# IP 2018

Authors:
Rashwan NI(1), Hassan MH(2), Mohey El-Deen ZM(3), Ahmed AE(1)

Title:
Validity Of Biomarkers In Screening For Neonatal Sepsis ‎‎- A Single Center -Hospital Based Study

Abstract:
BACKGROUND:
The diagnosis of neonatal sepsis still considered to be a challenge for both clinicians and the laboratory due to the non-specific clinical presentations. The present study aimed to compare and assess the diagnostic & prognostic values of C-reactive protein (CRP), high sensitivity CRP (hsCRP), presepsin, interleukin-6 (IL-6) and procalcitonin (PCT) in neonatal sepsis separately and in combination.

METHODS:
This hospital-based cross-sectional study has been conducted on 168 neonates recruited from the neonatal intensive care unit (NICU) of Qena University Hospitals, Upper Egypt. Measurements of CRP using latex agglutination test, hsCRP, presepsin, IL6 and PCT assays using commercially available ELISA assay kits were done to all included neonates.

RESULTS:
There were significantly higher serum levels of CRP among late onset versus early onset sepsis group with significantly higher serum levels of hsCRP and presepsin among early onset compared with the late onset sepsis group (p < 0.05 for all). There were significantly higher hsCRP, presepsin and PCT serum levels in proven versus probable sepsis group (p < 0.05 for all). Significantly higher serum levels of presepsin and PCT were noted among survivors versus non survivors sepsis group (p < 0.05 for all). The cutoff value of the serum level of CRP >6 mg/dl showed lower sensitivity and specificity than that of hsCRP at cutoff >140 ng/ml in diagnosing neonatal sepsis. The cutoff value of presepsin >200 ng/ml showed equal sensitivity and specificity to IL-6 at cutoff >22 pg/ml. The cutoff value of PCT at > 389 pg/ml showed sensitivity and specificity approximate to that of hsCRP.

CONCLUSIONS:
CRP could be a helpful prognostic marker in late onset neonatal sepsis. hsCRP and PCT have higher diagnostic accuracy in neonatal sepsis in comparison to other studied markers. Both IL-6 and presepsin have equal diagnostic utility in neonatal sepsis, but presepsin could be helpful diagnostic marker in early onset neonatal sepsis.

Author Info:
1
Department of Pediatrics, Faculty of Medicine and University Hospitals, South Valley University, Qena, Egypt.
2
Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, Egypt. Electronic address: Mohammedhosnyhassaan@yahoo.com.
3
Department of Pediatrics, Faculty of Medicine and Children' University Hospital, Assiut University, Egypt.


Authors:
Rateb MF(1), Eldaly ZH(1), Ibrahim WSE(1), Eldoghaimy AH(2).

Title:
Scanning Electron Microscopic Characteristics Of ‎Manually Loaded And Preloaded Foldable Acrylic ‎Intraocular Lenses

Abstract:
PURPOSE:
To compare surface alterations between preloaded and manually loaded intraocular lens.

METHODS:
Scanning electron microscope was utilized to evaluate surface alteration and deposits in four different types of intraocular lenses: preloaded hydrophobic acrylic, preloaded hydrophilic acrylic, manually loaded hydrophobic acrylic, and manually loaded hydrophilic acrylic. Six lenses with different powers (+6 D, +22 D, and +29 D) were used from each category, to represent different thickness categories of the intraocular lenses.

RESULTS:
In total, 30 intraocular lenses have been evaluated in this study: 4 from the control group (2 hydrophobic and 2 hydrophilic lenses) and 12 from the preloaded intraocular lens and manually loaded groups (6 hydrophilic and 6 hydrophobic lenses with different powers). Surface deposits were found in eight hydrophobic intraocular lenses compared to a single intraocular lens with scattered deposits on the optical surface of a hydrophilic intraocular lens. In manually loaded intraocular lens group, five hydrophobic and one hydrophilic intraocular lenses showed identifiable marks on the optical surface. In the preloaded intraocular lens group, three hydrophobic intraocular lenses showed identifiable marks on the optical surface and three hydrophobic intraocular lenses showed surface wrinkling. All hydrophilic intraocular lenses revealed no identifiable marks.

CONCLUSION:
Surface alterations and deposits are a common finding in both preloaded and manually loaded intraocular lenses. Water content of acrylic intraocular lenses is an important factor predisposing to these changes, and hydrophobic intraocular lenses are more vulnerable than hydrophilic lenses. The impact on the final visual outcome needs further studies.

Author Info:
1
1 Department of Ophthalmology, Assiut University Hospitals, Assiut, Egypt.
2
2 Ophthalmology Department, South Valley University Hospital, Qena, Egypt.


Authors:
Rayan A(1), Abdel Fattah ON(2), Soliman A(3), Hasan HA(4), Zahran AM(5).

Title:
Efficacy of Docetaxel and Oxaliplatin Regimen as a Second-Line Therapy for Patients with Advanced Pancreatic Adenocarcinoma

Abstract:
BACKGROUND AND AIM OF WORK:
Pancreatic cancer is the deadliest of the 21 most common cancers, largely because it is often identified at a late stage, we aimed to determine the control rates, and PFS for patients who received docetaxel-oxaliplatin regimen as a 2nd line therapy.

PATIENTS AND METHODS:
Twenty-five patients with advanced cancer pancreas progressed or failed on 1st line treatments and justified the inclusion criteria were eligible to receive Docetaxel 75 mg/m2 over 1h iv infusion on day 1, Oxaliplatin 80 mg/m2 over 2 h iv infusion on day 2, the cycle was repeated every 3 weeks for 6-8 cycles unless disease progression or severe toxicity appeared.

RESULTS:
No patients achieved complete response (CR), and the control rate (control rate = partial response (PR = 6/25, 24%) + stable disease (SD = 9/25, 36%) was 60% while disease progression (DP) was demonstrated in (10/25) 40% of patients, the median PFS was 7 ± 0.777 ms (95% confidence interval: 5.467-8.524 ms), grade 3 neutropenia, fatigue, diarrhea, and vomiting were developed in 12%, 8%, 12% and 8% of patients respectively.

CONCLUSIONS:
Docetaxel-oxaliplatin regimen was an active regimen in advanced cancer pancreas based on our encouraging results without occurrence of grade four toxicities.

Author Info:
1
Department of clinical oncology, Assiut University Hospital, Assiut University, Assiut, 71515, Egypt. amal3774rayan@gmail.com.
2
Department of clinical oncology, Assiut University Hospital, Assiut University, Assiut, 71515, Egypt.
3
Department of surgery, Assiut University Hospital, Assiut University, Assiut, Egypt.
4
Department of diagnostic radiology, Assiut University Hospital, Assiut University, Assiut, Egypt.
5
Department of clinical pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Authors:
Rego DC(1), Ahmed AKS(2), O'Sullivan GJ(3).

Title:
Addressing Infra-popliteal Thrombus in Iliofemoral DVT: The Criss-Cross Technique

Abstract:
PURPOSE:
The purpose of this work was to describe the results of a technique of simultaneous antegrade and retrograde vascular access ("criss-cross") to the popliteal vein to achieve venous recanalization in patients with acute, extensive, iliofemoral DVT with concomitant popliteal and calf vein thrombosis.

MATERIALS AND METHODS:
Seven patients were treated using this technique, in three patients as a bailout option after failed posterior tibial vein puncture and in four as a first option. Antegrade popliteal venous access was performed according to the usual technique using duplex ultrasound (DUS) guidance and thrombolysis (CDT), or thrombectomy (PMT) was performed. Following this, the retrograde sheath was placed under DUS guidance, a tibial vein was selectively catheterized and CDT, and/or a PMT was performed.

RESULTS:
Three patients underwent isolated CDT, another three had associated PMT, and one patient underwent iliofemoral PMT and catheter thromboaspiration of the popliteal and calf veins. Median thrombolysis duration was 72 h (24-72 h). SIR grade III thrombolysis was achieved in six patients and grade II in one patient. All patients underwent subsequent stenting of their iliac vein lesions. Minor complications were observed in two patients (ecchymosis), while one patient developed a hematoma on the popliteal fossa.

CONCLUSION:
This "criss-cross" technique represents a safe alternative to the distal (anterior or posterior tibial) vein access both as a bailout option after failed distal venous access as well as a primary approach due to its potential advantage of clearing larger thrombus volume. Experience in ultrasound-guided popliteal vein puncture is crucial to avoid complications.

LEVEL OF EVIDENCE:
Case series, Level IV.

Author Info:
1
Department of Angiology and Vascular Surgery, Centro Hospitalar do Porto - Hospital de Sto. António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal. duarterego@hotmail.com.
2
Vascular and Endovascular Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Interventional Radiology, University College Hospital of Galway, National University of Ireland, Galway, Ireland.


Authors:
Saad K(1), Abdel-Rahman AA(2), Elserogy YM(2), Al-Atram AA(3), El-Houfey AA(4), Othman HA(5), Bjørklund G(6), Jia F(7), Urbina MA(8),(9), Abo-Elela MGM(10), Ahmad FA(1), Abd El-Baseer KA(10), Ahmed AE(10), Abdel-Salam AM(11).

Title:
Randomized Controlled Trial Of Vitamin D ‎Supplementation In Children With Autism Spectrum ‎Disorder

Abstract:
BACKGROUND:
Autism spectrum disorder (ASD) is a frequent developmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and nonverbal communication, and stereotyped patterns of interests and activities. It has been previously reported that there is vitamin D deficiency in autistic children; however, there is a lack of randomized controlled trials of vitamin D supplementation in ASD children.

METHODS:
This study is a double-blinded, randomized clinical trial (RCT) that was conducted on 109 children with ASD (85 boys and 24 girls; aged 3-10 years). The aim of this study was to assess the effects of vitamin D supplementation on the core symptoms of autism in children. ASD patients were randomized to receive vitamin D3 or placebo for 4 months. The serum levels of 25-hydroxycholecalciferol (25 (OH)D) were measured at the beginning and at the end of the study. The autism severity and social maturity of the children were assessed by the Childhood Autism Rating Scale (CARS), Aberrant Behavior Checklist (ABC), Social Responsiveness Scale (SRS), and the Autism Treatment Evaluation Checklist (ATEC).

TRIAL REGISTRATION NUMBER:
UMIN-CTR Study Design: trial number: UMIN000020281.

RESULTS:
Supplementation of vitamin D was well tolerated by the ASD children. The daily doses used in the therapy group was 300 IU vitamin D3/kg/day, not to exceed 5,000 IU/day. The autism symptoms of the children improved significantly, following 4-month vitamin D3 supplementation, but not in the placebo group. This study demonstrates the efficacy and tolerability of high doses of vitamin D3 in children with ASD.

CONCLUSIONS:
This study is the first double-blinded RCT proving the efficacy of vitamin D3 in ASD patients. Depending on the parameters measured in the study, oral vitamin D supplementation may safely improve signs and symptoms of ASD and could be recommended for children with ASD. At this stage, this study is a single RCT with a small number of patients, and a great deal of additional wide-scale studies are needed to critically validate the efficacy of vitamin D in ASD.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Psychiatry, College of Medicine, Almajmaah University, Riyadh, Saudi Arabia.
4
Department of Community Health Nursing, Assiut University, Assiut, Egypt.
5
Department of Clinical Pathology, Aswan University, Aswan, Egypt.
6
Council for Nutritional and Environmental Medicine, Mo i Rana, Norway.
7
Department of Pediatric Neurology and Neurorehabilitation, The First Hospital of Jilin University, Changchun, China.
8
Department of Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
9
Departamento de Zoología, Facultad de Ciencias Naturales y Oceanográficas, Universidad de Concepción, Concepción, Chile.
10
Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
11
Department of Pharmaceutics and Industrial Pharmacy, Alazhar University, Assiut, Egypt.


Title:
Response To Letters: Randomized Controlled Trial Of ‎Vitamin D Supplementation In Children With Autism ‎Spectrum Disorder - Correction And Additional ‎Information

Author Info:
Associate Professor of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Saad K(1), Zahran AM(2), Elsayh KI(1), Abdelmoghny A(3), Aboul-Khair MD(4).

Title:
Variation of Regulatory T Lymphocytes in the Peripheral Blood of Children with Allergic Rhinitis

Abstract:
The studies of T-regulatory (Treg) cells in the pediatric allergic disorders, especially allergic rhinitis (AR), are very few and still far from being elucidated. The aim of this study is to assess the frequencies of CD4+CD25+Foxp3+ (CD4+Tregs) and CD8+CD25+highFoxp3+ (CD8+Tregs) regulatory T lymphocytes in the peripheral blood of children with AR. In fresh whole blood of 60 children with AR and 40 healthy controls, the frequencies of CD4+Tregs and CD8+Tregs were examined by flow cytometry. The total IgE concentration in the serum was measured. In AR children, the frequencies of CD4+Tregs and CD8+Tregs were significantly reduced when compared to control group (p = 0.041, p = 0.011, respectively). Moreover, the expressions of Foxp3+ in CD4+CD25+high and CD8+CD25+high cells were significantly lower in patient group than controls. We found a significant negative correlation between the frequencies of CD4+Tregs and the total IgE concentration (p < 0.01). In conclusion, the present study demonstrated that the percentages of CD8+Tregs and CD4+Tregs T cells were significantly decreased in children with AR. This suggests that decreased Treg cells might represent a defect in the compartment of T-cell population in children with AR. Further studies are warranted to fully appreciate the clinical relevance of Tregs in children with AR.

Author Info:
1
Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, 71516, Egypt. asmaa.zahran@yahoo.com.
3
Department of ENT, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
4
Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.


Authors:
Saccone G(1), Caissutti C(2), Ciardulli A(3), Abdel-Aleem H(4), Hofmeyr GJ(5), Berghella V(6).

Title:
Uterine Massage As Part Of Active Management Of The ‎Third Stage Of Labour For Preventing Postpartum ‎Haemorrhage During Vaginal Delivery: A Systematic ‎Review And Meta-Analysis Of Randomised Trials

Author Info:
1
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
2
Department of Experimental Clinical and Medical Science, DISM, Clinic of Obstetrics and Gynaecology, University of Udine, Udine, Italy.
3
Department of Obstetrics and Gynaecology, Catholic University of Sacred Heart, Rome, Italy.
4
Department of Obstetrics and Gynaecology, Women's Health Hospital, Assiut University Hospital, Assiut, Egypt.
5
Effective Care Research Unit, Eastern Cape Department of Health, Fort Hare and Walter Sisulu Universities and University of the Witwatersrand, Johannesburg, South Africa.
6
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.


Title:
Editorial Comment From Dr Safwat To Risk Of Urinary ‎Stones Among Women With Pelvic Organ Prolapse: A ‎National Population-Based Cohort Study

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


Title:
Spouse Reply to "Research Pearls: The Significance of Statistics and Perils of Pooling"

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


Authors:
Saleh MGA(1),(2), Parikh M(1), Lin P(1).

Title:
Treatment of Epithelial Downgrowth Masquerading as Unilateral Hypopyon Uveitis in a HLA-B27+ Individual

Abstract:
We report a case of an elderly woman with congenital rubella who presented with epithelial downgrowth (EDG) masquerading as hypopyon uveitis. We highlight the importance of endoscopy to completely identify all ingrowing epithelium with combined use of 5-fluorouracil to completely eradicate invading tissue.

Author Info:
1
a Department of Ophthalmology , Casey Eye Institute, Oregon Health & Science University , Portland , Oregon, USA.
2
b Assiut University , Assiut , Egypt.


Authors:
Sandrasegaran K(1), Cui E(2),(3), Elkady R(2),(4),(5), Gasparis P(2), Borthakur G(2), Tann M(2), Liangpunsakul S(6),(7).

Title:
Can Functional Parameters From Hepatobiliary Phase Of ‎Gadoxetate MRI Predict Clinical Outcomes In Patients ‎With Cirrhosis?‎

Abstract:
OBJECTIVES:
To determine the value of quantitative parameters of gadoxetate-enhanced magnetic resonance imaging (MRI) in predicting prognosis in patients with cirrhosis.

METHODS:
A cohort of 63 cirrhotic patients who had gadoxetate MRI and 2-year clinical follow-up was enrolled. Enhancement ratio (ER), contrast enhancement index (CEI) and contrast enhancement spleen index (CES) were calculated. The usefulness of these parameters and clinical scores, such as Child-Pugh score (CPS) and model for end stage liver disease (MELD), in predicting adverse outcomes, such as variceal bleeding (VB), hepatic encephalopathy (HE) and mortality at 2 years were evaluated.

RESULTS:
Fifteen, 31 and 27 patients, respectively, had VB, HE and mortality within 2 years. The ER at 15 min (ER 15) and CES at 20 min (CES 20) were found to be the best MRI predictors. Areas under the receiver operating characteristic curve (AUC) for predicting VB were 0.785, 0.729, 0.673, 0.714, respectively, for ER 15, CES 20, CPS and MELD scores. ER 15 of less than 48 had sensitivity of 96% and specificity of 84% for predicting onset of HE within 2 years.

CONCLUSIONS:
In patients with cirrhosis, ER 15 or CES 20 were equivalent or better predictors of major morbidity and mortality compared with commonly used clinical scores.

KEY POINTS:
• Gadoxetate parameters may identify cirrhotic patients at risk of adverse events. • Gadoxetate parameters usually show superior predictive values compared to clinical scores. • CES 20 score is associated with risk of mortality within 2 years

Author Info:
1
Department of Radiology, Indiana University School of Medicine, UH 0279, 550 N. University Blvd, Indianapolis, IN, 46202, USA. ksandras@iupui.edu.
2
Department of Radiology, Indiana University School of Medicine, UH 0279, 550 N. University Blvd, Indianapolis, IN, 46202, USA.
3
Department of Radiology, Jiangmen Central Hospital, Jiangmen, China.
4
Department of Radiology, Assiut University, Assiut, Egypt.
5
Department of Radiology, Taibah University, Medina, Saudi Arabia.
6
Department of Medicine (Division of Hepatology), Indiana University School of Medicine, Indianapolis, IN, USA.
7
Department of Medicine, Robert Roudebush VA Medical Center, Indianapolis, IN, USA.


Authors:
Sandrasegaran K(1), Territo P(2), Elkady RM(2),(3), Lin Y(2),(4), Gasparis P(2), Borthakur G(2), Lin C(2).

Title:
Does Intravoxel Incoherent Motion Reliably Stage Hepatic ‎Fibrosis, Steatosis, And Inflammation?‎

Abstract:
OBJECTIVE:
To investigate the usefulness of intravoxel incoherent motion (IVIM) in determining the severity of hepatic fibrosis, steatosis, and inflammation in patients with chronic liver disease.

METHODS:
Forty-nine patients who had liver MRI with IVIM sequence and liver biopsy within three months of MRI were enrolled. A reviewer, blinded to histology, placed regions of interest of 1-2 cm2 in the right liver lobe. In addition, the first twenty patients were assessed with a second reviewer. Perfusion fraction (f), pseudodiffusion coefficient (D fast), true diffusion coefficient (D slow), and apparent diffusion coefficient (ADC) were calculated from normalized signal intensities that were fitted into a biexponential model. Errors in the model were minimized with global stochastic optimization using Simulated Annealing. ANOVA with post hoc Tukey-Kramer test and multivariate generalized linear model analysis were performed, using histological findings as the gold standard.

RESULTS:
The most common etiologies for liver disease were hepatitis C and alcohol, accounting together for 76% (37/49) of patients. Low-grade fibrosis (F0, F1), hepatic steatosis, and inflammation were seen in 24% (12/49), 31% (15/49), and 29% (14/49) of patients, respectively. The interobserver correlation was poor for D fast and D slow (0.105, 0.173) and moderate for f and ADC (0.461, 0.418). ANOVA showed a strong inverse association between D fast and liver fibrosis grade (p = 0.001). A weak inverse association was seen between ADC and hepatic steatosis (p = 0.059). Multivariate general linear model revealed that the only significant association between IVIM parameters and pathological features was between D fast and fibrosis. On ROC curve analysis, D fast < 23.4 × 10-3 mm2/s had a sensitivity of 82.8% and a specificity of 64.3% in predicting high-grade fibrosis.

CONCLUSION:
D fast has the strongest association with hepatic fibrosis but has weak interobserver correlation. IVIM parameters were not significantly associated with hepatic inflammation or steatosis.

Author Info:
1
Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN, 46202, USA. ksandras@iupui.edu.
2
Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN, 46202, USA.
3
Department of Radiology, Assiut University, Assiut, Egypt.
4
Department of Radiology, Fuzhou General Hospital, Fuzhou, China.


Authors:
Sayed JA(1), Abd Elshafy SK(1), Kamel EZ(1), Fathy Riad MA(2), Mahmoud AA(3), Khalaf GS(4).

Title:
The Impact Of Caudally Administrated Tramadol On ‎Immune Response And Analgesic Efficacy For Pediatric ‎Patients: A Comparative Randomized Clinical Trial

Abstract:
BACKGROUND:
Immune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients.

METHODS:
Sixty ASA-I pediatric patients aged 3-10 years undergoing lower abdominal surgery. Patients were randomly assigned either to a caudal bupivacaine (0.25%) group (group B), or a group that received caudal tramadol (1 mg/kg) added to the bupivacaine (0.25%) (group T). Both were diluted in a 0.9% NaCl solution to a total volume of 1ml/kg. The systemic immune response was measured by collecting blood samples preoperatively, at the end of anesthesia, and at 24 and 72 hours postoperatively, and studied for interleukin IL-6, C-reactive proteins (CRP) cortisol levels, and leucocytes with its differential count. Postoperative pain was assessed along with sedation scales.

RESULTS:
Postoperative production of IL-6 was significantly higher in group B at the end of anesthesia, than at the 24th hour, and at the 72nd hour in group B and group T, respectively. The immune response showed leukocytosis with increased percentages of neutrophil and monocytes, and a decreased lymphocyte response rate within both groups with no significant differences between the groups. Cortisol and CRP were significantly higher in group B.

CONCLUSIONS:
Adding tramadol to a caudal bupivacaine block can attenuate the pro-inflammatory cytokine response, Cortisol, and CRP in children undergoing lower abdominal surgery.

Author Info:
1
Department of Anesthesia, College of Medicine, Assiut University, Assiut, Egypt.
2
Department of Pediatric, College of Medicine, Assiut University, Assiut, Egypt.
3
Department of Clinical Pathology, College of Medicine, Assiut University, Assiut, Egypt.
4
Department of Critical Care and Emergency Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt.


Authors:
Sayyed HG(1), Idriss NK(2), Gaber MA(2), Sayed S(3), Ahmed R(3).

Title:
Physiological Responses and Gene Expression in Ultrasound-Guided Supraclavicular Brachial Plexus Block: a Comparative Study

Abstract:
BACKGROUND/AIMS:
Ultrasound-guided supraclavicular brachial plexus block (BPB) has come into wider use as a regional anesthetic during upper limb operations. This study assessed the neurological and hemodynamic changes and gene expression after co-administration of midazolam or neostigmine with bupivacaine during supraclavicular BPB.

METHODS:
The study involved 90 adults divided into three groups: control (bupivacaine), midazolam (bupivacaine plus midazolam), and neostigmine (bupivacaine plus neostigmine). Blood samples were taken and interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) mRNA levels were measured by real-time PCR, and oxidative stress markers were identified. In addition to the hemodynamic variables, the onset and duration of sensory and motor blockades, duration of analgesia, pain scores, time of first request for an analgesic, and amounts of analgesics ingested were evaluated.

RESULTS:
Compared with the control and neostigmine groups, the midazolam group experienced longer sensory and motor blockades, prolonged analgesia, lower pain scores at 12 h and 24 h, and lower need for postoperative analgesics. Moreover, the midazolam group exhibited lower oxidative stress markers with a higher fold change in IL-6 and TNF-α mRNA levels.

CONCLUSION:
Midazolam co-administered with bupivacaine provided better analgesic quality than did neostigmine with bupivacaine. This might be due to its superior antioxidant and anti-inflammatory effects.

Author Info:
1
Departments of Medical Physiology, Assiut, Egypt.
2
Departments of Medical Biochemistry, Assiut, Egypt.
3
Departments of Anesthesiology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Shaaban OM(1), Abbas AM(1), Mahmoud HR(2), Yones EM(2), Mahmoud A(3), Zakherah MS(1).

Title:
Levonorgestrel Emergency Contraceptive Pills Use ‎During Breastfeeding; Effect On Infants' Health And ‎Development

Abstract:
OBJECTIVE:
The current study aims to evaluate the effect of the use of single packet of levonorgestrel emergency contraceptive pills (LNG-ECPs) during breastfeeding on the health and development of the nursing infant.

MATERIALS AND METHODS:
The current study was an ancillary observational cohort study carried out in a university hospital. We counseled all women delivered and planning birth-space and breastfeed for at least 1 year for participation during postpartum hospital stay. Eligible participants for inclusion in the randomized controlled trial (NCT 01111929) were allocated to receive adequate Lactational Amenorrhea Method (LAM) counseling (LAM-only group) or the LAM counseling in addition to counseling about LNG-ECPs use (LAM + emergency contraception (EC) group). These pills were to be used once if unprotected intercourse did occur after expiry of any of the LAM prerequisites and before the couples started to use a reliable method of contraception. We included the first 100 women in the LAM + EC who did use the pills and the first 100 women in the control group who completed the follow-up visits for 6 months to draw the infants' outcome. The primary outcome was the difference of anthropometric measurements of the infants at 3 and 6 months postpartum. Secondary outcome was the difference in the Psycho-social, fine and gross motor, and language development using Denver development screening test.

RESULTS:
There were no statistical significant differences between both the groups regarding the infants' weight, length, head circumference, chest circumference, and mid-arm circumference at each visit (p > .05). Additionally, there were no statistically significant differences regarding all items (psycho-social, fine and gross motor, and language) of Denver development screening test between the infants in LAM-only and LAM + EC groups (p = .081).

CONCLUSIONS:
The use of single packet of LNG-ECPs during breastfeeding not objectively affects health and development of nursing infants or subjectively affects the quantity of breast milk.

Author Info:
1
a Department of Obstetrics and Gynecology , Faculty of Medicine, Assiut University , Assiut , Egypt.
2
b Department of Obstetric and Gynecological Nursing , Faculty of Nursing, Assiut University , Assiut , Egypt.
3
c Department of Pediatrics, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Shah M(1), Tayar JH(1), Abdel-Wahab N(2), Suarez-Almazor ME(3).

Title:
Myositis As An Adverse Event Of Immune Checkpoint ‎Blockade For Cancer Therapy

Abstract:
OBJECTIVES:
Immune checkpoint inhibitors (ICIs) can successfully treat cancer, but their use can be hindered by serious immune-related adverse events. We report six patients receiving ICIs who presented with de novo myositis.

METHODS:
We identified patients with myositis who were receiving ICIs between January 2004 and September 2016 at The University of Texas MD Anderson Cancer Center.

RESULTS:
Six patients developed de novo myositis. The mean age was 64.3 years and five patients were male. Cancer types included melanoma, urothelial carcinoma, renal cell carcinoma, and prostate cancer. ICI regimens included single-agent ipilimumab (n = 1), pembrolizumab (n = 1), or atezolizumab (n = 1); nivolumab and ipilimumab (n = 3). The median time to development of de novo myositis from first infusion was 5.4 weeks (range: 2.1-17.1 weeks). All patients with myositis had elevated levels of creatinine kinase, ranging from 514 to 13,710U/L. Two of them developed rhabdomyolysis, one with concurrent myocarditis. Five patients were treated with 1-2mg/kg corticosteroids, with variable response rates; one patient received nonsteroidal anti-inflammatory drugs. Two patients with myositis died as a result of cancer progression.

CONCLUSION:
We found several occurrences of de novo myositis following ICI therapy. These preliminary data suggest that myositis can occur early after onset of ICI therapy with serious adverse outcomes.

Author Info:
1
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
2
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.
3
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: msalmazor@mdanderson.org.


Authors:
Shamshirsaz AA(1), Bateni ZH(1), Sangi-Haghpeykar H(1), Arian SE(2), Erfani H(1), Shamshirsaz AA(1), Abuhamad A(3), Fox KA(1), Ramin SM(1), Moaddab A(1), Maskatia SA(4), Salmanian B(1), Lopez KN(2), Hosseinzadeh P(1), Schutt AK(2), Nassr AA(1),(5), Espino

Title:
Cyanotic Congenital Heart Disease Following Fertility ‎Treatments In The United States From 2011 To 2014‎

Abstract:
OBJECTIVE:
To examine the risk for cyanotic congenital heart diseases (CCHDs) among live births in the USA, resulting from various forms of infertility treatments.

METHODS:
This study is a cross-sectional analysis of live births in the USA from 2011 to 2014. Infertility treatments are categorised into two of the following groups on birth certificates: assisted reproductive technology (ART) fertility treatment (surgical egg removal; eg, in vitro fertilisation and gamete intrafallopian transfer) and non-ART fertility treatment (eg, medical treatment and intrauterine insemination). We compared the risk for CCHD in ART and non-ART fertility treatment groups with those infants whose mothers received no documented fertility treatment and were naturally conceived (NC).

RESULTS:
Among 14 242 267 live births from 2011 to 2014, a total of 101 494 live births were in the ART and 81 242 resulted from non-ART fertility treatments. CCHD prevalence in ART, non-ART and NC groups were 393/100 892 (0.39%), 210/80 884 (0.26%) and 10 749/14 020 749 (0.08%), respectively. As compared with naturally conceiving infants, risk for CCHD was significantly higher among infants born in ART (adjusted relative risk (aRR) 2.4, 95% CI 2.1 to 2.7) and non-ART fertility treatment groups (aRR 1.9, 95% CI 1.6 to 2.2). Absolute risk increase in CCHD due to ART and non-ART treatments were 0.03% and 0.02%, respectively. A similar pattern was observed when the analysis was restricted to twins, newborns with birth weights under 1500 g and gestational age of less than 32 weeks.

CONCLUSIONS:
Our findings suggest an increased risk for CCHD in infants conceived after all types of infertility treatment.

Author Info:
1
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
2
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
3
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA.
4
Department of Pediatrics, Section of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA.
5
Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt.


Authors:
Shawky Abdelgawaad A(1), Babic D(2), Siam AE(3), Ezzati A(2)

Title:
Extraforaminal Microscopic Assisted Percutaneous ‎Nucleotomy For Foraminal And Extraforaminal Lumbar ‎Disc Herniations

Abstract:
BACKGROUND:
Foraminal and extraforaminal lumbar disc herniations are uncommon. The main presentation is radicular pain related to the exiting nerve root at the affected level. Different approaches for surgical intervention have been described.

PURPOSE:
This study aimed to evaluate the clinical outcome, complications recurrence, and reoperation rate of extraforaminal microscopic-assisted percutaneous nucleotomy, with literature review focusing on complications and recurrence rate.

STUDY DESIGN:
This is a prospective cohort study done in a high-flow spine center in Germany.

PATIENT SAMPLE:
Between October 2012 and October 2015, 76 patients (35 women and 41 men) with foraminal or extraforaminal lumbar disc prolapse were operated on.

OUTCOME MEASURES:
The following were the outcome measures: (1) self-report measures: Visual Analogue Scale (VAS) for leg pain and back pain; (2) physiological measures: standing plain X-rays (anterioposterior, lateral, and dynamic views); and (3) functional measures: Oswestry Disability Index (ODI) (validated German version) and Odom's criteria.

METHODS:
All patients were operated upon with trans-tubular extraforaminal microscopic-assisted percutaneous nucleotomy (EF-MAPN) technique. Preoperative clinical and neurologic evaluations were done. The mean follow-up period was 38 months (range 12-54). The study has not received funding for research from any organization. All authors do not have any conflict of interest.

RESULTS:
The mean age was 54 years. The most commonly affected level was L4/L5 (34 patients). The mean preoperative VAS for leg pain was 7.6 (3-10), which improved to 1.4 (0-4) postoperatively. The average operative time was 57.5 minutes. There were no intraoperative complications. One patient had temporary postoperative quadriceps weakness (L4 radiculopathy) that was completely improved at 3 months' follow-up. Another patient had deep venous thrombosis after discharge. Two patients had recurrences that necessitated another operation within the first 6 months postoperatively. Both were followed up for 1 year without a second recurrence.

CONCLUSION:
Trans-tubular percutaneous extraforaminal microscopic-assisted nucleotomy is effective for foraminal and extraforaminal disc herniations. It is a muscle-splitting minimally invasive approach with minimal morbidity. Complications, recurrence, and reoperation rate are not different compared with microsurgical open or endoscopic techniques.

Author Info:
1
Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089 Erfurt, Germany; Department of Orthopedics and Traumatology, Assiut University Hospitals, 71515 Assiut, Egypt. Electronic address: ahsh313@yahoo.com.
2
Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089 Erfurt, Germany.
3
Spine Center, Orthopedic Klinik Markgroeningen g GmbH, Kurt-Lindemann-Weg 10, 71706 Markgroeningen, Germany.


Authors:
Shawky Abdelgawaad A(1), Kellner G(2), Elnady B(3), Ezzati A(2).

Title:
Odontoid-Sparing Transnasal Approach For Drainage Of ‎Craniocervical Epidural Abscess; A Novel Technique ‎And Review Of The Literature

Abstract:
BACKGROUND CONTEXT:
Surgical approaches to the craniovertebral junction (CVJ) are challenging. Available approaches include posterior, transoral, endonasal, and anterior extended retropharyngeal approach. Resection of the odontoid process is necessary to gain access to the pathology posterior to it. The resultant cranio-atlanto-axial instability usually necessitates subsequent posterior stabilization.

PURPOSE:
To describe a new odontoid-sparing approach to the spinal canal at the CVJ. This dens-sparing approach preserves occipito-atlanto-axial stability and avoids the need for occipitocervical stabilization that adds to the extent of surgery and its associated morbidity and mortality.

STUDY DESIGN:
Describing a novel technique and reporting two cases.

PATIENT SAMPLE:
Two patients that presented with infection at the CVJ with a retro-odontoid epidural abscess were operated on.

OUTCOME MEASURES:
Self-reported measures: visual analog scale for neck pain. Physiologic measures: plain x-rays (anteroposterior and lateral views), magnetic resonance imaging with contrast, computed tomography scan, C-reactive protein, and leukocytic count. Functional measures: dynamic flexion-extension views of the cervical spine.

METHODS:
Two patients were operated on using a combined endoscopic transnasal-transoral approach for drainage of a retro-odontoid epidural abscess and debridement without dens resection. A 4-mm, 30-degree rigid endoscope was used. Preoperative clinical and neurologic status was evaluated. The follow-up period was 12 months. The study received no funding from any organization. None of the authors has any relevant financial disclosures or conflict of interest.

RESULTS:
Both patients improved clinically after the endonasal transoral abscess drainage. Follow-up contrast magnetic resonance imaging showed complete resolution of the abscess after 3 weeks. Culture-sensitivity tests were positive for Staphylococcus aureus in one patient. Antibiotic therapy with clindamycin and flucloxacillin was continued for 12 weeks postoperatively. There were no intraoperative or postoperative complications. There was no need for posterior occipitocervical stabilization in both cases.

CONCLUSION:
This represents the first clinical report of accessing the spinal canal at the CVJ without resection of the odontoid or the anterior arch of the atlas. The addition of endoscopic-assisted supra-dental approach to the transoral one improved visibility, and allowed access to the most cranial part of spinal canal without the need for dens resection, a procedure that significantly compromises C0-1-2 stability necessitating stabilization. This novel odontoid-sparing approach showed a favorable outcome in our first two cases with retro-odontoid abscess; however, it would likely pose a high risk in other pathologies including tumors.

Author Info:
1
Helios Klinikum Erfurt, Nordhaeuser St 74, 99089 Erfurt, Germany; Assiut University Hospitals, 71515 Assiut, Egypt. Electronic address: ahsh313@yahoo.com.
2
Helios Klinikum Erfurt, Nordhaeuser St 74, 99089 Erfurt, Germany.
3
Assiut University Hospitals, 71515 Assiut, Egypt.


Authors:
Soliman MK(1), Hardin JS(2), Jawed F(3), Uwaydat SH(2), Faramawi MF(4), Chu CJ(5), Yang YC(6), Sallam AB(7).

Title:
A Database Study of Visual Outcomes and Intraoperative Complications of Postvitrectomy Cataract Surgery

Abstract:
PURPOSE:
To analyze the visual outcomes and rate of intraoperative complications of phacoemulsification surgery after prior pars plana vitrectomy (PPV).

DESIGN:
Retrospective, multicenter database study.

PARTICIPANTS:
Eyes that underwent phacoemulsification between June 2005 and March 2015 at 8 sites in the United Kingdom.

METHODS:
Study eyes were classified as vitrectomized (prior PPV group) or nonvitrectomized (reference group) depending on the vitreous state at the time of cataract surgery. Eyes with multiple intraocular surgeries or history of ocular diseases known to cause cataract progression or increased risk of intraoperative complications during phacoemulsification were excluded.

MAIN OUTCOME MEASURES:
Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA), rate of intraoperative complications, and time interval to cataract surgery.

RESULTS:
Eyes in the prior PPV group (n = 2221) had worse preoperative logMAR VA (0.96±0.60 vs. 0.62±0.52, P < 0.0001), were from younger patients, and had longer axial lengths than the nonvitrectomized group (n = 136 533). At all postoperative time points measured up to 24 weeks, mean vision was poorer in the prior PPV group (0.41±0.47 vs. 0.17±0.29 at 4-12 weeks, P < 0.0001) and a smaller proportion of eyes achieved postoperative VA ≤0.30 logMAR (Snellen, ≥20/40) (60.8% vs. 86.5% at 4-12 weeks, P < 0.0001). The rate of posterior capsular rupture was not different between the prior PPV (1.5%) and the nonvitrectomized (1.7%) groups, but the incidences of zonular dialysis (1.3% vs. 0.6%) and dropped nuclear fragments (0.6% vs. 0.2%) were higher in the prior PPV group (P < 0.0001). The mean time interval between PPV and cataract surgery was 399 days.

CONCLUSIONS:
We found a significant improvement in VA with postvitrectomy cataract surgery. However, compared with eyes without prior PPV, there was a worse mean postoperative vision of 0.2 logMAR units, a higher rate of zonular dialysis and dropped nuclear fragments, and a similar rate of posterior capsule rupture.

Author Info:
1
Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada.
2
Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
3
The Jackson Laboratory, Farmington, Connecticut.
4
Epidemiology Department, College of Public Health and Biomedical informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
5
School of Clinical Sciences, University of Bristol and Bristol Eye Hospital, Bristol, United Kingdom.
6
Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, New Cross, Wolverhampton, United Kingdom.
7
Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Ophthalmology Department, Gloucestershire Hospitals NHS Trust, Cheltenham, United Kingdom. Electronic address: ahmedsallam11@yahoo.com.


Authors:
Soliman RK(1), Gamal SA(2), Essa AA(3), Othman MH(2).

Title:
Preoperative Grading of Glioma Using Dynamic Susceptibility Contrast MRI: Relative Cerebral Blood Volume Analysis of Intra-tumoural and Peri-tumoural Tissue

Abstract:
OBJECTIVES:
To assess the usefulness of intra-tumor and peri-tumoral relative cerebral blood volume (rCBV) in preoperative glioma grading.

PATIENTS AND METHODS:
21 patients with histopathologically confirmed glioma were included. Imaging was achieved on a 1.5T MRI scanner. Dynamic susceptibility contrast (DSC) MRI was performed using T2* weighted gradient echo-planner imaging (EPI). Multiple regions of interest (ROIs) have been drawn in the hotspots regions, the highest ROI has been selected to represent the rCBV of each intra-tumoral and peri-tumoral regions. Based on histopathology, tumors were subdivided into low grade and high grade. Receiver operating characteristic analysis (ROC) of rCBV, of both intra-tumoral and peri-tumoral regions, was performed to find cut-off values between high and low-grade tumors. The resulting sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated.

RESULTS:
Based on the histopathology, high-grade glioma (HGG) represented 76.2% whereas low-grade glioma (LGG) represented 23.8%. Both intra-tumoral and peri-tumoral rCBV of HGG were significantly higher than those of LGG. A cut-off value >2.9 for intra-tumoral rCBV provided sensitivity, specificity, and accuracy of 80%, 100%, and 85.7% respectively to differentiate between HGG and LGG. Additionally, the cut-off value >0.7 for peri-tumoral rCBV provided sensitivity, specificity, and accuracy of 100%, 66.6%, and 90.5% respectively to differentiate between HGG and LGG.

CONCLUSION:
rCBV of each of intra-tumoral and peri-tumoral rCBV are significantly reliable for the preoperative distinction between HGG and LGG. Combined intra-tumoral and peri-tumoral rCBV provides overall better diagnostic accuracy and helps to decrease the invasive intervention for non-surgical candidates.

Author Info:
1
Diagnostic Radiology Department, Faculty of Medicine, Asyut University, Assiut, Egypt. Electronic address: radwa.soliman@aun.edu.eg.
2
Diagnostic Radiology Department, Faculty of Medicine, Asyut University, Assiut, Egypt.
3
Neurosurgery Department, Faculty of Medicine, Assiut University, Asyut, Egypt.


Authors:
Soliman W(1), Sharaf M(1), Abdelazeem K(1), El-Gamal D(2), Nafady A(3),(4).

Title:
Ultrastructural Effects Of Silicone Oil On The Clear ‎Crystalline Lens Of The Human Eye

Abstract:
PURPOSE:
To evaluate light and electron microscopic changes of the anterior capsule and its epithelium after clear lens extraction of vitrectomized myopic eyes with silicone oil tamponade.

METHODS:
This prospective, controlled, non-randomized, interventional study included 20 anterior lens capsular specimens that were excised during combined clear lens extraction and silicone oil removal from previously vitrectomized highly myopic patients with silicone oil tamponade for previous retinal detachment surgeries. The specimens were examined via light microscopy and electron microscopy and compared with 20 anterior capsule specimens removed during clear lens extraction of non-vitrectomized highly myopic eyes.

RESULTS:
Light microscopic examination of clear lens anterior capsule specimens of vitrectomized myopic eyes filled with silicone oil showed relatively more flat cells with irregular outline of lens' epithelial cells with wide intercellular spaces, deeply stained nuclei, and multiple intracytoplasmic vacuoles. Scanning electron microscopy revealed collagenous surfaces filled with multiple pits, depressions, and abnormal deposits. Transmission electron microscopy revealed lens epithelial cells with apoptotic changes, many cytoplasmic vacuoles, and filopodia-like protrusions between lens epithelial cells and the capsule. Epithelial proliferation and multilayering were also observed.

CONCLUSION:
silicone oil may play a role in the development of apoptotic and histopathological changes in clear lens epithelial cells. Clarity of the lens at the time of silicone oil removal does not indicate an absence of cataractous changes. We found justification of combined clear lens extraction and silicone oil removal or combined phacovitrectomy when silicone oil injection is planned, but further long-term studies with larger patient groups are required.

Author Info:
1
1 Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
2 Department of Histology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
3 Department of Pathology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.
4
4 Electron Microscopy Unit, Assiut University, Assiut, Egypt.


Authors:
Suliman YA(1),(2), Kafaja S(2), Fitzgerald J(2), Wortsman X(3), Grotts J(4), Matucci-Cerrinic M(5), Ranganath VK(2), Furst DE(6),(7),(8).

Title:
Ultrasound Characterization Of Cutaneous Ulcers In ‎Systemic Sclerosis

Abstract:
Skin ulcers in scleroderma (SSc) patients are considered a major challenge, both in clinical assessment and treatment decisions. The objective of our study is to assess ultrasonographic (US) morphology of skin ulcers in SSc patients and evaluate if US will be of value in enhancing our clinical information and influence our management plans. We examined a convenience sample of 21 skin ulcers reported in 10 SSc patients by US. We used a previously published US definition of normal skin and developed a preliminary US definition of skin ulcer. Skin ulcers were evaluated by gray scale (GS) and power Doppler (PD) and separated into ulcer and non-ulcer lesions; pain and ulcer measures were obtained using visual analogue scales (VAS). Lesions were characterized and ulcers were clinically and sonographically measured. Ten patients presenting with 21 skin lesions were examined by US. Applying our US definition of skin ulcer, all ulcers were available to measure by ultrasound. Eight lesions were sonographically defined as ulcers, and 13 lesions as non-ulcer lesions. Three ulcers had high PD signals suggestive of infection requiring antibiotic treatment and were monitored for 2 weeks showing a decrease of the pain, VAS, and PD signals. Five lesions showed subclinical calcinosis. This is the first study to show the promising role of US in defining skin ulcers of SSc patients. US may support the assessment of morphology and extent of skin ulcers in SSc and can be a helpful tool for detecting underlying pathology.

Author Info:
1
Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt.
2
Department of Medicine, Rheumatology Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
3
Department of Radiology and Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile.
4
Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
5
Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, Florence, Italy.
6
Department of Medicine, Rheumatology Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. dan@furst.us.com.
7
Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, Florence, Italy. dan@furst.us.com.
8
Department of Rheumatology, Unversity of Washington, Seattle, WA, USA. dan@furst.us.com.


Authors:
Taha AG(1), Abou Ali AN(2), Al-Khoury G(2), Singh MJ(2), Makaroun MS(2), Avgerinos ED(2), Chaer RA(3).

Title:
Outcomes Of Infrageniculate Retrograde Versus ‎Transfemoral Access For Endovascular Intervention For ‎Chronic Lower Extremity Ischemia

Abstract:
OBJECTIVE:
Retrograde infrageniculate access is an alternative treatment strategy for patients who have failed to respond to antegrade endovascular intervention. This study compares the outcomes of infrageniculate retrograde arterial access with the conventional transfemoral access for the endovascular management of chronic lower extremity ischemia.

METHODS:
This was a retrospective single-center review of retrograde endovascular intervention (REI) from 2012 to 2016. Indications for intervention, comorbidities, complications, procedural success, limb outcomes, and mortality were analyzed. Technical failure was defined as the inability to complete the procedure because of failed access or unsuccessful recanalization. Infrageniculate access and transfemoral access were obtained with ultrasound or angiographic roadmap guidance. Patency rates were calculated for technically successful interventions.

RESULTS:
There were 47 patients (85% presenting with critical limb ischemia) who underwent sheathless REI after failed antegrade recanalization of TransAtlantic Inter-Society Consensus class D infrainguinal lesions, whereas 93 patients (83% with critical limb ischemia) underwent standard transfemoral access. There were 16 (34%) femoropopliteal, 14 (30%) tibial, and 17 (36%) multilevel interventions in the retrograde group compared with 41 (41%) femoropopliteal, 20 (20%) tibial, and 39 (39%) multilevel interventions in the transfemoral group. Access sites for the retrograde group included the dorsalis pedis (26%), midcalf peroneal (24%), anterior tibial (22%), posterior tibial (26%), and popliteal (2%) arteries. Overall technical success was achieved in 57% of the retrograde group compared with 78% of the transfemoral group. Mean follow-up was 20 months (range, 1-45 months). There were no significant differences in the primary patency rates between the two groups at 1 year and 2 years. The primary assisted patency rates were significantly better in the transfemoral group at 1 year (66% vs 46%; P = .031) and 2 years (56% vs 29%; P = .031). The secondary patency rates were higher in the transfemoral group at 1 year (93% vs 83%; P = .079) and 2 years (91% vs 76%; P = .079), although this did not reach statistical significance. The rate of reintervention was 41% for the retrograde group vs 40% for the transfemoral group. Most of the reinterventions (70% in the retrograde group and 61% in the transfemoral group) were endovascular interventions for a restenosis or occlusion.

CONCLUSIONS:
Infrageniculate access for REI can result in primary patency rates similar to those of antegrade interventions and does not compromise the access site. Technical failure is high in this initial experience and is mostly due to failed recanalization. Limb salvage may be achieved after technical failure with either repeated antegrade intervention or surgical bypass.

Author Info:
1
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; Department of Vascular Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
3
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: chaerra@upmc.edu.


Authors:
Taha MA(1),(2), Busuttil A(1), Bootun R(1), Davies AH(1).

Title:
A Systematic Review Of Paediatric Deep Venous ‎Thrombolysis

Abstract:
Objectives The aim was to assess the effectiveness and safety of catheter-directed thrombolysis in children with deep venous thrombosis and to evaluate its long-term effect. Method and results EMBASE, Medline and Cochrane databases were searched to identify studies in which paediatric acute deep venous thrombosis patients received thrombolysis. Following title and abstract screening, seven cohort studies with a total of 183 patients were identified. Technical success was 82% and superior in regional rather than systemic thrombolysis (p < 0.00001). One cohort study identified significant difference in thrombus resolution at one year between thrombolytic and anticoagulant groups (p = 0.01). The complication rate was low, with incidence rates of major bleeding, pulmonary embolism and others at 2.8%, 1.8% and 8.4%, respectively. The overall post-thrombotic syndrome rate was 12.7%. The incidence of re-thrombosis ranged from 12.3% to 27%. Conclusion Thrombolysis for paediatric deep venous thrombosis is an effective and relatively safe therapeutic option, lowering the incidence of post-thrombotic syndrome and deep venous thrombosis recurrence.

Author Info:
1
1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK.
2
2 Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt.


Title:
A Systematic Review On The Use Of Deep Venous ‎Stenting For Acute Venous Thrombosis Of The Lower ‎Limb

Abstract:
Objectives The aim is to evaluate venous stent patency, the development of post-thrombotic syndrome, recurrence, quality of life and the optimal post-procedural anticoagulation regimen in the treatment of iliofemoral deep venous thrombosis. Method and results EMBASE and Medline databases were interrogated to identify studies in which acute deep venous thrombosis patients were stented. Twenty-seven studies and 542 patients were identified. Primary, assisted primary and secondary patency rates 12 months after stent placement ranged from 74 to 95, 90 to 95 and 84 to 100%, respectively. The observed post-thrombotic syndrome rate was 14.6%. The incidence of stent re-thrombosis was 8%. In 26% of studies, patients received additional antiplatelet therapy. Quality of life questionnaires employed in 11% of studies, demonstrating an improvement in the chronic venous insufficiency questionnaire (22.67 ± 3.01 versus 39.34 ± 6.66). Conclusion Venous stenting appears to be an effective adjunct to early thrombus removal; however, further studies are needed to identify optimal anticoagulant regimen and effect on quality of life.


Authors:
Taha O(1),(2), Abdelaal M(3),(4), Talaat M(5), Abozeid M(2),(6).

Title:
A Randomized Comparison Between Staple-Line Oversewing Versus No Reinforcement During Laparoscopic Vertical Sleeve Gastrectomy

Abstract:
BACKGROUND:
Varieties of intraoperative methods such as oversewing of staple lines or other reinforcement products are used for preventing the laparoscopic vertical sleeve gastrectomy (LSG) complications. The aim of this study is to evaluate the complication rates of the gastric stapling alone versus stapling with oversewing invagination of the staple line in the LSG.

METHODS:
This is a single-center randomized study, Patients were randomized to two groups, 200 patients underwent LSG without reinforcement of the staple line and 200 patients underwent LSG with oversewing of the staple line. All patients were followed up for 1 year. The data collected prospectively for statistical analysis included demographics, BMI, preoperative comorbidities, operative time, complications, and hospital stay.

RESULTS:
The overall mean operative age was 33.7 ± 9.4 years and mean BMI was 42.4 ± 4.3 kg/m2. Patient baseline characteristics (age, gender, weight, and BMI) and comorbidities were generally a nonsignificant different between the treatment arms. Surgical time was shorter in patients of the nonreinforced group (44.3 ± vs 51.3 ± 4.3 min; p < 0.01) with lower %EWL (73 ± 13.8 vs 80.7 ± 13.6%, p < 0.01). One patient in the nonreinforced group was complicated by gastric leak. The staple-line bleeding rate was significantly lower in patients underwent oversewing of the staple line during LSG (p < 0.05).

CONCLUSION:
Oversewing of the staple line during LSG is a nonexpansive and easy method to decrease the incidence and severity of the postoperative bleeding. However, it is time-consuming and should be performed by experienced surgeons to avoid the complications which may occur secondary to the seroserotomy suturing.

Author Info:
1
Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt.
2
Overweight Clinics, Cairo, Egypt.
3
Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt. Mahmoud.abdel-aal@ucdconnect.ie.
4
Overweight Clinics, Cairo, Egypt. Mahmoud.abdel-aal@ucdconnect.ie.
5
Plastic Surgery Department, Sohag University, Sohag, Egypt.
6
General Surgery Department, Ain Shams University Hospital, Cairo, Egypt.


Authors:
Tamura R(1), Tomio R(2), Mohammad F(1),(3), Toda M(1), Yoshida K(1).

Title:
Analysis Of Various Tracts Of Mastoid Air Cells Related ‎To CSF Leak After The Anterior Transpetrosal Approach

Abstract:
OBJECTIVE The anterior transpetrosal approach (ATPA) was established in 1984 and has been particularly effective for petroclival tumors. Although some complications associated with this approach, such as venous hemorrhage in the temporal lobe and nervous disturbances, have been resolved over the years, the incidence rate of CSF leaks has not greatly improved. In this study, some varieties of air cell tracts that are strongly related to CSF leaks are demonstrated. In addition, other pre- and postoperative risk factors for CSF leakage after ATPA are discussed. METHODS Preoperative and postoperative target imaging of the temporal bone was performed in a total of 117 patients who underwent ATPA, and various surgery-related parameters were analyzed. RESULTS The existence of air cells at the petrous apex, as well as fluid collection in the mastoid antrum detected by a postoperative CT scan, were possible risk factors for CSF leakage. Tracts that directly connected to the antrum from the squamous part of the temporal bone and petrous apex, rather than through numerous air cells, were significantly related to CSF leak and were defined as "direct tract." All patients with a refractory CSF leak possessed "unusual tracts" that connected to the attic, tympanic cavity, or eustachian tube, rather than through the mastoid antrum. CONCLUSIONS Preoperative assessment of petrous pneumatization types is necessary to prevent CSF leaks. Direct and unusual tracts are particularly strong risk factors for CSF leaks.

Author Info:
1
Department of Neurosurgery, Keio University School of Medicine, Tokyo.
2
Department of Neurosurgery, Mihara Memorial Hospital, Gunma, Japan; and.
3
Department of Neurosurgery, Assiut University, Assiut, Egypt.


Authors:
Tay CT(1),(2), Joham AE(1),(2), Hiam DS(3), Gadalla MA(4),(5), Pundir J(6),(7), Thangaratinam S(7), Teede HJ(1),(2), Moran LJ(1),(4).

Title:
Pharmacological And Surgical Treatment Of ‎Nonreproductive Outcomes In Polycystic Ovary ‎Syndrome: An Overview Of Systematic Reviews

Abstract:
BACKGROUND:
Polycystic ovary syndrome (PCOS) affects up to 13% women and is associated with significant complications. The quality of evidence supporting the recommendations on treatment of nonreproductive outcomes in PCOS is unknown.

OBJECTIVE:
To summarize and appraise the methodological quality of systematic reviews and meta-analyses evaluating pharmacological and surgical treatments for nonreproductive outcomes in PCOS.

METHODS:
A literature search from MEDLINE, EMBASE, CINAHL PLUS and PROSPERO was performed from inception until 15th of September 2017. Article selection, data extraction and quality appraisal of included reviews were performed in duplicate. A narrative synthesis of the findings was conducted.

RESULTS:
This overview included 31 reviews. The quality was low for 7 (23%), moderate for sixteen (52%) and high for 8 reviews (26%). Two reviews assessed psychological outcomes. Metformin improved anthropometric (7 of 10 reviews), metabolic (4 of 14 reviews) and endocrine outcomes (3 of twelve reviews). Thiazolidinediones improved metabolic (2 of 5 reviews) and endocrine outcomes (one of 5 reviews) but worsened weight gain (5 of 5 reviews). Combined oral contraceptive pill (COCP) improved clinical hyperandrogenism (2 of 2 reviews). Statins improved lipid profile (3 of 3 reviews) and testosterone level (2 of 3 reviews). There was no conclusive evidence from included systematic reviews regarding the use of other interventions.

CONCLUSIONS:
There is reliable evidence regarding the use of metformin for anthropometric outcomes and COCPs for hyperandrogenism in women with PCOS but not for other interventions. There is significant gap in knowledge regarding the management of psychological outcomes in women with PCOS which needs further evaluation.

Author Info:
1
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
2
Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Vic., Australia.
3
Institute of Health, Exercise and Sport, Victoria University, Melbourne, Vic., Australia.
4
Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA, Australia.
5
Department of Obstetrics and Gynaecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
6
Centre of Reproductive Medicine, St Bartholomew's Hospital, London, UK.
7
Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.


Authors:
Thwaites RS(1), Coates M(2), Ito K(2), Ghazaly M(3),(4), Feather C(3), Abdulla F(3), Tunstall T(1), Jain P(1), Cass L(2), Rapeport G(2), Hansel TT(1), Nadel S(3), Openshaw PJ(5).

Title:
Reduced Nasal Viral Load and IFN Responses in Infants with RSV Bronchiolitis and Respiratory Failure

Abstract:
RATIONALE:
Respiratory syncytial virus (RSV) bronchiolitis is a major cause of morbidity and mortality in infancy. Severe disease is thought to result from uncontrolled viral replication, an excessive immune response, or both.

OBJECTIVES:
To determine RSV load and immune mediator levels in nasal mucosal lining fluid by serial sampling of nasal fluids from cases of moderate and severe bronchiolitis over the course of infection.

METHODS:
Infants with viral bronchiolitis necessitating admission (n=55) were recruited from a paediatric centre during 2016/17. Of these, 30 were RSV infected (18 'moderate', and 12 mechanically ventilated 'severe'). Nasal fluids were sampled frequently over time using nasosorption devices and nasophayngeal aspiration (NPA). Hierarchical clustering of time weighted averages (TWA) was performed to investigate cytokine and chemokine levels, and gene expression profiling was conducted.

MEASUREMENTS AND MAIN RESULTS:
Unexpectedly, cases of severe RSV bronchiolitis had lower nasal viral loads and reduced interferon (IFN)-γ and CCL5/RANTES levels compared to those with moderate disease, especially when allowance was made for disease duration (all P<0.05). Reduced cytokine/chemokine levels in severe disease were also seen in children with other viral infections. Gene expression analysis of NPA samples (n=43) confirmed reduced type-I IFN gene expression in severe bronchiolitis accompanied by enhanced expression of MUC5AC and IL17A.

CONCLUSIONS:
Infants with severe RSV bronchiolitis have lower nasal viral load, IP-10/CXCL10 and type-I IFNs levels compared to moderately ill children, but enhanced MUC5AC and IL17A gene expression in nasal cells.

Author Info:
1
Imperial College London, 4615, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland.
2
Pulmocide Ltd, London, United Kingdom of Great Britain and Northern Ireland.
3
St Mary's Hospital, Imperial College Healthcare Trust, London, United Kingdom of Great Britain and Northern Ireland.
4
Assiut University Faculty of Medicine, 68797, Assiut, Egypt.
5
National Heart & Lung Institute, Respiratory Medicine, London, United Kingdom of Great Britain and Northern Ireland ; p.openshaw@imperial.ac.uk.


Authors:
Tolba SM(1), Ali SS(1), Mohammed AM(1), Michael AK(1), Abbas AM(1), Nassr AA(1),(2), Shazly SA(1),(3).

Title:
Management of Spontaneous Labor in Primigravidae: Labor Scale versus WHO Partograph (SLiP Trial) Randomized Controlled Trial

Abstract:
OBJECTIVE:
 We aimed to compare maternal and neonatal outcomes of spontaneous term labor among primigravidae who were monitored by the novel labor scale versus the World Health Organization (WHO) partograph.

STUDY DESIGN:
 A single center, double-blinded randomized trial had been conducted between July 2015 and June 2016. Nulliparous women in spontaneous labor with singleton term pregnancies were randomized to either labor scale or the WHO partograph for management of labor. Primary outcome was successful vaginal delivery. Secondary outcome included low APGAR scores, birth injuries, postpartum hemorrhage, and infection.

RESULTS:
 One hundred ten patients were randomized (55 in each arm). Women managed with labor scale had significantly lower rate of cesarean deliveries than women managed with the partograph arm (3.6% versus 18.2%, P=0.03). There was a significant reduction in the rate and duration of oxytocin administration for augmentation of labor (21.8% versus 69.1%, P < 0.0001) and a significant increase in average 1-minute APGAR score in the labor scale group.

CONCLUSION:
 Labor monitoring with the labor scale is associated with lower rate of cesarean section, less and shorter use of oxytocin for augmentation of labor. Monitoring of labor progress starting at 5 cm or more is also associated with lower rate of cesarean delivery.

Author Info:
1
Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
2
Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas.
3
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.


Authors:
Tolcher MC(1), Shazly SA(2), Shamshirsaz AA(1), Whitehead WE(3), Espinoza J(1), Vidaeff AC(1), Belfort MA(1), Nassr AA(1),(4).

Title:
Neurological Outcomes By Mode Of Delivery For Fetuses ‎With Open Neural Tube Defects: A Systematic Review ‎And Meta-Analysis

Abstract:
BACKGROUND:
Controversy exists regarding the optimal mode of delivery for fetuses with open neural tube defects.

OBJECTIVE:
To compare neurological outcomes among infants with open neural tube defects who underwent vaginal compared with caesarean delivery.

SEARCH STRATEGY:
Electronic databases MEDLINE, EMBASE, Scopus, and Clinicaltrials.gov were searched from inception to November 2017.

SELECTION CRITERIA:
Eligible studies included observational or randomised studies comparing vaginal and caesarean delivery in pregnancies with fetal open neural tube defects who did not undergo prenatal repair.

DATA COLLECTION AND ANALYSIS:
Two reviewers independently reviewed abstracts and full-text articles. Outcomes were compared between vaginal and caesarean delivery and prelabour caesarean versus exposure to labour. The primary outcome was motor-anatomic level difference. Secondary outcomes included shunt requirement, sac disruption, meningitis, and ambulation at 2 years. Meta-analysis was performed and mean difference or odds ratios with 95% CI were calculated.

MAIN RESULTS:
Of 201 abstracts identified in the primary search, nine studies (672 women) met the eligibility criteria. Comparing vaginal and caesarean delivery, there was no significant difference in motor-anatomic level difference (mean difference -0.10, 95% CI -0.58 to 0.38; I2  = 57%). The vaginal delivery group was less likely to require a shunt or have sac disruption [odds ratio (OR) 0.37, 95% CI 0.14-0.95 and OR 0.46, 95% CI 0.23-0.90, respectively]. Comparisons by prelabour caesarean versus exposure to labour showed no significant difference in motor-anatomic level difference (OR 1.29, 95% CI 0.63-3.21) or ambulation at 2 years (OR 2.13, 95% CI 0.35-13.12).

CONCLUSION:
Caesarean delivery was not associated with improved neurological outcomes among fetuses with open neural tube defects.

TWEETABLE ABSTRACT:
Available evidence does not support routine caesarean delivery for fetuses with open neural tube defects.

Author Info:
1
Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Fetal Center, Houston, TX, USA.
2
Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.
3
Department of Neurosurgery, Baylor College of Medicine, Texas Children's Fetal Center, Houston, TX, USA.
4
Department of Obstetrics and Gynaecology, Women's Health Hospital, Assiut University, Assiut, Egypt.


Authors:
Torabi S(1), Sheikh M(1), Fattahi Masrour F(1), Shamshirsaz AA(2),(3), Bateni ZH(2),(3), Nassr AA(2),(3),(4), Pooransari P(5), Talebian M(1), Hantoushzadeh S(1),(6).

Title:
Uterine Artery Doppler Ultrasound In Second Pregnancy ‎With Previous Elective Cesarean Section

Abstract:
OBJECTIVES:
To assess the effects of previous cesarean delivery (CD) and placental location on second trimester uterine artery Doppler indices in subsequent pregnancy and to assess the predictive values of abnormal Doppler findings for adverse pregnancy outcomes in women with previous CD.

STUDY DESIGN:
This prospective cohort study evaluated 400 gravida two pregnant women (200 with previous none medically indicated CD and 200 with previous normal vaginal deliveries (NVD)) who were referred for second trimester fetal anatomic survey. Uterine artery Doppler studies were performed in all participants who were then followed until delivery.

RESULTS:
Compared with women having prior NVD, women with prior CD had significantly higher rates of abnormal uterine artery pulsatility index (PI) (p < .001), and significantly more adverse pregnancy outcomes (p = .01). Among women with previous CD, all the measured adverse pregnancy outcomes occurred significantly more often in women with abnormal uterine artery Doppler indices (p < .001).

CONCLUSIONS:
CD seems to be associated with increased risks of impaired placental function and circulation and adverse pregnancy outcomes in the subsequent pregnancy, particularly in women with anteriorly located placenta near the previous uterine scar

Author Info:
1
a Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences , Tehran , Iran.
2
b Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Baylor College of Medicine , Houston , TX , USA.
3
c Texas Children's Hospital Pavilion for Women , Houston , TX , USA.
4
d Department of Obstetrics and Gynecology , Women's Health Hospital, Assiut University , Assiut , Egypt.
5
e Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran.
6
f Breastfeeding Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences , Tehran , Iran.


Authors:
Vercouter AS(1), Sayed IM(2), Lipkens Z(3), De Bleecker K(4), De Vliegher S(5), Colman R(6), Koppelman M(7), Supré K(8), Meuleman P(9).

Title:
Absence Of Zoonotic Hepatitis E Virus Infection In ‎Flemish Dairy Cows

Abstract:
Recently, infectious HEV particles were discovered in milk and fecal samples of dairy cows in China. Given the recent increase of autochthonous HEV infections in Europe, we wanted to assess whether cows constitute an HEV reservoir in this region and hence may be responsible for the advance of HEV through consumption of cow produce. To verify the zoonotic risk cows potentially pose towards European consumers, we screened >10% of dairy milk farms in Flanders, Belgium for the presence of HEV. A quarter of these housed both cows and pigs, the latter a well-known reservoir for HEV. Milk and fecal samples were analyzed for the presence of HEV RNA and HEV-specific antibodies. Despite the fact that HEV is circulating amongst pig farms in Flanders and proof of active HEV infection in the pigs of at least one of the mixed farms included in our study, we could not detect any sign of active or past HEV infection in cows. The HEV prevalence in our study was 0%, with a 99.99% confidence interval (CI) for HEV RNA and anti-HEV antibody of [0%-2.30%] and [0%-4.23%] respectively. Our results suggest that, at least in Flanders, cows are not an HEV reservoir and hence do not pose a major health risk towards humans.

Author Info:
1
Laboratory of Liver Infectious Diseases, Department of Clinical Chemistry, Microbiology and Immunology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Electronic address: annsofie.vercouter@ugent.be.
2
Laboratory of Liver Infectious Diseases, Department of Clinical Chemistry, Microbiology and Immunology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: ibrahim.ibrahim@ugent.be.
3
M-team and Mastitis and Milk Quality Research Unit, Department of Obstetrics, Reproduction and Herd Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium. Electronic address: zyncke.lipkens@ugent.be.
4
Diergezondheidszorg Vlaanderen (DGZ), Lier, Belgium. Electronic address: koen.debleecker@dgz.be.
5
M-team and Mastitis and Milk Quality Research Unit, Department of Obstetrics, Reproduction and Herd Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium. Electronic address: sarne.devliegher@ugent.be.
6
Biostatistics Unit, Department of Public Health, Ghent University, Ghent, Belgium. Electronic address: statcel@ugent.be.
7
Sanquin, Amsterdam, The Netherlands. Electronic address: m.koppelman@sanquin.nl.
8
Flanders Milk Control Center (MCC), Lier, Belgium. Electronic address: karlien.supre@mcc-vlaanderen.be.
9
Laboratory of Liver Infectious Diseases, Department of Clinical Chemistry, Microbiology and Immunology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Electronic address: philip.meuleman@ugent.be.


Authors:
Widmer M(1), Piaggio G(1), Nguyen TMH(1), Osoti A(1), Owa OO(1), Misra S(1), Coomarasamy A(1), Abdel-Aleem H(1), Mallapur AA(1), Qureshi Z(1), Lumbiganon P(1), Patel AB(1), Carroli G(1), Fawole B(1), Goudar SS(1), Pujar YV(1), Neilson J(1), Hofmeyr GJ(1),

Title:
Heat-Stable Carbetocin versus Oxytocin to Prevent Hemorrhage after Vaginal Birth

Abstract:
BACKGROUND:
Postpartum hemorrhage is the most common cause of maternal death. Oxytocin is the standard therapy for the prevention of postpartum hemorrhage, but it requires cold storage, which is not available in many countries. In a large trial, we compared a novel formulation of heat-stable carbetocin with oxytocin.

METHODS:
We enrolled women across 23 sites in 10 countries in a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin (at a dose of 100 μg) with oxytocin (at a dose of 10 IU) administered immediately after vaginal birth. Both drugs were kept in cold storage (2 to 8°C) to maintain double-blinding. There were two primary outcomes: the proportion of women with blood loss of at least 500 ml or the use of additional uterotonic agents, and the proportion of women with blood loss of at least 1000 ml. The noninferiority margins for the relative risks of these outcomes were 1.16 and 1.23, respectively.

RESULTS:
A total of 29,645 women underwent randomization. The frequency of blood loss of at least 500 ml or the use of additional uterotonic agents was 14.5% in the carbetocin group and 14.4% in the oxytocin group (relative risk, 1.01; 95% confidence interval [CI], 0.95 to 1.06), a finding that was consistent with noninferiority. The frequency of blood loss of at least 1000 ml was 1.51% in the carbetocin group and 1.45% in the oxytocin group (relative risk, 1.04; 95% CI, 0.87 to 1.25), with the confidence interval crossing the margin of noninferiority. The use of additional uterotonic agents, interventions to stop bleeding, and adverse effects did not differ significantly between the two groups.

CONCLUSIONS:
Heat-stable carbetocin was noninferior to oxytocin for the prevention of blood loss of at least 500 ml or the use of additional uterotonic agents. Noninferiority was not shown for the outcome of blood loss of at least 1000 ml; low event rates for this outcome reduced the power of the trial. (Funded by Merck Sharpe & Dohme; CHAMPION Australian New Zealand Clinical Trials Registry number, ACTRN12614000870651 ; EudraCT number, 2014-004445-26 ; and Clinical Trials Registry-India number, CTRI/2016/05/006969 .)

Author Info:
1
From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.).


Authors:
Wiethoff S(1),(2), O'Connor E(1), Haridy NA(1),(3), Nethisinghe S(1), Wood N(1), Giunti P(1), Bettencourt C(1),(4), Houlden H(1).

Title:
Sequencing Analysis Of The SCA6 CAG Expansion ‎Excludes An Influence Of Repeat Interruptions On ‎Disease Onset

Author Info:
1
Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK.
2
Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard Karls-University, Tübingen, Germany.
3
Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt.
4
Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.


Authors:
Youssef AEA(1), Amin AF(1), Khalaf M(1), Khalaf MS(1), Ali MK(1), Abbas AM(1).

Title:
Fetal Biacromial Diameter As A New Ultrasound Measure ‎For Prediction Of Macrosomia In Term Pregnancy: A ‎Prospective Observational Study

Abstract:
OBJECTIVE:
The current study aims to evaluate a simple method for sonographic measurement of the fetal biacromial diameter for prediction of fetal macrosomia in term pregnancy.

MATERIALS AND METHODS:
The current study was a single center prospective observational study conducted in a tertiary University Hospital from January 2015 to May 2017. We included all consecutive term (37-42 weeks) pregnant women presented to the labor ward for delivery. Ultrasound parameters were measured as biparietal diameter, head circumference, transverse thoracic diameter, mid arm diameter, abdominal circumference, femur length, estimated fetal weight, and amniotic fluid index. The proposed ultrasound formula "Youssef's formula" to measure the fetal biacromial diameter is: [Transverse thoracic diameter +2 × midarm diameter]. The accuracy of proposed formula was compared to the actual biacromial diameter of the newborn after delivery. The primary outcome of the study was accuracy of sonographic measurement of fetal biacromial diameter in prediction of fetal macrosomia in terms of sensitivity and specificity Results: The study included 600 participants; 49 (8.2%) of them delivered a macrosomic neonates and 551 (91.8%) delivered average weight neonates. There was no statistical significant difference between the proposed fetal biacromial diameter measured by ultrasound and the actual neonatal biacromial diameter measured after birth (p = .192). The area under the curve (AUC) for prediction of macrosomia at birth based on the fetal biacromial diameter and the abdominal circumference was 0.987 and 0.989, respectively, on receiver operating characteristic (ROC) curve analysis. Using the biacromial diameter cutoff of 15.4 cm has a PPV for prediction of macrosomia (88.4%) and 96.4% sensitivity with overall accuracy of 97%. Similarly, with the abdominal circumference (AC) cutoff of 35.5 cm, the PPV for prediction of macrosomia (87.7%) and 96.4% sensitivity with overall accuracy of 96.83%. No statistical significant difference between both of them was observed for prediction of fetal macrosomia (p = .841) Conclusions: The sonographic measurement of fetal biacromial diameter seems to be a new simple and accurate method for prediction of fetal macrosomia and shoulder dystocia at birth.

Author Info:
1
a Department of Obstetrics and Gynecology , Women Health Hospital, Assiut University , Assiut , Egypt.


Authors:
Zahran AM(1), Youssef MAM(2), Elsayh KI(2), Embaby MM(2), Ibrahim AIM(2).

Title:
Clinical Significance of T-Cell Immunoglobulin Mucin 3 Expression on Peripheral Blood Mononuclear Cells in Pediatric Acute Immune Thrombocytopenia

Abstract:
T-cell immunoglobulin mucin 3 (TIM-3) is a transmembrane protein that plays an important role in several autoimmune diseases. The relationship between TIM-3 and excessive immune responses in immune thrombocytopenia (ITP) is still unknown. In this study, we evaluated the relationship between the expression of TIM-3 on peripheral blood mononuclear cells in patients with ITP and the disease severity. The frequency of lymphocyte and monocyte subsets and their TIM-3 expression were evaluated in patients with acute ITP (n = 45) and in healthy control (n = 20) using flow cytometry. Based on bleeding severity, patients were classified into 3 subgroups as mild (n = 12), moderate (n = 25), and severe (n = 8) bleeding. T-helper lymphocytes was found to be significantly decreased in the severe bleeding group compared to the mild and moderate bleeding groups, while CD56high natural killer (NK) cells were significantly expanded in severe bleeding group. In contrast, classical, intermediate, and nonclassical monocytes, natural killer T lymphocyte (NKT), and CD56dim NK cells showed no significant changes among different patient groups. This alteration of lymphocyte and monocyte subsets was associated with significant decrease in TIM-3 expression on CD56high NK cells, T-helper lymphocytes, NKT cells, and nonclassical monocytes in patients with ITP compared to the controls. Lower level of TIM-3 was found in severe bleeding group compared to mild and moderate bleeding groups. These results indicate that TIM-3 may be involved in the pathogenesis of ITP which subsequently can represent an opportunity for new therapeutic plan, moreover. This may have a prognostic value for disease severity.

Author Info:
1
1 Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
2
2 Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Zahran AM(1), Zharan KM(2), Hetta HF(3).

Title:
Significant Correlation Between Regulatory T Cells And ‎Vitamin D Status In Term And Preterm Labor

Abstract:
BACKGROUND AND AIM:
Vitamin D insufficiency and deficiency have been associated with an increased risk of adverse pregnancy outcomes. Also, vitamin D is known to play a role in promoting the function of regulatory T-cells (Tregs). Tregs play an important role in suppressing the immune response during pregnancy. Our study aimed to investigate Tregs phenotypes in preterm and tem laboring women and its association with vitamin D level.

METHODS:
This cross-sectional study included 82 pregnant women, divided into 46 term and 36 preterm laboring women in addition to 30 healthy non-pregnant women. The percentage of CD4+CD25+Foxp3+Treg cells and their composition of four different Treg subsets were evaluated using flow cytometric analysis. Also, serum vitamin D levels were measured by ELISA.

RESULTS:
The percentage of the CD4+ CD25+ FoxP3+ Tregs were significantly decreased in term and preterm laboring women compared to the non-pregnant controls. The percentage of CD45RA+ Tregs, was significantly increased in term laboring women than preterm laboring women and non-pregnant women. Also, term labor women had increased proportion of HLA-DRhighTregs. Preterm labor women had significant increased proportion of HLA-DRnegative Tregs compared to term labor women. The overall prevalence of vitamin D deficiency and vitamin D insufficiency was higher in preterm than term laboring women and non-pregnant women. Significant positive correlations were found between serum level of 25 (OH)D and percentage of CD4+ CD25+ Foxp3+Tregs and percentage HLA-DRhighTregs among term and preterm laboring women with vitamin D deficiency.

CONCLUSION:
There is a strong association between the percentage of Treg phenotypes and vitamin D level in term and preterm labor women with vitamin D deficiency. Also, the onset of term and preterm labor is associated with changes in the composition of the total Treg pool with different Treg subsets which in turn may be responsible for immunologic mechanisms that associated with labor induction.

Author Info:
1
Department of Clinical Pathology, South Egypt Cancer institute, Assiut, Egypt.
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: helalhetta@aun.edu.eg.


Authors:
Zahran AM(1), Mohammed Saleh MF(2), Sayed MM(3), Rayan A(4), Ali AM(5), Hetta HF(6).

Title:
Up-Regulation Of Regulatory T Cells, CD200 And TIM3 ‎Expression In Cytogenetically Normal Acute Myeloid ‎Leukemia

Abstract:
BACKGROUND:
The bone marrow immunosuppressive microenvironment of AML patients sustains and modulates proliferation, survival and drug resistance of AML through deregulation of both innate and adaptive immune response. We aimed to investigate the level of Tregs, expression of Tim-3 on peripheral blood T cells, expression of CD200 in myeloid blasts in newly diagnosed AML patients with normal cytogenetics (AML-NC) and their prognostic impact.

PATIENTS AND METHODS:
This study included 40 patients with de novo AML-NC and 20 healthy controls. Flow-cytometry was used for detection of CD4+CD25+high FoxP3+ regulatory T cells, Tim-3 expression on peripheral blood T cells and CD200 expression on myeloid blasts.

RESULTS:
The percentages of CD4+CD25+high and CD4+CD25+high Foxp3+ Tregs were significantly increased in AML patients than controls. The levels of Tregs, Tim-3/CD4+, Tim-3/CD8+, CD200 and MFI of CD200 were significantly lower in responding patients than in those with persistent leukemia. Only high CD200 expression (> 50%) showed statistically significant worse OS with P< 0.04.

CONCLUSION:
The increased levels of Tregs, Tim-3 expression on peripheral blood T cells and CD200 expression in myeloid blast in AML patients could play a role in the development of AML. Analysis of these markers could serve as prognostic markers and might guide the therapy in AML patients in the future.

Author Info:
1
Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
2
Clinical Hematology Unit, Internal Medicine Department, Assiut University, Assiut, Egypt.
3
Radiation Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
4
Clinical Oncology Department, Assiut University, Assiut, Egypt.
5
Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
6
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Zarzour OA(1), Santiago FR(2), Serrano NO(3), Abdallah AH(4), El-Sharkawy MA(5), Mourad AF(6).

Title:
CT-Guided Radiofrequency Ablation In Patients With ‎Aneurysmal Bone Cysts

Abstract:
INTRODUCTION:
Aneurysmal bone cyst (ABC) is one of most therapeutic challenging lesions for orthopedic surgeons specially in large-sized lesions and lesions, which are very close to important neurovascular structures. In the present study, we express our experience in the treatment of aneurysmal bone cyst by radiofrequency thermal ablation (RFTA).

METHODS:
In the last two years, we have treated 20 cases (12 males & 8 females) presented with painful aneurysmal bone cysts in different anatomical locations, the age mean (±SD) is 18.95 ± 8.02 years and median is 17.5 years, the mean size of the lesions (±SD) is: 32.25 ± 7.15 mm & the median (range) is 33.5 mm (18.0-43.0) mm. The treatment was done by (RFTA) only in 11 cases and by (RFTA) with cementation in the other 9 cases, then the patients underwent close clinical follow-up for clinical symptoms by using visual analogue scale (VAS) pain score & radiological follow-up for one month, six months & one year after the procedure.

RESULTS:
Close follow-up for the patients proved that (RFTA) is a clinically successful &curative treatment as there was significant reduction in the mean (±SD) of the (VAS) pain score in all treated cases from 8.40 ± 1.23 before the intervention to 0.20 ± 0.41 at the end of follow-up period. No recorded post-procedural complications or recurrence during or at the end of the follow-up period.

Author Info:
1
Radiology Department, Hospital Campus de Salud (PTS), Granada University, Av. de la Ilustración, s/n, 18016 Granada, Spain; Faculty of Medicine, Assiut University, Egypt. Electronic address: dr.osamazarzour@aun.edu.eg.
2
Radiology Department, Hospital of Traumatology, Complejio hospitilario universitario, Carretera de Jaen SN, Granada, 18014, Spain. Electronic address: ferusaan12@gmail.com.
3
Radiology Department, Faculty of Medicine-Granada university, El instituto de investigación biosanitaria de Granada (ibs.Granada), Calle Dr. Azpitarte, 4, 18012, Granada, Spain.
4
Radiology Department, Assiut University Hospitals-Assiut University, 71515, Assiut, Egypt.
5
Radiology Department, South Egypt Cancer Institute (SECI), Assiut University, 71515, Assiut, Egypt. Electronic address: dr.mostafamri@yahoo.com.
6
Radiology Department, South Egypt Cancer Institute (SECI), Assiut University, 71515, Assiut, Egypt.


Authors:
Zayed AE(1),(2), Saleh A(3),(4), Gomaa AMS(5), Abd-Elkareem M(1), Anwar MM(5),(6), Hassanein KMA(7),(8), Elsherbiny MM(9), Kotb AM(1).

Title:
Protective Effect of Ginkgo biloba and Magnetized Water on Nephropathy in Induced Type 2 Diabetes in Rat

Abstract:
We aimed in our current study to explore the protective effect of Ginkgo biloba (GB) and magnetized water (MW) against nephrotoxicity associating induced type 2 diabetes mellitus in rat. Here, we induced diabetes by feeding our lab rats on a high fat-containing diet (4 weeks) and after that injecting them with streptozotocin (STZ). We randomly divided forty rats into four different groups: nontreated control (Ctrl), nontreated diabetic (Diabetic), Diabetic+GB (4-week treatment), and Diabetic+MW (4-week treatment). After the experiment was finished, serum and kidney tissue samples were gathered. Blood levels of glucose, triglycerides, cholesterol, creatinine, and urea were markedly elevated in the diabetic group than in the control group. In all animals treated with GB and MW, the levels of urea, creatinine, and glucose were significantly reduced (all P < 0.01). GB and MW attenuated glomerular and tubular injury as well as the histological score. Furthermore, they normalized the contents of glutathione reductase and SOD2. In summary, our data showed that GB and MW treatment protected type 2 diabetic rat kidneys from nephrotoxic damages by reducing the hyperlipidemia, uremia, oxidative stress, and renal dysfunction.

Author Info:
1
Department of Anatomy and Histology, Faculty of Veterinary Medicine, Assiut University, Assiut 71515, Egypt.
2
Department of Biology, Faculty of Science, Jazan University, Jazan, Saudi Arabia.
3
Exploratory Center of Science and Technology, Cairo, Egypt.
4
Department of Physics, Faculty of Science, Jazan University, Jazan, Saudi Arabia.
5
Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
6
Department of Pharmacology, Faculty of Pharmacy, Jazan University, Jazan, Saudi Arabia.
7
Department of Pathology and Clinical Pathology, Faculty of Veterinary Medicine, Assiut University, Assiut 71526, Egypt.
8
Deanship of Scientific Research, Jazan University, Jazan, Saudi Arabia.
9
College of Public and Tropical Medicine, Jazan University, Jazan, Saudi Arabia.


Authors:
Zedan H(1), Ismail S(1), Gomaa A(1), Saleh R(2), Henkel R(3), Agarwal A(4).

Title:
Evaluation Of Reference Values Of Standard Semen ‎Parameters In Fertile Egyptian Men

Abstract:
The reference values of human semen, published in the WHO's latest edition in 2010, were lower than those previously reported. The objective of this study was to evaluate reference values of standard semen parameters in fertile Egyptian men. This cross-sectional study included 240 fertile men. Men were considered fertile when their wives had recent spontaneous pregnancies with time to pregnancy (TTP) ≤12 months. The mean age of fertile men was 33.8 ± 0.5 years (range 20-55 years). The 5th percentiles (95% confidence interval) of macroscopic semen parameters were 1.5 ml for volume and 7.2 for pH. The 5th percentiles of microscopic parameters were 15 million/ml for sperm concentration, 30 million per ejaculate for total sperm count, 50% for total motility, 40% for progressive motility, 62% for vitality, 4% for normal sperm forms and 0.1 million/ml for seminal leucocyte counts. In conclusion, fertile Egyptian men had higher reference values of sperm total motility, progressive motility and vitality, and lower reference values for total sperm counts as compared to those determined by the latest edition of the WHO laboratory manual in 2010. Other semen parameters were identical to those defined by the WHO 2010 manual.

Author Info:
1
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assuit, Egypt.
2
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.
3
Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.
4
Department of Urology, American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.


Authors:
Zhu L(1), Aly M(2), Wang H(3), Karakizlis H(4), Weimer R(4), Morath C(5), Kuon RJ(6), Toth B(7), Ekpoom N(8), Opelz G(8), Daniel V(9).

Title:
Changes Of NK Cell Subsets With Time Post-Transplant ‎In Peripheral Blood Of Renal Transplant Recipients

Abstract:
BACKGROUND:
There is evidence that NK cells with low cytotoxicity but strong immunoregulatory characteristics contribute to good graft outcome. We attempted to investigate which NK cell subsets increase post-transplant and might affect graft function.

METHOD:
Lymphocyte and NK cell subsets were determined in whole blood using eight-colour-fluorescence flow cytometry in patients pre-transplant and post-transplant. In total, 31 transplant recipients were studied.

RESULTS:
When cell numbers were compared in 9 patients pre- and 6 months post-transplant, post-transplant CD56dimCD16+ (p = 0.011) NK cells with the phenotype CD158a+ (p = 0.008), CD158e+ (p = 0.038), NKG2A+ (p = 0.008), NKG2D+ (p = 0.011), IFNyR+ (p = 0.008), perforin+ (p = 0.008), granzymeB+ (p = 0.008), perforin+granzymeB+ (p = 0.008) and perforin-granzymeB- (p = 0.021) were lower than those pre-transplant, indicating a post-transplant reduction of cytotoxic NK cells. In 28 patients NK cell subsets were analyzed with respect to time post-transplant (median 888 days post-transplant). CD56dimCD16+ NK cells co-expressing CD158a (p = 0.014), NKG2D (p = 0.047), IL4R (p = 0.038), IL10R (p = 0.008) and IFNy (p = 0.036) as well as CD56bright NK cells with the phenotype TGFß+ (p = 0.017), TGFR+ (p = 0.035), CD158a+ (p = 0.042) and perforin-granzymeB- (p = 0.048) increased with time post-transplant.

CONCLUSION:
Post-transplant, cytotoxic NK cells were lower than pre-transplant and remained low, whereas NK cell subsets with potentially immunoregulatory properties increased.

Author Info:
1
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany; Department of Hematology, Tongji Hospital, Huazhong University of Science and Technology, 430030 Wuhan, China.
2
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany; Nephrology Unit, Internal Medicine Department, Assiut University, Egypt.
3
Department of Surgery, Tongji Hospital, Huazhong University of Science and Technology, 430030 Wuhan, China.
4
Department of Internal Medicine, University of Giessen, Klinikstrasse 33, D-35385 Giessen, Germany.
5
Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany.
6
Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany.
7
Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
8
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany.
9
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany. Electronic address: volker.daniel@med.uni-heidelberg.de.


Authors:
Zhu L(1),(2), Aly M(1),(3),(4), Wang H(5), Karakizlis H(3), Weimer R(3), Morath C(6), Kuon RJ(7), Toth B(8), Ekpoom N(1), Opelz G(1), Daniel V(1).

Title:
Increased Natural Killer Cell Subsets With Inhibitory ‎Cytokines And Inhibitory Surface Receptors In Patients ‎With Recurrent Miscarriage And Decreased Or Normal ‎Subsets In Kidney Transplant Recipients Late Post-‎Transplant

Abstract:
Patients with recurrent miscarriage (RM) show up-regulated cytotoxic natural killer (NK) cells that are suspected to play a causal role in abortion. In the present study, we investigated counter-regulating inhibitory mechanisms and compared the results in RM patients with those of healthy controls (HC), patients with end-stage renal disease (ESRD) and kidney transplant recipients late post-transplant (TX). NK, NK T and T cell subsets were analysed in the peripheral blood of 31 RM, 14 female ESRD and nine female TX patients as well as 21 female HC using eight-colour fluorescence flow cytometry. Compared with HC, RM patients showed significantly higher absolute numbers of CD56+ NK cells co-expressing the phenotype interferon (IFN)-γR+ , IL-4+ , transforming growth factor (TGF)-β+ , IL-4+ human leucocyte antigen D-related (HLA-DR)+ , TGF-β+ HLA-DR+ , IL-4+ TGF-β+ , IL-4+ TGF-β- , IFN-γ+ and/or IL-10- IFN-γ+ (all P ≤ 0·01), more IL-17+ CD56bright (P = 0·028) NK cells and more CD56dim CD16+ NK cells co-expressing IFN-γR, IFN-γ, IL-4 and/or TGF-β (all P ≤ 0·01). When the same cell subsets were analysed in ESRD or TX patients, cytokine-producing NK cell subsets were not significantly different from those of HC. RM patients showed significantly higher absolute numbers of CD158a+ , CD158b+ , CD158a- CD158e+ (all P < 0·05), NKG2D+ NKG2A+ , NKG2D + NKG2A- , NKG2D+ and/or NKG2A+ (all P ≤ 0·01) CD56+ NK cells and higher CD158a+ , CD158b+ (all P < 0·05), NKG2D+ and/or NKG2A+ (all P < 0·01) CD56dim+ CD16+ NK cells than HC. In contrast, ESRD patients had normal and TX recipients had lower CD158a+ and NKG2D+ NKG2A- CD56+ NK cells and lower CD158a+ CD56dim+ CD16+ NK cells (all P < 0·05) than HC. RM patients have abnormally high circulating NK cells expressing inhibitory cytokines and inhibitory surface receptors which might contribute to the pathogenesis of RM.

Author Info:
1
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany.
2
Department of Hematology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
3
Department of Internal Medicine, University of Giessen, Giessen, Germany.
4
Nephrology Unit, Internal Medicine Department, Assiut University, Asyut, Egypt.
5
Department of Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
6
Department of Nephrology.
7
Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany.
8
Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Innsbruck, Austria.


Authors:
Hosny NM(1), Atia NN(1), El-Gizawy SM(1), Badary DM(2), Hareedy MS(3).

Title:
Innovative HPTLC Method With Fluorescence Detection For Assessment Of Febuxostat-Montelukast Combination And Study Of Their Protective Effects Against Gouty Arthritis

Abstract:
The present study was designed to evaluate the potential protective effects of the cysteinyl leukotriene receptor blocker montelukast (MNK) and the xanthine oxidase inhibitor febuxostat (FBX) and their combination on a model of acute gouty arthritis induced by intraarticular injection of monourate sodium crystal (MUC) injection in rats. Additionally, we established an HPTLC method for the quantitative determination of both drugs simultaneously and applied this method to detect this combination in rat plasma. In this study, the treated male Wistar rats were grouped as follows: a negative control group injected with phosphate buffer saline (PBS) and a positive control group injected with MUC in their tibiotarsal joint. Four groups were treated orally with diclofenac (4 mg kg-1), MNK (10 mg kg-1), FBX (5 mg kg-1) and MNK plus FBX before MUC injection in their tibiotarsal joints. MUC injection in joints without pretreatment led to a progressive significant increase in joint diameter and heavy leucocytic infiltration compared to the PBS-injected joints. Treatment with diclofenac or a combination of MNK and FBX significantly decreased both joint diameters and leucocytic infiltration compared to the MUC group. MNK or FBX treatment attenuated leucocytic infiltration and significantly decreased joint diameters compared to the MUC group. Thus, MNK and FBX can prevent the development of MUC-induced acute gouty arthritis in rats. Also, MNK can be an alternative preventive treatment, particularly in elderly patients who cannot tolerate NSAIDs or corticosteroid. Furthermore, a new thin-layer chromatographic method combined with fluorescence detection was developed and validated for the simultaneous estimation of a mixture of FBX and MNK in spiked human plasma. In this method, we employed TLC aluminium plates precoated with silica gel G 60F254 as the stationary phase and chloroform : methanol (9 : 1, v/v) as the mobile phase. The optimized mobile phase selected for development gives compact bands (Rf values are 0.28 and 0.63 for FBX and MNK, respectively). The emission intensities were measured using a K400 optical filter after excitation at 322 nm. The linear regression data for the calibration plots showed excellent linear relationship (r = 0.9990 and 0.9996 for FBX and MNK, respectively), and the linearity range was 10.0-800.0 ng per band for both drugs. According to ICH-guidelines, this method was validated for precision, accuracy, robustness and selectivity. Also, the limits of detection and quantitation were calculated. In addition, stability studies on the studied mixture were performed. Statistical analysis proved that this method is reproducible and selective for the estimation of a mixture of FBX and MNK.

Author Info:
The present study was designed to evaluate the potential protective effects of the cysteinyl leukotriene receptor blocker montelukast (MNK) and the xanthine oxidase inhibitor febuxostat (FBX) and their combination on a model of acute gouty arthritis induced by intraarticular injection of monourate sodium crystal (MUC) injection in rats. Additionally, we established an HPTLC method for the quantitative determination of both drugs simultaneously and applied this method to detect this combination in rat plasma. In this study, the treated male Wistar rats were grouped as follows: a negative control group injected with phosphate buffer saline (PBS) and a positive control group injected with MUC in their tibiotarsal joint. Four groups were treated orally with diclofenac (4 mg kg-1), MNK (10 mg kg-1), FBX (5 mg kg-1) and MNK plus FBX before MUC injection in their tibiotarsal joints. MUC injection in joints without pretreatment led to a progressive significant increase in joint diameter and heavy leucocytic infiltration compared to the PBS-injected joints. Treatment with diclofenac or a combination of MNK and FBX significantly decreased both joint diameters and leucocytic infiltration compared to the MUC group. MNK or FBX treatment attenuated leucocytic infiltration and significantly decreased joint diameters compared to the MUC group. Thus, MNK and FBX can prevent the development of MUC-induced acute gouty arthritis in rats. Also, MNK can be an alternative preventive treatment, particularly in elderly patients who cannot tolerate NSAIDs or corticosteroid. Furthermore, a new thin-layer chromatographic method combined with fluorescence detection was developed and validated for the simultaneous estimation of a mixture of FBX and MNK in spiked human plasma. In this method, we employed TLC aluminium plates precoated with silica gel G 60F254 as the stationary phase and chloroform : methanol (9 : 1, v/v) as the mobile phase. The optimized mobile phase selected for development gives compact bands (Rf values are 0.28 and 0.63 for FBX and MNK, respectively). The emission intensities were measured using a K400 optical filter after excitation at 322 nm. The linear regression data for the calibration plots showed excellent linear relationship (r = 0.9990 and 0.9996 for FBX and MNK, respectively), and the linearity range was 10.0-800.0 ng per band for both drugs. According to ICH-guidelines, this method was validated for precision, accuracy, robustness and selectivity. Also, the limits of detection and quantitation were calculated. In addition, stability studies on the studied mixture were performed. Statistical analysis proved that this method is reproducible and selective for the estimation of a mixture of FBX and MNK.


Authors:
Ahmed AE1, Hassan MH2, Rashwan NI1, Sayed MM1, Meki AMA3.

Title:
Myocardial Injury Induced By Scorpion Sting Envenoming And Evidence Of Oxidative Stress In Egyptian Children

Abstract:
In the present study, 45 children in Upper Egypt (less than 16 years old) were admitted to the Pediatric Intensive Care Unit for scorpion envenomation (SE). They were compared with 30 apparently healthy children of matching age and sex as controls. Out of the studied victims, 35 children (78%) showed signs of severe envenomation, while 10 victims (22%) showed signs of mild envenomation. The case fatality was 33%. The serum levels of cardiac markers, cardiac troponin T (cTnT) and I (cTnI), as well as the enzymatic activities of creatine kinase-MB (CPK-MB) and lactate dehydrogenase (LDH) were determined for both victims and controls. In addition, the serum levels of oxidative stress markers, nitric oxide (NO), malondialdehyde (MDA), superoxide dismutase (SOD), reduced glutathione (GSH) and zinc (Zn) were measured. Electrocardiography and echocardiography were done. All the envenomed victims showed signiﬁcantly higher mean values of cTnT, cTnI, CPK-MB and LDH than control group. These cardiac markers were elevated in severe cases and in non survivors in comparison with mild cases and survivors respectively. Furthermore, the serum levels of NO and MDA were significantly higher while the serum levels of SOD, GSH and Zn were significantly lower in all envenomed victims than the controls (p < 0.05 for all). There were no significant differences in the serum levels of oxidative stress markers among severe and mild cases or between survivors and non survivors victims. There were no significant correlations between the serum levels of cardiac markers and the oxidative stress markers in envenomed victims. In conclusions, oxidative stress occurs in scorpion envenomed children, but does not determine prognosis. Cardiac markers, but not the oxidative stress, remain the most important determining factor for the severity and the outcome of SE.

Author Info:
1
Pediatrics and Neonatology Department, Faculty of Medicine, South Valley University, Qena, Egypt.
2
Medical Biochemistry Department, Faculty of Medicine, South Valley University, Qena, Egypt. Electronic address: Mohammedhosnyhassaan@yahoo.com.
3
Medical Biochemistry Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Hassanein M1, Abdelhamid M2, Ibrahim B3, Sobhy M4, Nasr G5, Aboleineen MW6, Reda A7, Farag N8, Elshazly A9, Abdeldayem TK10, Elmesseiry F11, Boshra H12, Sobhy H13, Elbahry A14, Youssef A15, Ashmawy M16, Abdelmoneim A17, Saleh A10, Elrakshy Y18, Ebeid H19.

Title:
Gender Differences In Egyptian Patients Hospitalized With Heart Failure: Insights From The European Society Of Cardiology Heart Failure Long-Term Registry

Abstract:
AIMS:
This analysis evaluates gender differences in the Egyptian cohort of patients hospitalized for acute heart failure (AHF) in the European Society of Cardiology Heart Failure Long-Term Registry.

METHODS AND RESULTS:
From April 2011 to September 2014, 1634 patients hospitalized with AHF were enrolled by 20 hospitals all over Egypt. Of these patients, 1112 (68%) patients were male and 522 (32%) were female. Women presented with a higher admission systolic blood pressure and resting heart rate. Compared with men, women had a higher body mass index (32.5 ± 9.0 vs. 29.3 ± 4.9, P < 0.001), more frequent atrial fibrillation (34.7% vs. 22.4%, P < 0.001), and anaemia defined by haemoglobin < 12 g/dL (83.1% vs. 58.4%, P < 0.001). Women were more likely to present with heart failure with preserved ejection fraction (29.7% vs. 10.6%, P < 0.001). Women had more frequent diabetes mellitus (48.1% vs. 41.6%, P < 0.05) and hypertension (48.7% vs. 39.3%, P < 0.001) than had men, whereas smoking was rare among them (8.8% vs. 82.9%, P < 0.005). There was no significant difference in the primary aetiology of heart failure between both sexes. ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists, antiplatelets, statins, and nitrates were less frequently prescribed to women, whereas they more often received digoxin, amiodarone, anticoagulants, and calcium channel blockers. There was no significant difference in in-hospital (5.7% vs. 4.6%, P = 0.39) and 1 year mortality (27.9% vs. 25.9%, P = 0.48) between women and men, respectively.

CONCLUSIONS:
Men and women with AHF differ significantly in baseline clinical characteristics and management but not in adverse outcomes. These findings emphasize the importance of individualized management and need for more comprehensive recruitment of women in clinical trials.

Author Info:
1
Department of Cardiology, Faculty of Medicine, Alexandria University, Champillion Street, Azarita, Alexandria, Egypt.
2
Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.
3
National Heart Institute, Imbaba, Giza, Egypt.
4
International Cardiac Centre, Alexandria, Egypt.
5
Ismaileya Insurance Hospital, Ismaileya, Egypt.
6
Zagazig University, Zagazig, Egypt.
7
Menoufia University, Shibin El Kom, Egypt.
8
Dar Al Fouad Hospital, Cairo, Egypt.
9
Gamal Abdel Nasser Insurance Hospital, Alexandria, Egypt.
10
Ain Shams University, Cairo, Egypt.
11
Ras Eltin General Hospital, Alexandria, Egypt.
12
Beni Suef University, Beni Suef, Egypt.
13
El Menshawy General Hospital, Tanta, Egypt.
14
Port Fouad General Hospital, Port Fouad, Egypt.
15
Assiut University, Assiut, Egypt.
16
Tanta University, Tanta, Egypt.
17
Banha University, Banha, Egypt.
18
Students' University Hospital, Alexandria, Egypt.
19
Damanhour General Hospital, Damanhour, Egypt.


Authors:
Mekky MA1, Abdel-Malek MO2, Osman HA3, Abdel-Aziz EM4, Hashim AA5, Hetta HF6, Morsy KH7.

Title:
Efficacy Of Ombitasvir/Paritaprevir/Ritonavir/Ribavirin In Management Of HCV Genotype 4 And End-Stage Kidney Disease

Abstract:
BACKGROUND:
Till now, pooled data about the safety and efficacy of different direct-acting antiviral (DAAs) regimens in different renal situations are still under evaluation.

AIM:
To evaluate a real-life experience of the efficacy and safety of ombitasvir/paritaprevir/ritonavir plus ribavirin (OBV/PTV/r plus RIB) in patients with end-stage kidney disease (ESKD).

PATIENTS AND METHODS:
Between January 2017 and January 2018, an open-label multicenter prospective study was designed to enroll all consecutive patients with proven CHC genotype 4 infections and concomitant ESKD based on estimated glomerular filtration rate (eGFR) with (HD group) or without hemodialysis (non-HD group). Patients were given a co-formula of OBV/PTV/r (25/150/100 mg) once-daily plus RIB was given for 12 weeks. Sustained virologic response (SVR 12) was the primary endpoint.

RESULTS:
A total of 110 patients were enrolled. An overall SVR 12 was reported in 104 (94.5%) patients, and treatment failure were reported in 6 patients [2 patients (1.8%) were relapsed, and 4 patients (3.6%) patients were non-responders]. SVR12 was 96% in HD and 91.4% in non-HD patients (P = 0.286). There were no reported serious adverse events. Anemia was reported in 66.6% (n = 50) in HD group and in 31.4% (n = 11) in non-HD group.

CONCLUSION:
Although it is still challenging, achievement of SVR12 in patients with chronic HCV and concomitant end-stage kidney disease in the era of DAAs became possible with a 12 weeks course of a co-formula of ombitasvir/paritaprevir /ritonavir plus ribavirin. CLINICALTRIALS.

GOV ID:
NCT03341988.

Author Info:
1
Tropical Medicine and Gastroenterology Department, Hepatology Division, Faculty of Medicine, Assiut university, 71515 Assiut, Egypt. Electronic address: mmekky75@yahoo.com.
2
Tropical Medicine and Gastroenterology Department, Hepatology Division, Faculty of Medicine, Assiut university, 71515 Assiut, Egypt.
3
Tropical Medicine and Gastroenterology Department, Hepatology Division, Faculty of Medicine, South Valley university, Qena, Egypt.
4
Department of Internal Medicine, Nephrology Division, Faculty of Medicine, Assiut university, Assiut, Egypt.
5
Department of Internal Medicine, Nephrology Division, Faculty of Medicine, South Valley university, Qena, Egypt.
6
Medical Microbiology and Immunology Department, Faculty of Medicine, Assiut university, Assiut, Egypt.
7
Tropical Medicine and Gastroenterology Department, Hepatology Division, Faculty of Medicine, Sohag university, Sohag, Egypt.


Authors:
Othman ER1, Ahmed E2, Sayed AA3, Hussein M4, Abdelaal II4, Fetih AN4, Abou-Taleb HA4, Yousef AA4.

Title:
Human Uterine Leiomyoma Contains Low Levels Of 1, 25 Dihdroxyvitamin D3, And Shows Dysregulated Expression Of Vitamin D Metabolizing Enzymes

Abstract:
OBJECTIVES:
To evaluate tissue concentration of 1, 25 dihydroxyvitamin D3, and gene expression level of CYP27B1 that codes for 1-α hydroxylase (vitamin D activating enzyme), and CYP24A1 that codes for 24-hydroxylase (vitamin D catabolizing enzyme) in human uterine leiomyoma (ULM), its adjacent myometrium (Myo-F), and normal myometrium (Myo-N).

STUDY DESIGN:
Levels of 1, 25 dihydroxyvitamin D3 were measured using HPLC and Diode detectors whereas CYP27B1, and CYP24A1 expressions were assessed using Real-Time PCR in ULM, Myo-F, and Myo-N. Non-parametric statistics were used.

RESULTS:
ULMs contained significantly less 1, 25 dihydroxy vitamin D3 compared to Myo-F (3.0, IQR: 1.0-9.0 versus 6.0, IQR: 3.0-13.0 μg/ kg, P value is 0.03). No significant difference was detected between ULM and Myo-N, or Myo-F and Myo-N. Intratumoral level of the active form of vitamin D did not differ according to the type of ULM (submucous or interstitial/subserous), or to the ULM volume. CYP27B1 was expressed in ULM (2.17, IQR: 0.65-4.9), Myo-F (4.94, IQR: 1.04-22.59), and Myo-N (0.99, IQR: 0.49-1.71) to a comparable level. CYP24A1 expression was significantly higher in ULM compared to Myo-N (2.00, IQR: 0.69-10.77 versus 0.22, IQR: 00- 0.96, respectively, P value is 0.04).

CONCLUSIONS:
Human ULMs contain significantly lower 1, 25 dihydroxyvitamin D3 than its adjacent myometrium. ULM, Myo-F, and Myo-N express CYP27B1 and CYP24A1. ULMs express significantly higher level of CYP24A1 than normal myometrium indicating that over expression of 24-hydroxylase is a mechanism by which ULMs sustain a relative state of hypovitaminosis D.

Author Info:
1
OB-GYN Department, Assiut University, Egypt. Electronic address: essamrash@yahoo.com.
2
Women's Health Hospital, Assiut University, Egypt.
3
Medical Biochemistry Department, Assiut University, Egypt.
4
OB-GYN Department, Assiut University, Egypt.


Authors:
Zayed AE1,2, Saleh A3,4, Gomaa AMS5, Abd-Elkareem M1, Anwar MM5,6, Hassanein KMA7,8, Elsherbiny MM9, Kotb AM1,10.

Title:
Corrigendum to "Protective Effect of Ginkgo biloba and Magnetized Water on Nephropathy in Induced Type 2 Diabetes in Rat"

Abstract:
Abstract
[This corrects the article DOI: 10.1155/2018/1785614.].

Erratum for
Protective Effect of Ginkgo biloba and Magnetized Water on Nephropathy in Induced Type 2 Diabetes in Rat. [Oxid Med Cell Longev. 2018]

Author Info:
1
Department of Anatomy and Histology, Faculty of Veterinary Medicine, Assiut University, Assiut 71515, Egypt.
2
Department of Biology, Faculty of Science, Jazan University, Jazan, Saudi Arabia.
3
Exploratory Center of Science and Technology, Cairo, Egypt.
4
Department of Physics, Faculty of Science, Jazan University, Jazan, Saudi Arabia.
5
Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
6
Department of Pharmacology, Faculty of Pharmacy, Jazan University, Jazan, Saudi Arabia.
7
Department of Pathology and Clinical Pathology, Faculty of Veterinary Medicine, Assiut University, Assiut 71526, Egypt.
8
Deanship of Scientific Research, Jazan University, Jazan, Saudi Arabia.
9
College of Public and Tropical Medicine, Jazan University, Jazan, Saudi Arabia.
10
Department of Anatomy and Cell Biology, University Medicine Greifswald, Greifswald, Germany.


Authors:
Mohamed-Hussein AAR1, Sayed SS2, Eldien HMS3, Assar AM2, Yehia FE4.

Title:
Beta 2 Adrenergic Receptor Genetic Polymorphisms in Bronchial Asthma: Relationship to Disease Risk, Severity, and Treatment Response

Abstract:
BACKGROUND:
The β2-adrenergic receptor gene is one of the most extensively studied genes with respect to asthma prevalence and severity. The Arg16Gly and Gln27Glu polymorphisms in the β2-adrenergic receptor gene cause changes in the amino acids sequence of the receptor which may cause alteration in response to bronchodilators and the risk of asthma.

OBJECTIVE:
The purpose of the study was to determine the association between β2-adrenergic receptor gene polymorphisms and asthma risk, severity and response to therapy.

SUBJECTS AND METHODS:
58 asthmatic patients and 38 healthy subjects were included. The β2-adrenergic receptor polymorphisms genotyping was done using Real-Time polymerase chain reaction.

RESULTS:
The allelic frequencies for the Arg16Gly polymorphism were 15.5%, 48.3%, and 36.2% for the homozygous A wild, heterozygous, and homozygous G mutant alleles in asthmatics (P < 0.01) and 5.3%, 47.4%, and 47.4% in healthy subjects (P < 0.01). For the Gln27Glu polymorphism, the allelic frequencies for the homozygous C wild, heterozygous and homozygous G mutant alleles were 51.7%, 41.4%, and 6.9% in asthmatics (P < 0.01) and 44.7%, 39.5%, and 15.8% in healthy subjects (P < 0.01). The heterozygous Arg16Gly and Gln27Glu were found in most of severe asthma cases (7/13, 53.8% each). While homozygous wild and mutant seemed to be protective and associated with mild disease in both alleles. Finally, 75% of Arg16Gly heterozygous group were good responders (P < 0.01), 81% of homozygous G mutant were bad responders. For Gln27Glu polymorphism, 60% of C wild group were good responders and 75% of G mutant group were bad responders.

CONCLUSIONS:
The findings suggest that the Arg16Gly and Gln27Glu polymorphisms in the β2-AR gene are associated with asthma severity and response to therapy and might be used in personalized treatment for these patients in the future. This work is registered in ClinicalTrial.gov with ID: NCT03118869.

Author Info:
1
Chest Department, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt. aliaehussein@gmail.com.
2
Chest Department, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
3
Department of Histology & Cell Biology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
4
Tissue Culture and Molecular Biology Center, Assiut University, Assiut, 71515, Egypt.


Authors:
Abbas AM1, Mohamed AA1,2, Mattar OM3, El Shamy T4, James C4, Namous LO3, Yosef AH1, Khamis Y5, Samy A6.

Title:
Lidocaine-Prilocaine Cream Versus Local Infiltration Anesthesia In Pain Relief During Repair Of Perineal Trauma After Vaginal Delivery: A Systematic Review And Meta-Analysis

Abstract:
BACKGROUND:
Perineal trauma is a common problem that may affect women during vaginal delivery; this trauma can be either spontaneous (tear) or intentional (episiotomy). When repair of perineal trauma is required, adequate analgesics must be obtained. Topical products as lidocaine-prilocaine (EMLA) cream is one of the suggested methods, but still there is lack of evidence with regard to its efficacy and safety.

OBJECTIVE:
The aim of this review is to assess the evidence of utilizing EMLA cream in comparison to local perineal infiltration anesthesia for pain control during perineal repair after vaginal delivery.

DATA SOURCES:
Medline, Embase, Dynamed Plus, ScienceDirect, TRIP database, ClinicalTrials.gov and the Cochrane Library were searched electronically from January 2006 to May 2018 for studies investigating the effect of lidocaine-prilocaine cream in relieving pain during repair of perineal trauma.

METHODS OF STUDY SELECTION:
All randomized controlled trials assessing effect of lidocaine-prilocaine cream versus local infiltration anesthesia in relieving pain during repair of perineal trauma were considered for this meta-analysis. Fifteen studies were identified of which four studies deemed eligible for this review. Quality and risk of bias assessment was performed for all studies.

DATA EXTRACTION:
Two researchers independently extracted the data from the individual articles and entered into RevMan software. The weighted mean difference (WMD) and 95% confidence interval (CI) was calculated. Statistical heterogeneity between studies was assessed by the Higgins chi-square and (I2) statistics. When heterogeneity was significant, a random-effects model was used for meta-analysis. Otherwise, the fixed effect meta-analysis was used when there was no significant heterogeneity.

RESULTS:
Pooled analysis of result in "pain score" was insignificant between the two groups (WMD -1.11; 95% CI (-2.55 to 0.33); p = .13). Furthermore, the use of additional analgesia showed no statistically significant difference between the two groups (WMD 1.34; 95% CI (0.66-2.71), p = .42). Regarding patient satisfaction, an overall analysis of three studies showed significant results favoring EMLA cream group users (WMD 4.65; 95% CI (1.96-11.03), p = .0005). The pooled analysis of the outcome "duration of repair" showed the significantly shorter duration of repair in EMLA cream users (n = 92) than local infiltration anesthesia (n = 95) (1.72 min; 95% CI (-2.76 to -0.67), p = .001).

CONCLUSIONS:
This meta-analysis suggests that topical lidocaine-prilocaine cream gives comparable results in reducing pain during perineal repair after vaginal delivery.

Author Info:
1
a Department of Obstetrics and Gynaecology, Faculty of Medicine , Assiut University , Assiut , Egypt.
2
b Department of Obstetrics and Gynaecology , University of Nottingham, Royal Derby Hospital , Derby , United Kingdom.
3
c Kasr Al-Ainy Faculty of Medicine , Cairo University , Cairo , Egypt.
4
d Derby Teaching Hospitals NHS Foundation Trust , Derby , United Kingdom.
5
e Department of Obstetrics and Gynaecology, Faculty of Medicine , Beni-Suef University , Cairo , Egypt.
6
f Department of Obstetrics and Gynaecology, Faculty of Medicine , Cairo University , Cairo , Egypt.


Authors:
Aly MYF1,2, Mori Y1, Miyasaka Y1, Ohtsuka T1, Sadakari Y1, Nakata K1, Oda Y3, Shimizu S4,5, Nakamura M6.

Title:
Laparoscopic Surgery For Congenital Biliary Dilatation: A Single-Institution Experience

Abstract:
PURPOSE:
Laparoscopic surgery as a treatment for congenital biliary dilatation is uncommon. We herein present a series of laparoscopic surgeries for congenital biliary dilatation performed in our institution and review our experience with this approach over a long period of time.

METHODS:
Medical records of 36 consecutive patients who underwent laparoscopic surgery for congenital biliary dilatation from 1996 to 2015 were retrospectively reviewed. Data on patient demographics, operative time, blood loss, hospital stay, and complications were evaluated. A comparison between the former period (Group A, 1996-2005) and the latter period (Group B, 2006-2015) was performed.

RESULTS:
The patients comprised 23 females and 13 males with a median age of 34 years. The median operative time, blood loss, and hospital stay was 493 min, 154 g, and 11 days, respectively. Total early and late complications occurred in 7 (19%) and 2 (5%) patients, respectively. A comparison between Groups A and B revealed no significant difference in operative time or complications, but operative blood loss, open conversion, and hospital stay were significantly lower in Group B than in Group A (P < 0.05).

CONCLUSION:
Laparoscopic surgery for congenital biliary dilatation is feasible and provides acceptable results. Further prospective studies of larger numbers of patients are needed.

Author Info:
1
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
2
Department of Surgery, Assiut University, Assiut, Egypt.
3
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
4
Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, Fukuoka, Japan.
5
International Medical Department, Kyushu University Hospital, Fukuoka, Japan.
6
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. mnaka@surg1.med.kyushu-u.ac.jp.


Authors:
Ansari J1, Batubara E2, Ali M1, Farrag A1,3, Bashir F1, Farghaly HR4, Ali AM1,5, Shaukat A1.

Title:
Atypical Diffuse Bilateral Cystic Lung Changes Secondary To Erlotinib Treatment In A Patient With Metastatic Non-Small Cell Lung Carcinoma: A Case Report And Literature Review

Abstract:
Erlotinib is a first-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) approved in the first-line treatment of advanced non-small-cell lung cancer (NSCLC) patients with sensitizing epidermal growth factor receptor (EGFR) mutations. The response rate to erlotinib is ~60% and the incidence of erlotinib-induced interstitial lung disease (ILD) is ~1-4%. The Response Evaluation Criteria in Solid Tumours (RECIST) tool is commonly used to assess response to erlotinib; however, evaluation of response and subsequent progression in the presence of atypical cystic lung changes may be challenging. We herein present a rare case of diffuse cystic lung changes secondary to erlotinib treatment in a patient with EGFR mutation-positive metastatic NSCLC. Challenges in assessing atypical tumour response to erlotinib, pitfalls in using RECIST and differential diagnosis of TKI-related ILD are discussed in detail.

Author Info:
1
Department of Oncology, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia.
2
Department of Pulmonology, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia.
3
Clinical Oncology Department, Assiut University Hospital, Assiut University, Asyut 71515, Egypt.
4
Department of Nuclear Medicine Division, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia.
5
Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Asyut 71515, Egypt.


Authors:
Biglioli F1, Soliman M2, El-Shazly M3, Saadeldeen W4, Abda EA5, Allevi F6, Rabbiosi D7, Tarabbia F8, Lozza A9, Cupello S10, Privitera A11, Dell'Aversana Orabona G12, Califano L13.

Title:
Use Of The Masseteric Nerve To Treat Segmental Midface Paresis

Abstract:
Segmental midface paresis with or without synkinesis reflects incomplete recovery from Bell's palsy, operations on the cranial base or parotid, or trauma, in 25%-30% of cases. To correct the deficit, the masseteric nerve was used to deliver a powerful stimulus to the zygomatic muscle complex, with the addition of a cross-face sural nerve graft to ensure more spontaneous smiling. By doing this, the orbicularis oculi muscle continues to have an appropriate stimulus from the facial nerve, and the zygomatic muscle complex is separately innervated, which considerably reduces synkinesis between the two muscle compartments. For those patients with muscular contractures of the midface, the new healthy neural stimulus relaxes muscles at rest. From January 2011 to March 2017, 20 patients presented with segmental facial paresis of the midface and were operated on using this new technique. All patients were evaluated before and after operation using Clinician-Graded Electronic Facial Paralysis Assessment (eFACE), and they showed considerable postoperative improvements in static, dynamic, and synkinetic variables. Our proposed use of the masseteric nerve to treat segmental facial paresis produces favourable results, but our initial data require confirmation by further studies.

Author Info:
1
Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy. Electronic address: Federico.biglioli@unimi.it.
2
Plastic Surgery Department, Assiut University, Assiut, Egypt and Clinical Fellow at San Paolo Hospital, Milan University, Milan. Electronic address: Mahmoudsoliman56@aun.edu.eg.
3
Plastic Surgery Department, Assiut University, Assiut, Egypt. Electronic address: elshazly@aun.edu.eg.
4
Plastic Surgery Department, Assiut University, Assiut, Egypt. Electronic address: waelsaadeldeen@gmail.com.
5
Rheumatology and Rehabilitation Department, Assiut University, Assiut, Egypt. Electronic address: essamabda@hotmail.com.
6
Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy. Electronic address: fabiana.allevi@gmail.com.
7
Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy. Electronic address: dimitri.rabbiosi@tiscali.it.
8
Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy. Electronic address: filippotarabbia@gmail.com.
9
Service of Neurophysiopathology - National Neurological Institute C. Mondino, Pavia, Italy. Electronic address: alelozza@gmail.com.
10
Rehabilitation Medicine Department, San Paolo Hospital, University of Milan, Milan, Italy. Electronic address: silvia.cupello@ass-santipaolocarlo.it.
11
Rehabilitation Medicine Department, San Paolo Hospital, University of Milan, Milan, Italy. Electronic address: antonio.previtera@unimi.it.
12
Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy. Electronic address: giovani.dellaversanaorabona@unina.it.
13
Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy. Electronic address: califano@unina.it.


Authors:
Callaway NF1, Gonzalez MA1, Yonekawa Y2,3, Faia LJ2, Mandelcorn ED4, Khurana RN5, Saleh MGA6,7, Lin P6, Sobrin L3, Albini TA1.

Title:
OUTCOMES OF PARS PLANA VITRECTOMY FOR MACULAR HOLE IN PATIENTS WITH UVEITIS

Abstract:
PURPOSE:
Inflammatory macular hole is a rare complication of uveitis, and data on surgical outcomes of closure are scarce. The purpose of this study is to evaluate the anatomical and visual outcomes of conventional pars plana vitrectomy for patients with uveitis.

METHODS:
Noncomparative, interventional, and consecutive case series from 6 vitreoretinal surgical centers from 2007 to 2015. Twenty eyes of 19 patients were included with 4 patients separated as viral retinitis. The primary outcome was change in best-corrected visual acuity at Month 3. Secondary outcomes were closure of the macular hole and postoperative optical coherence tomography characteristics.

RESULTS:
All eyes underwent conventional three-port pars plana vitrectomy with indocyanine green-assisted internal limiting membrane peeling. Mean Snellen best-corrected visual acuity improved from 20/200 to 20/63 (P = 0.01 for a difference in logarithm of the minimum angle of resolution) at Month 3. Twelve (75%) of patients achieved 2 or more lines of visual acuity improvement by postoperative Month 3. Surgery resulted in decreased epiretinal membrane (P = 0.002), intraretinal fluid (P < 0.001), subretinal fluid (P = 0.029), central subfield thickness (P < 0.001), and central cube volume (P = 0.041). Surgical intervention achieved anatomical success, as measured by macular hole closure, in 13 (81%) of patients at postoperative Month 3.

CONCLUSION:
Patients with inflammatory macular hole respond well to conventional surgery, with good anatomical and visual acuity outcomes.

Author Info:
1
Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida.
2
Associated Retinal Consultants, P.C., Royal Oak, Michigan.
3
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
4
Donald K. Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada.
5
Northern California Retina Vitreous Associates, Daly, Mountain View, California.
6
Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
7
Department of Ophthalmology, Assiut University, Assiut, Egypt.


Title:
Sphenoid Meningioma Enplaque With Proptosis: Surgical Excision, Reconstruction And Outcome

Abstract:
OBJECTIVE:
To evaluate surgical outcome and reconstruction of bone defects after excision of sphenoid meningioma enplaque.

PATIENT AND METHODS:
Between June 2012 and May 2016, a series of 15 patients presented by proptosis attended to neurosurgery departments, Assiut university hospital, Qena university hospital, South Valley University and, These patients were diagnosed with sphenoid meningioma enplaque by fulfilling its criteria by neuroimaging (sheet-like meningioma and hyperostosis). All patients received preoperative imaging investigations including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) to evaluate the extension of both tumor components - soft tissue and bone involvement. Fifteen patients were operated by pterional approach under general anesthesia.

RESULTS:
Fifteen patients with meningioma enplaque were treated surgically. The mean age of patients at the time of admission was 46.5 years, age ranged between 35-56 years. 80% of patients were females (female to male ratio was 4:1). Ten (66.7%) patients have left sided lesion representing. Proptosis was the main presented manifestation in all patients. Complete tumor excision was done in 10 patients while incomplete excision was done in the rest of patients. Proptosis was improved post-operatively in patients presented by it: Ten (66.7%) patients had complete improvement while the other five (33.3%) patients improved significantly. No mortality occurred in our study. A mean follow-up period of 2.1 years (range: 4 months to 4 years), three (20%) patients have tumor recurrence.

CONCLUSIONS:
Total excision of Sphenoid meningioma enplaque carries difficulties and high rate of post-operative morbidity. Early detection with experienced neurosurgeons, microsurgical techniques and availability of high speed drill decrease the risk of post-operative morbidity. Reconstruction of dural and bone defect is very important regarding functional and cosmetic aspects.

Author Info:
1
Department of Neurosurgery, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt. Electronic address: abdelhakeemessa@aun.edu.eg.
2
Department of Neurosurgery, Qena Faculty of Medicine, South Valley University, Qena, Egypt. Electronic address: Ali.hemdan@med.svu.edu.eg.


Title:
Validation of an Egyptian Arabic Version of Skindex-16 and Quality of Life Measurement in Egyptian Patients with Skin Disease

Abstract:
PURPOSE:
To translate and cross-culturally adapt the Skindex-16, a brief skin-disease-specific QoL questionnaire, into Arabic for Egyptians and to evaluate its measurement properties in Egyptian patients with skin disease.

METHOD:
Translation and cultural adaption were performed following guidelines for cross-cultural adaption of health-related quality of life measures. Subsequently, Skindex-16 was administered to 500 consecutive dermatological patients and 500 healthy persons for verification of its reliability and validity. Next, we examined the effect of skin disorders on QoL as well as influences of age, sex, socioeconomic level, education, and use of medication on skin disease-related QoL.

RESULTS:
The instrument showed high internal consistency reliability and good construct and content validity. The quality of life was most deteriorated in the emotional domain followed by symptoms domain (mean percentage score 55.5 ± 23.1 and 31.7 ± 26.8 respectively), while functioning was the least affected domain (mean percentage score 29.1 ± 26.8). Higher total Skindex-16 scores were observed for patients with psoriasis, urticaria, acne, and atopic dermatitis than those with vitiligo and alopecia areata. Educational level, social class, medication use, and family history influenced the impact of skin disease on overall QoL.

CONCLUSION:
The adapted Egyptian Arabic version of Skindex-16 is valid and reliable; it showed that skin problems had a clinically significant impact on QoL in Egyptian patients.

Author Info:
1
Department of Dermatology and Venereology, Assiut University Hospital, Assiut, 71526, Egypt.
2
Department of Dermatology and Venereology, Assiut University Hospital, Assiut, 71526, Egypt. saramawad@gmail.com.


Authors:
Gadelkareem RA1, Shahat AA1, Abdelhafez MF1, Moeen AM1, Ibrahim AS2, Safwat AS1.

Title:
Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. VI. Unusual Events in Urolithiasis: 1. Long-Standing Urethral Stones without Underlying Anatomical Abnormalities in Male Children

Abstract:
OBJECTIVES:
The study aimed to present our center's experience with long-standing urethral stones in male children with normal urethra.

MATERIALS AND METHODS:
Retrospective search of our center data was done for the cases of long-standing urethral stones with normal urethra in male children during the period July 2001 - June 2016. Demographic and clinical data were studied.

RESULTS:
Of more than 54,000 urolithiasis procedures, 17 male children (0.031%) were operated for long-standing urethral stones with normal urethra. In 14 cases (82.4%), residence was rural and parental education levels were low or none. All children were regularly prompted voiding with a history of difficulty or dysuria. All the stones lodged in the posterior urethra with an approximate mean duration of 2 months. The mean stone size of 11.29 ± 3.88 mm and rough surfaces in 88.2% of cases represented the main predisposing factors. Major complications included rectal prolapse in 1 case and vesicoureteral reflux in 3 cases. Endoscopic push-back was followed by disintegration in 76.5% or cystolithotomy in 17.7%, while it failed in 1 case that was treated by cystolithotomy.

CONCLUSIONS:
Long-standing urethral stones in male children with normal urethra are very rare misdiagnoses. Stone topography and sociocultural factors predisposed to their lodgments and negligence. Endoscopic treatment is the best approach.

Author Info:
1
Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Anesthesia and Intensive Care, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Hammam N1, Gamal RM2, Rashed AM2, Elfetoh NA3, Mosad E4, Khedr EM3.

Title:
Fatigue in Rheumatoid Arthritis Patients: Association With Sleep Quality, Mood Status, and Disease Activity

Abstract:
OBJECTIVES:
Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by polyarthritis and systemic manifestations. RA-fatigue is a significant problem and adds on disease burden. Sleep disturbance, depression, and disease activity are suggested contributing factors to RA-fatigue; however, their combined role did not examine before among Egyptian RA patients. The objective of the study was to investigate the presence of fatigue, sleep and mood disturbances in RA patients. Also, to evaluate the possible association of poor sleep, depression, and disease activity with RA-fatigue.

METHODS:
This cross-sectional study included 115 RA patients diagnosed according to the 2010 ACR-EULAR criteria and 46 age and sex matched controls. Fatigue using the Multidimensional Assessment of Fatigue-Global Fatigue Index, sleep using the Pittsburgh Sleep Quality Index and mood status using Beck Depression Inventory were assessed for all participants. RA disease activity was evaluated using disease activity score-28 joints.

RESULTS:
RA patients had higher mean fatigue, sleep disturbance, and depression scores (27.2±8.9, 6.4±3.6, and 12.8±7.3; respectively) than controls (22.7±7, 4.8±3, 7.8±5.9; respectively) (P<.05). Poor sleep, depression and higher disease activity were significantly correlated with fatigue (r=0.4, r=0.65, r=0.55; respectively) (P<.001). The three variables may explain up to 49.1% of the variation in fatigue on multiple regression analysis.

CONCLUSION:
Fatigue, poor sleep, and depression are more common in Egyptian patients with RA. A remarkably higher fatigue was associated with poor sleep, depression, and high disease activity, thus monitoring these silent comorbidities in clinical practice is required.

Author Info:
1
Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada. Electronic address: hammam@ualberta.ca.
2
Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.
3
Department of Neuropsychiatry, Assiut University Hospitals, Assiut, Egypt.
4
Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Authors:
Mehio G1, Morsy M1,2, Cayci C1, Sabbagh MD1, Shin AY3, Bishop AT3, Moran SL1, Carlsen BT1.

Title:
Donor Site Morbidity and Functional Status Following Medial Femoral Condyle Flap Harvest

Abstract:
BACKGROUND:
The medial femoral condyle (MFC) free vascularized bone flap is a valuable alternative to other types of vascularized bone grafts. The donor site morbidity and functional outcomes after flap harvest have not been fully appreciated. Herein, we report the postoperative outcomes and analyze the impact of increasing the size of the flap on the knee donor site morbidity.

METHODS:
A retrospective chart review of patients who underwent MFC flap between 2001 and 2012 at our institution was done. The size of the flap was stratified, based on the largest dimension, into 3 groups. Demographics, outcomes, and complications related to the flap donor site were recorded and analyzed. Subsequently, functional status was assessed by administering a validated condition-specific measure: the Lower Extremity Functional Scale (LEFS) questionnaire. A univariate logistic regression analysis was done, and results were analyzed.

RESULTS:
A total of 75 patients were identified. Average age was 29.5 ± 15.2 years (range: 14-72). Average follow-up time was 13 months postoperatively. Overall Complication rate was 18.6%. Donor site paresthesia in the saphenous nerve distribution was the most common complication. Increasing size of the flap did result in a significant elevation in complication risk (p<.05). A total of 47 patients completed the LEFS questionnaire. Average LEFS score was 72.12 ± 14.18 (range 28-80). 51% (n=24) scored 80 points, indicating a normal level of function on average.

CONCLUSIONS:
The MFC flap has overall acceptable donor site morbidity with good level of function post-operatively. Larger flaps are associated with greater number of complications.

Author Info:
1
Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
2
Department of Orthopedic Surgery, Assiut University Hospital, Assiut University, Assiut, Egypt.
3
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.


Authors:
Ahmed Osman H(1), Aly SS(2), Mahmoud HS(1), Ahmed EH(3), Salah Eldin EM(4), Abdelrahim EA(5), El Masry MA(6), Herdan RA(7), Hassan MH(8).

Title:
Effect of Acid Suppression on Peripheral T-Lymphocyte Subsets and Immunohistochemical Esophageal Mucosal Changes in Patients With Gastroesophageal Reflux Disease

Abstract:
BACKGROUND AND AIMS:
Gastroesophageal reflux disease (GERD) is a common prevalent disease. We aimed to assess the dynamic changes in the peripheral T lymphocytes and lymphocytes infiltrating the esophageal mucosa after treatment with proton-pump inhibitor (PPI) in patients with GERD.

PATIENTS AND METHODS:
A total of 200 patients who presented with upper GIT symptoms were included in this prospective study. All patients were subjected to full history taking, clinical examination, and complete blood count. Upper endoscopy was performed to detect the grade of GERD, followed by 4 quadrant biopsies before and 1 month after acid suppressive drug therapy. Histopathologic and immunohistochemical examination were carried out for all biopsies. Flow cytometry analysis for the peripheral T lymphocytes and cytokine profile assay before therapy and after therapy were also carried out.

RESULTS:
In total, 200 patients comprising 132 male individuals (66%) and 68 female individuals (34%) with a mean age of 47.9±18.3 were included. The risk factors for development of GERD were smoking in 87 (43.5%), spicy food intake in 26 (13%), analgesics in 46 (23%), excessive tea and coffee in 35 (17.5%), and nondetected risk factors in 6 (3%). Endoscopic examination using Los Angeles grading system revealed that 102 patients (51%) were grade A, 57 patients (28.5%) were grade B, 38 patients (19%) were grade C, and 3 patients (1.5%) were grade D. No statistically significant differences could be detected in HGB levels and WBC, PLT, monocyte, granulocyte, and eosinophil counts before and after treatment with PPI. Histopathologic examination of esophageal biopsies showed significant posttreatment improvement in 132 cases (66%); however, 66 cases (33%) including the 2 cases (1%) of Barrett's esophagus showed nonsignificant pathologic improvement compared with the pretreatment picture. Immunohistochemical staining of esophageal biopsies with CD3 (T-cell marker) and CD20 (B-cell marker), before and 1 month after treatment, showed the presence of a very large number of infiltrating B cells in the esophageal mucosa (700±30/10 HPF) with large aggregations; in contrast, T-cell infiltration appeared less marked (570±23/10 HPF), and they formed smaller aggregates than those of B cells in pretreated patients, with P<0.01. However, 1 month after treatment with PPI, esophageal biopsies revealed a marked decrease in the number of both B (10±2/10 HPF) and T (290±12/HPF) cells in 66% of patients, with a P<0.01 in comparison with the pretherapy pattern. However, the remaining 33% of patients still showed a significantly high number of T cells (490±28/HPF), with a P <0.05 in comparison with the responder group that formed small aggregates with larger cell sizes, indicating their activation. Cytokine profiles before and after treatment revealed significant posttreatment reduction in their levels in the 132 cases with improvement in their clinical manifestations, and endoscopic and histopathologic findings, but there is no obvious change in the measured cytokine levels in 66 patients who simultaneously had no improvement in their endoscopic, histopathologic findings and mild improvement in their clinical manifestations. Moreover, significant posttreatment reduction of IL-8 and IL-1β in the 98 (49%) patients with Los Angeles grading B, C, and D was observed. With regard to serum levels of IL-10 and IL-4, there were no statistically significant differences before and after treatment with PPI. Peripheral blood immunologic parameters revealed a statistically significant reduction of the total CD3 absolute count, T-helper lymphocyte (CD4/CD3) percentage, T-helper lymphocyte absolute count, and the percentage and absolute cytotoxic T-lymphocyte count (CD8/CD3) after treatment with PPI. Moreover, the same significant difference of peripheral blood lymphocytes was detected after exclusion of patients with Los Angeles grade A, which may be considered normal.

CONCLUSIONS:
Acid-induced T-cell-related cytokine production plays an important role in inflammation occurring in patients with GERD. Mucosal and peripheral inflammation reduces with PPI use.

Author Info:
1
Tropical Medicine and Gastroenterology Department.
2
Clinical and Chemical Pathology Department.
3
Oncological Clinical Pathology Department.
4
Clinical Pathology Department.
5
Histology Department.
6
Internal Medicine Department, Division of Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Asyut, Egypt.
7
Oncological Pathology Department, South Egypt Cancer Institute, Assiut University.
8
Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, South Valley University, Qena.


Authors:
Idriss NK(1), Sayyed HG(2), Osama A(1), Sabry D(3).

Title:
Treatment Efficiency of Different Routes of Bone Marrow-Derived Mesenchymal Stem Cell Injection in Rat Liver Fibrosis Model

Abstract:
BACKGROUND/AIMS:
The most appropriate route for bone marrow-derived mesenchymal stem cell (BM-MSC) transplantation in the management of liver fibrosis remains controversial. This study investigated the therapeutic efficacy of intravenous and intrasplenic BM-MSC transplantation on carbon tetrachloride (CCl4)-induced rat liver fibrosis.

METHODS:
Fifty rats were divided into 5 groups (n = 10 rats per group): healthy control group, CCl4 group, CCl4/ recovery group, CCl4/BM-MSC intravenous group, and CCl4/BM-MSC intrasplenic group. BM-MSCs were isolated, labeled with green fluorescent protein (GFP), and injected into fibrotic rats either intravenously or intrasplenically. Gene expression of interleukins (IL-1β and IL-6), interferon (INF)-γ, hepatic growth factor, and the hepatocyte-specific marker cytokeratin 18 was estimated by quantitative real-time reverse transcription-polymerase chain reaction. Vascular endothelial growth factor and connective tissue growth factor was detected by western blot analysis and enzyme-linked immunosorbent assay, respectively. At 2 weeks after intravenous and intrasplenic BM-MSC injections, GFP-positive cells were detected in liver tissue.

RESULTS:
Both routes achieved a similar enhancement of liver function, which was confirmed by histopathological examination. The intravenous route was more effective than the intrasplenic route in reducing gene expression levels of IL-1β, IL-6, and INF-γ. However, fibrotic changes were still observed in the recovery group.

CONCLUSION:
Intravenous BM-MSC injection was an efficient and appropriate route for BM-MSC transplantation for the management of liver fibrosis.

Author Info:
1
Departments of Medical Biochemistry, Assiut, Egypt.
2
Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Medical Biochemistry and Molecular Biology Faculty of Medicine, Cairo University, Cairo, Egypt.


Authors:
Moeen AM1, Safwat AS2, Gadelmoula MM1, Moeen SM3, Abonnoor AEI1, Abbas WM1, ElGanainy EO1, El-Taher AM1.

Title:
Health Related Quality Of Life After Urinary Diversion. ‎Which Technique Is Better?‎

Abstract:
OBJECTIVE:
To compare quality of life (QoL) after urinary diversion (UD) following radical cystectomy (RC) using validated questionnaires.

PATIENTS AND METHODS:
Between January 2011 and June 2016, 150 patients (121 men [80.7%] and 29 women [19.3%]) with invasive bladder cancer who underwent RC and UD were included in this prospective study. Patients were divided into 2 groups; group I included the orthotopic neobladder 50 (33.3%) and uretro-sigmoidostomy 41 (27.3%) and group II included uretero-cutanoustomy 33 (22.1%) and ileal conduit 26 (17.3%) patients. QOL was evaluated using the Functional Assessment of Cancer Therapy-Bladder Cancer. The erectile function (EF) was assessed using the Sexual Health Inventory for Men Questionnaire. Evaluation was done before and after one year postoperatively.

RESULTS:
The mean ± SD patient age was 55.0 ± 7.9 and 59.5 ± 8.5 years in both groups, respectively (p = 0.001). There was a significant difference in the physical, social/family, emotional and functional statuses that were significantly higher in group I. One year postoperatively, the emotional well-being became insignificantly different, but other QoL parameters remained significantly different between both groups. Regarding EF, there was a significant difference between patients who underwent nerve-sparing (No. 29) and non nerve-sparing RC (No. 59) (p < 0.001).

CONCLUSIONS:
Which type of diversion is the best is still a controversial topic. Egyptian patients may prefer the continent UD to avoid the urostomy appliance and its associated daily-life constraints. Detailed patient counseling and active participation of the patient in selecting the treatment methods are important for better postoperative QoL.

Author Info:
1
Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt.
2
Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt. Electronic address: assafwat@gmail.com.
3
Department of Anesthesiology and Intensive Care, Assiut University, Assiut, Egypt.


Authors:
Abdel-Rahman KA1, Abd-Elshafy SK2, Sayed JA1.

Title:
Effect Of Two Different Doses Of Dexmedetomidine On The Incidence ‎Of Emergence Agitation After Strabismus Surgery: A Randomized ‎Clinical Trial

Abstract:
BACKGROUND AND OBJECTIVE:
Emergence agitation is a postoperative negative behavior that affects mainly children. We studied the effect of two different doses of dexmedetomidine on the incidence and degree of EA in children undergoing strabismus surgery.

METHODS:
90 patients were allocated into three equal groups; patients received 0.5μg.kg-1 of dexmedetomidine in high Dex group, 0.25μg.kg-1 of dexmedetomidine in low Dex group, or normal saline in the placebo group. All drugs were received with the closure of the conjunctiva before the end of the surgery. Pediatric Anesthesia Emergence Delirium (PAED) scale was used to evaluate the agitation, and Face, Legs, Activity, Cry, Consolability (FLACC) scale was used for pain assessment. Adverse effects of dexmedetomidine and recovery times were recorded.

RESULTS:
The incidence of agitation was significantly lower in high Dex group compared to other groups and it was significantly lower in low Dex group compared to placebo group. The median (range) of FLACC score was significantly lower in both Dex groups compared to placebo group. Recovery times; time from removal of laryngeal mask to eye opening and time stay in post anesthesia care unit was significantly longer in high Dex group compared to other groups. No significant bradycardia or hypotension was recorded. Recovery time was significantly longer in high Dex group compared to the other two groups.

CONCLUSION:
Dexmedetomidine (0.5μg.kg-1) before emergence from general anesthesia resulted in a reduction in the incidence of emergence agitation compared to a dexmedetomidine (0.25μg.kg-1) but on the expense of recovery times without adverse effects.

Author Info:
1
Assiut University, College of Medicine, Assiut, Egito.
2
Assiut University, College of Medicine, Assiut, Egito. Electronic address: sayed_k_72@yahoo.com.


Authors:
Abdelazeem K1,2, Sharaf M1,2, Saleh MGA1,2, Fathalla AM1,2, Soliman W1,2.

Title:
Relevance of Swept-Source Anterior Segment Optical Coherence ‎Tomography for Corneal Imaging in Patients With Flap-Related ‎Complications After LASIK‎

Abstract:
PURPOSE:
To evaluate the role of swept-source anterior segment optical coherence tomography (AS-OCT) in the diagnosis and management of laser in situ keratomileusis (LASIK) flap-related complications.

METHODS:
This prospective study included 25 eyes with LASIK flap-related complications imaged using swept-source AS-OCT between February and August 2016 at Alforsan Eye Centre, Assiut, Egypt. The images were acquired using a 6-mm line scan.

RESULTS:
Imaging of flap-related LASIK complications using AS-OCT revealed specific and nonspecific findings. Of note, epithelial ingrowth appeared as highly reflective lesions below the LASIK flap in the form of islands, nests, or a continuous sheet with or without changes in the overlying flap. Macrostriae manifested as dome-shaped irregularities on the stromal surface with regular overlying epithelium, whereas microstriae appeared as corrugations on the stromal surface with regular overlying epithelium. Less common complications included multiple flap macrostriae accompanied by a traumatic folded flap with a flap edge at the interface. Interface debris appeared as a highly reflective interface lesion with or without a surrounding reaction. One eye with a flap that was torn and lost intraoperatively showed epithelialization over a thin residual stroma underlying a contact lens with no stromal infiltration on the second postoperative day. AS-OCT was useful for the assessment of flap thickness and planning of the new flap thickness in the event of an incomplete cut.

CONCLUSIONS:
Swept-source AS-OCT is useful not only for diagnosis but also for management of eyes with LASIK flap-related complications by allowing noninvasive, noncontact, real-time acquisition of cross-sectional AS images.

Author Info:
1
Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
LASIK Unit, Alforsan Eye Center, Assiut, Egypt.


Authors:
Ahmed AT1,2, Abdel-Rahman O3,4, Morsy M5,6, Mustafa K7, Testini P8, Aleem IS9, Murad MH1,10, Nassr A11.

Title:
Management of Sacrococcygeal Chordoma: A Systematic Review and ‎Meta-analysis of Observational Studies

Abstract:
STUDY DESIGN:
Systematic review and meta-analysis of observational studies.

OBJECTIVE:
The aim of the study is to evaluate different treatment modalities in the management of sacrococcygeal chordoma.

SUMMARY OF BACKGROUND DATA:
Chordomas are primary malignant bone tumors associated with considerable morbidity and mortality.

METHODS:
We searched MEDLINE, EMBASE, Cochrane Central-Register of Controlled Trials, and Scopus from inception to July 2015. Eligible studies included patients with sacrococcygeal chordoma treated exclusively with surgery, radiotherapy, or both. Two reviewers independently assessed the eligibility of potential studies, risk of bias, and extracted data. Outcomes of interest were all-cause mortality, progression-free survival, and metastases. We analyzed further surgical outcomes by resection margin. All outcomes were assessed at 60 months and more than 60 months following intervention.

RESULTS:
We included 33 noncomparative studies reporting on 501 patients (mean age 57 years). Overall mortality rate was (16%) after surgical resection with adjuvant radiotherapy and (28%) after surgical resection, and (43%) after radiotherapy (P = 0.28). All-cause mortality following wide surgical resection was (32%) compared to (40%) after marginal resection (P = 0.51). Overall progression-free survival rate was (58%) after surgical resection with adjuvant radiotherapy and (55%) after surgery (P = 0.92). However, at more than 60 months follow-up, progression-free survival rates were significantly higher (P = 0.024) following surgical resection with adjuvant radiotherapy (74%) in comparison to surgery (55%) and radiotherapy (36%). Overall progression-free survival rates were nonsignificantly higher after wide surgical resection (66%) than marginal resection (33%) (P = 0.16). However, at 60 months follow-up, progression-free survival rates were significantly higher following wide surgical resection (73%) than marginal resection (33%) (P = 0.047).

CONCLUSION:
Sacrococcygeal chordoma is a difficult to treat disease entity. Until comparative studies become available, wide surgical resection and multidisciplinary management are the recommended approaches to improve patient outcomes.

LEVEL OF EVIDENCE:
3.

Author Info:
1
Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
2
Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN.
3
Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
4
Department of Oncology, University of Calgary, Alberta, Canada.
5
Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.
6
Department of Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt.
7
Department of Orthopedic Surgery.
8
Department of Neurological Surgery, Mayo Clinic, Rochester, MN.
9
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
10
Mayo Clinic College of Medicine, Rochester, MN.
11
Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN.


Authors:
Alanwar A1, Abbas AM2, Hussain SH1, Elhawwary G1, Mansour DY1, Faisal MM1, Elshabrawy A1, Eltaieb E1.

Title:
Oral Micronised Flavonoids Versus Tranexamic Acid For Treatment Of ‎Heavy Menstrual Bleeding Secondary To Copper IUD Use: A ‎Randomised Double-Blind Clinical Trial

Abstract:
OBJECTIVE:
The aim of the study was to compare the efficacy of micronised flavonoids versus tranexamic acid in reducing menstrual blood loss (MBL) associated with the use of the TCu 380A intrauterine contraceptive device (IUD) in women with heavy menstrual bleeding (HMB).

METHODS:
We conducted a randomised double-blind clinical trial between October 2016 and August 2017 in 100 women with HMB (defined as a pictorial blood assessment chart [PBAC] score >100) secondary to IUD use. After assessment of MBL using PBAC score in a baseline cycle, participants were randomised to receive either oral tranexamic acid 500 mg or oral micronised flavonoids 500 mg every 6 h for the first three days of menstruation. PBAC scores were collected in the three subsequent treatment cycles. The primary outcome was the difference in PBAC scores between the groups. Two-way repeated measures ANOVA was used to assess the primary outcome of the change in PBAC scores.

RESULTS:
Mean PBAC scores were significantly improved in the tranexamic acid group compared with the micronised flavonoids group (236 ± 48, 105 ± 26, 97 ± 16 and 93 ± 15 at the baseline, first, second and third study cycle, respectively, versus 227 ± 52, 139 ± 29, 128 ± 25 and 125 ± 24 in the micronised flavonoids group; p = .01). Moreover, the number of bleeding days and number of pads used were significantly reduced in the tranexamic acid group compared with the micronised flavonoids group (p = .009 and p = .03, respectively). Side effects were comparable between the two groups.

CONCLUSION:
Oral tranexamic acid compared with oral micronised flavonoids is more effective in reducing HMB associated with copper IUD use. Treating IUD-induced HMB using tranexamic acid was more effective compared with micronised flavonoids in decreasing MBL volume and the number of bleeding days.

Author Info:
1
a Department of Obstetrics and Gynaecology, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
2
b Department of Obstetrics and Gynaecology, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Borguet YP1, Khan S1, Noel A1, Gunsten SP2, Brody SL2,3, Elsabahy M1,4, Wooley KL1.

Title:
Development of Fully Degradable Phosphonium-Functionalized Amphiphilic Diblock Copolymers for Nucleic Acids Delivery

Abstract:
To expand the range of functional polymer materials to include fully hydrolytically degradable systems that bear bioinspired phosphorus-containing linkages both along the backbone and as cationic side chain moieties for packaging and delivery of nucleic acids, phosphonium-functionalized polyphosphoester- block-poly(l-lactide) copolymers of various compositions were synthesized, fully characterized, and their self-assembly into nanoparticles were studied. First, an alkyne-functionalized polyphosphoester- block-poly(l-lactide) copolymer was synthesized via a one pot sequential ring opening polymerization of an alkyne-functionalized phospholane monomer, followed by the addition of l-lactide to grow the second block. Second, the alkynyl side groups of the polyphosphoester block were functionalized via photoinitiated thiol-yne radical addition of a phosphonium-functionalized free thiol. The polymers of varying phosphonium substitution degrees were self-assembled in aqueous buffers to afford formation of well-defined core-shell assemblies with an average size ranging between 30 and 50 nm, as determined by dynamic light scattering. Intracellular delivery of the nanoparticles and their effects on cell viability and capability at enhancing transfection efficiency of nucleic acids (e.g., siRNA) were investigated. Cell viability assays demonstrated limited toxicity of the assembly to RAW 264.7 mouse macrophages, except at high polymer concentrations, where the polymer of high degree of phosphonium functionalization induced relatively higher cytotoxicity. Transfection efficiency was strongly affected by the phosphonium-to-phosphate (P+/P-) ratios of the polymers and siRNA, respectively. The AllStars Hs Cell Death siRNA complexed to the various copolymers at a P+/P- ratio of 10:1 induced comparable cell death to Lipofectamine. These fully degradable nanoparticles might provide biocompatible nanocarriers for therapeutic nucleic acid delivery.

Author Info:
1
Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, and the Laboratory for Synthetic-Biologic Interactions , Texas A&M University , College Station , Texas 77842 , United States.
2
Department of Medicine , Washington University , St. Louis , Missouri 63110 , United States.
3
Department of Radiology , Washington University , St. Louis , Missouri 63110 , United States.
4
Department of Pharmaceutics, Faculty of Pharmacy, Assiut International Center of Nanomedicine, Alrajhy Liver Hospital , Assiut University , Assiut 71515 , Egypt.


Authors:
Badary TM1, ElBadawy O1, Agban MN1, Kamel S2, Sadek A1.

Title:
Evaluation of Serum IFN- and IL-5 Levels in Response to Entecavir Therapy in Patients with Chronic Hepatitis B Virus Infection

Abstract:
Current treatment guidelines recommend the use of entecavir (ETV) as a first-line therapy for chronic HBV infection. Still little is known about its role in restoration of the exhausted HBV immune response. The aim of our study was to assess HBeAg serologic response and serum levels of IFN-γ and IL-5 before and after one year treatment with ETV in chronic hepatitis B patients (CHB) in a trial to find possible predictors for response to ETV treatment in those patients (hepatits B viral clearance and HBeAg seroconversion). The study included 30 chronic hepatitis B patients. All patients received de novo entecavir monotherapy at a daily dose of 0.5 mg for 1 year. Virologic [HBV DNA load, HBV markers (HBsAg, HBeAg, HBeAb)], Biochemical (AST and ALT) and immunological (serum IFN- and IL-5) assessments were done for all patients before and a year after treatment in comparison with healthy controls. Levels of AST and ALT were significantly reduced in all treated patients and normalized in 15. HBeAg seroconversion was achieved in 17 patients, HBV DNA was markedly decreased in all patients and not detectable in 10 of them. IFN-  level increased and IL-5 levels decreased markedly reaching normal levels. Significant relations were detected between HBV DNA, IL-5, HBeAg seroconversion and virologic response (VR) to ETV. ROC curve analysis have shown good prognostic accuracy for both pretreatment HBV DNA and IL5 levels in predicting VR and HBeAg seroconversion after ETV therapy in CHB patients, with pretreatment HBV DNA having somewhat better accuracy and higher propability for the test being correct in predicting loss of HBeAg after treatment. In conclusions, ETV markedly reduced HBV DNA and ALT levels, restored IFN- and IL-5 normal levels and HBeAg seroconversion was achieved in some patients. Both pretreatment levels of HBV DNA and IL5 can be used in predicting VR to ETV but HBV DNA is superior in predicting HBV seroconversion in HBeAg positive patients.

Author Info:
1
Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Tropical Medicine & Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
D'Ascenzo F1, Grosso A2, Abu-Assi E3, Kinnaird T4, Ariza-Solé A5, Manzano-Fernández S6, Templin C7, Velicki L8, Xanthopoulou I9, Cerrato E10, Rognoni A11, Boccuzzi G12, Omedè P2, Montabone A12, Taha S13, Durante A14, Gili S7, Ali HH10, Magnani G7, Autelli M2, Blanco PF6, Garay A5, Quadri G10, Marra WG2, Varbella F10, Queija BC3, Paz RC3, Fernández MC3, Pousa IM3, Gallo D15, Morbiducci U15, Dominguez-Rodriguez A16, Valdés M6, Cequier A5, Alexopoulos D9, Iñiguez-Romo A3, Gaita F2, Raposeiras-Roubin S3.

Title:
Incidence and predictors of bleeding in ACS patients treated with PCI ‎and prasugrel or ticagrelor: An analysis from the RENAMI registry‎

Abstract:
OBJECTIVES:
To evaluate "real life" incidence and independent predictors of major bleeding defined in ACS patients treated with PCI and current standard antithrombotic therapy with prasugrel or ticagrelor.

METHODS AND RESULTS:
The RENAMI project is a multicenter retrospective observational registry enrolling 4424 patients with ACS treated with PCI and prasugrel or ticagrelor plus aspirin. Primary endpoint was MACE (major adverse cardiovascular events). Secondary endpoints included each component of MACE, cardiovascular death (CV death), recurrence of ACS (reACS) and stroke. Eighty three (1.8%) patients developed out of hospital major bleedings after 14.1 ± 6.2 months. These patients had higher rates of MACE (14.5% vs 4.4%; p = 0.001) and of all-cause death (11% vs 2.1%; p < 0.001). Independent predictors of major bleeding were age >75 years (OR 2.00; 95% CI 1.18-3.41; p = 0.010) and female sex (OR 1.66; 95% CI 1.02-2.70; p = 0.041). BARC 3-5 bleeding was independently associated with all-cause mortality (OR 3.46; 95% CI 1.64-7.31; p 0.001).

CONCLUSION:
In ACS patients treated with PCI and ticagrelor or prasugrel, BARC 3-5 bleedings despite being uncommon negatively impacted on prognosis. Old and female patients are at increased risk, offering clinical indications for tailoring dual antiplatelet therapy.

Author Info:
1
Department of Cardiology, Department of Medical Sciences, University of Torino, Italy. Electronic address: fabrizio.dascenzo@gmail.com.
2
Department of Cardiology, Department of Medical Sciences, University of Torino, Italy.
3
Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain.
4
Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom.
5
Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain.
6
Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain.
7
Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom.
8
Medical Faculty, University of Novi Sad, Novi Sad, Serbia and Institute of cardiovascular diseases Vojvodina, Sremska Kamenica, Serbia.
9
University Patras Hospital, Athens, Greece.
10
Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli (Torino), Italy.
11
Catheterization Laboratory, Maggiore della Carità Hospital, Novara, Italy.
12
Department of Cardiology, S.G. Bosco Hospital, Torino, Italy.
13
Department of Cardiology, Faculty of Medicine, Assiut University, Egypt.
14
U.O. Cardiologia, Ospedale Valduce, Como, Italy.
15
PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy.
16
Department of Cardiology, University Hospital from Canarias, Tenerife, Spain.


Authors:
Dolatshad H1, Tatwavedi D1, Ahmed D2, Tegethoff JF1, Boultwood J1, Pellagatti A3.

Title:
Application Of Induced Pluripotent Stem Cell Technology For The ‎Investigation Of Hematological Disorders

Abstract:
Induced pluripotent stem cells (iPSCs) were first described over a decade ago and are currently used in various basic biology and clinical research fields. Recent advances in the field of human iPSCs have opened the way to a better understanding of the biology of human diseases. Disease-specific iPSCs provide an unparalleled opportunity to establish novel human cell-based disease models, with the potential to enhance our understanding of the molecular mechanisms underlying human malignancies, and to accelerate the identification of effective new drugs. When combined with genome editing technologies, iPSCs represent a new approach to study single or multiple disease-causing mutations and model specific diseases in vitro. In addition, genetically corrected patient-specific iPSCs could potentially be used for stem cell based therapy. Furthermore, the reprogrammed cells share patient-specific genetic background, offering a new platform to develop personalized therapy/medicine for patients. In this review we discuss the recent advances in iPSC research technology and their potential applications in hematological diseases. Somatic cell reprogramming has presented new routes for generating patient-derived iPSCs, which can be differentiated to hematopoietic stem cells and the various downstream hematopoietic lineages. iPSC technology shows promise in the modeling of both inherited and acquired hematological disorders. A direct reprogramming and differentiation strategy is able to recapitulate hematological disorder progression and capture the earliest molecular alterations that underlie the initiation of hematological malignancies.

Author Info:
1
Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, and Oxford BRC Haematology Theme, Oxford, UK.
2
Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, and Oxford BRC Haematology Theme, Oxford, UK; Clinical Pathology Department, Assiut University Hospitals, Faculty of Medicine, Assiut, Egypt.
3
Bloodwise Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, and Oxford BRC Haematology Theme, Oxford, UK. Electronic address: andrea.pellagatti@ndcls.ox.ac.uk.


Authors:
El-Deeb TS1, Bakkar SM1, Eltoony L2, Zakhary MM1, Kamel AA1, Nafee AM3, Hetta HF3.

Title:
The adipokine Chemerin and Fetuin-A Serum Levels in Type 2 ‎Diabetes Mellitus: Relation to Obesity and Inflammatory Markers‎

Abstract:
Chemerin and fetuin-A are recently discovered as metabolic regulator hormone in obesity and type 2 diabetes mellitus. However, elevated levels of chemerin and fetuin-A have been associated with insulin resistance and systemic inflammation. The present study aimed to investigate the significance of serum chemerin and fetuin-A levels in obese diabetic patients. Also, to determine whether, chemerin and fetuin-A along with markers of inflammation (IL6 and CRP) and obesity-related parameters in T2DM patients. Serum levels of chemerin and fetuin-A were evaluated using ELISA in 71 T2DM patients and 14 apparently healthy controls. Both groups were subdivided into obese and lean. Serum chemerin and fetuin-A levels were significantly higher in T2DM patients compared to controls (P < 0.001, for both) and significantly higher in obese T2DM in comparison to obese control group (P < 0.01 & P < 0.05, respectively). Serum chemerin and fetuin-A levels correlated positively with HbA1c, HOMA-IR, FBG, IL6 and CRP. In obese patients, serum chemerin and fetuin-A levels correlated positively with BMI and waist circumference. In conclusion, the strong association of chemerin and fetuin-A with insulin resistance and some inflammatory markers may provide an interesting link between obesity, inflammation and diabetes mellitus in human.

Author Info:
1
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
El-Sharkawy M1, Samy A1, Latif D1, Mahmoud M1, Samir D1, Abbas AM2.

Title:
The Effect Of Mechanical Cervical Dilatation During Scheduled ‎Cesarean Section On The Blood Loss: A Randomized Controlled Trial

Abstract:
OBJECTIVE:
This study evaluates the effects of mechanical cervical dilatation during scheduled cesarean section (CS) on intra- and postoperative blood loss.

METHODS:
A single-center randomized double-blind controlled trial ( NCT03444792 ) conducted at a tertiary University Hospital in the period between 1 April 2017 and 31 March 2018 included all women scheduled for scheduled CS under spinal anesthesia if they met our inclusion criteria. Eligible participants were randomized to one of two groups. Group (I): Women with intraoperative cervical dilatation and Group (II): women with no intraoperative cervical dilatation. The primary outcome of this study was the mean volume of total blood loss during CS. The secondary outcomes included the mean reduction in the hemoglobin and hematocrit, the rate of primary postpartum hemorrhage, the duration of surgery, the duration of hospital stay, the rate of wound infection and endometritis.

RESULTS:
No statistical significant difference between both study groups regarding the baseline characteristics. No significant difference in the intraoperative blood loss between both groups (p = 0.21), however there was significantly more postoperative blood loss in group II (p = 0.001). The total blood loss was significantly higher in group II (912.6 ± 242.1 versus 845.8 ± 188.9 mL) in group I (p = 0.029). There were significantly lower postoperative hemoglobin and haematocrit levels in group II (p = 0.014 and 0.033 respectively). The mean duration of CS was significantly shorter in the cervical dilatation group (p = 0.002). No difference between both groups regarding the rate of postpartum hemorrhage (PPH) (p = 0.21), the duration of hospital stay (p = 0.17), the rate of wound infection (p = 0.32), the rate of endometritis (p = 0.82).

CONCLUSIONS:
Mechanical cervical dilatation during scheduled CS could be associated with lower postoperative blood loss, higher postoperative hemoglobin & hematocrit levels and shorter duration of CS.

Author Info:
1
a Department of Obstetrics & Gynecology , Faculty of Medicine , Cairo University , Cairo , Egypt.
2
b Department of Obstetrics & Gynecology , Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
El-Sherbiny YM1,2,3, Psarras A1,3, Md Yusof MY1,3, Hensor EMA1,3, Tooze R4, Doody G4, Mohamed AAA1,5,3, McGonagle D1,3, Wittmann M1,3, Emery P1,3, Vital EM6,7.

Title:
Publisher Correction: A Novel Two-Score System For Interferon ‎Status Segregates Autoimmune Diseases And Correlates With Clinical ‎Features

Abstract:
A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Erratum for
A novel two-score system for interferon status segregates autoimmune diseases and correlates with clinical features. [Sci Rep. 2018]


Authors:
Farghaly WM1, Ahmed MA1, El-Tallawy HN1, Elmestikawy TA2, Badry R1, Farghaly MS3, Omar MS3, Hussein ASR4, Salamah M5, Mohammed AT1.

Title:
Construction Of An Arabic Computerized Battery For Cognitive ‎Rehabilitation Of Children With Specific Learning Disabilities

Abstract:
PURPOSE:
The aim of this study was to design an Arabic computerized battery of cognitive skills for training children with specific learning disabilities (SLD).

SUBJECTS AND METHODS:
Nineteen students from fourth grade primary schools in Assiut, Egypt, who were previously diagnosed with SLD, agreed to participate in the rehabilitation program. The study passed through four stages: first stage, detailed analysis of the cognitive profile of students with SLD (n=19), using a previously constructed diagnostic cognitive skill battery, to identify deficits in their cognitive skills; second stage, construction of an Arabic computerized battery for cognitive training of students with SLD; third stage, implementation of the constructed training program for the students, each tailored according to his/her previously diagnosed cognitive skill deficit/deficits; and fourth stage, post-training re-evaluation of academic achievement and cognitive skills' performance.

RESULTS:
Students with SLD have a wide range of cognitive skill deficits, which are more frequent in auditory cognitive skills (68.4%) than in visual cognitive skills (64.1%), particularly in phonological awareness and auditory sequential memory (78.9%). Following implementation of the training program, there was a statistically significant increase (P<0.001) in the mean scores of total auditory and visual cognitive skills, as well as in academic achievement (P<0.001) of the study group.

CONCLUSION:
Remediation-oriented diagnosis of cognitive skills, when tailored according to previously diagnosed cognitive deficits, leads to the improvement in learning abilities and academic achievement of students with SLD.

Author Info:
1
Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Psychology, Faculty of Arts, Assiut University, Assiut, Egypt.
3
Department of Educational Psychology, Faculty of Education, Assiut University, Assiut, Egypt.
4
Department of Hearing Disability, Faculty of Sciences of Special Needs, Beni-Suef University, Beni-Suef, Egypt, amr.sayed_ssn@bsu.edu.eg.
5
Department of Phoniatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Gamal RM1, Hammam N2,3, Zakary MM4, Abdelaziz MM2, Razek MRA2, Mohamed MSE5, Emad Y6, Elnaggar MG7, Furst DE8,9,10.

Title:
Telomere Dysfunction-Related Serological Markers And Oxidative ‎Stress Markers In Rheumatoid Arthritis Patients: Correlation With ‎Diseases Activity

Abstract:
Rheumatoid arthritis (RA) is an inflammatory autoimmune polyarthritis with progressive destruction of the synovial joints associated with systemic manifestations. RA is characterized by infiltration of the synovial joints with inflammatory immune cells with premature immunosenescence. Shorter telomere length in the peripheral blood cells and increase in the oxidative stress have been detected in patients with RA. The aim of the present study was to study the association of markers of telomere shortening and oxidative stress with RA disease activity. Sixty-one RA patients and 15 healthy controls were enrolled in the study. Demographic data, clinical examination, and disease activity status were evaluated for the RA patients. Serum levels of chitinase and NAG (telomere markers) were determined by biochemical reactions using colloidal chitin and NAG as substrates, respectively. Nitric oxide and superoxide dismutase (oxidative stress markers) were determined colometrically and spectrophotometrically, respectively, in the sera of RA patients and controls. Results were correlated with disease activity. Indices of telomere shortening and oxidative markers were significantly higher in RA patients compared to controls. These indices were correlated with signs of disease activity (including number of swollen and tender joints, DAS-28, and inflammatory markers). Rheumatoid arthritis is a disease in which markers of telomere shortening and elevated oxidant stress correlate with disease activity.

Author Info:
1
Rheumatology and Rehabilitation Department, Assiut University Hospitals, Faculty of Medicine, Assiut, Egypt. drraniami@gmail.com.
2
Rheumatology and Rehabilitation Department, Assiut University Hospitals, Faculty of Medicine, Assiut, Egypt.
3
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
4
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
6
Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University Hospital, Cairo, Egypt.
7
Clinical pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
8
Department of Medicine, Division of Rheumatology, University of California in Los Angeles (emeritus), Los Angeles, CA, USA.
9
Department of Rheumatology, Division of Rheumatology, University of Washington, Seattle, WA, USA.
10
Division of Rheumatology and Experimental Medicine, University of Florence, Florence, Italy.


Authors:
Gomaa AA1, El-Sers DA2, Al-Zokeim NI1, Gomaa MA3.

Title:
Amelioration Of Experimental Metabolic Syndrome Induced In Rats ‎By Orlistat And Corchorus Olitorius Leaf Extract; Role Of ‎Adipo/Cytokines

Abstract:
OBJECTIVES:
To determine the efficacy of Corchorus olitorius (C. olitorius) leaf extract in the prevention of metabolic syndrome induced in rats by high-fat diet (HFD) and compare it with that of orlistat.

METHODS:
Phytochemical analysis was performed. Effect of orlistat and C. olitorius extract on lipase activity and acute food intake were investigated. Body weight, biochemical parameters and histopathological examination were demonstrated.

KEY FINDINGS:
Corchorus olitorius extract inhibited the pancreatic lipase activity, but orlistat was more potent. Cumulative food intake has not changed by the tested agents. In obese rats, C. olitorius or orlistat significantly decreased weight gain and visceral white adipose tissue. They exhibited a significant reduction in serum glucose, total cholesterol, triglycerides, low density lipoprotein cholesterol, free fatty acids, IL-1β, tumour necrosis factor-α (TNF-α), insulin and leptin levels of obese rat groups while high density lipoprotein cholesterol and adiponectin levels were significantly increased by them. Histopathological examination of the liver revealed that C. olitorius was more effective than orlistat in the alleviating of steatosis and adipocyte hypertrophy shown in obese control rats.

CONCLUSIONS:
Corchorus olitorius is effective as orlistat in preventing obesity, hyperlipidaemia, steatosis and insulin resistance. These actions may be mediated by inhibiting of lipase activity, TNF-α, IL-1β and leptin resistance along with increasing of adiponectin.

Author Info:
1
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Plastic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Hamza WS1,2, Salama MF1,3, Morsi SS1,4, Abdo NM1,5, Al-Fadhli MA1.

Title:
Benchmarking For Surgical Site Infections Among Gastrointestinal ‎Surgeries And Related Risk Factors: Multicenter Study In Kuwait‎

Abstract:
PURPOSE:
To measure surgical site infection (SSI) rates among gastrointestinal surgeries and to identify the associated risk factors.

PATIENTS AND METHODS:
We conducted a multicenter, retrospective, surveillance-based study of adults undergoing gastric, colon, and small bowel (SB) procedures from January to December 2016. Univariate and multivariate analyses were conducted to determine the predictive variables in each surgery.

RESULTS:
In total, 71 of 2,099 patients developed SSI - 0.8%, 19.8%, and 10.8% following gastric, colon, and SB surgeries, respectively. In gastric surgery, the risk factors identified by univariate analysis were age, duration, wound class, risk index, emergency, and scope use (P<0.05). Logistic regression analysis revealed that the laparoscopic approach was the only significant predictor, with an inverse relationship of SSI rate vs open gastric surgery (P<0.05). Prolonged duration was a significant risk factor for developing SSI in colon surgery, and emergency was a significant risk for development of SSI in SB surgery. Gram-negative bacilli were the main causative pathogens, with a high percentage of multidrug-resistant organisms.

CONCLUSION:
Variances in SSI rates and risk factors among gastric, colon, and SB surgery were detected. The use of an endoscope in gastric surgeries exhibited a protective effect against the development of SSI. The reduction of the SSI rate can be achieved by targeted preventive interventions for the identified risk factors

Author Info:
1
Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait, wafaa95@gmail.com.
2
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt, wafaa95@gmail.com.
3
Department of Microbiology and Medical Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
4
Department of Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
5
Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt.


Authors:
Hanna RS1, Essa AA2, Makhlouf GA1, Helmy AA1.

Title:
Comparative Study Between Laparoscopic and Open Techniques for ‎Insertion of Ventriculperitoneal Shunt for Treatment of Congenital ‎Hydrocephalus‎

Abstract:
INTRODUCTION:
Different methods and devices have been developed to regulate cerebrospinal fluid flow for the treatment of congenital hydrocephalus (HC). In addition, progress in shape and materials of catheters and also valves has been achieved. Although many studies in literature have evaluated the benefits of a laparoscopic approach, few researches have compared the two techniques used for the insertion of the ventriculoperitoneal shunt (VPS).

AIM:
The aim of this study was to compare laparoscopically assisted VPS (LVPS) with open VPS and to evaluate the benefits of LVPS.

PATIENTS AND METHODS:
This cross-sectional analytic study was conducted on 192 children undergoing either laparoscopic or open placement of VPSs for congenital HC over 1-year period. Insertion of the proximal tube and reservoir were performed and the distal tube was then passed into the peritoneal cavity, either conventionally or laparoscopically assisted.

RESULTS:
Mean operative time was 50.1 minutes (28.0-121.8 minutes) in the laparoscopic group versus 74.0 minutes (39.0-162.0 minutes) in the open group (P < .05). Duration of hospital stay was the same (P = .938). The percentage of shunt failure during the follow-up period was 10% in the laparoscopic group and 17% in the open group (P = .623). Shunts were working in 85% at 6 months and 78.5% at 1 year.

CONCLUSION:
The laparoscopically assisted placement of VPS in children is safe, effective, associated with lower rates of abdominal malposition of the distal catheter, and a technically easy approach. It is an alternative method that may improve and simplify the safety of VPS surgery

Author Info:
1
1 General Surgery Department, Faculty of Medicine, Assiut University , Assiut, Egypt .
2
2 Neurosurgery Department, Faculty of Medicine, Assiut University , Assiut, Egypt .


Authors:
Hegab AE1, Ozaki M2, Meligy FY3, Kagawa S2, Ishii M2, Betsuyaku T2.

Title:
High Fat Diet Activates Adult Mouse Lung Stem Cells And Accelerates ‎Several Aging-Induced Effects

Abstract:
High fat diet (HFD) decreases the lifespan of mice, and is a risk factor for several human diseases. Here, we investigated the effects of a HFD on lung epithelial and stem cells and its interaction with aging. Young and old mice were fed with either a standard diet (SD) or a HFD then their trachea and lung were examined for histological changes, inflammation, and mitochondrial function. Their stem cell function was examined using the in vitro organoid/colony forming efficiency (CFE) assay. Aging reduced the number of tracheal basal and alveolar type-2 (AT2) cells. HFD significantly increased the number of AT2 cells. Aging also caused a significant increase in lung inflammation, and HFD caused a similar increase, in young mice. Aging reduced mitochondrial mass and function, and increased reactive oxygen species. In young mice, HFD caused mitochondrial changes similar to the aging-induced changes. Organoid culture of tracheal and lung epithelial cells collected from both young and old HFD-fed mice showed higher CFE compared to SD-fed mice. Switching the HFD to low calorie/fat diet (LCD) efficiently reversed several of the HFD-induced effects. Thus, HFD induces several histological, inflammatory, and functional changes in the lung, and exacerbates the aging-induced lung inflammation and mitochondrial deterioration. LCD can reverse many of the HFD-induced effects.

Author Info:
1
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan. Electronic address: ahegab@a2.keio.jp.
2
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
3
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Histology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
Comparison Of Intraperitoneal Versus Intravenous Dexamethasone ‎On Postoperative Nausea And Vomiting After Gynecological ‎Laparoscopy: A Randomized Clinical Trial

Abstract:
BACKGROUND:
The aim of the study was to compare the effect of intraperitoneal versus intravenous dexamethasone for the reduction of postoperative nausea and vomiting (PONV) after gynecological laparoscopic surgeries.

METHODS:
Eighty adult female patients, American Society of Anesthesiologists physical status I-II, scheduled for gynecological laparoscopic surgery were randomized to receive 8 mg dexamethasone intravenously (IV) (n = 40) or intraperitoneally (IP) (n = 40). The primary outcome was the incidence of PONV during the first 24 h following laparoscopy. Secondary outcomes included visual analogue scale (VAS) pain scores, total consumption of rescue analgesic during the first postoperative 24 h, the need for rescue antiemetic drugs and the incidence of pssible complications that may accompany medications.

RESULTS:
Eleven women (27.5%) in the IV group had nausea versus only 3 (7.5%) women in the IP group during 24 h post laparoscopy (p = 0.03). However, 5 patients (12.5%) in the IV group experienced vomiting versus only 2 patients (5%) in the IP group (p = 0.42). No statistical differences in the severity of nausea or the need for rescue antiemetics between both groups. IP group had lower rate of side effects versus IV group (7.5% vs. 27.5%, p = 0.03). The most common side effects in the IV dexamethasone group were headache and dizziness. No significant differences between both groups in the mean VAS of pain and total meperidine consumption during the first 24 h postoperatively.

CONCLUSIONS:
Intraperitoneal dexamethasone in a dose of 8 mg at the end of gynecological laparoscopy reduces the incidence of postoperative nausea.

Author Info:
1
Department of Anesthesia & ICU, Faculty of Medicine, Assiut University, Egypt.
2
Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Egypt.


Authors:
Johnson DH1, Zobniw CM2, Trinh VA2, Ma J3, Bassett RL Jr3, Abdel-Wahab N1,2, Anderson J2, Davis JE4, Joseph J2, Uemura M1, Noman A5, Abu-Sbeih H5, Yee C1, Amaria R1, Patel S1, Tawbi H1, Glitza IC1, Davies MA1, Wong MK1, Woodman S1, Hwu WJ1, Hwu P1, Wang Y5, Diab A6.

Title:
Infliximab Associated With Faster Symptom Resolution Compared ‎With Corticosteroids Alone For The Management Of Immune-Related ‎Enterocolitis

Abstract:
BACKGROUND:
Immune-related enterocolitis (irEC) is the most common serious complication from checkpoint inhibitors (CPIs). The current front-line treatment for irEC, high-dose corticosteroids (CS), have significant side effects and prolonged therapy may reduce CPI-anti-tumor activity. Early addition of TNF-α inhibitors such as infliximab (IFX) may expedite symptom resolution and shorten CS duration. Thus, we conducted the first retrospective study, to our knowledge, evaluating symptom resolution in patients with irEC treated with and without IFX.

METHODS:
Data were collected from the medical records of patients diagnosed with irEC. The primary endpoint was time to symptom resolution for irEC for cases managed with IFX plus CS (IFX group) versus CS alone (CS group). Duration of CS, overall survival (OS), and time to treatment failure (TTF) were secondary endpoints.

RESULTS:
Among 75 patients with irEC, 52% received CS alone, and 48% received IFX. Despite higher grade colitis in the IFX group (grade 3/4: 86% vs. 34%; p < 0.001), median times to diarrhea resolution (3 vs. 9 days; p < 0.001) and to steroid titration (4 vs. 13 days; p < 0.001) were shorter in the IFX group than in the CS group without a negative impact on TTF or OS. Total steroid duration (median 35 vs. 51 days; p = 0.150) was numerically lower in the IFX group.

CONCLUSIONS:
Despite higher incidence of grade 3/4 colitis, IFX added to CS for the treatment of patients with irEC was associated with a significantly shorter time to symptom resolution. The data suggest that early introduction of IFX should be considered for patients with irEC until definitive prospective clinical trials are conducted.

Author Info:
1
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
2
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.
3
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
4
Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
5
Department of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
6
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. adiab@mdanderson.org.


Authors:
Kadar A1,2, Kleinstern G3, Morsy M1,4, Soreide E1, Moran SL1.

Title:
Multiple Enchondromas of the Hand in Children: Long-Term Follow-Up ‎of Mean 15.4 Years‎

Abstract:
BACKGROUND:
Multiple enchodromatosis of bone, termed Ollier's disease, or Maffucci syndrome when associated with hemangiomas, is a rare disease that can affect the pediatric hand. This condition often causes a finger mass, deformity, pain and possible pathologic fractures, and has been associated with malignant transformation to chondrosarcoma. The aim of our study is to describe the long-term sequela of multiple enchondromatosis of the hand in the pediatric population, specifically the rates of malignant transformation, tumor recurrence, rates of pathologic fracture, and phalangeal growth arrest.

METHODS:
We examined 15 pediatric patients who were treated in our institute with a total of 127 phalanges and metacarpals lesions. Only patients with follow-up of at least 4 years were included. We retrospectively reviewed patients' chart and hand radiograph for symptoms including pathologic fractures, indications for surgery, and postoperative complications including tumor recurrence, and malignant transformation. We assessed phalangeal growth arrest with radiographs and normalized phalangeal growth charts.

RESULTS:
Mean age of diagnosis was 5.8 years and mean follow-up time was 15.4 years. Pathologic fractures were common at 46% of pediatric patients, but ceased to occur once reaching adulthood. Outcomes of pathologic fractures were excellent, regardless of treatment. Malignant transformation occurred in 1 patient and did not occur during childhood. A total of 80% of patients and 29% of lesions underwent surgical treatment of curettage and bone graft for the lesion, yet recurrence was common and affected 33% of treated patients. Phalangeal growth arrest was the most common long-term sequela and affected 11% of phalanxes and metacarpals. This sequela was significantly more prevalent in patients who had surgical excision of the tumor.

CONCLUSIONS:
Our findings reassure that malignant transformation of enchodromatosis of the hand is unlikely in the pediatric population. Pathologic fracture is common, but has excellent outcomes. When considering surgery, parents should be counseled about the possibility of phalangeal growth arrest and recurrence of the lesion.

TYPE OF STUDY/LEVEL OF EVIDENCE:
Level IV-therapeutic.

Author Info:
1
Department of Plastic Surgery.
2
Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
3
Health Sciences Research, Mayo Clinic, Rochester, MN.
4
Department of Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt.


Authors:
Kadhim M1, Oyoun NA2, Womer RB3, Dormans JP4.

Title:
Clinical And Radiographic Presentation Of Pelvic Sarcoma In Children

Abstract:
INTRODUCTION:
Pelvic sarcomas may present with vague symptoms. The aim of this study was to examine the characteristics and clinical presentations of different types of pelvic sarcoma in children.

METHODS:
This is a retrospective cohort study of patients up to 21 years of age with the diagnosis of pelvic sarcoma between January 2000 and June 2013. Data on demographics, tumor type and location, and clinical presentation were collected from the medical records.

RESULTS:
A total of 59 patients [37 males (62.7%) and 22 females (37.3%)] were examined in this study. Mean age at presentation was 11.3 ± 5 years (range 0.8-21 years). Thirty-six patients had Ewing sarcoma (61%), 9 osteosarcoma (6.8%), 4 undifferentiated sarcoma (6.8%), 2 (3.4%) rhabdomyosarcoma, 2 synovial cell sarcoma, and one (1.7%) of each fibrosarcoma, dermatofibrosarcoma, fibromyxoid sarcoma, chondrosarcoma, chordoma, and epithelioid sarcoma. Pain at presentation was reported in 41 patients, 13 mass, 8 limping, and 5 neurologic symptoms. Most of the bony tumors were painful (77%), while most of the soft tissue tumors were painless (70%). Nine patients presented with constitutional symptoms. Most patients presented within 4-12 months from symptoms beginning. Twenty-one patients (35.6%) presented with metastases (14 Ewing sarcoma, 6 osteosarcoma, and 1 synovial cell sarcoma). Pelvic radiographs showed lytic lesion in 11 patients, 4 sclerotic lesions, 6 mixed lesion, 6 had only soft tissue mass, 1 radiograph showed osteopenia, and 2 radiographs were reported normal.

CONCLUSION:
Ewing sarcoma was the most common pelvic sarcoma tumor in children. In most cases, pelvic sarcoma in children presented with pain mimicking other benign conditions. Some patients presented with metastatic disease with no prognostic clinical or radiographical signs or symptoms. Pelvic sarcoma should be considered a differential diagnosis as part of children work up.

Author Info:
1
Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Children's Hospital of New Orleans, New Orleans, LA 70112, USA.
2
Department of Orthopeadic Surgery, Assiut University Hospital, Assiut, Egypt.
3
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
4
Department of Orthopaedics, Indiana University School of Medicine, Indianapolis, IN 46202, USA.


Title:
Risk Factors For Diabetic Foot Ulcer Recurrence: A Prospective 2-‎Year Follow-Up Study In Egypt‎

Abstract:
OBJECTIVES:
To determine the frequency of diabetic foot ulcer recurrence and its potential risk factors.

METHODS:
This study included 93 patients with type 2 diabetes and followed for 2 years after primary healed foot ulceration. Demographic, diabetes related, comorbid and ulcer related variables were investigated as risk factors. Multiple logistic regression analysis was used to identify independent risk factors.

RESULTS:
61.3% of patients had recurrent ulcers particularly in the forefoot (33.3%) and big toe (24.6%). Peripheral neuropathy, peripheral arterial disease or both were reported in 69%, 12% and 19% of feet with recurrent ulcers respectively. In multivariate analysis, the significant independent potential risk factors for recurrence of foot ulcers were smoking (P=0.040), poor glycemic control [HbA1c cutoff of 10%] (P=0.010), peripheral neuropathy with lost ankle reflex (P=0.0001), peripheral arterial disease (P=0.0001) and previous ulcer location (P=0.050).

CONCLUSION:
The frequency rate of recurrent diabetic foot ulceration in patients with type 2 diabetes is high particularly in the first year despite regular follow-up and patient education.

Author Info:
1
Department of Internal Medicine, Endocrinology and Diabetes Unit, Assiut University, Assiut, Egypt. Electronic address: dr.walaaanwar@aun.edu.eg.


Authors:
Khalil M1, El-Badawy O2, Sharaf-Eldin A3, Sadek A2, Sabry A4.

Title:
Serum levels of Interleukins 1-Alpha & 12 as Predictors of Disease ‎Progression in Hepatitis C Diabetic Patients‎

Abstract:
This study evaluates the usefulness of interleukins 1 alpha and 12 in predicting disease progression in diabetic HCV and HCV related liver diseases compared to non-diabetics. The study included 76 hepatitis C virus-infected patients [38 diabetics, 38 none (with, without cirrhosis)]. Serum levels of IL-1α and IL-12 were measured by ELISA. Serum levels of IL-1α and IL12 were higher in cirrhotic than non -cirrhotic patients and higher in the diabetic patients. Significant correlations were detected between IL-1α, prothrombin time (PT), and severity scores in cirrhotic patients. Levels of both cytokines correlated with the fasting plasma glucose levels. Stronger correlations were evident between IL-12, PT and total bilirubin than IL-1α in diabetics. In conclusion; IL-1α and IL-12 are good markers for monitoring liver disease progression in cirrhotic and diabetic HCV patients. Whereas IL-1α is a better marker in cirrhotic patients, IL-12 is somewhat superior to IL-1α in diabetic patients.

Author Info:
1
Department of Microbiology & Immunology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
2
Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Tropical Medicine & Gastroentrology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Microbiology & Medical Immunology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
Abstract


Authors:
Khedr EM1, Al Fawal B2, Abdelwarith AM2, Saber M2, Tony AAH2, El-Bassiony A3, Rothwell JC4.

Title:
Changes In Recruitment Of Motor Cortex Excitation And Inhibition In ‎Patients With Drug-Induced Tardive Syndromes

Abstract:
OBJECTIVES:
It has recently been suggested that drug-induced tardive syndromes (TS) might be due to maladaptive plasticity, which increases motor excitability in cerebral cortex and basal ganglia. In order to test this hypothesis, we performed the first measurements of cortical excitability in TS.

METHODS:
Motor cortex excitability was examined using transcranial magnetic stimulation (TMS) in 22 TS patients and compared with that in 20 age and sex-matched healthy individuals. Resting and active motor threshold (RMT, AMT) and input-output curves (I/O curves) assessed corticospinal excitability. The duration of the contralateral silent period (cSP) at a range of stimulation intensities and ipsilateral silent period (iSP) were used as measures of inhibition.

RESULTS:
There were no significant differences in RMT and AMT between patients and controls, although the input-output curves were significantly steeper in patients. The cSP (at different stimulus intensities) and iSP were both longer in the patients compared to the control group. However, most of this difference could be accounted for by increased recruitment of motor evoked potentials (MEPs) in patients.

CONCLUSION:
TS is characterized by hyperexcitability of corticospinal output that might contribute to the lack of selectivity in muscle recruitment and contribute to excess involuntary movement. The findings are opposite to those in naturally-occurring hyperkinesia such as Sydenham's and Huntington's chorea, suggesting a fundamental difference in the pathophysiology.

Author Info:
1
Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Neuropsychiatry, Faculty of Medicine, Aswan University, Aswan, Egypt. Electronic address: emankhedr99@yahoo.com.
2
Department of Neuropsychiatry, Faculty of Medicine, Aswan University, Aswan, Egypt.
3
Department of Neuropsychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
4
Sobell Department of Motor Neuroscience and movement Disorders, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.


Authors:
Khedr EM1,2, Al Fawal B3, Abdelwarith A3, Saber M3, Rothwell JC4.

Title:
Repetitive Transcranial Magnetic Stimulation For Treatment Of ‎Tardive Syndromes: Double Randomized Clinical Trial

Abstract:
Tardive syndromes (TDS) typically manifest 3 months or later after exposure to antipsychotic drugs, and unfortunately have no satisfactory medical treatment. We explored the possibility of using therapeutic repetitive transcranial magnetic stimulation (rTMS). Twenty-six patients were allocated to receive real or sham rTMS over the hand/arm area of motor cortex (M1). Each received a daily total of 2000 rTMS pulses (20 Hz at 100% rMT: 1000 stimuli per hemisphere) for 10 consecutive days. Outcome was assessed using the Abnormal Involuntary Movement Scale (AIMS) and TMS measures of M1 excitability. Three patients in the sham group failed to complete the study. At baseline, there was no significant difference between the groups in age, sex distribution, duration of illness, AIMS score and drug treatment. rTMS improved symptoms in both groups. However, there was a greater reduction in the AIMS score of the real rTMS group compared with the sham group (real, 8.3 ± 1.7 points; sham 1.2 ± 3.3; repeated measure analysis ANOVA Time X Group interaction P = 0.001). The same trends were observed in the clinical subscales. Following treatment, MEP amplitudes at higher intensities (140, and 150%) increased more in the real treatment group than in the sham group. This is the first clinical trial study of bilateral hemispheric rTMS in patients with TDS and suggests that 20 Hz rTMS might be a feasible treatment option in patients unresponsive to "first-line" treatment. Clinical trial registration ClinicalTrials.gov Identifier: NCT03145311.

Author Info:
1
Department of Neuropsychiatry, Faculty of Medicine, Assiut University Hospital, Assiut University, Assuit, Egypt. emankhedr99@yahoo.com.
2
Department of Neuropsychiatry, Faculty of Medicine, Aswan University Hospital, Aswan University, Aswan, Egypt. emankhedr99@yahoo.com.
3
Department of Neuropsychiatry, Faculty of Medicine, Aswan University Hospital, Aswan University, Aswan, Egypt.
4
Sobell Department of Motor Neuroscience and Movement Disorders, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.


Authors:
M AB1, El-Badawy O1, Sayed DM2, Ibrahim MA1, E AM3, Seif-Eldin SS1,4, Thabit AG1.

Title:
Relation of Regulatory Foxp3+ T Cells with Helicobacter pylori and Its ‎Virulence Genes‎

Abstract:
The study aimed to assess the tangled relation between various CD25 subsets (positive, negative and high) of CD4+ FoxP3+ T cells and H. pylori including its virulence genes (CagA and VacA). Diagnosis of H. pylori and its virulence genes was based on a positive culture, histopathology and/or CLO-test and PCR. Flow cytometry was used toquantifyTregs.CD4+CD25high Foxp3+ T cells were higher in patients than controls and somewhat more in H. pylori positive than negative patients. CD4+CD25high Foxp3+ T cells secreting IL10 were lower in H. pylori positive patients.CD4+CD25-Fox3+T cells were also higher in patients than controls and more in those negative for H. pylori. Moderate negative correlation was found between the presence of CagA or VacA sm genotypes and Tregs secreting IL10. CD4+CD25- Foxp3+ T cells, especially those secreting IL10, tend to be higher in patients carrying VacA m1 allele than m2 allele. In conclusion, H. pylori stimulate a regulatory T cell response, probably contributing to gastric diseases. CD25 negative subset of Fox3+CD4+T cells needs further studying to declare its potential role in immunopathogenesis of gastric diseases. Tregs are positively associated with vacA alleles.

Author Info:
1
Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
3
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, KSA.


Authors:
Mahmoud AI1, Elsherbiny NM2, Afifi NA2, Ahmed BM1, Yasin AS1.

Title:
Occult Hepatitis B Infection Among Blood Donors in Al Azhar ‎University Hospital, Upper Egypt: The Current Status After 25 years ‎of Vaccine Introduction‎

Abstract:
Occult hepatitis B virus infection (OBI) is a challenging topic with much debate regarding its clinical and virological relevance. The reliance on anti HBc seropositivity for diagnosis of OBI is still controversial. We aimed to determine the frequency of OBI among Egyptian blood donors, the role of anti HBc and HBe Ag as predictors of OBI and the possible risk factors. A total of 300 randomly selected hepatitis B surface antigen (HBsAg) negative blood donors at the Blood Bank of Al Azhar University Hospital in Assiut were included. Measurement of liver enzymes and screening for HBV core antibodies (anti HBc) and Hepatitis e antigen (HbeAg) were done. Quantitative HBV DNA measurement was achieved by real time polymerase chain reaction with a detection limit of 20 IU/mL after DNA extraction from the peripheral blood mononuclear cells (PBMC). The prevalence of OBI was 3.7% (11/300) among the donors and the majority had low level viremia (63.6%). Anti HBc was detected in 20.7% (62/300) (group I). OBI was detected in 14.5% (9/62) in group I compared to 0.84% (2/238) in the anti-HBc Ab negative donors (group II). Anti HBc had a sensitivity and specificity of nearly 82% for detection of OBI with a high negative predictive value (99.16%). HBe Ag was detected in only 1.6% (1/62) of group I. There were no statistical significant differences regarding the liver enzymes, demographic data or risk factors between group I and II and even between cases of OBI and those without. We conclude that OBI exists in an alarming percentage among Egyptian blood donors. Anti HBc should be introduced in the routine blood screening. Negative anti HBc results ensures safe blood, while positive results need nucleic acid confirmation especially if given to high risk recipients. More in-depth evaluation of the immunization program is needed.

Author Info:
1
Department of Medical Microbiology & Immunology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
2
Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Metwalley KA1, Farghaly HS1, Abdelhamid A2.

Title:
Epicardial Fat Thickness In Children With Classic Congenital Adrenal ‎Hyperplasia

Abstract:
OBJECTIVE:
Epicardial fat thickness (EFT) is an emerging cardiometabolic risk factor and has been shown to be related to atherosclerosis. EFT has not been studied in the context of CAH. This study aimed to evaluate EFT in children with CAH and its relation to carotid intima media thickness (CA-IMT) and left ventricular functions.

METHODS:
36 children with classic CAH were compared with 36 healthy controls. All children had confirmed CAH and received steroid substitution therapy. Patients and controls underwent anthropometric evaluation, measurement of fasting lipids, glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR), Left ventricular functions and EFT were assessed using conventional echocardiography. Duplex ultrasonography was used to measure CA-IMT.

RESULTS:
Compared to controls, patients had higher EFT (p=0.001), HOMA-IR(p=0.001), CA- IMT (p=0.01), LVMI (p=0.001) and prolonged mitral deceleration time (DcT) (p=0.01).Abnormalities were marked in uncontrolled children on medical treatment. In multivariate analysis in children with classic CAH , EFT correlated positively with waist circumference (OR =1.9,95%Cl=1.07-1.14.p=001), 17-OHP; nmol/l (OR =1.6; 95% CI = 1.33-2.89, p = 0.05), testosterone , ng/dl(OR =1.7; 95% CI = 1.55-2.13, p = 0.01), LVMI (OR=1.14, 95%Cl=1.08-1.13, p=0.0001) , mitral DcT (OR=2.25;95% CI=1.15-2.05, p=0.01) and CA-IMT (OR=1.6 ;95% CI=1.15-2.05, p=0.01).

CONCLUSIONS:
EFT may be elevated in children with classic CAH particularly those with poor control and is correlated to carotid intima media thickness, left ventricular mass and mitral deceleration time. Measurement of EFT by Echocardiography in CAH children may help to identify those at high risk of developing left ventricular dysfunction and subclinical atherosclerosis.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Clinical Pathology, Qena Faculty of Medicine, South Valley University, Qena, Egypt.


Title:
Homocysteine Level in Children with Classic Congenital Adrenal ‎Hyperplasia: Relationship to Carotid Intimal Wall Thickness and Left ‎Ventricular Function‎

Abstract:
BACKGROUND/AIMS:
Homocysteine is an important and independent risk factor for atherosclerotic diseases. The aim of this study was to evaluate serum levels of homocysteine in children with congenital adrenal hyperplasia (CAH) and their relation to carotid artery intima-media thickness (CA-IMT) and left ventricular (LV) function.

METHODS:
This study included 36 children with classic CAH and 36 healthy children. All underwent anthropometric evaluation. Measurement of serum levels of total homocysteine was carried out. The LV mass (LVM) and function were assessed using conventional echocardiography. Duplex ultrasonography was used to measure CA-IMT.

RESULTS:
Compared to the controls, the patients had higher homocysteine levels (p = 0.001), a thicker CA-IMT (p = 0.01), a higher LVM index (LVMI) (p = 0.001), and a prolonged mitral deceleration time (DcT) (p = 0.01). Abnormalities were marked in children who were uncontrolled on medical treatment. In multivariate analysis, homocysteine levels were significantly correlated with systolic (OR = 2.2; 95% CI: 1.10-1.18; p = 0.01) and diastolic blood pressures (OR = 2.9; 95% CI: 1.45-2.4; p = 0.01), atherogenic index (OR = 2.6; 95% CI: 1.33-2.89; p = 0.01), HOMA-IR (OR = 1.3; 95% CI: 1.04-1.34; p = 0.001), LVMI (OR = 2.6; 95% CI: 1.1-1.13; p = 0.001), mitral DcT (OR = 2.4; 95% CI: 1.15-2.05; p = 0.01), and CA-IMT (OR = 1.6; 95% CI: 1.16-1.57; p = 0.01).

CONCLUSIONS:
Serum total homocysteine was elevated in children with classic CAH, particularly in those with poor control on medical treatment, and it was correlated with CA-IMT, LVMI, and mitral DcT. Measurement of homocysteine in children with CAH may help to identify those at high risk of developing LV dysfunction and subclinical atherosclerosis.


Authors:
Mohamed S1, Bayoumi H1, El-Aziz NA2, Mousa E3, Gamal Y4.

Title:
Prevalence, Risk Factors, And Impact Of Lung Cancer On Outcomes ‎Of Idiopathic Pulmonary Fibrosis: A Study From The Middle East‎

Abstract:
BACKGROUND:
No studies have addressed the impact of lung cancer (LC) on prognosis of patients with idiopathic pulmonary fibrosis (IPF) in Upper Egypt. We aimed to evaluate the prevalence and risk factors for LC among IPF patients and its impact on their outcomes and survival in Upper Egypt.

METHODS:
A total of 246 patients with IPF who had complete clinical and follow up data were reviewed. They were categorized into 2 groups: 34 patients with biopsy-proven LC and IPF (LC-IPF) and 212 patients with IPF only (IPF). Survival and clinical characteristics of the two groups were compared.

RESULTS:
Prevalence of LC was 13.8%. Pack/years was the most significant predictor for LC development in IPF (Odds ratio; 3.225, CI 1.257-1.669, p = 0.001). Survival in patients with LC-IPF was significantly worse than in patients with IPF without LC; median survival, 35 months vs 55 months; p = 0.000. LC accompanying IPF was one of the most significant independent predictors of survival in IPF patients (Hazard ratio 5.431, CI 2.186-13.492, p = 0.000). Mortality in LC-IPF patients was mainly due to LC progression in 36% and LC therapy-related complications in 22%.

CONCLUSIONS:
Prevalence of LC in IPF patients was 13.8%. Lung cancer has significant impacts on patients with IPF in Upper Egypt, in terms of clinical outcomes and survival. Smoking is the most significant independent predictor of LC development in IPF patients. A poorer survival was observed for patients with IPF developing LC, mainly due to LC progression, and to complications of its therapies. Further prospective, multicenter and larger studies are warranted.

Author Info:
1
1Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, 71516 Egypt.
2
2Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
3
3Department of Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
4Department of Pathology, Faculty of Medicine, Assiut University, Assiut, 71516 Egypt.


Authors:
Mohammed RAA1, Radwan MEM2, Alrufayi BM3, Abdulaziz LAQ3.

Title:
Does Loss Of Hormonal Receptors Influence The Pathophysiological ‎Characteristics Of The HER-2 Breast Cancer Phenotype? ‎

Abstract:
BACKGROUND:
Some breast carcinomas (BC) of the HER-2 type respond poorly to endocrine therapy, indicating that hormonal receptor (HR) status possibly impacts the biological criteria of this tumor class. The aim of this study was to compare the clinicopathological characteristics of HR-positive and HR-negative tumors occurring in HER-2 and non-HER-2 BC.

METHODS:
Tissue microarray sections from 336 primary invasive BC specimens were stained immunohistochemically with antibodies against HER-2, ER, and PR. Proliferation was assessed using Ki67 and the P53 status was identified.

RESULTS:
The HER-2 phenotype was identified in 42/336 (12.5%) specimens, while 293/336 (87.5%) were of the non-HER-2 phenotype. In the non-HER-2 group, 103/293 (35%) were HR-negative tumors. HR negativity was significantly associated with higher tumor grades (P < 0.0001), higher proliferation rates (P < 0.0001), presence of necrosis (P < 0.0001), and with a higher P53 expression (P < 0.0001). There were no differences in patient age, tumor size, LN status, or presence of vascular invasion (VI) between the HR-negative and HR-positive groups. In the HER-2 group, 16/42 (38%) had HR-negative tumors. No significant difference in clinicopathological characteristics, except for tumor grade, was detected between the HR-positive and HR-negative tumors in this group.

CONCLUSION:
Loss of HR does not influence the biological features of HER-2 BC. This finding may indicate that some tumors will 'biologically' move from being HER-2-positive/HR-positive tumors to behaving more like HER-2-positive/HR-negative tumors even when ER are present on the cell surface. Further studies are needed to explore this hypothesis and to identify the subset of tumors that will benefit from endocrine therapy.

Author Info:
1
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Pathology, Faculty of Medicine, Taibah University, Almadinahh Almounawwarah, Saudi Arabia.
2
Department of Radiology, Faculty of Medicine, Taibah University, Almadinahh Almounawwarah, Saudi Arabia; Department of Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: mradwan@taibahu.edu.sa.
3
Undergraduate studies (MBCHB), Faculty of Medicine, Taibah University, Almadinahh Almounawwarah, Saudi Arabia.


Authors:
Mosaad Zaki E1, Mohamed Zahran A1, Abdelazeem Metwaly A1, Hafez R2, Hussein S3, Elaiw Mohammed A4.

Title:
Impact Of CD39 Expression On CD4+ T Lymphocytes And 6q Deletion ‎On Outcome Of Patients With Chronic Lymphocytic Leukemia

Abstract:
OBJECTIVE/BACKGROUND:
Chronic lymphocytic leukemia is one of the commonest leukemias affecting adults. CD39 inhibits T-cell and Natural killer (NK) cell responses by hydrolyzing adenosine triphosphate and adenosine diphosphate, suppressing the immune system. We investigated expression of CD39 on CD4+ T Lymphocytes in chronic lymphocytic leukemia (CLL) patients and its relationship with deletion 6q, its association with disease stage and survival.

METHODS:
Thirty CLL patients and 20 matched controls were included in the study. Bone marrow studies with immunophenotyping, CD39, CD38, and ZAP-70, and detection of del 6q by FISH were performed.

RESULTS:
CD39+ CD4+ T helper cells in CLL patients were significantly expressed compared with the controls (p < .001). Levels of CD39+ CD4+ T cells were significantly expressed in high risk CLL patients. Del 6q was detected in 63.3% of patients and it correlated with CD39, CD38, and ZAP-70, and advanced stage disease. There was a significant relation between response to treatment and CD39 expression and del 6q, also there was a significant difference in overall survival (OS) between patients with and without Del 6q.

CONCLUSION:
CD39 expression on CD4+ Tcells and del 6q act as prognostic markers in CLL. Blocking or inhibition of CD39 may be a target for new immune therapy for CLL.

Author Info:
1
Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
2
Department of Internal Medicine, Clinical Hematology Unit, Assiut University, Assiut, Egypt. Electronic address: raniahafez@aun.edu.eg.
3
Department of Internal Medicine, Clinical Hematology Unit, Assiut University, Assiut, Egypt.
4
Department of Clinical Pathology, South Valley University, Qena, Egypt.


Authors:
Nagata Y1, Narumi S2, Guan Y1, Przychodzen BP1, Hirsch CM1, Makishima H3, Shima H2, Aly M4, Pastor V5, Kuzmanovic T1, Radivoyevitch T6, Adema V1, Awada H1, Yoshida K3, Li S7, Sole F8, Hanna R9, Jha BK1, LaFramboise T7, Ogawa S3, Sekeres MA10, Wlodarski MW5, Cammenga J11, Maciejewski JP12.

Title:
Germline Loss Of Function SAMD9 And SAMD9L Alterations In Adult ‎Myelodysplastic Syndromes

Author Info:
1
Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States.
2
Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan.
3
Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
4
Clinical Hematology Unit, Faculty of Medicine, Assiut University, Egypt.
5
Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany.
6
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.
7
Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, United States.
8
MDS Research Group, Josep Carreras Leukaemia Research Institute, ICO-Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain.
9
Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, United States.
10
Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States.
11
Department of Hematology, Linkoping University, Linkoping, Sweden.
12
Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States; maciejj@ccf.org.


Authors:
Nasr M1, Farghaly M2, Elsaba T3, El-Mokhtar M2, Radwan R4, Elsabahy M5, Abdelkareem A2, Fakhry H3, Mousa N6.

Title:
Resistance Of Primary Breast Cancer Cells With Enhanced ‎Pluripotency And Stem Cell Activity To Sex Hormonal Stimulation And ‎Suppression

Abstract:
Female sex steroid hormones have a fundamental role in breast cancer. Meanwhile, current evidence supports the contribution of breast cancer stem cells in carcinogenesis, metastasis, and resistance to cytotoxic chemotherapy. Nevertheless, the interaction between breast cancer stem cells with sex hormones or key hormonal antagonists remains elusive.

OBJECTIVE:
To investigate the effect of diverse sex hormonal stimulation and suppression regimens on the proliferation of a primary human breast cancer cells with stem cell activity.

METHODS:
Cells were exposed to estradiol, progesterone, letrozole, ulipristal acetate, or a combination of ulipristal acetate-letrozole, continually for 6 months. Additionally, nanoparticle-linked letrozole and ulipristal acetate formulations were included in a subsequent short-term exposure study. Phenotypic, pathologic, and functional characteristics of unexposed cells were investigated.

RESULTS:
The proliferation of breast cancer cells was comparable among all hormonal stimulation and suppression groups (P= 0.8). In addition, the nanoparticle encapsulated hormonal antagonists were not able to overcome the observed resistance of cells. Cell characterization showed a mesenchymal-like phenotype overexpressing three master pluripotency markers (Oct 4, SOX2, and Nanog), and 92% of cells were expressing ALDH1A1. Notably, the CD44 high/CD24 low cell population presented only 0.97%-5.4% over repeat analyses. Most cells lacked the expression of mesenchymal markers; however, they showed differentiation into osteogenic and adipogenic lineages. Upon transfer to serum-free culture, the long-term maintained mesenchymal-like cancer cells showed remarkable morphologic plasticity as they switched promptly into an epithelial-like phenotype with significant mammosphere formation capacity (P= 0.008).

CONCLUSION:
Breast cancer cells can develop a pluripotent program with enhanced stemness activity that may together contribute to universal resistance to sex hormonal stimulation or deprivation. Isolation and characterization of patient-derived breast cancer stem cells in large clinical studies is therefore crucial to identify new targets for endocrine therapies, potentially directed towards stemness and pluripotency markers. Such direction may help overcoming endocrine resistance and draw attention to breast cancer stem cells' behaviour under endogenous and exogenous sex hormones throughout a woman's reproductive life.

Author Info:
1
Zewail City of Science and Technology, Egypt.
2
Faculty of Medicine, Assiut University, Egypt.
3
South Egypt Cancer Institute, Assiut University, Egypt.
4
Department of Pharmaceutics, Faculty of Pharmacy, Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt.
5
Department of Pharmaceutics, Faculty of Pharmacy, Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt; Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX, USA.
6
Zewail City of Science and Technology, Egypt. Electronic address: noha.mousa@utoronto.ca.


Authors:
Nassr AA1,2, Erfani H1, Fisher JE1, Ogunleye OK1, Espinoza J1, Belfort MA1, Shamshirsaz AA3.

Title:
Fetal Interventional Procedures And Surgeries: A Practical Approach

Author Info:
1
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
2
Women's Health Hospital, Assiut University, Assiut, Egypt.
3
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, 6651 Main Street,Houston, TX77030,USA, alirezashamshirsaz@yahoo.com.


Authors:
Okasha HH1, Mahdy RE2, Elkholy S1, Hassan MS1, El-Mazny AN1, Hadad KEE1, Saeed M1, El-Nady M1, Elbalky OS3, Ashraf A4, El-Magd AA5, Awad A1.

Title:
Endoscopic Ultrasound (EUS) Elastography And Strain Ratio, Could It Help ‎In Differentiating Malignant From Benign Pancreatic Lesions?‎

Abstract:
Evaluating the role of endoscopic ultrasound (EUS) elastography and strain ratio in differentiation between malignant and benign pancreatic lesions.Three hundred twenty-five patients with solid pancreatic lesions were enrolled in this prospective study from 2014 to 2017. EUS real-time elastography scoring and strain ratio were done to all patients and compared to the final diagnosis to assess its sensitivity, specificity, positive and negative predictive values (PPV and NPV) in differentiating malignant from benign lesions.A cut-off value of 4.2 we had sensitivity of 95%, specificity of 63%, PPV of 89%, NPV of 81%, and accuracy of 87%. Another cut-off value of 10.9 showed a sensitivity of 75%, specificity of 88%, PPV of 95%, NPV of 54%, and accuracy of 79%. Adding the elastography to the better cut-off value gave a sensitivity of 97%, specificity of 63%, PPV of 89%, NPV of 88%, and accuracy of 89%.Real-time elastography and strain ration are valuable in differentiating malignant from pancreatic lesions.

Author Info:
1
Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo.
2
Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut.
3
General Surgery Department, Damanhur Teaching Hospital, Al Buhayrah.
4
Gastroenterology Department, Military Medical Academy, Egypt.
5
Internal Medicine Department, Armed forces college of medicine, Cairo.


Authors:
Ramadan HK1, Makhlouf NA2, Mahmoud AA3, Abd Elrhman M4, El-Masry MA5.

Title:
Role Of Vitamin D Deficiency As A Risk Factor For Infections In ‎Cirrhotic Patients

Abstract:
BACKGROUND:
Vitamin D plays a role in innate and acquired immunity. The risk for bacterial infections is increased in cirrhotic patients due to low levels of vitamin D. This study aimed to determine serum 25-(OH) vitamin D levels among cirrhotic patients in the presence and absence of infections and correlate this level with liver disease severity.

METHODS:
This cross-sectional analytic study recruited 87 hospitalised cirrhotic patients who were divided into the following groups: group with evidence of infection (45 cases) and group without infection (42 cases). Urine analysis, ascetic fluid study and chest X-rays were performed to find the site of infection. Serum 25-(OH) vitamin D was also measured.

RESULTS:
Vitamin D levels were lower in the cirrhotic with infection group than in the cirrhotic without infection group (17.3 ± 2.5 vs. 41.1 ± 3.1, respectively) (P-value < 0.001). Approximately 71.4% cirrhotic patients without infection had sufficient vitamin D levels, while 60% of cirrhotic patients with infection had insufficient vitamin D levels, and 28.9% had vitamin D deficiency (P-value < 0.001). Spontaneous bacterial peritonitis was the most common infection (62.2%). The cutoff point of vitamin D levels for cirrhotic patients with infection was 21 ng/mL.

CONCLUSION:
Vitamin D deficiency was found to be an independent predictor of infection in cirrhotic patients suggesting that vitamin D supplementation may be useful in these patients. No significant correlations were found between the vitamin D level and the Child-Pugh class and MELD score among the infected group and non-infected group.

Author Info:
1
Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address: Heidi_ramadan@yahoo.com.
2
Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address: nahedmak@yahoo.com.
3
Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address: Amal11068@yahoo.com.
4
Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address: m_z_abokrisha@yahoo.com.
5
Internal Medicine Department, Division of Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address: masaeed2@yahoo.com.


Authors:
Sabry D1, El-Deek SEM2, Maher M3, El-Baz MAH2, El-Bader HM2, Amer E4, Hassan EA5, Fathy W6, El-Deek HEM7.

Title:
Role Of Mirna-210, Mirna-21 And Mirna-126 As Diagnostic Biomarkers ‎In Colorectal Carcinoma: Impact Of HIF-1α-VEGF Signaling Pathway

Abstract:
Colorectal cancer (CRC) is a major cause of death worldwide. Novel non-invasive, high diagnostic value screening test is urgently needed to improve survival rate, treatment and prognosis. Stable, small, circulating microRNA (miRNA) offers unique opportunities for the early diagnosis of several diseases. It acts as tumor oncogenes or suppressors and involve in cell death, survival, and metastasis. Communication between miRNA and carcinogenesis is critical but it still not clear and needs further investigation. The aim of our study is to evaluate the role of miR-210, miR-21, miR-126, as non-invasive diagnostic biomarkers for screening, early detection of CRC, studying their correlation with prognostic variables, and clarifying the roles of miRNAs on HIF-1α-VEGF signaling pathway. The expression of miR-210, miR-21 and miR-126 was performed using qRT-PCR in adenocarcinoma (no = 35), adenomas (no = 51), and neoplasm free controls (no = 101). Serum levels of VEGF and HIF-1α was determined by ELISA Kit. The results show that the expression of miR-210, miR-21, VEGF, HIF-1α was significantly up-regulated while that miRNA-126 was down-regulated in both adenocarcinoma and adenomas compared with controls (p < 0.001 for each). No significant difference was noted comparing patients with adenocarcinoma and adenomas. The three miRNAs correlated with VEGF, HIF-α. The miR-210 and miR-21 associated with TNM classification and clinical staging of adenocarcinoma (p < 0.001) and they show high diagnostic value with sensitivity and specificity 88.6%, 90.1% and 91.4%, 95.0% respectively. Our study revealed that circulating miR-210, miR-21 were up-regulated while miR-126 was down-regulated in CRC and adenomas patients, they all correlated with TNM staging and they had high diagnostic value. HIF-1α VEGF signaling pathways regulated by miRNAs played a role in colon cancer initiation. To the best of our knowledge, this is the first study of this miRNAs panel in CRC in our community. These data suggested that these biomarkers could be a potential novel, non-invasive marker for early diagnosis, screening and predicting prognosis of CRC. Understanding the molecular functions by which miRNAs affect cancer and understanding its roles in modulating the signaling output of VEGF might be fruitful in reducing the incidence and slowing the progression of this dark malignancy.

Author Info:
1
Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. dinasabry@kasralainy.edu.eg.
2
Medical Biochemistry Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
4
Biochemistry Department, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt.
5
Tropical Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
6
Tropical Medicine Department, Faculty of Medicine, Beny Suef University, Beny Suef, Egypt.
7
Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Safwat AS1, Hasanain AF2, Mahran A3, Bakkar S4, Abdel-Aal S5, Nafee A6.

Title:
Erectile Dysfunction Among Patients With Chronic Brucellosis

Abstract:
OBJECTIVE:
Only a single study investigated erectile dysfunction (ED) among patients with chronic brucellosis without including a control group. Our study objective was to determine the prevalence of ED among patients with chronic brucellosis compared to normal subjects, and to explore the predictors of ED.

MATERIALS AND METHODS:
We included 93 chronic brucellosis patients and 92 subjects as a control, from June 2013 to August 2017. Chronic brucellosis was diagnosed based on persistent symptoms for ≥1 year with positive immunoglobulin G antibody titer (≥1:160) by standard tube agglutination test; the mean duration was 21 ± 6.2 months. Clinical evaluation (including an Arabic validated version of the five-item International Index of Erectile Function to diagnose ED; score of 5-21 was diagnostic), imaging studies (including scrotal ultrasonography) and laboratory investigations (including estimation of fasting serum level of glucose (after fasting for 8 h), lipids profile (after fasting for 14 h), and serum level of testosterone) were conducted. A fasting serum glucose level of ≥ 7 mmol/L defined diabetes mellitus (DM). Predictors of ED were identified using multivariate analysis (binary logistic regression).

RESULTS:
The mean age of patients was 35.4 ± 13.7 years; 24.7% of them had DM, while low serum level of testosterone was detected among 54.8%. Among the patients, ED was significantly more frequent compared to the control subjects (69.9% vs. 19.6%, p < 0.001). Low serum level of testosterone (OR 4.8, 95% CI 1.7-29.3, p 0.008), and DM (OR 3.5, 95% CI 1.2-34.6, p 0.011) were the predictors of ED among the patients.

CONCLUSIONS:
The prevalence of ED among patients with chronic brucellosis is high. Low serum level of testosterone and DM are associated with ED among such patients.

Author Info:
1
Department of Urology, Assiut University, Assiut, Egypt. assafwat@gmail.com.
2
Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt.
3
Department of Dermatology and Andrology (Andrology Unit), Assiut University, Assiut, Egypt.
4
Department of Biochemisrty, Assiut University, Assiut, Egypt.
5
Department of Diagnostic Radiology, Assiut University, Assiut, Egypt.
6
Department of Microbiology and Immunology, Assiut University, Assiut, Egypt.


Authors:
Safwat AS1, Hasanain A2, Shahat A3, AbdelRazek M4, Orabi H3, Abdul Hamid SK5, Nafee A6, Bakkar S7, Sayed M3.

Title:
Cholecalciferol For The Prophylaxis Against Recurrent Urinary Tract ‎Infection Among Patients With Benign Prostatic Hyperplasia: A Randomized, ‎Comparative Study

Abstract:
PURPOSE:
To explore the role of cholecalciferol for the prophylaxis against recurrent urinary tract infection (UTI) in patients with benign prostatic hyperplasia (BPH).

METHODS:
Our randomized, uncontrolled prospective study included 389 naïve BPH patients with moderate/severe symptoms, consecutively. The patients were randomly allocated to two groups; group-A included 193 patients who received tamsulosin, while group-B included another 196 patients who received tamsulosin with cholecalciferol. The study population was followed up for 2 years after the start of the treatment. For all the patients enrolled, clinical evaluation, imaging studies (abdominal and trans-rectal ultrasonography), and laboratory investigations [including urinalysis, urine culture with antibiotic susceptibility testing for positive cultures and estimation of prostate-specific antigen (PSA) level] were provided.

RESULTS:
The incidence rate of recurrent UTI was 9% among the study population; it was significantly higher among group-A patients compared to those of group-B (13.5% vs. 4.6%, p 0.003, OR 2.7, 95% CI 1.5-4.3). Compared to patients of group-A, those of group-B developed a significantly lower level of PSA at the end of treatment period (0.16 ± 0.03 ng/mL vs. 0.27 ± 0.08 ng/mL, p 0.043, OR 1.9, 95% CI 1.2-6.8).

CONCLUSIONS:
Adjuvant cholecalciferol supplementation may be protective against recurrent UTI among patients with BPH receiving tamsulosin therapy without extra adverse effects.

Author Info:
1
Department of Urology and Nephrology Hospital, Assiut University, Assiut, 71516, Egypt. assafwat@gmail.com.
2
Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt.
3
Department of Urology and Nephrology Hospital, Assiut University, Assiut, 71516, Egypt.
4
Department of Urology, South Valley University, Qena, Egypt.
5
Department of Medicine (Nephrology Unit), Assiut University, Assiut, Egypt.
6
Department of Microbiology and Immunology, Assiut University, Assiut, Egypt.
7
Department of Biochemistry, Assiut University, Assiut, Egypt.


Authors:
Said HG1, El-Radi MA2, Hassanein MY1, Said GZ1.

Title:
Orthopaedic Publications From Egypt In The Last Five Years: A ‎Bibliometric Report

Abstract:
INTRODUCTION:
This review was done to find the trend for orthopaedic publications from Egypt in the last 5 years, detailing the specialties that are most published and comparing this with the surrounding Middle East region.

METHODS:
The search included orthopaedic-related articles published in journals that are listed in PubMed, including author affiliation from Egypt between 2013 and 2017.

RESULTS:
Four hundred eighty-one publications were found. The results showed that Trauma was the highest published branch while Arthroscopy has shown the highest increase since 2013 to become as Trauma by 2017. Two hundred seventy-two articles were published in Q1 and Q2 journals which represents 56.54% from the total publications. There were 1243 citations for these publications. The country ranking was between the fourth and fifth in Middle East region over the last five years.

DISCUSSION:
Publications are an important part of each country's research work. The trend for orthopaedic publication is showing an increase in subspecialty publications with a gradual increase in number of publications per year, while Egypt's position remains in the top five in the region.

Author Info:
1
Orthopaedic Surgery and Traumatology Department, Faculty of medicine, Assiut University, Assiut, 71515, Egypt.
2
Orthopaedic Surgery and Traumatology Department, Faculty of medicine, Assiut University, Assiut, 71515, Egypt. abdelradimohamed@yahoo.com.


Authors:
Saleem TH1, Abo El-Maali N2, Hassan MH3, Mohamed NA1, Mostafa NAM4, Abdel-Kahaar E5,6, Tammam AS2.

Title:
Comparative Protective Effects of N-Acetylcysteine, N-Acetyl Methionine, and N-Acetyl Glucosamine against Paracetamol and Phenacetin Therapeutic Doses-Induced Hepatotoxicity in Rats

Abstract:
BACKGROUND AND AIMS:
Both paracetamol (PA) and phenacetin (PH) are analgesic and antipyretic agents. Part of phenacetin therapeutic activity is attributed to its metabolism into paracetamol. Paracetamol causes direct hepatic oxidative stress damage. The present study aimed to investigate the possible damaging effects of both PA and PH, when used in therapeutic doses, on rat liver and to compare the antioxidant and hepatoprotective effects of N-acetylcysteine (NAC), N-acetyl-methionine (NAM), and N-acetylglucosamine (NAG) against PA- or PH-induced hepatic damage.

METHODS:
90 male Wistar albino rats (120-140 gm) were undertaken, categorized randomly into 9 groups of 10 rats each, and administered by gavage for 2 weeks with DMSO 1% (controls), PA, PA+NAC, PA+NAM, PA+NAG, PH, PH+NAC, PH+NAM, and PH+NAG. Biochemical assays of malondialdehyde (MDA), nitric oxide (NO), reduced glutathione (GSH), total thiols, and alpha-fetoprotein (AFP) in liver homogenates and serum assays of ALT, AST, 8-hydroxy guanine (8-OH-Gua), and AFP were done. Also histopathological examinations of liver tissues in various groups were done.

RESULTS:
PA and PH cause significant increase in hepatic levels of MDA, NO, and AFP and serum ALT, AST, and 8-OH-Gua levels, with significant decrease in hepatic GSH and total thiols. NAG and NAC significantly improve the PA- and PH-induced hepatic and blood, biochemical, and histopathological disturbances, respectively.

CONCLUSIONS:
Both PA and PH induce oxidative stress in rat liver within their therapeutic doses. NAG and NAC in pharmacological doses can antagonize the oxidative damaging effect of both PA and PH.

Author Info:
1
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Chemistry, Faculty of Science, Assiut University, Assiut, Egypt.
3
Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, Egypt.
4
Department of Histology, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Medical Pharmacology, Faculty of Medicine, South Valley University, Qena, Egypt.
6
Institute of Pharmacology of Natural Products & Clinical Pharmacology, Ulm University, Ulm, 89081, Germany.


Authors:
Salem HF1, Kharshoum RM1, Abou-Taleb HA2, AbouTaleb HA3, AbouElhassan KM2.

Title:
Progesterone-Loaded Nanosized Transethosomes For Vaginal ‎Permeation Enhancement: Formulation, Statistical Optimization And ‎Clinical Evaluation In Anovulatory Polycystic Ovary Syndrome

Abstract:
Bio-identical progesterone (PRG) is an exogenous female steroidal hormone which is used for treatment of polycystic ovary syndrome (PCOS). However, it suffers from poor bioavailability due to hepatic metabolism and poor solubility. The target of this work was to evaluate and statistically optimize PRG-loaded nanovesicle transethosomes (NVTEs) based in mucoadhesive gel for transvaginal delivery of PRG as potential luteal-phase support. A 24 full factorial design was used to explore the effect of phosphatidylcholine (PC), Tween 80, cetyltrimethyl ammonium bromide and ethanol concentration on particle size, entrapment efficiency (EE%), % in vitro PRG release after 24 h and transvaginal flux. PRG-loaded NVTEs were prepared by injection sonication method. The results revealed that the mean particle sizes ranged from 133.3 ± 3.42 to 349.5 ± 1.24 nm, zeta potential ranged from -23.5 ± 3.84 to +74.6 ± 4.97 mV, EE% ranged from 87.93 ± 3.58 to 97.05 ± 2.61%, % PRG release ranged from 50.9 ± 2.75 to 90.69 ± 2.07 and transvaginal flux ranged from 0.274 ± 0.03 to 0.531 ± 0.04 mg/cm2/h. The optimized formulation was subjected to transmission electron microscope for morphological examination and then incorporated in the mucoadhesive vaginal gel using Carbopol 974, hydroxyl propyl methylcellulose and sodium alginate. The optimized formulation was clinically studied in anovulatory PCOS and showed a significant increase in the serum PRG, endometrial thickness, echogenicity degree and the pregnancy rate. Briefly, PRG-loaded NVTEs vaginal gel might be a promising formulation for luteal phase support and increase pregnancy rate in anovulatory PCOS.

Author Info:
1
a Faculty of Pharmacy, Department of Pharmaceutics and Industrial Pharmacy , Beni Suef University , Beni Suef , Egypt.
2
b Faculty of Pharmacy, Department of Pharmaceutics and Clinical Pharmacy , Nahda University (NUB) , Beni Suef , Egypt.
3
c Faculty of Medicine, Department of Obstetrics and Gynecology , Assiut University , Assiut , Egypt.


Authors:
Shaaban SY1, El Gendy YG1, Mehanna NS2, El-Senousy WM3, El-Feki HSA1, Saad K4, El-Asheer OM4.

Title:
The Role Of Probiotics In Children With Autism Spectrum Disorder: A ‎Prospective, Open-Label Study

Abstract:
OBJECTIVE:
There are limited data on the efficacy of probiotics in children with ASD, therefore, this study aims to evaluate the efficacy and tolerability of probiotics in an Egyptian cohort of children with ASD.

METHODS:
Gastrointestinal (GI) flora were assessed by quantitative real-time PCR of stool samples of 30 autistic children from 5 to 9 years old. GI symptoms of autistic children were assessed with a modified six-item Gastrointestinal Severity Index (6-GSI) questionnaire, and autistic symptoms were assessed with Autism Treatment Evaluation Checklist (ATEC) before and after 3 months of supplementation of probiotics nutritional supplement formula (each gram contains 100 × 106 colony forming units of three probiotic strains; Lactobacillus acidophilus, Lactobacillus rhamnosus and Bifidobacteria longum).

RESULTS:
After probiotic supplementation, the stool PCR of autistic children showed increases in the colony counts of Bifidobacteria and Lactobacilli levels, with a significant reduction in their body weight as well as significant improvements in the severity of autism (assessed by the ATEC), and gastrointestinal symptoms (assessed by the 6-GSI) compared to the baseline evaluated at the start of the study.

CONCLUSIONS:
We concluded that probiotics have beneficial effects on both behavioral and GI manifestations of ASD. Probiotics (a non-pharmacological and relatively risk-free option) could be recommended for children with ASD as an adjuvant therapy. At this stage, this study is a single center with a small number of patients and a great deal of additional wide-scale randomized controlled trials are needed to critically confirm the efficacy of probiotics in ASD.

TRIAL REGISTRATION NUMBER:
UMIN-CTR Study Design: Trial Number UMIN000026157.

Author Info:
1
a Pediatric Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
2
b Dairy Science &Technology Department , National Research Center , Giza , Egypt.
3
c Water Pollution Research Department , Environmental Research Division, National Research Center , Giza , Egypt.
4
d Department of Pediatrics, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Shazly SA1,2, Gayar AG2, Abdelbadee AY2,3, Afifi AM4, Nassr AA2,5.

Title:
Partial Tubal Devascularisation: A Novel Procedure For Tubal ‎Conservation In Ectopic Pregnancy

Abstract:
Ectopic pregnancy is a serious condition that complicates 1-2% of pregnancies. Using surgical management is efficient, but may have an impact on future fertility. Although conservative tubal surgery has not been shown to have a significant advantage over a salpingectomy in terms of the future fertility potential, the conservative surgical techniques remain widely-utilised, particularly in the context of a contralateral diseased or absent tube. We hereby report a case series of a novel procedure to conserve the fallopian tube with the minimal risk of an incisional site bleeding through a partial segmental devascularisation. This technique seems to be an efficient method to minimise the intraoperative bleeding, limit the need for a blood transfusion, and yields a higher success rate of the procedure without jeopardising the blood supply and vitality of the tubes. Impact Statement What is already known on this subject? Conservative surgery has a significant value in women with a contralateral absent or diseased tube. However, a conservative management could be challenging due to the significant bleeding which can be encountered during the surgery. What the results of this study add? The partial devascularisation technique could achieve an adequate haemostasis by blocking the ascending blood supply only to the affected segment of the fallopian tube. What the implications are of these findings for clinical practice and/or further research? A partial devascularisation is a successful conservative surgical treatment option in most patients when the procedure is indicated.

Author Info:
1
a Department of Obstetrics and Gynecology , Mayo Clinic College of Medicine , Rochester , MN , USA.
2
b Women's Health Hospital , Assiut University , Assiut , Egypt.
3
c Reproductive Biology Department , University Hospitals Case Medical Centre , Cleveland , OH , USA.
4
d Faculty of Medicine , Ain Shams University , Cairo , Egypt.
5
e Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , TX , USA.


Authors:
Taha EA1, Algahny Algahlan HA2, Zidan M3, Hafez A4, Farag FF4.

Title:
Scrotal Ultrasonographic Findings In Obese Infertile Patients And ‎Their Correlations To Semen And Hormonal Profile

Abstract:
OBJECTIVE:
The aim of this prospective study was to compare scrotal ultrasonographic findings in obese and normal weight infertile men and correlate these findings with semen parameters and hormonal profile.

MATERIAL AND METHODS:
A total of 188 men presented for infertility evaluation were included in this study. They were divided according to body mass indices into obese (n=96) and normal weight infertile patients (n=92). Basic infertility evaluation, semen analysis and scrotal duplex ultrasound examination in addition to measurement of serum levels of follicular stimulating hormone, testosterone and estradiol were done for all cases. The ratio between testicular size measured by scrotal ultrasound and body mass index were calculated.

RESULTS:
Any significant differences were not observed in semen parameters, serum levels of follicular stimulating hormone and testosterone between obese and normal weight infertile men. Serum estradiol level was significantly higher in obese than normal weight infertile men. There is significant increase in subclinical varicocele, hydrocele and testicular microlithiasis detected by scrotal ultrasound in obese infertile men than nonobese patients. Despite having comparable testicular size detected on scrotal ultrasound, infertile obese men had significantly lower total testicular volume to body mass index ratio and this ratio correlated positively with semen volume, sperm concentration, total sperm count and serum testosterone but negatively with serum follicular stimulating hormone and estradiol levels.

CONCLUSION:
We therefore conclude that the incidence of subclinical varicocele, hydrocele and testicular microlithiasis was higher in obese infertile patients and the ratio between testicular volume assessed by scrotal ultrasound and body mass index may be a new parameter that correlates with subfertility status in these men.

Author Info:
1
Department of Dermatology and Andrology, Assiut University School of Medicine, Assiut, Egypt.
2
Department of Radiology, Sohag University School Medicine, Sohag, Egypt.
3
Department of Radiology, Assiut University School of Medicine, Assiut, Egypt.
4
Department of Urology, Sohag University Hospital, Sohag, Egypt.


Authors:
Tawfik YM1, Abd Elazim NE1, Abdel-Motaleb AA1, Mohammed RAA1, Tohamy AMA1.

Title:
The Effect Of NB-UVB On Noncultured Melanocyte And Keratinocyte ‎Transplantation In Treatment Of Generalized Vitiligo Using Two ‎Different Donor-To-Recipient Ratios

Abstract:
BACKGROUND:
The melanocyte and keratinocyte transplantation procedure (MKTP) is a safe and effective procedure in treatment of vitiligo. Major advantage of this technique is that a small area of donor skin is needed to cover a large recipient area. To date, there is no consensus on the optimal donor-to-recipient ratio (D/R) required to achieve acceptable repigmentation following melanocyte and keratinocyte transplantation procedure (MKTP) in generalized vitiligo. It has been postulated that the addition of post-transplantation phototherapy may enhance the results. This is first study to assess two different (D/R) ratios with or without adjuvant phototherapy.

OBJECTIVE:
To compare the repigmentation after MKTP using two different D/R ratios (1/3 and 1/10) with and without adjuvant phototherapy (NB-UVB).

METHODS AND MATERIALS:
In this non randomized prospective clinical trial, 42 patients with stable generalized vitiligo bilateral and symmetrical in distribution were included. Patients were divided into two groups, 21 patients with a total of 50 lesions were treated with MKTP using a D/R ratio of 1/3 (Group I; 3000 ± 500 cell/mm2 ) and the other 21 patients with a total of 52 lesions were treated by MKTP using a D/R ratio of 1/10 (Group II; 1000 ± 200 cell/mm2 ). To study the role of adjuvant phototherapy on repigmentation, lesions in each patient were divided into two subgroups (a and b): lesions in subgroups Ia and IIa (did not receive NB-UVB) and lesions in subgroups Ib and IIb (received adjuvant phototherapy NB-UVB, two sessions per week for 6 months). The overall grading of repigmentation used was excellent (90%-100% repigmentation), good (75%-89%), fair (50%-74%), and poor (<50%). Also, the percentage of VASI change and color matching were used to assess the results. The study design was approved by the ethical committee of the Faculty of Medicine, Assiut University (IRB attached).

RESULTS:
The mean percentage of repigmentation was significantly better in group I than group II cases in both areas with or without adjuvant NB-UVB. It was 86.00 ± 16.21 and 87.62 ± 11.66 in subgroups Ia and Ib, respectively, vs 24.14 ± 18.08 and 29.98 ± 16.34 in subgroups IIa and IIb, respectively (P value was 0.000). The percent of excellent response was significantly better in group I than group II. It was 60% and 64% in subgroups Ia and Ib, respectively, and 7.6 and 11.5 in subgroups IIa and IIb, respectively (P value was 0.000). The mean percentage of VASI change was significantly better in group I than group II cases in both areas. It was -90.74 ± 15.84 and -92.06 ± 11.86 in subgroups Ia and Ib, respectively, vs -23.10 ± 32.85 and -26.03 ± 35.15 in subgroups IIa and IIb, respectively (P value was 0.000). The percent of excellent color match was better in group I than group II. It was 84% and 88% in subgroups Ia and Ib, respectively, vs 34.6 in both subgroups IIa and IIb (P < 0.05). A higher density of epidermal cells was transplanted in the recipient area in group I (3000 ± 500 cell/mm2 ) compared to group II (1000 ± 200 cell/mm2 ). There were no statistically significant differences between subgroups (Ia vs Ib and IIa vs IIb) although percentage of repigmentation was slightly better in NB-UVB subgroups.

CONCLUSIONS:
The higher density of epidermal cells used in the suspension, the higher the percentage of repigmentation obtained. The usage of adjuvant phototherapy following NKMT can enhance the repigmentation response.

Author Info:
1
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Plastic Surgery and Pathology Departments, Assiut University, Assiut, Egypt.


Authors:
Vogl TJ1, Mekkawy AIA2,3, Thabet DB4, El-Sharkaway M5, Kamel HM5, Albrecht MH1, Naguib NNN1,6, Hassan A7.

Title:
Transvenous Pulmonary Chemoembolization (TPCE) For Palliative Or ‎Neoadjuvant Treatment Of Lung Metastases

Abstract:
PURPOSE:
To retrospectively evaluate tumor response, local tumor control, and patient survival after the treatment of pulmonary metastases using transpulmonary chemoembolization (TPCE) in palliative and neoadjuvant intent.

MATERIALS AND METHODS:
One hundred forty-three patients (mean age 56.7 ± 13.4 years) underwent repetitive TPCE (mean number of sessions 5.8 ± 2.9) between June 2005 and April 2017 for the treatment of unresectable lung metastases, not responding to systemic chemotherapy. Patients had predominant lung metastases with bilateral lung involvement in 80.4% of the cases. Regional delivery of the chemotherapeutic agents was performed through selective catheterization of the tumor-supplying pulmonary arteries with subsequent injection of iodized oil and microspheres. Patients, who underwent subsequent ablation (n = 51), either for all lesions (complete) or dominant lesions (incomplete), constituted the neoadjuvant group, and those who underwent TPCE alone represented the palliative treatment intent (n = 92). The response was assessed according to the revised Response Evaluation Criteria in Solid Tumors (RECIST).

RESULTS:
Partial response was achieved in 11.9% (n = 17), stable disease in 66.4% (n = 95), and progressive disease in 21.7% (n = 31). The mean survival time and time to progression were 24.5 ± 1.7 and 7.5 ± 0.5 months, respectively. The mean survival time was shorter for the palliative group (19.7 ± 2), compared to the neoadjuvant group (30.1 ± 2.6 months). The use of TPCE alone or with incomplete ablation had a significantly increased hazard of death of 4.6- (p = 0.002) and 3.1-fold (p = 0.027), respectively, in comparison with TPCE with subsequent complete ablation.

CONCLUSION:
TPCE has the potential to improve local tumor control and to prolong survival with a neoadjuvant potential when combined with ablation therapy.

KEY POINTS:
• Transpulmonary chemoembolization (TPCE) is a locoregional technique for delivering chemotherapy in higher intratumoral concentrations and with reduced systemic toxicity. • TPCE can be an alternative treatment for patients with pulmonary metastases who failed prior systemic chemotherapy or with post-operative recurrence. • The current retrospective study revealed that TPCE is a feasible treatment option for patients with unrespectable lung secondaries in both palliative and neoadjuvant intent and has the potential of improving local control and prolonging survival.

Author Info:
1
Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
2
Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. time_dr@yahoo.com.
3
Department of Diagnostic Radiology, South Egypt Cancer Institute, Assiut University, Asyut, Egypt. time_dr@yahoo.com.
4
Department of Chest Disease, Faculty of Medicine, Assiut University, Asyut, Egypt.
5
Department of Diagnostic Radiology, South Egypt Cancer Institute, Assiut University, Asyut, Egypt.
6
Department of Diagnostic and Interventional Radiology, Alexandria University, Alexandria, Egypt.
7
Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Asyut, Egypt.


Authors:
Youssef MAM1, Salah Eldeen E2, Elsayh KI1, Taha SF1, Abo-Elela MGM1.

Title:
High Dose Dexamethasone As An Alternative Rescue Therapy For ‎Active Bleeding In Children With Chronic ITP: Clinical And ‎Immunological Effects

Abstract:
High-dose dexamethasone (HD-DXM) is debated as a second-line therapy for chronic Immune thrombocytopenia (ITP) in children. The aim of this study is to evaluate the efficacy and safety of HD-DXM as an emergency therapy in uncontrolled bleeding in children with chronic ITP and to assess its immunological effect on dendritic cells (DCs) percentage and their co-stimulatory markers CD86 and CD83. Totally, 20 children previously diagnosed as chronic ITP were enrolled in this study and all admitted to hospital with uncontrolled bleeding. Patients received HD-DXM as a single daily dose for 4 days. Blood samples were withdrawn from patients just prior to HD-DXM therapy and on day 5 to evaluate the platelet count and for flowcytometric analysis of DCs. Daily assessment of bleeding severity was performed. The platelet counts significantly increased in patients after 5 days of initiation of therapy compared with platelet count before therapy (p-value = 0. 0002). Control of bleeding observed in (90%), complete response (CR) documented in (50%), response (R) documented in (40%), and no response (NR) documented in (10%) of patients. The time to respond was raging from 1 to 3 days and minor complication recorded in two patients. Both plasmacytoid DCs and myeloid DCs percentage and their expression of co-stimulatory markers, CD86 and CD83 decreased significantly after HD-DXM therapy. Conclusion: short course of HD-DXM as a rescue therapy seems to be an effective alternative emergency treatment for uncontrolled bleeding in chronic ITP children especially in nations with limited resources.

Author Info:
1
a Assiut Children Hospital, Faculty of Medicine , Assiut University , Assiut , Egypt.
2
b Assiut Clinical Pathology Department, Faculty of medicine , Assiut University , Assiut , Egypt.


Authors:
Zahran AM1, Aly SS2, Rayan A3, El-Badawy O4, Fattah MA5, Ali AM5, ElBadre HM6, Hetta HF4.

Abstract:
BACKGROUND AND AIM:
Acute myeloid leukemia (AML) is one of the most common leukemias in adults. AML is generally regarded as a stem cell disease characterized by an accumulation of undifferentiated and functionally heterogeneous populations of cells, The aim of the present study was to identify leukemia stem cells in patients with AML and their correlations with treatment outcomes namely remission status, disease free survival, and overall survival.

RESULTS:
The mean percentages of CD34+CD38- and CD34+CD38low/-CD123+ LSCs were 2.2± 0.4and 22.3± 2.6, respectively. The percentages of CD34+cells, CD34+CD38- and CD34+CD38low/-CD123+ LSCs were significantly lower in AML patients with complete remission than those without complete response (P<0.001, P<0.004, P<0.001 respectively). The mean OS of all study patients was 20.03±1.2 months while the median OS was 21 months (95% CI=18.32-21.48). The mean DFS was 16.96±1.02 months and the median was 18 months (95% CI=8.9-11.4). DFS and OS were significantly higher among those who achieved CR than those without CR. In addition, there were significant negative effects of WBCs, CD34+cells, CD34+CD38- and CD34+CD38-CD123+LSCs on DFS and OS.

PATIENTS AND METHODS:
We investigated 30 patients with newly diagnosed AML; all patients underwent complete history taking, and thorough physical and clinical examination, complete blood count. Peripheral smears and bone marrow aspirates were also examined. Cytochemistry and immunophenotyping of leukemic cells were performed routinely in bone marrow using monoclonal antibodies. Flow cytometry was used to analyze leukemia stem cells and their expression of CD123.

CONCLUSION:
Our study elucidated that CD34+CD38-LSCs, with or without CD123+LSCs phenotype was present in a significant proportion of AML patients and it could be responsible for resistance to traditional treatments, and high percentage of MRD that was translated into significantly high number of non CR, poor DFS, and OS.

Author Info:
1
Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
2
Clinical and Chemical Pathology Department, Faculty of Medicine, South Valley University, Qena, Egypt.
3
Clinical Oncology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Medical Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
6
Medical Biochemistry Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Zahran AM1, El-Badawy O2, Mohamad IL3, Tamer DM3, Abdel-Aziz SM3, Elsayh KI3.

Title:
Platelet Activation and Platelet-Leukocyte Aggregates in Type I ‎Diabetes Mellitus‎

Abstract:
Hyperglycemia alone may not explain the increased risk of cardiovascular diseases (CVDs) in patients with type 1 diabetes (T1D) compared with type 2. This study emphases on the evaluation of some platelet activity markers in patients with T1D, with relevance to some metabolic disorders as hyperlipidemia and hyperglycemia. This study was performed on 35 patients with T1D and 20 healthy controls. All participants were subjected to full history taking, clinical examination and assay of glycated hemoglobin (HbA1c), and lipid profile. The expression of CD62P and CD36 on platelets and the frequency of platelet-monocyte, and platelet-neutrophil aggregates were assessed by flow cytometry. Patients showed significantly higher expression of CD62P and CD36 than the control group. Platelets aggregates with monocytes were also higher among patients than the control group. Levels of CD36+ platelets, CD62P+ platelets, and platelet-monocyte aggregates revealed significant correlations with the levels of HbA1c, total cholesterol, low-density lipoprotein, and triglycerides. Hyperlipidemia and hyperglycemia accompanying T1D have a stimulatory effect on platelet activation which probably makes those patients vulnerable to CVD than nondiabetics.

Author Info:
1
1 Department of Clinical Pathology, South Egypt Cancer Institute, Assiut, Egypt.
2
2 Medical Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
3 Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abdel Meguid AM1, Abdel Motaleb AA1, Abdel Sadek AMI2.

Title:
Cryotherapy Vs Trichloroacetic Acid 90% in Treatment of Common ‎Warts‎

Abstract:
INTRODUCTION:
Common warts are hyperkeratotic, benign cutaneous growths caused by types 1, 2, and 7 Human papilloma viruses. Different modalities are available to treat warts. Cryotherapy is one of the most common and effective treatments for common warts. Trichloroacetic acid (TCA), in high concentrations, can be used as a therapeutic modality.

OBJECTIVES:
The aim of this study is to compare the efficacy and safety of cryotherapy using liquid nitrogen (spray method) versus trichloroacetic acid 90% in treatment of common warts.

PATIENTS AND METHODS:
Thirty-five patients with 414 common warts, from the Dermatology outpatient clinic, Assiut University Hospital, were enrolled in this study. We used two techniques for the treatment of common warts. The lesions in each patient were divided into two groups (A and B), group A treated by cryotherapy while group B treated by trichloroacetic acid (TCA) 90%.

RESULTS:
There was significant decrease in the size of the warts in both groups. There were statistically significant better results among group A than group B regarding the mean percentage of improvement (90.11 ± 27.92 vs 26.19 ± 42.93, respectively; P < 0.001) and grade of improvement, where good response was obtained in 89.2% in group A compared with 26.2% in group B (P < 0.001). Complete cure was significantly higher in group A (83.1%) than group B (21.3%; P < 0.001). However, side effects were significantly higher among group A than group B.

CONCLUSION:
Cryotherapy is more effective than TCA 90% in treatment of common wart. TCA 90% has lesser complications than cryotherapy.

Author Info:
1
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Qena Hospital, Qena, Egypt.


Authors:
Zahran AM1, Saad K2, Abdel-Raheem YF3, Elsayh KI3, El-Houfey AA4,5, Aboul-Khair MD6, Alblihed MA7

Title:
Characterization of Regulatory T Cells in Preterm and Term Infants

Abstract:
Our study aimed to study regulatory T cells (Tregs) and their expression of CD45RA, HLA-DR, and CD39 in preterm and full-term infants. In an observational study, we used a three-color flow cytometry for determination of Tregs and their expression of CD45RA, HLA-DR, and CD39 in preterm and full-term infants. The percentages of CD4+CD25+highFoxp3+, CD39+ Tregs, HLA-DR+ Tregs and the expression of Foxp3+ in CD4+CD25+highFoxp3 Tregs cells were significantly lower in neonates when compared to healthy adult controls. The levels of naïve resting Tregs (CD45RA+Tregs) were significantly higher in neonates than controls. The percentages of CD4+CD25+highFoxp3+Tregs, total CD4+CD25+ and CD4+CD25+high were significantly higher in preterm infants when compared to the full-term group. Moreover, CD45RA+Tregs were significantly higher in preterm than in term infants. We found significant inverse correlations between the gestational age and the levels of both Tregs (r = - 0.395, p = 0.017) and CD45RA+Tregs (r = - 0.422, p = 0.010). Relative to full-term, the frequencies, and phenotypes of Tregs were affected by prematurity. A larger longitudinal study with a sufficient number of newborns is needed to investigate the Treg pool of term and preterm infants thoroughly and to explore the association between the Treg pool and clinical variables.

Author Info:
1
Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
2
Pediatric Department, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt. ksaad8@yahoo.com.
3
Pediatric Department, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt.
4
Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt.
5
Department of Community Health Nursing, Sabia University College, Jazan University, Jizan, Kingdom of Saudi Arabia.
6
Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
7
Department of Medical Biochemistry, School of Medicine, Taif University, Taif, Kingdom of Saudi Arabia.


Authors:
Alanwar A1, El Nour AA2, El Mandooh M2, Abdelazim IA2, Abbas L2, Abbas AM3, Abdallah A4, Nossair WS5, Svetlana S6

Title:
Prognostic accuracy of cerebroplacental ratio for adverse perinatal outcomes in pregnancies complicated with severe pre-eclampsia; a prospective cohort study.

Abstract:
OBJECTIVE:
The current study aims to assess the efficacy of fetal middle cerebral artery/umbilical artery pulsatility index ratio (cerebroplacental ratio CPR) in predicting the occurrence of adverse perinatal outcomes in pregnancies complicated with severe pre-eclampsia.

MATERIALS AND METHODS:
This cohort study included 100 pregnant women between 34 and 40 weeks of gestation attended the labor ward and diagnosed with severe pre-eclampsia. Doppler evaluation was carried out to measure the CPR. Apgar score and fetal umbilical artery pH were assessed within 5 min of delivery. The rate of neonatal intensive care unit (NICU) admission was obtained.

RESULTS:
Apgar score at 5 min >7 was in 82 cases (82%) and 12 cases (12%) scored < 7. Fetal blood PH was >7.2 in 67% of cases while 33% of cases had PH <7.2. As regard the NICU admission; 66% of neonates did not need admission while 34% of neonates were admitted to the NICU. There was a significant association between CPR and low Apgar score at 5 min (P < 0.001). The sensitivity of CPR in detection of Apgar score <7 was 50%, and specificity 88.1%. CPR had a poor predictive value of the low umbilical artery PH <7.2 (P = 0.318) with 43.75% sensitivity and 69.05% specificity. There was a significant association between CPR and NICU admission (P = 0.009).

CONCLUSIONS:
Adding CPR ratio to routine antepartum fetal surveillance from 34 weeks gestation may help with patient counseling regarding adverse neonatal outcomes for women with severe pre-eclampsia as there is a strong correlation between it and adverse neonatal outcomes.

Author Info:
1
Department of Obstetrics and Gynecology, Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: ahmed.elanour@med.asu.edu.eg.
2
Department of Obstetrics and Gynecology, Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
3
Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Obstetrics and Gynecology, Minia University, Minia, Egypt.
5
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
6
Department of Obstetrics and Gynecology, Marat Ospanov, West Kazakhstan State Medical University, Aktobe, Kazakhstan.


Authors:
Conrotto F1, Bertaina M1, Raposeiras-Roubin S2, Kinnaird T3, Ariza-Solé A4, Manzano-Fernández S5, Templin C6, Velicki L7, Xanthopoulou I8, Cerrato E9, Rognoni A10, Boccuzzi G11, Omedè P1, Montabone A11, Taha S12, Durante A13, Gili S6, Magnani G6, Autelli M1, Grosso A1, Flores Blanco P5, Garay A4, Quadri G9, Varbella F9, Caneiro Queija B2, Cobas Paz R2, Cespón Fernández M2, Muñoz Pousa I2, Gallo D14, Morbiducci U14, Dominguez-Rodriguez A15, Valdés M5, Cequier A4, Alexopoulos D8, Iñiguez-Romo A2, Gaita F1, Abu-Assi E2, D'Ascenzo F1.

Title:
Prasugrel or ticagrelor in patients with acute coronary syndrome and diabetes: a propensity matched substudy of RENAMI.

Abstract:
INTRODUCTION:
The safety and efficacy of prasugrel and ticagrelor in patients with diabetes mellitus presenting with acute coronary syndrome and treated with percutaneous coronary intervention remain to be assessed.

METHODS:
All diabetes patients admitted for acute coronary syndrome and enrolled in the REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) were compared before and after propensity score matching. Net adverse cardiovascular events (composite of death, stroke, myocardial infarction and BARC 3-5 bleedings) and major adverse cardiovascular events (composite of death, stroke and myocardial infarction) were the co-primary endpoints. Single components of primary endpoints were secondary endpoints.

RESULTS:
Among 4424 patients enrolled in RENAMI, 462 and 862 diabetes patients treated with prasugrel and ticagrelor, respectively, were considered. After propensity score matching, 386 patients from each group were selected. At 19±5 months, major adverse cardiovascular events and net adverse cardiovascular events were similar in the prasugrel and ticagrelor groups (5.4% vs. 3.4%, P=0.16 and 6.7% vs. 4.1%, P=0.11, respectively). Ticagrelor was associated with a lower risk of death and BARC 2-5 bleeding when compared to prasugrel (2.8% vs. 0.8%, P=0.031 and 6.0% vs. 2.6%, P=0.02, respectively) and a clear but not significant trend for a reduction of BARC 3-5 bleeding (2.3% vs. 0.8%, P=0.08). There were no significant differences in myocardial infarction recurrence and stent thrombosis.

CONCLUSION:
Diabetes patients admitted for acute coronary syndrome seem to benefit equally in terms of major adverse cardiovascular events from ticagrelor or prasugrel use. Ticagrelor was associated with a significant reduction in all-cause death and bleedings, without differences in recurrent ischaemic events, which should be confirmed in dedicated randomised controlled trials.

Author Info:
1
1 Department of Cardiology, University of Turin, Turin, Italy.
2
2 Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain.
3
3 Cardiology Department, University Hospital of Wales, Cardiff, UK.
4
4 Department of Cardiology, University Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
5
5 Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain.
6
6 Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
7
7 Department of Cardiology, Institute of Cardiovascular Diseases, Vojvodina, Serbia.
8
8 Department of Cardiology, University Patras Hospital, Rio, Patras, Greece.
9
9 Interventional Unit, San Luigi Gonzaga University Hospital, San Luigi, Italy.
10
10 Catheterization Laboratory, Maggiore della Carità Hospital, Novara, Italy.
11
11 Department of Cardiology, S.G. Bosco Hospital, Turin, Italy.
12
12 Department of Cardiology, Assiut University, Assiut, Egypt.
13
13 U.O. Cardiologia, Ospedale Valduce, Como, Italy.
14
14 PolitoBIOMed Lab, Politecnico di Torino, Turin, Italy.
15
15 Department of Cardiology, University Hospital of Canarias, Santa Cruz de Tenerife, Spain.


Authors:
Darwish A1, Bahlol M2, Ahmad A2, Fekry M2.

Title:
Uterus-sparing vaginolaparoscopic sacrocolpopexy for apical pelvic organ prolapse

Abstract:
INTRODUCTION AND HYPOTHESIS:
Our aim was to evaluate the safety, feasibility, and effectiveness of a vaginolaparoscopic sacrocolpopexy (VLS) technique for treating apical pelvic organ prolapse (POP).

MATERIALS AND METHODS:
This was a prospective interventional case series (design classification: Canadian Task Force II3) performed in the endoscopic unit of a tertiary care referral facility and university hospital. We assessed 15 symptomatic parous women with stage ≥2 apical POP according to the POP Quantification (POP-Q) classification. Interventions comprised posterior colpotomy with mesh fixation to the uterosacral ligaments and the back of the uterus that was further fixed to the anterior longitudinal ligament of the sacrum using a tacker via laparoscopy.

RESULTS:
The main outcome was a significant postoperative improvement in prolapse and resultant improvement in quality of life (QoL) after VLS. Six patients required concomitant reconstructive procedures. Mean operative time for the vaginal phase was 8.54 ± 3.10 (7-12) min and 32.36 ± 8.2 (27-41) min. for the laparoscopic phase Mean duration of VLS ranged from 30 to 50 min. At the 6-months follow-up, the procedure was successful in 14 of 15 patients (93.34%); one woman (6.66%) presented with recurrence at a lower stage. Neither mesh complications nor sacral ostitis were encountered. There was significant improvement in vaginal symptoms, sexual well-being, QoL, and clinical staging after the procedure.

CONCLUSION:
By eliminating all forms of intraperitoneal suturing, performing a posterior colpotomy, and the advent of tackers without evidence of sacral ostitis, VLS seems to be a simple, feasible, effective, and fast approach for treating POP.

Author Info:
1
Department of Obstetrics & Gynecology, Women's Health University Hospital, P.O. Box: 1, Assiut, 71111, Egypt. atef_darwish@yahoo.com.
2
Department of Obstetrics & Gynecology, Women's Health University Hospital, P.O. Box: 1, Assiut, 71111, Egypt.


Authors:
Foad AZ1, Mansour MA2, Ahmed MB1, Elgamal HR1,3, Ibrahim HEE4, Elawamy A5.

Title:
Real-time ultrasound-guided retrobulbar block vs blind technique for cataract surgery (pilot study).

Abstract:
BACKGROUND:
Retrobulbar regional eye block aims to ensure eye globe akinesia and anesthesia during ophthalmic surgery, and despite the rarity of occurrence of complications due to the blind needle passage while performing either peribulbar or retrobulbar block, some of them are serious and may be life threatening.

AIM:
The aim of this study was to estimate the accuracy and safety of real-time ultrasound-guided retrobulbar regional anesthesia in comparison with the blind technique for cataract surgery.

DESIGN:
This was a prospective randomized controlled trial.

METHODOLOGY:
A total of 30 patients who met the inclusion criteria were registered in our research and were divided into two groups: 15 patients received real-time ultrasound-guided retrobulbar block compared to 15 patients who received the block using the blind technique.

RESULTS:
One patient out of the 30 was excluded from the analysis, and no statistically significant differences were observed between the two groups regarding the onset of akinesia, numeric pain rating scores, rate of complications, and degree of patient and physician satisfaction.

CONCLUSION:
There were no statistically significant difference between real-time ultrasound-guided and blind retrobulbar regional eye blocks concerning the onset of action, total volume of injected local anesthetic solution, supplemental injection required, pain scores, and degree of patient satisfaction.

Author Info:
1
Kasr Alainy, Cairo University, Haram, Giza, Egypt, mahmoud_badry2000@yahoo.com.
2
Kasr Alainy, Cairo University, Nasr City, Cairo, Egypt.
3
Kasralainycairo University, Elmariotia, Haram, Giza, Egypt.
4
Kasralainycairo University, Elharam, Giza, Egypt.
5
Asiout University, Asyut, Egypt.


Title:
Iron deficiency and cyanotic breath-holding spells: The effectiveness of iron therapy.

Abstract:
AIM:
Frequent cyanotic breath holding spells cause fear and severe anxiety to parents. This study aimed to evaluate clinical, laboratory and treatment characteristics of children with cyanotic breath holding spells.

METHODS:
Included were 180 children (mean age: 1.82 ± 0.53 years) with cyanotic breath holding spells. They were divided into three groups: with iron deficiency, with iron deficiency anemia and without iron deficiency. Blood hemoglobin (HB), ferritin and iron concentrations were measured at baseline and after 3 and 6 months of iron treatment.

RESULTS:
The mean spell frequency was 24.57 ± 7.31/months, 83% had spells after the age of 1 year, 37% had daily spells, 16% had family history of spells, and 61% had Iron deficiency/Iron deficiency anemia (p = .001). No significant difference in the frequency of spells between children with iron deficiency and those with Iron deficiency anemia. Compared to patients without iron deficiency, there was significant reduction of spells frequency, increased hemoglobin, ferritin and iron levels after 3 and 6 months of iron therapy (p = .0001). Negative correlations were observed between spell frequency with hemoglobin (p = .001), ferritin (p = .0001) and iron (p = .001) levels.

CONCLUSION:
Not only Iron deficiency anemia but also iron deficiency alone without anemia is associated with a risk of high-frequency cyanotic breath holding spells. Iron therapy results in reduction in spells' frequency which was correlated with increasing ferritin and iron levels.

Author Info:
1
a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt.
2
b Department of Pediatrics , Children's Hospital, Assiut University , Assiut , Egypt.
3
c Department of Clinical Pathology , Assiut University Hospital , Assiut , Egypt.


Authors:
Moutsiana C1,2, Soliman R3,4, de Wit L2, James-Galton M5, Sereno MI6,7, Plant GT5, Schwarzkopf DS8,9.

Title:
Unexplained Progressive Visual Field Loss in the Presence of Normal Retinotopic Maps

Abstract:
Lesions of primary visual cortex or its primary inputs typically result in retinotopically localized scotomas. Here we present an individual with unexplained visual field loss and deficits in visual perception in the absence of structural damage to the early visual pathway or lesions in visual cortex. The subject, monocular from an early age, underwent repeated perimetry tests over 8 years demonstrating severe anopia of the lower hemifield, and a clockwise progression of the loss through her upper left visual field. Her visual impairment was evident in a number of standardized tests and psychophysics, especially in tasks assessing spatial integration using illusory contours. However, her intellectual ability was intact and her performance in some other tasks assessing color vision or object detection in scenes was normal. We employed functional magnetic resonance imaging (fMRI), electroretinography and visually evoked potentials. Surprisingly, in contrast to the participant's severe anopia, we found no evidence of abnormal function of her early visual pathways. Specifically, we performed retinotopic mapping using population receptive field (pRF) analysis to map the functional organization of visual cortex in the anopic participant and three control participants on two occasions three and a half years apart. Despite the behavioral visual field loss, her retinotopic maps and pRF parameters in visual areas V1-V3 were qualitatively normal. Further behavioral experiments confirmed that this discrepancy was not trivially explained by the difference between stimuli used for retinotopic mapping and perimetry. Structural T1 scans were normal at both time points, and volumetric analysis of white and gray matter tissue on the segmented T1 volumes did not reveal any abnormalities or deterioration over time. Our findings suggest that normal functional organization of early visual cortex without evident structural damage to the early visual pathway as disclosed by the techniques employed in this study does not necessarily guarantee conscious perception across the visual field.

Author Info:
1
Psychology, School of Social Sciences, University of Westminster, London, United Kingdom.
2
Division of Psychology and Language Sciences, University College London, London, United Kingdom.
3
Radio-Diagnosis, Assiut University Hospitals, Asyut, Egypt.
4
The Institute of Neurology, University College London, London, United Kingdom.
5
National Hospital for Neurology and Neurosurgery (NHNN), London, United Kingdom.
6
Psychology, San Diego State University, San Diego, CA, United States.
7
Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom.
8
School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.
9
UCL Institute of Cognitive Neuroscience, London, United Kingdom.


Authors:
Youssef MAM1, Zahran AM2, Hussien AM1, Elsayh KI1, Askar EA1, Farghaly HS1.

Title:
In neonates with vitamin D deficiency, low lymphocyte activation markers are risk factors for infection

Abstract:
BACKGROUND:
Vitamin D has regulatory effects on different cells of the immune system and low levels are associated with several immune-mediated diseases.

AIM:
To investigate the association between neonatal 25-hydroxy vitamin D (25-OHD) level and the expression of lymphocyte activation markers (HLA-DR, CD69, CD25, CD45RA) on T-lymphocyte subpopulations and its impact in neonatal infection.

METHODS:
25-OHD level was measured in the cord blood of 56 neonates and their mothers using an enzyme immune-assay method. Based on the 25-OHD level, infants were categorised into four groups: severe deficiency (n = 7), moderate deficiency (n = 21), mild deficiency (n = 15) and normal 25-OHD level (n = 13). Mothers were classified into deficient (n = 18), insufficient (n = 21) and normal levels (n = 17). T-lymphocyte subpopulations and lymphocyte activation markers were investigated using flow cytometry.

RESULTS:
There was a positive correlation between maternal and cord blood 25-OHD levels (r = 0.503, p = 0.001). The group with severe 25-OHD deficiency had the significantly lowest level of total lymphocytes, CD3+ T lymphocytes, CD4+ T-helper and CD8+ T-cytotoxic lymphocytes and CD4+CD45RA+ naïve T-cells compared with the other groups. The frequencies of CD8+CD25+, CD4+CD25+ and CD4+HLA-DR+ activated T-lymphocytes were significantly lower in the severe, moderate and mild deficiency groups than in the normal group. Seven of 43 (16.27%) infants with 25-OHD deficiency were admitted with sepsis to the neonatal intensive care unit and there were no cases of sepsis in the normal 25-OHD group.

CONCLUSION:
Vitamin D deficiency is associated with a reduction of lymphocyte subsets and altered T-lymphocyte activation which are considered to be risk factors for neonatal infection.

Author Info:
1
a Children Hospital, Faculty of Medicine , Assiut University , Egypt.
2
b Clinical Pathology Department, South Egypt Cancer Institute , Assiut University , Assiut , Egypt.


Title:
Bilateral uterine artery ligation plus intravenous tranexamic acid during cesarean delivery for placenta previa: a randomized double-blind controlled trial

Abstract:
OBJECTIVE:
To investigate the effect of adjunctive intravenous tranexamic acid (TA) on blood loss during cesarean section (CS) in patients with placenta previa undergone bilateral uterine arteryligation (BUAL).

METHODS:
The study was double-blind randomized controlled trial carried out in a tertiary University Hospital between June 2016 to October 2017. We includedpatients scheduled for CS due to placenta previa. They were randomly allocated to group (I) managed by BUAL alone and group (II) managed by intravenous TA plus BUAL. The primary outcome was the amount of totalestimatedblood loss both intra- and post-operative.

RESULTS:
Sixty-two patients were enrolled (n = 31 in each group). Patients received intravenous TA showed great reduction in total estimated blood loss compared with BUAL alone (p = .001). Additionally, the post-operative pulse was significantly higher in group (I) compared with group (II) (p = .002) and post-operative hemoglobin concentration was significantly lower in the same group compared with the other group (p = .034). More additional uterotonics was needed in group (I) than group (II) (29% vs. 3.2%, p = .006). Blood transfusion ≥4 units was required in 17 (54.8%) patients in group (I) versus 4 patients in group (II) (12.9%) (p = .0001). No difference between the study groups regarding the rate of cesarean hysterectomy (p = .27).

CONCLUSION:
The adjunctive use of intravenousTA in patients undergone BUAL due to placenta previa is associated with decrease blood loss, need for additional uterotonics and blood transfusion during CS compared with BUAL alone.

Author Info:
1
Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Egypt. Electronic address: bmr90@hotmail.com.
2
Department of Obstetrics & Gynecology, Faculty of Medicine, Aswan University, Egypt.


Date of Publishing:
Volume 23, Issue 4, December 2018, Page 514

Title:
Does sublingual misoprostol reduce pain and facilitate IUD insertion in women with no previous vaginal delivery? Methodological and statistical concerns

Author Info:
Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Abbas, A.M.aEmail Author,  Ali, S.S.a,  Salem, M.N.b,  Sabry, M.b

Date of Publishing:
Volume 23, Issue 4, December 2018, Pages 491-495

Title:
Effect of oral ketoprofen on pain perception during copper IUD insertion among parous women: A randomized double-blind controlled trial

Abstract:
Objective: The study aims to evaluate the analgesic effect of oral ketoprofen prior to copper intrauterine device (IUD) insertion on pain perception during the insertion procedure. Study design: A randomized double-blind controlled trial (Clinical Trials. Gov: NCT02905058). Setting: Assiut Women's Health Hospital, Assiut, Egypt. Materials and methods: The current study was conducted in the Family Planning Outpatient Clinic of a tertiary university hospital between October 2016 and February 2017. Parous women eligible for Copper IUD insertion were recruited and randomized in a 1:1 ratio to oral ketoprofen 150 mg or placebo tablets. The participants were asked to take 1 tablet of the study medications one hour before IUD insertion. The primary outcome was the difference in pain scores during the IUD insertion using a 10-cm Visual Analogue Scale (VAS). We considered a 1.5 cm difference in VAS scores between study groups as clinically significant. Results: One hundred forty women were enrolled (n = 70 in each group). ketoprofen significantly has lower mean pain score during all steps of IUD insertion with p < .001 except at tenaculum placement. Additionally, the duration of IUD insertion was significantly lower in the ketoprofen group (5.97 ± 1.78 vs. 7.20 ± 1.52 min, p = .023). The mean satisfaction scores were 7.04 ± 2.58 and 5.06 ± 2.01 in the ketoprofen and placebo groups respectively (p = .000). A lower ease of insertion score was observed among ketoprofen group (2.10 ± 1.59 vs. 3.70 ± 1.32, p = .016). No women reported adverse effects in both groups. Conclusion: This study depicts that the use of 150 mg oral ketoprofen prior to IUD insertion in parous women reduces the pain perception and increases the satisfaction of women with this highly effective long acting contraceptive method. © 2018 Middle East Fertility Society

Author Info:
aDepartment of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt
bDepartment of Obstetrics & Gynecology, Faculty of Medicine, Sohag University, Egypt


Authors:
Abdel Moneim, W.M.aEmail Author,  Yassa, H.A.aEmail Author,  Makboul, R.A.bEmail Author,  Mohamed, N.A.aEmail Author

Date of Publishing:
Volume 8, Issue 1, 1 December 2018, Article number 9

Title:
Monosodium glutamate affects cognitive functions in male albino rats

Abstract:
Background: Monosodium Glutamate is a silent toxin in our food, especially our kids’ food. Some of the products in the market contain MSG in a level exceed the European limit. Method: Sixty male albino rats divided into three groups, control group, and treated groups, the first with a low dose of MSG (1/20 LD50) and the second with a high dose of MSG (1/10 LD50). All animals examined for cognitive function, serotonin level. The second part in this study, examination of some commercial food for the presence of MSG and its level by HPLC. Results: MSG affected the cognitive function of treated rats in small and high doses of MSG. The weight of the animals in treated group with a high dose of MSG was significantly increased in comparison with the control group. Also, the cognitive function of the rats administered MSG affected significantly either in low dose and in high dose. Some of the studied commercial food in the market like Kapsa and Indomi contains a higher level of MSG more than the European limit. Conclusion: MSG has many dangerous effects on health especially kids, so it is so necessary to declare its presence or absence and level on the labels of the products. © 2018, The Author(s).

Author Info:
aForensic Medicine and Clinical Toxicology Department, Faculty of Medicine Assiut University, Asyut, Egypt
bPathology Department, Faculty of Medicine Assiut University, Asyut, Egypt


Authors:
Abdel-Rahim MH1, El-Badawy O1, Hadiya S2, Daef EA1, Suh SJ3, Boothe DM4, Aly SA1.

Title:
Patterns of Fluoroquinolone Resistance in Enterobacteriaceae Isolated from the Assiut University Hospitals, Egypt: A Comparative Study.

Abstract:
BACKGROUND:
An increasing pattern of fluoroquinolone resistance (FQR) among bacterial pathogens has been described worldwide. In this study, we compared the patterns of genetic mechanisms that confer FQR for Escherichia coli and Klebsiella pneumoniae isolated from the Assiut University Hospitals in Egypt.

METHODS:
Eighty-seven clinical E. coli and K. pneumoniae isolates were tested for mutations in gyrA, gyrB, parC, and parE genes by polymerase chain reaction (PCR) amplification and DNA sequencing. The presence of plasmid-mediated quinolone resistance (PMQR) genes qnrA, qnrB, qnrS, aac(6')-Ib, qepA was screened by PCR and characterized by conjugation. Correlations between different FQR mechanisms and ciprofloxacin minimal inhibitory concentration (MIC) levels were determined.

RESULTS:
A higher number of quinolone resistance-determining region (QRDR) mutations was detected in E. coli, while the number of PMQR determinants was significantly higher in K. pneumoniae. However, K. pneumoniae showed stronger correlations than E. coli between MIC levels and number of mutations in the QRDR per isolate (rs = 0.8, p < 0.0001 and rs = 0.7, p < 0.0001, respectively) as well as between MIC levels and number of plasmids (rs = 0.4, p = 0.005 and rs = 0.3, p = 0.02, respectively).

CONCLUSIONS:
Although we observed a prevalence of chromosomal mutations for E. coli and the presence of plasmid-encoded genes for K. pneumoniae that resulted in FQR phenotype, high levels of FQR appeared to occur as a result of gradual accumulation of mutations in QRDR for both bacteria. To our best of knowledge, this is the first study to report and compare the correlation between FQ MIC levels and different genetic mechanisms for FQR in Enterobacteriaceae.

Author Info:
1
1 Department of Microbiology and Immunology, Faculty of Medicine, Assiut University , Assiut, Egypt .
2
2 Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University , Assiut, Egypt .
3
3 Department of Biological Sciences, Auburn University , Auburn, Alabama.
4
4 Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University , Auburn, Alabama.


Authors:
Abdel-Salam, D.M.a,bEmail Author,  Alnuman, R.W.c,  Alrwuaili, R.M.c,  Alrwuaili, G.A.c,  Alrwuaili, E.M.c

Date of Publishing:
Volume 23, Issue 4, December 2018, Pages 435-439

Title:
Epidemiological aspects of dysmenorrhea among female students at Jouf University, Saudi Arabia

Abstract:
Background and objectives: Dysmenorrhea is a prevalent problem among young adults and adolescents. The objectives of the present study were to assess the prevalence, determinants, impact and treatment of dysmenorrhea among female students at Jouf University, Saudi Arabia. Methods: A cross-sectional study was implemented among 366 female students at Jouf University through multistage proportionate sampling method. A pre-designed, anonymous, self-administered questionnaire was used. Descriptive and analytical statistics were conducted. Results: Nearly 88% of the students had dysmenorrhea (mild 8.7%, moderate 57.3%, severe 34%). Significant predictors of dysmenorrhea were cycle irregularity, heaviness of menstrual flow and longer cycle length. Two third of the students took herbs to relieve symptoms of dysmenorrhea. Fatigue, emotional disturbances, abdominal distension, nausea, vomiting and sleep disturbances were the commonest associated symptoms. Effect on the daily activities because of dysmenorrhea was reported by 87% of students. Conclusion: A high prevalence of dysmenorrhea was detected among female students at Jouf University. Screening programs and health promotion are recommended. © 2018 Middle East Fertility Society

Author Info:
aDepartment of Family and Community Medicine, College of Medicine, Jouf University, Saudi Arabia
bDepartment of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Egypt
cMedical students, College of Medicine, Jouf University, Saudi Arabia


Authors:
AbdelHafez, F.F.a,bEmail Author,  Tang, Y.b,  Hassan, M.H.c,  Saleem, T.H.d

Date of Publishing:
Volume 23, Issue 4, December 2018, Pages 278-280

Title:
Assessment of Anti-Mullerian Hormone (AMH) levels in a pilot cohort of peripubertal females: Correlation with sex maturity rating (SMR)

Abstract:
Objective: Anti-Müllerian Hormone (AMH) is a quantitative marker for ovarian reserve found to be independent of the menstrual cycle. The objective of this study was to determine whether serum AMH levels correlate with sex maturity rating (SMR) in a group of peripubertal elementary school girls. Study design: This cohort study was conducted in a tertiary care facility. Baseline blood sampling was obtained in 71 peripubertal healthy elementary school girls from Upper Egypt. AMH was measured using commercially available kit (DSL Inc., Webster, TX, USA). SMR was determined clinically through observations of pubic hair and breast development rated from 1 (preadolescent) to 5 (mature adult female). A bivariate analysis was conducted between age, weight, SMR, and the AMH level. Data was stratified for further analysis by SMR, and SMR 3 and 4 were combined to ensure suitable sample size. Statistical analysis was done using R software version 3.2.2 (R Foundation for Statistical Computing, Vienna, Austria). Results: Seventy-one observations were analyzed with a mean age of 9.31 ± 1.80 years. Mean weight was 28.87 ± 7.45 kg, and the mean AMH level was 2.05 ± 0.52 ng/mL. SMR observations included 15 with SMR of 1 (21%), 26 with SMR of 2 (37%), 26 with SMR of 3 (37%), and 4 with SMR of 4 (6%). There were no significant associations between age, weight, SMR and AMH level. Upon stratifying the analysis by SMR, a significant correlation was found between age and AMH within the SMR of 3 and 4 grouping (rho = −0.4194, p = 0.02106). When considering all variables for regression it was found that the model that best fit the data was comprised of only an intercept term. Age, weight, and SMR were not included in the final regression model. Conclusion: The correlation of AMH with an advanced stage of maturation (SMR 3&4) may reflect modest late pubertal AMH peaks in this population of females. The proportionate association of AMH with breast development, reflective of the gonadotropins and steroidogenic functions, supports its role as a marker of ovarian function in young females. © 2018 Middle East Fertility Society

Author Info:
aDepartment of Obstetrics and Gynecology, Assiut Women's Health Center, Assiut University, Egypt
bFaculty of Medicine, University of British Columbia, Vancouver, BC, Canada
cBiochemistry Department, Qena School of Medicine, Qena, Egypt
dBiochemistry Department, Assiut School of Medicine, Assiut, Egypt


Authors:
Aboelkasem Ali Mousa, M.,  Abdelsabour Abdallah, M.,  Shamseddin Mohammad, H.Email Author,  Ahmad Aly Youssef, A.

Date of Publishing:
Volume 70, Issue 4, December 2018, Pages 403-407

Title:
Early predictors of left ventricular remodeling after primary percutaneous coronary intervention

Author Info:
Department of cardiology, Assiut University, Assiut, Egypt


Authors:
Akbas, M.a,  Elawamy, A.R.b,  Salem, H.H.cEmail Author,  Fouad, A.Z.d,  Abbas, N.A.d,  Dagistan, G.a  View

Date of Publishing:
Volume 21, Issue 5, September-October 2018, Pages E501-E508

Title:
Comparison of 3 approaches to percutaneous epidural adhesiolysis and neuroplasty in post lumbar surgery syndrome

Abstract:
Background: Percutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to be safe and effective in treating different spine pathologies, in particular post lumbar surgery syndrome (PLSS). Objectives: The purpose of this study was to compare the efficacy and complication rates of the 3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) used to treat PLSS. Study Design: This study used a case control, blind study. Setting: The research took place at the pain clinic and interventional pain practice room at Asyut University Hospital, Assiut, Egypt. Methods: Sixty consecutive PLSS patients were recruited and randomized into 3 groups (caudal, S1 foraminal, and L5-S1 transforaminal) before receiving adhesiolysis and neuroplasty. All patients underwent nerve conduction studies and magnetic resonance imaging (MRI). Pain severity levels were assessed and measured using the Oswestry Disability Questionnaire (OSW) and the Visual Analog Scale (VAS). Patient satisfaction was evaluated using a Likert scale. The first assessment was performed prior to the procedure to determine the patients’ baseline levels of pain severity. Follow-up assessments were performed 1-, 3-, and 6-months after the procedure. Results: Results of the group pairwise analysis indicated that, relative to baseline, there were significant decreases in pain relief scores (VAS and OWS) and functional assessment expressed by patients’ satisfaction across all time intervals and in all 3 groups (P < 0.01). Conversely, a between group analysis revealed that VAS, OWS, and patient satisfaction scores were comparable across the 3 groups at all time intervals (P > 0.05). There were no differences in rates of complications between the 3 different groups. Limitations: Our study was limited by the low number of patients and the short duration (6 months) of follow-up. Conclusion: The 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) result in the same outcome with regard to pain relief and complication rate. © 2018, American Society of Interventional Pain Physicians. All rights reserved.

Author Info:
aAlgology Division, Department of Anesthesia, Akdeniz University, Antalya, Turkey
bDepartment of Anesthesia, Assiut University, Assiut, Egypt
cDepartment of Neurology, Ain Shams University, Cairo, Egypt
dDepartment of Radiology, Cairo University, Cairo, Egypt


Authors:
Al-Hussaini, T.K.Email Author,  Shaaban, O.M.

Date of Publishing:
Volume 23, Issue 4, December 2018, Pages 354-356

Title:
Aspiration of endometrial cavity fluid at the time of egg collection

Abstract:
Aim: To evaluate the efficacy endometrial fluid aspiration at the time of egg collection. Methods: A prospective non-randomized pilot study of twelve infertile women who had ART (IVF-ICSI) at a University affiliated assisted conception unit. All women had persistent endometrial cavity fluid (ECF) in a controlled ovarian stimulation on the day of ovulation triggering. Results: Following the discovery of ECF on the day of ovulation triggering, all women were counselled for the possible management options. None of these women had opted for the alternatives of freeze all or aspiration of ECF just prior to ET. In ten women ECF was aspirated at the time of egg collection. Five out the ten women in whom ECF aspiration was performed became pregnant (50%). Spontaneous resolution of ECF occurred in the remaining two patients; both became pregnant. Conclusions: Aspiration of ECF at the time of egg collection is another new option for women with ECF. It obviated the need to freeze all or aspirate of ECF at the time of ET. It was associated with a good success andcan be a new convenient option in couples residing in low income countries. More studies are needed to establish the best management of ECF. © 2018 Middle East Fertility Society

Author Info:
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, El-Salama IVF/ICSI Center, Assiut, Egypt


Authors:
Alcaraz-Mateos E1, Jiang XS2, Mohammed AAR3, Turic I4, Hernández-Sabater L5, Caballero-Alemán F6, Párraga-Ramírez MJ6,7, Poblet E8,9.

Title:
A novel simulator model and standardized assessment tools for fine needle aspiration cytology training.

Abstract:
OBJECTIVES:
Fine needle aspiration (FNA) is an invaluable diagnostic procedure for evaluation of lesions; however, acquisition of diagnostic material is dependent on the skill of the practitioner. We report a novel patient simulator for teaching the FNA procedure and structured assessment tools for educators and learners.

METHODS:
We created a novel simulator model for FNA training, employed a standardized teaching module, and assessed procedure utility in medical students. Groups of students completed training using a commercial version of the model, and underwent structured evaluation using an Objective Structured Assessment of Technical Skills (OSATS) form, and the Debriefing Assessment for Simulation in Healthcare (DASH) tool.

RESULTS:
In the initial phase, 178 students rated the training workshop between valuable and essential (4.2 on a 5-point Likert scale). In the second phase, for students evaluated with the OSATS form, the mean overall score was 33 out of 50 (range 26-43). The areas of weakness for the participants were: (a) compression after the FNA procedure, (b) completion of the informed consent, and (c) correct explanation of the procedure to the patient. For the group of students that completed the DASH questionnaire, the results were: 6.2 (assessment by students) and 6.7 (assessment by instructor) out of a maximum of 7.

CONCLUSION:
A realistic simulation model, in combination with a standardized training program with formal assessment methods is a valuable tool to teach FNA. We here describe a process for teaching the FNA procedure to interested educators and learners.

Author Info:
1
Pathology Department, Hospital General Universitario Jose M Morales Meseguer, Murcia, Spain.
2
Pathology Department, Duke University Hospital, Durham, North Carolina.
3
Faculty of Medicine, Assiut University, Asyut, Egypt.
4
Faculty of Medicine, Split University, Split, Croatia.
5
University of Murcia, Murcia, Spain.
6
Intensive Care Unit, Hospital General Universitario Jose M Morales Meseguer, Murcia, Spain.
7
Faculty of Medicine, Universidad Católica San Antonio, Murcia, Spain.
8
Pathology Department, Hospital General Universitario Reina Sofía, Murcia, Spain.
9
Faculty of Medicine, University of Murcia, Murcia, Spain.


Authors:
Alhussaini M1, Abdelwahab A2, Arnaoutakis GJ3, Martin T3, Salama Ayyad MAK2, Ismail AIM2, Aalaei-Andabili SH3, Beaver TM4.

Title:
Neurologic Outcomes in Aortic Arch Repair with Frozen Elephant Trunk versus Two-stage Hybrid Repair.

Abstract:
BACKGROUND:
We compared outcomes of single-stage hybrid aortic arch replacement (frozen elephant trunk) versus two-stage hybrid repairs with primary open arch procedures followed by thoracic endovascular stenting.

METHODS:
Single-center retrospective review (2003-2016) of 118 patients undergoing hybrid repair of the aortic arch including: 48 single-stage repairs versus 70 two-stage repairs.

RESULTS:
Single-stage was performed in forty-eight patients 31 (64.6%) men; 17 (35.4%) women with a mean ± SD age of 64 ± 11 years and a two-stage procedure in 70 patients, including 42 (60%) men and 28 (40%) women with a mean ± SD age of 65.67 ± 13.3 years (P=0.46). More emergent single-stage procedures were performed 23/48 (47.9%) versus two-stage 8/70 (11.43%) (P<0.001). Between the single and two-stage groups, there was no difference in stroke [6.25% (3/48) vs 14.28% (10/70) (P=0.23)], spinal cord ischemia [4.16% (2/48) vs 5.7% (4/70) (P=1.0)] or 30-day mortality rate: 8/48 (16.7%) versus a combined 30-day mortality rate of two-stage 14.8% [4/70 (5.7%) first-stage and 5/55 (9.1%) second-stage] (P=0.56), respectively. After exclusion of the 30-day mortality, mid-term survival was 86% at 1-2 years for single-stage patients vs 80% at 1 year and 46% at 2-years for the two-stage patients. (p=0.0019).

CONCLUSIONS:
Both single-stage and two-stage hybrid arch replacements are effective approaches for treating complex aortic arch diseases. Early deaths and neurological outcomes in the single-stage group are comparable to those in the combined two-stage group. Furthermore, in this series, patients who had a single-stage hybrid procedure had a higher survival rate at 2 years.

Copyright © 2018. Published by Elsevier Inc.

Author Info:
1
Department of Cardiothoracic Surgery, Assiut University, Assiut, Egypt; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, USA.
2
Department of Cardiothoracic Surgery, Assiut University, Assiut, Egypt.
3
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, USA.
4
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, USA. Electronic address: thomas.beaver@surgery.ufl.edu.


Authors:
Ali, M.K.,  Abbas, A.M.Email Author,  Abdalmageed, O.S.,  Farghaly, T.A.,  Yosef, A.H.

Date of Publishing:
Volume 23, Issue 3, September 2018, Pages 211-215

Title:
Classic versus uterine sound-sparing approach for insertion of copper T380A intrauterine device: A randomized clinical trial

Abstract:
Objective: The current study compares the efficacy of the classic approach and the uterine sounding sparing approach (a new approach) for copper intrauterine device (Cu-IUD) insertion. Study design: A randomized clinical trial. Setting: Woman's Health Hospital, Assiut, Egypt. Materials and methods: The current study was an open parallel randomized clinical study conducted in Assiut Woman's Health Hospital, Egypt included women requesting Copper IUD insertion. Enrolled women were randomized into 2 groups; group I included women subjected to classic approach for Cu-IUD insertion and group II included women had Cu-IUD insertion using the uterine sound-sparing approach (USSA). This approach utilized transvaginal ultrasound (TV/US) for assessment of the uterine cavity length and position before IUD insertion without using uterine sounding. The primary outcome was the successful Cu-IUD insertion. Results: 46 women were analyzed in group I and 46 in group II. The pain during IUD insertion and 5 min post-insertion was significantly lower in group II than group I (p <.001). The Cu-IUD inserted easier in group I than group II (p <.001). Moreover; significant shorter duration of insertion was reported in group II (p =.002). More satisfied women were found in group II (p =.0001). At the 4 weeks follow-up; TV/US showed that all IUDs were in place in all women. Conclusions: Cu-IUD can be inserted successfully without using uterine sound provided using TV/US prior to insertion. This method associated with less pain, greater women satisfaction during insertion with shorter duration. © 2017 Middle East Fertility Society

Author Info:
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt


Authors:
Alsayed Hasanain AF1, El-Masry MA2, Zayed AAH3, Nafee AMA4, Attia RAH5, Abdel-Aal SM6.

Title:
Predictors of therapeutic failure among patients with acute brucellosis treated by dual therapy with doxycycline-rifampin

Abstract:
OBJECTIVE:
To determine the frequency of therapeutic failure among patients with acute and subacute brucellosis and to explore the predictors of failure.

METHODS:
The study included 213 consecutive, naïve patients with acute and subacute brucellosis. All participants underwent clinical evaluation, chest radiography, stool microscopic examination and interferon-gamma release assay. Patients received the WHO-recommended therapy of doxycycline 200 mg/day and rifampin 900 mg/day, for 6 weeks.

RESULTS:
Mean age of the study population was 39.8 ± 12.2 years; 64.8% of them were males. The therapeutic failure rate was 16.4%. Adverse effects were reported by 13.1%. Multivariate analysis of factors associated with therapeutic failure revealed latent tuberculosis infection (LTBI) (OR 3.1, 95% CI, 1.9-24.6, P: 0.009), ascariasis (OR 2.6, 95% CI 1.5-17.9, P: 0.012), and the use of acid suppressive therapy (OR 2.1, 95% CI 1.2-19.5, P: 0.037) as the predictors of therapeutic failure.

CONCLUSIONS:
The prevalence of therapeutic failure among the Egyptian patients with acute/subacute brucellosis is increasing. Predictors of therapeutic failure are LTBI, ascariasis, and the use of acid suppressive therapy.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Chest Diseases, 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 Diagnostic Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Ansari, J.aEmail Author,  Alhelali, S.b,  Albinmousa, Z.b,  Farrag, A.c,  Ali, A.M.d,  Abdelgelil, M.c,  Alhamad, A.a,  Alzahrani, G.b,  Ansari, A.e,  Glaholm, J.f

Title:
Rare Case of Intracardiac Renal Cell Carcinoma Metastasis with Response to Nivolumab: Case Report and Literature Review

Abstract:
Intracardiac metastases in the absence of inferior vena cava involvement is a rare occurrence in patients with metastatic renal cell carcinoma (mRCC). There is limited evidence regarding the efficacy and safety of standard treatment modalities for mRCC patients with intracardiac metastases. Presence of intracardiac metastases is known to indicate poor prognosis and may potentially increase risk of treatment-related complications. Recent advances in RCC management have integrated nivolumab, a programmed death-1 (PD-1) receptor inhibitor, as a preferred treatment option in the second-line setting after failure of prior anti-angiogenic therapy; or in combination with ipilimumab, an anti-Cytotoxic T-lymphocyte antigen-4 antibody as first-line therapy for intermediate to poor risk patients with mRCC. The efficacy and toxicity of nivolumab in patients with mRCC and intracardiac metastases has never been reported previously. We herein present the first reported case of mRCC with intracardiac metastasis and a resultant excellent response to nivolumab treatment and discuss the imaging techniques and treatment options for this rare presentation. © 2018 The Author(s). Published by S. Karger AG, Basel.

Author Info:
aDepartment of Oncology, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia
bPrince Sultan Cardiac Centre, Riyadh, Saudi Arabia
cClinical Oncology Department, Assiut University, Asyut, Egypt
dMedical Oncology Department, South Egypt Cancer Institute, Asyut, Egypt
ePermian Basin Kidney Center, Odessa, TX, United States
fDepartment of Oncology, Royal Marsden Hospital, London, United Kingdom


Authors:
Badry R1, Gamal RM2, Hassanien MM2, El Hamed MA1, Hammam N2, El Fawal BM3.

Title:
Sympathetic skin response in patients with systemic sclerosis and rheumatoid arthritis

Abstract:
BACKGROUND:
Sympathetic skin response (SSR) is a technique to assess the sympathetic cholinergic pathways. Sympathetic dysfunction may participate in the development of pain, which is the major complaint in patients with systemic sclerosis (SSc) and rheumatoid arthritis (RA).

OBJECTIVES:
In this study, we aimed to assess the autonomic dysfunction in patients with (SSc) and (RA) using SSR as a simple neurophysiologic test.

METHODS:
Palmar SSR to median nerve electrical stimulation was recorded in 21 patients with SSc, 39 patients with RA, and in 60 healthy age and sex-matched control subjects.

RESULTS:
Palmar SSR to median nerve stimulation (of SSc patients and RA patients) shows significantly delayed latency and reduced amplitude in comparison to the control group. SSR of SSc patients has significantly delayed latency and reduced amplitude when compared to RA patients. Moreover, six SSc patients have delayed SSR in spite of the absence of manifestations of polyneuropathy.

CONCLUSIONS:
Patients with SSc and RA have features of autonomic dysfunction with more affection of SSc patients.

Author Info:
1
1Department of Neurology and Psychiatry, Assiut University Hospital, Post Box: 711526, Assiut, Egypt.
2
2Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt.
3
3Department of Neurology and Psychiatry, Aswan University Hospital, Aswan, Egypt.


Authors:
Bruni C1, Ngcozana T1, Braschi F1, Pucci T1, Piemonte G1, Benelli L1, Poli M1, Suliman YA1, Guiducci S1, Bellando-Randone S1, Balduzzi S1, Grotts J1, Denton CP1, Rasero L1, Montecucco C1, Furst DE1, Matucci-Cerinic M1.

Title:
Preliminary Validation of the Digital Ulcer Clinical Assessment Score in Systemic Sclerosis.

Abstract:
OBJECTIVE:
To date, "healed/non-healed" and clinical judgment are the only available assessment tools for digital ulcers (DU) in patients with systemic sclerosis (SSc). The aim of our study is to examine a preliminary composite DU clinical assessment score (DUCAS) for SSc for face, content, and construct validity.

METHODS:
Patients with SSc presenting at least 1 finger DU were enrolled and assessed with the Health Assessment Questionnaire-Disability Index, Cochin scale, visual analog scale (VAS) for DU-related pain, patient global DU status, and global assessment as patient-reported outcomes (PRO), and physician VAS for DU status (phyGDU) as an SSc-DU expert physician/nurse measure. The DUCAS included 7 DU-related variables selected by a committee of SSc DU experts and weighted on a clinical basis. Face validity was examined by consensus and partial construct validity was tested through convergent correlation with other measures of hand function, using Spearman's correlations. A range of patients with SSc was examined. A linear regression model with backward stepwise analysis was used to determine the relationship of individual variables with the primary clinical parameter, phyGDU.

RESULTS:
Forty-four patients with SSc (9 males, mean age 55 ± 15 yrs, mean disease duration 9.9 ± 5.8 yrs) were enrolled in the study. Overall DUCAS showed significant positive correlations with all abovementioned PRO (r > 0.4, p < 0.01). When all scores and scales were modeled, only DUCAS significantly predicted phyGDU (r = 0.59, R² = 0.354, Akaike information criterion = 385.4).

CONCLUSION:
Preliminarily, we suggest that the DUCAS may be a new clinical score for SSc-related DU, having face and content validity and convergent/divergent correlations (construct validity). These early data suggest that this score deserves further evaluation.

Author Info:
1
From the Department of Experimental and Clinical Medicine, and Department of Public Health, University of Florence; Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliero- Universitaria Careggi (AOUC), Florence, Italy; the Centre for Rheumatology and Connective Tissue Diseases, University College London (UCL), Division of Medicine, London, UK; Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt; Department of Rheumatology, Institute for Research and Health Care (IRCCS) Policlinico San Matteo Foundation, Pavia, Italy; Department of Medicine Statistics Core, and Division of Rheumatology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA. Dr. Bruni has received a 6-month travel bursary grant from European League Against Rheumatism to undertake this project. Dr. Denton has been a consultant to Bayer, Roche, GSK, Actelion, Inventiva, CSL Behring, Takeda, Merck-Serono, MedImmune, and Biogen. He has received research grants from Actelion, GSK, Novartis, and CSL Behring. Dr. Furst has received grant/research support from AbbVie, Actelion, Amgen, BMS, the US National Institutes of Health, Novartis, Pfizer, and Roche/Genentech, and consultancy fees from AbbVie, Actelion, Amgen, BMS, Cytori, Novartis, Pfizer, and Roche/Genentech. Dr. Matucci-Cerinic has acted as a consultant to and/or received speaker fees from Actelion, GSK, BMS, Pfizer, and Italfarmaco, and he has received research grants from Actelion. C. Bruni, MD, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology AOUC; T. Ngcozana, BNurs, Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine; F. Braschi, BNurs, Department of Experimental and Clinical Medicine, University of Florence and Department of Geriatric Medicine, Division of Rheumatology AOUC; T. Pucci, BNurs, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology AOUC; G. Piemonte, BNurs, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology AOUC; L. Benelli, BNurs, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology AOUC; M. Poli, BNurs, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology AOUC; Y.A. Suliman, MD, PhD, Rheumatology and Rehabilitation Department, Assiut University Hospital; S. Guiducci, MD, PhD, Rheumatology and Rehabilitation Department, Assiut University Hospital; S. Bellando-Randone, MD, PhD, Rheumatology and Rehabilitation Department, Assiut University Hospital; S. Balduzzi, MD, Department of Rheumatology, IRCCS Policlinico San Matteo Foundation; J. Grotts, BStat, Department of Medicine Statistics Core, University of California at Los Angeles; C.P. Denton, MD, PhD, Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine; L. Rasero, BNurs, Department of Public Health, University of Florence; C. Montecucco, MD, PhD, Department of Rheumatology, IRCCS Policlinico San Matteo Foundation; D.E. Furst, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology AOUC, and Division of Rheumatology, Department of Medicine, University of California at Los Angeles; M. Matucci-Cerinic, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence and Department of Geriatric Medicine, Division of Rheumatology AOUC. Dr. Furst and Dr. Matucci-Cerinic made equal contributions as senior authors. Address correspondence to Dr. C. Bruni, Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Viale Pieraccini 18, 50139 Florence, Italy. E-mail: cosimobruni85@gmail.com. Accepted for publication August 9, 2018.


Authors:
Chelban V1,2, Bocchetta M3, Hassanein S4,5, Haridy NA1,6, Houlden H1, Rohrer JD7.

Title:
An update on advances in magnetic resonance imaging of multiple system atrophy.

Abstract:
In this review, we describe how different neuroimaging tools have been used to identify novel MSA biomarkers, highlighting their advantages and limitations. First, we describe the main structural MRI changes frequently associated with MSA including the 'hot cross-bun' and 'putaminal rim' signs as well as putaminal, pontine, and middle cerebellar peduncle (MCP) atrophy. We discuss the sensitivity and specificity of different supra- and infratentorial changes in differentiating MSA from other disorders, highlighting those that can improve diagnostic accuracy, including the MCP width and MCP/superior cerebellar peduncle (SCP) ratio on T1-weighted imaging, raised putaminal diffusivity on diffusion-weighted imaging, and increased T2* signal in the putamen, striatum, and substantia nigra on susceptibility-weighted imaging. Second, we focus on recent advances in structural and functional MRI techniques including diffusion tensor imaging (DTI), resting-state functional MRI (fMRI), and arterial spin labelling (ASL) imaging. Finally, we discuss new approaches for MSA research such as multimodal neuroimaging strategies and how such markers may be applied in clinical trials to provide crucial data for accurately selecting patients and to act as secondary outcome measures.

Author Info:
1
Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
2
Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Toma Ciorbă 1, 2052, Chisinau, Moldova.
3
Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, WC1N 3BG, London, UK.
4
Diagnostic Radiology department, Faculty of Medicine Assiut University, Assiut, Egypt.
5
Department of Brain, Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, WC1N 3BG, London, UK.
6
Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt.
7
Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, WC1N 3BG, London, UK. j.rohrer@ucl.ac.uk.


Authors:
El Tallawy, H.N.a,  Farghaly, W.M.a,  El Beh, K.A.a,  Mawgood, A.K.A.b,  Diab, A.O.c,  El Bahnasawy, A.K.b,  Ghanem, M.K.a,  Khalifa, H.E.aEmail Author,  El Tallawy, S.H.b,  Makhloof, A.M.d,  Ghanem, M.H.e

Title:
Impact of the January 25 Egyptian Revolution on different psychological domains in Assiut University students

Abstract:
Background Arab country revolutions reflect long-term governorate's authority for many years effect on the people. Dissatisfactory feelings about political and economic systems were the main firing of Januray 25 Egyptian Revolution. This dissatisfaction precipitated many psychological symptoms among Egyptian youth, which was expressed as anger. Aim The aim of this study was to identify the impact of January 25 Egyptian Revolution on the behavior and different psychological domains in Assiut University students immediately and 2 years after the revolution. Participants and methods Phase 1 (immediately after the revolution) study was carried out from 1 March 2011 to 30 April 2011 on 3193 students from Assiut University (36.8% males and 63.2% females; 33.8% students from practical vs. 66.2% from academic faculties). Phase 2 (2 years after the revolution) study was carried out from 1 March 2013 to 30 April 2013 on 2914 students from Assiut University (38.9% males vs. 61.1% females; 42.8% students from practical vs. 57.2% from academic faculties). The social, economic, and political parameters were evaluated through standardized questionnaire prepared specifically for this study. The psychological parameters were evaluated using Symptom Checklist-90-R and Scale of Personal Experiences Associated with Emotion of Anger. Results Increased prevalence of all psychiatric symptomatology was recorded among university students immediately after the revolution, particularly paranoia, anxiety, sensitivity, and depression. Although the prevalence of all psychiatric symptoms decreased 2 years after the revolution, hostility and phobia increased. However, the mean scores of all psychiatric symptoms were higher for 2 years than for immediately after revolution, and it was significant for somatization, anxiety, hostility, phobia, paranoia, and psychosis (Po0.001). The prevalence of all psychiatric symptoms was significantly higher among women than men in both phases of the study, except hostility when evaluated immediately after revolution. In contrast, the prevalence of anger was significantly higher among men than women immediately after revolution, whereas the reverse was observed 2 years later. Although the prevalence of anger among studied students decreased slightly, the prevalence of anger triggers, emotional feelings, and behavioral patterns associated with anger increased 2 years after revolution. Moreover, all psychiatric symptoms correlated significantly with nearly all subscales of anger immediately and 2 years after revolution. Conclusion Dissatisfactory feelings about political and economic systems, which were the main firing of 25th January Egyptian Revolution. This precipitated many psychiatric symptoms among Egyptian youth. These psychiatric symptoms, particularly paranoia, anxiety, sensitivity, and depression, led to unacceptance of others. Hostility, anger, rage and lastly expressed in revolution. © 2018 Institute of Psychiatry, Ain Shams University.

Author Info:
aNeurology and Psychiatry Department, Department of Neuropsychiatry, Assiut University Hospitals, Assiut, Egypt
bPsychology Department, Faculty of Art, Egypt
cPsychology Department, Faculty of Education, Egypt
dGynacology and Obstetrics Department, Assiut University, Assiut, Egypt
eNeurology and Psychiatry Department, Ain Shams University, Cairo, Egypt


Authors:
El-Beh, K.,  Eddin Khalifa, H.H.Email Author,  Hassaan, S.,  Noomani, M.

Title:
Measuring health-related quality of life in children with chronic medical conditions: Reliability and validity of the Arabic version of PedsQL 4.0 Generic Core Scales(Article)

Abstract:
Background Measuring health-related quality of life in large pediatric populations has several distinct benefits. It can aid in identifying the subgroups of children who are at risk of health problems, in determining the burden of a particular disease or disability, and in informing efforts aimed at prevention and intervention. The objectives of this study were to validate the Arabic version of the PedsQL 4.0 Generic Core Scales in Egyptian children with chronic conditions and to assess the impact of chronic illness on their quality of life. Patients and methods The analyses were based on 718 pediatric patients who were recruited from the outpatient clinics of Assiut University Children Hospital utilizing the Arabic version of PedsQL 4.0 Generic Core Scales. They were divided into eight groups: 71 children with acute lymphoblastic leukemia, 125 children with bronchial asthma, 40 children with type I diabetes mellitus, 149 children with epilepsy, 63 children with rheumatic heart disease, 110 children with chronic kidney disease, 104 children with ß-thalassemia, and 56 children with tuberculosis. An additional convenience sample of 121 healthy children and adolescents was gathered to assess comprehensibility and to test discriminant validity. Results Arabic version of the PedsQL 4.0 was feasible, easy to administer, completed without, or with minimal, help by most children and parents, and required a brief administration time. Cronbach's a internal consistency values for the total and subscale scores exceeded 0.70. Test-retest reliability was high (reliability coefficient exceeded 0.9). Physical, emotional, social, school, psychosocial, and total scores of healthy children were on average significantly higher than scores of children with chronic conditions. PedsQL 4.0 total scores also varied significantly across health conditions as measured by analysis of variance test. Patients with epilepsy and diabetes mellitus reported the highest scores, while patients with thalassemia and rheumatic heart disease reported the lowest scores. Conclusion The Arabic version of the PedsQL 4.0 Generic Core Scales proved to be understandable and feasible to use. It showed good reliability for healthy and children with chronic medical conditions and their parents. It also shows good construct and discriminant validity properties in this setting, making this instrument suitable for research and clinical use in the Egyptian setting. The results also demonstrate the effects of pediatric chronic conditions on patient health-related quality of life across disease clusters. © 2018 Institute of Psychiatry, Ain Shams University.

Author Info:
Department of Neuropsychiatry, Neuropsychiatry, Assiut University Hospitals, Asyut, Egypt


Title:
Aberration of Nrf2‑Bach1 pathway in colorectal carcinoma; role in carcinogenesis and tumor progression

Abstract:
Nrf2 and Bach1 are important transcriptional factors that protect against reactive oxygen species (ROS). Although aberration of these molecules was associated with malignant transformation and progression, their aberration pattern in colorectal carcinoma (CRC) is not yet fully studied. In this study, Nrf2 and Bach1 were immunohistochemically examined in 93 formalin-fixed paraffin-embedded blocks of colonic tumors (65 carcinoma with their corresponding surgical margins and 28 adenomas). Nrf2 expression was gradually increased in the apparently normal mucosa (57 ± 41)-adenoma (90 ± 36)-carcinoma (198 ± 78) direction and only showed significant higher mean of expression in CRC with brisk inflammatory peritumoral response. The mean of Bach1 expression was highest in apparently normal colonic mucosa (267 ± 16), lowest in adenoma (53 ± 31) and high in carcinoma tissues (194 ± 93). Significant higher mean of expression was detected in carcinoma with: LN metastasis (p = 0.04), lymphovascular invasion (p = 0.024); perineural invasion (p = 0.03) and advanced pathological stage (p < 0.001). Significant higher mean of expression of Nrf2 and Bach1 was detected in adenoma specimens with high grade dysplasia (p = 0.016 and p = 0.024) respectively. In conclusion, Nfr2 and Bach1 expression are altered in CRC but in different way. Nrf2 is gradually increasing from normal mucosa to adenoma and was highest in carcinoma but was not associated with features of tumor invasiveness. Bach1 was highest in normal mucosa; less in adenoma then increased in carcinoma and was associated with features of tumor invasiveness and metastasis. This may indicate a possible role of Nrf2 in CRC carcinogenesis and a role of Bach1 in CRC progression.

Author Info:
1
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: Hebaeldeek@gmail.com.
2
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
El-Giliny, A.-H.a,  Hamdey, I.b,  Fawzy, M.c,  Elwasify, M.bEmail Author,  Elwasify, M.b,  Barakat, D.d

Title:
Attitude toward psychiatry among interns in Egypt

Abstract:
Objective Negative attitude toward psychiatry (ATP) and not choosing it as a career are prevalent among graduated medical students; however, the situation in Egypt is unknown. This study aims to estimate the ATP and its choice as a career and their associated factors in Egyptian interns. Participants and methods A systematic random sample of 306 interns from two medical schools anonymously completed a questionnaire covering the ATP-30 scale, their choice of psychiatry as a career, and the possible associated factors. The reasons for choosing or not choosing psychiatry as a career were explored. Results The mean total ATP score was 98. The majority of interns (77.8%) reported a positive ATP and 22.2% reported a negative/neutral attitude. More than one-fourth (25.5%) of interns declared choosing psychiatry as a career. The most common reason for choosing psychiatry as a career was personal interest/enjoyment. The most common reason for not choosing psychiatry as a career was bad reputation/stigmatization. The logistic regression analysis showed that the independent predictors of negative attitudes are being affiliated to Assiut University [adjusted odds ratio (AOR)= 2.3]. The independent predictors of choosing psychiatry as a career are positive attitude (AOR=7.1) and previous history of mental illness (AOR=2.0). Conclusion Overall attitudes toward mental illness and choosing psychiatry as a career among interns in the two medical schools were positive. A further study with interns from different institutions is needed to gain a detailed nationwide picture. © 2018 Institute of Psychiatry, Ain Shams University.

Author Info:
aDepartments of Public Health and Preventive Medicine, Egypt
bDepartment of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, 33551, Egypt
cDepartment of Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
dDepartment of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt


Authors:
Abdelmohsen, S.M.aEmail Author,  Osman, M.A.b,  Takrouney, M.H.b,  Abdelazim, O.c,  Fathy, M.d,  Mostafa, H.A.a

Journal:
Journal of Pediatric Surgery Case Reports

Abstract:
Background: Crossed testicular ectopia (CTE) is one of the rare incidental findings during surgical intervention for an inguinal hernia or cryptorchidism, more than 100 cases have been reported in published studies. Methodology: We collected 7 cases of CTE operated during the period from September 2016 to January 2018 at 4 different university hospitals in Egypt, with the age range from (25 days–3 years); mean age at presentation was 1.6 year. Clinical presentation, intraoperative findings, operative technique and follow-up duration of 3 months up to 2 years were assessed. Results: Six cases were born full term, and one case was preterm. Four cases born as 1st offspring while 3 cases born as a 2nd offspring. Three cases associated with Persistent Müllerian duct syndrome (PMDS) (type 2), one case associated with penoscrotal hypospadias (type 3), one case associated with both (PMDS) and penoscrotal hypospadias (type 3), one case associated with congenital inguinal hernia only (type 1), and one case was not associated with a hernia or any associated anomalies. Three cases discovered accidentally during laparoscopic exploration for undescended testes, two of them had a common vas deferens or union cord. Surgery was offered to all patients, five cases were operated by Ombredanne's technique; one case was operated by laparoscopic intraperitoneal transposition approach and the last case had one testis atrophied which may be attributed to the ischemic effect of obstructed hernia but the other associated testis was normally vascularized. All testes except one atrophied fixed at ipsilateral subdartos pouch. Conclusion: CTE may be present in cases of cryptorchidism with or without an associated congenital hernia and may be discovered incidentally during diagnostic laparoscopy for cryptorchidism. It should be suspected in any case of abscent testis with congenital hernia in the same side. Karyotyping is recommended for cases of CTE with PMDS. We cannot find an evidence for relationship between prematurity and CTE as most of our cases were full term. © 2018

Author Info:
aAswan University Hospital, Egypt
bAssiut University Hospital, Egypt
cCairo University Specialized Pediatric Hospital, Egypt
dMinia University Hospital, Egypt


Authors:
Allaire, C.a,b,c,  Williams, C.a,b,  Bodmer-Roy, S.a,b,  Zhu, S.b,  Arion, K.b,  Ambacher, K.b,  Wu, J.b,  Yosef, A.a,b,d,  Wong, F.b,c,  Noga, H.b,c,  Britnell, S.b,  Yager, H.b,  Bedaiwy, M.A.a,b,c,  Albert, A.Y.c,  Lisonkova, S.a,  Yong, P.J.a,b,c

Date of Publishing:
Volume 73, Issue 5, 1 May 2018, Pages 276-277

Title:
Chronic Pelvic Pain in an Interdisciplinary Setting: 1-Year Prospective Cohort

Author Info:
aDepartment of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
bBC Women's Center for Pelvic Pain and Endometriosis, Vancouver, BC, Canada
cWomen's Health Research Institute, Vancouver, BC, Canada
dAssuit University, Assuit, Egypt


Authors:
Bakr, M.A.a,c,  Mohamed, S.A.b,d,  Mohamad, M.F.b,e,  Mohamed, M.A.b,e,  El Sherif, F.A.b,dEmail Author,  Mosad, E.b,f,  Abdel-Hamed, M.F.b,d

Title:
Effect of dexmedetomidine added to modified pectoral block on postoperative pain and stress response in patient undergoing modified radical mastectomy

Abstract:
Background: The most common surgical procedure for breast cancer is the modified radical mastectomy (MRM), but it is associated with significant postoperative pain. Regional anesthesia can reduce the stress response associated with surgical trauma. Objectives: Our aim is to explore the efficacy of 1 µg/kg dexmedetomedine added to an ultrasound (US)-modified pectoral (Pecs) block on postoperative pain and stress response in patients undergoing MRM. Study Design: A randomized, double-blind, prospective study. Setting: An academic medical center. Methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I– II (18–60 years old and weighing 50–90 kg) scheduled for MRM were enrolled and randomly assigned into 2 groups (30 in each) to receive a preoperative US Pecs block with 30 mL of 0.25% bupivacaine only (group 1, bupivacaine group [GB]) or 30 mL of 0.25% bupivacaine plus 1 µg/ kg dexmedetomidine (group II, dexmedetomidine group [GD]). The patients were followed-up 48 hours postoperatively for vital signs (heart rate [HR], noninvasive blood pressure [NIBP], respiratory rate [RR], and oxygen saturation [Sao2]), visual analog scale (VAS) scores, time to first request of rescue analgesia, total morphine consumption, and side effects. Serum levels of cortisol and prolactin were assessed at baseline and at 1 and 24 hours postoperatively. Results: A significant reduction in the intraoperative HR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) starting at 30 minutes until 120 minutes in the GD group compared to the GB group (P < 0.05) was observed. The VAS scores showed a statistically significant reduction in the GD group compared to the GB group, which started immediately up until 12 hours postoperatively (P < 0.05). There was a delayed time to first request of analgesia in the GD group (25.4 ± 16.4 hrs) compared to the GB group (17 ± 12 hrs) (P = 0.029), and there was a significant decrease of the total amount of morphine consumption in the GD group (9 + 3.6 mg) compared to the GB group (12 + 3.6 mg) (P = 0.001). There was a significant reduction in the mean serum cortisol and prolactin levels at 1 and 24 hours postoperative in the GD patients compared to the GB patients (P < 0.05). Limitations: This study was limited by its sample size. Conclusion: The addition of 1 µg/kg dexmedetomidine to an US-modified Pecs block has superior analgesia and more attenuation to stress hormone levels without serious side effects, compared to a regular Pecs block in patients who underwent MRM. © 2018, American Society of Interventional Pain Physicians. All rights reserved.

Author Info:
aFaculty of Medicine, Assuit University, Egypt
bSouth Egypt Cancer Institute, Assiut University, Assiut, Egypt
cAnesthesia and Intensive Care Department, Faculty of Medicine, Assuit University, Egypt
dICU, and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
eAnesthesia, ICU, and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
fClinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt


Authors:
El-kady, A.M.aEmail Author,  Fahmi, Y.a,  Tolba, M.b,  Hashim, A.-K.A.c,  Hassan, A.A.d

Date of Publishing:
Volume 42, Issue 4, 1 December 2018, Pages 630-635

Title:
Cryptosporidium infection in chronic kidney disease patients undergoing hemodialysis in Egypt

Abstract:
Patients with chronic renal failure are more susceptible to infections due to acquired immunodeficiency caused by uremia. Parasitic infections are one of the significant causes of morbidity and mortality in those patients, So we aimed to assess the prevalence of Cryptosporidium spp. and other protozoan infections in patients undergoing hemodialysis in Qena Governorate, Upper Egypt. The present study took place in Qena University Hospitals, Egypt. Participants were 150 Chronic Kidney Disease (CKD) patients undergoing hemodialysis, and 50 healthy individuals. After questionnaire, three consecutive stool samples from each participant were examined macroscopically and microscopically by different techniques for the presence of different stages of different protozoa. 66% of CKD patients and 26% of the control group were infected with intestinal protozoa. Cryptosporidium spp. were the protozoa with the highest prevalence in cases (40%) and control (6%) with statistical significance (P < 0.05). It was detected only in watery stool samples (P value < 0.05). Residence, age and gender were not significant variables in the prevalence of infection among patients with CKD. In Egypt, few studies had reported the prevalence of Cryptosporidiosis in chronic renal patients. Cryptosporidium infection should be suspected in all cases of prolonged watery diarrhea in CKD patients and stool samples should be examined using special stains as cold modified Ziehl–Neelsen staining for proper diagnosis of Cryptosporidium infections. © 2018, Indian Society for Parasitology.

Author Info:
aDepartment of Medical Parasitology, Faculty of Medicine, South Valley University, Qena, 83523, Egypt
bDepartment of Medical Parasitology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
cDepartment of Internal Medicine, Faculty of Medicine, South Valley University, Qena, 83523, Egypt
dDepartment of Zoology, Faculty of Science, Damanhour University, Damanhûr, 21634, Egypt


Authors:
El-Khayat, H.a,  Fouad, Y.b,  Mohamed, H.I.bEmail Author,  El-Amin, H.c,  Kamal, E.M.b,  Maher, M.d,  Risk, A.e

Date of Publishing:
Volume 47, Issue 5, March 2018, Pages 674-679

Title:
Sofosbuvir plus daclatasvir with or without ribavirin in 551 patients with hepatitis C-related cirrhosis, genotype 4

Abstract:
Background: The Daclatasvir and Sofosbuvir combination therapy (SOF/DCV) has shown efficacy in patients with chronic hepatitis C in clinical trials. Aim: To investigate the efficacy and safety of SOF/DCV for treatment of patients with hepatitis C-related liver cirrhosis genotype 4. Methods: Multicentre study involving 551 patients with liver cirrhosis genotype 4; 432 naïve patients and 119 treatment-experienced patients. All patients received SOF (400 mg) and DCV (60 mg) daily in addition to weight-based ribavirin (RBV) for 12 weeks and when RBV is contraindicated the treatment duration was extended to 24 weeks. Results: Sustained virological response at 12 weeks after end of treatment (SVR12) rate was 92% in naïve cirrhotic patients and 87% in previous treated patients (by ITT analysis). Virological failure was infrequent, occurring in 42 patients (8%) overall. Thirty-two (6%) were non responders; and 10 (2%) cases were relapsers, 31 patients (7%) were CTP-A and 11 (13.3%) patients were CTP-B (by ITT analysis). The most common adverse events were anaemia, fatigue, headache, pruritus. Serious side effects were recorded mainly in CTP-B cirrhotic patients including HCC and hepatic encephalopathy. Conclusions: The SOF/DCV combination therapy has proven efficacy and safety in treating patients with hepatitis C-related liver cirrhosis genotype 4 in a large cohort of patients in the real world. © 2018 John Wiley & Sons Ltd

Author Info:
aGastroenterology and Endemic Medicine Department, Theodore Research Institute, Cairo, Egypt
bGastroenterology and Endemic Medicine Department, Minia University, Minia, Egypt
cInternal Medicine Department, Assuit University, Assuit, Egypt
dGastroenterology and Endemic Medicine Department, Ain Shams University, Cairo, Egypt
eRheumatology Department, Cairo University, Cairo, Egypt


Authors:
El-Malky, M.M.a,bEmail Author,  Mowafy, N.M.a,c,  Zaghloul, D.A.d,e,  Al-Harthi, S.A.a,  El-Bali, M.A.a,  Mohamed, R.T.a,c,  Bakri, R.A.a,  Mohamed, A.A.a,f,  Elmedany, S.g

Title:
Prevalence of Cryptosporidium species isolated from diarrheic children in Makkah, Saudi Arabia

Abstract:
Cryptosporidiosis has been identified as a significant underlying cause of morbidity and mortality worldwide. Studies in high and low income countries have recognized the importance of Cryptosporidium as a cause of diarrhea. The objectives of the current study were to determine the prevalence rate and genotypes of Cryptosporidiumin in diarrheic children in Makkah Region. A total of 1,380 fecal samples were collected from children aged up to 14 years attending 3 major hospitals of Makkah between March 2015 and March 2016. Stool collected were subjected to direct microscopic examination and crypto antigen detection using ImmunoCard STAT, Cryptosporidium/Giardia rapid test. Part of each positive stool sample was kept frozen at -20ºC for molecular characterization. Initial screening by immunochromatographic detection kit revealed 23 positive cases. PCR was performed for positive cases by amplification of a piece of the gene encoding the small (18S) subunit of rRNA producing a 435-438 bp product. Cryptosporidium genotyping was performed by RFLP analysis of PCR products. Genotyping revealed 18 cases C. hominis genotype, 4 cases C. parvaum genotype and one sample failed to be amplified. The data revealed a higher incidence of the common human species C. hominis (81.8%). The detection of both C. hominis and C. parvaum genotypes point to the possibility of both anthroponotic and zoonotic transmission routes occurring in Makkah region. Further studies are needed to verify the subgenotypes of Cryptosporidium to elucidate the real transmission modes and hence plan for effective control strategies. © 2018, Malaysian Society for Parasitology. All rights reserved.

Author Info:
aDepartment of Medical Parasitology, Faculty of Medicine, Umm AL-Qura University, Makkah, Saudi Arabia
bDepartment of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
cDepartment of Medical Parasitology, Faculty of Medicine, Minia University, El-Minia, Egypt
dDepartment of Medical Parasitology, Faculty of Medicine, Assuit University, Assuit, Egypt
eLaboratory and Blood Bank Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
fDepartment of Medical Parasitology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
gDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Egypt


Authors:
Hetta, D.F.aEmail Author,  Fares, K.M.a,  Abedalmohsen, A.M.b,  Abdel-Wahab, A.H.b,  Elfadl, G.M.A.b,  Ali, W.N.b

Title:
Epidural dexmedetomidine infusion for perioperative analgesia in patients undergoing abdominal cancer surgery: Randomized trial

Abstract:
Objective: To assess the postoperative analgesic efficacy of epidural dexmedetomidine added to bupivacaine infusion for patients undergoing major abdominal cancer surgery. Methods: Patients scheduled for major upper abdominal cancer surgery were allocated to group bupivacaine (n =32), in which patients received epidural bupivacaine infusion (6 mL/h bupivacaine 0.1%) for 48 hours postoperatively, or group bupivacaine + dexmedetomidine (n=32), in which patients received epidural dexmedetomidine added to bupivacaine infusion (6 mL/h of bupivacaine 0.1% + dexmedetomidine, 0.5 µg/mL) for 48 hours postoperatively. The cumulative morphine consumption, the time to first analgesic request, and the VAS pain score were evaluated. Results: The cumulative morphine consumption was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine: mean ± SD of 10.40±5.16 mg vs 23.23±8.37 mg with an estimated difference (95% CI) of –12.83 (−16.43, –9.24), (P<0.001). The time to the first analgesic demand was significantly delayed in group bupivacaine + dexmedetomidine compared with group bupivacaine: median (IQR) of 6 (1.75, 8.25) h vs 1 (0, 4)h, (P<0.001). The mean collapsed over time of overall VAS pain scores at rest and movement was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine: mean ± SE of 1.6±0.08 vs 2.38±0.08 with an estimated difference (95% CI) of −0.8 (−1, –0.86), (P<0.001), and mean ± SE of 2.17±0.07 vs 3.25±0.07 with an estimated difference (95% CI) of −1.1 (−1.27, – 0.89), (P<0.001), respectively. Conclusion: Epidural infusion of dexmedetomidine added to bupivacaine for patients undergoing major abdominal cancer surgery significantly reduced morphine consumption, delayed time to first analgesic supplementation, and decreased pain intensity during the first 48 hours postoperatively without harmful derangement on hemodynamics. © 2018 Hetta et al.

Author Info:
aAnesthesia and Pain Management, South Egypt Cancer Institute, Assuit University, Assuit, Egypt
bAnesthesia and Intensive Care, Faculty of Medicine, Assuit University, Assuit, Egypt


Authors:
Hetta, D.F.a,cEmail Author,  Mahran, A.M.b,  Kamal, E.E.b

Title:
Pulsed radiofrequency treatment for chronic post-surgical orchialgia: A double-blind, sham-controlled, randomized trial: Three-month results

Abstract:
Background: Chronic post-surgical pain in the groin region represents a challenge for the managing physician and is a burden on the quality of life of the patient. None of the existing interventions or medical treatment is satisfactory. Objectives: We aim to evaluate the analgesic efficacy of pulsed radiofrequency (PRF) applied to the ilioinguinal nerve and the genital branch of the genitofemoral nerve for patients suffering from chronic post-surgical orchialgia. Study Design: A prospective randomized, controlled clinical trial. Settings: An interventional pain unit in a tertiary center at a university hospital in Egypt. Methods: Seventy patients complaining of chronic post-surgical orchialgia were randomized into 2 groups: PRF group (n = 35), received pulsed radiofrequency on the ilioinguinal nerve and genital branch of the genitofemoral nerve, or sham group (n = 35). The percentage of patients that showed > 50 % reduction of their visual analog scale (VAS) pain score as well as the percentage of patients that did not require additional analgesic drugs was assessed. The VAS pain score and the global perceived effect (GPE) were reported during the 3-month follow-up period. Results: The percentage of patients that showed > 50% reduction of their VAS pain score was 80% (24/30) in the PRF group versus 23.33% (7/30) in the sham group. The percentage of patients that did not require analgesic drugs was 50% (15/30) in the PRF group versus 3.3% (1/30) in the sham group. There was a significant reduction of the mean post-procedural VAS pain score at 2, 4, 6, 8, and 12 weeks (P = 0.001) in the PRF group in comparison to the sham group. Likewise, there was a significant improvement of the GPE in the PRF group in comparison to the sham group (P = 0.00). Limitations: The study’s follow-up period was limited to 3 months only. Conclusions: For patients suffering from chronic post-surgical orchialgia, PRF applied to the ilioinguinal nerve and the genital branch of the genitofemoral nerve is an effective treatment modality. It provides long-lasting pain relief and decreases the demand for pain medications. © 2018, American Society of Interventional Pain Physicians. All rights reserved.

Author Info:
aSouth Egypt Cancer Institute, Assuit University, Egypt
bAssuit University Hospital, Assuit University, Egypt
cAnesthesia and Pain Management, South Egypt Cancer Institute, Assuit University, Egypt


Authors:
Khaled, M.Email Author,  Elgafary, K.,  El-Adly, W.

Date of Publishing:
Volume 29, Issue 5, 1 September 2018, Pages 476-479

Title:
Percutaneous needle quadriceps tenotomy for treatment of idiopathic congenital dislocation of the knee

Abstract:
Background: Congenital dislocation of the knee is a rare condition with an incidence of 1:100000 and can be idiopathic or syndromic. Our study evaluated percutaneous needle tenotomy for treatment of idiopathic flexible congenital dislocation of the knee. Methods: A prospective case series was done on 15 infants with idiopathic congenital dislocation of the knee: nine boys and six girls. Closed reduction was first attempted, and if it failed the knee was examined. If the knee could be flexed beyond 0, serial casting was done. If the knee could not be flexed beyond 0, percutaneous needle tenotomy was done. Results: Fifteen infants presented with idiopathic flexible congenital dislocation of the knee. Three dislocations were reduced closed, five were reduced with serial casting with gradual flexion, and seven that could not be flexed beyond 0 underwent percutaneous needle tenotomy. All patients could walk within the normal age range with no pain. All had full range of motion and good quadriceps function. Ultrasound was done in patients who had percutaneous needle tenotomy at walking age to ensure healing of the quadriceps tendon, which was adequately healed in all patients. Conclusions: Percutaneous needle tenotomy is a good option for treatment of congenital dislocation of the knee. Careful selection of patients is mandatory. © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Author Info:
Orthopedic and Traumatology Assiut University Hospitals, Assuit, Egypt


Authors:
Khalil, R.aEmail Author,  Karim, A.A.a,bEmail Author,  Khedr, E.c,  Moftah, M.dEmail Author,  Moustafa, A.A.e,f

Date of Publishing:
Volume 12, 17 December 2018, Article number 468

Title:
Dynamic communications between GABAA switch, local connectivity, and synapses during cortical development: A computational study

Abstract:
Several factors regulate cortical development, such as changes in local connectivity and the influences of dynamical synapses. In this study, we simulated various factors affecting the regulation of neural network activity during cortical development. Previous studies have shown that during early cortical development, the reversal potential of GABAA shifts from depolarizing to hyperpolarizing. Here we provide the first integrative computational model to simulate the combined effects of these factors in a unified framework (building on our prior work: Khalil et al., 2017a,b). In the current study, we extend our model to monitor firing activity in response to the excitatory action of GABAA. Precisely, we created a Spiking Neural Network model that included certain biophysical parameters for lateral connectivity (distance between adjacent neurons) and nearby local connectivity (complex connections involving those between neuronal groups). We simulated different network scenarios (for immature and mature conditions) based on these biophysical parameters. Then, we implemented two forms of Short-term synaptic plasticity (depression and facilitation). Each form has two distinct kinds according to its synaptic time constant value. Finally, in both sets of networks, we compared firing rate activity responses before and after simulating dynamical synapses. Based on simulation results, we found that the modulation effect of dynamical synapses for evaluating and shaping the firing activity of the neural network is strongly dependent on the physiological state of GABAA. Moreover, the STP mechanism acts differently in every network scenario, mirroring the crucial modulating roles of these critical parameters during cortical development. Clinical implications for pathological alterations of GABAergic signaling in neurological and psychiatric disorders are discussed. © 2018 Khalil, Karim, Khedr, Moftah and Moustafa.

Author Info:
aDepartment of Psychology and Methods, Jacobs University Bremen, Bremen, Germany
bUniversity Clinic of Psychiatry and Psychotherapy, Tübingen, Germany
cDepartment of Neuropsychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
dZoology Department, Faculty of Science, Alexandria University, Alexandria, Egypt
eMARCS Institute for Brain and Behaviour, Western Sydney University, Sydney, NSW, Australia
fDepartment of Social Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar


Authors:
Nguyen-Kim, T.D.L.aEmail Author,  Maurer, B.b,  Suliman, Y.A.b,c,  Morsbach, F.a,  Distler, O.b,  Frauenfelder, T.a

Date of Publishing:
Volume 10, Issue 4, 1 April 2018, Pages 2142-2152

Title:
The impact of slice-reduced computed tomography on histogrambased densitometry assessment of lung fibrosis in patients with systemic sclerosis

Abstract:
Background: To evaluate usability of slice-reduced sequential computed tomography (CT) compared to standard high-resolution CT (HRCT) in patients with systemic sclerosis (SSc) for qualitative and quantitative assessment of interstitial lung disease (ILD) with respect to (I) detection of lung parenchymal abnormalities, (II) qualitative and semiquantitative visual assessment, (III) quantification of ILD by histograms and (IV) accuracy for the 20%-cut off discrimination. Methods: From standard chest HRCT of 60 SSc patients sequential 9-slice-computed tomography (reduced HRCT) was retrospectively reconstructed. ILD was assessed by visual scoring and quantitative histogram parameters. Results from standard and reduced HRCT were compared using non-parametric tests and analysed by univariate linear regression analyses. Results: With respect to the detection of parenchymal abnormalities, only the detection of intrapulmonary bronchiectasis was significantly lower in reduced HRCT compared to standard HRCT (P=0.039). No differences were found comparing visual scores for fibrosis severity and extension from standard and reduced HRCT (P=0.051-0.073). All scores correlated significantly (P < 0.001) to histogram parameters derived from both, standard and reduced HRCT. Significant higher values of kurtosis and skewness for reduced HRCT were found (both P < 0.001). In contrast to standard HRCT histogram parameters from reduced HRCT showed significant discrimination at cut-off 20% fibrosis (sensitivity 88% kurtosis and skewness; specificity 81% kurtosis and 86% skewness; cut-off kurtosis ≤26, cut-off skewness ≤4; both P < 0.001). Conclusions: Reduced HRCT is a robust method to assess lung fibrosis in SSc with minimal radiation dose with no difference in scoring assessment of lung fibrosis severity and extension in comparison to standard HRCT. In contrast to standard HRCT histogram parameters derived from the approach of reduced HRCT could discriminate at a threshold of 20% lung fibrosis with high sensitivity and specificity. Hence it might be used to detect early disease progression of lung fibrosis in context of monitoring and treatment of SSc patients. © Journal of Thoracic Disease.

Author Info:
aInstitute of Diagnostic and Interventional Radiology, Raemistrasse, Zurich, Switzerland
bDivision of Rheumatology, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
cDepartment of Rheumatology and Rehabilitation, Faculty of Medicine, Assuit University Hospital, Assuit, Egypt


Authors:
Sabra, T.A.a,b,  Okajima, H.aEmail Author,  Tajima, T.a,  Fukumitsu, K.a,  Hata, K.a,  Yasuchika, K.a,  Masui, T.a,  Taura, K.a,  Kaido, T.a,  Uemoto, S.a

Journal:
International Journal of Surgery Case Reports

Title:
Living donor liver transplantation for adult Budd Chiari syndrome – Resection without replacement of retrohepatic IVC: A case report

Abstract:
Introduction Suprahepatic caval resection and replacement of inferior vena cava (IVC) is standard procedure in deceased donor liver transplantation for patients with Budd-Chiari syndrome (BCS). However, replacement of IVC in living donor liver transplantation (LDLT) is difficult. We report a case of BCS successfully treated by LDLT without replacement of IVC. Presentation of case A 52-years-old female with a primary BCS due to IVC thrombosis. A vena cava (VC) stent placed after angioplasty without improvement of the hepatic, portal venous flow and liver functions, Transjugular intrahepatic portosystemic shunt was considered and the patient had a rapid deterioration and increased ascites. The patient was scheduled for living donor liver transplantation (LDLT). Her Child-Paugh and MELD scores were 11, 18, respectively at time of transplantation. Left lobe was obtained from her son. Preservation of the native suprarenal IVC was impossible due to massive fibrosis and thrombosed. The suprahepatic IVC was also fibrotic and unsuitable for anastomosis with hepatic vein. The retrohepatic IVC resected include suprahepatic IVC together with the liver. The supradiaphragmatic IVC was reached and encircled through opening the diaphragm around the IVC and a vascular clamp applied on the right atrium with subsequent anastomosis with hepatic vein of the graft. The hemodynamic stability of the patient was maintained throughout the operation without IVC replacement due to developed collateral vessels. Conclusion Patients with Budd-Chiari syndrome with obstructive IVC are successfully treated with living donor liver transplantation without replacement of IVC. © 2017

Author Info:
aDepartment of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Japan
bDepartment of General Surgery, Al-Rajhi liver institute, Graduate School of Medicine, Assuit University, Egypt


Authors:
Salah, S.a,  Hammam, N.a,bEmail Author,  Abda, E.A.a

Title:
Pulmonary involvement in juvenile eosinophilic fasciitis: A case report

Abstract:
Introduction: Eosinophilic fasciitis (EF) is a rare scleroderma-like disease, characterized by acute onset of symmetrical swelling, induration and thickness of the skin. Laboratory findings include peripheral eosinophilia, elevated inflammatory markers and increased gammaglobulemia. Although, the diagnosis is mainly clinically, a full thickness skin/fascia/muscle biopsy remains the gold standard for the definite diagnosis. Unlike systemic sclerosis, visceral involvement, such as pulmonary affection, is rare in EF. Although, few cases of systemic involvement in adult EF have been presented, we report a rare case of juvenile EF associated with pulmonary involvement. Case report: A 12-years old boy presented with symmetrical skin thickening of bilateral upper extremity, back, trunk, neck, face, and scalp of 2-weeks duration. The laboratory tests revealed marked peripheral eosinophilia 61.9% (normal 1–3%) and elevation of the acute phase reactants (erythrocyte sedimentation rate 40 mm/1st hour and C-reactive protein 15 mg/dL). Lung imaging study showed bilateral extensive pulmonary nodules. A full thickness skin/fascia/muscle biopsy revealed an inflammatory infiltration, fibrosis in the fascial and muscle tissues. These findings were concordant with EF. An initial treatment of intravenous (IV) methylprednisolone 30 mg/kg/day for 3 successive days was started followed by oral steroid (2 mg/kg/day) plus methotrexate (20 mg/week). Follow up revealed complete improvement in the skin thickening, pulmonary affection and systemic inflammation. Conclusion: To the best of our knowledge this is the first reported co-existence of pediatric eosinophilic fasciitis with pulmonary affection. Systemic involvement should be screened in EF cases, as it may have consequences in the management and outcome. © 2018 Egyptian Society of Rheumatic Diseases

Author Info:
aRheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt
bFaculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada


Authors:
Selim, Z.I.a,  El-Hakeim, E.H.bEmail Author,  Omran, E.A.H.c,  Idriss, N.K.d,  Gaber, M.A.d,  Ross, S.V.e

Title:
KIAA1199 Biomarker and Ultrasonographic Findings in Rheumatoid Arthritis Patients and their Correlation with Disease Activity

Abstract:
Introduction Rheumatoid arthritis (RA) is an autoimmune disease that affects multiple joints causing joint destruction. KIAA1199 is a novel angiogenic biomarker derived from fibroblast-like synoviocytes (FLS) it has a role in acceleration and proliferation of FLS and activation of angiogenic signaling pathways leading to erosion of cartilage and bone. Musculoskeletal ultrasound (MUSU) and Power Doppler (PDUS) directly visualizing the synovial membrane vessels, which is important in providing very early information on the changes in synovitis activity during the course of the inflammatory joint disease Objective To assess the serum level of angiogenic biomarker KIAA1199 in RA patients and its correlation with MSUS, PDUS findings, and the disease activity Patients and methods: Fifty RA patients and 40 healthy control persons age and sex-matched were recruited in this study, KIAA1199 was assessed in the serum of patients and controls, MSUS and PDUS were done for the wrist, elbow, and knee joints for all RA patients Results Serum KIAA1199 level was significantly higher among RA patients 4.36±1.22 ng/dl compared to control group 2.87±0.51 ng/dl (p<0.001). There was a highly significant correlation between KIAA1199 level and DAS28 (p=0.004), and there was a significant correlation between the PDUS with KIAA1199 level and DAS28 (p=0.001, 0.002 respectively) in wrist joints Conclusion KIAA1199 is a new pathway that enhancing cell proliferation and angiogenesis. Serum KIAA1199 level may be a useful biomarker for RA activity, and therapeutic target in RA. PDUS correlates significantly with clinical findings and novel angiogenic biomarker in RA patients. Copyright ©, Georg Thieme Verlag KG. All rights reserved.

Author Info:
aFaculty of medicine Assuit university, rhematology and rehabilitation, Assuit, Egypt, Egypt
bRheumatology and Rehablitation Department, Assiut, Assiut University Hospital, Egypt, Egypt
cFaculty of Medicine, Rheumatology, Rehabilitation and Physical Medicine, Assiut University, Assiut, Egypt, Egypt
dMedical Biochemictry, Assuit University, Assuit, Egypt, Egypt
eRheumatology, Rehabilitation, Physical Medicine, Assuit university, Assuit, Egypt, Egypt


Authors:
Zakhary, M.M.a,  Mahmoud, A.A.bEmail Author,  Hashim, M.S.b

Date of Publishing:
Volume 17, September 2018, Pages 124-127

Title:
Role of osteopontin and its rs11730582 gene polymorphism in breast cancer

Abstract:
Background: Osteopontin (OPN) is an extracellular matrix protein of the integrin family that is involved in several biological pathways. Genetic polymorphisms in OPN gene has been found associated with many types of cancer. Aims: In this investigation, we aimed to study the possible role of OPN and its rs11730582 C/T single nucleotide polymorphism (SNP) in patients with breast cancer. Methods: OPN plasma levels were measured by ELIZA and OPN rs11730582 was genotyped by Taqman genotyping assay in 60 breast cancer patients and 60 healthy controls. Results: Obtained results revealed a significant increase in plasma OPN levels in the patients compared to the controls (mean ± SD was 194.8 ± 43 in patients versus 80.6 ± 34.7 in controls, P < 0.0001). OPN plasma level was affected by rs11730582 genotype and the hormones receptors status of the tumor (P < 0.05), while, no effect of the stage, grade or histological type of the tumor on OPN plasma level was found. The distribution of OPN rs11730582 genotypes differed significantly in the patients compared to controls, TT-genotype was significantly higher in breast cancer patients (P < 0.05) and was associated with elevated OPN levels. In addition, rs11730582 genotypes distribution was associated with tumor grade and hormones receptors status. Multivariate analysis revealed that plasma OPN levels and OPN rs11730582 C/T SNP genotypes distribution were associated with breast cancer after adjustment of other variables. Conclusion: In conclusion, OPN and its rs11730582 SNP were implicated in breast cancer in our study. © 2018

Author Info:
aMedical Biochemistry Department, Faculty of Medicine, Assuit University, Egypt
bMedical Biochemistry Department, Faculty of Medicine, Sohag University, Egypt


Authors:
Rösler TW1,2, Salama M3,4, Shalash AS5, Khedr EM6, El-Tantawy A7, Fawi G8, El-Motayam A9, El-Seidy E10, El-Sherif M7, El-Gamal M4, Moharram M4, El-Kattan M4, Abdel-Naby M4, Ashour S5, Müller U11, Dempfle A12, Kuhlenbäumer G13, Höglinger GU14,15,16.

Title:
K-variant BCHE and pesticide exposure: Gene-environment interactions in a case-control study of Parkinson's disease in Egypt

Abstract:
Pesticide exposure is associated with increased risk of Parkinson's disease (PD). We investigated in Egypt whether common variants in genes involved in pesticide detoxification or transport might modify the risk of PD evoked by pesticide exposure. We recruited 416 PD patients and 445 controls. Information on environmental factors was collected by questionnaire-based structured interviews. Candidate single-nucleotide polymorphisms (SNPs) in 15 pesticide-related genes were genotyped. We analyzed the influence of environmental factors and SNPs as well as the interaction of pesticide exposure and SNPs on the risk of PD. The risk of PD was reduced by coffee consumption [OR = 0.63, 95% CI: 0.43-0.90, P = 0.013] and increased by pesticide exposure [OR = 7.09, 95% CI: 1.12-44.01, P = 0.036]. The SNP rs1126680 in the butyrylcholinesterase gene BCHE reduced the risk of PD irrespective of pesticide exposure [OR = 0.38, 95% CI: 0.20-0.70, P = 0.002]. The SNP rs1803274, defining K-variant BCHE, interacted significantly with pesticide exposure (P = 0.007) and increased the risk of PD only in pesticide-exposed individuals [OR = 2.49, 95% CI: 1.50-4.19, P = 0.0005]. The K-variant BCHE reduces serum activity of butyrylcholinesterase, a known bioscavenger for pesticides. Individuals with K-variant BCHE appear to have an increased risk for PD when exposed to pesticides.

Author Info:
1
German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
2
Department of Neurology, Technical University of Munich, Munich, Germany.
3
Medical Experimental Research Center (MERC), Mansoura University, Mansoura, Egypt.
4
Toxicology Department, Mansoura University, Mansoura, Egypt.
5
Department of Neurology, Ain Shams University, Cairo, Egypt.
6
Department of Neurology, Assiut University, Assiut, Egypt.
7
Department of Neurology, Mansoura University, Mansoura, Egypt.
8
Department of Neurology, Sohag University, Sohag, Egypt.
9
Department of Neurology, Zagazig University, Zagazig, Egypt.
10
Department of Neurology, Tanta University, Tanta, Egypt.
11
Institute for Human Genetics, Justus Liebig University Giessen, Giessen, Germany.
12
Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany.
13
Department of Neurology, Kiel University, Kiel, Germany.
14
German Center for Neurodegenerative Diseases (DZNE), Munich, Germany. guenter.hoeglinger@dzne.de.
15
Department of Neurology, Technical University of Munich, Munich, Germany. guenter.hoeglinger@dzne.de.
16
Munich Cluster for Systems Neurology (SyNergy), Ludwig-Maximilians-University, Munich, Germany. guenter.hoeglinger@dzne.de.


Authors:
Yasir M1,2, Icke C1, Abdelwahab R1,3, Haycocks JR1, Godfrey RE1, Sazinas P4, Pallen MJ2, Henderson IR1, Busby SJW1, Browning DF1.

Title:
Organization and architecture of AggR-dependent promoters from enteroaggregative Escherichia coli

Abstract:
Enteroaggregative Escherichia coli (EAEC), is a diarrhoeagenic human pathogen commonly isolated from patients in both developing and industrialized countries. Pathogenic EAEC strains possess many virulence determinants, which are thought to be involved in causing disease, though, the exact mechanism by which EAEC causes diarrhoea is unclear. Typical EAEC strains possess the transcriptional regulator, AggR, which controls the expression of many virulence determinants, including the attachment adherence fimbriae (AAF) that are necessary for adherence to human gut epithelial cells. Here, using RNA-sequencing, we have investigated the AggR regulon from EAEC strain 042 and show that AggR regulates the transcription of genes on both the bacterial chromosome and the large virulence plasmid, pAA2. Due to the importance of fimbriae, we focused on the two AAF/II fimbrial gene clusters in EAEC 042 (afaB-aafCB and aafDA) and identified the promoter elements and AggR-binding sites required for fimbrial expression. In addition, we examined the organization of the fimbrial operon promoters from other important EAEC strains to understand the rules of AggR-dependent activation. Finally, we generated a series of semi-synthetic promoters to define the minimal sequence required for AggR-mediated activation and show that the correct positioning of a single AggR-binding site is sufficient to confer AggR-dependence.

Author Info:
1
Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, B15 2TT, UK.
2
Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UA, UK.
3
Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs Lyngby, DK-2800, Denmark.


Title:
Alteration of BRCA-1 tumor suppressor gene expression in serous and mucinous ovarian neoplasms in the benign-borderline-malignant pathway

Abstract:
Alteration of expression of the tumor suppressor gene BRCA-1 has been widely studied in breast and ovarian carcinoma. However, pattern of this alteration in the benign-borderline-carcinoma sequence in serous and mucinous ovarian neoplasms have not yet fully described. Tissue sections from 214 formalin-fixed paraffin-embedded ovarian specimens were stained immunohistochemically with BRCA-1 antibody. Specimens were 10 normal ovarian surface epithelium, 10 fallopian tube epithelium, 70 benign adenoma (50 serous and 20 mucinous), 28 borderline (13 serous and 15 mucinous), 78 carcinoma (58 serous and 20 mucinous), and 18 metastatic deposit (13 serous and 5 mucinous). Expression was evaluated into 0, +1, +2, and +3. Score +3 staining similar to normal tissues was considered normal and other scores were considered altered expression. Strong expression was seen in all normal epithelium specimens. Altered expression was seen in 34 serous neoplasms; 17 of 50 (34%) of benign cystadenomas, 6 of 13 (46%) of borderline tumors, 43 of 58 (74%) of primary carcinoma, and in 8 of 13 (62%) of metastatic carcinoma. This alteration was significantly associated with higher histopathologic grade (P = 0.049), presence of necrosis (P = 0.0001), and higher proliferation rate (P = 0.001). In mucinous neoplasms; altered BRCA-1 was detected in 25 specimens; 7 of 20 (41%) of benign cystadenomas, 5 of 15 (33%) of borderline neoplasms, 9 of 20 (45%) of primary carcinoma, and 4 of 5 (80%) of the metastatic deposits. This alteration was not associated with any of the clinicopathologic tumor characteristics. In conclusion, alteration of BRCA-1 expression is more frequent in serous than in mucinous carcinomas and is associated with tumors of higher grades and high proliferation rate.

Author Info:
1
Department of Pathology, Faculty of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia.
2
Department of Pathology, Faculty of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia; Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: rabab_aamh@yahoo.com.


Authors:
Zahran AM1, Saad K2, Elsayh KI2, Abdelmoghny A3, Aboul-Khair MD4, Sobhy A5, Abdel-Raheem YF2, El-Asheer OM2, El-Houfey AA6,7, Alblihed MA8, Al-Neami I9.

Title:
Myeloid-Derived Suppressor Cells and Costimulatory Molecules in Children With Allergic Rhinitis

Abstract:
OBJECTIVES::
The aim of this study is to assess the level of myeloid-derived suppressor cells (MDSCs) and the expression of costimulatory molecules CD80 and CD86 on monocytes and their ligands (CD28) on T-lymphocytes in children with allergic rhinitis (AR).

METHODS::
The study included 60 children with AR and 50 controls. Flow cytometry was performed to analyze MDSCs and the expression of costimulatory molecules CD80 and CD86 on monocytes and their ligands (CD28) on T-lymphocytes.

RESULTS::
The percentages of total and monocytic MDSCs and the expression of costimulatory molecule CD86 on monocytes were significantly higher in children with AR than in healthy controls. In addition, the expressions of CD28 on CD4+ and CD8+ were significantly elevated in AR patients.

CONCLUSION::
The present study demonstrated that the percentages of MDSCs were significantly elevated in AR children. Moreover, the expressions of CD28 on CD4+ and CD8+ were significantly higher in children with AR.

Author Info:
1
1 Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
2
2 Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
3 Department of ENT, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
4
4 Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
5
5 Department of Clinical Pathology, Faculty of Medicine, Alazhar University, Assiut, Egypt.
6
6 Department of Community Health Nursing, Faculty of Nursing, Assiut University, Egypt.
7
7 Department of Community Health Nursing, Sabia University College, Jazan University, Kingdom of Saudi Arabia.
8
8 Department of Medical Biochemistry, School of Medicine, Taif University, Taif, Kingdom of Saudi Arabia.
9
9 Director of Training and Scholarship Administration, MOH, Gizan, Kingdom of Saudi Arabia.


Authors:
Zahran, K.M.a,  Mostafa, W.A.b,  Abbas, A.M.aEmail Author,  Khalifa, M.A.a,  Sayed, G.H.a

Date of Publishing:
Volume 23, Issue 3, September 2018, Pages 173-177

Title:
Clomiphene citrate plus cabergoline versus clomiphene citrate for induction of ovulation in infertile euprolactinemic patients with polycystic ovary syndrome: A randomized clinical trial

Abstract:
Objective: To compare the effect of adjunctive use of cabergoline with clomiphene citrate (CC) in infertile polycystic ovarian syndrome (PCOS) patients with normal prolactin level. Study design: A randomized clinical trial (NCT 02644304). Setting: Assiut University Hospital, Assiut, Egypt. Materials and methods: Infertile euprolactinemic PCOS patient were recruited and randomized in a 1:1 ratio to CC plus cabergoline or CC alone. All patients were evaluated by ultrasound examination for number, size of ovarian follicles and they were followed up for 3 consecutive cycles. The primary outcome of the study was the cumulative rate of ovulation in both groups allover the 3 cycles of treatment. The secondary outcomes included clinical pregnancy rate, miscarriage rate, multiple pregnancy rate, ovarian hyperstimulation rate and the rate of adverse effects of the study medications. Results: One-hundred thirty patients were included (65 in each group). No statistical difference between both groups regarding the basal criteria. The cumulative ovulation rate in the CC plus cabergoline group was 76.7% versus 58.3% in the CC group (p =.032). Additionally, the largest follicle size in each cycle was significantly more in the CC plus cabergoline group (p <.05). Patients in the CC plus cabergoline group had a higher clinical pregnancy rate reaching 31.7% versus only 13.3% in patients of the CC group (p =.004). No difference between both groups as regard the miscarriage rate (p =.74), multiple pregnancy rate (p =.83), ovarian hyperstimulation rate (p =.62) and the rate of adverse effects of the study medications. Conclusions: The use of cabergoline with CC in induction of ovulation in euprolactinemic infertile women with PCOS results in high ovulation rate, high pregnancy rate as compared to use of CC alone. © 2017 Middle East Fertility Society

Author Info:
Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
bDepartment of Obstetrics & Gynecology, Dairut Central Hospital, Assiut, Egypt


Title:
Comments on Manuscript: Intrauterine Inflated Foley's Catheter Balloon in the Management of Abnormally Invasive Placenta Previa: A Case-Control Study

Author Info:
1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Women Health Hospital, Assiut, 71511 Egypt.


Authors:
Eisa A1, Farouk O2, Mahran DG3, Badran M2, Abdelnasser MK2, Samir M2, Kalampoki V4, Hurtado-Chong A4, Rometsch E4, Mohamedean A2, Adam F2

Title:
Predictors of mortality after pelvic fractures: a retrospective cohort study from a level one trauma centre in Upper Egypt

Abstract:
PURPOSE:
The primary objective was to identify the predictors of in-hospital mortality after pelvic ring injuries. Secondary objectives were to analyze the differences between adults and children and to analyze the causes and timing of death.

METHODS:
A retrospective cohort study from the pelvic registry of Assiut University Trauma Unit (AUTU), a level 1 trauma centre in Upper Egypt, was carried out. A total of 1188 consecutive patients with pelvic ring fractures treated from January 2010 to December 2013 were eligible for analysis. Potential predictors were identified using standard statistical tests: univariable and multivariable regression analysis.

RESULTS:
Nine hundred fifty-one were adults (above 16 years) and 237 were children. According to Tile's classification, fractures type A, B, and C were 31.8%, 25.1%, and 43.1%, respectively. About a third of patients had fractures with soft tissue injury. Abdominopelvic collection as diagnosed by Focused Assessment with Sonography for Trauma (FAST) was positive in 11%. Associated injuries were present in 67.3% with abdominal-urogenital injuries being the most prevalent (66.3%). Median hospital stay was five days. Fifty-two patients (4.4%) were admitted to the ICU. One hundred three patients died (8.7%) within two peaks: first 24 hours and between 48 hours and one week. Multivariable logistic regression analysis identified increasing age, fractures with soft tissue injury, associated head injury, positive FAST examination, and admission to an ICU as significant predictors of in-hospital mortality.

CONCLUSIONS:
The first 24 hours were confirmed to be critical for survival in pelvic fracture patients. Advancing age, associated soft tissue injury, associated head injury, admission to ICU, and positive FAST examination can serve as reliable predictors for an elevated mortality risk in such patients.

Author Info:
1
Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, 71526, Egypt. amr.eisa@aun.edu.eg.
2
Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, 71526, Egypt.
3
Faculty of Medicine, Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt.
4
AO Clinical Investigation and Documentation (AOCID), AO Foundation, Dübendorf, Switzerland.


