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Background: Patients’ satisfaction represents an important indicator for the quality of health care delivery, and it is a widely accepted factor, which needs to be studied repeatedly for better functioning of health care systems. Patient is the best judge for the quality of health care so the factors affecting patients’ satisfaction must be taken in consideration. Objective: The aim of this study was improvement of quality of the health care services provided to children in Pediatric Zagazig University Hospital. Patients and methods: This study was a cross sectional study that was held a sample of Cardiology Unit at Pediatric Department of Zagazig University Hospitals. It was carried out during the period from July 2018 to April 2019 on a total sample of 106 patients attending Zagazig University Hospital Cardiology Unit at Pediatric Department. Results: Among 106 participants 100% were females, 70.8% were secondary educated, 73.5% were non-workers, 55.7% were of low social class, 69.8% were from rural resident and 76.4% had not enough income with mean age of 24.48 ± 4.5 years. It was concluded that most of the studied patients (89.6%) were satisfied about the studied cardiology unit at pediatric department. It was found that patient satisfaction is affected by sociodemographic factors as age, sex, occupation, education, and social class. In addition, it was affected by satisfaction about environment, facilities, treatment, doctors, nurses, administrative personnel and information given for them. Conclusion: It was concluded that most of the studied patients are loyal to Zagazig University Hospital, as they will definitely intend to reuse and recommend Zagazig University Hospital Outpatient Clinics to others. Patient loyalty was found to be significantly affected by level of their satisfaction where satisfied patients tend to re-use and recommend the hospital Cardiology Unit at Pediatric Department more than dissatisfied ones.

Background: Transthoracic ultrasound (TUS) has been established to be important in chest diseases including pleural diseases. Interventional pulmonology showed rapid growth and flex–rigid thoracoscopy development, which brought medical thoracoscopy to the forefront. Objective: To compare the diagnostic accuracy, advantages and complications of TUS pleural biopsies versus medical thoracoscopic pleural biopsies in patients with idiopathic and exudative pleural effusion (PE) in El-Minia University Hospital. Patients and methods: Seventy patients with idiopathic and exudative PE were divided randomly into two groups; group I included 45 patients underwent sonar guided pleural biopsy and group II involved 25 patients underwent thoracoscopic pleural biopsy. Results: TUS-guided biopsy was diagnostic in 40 of 45 (88.8%) compared to 24 of 25 cases (96%) were diagnosed by thoracoscopy. Forty-two patients had malignant cause of effusion; 23 patients (51%) in TUS group and 19 (76%) patients in thoracoscopy group. Twenty-two patients had nonmalignant pleural effusion; 17 in group I and 5 in group II. The diagnosis was unclear in 6 patients, 5 of them in group I. Thoracoscopic group displayed greater percentages of post-procedural complications especially pain in site of puncture. Conclusion: TUS examination has close sensitivity and specificity to medical thoracoscopy and allows better assessment of effusion with fewer complications.

Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease of unknown etiology. Objective: To assess serum levels of IL-17 in pediatric SLE (pSLE) and their association with clinical manifestations, laboratory findings, SLE disease activity index score (SLEDAI), and therapy. Patients and Methods: A case-control study was conducted at Pediatric Nephrology units, and Outpatient Nephrology Clinic of Children Hospital, Zagazig University. It was carried out over two years from September 2017 to August 2019. This study was performed on 60 patients classified into two groups: thirty of them were children with SLE and 30 apparently healthy children as a Control group of comparable age and gender. All patients were subjected to complete history taking and clinical examination. Laboratory investigations were done. Renal biopsy was done to 22 cases who were presented by renal symptoms. Results: Frequency of manifestation were malar rash 86.7%, photosensitivity 80.0%, renal manifestations, and anemia73.3% for each. SLEDAI score was 18 – 38. Class II lupus nephritis (LN) was the most common biopsies result (40%). The range of IL-17 for cases was (89.3 – 359 pg/ml), a highly significant increase in the Il-17 level in the case group than the control. A significant association between IL-17 level and renal manifestation, urea, creatinine, 24-hour urinary protein, and SLEDAI. Conclusions: Serum IL-17A is elevated more than 170 in pSLE patients with lupus nephritis, which correlates with disease activity and renal biopsy. IL-17 seems to have a possible role in the pathogenesis of lupus nephritis.

Background: Patients with chronic hepatitis C (CHC) often have increased liver iron, a condition associated with more rapid progression to cirrhosis. Hepcidin decrease is a possible pathophysiological mechanism of iron overload in these patients. Objective: The aim of the present work was to assess serum hepcidin in patients with chronic hepatitis C as an iron- regulating hormone. Patients and Methods: This study included 45 patients with CHC as patients group and 15 healthy individuals who served as a control group. All were subjected to full history taking, clinical examination, pelvi-abdominal ultrasound, laboratory investigations such as liver function tests, kidney function tests, complete blood count, prothrombin time, INR, C-reactive protein, serum iron, ferritin, transferring saturation and serum hepcidin level by ELISA. Results: Serum hepcidin (ng/ml) was highly significantly lower in CHC patients than in controls. Serum iron (μg/dl), serum ferritin (μg/l) and serum transferrin saturation (%) were significantly higher in CHC patients than in controls. Conclusion: Hepcidin levels in patients with CHC were significantly lower than that in HCV‐ negative individuals. It is an important factor in iron abnormalities and is detected in such cases in which serum iron levels, serum ferritin and transferrin saturation were significantly high in CHC patients compared to HCV‐ negative healthy individuals. The suppression of this hormone by hepatitis C virus is likely an important factor in liver iron accumulation.

Background: Total knee arthroplasty (TKA) is commonly performed for the advanced knee joint disease. Considerable postoperative blood loss, however, is an unavoidable occurrence because of extensive soft-tissue release, and the large area of cancellous bone osteotomy associated with the procedure. In addition, knee flexion and extension activities that begin the day after the operation adds to the problem. Aim of the Work: to compare between the intravenous the intraarticular tranexamic acid (TXA) administration in total knee arthroplasty surgery. Patients and Methods: It is a prospective double-blinded randomized controlled study. This prospective, two-arm, parallel-group study was conducted at El-Hussein University Hospital and El-Agouza Hospital on 20 patients who underwent total knee arthroplasty and fulfilled all assumed inclusion and exclusion criteria. Results: The average total blood loss amount in the drain after 48 hrs. in the 1st group was 365±74.722 while in the 2 nd group it was 575±88.976. This indicates a significant decrease in blood loss amount in the 1st group (intraarticular TXA group) than the 2 nd group (intravenous TXA group). Also, it was found that the decrease in hemoglobin (Hb) level is less in the 1st group than in the 2nd group which indicates less postoperative anemia. Conclusion: Concerning intraarticular administration of TXA seemed to be effective much more than intravenous injection in terms of blood loss amount and transfusion frequency.

Introduction: Fetal macrosomia is encountered in up to 10% of all deliveries. It occurs in 15-45% of diabetic pregnancies. Factors associated with fetal macrosomia include genetics; duration of gestation; presence of gestational diabetes; high pre-pregnancy body mass index (BMI); excessive gestational weight gain and diabetes mellitus. Macrosomia is reportedly associated with neonatal morbidity, neonatal injury, maternal injury, and cesarean delivery. Moreover, shoulder dystocia, brachial plexus injury, skeletal injuries, meconium aspiration, prenatal asphyxia, hypoglycemia, and fetal death. All types of maternal diabetes are risk factors for macrosomia and can affect the foetal cardiac development in the form of Hypertrophic cardiomyopathy and congenital cardiac malformation. Aim of work: To evaluate the cardiac changes and ventricular outflow tracts in macrosomic neonates clinically and by 2D transthoracic echocardiography. Patients and Methods: This prospective study was carried out in NICU of Sayed Galal University Hospital on fifty macrosomic neonates’ thorough detailed history, clinical examination, Chest X-ray, important laboratory investigation, two dimensional M-mode and Doppler echocardiographic examination. Results: The fifty macrosomic neonates consisted of 29 males (58%) and 21 females (42%) with mean age ± SD of 2.16±0.84 days (range, 1-5 days). Statistically, significant relation between inter ventricular septum diastole (IVSD) (mm) according to HbA1c level, increase IVSD with increase HbA1c level, and show statistically significant relation between inter ventricular septum diastole (mm) and LTVOTO. When IVSD increase the incidence of LVOTO increase While TABSE decrease with the increase in IVSD. It also showed significant negative correlation between IVSD and MPI and PAP. Conclusion: Elevated maternal HbA1c level can lead hypertrophic cardiomyopathy mainly septal hypertrophy, which increased incidence of ventricular outflow tract obstruction. These echocardiographic findings (TAPSE and MPI) seem to be a better index of the cardiac outcome of macrosomic neonates than other clinical, laboratory or radiological parameters. Recommendations: Early echocardiographic examination for early detection of myocardial dysfunction or cardiac defect is essential in all macrosomic neonates andIDM even those without audible murmur, especially so if not improving with proper intervention. Echocardiographic indices especially TAPSE and Tei index for all macrosomic neonates to detect early cardiac changes in particular left ventricular dysfunction.

Background: laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures worldwide, is accepted as the gold standard in the treatment of symptomatic gallstones for its minimal invasiveness, less pain and early recovery. Purpose: to predict the difficulty of laparoscopic cholecystectomy in patients according to the recently published scoring system and to add more items to it. Patients and Methods: this is a prospective cohort study. This study took place in Ain Shams University Hospital and Manshiet El Bakry Public Hospital, General Surgery Unit, Surgery Department; the study involved 120 patients admitted with calcular cholecystitis, arranged for laparoscopic cholecystectomy. Results: in our study we found that age, sex and ultrasonographic data were significant predictive factors for assessment preoperatively difficult cases that will be operated upon. We found 14 patients above 50 years who scored to be difficult and very difficult were at outcome difficult, only three patients converted to open surgery over fifty. Conclusion: According to sex males has been described to be associated with difficult LC as in our study that confirmed that as 14 males who participated in our study 10 of them were predicted to have a difficult surgery and 3 expected to be very difficult. Post-surgery 100% of males turned out to have a difficult procedure. Also according to other factors, such as history of acute attacks that increase risk and difficulty due to adhesions at Calot`s triangle and risk of cystic artery and bile spillage, were increased during dissection.

Objectives: Neonatal sepsis is clinical syndrome of bacteremia with systemic signs and symptoms. Neonatal sepsis is still a leading cause of mortality in neonatal intensive care units all over the world. Early diagnosis and treatment of the newborn infant with suspected sepsis are essential to prevent severe and life threatening complications. Objective: The aim of this study was to evaluate polymorph nuclear (PMN) leucocyte elastase as a diagnostic tool in neonatal sepsis. Subjects and Methods: This study was conducted on 45 full term and preterm neonates suspected as neonatal sepsis compared to 45 apparently healthy neonate with matched age and sex, as a control group. Results: 55.6% of our patients group were full-term patients and 44.4% were preterm. All the patients were subjected to full history taking, full clinical examination, lab investigation including CBC, CRP, blood culture and sensitivity, and measurement of serum polymorph nuclear leucocyte elastase enzyme. Conclusion: Significant elevation of serum polymorph nuclear leucocyte elastase level in neonatal sepsis with high specificity.

Background: Primary open angle glaucoma (POAG) is the most common type of glaucoma which is considered chronic progressive optic neuropathy, accompanied by a characteristic cupping and atrophy of the optic disc, visual field loss, open angle and no obvious systemic or ocular cause. Subjects and Methods: In this study all cases were examined in the period extending from December, 2016 to august, 2017, including 46 eyes of 30 subjects, the eyes were classified according to disease severity into 22 cases with early glaucoma, 16 cases with moderate glaucoma and 8 cases with severe glaucoma according to Hodapp, Parrish, and Anderson classification. Objectives: Inclusion criteria included: All cases have primary open angle glaucoma, presence of at least one reliable visual field, controlled IOP within range 12-21 mm/Hg. Exclusion criteria included: Cases with closed angles or any angle abnormality on gonioscopy, any other retinal or choroidal insult, including other causes of optic atrophy, patients with affected visual field due to any cause rather than POAG, secondary glaucomas. Results: This study included 46 eyes of 30 subjects which were classified according to disease severity into: Early glaucoma: included 22 eyes. Moderate glaucoma: included 16 eyes. Severe glaucoma: included 8 eyes. Conclusion: There is significant direct correlation between average retinal nerve fibre layer thinning and visual field mean deviation.