Kasr Al Ainy Medical Journal

COVID-19 infection: a magnified look at the kidneys Neveen A Soliman Kasr Al Ainy Medical Journal 2020 26(2):33-36 The global health crisis of novel coronavirus 2019 (COVID-19) pandemic has overwhelmed all medical disciplines, including nephrology. This review focuses on how kidneys are affected by COVID-19 infection and discusses some etiologic, pathogenic, and clinical aspects of kidney involvement in COVID-19 infection, including clinical outcome. Special strategies are required to improve clinical outcome and should be regularly updated based on gained knowledge and evidence.

The broad-spectrum antiparasitic ivermectin against COVID-19 Nadia A El Dib, Mona I Ali Kasr Al Ainy Medical Journal 2020 26(2):37-40 Ivermectin, the FDA-approved broad-spectrum antiparasitic drug, has recently shown excellent antiviral effects against many viral infections. This effect was especially important in the current pandemic infection of COVID-19. There are reports that ivermectin inhibited the replication of the virus in vitro in 48 h. Studies have been done on other viral infections and on this virus in vivo and in vitro. The results showed that it affects the viral replication by its effect on the protein transfer between the cytoplasm and nucleus inside the host cells. More information is still needed to approve its use in the treatment and prevention of COVID-19 pandemic, which will necessitate more studies to adjust the dose and mode of administration.

A practical approach to coronavirus disease 2019 pneumonia imaging Youssriah Y Sabri, Sally Emad-Eldin Kasr Al Ainy Medical Journal 2020 26(2):41-54 Coronavirus disease 2019 (COVID-19) was first recognized in China in December 2019 and then was declared as a pandemic by the WHO in March 2020. The most established diagnostic tool is the real-time reverse transcription-PCR, which is highly specific but has a relative low sensitivity. False-negative results and consequently the need to repeat the test and relative delay in conclusive results are a real diagnostic problem. Other laboratory marker tests are more suggestive than diagnostic. All these factors have made computed tomographic (CT) imaging in cases of clinically suspected COVID-19 a routine and an integral part of the algorithm for disease diagnosis in many countries including Egypt. The role of CT is well established in detecting the presence of a lesion, discriminating different types of lesions, and assessing distribution, severity, complications, associated extrapulmonary chest manifestations, and follow-up of cases. The CT picture of COVID-19 is known to reflect atypical pneumonia and/or organizing pneumonia. The presence of ground-glass opacities, consolidation, or crazy paving in bilateral subpleural distribution with predominant lower lobes affection is considered typical for COVID-19. Based on our experience, in the context of the current pandemic, the presence of CT inflammatory changes in a patient with clinical suspicion of COVID-19 should be considering as an alarming sign for the presence of COVID infection as the cause of ground-glass opacities. A negative CT report for COVID-19 should only be considered in cases of normal CT or if CT lesions do not represent inflammatory changes.

Resilience with the crisis: cardiology department experience to cope with the corona virus disease 2019 pandemic Ahmad Samir, Mera A.S Fahim, Ahmed Mohsen, Hossam Mahrous, Kareem Mahmoud, Ahmed Elamragy, Marwa S Meshaal, Hesham Yehia, Waleed Ammar, Karim Said, Yasser Baghdady, Hesham Salah, Magdy Abdelhamid, Mohamed Abdelghany Kasr Al Ainy Medical Journal 2020 26(2):55-59 Rationale During the coronavirus disease (COVID-19) pandemic, there were many challenges facing practices in different medical specialties. Objectives Maintain medical and educational services provided by Cardiology Department at the required standards amid the COVID-19 pandemic. Methods We described our experience in restructuring various strategies and activities and developing adaptive measures to cope with the crisis. Results and Conclusion Multiple considerations and self-adjusting adaptations are mandated in challenging situations like the COVID-19 crisis. Exchanging experiences is needed to improve performance in similar future situations.

Changes in eye care during the covid-19 pandemic from Egyptian patients' point of view Lameece M Mohamed, Ayah Marrie, Kareem B Elessawy Kasr Al Ainy Medical Journal 2020 26(2):60-67 Purpose This study aims to understand the impact of COVID-19 on patients’ view and willingness to seek ophthalmic services in Egypt. The study analyzes if there were changes in their eye care habits and under the conditions they would seek ocular advice. Patients and methods It is a cross-sectional observational study using a questionnaire that was sent online and the answers were received online. The questionnaire included 31 questions. All questions were closed-ended questions, provided with a list of optional answers (single-answer options or multiple-answer options). Results This study included the responses of 448 participants, who answered the questionnaire fully and included their names and email addresses. Of the participants, 262 were women (58.5%) and 186 (41.5%) were men. The largest age group that answered our questionnaire was between the ages of 20 and 40 years (85.3%). The vast majority of the participants (98%) claimed they would not visit an ophthalmologist during the pandemic and would not undergo any elective surgery. Conclusion Age, medical background, educational level, contact with vulnerable groups, and presence of chronic diseases significantly affect the patients’ willingness to seek ophthalmic services. Changes in populations’ information and doctor practice are needed in this pandemic.

HRCT chest in COVID-19 pneumonia: correlation between duration of symptoms and CT severity score Hegazy M.A Rania, Salah E.L Din Adel Lamia Kasr Al Ainy Medical Journal 2020 26(2):68-75 Objective The aim was to find the correlation between duration of symptoms and computed tomography (CT) severity score in patients with novel coronavirus pneumonia. Patients and methods This study was conducted on 108 patients with proven COVID-19 pneumonia. Results A total of 108 patients were enrolled in this study with proven diagnosis of COVID-19 infection with 81 positive swabs (75%) and 27 negative swabs (25%). The 27 patients with negative swabs had typical features of fever, laboratory studies consistent with infection, and CT features of bilateral pneumonic changes. The study included 72 (66.7%) men and 36 (33.3%) women, with mean age of 52.1 (age range: 34–81 years) years. Patients were categorized according to the duration of onset of initial symptoms and the date of CT scans: stage 1 (0–4 days, n=36); stage 2 (5–9 days, n=30); stage 3 (10–14 days, n=15); stage 4 (15–21 days, n=9); stage 5 (22–28 days, n=3); and stage 6 (>28 days, n=15). Each stage average CT chest score of severity and average percentages of both lung opacities were shown. The authors found that CT severity score increases, as the duration of initial symptom increases, up to 9 days, from the onset of symptoms. CT score has a second peak at less than or equal to 20-day duration of symptoms and a third peak at more than 28 days, where a plateau is reached. Although patient’s clinical condition and oxygen saturation may improve, yet CT changes may persist with a high CT severity score for weeks thereafter. Conclusion CT severity score corresponds to the duration of symptoms only in the early stage of disease. In later stages, some patients develop residual lung affection after recovery from acute symptoms, yet lung changes take weeks to resolve, and in some cases, residual chronic changes may persist.

Evaluation of anthelminthic activity of both pomegranate peels and Artemisia herba-Alba extracts in comparison with praziquantel in experimentally infected mice with Hymenolepis nana Azza H Abbas, Fetouh S Hassanin, Neveen M Sarhan, Heba M Abdelgalil Kasr Al Ainy Medical Journal 2020 26(2):76-82 Background Praziquantel (PZQ), is the drug of choice in the treatment of Hymenolepis nana infection, although it has some adverse effects (side effects and toxicity). Natural biological products that have minimal side effects and more safe. Many researchers demonstrated the antimicrobial and antiparasitic therapeutic effect of pomegranate and Artemisia. Objective Our study aims to evaluate the therapeutic effect of pomegranate and Artemisia as an alternative treatment in H. nana infection. Subjects and Methods 32 male albino mice were inoculated with human fecal sediments containing H. nana eggs (about 100 eggs/gm) and were divided into four groups after proven to be infected with H. nana: Group 1; treated with Pomegranate peels extract, Group 2; treated with Artemisia herb-Alba extract, Group 3; treated with PZQ, and finally, Group 4; treated with Pomegranate peels and Artemisia herb-Alba mixture’ extract. Results Both Pomegranate peels and Artemisia herb-Alba extracts presented a significant decrease (P-value = 0.002 and 0.001, respectively) in the number of viable eggs after 7 days of treatment in comparison to the first day. Pomegranate peels and Artemisia herb-Alba extracts ‘results established anthelmintic effect against H. nana. Conclusion Our results showed that both Pomegranate peels and/or Artemisia herb-Alba extracts can be used as alternative, less expensive and more safe therapeutic approach in H. nana infection.

Coronary angiographic profile in Egyptian patients with xanthelasma palpebrarum Noha Hassanin, Sameh Wadie Ghaly Bakhoum, Mahmoud Elsayed Saraya Kasr Al Ainy Medical Journal 2020 26(2):83-89 Background Xanthelasma palpebrarum are yellow plaques that are found near the inner canthus of the eyelid. However, it is still controversial whether such lesions are marker for coronary artery disease. Aim The aim of the study was to investigate the association between xanthelasma and severity of coronary artery disease using coronary angiography. Settings and design A prospective, case–control study was conducted on 86 patients scheduled for coronary angiography to diagnose coronary artery disease. The study population included two groups. Groups A and B were formed of 43 patients each with and without xanthelasma, respectively. Patients and methods The day before diagnostic coronary angiography, all patients were subjected to full medical history taking; clinical examination; laboratory investigations, including lipoprotein (a) [Lp (a)], serum creatinine, and lipid profile; 12-lead electrocardiogram; and transthoracic echocardiography. A written informed consent was taken from all included patients, and approval of the CMREC (Cairo Medical Research Ethics Committee) was obtained. Results Waist circumferences were increased in patients with xanthelasma compared with those without. Low-density lipoprotein and Lp(a) levels were significantly increased in patients with xanthelasma. The severity of coronary artery disease was significantly increased in patients with xanthelasma. Conclusion Hypertension, diabetes, and dyslipidemia were common in patients with xanthelasma palpebrarum. The presence of xanthelasma and Lp(a) were independent predictors of coronary artery disease. The severity of coronary artery disease was significantly increased in patients with xanthelasma.

Trans-knee amputation with posterior myocutaneous flap in patients with advanced peripheral arterial disease Mohamed T Yousuf Kasr Al Ainy Medical Journal 2020 26(2):90-94 Background Critical limb ischemia can result in major amputation when revascularization proved to be impossible. Major amputation is sometimes unavoidable in patients with acute lower limb ischemia with irreversible damage (category III). When compared with the above-knee amputation (AKA), trans-knee amputation (TKA) or knee disarticulation has a durable end weight-bearing stump with a long, powerful, active lever arm for control of the prosthesis with excellent muscle attachments. The round distal stump enhances suspension of the prosthesis. Another advantage is decreased operative blood loss with less bony or muscular disruption, less energy consumption, and resistance to infection by maintaining the cartilage barrier to infection. Purpose Our objective is to evaluate the outcomes of TKA with posterior myocutaneous flap in patients with advanced peripheral arterial disease who are not candidates for below-knee amputation (BKA). Patients and methods his prospective interventional study included 24 patients with advanced peripheral arterial disease in need for amputation and BKA is likely to fail. All patients underwent TKA with posterior myocutaneous flap including gastrocnemius muscle. The indication for amputation was critical limb ischemia owing to unreconstructable peripheral arterial disease in 21 (87.5%) patients in whom revascularization options are unavailable or exhausted and irreversible (category III) acute thrombotic lower limb ischemia in three (12.5%) patients. Results The study was conducted on 24 patients, comprising 15 (62.5%) males and nine (37.5%) females. The mean age of patients was 65.8±10.5 years. Overall, four (16.6%) patients had previous contralateral AKA. Three (12.5%) patients died: two patients died in the early 3 postoperative days and one patient died in the same hospital admission after 35 days. For the remaining 21 patients, healing by primary intention was achieved in 15 (71.4%) patients, by delayed primary intention (tertiary intention) in one (4.8%) patient, and by secondary intention in two (9.6%) patients. Major wound dehiscence occurred in three (14.2%) patients requiring AKA. Conclusion TKA with posterior myocutaneous flap is a safe operative method of amputation in patients with advanced peripheral arterial disease with good healing rates and acceptable functional outcomes. If it is not possible to perform BKA, TKA should be considered before AKA.

Dysphonia as the main presenting symptom of COVID-19: a case report Ahmad M Eltelety, Ahmed A Nassar Kasr Al Ainy Medical Journal 2020 26(2):95-97 The spectrum of illness associated with COVID-19 is wide, ranging from asymptomatic infection to life-threatening respiratory failure. Herein, the authors are presenting a case in which the main symptoms expressed by a patient infected with SARS-CoV-2 were simultaneous gradual change of voice with loss of olfaction but without nasal obstruction.

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