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Background: Adequate assessment of fluid status is an imperative objective in the management of HD patients. An inaccurate assessment of dry weight leads to many complications. Objective: The aim was to assess applicability of clinical using inferior vena cava (IVC) and lung ultrasonography to assess dry weight and the adequacy of fluid removal in hemodialysis children with special relation between acute and chronic renal failure. Patients and methods: 75 children were classified into two groups: Group (1): Chronic renal failure and group (2): Acute renal failure. Results: A statistically positive significant correlation between percent of weight loss after dialysis among the studied patients and all of serum ferritin, creatinine, phosphorus and iron. There was statistically negative significant correlation between percent of weight loss after dialysis among the studied patients and serum creatinine. There was statistically significant negative correlation between percent of weight loss after dialysis among the studied patients and SPAP. There was statistically non-significant correlation between percent of weight loss after dialysis among the studied patients and percent change in IVC inspiratory diameter, expiratory diameter, collapse index and B lines. There was statistically significant difference between the studied groups and expiratory IVCD, collapse index before and after dialysis, difference in B lines. Conclusion: Lung ultrasound is an accurate and sensitive method of quantifying subclinical fluid overload in children on dialysis before its clinical manifestation. IVC measurement is reliable to assess intravascular fluid overload in children on HD and was not correlated with extracellular fluid volume as need more time (2-3h) after dialysis and maneuver difficult with young age.

Background: - Nutrition management of premature neonates is considered an essential and important part of their care. Proper preterm neonatal positioning is necessary for physiological stability and nutritional status of neonates. So this study aimed to evaluate the effect of different positions on gastric residual volume of preterm neonates in Neonatal Intensive Care Unit (NICU). Research design, Quasi experimental research design was utilized in this study. Sample. A purposive sample of (60) preterm neonates who meet the inclusion criteria at a NICU in Assiut University Children Hospital. Two tools were used to collect the necessary data, Simple questionnaire sheet and Gastric residual volume record sheet. Results of this study revealed that minimum gastric residual volume was prone (0.57±0.47) position and maximum gastric residual volume was supine (2.08±0.89) position. There was highly statistical significance difference (

Background: The indication for routine hysteroscopy (HSC) in patients undergoing diagnostic hysteroscopy as part of an infertility work up is still a matter of controversy. Although most clinics continue to use hysterosalpingography (HSG) as their routine test to assess the uterine cavity, there is a growing body of literature dealing with the use of HSC as an important instrument to use in the evaluation and treatment of infertile couples. Objective: To evaluate the role of the diagnostic hysteroscopy in infertile women with normal HSG. Patients and Methods: This cohort observational study was carried out at Ahmed Maher Teaching Hospital, Egypt, from November 2019 till May 2020, on one hundred women Patients having primary infertility. Results: The mean age of the studied cases was 29.58 ± 6.75 with range (20-40). The mean period of infertility was 4.89 ± 1.07 with range (3-7), the mean BMI was 28.27 ± 2.13 with range (25-32). There were 10% illiterate, 45% with moderate education and 45% with high education, there were 92% Primigravida and 8% multigravida, and there were 92% with primary type of infertility, and 8% with secondary type of infertility. There were 17% with diabetes, 28% with hypertension and 13% with previous pelvic surgery. Among the studied cases, there were 38 with detected abnormality, i.e. (5%) endometrial polyp, (2%) Cervical Polyp, (6%) cervical stenosis, (3%) chronic endometritis, (3%) hypertrophic endometrium, (2%) atrophic endometrium, (5%) Intrauterine adhesions, (4%) Cornual fibrosis, (2%) cornual inflammation, (4%) Sub mucous myoma and (2%) septum. There was no significant difference between the cases who detected abnormality and who didn’t as regard age, period of infertility, BMI, education, parity and type of infertility. There was no significant difference between the cases who detected abnormality and who didn’t as regard menstrual history. There was no significant difference between the cases who detected abnormality and who didn’t as regard diabetes, hypertension and previous pelvic surgery. Conclusion: The incidence of uterine pathologies (congenital and acquired) in women with primary or secondary infertility approximated 30%, thus, justifying, the use of diagnostic hysteroscopy in the primary routine investigation of infertile women.

The pathogenesis of odontogenic lesions could be explained by the presence of stem cells as those odontogenic lesions contain a small number of stem cells. Many odontogenic tumors have been reported to originate from stem cells that present in remnants of the dental lamina. The maintenance of stem cells in early dental development is regulated by variety of transcription factors such as OCT-4, SOX-2, CD44, Nanog, Stat-3 and c-Myc. The aim of this study is to evaluate and compare the immunoexpression of two stem cell markers, which are CD44 and c Myc, in dental follicles and in benign epithelial odontogenic lesions. The study included 8 specimens of dental follicle, 6 specimens of inflammatory cysts, 8 specimens of odontogenic keratocyst and 8 specimens of dentigerous cysts. All cases of dental follicles showed positive immunoreaction for the two markers. Regarding c Myc all cases showed +ve immunoreaction except (OKC) were –ve. Regarding CD44 all cases showed +ve immunoreaction. Results of the present study characterize the presence of stem cells in dental follicle and in benign odontogenic lesions illustrating their role in the pathogenesis of these odontogenic lesions.

Background: Colorectal carcinoma (CRC) is one of the most common human cancers. It is the fourth most common cause of death from cancer. Colorectal cancer is the third most common cancer in men and the second in women worldwide. Objective: To evaluate the immunohistochemical expression of KAI-1/CD82 in different stages of colorectal carcinoma and to evaluate the biological behavior of tumor and target therapy. Patients and Methods: Thirty formalin-fixed, paraffin-embedded tissue of colorectal carcinoma (obtained from archive of Al-Azhar University Hospital Labs and some private labs). Clinicopathological and histological features were taken from files and confirmed by H&E examination. Immunohistochemical study was done by using CD82/ (KAI-1) marker. Results: CD82 showed an insignificant relation with age, sex, site of tumor and degree of differentiation. A significant inverse relationship was detected between CD82 expression in tumor cells and tumor stage according to modified Duke's staging. Insignificant relation between age, sex, site and grade. Conclusion: The decreased membranous and/or cytoplasmic expression of CD82 might be used as a prognostic marker to monitor patient with colorectal cancer.

Background: Glaucoma is a known cause of irreversible blindness worldwide. Several techniques are used for its diagnosis and follow-up. Optical coherence tomography angiography (OCTA) is new technology that provides a quantitative assessment of the microcirculation of the retina and optic nerve in a rapid, noninvasive method. Objective: To evaluate the changes at the macular vessel density (MVD) in primary open glaucoma patients (POAG) to correlate these changes with the changes of both ganglion cell complex (GCC) thickness and retinal nerve fiber layer (RNFL) thickness. Patients and Methods: Fifty healthy participants and fifty primary open angle glaucoma (POAG) subjects underwent visual field analysis, measurement of the whole image MVD, measurement of the average (RNFL) thickness, and measurement of the average thickness of (GCC). The area under the curve (AUC) was assessed for each parameter to differentiate POAG from healthy eyes. Results: MVD was lower in POAG than in the control group. The glaucomatous group showed that MVD was 21.18 ± 2.6 at the fovea, while it was 39.5 ± 4.71 at the parafovea. There was a statistically significant positive correlation between MVD (foveal and parafoveal (especially at the superior quadrant) and the mean deviation (MD) (R+ve, P < 0.05). There was a statistically significant positive correlation between MVD and structural parameters. The ROC curves showed that the cut-off points were < 28.2 and < 48 for MVD at the fovea and parafoveal area respectively, at the superficial vascular plexus with 100% sensitivity & 100% specificity between the controls and POAG eyes. Conclusions: MVD was reduced in cases with POAG compared to the control group. The assessment of macular vessel density by OCTA gave us good diagnostic abilities for diagnosis and management of glaucoma.

Background: Diabetic retinopathy is a common deficiency of diabetes mellitus. Diabetic macular ischemia [DMI] is a permanent form of diabetic maculopathy, and its presence reduces the potential benefits of diabetic retinopathy management. Optical coherence tomography [OCT] is used to precisely and reliably measure the macular thickness and outline the retinal layers. Optical coherence tomography angiography [OCTA] can be utilized as a reliable tool to classify the superficial capillary plexus [SCP], the deep capillary plexus [DCP] and the capillary non-perfusion [NP]. Aim of the work: The current research aimed to investigate the correlation between macular non-perfusion that diagnosed by OCTA and patterns of macular layers that diagnosed by OCT scans through the same parts, in a trial to help in the evaluation of both structural and vascular integrity. Patients and Methods: The study included 250 eyes of 125 diabetic patients. All study participants were scanned by OCTA. OCT angiograms were re-sampled with OCT scans from the same region, permitting synchronous evaluation of structure and blood flow. Results: 250 of 125 diabetic patients were categorized into two groups according to capillary NP, ischemic [G1] and non-ischemic [G2]. In current study the incidence of DMI was 40%. The incidence of DCPNP was 100% in eyes with DMI while the incidence of SCPNP was 71%. The incidence of foveal avascular zone [FAZ] irregularity, disorganization of the retinal inner layers [DRIL], inner/outer segment IS/OS and external limiting membrane ELM disruptions were 100%, 83%, 95%, 71% respectively among eyes with DMI. DCPNP was more found in all eyes with FAZ irregularity, DRIL, IS/OS and ELM disruption than SCP NP which makes it as the central cause of structural changes in the retina during ischemia. There was a strong positive correlation between the appearance of FAZ irregularity, DRIL, IS/OS and ELM disruption with each of the duration and severity of DR. Conclusion: FAZ irregularity, DRIL, IS/OS and ELM disruption are considered reliable OCT/OCTA findings that reflect an underling DMI and their existence can influence the visual prognosis.

Background: Myocardial infarction (MI) accompanies with different mechanical complications including ischemic mitral regurgitation (IMR) which is correlated with increased risk of mortality and heart failure. IMR existence and its severity had significant prognostic effect on patients’ mortality following acute myocardial infarction (AMI). Echocardiography is the choice imaging modality for the diagnosis and assessment of IMR and establishing its etiology. IMR usually results from papillary muscle displacement, ventricular dilation and remodeling with reduced closing forces. Objective: Assessment of the correlation between echocardiographic severity of ischemic mitral valve regurgitation following acute myocardial infarction and its electrocardiographic location. Patients and methods: This was a prospective study that included 100 patients admitted to CCU OF Beni-Suief General Hospital in the period from October 2019 to May 2020 . Those patients were divided on two equal groups: Group I: patients with STEMI and no, trivial or mild MR and Group II: patients with STEMI and moderate or severe MR. Results: Mean age of group I involved in the study was 55.44 ± 7.23 years and 70% of them were males. Mean age of group II was 58.38 ± 7.8 and 56% were males. 70 % of the group II had inferolateral STEMI compared to group I who had more anterior STEMI. Group II were more smokers with hyperlipidemia. Group II was with higher previous stable and unstable angina, with less streptokinase treatment, with higher abnormal chest radiogrgh and higher killip class. Group II had significantly lower EF and higher LVEDD, LVESD, LA diameter, RV diameter, MV A velocity, tricuspid valve excursion TAPSI and pulmonary artery pressure and more diastolic dysfunction. Mechanism of IMR in case group was mono leaflet tethering in 43 cases, both leaflet tethering in 7 cases and ring dilation in 30 cases. MR jet direction was medial commissure posterior in 31 (62%), lateral commissure anterior in 12 (24%), and both commissures central in 7 (14%) cases. Conclusion: Mitral regurgitation is common after acute myocardial infarction, especially in cases with inferior mitral regurgitation. The echocardiographic findings are indicative of left ventricular remodeling and abnormality of mitral valve apparatus.

Background COVID-19 associated critical illness characterized by rapidly evolving acute respiratory failure (ARF) can develop, especially on the grounds of hyperinflammation. Aim and methods A case-series of 61 patients admitted to our intensive care unit (ICU) between August 12 and September 12, 2020 with confirmed COVID-19 pneumonia and rapidly evolving ARF requiring oxygen support therapy and/or mechanical ventilation was retrospectively analyzed. We examined whether intravenous administration of tocilizumab, a monoclonal interleukin-6 receptor antibody, was associated with improved outcome. All patients received empiric antivirals, dexamethasone 6 mg/day for 7 days, antibiotics, and prophylactic anticoagulation. Tocilizumab was administered at a dosage of 8 mg/kg [two consecutive intravenous infusions 12 h apart]. Outcome measures such as mortality on day-14, ICU length of stay, and rate of nosocomial acquired bacterial infections were also analyzed. Results: Patients were males (88.2%) aged 51 [interquartile range (IQR): 42.5–58.75)], with admission Acute Physiology and Chronic Health Evaluation (APACHE) 4 score of 53 (IQR: 37.75–72.5), and had more than one comorbidity (62.3%). On admission, twenty nine patients (47.5%) were mechanically ventilated, and thirty two patients (52.5%) were receiving oxygen therapy. No serious adverse effects due to tocilizumab therapy were recorded. However, twelve patients (19.6%) developed nosocomial acquired infections. ICU length of stay was 13 (IQR: 9–17) days, and mortality on day-14 was 24.6%. Six patients were shifted to other hospitals but were followed-up. The overall mortality on day-30 was 31.1%. Non-mechanically ventilated patients had higher survival rates compared to mechanically ventilated patients although results were not significant [hazards ratio = 2.6 (95% confidence intervals: 0.9–7.7), p = 0.08]. Tocilizumab did not affect the mortality of critically ill COVID-19 patients. Conclusion Tocilizumab could be an adjunct safe therapy in rapidly evolving COVID-19 pneumonia and associated critical illness., Highlights • Rapidly evolving respiratory failure is a hallmark of COVID-19-critical illness. • Tocilizumab could be an adjunct safe therapy in critically ill COVID-19 patients. • Tocilizumab did not affect the mortality of COVID-19 critically ill patients. • The prevalence of bacterial infections post-tocilizumab therapy was 19.8%.

Background: Hypertensive disorders complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality. Objective: To evaluate the role of middle cerebral artery and umbilical artery pulsatility index (PI) ratio in predicting neonatal outcome in pregnancies induced hypertension. Patients and methods: This study which included 100 women with severe preeclampsia admitted to Alsayed Galal University Hospital during the period between November 2018 and July 2019. Were evaluated the accuracy of middle cerebral/umbilical artery pulsatility index ratio in predicting admission to neonatal intensive care unit (NICU), acidemia and low Apgar score at 5 minutes after birth in neonates of severe preeclamptic pregnant women. Results: The best cut off value of middle cerebral artery (MCA) / umbilical artery (UA) PI ratio for prediction of NICU admission was sensitivity 62.5%, specificity 71.43%, positive predictive value (PPV) 29.41%, negative predictive value (NPV) 90.91% and the accuracy 70%. The cut off value of MCA/UA PI ratio for prediction of low Apgar score at 5 min was 50% sensitivity and 88.10% specificity. Estimated positive predictive value =44.44 and negative predictive value =90.24, and the cut off value of MCA/UA PI ratio for prediction of low UA PH were 43.75% sensitivity, 69.05% specificity, estimated positive predictive value =21.21, and negative predictive value =86.57. Conclusion: Doppler data combining both umbilical and cerebral velocimetry provides information on consequences of the placental abnormality; Hence, Doppler can be a useful tool in the management of patients with preeclampsia and can help in deciding the time of delivery so that the fetus can be saved.

Background: Diabetes Mellitus causes many systemic and oral complications including impaired wound healing. Recently, platelet-rich plasma (PRP) treatment to utilize a patient’s own platelets and growth factors to improve healing at the site of injury has been used extensively. Objective: Evaluation of the effect of PRP on tongue wound healing in normal and Streptozotocin-induced diabetic albino rats by H&E and Masson's trichrome histological stains and by TEM ultrastructural examination. Methodology: A total number of 108 adult male albino rats with average weight 200gm, were used in the experiment. The rats were classified into two main groups: non-diabetic and diabetic groups. Each group was further divided into three subgroups: non-treated wound, PRP-treatment before wound, and PRP-treatment after wound. Tongue specimens were dissected on postoperative days 3, 7, and 10. The specimens were examined histologically by H&E and MT, and ultra-structurally by TEM. Results: The most rapid wound healing was revealed in the non-diabetic and diabetic subgroups treated with PRP before the wound, which occurred very early at the 3rd day postoperative. While complete wound healing was revealed at the 7th day postoperative in both the non-diabetic and diabetic subgroups treated with PRP after the wound, which was like the non-diabetic control subgroup. Whilst, the diabetic non-treated subgroup was the last to show wound healing which took place at the 10th day postoperative. Conclusion: PRP could be applied before or after wounding occurs, to prevent impaired wound healing and to enhance wound healing in diabetic and non-diabetic oral mucosal wounds.

Background: long term high blood pressure is a major risk factor for coronary artery disease, stroke, heart failure, peripheral vascular disease, vision loss and chronic kidney disease.Objective: the aim of this study is to demonstrate the relation between left ventricular diastolic dysfunction, increased left ventricular mass and ambulatory blood pressure recording in subjects not known to be hypertensive. Patients and Methods: this study is cross sectional study that was carried out on (100) normotensive patients in Cardiology Department Clinic at Matrouh Specialized Cardiothoracic and Interventional Catheterization Center from October, 2017 to January 2019. Results: significantly marked difference in left ventricular (LV) mass between two groups (normal blood pressure and latent hypertension) and significantly marked difference in diastolic dysfunction. According to (normal circadian and impaired circadian) there is significant difference between the two major groups in sex wheremale >female and marked difference in LV mass between the two groups (normal circadian and impaired circadian) and in smoking. Conclusion: ambulatory blood pressure (AMBP) plays an important role as a predictor to estimate prevalence of hypertension based on diastolic dysfunction and increased left ventricular mass in persons with normal blood pressure measures at office specially masked hypertension in white coat hypertensive patients.

Background: Preterm children present more often than children born at term with neurological problems that include severe neurological handicaps, such as cerebral palsy or severe mental retardation, or more subtle cognitive impairments. Purpose of the study: To investigate the relation between visual motor integration and cognitive development in full term versus preterm infants. Subjects: One hundred and twenty infants (full term & preterm infants) from both sexes, their ages ranged from 6 to 24 months. They were selected from Saray El-kobba Medical Center & Sawa Academy Nursery in Cairo (Ain shams area). Methods: Children were divided into 2 groups of equal number, Group A: Included sixty full term infants and Group B: Included sixty preterm infants (low risk preterm). Within the 2 groups children were subdivided into 3 subgroups according to their chronological age for full term and corrected age for preterm. The participants of both groups were assessed by the following tools to assess their visual motor integration and cognition by The Peabody Developmental Motor Scales–Second Edition (PDMS-2) and the Portage Guide to early childhood education: (Arabic version) respectively. Results: The results revealed that there was a strong positive correlation between PDMS-2 and Portage scale in full term sub groups (6-12months), (12-18 months) and (18-24 months) scores [( r= 0.48, p=0.03), (r=0.84, p=0.0001) and (r=0.75, p=0.0001) respectively]. There was strong positive correlation between PDMS-2 and Portage scale in preterm subgroups (6-12 months), (12-18 months) and (18-24 months) scores [(r=0.84, p=0.0001) – (r=0.63, p=0,003) –(r=0.88, p=0.0001) respectively]. Conclusion: Based on this study, it could be concluded that there is a relation between visual motor integration and cognitive development in full term versus preterm infants.

Chronic renal failure (CRF) is associated with male gonadal dysfunction that may lead to impotence, reduced libido, reduced size of testes and impaired spermatogenesis. The present study assesses the protective impact of Raphanus sativus seed extract (RSE) on testicular dysfunction and infertility associated with CRF induced by adenine in male rats. Twenty adult male albino rats were divided into four groups (5 each) and received their treatment for 4 weeks: group I, control; group II, (RSE): (0.52 ml/kg) orally via stomach tube, group III, (AD): (0.75 % W/W in diet), group IV, (RSE+ AD): received RSE and AD the same dose and route as groups II and III daily. The results showed a significant decline in the body weight gain, testicles and epididymides weights, testosterone level, semen quality ( sperm count, motility, and viability), reduced glutathione (GSH) level, superoxide dismutase (SOD) and catalase (CAT) activities, and increase in kidney weight, serum creatinine (SCr), BUN, uric acid, FSH & LH levels, sperm abnormality, malondialdehyde (MDA) & nitric oxide (NO) in AD treated rats, and histopathological alteration in kidney and testes tissue. But, RSE and AD co-administration partially successfully blocked these parameters and prevent histological structures abnormalities that nearly remain within normal levels in comparison with AD group .

Background: Jaundice is the most common condition that requires medical attention in newborns. The yellow coloration of the skin and sclera in newborns with jaundice is the result of accumulation of unconjugated bilirubin. Objectives: To assess the efficacy of intensive phototherapy as a treatment modality for neonatal hyperbilirubinemia. Subjects and methods: This was A prospective, cohort, controlled study that was conducted on 100 babies with neonatal jaundice. They were admitted to Luxor General Hospital NICU at the beginning of November 2018 to the end of October 2019. Those 100 cases had been divided into 2 groups: the first group received intensive phototherapy sessions as a treatment modality for neonatal jaundice and the second group received conventional phototherapy. Results: The results of the study revealed that intensive phototherapy had succeeded in decreasing the need for exchange transfusion in 39 cases (78 %), whereas 11 cases (22%) remained for exchange transfusion (p value (0.001) was highly significant). Conclusion: The use of intensive phototherapy in the treatment of indirect pathological hyperbilirubinaemia is as effective as exchange transfusion in lowering total serum bilirubin when its level is within 2-3 mg/dl (34-51 µmol/l) of the exchange level and it is effective in reducing needs for exchange transfusion and duration of phototherapy.

Background: Burns are one of the most common forms of trauma in children. Providing adequate care for burnt children properly is the most important contribution to the successful management. It aimed to determine nurses’ care provided to burn children at assiut hospitals. Research design: A descriptive research design was utilized in the current study. Sample a convenience sampling (50) nurses working at burn unit in Assiut University Hospital, Assiut General Hospital and El-Emane Elarbaeen Hospital. Two tools were used to collect the necessary data, interview questionnaire sheet and observational checklists. Results It was found that (96.0%) had incompetent level of knowledge regarding burn and its management while (74%) of them had competent level of practice regarding nurses' care of pediatric burn. There was statistically significant positive co-relation between total mean score of nurses’ knowledge and practice (P= 0.036). Conclusion: the majority of nurses had incompetent level of knowledge and more than two thirds of them had competent practice care. Recommendations: Periodical educational training programs for nurses working at burn unit are mandatory for updating knowledge and to maintain effective practice

Background We have previously shown in renally impaired (RI) CHB patients, including those with ESRD on HD, that switching to TAF from TDF and/or other OAVs maintains high rates of viral suppression with stable bone and renal safety parameters at Week 48. Here we present the final Week 96 results. Methods In this study, virally suppressed CHB patients (HBV DNA Results Of 93 patients (mod-severe RI 78; ESRD on HD 15), most (74%) were male and Asian (77%), 51% ≥65 y, 83% HBeAg-negative, 34% cirrhosis, and median ALT 17 U/L. Up to 24% had osteoporosis at hip and/or spine, with most having comorbidities. Twelve (13%; 11 mod-severe RI and 1 ESRD) patients discontinued the study early (5-withdrew consent, 3-deaths [none treatment-related], 2-AE, 2-investigator decision). Viral suppression (HBV DNA Conclusions Renally-impaired CHB patients, including ESRD patients on HD, who were switched to TAF from TDF and/or other OAVs maintained high rates of viral suppression, and bone and renal parameters remained stable or slightly improved after 2 years of treatment.

Eosinophilic pleural effusion can be the first presenting feature of a wide range of diseases, with malignancy being the commonest cause. Elevated levels of eosinophils could be an indicator of a favourable prognosis. In clinical practice, malignant lymphomas have been rarely associated with eosinophilic pleural effusions. In this report, we present the case of a 37-year-old otherwise healthy woman, who initially presented with a cough of five months' duration. Diagnostic workups including pleural and lymph node biopsies confirmed the diagnosis of nodular lymphocyte-predominant Hodgkin’s lymphoma.

Cerebral cavernous malformation (CCM) is a developmental abnormality of blood vessels that supply the brain. It is composed of large, adjacent capillaries which contain little or no neural tissue. They mostly occur in the supratentorial region. However, the occurrence of these vascular lesions can be seen at different sites of the central nervous system (CNS). The prevalence of CCM is estimated to be 0.4% in the general population and among the affected patients, 18.7% have multiple lesions. However, about 30-50% of CCM cases are asymptomatic and are found incidentally. Here we report a case of an eight-year-old girl with a massive hemorrhagic presentation of a left parietooccipital CCM.

Objective To assess the role of various anatomical variation of the nose in the pathogenesis of contact point rhinogenic headache of noninfective or organic cause and to evaluate the role of endoscopic surgery with removal or correction of the anatomical variation that caused headache in the management. Patients and methods This study included 30 patients with refractory or resistant headache for more than 1 year and diagnosed to have sinonasal anatomical variations. They were presented to the outpatient clinics of Al-Zahraa University Hospital in the period from May 2015 to May 2018. There ages ranged from 18 to 34 years. A total of 20 (66.7%) patients were males and 10 (33.3%) were females. Data from this group were analyzed retrospectively. Results Multiple anatomical variations were noted by endoscopy and computed tomographic scans in 30 patients. These variations included septum deviation in 30 (100%) patients followed by hypertrophied inferior turbinate in 15 (50%) patients then concha bullosa in 14 (46.7%) patients. In these 30 patients, 25 (83.3%) cases showed complete cure, three (10%) cases showed improvement, whereas two (6.7%) cases were unsatisfied. Conclusion Minor intranasal anatomical variations or hidden infection may be the cause of primary headache misdiagnosed as a headache of unknown etiology. The functional endoscopic sinus surgery had succeeded in eliminating or significantly reducing headache attacks.

Background: Irritable bowel syndrome is a symptom-based condition defined by the presence of abdominal pain or discomfort, with altered bowel habits, the diagnosis could be reached using symptom-based diagnostic criteria without the need for exhaustive investigation; however interest in the potential for a missed organic GI disease in patients diagnosed IBS has increased over the last years. Objective: This study aimed to evaluate the role of colonoscopy in diagnosing organic diseases in patients with colonic symptoms compatible with Rome IV criteria of Irritable bowel syndrome as well as studying the effect of the presence or absence of alarm features on detecting organic lesions Patients and methods: A cross sectional study was carried out on 50 patients fulfilling the Rome IV criteria for IBS. The study was conducted in in the department of Hepatogastroenterology, Al-Azhar university Hospitals from December 2018 to May 2019. Patients were selected and divided into two equal groups: Group A: fulfilled Rome IV criteria for IBS without alarm features, and Group B: included 25 patients fulfilled Rome IV criteria for IBS with alarm features. All patients underwent full colonoscopy along with biopsy from colon was taken for histopathological examination. Results: The mean age of participants was 40.12 years. Males were 27 (54%) while females were 23 (46%), Eleven of 50 patients (22%) fulfilling Rome IV criteria of IBS had organic colonic diseases. There was higher prevalence of organic GI lesions in patients who reported alarm features. Microscopic colitis was the predominant organic disease among studied patients. IBS-D has the highest contribution to the total number of organic diseases. Conclusion: Up to one in six patients meeting criteria for IBS without alarm features in routine clinical practice may have underlying organic GI lesions, and this increased to one in four patients if alarm features were present .

Background: Apelin is an endogenous ligand for the G protein-coupled receptor Apelin receptor (APJ), The expression of both apelin and APJ has been detected in a variety of tissues including heart, brain ,ovary , placenta and uterus. Aim of the Study: This study was designed to examine the circulating levels of apelin, estradiol, progesterone, glucose, insulin and Tumor necrosis Factor alpha (TNF α) in non-pregnant, pregnant rats at different stages of pregnancy. Materials and Methods: Sixty adult albino rats (48 females and 12 males). Female rats were randomly divided into (non -pregnant rats, early pregnant rats on day 6 of gestation, mid pregnant rats on day 12 of gestation and rats late pregnant rats on day 19 of gestation. The blood samples were obtained from the orbital venous plexus of animals and serum was separated from each blood sample and kept deep frozen until analysed. Results: The present study revealed that the serum levels of apelin were progressively and significantly increased from early (day 6) to mid-pregnancy (day 12) of gestation when compared to non- pregnant rats then showed a marked decrease on day 19 when compared to pregnant rats on day 12 of gestation. Conclusion: The fluctuations in serum apelin levels during pregnancy may be attributed to changes in serum levels of multiple interrelated factors such as insulin, insulin resistance, pro inflammatory cytokines such as TNF α and other factors such as changes in fat mass, the expression of angiotensin converting enzyme related carboxy peptidase-2 (ACE 2) and hormonal levels during pregnancy.

Oral myofibroma is an uncommon benign tumor that has great tendency to involve oral soft tissues with bony involvementremains a rarity. Most myofibromas exhibit a benign slow clinical course however intra-osseous lesions could be mistakenwith many aggressive tumors which necessitate accurate diagnosis. The aim of this report is to shed light on a rare caseof infantile central myofibroma of the mandible. Case report: A 6-month-old girl presented with an expansible painless leftmandibular swelling. Radiographic examination revealed a well-defined, unilocular, radiolucent lesion with cortical erosions.Histopathological examination showed a highly cellular, encapsulated mass comprised of spindle-shaped and smaller roundor polygonal cells in a vague biphasic pattern. Immunohistochemically, tumor cells showed strong cytoplasmic staining forα-SMA, weak Ki-67 and negative desmin, CD34 and S-100 protein. Accordingly, conservative surgical excision with bonecurettage was performed. Postoperative follow-up revealed excellent healing with no evidence of recurrence.

Background Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children that may be due to micro or macrovascular complications. Diabetic renal disease or nephropathy is a common complication of DM, clinically silent and the only detectable abnormality due to the presence of microalbuminuria. Subjects and methods This study was a case-control study. Participants were classified into two groups. The first group included 40 children with T1DM and the second group included 30 matched healthy controls. Serum apelin (APLN), chemerin, cholesterol, and triglycerides (TG) levels were measured for each case. Also, albumin/creatinine ratio was analyzed in random urine sample. Results Comparison between T1DM patients and controls revealed that serum apelin, chemerin, cholesterol, TG levels, and albuminuria were significantly increased in cases compared to their controls. Significant positive correlations were found between HbA1c% and albuminuria for APLN and chemerin in the diabetic group. Whereas significant negative correlations were found between apelin and glomerular filtration rate (GFR). Conclusion Increased levels of serum apelin and chemerin in T1DM patients may be considered as promising adipokines for the development of diabetic complication.

The ultimate goal of the present study was, to evaluate the effectiveness of Coenzyme Q10 (CoQ 10) supplementation as an adjunct to scaling and root planing in reducing gingival inflammation and periodontal tissue destruction in chronic periodontitis patients with type II diabetes mellitus (DM).Material and Methods: Thirty patients with chronic periodontitis and type II DM were equally divided into 2 groups. Group I received scaling and root planing plus placebo capsule for 3 months and groups II received scaling and root planing and Coenzyme Q10 for 3 months. Bleeding on probing and gingival index were taken at baseline,1, 3 and 6 months’ evaluation periods while probing pocket depth, clinical attachment loss at baseline, 3 and 6 months only. Gingival crevicular fluid (GCF) samples were collected for measuring matrix metalloproteinase -8 (MMP-8) in GCF at baseline,1, 3 and 6 months’ evaluation periods.Results: Statistical analyses demonstrated a significant reduction in clinical parameters from baseline to 6 months in group II (test group) as compared to their baseline value P 0.05. Intergroup comparison showed statistically significant differences between the two studied groups at all the study evaluation periods in favor to group II (test group). GCF-MMP-8 levels showed statistically significant continual reduction from baseline up to 3 months followed by slight increase at 6 months which is still below baseline value for both group PConclusions: from the results of the present study it is clear that dietary supplementation with CoQ 10 may provide a low-cost intervention to augment periodontal therapy. Hence, CoQ 10 as an antioxidant could be used safely as an effective adjunct to oral prophylaxis in treatment of chronic periodontitis in diabetic patients.

Background: Circulating procalcitonin (PCT) is an inflammatory marker produced by several cell types including adipose tissue following cytokine stimulation. In contrast to its role in the general population, obesity has been associated with improved survival in chronic renal failure patients undergoing haemodialysis. The aim of our study was to evaluate the link between plasma PCT concentration and metabolic parameters of obesity in chronic hemodialysis patients. Patients and methods: We determined PCT in 80 subjects; they were divided into: 30 obese, body mass index(BMI)>28Kg /m2, chronic renal failure patients’ undergoing haemodialysis, 30 non obese, body mass index(BMI) 28Kg/m2,normal healthy subjects as control. Complete clinical examination and laboratory investigations were done. Results: Elevated plasma procalcitonin (PCT) levels, within the normal range, of the 80 subjects included was not dependent on anthropometric measures including body weight, height, body mass index and waist circumference. It was found to be correlated to age (0.020, P

Background: Acquired Immunodeficiency Syndrome epidemic (AIDS) is one of the most serious public health challenges facing the world today. Aim of the study: to assess perception of non-medical faculties students at Minia University toward acquired immunodeficiency syndrome. Research design: A descriptive cross-sectional research design was utilized in the present study. Setting: This study was conducted at Minia University of selected three non-medical faculties classified into (faculty of Art Education, faculty of Tourism and Hotels and faculty of Dar-ELuloom). Subjects: A simple random sample of 602 students at Minia University, Egypt is included in this study. Tool of data collection: A structured form of interviewing questionnaire was used including three parts, demographic data such as faculty name, student name, age, sex, residence, marital status, academic year. Knowledge about AIDS. Attitudes toward AIDS. Results: the majority of the studied students have low knowledge and the lowest knowledge was in faculty of art education (90.7%) with statistically significant difference (p=0.002), the majority of the studied students have positive attitude (82.9%) and the majority was in faculty of Dar-ELuloom (85%). No correlation between knowledge and attitude, it was weak positive correlation. Conclusion: the majority of the studied students have low knowledge with statistically significant difference and the lowest knowledge was in faculty of art education and the majority of the studied students have positive attitude. No correlation between knowledge and attitude. Recommendations: It was recommended that an increase in community knowledge on acquired immunodeficiency syndrome and human immunodeficiency virus promotes more positive attitudes towards people living with human immunodeficiency virus.

Cattle are one of the farm animals of huge economic significance as the main source for meat and milk production in Egypt but their productivity is thought to be greatly reduced by blood protozoan parasitic diseases caused by tick borne blood parasite such as babesiosis and theileriosis Babesiosis and theileriosis are one of the most important and serious pathogenic protozoan diseases infect these animals in Egypt with highly prevalent and caused by Babesia and Theileria species The most practical and widely used method to control such disease is the chemical control of ticks with acaricides and treatment of infected animal but both way of control are not always fully effective and hence vaccination is the most sustainable option Many epidemiological factors are responsible for causing parasitic infections in cattle So proper monitoring diagnosis immunization and control of parasitic infections in cattle in Egypt are required for sustainable growth and proper development of cattle management program Therefore knowledge of prevalence of blood protozoan parasites and current species will help to minimize the economic losses in cattle sector So this short review might have been spotted the light on the current prevalence of such infections in cattle in Egypt with special attention to diagnostic tools and treatment used for this purpose

Since the emergence of the first cases of COVID-19 viral pneumonia late 2019 several studies evaluated the benefits of different treatment modalities. Early in the pandemic, the interleukin 6 (IL-6) receptor antibody Tocilizumab was considered in view of the cytokine release syndrome associated with COVID-19 infection. Several early observational studies showed beneficial effect of treatment with Tocilizumab on mortality, however, results from well-designed randomized clinical trials (RCT) were contradicting.ObjectivesTo perform a systematic literature review and meta-analysis of RCTs utilizing Tocilizumab in the treatment of COVID-19 pneumonia, with in-hospital mortality as a primary objective, while secondary objectives included composite outcome of mortality, intubation, or ICU admission, another secondary outcome was super added infection.MethodThis was a random effects model (DerSimonian and Laird) model of relative risk (RR), along with corresponding 95% confidence intervals, p values, and forest plots of both primary and secondary outcomes. A fixed effect sensitivity test was performed for the primary outcome, in addition to subgroup and meta-regression analyses with predefined criteria.ResultsThe primary outcome of mortality showed statistically insignificant reduction of mortality with Tocilizumab (RR = 0.9, 95% CI: 0.8 – 1.01; p = 0.09) although with an unmistakable apparent clinical benefit. There was a significant reduction in the RR of the secondary composite outcome (RR = 0.83, 95% CI: 0.76 – 0.9; p < 0.001), and no difference between groups in super-added infection (RR = 0.77, 95% CI: 0.51 – 1.19; p = 0.24). Treatment protocol allowing a second dose was the only significant predictor of improved mortality in the meta-regression analysis. Certainty of evidence was reduced to moderate for the primary outcome and the secondary outcome of clinical deterioration, while it was reduced to low for the secondary outcome of super-added infection.ConclusionModerate certainty of evidence suggest no statistically significant improvement of 28-30 day all-cause mortality of hospitalized COVID-19 patients treated with TCZ, although there may be clinically important value. Moderate certainty of evidence suggest lowered relative risk of a composite outcome of death or clinical deterioration, while, low grade evidence indicate no increase in the risk of super-added infection associated with TCZ treatment. A protocol allowing two doses of TCZ shows evidence of improved mortality as compared to a strictly single dose protocol.

Dendriform pulmonary ossification (DPO) is a rare interstitial lung disease characterised by the presence of mature bone with marrow elements in the lung parenchyma with typical radiologic findings of diffuse and numerous calcified nodules. In this case study, we are presenting a case of asymptomatic primary DPO discovered during routine screening chest X-ray. To our best knowledge, this is the first case of DPO reported in Bahrain.

Identification of risk factors is crucial to find ways to reduce rabies deaths. We investigated the hospital records of rabies deceased through contact tracing of the relatives of the victims using enhanced verbal autopsies (VA) to identify why the people had to die from rabies in recent years in Bangladesh. Patients whose deaths were confirmed by physicians based on the history of animal exposure and clinical signs were taken into account for VA. Socio-demographic profile of the deceased, animal exposure, nature of the wound, and history of post-exposure prophylaxis (PEP) data were obtained and analysed. The study found 256 cases in which the cause of death was attributed to rabies, most of the victims were male (71.88%), resided in the rural community (80.47%), dependent (49.22%), and children below the age of 15 years (47.27%). Dogs were the single most responsible (81.64%); however, cats (12.11%), jackals (3.91%) and mongoose (2.34%) were also found accountable for rabies incidence (P < 0.05). Significantly, limbs were the most common (67.97%) site of exposure, and the shortest incubation period was identified in the case of bites to head and face (P < 0.05). The majority (86.72%) of the deceased did not receive any PEP; whereas, 66.80% sought treatment from traditional healers. Among the deceased (13.28%, n = 34) who had received PEP, only 8.82% of them completed the full course of the vaccination regimen (P < 0.01); however, none of them had history of taking rabies immunoglobulin (RIG). The study recommends extensive public health awareness programs in the rural community and establishing methods to improve healthcare-seeking behaviours, including receiving PEP instead of visiting traditional healers. Moreover, the availability and accessibility of PEP in the government hospital facilities are desirable, and laboratory-based surveillance with compatible rapid data reporting may be incorporated in the existing policy., Epidemiology; Public health; Infectious disease; Bangladesh; Rabies; Vaccine; Verbal autopsy.

Background: Descending necrotizing mediastinitis [DNM] is a serious complication of odontogenic infections, being associated with a high mortality rate. The diagnosis, classification, and managemen...

Vaccinating dogs against rabies is an effective means of reducing human rabies. We subjected 1327 clinically diagnosed human rabies death and mass dog vaccination (MDV) data during 2006–2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (422) for clinico-epidemiological analysis. A positive and increasing trend of MDV (p = 0.01 and tau = 0.71) and a negative and declining trend (p

BACKGROUND: Sofosbuvir (SOF) was published in 2013 as a part of first-line treatments for hepatitis C virus (HCV); it has activity against all genotypes with extrahepatic adverse effects have recently arisen. AIM: Investigating sofosbuvir-induced alterations in the rat submandibular salivary gland (SMSG). METHODS: A group of 80 adult albino rats weighing about ± 150 gm were used in the experiment. The rats were divided into 3 groups: Group I (control group) received distilled water, Group II (experimental group) divided into 2 subgroups and received SOF 40 mg/kg/day dissolved in distilled water for 1 and 3 months and Group III (recovery group) allowed for 1 month of recovery after SOF withdrawal. All animals were sacrificed; the SMSG was dissected, and specimens were examined histologically and ultra-structurally. RESULTS: Compared to Group I, Group II subgroup (1) showed acinar and ductal vacuolisation, discontinuity of the epithelial lining associated with retained secretion and congested blood vessels. These changes were found to be exaggerated in the subgroup (2) accompanied by acinar and ductal shrinkage, interstitial oedema, haemorrhage, chronic inflammatory cells infiltration and loss of gland compactness. Amelioration of the histological changes was detected in Group III after SOF withdrawal. The ultrastructural examination confirmed the histological results. CONCLUSION: SOF had induced apparent alterations in the structure and ultrastructure of SMSG. The SOF-induced alterations were time-dependent, attributed mainly to mitochondrial toxicity and partially ameliorated by its withdrawal.

Objectives: To assess the prevalence of hypocalcemia in outpatient clinic neonates and its relation to vitamin D and calcium supplementation. Methods: This cross-sectional analytical study was conducted at the University Teaching Hospital from May to October 2016. Data were collected from 100 neonates by interviewing mothers using a structured questionnaire; which included socio-demographic information, maternal and neonatal history; in addition to investigations of serum calcium total and ionized and serum vitamin D level. Results: The prevalence of hypocalcemia was 76%, late hypocalcemia represent 52% of hypocalcemic neonates. The prevalence of hypovitaminosis D was 38%. Hypocalcemia was found more prevalent among neonates with no history of vitamin D supplementation (98.7%), no history of maternal calcium supplementation (57.9%), while they had a history of neonatal jaundice on phototherapy (46.1%) which increased to 53.8% with late hypocalcemia. Conclusion: Neonatal hypocalcemia is widely prevalent in Fayoum governorate with significant association with a history of neonatal jaundice on phototherapy, not receiving maternal calcium or neonatal vitamin D supplementation. Saudi Med J 2018; Vol. 39 (3): 247-253 doi: 10.15537/smj.2018.3.21679 How to cite this article: Elsary AY, Elgameel AA, Mohammed WS, Zaki OM, Taha SA. Neonatal hypocalcemia and its relation to vitamin D and calcium supplementation. Saudi Med J . 2018 Mar;39(3):247-253. doi: 10.15537/smj.2018.3.21679.

Objectives:To study changes in lipid profile in patients with rheumatoid arthritis (RA) and to evaluate the relation between lipid profile and disease severity of RA. Design: Cross-sectional study. Patients:Patients with rheumatoid arthritis (RA) according to 2010 ACR/EULAR classification criteria for RA (n = 150). Methods: Demographic data, arthritis history, medical and therapeutic history were evaluated. Disease activity was evaluated using DAS28 (ESR). Immunological investigations included RF, ESR, CRP, and anti-CCP.Lipid profile levels were measured. Results:Raised TG was found in 38 (25.3 %) of patients, raised TC was found in 69 (46 %) of patients and decreased HDL-C was detected in 85 (56.7 %) of the patients

Background:Type 2 diabetes mellitus is the most common single cause of end-stage renal disease (ESRD), where diabetic nephropathy (DN) is considered the cause in almost half of all patients with ESRD. Despite the availability of many modern therapies for glycemic control, there are no specific curative treatments yet for DN and many diabetic patients still progressed to severe renal damage. Currently, albuminuria is the most commonly used marker to predict onset and progression of DN clinically. However, this traditional marker for DN lacks both sensitivity and specificity to detect early stage of DN. Furthermore, there is a lack of a strong association between albuminuria and glomerular filtration rate (GFR). As such, it is crucial to find earlier and reliable markers for DN diagnosis and intervention providing an opportunity to stop the permanent damage caused by it. Objective: This study focuses on Cyclophilin A (CypA) in urine. CypA is a protein with ubiquitous characteristics, mostly distributed in the cytoplasm and facilitates protein folding and protein trafficking. It has relatively high expression level in normal kidneys. Recently, CypA has been reported to be a reliable novel marker for early diagnosis of DN. Subjects and Methods: Our study was conducted on 90 subjects of comparative age and sex. They were selected from Endocrinology Clinic after written consent at Ain Shams University Hospital and Railway Hospital. Participants were divided into: Group I: 30 healthy control subjects, Group II: 30 T2DM patients without albuminuria (normoalbuminuric), and Group III: 30 T2DM patients with albuminuric DN. Results: Our study showed that regarding the level of urinary CypA there was a highly statistical significant difference between the three groups (F= 221.730, p< 0.01), being higher in GII (normoalbuminuric) (1.69±0.87 ng/ml) than in GI (control) (0.55±0.14 ng/ml) (t= 7.04, p< 0.01) and higher in GIII (albuminuric DN) (6.01±1.61 ng/ml) than GII (t= 12.93, p< 0.001) and GI (t= 18.55, p< 0.0001). In addition, we found that urinary CypA was significant higher in GIIIb (macroalbuminuria) (7.23±0.76 ng/ml) than in GIIIa (microalbuminuria) (4.79±1.25 ng/ml) (t= 6.49, p< 0.01). It worth mentioning that, the level of urinary CypA started to increase significantly in stage 2 DN (2.49±0.50 ng/ml) in spite of normal level of albuminuria (no albuminuria) comparing with each of stage 1 DN (1.03±0.15 ng/ml), diabetics with no renal affection (0.99±0.45 ng/ml) and GI (healthy control) (0.55±0.14 ng/ml). There was significant positive correlation between urinary CypA and each of: sCr in GII (r= +0.39, p< 0.05), GIIIa (r= +0.89, p< 0.001) and GIIIb (r= +0.99, p< 0.001) and ACR in GIIIa (r= +0.93, p< 0.001) and GIIIb (r= +0.98, p< 0.001). Conclusion: Our study showed that there was a high significant difference in the level of urinary CypA between diabetic patients with any degree of renal affection and healthy subjects being higher in diabetics with renal affection even without the presence of albuminuria.

Background and Objectives: Chronic myeloid leukemia (CML) accounts for approximately 15% of newly diagnosed cases of leukemia in adults. In this study, the efficacy of nilotinib at 400 mg BID is compared with imatinib at 400 mg BID in CML patients with suboptimal molecular response after at least 12 months of daily dose 400 mg of imatinib therapy. Patients and Methods: This study included a total number of 50 patients, divided into two groups (25 patients each). The first group (Group I): Patients received imatinib at 400 mg BID, second group (Group II): Patients had a suboptimal molecular response to imatinib and received nilotinib at 400 mg BID in early chronic phase. During the two years period of data collection, the primary end included median survival. The secondary end included response rate, type of response, duration of response and progression free survival. Also side effects were recorded. Patients were followed up every month by complete and differential blood counts, liver function test, renal function test and (PCR) every three months for two year. Results: Nilotinib group had significantly higher frequency of major molecular response (MMR) where 23 (92%) patients achieved it while only 16 (64%) patients in Imatinib group achieved MMR (P = 0.01). Nilotinib had better toxicities profile than Imatinib. Conclusion: Both Nilotinib and high dose Imatinib achieved response in CML patients with suboptimal response with rapid and deeper molecular response, better survival outcomes and less side effects in nilotinib.

Objectives:To determine the prevalence of metabolic syndrome (MetS) in patients with rheumatoid arthritis (RA) and to evaluate the relation between parameters of MetS and clinical aspects of RA. Design: Cross-sectional study. Patients:Patients with rheumatoid arthritis (RA) according to 2010 ACR/EULAR classification criteria for RA (n = 150). Methods: Demographic data, arthritis history, medical and therapeutic history were evaluated. Height, weight, BMI, waist circumference (WC) and blood pressure (BP) were recorded. Disease activity was evaluated using DAS28 (ESR). Immunological investigations included RF, ESR, CRP, and anti-CCP. Fasting blood glucose and lipid profile were measured.The patient was diagnosed as having MetS according to 3 definitions; ATPIII (2004), IDF (2005), and JIS (2009). Results:Prevalence of MetS in rheumatoid patients was 48% (ATPIII definition), 52 % (IDF definition), and 46 % (JIS definition with Egyptian cut-off of WC), respectively. The most prevalent component of MetS was central obesity (75.3- 92 % according to the used definition).DAS28 was significantly higher in patients with MetS with higher number of tender joints and VAS (0-100) and most rheumatoid patients with MetS (68 %) had high disease activity. Conclusions:The increased prevalence of MetS components in RA patients, suggests greater attention be given to modifiable risk factors, including improvement of dietary habits, physical activity and blood pressure control.

Background:Posterior fossa tumors are the most common solid tumors found in the pediatric population. Approximately, 70–90% of patients with posterior fossa tumors present with hydrocephalus. This presents an interesting problem to pediatric neurosurgeons for which there remains no consensus: What is the best management strategy for hydrocephalus at the time of the initial presentation of the patient? Objective: This multicenter prospective cohort study compared endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of pediatric patients with secondary obstructive hydrocephalus due to posterior fossa tumors. Patients and Methods: Sixty four patients with posterior fossa tumors (24 medulloblastoma, 12 ependymoma, 27 astrocytoma and 1 schwannoma) associated with secondary hydrocephalus were divided into two equal groups according to the treatment procedure done to the secondary hydrocephalus either ETV or VP shunts, with a follow-up period of 6 months, were prospectively studied in this work. Results: Both procedures (ETV and VP shunt) proved to be effective clinically and radiographically. Endoscopic third ventriculostomy (ETV) proved to be superior due to shorter duration of surgery (17 min versus 58 min), no mortality (0% versus 6.25%), and lower incidence of procedure failure (15.6% versus 21.9%) with highest success rate of 100% was for astrocytomas followed by 80% for ependymomas and 63.6% for medulloblastomas. Conclusion: Both procedures (ETV and VP shunt) proved to be effective clinically and radiographically in the treatment of secondary obstructive hydrocephalus in pediatric patients with posterior fossa tumors. For ETV, the safety, simplicity, a more physiological of internal shunting, a significantly shorter surgery duration, absence of mortality, lower significant complications rate, a lower rate of procedure failure, the significant advantages of not becoming shunt dependent and avoidance of hardware complications (malfunction, obstruction, infection) and making safe handling and resection of the posterior fossa tumors feasible, all the previous factors made the ETV to be recommended as the first choice in the treatment of pediatric patients with obstructive hydrocephalus due to posterior fossa tumors.

Conjunctivitis is an inflammation due to infection in the lining over the eyeball and inside the eyelids. Inflammation can cause blood vessels in the eye to become larger; this makes the white of the eye look pink or red. Conjunctivitis is common among children under five years of age. Aims: To assess mothers' knowledge and practice about conjunctivitis in early childhood (< 5 years) at Assuit Ophthalmology Hospital. Design: Descriptive research design was used. Setting: The study was conducted in outpatient clinic at Assuit Ophthalmology Hospital. The Subjects: subject consisted of 200 mothers having children at early childhood (< 5 years) and suffering from conjunctivitis. Results: Results revealed that more than two fifths of them aged 1 - < 3 years. Female constituted 52.0% of the studied children. The majority of mothers lived in rural areas. The vast majority of them had poor knowledge and practice about conjunctivitis at Assuit Ophthalmology Hospital. Conclusions: There were significant relations between mothers' education, occupation, their knowledge and practice regarding early childhood conjunctivitis at Assuit Ophthalmology Hospital. Recommendation: Follow up sheet to every child has conjunctivitis frequently to identify causes of his recurrent infection and prevent it before complications that are avoidable before occurring.

Of 170 children who underwent 248 glaucoma procedures at a single center between 2005 and 2012, 13 eyes of 12 children (5.24%) developed decompression retinopathy, which resolved spontaneously, leaving no visible structural damage to the fundus structures. The mean age of children with hemorrhages was 39.2 ± 63.5 months; of those without, 8.0 ± 9.7 months. The fundus hemorrhages were peripapillary, subfoveal, dot-and-blot, and diffuse. Combined angle and filtering surgery with antimetabolite was the most common procedure performed in all eyes. There were no statistically significant differences between eyes with and without hemorrhages with respect to demographics or preoperative and operative characteristics. No definite ocular risk factor was identified for the occurrence of decompression retinopathy.

Purpose To report outcomes of femtosecond-assisted single-piece mushroom keratoplasty for the treatment of full-thickness corneal disease in pediatric patients with healthy endothelium. Methods Femtosecond-assisted mushroom keratoplasty was performed in 8 eyes of 8 patients (age range, 8-17 years) with central full-thickness corneal opacity. The single-piece mushroom-shaped graft consisted of a large anterior portion (9 mm in diameter; 250 μm in thickness) and a small posterior portion (6-6.5 mm). Donor and recipient corneas were prepared using the WaveLight FS200 laser (Alcon Laboratories, Fort Worth, TX). The donor cornea was oversized by 0.2 mm. Outcome measures were best spectacle-corrected visual acuity, spectacle refraction, topographic astigmatism, endothelial cell density, graft rejection, and graft failure at 1, 3, 6, and 12 months. Results Mean best spectacle-corrected visual acuity at 1, 3, 6, and 12 months was 0.28, 0.16, 0.13, and 0.10 logMAR; all patients achieved logMAR of at least 0.4 at 1, 3, 6, and 12 months. The mean refractive cylinder was 2.6 D, and mean endothelial cell loss was 13.3% at 12 months postoperatively. Two eyes had immunologic rejection episodes that were reversed with topical steroids. All corneas remained clear at final follow-up. Conclusions Femtosecond-assisted mushroom keratoplasty is a viable surgical option for eyes of older pediatric patients with full-thickness corneal stromal disease and healthy endothelium. Mushroom keratoplasty combines the refractive advantage of a large keratoplasty with the immunologic advantage of a small keratoplasty. Single-piece femtosecond-assisted mushroom keratoplasty may have a mechanical advantage over regular penetrating keratoplasty.