Abstract

Background: Post-burn cubital contracture is a common, debilitating complication, especially because the elbow has thin, mobile tissue and nearby neurovascular structures. Surgical reconstruction requires balancing coverage durability, recurrence risk, and early movement. Perforator flaps maintain axial blood supply while providing flexible, pliable tissue.

Objective: To evaluate functional and aesthetic outcomes of the lateral arm perforator flap (LAPF) for reconstruction of post-burn cubital contractures in children.

Patients and Methods: A prospective, single-centre case series was conducted at Assiut University Hospital from June 2023 to May 2025, involving children with mature postburn cubital contracture. They underwent scar excision, stepwise release, then reconstruction using Doppler-mapped perforator-based propeller LAPF. Follow-up occurred at 3, 6, and 12 months, assessing elbow motion and function with the Arabic version of QuickDASH (reported by parents in younger children and self-reported by older children, where feasible), scars with POSAS, and occurrence of complications.

Results: Fifteen children (4–18 years; mean 11 ± 7; 60% male) underwent surgery. The mean post-release defect was 7 ± 2 × 9 ± 3 cm; flap size was 8 ± 2 × 11 ± 3 cm with 120°–180° rotation. Donor sites were closed primarily in 10 patients (66.7%) and grafted in 5 (33.3%). Extension deficit improved from 73.1 ± 26.4° to 9.6 ± 7.4°; flexion–extension arc increased from 78.5 ± 21.9° to 126.8 ± 10.7°; Arabic QuickDASH improved from 51.2 ± 12.6 to 4.5 ± 2.8 at 12 months (all p < 0.001). All flaps survived; venous congestion in 3 patients (20%), with 2 (13.3%) having partial necrosis. No elbow instability or permanent ulnar nerve deficit occurred. POSAS improved to ~3 at 12 months.

Conclusions: LAPF is a reliable regional option for pediatric post-burn cubital contracture reconstruction, providing sustained improvements in elbow motion and patient-reported function with overall acceptable morbidity. A longer follow-up is required to confirm durability through growth.

Abstract

Background: Macroglossia is a term used to describe a large tongue which protrudes outside of the mouth while in a resting position. It is relatively an uncommon condition in children. True macroglossia; congenital or acquired; includes both muscular hypertrophy and tissue infiltration. Congenital macroglossia commonly presents as part of a syndrome, or idiopathic muscular hypertrophy which is a rare entity of true tongue enlargement without any underlying etiology. It is responsible for many functional and psychological disorders. The current surgical approaches emphasise protecting the neurovascular bundles, retaining sufficient length, and preserving lingual movement. The keyhole technique combines both an anterior wedge resection and a central tongue reduction. This debulks the tongue significantly while protecting the lateral neurovascular bundles.

Case Presentation: A five-year-old boy presented with congenital macroglossia due to idiopathic muscular hypertrophy. Other aetiologies, especially syndromes like Beckwith-Widemann syndrome Trenaunay Klipper syndrome and Down syndrome or vascular anomalies, like venous malformations were excluded. Macroglossia was surgically corrected by the keyhole technique. Functional and aesthetic results were excellent at rest and during mobility of the tongue.

Conclusions: Congenital macroglossia requiring reduction glossoplasty is relatively rare and these procedures are, therefore, uncommonly performed. Regardless of its rarity, it can be life saving for some infants and children, and life altering for the others. Reduction glossectomy can greatly enhance the functional and aesthetic results of macroglossia.

Abstract

Background: Gynecomastia surgery generally yields reliable chest contouring results. Perioperative bleeding sequelae (blood-stained lipoaspirate, drain burden, ecchymosis, and hematoma) remain clinically relevant and may delay recovery. Antifibrinolytic tranexamic acid (TXA) is routinely used in major surgeries to decrease blood loss and transfusions. Its use in gynecomastia surgery is limited.

Objective: To evaluate the efficacy of different tranexamic acid (TXA) application methods in controlling perioperative bleeding in gynecomastia surgery.

Patients and Methods: In a prospective, randomized, controlled trial at Assiut University Hospital (Assiut, Egypt), 48 males with true gynecomastia (16-45 years; BMI <35 kg/m²) underwent suction-assisted liposuction with selective glandular excision were randomized (1:1:1; n=16/group) to: Group A (standard tumescence), Group B (local TXA: 500 mg added to tumescence), or Group C (IV TXA: 500 mg, maximum 15 mg/kg). The primary endpoint was estimated intraoperative blood content of the lipoaspirate; key secondary endpoints were postoperative drain output and duration, ecchymosis (incidence and maximal extent), operative time, length of stay, and early complications over 6 weeks. One-way ANOVA with appropriate post-hoc testing and chi-square/Fisher tests were used (two-tailed P<0.05).

Results: Intraoperative aspirate blood content differed significantly across groups (P<0.001) and was lowest with local TXA (control 375.00±40.82 mL; local TXA 190.63±20.16 mL; IV TXA 341.25±37.04 mL). Drain output favoured local TXA (65.63±15.04 mL vs 41.88±11.09 mL vs 55.00±5.16 mL; P<0.001) with shorter drain duration (4.19±0.91 vs 3.19±0.40 vs 3.38±0.50 days; P<0.001). Ecchymosis extent was smaller with local TXA (6.19±2.01 vs 1.10±1.10 vs 2.10±1.20 cm; P<0.001), while ecchymosis incidence was numerically lower with local TXA (37.5% vs 6.25% vs 12.5%; P=0.057). Operative time differed modestly (98.75±7.19 vs 104.38±9.64 vs 106.25±8.06 minutes; P=0.039). Early complications were infrequent and did not differ significantly between groups (P=0.210).

Conclusion: Adjunctive TXA improved bleeding-related recovery surrogates in adult gynecomastia surgery, with local TXA in the tumescent solution providing the most consistent reductions in intraoperative aspirate blood content and drain burden. TXA also reduced the extent, with a non-significant trend toward fewer ecchymoses. Larger trials are warranted to define clinical benefit and safety.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the
main reason of hospital admission. Early diagnosis and prognostication of patients
are important to guide clinicians in optimal decisions regarding the type and site of
care. Different scores used to assess the severity of exacerbation and predict the
outcome. This study aimed to assess the value of four scores (DECAF, BAP-65,
CURB-65 and qSOFA) in predicting intensive care unit admission and in-hospital
death in patients with AECOPD

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the
main reason of hospital admission. Early diagnosis and prognostication of patients
are important to guide clinicians in optimal decisions regarding the type and site of
care. Different scores used to assess the severity of exacerbation and predict the
outcome. This study aimed to assess the value of four scores (DECAF, BAP-65,
CURB-65 and qSOFA) in predicting intensive care unit admission and in-hospital
death in patients with AECOPD.
 

Finding specific serum biomarkers linked to rheumatoid arthritis (RA) can help us understand the
course of the disease, and the prognosis. Here, we aimed to explore the potential use of arginine,
ornithine, tryptophan, citrulline, serotonin and several other biochemical markers for early
diagnosis of rheumatoid arthritis (RA). We examined serum samples from 30 controls and 60 RA
patients to achieve this goal. According to our findings, there was a statistically significant difference
in the serum levels of ornithine and arginine between RA patients and controls, with
higher ornithine and lower arginine in RA patients compared to controls. Furthermore, we found
that only patients with high disease activity index had considerably greater levels of serotonin.
Additionally, we found that using arginine alone can predict RA disease with 96.7% sensitivity
and 80.8 % specificity, while ornithine can predict RA disease with 100% sensitivity and 66.7%
specificity. Interestingly, the ornithine to arginine ratio (OR/AR) could identify people with RA
disease with 100% sensitivity and 83.3% specificity and this clear discrimination is not affected
by the disease index or duration. Hence, RA patients can be distinguished using the ornithine to
arginine ratio as a biomarker, which has higher specificity than each analyte alone. Our results
can undoubtedly serve as a foundation for additional research and multicenter studies in the
future to support accurate therapeutic management strategies for RA patients.

Introduction: New Delhi metallo-β-lactamase (NDM)-producing K. pneumoniae poses a high risk, especially among Egyptian pediatric patients who consume carbapenems antibiotics very widely and without adequate diagnostic sources. In addition, presence of efflux pump genes such as OqxAB increases resistance against many groups of antimicrobials which exacerbates the problem faced for human health. This study aimed to determine NDM variants among K. pneumoniae strains isolated from pediatric patients in Egypt, analyze the presence of OqxAB genes, and molecular characterization of blaNDM-5-positive K. pneumoniae. Methods: Fifty-six K. pneumoniae isolates were recovered from pediatric patients, and tested for carbapenemase by modified carbapenem inactivation methods (mCIM) test. Minimum inhibitory concentrations of meropenem and colistin were determined by meropenem E-test strips and broth microdilution, respectively. PCR was used for the detection of the resistant genes (ESBL gene (blaCTX-M), carbapenemase genes (blaNDM, blaKPC) colistin resistant (mcr1, mcr2)) and genes for efflux pump (oqxA and oqxB). BlaNDM was sequenced. The effect of efflux pump in NDM-5-producing isolates was assessed by measuring MIC of ciprofloxacin and meropenem before and after exposure to the carbonyl cyanide 3-chlorophenylhydrazone (CCCP). The horizontal gene transfer ability of blaNDM-5 was determined using liquid mating assay and PCR-based replicon typing (PBRT) was done to determine the major plasmid incompatibility group. Results: Twenty-nine isolates were positive for blaNDM-1, nine isolates were positive for blaNDM-5, and 15 isolates were positive for blaKPC. There is a significant increase of meropenem MIC of NDM-5-positive isolates compared with NDM-1-positive isolates. In addition, 38 isolates were positive for CTX-M, and 15 isolates were positive for mcr1. Both OqxA and OqxB were detected in 26 isolates and 13 isolates were positive for OqxA while 11 isolates were positive for OqxB only. All NDM-5-producing isolates except one isolate could transfer their plasmids by conjugation to their corresponding transconjugants (E. coli J53). Plasmid replicon typing showed that FII was predominant in NDM-5-producing K. pneumoniae. Similar strains were found between the three isolates and similarity was also detected between the two isolates. Conclusion: The highly resistant K. pneumoniae producing blaNDM-5 type was firstly isolated from pediatric patients. The association of efflux pump genes such as OqxAB is involved in resistance to ciprofloxacin. This highlighted the severity risk of blaNDM-5-positive K. pneumonia as it could transfer blaNDM-5 to other bacteria and has more resistance against carbapenems. This underlines the importance of continuous monitoring of infection control guidelines, and the urgent need for a national antimicrobial stewardship plan in Egyptian hospitals.