Background and purpose: The use of traditional and complementary medicine (T&CM)
is common in children with cancer globally.We aimed to assess the prevalence, types,
reasons, perceived effectiveness, and disclosure rate of T&CMuse among children with
cancer in Southern Egypt. We also investigated whether T&CM use contributed to
delays in initial presentation and treatment.
Materials and methods: A cross-sectional design was utilized. Data were collected via
an interviewer-administered questionnaire. Eligible children and their caregivers at
the South Egypt Cancer Institute were invited to participate.

Children with suspected cancer may succumb to their bad condition shortly after admission,
even before a definitive diagnosis can be reached. We aimed to address the issue of
delayed presentation and early deaths among children suspected of having cancer. We
analyzed also the types and causes of mortalities across different tumor types.
Materials and methods
A retrospective review of reports from newly admitted patients between 2006 and 2010 at
the pediatric oncology department of the South Egypt Cancer Institute (SECI) was done.
Parameters included age, gender, diagnosis, symptoms, the interval between initial symptoms
and the first visit to SECI, the duration from admission to death, and the cause of
death.

Systemic lupus erythematous (SLE) is an autoimmune disease that induces chronic inflammation of the major body systems. This disease induces autoantibodies production, causing immune complex formation and deposition in tissue, which result in inflammation and multi-organs damage. Among the common SLE complications is the development of lupus nephritis (LN) in which inflammation and damage to the kidneys occur. In the current study we aimed to evaluate the effect of administrating pulse therapy on LN patients during ovulation period (period of high estrogen level) in menstruating patients and during full moon period in non-menstruating group. This was a one year prospective cross-sectional study, included 101 LN female patients in the reproductive age attended Nephrology Department, Assiut University Hospital. They was divided into; Group A (menstruating group) that was subdivided into; Group A1: included 36 patients received pulse therapy during ovulation, Group A2: included 15 patients served as controls and received pulse therapy during any time (n=15). Group B (non-menstruating) that was subdivided into; Group B1: included 35 patients received pulse therapy during moon period, and Group B2: included 15 patients served as controls and received pulse therapy during any time. Patient’s response was evaluated to determine the best time for receiving the pulse therapy. In menstruating women, the degree of reduction in blood urea nitrogen (P=0.033, after three months of follow up), protein/ creatinine ratios (P=0.016, after two months of follow up, and P=0.005, after three months of follow up), and increase in hemoglobin level (P=0.006, after two months of follow up, and P=0.016, after three months of follow up) were significantly higher among patients who received pulse therapy during the period of ovulation. In non-menstruating women, receiving pulse therapy during full moon period enhanced and augmented its effect. In conclusion, estrogen hormone may play a major role in the female predominance of autoimmune disease, particularly systemic lupus erythematous.

Transarterial chemoembolization is commonly performed in patients with hepatocellular carcinoma classified as Barcelona Clinic Liver Cancer staging system B or C in selected patients according to current guidelines. Transarterial chemoembolization has been shown to improve the survival of patients with unresectable hepatocellular carcinoma and Child class A and B. Transarterial chemoembolization is associated with a low rate of major complications (4–7%). Complications of transarterial chemoembolization can be categorized into injury to the liver and extrahepatic structures. Hepatocellular carcinoma with partial portal vein thrombosis is still a thorny problem, and the current treatment choices are unable to extend the survival effectively. the current study we designed to identify the preoperative factors related to the short-term a by comparing the preoperative clinical data of patients who died in the short-term (< 3 months) with those who survived after transarterial chemoembolization A total of 140 patients with hepatocellular carcinoma and partial portal vein thrombosis were enrolled in the study. A retrospective-prospective hospital-based study was conducted at Department of Tropical Medicine and Gastroenterology at Al-Rajhi University Hospitals. It was conducted in the period between 2021 and 2023. The main findings in the current study were; 1) a total of 100 (71.4%) patients were still alive up to three months following transarterial chemoembolization and 40 (28.6%) patients died, 2) non-survivors had significantly lower albumin level with higher bilirubin, aspartate transaminase and more advanced albumin/bilirubin index grade and 3)

only predictor for short-term mortality in patients underwent transarterial chemoembolization was albumin/bilirubin index grade ≥ 2 with odd's ratio was 4.11. Lastly, the current study revealed that 40 (28.6%) patients died secondary to hepatic decompensation (29/40; 72.5%) or post-embolization syndrome (11/40; 27.5%). Also, response to transarterial chemoembolization in the current study was complete, partial and stable response in 90 (64.3%), 40 (28.6%) and 10 (7.1%) patients, respectively

Abstract Background: Standard balloon-catheter thromboembolectomy (TE) is an established effective treatment for acute lowerlimb ischemia (ALI) with recognized limitations when there is an underlying arterial lesion or thromboembolism of the infrapopliteal arteries. The aim of this study was to evaluate the efficacy and safety of image-guided surgical TE combined with routine intraoperative completion angiography in the treatment of ALI patients.

Methods: Between September 2020 and August 2022, this prospective study included all consecutive adult patients presenting to a tertiary center with unilateral ALI of Rutherford class II due to thromboembolic occlusion of native arteries who underwent image-guided surgical TE and routine completion intraoperative angiography. Adjunctive endovascular techniques (hybrid revascularization) including plain balloon angioplasty (PTA)±stenting or on-table lysis were used if underlying arterial lesions or residual thrombosis were detected on the intraoperative angiography, respectively. The primary outcome measures included technical success and 30-day major amputation rate. Perioperative complications, 1-year primary and secondary patency, limb salvage, mortality, and amputation-free survival rates were endorsed as secondary outcome measures.

Results: Image-guided surgical thrombectomy was done for 109 ALI patients (109 limbs), provisionally diagnosed as embolic (57 patients, 52.3%) or thrombotic (52 patients, 47.7%) arterial occlusion. Thromboembolectomy without adjunctive endovascular treatment was done in 38 patients (34.86%), whereas 71 patients (65.14%) required adjunctive PTA±stenting of underlying arterial lesions (60, 55.05%) or on-table lysis±PTA of residual thrombosis (11, 10.09%). The overall technical success rate was 92.66%. At 30 days, amputation and mortality rates were 3.67% and 5.5%, respectively. None of the patients had thrombectomy-induced arterial injuries. One-year follow-up data were available for 81 patients (74.3%). The Kaplan-Meier estimate of the 12-month primary and secondary patency, limb salvage, and amputation-free survival rates was 76.5%±0.04, 91.5%±0.03, 90.6±0.03, and 91.4±0.03%, respectively.

Conclusions: Image-guided TE combined with routine intraoperative angiography is a safe and effective technique for surgical TE in acute lower-limb ischemia patients with the advantage of immediate identification and treatment of underlying arterial lesions or residual thrombosis for optimal revascularization.

Keywords acute limb ischemia, image-guided thrombectomy, intraoperative angiography, endovascular therapy, arterial thromboembolism

Background: R2CHA2DS2-VA score has been used to predict short and long-term outcomes in many cardiovascular diseases. This study aims to validate the R2CHA2DS2-VA score as a long-term major adverse cardiovascular events (MACE) predictor after carotid endarterectomy (CEA). Secondary outcomes were also assessed regarding the incidence of all-cause mortality, acute myocardial infarction (AMI), major adverse limb events (MALE), and acute heart failure (AHF).

Methods: From January 2012 to December 2021, patients (n ¼ 205) from a Portuguese tertiary care and referral center that underwent CEA with regional anesthesia (RA) for carotid stenosis (CS) were selected from a previously collected prospective database, and a posthoc analysis was performed. Demographics and comorbidities were registered. Clinical adverse events were assessed 30 days after the procedure and in the subsequent long-term surveillance period. Statistical analysis was performed by the KaplaneMeier method and Cox proportional hazards regression. Results: Of the patients enrolled, 78.5% were males with a mean age of 70.44 ± 8.9 years. Higher scores of R2CHA2DS2-VA were associated with long-term MACE (adjusted hazard ratio (aHR) 1.390; 95% confidence interval (CI) 1.173e1.647); and mortality (aHR 1.295; 95% CI 1.08e1.545).

Conclusions: This study demonstrated the potential of the R2CHA2DS2-VA score to predict long-term outcomes, such as AMI, AHF, MACE, and all-cause mortality, in a population of patients submitted to carotid endarterectomy

Abstract Background: Superficial femoral artery (SFA) is commonly affected with atherosclerotic peripheral arterial disease leading to chronic limb-threatening ischemia (CLTI). Subinitimal angioplasty (SIA) is a minimally invasive option. We aimed to examine the relationship between the Global Limb Anatomic Staging System and SIA midterm limb and survival-related outcomes.

Method: A prospective observational study was conducted on all patients with CLTI (Rutherford 4–6 or WIFI stages 2–4), with diseased femoropopliteal segment underwent SIA from August 2020 to September 2021. Patients with non-atherosclerotic SFA occlusion and those requiring primary major amputation were excluded. Multivariable Cox proportional hazard regression was performed to assess possible predictors of midterm clinical outcomes. Kaplan-Meier survival curves were used to estimate limb-based patency (LBP), limb salvage, amputation-free survival (AFS), and overall survival.

Results: The study included 138 patients with CLTI due to chronic total occlusion of the SFA and underwent SIA ± treatment of associated ipsilateral hemodynamically significant inflow/outflow disease. Primary technical success was achieved in 116 cases (84%), with primary patency at 1, 6, and 12 months being 100%, 84%, and 79% respectively, while the limb-salvage rate at 6 and 12 months was 100% and 94%, respectively. The result of the comparison between CLASS 1 and Global Limb Anatomic Staging System III (GLASS III) revealed significantly worse patency with GLASS III (p=0.005), and better overall survival (p=0.037), limb salvage (p=0.021), and AFS (p<0.001) with GLASS I.

Conclusion: Subinitimal angioplasty is a safe, effective, and minimally invasive treatment option for lengthy SFA lesions by avoiding the patients’ anesthesia and operative risk. Our study suggests that the GLASS stage may be a useful predictor of midterm limb and survival-related outcomes of this approach. GLASS III anatomy in comparison with GLASS I is associated with a statistically significantly worse LBP, limb salvage, AFS, and overall survival.

Abstract Chronic pelvic pain (CPP) is a prevalent condition in middle-aged women that represents a heavy social impact on the quality of life of those females. Treatment of pelvic congestion syndrome is a complex and controversial issue, but treatment can be one of 3 lines: medical therapy, endovascular treatment, and surgical intervention. The endovascular line was first introduced in 1993 and has been popular over other lines of treatment methods. This retrospective study was conducted in a tertiary university hospital over 24 months, from March 2019 to March 2021. Forty patients with PGS were managed by left ovarian vein TCFS. The Institutional Review Board waived the need for ethics approval or informed consent to use anonymized and retrospectively analyzed data. The mean age of enrolled women was 33.80 ± 6.54 years, ranging between 20 and 45 years. Trans-catheter ethanolamine foam embolization is an effective and safe method to treat pelvic and atypical lower limb varices.

Keywords pelvic congestion syndrome, sclerotherapy, chronic pelvic pain, embolization.