Purpose: Fungal infections of the central nervous system (CNS) are potentially lethal conditions with high morbidity and mortality. In this review, we summarise the most common clinical manifestations, diagnostic methods, and treatment strategies for intracranial fungal infection at two tertiary care teaching hospitals. Material and methods: Prospective hospital study is carried out at Department of Neurosurgery; Assiut and Suhaj University Hospitals between January2010 to January 2018 (Minimum 12-months follow-up). Radiographs and hospital data of 74 patients with proven intracranial fungal infections were gathered and analyzed. There were no exclusion criteria: age, gender, clinical presentations, immunity status, radiological findings, laboratory, and microbiological data, types of management and outcome. In surgically treated patients, diagnosis was confirmed by pathologic evaluation. Gathered data were coded and entered into a computer and analyzed using SPSS version 22. Results: The greatest number of the patients had 40 to 60 years old (49; 66%) and the mean age was 44 years. There was an overwhelming male patient’s ranged preponderance 66%; 49 cases. Sixty-three patients (85%) were immunosuppressed; 11 cases (15%) were immunocompetent. The most common causes of immunosuppression were diabetes 27 patients; 43%, on chemotherapeutic agents 19 patients; 31%, on corticosteroid 16 patients; 25% and AIDS in one patient; 1%. Five different fungal types were identified but Cryptococcus spp. was the most common cause of CNS fungal infection, occurring in 39 patients (53%). This was followed by Candida spp. in 14 patients (19%), Aspergillus in 11 patients (15%), Blastomyces in 7 patients (9%) and Coccidiosis in 3 patients (4%). Headache was the most common presenting symptom, occurring in 33 patients (45%). Other relatively common symptoms were nausea or vomiting 11 patients (15%), fever 10 patients; (13%), seizures 9 patients (12%), acute mental status changes 8 patients; (11%) and stroke like Symptoms 3patients (4%). Different surgical procedures were done. Stereotactic biopsy is in 19 patients (deep; located in an eloquent region of the brain or multiple small lesion) or excision in 38 patients (cortical, relatively accessible regions of the brain), and CSF shunting in 17 patients. All patients received parenteral and, in some cases, oral antifungal chemotherapy in addition to surgical therapy. Overall mortality was 52.7% (39 deaths). An additional 8 surviving patients exhibited permanent morbidity due to neurological deficits and seizure disorders. Conclusion: This prospective population study demonstrates an insight into the intracranial fungal infection and management. CNS fungal infections have increased in frequency, particularly in immunocompromised patients; most infections are caused by Cryptococcus spp. Diabetes was the most common cause of immunosuppression and headache was the most common symptom at presentation. CNS fungal infection is still associated with a high mortality and morbidity. Prompt diagnosis; early and appropriate medical and surgical management are fundamental to optimize the outcome.

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Introduction: Pelvic sarcomas may present with vague symptoms. The aim of this study was to examine the characteristics and clinical presentations of different types of pelvic sarcoma in children. Methods: This is a retrospective cohort study of patients up to 21 years of age with the diagnosis of pelvic sarcoma between January 2000 and June 2013. Data on demographics, tumor type and location, and clinical presentation were collected from the medical records. Results: A total of 59 patients [37 males (62.7%) and 22 females (37.3%)] were examined in this study. Mean age at presentation was 11.3 ± 5 years (range 0.8–21 years). Thirty-six patients had Ewing sarcoma (61%), 9 osteosarcoma (6.8%), 4 undifferentiated sarcoma (6.8%), 2 (3.4%) rhabdomyosarcoma, 2 synovial cell sarcoma, and one (1.7%) of each fibrosarcoma, dermatofibrosarcoma, fibromyxoid sarcoma, chondrosarcoma, chordoma, and epithelioid sarcoma. Pain at presentation was reported in 41 patients, 13 mass, 8 limping, and 5 neurologic symptoms. Most of the bony tumors were painful (77%), while most of the soft tissue tumors were painless (70%). Nine patients presented with constitutional symptoms. Most patients presented within 4–12 months from symptoms beginning. Twenty-one patients (35.6%) presented with metastases (14 Ewing sarcoma, 6 osteosarcoma, and 1 synovial cell sarcoma). Pelvic radiographs showed lytic lesion in 11 patients, 4 sclerotic lesions, 6 mixed lesion, 6 had only soft tissue mass, 1 radiograph showed osteopenia, and 2 radiographs were reported normal. Conclusion: Ewing sarcoma was the most common pelvic sarcoma tumor in children. In most cases, pelvic sarcoma in children presented with pain mimicking other benign conditions. Some patients presented with metastatic disease with no prognostic clinical or radiographical signs or symptoms. Pelvic sarcoma should be considered a differential diagnosis as part of children work up.

Introduction: Patients with epilepsy (PWE) have poor quality of life (QOL) due to several events. This study is aimed to determine the effect of different anti-epileptic drugs (AEDs) monotherapy; Lamotrigine (LTG), Carbamazepine (CBZ) and Sodium Valproate (VPA) on QOL of newly diagnosed idiopathic generalized epilepsy. Patients and Methods: Thirty-six newly diagnosed patients with idiopathic generalized epilepsy from outpatient’s clinic of Assuit university Hospitals. According to AEDs treatment they were randomly classified into three groups with ratio 1:1:1: LTG, CBZ and VPA groups (N=12 for each). Quality of Life of these patients, using Epilepsy Inventory version 1.0 (QOLIE-31), and serum level of AEDs were assessed at baseline, after one and three months of treatment. Results: There was no significant difference between demographic and clinical data of the studied AEDs groups at baseline and there was a significant decline in frequency of seizures after three months, with significant improvement in overall score of QOLIE-31, social function and emotional well-being subscales, but Energy/Fatigue subscale showed significant improvement in LTG and CBZ groups without changes in VPA group. while the medication effect and overall QOL subscales showed significant improvement in LTG and VPA groups without improvement in CBZ group. The cognitive subscale of QOLIE-31 showed significant deterioration in CBZ group that was not found in LTG or VPA groups. Conclusion: AEDs monotherapy improve QOL of newly diagnosed Epileptic patients while LTG monotherapy was significantly more effective and tolerated for improving several aspects of QOL than VPA or CBZ monotherapy in newly diagnosed epileptic patients after 3 months of treatment.

Introduction: Patients with epilepsy (PWE) have poor quality of life (QOL) due to several events. This study is aimed to determine the effect of different anti-epileptic drugs (AEDs) monotherapy; Lamotrigine (LTG), Carbamazepine (CBZ) and Sodium Valproate (VPA) on QOL of newly diagnosed idiopathic generalized epilepsy. Patients and Methods: Thirty-six newly diagnosed patients with idiopathic generalized epilepsy from outpatient’s clinic of Assuit university Hospitals. According to AEDs treatment they were randomly classified into three groups with ratio 1:1:1: LTG, CBZ and VPA groups (N=12 for each). Quality of Life of these patients, using Epilepsy Inventory version 1.0 (QOLIE-31), and serum level of AEDs were assessed at baseline, after one and three months of treatment. Results: There was no significant difference between demographic and clinical data of the studied AEDs groups at baseline and there was a significant decline in frequency of seizures after three months, with significant improvement in overall score of QOLIE-31, social function and emotional well-being subscales, but Energy/Fatigue subscale showed significant improvement in LTG and CBZ groups without changes in VPA group. while the medication effect and overall QOL subscales showed significant improvement in LTG and VPA groups without improvement in CBZ group. The cognitive subscale of QOLIE-31 showed significant deterioration in CBZ group that was not found in LTG or VPA groups. Conclusion: AEDs monotherapy improve QOL of newly diagnosed Epileptic patients while LTG monotherapy was significantly more effective and tolerated for improving several aspects of QOL than VPA or CBZ monotherapy in newly diagnosed epileptic patients after 3 months of treatment.