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Objective: To record the epidemiological, characteristics of Acute hepatitis patients. Study Design. Cross Sectional study. Setting: Government General Hospital Ghulam Muhammad Abad, Faisalabad. Period: March 2019 to 30th of September 2019. Material & Methods: A total of 92 patients included in the study. Patient’s epidemiological characteristics, symptoms and lab results were recorded during hospital stay. Categorical variables were analyzed using Chi-Square and Fissure Exact tests. P value of

Background: Neck fractures of the metacarpal bone can alter optimal hand function. Many surgical fixation techniques are described for this fracture with no robust evidence for the best treatment. Recently developed low profile plates may, however, challenge the preference for K-wires. Low profile plates were found to have lower complications than conventional plates in addition to early range of motion and early return to work. The aim of the present study was to determine the best outcome in patients with unstable fracture neck metacarpals using either multiple K wires or low profile mini-plating. Methods: This prospective randomized controlled study included 37 patients suffering from metacarpal neck fractures. patients were designated as group 1 (AIN group; 18 patients), and the other consecutive patients were designated as group 2 (LPP group; 19 patients). Both groups were treated within the first 48 hours of their injury and followed up for a minimum period of 40 weeks; the maximum period of follow up was 48 weeks. Results: No significant differences were found for PVAS, Q-DASH, TAM, time to radiological union or residual deformities at last follow-up. Grip strength, however, was significantly better in the K-wire group. Operative time and time off work were significantly shorter in the k-wire group. Plate group showed prevalent complications both peri and post-operative hitting 63.2 % of the plate group vs 16.7% in K-wire group. Conclusions: Low profile plates with immediate mobilization paradoxically prolonged operative time, technical demand and disturbing the fracture’s biological environment along with the extra cost were thus not justified by results. Antegrade intramedullary K-wire nailing was superior for the management of unstable metacarpal neck fractures.

PurposeThis study explores the best strategies for regional economic development to attract highly skilled populations, regardless of whether the region is a multisector or unisector economic hub. It also determines the development variables affecting the success of integrated regional economic hubs to achieve spatial equality, enhance economic productivity and attain environmental sustainability.Design/methodology/approachIn addition to a qualitative analysis, this study employed quantitative techniques using SPSS software. This allowed amplification of the most significant explanatory variables affecting the weaknesses and strengths of economic hubs.FindingsThe results highlight approaches that can be used to achieve socio-economic sustainability in regional hubs. These include multisectors or main centralised hubs (smart economic regional capital), which provide new services to regions and act as a unidevelopment sector or as a regional, economic capital.Research limitations/implicationsThe study analyses the effect of economic strategies and integration of natural resources and the required core services in regional economic development.Practical implicationsCase studies of successful economic hubs are discussed. The most important services proposed in such hubs promote human development and increase the standard of living.Social implicationsIntegration between the hubs in a region is fundamental to attracting direct investments that can benefit the local population.Originality/valueThe results could help governments, economists and planners implement multisector developmental hubs to achieve sustainable development.

Background: Carpal tunnel syndrome is the most common type of peripheral nerve entrapment; it affects females more than males; it may be idiopathic or secondary to other disorders especially diabetes mellitus. Carpal tunnel syndrome mostly affects manual workers and may be bilateral or unilateral and mainly affects the dominant hand. Carpal tunnel syndrome has characteristic symptoms and signs including paresthesia and pain along median nerve distribution, these symptoms are usually accompanied by positive provocative tests. Electrodiagnostic studies remain the cornerstone in the diagnosis of CTS. Carpal tunnel syndrome can be treated conservatively by activities of daily living instructions, splints, medical treatments as neurotropic drugs and NSAIDs and local steroid injection. Also, it can be treated by surgical decompression in severe cases. Aims: The aim of this study was to evaluate local steroid injection in the treatment of CTS. Twenty-one patients with mild and moderate CTS were included in this study. Patients and Methods: This was a prospective study included 21 patients with symptoms and signs of mild to moderate CTS attending the outpatient clinic of orthopedic Department, Tanta University Hospitals in the period between February 2019- January 2020. 1 ml Triamcinolone was used with 2 ml lidocaine. Patient’ hand was rested on towel roll flexed about 30 to 45 degrees and injection was done according to landmarks. Night splint was described for 3 days after injection. Results: In regards to clinical assessment; there was a significant clinical improvement after injection and follow-up period as compared to before injection. In regards to electrophysiological assessment; there was a significant improvement in NCS after injection. Conclusion: Local steroid injection is an effective treatment and recommended as a therapeutic tool in the management of idiopathic mild to moderate CTS.

Background: Tibial pilon fractures are relatively uncommon injuries, representing only 1% of all fractures of the lower limb and 5% to 10% of those of the tibia. Frequent comminution and the thin soft-tissue envelope in the area make the treatment of these fractures challenging. The tibial pilon is characterised by a total absence of muscle coverage and marginal vascularity. Therefore, even moderate trauma often results in extensive soft-tissue damage. Objective: The aim of this present study was to evaluate the arthroscopic assisted (Ilizarov) ring external fixation of distal tibial intra articular (pilon) fractures. Patients and methods: This was a prospective study conducted between February 2012, April 2015 on thirty patients with closed, and Gustilo Types I & II open fractures of pilon fractures of the distal tibia who were admitted to Zagazig University Hospitals. During a period of two years, all cases were treated by Ilizarov fixators with or without limited internal fixation and assessment of intra-articular reduction tibial plafond by arthroscopy. Results: Nineteen patients had right-sided injury, eleven patients had left sided injury and one patient had bilateral injury. At the time of injury, the youngest patient was 19 years old and the oldest was 6o years. The results in relation to pain as distributed according to the fracture. It is noted that the excellent results were with type I & II fracture, while the fair and poor results were with type II and III fracture. Conclusion: The present study provided information on the use and the role of ankle arthroscopy in assisting and evaluation (the value, advantages, techniques of ankle arthroscopy and ring external fixators) of distal tibial intra- articular reduction after pilon fracture. The study showed that this technique might be a good method to manage the pilon fractures.

Background: Improving recovery after exercise is vital for decreasing cardiac mortality by dominance of parasympathetic nervous system control in recovery time. Objective: To determine the influence of coronary artery disease on heart rate recovery after exercise in patients with diabetes mellitus. Patients and Methods: The ethical approval was obtained from the hospital ethical research committee, in cardiology department in Al-Hussein university hospital from March 2019 to November 2019 and each patient signed an informed consent. Fifty patients were included in this study divided in 4 groups, all with no evident history of ischemic heart disease. Detailed history, physical examination, resting ECG, trans thoracic echocardiography, and finally treadmill exercise stress test was done. In this study we assessed heart rate recovery in 1st, 2nd& 3rd minute and also basal heart rate included. Results: Significant delay in heart rate recovery time was detected in diabetic patients with positive stress ECG test for myocardial included ischemia. Conclusion: Delayed recovery and reduced heart rate recovery after treadmill exercise stress test is an available and important index for detecting and revealing the extent of ischemic burden.

Depression is one of the commonest psychiatric disorders and is a prominent reason for major health problems worldwide. The prevalence and the dysfunction, morbidity, suffering, and economic burden. Depression can lead to upsurge in the health-seeking performance, diminished excellence of life and increased propensity for desperate tendencies. In the majority of the cases, the affected patients report late and owing to various scales of assessing depression, patients with depressive disorder are often undertreated. As per the Global Burden of Disease report the prevalence of depression is 1.9% among men and 3.2% for women and the overall one-year prevalence increases to 5.8% in men and 9.5% in women. Given the existing epidemiological evolution and demographic, the impact of unhappiness can be tremendous by 2020 with the burden of depression at about 5.7% of all the illnesses. The morbidity bearing will be so huge that and it would be the most important reason for disability-adjusted life years (DALYs), next only to ischemic heart disease. This education expected at to assess the prevalence and correlates of depression among type 2 diabetes mellitus patients and impact of treatment on diabetic status, glycemic quality and control of life after 6 months. The scales used in this study was Mini international neuropsychiatric interview – 6.0 , Hamilton Depression Scale (HAM-D), WHO Quality Of Life (WHO-QOL) – BREF scales, Morisky 8-item Medication Adherence Questionnaire. The study has highlighted the prevalence of depression in the study population, positive impact of depression on the treatment compliance, glycemic control and quality of life of the affected patients.

In 1997, during the 41st session of the Regional Committee for the Eastern Mediterranean, the 21 countries in the World Health Organization (WHO) Eastern Mediterranean Region* (EMR) passed a resolution to eliminate† measles (1). In 2015, this goal was included as a priority in the Eastern Mediterranean Vaccine Action Plan 2016-2020 (EMVAP) (2), endorsed at the 62nd session of the Regional Committee (3). To achieve this goal, the WHO Regional Office for the Eastern Mediterranean developed a four-pronged strategy: 1) achieve ≥95% vaccination coverage with the first dose of measles-containing vaccine (MCV1) among children in every district of each country through routine immunization services; 2) achieve ≥95% vaccination coverage with a second MCV dose (MCV2) in every district of each country either through implementation of a routine 2-dose vaccination schedule or through supplementary immunization activities§ (SIAs); 3) conduct high-quality, case-based surveillance in all countries; and 4) provide optimal measles clinical case management, including dietary supplementation with vitamin A (4). This report describes progress toward measles elimination in EMR during 2013-2019 and updates a previous report (5). Estimated MCV1 coverage increased from 79% in 2013 to 82% in 2018. MCV2 coverage increased from 59% in 2013 to 74% in 2018. In addition, during 2013-2019, approximately 326.4 million children received MCV during SIAs. Reported confirmed measles incidence increased from 33.5 per 1 million persons in 2013 to 91.2 in 2018, with large outbreaks occurring in Pakistan, Somalia, and Yemen; incidence decreased to 23.3 in 2019. In 2019, the rate of discarded nonmeasles cases¶ was 5.4 per 100,000 population. To achieve measles elimination in the EMR, increased visibility of efforts to achieve the measles elimination goal is critically needed, as are sustained and predictable investments to increase MCV1 and MCV2 coverage, conduct high-quality SIAs, and reach populations at risk for not accessing immunization services or living in areas with civil strife.

Background: There is an increasing awareness of the role of dyslipidemia in lupus nephritis patients, no researchers have studied dyslipidemia in systemic lupus erythematosus (SLE) in Tabuk. In this study, we aimed to investigate the association between dyslipidemia and lupus nephritis in Tabuk, Saudi Arabia. Methods: This cross-sectional comparative longitudinal hospital-based study was conducted at a rheumatic clinic in the North West Armed Force Hospital (NWAFH) during the period April 2014–June 2015. Seventy-three patients diagnosed with SLE were invited to participate in the study. All participants were required to sign a written informed consent, following which they were interviewed using a structured questionnaire. Data collected include demographic data, clinical characteristics, fasting lipid profile, renal function tests, urine analysis, antinuclear antibody, anti-double-stranded antibodies, complement levels, serum albumin, anticardiolipin, ant bodies, and antiphospholipid antibodies. Lupus nephritis was ascertained by renal biopsy. The research was approved by the ethical committees of both the University of Tabuk and the NWAFH and data were analyzed using the Statistical Package for Social Sciences (SPSS). Results: Out of 73 patients with SLE, 86.3% were females with a mean age of 34 ± 6.4 years. Lupus nephritis was evident in 26% of the patients, proteinuria in 44.1%, high total cholesterol in 17.8%, high low-density lipoprotein in 15.1%, high triglycerides in 27.3%, and low high-density lipoproteins in 52.1%. Patients with lupus nephritis had high total cholesterol, high LDL, high TG, and low HDL than those without lupus nephritis P-value < 0.05. Conclusion: Dyslipidemia was more common among patients with SLE nephritis, and an aggressive treatment is recommended to reduce this serious complication. The relatively small size of the study group and the fact that the study was conducted at a single tertiary center are the limitations of this study. Keywords: dyslipidemia, lupus nephritis, Saudi Arabia

Background: Polycystic ovary syndrome (PCOS) is a complex disease characterized by various endocrine disorders that are the potential cause of anovulation and hyperandrogenism. This heterogeneous syndrome affects about 5– 10% of reproductive-age female population and it can be considered the most common endocrine disorder affecting women during reproductive life. PCOS is a multifactorial polygenic disease. Genes that regulate steroidogenesis and folliculogenesis are interested. Hence, AMH measurement has been found to offer a relatively high specificity and sensitivity as a diagnostic marker. Objectives: The study aimed to assess the accuracy of AMH in the prediction of PCOS in patients admitted to Elsayed Galal and El Hussein University Hospital. Subjects and methods: This was a retrospective study that was done on 130 women, divided into two groups, group I include 100 PCOS patients and group II, 30 control subject. Results: The results of this study showed that there was no significant difference between the two groups regarding age, while there was a significant increase in BMI in patients more than in control. The level of LH showed a significant increase in patients more than in the control. The level of FSH showed a significant decrease in patients less than in the control. The Testosterone showed a significant increase in patients more than in the control. The androstenedione showed a significant increase in patients more than in the control group. The AMH showed a highly significant increase in patients more than in the control and in turn the number of follicles in group II (patients) was significantly higher than in the control. The sensitivity of AMH in diagnosis PCOS was 98.0, specificity was 80.0% and the total accuracy was 93.0 at the cutoff of point 0.911. Conclusion: Additional advantages of AMH as diagnostic tool are that it is biological, objective, quantitative marker not affected by day of menses or OCP intake. So in future, more studies should be undertaken to validate its role as diagnostic tool for PCOS.

Objective: To evaluate the value of fetal scalp blood sampling (FBS) as an adjunct test to cardiotocography, to predict adverse neonatal outcomes.\ud Study design: A multicentre service evaluation observational study in forty-four maternity units in the UK. We collected data retrospectively on pregnant women with singleton pregnancy who received FBS in labour using a standardised data collection tool. The primary outcome was prediction of neonatal acidaemia diagnosed as umbilical cord arterial pH

In 1997, the 21 countries in the World Health Organization (WHO) Eastern Mediterranean Region* (EMR) passed a resolution during the 41st session of the Regional Committee for the Eastern Mediterranean to eliminate measles† (1). In 2015, this goal was included as a priority in the Eastern Mediterranean Vaccine Action Plan 2016-2020 (2), approved at the 62nd session of the Regional Committee (3). To achieve measles elimination, the WHO Regional Office for the Eastern Mediterranean developed the following four-pronged strategy: 1) achieve ≥95% vaccination coverage with the first dose of measles-containing vaccine (MCV) among children in every district of each country through routine immunization services; 2) achieve ≥95% vaccination coverage with a second MCV dose in every district of each country either through implementation of a routine 2-dose vaccination schedule or through supplementary immunization activities (SIAs)§; 3) conduct high-quality, case-based measles surveillance in all countries; and 4) provide optimal measles clinical case management, including dietary supplementation with vitamin A (4). Pakistan, an EMR country with a population of approximately 200 million, accounts for nearly one third of the overall EMR population. This report describes progress and challenges toward measles elimination in Pakistan during 2000-2018. During the study period, estimated coverage with the first MCV dose (MCV1) increased from 57% in 2000 to 76% in 2017. The second MCV dose (MCV2) was introduced nationwide in 2009, and MCV2 coverage increased from 30% in 2009 to 45% in 2017. During 2000-2018, approximately 232.5 million children received doses of MCV during SIAs. Reported confirmed measles incidence increased from an average of 24.6 per 1 million persons during 2000-2009 to an average of 80.4 during 2010-2018, with peaks in 2013 (230.3) and 2018 (153.6). In 2017 and 2018, the rates of suspected cases discarded as nonmeasles after investigation were 2.1 and 1.5 per 100,000 population, reflecting underreporting of cases. To achieve measles elimination, additional efforts are needed to increase MCV1 and MCV2 coverage, develop strategies to identify and reach communities not accessing immunization services, and increase sensitivity of case-based measles surveillance in all districts.

Background: Variceal hemorrhaging due to portal hypertension is a severe complication of liver cirrhosis. Although several biomarkers have been reported as predictors of the presence of varices, it is still difficult to assess the risk of variceal bleeding without esophagogastroduodenoscopy (EGD). The ratio of glycated albumin (GA) to glycated hemoglobin (HbA1c) was reported to increase with the progression of liver fibrosis. The aim of the study was to investigate whether the GA/HbA1c ratio is related to the severity and bleeding risk of the varices. Aim of the work: goal of our study was to assess the value of Glycated albumin to Glycated hemoglobin ratio in the prediction of esophageal varices and assessing its risk of bleeding. Methods: We measured the GA/HbA1c ratio of HCV-related cirrhotic patients and analyzed its relationship with the presence and bleeding risk of varices. Results: The GA/HbA1c ratio was higher in the patients who had the varices with a high risk of hemorrhage than in the patients with a low risk of bleeding. In addition, the GA/HbA1c ratio was higher in patients with varices than that in patients without varices. Furthermore, the GA/HbA1c ratio was the most significantly different parameter of all the factors examined, including the platelet count, prothrombin activity and albumin level. Conclusion: The GA/HbA1c ratio is increased in patients with varices and with the bleeding risk of the varices.

The aim of this study is to investigate the prevalence of some diseases in domestic livestock in two protected areas in Saudi Arabia where gazelles have been reintroduced. King Khalid Wildlife Research Centre (KKWRC) was established in 1986 to breed and undertake scientific research on Saudi wildlife for reintroduction purposes. Mountain gazelles (Gazella gazella) were reintroduced to the Ibex Reserve 150 km south of Riyadh in central Saudi Arabia, which supports viable population of wild ibex. Sand gazelles (Gazella marica), Mountain gazelles and Arabian oryx (Oryx leucoryx) were reintroduced to Uruq Bani Ma’arid (UBM) Reserve in the Al Rub al Khali desert. Domestic livestock (camels, sheep and goats) owned by local people use the Reserves and the area surrounding for grazing and there is contact between these animals and reintroduced wildlife. Two surveys have been carried out at each Reserve. Serum samples collected from 1012 camel, sheep and goats were screened for some viral, bacterial and parasitic diseases that are of particular concern in Saudi Arabia. The results show the presence of antibodies against tuberculosis, brucellosis, bluetongue virus, akabane virus, contagious pustular dermatitis and toxoplasmosis. The Suadi Wildlife Authority (SWA) coordinated with the Ministry of Agriculture and established monitoring and remedial programmes to control diseases reported in the present study. The epidemiological significance, of the study, to wildlife was discussed. Key words: Domestic livestock, serosurvaillence, Ibex Reserve, Uruq Bani Ma’arid, Saudi Arabia

Percutaneous balloon mitral valvoplasty (PBMV) has become the treatment of choice for severe pliable rheumatic mitral stenosis. The multi-track system is a recent variation of the double-balloon technique and is easier owing to the use of a monorail balloon and a simple, single-guidewire approach. In the present study, we used the double-coil Inoue metal wire with a multi-track balloon instead of the conventional multi-track wire. We studied 62 consecutive patients (55 females) with significant symptomatic rheumatic mitral valve stenosis who underwent multi-track PBMV. Patients were randomized into 2 groups: the first group included 32 patients treated with the novel multi-track technique using the double-coil Inoue metal wire, and the second group included 30 patients treated with the conventional multi-track technique using a balloon endhole catheter and multi-track 0.035 inch stiff wire. None of the patients had cardiac tamponade, systemic thromboembolism, or any groin complications. No statistically significant differences were found between the 2 groups regarding any of the studied variables. There were no in-hospital deaths or complications necessitating emergent cardiac surgery in either group. In conclusion, this new technique with the double-coil Inoue metal wire achieves the double benefit of being as safe as (and indeed easier than) the conventional technique, and it utilizes fewer materials, making the multi-track system more cost-effective.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This paper has been retracted upon mutual agreement between the publisher and the Editor-in-Chief of EJCDT when it was discovered that this article had also been submitted and published in the International Heart Journal http://dx.doi.org/10.1536/ihj.54.196. The authors did not give clarification for the action; therefore the paper was retracted following international publishing practices.

Background and Aim: Percutaneous balloon mitral commissurotomy (PBMC) has become treatment of choice for severe pliable rheumatic mitral valve stenosis (RMVS). The multi-track system is a recent variant of the double-balloon technique which is easier through the use of a monorail balloon and only a simple, single guidewire approach. In the present study, we sought to use the Inoue metallic wire with multi-track balloon instead of the conventional multi- track wire will make the procedure safer and faster. Subjects and Methods: We studied 62 consecutive patients (55 females) with significant symp- tomatic RMVS who underwent multi-track PBMC. They were randomized into 2 groups: the first group included 32 patients treated with the novel multi-track technique using the double coil Inoue metallic wire, and the second group includes 30 patients treated with the conventional multi-track technique. Results: No statistically significant differences were found between both groups regarding any of the studied variables; apart from the pre-procedural MV area which was significantly lower in the novel-technique group compared to the conventional-technique group. None of the patients had cardiac tamponade, systemic thromboembolism or any groin complication. There were neither in-hospital deaths nor complications necessitating emergent cardiac surgery in both groups. Conclusions: This new technique achieves the double benefit of being safer and easier with Inoue wire and saving excess material with the multi-track system; which is more economic.