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.

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.

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.

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.