Introduction: Gastrointestinal bleeding (GIB) is more common in patients with end stage renal disease (ESRD) and is associated with higher mortality than in the general population. There are limited data regarding the occurrence of upper GIB in dialysis patients in our locality. So, we aimed to identify upper GIT lesions by endoscopy in ESRD patients with occult GIT bleeding. Patients and methods: Highly sensitive guaiac-based faecal occult blood Hemoccult SENSA test (FOBT) was performed on stool specimens of 100 ESRD patients with upper GI symptoms; 36 with advanced renal failure prior to dialysis (CRF), 64 on maintenance hemodialysis (HD). None of the patients had overt gastrointestinal bleeding prior to participation in the study. Patients with positive FOBT underwent diagnostic upper GI endoscopy. Results: Twenty eight patients had positive guaiac-based FOBT where the majority was HD patients (71.4%). 26 patients with positive FOBT had UGI lesions with positive predictive value of 92.8%. Gastric lesions (42.9%) were the most common lesions followed by duodenal lesions and angiodysplasia (21.3% for each). Conclusion: Fecal occult blood test can be used routinely as a simple and non-invasive screening tool for early detection of UGIB in ESRD patients. The positive test should be followed by additional diagnostic procedures to identify the cause of occult bleeding. Keywords: Upper gastrointestinal bleeding; End stage renal disease; fecal occult blood; Hemoccult Sensa

Introduction: Gastrointestinal bleeding (GIB) is more common in patients with end stage renal disease (ESRD) and is associated with higher mortality than in the general population. There are limited data regarding the occurrence of upper GIB in dialysis patients in our locality. So, we aimed to identify upper GIT lesions by endoscopy in ESRD patients with occult GIT bleeding. Patients and methods: Highly sensitive guaiac-based faecal occult blood Hemoccult SENSA test (FOBT) was performed on stool specimens of 100 ESRD patients with upper GI symptoms; 36 with advanced renal failure prior to dialysis (CRF), 64 on maintenance hemodialysis (HD). None of the patients had overt gastrointestinal bleeding prior to participation in the study. Patients with positive FOBT underwent diagnostic upper GI endoscopy. Results: Twenty eight patients had positive guaiac-based FOBT where the majority was HD patients (71.4%). 26 patients with positive FOBT had UGI lesions with positive predictive value of 92.8%. Gastric lesions (42.9%) were the most common lesions followed by duodenal lesions and angiodysplasia (21.3% for each). Conclusion: Fecal occult blood test can be used routinely as a simple and non-invasive screening tool for early detection of UGIB in ESRD patients. The positive test should be followed by additional diagnostic procedures to identify the cause of occult bleeding. Keywords: Upper gastrointestinal bleeding; End stage renal disease; fecal occult blood; Hemoccult Sensa

Background: Aplastic anemia is a disorder in which the bone marrow fails to make enough blood cells. Objective: to identify the various aetiological factors that stands behind aplastic anemia as a common hematological problem and the various outcomes of those patients along one year. Patients and methods: The study included 80 patients with aplastic anemia who were admitted to the Clinical Hematology Unit of Assuit University Hospital from November 2011 to October 2012. All patients were recruited for careful history and meticulous investigations to detect predisposing factors. Results: 42.5% of all studied aplastic anemia patients had any definite etological or predesposing factor, so considered as idiopathic group while, 57.5% were secondry to chmicels and/or insecticides (22.5%), hepatitis C (15%), systemic lupus erythematosis (SLE) (12.5%) and rheumatoid arthritis (7.5%). The observed outcomes showed that complete recovery in 39%t of he secondry aplastic anemia patients (P0.001), chronicity in 22% while 39% died. However, none of the idiopathic aplastic anemia patients reached recovry, 59% become chronic (P0.001) and 41% died (P0.05). Conclusion: Secondary aplastic anemia patients have a chance for recovery by correcting the primary etiology that is not an option in idiopathic patients. The hope for not recovered aplastic anemia patients is dependency on transfusional support and immunosupressive therapy waiting for a chance in allogeneic stem cell transplantation. The expected outcome of most of unrecovered patients is death unless find early chance for transplantation.So, there is a very potential need for stem cell transplantation center in Assuit University as an important referral center in Upper Egypt.

Background: Aplastic anemia is a disorder in which the bone marrow fails to make enough blood cells. Objective: to identify the various aetiological factors that stands behind aplastic anemia as a common hematological problem and the various outcomes of those patients along one year. Patients and methods: The study included 80 patients with aplastic anemia who were admitted to the Clinical Hematology Unit of Assuit University Hospital from November 2011 to October 2012. All patients were recruited for careful history and meticulous investigations to detect predisposing factors. Results: 42.5% of all studied aplastic anemia patients had any definite etological or predesposing factor, so considered as idiopathic group while, 57.5% were secondry to chmicels and/or insecticides (22.5%), hepatitis C (15%), systemic lupus erythematosis (SLE) (12.5%) and rheumatoid arthritis (7.5%). The observed outcomes showed that complete recovery in 39%t of he secondry aplastic anemia patients (P0.001), chronicity in 22% while 39% died. However, none of the idiopathic aplastic anemia patients reached recovry, 59% become chronic (P0.001) and 41% died (P0.05). Conclusion: Secondary aplastic anemia patients have a chance for recovery by correcting the primary etiology that is not an option in idiopathic patients. The hope for not recovered aplastic anemia patients is dependency on transfusional support and immunosupressive therapy waiting for a chance in allogeneic stem cell transplantation. The expected outcome of most of unrecovered patients is death unless find early chance for transplantation.So, there is a very potential need for stem cell transplantation center in Assuit University as an important referral center in Upper Egypt.

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is effective in the management of biliary obstruction. PTBD can be used as an alternative to endoscopic approach when it is unavailable or unsuccessful due to anatomical variations or technical difficulty. OBJECTIVES: To evaluate the success rate, complications, morbidity and mortality in patients with inoperable malignant obstructive jaundice treated with PTBD with or without stenting. SUBJECTS AND METHODS: 67 percutaneous transhepatic biliary procedures were performed for forty five selected patients with inoperable malignant extrahepatic cholestasis. In total there were 21 male (46.7%) and 24 female (53.3%) patients. The mean age was 69 years and ranged from 48-88 years. These patients were subdivided into three equal groups according to the planned drainage for internal-external drainage, external drainage or metallic stenting. Statistical analysis included Chi square test, values were considered significant when P values ≤0.05. RESULTS: The overall technical success rate was 83% while the overall therapeutic success was 86.6% with the best results (100%) reported in the group of metallic stenting. There was no procedure related mortality in the different groups. The overall immediate, early and late complications were 20%, 29% and 20% respectively, with the highest complications rate reported in the group of external drainage. The overall 30 days mortality was 26.7% with the highest incidence was reported in the group of external drainage (53.3%). CONCLUSION: PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with malignant biliary obstruction. Key Words: Percutaneous transhepatic biliary drainage- Malignant biliary obstruction- Biliary stent

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is effective in the management of biliary obstruction. PTBD can be used as an alternative to endoscopic approach when it is unavailable or unsuccessful due to anatomical variations or technical difficulty. OBJECTIVES: To evaluate the success rate, complications, morbidity and mortality in patients with inoperable malignant obstructive jaundice treated with PTBD with or without stenting. SUBJECTS AND METHODS: 67 percutaneous transhepatic biliary procedures were performed for forty five selected patients with inoperable malignant extrahepatic cholestasis. In total there were 21 male (46.7%) and 24 female (53.3%) patients. The mean age was 69 years and ranged from 48-88 years. These patients were subdivided into three equal groups according to the planned drainage for internal-external drainage, external drainage or metallic stenting. Statistical analysis included Chi square test, values were considered significant when P values ≤0.05. RESULTS: The overall technical success rate was 83% while the overall therapeutic success was 86.6% with the best results (100%) reported in the group of metallic stenting. There was no procedure related mortality in the different groups. The overall immediate, early and late complications were 20%, 29% and 20% respectively, with the highest complications rate reported in the group of external drainage. The overall 30 days mortality was 26.7% with the highest incidence was reported in the group of external drainage (53.3%). CONCLUSION: PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with malignant biliary obstruction. Key Words: Percutaneous transhepatic biliary drainage- Malignant biliary obstruction- Biliary stent

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is effective in the management of biliary obstruction. PTBD can be used as an alternative to endoscopic approach when it is unavailable or unsuccessful due to anatomical variations or technical difficulty. OBJECTIVES: To evaluate the success rate, complications, morbidity and mortality in patients with inoperable malignant obstructive jaundice treated with PTBD with or without stenting. SUBJECTS AND METHODS: 67 percutaneous transhepatic biliary procedures were performed for forty five selected patients with inoperable malignant extrahepatic cholestasis. In total there were 21 male (46.7%) and 24 female (53.3%) patients. The mean age was 69 years and ranged from 48-88 years. These patients were subdivided into three equal groups according to the planned drainage for internal-external drainage, external drainage or metallic stenting. Statistical analysis included Chi square test, values were considered significant when P values ≤0.05. RESULTS: The overall technical success rate was 83% while the overall therapeutic success was 86.6% with the best results (100%) reported in the group of metallic stenting. There was no procedure related mortality in the different groups. The overall immediate, early and late complications were 20%, 29% and 20% respectively, with the highest complications rate reported in the group of external drainage. The overall 30 days mortality was 26.7% with the highest incidence was reported in the group of external drainage (53.3%). CONCLUSION: PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with malignant biliary obstruction. Key Words: Percutaneous transhepatic biliary drainage- Malignant biliary obstruction- Biliary stent

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is effective in the management of biliary obstruction. PTBD can be used as an alternative to endoscopic approach when it is unavailable or unsuccessful due to anatomical variations or technical difficulty. OBJECTIVES: To evaluate the success rate, complications, morbidity and mortality in patients with inoperable malignant obstructive jaundice treated with PTBD with or without stenting. SUBJECTS AND METHODS: 67 percutaneous transhepatic biliary procedures were performed for forty five selected patients with inoperable malignant extrahepatic cholestasis. In total there were 21 male (46.7%) and 24 female (53.3%) patients. The mean age was 69 years and ranged from 48-88 years. These patients were subdivided into three equal groups according to the planned drainage for internal-external drainage, external drainage or metallic stenting. Statistical analysis included Chi square test, values were considered significant when P values ≤0.05. RESULTS: The overall technical success rate was 83% while the overall therapeutic success was 86.6% with the best results (100%) reported in the group of metallic stenting. There was no procedure related mortality in the different groups. The overall immediate, early and late complications were 20%, 29% and 20% respectively, with the highest complications rate reported in the group of external drainage. The overall 30 days mortality was 26.7% with the highest incidence was reported in the group of external drainage (53.3%). CONCLUSION: PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with malignant biliary obstruction. Key Words: Percutaneous transhepatic biliary drainage- Malignant biliary obstruction- Biliary stent

Objective: Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline. Design: In this study, data were collected prospectively in 107 patients with diabetic foot ulcer examined and followed between March 2009and March 2012 in the Diabetic clinic at Assiut university hospital and were used to evaluate potential predictors of ulcer non-healing, after a follow-up period for a maximum one year. Results : After 1 year of follow-up, 29.9% of the patients showed non-healed ulcers. Baseline predictors of ulcer non-healing in the whole study population were duration of diabetes > 10 years (P0.0001) , negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.0001) , colour changes in the foot (P0.0001) , duration of ulcer (>3 months) (P0.0001), HbA1c (> 12 %) and Texas classification class D .Older age (P0.004), presence of hypertension(P0.02) , nephropathy (P0.005) ,smoking , presence of PAD as ABI 0.9 ( P0.02) and absent pedal pulses (P0.0001) ,ulcer size (> 5 cm2) , ulcer depth grade 3, increase total white blood cell count, ,decreased serum albumin and decreased hemoglobin levels were also associated with increased risk of unhealing. Conclusions: duration of diabetes >10 years (P0.0001), negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.01), colour changes in the foot due to presence of PAD (P0.01), duration of ulcer >3 months (P0.04), HbA1c > 12 % (P0.001) and Texas classification stage D (P0.01) were considered a major independent predictors of unhealing of diabetic foot ulceration. List of abbreviation; ABI; ankle-brachial index. DFU; diabetic foot ulcer. ECG; electrocardiogram. LEA; lower extremity amputation. PAD; peripheral arterial disease. PNP; peripheral neuropathy.

Objective: Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline. Design: In this study, data were collected prospectively in 107 patients with diabetic foot ulcer examined and followed between March 2009and March 2012 in the Diabetic clinic at Assiut university hospital and were used to evaluate potential predictors of ulcer non-healing, after a follow-up period for a maximum one year. Results : After 1 year of follow-up, 29.9% of the patients showed non-healed ulcers. Baseline predictors of ulcer non-healing in the whole study population were duration of diabetes > 10 years (P0.0001) , negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.0001) , colour changes in the foot (P0.0001) , duration of ulcer (>3 months) (P0.0001), HbA1c (> 12 %) and Texas classification class D .Older age (P0.004), presence of hypertension(P0.02) , nephropathy (P0.005) ,smoking , presence of PAD as ABI 0.9 ( P0.02) and absent pedal pulses (P0.0001) ,ulcer size (> 5 cm2) , ulcer depth grade 3, increase total white blood cell count, ,decreased serum albumin and decreased hemoglobin levels were also associated with increased risk of unhealing. Conclusions: duration of diabetes >10 years (P0.0001), negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.01), colour changes in the foot due to presence of PAD (P0.01), duration of ulcer >3 months (P0.04), HbA1c > 12 % (P0.001) and Texas classification stage D (P0.01) were considered a major independent predictors of unhealing of diabetic foot ulceration. List of abbreviation; ABI; ankle-brachial index. DFU; diabetic foot ulcer. ECG; electrocardiogram. LEA; lower extremity amputation. PAD; peripheral arterial disease. PNP; peripheral neuropathy.