Introduction: Melasma is a common disorder of facial hyperpigmentation that is often difficult to treat and resistant to all treatment modalities and is therefore very frustrating to patients and dermatologists. Objective: Our purpose was to evaluate the efficacy of trichloroacetic acid (TCA) peeling in comparison to double frequency Q-switched (Nd:YAG) laser (1064 nm and 532 nm wavelengths) in treatment of melasma among Egyptian patients. Patients and Methods: A total of 65 adult Egyptian female patients with melasma (age > 18 years old, skin phototypes type III-V) were enrolled in this study. Wood’s light was used for classification of the type of melasma into epidermal, dermal or mixed. The patients were divided into 4 groups: Group 1: Fifteen patients with epidermal melasma were treated with TCA (20%). Group 2: Twenty patients with epidermal, dermal and mixed melasma were treated with TCA (25%). Group 3: Fifteen patients with dermal and mixed melasma were treated with TCA (30%). TCA peeling was performed every 2 weeks up to 8 sessions. Group 4: Fifteen patients were treated with double frequency Q-switched Nd:YAG laser, of whom 7 with epidermal melasma were treated with (532 nm), and 8 with dermal and mixed melasma were treated with (1064 nm). Laser treatment was performed every month up to 6 sessions. The end point of treatment for all patients was the clearance of melasma or occurrence of complications. Melasma area and severity index (MASI) score was used before and after treatment to assess the severity of melasma and evaluate the response of treatment. All patients were followed up monthly for up to 3 months after the end of treatment for possible recurrence. Results: The mean of improvement percentage of MASI score was significantly higher among group 2 treated with TCA 25% compared with other groups (p=0.000***). The epidermal type of melasma was significantly improved compared with the dermal type (p=0.0029***). Group 4 treated with Q-switched Nd:YAG laser (532 nm & 1064 nm) showed the highest complications of post-inflammatory hyperpigmentation (53.3%) compared with other groups. The recurrence of melasma was (32%) among all treated patients. Conclusions: Our findings suggest that TCA peeling is effective in treatment of melasma, TCA 25% was the most effective concentration with rare side effects. Double frequency Q-switched Nd:YAG laser (532 & 1064 nm) is not recommended in treatment of melasma because it was associated with the highest incidence of complications. In our community, the hot climate, the exposure to sunlight and the dark skin types are factors that interfere with the permanent cure of melasma. Therefore, avoidance of sun and heat exposure and the regular use of broad-spectrum sunscreens are essential for melasma patients.

Objective: The current study investigates the possible effect of lead, cadmium, arsenic and aflatoxin B1 toxicity as risk factors of IUGR. The study also aimed to determine the possible role of increased apoptosis in the pathogenesis of the above effect. Design: a case-control study Materials and Methods: The study was conducted in tertiary university affiliated hospital in Assiut, Egypt. Sixty pregnant women diagnosed to have asymmetrical IUGR and planned for immediate delivery were recruited at the time of delivery. An age and parity matched control group of (40) normal pregnancies were randomly selected as a control group. Maternal blood samples were obtained for measuring lead and cadmium level by plasma-optical emission spectrophotometer. Midstream urine samples were obtained for the assay of urinary cadmium, arsenic and aflatoxin B1 by layer chromatography. Neonatal scalp hair sample were analyzed for arsenic content. Quantitative determination of human placental Bcl-2 and caspase-3 using a monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) kits were performed. Results: There was significantly higher levels of lead, cadmium, arsenic and caspase-3 and lower levels of placental Bcl-2 in the IUGR group as compared with those of normal pregnancy (p0.001 for each). These levels were higher in working women who were from urban areas and those exposed to cigarette smoke than non-working women who lived in rural areas and non-smokers, respectively. Moreover, the levels of heavy metals were significantly positively correlated with placental caspase-3 while negatively correlated (except cadmium) with placental Bcl-2 levels. Conclusions: There are an alarming high level of lead, cadmium, arsenic and aflatoxin B1 toxicity in Upper Egypt. High level of heavy metal and aflatoxin B1 were positively correlated to IUGR and this is possible results from increasing placental apoptosis.

INTRODUCTION: Spontaneous bacterial peritonitis (SBP) is a common problem that affects liver cirrhotic patients. It is also, a major contributor to the deterioration and aggravation of liver failure complications. Complement deficiency considered as a major complication of liver cirrhosis and bacterial overgrowth in the intestine is the major source of bacterial peritonitis. Hyaluronan or hyaluronic acid (HA) is a connective tissue polysaccharide, synthesized by many cell types, although mesenchymal cells are believed to be predominant. The serum level of HA is regulated by the influx from the tissues via lymphatic system and its receptor-mediated clearance by liver endothelial cells. So, marked increase in serum levels are noted in liver diseases, especially in patients with cirrhosis, when the clearance is impaired. The hyaluronic acids (HA) have an important role in controlling tissue permeation, bacterial invasiveness and macromolecular transport between cells. HA was observed to enhance cellular infiltration and migration by facilitating cell detachment. It also, increase the proinflammatory cytokines TNF-α and IL-8 production. It is interesting to note that HA not only can promote the inflammation, but also can moderate the inflammatory response, which may contribute to the stabilization of granulation tissue matrix. The innate immune system uses TLRs to recognize microbes and initiate host defense. The repeating disaccharide structure of HA has features of pathogen-associated molecular patterns. Many pathogen-associated molecular patterns on pathogens utilize Toll-like receptors to initiate innate immune responses. AIMS&METHODS: To measure the level of complement-3 (C3) and hyaluronic acid in ascetic fluid of liver cirrhosis patients with and without spontaneous bacterial peritonitis. RESULTS: In our study we found that there was a significant decrease in C3 level in ascetic fluid of cirrhotic patients in comparison to ascetic fluid of patients with other causes (i.e. Nephrotic syndrome, and cardiac failure) (P0.05). Also, HA level shows significant decreased in ascetic fluid of cirrhotic patients in comparison to ascetic fluid of patient with other causes (i.e. Nephrotic syndrome, and cardiac failure) (P0.05). HA level in serum of liver cirrhosis patients have a highly significant increase (p0.001) in comparison to control group. There was a highly significant decrease in HA level in ascetic fluid of cirrhotic patients with SBP in comparison to HA level in ascetic fluid of cirrhotic patients without SBP (p0.001). CONCLUSION: C3 and HA are significantly decreased in ascetic fluid of cirrhotic patients. HA significantly decreased in ascetic fluid of cirrhotic patients with SBP in comparison to patients without SBP.

Objective: To determine the most discriminating two-dimensional gray-scale and colour Doppler sonographic features that allow differentiation between malignant and benign adnexal masses, and to develop a scoring model that would enable more accurate diagnosis with those features. Methods: A cross sectional prospective study was conducted on patients scheduled for surgery due to presence of adnexal masses at Woman’s Health Center, Assiut University, Egypt between October 2012 and October 2013. All patients were evaluated by 2D ultrasound for morphological features of the masses combined with colour Doppler examination of their vessels. The final diagnosis, based on histopathological analysis, was used as a gold standard. Results: One hundred forty-six patients were recruited, 104 with benign masses, 42 with malignant masses. Features that allowed statistically significant discrimination of benignity from malignancy were; volume of mass, type of mass, presence and thickness of septae, presence and length of papillary projections, location of vessels at colour Doppler and colour score. A scoring model was formulated combining these features together; Assiut Scoring Model (ASM). The cut-off level with the highest accuracy in detection of malignancy, was ≥6, had a sensitivity of 93.5% and specificity of 92.2%. Conclusion: Our Scoring Model; a multiparameter scoring using four gray-scale ultrasound and two colour Doppler features, had shown a high sensitivity and specificity for prediction of malignancy in adnexal masses compared with previous scoring systems.

Purpose: To study the architecture of Extra capsular cataract extraction (ECCE) versus Phacoemulsification clear corneal incisions using anterior segment spectral domain optical coherence tomography (SD-OCT). Setting/Venue: Ophthalmology Department, Assiut University Hospitals, Assiut, Egypt. Methods: This is observational prospective cross-sectional study comprised 40 eyes of 40 patients after cataract surgery (20 eyes underwent ECCE and 20 eyes underwent phacoemulsification). Each eye was scanned 2 months after surgery at the corneal incision site with anterior segment SD-OCT. (RTVue-100; Optovue) Results: We compared between the incision architecture in the ECCE and phacoemulsification groups considering any architectural changes in the epithelial side; endothelial side, stromal healing of the corneal wound. Wound apposition at the epithelial margin was achieved in all cases. Imperfect apposition of the endothelial margin (Stepping and wound gaping) was seen in 45% of the ECCE group and 10% of the phacoemulsification group. Irregularity of the stromal healing line was seen in 25% of the ECCE group while was not seen in the phacoemulsification group. Double level of stromal entry was observed in 20% of ECCE group and was absent in the phacoemulsification group. Only one case of epithelial ingrowth into the anterior chamber was detected in the ECCE group. Conclusions: Phacoemulsification clear corneal wound is characterized by better reproducibility in construction, more regularity in the stromal healing line, and more sealing at the endothelial side than the ECCE corneal wound. Both ECCE and phacoemulsification corneal incisions seal well at the epithelial side of the corneal wound.

Introduction and Objectives: Stented open pyeloplasty is widely used in pediatric urology practice. Our aim is to present our experience with stentless pyeloplasty in children. Materials and Methods: Between June 2009 to July 2012, 46 children had open Anderson-Hynes dismembered pyeloplasty using 2.5-3 cm flank incision. The children were prospectively randomized to 2 groups: stentless pyeloplasty (25 children) and stented pyeloplasty (21 children). Both groups were compared regards length of hospital stay, postoperative complications, success rates and number of surgical procedures needed to achieve success. Results: Both groups were comparable regards age (median 6 months each), sex, pre-operative hydronephrosis (HN) and split renal function. Median drain removal time and hospital stay were 2 days and 3 days in the stentless and stented groups, respectively (p0.001). Resolution or minimal residual HN was noticed postoperatively after median time of 4 months (range 2-12) for stentless group and after 4 months (range 2-14) in the stented group (p=0.568). Recurrent ureteropelvic junction obstruction developed in one patient in each group. Median number of surgical procedures needed to achieve success was 1 vs. 2 for the stentless and stented groups, respectively (p0.001). Conclusion: Open stentless pyeloplasty in children is feasible with shorter hospital stay and fewer surgical procedures.

Changing pattern of laryngeal tuberculosis

Changing pattern of laryngeal tuberculosis

Background: The principal sites of neonatal phototherapy (NNPT) action may localize not only in the skin but also in capillary circulation under the skin. Thus, the safety of phototherapy particularly in relation to hemodynamic control must be investigated. Since regional blood flow is affected by NO and ET, it is important to study the effect of phototherapy on circulating levels of both of them and to use the changes of vital signs as markers for hemodynamic stability . Aim of the work: This study aimed to evaluate the effect of phototherapy on blood ET and NO in hyperbilirubinemic newborn infants of different gestational ages with stable vital signs and to observe changes in vital signs in those newborn infants after 24 hours of phototherapy. Patients and Methods: This study included 50 newborn infants (29 preterm 37weeks and 21 full term ≥37 weeks) with stable vital signs who received phototherapy for high unconjugated bilirubinemia. Heart rate (HR), respiration rate (RR), mean arterial blood pressure (MABP), Serum endothelin-1 and nitric oxide level were detected before phototherapy subsequently monitored after 24 hours after phototherapy. Results: The present study revealed that after 24 hours of phototherapy there is a significant increase in NO and ET serum level, NO:ET ratio ,HR and a significant decrease in MABP in both full term and preterm newborns. There is no significant change in RR in both preterm and full term newborns. Conclusions: Phototherapy can disturb the dynamic balance between NO and ET, leading to a more prominent effect of NO. This effect may be not harmful in newborns with stable vital signs, but harmful effect may occur in newborns with septicaemia or decompensated vital signs. Careful observation of vital signs should be done in all newborns under the effect of Phototherapy. Also the safety of continuous phototherapy for more than 24 hours in newborn infants with different gestational ages and different birth weights must be verified.

Background: The principal sites of neonatal phototherapy (NNPT) action may localize not only in the skin but also in capillary circulation under the skin. Thus, the safety of phototherapy particularly in relation to hemodynamic control must be investigated. Since regional blood flow is affected by NO and ET, it is important to study the effect of phototherapy on circulating levels of both of them and to use the changes of vital signs as markers for hemodynamic stability . Aim of the work: This study aimed to evaluate the effect of phototherapy on blood ET and NO in hyperbilirubinemic newborn infants of different gestational ages with stable vital signs and to observe changes in vital signs in those newborn infants after 24 hours of phototherapy. Patients and Methods: This study included 50 newborn infants (29 preterm 37weeks and 21 full term ≥37 weeks) with stable vital signs who received phototherapy for high unconjugated bilirubinemia. Heart rate (HR), respiration rate (RR), mean arterial blood pressure (MABP), Serum endothelin-1 and nitric oxide level were detected before phototherapy subsequently monitored after 24 hours after phototherapy. Results: The present study revealed that after 24 hours of phototherapy there is a significant increase in NO and ET serum level, NO:ET ratio ,HR and a significant decrease in MABP in both full term and preterm newborns. There is no significant change in RR in both preterm and full term newborns. Conclusions: Phototherapy can disturb the dynamic balance between NO and ET, leading to a more prominent effect of NO. This effect may be not harmful in newborns with stable vital signs, but harmful effect may occur in newborns with septicaemia or decompensated vital signs. Careful observation of vital signs should be done in all newborns under the effect of Phototherapy. Also the safety of continuous phototherapy for more than 24 hours in newborn infants with different gestational ages and different birth weights must be verified.