PURPOSE: Factors determining in-hospital mortality of patients ventilated with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are not precisely understood. The aim of this study was to assess the correlation between acute phase proteins [High sensitivity C-reactive protein (CRP) and prealbumin (PA)] and mortality in ventilated patients with COPD. METHODS: We evaluated 336 COPD patients with AECOPD and on invasive mechanical ventilation. Detailed clinical evaluation was done daily. Concentrations of CRP and PA were measured on admission, 3rd, 8th and 16th day. RESULTS: During this study; 237 patients were discharged and 99 died. The difference between the two groups in CRP and PA was significant at admission, 3rd, 8th day and 16th day. In non survivors; there was a significant increase in CRP values with a significant decrease in PA with time (P0.001). In-hospital mortality was significantly associated with lower arterial oxygen tension, higher arterial carbon dioxide tension, lower arterial oxygen saturation, lower body mass index and longer hospital stay. CONCLUSIONS: CRP levels in patients who died were significantly higher on admission, 3rd, 8th and 16th day. A fall in CRP levels on follow up indicated a significantly better prognosis. An increase in the prealbumin level was observed in survivors. CLINICAL IMPLICATIONS: Persistently high CRP and low prealbumen in COPD patients on ventilator are associated with poor prognosis. Aggressive treatment of systemic inflammation and malnutrition may improve prognosis. Prediction of survival status may be enhanced by considering arterial oxygen tension, arterial carbon dioxide tension, albumin, body mass index and duration of hospitalization.

PURPOSE: Factors determining in-hospital mortality of patients ventilated with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are not precisely understood. The aim of this study was to assess the correlation between acute phase proteins [High sensitivity C-reactive protein (CRP) and prealbumin (PA)] and mortality in ventilated patients with COPD. METHODS: We evaluated 336 COPD patients with AECOPD and on invasive mechanical ventilation. Detailed clinical evaluation was done daily. Concentrations of CRP and PA were measured on admission, 3rd, 8th and 16th day. RESULTS: During this study; 237 patients were discharged and 99 died. The difference between the two groups in CRP and PA was significant at admission, 3rd, 8th day and 16th day. In non survivors; there was a significant increase in CRP values with a significant decrease in PA with time (P0.001). In-hospital mortality was significantly associated with lower arterial oxygen tension, higher arterial carbon dioxide tension, lower arterial oxygen saturation, lower body mass index and longer hospital stay. CONCLUSIONS: CRP levels in patients who died were significantly higher on admission, 3rd, 8th and 16th day. A fall in CRP levels on follow up indicated a significantly better prognosis. An increase in the prealbumin level was observed in survivors. CLINICAL IMPLICATIONS: Persistently high CRP and low prealbumen in COPD patients on ventilator are associated with poor prognosis. Aggressive treatment of systemic inflammation and malnutrition may improve prognosis. Prediction of survival status may be enhanced by considering arterial oxygen tension, arterial carbon dioxide tension, albumin, body mass index and duration of hospitalization.

PURPOSE: Ultrasound guided forceps for pleural biopsy is a technique that can cover the diagnostic yield gap between the needle biopsy of the pleura and thoracoscopy or thoracotomy. This technique enables operator to take biopsy from multiple pleural sites.Study objectives were: (1) To describe the ultrasound guided forceps for pleural biopsy as a technique not in common use in our practice to obtain pleural biopsy. (2) To evaluate the diagnostic yield of this technique in undiagnosed exudative pleural effusion. METHODS: This study included 96 patients admitted to Chest Department – Assiut University Hospital during the period from March 2011 to January 2012. All patients had exudative pleural effusion with first pleural tapping undiagnostic. Patients with bleeding tendency or blood coagulation defects were excluded from the study.. Each one was submitted for the procedure once. The equipments used were ultrasound apparatus ( ALOKA – Prosound – SSD – 3500SV ), biopsy forceps ( KARL - STORZ – Germany 10329L-BS), Trocar and canula of Cope's needle and rubber inlet seal. The procedure was performed under local anesthesia (Xylocaine 2%) and aseptic condition. The patients were premedicated by analgesic (Ketorolac thromethamine 20mg). Three to five biopsy fragments were obtained from each case and sent in 10% formaldehyde to the pathology laboratory. All patients were submitted for thoracoscopy under local anesthesia and thoracoscopic forceps biopsies of pleura were taken. RESULTS: Compared to thoracoscopy the sensitivity of ultrasound guided forceps pleural biopsy in diagnosis of malignant and tuberculous lesions was 85% and 88% respectively. The technique was absolutely specific in diagnosis of malignant and tuberculous lesions. CONCLUSIONS: Ultrasound – guided forceps for pleural biopsy is a simple, efficient, and safe procedure. It can be carried out easily and safely even in sick and obese patients. On the other hand, the procedure appears similar to the thoracoscopy in obtaining adequate pleural tissue specimens. Yet, it is simpler and less traumatic CLINICAL IMPLICATIONS: Ultrasound – guided forceps for pleural biopsy can overcome many of the limitations of the conventional needle biopsy procedures, provides multiple biopsy specimens of the parietal pleura that are inaccessible to the biopsy needle, and can be carried out easily and safely even in sick and obese patients. The diagnostic yield is nearly similar to thoracoscopy

PURPOSE: Ultrasound guided forceps for pleural biopsy is a technique that can cover the diagnostic yield gap between the needle biopsy of the pleura and thoracoscopy or thoracotomy. This technique enables operator to take biopsy from multiple pleural sites.Study objectives were: (1) To describe the ultrasound guided forceps for pleural biopsy as a technique not in common use in our practice to obtain pleural biopsy. (2) To evaluate the diagnostic yield of this technique in undiagnosed exudative pleural effusion. METHODS: This study included 96 patients admitted to Chest Department – Assiut University Hospital during the period from March 2011 to January 2012. All patients had exudative pleural effusion with first pleural tapping undiagnostic. Patients with bleeding tendency or blood coagulation defects were excluded from the study.. Each one was submitted for the procedure once. The equipments used were ultrasound apparatus ( ALOKA – Prosound – SSD – 3500SV ), biopsy forceps ( KARL - STORZ – Germany 10329L-BS), Trocar and canula of Cope's needle and rubber inlet seal. The procedure was performed under local anesthesia (Xylocaine 2%) and aseptic condition. The patients were premedicated by analgesic (Ketorolac thromethamine 20mg). Three to five biopsy fragments were obtained from each case and sent in 10% formaldehyde to the pathology laboratory. All patients were submitted for thoracoscopy under local anesthesia and thoracoscopic forceps biopsies of pleura were taken. RESULTS: Compared to thoracoscopy the sensitivity of ultrasound guided forceps pleural biopsy in diagnosis of malignant and tuberculous lesions was 85% and 88% respectively. The technique was absolutely specific in diagnosis of malignant and tuberculous lesions. CONCLUSIONS: Ultrasound – guided forceps for pleural biopsy is a simple, efficient, and safe procedure. It can be carried out easily and safely even in sick and obese patients. On the other hand, the procedure appears similar to the thoracoscopy in obtaining adequate pleural tissue specimens. Yet, it is simpler and less traumatic CLINICAL IMPLICATIONS: Ultrasound – guided forceps for pleural biopsy can overcome many of the limitations of the conventional needle biopsy procedures, provides multiple biopsy specimens of the parietal pleura that are inaccessible to the biopsy needle, and can be carried out easily and safely even in sick and obese patients. The diagnostic yield is nearly similar to thoracoscopy

PURPOSE: Ultrasound guided forceps for pleural biopsy is a technique that can cover the diagnostic yield gap between the needle biopsy of the pleura and thoracoscopy or thoracotomy. This technique enables operator to take biopsy from multiple pleural sites.Study objectives were: (1) To describe the ultrasound guided forceps for pleural biopsy as a technique not in common use in our practice to obtain pleural biopsy. (2) To evaluate the diagnostic yield of this technique in undiagnosed exudative pleural effusion. METHODS: This study included 96 patients admitted to Chest Department – Assiut University Hospital during the period from March 2011 to January 2012. All patients had exudative pleural effusion with first pleural tapping undiagnostic. Patients with bleeding tendency or blood coagulation defects were excluded from the study.. Each one was submitted for the procedure once. The equipments used were ultrasound apparatus ( ALOKA – Prosound – SSD – 3500SV ), biopsy forceps ( KARL - STORZ – Germany 10329L-BS), Trocar and canula of Cope's needle and rubber inlet seal. The procedure was performed under local anesthesia (Xylocaine 2%) and aseptic condition. The patients were premedicated by analgesic (Ketorolac thromethamine 20mg). Three to five biopsy fragments were obtained from each case and sent in 10% formaldehyde to the pathology laboratory. All patients were submitted for thoracoscopy under local anesthesia and thoracoscopic forceps biopsies of pleura were taken. RESULTS: Compared to thoracoscopy the sensitivity of ultrasound guided forceps pleural biopsy in diagnosis of malignant and tuberculous lesions was 85% and 88% respectively. The technique was absolutely specific in diagnosis of malignant and tuberculous lesions. CONCLUSIONS: Ultrasound – guided forceps for pleural biopsy is a simple, efficient, and safe procedure. It can be carried out easily and safely even in sick and obese patients. On the other hand, the procedure appears similar to the thoracoscopy in obtaining adequate pleural tissue specimens. Yet, it is simpler and less traumatic CLINICAL IMPLICATIONS: Ultrasound – guided forceps for pleural biopsy can overcome many of the limitations of the conventional needle biopsy procedures, provides multiple biopsy specimens of the parietal pleura that are inaccessible to the biopsy needle, and can be carried out easily and safely even in sick and obese patients. The diagnostic yield is nearly similar to thoracoscopy

This work has been done at orthopedics department, Assiut university hospital Assiut Egypt from January2008 to December 2010. It was done to assess the effect of use of these cages in multiple levels CSM up to 4 levels through the anterior approach instead of posterior wide decompression for such cases Fifty five patients were included in this study (age was 37-78 years with mean 55). Forty were males and 15 were females. They were followed up for one year in the average (at least 4 months). The patients were chosen according to the inclusion criteria: chronic complaint of more than 3 months, with any grade of spasticity with failure of conservative treatment, with radiological and electrical studies preoperatively. On follow up, the entire patients showed neurological improvement of one grade at least. no deterioration was reported in this study. the fusion was reported in all patients within 3 months in the average no cage extrusion or retropulsion was reported. Superficial wound infection was reported in 2 cases that was relieved by repeated dressings for short time with good wound healing. No tracheal or oseophygeal fistulae were reported The conclusion that this solution is a very good technique to mange CSM compared with other posterior techniques, with avoidance of complications of using iliac bone graft with no or minimal complications

Cisplatin (CP) is a chemotherapy drug that is given to treat cancer. Oxidative stress has been proven to be involved in CP-induced nephrotoxicity. The present study was done to evaluate the role of Vit C, DPPD and L-cysteine (L-Cys) as antioxidants in the protection against CP-induced nephrotoxicity. Forty rats were divided into control and 4 treated groups injected with CP (8 mg/kg). Group 1 positive control, G2, G3 and G4 were treated with Vit C (100 mg/kg), DPPD (125 mg/kg) and L-Cys (100 mg/kg) respectively. Histopathological examinations revealed severe degenerative and necrobiotic changes in renal tubules and glomerulei of GI. These changes became mild in the other groups. The biochemical results indicated a significant increase in plasma urea and creatinine in GI. Lipid peroxides, total peroxides, superoxide anion levels and DNA fragmentation were significantly increased, however, the enzymatic antioxidant activities and the contents of non-enzymatic antioxidants were decreased compared with the control rats. Administration of Vit C, DPPD and LCys with CP counteract the changes in oxidative stress markers in renal tissues of treated rats with CP. The present results conclude that DPPD, Vit C and L-Cys ameliorate the pathological and oxidative stress-induced by CP in the kidneys of male rats.

Older people face special challenges in living with and adjusting to epilepsy and seizures. Epilepsy in elderly people is one of the underestimated health problems in Egypt. Objectives: To estimate the prevalence of epilepsy in elderly people in Al Quseir city- Red Sea Governate, Egypt and to estimate its magnitude of treatment gap. Methods: The study was a part of door to door study, including every door to screen all inhabitants in Al-Quseir city (33,818 inhabitants); by 3 specialists of neurology and 15 female social workers. Number of people ≥ 60 years is 2106 persons among whom we detected 13 cases with epilepsy. All suspected cases were subjected to detailed history, clinical examination, EEG, Neuroimaging studies. Results: The study revealed that life time prevalence of epilepsy is 6.2/1000, with highest peak during the eighth decade of life, while the prevalence of active epilepsy is 2.4/1000 population. The prevalence rate of epilepsy in elderly males is double that in elderly females. Epilepsy in elderly detected in this study is caused by symptomatic cause (30%, n=4), idiopathic (53.8%, n=7), and cryptogenic (15.4%, n=2). The annual incidence rate is 142.4/100,000. Focal epilepsy is the most frequently encountered type (84.6%). The treatment gap of epilepsy in elderly in Al Quseir city is 80%. Conclusion: epilepsy among elderly is an underestimated health problem in Egypt and treatment gap is high which necessitates developing health services in this locality.

Domestic violence against women is increasingly recognized as a global problem. It poses a direct threat to women's health and has serious reproductive health consequences. Aim of the study: The study aims to identify the relationship between women exposure to spousal violence and some reproductive health indicators. Methods: Data from the 2005 Egyptian Demographic and Health Survey were secondary analyzed for 5,613 ever- married women aged 15-49 years. Results: More than three in ten women had an experience with any form of spousal violence. Fertility was higher among women have experienced violence than among women who have not (mean number of children ever born was 3.42.1 versus 2.9  2.4). Total family planning need was higher among women who have experienced violence than among women who have not. Self reported prevalence of sexually transmitted infections was higher among women who have ever or recently experienced violence than women who have not (21.4%, 26.1% versus. 18.5%). Conclusion: Marital violence is related to various negative reproductive health outcomes. Violence against women is a vicious circle that needs to be broken. Actions must be taken to make women and men understand that violence against women is not legitimate or acceptable and that everybody pays a high price for it.

Domestic violence against women is increasingly recognized as a global problem. It poses a direct threat to women's health and has serious reproductive health consequences. Aim of the study: The study aims to identify the relationship between women exposure to spousal violence and some reproductive health indicators. Methods: Data from the 2005 Egyptian Demographic and Health Survey were secondary analyzed for 5,613 ever- married women aged 15-49 years. Results: More than three in ten women had an experience with any form of spousal violence. Fertility was higher among women have experienced violence than among women who have not (mean number of children ever born was 3.42.1 versus 2.9  2.4). Total family planning need was higher among women who have experienced violence than among women who have not. Self reported prevalence of sexually transmitted infections was higher among women who have ever or recently experienced violence than women who have not (21.4%, 26.1% versus. 18.5%). Conclusion: Marital violence is related to various negative reproductive health outcomes. Violence against women is a vicious circle that needs to be broken. Actions must be taken to make women and men understand that violence against women is not legitimate or acceptable and that everybody pays a high price for it.