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Cost of external fixation vs external fixation then nailing in bone infection

World Journal of Orthopedics 2015年第1期6卷 145-149页

作者： khaled mohamed emara Ramy Ahmed Diab khaled Abd EL Ghafar Orthopaedic Surgery Ain Shams University

AIM: To study the cost benefit of external fixation vs external fixation then nailing in treatment of bone infection by segment ***: Out of 71 patients with infected nonunion tibia treated between 2003 and 2006, 50 patients fitted the inclusion criteria(26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence fromschool or work were calculated and compared between both ***: The cost of hospital stay and surgery in the group of external fixation only was 22.6 ± 3.3 while the cost of hospital stay and surgery in the group of early external fixation removal and replacement by intramedullary nail was 26.0 ± 3.2. The difference was statistically significant regarding the cost of hospital stay and surgery in favor of the group of external fixation only. The total cost of medical care(surgery, hospital stay, treatment outside the hospital including medications, dressing, physical therapy, outpatient laboratory work, etc.) in group of external fixation only was 63.3 ± 15.1, and total absence from work was 38.6 ± 6.6 wk. While the group of early removal of external fixation and replacement by IM nail, total cost of medical care was 38.3 ± 6.4 and total absence from work or school was 22.7 ± 4.1. The difference was statistically significant regarding the total cost and absence from work in favor of the group of early removal and replacement by IM ***: Early removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance, and health authorities.

关键词： Cost Fixator Nailing Infection

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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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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 value<0.05).ROM improved,with 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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Advances and challenges in the differentiation of pluripotent stem cells into pancreatic β cells

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World Journal of Stem Cells 2015年第1期7卷 174-181页

作者： Essam M Abdelalim mohamed M emara Qatar Biomedical Research Institute Qatar Foundation Education City PO Box 5825 Doha Qatar

Pluripotent stem cells(PSCs) are able to differentiate into several cell types, including pancreatic β cells. Differentiation of pancreatic β cells depends on certain transcription factors, which function in a coordinated way during pancreas development. The existing protocols for in vitro differentiation produce pancreatic β cells, which are not highly responsive to glucose stimulation except after their transplantation into immune-compromised mice and allowing several weeks for further differentiation to ensure the maturation of these cells in vivo. Thus, although the substantial improvement that has been made for the differentiation of induced PSCs and embryonic stem cells toward pancreatic β cells, several challenges still hindering their full generation. Here, we summarize recent advances in the differentiation of PSCs into pancreatic β cells and discuss the challenges facing their differentiation as well as the different applications of these potential PSC-derived β cells.

关键词： Embryonic stem cells Induced pluripotentstem cells Insulin-secreting cells In vitro In vivo Differentiation Maturation

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Virtual orthopedic assessment:Main principles and specific regions

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World Journal of Orthopedics 2021年第9期12卷 672-684页

作者： khaled M emara Ramy Ahmed Diab mohamed Amr Shady Abdelghaffar Mahmoud mohamed Nour Ahmed Abdelsalam Mahmoud Ahmed Elshobaky Mona Farhan Mostafa Gemeah Ahmed K emara Orthopedic Surgery Department Ain Shams UniversityCairo 11566Egypt Orthopedic Surgery Department Bank Ahly HospitalCairo 11566Egypt Department of Health Care Innovation Arizona State UniversityArizonaAZ 85287United States Department of Orthopedic Surgery Cleveland ClinicOhioNY 44195United States

Telemedicine was originally created as a way to treat patients who were located in remote places far away from local health facilities or in areas with shortages of medical *** is still used today to address those problems,and is increasingly becoming a tool for convenient medical *** the emergence of pandemics,telemedicine became almost a mandatory and valuable option for continuing to provide medical care in various *** the threat of pandemic progress has continued for months and may continue for years,it is essential to validate existing tools to maintain clinical assessment and patient treatment to avoid negative consequences of the lack of medical ***,the establishment of a virtual assessment technique that can be conducted effectively is of outmost importance as a way of adapting to the current *** study evaluated the role of telemedicine in the assessment of various orthopedic pathologies by means of a systematic virtual evaluation.

关键词： Telemedicine Virtual assessment Orthopedics Epidemic diseases

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

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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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Effect of Consolidation Conditions on the Tensile Behavior of Pure Aluminium-Carbon Nanotubes Reinforced Metal Matrix Composites

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材料科学与工程（中英文A版） 2013年第4期3卷 232-236页

作者： mohamed Mahmoud emara Department of Manufacturing Engineering The Canadian International College (CIC) Cairo Campus of Ottawa and Cape BretonUniversities Canada Cairo- Egypt

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The Effect of Particle Alignment on the Tensile Behaviors of Extruded Al2O3/2124 Aluminum Alloy Metal Matrix Composites

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材料科学与工程（中英文A版） 2014年第1期4卷 34-38页

作者： mohamed Mahmoud emara Department of Manufacturing Engineering The Canadian International College (CIC) Cairo Campus of Ottawa and Cape BretonUniversities Canada

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