Medicine and Health Sciences Commons^™

Assessment Of Health-Related Quality Of Life In Pediatric Patients With End Stage Renal Diseases, Nasteho Adan Awil, Ahmed Mahmoud Elrefaey, Abdel-Hady El-Gilany Abdel-Elfattah, Heba Mohamed El-Taher

Mansoura Medical Journal

Background: End-stage renal disease (ESRD) occurs when the glomerular filtration rate falls below 15 mL/min, requiring renal replacement therapy. Despite improved survival, affected children experience significant physical, emotional, and social challenges. Consequently, health-related quality of life (HRQoL) is markedly reduced compared with healthy peers.

Aim: This study aimed to assess health-related quality of life (HRQOL) in pediatric patients with end-stage renal disease (ESRD) and to identify factors associate with the quality of life in pediatric patients with   end stage renal disease (ESRD).

Methods:  All 60 eligible children who were enrolled in the Nephrology Unit at Mansoura University Children's Hospital …

Evaluation Of Cardiac Troponin T And Ischemia-Modified Albumin Changes With Hemodialysis Session In Pediatric Patients With End-Stage Renal Disease, Zeinab Ezz Elden Abass Abd Eldayem, Ashraf Mohammed Abdel Basset, Gehan Attia Abdehakem, Shiama Abdelmgiad, Nermin Yossef Abo Elkheir

Mansoura Medical Journal

Background : Cardiovascular status in dialysis patients is complicated by a wide range of factors that can affect long-term prognosis. Cardiac biomarkers changes with hemodialysis session could affect the cardiac integrity of those patients. Aim of the work: Assess the changes of cardiac ischemic biomarkers (Troponin T and ischemia modified albumin) before and after hemodialysis session in patients with ESRD in pediatric age group and study of correlations of changes with the hemodialysis parameters. Patients and methods: The study included 40 pediatric ESRD patients who were admitted to Pediatric Cardiology Unit, Pediatric Nephrology and Dialysis Unit of Mansoura University Children’s …

Fascia Transversalis Block With Different Volumes Of Local Anesthetic And Its Impact On Postoperative Pain In Major Abdominal Surgery: Prospective Randomized Study, Eman Eltabey Lotfi Taman, Mostafa Mohamed Ali Saied, Khaled Mohy Eldeen El Bahrawy, Abdelrahman Mamdouh El Naggar

Mansoura Medical Journal

Background Effective postoperative analgesia remains crucial in abdominal surgery to reduce physiological stress, improve respiratory function, and enhance recovery. The transversalis fascia plane block (TFPB) has recently emerged as an advantageous technique targeting the T12–L1 nerves responsible for somatic and visceral abdominal innervation. Objective To investigate the analgesic efficacy of different volumes of local anesthetic administered in TFPB and compare their effect on postoperative pain, visceral discomfort, and opioid requirements. Methods Eighty-one adult patients undergoing major abdominal surgery under general anesthesia were randomized into 3 groups: control (systemic analgesia only), lowvolume TFPB (20 mL total), and high-volume TFPB (25 mL …

Diagnostic Performance Of Digital Breast Tomosynthesis In The Characterisation Of Breast Lesions: Correlation With Sono-Mammography And Histopathology., Amira Hamed Megahed, Mona Mahmoud Zaky, Maha Mohamed Bilal

Mansoura Medical Journal

Background: Breast lesions range from benign to malignant, with early detection critical for management. Digital mammography is the standard screening tool but may be limited in dense breasts. Ultrasound (US) aids lesion characterisation, while digital breast tomosynthesis (DBT) reduces tissue overlap, enhancing lesion detection.

Objective: To evaluate the diagnostic performance of digital breast tomosynthesis in the characterisation of breast lesions compared with sono-mammography, using histopathology as the reference standard.

Methods: This prospective study included 33 symptomatic female patients with a mean age (45.4 ± 8.2 years) who presented with symptoms such as palpable breast lumps, Mastalgia and nipple discharge between …

Assessment Of Serum Level Of Lipocalin-2 In Patients With Alopecia Areata, Mohammed S. Sultan, N. M. Darwish, Hosam Abdel Tawab, Asmaa M. Shalaby

Mansoura Medical Journal

Background: Alopecia areata (AA) is a chronic autoimmune disease (AID)-causing non-scarring hair loss (NSHL), mainly on the scalp. It affects about 2% of people worldwide, usually starting in the third or fourth decade. This study aimed to evaluate serum lipocalin-2 levels in AA patients compared to healthy controls (HC), and to examine their correlation with disease severity Methods: This one-year prospective case-control study included 40 AA patients from Mansoura University Hospitals and 40 age- and sex-matched healthy control. Diagnosis was based on typical, well-defined non-inflammatory scalp hair loss (HL) confirmed by dermoscopy. Controls were healthy, with no autoimmune history or …

Comparative Study Between Serum Levels Of Interleukin-19 And Interleukin-38 In The Egyptian Patients With Non-Segmental Vitiligo, Reem Ahmed Al Maaddawy, Mohamed Kh. Selim, Ahmed Fawzi Ismail, Ahmad S. Hasan, Manar Ali Hassan

Mansoura Medical Journal

Background: The precise etiology of vitiligo remains unclear; nonetheless, it is predominantly regarded as an autoimmune disorder. This work aimed to compare serum levels of IL-19 and IL-38 between patients with non-segmental vitiligo (NSV) and healthy controls (HC). Patients and Methods: This study included 88 participants, evenly split into two groups: 44 individuals with non-segmental vitiligo and 44 healthy controls. Both groups underwent full history taking. The Vitiligo Area Severity Index (VASI) score and Vitiligo Disease Activity (VIDA) score were used to assess disease severity and activity. The levels of human IL-19 and IL-38 were also measured.

Results:Serum IL-38 …

A Comparative Study Of Topical 5% 5-Fluorouracil With Needling Versus 100% Trichloroacetic Acid With Needling Versus Needling Alone In Treatment Of Multiple Warts, Nesma Abd-Elmonem Saad, Hassan A. Fayed, Manar Ali

Mansoura Medical Journal

Aim: This study aimed to compare the efficacy and safety of topical 5% 5-Fluorouracil (5-FU) with Needling versus 100% Trichloroacetic acid (TCA) with Needling versus Needling Alone in treatment of multiple warts.

Methods: This study included a total of 60 patients clinically diagnosed with multiple warts, who were randomly allocated (computer-generated simple randomisation, 1:1:1, concealed in sequentially numbered opaque sealed envelopes) into three equal groups (n=20 per group). The first group received 100% TCA with Needling; the second group received topical 5% 5-FU combined with Needling; the third group underwent Needling alone. The study was single-blinded at the level …

Active Deresuscitation Strategies After Septic Shock: A Scoping Review, Alrefaey K. Alrefaey, Rania E Elbadrawy, Mohamed Aboelela, Mohammed Mamoun

Mansoura Medical Journal

Background: Fluid overload in septic shock patients is linked to higher morbidity and mortality. After the stabilization phase, fluid restriction may not result in the resolution of tissue edema. Active deresuscitation refers to the use of diuretics or ultrafiltration for the removal of excess fluids. Objectives: This review explores the current practices applied for the active deresuscitation strategies after stabilization of septic shock patients.  Search strategy: A literature search was performed through the following databases: Medline, PubMed, Google Scholar, Web of Science, and Scopus for relevant studies from 2015 to January 2026. Selection criteria:  The selected articles included …

Laparoscopic Versus Open Redo Anti-Reflux Surgery, Mohamed Barkok, Mohammed Said, Ahmed Shehta, Abdel-Raouf El-Geidie

Mansoura Medical Journal

Background

Gastroesophageal reflux disease (GERD) is common. Laparoscopic fundoplication became the gold standard for GERD surgery after medical treatment failed. If a previous anti-reflux surgery fails, redo surgery requires a thorough review to determine the cause and a skilled surgical team. Choosing the optimal approach during the redo surgeries, whether open or laparoscopic hasn’t been previously illustrated.

Aim

To compare the outcomes of laparoscopic versus open redo anti-reflux surgeries.

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Patients and methods

This study included 28 patients who underwent redo anti-reflux surgery. The patients were divided according to the approach into laparoscopic (n = 11) and open (n = …

Short Term Echocardiographic And Clinical Assessment Of Aortic Valve Neo-Cuspidization (Ozaki Procedure) In Comparison With Mechanical Aortic Valve Replacement, Amr Mohamed Ahmed Elshabrawy, Mohamed A. Gabr, Eid M Daoud, Mohammed Sanad, Sherif Arafa

Mansoura Medical Journal

Background: Aortic valve neo-cuspidization (AVNeo, Ozaki procedure) has emerged as an alternative to conventional aortic valve replacement, aiming to preserve native aortic root dynamics and improve postoperative hemodynamics. The replacement of the aortic valve presents challenges because both biological and mechanical prostheses have notable limitations.

Aim: To evaluate the short-term clinical and echocardiographic outcomes of aortic valve neocuspidization (Ozaki procedure) compared with mechanical aortic valve replacement (AVR) in patients with isolated aortic valve disease.

Patients and methods: This prospective comparative observational study included 42 adult patients with isolated aortic valve disease. 20 patients underwent AVNeo (Ozaki procedure) and 22 …

Dengue Fever With Normal Platelet Count In A Patient With Β-Thalassemia Trait: A Case Report., Pankaj Kumar Jain, Manoj Seval, Vikas Meena, Rajesh Kumar Yadav

Digital Journal of Clinical Medicine

Dengue fever is an arboviral infection caused by different serotypes of the dengue virus. Generally, it presents with a wide variety of symptoms ranging from undifferentiated fever to dengue shock syndrome associated with thrombocytopenia and hemoconcentration. But in patients with thalassemia, it presents with anemia due to hemolysis, rather than hemoconcentration. Here we present a case of an 18-year-old female diagnosed with Dengue fever with thalassemia trait, who presented with a normal platelet count and moderate microcytic anemia.

Limitations Of Plasma Exchange In Yellow Phosphorus-Induced Acute Liver Failure: A Case Report, Vihitha Vunnam, Swathi B.S

Digital Journal of Clinical Medicine

Yellow phosphorus is a highly toxic compound commonly used in rodenticides and is associated with significant morbidity and mortality following ingestion. Toxicity typically evolves through an initial gastrointestinal phase, a deceptive latent period, and a final phase characterized by fulminant hepatic failure and multiorgan dysfunction. We report the case of an 18-year-old male who intentionally ingested two tubes of Ratol containing 3% yellow phosphorus. After initial vomiting and transient clinical stability, he developed rapidly progressive acute liver failure with severe coagulopathy, conjugated hyperbilirubinemia, hepatic encephalopathy, acute pancreatitis, pancytopenia, acute kidney injury, metabolic derangements, and recurrent hypoglycemia. Serial laboratory trends demonstrated …

Understanding The Progression Of Borderline Personality Disorder During Adolescence: A Clinical Case Study, Anjali Chandak, Megha Sadashiv, Bhawna Sharma, Bhargav Mulpuru

Digital Journal of Clinical Medicine

Borderline Personality Disorder (BPD) often emerges during adolescence, but remains relatively understudied in this population. This case report explores the sociobiological factors shaping symptom expression in an adolescent girl. Longitudinal clinical evaluation revealed hallmark features, including affective instability, identity disturbance, interpersonal relations, and self-harming behaviour. Early attachment disruptions, emotional regulation difficulties, and heightened sensitivity to relational stressors were identified as key developmental risk factors. Diagnostic and therapeutic considerations are presented, highlighting the need for prompt, developmentally informed, and evidence-based interventions. The case further emphasises how prognosis and chronicity may be significantly influenced by an adopting developmental approach, providing insight into …

When Fever And Thrombocytopenia Are Not Infectious: A Case Of Vitamin B12 Deficiency Mimicking Tropical Fever, Ram Arvind Viswanathan Dr

Digital Journal of Clinical Medicine

Vitamin B12 deficiency is classically associated with megaloblastic anaemia and neurological manifestations; however, atypical presentations continue to pose diagnostic challenges. Fever in association with thrombocytopenia often prompts evaluation for infectious aetiologies such as dengue, malaria, or sepsis, particularly in tropical settings. We report a case of vitamin B12 deficiency presenting with pyrexia and isolated thrombocytopenia, initially suspected to be an infectious illness. Extensive evaluation failed to reveal an infective cause, and subsequent haematological workup demonstrated megaloblastic changes with low serum vitamin B12 levels. Remarkably, the patient showed rapid defervescence and normalisation of platelet counts following parenteral vitamin B12 therapy. This …

The Role Of Physicians In Society: Perspectives From First-Year Mbbs Aspirants, Jesymol Joy, Dr Rashmi S, Amogha Shree, Dr Sunil Kumar D

Digital Journal of Clinical Medicine

Background: Physicians occupy a pivotal role in society as healers and communicators, with ethical leadership embedded in professional practice. In India, this role is evolving in response to changes in healthcare systems, increasing commercialization, and shifting societal expectations. Understanding how medical students perceive the physician’s role at the onset of medical education is vital for early professional identity development.

Objectives: To assess the motivations, perceptions, and values of first-year MBBS students regarding the societal roles, qualities, and responsibilities of physicians.

Methods: A cross-sectional study was conducted among 430 first-year MBBS students at a tertiary medical college in Mysuru, Karnataka, using …

Do More Sexually Active Men Have Less Bothersome Lower Urinary Tract Symptoms Of Benign Prostatic Hypertrophy? – A Prospective Cross-Sectional Study, Sharad Kumar Sahai, Puneet Aggarwal, Satya Prakash Tripathi, Pushkar Mendiratta, Madhamshetty Ranjith

Digital Journal of Clinical Medicine

Objectives:

Lower urinary tract symptoms (LUTS) are common in adult males with benign prostatic hyperplasia (BPH) being a common cause, with significant effect on the patient’s quality of life and sexual function. Studies show that sexual dysfunction increases with increasing severity of LUTS. The present study aimed to analyse whether the severity of BPH symptoms assessed using scoring system had any association with ejaculation frequency and erectile function.

Methods:

This was a prospective cross-sectional study done over a period of 18 months. All consecutive patients reporting to the surgical department with BPH and meeting the inclusion criteria were enrolled for …

Stones, Bones, And Hormones: A Multisystem Presentation Of Primary Hyperparathyroidism Due To Parathyroid Adenoma, Gadgesh B, Varsha Tandure, Nandini K, Chandana Srinath

Digital Journal of Clinical Medicine

Primary hyperparathyroidism is an endocrine disorder characterized by excessive secretion of parathyroid hormone, most commonly due to a solitary parathyroid adenoma, resulting in hypercalcemia and multisystem involvement [1]. Although many patients are diagnosed incidentally, delayed recognition may lead to severe renal, skeletal, gastrointestinal, and cardiovascular complications.

We report the case of a 44-year-old male who presented with sepsis and acute kidney injury, later found to have hypercalcemia with nephrocalcinosis, chronic calcific pancreatitis, skeletal deformities, and markedly elevated parathyroid hormone levels. Imaging localized a parathyroid adenoma, and the patient underwent successful parathyroidectomy with significant biochemical and clinical improvement.

This case emphasizes …

Clinical Correlates And Predictors Of Suicide Attempt Severity In Elderly Patients: A Cross-Sectional Study From South India, Rajamani Siddamallappa, Kiran Kumar Kadarappa Dr, Megha C N

Digital Journal of Clinical Medicine

Background: Suicide in late life is a major yet under-recognized public health problem in low- and middle-income countries. Elderly suicidal behaviour reflects interactions between psychiatric morbidity, substance use, psychological distress, intent, and method selection. Indian data examining these factors comprehensively remain limited.

Objectives: To assess psychiatric morbidity, hopelessness, suicide intent, planning patterns, methods, and independent predictors of suicide attempt severity among elderly suicide attempters.

Methods: This cross-sectional study included 75 elderly individuals (≥60 years) admitted following a suicide attempt to a tertiary care hospital in South India. Depression severity, hopelessness, and suicide intent were assessed using Beck’s Depression Inventory-21 (BDI-21), …

Family Mental Health – A Case Report, Vikrant Arora, Medha Kosireddy, Mathumitha Ananth, Kishor M. Manohar Rao

Digital Journal of Clinical Medicine

Psychiatric illness in India is estimated to be 15% as per National Mental Health Survey 2015-16.  Mental health challenges within families, especially depression, anxiety disorders that are not common and when unaddressed exert cascading effects on all members, disrupting emotional cohesion, relational functioning, and socioeconomic stability. There are few case reports on entire family presenting to psychiatry department.

With informed consent a city-based middle-class family of non-consanguineous origin, where the 40-year-old female, presented with intractable limb pains and health anxiety, she had multiple consultation in last few months and her 48-year-old husband also had with episodic pains, irritability and her …

From Controversy To Comeback: The Renewed Role Of Pralidoxime In Op Poisoning, Dr Sanaa Jain, Dr Savitha V, Dr . Shashidhara K C

Digital Journal of Clinical Medicine

Organophosphorus compounds are commonly used as pesticides in agriculture, but they are responsible for approximately one-third of suicide deaths in Asian countries.The symptoms of organophosphate (OP) poisoning vary over time and are categorized into three phases: Acute Cholinergic Crisis (minutes to 24 hours), Delayed Phase (24 hours to 2 weeks), which may include intermediate syndrome, coma, and extrapyramidal symptoms, and Late Phase (OPIDP). Treatment typically involves Atropine, Pralidoxime, and symptomatic management, including airway support and mechanical ventilation.

Ropinirole-Induced Sleep-Related Behavioral Disturbances And Psychotic Symptoms In Parkinson's Disease: A Case Report, Kareena Arora, Akshatha C. J, Rajesh Raman, Vikrant Arora, Bindu Annigeri, Megha Sadashiv

Digital Journal of Clinical Medicine

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized primarily by motor symptoms such as bradykinesia, rigidity, and tremor. Though commonly associated with motor symptoms but can also present with significant non-motor symptoms such as sleep disturbances, psychosis, and cognitive decline. These symptoms may arise spontaneously or be medication-induced. We present the case of a 53-year-old male with Parkinson’s disease who developed nocturnal behavioural disturbances and psychotic features, likely secondary to dopaminergic agonist medication. Symptom resolution followed adjustment of antiparkinsonian medications and the introduction of antipsychotic medication

Unusual Case Of Pelvic Fracture Urethral Distraction Defect, Varuni Pragya, Madhukesh Rudramurthy, Siddalinga Murthy G

Digital Journal of Clinical Medicine

INTRODUCTION

Urinary bladder ruptures are an uncommon injury, occurring in less than 1% of all blunt abdominal trauma. Extraperitoneal bladder ruptures are generally associated with pelvic fractures and usually managed nonoperatively but open surgery is required when these injuries are associated with additional trauma to structures like prostate and urethra.

CASE PRESENTATION

We report our experience with a 32-year-old male who suffered a head on collision with a four-wheeler while driving a two-wheeler in a road traffic accident. He presented to the hospital with abdominal and pelvic pain, difficulty in passing urine and swelling of the scrotum. His X Ray …

Biomedical Waste Management Practices In A Rural Health Training Centre In Southern India: A Cross-Sectional Facility Audit Using Kayakalp Guidelines, Mathivathani Palaniyappan, Kathiravan Rajendran

Digital Journal of Clinical Medicine

Background

Effective biomedical waste management (BMWM) is essential to prevent environmental contamination and health hazards in healthcare settings. In India, regulatory frameworks like the Biomedical Waste Management Rules, 2016, mandate proper handling, but compliance varies, particularly in rural facilities. This study evaluated BMWM practices at a rural health training centre using the Kayakalp assessment tool.

Methods

A cross-sectional audit was conducted from April to June 2024 at a rural health training centre affiliated with a medical college in Coimbatore, Tamil Nadu, India. The Kayakalp checklist for primary health centres was employed, encompassing 10 measurable elements with 20 checkpoints scored as …

Comparison Of Post Operative Analgesia Between Dexmedetomidine Versus Clonidine As Adjuvant To Ropivacaine In Ultrasound Guided Adductor Canal Block In Arthroscopic Knee Surgeries: A Randomized Controlled Study, Shwetha Arun, Archana B N, Dr. Shivakumar G Pofessor And Hod, Devika Lekshmi S

Digital Journal of Clinical Medicine

The current study evaluated the analgesic efficacy of dexmedetomidine versus clonidine as adjuvants to 0.2% ropivacaine in ultrasound-guided adductor canal block. Effective postoperative pain management is essential for early mobilization and improved recovery following arthroscopic knee surgeries. Sixty ASA I–II patients aged 20–60 years undergoing elective arthroscopic knee procedures were randomized into two groups: Group D received ropivacaine 0.2% 30ml with dexmedetomidine 100 mcg, and Group C received ropivacaine 0.2% 30ml with clonidine 150 mcg. Duration of analgesia, pain scores, sedation levels, hemodynamic changes, and rescue analgesic requirements were recorded. Group D demonstrated significantly prolonged analgesia (18.08 ± 0.514 h) …

Pulmonary Hemosiderosis In A Young Child Presenting With Recurrent Respiratory Illness And Refractory Anemia: A Case Report, Praveen Das, Ratnapriya Chowdhry, Neha Bhongale, Poonam Wade

Digital Journal of Clinical Medicine

Pulmonary hemosiderosis (PH) is a rare cause of diffuse alveolar hemorrhage in children and often presents with nonspecific respiratory symptoms and refractory iron‑deficiency anemia. We report a 2.5‑year‑old girl with recurrent lower respiratory tract infections, severe transfusion‑dependent anemia, failure to thrive, and persistent bilateral pulmonary infiltrates since infancy. Bronchoalveolar lavage demonstrated hemosiderin‑laden macrophages, confirming pulmonary hemosiderosis. Further evaluation revealed C‑ANCA positivity and PR3‑ANCA negativity, raising suspicion for an ANCA‑associated vasculitis; however, there was no renal, ear‑nose‑throat, or other systemic involvement, and a lung biopsy could not be performed. The child was managed with systemic corticosteroids with clinical improvement. This case …

State Social Benefit Schemes For Women In Continuity Of Psychiatric Care: A Case Report, Mathumitha A, Kishor M. Manohar Rao Professor

Digital Journal of Clinical Medicine

Mental health disorders are a major global public health challenge. The disorders affect over a billion people worldwide, while depressive and bipolar spectrum disorders also contribute substantially to disability and reduced quality of life. According to the World Health Organization, major depression alone affects more than 300 million people globally and is considered a leading cause of years lived with disability. Beyond clinical morbidity, mental illnesses exert a profound economic impact, with depression and anxiety accounting for an estimated USD 1 trillion annually in lost productivity worldwide, while the overall global economic burden of mental disorders is projected to reach …

Dietary Micronutrients And The Risk Of Gestational Diabetes: Evidence From A Tertiary Care Setting In India, Sujatha Mahadevarao Premnath, Moneesh Sivasoupramaniane, Maghida S

Digital Journal of Clinical Medicine

Background: Gestational Diabetes Mellitus (GDM) is a significant health concern in India, affecting nearly 22.4% of pregnant women. While macronutrient roles are well explored, the impact of micronutrients on GDM risk, particularly with the Indian ethnic phenotype, requires exploration

Objectives: To compare the micronutrient intake between GDM and non-GDM pregnancies and evaluate the association between specific dietary micronutrients and GDM risk

Methods: An observational cross-sectional study was conducted among 115 South Indian pregnant women. Dietary history was taken using 24-hour recalls on two occasions and analysed via the Indian Food Composition Table (IFCT). GDM was diagnosed using International Association of …

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