Background: There is growing evidence for a gut-brain connection associated with autism spectrum disorders (ASD). This suggests a potential benefit from introduced digestive enzymes for children with ASD. Methods: We performed a double-blind, randomized clinical trial on 101 children with ASD (82 boys and 19 girls) aged from 3 to 9 years. ASD patients were diagnosed according to DSM-IV-TR diagnostic criteria. Structured interviews of at least one hour each both with the parents and the child were performed. Later on, another two hours-session was conducted applying the Childhood Autism Rating Scale (CARS). ASD patients were randomized to receive digestive enzymes or placebo. Results: The ASD group receiving digestive enzyme therapy for 3 months had significant improvement in emotional response, general impression autistic score, general behavior and gastrointestinal symptoms. Our study demonstrated the usefulness of digestive enzyme in our population of ASD patients. Conclusion: Digestive enzymes are inexpensive, readily available, have an excellent safety profile, and have mildly beneficial effects in ASD patients. Depending on the parameter measured in our study; we propose digestive enzymes for managing symptoms of ASD. Digestive enzyme therapy may be a possible option in treatment protocols for ASD in the future A randomized, Placebo-Controlled Trial of Digestive Enzymes in Children with Autism Spectrum Disorders. Available from: https://www.researchgate.net/publication/273063768_A_randomized_Placebo-Controlled_Trial_of_Digestive_Enzymes_in_Children_with_Autism_Spectrum_Disorders [accessed Jun 3, 2015].

Background: There is growing evidence for a gut-brain connection associated with autism spectrum disorders (ASD). This suggests a potential benefit from introduced digestive enzymes for children with ASD. Methods: We performed a double-blind, randomized clinical trial on 101 children with ASD (82 boys and 19 girls) aged from 3 to 9 years. ASD patients were diagnosed according to DSM-IV-TR diagnostic criteria. Structured interviews of at least one hour each both with the parents and the child were performed. Later on, another two hours-session was conducted applying the Childhood Autism Rating Scale (CARS). ASD patients were randomized to receive digestive enzymes or placebo. Results: The ASD group receiving digestive enzyme therapy for 3 months had significant improvement in emotional response, general impression autistic score, general behavior and gastrointestinal symptoms. Our study demonstrated the usefulness of digestive enzyme in our population of ASD patients. Conclusion: Digestive enzymes are inexpensive, readily available, have an excellent safety profile, and have mildly beneficial effects in ASD patients. Depending on the parameter measured in our study; we propose digestive enzymes for managing symptoms of ASD. Digestive enzyme therapy may be a possible option in treatment protocols for ASD in the future A randomized, Placebo-Controlled Trial of Digestive Enzymes in Children with Autism Spectrum Disorders. Available from: https://www.researchgate.net/publication/273063768_A_randomized_Placebo-Controlled_Trial_of_Digestive_Enzymes_in_Children_with_Autism_Spectrum_Disorders [accessed Jun 3, 2015].

Abstract: Purpose: This study was designed to evaluate the functional and radiological results of biplanar medial opening wedge high tibial osteotomy using Tomofix plate. Patients and Methods : This study included 69 patients with medial unicompartmental osteoarthritis of the knee joint, their age ranged from 35 to 54 years with an average of 47 years, 38 were males and 31 females. Partial weight bearing exercises were allowed after the first week of surgery. Results: Patients were followed up for a period ranging from 24 to 38 months with an average of 31 months. The American Knee Society Score was markedly improved in all patients from 61+/- 10 to 92+/- 5. The constitutional tibia vara angle improved from 5- 15 degrees to normal valgus angle 5-7 degrees. There was no recorded case of infection, non-union or metal failure. Conclusions: The medial biplanar opening wedge high tibial osteotomy is a successful tool in correction of mal-alignment of the knee joint, early weight bearing, no bone grafting was required and complication free. Key words: High tibial osteotomy, Tomofix plate, osteoarthritis, knee

Abstract: Purpose: This study was designed to evaluate clinical outcomes and complications following minimally invasive plate osteosynthesis (MIPO) with the proximal humeral internal locking system (PHILOS) for treating proximal humeral shaft fracture. Patients and Methods: Between March 2012 and March 2013, 37 patients with unilateral proximal humeral shaft fractures were treated using the MIPO technique with the PHILOS through the transdeltoid approach. All fractures were closed with no associated injuries and classified as 2-part (n=13), 3-part (n=19), and 4-part (n=5), according to the Neer's classification. Patients were followed up for 16.9 months (range, 12– 24), radiologically and functionally. Postoperative complications and functional Constant Shoulder Score were used for evaluation. Results: No intraoperative complications occurred. Postoperative complications included subacromial impingement in 3 patients. There was no deep infection, neurovascular damage, breakage or implant loosening. All fractures united in an average time of 10 (8–12) weeks. In terms of function, the Constant–Murley score was 89 points on average (range75–100). The range of motion of the involved shoulder was satisfactory, and pain-free in 84 % of patients. Conclusions: Using the MIPO technique with the PHILOS plate through the transdeltoid approach is a valid and safe method of treating proximal humeral shaft fractures.

Abstract: Background: Intra-articular fractures of the proximal tibia can often be troublesome because of the early and late arthritic complications of damage of the articular surface, and intra-articular lesions. There are some potential benefits of arthroscopy in solving some of the pitfalls of these fractures. The purpose of this work is to study these benefits of arthroscopy in treatment of those patients, and the benefits of adding an anti-glide screw. Patients and methods: Fifty patients with tibial plateau fractures were treated in Assiut University Hospitals. Of these patients only 16 were included in this study. Fourteen were men and 2 women. The age ranged between 27 and 60 years (mean 43 years). The inclusion criteria were patients with split, split depression, or local depression uni-condylar fractures according to Schatzker classification. The mean follow up was 15 months (6-24 months). The postoperative clinical evaluation depended up on Rasmussen scoring system. The radiological evaluation was according to Honkonen and Jarvinen. Results: Complete anatomical reduction of the fragments was achieved in 14 knees (87.5%). Up to 2 mm displacement or step off was accepted in two knees (12.5%). Clinical assessment according to Rasmussen classification was: 10 knees (62.5%) excellent, 4 knees (25%) good, 2 knees (12.5%) fair, and none was poor. Radiological results were: 13 (81.25%) grade one, 2 knees (12.5%) grade two, and one knee (6.25%) grade three. None of the cases were grade four at the final follow up radiographs. Conclusions: The use of arthroscopy allowed precise anatomic reduction of the articular surface of the knee joint. It is particularly helpful in type two and three injuries with central articular depression which are often difficult to assess on preoperative imaging studies. It is also helpful in assessing other intra-articular injuries and their management if possible. The anti-glide screw may help in prevention of loss of reduction.

Abstract: Background: Intra-articular fractures of the proximal tibia can often be troublesome because of the early and late arthritic complications of damage of the articular surface, and intra-articular lesions. There are some potential benefits of arthroscopy in solving some of the pitfalls of these fractures. The purpose of this work is to study these benefits of arthroscopy in treatment of those patients, and the benefits of adding an anti-glide screw. Patients and methods: Fifty patients with tibial plateau fractures were treated in Assiut University Hospitals. Of these patients only 16 were included in this study. Fourteen were men and 2 women. The age ranged between 27 and 60 years (mean 43 years). The inclusion criteria were patients with split, split depression, or local depression uni-condylar fractures according to Schatzker classification. The mean follow up was 15 months (6-24 months). The postoperative clinical evaluation depended up on Rasmussen scoring system. The radiological evaluation was according to Honkonen and Jarvinen. Results: Complete anatomical reduction of the fragments was achieved in 14 knees (87.5%). Up to 2 mm displacement or step off was accepted in two knees (12.5%). Clinical assessment according to Rasmussen classification was: 10 knees (62.5%) excellent, 4 knees (25%) good, 2 knees (12.5%) fair, and none was poor. Radiological results were: 13 (81.25%) grade one, 2 knees (12.5%) grade two, and one knee (6.25%) grade three. None of the cases were grade four at the final follow up radiographs. Conclusions: The use of arthroscopy allowed precise anatomic reduction of the articular surface of the knee joint. It is particularly helpful in type two and three injuries with central articular depression which are often difficult to assess on preoperative imaging studies. It is also helpful in assessing other intra-articular injuries and their management if possible. The anti-glide screw may help in prevention of loss of reduction.

Abstract: Background: Intra-articular fractures of the proximal tibia can often be troublesome because of the early and late arthritic complications of damage of the articular surface, and intra-articular lesions. There are some potential benefits of arthroscopy in solving some of the pitfalls of these fractures. The purpose of this work is to study these benefits of arthroscopy in treatment of those patients, and the benefits of adding an anti-glide screw. Patients and methods: Fifty patients with tibial plateau fractures were treated in Assiut University Hospitals. Of these patients only 16 were included in this study. Fourteen were men and 2 women. The age ranged between 27 and 60 years (mean 43 years). The inclusion criteria were patients with split, split depression, or local depression uni-condylar fractures according to Schatzker classification. The mean follow up was 15 months (6-24 months). The postoperative clinical evaluation depended up on Rasmussen scoring system. The radiological evaluation was according to Honkonen and Jarvinen. Results: Complete anatomical reduction of the fragments was achieved in 14 knees (87.5%). Up to 2 mm displacement or step off was accepted in two knees (12.5%). Clinical assessment according to Rasmussen classification was: 10 knees (62.5%) excellent, 4 knees (25%) good, 2 knees (12.5%) fair, and none was poor. Radiological results were: 13 (81.25%) grade one, 2 knees (12.5%) grade two, and one knee (6.25%) grade three. None of the cases were grade four at the final follow up radiographs. Conclusions: The use of arthroscopy allowed precise anatomic reduction of the articular surface of the knee joint. It is particularly helpful in type two and three injuries with central articular depression which are often difficult to assess on preoperative imaging studies. It is also helpful in assessing other intra-articular injuries and their management if possible. The anti-glide screw may help in prevention of loss of reduction.

Abstract: Objective: This is a prospective case series study, which was designed to evaluate the clinical outcome of posterior percutaneous plating of the humerus. Materials and methods: From the year 2010 to 2011, 37 patients with middle and distal third humeral fractures who met the inclusion criteria were surgically treated by minimally invasive plate osteosynthesis through posterior approach. Their age ranged from 19 to 43 with an average of 27.8 years. Type of fractures varied from B to C, and all of them were traumatic. Results: Patients were followed up for a period varied from 12 to 24 months with an average of 18. There were no cases of intraoperative complications, infection or metal failure. Union was achieved in all of them within 16–21 weeks with an average of 18. Iatrogenic postoperative temporary neuropraxia of the radial nerve palsy was observed in two patients. All patients achieved normal range of shoulder and elbow motion within 3 months after surgery. The average Quick DASH score at 12-month follow-up was 30. According to patient’s satisfaction, all of them returned to the usual pre-injury activity level within 6 months. Conclusions: This study suggests that the principles of minimally invasive plate osteosynthesis can be applied safely through posterior approach of the humerus to treat middle and distal third humeral fractures. This approach has the advantage of preserving the triceps anatomy and function facilitating rapid postoperative rehabilitation.

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Abstract: Charcot osteoarthropathy of the foot is a chronic and progressive disease of bone and joint associated with a risk of amputation. The main problems encountered in this process are osteopenia, fragmentation of the bones of the foot and ankle, joint subluxation or even dislocation, ulceration of the skin and the development of deep sepsis. We report our experience of a series of 20 patients with Charcot osteoarthropathy of the foot and ankle treated with an Ilizarov external fixator. The mean age of the group was 30 years (21 to 50). Diabetes mellitus was the underlying cause in 18 patients. Five had chronic ulcers involving the foot and ankle. Each patient had an open lengthening of the tendo Achillis with excision of all necrotic and loose bone from the ankle, subtalar and midtarsal joints when needed. The resulting defect was packed with corticocancellous bone graft harvested from the iliac crest and an Ilizarov external fixator was applied. Arthrodesis was achieved after a mean of 18 weeks (15 to 20), with healing of the skin ulcers. Pin track infection was not uncommon, but no frame had to be removed before the arthrodesis was sound. Every patient was able to resume wearing regular shoes after a mean of 26.5 weeks