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Background: Radical mastoidectomy is the outstanding standard technique for management of cholesteatoma. Long term studies showed increasing incidence of discharging cavities (1). Modified radical mastoidectomy was described to prevent recurrent cholesteatoma along with reconstruction of the ossicular hearing mechanismre. Exteriorization of the disease bearing areas is essential for effective follow up (2). However, there are many recesses which cannot be exteriorized regarding its anatomical location such as the mesotympanum. It will be a source of discharge or accumulation of keratin. Covering these recesses by grafting is an essential rather than optional step in all radical mastoidectomies to prevent problematic cavities. Aim of work: Demonstrate the necessity of grafting in radical mastoidectomy for obtaining dry cavity. Methods: A prospective, comparative study conducted from March 2016 to October 2019 on 60 cholesteatoma patients. Patients were randomized into 2 equal groups of 30 patients each. In group A, patients undergone modified radical mastoidectomy with grafting, while patients in group B have undergone radical mastoidectomy without grafting. Regular follow-up was done monthly for 1 year for both groups. Results: In group A, 22 patients have intact grafts, and dry well epithelialized cavities, 2 patients had perforated grafts, 5 patients had small discharging granulations and 1 patient had a keratin pearl under the graft. In group B, 19 patients suffered persistent discharging cavity, 8 patients had less discharge with keratin debris and granulations and 3 patients had dry cavities. Conclusions: Grafting is an essential step in radical mastoidectomy to prevent cavity problems. [ABSTRACT FROM AUTHOR]

Background: Background: Plantar fasciitis is caused by degenerative changes and repetitive stress, and it is a common cause of heel pain. Ultrasound is a reliable diagnostic tool for PF, but not all patients exhibit changes on ultrasound, making additional techniques necessary. the plantar fascia mechanical properties can be assessed by Elastography, such as Strain elastography and shear wave elastography. Strain elastography is subjective and operatordependent, while shear wave elastography provides a quantitative measure of tissue stiffness. Method: This study is a case control that has been conducted on 30 PFis patients (clinically diagnosed) and 30 matched control healthy individuals with no pain. It aimed to determine the added value of elastography to B-Mode ultrasound in the PFis diagnosis in comparison with healthy people. PF thickness and SWE stiffness elasticity (Young's modulus in kPa and shear wave velocity in m/s) were measured 1 cm distally from the calcaneal insertion. Correlations with VAS, AOFAS and the 17-Italian Foot Function Index (17-FFI) were determined. Results: Plantar fasciitis can be significantly assessed by SWE velocity and elasticity. There is a negative correlation between plantar fascia thickness and both SWE velocity and elasticity. Mean SWV value in healthy subjects was 5.92 m/s and in patients 3.02 m/s with a mean stiffness value of 109.1 kPa and 49.35 kPa respectively (p < 0.001). For SWV a cut-off value of 4.1 m/s had a specificity of 100 % and sensitivity of 93.33%. For stiffness a cut-off value of 48.1 kPa had a specificity of 100% and sensitivity of 76.67%. The mean thickness of healthy fascias was 2.93 mm (range 1.8-3.7) compared to 5.25 mm (range 3.4-8.3) in plantar fasciitis (p < 0.001) with cut off value about 3.7 had a specificity of 100 % and sensitivity of 90%. Conclusion: Our study has proven that the diagnostic accuracy is improved by SWE compared to B-US and that the combination of BUS and SWE is a strong diagnostic tool in detection of PFis and may be helpful in diagnosing early cases. [ABSTRACT FROM AUTHOR]

Background: Stroke is a heterogeneous and multi-factorial disease that affects people globally. Matrix Metalloproteinase-9 is involved in blood- brain barrier breakdown, edema development, pro-inflammatory cytokine activation and destruction of myelin proteins are all connected to the pathogenic events that take place during an ischemic stroke., matrix metalloproteinase- 9 concentration is greatly related to infarct extension, neurologic impairments, and hemorrhagic transformation in individuals with ischemic stroke. Objective: We focused our research on improving individuals' outcomes after having an acute ischemic stroke by assessing the level of serum matrix metalloproteinase-9 24 hours after the stroke begins and the relation between Serum levels of matrix metalloproteinase-9, clinical severity, and ischemic stroke prognosis. Methods: This follow up prospective cohort research was conducted at Zagazig University Hospitals' Intensive Care Unit and Stroke Unit at the Neurology Department and Emergency Room. The study included 54 people experiencing their first acute ischemic stroke. Stroke severity and serum MMP-9 level were assessed on admission and following a 15-day follow-up. Results: Level of Serum MMP-9 was 1085.93 ng/ml with a range from 485 to 1544 ng/ml. Statistically significant positive correlation was found between serum MMP-9 and neurological severity as measured by NIHSS at admission and after 15 days. Also, there was a highly significant positive correlation between MMP-9 and functional outcome as assessed by mRS after 15 da ys follow up. The best cutoff of MMP-9 in prediction of large size infarction, that was ≥ 1042 Also, the best cutoff of MMP-9 in prediction of severe stroke was ≥ 1091 ng/ml. The best cutoff of MMP-9 in prediction of severe stroke after 15 days is ≥972.5 ng/ml. Among factors significantly correlated with baseline NIHSS, MMP-9, size of infarct, BI and mRS were significantly independently associated with baseline NIHSS among studied patients.Conclusion: Serum MMP-9 may act as potential prognostic factor predicting neurological severity and short term outcome in individuals with ischemic stroke. [ABSTRACT FROM AUTHOR]

Background: Patients with liver cirrhosis who present with bleeding esophageal varices are at a higher risk of developing acute kidney injury (AKI), which, in turn, has negative impacts and a poor prognosis. In our study, we aimed to determine the association between recurrent esophageal variceal bleeding and the presence of AKI in patients with liver cirrhosis. Methods: Our study included 203 cirrhotic patients, divided into two groups based on the absence or presence of AKI. All patients underwent a comprehensive medical history evaluation, clinical examination, and laboratory investigations. Treatment for all patients included fluid resuscitation, vasopressor agents, and endoscopic management. Both groups were closely monitored to assess the rate of esophageal variceal re-bleeding. Results: Out of the 203 patients, 91 (45%) developed AKI. Several factors, such as low systemic blood pressure, a high volume of blood transfusion, and a high Child-Pugh score, were identified as independent predictors for AKI. Factors such as Child-Pugh scores (p = 0.006), active bleeding observed during endoscopy (p = 0.04), and the occurrence of AKI (p = 0.049) were identified as independent predictors of variceal re-bleeding at both 72 hours and 1 month. Among patients with AKI, the variceal re- bleeding rate was 27.5% at 72 hours, 16.5% at 1 month, and 12.1% at 3 months, compared to 9%, 5.4%, and 4.5%, r espectively, in patients without AKI. Within the first 72 hours, the rate of esophageal variceal re-bleeding was higher in patients with a more advanced stage of AKI. Conclusions: The incidence of recurrent esophageal variceal bleeding was significantly higher in patients with liver cirrhosis who developed AKI. [ABSTRACT FROM AUTHOR]

Background: Acute leukemia is considered as the most popular hematological neoplasm, reflected bypresenceof precursor cells of malignant clone in peripheral circulation and bone marrow. Objectives: Our survey was done to evaluate the role of new prognostic factors as body mass index in adult patients receiving induction chemotherapy for acute myeloid leukemia. Patients and Methods: this study was carried out during the period from February 2018 to February 2019 in Clinical Hematology Unit, Internal Medicine Department of Zagazig University Hospitals. The study is Cross sectional of total subjects included 80 patients who were diagnosed as acute leukemia; 28 of them were females and 56 were males. Body mass index (BMI) is defined as the summation of division of weight calculated in kilograms by the square of height calculated in meters (kg/m²). Results: We found a statistically significant difference between the overweight patients and underweight patients regarding primary induction failure (PIF) rates. There is an increase in rates of PIF in the group of underweight patients than overweight group. Patients whom BMI is more than 25 can carry better results than underweight patients whom BMI > 25 as regarding to induction chemotherapy outcomes and overall survival, it may be due to increased period of chemotherapy distribution through the obese patients body with low rates of drug clearance. Sensitivity and specificity of BMI as a predictor for detection of response was calculated under cut-off range. There was an increase in rates of death rates in the group of underweight patients than overweight group. In addition to Disseminated intravascular coagulation was more frequently observed in the underweight group as compared to the normal and overweight groups. BMI level cutoff > 26.4 the sensitivity was 75 % and specificity was 66.67 % and Sensitivity and specificity of BMI as a predictor for detection of primary induction failure was calculated with cut-off range ≤28.7, the sensitivity was 83.33% and specificity was 49.02%. and specificity of BMI as a predictor for detection of death was calculated ≤ 26.6, the sensitivity was 90.91 % and specificity was 59.42 %. Conclusions: Evaluation of BMI in acute myeloid leukemia patients before starting chemotherapy is is a respectable prognostic markers in assuming consequences in adult patients on induction chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing hemodialysis (HD) are more likely than the general population to contract the hepatitis C virus (HCV). Due to the possibility of developing cardiovascular disease and liver fibrosis, HCV hemodialysis patients' survival rates are lower than those without HCV. Evaluation of hepatic fibrosis by biochemical indicators such as serum hyaluronic acid and the evaluation of liver stiffness fibroscan can be used to evaluate the severity of fibrosis. Aim: To evaluate the role of fibro scan and hyaluronic acid (HA) for the detection of hepatic fibrosis in HD individuals who have HCV. Patients and methods: This cross-sectional study on HD children receiving regular hemodialysis was conducted in the Pediatric Nephrology Unit, Pediatrics Intensive Care Unit of Children Hospital, and Clinical Pathology Lab, Faculty of Medicine, Zagazig University. 54 patients were split into: Group 1: Hepatitis C individuals with HD make-up and Group 2: HD patients without hepatitis C. Serum hyaluronic acid and fibroscan were done. Results: Regarding serum hyaluronic acid, there is no statistically significant difference between the HD patient groups that were HCV positive and those that were HCV negative. There is a statistically significant correlation between serum hyaluronic acid and the degree of liver fibrosis, when performing a PAIRWISE comparison, F2 and F0 show a considerable difference. Conclusion: Fibroscan is a good noninvasive assessment of liver fibrosis in HD patients with HCV. Despite the study's small sa mple size, serum hyaluronic acid and the degree of liver fibrosis determined by fibroscan are significantly correlated. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is characterized by abnormal fat metabolism in the liver due to nonalcoholic causes. Adropin is a peptide hormone with an essential role in maintaining metabolic homeostasis. Methods: 42 male rats were divided into 2 groups, each group was subdivided into 3 subgroups: group Ia: control 4 weeks; group Ib: high fat diet (HFD) 4 weeks, group Ic: HFD 4 weeks +exercise; group IIa: control 12 weeks, group IIb: HFD 12 weeks; and group IIc: HFD 12 weeks + exercise. Serum Adropin, glucose, HOMA-IR, insulin, lipid profile, ALT, AST, TNFα, IL6, hepatic ROS, MDA, and SOD were measured. Histopathological examination, immunohistochemical study, and Mallory's trichrome staining of the liver were performed. Results: significant increases in insulin resistance, lipid profile parameters, ALT, AST, TNFα, IL6, hepatic ROS, MDA, and a decrease in SOD were found in HFD groups. Histopathological examination revealed steatosis in group Ib and steatohepatitis in group IIb. These changes were associated with a decrease in serum adropin levels. Exercise in groups Ic and IIc improved these changes with a significant increase in adropin level. Conclusion: HFD induced functional and structural deterioration in the liver, leading to NAFLD with a significant decrease in serum adropin level. Exercise induced a significant increase in serum adropin, which may have a role in the remission of hepatic inflammation, steatosis, and steatohepatitis. [ABSTRACT FROM AUTHOR]

Background: Insulin Resistance IR in sensory neurons may contribute to the development of neurodegeneration. Cerebellar degeneration-related protein 1 antisense RNA (CDR1as) is abundantly expressed in islet cells. Thus, we aimed to investigate CDR1 as relative expression levels in Egyptian patients with IR and to assess its association with risk and severity of peripheral neuropathy (PN). Methods: The current study conducted on fifty patients with IR (30 patients without PN and 20 patients with PN) and 45 subjects as control group. All research individuals were submitted to clinical and neurological complete examination as well as laboratory and nerve conduction studies. CDR1 mRNA relative expression levels were evaluated by RT-PCR. Results: Among IR patients, there were statistically significant lower values of CDR1 mRNA relative expression levels (0.42±0.31) in PN group compared to IR patients without PN (0.67±0.31) and control group (1.2±0.41). MNCV and CMAP amplitude of median nerve& SNCV and SNAP amplitude of sural and median nerve were significantly decreased in IR patients with PN. There was significant positive correlation between CDR1 mRNA relative expression levels, QUICK, MNCV (median nerve), SNCV (median nerve), CMAP amplitude (median nerve) and SNAP amplitude (median, sural nerve). Among studied parameters, HOMA ß, QUICKI, TCSS, CMAP amplitude of median nerve and SNAP amplitude of median nerve were independently correlated with CDR1 mRNA relative expression levels. Conclusion: IR patients with PN had statistically significant lower v alues of CDR1 mRNA relative expression levels than IR patients without PN additionally CDR1 mRNA relative expression levels associated with higher risk of IR and PN. [ABSTRACT FROM AUTHOR]

Background: This study was designed in order to estimate the alterations in the levels of serum zinc, magnesium, and copper in patients with type 2 diabetes mellitus with diabetic peripheral neuropathy in comparison to those without neuropathy and their relation to duration of diabetes and glycemic control. Method: 71 patients with Type 2 diabetes were recruited and divided into 2 groups: Group 1: 47 patients with diabetic neuropathy and Group 2: 24 patients with type 2 diabetes without diabetic neuropathy. The presence and absence of neuropathy was assessed using neuropathy disability score and neuropathy symptom score. Full history and examination were taken from all participants. Neuropathy symptom score and neuropathy disability score were assessed. A blood sample was taken for measuring A1c, serum zinc, magnesium, and copper. Results: There was a significant difference between both groups as regard duration of diabetes and serum copper level (P value< 0.05). After performing linear regression analysis, the duration of Diabetes was the significant risk factor for diabetic neuropathy symptoms. On the other hand, there was no significant difference between the 2 groups as regard serum zinc, serum magnesium, glycated hemoglobin, age, sex, and hypertension. Conclusion: High serum CU and low serum Mg and Zn are not independent risk factors for diabetic neuropathy as previously thought, and its alterations in diabetic patients may be due to the hyperglycemia itself. [ABSTRACT FROM AUTHOR]

Background: Infectious complications in children with chronic renal disease (CKD) are a major cause of increased morbidity and mortality rates among these children. This study aimed to determine the diagnostic value of Procalcitonin (PCT) and Pancreatic Stone Protein (PSP) as markers of infection in children with chronic renal failure and to decrease morbidity and mortality rates in these children. Methods: This case control study was conducted on 36 patients diagnosed with Chronic Renal Failure and admitted at Nephrology Pediatric Unit, Children's Hospital, Zagazig University during the period from October 2018 to February 2019. They were divided into 2 groups, the first group (case group) included 18 children with CKD diagnosed with infectious complications, the second group included (control group) 18 children with CKD who didn't develop any infectious complications. The serum expression of PCT and PSP was measured. Pearson correlation analysis was conducted to correlate PCT & PSP with each other and with CRP, temperature, HR, pus cells and blood culture. ROC analysis was used to test the value of PCT, PSP and CRP in early diagnosis of infection in Children with chronic renal failure. Results: The serum levels of PCT and PSP in case group were higher than in control group (P<0.01). Serum PCT concentrations showed a significantly positive correlation with PSP levels (P<0.001). ROC analysis showed that the area under curve (AUC) values of PCT, PSP and CRP were 0.944 (95% CI, 866-1.000), 0.870 (95% CI, 0.757-0.984) and 0.931 (95% CI, 0.729 -0.859) respectively and suggested cutoff levels were >0.62 ng/ml for PCT, >22.8 ng/ml for PSP and >6.5mg/L for CRP with sensitivity 88.9%, 81.8% and 83.3% respectively and specificity 95.6%, 72.2% and 94.4% respectively. Conclusion: Serum levels of PCT and PSP are promising biomarkers of early detection of infectious complications in Children with Chronic renal failure. [ABSTRACT FROM AUTHOR]

Background: Omentin-1 an adipokine expressed in visceral fat, endothelium and gut. Its level was found lower in obesity and type II diabetes. It is expressed in placenta and was associated with insulin sensitivity during pregnancy. Methods: Rats were divided into 4 groups; group I: control, group II: sham group (normal pregnant), group III: gestational diabetic group and group IV: omentin-1 treated gestational diabetic group. Blood glucose, insulin HOMA-IR, lipid profile, CRP and osteopontin (OPN) levels were measured and gene expression of PI3K, AKT, GSK-3, NF-κB and OPN Results: In group III, a significant increase in insulin resistance, CRP, OPN, increased mRNA expression of GSK-3, NF-κB, and OPN while PI3K and AKT expression decreased. Omentin-1 treatment in group IV attenuated insulin resistance, increased PI3K and AKT expression but decreased OPN, GSK-3, and NF-κB expression. Conclusion: Omentin-1 administration in gestational diabetic rats improved insulin sensitivity and attenuated inflammatory response through PI3K/AKT/GSK-3 pathway. [ABSTRACT FROM AUTHOR]

Background: Diphenylcyclopropenone (DPCP) contact immunotherapy has been successfully utilized in various forms for treatments of recalcitrant and facial warts, molluscum contagiosum (MC) and alopecia areata. The objective was to evaluate the safety and efficacy of DPCP in the treatment of MC. Methods: Twenty-four patients with MC were assigned to two groups: twelve patients (group A) were treated with topical application of DPCP one session per week for a maximum of 12 sessions or until clinical cure. Also, twelve patients (group B) were subjected to topical application of normal neutral saline as a control group. Follow-up was done for 3 months. Results: In group A, eight patients (66.7%) showed complete response while four patients (33.3%) showed partial response to the topical application of DPCP after seven to twelve sessions. However, in group B, eleven patients (91.7%) showed no response and (8.3%) showed partial response. A highly significant difference was found in the clinical response between both groups (p<0.05). Adverse effects were minimal and well tolerated in both groups. Conclusion: Diphenylcyclopropenone is safe and effective therapeutic option in treatment of MC and cost effective. [ABSTRACT FROM AUTHOR]

Background: renal stone is one of the commonest causes of loin pain and leads to multiple visits to the urology emergency department with increasing costs for health systems. this study to assess the accuracy of the NECT technique in the prediction of whether ureteral stones will pass spontaneously or not. Methods: In a prospective cohort study including 36 participants (age range, 18-70 years) having a ureteral stone, referred for NECT examination at the Radio-Diagnosis Department of Zagazig University Hospitals. Results: our study revealed two groups of patients according to the stone passage, group 1 (stone passed spontaneously) and group 2 (stone not passed). in which, there is a significant relationship between the two study groups according to the stone location (p <0.05). However, we found a statistically highly significant relationship between the two groups regarding the stone size (p < 0.001), but it is a statistically insignificant relation between outcome and other signs like (density, TRS, PFS and degree of hydronephrosis)... (P > 0.05). Our study demonstrated a method based on stone size and location can predict the probability of stone passage within a short time (8 wks.). Conclusions: That NECT is a good predictor for spontaneous passage of ureteral stones. [ABSTRACT FROM AUTHOR]

Background: Stroke is a multifactorial disease that affects people all over the world. Elevated plasma leptin levels have been found to be independently related to ischemic stroke; additionally, high serum leptin levels serve as an independent biomarker of poor outcome after ischemic stroke. The current study sought to investigate the role of serum leptin levels as a predictor of short-term outcome in acute ischemic stroke. Methods: This prospective cohort study included sixty patients with their first acute ischemic stroke (19 males and 41 females). All patients underwent a full clinical evaluation as well as a thorough general and neurological examination. The NIHSS was used to assess stroke severity on admission, and the mRS was used to assess functional outcome 30 days later. Serum leptin levels and routine laboratory tests were also evaluated. All patients had neuroimaging, including CT and/or MRI brain scans. Results: from the analysis it was found a statistically significant link between serum leptin levels and diabetes, hypertension, cardiac disease, and obesity. A statistically significant positive correlation was found between serum leptin levels and infarction size. There was also a statistically significant relationship between serum leptin level and stroke severity as measured by NIHSS score on admission. AIS patients with poor functional outcome as measured by mRS after 30 days of admission had highly statistically significant serum leptin levels. After adjusting for other confounding variables, a binary logistic regression analysis of neurological outcome with associated risk factors revealed that diabetes mellitus, elevated serum leptin levels, NIHSS, and mRS scores were the most significant risk factors for predicting deterioration and short-term outcome after ischemic stroke. Conclusions: Elevated serum leptin levels were associated with vascula r risk factors, infarct size, and severity of acute ischemic stroke, supporting the hypothesis that serum leptin can be used as a significant and reliable biomarker of poor outcome after ischemic stroke, independent of other baseline variables. [ABSTRACT FROM AUTHOR]

Background: The most prevalent infection in cirrhotic individuals is spontaneous bacterial peritonitis (SBP). Acute GI bleeding, a history of SBP, or low ascetic fluid protein contents are all risk factors for the development of SBP in cirrhotic individuals. The purpose of this study was to see if the neutrophil-tolymphocyte ratio (NLR) could predict spontaneous bacterial peritonitis in individuals with liver cirrhosis. Patients and methods: This prospective, casecontrol and observational study was conducted at Internal Medicine Department, Zagazig University Hospitals during the period from June 2021 to March 2022. The study included 100 cirrhotic patients. The patients were divided into two groups: Group I included 50 cirrhotic patients with SBP (case group) and group II included 50 cirrhotic patients without SBP (control group). Neutrophil to lymphocyte ratio was calculated for all patients. Results: In this study, there was statistically significant difference between the two studied groups in neutrophil count, lymphocyte count and increased neutrophil to lymphocyte ratio (group 1 had increased neutrophils and decreased lymphocytes than group 2). Conclusion: We can conclude the clinical utility of NLR as a biomarker predictive factor in the occurrence of spontaneous bacterial peritonitis (SBP) . [ABSTRACT FROM AUTHOR]

Background: Febrile seizures (FS) are the single most common seizure type and occur in 2 to 5% of children younger than age 5 years with a peak incidence in the second year of life. Evidence that iron might be important for neurological functioning has generated considerable optimism that this element might also play a role in initiation of febrile convulsions. This study aimed to determine the relation between iron deficiency anemia and febrile seizures in infant and children aged 6 months to 6 years. Methods: A case-control study was done in Pediatrics Department, Faculty of Medicine, Zagazig University during the period from September 2018 to March 2019. It included 90 infants and children (45 infant and children presented with febrile convulsions and 45 age and sex matched healthy infants and children between 6 months and 6 years as a control group). All children with febrile convulsion were investigated for iron deficiency to find if there is any association between Anemia and febrile convulsion. Results: The current study showed that cases were significantly higher regarding Total Iron-Binding Capacity (TIBC) than control group with no significant difference between groups regarding ferritin or iron. But, cases were significantly lower regar ding Mean Corpuscular Hemoglobin (MCH) and Hemoglobin (Hb). Therefore, cases were significantly associated with anemia. Conclusion: the study concluded that iron deficiency anemia is a risk factor for febrile seizures in infants and children aged 6 months to 6 years. [ABSTRACT FROM AUTHOR]

Background: Zinc (Zn) is an essential element in the nutrition of human beings. It is needed in all DNA and RNA syntheses and is required at every step of the cell cycle. Zinc deficiency in children can cause stunted growth and increased incidence of infections. Zinc deficiency has been suggested as a major risk factor for developing pneumonia. The aim of this study was to assess the serum Zn levels in children with lower respiratory tract infe ctions (LRTI) and study the association between low Zn levels and other known risk factors of LRTI. Methods: A cross-sectional study, which was conducted on ninety patients with acute LRTI. They aged between two months and five years. The patients were admitted to pediatric department at Zagazig University Hospitals during the period from February 2017 to February 2018. All patients were subjected to general and chest examinations. Also, complete blood picture, serum Zn level measurement and chest X ray were done. Results: Mean serum Zn level among the studied patients was 200.75 ± 37.44 µg/dl, which is considered normal or even slightly elevated than normal values There was no association between serum Zn levels and any of the other risk factors of LRTI. Conclusion: There was no significant difference in serum zinc level among different lower respiratory infections and there was no significant difference in serum zinc level and other risk factors of the disease. [ABSTRACT FROM AUTHOR]

Background: Locally advanced breast cancer (LABC) can be caused by a variety of breast neoplasms. The use of mammography with sonography to estimate pathological complete response (PCR) after neoadjuvant chemotherapy (NAC) has a good degree of precision. Aim of work: To evaluate the precision of breast sonomammography in determining LABC response to neoadjuvant chemotherapy. Subjects and methods: A total of 54 female patients with locally advanced breast cancer were included in the study, which was conducted prospectively from August 2019 to May 2020, they were sent to the Zagazig University Radiology Department and hospitals by the General Surgery and Oncology Departments. A thorough medical history (personal, past, present, and family) was collected, as well as a thorough physical examination. All subjects had bilateral digital mammography as well as a traditional B-mode ultrasonography examination. Before neoadjuvant treatment, a sonomammographic evaluation of the tumour size and morphometric criteria was performed. Biopsy processes were done for suspected breast masses. after finishing the NAC 1:4 weeks previous to surgery, a sonomammographic evaluation of the tumour size and morphological criteria was conducted. Results: There was significant association between post chemotherapy diameters and different breast subtypes in radiological assessment. HR-/HER2-were the most subtype to show radiological response followed by HR+/HER2-while none of HR+/HER2+ show response to NAC. Conclusion: In patients with LABC, mammography and breast ultrasonography are regarded more reliable techniques for assessing tumour size and nodal staging of breast cancer subtypes prior to or after treatment. [ABSTRACT FROM AUTHOR]

Background: Hypertrophic scars lead to aesthetic and local symptoms like pain and itching. Moreover these scars have psychological effects such as emotional disturbances, embarrassment, low self-confidence, and social isolation. Many treatment modalities had been used, but each one has its limited effect. Objectives: The aim of the study is to evaluate the role of hypertrophic scars management by comparing intralesional injection of Botulinum Toxin (BTXA) to intralesional injection of triamcinolone. Subjects and methods: This study was carried on 20 patients with hypertrophic scars, their scars were divided into two equal sectors, one sector was injected with BTX-A while the other sector was injected with corticosteroid (triamcinolone) as a control. Assessment of the results were achieved objectively and digitally photographed using the same camera, lightening setting and patient positioning before treatment, at one-month, three months and six months' visits. The hypertrophic scar score was calculated before and after treatment by patient and observer scar assessment scale (POSAS). Results: There was statistically significant improvement in both BTX-A and triamcinolone injected scars. The different parameters that assessed by POSAS showed better improvement and significant lower scores in the BTXA injected areas without side effects. The triamcinolone injected scars showed complication such as atrophy, hypopigmentations. The results of the study revealed that BTX-A has a significant role in treatment of hypertrophic scars with minimal side effects. Conclusion: In conclusion, intralesional injection of BTX-A is suitable for treatment of recent hypertrophic scars with decreasing associated pain and itching and better tolerated than corticosteroid. [ABSTRACT FROM AUTHOR]

Background: Death with graft function (DWGF) is an important cause of long-term loss of grafts and patients. In this study, we investigated clinical characteristics and causes of DWGF among kidney transplant recipients in Mansoura from 2002 to 2019. Methods: From March 2002 to December 2018, 1,499 living donor renal transplants were done in Mansoura. Their data were retrospectively analyzed. Out of 285 reported deaths, 193 patients died with good graft function without the need for dialysis. Results: Death with graft function occurred in about 27% of kidney transplant recipients at a mean age of 36 +10.7 years. Males were 140 (72.5%). They reached end-stage renal disease (ESRD) secondary to GN in 14, PN in 35, PCK in 7, and nephrosclerosis in 12 patients. 125 patients had acute rejections (64.8%). Post-transplant hypertension occurred in 115 patients (59.5%), DM in 44 patients (22.9%), infections in 99 (51.5%), hepatic complications in 44 (22.9%), and malignancy in 25 patients (13%). Fatal infections in 60 patients (31.3%) were the main causes of death followed by cardiovascular causes in 29 patients (15.2%), liver cell failure in 20 patients (10.7%), and malignancy in 9 patients (4.6%). The mean serum creatinine at the last follow-up was 2 ± 0.6 mg/dl. Conclusions: In our study, DWGF constitutes of 27% of total graft loss. The most typical causes were fatal infections and CVS disease, respectively. DWGF develops due to co-morbid medical illness, pre-transplant dialysis, and other transplantation-related factors. Understanding different causes of death are mandatory to improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Background and aim of work: Rheumatoid arthritis (RA) patients with concomitant hepatitis C virus (HCV) infection tend to have higher disease activity than patients with no HCV. This study aimed to explore the potential outcome of elimination of HCV on RA disease activity in the patients with comorbidity of RA and HCV infection. Methods: This is a retrospective study. The medical records of 55 RA patients with concomitant HCV infection were reviewed. RA clinical and laboratory parameters of RA activity and disease activity score-28 (DAS28) were obtained from the medical records before the initiation of the anti-viral treatment and 12-weeks after completing antiviral therapy for HCV. Results: After treatment, the sustained virological response 12-weeks (SVR12) was achieved in 83.6% of the patients. Good and moderate response based on EULAR response criteria was achieved in 76% of the RA patients. In RA patients achieved SVR12, there was a significant post-treatment decline in the RA activity measures including morning stiffness duration (p <0.001), presence of subcutaneous nodules (p <0.001), C - reactive protein (CRP) level (p<0.001) and erythrocyte sedimentation rate (ESR) level (p <0.001) as compared to pretreatment values. The DAS28-ESR was significantly decreased from 4.15 ±1.31 at the pretreatment to 3.08 ±1.28 after achieving SVR12 (P=0.004). The pretreatment viral load and attainment of SVR12 were the only factors that could predict improvement of RA activity in regression analysis. Conclusion: Elimination of HCV is associated with significant improvement in RA activity in chronic HCV infection patients with concomitant RA. [ABSTRACT FROM AUTHOR]

Background: Rhabdomyolysis is a primary skeletal muscle disruption syndrome with circulatory leakage of its intracellular contents and is seriously complicated by acute kidney injury (AKI). Asprosin is a novel glucogenic adipokine expressed in several tissues, including the kidneys, and has been implicated in some renal disorders via many pathogenic mechanisms. Methods: 32 rats were divided equally into the control group, the calcitriol-treated group, the glycerol-treated group, and the glycerol+calcitriol-treated group. Blood, urine, and renal tissue samples were collected for biochemical, histological, immunohistochemical, and gene investigations. Results: Rats given glycerol had elevated levels of asprosin, creatine kinase, creatinine, BUN, renal MDA, IL-6, caspase-3, and caspase-9, as well as PKA mRNA, TGF-β1, and SMAD-3. While creatinine clearance, renal SOD, and catalase were decreased. Marked histopathological changes imply sever renal injury, faint PAS-positive reaction, strong positive immunoreaction for iNOS and TGF-β were found. These changes were reversed in glycerol+calcitriol-treated rats. Asprosin positively correlated with MDA, IL-6, caspase-3, caspase-9, mRNA levels of PKA, TGF-β1and SMAD-3, while it negatively correlated with SOD, and catalase. Conclusion: Serum asprosin levels are increased in rhabdomyolysis-induced AKI and calcitriol protect against AKI via suppressing asprosin and its dependent PKATGF-β1-SMAD-3 signaling pathway. [ABSTRACT FROM AUTHOR]

Background: The relative efficacy and safety of Everolimus-eluting stents versus paclitaxel-eluting stents in the small coronary vessels (<2.75mm) remains less well defined so the objective was to assess the twelve months outcome of the Everolimus --eluting stents (EES) versus the Paclitaxel- Eluting Stent (PES) in the small coronary vessels (<2.75mm) coronary intervention. Methods: .91patients referred for coronary intervention with reference vessel diameter (R.V. D.) <2.75mm were randomly assigned to either EES or PES. The primary endpoint was target vessel revascularization (TVR) at twelve months follow up. Out of the 91 patients enrolled, 53.8% were assigned to receive EES; 46.2% were assigned to receive PES. Results: a significantly lower TVR among the EES group (2% versus 14.2%), p=0.03. Likewise, instant restenosis (ISR) rate was significantly lower among the EES group (6.1% versus 21.4%), p=0. 031.On the other hand; there were no significant differences in the rates of deaths; target vessel- related myocardial infarction or stent thrombosis between the two groups. Conclusions: Both stents were similarly safe while EES is more effective. [ABSTRACT FROM AUTHOR]

Background: There is an increase in the prevalence of obesity-related reproductive disorders, particularly anovulation and infertility so, this indicates use of insulin sensitizing agents such as metformin and use of weight reduction agents such as orlistat in order to achieve reduction of BMI, reduce androgenic effect and improve ovulation. To the best of our knowledge, no studies in this respect was performed in Zagazig University before. Our study aimed to asses the effect of orlistat versus metformin on improvement of ovulation rate, weight loss and lipid and hormonal profile. Methods: This randomized controlled trial was conducted at Zagazig University Hospital's outpatient clinic on 132 patients diagnosed with polycystic ovary syndrome. All cases were subjected to full history taking including, general examination and laboratory investigations including FSH, LH, TSH, free T4, free testosterone and prolactin level. Results: There was no statistical significant difference between both groups as regard ovulation rate. There was significant changes between studied groups at 1st and 3rd month as regard anthropometric data except BMI was insignificant at 1st month. Also, there was significant difference between studied groups as regard to laboratory data at 1st and 3rd month except FSH at 3rd month was insignificant. Conclusions: We advise choosing metformin as a safe and effective treatment over orlistat for the treatment of polycystic ovarian syndrome, preferably in conjunction with weight loss and a healthy lifestyle. [ABSTRACT FROM AUTHOR]

Background: Despite Bell's palsy is not a life-threatening condition, it has a lot of psychological impact, up to now the exact underlying pathophysiology of bell's palsy is not fully understood, so we are trying to recognize the factors that affect its recovery. Methods: This prospective cohort study was executed on 60 patients with Bell's palsy who underwent complete blood count including calculation of neutrophil lymphocyte ratio, evaluation of severity using B-H scale and neurophysiological testing of the facial nerve with evaluation of motor amplitude and degeneration index of the nerve, then follow up was done after three months. Results: 18.3% of our patients had severe bell's palsy, the mean NLR in mild cases was 3.1 ± 0.17 versus 3.71 ± 0.36 for severe cases, high NLR and comorbid diabetes were found to be associated with increased severity of bell's palsy, old age and high NLR were associated with poor recovery after three months. Conclusion: Neutrophil lymphocyte ratio, old age, initial B-H scale, degeneration index and diabetes were found to possess a potent statistical value in predicting short term outcome of bell's palsy. [ABSTRACT FROM AUTHOR]

Background: stroke is considered a major cause of disability worldwide. Vitamin D has been linked to cardiovascular health, including the reduction of stroke risk, while its role in stroke outcome has not been fully studied yet, so we aimed to find the role of vitamin D in the prediction of short-term outcomes of ischemic stroke. Methods: This prospective cohort study was conducted on 58 patients with their first acute ischemic stroke who underwent assessment of their serum vitamin D and their functional outcome three months later by modified Rankin scale. Results: serum vitamin D had a significant role in the prediction of poor short-term outcomes. The mean vitamin D level in our patients was 14.01 ± 8.94ng/ml. Conclusions: the poor short-term outcome of a stroke at three months can be predicted by the presence of hypovitaminosis D, so vitamin D supplementation should be taken into consideration when managing ischemic stroke patients. [ABSTRACT FROM AUTHOR]

Background:Neuropsychiatric Lupus Erythematosus (NPSLE) is the main cause for morbidity and mortality in Systemic Lupus Erythematosus (SLE). This study aimed to early diagnosis of neuropsychiatric dysfunctions in childhood - onset SLE by Magnetic Resonance Spectroscopy (MRS). Methods: This study was observational descriptive cross sectional study done in Nephrology unit, Pediatric department, zagazig university hospital from March 2017 to March 2018. Thirty patients with SLE were randomly selected, aged from 9-17 years old and divided into two groups. Group one was eleven cases with neuropsychiatric manifestations and group two was nineteen cases without neuropsychiatric manifestations. MRS used to assess any metabolic brain dysfunction causing neuropsychiatric disorders and the results of MRS readings of the two groups were compared with each others. Results: One hundred percent of patients in the study shows abnormal MRS findings instead of only, 36.7% of the studied group shows neuropsychiatric manifestations. There were non-significance differences between both studied groups in MRS findings. There was statistical significance increase in the NPSLE cases than others according to the presence of lupus anti -coagulant antibody. Conclusion: NPSLE can be diagnosed easily by MRS for early management which improves the quality of patient's life. MRS can also detect disease activity very early for reevaluation of management and the efficacy of treatment. [ABSTRACT FROM AUTHOR]

Background: Bone marrow lesions (BMLs) are a common finding after acute bone trauma. BMLs are assessed with conventional MRI sequences. Unlike conventional MR imaging sequences, diffusionweighted imaging depends on the random movement of water molecules. Intact bone marrow shows directional diffusion, whereas BML shows facilitated diffusion. ADC maps might add value to conventional MRI sequences in trauma imaging protocols. Objective: To compare ADC map with conventional fat saturation imaging sequences in the detection of bone marrow lesions (BMLs) after knee trauma. Methods: This study was carried out at Radio diagnosis Department in University Hospitals; the present study was carried on 20 patients after suffering from knee trauma. Patients underwent Conventional and diffusion MRI, the lesions were calculated in ADC maps, STIR and FS PD weighted imaging. Results: The BMLs have been calculated in terms of the number and volume in ADC map, PD FS weighted TSE imaging and STIR. The median volumes were calculated to test the level of significance. The total median value of all knee bones collectively in ADC map was (53.4 cm3) approximately twice the median lesion volume in STIR (20.7 cm3) and FS PD weighted images (24.7 cm3). The median values of the BML in ADC map of knee were statistically higher than the median value of BML in SITR and FS PD weighted TSE imaging sequences. All p-values were statistically significant. Conclusion: Our results indicated that ADC maps are more sensitive than conventional MRI sequences as it improves the detection of small bone marrow lesions. [ABSTRACT FROM AUTHOR]