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Aim of the work: To evaluate the renal resistive index (RI) in lupus nephritis (LN) patients and to study its association with clinical features, laboratory investigations and LN pathological classes in systemic lupus erythematosus (SLE) patients. Patients and methods: The study included 45 SLE patients and 25 matched controls. SLE disease activity index (SLEDAI) was assessed and patients subdivided into LN (renal SLEDAI ≥ 4) and no-renal activity (NRA) (renal SLEDAI = 0). Ultrasound Doppler renal examination was done to measure RI. Renal biopsies were performed in 30 LN patients. Results: The mean age of patients was 29.8 ± 10.1 years and disease duration 4.3 ± 3.9 years. They were 40 females and 5 males (F:M 8:1). Their SLEDAI was 10.9 ± 8.2 and renal SLEDAI was 5.2 ± 5.1. They were 30 with LN and 15 NRA SLE patients. Renal RI was significantly higher in LN patients compared to NRA SLE patients and controls (0.61 ± 0.04 vs. 0.55 ± 0.01 vs. 0.55 ± 0.02; p

Aim of the work: To assess urinary soluble CD163 (sCD136) in systemic lupus erythematosus (SLE) patients compared to healthy controls. In addition to determine its association with different SLE clinical features, laboratory investigations and pathological indices focusing on those suggest renal disease activity. Patients and methods: The study included 58 SLE patients and 30 controls. SLE disease activity index (SLEDAI) was assessed and patients subdivided into active lupus nephritis (ALN) (renal SLEDAI ≥ 4) and no-renal activity (NRA) SLE patients (renal SLEDAI = 0). Urinary sCD163 was measured by Enzyme-Linked Immunosorbent Assay (ELISA). Urine values were normalized to urinary creatinine excretion. Renal biopsies were performed in 21 ALN patients. Results: They were 54 females and 4 males with a mean age 31.8 ± 9.1 years and disease duration 6.2 ± 4.8 years. They were 31 with ALN and 27 NRA SLE patients. Urinary sCD163 level was significantly higher in SLE patients (1.85 ± 0.3) than controls (0.5 ± 0.36, p 0.82 with sensitivity of 90.3%, specificity of 88.89%, p

Background The Radiological Society of North America (RSNA) recently published a chest CT classification system and Dutch Association for Radiology has announced Coronavirus disease 2019 (COVID-19) reporting and data system (CO-RADS) to provide guidelines to radiologists who interpret chest CT images of patients with suspected COVID-19 pneumonia. This study aimed to compare CO-RADS and RSNA classification with respect to their sensitivity and reliability for diagnosis of COVID-19 pneumonia. Results A retrospective study assessed consecutive CT chest imaging of 359 COVID-19-positive patients. Three experienced radiologists who were aware of the final diagnosis of all patients, independently categorized each patient according to CO-RADS and RSNA classification. RT-PCR test performed within one week of chest CT scan was used as a reference standard for calculating sensitivity of each system. Kappa statistics and intraclass correlation coefficient were used to assess reliability of each system. The study group included 359 patients (180 men, 179 women; mean age, 45 ± 16.9 years). Considering combination of CO-RADS 3, 4 and 5 and combination of typical and indeterminate RSNA categories as positive predictors for COVID-19 diagnosis, the overall sensitivity was the same for both classification systems (72.7%). Applying both systems in moderate and severe/critically ill patients resulted in a significant increase in sensitivity (94.7% and 97.8%, respectively). The overall inter-reviewer agreement was excellent for CO-RADS (κ = 0.801), and good for RSNA classification (κ = 0.781). Conclusion CO-RADS and RSNA chest CT classification systems are comparable in diagnosis of COVID-19 pneumonia with similar sensitivity and reliability.

Purpose: Uremia influences bone remodeling. This study aimed to evaluate the impact of treatment with local injection of Vitamin D3 (Vit.D3) on bone remodeling associated with orthodontic treatment in uremic rabbits. Patients and Methods: rabbits were split into four groups: a healthy control, a sham second group, where antibiotic was given in therapeutic dose, uremic third group, uremia induced by a nephrotoxic dose of antibiotic, and the fourth uremic group treated with locally injected Vit.D3. All groups experienced orthodontic procedures. Bone density before and after tooth movement was determined using quantitative computed tomography. Analysis of serum parathyroid hormone was done by Elisa while serum calcium, urea, and creatinine were done by enzymatic colorimetric assay. Maxillary bone underwent histological analyses. Results: A statistically significant reduction in bone density in uremic models (P< 0.05) versus healthy models. Improvement in bone density in the treated uremic group after treatment with locally injected Vit.D3, which led to increase osteoblastic activity in comparison to the non-treated uremic group. A significant negative correlation was detected between serum calcium and bone density in the non-treated uremic group, this correlation was lost in the treated uremic group. Conclusions: Treatment of uremic models with locally injected Vit.D3, had significantly improved bone density by increasing osteoblastic and decreasing osteoclastic activity regardless of calcium and parathyroid levels. Local Vit.D3 could be used to improve bone remodeling in uremia.

Background A major role of CT in COVID-19 pneumonia is to assess disease severity and progress. In this study, we aimed to assess the validity, reliability, and survival outcomes of simple chest computed tomography (CT) score in the evaluation of the severity of lung involvement in coronavirus disease 2019 (COVID-19) compared with the current chest CT score. Results This retrospective analysis included 213 patients (121 men and 92 women; mean age, 46 ± 15.6 years; range, 1–85 years). The ROC curve was used to compare the validity of both scores. Interreader agreement (IRA) for both scores was calculated using Cohen’s kappa statistic. The survival analysis of both scores was investigated using the Kaplan–Meier survival analysis. The simple score showed a comparable validity with the current score (AUC = 0.89 and 0.90, respectively; p = 0.61). The ROC analysis demonstrated that a simple score of > 3 and a current score of > 12 were potential predictors of death with sensitivity values of 81.8% and 86.4% and specificity values of 96.3% and 93.7%, respectively. The simple score showed a higher IRA compared with the current score (κ = 0.645 and 0.458, respectively). Both scores were comparable for predicting survival outcomes. Conclusion The simple score was non-inferior for predicting survival outcome, compared with the current chest CT score. Furthermore, we suggest that the simple score should be used as it is simpler and more consistent.

Although adrenal cortical tumors are rare in children, pediatricians should be very cautious about it. Neoplasm is a rare but significant cause of Cushing’s syndrome. Unfortunately, they can be missed very easily, as there is often a time lag between the onset of the symptoms and final diagnosis. Here, we present a case of adrenal adenoma in a six-year - old Egyptian boy who regrettably misdiagnosed twice as exogenous Cushing syndrome and simple obesity. Diagnosis of an adrenal cortical tumor was confirmed by laboratory data, MRI and histopathological examination after more than 2 years of the onset of his symptoms. After resection of the tumor, serum steroids normalized, and clinical signs receded. The child received no additional treatment and remains disease-free after 18 months of close observation. The possibility of neoplasms should always be considered early to avoid delayed diagnosis and treatment of Cushing’s syndrome.

Background Intra-arterial chemotherapy has shown promising results and improved the prognosis of retinoblastoma in the developed countries. Here, we aim to report our initial experience, in Egypt, in the treatment of all stages of naïve retinoblastoma with ophthalmic artery chemosurgery (OAC), using melphalan. Results The technique was successful in 23 out of 26 eyes. Overall, a total of 63 treatment sessions were performed. Ophthalmic artery catheterization was performed in 59 treatment sessions, whereas middle meningeal artery catheterization was performed in 4 treatment sessions. Adequate tumor control was achieved in 95.6%. Progression has developed in one eye after the third OAC session. The mean follow-up period was 18.5 months. Recurrence of the main tumor as well as vitreous and subretinal seeds was reported in one eye after 19-month duration. A globe salvage rate of 91.3% was attained. No metastasis was recorded, and all patients were alive within the stated follow-up period. Conclusion A high globe salvage rate along with metastasis free survival and mild complications were achieved. Therefore, our initial experience with OAC in primary retinoblastoma proved to be safe and effective.

What's known on the subject? and What does the study add? Shock wave lithotripsy and flexible ureterorenoscopy are acceptable treatment options for lower pole stones smaller than 10 mm, while percutaneous nephrolithotomy is the favoured treatment for stones larger than 20 mm. For treatment of lower pole stones of 10-20 mm, flexible ureterorenoscopy has a significantly higher stone-free rate and lower retreatment rate than shock wave lithotripsy.To compare the outcomes of flexible ureterorenoscopy (F-URS) and extracorporeal shock wave lithotripsy (ESWL) for treatment of lower pole stones of 10-20 mm.The database of patients with a single lower pole stone of 10-20 mm was examined to obtain two matched groups who were treated with F-URS or ESWL. Matching criteria were stone length, side and patient gender. Stone-free rates were evaluated 3 months after the last treatment session by non-contrast computed tomography. Both groups were compared for retreatment rate, complications and stone-free rate.The matched groups included 37 patients who underwent F-URS and 62 patients who underwent ESWL. Retreatment rate was significantly higher for ESWL (60% vs 8%, P0.001). Complications were more after F-URS (13.5% vs 4.8%), but the difference was not significant (P= 0.146). All complications were grade II or IIIa on modified Clavien classification. The stone-free rate was significantly better after F-URS (86.5% vs 67.7%, P= 0.038). One failure of F-URS (2.7%) and five failures (8%) of ESWL were treated with percutaneous nephrolithotomy. Significant residual fragments in three patients (8%) after F-URS were treated with ESWL, while significant residual fragments after ESWL in five patients (8%) were treated with F-URS. Residual fragments (4 mm) were followed every 3 months in one patient (2.7%) after F-URS and in 10 patients (16%) after ESWL.For treatment of lower pole stones of 10-20 mm, F-URS provided significantly higher stone-free rate and lower retreatment rate compared with ESWL. The incidence of complications after F-URS was not significantly more than after ESWL.

To evaluate the effect of the position of the proximal and distal ends of Double-J ureteral stents on postprocedural flank pain, lower urinary-tract symptoms, and quality of life.The study included 120 patients who required unilateral Double-J ureteral stents for various indications. They were randomized into two equal groups. Group 1 had longer stents, with the proximal end in the upper calix and the distal end crossing the midline of the bladder. Group 2 had proper stent length with the proximal end in the pelvis and the lower end just beyond the vesicoureteral junction. Patients answered a questionnaire regarding flank pain, dysuria, and urgency as well as quality of life after 1 week of stenting.Forty patients (67%) of group 1 and 43 (72%) of group 2 had mild flank pain, especially during urination. There was no significant difference in the degree of flank pain in the two groups. Moderate to severe dysuria was reported by 53 patients (88%) in group 1 and 11 patients (18%) in group 2 (P0.001). Moderate to severe urgency was reported by 48 patients (80%) in group 1 and in 14 (23%) in group 2 (P0.001). A worse quality of life was reported by patients in group 1, among whom moderate to severe bother was noted by 51 (85%) compared with group 2, in which moderate to severe bother was reported by only 13 patients (22%) (P0.001).Ureteral stents are associated with flank pain and lower urinary-tract symptoms. The flank pain was not affected by the length of stent. Urgency and dysuria as well as a worse quality of life were significantly more common in the patients who had longer stents.