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Back ground: Surgery for patient with penetrating head injury during war is debatable in literature. Field hospital with limited resources in war area could have a role in the management of this less devastating head injures patients. Methods: During a 6 months of Syrian civil war (October 2012- March 2013), 30 patients with low velocity penetrating head injuries was referred to a 3 different field hospitals managed by the same surgical team. The patient inclusion criteria were including Glasgow coma scale (GCS) ranged from 11 to 15, whom didn’t need for neuroscience intensive care unit (NICU) admission. Patients had laboratory and image before management decision. After surgery, the patient had short term admission before discharge and follow up at outpatient clinic. Results: The mean age for civil war victim was 26. ± 10.1and most of cases were males. All cases had penetrating metal shrapnel injuries from barrel bomb explosion. The majority of cases had GCS =15 (43.3%). Frontal lobe was the most frequent affected lobe (53.3%). The most frequent CT finding was contusion, edema and mass effects (60%). Surgery was reported in (83.3%) with no reported mortality. Surgical outcome was affected by pre hospital chronic illness P= 0.04 and, numbers of affected brain lobes by penetrating metal (P= 0.001). Conclusion: Surgical outcome of penetrating head injuries patients can be affected number of the affected brain lobes by penetrating metal and bone fragments. Field hospital in war area could be valid in the management of such patient.

Aim: To the best of our knowledge, no previous studies have addressed the association of unexplained infertility with protein S activity. This case-control study was performed to evaluate the prevalence of protein S activity in women with unexplained infertility and to compare its prevalence in normal fertile women.Materials and Methods: This is a case-control study conducted to evaluate the prevalence of protein S activity inwomen with unexplained infertility conducted at Ain-Shams University Maternity Hospital. A total of 30 women withunexplained primary infertility and another 30 fertile women of matched age group as their control were recruited fromSeptember 2018 to March 2019. Using STA Compact Max® Coagulation System protein S was measured. STA-staclot kitsupplied by Stago, France is a clotting assay for measuring protein S activity in human citrated plasma. A venous bloodsample (3 ml) was collected from every participant at any day of the menstrual cycle then the samples were collectedin (3.2%) sodium citrate tubes (venous blood must be mixed with the sodium citrate immediately after collection byturning upside down gently the tube 3 or 4 times), then centrifugation performed as fast as possible less than an hour toobtain platelet-poor plasma and centrifuged at 2500g for 15 min (platelet poor plasma). Samples and test reagents areloaded into the instrument where sample handling, reagent delivery, analysis, and reporting of results are performedautomatically. Results: This study failed to find a relationship between protein S activity and unexplained infertility compared to the normal fertile population. Despite finding none in the unexplained infertility sample population with protein S deficiency and one in the control group, this difference failed to reach significance.Conclusion: In conclusion, this study failed to find any association between protein S activity and unexplained infertilitybut this study showed that the mean of protein S percentage in group 1 (cases) is lower than the mean in group 2 (controls).

Background Anterior nasal packing after septoplasty, when performed, it aims at reducing the risks of postoperative bleeding and hematomas formation; however, the demerits of anterior nasal packing motivate the idea of septoplasty without nasal packing. Objective: To assess the value of anterior nasal packing after septoplasty. Type of Study: Randomized clinical trial. Patient and Methods: This study was conducted on 50 patients who underwent septoplasty in one institute by the same surgeon (the senior author). They were randomly divided into two groups, in the first group postoperative anterior nasal pack was performed, in the second group there was no packing. Evaluation of subjective symptoms and physical finding was performed at three stages, early postoperative stage (at first and third day), 7 days, 2 weeks, and 2 months after surgery. Results: In the early postoperative stage, the first group experienced less feeling of pain, 2 cases in the second group experienced severe nasal bleeding that requires overnight admission and the bleeding was controlled without packing; also, sensation of pain, lacrimation, swallowing difficulties, and sleep disturbance were significantly higher in the first group in this stage. At the 7th day, the 2nd week, and the 2nd month after surgery, the prevalence of granulations, infection, and crust formations, respectively, were significantly higher in the packing group. Conclusion: Septoplasty without postoperative anterior nasal pack is more compliant with less postoperative morbidities. Packing should be preserved for patients with excessive bleeding during the primary surgery. Keywords: internal nasal packing; nasal septum; quality of life

Introduction Mechanical trauma to the nasal mucosa increases the risk of synechia formation, especially after chronic rhinosinusitis and nasal surgeries. Objective This study was carried to assess the effect of propolis administration in healing injured nasal mucosa in rats. Methods We randomly divided eighteen rats into three equal experimental groups: (1) non-treated group; (2) gum tragacanth (suspending agent for propolis) treated group; and (3) propolis treated group. The non-treated group received no treatment for 15 days. The second group received gum tragacanth administration (5 ml/kg, orally) once daily for 15 days. The third group received propolis suspension orally at a dose of 100 mg/kg once daily for 15 days. At the beginning of this study, we induced unilateral mechanical nasal trauma on the right nasal mucosa of all rats in the three groups using a brushing technique. A pathologist stained tissue samples using hematoxylin and examined eosin by using a light microscope. Results The severity of inflammation was milder with the absence of ulcerations in the propolis treated group compared with the non-treated and gum tragacanth groups. Goblet cell and ciliated cell loss was substantially lower in patients treated with propolis compared with groups without treatment and those treated with gum tragacanth. Conclusion Propolis decreased inflammation and enhanced healing of wounds of the nasal mucosa in rats.

The association of HLA antigens with vitiligo remains controversial issue. In order to determine which, if any, HLA markers were associated with an increased risk of vitiligo, we investigated HLA antigens in 50 patients with vitiligo and in 50 controls. Vitiligo patients had significant increase in HLA-A1, A19, B16, CW4, CW 6, DR 4, DR7 and DQ3 compared to controls. Familial vitiligo is marked by increased frequency of HLA-A28, B16, B27, B48, CW2 and DQ3, while non-familial vitiligo is marked by increased frequency of HLA-A1, CW6 and DR13. These findings suggest that immunogenetic mechanism may be responsible for vitiligo. Also there may be heterogeneity in the pathogenic process between familial and nonfamilial vitiligo.

Pseudoxanthoma elasticum (PXE) is a hereditary disorder that mainly involves the skin, eyes, and cardiovascular system. We reported a case of pseudoxanthoma elasticum with involvement of neck, axillae, abdomen and thighs, together with angioid streaking of fundi. Skin biopsy specimen was taken and was stained with hematoxylin and eosin (H and E) that revealed fragmentation of the elastic fibers. These features were suggestive of histopathological diagnosis of PXE. We have reviewed other published reports to obtain a better understanding of the genetics, histopathology, vascular and ophthalmological manifestations of pseudoxanthoma elasticum.

Piebaldism is a rare disorder present at birth and inherited as an autosomal dominant trait. It results from a mutation in the c-kit proto-oncogene and is associated with a defect in the migration and differentiation of melanoblasts from the neural crest. We report a 15-year-old girl with both piebaldism and neurofibromatosis type 1 (NF1). She presented with a congenital depigmented patch of the forehead, as well as acquired white forelock, depigmentation of the medial eyebrows, and depigmented patches of the legs. In addition, some cafe au lait macules were observed at birth on the trunk and neck. To our knowledge, the association of piebaldism and NF1 has been described previously in at least 6 case reports. Awareness of this rare association is relevant to ensure early diagnosis and adequate follow-up for NF1.

Leiomyoma is a benign tumour commonly encountered in the genitourinary and gastrointestinal organs in adults. Cutaneous leiomyomas are rare benign tumors arising from the arrector pili muscle of hair follicles. Cutaneous leiomyomas are more likely to occur in adults than in children. We describe a case of a 30-year-old male who presented with skin-coloured masses on the back. A punch biopsy was performed. Under high-power examination, spindle cells with an eosinophilic cytoplasm were observed and immunohistochemical studies were performed; the cells stained strongly positive for smooth muscle actin (SMA). The patient was subsequently diagnosed with pilar leiomyoma and referred to a plastic surgeon for surgical treatment. A careful clinical assessment led to the correct diagnosis and therapy in the present case.