# Internationally Published Papers 2015

Authors:
Abu Faddan NH1, Shehata GA2, Abd Elhafeez HA3, Mohamed AO4, Hassan HS5, Abd El Sameea F5.

Title:
Cognitive Function And Endogenous Cytokine Levels In Children With Chronic Hepatitis C.

Abstract:
Little is known about how hepatitis C (HCV) infection affects cognitive function in children. The aim of the study was to assess the impact of HCV infection on cognitive function of children with normal liver functions and their relationships to endogenous IFN-α, IL-6 and TNF-α. IFN-α, IL-6 and TNF-α were measured and the Arabic version of the Stanford-Binet test used to assess cognitive functions in 35 children with HCV infection and 23 controls. Serum levels of IL-6 and IFN-α were significantly higher in patients compared to controls. There was a significant effect on vocabulary, comprehension, and abstract visual reasoning, quantitative reasoning and bead memory tests, as well as total short-term memory and intelligence quotient in patients compared to controls. There was a significant positive correlation between IFN-α and IL-6. Also there were significant negative correlations between IFN-α and Abstract visual reasoning test, Quantitative reasoning test, Bead memory test, Total short-term memory and Intelligence quotient; and between IL-6 and Abstract visual reasoning test, Quantitative reasoning test and Intelligence quotient. There was no significant correlation between TNF-α and any of the cognitive functions. Cytokine levels were not related to demographic characteristics of the patients or viral load (PCR). Children with chronic hepatitis C infection in its early stages showed signs of cognitive impairment, with the memory tasks being mostly affected. There was a significant correlation between endogenous cytokines and cognitive impairment in these children. Further studies are needed to define the effect of successful antiviral treatment.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Psychology, Faculty of Art, Assiut University, Assiut, Egypt.


Authors:
Ahmed AE1, Abo El-Magd EA2, Hasan GM3, El-Asheer OM4.

Title:
A Comparative Study Of Propranolol Versus Silver Nitrate Cautery In The Treatment Of Recurrent Primary Epistaxis In Children.

Abstract:
BACKGROUND:
Epistaxis is a common medical problem in pediatric population. Although in most cases it is mild and self-limiting, a proportion of childhood epistaxis is massive, recurrent, or resistant to conventional management.

OBJECTIVE:
To compare effectiveness of propranolol as a treatment option for childhood epistaxis versus conventional silver nitrate cautery.

STUDY DESIGN AND METHODOLOGY:
This is a prospective interventional comparative study that was carried out during a period of 1 year (January 1, 2013 to December 31, 2013) at Qena University Hospital and Assiut University Children's Hospital. One hundred children aged 6-12 years who presented with epistaxis to Qena University Hospital and Assiut University Children's Hospital during the study period and fulfilling the inclusion criteria were included in the study. They were randomly assigned into one of two interventional groups, where 50 children were treated with oral propranolol (propranolol treatment group) and another 50 children were treated with conventional silver nitrate cautery (cauterization treatment group) for their epistaxis. Propranolol was given at a dose of 1.5-2 mg/kg/day (divided into three doses). Patients were followed for 6 months after their discharge for recurrence of epistaxis.

RESULTS:
Both groups of patients showed minimal recurrent epistaxis with rates of 14% for propranolol treated group and 12% for cauterization group, with no statistically significant difference between both groups. Local pain was found to be more in patients treated with silver nitrate cauterization.

CONCLUSION:
Treatment of primary epistaxis with propranolol or silver nitrate cautery showed equal rates of recurrence, and local nasal pain was slightly more among silver nitrate cauterization treated group. Propranolol could be a favorable treatment option for patients with primary epistaxis. Further studies that include multiple centers and larger number of patients are recommended for more clarification of the effectiveness of such treatment option.

Author Info:
1
Pediatric Department, Qena University Hospital, Faculty of Medicine, South Valley University, Qena, Egypt.
2
Otorhinolaryngology Department, Aswan University Hospital, Faculty of Medicine, Aswan University, Aswan, Egypt.
3
Pediatric Department, Assiut University Children's Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt ; Pediatric Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
4
Pediatric Department, Assiut University Children's Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Ahmed AE1, Abdel-Baseer KA1, Saad K2, Hassan AF3, El-Houfey AA4.

Title:
Endocrinological And Biochemical Changes Of Scorpionism In Children In Upper Egypt.

Abstract:
AIM:
The aim of this study was to determine some endocrinological and biochemical changes of scorpionism in children in Upper Egypt. In addition, it aimed to find any possible relationship between these changes and the severity of scorpionism.

PATIENTS AND METHODS:
The present study was carried out at two university hospitals in Upper Egypt and included 42 children with envenomation and 20 apparently healthy children as controls. In all subjects, levels were measured of noradrenaline, aldosterone, insulin and cortisol, and some biochemical parameters and electrolytes including nitric oxide (NO), creatine phosphokinase (CPK), Na+ and K+.

RESULTS:
Na+, NO and CPK levels were significantly higher in children with envenomation compared with the controls. Also, there was a significant reduction in K+ in patients compared with controls. Children with severe envenomation had significantly higher levels of noradrenaline, cortisol and aldosterone compared with the controls and mild cases. However, insulin levels were significantly decreased in severe cases of scorpionism compared with mild ones. Moreover, hyperglycemia was detected in all patients with envenomation compared with controls, with significantly higher blood glucose levels among children with severe envenomation compared with mild cases.

CONCLUSION:
Endocrinological changes were common in all children with scorpion envenomation and more obvious in cases of severe envenomation. The released mediators may account for several inflammatory manifestations such as pulmonary edema, myocardial failure, systemic inflammatory response syndrome and multiple organ failure. The use of insulin is recommended in cases of severe envenomation to improve the outcome.

Author Info:
1
Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Egypt.
2
Associate Professor of Pediatrics, Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut 71516, Egypt.
3
Department of Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Community Health Nursing, Faculty of Nursing, Assiut University, Egypt.


Authors:
Al-Amri FA1, Saeedi MY1, Al-Tahan FM1, Ali AM2, Alomary SA1, Arafa M3, Ibrahim AK4, Kassim KA1.

Title:
Breast Cancer Correlates In A Cohort Of Breast Screening Program Participants In Riyadh, KSA.

Abstract:
BACKGROUND:
Breast cancer is the first cancer among females in the Kingdom of Saudi Arabia, accounting for 27.4% of all newly diagnosed female cancers in 2010. There are several risk factors affecting the incidence of breast cancer where some factors influence the risk more than the others.

AIM:
We aimed to identify the different risk factors related to breast cancer among females participating in the breast-screening program in Riyadh, KSA.

METHODS:
Based on data from phase-I of the breast-screening program, a case-control study was conducted on women living in Riyadh, KSA. A sample of 349 women (58 cases and 290 controls) was recruited to examine the different breast cancer correlates. Multivariate regression model was built to investigate the most important risk factors.

RESULTS:
The mean age of cases was 48.5±7.1 years. Age at marriage, number of pregnancy, age at menopause, oral contraceptive pills, breast feeding and family history of breast cancer in first-degree relative were identified as the most important correlates among the studied cohort.

CONCLUSIONS:
The findings of the current work suggested that age at marriage, age at menopause ⩾50 years and 1st degree family history of breast cancer were risk factors for breast cancer, while, age at menopause <50 years, number of pregnancies and practicing breast feeding were protective factors against breast cancer. There was no effect of body mass index or physical inactivity. Further studies are needed to explore the hereditary, familial and genetic background risk factors in Saudi population.

Author Info:
1
Ministry of Health, Deputy Ministry for Public Health, Assistant Deputy for Primary Health Care, Riyadh, Saudi Arabia.
2
King Khalid University Hospitals, Medical Oncology Department, King Saud University, Saudi Arabia; Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Asyut, Egypt.
3
Community Medicine Department, King Saud University, Saudi Arabia.
4
Public Health & Community Medicine School, Faculty of Medicine, Assiut University, Asyut, Egypt. Electronic address: ahmed.khair@yahoo.com.


Authors:
Alamri FA1, Saeedi MY, Mohamed A, Barzanii A, Aldayel M, Ibrahim AK.

Title:
Knowledge, Attitude, And Practice Of Osteoporosis Among Saudis: A Community-Based Study.

Abstract:
BACKGROUND:
Osteoporosis is a global public health problem currently affecting millions of people worldwide, and Saudi Arabia is not an exception. Awareness and perceptions of susceptibility and belief in the seriousness of a disease can help in its prevention and control. We aimed to assess knowledge, attitude, and practices for osteoporosis among Saudi general population and to identify its determining factors.

METHODS:
A cross-sectional survey of people aged 18 years or older representing every region in the Kingdom of Saudi Arabia was carried out. A total of 2174 self-administered questionnaires were distributed to identify the levels of knowledge, attitude, and practice.

RESULTS:
Responses were obtained from 1830 individuals (42% female and 58% male). The majority of the study sample had heard about osteoporosis (78%). There were significant associations between the level of awareness and the following sociodemographics of the participants: age, sex, education, occupation, income, and residence (P<0.01). Regular practice of the main preventive behaviors was correlated with an increase in the level of awareness.

CONCLUSION AND RECOMMENDATIONS:
The majority of the study cohort had heard about osteoporosis. Female respondents were more knowledgeable. Age was negatively correlated with the level of awareness. Awareness levels and the main sociodemographic determinants were significantly associated. The study recommended that health authorities and physicians should have better involvement in patient education efforts to improve and maintain the information provided on osteoporosis.

Author Info:
aNon-Communicable Disease Directorate, Ministry of Health bFamily and Community Medicine Department, Medical School, King Saud University, Riyadh, Kingdom of Saudi Arabia cDepartment of Public Health & Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
Chemotherapy Alone for Patients With Stage II/III Rectal Cancer Undergoing Radical Surgery.

Abstract:
PURPOSE:
The purpose of this prospective pilot study was to determine the efficacy of preoperative chemotherapy with six cycles of FOLFOX 6 (without radiation therapy) followed by radical surgery followed by six additional cycles of FOLFOX 6 for patients with stage II/III rectal cancer.

PATIENTS AND METHODS:
From January 2010 to January 2014, patients with locally advanced rectal cancer who met the eligibility criteria were enrolled in this study. Patients received FOLFOX 6 chemotherapy comprising oxaliplatin and leucovorin calcium i.v. over 2 hours on day 1, then bolus, and then continuous fluorouracil i.v. over 46 hours on days 1 and 2. Treatment was repeated every 14 days for 6 courses followed by radical surgery followed by additional 6 cycles of FOLFOX 6.

RESULTS:
In total, 45 patients were enrolled in this study. In the preoperative re-evaluation, the overall response rate was 68.8% (clinical complete response was 4.4%, and the partial response was 64.4%). There were 14 cases (31.2%) of stable disease. No patients had progressive disease. Postoperatively, the pathologic complete response rate was 8 of 45 (17.8%; 95% confidence interval [CI]: 8.9%-28.9%). The median follow-up was 29 months (range 9-54 months). The actuarial 3-year overall survival and disease-free survival rates for all patients were 80.8% (standard error, 1.877; 95% CI: 69.3%-92.3%) and 67.9% (standard error, 2.319; 95% CI: 54.3%-81.5%), respectively.

CONCLUSION:
Neoadjuvant chemotherapy (FOLFOX) without radiotherapy is active and safe but cannot be considered a standard of care until the results of prospective randomized phase III trials are available.

IMPLICATIONS FOR PRACTICE:
Neoadjuvant radiotherapy of rectal cancer represents the current standard of care. However, its use is also associated with short-term toxicity and long-term morbidity. With the increasing use of total mesorectal resection resulting in better local control and advances in systemic therapy for colorectal cancer, this study highlights the question of whether radiation is a necessary component of neoadjuvant therapy for all patients with rectal cancer or whether select patients could be spared the additional toxicities and inconvenience of radiotherapy. This study suggests that neoadjuvant FOLFOX without radiotherapy is active and safe, but it could not be considered a standard of care till now.

Author Info:
1
Department of Clinical Oncology, Faculty of Medicine, and Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt samyalgiz@yahoo.com.
2
Department of Clinical Oncology, Faculty of Medicine, and Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Authors:
Ali H1, Elbadawy A2, Saleh M2, Hasaballah A2.

Title:
Balloon Angioplasty For Revision Of Failing Lower Extremity Bypass Grafts.

Abstract:
OBJECTIVE:
The aim of this study was to evaluate the efficacy and safety of balloon angioplasty as the primary method of intervention in patients with color duplex ultrasound documented failing bypass grafts and to determine factors that may affect the patency of lower extremity bypass grafts revised by percutaneous transluminal angioplasty (PTA).

METHODS:
All consecutive patients who underwent lower extremity bypass grafts from January 2009 to December 2013 were enrolled in a graft surveillance program. Patients identified as having failing grafts underwent arteriography to confirm the diagnosis with a view to concomitant treatment of the lesion using balloon angioplasty. Procedural success was defined as <30% residual stenosis. Treatment failure was defined as target lesion restenosis or graft occlusion. Descriptive and life-table analyses were performed.

RESULTS:
PTA was used to revise 96 failing grafts in 90 patients. Mean age was 65.8 years (range, 50-88 years), 64% were male, and 66% were symptomatic. Mean follow-up was 18.5 months (range, 3-24 months). Twenty-four grafts (25%) underwent repeat angioplasty for restenosis. Grafts with multiple lesions (P = .009) and grafts aged <6 months from the index operation (P = .004) were the only graft-related variables that showed a significant effect on the longevity of the endovascular revision. The PTA-revised grafts had primary, assisted primary, and secondary patency rates of 56.9%, 83.2%, and 90%, respectively, at 2 years.

CONCLUSIONS:
Primary balloon angioplasty of failing lower extremity bypass grafts, notwithstanding the higher restenosis rate and the need for reintervention, appears to be safe and is associated with acceptable early and medium-term patency rates. Grafts with multiple lesions and those revised ≤6 months of the index operation showed a significant association with the need for a second revision at the same site.

Author Info:
1
Vascular and Endovascular Surgery Department, Assiut University Hospitals, Assiut, Egypt. Electronic address: haithamvascular@gmail.com.
2
Vascular and Endovascular Surgery Department, Assiut University Hospitals, Assiut, Egypt.


Authors:
Ali SS1, Hamed EA2, Ayuob NN1,3, Shaker Ali A4, Suliman MI4.

Title:
Effects Of Different Routes Of Nicotine Administration On Gastric Morphology And Hormonal Secretion In Rats.

Abstract:
What is the central question of this study? Does chronic administration of nicotine by different routes affect gastric hormonal secretions and morphology in rats? What is the main finding and its importance? Chronic nicotine administration increased levels of gastrin, ghrelin and histamine but decreased prostaglandin E2 . Nicotine administered orally and by inhalation had a marked negative impact on the histological structure of the gastric mucosa compared with intraperitoneal administration. The negative impact of nicotine administration on gastric structure was associated with an increased concentration of gastrin and decreased prostaglandin E2 , which might be the cause of gastric/peptic ulcers in heavy smokers. The increase in ghrelin concentration and its effect following chronic nicotine administration needs further investigation. The aim was to assess the effects of different routes of chronic nicotine administration on gastric morphology and hormonal secretion; mainly gastrin, ghrelin, histamine and prostaglandin E2 (PGE2 ). Forty adult male albino rats were randomly assigned into four groups (10 rats per group), treated for 21 days as follows: control group (given standard rat pellets and water only); oral nicotine-treated group [50 μg (ml drinking water)(-1) ]; intraperitoneal nicotine-treated group [0.5 mg (kg body weight)(-1) ]; and inhaled nicotine-treated group [0.5 mg (kg body weight)(-1) ]. Concentrations of gastrin, ghrelin, PGE2 and histamine in serum and gastric tissue homogenates were assessed using ELISA kits. Stomach fundus was processed for histopathology and immunohistochemistry using light and electron microscopy. Different routes of chronic nicotine administration resulted in a significant increase in serum and gastric homogenate gastrin and ghrelin concentrations and a significant decrease in serum and homogenate PGE2 concentrations compared with the control group. Moreover, nicotine administration via oral and inhalation routes caused gastric erosion, transformation of peptic cells into the mucous variety, a significant increase in parietal cell numbers and an increase in expression of gastrin. In conclusion, the negative impact of nicotine administration on gastric structure that is associated with an increased concentration of gastrin and decreased concentration PGE2 might be the leading cause of gastric/peptic ulcers in heavy smokers. The increased ghrelin concentration and its effect following nicotine chronic administration needs further investigation. Based on these findings, we suggest that the alteration in gastric structure following chronic administration of nicotine can be prevented by reducing gastrin secretion and/or targeting its receptors.

Author Info:
1
Anatomy Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
2
Physiology Department, Faculty of Medicine, Assuit University, Asyut, Egypt.
3
Histology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.


Authors:
Alió JL1, Abdou AA, Abdelghany AA, Zein G.

Title:
Refractive Surgery Following Corneal Graft.

Abstract:
PURPOSE OF REVIEW:
To review the different surgical procedures for management of postkeratoplasty refractive errors after total suture removal.

RECENT FINDINGS:
There are different surgical options to address residual refractive errors that frequently occur after corneal transplantation. The correction can be done on the corneal surface or intraocular with intraocular lens (IOL) implantation which requires complete tectonic and refractive stability after suture removal. The most commonly used procedures are photorefractive keratectomy, laser in-situ keratomileusis and Phakic IOLs. Keratoplasty has been profited by recent advances in refractive surgery. Custom excimer laser ablation is an alternative way to treat irregular errors. New IOL modalities are good practical options for a wide range of errors. Femtosecond laser, as a new option in the toolbox, can modify corneal grafting refractive results and assist corrective refractive procedures.

SUMMARY:
Although being the most successful organ transplantation, keratoplasty is usually followed by significant ametropia. Different corrective modalities exist and the choice should fit ocular conditions, patient requirements, surgeon skills and the available technologies. Recent advances in ophthalmic surgery have improved the outcomes.

Author Info:
1
aVissum Corporation bDivision of Ophthalmology, Universidad Miguel Hernández cOphthalmology Department, Faculty of Medicine, Minia University, Egypt dOphthalmology Department, Ahmadi Hospital, Kuwait eOphthalmology Department, AUH, Assiut University, Egypt.


Authors:
Alsowayan O1, Barham A2, Alqarni N2, Alnazari M2, Alsakharni M2, Ewida T2, Trbay M2, Elderwy AA3, Alhazmi H2, Neel KF2.

Title:
Outcomes Of A Minimally Invasive Surgical Approach To Manage Persistent High-Grade Vesicoureteric Reflux Post Successful Augmentation Cystoplasty Of Patients With Non-Compliant Bladder.

Abstract:
INTRODUCTION:
Secondary vesicoureteric reflux (VUR) is a common problem associated with non-compliant bladders. Management of this disorder is debatable in literature. Many authors reported high resolution rate of VUR with augmentation cystoplasty (ACP) alone. Others showed significant residual VUR after ACP and recommend ureteric re-implantation (UR) at time of augmentation.

OBJECTIVE:
Studying efficacy of endoscopic correction of persistent high-grade VUR (ECVUR) post successful ACP.

DESIGN:
Patients with non-compliant bladders and high-grade VUR are enrolled in the program of our institute, where they are initially managed conservatively. Those not responding are managed endoscopically using intravesical botulinum toxin A and ECVUR. Patients who are not candidates or failed this approach undergo ACP without UR. A total of 82 patients with non-compliant bladder underwent ACP between 2001 and 2011. Of those, 24 patients had high-grade VUR with 44 refluxing units (RU), 20 bilateral and 4 unilateral. The mean age at intervention was 7.62 years with a mean follow-up of 5.6 years. Patients with persistent high-grade VUR and recurrent breakthrough febrile UTI despite antibiotic prophylaxis following ACP were identified and enrolled in our prospective trial of interval ECVUR. Statistical analyses was performed to identify predictors of high-grade VUR resolution after ACP and ECVUR. A p value <0.05 was considered statistically significant (Table 1).

RESULTS:
Of the 24 patients, 17 underwent ileocystoplasty and 7 underwent ureterocystoplasty. One of the patients that underwent ileocystoplasty found to have a blind ending RU that was excised. Of the 36 remaining RU, 21/36 (58.3%) showed complete resolution in the first follow-up cystogram, and 1 showed complete resolution after 1 year. Two patients, each with single RU, received repeat ACP because of poor compliance and/or inadequate bladder capacity post ureterocystoplasty and showed complete resolution of reflux post-operatively, which increased the resolution rate post ACP to 66.6% (24/36) (Table 2). Of the remaining 12 RU in 7 patients, 10 underwent trial of ECVUR. VUR resolved in 8 RU after the first trial and in another 2 after the second trial (Table 3). Parents of 1 patient with the remaining 2 RU preferred to continue with conservative management (Table 2).

DISCUSSION:
VUR in patients with non-compliant bladder is usually secondary to high detrusor pressure, low compliance and small capacity. Whereas some investigators showed high resolution rate of VUR post augmentation without UR, claiming that by successfully augmenting the bladder, compliance will increase, detrusor pressure will decrease, and as a result, VUR will spontaneously resolve. Others showed high incidence of persistent VUR (47-57%) and recommend UR at time of ACP. In our study, the incidence of spontaneous resolution was 66.6% (24/36). In cases where VUR persists, ECVUR was performed. With this approach, VUR resolution increased to 94% (34/36). This study is limited by the small number of patients, lack of randomization and lack of comparison group in which patients undergo ACP with UR.

CONCLUSION:
ACP without UR with interval endoscopic management seems to be an effective and adequate treatment for high pressure, non-compliant bladder as well as high-grade VUR when conservative management fails.

Author Info:
1
Division of Urology, Department of Surgery, College of Medicine and King Khalid University Hospital, King Saud University, PO Box 2925, 11461 Riyadh, Saudi Arabia; Department of Urology, College of Medicine and King Fahd Hospital of the University, University of Dammam, PO Box 40086, Alkhobar 31952, Saudi Arabia. Electronic address: sowayan81@gmail.com.
2
Division of Urology, Department of Surgery, College of Medicine and King Khalid University Hospital, King Saud University, PO Box 2925, 11461 Riyadh, Saudi Arabia.
3
Pediatric Urology Unit, Urology Department, Assiut University Hospital, Assiut, Egypt.


Title:
A Novel Alanine To Serine Substitution Mutation In Soxs Induces Overexpression Of Efflux Pumps And Contributes To Multidrug Resistance In Clinical Escherichia Coli Isolates.

Abstract:
OBJECTIVES:
The purpose of this study was to describe a putative role for a novel soxS mutation in contributing to multiple-antibiotic resistance in canine fluoroquinolone-associated MDR (FQ-MDR) Escherichia coli. This soxS mutation was discovered in canine faecal E. coli isolates during a study investigating the effect of oral fluoroquinolone administration on faecal E. coli in healthy dogs.

METHODS:
We determined via quantitative real-time RT-PCR that both soxS and acrB were overexpressed in the clinical soxS Ala-12→Ser (soxS(A12S)) mutants and this may account for their FQ-MDR phenotype. We validated the FQ-MDR phenotype of the clinical isolates by reconstructing the WT and the soxS(A12S) mutation in the E. coli soxS null mutant JW4023 (soxS::kn) via allelic exchange.

RESULTS:
The JW4023 soxS(A12S) derivative showed an increase in MICs of ciprofloxacin, enrofloxacin and chloramphenicol compared with the JW4023 derivative in which the WT soxS had been restored. The soxS and acrB genes were overexpressed in the JW4023 soxS(A12S) mutant compared with JW4023 with WT soxS. A similar overexpression of efflux pump genes and an increase in antibiotic resistance were observed upon stimulation with paraquat to resemble the phenotype of the clinical soxS(A12S) isolates.

CONCLUSIONS:
Our data suggest that the soxS(A12S) substitution mutation is selected in clinical isolates when dogs are exposed to a fluoroquinolone and that this mutation contributes to the FQ-MDR phenotype of E. coli isolates.

Author Info:
1
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71516, Egypt s-aly71@windowslive.com.
2
Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA.
3
Department of Biological Sciences, Auburn University, Auburn, AL 36849, USA.


Title:
A Novel Percutaneous Technique For Treating Complete Rectal Prolapse In Adults.

Abstract:
PURPOSE:
To evaluate a new technique for treating complete rectal prolapse in adults that combines injection sclerotherapy with anal encirclement.

METHODS:
From 2008 to 2012, 20 patients were treated using combined perirectal injection sclerotherapy with anal encirclement. The primary outcome was recurrent full-thickness/mucosal rectal prolapse.

RESULTS:
The mean age of the patients was 39 years. The mean operating time was 17 minutes. Patients had short hospital stays (range = 2-4 days) and rapid recovery with no serious postoperative complications. After a mean follow-up of 22 months, recurrence occurred in 9 patients, and was complete in 6 cases and mucosal in 3 patients. Recurrent mucosal prolapse was treated with a mucosectomy, while recurrent complete rectal prolapse was treated with an open rectopexy with mesh.

CONCLUSION:
The combination of perirectal sclerotherapy and anal encirclement for treating complete rectal prolapse in adults is a simple and safe procedure with reasonable outcome. These findings call for confirmatory trials in larger series.

Author Info:
1
Assiut University Hospitals, Assiut, Egypt samirahmed70@hotmail.com.
2
Assiut University Hospitals, Assiut, Egypt.


Authors:
Attia RA1, Mahmoud AE1, Farrag HM1, Makboul R2, Mohamed ME3, Ibraheim Z4.

Title:
Effect Of Myrrh And Thyme On Trichinella Spiralis Enteral And Parenteral Phases With Inducible Nitric Oxide Expression In Mice.

Abstract:
Trichinellosis is a serious disease with no satisfactory treatment. We aimed to assess the effect of myrrh (Commiphora molmol) and, for the first time, thyme (Thymus vulgaris L.) against enteral and encysted (parenteral) phases of Trichinella spiralis in mice compared with albendazole, and detect their effect on inducible nitric oxide synthase (iNOS) expression. Oral administration of 500 mg/kg of myrrh and thyme led to adult reduction (90.9%, 79.4%), while 1,000 mg/kg led to larvae reduction (79.6%, 71.3%), respectively. Administration of 50 mg/kg of albendazole resulted in adult and larvae reduction (94.2%, 90.9%). Positive immunostaining of inflammatory cells infiltrating intestinal mucosa and submucosa of all treated groups was detected. Myrrh-treated mice showed the highest iNOS expression followed by albendazole, then thyme. On the other hand, both myrrh and thyme-treated groups showed stronger iNOS expression of inflammatory cells infiltrating and surrounding encapsulated T. spiralis larvae than albendazole treated group. In conclusion, myrrh and thyme extracts are highly effective against both phases of T. spiralis and showed strong iNOS expressions, especially myrrh which could be a promising alternative drug. This experiment provides a basis for further exploration of this plant by isolation and retesting the active principles of both extracts against different stages of T. spiralis.

Author Info:
1
Department of Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut, Egypt.


Authors:
Badari MS, Elgendy SG, Mohamed AS, Hassan AT.

Title:
Immunomodulatory Effects of Levofloxacin on Patients with Pneumonia in Assiut University Hospitals.

Abstract:
The immunomodulatory effects of antibiotics could influence the degree of systemic and local responses to infection, so investigation of their intrinsic influence on the host's inflammatory response appears to be essential. Fluoroquinolones are known to exert modulatory activity on immune responses to microbial infection. However the mechanism of this immunmodulation has not been well elucidated. The aim of the work, is to assess the immunomodulatory effects of a levofloxacin, through examining its effect on the concentrations of tumor necrosis factor α (TNF-α) and Interleukin - 10 (IL-10) in serum of pneumonic patients. After following local research ethics committee approval and informed consent. This study included 40 patients with different types of pneumonia, admitted to department of Chest Diseases, Faculty of Medicine, Assiut University Hospitals, Egypt. Also, 10 healthy volunteers served as randomized controls. Both patients and controls received levofloxacin (750 mg once daily for 10 days). Serum levels of TNF-α and IL-10 were measured in patients and control before and after levofloxacin administration (750 mg once daily for 10 days) using human TNF-α and IL-10 ELISA kits respectively. Levofloxacin caused a statistically significant decrease in the mean level of TNF-α in both patients (20.82 ± 1.31 pg/ml) (P < 0.009) and control group (17.12 ± 0.84 pg/ml) (P < 0.004). In contrast, there was statistically significant increase (P < 0.000) in the mean level of IL-1 0 in patients (61.75 ± 2.85 pg/ml) while statistically significant decrease (P < 0.005) in control group (28.57 ± 1.37 pg/ml). In conclusion, our study demonstrates that treatment with levofloxacin affects production of TNF-α as a pro-inflammatory cytokine and IL-10 as an anti-inflammatory cytokines which may provide additional benefits in treatment of respiratory tract infections that are independent of its antibacterial properties.


Authors:
Badr G1, Sayed A2, Abdel-Maksoud MA3, Mohamed AO2, El-Amir A4, Abdel-Ghaffar FA4, Al-Quraishy S5, Mahmoud MH6.

Title:
Infection of Female BWF1 Lupus Mice with Malaria Parasite Attenuates B Cell Autoreactivity by Modulating the CXCL12/CXCR4 Axis and Its Downstream Signals PI3K/AKT, NFκB and ERK.

Abstract:
Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease characterized by abnormal autoreactivity in B cells. Lymphocytes and their soluble mediators contribute to the disease pathogenesis. We recently demonstrated that infecting lupus mice with malaria confers protection against lupus nephritis by attenuating oxidative stress in both liver and kidney tissues. In the current study, we further investigated B cell autoreactivity in female BWF1 lupus mice after infection with either live or gamma-irradiated malaria, using ELISA, flow cytometry and Western blot analysis. The lupus mice exhibited a significant elevation in plasma levels of IL-4, IL-6, IL-7, IL-12, IL-17, IFN-α, IFN-γ, TGF-β, BAFF and APRIL and a marked elevation of IgG2a, IgG3 and ant-dsDNA autoantibodies compared with normal healthy mice. Infecting lupus mice with live but not gamma-irradiated malaria parasite partially and significantly restored the levels of the soluble mediators that contribute to the progression of lupus. Furthermore, the B cells of lupus mice exhibited an increased proliferative capacity; aberrant overexpression of the chemokine receptor CXCR4; and a marked elevation in responsiveness to their cognate ligand (CXCL12) via aberrant activation of the PI3K/AKT, NFκB and ERK signaling pathways. Interestingly, infecting lupus mice with live but not gamma-irradiated malaria parasite restored a normal proliferative capacity, surface expression of CXCR4 and B cell response to CXCL-12. Taken together, our data present interesting findings that clarify, for the first time, the molecular mechanisms of how infection of lupus mice with malaria parasite controls B cell autoreactivity and thus confers protection against lupus severity.

Author Info:
1
Laboratory of Immunology & Molecular Physiology, Zoology Department, Faculty of Science, Assiut University, Assiut, Egypt.
2
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt; Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia.
4
Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt.
5
Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia.
6
Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia; Food Science and Nutrition Department, National Research Center, Dokki, Cairo, Egypt.


Title:
Different Types Of Headache In Patients With Systemic Lupus Erythematosus.

Abstract:
BACKGROUND:
Headache in patients with systemic lupus erythematosus (SLE) is considered a common neurological finding, although the relationship is unclear.

AIM:
In this study, we aimed to evaluate frequency and characteristics of different types of headache in patients with SLE.

METHODS:
40 SLE patients were chosen from those referred to the out patient clinic using the American College of Rheumatology (ACR) criteria for the diagnosis of SLE. Headache classification was done regarding the ICD-II criteria in the patients. Headache severity was assessed by visual analog scale (VAS), and subjects with VAS ≥4 were included in the study.

RESULTS:
30 patients out of 40 SLE patients (75%) have different headache types: tension type in 37.5% (n = 15) and migraine in 30% (n = 12), cluster 2.5% (n = 1), and intracranial hypertension 5% (n = 2) of all patients.

CONCLUSION:
Headache is frequent in SLE especially tension and migraine types, but overall, it is not associated with disease activity.

Author Info:
1
1Department of Neurology and Psychiatry, Assiut University Hospital, Egypt.


Authors:
Bakir H1, Yones D1, Galal L1, Huseein E1.

Title:
Resistance and Susceptibility to Malarial Infection: A Host Defense Strategy against Malaria.

Abstract:
BACKGROUND:
In an effort to understand what limits the virulence of malaria parasites in relation to the host genetic and immunogenic background, we investigated the possibility that the parasite and host genotype crossover interactions constrain virulence.

METHODS:
Two groups of mice from different genotypes were used (C57BL/6 (B6) and DBA/2 mice). The mice were infected with a virulent parasite line Plasmodium yoelii 17XL (P. yoelii 17XL). Parasitemia, hematocrit value and lymphocytes yielded by livers and spleens were evaluated. Fluorescence Activated Cell Sorting (FACS) analysis illustrated phenotypic characterization of lymphocytes.

RESULTS:
Infection with P. yoelii 17XL did not result in the death of DBA/2 mice. In contrast, B6 mice developed significantly high parasitemia and succumbed to death. Using (FACS) analysis, DBA/2 mice were found to experience a marked expansion of interleukin (IL)-2Rβ(+) CD3(int) cells and γδ T cells in the liver, especially in the recovery phase. The expansion of unconventional T cells (i.e. B220(+) T cells) was also marked in DBA/2 mice.

CONCLUSION:
The outcome of murine malaria infections depends on the dynamic interplay between the immune-mediator and the genotype of the host.

Author Info:
1
Department of Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Bakri MH1, Ismail EA1, Ali MS1, Elsedfy GO2, Sayed TA3, Ibrahim A4.

Title:
Behavioral And Emotional Effects Of Repeated General Anesthesia In Young Children.

Abstract:
BACKGROUND:
Preclinical and clinical data suggest the possibility of neurotoxicity following exposure of young children to general anesthetics with subsequent behavioral disturbances. The aim of the study was to determine the overall effect of repeated general anesthesia on behavior and emotions of young children aged 1½-5 years old, compared to healthy children.

MATERIALS AND METHODS:
Thirty-five children underwent repeated anesthesia and surgery were matched with the same number of healthy children who attended vaccination clinic, as a control group. Both groups were administered the child behavior checklist (CBCL) 1½-5 years and Diagnostic and Statistical Manual of Mental Disorders (DSM) oriented scale. Behavior data were collected through a semi-structured questionnaire.

RESULTS:
The CBCL score revealed that children with repeated anesthesia were at risk to become anxious or depressed (relative risk [RR]; 95% confidence interval [CI] = 11 [1.5-80.7]), to have sleep (RR; 95% CI = 4.5 [1.1-19.4]), and attention problems (RR; 95% CI = 8 [1.1-60.6]). There was no difference in the risk between the two groups regarding emotionally reactive, somatic complaints, withdrawn problems, aggressive behavior, internalizing or externalizing problems. On DSM scale, children with repeated anesthesia were at risk to develop anxiety problems (RR; 95% CI = 3.7 [1.1-12.0]), and attention deficit/hyperactivity problems (RR; 95% CI = 3 [1.1-8.4]). There was no difference in the risk between the two groups regarding affective, pervasive developmental and oppositional defiant problems.

CONCLUSION:
Young children who undergone repeated surgical procedures under general anesthesia were at risk for subsequent behavioral and emotional disturbances. Proper perioperative pain management, social support, and avoidance of unpleasant surgical experiences could minimize these untoward consequences.

Author Info:
1
Department of Anesthesia, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Pediatric, Faculty of Medicine, Children's Hospital, Assiut University, Assiut, Egypt.
3
Department of Psychiatry, Faculty of Medicine, Sohag University, Sohag, Egypt.
4
Department of Community Medicine, Faculty of Medicine, University of Western Kordofan, Sudan.


Title:
Comparison Of Dexmedetomidine And Dexamethasone For Prevention Of Postoperative Nausea And Vomiting After Laparoscopic Cholecystectomy.

Abstract:
BACKGROUND:
Postoperative nausea and vomiting (PONV) are common following laparoscopic cholecystectomy (LC). Dexamethasone has been reported to reduce PONV. However, there is insufficient evidence regarding the effect of dexmedetomidine in decreasing PONV. This study was designed to compare the effects of a single dose of dexmedetomidine to dexamethasone for reducing PONV after LC.

METHODS:
Eighty-six adult patients scheduled for LC were randomized to receive either single dose 1 µg/kg of dexmedetomidine (Dexmed group, N = 43) or 8 mg dexamethasone (Dexa group, N = 43) before skin incision. During the first 24 h postoperatively, the incidence and severity of PONV were assessed. Pain and sedation scores were assessed on arrival in the recovery room and early postoperatively. Analgesic and antiemetic consumption during the 24 h after surgery were calculated. Intra-operative and postoperative hemodynamics were recorded.

RESULTS:
Twenty-one percent of the patients in the Dexmed group developed PONV compared to 28% in the Dexa group (P = 0.6). Severity of PONV was similar between the two groups (P = 0.07). Early postoperatively, pain severity was significantly lower in the Dexmed group, but sedation scores were significantly higher. The first analgesic request was significantly delayed in the Dexmed group (P = 0.02). The total amounts of intraoperative fentanyl and postoperative tramadol administered were significantly lower in the Dexmed group. No difference in ondansetron was noted between the two groups. Mean arterial pressure and heart rate were significantly lower in the Dexmed group after administration of dexmedetomidine. No major side effects were reported.

CONCLUSIONS:
Dexmedetomidine reduces the incidence and severity of PONV, similar to dexamethasone. It is superior to dexamethasone in reducing postoperative pain and total analgesic consumption during the first 24 h after LC.

Author Info:
1
Department of Anesthesia, Faculty of Medicine, Assiut University, Egypt.
2
Department of Community Medicine, Faculty of Medicine, University of Western Kordofan, Sudan.


Authors:
Bakri MH1, Ismail EA1, Ghanem G1, Shokry M1.

Title:
Spinal Versus General Anesthesia For Cesarean Section In Patients With Sickle Cell Anemia.

Abstract:
BACKGROUND:
Sickle cell anemia (SCA) increases the rate of maternal and fetal complications. This pilot study was designed to compare the maternal and fetal outcomes of spinal versus general anesthesia (GA) for parturients with SCA undergoing cesarean delivery.

METHODS:
Forty parturients with known SCA scheduled for elective Cesarean delivery were randomized into spinal anesthesia (n = 20) and GA groups (n = 20). Perioperative hemodynamic parameters were recorded. Postpartum complications were followed up. Opioid consumption was calculated. Blood loss during surgery and the number of patients who received intraoperative or postpartum blood transfusion were recorded. Patient satisfaction with the type of anesthesia was assessed. The Apgar score at 1 and 5 min, neonatal admission to the intensive care unit, and mortality were also recorded.

RESULTS:
Blood loss was significantly higher in the GA than spinal group (P = 0.01). However, the number of patients who received an intraoperative or postpartum blood transfusion was statistically insignificant. Significantly more patients developed intraoperative hypotension and bradycardia in the spinal than GA group. Opioid use during the first 24 h was significantly higher in the GA than spinal group (P < 0.0001). More patients had vaso-occlusive crisis in the GA than spinal group without statistical significance (P = 0.4). There was one case of acute chest syndrome in the GA group. No significant differences were observed in postoperative nausea and/or vomiting, patient satisfaction, or hospital length of stay. Neonatal Apgar scores were significantly better in the spinal than GA group at 1 and 5 min (P = 0.006 and P = 0.009, respectively). Neonatal intensive care admission was not significantly different between the two groups, and there was no neonatal mortality.

CONCLUSIONS:
Spinal anesthesia may have advantages over GA in parturients with SCA undergoing Cesarean delivery.

Author Info:
1
Department of Anesthesia, Assiut University Faculty of Medicine, Assiut, Egypt.


Authors:
Barbieri A1, Mantovani F2, Bursi F3, Ruggerini S3, Lugli R3, Abdelmoneim SS4, Modena MG5.

Title:
Prognostic Value Of A Negative Peak Supine Bicycle Stress Echocardiography With Or Without Concomitant Ischaemic Stress Electrocardiographic Changes: A Cohort Study.

Abstract:
BACKGROUND:
a negative peak supine bicycle exercise stress echocardiography (ESE) was shown to have a long-term favourable prognostic value. Data on the long-term prognosis of ischaemic electrocardiographic (ISECG) changes in the setting of a negative peak supine bicycle ESE are lacking.

DESIGN:
we evaluated the prognostic value of negative peak supine bicycle ESE with or without concomitant ISECG changes in a referral population evaluated for chest pain after an inconclusive first-line work-up including clinical evaluation and exercise ECG stress.

METHODS:
from 2003 to 2010, patients who underwent a peak supine bicycle ESE and were deemed to be negative were evaluated. Two groups based on concomitant stress ECG tracing were analysed - those with normal stress ECG and those with ISECG changes. The primary endpoint was cumulative incidence of cardiovascular death, hospitalizations for acute coronary syndrome and coronary revascularizations.

RESULTS:
a total of 371 patients (mean age 59.1 ± 12.1 years, 49.9% women) were studied. Of those, 141 (38.0%) had concomitant ISECG changes. Mean follow-up was 3.46 ± 1.76 years. The primary endpoint occurred in 3.0% of patients, (2.2% in those with normal stress ECG, and in 4.3% with ISECG changes, p = 0.251); with unadjusted hazard ratio for primary endpoint of 2.04 (95%CI 0.62-6.69, p = 0.239) in patients with ISECG changes compared to those with normal stress ECG.

CONCLUSIONS:
in an outpatient population without known CAD evaluated for chest pain after inconclusive first-line work-up, a negative peak supine bicycle ESE confers an excellent prognosis regardless of the nature of concomitant stress ECG abnormalities.

Author Info:
1
Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy olmoberg@libero.it.
2
Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Mayo Clinic, Rochester, MN, USA.
3
Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy.
4
Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Mayo Clinic, Rochester, MN, USA Division of Cardiovascular Diseases, Assiut University, Egypt.
5
Modena and Reggio Emilia University, Modena, Italy.


Authors:
Bayoumy MA1, Elkady HA1, Said HG1, El-Sayed A1, Saleh WR1.

Title:
Arthroscopic Grading Of Common Wrist Disorders And Its Role In Management.

Abstract:
Palmer devised a classification system to guide treatment of triangular fibrocartilage complex tears in 1989. The main division is between traumatic Type I and atraumatic Type II tears. The wrist arthroscopy makes diagnosis and treatment of ulnar impaction syndrome possible in a less invasive way. Arthroscopy is the most valuable tool for diagnosis and treatment of acute scapholunate and lunotriquetral dissociation. Arthroscopic grading of Kienböck's disease better describes articular damage compared with plain radiographs and can help surgical treatment. The wrist arthroscopy generally makes it possible to make the diagnosis of the chondral lesion before they are visible by the usual imaging.

Author Info:
1
Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt.
Abstract


Title:
Short-Term Evaluation Of Arthroscopic Outside-In Repair Of Ulnar Side TFCC Tear With Vertical Mattress Suture.

Abstract:
BACKGROUND:
There has been controversy regarding the pathogenesis and treatment of TFCC tear. Different surgical techniques for the treatment of TFCC are prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic outside-in repair of the ulnar side TFCC tear with vertical mattress suture.

METHODS:
In this study, arthroscopic outside-in repair of the ulnar side TFCC tear was done. 37 patients with TFCC tear with failure of conservative treatment for a minimum of 6 months had surgery. Outcomes were assessed using modified Mayo wrist score (MMWS), the Disability of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS) for pain and satisfaction criteria, and patient-related wrist evaluation score (PRWE), in addition to the range of motion and grip strength.

RESULTS:
After arthroscopic surgery, overall satisfaction was extremely positive, and out of the 37 patients, 91.9% of the patients are satisfied. The mean score for pain improved from 7.6 to 2.9 points. The mean MMWS was improved from 62.1 to 91.2 points. DASH score also improved from 29.9 to 10.2 points and PRWE improved from 60 to 33 points. The ROM was improved from 85.8% to 92% of the normal side. The grip strength of the affected side improved from 82.5% to 89% of the normal side. All improvements are statistically significant (P < 0.05).

CONCLUSION:
Arthroscopic outside-in repair of ulnar side TFCC tear with mattress suture is a reproducible method with a marked improvement in function within a short period.

Author Info:
1
Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut 71111, Egypt.


Authors:
Benson CE1, Soliman MK2, Knezevic A1, Xu DD3, Nguyen QD1, Do DV1.

Title:
Bilateral Papillitis And Unilateral Focal Chorioretinitis As The Presenting Features Of Syphilis.

Abstract:
BACKGROUND:
Syphilis is a multisystem bacterial infection caused by Treponema pallidum. The incidence of infection in the United States has risen by more than 75% since the year 2000, when it was at a low of 2.1 per 100,000 people. Ocular involvement may occur in any stage of infection and may present in a variety of ways, with posterior uveitis being the most common manifestation. We report a case of ocular syphilis infection with an unusual presentation of bilateral non-granulomatous panuveitis with papillitis and unilateral focal chorioretinitis.

FINDINGS:
This is a retrospective case report with literature review. A 39-year-old Caucasian female presented with a 2-week history of bilateral ocular flashes and left eye pain. Dilated fundus examination revealed mild optic disc edema in both eyes, the right eye more than the left. In the left eye, there was an area of retinal elevation and whitening involving the peripheral retina. Fluorescein angiography, B-scan ultrasonography, and ocular coherence tomography were performed, and laboratory tests were ordered based on the clinical presentation. After rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) were positive, syphilitic uveitis was confirmed, and the patient was admitted for a 14-day course of high-dose intravenous penicillin G.

CONCLUSIONS:
The first signs and symptoms of syphilis may be ocular, which can lead to a diagnostic challenge. A high index of suspicion is the key for early diagnosis of ocular syphilis. Prompt treatment with intravenous penicillin G is highly effective in resolving the infection.

Author Info:
1
Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE 68105 USA.
2
Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE 68105 USA ; Department of Ophthalmology, Assiut University Hospital, Al Gamaa St, Assiut, 71516 Egypt.
3
Tenth People's Hospital, 301 Yanchang Road, Shanghai District, Shanghai, 200072 China.


Title:
SICOT-J: Why another Orthopaedic Open Access journal?

Author Info:
1
Clinique Orthopédique Emilie de VIALAR Lyon France.
2
Assiut University Hospital Assiut Egypt.


Authors:
D'Ascenzo F1, Taha S2, Moretti C1, Omedè P1, Grossomarra W1, Persson J3, Lamberts M4, Dewilde W5, Rubboli A6, Fernández S7, Cerrato E1, Meynet I1, Ballocca F1, Barbero U1, Quadri G1, Giordana F1, Conrotto F1, Capodanno D8, DiNicolantonio J9, Bangalore S10, Reed M11, Meier P12, Zoccai G13, Gaita F1.

Title:
Meta-Analysis Of Randomized Controlled Trials And Adjusted Observational Results Of Use Of Clopidogrel, Aspirin, And Oral Anticoagulants In Patients Undergoing Percutaneous Coronary Intervention.

Abstract:
The optimal antiaggregant therapy after coronary stenting in patients receiving oral anticoagulants (OACs) is currently debated. MEDLINE and Cochrane Library were searched for studies reporting outcomes of patients who underwent PCI and who were on triple therapy (TT) or dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel or dual therapy (DT) with OAC and clopidogrel. Major bleeding was the primary end point, whereas all-cause death, myocardial infarction (MI), stent thrombosis, and stroke were secondary ones. Results were reported for all studies and separately for those deriving from randomized controlled trials or multivariate analysis. In 9 studies, 1,317 patients were treated with DAPT and 1,547 with TT. DAPT offered a significant reduction of major bleeding at 1 year for overall studies and for the subset of observational works providing adjusted data (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.39 to 0.68, I2 60% and OR 0.36, 95% CI 0.28 to 0.46) compared to TT. No increased risk of major adverse cardiac events (MACE: death, MI, stroke, and stent thrombosis) was reported (OR 0.71, 95% CI 0.46 to 1.08), although not deriving from randomized controlled trials or multivariate analysis. Six studies tested OAC and clopidogrel (1,263 patients) versus OAC, aspirin, and clopidogrel (3,055 patients) with a significant reduction of bleeding (OR 0.79, 95% CI 0.64 to 0.98), without affecting rates of death, MI, stroke, and stent thrombosis (OR 0.90, 95% CI 0.69 to 1.23) also when including clinical data from randomized controlled trials or multivariate analysis. In conclusion, compared to TT, both aspirin and clopidogrel and clopidogrel and OAC reduce bleeding. No difference in major adverse cardiac events is present for clopidogrel and OAC, whereas only low-grade evidence is present for aspirin and clopidogrel.

Author Info:
1
Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy.
2
Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy; Department of Cardiology, Assiut University Hospital, Assiut, Egypt. Electronic address: esmaeil.salma@gmail.com.
3
Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
4
Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark.
5
Department of Cardiology, Twee Steden Hospital, Tilburg, Netherlands.
6
Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy.
7
Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
8
Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
9
Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
10
Department of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York.
11
Emergency Department, Royal infirmary of Edinburgh, Edinburgh, United Kingdom.
12
The Heart Hospital, University College London Hospital, London, United Kingdom.
13
Department of Medico-Surgical Sciences and Biotechnologies Sapienza University of Rome, Latina, Italy.


Title:
Significantly Prolonged Spinal Anesthesia With The Addition Of Dexamethasone: A Case Report

Abstract:
The purpose of the study is to highlight that prolonged blocks with spinal anesthesia are not usually due to neurologic defects. Consent for data publication was obtained. A 35-year-old female patient with right upper tibial chondrosarcoma was planned to undergo excision and reconstruction with a free vascularized fibular graft. The patient had no significant medical history. We gave spinal anesthesia, which is to be continued with general anesthesia after regression of the sensory level. After 3 hours, we evaluated the patient for the second time to find sensory block at T10 level. It was decided to carry out these evaluations hourly and wait for general anesthesia. Ten hours after the spinal anesthesia, the sensory block was still at T10 level. After 13 hours, the surgical procedure was finished, and the sensory block was still at T10 level and the motor block according to the Bromage scale remained at grade 4. A computed tomography was performed and did not reveal signs of spinal compression, spinal canal stenosis, or other anomalies (magnetic resonance imaging was unavailable). A complete motor and sensory recovery from the spinal block was observed 20 hours after spinal anesthesia. We present a case of major microscopic surgery done over 13 hours with a single shot of spinal anesthesia in a 35-year-old female patient. Complete recovery of sensory and motor blocks has been after 20 hours. We also review other cases of unusually prolonged spinal blocks and the possible differential diagnosis for that.

Author Info:
1
Anesthesia and Intensive Care Department, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt. Electronic address: mostafasamy@aun.edu.eg.
2
Anesthesia and Intensive Care Department, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt. Electronic address: omnia.askar@gmail.com.


Title:
Effects Of Curcumin And Captopril On The Functions Of Kidney And Nerve In Streptozotocin-Induced Diabetic Rats: Role Of Angiotensin Converting Enzyme 1

Abstract:
Oxidative stress and inflammation are involved in the development and progression of diabetes and its complications. The renin-angiotensin system also plays an important role in the pathogenesis of diabetes and its complications. We hypothesized that curcumin and captopril would restore the kidney and nerve functions of diabetic rats through their angiotensin converting enzyme 1 (ACE1) inhibiting activity as well as their antioxidant and anti-inflammatory effects. Diabetes was induced by a single intraperitoneal injection of streptozotocin (100 mg·kg(-1) body weight). One week after induction of diabetes, rats were treated with 100 mg·kg(-1)·day(-1) curcumin or 50 mg·kg(-1)·day(-1) captopril orally for 6 weeks. Compared with diabetic control rats, curcumin- or captopril-treated diabetic rats had significantly improved blood glucose, lipid profile, kidney/body weight ratio, serum creatinine, blood urea nitrogen (BUN), and pain thresholds assessed by Von Frey filaments, hot plate test, and tail-flick test. Diabetic control rats showed increased levels of total peroxide, renal and neural tumor necrosis factor-α and interleukin-10, and renal ACE1 compared with nondiabetic rats. Although treatment with either curcumin or captopril restored the altered variables, captopril was more effective in reducing these variables. ACE1 was positively correlated with BUN and creatinine and negatively correlated with paw withdrawal threshold, hot plate reaction time, and tail-flick latency, suggesting a possible causal relationship. We conclude that curcumin and captopril protect against diabetic nephropathy and neuropathy by inhibiting ACE1 as well as oxidation and inflammation. These findings suggest that curcumin and captopril may have a role in the treatment of diabetic nephropathy and neuropathy.

Author Info:
1
Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abd-Elshafy SK1, Khalaf GS2, Abo-Kerisha MZ3, Ahmed NT4, Abd El-Aziz MA2, Mohamed MA2.

Title:
Not All Sounds Have Negative Effects on Children Undergoing Cardiac Surgery

Abstract:
OBJECTIVE:
This study was designed to evaluate the role of music therapy on the level of stress in children undergoing repair of congenital heart disease.

DESIGN:
Prospective, randomized, double-blind, controlled clinical trial.

SETTING:
Children's university hospital.

PARTICIPANTS:
Fifty children aged 4 to 12 years undergoing repair of congenital heart disease.

INTERVENTIONS:
Patients were randomized into 2 equal groups (control group and music group); in the control group, patients listened to a blank CD, and in the music group, patients listened to a recorded CD of music and songs preferred by the child. Demographic data, clinical data, and preoperative vital signs were recorded. Baseline stress markers (blood glucose and cortisol levels) were sampled. Patients were assessed intraoperatively until extubation for vital signs and stress markers and after extubation for pain and sedation scales. An interview was conducted within the first postoperative week with the patients and their parents for assessment of post-traumatic stress disorder and negative postoperative behavior changes.

MEASUREMENTS AND MAIN RESULTS:
There were no significant differences in demographic characteristics, clinical data, vital signs, preoperative and at-extubation blood glucose levels, and preoperative blood cortisol levels between groups. Significant differences were found between groups in blood glucose levels and cortisol levels at all intraoperative times, but only in cortisol blood levels at extubation. Significant differences were found in pain score, sedation score, occurrence of child post-traumatic stress disorder, and occurrence of negative postoperative behavior.

CONCLUSION:
Listening to favorable music by children undergoing repair for congenital heart disease resulted in less stress and more relaxation.

Author Info:
1
Anesthesia and Intensive Care Department, Faculty of Medicine. Electronic address: sayed_k_72@yahoo.com.
2
Critical Care Nursing Department, Department of Nursing.
3
Clinical Pathology Department, Faculty of Medicine.
4
Critical Care and Emergency Nursing Department, Faculty of Nursing, Assiut University, Hospital, Assiut Egypt.


Authors:
Abdel Malek MA1,2,3, Jagannathan S1,2, Malek E1,2, Sayed DM4, Elgammal SA3, Abd El-Azeem HG3, Thabet NM3, Driscoll JJ1,2,5,6.

Title:
Molecular Chaperone GRP78 Enhances Aggresome Delivery To Autophagosomes To Promote Drug Resistance In Multiple Myeloma

Abstract:
Despite the clinical benefit of the proteasome inhibitor bortezomib, multiple myeloma (MM) patients invariably relapse through poorly defined mechanisms. Myeloma cells inevitably develop chemoresistance that leads to disease relapse and patient-related deaths. Studies in tumor cell lines and biopsies obtained from patients refractory to therapy have revealed that myeloma cells adapt to stress by inducing expression of glucose-regulated protein 78 (GRP78), an endoplasmic reticulum (ER) chaperone with anti-apoptotic properties. Treatment of myeloma cells with bortezomib increased GRP78 levels and activated GRP78-dependent autophagy. Expression profiling indicated that GRP78-encoding HSPA5 was significantly upregulated in bortezomib-resistant cells. Co-treatment with the anti-diabetic agent metformin suppressed GRP78 and enhanced the anti-proliferative effect of bortezomib. Bortezomib treatment led to GRP78 co-localization with proteotoxic protein aggregates, known as aggresomes. Pharmacologic suppression, genetic ablation or mutational inactivation of GRP78 followed by bortezomib treatment led to the accumulation of aggresomes but impaired autophagy and enhanced anti-myeloma effect of bortezomib. GRP78 was co-immunoprecipitated with the KDEL receptor, an ER quality control regulator that binds proteins bearing the KDEL motif to mediate their retrieval from the Golgi complex back to the ER. Taken together, we demonstrate that inhibition of GRP78 functional activity disrupts autophagy and enhances the anti-myeloma effect of bortezomib.

Author Info:
1
The Vontz Center for Molecular Studies, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
2
Division of Hematology and Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
3
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
5
Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
6
University of Cincinnati Cancer Institute, Cincinnati, OH, USA.


Authors:
Abdel Meguid AM1, Elaziz Ahmed Attallah DA, Omar H.

Title:
Trichloroacetic Acid Versus Salicylic Acid in the Treatment of Acne Vulgaris in Dark-Skinned Patients.

Abstract:
BACKGROUND:
Treatment options for acne include chemical peeling. Trichloroacetic acid (TCA) has been used for treating acne. The ability of TCA to diminish corneocyte cohesion and keratinocyte plugging addresses this mode of treatment. Salicylic acid is an excellent keratolytic agent. It is believed to function through solubilization of intercellular cement, thereby reducing corneocyte adhesion.

OBJECTIVE:
Comparing the therapeutic efficacy of TCA 25% peels with those of salicylic acid 30% in patients with acne vulgaris.

MATERIALS AND METHODS:
Twenty patients, Fitzpatrick skin Types III to V with facial acne, were enrolled. Twenty-five percent of TCA was applied to the right half of the face and 30% salicylic acid to the left half at 2-week interval for 2 months.

RESULTS:
Total improvement was more frequent with salicylic acid peeling (95%) versus (85%) with TCA. Total comedones improvement was more frequent with TCA peeling (80%) versus (70%) with salicylic acid. Improvement of inflammatory lesions was more frequent among the side treated with salicylic acid (85%) versus (80%) with TCA peeling. However, the results did not reach the statistical significance level.

CONCLUSIONS:
Trichloroacetic acid is more superior in treating comedonal lesions, whereas salicylic is more superior in treating inflammatory lesions, without significant different between their results.

Author Info:
1
Faculty of Medicine, Assiut University, Assiut University Hospital, Assiut, Egypt.


Authors:
Abdel-Aleem H1, Abdel-Aleem MA, Shaaban OM.

Title:
Nitroglycerin For Management Of Retained Placenta

Abstract:
BACKGROUND:
Retained placenta affects 0.5% to 3% of women following delivery, with considerable morbidity if left untreated. Use of nitroglycerin (NTG), either alone or in combination with uterotonics, may be of value to minimise the need for manual removal of the placenta in theatre under anaesthesia.

OBJECTIVES:
To evaluate the benefits and harms of NTG as a tocolytic, either alone or in addition to uterotonics, in the management of retained placenta.

SEARCH METHODS:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 January 2015), reference lists of retrieved studies and contacted experts in the field.

SELECTION CRITERIA:
Any adequately randomised controlled trial (RCT) comparing the use of NTG, either alone or in combination with uterotonics, with no intervention or with other interventions in the management of retained placenta. All women having a vaginal delivery with a retained placenta, regardless of the management of the third stage of labour (expectant or active). We included all trials with haemodynamically stable women in whom the placenta was not delivered at least within 15 minutes after delivery of the baby.

DATA COLLECTION AND ANALYSIS:
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

MAIN RESULTS:
We included three randomised controlled trials (RCTs) with 175 women. The three published RCTs compared NTG alone versus placebo. The detachment status of retained placenta was unknown in all three RCTs. Collectively, among the three included trials, two were judged to be at low risk of bias and the third trial was judged to be at high risk of bias for two domains: incomplete outcome data and selective reporting. The three trials reported seven out of 23 of the review's pre-specified outcomes.The primary outcome "manual removal of the placenta" was reported in all three studies. No differences were seen between NTG and placebo for manual removal of the placenta (average risk ratio (RR) 0.83, 95% confidence interval (CI) 0.47 to 1.46; women = 175; I² = 81%). A random-effects model was used because of evidence of substantial heterogeneity in the analysis. There were also no differences between groups for risk of severe postpartum haemorrhage (RR 0.93, 95% CI 0.62 to 1.39; women = 150; studies = two; I² = 0%). Blood transfusion was only reported in one study (40 women) and again there was no difference between groups (RR 1.00, 95% CI 0.07 to 14.90; women = 40; I² = 0%). Mean blood loss (mL) was reported in the three studies and no differences were observed (mean difference (MD) -115.31, 95% CI -306.25 to 75.63; women = 169; I² = 83%). Nitroglycerin administration was not associated with an increase in headaches (RR 1.09, 95% CI 0.80 to 1.47; women = 174; studies = three; I² = 0%). However, nitroglycerin administration was associated with a significant, though mild, decrease in systolic and diastolic blood pressure and a significant increase in pulse rate (MD -3.75, 95% CI -7.47 to -0.03) for systolic blood pressure, and (MD 6.00, 95% CI 3.07 to 8.93) for pulse rate (beats per minute) respectively (reported by only one study including 24 participants). Maternal mortality and addition of therapeutic uterotonics were not reported in any study.

AUTHORS' CONCLUSIONS:
In cases of retained placenta, currently available data showed that the use of NTG alone did not reduce the need for manual removal of placenta. This intervention did not increase the incidence of severe postpartum haemorrhage nor the need for blood transfusion. Haemodynamically, NTG had a significant though mild effect on both pulse rate and blood pressure.

Update of
Tocolysis for management of retained placenta. [Cochrane Database Syst Rev. 2011]

Author Info:
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University Hospital, Assiut, Assiut, Egypt, 71511.


Authors:
Abdel-Aziz MI1, Ali MA1, Hassan AK2, Elfaham TH3.

Title:
Factors Influencing Warfarin Response In Hospitalized Patients

Abstract:
The objective of this study was to investigate the influence of simultaneous factors that potentially keep patients far from achieving target INR range at discharge in hospitalized patients. Prospective cross-sectional observational study conducted at the Cardiology Department and Intensive Care Unit (ICU) of the Assiut University Hospitals. One-hundred and twenty patients were enrolled in the study from July 2013 to January 2014. Outcome measures were discharge INRs, bleeding and thromboembolic episodes. Bivariate analysis and multinomial logistic regression were conducted to determine independent risk factors that can keep patients outside target INR range. Patients who were newly initiated warfarin on hospital admission were given low initiation dose (2.8 mg ± 0.9). They were more likely to have INR values below 1.5 during hospital stay, 13 (27.7%) patients compared with 9 (12.3%) previously treated patients, respectively (p = .034). We found that the best predictors of achieving below target INR range relative to within target INR range were; shorter hospital stay periods (OR, 0.82 for every day increase [95% CI, 0.72-0.94]), being a male patient (OR, 2.86 [95% CI, 1.05-7.69]), concurrent infection (OR, 0.21 [95% CI, 0.07-0.59]) and new initiation of warfarin therapy on hospital admission (OR, 3.73 [95% CI, 1.28-10.9]). Gender, new initiation of warfarin therapy on hospital admission, shorter hospital stay periods and concurrent infection can have a significant effect on discharge INRs. Initiation of warfarin without giving loading doses increases the risk of having INRs below 1.5 during hospital stay and increases the likelihood of a patient to be discharged with INR below target range. Following warfarin dosing nomograms and careful monitoring of the effect of various factors on warfarin response should be greatly considered.

Author Info:
1
Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt.
2
Department of Cardiovascular Medicine, Assiut University, Assiut, Egypt.
3
Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt.


Authors:
Abdel-Ghaffar HS1, Abdel-Azeem HG2, Roushdy MM3.

Title:
Safety And Efficacy Of Pre-Incisional Peritonsillar Lornoxicam In Paediatric Post-Tonsillectomy Pain: A Prospective Double-Blind, Placebo-Controlled, Split-Body Clinical Study

Abstract:
OBJECTIVES:
To evaluate the risk of peri-operative bleeding and re-intervention with peritonsillar lornoxicam infiltration in paediatric tonsillectomy.

DESIGN:
Prospective, randomised, double-blinded, placebo-controlled, split-body study.

SETTING:
University hospital.

PARTICIPANTS:
A total of 68 patients (7-15 years), ASA I-II, scheduled for tonsillectomy divided into two groups (n = 34) to receive bilateral peritonsillar saline infiltration (placebo group) or peritonsillar saline infiltration in one tonsil (placebo side) and 8 mg lornoxicam in the other tonsil (intervention side; study group). Drugs were administered after induction of anaesthesia and before start of surgery.

MAIN OUTCOME MEASURES:
Intra-operative and postoperative bleeding score, platelet aggregometry before and 30 min after study drug administration, the verbal rating pain scale, time to first postoperative analgesic request, total analgesic consumption during 1st 24 h postoperative and adverse effects were evaluated.

RESULTS:
The difference in bleeding score between groups did not reach our definition of statistical significance (P < 0.05). Platelet aggregometry tests did not change significantly with time between groups. Lower postoperative pain scores, longer time to first analgesic request (372.76 ± 82.15 versus 64.89 ± 25.76 min P < 0.001) and lower paracetamol consumption (421.76 ± 125.63 versus 690.29 ± 141.47 mg, P < 0.001) were recorded in study group compared with control group. No patient required hospital re-admission or re-operation because of postoperative tonsillar bed bleeding.

CONCLUSIONS:
The lack of significant complications suggests that pre-incisional peritonsillar lornoxicam followed by intravenous paracetamol rescue analgesia may be safe for tonsillectomy in children. To avoid conflict with intra-operative bleeding, postoperative infiltration of lornoxicam is recommended.

Author Info:
1
Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Otorhinolaryngology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
Knowledge And Awareness Of Adverse Drug Reactions And Pharmacovigilance Practices Among Healthcare Professionals In Al-Madinah Al-Munawwarah, Kingdom Of Saudi Arabia

Abstract:
Adverse Drug Reactions (ADRs) are scantly reported with poor contribution by healthcare professionals worldwide and in particular in developing countries. The aim of this study was to assess the knowledge and awareness of adverse drug reactions (ADRs) reporting and pharmacovigilance system among healthcare professionals in Al-Madinah Al-Munawwarah hospitals, Kingdom of Saudi Arabia. A questionnaire was designed addressing; awareness of ADRs, knowledge of pharmacovigilance system, availability of ADRs reporting system, patient counseling about ADRs and documentation of ADRs. The questionnaire was distributed to randomly selected healthcare professionals (n = 585) such as physicians, pharmacists, nurses and pharmacists' technicians of hospitals. Completed questionnaires were collected and data were analyzed. Data were expressed in number as well as percentage. Of the 585 questionnaires circulated, a total of 384 healthcare professionals responded. Healthcare professional categories involved in the study were 148 physicians, 37 pharmacists, 158 nurses and 41 pharmacist technicians. The percent of the respondents who accepted to enroll in the study was 65.64%. Most of the respondents were unable to correctly define the pharmacovigilance term, but they were aware of ADRs. The awareness among healthcare professionals of the national pharmacovigilance system was 39.6%. Pharmacists had a good knowledge of pharmacovigilance and ADRs terminology and showed a more positive attitude to report ADRs. A greater number of the healthcare professionals were aware of ADRs reporting, but practically it is not implemented in hospitals. Most hospitals had follow-up documentation systems, but did not include ADRs reporting. There was no distinct pharmacovigilance system in place. Our study has demonstrated a lack of knowledge and awareness of pharmacovigilance and ADRs reporting among healthcare professionals in hospitals. The poor knowledge of ADRs reporting emphasized the urgent need to implement the appropriate strategies to improve the awareness of pharmacovigilance practices and ADRs reporting in Al-Madinah Al-Munawwarah hospitals.

Author Info:
1
Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia ; Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt.
2
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abdel-Raheem MH1, Salim SU1, Mosad E2, Al-Rifaay A3, Salama HS1, Hasan-Ali H4.

Title:
Antiapoptotic And Antioxidant Effects Of Carvedilol And Vitamin E Protect Against Diabetic Nephropathy And Cardiomyopathy In Diabetic Wistar Albino Rats

Abstract:
Carvedilol is a novel β-adrenoreceptor blocker, with antioxidant properties inhibiting lipid peroxidation and preventing the depletion of endogenous antioxidants. Moreover, carvedilol was reported to enhance the expression of Bcl-2 gene, which has antioxidant and antiapoptotic effects. There are few researches testing the protective effect of carvedilol on the development of diabetic cardiomyopathy and nephropathy. In this study, we induced diabetes mellitus in male Wistar albino rats. We investigated carvedilol, as well as vitamin E, administrated in healthy and diabetic rats for 6 weeks to compare their effects on biochemical parameters and the expression of Bcl-2 protein in both myocardial and renal tissues by immunohistochemistry. The study showed that the diabetic rats not only had renal dysfunction and more myocardial damage, but also showed lower expression of Bcl-2 protein. Carvedilol and vitamin E treatments were associated with better renal function and less myocardial damage, lower blood glucose, and lipid peroxidation, higher antioxidant capacity, better serum lipids, and higher expression of Bcl-2 protein in diabetic rats. These results indicate that carvedilol and vitamin E treatments partly protect against myocardial and renal damage probably via their antioxidant and antiapoptotic properties in diabetic rats.

Author Info:
1
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Clinical Pathology Department (Immunohistochemistry Lab), South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
3
Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Cardiovascular Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
Menaquinone-7 As A Novel Pharmacological Therapy In The Treatment Of Rheumatoid Arthritis: A Clinical Study

Abstract:
Menaquinones (MKs) have been reported to induce apoptosis in rheumatoid arthritis (RA) synovial cells. Recently, menaquinone-4 (MK-4) was proven as a new potential agent for the treatment of RA. However, menaquinone-7 (MK-7) has greater bioavailability and efficacy than MK-4 after oral administration. Yet, the therapeutic benefits of MK-7 in the management of patients with RA have never been addressed. This study was designed to clarify the therapeutic role of MK-7 added to normal therapeutic regimen of RA in patients with different stages of the disease with a clinical follow up through a randomized clinical trial. In a cross sectional study, 84 RA patients (24 male, 60 female) (average age=47.2 years) were enrolled in this study. The patients were divided into MK-7 treated group (n=42) and MK-7 naïve group (n=42). MK-7 capsules were administered in a dose of 100µg/day for three months in the first group without changing in other medications. The clinical and biochemical markers on RA patients treated with MK-7 and naïve group were assessed. In MK-7 treated group, serum concentrations of MK-7 were monitored before and after three months of MK-7 administration. In the cross sectional study, a significant decrease in MK-7 treated group for the levels of undercarboxylated osteocalcin (ucOC), erythrocyte sedimentation rate (ESR), disease activity score assessing 28 joints with ESR (DAS28-ESR), C-reactive protein (CRP) and matrix metalloproteinase (MMP-3) was found. In MK-7 treated group, a marked decrease in RA clinical and biochemical markers for moderate and good response compared to non-responders was observed in ucOC, ESR and DAS28-ESR. A marked increase in the levels of MK-7 for the moderate and good responders compared to non-responders was observed. The results suggest that MK-7 improves disease activity in RA patients. Therefore, MK-7 represents a new promising agent for RA in combination therapy with other disease modifying antirheumatic drugs.

Author Info:
1
Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Al Madinah AlMunawarah 30001, Saudi Arabia; Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: mahran44@hotmail.com.
2
Department of Rheumatology & Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Al Madinah AlMunawarah 30001, Saudi Arabia; Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt.


Authors:
Abdel-Wahab R1, Shehata S2, Hassan MM3, Habra MA4, Eskandari G5, Tinkey PT6, Mitchell J6, Lee JS7, Amin HM8, Kaseb AO3.

Title:
Type I Insulin-Like Growth Factor As A Liver Reserve Assessment Tool In Hepatocellular Carcinoma

Abstract:
Chronic liver diseases (CLDs) encompass a wide range of illnesses, including nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and viral hepatitis. Deterioration of liver capacity, with subsequent progression into cirrhosis and hepatocellular carcinoma (HCC), ultimately leads to a further decrease in the hepatic reserve. The Child-Turcotte-Pugh scoring system is the standard tool for assessing underlying liver reserve capacity in routine practice and in clinical trials of CLD and HCC. In this review, we highlight the clinical significance of insulin-like growth factor-I (IGF-I) and the growth hormone (GH) signaling pathway in HCC. IGF-I could be a marker for liver reserve capacity in CLDs and HCC in clinical practice. This approach could improve the risk assessment and stratifications of patients on the basis of their underlying liver reserve, either before active treatment in routine practice or before they are enrolled in clinical trials.

Author Info:
1
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt.
2
Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt.
3
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
4
Department of Endocrinology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
5
Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
6
Department of Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
7
Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
8
Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Graduate School of Biomedical Sciences, Houston, TX, USA.


Authors:
Abdellatief RB1, Elgamal DA2, Mohamed EE3.

Title:
Effects Of Chronic Tramadol Administration On Testicular Tissue In Rats: An Experimental Study

Abstract:
In a prospective experimental study, the effects of chronic tramadol administration on gonadotrophic and sex hormones, histopathological and morphometrical alterations in rat testicular tissue were investigated in a laboratory setting. Tramadol was given alone to adult male albino rats. Gonadotrophic and serum sex hormone levels were measured and testicular pathological and morphometric changes were observed in treated vs.

CONTROL GROUP:
After 30 days of treatment, tramadol induced a decrease in LH, FSH and testosterone serum levels. Histologically, degenerative changes in the seminiferous tubules were observed. They showed shrinkage, separation of tubular basement membrane, disorganisation and vacuolisation of spermatogenic layers. Morphometric analysis revealed significant decrease in the mean values of the tubular diameter and epithelial height. Ultrastructural abnormalities were detected in all cells of spermatogenic lineage in addition to the appearance of apoptotic cells. Sertoli cell vacuolation, huge lipid droplets and disrupted Sertoli cell junctions were observed. Leydig cells showed euchromatic nuclei and dilated smooth endoplasmic reticulum. In view of these findings, it is concluded that tramadol induces alterations in sex hormonal levels in conjunction with disruption of the normal histological structure of rat testis. This might lead to the risk of male infertility. Therefore, tramadol should be used with caution with appropriate dose monitoring.

Author Info:
1
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Histology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Dermatology and Andrology, Al-Azhar University (Assuit Branch), Assuit, Egypt.


Title:
Late-Onset Superior Mesenteric Artery Syndrome Four Years Following Scoliosis Surgery - A Case Report.

Abstract:
BACKGROUND:
Superior mesenteric artery (SMA) syndrome has been reported as an uncommon condition of external vascular compression of the SMA particularly after rapid weight loss, body casts, or after corrective surgery for spinal deformities, usually within the first few weeks after surgery.

METHODS:
This is a retrospective report of a case of a non-verbal autistic female patient who started to develop SMA syndrome at the age of 16, 4 years after posterior spinal fusion surgery for scoliosis. She was treated conservatively by increasing oral caloric intake, which resulted in increased body weight and relief of symptoms.

RESULTS:
Seen at 10 years' follow up, the patient is doing well, and is functional within the limits of her suboptimal cognitive and verbal conditions. She maintains good trunk balance with solid spinal fusion and intact instrumentation at latest follow up.

CONCLUSION:
Spinal surgeons should maintain a high index of suspicion for diagnosis of SMA syndrome even years after scoliosis surgery, especially for patients with communication problems, like the case we present here. Appropriate conservative measures can succeed in relieving the symptoms, increasing body weight, and preventing complications including the risk of death.

Author Info:
1
Department of Orthopaedic Surgery, Assiut University Hospital Assiut 71526 Egypt ; Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia 3401 Civic Center Boulevard Philadelphia PA 19104 USA.
2
Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia 3401 Civic Center Boulevard Philadelphia PA 19104 USA.


Authors:
Aboshady OA1, Radwan AE1, Eltaweel AR2, Azzam A3, Aboelnaga AA4, Hashem HA5, Darwish SY6, Salah R7, Kotb ON8, Afifi AM9, Noaman AM10, Salem DS10, Hassouna A11.

Title:
Perception And Use Of Massive Open Online Courses Among Medical Students In A Developing Country: Multicentre Cross-Sectional Study.

Abstract:
OBJECTIVES:
To assess the prevalence of awareness and use of massive open online courses (MOOCs) among medical undergraduates in Egypt as a developing country, as well as identifying the limitations and satisfaction of using these courses.

DESIGN:
A multicentre, cross-sectional study using a web-based, pilot-tested and self-administered questionnaire.

SETTINGS:
Ten out of 19 randomly selected medical schools in Egypt.

PARTICIPANTS:
2700 undergraduate medical students were randomly selected, with an equal allocation of participants in each university and each study year.

PRIMARY AND SECONDARY OUTCOME MEASURES:
Primary outcome measures were the percentages of students who knew about MOOCs, students who enrolled and students who obtained a certificate. Secondary outcome measures included the limitations and satisfaction of using MOOCs through five-point Likert scale questions.

RESULTS:
Of 2527 eligible students, 2106 completed the questionnaire (response rate 83.3%). Of these students, 456 (21.7%) knew the term MOOCs or websites providing these courses. Out of the latter, 136 (29.8%) students had enrolled in at least one course, but only 25 (18.4%) had completed courses earning certificates. Clinical year students showed significantly higher rates of knowledge (p=0.009) and enrolment (p<0.001) than academic year students. The primary reasons for the failure of completion of courses included lack of time (105; 77.2%) and slow Internet speed (73; 53.7%). Regarding the 25 students who completed courses, 21 (84%) were satisfied with the overall experience. However, there was less satisfaction regarding student-instructor (8; 32%) and student-student (5; 20%) interactions.

CONCLUSIONS:
About one-fifth of Egyptian medical undergraduates have heard about MOOCs with only about 6.5% actively enrolled in courses. Students who actively participated showed a positive attitude towards the experience, but better time-management skills and faster Internet connection speeds are required. Further studies are needed to survey the enrolled students for a better understanding of their experience.

Author Info:
1
Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt.
2
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
3
Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
4
Faculty of Medicine, Tanta University, Tanta, Egypt.
5
Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.
6
Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
7
Faculty of Medicine, Benha University, Benha, Egypt.
8
Faculty of Medicine, Assiut University, Assiut, Egypt.
9
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
10
Faculty of Medicine, Cairo University, Cairo, Egypt.
11
Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.


Authors:
Aboulghar MA1, Marie H2, Amin YM3, Aboulghar MM2, Nasr A4, Serour GI3, Mansour RT3.

Title:
GnRH Agonist Plus Vaginal Progesterone For Luteal Phase Support In ICSI Cycles: A Randomized Study.

Abstract:
In this prospective randomized study, the effect of daily gonadotrophin-releasing hormone agonist (GnRHa) in the luteal phase on IVF and intracytoplasmic sperm injection (ICSI) outcomes was assessed. Women (n = 446) were counselled for IVF-ICSI, and randomized on the day of embryo transfer to group 1 (daily 0.1 mg subcutaneous GnRHa until day of beta-HCG) (n = 224) and group 2 (stopped GnRHa on day of HCG injection) (n = 222). Both groups received daily vaginal progesterone suppositories. Primary outcome was clinical pregnancy rate. Secondary outcome was ongoing pregnancy rate beyond 20 weeks. Mean age, oestradiol on day of HCG, number of oocytes retrieved, number of embryos transferred, and clinical and ongoing pregnancy rates were 28.9 ± 4.5 years, 2401 ± 746 pg/mL; 13.5 ± 6.0 oocytes; 2.6 ± 0.6 embryos, and 36.2% and 30.4% consecutively in group 1 compared with 29.7 ± 4.7 years, 2483 ± 867 pg/mL, 13.7 ± 5.5 oocytes, 2.7 ± 0.6 embryos, 30.6% pregnancy rate, and 25.7% ongoing pregnancy rate in group 2. No significant difference was found between the groups. Subcutaneous GnRHa during the luteal phase of long GnRHa protocol cycles does not increase clinical or ongoing pregnancy rates after IVF-ICSI.

Author Info:
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt; The Egyptian IVF Center, Maadi, Cairo, Egypt. Electronic address: ghar1940@yahoo.com.
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt; The Egyptian IVF Center, Maadi, Cairo, Egypt.
3
The Egyptian IVF Center, Maadi, Cairo, Egypt.
4
Department of Obsterics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
de Visser V1, Sotgiu G2, Lange C3, Aabye MG4, Bakker M5, Bartalesi F6, Brat K7, Chee CB8, Dheda K9, Dominguez J10, Eyuboglu F11, Ghanem M12, Goletti D13, Dilektasli AG14, Guglielmetti L15, Koh WJ16, Latorre I10, Losi M17, Polanova M18, Ravn P19, Ringshausen FC20, Rumetshofer R21, de Souza-Galvão ML22, Thijsen S23, Bothamley G24, Bossink A23; TBNET.

Title:
False-Negative Interferon-y Release Assay Results In Active Tuberculosis: A TBNET Study.

Author Info:
1
Dept of Pulmonary Disease, Diakonessenhuis, Utrecht, The Netherlands veerledevisser@gmail.com.
2
Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari-Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
3
Division of Clinical Infectious Diseases, German Center for Infection Research (DZIF), Research Center Borstel, Borstel, Germany Dept of Medicine, University of Namibia School of Medicine, Windhoek, Namibia International Health/Infectious Diseases, University of Lubeck, Lubeck, Germany.
4
Clinical Research Unit, University of Copenhagen, Hvidovre Hospital, Copenhagen Denmark National Institute of Medical Research, Mwanza, Tanzania.
5
Erasmus Medical Centre, Rotterdam, The Netherlands.
6
SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
7
University Hospital Brno, Brno, Czech Republic.
8
Tan Tock Seng Hospital, Singapore.
9
University of Cape Town, Cape Town, South Africa.
10
Microbiology Dept, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Ciber Enfermedades Respiratorias, Barcelona, Spain.
11
Baskent University Faculty of Medicine, Dept of Pulmonary Diseases, Ankara, Turkey.
12
Dept of Chest Diseases and Tuberculosis, Assiut University Hospital, Assiut, Egypt.
13
IRCCS Instituto Nazionale Malattie Infettive "L. Spallanzani", Rome, Italy.
14
Uludag University Faculty of Medicine, Dept of Pulmonary Diseases, Bursa, Turkey.
15
Unità Operativa Complessa di Malattie Infettive, University of Verona, Verona, Italy.
16
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
17
University of Modena and Reggio Emillia, Modena, Italy.
18
The National Institute of TB, Respiratory Diseases and Thoracic Surgery, Vyšné Hágy, Slovakia.
19
Department of Pulmonary and Infectious Diseases, University of Copenhagen, Hillerød Hospital, Denmark.
20
Hannover Medical School, Dept of Respiratory Medicine, Hannover, Germany.
21
Treatment Center for Tuberculosis, Dept of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria.
22
Drassanes Tuberculosis Unit, Vall d'Hebron Teaching Hospital, Barcelona, Spain.
23
Dept of Pulmonary Disease, Diakonessenhuis, Utrecht, The Netherlands.
24
Dept of Respiratory Medicine, Homerton University Hospital, London, UK.


Authors:
Dyab AK1, Galal LA1, Mahmoud Ael-S1, Mokhtar Y1.

Title:
Xenomonitoring Of Different Filarial Nematodes Using Single And Multiplex PCR In Mosquitoes From Assiut Governorate, Egypt.

Abstract:
Wuchereria bancrofti, Dirofilaria immitis, and Dirofilaria repens are filarial nematodes transmitted by mosquitoes belonging to Culex, Aedes, and Anopheles genera. Screening by vector dissection is a tiresome technique. We aimed to screen filarial parasites in their vectors by single and multiplex PCR and evaluate the usefulness of multiplex PCR as a rapid xenomonitoring and simultaneous differentiation tool, in area where 3 filarial parasites are coexisting. Female mosquitoes were collected from 7 localities in Assiut Governorate, were microscopically identified and divided into pools according to their species and collection site. Detection of W. bancrofti, D. immitis, and D. repens using single PCR was reached followed by multiplex PCR. Usefulness of multiplex PCR was evaluated by testing mosquito pools to know which genera and species are used by filarial parasites as a vector. An overall estimated rate of infection (ERI) in mosquitoes was 0.6%; the highest was Culex spp. (0.47%). W. bancrofti, D. immitis, and D. repens could be simultaneously and differentially detected in infected vectors by using multiplex PCR. Out of 100 mosquito pools, 8 were positive for W. bancrofti (ERI of 0.33%) and 3 pools each were positive for D. immitis and D. repens (ERI 0.12%). The technique showed 100% sensitivity and 98% specificity. El-Nikhila, El-Matiaa villages, and Sahel Seleem district in Assiut Governorate, Egypt are still endemic foci for filarial parasites. Multiplex PCR offers a reliable procedure for molecular xenomonitoring of filariasis within their respective vectors in endemic areas. Therefore, it is recommended for evaluation of mosquito infection after lymphatic filariasis eradication programs.

Author Info:
Department of Medical Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
El Saman AM1, AbdelHafez FF1, Zahran KM1, Saad H1, Khalaf M1, Hussein M1, Hassanin IM2, Shugaa Al Deen SM3.

Title:
Tactile Electrosurgical Ablation: A Technique for the Treatment of Intractable Heavy and Prolonged Menstrual Bleeding.

Abstract:
OBJECTIVE:
To study the efficacy and safety of tactile electrosurgical ablation (TEA) in stopping a persistent attack of abnormal uterine bleeding not responding to medical and hormonal therapy.

METHODS:
This is a case series of 19 cases with intractable abnormal uterine bleeding, who underwent TEA at the Women's Health Center of Assiut University. The outcomes measured were; patient's acceptability, operative time, complications, menstrual outcomes, and reintervention.

RESULTS:
None of the 19 counseled cases refused the TEA procedure which took 6-10 minutes without intraoperative complications. The procedure was successful in the immediate cessation of bleeding in 18 out of 19 cases. During the 24-month follow-up period, 9 cases developed amenorrhea, 5 had scanty menstrual bleeding, 3 were regularly menstruating, 1 case underwent repeat TEA ablation, and one underwent a hysterectomy.

CONCLUSIONS:
TEA represents a safe, inexpensive, and successful method for management of uterine bleeding emergencies with additional long-term beneficial effects. However, more studies with more cases and longer follow-up periods are warranted.

Author Info:
1
Women's Health Center, Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Obstetrics & Gynecology, Faculty of Medicine, Sohag University, Sohag, Egypt.
3
Department of Obstetrics & Gynecology, University Hospital of Sana'a, Yemen.


Authors:
El-Asheer OM1, Darwish MM2, Abdou MA3, Saad K1.

Title:
Immunogenicity of Recombinant Hepatitis B Vaccine Among Routinely Vaccinated Healthy and Chronically Ill Children in Assiut, Upper Egypt.

Abstract:
BACKGROUND:
Egypt is considered a region of the intermediate prevalence of hepatitis B virus (HBV) infection (4.5%). Seroprotection is assured when hepatitis B surface antibody (HBsAb) levels are ≥ 10 mIU/mL. Our study aimed to evaluate and compare the long-term immunogenicity and efficacy of the recombinant hepatitis B (HB) vaccine.

METHODS:
A cross-sectional study was done for children aged from 9 months to 15 years, receiving health care at Assiut University Children's Hospital, Assiut, Egypt in 3 months. HBsAb was quantitatively determined by enzyme-linked immune sorbent assay (ELISA).

RESULTS:
Seroprotection in infants less than 1 year was 89.7% with 55.2% having titer > 100 mIU/mL and this percent dropped to 64.4% after the first year of age with only 29% having titer > 100 mIU/mL. The overall protection percentage was 32.5% (> 100 mIU/mL), 34.7% of children showed levels between 10 and 100 mIU/mL, while 32.8% were less than 10 mIU/mL. Patients with diabetes mellitus were found to have the lowest seroprotective levels (83.3% were not protected). Non-protective levels were also detected in patients with malnutrition (55.6%), congenital heart diseases (43.2%) and chronic liver diseases (57.1%).

CONCLUSION:
Our study shows failure to achieve satisfactory seroprotective levels for hepatitis B vaccine in both healthy and diseased children who adopted vaccination schedule in Upper Egypt. Booster dose in the second year of life is recommended for all children, particularly for those with diabetes millets, congenital heart disease and malnutrition.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Public Health & Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
El-Baz MA1, El-Deeb TS2, El-Noweihi AM3, Mohany KM4, Shaaban OM5, Abbas AM6.

Title:
Environmental Factors And Apoptotic Indices In Patients With Intrauterine Growth Retardation: A Nested Case-Control Study.

Abstract:
BACKGROUND:
Egypt has one of the highest incidences of IUGR. The current study investigates the effect of heavy metals toxicity as risk factors of IUGR and determines the possible role of increased apoptosis in their pathogenesis.

METHODS:
This study was conducted in Assiut, Egypt, included 60 women diagnosed to have IUGR. We measured lead and cadmium levels in blood besides arsenic and cadmium levels in urine. Neonatal scalp hair sample were analyzed for arsenic content. Quantitative determination of human placental Bcl-2 and caspase-3 were performed.

RESULTS:
There are significantly higher levels of heavy metals and caspase-3 and lower levels of placental Bcl-2 in the IUGR group. The levels of heavy metals were positively correlated with caspase-3 while negatively correlated (except cadmium) with Bcl-2 levels.

CONCLUSIONS:
There is an alarming high level of heavy metals toxicity in Egypt that was positively correlated to IUGR. Increased placental apoptosis may be one of the possible mechanisms behind the effect.

Author Info:
1
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: monaelbaz1@gmail.com.
2
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: Thorayaeldeeb@yahoo.com.
3
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: amira.elnewihi50@yahoo.com.
4
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: Khalidmohany9@gmail.com.
5
Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt. Electronic address: omshaaban2000@yahoo.com.
6
Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt. Electronic address: bmr90@hotmail.com.


Authors:
El-Gammal TA1, El-Sayed A1, Kotb MM1, Saleh WR1, Ragheb YF1, Refai O1, Morsy MM1.

Title:
Free Functioning Gracilis Transplantation For Reconstruction Of Elbow And Hand Functions In Late Obstetric Brachial Plexus Palsy.

Abstract:
BACKGROUND:
In late obstetric brachial plexus palsy (OBPP), restoration of elbow and hand functions is a difficult challenge. The use of free functioning muscle transplantation in late OBPP was very scarcely reported. In this study, we present our experience on the use of free functioning gracilis transfer for restoration of elbow and hand functions in late cases of OBPP.

PATIENTS AND METHODS:
Eighteen patients with late OBPP underwent free gracilis transfer for reconstruction of elbow and/or hand functions. The procedure was indicated when there was no evidence of reinnervation on EMG and in the absence of local donors. Average age at surgery was 102.5 months. Patients were evaluated using the British Medical Research Council (MRC) grading system and the Toronto Active Movement Scale. Hand function was evaluated by the Raimondi scoring system.

RESULTS:
The average follow-up was 65.8 ± 41.7 months. Contraction of the transferred gracilis started at an average of 4.5 ± 1.03 months. Average range of elbow flexion significantly improved from 30 ± 55.7 to 104 ± 31.6 degrees (P <0.001). Elbow flexion power significantly increased with an average of 3.8 grades (P = 0.000147). Passive elbow range of motion significantly decreased from an average of 147 to 117 degrees (P = 0.003). Active finger flexion significantly improved from 5 ± 8.3 to 63 ± 39.9 degrees (P < 0.001). Finger flexion power significantly increased with an average 2.7 grades (P < 0.001). Only 17% achieved useful hand (grade 3) on Raimondi hand score. Triceps reconstruction resulted in an average of M4 power and 45 degrees elbow extension.

CONCLUSION:
Free gracilis transfer may be a useful option for reconstruction of elbow and/or hand functions in late OBPP.

Author Info:
1
Hand and Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University School of Medicine, Assiut, Egypt.


Authors:
El-Kashef N1,2, Gomes I1, Mercer-Chalmers-Bender K1, Schneider PM1, Rothschild MA1, Juebner M3.

Title:
Validation Of Adequate Endogenous Reference Genes For Reverse Transcription-qPCR Studies In Human Post-Mortem Brain Tissue Of SIDS Cases.

Abstract:
Sudden infant death syndrome (SIDS) is the main cause of post-neonatal infant death in most developed countries. It is still of ambiguous etiology. Gene expression studies of relevant target genes using reverse transcription quantitative real-time PCR (RT-qPCR) in SIDS cases, and comparing them with age-matched controls, could help in understanding the pathogenesis of SIDS. However, selecting inadequate reference genes used for normalization of the RT-qPCR gene expression data can give misleading results. The aim of the present study was to identify reference genes with the most stable expression in post-mortem brainstem samples of SIDS and control cases. Among the five candidate reference genes (GAPDH, GUSB, HMBS, SDHA, UBXN6) studied in both groups, SDHA and UBXN6 were identified as the most stable. To further demonstrate the importance of using validated genes for RT-qPCR data normalization, the expression of a potential gene of interest in SIDS, the RPS27A gene, was evaluated using validated versus non-validated reference genes for normalization. This gene encodes the ubiquitin protein that has been shown in other pathological studies to be induced in SIDS. Using the identified most stable genes for normalization of RPS27A gene expression data revealed, as expected, a statistically significant up-regulation in SIDS as compared to the controls. However, using a single unstable reference gene for normalization resulted in no significant differences in transcript abundance of RPS27A between SIDS and the controls. This emphasizes the need for validation of the suitability of reference genes used in a given tissue type under certain experimental conditions.

Author Info:
1
Medical Faculty, Institute of Legal Medicine, University of Cologne, Cologne, Germany.
2
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Medical Faculty, Institute of Legal Medicine, University of Cologne, Cologne, Germany. martin.juebner@uk-koeln.de.


Title:
Impact Of Duplex Arterial Mapping On Decision Making In Non-Acute Ischemic Limb Patients.

Abstract:
AIM:
The aim of this study was to demonstrate the impact of Duplex arterial mapping on decision making in non-acute ischemic limb patient group reporting pain onset between 15 days and 3 months.

METHODS:
We prospectively evaluated patients presented with critical limb ischemia who reported pain onset of duration between 15 days and 3 months in one-year period. Our series included thirty cases (mean age=61.3 years old), as Duplex arterial mapping was the sole preoperative imaging tool performed in all of them. All patients, in whom duplex indicated thrombosis in long occluded segments, were candidates for fluoroscopically guided thrombectomy. When Duplex defined chronic arterial occlusions, patients underwent endovascular or bypass revascularisation procedures. Impact of Duplex wall interrogation on decision-making between the two groups (subacute and chronic) was measured.

RESULTS:
Duplex arterial mapping categorized correctly all 30 patients into either subacute ischemia with removable clot (N.=14) or chronic ischemia (N.=16). Fluoroscopic guided thrombectomy was performed in 14 cases when Duplex advised long occluded arterial segments as indicted by intact intima with echogenic thrombus inside. Bypass surgery was performed in 8 patients. Percutaneous transluminal angioplasty (PTA) was done in 7 cases and thrombendartrectomy of common femoral artery in a single case. One-year patency rate in our series was 86.6%. It was 71.4% in thrombosis group. Limb salvage rate was 93.3%.

CONCLUSION:
Duplex arterial mapping could be used to differentiate the subacute ischemia with removable thrombus and chronic arterial occlusions guiding for the best revascularization procedure accordingly.

Author Info:
1
Vascular Surgery Department, Assiut University Hospital, Assiut, Egypt - ahmedhassan.bakr@gmail.com.


Title:
Melanocytoma of the Optic Nerve Head, Thirty-Month Follow-Up

Abstract:
INTRODUCTION:
Optic nerve head (ONH) melanocytoma is a benign pigmented tumor that is detected as a dark brown mass on or adjacent to the optic disc. Ultrasonography, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA) can be used to differentiate it from other pigmented tumor as well as to monitor tumor growth. Visual field changes are variable in ONH melanocytoma. Usually, ONH melanocytoma has a stationary course with few cases of progressive growth or malignant transformation.

CASE PRESENTATION:
A 54-year-old female complained of blurring of vision. Best-corrected visual acuity (BCVA) was 0.9 in both eyes. On routine fundus examination, an elevated pigmented lesion was found, involving the optic nerve head of the left eye. B-scan ultrasound demonstrated a mass arising from ONH. FFA revealed blocked fluorescence corresponding to pigmented mass. HR-OCT scans showed a dome-shaped, elevated ONH lesion with highly reflective layer and optical shadowing behind it, obscuring most of the optic nerve head details. On regular follow-up for 30 months, the lesion had neither changed in its size nor affected the patient's visual acuity.

CONCLUSION:
ONH melanocytoma is a benign tumor with rare malignant transformation and visual impairment.

Author Info:
1
a Aswan Eye and Laser Center , Aswan , Egypt and.
2
b Ophthalmology Department , Assiut University Hospital , Assiut , Egypt.


Title:
Brenner's Tumor Associated With Ovarian Mucinous Cystadenoma Reaching A Huge Size In Postmenopausal Woman.

Abstract:
A case of a 70-year-old Egyptian postmenopausal woman presenting a Brenner's tumor associated with mucinous cystadenoma weighing 20.7 kg is reported here. Patient was admitted in our hospital with abdominal pain of one-month duration. On abdominal ultrasound, a huge heterogeneous mass was found to encompass the whole abdomen. At laparotomy, a giant, right heterogeneous mass was encountered and removed intact by right salpingo-oophorectomy. On the seventh postoperative day, she was discharged without any problem. Her pathology report disclosed a 52 x 41 x 36 cm, partially solid, partially cystic mass diagnosed as benign Brenner's tumor with mucinous cystadenoma weighing 20.7 kg. This is the largest ovarian mass that is ever reported in our hospital and one of the largest among the reported cases in the literature.

Author Info:
1
House Officer, Assiut University, Assiut, Egypt.


Title:
A Modified Onlay Island Flap Vs. Mathieu Urethroplasty For Distal Hypospadias Repair: A Prospective Randomised Study.

Abstract:
OBJECTIVE:
To compare the outcome of a modified onlay island flap (MOIF) with that of the Mathieu urethroplasty for distal hypospadias repair.

PATIENTS AND METHODS:
In a prospective randomised study, 60 patients with coronal, subcoronal and distal penile hypospadias, with a urethral plate width of ⩽6 mm, and minimal or no chordee, underwent either MOIF using a midline longitudinal outer preputial skin flap passed ventrally by penile buttonholing through dartos fascia incision, or a Mathieu urethroplasty. Closed envelopes were used for randomly selecting patients for each procedure. The operative duration, complications, cosmetic outcome, urinary stream and relatives' satisfaction were reported for each procedure.

RESULTS:
Preoperative data (patients' age and site of urethral meatus) and operative duration were insignificantly different between the groups (P = 0.653, 0.786 and 0.710, respectively). There were no intraoperative complications in either group. The duration of follow-up was insignificantly different between the groups. Patients treated with the MOIF had a statistically significant lower complication rate (P = 0.036), and a better cosmetic outcome, urinary stream and relatives' satisfaction (P < 0.001 for all).

CONCLUSIONS:
The MOIF urethroplasty seemed to be better than the Mathieu urethroplasty in patients with distal hypospadias and narrow urethral plates. Further studies including more patients, and a longer follow-up with an objective evaluation of functional outcome should be encouraged to confirm these early results.

Author Info:
1
Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Elgayar SA1, Eltony SA1, Sayed AA1, Abdel-Rouf MM1.

Title:
Genistein Treatment Confers Protection against Gliopathy and Vasculopathy of the Diabetic Retina in Rats.

Abstract:
Retinopathy remains an important complication of diabetes. This work was carried out to evaluate the protective effects of genistein from diabetic retinopathy in rat. Fifteen adult male albino rats were divided into two groups; Group I: control (n = 5) and Group II: streptozotocin induced diabetic group (n = 10), which is equally divided into two subgroups; IIa (diabetic vehicle control) and IIb (diabetic genistein-treated). Specimens were taken from the retina 12 weeks post induction, processed and examined using light, immunohistochemical, ultrastructural techniques. Blood samples were assayed for the levels of glucose. In comparison with the diabetic non-treated group, the histological changes in macro and microglial glial cells reactivity and retinal blood capillaries were improved in genistein-treated groups. In addition, GFAP and iNOS expressions in the retina and the blood glucose level were reduced. Genistein ameliorates the histological changes of diabetic retinopathy reaching healing features, which resemble that of a normal retina.

Author Info:
1
a Department of Histology, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Elgendy H1, El Moghazy WM, Nafady-Hego H, Uemoto S.

Title:
Outcome Of Critically-Ill Children After Living-Donor Liver Transplant.

Abstract:
OBJECTIVES:
The outcome of children who had living-donor liver transplant was analyzed according to their status before transplant, and we analyzed the outcome of critically ill patients.

MATERIALS AND METHODS:
This was a retrospective analysis of children who received primary living-donor liver transplant at Kyoto University Hospital. According to the criteria of the United Network for Organ Sharing, we divided patients into 3 groups: Group A patients had been admitted to the intensive care unit before living-donor liver transplant; Group B patients were hospitalized but did not require intensive care unit stay; and Group C patients were living at home and underwent elective transplant.

RESULTS:
A total 685 patients met inclusion criteria. Children in Group A were younger than Group B and received liver grafts from younger donors than Group B and C. Group A patients had marked impairment in liver and renal function and coagulation profile and needed higher volumes of fresh frozen plasma transfusions. Group A patients had significantly worse outcomes and early patient death than the other group; Group A patient survival was 68.3%, 63.2%, 60.1%, and 56.1% at 1, 5, 10, and 15 years after living-donor liver transplant (P < .0001). Group A had worse graft survival than other groups (P < .0001), and Group A graft survival was 68.3%, 65.9%, 54.1%, and 49.9% at 1, 5, 10, and 15 years. Low gamma-glutamyl transpeptidase was an independent risk factor for patient death in Group A (hazard ratio, 1.004; 95% confidence interval, 1.0-1.007) (P < .05). Group A patients had a higher rate of multidrug-resistant hospital-acquired infections.

CONCLUSIONS:
Children who were admitted to the intensive care unit prior to living-donor liver transplant had marked impairment of pretransplant laboratory parameters and worse outcome than other groups.

Author Info:
1
From the Department of Anesthesia, Assiut University, Assiut, Egypt; and the Department of Anesthesia, King Abdullah Medical City, Mecca, Saudi Arabia.


Authors:
Elsayed Yousef Y1, Abo El-Magd EA2, El-Asheer OM3, Kotb S4.

Title:
Impact of Educational Program on the Management of Chronic Suppurative Otitis Media among Children.

Abstract:
BACKGROUND:
Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide, affecting diverse racial and cultural groups in both developing and industrialized countries.

AIM OF THE STUDY:
This study aimed to assess the impact of educational program on the management of children with CSOM.

SUBJECTS AND METHODS:
An experimental study design was used. This study included 100 children of both sexes of 2 years and less of age with CSOM. Those children were divided into 3 groups: group I: it involved 50 children with CSOM (naive) who received the designed educational program; control group: it involved 50 children who were under the traditional treatment and failed to respond; group II: those children in the control group were given the educational program and followed up in the same way as group I and considered as group II. Tools of the Study. Tool I is a structured questionnaire interview sheet for mothers. It consists of four parts: (1) personal and sociodemographic characteristics of child and (2) data about risk factors of otitis media (3) assessment of maternal practice about care of children with suppurative otitis medi (4) diagnostic criteria for suppurative otitis media. Tool II is the educational program: an educational program was developed by the researchers based on the knowledge and practices needs. This study was carried out through a period of 9 months starting from September 2013 to May 2014. The educational program was implemented for mothers of children with CSOM in the form of 5 scheduled sessions at the time of diagnosis, after one week, 1, 3, and 6 months.

RESULTS:
There were significant differences between children who received the educational program and control group regarding the response to treatment after one and 3 months. The percentages of complete cure increased progressively 32%, 60%, and 84% after 1, 3, and 6 months in group I while they were 24%, 44%, and 64% in group II, respectively. Cure (dry perforation) was 64%, 36%, and 12% among children of group I after 1, 3, and 6 months while it was 64%, 44%, and 24% in group II, respectively. The percentages of compliance to the educational program improved with time in both groups: 44%, 64%, and 80% in group I and 32%, 48%, and 56% in group II after 1, 3, and 6 months, respectively. The percentages of cure were statistically significantly higher among children with complete compliance with the educational program in both groups in comparison to those with incomplete compliance (P = 0.000 for both).

CONCLUSIONS:
From this study we can conclude that the majority of children with CSOM had one or more risk factors for occurrence of the disease; the educational program is effective for management of CSOM (whether cure or complete cure); the higher the compliance of mothers with the program the higher the response rate; regular followup and explanation of the importance of the program played an important role in the compliance with the program.

Author Info:
1
Department of Pediatric Nursing, Faculty of Nursing, Sohag University, Egypt.
2
ENT, Faculty of Medicine, Aswan University, Egypt.
3
Pediatrics, Faculty of Medicine, Assiut University, Egypt.
4
Public Health, Faculty of Nursing, Assiut University, Egypt.


Title:
Cardiac Arrest in Children: Relation to Resuscitation and Outcome.

Abstract:
OBJECTIVE:
To determine the outcome of cardiac arrest in pediatric intensive care unit in relation to event variables.

METHODS:
The study included children with cardiac arrest who required resuscitation in pediatric intensive care unit over 1 y period. Two outcome variables were measured. The first was success [return of spontaneous circulation (ROSC)] and the second was survival to discharge from pediatric intensive care unit.

RESULTS:
Out of 700 admissions, 172 (24.6 %) patients developed cardiac arrest that required resuscitation. Return of spontaneous circulation was achieved in 78 cases (45.3 %), 25 patients (14.5 %) survived to discharge and 94 patients (54.7 %) did not respond to resuscitations. Success and survival rates were significantly higher in cases resuscitated for ≤ 20 min than in cases resuscitated for > 20 min (100 % and 33.3 % vs. 32.4 % and 10.1 % respectively). Success and survival rates were better in patients undergoing mechanical ventilation than those not (48.1 % and 17.8 % vs. 37.2 % and 4.7 % respectively). Defibrillation was successful in 10 cases (25 %) and survival was in 1 case (0.5 %) and out of survivors, 80 % had good neurological outcome.

CONCLUSIONS:
The frequency of inhospital cardiac arrest was 24.6 % where 45.3 % of them achieved successful resuscitation. The duration of cardiopulmonary resuscitation (<20 min) and mechanical ventilation were an indicator for better success and survival rates.

Author Info:
1
Department of Pediatrics, Children University Hospital, Assiut University, Asyut, Egypt, azeltayeb@hotmail.com.


Authors:
Eltayeb AA1, Askar GA2, Abu Faddan NH2, Kamal TM3.

Title:
Prothrombotic Risk Factors And Antithrombotic Therapy In Children With Ischemic Stroke.

Abstract:
OBJECTIVE:
Congenital and acquired prothrombotic disorders have been highlighted in a recent series of cerebrovascular stroke (CVS), with a controversial role in pathogenesis. The aim is to study some prothrombotic risk factors [activated protein C (APC) resistance, von Willebrand factor (vWF), anticardiolpin (ACL) antibodies and plasma homocysteine] in children with ischemic stroke, and to evaluate the role of aspirin and low molecular weight heparin (LMWH) in its management in relation to outcome.

METHODS:
A total of 37 cases aged from 1 month to 15 years ( mean ± standard deviation 26.2 ± 35.7 months), diagnosed as ischemic stroke (>24 hours) were recruited. Complete blood count, prothrombin time and concentration, partial thromboplastin time, serum electrolytes, random blood sugar, C-reactive protein, electrocardiogram and echocardiography were done. Levels of APC resistance, vWF, ACL antibodies [immunoglobulin G (IgG) and immunoglobulin M (IgM)] and plasma homocysteine were estimated. A total of 25 cases received aspirin 3-5 mg /kg/d and 12 patients received LMWH as initial dose at 75 international units (IU)/kg subcutaneously (SC) then 10-25 IU/kg/day for 15 days in a nonrandomized fashion.

RESULTS:
The levels of APC resistance, vWF, ACL antibodies (IgG and IgM) and plasma homocysteine were significantly higher in stroke cases than in controls. There was no significant difference between cases treated with aspirin and those with LMWH in all prothrombotic factors. Significant positive correlations were found between vWF and ACL antibodies (IgG and IgM) levels before treatment. Significant decrease in cognitive function was detected between cases treated with LMWH and those treated with aspirin.

CONCLUSION:
Ischemic CVS in children is multifactorial. Thrombophilia testing should be performed in any child with CVS. Early use of aspirin improves the prognosis and has less effect on cognitive function.

Author Info:
1
Assistant Professor of Pediatrics, Children University Hospital, Assiut University, Assiut, Egypt.
2
Children University Hospital, Assiut University, Assiut, Egypt Assistant Prof of Pediatrics, Children University Hospital, Assiut University, Egypt.
3
Assiut University Hospital, Assiut University, Egypt.


Title:
Topical Treatment Of Major Omphalocoele: Acacia Nilotica Versus Povidone-Iodine: A Randomised Controlled Study.

Abstract:
BACKGROUND:
Conservative management for major omphalocoele with topical agents as escharotics therapy is well established in practice. Different agents have been used in the past, including mercurochrome and alcohol, proved later to be unsafe. The aim of this study is to evaluate the efficacy and safety of the application of Acacia nilotica paste compared to povidone-iodine solution as a primary non-surgical treatment of major omphalocoele.

PATIENTS AND METHODS:
A double-blind, randomised study was conducted on 24 cases of major omphalocoele where they were randomly divided into two equal groups; Group A treated with topical application of A. nilotica paste and Group B treated with topical application of povidone-iodine solution. Cases with gastroschisis, ruptured major omphalocoele or minor omphalocoele were excluded from the study. The evaluating parameters were size of the fascial defect in cm, period of mechanical ventilation if needed, time required for full oral feeding tolerance, duration of hospital stay and any short- or long-term complications.

RESULTS:
There was no statistical significant difference between both groups regarding their gestational or post-natal age, weight and the mean umbilical port defect. Patients from Group A tolerated full oral feeding earlier and had shorter total hospital stay duration than those from Group B, but without a statistical significant difference (P = 0.347 and 0.242, respectively). The overall mortality rate was 33.3% without a statistical significant difference between both groups (P = 0.667).

CONCLUSIONS:
Application of A. nilotica is a safe and effective treatment of major omphalocoele as it was associated with rapid full enteral feeding tolerance, short duration of hospital stay and low mortality rate.

Author Info:
1
Assiut University Children Hospital, Pediatric Surgery Unit, Assiut University, Asyut, Egypt.


Authors:
Eltayeb AA1, Abdou MA1, Abdel-aal AM1, Othman MH1.

Title:
Vitamin D Status And Viral Response To Therapy In Hepatitis C Infected Children.

Abstract:
AIM:
To study the frequency of vitamin D deficiency in patients with hepatitis C virus (HCV) infection and to evaluate the role of vitamin D supplementation in improving antiviral therapy.

METHODS:
Sixty-six children aged from 7-14 years (mean ± SD, 11.17±2.293) diagnosed with HCV infection were matched to 28 healthy controls. Serum levels of 25 (OH) D3, calcium, phosphorus, alkaline phosphatase and plasma level of parathormone were measured. Quantitative PCR for HCV was performed Bone density was determined by dual energy X-ray absorptiometry. All cases received conventional therapy, and only 33 patients received vitamin D supplementation.

RESULTS:
Children with HCV showed significantly increased levels of HCV RNA (P<0.001), parathormone (P<0.01) and decreased vitamin D levels (P<0.05) (33.3% deficient and 43.3% insufficient) compared with controls. Abnormal bone status (Z score -1.98±0.75) was found in ribs, L-spine, pelvis and total body. Cases treated with vitamin D showed significant higher early (P<0.04) and sustained (P<0.05) virological response. There was a high frequency of vitamin D deficiency among the Egyptian HCV children, with significant decrease in bone density. The vitamin D level should be assessed before the start of antiviral treatment with the correction of any detected deficiency.

CONCLUSION:
Adding vitamin D to conventional Peg/RBV therapy significantly improved the virological response and helped to prevent the risk of emerging bone fragility.

Author Info:
1
Azza A Eltayeb, Children University Hospital, Assiut University, 71515 Assiut, Egypt.


Authors:
Emad Y1,2, Ragab Y3,4, El-Naggar A5,6, El-Shaarawy N7, Abd-Allah MA8, Gamal RM9, Fathy A10, Hawass M11, Rasker JJ12.

Title:
Gadolinium-Enhanced MRI Features Of Acute Gouty Arthritis On Top Of Chronic Gouty Involvement In Different Joints.

Abstract:
The aims of the current study are to describe gadolinium-enhanced MRI features of an acute flare of established gouty arthritis in different joints and to examine a possible association between serum uric acid and MRI signs indicative of ongoing inflammation and/or structural joint damage as well as association with disease characteristics and laboratory findings. Twenty-seven male patients with established chronic gout agreed to participate, mean age 47.6 years, and mean disease duration in months 43.2 (±31.8). For all patients, detailed demographic, disease characteristics, and laboratory findings were obtained and correlated with MRI findings. In 27 patients with established gout, a total of 50 MRI studies were performed of the following joints: feet joints (n = 23), ankles (n = 18), knees (n = 5), and hand and wrist joints (n = 4). MRI revealed capsular thickening in 19 patients, bone marrow edema (BME) in 15, soft tissue edema (STE) in 20, joint effusion in 21, bone erosions in 17, cartilaginous erosions in 4, and tenosynovitis in 9 cases. In 17 cases, tophaceous lesions were found. Post contrast MRI showed synovial thickening in seven cases. Positive correlations were observed between serum uric acid levels and the following MRI findings: capsular thickening (r = 0.552, p = 0.003), BME (r = 0.668, p ≤ 0.0001), STE (r = 0.559, p = 0.002), and tenosynovitis (r = 0.513, p = 0.006). Using MRI in chronic gout, important features can be detected like BME, minute cartilaginous erosions, and hypertrophic synovial inflammation in post contrast MR images. Serum uric acid (SUA) was positively correlated with capsular thickening, BME, STE, and tenosynovitis.

Author Info:
1
Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt. yasseremad68@gmail.com.
2
Rheumatology and Rehabilitation Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia. yasseremad68@gmail.com.
3
Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
4
Radiology Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia.
5
Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
6
Orthopedic Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia.
7
Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
8
Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
9
Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Asyut, Egypt.
10
Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
11
Internal Medicine Department, Nephrology Unit, Agouza Police Hospital, Cairo, Egypt.
12
Rheumatology Department, University of Twente, Enschede, The Netherlands.


Authors:
Erdem H1, Cag Y2, Ozturk-Engin D3, Defres S4, Kaya S5, Larsen L6, Poljak M7, Barsic B8, Argemi X9, Sørensen SM10, Bohr AL11, Tattevin P12, Gunst JD13, Baštáková L14, Jereb M15, Johansen IS6, Karabay O16, Pekok AU17, Sipahi OR18, Chehri M19, Beraud G20, Shehata G21, Del Vecchio RF22, Maresca M22, Karsen H23, Sengoz G24, Sunbul M25, Yilmaz G26, Yilmaz H25, Sharif-Yakan A27, Kanj SS27, Parlak E28, Pehlivanoglu F24, Korkmaz F29, Komur S30, Kose S31, Ulug M32, Bolukcu S3, Coskuner SA33, Ince N34, Akkoyunlu Y35, Halac G36, Sahin-Horasan E37, Tireli H38, Kilicoglu G39, Al-Mahdawi A40, Nemli SA41, Inan A3, Senbayrak S3, Stahl JP42, Vahaboglu H43.

Title:
Results Of A Multinational Study Suggest The Need For Rapid Diagnosis And Early Antiviral Treatment At The Onset Of Herpetic Meningoencephalitis.

Abstract:
Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome.

Author Info:
1
GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey hakanerdem1969@yahoo.com.
2
Dr. Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
3
Haydarpaşa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
4
Institute of Infection & Global Health, University of Liverpool, Liverpool, Merseyside, United Kingdom Tropical Infectious Diseases Unit at Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.
5
Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey.
6
Odense University Hospital, Department of Infectious Diseases Q, Odense, Denmark.
7
Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
8
Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Department of Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia.
9
Nouvel Hôpital Civil, Department of Infectious Diseases, Strasbourg, France.
10
Aalborg University Hospital, Department of Infectious Diseases, Aalborg, Denmark.
11
Copenhagen University Hospital, Institute of Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark.
12
Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
13
Aarhus University Hospital, Department of Infectious Diseases, Aarhus, Denmark.
14
Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine, Brno, Czech Republic.
15
University Medical Centre, Department of Infectious Diseases, Ljubljana, Slovenia.
16
Sakarya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey.
17
Private Erzurum Sifa Hospital, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey.
18
Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
19
Hvidovre Hospital, Department of Infectious Diseases, Copenhagen, Denmark.
20
Poitiers University Hospital, Department of Infectious Diseases, Poitiers, France.
21
Assiut University Hospital, Department of Neurology and Psychiatry, Assiut, Egypt.
22
University of Catania, Section of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Catania, Italy.
23
Harran University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sanliurfa, Turkey.
24
Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
25
Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey.
26
Ankara University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
27
American University of Beirut Medical Center, Beirut, Lebanon.
28
Ataturk University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey.
29
Konya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey.
30
Cukurova University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey.
31
Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
32
Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey.
33
İzmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
34
Düzce University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Konuralp, Düzce, Turkey.
35
Bezmi Alem Vakif University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
36
Bezmi Alem Vakif University, School of Medicine, Department of Neurology, Istanbul, Turkey.
37
Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey.
38
Haydarpaşa Numune Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
39
Haydarpaşa Numune Training and Research Hospital, Department of Radiology, Istanbul, Turkey.
40
Department of Neurology, Baghdad Teaching Hospital, Baghdad, Iraq.
41
Katip Celebi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
42
Joseph Fourier University and University Hospital of Grenoble, Department of Infectious Diseases, Grenoble, France.
43
Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey


Authors:
Farghaly S1, Galal M2, Hasan AA3, Nafady A4.

Title:
Authors' Response To "Brain Natriuretic Peptide As A Predictor For Weaning Or Outcome?"

Author Info:
1
Chest Department, Faculty of Medicine, Assiut University Hospital, Egypt. Electronic address: shereen_hssn@yahoo.com.
2
Anesthesiology Department, South Egypt Cancer Institute, Assiut University Hospital, Egypt. Electronic address: dr_mostafagalal@yahoo.com.
3
Chest Department, Faculty of Medicine, Assiut University Hospital, Egypt. Electronic address: aabdelazeem@yahoo.com.
4
Clinical Pathology Department, Faculty of Medicine, Assiut University Hospital, Egypt. Electronic address: asmaa_nafadyhn@yahoo.com.


Title:
Authors' Response To "Difficult To Wean Patients"

Author Info:
1
Chest Department, Faculty of Medicine, Assiut University Hospital, Egypt. Electronic address: shereen_hssn@yahoo.com.
2
Anesthesiology Department, South Egypt cancer Institute, Assiut University Hospital, Egypt. Electronic address: dr_mostafagalal@yahoo.com.
3
Chest Department, Faculty of Medicine, Assiut University Hospital, Egypt. Electronic address: aabdelazeem@yahoo.com.
4
Clinical Pathology Department, Faculty of Medicine, Assiut University Hospital, Egypt. Electronic address: asmaa_nafadyhn@yahoo.com.


Title:
Brain Natriuretic Peptide As A Predictor Of Weaning From Mechanical Ventilation In Patients With Respiratory Illness.

Abstract:
BACKGROUND:
Cardiovascular dysfunction has been reported as an important mechanism of weaning failure. Brain natriuretic peptide (BNP) is a sensitive and specific marker for cardiovascular dysfunction.

OBJECTIVE:
To determine the value of BNP levels measured at initiation and end of a 2h spontaneous breathing trial (SBT) as a predictor of successful weaning of mechanical ventilation in patients with respiratory illness.

PATIENTS AND METHODS:
Thirty consecutive patients ready for weaning were prospectively enrolled in this cross-sectional analytic study over a 6-month period. All patients had been on spontaneous mode of weaning for at least 2h. Tidal volume, respiratory rate, rapid shallow breathing index (RSBI), minute ventilation and PaO2/FiO2 were observed at initiation of SBT. BNP was measured at the initiation (BNP1) and at the end of SBT (BNP2). Weaning failure is defined as either the failure of SBT or the need for reintubation within 48 h following extubation.

RESULTS:
Out of the 30 included patients, 14 (46.6%) patients had failed weaning. PaCO2 and BNP2 were significantly higher in the patients with failed weaning as compared to those with successful weaning (P = 0.025, P = 0.031 respectively). However, BNP1 levels were not statistically significant between the 2 groups (P = 0.722). On multiple regression analysis, BNP% (percent change in the BNP level during the 2-h SBT) was the only predictor of weaning success. As compared to other weaning parameters, BNP% ≤ 14.9 had the best sensitivity, specificity, positive and negative predictive value.

CONCLUSION:
Measuring the percentage change in the BNP level during a SBT may be a good predictor of weaning success from mechanical ventilation in respiratory patients.


Authors:
Fawi G1, Khedr EM2, El-Fetoh NA2, Thabit MN3, Abbass MA4, Zaki AF4.

Title:
Community-Based Epidemiological Study Of Epilepsy In The Qena Governorate In Upper Egypt, A Door-To-Door Survey.

Abstract:
BACKGROUND:
The aim of this study is to estimate the epidemiological features of epilepsy in a representative governorate of Upper Egypt.

MATERIALS AND METHODS:
A door-to-door community-based survey study was performed using a sample of 10 areas among various districts of the Qena governorate in Upper Egypt. Six were classified as rural areas, and the remaining four were classified as urban areas, with a total population of 8027 inhabitants. The population was screened using an epilepsy-screening questionnaire. Positive cases with suspected epilepsy were referred to Qena University Hospital to be further evaluated by a qualified neurologist and for further investigations, such as neuroimaging and electroencephalography.

RESULTS:
One hundred patients had a confirmed diagnosis of epilepsy, with a lifetime prevalence of 12.46/1000. The active prevalence rate of epilepsy was 2.12/1000, while the incidence rate was 123/100000. Seventy-six percent of the patients had idiopathic epilepsies, while 24% had symptomatic epilepsy. Generalized epilepsies were more common (70.1%) than partial epilepsy (26.3%), meanwhile epilepsies with mixed seizure types were 2.6%. The most common seizure type was generalized tonic clonic seizures (51.8%). The age-specific prevalence rate of epilepsy was much higher in infancy and early childhood (62.5 and 37.04/1000, respectively), which regressed steadily with age. Idiopathic epilepsies were significantly more common in urban areas than in rural areas (P=0.01), while symptomatic epilepsies were more common in rural areas than in urban areas (P<0.005).

CONCLUSION:
Upper Egypt is characterized by a relatively high incidence and prevalence of epilepsy and epilepsy-related medical service, and more cultural education should be directed to those areas in Egypt.

Author Info:
1
Department of Neurology, Sohag University Hospital, Sohag, Egypt.
2
Department of Neurology, Assiut University Hospital, Assiut, Egypt.
3
Department of Neurology, Sohag University Hospital, Sohag, Egypt. Electronic address: Mohamed_hamdon@med.sohag.edu.eg.
4
Department of Neurology, Qena University Hospital, Qena, Egypt.


Authors:
Forlini M1, Soliman W2, Bratu A3, Rossini P4, Cavallini GM5, Forlini C6.

Title:
Long-Term Follow-Up Of Retropupillary Iris-Claw Intraocular Lens Implantation: A Retrospective Analysis.

Abstract:
BACKGROUND:
The ideal intraocular lens in cases of aphakia without capsular support is debated. Choices include anterior chamber lenses, iris- or scleral-sutured lenses, and iris-claw lenses. Our aim was to report our long-term evaluation of the use of retropupillary implantation of the Artisan iris-claw intraocular lens (RPICIOL) in several aphakic conditions without capsular support.

METHODS:
A retrospective analysis of consecutive 320 eyes of 320 patients (222 males and 98 females) without capsular support in which we performed RPICIOL implantation in post-traumatic aphakia (141 eyes, group 1), post-cataract surgery aphakia (122 eyes, group 2), and in cases in which penetrating keratoplasty was associated with vitrectomy (57 eyes, group 3). Either anterior or posterior vitrectomy procedures were performed with 20-, 23-, or 25-gauge techniques for different associated anterior or posterior segment indications. We reviewed the refractive outcome, anatomical outcome, long-term stability of the implants, and possible long-term complications.

RESULTS:
The mean patient age was 59.7 years (range, 16-84 years) in group 1; 60.1 years (range, 14-76 years) in group 2; and 65.8 years (range, 25-71.5 years) in group 3. The mean follow-up time was 5.3 years (range, 1 month to 8 years). At the end of the follow-up period, the mean post-operative best-corrected LogMAR visual acuity was 0.6 (range, perception of light to 0.3) in group 1; 0.3 (range, 0.5-0.1) in group 2; and 0.6 (range, hand movement to 0.2) in group 3. Disenclavation of RPICIOLs occurred in three cases because of slippage of one of the iris-claw haptics and spontaneous complete posterior dislocation occurred in one case. One case presented with retinal detachment, and no cases of uveitis were observed. Eight cases complained of chronic dull pain, and severe iridodonesis was seen in five cases. One case of post-operative macular edema was observed without post-operative increase in the mean intraocular pressure. There was no statistically different change in the endothelial cell density (cells/mm(2)) at the end of the follow-up period.

CONCLUSIONS:
RPICIOL for secondary implantations is a valid alternative strategy to scleral-fixated or angle-supported IOL implantation.

Author Info:
1
Department of Ophthalmology, Policlinico di Modena, Modena, Italy. matteoforlini@gmail.com.
2
Department of Ophthalmology, Assiut University Hospitals, Assiut, Egypt. waelsoliman73@yahoo.com.
3
Department of Ophthalmology, Hospital S. Maria delle Croci, Ravenna, Italy. bratu.adriana@yahoo.com.
4
Department of Ophthalmology, Hospital S. Maria delle Croci, Ravenna, Italy. paolorossini@hotmail.com.
5
Department of Ophthalmology, Policlinico di Modena, Modena, Italy. gianmaria.cavallini@unimore.it.


Authors:
Franjoine SE1, Bedaiwy MA2, AbdelHafez FF3, Geng C4, Liu JH1.

Title:
Clinical Effectiveness of Modified Laparoscopic Fimbrioplasty for the Treatment of Minimal Endometriosis and Unexplained Infertility.

Abstract:
OBJECTIVE:
To study the reproductive outcomes of modified laparoscopic fimbrioplasty (MLF), a surgical technique designed to increase the working surface area of the fimbriated end of the fallopian tube. We postulated that an improvement in fimbrial function through MLF will improve reproductive outcomes.

DESIGN:
Retrospective cohort study.

SETTING:
Academic tertiary-care medical center.

PATIENTS:
Women with minimal endometriosis or unexplained infertility, who underwent MLF during diagnostic laparoscopy (n = 50) or diagnostic laparoscopy alone (n = 87).

INTERVENTION:
MLF involved gentle, circumferential dilatation of the fimbria and lysis of fimbrial adhesions bridging the fimbrial folds.

MAIN OUTCOME MEASURES:
The primary outcome was pregnancy rate and the secondary outcome was time to pregnancy.

RESULTS:
The pregnancy rate for the MLF group was 40.0%, compared to 28.7% for the control group. The average time to pregnancy for the MLF group was 13 weeks, compared to 18 weeks for the control group. The pregnancy rate in the MLF group was significantly higher for patients ≤35 ys (51.5% versus 28.8%), but not for those >35 ys (17.6% versus 28.6%).

CONCLUSION:
MLF was associated with a significant increase in pregnancy rate for patients ≤35 ys.

Author Info:
1
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, MacDonald Women's Hospital, Cleveland, OH 44106, USA.
2
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, MacDonald Women's Hospital, Cleveland, OH 44106, USA ; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, The University of British Columbia, D415A, 4500 Oak Street, Vancouver, BC, Canada V6H 3N1 ; Women's Health University Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.
3
Women's Health University Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.
4
Department of Biostatistics and Epidemiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.


Title:
The "I-Pouch": Results Of A New Ileal Neobladder Technique.

Abstract:
OBJECTIVE:
The aim of this study was to investigate perioperative, oncological and functional outcomes of the "I-Pouch" neobladder.

MATERIALS AND METHODS:
From 2002 to 2011, 97 patients (72 men, 25 women, median age 65, range 42-84 years) underwent radical cystectomy with I-Pouch neobladder reconstruction. Complications were graded according to the Clavien-Dindo classification. Oncological and functional outcomes were assessed. The median oncological and functional follow-up was 41 months (range 3-107 months) and 18 months (3-111 months), respectively.

RESULTS:
In the total cohort, the 5 year cancer-specific survival was 67.9%. The major 30 and 90 day complication rates were 14.4% and 17.5%, respectively. Open reimplantation for ureterointestinal stricture was necessary in two (2.1%). Of the 95 functionally evaluable patients postoperatively, 93 urinated spontaneously (97.9%) and two patients (2.1%) required clean intermittent catheterization to empty their neobladder. The median postvoid residual urine volume (PVR) was 0 ml (range 0-200 ml). One patient had postoperative reflux (1%), as evidenced by voiding cystography. The median number of urinary tract infections per year was 0 (range 0-2) and showed no association with increased PVR (p = 0.18).

CONCLUSIONS:
The perioperative, oncological and functional outcomes of the I-Pouch are comparable to those of other types of ileal neobladder. An advantage of the I-Pouch is that the implantation of the ureters lies on the neobladder floor, which facilitates later instrumentation of the upper tract.

Author Info:
1
a 1 Department of Urology, University Hospital Tübingen , Tübingen, Germany.
2
b 2 Department of Urology, Assiut University Hospital , Assiut, Egypt.


Title:
Antiepileptic Drugs Influences On Body Weight In People With Epilepsy.

Abstract:
Data from clinical trials, retrospective and cross-sectional studies have quantified the metabolic changes associated with long-term use of antiepileptic drugs (AEDs). AEDs can be associated with weight gain or weight loss, although most are weight neutral. Weight gain is not only a cosmetic problem but also a risk for obesity-related vascular disorders. Weight loss may compromise growth in children/adolescents. This review discusses the possible contribution of peripheral and central hormones/neuropeptides (as leptin, insulin, adiponectin, neuropeptide-Y, ghrelin and galanin) and pathways that influence energy balance in the pathogenesis of weight changes with AEDs. As AEDs may influence weight, physicians have to properly select and characterize the suitable AED as an initial step or modify the existing AED if it compromises patient's health.

Author Info:
1
Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, Floor # 4, Room # 4, P.O.Box 71516, Assiut, Egypt


Title:
Differential Diagnosis Of A Vanishing Brain Space Occupying Lesion In A Child.

Abstract:
We describe clinical, diagnostic features and follow up of a patient with a vanishing brain lesion. A 14-year-old child admitted to the department of Neurology at September 2009 with a history of subacute onset of fever, anorexia, vomiting, blurring of vision and right hemiparesis since one month. Magnetic resonance imaging (MRI) of the brain revealed presence of intra-axial large mass (25 mm × 19 mm) in the left temporal lobe and the brainstem which showed hypointense signal in T1W and hyperintense signals in T2W and fluid attenuated inversion recovery (FLAIR) images and homogenously enhanced with gadolinium (Gd). It was surrounded by vasogenic edema with mass effect. Intravenous antibiotics, mannitol (2 g/12 h per 2 d) and dexamethasone (8 mg/12 h) were given to relief manifestations of increased intracranial pressure. Whole craniospinal radiotherapy (brain = 4000 CGy/20 settings per 4 wk; Spinal = 2600/13 settings per 3 wk) was given based on the high suspicion of neoplastic lesion (lymphoma or glioma). Marked clinical improvement (up to complete recovery) occurred within 15 d. Tapering of the steroid dose was done over the next 4 mo. Follow up with MRI after 3 mo showed small lesion in the left antero-medial temporal region with hypointense signal in T1W and hyperintense signals in T2W and FLAIR images but did not enhance with Gd. At August 2012, the patient developed recurrent generalized epilepsy. His electroencephalography showed the presence of left temporal focus of epileptic activity. MRI showed the same lesion as described in the follow up. The diffusion weighted images were normal. The seizures frequency was decreased with carbamazepine therapy (300 mg/12 h). At October 2014, single voxel proton (1H) MR spectroscopy (MRS) showed reduced N-acetyl-aspartate (NAA)/creatine (Cr), choline (Cho)/Cr, NAA/Cho ratios consistent with absence of a neoplasm and highly suggested presence of gliosis. A solitary brain mass in a child poses a considerable diagnostic difficulty. MRS provided valuable diagnostic differentiation between tumor and pseudotumor lesions.

Author Info:
1
Sherifa A Hamed, Department of Neurology and Psychiatry, Assiut University Hospital, Assiut 71516, Egypt.
Abstract


Authors:
Hamed SA1, Hermann BP2, Moussa EM3, Youssef AH4, Rageh TA4, Elserogy YE4, NasrEldin E5.

Title:
Evaluation Of Penile Vascular Status In Men With Epilepsy With Erectile Dysfunction.

Abstract:
PURPOSE:
Erectile dysfunction (ED) is common in males with epilepsy, likely of multifactorial etiology, including possible systemic vascular comorbidities and medication effects. Here we examined male patients for the possibility of a vasculogenic element of ED.

METHODS:
Research participants included 47 men with epilepsy (mean age=30.98 years; duration of illness=13.98 years) and 25 healthy matched men (mean age=30.36). Erectile function was assessed using the International Index of Erectile Function Questionnaire (IIEF-5). Penile blood flow was assessed using Duplex Ultrasonography (PDU) after intracavernous alprostadil injection. Penile peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were the functional parameters analyzed. Carotid artery intima media thickness (CA-IMT) was also measured.

RESULTS:
Thirteen of the 47 men with epilepsy (23.40% versus 0% for controls) reported ED, and of these patients, 11 (84.62%) had abnormal PDU [PSV=28.23 ± 6.1cm/s, P=0.0001; EDV=2.22 ± 5.71 cm/s, P=0.004; RI=0.89 ± 0.22, P=0.071] suggesting vasculogic ED. Penile arterial insufficiency was identified in 5 (45.45%), while 6 (54.54%) had mixed arterial insufficiency and venous leak. Compared to patients with high PSV, patients with low PSV had lower IIED-5 scores, higher EDV, lower RI, higher diastolic blood pressure and higher CA-IMT values. There were no differences in depression, anxiety or concentrations of sex hormones. Significant correlations were evident between PDU variables and duration of illness, depression and anxiety scores and CA-IMT values. In multivariate analysis, the association between PDU parameters and CA-IMT values remained significant even after adjustment for other confounding variables.

CONCLUSIONS:
Vasculogenic ED is frequent with epilepsy and its relationship to systemic atherosclerosis cannot be excluded.

Author Info:
1
Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt. Electronic address: hamed_sherifa@yahoo.com.
2
Department of Neurology, University of Wisconsin, USA.
3
Department of Radiology, Assiut University Hospital, Assiut, Egypt.
4
Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
5
Department of Clinical Pathology, Assiut University Hospital, Assiut, Egypt.


Authors:
Hamed SA1, Moussa EM2, Tohamy AM3, Mohamed KO3, Mohamad ME4, Sherif TM5, Abdellah MM6.

Title:
Seminal Fluid Analysis And Testicular Volume In Adults With Epilepsy Receiving Valproate.

Abstract:
Epilepsy and its medications adversely affect reproductive and sexual functions and fertility. This study aimed to assess sperm parameters and testicular volume in men with epilepsy on valproate (VPA). Included were 55 patients with idiopathic epilepsy with a mean age of 31.86 ± standard deviation (SD) 6.55 years, mean illness duration of 12.50 ± SD 5.10 years, and a mean treatment time of 9.55 ± SD 0.85 years. Sex hormone profile, semen analysis, testicular volume and total seminal plasma carnitine were determined. Compared to controls, patients had lower levels of free testosterone (p<0.01), sperm concentration (p<0.0001) and count (p<0.0001), carnitine (p<0.01), and testicular volume (p<0.01), and higher rates of immotile sperm (p<0.001) and abnormal forms (p<0.0001). Significant correlations were identified between sperm count, motility, immotile sperm, abnormal forms, testicular volume, carnitine levels and duration of illness, duration of treatment with VPA and VPA dose. Multivariable analysis demonstrated that duration of treatment with VPA, sperm count, motility and abnormal forms were significantly associated with seminal plasma carnitine. Long-term VPA treatment is adversely associated with reduced sperm count and motility, increased abnormal sperm count and reduced testicular volume. This may contribute to reduced fertility.

Author Info:
1
Department of Neurology and Psychiatry, Floor 7, Room 4, Hospital of Neurology and Psychiatry, Assiut University Hospital, P.O. Box 71516, Assiut, Egypt. Electronic address: hamed_sherifa@yahoo.com.
2
Department of Radiology, Assiut University Hospital, Assiut, Egypt.
3
Department of Neurology and Psychiatry, Floor 7, Room 4, Hospital of Neurology and Psychiatry, Assiut University Hospital, P.O. Box 71516, Assiut, Egypt.
4
Department of Andrology, Assiut University Hospital, Assiut, Egypt.
5
Department of Clinical Pathology, Assiut University Hospital, Assiut, Egypt.
6
Department of Pharmacology, Assiut University, Assiut, Egypt.


Title:
The Effect Of Antiepileptic Drugs On Thyroid Hormonal Function: Causes And Implications.

Abstract:
Epilepsy is a chronic disease and its treatment is lifelong in one-third of patients. Data from cross-sectional and prospective studies have reviewed the influence of antiepileptic drugs (AEDs) on thyroid hormones. Thyroid abnormalities were reported in one-third of the patients on AEDs. Subclinical hypothyroidism, reduced thyroxine, triiodothyronine, free thyroxine, free triiodothyronine and thyroid binding globulin concentrations were reported with phenobarbital, phenytoin, carbamazepine, valproate and oxcarbazepine, but not with lamotrigine, levitracetam, tiagabine and vigabatrine. All reported patients were clinically euthyroid and hormonal changes were reversible after AED withdrawal. The mechanisms for thyroid dysfunction with AEDs include enhanced metabolism and/or altered protein binding or interference of hypothalamic-pituitary-thyroid axis function. This review focuses on the evidence, mechanisms of thyroid abnormalities with AEDs and their clinical implications. The associations between subclinical hypothyroidism and metabolic risks due to AEDs are also discussed.

Author Info:
1
a Department of Neurology and Psychiatry, Assiut University Hospital , Floor 7, Room 4, P.O.Box 71516, Assiut, Egypt.


Title:
Variant Of Multiple Sclerosis With Dementia And Tumefactive Demyelinating Brain Lesions.

Abstract:
We describe an unusual clinical and diagnostic feature of a patient with multiple sclerosis (MS). A 25-year-old woman was admitted to the Neurology department (December 2009) with one month history of rapid cognitive deterioration. She had poor cognition, dysphasia, reduction in visual acuity and temporal pallor of the optic discs. She had prolonged latencies of P100 component of visual evoked potentials (VEPs). Magnetic resonance imaging (MRI)-brain showed multifocal large (≥ 3 cm) white-matter hypointense lesions in T1W and hyperintense in T2W and fluid-attenuated inversion recovery images and patchy enhancement. A diagnosis of tumefactive MS was given. She received two consecutive 5-d courses of 1 g daily intravenous methylprednisolone for 2 mo and oral prednisolone in dose of 80 mg twice/daily in between. At the 3(rd) month, Mini Mental State Examination and VEPs returned to normal but not the MRI. Patient continued oral steroids after hospital discharge (March 2010) for 9 mo with significant MRI improvement after which tapering of steroids started for a year. The patient refused immunomodulation therapy due to her low socioeconomic status. Neither clinical relapse nor new MRI lesions were observed throughout the next 4 years. In spite of the aggressive course of tumefactive MS variant, good prognosis may be seen in some patients.

Author Info:
1
Sherifa A Hamed, Department of Neurology and Psychiatry, Hospital of Neurology and Psychiatry, Assiut University Hospital, Assiut 71516, Egypt.


Authors:
Hareedy MS1,2, El Desoky ES1, Woillard JB2,3,4, Thabet RH1, Ali AM5, Marquet P2,3,4, Picard N2,3,5.

Title:
Genetic Variants In 6-Mercaptopurine Pathway As Potential Factors Of Hematological Toxicity In Acute Lymphoblastic Leukemia Patients.

Abstract:
AIM:
We investigated the associations between variants in genes coding for enzymes and transporters related to the 6-mercaptopurine pathway and clinical outcomes in pediatric patients with acute lymphoblastic leukemia.

MATERIALS & METHODS:
Statistical association between gender, age and genotypes of selected SNPs, and the risks of hematological toxicity and relapse were investigated using a Cox proportional hazard model in 70 acute lymphoblastic leukemia patients from upper Egypt.

RESULTS:
We found significant associations between ITPA, IMPDH1, SLC29A1, SLC28A2, SLC28A3 and ABCC4 SNPs and one or more of the hematological toxicity manifestations (neutropenia, agranulocytosis and leukopenia); age was significantly related to relapse.

CONCLUSION:
Genetic polymorphisms in enzymes and transporters involved in the 6-mercaptopurine pathway should be considered during its use to avoid hematological toxicity.

Author Info:
1
Department of Pharmacology, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt.
2
Inserm, UMR-850, Limoges, France.
3
Department of Pharmacology, Toxicology & Pharmacovigilance, CHU Limoges, Limoges, France.
4
Faculty of Medicine, Laboratory of Medical Pharmacology, University of Limoges, Limoges, France.
5
South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Title:
Changes In Platelet, Coagulation, And Fibrinolytic Activities In Mitral Stenosis After Percutaneous Mitral Valvotomy: Role Of Hemodynamic Changes And Systemic Inflammation.

Abstract:
Markers of platelet activity (P-selectin), fibrinolysis (d-dimer), thrombin activity (prothrombin fragments 1, 2 [PF1,2] and thrombin-antithrombin III complex [TAT]), and inflammation (interleukin 1β [IL-1β]) were measured in 65 patients with mitral stenosis (MS) before and 2 weeks after percutaneous mitral valvotomy (PMV) and in 23 controls. All markers were significantly higher than the control and significantly decreased after PMV. P-selectin change correlated with the changes in left atrial diameter (LAD), pulmonary artery systolic pressure (PASP), and IL-1β. d-Dimer change had similar correlations, LAD, PASP, and IL-1β. The PF1,2 change correlated with the change in IL-1β. The TAT change correlated with the changes in LAD. The IL-1β change correlated with the changes in PASP. In conclusion, MS is associated with heightened inflammatory, platelet, thrombin, and fibrinolytic activities that decrease after PMV. Altered hemodynamics and reduced inflammatory activity might have a possible role in these changes.

Author Info:
1
Department of Cardiovascular Medicine, Assiut University Hospitals, Assiut, Egypt.
2
Department of Clinical Pathology, Assiut University Hospitals, Assiut, Egypt eman_mosaad@hotmail.com.


Authors:
Hasanain AF1, Zayed AA2, Mahdy RE3, Nafee AM4, Attia RA5, Mohamed AO6.

Title:
Hookworm Infection Among Patients With Pulmonary Tuberculosis: Impact Of Co-Infection On The Therapeutic Failure Of Pulmonary Tuberculosis.

Abstract:
OBJECTIVE/BACKGROUND:
The aim of this study is to determine the rate of hookworm infection among patients with pulmonary tuberculosis (TB) and to find out if there is a relation between hookworm infection and the therapeutic failure of pulmonary TB.

METHODS:
We carried out a prospective, hospital-based study. The study included 231 naïve patients with pulmonary TB, consecutively. Patients were evaluated at the 4th month of therapy for persistence of Mycobacterium tuberculosis infection. All patients had clinical evaluation, laboratory investigations (including sputum culture and stool microscopic examination), and imaging studies (abdominal ultrasonography and chest radiography).

RESULTS:
The study population mean age was 42.7±13.9 years old with 26.8% of them 40 years old or more. Out of 231 patients, 133 (57.6%) were men. Therapeutic failure rate of pulmonary TB was 29.4%. Hookworm infection was diagnosed among 16.5% of patients and 27.7% had diabetes mellitus (DM). Using multivariate analysis, it was found that age of 40 years or more (odds ratio [OR] 8.4; 95% confidence interval [CI] 1.7-41.3; p=.009), hookworm infection (OR 7.6; 95% CI 1.2-49.9; p=.034), and DM (OR 5.9; 1.2-28; p=.027) were independently associated with therapeutic failure of pulmonary TB among the study population with pulmonary TB.

CONCLUSION:
In conclusion, the rate of therapeutic failure of pulmonary TB is high. Besides older age and DM, hookworm infection can reduce the therapeutic response of pulmonary TB. Screening for and control of DM and hookworm infection among patients with pulmonary TB may improve their therapeutic response.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Chest Diseases, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt.
6
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: a.fh@outlook.com.


Title:
Creatinine Modified Child-Turcotte-Pugh And Integrated Model Of End-Stage Liver Disease Scores As Predictors Of Spontaneous Bacterial Peritonitis-Related In-Hospital Mortality: Applicable Or Not.

Abstract:
BACKGROUND AND AIMS:
Despite intensive management, spontaneous bacterial peritonitis (SBP) is associated with poor prognosis especially in hospitalized patients. Therefore, the aim of this study was to determine prognostic factors for SBP-related in-hospital mortality, and to evaluate the predictive power of Child-Pugh (CP), model of end-stage liver disease (MELD), creatinine modified Child-Turcotte-Pugh (CrCTP), and integrated MELD (iMELD) for identifying the best score to predict mortality.

METHODS:
Predictors of SBP-related in-hospital mortality were assessed using regression analysis over 100 cirrhotic patients. Predictive abilities of CP, MELD, CrCTP, and iMELD were compared using the area under receiver operating characteristic curve (AUC).

RESULTS:
SBP-related in-hospital mortality was 22%. Age, serum creatinine, bilirubin, sodium, CrCTP, MELD, and iMELD were associated with mortality. Using AUC, CrCTP, and iMELD was significantly better than CP and MELD in predicting in-hospital mortality, where iMELD had the highest AUC (0.862). The cut-off with the best ability to predict in-hospital mortality was 43.5 for iMELD.

CONCLUSION:
Age, serum creatinine, bilirubin, and sodium were associated with SBP-related in-hospital mortality. The incorporation of these variables into CP and MELD significantly improves their predictive ability. iMELD followed by CrCTP provided useful prognostic information for critically ill patients with SBP.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Hassan MM1, Abdel-Wahab R2, Kaseb A3, Shalaby A3, Phan AT4, El-Serag HB5, Hawk E6, Morris J7, Singh Raghav KP3, Lee JS8, Vauthey JN9, Bortus G3, Torres HA10, Amos CI11, Wolff RA3, Li D3.

Title:
Obesity Early in Adulthood Increases Risk but Does Not Affect Outcomes of Hepatocellular Carcinoma.

Abstract:
BACKGROUND & AIMS:
Despite the significant association between obesity and several cancers, it has been difficult to establish an association between obesity and hepatocellular carcinoma (HCC). Patients with HCC often have ascites, making it a challenge to determine body mass index (BMI) accurately, and many factors contribute to the development of HCC. We performed a case-control study to investigate whether obesity early in adulthood affects risk, age of onset, or outcomes of patients with HCC.

METHODS:
We interviewed 622 patients newly diagnosed with HCC from January 2004 through December 2013, along with 660 healthy controls (frequency-matched by age and sex) to determine weights, heights, and body sizes (self-reported) at various ages before HCC development or enrollment as controls. Multivariable logistic and Cox regression analyses were performed to determine the independent effects of early obesity on risk for HCC and patient outcomes, respectively. BMI was calculated, and patients with a BMI of 30 kg/m(2) or greater were considered obese.

RESULTS:
Obesity in early adulthood (age, mid-20s to mid-40s) is a significant risk factor for HCC. The estimated odds ratios were 2.6 (95% confidence interval [CI], 1.4-4.4), 2.3 (95% CI, 1.2-4.4), and 3.6 (95% CI, 1.5-8.9) for the entire population, for men, and for women, respectively. Each unit increase in BMI at early adulthood was associated with a 3.89-month decrease in age at HCC diagnosis (P < .001). Moreover, there was a synergistic interaction between obesity and hepatitis virus infection. However, we found no effect of obesity on the overall survival of patients with HCC.

CONCLUSIONS:
Early adulthood obesity is associated with an increased risk of developing HCC at a young age in the absence of major HCC risk factors, with no effect on outcomes of patients with HCC.

Author Info:
1
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: mhassan@mdanderson.org.
2
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt.
3
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
4
Houston Methodist Hospital, Houston, Texas.
5
Baylor College of Medicine, Houston, Texas.
6
Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston, Texas.
7
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
8
Department of System Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
9
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
10
Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, Texas.
11
Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.


Authors:
Hassan MM1, Abdel-Wahab R2, Li D1, Kaseb AO1.

Abstract:
Comment on
Central obesity early in adulthood may affect outcomes of hepatocellular carcinoma. [Gastroenterology. 2015]
Obesity Early in Adulthood Increases Risk but Does Not Affect Outcomes of Hepatocellular Carcinoma. [Gastroenterology. 2015]

Author Info:
1
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
2
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas and Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt.


Authors:
Hassanein M1, Abdelhamid M2, Ibrahim B3, Elshazly A4, Aboleineen MW5, Sobhy H6, Nasr G7, Elmesseiry F8, Abdelmoniem A9, Ashmawy M10, Farag N11, Youssef A12, Elbahry A13, Elrakshy Y14, Sobhy M15, Khairy Abdel Dayem TM16, Ebeid H17, Reda A18, Boshra H19, Saleh A20, Maggioni AP21.

Title:
Clinical Characteristics And Management Of Hospitalized And Ambulatory Patients With Heart Failure-Results From ESC Heart Failure Long-Term Registry-Egyptian Cohort.

Abstract:
AIMS:
Our aim is to describe the clinical characteristics and management of patients hospitalized with acute heart failure (HHF) and ambulatory patients with chronic heart failure (CHF) in Egypt and compare them with heart failure (HF) patients from other countries in the European Society of Cardiology-Heart Failure (ESC-HF) registry.

METHODS AND RESULTS:
The ESC-HF Long-term Registry is a prospective, multi-centre, observational study of patients presenting to cardiology centres in member countries of the ESC. From April 2011 to February 2014, a total of 2145 patients with HF were recruited from 20 centres all over Egypt. Of these patients, 1475 (68.8%) were hospitalized with HHF, while 670 (31.2%) had CHF. Less than one-third (32.1%) of all patients were females. HHF patients {median age of 61 years [interquartile range (IQR), 53-69]} were older than CHF patients [median age of 57 years (IQR,46-64)]; P < 0.0001. They had more diabetes mellitus (45.4% vs. 31.8%; P < 0.0001). Left ventricular ejection fraction > 45% was present in 22% of HHF vs. 25.6% of CHF (P = 0.17). Atrial fibrillation existed in about a quarter of all patients (24.5%). Ischaemic heart disease was the main cause of HF in Egyptian patients. All-cause in-hospital mortality was 5%. Egyptian patients presented at a much earlier age than in other regions in the registry. They had more diabetes mellitus. Atrial fibrillation prevalence was remarkably lower. Other co-morbidities (renal dysfunction, stroke, and peripheral arterial disease) occurred less frequently.

CONCLUSION:
Patients in the Egyptian cohort exhibited distinct features from HF patients in other countries in the ESC-HF Long-term Registry.

Author Info:
1
Alexandria University, Alexandria, Egypt.
2
Cairo University, Cairo, Egypt.
3
National Heart Institute, Cairo, Egypt.
4
Gamal Abdel Nasser Insurance Hospital, Alexandria, Egypt.
5
Zagazig University, Zagazig, Egypt.
6
Menshawy General Hospital, Tanta, Egypt.
7
Health Insurance Hospital, Ismailya, Egypt.
8
Ras Eltin General Hospital, Alexandria, Egypt.
9
Benha University, Benha, Egypt.
10
Tanta University, Tanta, Egypt.
11
Dar Al Fouad, Giza, Egypt.
12
Assiut University, Assiut, Egypt.
13
Port Fouad General Hospital, Port Fouad, Egypt.
14
Alexandria University Students' Hospital, Alexandria, Egypt.
15
International Cardiac Centre, Alexandria, Egypt.
16
Ain Shams University, Cairo, Egypt.
17
Damanhour General Hospital, Damanhour, Egypt.
18
Menoufeya University, Shebin Elkoum, Egypt.
19
Beni Suef University, Beni Suef, Egypt.
20
Sednawy Hospital, Cairo, Egypt.
21
EORP, Sophia Antipolis, France.


Authors:
Hassany SM1, Moustafa EF1, Taher ME1, Abdeltwab AA1, Blum HE1.

Title:
Screening For Hepatocellular Carcinoma By Egyptian Physicians.

Abstract:
AIM:
To assess the practice of Egyptian physicians in screening patients for hepatocellular carcinoma (HCC).

METHODS:
The study included 154 physicians from all over Egypt caring for patients at risk for HCC. The study was based on a questionnaire with 20 items. Each questionnaire consisted of two parts: (1) personal information regarding the physician (name, age, specialty and type of health care setting); and (2) professional experience in the care of patients at risk for HCC development (screening, knowledge about the cause and natural course of liver diseases and HCC risk).

RESULTS:
Sixty-eight percent of doctors with an MD degree, 48% of doctors with a master degree or a diploma and 40% of doctors with a Bachelor of Medicine, Bachelor of Surgery certificate considered the hepatitis C virus (HCV) genotype as risk factor for HCC development (P < 0.05). Ninety percent of physicians specialized in tropical medicine, internal medicine or gastroenterology and 67% of physicians in other specialties advise patients to undergo screening for HCV and hepatitis B virus infection as well as liver cirrhosis (P < 0.05). Eighty-six percent of doctors in University Hospitals and 69% of Ministry of Health (MOH) doctors consider HCV infection as the leading cause of HCC in Egypt (P < 0.05). Seventy-two percent of doctors with an MD degree, 55% of doctors with a master degree or a diploma, 56% of doctors with an MBBCH certificate, 74% of doctors in University Hospitals and 46% of MOH hospital doctors consider abdominal ultrasonography as the most important investigation in HCC screening (P < 0.05). Sixty-five percent of physicians in tropical medicine, internal medicine or gastroenterology and 37% of physicians in other specialties recommend as HCC screening interval of 3 mo (P < 0.05). Seventy-one percent of doctors with an MD degree, 50% of doctors with a master degree or diploma and 60% of doctors with an MBBCH certificate follow the same recommendation.

CONCLUSION:
In Egypt, physicians specialized in tropical medicine, internal medicine or gastroenterology with an MD degree and working in a University Hospital are best informed about HCC.

Author Info:
1
Sahar M Hassany, Ehab F Abdou Moustafa, Mohamed El Taher, Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut 71526, Egypt.


Authors:
Hetta HF1,2, Mekky MA3, Khalil NK4, Mohamed WA2, El-Feky MA2, Ahmed SH2, Daef EA2, Nassar MI5, Medhat A3, Sherman KE1, Shata MT1.

Title:
Association Of Colonic Regulatory T Cells With Hepatitis C Virus Pathogenesis And Liver Pathology.

Abstract:
BACKGROUND AND AIM:
Forkhead box protein P3 (FoxP3)(+) regulatory T (Treg ) cells play a fundamental role in maintaining the balance between the tissue-damaging and protective immune response to chronic hepatitis C (CHC) infection. Herein, we investigated the frequency of Treg cells in the colon and their potential relationship to the various CHC outcomes and hepatic histopathology.

METHODS:
Colonic biopsies were collected from three groups with CHC: treatment naïve (TN; n = 20), non-responders (NR; n = 20), sustained virologic response (SVR; n = 20), and a fourth healthy control group (n = 10). The plasma viral loads and cytokines levels were determined by quantitative real-time polymerase chain reaction, and ELISA, respectively. Liver biopsies were examined to assess inflammatory score and fibrosis stage. Colonic Treg frequency was estimated by immunohistochemistry using confocal microscopy.

RESULTS:
A significant increase in the frequency of colonic Treg was found in TN, and NR groups compared with the control and SVR group. The frequency of colonic Treg , plasma interleukin (IL)-10 and IL-4 levels were significantly positively correlated with viral load and negatively correlated with METAVIR inflammatory score, and fibrosis stages.

CONCLUSION:
Colonic Treg cells are negatively correlated with liver inflammation and hepatitis C virus (HCV) viral load, which suggests a strong linkage between gut-derived Treg cell populations and HCV infection.

Author Info:
1
Department of Internal Medicine, Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio, USA.
2
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Assiut Liver Institute for Treatment of Hepatitis C, Assiut, Egypt.
5
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Hussein A1, Elderwy AA2, Askar E3, Afifi N4, Askar G5, Metwalley KA6, Alsaeid M7.

Title:
Impact Of Common Functional Polymorphisms In Renin Angiotensin System Genes On The Risk Of Renal Parenchymal Scarring Following Childhood Urinary Tract Infection.

Abstract:
BACKGROUND:
Pathogenesis of renal parenchymal scarring (RPS) after acute pyelonephritis (APN) is unclear. The risk of RPS varies markedly among individuals, suggesting a genetic role.

OBJECTIVE:
To investigate a possible role of common polymorphisms in renin angiotensin system genes in APN-associated RPS in children.

PATIENTS AND METHODS:
This study included 104 APN children and 300 controls. APN was diagnosed by urine culture and typical findings on 99Tc-DMSA scans. Voiding cystourethrogram tested the presence of vesicoureteral reflux (VUR). Follow-up DMSA scans were performed 4-6 months later to identify new RPS. Angiotensin converting enzyme gene I/D, angiotensin II receptor type-1 A1166C and angiotensinogen M235T polymorphisms were genotyped.

RESULTS:
New RPS developed in 44.2% (46/104) of children with APN. VUR was diagnosed in 35.6% (37/104) of APN cases. RPS developed in 73% of cases of VUR. The D allele of ACE gene I/D polymorphism was significantly more common in APN cases with RPS (73.91%) than non-RPS (58.6%) and controls (54.5%) (p = 0.021, p = 0.002, respectively). The AGTR-1 A1166C A allele was significantly more common in VUR than the non-reflux children (91.9% versus 76.1%; p = 0.005). VUR, in contrast to the D allele (OR 6.1, 95% CI 0.878-19.7; p = 0.05), was an independent risk factor for RPS.

DISCUSSION:
ACE gene D allele is associated with a twofold increase in RPS risk, which could be a result of a functional effect to increase tissue levels and activity of ACE during APN. However, D allele failed to qualify as an independent risk and its RPS association could be dependent on other co-factors, such as TGFβ1 activation, or the D-allele might link with recently discovered functional polymorphisms at the 5' end of the ACE gene. Although VUR is an independent risk for RPS, it is not clear whether this is due to exposure of the kidneys to infected urine, or VUR-associated dysplasia. In contrast with published literature, we noted higher rates of RPS and high-grade VUR, suggesting a more aggressive VUR course or local unawareness of APN. Our study has its limitations; the small number of VUR children, and the clinical and ethical difficulties of testing VCUG and DMSA in controls.

CONCLUSIONS:
ACE gene D allele is associated with, but cannot independently predict, RPS in children. VUR is an independent risk for post-pyelonephritic scarring. AGTR-1 1166A/C polymorphism is associated with occurrence, but not progression, of VUR.

Author Info:
1
Children Hospital, Assiut University, Egypt; Division of Pediatric Nephrology, Center for Children and Adolescent Medicine, University of Heidelberg, Germany. Electronic address: almontaser.bella@gmail.com.
2
Pediatric Urology, Assiut University Hospitals, Egypt. Electronic address: ahmad.elderwy@gmail.com.
3
Children Hospital, Assiut University, Egypt. Electronic address: emanaskar@hotmail.com.
4
Department of Microbiology and Immunology, Assiut University, Egypt.
5
Children Hospital, Assiut University, Egypt. Electronic address: gamal.askar@hotmail.com.
6
Children Hospital, Assiut University, Egypt. Electronic address: kotb72@gmail.com.
7
Children Hospital, Assiut University, Egypt. Electronic address: moustafa13@yahoo.com.


Title:
Structure Of The Secretory Cells Of Male And Female Adult Guinea Pigs Harderian Gland.

Abstract:
The main objective of this study was to investigate the structure of the Harderian gland (HG) in male and female guinea pigs. A total number of sixteen animals of 4 months age were divided according to sex into two groups; eight animals each. Unfixed glands were weighed and their length and width were measured. Specimens from fixed glands were processed and examined using light, transmission electron microscopy and immunohistochemistry for the detection of the presence of chromogranin A (CgA). The gland consisted of a well-developed duct system which included both intra and extra parenchymal ducts and secretory end pieces lined by many types of cells of variable morphological features and modes of secretion. However, the holocrine mode of secretion was rare as mitotic figures were occasionally present. The interstitial cells included fibroblasts and immune cells (mast cells, lymphocyte, plasma cells and macrophages). The secretion produced by the gland included lipid, protein, neutral mucin and CgA which may be a newly identified constituent of biologically potent proteins stored in the cells of the guinea pig HG. Neutral mucin and CgA may function in photoprotection. The gland revealed sexual dimorphism in mast cells and blood capillaries number and chromogranin secretory activity.

Author Info:
1
Histology Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.
2
Histology Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address: selgar1@hotmail.com.


Authors:
Idriss NK1, Blann AD2, Sayed DM3, Gaber MA1, Hassen HA1, Kishk YT4.

Title:
Circulating Endothelial Cells and Platelet Microparticles in Mitral Valve Disease With and Without Atrial Fibrillation.

Abstract:
Hypercoagulability in mitral valve disease (MVD), a cause of atrial fibrillation (AF) and stroke, is potentially due to endothelial damage/dysfunction (marked by circulating endothelial cells [CECs]), platelet activation (soluble P-selectin [sPsel], platelet microparticles [PMPs], and soluble CD40 [sCD40]), and oxidized low-density lipoprotein (oxLDL) cholesterol. We measured these variables in 24 patients with MVD as well as in 21 with MVD + AF and compared them with 20 healthy controls (HCs). The CECs and PMPs were measured by flow cytometry; sPsel, oxLDL, and CD40 by enzyme-linked immunosorbent assay. Compared with HCs, sPsel and PMPs were equally higher in MVD and MVD + AF; sCD40 and oxLDL were higher in MVD + AF than in HCs and MVD; and CECs were higher in MVD than in the HCs, with further increases in MVD + AF (all P < .001). We conclude that excess platelet activation is present in MVD regardless of AF, and that increased endothelial damage in MVD is greater when compounded by AF.

Author Info:
1
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Medicine City Hospital, University of Birmingham Centre for Cardiovascular Sciences, Birmingham, United Kingdom a.blann@bham.ac.uk.
3
Department of Clinical Pathology, Faculty of Medicine, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
4
Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Kamel-ElSayed SA1, Tiede-Lewis LM2, Lu Y3, Veno PA2, Dallas SL4.

Title:
Novel Approaches For Two And Three Dimensional Multiplexed Imaging Of Osteocytes.

Abstract:
Although osteocytes have historically been viewed as quiescent cells, it is now clear that they are highly active cells in bone and play key regulatory roles in diverse skeletal functions, including mechanotransduction, phosphate homeostasis and regulation of osteoblast and osteoclast activity. Three dimensional imaging of embedded osteocytes and their dendritic connections within intact bone specimens can be quite challenging and many of the currently available methods are actually imaging the lacunocanalicular network rather than the osteocytes themselves. With the explosion of interest in the field of osteocyte biology, there is an increased need for reliable ways to image these cells in live and fixed bone specimens. Here we report the development of reproducible methods for 2D and 3D imaging of osteocytes in situ using multiplexed imaging approaches in which the osteocyte cell membrane, nucleus, cytoskeleton and extracellular matrix can be imaged simultaneously in various combinations. We also present a new transgenic mouse line expressing a membrane targeted-GFP variant selectively in osteocytes as a novel tool for in situ imaging of osteocytes and their dendrites in fixed or living bone specimens. These methods have been multiplexed with a novel method for labeling of the lacunocanalicular network using fixable dextran, which enables aspects of the osteocyte cell structure and lacunocanalicular system to be simultaneously imaged. The application of these comprehensive approaches for imaging of osteocytes in situ should advance research into osteocyte biology and function in health and disease.

Author Info:
1
Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, 615 E. 25th Street, Kansas City, MO 64108, USA; Biomedical Sciences Department, Oakland University William Beaumont School of Medicine, 414 O'Dowd Hall, Rochester MI, 48309, USA; Medical Physiology Department, Assiut University School of Medicine, 71516 Asyut, Egypt.
2
Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, 615 E. 25th Street, Kansas City, MO 64108, USA.
3
Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, 615 E. 25th Street, Kansas City, MO 64108, USA; Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, 3302 Gaston Ave., Dallas, TX 75246, USA.
4
Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, 615 E. 25th Street, Kansas City, MO 64108, USA. Electronic address: dallass@umkc.edu.


Authors:
Kassan M1, Ait-Aissa K1, Ali M2, Trebak M3, Matrougui K4.

Title:
Augmented EGF Receptor Tyrosine Kinase Activity Impairs Vascular Function By NADPH Oxidase-Dependent Mechanism In Type 2 Diabetic Mouse.

Author Info:
1
Department of Physiological Sciences, Eastern Virginia School of Medicine, Norfolk, VA 23501, USA.
2
Department of Physiological Sciences, Eastern Virginia School of Medicine, Norfolk, VA 23501, USA; College of Nanoscale Science and Engineering, SUNY, Albany, NY 12203, USA.
3
Assiut University, Department of Medical Biochem


Authors:
Khalil R1, Abo Elfetoh N2, Moftah MZ3, Khedr EM2.

Title:
Acquired Equivalence Associative Learning In GTC Epileptic Patients: Experimental And Computational Study.

Abstract:
Previous cognitive behavioral studies based on Acquired Equivalence Associative learning Task (AEALT) showed a strong relation between hippocampus and basal ganglia in associative learning. However, experimental behavioral studies of patients with Generalized Tonic Clonic (GTC) epilepsy remained sparse. The aim of the present study is to integrate a classical behavioral cognitive analysis with a computational model approach to investigate cognitive associative learning impairments in patients with GTC epilepsy. We measured the accuracy of associative learning response performance in five GTC epileptic patients and five control subjects by using AEALT, all subjects were matched in age and gender. We ran the task using E-Prime, a neuropsychological software program, and SPSS for data statistical analysis. We tested whether GTC epileptic patients would have different learning performance than normal subjects, based on the degree and the location of impairment either in basal ganglia and/or hippocampus. With the number of patients that was available, our behavioral analysis showed no remarkable differences in learning performance of GTC patients as compared to their control subjects, both in the transfer and acquisition phases. In parallel, our simulation results confirmed strong connection and interaction between hippocampus and basal ganglia in our GTC and their control subjects. Nevertheless, the differences in neural firing rate of the connectionist model and weight update of basal ganglia were not significantly different between GTC and control subjects. Therefore, the behavioral analysis and the simulation data provided the same result, thus indicating that the computational model is likely to predict cognitive outcomes.

Author Info:
1
Department of Cognitive Biology, Otto-von-Guericke Universität Magdeburg, Germany ; Department of Developmental Physiology, Institute of Physiology, Otto-von-Guericke Universität Magdeburg, Germany ; IMN - Institut des Maladies Neurodégénératives, University of Bordeaux Bordeaux, France.
2
Department of Neurology, Faculty of Medicine, Assiut University Assiut, Egypt.
3
Department of Zoology, Faculty of Science, Alexandria University Alexandria, Egypt.


Authors:
Khedr E1, Fawi G2, Abbas MA3, Mohammed TA3, El-Fetoh NA1, Al Attar G4, Noaman M1, Zaki AF3.

Title:
Prevalence Of Mild Cognitive Impairment And Dementia Among The Elderly Population Of Qena Governorate, Upper Egypt: A Community-Based Study.

Abstract:
BACKGROUND:
There are only a few reports which provide prevalence rates of mild cognitive impairment (MCI) and dementia specifically in Arabic countries.

OBJECTIVE:
This study is aimed at estimating the prevalence of MCI and dementia among subjects aged ≥60 years using door-to-door survey in Qena Governorate/Egypt.

METHODS:
We conducted a door-to-door survey with multistage probability random sampling. Screening of all subjects aged ≥60 years (n = 691) employed a simple questionnaire including changes in memory, behavior, and daily activity, Memory and Executive Screening test (MES)as well as the Mini-Mental State Examination. Suspected cases were referred to the hospital for full clinical examination, DSM-IV diagnostic criteria, Hachinski Ischemic Score, neuroimaging, and laboratory investigations if indicated.

RESULTS:
Of the 691 participants, 12 cases had MCI, giving a crude prevalence rate (CPR) of 1.74/100 and 35 were identified as positive for dementia with a CPR of 5.07/100. The highest age-specific prevalence rates were recorded among subjects ≥85 years old (100/100). The CPRs were significantly higher in urban than rural areas (7.1 versus 3.27/100, respectively; p = 0.03), in industrial areas than non-industrial areas (13.23 versus 1.99; p = 0.00001), and in illiterate than literate participants (10.12 versus 2.25/100; p = 0.00001).

CONCLUSION:
Overall, the prevalence rate of MCI and dementia were lower in Qena/Egypt than in other countries. Advanced age, illiteracy, and living in an industrial area were found to be associated with dementia.

Author Info:
1
Departments of Neuropsychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt and head of Departments of Neuropsychiatry, Faculty of Medicine, Aswan University, Aswan, Egypt.
2
Departments of Neuropsychiatry, Faculty of Medicine, Sohag University, Sohag, Egypt.
3
Departments of Neuropsychiatry, Faculty of Medicine, South Valley University, Qena, Egypt.
4
Public Health and Community Medicine, Assiut University Hospital, Assiut, Egypt.


Authors:
Khedr EM1, Elbeh KA1, Abdel Baky A1, Abo-Elfetoh N1, El-Hammady DH2, Korashy F1.

Title:
A Double-Blind Randomized Clinical Trial On The Efficacy Of Magnetic Sacral Root Stimulation For The Treatment Of Monosymptomatic Nocturnal Enuresis.

Abstract:
PURPOSE:
Purpose of this study was to evaluate the long term efficacy of repetitive sacral root magnetic stimulation (rSMS) in patients with monosymptomatic nocturnal enuresis (MNE).

METHODS:
Forty four patients were randomized to receive either sham or real repetitive sacral root magnetic stimulation (rSMS; 15 Hz with a total of 1500 pulses/session) for 10 sessions. Evaluation was performed before starting treatment, immediately after the 5th and 10th treatment session, and 1 month later, using frequency of enuresis/week, visual analogue scale (VAS) and quality of life as outcome measures. Resting and active motor thresholds of gastrocnemius muscles were measured before and after the end of sessions.

RESULTS:
Both treatment and control groups were comparable for baseline measures of frequency of enuresis, and VAS. The mean number of wet nights/week was significantly reduced in patients who received real rSMS. This improvement was maintained 1 month after the end of treatment. Patients receiving real-rSMS also reported an improvement in VAS ratings and quality of life. A significant reduction of resting motor threshold was recorded after rSMS in the real group while no such changes were observed in the sham group.

CONCLUSION:
These findings suggest that rSMS has potential as an adjuvant treatment for MNE and deserves further study.

TRIAL REGISTRATION:
ClinicalTrials.gov NCT02328092.

Author Info:
1
Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt.
2
Department of Rheumatology and Rehabilitation, Assiut University Hospital, Assiut, Egypt.


Authors:
Khedr EM1, Ahmed MA, Ali AM, Badry R, Rothwell JC.

Title:
Changes In Motor Cortical Excitability In Patients With Sydenham's Chorea.

Abstract:
BACKGROUND AND PURPOSE:
The neurophysiological characteristics of motor cortex have been well characterized in patients with Huntington's disease. We present the first data on cortical excitability in patients with Sydenham's chorea.

METHODS:
Motor cortex excitability was examined using transcranial magnetic stimulation in 16 patients in the early clinical stages of Sydenham's chorea and in 17 age- and sex-matched control subjects. Investigations included resting and active motor threshold, motor evoked potential, input-output curves, contralateral silent period, and transcallosal inhibition.

RESULTS:
Resting and active motor threshold were significantly higher and motor evoked potentials were significantly smaller in patients in comparison with controls. The input-output curves were shallower in both hemispheres of patients with chorea compared with controls. No significant differences were seen in silent period or transcallosal inhibition duration.

CONCLUSION:
Sydenham's chorea is characterized by reduced excitability of corticospinal output similar to that observed in Huntington's disease.

Author Info:
1
Departments of Neuropsychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Khedr EM1, Kotb HI, Mostafa MG, Mohamad MF, Amr SA, Ahmed MA, Karim AA, Kamal SM.

Title:
Repetitive Transcranial Magnetic Stimulation In Neuropathic Pain Secondary To Malignancy: A Randomized Clinical Trial.

Abstract:
BACKGROUND:
Significant analgesic effects of repetitive transcranial magnetic stimulation (rTMS) have been found in several studies of patients with chronic pain of various origins, but never for malignancy. The objective of this study was to assess the efficacy of 10 sessions of rTMS over the primary motor cortex (M1) in patients suffering from malignant neuropathic pain.

METHODS:
Thirty-four patients were randomly allocated into one of two groups to receive real (20 Hz, 10 s, 10 trains with 80% intensity) or sham rTMS daily for 10 consecutive days. Patients were evaluated using a verbal descriptor scale (VDS), a visual analogue scale (VAS), Leeds assessment of neuropathic symptoms and signs (LANSS) and Hamilton rating scale for depression (HAM-D) at baseline, after the first, fifth and 10th treatment sessions, and then 15 days and 1 month after treatment.

RESULTS:
There were no significant differences between real and sham groups in the duration of illness or pain rating scores at the baseline. A significant 'Time × Group' interaction was recorded indicating that real and sham rTMS had different effects on the VDS, VAS, LANSS and HAM-D scales. Post-hoc testing showed that the group of patients treated with real rTMS had greater improvement in all scales that persisted up to 15 days, but were not present 1 month later. Significant positive correlations between the percentage of pain reduction and HAM-D after the 10th session and 15 days later were recorded.

CONCLUSION:
The results demonstrate that 10 rTMS sessions over the M1 can induce short-term pain relief in malignant neuropathic pain.

Author Info:
1
Department of Neurology, Assiut University Hospital, Egypt.


Authors:
Khedr EM1, Abo-Elfetoh N2, Elbeh KA2, Baky AA2, Gamal RM3, El Hammady D3, Korashy F2.

Title:
Transcranial Magnetic Stimulation Identifies Cortical Excitability Changes In Monosymptomatic Nocturnal Enuresis.

Abstract:
OBJECTIVES:
A limited number of electroencephalography (EEG) studies in nocturnal enuresis (NE) have reported cortical dysmaturity. The aim of the present study was to test this notion by examining cortical excitability in subjects with nocturnal enuresis (NE) using transcranial magnetic stimulation (TMS).

MATERIAL AND METHODS:
We investigated 41 patients with NE meeting the DSM-IV diagnostic criteria for NE, and 18 age- and sex-matched controls. Each subject was assessed clinically regarding frequency, duration of enuresis and Health Survey Measurement. Neurophysiological measures included resting and active motor thresholds (RMT, AMT), motor evoked potentials (MEP) of upper and lower limbs, cortical silent period duration (CSP) and transcallosal inhibition (TCI), in the upper limbs.

RESULTS:
Patients had a significantly lower Health Survey Measurement score for both physical and mental health components compared to the control group. RMT and AMT of both upper and lower limbs as well as the duration of the CSP and TCI were significantly reduced compared with the control group. There was significant positive correlation between RMT, AMT and Health Survey Measurement scores, especially Social Functioning.

CONCLUSION:
Patients with nocturnal enuresis are characterized by pathologically increased excitability and reduced inhibitory processing in the motor cortex, which could contribute to the pathogenesis of nocturnal enuresis.

Author Info:
1
Department of neuropsychiatry, Assiut university hospital, Assiut, Egypt. Electronic address: emankhedr99@yahoo.com.
2
Department of neuropsychiatry, Assiut university hospital, Assiut, Egypt.
3
Rheumatology and rehabilitation department, faculty of medicine, Assiut University, Assiut, Egypt.


Authors:
Kotb MB1, Abdel-Malek MO2, Eltayeb AA3, Makhlouf GA4, Makhlouf NA5.

Title:
Button Hole Hernioplasty: A New Technique For Treatment Of Umblical Hernia In Cirrhotic Patients. A Prospective Follow Up Study.

Abstract:
BACKGROUND:
Surgical treatment of umbilical hernia in cirrhotic patients is still an interesting topic in many studies to achieve the best method of treatment. These patients are liable to many surgical and medical risks.

AIMS:
to evaluate the surgical outcome as well as the postoperative course of Button hole hernioplasty as a simple, safe, and effective new technique for hernia repair in cirrhotic patients.

METHODS:
Forty cirrhotic patients with uncomplicated umbilical hernia were included in this study through collaboration between Departments of General Surgery and Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut, during one year period. Patients were categorized according to the severity of liver cirrhosis into three groups (A, B, and C). Patients were subjected to an elective hernioplasty after adjustment of the disturbed medical and biochemical factors.

RESULTS:
There was a significant difference in operative time, hospital stay, and prothrombine (time and concentration) among the three groups (p < 0.05). The three parameters were longest in group C when compared to the other two groups. No severe complications were recorded except in only one case. Also, no recurrence, no morbidities or deaths were recorded after 6 months follow-up.

CONCLUSIONS:
Button hole hernioplasty is a new simple surgical technique for treatment of umbilical hernia in cirrhotic patients with no significant complications.

Author Info:
1
Faculty of Medicine, Assiut University, Egypt; Department of General Surgery, Assiut University Hospital 71111, Assiut, Egypt. Electronic address: kottb73@yahoo.com.
2
Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Egypt. Electronic address: momar7619@gmail.com.
3
Pediatric Surgery Unit, Surgical Department, Assiut University Children Hospital, Assiut, Egypt. Electronic address: almoutazeltayeb@hotmail.com.
4
Faculty of Medicine, Assiut University, Egypt; Department of General Surgery, Assiut University Hospital 71111, Assiut, Egypt. Electronic address: g_makhlouf@yahoo.com.
5
Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Egypt. Electronic address: nahedmak@yahoo.com.


Authors:
Kurkar A1, Elderwy AA1, Abulsorour S1, Awad SM2, Safwat AS1, Altaher A1.

Title:
A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial Of "On-Demand" Tramadol For Treatment Of Premature Ejaculation.

Abstract:
OBJECTIVES:
The objective of this study is to assess the dose-related effects of tramadol on a group of patients with premature ejaculation (PE).

SUBJECTS AND METHODS:
During the period of months between June 2010 and July 2012, 180 PE patients presented to outpatient clinic of our hospital. Patients were randomized in a 1:1:1 fashion to receive different sequences of the three medications: placebo, 50 mg of tramadol and 100 mg of tramadol. Every patient received 10 doses of each medication for 2 months. Intra-vaginal ejaculatory latency time (IELT) was recorded in seconds initially and for each arm. Successful treatment of PE is defined if IELT exceeded 120 s. Side-effects of medications were reported.

RESULTS:
Of patients enrolled, 125 (69.4%) continued the study. Patients' age range was 20-55 years with PE complaint of 1 to 10 years duration. Mean IELT was 72 at presentation, 82 for placebo, 150 for tramadol 50 mg, and 272 for tramadol 100 mg (P < 0.001 for all comparisons). PE was successfully treated in only 2.4% of patients with placebo, in contrast to 53.6% and 85.6% with 50 and 100 mg tramadol, respectively (P < 0.001 for all comparisons). On multivariate logistic regression analysis, baseline IELT was the only predictor of successful treatment of PE with both tramadol 50 mg (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.03-1.07, P < 0.001) and tramadol 100 mg (OR: 1.07, 95% CI: 1.04-1.11, P < 0.001). Postmicturition dribble annoyed 12.8% of those who received 50 mg tramadol and 33.6% of those who received 100 mg tramadol (P < 0.001). Weak scanty ejaculation was the main complaint in 7.2% versus 21.6% of those using 50 and 100 mg tramadol, respectively (P = 0.002). Two patients discontinued tramadol 100 mg due to side-effects.

CONCLUSION:
Tramadol hydrochloride exhibits a significant dose-related efficacy and side-effects over placebo for treatment of PE.

Author Info:
1
Department of Urology, Assiut University Hospitals, Assiut 71515, Egypt.
2
Department of Dermatology and Venorology, Assiut University Hospitals, Assiut 71515, Egypt.


Authors:
Makboul R1, Refaiy AE1, Badary FA1, Abdelkawi IF2, Merseburger AS3, Mohammed RA1.

Title:
Expression Of Survivin In Squamous Cell Carcinoma And Transitional Cell Carcinoma Of The Urinary Bladder: A Comparative Immunohistochemical Study.

Abstract:
PURPOSE:
To compare the expression of survivin and its association with clinicopathological criteria in major types of urinary bladder carcinoma, specifically, transitional cell carcinoma with and without squamous differentiation and squamous cell carcinoma.

MATERIALS AND METHODS:
Immunohistochemical staining for survivin and Ki67 was performed on paraffin-embedded sections of 104 carcinomas: 52 transitional cell carcinoma, 20 transitional cell carcinoma with squamous differentiation, and 32 squamous cell carcinoma. Expression of survivin in >10% of tumor cells was described as altered survivin status. Ki67 staining in >20% of tumor cells was described as a high proliferation index.

RESULTS:
Altered survivin expression was detected in 60/104 specimens (58%) and was significantly more frequent in transitional cell carcinoma (78%) than in squamous cell carcinoma (38%) or transitional cell carcinoma with squamous differentiation (40%) (p<0.0001). In transitional cell carcinoma but not in squamous cell carcinoma, altered survivin status was associated with higher tumor grade, higher proliferation index, and recurrence. In the whole specimens, altered survivin expression was significantly associated with advanced stage (p<0.001), recurrence (p=0.005), distant metastasis (p<0.001), and death (p=0.001). In the multivariate analysis, altered survivin was an independent poor prognostic factor for recurrence.

CONCLUSIONS:
Unlike in transitional cell carcinoma, alteration of survivin expression in squamous cell carcinoma occurs less frequently and is not associated with features of tumor aggression or patient outcome. These findings raise a question: are urinary bladder carcinoma patients with squamous cell carcinoma type suitable candidates for survivin vaccine? This is an important question to be answered before approving the vaccine in management.

Author Info:
1
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany.


Authors:
Marra KV1, Wagley S, Omar A, Kinoshita T, Kovacs KD, Silva P, Kuperwaser MC, Arroyo JG.

Title:
Case-Matched Comparison Of Vitrectomy, Peripheral Retinal Endolaser, And Endocyclophotocoagulation Versus Standard Care In Neovascular Glaucoma.

Abstract:
PURPOSE:
To evaluate the efficacy of combination pars plana vitrectomy, endoscopic peripheral panretinal photocoagulation, and endocyclophotocoagulation (ECP) as compared with standard care in patients with neovascular glaucoma.

METHODS:
This age-matched case-controlled retrospective series of 54 eyes compared the clinical outcomes between a consecutive series of combination pars plana vitrectomy/panretinal photocoagulation/ECP (n = 27) versus the current standard of care (n = 27) for patients with neovascular glaucoma. "Standard" treatments for patients with neovascular glaucoma include panretinal photocoagulation, intravitreal bevacizumab, filtration surgery, pars plana vitrectomy, and Ahmed valve placement.

RESULTS:
After 1 year, mean intraocular pressure reduced from 40.7 ± 12.40 mmHg preoperatively to 12.3 ± 4.84 mmHg (P < 0.001) in the ECP group and from 34.7 ± 12.38 mmHg to 23.2 ± 12.34 mmHg in the control group (P = 0.002). Compared with controls, the mean drop in intraocular pressure in the ECP group was significantly greater at all postoperative visits. Logarithm of the minimal angle of resolution visual acuity outcomes were similar in both groups. There were 2 cases (7.4%) of postoperative phthisis bulbi in each group.

CONCLUSION:
Endoscopic pars plana vitrectomy, panretinal photocoagulation, and ECP seem to control intraocular pressure to a greater extent than standard glaucoma treatments in patients with neovascular glaucoma. In this aged-matched comparative case series, there was no significant difference between the two treatments' effects on visual acuity.

Author Info:
*Retina Service, Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; †University of California, San Diego School of Medicine, San Diego, California; ‡College of Human Medicine, Michigan State University, East Lansing, Michigan; §Beetham Eye Institute, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts; ¶Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt; and **Albert Einstein College of Medicine, New York, New York.


Authors:
Masoud WG1, Abo Al-Rob O2, Yang Y3, Lopaschuk GD4, Clanachan AS5.

Title:
Tolerance To Ischaemic Injury In Remodelled Mouse Hearts: Less Ischaemic Glycogenolysis And Preserved Metabolic Efficiency.

Abstract:
AIMS:
Post-infarction remodelled failing hearts have reduced metabolic efficiency. Paradoxically, they have increased tolerance to further ischaemic injury. This study was designed to investigate the metabolic mechanisms that may contribute to this phenomenon and to examine the relationship between ischaemic tolerance and metabolic efficiency during post-ischaemic reperfusion.

METHODS AND RESULTS:
Male C57BL/6 mice were subjected to coronary artery ligation (CAL) or SHAM surgery. After 4 weeks, in vivo mechanical function was assessed by echocardiography, and then isolated working hearts were perfused in this sequence: 45 min aerobic, 15 min global no-flow ischaemia, and 30 min aerobic reperfusion. Left ventricular (LV) function, metabolic rates, and metabolic efficiency were measured. Relative to SHAM, both in vivo and in vitro CAL hearts had depressed cardiac function under aerobic conditions (45 and 36%, respectively), but they had a greater recovery of LV function during post-ischaemic reperfusion (67 vs. 49%, P < 0.05). While metabolic efficiency (LV work per ATP produced) was 50% lower during reperfusion of SHAM hearts, metabolic efficiency in CAL hearts did not decrease. During ischaemia, glycogenolysis was 28% lower in CAL hearts, indicative of lower ischaemic proton production. There were no differences in mitochondrial abundance, calcium handling proteins, or key metabolic enzymes.

CONCLUSION:
Compared with SHAM, remodelled CAL hearts are more tolerant to ischaemic injury and undergo no further deterioration of metabolic efficiency during reperfusion. Less glycogen utilization in CAL hearts during ischaemia may contribute to increased ischaemic tolerance by limiting ischaemic proton production that may improve ion homeostasis during early reperfusion.

Author Info:
1
Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, 9-43 Medical Sciences Building, Edmonton, Alberta, Canada T6G 2H7 Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada Cardiovascular Research Centre, Alberta, Canada Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada Cardiovascular Research Centre, Alberta, Canada Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Faculty of Pharmacy, Yarmouk University, Irbid, Jordan.
3
Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, 9-43 Medical Sciences Building, Edmonton, Alberta, Canada T6G 2H7.
4
Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, 9-43 Medical Sciences Building, Edmonton, Alberta, Canada T6G 2H7 Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada Cardiovascular Research Centre, Alberta, Canada Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
5
Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, 9-43 Medical Sciences Building, Edmonton, Alberta, Canada T6G 2H7 Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada Cardiovascular Research Centre, Alberta, Canada sandy.clanachan@ualberta.ca.


Authors:
Mekky MA1, Tolba M2, Abdel-Malek MO1, Abbas WA1, Zidan M1.

Title:
Human Fascioliasis: A Re-Emerging Disease In Upper Egypt.

Abstract:
In recent years, the number of humans infected with Fasciola has risen rapidly. Diagnosis is based mainly on detection of eggs in stool analysis. The rate of infection in Egypt is unknown. In this retrospective study, we describe 23 cases of hepatic fascioliasis, and only 2 of these cases showed eggs in stools. The symptoms of infection, such as pyrexia of unknown origin, epigastric pain, and abdominal distension, were suggestive. Imaging techniques, including abdominal ultrasonography and computed tomography, were very helpful in detecting hepatic changes. An indirect hemagglutination assay proved to be of value for diagnosis. Treatment using a 2-day triclabendazole regimen cured the infection and signs of hepatic involvement disappeared. Combining both imaging techniques and laboratory tests is essential for diagnosis of fascioliasis in the early stage.

Author Info:
1
Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut, Egypt; Department of Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Internal Medicine, Faculty of Medicine, Assiut, Egypt; Department of Diagnostic Radiology, Faculty of Medicine, Assiut, Egypt.
2
Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut, Egypt; Department of Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Internal Medicine, Faculty of Medicine, Assiut, Egypt; Department of Diagnostic Radiology, Faculty of Medicine, Assiut, Egypt essa3eg@yahoo.com.


Authors:
Mohamad IL1, Saad K2, Abdel-Azeem A3, Mohamed SA3, Othman HA4, Abdel Baseer KA5, Thabet AF6, El-Houfey AA7.

Title:
Evaluation Of Pulmonary Function Changes In Children With Type 1 Diabetes Mellitus In Upper Egypt.

Abstract:
BACKGROUND:
Diabetes mellitus is a leading cause of morbidity and mortality among children across the world and is responsible for a growing proportion of global healthcare expenditure. However, limited data are available on lung dysfunction in children with diabetes.

AIM:
The aim of this study was to evaluate the pulmonary function changes in children with type 1 diabetes mellitus (T1DM).

METHODS:
We studied 60 children with T1DM (mean age 10.5 ± 2.32 years; disease duration 2.45 ± 0.6 years, and 50 healthy control children (mean age 9.9 ± 2.5 years). Spirometry was performed for all individuals to measure forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR). Glycemic control was assessed on the basis of glycated hemoglobin (HbA1c), with HbA1c values <8% considered to indicate good glycemic control, and HbA1c values ⩾8% to indicate poor control.

RESULTS:
There was significant reduction in all spirometeric parameters in diabetic children in comparison with healthy control children. Children with poor glycemic control had significant impairment in lung functions compared with those with good glycemic control.

CONCLUSIONS:
T1DM in children leads to impairment of lung functions and this impairment increases with poor glycemic control.

Author Info:
1
Pediatric Department, Faculty of Medicine, Assiut University, Egypt.
2
Associate Professor of Pediatrics, Faculty of Medicine, University of Assiut, Assiut 71516, Egypt.
3
Department of Chest Diseases, Faculty of Medicine, Assiut University, Egypt.
4
Clinical Pathology Department, Faculty of Medicine, Aswan University, Egypt.
5
Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Egypt.
6
Internal Medicine Department, Assiut University, Assiut, Egypt.
7
Community Health Nursing Department, Faculty of Nursing, Assiut University, Egyp


Authors:
Mohamed Sayed MH1, Saleh Farghaly HR2, Fadl FA3.

Title:
Rate Of Thyroglossal Duct Remnant Visualization After Total Thyroidectomy For Differentiated Thyroid Carcinoma And Its Impact On Clinical Outcome Of Radioactive Iodine (I-131) Ablation.

Abstract:
OBJECTIVES:
The rate and impact of thyroglossal duct remnant (TGDR) visualization in patients with hypothyroidism after total thyroidectomy for differentiated thyroid carcinoma (DTC) have not yet been fully determined. The aim of this study was to assess the rate of TGDR visualization in post total thyroidectomy whole body scan (WBS) for DTC and to evaluate its impact on the outcome of I-131 ablation.

METHODS:
A total of 60 consecutive DTC patients (51 papillary thyroid Ca., and 9 Follicular thyroid Ca.), underwent total thyroidectomy, followed by WBS (using I-131 in 28 patients and I-123 in 32 patients), neck ultrasound (US), thyroglobulin (Tg) and Tg anti-bodies (TgAb) assay after 40 days and subsequent I-131 ablation. At 6 months later follow-up I-131 WBS, neck U/S, Tg and TgAb were performed following suspension of L-thyroxine for 1-month (thyroid stimulating hormone [TSH] >30 μIU/ml) in 53 patients and following recombinant human TSH stimulation in seven patients.

RESULTS:
Of the studied 60 patients, 19/60 (31.7%) had a linear or focal radioactivity at the superior midline of the neck, suggesting TGDR (Group 1), and 41/60 (68.3%) had no uptake to suggest TGDR (Group 2). No significant difference regarding age, gender and histopathology between both groups. Neck US showed no evidence of thyroid tissue in the superior midline of the neck in both groups, and only a small or no residual thyroid tissue in patients of Group 1. There was a significant successful I-131 ablation rate among patients of group 1 compared to group 2 (79% in Group 1 vs. 41.5% in Group 2) (P = 0.007).

CONCLUSIONS:
Thyroglossal duct remnant visualization on WBS of hypothyroid subjects after total thyroidectomy suggests presence of only a small or no residual functioning thyroid tissue at the thyroid bed and can predict a good response to I-131 ablation.

Author Info:
1
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt ; Department of Nuclear Medicine, Almana General Hospital, Dammam, Saudi Arabia.
2
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Radiology and Medical imaging, Almana General Hospital, Dammam, Saudi Arabia.


Authors:
Mohammed EE1, Mosad E2, Zahran AM2, Hameed DA3, Taha EA4, Mohamed MA5.

Title:
Acridine Orange and Flow Cytometry: Which Is Better to Measure the Effect of Varicocele on Sperm DNA Integrity?

Abstract:
We evaluated the effect of varicocelectomy on semen parameters and levels of sperm DNA damage in infertile men. A total of 75 infertile men with varicocele and 40 fertile men (controls) were included in this study. Semen analysis and sperm DNA damage expressed as the DNA fragmentation index using acridine orange staining and chromatin condensation test by flow cytometry were assessed before and 6 months after varicocelectomy. The patients were also followed up for 1 year for pregnancy outcome. Semen parameters were significantly lower in varicocele patients compared to controls (P < 0.05). Mean percentages of sperm DNA fragmentation and sperm DNA chromatin condensation in patients were significantly higher than those in controls (P < 0.05). After varicocelectomy, sperm DNA fragmentation improved significantly, whereas sperm chromatin condensation was not significantly changed. In 15 out of 75 varicocele patients, clinical pregnancy was diagnosed; those with positive pregnancy outcome had significant improvement in sperm count, progressive sperm motility, and sperm DNA fragmentation, but there was no significant difference in sperm DNA condensation compared to negative pregnancy outcome patients. We concluded from this study that acridine orange stain is more reliable method than flow cytometry in the evaluation of sperm DNA integrity after varicocelectomy.

Author Info:
1
Dermatology and Andrology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
2
Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
3
Urology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Dermatology and Andrology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Gynaecology and Obstetric Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.


Title:
Quality Of Delivery Care In Assiut University Hospital, Egypt: Mothers' Satisfaction.

Abstract:
BACKGROUND:
Client satisfaction is an important parameter of quality assessment, as patient's preferences and demands influence health status and medical outcomes.

OBJECTIVE:
The aim of this study was to assess mothers' satisfaction with the quality of healthcare during hospital delivery and its determinants.

PARTICIPANTS AND METHODS:
A cross-sectional design was used. Women who gave birth at Women Health Center of Assiut University Hospital during a 2-month period in 2012 (n=435) were interviewed using a semistructured questionnaire to examine various dimensions of care.

RESULTS:
Nearly two-third of interviewed mothers (63%) were satisfied with the quality of delivery care they received at the hospital. They would deliver again in the hospital and would recommend the hospital to others. Younger women, primipara, and highly educated were more likely to be satisfied than their counterparts. Pregnancy intendedness was associated with the satisfaction (P=0.000). Mothers' satisfaction with the way health provider treated them varied among nurses, doctors, and workers (77.7, 69.2, and 56.1%, respectively). Only 11.7% of mothers reported that they were satisfied with the health advices from the health providers, whereas 92.0% were satisfied with the competence of care providers. High satisfaction with the physical environment of the hospital was reported (>90%).

CONCLUSION AND RECOMMENDATIONS:
Although mothers' satisfaction with provider competence was high, satisfaction with the interpersonal aspects of the quality of care and health information given during delivery care was low. Training the physicians about the communication and interpersonal skills and emphasizing the value of providing mothers with health information are highly recommended.

Author Info:
1
Department of Public Health & Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
Assessment Of Coronary Ischaemia By Myocardial Perfusion Dipyridamole Stress Technetium-99 M Tetrofosmin, Single-Photon Emission Computed Tomography, And Coronary Angiography In Children With Kawasaki Disease: Pre- And Post-Coronary Bypass Grafting.

Abstract:
BACKGROUND:
Coronary artery lesions in Kawasaki disease invasively assessed by coronary angiography. Evaluation of myocardial perfusion by single-photon emission computed tomography may identify the haemodynamic significance of coronary lesions.

OBJECTIVE:
To evaluate diagnostic accuracy of dipyridamole stress technetium-99 m tetrofosmin, single-photon emission computed tomography as a possible alternative to invasive coronary angiography for detection and follow-up of myocardial ischaemia in patients with Kawasaki disease, and pre- and post-coronary bypass grafting.

PATIENTS AND METHODS:
Coronary angiography and single-photon emission computed tomography were performed on 21 patients who were classified into three groups - group I (stenosis), group II (giant aneurysms), and group III (small aneurysms). Of the 21 patients, 16 (groups I and II) patients with myocardial perfusion defects, who underwent coronary bypass grafting, were followed up with single-photon emission computed tomography.

RESULT:
In group I, all patients had significant coronary stenosis and 100% of them had perfusion defects in the anterior and septal walls. In group II, all patients had giant aneurysms and 83% of them had inferior and inferolateral perfusion defects. In group III, all patients had small aneurysms and 100% of them had normal perfusion. Pre-coronary bypass grafting myocardial ischaemic defects disappeared in all patients after surgery. Sensitivity, specificity, and accuracy of single-photon emission computed tomography were 94, 100, and 95%, respectively.

CONCLUSION:
Technetium-99 m tetrofosmin single-photon emission computed tomography can be applied as an accurate non-invasive diagnostic technique for detecting myocardial perfusion defects with coronary artery lesions, and to show improved or even normalised perfusion of the myocardium in patients after surgical revascularisation.

Author Info:
1
1Department of Nuclear medicine,Assiut University,Egypt.
2
2Department of Pediatrics,Children and Women's University Hospital,Minia University,P.O. Box 61519,El-Minia,Egypt.
3
3Department of Nuclear Medicine,Cairo University,Egypt.


Title:
Contrast Patterns Of Cytomegalovirus And Epstein-Barr Virus Infection In Pediatric Living-Donor Liver Transplant Recipients.

Abstract:
OBJECTIVES:
Cytomegalovirus and Epstein-Barr virus remain leading causes of morbidity and mortality in the living-donor liver transplant population, particularly in pediatric patients. Herein we compare the incidence, timing, and risk factors for infection in this group.

MATERIALS AND METHODS:
We performed a retrospective study of 344 consecutive pediatric patients 193 women (56.1%) who received living-donor liver transplants at Kyoto University Hospital. Patients were followed-up for maximum 7.1 ± 3.6 years (range, 0.02-13.2 y) after surgery.

RESULTS:
The mean age at the time of transplant was 3.95 ± 4.75 years (median, 1.38 y; range, 0.07-17.87 y). A total of 156 patients (45.2%) developed viral infections. Of those patients, 91 (26.5%) developed cytomegalovirus infection, and 93 (27%) developed Epstein-Barr virus. Cytomegalovirus developed at 39.3 ± 34.6 days, while Epstein-Barr virus developed 3.99 ± 3.67 years after transplant. Frequent rejection attacks (hazard ratio [HR],1.58; 95% confidence interval [CI]: 0.14-2.18; P = .006) were an independent predictor for postoperative cytomegalovirus infection, while preoperative cytomegalovirus seropositive results (HR, 1.76; 95% CI: 1.03-2.18; P = .038), short cold ischemia time (HR, 1.0; 95% CI: 0.99-1.0; P = .02), larger graft (HR, 1.3; 95% CI: 1.00-1.73; P = .047), and new cases compared to old cases (HR, 2.27; 95% CI: 1.14-4.52; P = .019) were independent predictors for postoperative Epstein-Barr virus infection.

CONCLUSIONS:
Extended surveillance of cytomegalovirus and Epstein-Barr virus DNAemia is recommended for pediatric patients receiving living-donor liver transplants, particularly infants who are at high risk, and especially those exposed to frequent attacks of rejection and those that receive larger grafts.

Author Info:
1
From the Department of Microbiology and Immunology, Graduate School of Medicine, Assiut University, Assiut, Egypt; and the Department of Hematology and Immunology, Graduate School of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Abstract


Authors:
Nishikawa M1, Miyake H2, Behnsawy HM3, Fujisawa M1.

Title:
Significance Of 4E-Binding Protein 1 As A Therapeutic Target For Invasive Urothelial Carcinoma Of The Bladder.

Abstract:
BACKGROUND:
To evaluate the expression of multiple molecular markers involved in the mammalian target of rapamycin (mTOR) signaling pathway in human muscle-invasive bladder cancer (BC) and to assess the therapeutic efficacies of mTOR inhibitors in human BC KoTCC-1 cells.

METHODS:
Expression levels of 5 markers, including PTEN, phosphorylated (p)-Akt, p-mTOR, p-p70 ribosomal S6 kinase, and p-4E-binding protein 1 (4E-BP1), were measured in radical cystectomy specimens from 49 patients with muscle-invasive BC by immunohistochemical staining. We then analyzed the effects of treatment with temsirolimus or Ku-0063794, a dual inhibitor of mTOR complex 1 (C1) and mTOR complex 2 (C2), on changes in the growth and expression profiles of 5 mTOR-associated markers in KoTCC-1 cells.

RESULTS:
During the follow-up period of this study, disease recurred in 27 patients (55.1%), and of several factors examined, the expression level of p-4E-BP1 in addition to the pathological T stage was independently related to recurrence-free survival on multivariate analysis. Although the growth of KoTCC-1 cells was inhibited by both temsirolimus and Ku-0063794 in dose-dependent manners, treatment with Ku-0063794 resulted in a marked decrease in the expression of p-4E-BP1 in KoTCC-1 cells compared with that with temsirolimus. Furthermore, the growth-inhibitory effect of both mTOR inhibitors was shown to be proportional to the expression levels of p-4E-BP1.

CONCLUSIONS:
The phosphorylation status of 4E-BP1 appeared to be correlated with the prognosis of patients with muscle-invasive BC following radical cystectomy as well as the sensitivities of BC cells to mTOR inhibitors; therefore, the inactivation of 4E-BP1 using Ku-0063794 may be a promising novel approach for muscle-invasive BC.

Author Info:
1
Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
2
Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: hideakimiyake@hotmail.com.
3
Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
Cytoskeletal Focal Adhesion Proteins Fascin-1 and Paxillin Are Predictors of Malignant Progression and Poor Prognosis in Human Breast Cancer.

Abstract:
Breast cancer is a major health problem in both developing and developed countries. The incremental motility of malignant cells is a critical step in their migration, invasion, and metastasis and is regulated by the reorganization of the actin cytoskeleton and regulation of focal adhesion. Fascin-1 and paxillin are essential components of these cellular structures. In cancer, the expression level of fascin-1 and paxillin can vary depending on cell type. However, its precise role in breast cancer of Saudi women has not been evaluated in any published study. We investigated fascin-1 and paxillin expression in breast carcinoma, and we have related these results to the established prognostic factors. We studied 100 breast carcinoma specimens. Immunohistochemical analyses for fascin-1 and paxillin were conducted on paraffin sections of breast tissues using the avidin-biotin peroxidase method. Fascin-1 and paxillin were expressed in 58% and 43% of infiltrating duct carcinoma (IDC) cases. There was a statistically significant correlation between fascin-1 and paxillin expression with each of the following: tumor grade, clinical stage, lymph-node metastasis grade, and HER2 expression. Furthermore, there was a significant correlation between fascin-1 expression with paxillin immunostaining but no such association with PR or ER status. Increased fascin-1 and paxillin expression in IDC cells and their correlation with poor prognostic factors support their strong correlation with tumor progression, invasion, and metastasis in human breast cancer, indicating that these markers can be used as a target for the development of novel therapies.

Author Info:
1
Departments of Pathology, Faculty of Medicine, Assiut and Qassim Universities, Egypt and Kingdom of Saudi Arabia.
2
Department of Obstetrics and Gynecology, College of Medicine, Qassim University, Qassim, Saudi Arabia.


Authors:
Ragab A1, Hamed HO2, Alsammani MA3, Shalaby H4, Nabeil H4, Barakat R4, Fetih AN5.

Title:
Expulsion Of Nova-T380, Multiload 375, And Copper-T380A Contraceptive Devices Inserted During Cesarean Delivery.

Abstract:
OBJECTIVE:
To compare the expulsion rate of Nova-T380, Multiload 375, and Copper-T380A intrauterine contraceptive devices (IUCDs) inserted during cesarean delivery.

METHODS:
A comparative randomized study was conducted between January 1, 2013, and June 30, 2014, in three maternity centers in Egypt and Saudi Arabia. All women scheduled for an elective cesarean and accepting intraoperative insertion of an IUCD were randomly allocated to receive the Nova-T380 (group 1), Multiload 375 (group 2), or Cu-T380A (group 3) using a computer-generated table. Researchers and participants were not masked to the type of IUCD. Follow-up was for 1 year. The primary outcome was IUCD expulsion (complete or partial [i.e. displacement]).

RESULTS:
Each group contained 40 participants. At 1 year, expulsion had been reported for 5 (13%) women in group 1, 2 (5%) in group 2, and 6 (15%) in group 3 (P>0.05 for all). The frequency of displacement was significantly lower in group 2 (5 [13%] participants) than in group 1 (15 [38%]; P=0.001) and group 3 (14 [35%]; P=0.008).

CONCLUSION:
Despite a comparable risk of expulsion following IUCD insertion during cesarean delivery, the Multiload 375 device showed the lowest risk of displacement.

Author Info:
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Qassim University, Burraidah, Qassim Region, Saudi Arabia; Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Qassim University, Burraidah, Qassim Region, Saudi Arabia; Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: hossam_omar@yahoo.com.
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Qassim University, Burraidah, Qassim Region, Saudi Arabia; Department of Obstetrics and Gynecology, Faculty of Medicine, Bahri University, Khartoum, Sudan.
4
Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
5
Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Ragab SM1, Abd Elghaffar SKh2, El-Metwally TH3, Badr G4, Mahmoud MH5,6, Omar HM7.

Title:
Effect Of A High Fat, High Sucrose Diet On The Promotion Of Non-Alcoholic Fatty Liver Disease In Male Rats: The Ameliorative Role Of Three Natural Compounds.

Abstract:
BACKGROUND:
Non-alcoholic fatty liver disease (NAFLD) is a multifactorial disease with a complex pathophysiology. The clinical features of NAFLD include obesity, insulin resistance (IR) and dyslipidemia. Consumption of a diet high in saturated fats and sucrose is an important factor in the increasing occurrence of these metabolic disorders, primarily NAFLD and IR. We sought to assess the role of a high-fat, high-sucrose (HFS) diet in the promotion of NAFLD and to evaluate the effects of quercetin (Q), berberine (BB) and o-coumaric acid (CA) on modulation of these disorders.

METHODS:
Fifty male rats were divided into 2 main groups as follows: group 1 comprised 10 rats fed a standard diet (SD), and group 2 comprised 40 rats fed an HFS diet for 6 weeks and then subdivided equally into 4 groups; one of these groups served as the HFS diet and each of the other three groups received daily supplementation with either Q, CA or BB for 6 weeks.

RESULTS:
In the present study, several metabolic disorders were induced in our laboratory animal model, as evidenced by histological and biochemical changes. These alterations included serum and hepatic dyslipidemia (i.e., increased triglyceride, total cholesterol and low-density lipoprotein levels and decreased high-density lipoprotein levels), alterations in metabolic enzyme activities (lipase, glycerol-3-phosphate dehydrogenase, and glucose-6-phosphate dehydrogenase), histological changes in the liver (micro- and macrovesicular steatosis) and the downregulation of peroxisome proliferator-activated receptor γ (PPARγ) in adipose tissue and the liver. Daily oral supplementation with Q, CA or BB for 6 weeks after NAFLD induction had a hypolipidemic action and modulated metabolic markers.

CONCLUSION:
We showed that an HFS diet is able to promote NAFLD, and our results suggest that CA and BB are promising complementary supplements that can ameliorate the metabolic disorders associated with an HFS diet; however, Q requires further investigation.

Author Info:
1
Department of Zoology, Faculty of Science, Assiut University, Assiut, 71516, Egypt. sohair.2008@yahoo.com.
2
Department of Pathology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt. sary64@windowslive.com.
3
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt. thelmetwally@hotmail.com.
4
Department of Zoology, Faculty of Science, Assiut University, Assiut, 71516, Egypt. badr73@yahoo.com.
5
Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia. mm_hassanein@hotmail.com.
6
Food Science and Nutrition Department, National Research Center, Dokki, Cairo, Egypt. mm_hassanein@hotmail.com.
7
Department of Zoology, Faculty of Science, Assiut University, Assiut, 71516, Egypt. hossameldin.mo@gmail.com.


Authors:
Refaat B1, Ashshi AM1, El-Shemi AG2, Azhar E3.

Title:
Activins and Follistatin in Chronic Hepatitis C and Its Treatment with Pegylated-Interferon-α Based Therapy.

Abstract:
Pegylated-interferon-α based therapy for the treatment of chronic hepatitis C (CHC) is considered suboptimal as not all patients respond to the treatment and it is associated with several side effects that could lead to dose reduction and/or termination of therapy. The currently used markers to monitor the response to treatment are based on viral kinetics and their performance in the prediction of treatment outcome is moderate and does not combine accuracy and their values have several limitations. Hence, the development of new sensitive and specific predictor markers could provide a useful tool for the clinicians and healthcare providers, especially in the new era of interferon-free therapy, for the classification of patients according to their response to the standard therapy and only subscribing the novel directly acting antiviral drugs to those who are anticipated not to respond to the conventional therapy and/or have absolute contraindications for its use. The importance of activins and follistatin in the regulation of immune system, liver biology, and pathology has recently emerged. This review appraises the up-to-date knowledge regarding the role of activins and follistatin in liver biology and immune system and their role in the pathophysiology of CHC.

Author Info:
1
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-'Abdiyah Campus, P. O. Box 7607, Makkah, Saudi Arabia.
2
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-'Abdiyah Campus, P. O. Box 7607, Makkah, Saudi Arabia ; Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut 6515, Egypt.
3
Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah 21589, Saudi Arabia ; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80216, Jeddah 21589, Saudi Arabia.


Authors:
Refaat B1, El-Shemi AG2, Ashshi AM1, Mahamid EW1, Al-Qadi NM1.

Title:
Pegylated Interferon-α Modulates Liver Concentrations of Activin-A and Its Related Proteins in Normal Wistar Rat.

Abstract:
AIMS:
To measure the expression of activin βA-subunit, activin IIA and IIB receptors, Smad4, Smad7, and follistatin in the liver and the liver and serum concentrations of mature activin-A and follistatin in normal rat following treatment with pegylated interferon-α (Peg-INF-α) and ribavirin (RBV).

MATERIALS AND METHODS:
40 male Wistar rats were divided equally into 4 groups: "control," "Peg-only" receiving 4 injections of Peg-INF-α (6 µg/rat/week), "RBV-only" receiving ribavirin (4 mg/rat/day) orally, and "Peg & RBV" group receiving both drugs. The expression of candidate molecules in liver was measured by immunohistochemistry and quantitative PCR. The concentrations of mature proteins in serum and liver homogenate samples were measured using ELISA.

RESULTS:
Peg-INF-α  ± RBV altered the expression of all candidate molecules in the liver at the gene and protein levels (P < 0.05) and decreased activin-A and increased follistatin in serum and liver homogenates compared with the other groups (P < 0.05). There were also significant correlations between serum and liver activin-A and follistatin.

CONCLUSION:
Peg-INF-α modulates the hepatic production of activin-A and follistatin, which can be detected in serum. Further studies are needed to explore the role of Peg-INF-α on the production of activins and follistatin by the liver and immune cells.

Author Info:
1
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 7607, Al Abdeyah, Makkah, Saudi Arabia.
2
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 7607, Al Abdeyah, Makkah, Saudi Arabia ; Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut 6515, Egypt.


Title:
The Effects Of Pegylated Interferon-Α And Ribavirin On Liver And Serum Concentrations Of Activin-A And Follistatin In Normal Wistar Rat: A Preliminary Report.

Abstract:
BACKGROUND:
Activin-A and follistatin regulate the liver and the immune system.

AIMS:
To measure the effects of treatment with pegylated-interferon-α (Peg-IFN-α) and ribavirin on the concentrations of mature activin-A and follistatin in serum and liver tissue homogenates in rats.

METHODS:
A total of 28 male Wistar rats were divided equally into four groups as follow: 'Control group' (n = 7), 'PEG only group' consisted of those that only received a weekly injection of Peg-IFN-α (6 µg/rat) for 4 weeks, 'RBV only group' received ribavirin only (4 mg/rat/day) orally for 35 days and the last group received both Peg-IFN-α and ribavirin 'PEG & RBV group'. The concentrations of candidate proteins in serum and liver samples were measured using ELISA.

RESULTS:
Pegylated-interferon-α decreased activin-A and increased follistatin significantly in serum and liver of 'PEG only' and 'PEG & RBV' groups compared with the 'Control' and 'RBV only' groups (P < 0.05). There was no significant difference between the 'RBV only' and 'Control' groups (P > 0.05) in the concentrations of candidate proteins. A significant positive correlations between serum and liver activin-A (r = 0.727; P = 0.02 × 10(-3)) and follistatin (r = 0.540; P = 0.01) was also detected.

CONCLUSION:
Pegylated-interferon-α modulates the production of activin-A and follistatin by the liver, which is reflected and can be detected at the serum level. Further studies are needed to explore the role of Peg-IFN-α based therapy on the production of activins and follistatin by the liver and immune cells.

Author Info:
1
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, PO Box 7607, Makkah, KSA. bassem.refaat@yahoo.co.uk.
2
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, PO Box 7607, Makkah, KSA. dr_adel_elshemy2006@yahoo.com.
3
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt. dr_adel_elshemy2006@yahoo.com.
4
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, PO Box 7607, Makkah, KSA. aashshi@yahoo.com.


Authors:
Refaat B1, El-Shemi AG2, Ashshi A1, Azhar E3.

Title:
Vitamin D And Chronic Hepatitis C: Effects On Success Rate And Prevention Of Side Effects Associated With Pegylated Interferon-α And Ribavirin.

Abstract:
Chronic hepatitis C (CHC) is one of the most common causes of liver diseases worldwide, affecting 3% of the world population and 3 to 4 million people acquire new infection annually. Despite the recent introduction of novel antiviral drugs for the treatment of CHC, these drugs are expensive and the access to them is not an option for many patients. Hence, the traditional therapy by pegylated interferon-α (Peg-IFN-α) and ribavirin may still have a role in the clinical management of CHC especially in developing countries. However, this standard therapy is associated with several severe extra-hepatic side effects and the most common adverse events are hematological abnormalities and thyroid disorders and they could result in dose reduction and/or termination of therapy. Vitamin D has been shown to be a key regulatory element of the immune system, and its serum concentrations correlate with the severity of liver damage and the development of liver fibrosis/cirrhosis. Furthermore, supplementation with vitamin D with Peg-IFN-α based therapy for the treatment of CHC could be beneficial in increase the response rate to Peg-INF-α based therapy. Vitamin D has also been shown to regulate the thyroid functions and the process of erythropoiesis. This review appraises the data to date researching the role of vitamin D during the treatment of CHC and the potential role of vitamin D in preventing/treating Peg-IFN-α induced thyroiditis and anemia during the course of treatment.

Author Info:
1
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University Al Abdeyah, Makkah, PO Box 7607, KSA.
2
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University Al Abdeyah, Makkah, PO Box 7607, KSA ; Department of Pharmacology, Faculty of Medicine, Assiut University Egypt.
3
Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University Jeddah, KSA ; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University Jeddah, Saudi Arabia.


Authors:
Refaat B1, El-Shemi AG2,3, Kensara OA4, Mohamed AM5,6, Idris S7, Ahmad J8, Khojah A9.

Title:
Vitamin D3 Enhances The Tumouricidal Effects Of 5-Fluorouracil Through Multipathway Mechanisms In Azoxymethane Rat Model Of Colon Cancer

Abstract:
BACKGROUND:
Vitamin D3 and its analogues have recently been shown to enhance the anti-tumour effects of 5- Fluorouracil (5-FU) both in vitro and in xenograft mouse model of colon cancer. This study measured the potential mechanism(s) by which vitamin D3 could synergise the tumouricidal activities of 5-FU in azoxymethane (AOM) rat model of colon cancer.

METHODS:
Seventy-five male Wistar rats were divided equally into 5 groups: Control, AOM, AOM-treated by 5-FU (5-FU), AOM-treated by vitamin D3 (VitD3), and AOM-treated by 5-FU + vitamin D3 (5-FU/D). The study duration was 15 weeks. AOM was injected subcutaneously for 2 weeks (15 mg/kg/week). 5-FU was injected intraperitoneally in the 9th and 10th weeks post AOM (8 total injections were given: 12 mg/kg/day for 4 successive days, then 6 mg/kg every other day for another 4 doses) and oral vitamin D3 (500 IU/rat/day; 3 days/week) was given from week 7 post AOM till the last week of the study. The colons were collected following euthanasia for gross and histopathological examination. The expression of β-catenin, transforming growth factor-β1 (TGF-β1), TGF-β type 2 receptor (TGF-βR2), smad4, inducible nitric oxide synthase (iNOS), and heat shock protein-90 (HSP-90) proteins was measured by immunohistochemistry. In colonic tissue homogenates, quantitative RT-PCR was used to measure the mRNA expression of Wnt, β-catenin, Dickkopf-1 (DKK-1) and cyclooxygenase-2 (COX-2) genes, while ELISA was used to measure the concentrations of TGF-β1, HSP-90 and COX-2 proteins.

RESULTS:
Monotherapy with 5-FU or vitamin D3 significantly decreased the number of grown tumours induced by AOM (P < 0.05); however, their combination resulted in more significant tumouricidal effects (P < 0.05) compared with monotherapy groups. Mechanistically, vitamin D3/5-FU co-therapy significantly decreased the expression of Wnt, β-catenin, iNOS, COX-2 and HSP-90 and significantly increased the expression of DKK-1, TGF-β1, TGF-βR2, smad4 (P < 0.05), in comparison with their corresponding monotherapy groups.

CONCLUSIONS:
Vitamin D3 and 5-FU synergise together and exhibit better anticancer effects by modulating Wnt/β-catenin pathway, TGF-β1 signals, iNOS, COX-2 and HSP-90. Further studies are required to illustrate the clinical value of vitamin D supplementation during the treatment of colon cancer with 5-FU in human patients.

Author Info:
1
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah, PO Box 7607, Makkah, Kingdom of Saudi Arabia. bassem.refaat@yahoo.co.uk.
2
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah, PO Box 7607, Makkah, Kingdom of Saudi Arabia. dr_adel_elshemy2006@yahoo.com.
3
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt. dr_adel_elshemy2006@yahoo.com.
4
Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah, PO Box 7607, Makkah, Kingdom of Saudi Arabia. o.kensara@gmail.com.
5
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah, PO Box 7607, Makkah, Kingdom of Saudi Arabia. amrmohamed2004@yahoo.com.
6
Clinical Laboratory Diagnosis, Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut, 71526, Egypt. amrmohamed2004@yahoo.com.
7
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah, PO Box 7607, Makkah, Kingdom of Saudi Arabia. shakir_sust@hotmail.com.
8
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah, PO Box 7607, Makkah, Kingdom of Saudi Arabia. jawad7776@gmail.com.
9
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah, PO Box 7607, Makkah, Kingdom of Saudi Arabia. athar.h.k@hotmail.com.


Authors:
Roman S1,2, Keefer L1, Imam H1,3, Korrapati P1, Mogni B1, Eident K1, Friesen L1, Kahrilas PJ1, Martinovich Z1, Pandolfino JE1.

Title:
Majority Of Symptoms In Esophageal Reflux PPI Non-Responders Are Not Related To Reflux.

Abstract:
BACKGROUND:
Genesis of persistent gastro-esophageal reflux symptoms despite proton pump inhibitor (PPI) therapy is not fully understood. We aimed at determining reflux patterns on 24-h pH-impedance monitoring performed on PPI and correlating impedance patterns and symptom occurrence in PPI non-responders.

METHODS:
Seventy-eight PPI non-responder patients underwent 24-h pH-impedance monitoring on PPI. Reflux impedance characterization included gastric and supragastric belches and proximal extent of reflux. Symptoms were considered associated with reflux if occurring within 5 min after a reflux event. Patients were classified into three groups: persistent acid reflux (acid esophageal exposure [AET] >5% of time), reflux sensitivity (AET <5%, symptom index [SI] ≥50%), and functional symptoms (AET <5%, SI <50%). Dominant impedance pattern was determined for each patient.

KEY RESULTS:
Seven patients (9%) had persistent acid reflux, 28 (36%) reflux sensitivity, and 43 (55%) functional symptoms. A total of 4296 reflux events were identified (median per patient 45 [range 4-221]). Although liquid reflux was the most common pattern in all groups, patients with reflux sensitivity and functional symptoms had much more variability in their pattern profile with a large proportion being associated with gastric and supragastric belching. Only 417 reflux events (9.7%) were associated with symptoms. Reflux with a supragastric component and proximal extent were more likely to be associated with symptoms.

CONCLUSIONS & INFERENCES:
The impedance reflux profile in PPI non-responders was heterogeneous and the majority of reflux events were not associated with symptoms. Thus, the treatment of PPI non-responders should focus on mechanisms beyond reflux, such as visceral hypersensitivity and hypervigilance.

Author Info:
1
Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
2
Digestive Physiology, Hospices Civils de Lyon, Lyon I university and LabTAU Inserm 1032, Lyon, France.
3
Gastroenterology and Hepatology Unit, Department of Internal Medicine, Assiut University Hospital, Assiut, Egypt.


Authors:
Saad K, El-Houfey AA, Abd El-Hamed MA, El-Asheer OM, Al-Atram AA, Tawfeek MS.

Title:
A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Of The Efficacy Of Treatment With Zinc In Children With Intractable Epilepsy.

Abstract:
This study was conducted to assess the efficacy of oral zinc supplementation in children with intractable epilepsy. Forty-five children aged between three and 12 years and diagnosed with idiopathic intractable epilepsy at Assiut University Hospital, Assiut, Egypt were recruited. The patients were randomly allocated to two groups: the intervention group received oral zinc supplementation (1 mg/kg/day) while the placebo group received placebo, each for six months. The parents of each child filled in a detailed questionnaire that covered demographic characteristics, type of seizures, frequency, duration of seizures, previous hospital admissions, postictal phenomena and the occurrence of status epilepticus. The primary outcome (frequency of seizures) was compared between the two groups. Zinc supplementation resulted in a significant reduction of seizure frequency in 31% of the treated children. Zinc is an important trace element. Our results suggest that it has mildly beneficial effects in children with intractable epilepsy. We recommend further investigation of oral zinc supplementation as an adjunctive therapy for managing intractable epilepsy in children. Zinc therapy may be an option in treatment protocols for intractable epilepsy in the near future.


Authors:
Saad K1, Eltayeb AA1, Mohamad IL1, Al-Atram AA2, Elserogy Y3, Bjørklund G4, El-Houfey AA5,6, Nicholson B7.

Title:
A Randomized, Placebo-controlled Trial of Digestive Enzymes in Children with Autism Spectrum Disorders.

Abstract:
OBJECTIVE:
There is growing evidence for a gut-brain connection associated with autism spectrum disorders (ASDs). 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 the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (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.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Psychiatry, College of Medicine, Almajmaah University, Kingdom of Saudi Arabia.
3
Department of Neuropsychiatry, Assiut University, Assiut, Egypt.
4
Council for Nutritional and Environmental Medicine, Mo i Rana, Norway.
5
Department of Community Health Nursing, Faculty of Nursing and Health Allied, Jazan University, Kingdom of Saudi Arabia.
6
Faculty of Nursing, Assiut University, Assiut, Egypt.
7
Nicholson Science, Tampa, FL, USA.


Authors:
Sadiq MA1, Hassan M2, Agarwal A3, Sarwar S4, Toufeeq S5, Soliman MK6,7, Hanout M8, Sepah YJ9, Do DV10, Nguyen QD11.

Title:
Endogenous Endophthalmitis: Diagnosis, Management, And Prognosis.

Abstract:
Endogenous endophthalmitis is an ophthalmic emergency that can have severe sight-threatening complications. It is often a diagnostic challenge because it can manifest at any age and is associated with a number of underlying predisposing factors. Microorganisms associated with this condition vary along a broad spectrum. Depending upon the severity of the disease, both medical and surgical interventions may be employed. Due to rarity of the disease, there are no guidelines in literature for optimal management of these patients. In this review, treatment guidelines based on clinical data and microorganism profile have been proposed.

Author Info:
1
Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. ali.sdq@hotmail.com.
2
Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. muhammadhassan070@gmail.com.
3
Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. aniruddha9@gmail.com.
4
Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. salman.sarwar@gmail.com.
5
Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. shafak.toufeeq@nhs.net.
6
Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. mhmd_soliman@hotmail.com.
7
Department of Ophthalmology, Assiut University Hospital, Assiut University, Assiut, Egypt. mhmd_soliman@hotmail.com.
8
Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. mostafa.hanout@gmail.com.
9
Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. yasir.sepah@unmc.edu.
10
Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. diana.do@unmc.edu.
11
Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. quan.nguyen@unmc.edu.


Authors:
Saleem TH1, Attya AM, Ahmed EA, Ragab SM, Ali Abdallah MA, Omar HM.

Title:
Possible Protective Effects of Quercetin and Sodium Gluconate Against Colon Cancer Induction by Dimethylhydrazine in Mice.

Abstract:
Micronutrients in food have been found to have chemopreventive effects, supporting the conclusions from epidemiologie studies that consumption of fresh fruits and vegetables reduces cancer risk. The present study was carried out to evaluate the role of querctin (Q) and sodium gluconate (GNA) supplementation separately or in combination in ameliorating promotion of colon tumor development by dimethyl-hydrazine (DMH) in mice. Histopathological observation of colons in mice treated with DMH showed goblet cell dysplasia with inflammatory cell infiltration. This pathological finding was associated with significant alteration in oxidative stress markers in colon tissues and carcinoembryonic antigen (CEA) levels in plasma. Mice co-treated with GNA and Q showed mild changes of absorptive and goblet cells and inflammatory cell infiltration in lamina properia, with improvement in oxidative stress markers. In conclusion, findings of the present study indicate significant roles for reactive oxygen species (ROS) in pathogenesis of DMH-induced colon toxicity and initiation of colon cancer. Also, they suggest that Q, GNA or the combination of both have a positive beneficial effect against DMH induced colonic cancer induction in mice.

Author Info:
1
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt E-mail : hossameldin mo@gmail.com.


Authors:
Saleh Farghaly HR1, Mohamed Sayed MH2, Nasr HA3, Abdelaziz Maklad AM4.

Title:
Dual Time Point Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography In Differentiation Between Malignant And Benign Lesions In Cancer Patients. Does It Always Work?

Abstract:
OBJECTIVES:
Assess the added value of dual time point F-18-fluorodeoxyglucose positron emission tomography/computed tomography (DTP F-18-FDG-PET/CT) in the differentiation of malignant from a benign lesion in cancer patients.

MATERIALS AND METHODS:
Totally, 140 F-18-FDG PET/CT scans of 60 cancer patients who underwent DTP protocol (early whole body PET/CT [E] at 60 min [range, 45-76 min] and delayed limited PET/CT [D] on areas of interest at 120 min [range, 108-153 min] after the tracer injection) were retrospectively reviewed. Visual and semi-quantitative analysis was performed on both early and delayed images. All findings were confirmed by histopathology and/or at least 3 months follow-up (F-18-FDG PET/CT, CT, or magnetic resonance imaging). The result was considered true positive (TP) if delayed standardized uptake value (SUV) of suspicious lesions increased and confirmed to be malignant, false positive (FP) if delayed SUV increased and confirmed to be benign, true negative (TN) if delayed SUV unchanged or decreased and confirmed to be benign, and false negative (FN) if delayed SUV unchanged or decreased and confirmed to be malignant.

RESULTS:
A total of 164 suspicious lesions were detected (20 presacral lesions, 18 lung nodules, 18 Hodgkin's disease (HD) lesions, 16 rectal lesions, 16 head and neck (H and N) lesions, 14 hepatic lesions, 14 non-Hodgkin's lymphoma (NHL) lesions, 12 mediastinal lymph nodes (LNs), 10 focal gastric uptake, 10 soft tissue lesions, 8 breast lesions, 4 peritoneal nodule, and 4 others). Sixty-four lesions were pathologically confirmed, and 100 lesions were confirmed based on 3-6 months follow-up. There were 62 TP lesions, 44 FP, 58 TN and no FN results. The overall sensitivity was 100% of DTP F-18-FDG PET/CT in detecting suspicious lesions. The specificity was 57% in differentiating malignant from benign lesions, and the accuracy was 73%. Positive predictive value was 59%, negative predictive value (NPV) 100%. All hepatic lesions were TP. Accuracy in metastatic hepatic lesions HD, presacral soft tissue, lung nodules, H, and N cancer, breast cancer, NHL and mediastinal LN was100%, 88.8%, 80%, 78%, 75%, 75%, 71%, and 33.3%, respectively.

CONCLUSIONS:
DTP F-18-FDG-PET/CT protocol does not always work in differentiation between benign and malignant lesions. However; it has high NPV, and promising results was noted in hepatic lesions, lymphoma, and recurrent rectal cancer.

Author Info:
1
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt, Saudi Arabia ; Department of Radiology, Division of Nuclear Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
2
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt, Saudi Arabia.
3
Department of Oncology and Nuclear Medicine, Nuclear Medicine Unit, Kasr Al-Aini - Cairo University Hospital, Cairo, Egypt.
4
Department of Clinical Oncology, Faculty of Medicine, Sohag University, Sohag, Egypt.


Title:
Technetium-99m Dimercaptosuccinic Acid Scan In Evaluation Of Renal Cortical Scarring: Is It Mandatory To Do Single Photon Emission Computerized Tomography?

Abstract:
OBJECTIVES:
Renal cortical scintigraphy with technetium-99m (Tc-99m) dimercaptosuccinic acid (DMSA) is the method of choice to detect acute pyelonephritis and cortical scarring. Different acquisition methods have been used: Planar parallel-hole or pinhole collimation and single photon emission tomography (SPECT). This study compared planar parallel-hole cortical scintigraphy and dual-head SPECT for detection of cortical defects.

PATIENTS AND METHODS:
We retrospectively reviewed 190 consecutive patients with 380 kidneys and 200 DMSA scans referred to rule out renal cortical scarring. The diagnoses were 52 vesicoureteric reflux, 61 recurrent urinary tract infection, 39 hydronephrosis, 20 renal impairment, and 18 hypertension. All patients were imaged 3 h after injection of Tc-99m DMSA with SPECT and planar imaging (posterior, anterior, left, and right posterior oblique views). For each patient, planar and SPECT images were evaluated at different sittings, in random order. Each kidney was divided into three cortical segments (upper, middle and lower) and was scored as normal or reduced uptake. The linear correlation coefficient for the number of abnormal segments detected between planner and SPECT techniques was calculated.

RESULTS:
From 200 DMSA scans, 100 scans were positive for scar in SPECT images, from which only 95 scans were positive for scar in planner imaging. Out of the five mismatched scans, three scans were for patients with renal impairment and high background activity and two scans were for very small scars. No significant difference was seen in the average number of abnormal segments detected by planar versus SPECT imaging (P = 0.31). The average correlation coefficient between was high (r = 0.91 - 0.92).

CONCLUSIONS:
Tc-99m DMSA renal cortical scanning using SPECT offers no statistically significant diagnostic advantage over multiple views planar imaging for detection of cortical defect.

Author Info:
1
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt ; Department of Radiology, Division of Nuclear Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
2
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Salem HF1, Ahmed SM2, Hassaballah AE3, Omar MM4.

Title:
Targeting Brain Cells With Glutathione-Modulated Nanoliposomes: In Vitro And In Vivo Study.

Abstract:
BACKGROUND:
The blood-brain barrier prevents many drug moieties from reaching the central nervous system. Therefore, glutathione-modulated nanoliposomes have been engineered to enhance the targeting of flucytosine to the brain.

METHODS:
Glutathione-modulated nanoliposomes were prepared by thin-film hydration technique and evaluated in the primary brain cells of rats. Lecithin, cholesterol, and span 65 were mixed at 1:1:1 molar ratio. The molar percentage of PEGylated glutathione varied from 0 mol% to 0.75 mol%. The cellular binding and the uptake of the targeted liposomes were both monitored by epifluorescent microscope and flow cytometry techniques. A biodistribution and a pharmacokinetic study of flucytosine and flucytosine-loaded glutathione-modulated liposomes was carried out to evaluate the in vivo brain-targeting efficiency.

RESULTS:
The size of glutathione-modulated nanoliposomes was <100 nm and the zeta potential was more than -65 mV. The cumulative release reached 70% for certain formulations. The cellular uptake increased as molar percent of glutathione increased to reach the maximum at 0.75 mol%. The uptake of the targeted liposomes by brain cells of the rats was three times greater than that of the nontargeted liposomes. An in vivo study showed that the relative efficiency was 2.632±0.089 and the concentration efficiency was 1.590±0.049, and also, the drug-targeting index was 3.670±0.824.

CONCLUSION:
Overall, these results revealed that glutathione-PEGylated nanoliposomes enhance the effective delivery of flucytosine to brain and could become a promising new therapeutic option for the treatment of the brain infections.

Author Info:
1
Department of Pharmaceutics and Industrial Pharmacy, Beni-suef University, Assuit, Egypt.
2
Department of Industrial Pharmacy, Assiut University, Egypt.
3
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assuit, Egypt.
4
Department of Pharmaceutics and Industrial Pharmacy, Beni-suef University, Assuit, Egypt ; Department of Pharmaceutics and Industrial Pharmacy, Deraya University, Egypt.


Authors:
Saso S1, Louis LS2, Doctor F3, Hamed AH4, Chatterjee J2, Yazbek J5, Bora S3, Abdalla H3, Ghaem-Maghami S5, Thum MY3.

Title:
Does Fertility Treatment Increase The Risk Of Uterine Cancer? A Meta-Analysis.

Abstract:
An ongoing debate over the last two decades has focused on whether fertility treatment in women may lead to an increased risk of developing uterine cancer over a period of time. Uterine cancer (including mainly endometrial carcinoma and the less common uterine sarcoma) is the commonest reproductive tract cancer and the fourth commonest cancer in women in the UK. Our objective was to assess the association between fertility drugs used in the treatment of female infertility (both as an independent therapy and during in vitro fertilization cycles) and the development of uterine cancer. A literature search was performed using Medline, Embase, Cochrane Library and Google Scholar databases for comparative studies until December 2014 to investigate a clinical significance of fertility treatment on the incidence of developing uterine cancer. General and MESH search headings, as well as the 'related articles' function were applied. All comparative studies of 'fertility treatment' versus 'non-fertility treatment' reporting the incidence of uterine cancer as an outcome were included. Uterine cancer incorporated the following terms: uterine cancer, uterine body tumours, uterine sarcomas and endometrial cancers. The primary outcome of interest was the uterine cancer incidence in all 'fertility treatment' versus 'non-fertility treatment' patient groups. Secondary outcomes of interest were: (a) uterine cancer incidence in 'IVF' versus 'non-IVF' patient groups; and (b) uterine cancer incidence according to type of fertility drug used. Odds ratio was the summary statistic. Random-effects modelling, graphical exploration and sensitivity analysis were used to evaluate the consistency of the calculated treatment effect. We included six studies in our final analysis, which comprised 776,224 patients in total. Of these, 103,758 had undergone fertility treatment and 672,466 had not. There was 100% agreement between the two reviewers regarding the data extraction. All the studies contained groups that were comparable in age, although the criteria of reporting age varied. Taking all studies into account, the incidence of uterine cancer was 0.14% (150 of 103,758) in the fertility treatment group and 2.22% (14,918 of 672,466) in the non-fertility treatment group. Using the random-effect model to analyze uterine cancer incidence, this difference was not found to be of statistical significance: OR 0.78 (95% CI, 0.39-1.57). The degree of heterogeneity was high (I(2)=68%). The risk for the development of uterine and in particular endometrial cancer posed by infertility and an unopposed oestrogen state is widely recognized. The present analysis aimed to perceive whether standard fertility drugs were also a risk to future uterine cancer development. The treatment does increase the concentrations of unopposed oestrogen for a short periods of time but if successful leads to fertility. This meta-analysis points to a non-deleterious effect of fertility drugs towards the development of uterine cancer, a conclusion strongly supported by our sub-group analysis.

Author Info:
1
Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK. Electronic address: srdjan.saso@imperial.ac.uk.
2
Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK.
3
The Lister Hospital, Chelsea, London, UK.
4
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Imperial College London, Hammersmith House, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK.


Authors:
Saso S1, Clarke A2, Bracewell-Milnes T3, Al-Memar M1, Hamed AH4, Thum MY5, Ghaem-Maghami S1, Del Priore G6, Smith JR1.

Title:
Survey Of Perceptions Of Health Care Professionals In The United Kingdom Toward Uterine Transplant.

Abstract:
CONTEXT:
Currently, the only 2 options that women with absolute uterine factor infertility have for managing their infertility are surragocy or adoption. These women may also benefit from a possible future third option: uterine transplant.

OBJECTIVE:
To investigate the opinions and views of UK health care professionals toward uterine transplant and rank issues related to uterine transplant by importance in order to make uterine transplant transparent and understandable to colleagues.

DESIGN:
Large, in-depth survey investigating health care professionals' opinions on uterine transplant.

SETTING:
Analysis done at Imperial College London.

PARTICIPANTS:
UK transplant professionals (surgeons, nurses, operating room staff, and donor coordinators) and obstetricians and gynecologists (trainees, members, and fellows of the Royal College of Obstetricians and Gynaecologists).

INTERVENTION:
Questionnaires were given out at hospital grand rounds, trainee teaching days, and conferences (national and international).

MAIN OUTCOME MEASURES:
Should uterine transplant take place? Is uterine transplant achievable? What is the rank order of importance of key issues related to uterine transplant?

RESULTS:
The study had 528 participants. With respect to overall support for uterine transplant and as a possible future therapeutic option for absolute uterine factor infertility, 93.8% (n=495) thought that uterine transplant should take place if considered appropriate medically, surgically, and ethically and 57.2% (n=302) thought it was an achievable objective. Issues related to immunology of uterine transplant and pregnancy after uterine transplant were unanimously thought of as most important. More effort is required to educate health care professionals about all aspects of uterine transplant.

Author Info:
1
Imperial College London.
2
Royal Free London, NHS Foundation Trust, London.
3
William Harvey Hospital, Ashford.
4
United Kingdom, Assiut University, Assiut, Egypt.
5
The Lister Hospital, Chelsea, London, United Kingdom.
6
Southeastern Regional Medical Center, Georgia.


Authors:
Sayed S1, Idriss NK, Blann A, Sayyed HG, Raafat DM, Fouad D, Tawfeek MS.

Title:
The Number of GT(n) Repeats in the Hemeoxygenase-1 Gene Promoter is Increased in Pediatric Heart Failure but is Unrelated to Renal, Antioxidant and Anti-inflammatory Markers.

Abstract:
Products of hemeoxygenase (HO)-1 have anti-inflammatory and antioxidant functions. The HO-1 promoter has a variable number of GT(n) repeats: A low number (n < 23) is associated with high transcriptional activity in response to oxidative stress. We hypothesized that the frequency of GT(n) repeats in pediatric heart failure (HF) reflects plasma biomarkers of different disease processes: the soluble receptor for advance glycation end products (sRAGE, marking cellular activation), oxLDL (oxidative stress), NGAL (impaired renal function), HIF-1α (hypoxia) and hsCRP (inflammation). Sixty HF children [aged 4-14 years, 30 with HF due to idiopathic dilated cardiomyopathy (IDCM), 30 due to chronic renal failure (CRF)] were compared to 20 healthy controls (HC). Leukocyte HO-1 GT(n) repeats were determined by PCR, plasma markers by ELISA or nephelometry. The number of GT(n) repeats in the HF patients was higher than the number of repeats in the controls, with no difference between the patient groups (p < 0.001). sRAGE, oxLDL, HIF-1α, NGAL and hsCRP were higher in both HF groups compared to HC (all p < 0.01). IDCM had higher sRAGEs and HIF-1α compared to CRF patients (p < 0.01). NGAL was higher in CRF compared to IDCM (p < 0.01). None of the plasma/serum markers correlated with the number of GT(n) repeats in any group. The number of HO-1 promoter GT(n) polymorphism is increased in both IDCM and CRF children with HF, but is unrelated to plasma markers of different pathological processes. This casts doubts on the clinical value of the number of GT(n) repeats in pediatric HF.

Author Info:
1
Anesthesiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Shaaban OM1, Abbas AM2, Moharram AM3, Farhan MM4, Hassanen IH5.

Title:
Does Vaginal Douching Affect The Type Of Candidal Vulvovaginal Infection?

Abstract:
The normal vaginal microbiota is a dynamic system that continually fluctuates under the environmental changes and different physiological conditions. Yeast infections of the vagina are caused by one of the species of fungus called Candida (C.). The study aimed to evaluate the types of mycobiota in women with vulvovaginal candidiasis (VVC) who were performing vaginal douching (VD) or not. Furthermore, it studied the antifungal sensitivity toward different fungi isolated from the vagina. In a cross-sectional study conducted in Assiut University Hospital, Egypt, women with VVC were interviewed regarding relevant history including the habit of VD. Vaginal swabs were obtained and processed by direct microscope and by culture on CHROMagar Candida and other differential media. The types of Candida in women with the habit of VD were compared with those not having this habit. We found that VD habit was practiced by 67.4% of women with VVC, and Candida albicans was the commonest (78.3%) type observed. There was no significant difference in the percentage of non-albicans types between women performing VD (23.6%) and those not reporting this habit (18.9%). Harboring non-albicans types were significantly increased in regular performers of VD compared with those who had this procedure only after sexual intercourse or after the end of menstruation (36.8%,12.5%, and 16.7%, respectively) (P = .048). Thus, vaginal douching does not influence the type of Candida infection involved in VVC. Frequent performance of VD increases the likelihood of having non-albicans types and the resistance to the common antifungal agents.

Author Info:
1
Assiut University, Obstetrics and gynecology, Assiut, Egypt.
2
Assiut University, Obstetrics and gynecology, Assiut, Egypt bmr90@hotmail.com.
3
Assiut University, Botany Department, Assiut, Egypt.
4
Ibb University, Medical Microbiology, Ibb, Yemen.
5
Sohag University, Obstetrics and gynecology, Sohag, Egypt.


Authors:
Shaaban OM1, Abbas AM1, Abdel Hafiz HA2, Abdelrahman AS2, Rashwan M3, Othman ER1.

Title:
Effect Of Pregnancy-Lactation Overlap On The Current Pregnancy Outcome In Women With Substandard Nutrition: A Prospective Cohort Study

Abstract:
BACKGROUND:
Pregnancy during lactation is common in Egypt and is often unplanned. Overlap between pregnancy and lactation could be associated with an increased risk for the pregnant mother, her fetus as well as her nursing child.

AIM OF THE STUDY:
The current study aims to compare the maternal and perinatal outcome of pregnancies occurred during lactation with those occurred after weaning in women with substandard nutrition.

MATERIALS AND METHODS:
A prospective-cohort study was carried out in six Maternal and Child Health Centers in Assiut-Egypt. Estimated sample size was 540 women divided equally into two groups; the first included women who got pregnant during breastfeeding (PDBF), while the second included women who got pregnant after weaning (PAW). Tools were consisted of structured interview questionnaire including personal history, obstetrical data, breastfeeding, family planning histories and dietary intake during pregnancy. Pregnant women had been followed up to delivery to assess different maternal and fetal outcomes.

RESULTS:
Miscarriage rate was not statistically significant between both groups (2.2% in PDBF and 0.4% in PAW, p = 0.284). Women in PDBF group had higher prevalence of maternal anemia (54.1% versus 30.7%), intrauterine growth restriction (16.7% versus 4.8%), cesarean delivery (43.7% versus 31.5%), prolonged labor (13.3% versus 11.1%) and low birth weight infants (15.7% versus 8.8%) compared to women in PAW group.

CONCLUSION:
Pregnancy during breastfeeding is associated with an increase in the overall complications of pregnancy as compared to PAW. Although it does not increase the miscarriage rate, it increases the prevalence of maternal anemia, delayed fetal growth, prolonged labor, cesarean section delivery and the prevalence of low birth weight infants.

Author Info:
1
Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut Governorate, Egypt.
2
Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Assiut University, Assiut Governorate, Egypt.
3
Department of food science and technology, Faculty of Agriculture, Assiut University, Assiut Governorate, Egypt.


Authors:
Shaaban OM1, Ali MK2, Sabra AM2, Abd El Aal DE2.

Title:
Levonorgestrel-Releasing Intrauterine System Versus A Low-Dose Combined Oral Contraceptive For Treatment Of Adenomyotic Uteri: A Randomized Clinical Trial.

Abstract:
INTRODUCTION:
This study compares the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) and a low-dose combined oral contraceptive (COC) in reducing adenomyosis-related pain and bleeding.

MATERIALS AND METHODS:
A randomized clinical trial included 62 participants complaining of pain and bleeding that was associated with adenomyosis. Participants were randomly assigned to either LNG-IUS or COC treatment. The outcomes included the improvement of pain using a visual analogue scale, menstrual blood loss using a menstrual diary and estimated uterine volume by ultrasound for 6 months of treatment. We also compared uterine arteries and intramyometrial Doppler indices before and 6 months after treatment with both LNG-IUS and COCs.

RESULTS:
Both treatments significantly reduced pain after 6 months of use; however, the reduction was greater in the LNG-IUS group (from 6.23±0.67 to 1.68±1.25) compared with the COCs group (from 6.55±0.68 to 3.90±0.54). Both treatment arms significantly decreased the number of bleeding days, uterine volume and Doppler blood flow in the uterus from before to after treatment. These effects were more significant in the LNG-IUS arm compared with the COC arm.

CONCLUSION:
Both LNG-IUS and COCs decreased the pain and menstrual bleeding that is associated with adenomyosis. However, LNG-IUS is more effective than the COCs in reducing pain and menstrual blood loss. This effect may be secondary to the decrease in uterine volume and the increase in blood flow resistance.

Author Info:
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt. Electronic address: omshaaban2000@yahoo.com.
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt.


Authors:
Shazly SA1, Murad MH2, Dowdy SC3, Gostout BS3, Famuyide AO4.

Title:
Robotic Radical Hysterectomy In Early Stage Cervical Cancer: A Systematic Review And Meta-Analysis.

Abstract:
OBJECTIVE:
To compare intraoperative and short-term postoperative outcomes of robotic radical hysterectomy (RRH) to laparoscopic and open approaches in the treatment of early stage cervical cancer.

METHODS:
A search of MEDLINE, EMBASE (using Ovid interface) and SCOPUS databases was conducted from database inception through February 15, 2014. We included studies comparing surgical approaches to radical hysterectomy (robotic vs. laparoscopic or abdominal, or both) in women with stages IA1-IIA cervical cancer. Intraoperative outcomes included estimated blood loss (EBL), operative time, number of pelvic lymph nodes harvested and intraoperative complications. Postoperative outcomes were hospital stay and surgical morbidity. The random effects model was used to pool weighted mean differences (WMDs) and odds ratios (OR).

RESULTS:
Twenty six nonrandomized studies were included (10 RRH vs abdominal radical hysterectomy [ARH], 9 RRH vs laparoscopic radical hysterectomy [LRH] and 7 compared all 3 approaches) enrolling 4013 women (1013 RRH, 710 LRH and 2290 ARH). RRH was associated with less EBL (WMD=384.3, 95% CI=233.7, 534.8) and shorter hospital stay (WMD=3.55, 95% CI=2.10, 5.00) than ARH. RRH was also associated with lower odds of febrile morbidity (OR=0.43, 95% CI=0.20-0.89), blood transfusion (OR=0.12, 95% CI 0.06, 0.25) and wound-related complications (OR=0.31, 95% CI=0.13, 0.73) vs. ARH. RRH was comparable to LRH in all intra- and postoperative outcomes.

CONCLUSION:
Current evidence suggests that RRH may be superior to ARH with lower EBL, shorter hospital stay, less febrile morbidity and wound-related complications. RRH and LRH appear equivalent in intraoperative and short-term postoperative outcomes and thus the choice of approach can be tailored to the choice of patient and surgeon.

Author Info:
1
Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; Department of Obstetrics and Gynecology, Women Health Hospital, Assiut University, Egypt.
2
Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA.
3
Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
4
Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA. Electronic address: famuyide.abimbola@mayo.edu.


Authors:
Shehata GA1, El Mistikawi T2, Risha AS2, Hassan HS2.

Title:
The Effect Of Aphasia Upon Personality Traits, Depression And Anxiety Among Stroke Patients.

Abstract:
BACKGROUND:
Post-stroke patients with aphasia have higher levels of psychological distress. We aimed to find the relation between post-stroke aphasia and depression, anxiety and personality traits.

METHODS:
One month after stroke, 61 consecutive patients with stroke were included in this study. Thirty post-stroke patients with aphasia and 31 patients without aphasia. We used the following scales a clinical-friendly: Aphasic test, Eysenck Personality Questionnaire, Hamilton anxiety and Beck Depression Inventory.

RESULTS:
Depression and anxiety were more prominent among patients with aphasia than stroke without aphasia. Psychosis was more prominent among post-stroke patients with aphasia.

LIMITATIONS:
Our results may not exclusively exclude pre-morbid personality traits.

CONCLUSIONS:
Our study highlights the growing need to develop community rehabilitation services in the developing world, which address both physical and psychological morbidity.

Author Info:
1
Department of Neurology and Psychiatry, Assiut University Hospital, Hospital of Neurology and Psychiatry, Floor # 7, Room # 4, P. O. Box 71516, Assiut, Egypt. Electronic address: ghaydaa83@yahoo.com.
2
Department of Psychology, Faculty of Arts, Assiut University, Assiut, Egypt.


Authors:
Shibui A1,2, Takamori A2, Tolba MEM1,3, Nambu A2, Shimura E2,4, Yamaguchi S2, Sanjoba C4, Suto H5, Sudo K6, Okumura K5, Sugano S1, Morita H7, Saito H7, Matsumoto K7, Nakae S2,8.

Title:
IL-25, IL-33 And TSLP Receptor Are Not Critical For Development Of Experimental Murine Malaria.

Abstract:
IL-25, IL-33 and TSLP, which are produced predominantly by epithelial cells, can induce production of Th2-type cytokines such as IL-4, IL-5 and/or IL-13 by various types of cells, suggesting their involvement in induction of Th2-type cytokine-associated immune responses. It is known that Th2-type cytokines contribute to host defense against malaria parasite infection in mice. However, the roles of IL-25, IL-33 and TSLP in malaria parasite infection remain unclear. Thus, to elucidate this, we infected wild-type, IL-25-/-, IL-33-/- and TSLP receptor (TSLPR)-/- mice with Plasmodium berghei (P. berghei) ANKA, a murine malaria strain. The expression levels of IL-25, IL-33 and TSLP mRNA were changed in the brain, liver, lung and spleen of wild-type mice after infection, suggesting that these cytokines are involved in host defense against P. berghei ANKA. However, the incidence of parasitemia and survival in the mutant mice were comparable to in the wild-type mice. These findings indicate that IL-25, IL-33 and TSLP are not critical for host defense against P. berghei ANKA.

Author Info:
1
Department of Medical Genomics, Graduate School of Frontier Sciences, The University of Tokyo, Chiba 277-8561, Japan.
2
Laboratory of Systems Biology, Center for Experimental Medicine and Systems Biology, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan.
3
Department of Parasitology, Assiut University, Assiut 71515, Egypt.
4
Department of Molecular Immunology, School of Agricultural and Life Sciences, The University of Tokyo, Tokyo 113-8657, Japan.
5
Atopy Research Center, Juntendo University, Tokyo 113-8412, Japan.
6
Animal Research Center, Tokyo Medical University, Tokyo 160-8402, Japan.
7
Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan.
8
Precursory Research for Embryonic Science and Technology (PRESTO), Japan Science and Technology Agency, Saitama 332-0012, Japan.


Authors:
Silva PS1, Cavallerano JD2, Haddad NM3, Kwak H3, Dyer KH3, Omar AF4, Shikari H3, Aiello LM2, Sun JK2, Aiello LP2.

Title:
Peripheral Lesions Identified on Ultrawide Field Imaging Predict Increased Risk of Diabetic Retinopathy Progression over 4 Years.

Abstract:
OBJECTIVE:
To determine whether peripheral diabetic retinopathy (DR) lesions identified on ultrawide field (UWF) imaging are associated with increased DR progression.

DESIGN:
Prospective, longitudinal cohort.

PARTICIPANTS:
Two hundred eyes of 100 participants previously enrolled in a comparative instrument validation study.

METHODS:
Baseline mydriatic 7-standard field Early Treatment Diabetic Retinopathy Study (ETDRS) photographs and UWF images were obtained. On UWF images, DR lesions with a greater extent outside versus inside standard ETDRS fields were defined as predominantly peripheral lesions (PPLs). Follow-up ETDRS photographs were obtained 4.2±0.3 years after baseline. Baseline and follow-up DR severity were graded from ETDRS photographs.

MAIN OUTCOME MEASURES:
Rates of 2-step or more progression and progression to proliferative DR (PDR) in eyes with PPLs compared with eyes without PPLs identified on UWF imaging at baseline.

RESULTS:
In eyes without PDR (n = 109) at baseline, 56 (51%) had at least 1 field with PPLs and 43 (39%) had DR progression. Compared with eyes without PPLs, eyes with PPLs had a 3.2-fold increased risk of 2-step or more DR progression (6 [11%] vs. 19 [34%]; P = 0.005) and a 4.7-fold increased risk for progression to PDR (3 [6%] vs. 14 [25%]; P = 0.005). These findings remained statistically significant after adjusting for gender, diabetes type, diabetes duration, hemoglobin A1c (HbA1c) levels, and baseline DR severity. Increasing extent of fields with PPLs increased the risk for 2-step or more DR progression (P = 0.004) and progression to PDR (P = 0.009).

CONCLUSIONS:
Presence and increasing extent of PPLs were associated with increased risk of DR progression over 4 years, independent of baseline DR severity and HbA1c levels. Increasing extent of PPLs substantially increased the risk of DR progression and progression to PDR, especially with less severe DR at baseline. These findings demonstrate that detailed peripheral retinal evaluation provides important information that is necessary to assess completely the risk of DR progression.

Author Info:
1
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts. Electronic address: paoloantonio.silva@joslin.harvard.edu.
2
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
3
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
4
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Soliman MK1, Sarwar S2, Hanout M2, Sadiq MA2, Agarwal A2, Gulati V3, Nguyen QD4, Sepah YJ4.

Title:
High-Resolution Adaptive Optics Findings In Talc Retinopathy.

Abstract:
Talc retinopathy is a recognized ocular condition characterized by the presence of small, yellow, glistening crystals found inside small retinal vessels and within different retinal layers. These crystals can be associated with retinal vascular occlusion and ischemia. Different diagnostic modalities have been used previously to characterize the retinal lesions in talc retinopathy. Adaptive optics, a high resolution imaging technique, is used to evaluate the location, appearance and distribution of talc crystals in a case of talc retinopathy.

Author Info:
1
grid.266813.80000000106664105Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, NE 68198-5540 USA ; grid.252487.e000000008632679XDepartment of Ophthalmology, Assiut University Hospital, Assiut University, Assiut, Egypt.
2
grid.266813.80000000106664105Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, NE 68198-5540 USA.
3
grid.266813.80000000106664105Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE USA.
4
grid.266813.80000000106664105Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, NE 68198-5540 USA ; grid.266813.80000000106664105Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE USA.


Authors:
Suliman YA1, Dobrota R2, Huscher D3, Nguyen-Kim TD4, Maurer B4, Jordan S4, Speich R4, Frauenfelder T4, Distler O4.

Title:
Brief Report: Pulmonary Function Tests: High Rate of False-Negative Results in the Early Detection and Screening of Scleroderma-Related Interstitial Lung Disease.

Abstract:
OBJECTIVE:
Validated methods for the screening and early diagnosis of systemic sclerosis (SSc; scleroderma)-related interstitial lung disease (ILD) are needed. The aim of this study was to evaluate the performance of pulmonary function tests (PFTs) compared with that of high-resolution computed tomography (HRCT) of the chest for the detection of SSc-related ILD in clinical practice, and to identify predictors of lung involvement that is functionally occult but significant on HRCT.

METHODS:
Prospectively enrolled patients with SSc were assessed according to the European League Against Rheumatism (EULAR)/EULAR Scleroderma Trial and Research standards. The assessment included PFTs and HRCT. The HRCT images were evaluated in a blinded manner by 2 experienced radiologists. The performance parameters of PFTs for the diagnosis of SSc-related ILD were calculated. Predictors of significant ILD as determined by HRCT in patients with normal forced vital capacity (FVC) values were identified through logistic regression.

RESULTS:
Among the 102 patients, 64 (63.0%) showed significant ILD on HRCT, while only 27 (26.0%) had an FVC <80% of predicted, and 54 (53.0%) had a decrease in the results of at least 1 PFT. Forty (62.5%) of 64 patients with significant ILD on HRCT had a normal FVC value, translating into a high false-negative rate. Notably, 5 of 40 patients with a normal FVC value had severe, functionally occult lung fibrosis; in 2 of these patients, the results of all of the PFTs were within normal limits. Patients with normal FVC values despite evidence of fibrosis on HRCT more frequently had anti-Scl-70 antibodies and diffuse SSc and less frequently had anticentromere antibodies (ACAs) compared with patients with both normal FVC values and normal HRCT results.

CONCLUSION:
The derived evidence-based data reveal a high risk of missing significant SSc-related ILD when relying solely on PFTs. More comprehensive screening algorithms for early detection are warranted. In particular, additional imaging investigations for the early detection of SSc-related ILD should be considered in ACA-negative patients with normal FVC values.

Author Info:
1
University Hospital Zurich, Zurich, Switzerland, and Assiut University Hospital, Assiut, Egypt.
2
University Hospital Zurich, Zurich, Switzerland, and Dr. I. Cantacuzino Hospital and Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
3
German Rheumatism Research Centre and Charité University Hospital, Berlin, Germany.
4
University Hospital Zurich, Zurich, Switzerland.


Authors:
Tonelli AR1, Ahmed M2, Hamed F1, Prieto LR3.

Title:
Peripheral Pulmonary Artery Stenosis As A Cause Of Pulmonary Hypertension In Adults.

Abstract:
Peripheral pulmonary artery stenosis (PPAS) is an underrecognized condition in the adult population. PPAS can lead to pulmonary hypertension but is likely misdiagnosed as either idiopathic pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. We retrospectively identified adult patients with PPAS either in its isolated form or related to other congenital defects from January 1998 to September 2012. We reviewed the patients' clinical data by using our hospital electronic medical records and/or their paper charts. We identified 6 adult patients with PPAS with an age range of 16-56 years (1 woman and the rest men). Presenting signs and symptoms were thoracic murmurs, progressive dyspnea, and syncope. Three patients had Williams-Beuren syndrome. Pulmonary angiography showed that PPAS was predominantly located in main branches or lobar pulmonary arteries in 5 patients, while in 1 patient the arterial narrowing was at the level of the segmental pulmonary arteries. Right heart catheterization showed a mean pulmonary artery pressure (PAP) ranging from 35 to 60 mmHg. Balloon dilation was performed in all patients, predominantly in the lobar arteries, and it caused a decrease in mean PAP that ranged from 16% to 46% in 5 patients. In 1 patient the mean PAP did not decrease. All but 1 patient had follow-up echocardiograms at 1 year that showed stable echocardiographic findings. Pulmonary hypertension due to PPAS continues to presents a diagnostic challenge. Therefore, a high index of suspicion during the initial evaluation of pulmonary hypertension is essential for its prompt diagnosis and adequate treatment.

Author Info:
1
Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
2
Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Chest Diseases, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Center for Pediatric and Congenital Heart Disease, Cleveland Clinic, Cleveland, Ohio, USA.


Title:
Circadian Pattern of Melatonin MT1 and MT2 Receptor Localization in the Rat Suprachiasmatic Nucleus.

Abstract:
The suprachiasmatic nucleus (SCN) is the master circadian pacemaker. The pineal hormone melatonin is involved in the regulation of circadian phase. As a part of the circadian system, its synthesis and secretion is under SCN control. On the other hand, melatonin feeds back on the SCN to regulate its function. Melatonin has two specific windows of time at which it regulates SCN function, namely dusk and dawn. It has been suggested that melatonin exerts its effect on the SCN during that specific window of time via one or both of its specific receptors, MT1 or MT2. The hypothesis that the density of these receptors varies across the circadian cycle was tested. Using immunohistochemistry with receptor-specific antibodies, the localization and distribution of melatonin receptors MT1 and MT2 was studied in the SCN at different Zeitgeber times (ZT): ZT 11-13 (dusk), 23-01 (dawn), 5-7 (mid-day), and 17-19 (midnight). Our results show that MT1 receptor density significantly increased at dusk relative to dawn and midnight (p<0.01 and p<0.001 respectively). Although MT1 receptors were widespread in the SCN and parts of the optic chiasm at dusk, they were restricted to the SCN during the mid-day period. MT2 receptors were not detected in the SCN. Thus, we find that melatonin receptor MT1 density and distribution varies with circadian time. This creates a time window during which melatonin can affect the operation of the SCN. We also find that melatonin regulates SCN function via MT1 receptors with a minimal role for MT2.

Author Info:
1
Department of Physiology, School of Medicine, Assiut University, Egypt.
2
Department of Biomedical Sciences, Creighton University, United States.


Authors:
Yamamichi F1, Shigemura K2, Behnsawy HM3, Yamashita M4, Shirakawa T2, Fujisawa M2.

Title:
Beta-3 Adrenergic Receptors Could Be Significant Factors For Overactive Bladder-Related Symptoms.

Abstract:
The treatment failure often happens in overactive bladder (OAB) partly owing to its unknown pathogenesis. The purpose of this study is to find significant receptors or biological markers for OAB-related symptoms for establishment of potential order-made therapeutic strategies. The overactive bladder symptom scores (OABSS) and international prostate symptom scores (IPSS)/quality of life (QOL) were questioned in all the 18 patients with OAB diagnosis. Their bladder mucosal tissues were taken from the random biopsy of bladder cancer suspected patients without any finding such as inflammation or carcinoma in situ. They were investigated quantitatively by immunohistochemical (IHC) stainings for inflammatory or immune-system (Interleukin (IL)-6 and cyclooxygenase-2 (Cox-2)), Caspase-3 apoptosis markers, angiogenesis (CD-31), epithelial-mesenchymal transition (E-cadherin) and muscarinic receptor (Muscarine-2 (M)-2), adrenergic receptors (ARs) (alpha 1-d (α1-d) and beta-3 (β-3)). The statistical correlation between the expressions of these 5 markers and 3 receptors and these symptom scores were examined under the comparison between OAB patients and control patients who had urgency score with less than 2 in OABSS. The OABSS and IPSS/QOL was 7.39 ± 2.69 and 21.2 ± 6.59/4.33 ± 1.33, respectively but those of control patients were 2.00 ± 1.41 and 10.1 ± 9.52/2.14 ± 1.46, respectively (P<0.05). Regarding the correlation of those markers' expressions and symptom scores, in OAB patients, OABSS total significantly correlated with β-3 AR expressions (P=0.0457). IPSS post-voiding significantly correlated with β-3 AR expressions (P=0.0308) but no significant relationship in control patients (P>0.05). In conclusion, this study demonstrated that β-3 AR in our tested 8 markers or receptors was correlated strongly with OAB-related symptoms. These data may help elucidate the pathophysiology of OAB and offer possible strategy for its order-made therapies.

Author Info:
1
Department of Organs Therapeutics, Division of Urology, Faculty of Medicine, Kobe University Graduate School of Medicine 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan ; Department of Urology, Hyogo Prefectural Amagasaki General Medical Center 2-17-77 Higashi Naniwa-cho, Amagasaki 660-8550, Japan.
2
Department of Organs Therapeutics, Division of Urology, Faculty of Medicine, Kobe University Graduate School of Medicine 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan.
3
Department of Organs Therapeutics, Division of Urology, Faculty of Medicine, Kobe University Graduate School of Medicine 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan ; Department of Urology, Assiut Urology and Nephrology Center, Faculty of Medicine, Assiut University Assiut, Egypt.
4
Department of Urology, Shinko Hospital 1-4-47 Wakihama-cho, Chuo-ku, Kobe 651-0072, Japan.


Authors:
Yones DA1, Galal LA1, Abdallah AM2, Zaghlol KS2.

Title:
Effect Of Enteric Parasitic Infection On Serum Trace Elements And Nutritional Status In Upper Egyptian Children.

Abstract:
INTRODUCTION:
Enteric parasitic infections still the cause of major health problems among Egyptian children as they have great morbid effect on their physical and cognitive development. Malnutrition makes children more prone to micronutrient deficiency and subsequently more vulnerable to parasitic infection. The present study aimed to identify the effect of intestinal parasitism on micronutrient serum level and children nutritional status.

MATERIALS AND METHODS:
A case control study was carried out on children from 1 to 6 years old who were attending the Assiut University Children Hospital outpatient clinic, after parasitological stool examination they were divided into Group 1 (G1, n: 60) positive with enteric parasite and Group 2 (G2, n: 60) age and sex matched and free of parasites. Anthropometric measurements were expressed as weight for age (WFA), height for age (HFA), and weight for height (WFH) parameters. Serum zinc (Zn) and copper (Cu) were determined by atomic absorption spectrophotometer.

RESULTS:
Intestinal parasitic infection rate was 55.7%; more commonly detected parasites were Giardia lamblia 28%, Cryptosporidium sp. 20%, and polyparasitism 18%. All children (G1 and G2) were underweight (WFA) while 63% of G1 were malnourished, either in the form of wasting (WFH) or stunting (HFA) or both aspects. Stunting and wasting were more dominant among children infected with G. lamblia and Cryptosporidium sp. and most of them were below 2 years old.

CONCLUSIONS:
Coincident decrease in serum Zn level and an increase of serum Cu was more prominent among G. lamblia and Cryptosporidium sp. patients. G. lamblia and Cryptosporidium sp. were found to be more associated with nonstandard children nutritional status beside to an altered micronutrient level.

Author Info:
1
Department of Medical Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Zahran AM1, Elsayh KI2, El-Deek SE3, El-Baz MA3.

Title:
Oxidative Stress, Trace Elements, And Circulating Microparticles In Patients With Gaucher Disease Before And After Enzyme Replacement Therapy.

Abstract:
We studied the level of lipid peroxide, nitric oxide (NO), trace elements (TEs), and microparticles (MPs) in Gaucher disease (GD) before and after 1 year of enzyme replacement therapy (ERT). A total of 15 children with GD and 15 healthy controls were enrolled in this study. Serum level of lipid peroxide, NO, and TEs was determined. The MPs were detected by flow cytometry. The level of lipid peroxide was significantly higher in the patients than in the controls even after ERT. Although NO level was normalized in the patients after ERT, zinc and copper were still lower in the patients after ERT. The percentages of various MPs were significantly higher in the patients than in the controls both before and after ERT. There were positive correlations between chitotriosidase and both lipid peroxide and total MPs.

CONCLUSION:
The GD is associated with alteration in oxidant and antioxidant status and high level of circulating MPs.

Author Info:
1
Department of Oncological Clinical Pathology, Flow Cytometry Lap, South Egypt Cancer Institute, Assiut University, Egypt.
2
Department of Pediatrics, Faculty of Medicine, Assiut University, Egypt elsayh23@yahoo.com.
3
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Egypt.


Authors:
Zahran KM1, Agban MN2, Ahmed SH2, Hassan EA2, Sabet MA3.

Title:
Patterns Of Candida Biofilm On Intrauterine Devices.

Abstract:
Biofilms are colonies of microbial cells encased in a self-produced organic polymeric matrix and represent a common mode of microbial growth. Microbes growing as biofilm are highly resistant to commonly used antimicrobial drugs. We aimed to screen and characterize biofilm formation by different isolates of Candida on removed intrauterine devices (IUDs), to perform experimental biofilm formation with isolated strains, and to examine biofilm by the crystal violet and XTT reduction assays and scanning electron microscopy (SEM). A total of 56 IUDs were examined for biofilm formation using Sabouraud's dextrose chloramphenicol agar. Suspected colonies were identified by different methods. Antifungal susceptibility testing with fluconazole (FLU) and amphotericin B for the isolated strains and in vitro experimental biofilm formation was carried out. The biofilm was quantified by crystal violet, XTT reduction assay and SEM. Among the 56 IUDs investigated, 26 were Candida positive (46.4 %). Candida albicans was recovered from 15 isolates. The biofilm MIC of FLU was increased 64 to 1000 times compared to the MIC for planktonic cells. The XTT method results were dependent on the Candida species; biofilm formation was highest in Candida krusei and Candida glabrata strains, followed by C. albicans and Candida tropicalis. SEM of Candida biofilm revealed a heterogeneous thick biofilm with a mixture of micro-organisms. The main conclusion from this study was non-albicans Candida represents more than a half of the Candida biofilm. Better understanding of Candida biofilms may lead to the development of novel therapeutic approaches for the treatment of fungal infections, especially resistant ones among IUD users.

Author Info:
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt drzahranmk@gmail.com.
2
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Mother and Child Care Clinic, Ministry of Health, Assiut Governorate, Assiut, Egypt.


Authors:
Zaky S1, Makhlouf NA, Abdel Malek MO, Bakheet AA, Seif HM, Hamza HM, Sabry AM.

Title:
Multidisciplinary Decision Making In The Management Of Hepatocellular Carcinoma: A Hospital-Based Study.

Abstract:
BACKGROUND/AIMS:
To evaluate the short-term outcome of the decision taken by the Hepatoma Board for the treatment of Hepatocellular carcinoma (HCC).

MATERIALS AND METHODS:
This was a prospective descriptive study involving 74 patients with HCC diagnosed by the known criteria. The decisions taken by the Hepatoma Board for the 74 patients were as follows: 1- surgical resection (7 patients), 2- local ablative therapy (LAT) (22 patients), 3- conventional transarterial chemoembolization (TACE) (24 patients), and 4- palliative supportive care (21 patients).

RESULTS:
The short-term mortality rate was 25.7% of the total patients. The success rate was nearly equal in LAT (68.2%) and surgery (71.4%), whereas the success rate was approximately 33.3% in TACE. There was no difference in the mean total bilirubin level before and after LAT, surgery, or TACE (p>0.05 for each). There was a significant decrease in the mean serum albumin level after TACE (p=0.000). There was a decrease in the mean alpha fetoprotein level after surgery and LAT (p=0.033) for surgery and (p=0.048) for LAT.

CONCLUSION:
The management of HCC is better performed through a multidisciplinary team decision. Surgery has comparable outcome to LAT but is more invasive. According to our local experience, conventional TACE has a success rate of 33.3%.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Assiut University Faculty of Medicine, Assiut, Egypt. nahedmak@yahoo.com.


Title:
Total Mesorectal Excision For The Treatment Of Rectal Cancer.

Abstract:
INTRODUCTION:
In the surgical treatment of rectal cancer, a clear circumferential resection margin and distal resection margin should be obtained. The aim of this study was to determine the morbidity, mortality, survival outcome, and local failure after total mesorectal excision (TME) in the surgical treatment of rectal cancer.

METHODS:
This retrospective study was conducted on 101 patients treated for rectal cancer using low anterior resection (LAR), abdominoperinial resection (APR), or Hartmaan's technique. In all operative procedures, total mesorectal excisions (TMEs) were done. The patients were treated from November 2000 to April 2011 in the South Egypt Cancer Institute (SECI) of Assuit University (Egypt). Neo-adjuvant therapy was given to those patients with serosalin filtration, lymph node involvement, and sexual and urinary function impairment. Data were analyzed using IBM-SPSS version 21, and survival rates were estimated using the Kaplan-Meier method.

RESULTS:
One hundred one patients were evaluable (61 males, 40 females). Regarding the operative procedure used, it was: (APR), LAR, Hartmaan's technique in 15.8%, 71.3%, and 12.9% of patients, respectively. Operation-related mortality during the 30 days after surgery was 3%. The operations resulted in morbidity in 25% of the patients, anastomotic site leak in 5.9% of the patients, urinary dysfynction in 9.9% of the patients, and erectile dysfunction in 15.8% of the male patients. Regarding safety margin, the median distances were distal/radial margin, 23/12 mm, distal limit 7 cm. Median lymph nodes harvest 19 nodes. Primary tumor locations were anteriorly 23.8%, laterally 13.9%, posteriorly 38.6%, and circumferential 23.8%. Protective stoma 16.8%. Primary Tumor TNM classification (T1, T2, T3, and T4; 3, 28.7, 55.4, and 12.9%, respectively). Nodes Metastases (N0, N1, and N2; 57.4, 31.7, and 10.9%, respectively). TNM staging (I, II, III, and IV; 15.8, 29.7, 46.5, and 7.9%, respectively). Chemotherapy was administered to 67.3% of the patients. Radiotherapy (short course neoadjuvant, long course neoadjuvant, and adjuvant postoperative used in 33.7, 20.8, and 19.8% of patients, respectively). Survival 5-years CSS was 73% and 5-years RFS 71%. Mean operative time was 213 minutes. The average amount of intraoperative blood loss was 344 mL.

CONCLUSION:
Total mesorectal excision (TME) represents the gold-standard technique in rectal cancer surgery. It is safe with neoadjuvent chemoradiotherapy and provides both maximal oncological efficiency (local control and long-term survival and maintenance of a good quality of life).

Author Info:
1
M.D., Lecturer of Surgical Oncology, Department of Surgical oncology, South Egypt Cancer Institute, Assiut University, Assuit, Egypt.
2
M.D., Lecturer of Clinical Oncology, Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assuit, Egypt.


Authors:
Zidan A1, Ibrahim H1, Farrag M1, Shehata M1, Maghrabi M1.

Title:
Giant Haemangioma Of The Liver With Haemangiodudenal Fistula: The First Reported Case In Literature.

Abstract:
Giant liver haemangiomas are usually asymptomatic with normal liver function, which makes the course long and uneventful. The most commonly reported complications of giant haemangiomas are rupture with intraperitoneal haemorrhage that is either traumatic or non-traumatic, consumption coagulopathy, Budd-Chiari syndrome and congestive heart failure. We describe the first reported complications of a giant liver haemangioma as a fistula between the haemangioma and the gastrointestinal tract.

Author Info:
1
Rajhy Liver Hospital, Assiut University , Egypt.


Title:
Histological Study of the Possible Protective Effect of Curcumin on Diabetic ‎Cardiomyopathy ‎

Abstract:
Background Excessive generation of reactive oxygen species is mainly involved in the pathophysiology of diabetic cardiomyopathy. Curcumin is known to be a potent antioxidant and anti-inflammatory polyphenol. Turmeric has been used to treat diabetes mellitus in ancient China and India. Aim of the work The aim of this work was to investigate the potential effects of curcumin on alterations in cardiac muscle histology in diabetic rats and study its associated mechanisms as well. Materials and methods Thirty adult male albino rats (8 weeks) were divided into three equal groups: group I comprised control animals; group II comprised diabetic animals (which received a single intraperitoneal injection of streptozotocin at 65 mg/kg body weight); and group III comprised curcumin-treated diabetic rats (which received curcumin at 80 mg/kg body weight in aqueous oral suspension daily for 6 weeks). Specimens were obtained from the left ventricle and processed for light and electron microscopy and immunostaining. Blood glucose levels were estimated. Results Streptozotocin-injected diabetic rats showed cytoplasmic vacuolation, myofibrillar fragmentation, fibrillolysis, disarrangement and discontinuation of Z-lines, mitochondrial damage with altered chromatin distribution in some nuclei of some cardiac muscle fibers, and an obvious collagen fiber deposition between the cardiac myocytes. Curcumin treatment ameliorated most of these changes and decreased S100A1 protein (calcium-binding protein) immunoreactivity compared with diabetic animals. Conclusion Curcumin treatment ameliorated most of the diabetic cardiomyopathy changes because of its antioxidant and probably its modulating effect on the S100A1 protein expression. © 2015 The Egyptian Journal of Histology.

Author Info:
Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt


Date of Publishing:
Volume 38, Issue 1, 24 April 2015, Pages 57-67

Title:
Effect of Long-Term Boron Administration on the Renal Cortical Structure of ‎Adult Male Albino Rats and Role of Vitamin C Coadministration‎

Abstract:
Background Boron is a chemical and a trace element that exists in the environment, forming borates or acids. Humans consume about a milligram of boron daily, mostly from fruits and vegetables. Boron exposure may occur during industrial processing, intake of boron containing medicines or private botteled drinking water. It is well established that vitamin C is a free radical scavenger that prevents oxidative stress to various cellular macromolecules. Aim of work As More than 90% of boron is eliminated through the kidneys without being metabolized in the body, the present work aimed to study the structural effects of low-dose, long-term boron ingestion on the renal cortices of adult male albino rats and to evaluate the protective role of vitamin C against the possible induced changes. Materials and methods Thiry adult male albino rats were divided into three equal groups: Group I was the control group, group II: received drinking water containing 55×10 -6 g boron/liter for 90 days, and group III received vitamin C (200 mg/kg body weight) orally along with boron for the same period. Kidney specimens were processed for light and electron microscopic study of renal cortices. Results Renal cortices of boron-treated animals showed hypercellularity with narrowing or obliteration of the capsular spaces of the renal corpuscles; the cortical tubular cells showed apoptotic and necrotic changes with many exfoliated cells in the lumina. Abnormal mitochondria and many lysosomes were observed in the tubular cells. Vitamin C coadministration only obviously improved the structural changes in the renal corpuscles and the proximal convoluted tubules. The changes in the distal convoluted tubules and the cortical collecting ducts were not improved. Conclusion Long-term intake of relatively low doses of boron was associated with a toxic effect on the renal cortical structures. Coadministration of vitamin C improved some of these structural changes, most probably owing to its antioxidant and antiapoptotic functions. © 2015 The Egyptian Journal of Histology.


Authors:
Abdel-Wahab, B.A.aEmail Author,  Al-Qahtani, J.M.b,  El-Safty, S.A.c

Title:
Omega-3 Polyunsaturated Fatty Acids in Large Doses Attenuate Seizures, ‎Cognitive Impairment, and Hippocampal Oxidative Dna Damage in Young ‎Kindled Rats‎

Abstract:
Omega-3 (OM3) dietary polyunsaturated fatty acids have promising seizure-protective effects, as well as enhancing effects of cognitive development and memory-related learning. This study aimed to explore the effect of large doses of OM3 on cognitive impairment and hippocampal oxidative DNA damage produced by seizures in epileptic children using a PTZ-kindled young rat model. Cognitive functions, biomarkers of oxidative stress, and DNA damage were assessed in PTZ-kindled young rats (30. mg/kg, i.p. once every other day for 13 injections) pretreated with OM3 (200-500. mg/kg, p.o.). Pretreatment with OM3 at the tested doses significantly attenuated PTZ-induced seizures and decreased cognitive impairment in both passive avoidance and elevated plus maze tests in the PTZ-kindled rats. Moreover, OM3 significantly attenuated the increase in hippocampal malondialdehyde and 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels, as well as the decrease in reduced glutathione (GSH) levels and GSH-peroxidase activity induced by PTZ kindling, in a dose-related manner. Relatively large dose levels of OM3 (200-500. mg/kg) effectively attenuated seizures and their associated cognitive deficits, and reduced oxidative stress and hippocampal DNA damage in PTZ-kindled young rats. © 2014 Elsevier Ireland Ltd.

Author Info:
aDepartment of Pharmacology, College of Medicine, Assiut University, Assiut, Egypt
bDepartment of Pediatrics, College of Medicine, Najran University, Najran, Saudi Arabia
cDepartment of Physiology, College of Medicine, Najran University, Najran, Saudi Arabia


Authors:
Abdel-Wahab, B.A.a,bEmail Author,  Metwally, M.E.c,d

Date of Publishing:
Volume 15, Issue 4, 26 October 2015, Pages 355-365

Title:
Clozapine-Induced Cardiotoxicity: Role of Oxidative Stress, Tumour Necrosis ‎Factor Alpha and Nf-Κβ‎

Abstract:
Safety concerns have been raised about clozapine-induced cardiotoxicity particularly in young patients. The exact mechanism of clozapine cardiotoxicity has not yet been thoroughly studied. This study aimed to investigate the possible mechanisms of clozapine-induced cardiotoxicity in a rat model. Young male Wistar rats were treated with clozapine (10, 15 and 25 mg/kg/day, i.p.) for 21 days. Haemodynamic and echocardiographic studies were performed for assessment of cardiac functions. Heart sections were studied histopathologically and immunohistochemically. Serum and cardiac markers of cardiotoxicity, oxidative stress, inflammation and apoptosis were evaluated. Heart sections of clozapine-treated animals showed increased cardiac inflammation that correlated with the clozapine dose. Serum levels of CK-MB and LDH levels increased, as did cardiac levels of TNF-α, MDA, NO, myeloperoxidase, 8-OHdG, caspase-3 and NF-κB p65. In contrast, GSH levels and GSH-Px activity decreased. Furthermore, immunohistochemical examination of the heart sections showed positive immunostaining for both 3-nitrotyrosine and caspase-3 in all clozapine-treated groups. Clozapine, particularly in relatively high doses, has a clear cardiotoxic effect. This cardiotoxicity is accompanied by increased myocardial oxidative stress, inflammatory cytokines, DNA damage and apoptosis with attenuation in antioxidant defences, thus explaining the previously reported myocarditis and pericarditis during clozapine therapy in clinical studies. © 2014, Springer Science+Business Media New York.

Author Info:
aDepartment of Pharmacology, College of Medicine, Assiut University, Assiut, Egypt
bDepartment of Pharmacology, College of Medicine, Najran University, Najran, Saudi Arabia
cDepartment of Forensic Medicine and Toxicology, College of Medicine, Suez Canal University, Ismailia, Egypt
dDepartment of Forensic Medicine and Toxicology, College of Medicine, Najran University, Najran, Saudi Arabia


Authors:
Abdel-Wahab, R.a,f,  Shehata, S.f,  Hassan, M.M.a,  Xiao, L.b,  Lee, J.-S.c,  Cheung, S.a,  Essa, H.H.f,  Hassabo, H.M.a,  Shalaby, A.S.a, Mosad, E.g,  Raghav, K.a,  Rashid, A.d,  Wolff, R.A.a,  Morris, J.S.b,  Amin, H.M.e,h,  Kaseb, A.O.a

Title:
Validation of an Igf-Ctp Scoring System for Assessing Hepatic Reserve in ‎Egyptian Patients with Hepatocellular Carcinoma‎

Abstract:
Background The Child-Turcotte-Pugh score (CTP) is the standard tool for hepatic reserve assessment in hepatocellular carcinoma (HCC). Recently, we reported that integrating plasma insulin-like growth factor-1 (IGF-1) level into the CTP score was associated with better patient risk stratification in two U.S. independent cohorts. Our current study aimed to validate the IGF-CTP score in patients who have different demographics and risk factors. Patients and Methods We prospectively recruited 100 Egyptian patients and calculated their IGF-CTP score compared to CTP score. C-index was used to compare the prognostic significance of the two scoring systems. Finally, we compared our results with our U.S. cohorts published data. Results IGF-CTP score showed significant better patient stratification compared to CTP score in the international validation cohort. Among CTP class A patients, who usually considered for active treatment and clinical trial enrollment, 32.5% were reclassified as IGF-CTP class B with significantly shorter OS than patients reclassified as class A with hazard ratio [HR] = 6.15, 95% confidence interval [CI] = 2.18 -17.37. Conclusion IGF-CTP score showed significantly better patient stratification and survival prediction not only in the U.S. population but also in international validation population, who had different demographics and HCC risk factors.

Author Info:
aDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
bDepartment of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
cDepartment of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
dDepartment of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
eDepartment of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
fDepartment of Clinical Oncology, Assiut University, Egypt
gDepartment of Pathology, Assiut University, Egypt
hGraduate School of Biomedical Sciences, Houston, TX, United States


Authors:
Abdelgawad, M.I.a,  El Gezawy, E.M.b,  Mohammed, H.S.E.-D.c

Date of Publishing:
Volume 12, Issue 6, 25 June 2015, Pages 186-192

Title:
Chronic Hepatitis C Virus Infection and B-Cell Clonality‎

Abstract:
Background and Aim: An association between non-Hodgkin’s lymphoma (NHL) and hepatitis C virus (HCV) has been evidenced since few years. Expansions of B-cell clonality have been detected in peripheral blood and bone marrow in HCV patients. Lymphoid aggregates are found in the liver of chronically HCV-infected patients. Studying the nature of the aggregates in the molecular level is a guide to find out the prevalence of B-cell clonality. In this work we aimed to study B-cell infiltration of the liver and type of expansion whether monoclonal or polyclonal in chronically HCV patients and factors affecting it. Subjects and Methods: Liver biopsies of 120 patients with chronic hepatitis C viral infection were examined for presence of lymphoid aggregation. Clonality of lymphoid B-cells tested by polymerase chain reaction (PCR) to identify immunoglobulin heavy chain gene (IgH) rearrangements. The product is monoclonal if only one discrete band was detected. The correlation between clonality on one side and HCV RNA viral load, stage of fibrosis, grade of inflammation, levels of transaminases, alpha fetoprotein (AFP) and lactic dehydrogenase (LDH) was studied. Results: Sixteen patients (13.33%) expressed monoclonal B-lymphocytic (MBL) expansion and 18 patients (15%) showed polyclonal B-lymphocytosis (PCBL). No significant difference in the stage of fibrosis, the degree of inflammation and AFP levels between MBL positive and negative groups was detected in the current study. MBL positive patients had significant much higher viral load (p=0.0001), AST(p =0.0001), ALT(p =0.006) and LDH(p =0.04) compared to MBL negative ones. On the other hand positive polyclonal B-lymphocytes (PCBL) had significant higher stage of fibrosis (p =0.011), grade of inflammation (p =0.026) and liver enzymes; AST and ALT (p =0.0001 for each) serum LDH (p =0.016) and lower viral load (p =0.0001) compared to negative PCBL patients, but no significant difference between PCBL positive patients and PCBL negative patient regarding AFP levels. Correlation between occurrence of clonal IgH with laboratory variables revealed significant positive correlation between the occurrence of clonal IgH and liver enzymes (AST, ALT), LDH, fibrotic stage and grade of inflammation. Conclusion: B-lymphocytic infiltration of the liver occurs in 28.3% in HCV chronically infected patients. We can expect lymphoproliferative infilteration in the liver using noninvasive laboratory investigation as AST, ALT and LDH. We could not depend on viral load to predict lymphoproliferative infilteration in the liver. Rearrangements of clonal IgH have significant positive correlation with liver enzymes (AST, ALT), LDH, fibrotic stage and grade of inflammation this suggest that these markers provides a convenient way to study the early stages of neoplastic transformation. © 2015, Zhengzhou University. All rights reserved.

Author Info:
aClinical Oncology Department, Faculty of Medicine, Assiut University, Egypt
bClinical Pathology Department, Faculty of Medicine, Assiut University, Egypt
cInternal Medicine Department, Faculty of Medicine, Assiut University, Egypt


Authors:
Abdelmaksoud, A.H.K.aEmail Author,  Taha, M.E.-S.b,  Kassas, M.E.c,  Mahdy, R.E.d,  Mohamed, G.E.-D.E.e,  Samy, H.A.a

Journal:
Egyptian Journal of Radiology and Nuclear Medicine

Date of Publishing:
Volume 46, Issue 2, 1 June 2015, Pages 293-297

Title:
Prospective Comparison of Transient Elastography and Liver Biopsy for the ‎Assessment of Fibrosis in Chronic Hepatitis C Infection‎

Abstract:
HCV is a worldwide problem and the need to assess the degree of fibrosis is the corner stone in its treatment. Liver biopsy has been used for years to assess the degree of fibrosis and activity but recently many non-invasive methods have emerged to replace it as aspartate transaminase/platelet ratio [APRI), abdominal ultrasonography measuring caudate/right lobe ratio and hepatic stiffness [Fibroscan). Purpose Correlate the accuracy of Transient Elastography [Fibroscan) in comparison to liver biopsy as a non-invasive method for fibrosis assessment in chronic hepatitis C patients. Methods The study was done on 50 patients with chronic HCV [32 males and 18 females) for which liver biopsy and fibroscan were performed. Results There was positive correlation of liver biopsy with fibroscan score, there was moderate agreement [matching) between liver biopsy and fibroscan the lowest matching were in F0 and the highest were in F3. Conclusion Fibroscan has a good matching with liver biopsy in the detection of hepatic fibrosis and follow up of its progression. © 2015 The Authors.

Author Info:
aDiagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Egypt
bRadiology Department, National Hepatology and Tropical Medicine Research Institute, Egypt
cHepatology Department, National Hepatology and Tropical Medicine Research Institute, Egypt
dDepartment of Internal Medicine, Assiut University Hospital, Egypt
eTropical Medicine Department, Cairo University, Egypt


Authors:
Abubeih, H.M.A.,  El-Adly, W.Email Author,  Kotb, M.M.

Date of Publishing:
Volume 26, Issue 6, 1 November 2015, Pages 614-618

Title:
Modified Calcaneo-Stop Screw Method for Treatment of Symptomatic Pediatric ‎Flexible Flatfoot Deformity‎

Abstract:
Background: The aim of this study was to evaluate a modified calcaneo-stop screw method for treatment of symptomatic flexible flatfoot in children. Methods: We retrospectively evaluated the results of calcaneo-stop screw method in a series of 45 flatfeet in the age group ranging from 7-14 yr between 2008 and 2011. We used a noncannulated 6.5-mm cancellous screw with washer(s) inserted with modified technique. The results were evaluated clinically by assessment of the heel valgus angle and radiographically by measuring the lateral talo-first metatarsal angle (Meary's angle). The final result was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Results: The mean heel valgus angle decreased significantly from 13.09 degrees preoperatively to 2.24 degrees at the time of follow-up. The average correction of valgus was 10.84 degrees. There was significant improvement in the Meary's angle from 158.84 degrees before surgery to 176.27 degrees at the time of follow-up. The average correction of Meary's angle was 17.91 degrees. The AOFAS Ankle-Hindfoot Scale improved from 72.89 before surgery to 92.67 at time of follow-up. No complications were observed in our series. Conclusions: The modified calcaneo-stop method is a fast, relatively simple, effective, and economical method for operative treatment of symptomatic idiopathic flexible flatfoot in children. © 2015 Wolters Kluwer Health, Inc.

Author Info:
Orthopedic Department, Assiut University Hospital, Assiut, 71111, Egypt


Authors:
Akhavan, A.a,  Elderwy, A.b,  Grady, R.c

Journal:
Pediatric Urology: Surgical Complications and Management: Second Edition

Title:
Complications: Epispadias and Bladder Exstrophy‎

Abstract:
The management of exstrophy-epispadias complex presents one of the most challenging anomalies in urology. Despite advances in surgical technique for exstrophy-epispadias repair, the incidence of complications remains significant. Knowledge of the management of potential morbidities is essential for all physicians involved in the management of these complex patients. This chapter focuses on the management of short-term, intermediate, and long-term complications that can arise following primary closure. © 2015 by John Wiley & Sons Ltd. All rights reserved.

Author Info:
aJames Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, United States
bAssiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
cUniversity of Washington School of Medicine, Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, United States


Authors:
Al-Shobaili, H.a,  Hassanein, K.M.b,  Mostafa, M.S.b,cEmail Author,  Duways, A.S.A.d

Date of Publishing:
Volume 29, Issue 1, 1 January 2015, Pages 43-46

Title:
Evaluation of the Herpeselect Express Rapid Test in the Detection of Herpes ‎Simplex Virus Type 2 Antibodies in Patients with Genital Ulcer Disease‎

Abstract:
Background: A rapid point-of-care test with high sensitivity and specificity is required in order to fulfill the need for early detection and screening of Herpes simplex virus type 2 (HSV-2) infection among patients with genital ulcer disease (GUD), for better management and control of virus transmission. Methods: The goal of this study is to evaluate the performance of the commercially available HerpeSelect Express rapid test in comparison with three ELISA assays: HerpeSelect ELISA, Kalon HSV-2 glycoprotein G2 assay, and monoclonal antibody blocking enzyme immunoassay, which was used as the gold standard for the detection of HSV-2 antibodies. Results: This study showed high sensitivity (ranging from 82.6 to 100%) and specificity (100%) of the HerpeSelect Express rapid test when compared to the three ELISA assays. The agreement between the HerpeSelect Express rapid test with the three ELISAs ranged from 93.3 to 100%. Conclusion: The HerpeSelect Express rapid test has adequate sensitivity and specificity for confirming HSV-2 infection in patients with GUD, indicating its suitability for epidemiological studies. © 2014 Wiley Periodicals, Inc.

Author Info:
aDepartment of Dermatology, College of Medicine, Qassim University, Buraydah, Saudi Arabia
bDepartment of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt
cDepartment of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt
dDepartment of Dermatology, Najran General Hospital, Najran, Saudi Arabia


Authors:
Althagafy, K.T.a,  Alaoni, S.a,  Batouk, A.A.a,  Elgendy, H.a,b,  Sersar, S.I.a,cEmail Author

Journal:
Asian Cardiovascular and Thoracic Annals

Date of Publishing:
Volume 23, Issue 6, 19 July 2015, Page 743

Title:
Chest Tube in Transected Left Main Bronchus after Blunt Chest Trauma‎

Author Info:
aKing Abdullah Medical City, Makkah, Saudi Arabia
bDepartment of Anaesthesia, Assiut University, Egypt
cDepartment of Cardiothoracic Surgery, Mansoura University, Mansoura, 35516, Egypt


Authors:
Atta, H.aEmail Author,  Seifeldein, G.S.bEmail Author,  Rashad, A.cEmail Author,  Elmorshidy, R.c

Date of Publishing:
Volume 46, Issue 2, 1 June 2015, Pages 355-361

Title:
Quantitative Validation of the Severity of Emphysema by Multi-Detector ‎Ct‎

Abstract:
Objectives To determine whether MDCT reflects the severity of chronic obstructive pulmonary disease (COPD) compared to the pulmonary function tests (PFTs). Patients and methods A prospective study included 63 COPD patients. Spirometry was done and included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and the ratio of forced expiratory volume in 1 s over forced vital capacity (FEV1/FVC). Patients were grouped according to GOLD guidelines. MDCT examinations were obtained during full inspiration. The extent of emphysema was quantified by using dedicated software. -950 Hounsfield units (HU) used as the percentage of low-attenuation (%LA) emphysematous areas. Statistical study between PFTs, and CT emphysema extent was performed. Results The study included 26 females and 37 males with a mean age of 53 years. A moderate significant relationship was found between lung volume less than -950 HU and FVC, FEV1, and FEV1/FVC (p < 0.001). Pulmonary function tests revealed that 23.8% had mild restrictive defect, 14.3% had moderate obstructive defect and 61.9% had severe obstructive defect. A good correlation was observed between the quantitative assessments for the lower lung regions with -950 HU (%LA) and pulmonary function variables (p < 0.001). Conclusion MDCT results are significantly related to the data of PFTs for defining the severity of emphysema. © 2015 The Author.

Author Info:
aDepartment of Radiology, South Egypt Cancer Institute, Assiut University, Egypt
bDepartment of Diagnostic Radiology, Assiut University Hospital, Assiut University, Egypt
cDepartment of Chest Diseases, Assiut University Hospital, Assiut University, Egypt


Authors:
Attia, N.M.aEmail Author,  Seifeldein, G.S.a,  Hasan, A.A.b,  Hasan, A.a

Date of Publishing:
Volume 46, Issue 1, 1 March 2015, Pages 25-32

Title:
Evaluation of Acute Pulmonary Embolism by Sixty-Four Slice Multidetector Ct ‎Angiography: Correlation between Obstruction Index, Right Ventricular ‎Dysfunction and Clinical Presentation‎

Abstract:
Introduction MDCT pulmonary angiography is the method of choice for the detection of pulmonary embolism (PE). The severity of PE as estimated by the obstruction index (OI) and right ventricular dysfunction (RVD) can be evaluated with MDCT. Objective To investigate the correlation between the OI, RVD and clinical presentation in patients with acute PE. Methods Among 70 patients with suspected PE, 35 patients proved to have PE with MDCT. The CT OI and the RV/LV diameter (RVD-ratio) using the four-chamber view of the heart were calculated for PE patients. The cut-off for the OI to detect RVD was constructed using ROC curve. Results Dyspnea and RVD (RVD-ratio >1) were significantly more common in patients with central pulmonary emboli. The mean OI (35% ± 19%) was significantly higher in patients with dyspnea, tachycardia and obesity. A positive correlation was found between the OI and both the CT pulmonary artery diameter (r = 0.66, p < 0.001) and the RVD-ratio (r = 0.628, p < 0.001). The mean OI was significantly higher in patients with RVD (p < 0.001). A CT OI > 43% identified more than 90% of patients with RVD (area under the curve on ROC analysis: 0.825; p < 0.001). Conclusion The mean OI correlated linearly with PA diameter and RVD-ratio. OI > 43% proved to be an independent predictor of RVD. © 2014 The Egyptian Society of Radiology and Nuclear Medicine. Production and hosting by Elsevier B.V. All rights reserved.

Author Info:
aRadiology Department, Faculty of Medicine, Assiut University, Egypt
bChest Department, Faculty of Medicine, Assiut University, Egypt


Authors:
Badr, B.M.a,  Moustafa, N.A.b,  Eldien, H.M.S.c,  Mohamed, A.O.d,  Ibrahim, H.M.a,  El-Elaimy, I.A.a,  Mahmoud, M.H.e,f,  Badr, G.gEmail Author  View Correspondence (jump link)

Date of Publishing:
Volume 35, Issue 1, 21 January 2015, Pages 137-147

Title:
Increased Levels of Type 1 Interferon in a Type 1 Diabetic Mouse Model ‎Induce the Elimination of B Cells from the Periphery by Apoptosis and Increase ‎Their Retention in the Spleen‎

Abstract:
Background: The autoimmune disease type 1 diabetes mellitus (T1D) is associated with a defect in the immune response, which increases susceptibility to infection. We recently demonstrated that prolonged elevated levels of type 1 interferon (IFN) induce lymphocyte exhaustion during T1D. Aims: In the present study, we further investigated the effect of blocking the type I IFN receptor signaling pathway on diabetic dyslipidemia, in which an abnormal lipid profile leads to the exhaustion of B cells and alteration of their distribution and functions. Methods: T1D was induced in a mouse model by an intraperitoneal injection of a single dose (60 mg/kg) of streptozotocin (STZ). Three groups of mice were examined: a non-diabetic control group, a diabetic group and a diabetic group treated with an anti-IFN (alpha, beta and omega) receptor 1 (IFNAR1) blocking antibody to block type I IFN signaling. Results: We observed that induction of T1D was accompanied by a marked destruction of β cells and a reduction in the insulin levels in the diabetic group. Diabetic mice exhibited many changes, including alterations in their lipid profiles, expansion of splenic B cells, increased caspase-3, -8 and -9 activity, and apoptosis in peripheral B cells. Blocking type 1 IFN signaling in diabetic mice significantly returned the insulin and lipid profiles to normal levels, subsequently restored the B cell distribution, and rescued the peripheral B cells from apoptosis. Conclusion: Our data suggest the potential role of type I IFN in mediating diabetic dyslipidemia and an exhausted state of B cells during T1D. © 2015 S. Karger AG, Basel.

Author Info:
aZoology Department, Faculty of Science, Minufiya University, Shebin El-Kom, Egypt
bDepartment of Zoology, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
cHistology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
dDepartment of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
eDeanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
fFood Science and Nutrition Department, National Research Center, Dokki, Cairo, Egypt
gLaboratory of Immunology and Molecular Biology, Zoology Department, Assiut University, Assiut, 71516, Egypt


Authors:
Bakry, R.aEmail Author,  Sayed, D.aEmail Author,  Sayed, S.bEmail Author,  Mohamed, M.A.cEmail Author,  Idriss, N.K.d

Date of Publishing:
Volume 24, Issue 6, 1 November 2015, Pages 1573-1577

Title:
The Immunological Role of Monocytes and Their Cytokines in Patients with ‎Breast Cancer Undergoing Paravertebral Analgesia‎

Abstract:
Paravertebral block is a method of regional block used to make pain relief and decrease systemic analgesic requirements for patients undergoing breast cancer surgery. This work aimed to evaluate the effect of paravertebral block on monocyte phenotype and their functions after surgery for cancer breast patients. One hundred patients which the American Society of Anesthesia (ASA) I–III planned for breast cancer surgery were allocated into two groups. Group A (n = 50) received general anesthesia in a standard technique. Group B (n = 50) received paravertebral block T2–T6 20 ml plain bupivacaine 0.5 % plus 10 ml 2 % lidocaine prior to induction of general anesthesia. Two samples were collected from all patients preoperatively as a baseline and 24 h after surgery. Flow cytometric monocyte phenotype analysis (CD14, HLA-DR, and CD86) was performed. In addition, tumor necrosis factor alpha (TNF-α), monocyte inhibitory factor (MIF), and macrophage chemoattractant protein (MCP-1) were measured in both groups. There were no significant differences between the two groups as regard to age, weight, height, and duration of surgery. One day after surgery, there was significant decrease in all measured markers (CD14, HLA-DR, and CD86) in group A. On the other hand, insignificant decrease in CD 14 and HLA-DR and insignificant increase in CD86 in group B were observed, also 24 h after surgery. As regard to monocyte producing cytokines, significant increase in TNF-α and MIF levels was recorded in both groups after 24 h of surgery; these increases were the same in TNF-α level and more significant in MIF in group A than group B. MCP-1 was decreased insignificantly in group A and significantly in group B. Paravertebral block combined with general anesthesia can significantly reduce monocyte suppression which is an integral part of immunological response following major surgery. © 2015, Springer-Verlag London.

Author Info:
aClinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
bAnesthesia Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
cAnesthesia Department, Faculty of Medicine, Assiut University, Assiut, Egypt
dBiochemistry Department, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Diamond-Smith, N.a,bEmail Author,  Bishai, D.c,  Gibaly, O.E.d

Title:
Inter-Generational Co-Residence and Women's Work and Leisure Time in ‎Egypt‎

Abstract:
Background Labor force participation among women in Egypt remains low. Due to low fertility and increases in life expectancy, in the future women in Egypt may spend more time co-residing with aging in-laws. Past literature has suggested that in some settings co-residence allows women to enter the labor force, as mothers-in-law help care for their grandchildren, or inhibits labor force participation, when mothers-in-law reinforce traditional values or require care. There is little research on co-residence and labor supply or leisure time in Egypt, especially accounting for mother-in-law disability status. Objective This paper examines the role of intergenerational co-residence in women's work, work time, and leisure time using data on time allocation in Egypt. Methods Data were collected from 548 women with a living mother-in-law: 291 co-residing their mother-in-law and 257 not. Survey data included work status, a 24-hour time diary, and a health assessment of the mother-in-law. Multivariate regression models predicted work, work time, and leisure time use using standard models. Results Co-residing with a disabled mother-in-law was associated with decreased odds of women working and fewer minutes spent working a day. Leisure time was not associated with the co-residence and disability status of a mother-in-law. Factors relatedto couples' relationships and the woman's views on gender norms were also associated with women working. Conclusions Co-residence appears to be associated with women's work, depending on the disability status of the co-residing mother-in-law. If increased life expectancy is associated with more time spent in a disabled state for mothers-in-law, this could put downward pressure on women's work in this setting. © 2015 Diamond-Smith, Bishai & El Gibaly.

Author Info:
aUniversity of California, San Francisco, CA, United States
bJohns Hopkins Bloomberg School of Public Health, United States
cJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
dDepartment of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
El Tallawy, H.N.a,  Farghaly, W.M.a,  Badry, R.aEmail Author,  Hamdy, N.A.b,  Shehata, G.A.a,  Rageh, T.A.a,  Metwally, N.A.c,  Hassan, E.M.b,  Elsayed, S.S.b,  Yehia, M.A.b,  Soliman, W.T.b

Title:
Epidemiology and Clinical Presentation of Stroke in Upper Egypt (Desert ‎Area)‎

Abstract:
Background: Stroke is a common cause of morbidity and mortality worldwide. Four out of five strokes occur in the low- and middle-income countries. This study aims to find lifetime prevalence of stroke in Upper Egypt and to identify clinical presentations and possible risk factors of stroke in this population. Methods: This is a door-to-door (every door) study conducted on all inhabitants in Al Kharga district (representative of western desert) and Al Quseir city (representative of eastern desert). The study was conducted in two stages, and every stage consisted of three phases (screening, diagnostic, and investigatory). Results: The total lifetime prevalence of stroke was 8.5/1,000 in the population aged 20 years and more. It increased with advancing age and was higher among males than females among all age groups except in the childbearing period (20 years to < 40 years of age). Lifetime prevalence of ischemic stroke (7.2/1,000) was higher than hemorrhagic stroke (1.1/1,000). Hemiparesis and hemiplegia were the commonest presentation of stroke. Headache, vomiting, and vertigo were found to be significantly more common accompaniments of hemorrhagic stroke. The most common risk factor was hypertension, followed by hyperlipidemia and diabetes mellitus. Conclusion: The total lifetime prevalence of stroke in the population aged 20 years and more in Upper Egypt (desert area) lies within the range that is recorded in developing countries. Clinical presentation and risk factors are similar to those recorded from developing and developed countries. © 2015 El Tallawy et al.

Author Info:
aDepartment of Neurology and Psychiatry, Assiut University, Assiut, Egypt
bDepartment of Neurology, El Minia University, El-Minia city, Egypt
cDepartment of Neurology, Al-azhar University (Assuit Branch), Assiut, Egypt


Authors:
El-Amir, M.I.a,b,  El-Feky, M.A.b,c,  Laine, A.-P.a,  Härkönen, T.d,e,  El-Badawy, O.c,  Eltayeb, A.A.f,  El-Melegy, T.T.g,  Kiviniemi, M.a,  Knip, M.d,e,h,i,  Ilonen, J.a,jEmail Author  View Correspondence (jump link)

Date of Publishing:
Volume 31, Issue 3, 1 March 2015, Pages 287-294

Title:
Risk Genes and Autoantibodies in Egyptian Children with Type 1 Diabetes - Low ‎Frequency of Autoantibodies in Carriers of the Hla-Drb1*04:05-Dqa1*03-‎Dqb1*02 Risk Haplotype‎

Abstract:
Background: The study aimed to define the frequencies of type 1 diabetes-associated gene polymorphisms and their associations with various diabetes-associated autoantibodies in Egyptian children. Methods: One hundred and one children with type 1 diabetes and 160 healthy controls from the same region were studied for HLA-DQB1, HLA-DQA1*03-DQB1*02 (DR4-DQ2) (23.8%, OR 5.2; p<0.001), and DRB1*04:05-DQA1*03-DQB1*03:02 (DR4-DQ8) (8.9%, OR=7.7; p=0.007) were also significantly increased. HLA-(DR15)-DQB1*06:01, (DR13)-DQB1*06:03, and DRB1*04:03-DQA1*03-DQB1*03:02 were the most protective haplotypes with OR values from 0.04 to 0.06. Patients positive for DR3-DQ2 but negative for DR4 haplotypes had a high frequency of glutamic acid decarboxylase antibodies (78%; p<0.001 versus other genotypes), but only 26.6% of those with DR3-DQ2/DR4-DQ2 tested positive for glutamic acid decarboxylase antibodies (p=0.006 versus other genotypes). Subjects with the DR4-DQ8 haplotype without DR3-DQ2 or DR4-DQ2 were more often positive for islet antigen-2 and zinc transporter 8 antibodies (55.5%, p=0.007 and 55.5%, p=0.01 respectively). The AA genotype of the INS gene was more common in patients than in controls (75.2 versus 59.5%, OR=2.07; p=0.018). Conclusions: Besides a strong HLA-DR3-DQ2 association, a relatively high frequency of the DR4-DQ2 haplotype characterized the diabetic population. The low frequency of autoantibodies in children with HLA-DR4-DQ2 may indicate specific pathogenetic pathways associated with this haplotype. © 2014 John Wiley & Sons, Ltd.

Author Info:
aImmunogenetics Laboratory, University of Turku, Turku, Finland
bDepartment of Microbiology and Immunology, Faculty of Medicine, South Valley University, Qena, Egypt
cDepartment of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
dChildren's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
eDiabetes and Obesity Research Program, University of Helsinki, Helsinki, Finland
fDepartment of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
gDepartment of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
hFolkhälsan Research Center, Helsinki, Finland
iDepartment of Pediatrics, Tampere University Hospital, Tampere, Finland
jDepartment of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland


Authors:
El-Malah, H.E.-D.G.M.aEmail Author,  Hany, S.aEmail Author,  Mahmoud, M.K.aEmail Author,  Ali, A.M.bEmail Author

Date of Publishing:
Volume 46, Issue 2, 1 June 2015, Pages 469-474

Title:
Lung Ultrasonography in Evaluation of Neonatal Respiratory Distress ‎Syndrome‎

Abstract:
Objectives To evaluate diagnostic ability of lung ultrasonography (LUS) in detection of pulmonary manifestations of neonatal respiratory distress syndrome as well as follow up the response to treatments. Patients and methods One hundred neonates with clinical and radiographic signs of respiratory distress (RDS) were included in this prospective study. LUS was done using both a transthoracic and a transabdominal approach within the first 24 h of life and after that for detection of pulmonary manifestations and follow up the response to treatment. LUS findings were compared with chest radiography findings. Results In comparison with chest X-ray the LUS had sensitivity 98% and specificity 92% in detection of pulmonary manifestations of RDS. In follow up to response of treatment the LUS had 100% sensitivity and 94% specificity. Conclusion The LUS can be an alternative diagnostic imaging modality for chest X-ray in follow up neonates with RDS and subsequent reduction dose of radiation. © 2015 The Authors.

Author Info:
aDepartment of Diagnostic Radiology, Faculty of Medicine, Assiut University, Egypt
bDepartment of Pediatric, Faculty of Medicine, Assiut University, Egypt


Authors:
El-Malah, H.E.-D.G.M.aEmail Author,  Radwan, M.E.E.-D.M.a,bEmail Author,  Ali, A.M.cEmail Author,  Shaaraway, M.E.T.E.dEmail Author

Date of Publishing:
Volume 46, Issue 4, December 2015, Pages 1163-1170

Title:
Utility of 64-Row Mdct in Assessment of Neonates with Congenital Ea and Distal ‎Tef‎

Abstract:
Introduction Esophageal atresia (EA), with or without trachea-esophageal fistula (TEF), is one of the most challenging congenital anomalies in neonates, due to its high morbidity and mortality. The anatomy of the EA should be clearly known before surgery because the surgical approach of congenital EA with distal TEF depends on the correct evaluation of the trachea-bronchial tree and the distance between the proximal pouch and distal fistula. Aim To evaluate the application of multiple planar reformatting (MPR) and three-dimensional (3D) transparency lung volume rendering (TL-VR) with virtual tracheo-bronchoscopy by 64-row multidetector computed tomography (MDCT) in neonates with congenital EA and distal TEF. Methods Twenty-three neonates (10 boys and 13 girls) born with EA and distal TEF were enrolled in this study. All patients were preoperatively examined by 64 multidetector non-enhanced CT examinations with multiplanar reformatting, 3D volume rendering TLVR and virtual endoscopy. The MDCT findings were correlated with operative findings in 19 cases. Results MDCT could detect the proximal esophageal pouches, gap distance in all patients. The gap distances ranged from 7 mm to 38 mm (mean 18 mm). The gap distances by MDCT were the same of surgical findings in 14 cases and less than surgical findings by 1-2 mm in 5 cases. No statistically significant difference was detected between the two measurements, P = 0.908. The site of the fistula was seen by the axial images in 23 patients, followed by sagittal MPR and 3D TL-VR (20 patients), coronal MPR images in 18 patients while the virtual tracheo-bronchoscopy showed the site of the fistula in 16 patients. The most common site of distal fistula in this study was main trachea in 10 of 23 neonates (43.5%). Conclusion Preoperative MDCT scan with MPVR, 3D TL-VR of 64-row MDCT which is a noninvasive technique could provide more accurate information about the assessment of the origin of the fistula, the distal esophageal pouches and inter-pouch distance in neonates with EA and distal TEF. © 2015 The Egyptian Society of Radiology and Nuclear Medicine. Production and hosting by Elsevier B.V.

Author Info:
aDepartment of Diagnostic Radiology, Faculty of Medicine, Assiut University, Egypt
bDepartment of Diagnostic Radiology, Taibah University, Saudi Arabia
cDepartment of Pediatric, Faculty of Medicine, Assiut University, Egypt
dDepartment of Pediatric Surgery, Faculty of Medicine, Assiut University, Egypt


Authors:
El-Nashar, S.A.a,b,  Shazly, S.A.M.a,bEmail Author,  Famuyide, A.O.a

Date of Publishing:
Volume 12, Issue 3, 13 August 2015, Pages 157-163

Title:
Pictorial Blood Loss Assessment Chart for Quantification of Menstrual Blood ‎Loss: A Systematic Review‎

Abstract:
To evaluate the diagnostic accuracy of pictorial blood loss assessment chart (PBLAC) compared to objective measurements of menstrual blood loss (MBL), a systematic search of MEDLINE, EMBASE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and EBM Reviews-Cochrane Central Register of Controlled Trials from inception until September 30, 2014 was performed. Terms referring to “pictorial blood loss assessment chart,” “menstrual blood loss evaluation,” and “alkaline hematin” were used. The ability of PBLAC to predict significant blood loss, compared to alkaline hematin as a standard objective method, represents our primary outcome. Out of 255 reports identified by the primary search, seven reports were included in the review. Quality of these reports was assessed. Compared to alkaline hematin, PBLAC sensitivity and specificity ranged from 58 to 98 % and 7.5 to 97 %, respectively, with likelihood ratios (LR) for positive ranging from 1.1 to 7.8 and LR for negative tests ranging from 0.04 to 0.48. Diagnostic odds ratio ranged from 2.6 to 86.9. Although diagnostic testing was not always supportive in terms of sensitivity, specificity, and LRs, most studies support the use of PBLAC as a semi-objective method that can be implemented in research and clinical practice. © 2015, Springer-Verlag Berlin Heidelberg.

Author Info:
aDepartment of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States
bDepartment of Obstetrics and Gynecology, Assiut University, Assiut, Egypt


Authors:
Elgayar, S.A.M.Email Author,  Abou-Elghait, A.T.,  Sayed, A.A.

Title:
Morphology of Female Guinea Pig Harderian Gland During Postnatal ‎Development - Secretory Endpieces‎

Abstract:
The main objective of this study was to investigate the morphological aspects of the development of the Harderian gland (HG) in the female guinea pig. A total number of thirty animals were used and divided according to age into groups, five animals each. Specimens were taken at the following ages; birth, one week, two weeks, three weeks, four weeks and two months postnatal. Histological, histochemical and immunohistochemical techniques were used. The gland was constituted of secretory end pieces and a duct system formed of intra- and extra-parenchymal ducts. At birth, the female guinea pig HG was active in the secretion of lipid and neutral mucin and the differentiation of several populations of cells (light and dark) was possible. However, its histological structure was still incomplete. The lining cells revealed many free ribosomes, a few and small organelles and large irregularly shaped nuclei and numerous mitotic figures. The secretory cells reached maturity by the age of three weeks, but growth in size continued up to the age of two months. They were light or dark; the light cells presented three forms that exhibited different morphological features. All modes of secretion (apocrine, merocrine and holocrine) were detected.

Author Info:
Department of Histology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt


Authors:
Eloteify, M., Jra,bEmail Author,  El-Shazly, M.a,  Saadeldeen, W.a,  El-Sonbaty, M.a

Date of Publishing:
Volume 38, Issue 2, 1 April 2015, Pages 109-116

Title:
Subjective Psychic Perception Versus Objective Nasofacial Measures in ‎Assessment of Rhinoplasty Results: A Clinical Report‎

Abstract:
Background: Rhinoplasty has become one of the main performed cosmetic surgeries. One of the main success factors for this type of surgeries is patients’ satisfaction; some of the patients are hardly satisfied with the postoperative results. Therefore, finding reliable, valid, agreeable, and effective evaluation tools for subjective and objective assessment of the rhinoplasty results is of great importance for both patients and surgeons. Methods: Forty rhinoplasty patients were included in this work. The patients were evaluated by three methods objectively and subjectively; as patients’ and doctors’ satisfaction (subjective) and comparing that with the parameters of the ideal aesthetic nose that measured on the postoperative computer nasofacial images (objective). Results: There was a highly significant difference between patients’ and surgeons’ satisfaction scores both pre- and postoperatively. Patients, more than 20 years old were more satisfied than the younger ones. The measured nasal parameters showed a significant difference in both the angles and ratios pre- and postoperatively. Conclusions: Rhinoplasty is the aesthetic surgery that has the lowest satisfaction rate. Identifying good candidates to the procedure is fundamental to obtain good results. This study emphasizes the importance of using evaluative tools to subjectively and objectively assess rhinoplasty patients. The used evaluating tools appear to be internally consistent and valid brief instrument for assessing rhinoplasty patients, their aesthetic status and their surgical results. Level of Evidence: Level IV, risk/prognostic study. © 2015, Springer-Verlag Berlin Heidelberg.

Author Info:
aDepartment of Plastic Surgery, Assiut University, Assiut, Egypt
bDepartment of Plastic Surgery, Aswan University Hospital, Aswan, Egypt


Authors:
Eltayeb, A.A.aEmail Author,  Shehata, G.A.b

Date of Publishing:
Volume 19, Issue 4, November 2015, Pages 151-159

Title:
Sphincter-Saving Anorectoplasty for Correction of Anorectal ‎Malformations‎

Abstract:
Aim: Posterior sagittal anorectoplasty (PSARP) popularized by de Vries and Peña has become the preferred technique for surgical correction of anorectal malformations (ARM). Despite performing a technically perfect operation, it involves midline division of the sphincter with a subset of patients requiring significant lifelong bowel management for constipation or incontinence. Pratap et al. introduced sphincter-saving anorectoplasty (SSARP) trying to spare the sphincter. The aim of this study is to preserve the neurophysiological function of the sphincter through SSARP in ARM patients and evaluate the outcome of these patients through this approach. Patients and Methods: This prospective study conducted on ARM cases presented with high or intermediate anomalies. Patients with sacral agenesis and rectovesical fistula were excluded from the study. All patients underwent pre and postoperative electrophysiological studies of the external anal sphincter. Also a guide wire was introduced through the middle of the sphincter under sonographic guidance in all patients immediately before the operation. Results: During the study period from January 2011 to September 2014 18 cases underwent surgical correction with SSARP technique. Their age ranged from 6 months to 5 years and weight ranged from 7 kg to 20 kg. The total duration of the SSARP procedure ranged from 65 to 90 min. There were no intra-operative complications or mortality. No conversion to classic PSARP approach was necessary in any case. During the follow-up period no recurrent urethral fistula or urinary retention was observed. Conclusion: SSARP technique is a safe and effective approach in correction of ARM with acceptable postoperative complications. © 2015 College of Surgeons of Hong Kong.

Author Info:
aPediatric Surgery, Assiut University Children Hospital, Assiut, Egypt
bFaculty of Medicine, Department of Neurology, Assiut University, Assiut, Egypt


Authors:
Eltony, S.A.a,  Elgayar, S.A.M.aEmail Author,  Mohamed, S.K.b

Title:
Protective Effect of Substituted Biguanidine on Rat Diabetic Nephropaty-‎Histological Study‎

Abstract:
Nephropathy remains an important complication of diabetes. This work was carried out to evaluate the protective effects of N-thioacetylbiguanidine on the diabetic rat kidney. Fifteen adult male Wistar rats were divided into two groups: Group I, control (n=5) and Group II, diabetic group (n=10). The latter was equally divided into two subgroups: IIa (diabetic control) and IIb (diabetic Nthioacetylbiguanidine treated). Specimens were taken from the renal cortex, processed and examined using light, immunohistochemical, ultrastructural and morphometric techniques. The renal cortices from diabetic animals showed dilated glomeruli and tubules and thickening of the glomerular capillary basement membranes. The proximal tubules revealed partial loss of brush border and deposition of PAS-positive material in some distal tubules. iNOS-immunoreactivity was strongly expressed in the renal tubules and glomeruli. The juxtaglomerular (JG) cells revealed no intra-cytoplasmic secretory granules. The histological changes in renal glomeruli and tubules were improved in N-thioacetylbiguanidine treated group. Use of N-thioacetylbiguanidine characteristically reduced iNOS expression in kidney and renin secretion in JG cells. In conclusion, N-thioacetylbiguanidine is effective in attenuating the histological changes of diabetic nephropathy reaching healing features, which resemble that of a normal kidney.

Author Info:
aHistology Dept, Faculty of Medicine, Assiut University, Egypt
bChemistry and Environmental Division, Manchester Metropolitan University, England, United Kingdom


Authors:
Fahmy, H.S.aEmail Author,  Khater, N.H.bEmail Author,  El Shahat, H.M.aEmail Author,  Madani, A.A.cEmail Author,  El Hadidy, S.S.dEmail Author

Date of Publishing:
Volume 46, Issue 4, 23 March 2015, Pages 1085-1090

Title:
Reassessing the Value of MRI T2∗ in Evaluation of Hepatic and Myocardial Iron ‎Concentration: An Institutional Study‎

Abstract:
Patients with chronic hemolytic anemia like thalassemia and sickle cell anemia need repeated blood transfusions which lead to iron overload and cellular damage especially in the heart and liver. Classically, serum ferritin and liver biopsy have been used to monitor patient response to chelation therapy. Magnetic resonance imaging (MRI) has been proved effective in detecting and quantifying iron in the heart and liver. Objective: To assess the accuracy of MRI T2∗ procedure in assessment of hepatic (LIC) and myocardial iron concentration (MIC). Methods In 70 cases of monthly transfused patients, hepatic and myocardial iron overload was measured by multibreath holds MRI T2∗ and compared to serum ferritin (a traditional marker of iron overload). Results: No significant correlation was observed between serum ferritin level and cardiac T2∗ MRI (p = 0.528, r = -0.077). However, a significant correlation was observed between serum ferritin and liver T2∗ MRI (p = 0.007, r = -0.318). Conclusion: Routine evaluation of liver and heart iron content using MRI T2∗ is suggested to better evaluate the hemosiderosis status in thalassemic and sickle cell patients. © 2015 The Authors. The Egyptian Society of Radiology and Nuclear Medicine. Production and hosting by Elsevier B.V.

Author Info:
aZagazig University Hospitals, Zagazig, Egypt
bAin Shams University Hospitals, Cairo, Egypt
cAssiut University Hospital, Internal Medicine Department, Assiut, Egypt
dMansoura University Hospital, Community Medicine Department, Mansoura, Egy


Authors:
Farag, A.H.aEmail Author,  El-Deen, M.H.N.aEmail Author,  Hassan, R.M.b

Date of Publishing:
Volume 20, Issue 4, December 2015, Pages 217-223

Title:
Triggering Ovulation with Gonadotropin-Releasing Hormone Agonist Versus ‎Human Chorionic Gonadotropin in Polycystic Ovarian Syndrome. A ‎Randomized Trial‎

Abstract:
Objectives: To compare GnRH agonist to hCG for triggering ovulation in polycystic ovarian syndrome treated with clomiphene citrate. Study design: Prospective randomized study. Materials & methods: Eighty five infertile women with PCOS participated in a randomized allocation concealed prospective trial and had induction of ovulation with clomiphene citrate. GnRH agonist 0.2 mg subcutaneously (group 1) or hCG 10,000 IU intramuscularly (group 2) was given to trigger ovulation. Primary outcome was mid-luteal serum progesterone, while secondary outcomes were ovulation rates and clinical pregnancy rates along 3 cycles. Results: No difference was found between group 1 and group 2 regarding mean serum progesterone and clinical pregnancy rates in each cycle. Cumulative pregnancy rates were similar (17.14% versus 20% respectively; P = 0.332). Ovulation rates were 80% versus 68.6% (P = 0.413); 94.3% versus 90.9% (P = 0.669); 97.1% versus 93.7% (P = 0.603) in the two groups respectively. However, a significant rise in number of patients with mid-luteal serum progesterone >10 ng/mL was noted in the 3rd cycle between both groups, (P < 0.0001 for group 1 while P = 0.007 for group 2). Conclusion: Triggering ovulation with GnRH-a after treatment with clomiphene citrate in PCOS, in view of its known protective effect against OHSS, may be an effective physiological alternative to conventional hCG without compromising luteal function and pregnancy rates after repeated cycles of treatment. © 2015 The Authors.

Author Info:
aObstetrics and Gynaecology department, Ain Shams University, Abbasia Square, Cairo, Egypt
bAssiut University, Assiut, Egypt


Authors:
Farghaly, T.b,  Khalifa, E.b,  Mostafa, S.b,  Hussein, M.b,  Bedaiwy, M.c,  Ahmady, A.aEmail Author

Journal:
In Vitro Cellular and Developmental Biology - Animal

Date of Publishing:
Volume 51, Issue 7, 19 August 2015, Pages 662-671

Title:
The Effect of Temporary Meiotic Attenuation on the in Vitro Maturation ‎Outcome of Bovine Oocytes‎

Abstract:
The aim of this study was to investigate the effect of delaying maturation by extended culture of immature bovine oocytes in prematuration medium (PMC) containing single maturation inhibitor on their meiotic resumption and embryonic development. Bovine immature oocytes were cultured in M199 containing 10 μM of either inhibitor (roscovitine, cilostamide, or forskolin) for either 72 or 120 h followed by up to 48 h in maturation media supplemented with 7.5 IU follicle-stimulating hormone (FSH)/luteinizing hormone (LH). Two control groups were used. In untreated control, immature oocytes were cultured in the same medium as the experimental group without any inhibitors. In the FSH/LH control group, oocytes were cultured directly in the maturation medium supplemented with FSH/LH up to 48 h. In vitro matured oocytes were then inseminated with frozen–thawed bull sperm. Fertilization, defined as two-cell division 48 h post-insemination, and blastocyst formation were recorded. Total maturation rate for the 72-h group was 73%, 70%, 66%, and 69% for roscovitine, forskolin, cilostamide, and FSH/LH control, respectively, with no significant difference indicating that inhibitors have no negative effect on the oocyte maturation rate. The total fertilization rate for the 72-h group revealed that cilostamide (47%) and roscovitine (35%) were significantly higher than FSH/LH control (20%). The total blastocyst formation rates per inseminated oocytes revealed that among treatment groups, roscovitine (20%) had significantly higher rate than forskolin (9%). Overall, 72-h exposure period had better outcomes than 120 h in all the treated groups. In conclusion, prematuration culture of the bovine oocytes in the presence of maturation inhibitor for 72-h period at 10 μM concentration is sufficient in improving the bovine oocyte developmental competence. © 2015, The Society for In Vitro Biology.

Author Info:
aUniversity Hospitals Fertility Center, 1000 Auburn Dr, Beachwood, OH 44122, United States
bObstetrics and Gynecology Department, Assiut University, Assiut University Street, Assiut, 71515, Egypt
cDepartment of Obstetrics and Gynaecologyology, University of British Columbia, Vancouver, BC, Canada


Authors:
Farouk, O.,  El-Adly, W.Email Author,  Khalefa, Y.E.

Title:
Late Fixation of Vertically Unstable Type-C Pelvic Fractures: Difficulties and ‎Surgical Solutions‎

Abstract:
Background: Delayed surgical stabilization of unstable pelvic ring disruptions is expected to have difficulties in achieving reduction and fixation with possible higher complications. The aim of this study is to report the difficulties and to evaluate the results of late surgical stabilization of vertically unstable type-C pelvic injuries.

Methods: This study included 16 patients with 20 vertically unstable pelvic fractures who presented 4 weeks or more after the initial trauma during a period of 5 years. Time since injury averaged 7.6 weeks. Age of the patients averaged 28 years. There were 12 unilateral and four bilateral injuries. Seven patients had neurologic injuries. Combined posterior and anterior pelvic ring stabilization was carried out in nine patients, while posterior pelvic ring fixation alone was done in seven. The mean postoperative follow up was 31 months.

Results: All fractures healed with average 14 weeks. Complications included transient L5 palsy, ilio-femoral DVT, and early metal failure. Fracture reduction was considered excellent in 69 %, good in 25 %, and fair in 6 %. Functional outcome according to Majeed score was excellent in 75 %, good in 19 %, and fair in 6 %. There was a high significant positive correlation between time of treatment and fracture reduction (p = 0.009) and a significant correlation between preoperative neurological co-morbidity and functional outcome (p = 0.015). A significant negative correlation was found between functional outcome and fracture type (p = 0.039).

Conclusion: Surgical management of delayed vertically unstable pelvic fractures is recommended to achieve anatomical reduction and rigid fixation and to avoid long-term morbidity. © 2014, EFORT.

Author Info:
Orthopaedic Department, Assiut University, Assiut, 71111, Egypt


Authors:
Farouk, O.,  El-Adly, W.Email Author,  Khalifa, Y.E.  View Correspondence (jump link)

Title:
Erratum To: Late Fixation of Vertically Unstable Type-C Pelvic Fractures: ‎Difficulties and Surgical Solutions[European Orthopaedics and Traumatology, ‎‎(2014), Doi 10.1007/S12570-014-0266-Y]." ‎


Authors:
Farrag, W.S.H.,  Ibrahim, A.S.,  Mostafa, M.G.,  Kurkar, A.,  Elderwy, A.A.

Date of Publishing:
Volume 7, Issue 3, 1 July 2015, Pages 325-329

Title:
Ketamine Versus Magnesium Sulfate with Caudal Bupivacaine Block in ‎Pediatric Inguinoscrotal Surgery: A Prospective Randomized Observer-Blinded ‎Study

Abstract:
Introduction: Possible approaches for postoperative analgesia after pediatric inguinoscrotal surgery are caudal block by bupivacaine/ketamine (BK) and bupivacaine/magnesium sulfate (BM). Aim: The purpose of the following study is to compare the analgesic efficacy and safety of ketamine and magnesium sulfate in combination with bupivacaine for caudal blockade in pediatric patients after inguinoscrotal operations. Materials and Methods: Patients randomly received one of the two solutions for caudal epidural injection after induction of general anesthesia. Group-BK: Were given a mixture of 0.25% bupivacaine and 0.5 mg/kg of ketamine. Group-BM: Were given a mixture of 0.25% bupivacaine and 50 mg magnesium sulfate. Postoperatively, a blinded post-anesthesia care unit nurse assessed the quality of analgesia with a visual pain analog scale (VPAS). Significant pain is defined as one that has a VAPS of ≥3. Results: Forty American Society of Anesthesiologists I-II children (20 in each group) completed the study. The two groups were comparable regards age, sex, body mass index, anesthesia and surgery durations, recovery time and sevoflurane concentration. The mean duration of caudal analgesia ± standard deviation was 462 ± 17.2 min versus 398.05 ± 12.9 min for BK and BM groups, receptively (P < 0.001). Supplemental rectal paracetamol within 12 h postoperatively were 15% for BK group versus 25% for BM (P = 0.05). Four patients in BK group only experienced postoperative nausea and vomiting (P = 0.053). Conclusion: Caudal administration of BK is efficient and safe for pediatric inguinoscrotal operations with longer postoperative analgesia than BM sulfate.

Author Info:
Department of Urology, Assiut University, Asyut, 71516, Egypt


Date of Publishing:
Volume 10, Issue 2, 7 February 2015, Pages 135-136

Title:
Sexual and Reproductive Health for All: The Challenge Still Stands‎

Author Info:
Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt


Authors:
Ghafeer, H.H.a,  El-Gamal, D.A.a,  Mohamed, N.A.aEmail Author,  Hassanin, A.I.b

Date of Publishing:
Volume 38, Issue 1, 24 April 2015, Pages 41-56

Title:
Histological Study of Human Abdominal Skin after Repeated ‎Pregnancy‎

Abstract:
Background Normal human skin has the ability to stretch and return to its shape without becoming damaged. Many conditions involving skin stretch such as fluctuations in body weight or repeated pregnancy might induce histological skin alterations. Objective The aim of this work was to study stretch-induced morphological changes that occur in skin because of repeated pregnancy in adult women. Participants and methods Fifteen biopsies were taken from the skin of the lower anterior abdominal wall of Egyptian adult women after obtaining written consent. They were divided into three groups: group I (control) included three biopsies taken from nulligravidas who had undergone appendicectomy, group II included six biopsies taken during cesarean deliveries for primigravida women, and group III included six biopsies taken during cesarean deliveries for multigravida women. The specimens were processed for histological, immunohistochemical, and morphometric procedures. Results Repeated skin stretching showed a significant increase in the thickness of nucleated keratinocytes compared with group I. Wide intercellular spaces appeared in the spinous cell layer in most semithin sections. The dermal papillae became deeper and more frequent. The dermis showed disorganized and separated collagen bundles and decreased elastic fibers. Proliferating cell nuclear antigen immunoreactive expression was significantly increased in the nuclei of most epidermal layers. A significant increase in the expression of α-smooth muscle actin-positive myofibroblasts was observed. Ultrastructurally, fibroblasts showed indented nuclei and dilated perinuclear cisternae. Myofibroblasts and mast cells were frequently observed in the dermis. Conclusion Repeated abdominal skin stretching because of pregnancy showed variable histological changes compared with single stretching. © 2015 The Egyptian Journal of Histology.

Author Info:
aDepartments of Histology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
bDepartments of Obstetric and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Ghany, M.A.Email Author,  El Maghraby, K.

Title:
Syntax Score Calculation with Multislice Computed Tomographic Angiography ‎in Comparison to Invasive Coronary Angiography‎

Abstract:
The aim was to study the feasibility of syntax score calculation with Multislice Computed Tomographic Angiography (MSCTA). Methods: Syntax score was calculated and compared for 91 consecutive patients underwent MSCTA and Invasive coronary angiography (ICA). Results: MSCTA for the diagnosis of >50 % stenosis per coronary artery showed that MSCTA had a specificity, sensitivity, specificity, negative predictive value and accuracy of 92.2% (217/235), 97.1% (125/129), 98.2% (217/221), and 94.3% (364/386) respectively. Agreement between modalities was high with a kappa of 0.74. There was a positive correlation between MSCTA and ICA Syntax scores (. r=. 0.73, p=. 0.000). The mean Syntax score was 15.8. ±. 7.16 for ICA versus 16.3. ±. 7.6 for MSCTA (Kappa of Cohen 0.66, p=. 0.000). The Bland-Altman plot revealed that the estimated bias was 1.9. ±. 3.4 and the most bias occurred with a higher syntax score. Lesions per patient were more identified with MSCTA than ICA (2.5. ±. 1.4 vs. 1.9. ±. 1.1, p<. 0.001), with a good level of agreement (kappa. =. 0.65). Syntax score per lesion was similar with a high level of agreement (6.3. ±. 5.8 vs. 6.0. ±. 4.8, kappa. =. 0.74, p<. 0.001). Calcified lesions were identified to a similar extent (28 vs. 26 cases) with a fair level of agreement (kappa. =. 0.42). Lesions identified with both techniques showed a higher level of agreement than the total score (6.5. ±. 4.8 for MSCTA vs. 6.9. ±. 6.3 for ICA, p<. 0.05), kappa. =. 0.76. Conclusion: MSCTA showed a good level of agreement with ICA in syntax score calculation. © 2014.

Author Info:
Department of Cardiology, Faculty of Medicine, Assiut University, Egypt


Authors:
Grigoriou, E.a,  Abol Oyoun, N.a,b,  Kushare, I.c,  Baldwin, K.D.a,  Horn, B.D.a,  Davidson, R.S.a,d,eEmail Author

Date of Publishing:
Volume 39, Issue 4, 22 March 2015, Pages 721-725

Title:
Comparative Results of Percutaneous Achilles Tenotomy to Combined Open ‎Achilles Tenotomy with Posterior Capsulotomy in the Correction of Equinus ‎Deformity in Congenital Talipes Equinovarus‎

Abstract:
Purpose: The purpose of this study is to compare the efficacy of percutaneous Achilles tenotomy (AT) to combined open Achilles tenotomy and posterior capsulotomy (PC+AT) in the correction of residual equinus deformity in congenital talipes equinovarus after Ponseti serial casting in both idiopathic and non-idiopathic clubfeet.Methods: The authors retrospectively reviewed 591 patients treated for congenital talipes equinovarus between January 1, 2001 and January 1, 2011. Available medical and operative records were reviewed for basic demographic data as well as ankle dorsiflexion pre-operatively, postoperatively and at latest follow up.Results: A total of 167 children with 260 discrete clubfeet that met our inclusion criteria were identified. Of them, 189/260 clubfeet (72.7 %) were idiopathic and 71/260 clubfeet (27.3 %) were non-idiopathic with a mean total follow up of 4.8 ± 2.4 years (minimum follow-up of two years). At latest follow up, there was no statistically significant difference in the mean ankle dorsiflexion (p = 0.333) or recurrence rate (p = 0.545) between PC+AT and AT groups in both idiopathic and non-idiopathic clubfeet.Conclusion: In our series, the addition of posterior capsulotomy to Achilles tenotomy did not improve the mean dorsiflexion at latest follow up or decrease the rate of recurrence of equinus deformity in both idiopathic and non-idiopathic clubfeet. It is therefore advisable that percutaneous Achilles tenotomy alone be used in the correction of equinus deformity in both idiopathic and non-idiopathic congenital talipes equinovarus after successful Ponseti serial casting. © 2015, SICOT aisbl.

Author Info:
aDivision of Orthopedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
bDepartment of Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt
cDivision of Orthopedic Surgery, Children’s National Medical Center, Washington, DC, United States
dDivision of Orthopedic Surgery, Shriners Hospital, Philadelphia, PA, United States
eThe Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States


Date of Publishing:
Volume 17, January 01, 2015, Pages 145-168

Title:
Body Weight Changes with Antiepileptic Medications: Relationship to Adiposity ‎Hormones and Neuropeptides‎

Abstract:
Numerous pooled and specifically assigned data from clinical trials plus retrospective and cross-sectional studies have reviewed and quantified the metabolic and endocrinological changes associated with the currently used antiepileptic drugs (AEDs), among is weight changes. Weight gain has been reported with valproate (VPA), carbamazepine (CBZ), gabapentin (GBP), vigabatrin (VGB) and pregabalin (PGB). Weight loss has been reported with topiramate (TPM), felbamate (FBM), zonisamide (ZNS) and rufinamide (RUF). No weight changes (weight-neutral) have been reported with phenytoin (PHT), oxcarbazepine (OXC), lamotrigine (LTG), tiagabine (TGB) and levitracetam (LEV). Because epilepsy is a dyanamic medical illness and its treatment is often for years or lifelong, physicians should be aware of the metabolic and endocrinological changes associated with AEDs. Weight gain is not only a distressing problem which impairs body image and self-esteem but also a risk for disorders associated with obesity as dyslipidemia, hypertension, diabetes mellitus and atherosclerosis. Weight loss may compromise growth particularly in children and adolescents. The exact mechanisms for weight changes associated with AEDs are exactly unknown. The metabolic or endocrinologic consequences of AEDs on peripheral and/or central processes which regulate glucose metabolism, food intake and energy expenditure are highly incriminated. This review discusses the metabolic adverse effects of AEDs in relationship to weight changes with epilepsy. It also discusses the contribution of hormones and neuropeptides which influence energy balance (as leptin, insulin, adiponectin, neuropeptide-Y, ghrelin and galanin) in the pathogenesis of weight changes with AEDs. The information that AEDs may influence weight may help in proper selection and characterization of suitable AED as an initial step or a modification of an AED during management and follow up of patients. © 2015 by Nova Science Publishers, Inc. All rights reserved.

Author Info:
Department of Neurology and Psychiatry, Assiut University Hospital, Hospital of Neurology and Psychiatry, Floor # 7, P.O. Box 71516, Assiut, Egypt

DOI:
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84957016781&partnerID=40&md5=bf294be4ab127874d3551cb411fea525#..\update 2015 IP Database.docx#_Hlk531692578	1,9205,9318,179,,https://www.scopus.com/inward/re


Authors:
Hassan, A.K.M.aEmail Author,  Shams-Eddin, H.a,  Abdel-Rahim, M.H.M.b,  El-Hafeez, H.A.A.c,  Edroos, S.d

Date of Publishing:
Volume 67, Issue 4, December 2015, Pages 315-323

Title:
Cardio- and Reno-Protective Effect of Remote Ischemic Preconditioning in ‎Patients Undergoing Percutaneous Coronary Intervention. A Prospective, Non-‎Randomized Controlled Trial‎

Abstract:
Objectives: This study assessed the cardio- and renoprotective effect of remote ischemic Preconditioning (PreC) in patients undergoing percutaneous coronary intervention (PCI). Background: Myocyte necrosis and contrast induced nephropathy (CIN) occur frequently in PCI and are associated with subsequent cardiovascular events. Methods: Two hundred consecutive patients undergoing elective PCI with normal baseline troponin-I (cTnI) values were recruited. Subjects were systematically allocated into 2 groups: 100 patients received PreC (created by three 5. min inflations of a blood pressure cuff to 200. mmHg around the upper arm, separated by 5. min intervals of reperfusion) <2. h before the PCI procedure, and control group (n= 100). Results: The incidence of PCI-related myocardial infarction (MI 4a) at 24. h after PCI was lower in the PreC group compared with control group (41% vs 64%, P=0.02). Subjects who received PreC had significant trend toward lower incidence of CIN at 72. h after contrast exposure (4 vs. 11, P=0.05) and less chest pain during stent implantation compared to control group. At 3 months, the major adverse event rate was lower in the PreC group (6 vs. 14 events; P= 0.04). Conclusions: The use of PreC. < 2 h before PCI, reduces the incidence of PCI-related MI 4a, tends to decrease the incidence of CIN and improves ischemic symptoms in patients undergoing elective PCI. The observed cardio- and renoprotection appears to confer sustained benefit on reduced major adverse events at 3 month follow-up beyond what is seen with judicious pre- and post-hydration (ClinicalTrials.gov identifier: NCT02313441). © 2015 The Authors.

Author Info:
aDepartment of Cardiology, Faculty of Medicine, Assiut University, Egypt
bDepartment of Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt
cDepartment of Clinical Pathology, Faculty of Medicine, Assiut University, Egypt
dDepartment of Cardiology, Princess Alexandra Hospital, Harlow, Essex, United Kingdom


Authors:
Hassan, W.A.a,  Darweesh, A.E.-D.M.c,  Marzouk, S.A.bEmail Author,  Yousef, Y.E.d,  Thabet, R.A.c

Date of Publishing:
Volume 22, Issue 2, 24 April 2015, Pages 107-113

Title:
Cognitive Behavioral Remediation Program for Children with Attention Deficit ‎Hyperactivity Disorder‎

Abstract:
Background Attention deficit hyperactivity disorder (ADHD) is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3-5% of children globally. Cognitive-behavioral therapy interventions have been increasingly applied to remediate self-control and behavioral problems in children. This study aimed to implement a remediation program for behavioral manifestations of children with ADHD. Patients and methods A quasi-experimental study was carried out on second-grade kindergarten children in Assiut city. The participants included 518 children (mean age 5.34 years) screened for ADHD. Thirty-two children who were diagnosed with ADHD received a cognitive-behavioral remediation program and were followed up for its effectiveness to modify ADHD manifestations. Children were evaluated with the Children's Attention and Adjustment Survey School form, the Children's Attention and Adjustment Survey House Form, and Wechsler Intelligence Scale for children, which were used in the preimplementation phase and after the remediation program. Diagnosis was based on DSM-IV diagnostic criteria for ADHD. Results The study revealed that the prevalence of ADHD was 6.18% and the male to female ratio was 2: 1. Follow-up showed statistically significant improvement in children with ADHD after the implementation of the cognitive-behavioral remediation program (P≤0.000). Conclusion and recommendation This cognitive-behavioral program is effective in the modification of ADHD manifestations. A larger sample size is needed to strengthen the effectiveness of the program. © 2015 Institute of Psychiatry, Ain Shams University.

Author Info:
aPsychiatry Department, Assiut Faculty of Medicine, Assiut, Egypt
bPediatric Nursing Department, Faculty of Nursing, Assiut University, Assiut, Egypt
cPsychiatric Nursing, Assiut Faculty of Nursing, Assiut, Egypt
dPediatric Nursing, Sohag Faculty of Nursing, Sohag, Egypt


