This study is conducted during the period between January 2005 and December 2010 in the ENT department, Assiut University Hospital, Egypt. The study included 93 ears in 91 patients (2 patients had bilateral operations). Each ear had either total (6) or near total (87) perforation of the tympanic membrane (TM). All operations were done under general anesthesia using endo-tracheal inhalation route. In each case the TM is grafted using underlay TFG taken through post-oral incision supported externally by STSG taken from the medial surface of the lobule of the ear using no 15 scalpel. The lobule is stretched between 2 hands and the graft is taken. The round knife is used to abrade the mucosa of the lateral wall of the Eustachian tube and attic anterior to the malleus, floor of the middle ear (ME) and the undersurface of any remaining parts of the TM. Next, a small rim of the remaining TM is trimmed to freshen the edge for better healing. The ME is then packed with small pledges of gelatin sponge, then, the dried TFG is laid over the gelatin sponges and positioned to be under the skin of the posterior meatal wall and any remaining part of the TM. The STSG is then laid partly over the TFG and partly over the deep meatal skin. It could be used as one piece or cut into pieces. The assembly is supported externally by other pieces of gelatin sponge. The external ear is packed with antibiotic-containing Vaselinesed gauze. The wound is closed in layers and the patient is discharged from the hospital next morning. Patients come for the first post-operative visit at 5-7 days where the stitches are removed and so the aural pack and the patient is given steroid-containing antibiotic ear drops twice a day. The next visit is usually at 3-4 weeks where the external canal is dry-cleaned and the graft is checked and the patient is asked to continue the ear drops if needed. The 3rd post-operative visit is usually at the 3rd month where the ear is examined again for the status of the graft and checked audiologically where the post-operative air-conduction threshold is compaired with the pre-operative one at frequencies 500, 1000, and 4000Hz.to calculate the hearing improvement. Pure-tone average PTA change is calculated again for the 54 patients who came for follow up at one year. Results The success rate for this technique to close the large defects of the TM was about 92% (86 out of 92 operations). The average PTA improvement was 16.3 decibel (dB) at 3 month follow up, dropped to 15.5 dB at one year. Failure to close the TM defect was noticed in 7 patients ( 8 %), 2 of them had total perforation and 5 had near-total ones. The cause of failure was local infection in 3 cases and unidentified in 4 cases. All failures were in the anterior half of the tympanic membrane. Prolonged swelling of the graft was noticed in 2 cases (with formation of a tag-like part in one of them) .It persisted for more than 2 months both recovered during follow-up. Local infection with some muco-purulent discharge occurred in 3 cases, one of them improved with treatment and the other one ended with breakdown of the graft. Bleeding from the Jugular bulb or one of its tributaries occurred twice during abrading the mucosa of the floor of the ME. One of them stopped with oxidized cellulose and the other required extraluminal packing of the sigmoid sinus after cortical mastoidectomy. In both cases the operation could be continued successfully. No complications were noticed from any of the donor sites.

Analytical procedures for the determination of tramadol (T), O-desmethyltramadol (ODT), and N-desmethyltramadol (NDT) in human urine have been developed and validated using gas chromatography–mass spectrometry (GC/MS). Sample preparation involved liquid–liquid extraction with methyl-tert-butyl ether (MTBE) and followed by back extraction with 0.1 M hydrochloric acid. Proadifen (SKF525A) was selected as internal standard (IS). Extraction efficiencies of T, ODT and NDT were 102.12, 101.30, and 98.21%, respectively. The calibration curves were linear (r2 > 0.99) in the concentration range 10–1000 ng/mL for all compounds. Limits of quantification (LOQ) were 10, 10 and 20 ng/mL for T, ODT and NDT, respectively. Intra-assay precision was within 1.29–6.48% and inter-assay precision was within 1.28–6.84% for T, ODT and NDT. Intra-assay accuracy was within 91.79–106.89% for all analytes. This method detected urine concentrations of T, ODT and NDT in six healthy volunteers for 7 days after administration of 50 mg oral doses of tramadol.

There is very little published information about the prevalence, patterns, and predictors of peripheral neuropathies. The current study is a community-based survey was conducted in the Assiut Governorate to estimate their prevalence and clinical profile. Material and methods: A door-to-door study was carried out on 42 223 persons from rural and urban communities in the Assiut Governorate, Egypt. There were 13 288 (31.5%) subjects from the urban and 28 935 (68.5%) from the rural area. All subjects filled in a questionnaire designed specifically for diagnosis of peripheral neuropathy. Positive cases were then given a complete medical and neurological examination, routine laboratory tests, neurophysiology, and neuroimaging (magnetic resonance). Results: The crude prevalence rate (CPR) of peripheral neuropathy was 3181/100 000 inhabitants. There was a significantly higher prevalence in the rural compared with the urban population (3795 versus 1844/ 100 000) and in females than males (4473 versus 1943/100 000; P,0.001 for both). The most common type reported was entrapment neuropathy (736 cases with CPR of 1743/100 000), particularly carpal tunnel syndrome (1686/100 000). Diabetic neuropathy was the most common non-compressive neuropathy with a CPR of 649/100 000. Type II diabetes was recorded in 241 patients with a CPR of 571/100 000. Compressive radiculopathy had a crude prevalence of 358/100 000; traumatic and iatrogenic radiculopathy had a prevalence rate of 149/100 000. Less common conditions were: uremic neuropathy (21/ 100 000) hepatic neuropathy (14/100 000), Bell’s palsy (28/100 000), Guillian–Barre’ syndrome (12/ 100 000), chronic inflammatory demyelinating polyneuropathy (12/100 000), hereditary sensory motor neuropathy (12/100 000), and idiopathic neuropathy (92/100 000). Conclusion: The overall prevalence of peripheral neuropathies was high in comparison to other studies. Entrapment neuropathy, diabetic neuropathy, and spondylotic radiculopathy were the most common. Overall, the prevalence of peripheral neuropathy was higher in the rural than in the urban population.

There is a lack of awareness among physicians of the considerable disability caused by non-motor symptoms (NMS) in PD. The aim of this work is to estimate the prevalence of NMS in a series of patients with Parkinson's disease (PD). MATERIALS AND METHODS: We studied 112 patients with Parkinson's disease. Motor symptoms were scored on the Unified Parkinson's Disease Rating Scale (UPDRS) part III and the Hoehn and Yahr (HY) Scale. Other symptoms were quantified with the Non-Motor Symptom Questionnaire and Scale (NMSQuest and NMSS) as well as Minimental State Examination (MNSE). RESULTS: Analysis of the data from the NMSS showed that mood/cognition was the most commonly affected domain (prevalence rate=87.5%), followed by sleep disturbance/fatigue second (78.6%). However, all other non-motor symptoms scored highly: gastrointestinal and urinary (76.8% for both), sexual dysfunction (73%), cardiovascular (70.5%) with significantly higher percentage in predominantly akinetic/rigid patients. Perceptual problems/hallucinations (9.9%) were infrequent in this population. Dementia was recorded in 22.3% of patients, most of them having a mild degree of dementia. UPDRS scores were correlated with total scores in both NMSQuest and NMSS. CONCLUSIONS: Mood/cognition, sleep disorders, GIT, and sexual disorders were common non motor manifestations in this population of PD patients.

There is a lack of awareness among physicians of the considerable disability caused by non-motor symptoms (NMS) in PD. The aim of this work is to estimate the prevalence of NMS in a series of patients with Parkinson's disease (PD). MATERIALS AND METHODS: We studied 112 patients with Parkinson's disease. Motor symptoms were scored on the Unified Parkinson's Disease Rating Scale (UPDRS) part III and the Hoehn and Yahr (HY) Scale. Other symptoms were quantified with the Non-Motor Symptom Questionnaire and Scale (NMSQuest and NMSS) as well as Minimental State Examination (MNSE). RESULTS: Analysis of the data from the NMSS showed that mood/cognition was the most commonly affected domain (prevalence rate=87.5%), followed by sleep disturbance/fatigue second (78.6%). However, all other non-motor symptoms scored highly: gastrointestinal and urinary (76.8% for both), sexual dysfunction (73%), cardiovascular (70.5%) with significantly higher percentage in predominantly akinetic/rigid patients. Perceptual problems/hallucinations (9.9%) were infrequent in this population. Dementia was recorded in 22.3% of patients, most of them having a mild degree of dementia. UPDRS scores were correlated with total scores in both NMSQuest and NMSS. CONCLUSIONS: Mood/cognition, sleep disorders, GIT, and sexual disorders were common non motor manifestations in this population of PD patients.

There is a lack of awareness among physicians of the considerable disability caused by non-motor symptoms (NMS) in PD. The aim of this work is to estimate the prevalence of NMS in a series of patients with Parkinson's disease (PD). MATERIALS AND METHODS: We studied 112 patients with Parkinson's disease. Motor symptoms were scored on the Unified Parkinson's Disease Rating Scale (UPDRS) part III and the Hoehn and Yahr (HY) Scale. Other symptoms were quantified with the Non-Motor Symptom Questionnaire and Scale (NMSQuest and NMSS) as well as Minimental State Examination (MNSE). RESULTS: Analysis of the data from the NMSS showed that mood/cognition was the most commonly affected domain (prevalence rate=87.5%), followed by sleep disturbance/fatigue second (78.6%). However, all other non-motor symptoms scored highly: gastrointestinal and urinary (76.8% for both), sexual dysfunction (73%), cardiovascular (70.5%) with significantly higher percentage in predominantly akinetic/rigid patients. Perceptual problems/hallucinations (9.9%) were infrequent in this population. Dementia was recorded in 22.3% of patients, most of them having a mild degree of dementia. UPDRS scores were correlated with total scores in both NMSQuest and NMSS. CONCLUSIONS: Mood/cognition, sleep disorders, GIT, and sexual disorders were common non motor manifestations in this population of PD patients.

Objective: to test the value of treatment of gasteroesophageal reflux disease (GERD) in improving the obstructive sleep apnea syndrome (OSAS). Patients and methods: The study included 63 patients diagnosed with OSAS after complete history taking, Epworth sleepiness scale (ESS), physical examination, and full night polysomnography. Of them 29 patients were diagnosed with concomitant GERD by standardized Reflux Disease Questionnaire (RDQ), upper endoscopy, and 24-hour pH monitoring and received Pantoprazole 40 mg once daily for 2 months. The patients were reevaluated by polysomnography, ESS, quality of life SF36 v2 questionnaire. Results: The twenty- nine patients with OSAS and GERD had significantly higher body mass index (BMI), waist circumference, and reported non significant increase in sleep and daytime symptoms of OSAS. After 2 months treatment with Pantoprazole, there was significant decrease in apnea hypopnea index (AHI), snoring events, arousal index, and ESS. Meanwhile, there was a significant improvement in sleep efficiency, minimum O2 saturation, desaturation index and quality of life parameters (SF 36 v2). Conclusions: GERD and OSAS are common co morbid conditions. Adequate treatment of GERD with Pantoprazole, 40 mg/day for 2 months was effective in improving many subjective and objective findings of OSAS. In patients with OSAS and history suggestive of GERD, upper endoscopy, pH monitoring and treatment with proton pump inhibitors (PPIs) may be an important adjunct in controlling OSAS symptoms.

To date, no single agent has gained a sufficient prognostic significance for NSCLC patients. So, there is an urgent need for new innovative biomarkers in NSCLC. The present study was designed to: 1) Evaluate the role of Nitric Oxide (NO), Sialic Acid (SA) and Glutathione S-Transferase (GST) as prognostic indicators in NSCLC.2) Correlate the above parameters levels with the clinicopathological status of the patients. The study included 30 patients with newly diagnosed histopathologically confirmed NSCLC, as well as 10 healthy volunteers with matched age and sex as controls. Blood samples and lung tissue biopsies were taken from all subjects on admission. Results: Serum and tissue levels of NO, SA and GST activities were significantly higher in NSCLC patients compared to controls. These levels decreased significantly after chemotherapy. The serum and tissue levels of the studied parameters decreased significantly in the responders compared to resistant cases. In conclusion, NO, SA, besides GST correlated significantly with the clinicopathological status of NSCLC patients and are considered sensitive prognostic biochemical indices.

Objective: to test the value of treatment of gasteroesophageal reflux disease (GERD) in improving the obstructive sleep apnea syndrome (OSAS). Patients and methods: The study included 63 patients diagnosed with OSAS after complete history taking, Epworth sleepiness scale (ESS), physical examination, and full night polysomnography. Of them 29 patients were diagnosed with concomitant GERD by standardized Reflux Disease Questionnaire (RDQ), upper endoscopy, and 24-hour pH monitoring and received Pantoprazole 40 mg once daily for 2 months. The patients were reevaluated by polysomnography, ESS, quality of life SF36 v2 questionnaire. Results: The twenty- nine patients with OSAS and GERD had significantly higher body mass index (BMI), waist circumference, and reported non significant increase in sleep and daytime symptoms of OSAS. After 2 months treatment with Pantoprazole, there was significant decrease in apnea hypopnea index (AHI), snoring events, arousal index, and ESS. Meanwhile, there was a significant improvement in sleep efficiency, minimum O2 saturation, desaturation index and quality of life parameters (SF 36 v2). Conclusions: GERD and OSAS are common co morbid conditions. Adequate treatment of GERD with Pantoprazole, 40 mg/day for 2 months was effective in improving many subjective and objective findings of OSAS. In patients with OSAS and history suggestive of GERD, upper endoscopy, pH monitoring and treatment with proton pump inhibitors (PPIs) may be an important adjunct in controlling OSAS symptoms.