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Background: Congenital ureteropelvic junction obstruction (UPJO) is by far the most common cause of pediatric hydronephrosis. UPJO standard surgical treatment is open dismembered pyeloplasty (Andersons-Hyens). Aim of the work: To study the morphological and functional outcome of dismembered pyeloplasty in infants and toddlers with unilateral UPJO. Materials and Methods: This prospective study was carried on 50 infants and toddlers aged 2 months - 36 months with unilateral UPJO at Cairo University Children Hospital. Results: The mean age of studied group was 11 ± 3 months. The main symptom was recurrent urinary tract infect in 18 (36%) of cases, followed by loin pain in 12 (24%), hematuria in 4(8%) and 16 (32%). Initial pre-operative ultrasound demonstrated moderate and severe hydronephrosis (HN) in 29 (58%) and 21 (42%) of the cases, mean cortical thickness was 6.78 ± 1.57 cm and mean anteroposterior (AP) diameter was 3.27± 0.58 cm. After 3 and 6 months, 24(48%) and 30 (60%) had mild degree of HN, 23 (46%) and 17 (34%) had moderate HN and 3 (6%) and 3 (6%) had severe HN respectively (p=0.000). The mean cortical thickness increased to 8.66 ± 1.49 mm (p=0.000). The mean AP dropped substantially as well to 2.7± 0.57 cm (p=0.000). Operative time did not influence outcome (p=0.653), yet pre-operative lesser degree of HN, more cortical thickness and lesser AP diameter was associated with better outcome (p=0.000, p=0.000 and p=0.000 respectively). Those with younger age at presentation had better outcome (p=0.001) Conclusion: The better outcome of dismembered pyeloplasty (Andersons-Hyens) relies on early diagnosis and implementation before development of HN, cortical thickness erosion and increase in AP diameter. Pyeloplasty for unilateral UPJO in younger age seems to allow cortical remodeling and regeneration. Long term follow up remains crucial to verify the long term outcome.

Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin's lymphoma that accounts for 4% of newly diagnosed central nervous system (CNS) tumors. Most primary lymphomas of the central nervous system are of the subtype of diffuse large B-cell lymphomas, which have highly aggressive behavior and may involve the brain, leptomeninges, eyes or spinal cord without evidence of systemic disease. Primary CNS lymphomas are very rare in immunocompetent patients, but their rates are increasing. So far, only 11 primary Gasser ganglion lymphomas have been reported, with an incidence of 2.5 cases per 30,000,000 inhabitants. However, B cell lymphomas of the marginal zone of the Gasserian ganglion have been very rarely reported. We report here a clinical presentation characteristic of B cell lymphoma of the marginal zone of the Gasser ganglion in an immunocompetent patient who was treated with surgery and radiotherapy, evolving with improvement of symptoms and without recurrence in 3 months of follow-up.

Background: Penile hair coil strangulation is a rare condition that might culminate in penile gangrene and amputation. Aim of work: To report clinical presentation, management, complications and outcomes of hair coil strangulation of the penis in the pediatric age. Material and Methods: We reviewed the data of 31 patients who presented with penile hair coil strangulation between January 2010 and December 2020 to the Urology Department at Cairo University Specialized Pediatric Hospital. Injury was graded as proposed by Bashir and El Barbary. Data regarding presentation, surgical intervention, complications and the outcomes were recorded. Results: Mean age at presentation was 4.43 ±2.5 years. Thirty (97%) patients presented in the strangulation phase. Onset of symptoms was estimated to be 1-4 weeks earlier. All boys were circumcised. None had any neurological disease. Hair coil removal and medical management (antiseptic, antibiotics, anti-inflammatory) was done for all patients on the day of presentation. Examination under anesthesia and hair removal was done for 7 (22.5%) boys. Urinary diversion was not done on day of presentation. Mean follow up period was 22.5±8.65months (6 - 36). Five (16%) boys had superficial skin injury grade (0) and were managed conservatively, 19 (61%) had partial transection of the urethra grade (1), 6 (19%) had complete transection of the urethra grade (2) and 1 (3%) had transection of the spongiosum and the cavernosum with amputated glans grade (3). Surgical intervention was delayed for 3 months after hair coil removal. Twenty six boys (84%) needed surgical intervention. Mean duration until catheter removal was 7.65±3.05 days (5-14). Twenty four boys (92%) had satisfactory cosmetic outcome (normal looking glans, no constriction ring), 2 (8%) had persistent constriction ring which was surgically corrected later and 4 (15.38%) had small urethrocutaneous fistula which was repaired after 6 months. None of our boys developed anastomotic strictures. Success rate was 77% after primary surgery. Conclusion: Penile hair coil strangulation is a rare condition that can be easily misdiagnosed as balanitis, proper diagnosis requires high index of suspicion. Delayed single stage surgical intervention gives chance for inflammation to subside with satisfactory functional and cosmetic outcome.

Abstract The necessity to resolve the issue of rapid charge carrier recombination for boosting photocatalytic performance is a vigorous and challenging research field. To address this, the construction of a binary system of step-scheme (S-scheme) CuO@TiO2 heterostructure composite has been demonstrated through a facile solid-state route. The remarkably enhanced photocatalytic performance of CuO@TiO2, compared with single TiO2, which can consequence in the more efficient separation of photoinduced charge carriers, reduced the band gap of TiO2, improved the electrical transport performance, and improved the lifetimes, thus donating it with the much more powerful oxidation and reduction capability. A photocatalytic mechanism was proposed to explain the boosted photocatalytic performance of CuO@TiO2 on a complete analysis of physicochemical, DFT calculations, and electrochemical properties. In addition, this work focused on the investigation of the stability and recyclability of CuO@TiO2 in terms of efficiency and its physical origin using XRD, BET, and XPS. It is found that the removal efficiency diminishes 4.5% upon five recycling runs. The current study not only promoted our knowledge of the binary system of S-scheme CuO@TiO2 heterojunction composite photocatalyst but also shed new light on the design of heterostructure photocatalysts with high-performance and high stability.

Abstract Background Giant hydronephrosis is rare with a controversy about the complete loss of renal functions. Our objective is to present our center’s experience with the management of cases of clinically visible giant hydronephrosis considering the potential residual functions. Our study is a retrospective case series of clinically visible giant hydronephrosis which was managed during the period July 2001–June 2016. Demographic and clinical variables were studied with specific considerations to the potential residual functions. Results Of more than 82,000 urological interventions, only 47 cases (0.057%) were operated upon for clinically visible giant hydronephrosis. Group 1 included 21 patients (mean age = 50.43 ± 13.71 years) who were treated initially by nephrostomy tube, and group 2 included 26 patients (mean age = 42.96 ± 15.16 years) who were treated primarily by nephrectomy. The main clinical presentation was abdominal distention (61.7%), while 13 patients (27.7%) were unaware of the swellings. The commonest underlying causes of hydronephrosis were urolithiasis (68.1%) and bilharzial ureteral strictures (23.4%). The contralateral kidney was diseased in 22 cases (46.8%) including the bilateral clinically visible hydronephrosis in 7 cases (15%). Indications of placement of a nephrostomy tube included uremia, infections, and evaluation of renal functions, where 5 cases of group 1 regained significant split function ranged 14–33%. Conclusions Clinically visible giant hydronephrosis is an extreme form of renal dilatation with different etiologies such as urolithiasis and bilharziasis. Initial placement of a nephrostomy tube may save significant residual functions in these kidneys.

The cowpea chlorotic mottle virus (CCMV) is a plant virus explored as a nanotechnological platform. The robust self-assembly mechanism of its capsid protein allows for drug encapsulation and targeted delivery. Additionally, the capsid nanoparticle can be used as a programmable platform to display different molecular moieties. In view of future applications, efficient production and purification of plant viruses are key steps. In established protocols, the need for ultracentrifugation is a significant limitation due to cost, difficult scalability, and safety issues. In addition, the purity of the final virus isolate often remains unclear. Here, an advanced protocol for the purification of the CCMV from infected plant tissue was developed, focusing on efficiency, economy, and final purity. The protocol involves precipitation with PEG 8000, followed by affinity extraction using a novel peptide aptamer. The efficiency of the protocol was validated using size exclusion chromatography, MALDI-TOF mass spectrometry, reversed-phase HPLC, and sandwich immunoassay. Furthermore, it was demonstrated that the final eluate of the affinity column is of exceptional purity (98.4%) determined by HPLC and detection at 220 nm. The scale-up of our proposed method seems to be straightforward, which opens the way to the large-scale production of such nanomaterials. This highly improved protocol may facilitate the use and implementation of plant viruses as nanotechnological platforms for in vitro and in vivo applications.

Abstract Background Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder characterized by obesity, hyperandrogenism, and insulin resistance. Intercellular adhesion molecule-1 (ICAM-1) is a proinflammatory and proatherogenic cytokine which is associated with atherosclerosis, insulin resistance, and cardiovascular disease (CVD). The pathogenesis of PCOS is not precisely known. Thus, the purpose of this study was to investigate the potential role of ICAM-1 expression and serum ICAM-1 concentrations in pathogenesis of PCOS. Moreover, we aimed to evaluate the possible relationship between ICAM-1 gene expression with carotid intima-media thickness as well as clinic-morphological features of PCOS. Methods This case control study enrolled 180 patients with PCOS and 120 controls groups and they were stratified according to their fasting plasma glucose (FPG) into three subgroups; normal glucose tolerance (NGT) [n = 75], those with impaired glucose tolerance (IGT) [n = 65], and 40 patients with type 2 diabetes mellitus (T2DM). Circulating ICAM-1 expression levels were determined by real time polymerase chain reaction (RT-PCR). Serum ICAM-1 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Results Our results revealed that PCOS patients had higher values of ICAM-1expression and serum levels. Among PCOS patients, T2DM patients had the highest values of ICAM-1 expression and serum levels compared to IGT and NGT subgroups. The ICAM-1 expression and serum levels were significantly positive correlated with cardiovascular risk and PCOS phenotypes. Linear regression test showed that HOMA-IR was the main predictors of serum ICAM-1 levels in PCOS. Receiver operating characteristic curve (ROC) analysis revealed that, the power of ICAM-1 expression levels was higher than serum ICAM-1 in diagnosis of PCOS and in differentiating T2DM from IGT and NGT subgroups. Interestingly, combination of both ICAM-1 expression and serum levels improved the diagnostic role of serum ICAM-1. Conclusion ICAM-1 expression and serum levels were higher in women with PCOS compared to control group also, there was a strong independent association between higher ICAM-1 expression and serum levels with cardiovascular risks in PCOS group.

Background: Letrozole is as effective as clomiphene citrate for induction of ovulation in patients with PCOS. Adequate endometrial development is required for pregnancy to occur, and pregnancy rates were found to be higher when the endometrium reached at least 10 mm thickness. Objective: To study the effect of estradiol valerate on the endometrial thickness and subsequently the pregnancy rate in PCOS cases receiving letrozole for induction of ovulation as compared to letrozole alone. Study design: A randomized controlled study. Setting was at the infertility clinic of the Cytogenetic and Endoscopy Unit, Zagazig University Hospital. Material and methods: The study included 273 patients who underwent ovulation induction and timed intercourse. Patients were divided into 2 groups: controlled ovarian stimulation was done in group 1 by letrozole with addition of estradiol valerate and in group 2 by letrozole alone. Results: As regard the clinical pregnancy rate, we found a statistically significant difference between the 2 studied groups, with documented clinical pregnancy in 34 patients in group 1 compared to only 16 patients in group 2. Conclusion: This study showed that the pregnancy rate achieved with letrozole/estradiol valerate combination was significantly higher than with letrozole alone. This was attributed to the improvement of endometrial thickness by estradiol valerate. Keywords: Endometrial thickness, Estradiol valerate, Letrozole, Ovulation induction

Duloxetine hydrochloride (DH) is a serotonin–norepinephrine reuptake inhibitor (SSNRI) indicated for the treatment of depression. Duloxetine suffers from reduced oral bioavailability (≈50%) due to hepatic metabolism. This study aims to develop DH buccoadhesive films to improve its bioavailability. DH buccoadhesive films were prepared adopting the solvent casting method using hydroxypropyl methylcellulose (HPMC) and polyvinyl alcohol (PVA). The prepared films were evaluated for weight uniformity, drug content, surface pH, swelling index, mucoadhesion strength and drug release percentages. Accelerated stability and bioavailability studies in healthy human volunteers were also performed for the selected films. Results of the evaluation tests showed that the optimum physicochemical characters were obtained by the films prepared with 2% HPMC using 10% propylene glycol (F2 films). Accelerated stability studies revealed that DH showed proved stability throughout the experiment time. DH bioavailability from F2 films was determined and compared with that of the marketed oral capsules (Cymbalta® 30 mg). The pharmacokinetic results showed that Cmax for F2 was higher than the market product. In addition, ANOVA analysis showed that a Tmax of F2 film was significantly lower, while, the AUC0–72 of F2 was significantly higher than that of Cymbalta capsules. The percentage relative bioavailability of DH from F2 was found to be 296.39%. Therefore, the prepared buccal films offer an alternative route for the administration of DH with the possibility of improving its bioavailability.

Aim: The aim of this study was to assess the effectiveness of transrectal sectional sonography (TRSS) in the diagnosis and treatment of prostatic abscess. Materials and Methods: Eighteen patients with prostatic abscesEs were the material of the present study. The criteria of abscess collection within the prostate gland and the periprostatic tissues were confirmed by TRSS, which guided the aspiration in all patients. Results: Diagnosis and transperineal needle aspiration of prostatic abscesses were successful in all cases. After the second puncture procedure, recurrence noted in 2 (11.1%) out of 18 patients, who were further subjected to transurethral deroofing under TRSS vision. The amount of pus drained ranged between 3.6 and 29.3 mL (mean: 15.1 mLSD ± 1.5), compatible with the estimated volume by virtual organ computer-aided analysis three-dimensional measurements. The most frequently involved organism was Escherichia coli. All patients received intravenous antibiotics (third generation cephalosporin) after the midstream urine analysis and further proper antibiotics, according to the aspirated pus culture and sensitivity. Conclusions: Transrectal sectional sonography could be a more reliable method in the diagnosis of prostatic abscesses. It can provide precise needle-guides into the best drainage location of the abscess cavity and justify transurethral unroofing if persistent recurrence is there.

Background and Objectives: In Arab countries, epidemiological data about psychological morbidity among medical undergraduate students are scarce. This study sought to determine whether there was a difference in perceived stress levels of male medical students at Mansoura University, Egypt, compared with male medical students at King Faisal University, Saudi Arabia. Methods: The sample consisted of 304 male medical students in Egypt and and 284 male medical students in Saudi Arabia. The self-reported questionnaire covered four categories, including 15 items, on sources of stress (stressors). The perceived stress scale and hospital anxiety and depression scale were used to measure stress, anxiety and depression. Results: There was no significant difference between the two groups in number of stressors. However, Egyptian students were more likely to cite relationship, academic and environmental problems than Saudis. The prevalence of high stress was nearly equal in both groups. However, anxiety and depression were significantly higher among Egyptian than Saudi students. A logistic regression analysis of independent predictors of severe stress among both groups combined revealed that a satisfactory family income and university-graduated father were independent protective factors. The independent risk predictors were anxiety and number of stressors. Conclusions: Stress, anxiety and depression are frequent among medical students. Counseling and preventive mental health services should be an integral part of the routine clinical facilities caring for medical students.