Benha University
  • Banhā, Egypt
Recent publications
Objectives: Evaluation of outcome of women undergoing laparoscopic hysterectomy under general anesthesia with intraoperative (IO) multimodal analgesia. Patients & Methods: 129 women were allocated into three groups: Group F received fentanyl loading dose and IO infusion; Group D received loading doses of dexmedetomidine (DEX) and lidocaine (LID) and infusions; Group M included patients received parecoxib sodium infusion (80 µg/ml), 30 minutes prior to induction of anesthesia and loading doses and IO infusions as group D in addition to parecoxib infusion. Heart rate (HR) and mean arterial pressure (MAP) were continuously non-invasively monitored. Blood samples were obtained for ELISA estimation of serum levels of inflammatory cytokines. Outcomes included adequacy of IO analgesia to control intraoperative MAP changes and postoperative (PO) pain scores and its relation to change in serum cytokines’ levels. Results: Fentanyl infusion induced significantly higher incidence and extent of decreased MAP in relation to preoperative MAP, while IO analgesia used for groups M and D allowed more hemodynamic stability. Patients of groups D and M had significantly shorter duration of PACU stay, longer duration of PO analgesia and lower number requests of rescue analgesia with significantly lower 24-hr pain score. Serum cytokines’ levels were significantly lower in patients of group M than in groups D and F with significantly lower levels in patients of group D compared to group F. Conclusion: Multimodal IO analgesia was efficient to provide IO hemodynamic stability, reduce PO pain, consumption of rescue analgesia and serum cytokines’ levels. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
To ensure the global energy demands and decarbonize the production of electricity, the expanded utilization of solar photovoltaics (PV) as a renewable energy resource has been increasing in recent decades, principally with the feasibility to be integrated with the conventional power grid. However, supplying clean power from PV grid-connected systems is often hampered by power quality (PQ) disturbances caused by the intermittent nature of solar radiation and other factors related to the grid, converters, and connected loads. To prevent deterioration of the power quality of the system, these disturbances must be mitigated. This paper technically studies some of these PQ issues, that is, the current total harmonic distortion (THD) which causes harmful effects on the whole connected power system and the linked loads. The case study works on a 5.5 kW grid-connected rooftop PV power system established at Benha Faculty of Engineering, Egypt, with the assistance of an installed weather station that boosts the validation of the research results. All aspects regarding the aforementioned small plant are presented including description and simulation of the whole system, review of current THD problems occurring at the point of common coupling (PCC), and a review of other disturbances observed by connected meters. A detailed examination of four techniques for harmonic mitigation, namely the on-off technique, LCL filter, active power filter, and hybrid active power filter is presented with a final comparison to assess the merits and demerits of each one. This research achieved a current harmonic limitation of 1.5%. © 2022 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.
Background Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with more than one organ involvement. Kidney is the foremost commonly affected one. Gelsolin is a protein that induces depolymerization of actin filaments thus preventing downstream stimulation of inflammatory reactions. The aim of this work was to detect the relation of plasma gelsolin to SLE disease activity and severity indices in order to find out if plasma gelsolin could be used as a biomarker of the disease. This study was conducted on 50 SLE female patients and 30 matched control. SLE disease activity Index (SLEDAI) and SLE damage index (SDI) were assessed. All lupus nephritis (LN) patients were subjected to an ultrasound-guided kidney biopsy. Plasma gelsolin level was measured. Results The mean age of the patients was 38.5 ± 6.3 years (26–51 years) with median disease duration of 5 (3–9.3) years. Eighteen patients had LN, 11 had cardiac manifestations and 12 had chest manifestations. The mean SLEDAI was 13.1 ± 4.5 (4–22) and the median SDI was 2 (1–3). Plasma gelsolin level was significantly lower in SLE patients (74.9 mg/l; 57.5–98.8 mg/l) compared to control (801.5 mg/l; 225–1008.3 mg/l) ( p < 0.001). There were significant negative correlations of gelsolin levels with anti-ds DNA ( r = − 0.63, p < 0.001), SLEDAI ( r = − 0.79, p < 0.001), and SDI ( r = − 0.74, p = 0.001). Plasma gelsolin level was significantly lower in SLE patients with high/very high activity grades compared to those with low and moderate ( p = 0.007 and p < 0.001 respectively). A gelsolin level of ≤ 78.95 mg/l significantly predicted renal affection ( p < 0.001), with a sensitivity of 100%, specificity 71.9%, and a positive predictive value 66.7%. Conclusion A decreased gelsolin level is associated with disease activity in SLE patients. Plasma gelsolin was well related to disease activity and severity with a high predictive value for renal affection comparable to anti-ds DNA titre. Plasma gelsolin is a potentially important predictive biomarker for SLE and LN.
Background Scuba diving has become a popular hobby. However, diving puts the auditory system at the risk of a wide variety of complaints including tinnitus. Low-level laser therapy is a new modality in treatment of tinnitus. This study evaluates effect of laser therapy on tinnitus of scuba divers in Red Sea. This randomized study included 200 scuba diving patients with tinnitus without any other audiological symptoms. They were randomly divided into two groups: GI ( n =100) patients were subjected to 60 sessions of laser therapy, and in the other group GII ( n =100), the machine was off while doing the procedure. The Tinnitus Questionnaire (TQ) was done every 20 days to evaluate the severity of the tinnitus for both groups. Results Both groups were matched regarding age and sex distribution. GI group experienced significantly decreased tinnitus severity compared to GII after laser therapy. There was no relation between duration of diving and laser therapy effect in GI. Conclusion Laser therapy is effective in treatment of tinnitus of scuba divers and its effect is increased by number of laser sessions.
Background The presented evidence-based clinical practice guideline (CPG) is proposed as a National CPG using an evidence-based and formal CPG adaptation methodology. The purpose of this study was to adapt the international CPGs’ recommendations for children with bronchiolitis to suit the healthcare system in the Egyptian context. This CPG, ‘diagnosis, treatment, and prevention of Bronchiolitis’, applies to children from 1 through 23 months of age. Other exclusions are noted. The quality of evidence, benefit-harm relationship, and strength of recommendations are indicated. This study is part of a larger collaborative initiative with the faculty staff of pediatric departments of 15 Egyptian universities and a national research center to formulate a national Committee (EPG) that aims to define the topics of, assign authors to, and assist in the adaptation of pediatric evidence-based CPGs according to a national strategic plan. The committee is guided by a formal CPG adaptation methodology: the ‘Adapted ADAPTE’. Results The Bronchiolitis Guideline Adaptation Group (BGAG) reviewed the results of the AGREE II assessment and decided to adapt mainly the Australasian (PREDICT) CPG and for the questions not answered in PREDICT we adapted the relevant recommendations from the American Academy of Pediatrics (AAP) CPG. Seven implementation tools were included: a care pathway for assessment of severity, a clinical algorithm for treatment of acute bronchiolitis in the emergency room, a separate flowchart for assessing babies with bronchiolitis, a power point slide presentation lecture for treatment of acute bronchiolitis, patient information in Arabic, a clinical score (Modified Tal Score) for prediction of bronchiolitis severity, and the criteria for admission and discharge in the hospital. A comprehensive set of multifaceted CPG implementation strategies was provided for the clinicians, patients, nurses, and other relevant stakeholders contextualized to the national settings Conclusion Our experience with this adaptation methodology provides useful insight into its utilization on a national level in Egypt. The BGAG recommended the next review of this adapted CPG to be after 3 years from its publication (i.e., 2022) after checking for updates in the original CPG.
Background Hypotension is often occurring after induction of general anesthesia (IGA) and can cause organ hypoperfusion and ischemia which associated with adverse outcomes in patients having both cardiac and non-cardiac surgery. Elderly patients are particularly more vulnerable and at increased risk to the depressant effect of anesthetic drugs. So, recognition and prevention of such event are of clinical importance. This study recruited patients aged above 60 years, with ASA physical status classification I-II-III who were scheduled for surgery under general anesthesia with the aim to assess the effectiveness of preoperative IVC ultrasonography in predicting hypotension which develops following IGA and its association with the volume status in elderly patients receiving general anesthesia, through measurements of the maximum inferior vena cava diameter (dIVCmax), minimum inferior vena cava diameter (dIVCmin), inferior vena cava collapsibility index (IVC-CI), and basal and post-induction mean arterial pressure (MAP). Results Thirty-nine (44.3%) of the 88 patients developed hypotension after IGA, and it was significantly more in patients who did not receive preoperative fluid ( p = 0.045). The cut-off for dIVCmax was found as 16.250 mm with the ROC analysis. Specificity and sensitivity for the cut-off value of 16.250 mm were calculated as 61.2% and 76.9%, respectively. The cut-off for IVC-CI was found as 33.600% with the ROC analysis. Specificity and sensitivity for the cut-off value of 33.600% were calculated as 68.7% and 87.2%, respectively. Conclusions IVC ultrasonography may be helpful in the prediction of preoperative hypovolemia in elderly patients in the form of high IVC-CI and low dIVCmax. The incidence of hypotension was lower in patients who received fluid infusion before IGA.
Background Sleep disturbance is closely related to inflammation and pain. Good sleep quality is essential for patients’ psychological and physical states as well as their quality of life. The aim of this study was to detect how insomnia as a major sleep disturbance could add to the disease burden in rheumatoid arthritis (RA) and osteoarthritis patients (OA) and to determine the predictor parameters in each of them in order to orient the rheumatologist to this unnoticed symptom that could adversely affect the patients’ life. This study included: 20 RA patients, 20 primary knee OA patients together with 20 healthy controls. RA disease activity was assessed by the disease activity score (DAS-28). All participants were assessed for sleep disturbances by the Athens Insomnia Scale, quality of life (QoL) using the short form QoL (SF-36 QoL) scale, depression by the Beck depression inventory (BDI), and functional disability by the Health Assessment Questionnaire Disability Index (HAQ-DI). OA patients were assessed by the Knee OA Flare Up Score (KOFUS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Radiological evaluation for RA patients was done by the Simple Erosion Narrowing Score, while the Kellgren and Lawrence (K-L) radiological grading system was used for OA patients. Results Insomnia was found in 75% of the studied RA patients, 25% of the studied OA patients and none of the healthy control with significant difference ( P < 0.001). Significant correlations of the insomnia scale with the number of tender and swollen joints ( r = 0.66, 0.76 respectively and p = 0.001 both), DAS-28 ( r = 0.71, P < 0.001), anti-CCP antibodies titre ( r = 0.53, p = 0.02) and the BDI ( r = 0.65, p = 0.002) among RA patients were found. Correlations among OA patients occurred with morning stiffness duration ( r = 0.69, P = 0.001), number of affected joints ( r = 0.81, P = 0.001), the BDI scale ( r = 0.51, P = 0.02), the WOMAC index ( r = 0.57, P = 0.009), the KOFUS score ( r = 0.76, p < 0.001) and the K-L score ( r = 0.67, P = 0.001). Linear regression analysis indicated that the predictors for insomnia in RA were DAS-28 and the BDI, while in OA were the number of affected joints and the KOFUS score. Conclusions Insomnia is a disease burden especially in RA patients being one of the leading causes of depression and is greatly affected by the disease activity. In general the burden of insomnia is much less in OA except in severe cases with markedly affected joints. Rheumatologists should be aware of this disorder that could affect patients’ health, mood, and functional activity.
Mycotoxins are secondary metabolites of different species of fungi. Aflatoxin B 1 (AFB 1 ), deoxynivalenol (DON), zearalenone (ZEN) and fumonisin B 1 (FB 1 ) are the main mycotoxins contaminating animal feedstuffs. These mycotoxins can primarily induce hepatotoxicity, immunotoxicity, neurotoxicity and nephrotoxicity, consequently cause adverse effects on the health and performance of animals. Therefore, physical, chemical, biological and nutritional regulation approaches have been developed as primary strategies for the decontamination and detoxification of these mycotoxins in the feed industry. Meanwhile, each of these techniques has its drawbacks, including inefficient, costly, or impractically applied on large scale. This review summarized the advantages and disadvantages of the different remediation strategies, as well as updates of the research progress of these strategies for AFB 1 , DON, ZEN and FB 1 control in the feed industry.
Background Forensic entomology (FE) is widely considered as an important field of forensic science, particularly in the field of estimating postmortem intervals, which has advanced considerably across the world. Main body Researchers used necrophagous insects in twelve Egyptian governorates to look into the variables that impact insect succession and the growth of juvenile stages from infesting animal models and humans, draw toxicological conclusions, and identify insect species using morphological and molecular-based approaches. The study includes analyses of insect abundance and dispersion, along with biochemical and electrophysiological experiments. Comparable data from other Egyptian governorates, on the other side, is currently unavailable. Aspects of FE are also missing, which might be addressed in a future research project. Conclusion This review aims to provide an outline of FE in Egypt, other than to assist existing researchers in identifying research needs and recruiting new researchers into the field by highlighting significant forensic insects that might be employed in criminal prosecutions.
Background Cellulose is the most prevalent biomass and renewable energy source in nature. The hydrolysis of cellulosic biomass to glucose units is essential for the economic exploitation of this natural resource. Cellulase enzyme, which is largely generated by bacteria and fungus, is commonly used to degrade cellulose. Cellulases are used in a variety of industries, including bioethanol manufacturing, textiles, detergents, drugs, food, and paper. As part of our quest to find an efficient biocatalyst for the hydrolysis of cellulosic biomass, we describe the amplification, cloning, and sequencing of cellulase (cel9z) from Bacillus licheniformis strain Z9, as well as the characterization of the resulting enzyme. Results Cellulase was partially purified from B. licheniformis strain Z9 using (NH 4 ) 2 SO 4 precipitation and Sephadex G-100 gel column chromatography with 356.5 U/mg specific activity, 2.1-purification fold, and 3.07 % yield. The nucleotide sequence of the cellulase gene was deposited to the GenBank, B. licheniformis strain Z9 cellulase (cel9z) gene, under accession number MK814929. This corresponds to 1453 nucleotides gene and encodes for a protein composed of 484 amino acids. Comparison of deduced amino acids sequence to other related cellulases showed that the enzyme cel9z can be classified as a glycoside hydrolase family 9. SDS-PAGE analysis of the purified enzyme revealed that the molecular mass was 54.5 kDa. The optimal enzyme activity was observed at pH 7.4 and 30 °C. The enzyme was found to be strongly inhibited by Mg ²⁺ and Na ⁺ , whereas strongly activated by Fe ³⁺ , Cu ²⁺ , and Ca ²⁺ . Conclusions B. licheniformis strain Z9 and its cellulase gene can be further utilized for recombinant production of cellulases for industrial application.
Background No doubt that the corpus luteum (CL) plays a vital role in the regulation of female cyclicity in mammals. The scenarios among microRNAs (miRNAs) and their target genes and steroid hormones {estradiol (E2) and progesterone (P4)} are required for better understanding the molecular regulation of CL during its formation, maturation, and regression. We aimed to (I) study the changes in the relative abundance of miR-205, miR-26a-5p, miR-17-5p, and let-7b-5p and their target genes: LHCGR, CASP3, PCNA, AMH, and PLA2G3, during different stages of corpus luteum in Egyptian buffaloes, and (II) and to address different scenarios between steroid concentrations in the serum and the expression pattern of selected miRNAs and their targets. Methods The paired ovaries and blood samples were collected from apparently healthy 50 buffalo cows at a private abattoir. The ovaries bearing CL were macroscopically divided according to their morphological structure and color into hemorrhagic (CLH), developing (CLD), mature (CLM), regressed (CLR), and albicans (CLA). Small pieces from different stages of CL (CLH, CLD, CLM, CLR, and CLA) were cut and immediately kept at − 80 °C for total RNA isolation and qRT-PCR. The serum was separated for steroid level estimation. Results The LHCGR was expressed during different stages of CL, and the peak of expression was at the mid-luteal stage. The CASP3 revealed a stage-specific response at different stages of CL. The PCNA has an essential role in cellular proliferation in buffaloes CL. Both expression patterns of PLA2G3 and AMH were found over the various developmental and regression stages. It was noticed that miR-205 is conserved to target LHCGR and CASP3 transcripts. Moreover, CASP3 and AMH were targeted via miR-26a-5p. Additionally, the CASP3 and PLA2G3 were targeted via let-7b-5p . The P4 level reached its peak during CLM. There were positive and negative strong correlations between miRNAs (miR-26a-5p and miR-205), target genes (LHCGR and CASP3) during different stages of CL, and steroid hormones in the serum. Conclusions Taken together, the orchestrated pattern among miRNAs, target genes, and steroid hormones is essential for maintaining the proper development and function of CL in buffalo cows.
Background Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with variable clinical manifestations that can affect various organs and tissues. Estrogen is an important element that performs a vital role in the pathology of SLE. It acts on target cells through binding to estrogen receptors (ERs). This study aimed to assess the effect of ER alpha gene polymorphism on SLE disease activity and clinical manifestations. This study included 30 SLE female patients and 20 healthy subjects as controls. ERα gene ( pvull and xbal) polymorphisms were genotyped using the real-time polymerase chain reaction (RT-PCR) and correlated with clinical and laboratory manifestations of SLE as well as the activity and severity scores. Results Regarding ERα ( rs1 2234693 Pvull ) polymorphism, the TC and CC genotypes were mainly associated with SLE patients, with a high frequency of the mutant C allele. The TT genotype was found mainly in the control group. Concerning rs2 9340799 Xbal polymorphisms, the AG , AA , and GG genotypes frequencies were not significantly different between patient and controls. The TC/AA , CC/GG , and CC/GG genotypes were the most prevalent combinations among SLE patients, while the later combination is completely absent from the control group. There was a significant statistical association with the AA genotype with the neurological disorders and/or hematological affection in SLE patients. The TC genotype was more related to serositis, leucopenia and pyuria, while the AA polymorphism was associated only with leucopenia. Conclusions We conclude that the study offers a clue to the associations of ERα gene polymorphisms in SLE disease, and the combinations relevant to certain clinical manifestations. Estrogen level itself does not affect SLE susceptibility or activity but the mutations in its receptors are the main pathogenic factor.
Background To evaluate the safety and efficacy of mini percutaneous nephrolithotomy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of kidney stones 20–30 mm. Methods A prospective randomized study of 70 patients who presented to the urology department with calyceal or renal pelvic stone of 20–30 mm between September 2017 and September 2019. Patients were randomly divided into two groups, Group A (Mini PCNL) consists of 35 patients who were treated with mini PCNL and Group B (RIRS) consists of 35 patients who were Achieving success of the technique was considered when the patient is stone-free or has radiologically insignificant residual fragments < 4 mm. Results The demographic data in this study were comparable in both groups. The stone size was 20.43 ± 2.2 mm in group A & 20.5 ± 2.1 in group B, with no statistical significance. Meanwhile, the operative time in group A was 59.71 ± 19.44 min and in group B was 80.43 ± 14.79 min with statistical significance difference ( p value < 0.001), while Fluoroscopy time had a mean of 8.11 ± 2.05 min in group A & 5.8 ± 1.98 min in group B with statistically significant diffrence ( p value < 0.001). The stone free rate (SFR) was 88.6% in mini PCNL and 82.9% in RIRS with no statistically significant difference ( p value: 0.5). Conclusion RIRS and mini PCNL can be an effective and alternative option for treatment of renal stones 2–3 cm. Both techniques have relatively similar SFR but RIRS showed more operative time, on contrary Mini-PCNL has more operative and postoperative complications. A multicenter studies with larger numbers of patients will be more effective to confirm these results.
In this study, we investigated the heat and mass transport properties of a non-Newtonian Casson-Williamson nanofluid flow. We explore the effect of viscous dissipation and the velocity slip boundary condition on the mechanism of heat and mass transfer due to a stretching sheet which embedded in a porous medium with heat generation under the influence of both thermal radiation and a uniform magnetic field. All physicochemical characteristics of Casson-Williamson nanofluid are considered to be constant. The nanofluid concentration is investigated under chemical repercussions as a result of the movement of the nanofluid particles. This study assumes that there is no suction (solid wall). A set of nonlinear partial differential equations with boundary conditions are used to mathematically model this physical problem. The numerical solution for the differential equations with the related boundary conditions was illuminated using the Runge–Kutta approach in conjunction with the shooting technique. The numerical examination is then pictorial displayed to show the impact of various governing factors on velocity, temperature, and concentration. The non-Newtonian nanofluid has a faster velocity in the absence of a magnetic field than in the presence of it, although the temperature field has the opposite trend. Further, the skin-friction coefficient increased as the porosity parameter increased, whereas the rate of heat transfer dropped.
The foremost purpose of the current study is to examine the heat transmission characteristics of two-phase and hybrid phase rotating nanofluid flow in three dimension over the stretchable sheet in the applied magnetic field. The novelty of this work is that due to numerous applications it considers a new sort of nanofluid i.e. hybrid nanofluid. Water is utilized as base fluid while silver,Ag and molybdenum disulfide, MoS2 are used as nanoparticles in the current study. The nanofluid is rotating around the straight-up axis with a fixed angular speed ω∗. The resultant nonlinear partial differential equalities are transformed into ordinary differential equations via a resemblance transformation. The numerical results are obtained at Matlab by using the bvp4c technique. Rotation parameter increases while stretching ratio parameter decays the temperature transference rate. In this particular research, the temperature transmission rate of hybrid nanofluid Ag/MoS2-water was found higher than Ag-water nanofluid in the existence of the magnetic effect. The temperature transmission rates of hybrid nanofluid can be achieved higher by using a suitable combination of nanoparticles.
Background Most of the surgeons tend to avoid exposing and identification the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy. In this study, our aim is to assess sequential steps to ligate superior thyroid vessels safely away from the External branch of superior laryngeal nerve (EBSLN). Methods This prospective case series study was conducted on 60 patients going for either total or hemi thyroidectomy in a tertiary teaching hospital between January 2016 and June 2019 . During thyroidectomy, firstly we skeletonized the upper pole of the thyroid gland by its capsular dissection followed by anterolateral down retraction of the superior pole. Then, entry and opening of the cricothyroid space and lastly clamping and ligating superior thyroid pedicle close to the upper pole away from EBSLN. Results This study included 60 cases; 19 total thyroidectomy and 41 hemi thyroidectomy with 79 superior thyroid vessels ligation and EBSLN at risk. In all patients, no evidence of superior laryngeal nerve (SLN) palsy or bleeding was detected. Postoperative video laryngoendoscopy showed apparently normal mobility, length, level, and position of the vocal folds with symmetry of the larynx. The patients’ voice showed no changes from preoperative evaluation in all studied patients at 3 months postoperative evaluation. No patients complained of any changes in their voice or voice activities. Conclusion The described stepwise approach for preservation of the EBSLN serves to completely remove the superior pole of the thyroid gland and ligate superior thyroid vascular pedicle without risk of SLN injury.
Background The CT details of the dimensions of the posterior ethmoid sinus are not fully covered in the literature, so building up for a base for the CT measurements and description of that area is important. Preoperative details of the posterior ethmoid sinuses are mandatory before any approach or procedure involving this area . Objective To determine the different dimensions, measurements, and grading of the posterior ethmoid sinus by computed tomography (CT) that were not previously published. Methods Two hundred paranasal CT scans (400 sides) were included in the study. Axial images were acquired with multiplanar reformats to obtain delicate details in coronal and sagittal planes for all subjects. Results Within 200 CTs (400 sides), the mean anteroposterior dimension of the posterior ethmoid was 13.62± 1.75 mm (range= 9.5–19.5), the mean posterior ethmoid transverse diameter was 12.15+1.6 mm (range= 8–16.2) and the mean posterior ethmoid height was 44.64±3.83 mm (range= 35.8–56) without reported significant differences between both sides in all posterior ethmoid dimensions. The mean width of the posterior ethmoid sinus and its height from the orbital roof and nasal floor was significantly more in males than in females. There was significantly lower fovea ethmoidalis in males than females as we go posterior. Conclusion This study improves surgeons’ awareness and orientation of posterior ethmoid sinus variations in the endoscopic sinus surgery and can be of help to residents in training.
Introduction New therapies, management approaches, and evidence regarding the management of gout have become available over the past years. This triggered the need for an updated recommendation for gout management. Through an up-to-date consensus evidence-based clinical practice guideline for the management of gout including recommendations for management of gout flares, optimum usage of urate lowering therapy for chronic gout, as well as patient education and lifestyle guidance. A wide systematic literature review was performed, and evidence-based recommendations were extrapolated, based on 16-key questions identified according to population, intervention, comparator, and outcomes (PICO) approach. These were evaluated by a panel consisted of 17 rheumatology experts via online surveys over a 2-round Delphi process. The purpose of this study is to offer an updated, consensus-evidence-based, and in the meantime patient-focused, expert recommendations for the treat-to-target approach of gout management. Results Results revealed that after round 2 ended, a total of 30-recommendation items, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7–9) ranged from 90 to 100%. Consensus was reached (i.e., ≥ 75% of respondents strongly agreed or agreed) on the wording, the grade of recommendation, and level of evidence of all the 30 clinical standards identified by the scientific committee. Conclusions This guideline provides updated evidence-based recommendations for the prevention and treatment of acute as well as chronic gout. This guideline provides an approach for physicians and patients making decisions on the management of gout. It will also facilitate improvement and uniformity of care.
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7,007 members
Ahmad elBanna
  • Department of Electrical Engineering (Faculty of Engineering at Shoubra)
Ibrahim A. M. Abdel-Halim
  • Department of Electrical Engineering (Faculty of Engineering at Shoubra), Cairo, Egypt.
Alaa Sayed Amin
  • Department of Chemistry
Basem M. ElHalawany
  • Department of Electrical Engineering (Faculty of Engineering at Shoubra)
Tarek M. El-Karamany
  • Department of Urology
Elshaheed Farid Nada, Banhā, Egypt
Head of institution
Prof.Dr. Gamal El Saeed
013 3231011