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Trauma to the solid abdominal organs:The missed dark box of colonoscopy

World Journal of Gastroenterology 2024年第7期30卷 624-630页

作者： Mohamed h emara Usama Mazid Yasmine A Elshaer Mahmoud A Elkerdawy Dilaver Farooq Malik Aya M Mahros Department of hepatology Gastroenterologyand Infectious DiseasesKafrelsheikh UniversityKafr-Elshikh 33516Egypt Department of Medicine Alyousif HospitalAlkhobar 31952Saudi Arabia

Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient *** is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used,the sedatives used,but to the procedure related as well including bleeding and *** to the extra-luminal abdominal organs during colonoscopy are uncommon,however,serious complications related to the procedure have been reported infrequently in the *** threatening injuries to the spleen,liver,pancreas,mesentery,and urinary bladder have been reported as early as in *** injuries should not be overlooked by clinicians and *** increasing abdominal pain,abdominal distension,and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ *** and hepatic injury following colonoscopy are usually serious and may be life *** conservative management may help,yet they usually need interventional radiology or surgical *** pancreatitis following colonoscopy is usually mild and is mostly managed *** mechanism of abdominal organ injuries during colonoscopy is not fully understood,however many risk factors have been identified,which can be classified as-organ related,procedure related,and local abdominal *** colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these *** lateral position,avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.

关键词： Colonoscopy Pancreatitis Trauma Complications Adhesions

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Post-cholecystectomy iatrogenic bile duct injuries:Emerging role for endoscopic management

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2709-2718页

作者： Mohamed h emara Mohammed hussien Ahmed Mohamed I Radwan emad h.ssan emara Magdy Basheer Ahmed Ali Asem Ahmed Elfert Department of hepatology Gastroenterology and Infectious DiseasesKafrelsheikh UniversityKafr-Elshikh 33516Egypt Department of Tropical Medicine Zagazig UniversityZagazig 44519Egypt Department of Diagnostic and Interventional Radiology Kafrelsheikh UniversityKafr-Elshikh 33516Egypt Department of Surgery Mansoura UniversityMansours 44176Egypt Department of Emergency Hargeisa Group HospitalHargeisa 1235Somalia Department of Tropical Medicine Tanta UniversityTanta 33120Egypt

Post-cholecystectomy iatrogenic bile duct injuries(IBDIs),are not uncommon and although the frequency of IBDIs vary across the literature,the rates following the procedure of laparoscopic cholecystectomy are much higher than open *** injuries caries a great burden on the patients,physicians and the health care systems and sometime are *** are associated with different manifestations that are not limited to abdominal pain,bile leaks from the surgical drains,peritonitis with fever and sometimes *** injuries if not witnessed during the surgery,can be diagnosed by combining clinical manifestations,biochemical tests and imaging *** such techniques abdominal US is usually the first choice while Magnetic Resonance Cholangio-Pancreatography seems the most *** approach was the ideal approach for such cases,however the introduction of Endoscopic Retrograde Cholangio-Pancreatography(ERCP)was a paradigm shift in the management of such injuries due to accepted success rates,lower cost and lower rates of associated morbidity and ***,the literature lacks consensus for the optimal timing of ERCP intervention in the management of *** management of IBDIs can be tailored according to the nature of the underlying *** the subgroup of patients with complete bile duct ligation and lost ductal continuity,transfer to surgery is indicated without *** patients will not benefit from endoscopy and hence should not do unnecessary *** low–flow leaks *** bed leaks,conservative management for 1-2 wk prior to ERCP is advised,in contrary to high-flow leaks *** duct leaks and stricture lesions in whom early ERCP is *** plus stenting is the ideal management line for cases of *** radiologic techniques are promising options especially for cases of failed endoscopic repair and also for cases with altered *** studies will

关键词： Iatrogenic bile duct injuries Cholecystectomy Surgical repair Endoscopic Retrograde Cholangio-Pancreatography Interventional radiology

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Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics

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World Journal of hepatology 2023年第2期15卷 216-224页

作者： Mohamed h emara Mariam Zaghloul Ibrahim F Amer Aya M Mahros Mohammed hussien Ahmed Mahmoud A Elkerdawy Eslam Elshenawy Abdelrahman M Ahmed Rasheda Tarik I Zaher Mona Talaat haseeb emad h.ssan emara h.ssan Elbatae Department of hepatology Gastroenterology and Infectious DiseasesKafrelsheikh UniversityKafr-Elshikh 33516Egypt Department of Internal Medicine Gastroenterology UnitSecurity Forces HospitalRiyadh 11481Saudi Arabia Tropical Medicine Zagazig UniversityZagazig 44519Egypt Department of Diagnostic and Interventional Radiology Kafrelsheikh UniversityKafr-Elshikh 33516Egypt

Acute variceal bleeding in patients with liver cirrhosis and portal hypertension(PhT) is the most serious emergency complication among those patients and could have catastrophic outcomes if not timely managed. Early screening by esophago-gastro-duodenoscopy(EGD) for the presence of esophageal varices(EVs) is currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in studies to investigate and validate non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder(GB) wall thickness(GBWT) measurement has been found promising in many published research articles. We aim to highlight the validity of sonographic GBWT measurement in the prediction of EVs based on the available evidence. We searched databases including Cochrane library, Pub Med, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PhT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cutoffs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive *** cirrhotics, GBWT > 3.5 mm predicts the presence of advanced(grade Ⅲ-Ⅳ) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.

关键词： Sonographic Gallbladder wall thickness Prediction Esophageal varices Portal hypertension Esophago-gastro-duodenoscopy

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Mid-term results of sub-trochanteric valgus osteotomy for symptomatic late stages Legg-Calvé-Perthes disease

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World Journal of Orthopedics 2023年第5期14卷 328-339页

作者： Khaled M emara Ramy Ahmed Diab Ahmed K emara Mohamed Eissa Mostafa Gemeah Shady Abdelghaffar Mahmoud Department of Orthopedic Surgery Ain Shams UniversityCairo 11591Egypt Department of Orthopedic Surgery Cleveland Clinic FoundationClevelandOH 9500United States health Care Innovation Program Arizona State UniversityTempeAZ 85287United States

BACKGROUND The treatment of late stages of Legg-Calvé-Perthes disease(LCPD)is *** the concept of femoral head containment is a well-established technique of treatment,its use remains debatable in the late stages of the disease,as it does not improve symptoms in terms of limb length discrepancy and *** To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes *** From 2000 to 2007,36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion(ROM)*** Mose classification was also assessed at the last follow-up to reflect possible *** patients were 8 years old or older at the time of surgery,in the post-fragmentation stage,and complaining of pain,limited ROM,Trendelenburg gait,and/or abductor *** The preoperative IOWA score(average:53.3)markedly improved at the 1-year post follow-up period(average:85.41)and then slightly improved at the last follow-up(average:89.4)(P valueh internal rotation increased on average by 22°(from 10°preoperatively to 32°postoperatively)and abduction increased on average by 15.9°(from 25°preoperatively to 41°postoperatively).The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up *** tests used were the paired t-test and Pearson correlation test,where the level of significance was a P value less than *** Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.

关键词： Legg-Calvé-Perthes disease Femoral head avascular necrosis Valgus osteotomy Deformity correction Post fragmentation stage Late stage Perthes

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Schistosomal(bilharzial)polyps:Travel through the colon and beyond

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World Journal of Gastroenterology 2023年第26期29卷 4156-4165页

作者： Mohamed h emara Aya M Mahros Abdelrahman M Ahmed Rasheda Mohamed I Radwan Besher Mohamed Osama Abdelrazik Mostafa Elazab h.ssan Elbatae Department of hepatology Gastroenterology and Infectious DiseasesKafrelsheikh UniversityKafr-Elshikh 33516Egypt Department of Internal Medicine Gastroenterology UnitSecurity Forces HospitalRyiadh 11481Saudi Arabia Department of Tropical Medicine Zagazig UniversityZagazig 44519Egypt Department of Gastroenterology Surrey and Sussex Hospitals NHS TrustSurrey RH15RHUnited Kingdom Department of hepato-Gastroenterology and Infectious Diseases Al-Azhar UniversityCairo 11651Egypt

Schistosomiasis(bilharziasis)is a major neglected tropical *** is endemic in many tropical and subtropical *** polyps(***)are not uncommon presentation of this *** the colon is the most commonly affected organ,many other organs are *** are associated with a variable range of morbidity independent of the Schistosomal *** are frequently described in endemic areas and increasingly reported in non-endemic areas mainly among immigrants and visitors to the endemic *** review aimed to increase awareness of practitioners,especially gastroenterologists,for this peculiar type of polyps caused by this neglected infection hence improving patient ***-based search of different databases was conducted for the literature focusing the development of *** in the colon and other organs with analysis of the clinical manifestations,diagnosis and *** following key words were used in the search,“Schistosomiasis”OR“Bilharziasis”AND“Polyps”OR“Polyp”AND“Colon”OR“Small intestine”OR“Duodenum”OR“Stomach”OR“Esophagus”OR”Gallbladder”OR”Pharynx”OR“Larynx”OR“Trachea”OR”Urinary bladder”OR“Ureter”OR“Renal Pelvis”OR“Urethra”.All publication types including case reports,case series,original research,and review articles were retrieved and *** are not infrequent presentation of acute or chronic Schistosomal *** are described in many organs including the bowel,genitourinary tract,skin,gallbladder and the *** of *** is variable and depends on the site,number as well as the polyp *** relationship of *** to malignant transformation is a matter of *** of *** is sometimes the only manifestation of *** polyps can be treated medically with praziquantel,while large accessible polyps are amendable for endoscopic excision through different polyp resection ***,huge,complicated,non-accessible and sus

关键词： Schistosomiasis Bilharziasis Schistosomal polyps Colon Praziquantel

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Enhancing Parkinson’s Disease Prediction Using Machine Learning and Feature Selection Methods

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Computers, Materials & Continua 2022年第6期71卷 5639-5657页

作者： Faisal Saeed Mohammad Al-Sarem Muhannad Al-Mohaimeed Abdelhamid emara Wadii Boulila Mohammed Alasli Fahad Ghabban College of Computer Science and Engineering Taibah UniversityMedina41477Saudi Arabia School of Computing and Digital Technology Birmingham City UniversityBirminghamB47XGUnited Kingdom Information System Department Saba’a Region UniversityMareebYemen Computers and Systems Engineering Department Al-Azhar UniversityCairo11884Egypt RIADI Laboratory National School of Computer SciencesUniversity of ManoubaManouba2010Tunisia

Several millions of people suffer from Parkinson’s disease ***’s affects about 1%of people over 60 and its symptoms increase with *** voice may be affected and patients experience abnormalities in speech that might not be noticed by listeners,but which could be analyzed using recorded speech *** the huge advancements of technology,the medical data has increased dramatically,and therefore,there is a need to apply data mining and machine learning methods to extract new knowledge from this *** classification methods were used to analyze medical data sets and diagnostic problems,such as Parkinson’s Disease(PD).In addition,to improve the performance of classification,feature selection methods have been extensively used in many *** paper aims to propose a comprehensive approach to enhance the prediction of PD using several machine learning methods with different feature selection methods such as filter-based and *** dataset includes 240 recodes with 46 acoustic features extracted from3 voice recording replications for 80 *** experimental results showed improvements when wrapper-based features selection method was used with K-NN classifier with accuracy of 88.33%.The best obtained results were compared with other studies and it was found that this study provides comparable and superior results.

关键词： Filter-based feature selection methods machine learning parkinson’s disease wrapper-based feature selection methods

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Effect of lengthening along the anatomical axis of the femur and its clinical impact

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World Journal of Orthopedics 2017年第5期8卷 431-435页

作者： Khaled M emara Ahmed Nageeb Mahmoud Ahmed K emara Mariam K emara Limb Reconstruction and Deformity Correction Unit Orthopaedic Surgery Department Ain Shams University Hospitals

AIM To review and study the effect of lengthening along the anatomical axis of long bones and its relation to the mechanical axis *** We try in this review to calculate and discuss the exact clinical impact of lengthening along the anatomical axis of the femur on affecting the limb alignment. Also we used a trigonometric formula to predict the change of the femoral distal anatomical mechanical angle(AMA) after lengthening along the anatomical axis. RESULTS Lengthening along the anatomical axis of the femur by 10% of its original length results in reduction in the distal femoral AMA by 0.57 degrees. There is no objective experimental scientific data to prove that the Mechanical axis is passing via the center of the hip to the center of the knee. There is wide variation in normal anatomical axis for different populations. In deformity correction, surgeons try to reproduce the normal usual bone shape to regain normal function, which is mainly anatomical axis. CONCLUSION Lengthening of the femur along its anatomical axis results in mild reduction of the distal femoral AMA. This may partially compensate for the expected mechanical axis lateralisation and hence justify its minimal clinical impact.

关键词： Bone lengthening Deformity Femoral lengthening External fixation Intramedullary nail Axis deviation

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A Survey of Data Partitioning and Sampling Methods to Support Big Data Analysis

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Big Data Mining and Analytics 2020年第2期3卷 85-101页

作者： Mohammad Sultan Mahmud Joshua Zhexue huang Salman Salloum Tamer Z.emara Kuanishbay Sadatdiynov National Engineering Laboratory for Big Data System Computing Technology Shenzhen UniversityUniversityShenzhen 518060China Big Data Institute College of Computer Science and Software EngineeringShenzhen UniversityShenzhen 518060China.

Computer clusters with the shared-nothing architecture are the major computing platforms for big data processing and *** cluster computing,data partitioning and sampling are two fundamental strategies to speed up the computation of big data and increase *** this paper,we present a comprehensive survey of the methods and techniques of data partitioning and sampling with respect to big data processing and *** start with an overview of the mainstream big data frameworks on hadoop *** basic methods of data partitioning are then discussed including three classical horizontal partitioning schemes:range,hash,and random *** partitioning on hadoop clusters is also discussed with a summary of new strategies for big data partitioning,including the new Random Sample Partition(RSP)distributed *** classical methods of data sampling are then investigated,including simple random sampling,stratified sampling,and reservoir *** common methods of big data sampling on computing clusters are also discussed:record-level sampling and blocklevel ***-level sampling is not as efficient as block-level sampling on big distributed *** the other hand,block-level sampling on data blocks generated with the classical data partitioning methods does not necessarily produce good representative samples for approximate computing of big *** this survey,we also summarize the prevailing strategies and related work on sampling-based approximation on hadoop *** believe that data partitioning and sampling should be considered together to build approximate cluster computing frameworks that are reliable in both the computational and statistical respects.

关键词： big data analysis data partitioning data sampling distributed and parallel computing approximate computing

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Methods to shorten the duration of an external fixator in the management of tibial infections

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World Journal of Orthopedics 2011年第9期2卷 85-92页

作者： Khaled M emara Khaled Abd Al Ghafar Mohamed Ahmed Al Kersh Orthopaedic Surgery Ain Shams University HospitalsCairo 0020Egypt Lecturer in Orthopaedic Surgery Ain Shams UniversityCairo 0020Egypt Assistant Lecturer of Orthopaedic Surgery Ain Shams UniversityCairo 0020Egypt

Massive segmental bone loss due to chronic osteomyelitis represents a considerable challenge to orthopedic surgeons and is a limb threatening *** only option available in such a clinical situation is segment transport using the Ilizarov technique of distraction osteogenesis;yet the most common problem in cases of bone transport with the Ilizarov technique in massive bone loss,is the long duration of the *** addition to autologous bone grafting,several mechanical,biologic,and external physical treatment modalities may be employed to promote bone formation and maturation during segment transport in osteomyelitis *** approaches include compressive loading of the distraction regenerate,increased frequency of small increments of distraction,and *** nailing and hemicorticotomy can reduce the time in external fixation;however,these techniques are associated with technical difficulties and *** application of low-intensity pulsed ultrasound or pulsed electromagnetic fields may shorten the duration of external *** promising modalities include diphosphonates,physician-directed use(off-label use)of bone morphogenetic proteins,and local injection of bone marrow aspirate and platelet gel at the osteotomy ***-designed clinical studies are needed to establish safe and effective guidelines for various modalities to enhance new bone formation during distraction osteogenesis after segment transfer.

关键词： Ilizarov Bone infection Intramedullary nail hemicorticotomy Tibiofibular synostosis Fibular transport

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On-line coupling of derivatization with pre-concentration to determine trace levels of methotrexate

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Journal of Pharmaceutical Analysis 2013年第1期3卷 28-35页

作者： Samy emara Tsutomu Masujima Walaa Zarad Maha Kamal Ramzia EL-Bagary Pharmaceutical Chemistry Department Faculty of PharmacyMisr International University Analytical Molecular Medicine and Devices Laboratory Hiroshima UniversityGraduate School of Biomedical Sciences Pharmaceutical Analytical Chemistry Department Faculty of PharmacyModern Sciences and Arts University Pharmaceutical Chemistry Department Faculty of PharmacyCairo University

A new simple, sensitive and precise green analytical procedure using an automated packed-reactor derivatization technique coupled with on-line solid-phase enrichment （SPEn） has been developed and evaluated to determine trace levels of methotrexate （MTX）. The method was based on injection of MTX into a flowing stream of phosphate buffer （0.04 M, ptt 3.4）, carried through the packed oxidant reactor of Cerium （IV） trihydroxyhydroperoxide for oxidative cleavage of the drug into highly fluorescent product, 2,4-diaminopteridine- 6-carboxylic acid, followed by SPEn on a head of short ODS column （10mm x 4.6 mm i.d., 5 I＋tm particle size）. The flow rate was 0.25 mL/min and packed reactor temperaturc was 40 ~C. The trapped product was back-flush eluted from the ODS column to the detector by column-switching with an environmentally friendly mobile phase consisting of ethanol and phosphate buffer （0.04 M, ph 3.4） in the ratio of 5：95 （v/v）. The eluent was monitored at emission and excitation wavelengths of 460 and was linear over the concentration range of 1.25-50 360 nm, respectively. The calibration curve ng/mL with a detection limit of 0.08 ug/ml..The method was successfully applied to determine MTX in pharmaceutical formulations with mean percentage recovery ranging from 99.48 to 99.60.

关键词： Methotrexate Flow injection analysis Cerium (IV) trihydroxy-hydroperoxide On-line solid-phaseenrichment Fluorescence detection

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