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Background: Prominent ear deformity represents one of the common congenital anomalies in general population with an incidence of approximately 5%. Surgical correction of prominent ears has passed through many modifications along the years. However, there is still no ideal technique and still there will be an evolution for new techniques and refinements. Aim: is to apply a new modification in remodeling of antihelix through cartilage fenestration to overcome the cartilage memory, with usage of distal based post-auricular facial flap in combined approach otoplasty. Patients and Methods: This retrospective study was done in Ain Shams University Hospitals during the period from December 2021 to April 2023 on patients with prominent ear. Patients underwent combined approach otoplasty with cartilage fenestration and coverage by distal based post-auricular facial flap. Results: Eighteen patients were included in this study, ten females and eight males, no bleeding or hematoma was found in any of the patients in the lateral surface of ear as there was no anterior dissection or anterior cartilage scoring. Patients' satisfaction was assessed by satisfaction score, where twelve patients (66.7%) were very satisfied, and four patients (22.2%) were satisfied, and one patient (0.05%) was neither satisfied or dissatisfied and one patient (0.05%) was dissatisfied. Conclusion: remodeling of the antihelix through cartilage fenestration and coverage by distal based post-auricular facial flap represents a reliable method for prominent ear otoplasty with no anterior cartilage dissection, no anterior cartilage scoring, minimal or no complications and high patient's satisfaction outcome. [ABSTRACT FROM AUTHOR]

Background: With a frequency of 0.5–2% in the general population, vitiligo is a chronic acquired depigmentary condition that manifests as single or clusters of achromic macules and patches on various body parts. Objective: This study aimed to evaluate the efficacy of topical psoralen-narrow band ultraviolet B (NB-UVB) treatment of non-segmental vitiligo patients in comparison with NB-UVB alone. Patients and Methods: This prospective interventional study included forty non-segmental vitiligo (NSV) patients, divided into two equal groups. Group I received only NB-UVB sessions while group II treated with topical psoralen plus NB-UVB. Vitiligo extent tensity index (VETI) was used for disease severity evaluation. All patients received three sessions weekly for sixteen weeks. The participants were recruited from the Dermatology Outpatient Clinic of Vitiligo, Ain- Shams University Hospitals. Results: Group I and II were statistically matching as regards age, sex, special habits, vitiligo family history, disease activity or duration and associated diseases. VETI scores showed highly statistically significant post-treatment improvement in both groups. However, no statistically significant difference could be detected in those receiving NBUVB alone versus psoralen plus NBUVB. Conclusion: The combination of topical psoralen and narrow band UVB is a successful treatment option for nonsegmental vitiligo that is well tolerated. Its effectiveness is comparable to narrow band UVB alone, but not better. [ABSTRACT FROM AUTHOR]

Background: When it comes to cancer, breast cancer (BC) is by far the most common type among females worldwide. As a result of a number of circumstances, including the current COVID-19 pandemic, routine breast imaging has been drastically reduced in recent times. It is also important to keep in mind throughout this time frame since a delay in diagnosis of as little as three months can have a significant impact on breast cancer survival rates. Objective: Review of the literature on imaging modalities of breast masses. Methods: We looked for data on Breast Masses and Imaging, in medical journals and databases like PubMed, Google Scholar, and Science Direct. However, only the most recent or extensive study was taken into account between July 2000 and February 2021. References from related works were also evaluated by the writers. There were not enough resources to translate documents into languages other than English, hence those documents have been ignored. It was generally agreed that documents such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations did not qualify as legitimate scientific study. Conclusion: Functional imaging has been shown to have better diagnostic performance than morphological imaging, allowing for earlier diagnosis and thus ever-more-tailored treatments and screenings for individual patients. [ABSTRACT FROM AUTHOR]

Background: Melasma is an acquired hyperpigmentation characterized by bilateral irregular brown macules and patches over sun-exposed areas of face and less commonly, forearms. No single treatment is universally effective. It has been shown that metformin could decrease intracellular cyclic adenosine mono phosphate. Since c-AMP has a role in melanogenesis, metformin can inhibit melanogenesis resulting in a significant reduction in melanin in the basal layer. Objective: The aim of the present study was to evaluate the effectiveness and safety of topical metformin for melasma treatment. Patients and Methods: A quasi-experimental (pre-post comparison study) study included 30 female cases of melasma from the Dermatology outpatient clinic of Mansoura University Hospital, during the period between March 2021 and March 2022. Included females had more than 18 years old. The metformin lotion was prepared using metformin powder and a mixture of polyethylene glycol (PEG) -6; Ethylene Glycol; PEG-32, acetyl alcohol, liquid Paraffin, Methylparaben, propylparaben, and distilled water. Participants applied one layer of metformin 30% lotion on the affected area on face at night to the morning for a period of 3 months. Results: Melasma Area and Severity Index (MASI) score decreased gradually after successive sessions (mean 13.8, 13.7, 11.5, 11.4, 11.4, respectively), with statistically significant improvement after 2, 3 months and also 1 month after the end of treatment (P values 0.002, 0.001, and 0.001, respectively). Grades of improvement significantly increased after 1, 2 months, but became stable by the 3rd month and one month after therapy. After the end of therapy, 20% of participants were satisfied, 36.7% were slightly satisfied, 26.7% were poorly satisfied, and 16.7% were not satisfied. No side effects were reported. Conclusion: Melasma was improved after using of topical metformin with no side effects appeared. Thus, topical metformin is a new, safe, and effective for melisma treatment. [ABSTRACT FROM AUTHOR]

Background: Ischemic heart disease is a major cause of heart failure and has a poor prognosis. Addressing behavioral risk factors like obesity and overweight helps avoid most cardiovascular illnesses. The satiety hormone leptin reduces appetite and regulates energy. Aim of the study: Leptin levels in lean and obese patients with ischemic heart disease, with or without diastolic dysfunction, were compared. Methods and Patients: Between June 2019 and November 2020, 140 ischemic patients from Ain Shams University hospitals were included. History, examination, Duke Coronary Artery Disease score, Body Mass Index, serum leptin, and echocardiography were recorded. Patients were placed into four BMI and diastolic function groups plus the control group. A: lean ischemic patients without significant diastolic dysfunction, B: lean ischemic patients with diastolic dysfunction (II-IV), C: obese ischemic patients without significant diastolic dysfunction, Group D: obese ischemic patients with diastolic dysfunction, and E was a control group. Results: A positive correlation was seen between serum leptin and Duke score in all ischemia groups (n=140) (p<0.001). Serum leptin was higher in diastolic dysfunction groups (n=70) than in non-dysfunction groups (N=70) (Group B 25.7%, Group D 28.6% vs Group A 5.7%, Group C 8.6%, and Control Group (n=35) 0.0%). Conclusion: Leptin independently increases CAD risk. In CAD patients, elevated leptin was related to diastolic dysfunction. [ABSTRACT FROM AUTHOR]

Background: Maternal Spinal anesthesia frequently has side effects like hypotension and bradycardia during caesarean delivery. Maternal Spinal anesthesia frequently has side effects like hypotension and bradycardia during caesarean delivery. Objective: The current study aimed to evaluate effect of prophylactic intravenous ondansetron on hemodynamic parameters in elective cesarean section (CS) under spinal anesthesia. Patients and methods: A total of 80 patients with physical condition as defined by the ASA class II and ages ranging from 21 to 45 years old scheduled for surgery at Zagazig University's Department of Anesthesia and Surgical Intensive Care Hospitals; elective CS and Surgery were lasting no longer than 60 minutes. Patients in the control group (group C) got 10 ml of saline. Individuals in the ondansetron group (group O) received intravenously 4 mg of ondansetron diluted in 10 ml of saline five minutes before subarachnoid block. The following variables were measured throughout the course of the trial in both groups: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MAO), heart rate, oxygen saturation percentage, and intraoperative need for ephedrine. Moreover, any issues that arise throughout or following operation were recorded. Results: The frequency of hypotension in expectant women undergoing spinal anesthesia for elective caesarean delivery was significantly reduced, when prophylactic 4 mg ondansetron was administered. The use of vasopressors Ondansetron significantly decreased the incidence of hypertension. Systolic blood pressure was consistently higher and fewer vasopressor medications were used in the ondansetron group. Conclusion: Intravenous premedication with 4mg ondansetron can effectively reduce the drop in SBP, DBP, and MAP in expectant mothers scheduled for CS. [ABSTRACT FROM AUTHOR]

Background: Inflammatory rheumatoid arthritis (RA) worsens over time. Severe symptoms can be avoided with an early diagnosis. RA increases CRP-albumin ratio (CAR) as acute-phase reactants. Objective: To validate the CAR inflammatory impact in RA and how it correlates with disease activity indices and musculoskeletal ultrasonography. Methods: Seventy-five RA patients were involved in this cross-sectional research. 50 normal subjects were included as a control group. All participants were tested for CRP, albumin, and CAR. Disease activity indices "The Disease Activity Score 28 (DAS28) with erythrocyte sedimentation rate (ESR), the Modified Health Assessment Questionnaire (MHAQ), and the Clinical Disease Activity Index (CDAI)?, and ultrasound, which was performed in both grayscale and power Doppler modes, were utilized to assess the patient's disease activity. Results: CAR in the RA group was 2.25 (0 -13) and 0.41 (0 - 0.9) among controls (p< 0.001). ESR, albumin, CRP, DAS-28, CDAI, and HAQ scores were all found to be correlated with CAR. In patients with active RA, CAR levels were considerably greater than in patients in remission (P< 0.001). Cases who had synovial thickening and power Doppler alterations had higher CAR (p<0.001). At a cut-off of (2.6), sensitivity was 79.1%, specificity was 72.3%, and the area under the curve (AUC) was 0.77, as measured by the receiver operating characteristic (ROC) curve. Conclusion: CAR is a measure that can be evaluated easily and affordably. CAR predicts disease activity among moderate to severely active RA patients. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome (PCOS) is considered the most frequent ovulatory disorder. PCOS often has a problem in (GnRH) release, with increase in the pituitary secretion of (LH) hormone and high LH/FSH ratio. Objective: The current study aimed at detecting the predictive level of LH/FSH ratio for the ovarian response, pregnancy and miscarriage rates in PCOS patients underwent mild ovarian stimulation. Patients and methods: A prospective cohort study was conducted in Gynaecology and Obstetrics Department, Zagazig University Hospitals. The study included PCOS women aged from 20 to 37 years, with at least 1 year of infertility, and normal semen analysis. The exclusion criteria were pelvic surgery and/or pathology. Cycle day 2-5 Serum LH and FSH were measured. Transvaginal ultrasound was done on cycle day 2-3 to prove quiescent ovaries, letrozole (2.5-5mg) was started from day 2-3 for successive 5 days with/without HMG (75-150IU/d) then follicular tracking was done till 1-3 follicles reached =18 mm upon which ovulation trigger was given. Results: A total 63 infertile women were included in the study. The mean age was 24.81 (SD 2.83) years, the mean BMI 30.65 (SD 6.58) Kg/m2. Basal FSH, LH level, and LH/FSH ratio ranged from 1.9-11.9 mIu/ml, 2.34-21 mIu/ml and 0.37-4.63, respectively. ROC curve analysis showed LH/FSH ratio to be non-useful predictor of ovarian response, occurrence of pregnancy or miscarriage in PCOS patients underwent simple ovarian induction, AUC (0.51, 0.64 and 0.69 respectively). Conclusion: LH/FSH ratio seems to have no role in prediction of stimulated cycle outcome. [ABSTRACT FROM AUTHOR]

ackground: Until now there is no clear evidence to support the superiority of one strategy over the others to treat STEMI patients. Serial B‐type natriuretic peptide (BNP) measurements accurately predict the risk of death or congestive heart failure in STEMI patients. Objective: The aim of the study was to determine which strategy is the best strategy to treat acute STEMI and if BNP give an incremental prognostic value in treated STEMI patients. Patients presented with acute STEMI were enrolled in the present study. Patients and methods: Only 93 patients were followed up with us for 6 months and divided to 3 groups according to the treatment strategy. All patient underwent BNP analysis, echocardiography and treated with either received only thrombolytic therapy (Group I), primary PCI (Group II) or received thrombolytic therapy then went to catheterization (Group III). Results: Regarding BNP level change was higher in Group I and in Group III had high BNP level higher than Group II but this difference doesn`t reach level for statistically significant correlation between BNP levels and type of reperfusion in the three groups. Regarding LV systolic function, there was no statistically difference between the percent change in LV systolic function in Group I and Group III (P-value = 0.854, 0.152 respectively) but there was statistically significant difference between the percent change in LV systolic function in Group II (P-value=0.031). Conclusion: The best way for treatment of acute STEMI patients, is a primary PCI the most significant predictive methods are recovery of EF% and reduction of BNP, however pharmacoinavsive strategy like PCI strategy has good follow up prognosis and better than thrombolytic alone therapy. [ABSTRACT FROM AUTHOR]

Background: Multiple myeloma can be distinguished from asymptomatic myeloma and monoclonal gammopathy of uncertain significance thanks to CRAB factors. Objective: To assess role of CRAB factors in prognosis of cases who had multiple myeloma and being treated with novel therapeutic agents in comparison with non-novel agents. Patients and Methods: A comparative cross-sectional study was conducted in the Hematology Unit, Internal Medicine Department, in Zagazig University Hospitals on 100 patients with multiple myeloma. We looked at how the existence of CRAB factors affected the survival rates of individuals with symptomatic myeloma who were receiving novel therapies. Results: Hb, PLT, albumin were higher in Novel Containing Regimen (NCR) group than Non-Novel Containing Regimen (NNCR) group, while creatinine, Bence Jones protein in urine, serum beta-2-microglobulin and calcium were lower in (NCR) group than (NNCR) group. Bone marrow plasma cells after treatment, lytic lesion, anemia, hypercalcemia and renal insufficiency were lower in (NCR) group than (NNCR) group. About 91% of patients had M protein type IGG and 9% had IGA, the mean bone marrow plasma cells was 24.6 ± 4.3, 21% had abnormal cytogenetics, 25% had high risk FISH, 70% had lytic lesions, 17% had EMD at diagnosis, 29% had anemia (decrease of Hb more than 2 g/dl or to equal or less than 10 g/dl), 17% had hypercalcemia =11.5 mg/dl, 16% had renal insufficiency (increase of serum creatinine more than 2 g/dl). Conclusion: Overall survival and progression-free survival for myeloma patients treated with new medicines; both significantly improved. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciopathy (PF) is a cumulative excessive strain on the enthesis of the plantar fascia. One cause of PF is a prolonged pronated foot. Numerous studies have shown that weakness of hip muscles may be one factor contributing to PF. Objective: To identify whether there is a relationship among PF and hip abductors as well as external rotators' weakness. Patients and Methods: Two groups were included in this study, each group had forty participants. Participants in group (A) had PF whereas those in group (B) were healthy participants. The isometric muscle strength of the hip abductors and external rotators was assessed utilizing a hand-held dynamometer. For the reason to verify a PF diagnosis, ultrasound device was used. Results: Our results revealed significant decrease in the hip abductors' muscle strength of the involved side of the examined group when contrasted with the non-involved side in the same group (p = 0.006), and a significant decrease in the strength of the hip external rotators of the involved side of the examined group when contrasted with the noninvolved side in the same group (p = 0.007). Additionally, there was a substantial decline in hip abductors and external rotators muscle strength on the involved side of the study group in comparison with the matched side of the control groups. Conclusion: This study showed that the deficits in the proximal hip abductors and external rotators muscles were associated with plantar fasciopathy. [ABSTRACT FROM AUTHOR]

Background: The most frequent condition affecting the shoulder is likely subacromial impingement syndrome (SIS). Although there is evidence linking upper body posture and shoulder function, there is no evidence linking posture to SIS. Objective: To determine the relation between aberrant upper body posture and shoulder ROM. Also, to determine the relation between aberrant upper body posture and shoulder disability levels in cases of SIS. Patients and Methods: The study included 37 subjects with SIS (group B), their mean age was 28 years, (male & female) and 37 age and gender-matched controls (group A). Upper body posture was analysed using bubble inclinometer for thoracic kyphosis (TK) measurement, lateral scapular slide test (LSST) for detecting scapular dyskinesia (SD), tape for pectoralis minor length measurement. Results: There was statistically significant reduction in mean values of kyphosis in favor to control group (P=0.027). But there was statistically significant increase in mean values of pectoralis minor length in favor of control group (P=0.033). Also, no statistically significant differences in mean values of LSST at the three different positions were found between both groups (P > 0.05). Within the SIS group there was no statistical significant correlation between aberrant upper body posture (thoracic kyphosis, scapular dyskinesia and pectoralis minor length) and passive shoulder flexion ROM, passive shoulder abduction ROM, shoulder pain and disability levels. Conclusion: Patients with SIS had a more exaggerated TK and less pectoralis minor length and no difference in scapular position compared to age- and sex-matched normal controls. [ABSTRACT FROM AUTHOR]

Background: Patients with acute myeloid leukemia (AML) with a high white blood cell count are at a significant risk for developing serious complications and passing away before their time. Dexamethasone has been recommended for usage in AML patients because it has a strong inhibitory impact on cytokine production and modulates the inflammatory response. Objective: To evaluating the effect of adding dexamethasone to induction chemotherapy on the clinical outcome for the first time in Egyptian AML patients with high leucocyte burden. Patients and methods: This randomized clinical trial included 82 adult patients with AML with high leucocytic count, conducted in Clinical Hematology Unit, Internal Medicine Department, at Zagazig University Hospitals. Patients were divided into two groups; a control group received an induction 3+7 chemotherapy regimen; and a DEXA group received dexamethasone in addition to induction chemotherapy. Patients were followed up after receiving their treatment for a total period of 12 months to estimate survival. Results: High leucocytic count was positively correlated with peripheral blood blast, AST, creatinine and LDH and negatively correlated with both serum albumin and potassium. Early death was significantly higher in the DEXA group (56.1% vs 24.4% in control group, P= 0.003). Moreover, there was higher death, primary induction failure rates in the DEXA group (P= 0.031 and 0.007 respectively) and lower relapse rates (20% vs 53.3% in control group, P= 0.043). There was statistically significant lower 1-year overall survival in the DEXA group (overall-survival rate 10% vs 21% in the control group, P= 0.003). Conclusion: Although the use of dexamethasone in AML patients with hyperleukocytosis lowered the relapse rates, it was associated with higher treatment-related mortality and inferior overall survival with no effect on relapse-free survival. [ABSTRACT FROM AUTHOR]

Background: Chronic inflammation was associated with the hyporesponsiveness to erythropoiesis stimulating agents (ESA) in hemodialysis (HD) patients. A rising indicator of inflammation is the platelet-to-lymphocyte ratio (PLR). Objective: The aim of the current work was to assess the role of the PLR in detection of the response to ESA in HD cases. Patients and methods: This cross-sectional study included a total of 80 patients who underwent regular HD at the Department of Internal Medicine, Zagazig University Hospitals. Patients were classified according to median value of erythropoietin hyperresponsiveness index (EHRI) into two groups: Group1; included (41 patients) with low resistance EHRI < 0.167, and Group 2: included (39 patients) with high resistance = 0.167. PLR was assessed in both groups. Results: PLR best cutoff value derived from ROC curve to predict EPO resistance was =87.5, with specificity, and sensitivity, were 51.3%, and 56.1%, respectively. PLR had significant positive linear correlation with MCH, MCHC, PLR platelet count, serum sodium and creatinine clearance. PLR was negatively correlated with ALC, AMC, serum creatinine, potassium, and LDL cholesterol, serum iron and TIBC. However, in multivariate linear regression analysis only ALC, platelet count, TIBC and MHCH were found to be independent determents of PLR in HD case. Conclusion: Despite being a simple widely available marker of inflammation, PLR did not appear to be useful in reflecting the EHRI in CKD patients. Thus, we recommend further future multicenter and nationwide studies to stand on the suitable marker for EHRI in CKD population in Egypt. [ABSTRACT FROM AUTHOR]

Background: In Egypt, irritable bowel syndrome (IBS) and non-alcoholic fatty liver disease (NAFLD) are both common conditions. There has been increased interest in the apparent co-incidence of NAFLD in individuals with IBS as we gain a better understanding of their overlapping risk factors and pathophysiology. The aim: to ascertain the prevalence of NAFLD among IBS patients, as well as the relationship between NAFLD and IBS severity. Patients and methods: A cross-sectional study was conducted on 150 IBS patients who were older than 18 years old at the Hepatology, Gastroenterology, Infectious Diseases Outpatient Clinic and Clinical Pathology Department of Al-Ahrar Zagazig Teaching Hospital. All patients underwent a history taking, general clinical examination, and clinical assessment, imaging studies and laboratory analysis. Results: There were 70.7% people who had NAFLD. 30.2% of patients had severe NAFLD, 19.8% had mild NAFLD, and 50% of patients had intermediate NAFLD. Conclusion: IBS patients have a significant prevalence of NAFLD. In the study participants, moderate/severe NAFLD was a predictor of moderate/severe IBS. [ABSTRACT FROM AUTHOR]

Background: Pregnant women with anemia, especially those with severe anemia, run the risk of having poor physical activity levels, higher maternal morbidity, and increased death. Also, their newborns experience adverse effects such as perinatal mortality, intrauterine growth restriction, premature delivery, low birth weight, and fetal anemia. Objective: The aim of the current study was to compare the bioavailability, safety, efficacy and hematological responses to oral ferrous bisglycinate supplementation and sucrosomal iron in the treatment of iron deficiency anemia (IDA) in pregnant women. Patients and methods: A clinical trial was conducted at Antenatal Care Outpatient Clinic of Zagazig University Hospitals. The clinical trial included 66 oregnant women in their second and third trimester with IDA (hemoglobin level =10 g/dl). Participants were divided two groups; Group 1included cases who received ferrous bisglycinate supplementation and Group 2 included cases who received sucrosomal iron therapy. All Pregnant women were subjected to a full medical history, physical examination, and laboratory testing, including CBC, iron, ferritin, and total iron binding capacity (TIBC). Results: In groups I and II, there was significant increase of RBCs, hemoglobin, HCT%, MCV, MCHC and ferritin, iron and TIBC at final values compared to the corresponding basal value. The improvement of CBC findings, ferritin, iron and TIBC was more significant in group 2 cases who received sucrosomal iron therapy. Conclusion: Oral sucrosomal iron therapy is more effective and acceptable than oral iron salts for the treatment of IDA. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris is the most common cutaneous ailment in the world, affecting up to 80% of teenagers and up to 50% of adults. It is a chronic inflammatory disease of the pilosebaceous unit. The development of acne lesions is heavily influenced by keratinocyte proliferative and inflammatory states, which have been observed to elevate survivin levels. Objective: This study was conducted to assess survivin gene polymorphism and its plasma level in patients with active acne vulgaris and patients with post acne scars with varying severity. Patients and methods: The study included 60 acne patients divided into two groups: 30 patients with active acne lesions and 30 patients with post acne scars; in addition to 30 healthy volunteers who were served as control group selected from Outpatient Clinic, Department of Dermatology, Andrology and STD, Mansoura University Hospitals, Mansoura, for 1 year duration. Results: The levels of serum survivin in both group of patients with active acne and group of patients with post acne scars are significantly higher than that of the control group. There was no statistically significant difference in the serum survivin levels among the patients with different grades of acne. There was a significant increase in the serum survivin level with increased severity of post-acne scars. The distribution of the survivin rs-9904341 & rs-1042489 genotypes among the study's groups did not differ significantly (P > 0.05) for each. Conclusion: It could be concluded that survivin may be used as a diagnostic biomarker in acne vulgaris and as a prognostic tool for post acne scarring severity. Survivin is involved in the pathogenesis of active acne vulgaris and more importantly, the pathogenesis of the development of fibrotic tissue in acne scars. [ABSTRACT FROM AUTHOR]

Background: A bloodstream infection that has been proven by a laboratory within 48 hours after the installation of a central line and is unrelated to an infection at another location is known as a "central line-associated bloodstream infection" (CLABSI). Objective: To improve the safety of patients with Central Venous Catheter (CVC) via decreasing the incidence of Catheter-Related Blood Stream Infection (CRBSI) in hemodialysis patients at Benha University Hospital. Patients and Methods: This study was a prospective interventional study conducted at Hemodialysis Center in Benha University Hospital on 45 patients with CVC inserted more than 48 h and followed up for CRBSI during the period from the beginning of February 2021 till the end of April 2021, followed by educational program during May 2021 about general infection control measures and to preventive bundles of CLABSI, then reassessment was done during the period from the beginning of June 2021 till the end of September 2021. Results: 45 patients, males and females were equally distributed before and after intervention educational program, whose median age was 62 years old, the incidence of infection in the pre-intervention was 40 % which was significantly decreased after intervention to 13.3 %. The intervention had significantly decreased the incidence of the participants, fever, chills, discharge and tenderness (P< 0.05), comparison between infection control practices (pre-intervention versus post-intervention) showed that the intervention had significantly improved the infection control practices. Conclusion: The catheter related infection (CRI) among dialysis patients is due to prolonged duration of CVC usage and difficult insertion have been found as risk factors of infection. Patient role (Keep the catheter dressing clean and dry), catheter type and CVC insertion duration was the significant predictor of presence of infection. [ABSTRACT FROM AUTHOR]

Background: The autoimmune disease systemic lupus erythematosus (SLE) causes inflammation. Activity evaluation could be conducted using a number of different methods. Biomarkers like ß2 is a biomarker, which is found on all nucleated somatic cells and its use as a prognostic is under investigation. Objective: The study aimed to assess the association between serum levels of ß2 microglobulin (B2M) and disease activity. Patients and Methods: The study included fifty lupus patients and fifty healthy people served as controls. The levels of C-reactive protein (CRP), complement 3, and complement 4, as well as the erythrocyte sedimentation rate (ESR), anti-nuclear antibody (ANA), and anti-double-stranded DNA antibody (dsDNA), were measured. The serum Beta 2-microglobulin (B2M) was measured using an enzyme-linked immunosorbent assay. Results: The serum B2-microglobulin levels were significantly higher in SLE patients (mean values 27.42± 5.5) compared with the controls (6.80± 1.61) (P value =0.001). In contrast to inactive individuals, active patients had a greater mean serum B2-microglobulin concentration. Conclusion: A good correlation between B2M and SLE disease activity may explain the role of this marker in the inflammatory process. [ABSTRACT FROM AUTHOR]

Background Adults who had Rheumatoid arthritis (RA) are more prone to falls. Falling in RA increases the risk of hip fracture as decreased bone mineral density is a prominent feature in RA Objective: The aim of the current work was to assess the prevalence of falls and its association with different clinical conditions and different physical performance status. Patients and Methods: This cross-sectional study included a total of 75 patients with RA, diagnosed according to 2010 American College of Rheumatology's Categorization Criteria, attending at Outpatient and Inpatient Clinics, Department of Rheumatology and Rehabilitation, Beni-Suef University Hospital. Participants were divided into non-fallers and fallers. Results: The prevalence of falls among RA patients was 33.3%. Faller RA patients had significantly higher Health Assessment Questionnaire-Disability Index (HAQ-DI) and Clinical Disease Activity Index (CDAI) as compared with non-fallers (p-values< 0.001). Faller RA patients had significantly lower Berg Balance Scale (BBS) as compared with non-fallers (p-value <0.001), Faller RA patients had significantly longer 5-Time Sit Down-To-Stand Up Test (SST5) and longer Timed Up and Go Test (TUG) as compared with non-fallers (p-values< 0.001). Conclusion: It could be concluded that the prevalence rate of falls in RA patients is high, most of them are associated with disease-related outcomes primarily (CDAI) and (HAQ-DI). This makes these tools useful to assess the risk of falls in RA. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a systemic autoimmune chronic inflammatory condition that may impact a variety of organs and tissues, but mostly targets flexible (synovial) joints. Objective: The aim of the current study was to assess influence of power Doppler ultrasound (PDUS) and high-resolution ultrasonography (US) in estimation of ankle joints abnormalities in patients suffering RA with or without ankle joint pain. Patients and Methods: A cross sectional study was conducted on 100 participants presented with clinical diagnosis of RA, from the Rheumatology and Rehabilitation outpatient clinic of Al-Azhar University Hospitals. Participants were subjected to a comprehensive history, clinical examination by the referral to rheumatologist, laboratory tests, and high-resolution US and PDUS examination. Results: Patients with symptoms had a considerably higher Disease Activity Score in 28 joints (DAS 28) than those without symptoms (P<0.001). Patients without symptoms had a considerably greater prevalence of low DAS 28 scores (P<0.001), but high score was considerably greater in symptomatic individuals (P=0.007). Conclusion: US enables rapid identification and precise detection of joint and/or tendon inflammatory involvement at ankle level in individuals with RA. Clinicians should be recommended to utilize US more often to identify pathological ankle problems. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization has identified psoriasis as a serious global health issue. Psoriasis is a persistent, autoimmune skin condition. Survivin is a member of the inhibitor of apoptosis family (IAP) family of molecules that has significant effects on cell survival and proliferation. Survivin, unlike other IAP members, is seldom expressed in healthy adult tissues but is abundantly expressed in the majority of neoplasms. Fetal tissues also have a high level of expression. Objective: The aim of the current study is to estimate serum level of survivin in psoriatic patients and searching for correlation between its level and disease severity. Subjects and Methods: This is a case control study was carried out on 45 patients with psoriasis & 45 matched healthy controls. All participants were recruited from those attending the outpatient clinic of Dermatology, Andrology & STDs Department, Mansoura University Hospitals, Mansoura, Egypt. Results: Non statistically significant difference was found between studied groups as regard occupation, marital status and smoking history. Among all studied cases, 75.6% have gradual disease onset, 40% progressive, median disease duration is 8 years ranging from 1 to 40 years and 13.3% positive family history, 15.6% positive systemic diseases, 15.6% surgical operation, 71.1% have psychological stress, 4.4% positive drug history, 100% topical therapy, 4.4% previous systemic therapy and 26.7% positive previous phototherapy, 100% Skin affection, Presence of trauma, positive Grattage test, 62.2% hair affection and 46.7% nail affection. Conclusion: Patients with psoriasis have higher levels of survivin. Survivin did not correlate with severity of psoriasis (PASI). Higher survivin could predict psoriasis susceptibility, but not severity of psoriasis. [ABSTRACT FROM AUTHOR]

Background: Less than 1% of all adult malignancies and 12% of pediatric cancers are sarcomas, an uncommon and diverse category of mesenchymal malignant tumors. The histologic subtype of soft tissue sarcoma (STS), in addition to the tumors, location, and grade, is a key prognostic factor currently, among the most popular therapies for STSs include surgery, radiation, and chemotherapy. Objective: The goal of this paper is to determine soft tissue sarcoma's epidemiology and prognostic markers retrospectively. It also shows the outcomes for overall survival (OS) and event-free survival (EFS) among Egyptian patients treated at the clinical oncology and nuclear medicine department of Zagazig University and Ahmad Maher Teaching hospitals. Patient and Methods: We reviewed retrospectively clinical features and tumor characteristics of the medical record of 121 patients with soft tissue sarcoma presented to Ahmed Maher teaching hospital and clinical oncology and Nuclear Medicine Department of Zagazig University in the period from January 2010 to December 2021 received chemotherapy or chemoradiotherapy, the study group's demographic information included sex, age, follow-up time, and gender, the main tumor site, size, histological subtype, grade, clinical group, and risk stratification were reviewed as tumor features, to assess the degree of tumor resection or elimination, surgical reports, pathology reports, and tumor response to treatment. Conclusion: Overall survival (OS) is better in extremities than retroperitoneal sarcoma, local recurrence-free survival (LRFS) was better in extremities and visceral sarcoma, disease-free survival (DFS) was better in extremities than retroperitoneal which was better than visceral sarcoma and progression-free survival (PFS) was better in extremities than visceral sarcoma. [ABSTRACT FROM AUTHOR]

Background: Primary percutaneous intervention (PCI) is the favored reperfusion strategy to achieve normal cardiac blood flow. Objective: To study if the level of NT-pro BNP before primary PCI can be used as an independent predictor for successful reperfusion in cases presented with STEMI after primary PCI. Patients and Methods: This study included 40 cases subjected to Emergency Departments of Ain Shams University and Misr University for Sciences and Technology (MUST) Hospitals from September 2021 to June 2022, diagnosed with STEMI and had been revascularized by primary PCI. Serum samples for NT-pro BNP were collected before primary PCI and correlated with the TIMI flow, MBG grades, and ST resolution post primary PCI. Results: Our study demonstrated a higher baseline NT-pro BNP level that was significantly correlated with increased risk of poor myocardial reperfusion following primary PCI expressed by ST resolution less than 50%, TIMI flow grade < 3 as well as MBG < 3 and was also associated with increased incidence of No Reflow. Conclusion: Initial NT-pro BNP level in STEMI cases correlates with myocardial reperfusion following primary PCI besides its early marker for risk stratification of STEMI patients. High-risk patients are in need of more aggressive complementary treatment strategies to improve microvascular perfusion and optimization of medical treatment. [ABSTRACT FROM AUTHOR]

Background: Hepatic decompensation and mortality are common after COVID-19 infection in patients with cirrhosis. According to Child-Pugh class, mortality rose in a linear pattern. Objective: The aim of the current study is to predict outcome of COVID-19 infection in cirrhotic patients. Patient and methods: A total of 104 patients with COVID-19 infection with history of cirrhosis admitted to Zagazig University Hospital and El-Ahrar Teaching Hospital participated in our case control study. Patients were divided into 2 groups: The case group included 52 COVID-19 cirrhotic patients, and the control group included 52 patients with cirrhosis but with no evidence of COVID-19 infection. All subjects were subjected to full history taking, clinical examination, laboratory investigations, and radiological findings. Results: The inflammatory markers (D-dimer, CRP, ESR first hour, ESR second hour and WBC) and Ferritin were statistically significant higher in the case group compared with the control group. There were high significant correlations between severity COVID-19 and Child Pugh classification. There were high significant correlations between laboratory parameters and severity of COVID-19. Mortality rate was significantly higher in the case group compared with the control group (13.4% vs. 25%, respectively). Length of hospital stay, Child Turcot Pugh, fresh frozen plasma transfusion to correct coagulopathy, ascites and hepatic encephalopathy could predict hospital mortality among COVID-19 patients. Conclusion: The in-hospital mortality rate for patients hospitalized with COVID-19 in the context of cirrhosis is higher than the in-hospital mortality rate for patients hospitalized for cirrhosis alone. It is essential to acknowledge that hospitalized patients with cirrhosis are at an elevated risk of mortality regardless of the presence of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Over the past several decades, we have witnessed a significant shift in healthcare delivery from the acute, inpatient hospital setting to a variety of outpatient settings. Much of the inpatient care is now delivered in outpatient settings, using invasive procedures and advanced technologies, which increase the risk for HCAIs. Objective: To evaluate the role of educational program in eliminating infection potential hazards inside gynecology and obstetrics clinic. Material and Methods: Three phases interventional study included before education (phase I) for 3 months, after education (phase III) for 3 months, and interventional phase of 1-month (phase II) in which educational sessions about IC standard precautions, environmental cleaning and reprocessing medical devices done. Result: Contamination level in phase I was 77.8% in bed, 83.3% in table, 63.9% in stethoscope, 80.6% in U/S abdominal probe, 50% in vaginal speculum after cleaning, and 16.7% in vaginal speculum after sterilization. This level decreased in phase III to 38.9% in bed, 38.9% in table, 30.6% in stethoscope, 27.8% in U/S abdominal probe, 13.9% in vaginal speculum after cleaning, and 0% in vaginal speculum after sterilization. The indicator organisms isolated were [MRSA, Pseudomonas spp., Acinetobacter spp. E. coli, and Klebsiella spp.]. (100%) S. aureus isolates (48/48) were MRSA, (100%) Acinetobacter spp. (15/15), E. coli (5/5), and Klebsiella spp. (3/3) were multidrug resistant (MDR), and 88.2% (15/17) of Pseudomonas spp. isolates were MDR. Conclusion: The educational program in phase II succeeded in achieving a statistically significant reduction in contamination level (p=0.05 at all sites), also achieved a decrease in number of indicator organisms found in all sample sites. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery interferes with food absorption, which may cause deficiencies in certain elements and complications. Copper deficiency after bariatric surgeries may be misdiagnosed, which may cause serious diseases. Objective: The current study aimed to investigate the significance of serum copper level in the early detection of anemia related to bariatric surgery. Patients and methods: This study included 50 participants from both sexes divided into 25 anemic patients after bariatric surgery and 25 healthy individuals. Full history taking and complete clinical examination were performed for all participants. Laboratory investigations included hemoglobin (Hb) measurement, serum copper measurement, and iron parameters including serum iron, ferritin, total iron binding capacity (TIBC), and transferrin saturation. Results: There was a highly statistically significant decrease in Hb, serum iron, copper, and ferritin levels after bariatric surgery while transferrin level and TIBC were significantly higher in cases than their controls (P <0.001 for each), while transferrin level and TIBC were significantly higher after bariatric surgery compared to controls (P <0.001 for each). There were highly statistically significant positive correlations between copper level and each of serum hemoglobin (r= 0.726, P=0.03) and iron level (r=0.986, P <0.001), while there were significant negative correlations between copper level and each of transferrin level (r=-0.617, P=0.005) and TIBC (r=-0.520, P=0.008). Conclusion: Copper deficiency after bariatric surgery is associated with iron deficiency anemia. So, copper supplement in addition to iron supplement after bariatric surgery is necessary to avoid the occurrence of anemia. [ABSTRACT FROM AUTHOR]

Background: The multifactorial nature of pathologies causing mitral valve insufficiency in children along with the anticipated child's growth make mitral valve repair in such age group a complex procedure. The main cardiac surgeon's consideration in repairing insufficient mitral valve is to rgestore the valve's geometry and motility using the simplest possible technique. Objective: This study assessed mid-term feasibility and durability of mitral posterior annuloplasty using pericardial patch in patients aged less than 18 years as a simple technique of mitral valve repair. Patients and Methods: Data from Cairo University Hospitals on total number of 100 children who underwent successful mitral valve repair (without need for valve replacement) were gathered from their records, including postoperative and follow-up echocardiographic studies. Results: there were no in-hospital mortalities nor early postoperative significant mitral regurgitation (MR). Follow-up echocardiographic studies revealed moderate mitral regurgitation in 8 patients (8%) and only one patient (1%) required re-operation for severe mitral regurgitation where mitral valve replacement (MVR) was done. Conclusion: MV repair (MVr) in children using pericardial patch for posterior annuloplasty showed excellent survival, acceptable re-operation rate and satisfactory valve function at short and mid-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Mycophenolic acid (MPA), an efficient immunosuppressive medication used in SLE, is glucuronidated by UGTs into an inert 7-O-glucuronide. Studies have shown that the -275T>A and-2152C>T SNPs in the UGT1A9 promoter region are associated with greater hepatic production of UGT1A9 and higher MPA in vitro glucuronidation activity. Subjects and Methods: patients were selected from outpatient Clinics of Rheumatology and immunology department, UGT1A9 -275T>A and-2152C>T (SNPs) were genotyped in 50 SLE Egyptian patients and 100 healthy controls using PCRRFLP. In addition, MPA serum concentrations were measured in patients by homogeneous particle enhanced turbidimetric inhibition immunoassay (PETINIA) technique. Results: UGT1A9-2152C>T and -275T>A distribution of genotypic analysis in SLE patients and controls revealed that the -2152C>T mutation is present in 14% patients and 21% of the control group (P = 0.3), whereas the -275T>A mutation is present in 50% of patients and only in 11% of the control group (P = 0.001). In comparison to the (TT) genotype, the combined (TA+AA) genotype exhibited significant correlation with greater GIT symptoms (68% versus 5%, respectively, P = 0.001). In SLE patients taking MPA with CT+TT genotype against CC genotype, -2152C>T mutations revealed a higher incidence of anemia (85.7% versus%, 30.2 respectively P =0.009). Both SNP genotype carriers had statistically lower C0 MPA values compared to non-carriers (1.25 umol/L (0.62-7.8) versus 4.68 umol/L (0.62-25.9), P = 0.028. Conclusion: Carrier of both UGT1A9-2152C>T and -275T>A SNPS is associated with lower C0 MPA in comparison to non-carrier in Egyptian SLE patients. [ABSTRACT FROM AUTHOR]

Background: Men with diabetes mellitus frequently experience erectile dysfunction (ED). Objective: The purpose of this study is to determine whether or not 5 mg of tadalafil daily is effective in treating erectile dysfunction in men who are diabetic. Patients and methods: In this trial, 50 diabetic males with ED were given 5 mg of tadalafil once daily for 12 weeks. Using the International Index of Erectile Function (IIEF) and penis-specific Color Duplex Doppler Ultrasonography, researchers evaluated tadalafil's effects on erection quality and duration. Results: Age of 45 was the median, and the average body mass index was 30.3 kg/m², 54 % of them were smokers. We found statistical significant (p-value < 0.001) increased 12 weeks IIEF score (median = 18.5, IQR = 13 – 22) when compared baseline IIEF score (median = 12.4, IQR = 10 – 17). Our results showed statistical significant (p-value < 0.001) increased 12 weeks PSV (median = 36, IQR = 35 – 37) when compared with baseline PSV (median = 33, IQR = 30 – 35). Using multivariate logistic regression analysis, we demonstrated that smoking, BMI, dyslipidemia and bad glycemic control were predictive factors for ED severity. Conclusion: Taking 5 milligrams of tadalafil once a day may help diabetic men's erectile dysfunction. [ABSTRACT FROM AUTHOR]

The human endometrium is a complex, multicellular tissue that is regulated by steroid hormones (estrogens, progesterone, androgens, and glucocorticoids) and has different characteristics in the various phases of the menstrual cycle. HCG plays a major role in endometrial receptivity via modulation of the production of various cytokines and chemokines. Aim of the Work: The study aimed to show the effect of intrauterine injection of Human Chorionic Gonadotropin (HCG) on the day of ovum pickup in patients with a history of one or two failed Intra Cytoplasmic Sperm injections (ICSI). Patients, and Methods: A sample of 110 patients was obtained, half of them were candidates for intrauterine injection of 500 units of HCG immediately after ovum retrieval during the mock, while the other half were controls. All patients underwent controlled ovarian stimulation using the long protocol. The study was conducted at the Assisted reproduction unit of Obstetrics and Gynecology Hospital, Faculty of Medicine, Cairo University, between December 2019 and November 2021. Results: The rate of chemical pregnancy was 39.6 % in the first group and 27.8% in the second group. The clinical pregnancy rate was 28.3% in the first group and 18.5% in the second group. There was no significant difference between the two studied groups regarding the proportion of chemical pregnancies (P-value 0.195) and the proportion of clinical pregnancies (P-value 0.232). Conclusion: Although intrauterine injection of HCG improves chemical and clinical pregnancy rates in patients undergoing ICSI trial after failed one or two trials, statistically seems with no differences. [ABSTRACT FROM AUTHOR]

Background: End-stage renal failure (ESRF) is a prevalent problem at national and global levels. It’s a public health concern. Quality of life (QOL) conception had evolved over time but still emerging in Egypt. Reduced QOL of hemodialysis (HD) patients has been linked to non-compliance to treatment, a surge in hospital admissions, hemodialysis complications, and mortality. Objective: It was to evaluate QOL of the hemodialysis patients in Minia, Egypt. Patients and Methods: A cross-sectional study was carried out at Nephrology and Urology Unit, Minia University Hospital on 60 patients. A validated questionnaire was utilized. Results: The study revealed that the patients aged 33.5-60 years and most (56.7%) of them were males. There were significant differences between patients at morning and night shift regarding kidney disease effect, disease burden, cognitive function, and sleep (p-values = 0.001, 0.027, 0.002, and 0.001; respectively). There was a significant negative correlation between hemoglobin level and the effect and burden of kidney disease, cognitive function as well as social function (p= 0.035, 0.033, 0.02, and 0.031; respectively). Nevertheless, there was no correlation between total and ionized calcium, phosphorus, PTH, URR, KT/V, or S. albumin and QOL. Conclusions Time of hemodialysis, either morning or night shift, has an impact on QOL of HD patients as the morning shift was significantly associated with better QOL in contrast to the night shift in our study in terms of kidney disease effect, kidney disease burden, cognitive function, and sleep. [ABSTRACT FROM AUTHOR]

Background: COVID-19 could lead to severe acute respiratory syndrome leading to myocardial injury. It is associated with high morbidity and mortality. COVID-19 progression severity can be predicted by cardiac signs. Biomarkers can be used for early detection of cardiac injury and damage and prediction of severe prognosis ultimately. Echocardiography is used for therapeutic management and diagnostic procedures for COVID-19 patients. Detection of subtle cardiac damage early allows for providing efficient treatment. Objective: The aim of the current study was to predict early cardiac involvement in COVID-19 depending on different laboratory and echocardiographic parameters. Patients and methods: This prospective analytical observational study included a total of 100 patients diagnosed as positive COVID-19, depending on polymerase chain reaction ‘PCR’ of nasopharyngeal swabs. Patients underwent full echocardiographic assessment, electrocardiogram (ECG) and laboratory investigations just upon admission. Further grouping of patients according to clinical deterioration was done to detect the prognostic value of investigations. Results: Group I of clinically deteriorated patients had more lymphopenia (mean ±SD: 954.2± 6.5x109 /l), higher neutrophils-lymphocytic ratio (mean ±SD: 3.9± 0.2), less TAPSE (tricuspid annular plane systolic excursion) (mean ±SD: 14.85 ± 3.29mm) and more basal RV (right ventricle) diameter (mean ±SD: 39.93 ± 3.08 mm) in comparison with clinically stable patients. Deterioration of TAPSE (p value = 0.017) & basal RV diameter (p value = 0.044) were found to have significant relation with grading of respiratory failure using PO2/FiO2 ratio which had significant positive correlation with RV diameter (p value= <0.001 and r= 0.357). Conclusions: TAPSE & basal RV diameter can early predict cardiac involvement in COVID 19 disease and have the prognostic ability to predict the degree of respiratory failure in deteriorated patients. [ABSTRACT FROM AUTHOR]

Background: Early cervical cancer is mainly treated with surgery, whereas middle- and late-stage of cervical intraepithelial neoplasia (CIN) is mainly treated with radiotherapy. Therefore, accurate preoperative diagnosis and staging of cervical lesions are crucial to patients with cervical lesions. Objective: The present study aimed to assess transvaginal sonoelastography in differentiation between normal cervix, CIN and cancer cervix. Patients and methods: A Case-control study carried out in Departments of Obstetrics & Gynecology and Radiology, Zagazig University Hospitals. Women were classified into three groups: Group A: 20 cases with normal cervix, group B: 10 cases with CIN and group C: 10 cases with cancer cervix. Results: There was non-significant difference between studied groups as regards age and smoking. While there was significant difference regarding family history, weakened immune system, endometrial thickness and strain ratio. Conclusion: Real time elastography (RTE) strain ratio (SR) of the uterine cervix, performed with a silicone ED as a reference material, seems a reliable method for distinguishing between a normal cervix and malignancy. The technique also showed promising results as a complementary investigation in diagnosing CIN. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis-C, a necroinflammatory disease of the liver that leads to liver cirrhosis in roughly 20% to 30% of patients, is caused by hepatitis C virus (HCV) infection. Liver cancer occurs at an average of 3.5 percent every year when cirrhosis has been formed in the liver. Nowadays, computed tomography (CT) scan is considered as a promising screening tools. Triphasic CT often shows enhanced contrast enhancement of the focal lesion during the arterial phase of the test (wash-in) and contrast wash-out during the portal/venous and late equilibrium phases for hepatocellular carcinoma (HCC) radiology. Objective: To assess possible role of triphasic computed tomography for detection of hepatitis C virus consequences. Methods: PubMed, Google scholar and Science direct were searched using the following keywords: Triphasic Computed Tomography, Hepatitis C virus and Hepatocellular Carcinoma. The authors also screened references from the relevant literature, including all the identified studies and reviews, only the most recent or complete study between January 2003 and February 2021 was included. Documents in a language apart from English have been excluded as sources for interpretation was not found. Papers apart from main scientific studies had been excluded: documents unavailable as total written text, conversation, conference abstract papers and dissertations. Conclusion: Using of triphasic CT has been considered as a golden diagnostic imaging technique to detect the incidence of hepatocellular carcinoma as well as its possible complications. [ABSTRACT FROM AUTHOR]

Background: Multiple myeloma (MM) is a clonal neoplastic plasma cell disorder. With availability of immunomodulators and bortezomib, better response rate and survival outcome have been achieved in newly diagnosed multiple myeloma (NDMM) patients. Objective: To evaluate patients' response and outcomes to anti-myeloma treatment in a tertiary referral center. Patients and Methods: From September 2020 to February 2022, at Zagazig University Hospitals, Hematology Unit of Internal Medicine Department, our prospective cohort study was conducted on 36 treatment-naïve patients with NDMM. All patients had received anti-myeloma agents and assessed for response and outcome. Results: About the performance status (PS), one quarter of the cases had PS 0 (25%), and 55.6% of the cases were PS 1. Majority of cases responded to treatment (91.7%), while only three cases did not respond. Thirty-three cases showed no progression (91.7%) and three cases only showed progression (8.3%). Ten patients underwent autologous stem cell transplantation (ASCT). After a median follow-up period of 12 months (range 4-18 months); the OS rate was 76.8%, and PFS rate, was 90.7%. Conclusion: This study highlights that by using proper anti-myeloma agents, a reasonable clinical outcome can be achieved in our tertiary center. [ABSTRACT FROM AUTHOR]

Background: Acitretin belongs to a group of drugs known as retinoids which have similar activity to vitamin A. Vitamin A helps regulate the immune system, impacts cellular growth, differentiation, proliferation, and plays a role in embryonic development. Objective: The aim of the current study was to evaluate the effect of acitretin administration on semen parameters in male psoriatic patients. Patients and methods: This cohort study included a total of 31 male psoriatic patients, attending at Dermatology and Andrology Clinics, Mansoura University Hospitals to demonstrate the effect of Acitretin administration on semen parameters. This study was conducted between June 2019 to September 2020. Results: The average Psoriasis Area and Severity Index (PASI) score of the studied cases was 17.96 ± 4.55. Most of the studied cases has moderate to severe activity, while only 25.8% of which had severe disease. Positive family history and associated skin diseases were demonstrated in 22.6% and 16.1% of cases respectively. There was no statistically significant differences were detected after treatment as compared with before treatment as regards mean semen volume, semen PH, mean total sperm motility, mean ratio of live sperms, mean sperm concentration, mean pus cells count and mean ratio of sperm with normal morphology. Conclusion: It could be concluded that retinoids seem to have no adverse effects in the context of semen parameters in male psoriatic patients. [ABSTRACT FROM AUTHOR]

Background: Within the gestational sac, the yolk sac is the first embryonic structure to be seen. The size, shape, and function of the yolk sacs, as well as the heart rates of the developing embryos, all play a role in the evaluation and prognosis of first-trimester pregnancy losses. Objective: The purpose of this study was to determine if yolk sac diameter (YSD) and embryonic heart rate (HER) could be used to predict pregnancy outcomes. Patients and Methods: 52 pregnant women at gestational age ranged between 6-12 weeks who were included in the study. Our prospective cohort study was carried out in Obstetrics and Gynecology Department at Fetomaternal Unit, Zagazig University Hospital and Fetomaternal & Ultrasound Units, Matrouh Maternity Hospital. Measurements of the embryo's crown-rump length as well as their heartbeat rate and the size and shape of the yolk sac were done. Results: Normal sac diameter was seen in the great majority of YSD patients in the study groups (80.8 percent). Only one case of normal diameter YSD ended in miscarriage after the first trimester in all patients with normal YSD. A 98.1% success rate in predicting miscarriage was achieved by YSD, which had 97.6% sensitivity and 100% specificity. Firsttrimester pregnancy outcomes were accurately predicted by EHR with a sensitivity of 97.5% and a specificity of 100%. Conclusion: Maternal risk variables including age, weight, or parity have no effect on the poor pregnancy outcome related with abnormal yolk sac diameter and embryonic bradycardia. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome is a hormonal disorder commonly found in women of reproductive age affecting about 15% of them and is considered the most common cause of anovulatory infertility. Administration of metformin to these anovulatory women increase ovulation rate and continuing in first trimester improves the pregnancy outcome. Objective: To assess pregnancy outcome in women with polycystic ovary syndrome who continue metformin during first trimester with its co-morbidity and mortality. Patients and Methods: This prospective intervention study was conducted on 44 pregnant polycystic ovary syndrome women who were attending for antenatal care at Outpatient Clinic, Obstetric and Gynaecological Department, Zagazig University Hospital. These 44 women took metformin before pregnancy and was followed up by indication of ovulation and metformin (1000-1500 mg/day) until they got pregnant. Then they were divided into two group: group 1 (22) continuous metformin dose during first trimester and group 2 (22) who discontinued metformin therapy once pregnancy diagnosed. The 2 groups followed up by fasting blood glucose and fasting serum insulin at their first visit and at 28 weeks of gestation. Results: group 1 who continued (1000_1500mg /day) metformin in first trimester had good pregnancy outcomes (significantly lower weight gain, lower gastrointestinal diabetes mellitus and lower spontaneous miscarriage) than group 2 who discontinued metformin (p value: 0.001). Conclusions: good maternal outcomes in women with polycystic ovary syndrome who continued metformin during first trimester including decrease incidence of spontaneous miscarriage and gastrointestinal diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is a metabolic disorder caused by a complex interaction of genetic and environmental variables. T2DM is associated with transcription factor 7-like 2 (TCF7L2) and fat mass and obesityassociated (FTO) genetic polymorphism. Objectives: The goal of this study was to examine the common genetic risk factors of T2DM and related metabolic traits in Upper Egyptian population, in attempt to understand the genetic structure of T2DM in the Egyptian community. Methods and Materials: This case control study included 250 participants, 124 T2DM patients and 126 non-diabetics. Using mutagenically separated polymerase chain reaction (MS-PCR), genotyping of single nucleotide polymorphisms (SNP) rs7903146 of TCF7L2 and rs17817449 of FTO genes was carried out. Results: T allele of TCF7L2 variant rs7903146 confers a risk for T2DM (allelic OR=1.97, 95% CI: (1.34 to 2.88) p =<0.001). The minor G allele of FTO rs17817449 polymorphism was significantly higher in diabetics than controls (allelic OR=1.87, 95% CI=1.30 to 2.68, p<0.001). Genotype risk was evident under both recessive and dominant modes of inheritance (OR=3.18, CI (1.35-7.45), P =0.008, OR= 2.04, CI (1.23-3.38), p=0.006) for TCF7L2 and (OR= 2.55, CI (1.28 -5.09), p=0.008 and OR= 2.14, CI (1.25-3.63), p= 0.005) for FTO respectively Conclusion: TCF7L2 rs7903146 and FTO rs17817449 variant conferred risk for T2DM in Upper Egyptian population. The study noted the interaction between certain biological and environmental risk factors including BMI, age, and sex and the conferred genetic risk. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance, pre-diabetes, and obesity have all been linked to excess adiposity. Proinflammatory adipokine visfatin is thought to play a key role in type 2 diabetes inflammation. Objective: This study aimed to estimate visfatin level among prediabetic obese patients and to observe and detect the interplay between visfatin, insulin resistance and obesity. Patients and methods: 96 adult subjects were studied in case-control research at Internal Medicine Department and Clinical Pathology Department, Zagazig University Hospital. The study was carried out from January 2021 to November 2021. Subjects were divided into 3 groups: Group (1) included 24 healthy individuals as a control group, group (2) included 48 prediabetic individuals and group (3) that included 24 patients type 2 diabetes who never been treated in any of these. Serum visfatin was assessed in all participants. Results: Diabetes mellitus (DM) patients had higher visfatin levels than those with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Visfatin had a significant positive correlation with BMI, WC, FBS, PPS, HA1c, LDL, fasting insulin, and HOMA IR, while HDL had a significant negative correlation. Conclusion: Visfatin levels were significantly linked to type 2 diabetes. HOMA-IR, fasting insulin, and BMI all showed a strong positive correlation with visfatin levels, suggesting that it may be a useful biomarker for detecting type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Nasal and sinus illnesses are diagnosed with computed tomography (CT) because CT scans effectively bone anatomy is depicted with air spaces, opacified sinuses, and detailed structural details. Objective: The significance of using multislice CT for the detection and characterization of sinus polyps and the relationship between the CT findings and those of functional endoscopic sinus surgery (FESS) have been studied. Patients and methods: At Zagazig University's Radiodiagnosis Department, we conducted this study on 18 patients, 10 of which were females and eight were males, from a total of 33 individuals. To emphasize the role of multislice (CT) in diagnosis and characterization of sinonasal polypi during functional endoscopic sinus surgery, numerous CT parameters were used and correlated with operational findings. Results: There was a strong correlation calculated by Spearman correlation coefficient (r) for rightsided and left-sided surgeries of 0.76 and 0.87, respectively, for operative endoscopic and Lund-Mackay staging scores. Conclusion: Based on functional endoscopic sinus results, CT and diagnostic endoscopy may be the new standard of care in the diagnosis of sinonasal diseases. [ABSTRACT FROM AUTHOR]

Background: Acanthosis nigricans (AN) is a common cutaneous condition that can be a manifestation of systemic disease. AN is characterized by hyperpigmented and hyperkeratotic velvety skin lesions that presents mainly on the flexural sites, for example, the neck, the axillae, and groin. Objective: The aim of this study was to evaluate the clinical efficacy of fractional carbon dioxide laser versus glycolic acid peel 70% in treatment of pseudo-acanthosis nigricans through assessing changes in degree of area index, severity and texture of lesion. Patients and methods: Twenty patients with pseudo-acanthosis nigricans were included in this study. They were chosen from the Outpatient Clinic of Dermatology, Andrology & STDs department, Mansoura University Hospitals. All cases were subjected to fractional CO2 laser on the right side of the neck and glycolic acid peel 70% on the left side of the neck. Each patient was followed up for 3 and half months. Results: There was statistically significant difference regarding improvement in area index, severity and texture across time subjected to glycolic acid (GA) peeling 70%. There was statistically significant difference regarding improvement in area index, severity and texture across time subjected to fractional CO2 laser. There was no statistically significant difference when comparing effect of laser and peeling on adult and children. There was no statistically significant difference when comparing effect of laser and peeling on rural and urban cases. Conclusion: Acanthosis nigricans is a difficult dermatosis to treat, although there are many methods of treatment. Glycolic acid peeling 70% and fractional CO2 laser are considered effective modalities for AN treatment. However, GA peeling was more effective but statically insignificant. [ABSTRACT FROM AUTHOR]

Background: End-Stage Renal Disease (ESRD) patients on hemodialysis suffered from many central and peripheral neurological insults. Aim of the work: This study aimed to assess the value of using MRA, MRV, and SWAN sequences in early visualization of the silent cerebrovascular complications in those patients. Patients and Methods: Our study was conducted on forty-five patients with well-documented ESRD on regular hemodialysis for more than 5 years with no neurological manifestation, all undergone unenhanced MRI, DWI with ADC and measuring the ADC value, SWAN, MRA, and MRV. Results: we found that 11% of cases have acute infarction at the basal ganglia region. 36.7% of patients are diagnosed with intracerebral hemorrhage, only 26.7% of them are seen by the conventional MRI, and 16.7% of cases showed microbleeds on SWAN with normal conventional MRI. The sensitivity and specificity of SWAN with ADC value to detect brain hemorrhage are 100% and 88.8% respectively. Conclusion: Visualization of cerebrovascular complications such as infarction, hemorrhage, atherosclerosis, and arterial and venous occlusion using DWI with ADC, MRA, MRV, and SWAN and is very useful in early management and better prognosis of ESRD patients even with silent complications that don’t give up symptoms with high sensitivity and specificity of SWAN in early detection of hemorrhage and microbleeds. [ABSTRACT FROM AUTHOR]

Background: Awareness and education of kidney disease has an impact on its effective management and will reduce the economic and public health burden. Objective: We conducted a cross-sectional descriptive study to assess the level of awareness, knowledge and common risk factors of CKD in the community to plan to preventive modalities. Patients and methods: We used a pretested validated questionnaire to gather information about sociodemographic knowledge and risk factors of CKD from 464 residents aged >18 years. Results: A total of 464 residents completed this study with a median age of 30 years, 50.5% of them were females. The mean knowledge score of chronic kidney disease (CKD) was relatively poor as it was 13.12% ± 3.95. Only 48.6% could mention at least one function of the kidneys with 66.4% agreeing with that certain medications can help to slow-down the worsening of chronic kidney disease. A laboratory test for kidney function was known by 75.9%. 92.9% and 17.2% believe that CKD can be cured by spiritual means and herbal concoctions respectively. Abdominal obesity and excessive stress were seen in 64.7% and 45.5% respectively. Hypertension was seen in 56.5% while diabetes mellitus was found in 57.1% as risk factors for chronic kidney disease. Conclusion: Efforts should be made to increase the public knowledge of CKD in Minia, Egypt as it was relatively poor that may be achieved by increasing awareness, education of people about CKD and how to prevent or regress its risk factors. [ABSTRACT FROM AUTHOR]

Background: There are 170 million people in the globe living with hepatitis C virus (HCV) infection, which causes inflammation and hepatic fibrosis in various degrees. A portion of these patients will develop cirrhosis and other end-stage liver disease problems over the course of twenty to forty years. Low levels of serum ceramide 24 (Cer24) are linked to severe liver fibrosis and poor response to antiviral therapy in those with chronic HCV infection. Objective: This study was designed to assess level of ceramide 24 in chronic HCV and normal individuals. Subjects and Methods: The study was carried out as a case control study at Tropical Medicine Department, Clinical Pathology Department in Zagazig University Hospitals and at Viral Hepatitis Treatment Unit in Al-Ahrar Teaching Hospital. The study included 60 individuals who were divided into 2 groups. Group 1 included 30 case and group 2 was 30 healthy subjects as control. All patients were clinically evaluated, had routine laboratory investigations and measurements of circulating levels of ceramide 24. Abdominal ultrasonography was done. Results: Serum ceramide 24 level in HCV patients (cases) is 15.16 ± 6.93 while its level in normal individuals (control) is 65.01 ± 65.84. Conclusion: It was found that serum ceramide 24 level was significantly reduced in case group. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is the emerging cause of chronic liver disease. In addition, steatosis may lead to failure of obtaining sustained virological response after hepatitis C virus eradication. Therefore, there is a trend to identify effective strategies for managing hepatic steatosis. Farnesoid X receptor (FXR) agonists are reported to play a role in NAFLD treatment. Objective: This study aimed to explore the immunohistochemical expression of FXR in NAFLD spectrum in association with the clinicopathological data. Material and method: This was a retrospective study including 50 cases of NAFLD and 23 cases of normal liver. The NAFLD group was subdivided into 11 cases of NAFL (simple steatosis) and 39 cases of non-alcoholic steatohepatitis (NASH). Results: Hepatocyte FXR nuclear expression was significantly decreased in NASH group (P=0.001) with no significant decrease in NAFL group compared to normal liver (P=0.149). Bile duct FXR expression was significantly lower in NAFL group compared to normal liver (P= 0.009) to reach the lowest level in NASH group (P= 0.017). In NAFLD group, there was an inverse correlation between hepatocyte FXR nuclear expression and the ALT/AST ratio (r=-0.349 and P=0.013). However, hepatocyte FXR nuclear expression was significantly associated with moderate grade of steatosis and severe fibrosis (P= 0.044 and P= 0.033, respectively). Conclusion: Hepatocyte FXR nuclear expression showed a stepwise decrease in its expression from normal to NASH passing with NAFL. Therefore, FXR has a protective role against NAFLD progression. Elevated liver enzymes could be used as a non-invasive method for monitoring FXR agonists' efficacy. [ABSTRACT FROM AUTHOR]

Background: Pain continues to be a very prevalent symptom too often undertreated in cancer patients at all stages of their disease. It is difficult to manage, and patients often show a poor or limited response to analgesic medications or experience intolerable adverse effects. Objective: The aim of the current work was to compare the effect of adding calcitonin to methylprednisolone versus methylprednisolone alone to local anesthetic in erector spinae plane block for patient suffering from thoracic cancer pain. Patients and methods: A double-blind study was conducted from November 2019 until November 2020 at Outpatient Pain Clinic, Oncology Center, Mansoura University (OCMU). This study included thirty patients of both sexes and range of ages (30-70 years), with a history of chronic thoracic cancer pain ≥ 4 on a visual analogue scale (VAS) of 0 – 10 and Chronic pain for at least 3 months prior to study entry. Patients were divided into ywo groups, 15 each, Group (I) (methylprednisolone group) and Group (II) (calcitonin group). Results: Any post block events like nausea, vomiting, respiratory depression (when SpO2 less than 92%) and pneumothorax were recorded. Consumption of analgesics (tramadol 1 – 1.5 mg / kg when needed) during first three months post procedure was measured. Patients of both groups gained benefits from the techniques. The two groups showed decline in the VAS scores and the total tramadol consumption. Calcitonin group has more prolonged duration of pain relief, significant reduction in pain scores, lower tramadol requirements, tolerable side effects. Conclusion: Patients received calcitonin added to methylprednisolone and local anesthetics had significant reduction in pain scores, more prolonged duration of pain relief, less rescue analgesia (tramadol) consumed and was more satisfied with the treatment [ABSTRACT FROM AUTHOR]

Background: Pain continues to be a very prevalent symptom too often undertreated in cancer patients at all stages of their disease. It is difficult to manage, and patients often show a poor or limited response to analgesic medications or experience intolerable adverse effects. Objective: The aim of the current work was to compare the effect of adding calcitonin to methylprednisolone versus methylprednisolone alone to local anesthetic in erector spinae plane block for patient suffering from thoracic cancer pain. Patients and methods: A double-blind study was conducted from November 2019 until November 2020 at Outpatient Pain Clinic, Oncology Center, Mansoura University (OCMU). This study included thirty patients of both sexes and range of ages (30-70 years), with a history of chronic thoracic cancer pain ≥ 4 on a visual analogue scale (VAS) of 0 - 10 and Chronic pain for at least 3 months prior to study entry. Patients were divided into ywo groups, 15 each, Group (I) (methylprednisolone group) and Group (II) (calcitonin group). Results: Any post block events like nausea, vomiting, respiratory depression (when SpO2 less than 92%) and pneumothorax were recorded. Consumption of analgesics (tramadol 1 - 1.5 mg/kg when needed) during first three months post procedure was measured. Patients of both groups gained benefits from the techniques. The two groups showed decline in the VAS scores and the total tramadol consumption. Calcitonin group has more prolonged duration of pain relief, significant reduction in pain scores, lower tramadol requirements, tolerable side effects. Conclusion: Patients received calcitonin added to methylprednisolone and local anesthetics had significant reduction in pain scores, more prolonged duration of pain relief, less rescue analgesia (tramadol) consumed and was more satisfied with the treatment modality as compared to methylprednisolone and local anesthetics treated patients in 3 months follow up periods. [ABSTRACT FROM AUTHOR]

Introduction: Rotavirus (RV) belongs to the Reoviridae virus family and the virion comprises of three concentric protein layers. Worldwide, rotavirus (RV) is the most common cause of severe gastroenteritis (G.E.) among infants and young children especially in those countries which has not launched a RV vaccination program and approximately 40% of hospitalized patients suffering from gastroenteritis were infected with RV. Objective: To determine the prevalence of rotavirus infections, genotypes and degree of severity of its acute diarrhea in infants and children attending the children hospital, at Zagazig University Hospitals. Patients and methods: this study was done on 140 patients admitted to Children Hospital, Zagazig University suffering of gastroenteritis, Vesikari clinical severity score was done and stool sample was taken from patients, which was tested for RV by dipstick method and positive patients underwent genotyping by immunochromatography using PCR technique. Results: Among the studied group 128 patients (91.4%) showed positive results for rotavirus detection by dipstick analysis of stool, while only 12 patients (8.6%) were negative. The Vesikari score of severity ranged from 9 to 15 with median of 12 and its mean ± SD was 11.9±1.3. G3 and P8 were the most types in the examined patients. Conclusion: rotavirus is still the main cause of severe gastroenteritis that requires hospital admission. G3 and P8 are the most detectable genotypes. [ABSTRACT FROM AUTHOR]