data were expressed as median and interquartile range (IQR). RESULTS: Out of 32 patients, 26 patients reported neurological symptoms, 6 cases went unnoticed, 7 cases showed involvement of the cranial nerves, 12 cases did not, and 13 cases went unreported. CONCLUSIONS: It is too early to draw any conclusions concerning a potential relationship between SARS-CoV-2 infection and GBS. More large-scale observational studies are required to understand the pathogenesis of SARS-CoV-2-associated GBS and to demonstrate a definite causal relationship between GBS and SARS-CoV-2 infection.

Hepatic resection in cirrhotic liver for treatment of hepatocellular carcinoma in Egyptian patients. Experience with 140 cases in a single center.

BACKGROUND/AIMS: In many centers hepatic resection is still the treatment of choice for hepatocellular carcinoma in cirrhotic liver. Several factors affect the prognosis; one of them is the extent of resection. This study retrospectively evaluates outcome after different types of hepatic resection in cirrhotic liver. METHODOLOGY: Hepatectomy was performed in 245 patients. From them, 140 patients were subjected to hepatic resection for hepatocellular carcinoma in cirrhotic liver. According to the type of resection the patients were divided into three groups (A, B and C), major resection (group A) in 79 (56.3%), segmental resection (group B) 31 (22.1%) and localized resection (group C) in 30 (21.4%). Early postoperative mortality and morbidity as well as long-term survival and recurrence were assessed. RESULTS: The overall hospital mortality rate was (8.6%) with total complications 26%, recurrence rate 32.8% and median survival was 24 months (3-120). Group A showed high incidence rate of hospital mortality, total complications and hepatic cell failure than the other two types (p>0.05). On the other hand, group C patients showed high incidence of wound infection and recurrence rate after hepatic resection than the other two types (p>0.05). At the end of the study, the median survival was 18 months (4-120), 24 months (3-48) and 24 months (3-120) for the three groups respectively without significant difference. The overall 5-year survival rate was 20%, 0% and 15.3% for the three groups respectively (p>0.05). CONCLUSIONS: Although major liver resection in cirrhotic liver has high incidence of early mortality and morbidity, it gives low incidence of recurrence and better survival in comparison with segmental and localized resection. However it has to be reserved for large tumor in good liver and early cirrhosis.

Is resection for large hepatocellular carcinoma in cirrhotic patients beneficial? Study of 38 cases.

BACKGROUND/AIMS: Hepatocellular carcinoma in cirrhotic patients generally carries a poor prognosis either due to recurrence or to postoperative morbidity or both. Several factors affect the prognosis of hepatocellular carcinoma resection as presence of cirrhosis of the liver, tumor diameter and tumor capsulation. METHODOLOGY: Thirty-eight patients with large hepatocellular carcinoma greater than 5 cm with a background of cirrhotic liver were divided into two groups according to tumor diameter. Group A (n = 20) with tumors less than 10 cm in diameter, and group B (n = 18) with tumors larger than 10 cm. All patients underwent preoperative investigations including clinical laboratory tests, sonography, computed tomography, selective angiography and upper gastrointestinal endoscopy. All patients were subjected to different types of hepatic resection. RESULTS: A significant difference in tumor size, capsulation, and operation time were recorded between the two groups, of patients. No significant difference was detected between both groups regarding sex, age, viral markers, pathologic features, and Child classification. Hospital mortality occurred in 5% versus 11.1% of both groups, respectively. Postoperative jaundice and ascitis occurred in 30%, 35% versus 44.4%, 72.0%, respectively (P < 0.005, P < 0.04). Late mortality occurred in 65% of patients in group A and in 77% of group B. Recurrence was detected in 42% of group A and 62% in group B. Recurrence after resection in capsulated tumors was significantly lower than in noncapsulated tumors in group A (P < 0.01), but not significant in group B. Also, survival rate in patients with capsulated tumors was significantly better in both groups (P < 0.01) than that with noncapsulated tumors. CONCLUSIONS: Resection of hepatocellular carcinoma with diameter larger than 10 cm recorded bad prognosis regarding recurrence and mortality rates than tumors less than 10 cm. However, capsulated tumors gave better postoperative prognosis than noncapsulated ones.

Hepatocellular carcinoma in Mansoura-Egypt: experience of 385 patients at a single center.

BACKGROUND/AIMS: Hepatocellular carcinoma is one of the commonest malignancies in the world. The two main etiological factors for hepatocellular carcinoma are cirrhosis and viral hepatitis. Although the first choice of treatment for hepatocellular carcinoma is surgical resection, most of them are unresectable at the time of diagnosis. METHODOLOGY: From January 1994 to June 1999, 385 patients with hepatocellular carcinoma were presented to the Gastroenterology surgical center, Mansoura University, Egypt and subjected to similar diagnostic process. Forty-five (11.6%) of these patients (34 males and 13 females) with a mean age of 50.9 years (+/- 7.53 years) were subjected to different types of hepatic resection. RESULTS: The underlying liver pathology was cirrhosis in 85%. Positive virology was found in 82.5% (HCV 61%, HBV 14.5% and combined 7%). The main presentation were asymptomatic in 144 (37.4%) patients, abdominal pain in 92 (23.9%) patients, ascites in 95 (24.6%) patients, jaundice in 53 (14%) patients and upper gastrointestinal hemorrhage in 26 (6.75%) patients. Only 45 (11.6%) were resectable, they were subjected to hepatic resection with operative mortality in 2 cases (4.4%) and with overall mortality in 29 (64.4%) cases after 48 months (32.8 +/- 19 months) of follow-up. The main causes of late mortality were recurrence in 14 (31.1%) cases, hepatic cell failure in 7 (15.5%) cases and other causes in 6 (13.3%). CONCLUSIONS: Hepatocellular carcinoma is now a common malignancy in Egypt, which usually develops on top of cirrhosis of viral origin in 82%. Hepatic resection is the only method of treatment with a low resectability rate.

Correlation of serum hepatitis C virus RNA titre with aminotransferases and liver histopathological findings in HCV-seropositive cases with end-stage chronic liver disease.

The quantity of circulating hepatitis C virus (HCV) RNA, aminotransferases and the degree of liver cell injury in relation to HCV serotype have not been fully studied. In this work, we estimated the HCV RNA titre in serum and correlated the findings with levels of aminotransferases, gamma glutamyltransferase (GGT), and liver histopathological changes and with HCV serotype. HCV RNA was found in 22 out of 30 HCV-seropositive cases included in this study (73. 3%) and serotype 4 represented 90.9% (20/22). Levels of aminotransferases and GGT correlated with the levels of serum HCV RNA. Noticeably, GGT showed the highest positive correlation with the level of HCV RNA. Liver histopathological findings of 15 patients showed that eight had hepatocellular carcinoma and seven had cirrhosis. There was no significant difference between these two groups regarding levels of enzymes or serum HCV RNA titre.

Fundal varices: problem and management.

BACKGROUND/AIMS: The pathophysiology of gastric varices may be due to generalized or segmental portal hypertension. A considerable debate has arisen regarding the role of injection sclerotherapy in the pathogenesis of gastric varices. METHODOLOGY: During the period from 1987 to 1997, a total of 1686 cases with bleeding varices were presented to our center and 225 cases (13.3%) with bleeding gastric varices were diagnosed. There were 198 males and 27 females with a total mean age of 45.7 years (+/- 7.6). Primary fundal varices (FV) were found in 121 (54%) cases and secondary FV were found in 104 (46%) cases. All patients with isolated FV presented with repeated attacks of upper gastrointestinal bleeding. RESULTS: The pathological diagnosis was studied in 120 cases; it was schistosomal in 8.3% of cases, non-schistosomal in 33.3% of cases, and mixed (Schistosomal with post viral cirrhosis) in 58.3% of cases. Seventy-five cases were subjected to splenectomy and gastroesophageal decongestion (SGED), 64 cases were subjected to distal splenorenal shunt (DSRS), and 86 cases were subjected to sclerotherapy. Mortality after DSRS was 7.8%, after SGED it was 12%, and after sclerotherapy it was 21%. Rebleeding was the major complication and occurred in 3% after DSRS, in 13% after SGED, and in 18% of cases after sclerotherapy. CONCLUSIONS: Gastric varices are not an uncommon condition as a cause of upper gastrointestinal bleeding. Our findings support the hypothesis that gastric varices may be considered a late sequel of injection sclerotherapy, though they may also be considered as one of the pathophysiologies of generalized portal hypertension. Finally, DSRS was found to be the treatment of choice in the management of fundal varices.

Comparison of amplicor and 32-kilodalton PCR for detection of Mycobacterium tuberculosis from sputum specimens.

The commercial PCR test Amplicor was compared with the 32-kDa PCR for detection of Mycobacterium tuberculosis from 76 sputum specimens from Egyptian patients. Both tests performed with rather equal efficacy (resolved sensitivity of 88.9% for both tests; specificity of 98.0% for Amplicor and 93.9% for 32-kDa PCR). PCR was found to be useful in detection of auramine fluorescent stain-positive, culture-negative specimens.

Use of biplane transesophageal echocardiography as the only imaging technique for percutaneous balloon mitral commissurotomy.

Percutaneous balloon mitral commissurotomy with the Inoue technique was attempted in 9 patients with rheumatic mitral stenosis under the sole guidance of biplane transesophageal echocardiography and was completed in 8 patients. This preliminary experience points to the feasibility and relative safety of performing percutaneous balloon mitral commissurotomy under the sole guidance of biplane transesophageal echocardiography.

Ten years of experience with patients with chronic active liver disease variceal bleeding: ablative versus selective decompressive therapy.

BACKGROUND: Variceal hemorrhage is an added major threat to survival in patients with chronic active liver disease (CALD). The hemodynamic consequences of surgical therapy and the continued activity of the underlying liver disease both contribute to the hepatic dysfunction and determine patient survival. METHODS: Two hundred and seventy two consecutive cases of (Child A or B) variceal bleeding with chronic hepatitis were surgically treated during a 10-year period. Histologic chronic active hepatitis (CAH) was documented in 160 (59%) patients, whereas chronic persistent hepatitis (CPH) was evident in 112 (41%). The applied surgical procedure was distal splenorenal shunt (DSRS) in 99 (36%) patients, splenectomy and gastroesophageal devascularization (SGD) in 108 (40%), and splenectomy with left gastric ligation (SLGL) in 65 (24%) patients. The preoperative data base obtained on these patients was matched comparing the three surgical modalities within each pathologic group (p > 0.05). RESULTS: The operative mortality was low among the patients with CAH (DSRS, 5.1%; SGD, 4.2%) with no deaths occurring in the CPH group. Among the individuals with CAH, recurrent variceal hemorrhage occurred significantly (p < 0.05) more often after SLGL (26%) and SGD (17%) than after DSRS (5%). Sclerotherapy rescued 93% (SGD) and 70% (SLGL) of the patients with rebleeding. DSRS significantly (p < 0.05) increased the risk of encephalopathy (28%) compared with SGD (4.2%) and SLGL (8%). The morbidity rates were quite low among the patients with CPH with no significant (p > 0.05) differences noted when the three surgical modalities were compared. Both groups experienced a significant (p < 0.05) increase in aspartate aminotransferase levels after the three procedures with a significant (p < 0.05) increase in bilirubin level occurring only after DSRS. The 5-year survival rate for the patients with variceal bleeding with CAH was 76% (DSRS), 73% (SGD), and 88% (SLGL). The leading causes of death were liver failure after DSRS (70%), variceal hemorrhage after SLGL (60%), and equally divided between septicemia (43%) and liver failure (43%) after SGD. The patients with CPH had a better 5-year survival of 89% (DSRS) and 100% (nonshunt operation). CONCLUSIONS: These data showed that (1) CALD is common among cases of variceal bleeding; (2) elective surgical treatment of variceal hemorrhage in patients with Child A or B CALD has a low operative mortality; (3) SLGL backed up by sclerotherapy is a better surgical alternative to either selective shunt or SGD in patients with active hepatitis, and (4) both DSRS and nonshunt operation are equally good surgical options for patients with CPH.

Clinico-immunogenetic study on Egyptian multicase tuberculous families.

Thirteen multicase Egyptian families (having more than one sib affected) with pulmonary tuberculosis have been studied. They include 26 parents (4 were tuberculous) and 53 sibs (30 tuberculous and 23 healthy). For all of them the following have been carried out: (a) Clinical, radiological, and bacteriological examination for diagnosis and evaluation of the disease severity; HLA-antigen determination using 9(A), 16(B) and 6(DR) antigens. The analysis of data revealed: (1) high incidence of tuberculosis among sibs in families having A2 B5 in their haplotypes compared to those having A2 X or B5 X--affected sibs with A2 B5 showed more severe manifestations than those having only one of the two antigens; (2) aggregation of HLA concordance among the sib pairs, both fully identical and haploidentical, while none of the sib pairs is non-identical; (3) Lod score studies showed linkage between the genetic control of susceptibility to pulmonary tuberculosis and HLA; (4) identity by descent study confirms the dominant pattern of transmission. The recommendation is that in a clinical setting of genetic counselling healthy individuals having either A2 or B5 antigens in their haplotypes should be vaccinated with BCG. Furthermore tuberculous patients having these HLA antigens should be managed aggressively, especially those having A2 B5 haplotypes in whom the disease is likely to run a severe course.

Should both schistosomal and nonschistosomal variceal bleeders be disconnected?

Splenopancreatic disconnection (SPD) was conceived and implemented as a technical addition to distal splenorenal shunt (DSRS) to maintain its selectivity and preserve portal perfusion. The proposed hemodynamic and metabolic stability of hepatocytes after DSRS-SPD should improve survival. In this nonrandomized study, 145 consecutive (Child A/B) variceal bleeders were electively subjected to selective shunt with DSRS in 93 and DSRS-SPD in 52 patients. The 2 groups were similar before surgery with a mean follow up of 24 +/- 12 (DSRS) and 27 +/- 14 (DSRS-SPD) months. DSRS-SPD had an operative mortality of 3.8%. Postoperative pancreatitis occurred in 7.7% after DSRS-SPD and 3.2% after DSRS alone, with schistosomal hepatic fibrosis representing 86% of morbid cases. Shunt patency was high and recurrent variceal hemorrhage was low in both groups. Clinical encephalopathy was significantly reduced after DSRS-SPD (p less than 0.05). The addition of SPD significantly reduced both the incidence of chronic hyperbilirubinemia in the schistosomal patients (p less than 0.05) and the difference between the changes in total serum bilirubin in all patients (p = 0.001). Portal perfusion was preserved after DSRS-SPD in all of the angiographically-studied patients. The overall survival was 84% after DSRS and 88% after DSRS-SPD. The schistosomal patients showed an incidence of 95% and 96% survival after DSRS and DSRS-SPD, respectively. DSRS-SPD was able to improve survival (92%) better than DSRS (77%) among well-matched nonschistosomal patients. These data show: (1) DSRS-SPD still has low operative mortality and a high patency rate with a low incidence of recurrent variceal hemorrhage, (2) DSRS-SPD maintains portal perfusion, achieves better survival, and reduces the incidence of encephalopathy, especially in patients with nonalcoholic cirrhosis and mixed liver disease, (3) in the schistosomal population, DSRS-SPD reduces the incidence of chronic hyperbilirubinemia but increases the risk of postoperative pancreatitis.

Selective shunt versus nonshunt surgery for management of both schistosomal and nonschistosomal variceal bleeders.

This clinical study included 219 (Child A/B) consecutive variceal bleeders. Electively 123 had distal splenorenal shunt (DSRS) and 96 had splenectomy with gastroesophageal devascularization (S&GD). Liver pathology was documented in 73% of patients, with schistosomal fibrosis in 41% and nonalcoholic cirrhosis or mixed pattern (fibrosis and cirrhosis) in 59%. The surgical groups were similar before operation, with a mean follow-up of 82 +/- 13 and 78 +/- 18 months, respectively (range, 60 to 120 months). The two pathologic populations were also similar before each and both procedures. The operative mortality rates were low, with incidences of 3.3% (DSRS) and 3.1% (S&GD). Rebleeding occurred significantly (p less than 0.05) more frequently after S&GD (27%) compared to DSRS (5.7%). Sclerotherapy salvaged 65% of S&GD rebleeders. Encephalopathy developed significantly (p less than 0.05) more after DSRS (18.7%) compared to S&GD (7.3%), with no significant difference among the current survivors. The difference in overall rebleeding and encephalopathy rates between both procedures was statistically related to patients with cirrhosis and mixed lesions (p less than 0.05). Distal splenorenal shunt significantly reduced the endoscopic variceal size more than S&GD (p less than 0.05). Prograde portal perfusion was documented in 94% of patients in each group, with a variable distinct pattern of portaprival collaterals in 91% (DSRS) and 65% (S&GD). The total population cumulative survival was similar with 80% for DSRS and 79% for S&GD (plus sclerosis in 23%), with hepatic cell failure the cause of death in 46% and 50%, respectively. However, in the schistosomal patients, survival was better improved after DSRS (90%) compared to S&GD (75%), with no difference among the cirrhotic and mixed group (DSRS 73%, S&GD 72%). In conclusion (1) both DSRS and S&GD have low operative mortality rates, (2) DSRS is superior to S&GD in the schistosomal patients, and (3) S&GD backed by endosclerosis for rebleeding is a good surgical alternative to selective shunt in the nonalcoholic cirrhotic and mixed population.

Schistosomal versus nonschistosomal variceal bleeders. Do they respond differently to selective shunt (DSRS)?

The distal splenorenal shunt (DSRS) was performed in 125 consecutive variceal bleeders. To date, no patients have been lost to follow-up (mean of 79 +/- 20 months). Liver pathology was documented in 85 patients: 45 patients had schistosomal hepatic fibrosis, 17 had nonalcoholic cirrhosis, and 23 had mixed pattern (hepatic fibrosis and cirrhosis). The preoperative data base for these three groups was matched (p greater than 0.05), with a mean follow-up of 79 +/- 20, 70 +/- 14, and 77 +/- 22 months for each population, respectively. The results showed low operative mortality (4.8%), high cumulative patency rate (94.8%) and low recurrent variceal hemorrhage (5.6%). The biochemical data showed significant increase in serum bilirubin (p less than 0.001) and aspartate transaminase (AST) (p less than 0.05) in the nonschistosomal patients. Chronic hyperbilirubinemia was found in 33% of the schistosomal group. Prograde portal perfusion was detected in 94% of the patients, with development of collaterals in 91%. The angiographic pattern of these collaterals was 50% pancreatic, 45% gastric, and 26% colosplenic. Patients with mixed liver disease had a high incidence of Grade III portal perfusion (57%) and more common pancreatic and gastric collaterals (71%). The cumulative survival for all patients was 74.1%, with hepatic cell failure being the leading cause of death (13 patients, 50% of all deaths). The schistosomal patients had a 91.6% incidence, whereas the cirrhotic and mixed groups had survival rates of 75.6% and 65.2%, respectively. Also, of a 15% total incidence of encephalopathy, 4.4% was related to the schistosomal patients, 23.5% to the cirrhotics, and 21.7% to the mixed population. Statistically, the survival rate was significantly better (p less than 0.05) and encephalopathy was significantly lower (p less than 0.05) in the schistosomal population. In conclusion, this data shows that: 1) DSRS has a high patency rate and a low variceal hemorrhage recurrence rate; 2) it maintains some degree of portal perfusion in patients with different nonalcoholic liver diseases, despite development of collaterals; and 3) the schistosomal patients have a better survival rate, with a low incidence of encephalopathy after DSRS, compared with the cirrhotic and mixed populations.