Proposed Strategies to Improve Adult Asthma Management in Egypt: Expert Review and Recommendations.

Background: Several challenges face asthma management in Egypt, including the high percentage of uncontrolled patients, inadequate compliance, and overuse of short-acting beta-agonists (SABAs) leading to increased asthma-related morbidity and mortality. In this regard, the recent Global Initiative for Asthma (GINA) recommendations included inhaled corticosteroids containing therapy for mild asthma. Local healthcare systems and healthcare professionals (HCPs) often experience practical challenges when implementing global guidelines. Objective: The present expert review aims to outline the development of local guidelines and health policies that integrate global advances in asthma management while addressing unmet needs and challenges in Egypt. Methods: A steering committee of health policymakers and respiratory experts from the principal healthcare sectors in Egypt came together in March 2021 to develop a consent and national guideline for local asthma management, codifying the current challenges and the required elements for adequate control. The recommendations were either evidence-based or consensus-based from the clinical expertise and perspectives of the committee. Results: The committee identified vital challenges facing all chronic airway diseases with initial focus on asthma management in Egypt in diagnosis, data collection, policymaking, patients' awareness, and physicians' attitudes. In general, the committee stated that globally adapted management protocols necessitate addressing from diverse perspectives through policymakers, HCPs, and patients. Accordingly, it is vital to provide relevant education for the patient and HCPs. The recommendations emphasize key elements concerning baseline assessment, diagnosis, treatment strategy with regular review of patient progress, and compliance toward the introduced reforms. Conclusions: Full integration of these recommendations into local practice allows physicians to sustain adequate management while reducing preventable exacerbations and unnecessary burdens. The proposed strategies outline efficient patient-centered management that approaches asthma as an inflammatory condition, encouraging health promotion and patients' compliance.

Management of femoral head fracture by Ganz surgical dislocation of the hip.

INTRODUCTION: Posterior hip dislocation is the commonest type of hip dislocation. It is associated with femoral head fracture in 7% of cases. Urgent and congruent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of this study is to assess the safety and functional and radiological outcomes of surgical hip dislocation by Ganz technique for treatment of femoral head fracture. PATIENTS AND METHODS: In this retrospective study, 18 cases of femoral head fracture were included. Six cases had Pipkin type I and 12 had Pipkin type II fracture. They were treated through surgical hip dislocation. All cases were followed up for at least 24 months. Matta's criteria were used for radiological evaluation (plain radiographs). Functional evaluation was done using Harris Hip Score and modified Merle d'Aubigne and Postel score at final follow-up. RESULTS: No patients were lost during the follow-up period. No signs of infection or wound dehiscence were noted in this study. There was one case of osteonecrosis. All cases had labral injury, which was debrided. None of our cases needed suture anchor repair of the labrum. Radiographical evaluation according to Matta's criteria yielded anatomic fracture reduction in 17 patients but imperfect in 1 patient. According to Harris Hip Score, four Pipkin type I cases were rated as excellent and two as good. Among cases of Pipkin type II fracture, six were rated as excellent, four as good, one as fair, and one as poor. According to modified Merle d'Aubigne and Postel score, 11 cases had excellent results, 5 cases were rated as good, one as fair, while one case had poor results. CONCLUSION: Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rate.

Clinical evaluation of pregnant women with SARS-COV2 pneumonia: a real-life study from Egypt.

BACKGROUND: Knowledge about the outcome of COVID-19 on pregnant women is so important. The published literature on the outcomes of pregnant women with COVID-19 is confusing. The aim of this study was to report our clinical experience about the effect of COVID-19 on pregnant women and to determine whether it was associated with increased mortality or an increase in the need for mechanical ventilation in this special category of patients. METHODS: This was a cohort study from some isolation hospitals of the Ministry of Health and Population, in eleven governorates, Egypt. The clinical data from the first 64 pregnant women with COVID-19 whose care was managed at some of the Egyptian hospitals from 14 March to 14 June 2020 as well as 114 non-pregnant women with COVID-19 was reviewed. RESULTS: The two groups did not show any significant difference regarding the main outcomes of the disease. Two cases in each group needed mechanical ventilation (p 0.617). Three cases (4.7%) died among the pregnant women and two (1.8%) died among the non-pregnant women (p 0.352). CONCLUSIONS: The main clinical outcomes of COVID-19 were not different between pregnant and non-pregnant women with COVID-19. Based on our findings, pregnancy did not exacerbate the course or mortality of COVID-19 pneumonia.

One sacroiliac screw for posterior ring fixation in unstable pelvic fractures.

Unstable pelvic injuries are considered uncommon and they are usually associated with high rate of morbidity and mortality. High energy blunt trauma and falling from height are usually the main mechanism of injury. It is a retrospective study that was performed in academic level I trauma center. From September 2015 to December 2019, a consecutive series of 26 patients (7 females), with average age of 32 years with unstable pelvic fracture were included in this study. All patients underwent reduction and percutaneous fixation with one sacroiliac screw posteriorly for each sacroiliac joint and anterior arch fixation of the pelvic ring with either platting or external fixator. The average duration of follow up was 36 months. Clinical results: at the final follow-up, all patients had complete radiological healing of the fractures. The subjective functional assessment yielded excellent for twenty-two patients, good for two patients and fair for two patients. Posterior arch fixation of the pelvic ring with one sacroiliac screw beside anterior arch fixation in unstable fracture pelvis is a sufficient fixation method to maintain the requiring stability to allow complete union of the fracture. Level of Evidence: Therapeutic Level III.

Modified Stoppa Approach for the Treatment of Complex Acetabular Fractures.

Complex acetabular fractures are due to high-energy trauma in most cases. The operative management of these types of fractures is often difficult and technically challenging. Almost all of these types of fractures are treated through extensile approaches, and a variety of them have been described. Some of these approaches are associated with complications such as infection, heterotopic ossification, and increased blood loss in addition to increased operative time. This retrospective study was performed at an academic Level I trauma center. From January 2013 to March 2019, 21 patients with complex acetabular fractures were treated with open reduction and internal fixation through a single anterior modified Stoppa approach. The average operative time was 98.80 minutes (range, 60-180 minutes), the average follow-up time was 40 months (range, 24-72 months), and the average Harris Hip Score (HHS) was 87.85 (range, 75-100). At the latest follow-up, 12 (57.1%) patients had an excellent HHS, 8 (38.1%) patients had a good HHS, and 1 (4.8%) patient had a fair HHS. Complex acetabular fractures can be effectively managed by a modified Stoppa approach without the need for extensile or combined approaches. [Orthopedics. 2021;44(3):e353-e358.].

Repair of Traumatic Avulsed Achilles Tendon using Double Cerclage Trans-calcaneal Stainless Steel Sutures: Prospective Study and Review of Literature.

INTRODUCTION: Achilles sleeve avulsion results in a direct disruption of the triceps surae-calcaneal complex from its insertion. It represents a surgical challenge to all orthopedic surgeons as a little tissue is available for direct repair of the achilles tendon into its insertion. Methods of fixation include suturing of the avulsed bone fragment, screw fixation, tension band wiring and suture anchors. In this study, we will present a new technique for repairing of the achilles sleeve avulsion injury using double cerclage stainless steel sutures. PATIENTS AND METHODS: Seven patients with sleeve avulsion of the achilles tendon were included in this study. Only post traumatic cases were involved. Repair of the avulsed tendon using double cerclage stainless steel sutures had been done for all patients. Postoperatively all patients had below knee cast for 4 weeks. Physiotherapy started after cast removal. Patients were followed at 3, 6, 12, 24 months. Pain was measured using VAS score. The AOFAS score was measured at the last follow up. RESULTS: All patients were followed for at least 24 months. Six males and one female were included in this study. The mean time for returning to work was about 15 weeks. One complication (delayed wound healing) occurred in one patient and healing was well after treatment with antibiotics and continuous dressing. The AOFAS score was excellent for six patients and good for one patient. CONCLUSION: Double cerclage stainless steel sutures can be used safely to treat patients with achilles sleeve avulsion fracture with a satisfactory clinical outcome.

The Effects of Sildenafil and/or Nitroglycerin on Random-pattern Skin Flaps After Nicotine Application in Rats.

Smoking aggravates skin necrosis as a complication of random-pattern flap ischaemia. Sildenafil and nitroglycerin (NTG) are vasodilator agents that may affect skin flap survival. Fifty rats were subjected to a dorsal random-pattern flap operation and randomly divided into 5 groups. The control group received no treatment. The ischaemic group were administered local nicotine injections. The sildenafil group were administered oral sildenafil treatment in addition to the same intervention as the ischaemic group. The NTG group received topical NTG ointment application instead of sildenafil. The combined group were given both sildenafil and NTG treatments. After 7 days, all rats were sacrificed for flap assessment. Flap survival percentages at the 3rd and 7th days were significantly higher in the combined group than in the other study groups. Histologically, the ischaemic group exhibited dermal disorganization and inflammatory cell infiltration, which were improved in the 3 treated groups; however, the combined group presented the most relevant effect. The epidermal thickness showed a decrease in the ischaemic group (23.1 µm) that was significantly increased in the sildenafil (28.4 µm), NTG (28.8 µm) and combined (35.8 µm) groups. Immunohistochemically, the combined group exhibited a significant decrease in the apoptotic index and an increase in the proliferative index (2.3 and 56.9%, respectively) compared to those in the ischaemic (63.2 and 3%), sildenafil (41.7 and 28.1%) and NTG (39.3 and 30.4%) groups. Transmission electron microscopy (TEM) showed that the combined group displayed improvement in most of the ischaemic changes. Our analyses suggest that the combined use of sildenafil and NTG is more efficacious than using only one of these treatments for skin flap survival.

Open Complete Medial Talar Dislocation without Fracture of the Talus or the Malleoli: A Case Report.

CASE: A twenty-three-year-old man presented with an open complete medial talar dislocation without fracture of the talus or the malleoli; this was associated with an injury to the posterior tibial artery and the tibial nerve. It was difficult to reduce because of entrapment of the tendons of the flexor digitorum, the flexor hallucis longus, and the tibialis posterior, as well as entrapment of the posterior tibial artery and the tibial nerve. At the twelve-month follow-up, the talus did not show osteonecrosis. CONCLUSION: After a complete medial talar dislocation, the patient was found to have no arthritis or osteonecrosis, and he had return of normal sensation at one year postinjury.

Evaluation of surgical outcome of penile augmentation and lengthening procedures.

Our study included 280 patients complaining of small-sized penis. They were seen in the outpatient clinic of the Andrology Department, Kasr El Aini, Cairo University. Patients were collected from 2002 till 2008 and classified into 4 categories from an etiological point of view. Eleven patients (3.9%) were operated upon according to fine selection criteria; six patients were selected for lengthening procedures, while two patients were selected for increasing girth procedures and three patients for combined operation of lengthening and increasing girth techniques. Seven patients showed subjective satisfaction after lengthening procedures and four patients showed subjective satisfaction after increasing girth techniques. In conclusion, detailed analysis of short penis complaint with a proper diagnosis and patient education are required for accurate management of patients complaining of a short penis.

Beneficial effect of adding pentoxifylline to processed semen samples on ICSI outcome in infertile males with mild and moderate asthenozoospermia: A randomized controlled prospective crossover study.

BACKGROUND: No extensive studies were done that included the use of pentoxifylline or verify its effect on the outcome of ICSI in cases of mild and moderate asthenozoospermia. OBJECTIVE: The aim of this study was to evaluate the effect of pentoxifylline used in preparation of semen samples which doesn't need motility enhancement prior to ICSI. MATERIALS AND METHODS: The study was carried on 30 infertile patients where pentoxifylline was used for semen processing (group I), another 30 patients without pentoxifylline (group II) in addition to 60 infertile patients where crossing over of the semen sample was done further subdividing it into 2 subgroups in which the first half of the semen sample was incubated with pentoxifylline (group IIIA) and the second half of the sample without pentoxifylline (group IIIB). RESULTS: The numbers of oocytes injected, numbers of oocytes fertilized, fertilization rate, the total numbers of embryos, numbers of good embryos and the numbers of embryos transferred of group IIIA were found significantly higher than that of Group IIIB (p=0.00). The overall 6 month pregnancy rate of group I was significantly higher than that of group II (73.3% vs. 60% respectively, p=0.04). The abortion rate of (Group I) and that of (Group II) was found non - significantly different (20% vs. 27.8% respectively, p=0.53). CONCLUSION: Pentoxifylline can be used as a useful compound for improving ICSI outcome in semen samples preparation prior to oocytes injection regardless of the state of sperm motility or the degree of asthenozoospermia. Registration ID in Clinical Trials.gov: NCT01793272.

Single tubule biopsy: a new objective microsurgical advancement for testicular sperm retrieval in patients with nonobstructive azoospermia.

OBJECTIVE: The aim of this study was to measure the diameter of seminiferous tubules (ST) during microdissection testicular sperm extraction (TESE) using a micrometer fixed to one of the eyepieces of the operating microscope to find a correlation between the extracted ST diameter and TESE outcome. DESIGN: A prospective comparative study. SETTING: Adam International Andrology and Infertility Clinic, Giza, Egypt. PATIENT(S): Two hundred sixty-four patients with nonobstructive azoospermia (NOA) were included. INTERVENTION(S): Patients underwent TESE using the open surgical technique. The STs were measured using the micrometer, and the tubule with the largest diameter was excised and freshly examined under an inverted microscope. If no spermatozoa were found, another sample was taken from the second most dilated tubule area and then at random until sperm were found or a maximum six samples were harvested. If no spermatozoa were detected, the contralateral testis was operated upon. MAIN OUTCOME MEASURE(S): The TESE outcome in relation to ST diameter. RESULT(S): The total sperm recovery rate was 105 out of 264 (39.8%). When ST measured >or=300 microm the sperm retrieval rate was 16 out of 19 (84.2%). When ST diameter was <300 microm, the sperm retrieval rate was 36.3% (89 out of 245). CONCLUSION(S): During microdissection TESE, the best cutoff level of the ST diameter for harvesting testicular spermatoza is 110 microm with sensitivity 86.0% and specificity 74.4% (AUC 0.653, 95% confidence interval 0.608-0.663). When ST diameter is 300 microm or more a single tubule biopsy is usually sufficient to harvest enough testicular spermatozoa for intracytoplasmic sperm injection or sperm freezing with minimal tissue excision.