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Background: Labor is a physiologic process during which the products of conception (i.e. the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. Labor is divided into three stages that include cervical dilatation, fetal delivery and delivery of the placenta. Objective: The aims of this study were to quantify the degree of fetal head deflection via the use of Ultrasound during the first stage of labor and to determine whether a parameter derived from ultrasound examination (the occiput-spine angle) has a relationship with the progress of labor, subsequent effect on maternal, fetal complications and rate of cesarean delivery. Methods: This is a prospective cohort study which includes a total of 200 women with gestational age 37-42 weeks were assessed in this study in Ain shams Maternity hospital labor ward by 2 dimensional ultra sound. Examinations were performed after a verbal and written consent from the patient with the patient lying in the dorsal supine position. And exclusion of Occiput-posterior position, multigravida, Indication for cesarean, Medical disorder eg hypertension or diabetes, pre labor rupture of membranes to correlate between the Occiput- spine angle (OSA) and the outcome of labor regarding the progress of labor, incidence of cesarean section, maternal and fetal complications. Results: This study demonstrates that the sonographic measurement of the angle formed by the fetal occiput and the spine (occiput-spine angle) is feasible and reproducible, the occiputspine angle in the first stage of labor is positively correlated with the clinically established station and the risk of obstructed labor requiring an operative delivery ie, Occiput-spine angle have been statistically significantly lower in cases underwent operative delivery. Occiput-spine angle had a statistically significant low diagnostic performance in predicting operative delivery. Conclusion: The occiput-spine angle in the first stage of labor correlates significantly with the risk of obstructed labor Compared with spontaneous vaginal deliveries, cases that require obstetric intervention demonstrated a smaller occiputspine angle at a similar station, suggesting diminished flexion of the fetal head. For occiput anterior fetuses, the greater the degree of fetal head deflexion, the greater risk of operative delivery due to labor arrest. [ABSTRACT FROM AUTHOR]

Objective: to measure the level of hair zinc, as well as its level in serum, in patients with epilepsy and compare them to the levels found in non-epileptic age and gender matched children, and to explore any potential correlation between either serum or hair level of magnesium and seizure characteristics in children with idiopathic epilepsy. Methods: An observational cross-sectional study including 50 children with idiopathic epilepsy and 100 non-epileptic age and gender matched control subjects. Cases were subjected to full history taking, examination and measurements of serum and hair levels of zinc, control subjects only had their serum and hair level of zinc measured as for the cases. Results: The mean serum zinc was 1.13 (0.61 - 1.69) ug/ml for cases and 1.81 (0.75 - 3) ug/ml for controls and the median hair level of zinc was 116.58 ug/g with IQR of 74.97 - 176.58 for cases and 143.64 ug/g with IQR of 95.22 - 178.28 for controls. Serum zinc level was significantly lower in cases compared to controls, but the difference was not statistically significant for hair zinc. No statistically significant correlation was observed between either hair or serum levels of zinc and seizure characteristics. Conclusion: Serum zinc levels are reduced in epileptic patients compared to healthy age and gender matched controls. Hair zinc levels do not seem to be affected in idiopathic epilepsy. Studies involving larger numbers of patients are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Background: There is controversy regarding treatment of unexplained infertility due to absence of specific pathophysiological rational which allows curative intervention. The main three lines of treatment of such cases are confrolled ovarian hyperstimulation, IUI with spontaneous or induced ovulation and third is IVF. Aim of the Work: to evaluate the effect of metformin on chemical pregnancy rate in women with unexplained infertility. Patients and Methods: This was a prospective randomized controlled trial study which was conducted on 170 women with unexplained infertility in Ain Shams Maternity Hospital. Results: Incidence of chemical pregnancy was not statistically sigfificantly different between both groups (PR: 18.8% vs.16.5% P 0.84) in metfonnin and clomiphene youp respectively. (NNT) was estimated to be 42.5. Conclusion: our study showed little benefit was added to the patients by using metfonnin as adjuvant therapy to clomiphene citrate during ovulation induction as regards chemical pregnancy. 42 women are needed to be freated with metformin to get one more pregnant woman by pregnancy test. [ABSTRACT FROM AUTHOR]

Objective: To measure the level of hair Mg, as well as its level in serum, in patients with epilepsy and compare them to the levels found in non-epileptic age and gender matched children, and to explore any potential correlation between either serum or hair level of magnesium and seizure characteristics in children with idiopathic epilepsy. Methods: An observational cross-sectional study including 50 children with idiopathic epilepsy and 100 non-epileptic age and gender matched control subjects. Cases were subjected to full history taking, examination and measurements of serum and hair levels of magnesium, control subjects only had their serum and hair level of magnesium measured as for the cases. Results: The mean serum magnesium was 29.11 6 13.42 ug/ml for cases and 27.67 6 7.24 ug/ml for controls and the median hair level of magnesium was 42.22 ug/g with IQR of 25.9 - 56.82 for cases and 38.6 ug/g with IQR of 25.21 - 61.25 for controls. No statistically significant difference was observed between both groups as regards either serum or hair magnesium levels. No statistically significant correlation was observed between either hair or serum levels of magnesium and seizure characteristics though the correlations were nearing statistical significance for the hair magnesium content. Conclusion: Hair magnesium level may be better correlated to seizure characteristics and control than serum levels in patients with epilepsy. [ABSTRACT FROM AUTHOR]

Background: Acute ankle sprain is a very common injury which comprises 80% of all ankle injuries. Acute ankle sprain affects almost exclusively the lateral ligamentous complex including ATFL followed by CFL, while PTFL is rarely of clinical significance. Objective: To study the clinical trials in a Meta-analytical form, in order to compare surgical versus conservative treatments for the management of acute injuries of the lateral ligament complex of the ankle. Materials and Methods: We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) statements. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. Results: In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from their inception till April 2019. The search retrieved 702 unique records. We then retained 48 potentially eligible records for full-texts screening. Finally, 14 studies (Total No. of patients=1896) were included in the present systematic review and meta-analysis Conclusion: Starting a physiotherapy programme as early as possible is essential to control pain and swelling, to improve and maintain the range of motion, and to minimize the risk of stiffness and muscle wasting, which are the two decisive factors which delay patients from returning to their normal activities. Regardless of severity, surgery for acute ankle sprain is not recommended anymore. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of this study is to compare open repair and minimally invasive repair in acute Achilles tendon rupture in adults regarding operative techniques, functional outcome and complications. DESIGN: A prospective randomized controlled comparative trial. METHODS: 40 consecutive cases with acute complete Achilles tendon rupture were divided randomly in 2 equal groups (20 treated by open Krackow repair and 20 treated by minimally invasive repair with the PARS device), average age 41 years, follow up time was average of 7 months. Patients were assessed clinically and functional scoring system of postoperative American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS) was used postoperatively. RESULTS: Our results found that there were no significant differences between both groups in rates of postoperative complications (MIS group 10%, open repair group 15; P = 0.134). PARS group had greater postoperative AOFAS score, early rehabilitation, better cosmetic appearance and smaller scar length than open Krackow repair of acute Achilles tendon rupture. CONCLUSIONS: We have found out that minimally invasive techniques such as the PARS are clinically and biomechanically suitable alternatives to open repair based on both clinical outcomes and repair strength. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and is a leading cause of cancer related death worldwide. In the United States, HCC is the ninth leading cause of cancer deaths. Despite advances in prevention techniques, screening, and new technologies in both diagnosis and treatment, incidence and mortality continue to rise. Cirrhosis remains the most important risk factor for the development of HCC regardless of etiology. Hepatitis B and C are independent risk factors for the development of cirrhosis. Alcohol consumption remains an important additional risk factor in the United States as alcohol abuse is five times higher than hepatitis C. Diagnosis is confirmed without pathologic confirmation. Screening includes both radiologic tests, such as ultrasound, computerized tomography, and magnetic resonance imaging, and serological markers such as afetoprotein at 6-month interval. Aim: To compare characteristics and behavior of Hepatocellular carcinoma (HCC) in chronic HCV patients and HVB patients Patients and Methods: The current study was conducted on patients with de HCC presented at HCC clinic, Tropical medicine department Ain Shams University Hospitals between December 2017 and December 2018, aged (18-70 years old) . Results: eline characteristics of study population shown in Table 1 at enrolment, including gender, Education status, comorbidity, underlying presence or absence of cirrhosis, Child Pugh class of patients infected with viral hepatitis, and αfetoprotein levels. Male proportion observed to be predominant in both HCV (62%) and HBV (75.4%) infected HCC population. Overall prevalence of HCV and HBV in patients having HCC was 65.95% and 34.04%, respectively. Presence of underlying liver cirrhosis was more significantly associated with HCV seropositives as compared to HBV seropositive patients (p0.05). Table 2 shows comparison of means between HCV and HBV seropositive patients with HCC. In univariate analysis, mean age difference (11.6 years), and total bilirubin levels (-1.91mg/dl) were the only statistically significant observations noted among HCVHCC group (p = 0.05) Conclusion: Hepatocellular carcinoma is mainly caused by Hepatitis C and Hepatitis B viruses, but latter showed predominance, comparatively worldwide and correlated HBV directly as a cause of HCC rather than HCV whose relation with HCC is still unclear (Shepard et al., 2006; Di Bisceglie, 2009). Because of the geographical differences and risk factors, the epidemiological burden of HCV and HBV has been observed different in different areas of the world. In developing countries due to high burden of HCV infection as compared to HBV such as in Taiwan (HCV 17.0%, HBV 13.8%) (Kao et al., 2011), Guam (HCV 19.6%, HBV 18%) (Haddock et al., 2013), and Pakistan (HCV 4.8%, HBV 2.5%) (Rehman et al., 1996; Raza et al., 2007; Qureshi et al., 2010; Butt et al., 2012;) will possibly. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris is a multifactorial inflammatory skin disease of the pilosebaceous unit with complex pathogenesis. Calprotectin is a heterodimer of two calcium-binding proteins S100A8 and S100A9, which are members of the S100 protein family, and which play a role in various inflammatory processes, it is mainly present in the cytoplasm of neutrophils and expressed on the membrane of monocytes. Objective: to assess the level of Calprotectin in blood and in tissue of AV patients and compare it with healthy controls. Beside correlate it with the degrees of severity of acne in order to further understand the role of Calprotectin in the pathogenesis of AV. Subjects and Methods: This case-control study included 28 subjects who have AV, divided into four groups according to Global Acne Grading System: the first group included 7 patients with mild acne, the second group included 7 patients with moderate acne, the third group included 7 patients with severe acne, and the fourth group included 7 patients with very severe AV. In addition to a control group which included 28 apparently healthy individuals of matched age, sex and with no previous history of acne or active acne. All the patients were recruited from the outpatient clinic of Al Haud Al Marsoud hospital from September 2019 till January 2020. After taking the approval of research ethics committee (FMASU M S 22/2019) all subjects gave an informed consent to participate in this work. Results: Our study showed that the increase in AV severity was not affected by the difference in gender, type of acne, nor disease duration. However, there was a significant correlation between plasma calprotectin level and AV severity. In addition to, There was a significant statistical correlation between the increase in the age of patients and the decrease in the severity of acne, which indicates that AV is more severe in younger patients than older ones. The correlation between the Plasma Calprotectin level in patients group and Tissue Calprotectin level in inflammatory lesions (papules) was non-significant. However, the correlation between the Plasma Calprotectin level in patients’ group and Tissue Calprotectin level in non-inflammatory lesions (comedones) was highly significant. Conclusion: Plasma Calprotectin level showed significant relation with AV severity and presence of scar. The correlation between plasma Calprotectin level and tissue Calprotectin level in noninflammatory lesions (comedones) was highly significant. [ABSTRACT FROM AUTHOR]

Background: The no-reflow phenomenon is defined as the occurrence of areas with extremely low tissue flow after reopening the target vessel. Current knowledge suggests that the noreflow phenomenon is caused by the damage to microvascular integrity established both during ischemia and during reperfusion.. D-dimer is a final product of fibrin degradation by plasmin, the plasma concentrations of which increase in subjects with ongoing or recent thrombosis; its levels reflect the fibrin turnover and gives an indirect estimation of the size of the thrombotic mass available for fibrinolysis and the severity of hypercoagulable state. Moreover, high thrombus burden is known to be associated with no-reflow phenomenon. Objective: To: determine the value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction, Patients and Methods: The study was conducted among 100 patients with STEMI admitted in coronary care unit and coronary catheterization lab unit of cardiology department in Ain Shams University Hospital & Misr University Hospital undergone successful primary PCI. 74 patients showed normal re-flow after PCI and 26 patients showed noreflow phenomenon after PCI and D –dimer level and other clinical parematers for the no re-flow phenomenon were analysed. Results: patient with high plasma D-dimer levels showed higher risk of no-reflow phenomenon compared with patients with low plasma D-dimer in predicting no-reflow. D-dimer level ranged from 210 to 776 ng/ml with mean6 SD was 415.35 6 164.91 ng/ml. (55%) of the patients had D-dimer levels <500 ng/ ml.and (45%) had D-dimer >500ng/dl. coronary angiography showed that (74%) showed normal flow and (26%)showed no reflow. ROC curve of the relation of no-reflow, TIMI flow and MBG grade, showed that the best cut off point for D-dimer to detect cases with no reflow was found ) 560 with sensitivity of 96.15%, specificity of 79.73% and area under curve (AUC) of 86.5%. Conclusion: D-dimer level on admission independently predicts no-reflow after p-PCI. High D-dimer level on admission has an independent prognostic value. [ABSTRACT FROM AUTHOR]

Background: By various molecular and cellular research efforts it was displayed that folliculogenesis, ovulation, and corpus luteum formation is considered as an inflammatory processes that hav raised the research interest to investigate that serum amyloid A as an inflammatory mediator to reveal its possible role in infertility. Objective: This study aims to assess the association between SAA and unexplained infertility in women. Methods: The current research study have been conducted at Ain Shams University Maternity Hospital during the period from September 2018 to April 2019. Women approached were recruited from outpatient clinic of Ain Shams University Maternity Hospital. The recruited 90 research study subjects have been divided into two research groups Results: Serum amyloid A was statistically significantly higher among the unexplained research group versus control group (SAA had excellent discriminative value with an area under the ROC curve (AUC) of 0.992 (95% CI = 0.945 to 1.000, Pvalue <0.0001). A best cutoff criterion is SAA of 28.7 mg/l (sensitivity = 98%, specificity = 96%, J-index = 0.93)) denoting that amyloid A as an acute phase inflammatory modulator is higher among the unexplained research group reflecting a form of chronic inflammatory process in those category of cases. Analytical research results of multivariable binary logistic regression analysis as regards the correlation between SAA and unexplained infertility after adjustment for age and BMI, it was revealed that serum amyloid A an independent predictor for unexplained infertility. Conclusion: s: Serum amyloid A as a biomarker for could be implemented as a predictability tool for unexplained infertility since it is a reflector of an chronic inflammatory process that is ongoing that could affect the process of implantation and ovulation however the clear molecular and cellular processes linked to the pathophysiological process that reflects the fertility hindering process should be implemented in future research efforts taking in consideration to have multicentric fashion of research with larger sample sizes to verify the value of serum amyloid A as biomarker that reflects the fertility potential besides the routine infertility work up. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of subthreshold micropulse laser as compared to intravitreal injection of ranibizumab in treatment of center involving diabetic macular oedema. Methods: A total of 76 eyes of 62 patients with center involving diabetic macular oedema were divided into two groups. Group A received intravitreal injection of ranibizumab while group B received subthreshold micropulse laser with rescue intravitreal injection of ranibizumab. The change from baseline in best correscted visual acuity and central subfield thickness were compared at 3, 6, 9 and 12 months follow-up. Any adverse effects were recorded. Results: Group A (n ¼ 34 eyes) experienced a statistically significant improvement in best corrected visual acuity (from 0.3260.16 Log MAR at baseline to 0.2160.14 Log MAR at 12 months) (P value ¼0.006), with a statistically significant reduction in central subfield ghickness (from 352.06634.34mm to 289.47658.88 mm) (P value¼0.001). Group B (n ¼ 42 eyes), also experienced a statistically significant improvement in best corrected visual acuity (from 0.3460.22 Log MAR at baseline to 0.1360.31 Log MAR at 12 months) (P value¼0.001), with a statistically significant reduction in central subfield thickness (from 300647.34mm to 253.12639.60 mm at 12 months) (P value¼ 0.009). The mean difference in best corrected visual acuity between the group B and group A was -0.08 Log MAR with a 95% CI ranging from -0.197 to 0.037, which supports the claim of non-inferiority between the two treatment regimens. No adverse effects from subthreshold micropulse laser were recorded in both groups. Conclusion: subthreshold micropulse laser with rescue intravitreal injection of ranibizumab was non inferior to intravitreal injection of ranibizumab in treatment of center involving diabetic macular oedema as regards the mean change in best corrected visual acuity. [ABSTRACT FROM AUTHOR]

Background: Age-related macular degeneration (AMD) is the leading cause of severe irreversible visual impairment worldwide. The disease has a deep impact on the quality of life of affected person and represents a major socioeconomic challenge. Neovascular age-related macular degeneration (nAMD) is a rapidly progressing disease which impacts central vision. It is responsible for 90% of cases of AMD associated severe vision loss. Choroidal thicknening is hypothesized to occur in the active phase of neovascular AMD. On the other hand, multiple studies reported progressive choroidal thinning in nAMD. Aim: to study the correlation between choroidal thickness, and the activity of choroidal neovascularization in cases of neovascular (wet) Age related macular degeneration using Spectral domain Ocular coherence tomography. Methodology: Our study included 33 eyes of 30 participants subdivided into neovascular AMD group (23 eyes of 20 patients), and age matched control group (10 eyes of 10 participants). Spectral domain optical coherence tomography (Avanti RTVue XR AngioVue OCT (Optovue Inc, Fremont, USA) was used to measure central foveal thickness (CFT), and subfoveal choroidal thickness (SFCT) after conduction of complete ocular examination and history taking. Results: Our study shows a significant decrease in subfoveal choroidal thickness in neovascular AMD group (157.82 þ 68.67 mm) when compared to the age matched control group (266.9þ 48.37 mm) with (P value <0.001). But, we found no clinically significant difference in SFCT between active CNV (179.23 þ 64.36 mm) and inactive CNV groups (136.4 þ 72.97 mm) (P value ¼ 0.19). Conclusion: there is a significant thinning of choroid in nAMD in comparison to control. But no statistically significant difference in SFCT between active and inactive choroidal neovascular groups. Key words: Neovascular age-related macular degeneration (nAMD), Choroidal neovascularization (CNV), Spectral domain optical coherence tomography (SD-OCT). [ABSTRACT FROM AUTHOR]

Background: The pathogenesis of rotator cuff tear (RCT) remains controversial. The acromion portion of the scapula and its morphology may be attributable for a variety of shoulder disorders such as RCT. Patients and Methods: This was a retrospective study that included 40 patients divided into two groups; a group with RCT included 20 patients and a control group with no RCT included the other 20 patients. 19 were males and 21 females, their age 20-69 years old with a mean age of 45. Cases were selected from the PACS system of the Radiology department of Ain Shams University Hospital. Statistical data analysis was done using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp) Results: The study revealed that Type Il acromion was encountered in most of the male patients (42.1%) and type Ill acromion was encountered in most of the female patients (42.9%) while type IV acromion was less frequently seen among males and females (5% & 0%) respectively. It also revealed that Type Ill is mostly encountered in RCT (50%); 58% of full-thickness tear and 37% of partial thickness tear. while type I is less frequently associated with a partial tear or full thickness tear (8%) for each. Acromion type Ill was the commonest type of acromion found between the patients of the case group with a significant statistical difference found between the case and control groups (P value: 0.006). However, type I acromion was the commonest acromion type found between the control group with also a significant statistical difference (P value: 0.011). Conclusion: Type Ill acromion may be a risk factor leading to rotator cuff tear. This may help guide therapy in patients with shoulder pain and findings suggesting type Ill acromion shape. [ABSTRACT FROM AUTHOR]

Background: Warts (verrucas) are an extremely common, benign, and usually self-limited skin disease. Their size ranges from a few millimetres to several centimetres. The normal skin lines are interrupted by skin coloured to brownish-grey proliferations, the diagnosis is established clinically; no supplementary histologic or virologic investigations are needed. Objective: The aim of this two armed double blinded randomized clinical trial was to evaluate the clinical efficacy of intralesional combined digoxin and furosemide in the treatment of multiple planter warts. Methods: This study included 40 patients with plantar warts, they were divided into 2 groups, 20 patients per group, the first group received intralesional normal saline, one injection session every week for maximum 5 injection sessions. The second group received intralesional combined digoxin and furosemide, one injection session every week for maximum 5 injection sessions. All the patients were recruited from the Dermatology outpatient clinic at Ain-Shams University Hospital and Shobra General Hospital during the period From July 2018 to July 2019. Results: There was no statistically significant difference between the 2 studied groups as regard size of wart before treatment. While there was statistically significant difference between the 2 studied groups as regard size of wart after the 5th session. Also there was a steady increase in the response to treatment in group 2 showing an earlier response to treatment and most of patients with excellent and very good response to treatment after the 5th session. There was no statistically significant difference between the 2 studied groups as regard the number of warts before treatment. While there was statistically significant difference between the 2 studied groups as regard the number of warts after the 5th session. There was no statistically significant correlation between age, sex, disease duration and response to treatment (as regard reduction in number of warts) after the 5th session in group 2. While in group 1 there was no reduction in number of warts after the 5th session. There was a statistically significant difference between the number of warts before and after receiving the active treatment in group 1, in group 2 and for both groups together (all patients). Conclusion: We concluded from this study that intralesional injection of combined digoxin and furosemide offers effective alternative form of treatment for plantar warts in adults. It is inexpensive and safe to treat plantar warts. [ABSTRACT FROM AUTHOR]

Background: Systemic sclerosis and dermatomyositis are autoimmune connective tissue diseases affecting the skin and various internal organs. Systemic sclerosis is characterized by fibrotic arteriosclerosis of peripheral and visceral vasculature. Objective: Analysis of video dermatoscopic picture of systemic sclerosis and dermatomyositis patients and find a characteristic feature for both. Assess serum vascular endothelial growth factor (VEGF) in these patients using enzyme linked immunosorbent assay (ELISA) kits. Perform a statistical analysis of the results to find a relation between video dermatoscopic Picture of systemic sclerosis and dermatomyositis patients and their serum VEGF to help in diagnosis, grading, prognosis and management. Patients and Methods: Our case control study included 25 patients with SSc or DM (2555 years) recruited from Ain Shams University Hospitals and 25 apparent healthy controls with matched age and sex. After the study had been approved by Ain shams University of Medical Sciences Research Ethics Committee, all the subjects signed an informed consent before inclusion in the study. Results: Serum VEGF level was highly significant in patients than in controls. This may be explained by the excessive release of VEGF in patients due to hypoxia caused by microvascular occlusion that not present in healthy controls. Conclusion: Microvascular abnormalities are the earliest features of SSc and DM with elevation of serum VEGF level indicating its role in disease pathogenesis and disturbance of microvessls. Videodermoscopy and measurement of serum VEGF are effective tools in diagnosis, prognosis and grading of autoimmune connective tissue diseases as SSc and DM. [ABSTRACT FROM AUTHOR]

Background: Cellular and cell-derived components of adipose derived tissue for the purposes of dermatologic and aesthetic rejuvenation applications have become increasingly studied and integrated into clinical practice. The hair follicle goes through phases of growth, regression, and quiescence, and it is suspected that adipocytes secrete factors to promote activation of hair follicles dermal papilla cells, increasing migration, and proliferation in vitro; as well as increasing conversion of hair follicles from the telogen to anagen phase in vivo. Objectives: Evaluation of efficacy and safety of adipose-derived adult stem cells (ADSCs) injection in hair follicle regeneration in female pattern hair loss (FPHL). Methods: 33 patients were included and divided into 3 groups according to Sinclair’s classification according to severity. ADSCs were extracted from lipoaspirate and injected into the frontoparietal scalp. Patients were assessed clinically, trichoscopically and immunohistochemically. Results: At week 24, there was improvement of hair thickness and count, both in frontal and occipital areas. Histopathological and immunohistochemical assessment at week 12 showed decrease of perifollicular inflammation and decrease of DKK-1 immunostaining. Conclusion: The use of ADSCs in treatment of FPHL in subjects included in this study showed improvement of perifollicular inflammation, in addition to density and thickness of hair. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases represent the leading cause of mortality worldwide. Ischemic heart disease is one of the main causes of diastolic heart failure and its presence predicts a poor prognosis in ischemic heart patients. Most cardiovascular diseases can be prevented by addressing behavioral risk factors such as overweight and obesity. Leptin –also known as satiety hormone- helps in inhibiting hunger and regulate energy balance (1). Objective: to correlate leptin level with ischemic heart disease with or without diastolic dysfunction by comparing it in lean and obese patients. Material and Methods: from June 2019 to November 2019, 140 ischemic patients documented with CA, MSCT or history of PCI AND 35 Control subjects were enrolled from both Ain Shams University, Cardiology department wards and outpatient clinic and Misr University for science and technology, cardiology department wards and outpatient clinic. All participants subjected to history, clinical examination, Duke CAD index to estimate the severity of ischemia, calculation of their BMI, blood sampling for measuring their serum leptin level and echocardiography for detecting the diastolic function. Patients were divided into four groups according to their BMI and Diastolic function in addition to the control group. Groups were demonstrated as follow Group A lean ischemic patients without significant diastolic dysfunction, Group B lean ischemic patients with diastolic dysfunction (II-IV), Group C obese ischemic patients without significant diastolic dysfunction, Group D obese ischemic patients with diastolic dysfunction(II-IV), Group E is a control group lean non ischemic without diastolic dysfunction . Results: There were significant positive correlations between serum leptin and Duke score in all ischemic groups (n=140) (p<0.001). Serum leptin abnormality was significantly more frequent 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%, also was lowest in control group (n=35) 0.0%. serum leptin was significantly positive correlated with ischemia as in group A17.8±2.1ng/mL group B 23.4±11.1ng/mL group C 55.4±10.9 ng/mL group D 65.2±10.8 ng/mL vs control group E 13.1±2.7 ng/mL. Conclusion: leptin is an independent risk factor for coronary heart disease. Also elevated plasma leptin levels are associated with impaired left ventricular diastolic function in patients with CAD independently of obesity and other confounding variables. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency anemia and dental caries are among the most prevalent diseases in some developing countries. However, few studies have been conducted to assess the association between Iron deficiency anemia (IDA) and early childhood caries (ECC). Objectives: The aim of the study was to assess the association between IDA and ECC. Methods: 40 children with proved iron deficiency anemia (using iron profile panel done initially) and another 40 healthy age and sex-matched children were examined by one trained and calibrated dentist where the oral status of all enrolled children was assessed in terms of the Decayed, Missing, Filled (DMF) index and gingival health using Gingival index of Loe and Sillness. Results: Children with anemia had a significantly higher DMF index (4.37±4.44) than children without anemia (0.50±0.90) (P < 0.001). It was found that there was a negative significant correlation between DMF index and the presence of anemia (r= -0.60, P < 0.001), hemoglobin level (r=-0.454, P < 0.001) and MCH level (r= -0.380, P = 0.001). The multiple regression model statistically significantly predicted DMF index (P = 0.001), (R2=0.34) and only the presence of anemia was found to add significantly to the model (P = 0.027). Conclusion: Children with iron deficiency anemia have increased risk for development of dental caries than children without anemia. Any children with significant dental caries should be investigated for IDA and anemia should be treated if present. [ABSTRACT FROM AUTHOR]

Background and rational: Shivering, a very common complication of surgery owing to postoperative pain and post anesthesia hypothermia, is distressing for both patients and clinicians. It can be defined as involuntary and oscillatory muscular activities that increase the metabolic rate by two to three folds to maintain the core temperature. Both neuraxial (epidural and spinal anesthesia) and general anesthesia are associated with a significant incidence of shivering. The incidence is 40%-60% in regional anesthetic patients and up to 60% in general anesthetic ones. Patients and Methods: This study was conducted at Ain Shams University Hospitals between September 2018 and February 2019, after obtaining approval of research ethical committee and patients' informed consents, 150 patients were included in the study and underwent elective gynecological, and received general anesthesia. Results: this study show incidence of post anesthetic shivering is significantly reduced after combination of granisetron and dexamethasone compared to control group. Conclusion: Combination of granisetron and dexamethasone significantly reduced Post anesthetic shivering (PAS) compared to granisetron alone. It is difficult to establish which drug can be considered the gold standard in prevention of PAS after general anesthesia. Because many research centers have reported that the effects of different anti-shivering drugs are similar, it is wise to administer the cheapest and safest drugs. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the macular, retinal nerve fiber layer (RNFL) and choroidal thickness alterations by using spectraldomain optical coherence tomography (SD-OCT) in postmenopausal, pregnant and non-pregnant women. PATIENTS AND METHODS: A comparative study included a total of 42 eyes (Right eye) of 42 healthy females in the period from march 2019 to September 2019 divided into 3 groups: a) Non pregnant women. b) Pregnant women.c) Postmenopausal women. Each subject underwent a comprehensive ophthalmologic examination. Following this detailed ophthalmologic examination, the Rs 3000 Nidek Japan OCT device was used for the assessment choroidal, macular and RNFL Thickness. RESULTS: The mean age of non-pregnant females was 29.64 63.13, mean age of pregnant females was 28.93 63.89 and of postmenopausal women was 53.86 6 1.75. There was no significant difference in all macular quadrants in the 3 study groups. Choroidal thickness was statistically significant thicker in healthy pregnant females (333.36 644.42) than in healthy non pregnant (326.93631.50) and significantly thinner in healthy post-menopausal women (282.64628.04) than healthy non pregnant females. There was no significant difference in RNFL thickness between the 3 study groups. CONCLUSION: Oct has evolved over the past decade as one of the most important ancillary tests in ophthalmic practice. Pregnancy hormones may lead to an increase in fluid volume in many tissues of the body. There was no statistically significant difference in macular thickness and RNFL thickness between the 3 study groups. Choroidal thickness was statistically significant thicker in healthy pregnant than in healthy non pregnant and significant thinner in healthy post-menopausal women than healthy non pregnant. [ABSTRACT FROM AUTHOR]

BACKGROUND: Multiple Myeloma (MM) is still considered an incurable relapsing disease, despite major advances in multi- drug combinations, incorporation of autologous transplant and achieving higher rates of CR. This suggests persistent presence of residual disease, not detected by current techniques. Minimal residual disease (MRD) monitoring by multiparameter flow cytometry (MFC) is a powerful tool to quantitatively measure residual disease and allow tailoring of the management plan on individual basis. AIM: To assess the value of MRD by MFC in determining the efficacy of treatment, monitoring depth of remission and predicting impending relapse. PATIENTS AND METHODS: We included 33MM patients, who were candidates for ASCT in this prospective study. MFC (with a 0.01% limit of detection) on a BM aspirate obtained before trans- plant and at day 100 post-transplant, was used to measure MRD for all patients. Patients were then later assessed for progression 1-year post-transplant. RESULTS: MRD status at 100 days post-transplant was strongly related to the risk of 1-year post-transplant progression (p-value 0.001), and by using a ROC curve, we found that MRD (%) at 100 days post-transplant can predict progression after 1 year with a best cutoff value ≥ 0.04 achieving a 75% sensitivity and 81.2 specificity. On dividing the patients according to their MRD status before and after transplant, group 3 who were MRD positive pre- and post-transplant, had a high risk of progression 1year post-transplant (p-value 0.003). The use of bortezomib-based regimens resulted in a deeper response and a more negative MRD pre-transplant (p-value 0.01), that was maintained post- transplant. Also, ASCT resulted in the development of deeper remission (p-value 0.004) and more MRD negativity (p-value 0.02). CONCLUSION: we recommend the use of MRD by MFC as a powerful prognostic tool that should be incorporated in routine myeloma workup [ABSTRACT FROM AUTHOR]

Background: It is already known that Barrett’s esophagus (BE) is a premalignant condition in which the normal squamous epithelium of the distal esophagus is replaced by columnar epithelium (intestinal metaplasia or gastric metaplasia) due to GERD. Most observers believe that there is a progression from intestinal metaplasia to low-grade dysplasia (LGD) to highgrade dysplasia (HGD) to cancer. The relative risk of developing esophageal adenocarcinoma in patients with BE appears to be 30-fold higher. Conventional therapies include medical treatment (profound acid inhibition), endoscopic treatment (like endoscopic mucosal resection) and surgical treatment (fundoplication). Methodology: Types of studies: Published studies about the efficacy of Nissen’s Fundoplication with or without Endoscopic Mucosal Resection in the treatment of Barrett’s Oesophagus (carried out in the period between 2015 – 2020), types of participants Patients with clinically proven Barrett’s Oesophagus diagnosed by endoscopy and biopsy, types of interventions Nissen’s Fundoplication (Open or Laparoscopic) with or without Endoscopic Mucosal Resection, types of outcome measures Outcome of treatment in the form of Complete Remission of Columnar Metaplasia of the oesophageal mucosa or regression in recurrence rate as proved by follow-up endoscopy. Results: The strategy of endoscopic therapy for Barrett’s metaplasia, dysplasia and/or intramucosal cancer along with fundoplication results in similar durability and recurrence rates when compared to patients being managed with PPIs following endoscopic therapy. However, fundoplication along with endoscopic therapy is superior to either of them alone in preventing further progression of disease and the development of cancer, particularly in refractory patients. Fundoplication is an important strategy along with endoscopic therapy for Barrett’s to achieve and maintain CR-IM, and to facilitate the eradication of persistent dysplasia. Conclusion: Endoscopic mucosal resection after Nissen’s Fundoplication is a safe modality, with high rate of success in complete eradication of BE in symptomatic GERD patients, especially those with severe anatomical impairment in distal esophageal segment. As a concurrent procedure, endoscopic procedures may be beneficial in the terms of reducing the early recurrence rates, which seems to be important issue during the management of BE. By doing synchronous endoscopic procedures and fundoplication, one might observe a true anatomy of esophagogastric junction in its entirety and might be able to truly observe the distal extent of columnar esophagus. [ABSTRACT FROM AUTHOR]

Background: The proximal interphalangeal (PIP) joints of the fingers are extremely important for gripping things with hands, more specifically, what is called the ‘power grip’. Aim of the Work: To compare the different modalities of repair of intra-articular fractures of PIP joint. Materials and Method: A systematic review and meta-analysis were performed in accordance to the recommendations of the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA). PRISMA is reporting checklists for the authors, the editors, and the reviewers of Meta-analyses of the interventional and the observational studies. According to the International committee of medical journal association (ICJME), the reviewers must report their findings according to each of the items listed in those checklists. Results: The results of this study includes the search results and data extraction results which includes summary characteristics and baseline characteristics of the included Studies, outcome measures and Complications of the included studies. Conclusion: There is no consensus regarding the most effective technique for management of unstable PIPJ fractures. The extension block pinning, closed reduction and percutaneous pinning of the fracture fragments, dynamic distraction and external fixation, open reduction and internal fixation, and hemihamate reconstruction arthroplasty are safe and reliable and reduce the risk of iatrogenic damage when used to treat unstable dorsal fracture-dislocations of the PIP joint. [ABSTRACT FROM AUTHOR]

Background: Heart valve calcification was first described a century ago. Its pathologic features were first described by Dewitsky in 1910. Valvular heart disease is common in endstage renal disease patients. The incidence of valvular heart disease is 5 times greater in dialysis patients than in the general population MGP plays a key role in the inhibition of tissue calcification, which was demonstrated in MGP-deficient mice bjective: To detect the prevalence of cardiac valvular calcifications among end stage renal disease patients on prevalent haemodialysis and its relation to Matirx Gla protein. Patients and Methods: Enrolled patients were recruited from Ain shams hospitals, divided into two groups according to the presence/absence of valvular calcifications on echocardiographic examination as follows: Group A: included patients with valvular calcifications. Group B: included patients without valvular calcifications. Results: In current study, 19 (23.8%) patients showed mitral calcification, 30 (37.5%) showed aortic calcification and 44 (55.0%) had calcification in general as 5 patients had both mitral and aortic calcifications. In current study, the patient who had calcification were significantly older, heavier in weight and BMI and were had HD for longer than those who didn’t have calcification. Patient who had calcification had lower levels of both platelets and urea than those who didn’t have calcification. In current study, the mean ucMGP was 549.5 ± 160.1 and the patient who had calcification had higher levels of ucMGP than those who did not have calcification. There was a significant positive correlation between age, weight, BMI, duration of HD and ucMGP. And there was a significant negative correlation between platelet count, serum albumin and ucMGP. Conclusion: In current study, MGP was able to significantly differentiate between patients with and without calcification at a cutoff point (>564 pg/mlv) with sensitivity 86.36%, specificity 97.22. Our study confirmed that older age, hypertension, diabetes mellitus low platelet, higher ucMGP and blood urea are the most predictive parameters of valvular calcifications in hemodialysis patients. Other markers were not associated with valvular calcifications. ucMGP serum levels can significantly differentiate between HD cases with valvular calcifications and those not and those who had findings in CXR [ABSTRACT FROM AUTHOR]

Background: Mechanical ventilation is the defining event of intensive care unit (ICU) management. It is a lifesaving intervention in patients with acute respiratory failure and whose spontaneous ventilation is inadequate for subsequent development of life threatening hypoxia and/or respiratory acidosis. Many physicians simply look at the patient’s ability to tolerate a spontaneous breathing trial (SBT) without distress through the respiratory rate (RR) and TV during the SBT. The RR/TV ratio, i.e., the rapid shallow breathing index (RSBI), one of the most used clinical indices to predict weaning outcome, reflects the balance between mechanical load posed on the inspiratory muscles and the inspiratory muscles ability to face it during the weaning attempt. However, RSBI was found to have both variable sensitivity and specificity for predicting weaning outcome. Although the diaphragm plays a fundamental role in generating TV in healthy subjects, if the diaphragmatic efficiency is impaired the accessory inspiratory muscles mild contribute to the ventilation for a limited period of time, for example during a SBT. However, since they are by far less efficient and more fatigable than the diaphragm, their exhaustion was likely lead to weaning failure in subsequent hours. Hence, the contribution of the accessory muscles to TV could compromise the diagnostic accuracy of the RSBI by masking the underlying diaphragmatic dysfunction. Aim of the Work: To assess the accuracy of Diaphragmatic Rapid shallow breathing index and Maximum inspiratory pressure in predicting the outcome of weaning from mechanical ventilation. Patients and Methods: The study was conducted at Ain Shams University Hospitals over 6 months on Patients who were mechanically ventilated for more than 48 hrs who were ready for weaning. Inclusion Criteria: Patients intubated & mechanically ventilated for more than 48 hrs. Patients at their first SBT.Patients with adequate cough reflex. Patients fulfilling criteria of readiness for weaning from mechanical ventilation after resolution of cause of respiratory failure: Patients with score ranging between -1 and þ1 on the Richmond Agitation and sedation scale (RASS). Exclusion criteria: Age < 18 yrs. Patients with thoracotomy, pneumothorax, or pneumomediastinum. Patients with presence of flail chest or rib fractures. Patients with neuromuscular disease. Use of muscle-paralyzing agents within 48 hours before the study. History or new detection of paralysis or paradoxical movement of a single hemi diaphragm on diaphragmatic ultrasonography. Pregnant females. Unconscious noncooperative patients. Patients with intra-abdominal hypertension, Long term steroid therapy. Results: I- Distribution of the studied patients regarding final outcome. II- Demographic data. III. Causes of MV. IV- Days on MV. V- Patients’ data and characteristics before start of weaning trial. VI- SBT Ventilator Breathing pattern after 30 min. VII- Study predictors. Conclusion: D-RSBI is a new and promising tool that is superior to the traditional RSBI in predicting weaning outcome also MIP provides appreciated data with greater accuracy to assess inspiratory muscle strength and predicting weaning success in mechanically ventilated patients. Recommendations We could recommend the measurement of MIP and DRSBI as weaning predictors should be an integral part of evaluation of patients plan for weaning from MV. All intensivists should be acquitted with the use of U/S in the evaluation of diaphragmatic function. [ABSTRACT FROM AUTHOR]

The aim of the present work was to design praziquantel (PZQ) loaded chitosan nanoparticles (PZQ-Cs) to improve the oral bioavailability and overcome the drawbacks of conventional PZQ therapy. The synthesized chitosan nanoparticles (CsNPs) were physico-chemically characterized by TEM and dynamic light scattering (DLS) with the calculation of the encapsulation efficiency (EE). PZQ was loaded into CsNPs in three different doses; reduced dose (250 mg/kg), high dose (500 mg/kg) and fully effective dose (1000 mg/kg). Infected treated groups received either oral PZQ-Cs or oral PZQ alone 42 days post-infection and were sacrificed 2 weeks post-treatment. The current study revealed that PZQ-Cs induced a significant anti-schistosomal effect, compared to the infected non-treated control. However, on comparison with conventional PZQ treatment at the corresponding doses, oral PZQ-Cs showed a lower anti-schistosomal potential as reflected by the total worm burden, tissue ova count and oogram pattern. PZQ-Cs was significantly effective in attenuating the oxidative insult associated with S. mansoni infection, compared to the infected non-treated and PZQ treated groups. Genotoxicity assessment proved the safety of CsNPs, as they did not induce a significant DNA fragmentation in non-infected mice treated with blank CsNPs. The present work highlights CsNPs as safe, effective anti-inflammatory and antioxidant agents that could find a clinical use in the treatment of schistosomiasis induced oxidative stress and hepatic dysfunction. Further studies are recommended, however, to investigate how PZQ-Cs could be further modified to increase its anti-schistosomal potential. [ABSTRACT FROM AUTHOR]

Background and Rational: To date, only few studies have evaluated the benefits of anticoagulation in individuals with cirrhosis. An obvious goal of anticoagulation is PV recanalization: when cirrhotic individuals with PVT are treated with anticoagulation, complete recanalization has been described in 33-45% while partial PV recanalization is observed in 15-35% of cases. LDLT has emerged as the alternative life-saving treatment to DDLT. Over the past 2 decades, the number of LDLTs has steadily increased in many transplant centers, especially in Asia. The separation between occlusive and non-occlusive thrombosis is very important; in patients with partial PVT, post-transplant mortality outcomes are no different from non-PVT patients but it is significantly increased in patients with complete PVT. Patients and Methods: This randomized prospective study will include 79 patients who will undergo LDLT in Ain Shams Specialized and Egypt Air hospitals, there are two groups of patients according to presence of portal vein thrombosis or not group A 39 patients of non PVT and group B 40 patient of PVT including different grades of PVT according Yerdel classification. Results: In this study, there is no significant difference between groups regard age but Males were significantly associated with group B. In this study, there is no significant difference between groups regard CHILD and MELD scores and this findings. In our study there is no significantly difference between groups A and B regarding ICU stay, hospital stay and cell saver. In this study, comparisons of the PVT patients and controls showed no statistical significant differences regard HA thrombosis, post operative pulmonary embolism and biliary leak but PV rethrombosis is significantly associated with PVT patients, mortality sig associated with PVT patients. Conclusion: The outcomes of patients with PVT who underwent LDLT are inferior to those without PVT. Patients with PVT has lower survival rate, higher postoperative PV rethrombosis. [ABSTRACT FROM AUTHOR]