Chronic obstructive pulmonary disease (COPD) is an increasingly common disease among older adults that has been linked to other comorbid conditions with serious morbidity and mortality, including cognition impairment. However, it remains poorly understood in COPD. The aim of this study is to evaluate cognitive dysfunction in COPD and to relate it to the severity obtained from spirometric and gasometric evaluation of COPD patients.

Methods: 21 patients with histopathological confirmed glioma were included. Imaging was achieved on a 1.5T MRI scanner. Dynamic susceptibility contrast (DSC) MRI was performed using T2* weighted gradient echo-planner imaging (EPI). A series of 50 dynamic scans were acquired at 1.9 seconds intervals after intravenous bolus injection of 10 mmol/kg Gd- DTPA. Multiple ROIs have been drawn in the hot spots of both intra-tumoral and peri-tumoral regions, corresponding the colour maps. The highest ROI has been selected to represent the rCBV of each intra-tumoral and peri-tumoral regions. Tumors were subdivided into low grades and high grade on the basis of histopathology. Receiver operating characteristic analysis of rCBV, of both intra-tumoral and peri-tumoral regions, was performed to find cutoff values between high and low grade tumors. The resulting sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: Based on the histopathology, high grade glioma (HGG) represented 71.4% whereas low grade glioma (LGG) represented 28.8%. Both intra-tumoral and peri-tumoral rCBV of HGG were significantly higher than those of LGG. The cut-off value = 2.9 for intratumoral rCBV provided sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of 80%, 100%, 100%, 66.7% and 85.7% respectively to differentiate between HGG and LGG. Additionally, the cut-off value = 0.7 for peri-tumoral rCBV provided sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of 100%, 66.6%, 88.2%, 100%, and 90.5% respectively to differentiate between HGG and LGG. Conclusion: ROI of the highest rCBV is significantly reliable for the preoperative distinction between HGG and LGG. Combined intra-tumoral and peri-tumoral rCBV provides overall better diagnostic accuracy and helps to decrease the invasive intervention for non-surgical candidates.

Methods: 21 patients with histopathological confirmed glioma were included. Imaging was achieved on a 1.5T MRI scanner. Dynamic susceptibility contrast (DSC) MRI was performed using T2* weighted gradient echo-planner imaging (EPI). A series of 50 dynamic scans were acquired at 1.9 seconds intervals after intravenous bolus injection of 10 mmol/kg Gd- DTPA. Multiple ROIs have been drawn in the hot spots of both intra-tumoral and peri-tumoral regions, corresponding the colour maps. The highest ROI has been selected to represent the rCBV of each intra-tumoral and peri-tumoral regions. Tumors were subdivided into low grades and high grade on the basis of histopathology. Receiver operating characteristic analysis of rCBV, of both intra-tumoral and peri-tumoral regions, was performed to find cutoff values between high and low grade tumors. The resulting sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: Based on the histopathology, high grade glioma (HGG) represented 71.4% whereas low grade glioma (LGG) represented 28.8%. Both intra-tumoral and peri-tumoral rCBV of HGG were significantly higher than those of LGG. The cut-off value = 2.9 for intratumoral rCBV provided sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of 80%, 100%, 100%, 66.7% and 85.7% respectively to differentiate between HGG and LGG. Additionally, the cut-off value = 0.7 for peri-tumoral rCBV provided sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of 100%, 66.6%, 88.2%, 100%, and 90.5% respectively to differentiate between HGG and LGG. Conclusion: ROI of the highest rCBV is significantly reliable for the preoperative distinction between HGG and LGG. Combined intra-tumoral and peri-tumoral rCBV provides overall better diagnostic accuracy and helps to decrease the invasive intervention for non-surgical candidates.

Methods: 21 patients with histopathological confirmed glioma were included. Imaging was achieved on a 1.5T MRI scanner. Dynamic susceptibility contrast (DSC) MRI was performed using T2* weighted gradient echo-planner imaging (EPI). A series of 50 dynamic scans were acquired at 1.9 seconds intervals after intravenous bolus injection of 10 mmol/kg Gd- DTPA. Multiple ROIs have been drawn in the hot spots of both intra-tumoral and peri-tumoral regions, corresponding the colour maps. The highest ROI has been selected to represent the rCBV of each intra-tumoral and peri-tumoral regions. Tumors were subdivided into low grades and high grade on the basis of histopathology. Receiver operating characteristic analysis of rCBV, of both intra-tumoral and peri-tumoral regions, was performed to find cutoff values between high and low grade tumors. The resulting sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: Based on the histopathology, high grade glioma (HGG) represented 71.4% whereas low grade glioma (LGG) represented 28.8%. Both intra-tumoral and peri-tumoral rCBV of HGG were significantly higher than those of LGG. The cut-off value = 2.9 for intratumoral rCBV provided sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of 80%, 100%, 100%, 66.7% and 85.7% respectively to differentiate between HGG and LGG. Additionally, the cut-off value = 0.7 for peri-tumoral rCBV provided sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of 100%, 66.6%, 88.2%, 100%, and 90.5% respectively to differentiate between HGG and LGG. Conclusion: ROI of the highest rCBV is significantly reliable for the preoperative distinction between HGG and LGG. Combined intra-tumoral and peri-tumoral rCBV provides overall better diagnostic accuracy and helps to decrease the invasive intervention for non-surgical candidates.

Background: Ascites is the most common complication of liver cirrhosis and about 5-10% of all cases develop refractory ascites, 50% of such patients die within 6 months of its development. Aim of the Work: to assess the usefulness of adding midodrine beside the standard medical treatment for patients with liver cirrhosis and refractory ascites. Patients and Methods: This study included 78 patients with liver cirrhosis and refractory ascites or recurrent ascites, Group A: (n=37) patients on standard medical treatment (SMT) [low sodium diet + diuretic therapy (loop diuretic in a dose 40-160 mg/day and distal acting diuretic in a dose 100-400 mg/day + large volume paracentesis as needed] Group B: (n=41) patients with standard medical treatment (SMT) and midodrine tolerable dose. Results: Statistical significant difference between the SMT group and midodrine group as regard reduction in body weight and increase in mean arterial blood pressure and 24 h-urinary volume where P value was 0.05. Conclusion, midodrine is a safe treatment for patients with liver cirrhosis and its addition to standard medical treatment is associated with better control of ascites.

Introduction: Esophageal high resolution manometry (HRM) coupled with high resolution pressure topography has dramatically changed the manometric studies and now replacing the conventional manometry in diagnosing achalasia and its subtypes. Aim of the work: To assess and compare the clinical and manometric characteristics of achalasia subtypes among untreated Egyptian patients using esophageal HRM. Methods: Forty Egyptian patients with achalasia underwent HRM at the GI motility unit, Internal Medicine department, Assuit University Hospital. Clinical and manometric data from 40 achalasia patients and 400 water swallows were analyzed according to Chicago classification into 3 subtypes: type I (classic achalasia), type II (achalasia with esophageal compression), and type III (spastic achalasia). Results: Type I achalasia was diagnosed in 16 patients, type II in 19 and type III in 5. Dysphagia and regurgitation were the main symptoms in types I and II achalasia. While, type III achalasia patients had dysphagia and sometimes chest pain, high lower esophageal sphincter (LES) pressure and esophageal spasm with swallowing when compared to types I and II. Integrated relaxation pressure (IRP) was significantly lower in type I than in types II and III. Maximal esophageal pressurization was significantly higher and LES length was significantly longer in type III than types I and II. Conclusions: The clinical and manometric variables of the 3 types of achalasia are distinct. The Egyptian cohort of achalasia had comparable data as those of the western population. Further investigations are needed to identify the optimal method of treatment within each subgroup.

Background: Diabetes is important as a cause of cardiovascular disease (CVD), ranging from asymptomatic ischemia to clinically evident heart failure. Therefore, early identification of sub-clinical CVD in diabetic patients may be particularly important in leading to early initiation of treatment. The aim of the present study was to identify role of BNP (Brain natriuretic Peptide), Ankle Brachial Index (ABI) and carotid Doppler in detection of sub-clinical CVD in type 2 diabetic patients. Patients and methods: BNP was measured in 60 consecutive diabetic patients (patients group) whom were attended internal medicine outpatient clinics or admitted at endocrinology unit of Assiut university hospital. Another 40 patients; were chosen as (control group) their age and sex matched with patients. Echocardiography examinations were performed to all participants. ABI measurements were conducted on all study participants. Carotid intima Media Thickness (CIMT) and carotid Plaque were evaluated by Carotid Doppler Ultrasonography, along with the determination of anthropometric parameters, HbA1c, lipid profile, assessment of diabetic retinopathy, nephropathy, and neuropathy, in patients with type 2 diabetes mellitus (T2DM). Results: Our study revealed 11 patients had Left ventricular hypertrophy (LVH), 20 patients had Left Ventricular Diastolic Dysfunction (LVDD), and no systolic dysfunction were detected. BNP were independent determinants of mild to moderate LVDD. Prevalence of a low ABI (0.9) was 18.3%. Patients with low ABI had significant increased mean ages (P=0.038) duration of DM (P=0.004), concentration of HbA1c (P=0.044), BNP (P=0.013) and microalbuminurea (P=0.007).Patients with low ABI significantly associated with nephropathy (P=0.001), retinopathy (P=0.007), LVH (P=0.010) LVDD (P=0.018) and carotid artery atherosclerosis (P=0.018). 20 patients( 33.3%) were found to have evidence of carotid artery disease of them 5 patients (8.3%) had increased CIMT and 15 patients (25%) had carotid artery plaques. patients with carotid plaque were significantly smoker (P=0.008), male gender (P=0.013), had low HDL (P=0.008) and higher concentration of HbA1c (P=0.001). Also patients with carotid artery atherosclerosis were significantly associated with nephropathy (P=0.000), neuropathy (P=0.050), Peripheral Arterial Disease (PAD) (P=0.018), LVDD (0.002).Conclusion: Our study showed that BNP discriminated patients at high risk for mild to moderate LVDD. A low ABI were prevalent in our study and associated with age, duration of diabetes, high HbA1c, microalbuminurea and chronic complication of DM, also carotid atherosclerosis high prevalent in our study especially carotid plaques which significantly associated with male gender, smoking, high HbA1c, low HDL, LVDD, PAD, and diabetic microangiopathy.

Introduction: Gastrointestinal bleeding represents an important clinical problem, which can be encountered in several presentations including overt, occult and obscure forms. The management of gastrointestinal bleeding represents an important clinical problem particularly the obscure overt bleeding. This study aimed to evaluate the role of angiography in the management of this type of bleeding. Patients and Methods: 30 patients (25 males and 5 females) The age ranged from 16-72 years with the mean age 67.9 years, the patients presented with obscure overt gastrointestinal bleeding and were studied at our interventional radiologic unit. Six patients with hematemesis and melena, 15 patients with only melena, 5 patients with melena and hematochesia and 4 patients with hematochesia only. Angiography as digital subtraction technique with embo-lotherapy was done for all. Results: Angiodiagnosis showed dysplasia in 24 patients, colonic diverticulum in 3 patients, small intestinal tumors in 2 patients and solitary rectal ulcer in one patient. The embo-lotherapy was successful in 24 patients and failed in 6 patients. Conclusion: Angiography has a definite and indispensible role in the management of obscure overt gastrointestinal bleeding. Diagnostic angiography followed by embolotherapy may represent and alternative non invasive technique that may replace surgery.

Background: Intensive Care Units are units designed to take care of patients with the most severe and life-threatening illnesses and injuries; that require constant, close monitoring and support from specialist equipment and medication in order to maintain normal bodily functions. Objective: Was to evaluate mortality rate in medical ICU and related risk factors, as little is known about the causes and risk factors for death in critically ill patients in our medical ICU. Methods: Data were obtained from 100 patients admitted to the 12-bed Medical Intensive Care Unit in the Department of Medicine, Assiut University Hospital, between January 1, 2012 and June 30, 2012. The admission records of each patient admitted to the ICU were reviewed prospectively during the period of 6 months. Patient characteristics including demo-graphic variables, diagnosis, acute physiology and chronic health evaluation (APACHE II) score at the time of ICU admission and length of stay in the ICU were obtained. The treatment outcome was determined by survival at the time of ICU discharge. Results: 53% of the admissions involved were female, with mean age 49.85±19.20 years, 25% patients stayed for 5- 10 days, 25% of patients were died, while 75% survived, with average APACHE II score 18.34±0.72, and predicted death rate 33.60±2.02. Predictors of non survival were higher APACHE II score (p-value 0.038), low GCS (p-value 0.001) and decreased PO2 (p-value 0.001). Conclusion: The actual death rate in our medical ICU is lower than the expected risk of death according to APACHEII scoring system.

Background: Associated symptoms of bronchogenic carcinoma other than chest complaints like dysphagia are rarely demonstrated in literature regarding prevalence, cause–effect relationship and proper management plan. Gastrointestinal motility disorder as a cause of dysphagia in lung cancer is incompletely understood. This prospective preliminary study aims to find out the prevalence and different aetiologic mechanisms for dysphagia among lung cancer patients using oesphagoscopy and oesphageal manometry. Patients and methods: All lung cancer patients with dysphagia admitted in the Cancer Institute, Assiut University during the year 2010–2012 were included in the study. All patients were subjected to oesophagoscopy and oesophagomanometry study. Results: We collected 165 cases of bronchogenic carcinoma during the study period. Dysphagia was diagnosed in 20 cases (12.1%) regardless the stage of malignancy. Four separate dysphagia causes were identified. Secondary achalasia was diagnosed in 10 cases (50%), whereas enlarged mediastinal lymph nodes and candidal oesphagitis in 4 cases each (20%), and chemoradiotherapy in 2 cases (10%). Conclusions: Dysphagia associated with bronchogenic carcinoma is not uncommon and should be asked for and documented in all cases if present. Secondary achalasia is the commonest mechanism of dysphagia based on oesphagoscopy and manometry. Further large sample multicenteric