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Abstract Background Coronary artery disease (CAD) is the main cause of death in Egypt. Many LDL-R gene locus single nucleotide polymorphisms (SNP) are found to be associated with the risk of CAD. This research aimed to assess the allelic and genotypic frequencies of rs1122608 SNP and their association with the extent of vessel affection and lipid profile in a population of Egyptians.100 CAD patients and 100 healthy controls of Egyptians were included. PCR–RFLP was used to genotype rs1122608 SNPs. Results Significantly higher proportion of ‘T’ allele among patient (risk allele). This association is of low strength (ϕ lies between 0.1 and 0.3). A participant with ‘T’ allele has 1.95 times higher odds to exhibit CAD versus a participant with ‘G’ allele. Significantly higher proportion of ‘T/T’ genotype among cases versus control (risk genotype). This association is of low strength (Cramer’s V lies between 0.1 and 0.3). A participant with ‘T/T’ genotype has 4.5 times higher odds to exhibit CAD versus a participant with ‘G/G’. Gensini score showed no significant association with rs1122608 genotypes (p = 0.863). Conclusions The mutant GT and TT genotypes and minor T allele of rs1122608 were positively correlated with CAD and considered as independent risk factors for CAD.

Abstract Background Pulmonary nodule detection in CXR is challenging. Recently, the use of artificial intelligence (AI) has been a major attraction. The current study aimed to evaluate the diagnostic performance of the AI in the detection of pulmonary nodules or masses on CXR compared to the radiologist’s interpretation and to assess its impact on the reporting process. The current study included 150 patients who had CXR interpreted by radiologists and by AI software. Results CT detected pulmonary nodules in 99 cases (66%) while the visual model of analysis, as well as AI, detected nodules among 92 cases (61.3%) compared to 93 (62%) cases detected by combined visual/AI model. A total of 216 nodules were detected by CT (64.4% solid and 31.5% GG). Only 188 nodules were detected by the AI while 170 nodules were detected by visual analysis. As per case classification or nodule analysis, the AI showed the highest area under curve (AUC) (0.890, 95% CI) and (0.875, 95% CI), respectively, followed by the combined visual/AI model. Regarding the nodules’ texture, the AI model’s sensitivity for solid nodules was 91.4% which was greater than the combined visual/AI and visual models alone, while in GG nodules, the combined visual/AI model’s sensitivity was higher than the AI and visual models. The probability score using the combined visual/AI model was significantly higher than using the visual model alone (P value = 0.001). Conclusions The use of the AI model in CXR interpretation regarding nodules and masses detection helps in more accurate decision-making and increases the diagnostic performance affecting the patient’s morbidity and mortality.

Abstract Background Mastitis is a major cause of economic loss for dairy farmers and industry. River buffalo plays an economically significant role in Egypt. Buffaloes with mastitis have reduced milk yield and change in milk composition. Genetic variations in the Toll-like receptor4 (TLR4) gene have been related to several diseases in farm animals and humans including mastitis. The present investigation aims to find the genotypic variations in the TLR4 gene and their relation to mastitis in the river buffalo, Egyptian breed. Results DNA from 30 buffaloes' blood samples (15 healthy and 15 with mastitis) were extracted and the TLR4 gene was sequenced. Twenty-one Single nucleotide polymorphisms (SNPs) were found from which four SNPs were associated with mastitis: one in 5'UTR (c.1-g27) and 3 SNPs in the coding region at c.87, c.575, and c.576. The nucleotide variations in SNPs c.1-g27(C > A) and c.87 (C > A) were only present in buffalo with mastitis, while buffaloes with genotype CC at both locations were healthy. The AA genotype at c.87 (P.29) results in a stop codon leading to an abnormally shortened protein. The nonsynonymous SNPs c.575 A > G and c.576 T > G shared amino acid 192 resulting in three amino acids (His192Arg/Gln). The dominant genotypes AA at c.575 and TT at c.576 were associated with mastitis resistance (OR 1.00). These two SNPs may affect their role in ligand recognition since they were in the LRR4 domain (p.174–p.197) which is part of coreceptor binding region 1. Conclusions The present study confirms the relation between TLR4 genotypes and mastitis resistance or mastitis susceptibility in Egyptian dairy buffalo. The study suggested four SNPs (c1-g27C > A, c.87 C > A, c.575A > G, and c.576 T > G) have the potential to be markers for assisted buffalo selection to improve milk production.

Abstract A worldwide shortage of molecular biology consumables is in surge. This includes filter tips, nucleic acid purification kits, polymerases, reverse-transcriptase, and different types of reagents which are included in viral diagnostic kits. In developing countries, the problem is even worse, since there is few capital enterprise to adopt this kind of industry. So, our aim is to develop a suitable, functional, comparable to commercial ones, and affordable in-house protocol to purify viral RNA. We sought some published and commercial RNA purification solutions to set-up an in-house protocol for viral RNA extraction. Solution was prepared accordingly. Also, LPA (linearized polyacrylamide) carrier was evaluated. The whole setting of in-house solutions with addition of LPA carrier was compared to QIAamp viral RNA minikit solutions. Our results showed that linearized polyacrylamide (LPA) carrier in homemade solutions is comparable to poly A carrier which is used in the most commercial kit. In addition, the whole setting of RNA purification solutions did achieve the purpose of viral RNA purification. Also, the result was confirmed using sputum of a Sars-Cov2 infected patient. Our experiments did end up with an affordable homemade solutions for viral RNA purification.

Abstract Background K. pneumoniae is one of the most virulent and multidrug resistant bacteria, of great concern in both human and veterinary medicine. Studies conducted on the drug resistance of Klebsiella pneumoniae in equine are lack in Egypt. Results The distribution pattern of ten drug resistance genes were investigated and analyzed among fifteen Klebsiella isolates (previously isolated, identified and antibiogram tested). The targeted determinant genes were coded on the chromosomes, conferring the resistance against β-lactams, carbapenems, fluoroquinolones and aminoglycosides, in addition to the gene determinants of porin protein and efflux pump. The study revealed an incidence rate of 86.7, 100, 23, 7.7, 0, 0, 73.3, 40, 100 and 0% for the genes bla CTX-M , bla TEM , bla KPC, bla NDM-1, bla VIM , qnrB, qnrS, aadA1, AcrAB and ompK35 respectively. The Extended Spectrum β-lactamase-production coding genes were detected in all strains with at least one of their genes. In addition, the efflux pump codding gene and mutation in porin protein gene, which are two important co-factors in the drug resistance mechanism were also detected in all strains. By investigating the association of the drug resistance determinants within a single strain, it was showed that 40% (6/15) of the strains harbored 5 associated genes, 27.7% (4/15) harbored 6 associated genes, 13.3% (2/15) harbored 4 and 7 genes as well and finally only 1 isolate harbored 3 determinants, with complete absence of strains having sole existence of one gene or even two. Pareto chart elucidated that the association of β-lactamases, AcrAB and Qnr with the mutation of the porin protein was the most existed (26.7%). Interestingly, the sequencing results of the CTX-M PCR amplicons were typed as OXY-5 (50%), CTX-M-15 (40%) and CTX-M-27 (10%). Conclusions The current study represented the first record of the drug resistance genes’ predominance and their association among the K. pneumoniae strains; recovered from equine in Egypt, offering a helpful guide for scientists seeking new alternatives other-than antibiotics.

Abstract Background Coronavirus disease (COVID-19) is a new infection with three pandemic waves up till now. CT plays an important role in diagnosis with multiple reporting systems that can be used during CT analysis. We aimed to compare reporting using the recommendations of the radiological society of North America (RSNA) versus the coronavirus disease reporting and data system (CO-RADS) and to assess the performance of CT if used in asymptomatic patients as a screening. Two hundred and fifty-one patients who underwent chest CT scanning either due to clinical suspicion or as screening before hospital admission were included in this retrospective observational cross-sectional study. This was followed by RT-PCR for confirmation. Three radiologists with different years of experience interpreted the CT findings using the RSNA recommendations and the CO-RADS reporting. The data were collected and compared. Results There was no statistically significant difference noted in the diagnostic accuracy obtained while using the RSNA recommendations and the CO-RADS reporting system. Also, a good inter-rater agreement was noticed while using the two reporting systems. The CT showed a highly significant value while used in the assessment of symptomatic patients in controversy to the screening of asymptomatic patients. Conclusion Both reporting systems show similar diagnostic accuracy with a good almost similar inter-rater agreement. Both can be used while interpreting the CT images of cases with suspected COVID-19 infection. CT can be used effectively in the detection of COVID-19 infection between symptomatic patients while it is of a lower value in the screening of asymptomatic patients.

Abstract Background PET/CT plays an essential role in the diagnosis, staging, and follow-up of lung cancer. We aimed to assess the ability of PET/CT to differentiate between adenocarcinomas (AC) and squamous cell carcinomas (SCC) of the lung using tumor size, tumor maximum standardized uptake value (SUVmax), lymph nodes SUVmax, and tumor to liver SUV ratio (TLR). Results A total of 60 patients pathologically proved to have non-small cell lung cancer either AC or SCC were retrospectively evaluated. The mean tumor size, SUVmax of the tumor, and TLR were significantly higher in SCC lesions compared to AC lesions. The mean SCC tumoral size was 7.96 ± 2.18 cm compared to 5.66 ± 2.57 cm in AC lesions (P = 0.008). The mean tumor SUVmax in SCC lesions was 18.95 ± 8.3 compared to 12.4 ± 7.55 in AC lesions (P = 0.04). While the mean TLR of SCC lesions was 10.32 ± 4.03 compared to 7.36 ± 4.61 in AC lesions (P = 0.028). All three parameters showed the same sensitivity (75%), while TLR showed the highest specificity (77.78%) followed by tumor size (76.47%) and then SUVmax of the tumor (72.22%). Conclusions SCC of the lung has a higher mean tumor size, SUVmax of the tumor, and TLR as compared to AC which can be helpful tools in differentiation between them using PET/CT.

Abstract Background Bilingualism is the phenomenon of speaking and understanding two languages. The increased representation of bilingual populations calls for in-depth studies of bilingualism. The aim of this work is to devise an assessment protocol that could help in evaluating some aspects of Arabic and English languages acquired in typically developing bilingual preschool Egyptian children as a preliminary attempt to comprehend the language profiles of both languages in the studied group. The study was conducted on 80 bilingual Egyptian preschool male and female children exposed to both Arabic and English languages. Their age ranged from 4 to 4 years and 11 months from international English schools with regular attendance and of normal Arabic language development. All were subjected to the designed Bilingual English-Arabic semantic test, and narrative assessment and their parents and teachers filled in the questionnaires addressing the variables affecting both languages’ acquisition. Results Bilingual English-Arabic Semantic and Narration Tests revealed that children under the study had variable development in some aspects in semantic and narration between both languages and according to their age. Conclusions Data gathered from the study can be considered a preliminary nucleus for identification of the bilingual children’s normative data to be able to pick up the cases with language impairment of bilingual children and help in making diagnostic decisions and planning for future intervention.

Abstract Background With the tremendous rise in COVID-19 infection and the shortage of real-time reverse transcription-polymerase chain reaction (RT-PCR) testing, we aimed to assess the role of CT in the detection of COVID-19 infection and the correlation with the patients’ management. A retrospective study was conducted on 600 patients who presented with symptoms suspicious for COVID-19 infection between March and the end of June 2020. The current study followed the RSNA recommendations in CT reporting and correlated with the RT-PCR. CT was reviewed and the severity score was correlated with the patient’s management. Results Four hundred sixty-six patients were included with a mean age of 46 + 14.8 years and 63.3 % were males. Three hundred forty patients were confirmed positive by RT-PCR. CT sensitivity was 92.6% while the RT-PCR was the reference. The CT specificity showed a gradual increase with the CT probability reaching 97.6% with high probability CT features. Ground-glass opacities (GGO) was the commonest findings 85.9% with a high incidence of bilateral, peripheral, and multilobar involvement (88%, 92.8%, and 92.8% respectively). Consolidation was found in 81.5% of the ICU patients and was the dominant feature in 66.7% of the ICU cases. CT severity score was significantly higher in ICU patients with a score of ≥ 14. Conclusions COVID-19 infection showed typical CT features which can be used as a rapid and sensitive investigation. Two CT phenotypes identified with the predominant consolidation phenotype as well as severity score can be used to determine infection severity and ICU need.

Abstract Background COVID-19 is a pandemic disease and is important to know the nature of the disease during follow-up. We aimed to study different imaging signs and changes that occurred during the initial scan, follow-up, and complications. Moreover, to study the CT severity score and its relation to the patients’ clinical condition using oxygen saturation as a parameter. This was a retrospective study conducted on 125 patients, including 293 CT studies, from March till the end of August 2020. The mean age was 47.4 ± 15.7 years and 64.8% of the patients were males. All patients proved to have COVID-19 by the RT-PCR test. The CT studies of the patients were divided into four stages according to the timing after the onset of symptoms. The incidence of different CT features, patterns, complications, CT severity score, and oxygen saturation were recorded in different stages. Results During follow-up studies, GGOs were the most constant and common CT features. Consolidation and crazy paving showed gradual progression to reach the peak at the 3rd stage. Mixed attenuation pattern was the commonest pattern at the 3rd stage while a pure GGO pattern was the commonest feature in other stages. The complications occurred mostly in the 3rd stage. Nevertheless, the CT severity score showed an inverse relation with oxygen saturation. Conclusion Radiological evaluation of COVID-19 pneumonia showed gradual progression till the peak critical stage at 8-14 days from the onset of symptoms. Consolidation and mixed attenuation pattern can be considered as CT signs of disease severity.

Abstract Background Acute bilateral lower limb weakness is a common problem in children which necessitates a rapid method for diagnosis. MRI is a non-invasive imaging technique that produces high-quality images of the internal structure of the brain and spinal cord. Results MRI was very helpful in reaching rapid and prompt diagnosis in children with acute inability to walk. Acute disseminated encephalomyelitis (ADEM), Guillain–Barré syndrome (GBS), and acute transverse myelitis (ATM) were the most common causes in our study. MRI proved to be of high sensitivity in detecting the lesions and reaching the diagnosis in ADEM and GBS; however, there was no significant relation between the lesions’ size, enhancement pattern, and severity of the disease or prognosis, yet in ATM the site of the lesion and number of cord segment affection were significantly related to the severity of the disease and prognosis. Conclusion MRI is a quick tool to reach the diagnosis of children with acute secondary inability to walk, and to eliminate other differential diagnosis which is essential for proper treatment and rapid full recovery. It is highly sensitive in detecting the lesions, their site and size.

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

Abstract Background and objectives Family caregivers play a curial role in supporting and caring for their mentally ill relatives. Their struggle for facing stigma and shouldering caregiving burden is marginalized, undervalued, and invisible to medical services. This study assessed the stigma and burden of mental illnesses, and their correlates among family caregivers of mentally ill patients. Methods A cross-sectional study design was used to collect data from 425 main family caregivers of mentally ill patients at Assiut University Hospital. A structured interview questionnaire was designed to collect socio-demographic data of both patients and their caregivers. Stigma scale for caregivers of people with mental illness (CPMI) was used to assess the affiliate stigma, while the associative stigma was assessed by the explanatory model interview catalogue stigma scale (EMIC-Stigma scale). The caregivers’ burden was assessed using Zarit burden Interview, and Modified Attitude toward Mental Illness Questionnaire was used to assess caregivers’ knowledge and attitude towards mental illness. Results Bipolar disorder (48%) and schizophrenia/other related psychotic disorders (42.8%) were the most common mental illnesses among the study patients. The mean scores of CPMI total scale, EMIC-Stigma scale, and Zarit Burden scale were 56.80 ± 7.99, 13.81 ± 5.42, and 55.20 ± 9.82, respectively. The significant correlates for affiliate stigma were being parents of patients (ß = 4.529, p < 0.001), having higher associate stigma (ß = 0.793, p < 0.001), and aggressive behavior of mentally ill patients (ß = 1.343, p = 0.038). The significant correlates for associate stigma of the study caregivers were being caregivers’ relatives other than parents (ß = 1.815, p = 0.006), having high affiliate stigma (ß = 0.431, p < 0.001), having poor knowledge and negative attitude towards mental illness (ß = − 0.158, p = 0.002), and aggressive behavior of mentally ill relatives (ß = 1.332, p = 0.005). The correlates for the high burden were being male (ß = 3.638, p = 0.006), non-educated caregiver (ß = 1.864, p = 0.045), having high affiliate stigma (ß = 0.467, p < 0.001), having high associative stigma (ß = 0.409, p < 0.001), having poor knowledge and negative attitude toward mental illness (ß = − 0.221, p = 0.021), seeking traditional healers and non-psychiatrist’s care from the start (ß = 2.378, p = 0.018), and caring after young mentally ill relatives (ß = − 0.136, p = 0.003). Conclusion The studied caregivers suffered from stigma and a high level of burden. Psycho-educational programs directed toward family caregivers are highly recommended.

Abstract Background The current COVID-19 pandemic has resulted in marked and rapid changes to the standing policies of radiology departments globally. The aim of this review article is to describe the various processes implemented by a radiology department in an educational institution in a resource limited country during the COVID-19 crisis, giving insights into the adopted strategies in other institutions in developed countries. Main body Our preparedness strategy was directed into five main domains: protection and wellness of radiology faculty and staff, radiological examinations and patients’ safety, education, research, and financial support. By implementing new strategies, we found that work reorganization through the use of home PACS provided safe and effective reporting service, low infection rate with zero mortality, and online lectures and theses defense were successful. Furthermore, governmental support and donations were helpful in facing financial challenges during the pandemic. A comprehensive literature review search for policies adopted by other radiology departments in the world was performed. The adopted strategies of various centers are generally similar to ours aiming for mitigating the spread of the virus, keeping good patients’ care, and maintaining the educational process. Few policy differences across institutions were found in the reporting strategy of COVID-19 pneumonia and according to the availability of resources. Conclusion Covid-19 pandemic has opened the door for changes in the radiology department policies with renewed focus on educational, clinical, and scientific strategies. Documentation of the dynamic modifications of everyday practices and lessons learned are important as a reference for preparedness for possible second surge or future crisis.

Abstract Background A healthy youth is considered the major human resource for any country development. They are suffering from unmet health needs. Considering these needs and their attitude towards the use of youth health center (YHC) services would help to improve both the quality and quantity of these services. Objectives To identify the students’ perceived health needs and their attitude towards use of the YHCs in Assiut University campus, Upper Egypt a cross-sectional study was conducted among 305 randomly selected university students. Data were collected using an interviewer-administered questionnaire. Results The majority of the students (80%) said that youth have special health needs. The most reported needs were psychological support, health education on different topics including reproductive health and sexually transmitted diseases, and nutritional services respectively. There was a high perception among surveyed students (71.5%) that the existing health services are inadequate for meeting their needs. Counseling, laboratory services, and premarital examination were the most frequently reported services mentioned by youth to be offered in YHCs. The majority (78.1%) preferred the health provider to be of the same sex. Despite the prevailing conservative culture in Upper Egypt, the students had positive attitude towards availability of sexual and reproductive information and establishment of a YHC in the university campus. A low awareness rate (15.1%) about the already existing YHC in university campus was revealed. Conclusion University students perceived that there are unmet needs for youth-specialized services, mainly for providing sexual and reproductive information, and establishment of an on-campus YHC. The study provides important information for policymakers about the perspectives of youth which should be taken into consideration when new YHC are planned and implemented.

Abstract Background To evaluate the role of partial splenic artery embolization in corpuscular correction in cirrhotic patients. Results Bleeding tendency was experienced in two thirds of patients (66.7%) and anemia in 63.3%. Splenic size ranged from 14.3 to 22 cm. PV diameter ranged from 11 to 18 mm. The mean platelet at the pre-operative laboratory was 34.9 ± 10.3 × 103, corrected to 137.6 ± 37.1 × 103 within 1 month follow-up, and then 140 × 103 after 6 months. The mean of RBCs was 3.6 ± 0.3 × 106, then 4 ± 0.5 × 106 at 1 month follow-up period. WBCs showed correction at the early post-operative period, 3.3 ± 0.4 × 103, compared to 5.4 ± 1.4 × 103 at 1 month. Reduction in splenic size was achieved by 3–6 months. All patients (100%) had post-embolization syndrome. Gelfoam was used in 20 patients, PVA was used in 5 patients, and microspheres were used in 5 patients. Antiviral treatment regimen was started after an adequate rise in corpuscular counts in all patients. Conclusion Partial splenic artery embolization is an effective alternative method to surgery in treatment of hypersplenism particularly in cirrhotic patients prepared for antiviral treatment with correction of the associated thrombocytopenia.

Abstract Background Diabetic retinopathy is one of the common microvascular complications of diabetes. The formation of advanced glycation end products (AGE) exerts deleterious effects by acting directly to induce cross-linking of proteins promoting vascular damage. Hyperglycemia causes disturbance in glycogenesis pathway resulting in reduction of glucose to sorbitol which is converted to fructose by sorbitol dehydrogenase. Methods The levels of advanced glycation end products (AGE), lipid profile, and glycosylated Hb were estimated in 266 type I diabetic patients without retinopathy, patients with nonproliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy patients (PDR).The association between genotypes of two polymorphisms of sorbitol dehydrogenase gene (SDH) was estimated in the promoter region: a C/G transversion located at _1214 position and a G/C transversion at _888 position. This study showed allele–specific PCR for C-1214G polymorphism and restriction fragment length polymorphism (RFLP) technique for a G/C transversion at _ 888 position. Results Significant increase was detected in glycosylated Hb levels in diabetic group, both with retinopathy and without retinopathy. Also, a significant increase in Hb1c in PDR group compared to NPDR. Significant increase in total cholesterol, HDL, TG, and AGE in PDR group compared to the group without retinopathy. No significant change was observed in the same parameter between PDR and NPDR group. Significant increase in AGE in both PDR and NPDR group compared to the group without retinopathy. No significant change in PDR group compared to NPDR. The results of this study showed no significant difference in genotype distribution (C/C, C/G, G/G) of the C˗1214G polymorphism between the two groups of patients with and without DR A2-. There was no statistically significant difference between the three genotypes (CC, CG, and GG) of the C˗1214G polymorphism in relation to DR severity in male genders. However, there was a statistically significant difference in female gender with increased frequency of CC genotype (2.7%, 21.9%, and 23.7%). There was no significant difference in genotype distribution (C/C, G/C, and G/G) of the G˗888C polymorphism between the two groups of patients with DR and without DR. However, the CC genotype occurred more frequently in patients with DR than patients without DR (6.7% vs. 3.9%), and G/G genotype occurred more frequently in patients without DR than patients with DR (0.70.6 vs. 0.59.7). There was no statistically significant influence of the three genotype (GG, GC, and CC) polymorphism on DR progression in both genders. However, there was an increased frequency of CC genotypes polymorphism with severity in both genders (0.0%, 4.2%, 6.9%) in males and (5.6%, 6.3%, 8.8%) in females. Conclusion The onset of diabetic retinopathy is multifactorial, and a cascade of hyperglycemia-oxidative pathways has been involved in the initiation and progression of this disease. However, further research is required to understand the cellular and molecular mechanism of diabetic retinopathy pathogenesis. So that novel anti–diabetic retinopathy strategies can be developed, aiming to reduce the major economical and medical burden caused by diabetic retinopathy.

Abstract Background Diabetic retinopathy is a multistage event, and the most important of it is angiogenesis. The possible association between vascular endothelial growth factor (VEGF) +405G/C gene polymorphism and various diseases, in which angiogenesis might be critical in disease development, encourages many investigators to study its role in diabetic retinopathy (DR) development in diabetics. The aim of this work is to investigate +405G/C polymorphism of VEGF gene in Egyptian patients with type 1 diabetes mellitus (T1DM) and to assess its possible role as a predictor for the development and progress of diabetic retinopathy. A cross-sectional, observational study was undertaken in a sample of type I diabetic patients who attend diabetes polyclinic of RIO Hospital, Giza, Egypt, between October 2012 and December 2016 and who were willing to participate. Two hundred and sixty-six type 1 diabetic patients were studied (108 males and 158 females). All subjects were analyzed for VEGF +405G/C polymorphism by real-time PCR using TaqMan pre-designed single nucleotide polymorphism (SNP) genotyping assay. Results There were increased serum levels of VEGF in T1DM suffering from DR compared to those without. Also, there was increased +405 C/C of VEGF polymorphism and C allele frequency related to the severity of DR (non-proliferative retinopathy (NPR), proliferative diabetic retinopathy (PDR), and macular edema (ME)) and type C phenotype (ischemic) in T1DM suffering from DR. Conclusion Serum levels of VEGF and its +405G/C polymorphism could be used in the evaluation, development, and progression of DR.

Abstract Background The assessment of liver stiffness and the degree of fibrosis are important factors affecting the management strategy. Multiple non-invasive tools are now available to offer an adequate alternative to biopsy. In this study, we tried to compare the performance of 2D shear wave elastography (SWE) to the transient elastography/fibroscan as a non-invasive tool in the prediction of liver stiffness. This is a prospective study of 215 patients confirmed by serology to have positive virus C or B infection. 2D SWE was done followed by vibration-controlled transient elastography (VCTE) known as fibroscan at the same session. Biopsy results were collected. Results The mean age was 51.07 years ± 6.07 SD. Five cases were excluded due to insufficient data. Fibroscan failed in 30 cases out of 210 cases (failure rate of 14.3%) compared with only 12 patients (6.7% failure rate) while using SWE. Only 180 patients completed the study to the result analysis. SWE results showed significant agreement to the fibroscan results with 86.7% agreement with a tendency for overestimation of the degree of fibrosis (11.7%). The efficacy of SWE was the highest during the assessment of patients with F0 (98.9%), F1 (97.8%), and F4 (93.3%) respectively and relatively low in F2 (92.8%) and F3 (90.6%). Conclusion 2D SWE is a relatively recent non-invasive tool in the assessment of liver fibrosis grading which can be used as an alternative to the fibroscan with almost similar diagnostic performance especially when fibroscan is not capable to obtain adequate results such as in obesity and ascites.

Abstract Background Mental illness is associated with misunderstanding and unfavorable attitude worldwide. The belief in its spiritual nature made traditional healers the main service consultants for mentally ill patients. The present study is a cross-sectional study conducted among 425 main family caregivers of mentally ill patients at Assiut University Hospital. The objective of the study was to assess the caregivers’ knowledge and attitude towards mental illness as well as their health-seeking behavior for their mentally ill relatives. Results The studied caregivers had low scores of knowledge and attitude towards mental illness. Age of the caregivers, their education, and the type of first consulted care and aggressive behavior of the mentally ill relatives were the significant predictors of caregivers’ knowledge and attitude towards mental illness. The majority of caregivers (80.2%) sought advice for the first time from traditional healers. Traditional healers referred only 16.4% of caregivers’ mentally ill relatives to psychiatric care. Conclusion The studied caregivers had poor knowledge and a negative attitude towards mental illness. Traditional healers were the main consulted care. So, increasing awareness of mental illness is highly recommended.

Abstract Background Asthma is a diverse disease with various phenotypes. Correlation of clinical asthma phenotypes with their underlying inflammatory biomarkers could help tailor asthma management and in turn improve the patient’s outcome. Aim of the study To validate the clinical classification of asthma phenotypes and to portray cough-predominant asthma phenotype and wheezy phenotype in accordance with their related inflammatory biomarkers. Patients and methods This is a case–control study comprising 50 patients with cough-predominant asthma phenotype and 50 patients with wheezy asthma phenotype, together with 50 healthy controls. Serum interleukin-10 (IL-10), transforming growth factor-beta 1 (TGF-β1), and total serum immunoglobulin E (IgE) levels were assessed using immunoassay techniques. Results The asthmatic children showed a significant increase of eosinophilic percentage, total serum IgE, and TGF-β1, when compared with the control group, whereas they showed a significant decrease of serum IL-10 when compared with the control group. As regards the clinical characteristics of both phenotypes, the prevalence of associated allergic rhinitis and atopic dermatitis in patients with cough-predominant asthma was significantly higher compared with the wheezy group. As regards laboratory biomarkers, total serum IgE was significantly elevated in cough-predominant asthma phenotype compared to wheezy phenotype. No significant differences were found between both phenotypes regarding serum TGF-β1 and IL-10. Conclusion Cough-predominant asthma phenotype is characterized by prominent atopic features (allergic manifestations and elevated total IgE). However, cough-predominant asthma and wheezy asthma phenotypes were similar regarding serum TGF-β1 and IL-10.

Abstract Background Drug addiction results in serious pulmonary complications. Thoracic complications of drug addiction vary depending on the type and the route of administration of the drug that has been abused. Aim To study the pattern of chest diseases among addicts in Poison Control Center of Ain Shams University Hospitals. Patients and methods A total of 200 addict patients were selected from Poison Control Center of Ain Shams University Hospitals in the duration between June 2016 and June 2018. All patients with pulmonary complications referred to Abbasia Chest Hospital were included. Results A total of 200 addict patients were enrolled in this study. Of them, 100 addicts with drug overdose with no pulmonary complications were excluded, and the other 100 patients were included, comprising 99 males and only one female, with mean age of 39.91±10.75 years. Overall, 63% of drug addicts were cannabis addicts, 27.0% were opiate addicts, 8.0% were polysubstance abusers, and 2.0% were alcohol addicts. Pulmonary tuberculosis was the most common pulmonary complication of all drug addicts. There was a statistically significant correlation between the type of drug addiction and the pulmonary complications. Pulmonary tuberculosis was the most common among cannabis addicts as well as polysubstance abusers. Parenchymal lung diseases (pneumonia and lung abscess) were the most common among opiate and intravenous drug addicts. There was no significant difference between different types of drugs and outcomes of the patients. Mortality represented 3.0% of all drug addicts. Conclusion Many pulmonary complications are associated with drug addiction. Achievement of early diagnosis and treatment can be obtained by proper counseling and therapeutic programs.

Abstract Background Airway evaluation and its management remain an emerging clinical science. Ultrasound (US) provides point-of-care dynamic views of the airway in perioperative, emergency, and critical care settings. Identification of a difficult airway before intubation allows for optimal preparation, equipment selection, and participation of experienced personnel. Objective The aim of this study was to evaluate the role of US in the assessment of airways and to determine whether US has the potential to serve as an effective, noninvasive method for the diagnosis of tracheomalacia. Patients and methods A prospective cross-sectional study was carried out on patients admitted at the respiratory ICU. US examination of the airways and diaphragm was performed together with either fiberoptic bronchoscopy (FOB) or dynamic expiratory computed tomography chest. Dynamic expiratory computed tomography chest and FOB were done within 24h of US examination. Results A total of 53 patients were included. US could successfully confirm endotracheal tube (ETT) placement in all patients. ETT was endotracheal in 30 (94%) patients, whereas it was esophageal in two (6%) patients. Hyomental distance at a cut-off of up to 4.51cm was a good predictor of difficult intubation with 100% sensitivity and 87.5% specificity. Subglottic airway transverse diameter was used as a predictor of ETT size. Patients with tracheomalacia by FOB had a significantly longer duration of mechanical ventilation. Lateral pharyngeal wall thickness was used as a predictor of obstructive sleep apnea, a new cut-off point was used at more than 4.1 cm in the intubated group of patients with 87.5% sensitivity and 95.8% specificity, whereas a cut-off point more than 4.2 cm in the nonintubated patients had 100% sensitivity and 100% specificity. In the intubated group, out of the seven cases diagnosed with tracheomalacia by FOB, five patients were missed by US with 40% sensitivity, whereas in the nonintubated group, the results were significantly better, where only one case was missed by US with 80% sensitivity. Conclusion US has many advantages for imaging the airway; it is safe, quick, repeatable, portable, widely available, and provides real-time dynamic images relevant for several aspects of management of the airway. Thus, it seems reasonable to consider the routine use of airway US in the ICU.

Objective: To evaluate the outcome and the cost value of surgical clips use as guidance for breast cancer localization in patients prepared for neoadjuvant chemotherapy (NAC). Methods: A prospective study of 43 patients confirmed histopathologically to have breast cancer and prepared to receive pre-operative NAC. Surgical clips were inserted via US guidance. The patients were followed up by mammography and US before surgery to evaluate the treatment response meanwhile, assessment of clips location, migration and complications. The overall cost of clips was also calculated. Results: Only 32 patients completed the study; the mean time interval was 32 weeks ± 2 weeks between the clip insertion date and the surgery. The number of the inserted clips was 34 surgical clips. Only two cases showed positive migration yet with no evidence of other complications occurred in our study patients. The average cost of the surgical clips was 145 ± 20 Egyptian pounds (average 8–9 US$). Conclusion: Surgical clips can be used safely to replace the usual commercial markers in the localization of breast cancer before NAC. They showed effective results with no complications, don't interfere with the patients' imaging and of the significant low cost compared to the commercial ones. Keywords: Surgical clips, Ultrasound-guided, Breast cancer, Neoadjuvant chemotherapy

Objective: A comparative study of manual and automated post processing software tools to measure CT parameters before Transcatheter Aortic Valve Implantation (TAVI). Patients and methods: 51 patients were included; all admitted to the Cardiology Department with clinically established severe aortic stenosis, in whom TAVI was the treatment of choice. All patients underwent CT angiography (CTA) pre-TAVI. The CT images were post processed and the needed CT parameters were calculated using both manual and automated methods. The results were compared for statistical analysis. Results: Only 43 patients completed the study, with mean age 65 years old. The automated software provided accurate almost similar results as the manual method, especially for aortic annulus area and aortic circumference measurements (p-value = 1 and 0.548) and was accepted for left and right coronary artery ostium height (p-value = 0.191 and 0.635). However, there was a statistically significant difference for the minor diameter axis and mean annular diameter (p-value = 0.001 and 0.021). Conclusion: The automated software introduced rapid, accurate and reliable measurements for the aortic annulus in cases prepared for TAVI and can be used as a standard method. Also, it can be performed by junior staff with avoidable human errors.

Objective: The aim of this work is to evaluate bone mineral density (BMD) in children with idiopathic epilepsy under anti-epileptic drugs and to determine the effect of the type and the duration of drug administration on BMD. Subjects and methods: This study conducted on 120 children divided into two groups, Epileptic group included 60 children diagnosed as having epilepsy on the basis of clinical examination receiving antiepileptic drugs (AEDS). Control group included 60 healthy children. All patients subjected to clinical examination and determination of bone mineral density. Results: Among epileptic children, there were 35 children (58.3%) with generalized tonic clonic seizures, 11(18.3%) were partial, 10(16.7%) were partial with secondary generalization, 4(6.7%) were absence seizures. 41(68.3%) epileptic patients were on antiepileptic monotherapy while 19 (31.7%) were on polytherapy. Seventeen children with low bone mineral density state (LBMD) and 43 with normal bone density. Epileptic patients had lower BMD, Z- score, and AM compared with controls (P value

Abstract Background Patients with acute respiratory acidosis caused by an acute exacerbation of chronic obstructive pulmonary disease(AECOPD)constitute the group that benefits most from noninvasive positive-pressure ventilation (NIPPV). However, there are some patients who do not respond to NIPPV. Studies from the west report variable failure rates. Delaysin recognizing non responders can increase hospital morbidity and mortality. Objective The aim of this study was to assess the effectiveness and safety of NIPPV in patients with acute hypercapnia respiratory failure (AHRF) secondary to AECOPD. Patients and methods This was a prospective observational study of 119 consecutive chronic obstructive pulmonary disease patients who were admitted with a diagnosis of AHRF and in whom NIPPV was applied. Results The overall success rate of NIPPV in the studied group was 94%. Mortality and duration of hospitalization were significantly higher in the failure group (P=0.0001 and 0.002, respectively). The most encountered complications were air leak (29%) and mask discomfort (24%). Comparison between the success and the failure group at the time of hospital admission revealed that the failure group was associated with old age (P=0.043), low hemoglobin (Hb) (P=0.037), low albumin (0.017), lower Glasgow Coma Scale (GCS) score (P=0.0001), higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P=0.001), higher heart rate (P=0.002), lower systolic blood pressure (SBP) (P=0.013), lower diastolic blood pressure (DBP) (P=0.034), and higher white blood cells (WBCs) (P=0.0001). Multiple regression analysis identified age more than 65years, respiratory rate35ormore,pHless than 7.26, and WBCs more than or equal to 20 000 or less than 4000 as significant independent predictors of NIPPV failure in our patients. Conclusion NIPPV is an effective and safe modality for treating patients with AHRF secondary to AECOPD. Widespread availability and training of medical staff in the use of NIPPV is recommended.

Objective: To assess whether the diaphragmatic and lung ultrasound (US) can be used as additive new parameters for the weaning process in intensive care units (ICU) patients in comparison to the traditional weaning parameters. Patients and methods: 68 patients were included in our study. All patients admitted inside different ICU units-Ain Shams University for different causes mainly post major surgeries. All patients met the traditional criteria for weaning, had diaphragmatic and lung ultrasound after extubation. We measured the diaphragmatic excursion (E), diaphragmatic thickening fraction (DTF) as well as the degree of lung aeration. All US results were collected and compared with some of usual weaning parameters namely the arterial blood gases as well as respiratory mechanics. The results were statistically analyzed. Results: 50 patients showed successful weaning process. Diaphragmatic E and TF showed high sensitivity and specificity in correlation with the other parameters. The cut off value was 10 mm for the E and 28% for the DTF and 12 for the lung US. A score was put to predict the outcome of weaning process. Conclusion: For the patients undergoing weaning process, diaphragmatic and lung ultrasound can be used as additive new parameters for prediction of weaning process outcome.

Objective The aim of the paper was to assess value of ultrasound 7 score (US7) in the detection of synovitis in rheumatoid arthritis (RA) and its correlation with clinical disease activity indices. Patients and methods A total of 50 patients with RA were included. Disease activity was assessed by clinical disease activity indices. Erythrocyte sedimentation rate was measured, and simple erosion narrowing score was used for radiography scoring. Musculoskeletal US7 score was done which combines each joint score for synovial proliferation (gray-scale ultrasound ‘GSUS7’) and vascularization (power Doppler ultrasound ‘PDUS7’). Results Detailed joint region examination by US7 score was done. Dorsomedian aspect of wrist (94%), palmar aspect of metacarpophalangeal joint (MCP) II (96%), and palmar aspect of phalangeal interproximal (PIP) II and III (92%) were the most affected joint regions with synovitis by GSUS. However, for detection of synovitis by PDUS, dorsomedian aspect of wrist and dorsal aspect of MCP, PIP II, and PIP III were involved. Erosions were found most in radial aspect of MCP II (70%), lateral aspect of metatarsophalangeal joint V (72%), and dorsal aspect of PIP II (54%) and PIP III (44%). All clinical disease activity indices were correlated with GSUS7 and PDUS7 synovitis. Conclusion US7 was simple and practical sum scoring system for use in the detection of synovitis in patients with RA. The correlations between the clinical disease activity indices, erythrocyte sedimentation rate, duration of illness, radiographic score, and components of the US7 score reflects the value of US7 score in assessment of disease activity and severity.

Objective The aim of this study was to investigate differences in BMI, waist circumference (WC), and waist-to-hip ratio (WHR) in rheumatoid arthritis (RA) patients and their association with serum adiponectin and disease parameters. Patients and methods Fifty RA patients and 25 matched healthy controls were included. Anthropometric measurements, disease status, and serum adiponectin level were assessed. Results Out of 50 RA patients, 48% had normal BMI (18.5–24.9 kg/m2), 20% had BMI in the range of 25.0–29.9 kg/m2, which is considered to be overweight, and 32% were obese, with BMI greater than 30 kg/m2. Almost similar findings were observed by the measurements of WC − that is, 34% of patients were obese ‘abdominal obesity’. However, the percentage of obese patients increased to 42% when classified as per WHR ‘truncal obesity’. Serum adiponectin was significantly increased in RA patients compared with controls (P=0.002). Significant negative correlations of BMI and WC with serum adiponectin level were found (r=−0.9, P≤0.001; r=−0.7, P≤0.001, respectively). There were positive correlations of WHR with Disease Activity Score 28 (r=0.3, P=0.047), Multidimensional Health Assessment Questionnaire (r=0.3, P=0.04), and ultrasound Disease Activity Score (r=0.4, P=0.04), whereas there was a significant negative correlation with ultrasound erosion rate (r=−0.3, P=0.02). Conclusion BMI, WC, and WHR measurements should be used and encouraged in the RA population. Our findings suggested that WHR was better associated with disease activity, disability, and severity than with other measures.